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HomeMy WebLinkAbout97-00971 " '0.- \ I "- '" . 0 Tn Z ~LI.I " . . /, i " I)KITI'ION "'OR I)ROnATE IIlId GRANT (W LETTERS 2l-!J7-' 1 I 1;~I'lal(' qf' Allen It. Clark also k"oll''' as. Mien Wchurd CIUl'k No. To: l{egisler of Wills for Ihl' , /J1'('('l/,lwl. ('ouuly of Cumborlond ... in Ihe :~'oil;i/.~('I'l/"IIY No, 208-24-0J40. ('onllllonll'eallh of Peunsylvl'nla The pellllon of Ihe undersigned respeelfully represenls Ihal: Your pClitiollcr(sL who b/al'l' 1M years or ugc or older an the CXCl.:UL()_~ _ ,. in Ihe 111.11 will of Ihe IIlmve dt'cI'deIH. daled "".., .."."".., ., AprilS.. IInd codicil(s) dllll'd none __.__.__ ...._.___,,_. nllllled .___, 19..Jl1...__ '0 "- i"'~" ,.."..' :t.!..,.. ,'.:....'-..1 "h r'" ... ----~---_.,,----- ~.l>~~ ",'h~-.~- ~"If;'~~~'--'" .'--r-f-iL--- (~lall' rl'levllll[ dfL'lIIll~laH~L", l'.g. rCIHllh.:ialio/l, d~',llh (l11~\l'l'\Ilnr, l'll'.) Dcetndelll \Vas domiciicd at delllh in _.QlJlTlb.!'.l'l!ind .. ('oHnly. Pennsylvllnill, wllh hJ~.____ lasl family 01' principIII residenee lI1 .[ijiiL!IrQ..n..1l'1ll.tJ;lrJ~QUd. CUlIUl-lllll,.1'!I.L.___ ,_.EI\sLPennsbID'o_Townshlp .,,___... . .. ....-.---- (list ,neCI, nlllllbl'l' and ll\lIll1,:iplllil~') Dcccndcnl, th~l\ ___~~_________ years of age, died .. ... '._ ,_._ De_Q_e_m~C_r_~_,.__".. ...__________1 19_..9..7__1 al _..._HolySplrltHospltlll.Camp_IJill..PIL.. .... .____.__..._._.__~__. Excepl us f"lIows, deeedenl did nolmurry, \Vus nol divorced und did nOl huve u child born or IIdopled after exeelllion of Ihe will ofl'ered 1'01' probule; \Vus nollhe viclim of a killing und wus never adJlIdicllled incompetenl: none , ._________ ....._.._,__._______ Deecndelll at demh owned property with eslimuled vullles as follows: (If domiciled In I'u.) All personul propeny (If nol domiciled In I'u,) I'ersonai property ill I'ennsylvaniu (If Illll domiciled in I'll.) Personal property in ('ollnlY Vallie of real estate ill Pcnll\):'lvilnia "i 111111 cd us follows :_5_66_ ..Brel1twa,te r ItolldLQ.!!'I].IU!!!!._l'I!!..._m . _.___.___... $ ___l!I1~sti mated $.----.--..---- $ $ unestTmate~ WHEREI'Ol{E, pelitiotrer(s) respeelflllly reqllesl(s) Ihe probale of Ihe lusl will und codkil(s) presented herewilll und Ihe grunl of lellers_1&!llUJll!;mt.Ury.....__..___._______..__..._____._____ (tCstllIl1C!\tlHY; adlllinbtl'atioll c,l.a.; administration (\,h.n,c.t.u,) Iheroll. " ..,. u o u '0 __ .~~ ",0 " "O,5{ ~'5 ~~ ..,.~ EO ~ o '" Iii ~I}w Lt!da~l=:-(JJ&... 2~t;~~d'~~~r~ c ar~ :"'_...Mechanlcsb'iil'i-:--PA'i 7055 .- ----...-..,......---...----. ---~-~-- ~ ._~__.__....h.__._._._ .___ ._..__.____.m___ OATH OF PERSONAl, REPRESENTATIVE COMMONWEAtTH ()Ii I>ENNsnv ANIA l 'S COUNT\' Of' ___ CUMBERLAND J >;. The pelilioner(s) uhovt'..numed sweur(s) or lIl'nrm(s) Ihnt lite slulemenl.l in Ihe I'oregoing pClitionllre Irlle und correct 10 tlte besl of Ihe knowledge nnd hellr'f of pelilioner(s) and Ihal as personn\ reprcscn. Inlive(s) 01 the nbove de,edenl pelilionel(s) will wellnnd 1I1IIy adnllnislel Ihe eslule nee2.['ling 10 IlIw. Sworn 10 0' ullnmed ami Sllhse"hed~ 4.ntA!:l__tJ...!..dY!-tgmcUu..L._ \(! hci'me me this..3__ _ da; 01 .'1:: -- ---.--.--. ~ December I"~ 97/.",/ " ~71'i' n -,~, .. .I' 7 ~"I.n1. -I . . . ..- -.---. ~ /L"'I.k..~ .\..C ;;:;;.u~rl:.t.L .4< .f'~ - -- " ~ry C. -LewI8,-- 1 H('~'.\IeI ~-~:k_ _ B' /0~-t;;,/J-13 {I " \ \ I' I II I "I", ,,1,\,',1'\' ,\1,\,1',\,,<\ i'ld, ;, I" "'lilly' ,,(\ I 1(' ,\\1<,",,,"1"" 1<'1<' 1',\\'<'" ;.. ,"I H'lI ,''''1'\1'< ,,,,,I ,'" ""1',;'1.' '" '" , IH""! 1<<'\',1'11,11. i'll(' H"\,,I\\.I1 ,ell ii'" ,II" \\'i1\ \oc Illl\\'.lHtvd ,,, ill\' S,,",' \'",i1 It"",,,I,, ( )11;,,' I.., 1,('11\\,""'''' lil,,'I'" widl lilt' ,I'" Ilil,,"I.I',I'."'(" WARNING: II Is Illegal to duplicate thlti copy by photostat or photO\llOph. h.-'l' lllr {hi... lTn\lkMl', ~.l..()ll _ii1ii;;i/J/;J",;",;, )""~"\W Of Nfp, A'\~/ 'JrJ;i;\ ~"~"/" " ,'?,',>",,' ~.r '~~ Z!I -i;: \ *&~- ,,;,.;/ '. ~'_ s:."" .,"11>>' ,~"t '~,~MfN1 \\' ~,lliL\ ~'tm{!W!!V ,~/~.1~~'r 1II\.,\\\t'-'j',IM.lI m:c u ~ \99'{ 4688875 \l,IlV .-~--~------'-,,-~----'~> No. I}U..1111 COr,lMONWEALlH Of PENHSYLYANIA ' OEPARTMENl OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH _._~~_...-..._---_._~ O,llEOf'(Jf.....lli,JAGl,.\l'dv.-1 0, IloceRulor 2, 1997 11~lt I ilIll\l"'8~11 _.,:;;-:;';,: ',",;~ --,-,...-,.,., -' 'l~'~" 1"";;7..:'~'--;;';;- AUE (l ~'\lI\ll1"'IiIV\ UNDER I vl!AA UNOEA' OM o"n Of iiATliJ--i~lACfilil;'-;1 PI,V,E OI'---r.i5.wiC'i.. ";7;:i;:~-;;-;;-,~;-;;I;;,,7.;7"'i;f, ;:~I 6-J _MQnCIlI i O.~I ~--T.lol.,..";t.. M.:l'y"'17~; ''''''I Ut M"II'n',".'~,'{,"PII';IA t1051'1mll- --~-- ~- l..,-' - -.II---.-.l~~~~~- --. ()hH J ".! i 1934 ;". 01, '"'''~, - ,,~,.".. "'" -1:" ,J _.~I ,,,",',1.1 r.QuHlYOf Ot!J,IH CITY, IIOAO. twP Of-.fJEm~F".'ltf1YNA"'[ 11I"'-'I.""';;;;'.;O,,;;;,"~;;;:;;;------ ,",,,,,,,,!,Of ",,""'-OOKii;;;--EAC€ A'''..o:...l......n 11IIo;. Vl1IJ1 II~ , ' ' ' .' .,1lO ~., 10,"--""" "'~'" cunlJerland L. ponns\)oro 1\<11" lIoly SpHl1' IIO"pllal "..~,-".~.. white ~Eoi;NI'5\JSUAIOCC'jp.qlOM- IOHOOfllU ,,"{SSiIHDUSTAY ~""iT:jfao~illE~ERIH ,----oEC€,[J(.Hl~SH)U,6..i,~.- 1,I-;'IIlAI!lIAH!5 1ol1~''''1 - 1'.--WIN1V1HO!iKi05i"- \o.".t..IdtJI"";i'A'r"~r;;M ~ ..__._._~...--~.~._-_... uS A1'MEDFORCE!\I _._~~o!'i9!~IL'U!"Jll!I'!!m!'~..-- ~II","'II'~ W_tlI ,"d. "'.."'....~\,'..".I CI ~........"'...,~,...ll ~I II ,...."",,""'''''" c,_ ""","""~" Uer DOl" cornoer ,COllnt:y_ ('.'",,~~~_, _~.-:---~--- ,,~,~- _J.'::~-'.:'--- ,,-~1dQd_. 11 llIECEDEHT !IolAIIINGApOfIESS(S""'" CI,Ir.-,.." SM'. l~,Ccd.l\ J"'''''.'' {'!'oosy vanJa IXI Fast PcnnBboro 566 Urontwat or Road :;~:~~,.c,'" "..,_ -.' ::::... '" ,,","-'""'.-'-- ---" c,., -,,-- Camp 11111 1 m 17011 :~,::~'~~;,'" ('clAuJel-land -:::,~:., ...11::.=:'::", _ _~ ~____ _ ~~~'!t._- . . - --- - --------- IolOItIEfI'S 'lAME Iff'" M ,1<"" l,.~'l~;' f,.,,,'''')~l ____~_-_._ ' _Ylry_.~~:ke _ .--..------------. Itlfonl.lAHl'S I,lAI\.INO A{)(}fIESS ISO'''' C~I"""" Sill. 11'C'~"'1 2 Cloud Court I ~chftn iC!-iburg, P^ 1705~) oAtro7Oi9POslffm-.-~" PlACEOf'OISPOSiiM.%HlIMofr.,.;;Wy~-.JlOC~'l6ff.C""~Iiii1"'r~---~- 11,4,~'~' (1<11_1 ~(,..tPl..:. "lllloCcllIbor 5,1997 m. olJ.vot Cewet:ery FaJrviow 'lwp., York Co., PA --,""'AC"""'''''.- "---1'<"",,,",,,- -- -- ''''_r,''_,"".ooiif''''''ii.ii'iTI'al'mo\\{)re'l''lU10ra I llitID~'[iiC,"'- _ _-----JJl,,1'\l. 0If!_6:'~,,1.c.-_--..JmY-'-'20~)X 431. >>C'w t'un!,erland I'A 17070-114)L- lllellMt mt1nc''IIIedQlI 'lof'lh<X~ljtr.".\I""um' d~lllI"lrI.c,""11I<l ~lCfIlSENtJ"'BEfI D~n:SKlMfO ''''~"....",., ,-, ,.,-' )(J....,..., Ii: mow'';' C>,; tlJcnUf. ~ /,{ "3 '17 ...."