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Home My WebLink About01-0854 PETITION FOR PROBATE and GRANT OF LETTERS Estate of l-lAIZ-OLP f3~ OLSoN No. .!LI- 0 1- ~S-I{ also known as To: Register of Wills for the Deceased. County of eu AAse-,E:LAN' Din the Social Security No. <) 3~ - /0 - 93 S-o Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executc~d" J>o~,I..~ ~~ OLSf:rmed in the last will of the above decedent, dated 'Dec.... z. -=z- , 19~ and codicil(s) dated (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in CU M.~(ij;"/Z...LAf'oJ 1> h ,<; last family or principal Iesidence at I Q Mess I AJ.I 1VI~c..HA-N'C.S13u~G) pA , 7-055"- ~,s- (list street, number and muncipality) Decendent, then 1'1 years of a~, died SEPT: /3 ,~ 'Zoo I, at Mc~$,AU- V,L-L~E KwrTI1Z-c'l'J1E)JT ~TE7Z-. Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: N o""/E ~ounty, Pennsylvania, with , L L..AGE"' -po '2,.Q I ~ UP PE1Z- A L..tt,.) Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: <::) Goa,OOo . $ $ $ $ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters rE'f) rAtt1 /E')Jr~Y theron. ~ Cl) h V~~.9t::: Ol:~ ].g t':l.;:: 3~ Cl) '- 50 <;;; c::: l:lO Vi (testamentary; administration c.La.; administration d.b.n.c.La.) .-::z. ~- "'" 17 0p ", I L. c::::',A. J 70 I , I 7 0 ~I t.E I''''. ~ tf' -- r ,. .J OATH OF'PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA } ss COUNTY OF c.UrY7eE"~.I> The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and ruly administ~ the estate according to law. Sworn to or affirmed . and subscribed { e ~ O~ ~ . ~~~%J (~~. day~of f ~~_ .I1.~fY~ ~ .f..~ . ,- eglster ~ I 7- /)- 9 ~o. 21-01-854 Estate of HAROLD B. OLSON , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW SEPTEMBER 18, )}lj2001 ,in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated DECEMBER 22, 1999 described therein be admitted to probate and filed of record as the last will of HAROLD B. OLSON and Letters TESTAMENTARY are hereby granted to DONALD E. OLSON 'mtl~y ~ I/~ 1./& J;w. ~ti.:Jj/"~ f)"",,4j., Register of Wills FEES Probate, Letters, Etc. ......... $ 375.00 Short Certificates(6) . . . . . . . . .. $ 18.00 ~ E;41'M .l?~~. .~ . .. $ 6.00 JCP $ 5.00 TOTAL _ $ 404.00 Filed .~~r:r:f;~~~ .H~,. .2;QQ~.......... ... AITORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE LETTERS AND ORDERS MAILED TO EXECUTOR 9-18-2001 15.805 REV 9/86 This is to certify that the information here given is correctly copied from an original certificate of death duJ1 filed with me as Local ~egistrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. 'f9.t."'.Ah:h tf::P.Ho D<>~. Local Re istrar Q () Fee for this certificate, $2.00 p 7556100 JF_vy<-L^_J/f; c!<J~ I Date H 105 143 Rev 2!B7 COMMONWEALTH Of PENNSYLVANIA. DEPARTMENT OF HEALTH e VITAL RECORDS CERTIFICATE OF DEATH 7YPfJPRINT IN PER.....NEH r Bl...CK INK 99 UNDER 1 yEAR loIonItIo DaI'O UNDER , olfi __ ! Minu'. SlATE F'l.l :<UMBER ------------------------ ~al~-J:08Ct:;oeR _ 935;-1:0~HM~~~.~:;C()\- lllfll'HPlACE iC-Iy iiRd Pl...OCE 01' DEATH .CNtclo ""'Y""" -- _.,'...0<''''''''011''''''''.....1 3la18 01 Fc""g" Counuyl HOSPITAl.: - .___0. eRl~ 0 7. ... FACILITY NAME (1l not on......._. ~ ..,... OIl(1~, :="Y,O NMlE 01' DECEOENT IF',"M.Qdi8-C~- --------- Harold B. Olson AGE 11.... _v) Vr. .. COUNTY OF DEATH ~ ~ ~ o \5 2 < z Messiah Village ... Mechanicsburg, PA 17055 FATHER'S HMlE (F.... Iot_. LaSll ,.. Gustave O~son _OAMAHT'S ~ (T:lQ8lf'r1l1ll ... Dona~a O~son MEtHOOOF DISPOSITION D - 0 C._ion IX! ~ 0lh0I (SpecJIy1 . 