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Home My WebLink About96-01060 . .... o CD .. . o .. tit ~ PETITION I'OI{ 1-IWnATE and GRANT 01' LETTERS No. __Q2I-qlQ - /0<00 To: ? ., ,I>,;"Yd'"; Eslal., of ,"" . 114', I' f; <' a/so k /1011'/1 as Register of Wills for the , /Jr,'ra"ed. County of r.\JI~BERI AND in Ihe Soda/ SeCllrity No. I 7 <;- - (. l--("" ~7 " Conllllonwe:llth of Pennsylvania The petition of Ihe uudersigned respeClfully represeuts Ihm: Your pelitioner(sl, who is/nre IN yenrs of nge or older nn the exeeut c, , in the Inst will of the nbovc decedenl, dated J" 'Ld '-1 r y' ::1_1 and codicil(s) dnled ' named ,19..EL. (\IUIC 1('IC\'alll dlClllll"lllllCC\, c.~. rcnunciation, dealh ur c'teular, cIC.) Decendenl wns dDmiciled nl denlh in ('~I/>";<"I Ie " CounlY. Pennsylvania, with It i 5' last family or principal residence at r. <:z .I- c.<" t ,t...",.. > /l:'t!<'/on,,:" f' A" ~ j7/l /7C'55 / / (li"t ~Uet'l. numbcI and lTlundpalil)') x5? years of age died ce...., h /7 ,19 '7 C- al t1 " rC A,') Cu,..,Jl"'r":J I- Except as follows, decedenl did nol marry, was not divorced and did not have a child born or adopted afler eMecution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at dealh owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ ~ c C c!, 00 (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real eslate in Pennsylvania $ situated as follows: /II C 1/ ," " WHEREFORE, petitioner(s) respectfully presented herewith and Ihe grant of lelters theron. requeSl(s) the probate of lhe last will and codicil(s) 're rI'..ff',y., To. r- y (leSlumentar)'; administralion c.t.a.; administration d,b.n.c.I,I,) I , " j 1\ \ I I I I I I , I I \ i ; i \ i 1 i ;?...f-t II, tyo-!;! ~_ )< ~A~;U",t1 G-4.~ '6~ - -:;. t.uM r4"e "'~ -g.g A:t!c.. r"~ r .~ '-!> ",.- J, r f.. . ";;i~ 11.... >< ~J> ' ...f,A r ~ 0 {,';:L Gr-" f' '" :; ~ ", l. I ~c3 iii I\( .,~/ OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PEN~SYLVANIA } ss COUNTY OF (umhrlr.llr The petitioner(s) above. named swear(s) or aflirm(s) Ihat the statements in the foregoing petition are true and correct to the best of Ihe knowledge and belief of petitioner(s) and that as personal represen- tative(s) of Ihe above decedent pelitioner(s) will well and truly adminisler the estate according to law. .. SUbSJ~~b~~ "~; t~: /:;3. ;; ~ ) ~;J /,-, ,; /'(1'/ , ," f1t ~ Rel/isler (J 't-:'!:.;J({"-.,h /-f_'i"'';- '" 00' ,. Q - " ~ ~ Sworn 10 or affirmed3RiUld berore me this 7 w 15_1~5()-\ -~.. - - ----~ << I No. 21 ~ 96 - 1060 Estate of C;'~rli~ g. g)"'l"rs . Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW DECEMBER 27. 19~, in consideration of the petltiDn on the reverse side hereof, salisfactory proof having been presented before me, IT IS DECREED Ihallhe instrument(s) dated JQnu<? ~v ~ S' 1'1/i'1? described therein be admilled to probate and filed of record as the lasl will of C/1d r I. e II. Ry~rs and Lellers 7?rf';-d/t""/~(r..... ' are hereby granted to Rut,," I/. JP-",rs" Alf"k""" wyr-...",,,,;a,,r/ip/?/'y'r;.Jr-. 7~ FEES Probate, Lellers, Elc. ......... $ 40.00 Short Certificales(2 ) . . . . . . . . .. $ 6.00 Renunciation................ $ X~PAGES $ 6.00 JCP TOTAL _ $ ~.uu . DECEMBER 27. 1991F .eo Filed.................................. . ~ftreyl9..erl1;G-O t)791?1 , o I ATIORNEY (Sup. Ct. 1.0. No.) P/.l~"tl.1t " /n,lt!r$<!11 a. ''?o;l/. 1c.P r t. E;~ldt. Fker 11&\ r,..i S-P"7'ADDRESS {7/l .l71tJ I (717):;J37-'1~SI PHONE M ~~ - '7) 0 rJ> ItJz.;; OJ " 0:>: : .j t' - - '.U , .-1 M " N "J '(~ , I;;' .~ t,j o ~.1 c::I 1) ~.- . 0 Jl ..;:) U ~ ~ '- E Q)a: a: .!!!::s UU Mailed letters and order to attorney on 1~-30-96. ~ 1 - 96 - 1060 2(') ~ ::0:0 3~ t:>P; C"" :~.Q c:- o .... \~ ':;-"l F n ':, CJ. " Cl ~ ':. , . c,: :';n p , :I:t ~":t.' (l CD u; 0 :-O~ (,j - )>~ w LAST WILL AND TESTAMENT I, CHARLIE B. BYERS, of 21129 Scotland Road, Chambersburg, Greene Township, Franklin County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all wills by me at any time heretofore made. FIRST. I direct that all my just debts, eMpenses and inheritance taMes shall be paid by my EMecutors hereinafter named, as soon as may be convenient after my death. SECOND. I give, and miMed, whatsoever she shall survive me. devise and bequeath all of my property, real, personal and wheresoever situate, to my wife, Ruth H. Byers, if THIRD. In the event my said wife, then I give, devise and bequeath all miMed, whatsoever and wheresoever situate, Ruth H. Byers, does not survive me, of my property, real, personal and as follows: (a) Three (3~) per cent to the ROMbury Holiness Camp of the Brethren in Christ Church, located near ROMbury, Pennsylvania; (b) Five (5~) per Association, with offices Chambersburg, Pennsylvania, and to its successors to be used for cent to the Gospel Tide Broadcasting located at 152 Lincoln Way East, if not in cMistence at the time, then the purpose of spreading the gospel; (c) Two (2~) per cent to the Brethren in Christ Church located at the corner of Center and Reservoir Streets, Chambersburg, Pennsyl vania; (d) Five (5~) per cent to the Board for World Missions of the Brethren in Christ Church, with offices located at 500 South Angle Street, P. O. BOM 390, Mt. Joy, Pennsylvania 17552-0390; and TINOTHY 5, SPONULLtA (e) All of the rest, residue and remainder of my property, real, personal and miMed, whatsoever and wheresoever situate, to my four (4) children, namely Nelson W. Byers, Charlie B. Byers, Jr., Ruth Ann Shelly and Ivan W. Byers, in equal shares. If anyone of my said children is not living at the time of my death, but leave children to survive him or her, then the surviving children shall divide equally the share of my deceased child. AHOINEI At u.... FOURTH. the age of Farmers and If any person inherits an interest in my estate before reaching eighteen (lB) years, then for such person's estate I appoint Merchants Trust Company of Chambersburg, Chambersburg, tl'CHAMlllsaUlwllU"ILDG, CIIUIIUIIUIG, 'A nZOI "7an.au. Pennsylvania, as trustee for such minor I s estate. FIFTH. 1 nominate, constitute and appoint my son, Nelson W. Byers, my wife, Ruth H. Byers, and my son, Charlie B. Byers, Jr., as Executors of this my Last Will and Testament, and my said EMecutors shall not be required to give bond in the settlement of my estate. IN day of WITNESS WHEREOF, ..JANUh-If? I have hereunto set my hand and seal, this ,:;/~ , 1988. &<~d CHARLIE B. BYER (SEAL) Signed, sealed, published and declared by the Testator, CHARLIE B. BYERS, as and for his Last Will and Testament, in the presence of us, who have at his request, signed this Will as witnesses, in the presence of the Testator, CHARLIE B. BYERS, and of each other. WITNESS: ':' " I ~f(} &'-'/ /It'-YL1Li IL' Hid ff/lUt ;;f~ t- WITNESS: TIMOTHY S. SPONSELLER ."OIlM[Y AI lAW It.CH....U..U.G flUst '~DG, CHAMUU,ula, 'A 'n01 711111.un -2- g~RTI FICL\TION QE1iOJICJl!JWJm~_RUJ.j~2J1{6?f I~" '::IW, Nllme or Decedent: Chllrlie B, Byers Dille orDelllh: 12117/96 '97 Jntl17 fill :47 Will No,: 1996-0 I 060 Clcl ,; lit CUlT,,- I, j,. PA Admin, No,: TD the Register: I certify that notice or beneficial interest required by Rule 5,6(a) of the Orphans' Court Rules was selVed on or mailed to the rollowing heirs and/or beneficiaries or the above-captioned estate on December 24, 1996: Name Address Ruth H. Byers 592 Locust Lane Messiah Village Mechanicsburg, PA 17055 Charlie B. Byers, Jr. 3402 Grove Place Columbus, IN 47203 Nelson W. Byers 2413 Scotland Road Chambersburg, PA 17201 Ivan W. Byers 216 Poage Fann Road Cincinnllti,OH 45215 Ann Shelly 14 Cedar Court West Cllrlisle, PA 17013 Date: December 26, 1996 Signature ---,-" .:~. Nllme: Address: JelTrey A. Emico, Esq, Buchanan Ingcrsoll Proressionlll Corporation 30 North Third Street, 8th Floor Harrisburg, PA 17101 Tclephone: (717) 237-4800 Cllpacity: Personal Rcprcscntative X Counsel for Pcrsonal Representative HBG1; 57S76.' IN THE COURT OF COMMON PLI~AS OI~ CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION In Rc: ESTATE OF CHARLIE B. BYERS, Late of Mechanicsburg, Cumberland County, Pennsylvania, dcceascd Estate No. 1996.01060 III ~~~~j,-( ~ AND NOW, this ~ day orr ',1997, on consideration of Executrix's Petition for Settlement of Wrongful Death and Survival Actions and Apportionment of Settlement Proceeds Pursuant to 20 Pa.C.S. ~3323(b), and any response thereto, it is hereby ORDERED and DECREED that Petitioner is authorized to enter into a settlement with Shawn Knepper and Edward Hess, in the gross sum of $150,000.00. It is further ORDERED and DECREED that the settlement proceeds shall be distributed as follows: 1. To the Law Offices of Mette, Evans and Woodside: $ 846.88 for reimbursement for costs $37,500.00 for counsel fees $38,346.88 - Gross Amount. 