..............-" ._ "., 6>"";'-- -----10.""00"",,,0'6""',,;;;;;' ""'-.;;;------ ...."".'jffi.A<DIO.""'''' ".,,,,,,,., . ...-.....::::-"::..-.._._._" _1L~- _ A..J!L.------- .__- _ __:-or I ...I.Y ".....', ,..,....".... "......_.._.~''''_''~~.." ,~~,,,,,""'"""'.'"' 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",,'" I I ""I'""",""'"'' """,,, ...oeo",,"'""''''''' DE"" Illf"",/\T1p1101l'IIIl1 ......."...'."'''0'0..' ~~Imllc 1 j(. wowory, i)' 1 Onlh.. b..l. ol..tml"luon .ndJOII/'t~..tl9.1I(l". II' Ifl~ 1I~IIIIOf\. d,"\tlllf'~",r.d II UIIIIrnl, 4.'1. ."d pl.u, ,"d dll' 'II lhl a.ulM~.I.nll "'.""......,,........., .' . .. ......,..., . ,..... . ...' ' .. II.. Zlt (;n'coW,x~l Ill'. ,NeW ClIlluJorland, PA '-i1fQiilf"",,-;","irui""I'oii;""" -----. :;..., / ~ / I _ ::'''~OI.~~2'':~Hlij-------------'------ _fJ?~ ~~~~~~~~=:--~ :~~,-I_ t- ---..---.-- ---~- H.""I.III,QIfl$I.,.ll __ .(1Jt'!:.?.!-,j J.~~/~'I----' - ---- ------- . __-C'4!JL~, 11"",,1 - OUE JO(OO ,,-,>,eXlIISf.l)IJ!',tIC( 0'-\ A. ii- 1'1 ,ll.J J...I _,:(...,.,',1, 4,_,1. ,_,JI'" \'_tL_" .L__ 'l.~r'L, - OIl.~:~)I(lfIA!lA(:OlI';f(iflllttf{L[*l ,_ _...__c.Q;,~~!.!1;'J ..t'tt_/,'/,-- j),1U(~t!- OUE total "~AC(/lSt(J\)tNC[;r;: . _ __.. j)C!(,t!fj mti (/I'! -- wt;t\EAUTI.-ii>sVf'iH(ilOOS l.l"HHf.ROiii'fAlil-----..----.-.. ,fUIJlAI\El'f'lOfI1('1 c()t,lPIElIOH Of CAUSE OfOEAl'H? .-------...~_. . ._.._.~_..__.._--- ,_ ..._u N.llifll ItY' II II '1QIl'''.,,1II ~,,- v..l1 ...[1 ........ .... . , 2'1-97-971 LAST WILL AND TESTAMENT I, ALLEN RICHARD CLARK, of the Township of East Pennsboro, County of Cumberland, Co~nonwealth ot Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish, and declare this as and for my last Will and Testament, hereby revoking and making void all former wills and codicils by me at any time heretofore made, FIRST: I order and direct that all my just debts and funeral expenses by paid by my Executor or Executrix, as the case may be, hereinafter named, as soon as conveniently may be done after my decease. SECOND: I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated, to my wife, DOROTHY MAE CLARK. In the event that my wife, Dorothy Mae CLARK, should predecease me, I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever si tuated, in four equal shares un to my three (3) children, namely Janles William CLARK, Douglas Allen CLARK, Lisa Ann CLARK, and my step-son, Donald William CHESBRO, share and share alike, absolutely and in fee simple. If any of my said children should predecease me and leave lawful issue to survive me, I order and direct that the share of any such deceased child shall be distributed unto his or her lawful issue per stirpes by represe~tation and not pet capita, subject, however to the provisions of Item Third hereinbelow. If there be no such issue, then such share shall lapse. THI~ I order and direct that the share of my estate passing to any person who has not attained the age of twenty-one (21) years shall be delivered and distributed unto Dauphin Deposit Trust Company, of Harrisburg, Pennsylvania, IN TRUST, NEVERTHELESS, (and in separate trusts if there be more than one such beneficiary) to hold, manage, invest and reinvest for the use and benefit of such beneficiary with discretionary power and authority to use, expend and apply from " -2- time to time such amounts of income and principal as my said Trustee shall deem neceseary and appropriate for the beneficiary's education, support and maintenance; and upon the beneficiary attaining the age of twenty-one (21) years, to distribute the remaining balance of said trust to the beneficiary, absolutely. LASTLY: I nominate, constitute and appoint my son, James William CLARK to be the Executor of this, my Last Will and Testament, but if for any reason he should fail to qualify as such Executor or cease so to serve, then and in that event, I nominate, constitute and appoint my second son, Douglas Allen CLARK, to be the Executor hereof, each to serve without bond. IN WITNESS WHEREOF, I, Allen R. CLARK, have hereunto set my hand and seal to this, my Last Will and Testament which consists of ~. I two (2) typewritten pages to each of which I have affixed my ~ signature this fi:J/t day of ()~/ld) ,A.D., One Thousand Nine ~ .. afi.LPA'~ ))1;;", <J l ~. The proceding instrument, consisting of this and one (1) other \~ typewritten page, each identified by the signature of the Testatror, ~j was on the date thereof signed, sealed, published and declared by Allen Richard CLARK, the Testatror therein named, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence, and in the presence of each other, have subscribed our nameS as witnesses hereto. /:); .; /J /J ., 1 v~/ +: ,'/-, m),. . ~;?t. BARBMlA IiI. :,I'J"" eaT :,~ . My Comml::ls1on bpill)~; (.;\:m.:h .:,~, \) ,,: HllrlltJu,llo lJ.uphln CQunty, I'a. (t., ., j,1 [.' . ---"'- L-t j "I_fa. ',;J;j.!,t-.r_,l"-L~"" ~. ,/;7 '" ~ , / Il".t/" 4.;' 2<:y.l~. > > BE SU~E TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < U~7'P~t.AllifJS of perJury. I doclare thaI I have oxamined 1hls rolurn, inCludiJ1Q accompllnying schedllles and Mdlamenls, and to tho 0051 01 my knowleclgQ and btIhof. il i~ lrue. corrool ilnd complflte Oedarahoo 01 Pfapilt&' other ~IlPQLsonalro[)j'esontalivoisbas~rmatiCflOlwhichJl~~1nO'tltledao ~____.________ SIGN.ATtIRE OF PERSON RESP~NSIBLrJ:OR FILING RETURN AODRF.SS _. W _ C~ ll_.~'':!!.i'1\'-~ C!9l!s! Couth.M.Qchanlcsb!!l'i. I'A 17055 Sib TIIRE OF PREPARER OTHER THAN RESENTATIVF. ADDRESS ___h__ rc~'1-v...:l- I~. ____:~---h.5.~-~~I~I'-'I~~~~~~-~-t-'-'-~;-~~~~~-'-~~~!~-- ~ ~~~ ~~-J U.." :t ~ z ~ ~ ~ o u z o F; ~g f-'ll. :Ii o o /.S- - "~I -, - I J REV.1500 INHERITANCE TAX RETURN RESIDENT DECEDENT G..... R~V15t \ '(19/1 j,~t. GOMMON;~SYLVANIA DEPARTMENT OF REVENUE orp] 2iJQ601 H fUF'O R PA 1 I Df:CEOENT'S NAME (LAST, fiRST, AND MIDilLE INITI,4.I) lJ~e a bI&~k bled to "pvolle '/fI)rd$ fU NUMIlER 297 ~ I) 0 9 7 1 ~ W Q W (.1 W Q CLARK, ALLEN HIClIAHD SOCiAl Sf'CUflITY NlJMAFU OATf OF DfAft! OATEOf 6!IWI / 02 / 1997 05 / 17 / 1934 I~ THIS RETURN MUST BE FILED IN DUPLICATE WijH THE REGISTER OF WILLS ----.--. usj1. Original RfltUfIl 0 2, Supplementr11 Return (] 3 Remainder Return Id.teoldltllhpmUllnU2i o 4. Limited Esti:lte [.J 4a. Futuro Interest Compromise (llaleolooafflaftl!112.1H21 0 5. Federal Estate Tax Return Required ~ 6, Decfldp,,\t Died Testate (An;.;tlcopycr\'ldl) 0 7, Docedent Maintained a Ulilng Tru,;t (An,y,hCopyonl~~t) ._._. 