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Home My WebLink About01-0780 Estate of . IE V' Yh 4 I. also known as PETITION FOR PROBATE and GRANT OF LETTERS Y}' ;. j, tJ l.s () )--,. No. ~ J -01- 0 '7 g 0 To: Register of Wills for the , Deceased. County of in the Social Security No. Lf ~ 'f - Lf~ - q '8) 1 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an tb,e execut in the last will of the above decedent, dated g - 7 ~ ~ and codicil(s) dated n?d ,19~ (state relevant circnmstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in C u.. h ~ Y""' last family or principal residence at /' Co..VY'I'f Nil! I ()yt r7()) \ i"u)e'l' (list street, number and muncipality) Decen ent, then at Except as follows, ecedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: ,...) / . ~ c- Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: ~- /0 , tJ) .26 tJ I ' $ .L.j 7., ()-'CJCJ $ $ $ 1JO'>l\~ WHEREFORE, petitioner(s) respectfully presented herewith and the grant of letters theron. ~ '" '<r u c ., -o~ .- '" "'~ .,... ~., C -00 co;::: tV "':: ~., ~p.. .,... 50 ~ c 00 Vi ~{).liJ.htJ UJ.~ Yd-~tL7;"(j", ~7"1~ OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PEl'iNSYLV{\NIA } ss COUNTY OF ~~L\.IYI[~t-j-< LJ~V . The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer t e est according to law. '\ affir a)ld subscribed ..) ..- of ...~; I ,j en 1iQ' ::s l:l ... s::: ~ ~ '" t'7-2-.[) Estate of No. -1J -01- Ol]g{) 121\ m A- r, N l LJto L\S{) f\.( , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW k1Ab. 1- 2- ~ 2.JJD, In consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated 8 - ~ <:tc] 5--- described therein be)ldmitted to probate an filed of record as the last will of ./' I' (, ,'" .. . /1- and Letters /..s.. fI / \ are hereby granted to 1) U. (r1\I E A, N l Ci-tD L0U~ g~ ',~ Probate, Letters, Etc. ......... $~ Short CertificateS,(~)) ^.. .. . .... $~ .. ..... U(/J..' !j oD I, WIt.. -:"1V .~.... S r, i:, ,', ~~$ W.IJQ._ TOTAL _ sJ.i2!d..LD) FEES ATIORNEY (Sup. Ct. 1.0. No.) ADDRESS Filed .................................. . PHONE ~ ryc~ L~ It !?IJ1lLftK. WARNING: IT IS II.LEGAL TO ALTER THIS COpy OR "1"0 DUPLlCJlnE BY PHOTOSTAT OR PHOTOGRAPH. , a, II ,'Ih lIE 1111: 'vi N Uf f N'!;\ r ,II" \l JI'; l ]: '. 'El:d~ F:AF ;E HIe' I (1"1 (iF DFt\TH CERT. NO. T 4 9 4 E; 0 14 "" i'~'\ ~Oi.: ~~~, , ~~ ': ., . ~) J . ~.:f' j"'~ i'~ ~!~ ~. ',. '~,.~-:~ '.' ~ [""... "..aa- t~:>~ J~'~.,: : ,; ~': /;! ,. 1 ' ;~~~: ~t -___--.1!.~~6 - 2J2.Q~ Date of Issue of This Certifi ::ation Name of Decedent __.~~lJlq ri'" I. ______~c h 0 Iso n l_ij'';! Sex____.f_~_~a_l_~._ _ Social Secu:ity No" 444-48-9817 _M.M._ Date of Death 8-10-2001 D ate of B I rth.J..<!./'l_ ....l.?.1...!JlR_. B i rt h p I ace_____ _ .Taj-n.tQJ:'.L..lQY!iL_.__. Place of Death I:Lo 1 Y___~J) iIJ._L H_~~_p_ i ~___._C_lJ fIl1?~}::J3!rlc.! .______ , ,,'il", :"j,H' Or\' BCr()IJrJ~1 0' T~~\\'r:~;lllp R ace_ .__l-V tl~_t;_e.._u_ Occu pa ti on___H~I'!l~fI1_C!'5.~I'__ D(,cedent's Mantal Status Widow _ .._ Mailing Address _~?1 'J,."-:I"', Armed Forces? (Yes or No) No bi.~QlJJ:'D. _fio a d____.n~__ .______G. amp ---.tI i ll_ ~!t'",1 l~;' r O'f~'1 PA 17011 State Informant ____Q.ua_':1._~_N~~J"1g~son_._.__._~__ Funeral Director __.!l_~l..l.9J~IJ..Q.Yer .. Name and Address of Funer'al Establishment _ .~.Q Y ~.!'.._f_lI.!ll:l.!'~.LHo 1TI.l:lJ.. 2 ~9__N.u J-IJ.9llSt . . Pait I Immediate Cause Duncannol'L.. PA 17020 Interval Eletween I Onset and Death (a)~ Cardiac arrest (0) (c) .--_.-.---~-~__---1 I Part II: (d) ~u_ ..-.___. -.-..-~_._.__M__~_.__ Other Significant Conditions - .__..~--.------- - -_._-_.__._--'-~._-~-~~---~~-~----,---_._--------- _.L. Manner of Death Describe how injury occurred: Natural Accident x:x Homicide Peqdlng Investigation Could not be Determined Suicide Name and Title of Certtier --"._-_.._._--~.~---~--~-----_.._.._._----------~--,-- Robert D. Kusetos M.D. (M.D., D.O., Coroner, M.E.) --- ----_._--_._--_._---~---------_._._---_.- ----. ._._---_.-._~--------~_._~--_._--_..- 207 House Ave., Camp Hill, PA 17011 Address This is 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 filin..~. · L4m~.-J 50-455 Ck.m:1 No 8 -16 - 2 0 0 1 !Q~M.B~ r 1'1~_t;!.. . S ~.:..~. __N e w ~.1 0 0 m f i~!~~..8~ 068 ('I'Y_ 80r,)II]I1. ]O\vnsl'lp " ,. .. , , . J .Jr y 1liast ~ i 11 an~ W.estam.ent OF ERMA I. NICHOLSON My name is ERMA I. NICHOLSON and I am a married woman, residing at 824 LISBURN ROAD, APT. #502, CAMP HILL PA 17011, CUMBERLAND COUNTY. My husband's name is CARL A. NICHOLSON, and I am MOTHER of TWO children named DUANE A. NICHOLSON AND JANET E. WILSON. Though I realize the uncertainty ofthis life, and with full confidence and trust in our Lord and Savior, Jesus Christ, in His death for my sins on the cross and in His shed blood as an atonement for my soul, and knowing that by faith in His sacrifice on the cross for me I have eternal life. I declare that I am of sound mind and disposing memory, full legal age, that I am not acting under duress, menace, fraud, restraint or undue influence