The URL can be used to link to this page

Home My WebLink About01-1148 PETITION FOR PROBATE and GRANT OF LETTERS Estate of DOROTHy":rr LUKENS also known as DOR_oT"" \.1 V. LlA..KE1\/5 No. To: 2]-01-1148 Register of Wills for the Deceased. County of CUMBERLAND in the Social Security No. 199- 34 - 7 ~ 0 4 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who iYare 18 years of age or older an the execut ors in the last will of the above decedent, dated January 14 and codicil(s) dated Auqust 2, 1994 named , 19-2J.... (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County. Pennsylvania, with h er last family or principal residence at 17 Markp.r Srrpp.r Borough of WOrmlp.YRhllrg (list street, number and muncipality) Decendent. then 88 years of age died December 3, 2001 at Claremont Nursinq & Rehab. Except as foIIows, decedent did not marry. was not divorced and did not have a child born or adopted after execution of the wiII 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: (If domiciled in Pa.) All personal property $ 3 , 500 . 00 (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ 55 , 000. 00 situated as foIIows: 17 Market Street, Borouqh of Wormleysburq, Cumberland County, PA Tract of qround located in Perry County WHEREFORE, petitioner(s) respectfuIIy request(s) the probate of the last will and codicil(s) pre<;ented henewith and the grant of letters Testamentary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. t (7/ v~ ~ o::~ -00 c'= C'iJ".:: 3ct: v.... ~ 0 Cii c 00 Cii j;b~1!u@~ 567 Rupley Road Camp Hill, PA 17011 13 Ferrv Street Jlo.rmleYRhurg. PA 17043 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF CUMBERLAND ) The petitioller(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 bel' petitioner(s) and that rsonal represen- tative(s) of the above decedent petitioner(s) will w an truly ad . 'ster the t according to law. '"' affirmed and 14th c" QQ' ::s ~ s:: ~ ~ ~o. 21-01-1148 Estate of DOROTHY V. LUKENS , Deceased DECREE OF PROBATE A~D GRA~T OF LETTERS AND NOW DECEMBER 19 . 200 ~ in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, lT IS DECREED that the instrument(s) dated January 14, 1963 and August 2, 1994 described therein be admitted to probate and filed of record as the last will M and Codic il Dorothy V. Lukens and Letters Testamentary are hereby granted to Harry N. Lukens and Russel V. Lukens 115.00 9.00 10.50 ~~~~~~-,~~~v4~a&/ 7 I )legister of ~s I David W. DeLuce (41687) Johnson, Duffie, Stewart & Weidner . FEES Probate, Letters, Etc. ......... Short Certificates( ).......... i~RJRc1ktion ................ JCP $ $ $ $ TOTAL _ $ 139.50 .DECEMBER .14.. .2QOl. ........... . AITORNEY (Sup. Ct. 1.0. No.) 301 Market St., P. O. Box 109 T.pmnynp, P.1'. 17041-010Q ADDRESS 5.00 Filed (717) 761-4540 PHONE l.f') if) - r~ 0:... ""'" .- 1.., Ci '..'.' ,) 0) ;"DOC a: c..J Cl .,,\ ..0 ,';' ;;: ~) = !'3c3 p '+- o "-';: I, ;"', ),'~ I~ ~j: o (,) Wee a::: I.f"l c.j) 0.. ~ - u Cl i:i 3) .>.0 '.':;: ~ \1>= Go p WILL (Single Sheet) Published by The PI2nkenhorn Co.. WilIiam~port 2. I-'a 13r it Rrmembrreb 21-01-1148 That I, V l- ~Z1-' V: ,'Ivvk,/Vi,/.:) ,of /7 h'~~~U: in the County oj t~_/(/~~ c~L and State of Pennsylvania, being of sound mind, memory and understanding, and considering the uncertainty oj life, do hereby make, publish and declare this my last Wltll and '{testament, hereby revoking and making void any and all former Wills by me at any time heretofore made. FIRST: I direct that all my just debts and funeral expenses be paid by my Execut c/v hereinafter named, as soon after my decease as may be convenient. S~ND' -{give, devJ,and,bequroth Iu'Gi'i-Ud, Ma.(! /~~ Z't. tV~ iIf~ Ir/ .~[0 ti1.<- ~ /fi;j '~u..c...L t'v.:./'~~ /,' ~U~. ,7rt:"7 I-~dte ;td~ a:t:>= Zk- ~~ i.?~. ueA~ t&J ~~ :&C1}-.~ /7uf,"""/~.. !;J I 1/ /J/ I ., J-I ~, A!(..1A!i,tC: !/ ..(L</U~ c~ ''*1.7 Jv. )>~~-./ ;J. "'L~,t~ ,<2/J .'t,J ) ,,-'j;1.~/;'-- c/(;'~I ~ GuIC' e: - -l-J.-..- i) /" / ,;'1 l~{4..{ru {t->77 6z1ftl.~, i/' .'.,- / ~MdI z/ i!uiib~."o AND LASTL V-I do make, constitute and appoint ,4("!' to be Execut {J/-~: of thts my last Will and Testament. 1In 'Wlt.tJl~a Wlbcrcoft I have h8,eunto .subscribed my n~me, and affixed my seal, ~he jf./ tlj. "; .J- , .:-ilJ ,day oj ....jfif..~..a.;; I1l the year one thousand nl1le hundred and ~ C1 (I'f./rLf. rJ II Signed, sealed, published and declared by [\ t[~ bj th;";~;i::Mfdft~'0~"~~~~d:d;:;Ji; 1/1 f r last Will and Testament, in the presence of us, who have at hY request, subscribed our names in rJ(/ ~ presence, and in the presence of each other, as witnesses hereto. / /J .# /;JJ .J :J2-<t"u{(;7~~ g9~.;j' Jj K2;p;AJd /':}i / 'I /' rJu'-i.a ,'i,:w. , My Commission Expires Jan. 3, 1966 (f\ ~ ~' V/It,-"~l(J t . ,*",v/;:(,"",,~,~ ,e x . z . . z ,I ;: ! ~ ~ o \../ .. (t Ci.,; ~? ..~~; o ,:/'1 '-' cp a>Q: a: In If:I ::~ rf:. -) CL """ - c...J c::::l .,Xi ;:1) .t"2 ,,~5 rJU p . ~ ~ ~ :---.:-. .~ ~\, . ~~ : \'-) \" : r- '0 ('- ~ \ ~, '-\ r.....\ f"" \ f (, _ r\ ~, " --... '-J ~~ 'I' ~ (~\ ~ i~' , " "\. i-- "," ... \ . , '?--c.: "'. .J c~ N <:.. "" <::.~f' V,:,." "-- ... '" \:.,( ~, ,> ~ ."""" t': :":> ~ ..... ..-. ..-. ~ =: ~ ~ Gl ~ t:'t ... ~ a ~ =: ... 21-01-1148 REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS .......... U"" L.f'"\ di cil resented herewith, (each) being duly qualified according to present and saw (each) a subscribing witness to the law, depose(s) and say(s) that the testat__, sign the same and that reqilest of testat in h presence and (in the other subscribing witness(es)). signed as a witness at the sence of each other) (in the presence of the Sworn to or affirmed and subscribed before me this day of ''''" ,- .'J., '1""- CL ~::t ..- c...J C::l I_!) "n SE ......J - -"..' .." DU (Address) :_~~,:,,:. () (~) ~cc ~3 REGISTER OF WILLS OF CIJMRF.RT.l'\I\TD COUNTY OATH OF NON-SUBSCRIBING WITNESS ~( L~~ fz- (each) a subscriber hereto, (each) being duly qualifie according to law, depose(s) and say(s) that they are familiar with the signature of Dorothy V. Lukens codicil aU testat rix of (SRI) sf tRI) DH8DtlrisiR@ 'dtR.l!