8. Total Nllmber of 8al{l Deposit Bmos o 9. Litigation Proceou5 ROCfli'tod LJ 10, Spousal Poverty Credit (dlleoldltathbetwelll\ 12)1.91 and 1.!,!l~) [J 11, E:lection to tax undm Sec, 9113(A) (,1,11I(11 SGIIO) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ~jMIE c IPlFTE MAILlNOAOORESS . r- Robert M. Frey 5 South lIanovOl' B-treet ,iir"""'E I""""""" eal'lisle, P A 17013 Frey and Tiley fF.lf:PfIONE ~IUMeER 71 243-5838 208 - ~4 0140 12 (IF APPLICABLE) ~lJIlVIVlNOf;flOUB[f, ~jMjf (IMlT, FIRSl. AND MIDlJlE INITIAL) SOCIAL SECURITYtlUMBER -"1 1. Real ESlale (Schedule AI (1) I (" l' (l () (! (J () 'n 1 1 " 'I 1 F ;? ..J ~ .' en I I 7 1 {i ;1 / . I, 'I 2 Slock, and Bond, ISchedule 81 (2) 3. Closely Held Corporalion,Parlnership or Sole.Proprlotor'3hip (3) z o ~ :J l- ii: .( u W 0: 4 Mortgages & Nole' Receivable (Schedule D) 5, Cash, Bank DeposliS & Miscelli'lneous Personal Property (Schedule EI 6. Jolnlly OWned ProP"rtv (Sclledule FI 7, Inter-Vivos TrarJsfers & Miscellaneous Non.Probale Property (Schedule G or l) B Tol.1 Oro" AmI, (Iolal Lines 1.7) 9 Funeral Expor"e, & Admlnl,lroll,e Costs (Schedule HI (91 (101 (41 (5) (6) (7) ,/t<21,.r.1s 11 (81 1 I} / (, , r 'I 'I. '-I 0 4/ [I I fl,c) '/ 10. Dobis 01 Decodenl, Mortgage lIabllllle'. & liens (Schedule I) 11. Tel.1 Deduction, (Iolalllne' g & 10) (11) (12) (13) 4 I , U .57",1 1'1.0'/ ,?"F. J ) 12. Ne' V.lue of E,'.'e (Line B mlnu, line 11) 13. (;hantable and Governmental BAq1l9Sts/8cc 9113 Trusts for which an election 10 tax has not been made (Schedule JI 14. Ne' V.lue Subjeclle Tn (linol2 minus Line 13) 15. Amount of line 14 taxable at lhe spousal lax rate I I SflO inslructions on reverse side for applicable percentage 16. Amount of line 14 taxable '1"7 '> -, J '( L '1 J al6%rale ,.~" C I I I .)- .) 17. Amount of line 14laxable <ll 15% ff1to - - (14) " '/ S .) - 'I /,S'.3 ) x .0 (15) -,{ ,~ ~'5-'1' ,~ I / X06 (16) (17) (IBI I / x .15 - - .J < ,..f .,Sn t IB, Tn Due 19. DATE Oet. DATE Oct. 1998 , 1998 DecEldont's Completo Addrllss: ~'";iU'~~~~i.i:;~w p511~ B. ""..;" 1\';'~=-_~~':--=:':::"~~_~- --1 ' -~_P'-----',"-------_.' ..... . . .- -.-- -- ------------.---.---~< ------.~ - LIlY Camp 11111 "WI PA 111' 17011 __..........._.._._,..~_~__._.__..",.,._n...~___ __~_. . -~~--_.- ---... 'Tax Payments and Crodits: 1. Tax D,," (Pngolllllo W) 2. CrodilslPayrll(llll, A. Dnousal POVtlfty Cro<!il ..... ,. ..._~__.__~"_"w,_,,__~ a. Prior P11Yl1l01llS C.Oisco,,"1 (I) 22,559.11 ---r--'-~- ___ ..21..11011..0.0., ___ _ .....____Lllll....!!JL T,)laICradilsIA. 8. C) (2) __~110.00 3. InlerosVPenally il applicilble O. Inlerosl E. Penally Tolallnlero~VPonalty ( D' E I (3) 11111\02 is glaatar Ihan line 1 . IIn~ :1, enlor Ihe dlllerolleo. This is 1110 OVERPAYMENT. Chock box on Plge 1 Line 1910 roquelll refund If line 1 . line 3 15 yreater than lina 2. enlerlho dilforonco This Iq llie TAX DUE. (4) (5) 4 5. 449.11 1M) __.___-Y.:.L 8. Enler Ihe 10101 of Line 5. 5A. This is the BALANCE DUE. (58) ____ 453.32 Make Check Payable to: REGISTER OF WILLS, AGENT Ullllnl~llllauIHllli- . "-_1I'lI.. HL11~....,,- PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS t Old decedent make a transfer and: a, retain the use or income of Ihe property lrensferred; . , b. retain the right to deslgnele who shall use Ihe property transferred or lis income; .. c. retain a reversionary Interesl; or...,.,. ..........,..... d, receive the promise for life of either paymdnts, benefits or care? . 2. If death occurrad on or before Decembor 12,1982, did decedent within two years preceding death transfer property without receiving adequate consideration? If dealh occurred after Decamber 12,1982, did decedent transfer prop8lty within one year of dealh wllhoul receiving adequate consideration?, . 0 [l11 3. Old decedent own an "inlrusl for"' or payable upon death bank accounl or security at his or her death?. .. .....l] 4. Did decedent own an Individual retirement aocoun!. annuity, or other non-probate property?.. ~ A. Enler Ihe Inlaresl on Iha lax due. - Yes ........0 ............0 o o No ~ ~ CiI CiI ~ o IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN liF"""''''i;''''''!'i!~''''\'''''''''j''rlri''''/1''t''''._."1'''~!>'"''K,L'' ";.""'" ,"'''It."" 'fV"~',,.,.,,..,,~,,,,,,.. ";lij~""'l'/J:!Il!l"~"""l\I.; w.~'!;;~~i,~f J~H!tmI'{f~;ot\!~iJ,i'~.Vf-ij.,,!'\~~lJnmiM.i:-f/M"'j7!'_;-'ifil.;';;'_!)-~{'j:'!f}ti~I/'l4!;iJ.t_~h~.}j,;i'ii1!':T,;~rlji~;_';!I;i-;?:<;'j~":\r_!,\H~Io,~~~~'fdt-X'fil:J\l~...,-;,,,,: 72 P.S. ~9118 (a) (1.1) (i) provided for the redllclion of 1110 tax rala Imposed on the nel value oflransfers to or for Ihe use of Ihe surviving spouse from 6% to 3% for dates of death on or after ./uly 1. 19(14 and before January 1, 1995. 72 P.S. ~9116 (a) (1, 1) (II) provided for the reduction of the rale imposed on the nel vallie of Iransfers 10 or for the lIse of the surviving spouse from 3% to 0% for dates of dealh on or altel ./anuary 1. 1995. The slalute go_,,-s I1ClL-"xeml'-l A Iransfer 10 a surviving spouse from tax, and the statutory requlremenls for disclosure of assets Hncl fIIInfl a tax rolllrn are sllll applicable even If the surviving spouse Is the only benefiolary. FOR DATES OF DEATH ON OR AFTER JANUARY 1, 1995 - Pleaso answm Iho following quostion by placing an "x" in the appropriale space. Old the decedent create a trust or similar arrangemunl which Is solely for tho surviving spouse's benefit for his or her entire lifetime? Yes [] No [I If you answered yes to the above questiol1, the tax on the trust or similar arrangement Is postponed 1111111 the dealh of the second spouse, at which time II Will be fully taxable ellho rate(s) applicable 10 tile remainder beneficiary(les). Enter tile value of the trust on Schedule J, Part ii, 111 order to romovo II fromlhe calclllallon of the lax tlue in Ihls estale. You may wish to file Schedule 0 In ordel to make the eleclion available under Section 9113 If the election Is made, the trusl or similar arrangement Is taxed Il1lhe estate of the first decedent spouse, Ihe portion of the Irusl or similar mrangemenl whicl, bene fils Ihe surviving spollse Is taxed al the zero lax rale, and the remainder Is laxed at the rate(s) epplicable 10 Ihe remainder boneflclary(ies). If you cl100se 10 mako the election, you must allac!, Schedule 0 to a timely-flied tax relurn, alol1g with SchHdule(s) K and/or M In order to show Ih. apportion me 111 of the trllsl or similar arrangement belweel1lhe surviving spouso al1d Ihe remainder beneficlary(los) W"'MIIIIIIQI It II . IIdll' to kll".,ln,ly .'11' hll' .l.l"'nU to th, ufllt." ttll.. 11I1 tldl Of .Wl' othlr II.Uu 'OIfa. ,.nattl'l 1110(11\ "<ln~l"tlon ,,11\ illOhlde . 