The URL can be used to link to this page

Home My WebLink About96-00919 HM OOPy. t"'.~.s Ill' CllOIl - COMMONWEALTH OF PENN5Y!.V...NI... COUNTY or CUMRRRI.A ND 55: +l, PnoonaUy appeared before me, thll t., day of Seotember 19.!2- John D. Hendrickson, Executive Director ot the Alliance Home ot Carlisle, P A, Inc., who. belnl duly Iwom aecord!nl to law. deposel and .aYI lIullhe.u menta conralntd In the (onlolnC IppU. callon are crue. (SEAL) ~i:'t';_'1<""", 2."ll....../ --0 1'fO'IrJf'r'~) 0 NolltlIlS... My CommiSSIon expires I lit. Holly ptfngs Bo.... CumboItllld CQunIv INSTRUCTIONS FOR COM IS . pl.21,1888 MIrTCer.F...4,....Ia~of~ A. ^Ppliclllon mUll be siGned In beh.lf o( the appllcanl corporaUon and (or aU other enUUee laled with II in Parall1'aph 8. . B. It the appllcanl JI a fonnin corporatlon. IJ1c applicanl muS!, plior 10 the flIInl o( an application, be duly aulJ10rtzed 10 c:1n'y on or conduct the bul.lneal cletc::tbed In Paralfaph ~ under thelawa of thle Common. weaJlJ1. If Ihe aulhonZ2Uon to do bUllne", wu ll&Ucd by lhe Inlurance Depanmenl or It no earUlIeele of authomy" required by I;?w. Para!P'aph 1 of the (onn ahould be modified eccordlnllY. C. Wherlllllndlvldual fa A member of e pannenhip or join! venNre wllh one or more cOrpOl'lr.lolll under a ftcUr.loua Ilamc, ronn OSCB: 15-55/54.28.1 (AppUcallon (or conduCUnI bUllnul under aD AuIml8d or F'lcUuou. Name-Indlvlduala and CorporaUoftl) ahould be uaed. O. F'onn. and wormaUon related to mini In the office oi Ihe prothonotary of the proper county ahall be leCured by dJrecllnqulry addrelttd 10 the prothcnorary. E. All informauon shaU be cypcd or prtnred. In black Ink. r. Mike check ..ayable 10. Secrerary o( lJ1e Commonwealth. (C...SH WI!.!. NOT BE ACCEPTED), C. Send appUcallon and check 10. Corporauon Buruu, Department o( Slare, Room 308 North Ofllce Bldl', Hunlburl. Pa. 17120. successor allorney-in-fact is appointed under the Power of Allorney, nor was Petitioner given the power to appoint his successor allorney-in-fact. 4. The Alleged Incapacitated Person is 10 I years of age, having been born on October 3 1895. 5. The Petitioner is not related to the Alleged Incapacitated Person. 6. The Alleged Incapacitated Person is widowed. 7. The Alleged Incapacitated Person was not a member of the armed services of the United States and is not receiving any benefits from the United Stales Veterans Administration or its successor. 8. The Alleged Incapacitated Person has no Iincal descendants or living brothers or sisters. She does have several nieces and nephews which to lhe best knowledge of the Petitioner are as follows: Mary Chess, 1260 Stueben Street, Pillsburgh, PA, 15220 William G. Chess, 48 Belvedere Ave., Pillsburgh, PA, 15205 John A. Chess, 1041 Marina St., Pillsburgh, PA, 15220 Robert D. Chess, 1260 Steuben St., Pillsburgh. PA, 15220 Richard B. Chess, 1260 Steuben SI., Pillsburgh, PA, 15220 Lois Virginia Mock Leeder, 2303 Cedar Place, Longview. WA, 98362 Jean Elizabeth Mock O'Neil, 5345 N. 29th SI., Omaha, NE, 681 II Wil1iam Russell Mock, 4315 W. 176th St., Torrance, CA, 90504 Jack Allen Mock, 156 Toway Lane, Huntington Beach, CA, 92647 Richard Warren Mock, 4716 Valley St., Omaha, NE, 68106 9. No other court within the Commonwealth of Pennsylvania, of which Petitioner has knowledge, has appointed a guardian for the Alleged Incapacitated Person. 10. The Alleged Incapacitated Person has income consisting of money due from Social Security in the amount of $448.00 per month. II. The Alleged Incapacitated Person has assets, real and personal, of which the Petitioner is aware, in the amount of $184,498.42, consisting of those assets and their values as more particularly set forth in Exhibit B attached hereto and made a part hereof. 12. Chapel Point (formerly the Alliance Home) located at 770 So. Hanover Street, Carlisle, Pennsylvania, is currently the institution providing residential services to the Alleged Incapacitated Person. 13. Petitioner is unaware of any other service providers. 14. The Alleged Incapacitated Person is incapable of managing her financial resources or of caring for her person as a result of her incapacity for reasons set forth in the attached Affidavit and Competency Report prepared by Dr. Robert Hollen attached hereto and made a part hereof as Exhibit C (the "Competency Report"). The Competency Report sets forth the functional limitations and physical medical condition of the Alleged Incapacitated Person. Based upon the Competency Report, Petitioner believes that the Alleged Incapacitated Person is totally incapacitated as defined under Chapter 55 of the Probate, Estates and Fiduciaries Code. IS. Financial Trust Services Company ("Financial Trust"), located at One W. High Street, P.O. Box 220, Carlisle, Pennsylvania, 17013, having no interest adverse to the Alleged Incapacitated Person, has agreed to act as guardian of the Estate of the Alleged Incapacitated Person if this Honorable Court shall so appoint. The consent of the proposed guardian to so act is attached hereto and made a part hereof as Exhibit D. 16. Petitioner believes that it is in the best interest of the Alleged Incapacitated Person that Financial Trust serve as guardian due to the fact that it is presently located ncar the residence of the Alleged Incapacitated Person and has a strong history of serving as guardian of the estate to other incapacitated individuals within the community. 17. If this Honorable Court should appoint Financial Trust as guardian to the Alleged Incapacitated Person, Petitioner shall resign as allorney-in-factto the Alleged Incapacitated Person. 18. Due to the fact of the severity of the Alleged Incapacitated Person's physical and mental condition, the unavailability of any close heirs, and the likelihood that the L ~ -~;"~",,-~~~...,c:-._~..-;,....-............._.,, ~ $jw..m'JJJ!JJ!IJb.~ ."'iJi~jhr$);lJJ;.~ WI!llt I, IIELDI ORPIIII CIIESS, of tho City of IIllontown, County of LehiCJh and Commonwealth of Pennuylv,101'l, !,llla va Illude, cOII.tilllled 1//lIll1l'poillled 11/111 by /I,,'se I"eselll. do IlllenlltIIlN"';II1 fillY 1/. BRENlIEtI, ESQUIRE, my /lllIke, cO/uti. trlle IImllawltll uUm'lIclI name,lIlnce (lilliS/CUlt to generally acl for Ille, (ur lOa nml ill my and lhis powar of attorney ahall nol be affected by disabillly of lho principal. " llerebv J!i"ill/! tl/l/ll!rtllltilllt unlo my said nUorney (ull alld wllOle pOlller alld (",Ihorily ill ami nbollt Ih. premises; "lid l!ellernllv all ami 8"e'7/ act a,ut ncts, thilld awl th;1l~s, tl,wivfl {lIill cltwicr.y, in Ihe law whalsofwer noedful tllld 1UJceuarll to be llfmo ill (lIul about thfl promises, for me and in my name to ,lo, c.l:(!Outelllul pcrlorm- in I"rto and amply, to all info"t, ami purposes, as I miltht ur (lould tlo, i( personally presCllI,' "m! nil aUornev or a/lorney. ulltler him (ur Ih. p"rpo.e a(oresaid, 10 /lwke alld oomtilu,te, anil tho SCUIlO to rtJTlW"C llud rct'okc ILt my pleasu,rtJ, hercby mti(yint and COllfirmillC ". C'uotl (//111 ,'jJ'ee/lwE, ill Eaw ami ill equitv, all that my sai,l aUorlley or his .u".,lilul"s .h"U/nIll(uIlV 1III<llc4nlly do bV l'iTtlt" Ittwcnf. .3111 ~ihll'.~.~\ .a~II'l'l'l'a,f, T /,,"'.. 1""""11I10 s..t my /1II"d 1I11'{ ".,Ll Ill. 20th dllll ",- Mo reh ;.. Ill. VO.., one tllol/sand /line ,,,tI,,lrcd alii! elCJhly (1960). ! 'A1J/W)'t wlmP!hIU!liIiI!i)J ~ a I' JIII1JlrUI'II~'Uf _.4.. _~~~.M . ....... ,fEr EtI ORPHA cii?s1;!..-= ... ; ~7li~att J}}l '. (, ____m_'_________.___._____'_. I ~110 ------ - --" --t>> I --'-.---Ct i ~~~m~~bM\~ I On IMI, Iht 20th day of March , 19 8116ifort mt a Ilotllry Public, tht undm;vud o./liar. pmonal" apptartd IIELEIl ORPIIA CIIESS, widow, known 10 mtlor lal;t/allor;" prootn)10 6t 1M ptrlon IVholt namt 15 lu!ur;6tJ 10 Iht 1V;IMn ;mlrumtnl, and adnowltdgld Ihal sht tXU/lud Iht Jamt for Iht purpolt Ihtrtin lonl,,;nd. IN WITNESS WHEREOF, I haot hmllnlo Itl my hand and notarial Ital. I - j ............ h~" .... ..... f}.....' ..' . ~( '" ~ ........ ~u.."SsION E:~ . ." ,'..Lj)l'~ ..,~, /J',"'J' ~~'-:""\ If('s _ IT0_... c'{a___ ({-----* :=t: III -4 ~;i BETTY JEAN MUSTE .. : . : ,.. , ~ :..: .",., MI<, "",".. ,,,,,, f.. , l; . ....~i~. '0 .::','.. j ., c..",,,,, ....n '.,.. 11 , 1 "~ .... .',. c,f:::-,;:" I..... 11'\.... '" .., , ............. .' I ii' o co C'> ~ ~ Ii-' . CI) Cfl !il u '" if ii! o Hl H P 0 Cfl ~ hI . F.i ~ II' II'l . II' . o '" .<1 u .. '" ;;: ,., .., ~ ::: .. ~ '" " \Q = e J .. ::: :l ., .sc..,.; :::Jt ... 001 e"'" - .!! do a~::i I'll- .11 "'" E . "" "c =n Ia' a ~,., ~ ~::1;.!l ., - do ~ ~'ml~,tJW}."~JJ ()A ~~~)(J9JlJJtJ, ( ~ ~~~ \ F.i r:l .f. :-;; 01 ~ (.;/ ~, ' ~~~.q,I),\',~~~) I'll fll/:c_____,... ,.II:IYl'/' .J/.'iU.9_ ill lIlt' 'l/cCl'rtl"','.l; lY(z'C" (If saiel C(lI/lI~JI' ilL.un. __+______._ _ 'Iltll'/." ,'l'i,l. .l~lf;h.____ r,t'JIt'II wzd,!)' my Iltmd and st'al o/:Llze saiel.tlffice flu Iralt! <1/0(11''' lI'ri/l,'JZ. IN THE MATTER OF HELEN ORPHA CHESS, AN ALLEGED INCAPACITATED PERSON EXHIBIT B Schedule of Assets of Helen Oroha Chess as of October 4. 1996 Checking Account: 700 shares AT & T Corporation (formerly American Telephone and Telegraph Company) common: 420 shares Ameritech Corporation (formerly American Information Technologies Corporation) common: 280 shares Bell Atlantic Corporation common: 630 shares BellSouth Corporation common: 280 shares Nynex Corporation common: 280 shares Pacific Telesis Group common: 280 shares AirTouch Communications common: 420 shares SBC Communications (formerly Southwestern Bell Corporation) common: 280 shares U.S. West Communications Group (formerly U.S. West, Inc.) common: 280 shares U.S. West Media Group common: 226 shares Lucent Technologies, Inc. common: TOTAL ASSETS: $ 18,027.54 -. 27,562.50 22,575.00 17,360.00 24,570.00 12,810.00 9,747.50 7,770.00 20,921.25 8,750.00 4,672.50 9.732.13 $184,498.42 BELVEDERE MEDICAL CENTER B!50 WALNUT BOTTOM ROAD CARLISLE. PENNSYLVANIA 17013 FAMIL V PRACTICE ROBERT A, HOLLEN. MO HAROLD G. KRETZING. M,O. BRUCE O. BAilEY. M,O, BRUCE G. KIPP III. PA PHONE: 243.1515 FAX: 243.7171 October 14. 