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HomeMy WebLinkAbout02-0015Register of Wills of ~ County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of ~J also known as £~,3e~e ~¢cle /,d;'s3;¢d~ , Deceased TESTAMENTARY .o. Social Security N°. ZoF-Iq-3q'-17 (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that PetitionerO~is/~t~he executor- named in the Last Will of the '~ Decedent, dated f'ebrv~c~ ZS', 197q and codicil(s) dated Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: B. Grant of Letters of Administration {c.t.a.. d.b.n.c.t.a.: pendente lite; dulante absentie; du~m~te mlnoritate) I Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship -,. Residence' (COMPLETE iN ALL CASES:) Attach additional: heats if necessary. Decedent was domiciled at death in (~l~ ~r-10.~to~ County, Pennsylvania, w,t._h=h. ,s/.l~e~last family or p. dncipal' residence at '7 70 pole/Ac Cl, xqrc~ P.-~. , Ca./~? /_~Z,'//.. · , (list street, numbe~ mid n~/nicipalit¥) Decedent, then 7~' 'years of age, died ~//~¢¢e. bc~r / ~ , 20o_L' at /-/~/.y Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property ....................... '.. (If not domiciled in PA) Personal property in Pennsylvania ...................... $ (If not domiciled in PA) Personal property in County .............. ' ............ Value of real estate in Pennsylvania ............................................... Total ..................................................... Real Estate situated es follows: Wherefore, Petitioner(s) respectfully .request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Signature Typed or printed name and residence RW-7 /57~,.F/,/:3 '~ Oath of Personal Representative Commonwealth of Pennsylvania County of ~-~~x CUMBERLAND The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to and affirmed and subscribed before me this 2hth day of __ De_c~rDk2~r 20 Ql Mary DECREE OF REGIST~F Estate of ~~'?~ E. WISGIRDi~,, A/K/A Deceased No. 21-2002-0015 EUGENE EARLE WISGIRDA also known as Social Security No: 208-14-3447 Date of Death: November 19,2001 AND NOW, FE'RRUARY 2.2nd 20 Q2~, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ®Testamentary ^ of Administration _ are hereby granted to ~~.~.a.: e.o.n.ac.; uanaen~a iiie; d~~ame osseous; ewame minmita~ei in the above estate and that the instrument(s), if any, dated Codicil N,,~~ch 26th, 1997 described in the Petition be admitted to probate and filed of record aslast mill of~l~edent. c FEES ° c~ ~ a Letters ........................... S 60.00 ~~, Register of Wills M~Y"~7 C• -:~W1S ~~ Short Certificate(s)........ S 6.00 ~ `-' _:.. Codicil °~ .~ ~ . as Renunciation .................. S Affidavit ( ) ................. 5 Extra Pages (1 )............ S 3.00 dx ........................ S JCP Fee ........................ $ 5.00 Inventory & Tax Forms... S Other ............................ S TOTAL ................ g 84.50 ~m,R~ ~.a 7a MAILED LEVERS Td AZ I'URNEY Attorney: tsars L - ~~ t~i'c~i~d~ I.D. No: ~Z~~~ Address: ~'-/S 1 orc~S"~ ~~%~~s ~r~ Sf~ 3S /~rr~ 3L~iJ~~ z /''A J 7//~~ ~ _. Telephone:_ (717 ~ 5 yU - 3 S la DATE FILED: December 26, 2001 WILL AND TESTAMENT' 1~O 616 21-2002-0015 in the County of ~°rtNW~PP/M and State of Pennsylvania, being of sound mind, memory and understanding, do make and publish this my last will and .testament, hereby revoking and making ~oid all former wills by me at any time heretofore made. And first, I diree~ that my funeral be conducted in manner corresponding with my estate and situation in fife and that all my just debts and funeral expenses be fully paid and satisfied as soon as coffveniently may be after my decease. As to such estate as it hath Pleased. God to intrust me with, I dispose of the same as follows, viz: bC~8//~,gYg.-~ /~¢'/q/ .-/¢/.