218. SlGHATUf:!E 01' FUHE~ SER h." eo...pIele._ ~ only _ "..,......... "'" .._.. .- 01 c1HIlI 10 -"'Y ca.- 01 de,"'. MARITAl. STATUS. _ ..._ ....ied. W\dDIoed. DMwceCllSoecolYl widowed ::.- r~r ..... e CUmber land --"1 1,11II.0 :::::'..:::'" MOTHER'S NAME (F.... _. Iot_Su",.me) EMna 1IACE.__._k._.. (Spody, lo.white SURVlVING SPOUSE 1'-.9"'8-'*""1 Clnnber land ..... '710. ~ A \ ~ \ '-eo \ l"\j \ (. / ~ DUE 1O(Ofl AS A CONSEOUENCE Of)' T,)( \) .ll..J') \ C ^-- Z3c. YlI'S CASE REFERREO TO ME~ ElCAMIHEIIlCORONER1 _ JB... NoD H.. :==-. l--- I I I PART .: 0lI..-1igniIlcanI_ """"-.gIG_III...... ....--.in...~__..P/lIfJ I. I : DUE 10 (OR AS A CONSEOUENCE Of)o DUE 10 (Ofl AS A CONSEOUE NCE Of)o Sulcode B"'" o o DATE Of' INJURY (MOI>ln Oav. "'aI) TIME Of INJURY INJURV AT WORK? OESCRUIE HDN IHJ(JRY OCCURREO. WERE AlJlOPSY FINDINGS -.!l.A8LE PRIOR 10 COMPlETION 01' CAUSE Of' DEATH? MANNER 01' DEATH Acc_ p~ In......~llon o fJ o PUlCE Of"NJURV .AI_.larm. ..._.lac1oIy.oIIlce 101. bf.MIding. "c. tSpac.lh/) _. _ 0 NoD Hat",.. Homicide V.O NoD Could not be de,.rm.ned 001 :ze.. 2". CERTifIER ,o,eck oniy onel "CERTIFY'" PHYSICIAN (Phys.c.an (.~~ cause d death 'e\'ttef' ~noItl8f phvSlClan tldS PI'()(tQlJoceO de.un allO complttleO l1em 231 TolhebHtolmr ............. .....occWl'edc:tu...thecauH{.'.ndm~' .....ted. . ... H. .PROHOUMCaNG AND CEATWYtNG ~'fSICtAN .PhySIClaO boItl 0lf0llOUflC1nQ lJedftl dOdt.:ettety.nq rOCatJS8 01 dedIt)) To the bnt 01 my knqwIHg., de..", occ"'.... at ... ...., d.le. and place. and due to the eau..(.. and m.nner .. at.ted. . 'MEOICAl UAMlNERlCORONER On the kM. o. ...min.Uon and/or investigation, in mv opintOn. death occu"u at the t'me, ".ee,.nd pl.cel and due to the cause,.) and manne'... st.'ed.. . . . . . .. . . . . . .. . . . - . . -. - " . . . .. . . . . . . . . . . . ... . . . . ... " . . . . . . . . . . . . . . . . . .. , . . . . ., . . .. . . .. ........ )'. REGIST~S SIGNATURE ANi) NUIoIBER . / 11, I I ~ / loll 21-01-854 LAST WILL AND TESTAMENT OF HAROLD B. OLSON I, HAROLD B. OLSON, of Upper Allen Township, Cumberland County, Pennsylvania, being of sound mind, memory and understand- ing, do hereby make, publish and declare this to be my Last will and Testament, hereby revoking and making void any and all Wills by me at any time heretofore made. ITEM I: I direct that all my funeral expenses and estate or inheritance taxes be paid by my hereinafter named Executor as soon after my death as may be found convenient. ITEM II: I give, devise and bequeath all the rest, residue and remainder of my estate, both real and personal, wherever situate, in equal shares to my children, DONALD E. OLSON, RUSSELL L. OLSON and BARBARA L. DE RONDE. If any of my children predecease me, I give that child's share to his or her issue, per stirpes. ITEM III: I appoint my son, DONALD E. OLSON, as Executor of this, my Last will and Testament. If my said son is unable or unwilling to serve, or, ~aving been appointed is unable or unwilling to continue to act, I then appoint my son, RUSSELL L. OLSON to serve as Executor. ITEM IV: I direct that no personal representative hereunder shall be required to provide security, surety or bond in any jurisdiction for the faithful performance of any duty under this will. This clause is applicable only to such personal representa- tives as are specifically named in this Will. IN WITNESS WHEREOF, I, HAROLD B. OLSON, have set my hand and seal to this, my Last Will and Testament, this ~~ day of ____ '~b;V'", 1999. '#JI -( ~ 0 I. - f (ljc~..