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Home My WebLink About01-0795 \/ f~EV.1~0(! [;~ i,{JO) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 /?-~ --~ W I- :.:::$(1,1 (,)11:::':: wO-u J:oo (,)II::..J O-lll 0- <( FILE NUMBER 21 01 INHERITANCE TAX RETURN RESIDENT DECEDENT YEAR NUMBER 0795 COUNTY CODE ~ Z W C W (.) W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) DAVIS, L YLA L. SOCIAL SECURITY NUMBER 203-10-2504 DATE OF BIRTH (MM-DD-YEAR) OS/27/20 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER DATE OF DEATH (MM-DD-YEAR) 08/06/01 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) DAVIS, H. ROBERT ~ 1. Original Return D 4. Limited Estate D 6. Decedent Died Testate (Attach copy of Willi D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise idate of death after 12-12-82) D 7. Decedent Maintained a Living Trust (Altach t.opy of Trust) D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) D 3. Remainder Return idate of death prior to 12-13-82) D 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(Aj(Allacl1 Sell 0) I- Z w C Z o 0- (1,1 w II:: II:: o (,) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS PHILIP E. FAGUE P.O. BOX 250, SHIPPENSBURG, PA 17257 FIRM NAME (If Appli.:able) ORRSTOWN BANK TELEPHONE NUMBER (717) 530-2605 (1) (2) (3) (4) (5) 18,993.00 1,211,903.97 0.00 0.00 187,243.27 z o ~ ...J ::) ~ c: <( (.) W 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 Properly (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13 Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) (11) (12) (13) 15,227.00 1,459,211.24 (6) 0.00 (7) 56,298.00 (9) (8) 15,227.00 0.00 1,474,438.24 (10) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 1,459,211.24 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ~ ::) 0.. :lE o (.) >< ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) m~..?.~.!~~5.3.Q_ x .0 Q_._ (15) mmm4?Q,f.I?,~'1: x .0 4? (16) 21,387.42 16. Amount of line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate x12 (17) x .15 (18) (19) 18. Amount of Line 14 taxable at collateral rate 19. Tax Due CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 20.~ Decedent's Complete Address: STREET ADDRESS 508 CREEKVI~W LANE CITY MECHANICS BURG Tax Payments and Credits: 1, Tax Due (Page 1 Line 19) 2, Credits/Payments A. Spousal Poverty Credit 8, Prior Payments C, Discount STATE PA (1) ZIP 17055 21,387.42 204,500.00 1,289.41: Total Credits ( A + 8 + C ) (2) 25,789.47 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) 4,402.05 5, If Line 1 + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE. (5) (SA) (58) A. Enter the interest on the tax due, S, Enter the total of Line 5 + SA. This is the BALANCE 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 transferred;."..""."...""..".""".""."""....".""""..".""""."..""""""". 0 b. retain the right to designate who shall use the property transferred or its income; """"""""""."""""""".""" 0 c. retain a reversionary interest; or...""""".."",,,.,..,...,,.............,,........,,.........,,,,..,,,,..,,...,,,,..,,,,""".........".........." 0 d. receive the promise for life of either payments, benefits or care? .."""""""........"".......""......."........".."........ 0 2. if death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .."..,....""",......."..........".......................".............".".....".,' .................. 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .."......".. 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................. ,,,. ,....."..................""......" ...."."...."."."................. ..,...".,............ ~ No ~ ~ [i] [i] IKl [i] o 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 penatties of pe~ury, I declare that I have examined this retum, inciuding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all infonnation of which preparer has any knowledge. BlE FOR FILING RETURN -i $"e."'\' (I ~ Tru..<J- Df{,'( eI' () rr.; J OW." Bq~ J< DATE 05/06/02 SIGN.~AT)!e~E .P, .SON RESP "-I:::.' E' ., ADDRESS P.O. BOX 250, SHIPPENSB RG, PA 17257 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS DATE For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 PS. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not 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. 39116(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. 39116(1.2) [72 P.S. 39116(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. 39116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. , REV-1502 EX+ (S-9W COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF DAVIS, L YLA L. FILE NUMBER 21-01-0795 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. TOWER ROAD REAL ESTATE, SOUTH MIDDLETON TOWNSHIP: 4 LOTS: TOTAL MKT VALUE $65,000.00 AlLOT # 2; 10 ACRES-DEED BOOK # V-28, PG 793; 1/3 INTEREST BILOT # 3, 16 ACRES-DEED BOOK # V-28, PG 795; 1/3 INTEREST CILOT # 4; 17.41 ACRES-DEED BOOK #J-29, PG 96; 115 INTEREST DILOT # 12; 13.032 ACRES-DEED BOOK #W-28, PG 965; 1/3 INTEREST 3,833.00 6,160.00 4,000.00 5,000.