¢-?1~ ;u!oddv pu~ ~;n;!;suoa 'o;~m. mou Xqo~aq I ptrv Register of Wills of Dauphin County, Pennsylvania OATH OF SUBSCRIBING WITNESS Estate of ~_ ~) o~ ~_ ~,~ ~-- also known as , Deceased 91-2002-0015 (each) a subscribing witness to the~,codicil(s) FJwill(s) presented herewith, (each) being duly qualified according to law depose(s) and say(s) that s~e/he/tbe¥ was/we+e present and saw the above Testator(+i~-f sign the same and that she/he/tla~y signed as a witness at the request of Testatork~) in his/l~r~r presence and [] in the presence of each other I~ in the presence of the other subscribing witness(~ff. '~Signature) (Add~ess) ' ' (Signature) Sworn to or affirmed and subscribed before me this ~r~%~-~.. day of N°tar~Public , My C~mission E~xp,ires: NOTE: (Address) To be taken by officer authorized to administer oaths. Please have present the original or copv of Instrument(s) at time of notarization. RW-11 THE LAW OFFICES OF GARY L. ROTnSCmL1) 2215 Forest Hills Drive Suite 35 Telephone (717) 540-3510 Northwood Office Center' Harrisburg, PA Facsimile (717) 540-3512 17112 January 7, 2002 Ms. N/f;.~y C. Lcghvis, R.~gi'oter of Wills REG~ER Ot~VILES'"'OFFICE Cum~er~gnd C~nty Coqghouse '1 Co~ouse ~are Carli~A 1~13 Re: Estate of E~gene Earle Wisgirda, Deceased · 21-2002-0015 Dear Ms. Lewis, I represent Marvin W. Waiter, the named Executor of the Estate of Mr. Eugene Earle wisgirda. Mr. Wisgirda died on November 19, 2001. On December 26, 2001 I appeared at your office With Mr. Walter and presented Mr. Wisgirda's Will and Codicil to one of your staff. At that'time I filed Mr. Walter's Petition For Grant of Letters and Pennsylvania Department of Revenue Estate Information Sheet and paid the requested probate fees of $ 84.50. As Mr. Wisgirda's Codicil and Will were not notarized Mr. Walter gave an Oath affirming the signatures of Mr. Wisgirda. The Petition, filing fee and Estate Form were to be held pending submission of a second "Oath of a Subscribing Witness" which I have now obtained and enclose herewith. Please forward a receipt for the $ 84.50 previously paid, issue Letters Testamentary and Short Certificates as requested. Also, please forward a copy of the Cumberland County Status Report and InventOry to be filed by the Executor. I have enclosed a postage-prepaid, return envelope for your convenience. Please contact me if you have any questions concerning the enclosed. Gary L. Rothschild, Esquire Enclosures cc: Mr. Marvin W. Walter (w/ enclosures) THE LAW OFgiCES OF GARY L. ROTnSCmLD 2215 Forest Hills Drive Suite 35 Telephone' (717) 540- 3510 Northwood Office Center Harrisburg, PA Facsimile (717) 540- 3512 17112 February 6, 2002 Attention Donna REGISTER OF WILLS' OFFICE Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Eugene Earle Wisgirda. Deceased Dear Donna, I represent Marvin W. Walter, the named Executor of the Estate of Mr. Eugene Earle Wisgirda. Mr. Wisgirda died on November 19, 2001. On December 26~ 2001 I appeared at your office with Mr. Walter and presented Mr. Wisgirda's Will and Codicil to one of your staff. After filing, it was determined that the Codicil which I had presented was not the original, although the second page, indicating witnesses, was an original. I have been in contact with the attomey that drafted the Codicil and he has forwarded ,the original signature page of the codicil. I believe that after the codicil was signed the original pages were copied and somehow not stapled together. I have enclosed what I believe is the original first page of the codicil and would ask for your inspection of the same. It appears to me that the enclosed is the .original based upon the way the signature overlaps the typed name of the decedent. If you agree that the enclosed is the original page one of the Co~ticil, please forward a 'receipt for the $ 84.50 previously paid, issue Letters Testame~n. taryand Short Certificates ~as requested. Also, please forward a copy of the Cumberland County Status Report and Inventory to be filed by the Executor. I have enclosed a postage-prepaid, return envelope for your convenience. , .