{d J.. /~t.--- HAROLD B. OLSON ( SEAL) * * * * * * * * * * * Signed, sealed, published and declared by HAROLD B. OLSON, the Testator, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence and in the presence of each other, we bel ieving him to be of sound mind, memory and understanding have hereto subscribed our names as witnesses. ~ .~.~}~ of \'\v \T--" \'~../\5::.~~uJf" , C?A , G?' l /rJda 7/. ~JM~ I of i.. ::/ uJorrYlle./.~6o~r />; I / 2 COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF DAUPHIN We, HAROLD B. OLSON, Testator, 1'''/'1 /7 ~,--- -;<); cJO <::.,/5 and /' /v1dA /;~;; ~/J e , witnesses, respecti vely, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witnesses and that to the best of their knowledge, the Testator was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. N~-~( /l~ L3 ( rJ...--.tUfi'l.- HAROLD B. OLSON - Testator ~ ~,.~~ L.,I::> (/"'70& 7 ( -1 ';/lk/C/J / Subscribed, sworn to and acknowledged before me by HAROLD B. OLSON, the Testator, and subscribed and sworn to before me by r1" ,4,1/1 ~ -~h()ad..s and it! IY/~;~ A/ pl;;~;/'J e.-. witnesses, this '<?~d day of tI~~~d~~ , 1999. Ua~d~ NOTAWf PUBLIC Notarial Seal Jenny A. Tobias, No~ary Public Harrisburg, Dauphin County My Commission Expires Feb. 15, 2001 "~,,, ,I- 'c Pflnn~w'\I:I!1ia 4f)~m,;!~tien Of NQtane3 E CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: flA/2..DLP t3. OLSO,.} Date of Death: 7-/3,-01 Will No. 2-0 0 I - 0 0 854 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 CJ - '2,..0 - 0 1 Name Address -Pou~U? E OLSaJ '30 B(1..'rtE}2"., CA-tYf P I/-II,.!.. 'fA t(O I' 1 I?VSSEU- LO~f>>,J (8'0 WlL5\.t-,~1C-P., ROCH-~~, NY t4.bl8 B A 146 AM- 0_ Di"" 1?otJt>€ 4543 R,J~ R, 1>{:E D(Z-'V'l:, S-row, 0 H 44-22+ Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: ,- *Z-1 -0' ~ .~.~ Signature Name 1)O,.JAL..1;> _ p _ 0 LSo,J Address , ~O 8' (Z.- 'r'CL !2.P.. C~ P J.ll{..,L. 'PA, 7'01 , Telephone (117 '{ '3 I -~ '3 , 3 Capacity: ~ Personal Representative E ~t: c.u TO ~ _Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT OLSON DONALD E 130 BRYCE ROAD CAMP HILL, PA 17011 _n_____ fold ESTATE INFORMATION: SSN: 086-10-9350 FILE NUMBER: 21-2001- 0854 DECEDENT NAME: OLSON HAROLD B DA TE OF PAYMENT: 11/20/2001 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 09/13/2001 NO. CD 000543 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $29,199.52 I I I I I I I I TOTAL AMOUNT PAID: $29,199.52 REMARKS: DONALD E OLSON CHECK# 112 SEAL INITIALS: VZ RECEIVED BY: ~rSTER" dP' tv!r.t~r"' MARY C. LEWIS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT OLSON DONALD E 130 BRYCE ROAD CAMP HILL, PA 17011 -------- fold EST A TE INFORMATION: SSN: 086-10-9350 FILE NUMBER: 21-2001- 0854 DECEDENT NAME: OLSON HAROLD B DATE OF PAYMENT: 12/10/2001 POSTMARK DATE: 1 2/07/2001 COUNTY: CUMBERLAND DATE OF DEATH: 09/13/2001 NO. CD 000623 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $4,189.50 I I I I I I I I TOTAL AMOUNT PAID: $4,189.50 REMARKS: DONALD E OLSON CHECK# 0113 SEAL INITIALS: PB RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT OLSON DONALD E 130 BRYCE ROAD CAMP HILL, PA 17011 __u____ fold ESTATE INFORMATION: SSN: 086-10-9350 FILE NUMBER: 21 - 2001 - 0854 DECEDENT NAME: OLSON HAROLD B DA TE OF PAYMENT: 01/18/2002 POSTMARK DATE: 01/17/2002 COUNTY: CUMBERLAND DATE OF DEATH: 09/13/2001 NO. CD 000769 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $2,950.