19Yb RE: Helen Orpha Chess Competency Report Based on my examination and medical history of Ms. Chess. her present mental condition is one of being confused as to time and place. Emotionally she appears to be stable and seems to be very happy. however. she will also have occasional outbursts if she does not want to do a particular task such as getting dressed or being up and around. Her physical condition: she is mildly hypertensive and she does have edema of her lower extremities. She does not have social skills where she can interact in meaningful conversation. I do not feel she has the ability to manage her financial resources and does not have any capability of regaining or redeveloping any lost abil it ies. I feel a guardian of the estate for Ms. necessary as I feel she is totally incapable dling the affairs of her estate. Chess is of han- I do not feel she would be capable of attending a hearing at the Court House because of her difficulty in getting around. It would be preferable that a hearing be held at the Alliance Home. I do feel that she has sufficient cerebral arteriosclerosis that prevents her from making any decisions concerning the handling of affairs of her estate. ) . \ ~J.r1' ~~1t / (1- i II {)j!,.- ,:J RoJert A. Hollen. M.D. RAH: ja FP-231 IN RE: IIgLEN OHPIIA ('1I1';S:C; An A 11 '~(J0r1 1 nrill'ar I. ta tJ.d P~rfion IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 96. 'J llJ ORPHANS' COURT IMPORTANT NOTICE CITATION WITH NOTICE A petition has been filed with this Court to have you declared an Incapacitated Person. If the Court finds you to be an Incapacitated Person, your rights will be affected, including our right to manage money and property and to make decisions. A copy of the petition which has been filed by Hav H .Ilrenn"m. EsCl. is attached. ('1Ii1PEL POINT. You are hereby ordered to appear at a hearing to be held in lZl)u'lU!()Qlii<NlS)(XXXX , Cumberland County Courthouse, Carlisle, Pennsylvania, on DEe'. 23 , 19~, at 10: 0 0 ~.M. to tell the Court why it should not find you to be an Incapacitated Person and appoint a Guardian to act on your behalf. To be an Incapacitated Person means that you are not able to receive and effectively evaluate information and communicate decisions and that you are unable to manage your money and/or other property, or to make necessary decisions about where you will live, what medical care you will get, or how your money will be spent. At the hearing, you have the right to appear, to be represented by an attorney, and to request a jury trial. If you do not have an attorney, you have the right to request the Court to appoint an attorney to represent you and to have the attorney's fees paid for you if you cannot afford to pay them yourself. You also have the right to request that the Court order that an independent evaluation be conducted es to your alleged incapacity. If the Court decides that you are an Incapacitated Person, the Court may appoint a Guardian for you, based on the nature of any condition or disability and your capacity to ." ! .~ o Addrossoo's Addruss ~ -l: Ct" S: 4b. Sorvico Typo a::-! o RDgi.IDrDd 0 In.urDd O ~. DrtiliDd COD .~, o Expross Moil N'Rotu,n Rocoipt for :;t t.-f'4i M rchandi ~. 7. Doto of Dolivory -:; I ~ . . B. Add'D..DD'. AddrD..IOnly if 'DquD.IDd..l .nd 'DO I. p.idl ~ . I., 'ii' ,',i iii.; , i' R ( I: i I 11111 It Ii} I also wish to rocoivo tho following $orvicos tlar on 0;1.118 '0.1: 1. ,.. " SENDER: :a . Comp1lllltlml I Indlof 2 rur ,dd.!lo"" '''Iflu.. ! . Compl~.J"".'l. and'" 6 b. C . Pllnt ~ou'n.m. .nd .dd,... on thl II"''''' 0' thll 101m 10 thlt WI tin II IlIuIA ,hi, tlfl' lu 'fOUl ~ . Au.ch thi. 'Dim 10 Ih. honl ollll8 n11.lpllU, 01 on thl bit'" II apl" .... do.. nol ptlrnll. .! . Willi "R'turn R"I,pl n,quI'lld" un Ihe "",Ip.". below lh, I'll'" numbll .. . T'" RIlum R'CI'pl Will .how 10 whom the l'tII;l, WII dl".,.."d end tile dl" g d,h...".d . . "0 3. Articlo AddruSlod to: -i lli\\\o..~ C\-.e:S-~ ~ l ~loa -S-t ue b?l\ S-\-- ; --P\~bll~~' fA \6~ o < ~ 6. ~ a: 6. ~ " o .. PS Form .~ 2. 0 Rustrictod Dolivory Consult ostmostor for foo; 4.. ~1~~'1).~ltC '1 F!J. . (I IIi! I il '.,--"'" '~""-'-.-"-''''''' . DOMESTIC RETURN RECEIPT I I 11. D.c.mb., 1991 Qu.s.GPO; ,Ii3-3S2.7t4 ..., ... SENDER: :I . Compl.t. 111m. 1 ,ndlor 2 for .dditional ..,~ie... .~ I also wish to receive the . . Compl.t. II,IN 3. and ... & b. following services lIor an extra' .;: ~ . Print your n'mf .nd .dd,u. on the IIV.,,, of this form 10 that w. t.~' J.! 5 "Iurn ,ht, card to you. . . fee): ,: i::: ~ . Attach thl. form to thllront 01 thl mlilpi.tI, or on the back If ,ple. ',' 1. 0 Addr~lsee'8 Address ~ ; . ~ do.. not plrmlt. . - ! . Writ,"R.turnR.c:.iptRtQlM.tld"onthemlil,pllc.btIQwthe.nlcl.numbtr '2. 0 Restricted Delivery 0." ~ . The R.turn R".ipI wlU show to whom the .rUe" w.. d,livered'f\d \he dll" G . C dellv.red. Consult' ostmaster for fee.' U o " ." 3. Artlcl. Addr....d 10: 4..' Articl. Numb.r, . ,. a:, Ie" /'1"\,1.:. -CheSS .ZJ)I' 4(r1oq,'~t u. \CA.I.,. 4b:.S.rvlc. Typ. ...... , '" " ~ 'K.t".d 'Co.,: Co0a5 ~~~:~.~r.gi~~.\ ...' i_, i ~ ~c."\Se. A 2. ~s(oo (0 0 ExprD~~'Mail .Iurn R.c.lpt 'Dr !l1 o ' d: o 7. D." o',D.IlV.ry .. , < . '.'V,l ':;2-:1- . &: z ... 2 6. Slgn.lu,. !Add'D....' B. Addr....... Add'... (Only If ,.qu..l.d "" ; [ii;' ..nd!...i. p.id) " . . .r !. ~ 6.,Slgn.lur..!A,llDntl ; III I. li,i'I.i 1'1"1"';;"::";1"1";':;';1 ;,:,(: .. 1-; II;.!! I'~. I' 1"1 l'll.li I .;1, .,1', "\ :',> I,,, .'" ~ ~~ .II PS Fo'~ .D.c.mb.r,1991 u.s.o.P.O::l092-307.S30'; DOMESTIC RETURN RECEIPT;,: " ...~...,......,. ,. ::..~.~<,..",...;'..,. ....~:.:I~.:. 4. ~ . -' " \'~ :~ l ; ! \1 'c \ 0 :." ,D ;-1 ; e i 8 ;'CI) ,Ul Ul a: o o cl z .a: ~ a: ~ " o .. , -:---r- . ".. SENDER:, . . , 1:'.1.0 wl,h to rDc.iv.. tho . Complet. J.!..s,mfe' .nd/of 2 tor .ddltlon.1 ..rvlttl. '. ~. i' . . C~rt.ma 3. 'M ... 6 b. . '... following lervlcel (for 8n extra J ,. . P,lnt your name and .dd,... on thl r.....II. of ,hla form '0 Vl.t ,WI (In foo): . . . - ~ rttumtN,catdtoyou.4 . .:" "'.., . . . Att.th thl. lorm to the hont 0' thl mallpl.c., or on thl b.ck II .pee. " ~ 1 ~ ,0 AddrelseD'. Addres. ; ~ ' dOllnotpermll. . '. '.' ,."'. .' ~ 'I 10 the I I be D'" ~ ' ' . .. (Co-, . Wrlt."R.tumRlc:.lptRequtlt.d"onthtm.1pittlbt Vi .nt.num f, 2.. Reltrictod Dolivery - ~,ii . The R.tum R.clipt will .how to whom the .rtld. WI' d.U....r.,d and \hi date. '1" , f' - U d.llvll.d, . . .. - Consu t ostmaltor or 00. CI ~~i~I.Addtr.".Cdl'Ls.~ ," 4~'?1I.NU~q~'1'~5'i53 !i \-\.ooe, r'e ,.' ':. 4b.'S.rvlc.Typ. i fiG- ~\\)\r~e ~t-." ;' ." DR.gi.l.r.d.. Oln.urDd ;.\ '"\ 0 oC. "'\ 5 .rtlfi.d'. , 0 COD ... ~ ,-t\ S II ',) ) '\ J 1- I '5c:>e: 0 . 0 Expr.,. ",.n . 'V! RDI~rn ~.felpl 'or ~ i 7 Ooto ofOelivory .... ~ l"':Yb !I 6. Sign.lur. (Addr.....) B. Addr...D.', Addr... (Only If ,equ.ll.d"" " and foo II paid) . . ; , ..' Fl . I " ... I ~ . C 'erne I .nd'Uf 1 flu .ddlllufl.1 '.'viuI I 'I. CDmPltlt lI.me :I, Ind .. . b. I, Print ,GUf "'mt Ind IIIl1"" on Ih, I....'.. ul till' hum '0 thl' "". un I "lIMn thil UII' 10 'UU, . AUlch lhi, tlHm to lhl honl 01 Ih, nl..lfll"', Of on Ih. lI'tSi II 'Pl" do.. not Ilttml1. I I . WIlli "Il,tu'n n,nlpl ".qunttd" un U~ mill...." beltlw the tlllCle numb., -a . lhl"'hHn "'(lIP, "".- tho"" 10 ",hum th. "Ud, "'" d.II,,,.d.nd ,tit d.t. i 1I,,,,,"d I a. ArUel. Addll...d 10: 'R,c.\V\.c.\.. C~5~ 3'63.\ lJ:,.(b~ ~\' \~\'c}. \c %\o..N ~ ~ d ~l\ ~ 6. I 0110 wish to rocoivo the following sorvices IIor an 8xtra ~ 1001: 'l: . 1. 0 Addrolloo', Add,... eX a '3 G a:' E, i! G' a: 2. 0 R..triet.d D.llvery Contult ollmltltef for f08. 4.. Arliel. Numb.r \ , ~<:t()5l{(:)'')8~ 4b,' Servieo Typo o R.gl.tOlod ~.rllliod o Expr... Moil 7. Oato, ~Oolivor /1/.7(/ .. 8. Addr....o. Mdro.. 10nly II r.quOltod ... .nd f.. i. p.ldl ; F: I o In.uroo o COD Aoturr. Receipt for n I '" .6 " " ~ .l! " O' '----. " U.S,OP.O. "..2,,.'...., DOMESTIC RETURN RECEIPT .-' Jl R: I .Iso wish to roeolvo Iho ; . Compl.I.II.m. I .nd/Of 2 fo' .ddilion.1 ..,,,iu.. Ii . CortlpJeI. lI,ml 3. .nd .1 . b. following services (for on oxtro u I. Punt you' n.ml .nd ,dd,... on the 11""1' 01 this fOlm 10 thlt we tan fool: e '1t1l1A thl, (lId to you. 0 Add" . AII'th ttlt, 101m 10 Ih. hont 01 the mlllpiltl. or on th. bltk if IPIC;' 1. Addrosseo's ress en, don nol pI"nU, 1: : . Will. "AllulnR.tlipl R,quIII.d" onth. mlllpieu below th. allielo number 'i I 'hi n.IUfO RIUlpt ",11* thow 10 whom the .lticl. wll deliyered and the dll. ~ g d.IIYII.d. cr. 'i a. Artie!. Addr....d 10: 5 i J ^/ II (j . "". AA"". I, J Afdl Sorvleo Typo ~ E I-U S vi 'J I, I c.., 1If' ",-,L. L-t' 0 Rogistor.d 0 Insurod 0 E ,.I oJ' 111 )IS C.rlifi.d 0 COD .~ ~ ~~03 c.~(A.a., rl. 0 Expross Mail )!l!'R.turn Roeolptlor : iJ~n ~:WI WA Dot of.r:3~ci.r h ndls i Za: 6. Sign ure tAddlo.sool A dressoo's Address (Only if requested .:tl and feo is paid) fi ? ~ Iii .., a: 6. SignOlur. IAgonll !I ! \ \' \ \ i \: I ~ \ . , ~ PS Form 1, Doe.mb.r 1991 .II ,I \ ,"!'LI \ \ "\\i\\i; .u.s.oPO, ,..3-05>,7" DOMESTIC RETURN RECEIPT ....~. DER: . Compl.IIUlm. , .nd/ol 2 10f .dd.Uon.1 1I,..,Ic;n. ....' . Compl..III.m. 3. Ind 4.. b. rc:("'I"('1i~ ~..r.'nmn . Pflnl ,,0Uf n.me Ind .ddllll on Ihl flY"" Q,lU1I.' (Oltll .0 Ifllt 'i'1f,cJ!'n lI.um ,tit, tlld to you. t\il'J("::r:n (:'. ,',It;, . A'"th ,hot. lorm to the Iront ollh. m'llpi.t.. 01 on thl blck If 'P'CI dot.nalptlmlt. _ . _ ..,. ""\ ,., j("'.: . W,ll. "Rllum "IUlpt R.qullt.d . on the mldpl.cl below \.he .It,de nuJ1'\Mr . 1he A.lurn R.tl1pl Will lhow to whom the .rtltl. wn dellYII.d and th. d.l. I1llnl'...d 3. Arlier. Addr....d to: i I ! I g ,11 , - - jJea.n Eltza.bf"fh MOCl {}Nt; ~ 55'#3 N, :J...q-t.h Sf: ~ {)rnCLha., NG /.JB II I Q 1 .. ..~t"; '. ~. f "1' (~ . ~. Sign.tur. IAddro....l ??: [, .,'lr\ , ~ 'J,thJ,:_r;~.:.J..I,J.,id.' ~ IU"rJIUIC f^urnll I also 'wish to receive the following services lIor an oxtra 5 f..I: ~ 1. 