2. To the Law Offices of Mette, Evans and Woodside's escrow account, $43,713.01 pending disposition of the disputed Medicare lien 3. The remaining balance of $67,940.11 is apportioned as follows: Wrongful Death Claim Survival Claim $50,000.00 $17,940.11 4. The wrongful death claim of $50,000.00 shall be paid to the issue of the decedent as follows: (a) To: Nelson W. Byers, (b) To: Charlie B. Byers, Jr, (c) To: Ruth Ann Shelly (d) To: Ivan W. Byers son son daughter son $12,500.00 $12,500.00 $12,500.00 $12,500.00 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION In Re: ESTATE OF CHARLIE B. BYERS, Late of Mechanicsburg, Cumberland County, Pennsylvania, deceased Estate No. 1996-01060 EXECUTRIX'S PETITION FOR SE'ITLEMENT OF WRONGFUL DEATH AND SURVIVAL ACTIONS AND APPORTIONMENT OF SE'ITLEMENT PROCEEDS PURSUANT TO 20 Pa.C.S. ~3323(b) AND NOW, comes the Executors of the above-captioned Estate, Nelson W, Byers, Charlie B. Byers, Jr. and Ruth H. Byers, by and through her attorneys, Mette, Evans and Woodside, to petition this Court for approval of a settlement and apportionment of settlement proceeds pursuant to 20 Pa.C.S. ~3323(b), and in support thereof states as follows: 1. The Last Will and Testament of Charlie B. Byers, decedent, was admitted to probate by the Register of Wills of this county on December 27, 1996. A true and correct copy of the Last Will and Testament is attached hereto and made a part hereof as Exhibit "A." 2. Petitioners, Nelson W. Byers, Charlie B. Byers, Jr. and Ruth H. Byers, were duly qualified as Executors under the Will of Charlie B. Byers, deceased, on December 27, 1996. 7, The drivers of the automobiles involved in the subject collision, Shawn Knepper and Edward Hess, have agreed to policy limit settlements of $100,000.00 and $50,000.00, respectively, in exchange for general releases. The underinsurance carrier for the decedent and the driver of his vehicle, Mrs. Drost, have consented to these settlements and have agreed to waive subrogation rights. 8. The only outstanding claims are as follows: Buchanan Ingersoll, P,C. Medicare Lien (disputed) $ 4,763.50 $43,713.01 9. To date, counsel has incurred out.of-pocket expenses in the total amount of $846.88 for which reimbursement is sought. 10. Counsel requests counsel fees in the amount of 25% of the proposed settlement of $150,000.00 (less the balance due and owing to Buchanan Ingersoll, P.C. _ $4,763.50), $32,736.50, which represents full and fair compensation for their representation of Petitioner in the claims against Hess and Knepper as hereinabove set forth. 11. Petitioner requests the allocation of the net proceeds of the settlement (after deduction of costs, liens and attorneys fees) as follows: (a) Wrongful death claim (b) Survival claim $50,000.00 $17,940.11 - 3 - VERIFICATION We, the undersigned, RUTH H, BYERS, CHARLIE B. BYERS, JR, and NELSON W, BYERS have read the foregoing Petition and to the extent that it contains facts supplied by us, they are true and correct to the best of our personal knowledge, information and belief; however, to the extent that the foregoing document and/or its language is that of counsel, we have relied upon counsel in making this verification. We make this Verification subject to the penalties of 18 Pa.C.S. ~4904 relating to unsworn falsification to authorities. \ , _ull...lI..U. A '. TIMOTHY S. SPONUUER AnOllfU " UW II' C"A.UUUUUtlun ILOG, CMIlIIUIIUU, '''' 17Z01 7UUNtI. LAST WILL AND TESTAMENT I, CHARLIE B. BYERS, of 2~29 Scotland Road, Chambersburg, Greene Township, Franklin County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and ell wills by me at any time heretofore made. FIRST. I direct that all my just debts, expenses and inheritance taxes shall be paid by my Executors hereinafter named, as soon as may be convenient after my death. SECOND. I give, and mixed, whatsoever she shall survive me. devise and bequeath all of my property, real, personal and wheresoever situate, to my wife, Ruth H. Byers, if THIRD. In the event my said wife, then I give, devise and bequeath all mixed, whatsoever and wheresoever situate, Ruth H. Byers, does not survive me, of my property, real, personal and as follows: (a) Three (3~) per cent to the Roxbury Holiness Camp of the Brethren in Christ Church, located near Roxbury, Pennsylvania; (b) Five (5~) per cent to the Gospel Tide Broadcasting Association, with offices located at 152 Lincoln Way East, Chambersburg, Pennsylvania, and if not in existence at the time, then to its successors to be used for the purpose of spreading the gospel; (c) Two (2~) per cent to the Brethren in Christ Church located at the corner of Center and Reservoir Streets, Chambersburg, Pennsylvania; (d) Five (5~) per cent to the Board for World Missions of the Brethren in Christ Church, with offices located at 500 South Angle Street, P. O. Box 390, Mt. Joy, Pennsylvania 17552-0390; and (e) All of the rest, residue and remainder of my property, real, personal and mixed, whatsoever and wheresoever situate, to my four (~) children, namely Nelson W. Byers, Charlie B. Byers, Jr., Ruth Ann Shelly and Ivan W. Byers, in equal shares. If anyone of my said children is not living at the time of my death, but leave children to survive him or her, then the surviving children shall divide equally the share of my deceased child. FOlJ.RTH. the age of Farmers' and If any person eighteen (18) Merchants inherits an interest in my estate before reaching years, then for such person's estate I appoint Trust Company of Chambersburg, Chambersburg, Pennsylvania, as trustee for such minor's estate. FIFTH. I nominate, constitute and appoint my son, Nelson W. Byers, my wife, Ruth H. Byers, and my son, Charlie B. Byers, Jr., as Executors of this my Last Will and Testament, and my said Executors shall not be required to give bond in the settlement of my estate. IN WITNESS WHEREOF, day of -.lANUA-fl"Y I have hereunto set my hand and seal, this .:;/~ , 1988. CH~~.~h'~~/ (SEAL) Signed, sealed, published and declared by the Testator, CHARLIE B. BYERS, as and for his Last Will and Testament, in the presence of us, who have et his request, signed this Will as witnesses, in the presenoe of the Testator, CHARLIE B. BYERS, and of each other. WITNESS: vrt!. '\..-lJL(>J;u.rl/)L' v v jf/1 t/A4 ~ WITNESS: TIMOTHY S, S'ONUurR ""DUlY ",u. II' CMAltll"'U.'lIU" ILlO, C""..UI.UIII. 'A 17101 7UUI-IIII , . . -2- ~. ..- We, CHARLIE B. BYERS, Testator, and the witnesses whose names are signed to the foregoing instrument, being first duly sworn/affirmed, do hereby deolare to the undersigned authority that the Testator signed and exeouted the foregoing instrument as his Last Will and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that eaoh of the witnesses, in the presenoe and hearing of the Testator, signed the Will as witnesses and that to the best of the knowledge of each witness the Testator was at the time eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence. c{~f~ ~a. 7lL~~lt:~ WITNE~ . ~ ~~/' WITNESS Sworn/affirmed and subscribed to and aoknowledged before me this ':;;'/~ day of , 1988. otary Public amy II. ILE. NOTARY PUUlIC CHAMBERSCURO BORO. FRANKlItl COUNtY IlY COMMISSION EXPIRES SEPl. L7. 1981 M,mb... Plnnsyl,sn's Associstlon 01 Not..,.. 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UNl" o 0 ;ffiill ~'.r,~;,:.F;:-l)lY" J~ii'SiiT IS ci.o nSI ",,/,: ~7"b"'Ii,' P2 rYPE V'ESUL 15 D NO f[lli;;~r~e;T,'w;o;J . ~ U~I IlSI 0 HI 'Wf .~...: t,~f T(:sr D nErllSF. r.ov.~e1f , IINU I 0.__._ % 0 L..NM UNit" 0__0/00 U"' VES gJ'o 0 .-- ..- ---. --.--.- . ..--- , ' " " "''''4!Jf;lln:'1 :r PAGF. .S'.. ----cE,.JfIl FUfI II:ri1r,o",O( ~AfElV UUU1~()6 j\//I' ~...~\ COMMONWEALTH OF PENNSYLVANIA ~\ POLICE ACCIDE T SUPPLEMENTAL 101 i\UEnlOCMlllJo'S1EE11 ~ 11' n'.m[ ,.ml1fl'Ol~[ n "",l(J(llUI&C>>U ~)t' ~:,~!:~ ::. POLICE INFORMATION ' ACCIDENT TIME a Loc"nO'Nt;:!'~II",',!/:, , If': N / " ",CtUN L{ 10_ OAr WUK ',,j_R -\: '17/2. 1l1,1[ 0' 19....... 11./ L.-G(NCY _ " "'" 01 ." I " ll, NU'"1E1l -,.. IIlLE ,:.N,wl.s 7>1 . 