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 18,993.00 REV01503 EX+ (6098* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF DAVIS, L YLA L. FILE NUMBER 21-01-0795 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 DESCRIPTION 1600 shs Abbott Labs, cusip 002824100 @ $51.925 30,000 par Carlisle SID Bond 4.75% due 3/1/08 @ $103.362 + $621.49 acc int. 500 shs Dominion Resources, cusip 25746U109 @ $60.445 2123.278 units Emerald Bank/Finance @ $15.93, cusip 29089R301 30,000 par Gateway SID Bond 5.20% due 7/15/12 @ $103.967 + acc int $91 250 shs Hershey Foods @ $59.445, cusip 427866108 912 shs M&T Bank @ $80.645, cusip 55261F104 499 shs Orrstown Financial Svcs.@ $44.769, cusip 687380105 5700 shs PNC Bank @ $67.055, cusip 693457105 500 shs PPL Resources @ $44.16, cusip 69351T106 800 shs PPG @ $55.25, cusip 693506107 45,000 par PA Housing Finance Agency 4.85% due 10/106, cusip 708792TCO; @ $102.404 + accrued int $ 763.88 50,000 par PA ST Bond 5% due 11/15/03 @ $104.378+ acc int $576.39; cusip 709141AK1 25,000 par PA GO Bond 5% due 10/1/09 @ $105.975 + acc int $440.97; cusip 709141EX9 200 shs Pepsico @ $44.215, cusip 713448108 1600 shs Radio Shack @ $27.10, cusip 750438103 25,000 par Unionville-Chadds Ford SID 5.70% due 6/1/10; cusip 909124EU9; @ $104.836 + $261.25 accrued int. 1504.38 units Vanguard Int'I Growth Fund @ $16.01, cusip 921910204 6762.139 units Vanguard PA TfF Adm Fund @ $11.39, cusip 92204L302 20,000 par West Chester SID Bond 5.40% due 1/15/08, cusip 952030FM1 @ $102.008 + accrued int $63 798.339 units American Hi Inc. Muni Bond Fund @ $15.30, cusip 026545103 8102 shs Franklin Templeton T/F Hi Yield Fund @ $10.66, cusip 354723702 1056.558 units Decatur Equity Inc Fund @ $17.27, cusip 245907100 . . - " U~~~~ ~u~.~ ~~ . TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) VALUE AT DATE OF DEATH 83,080.00 31,630.09 30,222.50 33,823.82 31,281.10 14,861.25 73,548.24 21,265.28 382,213.50 22,080.00 44,280.00 46,845.68 52,765.39 26,934.72 8,843.00 43,360.00 26,470.25 24,085.12 77,020.76 20,464.60 12,214.59 86,367.33 18,246.75 1,211,903.97 REV-15G8 EX+ (6-98l SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DAVIS, L YLA L. FILE NUMBER 21-01-0795 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1 Orrstown Bank Trust Department, money market balance 2 Orrstown Bank checking account # 409537 3 Orrstown Bank checking account # 108210035 4 Automobile-2000 Buick Park Avenue @ appraised value VALUE AT DATE OF DEATH 149,991.87 5,126.33 12,430.07 19,695.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 187,243.27 , REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DAVIS, L YLA L. SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21-01-0795 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COpy OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. GLENN R. DAVIS, SON 1/31/02 (CASH) 10,000 100% 3,000 7,000.00 2 ANNE.FRENCH,DAUGHTER 1/31/02 (CASH) 10,000 100% 3,000 7,000.00 3 SUSAN L. CONTI, DAUGHTER 1/31/02 (CASH) 10,000 100% 3,000 7,000.00 4 JOANN DAVIS, DAUGHTER-IN-LAW 1/31/02 (CASH) 10,000 100% 3,000 7,000.00 5 PAUL CONTI, SON-IN-LAW 1/31/02 (CASH) 10,000 100% 3,000 7,000.00 6 H. ROBERT DAVIS, SPOUSE; SUN LIFE ANNUITY PAYABLE ON DEATH OF L YLA DAVIS 21,298 100% 21,298.00 TOTAL (Also enter on line 7 Recapitulation) $ 56,298.00 (If more space is needed, insert additional sheets of the same size) . REV-1511 EX+ (12-99) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DAVIS, L YLA L. FILE NUMBER 21-01-0795 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: RONAN FUNERAL HOME, FUNERAL EXPENSES 7,129.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 7,704.00 Name of Personal Representative(s) ORRSTOWN BANK, EXECUTOR Social Security Number(s)/EIN Number of Personal Representative(s) Street Address P.O. BOX 250 City SHIPPENSBURG, Year(s) Commission Paid: 2002 State ~Zip 17257 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, allach explanation) Claimant Street Address City State _Zip Relationship of Claimant to Decedent 4. Probate Fees 394.00 Short Certificates $18; Probate fees $361; 5. Accountant's Fees Filing fees $15 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 15,227.00 . REV-1513 EX. (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DAVIS, L YLA L. FILE NUMBER 21-01-0795 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] H. ROBERT DAVIS SPOUSE Life interest as 508 CREEKVIEW LANE specified in Second MECHANICSBURG, PA 17055 Paragraph of Will $129,776.94; Rest, 2 GLENN R. DAVIS Residue and 318 EAST MEADOW DRIVE Remainder of Estate MECHANICSBURG, PA 17055 SON $100,000.00;1/3 +1/5 3 ANN E. FRENCH Interest in Tower Rd. 1387 INDIAN PEG ROAD RE/4 lots $5505 BOILING SPRINGS, PA 17007 DAUGHTER $100,000.00; 4 SUSAN L. CONTI 1/5 Interest in Tower 205 EAST LAUER LANE Rd REILat # 4 $2497 CAMP HILL, PA 17011 DAUGHTER $100,000.00; 1/5 Interest in Tower Rd REILat # 4 $2497 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- 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) REV-1514 EX+ (6-98) l'I W COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN Check Box 4 on Rev-1500 Cover Sheet ESTATE OF DAVIS, L YLA L. FILE NUMBER 21-01-0795 This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5-1-89. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. il Will 0 Intervivos Deed of Trust 0 Other LIFE ESTATE INTEREST CALCULATION H. ROBERT DAVIS 08/11/20 NEAREST AGE AT TERM OF YEARS DATE OF DEATH LIFE ESTATE IS PAYABLE 81 III Life or 0 Term of Years NAME(S) OF LIFE TENANT(S) DATE OF BIRTH o life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years 1. Value of fund from which life estate is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Actuarial factor per appropriate table ............................................... Interest table rate - 03112% il 6% 010% 0 Variable Rate ..% 3. Value of life estate (Line 1 multiplied by Line 2) ....................................$ 364,501.00 ..._.....~J56O'4 129,776.94 ANNUITY INTEREST CALCULATION NAME(S) OF LIFE ANNUITANT(S) DATE OF BIRTH NEAREST AGE AT DATE OF DEATH TERM OF YEARS ANNUITY IS PAYABLE o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years 1. Value of fund from which annuity is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Check appropriate block below and enter corresponding (number) . . . . . . . . . . . . . . . . . . . . . . . . . Frequency of payout - 0 Weekly (52) 0 Bi-weekly (26) 0 Monthly (12) o Quarterly (4) 0 Semi-annually (2) 0 Annually (1) 0 Other ( ) 3. Amount of payout per period .....................................................$ 4. Aggregate annual payment, Line 2 multiplied by Line 3 ................................. 5. Annuity Factor (see instructions) Interest table rate - 03112% 06% 0 10% 0 Variable Ratem% 6. Adjustment Factor (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. Value of annuity - If using 3112%, 6%, 10%, or jf variable rate and period payout is at end of period. calculation is: Line 4 x Line 5 x Line 6 . . . . . . . . . . . . . . . . . . . . . . . . .$ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. the resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13, 15, 16 and 17. (If more space is needed, insert additional sheets of the same size) /?-~"6- PHILIP E FA6UE ORRSTOWN BANK PO BOX 250 SHIPPENSBURG COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN DATE ESTATE OF DATE OF DEATH FILE NUMBER 1 3 lY11: p'pUNTY ACN *' BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 IEY-4I5 EX tiP (11-12> .02 12-16-2002 DAVIS 08-06-2001 21 01-0795 CUMBERLAND 201 Mount R..i tted LYLA L \,., PA 17257Ctl MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 tlJTE: To insure proper credit to your M:count, subIIit th. upp.r portion of this for. with your tax "y...,t. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES ...... i'{y=4u--ii--AFP--Coi:.-ciir----iii-NOfici'-oi:--iiti-iiiiiiAiioti-iNi-ASsiisliiNy---------------------------- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN .. ESTATE OF DAVIS LYLA L FILE NO.21 01-0795 ESTATE TAX DETERMINATION ACN 201 DATE 12-16-2002 1. Credit For State Death Taxes as Verified .00 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) 14.641. 53 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 5. Pennsylvania Estate Tax Due 14.641. 53 .00 4. Total Inheritance Tax Assessed TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 -IF PAID AFTER THIS DATE, SEE REVERSE SIDE lIF TOTAL DUE IS LESS THAN .1, NO PA~ENT IS REQUIRED FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" lCR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) //?-3 -~- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDMDUAL TAXES INHERITANCe-TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE :, ESTATE OF DATE OF DEATH FILE NO. COUNTY 'LiZ .j :3 :\ 4 ACN 11-25-2002 DAVIS 08-06-2001 21 01-0795 Cumberland 101 . . '\ PHILIP E FAGUE ORRSTOWN BANK PO BOX 250 SHIPPENSBURG PA 17257 '* REV-1547 EX (12-87) PC L YLA L Amount Remitted f'U_. \, ~ MAKE CHECK PAYABLE AND REMIT PAYMENT TO: Register of Wills Cumberland County Courthouse Carlisle, PA 17013 CUT ALONG THIS LINE t::> RETAIN LOWER PORTION FOR YOUR RECORDS ~ --REV:1547EX-(06-97fPC--- - -- --- - - -- -Notic-E -CfF -INHERiTA-Nce-t"AxAP-PRAiS-EMENt: - AIC.oWANCE-OR - --- - - - - --- - -- -- - --- - - - - - - - - - --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DAVIS LYLA L FILE NO. 2101-0795 ACN 101 DATE 11-25-2002 TAX RETURN WAS: (D) ACCEPTED AS FILED ( 181 ) CHANGED SEE ATTACHED NOTICE 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 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. CostsIMisc. Expenses (Schedule H) (9) 15,227.00 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 0.00 11. Total Deductions (11) 15.227.00 12. Net Value of Tax Return (12) 1,447.710.24 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) 0.00 14. Net Value of Estate Subject to Tax (14) 1.447,710.24 NOTE: If an assessment was Issued previously, lines 14, 15 and/or 16,17 and 18 will reflect figures that Include the total of ALL returns assessed to date. ESTATE OF (1 ) (2) (3) (4) (5) (6) (7) 7,492.00 1.211,903.97 0.00 0.00 187,243.27 0.00 56,298.00 (8) ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 taxable at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: NOTE: To Insure proper credit to your account, submit the upper portion of this form with your tax payment. 