0 Addresseo's Addross ~ 2. 77 4b. Service Typo o R.glsl.rod 0 Insur.d )(Corlifiod 0 COD g o Expross Mail ~eturn ReFoipt for .~ c 7. 0.1. of Oil' "?-2-- ~ ~ 8. Addressoo's Address (Only If roquested .:a and feo is paid) ~ .r: .. . - a ~ = II: ~ 'i a. ~ .. . ~jJJlJJtiJJ~JlJ!IJb~tll'Jt~JW~JIJt$ ~ ~1!llt I, HELElI ORPIIA CHESS, of tho City of Allentown, County of I.ohigh and Commonwoalth of Pennoylvilnla, !.I 1m ve mad~, eon$titul~d and. appoinl~d and by Ih~s~ pr~senls do lul. and appoinl RAY R. BREIIlIEII, ESQUIRE, my mak~, eonsli. Im~ and lawful ul/urney for me and in my name,plac.andsl~adlo generally act for me, and this power of attorney shall not be affected by disability of the principal. }[~r~bv J!ivinJ! and J!rantin~ unlo my said al/orn.y full and wluJ14 pow.r and aulhority in and aboullh. pr~mises.. and tenerally all and ~v~rv acl ana acls, lhint alld Ihints, devieo and devie~s, in Ihe lau,- whalsoever noedful and Ilecessary 10 be don. in and aboul lite pr~mises, for me and in my name 10 do, exeeale and perform as lart. and amply, /0 all inl.nls and purposu, a$ I mif!hl or could do, if p~rsonally pr~sCllI.. and an al/orn~1I or al/orneys nnd~r him fur Ih. purpos~ aforosaid, 10 mak~ alld con$/itule, and Ih. sam. 10 remov~ and revoke al my pleasure, It~rebll raUfyinf! and confirminf! as tood and ~t1"cl"al, in law and in ~quity. all Ihal my said al/orMII or his ....bs/illtlcS shall lawfully and ujally do bV I,irllt. !",,'cnf. .]n ~iitll';,i~ P~U'l'l'l.'ilf, IIIII/Ir II"wnlo s.1 my .veal Ih. 20th dall u1' Mil rch on. thou$and nino !mndred and eighty (1980). ~jljJ~~lmwJlIi!!llJ~~ '.Y./~{J~ ~ 'tfi:;!r;~ 11.,~~ o~F-- hand an<i in lllt] (/ear - - - _________n_.___ ___0 . IN THE MATTER OF HELEN ORPHA CHESS, AN ALLEGED INCAPACITATED PERSON EXHIBIT B Schedule of Assets of Helen Oroha Chess as of October 4. 1996 Checking Account: 700 shares AT & T Corporation (formerly American Telephone and Telegraph Company) common: 420 shares Ameritech Corporation (formerly American Information Technologies Corporation) common: 280 shares Bell Atlantic Corporation common: 630 shares BellSouth Corporation common: 280 shares Nynex Corporation common: 280 shares Pacific Telesis Group common: 280 shares AirTouch Communications common: 420 shares SBC Communications (formerly Southwestern Bell Corporation) common: 2BO shares U.S. West Communications Group (formerly U.S. West, Inc.) common: 280 shares U.S. West Media Group common: 226 shares Lucent Technologies, Inc. common: TOTAL ASSETS: $ IB,027.54 27,562.50 22,575.00 17,360.00 24,570.00 12,810.00 9,747.50 7,770.00 20,921.25 8,750.00 4,672.50 9,732.13 $184,498.42 ~..~l.Ilo1', ... '5t! Cl :-::l.:;:"'... UI \'- t1':: ool:.. .t- .,~ 60.1.. .~... 'lii UI .:0) ; rn .t- ..,...) ,>:: n:: lrT1 . ~h3 .w ....., ~~L:.: :iil........ ..,....".,.. .- .. . ~ ",-C ,.c III.C. 'U. . .. .:1.i= .. ,. N .;~ 1./ ',') '" .U r ." .J .n ". ,"" j:i: '" ~HJJ ~ 0:-' " " I' .. 11 !: ,; IN R~I 111Et.f'T1I STIt~~T CIIURCII 01' TilE CIIRIS1'lAN AND mSSIONARY AI.I.IANC~ 01' Al.l.ENTOIIN, 1'~NUSYt.VANIA AHENDHENl' 1'0 ARTICt.ES 01' INCORPORATION The 1l00lcruLnneu duly Duthorf,zcd officers of the Twulfth Street Church of the Christinn and mssionary Alliance of II I, :1 Allentown, hereby execute lhis Article of Amendment pursuant 1 to the provisions of the Nonprofit Coporation Law of 1972: 1. The name of the Nonprofit Corporation is T\~Et.I'TII STREET CIIURCII OF TilE CIIRIS1'lAN AND HISSIOUARY Al.LIANCE 01' " At.t.ENTOI~I, and its heretofore registered office was 217 North !' I' 12th Street, Allentown, PA 18102. I q 2. The said Corporation was incorporated on March 2, 1903, under the provisions of the Act of Assembly entitled "An Ii Act providing for the Incorl'ucullull unu RCtlulaltluli of c~rtuin I Corporations," approved April 29, 18711, as amended. 3. The Article of Amendment contained herein shall he I, ,: effective as of February 1, 1982, for accounting purposes only. ' 4. The said Amendment was voted upon favorably by a i' :: ma.lority of the active members of the said Corporation, at a I, i meeting duly called pursnant to proper legal notice and held I. " on October 5, 1980. The said Amendment Has further ratified i' and confirmed by the unanimous vote of the Executive Conunittee ,I ii of the said Corporation at a regular meeting held on October 9, i' 1980. , I :1 5. The Article of Amendment adopted by the Corporation: !' as aforesaid is as follows: ARTICl.E 1. The name of the Corporation shall he "TilE SCIIANTZ \lOAD COHHUNITY CIIIlRCII OF Tim CIIRISTIAN AUD i; mSSlONARY AU.lANCE"; the registered office of the Corporation shall be P.O. Box 3189, Wescosville, PA 18106. - 1 - l VOL HI pm 90~ I f :t t < .... Ii I' I' .' <, II t ~ ! I L 'I I. I: i. ( . -~..__... Hllliam Hohr, J. F. Niebuhr and Elwood 8allmer and in due form of law acknowledged the foregoing instrument to be their act and , deed for the purposes therein specified. IHtness my hand and notarial seal this 2nd day of ~'ebrllary, A.D. 1903. Commission Expires ,: Hay 16, 1905 II ;1 " " Kstherine O'Loughlin N.P. 11 , " Ii I: i' il Ii t 11 Ii 1 II I I ,I I I, I! j: l. II il I I. i' !! il " ~ I 11 !I I. II I " l VOl HI fILE !.Ill'; ,'STATE OF PENNSYLVANIA t COUNTY OF LEHIGH r ss: Atl~:10NY M. MUI~. E~l~ Secretary, Bar Association of Lehigh County, the owner of LEHIGH LAW JOURNAL being clulr sworn according to law, says that he IS one of the publishers and managers of the Lehigli Law Journal, a legal periodical, as defined by Act of Assembly, published at the City of Allentown, in said County, continuously since 1904; that the hereto attached notice (exactly as printed) was pub- lished in said Lehigh Law Journal, on Fridays, the _ .........,.... .~~t:I~.............,... days of ... .-!?J:l.l!<!ry,.... .,... and the . . . . . . . . . . . . . . . . . . . . . . . . . . . .. days of ............................ 19. ?2.. i that this deponent is not interested in the subject, at r of the notice or ad- vertisement; and that all of the allega- tions of ithe sta ment as to the time, ~~~rnrb.O"ti~~ ~~. Sworn and subscribed to before me the 4\'~~1!.!1t.'",; d f January \' ~. '~.' 'j!' ,... 2' ay 0 ....,......,. ," . I.'............':...' ", ". . '. I,,' . "")' .~'bo..... ~',..' B f'v.' ,1:1.91-: '2?-J'''~ '. LV . v ,r..,"_ 'tJ ~ ~ 7# ~ : . !'.~ . . . . . . . , .~ . .. . ~. .. .......... .. - ""'0"1\':: K'I-" '" .. o. I' . ..- .' " 11 :." I ':';~'l. 11__ ... ,/1 Ie :",:~ . . " 'B!tlTIoo..cb.AI=:t.~::;;~:::1 C~:'::ity. P::!, . . " My :pnillll~:l"n :.plra: ;~na :3. 1934 "'~ ;') u'O.... . 'I, ..I;.....~.... ,.'~ NOTICE Nollce Ilt hereby ~IYen, pursuant 10 the provtSIOn:l o( rhe Nonprofit Corporallon Lo,w of 1972. that Twelfth Slreet Church of the Chrt., Uan and ~U~lonary Alltance or AJlentown. wtth It.! registered office located at 217 N. Twelfth Street. Allentown. PA will me In the (kpanment of State of the Com- monwealth of Pennsylvania on I February I. 1982. Article. of Amendment to Its Art1c:les of Incor- poration. The nature and character or the amendment ts: ARTtCLE I. The name of the Cor- pornllon .hall be THE SCHANTZ ROAD COMMUNITY CHURCH OF THE CHRISTIAN AND MIS- SIONARY ALLIANCE IIn place of Twelfth Street Church of the Chrt". lIan and Missionary Alliance of Allentown): the registered offic:e oC the Corpornllon .hall be P,O. Box 3189. We!Cosvllle. Pa 18t06 IIn place of 217 N. Twelfth Street. Allentown. PAl. JOHN M. METZGER ESQ, 42 N. 6th Street Allentown. PA 18101 J.22 TO LEHIGH LAW JOURNAL, DR. For publishing the notice hereto attached on the above stated dates Proof of Publication $12...40... .. $. ~"'Z~.. .. Total $.1.3...65.... PUBLISHER'S RECEIPT FOR ADVERTISING COSTS, The Lehigh Law Journal, a legal journal published in the City of Allentown, in Lehigh County, hereby acknowledg-es receipt of the aforesaid publication costs and certifies that the same have been fully paid. LEHIGH LAW JOURNAL By: aJ. S. ~ VOL 19 ~AGE 907 Proof of Publication Notice in the Morning Call Und~r .\ct No. 5S'l. '\Pl1rllyp.d ~In)' IIi. I~;'::J and Il~ .1mtJIIllulI'ntll STATE OF PENNSVL'/ANIA COUNTV OF LEHIGH I I' SS: COPY OF :;OTICE 1)1( .\DVEI(TISE~IE:;T - Frederick R. Dieter,Asst.Treasurer . . .... . . . . . . ... . . . . ... . ................ ,...' . .. .. ..... ot tbe C,\LIr cnnONICLE ~EWSPAPEn.S. INC. ot the County :lnd St:l.te aforesaid. beloe; duly 3worn. dl'po!ll~lI and :lilYS that THE ~10R:'olING CA~L Ie a DU\YSpl1rwr ut I;ellt!ral l:lrc-ulatlun as det1nr!d by the aforesaid Act. WhOll8 iliacI! lit bu~lnl!~~ 13 101 :-.'urth Sixth :5trtwt. City ill .\Ilcntown, County and Statu atorfO:JUld. anti that th., salll nf!wspaper was p.Mtahllsht!d In 18se since which date THE lIOn:--:l:--ln CALL bas beltD rp.gularly Iuued In said County. and tbat tbo prtntt!d notice or advertisement attached hereto Is oxactly thu ~aml! a8 was prlnt~d :lond published In regular edltlona aDd Issue~ ot the saltt THE :\10n:.tr:.tC C.\LL on the tollowtoJ;' dates, vi:..; NonCI' NOII1::."l'Itft""tg,.,,,,,DlJt'11r .nlla lilt Ofa'ttSlon'ctIr.NOIt- ~I ~'f~O'l y_ at Itn. II'.' flllltttln 51'"' 0Iurcn of IN Cfl,t""n "nG Mlu.one..... A"I' .na of APtnlown. .,m ,ts ,Igt\. IlflCl'otflct IQQIICI .. 211 Pi. fwetttPl SI,"" Alltl'ltown. PA ... flit in me o.o.mn.nr of 51." of I,. tommatlWHlI" of P.lln''tl....nt. on FI'D'u,rv I" 1912. .1,"1(1" of ....".".,ment 10 II' Artldft of 1nCoroor.IIQ1'l The n.,u'....nd tn.tltltr of In, amtnC2mtnt is:. ARTICLE I. The ~ of ttt. Ca,poullon 1".11 o. THE SCHANTZ OOAO COMMUNITY 'CHURCH 0': THE CHIU$TIAN AHD MlSSlONARY AWANCE IIn "I"" of T..ttt" S'r... OVen Of '''' Chtl"..n and MI,.. IKlt\Itv AlUtna of All<<llOwnl; thlt '"'''lflCl amc. of me Cor- POI'IlIOll "'.11 be PO. Bo. )1". :'ffi"~~"'r~"m11511~~,n ...~ lawn.IJAI, ~OHH .JJ\. METZGER. EIlL '2 N. "" Slr.., Alltfllawn, P... 11101 (12990 - ~.n. 21 .................. .nd tbo. .2.2nd. day oIJanuar.y.. A. D. 19.82.. Atrlant turther deposes that be Is the designated .utborlzed by CALL-CHRONICLE :;EWSPAPERS. INC.. a Asst. ~..... .l~ e Newapapers. Inc. SWOR:; to and ,ubscrtted bolor. m. tbls...... 28.th,........ ..day 01 J QI') ij;-~;I"J" ", '. .. ........... anu:l.l:y........ ........ 19"'''",., ..' 'i l\ ,,~,.. .... ,,-) 1" /....:'. ~.:.:.. <.,.... '-, <' :,',~..,', .' - 1{I,lL....\...-. ~l-....<..._v__I:-'(.'-~.__/ I'<" .,. .. ... .......,. . , . .... .. . , N~i~,:y- pubii~ .... .'. ........" J'O'" ....... .I"J ~ MARIE 8USOUIS. NOTAIll' PUIl(IC . "'I .~~: ~Iy Commission Expires: ALLENTOWN LEHIGH Cl1ii~rY -?,.l.. .... '.11 COMMISSION EXPIRES M~Y Y.l.~9~5 ....' ..' . 'oleml>el. Pe..~IIVln~ AmCtallon-oI ~"",.,g ~. / PUBLISHER'S RECEIPT FOR ADVERTISING COSTS .... '. ........ , Tbe CALL-CHRO:;ICLE m1\VSPAPERS. INC.. publlsbor olTHE ~IOR."l1NG CALL..newspaporoLgenonl!"'" circulatloD. hereby acknowledges recoipt at the atoresaid nodct! aDd pUblication costs and certifies that the same haTe been duJy paid, C,\I,L-CHRO:;ICLE mlWSPAPERS. INC.. . CorpOr3Uoo. Publish.... 0/ THE ~IORNING CALL .\ ~ewspaper ot Gener:1J Clrculatlon ....71... By. /~:... .":~:~:-: .~-.~';t. r-:-...:,.......,...." l VOL 19 PAGE Ef08 r IN THE MATTER OF IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION No. 21~19-1996 HELEN ORPHA CHESS, an alleged incapacitated person IN RE: PETITION FOR GUARDIANSHIP OF ESTATE BEFORE OLER. J. ORDER OF COURT AND NOW, this 23rd day of December, 1996, upon consideration of the Petition for Appointment of Guardian in the above-captioned matter, and following a hearing conducted at the Chapel pointe Home in carlisle, cumberland county, Pennsylvania, at which hearing the allegedly incapacitated person, Helen Orpha Chess, was present and represented by her court-appointed counsel, Carol J. Lindsay, Esquire, Ms. Chess is adjudicated an incapacitated person with respect to her estate, and Financial Trust services company, located at 1 West High street, Post Office Box 220, Carlisle, Pennsylvania, or any successor in interest thereto, is appointed plenary guardian of her estate. The guardian is directed to file reports in accordance with the provisions of 2D Pa. C.S. section 5521(C). No bond shall be required of the guardian. The status of attorney-in-fact of Ray R. Brennen, Esquire, on behalf of Ms. Chess is hereby terminated. Notice is hereby provided to Helen Orpha Chess of her right to appeal and to petition to modify or terminate the guardianship of her estate. 3. Petitioner is Ray R. Brennen, Esquire, who resides at 2643 Hamilton Boulevard, Allentown, Lehigh county, Pennsylvania. Mr. Brennen presently serves as attorney-in-fact for Ms. Chess, but finds himself unable for health reasons to continue to serve in that capacity. 4. The allegedly incapacitated person, Helen Orpha Chess, suffers from general cerebral arteriosclerosis. 5. As a result of this condition, Ms. Chess is an adult whose ability to receive and evaluate information effectively and communicate decisions is impaired to such a significant extent that she is totally unable to manage her financial resources. 6. The aforesaid condition is apparently of a permanent nature. 7. Based upon the aforesaid condition, the Court finds that it is necessary to establish a plenary guardianship with respect to the estate of Ms. Chess. 8_ In view of the absence of a contrary prognosis at this time, the duration of the guardianship required must be said to be indefinite, pending further Order of court, and apparently permanent. 9. The guardianship to be established herein is necessary notwithstanding the assistance which Mr. Brennen has provided to Ms. Chess over a period of many years. 10. Financial Trust Services Company is found to be an organization qualified under 20 Pa. C.S. section 5511(f) to serve as plenary guardian of Ms. Chess's estate. 11. The foregoing Findings of Fact are made on the basis of clear and convincing evidence. DISCUSSION The provisions respecting an adjudication of incompetency have been recently amended and are contained in 20 Pa. C.S. sections 5501 et. sea. Petitioner appears to have fully complied with these provisions, and based upon the foregoing Findings of Fact the following Order of Court will be entered. ORDER OF COURT AND NOW, this 23rd day of December, 1996, upon consideration of the Petition for Appointment of Guardian in the above-captioned matter, and following a hearing conducted at the Chapel pointe Home in Carlisle, Cumberland county, Pennsylvania, at which hearing the allegedly incapacitated person, Helen Orpha Chess, was present and represented by her court-appointed counsel, Carol J. Lindsay, Esquire, Ms. Chess is adjudicated an incapacitated person with respect to her estate, and Financial Trust services company, located at 1 West High street, Post Office Box 220, Carlisle, Pennsylvania, or any successor in interest thereto, is appointed plenary guardian of her estate. The guardian is directed to file reports in accordance with the provisions of 20 Pa. C.S. section 5521(c). No bond shall be 16 NAME OF AT1'QRNEY/PAYEE AND ~;;:;::;")k,{~~ A~ V- KD~d~ " 'i . If,S k 'fTt: ~r?Ie.) I?t 1717 /3 tijl:liHlY~o ., 5 13 CLAIM FOR SERVICES OR'Ex~NSES HOUPS OATES AUTItOnlry TO PAY COURT APPOINTrl) COUNSEL ICl)\H1T ~ ~~L~ii:r~,~on rlo~,'~_:1 ~-"I'~~~~rl'"<,,,~~, . -- "n______. ~~i::~~~.-' I-~"."Gr:~~' ~~?'~~"~':~C~'~i"):~I__ ? pnOcEEtlNGS IOIJ~Cllbrt bFII.t1l1'1 II flOl'~O" '1[J1n[S[f~T[O Gi-~~ va F.-..n PY1 I ". 0.'.",',,,, l " U"'"'''''&''' I : 'dllll 1u."""" , , ...,,[.,.'.-'''1 ""'1"'"'' IlH,,,,\P"Io!-f)"'" -- 10 Pln'iO~' ~t pnE5UHEO \Full ~~dm~l Ii ; '''~I""", -,'w.I",,, 1'1" ;.... <:"",,,"'1 W.ll't ,"JI,I.Ort ~ ""l!,.Hl".' Cro.'-.I",J 'II.!'" "'O"',~n 'J Jooo""!')'''.., ~~e:: s:W,,~{~ NJfY' NAME OF COMMON PLEAS fUDGE ASSIGNED TO CASE CMe:;,~ 19, SERVICE .... a: :> o u :!; a Ar,algnment Indlor Pt.. b P'lIhm,nlry Helrlng c. MOltons and RIQue,I, d aad HunnO' ~ Senile"'. H.lflngl I.T"31 Q R,..oc:allon HltlFlngs " Jl.:~enlle Heallngs I __"peals Cou" I Olhel ISoeclty on 10121110nll S"nISJ /.5' .- /. , J. ...; 1~2'ltND , 'f'>--' '~ERHOUR 111M 1I1z."L '0_ /,? '. )(', . , TOTAL HOURS. 20. a Inle~'e"''S Ind conl.rlln,e' b ODlaln,nQ Ind re~,e...,ng 'ecord' c Le9al r'!,el"" .}nd br,er .....'lllng :, Il"veSrltj3tl'o1t and o!~e' WOIIt (Spe.o~ on accl!tlonal $t1eels) "-0- Oa: ....:> :>0 OU TOTAL HOURS. ,- /. ~ .1~) ';.>&PER HOUR AMT PER ITEM 21 ITEMIZATION OF REIMBURSABLE EXPENSES M,la;lI'lO S 2S rv'!r mila lC a: w " .... o 22 CERTlFICATlOfl OF ATTORNEY/PAYEE Has compttnsallon and/or fOtmbUnlemenllor work in Ihls case proviousty been spplled 'or? a YES Q...NO llyes.~f!,p.YOuPJ,d? C YES a NO Ilyes.bywhomwofoyoupald'?___Howmuch? Has Ino p,,,,on ,.p'o,onled pa,d anV monoV 10 vou. or to V"'" "n~~vono 0"., . .n, connecllon wllh 1M maner for whlC" you welp. apPOlnled 10 pfo~lde reDfes8ntat~~ ~~S ~~IVO dttlalts on add?IQ~I'M~ I sweM Of alllfm Ihp.1fulh or com'Clne" ~~1'7-/...--= ollr.e .lbO~fJ slalem.,,,ls - S'Oni(ur or AJtorn.y/p-;:,:;;j, ~"-_.- /,-- ,- 0;;- 26" ':':',::' ',I 5.,n"".. ,,' " 1./ ~" L t 3-' (j.-' ......011..,1 JuI.lQ" ,. "/ l", I.. '.);"_ l -< t' ,1 .011.;) '~l./ cdpv 1 . Mall 10 Court Adminfslrator at complulIon of service 6f- -n') \ 2 VOUCHCR N~ 2538 ~ UUDGO CODE 1'\ ,~J~. I. '/I-/'{'(' 8 0 PETTY OFFENSE (J FELONY 0 MISDEMEANOR 12 CIVIL DOCKET NO I cf~ - 2-/-.lI'f a ' IJ CRIMINAL DOCKEt/NO G-. \4 APPEALS DOCKET NO 18. S~~I"l !:IECUR~t.' ~o OR E)U NO .L) )/.-;i/ /'1 c.; AMOUNTS CLAIMED Mulllply 'ale per flOu' lIme, 10111 hours 10 obllln "In COurt- com. penullon Enle, lclal below 19" TOTAL IN COURT CaMP, .:: ~&7'XI -s - . . MultIply rile pef hou' lIme'tolal hours. Enl.r lolal .Oul of Cou"" c:ompenuhon btIlow 20.. TOTAL OUT OF COURT COMPo ./ ,',. L> . :J<.., .;'s/'~- . . ...frlI. 21" TOTAL ITEMIZEO EXP. -s 0 2J GRAND TOTAL CLAIMED -s /3.5 24. DEDUCT. PRIOR PYMTS. -s - 2~ NET AMOUNT CLAIMED -5/.3.5 27_ AMT. APPROVED -s r "3-~, 00 AUTHORITY TO PAY counT APPOINTED COUNSEL MAY J JI~876"-- T:\ :;! 2 VOUCIl[R N~ 2538 5 DUDGO CODE ()\ - d?,L,.(,,'II-t"f'{) 8 0 PETIY OFFENSE o FELONY 0 MISDEMEANOR 16 NAME OF "nOnNEY/PAYEE AND ;;~;:;:;"k{~~ Fl~ tj- ~a~d~ ,,7: .H/Sh ~ ~r",;le) ~ /717 /3 ~ 7rljllt.~~o -5513 CLAIM FOR SERVICES OR t:xl't:NSES HOUPS OATES I eOUAl o DI~trlct Ju~l,cu ~mmon Plci1~ [J Appollalo (] Other ,. _ _ . __ ".r:::.'::''''Q (""~ F~'~e - --- 6 ~IlE CASE ':It~iV";;;-;:;:;-I- I CIlAllGl'/or'rr.5r il'UllOON ClIAlIONI ~.dNl t~~~ I) pnOCEE'IUG510Q~Cllbe bflell.,.1 11 pcnsOf. n[f1nE5(NI(O 1 tl Oal.M.", Adult 1 (] O"""lf.'" J\l.'flol, ) f1 "ODf'II,,,, .. ~ I .pl1"II,.. !I :1 IUb...,r.!.,.o""" c. (J I.lAlll".lIW,I"'... , (l PA'ul". C......O"" W.,,, V'IlI'I'O" II U P'OII."O".' C",.g,," W,'1'l '-"01.1,0'" I) ...-0'''.' Gi-1{~aM 'ff ~ c,n IJv} -. 10 PEnSON R(PRESENrED tFull Namcl JJ.J~t;t. .,.. 0". uJ q" s: W~~ t'iv1lJJ".J/ NAME OF COMMON PLEAS fUDGE ASSIGNED TO CASE CMe~~ 19 SERVICE 0- 0: :> o u ~ I A"algnment Indlor PI.. b P,ehm,nlty Huting c:. Mollonl Ind AeQuell. d. eld Helflngl tJ Senll!nc. Hurlngl I.TIIII o Re"OC3'lon Helringl 1'1_ Ju...."'le Hutlngl I. A!:lDUh COu" i Olhe, ISD'clly on lalMIOnl1 sheelsl J. ~ - /. :J J. ..., 1~2"IYh I L\0 . X)l<l'fER uoon 1111A 1l1z.'L h.//'7 I TOTAL HOUAS. 20. a Inll!NlewS .na conlerencel b Obl0llln1nQ Ind I....Il!Wll'Ig ,&Co,al c Ll!!Qill 'l!!Sl!a,ChlnlJ btll!1 wtlllng ::I Invescg30'o'lJ and or~er ""Ofk (SpcoPy on aadlllOnal sheets) "-0- 00: 0-:> =>0 au TOTAL HOURS. - I. ~ -{",. X~r[RIloo" Af.IT PER ITEM 21, ITEMIZATION OF REIMBURSABLE EXPENSES f..MoOlQO S 25 por mila . 0: w J: ~ o 22 CERTlFICATlOU OF AnORNEY/PAYEE Has componsatlon and/or reimburumenl lor woOl. In this caUl pr.....iou.ty been .pplled lor? 0 YES ~ lIyes,wfJu!youpa'd? a YES a NO lIyes.bywhomwereyoupald1 Howmuch1 Has 11'10 pcrson ,cp,osonled plid any money 10 yo~ o.! to your knO*le~ anyone else, In connecllon WIth tho maner lor whICh you wOle olPPOlnted to p'o....lde representa"Ji J~ ~:s ~.. IfAe~s.,_gl"'" delalls onj;~1tj!l.'~ I SVlfI!.)f or olfl"m U'll'! Ituth 01 conectness ~ - ~.:-~ __ _ -/...--:-- 01 Ihe abo...Q slalomnnls SoOn ~o!ft\tOtn.Y/P'r;. 