011' ...." fY "'''& ::2 :I. "A oON/ / " '.'u.LU . "'" ,"U · "11" ""uP 'R!ClNCl I, ,::::"J..'IlJAuf68:l$ lJ lOl".._ (.J ACCU[Ill .... L ffl .Q n ""... I< .;......~,i.> \,) ,,,,...lEn ':1;.".2..f.) _' J.ve'it1..J ,.A'POO'I' ,l, '_~'\;;: \ '~O 1WlO> \\J,';L- ",","__,"-,lIlY cOOt ~~ _ ..."'-,...... ,I,..; ,YC\'/O iililoO!!f.!L .. ~7"> [)f/ "',ooJ 7W~ 2(' COMPLETE ONLY THE ItlFOriMATION THAT HAS CHANGED SINCE ORIGINAL REPORT 11 BfQ . SIAII. LI onlVllt PlAlE "^t.OE .. UflNEn AoonFSS 6lJ CHY.5IA e & IIfICOOE II SE~ Y .,.0't'1I' It 1ollOIU'SS r...CII'I.'''IE IlIl'COOE ,&3. yEAR 64 COlu.t YEH Y r. 67.CAAAf.R 62 DAlE or BlnTlt ~ DRiVEn CLASS .r-Ii a.wU: cS I.IJOELlNOt ooov np\ if"'. DOO't . T'lPf ~HALUr.lP"C' pOlNl ~ EIlIClE G,w:~Nl 60. DRIVER puel - 13 AliCiO 00'1' tyPE 10. "llOOtl!; A'll" ~ ..."A 1/1 I II. NARllAlIYE . 'D"H'" PREClP"Al'NO EVi.ll.CAUSll,OIl ,"CIORI. SEooENCE Of EVENTS. WIlIIESS SlAn"ENTS. OliO PROV'DE 1000'"0"" 0I1..l.S o ," "f. .f/-'''u,ff: 09/ZV/.,t 0'"' ().,h'lhtf' ;'1T M',/;>( ~t.fCl ,n.;"'<l. i}(IJ o,rl"I"yr (l)I!~ J<I...,..J f. L""ot"Y.)I.~".......~, o.JEA.tI2 ;'1/ /HI' J(,......~ "'~'<! "z .,,:/~.~#' ~; .... t..-'IJ ro........t- .!i:Jui)I "'oI,,-~ ?l"J c,'"y AJ ",.... .. A':<'''' '7711' Iflif ~lfJ4./JJ hE. "to l,p'J AU 'M:~ i;"",- ,.to-l,). .17' {.("~~ ,II.,' .~. 'J J''''''fll ... TJIv"';I;-......r. {.t,""" ,/Of.;J ,'J, 11""- /)Ir;.J....E wE".-T all.r/.. .v . ~. ...lLt11.:' 0... - - -- Q._.rJ~.A~A( ;'1T ./10,(,..... lz.fS ,,1;.'<'. ;",J ,.,;1>,":;< (llIi J.4r>cJ 1 (......,"') ,~,~...., ,~- ,.,.".<1,,'- /JC,l'd &:_",,'-<, LJ/vl.., ,.1 ",.~ I,~/.>..A: w' ,,, 7>11','- lbA l,.,,,, r;~I(",,,~LL.i .:ll' ,; , "~..'. ,ji'N",r./ ..it-'"~'-? 71<'" lhr CL,y;II."'''-'''' ,O~.I,r~U'IJ ,...,1J vJ../.!.,.:'1!i.JI' .. t:".~: '; -, '- "C~"' tE- "".""'-~~ ,~" p ,,,,,,,,-kU-L-b.-UC--"'''---' "--,,,r I}#) "'~". .'.,:L,j"lll' 1,..1r.lVdU - -- -'--- \~'. -- ----- - ._-=~~==- L- - ------.-...-..--.- 1- . - ~";SUMH<' ,<';';'""'"Y , - - --- 'Irc::lflMATICH __..._-....-----.-.-~R~ ~ . l.tlll l'tA ~.f uo ,.1.' "A-;SSiim, - ----- .------- .---. . } 9< 1P^';;;.;~W;Cc;.."'E1<1 --- YES rf3'~ "" 0 r~r:L. -0-----.-- r7t:iFnr.:.i,P,;;;,i'i\v'ATrEiY ., . CERTIFICATE OF SEll VICE I hereby certify that I am this day serving a copy of the foregoing document upon the person(s) and in the manner indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure, by depositing a copy of same in the United States Mail, Harrisburg, Pennsylvania, First Class Mail, postage prepaid, as follows: Ruth H. Byers 592 Messiah Village Mechanicsburg, PA 17055 Nelson W. Byers 2413 Scotland Road Chambersburg, PA 17201 Charlie B. Byers, Jr. 3402 Grove Place Columbus, IN 47203 Ruth Ann Shelly 14 Cedar Court West Carlisle, PA 17013 Ivan W. Byers 216 Poage Farm Road Cincinnati, OH 54215 METrE, EVANS & WOODSIDE BY~ n('11UlM Christ pher C. Conner, EsqUIre sup. Ct. !.D. #36407 Jeffrey A. Ernico, Esquire Sup. Ct. 1.0. #07981 3401 North Front Street P.O. Box 5950 Harrisburg, PA 17110-0950 (717) 232-5000 Date: "/IBhf Attorneys for Executors: Ruth H. Byers Charlie B. Byers, Jr. Nelson W. Byers 121246 1 t .' . f' ) , , ., " " .. ; . \If. J . ~" )- '. ~ 'n . , r , oj ~ . ~ -' . .."'\ , . , . " . '. '.-:"~ '(., , , J . ~. \. , ~ ^:.. . i, ..~ .. r-:: ~:;M. ___A~. " _ _ ~ ~, --r:';'''~'' I ! 1 ' \ " '. , .. CERTIFICATE OF SERVICE I hereby certify that I am this day serving a copy of the foregoing document upon the person(s) and in the manner indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure, by depositing a copy of same in the United States Mail, Harrisburg, Pennsylvania, First Class Mail, postage prepaid, as follows: Ruth H. Byers 592 Messiah Village Mechanicsburg, PA 17055 Charlie B. Byers, Jr. 3402 Grove Place Columbus, IN 47203 Nelson W. Byers 2413 Scotland Road Chambersburg, PA 17201 Ruth Ann Shelly 14 Cedar Court West Carlisle, PA 17013 Ivan W. Byers 216 Poage Farm Road Cincinnati, OH 54215 METTE, EVANS & WOODSIDE By: ( Christo er C. Conner, Esquire Sup. Ct. 1.0. #36407 Jeffrey A. Ernico, Esquire Sup. Ct. 1.0. #07981 3401 North Front Street P.O. Box 5950 Harrisburg, PA 17110-0950 (717) 232-5000 Date: 11/1f>{11 Attorneys for Executors: Ruth H. Byers Charlie B. Byers, Jr. Nelson W. Byers 121246 1 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION In Re: ESTATE OF CHARLIE B. BYERS Late 01 Mechanlcsburg, Cumberland County, Pennsylvania, deceased Estate No. 1996-01060 RECEIPT OF DISCLAIMER Nelson W. Byers, Charlie B. Byers, Jr. and Ruth H. Byers, being duly sworn according to law, depose and say that they are the Executors 01 Charlie B. Byers' estate and that on the date and place as hereinafter set lorth, they received the loregolng signed Disclaimer Irom Ruth H. Byers. Signature ~tI(; .d /&~f.(.., Ruth H. Byers V SWORN TO AND SUBSCRIBED belore me this 1997. _.-r ---..... HolariaJS~1 JIllrl'/ A. E..co./loury PubUc t'.J."lstu,~. Dauphin C':l:mty, rA MvCo:nr:'tIU:onb:OlfesSepllO.199!1 114SSU n ,) CERTIFICATE OF SERVIC.E. I hereby certify that I am this day serving a copy of the foregoing document upon the person(s) and in the manner indicated below, which service satisfies the requirements of the Pennsylvania Rules of Civil Procedure, by depositing a copy of same in the United States Mail, Harrisburg, Pennsylvania, First Class Mail, postage prepaid, as follows: Ruth H. Byers 592 Messiah Village Mechanicsburg, PA 17055 Nelson W. Byers 2413 Scotland Road Chambersburg, PA 17201 Charlie B. Byers, Jr. 3402 Grove Place Columbus, IN 47203 Ruth Ann Shelly 14 Cedar Court West Carlisle, PA 17013 Ivan W. Byers 216 Poage Farm Road Cincinnati, OH 54215 METrE, EVANS & WOODSIDE By, ~ cr.hA<lLl Christ pher C. Conner, Esquire Sup. Ct. LD. #36407 Jeffrey A. Ernico, Esquire Sup. Ct. LD. #07981 J1' 3401 North Front Street P.O. Box 5950 Harrisburg, PA 17110-0950 (717) 232-5000 IJate: I' ltt'l~~ Attorneys for Executors: Ruth H. Byers Charlie B. Byers, Jr. Nelson W. Byers 121246 1 \ ~()\~ REV-l~CO EX '1l-~71 . '--" REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OF~'CIAL U",[ uN!,." 15-/UO COMMONWEALTH OF PENNS'ILVAlIIA DEPARTMENT OF REVENUE DEPT, ~S060 I HARRISBURG. PA 171~S-0601 14. Net Value Sublect to Tax lUna 12 minus Lino 1:Jl 15. Amount olllnQ 14 laxat:lo at tho spou~:l1 tOJ;( (.:lta Seo Insrructlons on page 2 lor applic:Jblo percentago 16, Amount 01 II no 14 tilX3blo at 6~o ralc 11, Amount of hno 14 lax.tlo.115%,.,0 0.00 x .15 (17) la, T>x Duo 11BI 19, CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT >> BE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND RECHECK MATH << Under penaltlQs 01 pCfJur,.. I declare lnall ho'lvO exammed Itlls return. including 3c::omcanymg 5chQdu!o~Jlld :;tJlemonts. and to the cost 01 my knowlodgo and bollOI. II is true. correct and complete. DeclaratIOn 01 preparer olhor than {he personal rcprcsontallVQ IS cased on all mlormallon of oN'11eh preparer has any knowledc;o. DECEDENT CHECK APPRO- PRIATE BLOCKS CORRES- PONDENT RECAPIT- ULATION TAX COMPUTA- TION FILE NUMBER ,:cu,~~C{ 1q96 "("';:1 01n"n fjlJMO(!l DECEDENrs NAME (LAST, FIRST, AND ~IIDDLE INITIAL) Evers. Ch~lie S. SOCIAL SECURITY NUMBER DATE OF DEATH 175-03-0573 12/17/96 !IF "'P~~!C.a.DLt:llulol'JI"I~ J SP';i1,l1t'J ~"ME ILAST. SOCIAL SECURlr( NUMBER j:IAS'f. ANQ '.JIlOOU: :~~IT'lALI BYers. Ru::.."'. H. 175-32-0824 1. OrrglOal Rerum 2. Supplomental Return 4. Umllod Estalo olD. rdY..lr:~:"al:::~t..;,~~~;~7:~~:1 G. 0.:.11'''1 C,,:t hll..,. 7. OII;I(I,"t V.amUln,o.. L.IVlng r,~.1 1~ltact! l:OIl'l' iSl'N,UI l"'I1.1C" C::SCY:l1 TrOl.l! 9. l.Jttcatlon Proceeds Recolved 10. ~g~f,I~~~~~~'~! f~::~t ta.al. ot jull'l bit....." DA TE OF BIRTH 02/11/1908 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS o J. A,"'''I"!!'' ~.t..," ICUlllol jutll~"Q'tD 1:..lJ"l:l 5. Fodoral Estalo Tax Rtm. Rcquired 8, Tolal No, 01 Sate Deposit BOlCOS 1 f. Et'ctlon 10 La. IIn"., s.c. ~1131AI IAIt..e" '!e'" "I THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE & CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS Jeffrelf A. E::r.i::o 3401 N. Fr::r.t Street FIRM NAME III Appllc.blo) P.O. Ecx 5950 ;.:ette. E'rar.s & 'ticcds.:.de Harrisburg. PA 17110 TELEPHONE NUMBER 717-232-5000 1. Rolli Est.,o (Scho~ulo AI 2. Slack. and Bond. (Scho~ulo B) J. Closely Held Carper.ulan. P;utncrship or Sole-Proprlotorship 4. Mortgages &. Noles Receivable (Schedule 0) 5, Cash. Bank Deposits &. MIscellaneous Personal Pro pony (Schodulo E) 6. Jointly Ownod Propony (Scho~ulo F) 7. Inler-Vivos Translcrs &. Miscellaneous Non-Probato Propony (Scho~ulo G or L) (1) (2) r.:cr.e r:C!:e:~' -' QF;::IC:AL USE ON\.Y -0 OJ :o~ ~} 0 ,.