of any person whomsoever, I hereby make, publish and declare this instrument to be my Last \Mil and Testament hereby revoking and canceling all former \Mils and Codicils made by me. Where a gift, bequest or devise is expressed as a percentage in the following Articles, it refers to the percentage of that portion of my gross estate available for distribution unless a contrary intention appears in the Article. Priority for distribution of the gifts and bequests herein made shall follow the Article number with the lower numbered Article taking priority over any Article appearing subsequently unless a contrary intention appears in the Article. This Will is not made as a result of any contract or agreement either expressed or implied which would in any way restrict the Testator's right and power to revoke any or all provisions of this \Mil. If any provision of this \Mil shall be declared inoperative or in violation of any rule of law, such invalidity shall not affect the remaining provisions of this \Mil and they shall remain in full force and effect. ARTICLE I I direct my Executor or Executrix to pay all of my just debts except encumbrances on real or personal property. When such encumbered property exists it shall pass under the terms and conditions of this \Mil subject to said encumbrances, provided however, that any arrearage or past due installments on either principal or interest on such encumbrance may be paid by the Executor or Executrix in his or her discretion. I direct my Executor or Executrix to pay the expense of my last illness and the cost of a Christian Funeral and burial, head stone or marker all as may be requested by my next of kin. I further direct that all inheritance, transfer, succession, estate and other such taxes or assessments levied against my estate together with all probate cost and administrative expense, shall be paid out of my general estate and not levied against any particular beneficiary. ARTICLE II I give and bequeath all items of tangible personal property used for personal reasons, excluding all gain seeking items or personal property, any including household, affects, clothing, jewelry, furniture, china, musical instruments, books, pictures and automobiles as follows: VVith full knowledge of my beloved husband, Carl A. Nicholson, whom I love dearly, I give and bequeath 100% all the above mentioned described items to my surviving children. The estate is to be -' .. , The Will of ERMA NICHOLSON Pace # -2- divided between my surviving children into equal shares with one share given to each child who survives me, plus one share for each of my children who have predeceased me if the deceased child is survived by one or more lineal descendants who survive me. Said lineal decendants shall take their deceased parent's share by right of representation, share and share alike. ARTICLE '" If any person shall be required to survive me or another person in order to take any interest under this Will, such person shall be deemed not to have survived if such person shall die as a result of a common disaster or under circumstances rendering it impossible to determine the survivor or where there is not sufficient evidence to determine that such person survived, except as to my husband and in order for his to take any bequest provided for him in this will she must survive me by sixty days. ARTICLE IV I hereby nominate and appoint DUANE A. NICHOLSON, as my EXECUTOR hereunder and direct that my EXECUTOR shall serve without surety or bond. In the event that DUANE A. NICHOLSON shall predecease me, or shall be unable to serve for any reason, I nominate and appoint JANET E. 'MLSON, as my exECUTRIX hereunder and direct that EXECUTRIX shall serve without surety or bond. IN 'MTNESS WHEREOF, I, the said Testatrix, hereby declare this instrument to be my Last Will and Testament and have signed my name on this ~ day of A~u.s-t ,19 q5 . t~~,~ >t-. 'd~L~^ estatrix The foregoing instrument, consisting of -L pages, was signed and declared by the testatrix to be her Last Will and Testament, in the presence of each of us, who in the presence of each other, have signed our names as witnesses; and we declare that at the time of the execution of this instrument the testatrix, according to our best knowledge and belief was of sound mind and under no constraint or undue influence. NameGd..fAL~LJ 111 rJ-tt)e- ~ Address: .1 ~ __J) t w-t. ,Iii-. .:!!}j)jJ..AuUf!A-hur I 'JOS5 (J1l N.me:QLK~ Address: ~J ~ !r \A,h -I-e \ 5/ jJ-e\AJ (~"N)hfO\{uI\J 8ii.I070 .' . J;.