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HomeMy WebLinkAbout96-00152 ,,' .j!. .~~~; \,. 'j'.,<:;..., :::': ",- .: ~ "\..:':. ,'1",', ,~ . <.'~, (.:' 'j) ;;:.-" :.' .' ~ .'" >- . /: , ... ;' ::~ '.~ , 'I: ,," .. ',:' -, ~~:-.. I,;. . " ~ :;~j{(:::; (:~':~~:~;~:{ {: :i.:; .".. ',r, "'c" " ~',f" - ,;. - ."", 'J:, ".- ---j- .. >: . "r: -.._:~~ l' -: i' ",'.. " ';' " '.....:' -t- . ,l.' I'" , , , . ..',,; v:-;-::-; . ",,- .'." ,', /-<, . ".'..' -': ',' ;.! .', " ',! " ", " I " ", '~;. '.~ " , " ~ ; " ,. , r. , , , ' '. .' ",-' . ,\ '.- ., h .. . " '. ..\.~ I:" \.: ,', .',' ~ ~- ,,' \, ., .' .1',.::" , <7';" r:",;' ~ f~(:; ',: ". '.. r....,. :f:( " ",. , ~-.! it> - "oJ " , " " ", . ~ ;. "':,' .' ~, ' " :',-: J _'",,:. ;'. ~\ " , -/, '..- ',. .," .' '> },', ..,,,, :; , ;~ . , " ,-, ~' . "( \ ',.,~ ~A '';:,.,;:',:- ~'"" .:'!':"4";' ,;. i~~Jf~~.;:~~~~r~:' ~;:~ ." '.' ,>: " . ""~ t'," ,'; '-' "''-' ", ,,'. '\', . ,;.? " ,,' 'I, .,.". ". ','..J' c~: "i r " 'L ,', '1",'" -<,.-'" ,.' '.'. ,\..,;,-. ",..; , '.. . [., . <:"< " . t'~, ~~' \ , .', ',' _,l ....1: y;: " " ~' :,1", ,'".- " :>--.. '.".',\';,":.i' " '.., .',' , ~, ';<.> "\ ';'-~". ..', ,,;:,:,.,,:: 4" , . , /.. ., " ..;,>:;~\::\' ': '.;' '! - l' ",'~::.;, .; ,_ ;f;:::?,;' u " ','. " '.' , )! ,- ;'., - .':., 't,- '::-:,,,";:;.,, ':.' , .',," , ' ", , :' ~,: ','.. '.'(:"::~~:,::,< <'~ ~I \',. : :, ',~,. ,::-.~:;" " .~ "..t, , ,': ",'.t,.. . ,,~ .,. _r. '0 {:. < ',~~,:., "" ."/ " ,. I . '." 'j i. ;P;- " ,"," -,'r' . ;c~':~ '. -. ,', . " ",". ,~ . "';.' ,~. 'j",. ""i " . . .... :,.". ","', : ,l'~,' ,-",i' ~:" , " ': ~ ~ ~'I'; ,:>,. ,". " ., ,j ~-'." " .',1 ",", e,:, ''','. '.' <,.J. '" , ,~ ;',,': '" ,," ~ .,," , . . ," .> ~ . PETITION FOR PROBATE and GRANT OF LETTERS No. :J./ - ,qql.t - /5:l. To: Bwwof Carl Ravmond Adams also known as Regisler of Wills for the Deceased. County of ('limn....' ''',Q in the Social Security No. 200-24-062R Commonwealth of Pennsylvania The pelition of Ihe undersigned respectfully represents that: Your pelitioner(s), who Is/arc 18 years of age or older an the execut .. i y In the last will of Ihe above decedenl, daled AUQust 17 I and codicil(s) daled named , 19-6!L (MaIC relevant circnmSlanCt5, e.g. renunciallon. dealh of c"4t!:ulor. cle.) ~ecendent was domiciled at death in cu~befland County, Pennsylvania, with h s lasl family or principal residence at 13 E m Street I Carlisle, PA g01(O 0 r: C 1lRi-l Hf= (list stretl, number and muncipalil)') . . . Dcccndenlj then 63 'years of aJle, died M"..,.h F;. ,19 96 at CarlisJ.e Hospi t{ll.l_~arl1s1e I PA . Except as. follows, decedent did not marry, was nOI divorced and did nol have a child born or adopted arter execution of the will offered for probate; was notlhe victim of a killing and was never adjudicaled incompetent: Decendenl at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property S 10.000.00 (If not domiciled in Pa.) . Personal properiy in Pennsylvania S (If not domiciled in Pa.) Personal property in County S Value of real estate in Pennsylvania S 20.000.00 situaled as follows: 134 Elm Street. C1lrl j"I... FA 1 701 ~ WHEREFORE, petitioner(s) respectfully request(s) Ihe probale of the last will and codicil(s) presented herewith and Ihe grant of lellers testamentary Iheron. (1e5lamCnlary: adminimation c.I,a.: administration d.b.n.c.l.a.) i .,,- 'iii "'6 -g.;: ft.- -:;;~ 'C'_ ~o ~ .. Iii / /' . \... ~. ~-) .... ----r/;/~: .Wtt:.1{'('N { _I?~?(~ / v I '/ ~21"te~ti~~"street Albany. CA 94706 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OJ. PENNSYLVANIA } ss COUNTY OF ___CUMBERLAND The petitioner(s) above-named swear(s) or affirm(s) thatlhe statemenlS in Ihe foregoing petition are true and correct to tile best of the knowledge and belief of elitioner(s) and that as Ilersonal represen- tative(s) of the ahove decedem pi~i1io~er(s) will~ll~nd ~IY_ a~~te.r)he eSI~te al:eording to law. Sworn to or affirmed. and s ubs':ribed { ,f{. <. U . / . before me this _l.1j;b <lay of ~nllY M. ~Ilams ~. MARr'H ~~~~M1..-) .' / ~ /J.IA f J:: ~C. LEWIS "!tr1.l.~er ~ /5-qQ-1 ~r --,,-- . ..'- .-.---.......,........,.."...,-.. ;'[:, '.- :>1:~,~::\',,\:,~ " ""'&''iftt ' :~;;r,~(~L:~D::[~ : ,," ,~,'"'I(:;"...}J..1?1', ' ;,., "-"'"W"~' .J""" ,-, ~';."'jj':"'5' ,,;,", ':""";;",';'1',',: ','';>h ",>:r: .:~<. i ':~,J~t ,w:<.., .~..(-'ot "'t~1 ),""L,,-''', :'~;.~' " . '~~ ;f1f.,,~ ...,!JI '!~;}~', :,; t --:'... ..,~ . " .:~ '.:', . ';"'-i ~". . .. LAST Il'IU. AND TKSrAm;NT O~' CArlL IlAnlOND ADMIS KNO~' A1.L ~IKN IlY TIIKSK I'nKSKNl'S, That I, Carl Raymond Adams, of tho norouah of Curllllto, Cuml,ol'la'lll County, Ponnsylvania, boing ; of 1I0unl! mincl, 1II0011ory Rllll IInllo I'll talllli nl:, do mako, publish and declare " thill my Lall\; ~'ill ancl To II tlllllo nt , hOl'ohy rovoking and making void any arul aJ 1 h'illll IIr 1110 01. ullY 1.11111' ho,'oloro,'o made. I I , ITEM J. 1 I:ivo, c1ovJso alW hequoath all of my property, who ther the 11011I0 ho rOllt, 1IO"IIonll I or mixod, aol! whorosoevor 5i tuato, to my lIistor, Nancy M. Adams. ITK~I 2. 1 al'poJnt my sistor, Nancy ~l. Adams, to be the I I I I I Exocutrlx of lilY olltato. IN Il'ITNESS IWErlEOF, I have executed this my Last 1\'111 and \ I Tostamont, conllistin/t of ono typowritton pago, by affixing my signature and my soal to 111111I0, this {7 day or H.I'.1/.L.d , 1960. (l ") ,i/ ,} I ""1 ( k~ 1 A't/("I((, / /:!i2tlJ-1tA-.j (SEAL) ',1 ! Tho wrltlnlt containod on this one shoet was signed and soalod hy tho abovo nomoll Cn rl Raymond Adams, and by him PUblished and declared all and fOl' his LOll t "'ill onel Tos tamont in tho presence of us, who here- unto suhscrihod our namos as and in tho prosonco of onch witnossos, a~is roquost, in his presence, othor, tho~ day of--11}J.~I.III.A"'" , 1960. \;"v'\..-~'\1 , ~\.:G.L.. /~ /~) . -1,/./Y I ~ '^"J~"A :". .-J-,II?",,~-,.,. ,. 'T' 'V'"" .'~..,. "'.' ,,:i ~jM:;'" ",If.",' ':.: ;::,'.. '.: J..','. ."r.I:,. A.;,:,;., . , '.~' '. . . ;.,' ,.!.: '-.'" ','.!J " -:;':~.;~,~,:." "'<:;~: '''.c,'-' .' . , .~!t .' , .." ~': ....;J~!>..\ ."." ., ""'.1' ,:....-::.'-:,' '-"-'. .-......:,.. R.e.,...."....: """''V''''''' R-. ..... ,.,.....-. ',' .' .,r '-' .,....,,<.;; \. '~. ";-}iilS , ,":-J:.: :.\.",\ " tlfU1 11 P2 :03 '96 CI(;I. Cur..,...". :"iJlt ',,"., Pr\ ".-" . " ~,.' . .' ~ "'. , " '. II) ~ <Q ..... ~ ~ ~; 0 ~. ~ ,~. '; , ~ " . j' " ,'. ~:A. ,<, , .~'~', ',:'.-' ''': " '".,' :~. '. ' 'I _.~. . " "" , . - .1 ..: . ~,'-;" ;c.-r .. J,,\,:. .-v:, ';.i,,'._ c-.;..,'.', '~.'~r '-'~.. " ---,' '.. ,""!.:':' ...j" .t.:._.;r_.-: f~'i-': -'.' ,-';'-:;:": <. ; ... N<! UNITED STATES FIDELITY AND GUARANTY COMPANY POWER OF AITORNEY NO. 106331 .. KNOW IIU. MEN BY TIIESE PRESENTS: ThaI UNITED STII ns nOEUlY ANO GUIIRIINlY COMPIINY. a ,o"",...i.. .rp.izcd aod ..illi., Wider It..law. ohbt SLalc of Muylud aDd ......i.. ill priacipal office" Ibe CII)' of Uahimort, ill tbe Slale of Marylaad. doc. btrtb)' Wllhlute aDd tppoilll Richard A. Neidcrcr orlhecityor Carlisle ,Staleof Pennsylvania ilJINCudl.wfuIAllomcyCl)-iDoFact.uchilllbci,nparalc clflKiry lImon IbaD Olt i. umed above. to ai,. its ume U I\Il'tfy 10, aad 10 exccute,.al ud IckDowlcdlt aD)' &ad aU boack. uadcnakiDl1. coDlractJ ud olber MiacI iUlrumCDlJ ialb, Ulun thereof 01 bcbalrorthe Compaay iD ill bulisell of palUltCiDI tile fid.lu)' orpenocu: JUIIlDlCtia,lbc pcrformuc. or coetracts; &lid ute...i_1 or paraDacci., bold. ud UDdcnakjDI' requirtd or pcrmiacd ia "Y adioDS or procccdia.. allowed by la.... ID WilDts' Whereof. 1M uid UNITED STAres FIDEun"' AND OUARAl'ilY COMPANY hu ClUlCd lbi. iDJINmlDllO be ...Ied wilt. iu corporalc suJ. duly llte.ed bylbe .i.lWUrtS orhsSCD.ior Vice Pmidtlt &ad AJlilWll Secretuy.lbi. 8th da)' or January . A.D. 19 93. UNlTEO STII ns FIDELITY IINO GUIIRIINlY COMPIINY (Sipcd) BY"'~ .. (Sipcd) BY........