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", , , ,I:, . .', ,. ',,,,.j' 'l!\ r ',; , " ~ ' ' .. ,,', ,.: . '1"- , " . ..'" ,...J..., .~ ." No. 21 - 95 - 478 Estate of NILgS I. CLARK I Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW JUNE 22. 19-9..5..-, In consideration of the petition on the reverse side hereof, satbt'actory proof havlna been presented before me, IT IS DECREED that the Instrument(s) dntetL Ma y 23, 1989 described therein be admitted to probate and nIed of record as the last will of Niles I. Clark and Letters Testamenta ry are hereby aranted to _ GraN' F., ('1" rk RlilSlot or Wills MARY C, LEWIS Edmund G, Myers (20558) Johnson, Duffie, Stewart & Weidner 301 ... TTORNEY (Sup, Ct, I.D, No,t MarKet St., P. O. Box 109 Lemoyne, PA 17043-0109 ADDRESS FEES Probate, Letters, Etc, .,....." S 50,00 Short Certificates( 3) .. , .. .. .., S 9 ,00 ~:~ua"8~aJlon ......,......... S 2 1. 00 JCP' $ 5.88 TOTAL _ S 85.00 Flied ,;.., .~V~,~ .?~~. .m?,.....,."", (717) 761-4540 PHONE Mailed letters and order to attorney on 6-23-95., 21' . 95 ~ ,I' '" I ','.1 ,. 'I I, , I .. " j., I' II,!' ';' ," ..', ',' ii' ,I'" 'I. I I' ." ,\',-, I' 1\ .. d' , , II d\ ,\ ~\';, '; 'I, ,1'1: " II I' "', " , j,'" "" " '/, ;1' ;1\ i" '" jJ,' .I' " II ,." ,'. I' !", j.- ;1 , , .. .. , : ~ : " " :' ., I , l; "'I.' j, I' " ',.;,!! 'I"" '\' " "i-t, "1 'I H " " ,I ".'J " ,I I,', I'; "', II " , " ,. !to 'II p,~', I' ,;;' ..J 'Ci '" \{tJ ,'0, 1'-' ri','j. i ~ '_I' l,~ I', . , H I' ,. I I,' 1", i;: , " I, ,! ',.1' fe', " " " I_I; '/.\i.;' Ii. 'i; '.1' , (,I u' ". ih;;,1. (', p ". i,_ I, 'ii ;g.~. .. I' " " " 11\ 'I", I " 'I' "j, " " I,,! 'j ',-,. I' Ii ,I.. I, .. " IJ/ ,', " , , ,. " dl jl ., " ,~ ' \' I', ,', . I ~ " , " I. , Ij " 'I; I, ';i' ,. In HI' ,I , 'Ii!, 'I' " \; , , I' , I, ,i 't1\ 'l~ \0 U1 a:> .., I, I' , \, ,-j t., d, II '; ''I Ii Ii i, " ,',1,_. /, , " " ,.1' I, ,. " , I " " " ",' I... , I. ':0 '" :nco. (I> [". r() ':1 ".,,-, r,\ n) f i~' :l,,~ l:'..' "; ') ;:.y :g~~ f'Y' .. (ii' '[) ;~h \ ie " ~ I. I' !i. ., /, 'Ii I' ,", .1, !' I{ 1-,,';', I' "j , '\1 1\," j'" 't, ' < /' " " ,j; if' I, " if, ,) I,j, i'" I' I;, " ,. I, " " ;i .. ;1, 1 I ",.,i' 1"'1 I',,', .I,' '\I II, ", \-'1 ). 'I 'I' " I ij, ,. It,' :'!'_I' ,,I. " , l,n. " " .,1' " \" 'I, I, , ;. I' "I' " I '; ,~,I' j-' " 1.- ,. I' j ,. " '" It/: i, 1.,/, .. 'i. " " ,'< "I. I' 1\, I 'l '1 ~ 'I l,\ ;",It 'ji, W' i ,:,~ t I,':'. ; '1'1' '-,\ . , LAST HILL AND TESTAMENT OF NILES I. CLARK I, NILES I. CLARK, of Lemoyne, Cumberland County, Pennsylvania, revoke my prior wills and declare this to be my last will: I. Debts and Funeral EXDenses: My lawful debts and the expenses of my last illness, funeral and burial shall be paid out of my estate. II. Personal and Household Effects: I give all my automobiles, and all other articles of personal or household use, together with all insurance relating thereto to my wifw, GRACE E. CLARK if she survives me by thirty days, If she fails to so survive me then I give all such property and insurance to such of my children as so survive me, to be divided among them as they may agree or, in the absence of agreement or if any of them is a minor, as my executor may think appropriate; provided that articles which my executor considers unsuitable for a minor child may be sold and the proceeds thereof added to my residuary estate. My executor may, without further responsibility, distribute property passing to a minor under this article to the minor or to any person to hold for the minor. III. ~duarv Estate: I give the residue of my estate, real and personal: A. To my wife, GRACE E. CLARK, if she survives me by thirty days; or, if she does not so survive me, w ,~, ',' u~ ilH ~ll, ~r;'l ~i'\ i!I.