~ Please contact me if you think the enclosed is not the"ori~.fial page or if you have any questions concerning the enclosed. Enclosure Very truly yours,~, cc: Ralph H. Wright, Jr., Esquire (w/o enclosure) Mr. Marvin W. Walter (xv/o enclosure) 21-2002-0015 FIRST CODICIL TO LAST WILL AND TESTAMENT OF EUGENE EARLE WISGIRDA I, EUGENE EARLE WISGIRDA, now a resident at Blue Ridge Haven West, Camp Hill, Pennsylvania, hereby declare this to be the First Codicil to my Last Will and Testament previously executed by me on February 25, 1979. 1. If my wife, ALMA NAOMI WISGIRDA, predeceases me, or dies at such time that the order of our respective times of death cannot be determined, then, and in either such event, I give, bequeath and devise all of my estate, of whatever nature and wherever situate, unto the grandchildren of my said wife, DAVID WALTER, of West Chester, Pennsylvania, DOUGLAS WALTER, of Harrisburg, Pennsylvania, MICHAEL WALTER, of Mechanicsburg, Pennsylvania, and LINDA WOOD, of Harrisburg, Pennsylvania, share and share alike, or their issue, per stirpes. 2. I revoke the appointment of my wife, ALMA NAOMI WISGIRDA, as Executrix of my will, and in her stead, I appoint as my Executor my wife's son-in-law, MARVIN W. WALTER, of Harrisburg, Pennsylvania. If for any reason he should be unable to serve, or to continue to so serve, I appoint in his stead, with the same powers and duties, my wife's granddaughter, LINDA WOOD, of Harrisburg, Pennsylvania. 3. Except as herein modified, all other provisions of my Last Will and Testament shall be and remain in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~{~ day of March, 1997. 21-2002-0015,- FIRST CODICIL TO LAST WILL AND TESTAMENT OF EUGENE EARLE WISGIRDA I','EUGENE EARLE WISGIRDA, now a resident at Blue Ridge Haven West, Camp Hill. Pennsylvania, hereby declare this to be the First Codicil to my Last Will and Testament previously executed by me on February 25, 1979. 1. If my wife, ALMA NAOMI WISGIRDA, predeceases me, or dies at such time that the order of our respective times of death cannot be determined, then, and in either such event, I give, bequeath and devise all of my estate, of whatever nature and wherever situate. unto the grandchildren of my said wife, DAVID WALTER, of West Chester, Pennsylvania. DOUGLAS WALTER, of Harrisburg, Pennsylvania, MICHAEL WALTER, of Mechanicsburg. Pennsylvania, and LINDA WOOD, of Harrisburg, Pennsylvania, share and share alike, or their issue, per stirpes. 2. I revoke the appointment of my wife, ALMA NAOMI WISGIRDA as Executrix of my will, and in her stead, I appoint as my Executor my wife's son-in-law, MARVIN W. WALTER, of HarriSburg, Pennsylvania. If for any reason he should be unable to serve, or to continue to so serve, I appoint in his stead, with the same powers and duties, my wife's granddaughter, LINDA WOOD, of Harrisburg, Pennsylvania. ' 3. Except as herein modified, all other provisions of my Last Will and Testament shall be and remain in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~{o'l'~ day of March, 1997. Signed, sealed, published and declared by the said EUGENE EARLE WISGIRDA, the above testator, as and for the First Codicil to his Last Will and Testament, in the presence of us, who have hereunto subscribed our names at his request as witnesses thereto, in the presence of the said testator and each other. · Witness{]' ~,~'" - Register of Wills of .Dauphin County, pennsylvania OATH OF NON-SUBSCRIBING WITNESS Estate of ~._~,~ ~_~.~,.~_. also known as , Deceased 21-2002-0015 (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that s~dhe/t~ was/v,~em familiar with the signature of&o~-,~_~,.L ~-~,-~'~ ~.