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Home My WebLink About01-0846 C' U,A1 MRLIr^J D Register of Wills of County I Pennsylvania PETITION FOR GRANT OF LETTERS ArnINISTRATION Estate of C I(~ ~ R.. 730 We,{! S also known as (' 114-fi l... lL)" ((. C,," It1e' 0 ~O u.J e" s No. ~J-O/-?</b , Deceased Social Security No./.6.8' -d'l- -.27 31 "t:lItl'H.CII_-' wnO'I'a_. 18 yea'. 01 age 01 Gtd... .pply(r..' tor: (COMPLETE" A" OR "B" BELOW:) Q A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut_ named in the Last Will of the Decedent, dated and codicil(s) dated SI..e ,.evant circ:umslanus. e.Q.. renunciation. dUlh 01 execulor. .Ie. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudic8ted incompetent: r !\ 'I ra B. Grant of Letters of Administration fG...... d.b.n.C.I...: pendon'. tit.; ISmall., IIhst:III.a, tJuu..lc nMIlOlUlIIt:' Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (it any) and heirs: Name Relationship Residence "S , Pennsylva ia, n ;1,..00 I M , ..f9r_. at ILflTYl Decedent, then ~ years of age, died VI S. HLi<S 1/ E Y' /J/(if) IC~L (e.vlU. (I.Ur..ll1(.ul / r Decedent at death owned property with estimated values as follows: (If domiciled in PAl All personal property .............................. $ (It not domiciled in PAl Personal property in Pennsylvania. . . . . . . . . . . . . . . . . . . . . . $ (If not domiciled in PAl Personal property in County. . . . . . . . . . . . . . . . . . . . . . . . . . $ Value of real estate in Pennsylvania ............................................... $ Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ Real Estate situated as follows: 1'1 "cl?O · 0 0 5 I IOlocOo.vO . Wherefore. Petitioner(sl respectfully request(s) the probate of the last Will and Codicil{sl presented with this Petition and the grant of letters in the appropriate form to the undersigned: Typed or printed name and resIdence RW-7 ~ /7- fo- I~ Oath of Personal Representative Commonwealth of Pennsylvania County of ~ CUMBERLAND The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. /(#tdt&~ /)/(. before me this 12th Sworn to and affirmed and subscribed ~ day of September ~ Lewis, Register of Wills DECREE OF REGISTER Estate of C IIItR L€.. S" f. t L #-tA-~ O' . ~tUi:.R.s- alsa known as Co. U ~I'l L.ta <> R \?" (. J C R S Social Security No: 16 ~ - ;lY - c:l71 ? Deceased 21-2001-846 No. Date of Death: .sEl'r 3 dCJc:) ( " AND NOW, ~pph:lIT1hPr J 3t-h , ~Oo/in consid~ration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters 0 Testamentary J( of Administration are hereby granted to ~ If{. I PO); A.J M # ~ 0 LLJE Ie ~ Ce.t ft.; It ft II (; r . 1k:luh:fJll: lite; (hlli1l\Ic .UI~U:f1fl~l. ,h.It"'u!: ,IUIIClllInll:1 in the above estate and that the instrument(s), if any I dated described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters........................... $ 40.00 Attorney: J~E5' 8 PI"141A/elil'/Kei: 1.0. No: (9'(667 Address:y#'~AlLAt?~ ?if .J2JAlef. PC _ .. ifAPtJ VIAlL Sr: YHtlJIJU7i1wA.! f #. 171)$7 Telephone: '7' 7 - r '7'~ - /5 3 )r DATE FILED: September 13.2001 MAILED LE'ITERS 'IO ATIORNEY PANNEBAKER Short Certificate(s).... ~.... Renunciation................. . Affidavit ( )................. Extra Pages ( )............ Codicil.................... ...... JCP Fee........................ Inventory & Tax Forms... Other............. ... ............ TOTAL............... . RW-7a $ 15.00 $ $ $ $ $ $ $ 5.00 $ 60.00 ;,,<~,,< t)t:'\yC\'qr, This is to 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. Fee for this certificate, $2.00 p 7621723 No. 21-2001-846 ~L1e~ Str U 5 2001 Date R.v. 2/81 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH NAME OF DECEDENT IF". Middle. L_ 1. ChaJr.lu R-ic.haJr.d BoWVt-6 UNDER 1 YEAR ManIla Oaya SEll 8IRTHPlACE (C./y ...., S- Of Fcteogn CCIUt1/f'll 1. HaJr.lc.<<bwr. FAC....'" HAME (If not...-........ gNe SlrHl...., ~I 12. ". 118. Sl-. PA Old ....... ..... Cumbvc.la.nd -....? 