~.. III iI' rx'1il ""11 I~!..) , ~;.;\i!f F;;,,'. .:~ :~". ',1' :~ '- ~ ,"\ ;i1 " B. In equal shares to such of my ohildren as so survive mel provided that if a child does not so survive me but leaves descendants who so survive me, such descendants shall reoeive, per stirpes, the share that ohild Nould have reoeived had he or she DO survived me. IV. Benefioiaries Under 21 or Dis~: If any benefioiary beoomes entitled to an outright distribution of inoome or prinoipal and is (i) under 21 or (ii) in my trustee's opinion, disabled by illness or other cause and unable to properly manage the funds: A. As muoh of suoh income or principal as my trustee may from time to time think desirable for that benefioiary either shall be paid to him or her or shall be applied for his or her benefitl and B. The balanoe of such inoome and principal and thfl net income from those funds-- shall be kept invested and managed as a separate trust for that beneficiary, with the trust funds paid to o~ for the beneficiary in accordance with the provisions of the preceding paragraph, When the beneficiary reaches the age of 21 or, in my trustee's opinion, becomes free of disability, as the case may be, the balance shall be paid to the beneficiary. If he or she dies before that time, the balance shall be paid to his or her executors or administrators. Any funds to be applied under this article either shall be applied directly by my trustee or shall be paid to a parent or JI ,..:.",:' \;;.;:-~""';',';"r~''''.'''''-.f'r''~'-'''\'''',' l. [i r,l; , '. guardian of the benefioiary or to any person or organization taking oare of the benefioiary. My trllstee shall have no further responsibility for any funds so paid or. applied, V. Earl v Endina of Trustll: If my trustee, in his sole cHscre.- tion, determines that it is desirable to do so, my trustee may end any trust under this deed. This may be done by paying the then-remaining principal and income of that trust to the person then eligible to receive the income. If any person is a minor or is, in my trustee's opinion, disabled by illness or other cause and unable to properly manage the funds, my trustee may pay the funds to his or her parent or guardian or to any person or organization taking care of the person. In the case of a minor, lny trustee also may deposit the funds in an interest bearing account in the minor's name payable to the minor at majority, or appoint and pay the funds to a custodian for the minor under the. Uniform Gifts to Minors Act of any state. My trustee shall have no further responsibility for funds so paid or deposited. VI. ExQtective provision: No interest in income or principal shall be assignable by, or available to anyone having a claim against, a beneficiary before actual payment to the beneficiary. VII. Death Taxes: Any federal, state and other death taxes payable on the property forming my gross estate for tax purposes, whether or not it passes under this will, shall be paid out of the prinoipal of my probate estate just as if they were my debts, " \ , . ~.". ," ... ~.,":I'''' ''''1'"'''' '.' ,~~ I ..I"i:.II~..-" ,r',_,'.':,',,", f.:,r'T~" " :~..~ I '. ',I !:~t l..1 ,\, ".,\ ~,I;J ....~.;'\),r." " and none of those taxes shall be charged against any beneficiary. , , 'I " , VIII. Manaqement provisions I I authorize my executor and my trustee I A. To retain and to invest in all forms of real and personal property, including common trust funds regardless of any limit~tionB imposed by law on investments by exeoutors or trustees, or any principle of law oonoerning investment diversifioation; B. To oompromise claims and to abandon any property WhiCh, in my exeoutors' or my trustees' opinion, is of little or no value; C. To borrow from, and to sell property to, my or my spousels trustee or others, and to pledge property as security for repayment of any funds borrowed; D. To sell at public or private sale, to exchange or. to lease for any period of time, any real or personal property, and to give o~tions for sales or leases; E. To join in any merger, reorganization, voting-trust plan or other concerted action of security holders, and to delegate discretionary duties with respeot thereto; 'I' ".