~.. Q.......... ;\.:~:.r.~:~.. ~~:'~.: ,~ AlIlSlaDt SecMary -.:;1...) \<.:., .\\\. ......\\\J Oolhi. 8th day.r January .,..0.1993 .bcr......pcnoaall~..n'lc Robert J. Lamendola S.ai., Vi" P...id..,.rtb. UNlTEDSTllns FIDELITY Al'lt\G\JIIRMTICOMPIINYUcI, Paul D. ~ims .IIui..... S.'Rtary or said C.mplD)'. wi.b bo,b or...bom 1 am ~\IiYacquai.l.d. ...... bci.81oY'"" k~.,.lIy duly aw."" Ill"""" ,bey. lb. said Robe r t J. Lamendola aad Paul D\.tsims ....z \. ....R RlpcC'ivelYllio! ~br Vi" PRlid....od ,be IIui....' S.'Rlary .r (be said UNITED STATES ROElIn' ANQ.~..\ltA'Nn' COMPAt<N. ~~ralioa delCribed ia a.Q~ fo'~~.ecuted Ibe rortloiq Powcror Allomcy: tballbey eacb kAt.".lbc aul of...id corporalioa; IUlI~ lCal affixed 10 pid rO~~'orAnomey wu sucb corpq~)llf.lballl was ~ alTUlcd by order orllle Board of Directofl or....d corporw:loa. IoDd Ihallbe)' .iped Ibeir aamts IbtrCto br\Ii.~ ~r as Seaior Vice pres,df'iI"'alt Allillaal Sccrrlaly. rurccllvcly. orllle Compaay. MyConuniui..cxptRllb. 11th daY!.a.V1lirChll'~"95. ~" ~' .. . ,~.~ .~ / . r~ (SiPC~) ... 1<\frl14:,,(\E..r.t!~.~ ~~ . .. \1...1'-: NOTIIRVPUOUC ni. rower lor ADOntC)' i'lfIDted uader aad.br ~~~~)' ortbe rolloWlag Resolulioas adopled by Ibe Board or Dirrcto~ orlbe UNITED STATES noarrv ANti GUARllt.TI COMPANY.. ScptcmW'i4, 1992: RESOLVED.IW il cOlacclioa with lbe fidelity aDd lW'et)' ilsunace bwileSl ortbe COmplD)'. all hoads. uDdenakiap. coatracts aDd otber iaANmcDtJ RlaliDllo J.Iid bUliDell ma)' be siped. uecUlcd. ud ackDowledled by pCDOU or tDlItiu appoialed u ADome)1I).ia.Facl punuaallo a Power of Anorae)' iuued ia accorduKe with lheae RIOIUliollJ. Said Powertl) of Anome)' ror aad oa bebalr orlbe COmpaD)' ma)' aad .hall be executcd ia lbe IWI'IC aDd oa bebalf orlhe COmpaD)'. tilber by lbe Cbail1TWl, or llIe PrllideDl. or aD E.Il.ecutlve Vice Pre.idcDI, or a SeElior Vice PreSldeG(. or a Vicc Prnideal or aa AuilWlI Vice Presidcllt. joiDtI)' wilb tbe ScCftlaty or aa AuillaDl Secftlary. uDder lheir Rlpectivt dclllalJioDI. The ",ulure or IUcb offiura ma)' be tDl"vcd. pnaled or lilbolnpbed. ne lilnatW'C or eacb orllle rORloiq officcl'l &lid lbe lCal orlbe COmpaDY ma)' be atrUled b)' racsimile 10 aay Power or Alloncy or 10 aa)' "nificlJe relaLilllbeRlo appoiatiq ADomcy{.)oia.Facl ror purpo.u ooly or cuculiDI &lid annlla; boad. aad uDdutauass aad ocber wnllap oblilaJory iD Ibe natW'C Ibertor. aad. ualell subltqueDtI)' Rvok.cd ud subject 10 aay Iinuwioa'lCl ronb IbeRia, al)' lueb Power or ADome)' or cenlfil:ale bunas sucb racllrNle "paNre or rauimile "al thall be valid ud biDdiDI UpoD tbe Compuy ud aay IUcb power 10 ueculed aad unified b)' Iueb racaimile .ipaJurt aDd facllmile Hal .hall be valid aad biadiaa upol Ibe CompaD)' witb rapccllO aa)' boDd oruDdcrtalria,lo wtucb il is validl)' attacbed. RESOLVED. tbal Auomty(.)oiD-Facl .hall bave Ibe power aDd aUlbonty. UDlcss IUblCqueally revoked aad. ia aD)' cue, subjeello Ibe terms &lid limiwioal orlbe Powtr or Anol'1MY iuucd 10 tbem. 10 execute aad deliver oa bebalr orlbe Compaa)' aDd 10 anacb Ibe 5Cal orlhe Co"",aay 10 aay aDd all boDCh ud uadenakiap. ud olllerwriliDl' oblipLoty illlbe UlUrc tberrof, &ad aa)' such taANmcal elltculed b)' sucb AlloneY(')-Ia.Facl .baI1 be u biDdias upoa lbe Corqsu)' u ir.ipcd by aD Executiw Officer aad aelled &lid aacucd 10 by Ibe Sccrelary or lbe Compaa)'. L Paul D. Sims ... IIui.... S'CRtary .fIb, UNlTEO STllns F10EUlY IINO GUIIJV.NlY COMPIINY. do b.nbycenify lhallbe rOnlOia.i. .INe exurpl from Ibe Ruolutioa orlbe u.id Co~aa)' II adopted by its 80am orOtrrclol'lOa ~plembcr 24.1992 aad tballbi. Rtaolutioa ia ia full rorce aad ,rrect. 1.lbe uadel'lip,d Auillaal Secretary oflbe UNITED STA 'ffiS F1DELfTY ANO GUARAN1Y COMPANY do bereb)' ctnif)' lballhe rOnlcial Power or ADoney i. i. full rorte ud effecl ud!au Dol bin ftvokcd. 1t I. T,"imo.y WIl....r.1 b.ve bm..,.... my ba.d aod 'b. ,..1.11 . m~TA ns FIOELllY ANO Gl'ARIINlY COMPIINY .. thi. day .r ~~I~~ .........~..~:..~:........... ~ 1. "J! AlstltallSn:rellry ~~ @'~ N~ ~~! ~~I'I'~ STII n; or MIIRYLIINO) 55: BIlL TIMORE CllY NOTICE OF BENEFICIAL INTEREST IN ESTATE BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA In re Estate of CARL RAYMOND ADAMS, , deceased, No. 152 of 1996 TOI Nancy M. Adams (beneficiary) (address) P. O. Box 1330 Pleasanton, CA 94566 Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. You may have a beneficial interest in the estate as follows: YOU ARE THE SOLE HEIR TO THE ESTATE OF CARL RAYMOND ADAMS, DECEASED, PURSUANT TO HIS LAST WILL AND TESTAMENT DULY PROBATED. (if additional space is needed, use back of page) Name of decedent Carl Ravmond Adams Last known address 134 Elm Street, Carlisle, PA of decedent Date of death March 6, 1996 Place of death Carlisle Hosoital, Carlisle, PA County of grant of original letters Cumberland Decedent died intestate. x testate A copy of the will -z-- is is not attached. Name(s), address(es) and telephone nurnber(s) of all personal representatives appointed Name Address Telephone P. O. Box 1330, Pleasanton, CA 94566 (510) 244-1624 Nancy M. Adams Name(s), address (es) and telephone number(s) of all counsel Telephone Name Address Dale F. Shughart, Jr. 28 S. pitt st., P.O. Box 208 Car s e, PA 17013 249-8300 Additional information may be obtained from the undersigned. Date March 19, 1996 Signature Name uale F. Shughart, Jr. Address 28 S. pitt st., P.o. Box 208 carlisle, PA 17013 .. Telephone ( 7171 249-8300 capacity: personal Representative y Counsel for personal representative NOTICE OF BENEFICIAL INTEREST IN ESTATE BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA In re Estate of CARL RAYMOND ADAMS, , deceased, No. 152 of 1996 TOI Sara E. Mowery C/O Nancy MOW~~Y 44 Casielli Avenue San Francisco, CA 94111 (beneficiary) (address) . please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. You may have a beneficial interest in the estate as follows: The attached will of Carl Raymond Adams leaves his entire estate to his sister, Nancy M. Adams. The Will has been probated and you are not an helr. If Mr. Adams had died without a Will, you would have been entltled to a l/~ share as (if additional space is needed, use back of page)sole survlvlng lssue of Mr. Adams' sister, Helen. Name of decedent Carl Ravmond Adams Last known address 134 Elm Street, Carlisle, PA of decedent Date of death March 6, 1996 Place of death Carl isle Hosoital, Carlisle, PA County of grant of original letters Cumberland Decedent died x testate intestate. A copy of the will -K-- is is not attached. Name(s), address(es) and telephone number(s) of all personal representatives appointed Name Address Telephone P. O. Box 1330, Pleasanton, CA 94566 (510) 244-1624 Nancy M. Adams . , , - ~_._.- NOTICE OF BENEFICIAL INTEREST IN ESTATE BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA The attached Will of Carl Raymond Adams leaves his entire estate to his sister, Nanc M. Adams. The will has been' robated and ou are not an heir. If Mr. Adams ad dled wlthout a Will, you would have been entitled to a 1 10 share as (if additional space is needed, use back of page) surviving issue of Mr. Adams' brother, Glenn. In re Estate of , deceased, CARL RAYMOND ADAMS, No. 152 of 1996 TO: Glenn A. Adams, Jr. (beneficiary) (address) 22 Holly Street Mt. Holly springs, PA 17065 . Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. You may have a beneficial interest in the estate as follows: Name of decedent Carl Ravmond Adams Last known address 134 Elm Street, Carlisle, PA of decedent Date of death March 6, 1996 Place of death carlisle Hosoital, carlisle , PA County of grant of original letters Cumberland Decedent died x testate intestate. A copy of the will -K-- is is not attached. Narne(s), addressees) and telephone nurnber(s) of all personal representatives appointed Name Address Telephone P. O. Box 1330, Pleasanton, CA 94566 (510) 244-1624 Nancy M. Adams 1\ I' I~ I, it ~ i, " , i,' I I , \ :"~. . ^ .