1111. BoWVt-6 '3,2.001 :=".,,0 olUvc. .... cilyitIDov. .....24-2S__~br ...-wfIo~"". _0 MAT .: Olhw........ -----c:anlIiIUInOlDdNlIl.1luI _.......111 lhellftdellWing_..... in IWn' I. ~.CAUSlElF'" ....... 01 concMoon -.llingon,*",_ T" -t ,...,..v_~ri ,-Jo.r \-Ie""c-r~\... DUE 10 toR AS A CONSEOUENCE Of): ~..---- ............10 ........ _. E-.UIIDIIIU'IHG CAUlEto..... qury ...~- .......... on ~ LMT E DUE 10 toR AS A CONSEQUENCE Of): DUE 1O(OA AS A CONSEQUENCE OF): .. AHAU1'OPSV MAE AAIlOP$Y fINDINGS w.NNER OF DEATH PERFORMED? ~PRIOft1D OF CAUSE 'g1 OF DERH? ........ Homieide ~ 0 Pending~ -. 0 -CX -.0 NoD< Suicide 0 CouId__delernuned DATE 01' INJURY -. Dey. --, ... 2a. II. CBIJ.... ca-~..... .C8IT1I"tlNG PHY*CIAM (PhySlCt8ll~__... _ _ _ Pf\vSC.... hes prQnClUlll:8O clealll ana compleled Ilem 231 To..........""............ ___.....-..(.,....._.............................................................. '~INCING AND CERTIFYING ,,"YSIClAH~ bQltl;>>OFlOU/lCono 0Nlh and '*I"Yono 10.,.. "'_I T.'" -....11 ~. - -......... ... _. ...... ..... plac.. _ _to.... caueeca,_ man...,.. ....lad.. . . . . . . . . . . . . . . . . . . . . . . . . 'MEDICAL EXAMINIAICORONER On the.... of ..MllNtlon Iftd/<< lIIVestlgMlon.1n my oplnioft. ..t" occ:urYeG at tile little, dat.. and plac.. and due to Ill. cau..(.) and -......................................................................................................... . 31.. REGISTRAR'S AI: AND N 3:1. Jl J'~ lI' ,II TIIotE OF INJUAY INJURY R WORK? DESCRl8e HOW INJUf1Y OCCUAAED. ... 0 NoD Hershey, PA 17033 DATE FILED lMonlh. Day. _, 34. I COMMONWEALTH OF PENNSYLVANIA CUMBERLAND COUNTY G -- CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: CHARLES RICHARD BOWERS Date of Death: 91~lQJ Estate No. 2001-00846 SSN: 16~-24-2739 File No. 21-01-0846 Date Letters Granted: 9/13/01 Will or Administration No. To the Register: I certify that Notice of 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 9/27/01 Name Address KATHLEEN M. BOWERS 15 WILLOW STREET _.~~----~_._- -----~ HIGHSPIRE PA 17034 VICKIE BONEVELLE E 5392 WOODLAND AVENUE AU TRAIN MI 49806 MICHELLE PRITT 10 LAKE MEADE DRIVE -- --~...__._.- EAST BERLlNE PA 17316 RICK BOWERS 181 FLATBUSH ROAD -- L1TTLETOWN PA 17340 DENNIS BOWERS 2934 TUNNEL HILL ROAD ~----~-...._.._---- LEBANON PA 17046 ---- Notice has now been given to all persons entitled thereto under Rule 5.6(a) except NONE Date: -- ~#t2/- Signature JAMES B. PANNEBAKER Name (Please type or print) PANNEBAKER AND JONES, P.C. Address 4000 VINE STREET Capacity: Personal Representative X Counsel for Personal Representative MIDDLETOWN PA 17057 Telephone No. 717 944-1333 REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY , Deceased No.21 01 0846 Date of Death 09/03/2001 Social Security No. 168242739 Estate of Charles R. Bowers also known as 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 the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. l!We verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. tion 4904 relating to unsworn falsification to authorities. Personal Representative: Name of Attorney: Jam ~r~dJt~ /J1~ , 1.0. No.: 09667 Kathleen M. Bowers Address: 4000 Vine Street Dated I S- /!JUt! cJ I Middletown Telephone: (717)944-1333 PA 17057 Description AIIFirst Bank-Acct #61255378 Checking Acct. Value 13,813.59 U.S. Treasury-Soc. Security for August 105.00 Commonwealth of PA-PA Mun. Retirement-Pay Period 8/1 to 8/31/2001 1,980.97 1997 Ford Explorer Sport 4x4-Appraisal Value 11,650.00 AIIFirst Bank-Acct# 94-312095, Money Market 2,027.37 Total 29,576.93 (Attach Additional Sheets if necessary) 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. RW-4 v //}.-r:;~/~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX Recorc:"~,. "' Re~;ish" DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-14-2002 BOWERS 09-03-2001 21 01-0846 CUMBERLAND 101 JAMES B PANNEBAKER .