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: DONALD E OLSON CHECK# 0114 SEAL INITIALS: CW RECEIVED BY: REGISTER OF WILLS $2,950.00 MARY C. LEWIS REGISTER OF WILLS \ /'?- p- 'l /II> COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX Recorc'''"~<' Regi;';t! ~UREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG~ PA 171Z8-0601 of DATE ESTATE OF DATE OF DEATH P3 .4,fILE NUMBER . . ~OUNTY ACN -02 JAN 18 DONALD E OLSON 130 BRYCE RD CAMP HILL Clerk . PA 17 o Qtfnbt;, _k. ',.. " Fi\ 01-14-2002 OLSON 09-13-2001 21 01-0854 CUMBERLAND 101 '* REV-1547 EX AFP (12-00> HAROLD B Allount Rellitted (1) (2) (3) (4) (5) (6) (7) .00 619,176.67 .00 .00 37,038.97 .00 98.000.00 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=is4-j-ix-AFP-fi'2-:ooi--NCffici--OF-.rtiHiififANCi-yAi-jrpPRAIsii'-ENT~--Ar.i-owAircE-ori------------ - - --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF OLSON HAROLD B FILE NO. 21 01-0854 ACN 101 DATE 01-14-2002 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( x) 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. Hortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Hisc. 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) 7,337.45 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. (8) 754,215.64 .00 (11) (12) (13) (14) 7.337 41i 746,878.19 .00 746,878.19 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. A.ount of Line 14 taxable at Lineal/Class A rate 17. Allount of Line 14 at Sibling rate 18. Allount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due (15) .00 X 00 = .00 (16) 746,878.19 X 045 = 33,609.52 (17) .00 X 12 = .00 (18) .00 X 15 = .00 (19)= 33,609.52 TAX ~KC.U~I:i: PAYHENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-20-2001 CDOO0543 1,536.82 29,199.52 PAYMENT MUST BE MADE BY 06-13-2002*. TOTAL TAX CREDIT 30,736.34 BALANCE OF TAX DUE 2,873.18 INTEREST AND PEN. .00 TOTAL DUE 2,873.18 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS ~EFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) . REV-1470 EX (6-88) I . INHERITANCE TAX EXPLANA TION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENrS NAME FILE NUMBER Harold B. Olson 2101-0854 REVIEWED BY ACN John Kuchinski 101 ITEM SCHEDULE NO. EXPLANA liON OF CHANGES G 1-14 Included on the return per the schedule submitted to the Department. ROW Page 1 I 7- g - 'I BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT ~)~. ~V REV-liD7 EX iFP el2-00) DONALD E OLSON 130 BRYCE RD CAMP HILL .02 JAN 25 DATE OT ESTATE OF DATE OF DEATH FILE NUMBER P 2 :OtfOUNTY ACN 01-22-2002 OLSON 09-13-2001 21 01-0854 CUMBERLAND 101 HAROLD B Recore;::.;'. Reg1~.;;c' Allount Rellitted PA 170~erk. Glllnbel'ls.;;:] PA 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:i60j-EX--AFP--(i2-:0()r------...--iNHERi~fANCE-TAX-STA-fEMENT-O"F-iccouiif--...