1.462,937.24 (15) 1,105,218.24 X.OO 0.00 (16) 342.492.00 X.045 15.412.14 (17) 0.00 X .12 0.00 (18) 0.00 X .15 0.00 (19) 15.412.14 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID 1-) 10-26-2001 CDOO0453 770.61 24,500.00 TOTAL TAX CREDIT 25,270.61 BALANCE OF TAX DUE 9,858.47 CR INTEREST 0.00 TOTAL DUE 9,858.47 CR * :II' PUD AI"l'BR DAD :IND:ICATBD, SBB RBVBRSB J'OR CALCOLAT:ION 01' ADD:IT:IONAL IN'l'BRBST. (:II' TOTAL DUB: :IS LBSS TBAN $1, NO PADIBNT :IS RBQUJ:RBD. :II' TOTAL DUB: :IS RBJ'LBCTBD AS A CRBDIT (CR), YOU MAY BS DUB A RBl"DND. SBB RZVBRSB S:IDB 01' THIS PORK I'OR :INSTRUCT:IONS.) REV-1470 EX (8-88) ." *' INHERITANCE TAX EXPLANATION COMMONWEAL Tt-l OF PEJiti.!SYLVANIA OEPARTME~foFREVENUE OF CHANGES BUREAU OF INDMDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME L YLA L. DAVIS FilE NUMBER 2101-0795 REVlEWEDBY CHARLES WRIGHT ACN 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES Accepted revised return. ,. ROW Page 1 Estate of LYLA L. DAVIS also known as PETITION FOR PROBATE and GRANT OF LETTERS ~l:flJ-07q~ No. To: Register of Wills for the . Deceased. County of CUMBERT.ANnjn the Social Security No. ?03-10-250/1 Commonwealth of Pennsylvania The petition of the undersiened respectfully represent~ that: Your petitioner(s). who is/are 18 years of age or older an the execut nT. ORRS'T'OIDl BANK named in the last will of the above decedent, dated pRRRTTARV O? , 19.2.2.- and codicil(s) dated (state relevant circumstances, e.g. renunciatioTJ, d~a.th or executor, etc.) Decendenr was domiciled at death in CIJMRF.RT..<\Nn County, Pennsylvania, with her last family or prindpa! residence at SOli! CREEKVIF.W T.ANF. mon rce. T~~ MF.CHANTrSBUR~> FA 17n~~ (list SHeet, nl,lm~r lI.nd mUllcipalil)') Decendent. then 81 years of age. died ATT~TTC:'T' gg ,19 2001 , at 'i08 r.RF.F.KVTF.T.J T AN};' MF.CHANH~~RTTR~, PA 170'i'i Except as foUows, decedent did not marry, was not divorced and did not have a child born or adopted after E:)tecution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: 3oq, ODD. ,1"0 ~ (If domiciled in Pa.) AU personal property $ h ~on,oo~ fiR (If not domiciled in Pa.) Persona! property in Pennsylvania $ (If Dot domiciled in Pa.) Personal property in County $ Value of [eal estate in Pennsylvania $ situated as foHows: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters TEST.AMnTT-ut~ (te~tamentary; administration c.LIl..; administralion d.b.n.,.t.Il.) theron. ~ OJ <; i:: OJ "I:I~ .- .., ~b tx<,: '"dO ~.:: -0> "'~ 'E'<;:; ;;l ~ ~ Ui -~ ~ c:. :_~f.~- ~~ q~ ~~ c~ ~SO ~ (l P 1'\ 'b().rJ P4 L 7,2'5] OATH OF PERSONAL R.EPRESENTATIVE COMMONWEALTlI OF PENNSYLVANIA } ss COUNTY OF CUMBERLAND 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 personall'epresen- tative(s) of the above decedent pctitioner(s) will well an truly administer the estate ccording to law_ ofc: en ~. l:l ~ 17-d-& Sworn to or affirmed ~l1d subscribed ~~~~V yof Estate of No. ~/-DI- 07Q 5- L'1 LA- L. 'lYPrv IS , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW Avu;~T 24- ft2~i~ consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated 2 - 7- -95 described therein be admitted to probate and filed of record as the last will of L. /2ittiff-~1 V~~') V Register of Wills L/ Probate, Letters, Etc~~~~. . . . .. $ \305. DO Short C~sdO . . .. , , , . ,,$ (3)0. 00 R8RHR~ . .. .. .. ".:.r.;. 'f)'" $ 8, I . DO ~$ \5.0D TOTAL_$~ ATTORNEY (Sup, Ct. I.D. No.) ADDRESS Filed .................................. . PHONE nlU:>.6UJ Kt.V ';11Mb ~ .'11S is ro certiFy that the information here given is correctly copied fro~ an original certificate of death dul~ filed with me as Local Registrar. The original certificate will be forwarded to the State VItal Records Office for permanent filmg. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fe~ for this certificate, $2.00 p 7578287 LL~.~~~ Local Registrar No. AUG Ii,; 8 2001 Date H,OS, :&3Aev 2187 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH 'INT ENT NK NAJ.4E OF OeCEDENT 1F-'rSl MIddle ~aSlI UNDER 1 DAY Hours MitM" SEX 2. Female STATt ~ILE ~UM8EA SOCIAL SECURITY NUMBER 3. 203 _ 10 OATE OF DEATH ,Mcntn. o.~. -"MIl .. August 6, 2001 1. AGe (Last Blttr'oday) LYLA LOUISE DAVIS 81 UNDER 1 YEAR Montn. Cays BIRTHPLACE (C4y ~t:d Pl.M:E OF DEATH ICtoecll only QI'4l h "'" .nl1lUCloao, on Qft'oer '3IOej 3lI..e Of fc,e.gn Counr,V) HOSPITAL: _ Cleveland Ohio I_I~O 7. ... FACILrrY NAME (tt noIlOSNUhOn, Qlve SI,", ana numberl ~=tyl0 .. COUNTY OF DEATH v... ~I Cumberland RACE .Atnencan ~n, Btack, wtut.. Me 1S".c",) White 10. DECEDENT'S USUAL OCCUPATlON (~:"'~~~~::~:i' l1L Secretary "..Insurance Office DECEDENT'S MAILING AOOAESS (SIr... CI'yIrown, SIaI., ZoCode) DECEDENT'S 508 Creekview Lane ~~~ fSee~1OnS 1.. Mechanicsburg, Pa 17055 on 011'....... FAllTHER'S NAMe IFits!. M.odle. lastl Hubert W. Townsend fMRlTAl. STATUS. Mamtd Nt'VeI MarriH, Widowed. Divorced (Specify) Married SURVIVJNQ SPOuSE 1"",".gtWI~namel Robert Davis, Jr. '11>. Cumberland l>d - Iiwina 1OWnShip1 17d.O ~dItc:'='",=ot MOTHER'S NAME (F"II. Mlddte. Malden Surname) Emma L. Hutton Monroe ...". ... IHFORMANT'S NAME (T yplWPtinfl _.H. Robert Davis, Jr. METHOD OF DISPOSITION _fi ""* /' ""'-.. M.D. .. INFORMANT'S MAtlING AOOAESS (SIr... CitylTown, Slat., ZiQ Code) .... 