~Q JAN 18 PANNEBAKER & JONES 4000 VINE ST Cierk-i' MIDDLETOWN flUrbWil:c;(j P 3 :15 '* REY-1547 EX AFP n2-0n CHARLES R Amount Rell! tted ,-~cun PA 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=is,rj-EX-AFP-ci'z-:ooi--NC)y-ici--OF-'rNHijfifiiici-TAjrAPPRAisEMENT~--ALLOWAifcE-OR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BOWERS CHARLES R FILE NO. 21 01-0846 ACN 101 DATE 01-14-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED 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. Amount 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 RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Hortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/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 29,576.93 .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 Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 2,548.60 2.351.76 (11) (12) (13) (14) NOTE: 24,676.57 X 00 = .00 X 045 = .00 X 12 = .00 X 15 = NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 29,576.93 4.900 ~6 24,676.57 .00 24,676.57 (19)= .00 .00 .00 .00 .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 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.) PLEASE FILE THIS RE~RT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF .J 1. THE STATUS OF THE E AT~ IF ESTATE IS NOT COlVIPLETED, FILE a 6.12 FO~1 YEARLY UNTIL COMPLETION c/ v STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: C/f.;f/(Lt s f2 I SEF T:5 ~Oc:J I , o I\J €'- 730'1)E~S Will No.: Admin. No.: oo<l~ () ~ d.(!)cJ I Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X. No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is yes, state the following: A. Did the personal representative file a final account with the court? Yes No >( B. The separate Orphans' Court No. (if any) for the personal representative's account IS: c. Did the personal representative state an account informally to the parties in interest? Yes X No Copies of receipts, releases, joinders and approvals of formal or informal accounts :~~~ filed with the Clerk of the orpha~ attached to this Signature~ 71/V1 ES VS, N11/VZB4-KE...l(_ _f7?/l/tf/~1( ~ JOAlD; P.C~ Name (Please type or print) r I.f<; 00 t/ ( Ai IE Srf< €.LT HIP/)/ G 72JI.LJAJ -f# /7057 Adfuess D. Date: () /;6 a-oo~ I I (MAH:rmt/AM3) 7(~ --1Y'f--(3'3"3 Telephone o. Capacity: Personal Representative R.W. - 27 J( Counsel for Personal Representative , ~ t IN RE: ESTATE OF CHARLES R. BOWERS, Deceased IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 2001-00846 RELEASE KNOW ALL MEN BY THESE PRESENTS that the undersigned, Kathleen M. Bowers, as Administratrix and Kathleen M. Bowers, individually of 15 Willow Avenue, Highspire, Pennsylvania, does hereby acknowledge receipt from Kathleen M. Bowers, Administratrix of the above named decedent, of the following: CASH IN-KIND-1997 Ford Explorer $11,798.79 11,650.00 TOTAL DISTRIBUTION $23,448.79 ---------- ---------- In full satisfaction. IN CONSIDERATION of said full payment and to the extent thereof, the undersigned does hereby release, remise, quit claim and forever discharge the said Administratrix of and from all actions, suits, payments, . accounts, reckonings, claims and demands whatever for or by reason thereof, or any other account, matter, cause or thing whatever relating to the estate of the said decedent. AND the undersigned does hereby agree to indemnify and save harmless the said Administratrix, to the extent of the full distribution received, against any and all losses, damages, costs, verdicts, judgments, awards and expenses which said Administratrix may suffer, incur, be put to, pay or layout by reason of having made full distribution to the undersigned and agrees to refund said distribution to the Administratrix upon receipt of such a request from the Administratrix. AND the undersigned does hereby release all real estate of the decedent and of the said Administratrix from all