--------------------- ESTATE OF OLSON HAROLD B FILE NO.21 01-0854 ACN 101 DATE 01-22-2002 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: 01-14-2002 P R I NC I PAL TAX DUE: ...................................................................................................-.................................................................................................................... 33,609.52 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-20-2001 CDOO0543 1,536.82 29,199.52 12-07-2001 CDOO0623 143.66 4,189.50 TOTAL TAX CREDIT 35,069.50 BALANCE OF TAX DUE 1,459.98CR INTEREST AND PEN. .00 If IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 1,459.98CR 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-- (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) , .... /T-g-Lj COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RECORD ADJUSTMENT BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG1 PA 17128-0601 Reee!'; - Rf.~.. tC;. ; ,::.:f 01-31-2002 OLSON 09-13-2001 21 01-0854 CUMBERLAND 101 DONALD E OLSON 130 BRYCE RD CAMP HILL ~02 FEB 1 3 m 0 :49 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN Allount Rellitted P AGlt11011 Clunbc C/* REV-1595 EX AFP elZ-DD) HAROLD B 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 for.. with your tax paYll8nt. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ i'fv=is93-i3f-AFP--fi'2-:oo-f-----..-iiiHERITAN'ifi-TAx-RECORU-ADJ-USTMENT--..----------------------------- ESTATE OF OLSON HAROLD B FILE NO. 21 01-0854 ACN 101 DATE 01-31-2002 ADJUST"ENT BASED ON: VALUE OF ESTATE: ADMINISTRATIVE CORRECTION 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. "ortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/"isc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets DEDUCTIONS AND EXEMPTIONS: U) (2) (3) (4) (5) (6) (7) .00 619,176.67 .00 .00 37,038.97 .00 196,000.00 (8) 9. Funeral Expenses/Adllinistrative Costs/ "iscellaneous Expenses (Schedule H) Debts/"ortgage Liabilities/Liens (Schedule I) Total Deductions Net Value of Tax Return Charitable/Governllental Bequests; Non-elected 9113 Trusts Net Value of Estate Subject to Tax 10. 11. 12. 13. 14. TAX: 15. AlIOunt of Line 14 at Spousal rate 16. Allount of Line 14 taxable at Lineal/Class A rate 17. Allount of Line 14 at Sibling rate 18. Allount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: (9) (10) 7,337.45 .00 (11) (12) (13) (14) (Schedule J) .OOX 00 = 844.878.19X 045= .OOX 12 = .OOX 15 = (9) (5) (6) (17) (8) 852,215.64 7,337.45 844,878.19 .00 844,878.19 .00 38.019.52 .00 .00 38.019.52 , ,. II ,..... , KI=l;U,t'1 l+J A"OUNT PAID DATE ~BER INTEREST/PEN PAID (-) 11-20-2001 CDOO0543 1,536.82 29,199.52 12-07-2001 CDOO0623 220.50 4,189.50 01-17-2002 CDOO0769 .00 2,950.00 TOTAL TAX CREDIT 38.096.34 BALANCE OF TAX DUE 76.82CR INTEREST AND PEN. .00 TOTAL DUE 76.82CR . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAY"ENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "'CREDIT"' (CR), YOU "AY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS.) II REV-1470 EX (6-88) '* INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME FILE NUMBER REVIEWED BY ACN 2101-0854 101 OLSON, HAROLD B Bryan Rondon ITEM SCHEDULE NO. G EXPLANATION OF CHANGES Another $ 98,000.00 was assessed as gifts on this schedule per instructions followed on your fax dated 01/28/2002. Receipt# CD000769 applied to the estate. ROW Paqe 1 //-~'l \v BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG1 PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT '* REV-1U7 EX AFP 101-02) .02 f1/W -3 /-\11 DATE ESTATE OF DATE OF DEATH FILE NUMBER :21 COUNTY ACN 04-15-2002 OLSON 09-13-2001 21 01-0854 CUMBERLAND 101 HAROLD B DONALD E OLSON 130 BRYCE RD CAMP HILL Allount Rellitted PA 17~~;~L__ 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 ~ HE-V =i6ifj-Ex--AFP--foi-:021-------...