-".':.'. '.'.' 'j' It' :.1\ r f\\ I', F. To use administrative or other expenses of my estate as inoome tax or estate tax deductions and to value my estate for tax purposes by any optional method permitted by the law in force when I die, without requiring adjustments between income and principal for any reSUlting effect on income or estate taxes; and tl ,I~ >;' I' ': ! G. ~o distribute in kind and to allocate specifio assets among the beneficiaries (inClUding any trust hereunder) in such proportions as my executor may think best, so long as the total market value of any beneficiary'S share is not affected by such allocation, H. To join with my spouse in filing a joint income tax return without requiring my spouse to indemnify my estate against liabHity for the tax attributable to any income, and to consent to any gifts made by my spouse being treated as having been made one-half by me for the purpose of federal laws relating to gift tax, These authorities shall extend to all real and personal property at any time held by my exeoutors or my trustee and shall continue 'in full force until the actual distribution of all such property. All powers, authorities, and dJ.scretion granted by this will. shall be in addition to those granted by law and shall be exercisable without leave of court. IX. ~outor and Truste~: I appoint my wife GRACE E. CLARK executrix and trustee of my will. If she does not w'ish to or is . unable to aot, then I appoint DANIEL I. CLARK substitute executor and trustee. If is unable to serve then I appoint BARRETT N. CLARK as executor and trustee. All are to serve without bond. IN WITNESS WHEREOF, I have hereunto set my hand and seal this t 3 day of ~____.19a9, at the end hereof, composed in all of {, pages. '~.C~:(j:~ ,," r.,',' , " , '1' !., , " "', " I] .' " . , I' ", ,I" " , ,. " , I: I, , , " 'I' I,' "'I " ", , II" I,', II' I, " " 1 ,.' , \\ i. ,-(~" exeoutrix and trustee of my will. If she does not wish to or is unabl~ to aot, then I appoint DANIEL I. CLARK substitute exeoutor and trustee. If is unable to serve then I appoint BARRETT N. CLARK as exeoutor and trustee. All are to serve without bond. IN WITNESS WHEREOF, I have hereunto set my hand and seal this' ,-I '/ l Jt 'y ;) day of ) t"d 1989, at the end hereof, oomposed in all of f.., paqes. ~....~ Q Ai:. )/ V, . I S I. CLARK f-j~;L-j~ , , ,\ " "{', (, ,.' I. I'".. " " ", , I ., , " '.' ' f,', ': ' ,',"\ " " ," , , , , ",\f '. '. " " , SIGNED, SEALED, Testator as and for his of us, who, at his of each other, all aat our ..nda~. PUBLISHED AND DECLARED by the above Last Will and Testament request, in his presence and in the being present at the same time, tnesses. named in the presence presenoe have hereunto address Lib 2~~ ~l;Z{{el/)V' t L)( )0 /7 / I {\ . ", ~~t-;L. address ,,' u !I " " , .:', , " , , I' 'I " L ,. ,. '" II " " ," I I' ,. .. " " I " , " II " I' " " , ,I " " , " " :' I' I'. , , .. ,I , " ,11 ,. .5 .. , ," i' ,I' " !, " , . " , " , " , '" " , 'I " I' " " " ". ,/1' " .. .. " .' .. " ", /, ", .. ,Ii .. 1/. " " .' It 1 ,1\ , , , " I,: ., " I, , " ',' I, . , 'i "~I; " .I'. .. , I' ,,, , I .. " , " , " " " , "t I" " ", , 'I' . , , .. " " . ' . .,-.