508 Creekview Lane, Mechanicsburg, Pa 17055 PlACE OF OISPOSrTIQN. Name of C.metety. CtemalOty LOCATION. CitylTown. Sial.. ZIP CoctII '" ""* ...... Mt. Zion Cemetery Boiling Springs, Pa 17007 21d. 2001 21c. ... -;:)M. 2.. 27. ~ I: enlerfP'lediH...S, tt11",""OtCGmpI9Cahons whicnCIIUSedlhedealh. 00 nolent.'lhe mode 01 dying, s l* only one callM on eacn!lne (fY~/c~ (~~eov- DuE TO (OR AS A CONSEOUENCE 0f1: ... '''pproll.im.a" : in~ betwMn I 0ftM1 and de.th , I PART II: OIher siQnincanl ~ <:onttibut:ir1g 10 OUfh, buc I'lOf resufling in the ~caUM g;....nirl PlVO' I ~ OUElOCOR AS.... CONSEOUENCE Of)' DUE TOCOAA,SACONSEOUENCE Of): .. WERE AUTOPSY FINDINGS A\M.1l.A8LE PAM:)A to COMPlETlON OIF CAUSE OF """"'7 MANNER OF DEATH Nalural ~ o o OATE OF INJURY {Moo.". Day, Vqtl TUotE OF INJURY INJURY I::r WORK? DESCRIBe HOW INJURY OCCURRED. Homicide o o o PlACE OF INJURY. AI home, farm, Slt..I, laC'fory, otric:. M. buikflnQ.lIfC,ISpec:/tv. ,... _0 ~ - 0 No~ Yes 0 a.. 2.. CEll'TIFIERfChec:koniyone-l .CERTIFYING PHYSICIAH {Ph)'S<:.an certifying cause d death \oYhe,. another Chvsc..n hes pronoonc:ed dealh &nO cOtnPlelItO lIem 231 To She best a' "'y knowtecfge. d.ath oceulTed.... to Ihe cauu(I).nd manMr.. s'ated. _nt P1Inding IrweSlt;.11on NoD Su;c;oo Could noI ~ 91.nnlned ~i1I~\ 01 o ... 'PAONOUNCiHG AND CERTIFYINQ f'tiYStCIAN fPhVSC..n tloItl P'OtlOunclfl9 oeoJlh.and cenJl'fl"'91O cause 01 dealt'll To the ~ of "'y knoWledgft. d..ttt OCC....racII.t IN 8fna. date. and p1~.. and due to lhe UUH(a)"nd manner a. .t.led., , ., .UEDICAl EXAMINER/CORONER On the ba.is of examination and/or invesUgation. in my opinion, d.ath OCCUrted.1 the time. da'.. .and place. and due to the cause(.) and "'.nn., as staled., .. . ..............,..."...,.,......,.,..,.....,.........."...,...,....,.......,.,....,....... )1.. REGISTRAR'S SIONATUAE AND ~. ~w..~~ /lvs . /ro~ ,.. , I " c:\wp51 \~ills\davi81yIa.wi1 iEast JlIill attb Qf~stam~ttt OF L YLA L. DAVIS I, LYLA l. DAVIS, of Mechanicsburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all former Wills, Codicils, or writings in the nature thereof, by me at any time heretofore made. FIRST: I hereby order and direct my Executor, hereinafter named, to pay all my just debts, funeral expenses, testamentary expenses and all Inheritance, Estate, Transfer and Succession Taxes, as soon as may be conveniently done after my death, out of my residuary estate. SECOND: I hereby give to my husband, H. ROBERT DAVIS, all of my personal effects, clothing, furniture, furnishings, jewelry, automobiles, and any other tangible personal property of every kind and any insurance thereon, provided he survives me for a period of thirty (30) days. If he shall not so survive me, then I give the same in equal shares to such of my children as survive me, to be divided among them as they may agree, or if they are unable to agree, as my Executor may decide. Any items of value not so disposed of shall be sold by my Executor and the proceeds added to my Residuary Trust. . . c:\wpSl.\wills\davislyla.wil THIRD: I give and bequeath to each of my children, SUSAN LOUISE CONTI, GLENN ROBERT DAVIS and ANN ELIZABETH FRENCH, per stirpes, the sum of One Hundred Thousand ($100,000.00) Dollars. FOURTH: In the event that my husband, H. ROBERT DAVIS, survives me, give to the Orrstown Bank of Carlisle and Shippensburg, Pennsylvania, or its successors, IN TRUST, for the benefit of my husband, to hold in trust (hereinafter referred to as Marital Deduction Trust), assets equal in value to an amount which, when added to the final estate tax value of all of the property included in any gross estate which passes to my husband, and which qualifies for the federal estate tax marital deduction, will entitle my estate to the minimum federal estate tax marital deduction, allowable in determining the federal estate tax payable by reason of my death, necessary to reduce my taxable to an amount on which no federal estate tax is due and the federal unified credit available to my estate is fully utilized; provided that the allocation to the marital trust shall be satisfied only from assets qualifying for the marital deduction. My trustee shall invest and manage the marital deduction trust in a manner which will not disqualify the marital deduction, and will make distributions as follows: A. During my husband's lifetime: (i) The entire net income shall be paid to him at least monthly: (ii) As much of the principal as my trustee may from time to time think desirable for him welfare, comfort or support shall be paid to him; and (iii) He shall have the unrestricted right to withdraw any part or all of the principal at any time. 2 . . c:\wpSl.