-# .. AFFIDAVIT STATE OF PellrlsyIVCU\I'{t I COUNTY OF C LU~LXVI(U'\cL 55. Before me, this undersigned, an officer authorize to administrate oaths, on this day appeared frmLL I. N ,chd::c:n (Testator) to me known to be the Testator and the Witnesses whose names are herein after subscribed as witnesses and who appeared together before me and after being duly sworn upon their oath declared that they signed the annexed or foregoing Last Will and Testament as Testator and Witnesses respectively. I certify that the Testator declared to me, and to the Witnesses in my presence, that said instrument is his LAST WILL AND TESTAMENT and that he had willingly made and executed it as his free and voluntary act and deed for the purpose therin expressed, and the said Witnesses, each on their oath stated to me, in the presence and hearing of the Testator, and in the presence and hearing of each other, that said Testator had declared to thism that said instrument is this Testator's LAST WILL AND TESTAMENT and that he executed the same as such and requested each of them to sign the said instrument as Witnesses, in this presence of and at this request of this Testator and in this presence of each other Witness. Each Witness states upon their oath that they saw the Testator sign the instrument; That they saw each othis Witness sign this instrument; That at the time the Testator signed the instrument he was of full age and sound mind and memory; That they make this affidavit at this request ofthis Testator. e ~/ru/V ,<-1. ~'c~~o--l~n/ Testator ('l~LuJ .}1zILtUZ-. Witness (Jj7r7?~~~~ Witness Subscribed, sworn and acknowledge before me by this said t=rl11Cl I. t'./lci1{ji~Dn Testator and subscribed, sworn and acknowledged before me by this Witnesses whose names and signatures appear~boveCls Witness~ . _. '7R IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal this day of ,,-i (.{~I>t , 1995 . (seaQ ~"~P<-'~ Notary Public. ! NOTARIAL SEAL DONNA J. BAER, Notary Public Camp Hill Boro, Cumberland County M Commission Ex ires Ma 18. 1998 - e: --- CERTIFICATION OF NOTICE UNDER RULE 5.6(a} NAME OF DECEDENT: DATE OF DEATH: WILL NO.: Erma I. Nicholson Aueust 10. 2001 2001-00780 ADMIN. NO.: 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 September 17, 2001: Name Address Duane A. Nicholson. 33 Tannerv Road. Dillsbur2:. PA 17109 Janet E. Wilson. 1827 20th Street. Woodward. OK 73801 Tara Nicholson. 2902 Bel Aire. Hutchinson. KS 67501 Kira GU2:ler. 1993 Union Road. Chaoman. KS 67431 Jeri Melin. 942 Whioooorwill Road. Derbv. KS 67037 Lori Brunholtz. 9105 N. 130th East Avenue. Owasso. OK 74055 Date: September 17, 2001 Notice has been given to all persons entitled thereto under Rule 5.6(a) except NONE (U~~. -4: -..:-p..-. ~ ~ Signature Name Earl Richard Etzweiler. Esquire Address 105 N. Front Street Harrisburg:. PA 17101 Telephone (717) 234-5600 X Counsel for Personal Representative r -- CERTIFICATION OF NOTICE UNDER RULE 5.6(a) NAME OF DECEDENT: DATE OF DEATH: WILL NO.: Erma I. Nicholson Aueust 10. 2001 2001-00780 ADMIN. NO.: 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 September 17, 2001: Name Address Duane A. Nicholson. 33 Tannery Road. Dillsbur~. PA 17109 Janet E. Wilson. 1827 20th Street. Woodward. OK 73801 Tara Nicholson. 2902 Bel Aire. Hutchinson. KS 67501 Kira GUl!ler. 1993 Union Road. ChaDman. KS 67431 Jeri Melin. 942 WhiPDoorwill Road. Derbv. KS 67037 Lori Brunholtz. 9105 N. 130th East Avenue. Owasso. OK 74055 Date: September 17, 2001 Notice has been given to all persons entitled thereto under Rule 5.6(a) except NONE Ie/; i?k~ . Q ""('L-<-Y [, Ib-_. . . . - ~9--.- ) '- Signature Name Earl Richard Etzweiler. Esquire Address 105 N. Front Street Harrisburg. PA 17101 Telephone (717) 234-5600 X Counsel for Personal Representative Earl Richard Etzweiler Christian s. Daghir ETZWEILER AND ASSOCIATES ATTORNEYS-AT-LAW 105 NORTH FRONT STREET HARRISBURG, PA 17101 (717) 234-5600 HALIFAX LINE (717) 896-3737 Fax Line: (717) 234-5610 November 2,2001 2 West Main Street Elizabethville, P A 17023 (717) 362-8395 225 Market Street Millersburg, P A 17061 (717) 692-2519 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 RE: ESTATE OF ERMA I. NICHOLSON FILE NO. 2001-00780 Dear Sir or Madam: Please find enclosed for filing the following: 1. The original and one copy of the Inheritance Tax Return wi extra cover page; 2. The original and one copy of the Inventory wlextra cover page; 3. A check in the amount of$I,813.73, payable to the Register of Wills, Agent; 4. A check in the amount of$25.00. Please process the enclosed documents and kindly return time-stamp and return the extra cover pages to our office for processing in the self-addressed, stamped envelope provided. Since:o - i ~/~ Earl Richard Etzweiler ERE:haf Enclosure ./ 7 - ~ -s- REV-1500 EX + (6-00) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY o E C E o E N T COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Nicholson Erma I. DATE OF DEATH (MM-DD-YEAR) FILE NUMBER ,;}, 01 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 444-48-9817 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE '7go NUMBER C P o 0 R N R 0 E E S N T C o M P T U A T X A T I o N REGISTER OF WILLS SOCIAL SECURITY NUMBER 1. Original Return 4. Limited Estate 6. Decedent Died Testate 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach copy of Trust) D 10. Spousal Poverty Credit D (date of death between 12-31-91 and 1-1-95) 3 date of death . Remainder Return prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch 0) 105 North Front Street Harrisburg, PA 17101 Copyright (c) 2000 form software only The Lackner Group, Inc. NAME Earl Richard Etzweiler FIRM NAME (If Applicable) Etzweiler and Associates TELEPHONE NUMBER COMPLETE MAILING ADDRESS R E C A P I T U L A T I o N 234- 6 0 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) None None None OFFICIAL. USE ONL. Y (1) (2) (3) (4) (5) None 48,605.15 None None (8) 48,605.15 (11) 6.178.67 (12) 42,426.48 (13) (14) 42,426.48 (15) (16) (17) (18) (19) 0.00 1,909.19 0.00 0.00 1,909.19 (6) 5,190.11 988.56 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. 