- -'f Name(s), address(es) and telephone number(s) of all counsel Name Address Telephone (717) 249-8300 Dale F. Shughart, Jr. 28 S. Pitt St., P.O. 80x 208 Carlisle, PA 17013 Additional information may be obtained from the undersigned. Date March 19, 1996 Signature Name llale F. Shughart, Jr. Address 28 S. Pitt St., P.O. Box 208 Carlisle, PA 17013 ~ Telephone (717) 249-8300 Capacity: Personal Representative y Counsel for personal representative ~""~"~'<'--""" m",~"""~,~__.__"u~'..>.._n_", , COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND } u: -' b.lng duly slIorn occordlng to law, d.polol o..d soys that fl.o is the Executrix 0' tho Estoto of Carl R. Adams lot. of _.bQJ;'ough_of_Carliale,_____ , Cumborlond County, Po., d.ceas.d ond that tho withIn Is on Inventory mado by ._ ___, tho sold Executrix of tho ontiro ost.to 0' soid d.cod.nt, consisting of .11 tho p.rson.1 prol'.rty .nd rool .stoto, ..c.pt r..1 .,t.t. ouhld. tho Commonw.olth 0' P.nnsylvonl., and that th. liguros opposite ooch It.m of tho Invontory r.prount It's faIr volu. os of th. do to of d.c.d.nt's d.oth. ~/ '~ /; / SlIom ond subscribod bo'or. m., .'f. ;?!2({ ,'" ,-;J.:(v.'f!&:',/c.-:!/ ~~,~ ,. 1/ xecu'or . ~tor F/ Nancy M. Adams 921 Cer ito Street l'lancyJl--.1\dams _Oc;.tober 7. 19 96 ~,~ ~"1& -/ NOTAIIIAl. SEAl. CJ BONNIE L. COnE. NOTARY I'UIK.lC 101IO OF lIT HOlLY SPIIHGS, CtJlIBERlJJlO CO. IIY COMIIISSION EXPI~S OCT06[R 17, ligS I Albany, CA 94706 Add,... Dot. of Death 6th Doy Yur March Month 1996 INSTRUCTIONS I. An Inv.ntory must b. flIod withIn three months oft.r appolntm.nt of p.rson.1 repr.senlotiv.. 2. A supplem.nt Inventory must bo flIod within thirty d.ys of discov.ry of .ddition.1 ....ts. 3. Additional sho.ts m.y bo attached .s to p.rsonalty or roalty 4. So. Articlo IV, Fiducl.rlos Act 0'1949. N .' ,- .. '. r:; , " '<J' ~ ..... ~.~ ;~I..~ '~ V' .:.~ :J u.. UU ~ 01 .,; w .. ~~ ~ ~ '" ... ~ w ~ ~ 0.. U 0 ~ 0 W III C '" w .... :r 0.. u. Z ... -' ~ u. -' jj 0 0.. W 0 -< j l'l > z '" l' Z 0 c c ~ - III Z 0 0 '" 0 Z w 4( . 0.. Il: '0 c - ~ .... 0: ... 0 ~ ~I .lI .. E I . ~ ~ -' 0 .. '" ~ 0.. ... '0 .! u: ". o o CD . i 'i ;/ :\ :, !I ( ) 00 o-l ~ Il: .. r! oll} 2: < - ~ ~ - III ~ >,. , - < PERSONAL PROPERTY 1. Cash on hand. 2. clothing and personal effects. 3. Cedar Chest, mission desk with chair, Roseville baskets, two cut glass bowls, sterling teaspoons, digital clock, value based upon appraisal of Ben E. Rowe, attached. 4. Miscellaneous household goods sold by executor, value based upon actual sale price. 5. Household goods and furnishings sold at public auction, value based upon actual sale price. 4,132.90 6. Firearms, value based upon appraisal of Dewalts Gun Room, attached. 7. 1994 Mercury Sable LS sedan, value based upon appraisal of Kirk M. Wise, general manager, Family Ford Mercury, attached. 8. U.S. Treasury, 1995 income tax refund. 9. Patriot News Company, unexpired pension checks on hand and deposited. 10. Patriot News company, reissuance of payment for expired uncashed pension checks. 11. Base share account #390000, West Shore Teacher's Federal Credit Union. principal - Accrued interest - 12. Checking Account #4000017, Principal - Accrued interest - 13. savings Account #1-149821, Farmers Trust Company Principal - Accrued interest - 14. One $75 Series EE, U.S. Savings Bond #K-0-100-136-678EE, issued February 3, 1993 15. Accordia, refund on executor's bond. 16. Pennsylvania Blue Shield/Blue Cross, major medical reimbursements 17. National Wildlife Federation, subscription refund. 18. Royal Insurance, auto insurance refund. Inventory of the real and personal estate of CARL R. ADAMS, Deceased REAL PROPERTY Lot improved with two-story frame attached dwelling house situate in the Borough of Carlisle, Cumberland county, Pennsylvania, known as 134 Elm street, Carlisle, PA 17013. NON PROBATE Life Insurance 1. West Shore Teachers FCU 2. Metropolitan Life Insurance Company TOTAL PERSONAL PROPERTY 50,000.00 318.00 o 210.00 555.00 2,400.00 9,935.00 273.00 1,150.00 5,750.00 5,473.78 29.69 12,338.62 0.00 18,704.77 137.46 43.50 10.00 12,512.60 15.48 65.07 3,822.11 5,032.88 132,909.86 ". ....~.....~...... -----..........---...... __. .~,......,...,..~. ."'~ ~. ) ...L. IS-Clf:' I cO..~Fm'rN~'lfFP.llM!i1b~ANI. HARRIS8~~liJ.'.ffi 121...., INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGISTER OF WILLS FOR OATES OF DEATH AFTER '213'19' CHECK HERE IF A SPOUSAL P Y R CR OITISC AIM 0 FilE NUMDER REV.. t500EX .(7.14) CAB H ~ l ERg Co K K P 5 21-96-lit- YEAR NUUBER 2. Supplemonlal Return 4a. Futuro IntereSI Compromise (lor dale' 01 dealh alter 12-12-82) []] 6. Dccedent Died Testate D 7. Decedenl Maintained a living Trusl (Attach co of Will) (Anach a cop 01 Tru,l) C P All CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD DE DIRECTED TO: 2 2 NAUE COUPLETE MAILING ADDRESS R 0 Dale F. Shu hart Jr. Fowler. Addams, Shughart (, Rundle ~ ~ TelEPHONE NUMBER 28 South Pitt Street - T 717 249-8300 Carlisle PA 17013 1. Real E,la'e ISchedule A) 1 50,000.00 2. S,ocks and Bonds (Schedule D) (2) 3. Clo'ely Held SlocklPartnership Inlere,' (Schedule C) (3) 4. Mortgage, and Noles Receivable (Schedule D) (4) 5. Cash, Bank Depo'~' & Mi,cellaneou, Personal Property (Sch, E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Tren,fers (Schedule G) (Schedule l) (7) 8. Total Gross Assols (tolal Lines 1-7) 9. Funeral Exp.nses. Adminislrative Costs. Miscellaneous Expenses (Schedule H) 10. Debls, Mortgage llabil~ies, lien, (Schedule r) 11. Tola' Deduc'ions (1ola' Line, 9 & 10) 12. Nel Value of Esla'e (line 8 minu, line 1') 13, Charitable and Governmen..' Bequests (Schedule J) 14. Nel Valu. Sub cl'o Tax (Lin. 12 minus line 13) 15. Spousal Tran,f.rs (for dares 01 dealh alter 6-30-94) Sit Instrucltons for Applicable Percentage on page 2. (fntlud. valulS from Sch.dul. K or Sch.dul. M,) 16. Amounl of line 14 taxable al 6'/, rate (fntlud. va'ulS from Schedule K or Schedule M,) 17. Amounl of line 14 taxable at 1S'/. rate (Include values from Schedule K or Schctdul~ M.) 18. Principal lax due (Add lax from line 15, '6 and 17,) 19. CreditslSp Pover1y Prior Payments Discount + 8,000.00 + ',21.05 20. If line 191, g"aler Ihan Line '8, onlo"he dlllerence on Line 20, This is Ihe OVERPAYMENT. ~ D ICheck here II you Ire requesting I refund 01 your overpaymentl 21. If line t81s greater than line 19. enter the difference on lin~ 21. This is tho TAX DUE. A. Entll lhelnt.resl on tho balance duo on line 21A B. Enter Ih. 10'.1 01 Line 21 and 21A on line 2'B, This is 'he DAlANCE DUE. Mako Check pa able 10: Re iste, of Wills. A ent ~ ~ DE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND TO RECHECK MATH .. .. Under peNllles 01 pe'lury.1 dlKla,ethat I haye e.amlned thl' '.t!Un.lncludlng accom~nylng schedul.sand .l"e~nt.. and to Ihe best 01 my knowledge and belief. It I. true. COffeet andcompltt!.l dKlarelhatall ,o,ll..lal. hit bHn,.pofted allrue mlf...1 value. DlKla'ltlon at pt'~I" other thin Ihe pellOnal ,.presentlllvels blled on IlIlnlOlmlllonof which pt'p"er h any knowledg.. (- SICN.W EOFPERSONRESPONS ,~EFORIIlINCRE1.UR/l Nancy M. Adams '-- .. . : I c J 1921 Cerr! to Street I; ,,/}I 'l/~' i:'., ,'^yb~;,..:.cii..9i..i66................................ SI REOF Wr OIH RT .N~ IVE ~~.~~;~.~~~~.~;~~.~~~~.~~~~.~~.~..~~~.~~~............ I Carlisle, PA 17013 D E C E D E N T DECEDENT'S NAME (LAST. FIRST. AHD MIDDLE INITIAL) Adams Carl R. COUNTY CODE DECEDENT'S COMPLETE ADDRESS 134 Elm Street Carlisle, PA 17013 OATE OF BIRTH 12/03/32 DATE OF DEATH 03/06/96 soctAL SECURITY NUMBER 200-24-0628 Cumberland Count R.mainder Relurn (for da'ts of d.arh prior 1012-13-82) Federal Estato Tax Return Requited Tolal Number of Safe Depo'~ Doxe' OF APPLICABLE)SURVIVlNG SPOUSE'S NAME (lAST .FIRST AND MIDDLE INITIAL) SOCIAL SECURITYNUMDER AMOUNT RECEIVED (SEE INSTRUCTIONS) X 1. Original ReMn 4. llmiled E5Ia.. o 5. o 8. R E C A P I T U l A T o N 74,054.87 (8) 124 ,051..87 (9) 29 , 291.18 (10) 11,619.91 40.911. 09 83,143.78 (11) (12) (13) (14) 83 143.78 (15) 0.00 0.00 X = (16) 0.00 o . 00 X ,06 = T A X C o M P U T A T I o N 12".71.57 (17) 83,143.78X ,'5 = (18) 12 ,1.71.57 Inloresl (19) (20) 8,421.05 0.00 (21) (21A) (21D) '. ,050.52 0.00 '.,050,52 ~ ~ flzs!f/ SALES COMPARISON APPROACH In arriving at this conclusion of the value of the subject property, the appraiser made a survey of properties that have sold in the area of the subject property. Consideration was given and adjustments were made on each comparable sale as to time of sale, size, location, as well as all other factors that might affect value. A resume of some of the sales considered by the appraiser is as follows: SALE NO. 1 Location: Date of Sale: Sale Price: Size: Unit Price: 140 Elm Street, Carlisle, September 15, 1995. $52,500 1,332 sq. ft. $39.41 per sq. ft. Pa. SALE NO. 2 Location: 138 Elm Street, CarliSle, Pa. Date of Sale: October 26, 1995. Sale Price: $56,500 Size: 1,232 sq. ft. Unit Price: $45.86 per sq. ft. SALE NO. 3 Location: 130 Elm Street, Carlisle. Pa. Date of Sale: June 21, 1994. Sale Price: $61,900 Size: 1,368 sq. ft. Unit Price: $45.25 per sq. ft. The appraiser, in addition to the sales listed, also considered several additional sales in arriving at his final opinion of value. After making all of the .necessary adjustments, it is the appraiser's considered opinion that the indicated value of the subject property by the Sales Comparison Approach is $50,000. 7 CERTIFICATE OF APPRAISAL Your appraiser hereby certifies that: 1. I have no present or contemplated future interest in the sUbject property. 2. I have no personal interest or bias with respect to the subject matter of this appraisal report or the parties involved. My findings are not based on the employment to make the appraisal, the compensation expected, a requested minimum valuation, a specific valuation, or the approval of a loan. IImrnr J. To of fact analyses, based, are the best of my knowledge and contained in this appraisal opinions, and conclusions true and correct. belief, the statements report, upon which the expressed herein are o 4. This appraisal report sets forth all of the limiting conditions (imposed by the terms of my assignment or by the undersigned) affecting the analyses, opinions, and conclusions contained in this report. 5. This appraisal report has been made in conformity with and is sUbject to the requirements of the Code of Professional Ethics and Standards of Professional Conduct of the National Association of Real Estate Appraisers. 6. No one other conclusions, and set forth in this than the undersigned prepared the analyses, opinions concerning real estate that are appraisal report. ~:~ Chief Appraiser t.. 10 COMPARABLE NO 2 138 Elm St. Carlisle Same street $ 56 $45.86 CZl Courthouse & MLS OESCnIPT~ ".'5"""1"''''_ $ 4 5.25 Courthouse OE SCRIP liON COMPARABLE NO 3 130 Elm St. Carlisle Same street $ 61 lZl & MLS I O"IS AdIUSltntn! , , , 2 000 None 6-21-94 Similar 25' x 100' Similar Wood 106 ears Su erior rofJI .edrms. Baths 2.000 (1,000) 7 . 3 1 I 368 Sq H ; Oil hot wtr. None Encl. porch, balcon . Typical for the re ion. None Unheated rm. on first fl Porch I 000 Porch atio 500 Si ilar Si ilar Oil FHA Similar Porch, balcdny, stor. bld : , . , , I .\ , Similar Similar Similar Similar s I 000 12 000 1 000 6 500 ~ew roo f . ~ r...us None S 40 500 50 000 sales are acce table of value of 50 000. -------~----_... ."... ..._---_._-~-_.__._.._.__._._._-----_.__.__.....- . -----.....-.. ~---'--- .------- -- -.._. -- ------..___ h.__ _ _._.~_.______.___ .----.-------- ._-~ u.._._ -__. ..---~.--_.__._.h.._._..._______ -.----.--- --.-----------------..-- ,.~ -..---.-- - ------------.-------- .n --~.----__..___h..______._ __..__._.____.. lJ 5 I=QRMS INC ;tCENTRAL SO. GRAFTON, MA 01519 044(j I 800 12~ 95dJ. t 8J!J 4.11 ('i ri BILL ROWE. AU 1538L EN . AU 1092L 08 . AU 2276L R. D. 4, Box 353 · Carlisle, P A 249.2677 249.1978 Auction Is Action Call uROWE"For Satisfaction May 21, 1996 TO: Dale Shughart 28 South Pitt Carlisle, Pat Jr. Street 17013 COPY: Nancy Adams Executrix FROM: Benny E. Rowe Auctioneer/Appraiser 2505 Ritner Highway Carlisle, Pat 17013 REF: Carl Raymond Adams Estate Appraisal, 134 Elm Street, Carlisle, Pa..Current Market Value. Cedar Chest Cogar Wargrobe Mission Oak Desk w/Chair Roseville Basket 2 Cut Glass Bowls Sterling Teaspoons Digital Clock .'IOR Zeai tit .VCR Zenith Tit Color O;lk Buffet dlt:l.fferese ~loor Model Victrola Fleer "e~el Radio Hise. Small ~ool~ t2' Alumiflum-Laeeer $ 55.00 6!i.OO 110.00 15.00 15.00 10.00 5.00 '0 no 25.00 7S 00 B5-.-().() 45.00. 125.00 i~A-IlO 1 0....00 JS.O.o. 2 H9ild 4 Head C'onC!nl~- 7.on;"h \ l' e vv\s /J V\ed Ol.\[ we~-e.. 'SoIA by Q,).-ecAA1OR \\- Df70 TOTAL $705.00 Cri. ~ ~ c ( INVENTORY & APPRAISAL OF FIREARM COLLECTION OF CARL R. ADAMS, DECEASED . 'DATE. OF .DEATII: .' MARCil 6,. l0996 ID'INDGlm 1. Smith & Wesson revolver Model lO ! .38 caliber $lOO .00. 2. Smith & Wesson seni-auto Model 6906 ! 9 mm $300.00. RnLES 1. Remington rifle Model 700 ! caliber .270 $350.00. 2. Remington rifle Model 700 ! caliber 30-06 $350.00. 3. Remington rifle Model 700 ! caliber 22-250 $350.00. 4. Savage rifle Model 840 ! caliber .222 S200.00. :,nJl"'-lr'lS 1. Ithica SKB double barrel sootgun! Model lOO (12 gal $300.00. 2. Ithica " " " $300.00. 3. K-MARl' double barrel sootgun! 12 ga $l50.00. o? .~~ ~ ~' S~~ " "~'. . .-': ~:~-: ',:, ,:~<>. ,~_.,;;:,:--':~: . .-, ""e,'~ .."./~;~ . .,.;;",.,,~ ,- '_'--",'~~Y"wV~ -. :~~ -;~. '" .:~,). ..J / ..",'" c ~ ~...:..-.~.- --'-." . ......1.. tswu 'AH' Ir' ,"__as.OI 'M CUII.IICIt' 1M 'WINDOW.QI '10 fOWIllUf.OS ... ....... == ::UllAf.WOH .... .OWII MOONIOOr <100 Inl'lO .- UMI.. 111t1 "NDIoH 14.. cut. AYe. ..... IJll. _.,AnDNWAOQH :~,. I,!!~.J lot7, "U UIU U -- 11121 1I0U 11111 ClIfDAN IS""" . 'IAhClNWAOON ::;'..',IJJU 1191' IOJ1J '.. " WI UJT. nou _.....""1 '-.' 94 SAlU ,-. 1t0 IIOIIWttlllI III ClWfCONtlOf. U. . WWOOW. 01 11. POW'IIWI JOG UAhlfl 1"MIOKU.WQH 111 CD ISO POWtI M(l()HIOOf NO "Irq . UMI.. tlJO AOII1UH IDUO :::,:"WAClON ::m :n: I:: ::: IOU' .UDAN ~ 1I1OS """1'lOM WAGON non IIJU U7J 11." nn. 11. "IS ,.....""ACI ......,. ,...."n.q '-' ... """"'" IWI -- 93 SAW ,-. lIS IIOIfWMIIU 100 auuCDCllOl 100 ,WHlOW.GI IDO fOWIIlW ... ....... 110 MlDW,t.WOH 'JO CD ... -,-""", \.DAM lAId II a.a. CUI. 7J4O . mwt '''0 It.JO Mil . "...noN 'fl'AOON 10f71 Ion. .... u .ISt .1UlAH '0'" ..c7' ..., 'ClnAnoNWAOON 11100 '1100 .... n.. on, .." .... .-.....""1 '-' no wmon "All 92SAlU . ."... 100 UOIf WIlLI 7J OUlllCDMTlCl'. 7. ,WIClOW.G$ 7J fOWlIWI 100 &lAM' 11J ....w.I.WOM 111m :uo POWIIIlIOOHIOOf .... .. "" .IDAN 1020 1m toSO nu ,,"AhClNWAOOH ,j(lO 1700 7100 .... U .no 4D1IDAH 9OJO 'UO 7000 .170 C1.,.,onffAOClN '"'" ..., 'UO -... .J ("') '. ' \ J ..' ~tUt. IS , ~IJ. <-. '.. -. . ,~. v"*-- u t:- .'N~tt.Ih~ ~ 9:9 :S::> . ~ . I 5 9~ s t1<1 Lt &5: $ U; 4-N - .... n" .... .... ~~if to ~~ -~ dt . WI'€.. 6&1/. "h,t? ;;.....,.... ;;171). ;f((0'0A. I .' .... .... ".. "'" .'i !it ~ I "' f .'