\wills\davia1yla.wil B. On my husband's death, any then remaining principal shall be paid to such one or more persons or organizations, including her estate, on such terms as she may appoint by a Will specifically referring to this power of appointment. C. If my husband does not exhaust his power of appointment under the preceding paragraph, on his death: (i) Any increase in death taxes or administration expenses in his estate caused by inclusion of this trust in it for tax purposes shall be paid out of the unappointed principal, and a written statement by his executor or administrator of the amounts payable may be accepted as correct; and (ii) The balance of the unappointed principal shall be added to and thereafter treated as a part of the principal of the Residuary Trust, as identified below. FIFTH: After my death, my trustee, the Orrstown Bank, or its successors, shall invest and manage all the property not allocated to the Marital Deduction Trust as a separate trust, referred to as the Residuary Trust, and make distributions as follows: A. If my husband, H. ROBERT DAVIS, survives me, during his lifetime: (i) The net income shall be paid to him in monthly or other convenient installments; (ii) as much of the principal as my trustee may from time to time think desirable, taking into account funds available from other sources, for the health, support, maintenance or education of my husband or any of my children either shall be paid to 3 . . c: \wpSl \wilJa\davialyla. wi! that person or shall be applied directly for those purposes. However, none of the principal of this trust shall be paid or applied for the benefit of my husband unless the principal of the marital deduction trust has been exhausted; and (iii) After the Marital Deduction Trust has been exhausted (or after my death if no Marital Deduction Trust will be established), my husband shall have the right in each calendar year to withdraw from the principal up to $5,000 at any time and, in addition, if he is living on December 31 of any year, to withdraw up to 5% of the fair market value of the principal determined on December 31 of that year (the amount subject to withdrawal as of December 31 to be reduced by any prior withdrawals during that year, any rights of withdrawals for a particular year to lapse if not exercised during that year). B. Upon my husband's death, if he survives me, or mine if I survive her, my Trustee shall distribute the entire remaining principal of this Trust in equal shares to my children, SUSAN LOUISE CONTI, GLEN ROBERT DAVIS and ANN ELIZABETH FRENCH, per stirpes, and not per capita. Any income earned by the Trust as of the date of my husband's death, and not yet distributed to him, shall be an asset of his estate and shall be distributed in accordance with the terms of his Will. SIXTH: In funding the Marital Deduction Trust, only property eligible for the marital deduction shall be used. Property distributed in kind in satisfaction of the marital deduction shall be distributed at the lower of (i) its value at the time of its distribution and (ii) its adjusted federal income tax basis. Subject to the foregoing and 4 . . c:\wp.5l\W'ills\davialyla.wil without regard to the effect upon the size of the Residuary Trust, my trustee shall have absolute discretion in selecting the property to be allocated to the Marital Deduction Trust. SEVENTH: All federal, state and other death taxes payable because of my death shall be paid out of the principal of the Residuary Trust. None of those taxes shall be charged against the Marital Deduction Trust or any beneficiary, and no property which would be otherwise exempt from federal or state death taxes shall be used to pay any death taxes under this article, or attributable to my estate generally. LASTLY: I nominate, constitute and appoint THE ORRSTOWN BANK, of Carlisle, Pennsylvania, or its successors, to be the Executor of this my Last Will and Testament. I confer upon my Executor the right to sell or otherwise convert any real or personal property at public or private sale, and upon such terms as my Executor shall determine, and to execute and deliver good and sufficient conveyances, assignments and transfers thereof, without liability of any purchase or for the application of any consideration; to obtain any investments at discretion; to borrow money and to secure its repayment by a Mortgage of real or personal property, a pledge of investments or otherwise, without liability on the part of the lender to see to the application thereof; to invest and reinvest at discretion, without restriction to so called "legal investments"; to make distributions in cash or in kind; and to do all other acts and things necessary or appropriate in the management, administration or distribution of my estate. The Orrstown Bank, whether in its role as Executor or in its role as Trustee, shall be 5 . . c:\wp5l\willa\davialyla.wil compensated as such in accordance with its schedule of fees in effect from time to time when such services are rendered. ~JL IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of F~J... , 199/.6' ~ci'~ la L. Davis SIGNED, SEALED, PUBLISHED and DECLARED in the presence of: IL 6 : c: \wp51 \wilb\davialyla. wi! COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUMBERLAND I, LYLA L. DAVIS, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or rrmed to and ac~edged before me, by L YLA L. DAVIS, the Testatrix, this .;;JtV] day of 1:1Jvu..