0.00 42,426.48 0.00 0.00 x X X X .0 0 .0 45 .12 .15 Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 824 Lisburn Road CITY I STATE I ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 1,909.19 1,813 .73 95.46 Total Credits ( A + 8 + C) (2) 1,909.19 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (S) A. Enter the interest on the tax due. (SA) B. Enter the total of Line S + SA. This is the BALANCE DUE. (SB) Make Check Payable to: REGISTER. OF WILLS, AGENT 0.00 0.00 0.00 0.00 0.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN ,jx" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; . . . . . . . . . . . . . ~ ~~x 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . " D [B 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . D [B 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D [B 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 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 complete. Declaration of pre parer other than the personal representative is based on all information of which preparer has any knowledge. TURE OF PERSON RESPONSIBLE FOR FiLING RETURN Duane A. Nicholson _ _ _~~ _ rc:~~~_r.:Y _ ~_~~~_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ Di11sbur , PA 17019 Etzwei1er and Associates 105 North Front Street ----------------------------------------------------- Harrisbur , PA 17101 DATE /0/:11/0/ DATE For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 9116 (a) (1.1) (il). For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [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%, 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% [72 P.S. 9116(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. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1 SOO EX (Rev. 6-00) 1finst ~ i 11 nnb W.estnm.ent OF ERMA I. NICHOLSON My name is ERMA I. NICHOLSON and I am a marriea woman, residing at 824 L1SBURN ROAD, APT. #502, CAMP HILL PA 17011, CUMBERLAND COUNTY. My husband's name is CARL A. NICHOLSON, and I am MOTHER of TWO children named DUANE A. NICHOLSON AND JANET E. WILSON. Though I realize the uncertainty ofthis life, and with full confidence and trust in our Lord and Savior, Jesus Christ, in His death for my sins on the cross and in His shed blood as an atonement for my soul, and knowing that by faith in His sacrifice on the cross for me I have eternal life. I declare that I am of sound mind and disposing memory, full legal age, that I am not acting under duress, menace, fraud, restraint or undue influence of any person whomsoever, I hereby make, publish and declare this instrument to be my Last Will and Testament hereby revoking and canceling all former Wills and Codicils made by me. VVhere a gift I bequest or devise is expressed as a percentage in the following Articles, it refers to the percentage of that portion of my gross estate available for distribution unless a contrary intention appears in the Article. Priority for distribution of the gifts and bequests herein made shall follow the Article number with the lower numbered Article taking priority over any Article appearing subsequently unless a contrary intention appears in the Article. This Will is not made as a result of any contract or agreement either expressed or implied which would in any way restrict the Testator's right and power to revoke any or all provisions of this Will. If any provision of this VViIl shall be declared inoperative or in violation of any rule of law, such invalidity shall not affect the remaining provisions of this Will and they shall remain in full force and effect. ARTICLE I I direct my Executor or Executrix to pay all of my just debts except encumbrances on real or personal property. VVhen such encumbered property exists it shall pass under the terms and conditions of this Will subject to said encumbrances, provided however, that any arrearage or past due installments on either principal or interest on such encumbrance may be paid by the Executor or Executrix in his or her discretion. I direct my Executor or Executrix to pay the expense of my last illness and the cost of a Christian Funeral and burial, head stone or marker all as may be requested by my next of kin. I further direct that all inheritance, transfer, succession, estate and other such taxes or assessments levied against my estate together with all probate cost and administrative expense, shall be paid out of my general estate and not levied