11111 ""1 1.l;>rhol\lI'lIt, ror d.UII. .... T'tll \I \J.6. ClId. I."tlnn 1001 . 1011). .... SE11TloF.MtoiWI' H'PlVrEMEN't "AGg 2 .- ~!!'i"'''~'~':'::''-=-~~=---=~=~=~~::=:::===:::===:==:-~='~=~=: -. ~~"'I. ~.:~-'.!.~~~~u_~~~_~.~.~~-1~.!.!.~IOO~~--,_~~,,--!-w~-~~.!~~~o_.- f--. (lIYIII~~I~~.~_?~.J_~_~~h.!.2~l-~~..!~~~~-_.._-"-~"--- -"--~' ~..-~ ,-~ i---,Ol., 4,I,'.00lo H...Mllt.,. II"\\Y <1101111 -------~------..--.-.----., -~..---..-- --- "iOi~'-.---.;11i:o~ ~.~.~~-i;~i-w.~;t.~-- ."-~;;;;;;i';~';~'il.i-;t;~tt);;~~-'----~"-'--~'~-' ~-----..-.~----.~~.-.-_.-- '----:;O~-..,~_w-----._---.~ _.~-~_.----------.__.-~.----~ --..-.--.-------.---~.--.-. ..-~_. ---"..---' .-- -iOO.IT_nYili:.--"i"M~iCTiQiWlTHm~';-----'--~.----- ~~ ~;~t~h;'-l:"QOOM"'''- .-, -----..~ --- 'OJ. I.o.n OUolJlln\ J.oooo. lOJ. "PIIule.I'" tll 104, arelll\ !.pOft to 10~. I..nlh'f" In'l'floUQl\ r.. '04. Mart,.,. 'l\.oun~o~11:il?ti~n rll ,Ql. "ullaptlon ,.. 101, Flood ,.. ~.:..undll'wrhln,raa "0, 'll. ~~l)0. '01. '02. '0). '04. .~ilJ''';-ItOK~ -;;II;'~ ao....OtIJ,A.. 111,1,'"'' rUIIPI toT ,UIIOII "f '1rM'1,IMIM'r IItr-rUM"ll'r -.-- ----~-~-_. ._._....,-~._..~ _'_"_ .,6()0,00~_ .._~_._____.L.-. .-...--------~,.~ .---~~~;:~~~~ .~.__I,Il)n..:~------------,_ ..------- p~o,OO ,oc . ".Ill) ,00 "~-----~.- ____ u______ - .,- --.-' -'--'-~ -.--- ,. ------ \I ,Oil IOfLII!) -.------ . ..;z In", ~UI"'D I' LIIIPIIt '1'0 .. 'AIO 1M "DV~IIC. hun.\ fIr.- 01/21/" \0 0"01~" .~~...,. In.lluno. "..111. '01 .,onth. \Q ...ud In,lIl'Ino. 'ulll"a 'or yun ~o ".UOIO ,d;;--- 100,11 ---- 'A'. 1000. 1001. 100a, 1(0). )004. I(lO~, 1006. 1001, ~~Ol. l1nO. ~~' 1101. \101. \106. 110S. 1106. 1101. 1--- I 1101, toOOUo.\TI totlJUITHttl1 TtTl.1 clI"A41' --- I.tth.ant or clOlln., ha Ml.tuot or Ull, .uroh - TH1. ....lnulon 'lith In.ureno. bln'h,r 1 _nth." aonth. , , IIOn'h'" . llOn\h.' , 2 aonth' , , Monthe t t 1II"!n\h. . . I 1II0n\h. , . -.-- n.n par Month ".n - pU .unth -- ver IlOnth 41." par all)n\h 261.41 - ~O.IO US.4" plr IlOnth p.rllOnth - plr ItOnth __i1l4.01 per aonlll ..'04,01 _h' P.IIIIIVt!l Plro.ITlD WITH 1..\tOr-1Il "..ard inllluncla Mort,.".ln.lluno, alty proptlrty \all'. _ calln\y.!~P4lfty UlllI .nnual ........nt. oooulII.nt praparatlon IIl1)tIlry'''' "ttornly'l .... to ruy' 'lU'y . ,OC Itllalud'.."('>Y'llllll;-~\iii'i"'O.ad T1th Inluune. 10,00 ~.OO -- to rrancl. M, 'lKlhl, I.q"ir. I ,~-~~ I -~ lilllllud.. abov. H... LlfIIllf'l aov'U,' . OWn.r" COV'I'."" . Ihlab4lu' Ind. UIOOO.OO 140,000,00 100/100/1.1 -- 110t. 1110. OIL - ~~ OYlfnlqht Mail llo.n duo' to PIlaU) lUl. UOO. ClOVlIIJU"'M1' Mco!WllIlJ "liD fUNlnk ell.u.o" !'l01, lI..uorllln, ""' ~ 'IO.OI),"ort,.,., (0,0011'..11..... I'O~, Chy/co,"i\y \all/nUll' I D..d' l,fOO,OO IMort"q'L- U\l1. .ut. tn/.\'.p" DIed' t"eo.oo ,MOI\"19" ~~-_.._- Ul)~, 'I,t ,.nn.llorll Ta....n.hlp ,u""/trulI . Jrd qUI '-JOO, "PtlITIOMM, "TTI,IMI"T 0"1.1'<1'1 1101, lury.y _..~. -~~~-- 110~, .ut In.~c\lon U sw.re I'~~.~-=-~.T~rnl 1)01. ,kdd'l hPlIt. to Odin. ,U1.IO 'OC 1..11.<) U04, IlIA o\nd.uan ",.1 ..Uu thOll' wlfulItyl ~ ~. Jan. .. Ilddl. p,,,'" lIahl>Ol UlllI' _ '400, 'I'OTtoL 'l'l"rUMIMT cllAAQI' can\u II)n line 101, Il<:Illon J .nd Ill.. "OJ, ,,"llnn"l ~- IS,SO -.- -- 10.00 1,'00,00 IIUO.OO ---- 1"1.15 ----. --- -.---------;0:0;- _n_ ----- --- --- ,,400," 1".00 I,.n,~o 1lI,sn,u --"---' c.ll.Tlr1C"Tl0lf IIUUUn\ .lId to tll' ba.t of .y knOllI.d,. .nd b.Il", it I. . tru" .nd .aouut. '>II roy .oaal/Ilt or by.. in till. tnnuatton. I '1IIth.r o.r\lIy that I hay. IIcalved .J..... "liTi-.:;;clirii, Ineli\O' ---- ,.Ihn IlUO-1 ,.UI .nt' a\aa'nl "hlnh I h.~, prtll'u.d II . tro. .nd .ccUIIU ."cnunt 01 tllla llln..otloll. I h'y" n.llud lit "U1 the fUlId. t<1 h" dlllurlld In .coord.nn, with thL' .taU..'lIl, .hlly H, J!l98 Oilii-----.- --_..~-_...----------~ I.\tl...nt. A,,'lIt Ff.not. M. IM.h., ...--;q;j;;--...------------ ), ('IOSIIlII, The parties agree that Closing shallwke place by llIail. The I':xeclltor of the Clark Estate will executc this Assignment Agrecmcnt Hlld rclllrn it to Conlpany's "ounsl'!, Buehananlllgersoll, I'.C., )0 North Third Strcct, Fighth Floor, Harrisburg, I' A 17\ 0 I, along with Clark's or!gillal stoek ccrti firatc. I) pon alld as of (:ompany' s counsel's rl\l'cipt of the cxccul\'d Assignment Agreement and original stO\,k certilkal' '!h' Comp:IIlY shall eountl'r-execute the Assignmcnt Agreemelll and return it by "ertified Illaillo the Clark Estale, :dong with a C\Ttilied check for $11,000. 4. JiclQas.c.. In considcration ofthc agrccments madc by the partics hercin, caeh party, their hcirs, assigns and legal representatives, hercby rclcases the other from and al\ainst allY and all claims, lawsuits, dcmands, damages, losses, lines, costs and cxpcnses (ine.luding reasOllllble attorneys' fecs and disburscmcnts), rcsulting from or rclating in any way to any claim or dcmand made or thrcatened, arising out of or in an way relating to any action takcll or omitted to have been taken by either party in conncetion with the matters addrcssed in this Agrecmcnt, thc business or affairs of the Company whethcr bcfore or after the date of this Agreement or with the rcsolution of the demand madc by Clark to Company to purchase the Shares (including attorncys' fees and disbursements incurred in wnneetion with any settlemcnt of sueh claim, action, proceeding or investigation); provided howcver that any such action taken or omitted to have been taken by either party is not determined to constitute willful misconduct, gross negligence or breach of a matcrial provision of this Agreement with reSpe\1t to thc matter or matters as to which a release is sought S. denera!. A fu;yerability. The invalidity or unenforceability of any provision hereof shall in n() way effcct thc validity or enforceability of any other provision. B. ~. This Agreement supersedes all previous and contemporaneous oral negotiations, commitments, writing and understandings between thc parties concerning the matters in this Agreement. C. Modifications. This Agreemcnt may not be changed or tcrminated orally. No modification, tennination or attempted waiver of any of its provisions shall be valid unless in writing signed by the pal1y against whom the salnc is sought to be enforced. D. QQ.verninil Law. Tbis Agreement and all questions arising in connection with it shall be governed by the laws of the Commonwcalth of Pcnnsylvania, without refcrence to the principles govcrning the connict of the laws applicable in that or any other jurisdiction. E. Waivcr. No failure or dclay by either Company or the Clark Estate in exercising any right or rcmedy under this Agreement will waive any provision of thc Agrcemcnt. Nor will any single or partial exercise by either party of any right or rcmcdy under this Agreement preclude cither of them from otherwise or further A!V.UIO 11'1""1 COMMONWIAlT~ Of 'ENNSYWANI^ INNI!IT~NCI TAX mUiN illlOlNl .le!OINl SCHEDULE 110" TRANSFERS I""-TI'O'" ... . flU NUMIIR AI,LEN HICIIAIW CLAHK 21-97-971 'HIISCHIDULI MUSUI COMrLITID AND rlLlD Ir THI ANSWIR TO ANY or THI QUIITlONS ON THI RIVIRSlIIDI or THI COVIR IHln II YIS. -ITEM' TOTAL VAlUE oleo. 