~tlD t8) the will presented herewith and codicil aU that they believe, the signature on the will is in the handwriting of Dorothy V. Lukens to the best of_the iL knowledge and belief. o~/~ I J I ~ 5i-r1(~) ~{'lC'<<:L /71/dd (e-i-o-urx J fA:' J 7 () t;; 7 f?z ~. dress) ~Z4: ') I / I c;- _ '-Iv- I 'l#ic5ne) /:-oa.. cL /f{,'J d I~ {owx , fA- /765" 7 I (Address) Sworn to or affirmed and subscribed before me this 14th day of ~CmoBER 2001 7~u<~,j/Jf'~ / Reglste 21-01-1148 ~r J...j 1'i99 J ~~~/ ~h A-4-<e~~ k.^"O ~ ~ j/! ~ O::!YI ~'>J'~L~>,~ ~1~~. ~~~~ ~. Y~~Ai ~~~7~' ~~~xG~ ~ :),/J91Lj rn~rt;~ ~ Sworn and SUbsc~'bed I:m."10t: .r..e f'jj< -'1m ~ ~ I~ '4r ",. I.vrr.<6U>>,' 'h . · (1' 'fuy~ :;::;;~:::"I1i#-:''':~~;~ - C~ u, ...-....' -.:::: {.n c'5~ OQ) wa:: a: I.{) if) a.. --=t .- c...J c::J .'tt t ...a ;;::J:: J>= ..."" .I.J rJO p CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: DOROTHY LUKENS a/k/a DOROTHY V. LUKENS Date of Death: December 3, 2001 Will No.: 2001-01148 Admin. No.: To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on December 19, 2001. Name Address 13 Ferry St., Wormleysburg, PA 17043 567 Rupley Rd., Camp Hill, PA 17011 Harry N. Lukens Russel V. Lukens Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None. /) //'~ ( II -.,.- .1 Date:~// ~YoL '~') nature Name: David W. Deluce, Esq. Johnson, Duffie, Stewart & Weidner Address 301 Market St. P. O. Box 109 Lemoyne, PA 17043-0109 Telephone: (717) 761-4540 Capacity: Personal Representative X Counsel for personal representative ~ /~-~ ,r ~ (' ... ':~ r: ~ ..".., \' \' " D ~ ~ Z (j) Cl 0 ....... - ~ 0 ~ ~ G9(-< 3 E-<~ !::: ~~(j)<: Vl~(-<O_ "-l~Vl_Z !::!~(-<><< ttE-<~o~ O~~I%:I>- ~~~oz ..J ~:::s . z ~-j:l.,~ :::Jo j:l., Cle') W Z Z >- o ~ ~ ~ Z ..J ::r:: o """-- Cleri< ell" ,~.., ~ .~ of OJ VVi!!.' '02 MAR-1 w (/) ::> o I I- 0::: w::> UO LLUWr-- ~~~~~ '4- (/) 2 ::> M --J .....J::> a ..- -.....JO(/)o ..........SUW~ ILLO~4: --0200.. (Jo:::::iIw )WO:::I-.....J I-wO:::(/) -- (/) co ::> ::::i C'x <.9 :?: 0 0::: \)w::>U4: O:::U~U r,.I tSI N IT ." I" ::-:: ...~ .... tSI r- .... .. TO Register of Wills Office Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 SUBJECT: Estate of Dorothy Lukens No. 21-01-01148 000: December 3, 2001 FROM JOHNSON, DUFFIE, STEWART & WEIDNER Attorneys at Law P.O. Box 109 lemoyne, PA 17043 (717) 761-4540 DATE: February 28, 2002 Enclosed is a check in the amount of $1,900.00 as a payment on account of Inheritance Tax for the above-captioned Estate, being made within the 90 days to allow for the 5% discount. SIGNED: Damd W. Deluce csh . , C'.J ~- I I'"'"';'''' '-" .z: ~ s::: ..-1) :::: . -' "'"r'" .~'- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRIS8URG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT JOHNSON DUFFIE STEWART WEIDNER 301 MARKET STREET POBOX 109 lEMOYNE, PA 17043 _nn___ fold ESTATE INFORMATION: SSN: 199-34-7604 FILE NUMBER: 2101-1148 DECEDENT NAME: LUKENS DOROTHY DA TE OF PAYMENT: 03/01/2002 POSTMARK DATE: 02/28/2002 COUNTY: CUMBERLAND DATE OF DEATH: 12/03/2001 NO. CD 000908 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,900.00 I I I I I I I I TOTAL AMOUNT PAID: $1,900.00 REMARKS: RUSSEL V LUKENS C/O JOHNSON DUFFIE STEWART & CHECK#1007 SEAL INITIALS: DO RECEIVED BY: REGISTER OF WILLS MARY C. lEWIS REGISTER OF WillS /;)- l?-;? - / '\ ". COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPARTMENT 280601 HARRISBURG, PA 17128-0601 August 16, 2002 Telephone (717) 787-3930 FAX (717) 772-0412 Johnson, Duffie, Stewart & Weidner 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 Re: Estate of Dorothy V. Lukens File Number 2101-1148 Dear Mr. Deluce: This is in response to your request for an extension of time to file the Inheritance Tax Return for the above estate. In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before March 3, 2003. Because Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be granted that would exceed the maximum time permitted. Sincerely, N.~ ~e~lIenbush, Supervisor Document Processing Unit Inheritance Tax Division } Register of Wills of Cumberland, County, Pennsylvania PETITION FOR AMENDED GRANT OF LETTERS Estate of DOROTHY LUKENS No. 2001-01148 Also known as DOROTHY V. LUKENS Deceased. Social Security No. 199-34-7604 The Petition of the undersigned respectfully represents that: Your Petitioner, who is 18 years of age or older and one of the Co-Executors named in the Last Will of the above decedent, dated January 14, 1963 and Codicil dated Auaust 2, 1994 on which LETTERS TESTAMENTARY were granted to Russel V Lukens and Harry N. Lukens on December 19. 2001. Harry N. Lukens died on October 25.2002. A Death Certificate is attached. Decedent was domiciled at death in Cumberland County, Pennsylvania. Decedent died December 3. 2001. 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 to victim of a killing and was never adjudicated incompetent: Decedent 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 ......................................................................................................................$ T otal......................................................................................................... $ See Oriainal Petition Real Estate situated as follows: See Oriqinal Petition WHEREFORE, Petitioner respectfully requests that the Letters Testamentary issued on December 19, 2001 be amended to certify that RUSSEL V. LUKENS, due to the death of Harry N. Lukens, Co- Executor, has duly qualified as Executor and has agreed to continue to administer the Estate in accordance with the law and the last Will of the decedent. 13th day of NOVEMBER 2002 l (jJ f}/1l~ ...J, UStE.t-WLUKEN~ ~~~~ 'f'<> 9~ O..,J1- 567 Ruplev Road Camp Hill. PA 17011 J COMMONWEALTH OF PENNSYLVANIA : SS. 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 estate according to law, Sworn to and affirmed and subscribed Before me this -12th_ day of NOVEMBER 2002 NO. 2001-01148 Estate of DOROTHY V. LUKENS , Deceased DECREE OF PROBATE AND GRANT OF AMENDED LETTERS AND NOW, NOVEMBER 13 , 2002, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that AMENDED LETTERS TESTAMENTARY are hereby granted to RUSSEL V.LUKENS FEES Short Certificate(s) $ Renunciation.............. $ Affidavit ().................. $ Extra Pages ()....... $ Cod ici I............................ $ JCP Fee....................... $ Inventory...................... $ Other.............................. $ TOT AL......... $ 3 1 . 