~ 0 .., : Cl. ", -l. ~ r) ~:cne ~;cne (3) (4) ~i: , '.oJ 49.005.73 ~:cr.e (5) (6) -i ;~. VI Q. (7) ~:cne B, Tobl Gross Assets 1101a1 Unos 1-7) 9, Funeral Expenses &. Acmlnistrallve Costs ISen,dul. HI (9) 10. Detts 01 Dccodent. Mortg. Liabilities. & Uens IS:M,l) (10) (a) 1:.231.99 2.163.02 49.005.72 11. Tab! OeducUons 1101>1 Unos 9 & 10) 12. Net Value of Estate (Uno! mmus Line 11) 1:], Ch.mlablc and Govemmcnlal Bequests/Soc 911:3 Trusts lor which an electIon to tax hJS nol beon made (Schedulo J) (11) (12) 17.39:.0: 31.6:0.77 (13) r.:cne (1J) 31.610.77 31.610.77 x .oJ o.oe (15) 0.00 x 0.00 .06 (16) o.oe o.ce AOORE~S See Scr,edule attacb:-d C.'s-/.2t/91 c.rE~~99 . , . "A"'l PE;:O~~St'ji":WE ...OCR€.S'5 3401 ~:or~~ F~cr.t Street H~~istuyg. ?A 17110~095C 001 r4T~ 'Iltoi) fl;I'HFarl!ll Scll..~'. 0,.,1:(. I'JH :'-ltl'~. :,.,:. Pogo 2 PA REV-H500 EX (1-97) Decedent'. Com lete Address: STREET ADDRESS 592 I..oC\lSt Lane ~csbur . PA 17055 CITY STATE ZIP Tax Payments and Credits: 1. Tox Duo (Pogo 1 Uno 18) 2. C/odllS/poymonts A. Spousol PovllflY CredA B. PrIo' poymonts C. Discounl 0.00 (1) 0.00 Tolol C,ed,ls (A + B + C) (2) 0.00 3. InteresVPenolty n applicable D. Inleres1 E. Penolty 0.00 Tolollnle..sVPonelty (0 + E) (3) 4. II line 21s grooler than I,ne 1 + IIno 3, enler Iho d,"orenco. This Is Ihe OVERPAYMENT. Chock box on Page 1 Uno 1910 requo.l a relund (4) 5. II line 1 + line 31s g..olor Ihon line 2. enler Ihe d,"ereoce. This islho TAX DUE. (5) A. Enler Ihe Inle,est on Ihe tox due. (SA) B. Enler the tolol 01 Une 5 + SA. This is the BALANCE DUE. (56) Make Cheek poVoblelo: REGISTER OF WILLS. AGEHT 0.00 0.00 0.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedenl moko 0 .onsler and: Ves No a. rotain tho use or Income oltha pfoperty transforred:, . . . . .. ., .. .. , .. ., .., , . .. , .. ,. . . ., , . . .., ~ I b. 'eloln Ihe right to designale whe sholl use Ihe propeny .on.lorred or Its Income;. . .. . ... . .... . . . .. c. relain a reversionory Inlorest; or.. . . . .. . . .... . . .. . . . . . . ... .. .. .. . . . .. ." . . . ... . . .. .. . ... d. rocaNe the promise 10f 1110 01 either payments, benefits Of caro? , . -.. .. , .. . . . . , . . , ., . .... . , . , . 2. It deolh occurred on or belore Deeomber 12. 1982. did decedent w1Ihin twO Veors preceding deolh .onster propony withoul reeoivlng edoquote considorolion? II doolh occurred ohor December 12. 1982. did decedent .onsle, propeny wilhin ono Vear 01 doolh withoUI reeoivlng odequole considerobon?.. . . . .. . . . . . . . . . . . . .. . . . . . .. .. . .. . . . . . .. .. . . . . . . . .. . . . ... 0 3. Did decedent own an "in trust fof" or payable upon doath bank account or socurity 01 his or her death? .... ................................................................ 4, Did decodent own an Individual fotiremont account, annuity. or other non-probalD property?, . - . . . , , . . . . :fit 8 ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN 72 P.S. !9116 (0) (1.1) (i) providod lor Ihe ,oducbon 01 tho tox rolo impo.od on the nel volue 01 .onslors 10 or for Ihe use ollhe surviving spouse hom 6"4 10 30/. for doles 01 doolh on 0' oher July 1. 1994 and bolore Jonuory 1. 1995, 72 P.S. !9116 (a) (1.1) (ii) providod lor tho reducbon ollho 'ole imposed on Ihe not voluo 01 .onslers to or lor Ihe use ollhe surviving spouse ~om 3'4 10 0'4 lor doles 01 doOlh on or oher Jonuory 1. 1995. The slotule does nol e,ompl a .onsler 10 a survivlng spouse Irom tOlC. and Ihe slolulOry requ"eroonlslor d,sclosure 01 ....15 and filing a tox ,oMn ore still applicable even 11 the surviving spouse Is the onlv benoficiory. FOR DATES OF DEATli ON OR AFTER JANUARY 1, 1995 -- Plo..e answer Ihelollowing quosbon bV placing on")(' in Iho appropriole space. Old tho decedent create IlNot or oImllar arrangement whIch Is oololy lor the oUlVlvlng opou..'o benem lor his or her enUre IlleUme? Yes 0 Noi9: II VOU answered Ves to Ihe obave questiOn, lhe tox on lhe trUsl or simlar OfTongeroont Is postponed unbl the death 01 the oecond spouse. 01 which bme n will be tully toxoble 01 the role(s) oppliceble to Iho ,emainder boneliclory(los). Enler the volue ollhe trUsl on Schodule J. PlII1 II. In order 10 ,emove II ~om the caiculobon ollhe lOX due In Ihis estole. You mav wish to file Schodulo 0 in order 10 mako Iho eleebon available under Section 9113. IIlho electIOn Is made. lhe trust 0' simlar orrongement Is toxed In lhe eslole ollhe firsl docedont spouso. Ihe portion of the trUsl or simlor OfTongemenl which benofits lhe surviving spouse IslOlCOd ollhe zero tox 'ole. and the remornder Is toxed OllhO rote(s) applicable to Ihe ,emainder beneficlory('es). II VOU choose to mai<e lhe oIecbon, you ....st onoch Schedule 0 10 a brooIV-fi\ed tox roturn. oIong wllh Schedule(s) K and/or M In order to sheW Ihe apportlonmenl ollhe trUsl 0' simlor anaogomont between the suMVing spouse and lhe romamdof bonorlCilU)'(los). 7 PA15002 NTF \0110 COPYllgtlt Fa''''. Sallow.f. Only, ,,,, N.lto,lnc, REV-1511EX. (1-87) COMMONWEALTH OF PENNSVLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTAT1! OF Charlie B. Byers SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FlU! NUMBER -1996-01060 _ 01 cIecedont mWlt be ITEM NO. A. FUNERAL EXPENSES: on Schedule I. DESCRIPTION AMOUNT 1 Cocklin Funeral Hare 2 ChaIriJersburg Brethren in Christ Church - Funeral Luncheon 7.760.68 800.00 B. ADMINISTRATIVE COSTS: 1. PerIonal Rop'ooenta1ive'a Cormisslon. Name 01 PllSOnal RepresenleOV.(a) SocIal Securtty Numbof(.)/EIN No. 01 POI1Onal RoprosontaOVe(a) Slroot Addr... CIty SlOte 0.00 Zip Veer(s) Cormisslon Paid: 2. 3. AnornoyFoes Nane: Mette. Evans & Woodside Fonily Ex""1lllon: (If decodenl'a address Is not tho aame IS cla/manra. aeach explanation) C1a1manl Ruth H. Byers S.ooIAdd'... 592 Locust Lane. Messiah Village CIty Mechanicsburg Stale PA Zip 17055 RoIallonshlp 01 C1a1manllo Decodenl SUIVi ving Spouse 3.000.00 3.500.00 4. Probal. Foes 57.00 0.00 0.00 54.31 60.00 5. Accountanre Foes 6. Tax Return Properor'e Foo. 7 The Sentinel - Legal Advertising 8 CUmberland Law Journal - Legal Advertising TOTAL Also enter on line 8, Roc ltulallon S (If more space Is needed. InllOf1 addlllonal ahools ollho aame aIzo) 15.231. 99 7 CPAll NTF '011' COPY'lght Forlll' 5011..,. Only, '"1 NIlcO,lnCo \. REV-Ial3 EX. (I-lln COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER Olarlie B. BYers -1996-01060 RELATIONSHIP TO DECEDENT AMOUNT OR Do Nol UsI Trusloe(s) SHARE OF ESTATE No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABlE DISTRIBUTIONS (Includa outrighl spoussl dlsll1b1lllons) 1 Ruth H. Byers 592 lDcUSt Lane Messiah Village Mechanicsburg. PA 17055 Surviving spouse 31.610.77 ENTER DOLLAR AMTS. FOR DISTRIBS. SHOWN ABOVE ON LINES IS THROUGH 17 AS APPROPRIATE ON REV 1500 COVER SHEI'T 11. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE None B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS None TOTAL OF PART 11__ ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET S 7 CPA13 NTF '0113 CopyngM Fa,m. Saltwar, Only, 1111 Nllca,lllc' (II mora SplCO Is noodod. InlOl1 additional shools 011110 sarno size) 0.00 ..; ...-... A IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION In Re: ESTATE OF CHARLIE B. BYERS, Late of Mechanicsburg, Cumberland County, Pennsylvania, deceased Estate No. 1996-01060 ORDER (7 &- Dt:.ct!'nlhr AND NOW, this....!d.- day of Nevember, 1997, on consideration of Executrix's Petition for Settlement of Wrongful Death and Survival Actions and Apportionment of Settlement Proceeds Pursuant to 20 Pa.C.S. ~3323(b), and any response thereto, it is hereby ORDERED and DECREED that Petitioner is authorized to enter into a settlement with Shawn Knepper and Edward Hess, in the gross sum of $150,000.00. It is further ORDERED and DECREED that the settlement proceeds shall be distributed as follows: 1. To the Law Offices of Mette, Evans and Woodside: $ 846.88 for reimbursement for costs $37,500.00 for counsel fees $38,346.88 - Gross Amount. 