'I Olle 26 ~:::~::~:'I ~:'o~~u" 01 "",. J . d/~ e. {} f:, Ii .0".!J 13 { '1 ? cdpy 1 . Mall 10 'C;;url Administrator at complellon 01 SCrvlCC 12 CIVIL DOCKET NO fjt, -2-I~1 tJ~h.u~ lJ CRIMINAL DOCKE NO '3-. 14 APPEALS DOCKET NO 1~Sf:;IALiL~;?'//$?q I AMOUNTS CLAIMED Mulhl'ly tile Plr hour Ilmellolal hour. to oblaln "In Cou"" com. pentllion. Enlel 10111 below 19A. TOTAL IN COURT CaMP. _s~_&7-'50 MultIply f.'e PI' houl limn IOIJI hours. Enter 10111 "Oul 01 Coul1" comptlnnlion Mlo...,. 20A. TOTAL OUT OF COURT CaMP, [" 1. S0 -~- 21" TOTAL ITEMIZED EXP. -s 0 2J. GRANO TOTAL CLAIMED -s /36 24 OEDUCT. PRIOR PYMTS. -s - 25 NET AMOUNT CLAIMED -s/35 27 AMT. APPROVED -s I '3S-. 00 Incolll~ I(~l'~illls (conlinu~d) ()il'id~nds. Luc~nt Tedlllologics. Inc. J.IU.IJ7 10 1).2.1)7 lulcrcsl. Fed Fund 12.27.1)(,10 11.4.'J7 Inlcrcst. Temp Fund 12.27.1)(,10 11.4.'J7 50,H5 7%.HI IH 2J Totallncomc Reecipls $(..1 14.0l) I'rincipal Dishnrsemcnls 3.19.97 4.9.97 4.\0.97 4.15.97 4.22.97 5.\4.97 Bell'cdcrc t\lcdical Corp. Bell'cderc Medie:tl COI"(I, Beh'cdere Medie:tl Corp. PA Dept. OI'Rcl'cnuc.tax due PA40 Capilal Bluc Cross. prcmium Chapel Poinle at Carlislc Finaneiul TllIsl Scrl'iecs Company 64.56 50.00 32.2H IH.OO 357.45 3.2H9.20 13IOH Total Principal Disburscmcnls ~1,542.57 Financial TllIst Serl'iees Company. Plenary Guardian. Helcn Ol"(llm Chess LltL Jm c F. Burke. Presidenl/CEO COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND: Jane F. Burkc. I'rcsidcnt/CEO. bcing dnly sworn according 10 law. deposes and says that shc is Trust Officcr of Financial Trnst Ser\iecs Company. Ihe Accountant inthc Estale abol'c namcd. and thatlhc faels scl forth inlhc Stalclllcnl of Ihe RC:lsons for lhc Proposed Dislribution arc tlllC aud eorrcet. . (Uu...- J-e.LUt Ja c F. Burkc. Prcsidcnt/CEO Swam a~d subscribcd 10 bcl'orc mc this ~ duy of Dcecmbcr. 1')IJ7. "- Il,\ Nolanal Seal Tammy S. PrOIlleI. Nolllry Public South MiddloIon Twp.. Curnbo!fand County My Commission E'pires Del 25. 1'!!1.\ r. P.nnsytvan~ As.""", n 01 alArlO, 5 . " '_#" \...0 ..: "t; c '\J ... i c. ~ ~ ';U ~ (Q \0 ::I C ~ ~...._ c ) 'C c c U 0\ r-- U Q) 8 CD Ul . ~ 0\ <t~..~ c ~ E-t -t E-t Ul 0\ .!!l c.;;: .. <'0.8 o . z ~ l:.: Ul . ~ ..c .8 0 ~.. . ~dl ~ 0 H 0 ~ Z ,., ==... oCb 0 p., 0 :I: Ul-t N . o 'i > 0 ~ ~ 0.. co'" ,- U U UZ~H N g>..'tIc~nl i ~ gcn U z ouo l:.: ~ =Elii!l!ca -t 0 - -tUlHl:.: ~ l;: lJl.!2'- 3: III ~>tUl :I:l:.::>-t m l:.: Q) C)oco H E-tZ p.,~l:.:O :l1: ~ ..c:G.1~CClD - ? UO) -t oz-t l:.:p.,~t:l ~ m =-5_Q).:.tai ~ ~ ~I~!~ H UO:I: 0 Ul U :l1: Dc-met;; E-t Op., 0 >t ~ ~ ~~~~~CD l:.: rr..Ul:.: \OZ~E-tl:.: 0 U , , ,i::~_ -t 0 0 O\~E-tUl-t ~ '''~CCUCD! III \-,2..0),- p., 0 O\H-tOZ .. 0 o OJ to J:. Q.... .di -,l .nHC'I) E-tz-t ~~E-tl:.:~ 0 cue... c ceo 0'" Q)'- ~~- 0 l:.:-tH I:I:HE-tH ~ .. cu-',;:;C&.t; 4r "" Z O..:lZ 0\ U p., E-t 0 =Q.ra::J_ep rV ~ 'u -t Ol:.:-t ~rr..-tH -t ~ ._'tIE~o~ u~:>zO\op.,-t . 0 H ~c~ ~.. co; c( C u.:~c: E-t m..:lO I -tH>t H ... Q) C >- Ul ~:l1:>tH~~UUZ ~ rr.. <'0 E 8't1 c' ~ m ~ ~ l:.: :I:OUlUlNE-tZZ-t ~ s; ._ .- Q) co ,c H E-tUZH -tH-tp., l:.: ~ ~~~lJlOE:;Z 2 .- ~a)o .. - rr.. z:> . E-t Z:l1: U E-t '-"'-o'O'Cio ~<%:;t~ Zrr..~HOUlZHO ~ -t t:<'Ot:~c-~ ,U:: HOp.,OZ~-trr..U 0 0 Q)~::Jt/)co~cu $_u.g~Q).. - Q)ocutiE~O Q; TJ -5 .~.- ~ .~ J:co.c~o~ (t'.... C u... Q SUMMARY 'OF ACCOUNT Cuardianship Hslen O. Chess Incompetent For Period of 11/26/1997 through 06/11/1999 Proposed Distributions to Beneficiaries Fiduciary Current Acquisition Page Value Value .......- ........... ..................... 17 19', ,815.37 112,717.55 PRINCIPAL Receipts: Per Inventory Filed This Account 1 Net Cain (or Loss) on Sales or Other Disposition 2 136,504.96 62,962.12 199,467.08 Less Disbursements: Ceneral Disbursements Fees and Commissions 3 4 84,175.09 2,574.44 86,749.53 Balance before Distributions Distributions to Beneficiaries 112,717.55 0.00 Principal Balance on Hand 5 112,717.55 For Information: Investments Made Changes in Investment Holdings 6-7 INCOME Receipts: This Account 8.11 68,188.93 Net Cain (or Loss) on Sales or Other Disposition 0.00 68,188.93 Less Disbursements 12.15 57,675.27 Balance Before Distribution Distributions to Beneficiaries 10,513.66 0.00 Income Balance on Hand 16 10,513.66 For Information: Investments Made Changes in Investment Holdings COMBINED BALANCE ON HAND 123,231.21 -- SCHEDULE A RECEIPTS OF PRINCIPAL Flduciary Acqulsltlon Value ............... CASH: 11/26/97 Provldent Fod. Fund - Balance forward 12,361. 37 ........................... .. 12,361.37 STOCKS/LISTED: ....---..........--- 11/26/97 420.000 shares Amerltech Corp 24,255.00 Balance forward 11/26/97 700.000 shares AT&T Corporatlon 27,212.50 Balance forward 11/26/97 215.000 shares Bell At1antlc - Balance 4,693.36 forward 11/26/97 400.000 shares Be11South Corporatlon 17,000.00 Balance forward 11/26/97 226.000 shares Lucent Technologles, l1,B36.75 Inc. - Balance forward 11/26/97 624.000 shares SBC Communlcatlons Inc 30,115.9B . Balance forward 11/26/97 280.000 shares US West Communlcatlons 9,030.00 Group - Balance forward ..........-...------.. 124,143.59 ........................... .. TOTAL RECEIPTS OF PRiNCiPAL............... 136,504.96 ------- -1- SCHEDULE C DISBURSEMENTS OF PRINCIPAL SCHEDULE C.l GENERAL DISBURSEMENTS .............................. .. 12/26/97 Chapel Pointe et Carlisle 3,316.66 Nursing home expense 01/14/98 Chapel Pointe at Carlisle 3,395.52 Nursing home expense 02/19/98 Chapel Pointe at Carlisle 3,268.22 Nursing home expense 03/12/98 Chapel Pointe at Carlisle 3,/,58.97 Nursing home expense 04/08/98 Internal Revenue Serv ice 5,151.00 1997 1040 income tax 04/15/98 Transfer Cash . From 5,000.00 principal to income to cover nursing home & general expenses 05/12/98 Chapel Pointe at Carlisle 3,512.63 Nursing home expense 06/12/98 Transfer Cash . From 2,600.42 principal to income to cover payment of personal federal & state tax estimates 07/13/98 Transfer Cash . From 10,000.00 principal to income 07/14/98 Transfer Cash . From 3,407.61 principal to income 10/15/98 Transfer Cash . From 1,318.87 principal to income 10/20/98 Transfer Cash . From 10,000.00 principal to income .3- 01/13/99 Transfer Cash . From 2,000.00 principal to income 01/27/99 Transfer Cash . From 387.19 principal to income 02/24/99 Chapel Pointe at Carlisle 3,348.00 Nursing home expense 02/24/99 Chapel Pointe at Carlisle 10.00 Nursing home expense 03/29/99 Transfer Cash - From 4,000.00 principal to income 04/22/99 Transfer Cash - From 10,000.00 principal to income 04/23/99 Transfer Cash - From 10,000.00 principal to income ..........--........ TOTAL GENERAL DISBURSEMENTS......................... 84,175.09 SCHEDULE C-2 FEES AND COMMISSIONS 12/16/97 Eckert, Seamans, Cherin & Mellott Legal services Oct. & Dec. 1996 2,574.44 TOTAL FEES AND COMMISSIONS.......................... 2,574.44 TOTAL DISBURSEMENTS OF PRINCIPAL.................... 86,749.53 .4- SCHEDULE F CHANGES IN INVESTMENT HOLDINGS . PRINCIPAL Gost Ameritech Corp 11/26/97 01/27/98 420.000 shares inventoried 420.000 shares received in stock split 24,255.00 0.00 840.000 24,255.00 ---------- AT&T Corporation 11/26/97 04/20/99 700.000 shares inventoried 350.000 shares received In stock split 27,212.50 0.00 1,050.000 27,212.50 ---------- --- - Bell Atlantic 11/26/97 06/30/98 07/16/98 215.000 shares inventoried 215.000 shares received in stock split (430.000)shares sold 4,693.36 0.00 (4,693.36) 0.000 0.00 ----------- Be11South Corporation 11/26/97 12/28/98 400.000 shares inventoried 400.000 shares received in stock split 17,000.00 0.00 800.000 17,000.00 Lucent Technologies, Inc. 11/26/97 02/23/98 226.000 shares inventoried (226.000)shares sold 11,836.75 (11,836.75) 0.000 0.00 -------------- ----- .6- SCHEDULE C RECEIPTS OF INCOME SCHEDULE C-l DIVIDENDS .........-.....-.... Amerltech Corp ...................................... ... 252.00 252.00 252.00 252.00 266.70 266.70 02/02/98 05/01/98 08/03/98 11/02/98 02/01/99 05/03/99 420.000 shares 840.000 shares 840.000 shares 840.000 shares 840.000 shares 840.000 shares --.....-..--.....--..- 1,541.40 AT&T Corporation -......---...-----....... 02/02/98 700.000 shares 231. 00 05/01/98 700.000 shares 231. 00 08/03/98 700.000 shares 231. 00 11/02/98 700.000 shares 231.00 02/01/99 700.000 shares 231. 00 05/03/99 700.000 shares 231. 00 --...---...--....-- 1,386.00 Bell Atlantic ----............-....- 02/02/98 215.000 shares 165.55 05/01/98 215.000 shares 165.55 08/03/98 430.000 shares 165.55 --...-.....-......-........ 496.65 Bel1South Corporation ---.........--...-...---...--...-...- 02/02/98 400.000 shares 144.00 05/01/98 400.000 shares 144.00 08/03/98 400.000 shares 144.00 11/02/98 400.000 shares 144.00 02/01/99 800.000 shares 152.00 05/03/99 800.000 shares 152.00 ......-...--............... 880.00 Lucent Technologies, Inc. .................................................................. .. 12/02/97 226.000 shares 16.95 03/02/98 226.000 shares 16.95 ....---.....-......-..-- 33.90 .8- SCHEDULE I DISBURSEMENTS OF INCOME 12/10/97 Register of WIlls - Filing 107.00 fee for First & Partial Account 01/23/98 Capital Blue Cross Medical 411. 90 Insurance premium 03/06/98 Belvedere Medical Corp. 32.32 Balance due services 1/29/98 03/30/98 Belvedere Medical Corp. - 32.32 Balance due services 2/26/9B 04/07/98 Capital Blue Cross Medical 411. 90 Insurance premium 04/08/98 Pennsylvania Department of 784.00 Revenue - 1997 PA 40 Income tax 04/09/98 Internal Revenue Service l,2B8.00 199B estimated personal Income tax 04/09/9B Pennsylvania Department of 196.00 Revenue - 1998 estimated personal Income tax 04/13/98 Chapel Polnte at Carlisle 3,440.29 Nursing home expense 05/05/98 Belvedere Medical Corp. 32.32 I Balance due services 3/26/98 , II 06/10/98 Chapel Polnte at Carlisle 3,300.74 d ., Nursing home expense ;\ 06/10/98 Internal Revenue Service 1,288.00 Estimated personal Income tax 06/10/98 Pennsylvania Department of 196.00 Revenue - Estimated personal Income tax -12- 07/08/98 07/23/98 08/19/98 08/19/9B 09/04/98 09/04/98 09/04/98 09/09/98 10/08/98 10/08/9B 10/23/98 11/05/98 11/05/98 12/04/98 12/04/98 Chapel Polnte at Carlisle - Nursing home expense 3,479.47 Capital Blue Cross Insurance premium Medical 411. 