~" ~ CERTIFICATION OF NOTICE UNDER RUl,E 5,6 ( a) Name of Decedent I NILES 1. CLARK Date of Death I January 2, 1995 Will No, 0478 Admin, No, To the Rogister! I certify that notice of benofJcia1 interest required by Rule 5,6 (a) of the Orphans' Court Hu1es was served on or mailed to ,the following beneficiaries of the above-captioned ostate on June 22, 1995 I ' ~ Graoe E. Clark (Surviving Spouse & Executrix) Address 312 Old Fort Road, Lemoyne, PA 17043 Notice has now been given to all persons entitled thereto under Ruie 5.6(a) except None Datel c:Jh1Sf'1r , ~~/%1%'- Signature Name Edmund G. Myers, Esq. Johnson, Duffie, Stewart & Weidner Address 301 Market St. P. O. Box 109 Lemoyne, PA 17043-0109 \' I ' 't'i '1"'I'_una '010, )11 ' Telephonell7) 761-4540 rQ:(JIII ,tiZ ~nv :'6. Capacity I Personal Representative Counsel for personal representative fill 1i.\ x ,;u 'I:J!:-J Is -~o'11 ~ fOR DAIIl 01 DIATH AnlR 1~/31/91 CHICK HIRI INHERITANCE TAX RETURN ~'o~m~,uWDIIIIClAIMID ~ RESIDENT DECEDENT r;liINuMm---n CUMMONW,"'" 00 '/NN!,,,AN" (TO BE FilED IN DUPLICATE .1 21 PEru MINt 0' RfV(NUf om 110001, WITH REGISTER OF WillS) .COUNT_Y '_0.'1 _ YEAR HU.IUURO~ h "'21,O~O _ _ DON' NAM t."U.'1 ,AN loll Dl INI 11011 - ~I- tllCIDltll ~ CO'MlfH "D~qU CLARK, NILES I. 312 Old Fort Road ~OCI"I nCull'" ....UMU. D'1I 01 [l(A1H "lD;:;ioi'iii;;;---- LOnloyne, PA 17043 203-10-7918 1/2/95 B18/20 C,"', CUMBERLAND ('1 oI."II('hl, hih',".t.I ~'O.JU" ~h'IIo'" IICI' ",'.D ~IPM ''i'I''1I ~OCIAI ucvwi17liMlII AMOUN! ItCII'IIt' lSlIIt;5UuClI0N5j :{o.' ~,t I'. ,~~A! '" !'is'' l:i:f~ :J:~9 uil/'" ~:~'v, ~ .. 15 e U w " 95 0478 NUM8ER $1l.394.31 ~ 3, [1 s. Grace E. Clark [11. Original R.'u,n 204-03-0153 o 2. SlJppl,m,nlal R.turn o A. limit.d EIlal. 0 Ao. Future lnltrlll Compromiu 110' do", 01 d.o,h oher 12,12,92) fi6. Dlud.nt Di.d T.llol. 0 7. Dec,d.nt Maintain.d a living T,ull IANoch copy 01 Willi IAlloch copy 01 TM'I ALL CORR~SPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE lllRECTED TO. NAMI - COM'LllI ....AILING AOOr.IU Edmund G. Myers. Esq. Johll8Oll. lXIffie. stewart: & Weidner 1''''''oNl NUMI" 301 Market st.. P. O. Box 109 ( 717 I 161-4540 ne PA 17043-0109 I. l.ol E 1I01t ISch.dul. A) 111 2, Stock, and aond! (Sch.dul. al 121 3, 'Iollly H.ld S'ock/PorTn",hlp In'. rill ISch.dul. C) 131 4, MOMgOS" ond Nolt! Rec.lvobl. ISch.dul. 01 141 5. COlh, Bonk D.posl's & Milcellon,oul P,nonol Propflrty (5) ISch.dul. EI 6, Joi"ly Own.d P,op'''y ISch.dul. FI 161 7, T,o"I,,, (Sch.dul. GIISch.dul. LI 171 e. TOlal Grall An'"ltotallir.tI 1.7j 9. Fun.ral hp.nus, AdminiUrotlv. COlli, Milcelloneoul 19) "Plllll! ISch.dul. HI 10, D.b", M01l909' lioblll'i.., li.n. ISch.dul. II 1101 11. T 0101 D.du~ion! 110'01 llnll 9 & 101 12, Nil Volu. 01 Ellolt ILlno 9 mln" lln. 1'1 13, Cho,ilobl. and Governm.nlol a.quII" ISch.dul. JI 14, N., Volu. Subj.ct 10 To, Illn. 12 minu! Lln. 131 15, Spou,ol T,onll,,! liar dOlt' 01 d.olh oher 6,30,941 S.. Inllru~lonl 101 Applicobl. PerctniOS. on R.v".. 115) Sid., Ilnclud. volulI ',om Sch.dul. K 0' Sch.dul. M,) 16, Amoun' 01 L1n. 14 'o,ohl. 01 6% rolt 1161 Ilnclud. volulI Irom Sch.dul. K 0' Sch.dul. M,I 17, Amounl ollln. 14 'o,obl. 01 15% 'Olt 1171 Ilnclud. volu.. f,om Sch.dul. K or Sch.dul. M,I 18, P,lnclpol'o, due IAdd '0' /rom lIn.. 15, 16 and 17,1 19. Credill Spousal Po~,.r1y Credil Ptlor Peym.nll + + 20, II Lln. 19 II g"o'er ,hon lln. 19, .nler Ih. diHtrtnct on line 20, Thl. II Ih. OVERPAYMENT, me R.moind., R'lvrn 1101 do'.. 01 d.o,h p'ior '012,13,92) F.d.ral Ellal. Tax R.lurn R.qulred .... ",15 .... "a: SIe z S! 5 ::> .. ~ .. z 2 ~ . " U ~ .. _ 8, 10101 Number 01 Sol. D.po!iI 80'" 1,449.54 20,521.63 9,821.25 19 ) 21.971.17 755.61 11,394.31 1111 10.576~ 112) 11,394.31 1131 -0- 1141 11.394.31 K,QQ..a -O- K ,06 a -O- K ,15 a -0- 1191 -0- 1191 -0- 1201 OJ.count Int.rlll efll'd, 111'1(' .1 you m(' .('(I\H'~1'"9 n ...fund 01 vour ovrrpnVml'ftl 1211 121A) 121al _ -0- -0- -0- 21. IIlln. 