liens, claims, actions, suits, payments, accounts, reckonings and demands whatever for or by reason thereof, or of any other account, matter, cost or thing, whatever. It is the intention of the undersigned to be legally bound by this instrument. ~ ,. IlL RECEIVED FEB 2 5 20U2 FEB 2 1) 2082 IN RE: ESTATE OF CHARLES R. BOWERS, Deceased IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 2001-00846 RELEASE KNOW ALL MEN BY THESE PRESENTS that the undersigned, Rick Bowers of 181 Flatbush Road, Littletown, Pennsylvania, does hereby acknowledge receipt from Kathleen M. Bowers, Administratrix of the above named decedent, of the following: CASH 0.00 ----- ----- In full satisfaction. IN CONSIDERATION of said full payment and to the extent thereof, the undersigned does hereby release, remise, quit claim and forever discharge the said Administratrix of and from all actions, suits, payments, accounts, reckonings, claims and demands whatever for or by reason thereof, or any other account, matter, cause or thing whatever relating to the estate of the said decedent. AND the undersigned does hereby agree to indemnify and save harmless the said Administratrix, to the extent of the full distribution received, against any and all losses, damages, costs, verdicts, judgments, awards and expenses which said Administratrix may suffer, incur, be put to, pay or layout by reason of having made full distribution to the undersigned and agrees to refund said distribution to the Administratrix upon receipt of such a request from the Administratrix. AND the undersigned does hereby release all real estate of the decedent and of the said Administratrix from all liens, claims, actions, suits, payments, accounts, reckonings and demands whatever for or by reason thereof, or of any other account, matter, cost or thing, whatever. It is the intention of the undersigned to be legally bound by this instrument. '-, IN RE: ESTATE OF CHARLES R. BOWERS, Deceased IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 2001-00846 RELEASE KNOW ALL MEN BY THESE PRESENTS that the undersigned, ~ on../I/..R.II ~ Victoria Anne nonn6v~e of E 5392 Woodlawn Avenue, Au Train, MI 49806, does hereby acknowledge receipt from Kathleen M. Bowers, Administratrix of the above named decedent, of the following: CASH 0.00 In full satisfaction. IN CONSIDERATION of said full payment and to the extent thereof, the undersigned does hereby release, remise, quit claim and forever discharge the said Administratrix of and from all actions, suits, payments, accounts, reckonings, claims and demands whatever for or by . . , reason thereof, or any other account, matter, cause or thing whatever relating to the estate of the said decedent. AND the undersigned does hereby agree to indemnify and save harmless the said Administratrix, to the extent of the full distribution received, against any and all losses, damages, costs, verdicts, judgments, awards and expenses which said Administratrix may suffer, incur, be put to, pay or layout by reason of having made full distribution to the undersigned and agrees to refund said distribution to the Administratrix upon receipt of such a request from the Administratrix. AND the undersigned does hereby release all real estate of the decedent and of the said Administratrix from all liens, claims, actions, suits, payments, accounts, reckonings and demands whatever for or by reason thereof, or of any other account, matter, cost or thing, whatever. It is the intention of the undersigned to be legally bound by this instrument. . IN WITNESS WHEREOF, the undersigned has caused this instrument to be executed on the 6th day of February , 2002. WITNESS: ARLENE MARIE SWANBER.G . Notary Public for Alger County, Michigan My Commission Expires January 1. 