'gollAR VAlU,' NUMleR OESCRIPTlON OF PROPERTY EXClUSION OF "SET % f DEceDeNT S M IN1. INlEReSl 1. USG Annuity & Life Compuny Equitable Life Insurance Co, of lowu IRA 96,050,99 100\\\ 96,050,99 2. Life U,S,A. IRA 28,236.45 100% 28,236.45 3. Oppenheimer Funds IRA 4,308.44 100'!6 4,308.44 NOTE: Beneficiaries of each of the above IRAs are: James William Clark,Douglas Allea Clark, Lisa Ann Byers, and Donald William Chesbro to share equally . . .,....__,.._.__.__.._~ --'-~~.__..... __~.__._,_._......><._"'.'~T~._'_ _.__~________.!()!ALJAII.,,-'~I!.'_~n_lln~7,JI:~apl"'I.~nl. L..-!J_8,5_~~~.8.8 (If'mort .pat:tl. n,.d.d In..'' addltlonol.ht.','o' .om. ,Ire.) U'{1511 U.17,ul SCHEDULE H ~~;fc. FUNERAL EXPENSES, COMMONWEAL'" Of PENN "'VANIA ADMINISTRATIVE COSTS AND IN'i\~\~~';'No',~',~~~ur MISCELLANEOUS EXPENSES I .. . PI.a.. Prlnl or Tvp. ESTATE 6, . -.._--~_._------..-,.--.-----.-- ------fllLE NUM1IER'~"~~-- ITEM NUMBER A. ,. AI,LEN lllCIIAIW CLAnK 21-97..971 DESCRIPTION AMOUNT Fun.ral Exp.n'.1I Parthemore Funeral Home, funeral services New Cumberland Fire Hall, funeralluneheon 7,276.00 500.00 8. Admlnl.tral'''. Co.III 4. C, 1. 2. 3. 4. 5. 6. 7. 8. 1. Personol Representallve Camm11110n. _ Soclol Security Number of Personal Represenlatlve, --.-_.~. Vear Commissions pold _.____.__ ...__.________ 0.00 2. Attorney Fees 11 ,655.00 3. Family Exemplion Clalmonl ___.._...______.__~______. Address of Cloimont 01 decedenl's dooth Slrool Address _____... .__.____________ 0.00 Relat...,nlhlp City ___.___________. _.________.___.__.____..Slole Zip Code_ Pro bale Foes 267.00 MI.collan.ou. Exp.n'.1I ATS debit, automobile payment Checks cleared after death 708.94 277.05 Dauphin Deposit Bank, Visa and Master Card ch8l'ge card balimces 1 ,390.34 57.22 18.94 Mobil, credit card balance PAWC, water bill Bell Atlantic, telephone service 47.69 PP&L, electricl ty Dauphin Deposit Bank, chat'ge for estate checks 68.26 42,42 TOTAL (Also onler on line 9, Recapllulotion) S (If more .pac. I. n..d.d, In..rl addltlonol .h.... 01 .am. .,...) SCHEDULIlIl FUNERAL EXPENSES, ADMINISTRA'r1VE COS'l'S AND MISCELLANEOUS IlXPENSES PAGE 3 ESTATE OF ITEM NUMBER ALLEN RICHARD CLARK DESCRIPTION FILE NUMBER 2H7~911 AMOUNT 37. Patriot-News, advertising Letters Testamentary 121.38 38. Mark Ettinger, cleaning siding, painting 190.00 29. East Pennsboro Township, sewer and trash 87.75. 30. PP&L, electricity 30.12 31. PA Department of Revenue, 1997 Personal Income Tax 14.04 32. PAWC, water bill 14.57 33. G!ngrleh, engraving on gravestone 72.00 34. 1998 County and Borough real estate taxes - 512.44 less pro-ration of 230.68 281.76 35. PP&L, electricity 21,59 36. Bob Foose, cleaning sides of house and tool shed 75.00 37, PAWC, water bill 14.11 38. PSECU, fee 6.00 39. Register of Wllls, 2 short eertlflcates 6.00 40. 1'1'&1" electrlclty 26,83 41. PAWC, water bill 13.67 42. PP&L, electricity 16.73 43. Orkin Pest Control, treatment 567.10 44. Realtor's commission on sale of 566 Brentwater Road 9,600.00 45. Notary Public fee 5.00 46. Recorder of Deeds, I'ealty transfer taxes 1,600.00 47. East Pennsbol'o Township, sewer and trash - 87.75 less pro-I'ation of 66.50 21.25 48. Pest Inspection 30.00 49. ERA Anderson Real Estate, home warranty 385.00 50. 1998-99 school real estate taxes - 1827.50 less pro-ration of 1747.29 80.21 ;5.)171-3 BUREAU Of INDIVIDUAL TAMES IMHERlTAMCE tAl( Dl\1lStDH Df:PT. 280601 ttARRlSlURO, PA lJ'lze~GftOl COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE *' t~~ NOTICE OF INHERITANCE TAM APPRAISEMENT. ALLOWANCE OR OISALlOWANCE Of OEDUCTIONS AND ASSESSMENT OF TAM In-It.' U'" In-tll 12-14-1998 CLARK 12-02-1997 21 97-0971 CUMBERLAND 101 E"~~"-,_U~i:~:d- -3 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-: irr;f-iY-AFP-iil9-:Q7Y-NiifiiSi--oii-YtiHERifANCi-TAX -APjiiiAisEHF.Nf;-ALLoiiANci-oli----------- - --- -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ALLEN R FILE NO. 21 97-0971 ACN 101 ROBERT M FREY FREV II TI LEY 5 S HANOVER ST .CARLISLE DATE ESTATE OF DATE OF DEATH FILE NUMIER COUNTY ACN AUEN R PA 17013 DATE 12-14-1998 ESTATE OF CLARK TAM RETUIlH WAS I I X I ACCEPTED AS FILED I CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RE1URN BASED ONI ORIGINAL RETURN I. R..I Elt.t. ISoh.dul. Al 2. Stockl end Bondi ISohedul. BI 3. tlol.ly Held Stook/P.rtnorlhip Int.r..t ISoh.dul. CI 4. Mortgege./Not.. R.o.i.abl. (Sohedul. DI S. C..h/Benk Depositl/MiIO. P.rlonll Prop.rty ISohedul1 El b. Jointly Domed Prop.rty 150hedulo f I 7. Trenlf.rs (Sohedul. GI .. Total A...t, MOTEl To lnlur' proper oredit to your aooount_ lubIIH the upper portion of thl. forM with your t.. p."......t. (II 160.000.00 121_ 11.321.SS (31. .00 141_ .00 151 117. 081. 64 Ibl .00 171 128.595.S8 1111 416.999.40 191 1101 41.014.09 .00 1111 1121 1151 1141 41.01" 09 375.985.31.. .00 375.985.31 APPROVED DEDUCTIONS AND EXEMPTIONS I 9. Funeral EMpen.../Adm. COlts/HiIC. Expenue, (Sohedule H) 10. Debtl/Nortgege Liabiliti.l/li.nl ISoh.dull II 11. T otel Deduotions 12. Het V.lus of T.. R.turn 13. Charitable/Governaental 8eQUM.t,; Non~.l.ct.d 9113 Trult. (Sohedul. J) 14. Net V.lus ~f Elt.t. Subj.ot to T.. If .fl ........nt was i..u.d previouslY, line. 14, 15 .nd/or 16, 17 and 18 will rllfl.ct figur.. that includ. the total of ill r.tu.'n. a......d to dat.. ASSESSMENT OF TAXI 15. AMOUnt of Line 14 .t Spoul.1 rlt. 1151 lb. AMOUnt uf Line 14 t..obl. .t Lln..l/Cl.11 A r.t. lib) 17. AlOunt of Line 14 t....I. .t Coll.t.r.I/Cl.11 B r.t. 1171 18. Prinuip.1 T.. Due NOTE I .00 M .00. .00 375.985.31 M .06. 22.559.11 -:DOM.15. .00 - 11111_ 22.559.11 TAX CREDITS I PAYMENT DATE 02-26-1998 10-09-199S ------ --------.- DISCOUNT I + I INTEREST/PEN PAID 1-) 1.105.26 .00 AIIOUNT PAlD 21,000.00 453.32 RECEIPT NUIIBER ------riA269796 AA296752 INTEREST IS CHARGED THROUGH 12-29-199S AT THF. RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 22.558.58 .53 4.16 4.69 . If PAID AfTER DATE INDICATED. SEE REVERSE fOR CALCULATION Of ADDITIONAL INTEREST. ( If TOTAL DUE 15 LESS THAH 81. NO PAYMENT 15 REQUIREO. If TDTAL DUE 15 RefLECTED AS A "CREDIT" ICRI. YOU MAY BE DUE A REFUND. SEE REVERSE SIDE Of THIS FORM FOR INSTRUCTIONS. I ,.. ...