. ,. ? , ~ ,-~ ( r FARMERS m TRUST _ April 3, 1996 Fowler, Addams, Shuchart . Rundle PO Box 208 28 South Pitt Street Carlisle, PA 17013-0208 Re: Estate of Carl R Adams SSN 200-24-0628 Date of Death: March 6, 1996 Dear Mr Shuchart, Jr: In answer to your request concernlnc accounts owned, either separately or Jointly, by the above referenced decedent and the balance in each account as of the date of death, we have checked our records and are submittinc the followinc information in duplicate. We succest that you file one of these letters attached to the Pennsylvania Inventory forms (RCC)to substantiate the balance you report. Note that we have shown the correct reclstration for each account. Also, interest accrued to the date of death, if any, is listed as a separate ficure. Checklnc account 8400017 was orieinally opened 9/1/67 or before. The account was titled In Carl R Adams' name alone. The balance as of 3/6/96 was $12,338.62. The account was non-interest bearlnc. Savlncs account 81-149821 was oricinally opened 3/23/68. The account was titled In Carl R Adams' name alone. The balance as of 3/6/96 was $18,704.77 plus $137.46 accrued interest for a total of $18,842.23. The account was carnine 2.80' interest at the time of death. We have no record of a safe deposit box in the decedents name. Sincerely, h~.0')\.y'>.<;"CA"~ Karen Tomassone Supervisor Customer Service One Wl'Slliigh Slfl'eIP.O. Box 220 Carlisle, Pennsylvania 17013 (717) 243-3212 '\ .' SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCEllANEOUS EXPENSES REV .1511 EX . (7."1 CO"'r._{\,U~]hYAHIA ESTATE OF Carl R. ITEM NUMBER A. B. c. 1 2 3 4 5 6 7 8 9 lO 11 12 l3 14 l5 Adams SS 200-24-0628 03 06 96 DESCRIPTION 1 2 Funlral Expln...' Hoffman-Roth Funeral Home, funeral bill. Carlisle Memerial Services, menument. 1. Admlnl.traUvl co.t., Personal R.presentativI Convnissions Social Security Number of Personal Rfpresentative: Vea, Convrissions paid 2. Attorney Fe.s Fowler, Addams, Shughart & Rundle (Statements attached) 3. Family Exemption Claimant Add,..s 01 Claimant at docld.nt's d..th SU"I Addllss City Slat. Zip Cod. R.lationship 4. Pro bat. Fees Register of Wills Mlscellan.ous Exp.n.... H&R Block, prepare tax returns. Dauphin Oil, fuel oil. UGI, gas (9.65; 9.88j 6.60; 42.02; 9.00j 10.00) PP&L,elec(18.03;16.l3;32.30;37.00;20.65j7,42j6.45;50. Carlisle Borough, sewer & water (80.93j256.17;l8.94j23.68;11.82;11.82j50.00. United Telephone Co., phone (57.59; 42.37 Register of Wills, short certificates Register of Wills, filing inventory and inheritance tax return. Cumberland Law Journal, advertise Letters. The Sentinel, advertise Letters. Commonwealth of PA, automobile registration. UPS, overnight mell. L&M Heating, repair water heater, Jones Plumbing, plumbing repairs. Richard Beaston, carpentry, ropalrs and new lock. Total of Continuation Schedule(s) TOTAL (Also .nler on fin. 9, R.c. ~ulalion) (If more spice Is needed, Insert additional sheets of same Ilze.) ,..._......."..\ ,Gill' ...._............. ....... ,.~.,...._ 1_ ""'_7_ --. -, "'-, ~~~r"",..',..,~ \--_.~..''''~'~~~.4~~.,;:-"......_''. ~................. Pi.... Print or T I FILE NUMBER 21-96-156 AMOUNT 6,671.00 440.00 8,325.00 3l5.00 81.00 171. 63 87.l5 187.98 453.36 99.98 18.00 25.00 60.00 74.71 24.00 8.00 74.20 869.45 143.89 11 l61. 83 S 29 291.l8 . . ;',--" t".> c' '. ,;.....-,.--...-. -"-- ", _....,..-"..........,~..... . ..~'...- .-' Estate of: Carl R. Adams Soc Sec I: 200-24.0628 Date of Death: 03/06/96 Item I Continuation of Schedule H-C (Miscellaneous Expenses) Amount Dsscdption 110.00 16 17 USF&G, surety bond. Gilbert's Pest Control, termite trentment Postmaster, certified mnil. Darlene Moyer, 1996 county nnd borough real estste tnxes Cspital Tax Collection Burenu, personal taxes. Bonnie Coyle, notary fees Nancy M. Adams, reimbursement of air travel expenses (2 round trip from California to Pennsylvania). Nancy M. Adams, reimbursement of out-of-pocket expenses for postage, auto expense and long distance telephone calls. Benny E. Rowe, appraisal of household goods. Benny E. Rowe, auctioneer's commission Jay Cayman, trash hauling Lube N Co, automobile service, inspection and repairs to pass inspection. Mailboxes, Inc., shipping personal property (furniture, personal effects, financial records and documents) to executor/beneficiary in California. Darlene Moyer, 1996-97 school district real estate tax. Donegal Mutual, fire insurance. Jonea & Associates, processing medical insurance claims. Century 2l, Brenneman, realtor commission (estimated). Recorder of Deeds, realty transfer tax (estimated) . Reserve for Accounting and prepnrlng fiduciary income tnx returns. 11,161. 83 .............. 500.00 919.55 2.52 l8 19 20 21 22 1,064.00 23 24 50.00 l,445.90 500.00 25 26 27 28 1,340.77 29 30 3l 3,000.00 32 33 34 l86.84 9.90 20.00 304.l8 388.13 435.04 135.00 250.00 500.00 .'........~..._"" ... ...~.. ,........ "'t:l._ , , FOWLER, ADDAMS, SHUGHART & RUNDLE ATTORNEYS AT LAW P.O. BOX 208 28 SOUTH PITT STREET CARLISLE, PENNSYLVANIA 170 T 3.0208 JOHN I. 'OWLEft, III WILLIAM A. ADDAMS MICHAU R. RUNDLE .rrclAL CDUNItL DALE ,. IHUGHA"T. JR. TElEPltONE 17171 248,0300 FAX 17171248.0164 'OWLER. ADDAM' . .HUQHAftT 1117....121 0' COUHIU HOHO"AIU DALE ,. IHUGHAftT 11114'111" September 25, 1996 Nancy M. Adams, Executrix Estate of Carl R. Adams TO: FOWLER, ADDAMS, SHUGHART & RUNDLE (S) Professional services rendered as follows: 5/29/96 - Letter to client. .5 6/03/96 - Office conference with Nancy; prepare statement of reimbursable expenses; pay estimated tax. 1.0 6/06/96 - Review message from Nancy; telephone conference with Berkheimer and message for Nancy; review proposed Agreement. .9 6/06/96 Telephone conference with Nancy and Larry Foote and Marjorie Berkheimer; fax to Foote and letter to client. 1.0 6/10/96 Telephone conference with Nancy. .3 6/12/96 Recorder's Receipt for estimated tax; and letter to client. .2 6/17/96 Checks to client. .1 6/18/96 Review and compiling information; letter to client, CV Nephrology and RWC. 1.0 6/21/96 Updating inheritance return; telephone conferences with Nancy, Larry Foote, Sollenberger's and Register of Wills. 1.5 6/24/96 Office conference with Nancy and final preparation of expense itemization. 1.0 6/27/96 Review and organize information from Nancy. .5 6/28/96 Check mail at Elm Street. .2 7/02/96 - Balance checkbook and statement savings. .3 7/03/96 Review file; balance bank statements and letter to client. .6 7/05/96 Bill from Yellow Breeches; letter to Yellow Breeches and Jones; review file. .5 7/08/96 Deposit Rowe check; letter to client. .2 7/10/96 Review information received; letter to Jones, client and providers. 1.7 ,I .,.........._....;f~........ .; ...;..~.;.;." ...;.:..-,.....i!~.t:. ". 7/10/96 _ Telephone conference with McDowell Insurance and letter to McDowell. _ Information from Jones; letter to Jones and Nancy; pay sewer and water bill. _ Check to PP&L; letter from Berkheimer; letter to Berkheimer and client. 7/30/96 -.Review bank statements; pay Blue Mountain; and letter to client. _ Telephone bill to Nancy. _ Telephone conference with Nancy. _ Pay school district tax and letter to client. 8/06/96 _ statements from Blue Cross/Blue Shield deposit check and letter to Nancy and Jones. 8/13/96. _ Information from Homeowner's insurance and auto; letter to client and deposit check. 8/20/96 _ Carlisle Hospital bill and check from Blue cross/Blue Shield, deposit and issue check; letter to client and Jones. 8/23/96 _ Report from Berkheimer; letter and bill to Nancy, Balance accounts with bank statements and letter to client. Telephone conference with Nancy. Report from realtor. Telephone conference with Joan Jones; letter to client. 9/24/96 _ Telephone conference with Nancy, 9/25/96 _ Final preparation of Inheritance Tax estimate and Inventory; letter to Nancy, 4.~ ...... .." . . FOWLER, ADDAMS, SHUGHART & RUNDLE September 25, 1996 Pa&e 2 7/23/96 7/29/96 7/31/96 8/03/96 8/05/96 8/29/96 9/01/96 9/18/96 9/19/96 Total hours - Total fee at $125/hr. NOTE: Estimated fee to complete administration and distribution of Estate. Total fees to date and estimated fee. .2 .5 .5 .5 .1 .2 .1 .3 .6 .6 .2 .2 .2 .1 .2 .2 20.20 $2,525.00 1.000.00 $8,325.00 r--if .". FOWLER, ADDAMS, SJlUGIIART & RUNDLE ATTORNEYS AT LAW P.O. BOX 208 28 SOUTH PITT STREET CARLISLE. PENNSYLVANIA 17013-0208 JOHN I. 