2004 ~~(r~~SEAL) Victoria nne Bonnevllle /J;:> 0/1" el/ e / / '( . IN RE: ESTATE OF CHARLES R. BOWERS, Deceased IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 2001-00846 RELEASE KNOW ALL MEN BY THESE PRESENTS that the undersigned, Michelle Pruitt of 10 Lake Meade Drive, East Berlin, Pennsylvania, does hereby acknowledge receipt from Kathleen M. Bowers, Administratrix of the above named decedent, of the following: CASH 0.00 ----- ----- In full satisfaction. IN CONSIDERATION of said full payment and to the extent thereof, the undersigned does hereby release, remise, quit claim and forever discharge the said Administratrix of and from all actions, suits, payments, accounts, reckonings, claims and demands whatever for or by ... . reason thereof, or any other account, matter, cause or thing whatever relating to the estate of the said decedent. AND the undersigned does hereby agree to indemnify and save harmless the said Administratrix, to the extent of the full distribution received, against any and all losses, damages, costs, verdicts, judgments, awards and expenses which said Administratrix may suffer, incur, be put to, pay or layout by reason of having made full distribution to the undersigned and agrees to refund said distribution to the Administratrix upon receipt of such a request from the Administratrix. AND the undersigned does hereby release all real estate of the decedent and of the said Administratrix from all liens, claims, actions, suits, payments, accounts, reckonings and demands whatever for or by reason thereof, or of any other account, matter, cost or thing, whatever. It is the intention of the undersigned to be legally bound by this instrument. ... IN WITNESS WHEREOF, the undersigned has caused this instrument to be executed on the day of , 2002. WITNESS: &. -<-- ~ . . ~~p~ (SEAL) Michelle PLulLt P('~ tt- IN RE: ESTATE OF CHARLES R. BOWERS, Deceased IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 2001-00846 RELEASE KNOW ALL MEN BY THESE PRESENTS that the undersigned, Dennis Bowers of 2934 Tunnel Hill Road, Lebanon, Pennsylvania, does hereby acknowledge receipt from Kathleen M. Bowers, Administratrix of the above named decedent, of the following: CASH 0.00 In full satisfaction. IN CONSIDERATION of said full payment and to the extent thereof, the undersigned does hereby release, remise, quit claim and forever discharge the said Administratrix of and from all actions, suits, payments, accounts, reckonings, claims and demands whatever for or by \ . reason thereof, or any other account, matter, cause or thing whatever relating to the estate of the said decedent. AND the undersigned does hereby agree to indemnify and save harmless the said Administratrix, to the extent of the full distribution received, against any and all losses, damages, costs, verdicts, judgments, awards and expenses which said Administratrix may suffer, incur, be put to, pay or layout by reason of having made full distribution to the undersigned and agrees to refund said distribution to the Administratrix upon receipt of such a request from the Administratrix. AND the undersigned does hereby release all real estate of the decedent and of the said Administratrix from all liens, claims, actions, suits, payments, accounts, reckonings and demands whatever for or by reason thereof, or of any other account, matter, cost or thing, whatever. It is the intention of the undersigned to be legally bound by this instrument. ... I " IN WITNESS WHEREOF, the undersigned has caused this instrument to be executed on the day of , 2002. WITNESS: 3~ ( SEAL) Dennis Bowers t I J FIRST AND FINAL ACCOUNT OF KATHLEEN M. BOWERS, ADMINISTRATRIX FOR THE ESTATE OF CHARLES R. BOWERS, DECEASED CUMBERLAND COUNTY-CODE NO. 2001-00846 Date of Death: September 3, 2001 Date of Executor's Appointment: September 13, 2001 The Estate advertisements were in the following publications on the following dates: A. The Sunday Patriot News: October 1, 2001 October 8, 2001 October 15, 2001 B. The Sentinel: October 1, 2001 October 8, 2001 October 15, 2001 Accounting