--iNirERITANCE--YAX--SyjrfEME-tiY-ifF-AC-Couiff--...---------------- ----- ESTATE OF OLSON HAROLD B FILE NO. 21 01-0854 ACN 101 DATE 04-15-2002 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PRO~ECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-30-2002 P R I NC I PAL TAX DUE: ...................................................................................................................................................................___....................................___.............. 38,019.52 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-20-2001 CDOO0543 1,536.82 29,199.52 12-07-2001 CDOO0623 220.50 4,189.50 01-17-2002 CDOO0769 .00 2,950.00 04-01-2002 REFUND .00 76.82- TOTAL TAX CREDIT 38,019.52 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 PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l / (:~i . I ;Pi') - / :!:: "v BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE *' NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP (01-03) DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 06-23-2003 MARTIN 10-03-2000 21 00-0854 CUMBERLAND 101 BLANCHE A t1iJC:i' '03 JUN 30 1\ 8 :00 DONALD BOWEN PO BOX 416 WORMLEYSBURG PAl t..oi43 C\HTlb(~; lL<.' < Amount Remitted i--i-- MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MARTIN BLANCHE A FILE NO. 21 00-0854 ACN 101 DATE 06-23-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN Stocks and Bonds (Schedule B) (lJ (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 .00 .00 .00 (8) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 1. Real Estate (Schedule A) 2. 3. 4. 5. 6. 7. 8. Closely Held Stock/Partnership Interest (Schedule C) Mortgages/Notes Receivable (Schedule D) Cash/Bank Deposits/Misc. Personal Property (Schedule E) Jointly Owned Property (Schedule F) Transfers (Schedule G) Total Assets .00 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) ClO) .00 .00 CllJ Cl2) Cl3) Cl4) no .00 .00 .00 If an assess.ent was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: NOTE: Cl5) (16) Cl7) Cl8) .00 X .00 X .00 X .00 X 00 045 = 12 15 Cl9)= .00 .00 .00 .00 .00 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT 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.) .. c'v STATUS REPORT UNDER RULE 6.12 Name of Decedent:JA~OL1/ B... OLso,.) Date of Death: 1- 13 - 0' Will No. 2. 0.0 I - 0 0 8 5' 4- Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1 . Stat~yhether administration of the estate is complete: YesA' 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 r~esentative 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 s!a}e an account informally to the parties in interest? Yes ~ No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Date: '3-'2.2.-D2.. (~ ~.~ Signature -a ,.) A-l.:P ~ _ 0-s0,J Name (Please type or print) I ~o &-'t'ce; Rl'_ G.W\P I-It u-. -rA Address ~ If'l \'4 - :z.