19 I. 9,,01t, Ihon lln. 19, .n'"th. dIHer.nc. on line 21. Thll II 'h. TAX DUE, A. Ent.r 11'1. int.,.u on 11'1. bCllanct due on lln. 21A. 8, Enlt' Ih. lOlnl 01 lIn. 21 and 21A on lln. 219, Thl, I, ,h. BALANCE DUE, Mo~. ChICk Pay obi. to, R.gI.t.. .f Will., Ag.nt ~ ~. IE SURE fO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH oIl(-< Und.r p.nahi'l of p.rlury, I d.clar. lhall hov. lJtamlnild lhil r.turn, including accompanying Ich.dulll and IInt.menU, and 10 Ih. bIll of my Mnowl.dg. and blll.f, It h tru., (O".ct and compllll. I dlclar. thaI 011 r.al '1101. hOI bun repart.d ollrv. mark.t valu.. O.cloraliun of pr.par.r olh.r Ihan Ih. p'rlonal r'pr...ntallv. h bal.d on alllnformollon 0 whIch r. m.r nOI an knowltdge. "~~IU' 0' '''jQJ<' ,o"III~' IIINO liMN AOOIIU 312 Old ~ort Road OAlI ,l'-y, :.<., (' :?0A 7'lzrr!95 " {. (; VI AODlIl 301 Market St., P. O. Box 109 OAT~J l"~ I........ )/....; :,(~~ .... ----.WJpvne. PA 17lJ.43-0109 fJ It'?" am.md G. Myers ' Act '48 of 1994 provld.. for the r.ductlon of the talC rat.. Impo..d on the n.t valu. of Irand.,. to or for the u.. of the 'POUI', Th. rat.. a. pr.mlb.d by the .tatut. will b.1 . 3% (.03) will b. appllcabl. for ..tat.. of dllc.d.nh dying on or aft.r 7/1194 and b.for. 1/1/96 . 2% (,02) will b. appllcabl. for ..tat.. of d.c.d.n.. dying on or Clft.r 1/1196 Clnd b.for. 1/1/97 . 1 % (.01) will b. appllcabl. for ..tat.. of d.ced.nt. dvlng on or Clft.r 111/97 and b.for. 1/1/98 · Spou.al trand.r. occurring on or aft.r 1/1198 will b. .xampt from Inh.rltanc. tax, PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (....) IN THE APPROPRIATE BLOCKS. YIS 0 1. Old decedent make a transfer and: g, r.toln the us. or Income of the property transferred, .....".................."..............."........... x b. retain th. right to designate who shall use the property transferred or Its Incame, '........,..,.. x c. r.taln a reversionary Int.r..t; or "'..,.,..........,...,........,.."....'....0...................,................. x d. rec.lv. th. promll. for 11ft of elth.r paym.nll, benefits or care' ,..,....,..,........,........,......... 2. If d.ath occurred on or before December 12, 1982, did decedent within two years prec.dlng d.ath transf.r property without receiving ad.quate consideration' If death occurr.d aft.r D.cemb.r 12, 1982, did decedent transf.r property within on. year of death without r.celvlng ad.quat. consideration'.., I.............,........"...,......,.........,..,...............,..............,..,............. x x 3. Old d.ced.nt own an 'In trust for' bank account at his or her d.ath"',........,..,......,..............., x IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. '" .. '. , {'I I ,. " , ~...' "l.l I ~ 1 U:' ~.j'l ,J :; l5u RIY,11011K+ Ij,I61 ~~ COMMONWIALIH 0' P1NNIYlYANIA INHI!IlANCI IA~ U!UIN IIlIDINI OICIDINI ISTA" OP SCHEDULE B STOCKS AND BONDS PILI N MiliA CLARK. NILES I. 21-95-0478 (All p,oporty lolnlly.ownod with Al,hl of Survluollhlp mull bo dllClolod on Sch.dulo Po) ITEM NUMBER DESCRIPTION 1. VALUE AT DATE OF DEATH 71.5823 Shares UGI Corporation Coomon Stock @ $20.250 per share $ 1,449.54 'I, ,; " ,. " , ., 1" .. ..' " , " " TOTAL Alia .nlor on IIn. 2, Roco lIul.llon (1/ more 'poco Ie n..d.d, In..rt addiflona' ,h.." o( lam. ''",) $ 1,449.54 ""III'hP"" ~' '. SCHEDULE H . J'i:~ FUNERAL EXPENSES, COlo\MONWIA-;;H O;';INNIYlVAN'A ADMINISTRATIVE COSTS AND INHIIIl.NCI 'A' IIIUIN MISCELLANEOUS EXPENSES IIIIDINI DICID NI ITEM NUMBER A. 2. 3. II. A, C. 1. 2, 3, .c. 5. 6. 7. 8. PI. a.. P,lnt 0' T . CLARK, NILES 1. 