'OWUR. III WILLIAM A. ADDA'" ...CHAIL ft. RUNDLE TELEPHONE 17171 241.8300 FAX 17171 241.8164 'OWLUI. ADDA'" . IHUOH"RT 11t7l.'IIJI 'PlCIAL COUHUL DALE Po IHUaHART. JR. 0' COUHIlL HOHOR"I\.I DALI Po SHuaHART May 28, 1996 Nancy H. Adams, Executrix Estate of Carl R. Adams, deceased TO: FOWLER, ADDAMS, SHUGHART & RUNDLE (S) RE: Estate of Carl R. Adams Professional services rendered as follows: Cash advances: Postmaster, certified mail letter to DPW 2.52 Fees: Dale F. Shughart, Jr. 03/11/96 - Office conference with client; preparation of probate petition and bond; conference with insurance agent Dick Neiderer. 3.5 03/12/96 - Office conference with client. .3 03/13/96 - Review and compile documents. 2.5 03/14/96 - Office conference with client; to Farmers Trust company with client; SS4 to IRS various telephone conversations. 3.0 03/15/96 - Recording 00214; brief office conference with client; letter to client. 1. 5 03/18/96 - Organization of client's records and various correspondence. 2.5 03/19/96 - Hailing complete correspondence and organization of file; notices to Beneficial Interest and cover letter. 2.0 03/20/96 - Telephone conference with client. .2 03/21/96 - Obtaining value of U.S. savings Bonds; telephone conference with Jones & Assoc.; review of tax returns; letter to client. .8 03/22/96 - Review of correspondence; letter to client. .5 03/25/96 - Filing W-9; check to UGI; letter to client; telephone conference with client; letter to Glenn and Carol. .9 03/27/96 - Check to PP&L; letter to National Geographic and client. .2 FOWLER, ADDAMS, SHUGHART & RUNDLE Ma, 28, 1996 Pqe2 03/28/96 - Letter from cli~nt and Teacher's CUi letter to Teacher's CU and Patriot News; message from Glenn; second letter to client. 04/02/96 - Letter to Jones, client and American Express; deposit checks. 04/04/96 - correspondence to client, Carlisle Hospital and Jones & Assoc. 04/10/96 - Review medical information; letter to Jones & Assoc.; C.V. Nephrology and client; review of proof of publication from CIJ. 04/15/96 - Review hospital bill; letters to client and Jones & Assoc.; deposit insurance proceeds. 04/16/96 - Review letter from Jones & Assoc.; deposit tax refund. 04/22/96 - Telephone conference with Mrs. Polk at BS/BC; letters to Jones & Assoc., Berkheimer and client (2); review sentinel proof of publication; telephone conference with client. 04/24/96 - Office conference with client; compiling medical bills. 04/25/96 - Final sorting of medical bills and cancelled checks; letters to Jones & Assoc.; Blue Mountain Anesthesia and client. 04/26/96 - Review information from Carlisle Hospital and BS/BC; telephone conference with Jeff Gilbert; letter to Jones & Assoc. and client. 04/29/96 - Telephone conferences with client, Marjorie Berkheimer, and Ben Rowe. 04/30/96 - Review of information from Gilbert, BS/BC and Berkheimer; letters to client, Berkheimer, Jones & Assoc and PA Department of Welfare (certified). 05/01/96 - Review bank statement and contract with Gilbert; telephone conference with Richard Beaston. 05/03/96 - Telephone conference with DPW. 05/13/96 - Review medical information and corres- pondence; letters to clients and Jones & Assoc. 05/15/96 - Office conference with client; letter to Jones. t' .9 .6 .5 .6 .6 .1 1.0 1.5 1.0 1.0 .5 2.2 .5 .1 1.5 .7 I' f: I I: roi l h ,,,., ,. 1.5 ... _. , - - - LAST 'fILL AND TESTAl>IENT OF CARL RAYMOND ADAMS , KNOW ALL MEN BY THESE PRESENTS, That I, Carl Raymond Adams, ... of the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound mind, memory an~ ,understanding, do make, publish and declare this my Last Will and Testament, hereby rovoking and making void any. and all Wills by me at any time heretofore made. ITEM 1. I give, devise and bequeath all of my property, whether the same be real, personal or mixod, and wheresoever situate, to my s1ste~, Nancy M. Adams. ITEM 2. I appo~nt my sister, Nancy M. Adams,' to pe the Executrix of my estate. IN WITNESS WHEREOF, I have executed this my Last Will and Testament, consisting of one typewritten page, by affixing my signature . 'and my seal to same, this 17 day of fl Al,t "t..d , 1960. tJ..'fJ.': Rr-O"fU('>-KJ):;; I!~W'-!J (SEAL) The writing contained on .this one sheet was signed and sealed by the above named Carl Raymond Adams, and by him published and declared as and for his Last Will and Testamont in the presence of us, who here- unto subscribed our names as witnesses, a~is request, in other, the~ day of . his presence, and in the presence of each 1960. ~~\r., .()~'v'\'d',,,,, /~ (;) ~ \.J.:j;d-l~" }!, "7.//,,,,:,, I J ..r--------------------- ._-.--_. I I I I I I I I I I I I I t I I I I I I I I I I J I ~ I -J I I - - - - - - - - --- - - -- _. -- _. ~-- -- - - - - - - - - -,- ~ - - -,- j ..., ~ .---..- -, ..~.._.... , -- --- --- ~- -- - - - - _.- - - -- RECEIVED FROM, & ACN ASSESSMENT fl' CONTROL ~ NUMBER AMOUNT SHUGHART DALE F JR 28 S PITT STREET 101 18,000.00 : CARLISLE, PA 17013 ESTAT! INfOIlMAT10N. !IIINMR II 21-1996-01~2 SBN 200-24-0628 !II NAME F DECEDENT (lAST) (FIRST) (Mil ~ ADAMS CARL RAYMOND I E P"YMfN 'r B POSTMARK l>>JE COUNTY m TOTAL AMOUNT PAID 18,000.00 .. VZ C I' \.. . \."jI RECEIVED BY ! /I., /: tltM.:tl /'?i/ MARY C. LEWIS ,_ '%t/.'1U /y(/, . REGISTER OF WILLS I REMARKS NANCY MADAMS C/O DALE F SHUGHART CHECK" 3~ JR ESe SEAL REGISTER OF WILLS " i \ -. ~. . ~' :< " . ' - ..- ,.--,. -~.... "R , .... 11 .. o.-._~ , _'-r ~- ~. \. --:--..:.r. r /5- fl/) - 1 COHHONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERltAHCE fAX DIVISION DtPT. 1I0Ul HARRISIURC, Pi 11121.0601 NOTICE OF INHERITANtE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DALE F SHUGHART JR FOWLER ETAL 28 S PITT ST CARLISLE PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-03-97 ADAHS 03-06-96 21 96"0152 CUHBERLAND 101 Anount Re.itt.d c..- ~* 11"1"'11 l" IIt.tll CARL R MAKE CHECK PAYABLE AND REHIT PAYMENT TOI REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ..... iiiv: iSiii"EX"AFii "nF96T"iioYicEnOFniNHEiiii'AiicE"YAX"A"P PRiiisEHiiir;",\L.i."OWANCE"b"Ii"--"m"--mm- DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF ADAMS CARL R FILE NO. 21 96-0152 ACN 101 DATE 02-03-97 If an assessment was issued previously, lines 14, IS and/or 16, 17 and 18 reflect figures that include the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Anount of Line 14 at Spou..l rat. (15) 16. A.ount of Lin. 14 taxable at Lin.al/CI... A rat. (16) 17. A.ount of Line 14 ta.abl. at Coll.t.ral/Clals B r.t. (17) 18. Principal Tax Du. TAX CREDITS: PAYMENT DATE 06-03"96 10-14"96 TAX RETURN WAS I I X I AtCEPTEO AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN 1, Rool Eatoto ISchodulo Al III 2. Stocka and Bonda ISchodulo BI C21 3. Closely Held stock/Partnership Int.r..t (Schedul. C) (3) 4. Hortg.gal/Hota. Raceivable (Schadule DJ (4) 5. Ca.h/Bank Deposita/Hilc. Pa'lonal Property (Schedule E) IS) 6. Jointly Owned Property (Schedule F. 16J 7. Trenlferl ISchedule GJ 17J e. Totel Alletl APPROVED DEDUCTIONS AND EXEHPTIONS: .. Funerel E~penlel/Ad.. COlts/Hisc. E~p.n.e. (Schedule HJ 19J 10, Oabta/Mortgago Llobllltlo./Llon. ISchodulo II 1101 11. Tot.l Deduction. 12. Net Velue of T.. Return 15. Chariteble/Covern.entel aaque.t. ISchedule JJ 14. Net V.lu. of Elt.te Subject to Tax NOTE I RECEIPT NUMBER AA1l2893 AA146842 OIStOUNT C+I INTEREST C-I 421,05 ,00 I CHANGED 50.000,00 ,00 ,00 ,00 74.054,87 ,00 ,00 IBI 29,291.18 11.619,91 1111 n21 CUI n41 ,00 X .00. ,00 X ,06. 