2. To the Law Offices of Mette, Evans and Woodside's escrow account, $43,713.01 pending disposition of the disputed Medicare lien 3. The remaining balance of $67,940.11 is apportioned as follows: Wrongful Death Claim Survival Claim $50,000.00 $17,940.11 4. The wrongful death claim of $50,000.00 shall be paid to the issue of the decedent as follows: (a) To: Nelson W. Byers, (b) To: Charlie B. Byers, Jr, (c) To: Ruth Ann Shelly (d) To: Ivan W. Byers son son daughter son $12,500.00 $12,500.00 $12,500.00 $12,500.00 . . IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION In He: ESTATE OF CHARLIE B. BYERS, Late of Mechanicsburg, Cumberland County, Pennsylvania, deceased Estate No. 1996-01060 EXECUTRIX'S PETITION FOR SE'ITLEMENT OF WRONGFUL DEATH AND SURVIVAL ACTIONS AND APPORTIONMENT OF SETTLEMENT PROCEEDS PURSUANT TO 20 Pa.C.S. ~3323(b) AND NOW, comes the Executors of the above-captioned Estate, Nelson W. Byers, Charlie B. Byers, Jr. and Ruth H. Byers, by and through her attorneys, Mette, Evans and Woodside, to petition this Court for approval of a settlement and apportionment of settlement proceeds pursuant to 20 Pa.C.S. ~3323(b), and in support thereof states as follows: 1. The Last Will and Testament of Charlie B. Byers, decedent, was admitted to probate by the Register of Wills of this county on December 27, 1996. A true and correct copy of the Last Will and Testament is attached hereto and made a part hereof as Exhibit "A." 2. Petitioners, Nelson W. Byers, Charlie B. Byers, Jr. and Ruth H. Byers, were duly qualified as Executors under the Will of Charlie B. Byers, deceased, on December 27, 1996. I=vhlhlt A .",..11....... ","".".." ", 1:\ ...,,,, W '. TIMOrHY S. S'ONItUIlt .noun AT UW 111 (II" 11"''''11 ,.",n lUll, CIIU'''II'''." '''' IlJOt '" I"..... LAST WILL AND TESTAMENT I, CHARLIE B. BYERS, of 2~29 Scotland Road, Chambersburg, Greene Township, Franklin County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all wills by me at any time heretofore made. FIRST. I direct that all my just debts, expenses and inheritanoe taxes shall be paid by my Executors hereinafter named, as soon as may be convenient after my death. SECOND. I give, and mixed, whatsoever she shall survive me. devise and bequeath all of my property, real, personal and wheresoever situate, to my wife, Ruth H. Byers, if THIRD. In the event my said wife, then I give, devise and bequeath all mixed, whatsoever and wheresoever situate, Ruth H. Byers, does not survive me, of my property, real, personal and as follows: (a) Three (3~) per cent to the Roxbury Holiness Camp of the Brethren in Christ Churoh, located near Roxbury, Pennsylvania; (b) Five (5~) per cent to the Gospel Tide Broadcasting Association, with offices located at 152 Lincoln Way East, Chambersburg, Pennsylvania, and if not in existence at the time, then to its suocessors to be used for the purpose of spreading the gospel; (c) Two (2~) per cent to the Brethren in Christ Church looated at the corner of Center and Reservoir Streets, Chambersburg, Pennsyl vania; (d) Five (5~) per cent to the Board for World Missions of the Brethren in Christ Church, with offioes looated at 500 South Angle Street, P. O. Box 390. Mt. Joy, Pennsylvania 17552-0390; and (e) All of the rest, residue and remainder of my property, real, personal and mixed, whatsoever and wheresoever situate, to my four (~) children, namely Nelson W. Byers, Charlie B. Byers, Jr., Ruth Ann Shelly and Ivan W. Byers, in equal shares. If anyone of my said children is not living at the time of my death, but leave children to survive him or her, then the surviving children shall divide equally the share of my deceased child. FOlJ.RTH. the age of Farmers' and If any person inherits an interest in my estate before reaChing eighteen (18) years, then for such person's estate I appoint Merchants Trust Company of Chambersburg, Chambersburg, Pennsylvania, as trustee for such minor's estate. FIFTH. I nominate, oonstitute and appoint my son, Nelson W. Byers, MY wife, Ruth H. Byers, and my son, Charlie B. Byers, Jr., as Exeoutors or this my Last Will and Testament, and my said Executors shall not be required to give bond in the settlement of my estate. IN WITNESS WHEREOF, day of -.lANUA-fl"Y I have hereunto set my hand and saal, this .:;/~ , 1988. ~J :..I!!.{ CHARLIE B. BYER (SEAL) Signed, sealed, published and declared by the Testator, CHARLIE B. BYERS, as and for his Last Will and Testament, in the presenoe of us, who have at his request, signed this Will as witnesses, in the presenoe of the Testator, CHARLIE B. BYERS, and or each other. WITNESS: " -Yir t!. '\..-lIU;~~~trl/)l' jf/! tlAA ~ WITNESS: TIMOTHY s. S'OHuwa ,noun Af LA. " I CII&.IIUIU..'lun IUI. C"UI....U.., '''' 17101 fn ........ , -2- I=vhlhlt R ~ ...'.r. M~ .~. . ,:,....::.; / 0"~ . I....'. . 'f" '. . J xx. I'lf!ATO(l'NUloV!KIl' 0001260 COMMONWEALTH OF PENNSYI. VANIA POLICE ACCIDEf{T REPORT I\lPORTAllLf HOH.l\trcATIollLE ACCIDENT ':: ....'f.. f. , ,,\: .........., . ..., ,. ~ :..:,"!O," .1, . .,l'~~ ..''''l' J' PUHlOTUllCllLV (0" .1,',' . ~ . LO':AT10N~..::~~"~.';)-; li~'!' ',~: . 24,T'f'PE U HlOHWAV canRCl INTERSECTING ROAD: 2OcOOHlV a' WHCIPAUTY PRINCIPAL ROADWAY INFORMA TION - . 2.IiTA IOHI . PN;CINCT . . . 22 STnHT ..- 2:1. SPLEU \,0.111 ~ .~:.. 'L.UY . R N~ lU ACCIDENT INFORMATION ._ ,o.~Y K 21 !YP $S HlGHWAV can RCl IF NOT A T INTERSECTION: 26 HCUTE hQ. OR STAfEl N_ 21 SPUD llU1T .. 'DATt \ i:~~:~:';i '~~'" ,'~ I.Al:GU 'I. DAlE II. IIoEOf DAV ,:J,.,ttLLf,O \2. NVUe.:A Cf'~ns ...PRIV.PF\OP. ACCCEIIT V ,1. VEHICle llAlolIoGE o.NONE lIOr3 '.LIGIlT 2.IoIIOCfIl'TE 3. SEVERE ,a, Pi ;13. DISTANCE SEW FROJSlTE llE....o;uREO 0 O @TRAFF;C C(lHTtlOl DEVICE , .. . ItUJRED Fl 0_ ME RSECTIIlCI o EST....TtD PRIlClPAl. o ,I. OlIlVEHIClE HAVI TO DC RElDo'EIl flOlnEsUNl" 1.IllT3 .. :V~ NO .'. . .'I''lf . '....',. ':'; UNIT.2 lnin. II. UAliRW,S 36 \lAU.'" Y N 31. PAAt(ED' PlA 1 E 39. PA tllLE OR OJl.Of STATEVN "'O~R . 0' -,..' ~;-;~: ~;~;"..:.:'~.: ., CWNER A[X)RESS ,,"C'Il.STA1E IlirCOOE .3 yEAR --- --..- u.......I\( .. .., 0 o. '--0 \' H UN1C "q. EtiC\.f ...- a^'NER.IIi~,r !t2 T~Vil SPEC'D .~ UO~\. -tN01 eoov !YI'€ ")600' . !yO[ ~=WP"Cl .-- . ---'--. ----. ----- G. tOtr&l ~EU vONO .__ _,_ -.--.- -; 6; CARRE.R . .___J ~~niii"n ....llmrss .i,lfciTV.S1ATt" . I'PtoO! ;0 115001. l!!JifII-- QCN>IC', :'or;,.ri~ ULP-, /",,"'I,'Cl'1 .,.-. (I. CAntiER AllllRESS .. citY.5TA1~ UIPCOOE \PlX:i -io USOO1' ,,-ovWn ' (ffJ.:m-- CONfIO ;; ilflf,,~d.~ II" ,"^, ii';Ki(7 ,L1l1l]"II,Q A>.lE~ ,.~~ ~~T~~.'.:~.'.- II ,"'tl[)Cl,I', f.\fllt:flVtl!'. ~, . - -'\ruC,.. . j;'ovWU . ..- . . ~ .1 ;..i,)~1 i1fll"ziili \ , [J II l.IulI.IJ rElll1n rU'lIUfUIWAt r.I,ff.1Y I~l":.' n CAllr.u Y'YPf \ ,;ew Af1IQ,IC, .....I.v.lrIH\I~ rill: 0375618 Ill, II, AlpoNlHlllOS AOEHC'f 1I.'-DCA&. FACUn lC>>LlIHf04WA'WH . cor F INCIDENT .: CCIDENT DA E: . ,'. ,. MlORE 55 IVl.'N''f'- fo/' , 1/ ~ jJ 7/7. ~',:f:i 17J'.../J._ 'f. II LLUUU.'.IION (dJ &AIHER I 0 I @IIOAllSUlYoICC[2] .. OIAOfW,l . 14 rCNtlSTLVAHLA ~::U')Q. DEStRCr III' APPlICA8C.E; , ./ A .LU-.. as SCIUP1DHJ UN4AGLOPROPERI'r' 5EE. 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"'-I'" ..- 1'^r,F.:3 - ... . cEHYEn;i)rilthlMWAyiAfiilY' 0375618 r::' ::.:~ \~ nnn1-~G3 I.;V!!~.\jq'B @ C~THOFPENNSYLVANIA ::{., "t!lf' . PAR CONTINUATION SHEET i.,' (.x)Nnn1tlll\/SUY6lttElS REI'Ol1lMlLE ~HOHnrI'ORTAlLI 0 '. . J~ -~.-<'- , '> A. .., 1 :l r~~HI J'lr~ /, q jqt, Fr'/,~~v~-q .; IIIOH H'OlWA"OH' UIlE lM/UY fJ lIt:tl fOIl WIU ..\. " . C 0 E F D NAIoE .OORE8& ., or . .' ",'" rlIfO'fua....V .'-:1 11lU~~:;'AL ::l"..s- .1 ~ I J K l .. " I . , :! \'. t.:, ' -, - 11.~~: :J::. J/1J';~ /~/.....LJH -.. "M~~ .,,;, ;...://:-: -..., .'. li"Jj :..('. ';,.-/1./1 A .</JjJj)/j:M":/J~1 : ;.0.':\: :~; _ . ,A ,_'" ~ d.l/ ":iJ.'_. ", : : ~ /i.",r#/: ~",.!r', J<t,I ", ,,,C -;-;".. ,,;': : :: : . :",: ,G!:I: -"'.. ,,' Av -~",.r"IJ -;-. "':; (': : Ijo;~ ~ Wr:(.J/~""" AVI -1":-,/ ~LU~ .IL -,. ~".7J : : ' , -;_ :_.;._~ Ll."?" -___. 4t'.1-/1;::' At.-' ~ lLJ,u..'.t /./i-,.fl.: : . . 711; V~<: 7';' 7},,//- ~~..,-.I1'1. ~-// -, Ad, JJAp ~ ... -: 7"'7~: "'I'A..,;'C'. :~: "J ".J/lII;'I) . : : ..; .: t{IlI'T}fI~: i.l)I;/JIJA/.'/r.P /AJ/:::O~ IIA--~JJ' .A - :: ":.', : ' . ' . . -Jh.l~<t:l::...r ...,.r-.......,I? ." .' /'. ,7"/1 '1In.li/l :, n 2J'l" /I';;" --.4 :d t: I') J'l.l J /jjJJ),i / : : . , ; : : : , : : : : : : : . : .. : : : ' -- ...-;.- _._~-- ..- ..---- ~--~~...~--:.- , ~1Il U'.:"""~~.~~_.__. ___ Ull" ---- Utol1 ~: 9' I'll;:':.'" I :<iillY1.. - ~J'~SIIl rs-6 10 TESI ...."r.''[ '9', J.,rciiWill USI f-/U.SI D fEfUSE :"~ '-, liSf UNlf 1 0.__ ._."'0 Cl loNIC UNII 2 . - .----- .. .u4!lCtll'W-'l I wo SI.CllUHNUMUcRHIUNLYIt CH^HOtUl 1\. hTC Pl.)"PE .......lESI o 0 --- _H DO _..---~~ ~ltSUL1S 0 NO resl .. IINE~nu^1'OI1 o REfUSE r.0MI'I Elf , 0__"10 0 UNK VIS ~.IO 0 -. .