21-95-0478 DESCRIPTION I, Funeral bp.nu.. Musselman Funeral Home, Inc. - funeral expenses; grave opening and minister's gratuity Church Hill Canetery - installing Veteran's marker Church Hill Cemetery - gravemarker 1. Admlnlltratlv. Coil.. P.r1onal R.prtl.nlatlv. Commllllon. Social S.curlty Numb.r of P.rlonol R'pr.l.nlatlvtl V.a, Cummllllon. paid 2, "'"orney F... - Johnson, Duffie, Stewart &' Weidner 3, Fomlly Ex.mptlon Claimant Grace E. Clark R.lallon.hlp Wife Addl'tll of Clalinanl at d.ced.nl'. d.alh 312 Old Fort Road Str"l Addr," CIty Lemoyne Stat. PA Zip Cod. 17043 P,obat. Fe.. - P.egister of Wills - Cumberland County Mllctllan,oul Elcp.nl... Register of Wills - file Inventory & Inheritance Tax Return Reserve for close-out costs TOTAL (AI.o .nl.r on IIn. 9, R.capltulatlan) (If mo,. Ipan II n..d.e1, Inurt aclelltlonallh.... of lam. 111t.1 AMOUNT 4,920.40 60.00 2,975.00 750.00 955.85 85.00 25.00 50.00 S 9,821.25 - I-',"~ ,:,',', "-~t~';i i.'~i::',;..."._;.~~:j,~":~,,,~' . .IV.UU~". 11,'11 W (OIrll"OHW,Al1H 0' "NHinVl,HIA . tHHU""NCI1,.MIIfUlH _UIDlHI DlelDIUI SCHEDULE J BENEFICIARIES mATI OF FILE NUMBER CLARK I NILES I. 2l~95-0478 ITIM NUMB~R NAME AND ADDRESS OF BENEFICIARY . RELATIONSHIP AMOUNT OR SHARE OF 1ST A TI A, To.obl. hquIIl1I 1. Grac~ E. Clark 312 Old Fbrt Road Lemoyne, PA 17043 Wife ' Personal & Household Effects and Residue ,'" . ," \' ITEM NUMIER NAME AND ADDRESS OF BENEFiciARY AMOUNT OR SHARE OF ISTATI B. Cha,hobl. and Gov.rnm.ntal BoquII11I 1. I: " , TOTAL CHARITABLE AND GO~ERNMENTAL BEQUESTS IAho .nlor on ,In. 13, Rocaphulanon) 111 more .pan 11 n..d.d, In.or' oddlllonal ~h.." af laml II..) $ I' .. . , . . REV.1649 F.Xt (8I9l) '* SCHEDULE 0 TRANSFERS TO SURVIVING SPOUSE ~nIOfmHIYlVANIA NDrrANl'B TAX U'1'VlI14 -- F.lITATEOF FU.Nun'Nr CLARK, NILES I. 21-95-0478 'JART Al F.~I" tho cb<,lfIllon and v.llI. ofalllnl"'IU, bo!h ,...hl. .nd non.I...hl., "gudl... ofl",.lIon, (n<t of l~du,UOIlI) whl,h pullo tho drctdrnl'..urvlvlnglflOlI" hy will, InIOll"Y, o~,,'lon of IllY, .. oll~r\\'h., Dcscripllon of Iloms I Amount UGI EInployees Federal Credit Union - IRA ACCOlINI' No. 10900-76-1 Designated Benaficiary: Grace E. Clark $ 11,394.31 2. Residue - Paragraph III of decedent's Will - See attached. -0- 'Paii'A"T0II1: I!nl<<tho II110lUnl ahown on tho ,,,,,pUIII.llon Iltort In the Il<<td.n' Inlonn.Uon SoOt/OIL ~ 11 1q4 11 Election To SubJcc:t Property To Tn Under Section 2tlJ(A) A. A Tuable Transfer By Thl. Decedent, II .lnlIt ",.lmIlar ItrI/1grmll1l modi the ..qui,,,",,,~ ofSO<\lon 2113(A), and: L Tho lnlIt ",.Imllu mangrmonlI. IIst.d on S,hodul. 0, and b, Tho valu. of tho lnlIt ",.Imllar mangomenll. onl",d In whol. '" in put u an....1 on S,h.dul. 0, then the trwf....... pononal 'cpresrntaUvo may 'po<lfically Idrnllfy the !nlll (.11 or. fraelluOlI fIO,tlon or ",,,onl.g.) 10 he Included In II" .I.ellon 10 h.v. lOch lnlIt ",.lmIlar property 1r00lo4 u. .....bl'IrANf" In !hI. ""to, If 1",1han lhe oollra valu. of 0.. IlUst ",limllar proprrty i.lnclurlod u . .....bl.trwf.. on S,hedul. 0, tho pmonal..pr....~II.. ""II he ,on.lder.d 10 ha.. made tho .I'ellon only u 10 . f,actlon of the ltult ",.lmllar mang"""'I, Tho 00",...1", ofW. fraction Is equ.llo tho amounl of!h.llUlt ",.Imllar urang""",1 included u. "'"hl. w<t on S,hedul. 0, Tho donomIna'", Is equ.1 10 the 10001valu. of tho IlUlt ",.bnll" IITIltgomenl. ELECI'ION, Po you.1rd w.r St<tlon JII3(A) 10 ,,,.1 u .,...b"lrarul.r In lhla ....... aU or. ponlon .1.,,,,,, o..lmllar ...II1'....nl ,,,.,... lor the ........ .llhb d".d.nl'..urvlvln"po'" durin,lh. .urvlvlll"po"'" toUre UI.lImt1 YES D NO [-] Sll1\llul< Il,I. Notillftlt. tlKtton .ppUtt to mort than ont trwt or Ilmllu arnnlrRlrnt, thrn 11 Itp.ratr ronn mwl bt Illnrel andlUtd. Part HI Euler tho dtscriflllon and v.lu. of.lllnl"OII., bo!hl..,bl. lod /lon,lmbl., "gudl.u of 1",.11011, (ncl of deductions) whl,h pullo the dooodonl'..urvlvlng .pou.. for wld,h I S.ction 1113 (A) .I.ellon I. heln made, Description of itoms Amounl I PIllDT....1 , .. ESTATE OFl CLARK, NILES I. RE5IIXJE !i Assets '" Schedule B $ 1,~49.54' Assets , , . rtemsl, 2 and 4' of Schedule ill " 9,127.32 ,\ Total Assets '$ 10,576.86 I ", Deductions Schedule H 9,821.25 ) Deductions - Schedule I " ,755.61) \I " Residue ,~o... !; ';, iI'o " " ' Ii, "I' ., " ,I' " i:' 'Ii ..' ,li' ,'.,. ." ,'I , .. , " 'I 1),.1, ", " "" , , , " " " " I' " 'I, 'I, ,-." "".,' " " " " , " " " "1-1 " " " , \, ,\' , II l) I' Li (.,' 1\ \1 ; ", " " ',I ,j: 'I-' " " , " , " " " '4. " ,,' t, , J'I "'I 'II, " , " III , " (;, " " Ii> 21-95-0478 " , " " ,', ",,I ",I' " ,. , " f'l' ., 1; jl' ,,/' .' " " ,,;!, , " .' "I',. d;' ,l" 1/ /.5 'It>. /3 ~I NOTICE OF INNERITANCE TAM APPRAISENENT, ALLOWANCE OR OISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAM DA TI! 01- 09 - 9 6 c= FILl! NO. -- "'2T ~-0478- DATI! OF DI!ATH 01-02-95 COUNTY CUMBERLAND HOTE. TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUINIT THE UPPER PORTION OF TNIS FORN WITH YOUR TAM PAYNENT TO THE REOISTER OF WILLS, HAKE CHECK PAYAILE TO "REGISTER OF WILLS, AOENT" REMIT PAYMENT TOI RI!Yo1547 I!X AFP (12095* COMMONWEAL TII OF PEHHSVlVAHU, DEPARTMENT OF REYENUE IUllEAU Of INDIVIDUAl TAXES Il[PT. 110601 HARAlllUAO, PA 11121.0601 ACN 101 -~ EDMUND G MVERS ESQ JOHNSON ETAL PO BOX 109 LEMOVNE PA 17043 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 r AMount R.Mltt.d - J CUT ALONG n:u LINI! .. RI!TAIN LOWER PORTION FOR YOUR RECORDS .. R"!V: i5'47 0 sic' AFpo, f l'F 9sT. Nor-icE" -oF - "iNHER if ANcE -r-A' x - 'ApjiitXiiiEiiiNr; 'ALrowAifcE' ijli' - -... -. -.. -... -. DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATI! OF CLARK NILES I FILE NO. 21 95-0478 ACN 101 DATI! 01-09-96 TAM RETURN WAS I I X) ACCEPTEO AS FILEO () CHANOEO RiiiRYATION CONC!RNING FUTURE INTEREST - SF.E REYERSE APPMAISI!D YALUE OF RETURN BASED ONI ORIGINAL RETURN 1. R.el ElIoIo (S.h.dul. A) (1) 2, stooke end Bondi CSoh.dul. B) 121 s, Clol.b H.ld Stock/portn.rohlp Inlorllt CSch.dul. CI IS) 4. Hart..geI/Not.1 R...I,.bl. (Soh.dul. 0) (4) i, Cllh/llonk Oepolih/Nhc. Parlon.l Prcparty (Schldul. E) IiI 6, JointlY Own.d Prop.rty (Sch.dul. FI 161 7, Trenlf.rl (Sch.dul. 0) C71 a, Tot.1 huh .00 1,449.54 .00 ,00 20,521.63 .00 .Jl.Q.. (e) 21 ,971.17 APPROYI!D DEDUCTIONS AND EXEMPTIONS I 9,821,25 9, FIlM""1 Exp."uI/Ad., CClh/Nho. E.plnul (Schldul. H) C91 10. D.bh/Nortg.g. LhblllUII/LI.nl (Schldul. II 1101 755,61 11. Tot.l D.duotlcnl (11) 12. Not V.lue of T.x R.turn (121 IS, ChorU.bl.IOovarn..nlol I.qullh ISch.dul. JI liS) 14, Not V.lu. of Eliot. Subj.ct to To. 1I4) NOTEI If In 811111~lnt WII ilauld previaully, line. 14, 15 end/or 16. 17 and 18 refleot figure. thAt includl the total of abh rlturnl 1IIIIIed to dati. ASSI!SSMI!NT OF TAXI Ii. Aoount of Lln. 14 .t SpoUI.1 r.t. 16. Aoount of Lln. 14 t...bl. .t Lln..I/CI.I. A r.t. 17. Aoount of Lln. 14 t...bl. .t Coll.t.r.I/Cl... e r.t. Ie, Prlnolp.1 T.x Du. TAX CRl!DnSI PAYNE NT DATE 10.;7(,.8& 11,394,31 ,00 11 ,394 ,31 will lIi) 1I6) 1I71_ 11,394.31 M ,00. ,00 M ,06. ,OO.M.15. lie) ,00 .00 ,00 ,00 RECEIPT NUHIER DISCOUNT Ct) INTEREST C-) AHOUHT PAID TOTA~ TAX CRI!DIT BALANCI! OF TAX DUE INTI!RI!ST TOTAL DUE ,00 .00 ,00 .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN ii, NO PAYHENT IS REQUIRED, IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU NAY DE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.) ". RUEA'I~TlO'h _Of NOTICE, ~A\'HfNTI REf UNO (CIlI' OlJl!CTlOIII. ADf1IN IIlRATlYl! CDRRt:CTlOIII, OIlCDUNT' INTEREIT, " ,., ,.il " , ' ,,," "I' , " ,. .. " " !.J :o'L,) ':('1 J'" In I ",-'j " 1\ ~jR ..-1 () E,t,t.. of dlc,dlnt, d~l", on or btfor. Dtetlbtr 12, .9" -- If tny future lnter..t In thl II'at. 1. t,,".flrr.d In pall..lton or .njoYI.nt to C1I.I . (cal1.'