83.143,78 x.lS. nel AMOUNT PAlO 8,000,00 4,050,52 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE NOTEs To inlure proper credit to your account, lub.it tha upper portion of thil for. with your tax pay.ant. 124.054,87 4n.911 n9 83.143.78 ,00 83,143,78 will .00 .00 12.471,57 12.471.57 12,471.57 .00 .00 ,00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS TNAN tl, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "tREOn" CCRI, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I AUERYAHONI PURPOSE Of' HOHCll PAYtlEHTI REFUND tCA) I alJECTIONSI AIlHtN ISTAAlIVE CORAfCTIOHSI DISCCk.JtTl PENALTY, INTEREST t 00 ~ :0:0 em (1)~ :3 ..: c ~. ! (~ -n ,,, It, ~ CD ., I \..oJ "_ :u~ }.~ ...:.... ~.'. (Ii 2. B o i..J 00 [sh... a' d.udln" dying on ar btIfon O.ullbtlr 12, 1912 ~- If MY fu'ur. In'.r..' In 'M ...... 11 'r,"".rr" In po.....lon or enJoy..n. '0 CII" I l~oll,'.r.l) bM,'I~I.rl.. of th4 d.~.den' .f..r ,h. I.plr.tlon 0' en, ....t. II" or 'or y..r., th4 C~onwe.I'h h4rlby ..pr...I, r...rv.. thl right to ,ppr.I,. end I"'" tren,'.r Inherl'ancl .t thl lewful CI... I l~oll".r.l) rlt. on any .u~h 'utur. Int.rlst. '.r Tlu. To 'ulflll tM r.qulr...nts 0' S.~tlon ZI~O 0' thl Inh.rltanc. and Est.tl T.. Act, Act ZZ 0' 1991. 7l P.S. Sactlon '140. Det.ch th4 top portion 0' this Notlcl and sub.lt with your p.y.,nt to thl A.glst.r 0' Will. prlntld on the rlv.r.. ,Id.. --M.... chltk or 110M' ord.r parlbl. tal REGISTER 0.' MILLS, AGENT All p.yaent. rlc.lvld shill 'Irst b. appll.d to any Int.rlst ~hleh ..y b. dul with any r'lllnder appll.d '0 th4 tl.. A r.fund 0' I taM credit, which WI. not rlqu.stld on thl 'a. R.turn, .., bl rlquestad by coaplltlna an -Appllc.tlon 'or A.,und 0' Pann.,lvenll InhlrltlnCl and Elt.ta T..- (REV-ISIS). Appllcltlonl Ir. Iv,lllbl. at the O"lc. 0' thl A.,I.t.r 0' Wills, any 0' the 2S R.v~. Dlltrlct a"lc.l, or by cllllng the Ip.el.1 Z'-hour InIWlrlng l.rvlcl nu.b.r. 'or 'or.. ord.rlngl In P.nnsylvanl. 1~'00~S6l-2050, outsld. Pennsylvanl. and within loc.1 H.rrl.burg .r.. (717) 717~1094, TOO' (717) 772-Z2SZ (H..rlng lap'lred Onl,). Any p.rty In Int.rllt not l.tl,'I.d with the .ppr.ls...nt, .Ilo~anc. or dls.llowanc. of d.ductlon., or ......-.nt of ta. (Including dl.count or Int.r..t) .. shown on thl. Notlc. .u.t obJ.ct within ,I.ty (60) d.y. 0' rec.lpt of this Notlc. by! --written prot..t to the PA D.part..nt of Ravlnu., lo.rd of App..I., D.pt. 2110ZI, Harrl.bur" PA 17121~IOZ1, OR --.Iactlon to h.v. thl ,.tt.r d.t.r.lned .t .udlt a' the .ccaunt of the p.r.onal r.pr..en..tlv., OR --app,11 to the Orphln." Court. FaetUtI .rror. dl.cav.r.d on thl. I.....,.nt .hould b. .delr",ld In writing tal PA a.p.rt,."t of ..venu., IurllU of Indlvldu.l T...., ATTNI Pa.t A......ant R.vllw unit, a.pt. l10601, H.rrl.bur" PA 17Il.~0601 Phon. (717) 7.'.6505. S.. pI,. 5 a' the bookl.t -In.tructlon. far Inh.rltlnc. T.. R"urn far. R..ldant Oac:ldlnt- (R[V~lsO)) far In .IlPlanlUon of .dIIlnls.r.Uv.h carrlctabl. .rrar.. If an, ta. due I. p.ld wIthin thrl. eS) c.l.nd.r .anth. .ft.r the d.c.dent". d..'h, . flv. parelnt Cs~) dl.count a' the t.. p.ld It .llowed. The Is~ ta. a.nt.ty non-p.rtlelp.tlon pen.lty I. eaaput.d on the tatll a' the t.. and In'.r..t ......IeI, and not p.ld bafor. Janulry II, 1'96, the flr.t day af'.r the end 0' thl t.. .-n..ty p.rlad. Thl. non~p.rtlclp.tlon panllty I. .pp..labl. In the .... .ann.r and In the thl .1.. .1.. p.rlad .. YOU would .pp..l the t.. and Intar..t th.t hi' blan .......d .. Indlc.t.d on thl. notlc.. In..r..t I. ch.r,.d blQlnnlno with 'Ir.t d.y of d'llnqu.ncy, or nine (91 eonth. and one (I) d.y 'rot the d.t. a' d..th, to the data of p.yaent. """ which bac... dellnqu.nt b.for. Januar, I, 1"Z b..r Int.r..t .t thl r.t. of .1. C6~) p.rcent p.r ~ cllcul.t.d .t . d.lly r.ta 0' .DDOI64. All t,"" which b.c... d.llnquent on and .f'.r Januery I, 19', wIll b..r Int.r..t .t . r.t. which will v.ry fro. c.llnd.r v..r to c.landar y..r with th.t r.t. ennounc.d b, the PA Dlp.rt'ent a' R.v.nue. 'h. Ippllcabll In'lre.t r.ta. 'or I,., through 199' .rll !!.!! Interllt R.t. a.llv Inter..t F.ctor !!!r- In'.r..t R.t. D.llv In'.rllt Flc'ar 1911 ZOX .0005" 191' 'Z .OOUU 1913 16Z .000lt1l I9I'~1991 llX .000101 19l~ IIZ .000101 199Z .Z .0002" 1985 UZ .000556 1995~I99lt 'Z .000192 nil lOX .000l7lt 199s~1997 'Z .00Ult' ....Intar..t I. calculat.d .. 'aUa..t INTEREST . BALAnCE OF TAX unPAID X nUnBER OF DAYS DELInqUENT X DAILY InTEREST FACTOR -~&n, Natlcl I..u.d .f'.r the t.. b.ca'.. d.llnqu.nt will r.fl.ct an In'lr..t cllculatlon to flft.an (IS) d.V' beyond the d... of thl .......ant. If p.yaant I. ..d. "t.r thl In..r..t co~t.tlan dlt. ,hown on thl Notlc., addltlon'l Intlr..t au.t ba c.lcul.t.d. r.II1LU>IlATAF1LMOSPfTALllOC\,...m.I'ldo er.e.t.1WUIt,.,t.2....... .........C121IWOUUI'M ALLEGED INCAPACITATED PERSON IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION 96. / ~-,:;l. ORPHANS' COURT INRE: CARL R, ADAMS CITATION WE COMMAND, you that laying aside all business and excuses whatsoever, you be and appear in your proper person before the Honorable Judges of the Common Pleas Court, Orphans' Coun Division at a session of the said Coun there to be held. for the County of Cumberland to show cause why Carl R, Adams should not be adjudged an incapacitated person and a guardian of his person and of his estate appointed, A hearing upon said citation is to be conducted on the 'iJ U day of Ov,',C' . 1996, at?: 30 o'clock L,M" in Coun Room No, ~ of the I Cumberland County Coun House, Carlisle, Pennsylvania, at which ,time all interested parties may be heard, Written notice of said Petition and hearing shall be given in large type and in simple language to the alleged incapacitated person, The notice shall indicate the purpose and seriousness of the proceeding and the rights that can be lost as a result of the proceeding, It shall include the date, time and place of the hearing and an explanation of all rights, including the right to request the appointment of counsel and to have counsel appointed if the Coun deems it appropriate and the right to have such counsel paid for if it cannot be afforded, A copy of the Petition shall be attached, Personal service shllll be made on the alleged incapacitated person, and the contents and tenns of the Petition shall be explained to the maximum extent possible in language and tenns the individual is most likely to understand, Service shall be no less than twenty (20) days in advance of the hearing, In addition, notice of the Petition and hearing shall be given by cenilied mail to all persons residing with in the Commonwealth who are sui juris and would be entitled to share in the estate of the alleged incapacitated person if he died intestate at that time, and to the person or institution providing residential services to the alleged incapacitated person, Witness my hand and official seal of office at Carlisle, Pennsylvania this ~of/ day of 1.,1, ,1996. . /.' jJ' \\ ~ /)//h.d r', .,'t. '" ().. ;; ,)..,,,, \, # I J CQ" ~.. 'i D.yQ,,,,.. c .....L "".. '" INRE: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL V ANlA ORPHANS' COURT DIVISION 96. JS~ CARL R, ADAMS ALLEGED INCAPACITATED PERSON ORPHANS' COURT {\\ ORDER AND NOW, this Kday of ~996, upon consideration of the within Petition and upon motion of MARTS ON, DEARDORFF, WILLIAMS & OTTO, attorneys for Carlisle Hospital, Petitioner herein, a citation is hereby awarded to the Petitioner and directed to Carl R, I Adams, an alleged incapacitated person, to show cause why he should not be adjudged an incapacitated person and a guardian of his person and of his estate appointed, A".'. 