for the period: From September 13, 2001 to January 28, 2002. Purpose of Account: Kathleen M. Bower, Administratrix offers this account to acquaint interested parties with the transactions that have occurred during her administration. The Accountant also indicates the proposed distribution. It is important that the account be carefully examined. Requests for additional information or questions or objections can be discussed with: James B. Pannebaker, Counsel Pannebaker and Jones, P.C. 4000 Vine Street Middletown, PA 17057 (717)944-1333 " . I , I I SUMMARY OF ACCOUNT Principal Receipts Receipts/Assets Add: Income/Interest & Dividends Total Assets Less Disbursements: Debts of Decedent Administration Expenses Federal and States Taxes Funeral Expenses Fees Total Disbursements $2,421.51 440.05 0.00 0.00 1,000.00 Balance Before Distribution/Transfer Distributions: Reserved Cash for filing fees, Fiduciary Income Tax Return, Executrix and Attorneys Fees Balance Before Distributions Distribution to Beneficiaries Balance After Distribution $29,984.03 74.81 $30,058.84 (3,861.56) 26,197.28 (2,748.49) $23,448.79 (23,448.79) $ 0.00 ---------- ---------- " .. , RECEIPTS OF PRINCIPAL ASSETS LISTED IN INVENTORY (VALUED AS OF DATE OF DEATH) AllFirst Bank Acct# 61255378 Checking Acct. $13,813.59 u.s. Treasury-Soc. Security For August 105.00 Commonwealth of PA- PA Mun. Retirement-Pay Period 8/1 to 8/31/01 1,980.97 1997 Ford Explorer Sport 4X4-Appraisal Value 11,650.00 AllFirst Bank-Acct# 94-312095 Money Market 2,027.37 . f I TOTAL RECEIPTS OF PRINCIPAL $29,576.93 ADJUSTMENTS TO INVENTORY Cashed In Value AllFirst Bank Acct# 61255378 Checking Acct.-Inventory Net Increase $14,220.69 -13,813.59 TOTAL ASSETS INTEREST INCOME Mellon Bank-Estate Checking Acct. 9/13 to 12/31/02 Mid Penn Bank-CD 306-07-1157 11/14/01 to 1/28/02 TOTAL INTEREST INCOME +407.10 $29,984.03 ---------- ---------- $10.33 64.48 $74.81 . . I 9/27/01 Enviro Group- Housewide Cleaning 9/27/01 Comcast TV Cable- Cable Service 9/27/01 Shipley Energy- Heating Oil to 9/14/01 9/27/01 Verizon-Phone Svc 9/27/01 Erie Ins. Group- Auto Ins. Policy 10/3/01 Kathleen Bowers- Reimbursement for Janitorial and yard work 10/3/01 PP&L-Electric 10/24/01 Erie Ins. Group- Auto Ins. Ford Explorer 11/2/01 Kathleen Bowers- Reimbursement for Vet Bill for Surgery 10/23/01 Mellon Bank- Check Supply TOTAL DEBTS ~ . I DEBTS $768.50 29.17 144.01 27.98 207.00 225.00 53.10 207.00 690.00 69.75 $2,421.51 iii 1 , ADMINISTRATION EXPENSES 10/2/01 Register of Wills- Probate Estate $60.00 10/2/01 Travel to and From Register of Wills 28.70 10/2/01 Faxing to IRS 2.50 Register of Wills-Filing fee For Inheritance Tax Return 20.00 The Sentinel-Legal-10/22/01 Estate Advertisement 103.55 The Patriot News-10/22/01 Estate Advertisement 225.30 TOTAL ADMIN EXPENSES .. · J $440.05 " II , FEDERAL & STATE TAXES Register of Wills-Inheritance Taxes, N/A ATTORNEYS FEE 11/15/01 Pannebaker and Jones- Attorney Progress fee ... . J $0.00 $1,000.00 --------- --------- . ... RESERVED FOR ADMINISTRATION EXPENSES, FEES AND CONTINGENT PENNSYLVANIA FIDUCIARY INCOME TAX RETURNS PA Dept. of Revenue-Estimated Fiduciary Income Tax, PiE $2.00 Internal Revenue Svc.- Fiduciary Income Tax Return, 0.00 Register of Wills-Estimated Filing Fees, for First and Final And Release 25.00 Balance Due for Executrix Kathleen M. Bowers 1,502.94 Pannebaker & Jones, P.C.- 1,200.00 Balance due for Attorneys Fees Pannebaker & Jones, P.C.