~ ' 199Y. ~i'~ ... yla L. Davis, Testatrix y~\)~ Notary Public NOTARIAL SEAL PATRICIA D. OL YARN1K, Notary Public Hampden Twp., Cumberla'ld County, Pa. My Commission Expires AUQIlst25, 1997 7 : c:\wpSUwilla\davislyla.wil COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUMBERLAND We, James D. Flower, Jr. and Merlene Marhevka ,Jhe witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her Last Will; that LYLA L. DAVIS signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight. of the Testatrix signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by James D. F10\'I7er, Jr. and Merlene Marb,,"ka this r):)j~d day of :lb:ill~ 199f. ~~~'p~ NOTARIAL SEAL PATRICIA D. OL YARNIK. Notary Publk Hampden Twp., Cumberland County, F:, My Commission Expires August 25, E:. : 8 r o o r-l . 00 00 NL{') M ~o::I' NL{')N \.ON* r:-- +J U o E-l Z 111 ~ ~ :it; ~ Z ~";l UOoilO CJ) I,') 00ilE-<~ H \),. ::r:-<-< H UQ ~ H I'\.. ~ Ooil ,I ~ 1%.1 -< 0 "- j:l., ~ P::: 111 111 "'- :;:l E-l Q CJ) '0 H CJ) C!> 111 111 ~ P::: 111 tJ ~ H P::: 111 111 ~ ~ H E-l ~~ CJ) r-l11l 1%.10 MCJ) OtJ "OH CJ) ~ > .. E-l H ~\.O~ Z Z Q 9 111 ~ ~ E-< ~* ;Jo. j:l., L{') Z H ; ~ CJ) E-<O~ ~ 111 CJ) V1 0 # Ooil P::: 111 ;l CJ) ~ 0 >t CJ) QIllH E-<MH I ! ~.."...t:...... 111 NI : N ~ o Go SS'd'~ .lSItfl 03.1ijOS3Yd ~~ ~i ~~: ~ @2~ O~ ~ ~ ~ .~ 9 ~ ~ U) ::> o H:I:: z~ t5::> <O~M u~..-l .. 0 U)>-t ..... ....:lH::>..-l ....:lzO' H::>u) :30~< UU)p., ~~::> o 0 p::::;a:I::~ ~;j~~ H~::>H ~~8~ gaU..-lU - - ('l o ('l '" f") f") .,. f") 4'" o t'" 4'" ~ ORRSTOWN BANK October 25,2001 jh Register of Wills, Agent Cumberland County Courthouse 1 Courthouse Square Carlisle, PAl 7013 RE: Estate of Lyla L. Davis, File No. 2001-00795, PA File No. 21-01-0795 To Whom It May Concern: Please find enclosed our payment of the estimated inheritance tax liability for the above- mentioned estate. Lyla Davis died on 08/06/2001 and this payment of $24,500 represents payment in full for this estimate, less the applicable 5% discount. Please accept this payment on behalf of the estate. Please notify us if you have any questions or concerns. You can reach me directly by calling (717) 530-2655. Sincerely, ~~ Chris Jackson Trust Administrator Orrstown Bank Trust Department, Executor Enclosure PO Box 250 · Shippensburg, PA 17257 · (717) 532-6114 · (717) 532-4143 Fax. www.orrstown.com COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRIS8URG, PA 17128-0601 RECEIVED FROM: ORRSTOWN BANK TRUST DEPARTMENT POBOX 250 SHIPPENSBURG, PA 17257 _____h_ fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: SSN: 203-10-2504 FILE NUMBER: 21-2001- 0795 DECEDENT NAME: DAVIS L YLA L DATE OF PAYMENT: 10/29/2001 POSTMARK DATE: 10/26/2001 COUNTY: CUMBERLAND DATE OF DEATH: 08/06/2001 REMARKS: ORRSTOWN BANK TRUST DEPARTMENT CHECK# 007623 SEAL ACN ASSESSMENT CONTROL NUMBER 101 TOTAL AMOUNT PAID: INITIALS: SK RECEIVED BY: REV-1162 EX(11-96) NO. CD 000453 AMOUNT -------- I $24,500.00 I I I I I I I I I $24,500.00 MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS CJ .. CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Lyla Louise Davis Date of Death: August 6, 2001 Will No. 2001-00795 Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration 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 October 11, 2001 : Name Address H. Robert Davis . 508 Creekview Lane, Mechanicsburg, PA 17055 Susan Davis Conti 205 East Lauer Lane, Camp Hill, PA 17011 Ann E. French 1387 Indian Peg Road, Boiling Springs, PA 17007 Glenn R. Davis 318 East Meadow Drive, Mechanicsburg, PA 17055 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except N/A Date: 4 ~ 1 ! OlD::) I Signatur~llli..b Name Glenn R. Davis Address P.O. Box 825 co '0 ':'t Harrisurg, PA 17108-0825 r ~,l CL Telephone (717) 761-1880 (.:~ co N :::> o :z ,'<3 Capacity: _ Personal Representative ".C~\ (i.l '.;," ~.~i:" 6 0)' <UQ: a: p -u '., ..a 'C ):; (1) ::::: Gu ~Counsel for personal representative /'}-3-0-" BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN - REY-413 EX AFP (Dl-D21 PHILIP E FAGUE ORRSTOWN BANK PO BOX 250 SHIPPENSBURG DATE ESTATE OF DATE OF DEATH FILE NUMBER CA;lUNTY ACN 12-16-2002 DAVIS 08-06-2001 21 01-0795 CUMBERLAND 201 LYLA L Allount Rellitted PA 17257. MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES ~ RE-V:4i]f-EX--AFP--[oi~-02i-----.ii-NifffcE--OF--DETE-RMiN~Tio-N-AiiD-ASisESS-MENT----------------------------- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN .. ESTATE OF DAVIS LYLA L FILE NO.21 01-0795 ESTATE TAX DETERMINATION ACN 201 DATE 12-16-2002 1. Credit For State Death Taxes as Verified .00 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) 14.641. 