= N P "s;.:: I:' ::::: - ,.,,.... .-....... (111) 131-~ 31~ Tel. No. Capacity: 'f.. Personal Representative Counsel for personal representative (MAH:rmf/AM3) ----- c-.... ....I C) ,..... ~~'.1 " (.J (..1 I.il \" "".' - - -'" ;:"'" -" - - - -' - -' - -' ~. -' d N :o~ ro () .~ c:; (~2",~,:"; ~:: fL C- ~ --" 00 ''''. ~. l:1 s. ~ """'- -,.,.- _.."~.. :E t) --.,-:-: 0 ~<) y,.... -.llC l~ ~ ()-J3. ~ ~~~\~ '-~ ~ ~ ~c .~ ~ll\ 0" ~/ Mi I _ ~ _ (' 0'. -J <;t) ~ ~ !'; - -0 \r~ ~ -e 4 t \' 8 ?~ .c~ C "<,. Ii' ,,1 6 ~ ~ ..,.~~ \ ~ ~X - ~ \\\\\.... C ~ l , lM ~C iI;'l) o ~ J i ; '. ..' i j ~ 1 ~".' !'..A .' ,': . \ ~ ' I ~ i I \ ~\.~t~ \ \ \ \ \ \' ~' - l \) -. I ~ -.c. o rJ REV-1500 ~x 16-001 (/ INHE~T~~~ ~A~ ~~URN RLE-NU1~1~11=_~o-i5It RESIDENT DECEDENT co8vcLE YEAR ~ NUMBER -- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 I- Z W C W U w C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITjA1) OLSON HA/2..0LP DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 'I -I 3 _tJ I :3 _ 2 9 - 0 Z- (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER SOCIAL SECURITY NUMBER Ogro - /0 B CJ 35'0 w ..., ~:!(/) uO::~ wl1.U J:oo uO::...J 11. III 11. <( ~ 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 3. Remainder Return (date of death prior 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 Sch 0) 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 of Trusf) o 10. Spousal Poverty Credit (dafeofdeafh between 12-31-91 and 1-1-95) I- Z W C z o 11. (/) W 0:: 0:: o U FIRM NAME (If Applicable) I "30 Brz. 'r C-t= t<P. II VA J70l} CA-Wl p tT)LL If/+- TELEPHONE NUMBER z o !;;: ..J ::::) l- ii: <( u 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 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) 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) ~c =c =;. c;;,/9. /7Ca.rJfl ; - ~,. . ~:":) . ~L USE ONLY---------, .~~ (1) (2) (3) (4) (5) '~.._ I 37')038- 97 , B o N U1 (6) -1::: ,"""'" ,- r-'" (7) (9) (10) (8) 7337.45' ~ 5"f;; 21 S-_~4 1 (11) (12) (13) 7 337. 4S:- {,4-8J87H./9 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) ~4-8J 878 - /'1 f SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o 1;;( ~ ::::) Q. :E o U g 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0_ (15) x .0 ~5 (16) '2..9,1'1'1..52- , 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 2.<t} 1'11.52- 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT . REV.l51J3 Ex,. (1-97) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FilE NUMBER HA120LP B_ OLSON "7 )<>/0 I.... ';'7/0 I VALUE AT DATE OF DEATH '2..~3B .so ~S7. ~o 11,_So. G3fo8.CO+ GKCJ Z _ <:,..tf 5'12.1i'7- 5"7.57 USe_ 2+ i "LO,7. 2-+ 5"6 (Q 7 . 3C: l8'o8c.oO ~ 106 946. zg , '2.1; /2 3. 2c. 8"~2. 5"6 'Z .00 ~6 :.33.bo z.. 'j~ 470_ 4.0 .r3"..00 Z12.2 g 4-756.t!'J ~ 2.. Zrf.oo '3 '17 3.(\'0 4~oCj."..a6 18r:kCC. I OJ ~5:2.QO 476 993.22... A Ve'. CLD~ING- P~Ic..ES . All property jointly-owned with right of sUlVivorship must be disclosed on Schedule F. ITEM NUMBER 1, '2. ~- ~- 5".. ~- 7. 5'- <f. 10. II.. 12. 13. I+' i5. I'. 17. J 8. 1 ~- ;!.s:J , ~(. :z~. z3. z.+.. NcJ. 150 48 DESCRIPTION A'T~T Coep AT..,..., WuzeLESS; SefZ.V'Ic.ES AVAYA INc-ot=.f"t.lC:ArE"P c.. ~ E:otz.p CINER6'Y CoRP C.O IJEe, I V :I:,.Jc.aJe.pee....., 1::.1> Co ,,",SC'l1V ~C CL-ASS 4 ~~Fl:~2Ej) COf.JScLi PAT'C1> El='1.