------------. ~ ;j)~ ,.)"A AtSERYATlO.h e.t.t.. of ~"nh dYint onGr before o.o..ber il, 1982 .... if ..y future Int.r..t 1n ttMI ..tat. II trilnlf.rr4ld 1n po.....lon or ~jo~t to CI... . (coll.t'r.l~ ~flol.rl.. of the ~nt .ftlr the 'Mplr.tl~n of ~Y ust.t. for Uf. or for yur., the eo.tHwIllIlth hlreby IKPr...1Y rINr"'e. tM right to IIPPralH ..t ...... tr.....f.r Im.rItMCe T'M" .t the lewful CI..~ r. reGII.t.r.I) r.te on eny .uch future Int.rl.t. PllRPOSE Of' HDTICE~ To fulfill the requlr...,..t. of SecUon 21itO af thl ]ntMrJt~e IOd E.t,tt '.x Act, Act 21 of 1995. (7Z P.S. SeeUon '140). PAVMF.HTI o.tech the top portion of this Notlc. and .ubltlt ..lth your pllYMf1t to the Rqhter of Nllll printed on the uy.r.. .Ide. .~""e check or IK)MY ordtr peyable tOI REGISTER OF NILLS_ AGENT REFUND (CA)1 A refWld of . t.)( credit, which "a. not r.que.ted 00 the 'ax Return, uy be rllqUe.tad by eapleUog en "ApplloeUon f~r RefWld of p~.ylvanl. In~rltance ~ E.t,te l'x" (REYM1~1~). Application. are .v.llabl. at the Offlo. of thl! RIghter of N11l1, ....y of the 23 Revenue District Offlc.., or by calling the .peed.1 2it-houf answering .arvlcl ~rl for forll ordering: In Penn.ylvanl. 1-800-362-2050, outllde Pvnn.ylvenl. ~ "Ithln 10011 tMlrrbbuf'g .r.. (717) 787"8094, TOOl (717) 772"2252 Uieatlng l"Pair.d Only). OBJECTIONS I Any party In Int.r..t not ..ti.fied with the appr.i....nt, .IIOMence or dl.allowlnC4 of deductions. or .......-nt of t.1< (JnolucUng dltcount or interllU a. .hotm on this Notice IIUlt Object w!thin .Ixty (601 ciays of r.c.lpt af thl. Notlc. bYI ....wrltt.n prot..t to the PA Depert..nt of RIVenue, lo.rd of Appe.ID, Dept. Z81021, Harrisburg, PA 17121w1021, OR --.lecUon to hlv. the ..tt.r d8ter.lned .t IUdIt of the ItOClount of thU perlOMI r.pr..~t.t1", OR --..pIIal to the orphan.' Court. A,,"IN ISTR,.TlYE CORRECTlOHS I Factual .rror. dl.cov_red on thl. ......-.nt .hould be addre..ed ln writing tOI PA Depart..nt of Revenue, Bureau of Individual l.K.', ATTHI POlt A.......nt RGvlew Imlt, Dept. 210601, HarriSbUrg, PA 17128-0601 Phone (717) 787-6505. S.. page 5 of the book1.t "In.tructions for Inheritance T'K R.turn for. R..ldent Dec.dent.. (REY-IS01! for In 'Mpl.n.tion of ~lni.tr.tlvely corrlctlbl. error.. DISCOUNT I If any t.x due i. paid within thr.. (3) c.lend.r .onth. after the dec~t'l d.ath, . five paroent (5~) di.count of the t.x p.ld i. allowed. PENAL TV J The 15X t.x aane.ty non-p.rtlclpation p.n.lty I. c~uted on the tot.1 of the taM end lnter..t ......ed, and not p.ld befo... Jenuary 18, 1996, thl Urllt day after the .net of the tal< ..,..ty periOd. Thit non-pllrtlclpat1on penalty h lIPfleal8ibl. In the .... nnnflr and In the the s..e UIl. p.rlo\' II YOU would 1IPP'.1 the tllX and Int.r..t thlt hi. ~n ......ed ., Indicated un thl. not Ie.. INTEREST ~ Intarelt h chlrgac:l btttlnnlno with fll".t d.y of deUnqutACY, or nine (9) IIOflthl and OM (I) day frOll the data of detth, to the d.t. of pa!lMOt. TeMfll which bec... delinquent before Jlflllary I, 198Z bear Inter..t .t the ret. of III< (6~) percent per ennui c.lcul~ted .t . dally rate of .000164. All t'l(es Which bee... d.llnqu.nt on end .ft.r January 1, 1982 NUl bur int.r..t at II rate Mhlch will va"y frOll cal.ndar y.ar to c.llndar year IIIUh thllt rlt. announced by the PA Depart..nt of R.v~. ThI appliCable inter..t rata. for 1982 through 1999 ar.: Y!!r Inter..t R.t~ Oelly Int.r..t Factor l!!r Int.r..t Rate Oath Int.",st Factol' 19lI' ZO:< .'005lt8 1'"-1991 11:< .000301 I"S 16:< .000438 ..., .% .OO02it7 1.84 m .000501 19'J1-1994 7% .000192 1.85 n:< .000556 199!i-1998 9% .000247 .... lOX .00027'" .999 7% .000192 1987 .% .G002it7 "~Int.rl.t il calcul.t.d a. follOW': INTEREST . IAL.~NCE OF TAX UNPAID X NUHIER OF DAYS DELINqUENT X DAILY INTEREST FACTOR ~-Any Notlo. 1..ued eft.r the t.x beCOlllI delinquent ..Ill reflect an inter..t c.1cul.tlon to fifteen (15) dly. beYond thl det. of ttM ........"t. If paYHflt II .... .H.r the Int.re.t c~ut.tion data .hIMfn M the Notlco, additional Intera.t -U.t be c.lculatad. PAVlElfI' DltllClh thI top portion of thh' MoUe. Met .utMl1't with ~our pay..nt ..de Plylble to the f\NHl and Itddr... pr int" 0f'I the rev.r.. ,leM. IfItESlOOHT DECEDENT .lIke otwelk or hMY nrdtlr payable tOI REGISTER OF WILLS, ~Q,gNT, If MON~RESIDEHT DECEDENT ... eh80k or .OMY ordtir pay8bh tOI COttttONWEAlTH OF PENNSYLVANIA. REFUMD (CR)1 . r'~ of . tllx cl'edit, which ...s not requuted (tfl the hx Return, ..y be requa.tad by coapleUng ., "Appllcltlon for Refund of Pennsylvania Inheritance end estet, Tlx" (REY~1313). Applicationl er. .v.ll~l. at thll OHln. of the R~ht.r of Wills, ..y of the 23 R.v.nue District Dfflult or frOll the D4tplrt.."t'. 24~hoUr InJWer1no .ervice nUlGer. for for.. orderIng I In P,nnlylvanl, 1-800-36Z-Z0S0, out.l~ Penn,ylvanl. 8Md wIthin local Harrisburg er.. (117) 737-8094, TOOl (71?) 772-2252 (H..rlng l~.lr.d only), flf.PLV TOi Questions regarding arrors contained on this notice .t~uld be ~dra"ed tQI PA Depart.ent of Ravanue. IYraeu of Indlvidu81 Tllxa., ~TTHl Po.t A,,,,..."t Revl.w Unit, nept. 280601. Harri.bura, PA 17128-0601, phone (117) 787R6505. DISCOUNlI If ~y taM due i. peid withIn thr.. (5) cIIlendar ~nths .fter the decedent', de.th, II flva percent (5X) di.count of the taM paid Is .1IGNed. PENALTYI The IS% taM __sty non-pllrtlclpat1on penalty h cHPut.d 00 the total of the t.x and Inter..t .......c!. and not pilld before January 18, 1996, thl! f.Irlt de)' after thl end of the tllX ...,e.t)' periOd. INTERfSTI Inter..t II charged beainnlng with flr.t day of delinquen~y, or nine (9) IOnth. and one (1) day fr~ the date of deeth, to the data of plly.ent. 1.Ma. whIch bee..e delinquent before Januery 1, 1982 blsr Intere.t at tha rat. of elx (6%) percent par ~ calculeted at n dally rat. of .000164. All taMa. which bac... delinquent on Ind Ifter JIlnuary 1, 1912 will ~lIr Inhrast at II rata which will \l'lIry frOll cIIle'ldar ynr to calandar yaar with that rat. ~ed by the PA Depart..nt of Reyenue. Tha appllcabla intare.t rate, for 1982 through 1999 .r'l Vnr Intaralt Rata Dally Inter..t Factor "ellr Intere.t Rot. Olllh lnterelt F.ctor 1982 ZOiC .OOO5U 1918-1991 lliC .0aOlOl 1915 16X .00008 lCJ9l 'Ii: .OOOZ~7 1'114 lliC .001301 1993~)994 n .OOO19Z 19I5 13;( .000556 1995-1994 9% .000247 1- lOX .OoaZ7~ 1999 n .000191. I'll 'X .aoOZ"? --Inter..t Is olllcul.ted a. followll