-Reimbursement For Cost Paid on behalf of the Estate For: Postage, Copying of First & Final, Release, Travel and Copies of the u.s. Federal Fiduciary Tax Return and the 18.55 PA Fiduciary Income Tax Return TOTAL RESERVED TO PAY $2,748.49 1Il ~. A '" II . IN THE ORPHANS' COURT IN AND FOR THE COUNTY OF CUMBERLAND AND COMMONWEALTH OF PENNSYLVANIA ESTATE OF CHARLES R. BOWERS, DECEASED NO. 0846, YEAR OF 2001 AND NOW, TO WIT, this ';.? CERTIFICATE OF MEMBER OF BAR day of ~, 2002, this is James B. Jt~n!baker, a to certify that the undersigned, practicing attorney and a member of the Bar of Orphans' Court of Dauphin County, Pennsylvania, being familiar with the administration of the above-captioned Estate and having examined the items of credit and debit set forth and contained in the foregoing First and Final Account of Kathleen M. Bowers, Administratrix of the Estate of Charles R. Bowers, Deceased, certifies that according to his knowledge, information and belief, all such items are true and correct without any exceptions whatsoever. James B. er, Esquire Panneba and Jones, P.C. I. D. #09667 4000 Vine Street Middletown, PA 17057 (717)944-1333 L .. - "".;. .. DECLARATION OF ADMINISTRATRIX Kathleen M. Bowers, Administratrix of the Estate of Charles R. Bowers, Deceased, hereby declares under oath [penalties of perjury] that she has fully and faithfully discharged the duties of her office; that the foregoing First and Final Account is true and correct and fully discloses all significant transactions occurring during the accounting period; that all known claims against the Estate have been paid in full; that to her knowledge, there are no claims now outstanding against the Estate; and that all taxes presently due from the Estate have been paid. I(~ h1~ Kathleen M. Bowers, Administratrix of The Estate of Charles R. Bowers SWORN and supscribed to 1:::?ih . 2-9'-1<- day 0 f , 20 O&;-2 . NOTARIAL SEAL ~ ESP/R/ARION A. COLUNGA, Notary Public j<!. ' · . ':1/ Mlddlet?w~ PA, Dauphin County N tary PUb~c . ~~E_on:~~~O~~~ay 7.2002 :sls BOWERCHARLES FIRSTANDFINALACCOUNT #17164 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT 280601 HARRISBURG, PA 17128-0601 t- Z W Cl W U W Cl DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Bowers, Charles R. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) 09/03/2001 02/08/1934 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) W f- ~ :;!;(/l U o:~ w~U J:o:g Ull.CQ ll. <I: 00 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy ofTrust) o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) OFFICIAL USE ONLY c!- ----Jl_=-~_- (q_~ FILE NUMBER 2 1 - 0 o 8 4 6 COuNT'iToDE --vE~ - - NuMsER- - SOCIAL SECURITY NUMBER 6 8 - 2 4 - 2 739 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (date of death poor to 12-13-82) o 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach SchO) ..... Z W Cl Z o ll. (/l W 0: 0: o U THIS SECTION MUST BE COMPLETED. All CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTEDTO: NAME COMPLETE MAILING ADDRESS James B. Pannebaker, Es uire 4000 Vine Street FIRM NAME (If Applicable) PANNEBAKER AND JONES, P.C. TELEPHONE NUMBER (717 944-1333 Middletown PA 17057 z o j:: <( ..J ::) t- o.. <( u w e:::: 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 (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) (1) (2) (3) (4) (5) (6) (7) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o t- <( t- ::) a.. :E o u ~ t- 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 24,676.57 X .O~ (15) XO_ (16) X .12 (17) X .15 (18) (19) 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 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < r- -.-- -- OFFICIAL USE ONLY . . ~.1 ~~.; ;;...: fl':" '.". c:i ---' c.:, <:::; 29,576.93 --- '0 "'J :".....J 0\ 29,576.93 24,676.57 Decedent's Com Jete Address: 'STREET ADDRESS Ch I R B ar es . owers 315 Third Street CITY Summerdale STATE PA ZIP 17093 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 0.00 Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( 0 + 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. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) Make Check to: REGISTER OF WILLS, AGENT 0.00 o. co PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................................................... 