00 filed 11-13-2002 mailed 11-13-2002 6.00 Letters........................... $ 2 5 . 0 0 Attorney: David W. DeLuce 1.0. No: 41687 Address: Johnson. Duffie. Stewart & Weidner. 301 Market Street. P.O. Box 109. Lemovne. PA 17043- Telephone: 717-761-4540 .} ,. " TO Donna Otto, First Deputy Register of Wills Office Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 SUBJECT: Estate of Dorothy Lukens No. 21-01-1148 Dear Donna: FROM JOHNSON, DUFFIE, STEWART & WEIDNER Attorneys at Law P.O. Box 109 Lemoyne, PA 17043 (717) 761-4540 DATE: November 7,2002 Enclosed is the original "PETITION FOR AMENDED GRANT OF LETTERS" for the Dorothy Lukens Estate. Russel V. Lukens and Harry N. Lukens were appointed on December 19, 2001 when the Will and Codicil were probated and the Letters issued. Harry N. Lukens died on October 25, 2002. An original death certificate is attached to the Petition. If the "Petition" meets with your approval, please forward the amended Letters to this office in the envelope provided, together with two (2) short certificates. A check in the amount of $31.00 is enclosed for the Letters and the short certificates. If you have any questions, please call me. Thank you. SIGNED: Cindy Hubler, Estate Administration ~-~. ~ '. ~-~:~ C) ...,,, .'-"-') ~-, w CI) ::> o I I- ~w~ ::>uo a..i:Luw,..... WI..L.>-C!::co OOI-<(~ I-CI)Z::> , CI)....J::>a~ C!:::::!oCl)o LLSUW""" -l..L.oCl)~ OOZ::><( I- o a.. I- C!:: <( I . OWc2l-~ <(t;:;w~CI) Z_CO ....J Z<.9~OC!:: OW::>U<( OC!::u~u ~ ~ Z Cl m - 0 ~ ..... ~ 0 I ef) G9 'f E-< !-< 0 ~ t-- ~ ~ ..... ~ P::i m -< V) !-< 0 ..... LU CI) ..... Z u u: ~ !-< >< ~ "- E-<~ 0 0 V):.tI >-l . P::i Q:I >< ~ . CI) ~-< Oz ~~ ~ z ~..... ~ :::>0 ll.. Clef) ~. Z Z >< 0 0 V) ~ Z i-LJ >-l ::c 0 -- =::: .. -- ... ...,.,. -z:- --;: -- -- ;.. =::: ~"t ..~ N 1:1.) ..... IS! (.:. ,'1;- .... f';' , ...... l'!:l 1\ .,.., ~i'hi:' lS"'to u:nify that the information here hiven is correcrly copied from an original cendiutt of ,k.i ! "'d.d I.oe:d Rq;isrrar. The ori f.',inal certificate will he forwarded to the State Vital Rl'CCirds Olllcc 1(1l' i',elm!. ',",[ ,j 1>11" WARNING: It is illegal to duplicate this copy by photostat or photograpli. ~ii7ffjj/7i';;;;~ /.i",1 U OF "- ,,'III"~~\.\ n PEi:----__ "'-#~!fij,,,,- 1/!it.I-~ -. ....\~~ t~/ - ~-- - \,~l\ ~c::>>i - _~~.' :~~ \~'~'>.,i*}! - (:2' -'. /~ Y \~". ...~/ "'" -?P~_./'-\.\-'r ".y -"'-fIMENT \\\ ~ III!!~ ''''''''f'''/NHIJJIlI"JI,/ /) ;;"'1'1 _...0J l~> ~-~~~~-_!!_--~:~.C- l'k,1I :::-I~ /'.." ...~ ~ .., ~ ;'1 _~~__t'~~-k:::l_dL,~~P(~/V:..-->' Lit (J hT till' rhis certitlClte, S2.00 P 8643125 OCT 2 8 2002 :\i o. i)"Ut ;"JAev.2187 COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH 56 UNDeR 1 YEAR Months DaY' UNDER 1 DAY ~ Hou.. ! ........ STArE FILE ~UM8ER Sex-------FC,A, SECURITY NUMBER .male W3 - 36 --:?r: BIRTHPLACE le.l..,.. .rod PlACE OF OEAi~i;Ct,toClt Ill")' 'JI'e ~ 'f':.l'l.JCI,o,''j OIl Vlt'"" ,,'oel Stale Of fcre'9" Country) p ~OSPITAL 6 Harr i sburg 'n,,",...xx ERiOutpo".nl C 000. 0 1 ... FACIUT'l' NAME {II nollnSt'lulton, give slJ~1 and number, NAME OF DECeOENT IF,~Sl. Middle, la&l) FATHER'S NAME (Fits!. Middle. last) a Russell N. Lukens INFORMA~rs N.......E f!:VJ*Ptin.!1 .00Juai th [VI. Lukens lAETHOO OF DISPOSITION 8urialfi CI~lion 0 R.mo.....lrom Slale 0 Donohoo 0 01... (~otv . 21.. SIG TU tYb. County "'" _odenl 11Y811l. IOWn....,,1 l1d.CX::='::::o,Wormleysburq MOTHEA'S NAME \F!f~1. M,adle. M~ldeo Su,name) White .. Harry AGE (last B1rtMaVI N. Lukens Y,.. $. COUNTY OF OE,(I'H . Dauphin lb. Ie. Harrisburg DECEDENT'S USUAL OCCUPATION (~v.:;~;:'~~u~~r~ Raolice Off' er & DECEDENT 13 Ferry St. .~ormleysburg , Police DECEDENT'S ACTUAL RESIDENCE (See InllfrucllOflS onolhar SIde) WAS DECEDENT EvEA IN U S ARMED FORCES? v..Xl No 0 OECEDENT'S EDUCATION , onl r> ClSI" <Jet: llil(~l E~tr~~Ondilu)t llC40~1 13. MARITAL 51"T08. Manl8d N.....' Mamed. w~, marfr~1:fpec'Vl '4. SURVIVING SPOuse HI....,;e, 1'..... matOen name) Harlan ". 11a. Sial. Pa 171:.0 Yea, dKed8nc IMtdf/l IWp Pa. 17043 c..,-., R PERSON ACTING A8 SUCH lICENSE NUMBER .... 011248 L To the beat 01 mv knowl.dge, daillh occurred allh. t,m.. dal. and place staled (Stgnd!t.ole and T !tiel 2002 to. LY . FQRMANT"S ".AIUNl) ADDRESS ,Street. Cll'rfTown. 5a818. Zip Code! .J. Ferry st. Wormleysburg, Pa. PLACE OF DISPOSITION. Nam. 01 Cemetery, C,emalory LOCATION. CllylTown. Sial.. Zip Code or Other Pyce Union 21c. Duncannon, 21d. Pa. Perry CO. Home& Creme Servo ES 0 (Monlh. Day. '(Ball '30. . dtJi ... 23b. 2 . WAS CASE REFERRED TO MEDICAL EXAUINERlCOAONEA7 v.. 0 No~ IMMEDIATE CAUSE (F'nal dl58aS8 or cond41()(l (esullInQ I/'l death)_ SQ~~<-, DUeTO( ASACONSEOUENCEOF)' I AppIol(lmat. : interval between I 005eI and death I i PART II: o.h.r&lgnjftcan'~cool"butingtocM...th, but: not r.suntng in the und.rlYlng UUH QlWn In PART I. ':)' b C- Sequentially lill condition. if any. Udin; 10 lfY'Imedia.. cau... Em. UNDERLYING CAUSE (0tMase Of lOfUry 4 IhaIII\lbated events re&ul1/lQ 10 dealh) LAST DUE 10 (OA AS A COOSEQUENCE OF): DUE TO lOA AS A CONSEQUENCE OF) Natural lie o [J DATE OF INJURY (Manlh Day. Yeal) I . __-L-_ TIME Of INJURY INJURY AT \o\IOAK1 DESCRIBE HOW INJURV OCCURRED. d WERE AUTOPSY FINDINGS AVAILABlE PRtOR TO COMPlETKlN OF CAUSE OF DEATH? MANNER OF DEATH Hom'c~ o o [J ~CEOF INJURY. AI ~m~f-;;~.~;;I. j;cIOfY. bu,kfjng, etc, ,SpOCJllfl 30e v.. 0 NoD Accident Pending InvestigatIOn v.. D No 5!1 v.. 0 No 0 SUICide Could not be delermlned 3 2... 21b. CERTlFlEA (Check oniy onel ... 'CERTIFYING PHYSICIAN (Phys.c....n Cf'ft.tv,ng cause 0' (It'dlll ...r.er ,jllult>er ph.,'f.I(,o<In has prorlOl.lnCI3d iJealh ana cornpleltld !16m lJt ~ To &h. beel 01 my know'-dge, d..th occurrlld due to the c.u..{.. and moil"n.,.. atated. :I 'PRONOUNCIHQ AND CERTIFYING PHYSICIAN (Ptl,,,",e'df' t;t."r- ;";1:)00',' ...::,j\(J tl~dlh dnd <.ett,IY'f\Q Iv '..1'~~;e 01 dedlt,j ~ .:=:::~:~-'~"~_.._._-_.'.._.'._-"-""- iiiiiiiii ~~~~:~::~t::~.~~.I~~~I~~ .~~/~ invesllgallon, in my opinion, death occuHed at lhe lime, date, ilnd place, and due to Ihe cause(s) and _31. 29. RE~~'S SIG~"T~~~:~~D ~.~~~_~~/ JJ .....(:/...t-...t....... '" . ( -/('.l-l~!..~;t' ""'~::'..l~' ~~ 34. ~ ,'" --.. .~ ~ .-. , ,'" --.. .~ , '" ....... .~ .