INTERSBT m IALANCB OF TAX UNPAID X NUftlSR OF DAYS DSLINQUSNT X DAILY INTEREST FACTOR --An)' Notloa b.uact .fter the t8M lMc~a' d4l1lnqUllnt 1Il1l1 refl.Qt an Inter..t c.lcul.tion to flftean (15) d.y. tMvot'td 'hai dete of the ul.....nt. If PIIVHflt Is .ade Bftar ttHt Intar..t cCNlputetlon det. ""*fl on the Hotlo., addltion.1 Intar..t Ilu.t tMI a.loulRtad. FIRST AND FINAL ACCOUNT OF JAMIlS WILI,IAM CLAHK, EXECUTOR OF 'I'IIE LAST Wll.L AND TESTAMENT OF AI,LIlN RICIIAHD CI,ARK, LATE OF EAST 1'IlNNSBORO TOWNSHIP, CUMBEHLAND COUNTY, PENNSYLVANIA, DECEASED ES'l'ATE FILE NO, 21-97-971 I.ETTERS TESTAMENTARY ADVERTISED: CUMBERI,AND LAW JOURNAL March 20, 27, and April 8, 1998 TilE I'ATRIOT March 16, 23, and 30, 1998 DATE OF DEATII: December 2, 1997 PRINCIPAL RECEIVED Accountant charges himself with thB following' princlpal amounts received: 1997 Dec. 2 Dauphin Deposit BBnk account # 38-33717-7 550.00 2 Dauphin Deposit Bank account #22-82119-8 3,872.09 Accrued interest to December 2, 1997 2.'19 2 Harris Savings Bank account #8203 4,229.67 Accrued interest to December 2, 1997 6.04 4 Life USA, monthly annuity payment 770.09 8 Roll of coins 57.00 8 Cumberland County expense check 125.00 12 Cumberland County paycheck and vacation pay 7,597.91 15 Cumberland County expense check 77.42 24 Proce~ds sa Ie of bottles 3,000.00 24 Proceeds sale of 1986 Pickup truck 2,500.00 29 Proceeds sale of bottles 1,400.00 29 Proceeds sale of recliner 125.00 30 Proceeds sale of VCR 93.00 1998 Jan. 8 Proceeds sale of tools, shredder, compressor, etc. 1,086.00 8 Death benefit, VeterBns Administration 100.00 12 Proceeds sale of mower, rototiller, leM blower 390.00 12 5 shs. Motorola com, @ 64.375 321.88 12 Refund, 360 telephone service 22.76 12 Proceeds sale of household goods 135.00 20 Cumberland County pension 55,421. 00 -1- Jan. 20 Munlclpal account, Bank of Now York 16,01 20 I'roceeds sale of household goods and porsonal pl'operty 2,363.50 Feb. 9 Gross proceeds sale of housllhold - l,elglel"s Auction 12.50 11 Proceeds sale of camera and coins 175.00 19 Gross proceeds sale of household goods and persona 1 property- Zelgler's Auction 4,688.50 23 Refund of pre-paid Interest, G M AC 197.42 26 Proceeds sale of bedroom furniture 200.00 Mar. 9 200 shs, Streetgard, Inc" Restrictive Share Agreement 11 ,000.00 9 Magazine subscription refund 12.31 19 Gross proceeds sale of household goods and personal property- Zeigler's Auction 9,550.00 23 Refund, auto Insurance cancellation 111 .00 Apr. 2 Refund of pre-paid interest, Harris Savings Bank 996.72 June 5 Internal Revenue Service, 1997 Income tax refund 956.00 July 23 Proceeds sale of 566 Brentwater Ct.,East Pennsooro Township, cumberland County, Pa. 160,000.00 Aug. 28 Refund, fire Insurance cancellation 112.00 Miscellaneous household goodS, in kind 5,000.00 1996 Chevrolet Lumina, In kind 12,000.00 TOTAL PRINCIPAL RECEiVED 289,273.61 INCOME RECEiVED Accountant charges himself with the following income amounts received: 1997 - 3 Interest, Dauphin Deposi t Bank Dec. .10 5 Interest, Harris Savings Bank 1.44 15 Interest, Dauphin Deposi t Bank 1.71 19 Interest, Harris Savings Bank 1.72 24 Interest, Harris Savings Bank 3,06 1998 J8tl:"" 8 Interest on Estate account - Dauphin Deposit Bank 6.58 12 I,oss on sale of 5 shs. Motorola (90.78) 23 Interest on Estate account - Harris Savings Bank 32.87 23 Dividend, Motorola .60 Feb. 5 Interest on Estate account - Dauphin Deposit Bank 2.81 25 Interest on Estate account - Harris Savings Bank 118.62 -2- Mar. 6 25 ApI', 7 24 May 7 27 June 5 25 July 25 Aug. 25 28 Sept, 25 Oct, 16 19 Nov. 25 Dec. 24 1999 Jan. 24 Feb. 24 Mar. 25 Apr. 13 23 Interest on Estate account - Dauphin Deposit Bunk Intcrest on Estate account - lIurl'is Suvlngs Bonk Interest on Estate account - Duuphln IItlposlt Bank interest on Estate account - lIarrls Suvlngs Bunk Intel'est on Estate account - Dauphin Dcposlt Bunk Interest on Estate account - lIarl'ls Savings !.lank Interest on Estate nccount - Dauphln\lcposlt !.I811k Interest on Estnte account - lIarrls Suvlngs Uank Interest on Estate account - lIarl'is Savings Bank Interest on Estute account - lIarrls Savings Bank Interest on Certificate of Deposit Investment Interest on Estate account - lIarrls Suvings Bank Interest, PSECU savings account Interest on Estate account .- lIarrls Savings Bank Interest on Estate account - Harris Savings !.lank interest on Estate account - Harris Savings !.lank Interest on Estate account - Harris Savings Bank interest on Estate account - Harris Savings Ranl( Interest on Estate account - Harris Savings Bank Refund, 1998 Federal Income Tax interest on Estate account - lIarrls Savings Bank TOTAL INCOME RECEIVED DISBURSEMENTS Accountant claims credit for the following amounts paid: 1997 Dec. 3 5 12 15 15 15 17 22 30 30 30 30 Register of Wills, Letters Testamentary and 1 short certificate ATS debit, auto payment Checks cleared after' death Dauphin Deposit Bank, Visa and Master Ch!ll'gc balances New Cumbel'land Fire lIal1, funeral luncheon Mobil, credit card balance PAWC, water bill Bell Atlantic, telephone Parthemore Funeral Home, funeral services PP&L, electricity Dauphin Deposit Bank, charge for checks Jay Zelgler, appraisal fee -3- 2.91 80.12 1.85 1(l3.93 1.56 94.28 1.03 29.73 12,84 85.35 822.70 82.15 5.05 74.66 81.48 69.18 33.86 31.48 1.~7 14,150.88 7.03 15,852.37 267.00 708.94 277.05 1,390.34 500.00 57.22 18.94 47.69 7,276.00 68.26 42.42 70.00 , i' ! \ l 1998 Jan, 2 Automobile Insurance premium 108.00 12 Harris Savings Blink, charge for checks 17.99 13 Steve Byers, painting and supplies for dining room 175.00 14 PP&L, electricity G7.20 15 Holy Spirit Hospital, account 35.00 15 East Pennsboro 'rownshlp, sewer and trash 87.75 20 The Patriot News, advertising 11. 50 23 ABC Fuel all Co., heating 011 128.84 23 Automobile Insurance premium 80.50 23 Bell Atlantic, telephone 12.02 23 Reader's Digest, account 46.92 25 PAWC, water bill 21. 34 Feb. 9 PP&L, electrici ty 31.69 9 Zeigler's Auction, com missions 4.40 17 Cleaning supplies 5.07 17 Repairs and maintenance to house 1,150.00 19 Zeigler's Auction, commission and fees 1,410.39 19 Evelyn Byers, cleaning 250.00 21 Automobile Insurance premium 80.50 21 Bell Atlantic, telephone - 12.27 less refund of 2.11 10.16 21 Dan Bllrninger, rea 1 estate appraisal 250.00 26 Lisa Byers, cleaning supplies 21. 