- ..-- CENT[IlFUlI n:nlfN.\"tSAfE1't -- ---.- ----..---.--- Po\GE' ..s: I )..." " L _"J,lINHERITANCE TAX RETURN " RESIDENT DECEDENT \ (TO BE FILED IN DUPLICATE WITH REGISTER OF WILLS) DECEDENT$ NAME (LA$T. r1R$t. AND MIDDLE INITIAL) I err" Charl,ie B. $OCIAL $ECURITY NUMDER DATE OF DEATt! 175-03-0573 1~/1?/96 I, Al'l'lICA 11I./ 'iUnVIVINO 'Wl)IJ'jl"j NAMl II A'i!. 1It";1 ANn Mln Il r IWllAlI [lyers, RUUl II. 1. Onginol Rohlll1 o 40, FutUlu InlulU:.!1 CnrnplUllw:iO (1m dalU5 01 dOlllh dl1ur 12.12.02) lB 6. Docodonl Dlod Testato 0 7. DecoduIl1 Mnmllllnod a living Trust (Attoch copy 01 W,III (Attach copy 01 TIlI.I) AU. CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAIL'NG ADDRESS Jeffrey A. Emico, Esquire 3401 N. Front Street TELEPHONE NUMBER P.O. Box 5950 (717) 232-5000 Harrisburg, PA 17110-0950 1. Rool E.lolo (Schodulo A) ( 1 ) None 2. Slocks and Bonds (Schodulo B) ( 2 ) None 3, Closoly Hold SIOck/POIlnOlship InlOlosl (Sch. C) ( 3 ) None 4. Mo~gogos ond NolOS Rocoivoblo (Schodulo D) ( 4 ) None 5. Ca.h, Bank Doposils & Miscollonoous POIsonal ( 5 ) 5, BOO. 00 Proporty (Schodulo E) 6. Jointly Ownod Proporty (SchodulO F) 7. Trans!ors (Schodulo G) (Schodulo L) 6. Tolal Gross Assols (Iolal Unos 1-7) 9, Funeral Expensos. Adminlstrativo CoslS, Miscollanoous E.ponsos (Schodulo H) 10. DobIS, Mo~gago Uobililios, Uon. (Schodulo I) 11. Tolal Doduclions (Iolal Uno. 9 & 10) 12. Not Valuo 01 Eslalo (Uno 6 mnus Uno 11) 13. ChOlilablo and Govornmonlol Boquosls (Schodulo J) 20, II Uno 191s groater than Uno 18. onler tho dillOlonco on Uno 20. This Is Iho OVERPAYMENT. A. Chock hare" au ara ro uasUn a refund 01 our ova ymenL 21. II Uno 1B Is groator than Uno 19, ontor tho dllfOlonco on Uno 21. This is tho TAX DUE. A. Enlor tho Inlerest on tho balance duo on Uno 21A, B. Enlo. Iho 10101 01 Uno 21 and 21A on Uno 21B. This iSlho BAlANCE DUE. Maka Check Payabloto: Register 01 Wills, Agent .. .. BE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 ANO TO RECHECK MATH" .. UndOl ponal"os 01 porjury. I doclOlO Ihall hovo o.amnod ""s rolurn. including accompo"y,ng scllodulos ond slolomonls. and 10 Iho bosl 01 my knowlodgo and boliol.l1 islruo. conocl and complolo. I doclaro Ihol oil roal oslalo has boon loperlod all'uo markol voluo, Docloral'on 01 proparor olhor Ihan Iho pOlsonal fO fosontativo Is based on all Information of which pfCparcr has any knowlodgo. SIGNAl,URE OF PERSON RESPONSIBLE FOR FILING RETURN ADORE 55 ~ ~ . 'YI c I..V See Schedule attached SiaN OF P ES[NIATlV[ ADDRESS f /', , 'I /\ I " I , IHIJ.I!lllul'.I'-lIotl 1;1 I, .-i. <." CI1MMllNWI o\l III 01 1'1 NNr,'1IIJANIA 011'0\1I1MI NI 01 IHVI NUl 1)( I'LlIlIlIonl lIA"'H~,lIl1l\ll,I'^ 1"11 IHllll DECEDENT CHECK APPRO- PRIATE BLOCKS o 4. Umitod Estato CORRES- PONDENT RECAPIT - UIATION TAX COMPUTA- TION 14. Nol Valuo Sub oct 10 Tax (Uno 12 minus Uno 13) 15, Spousal Transtelstter dales 01 duth allel6-30-94). Sn Ins!ruttlonstor Applltable Plften!age on Page 2. (l"cliJde values from Schedule K.ar Schedul. M.) 16, Amount 01 Uno 14 taxablo at 6% folD (Includo valuostrom Schodulo K 01 Schodulo M,) 11. Amount 01 Uno 14taxablo at 15% fato (Includo valuos from Schodulo K or Schodulo M.) 16. Principal lax duo (Add lax trom Unos15. 16 and 17.) 19. Crodits Spousal Poverty Clldl! Prior Payments + 0 . 00 + FOil DATES OF DEATIt AFTEIl121JI/91 ClfECK If ERE IF A SPOUSAL [1 POVEIlTV CREDIT IS ClAIMED FILE NUMBER (I ,/ 010hO NUMU[Il COUNfY conE 1'1')(, YEAI1 OECEDENI'S COMPLETE ADDRESS I}l)/. I/X~\1ril. J,dll(~ DAtE or Dllntf M.x:l1dll i c;burq. I'A 1'/0',', O?/11/1')OH CU\I\lly CUlrUx,rlilllCl $OCIAL $ECUHlTY NUMDER AMOUNT RECEIVED ($E[ INSTRUCTIONS) 1'1~, 17.0H7.4 (11.~95.01) BuppllllttUlllul Rutllll1 J. Rultlllllldnr Rulull1 Iltl!t.l~'nllldUlh(l11U111111.1J-11I Dr. Fodoral Estnlo TalC AulUllt RuqUllod o B. Tolal NU01bUl of Salo Doposit BoXU9 ( G) ( 7) None None 5.BOO.00 (6 ) (9) 15,231. 99 (10) 2,163.02 17,395.01 (11,595.01) None (11) (12) (13) (14) (15) (11. 595. on .QQ... = (16) 0.00. .06 = (17) 0.00. .15 = (16) Discount lnlorost (11.595.01) 0.00 0.00 0.00 0.00 (19) (20) 0.00 (21) (21A) (21B) 0.00 0.00 0.00 OA~ ((lff7 o~r/~' 1'191 NTFfle19 CapYllohtFelml Sof1'1lf.tll Only. 1994 Nelca, Inc, N9otPAOOl 3401 North Front Street Harrisburg, PA 17110-0950 PA REV-l500 EX (7-D4) rogu2 Act "48 01 1994 provides lor the reducllon 01 the lax rates Imposed on the net value 01 transfers to or lor tho use 01 the spouse. Tho rates as prescribed by tho stalule will be: . 3% (.03) will be applicable lor estates of decedents dying on or aller 7/1/94 and boforo 1/1/96 . 2% (.02) will be applicable lor estatos 01 decedonts dying on or aller 1/1/96 and before 1/1/97 . 1% (.01) will be applicable lor esta10s 01 decedonts dying on or aller 1/1/97 and bofore 1/1/98 . spousaltranslers occurring on or aller 1/1/98 will be oxempt Irom Inherllance tax. PLEASE ANSWER THE FOllOWING QUESTIONS BY p~CING A CHECK MARK (oJ) IN THE APPROPRIATE BLOCKS. YES NO 1. Old docodonl mal<o a nan.lor and: a. rolaln tho uso or Incomo 01 tho proporty Iron.lonod, . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .. . .. . . . . . .. . .. . . . X b. rolaln Iho rlghllo do.lgnalo who .hall uso Iho proporty nan.lonod or 11.lncomo.. . . . . . . . . . . . . . .. . . . .. .. . . . . .. . . . . . . . . .. . . . X c. rOlalnarovorslomUYlnIOrosl;Or................................................................................ X d. rocolvo tho promiso lor 1110 01 ollhor paymonl., bonolll. or caro?.. . .. .. . . . . . .. . . . . . . . . . . . . . . . . . . . . .. . .. . . .. . . .. . . .. . .. . X 2. II doalh oceunod on or boloro Docombor 12. 1982. did docodonl wilhin !Wo yoars procodlng d8aU,lran.lor proporty wilhout rocolving adoqualo consldorallon? II doath oceunod allor Docombor 12. 1982. did docodonllran.lor proporty wilhln ono yoar 01 doalh withoul rocelving adoqualo consldoration? .. . .. . . . . .. . .. . . .. . . . . . . . .. .. . . .. .. . .. . . . . . . . . . . . . .. . . . . .. . . .. . .. . . . .. .. . . . . . .. X 3. Old docodonl own an 'In 1rU.llo( bank accounlal hi. or hor doalh? . . . . . . .. . . . .. . . . .. .. . . . . . . . . .. . . . .. . .. .. . . . . .. .. .. . .. . X IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FilE IT AS PART OF THE RETURN. PA1SOO2 NTF euo COP'ffloht Forms Sot1wue Only, ,99. N.lco,lnc.. N94PA002 .r- \ , R[V-l~t1 [11.1 "-11) SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES Pl.... Print or Typ. COMMONWEAL TU OF rENN~VlVANIA INttERlfANCE fAIl.R[fUnN "ESIOENf DECEOENT FILE NUMBER -1996-01060 ESTATE OF Charlie B. ers ITEM NO. A. Fun.ral Expon...: DESCRIPTION AMOUNT 7,760.6B BOO.OO 1 cocklin Funeral Hare 2 Chambersburg Brethren in Christ Church - Funeral Luncheon B. Admlnl.traUV. Co.Is: 0.00 1. P....ns! Rep,o..nl.tivo Convnlsslons Socls! Socu,Uy Number 01 POISOns! Roprosonlalivo: Yoar Convnlsslons paid 2. Anornoy Foos Narre: M:!tte, Evans & Woodside 3. FomIly Exomption Cls!manl Ruth H. Byers Rotationshlp surviving Spouse 3,000.00 3,500.00 Add,... 01 Clalmanl al docodonl's doalh 5nool Add,... 592 LocUst Lane, M:!ssiah Village City Mechanicsburg 51alo PA Zip Codo 17055 57.00 4. Probalo Foos C. Mlsc.llaneou. Expon....: 54.31 1 The sentinel - Legal Advertising 2 cumberland LaW Journal - Legal Advertising 60.00 TOTAL (Also onlo' on IIno 9. Rocapllulalionl $ (II more spac.'. needed, In..rt addlllonal .h..1s 01 sam. .Iz..) 15,231.99 PA15111 NT' ".. Copyright Fo,mI5oltw&t. Only, 'lI!I4 N.lco,lnc. Ni4PA'11 "[~."1J Ell' (2.171 COMMONWEALTH OF PENNSYLVANIA INHERITAHCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER Charlie B. ITEM ND. -1996-01060 AMOUNT OR SHARE OF ESTATE ers NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP A. T..ablo 8oquosls: 1 Ruth H. Byers 592 Locust Lane Messiah Village Mechanicsburg. PA 17055 surviving spouse (11.595.01) ITEM NO. NAME AND ADDRESS OF BENEFICIARV AMOUNT OR SHARE OF ESTATE B. Charllablo and Go.ornmanla! 