-. , ~ ... a: 111 :z: o iii ~ ~ I-~I- a: Iil ~ c(j~O)Z ~I-I-O~ 111<00-.../ WI- ~ ti ~ ~ Iil :lJ::: m Z 1Ji~~6~ ;;:o~o;Q. lL. t: - hi ::J < 0 Z o (I) >- o ~ Iil .../ z o en :z: J..- ,. o .., w - .- .ca ~ (I) (I) ca - o .... e .- I.L. (I) ~ o " - W U) ::J o W:r: UE-< r-. H~ co 4.::J (V) 4.0 (V) OUWI ~(V) U)::>;,q;..-; ~E-<::JO ~ Z 0Ir-. H::JU)..-; ~O Uk/,q; 4. U)o.. OO::J Z 0 , O:;,q;:r:W W~E-<~ E-<o:.o:.U) U)W::JH HIXlO~ C1.:E:U~ W::J ,q; o:.U"-;U .- \ TO Register of Wills Office Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 FROM JOHNSON, DUFFIE, STEWART & WEIDNER Attorneys at Law P.O. Box 109 Lemoyne, PA 17043 (717) 761-4540 DATE: February 18, 2003 SUBJECT: Estate of Dorothy V. Lukens No. 21-01-01148 Enclosed for filing in the above-captioned Estate are the following: 1. Original Inventory 2. Original and copy of Inheritance Tax Return. 3. Check in the amount of $31.00, filing charges. 4. Envelope to mail the filing receipt to me. SIGNED: Cindy Hubler, Estate Administration -r ... E:state of LU./;r '.....ENS DO also kno... -' _'ROT/[y V ~nas _. Register Of Wills Of C 11l11beJ-1alJd C aUnt}' Pe 1NIII:N1"ORY , nnsY/ltania - -~----- Attorney, No. 21_ 01 _ 1l0"el V D-----QI148 ' - L"ken, ate of D---~___ - he Pe"ona, eath 12<1/'-~_~ mC'Ode a" Rep'esent --.. SoCi_~<OOl~~: Of said D'::'~the Pe'Sona7.'e( S) Of the ab -.~._ al SecUfity No Deced Uent th taSsels Wh O'e Est>_~ . 199 3 Which a~":: dealh: an~ ~e 'alUalion p~;evef Silual:~e. deceas~~;,~. ::.:::!-~ ~ '::~i,::,rrect ~%:: ~ rnerno~~~~ DecerJe~e:.:Po.ffe ':,c~/t th"re";/~~al the if{,,,,s . ~ ~ 9 to unswo", ~a~:~:~d th; Z:s~~:nd Of~~i~;:al es~: ~~ ~id In~~~ry ted in ~~~ng in the IOn to aUth ,~tements h e,ntory, I/lA1 sIde of th rePrese ' ofllles. efem are "'e ~~ iii e ~ made s(l,'" at !he u~l, . ---------- I,D, No.' Da\1jd tV ~ ~ Del h_ 'l~~"' ~,;;","",/""""''';;';' c.% ";,. ,.:"~;::JEll!!~lIll1l~' . ."."~~ ...."" ~ ( . Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of LUKENS, DOROTHY V. No. 21-01-01148 also known as Date of Death 12/3/2001 , Deceased Social Security No. 199-34-7604 Russel V. Lukens ________. - ___,..____._____~.____.,.~~_.~___.,,______.___________ The 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 located 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 the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. Attorney: David W--'- De~~ce, Esq:_ Personal Represfn~ive ..../,/ J 4~ > ._ Signat re:, ~ ~~h~p;C!:-. ussel V. Lukens 1.0. No.: 25-1802360 Signature: Signature: Address: Johnson, Duffie, Stewart & Weidner Lernoyne, PA 17043-0109 Address: 567 Rupley Road Camp Hill, PA 17011 Telephone: 717/761-4540 Telephone: (717) 763-8378 Dated: ..:JJ/ ?/tj!J ~'?/~"'._--_._- Personal Property $50.00 Series EE Bond Dated 7/1996 31.94 33 Shares - Prudential Common @ $18.098 per share 597.24 Household Goods - sold at auction 3,546.34 Allfirst Bank - Checking Account No. 00565-4886-9 Date of death balance 1,896.04 Allfirst Bank - Savings Account No. Date of death balance 3,512.95 Corncast Cable - refund 14.65 Verizon - refund 0.65 Milton S. Hershey Medical Center - refund 25.11 (Attach additional sheets if necessary) Total Personal Property and Real Estate $54,627.18 Register of Wills of Cumberland County, Pennsylvania INVENTORY continued Estate of LUKENS, DOROTHY V. No. 21-01-01148 Date of Death 12/3/2001 also known as , Deceased Social Security No. 199-34-7604 Musselman Funeral Home - refund 75.00 American Sentinel Insurance - premium refund 5.48 P A Blue Shield - premium refund 57.22 Dennis P. Freistak, Tax Collector - refund - personal taxes 9.80 Prudential Insurance Company Policy No. 562304799 - Beneficiary: Estate 3,854.76 Total Personal Property $13,627.18 2 Register of Wills of Cumberland County, Pennsylvania INVENTORY continued Estate of LUKENS, DOROTHY V. No. 21 - 01 - 01148 Date of Death 12/3/2001 also known as , Deceased Social Security No. 199-34-7604 Real Estate No. 17 Market Street, Borough ofWormleysburg, Cumberland County, PA - Deed Book A, Volume 19, Page 460 Sale Price Vacant Land situated in Toboyne Township, Perry County, P A Deed Book 155, Page 529 Sale Price 35,000.00 6,000.00 Total Real Estate $41,000.00 3 REV.1,oon.16-1lO1 . p. ~~~j'- REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT -~ 1. Original Return - ---- D 2. Supplemental Return D 4. Limited Estate D 4a. Future Interest Compromise (date of death after 12-12-82) ~ 6 Decedent Died Testate {Attach copy D 7. Decedent Maintained a Living Trust {Attach of Will) copy of Trust) D 9 Litigation Proceeds Received D 10. Spousal Poverty Credit {date of death between ___ 1.;1:}1:~j~a!:lQ1-1-951 THIS SECTION MUST BE COMPLETED. ALLCORRESPONOENCE AND CONFiDENTIALtAX INFOflMATtDN SHDULD BE DIRECtED to: NAMEn-------------nu.- --------- -"------~~-~--.--------- ICOMPlETE"MAiLING ADDRESS ------ David W. DeLuce COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT.280601 i HARR!~~~~G, PA 17128-0601 I ---------- DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) LUKENS, DOROTHY V. DATE OF DEATH (MM-DD- YEAR} I DA"fEOF BIRTH (MM~6D:YEAR) ! 08/03/1913 12103/2001 - -- (IF APPLICABLE} SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) < U W , U FIRM NAME (If applicable) Johnson, Duffie, Stewart & Weidner rrELEPHONE NUMBER 717/761-4540 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) 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) (.., NUMBER 21 01 CODE__:tEAR SOCIAL SECUR!TY NUMBER 01148 NUMBER 199-34-7604 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3 Remainder Return (date of death prior to 12-13-82) o 5. Federal Estate Tax Retum Required 8. Total Number of Safe Deposit Boxes D 11 ,Election to tax under Sec. 9113(A) (Attach Sch 0) 301 Market Street Lemoyne, PA 17043-0109 ----- (1) 41,000.00 (2) 629.18 (3) None (4) None (5) 9,143.24 (6) None (7) None (8) 50,772.42 --- (9) 19,486.86 (10) 525.00 (11) 20,011.86 (12) 30,760.56 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) (13) (14) 30,760.56 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) ----- 2 30,760.56 .045 (16) 0 16.Amount of Line 14 taxable at lineal rate x ~ ~ ~ ~ 17.Amount of Line 14 taxable at sibling rate x .12 (17) ~ 0 u x 18. Amount of Line 14 taxable at collateral rate < x .15 (18) " 19. Tax Due (19) 1,384.23 1,384.23 20. ~ CHECK HERE IF YOU ARE REQUESTING A REFUNO OF AN OVERPAYMENT -:-==:::2>_ BE SURE Tel ANSWER Al._L QUESTIONS ON REV~~SE SIDE AN!) :RECHECKMATH << Copyright 2000 form software only The Lackner Group. Inc. Form REV-1500 EX (Rev. 6.QO) I STATE PA ZIP 17043 (1) 1,384.23 --.