.r..' beneflcl,rl.. of ~h. dlCodInt .ft,r thl 'Mplr.tlon of any Ilt.t. far 11'. or for VI.r., thl COIMOnw.llth hlr.by Ikpr..llv r...rv.. thl right to Ippr.ll. ,nd ...... tran.f.r Inherltancl TIM" It the ltwful Cl... . (colllt.r.l) rat. on tnV ,uoh future Intlr..t. To fulfill thl requlr...nt. of Slot Ion 21~O of thl Jnhlrltanc' and E,t,t, T.~ Aot, Act 22 of 1991. 72 P.S. IlOlIon !l40, Detach thl top portion of thl, Hotlo' and .ubllt with your Plvaent to t~ Rlgllt,r of Will' printed on thl r.ver.. ,Id.. ""Ik, chock or oono. ordor .,.obl, to, REOISTER OF HILLll, AOENT All Plvantt r,cllved 'hlU fin' bl IPPUld to .ny lntor..t which .IY bt due with *,y r...lndtr IPPU,d tc thl hie., A r.fund of . tllC or,dlt, which WI' not r.quelted on thl TIIC Alturn, .,y bl rlqueltld by a~.pl.tlng 10 "Appl1cltlon for R,fund of Penn,vlvant_ tnherltance and E,t,t, TalC" (RfV~IS1S). Appllcltlonl Ir. Iv_titbit It t~ Of,l01 of the Algl,t,r of Willi, any of thl 25 Aev.nuI Dlltrlot Offlol., or by cll11ng thl ,plol,1 2~.hour InIVlrlne '.rvlol ~'r' for for.. orderlngl In Penn'Ylvant, 1-100-362-2050, outtlde P,nn.vlvanll ~ ~Ithl" lOCI. Hlrrl,burg .rl. (717) 7'7-1094, TOOt (717) 772-2252 (HI.rlng l.p,lred Only), Anv p.rtv In Int~r..t not Iltl.ft'd with the Ippr,l...ent, allowlncl or dl..llowanct of deduction., or a......-nt of tllC (lnoludlng dhClc.unt or Int.rut) .1 .hown on thh Noucl 1\I.t objlct within .httv l60) dl'tI of rlcllpt of thlt Noue. bVI ..wrltt.n protl.t to thl PA D_p,rt..nt of RIV'nu., 80ard of App.al., D.pt. 281021, H.rrl.burg, PA 11128.1021, OR --lllOtlon to hlv, thl latt.r d.tar.lned at ludlt of the account of thl p.r.on'l rtpr...ntltlvl, OR ulPP.al tp the Orphan.' Court. Flatul. .rrar. dl.,ovlr.d an thl. a.......nt .hould bl addr....d In writing tal PA Dlplrtl,"t of A.v~, Bur.au of lndlvldull TIXI', ATTNI po.t A.......nt Rlvlew unit, D.pt, 280601, Hlrr.tbYr" PA 1712'.0601 Phone (7171 781-650S. S.e P'" S of thl book)lt "rnttruetlonl for rnh,rltancl Tax A.turn for I RI,ldlnt Dtel~t" (REY-1S01) for 10 Ixplanltlon of Idllnl.tr.tlv'lv corrlct.bll Irror.. If IIOV tllC due 11 p.ld within thr.. (5) clllndlr lonth. aftlr tho dlc.dent'. duth, I flYI p.rclnt UX) dhootM'\t of thl tlM Plld I. 1110w.d. Jnterl.t 1. chlrged bl,lnnlng with flr.t dlV of dellnqulnov, or nln, (9) .onth. and one (1) day fro. tht dltl of dlath, to thl dati of PIVMtnt. T.IC., which bee... dlllnqu4nt blfor. J.nulrv 1, 1912 bllr Inter..t It thl rlti'of .IM (6X) ptro.nt plr ~ cllcullttd .t I dlllv rltl of .OOOI6~. All tlICI. which ble... dlllnquent on and Iftlr Jenulrv 1, 1912 will bl.r Intlr..t at I rat. which wIll yatv fro. calandar Vlar to c.llndar V'lr with thlt rlt. aMOUncld bv the PA O,plrtHnt of Revenut, TM IPplhlbl1 Intlrllt ratll for 1912 thrOUGh 1996 aral '!!!!: Int.rut Rlt. DallV Int.rl.t Factor t.!!r Int.rllt Alt. DIllv Intlrllt Flctar I9IZ ZOX ,0001\1 I9IT 9X ,DDDU7 1915 16X ,omn 1911-1991 IlX ,DODm 191\ IlX , oaDm 199Z 9X ,Doam 1911 llX ,ODOSl6 1995-199\ 7X .ODll9Z 1916 lOX ,DODm 1991"1996 9X ,ODDZ\T utnt.rllt I. oalcullt.d I. followll INTERElT . BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR ..Anv Notlel luued Iftlr thl tlM He... dellnqu.nt wllJ rlfleet II'l I"terll' clloullUon to fltt"n USl dlV' b.yond thl d~Ut of thl ......HRt. 1f pavant It ..d. aft.r the lntar..' COfIpUtlUon at, ihown on 'hi Hotlcl, .ddltl~ll Inttrllt lU.t be e.lcullt,d. Inventory 01 the real and personal osiale 01 NILES 1. CI,ARK deoeased ---"- 1. 71.5823 ShIlres 001 Corporation Cat1110n Stock @ $20.250 per share 2. 1986 EZ Load Trailer and MFG Boat :1.,449 54 800 00 3. 001 Employees Federal Credit Union Shar.e Account No. 10900-00-1 Date of death balance, plus accrued dividends 4. Internal Revenue - 1994 incane tax refund' 7,616 32 711 00 'IUrA!. 10,576 86 , I :' , i I 'i' " , , , " .;1 ",. " Ii , i' '.. " , " it , 'I' .1,,' " ,. I' . " ," ',_,"1 " .' , ,I , , .' , " .,1 " , ,,'1 " " 10 01 'I I, f I' .," " .j .'