90 Chapel Polnte at Carlisle Nursing home expense 131. 04 Chapel Polnte at Carlisle Nursing home expense 3,403.00 Internal Revenue Service Estimated personal Income tax 1,288.00 Pennay1vanla Department of Revenue - Estimated personal Income tax 196.00 Tax Preparation Fee - FInancIal Trust ServIces Co. 175.00 Chapel PoInte at Carlisle Nursing home expense 3,304.91 Chapel Polnte at Carlisle Nursing home expense 49.96 Chapel Polnte at Carlisle Nursing home expense 3,496.86 Capltal.B1ue Cross Insurance premium Medical 411. 90 Chapel Polnte at Carlisle Nursing home expense 26.00 Chapel Polnte at Carlisle - Nursing home expense 3,301.12 Internal Revenue Service Estimated personal Income tax 1,288.00 Pennsylvania Department of Revenue - Estimated personal Income tax 196.00 -13- 12/10/98 01/11/99 01/11/99 01/22/99 02/12/99 03/19/99 03/29/99 04/14/99 04/21/99 04/21/99 04/21/99 04/23/99 04/26/99 04/26/99 Chapel Polnte at Carlisle Nursing home expense 3,482.43 Chapel Polnte at Carlisle Nursing home expense 31.90 Chapel Pointe at Carlisle Nursing home expense 3,708.00 Capital Blue Cross - Medical Insurance premium 430.05 Belvedere Medical Corp. . Services rendered by Robert A. Hollen, MD 32.45 Belvedere Medical Corp. - Services rendered by Robert A. Hollen, MD 32.45 Chapel Polnte at Carlisle Nursing home expense 3,884.12 Market Value Fee - Financial Trust Serlces Co. 1/14/98-4/14/99 1,847.17 Internal Revenue Service 1999 estimated personal Income tax 350.00 Pennsylvania Department of Revenue - 1999 estimated personal Income tax 360.00 Pennsylvania Department of Revenue - 1998 personal Income tax 1,500.00 Capital Blue Cross - Medical Insurance premium 430.05 Chapel Polnte at Carlisle Nursing home expense 35.90 Chapel Polnte at Carlisle Nursing home expense 3,650.37 -l4- 05/13/99 Belvedere Medical Corp. . 35.l0 Services rendered on 4/8/99 05/l4/99 Chepel Polnte at Carlisle 3,887.74 Nursing home expense 05/14/99 Chapel Polnte at Carlisle - 53.10 Nursing home expense 06/11/99 Market Value Fee - Financial 244.49 Trust Serlces Co. - Prorated for period 4/1/99 thru 6/11/99 TO BE PAID 06/11/99 Reserve - For miscellaneous 1,000.00 closing costs & account filing fee -.. - - - -.... -.. - -..- TOTAL DISBURSEMENTS OF INCOME.................. 57,675.27 -15- INCOME BALANCE ON HAND (I Units Description or as Noted Fiduciary Acquisition Value Current VaIue Governor Prime Money Market 10,513.66 10,513.66 --------------- --------------- 10,513.66 10,513.66 Financial Trust Services Company, Guardian of the Estate of Helen O. Chess, an Incompetent tn4U1 John Schall, Vice President & Trust Officer COMMONWEALTH OF PENNSYLVANIA COUNTY OF {jUlIBERLAllD t(tM ):,1:" (, ,. John Schall, being duly sworn according to law deposes and says that he is a Vice President and Trust Officer of Financial Trust Services Company, the Accountant in the Estate of the' above-named, and that the facts set forth in the Statement of the Reasons for the Proposed Distribution, as follows, are true and correct. ;1 I '1J 'i ~11~Uf John Schall, Vice President & Trust Officer . I Sworn to and Subscribed before me this ~ day of ~, 1999 ~~!: Ii.. ~ Nolarlal Seal A1ynne L. Word. Nolory Public Chombersburg Bora. Franklin County My Commission Expires Jan. 29. 2001 -16- " " , I' , , "'''. ',,, " Ii , ~l CUI l"l f.Ll.. f-4...J O. 15 ~ t;8~~tl~iil s"'u ~...t3< ow (.LJ\C 0 ffi UUQO\U ..~ UH O'\z.....o <>f-4.....H..... l1.l P:P: :I: il~8~~~g~ 'Z t;p:p:ui"'~~ Ii: =>l"ll"l"'\S1'l0 ~r:~e~~~U! Cl~~::lci~~ ZUH 00 o~~fil15l"ll"l~ hl i::b!;;:!;l!;;:!;;:S ",~c.:>Cl:I:Clo-lU , cr. i/, ?'M~ti~~i' .ac.u"'~QlE .'.., "'0;: CIS 01 5e5ge01:l" o:g1;'!l!~o! Q)l'i"li"'", . .g'a_1i\!!l~~g gai~.!!lEg':i lii~!~g~~n 'i:!O~l~: ~i~~~1:I~1' ~c!I~g~::t 5"..~~~=c~ f~=lt ~g~~ e'~ ",..16 ._'" "'- .-I.....D -GJ 1 ti 1: h I. " "I >> ~ 0- S OCll UQJ ~l\ U .~ (l)lt:; c2:QJ::- ~rI) ~ .- u = ~ = .- ~ IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA ORPHANS' COURT DIVISION IN THE ESTATE OF HELEN O. CHESS, AN INCOMPETENT DECEASED JUNE 11, 1999 LATE OF THE BOROUGH OF CARLISLE SCHEDULE OF PROPOSED DISTRIBUTION The following is proposed distributable to the personal representative of the estate of Helen O. Chess as of June II, 1999: # ShareslUnits Current Value (or as noted) Fiduciary Acquisition Value Principal Residue On Hand: 840.000 shs Ameritech Corporation - residue of principal account S 57,592.92 S 24,255.00 1,050.000 shs AT & T Corporation - residue or principal account 56,372.40 27,212.50 800.000 shs Bell South Corporation - residue of principal account 36,600.00 17,000.00 Governor Prime Money Market - residue of principal account 44.250.05 44.250.05 112,717.55 194,815.37 Income Residue On Hand: Governor Prime Money Market. residue ofincome account S 10.513.66 S 10.513.66 SI23.230.8L Combined Balance On I-land $205.329.03 Thi\ 1\ III ll'llIh' I h,1I tllt. lIdllllll.lT 1"11 hl'll ;'.1\ I II 1\ ,11111', Ih I ll\ll\ d Itlllll .111 I q l,l'lI1.d I \ lId" ,Ill pt ,k,ll" dllh likd \\ 1111 lilt. .1\ 111\.11 Hq:I\II.U I ill' 1l1l)',lll,d I I'llllil .IlI \\ 111 11\ Illl \\ 1111, ,\ III till \',Ill \ lI,d HI, pIll, t Hlil I' 1111 pl'll1l.1lh III tillll;: WARNING: It Is illcflallo duplicalc Il1ls copy by pholoslal or phOlo!)raph. 11'1 "'11111"11!!11. II. \'11l1 ,,<~\'H III PIJ ' /'\\' ' I '..... 'J; /:;/ ""'j..';'\ . )'\ i"'~_' ," . Cl __I \ LJ :.', .1'..1' \*.. _~.:"... . *,i 'il:",'1 '-~ ~/ ',.,f/lll ol'l-\,," '<,Nl..~""," 2~...... ~. ~~C~t"~~", IIl,.1i 1'',1:1'.110 ~)' ( I :~ '~I , :~" EFHI I).llt' 21-96-919 "Ct'.'''":,, COMMO'4WEALTH OF PENNSYLVANIA' DEPARTMENT OF tlULTH. VITAL REceRDS CERTIFICATE OF DEATH '...,..'...._.. ~.lI(C'C(u;'~..~...';;h.:~S --.--.---.. _._H_________._______. :'~ema~~Tl.~~I~.:~U"~~ _ ..101......,........ ~III'U" lJ'C'>I"'O... ~..'{Oo-..........- PVl.ICWOl..'.....-.........___....,....~...._.... _. 0... _',_ ......,...-, ..o\iil"'l 103 .., : Oct 3,1895 McConne11sburg ,-,_0 I~..... W : '-- ~ .. tov'>It\tOfOlla.. tn~1I>OO"O rwPOIOf"''' ...cllln.....ll~...._.___~...._........... --~'... ..--- C.TIC'CI"'......... ~..._, t. June 11, 1999 =*,",0 ct\ llACl"''''''''_._',_,OOl ,~-"'" CUI1'berland Of. I[:I(I(! """"10<<:",_ ..__-..::;....::~:;J:::: .. carlisle Boro .II'>IO(JlI''''\oklU'''2'V\I.~ .. h'hlte ~"'Ou'" ..-,...---- ....."I\'.o.ttn.W_ ..-........-- .,.,..............fyI II It. OfaDl"TS"''''WG.o\DOII'f"l":.o<...t~ $l.-lllltJonol 770 South Hanover Street carlisle. Penna. 17013 [:I((10I..1S -"CIU"l "'l~'<t -.-...."....... ...-..... H, ~...._Penna. ... -- Cu~rli!Ocl.-- ~. .. "..0....___.. ~ '. 'IQHlII."..................ltwl .. ...()IItoI"'''TS''''''lI:~~ tf! at c.'ld i .~c__ .,.f1::....,-:.=..:::.. Ca.rlhlll .~- WO'Hl.'........... __ .._....._ :0fl.....~~.'II'OQ-"OCfIlSSl:.o>....t,.,,1_5-.1"l<.-t W(.o<lOOO....\I'OSI,1()oo ......(X c.__O "-__50...0 cw-D o..,~_.. .. 0.'1 rJl Oo""'-;""'l'." ._l..._1 '" 70 SO """U 01 Ot~"~'('JI'>I,,,_,,,c........ e._......, ...00_..... Carll Ie, Penna. 17013 10C-"l'1OIO (...,n,- ~..l.(;Mo [1 '''....Jl:ti~1999 '!-!lnljCLCmoote ",McConneUsbu Pa. 17233 . "UVC" .(;I.......WIll.. ...IOUNQ'O(.flI f~n Hoffman-Roth fUneral lIome, Inc. __ '....JlIOJ43J. '!c2l9_N E:tlLllano.~er....streetJ tiW~a..JlQl . :;J;' .{/t;"d'~d~-~ji~t~'~; ()).JliJ~I...J "'R.':)>; :/lg, .. L ~ ':"':/ 1/ _,.."'_.._..... 111IO( 01""" O-"r~.1 GIDCHlJ,...i- 0.. _1 .....Sc.ut.I.lAAlDlOlOtOlCAl.lu.....11IoC ----...- t 11~3,IA.." '.J..ltt~...II, ,......0 ~ Ir,HJtt., 1_...._...' _...____...-...."'.... 0.__..........., ....... ..."....._...._..~..'... _............... .--.._ ,..".: l....,_.-......,._ tA.. ,.......- __cunuusl~_ /J_ I.,~: ;__010"" =~'.:::'"- .~ _ :Lfe/:t4!:s._ R~tA : ~1U1(.-f'"l.C(.f.....'-"J(.O(I(fl _w_ ,...,.........- _(lQtUOCllIlll'MO CMII.IOoo-........., ~-- '......,.._U..f ......... 1'---cM"i6iiii"i'ilU;;~to,\~-- --~~ ------------. . ------------;-- OUlIOIlfIO'S.C~OVI..(((fl : . 'I'I'I"l'l,OTOPS,.lto()I..:}S --....U"'(lII1Q COWlnIC:lOOClC"'UU OIDUr"' ,/(/.../~~-L~ cJ:a~~;;~1 _ 0 ...., _0 ..........0" rA...r.. .-. ~ -.- 0 ...- 0 .......--..- 0 ....- 0 C_"",,,",,,,,_ 0 OAII()f",~, _n.,...., ["~""" "'- - O\.ocI()foOiJUCll',~'_'__",-,_, _...._..of....... ~ ..../UA,...,M)lU<, OIK"...._IOUVII.ClCC\/nllfD _ 0 ..0 ~O . ... ,.. U"'......Q.._"'"' .tI/I'III"\'IlOQ,...IlCT."...........,.'_.-)t_.f.,...._........._.,._..""'............~...."....._I._IJ' "..............-................--.-......'".......-......."" " ..I~'\'.....H~~.I~' ...n~,~ ~..~~~~~~~~.-- ~.\Id..\:l): .OCI..U ...." D.r~_o.._, ~) 'Le.' ~z.f.1'!!, 1.:_ ......>l<U<'" /1 r'?'i'l -:.::I'!ii:..oc::.~~~ltf,tfft~~'r.;,. 'J r:s.-b W,uJ;.}.t .7k->- &i ~ ~,____?4.r1sl!!..-!-' (L /'rO/5 ,..TI '~I:''',. .. _.' J'>\'LlC. J'\12\________ j"-- .~*GIIOOCI~II"...."..."I(..",I....._.... ............,'..... ..."_,~,,. ....'~ .....' "'--.....,....~...."'.........."..._,.... ........ ...-..-......1.1.................,...... 'VIDCALIUVI"rlliCOfIlCtUIl Cft_........._OI.."........._..r....oo".."...,..,......".<ln'''.......... ..'''.1_.,4.'..... "It., ..... "d I..... ......ill..... ..-..'''...., , ... ;, ,..1 >'j ,\ I, ~. Ct,f: ., t ~ ~ Ff f2 ~ ... ~ ~ = t:l ~...... = t.l iJ!j ~ ~ ~ ~ ..t; ~ te> ~i t \4-+ Q ~ ~ 0 ~ ~ ~ ',' ~i ria ~ ..~ t, S ~ '. . .' . . .... .'. . . . " (,I Cu RENUNCIATION In Re Estate of IlELEN O. CHESS deceased. To the Register of Wills of CUMBERLIIND County, Pennsylvania. The undersigned Chapel PoInte, formerly ChrIstian & Missionary Alliance of Church lIome the above decedent, hereby renouncc(s) the right to administer the estate and respectfully ask(s) that Lellers of l\dmi.nistration erA - be Issued to WITNESS r k CJ uL Financial Trust Services Corrpany hand this ...,(1.. 11 I, dayof'1 'd...1 / . 19...11.-. ~jj~9~/!