- 1,900.00 69.21 Total Credits (A + B + C) (2) 1,969.21 Decedent's Complete Address: STREET ADDRESS 17 MARKET STREET CITY WORMLEYSBURG Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount 3. Interest/Penalty jf applicable D. Interest E. Penalty (3) 0.00 ---- (4) 584.98 (5) -- (5A) (58) 0.00 TotallnteresUPenalty (0 + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. Make Check Payable 10: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS No ~ ~ ~ ~ ~ 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred; ..................... ................. ........... .0 ~: ~:~::~ :h~e~;~:i:~~~s:~~;~s~~~ .~~~~~.~.~.~..t.~~.:.~~:.~~.t~ ~~~~~~~~~~~.~~.~~~.~~.~.~.~~; .'::.'::::::::::::B 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 o o 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ............... ................ ................. IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return. including accompanying schedules and statements. and to the best of my knowledge and belief. it is true, correct and complete. Declaration prep~rer other th.a_nthe per~o.~ill repres tati~e is based on all informatio~ of which p~~er has any_knowledge. JfZATU RE OF P RSON ~ESP E FOR FILING RETURN ADDRESS /. ' el V. L ~ 2 567 R Ie R d .. ilM: . . Q 'JIi Y oa . hAJJ. m_ ADDRESS Camp ill,PA 17011 (;~G~~TUR,E OF PE N R. ,FILING RETURN S'- N JiOF R R. 'ADDRESS D d \V. DeLli e, Esq. Johnson, Duffie, Stewart & Weidner Lemoyne, PA 17043-0109 DATE djjfi~J .... 2fr/u~ OAT / 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. 99116 (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 exemoE 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. 99116 1.2) [72 P.S. 99116 (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. 99116 (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. *' SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LUKENS, DOROTHY V. FILE NUMBER 21-01-01148 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 1 DESCRIPTION VALUE AT DATE OF DEATH - - 35,000.00 No. 17 Market Street, Borough ofWormleysburg, Cumberland County, PA - Deed Book A, Volume 19, Page 460 Sale Price - copy of Settlement Sheet attached. 2 Vacant Land situated in Toboyne Township, Perry County, PA Deed Book 155, Page 529 Sale Price - copy of Settlement Sheet attached. 6,000.00 TOTAL (Also enteron Line 1, Recapitulation) 41,000.00 AtiettlmiMt Statem~nl U.S. Vepartment.of Housing and Urban Development OMB No. 2502-0256 B. Tvoe of loan 1 FHA 2. FMHA 3. Cony. Unlns 6. File Number 7. Loan Number: 4. VA 5. Cony. Ins. 0027-03 MortQaj:le Insurance Case Number: C Note: this form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o. c.)" were paid outside the closing; they are shown here for Information Durcoses and are not included in the totals. D. Name/Address of B~ I/IJ- SCOTT A, WALTERS WER ROAD, MARYSVlllE, PA 17053 E, Name/Address of Seller: RUSSEL V. LUKENS EXECUTOR of the ESTAT of DOROTHY V. lUCKENS 567 RUPLEY ROAD, CAMP HILL, PA 17011 F, Name/Address of Lender: G, Property Location: Jsettlement Agent: Arthur M. Feld, Esquire 17 MARKET STREET, WORMLEYSBURG 17041 1309 Bcidge St., New Cumberland, PA 17070 TIN: 23-258276 Date of Settlement JANUARY 31, 2003 J, SUMMARY OF BORROWER'S TRANSACTION SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 101. Contract Sales Price 35,000.00 401. Contract Sales Price 35,000.00 102. Personal Pro ert 402. Personal Pro ert 103. Settlement char e to borrower Line 1,072.50 403.00 1400 104,00 404.00 105.00 405,00 Ad'ustments for items aid by seller in advance Ad'ustments for items aid b seller In advance 106. Cit !town taxes 406. Cit !town taxes 107 Count Taxes 01/31/03-12/31103 223.78 407. Count taxes 01/31/03-12131103 223.7B 108, School Taxes 01/31/03-06/30/03 270.00 408, School Taxes 01/31/03-06/30/03 270.00 109. Refuse 409. Refuse 110.Water 410. Water 111. Sewer 411. Sewer 112. See lines 406/40B 412 120, GROSS AMOUNT DUE FROM BORROWER 36,566.28 420. GROSS AMOUNT DUE TO SELLER 35,493.78 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500, REDUCTIONS IN AMOUNT DUE TO SELLER 201. Deposit or earnest mone 2,000.00 501, Excess De osit see instructions 202. Princi al amount of new loan(s 502. Settlement char es to seller (line 3,696.19 1400) 203, Existin loan s)taken sub'ectto 503. Existln loan s taken sub'ectto 204,00 504. Pa off of 1st Mort a e Loan 205.00 505. Pa off of 2nd Mort a e loan 206.00 506.00 207,00 507.00 ADJUSTMENTS FOR ITEMS UNPAID BY SELLER ADJUSTMENTS FOR ITEMS UNPAID BY SELLER 210.Cit Itown taxes 510. Cit Itown taxes 211. Counlvtaxes 511. Countvtaxes 212. Assessments 512. Assessments 213, School Taxes 513. School Taxes 214. Refuse 514. Refuse 215. Water 515. Water 216. Sewer - 516. Sewer 217.00 517.00 218.00 518.00 219,00 519.00 220. TOTAL PAID BYIFOR BORROWER 2,000.00 520. TOTAL REDUCTIONS IN AMOUNT DUE 3,696.19 SELLER 300. CASH AT SETTLEMENT FROMfTO BORROWER 600. CASH AT SETTLEMENT TOIFROM SELLER 301. Gross amolint due from borrower 36,566.28 601. Gross amount due to seller line 35,493.78 line 120) F 420) 302. Less amounts aid b Ifor borrower 2,000.00 602. Less reductions in amount due 3,696.19 line 220) seller (line 520 303.,CASH X From TO( ) Borrower 34,566.28 603. CASH FROM TO X SELLER 31,797.59 SUBSTITUTE FORM 1099 SELLER STATEMENT: Tt.", i'lf.-.rmifltlon conta!'Ied herein Is imoortant tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other sanction will be imposed on you if this item is reqUired to be reported and the IRS determines that it has not been reported. The Contract Sales price described on line 401 above constitutes the Gross Proceeds of this transaction. SELLER INSTRUCTIONS: If this real estate was your principal residence, file Form 2119, Sale or Exchange of Principal Residence, for any gain, with your Income tax return; for other transactions, complete the applicable parts of Form 4797, Form 6252 and/or Schedule 0 (Form 1040) You are required by law to provide Arthur M. Feld, Esquire with your correct taxpayer identification number. If you do not provide your correct taxpayer identification number, you may be subject to clvil or criminal penalties imposed by law, and Under penalties of perjury. I certif that the number shown on the additional documents signed at settlement is my correct taxpayer identification number. Seller #1 Buyer #1 Se\ler#2 Buver#2 rSETTlEMENT CHARGES 700. TO..L SALE::;:/BROKER'S COMMI~SION BASED ON PRICE $ PAID FROM PAID FROM AT % BORROWER' SELLER'S Division of Commission (fine 700) as follows: FUNDS AT FUNDS AT 701. $ 1500.00 to ERA-NRT, INC. SETILEMENT S ETILEMENT 702. $ 1500.00 to REMAX REALTY ASSOC. 