53 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed 14.641.53 5. Pennsylvania Estate Tax Due .00 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 -IF PAID AFTER THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ./ - . /"/-$-~ BUREAU OF INDIVIDUAL TAXES INHERITANCE'TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE IJ \ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NO. COUNTY ACN 11-25-2002 DAVIS 08-06-2001 21 01-0795 Cumberland 101 PHILIP E FAGUE ORRSTOWN BANK PO BOX 250 SHIPPENSBURG PA 17257 REV-1547 EX (12-97) PC L YLA L Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: Register of Wills Cumberland County Courthouse Carlisle, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ - -rfEV=1547 EX -(06-97fpc - - - - - - - - - - - - - -Notic-E -6-F -fNi.fERii A-NCE-lAic" APj:iRAis-EME-Nl~ -ALL.OWANCE- OR - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF DAVIS LYLA L FILE NO. 2101-0795 ACN 101 DATE 11-25-2002 TAX RETURN WAS: (D) ACCEPTED AS FILED ( ~ ) CHANGED SEE ATTACHED NOTICE 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 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 15,227.00 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 0.00 11. Total Deductions (11) 15,227.00 12. NetValueofTaxReturn (12) 1,447,710.24 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) 0.00 14. Net Value of Estate Subject to Tax (14) 1 ,447,71 0.24 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16,17 and 18 will reflect figures that include the total of ALL returns assessed to date. (1 ) (2) (3) (4) (5) (6) (7) 7,492.00 1,211,903.97 0.00 0.00 187 ,243.27 0.00 56,298.00 (8) ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 taxable at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 1 ,462,937.24 (15) 1,105,218.24 X .00 0.00 (16) 342,492.00 X .045 15,412.14 (17) 0.00 X .12 0.00 (18) 0.00 X .15 0.00 (19) 15,412.14 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10-26-2001 CDOO0453 770.61 24,500.00 TOTAL TAX CREDIT 25,270.61 BALANCE OF TAX DUE 9,858.47 CR INTEREST 0.00 TOTAL DUE 9,858.47 CR * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. (IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A CREDIT (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) REV-1470 EX (6-88) COMMONWEAL Tf-l OF PENl~SYLVANIA DEPARTMEr:JT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME REVIEWED BY L YLA L. DAVIS CHARLES WRIGHT ITEM SCHEDULE NO. Accepted revised return. INHERITANCE TAX EXPLANATION OF CHANGES EXPLANATION OF CHANGES ROW FILE NUMBER ACN 2101-0795 101 Page 1 \ /?-c:8 -~-- 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-1U7 EX AFP (01-05> PHILIP E FAGUE ORRSTOWN BANK PO BOX 250 SHIPPENSBURG t: t~ t'; DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 12-23-2002 DAVIS 08-06-2001 21 01-0795 CUMBERLAND 101 LVLA L Allount Rellitted ,P~ 17257 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 ~ REV=i6'ifi-Ex--AFP-foY:03y------...--fNHERITANc'E--yiX--STATEM'E-tiy-o-F'-icfcOlii.ff--...---------------- -- --- ESTATE OF DAVIS LYLA L FILE NO.21 01-0795 ACN 101 DATE 12-23-2002 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: 12-03-2002 PR I NCI PAL TAX DUE: ........................................................................................................................................................................................................................... 15,412.14 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10-26-2001 CDOO0453 770.61 24,500.00 12-03-2002 REFUND .00 9,858.47- TOTAL TAX CREDIT 15,412.14 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 PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. J 07/08/2003 09:44 FAX 7177612286 Latsha,Dav1s&Yohe I4J 003 := ~~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: LYLA L. DAVIS Date of Death: AUGUST 6, 2001 Will No.: 2001-00795 Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Oxphans' Court Rules, I report the fOllowing with respect to completion of the administration of the above-captioned estate: 1. State whether atiministration of the estate is complete: Yes Qq No 0 2. If the answer is No, state when the personal representative reasonably believes that the ::uIministration will be complete: 3. lfthe answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No IKl 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 0 No rn c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be with the Clerk of the, Orphans' Court and may be attached to tbi r Date: 7/15/03 CHARLENE L. FEUCHTENBERGER, TRUST ADM. Name '~lqUl!l~J . ,:; ,-) ORRSTOWN BANK, EXECUTOR P.O. BOX 250, SHIPPENSBURG, PA 17257 Address L c: 11V 9 L lnr' m. (717) 530-2614 Telephone No, Capacity: [!l Personal Representative o Counsel for personal representative PHILIP E FAGUE ORRSTOWN BANK PO BOX 250 SHIPPENSBURG COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN *' v BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 REY-756 EX AFP lDl-D2l 02-02-2004 DAVIS 08-06-2001 21 01-0795 CUMBERLAND 202 LYLA L Allount Rellitted PA 17257 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES ~ REV=736-EX--AFP-Toi:02r----.-.-Ncffic'E--oF--DET'E-RMlifAilcfti-AND-AS-SEss-MENY---------------------------- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER .. ESTATE OF DAVIS LVLA L FILE NO.21 01-0795 ACN 202 DATE 02-02-2004 ESTATE TAX DETERMINATION 1. Credit For State Death Taxes as Verified .00 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) 14,641.53 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed 14,641.53 5. Pennsylvania Estate Tax Due .00 6. Amount of Pennsylvania Estate Tax Previously Assessed Based on Federal Estate Tax Return .00 7. Additional Pennsylvania Estate Tax Due .00 TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 -IF PAID AFTER THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)