against any particular beneficiary. ARTICLE II I give and bequeath all items of tangible personal property used for personal reasons, excluding all gain seeking items or personal property, any including household, affects, clothing, jewelry, furniture, china, musical instruments, books, pictures and automobiles as follows: With full knowledge of my beloved husband, Carl A. Nicholson, whom I love dearly, I give and bequeath 100% all the above mentioned described items to my surviving children. The estate is to be .r -- The Will of ERMA NICHOLSON Paae # -2- divided between my surviving children into equal shares with one share given to each child who survives me, plus one share for each of my children who have predeceased me if the deceased child is survived by one or more lineal descendants who survive me. Said lineal decendants shall take their deceased parent's share by right of representation, share and share alike. ARTICLE III If any person shall be required to survive me or another person in order to take any interest under this Will, such person shall be deemed not to have survived if such person shall die as a result of a common disaster or under circumstances rendering it impossible to determine the survivor or where there is not sufficient evidence to determine that such person survived, except as to my husband and in order for his to take any bequest provided for him in this will she must survive me by sixty days. ARTICLE IV I hereby nominate and appoint DUANE A. NICHOLSON, as my EXECUTOR hereunder and direct that my EXECUTOR shall serve without surety or bond. In the event that DUANE A. NICHOLSON shall predecease me, or shall be unable to serve for any reason, I nominate and appoint JANET E. WILSON, as my EXECUTRIX hereunder and direct that EXECUTRIX shall serve without surety or bond. IN WITNESS WHEREOF, I. the said Testatrix, hereby declare this. instrument to be my Last Will and Testament and have signed my name on this !1!:!:.... day of ,q(.,~ust ,19 qS . -f,k>nfiJl >t;d'c-i.~, Testatrix The foregoing instrument, consisting of -L pages, was signed and declared by the testatrix to be her Last Will and Testament, in the presence of each of us, who in the presence of each other, have signed our names as witnesses; and we declare that at the time of the execution of this instrument the testatrix, according to our best knowledge and belief was of sound mind and under no constraint or undue influence. Name(:JaD'cc~UL; 111 LLt(J(_ ~ Address: >- '1 ,) 'A S (~ ~v.t. .f< fL. /!rIJ)!)L/L1U<!.Al tv[ ( vr (J4 / '705/5 ()J1 ~~ Name: _ L,..-n J .' ." .~ J Address: 1.-/ ~) (~ 'vvh -~-e (' d, ~ 't 'AI' (~YVl h N,- (t'i n j p,l ( ({""7(-) AFFIDA VIT STATE OF PennSY/'vL\f\\';t I CO U N TY 0 F C \A. \ 1'"\ 1:::t:Ylcu,\[( SS. Before me, this undersigned, an officer authorize to administrate oaths, on this day appeared fr-rnLL .I. tV t'e hc....+5L'fl (Testator) to me known to be the Testator and the Witnesses whose names are herein after subscribed as witnesses and who appeared together before me and after being duly sworn upon their oath declared that they signed the annexed or foregoing Last Will and Testament as Testator and Witnesses respectively. I certify that the Testator declared to me, and to the VVitnesses in my presence, that said instrument is his LAST WILL AND TESTAMENT and that he had willingly made and executed it as his free and voluntary act and deed for the purpose therin expressed, and the said Witnesses, each on their oath stated to me, in the presence and hearing of the Testator, and in the presence and hearing of each other, that said Testator had declared to thism that said instrument is this Testator's LAST WILL AND TESTAMENT and that he executed the same as such and requested each of them to sign the said instrument as Witnesses, in this presence of and at this request of this Testator and in this presence of each other Witness. Each Witness states upon their oath that they saw the Testator sign the instrument; That they saw each othis Witness sign this instrument; That at the time the Testator signed the instrument he was of full age and sound mind and memory; That they make this affidavit at this request of this Testator. ,jc. / '-T7' ;/ I it" /{ J"y!.- fr/' -----I 7' /t.'--'I2.,t"'--C~ (!-}'z-. ' Testator /)i / "-. 17[[~LLLA.J 'Pi!L Z f!.-j~ Witness ./\, / ~ I /' ,;' ,.- r1! I" ,//, k{" ',,'~ ~/f/ L-:-::'T--i;,-Y ----r--. :---\. ,(. -- Witness v Subscribed, sworn and acknowledge before me by this said ~rlll;\.. I ,1\ C.i':.;/'-{'r J Testator and subscribed, sworn and acknowledged before me by this Witnesses whose names and signatures appear.above ~s Witnesses:- . - 1R IN WITNESS WHEREOF, I have ltereunto subscribed my name and affixed my official seal this day of \ --1l...lCK< s.-t , 19 ~./5 . .J - (sea~ ~ "-- i'-.'