#u~ (/ (Signature) (Address) (SI&I\llure) (Address) (Signalure) (Address) RENUNCIATION In Re Estatc of 1I1(I.I(N o. CIII(SS dcecased. To the Register of Wills of CU~lImRI.ANIl County, Pennsylvania. The undersigned of the above decedent. hereby renounce(s) the right to administer the estate and respectfully ask(s) that Lellers of AdminIstration C.T.A. be issued to Financial Trust Survices Company WITNESS ~ hand Ihis \Ult:-. day ofAu.~us r . 19.iL. J,!? ~~~ , (Signature) ;(.,<-13 flAfYllLnJN BLVD ALleNTOWN, fA I 7"lOl/ ~t.1I3 (Address) (Signalure) (Address) (Signalure) (Add,es.) ... / /. / (\ / :.. , REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT cv.'DD.~'." ~'l. CCI,II,IC';~SYL""IA CE?~~TCF~IE~UE eEl" :a:t>O' .....~F:IS8 'IU': :14 '7'~ I JKU:Ufr~ ~ ,\"AST.F1ASf_ N'fJ ....COlE.NlfJrLI M' Cin:XO D.... dGI , .' 'I' '~I..: i: ::ol1 "'"FU'<tlJM5ER""~-:-':<'''''''~;'=>~~~~'' 21 96 0919 #'" ~--- ~ W o W o W o CIIESS, IIELEN O. SCiCo'l.\fa.IUlY........ i:;Ali.,.:.f ojlRTH 198 - 36 - 2068 ~fECfCf.'T11 06lld99 llF lJlO\..C\&.f).)l..R';1WtG;flCUSESkUoIElAST,FAST.JMJWXUHrJrLI scx;.:,.t.L:;.EC.Rlff'~ "'.""". ""10 ex 1. C"l,nal RelUm 0 2, Su~~~mental RelUm 0 l. RemaiO~er Relllml_d_"'~".'><ll o 4. Lmrted E'tate 0 4a. FUlUI1l InlllresICom~mm"'l_d_",':,'I.n 0 5. Federal Eltl18 Tal RolUm Requm !Sa 6. Dece<lenlDlecl Testate """,,,,,,dWII 0 7, Decedenl MaiOtalnecl a LNI"'l Tru>I"""''''''.''''''' - 6, Total Numllefol Salo Cep004 B""es o 9. L.1iganon Pnx:eods R""oed 0 10, Spousal PO'Ier\j Cteclrt ,_.....-"."." "".'."1 011. E!ec:IOn ill tax uncle< See. 9113IAI~SdlOI THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL. TAX INFORMATION SHOULD BE DIRECTEO TO: kNoIE CCIoIf'\..ETf'Nolt,.PiGolDCA1SS KEYSTONE FrNANClAL BANK. N. A. Onc Wcst lIigh Strcet n......... .0_' Carlislc. PA 17013 .. .. ,~.. ,"'''' ,..U .00 ."'-' '.... .. ~ 12. Not V.luo 01 EsI2tO \Lno 6 mmus \.lno 11) 13. Chantable and Governmental Bequests/Sac 91 13 TNSt5 Icrwnld1 an ele(:cn to tal has not teen maoo \SOlledulO J) 14. Not V.luo Subject to Tn ILnol2 minus Lno13) 15. Amount of line 14 :owele at:he spousal ~ ra18 ' ,. See il\SIl'UdiOns on ""'''''' .ido for ",~Ilc:ltlO po";;'ta98 ' . 16. Amounl 01 line 14 taxatlO aI6~"'1Il " 17. Amountcf'ine 14 :axaCIe at15~ratB .. z .. a z o .. .. .. x '" o u fufpo<CkE """Ell ( 71 7 I 240-4 5 7 . 8 2 8 ..0.' 6 " o~O .0 :1l (6) 1 8 I 3 7 9.6 2 , I 8 0 3 .6 2 (11) (1) (21 (31 (41 1 4 9 I 1 . .'_0' .."'''''- '... I 0 I 0 3 II 8 9 5 "<IS RETlJRM MUST BE FlI.fIl Dl DUPUCArE WITH TllE REGISTER OF WILLS :;.~..;~~':I""~ 2 . 0 0 0.9~1 o :;<F.. 8 . tr' 0:'0 .' :0 :rJ Xc;: r:- C"' .' ,- > > BE SURE TO ANSWER ALL QUESTIONS OM REVERSE SIDE AND RECHECK MATH < < .r_"'cI""""",,,"::,,~"'n"'_""''''''''''''''''''l__''''-~''''''''''''''cI''''''''''''''9'''''''''''''''''''''''""''''''_~cI-- ~ I ""~; 1'1 .T1 ~ ;NATURE CF pCRSCN RESPCN ISLE FCR FILING rETURN IlL - lL),~t. ~ I ~NATURE CF P E?ARER OTl<ER Tl<AN RE?RESENTA TlVE J 1. Real Estato lS<nedule A) 2. StoCXS ano Bonos ISOlleduto BI 3. C:osoly Held corporallOn,Panno"n,. or Sol<H'nlpntto"n,. z o 5 :J l- e: <( o w a: 4. Mortgages & NoteS R""oable (S<nodulo D) 5. casn. Bank Oeposrts & Miscellaneaus per>Ol1al Pnlperty (S<neduIO E) 6. JomOy o"ned Pnl~erty ISOlledu~ F) i. Inter.l{lVCS Transfe" & Mlscellanecus Non.?rocate procerty (SOlleduto G or L) 6. Tal>I Groll AllOts (totaILnesl.7) 9. Funeral e..~en... & ACnUI\l.traIlVO Costs (S<nedulO H) 10, Debts of Deceden~ ~oIortlJa<JO Llabllilies. & Uens (SOlledulO I) 11. Tol>l Deducllonl (tolal Lnes 9& 10) z o ~ :l- .:) 'Q. :l o tJ " ~ Cl -J 'oJ U' ,"" (51 (6) (7) (9) (10) ( ,0 ( ,06 ( ~5 iO co 2 O. ~..' ..'!...!+ 9. 0 0 (12) . I (13) .' (14) , I (151 (16) (17) (161 1 8 1 9, 1 7. 7 3, 6 8 3; 2 4 6 5.7 6 6 7.52 7 tit 0 9 8. 2 4 .00 . :::,~):':~::.?;~ ;-~"~. ." :. 2 .' 0 0 ." ~ ,.I.. ,',\o~'" .... . ..". 6, 1 1 4. 7 4 2 .6' 1 .1.....4. 7 4 16. Tax Duo 19. ADDRESS DATE 3-IO-CO tRUSt DEPARtMENt DATE ADDRESS CARUSLE, PA 17013 Decedent's Complete Address: jrroEt:7 J,CCREj~ ';:IY I ~p Tax Payments and Credits: 1. Tax Cue IP~e I une '8) PI 2. CrecllSiPayn:enls A. SocusaJ P~vef1'( C,ecll 3. Pncr Paymenls C. Cisccunl 26,11/,.74 3, InleresUPenalty ,f acclic.:Jcle D.lnleresl E. Penalty TctJJ Creells (A. e ..:) (2) nn ., ". '~-.:' .t,",:.r .;.... .,'.. :, ',',_ . ...., ';..,':. . iClallnleresuPenally (D.:: I (3) 4, II line 2,s greater :han line 1 . line 3, enler:he difference. ihls 'S Ihe OVERPA YMENT. Check box on Page tllne 19to reque.t a refund (4) 5. II lina 1 . line 3 is grealer :han ,ioe 2, enter:he cifference, ihlS is:he TAX DUE. (5) 26. 114.7/, A. Enler lIIe inlerest cn :he:ax cue. 15,11 nn 3,::n1er:helclalcluna5.5A. This 'stile BALANCE DUE. (531 16.114 74 Make Che~ble to: REGISTER OF W/~~~N,!,--. PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. relain the use or Income of the property Iransferred; ............................................................. 0 ~ b. retain Ihe righl to designale who shall use Ihe property lransferred pr ils income; ................ 0 ~ c. relain a reversionary inleresl; or........................................................,.................................... 0 ~ d. receive Ihe promise for life of ellher paymenls. benefils or care? ......................................... 0 ~ 2. If dealh occurred on or before December 12. 1932, did decedenl within two years preceding dealh transfer property wllhoul receiving adequale consideralion? If death occurred after December 12. 1982. did decedent transfer property wilhin one year of dealh wilhout receiving adequate consideralion? ..,..,................................................,........,..................,...........0 l!] 3, Did decedent own an 'In trust for" or payable upon dealh bank account or security at his or her dealh? ......................................................................................................................0 Ii] 4. Old decedent own an inc:vidual relirement account. annuity. or olher non-probale property?.... 0 Ii] .00 ':.. .... :,', . 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>..... - ~--"'~IIIII!"IIIIll--o f".....---~- d!IlII~\l> L.M~ ..~ -72 P.S. s911 B (a) (1.1) (i) provided for !he reduction of Ihe tax rale Imposed on the nel value of Iransfers to or for the use of !he surviving spouse from 6% to 3% for dates of dealh on or after July 1. 1994 and before January 1. 1995. 72 P,S. s9116 (a) (1.1) (Ii) provided (or Ihe reduction oflhe rale imposed on the net value oflransfers to or fOrlhe use oflhe surviving spouse from 3% to 0% for dates of death on or after January ,. 1995, The statule does not exemOI a transfer to a surviving spouse from tax. and Ihe slalutory requirements for disclosure of assets and filing a tax return are still applicabla even i( Ihe surviving spouse is the only beneficiary. '. .,'. .......... ". FOR DATES OF DEATH ON OR AFTER JANUARY 1. 1995. Please answer the (ollowlng queslion by placing an 'x. In !he appropriate space. Old !he decedent create a trust or similar arrangement which is solely for the surviving spouse's benefit for his or her enlfre IIfelfme? Yes 0 No ~ If you answered yes to the above queslion, the lax on the trusl or similar arrangement is pcslponed untillhe dealh of the second spouse. at which time It Will be fully taxable althe rale(s) applicable to Ihe remalOder benefic'ary(ies). Enler!he value of the irusl on Schedule J. Part II. in order to remove il from Ihe calculation of Ihe tax d~e in Ihis eslale. You may wish to file Schedule 0 in order to make !he election available under Section 9113. If Ihe election is made. the trust or similar arrangement is taxed in !he eslate of !he first decedent spouse. the portion of Ihe trust or sim:lar arrangement which benefits Ihe surviving spouse is taxed at the zero tax rale. and Ihe remainder is laxed al the rale(s) applic:Jbleto Ihe remainder benefic'ary(ies). If you choose 10 make Ihe election. you must al1ach Schedule 0 10 a timely-filed lax relum. along With Schedule(s) K andlor M in order to show Ihe apportionmenl of Ihe lrust or , , similar arrangement belWeen the surviVing spouse and the remainder benefic,ary(ies). ,... . " , . , " ;,) , ~ ....""U.Il'.. CCMt.oOHWE.ALTH OF P(HHSYlVAHIA IHHEFIlTAHCE TAX RETURN RESUlEHT DEe DENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF HELEN O. CHESS FILE NUMBER 2196-0919 Include unrelmbul1ed medical expense,. ITEM NUMBER DESCRIPTION 1. Genesis Eldercare Rehab Services 2. Chapel Pointe At Carlisle 3. Tax Preparation fee 1998 Form 1040 AMOUNT 66.00 512.62 225.00 TOTAl (Also enteron line 10. RecaPllulatlon) Se03.62 (If more space" needed. insan addillonal sheelS of Iha some size) COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND 1. J u: Jane F. Burke, Vice I'resident, Keystone Financlsl Bank, N. A. b.ing duly sworn .ccordlng to I.w, d.po.es .nd ..y~ that sh. fR J!v".."rn" of the Estat. of lIeIen O. Chess lat. of the BorouRh. of CJ!l'JJRl.<L--_ , Cumb.rl.nd County. P.., d.c....d .nd th.t the within I. .n inventory m.d. by KeYRtone Financial Bank. lL...A. , the ..id F..t!..lItor of the .ntir. est.t~ of ..id d.c.dent, con.i.ting of .11 the p.rson.1 prop.rty .nd real est.te, except real .stat. outside the Commonwealth of Penn.ylv.ni., and that the ligures oppo.ite .ach item of the Inv.ntory r.pr..ant it'. f.ir v.lu. as of the data of deced.nt'. d..th. .nd .ub.crib.d b.for. me, ~".t)4.. 10 I~~a~ &.cutor . Aclminist,.tor Jane F. Burke, Vice President KeYRtone Financial Bank. N. A. One WeRt lIigh Street Carlisle, PA 17013 Add,... :19- ,;;rx')c) Nolartal Seal Hilda O. {)owIing. Notary PubliC HaniWurg. Uauphtn County MVCommISSion (Jplres March 11, 2002 Oat. of 'if.l'l.Ifll' PoMSytvanl8 AssoflfIj9f\ 01 Notanes DIY 1I1JJI1 Month 1999 Yu, INSTRUCTIONS I. An Invantory mu.t b. fiI.d within thr.. month. after appointment of personal r.pr.untatlve. 2. A .uppl.mant inv.ntory mu.t b. filed within thirty day. of di.covery of additlon.1 ....h. 3. Addition.1 .h..ts m.y b. .tt.ch.d as to personalty or realty 4. S.. Articla IV, Fiduciaries Act of 1949. o .. ~ .,; w .. - ~ '" s i .. w .. a.. u .. 