0 A hearing upon said citation is to be conducted on the 8ft\. day of Pr P''''^' , 1996, at q', ~O o'clock k ,m., in Court Room No,;' of the Cumberland County Court House, Carlisle, Pennsylvania. at which time all interested parties may be heard, Written notice of said Petition and hearing shall be given in large type and in simple language to the alleged incapacitated person, The notice shall indicate the purpose and seriousness of the proceeding and the rights that can be lost as a result of the proceeding, It shall include the date, time and place of the hearing and an explanation of all rights, including the right to request the appointment of counsel and to have counsel appointed if the Court deems it appropriate and the right to have such counsel paid for if it cannot be afforded, A copy of the Petition shall be attached, Personal service shall be made on the alleged incapacitated person, and the contents and tenns of the Petition shall be explained to the maximum extent possible in language and tenns the individual is most likely to understand. Service shall be no less than twenty (20) days in advance of the hearing, In addition, notice of the Petition and hearing shall be given by certified mail to all persons residing within the Commonwealth who are sui juris and would be entitled to share in the estate of the alleged incapacitated person if he died intestate at that time, and to the person or institution providing residential services to the alleged incapacitated person, BY THE COURT, 1. \ INRE: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION CARL R, ADAMS ALLEGED INCAPACITATED PERSON ORPHANS' COURT 96- PETITION FOR ADnmICATION OF INCAPACITY AND APPOINTMENT OF GUARDIANS FOR HIS PERSON AND ESTATE TO THE HONORABLE, THE JUDGES OF SAID COURT: The Petition of Carlisle Hospital, by its attorneys, MARTSON, DEARDORFF, WILLIAMS & OlTO, is made in accordance with 20 Pa. C,S,A, ~5511(e) and respectfully represents as follows: I, Petitioner, Carlisle Hospital, is a Pennsylvania nonprofit corporation with a place of business at 246 Parker Street, Carlisle, Cumberland County, Pennsylvania 17013, Petitioner has been providing health care and counseling to the alleged incapacitated person since November 26, 1995 and is interested in his welfare, 2, The alleged incapacitated person is Carl R, Adams, a 63 year old adult individual born on December 3, 1932, 3, The alleged incapacitated person resides at 131 Elm Street, Carlisle, Cumberland County, Pennsylvania 17013, 4, On or about November 26, 1995, the alleged incapacitated was admitted to Carlisle Hospital, The diagnosis for Mr, Adams was renal failure, diabetes, and esophagitis, Mr, Adams is also legally blind, 5, The alleged incapacitated persons' spouse and parents are deceased, The alleged incapacitated person has three living siblings, Meryl Adams, Gene Bender and Nancy Adams, all of whom reside in the state of California, 6, The alleged incapacitated person has a nephew, Glenn Adams and a niece, Carol Wickard, both of whom reside in Cumberland County, Pennsylvania. Mr, Adams and Mrs, Wickard have declined to act as guardian for the alleged incapacitated person, 7, The Petitioners know of no other relatives of the alleged incapacitated person, 8, No person or institution is providing residential services to the alleged incapacitated person, The alleged incapacitated person is currently an inpatient at Carlisle Hospital, Prior to onset on illness to the present degree, he resided at his above referenced Elm Street home, 9, The guardianship is sought because the ability of the alleged incapacitated person to receive and evaluate infonnation effectively and communicate decisions is impaired to such a significant extent that he is totally unable to manage his medical condition to meet essential requirements for his physical health and safety, and is totally unable to manage his financial resources, 10, Mr, Adams consistently refuses most medically necessary medications, frequently refuses meals or eats little and refuses to restart nutritional IV, Such actions jeopardize Mr, Adams' life and illustrate his inability to comprehend and evaluate infonnation in order to make infonned and rational decisions, In addition, Mr, Adams refuses physical therapy, rehabilitation, personal care or to engage in discharge planning, II, Steps were taken to find less restrictive alternatives to guardianship, however, these steps have failed, Petitioner believes that until his most recent hospitalization, the alleged incapacitated person was handling his own affairs with the assistance of others, However, Mr, Adams condition is such that he now requires constant supervision and care, Petitioner is not aware of any durable general powers of attorney, trusts or other advance directives in existence, The alleged incapacitated person lacks sufficient capacity to appoint an attorney-in-fact, For these reasons, Petitioner respectfully submits that there is no less restrictive alternative to plenary guardianship of the person and of the estate, 12, The specific areas of incapacity over which it is requested that the guardians be assigned powers are the management of all aspects of the physical care and well-being of the alleged incapacitated person, as to the guardian of the person, and the management of all financial resources and property in the alleged incapacitated person's estate, as to the guardian of the estate, 13, Petitioner suggests that Capitol-Public Guardianship Agency, P,O, Box 1113, Camp Hill, Pennsylvania, owned and operated by Ann Thorek, be appointed plenary guardian of the person and estate of the alleged incapacitated person. The qualifications of the proposed guardian is that it is familiar with arranging care for those incapable of doing so for themselves and also of handling financial matters for such persons in a fiduciary capacity. 14, The proposed guardians have no interests adverse to the alleged incapacitated person, 15, Based upon infonnation provided, the gross value of the alleged incapacitated person's estate is estimated to be $50,000,00, though no appraisals have been conducted, 16. The alleged incapacitated person's annual net income from all sources is unknown, 17, No other court has assumed jurisdiction in any proceeding to detennine the capacity of the alleged incapacitated person and no other Court or other body has appointed a limited or , plenary guardian for the alleged incapacitated person or his eSlate to the best of the knowledge and infonnation of the Petitioners, 18. The written consent and statement of the proposed guardian of the person and estate, as required by C,C,O,C,R, 14,2-2, is attached hereto and marked as Exhibit "A," WHEREFORE, Petitioners pray this Honorable Court, pursuant to the provisions of Chapter SS of the Probate, Estates and Fiddciaries Code \:0 Pa, C,S.A. ~SSOI, et seq.), to award and issue a Citation directed to the alleged incapacitated person, the said Carl R. Adams with notice thereof to his presumptive adult heirs and to such other persons as the Court may direct, to show cause why the said Carl Adams should not be adjudged an incapacitated person and a plenary guardian of his person and of his estate appointed, Attorneys for Petitioners Respectfully submitted, MARTS ON, DEARDORFF, WILLIAMS & OTIO By ~~. D~/I W, Darren Powell, Esquire Ten East High Street Carlisle, PA 17013 (717) 243-3341 Date: 2 -\ (, . 'Ie. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Carl R. Adams Date of Death: March 6. 1996 Estate xWiH No. 21-96-1- - 151- 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 x No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No v b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes x No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this repo t. Date: April 28, 1997 ,~ o f~ 0'\ R ~~ N , fL , . to .> N ~ r- .- f1\ ~t: u8 Capacity: Personal Representative .'-.:: Dale F. Shul!hart. Jr.. Esauire Name (Please type or print) ~ ~J ~ :i Ii) <1>0: a: 35 East Hil!h Street. Suite 201 Address Carlisle, PA 17013 (717) 241-4311 Tel. No. x Counsel for personal representative (MAH: rmfl AM3)