_ '\ ,YI~~ L/ Notary Public ! / / NOTARIAL SEAL DONNA J BAER, Notary Pubiic Camp Hill Bora. Cumberland County M Commission Ex ires Ma 18, 1998 REV-1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Erma I. Nicholson SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER SSII 444-48-9817 08/10/2001 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 I DESCRIPTION Penn-Del Loan Fund - balance of account after liquidation of eleven separate notes. VALUE AT DATE OF DEATH 40,750.03 2 Waypoint Bank - checking account no. 400017949. 2,355.12 3 1994 Ford Taurus - sold at private sale 5,500.00 TOTAL (Also enter on line 5, Recapitulation) $ 48,605.15 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) 4651 Westport Drive · Mechanicsburg, PA 17055 Telephone: 717/795-5921 · Fax: 717/795-5928 An Investment That WOrks E-mail: pddcag@aol.com September 20, 2001 Etzweiler And Associates Attorneys-At-Law Attn: Mr. Earl Richard Etzweiler 105 N. Front Street Harrisburg, P A 171 0 1 Re: Estate of Erma 1. Nicholson S.S.N.444-48-9817 Date of Death: August 10,2001 Dear Mr. Etzweiler: Enclosed is a check in the amount of $40,750.03 for the redemption in full of all unsecured promissory notes under sole ownership of the above named deceased at the date of her death. The following table displays the information your requested for each note: Note # Date Opened Int. Earned Principal Bal. Accrued Maturity Date Calendar Year As of Date of Interest from up to Date of Death Date of Death Death to 09/20/01 0415 07/15/86 $325.27 $6,996.71 $61.31 07/15/02 0545 01/12/87 $155.75 $3,685.98 $29.32 01/12/03 0926 10/07/88 $122.63 $2,795.99 $23.12 10/07/04 1308 07/10/90 $130.18 $2,800.56 $24.55 07/10/02 1310 07/10/90 $130.18 $2,800.56 $24.55 07/10/02 2993 06/08/94 $236.19 $5,164.26 $44.40 06/08/02 2995 06/08/94 $94.4 7 $2,000.00 $17.77 06/08/02 2996 06/08/94 $94.47 $2,000.00 $17.77 06/08/02 2997 06/08/94 $94.47 $2,000.00 $17.77 06/08/02 2998 06/08/94 $94.47 $2,000.00 $17.77 06/08/02 4615 09/08/98 $182.97 $4,000.00 $34.38 09/08/02 u Pennsylvania-Delaware District Council of the Assemblies of God Please be advised that no joint ownership existed for any of the above-referenced notes within one year of death of decedent. Please don't hesitate to contact me if you have any questions concerning this redemption. Z/lIc Michael Bongiorno Executive Director Enclosure ~IWay~qi!1J LOOK FOR US. WE'LL GET YOU THERE. 09/19/2001 ETZWEILER & ASSOCIATES 105 N FRONT ST HARRlSBURG PA 17101 The information which you requested on the account(s) of ERMA NICHOLSON ESTATE (Social Security Number 444-48-9817) is/are as follows: Account Number 400017949 CHECKING 03/07/00 2355.06 .06 2355,12 Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership SOLE Name of Joint Owner, if any Date Ownership Was Established Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established Additional Information Requested PLEASE COMPLETE W-9 Sinl0~ ~ 2Jn1117c. KA TH"VYouN6- SENIOR SERVICES REP. P.O, Box 1711. HARRISBURG. PENNSYLVANIA 17105-1711 Toll Free 1-866-WAYPOINT (1-866-929-7646) . www.waypointbank.com REV-1511 EX +(1-97) COMMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Erma I. Nicholson Debts of decedent must be reported on Schedule I. ITEM NUMBER A. B. FILE NUMBER SS1! 444-48- 9817 08/10/2001 DESCRIPTION AMOUNT FUNERAL EXPENSES: 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Duane A. Nicholson Social Security Number(s) I EIN Number of Personal Representative(s) Street Address 33 Tannery Road City Dillsburg State PA Zip 17019 2,430.26 Year(s) Commission Paid: 2. 3. Attorney's Fees Etzwei1er and Associates Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 2,430.26 City Relationship of Claimant to Decedent State Zip 4. Register of Wills 109.00 Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs Cumberland Law Journal - advertise Letters Testamentary 75.00 2 Etzwei1er and Associates - notary fee, postage and photocopies. 30.00 3 The Sentinel - advertise Letters Testamentary 90.59 4 Cumberland County Register of Wills - file estate papers 25.00 TOTAL (Also enter on line 9, Recapitulation) $ 5,190.11 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) REV-1512 EX +(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Erma I. Nicholson SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS FILE NUMBER 8811 444-48-9817 08/10/2001 Include unreimbursed medical expenses. ITEM NUMBER 1 DESCRIPTION Mellon Bank - balance due on Mastercard Account AMOUNT 201.84 2 The Woods - balance due for services rendered. 750.00 3 Verizon - balance due phone service 11.72 4 Waypoint Bank - delinquent balance due for safe deposit box. (now closed) 25.00 TOTAL (Also enter on line 10, Recapitulation) $ 988.56 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) @ Mellon Bank 0100 010827 Page 1 of 2 SAD 6 7 18 5414 0003 8456 1490 OlAD5414 10972 " ~ \} '. "~I 'V' P . . \ T''-' \ ~ I, $229,88 $30,00 $0.00 $1.96 $0.00 $201.84 Account Statement Statement Date Account number New balance Past due amount m;:~~~:;;;~r;:t~t:~~,~ Page 1 of 2 08/27/01 5491 4920 1123 2935 $201.84 $0.00 $15.00 ...'............,...)