703 Commission paid at Settlement (Money retained by broker applied to commission ($ ) 3,000.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Origination Fee % First National Bank of MarysvilJe 802. Loan Discount % 803, Appraisal Fee $ to First National Bank of Marysville 804. Credit Report to 80S. Broker Fee to 806. Tax Service Fee to 807. Processing Fee to 808. Courier Fee to 809. Flood Cert. To 810. Yield Spread to Broker 811. Admin Fee to 812 Application Fee to First National Bank of Marysville 813.00 814.00 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901, Interest from to @$ /day 902.00 903.00 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard insurance months@$ per month 1002. Mortgage insurance months @ $ per month 1003. City property taxes months @ $ per month 1004. County property taxes months @ $ per month 1005. School taxes months@$ per month 1100. TITLE CHARGES 1101. Settlement Fee DAVID W. DELUCE ESQUIRE poe 1102. Title Examination to 1103. Document Preparation 10 1104. Notary Fees cash 2.00 4.00 1105. Attorney's Fees to ArthurM. Feld 375.00 1106 Title Insurance 1107. Endorsements 100f300f8.1 to 1108. lender's Coverage $ 1109. Owner's Coverage $ 1110. SeltlementX office to 1111. Extra Copies to 1112. Recording to 1113 Closing Service Letter fee to - 1200. GOVERNMENT'RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $'2\0.50 ; Mortgage $ ; Release $ 40.50 1202. City/county tax/stamps Deed $ 350.00 Mortgage $ 350.00 1203. State Tax Stamps: Deed $ 350.00 Mortgage $ 350.00 1204.00 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survey to 1302. Pest Inspection to 1303. Overnight Fee . 1304. Pay-off m 1305' TRANSACTION FEE ERA-NRT, INC. 100.00 1306 TRANSACTION FEE REMAX REALTY INC. 250.00 1307 PARAMOUNT PESTS 55.00 1308 DENNIS P FREISTAK TREASURE 2003 COUNTY TAX BILL 242.19 1309.00 1400. TOTAL SETTLEMENT CHARGES (enter on lines 103 and 502) 1,072.50 3.696.19 I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account in this transaction. I further certify ~::::::::ece7~OOPY ; thj:e.,ement Smtement Borrower #2 Seller" I"': . jJ /1)"" " ifx/'!- Seller #2 To the besl of my knOwledge, the HUD_1 Settlement Statement which I have prepared is a true and accurate account of Ihe fund, which Weni,ed 'nd h"i~~e disb,,,ed by the 'nde"igned " p,rt 01 the ,etttement of thiS transaction. l \ , ) Arthur M. F eld \ It!" . ~" Settlement Agent ,- u. s. DEPARTMENT OF HOUSING and URBAN DEVELOPME~ OMS No. 2502-0265 SETTLEMENT STATEMENT Tillepro for Windows TM JOHNSON, DUFFIE, STEWART, WEIDNER B. TYPE OF LOAN 301 Market Street D1.FHA D 2. FMHA 03. CONV.UNINS. Lemoyne, PA 17043 D4.vA 05. CONY. INS. (717) 761-4540 6. FILE NUMBER: 17. LOAN NUMBER: 1014 MORT. INS. CASE NO.: 12733-1 C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid 10 and by the settlement agent are shown. Items marked "(p.c.c.)" were paid outside the closing; they are shown here for information purposes and are not included in the totals. D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER Ray Gene Smith, Janet M. Smith Harry N. Lukens and Russell V. Lukens, Executors Cash of the Last Will and Testament R D.#1,80x 1134 of Dorothy Lukens alkla Dorothy V. Lukens Blain PA 17006 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: Johnson, Duffie, Stewart & Weidner I. SETTLEMENT DATE: Lower Buck Ridge Road April 9, 2002 Toboyne Township PLACE OF SETTLEMENT: 301 Market Street, Lemoyne, Pa 10:00 a.m. Perry County, PA J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. Gross Amount Due From Borrower 400. Gross Amount Due to Seller 101. Contract sales price 6,000.00 401. Contract sales price 6,000.00 102. Personal Property 402. Personal Property 103. Settlement Charges (Hne 1400) 88.50 403. 104. 404. 105. 405. Adjustments for items paid in advance by seller(s) Adjustments for items paid in advance by seller(s) 106. CitylTown lax 406. CitylTown tax 107. County/City lax 4/5/2002 to 12131/2002 14.68 407. County/City tax 4/5/2002 to 12/31/2002 14.68 108. Assessments 408. Assessments 109. School Tax 4/5/2002 to 6130f2002 23.37 409. School Tax 4/5/2002 to 6f30/2002 23.37 110. 410. 111. 411. 112. 412. 120. Gross Amount Due from Borrower 6,126.55 420. Gross Amount Due to Seller 6,038.05 200. Amounts Paid By Or In Behalf Of Borrower 500. Reductions In Amount Due To Seller 01. Deposit or earnest money 500.00 501. Excess deposit (see instructions) 02. Principal Amount of new loan(s) 502. Selllement charges to seller (line 1400) 60.00 203. Existing loan(s) taken subjecllo 503. Existing loan(s) taken subject to 204. 504. Payoff of First Mortgage Loan 205. 505. Payoff of Second Mortgage Loan 06. StaB Survey 150.00 506. S to B Survey 150.00 07. 507. 08. 508. 209. 509. Adjustments for items unpaid by seller Adjustments for items unpaid by seller 10. CitylTownlax 510. CitylTownlax 11. County/Citytax 511. County/Citytax 12 Assessments 512. Assessments 13. Schoo/Tax 513. School Tax 14. 514. 15. 515. 216. 516. 217. 517. 218. 518. 219. 519. ~20. Total Paid By/For Borrower 650.00 520. Total Reduction Amount Due Seller 210.0( 300. CASH AT SETTLEMENT From/To BORROWER 600 CASH AT SETTLEMENT To/From SELLER 301. Gross AmI. due from borrower (line 120) 6,126.55 601. Gross Amount due Seller (line 420) 6,038.0~ 302. Less Amt. paid by/for borrower (line 220) 650.00 602. Less reduction in Amt.due Seller (line 520) 210,0( 303. Cash C2J FROM DTO Borrower 5,476.55 603. Cash lSI TO D FROM Seller 5,828.0! Buyer or Borrower's Signature Seller's Signature HUD-1 r- L SETTLEMENT CHARGES Paid From Paid From 700. Total Sales Commission based on Price: $ % Borrower's Seller's Division of Commission al: $ Total Funds At Funds At I 701. Settlement Settlement 702. 