71 26 Register of Wills, Agent, a/c Pa. Transfer Inheritance Tax 21,000.00 26 PAWC, water 17.18 'Mar. 6 ABC Fuel all Co., heating oil 146.27 11 Cumberland Law Journal, advertising Letters Testamentary 60.00 12 PP&L, electrlcity 40.17 19 Zeigler's Auction, commissions 961.50 20 PA Department of Revneue, 1997 Fidu'ciary income Tax 5.35 25 PAWC, water bill 14.56 Apr. 3 The Patriot News, advertising Letters Testamentary 121.38 3 Mark Ettinger, cleaning siding, painting 190.00 6 East Pennsboro Township, sewer and trash 87.75 10 PP&L, electrlcl ty 30.12 14 Register of Wills, 1 short certificate 3.00 -4- Apr. 15 I'A Depurtment of Hevenuo, 1997 I'el'sonlll Incomo '['ax 14.04 24 I'AWC, water bl1l 14.li7 30 Gingrich Memol'lals, engrllvlng gl'ave m8l'kel' '12.00 30 1998 County and 'l'ownshlp real estate taxes - 512.44 less pro-ration of 230.68 281.76 May 12 I'P&L, electricity 21.li9 16 Bob Foose, cleaning sides of hOllse and tool shed 7li.OO 27 I'AWC, watel' bl1l 14~1l 28 I'SECU, fee 6.00 JunB 3 Register of Wills, 2 short certificates 6.00 8 PP&L, electricity 26.83 24 PAWC, wuter bl1l 13.67 July 8 1'1'&1" electrl city 16.73 20 Orkin Pest Control, trelltment li67.10 23 Realtor's commission on sule of 566 Brentwatel' Road property 9,600.00 23 Notary Public fee li.OO 23 Recorder of Deeds, realty transfer taxes 1,600.00 23 East Pennsboro Township, sewer and trash - 87,7li less pro-ration of 66.liO 21. 25 23 Pest Inspection 30.00 23 ERA Anderson Real Estate, home warranty 385.00 23 1998-99 schoolreal estate taxes - 1,827.50 less pro-ration of 1,747.29 80.21 23 I'AWe, water bill 12.84 28 PP&L, final electric 27.37 30 PAWe, final water bill 4.25 Oct, 9 RBglster of Wills, filing Pa. Inheritance Tax Heturn lli.OO 9 Register of Wills, Agent, Pa. Transfer Inheritance Tax 453.32 9 Register of Wills, additional probllte fee 35.00 Dec. 15 Register of Wills, bal. I'a, Transfer Inh~ritance Tax 4.69 1999 Feb, 18 Register of Wills, 1 short certificate 3.00 18 PA Department of Revenue, 1998 Fiduciary income tax 48.00 May 4 James W. Clark, reimbursement for miscellaneous costs 6.80 Frey and Tiley, Attorney's fee 11 ,655.00 RBsel've to file Account 120.00 TOTAL DISBURSEMENTS 62,633.25 -5- . 1lI\CAI'I'I'UI,A'I'ION Total Principal Received Totallnoome Reoelvod Total Reoelpts Less Total DlsburBements Balance for Distribution 289,273.61 15,852.37 305,125.98 - 62,633.25 242,492.73 PROPOSED SCHEDULE OF DISTRIBUTION BALANCE FOR DISTRIBUTlON 242,492.73 TOI James Wllllam Clark 2 Cloud Cl'urt Mechanlcsburg, PA 17055 One-fourth residue of estate: Household goods, in kind 1,250.00 Partlal distribution - August 4, 1998 37,000.00 Partial distribution - December 15,1998 12,000,00 Partial distribution - February 22, 1999 4,000.00 Bnlance for distribution 6,373.19 60,623.19 TO: Douglas Allen Clark 215 Locust Lane . DllIsburg, P A 17019 One-fourth residue of estate: Household goods, In kind 1,250,00 1996 Chevrolet Lumina, In kind 12,000.00 Partial distribution - August 4, 1998 37,000.00 Partial distribution - February 22, 1999 4,000.00 Balance for distribution 6,373.18 60,623.18 TOI Lisa Ann Byers 102 Crescent Streat " Hummelstown, PA 17036 One-fourth residue of estate: Household goods, in kind 1,250.00 Partlal distribution - August 4, 1998 37,000,00 Partial distribution December 15, 1998 12,000.00 Partial distribution - February 22, 1999 4,000,00 Balance for distribution 6,373.18 60,623.18 -6- I~ST W~LL AND TESTAMENT I, ALLEN RICHARD CLARK, of the Township of East Pennsboro, County of Cumberland, Commonwealth of Pennsylvania, belng of sound and disposing mind, memory and understanding, do milke, publish, and declare this as and for my last WHl and Testament, hereby revoking and making void all former wills and codicils by me at any time heretofore made, FIRST: I order and direct that all my just debts and funeral expenses by paid by my Executor or Executrix, as the case may be, hereinafter named, as soon as conveniently may be done after my decease. SECOND: I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated, to my wife, DOROTI1Y MAE CLARK. In the event that my wife, Dorothy Mae CL~RK, should predecease me, I give, devlse and bequeath all the rest, res idue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated, in four equal shares unto my three (3) children, namely James William CLARK, Douglas Allen CLARK, Lisa Ann CLARK, and my step-son, Donald William CHESBRO, share and share alike, absolutely and in fee simple. If any of my said children should predecease me and leave lawful issue to survive me, I order and direct that the share of any such deceased child shall be distributed unto his or her lawful issue per stirpes by representation and not pet capita, subject, however to the provisions of Item Third hereinbelow. If there be no such issue, then such share shall lapse. THIRD~ I order and direct that the share of my estate passing to any person who has not attained the age of twenty-one (21) years shall be delivered and distributed unto Dauphin Deposit Trust Company, of Harrisburg, Pennsylvania, IN TRUST, NEVERTHELESS, (and in separate trusts if there be more than one such beneficiary) to hold, manage, invest and reinvest for the use and benefit of such beneficiary with discretionary power and authority to use, expend and apply from '".. -2- time to time such amounts of income and principal as my said Trustee shall deem necessary and appropriate for the beneficiary's education, support and maintenance I and upon the beneficiary attaining the a~e of twenty-one (21) years, to distribute the remaining balance of said trust to the beneficiary, absolutely, LASTLY: I nominate, constitute nnd nppoi.nt my son, James William CLARK to be the Executor of this, my Last Will and Testament, but if for any reason he should fail to qualify as such Executor or cease so to serve, then and in that event, I nominate, constitute and appoint my second son, Douglas Allen CLARK, to be the Executor hereof, each to serve without bond. . IN WITNESS WHEREOF, I, Allen R. CLARK, have hereunto set my hand and seal to this, my Last Will and Testament which consists of ~ two (2) tYPewritte~ages to eacb of which I have affixed my .signature I:his };/ day of (i1Alr) ,A.D., One Thousand Nine Hundred Eighty Two (1982). ~ ~ 7 ~Ja;k~.~ / ~ The proceding instrument, consisting of this and one (1) other \~ typewritten page, each identified by the signature of the Testatror, ~ was on the date thereof signed, sealed, published and declared by Allen Richard CLARK. the Testatror therein named, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence, and in the presence of each other, have subscribed our names as witnesses hereto. If;:~ BARBARA ~(~tgfMI1 My Commission ""pl.os March ~2, I).,J Hllr1Iburjl, Dauphin Coun\\l, Pa.