0 0 b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 0 c. retain a reversionary interest; or ...................................................................................................... 0 0 d. receive the promise for life of either payments, benefits or care? ............................................................. 0 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................. 0 0 3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? ................. 0 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 0 0 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 complele. Declaration of preparer other than the personal representative is based on all infonmation of which preparer has any knowledge. SIGNATURE V PERSON RESPONSIBLE FOR FILING RETURN DATE ~ a..l..bJV1-' CJl ADDRESS Kathleen M. Bowers 15 Willow Stree I SIGNATURE OF PREPARER OTHE HAN RE ADDRESS 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. S9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not 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. 99116(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. S9116(1.2) [72 P.S. s9116(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. s9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. .~,..".".'" '*' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Bowers Charles R. FILE NUMBER 21 01 0846 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly.owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION All First Bank-Acct #61255378 Checking Accl. VALUE AT DATE OF DEATH 13,813.59 2. U.S. Treasury-Soc. Security for August 105.00 3. Commonwealth of PA-PA Mun. Retirement-Pay Period 8/1 to 8/31/2001 1,980.97 4. 1997 Ford Explorer Sport 4x4-Appraisal Value 11,650.00 5. AIIFirst Bank-Acct# 94-312095, Money Market 2,027.37 TOTAL (Also enter on line 5, Recapitulation) $ (If more space IS needed, Insert additional sheets of the same size) 29,576.93 REV.'511EX'll.97i ~_ ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Bowers. Charles R. 21 01 0846 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees PannebakerandJones, P.C. 2,090.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees to Register of Wills for short certificates, tax filing fee, etc. 60.00 5. Accountanfs Fees 6. Tax Return Preparers Fees 7. The Sentinel-Legal Estate Ad 103.55 8. The Patriot News-Legal Estate Ad 225.30 9. Mellon Bank-Check Supplies 69.75 TOTAL (Also enter on line 9, Recapitulation) $ 2,548.60 .. (If more space IS needed, Insert additional sheets of the same size) REV-1512 EX... (1-97) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bowers. Charles R. FILE NUMBER 21 01 0846 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 768.50 1. Enviro Group-Housewide Cleaning, 9/27/01 2. Comcast TV Cable- TV Services, 9/27/01 29.17 3. Shipley Energy-Heating Oil, 9/27/01 144.01 4. Verizon-Phone Services, 9/27/01 27.98 5. Erie Insurance Group-Auto Ins. Policy, 9/27/01 207.00 6. Kathleen Bowers-Reimbursement of Janitorial & Yard Work, 10/3/01 225.00 7. PP&L Electric-Utilities, 10/3/01 53.10 8. Erie Ins. Group-Auto Insurance for Ford Explorer, 10/24/01 207.00 9. Kathleen Bowers-Reimbursement for Veterinary Surgery 690.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 2,351.76 ,"";".""" '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Bnwprc: Ch::lrlec: R. 21 01 OR4R RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. Kathleen M. Bowers 8pouse $30,000.00 plus 1/2 15 Willow 8treet of Balance of the Estate Highspire, PA 17034 2. Rick Bowers (88#159-58-9381) 181 Flatbush Road 80n None Littletown, PA 17340 3. Victoria Anne Bonneville (88#181-52-0651) E 5392 Woodlawn Avenue Daughter None Au Train, MI 49806 4. Michelle Pritt (88# 159-58-9223) 10 Lake Meade Road Daughter None East Berlin, PA 17316 5. Dennie Bowers (88# 159-52-7832) 2934 Tunnel Hill Road 80n None Lebanon, PA 17046 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART 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)