........;.09]21/01..) Account Summary Previous balance Payments and credits Purchases and advances FINANCE CHARGE Debit adjustments New balance Credit limit Available credit Days in billing period $9,500 $9,298 32 For customer service or to report a lost or stolen card, call toll.free: 8n-888-5132 Send payments to: P.O. BOX 8034 SOUTH HACKENSACK,NJ 07606-&034 'il [81 @ Mellon Bank MASTERCARD@ _ TransactioIlS<i:!;:~::;)::::::-" .......:';-:::::;<;:::::;:<<:/::i;:i:i;~ii::i:<::i:/:::':".;,," Trans Post Reference Number Description . -.. . ..... ,., . -. . .-_.-......-.....-..-......-.-... .__......._.....m.'.._....._... ...,..".-................ ..........-......... . ...--....-........ Amount .... \ I .. .. 08106 08106 30.00- 1.96 85256076S0162DL5X 'FINANCE CHARGE' -PAYMENT-THANK YOU- WILMINGTON DE PURCHASES $1.96 CASH ADVANCE $0.00 An amount followed by a minus (-) is a credit or credit balance. fii ....... Average Daily Annual Daily Periodic Nominal Percentage Transaction Finance Balance Rate APR Rate (APR) Fees Charqe Purchases 210.22 .02917"10 10.65% 10.65% 0.00 1.96 I Cash 0,00 .04013% 14.65% 0.00 0.00 CardmemberNews.............. ..;...;...,.;,...".;....,....','.',.,. ';".,.' PAY YOUR CREDIT CARD BILL ONLINE. ENROLLMENT IS EASY",AND FREEl SIMPLY GO TO WWW.MYCREDITCARDONLlNE.COMIMELLON/AND ENROLL IN ONLINE ACCOUNT ACCESS, THEN SIGN UP FOR THE ONLINE BILL PAY SERVICE. GIFT CARDS ARE A GREAT IDEA FOR SOMEONE GOING AWAY TO SCHOOL, BIRTHDAYS, WEDDINGS, OR A SPECIAL OCCASION I SEND A GIFT CARD TO SHOW LOVED ONES AND FRIENDS HOW MUCH YOU CARE AND LET THEM SHOP FOR WHATEVER THEY REALLY WANT WHEREVER THEY WANTl TO ORDER CALL 1-Sn-265.GIFT (4438) OR VISIT WWW.PERFECTGIFTIDEA.COM. -- (j~t Luc~-/:) -r!/t!C; j~~~ti70CJ_OO ~ _. ,'dl ~(/tl/JL-C of- fJ*:^'-~ _~~0 - g//v/O/- U~( ~vudJ A'~tU-Lr~~ r-;; #J---~ - - -" - ,-t9. / A -r uO d----.. - ", !J~LU{ < (/lJ (j/crY-ly 7/1t!-O::~ 1A LV c-6~,e{) - ~... veri700 Page 2 of 11 717 975-2583-131 44Y Augus t 22, 2001 This information is required by the Public Utility Commission. "Basic" service includes the line charge, local calling and TOUCH TONE service (if applicable). "Non-Basic" service includes optional services, other than TOUCH TONE, such as Maintenance agreement for inside wire and Guardian and does not include toll services. BASIC Past Due Ba lances $14.46 $9.37 $9.37 Current Charges $-13.11 Totals $1.35 TOLL $.00* NON- BASIC 'I C/ \~~\ $24.83 The following pages provide additional billing details. * (Includes Verizon and other service provider(s) charges.) $1.00 $.00* $1.00 TOTALS $ -13.11 $11.72 lflWaYROlnt BANK Lock for us. W~'!l get you the;,:. RE.[EIPT Hc-ct; ~'~"-.t\t\"\i1 ~, .;,;.,._..._,.-t....'-'~'~'~~ : -i-t* ..' ~ -,,~', , ~'-~'-~.' f .........- .... ,'l .:_ '. '.~ i.. _." a -..,;... ~C..,=..._: .__ i"'\...._.......__......~..J:- :::......._.. ;';'::'~'O ~ -c ~"'-:::>-'..../~..L~. ":./W?-. - , '-c _. '''-'''o.,","'~":," 7" c,":t;rrc-:'! L. ~:::':'.\.:.;' :,:;,,,nf'f~ _ ;. I-r.;. '.)';"'; ::: ." ~-l. ,i';,('\t\ t :';".~ .:.;.-.,,.. ~ - ~,,-\_.. ~ ':. ./ 1. .'1. / ''"':i -.-"-.'-....,. ~ ~" ~--?,l '.;'~"_';/ ~ 11.:12~46 .;2;71 .L-e-Jsc; Ea.} '::/; ,~. ~ Check and other items received for deposit are subject to the provisions of the Uniform Commercial Code. Certain deposits are subject to delays in availability according to Bank policy. TEL-G09 110/001 THIS IS YOUR RECEIPT Member FDIC REV -1513 EX . (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIAR IES ESTATE OF Erma I. Nicholson FILE NUMBER SS1! 444-48-9817 08/10/2001 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS [Include outright spousal distributions, and transfers under Sec. 9116{a)(1.2)] RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE See attached husband, Carl A. Nicholson died 4/3/1992 ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON- TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, Inc. 0.00 Form REV-1513 EX (Rev. 9-00) Schedule J - Beneficiaries Name/Address Relationship SharelInterest Duane A. Nicholson Son 1/3 residue 33 Tannery Road Dillsburg, PA 17109 Janet E. Wilson Daughter 1/3 residue 1827 20th Street Woodward, OK 73801 Tara Nicholson Granddaughter 1/12 residue 2902 Bel Aire Hutchinson, KS 67501 Kira Gugler Granddaughter 1/12 residue 1993 Union Road Chapman, KS 67431 Jeri Melin Granddaughter 1/12 residue 942 Whippoorwill Road Derby, KS 67037 Lori Brunholtz Granddaughter 1/12 residue 9105 N. BOth East A venue Owasso, OK 74055 Register of Wills of CUMBERLAND County, Pennsylvania INVENTORY Estate of Erma I. Nicholson No. 2001-00780 also known as Date of Death 08/10/2001 ,Deceased Social Security No. 444 - 48 - 9817 Duane A. Nicholson, Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I !We verify that the statements made in this Inventory are true and correct. l!We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: Earl Richard Etzweiler Personal Representative S;gMru~ a A.I.Vn< 71 ~ t2f M>-' Duane A. Nichol on I.D. No.: 06398 Signature: Address: 105 North Front Street Address: 33 Tannery Road Harrisburg, PA 17101 Dillsburg, PA 17019 Telephone: 717/234 - 5600 Telephone: 717/502 - 8133 Dated: 10,,31-01 Description Value CASH: Penn-Del Loan Fund - balance of account after liquidation of eleven separate notes. 