0 .. 0 W II> C '" '" w "', .. I- J: a.. LL "'I ,,; a.. Z ... -' LL -' <( 0 !:l. a.. W 0 <( w ~I .;. > Z '" ~ c Z 0 c 01 :J II> Z 0 0 '" ell u z w <( .... a.. ." ~i " .. - -.: 0 .. .l> ." ... .. E - .! 0 .. :J 0 -' U .u: CD , Inventory 01 the real and personal estate 01 IIKI.KN O. CIIKSS 1050 shs. AT&T Corp. 840 shs. Ameritech Corp. 800 shs. Be1~South Corp. Principal Cash from Guardianship account Keystone Financial Bank, N. A. Plenary Guardian Income Cash from Guardianship account Keystone Financial 8ank, N. A. Plenary Guardian deceased (')u 8 c:- :Il -'" ::l~ <tl 0-" (~ r.' ::~ i ~ L ~ . 0 '" -" C "lJ -, c~ VJ ~ 9.. "DC N ;:.=- N "" 55,879 69 57,041 25 36,200 00 44,250 05 10,513 66 COMMONWEALTH OF PENNSYLVANIA OEPAnTMENT OF nEVEliUE BUREAU OF INDIVIDUAL TAXES OEI'T,280001 HARRISOURG, PA 11128.0001 '* No/Aft. 407691nEv'"62Ex"'061 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT RECEIVED FROM: r ACN ASSESSMENT CONTROL NUMBER AMOUNT ~INANCIAL TRUST SERVICES CO ~'26.114.74 1('1 ONE WEST HIGH STREET CARLISLE, PA 17013 FCl.DHERE ESTATE INFORMATION: FILE NUMBER 21-1Q96-0919 SSIIJ 198-36-2('69 NAME OF DECEDENT (LAST) (FIRST) CHESS HELEN QRPHA (Mil DATE OF PAYMENT 3110/2000 POSTMARK OATE 0/00/0000 COUNTY CU~IBERLAIIJD 1;2=.114.74 TOTAL AMOUNT PAlO DATE OF DEATH 6/1 1 11 99"1 REMARKS " . t:.," AC " n" /)-Y::? RECEIVED BY /. ~ Yt'.{ L. /, ~lr.Rv L. L::'.,'~ '/ // f:'EG I STER _~ t- ~'J I LL S",;~';7ltvl/( "'-l.' /..'(~~I."t I :7j.1'f' ...- CHECK" 177"100 SEAL RF.c!:-~.r:~Fl ()(- \')iU j____ __ - ____ - - - _""'-___________a ___~___.&.__ ________ __~_.~- .. , -... -' -_I ~~ ..-:"..JllI" _ ,#-.-.T ",:. 7~7IJ . / ,/(7/ 'J --'\ '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU or JNOIVIDUAL TAXES ...I:AllANC[ UIl DIVISION D[Pl. ,.060 I HARRlSIURG, PA 171l8-0601 (> NOTICE or INHERITANCE TAX APPRAISENENT, ALLOWANCE OR DISALLOWANCE or DEDUCTIONS AND ASSESSNENT or TAX IIH"'" '" III."' I, 05-30-2000 CHESS 06-11-1999 21 96-0919 CUMBERLAND 101 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN tlELEN 't" KEYSTONE FINANCIAL BANK 1 W HIGH ST l' CARLISLE PA 17~~~ A.ount R...t U.d MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER DF WILLS CUMBERLAND CO COURT tlOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ iiiY:is4TEX-"FP-nZ:99riioi"icEuOF-YtiHERii'ANCE";--A'X'APPRAisEHiiir-,--"LLOwiiiicE-il.Fi----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF CtlESS HELEN FILE NO. 21 96-0919 ACN 101 DATE 05-30-2000 TAX RETURN WASI I X I ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Est.t. ISchedul. A) 2. Stock. end Bond. (Schedul. B) 3. Clos.ly Held Stock/Partnership Int.r..t (Schedule C) 4. HortgageI/Not.. Receivable (Schedule DJ 5. C.shlBank Depoaita'"lsc. Parsonal Property (Schedule E) 6. Jointly lltmed propedy (Schedul. F) 7. Transfer. (Schedule G) a. Total A...t. I CHANGED NOTE: To insure proper credit to your account, sub.it the upper portion of this for_ with your tax pay..ant. .00 149.120.94 .00 .00 57,828.06 .00 .00 (8) II) 12) (3) 141 IS) 161 (7) 206,949.00 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expen.../Ad.. CostslHlsc. Expanse. (Schedule HJ 10. Debt.lHortg.g. Llebiliti../Llon. ISch.dul. JI II. Tot.1 Deduction. 12. N.t Value of Tax Return 13. Charitabl./Gov.~.nt.l Bequasts; Non-.lected 9113 Trusts (Schedule J) 14. Net V.lue of e.t.t. Subj.ct to T.. 191 110) 18,379.62 803.62 1111 112) 113;. 114) IQ .18:\ :>4 IB7,765.76 13,667.52 174,098.24 will If an assessment was issued previouslY, lines 14, 15 and/or 16, 17 and lB reflect figures that include the total of ahh returns assessed to dete. ASSESSMENT OF TAX: 15. Aeount of Line 14 .t Spou..1 r.t. 1151 16. A.aunt of Lino 14 t...bl. .t Line.I/CI... A r.t. (16) 17. A~t of Line 14 t.xable at Coll.t.raI/Class 8 rat. (17) 18. Principal Tax Due NOTE: .00 X .00= .00 X .06= 174,098.24 X .15= 118) .00 .00 26,114.74 26,114.74 TAX CREDITS: PAYNENT DATE 03-10-2000 DJSCOUNT l+ I JNTEREST/PEN PAJD (-I .00 RECEJPT NUHBER AA40769l ANOUNT PAID 26,114.74 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 26,114.74 .00 .00 .00 . JF PAJD AFTER DATE JNDJCATED, SEE REVERSE FOR CALCULATJON OF ADDITIONAL JNTEREST. I IF TOTAL DUE JS LESS THAN .1, NO PAYNENT JS REQUIRED. JF TOTAL DUE JS REFLECTED AS A "CREDJT" ICRI, YDU NAY BE DUE A REFUND. SEE REVERSE SJDE OF THIS FORN FOR JNSTRUCTIONS.) COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA ORPHANS' COURT DIVISION No. 2196-0919 Estate of HELEN ORPHA CHESS aIkIa HELEN O. CHESS, Deceased Late of the Borough of CarUsle FIRST AND FINAL ACCOUNT OF KEYSTONE FINANCIAL BANK, N. A" SUCCESSOR TO FINANCIAL TRUST SERVICES COMPANY, EXECUTOR Date of Death: Lellers Granted: First Complete Advertisement of Grant of Lellers: Account Stated to: June 11,1999 September 9, 1999 November 9, 1999 July 21,2000 SUMMARY 3. INDEX fagas PRINCIPAL Receipts 2 $ 229,313.74 Net Loss on Conversions 2 0,33 229,313.41 Less Disbursements 2-3 50,043.98 179,269.43 Less Distributions to Beneficiaries 3 25.000.00 Capital Changes Principal Balance Remaining $ 154,269.43 INCOME Receipts 3 $ 5,467.31 Less Disbursements 3 328.04 Income Balance Remaining 5,139.27 COMBINED BALANCE REMAINING $ 159,408.70 1050 shs, 800 shs. 1105 shs. Cash Cash COMPOSITION OF NET BALANCES Prlncloal Market Valua 07/10/2000 Cost Basis AT&T Corp, BellSouth Corp. SBC Communications, Inc. 33,993.75 33,600.00 49,518.37 5,171.19 55,879.69 36,200.00 57,018.55 5,171.19 s 122.283.31 s 154.269.43 Income s 5,139.27 S 5.139.27 PRINCIPAL RECEIPTS Invenlorv Filed Per copy of Inventory filed S 206,949.00 7,455.54 7,454,60 7,454.60 22.364.74 S 229.313.74 SubSBOuent Receints 06121/00 William G. Chess, pro-rated share of PA Inheritance Tax Richard B. Chess, pro-rated share 01 PA Inheritance Tax Robert D. Chess. pro-rated share of PA Inheritance Tax Total Principal Receipts PRINCIPAL CONVERSIONS INTO CASH GaIn LlWl 11/18/99 Fractional Share SBC Communications, Inc. Proceeds 22.37 Inventoried at 22.70 .00 0.33 0,33 0.33 Totals Net Loss on Conversions 09/10/99 09/13/99 09/22/99 10/20/99 11/16199 03/09/00 03/09/00 03/30/00 S PRINCIPAL DISBURSEMENTS Register of Wills, Letters Testamentary Genesis Eldercare Rehab Services Reeder's Memorials, lettering monument Hoffman-Roth Funeral Home Chapel Pointe at Carlisle Martson, Deardorff, Williams & Otto, legal opinion Cumberland Law Journal. advertising Letters Testamentary Tax preparation lee The Sentinel, advertising Letters Testamentary Register of Wills, filing Inventory Register of Wills, filing PA Inheritance Tax Return Register of Wills, PA Inheritance Tax PA Depl. of Revenue. tax due PA40 S 308.00 66.00 65.00 5,906,00 512,62 225.00 60.00 225.00 72.40 10.00 15.00 26,114.74 386.00 2 fBlHClPAL DISBURSEMENTS (contlnuedl 03130/00 Internal Revenue Service, lax due Form 1040 04/24/00 Recorder of Deeds, filing Releases Reserved: Keystone Financial Bank, N. A. Martson, Deardortt, Williams & Otto Closing and Filing Cosls 4.084.00 26.00 9.243.22 1.225,00 1 ,500.00 Total Principal Disbursements $ 50,043.9B PRINCIPAL DISTRIBUTIONS TO BENEFICIARIES 03/29/00 Susan D. Niemi Richard Warren Mock Jack Allen Mock William Russell Mock Jean Elizabeth Mock O'Neil $ 5,000.00 5,000.00 5,000.00 5,000,00 5,000.00 $ 25,000.00 Total Principal Distributions CAPITAL CHANGES Amerllech Corp 06111/99 840 shs. 10/13/99 840 shs. o $ 57,041.25 57.041.25 0.00 Invenloried at Merged with SBC Communications $ INCOME RECEIPTS Dividends, Amerltech 8.2-99 to 1-3.00 Dividends, AT&T Corp 8.2.99 to 5-1-00 Dividends, BellSouth Corp. 8.2.99 to 5-1.00 Dividends, SBC Communications, Inc. 2.2.00 to 5-1-00 Dividends, Money Market tund 7.1-99 to 7-3.00 $ 533.40 924.00 608,00 549.73 2.852.18 $ 5.467.31 Total Income Receipts INCOME DISBURSEMENTS Keystone Financial Bank, N. A., Income commission $ 328.04 KEYSTONE FINANCIAL BANK, N. A., SUCCESSOR TO FINANCIAL TRUST SERVICES COMPANY EXECUTOR HELEN O. CHESS ~~ -' ll.h.~ J e F. Burke, Vice President 3 STATEMENT OF THE REASONS FOR THE PROPOSEO DISTRIBUTION The above distribution Is proposed In accordance with the terms 01 the Last Will and Testament of Helen Orpha Chess alII/a Helen O. Chess, Late of the Borough of Carlisle, Cumberland County. Pannsylvanla. llhL J' ne F. Burke, Vice President COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Jane F. Burke, being duly sworn according to law, deposes and says that she Is Vice President of Keystone Financial Bank, N. A., the within named Accountant In !he Estate above named, and that the facts sel forth in !he Statement 01 the Reasons lor the Proposed Distribution are true and correct. .i Sworn to and Subscribed before me !hIS~dayofJuly, 2000. Jon F. Burke. Vice President ~J"O'n Y' /r:' ( .- Notary Public Nolarlal Saal Wanda L. Dala. NOlory Public Carlisla BolO. Cumbe~.nd Counly My Commission Expires July 1. 2002 MambBr. Pennsylvania AssocIOliOn at NOtaries 6 ~...~..>"...'.~'-- ... , ,---_.,--- \ ..~, \ " Ii :i Uiillll ! ~ ~i.8Jllll!; I 1l1,lljiSli a ~ Iii il;~i :3 ! !;nhl1l~..). tll:~I~. r~:,. C\ Ii ~8 f h':; l; . '" & f. .. '1 I r,; I! -' ~Jafjfls . g!iIJfal~ . lii~laf~a~ ~ ~1!.8'15Jli13 !tilg II~ ~ f"ltsi1!~~ ) tlmm0 III Z .... 0 ;s .>l l"l H. Z ";; lil f:;. -< H I'l< ~ ~ iil~~z ~'" l:l'1:ltJ Ii;. offi~ ~hl~~~ ~p.,~H tdG.l oc:a~ p.,U:I:Ul"l ,,> cx:cut!)ucn~ p.,~H ocoP<O co 0 p., ~ H 15ui~:;Jg~ ~8~~r.l~I'l;::jp.,z o o"d;l:I:!:l~~H U!UO Ui=< o~ I&. _ '" ~. e l"ll"l o "'''' o~::ao-lZ l!;j....l"l 0 PO Hl"liilNH15 Hf.lH 8~::lci~r.l~~e~ UUOZl"l53o-ll&.",i2 H '" ~~ Hf:; ~U U~ ~ . ~~ ~~ p:U 0'" "'l"l "'U l"lH U> uP: =>l"l "'''' '" 0 '" 0 '" 0 .... N . . .... .... .... N '" >. g :l .., .., .. .. c.:> ~ ~ co ~ ~ I&. o 0 l"l l"l !;;: !;;: co co 'l7l~ '1 ?1JLIh-f{ l~ uno:> 't!ql Ag 'qll.t!eJeq .:-. '1' .~qol Pllodold UOllnQlllllP 10 "I" P."o.p ~II" UUlPIOOOI UI l*U1,/IIOO ~'IIIIP pn A'.ln,oIQI QIJ'tJY1-t7' Z Z .. .. o ... ~ aJ- c.s:2 au ~C ~~ Q,).- ~w.. a .... .... .... .... ~ . .... .... ~ o '1:l ~ III '" co . II o .. .. ~ )!