703. Commission paid al Settlement I 704. I I 800. Items Payable in Connection With Loan 80t. Loan Origination Fee Cash 802. Loan Discount 803. Appraisal Fee to 804. Credit Report 10 805. Inspection Fee to 806. Mortgage Insurance 10 807. Assumption Fee to 80B. B09. 810. 811. 900. Items Required By Lender To Be Paid In Advance 901. Interest from 0 902. Mortgage Ins. Premium 0 Months to 903. Hazard Ins. Premium 0 Years to 904. 0 Years to 905. 0 Years to 1000. Reserves Deposited With lender For 1001. Hazard Insurance 0 Monlhs@$ {Month 1002. Mortgage Insurance 0 Months@$ /Month 1003. CityfTown Taxes 0 Months@$ /Month 1004. County Taxes 0 Months@$ 1.64 IMonth 1005. Assessments 0 Months@$ IMonth 1006. School Taxes 0 Months@$ 8.23 IMonth 1007. 0 Months@$ IMonth 1008. 0 Months@$ /Month 1100. Title Charges 1101. Settlement or closing fee to 1102. Abstract or title search 1103. Title Examination 1104. Title Insurance Binder 1105. Document preparation 1106. Notary fees 1107. Attomey'sfees I (includes above items No. t 1108. Title Insurance Johnson, Duffie, Stewart & Weidner ... (includes above items No ,) 1109. Lender's coverage $ 1110. OWner's coverage $ 1111. 1112. I I 1113. I I 1200. Government Recording and Transfer Charges 1201. Recording Fees: Deed $ 28.50 Mortgage $ Release $ 28.50 1202. City/County taxlstamps : Deed $ 60.00 Mortgage $ 60.00 1203. State tax/stamps: Deed $ Mortgage $ 60.00 60.00 1204. Recorder of Deeds 1205. 1300. Additional Settlement Charges 1301. Survey to 1302. Pestlnspeclion to 1303. 1304. 1305. 1400. Total Settlement Charges (enter on lines 103 & 502, Sections J & K) 88.50 60.00 Parties agree that no liability is assumed by Settlement Agent lor the accuracy 01 information lurnished by others as shown on the HUO-1 Settlement Statement HUD CERTIFICATION OF BUYERS AND SELLERS I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disburseme 5 made on my account;w-me in th~taction. I further certify that e received copy of th 1 Selllement Statement. ~ ~I ~~ , .... ~ f"nJ.Q ., 'fi / Buyer or EiPfl"ower's Signature Buyer's Address & Phone Seller's New Address & Phone Sell m tAg nt Date WAR NG: It is a crime to knowingly make false statements to the United Stales on this or any similar I *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RE$IDENTDECEDENT ESTATE OF LUKENS, DOROTHY V. SCHEDULE B STOCKS & BONDS FILE NUMBER 21-01-01148 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 $50.00 Series EE Bond Dated 7/1996 2 33 Shares - Prudential Connnon @$18.098pershare DESCRIPTION UNIT VALUE I VA-CUE AT DATE O-F DEATH --------- 31.94 597.24 629.18 TOTAL (Also enter on line 2, Recapitulation) -+ '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LUKENS, DOROTHY V. FILE NUMBER 21 - 01 - 01148 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorshIp must be disclosed on schedule F. ITEM NUMBER I Household Goods - sold at auction DESCRIPTION VALUE AT DATE OF DEATH 3,546.34 2 Allfirst Bank - Checking Account No. 00565-4886-9 Date of death balance 1,896.04 3 Allfirst Bank - Savings Account No. Date of death balance 3.512.95 4 Comcast Cable - refund 14.65 5 Verizon - refund 0.65 6 Milton S. Hershey Medical Center - refund 25.11 7 Musselman Funeral Home - refund 75.00 8 American Sentinel Insurance - premium refund 5.48 9 P A Blue Shield - premium refund 57.22 10 Dennis P. Freistak, Tax Collector - refund - personal taxes 9.80 TOTAL (Also enter on Line 5, Recapitulation) 9,143.24 .~. ~ SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LUKENS, DOROTHY V. I FILE NUMBER 21-01-01148 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES: 1. Musselman Funeral Home DESCRIPTION AMOUNT 2. BrachendorfMemorials - Marker 3 Blue Ridge Memorial Gardens - interment charges 4 Harry N. Lukens - food for funeral brunch 5 Russell V. Lukens - estate postage B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Russel V. Lukens Social Security Number(s) / EIN Number of Personal Representative(s): Street Address 567 Rupley Road City Camp Hill Year(s) Commission paid 2003 State PA Zip 17011 2. Attorney's Fees Johnson, Duffie, Stewart & Weidner' 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 4. City Relationship of Claimant to Decedent Probate Fees Register of Wills, Cumberland County State Zip 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs Cumberland Law Journal - Legal Advertisement 2 The Patriot-News Co. - Legal Advertisement Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) 6,895.00 295.00 730.00 107.64 6.80 2,500.00 2,500.00 139.50 75.00 108.43 6,129.49 19,486.86 - ~. .~ Schedule H Funeral Expenses & Administrative Costs continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LUKENS, DOROTHY V. - 3 Register of Wills - File Inventory & Inheritance Tax Return 4 Gloria J. Beaston, Tax Collector - Toboyne TwpiPerry County 5 Dennis P. Freistak, Tax Collector - County/Borough real estate taxes 6 Recorder of Deeds - Transfer Tax - sale of Perry County Real Estate 7 Thomas L. Palm, Surveyor - seller to buyer of part of survey charges 8 PA American Water Company 9 PP&L - electric service 10 Shipley Energy - oil deliveries 11 Dennis P. Freistak, Tax Collector - School District Real Estate Taxes 12 State Farm - Homeowner's Insurance - 17 Market St. Wormleysburg 13 VGI - final gas charges 14 Borough of W ormleysburg - sewer/refuse 15 Bags for removal of trash 16 County real estate taxes due at settlement - 1/1/2003 - 1/31/2003 17 ReMax/Era-Nrt, Inc. - commission - sale of real estate 18 Notary fees - sale of real estate 19 Recorder of Deeds - I % transfer tax - sale of real estate 20 Era-NIt, Inc. - transaction fee - sale of real estate 21 Reserve for close-out costs I FILE NUMBER I 21-01-01148 ,- Page 2 of Schedule H 31.00 19.79 251.99 60.00 150.00 173.70 148.45 777.88 645.74 230.21 5.83 104.00 8.49 18.41 3,000.00 4.00 350.00 100.00 50.00 '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LUKENS, DOROTHY V. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS Include unreimbursed medical expenses. ITEM NUMBER I Claremont Nursing Home - account balance DESCRIPTION , FILE NUMBER 21 - 01 - 01148 TOTAL (Also enter on Line 10, Recapitulation) AMOUNT 525.00 525.00 REV-1513 EX+ (9-00) .- SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF - -- -- LUKENS, DOROTHY V. FILE NUMBER 21 - 01 - 01148 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT -Do.NotLlsUruste8(s) AMOUNT OR SHARE OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) RUSSELL V. LUKENS , 567 RUPLEY ROAD CAMP HILL, PA 17011 SON One-half Residne 2 ESTATEOFHARRYN.LUKENS (Date of Death - 10/25/2002) 13 FERRY STREET WORMLEYSBURG, PA 17043 I SON lone-half Residne : Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet I 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 II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET \. 1,?-c:2,?- / BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DAVID W DELUCE JOHNSON HAL 301 MARKET STREET LEMOYNE PA DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-31-2003 LUKENS 12-03-2001 21 01-1148 CUMBERLAND 101 REY-15~7 EX AFP <0l-D5J DOROTHY V Allount Rellitted 17043 . 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 =is4-j-Ex--AFP--foY:03Y-NoTlcE--oF-YNHEififAifci-':fA'x-A-ppRA-isEirENT:--ALrowAifci-ifli-------------- --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF LUKENS DOROTHY V FILE NO. 21 01-1148 ACN 101 DATE 03-31-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED 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. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: 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 lI) (2) (3) (4) (5) (6) (7) 41,000.00 629.18 .00 .00 9,143.24 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H) 10. Debts/Hortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) lIO) 19,486.86 525.00 lIl) lI2) lI3) lI4) NOTE: .00 X 30,760.56 X .00 X .00 X NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 50,772.42 20.011 86 30.760.56 .00 30,760.56 00 = 045 = 12 = 15 = .00 1.384.23 .00 .00 1.384.23 lI9)= n. . (+) AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) 02-28-2002 CDoo0908 69.21 1.900.00 TOTAL TAX CREDIT 1,969.21 BALANCE OF TAX DUE 584.98CR INTEREST AND PEN. .00 TOTAL DUE 584.98CR · IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) RESERVATION: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoy.ent to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and sub.it with your payment to the Register of Wills printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS> AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice .ust object within sixty (60) days of receipt of this Notice by: --written protest to the PA Depart.ent of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (570) discount of the tax paid is allowed. PENALTY: The 1570 tax a.nesty non-participation penalty is co.puted on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of pay.ent. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (670) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are: Interest Daily Interest Daily Interest Rate Factor Year Rate Factor Year Rate Daily Factor Year 1982 2070 .000548 1987 970 .000247 1999 77. .000192 1983 1670 .000438 1988-1991 ll% .000301 2000 870 .000219 1984 ll% .000301 1992 970 .000247 2001 970 .000247 1985 1370 .000356 1993-1994 77. .000192 2002 670 .000164 1986 1070 .000274 1995-1998 970 .000247 2003 570 .000B7 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax beco.es delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION. I C- oK STATUS REPORT UNDER RULE 6.12 Name of Decedent: DOROTHY LUKENS a/kla DOROTHY V. LUKENS Date of Death: December 3. 2001 Will No.: 21-01-01148 Admin No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes ~ 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 ~ No D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attac d to his report. Date: nqUlil8 ';1:;1;) David W. Deluce Johnson, Duffie, Stewart & Weidner 301 Market Street, P.O. Box 109 lemovne. PA 17043-0109 Address o t: It\f L - ^~~l EO. (717) 761-4540 Telephone No. Capacity: Personal Representative ~ Counsel for Personal Representative ;i:J~j ::; )(}.)E1lj \. /?-,2..p- 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 '* REY-1607 EX AFP [Ol-O~) ReccrccCl Re~~1i ~~t~: CPATE ESTATE OF DATE OF DEATH FILE NUMBER AlO :"~UNTY ACN 04-28-2003 LUKENS 12-03-2001 21 01-1148 CUMBERLAND 101 DOROTHY V DAVID W DELUCE JOHNSON ETAL 301 MARKET STREET LEMOYNE PA '03 11AY 16 Allount Rellitted Ctsrk- 17 o 43Cumbeiicincj , Fi~ 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 = i6ifj-Ex--AFP--foY=03Y------...--zNifERITANc'E--fAx--sTjrfE~iE-Nf-(fF-AC-coUiff--.-i.--------------- - ----- ESTATE OF LUKENS DOROTHY V FILE NO. 21 01-1148 ACN 101 DATE 04-28-2003 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 PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 03-24-2003 P R I NC I PAL TAX DU E : .......................................................................................................................................................................................................................... 1,384.23 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 02-28-2002 CDOO0908 69.21 1,900.00 04-07-2003 REFUND .00 584.98- TOTAL TAX CREDIT 1,384.23 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 II 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" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. If RESIDENT DECEDENT make check or money order payable to: REGISTER OF WILLS, AGENT. If NON-RESIDENT DECEDENT make check or money order payable to: COMMONWEALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REY-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or from the Department's 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-3020 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5X) discount of the tax paid is allowed. PENALTY: The 15X tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6X) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rata announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20X .000548 1987 9X .000247 1999 n .000192 1983 16X .000438 1988-1991 llX .000301 2000 8X .000219 1984 llX .000301 1992 9X .000247 2001 9X .000247 1985 13X .000356 1993-1994 n .000192 2002 6X .000164 1986 lOX .000274 1995-1998 9X .000247 2003 5X .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated.