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HomeMy WebLinkAbout97-00682 PETITION H)R PR08A n: llnd GRANT OF LKrn:RS 11:1/(I{(' (~r Oq,!,,' I itl. Jj(!~~(/I. ) ,1. No, ,-J) ru(, lr ~_~. (11,10 kllOIl'1I (1,1' ___ J 1'0' _____<_________ _ , [)(J('('lISt'tI. Sod(ll Sl'<'IIrily No, . :111.- 1 D- (,1.8 7 Kegist'" ot Wills tOI the J ('OlllltY ot (u",t.fI'JIr'~..___. III the ('OIll1ll0Ilwelllth 01 l'ellllSylvliniu nH' I'clll!l1l1 01' till' 1IIHll'P;jglH.'il n..'sPl'l'lftllly I'cpri.'''iCllls thai: \' 0\11' "ellliolle,(s), who is/all' 1 H Y"'"S 01 age "']I'.Il'f a.ll I he f.'.WL.'UI 0 f\ 11111", last will 01 ,h,' aho"e de<'l'del~, daled I'" v~n7 ;l.i'_ IIlld eodkills! dal,'d ,.1/ ,'u___ .._______.,. ll11med _ _ ___n__' 19.'11~ (\tatl' f('k\ilI11 ,-in:lltlht<llln''', \'.1'. fl,'tllln!.'iHllllll, dl'illh 01 L'\Cl'utm, ('1\.'.) I)welld,'1I1 was dOlllicikd al death il.'. ('..~, /:;"./II".,..J. " .... ...... m." County, I'cllnsylXllnlll, I'/llh -~.' ILLL .IaSI~i~r"I;iiW\I\~~dfWlal :l,l~o SvIIN4iJc.Y .nt(~~"~=~~~f~(lO\ f1 tiJ Gth\t \trL'l'l, Il\lllll1l'l and 1ll1Ilh'lp<llil\') Ikeelllknl, Ihl'I'rJ t~.. -I yea,s 01 ag~ died r: .. 'j I lu - .... . ...~, 19..j'1__, al r;~c"I~~~t 1~)ff::~s,d:Jl~nl~Lill~;~I~{,;;,:'~b I:'~I divo,e"d and d;(II'~;I-II~~;;-;:i;iid-b~)rn or IId~PICd 111'1<'1' ,:,e,'ulion 01 Ihl' will oHered 1m prohate; WllS 1I0tthe \'klilll of a killing and was ncvcr adjudicatcd inrollll'WIt...'IlI: __ ___._. :--. .--------~~-~..~.-.~----- [)(,'ci:.;ndl'nl at dl'illh O\\lll'd propl'l'lY With csllmHlcd val lies as follows; (II' dml1icilcd ;n 1'",)" All persollal property $.2~fV~, (If 1\01 dlHllkilcd in Pa,)' Ilrfsonal prop('rlY in Il(.'nnsylvl\l1ia $--..--.--- (II not dOlllk'lkd in h\.) Personal propl,'l'lY ill ('t.HlnIY $_.-.~~._-- YuluV lit' l'~illl,.,Sl:HL',iJl Pl'llnsylvunia .J h b $_.If. ,il1lal,d '" lolh"I', .... -38~~ SvIIIVl1~I:SYn _mrf~^,-l(~YJ--~~~ . =-~== ".'llI:KU'ORL, pCliliolle!'!,) !'espeClI'UI.I).'..J;.!'e'iu.esll.".I.. ,llhe 1.'l'o.baIC 0.1' Ihe lasl will IInd codicil(s) p!'csellled h"!'l'w;,1t alld lltl' grant 01 klier' nl<)'/Tlftl ~"0.~__ -. ., ...---~--"- - , ' lll.,t;lllll'Il!,/J-y; "dmi"i'l' Hi,,,, " 1,11.; ndn,;";_.L..,;",, ,1.1'<f1.c,l.lt,) Illl.'roll. z a ~: 0" ~-~ -j ~ ~:~ ~~.~~~r:::~d^-l . ifi1hp.1JfJ-Ah .Ulll'f1.-n -~~ ~, Vi ____._______.._.__._ .__..___-'---~.____..u._.___..~__.._..__ ---- ,...~--_.,-~----~--_._.._. .-------. OATU (W PERSONAL REPRESENTATIVE COl\tMONWEAI.T11 m- "~rNSnVAN'A I " CmXI'\' OF _CV(l'b(!(l~.I__ ",______ J "'.. llrnl'llll..'d alld 131;11 'iil(' ..~Ug~<~., . UCl /) fl. 't') l I<<'dlil'/' / t- v r:.~ 1',0, 'I. ., F" ~ .:;J -,-77 ,-~ '~ Tlw pl..tlllOlll'l"{,,1 abl)\(,'.nitllll'd \wcar(q m affirm(,,) Ihut Ihe stall'men!S in thl' foregoing petition are IrUl' ilnd~-(lrn.'t.:'1 10 till' hl'q Ill' Illl' ~Ihl\\'ll'dv.l' Hnd hl'lil'f of 1''Il'litiolwr(s) and Ihal as pcr!\onal reprcsen* tall\'l'(:,1 or Ill(' 11110\,(,: !.kcl'(knl 1"Il'lillOlll'rU,) will wdl and truly adlllini:'ilcr thl' ('slale according to law. I /j~r!Q),,~=~ f l' ..,~~-=-..~~= ! "uh"crilwd dm of 1'197 SWOl n 11\ 01 lwfnl'l' Illl' III i ~ --..- ;' .----, No. __.21-9'1-682 t~~~~ J &V. J~!f!!L-~~~.--'------'-~-' Ileceased DECREE 01' PRORAn: ANI) GRANT OF LE'fn~RS Estate of_ AND NOW ___-_--.A1J.Ci\!S'I'P-- I'jl?, il\ cOI1,iderllliol1 of Ihe pellllol1 on the reyerse side hereof, '1IIi,fllelOrv proof hIlY\I1~ beel1 pre,el1led before rile, IT IS DECREED Ihlll Ihe 111,lr\l1\1el1l(') dllled- _\1.&NUJ\l\'t28_. l2~n-----..-._--'----------- dcscribed 11\I:rell\ be ndll1llled IOPtohl!le IIl1d flied of record lIS the \,,'1 will "I' -,_.-,~_._---~._'- __ DfI!:!!].k-W-.-ll\1\l-@J~.L~!Jh-- ----.--'--.----- ,: IIl\d Letter, _-~.1'.l'.MF,)I'l'l' l'.BL,-.--~--.-,-,---...,--.--.-.-..,-.--------- arc hereby gral1led 10 ._,...JlA.liUl1<..J'I..t-- Il.~lR..GJ'lB...JR. _.-_..-.-.~-.-. --.-..--...---'-- -,-------'-- -_.._._--_.__._,--,_._-_.._..._-,--~._-_.._--_._------- - -,-------.-------.-,-------'.'-----...--.---'-.----- l'EES Probate, Letters. Etc, "" _, ' " $115. 9JL Shotl Certll'icales6 ) , , , , , ' , ' " $JJl.....M- Renunciation """""""" $ x-pages $ 12.00 JCP TOT'L--" $--~ " --,t~ Flied","" ,M19P,WI'" p"~~~,?,,,,,,, .. :lJ)Q 11 \! e_ c..xg,t~.~.flA (\ "t. o - R,,~I"cr of Will' ~---\ f's. ,rI) J,K' 1~/t!((j{J.j(/1. lJ)r( ~'1-~11 _~__---....-_..-~"-~,._~-r---- ATTORNEY (s..p, CI, l,\), No,1 __ JW7 tld,ttl/V J~.-#f6- ;1.17;1D AI)\)R\:,SS _- ('711) 1.>X'6{,C! I'BONE " '\\'I~) n() lll',', t: \ n~W I G, IYlll:..M ~ b- ,i-/$-q' It -, '9i' 1-&10 '1] - I-EJ :~)n "it _-of . , ~ Cd :;: Ul .~ . ;xl ~ ~j t'- ',- <'t Ul '1l Iil rc: Jl 1Io l;.< ;.l ... -.9 .:l i.o., cQ . I ~ 0 . :.0 ~;, r.\j t"- ~ ..) :>" ;" 0"" I..:i ,~ H I :;10 ~ ~ -- @ 06 ~ Cl Ul \ .., j .. (.:l ~ I..:i l;.< ~ '<Ii A '. _,;0 1'I '1" -hi ~ ~.. .- ,ie_' i')jf ,'.. , , . " LAST WILL. AND 'l'ESTAMKNT OF ,DANIEL W. BURGER, SR. I, DANIEL W. BURGER, of 3820 Sullivan street, being of sound and disposing Mechanicsburg, pennsylvania 17055 mind, memory, and understanding, do hereby make, publish and declare this to be my Last Wi 1.1 and Testament, hel'eby revoking all other Wills and Codicils previously made by me. ITEM I: I direct the payment of all my just debts, expenses of my last illness, funeral expenses, and the costs of administrating my estate from my estate as soon after my death as conveniently may be done. ITEM II: I give, devise and bequeath the rest, residue and remainder of my estate, together with all insurance proceeds thereon of whatever nature and wheresoever situate to my son, DANIEL W. BURGER, JR. ITEM III: I authorize and empower my personal representative and/or said Trustee to compromise, adjust, release and discharge in such manner as my personal representative may deem property, all debts and claims owed by or to me or my Estate; to sell, lease or exchange at public or private sale or in such manner, at such prices, and upon such terms of credi.t or otherwise, as my personal representative of said Trustee may deem proper, all or any part of my property, real or personal; to execute, acknowledge and deliver instrument.s of conveyance, including Deeds in fee simple; to borrow money for the pur'pouo of paying ostate, inheritance or other taxes whleh lire required to bfl pald to secure any such loan by pledge or mortgaqo of all or' any part of my property and to execute the necessary lnstrumenta to carTY out such powers; to distribute my estate in kind or partly in money or partly in kind, and to determine the fair val.ue at which any property so distributed in kind shall. be received by the distributees; to conduct any business in which I have an interest at the time of my decease, for such period as my per!lonal representative may deem proper, power to borrow money and pledge assets of the business and the power to do all other acts that I, in my lifetime could have done, to delegate such power to any partner, manager or employee without liability for any loss occurring therein and to organize a corporation to carryon said business as capital to such organization and accept stock in the corporation in lieu thereof and hold such stock for the uses of this my Will, and to vote said stock or sell the same as to my personal representative may' seem best; to retain all stocks, assets, bonds and investments owned by me without being confined to what is known as legal investments; to execute any options to purchase, to apply for stoclts, bonds or other inveetments, to purchase or otherwise acquire real estate and to execute the same powers thereover as hereinbefore provided, to retain indefinitely any part of my assets, real or personal which is or may become unproductive or to make sale t.hereof;to pay carrying charges and expense of the property out of other principal or income of my estate; to invest and reinvest in all forms of property without . 'l " restriction to inve/ltment8 nuthori.zed for Pennsylvania fi.duciari.es, aij they deem proper, without regard to the prinui.ple of diversification or ri.sk; to oxorci.Bo any law-gi.von option to troat administrative elCpenBes ei.ther liB income tlllC or as estate tax deductions, without regard to whether the {lXpenSos were paid from princi.pal or income. The powers hereIn conferred shall be to my named personal represontative and said Trustee and all successors thereto and shall be in addition and not in limitation of other powers conferred on said fiduciaries. Any and all payment or payments of any sum or sums, whether in cash or in kind and whether for principal or income, payable to any beneficiary shall be made upon the sole receipt of the respective beneficiary to whom the payment is made, and free from artticipation, alienation, assignment, attachment, and pledge and free from control by the creditors of any such beneficiary. All shareR of principal and income hereby given shall be free from anticipation, aElsi.gnment, pledge or obligation of the beneficiaries and any of them and shall not be subject to any execution or attachment, levy or sequestration or other claims of the creditors of said beneficiaries or any of them. ITBM IV: I nominate, constitute and appoint DANIEL W. BURGER, JR., Executor of this my Last Will and Testament. In the event of the renunciation, death, rosignation, refusal or inability to act for any reason whatsoever of said Daniel W. Burger, Jr., I nominate, constitute and appoint HELEN LINARDI, to be the sole Executrix of this my Last will and Testament. I hereby relieve my Executor/rix from the necessity of posting security in connection ,'- . , ." '. f-" COMMONWEAL~H OF PENNSYLVANIA COUNTY OF ~CD~~ ) ) ) BSI We, the undersigned, the 'rIlBt.lItor and the witnesses, respectively, whose namss are signed to the foregoing instrument, being first duly sworn !Inri qualified acoording to law, do hereby deolare to the undersigned llllt.hnl.'.iLy that we were present and saw the Testator sign Ilnd exeuut.fl the Inutrument as his Will, and that he had signed willingly ftnd LhaL he execuLed it as his free and voluntary act for the pUl'pOllell Lhtoll'e.!.n expressed, and that each of the witnesses, in the prellfflHle and hearlng of the Testator, signed the Will ae witnesses and that to the best of their knowledge, the Testator was at that Lime elghtHen (18) Ytlan of age or older, of sound mind llnd under no constl'!lint or undue influence; llnd I, the said Testator, do hereby acknowledge trllt I eign~d and executed the instrument ae my Last Will and 'restllment, that I signed it willingly, and that I signed il #111 my free and voluntary act for the purposes therein expressed. kJ;-t ?~E~~ fl /) I)' ..I -i>' . J! )1VI!r\lt'<~ If, ~ , WI/rHEBS .,1 I) () 11.41 ""-If /1 (.4?1' V 7'wi;'ri~r ~( Sworn to and Dubso ibed before me thb ~:"Co~. ' ] 997 _ ,- -~, ~~~t_ _"'_ . 'Yfotary Publ! fJ My Comm! l8ion tXllirell1 Nola,lal Sail L Unld v, Manln, Notlry PubIo f'."vl.w Tw )" YOlk COIl My !!..~"'",I.'lon~. . J It 1... '..... CER'l'IFlCATIONOF NOTICE UNDER RULE 5.6(a) Name of Decedent: DANIEL W. BURGER, SR. Date of Death: August 5, 1997 will No. 21-97-0682 Admln. No, To the RegisLer: 1 certiti'Lhat notice ot beneficial interest required by RuLe 5.6(.1) of the orphans' Court Rules was served on or maiied to the [allowing beneficlaries of the above-captioned estate on August 21, 1997 Address Nanle --- Daniel W. Burger, Jr., 320 WJ.ndcrest Road, Harrisburg, PA 17112 - Notice has noW been given to all persons entitled thereto under Rule 5.6(.1) except nnn~ Date: Augsut 21, 1997 rJojJ );( _ Signaturo Name Herschel Lock Esquire \".-_1 C Address 3107 N. Front Street Harr.isburg, PA 17110 1Il \;,i C,I \'J L:> ~-? Telephone! J 717-23U-6~1 Capacity: personal Representative counsel for personal representative \'-u 9'\ u c ~,- ::; ()u x AV~" . Q.. 'OIy.,soo','.I'9'1 I ~:) -,1(/ '1" ,1<)' \,oaPAtlIO'DIA'HAnUI213I'''CHICKHla, *' \ 'NH::~I:~N~E Jtc~::~~RN ~;vl:'f!u:;~~IfI'CL,"!"ID..n -.,.---- -~~ii:;N(7.':::"" ..I~,~ :I~~~,~~ ~~p~~;t . ::":~:: - J,li' :'06~;"'" "' "AM 1 --:-i"-:':':H~ MI~.ii"HI,i'\I~~ ,- . ,=,~"'~~- OWllmfl coM,ii1f'iliiim---- Burner Daniel W "t' 3020 Sull. iVlln Stt'eet 10c..,,,tu'i';fv'IwM"'----. _.u li;~";i'-61'''i . "fOA" 0""'" -. Mechanicsbut''.l' PII 17055 717 -1 0-6 7 B7 _' __' ~l_-.~ -.?7 _\.. l ~-_ 1 ~ -_1911 c"l_MOIC"'~lJ.rn,cb'_I~,t'o_-ll,a,--,~l,cll-'-U'('-'1-0''''-1', -=--~-~_-.- --_'- I" ..."""" ,",,"'''0 '=:'."_::,'''o.'':''.:'~':~~. ~c~^,~"U'~'~~\:'" J" _" . _."~ _" _._. -- rn \. Original R.,urn [1 'I, Suppl.m.n'ol ROlurn [-I 3, R.maind.r R.'urn U (lor dolO' 01 d.alh prior to 12,13,82) 04, lIml..d E,'ato [I 4., Futur. In'.r." Compraml.. [I 5. Fod.rol E,'ol. Tax R.,.rn R.quirod l'ar do'" 01 d.o'h ah.r 12.12,82} o 7, Deced.nt Malntaln.d Q Uvlng Trusl (Alloch copy 01 Trull) tON"DINl1AL 'AX INI'ORMAnoM IHOl/lD BI DIRlcTED TO. '0, ":,,.' ',0<,';'1' \ :'. \'!/.f: ,\ ,'t,' .i(\if"l ....-- . ." -. . .-,.' .--- . -..,'. ~...' COMfJlflE MAlllNG A,OOlles!J 3107 North Front Street HarrisbUt'g, P~r 17110-131Q ~ J i., j , .)J --;;. .'_ . c ' ,.- 1. R.al E..o" (Sch.dul. A) 2, S'ock. and Eond. ISch.dul. 8} 3, Clo..ly H.ld Slock/Partn.rshlp I...r..' (Sch.dul. q A. Mortga9t5 arid Not.s R.celvable (Schedule 0) 5. Cash, Bank Oeposits & Mlscellan~ous Penonal Properly ISch.d.l. E) b, Joln,ly Own.d Prop.rty (Sch.dul. F) 7, Trond... (Sch.d.l. G) (Sch.dul. L) 8. Total Gros~ Au.U (Iotalll"" \.7l 9. funeral bp.rutl, Admlnlstratlv. Costs, Miscellan.ous Exp.n... ISch.dul. H) 10, D.b.., Mortgag. Lloblllli.., LI.n. (Sch.dul. II 11, '0'01 o.ducllon. (10'01 Lln.. Q & 101 12. Ntl Valu. of estate (lin. 8 minus line \1) \3. Charltabl. and Go....rnm.ntal 8equ-''' ISchedule JI 14, N.' Val" Subl'c1'o Tax (L1n. 12 minus L1n. 13) 15, Spousol'rand." (far dolo. 01 d.o,h ok.. b,30,Q41 5.. Instructions for Appllcabl. P.rcentag. on Rev.use (\5} Sid.. llnclud. values horn Schedul. K or Schedule M.) lb. Amounl of line \.4 taxable al 6% role (Indude values from Sch.dul. K or Sch.dul. M.) 17. Amounl of lln' 141axablll 01 '15% ral. (Include valu" from Schedul. K or Schedule M.I 18, Principal lax duo (Add '0' Irom Lln.' 15, lb and 17,) 19. Credl" Spousal Pov.rty Credit _prior Pa.,ymenll Olscount _ + ~~_~_ +..250.00 20. If line 19 Is greater than lln. 18, enter Ih. dIH.renc. on lIn. 20. This is lh. OVERPAYMENT. aD 21. If Un. \8 is gr,ol.r than lint \9, enter th. difference; on Une 21. This is the TAX DUE. A, enter th.lnl.r,,' on the balanc. due on Une 2\A. 8, En'.r 'h' '0'01 01 \In. 21 ond 21A on Lin. 218, Thl.I.,h. BALANCE DUE, Mak~.k Payabl. ,., h,I~WIll., A,.nl __ . . . ' I. SURE TO ANSWIR ALL QUEStiONS ON R&vim 5101 AND TO RECHECK MATH .0( .e,~' Und.. p.nohl.. 01 p.rlury, I d.da" ,ho' I hov. "amln.d IhI. r.'urn, Including o<componylng "h.dul., and .'O'.01.nll, and 10 'h. ".., 01 my knawl.dg. ond b.II.1. It i. 'ru., corr.ct and campi.,., I dodor. Iho' all r.ol."OI. ho. b..n r.por'.d o,!rU. mark.' valu., O.clorallon of pr.por.r o,h.r 'hon 'h. p...onol r.pr...n'a,lv. I, bal.d on 011 Information of which preparer has any knowledg.. "o~uoo 01 ""0" 00"0"'1"':'0' filiNG ""UR" ADO'fSS---"---.-~--~. --------, ~: OAl , ~' . 1:0, ~~~"-~~-,_J.1CJ Cl.IJ..QJ:.<;,~E"-c~.AjiJ1tJ~\t;A~N;' . 'Ii ni ':-~'" ~."!r:'"_':'~:::- ;,;;71},A?iX ~!Uf... - ---.-.-" (~>rlr I &l .. ~ rl:5~ !l!h u~.. ,;,1- II _ 8, Total Number of Safe D.posll 60xII 717 I 2~B-6661 ~. (11 93,'1B1.00 (21 00 .00 (31___~ 00 00.00 14) . 6 "913"-49"-- (5) .-2.,-~.__,,:---' 00.00 00.00 120,694.49 -----' f-...\ \I_J fl 5 ~ &l or. 1 b) (7) --" ---.-- ( 8) (QI.....-lQ.B3'1.45 2,255.39 19,092.84 101,601.65 00.00 -- 101,601.65 (101 (11) (12) (13) (141 )(,.__'iIII (1 b) 101,601.i.?__" ,06 D 6,096.10 (17) __)(.lS- (18) 6,096.10 - ~ !C f . co u Inleres! 5,250.00 \lQI (20) 846.10 (21)--.--' (21A) (216) ~ I- 1'\46.lQ j SCHEDULE H I FUNERAL EXPENSES, : , A~rs~~l~~~~6'~~C~}~:N~~J'ILI'NUM:Jr~.,!llnl,_OI Typ. ",1.1 W, ,",,0<, ''''-''~CRl~IO~ L997'::OT~UN;- ._---------,------~AM---------~---------.-I "V.I'Illhl"'" tj~ CQMMONWIAlTH Of "NN~YWANIA INHUITANCI TAX ~nU_N IIJ!SIDENT DICIOIHf ISlATE OP ITIM NUMBIR A. l. 2. B, ,. 2. 3. 4, C. " 2. 3. 4. . 5, 6, 7, 8. Funeral bp.n...: Wiedeman FunerB1 Home/ Inc. Stee1ton, PA. Post Funeral Meal - Knights of Columbus AdmlnllllOllv. Casl" Personal Representative Commissions Sodol Securily Number of Per.onol ReprD.enlotlve: Vear Commi..lon. pold Attorney Fee, - Herschel Lock 3107 N. Front Street Harrisburg, pa 17110-1310 Fomily Exemplion Clolmonl Addr... of Cloimonl 01 decedenl" dealh Relationship Slr.el Addre" Ciiy Zip Code__ 115.00 18.00 12.00 5.00 ------- Probol. F.e. _Slole Petition for Probate Short Certificate Extra Pages ,1CP Feea MI.c.llan.ous Exp.nst" A.dvertiaement - The Sentinel-Legal, Kathryn w. Fetrow, Treasurer Real Estate Tax Settlement Costs - Sale of House Dan Barninger & A.ssociates (A.ppraiser) 3,163.15 620.00 6,587.78 150.00 60.00 65.22 1,026.73 4,914.57 ,I 250.00 TOTAL IAI.o el\I.r on line "I, Recopllulolion} \ 5 16,837.45 (If mar. .pac. I. n..d.d, Inst,l oddltlonal .h..h of .am. .1...) U",Ullfl. IIp!1 SCHEDULE J BENEFICIARIES J PILE NUMBER '!~;'b COMMONWl ,,\It~ Of H~IH~'\ j ,HIlA INttUIIANCl',U U1UIN "._~I."I!I.~' O~~~~~~_, .c .~ - ------"'~ - ~... . - -- ISTATE OF 199,/-00682 ... ._,__". ,..._ _....____'___.___'__.\_.~-------u.--.. AMOUNT OR RBLATIONSHIP SHARB OF ISTATI ..___.m' __u,__. ..~_..______--,+:.c.---~-'_u_--'" DaniGl W. Burger, Sr. .- N~T~:'r-'-- ..-- 'N~:~:N~~~~AuS OF IINEFICIAAY ---'- _.--_.,-~._- ,-----.---....-....-. - --..--. ..- 100% of Net Estate A. TaMable a"que,lS: Son 1, Daniel W. BUrger, Jr. 320 Winder est Road Harrisburg, p~ 17112-8985 \ \ ITEM NUMBER NAME AND ADDRESS OF BENBFICIARY U~~OUNT OR .---J~ OF IST~ 8, Chatltable a'nd Governmentdl 8eque$U1 1, None TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (AI.o enlor on line 13, Recapitulation) I S -0- -- - - IIf mo'. .poco I. n..d.d, In..,t oddltlonol .h..t. 01 .om. .1..\ CUMBERLT\ND Register of Wills of ~~~~ County, Pennsylvania INVENTORY Estate of Daniel W. Burqer, Sr. No, ,__19,97::QQy.(l..f--,-.------. Dale of Death 8-5-97 .~---- also known as 717-10-6787 --' Dcceased Social SOClIflly No, ,.--- .~~-~..~..._.- Po"onol Rop,o.o"toli"l" ollh. .1>0," 1.".'0, do.....d, v."lv ,h.1 tho iI.n" ..ppo",,,,y'" 'ho loll,"y",y ,''v.",",, ,,,oludo nil olth. po"o""ln"ot' wh."v" ..10." nnd .11 ollho '.01".'0'. ,n tho Commonwo.llh 01 POl"",I",,,," 01 ,",d O.".dont, Ih91 'h. ,.Io.lio" pl."od 01'''0'''. .neh ,,,m 01 ..,01 Invon\O" fOp'''"'''' ,Is I"" voloo ," 01 ,100 01,"0 "I th.. 0.",,'10""" d".,h, .IId ,h.t O.e.dont own.d no '0.1.".'. oo,,,do 01 ,h. Commo"w..llh 01 P,nn!lylvoni. .,copt ,100' wh,eI, <'PPOl'" ",.. "wmo,o"dllm nt tho ond of this inventory. If\N!} verily that the Slttttln1ent9 modo In thl!! InVtJntofV tHU {r\lfl and <:urrtJI;t. liWu \H\du'~tIInd thut fal98 IItotl3(nonl9 heroin oro made Rubleot to thu pllnlllh69 01 18 Po, C.5. $llctlon 4B04 r"I,I!H\'J to UIHIWOfll 'UIHlllotlllun 10 authOrities. Pursonill Rtlprtl"Ilf1lil\I'/U' Name 01 Attornev: He r schaL.L.ock..---..----- .--- -., --..-...----....----. --_._~--_._." -----~-.,-~- 1.0, No,: _V-241.059J.--.----.---.-.---.- Add,o": 3107 N. Front Street .~_-_~.-_.-.~-T-...--~.-----..---'----.--- Dated ~.._______._____ ._______.___...____ _u_~_.'_ _.____~"_______._~_ ___._._.~.H__~__.._.__~_<.___..__ ~ r~ i sb:'rg_~_!.~_~2-1:..~~---.q_.--- Tolnphono:__ 717-238-6661 ----~---_.__... Valun OOSCflptlon 1. 1992 For Truck (L.B. smith Fo~d, Inc.) 2. 1987 Cree Trailer (Lerch's Outdoor Center) 3. property 3820 Sullivan Street, Mechanicsburg/ PT\ 4. Dauphin Deposit T\cct. # 0018635377 Closed 8/25/97 S. uni t.ed Heal thcare (Metrohealth Insurance) Check No. 00045835 Cancelled B/6/97 $ 10,000.00 6,000.00 93,781.00 10,804.55 108.94 ("'.J {fl r<> ('-I (".'1-_ Lit I.e--) ,~ "J it) (1: IX ~i ;11 :; atJ ~ Total: 120,694.49 (Attaah AdditIOnal Shoets il "eoessorvl NOlr: The MernOlllHtW1\ ul /fIlIil elOtlltO OII\$ld" lllll {;umrnOll......II,llIh 01 PutllltlyIYllllillllHl'f, 11\ tht! th'C!IOll 01 llit! PIH501111llllpflJllOnllltlvIL ifl(llllclu thu \/81ulI olltllCh il1,"" but IUd' l!{Illtfl9 9110ltld Ilot bo n~!ulldud mill IIld total ot tho ilh'IHlturv RW-6 HERSCHEL LOCK Attorney .'/.ow 3107 NORTH FRONT STREET HARRISBURG, PENNSYLVANIA 17110.1310 (717) 238.8881 . FM 238.5258 September 21, 1996 Register of Wills Cumberland County Courthouse Hanover and High Streets Carlisle, PA 17013 REI Estate of Daniel W. Burger, Gr. Date of Death: August 5, 1997 Will No. 1997-00662 SS #: 717-10-6767 Dear Sir or Madam: Enclosed herein please find the following items related to the above referenced Estate: 1. Two Sets of Schedules 2. A Release 3. Checks in the amount of $10.00 and $19.00 each for filing fees and a check in the amount of $846.10 for taxes owed. I ask that you be so kind as to appropriately file the documents and send me a receipt for the checks in the enclosed self-addressed envelope. Thank you very much for your attention to this matter. Sincerely, ~~,.I-/J.J Herschel Lock HL:djs Enclosures als ~/"i \.'.. Pr!('" qUI:18 'J'~I~ n': HII n:.d3S 86, ~il!: .' 'll:/ j<'J "",,"lOl/ ....t ~,.~'" \~ ~"'" i I ..~...<'" '\" ,_\, ~_' T', ",,,_" I , " . '~""'-'.'(>>".'.'. I j~ ~ "liKAk ~ ~-~_.... FIRST CLASS MAIL I I I I , /' LAW OFFloes HERSCHEL LOCK 3107 NORTH FRONT STR~ET HARRISBURG, PA 17110 Register of wills Cumberland County Courthouse Hanover and High Streets Carlisle, PA 17013 !~:,t \. -"'-, "'/"'+ I ,qUI1L) '/1':1\C) i 1< \' ;:l (1:)'\ B6., \A !(. (~-:HH\ "'~d ""\'\ ';'i_h-t, ! ) , r . , r ~; , \f' {:", ,: 'j VI' , , 't.' ",. , , r 'lj_ . , "". p.f!i .! '. t.. ", 'I -L " .. ,t ~, .,t.;. ('l , " l ^ " ....-- ~ rrr :..'\~ n"'T'-7"~' . I "!""-"'_~~;-'-:-_''1o'''''--''-J'1 -'r"'" - - . ';,"-",,;,.-i.:r-~: .~~ OF INDIVIDUAL TAxes IIHRH_E lA' DIYIS',," DEPT. ZIO'Ol ~I'IURO, PA 111?ft~060t r; COMMONWIALTH OF PIMNSYLVANIA DEPARTMENT OF REVENUE * NOTice OF INHERITANCE TAX ArrRAISEHeNT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ttv.IIU II If' ,".," 12-28-1998 BURGER 08-05-1997 21 97-0682 CUMBERLAND 101 E.-~~.o~~~~'~d ,,~ ____.LZ-. -~ MAKE CHECK PAYABLE AND REMIT PAYMENT TOI REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ iiiV:ii54f-iX-AiiP-fiI9:97Y-MOi"ici--OF-Yiiili.iiifAMCE-YA'itAPPRAis~iiiM:r;-Atl"6WAMCE-i:iR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DANIEL W FILE NO. 21 97-0682 ACN 101 HERSCHEL LOCK ESQ 3107 N FRONT Sf HIG DATE ESTATE OF DATI OF DEATH FILE NUMBER COUNTY ACN DANIEL w PA 17110 DATE 12-2B-1998 ESTATE OF BURGER ) CHANGED TAX RETURN WASI (X I AccerTEO AS FILeD RISERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN 1. R..l E.t.t. (Sohedul. A) 2, Slook. ..,d land. (SoMdul. II S. Clo.oly "-ld Stook/r.rt~rohlp Intor..t ISoh.dul. CI 4: tIor~g...../Not.. R.o.I..bl. (SoMdul. 01 S. C..h/l""" 'Oopoolto/"I~O. r..ro~...lrrop.rty '(Sohodule E) 6. JointlY own-d rrop.rty (SoMdul. F) 7. lr.nlfarl (Sohedule G) a. Tobl A...t. NOTE 1 '1'0 insure proper orad! t to ~our acoount, .ubMlt tM uppor portion of, thl. foro rlth your, .' toix P.~t. 93.781.00 .00 .00 .00 26.913.49 .00 .00 (81 UI (2) 151 (4) (5) 161 (7)_ 120,694.49 16,837.45 -- 2.255.39 (111 (12) US) 1141 1 ~ . nQ, A4 101,601.65 ,00 101,601.65 APPROVED DEDUCTIONS AND IXEMPTIONSI ,. Funeral E~p.n.../AdM. Co.t.l"llc. EKpan... (Schedule H) 10. Dobt./KortgoU- Llobllltl../LI.n. (Soh.dulo I) 11, Totol o.duotlon. 12. Met Value oi Tax R.turn IS. Chorlt.bl./Go..rnoont.l I.qu..t.; Non-oloot.d 9115 Tru.t. ISoh.dul. J) 14. Mlt V.lue of E.t.t. Subj.ot to T.x (,) UO) If .n ....I...nt w.. i..u.d previou.lY, linl. 14. 15 .nd/or 1~. 17 .nd 18 will r.fl.ct figur.. th.t includ. the tot.l of ~ return. .......d to d.t.. ASSISSMENT OF TAXI IS. A...unt of LI~ 14 .t Spou..l r.to (151 16. A.aunt of Li~ 14 t...bl. .t Lln..1/C1..' A ..t. (16) 17. AMOUnt of LI~ 14 to,obl. .t Coll.t.r.l/Clo.. I r.to 1171 18. rrlnclp.l T.x au. TAX CREDIT81 rAYHENT DATE 10-24-1997 09-23-1998 NOTlI .00 x .00. 101,601.65 K .06. ---:00 x . 1 5. U81 ,00 6,096.10 ,00 6,096.10 REcurT NUIlIER AA242395 AA296685 DISCOUHT It' INTEREST/rEN rAID 1-) --- 263.16 13,16- AIIOUHT rAID 5,000.00 846.10 - BALANCE OF UNPAID INTEREST IPENAL TY AS Of" 09.'24-1998 TOTAL TAX CREDIT -" BALANCE OF TAX DUE ----.- INTEREST AND PEN. -- TOTAL DUI 6,096.10 .00 15.85 15.85 . IF rAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEReST, IF TOTAL DUE IS LESS THAN .1, NO rAYHENT IS REquiReD. IF TOTAl. DUE IS REFLeCTED AS A "CREDIT" ICR', YDU HAY ae DUE A REFUHD, SEe REVERSE sloe OF THIS FORK FOR INSTRUCTIONS.' ....~ ,....(j ;.J .~. l~:~ I!' :n t",,) -" '""j I_I " Uj RESEMYA110Ml E.t.t.. of deoedent_ dying on or b.for. Dee.abet 12, 1982 ~~ If ~y tutur. 1nt.r..t In the ..t.t. I, tr~.f.rrtd In po.....lon or.njoy..nt to Cl... a (ooUet.r.U MM"oilri.. of the .IHnt .Ult thl Il(plr.tlon of .,y I.t.t. for Uti or fo'- v..r., thl C~.Uh her.bY IMPr'''1y r...r".' thfl right to ItPpr.ltl ..ld ...... tten,f.r IntMrltM'lC1 'IMI. It the lewful Cl... I (col1et.r.ll rlt. on Iny luch tutur. Int.r..t. PIlRPDSE Of NOTI CE I To fulfill -::he r.qulrHe:ltl of Slotion Ui'tO of th.) lnhtrlt.nc. Ind Est,t, 'II( Aot, Act 21 of 1991), (72 P.S. SIOtlon 9140), Detaeh ttM top portion of this Notice end sub.it with YOur ply..nt to th. RIglst.r of WHis printed on the rivet.. .Ide. R~Katl. check or .l\MY ord.t JtIYlbll tOI REGISTER OF' MILLS, AOENT PAYMENTl REFtMO (CR) I A r.fund of . tlM or.dlt, which WI' not r.qu.sted on the Tax Return, .ay ba r.que.ted by c~letina an wAppllcation for Refund of P.nnsylvanla Inheritance and E.tate TalC" (REY~13U). Appllclltlons are avaUable at the OffIce of th8 Regl.tar of Will., BOy of the 21 R.v.nue 01.trlct Office., or by calling the special 24-hour an.werlng ..rvlc. ~r5 for for.s orderlngl In Penn.ylvania 1~800-562-2050, out.lde Penn,Ylvenla ~ within local H.rrl.burg araa (717) 787-8094, TOOl (117) 172-2252 (Hearing lapalrad Only). OBJECTIONS I Any party In Intar..t not .athU.d with the ItPprah...nt, .llow.nca or dlsaU~.nca of dtldUctlon., or ..."..lient of talC UnclucUng discount or Inter..t) .. .hown on thh HotlcD .u.t obj.ct within slICh (60) day. at rec.lpt of thlt HoUca bYl --",rUtan prot..t to the PA D.part.ent of Rev.nue, Board of Appealt, Dapt, 2ftlOll, Harrhburg, PA 17128-1021, OR ~-.I.cUonto ha"a the .atter detar.ln.d at audit of the account of tha p.r.onal rapre..ntatlve, OR -~~p.al to the Orphan.' Court, ~IIHI" ISTRATlYE CORRECTIONS I Factual .I'ror. discover.d on this a......."t should be addressed In wrlUng tal PA nepart..nt of R.vllf1Utl, Bur..u rf Indlvldu.1 Tax.., ATlN: Po.t A.......nt R.vlew Unit, D.pt, 2&0601, Harrl.burg, PA 17128-0601 Phone (717) 7&7-6505. Sa. pag. 5 of tlM bookl.t ftln.tructlon. for Inhurltanc. TalC M.turn for a R..ident Decadt;nt" (REY-IS0l) fOI' an .xplanatlon of adlllnhtratlv.1Y corr.atabl. .rror.. DISCOUNT 1 If toy tax dull I. paid within thr.. (3) calendar tonth. aft.r the deaadent', d.ath, a flva p.rc.nt (5X) dl.count of the t.x paid it al1ow.d. Pf"ALTVl The 15~ ta~ .."..ty non-participation penalty I. colputad on the total of the taK and Int.r..t .......d, end not paid bafor. January 18, 1996, the flr.t day aft.r the .nd of the tax aan..ty p.rlod. Thl. non-partlclpatlon pt"altY 11 appaalabl. If! the .... 8enn.r and In th' the ... U.. p.r lad .. you would appaal the tax .,ct Int.r..t that hat been .......d a. Indlcat.d on thl. notl~', INTEREST I Int.r..t Is charged bqlnnlne with flr.t day of ctellnqUlllncy, 01' nine (9) aonth' amt one (1) day frOll tM date of death, to the data of pllYHnt. Tax.. Nhich b.c", delinquent bafor. January 1, 19&2 b.ar Int.ra.t at the rat. of .IM (6iO paraWlt p.r lIMUII calculat.d at a dailY rat. of .000164. All taM.' which b.CM. d.Unq\Hlnt on and after Januarv 1, 1912 w1l1 b.ar Inter..t at a rate Nhlch will vary fro. cel.ndar y..r to ca1.ndar y.a'. with that rat. ",nouncad by the PA Depart..nt of R.v.nua. The app1lcaul. Int.r..t r.t.~ for 1982 through 1~~9 ar'l ~ Inte,...t 'Kat. DallY Inter..t factor X!!r Int.ra.t Rat. Dally Int.r..t factor 19&2 20Y. .00054& 1988-1991 11~ .000:\01 19a~ 16;( .000438 19" 9~ .000247 1914 llX .000301 1991~199't n: ,000192 1915 )3.;1, .000356 1995-199& "' .000247 10.. 1O~ .000274 10" n .00019i! 19&7 OX .000247 ..Intara.t I. calculated at followSI INTEREST . IALA"CE OF TAX UNPAID X NU"BER OF DAYS DELINqUENT X DAILY INTEREST FACTOR --Any MoUo. h.uact after thee tax beoOM' delinquent Nlll r.fl.ct an lnt.r..t aaloulaUon to flftH" (JS) PI" lMIyond the etat. of the ........"t. If pIl/Hnt AI .4tda aft.r the Int.r..t coaput.Uan date .hOMn on the Hotl~., addltlona1 IntAr..t au.t ~ calcul,t.d. t:....N7-1 (!~ '* COMMONWEALTH OF PENNSYLVANIA DIPARTMINT OF REVENUI INHERITANCE TAX STATEMENT OF ACCOUNT BUREAU OF INDIVIDUAL, TAKES IHRnAMeE TAl( DIY,SIGN DEPT. fR"'l HARRISIURO, PA 111Z'~0601 In.16I1 u ." cu.m HERSCHEL LOCK ESQ 3107 N FRONT ST U HaG PA ~~~~O DATE 03-22-1999 ESTATE OF BURGER DANIEL W DATE OF DEATH 08- 05-1997 FILE NUMBER 21 97-0682 COUNTY CUMBERLAND ACN 101 ~""""t RMlI!t;ii=:=\ MAKE CHECK PAYABLE AND RIMIT PAYMENT TOI REGI~TER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 MOTEl To in.ure pr~r oredit to your acoount, .ubMit the upper portion of thia forM with your t.K pay.ant, CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ iiEY:U,1ii"ix"Apji-rOr:9'iy----- -iiiiii-iiiiiiR iYA'NC!"fAiCiii'A"fiiiE"tif- OF"ACCouiif--j;liir---- ."---------- ---- ESTATE OF BURGER DANIEL W FILE, NO. 21 97-0682 ACN 101 DATI 03-22-1999 TNIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE, SHOWN IELON IS A SUMMARY OF THE PRINCIPAL TAX DUE. ~PPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE. AND. IF APPLICAILE, !Jr.ROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 12-21-1998 PRINCIPAL TAX DUE, 6 ,096,10 PAYMENTS (TAX CREDITS), PAYMENT DATE 10-24~1997 09-23-1998 01-20-1999 RECEIPT NUMBER AA242395 AA296685 . AA324526 DISCOUNl (+) INTEREST/PEN PAID (-) 263.16 13.16- 15,85- 5,000,00 846 . 10 15,85 AMOUNT PAID TOTAL TAX CREDn BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 6..096.10 ,00 .00 .00 . IF PAID AFTER THIS DATE. SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST, IF TOTAL DUE IS LESS THAN n. NO PAYMENT IS REquiRED. IF TOTAL OUE IS REFLECTED AS ~ "CREDIT" I CR I, YOU HAY IE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS, PAYMENT' oeloeh 1M lop porllon of Ihl. 11011.. ..... ._It .lth .""r p....nt ..do p.....I. 10 1\10 0_ ... oddro.. pr."t~ on th. r.v.r.. al~, If RESIDENT DECEDENT .ok.oh.ok or .-.. or...r p.....I. 10' REGISTER Of NILLS. ~QEMT. If ",,"-RESIDENT DECEDENT .... .hO.k or .-.. or..r p..ohl. 10' COllltONllEAL TH OF PENNSYLVANIA. REFlIH1> 'CAll ~ rofund of . to. .rodll. ""I.h ... 001 roquo.lod 00 lho TIk ...urn. ... .. roqu..locI .. ._,.1'00 ... ....II..llon for "fund of pooo"I....I. Inh.rllo"'" .nd E.IoI. ,,,. 'REY-13U). ~ppll..llon..re ...lIobl. .1 lhO Dffl.o of lhO R..I.I.r of .1111. Ill" of lhO 23......... Dltlrlo' Of 0... or froo lho ""porl..ol', ..-hoUr .o...rIOO ..r.I" ......r. for for" or..rlOO' 10 p.oo..I..ol. :_,00-3.2-20.0. oul.ld. p.nn..I.IOI. .... .lthlo 1..01 H"rl..ur. .ro. (111) 181-"'4, TD" (111) 112-2m (\IO.rlo. 1...lr.d onl.). REPlV TOI .....Ilon. ro."dIOO orrort .00,..lo.d 00 .hl. 001100 .hOuld .. .",,,...d to, p~ oeo"...ol of R..'''''', luro'. of Indlvl....l T..... ~Tl., po.' ~.......ol ...1.. Uolt, D.p'. ,".01. H"rl...r., p~ 11120-0.01, oMOO (117) 717~6505, OlSCQUhT' If .... t.. dUO I. p.ld .llhlo 'hr.' (3) ..1.nd.r .ooth' .f..' ,h. d.o.d.ot.. ...Ih, . fl.. por..ol ,.r.) dl..ounl of the UM pald 11 .ll~.d. PENAL TVl T\IO "r. t.. ....... non_p"Il.lp.lloo p.o.I" It co.putod .0 lhO '01.1 of lhO h. .... lolor..1 ......od. .... .... o.ld ..foro J....or. II. 1.... thO 0'" d.. .ft" thO .nd of .hO I.. "0"" p"lod. INTEREST I lotor'" It chorgod ...Innloo .lth Oct' do. of "'lloo..nc., " nino (9) .on'h. .nd 0"" (\ 1 d.. fr" thO ..t. of ...th, to t\lO ..I. of p....o.. T.... ""Ioh .00_ dolloq_1 bO'or. J.","" I, "82 ..or 10'''''' .t thO rol. of 01. ,.r.) poro""t por ...... o.lc.I...d .. . d.lI. rol. of .00"." 'II 10... ""I.h b.o_ "11_' on .... .ft" J....". I, \.82.111 bO" lotor..t .. . rot. ""I.h .111 .m fro' ool."d" ...r t. ..,.ndor ...r .lth th.1 ro'. """,,"""od .. tho p~ ""p"._t of R""""" Th. .Pollo..', In'..... rot.. for "82 thr...... \... ".. y..r Int.r..t R.t. DlIlly Intor..t f.ctor v..r Int.nst R.te O.ll~ lnt.r.st F.otor - -- 1912 ZD:'. ,ODOYt& 1916-1991 11:'. .000l01 1915 I.r. ,00008 1992 9:'. .000247 1914 11:< .000301 1993-1994 1r. .000192: 1985 n:l. .(100356 1995-199ft 9:'. .000247 1916 lOX ,0002:14 1999 1:'. ,000192 1911 .r. ,0002:47 -~Int.r.st is cftUu1.t.d ft' fal1~'1 IHTEREST . IALAMCE Of TAX UNPAID X NU"IER Of DUS DELINqUENT X DAILY INTEREST FACTOR ,,-~nv Hollo' I..",d 'ft" tho t.. ....... ..,100,,01 .111 ""... '0 lot"... oolc.,.llon '0 Oft- lIS) .... ...ond thO d... of '\10 ........0.. If p....o' I. .... ..,.r .hO In..r..' ........Ion d.t. ...... on lhO MoUe_. addition.l 1nt.r..t lIU,t be calculat.d, PimE ft'tjms REPORt wrmIN 'M YmS OF DATE OF DF.A1lI Rm\RDlL'iS OF 'ltiE STA'IUS OF 'ltiE ESTATE. tFFSrATE IS tm 0)ll'LEllD, FU.E A 6.12 FORM YmLY oon. <n1PtETIOO. (!) .; STATUS R~POR1 UNDER RULE 6,12 Name of Oecedent:_~iel W. Burger, Sr. Date of oeath:~'!9.ullt2.L.-.-!-99}___" Will No. 1997-00682 ~_.._~_.~-- -----.-.-.-..-- AdmJ n, No, Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report th.. following with resp"lct to conlplatlon of the administration oC t1\l~ dbovr~-cal't.ioned Bstate! I, State 'n'hetIHH auministrat ion at the est.ate i:3 L:ompie\c<": Yes_---1L_ No___ 2. If the anSW'H is No, state whfHl the personai representative reasonably believes that the administration' will be complete: J. If the answer to No. I is Yes, sLat.e the following: a. Did t.he personal representat.ive file a final account with the Court? Yes X No b. 'l'he separate Orphans' C'.'urt. No, (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes x No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may b~ attached to this [''!port. ~Jjt Date: ()A')lq~ Signature _ Herschel Lock, Esquire Name (Please type or print) "-'J 1,.,1 3107 N. rront Street Address Harrisburg, PA 17110~1310 rf) ~ LU 71 238-6661._ Tel. lie'. il. l_d t.") Cclpacity: rersonal Repr~8entati~e _-;,.1 ,,, ,: ~v ;J Uu , (MAH:rmtiAM)) ,,) 'f:) (j)"'" eel).,. tOO ?, X ,c':unsel f()r p'3rsonal r'3pres~ntative ~\-i':": ':'