$O,u rNC 1/Ct-PUI Avro~'TIVc S.,..srefl1S' e AS',MA,.,) ~oPAfJ-. ContPAJo,/ 'r' C r;.ECT!Zo,vlC. 04rA S'rS'rEn"l C"I!.p.. E..,..E'-ON CoIZ-Pf>R.ATlotJ E')4?,-oA/ Mor:>u..E Co~p GE N=1UltL Mc~' CbJZ.P GEA/e~AL A1oro~~ CDI!i?P CLAS.s II. NEW HOAIEt'WEU- XN7E~.AT(CNAL Lu CE~r 7ECH'^,oI.o61 E.:J 1: ",cC#~p N Ci< CQ~(;.>RA ,(ON NEW Nl S OU/z'CE" :r,.;c. "e.p NI ~'oull.c~ ::rI>JCCFZ.P .;f2.6.o PIZ-EI=E/Z../ZEP No Fl..rcLF S'oVi?/E~ R4/L-WA't3 ~2.~O p~Fe#.a P..,eLIC Jirtz.VICE €II,/~JZ.F'~ IS'E Su178V~r CO#TACT #t"".-3 L T E~ 1%'0# Q,O""f1V')U NL cA,le N S "TerrAL.. S-ro c..K , AL.u r: ,0 , 92- ~, , 2.2 ~ '4 /~ ;:JS 32.0 1953 2.'17~ faCiO :2..4<J 9c-4- /Z8 ~ 19~ lao /00 105'4- 500 zag qJVAN nr'r 6o/'-J io, 000 'S; coO IS-I, 184- 70,000 10)000 ~o 000 , IO} 000 4..0,000 10100e:) (Joe AL1-.EGilEN'r PA Sew'Ef' ~.$O % IZ/O',/I~ !JI.IC 14.5' ~ W ATeJe J. S~w~te. G..So ~ I Z/CH /12- FN/I1A tlFb7879 9_7s,70 Io./e/;;' GNMA -# /SIIK' 8.00% 5'/15/17 IIEr;1Pr/ELP FA S:J2.S~ /0/15;;0 laz,. LAC.~,AWAN/JA PA '-'.I5?o 4-/01/05 /d/./ r?^,,,,S8ut<~ PA .scHooL Dt~e:r ;.5(;.% OJ;Jsj,z /CQ.S: PA ~T SelZle~ A s:oo~ O'7/0'/~ JOO] PA S'T HErA 7.05% I/%ill' 10(5<; us r~EMu[z''i N()7'E 5"_So % 02./1:5/03' /o~3 lor... L- BON]:> V A LU E 10)018.00 is, 5' S-&J. 5'0 i3ct4..8q 3,57- IS I 0, 2.....4~oo 20 234.00 I 10 050..00 l 4a ~oc.oo I lO~ IS?:J .00 21) 0"7" .00 1 4"2~ 18.3 _-4.s" TOTAL (Also enter on line 2, Recapitulation) $ ~ 19) 17'.1.0 7 (If more space is needed, insert additional sheets of the same size) REV~1508 EX,' (1~97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (-LAi<-OLP B. 0 WON FILE NUMBER Include the proceeds of IiUgaUon 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 VALUE AT DATE OF DEATH '57) 0-08. 97 Mo,JE.~ fV1Ae.~T TOTAL(Alsoenteronline5,Recapitulation) $ '31, o'3~. 97 (If more space is needed, insert additional sheets of the same size) REV~1511 EX+ (12-99) . Sl;\~f'~.'.. '.~~ ESTATE OF iTEM NUMBER A. B. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT HAf!..OLP 5~OLSON FILE NUMBER Debts of decedent must be reported on Schedule I. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: MEC.# A/t./ ICS e V J!.. Gee /Y7EF/AIZ. 'r' Ass (.) CIA rlO"'/ G,N G ~1c:..J-I MeN'! o/Z.IAL $ I<. O'rH efZMt:L'S FLL:>/iZ.l~T MALPEZZ-I FVJ./cI<AL I-IOMC FVNc!Z.A-L GA-f}fE:fZJI\JG 11, sse-e=L-LA/\/couS 32-~_-OC 75_00 J 0 ~_oo 14 10..00 goz_ 92 50_00 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City ___ State ____ Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _ Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees "38'7 t . ,",0 J:33- <13 fa3...D 0 5"00-00 7. 1'1 E.:>S I A /.I Vi LL-AG-c PilAR- (\//EfZ..,cA fV!OVING EXPC-NSE'S lOW^' .t- Cou ,...lTfZ-" /3APTl ST CH-U~ Qf-/ TOTAL (Also enter on line 9, Recapitulation) $ 7337- 4S (if more space is needed, insert additional sheets of the same size) NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 6? OLSON L_ OLSo,J 0. 1/c1?otJ't7C REV;1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF \-1 A R 0 L-p NUMBER I 1. l)OrJAL-1' 1'<...0 s S' e:LL- 13 ~BkR A SCHEDULE J BENEFICIARIES B- OLSo"; FILE NUMBER RELATIONSHIP TO DECEDENT Do Not List Trustee(s) 50...1 :30,..1 V/tU G 1+ I I::::. ,z.. AMOUNT OR SHARE OF ESTATE '/~ , I~ J I~ 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 1. 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size)