8oqUDS1S: None TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also onlor on Iino 13. Roc ilulation) (II more apace la needed, Insert .ddl~on.1 sheets 01 ..me size) $ PA1S131 NTF ",.A Copyright Form I Sollw". Only, 1ut4 Nllto,lnt. NI4PA131 0.00 R,EV-1G49 EX+ (BI95) SCHEDULE 0 TRANSFERS TO SURVIVING SPOUSE COMMONWEAL T H OF PENNSVLVANIA INHERITANCE fA'" R(TURN RESIDENT DECEDENT FII. Numb.r Charlie B. ers -1996-01060 PART A: Enlor tho doscription ond valllo 01 alllnloro.", boll. la,ablll and non_la,ablll.lOgardlo," 01 location. (nol 01 dodllclions) which pas. 10 1110 docodoor. .urviving 'pOllSO by wllI.lnloslacy. oporation 01 law. or olhorwl9o, Doscr! tion 011101115 Amounl 1 1 surviving spouse's share of residue of estate. (11,595.01) ESTATE OF PIlJl A Tolol: EnlOf llI1lOunlohown on Iho ,oca Ilulation .hool in Iho Dee.denl In!onnaUon S.eUon. (11,595.01) Election To subJect Property To Tax Under Section 2113(A) As A Taxable Transfer By this Decedent. II a \rU.t or slmllar arrangomenl moolS Iho foqulromenl. olsoction 2113(A), and: a. Tho \rUst or slmllar ar,angomenlls lIoled on Schodlllo O. and b. The voluo of thO \rUol or slmllar arrangomentlo onlorod In wholo or In pllJl a. an assel on Schodulo O. then lho lIanoloror'o porsonol ,opresentativo may .pocllicolly Idonbly Iho lruot (oil or a "actional portion or porcontago) 10 be Included In the oloction 10 havo such lIuot or .Imllar proporty 1I0alod ao ataxablo lIanslor In thl. ootalo. III... than Iho ontiro valuo ollho \rU.I 0' olmilar property ,.Includod a. a t""ablo lIanslor on Schodulo O. tho porsonol ,oprosenlallvo .holl be consldorod to havo mado tho elocbon only a.to a I,action 01 tbe \rUot or olmilar arrangement. Tho numeralor 01 thlo Iraction I. oqual to Ihe amounl 01 tho lIuot or olmilar arrangment Includod as a laxablo asset on Schodule O. The donomlnalo' 10 oquollO Iho 10101 valuo ollho truol or slmllar arrangoment. ELECTION: Do you .I.el under SeeUon 2113(A) 10 treal.. a Ia,abl. lranof.r In this a.lal. all or a porllon of a trusl or similar arrangem.nl erealed for tha sol. us. of this d.cedenl's survIVing spou.e durtng th. surviving spou.... .nUr. \lfeUm.? YES 0 NO ~ Slgnalur. Dale Nol.: If tha .leeUon Ilea 10 mora than on. trusl or sImilar arran menl. then a s aral. fonn musl b. sl ned and flied. Part B: Entor the doscrlption and voluo 01 alllnloroolo, both taxeblo and non-taxable. ,egardloSS 01 location, (nel 01 doduclion.) which pass to tho docodenl's surviving opouso lor which a Secllon 2113 (A) elocllon I. being made. "",,,unt Doserl tion 01 1101115 1 None PIlJIBTolal 0.00 PA16491 NT' ,," copynQht FilII'" SoH"""'. Only. ,99!1 Nelco,lnt. N9SPA4lJl /5- /5()-/ COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE BUREAU OF INDIVIDUAL TAXES IHII(AlTiNeI 1A1 DiviSION (11 Pl. ,'.GIIDl "."'AISIURC. PA 111:e'01t01 NeT ICE OF INHERITAHCE TAX APPRAISEHEHT, AllOWANCE OR DISAllOWANCE OF OEDUCTIOHS AND ASSESSNEHT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUHBER COUNTY ACN 12-15-97 BYERS 12-17-96 21 96-1060 CUHBERLANO 101 JEFFREV A ERNICO 3401 N FRONT ST PO BOX 5950 HBG ESQ PA 17110 ...aunt R...U hd ,I '- I~ I~~~ Il..;hl II .', III-I" CHARLI E B HAKE CHECK PAVABLE AND REHIT PAYHENT TO: REGISTER OF WILLS CUHBERLANO CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR VOUR RECORDS ~ iiEV:iS'4i-EX--jiFP--fo'F97Y-NOYicE--OF-YNHEiiiTANCE-YAX-i\-PpiiiiisEHENi'-;-,\i.'i"liwANCE-b-Ii-------------nn DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF BVERS CHARLIE B FILE NO. 21 96-1060 ACN 101 DATE 12-15-97 If an assessment was issued previously, lines 14, 15 and/Dr 16, 17 and 18 will reflect figures that include the total of abh returns assessed tD date. ASSESSHENT OF TAX: 15. ...aunt of Line 14 at Spousal ~.t. CIS) 16. .Ilount of lina 14 taxable at Lin..I/Cla.1 A rat. (16) 17. A.aunt of lina 14 taxable at Collateral/Cla.s 8 rat. (17) 18. PrIncIpal rax Du. TAX RETURN WAS: (X I ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST . SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..I Estat. (Schedule A) 2. Stocks and Bonds (Schedula 8) 3. Closely Hald stock/PartnershIp Intarast (Schedul. C) 4, Hortg.gas/Not.. Receivable (Schedule OJ 5. Ca.h/Bank Deposits/Hisc. Parsonal Property (Schedule E) 6, Jointly Owned Property CSchedule fJ 7. Trensfers CSchedula G) 8. Total Asset, APPROVED DEDUCTIONS AND EXEHPTIONS: 9, funeral Expenses/Ad.. Costs/Hisc. Expenses (Schedule H) 10. Debts/Hortgaga Liabilitie./Liens CSchedule I) 11. Total Deduction, 12. Hat Value of Tax Return 13. Charitable/Govern.ental Bequests; Hon-elected 9113 Trusts 14. Nat Value of Estate Subject to Tax NOTE: TAX CREDITS: PAYNENT DATE RECEIPT NUNDER DISCOUNT (+1 INTEREST/PEN PAID I-I ( ) CHANGED III 121 131 141 ISI 1&1 17l .00 .00 .00 .00 5.800.00 .00 .00 (BI HOTE: To insure proper cradit to your account, sub. it tha uppar portion of this for. with your tax pay.ant. 5.800.00 17.~q.; 01 11.595.01- .00 11.595.01- .00 .00 .00 .00 .00 .00 .00 .00 . IF PAID AFTER aATE INDICATED. SEE REVERSE FOR CALCULATION OF AOelTIONAl INTEREST. ( IF TOTAL DUE IS lESS THAN $1, Ne PAYNE NT IS REQUIRED. IF TOTAL DUE IS REflECTED AS A "CREDIT" ICRI, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE eF THIS FORN FOR INSTRUCTIONS. I 191 1101 15,231. 99 2.163.02 1111 1121 1131 1141 (Sch.duh J I .00 X .00= .00 X .06= .00 X .15= (18) ANeUNT PAID I TOTAL TAX CREDIT \ BALANCE OF TAX DUEl INTEREST AND PEN. TOTAL DUE RESERVATION I PURPOSE Of' NOTICE: PAYMENT: REflJr(D (CA): E,t.tl' of dlCldent. dying on or be for. Olc..ber 12. 1'12 -~ If any future Int.rl,t In th. e,tat. I, transferred In po,.e.,lon or .nJoY.lnt to Cle., B (colleter.l) benaflclarla' of the decedant after thl explr.tlon of any e,t.t. for Ilf. or for ye.r" the Co..onvealth hlr.by e.pre"ly re"fve. the right to appral,e and a"." tran,f.r Inh.rltance 'a.., at the lawful CI." B Icoll.t.ral) rate on any such future Int.re,t. To fulfill the requlre.ent' of S.ctlon 21~0 of the Inhlrltance and E,tat. Ta. Act, Act 21 of 199~. 172 P.S, Sac lion 911,0). Detach the top portion of thl. Notice and ,ub.lt vlth your pay.ent to the Regl,t.r of Will. printed on the rev.r.. ,Ida. u"ak. chack or .oney ordlr payable to: REGISTER OF MILLS, AGENT A rafund of a ta. cradlt, which wa' not requ..ted on the Ta. Return, .ay be reque.tld by coaplatlng an "Application for Rafund of Pennlylvanla Inheritance and E,t.te fa." IREV-Illl). Application, ar. avallabl. .t the Office of the Regl,t.r of WIll.. any of the 2l A.venue District OffIce" or by c.lllng the ,pacl.l 2~-hour an,w.rlng ,.rvlcl ~berl for fora, ordering: In Pennsylvania 1-100-]62-Z0~0. out. Ide Pennsylvanl. and within loc.1 Harrllburg ara. (717) 717-1094, TOO' (717) 77Z-ZZ~Z (Haarlng lapalr.d Only). OIJECTIONS: Any p.rty In Int.r..t not s.tl.flad with th. appralse.ent. allowance or dl,.llowanca of dedUction., or a"e.,.ant of t.. (Including dl.count or Intar.st) a. shown on thl, Hotlce .ust obJ.ct within 'I.ty (60) day, of racalpt of this Hollel byl AO'UN ISTRATJYE CORRECTIONS: DISCOUNT: PEN"'l TYI INTEREST: --wrltt.n prot.st to th. PA Depart.ant of Ravenue, Board of Appeal., D.pt. ZIIOZl, Harrl'burg, PA 17121-1021, OR .-.Iactlon to hay. the ..tter dat.ralned at .udlt of tha account of tha personal rlpra,ent.tlve. OR --app.al to tha Orphan" Court. Factu.l .rror, dl,cov.r.d on this .I......nt .hould b. addras..d In writing to: PA Oep.rt.ent of R.v.nue, Bureau of Individual T...., AfTNI Post A.se...ent R.vlew unit, aept. 210601, Harrl.burg. PA 171ZI-0601 Phona (711) 111-6~OS. Se. pag. S of the bookl.t "Instructions for I~rltance T.. R.turn for a R..ld.nt D.c.dent" IREV-IS01) for an ..plan.tlon of adalnl,tr.tlv.ly correctabla .rror.. If any ta. due I, p.ld within thrl. Il) calendar aonth, after the dacedent., death, a five percent (SX) dl,count of the ta. paid I. allowad. The IS% t.. aan.sty non-partlclp.tlon penalty I, co.puted on the total of the ta. and Intere,t .,se..ed, and not paid beforl January II, 1996, the flr,t day after thl end of the ta. aane.ty plrlod. Thl. non-participation penalty I, appealable In th. .a.. .ann.r and In the the .... tl.e period a, you would appeal the ta. and Int.rest that ha' baen a,...,.d ., Indlc.t.d on this notlc.. Int.ra.t I' charged b.glnnlng with flr.t day of dellnquancy. or nlna (9) .onth' and ona (1) day fro. th. data of d..th, to the d~te of pay.ant. T.... which baca.e dlllnquant blfore January I, 1912 blar Int.rl,t .t th. rata of .Ix 16~) p.rclnt p.r annua calculat.d at a dally r.t. of .00016~. All ta... which blca.. dlllnqu.nl on and aftar January I, 191Z will bear Int.re.t at a ratl which viii vary frD. cellndar y.ar to calendar y..r with that rat. announc.d by th. PA aapart.lnt of Ravlnul. Thl applicable Intarl.t rat.s for 1911 through 1991 arl: '2.!r Interlst Aate Dally Inter.,t Factor !!!!" Interl.t Allt. Dally Int.rest Factor lU2 ZU .0OO!i41 1987 OX .OOOZU 1'13 16;( .000~38 1911-1991 11~ .000501 191~ 11~ .000301 1992 OX .00021,7 IUS UX ,OOO5!i6 19qJ-1991, n .000192 1916 lOX .00OZ7~ 199!i-1991 OX .00021,7 --Intar.st 11 calculatad .. follow,: INTEREST = aALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X eAILY INTEREST FACTOR .-Any Notice Is,uld afllr the tax baco.I' delinquent will reflect an lnllr.st calculation to flft.en (IS) day. bayond the data of th. .,sls,..nt. If pay.ant I, .ade aftar thl Intarlst co.pulatlon date shown on the Notlca, additional Intlra,t au.t be calculated. \ /5/.5fJ./ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INttCAITlHC[ UX DIVISION DEPt. zA06G1 .U....nUSBURC, Pi 17IZB~a6D1 NOTICE OF INIIERITANCE TAX APPRAISEHENT, ALLOWANCE OR OISALLOWANCE OF OEDUCTIONS AND ASSESSHENT OF TAX JEFFRVE A ERNICO 3401 N FRONT ST PO BOX 5950 HARRISBURG DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-17-1998 8VERS 12-17-1996 21 96-1060 CUMBERLAND 101 Allount Re..itted PA 17110 ~* .,,-IUI ..." lit.'" CHAR LI E B MAKE CHECK PAYABLE AND REMIT PAVMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ifEv:i!;4i-Ex-"FP-fji9':ij:fi-iiiiricE--oj:-YNHEilii'ANCE-YAiC"AppRAisEHiiir-;-"iDiwANcE-oli----------m---- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BVERS CHARLIE B FILE NO. 21 96-1060 ACN 101 DATE 08-17-1998 TAX RETURN WAS' ( I ACCEPTED AS FILEO ( XI CHANGED SEE ATTACHED NOTICE NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17 and 18 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Aeaunt of Lin. 14 et Spousal rata (5) 43,205.78 X .00= .00 16. AIIount of Lin. 14 taxablo at Lin.al/Closs A rata U61 .00 x' 06= .00 17. Aeaunt of Line 14 taxablo at Collateral/Closs B rate U71 .00 X .15= .00 18. Principal Tax Dua U81 .00 TAX CREDITS: PAYHENT DATE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN 1. Real Estate (Schedule Al (11 2. stocks and Bonds (Schedule OJ (2) 3. Closely Held stock/Partnership Interest (Schedule C) (3) 4. Hortg.gas/Nota. Receivable (Schedule OJ (4) 5. Cash/Bank Deposits/HIsc. Personal Property (Schedule E) (5) 6. Jointly OWned Property (Schedule F) (6) 7. Transfers (Schedule OJ (7) 8. Total Assets NO. 01 .00 .00 .00 .00 43,205.78 .00 .00 (81 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. funeral Expenses/Ad... Costs/Hisc. Expenses (Schedule H) (9) 10. Dabts/Hortgaga Llabllltlas/Llens (Schadule I) (101 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmantal Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax .00 .00 Ull 1121 U31 (141 RECEIPT HUHBER DISCOUNT (+1 INTEREST/PEN PAID (-) AHOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE NOTE: To insure proper credit to your account, submit the upper portion of this fora with your tax paYllent. 43,205.78 nn 43,205.78 .00 31.610.77 .00 .00 .00 .00 . If PAID AFTER DATE INDICATED, SEE REVERSE feR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, HO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU HAY BE DUE A REFUHO. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIOHS.I , RESERVATJOth E,t.t.. 0' decadant. dyIng on at bafor. Oec.-ber 12, 19!2 .. If any future Int.t..t In the a.t,t. 1. transfarred in po.....lon or ~joy.ent to CI... a leolla'at.l) baneflcl.rl.. of t~ d~~enl a,tar the axplratlon o' any .,tet. for 11f. or for y..r., the C~..lth hereby a.pt..,ly t".tV" the right to apprai" and a..... transf.r Inheritance Ta.a. at the lawful CI... I (collateral) rata on any luch future 1nt.r..t. PURPOSEill' MOnCEI To fulflll the requlr..ents of Section 2140 of the Jnh.rltanca and Estata lax Act. Act 21 of 1995. (72 P.S. Section 9141). PAYttEHTI o.taeh the top portIon of thl, Hotlce and subalt wIth your p.~ant to the Raglstar of Will. prInted on the rever.. ,Ida. .-Kek. check or 80011Y order payable to: REGISTER or MILLS, AGENT REFlIID (CRll A r.fund of . tax credit. which va. not reque.tad on the lax Return, aay b. r.que.ted by co~letlng an ~Appllcatlon for Refund of Penn.ylvanla Inh.rltanc. and E.tat. 'ax~ (REV~1313). Application. ar. avallabl. at the Offlc. of the Ragl.t.r of Will., any of the 23 R.venue DI.trlct Offlc.., or by calling the .peclal 2~~hoUr an.w.rlng .ervlce ~.r' for for.. ordering: In Penn.ylvanla 1.800~362~2050, out.ld. Penn'Ylvanla and within local Harrisburg .r.a (717) 787.809~, TOOl (717) 772.2252 (Hearing I~alrad Only). OBJECTIONS: Any party In Int.r..t not satl.fl.d with th. appral....nt, .llowanc. or dl.allowanc. of deduction., or a.......nt of tax (Including dl.count or Int.r..t) a. .hown on thl. Notice .u.t obj.ct within .Ixty (60) day. of r.celpt of this Notice by: ..wrltten prot..t to the PA Depart..nt of Rev8nU.. Board of App.al., D.pt. 281021, Harrl.burg, PA 17128.1021, OR ...I.ctlon to have the .att.r d.t.r.lned at audit of the account of the p.r.onal r.pr..entatlv., OR ..appe.l to the Orphan.. Court. ANtIN ISTRATlYE CORRECTIONS: Factual error. dl.covered on thl. ........nt .hoUld b. addr....d In wrIting to: PA Depart.ent of Revenu., Bur.au of Individual tax.., ATTN: Po.t A.......nt R.vl.w unit, Dept. 280601, Harrl.burg, PA 17128.0601 Phon. (717) 781.6505. See p.g. 5 of the bookl.t ~In.tructlons for Inh.rltanc. Tax R.turn for a R..ld.nt Dec.dent~ (REV~15Dl) for an .xplanatlon of .~lnl.tratlv.lY corr.ctabl. .rror.. DISCOlJtT: If any tax due Is p.ld within thr.. (3) c.l.ndar ~th. aft.r the dec.d.nt'. d.ath, a flv. p.rcent (SX) dl.count of the tax paid I. allow.d. PENAL TV: The ISX tax ..ne.ty non.partlclpatlon p.nalty I. coaputed on the tot.l of the tax and Int.r..t .......d, and not paid bafor. January 18, 1996, the flr.t day aft.r the end of the tax .~..ty p.rlod. Thi. nonapartlclpatlon penalty I. appe.l.bl. In the .... .ann.r and In the the .... tl.. p.rlod a. you would appeal the tax and Int.r..t that has b..n .......d as Indlcat.d on thl. notic.. IHTEREST: Inter..t I. charg.d beginning with flr.t day of d.llnquency, or nine (9) aonth. and one (1) day froe the date of d.ath, to the date of pey.ont. 'ax.' which b.c". d.llnqu.nt b.for. January 1, 1982 bear Int.r..t at the rate of .Ix (6~) p.rc.nt p.r annua calculat.d at a dally rat. of ,OOOI6~. All tax.. which bec..e delinquent on and after January 1, 1982 will b.ar Intere.t at a rate which will vary froe calendar y.ar to calendar year with that rate announced by the PA Depart.ent of Revenue. The applicable Intere.t rate. for 1982 through 1998 ar.: ~ Inter..t Rat. Dally lnt.rnt ractor !!!r Int.rest Rat. Dally lnt.r..t ractor 198Z zoX .OOOSlt8 1987 OX ,000247 1985 16;( .000itS! 1988.1991 lIX ,000301 10" n:c .000301 199Z OX .000247 19115 U:C .000356 1993.1994 7X .000192 1986 1O:C .000274 194J5.1998 OX .OO02~7 uJnt.r..t I. c.lculat.d a. follow.: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR ..Any Hotlc. I..u.d aft.r the tax becoee. d.llnquent viii r.flect an Int.r..t calculation to flft..n (15) day. beyond the date of the ........nt. If paye.nt I. .ad. aft.r the Inter..t co~tatlon date .hown on the Hotlc., additional Int.r..t au.t be calculat.d. Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate 01 Charlie B. Byers No. 1996.01060 Date of Death December 17, 1996 also known as Deceased Social Security No. 175.03.0573 Ruth H. Bvers P.rsonal Repr...ntabv.!.) ollh. obov. E.tat.. dec.o.ed. v.nly lhot lh. it.m. opp.oring in the lollowing inv.nlory include oil ollh. p.rsonal....I. wh.r.v.r .ituote and all ollh. r.ol ..tal. in lh. Common....olth 01 P.nnsylvonio 01 soid Decedenl. lhot lh. voluobon ploced oppo.it. 84ch it.m 01 soid Inventory r.pr...nt. it.loir volu. o. ollh. dol. ollhe D.ced.nt. deolh. and lhot D.cedenl owned no real estate outside 01 the Commonwealth of Pennsylvania excepllhat which appears in a memorandum at the end of this inventory. IflNe v.rily lhot lh. .tal.m.nl. mode in lhi.lnvenlory or. true ond correct. IfIN. understand thollolso .talem.nl. h.r.in or. mode IUbject to the penalties 01 18 Po. e.s. Section 4904 folating to unswom falsification to authorities. Nom. 01 Mom.y: Personal Representative: Ruth H. Byers C/t~ fill-Lt/ Dated: ilL" J.ffrey A. Emico 1.0. No.: 07981 Addre.. 3401 N. Front Slre.t. Horri.burg. PA 17110 Telephon.: (717) 232.5000 DESCRIPTION VALUE 1. 1992 Dodge Dynasty $ 5.700.00 2. Miscellaneous personal property $ 100.00 TOTAL: $ 5,800.00 Altach Additional Shools If NI)C(J5U ) NOTE: Thofl<<lmotandtm 01 loalestalo ouIloHte 1ho Commonwoallh of Pcnnsytvanla mOl"', altho olection of Iho paf~al replOsonlallvo. includo tho valuD of each item, but such figurus should not bo odondcd into Iho lolal ollhe Invonlory. 1I17ti:11