40,750.03 Waypoint Bank - checking account no. 400017949. 2,355.12 43,105.15 PERSONAL PROPERTY: 1994 Ford Taurus - sold at private sale 5,500.00 5,500.00 (Attach additional sheets if necessary) Total: 48,605.15 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. r '-/..,,~.- ~ ~-~T "'~~ ".~~ 'l'fi .;4' ,"{i.l .."- ii. .'..~. 1( 1<: .... ..-........"'~ ~ ,~< ,', - """'-jCt,fll ~_:~ ~""~ ;~~\.! ,/} ;--,,, ~ ~- ~~~ ;i.:J::' \,1' ..:::..'l (~ ~ (,t.' ..'_~ 1 ~~ ~~ w lw.. l~:-~rZ~'~)~[;i~Bi :j _I _I ~I I 11:1 ..:: U~ U~ <' 1II _I c.~ i I- .' ~) c: ..,. IJ. tJ) uJ !c 0 _ 0 <0 o U:C") 9 U;~ 01# ;:: T"" I tJ)~....O c(.!.~T"" CIS"''' C&,OOT"" Z ~C~ c(c:o - "Ou:E! W!;:..c:.5 ....I....-cn _ 0 .C W Z~ == LOX N 0 .... T"" W ~ " 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 NO. CD 000481 NICHOLSON DUANE A 33 TANNERY ROAD DILLSBURG, PA 17019 ACN ASSESSMENT CONTROL NUMBER AMOUNT -------- fold 101 $1,813.73 ESTATE INFORMATION: SSN: 444-48-981 7 FILE NUMBER: 21-2001- 0780 DECEDENT NAME: NICHOLSON ERMA I DATE OF PAYMENT: 11/05/2001 POSTMARK DATE: 11/02/2001 COUNTY: CUMBERLAND DATE OF DEATH: 08/10/2001 TOTAL AMOUNT PAID: $1,813.73 REMARKS: DUANE A NICKOLSON C/O EARL R ETZEILER ESQUIRE CHECK#? SEAL INITIALS: PB RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS '\. / 7~c2-C COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT~ ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX RecorO-'?of i R -\.. egister BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 12-17-2001 NICHOLSON 08-10-2001 21 01-0780 CUMBERLAND 101 (;e of 'i\iills 'OJ Ole 27 AlO =12 EARL RICHARD ETZWEILER ETZWEILER & ASSOCS Clerk,::' . i 105 N FRONT ST Qllnheri;::/., ','~' . '-,'UUrI HBG PA 17fUl'.....' L_, \AJ.. PA '* REY-1541 EX AFP 112-011 ERMA I Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE~ PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REY=is4i-EX--AFP-fi'2-:o0Y-NOYicE--OF-YNHEifiTAirCE-YA"X-APPRAisEHENT~--ALi-oWANCE-OR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF NICHOLSON ERMA I FILE NO. 21 01-0780 ACN 101 DATE 12-17-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 48.605.15 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 5~190.11 NOTE: To insure proper credit to your account~ subllit the upper portion of this forll with your tax paYllent. 48~605.15 6.178 67 42.426.48 .00 42.426.48 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due CR S: AYMEN DI N (+) DATE INTEREST/PEN PAID (-) PAYMENT MUST BE MADE BY 05-10-2002*. . IF PAID AFTER DATE INDICATED~ SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 988.56 (11) (12) (13) (14) .00 X 00 = .00 42~426.48 X 045 = 1~909.19 .00 X 12 = .00 .00 X 15 = .00 (19)= 1,909.19 AMOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 1.909.19 .00 1~909.19 ( IF TOTAL DUE IS LESS THAN $l~ NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)~ YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) \ 1'7-;;, -0>' BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REV-16D1 EX AFP 112-001 ReCOlOfr:t Reg\stc' of 'NiHs .0] Ole 27 EARL RICHARD ETZWElLER ETZWEILER 8 ASSOCS 105 N FRONT ST Clerk- HBG ~antD~t(Jl(C A10 :07 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 12-17-2001 NICHOLSON 08-10-2001 21 01-0780 CUMBERLAND 101 ERMA I 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 ~ iiE"v=i61fj-ix--AFP--fi'2-:ooY------...-iNHERiTANc'E-TA3CSTA-fE~iE-NT-oF-AccoUNf--...--------------------- ESTATE OF NICHOLSON ERMA I FILE NO.21 01-0780 ACN 101 DATE 12-17-2001 THIS STATE"ENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NA"ED ESTATE. SHOWN BELOW IS A SU""ARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAY"ENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-17-2001 PR I NCI PAL TAX DUE: ........................................................................................................................................................................................................................... 1,909.19 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-02-2001 CDOO0481 95.46 1,813.73 TOTAL TAX CREDIT 1,909.19 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAY"ENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU "AY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. ) ~'-.) <Y"\ b~"--~6 Cc~ STATUS REPORT UNDER RULE 6.12 v' o ~ Name of Decedent: S-r\"<"\...<L- \"' ",-,-h<:J\ 'S. c"", Date of Death: ~- \ a --0 \ Will No. ~<:)<..;;-\ -0(:), c-oo Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate. 1. State whether administration of the estate is complete: Yes ".f!..-- No. 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes_ No. X. b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes~ 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. Dated: L{ -~-D3 ~ Signature - Earl Richard Etzweiler, Esquire 105 North Front Street Harrisburg, P A 1710 1 (717) 234-5600 Capacity: _ Personal Representative X Counsel for personal representative