~'~',¢~c. , testator(rix) of th~ presented herewith, and that such subscriber(~ believes the signature on the will is in the handwriting of ~_ ~.~L ~,.~ ~.%~.~_ to the best of such subscriber's kn0wledge~nd belief, {Sionaturel (Address) (Signature) (Address) Sworn to or affirmed and subscribed before ~n~ this ~r'~ day of Fort~Register ' ' A RW-12 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death:- Eugene E. Wisgirda, also known as Eugene Earle Wisgirda November 19, 2001 Will No. 2002-00015 Admin. No. n/a To the Register: I certify that notice of estate administration required by Rule 5.6 (a) of the Orphans' ,Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on Name Mr. David Walter Mr. Douglas Walter Mr. Michael Walter Ms. Linda Wood March 20, 2002 Address Way-Lin Manor,Apt. 311 2020 Garrett Road 2456 Aspen Way 703 Moores Mt. Road 5007 Mt. Ridge Lane Lansdowne, PA 19050 Harrisburg, PA 17110 Mechanicsburg, PA 17055 Harrisburg, PA 17112 NotiCeDate: has~//~.//o ~n°w been given to all perso~ Signatu~ e~ (a) except: n/a. Nallle: Gary_ L. Rothschild, Esquire Capacity: Address: Telephone: X 2215 Forest Hills Drive, Suite 35 Northwood Office Center Harrisburg, PA 17112 (717) 540-3510 Personal Representative Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 001 538 ROTHSCHILD GARY L ESQUIRE 2215 FORREST HILLS DRIVE SUITE 35 HARRISBURG, PA 17112 ........ fold ESTATE INFORMATION: SSN: 208-14-3447 FILE NUMBER: 2102-001 5 DECEDENT NAME: WlSGIRDA EUGENE E DATE OF PAYMENT: 08/1 9/2002 POSTMARK DATE: 08/1 6/2002 COUNTY: CUMBERLAND DATE OF DEATH: 11/1 9/2001 ACN ASSESSMENT CONTROL:" NUMBER ~ AMOUNT 101 $1,232.94 TOTAL AMOUNT PAID: ,232.94 REMARKS. MARVIN W WALTER C/O GARY L ROTHSCHILD ESQUIRE SEAL CHECK# 508 INITIALS: CW RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS o P. EV. I~eo.~(.. (e.ee) · COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601. 'REV,1500 INHERITANCE TAX RETURN RESIDENT DECEDENT USE ONLY OFFICIAL ,, [ 21 02 000]5 ] COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Wisgirda, Eugene E 208-14-3447 DATE OF DEATH (MM-DD-YEAR) . DATE OF BIRTH (MM-DD-YEAR ~HIS RETURN MUST BE FILED IN DUPLICATE WITH THE 11/19/2001 01/20/1926 REGISTER OF WILLS SOCIAL SECURITY NUMBER OD ,~ n,z O0 F APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) predeceased, [] 1. OdginalReturn [] 2. Supplemental Return ] 3. Remainder Return (date of death pdor to 12-13-82) [] 12-31-91 and 1-1-95) qAME Gary L. Rothschild 4. Limited Estate [] 4a. Future Interest Compromise (date of death after [] 5. Federal Estate Tax Return Required 12-12-82) 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach 0 8. Total Number of Safe Deposit Boxes of Will) copy of Trust) -- 9. Litigation Proceeds Received [] 10. Spousal Poverly Credit (date of death between[] 11. Election to tax under Sec. 9113(A) (Attach Sch O) I COMPLETE MAILING ADDRESS :IRM NAME (If applicable) The Law Offices of Gary L. Rothschild FELEPHONE NOMBER 717/540-3510 2215 Forest Hills Drive, Suite ~5 Harrisburg, PA 171 i2 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 8,652~15. None None-. 30,354~189.: None 30,433.51 7,1~9.65 34,842.34 (8) (11) 12. Net Value of Estate (Line 8 minus Line 11) (12) 69,440.55 42,041.99 27,398.56 27,398.56. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) 16. Amount of Line 14 tax.able at lineal rate 27,398.56 x .045 (16) 1,232.94 17.Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .1,5 (18) 19. Tax Due (19) 1,232.94 20. [] ; Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Deoedent's Complete Address: ISTREET ADDRESS . CITY ' Camp Hill 770 Poplar Church Road STATE PA ZIP Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty (1) Total Credits (A + B + C) (2) Total Interest/Penalty tD + E) (3) 17011 1,232.94 0.00 0.00 4. If Line 2 is greater than Line I + Line 3, enter the difference. This is the OVERPAYMENT. ~ (4) Check box on Page 1 Line 20 to request a refund ~, 5. If Line l + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. i (5) 1,232.94 A. Enter the interest on.the tax due. ; (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. i (5B) 1,232.94 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X' IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ................................................ j ................................. [~ . b. retain the right to designate who sha use the property transferred or its income'. ........... [ ....................... c. retain a reversionary interest; or .......................................................................................... , ............ d. receive the Promise for life of either payments, benefits or care? ...................................... [ ....................... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate cons derat on? ....................................................................................................................... [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or he~r death? ......... [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a benefic ary des gnat on? .............................................................................................. [ ....................... [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE ~ AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my kn preparer other than the personal representative is based on all information of which preparer has any know~edge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS SI~' TtJRE OF P~'RSOTN~ESISO~ISIBi'E FOR I~ILIN~R~'TI~I ADDRESS 4399 St. Andrews Way Harrisburg, PA 17112 )wtedge and belief, it is true, correct and complete. Declaration of DATE DATE SIGNATLJRE~ OF PREPARE~ OTHE~AN R~PR 'ESEI3~TATIVE ADDRESS _ - ,, -- - [ ~. . DATE /(// .//~V//' ~ 2215 Forest Hins Drive, Suit,e .~, ~/ ! . Harrisburg, PA 171,12 i ~/15'JoZ- For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net valffe of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) il .1) (i)]. I For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for tl~e use of the decedent's siblings is 12% [72 P.~. §9116 (a) (1 3)] A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether bylblood or ad(~pii(~. COMMONWE/U.~'I OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Wisgirda, Eugene E 21 - 02 - 0 0 01 5 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivomhlp must be disclosed on.schedule F. ITEM VALUE AT DATE OF NUMBER DESCRIPTION DEATH Checking Account-Mellon Bank, Acct. # 100-010-5211 (see attached statement) Personal Account-West Shore Health & Rehab.. Refund for prepaid care-West Shore Health &Rehab. Refund for long-term care insurance - John Hancock Mutual Life Insurance Co. TOTAL (Also enter on Line 5, Recapitulation) 5,632.30 796.61 1,620.42 22,305.56 30,354.89 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER ~ Wisgirda, Eugene E 21 - 02 = 0 0 01 5' This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE VALUE ITEM Include the name of the transferee, their relationship to decedent and the date of transfer. VALUE OF ASSET INTEREST NUMBER Attach a copy of the deed for real estate, (IF APPLICABLE) 1 Annuity-Mellon Bank/Transamerica Life & Annuity 30,433.51 100% 30,433.51 Contract #'26252860 Two Mellon Bank Ctr, 500 Grant St:, Room # 4905, Pittsburgh, PA 15259 £ TOTAL (Also enter on line 7, Recapitulation) 30,433.51 OMMONV~-ALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Wisgirda, Eugene E FILE NUMBER 21 - 02 - 00015 Debts of decedent must be reported on Schedule I. ITEM NUMBER Ao DESCRIPTION FUNERAL EXPENSES: ADMINISTRATIVE COSTS: Personal Representative's Commissions Marvin W. Walter Social Security Number(s) / EIN Number of Personal Representative(s): Street Address 4399 St. Andrews Way City Harrisburg State PA Zip 17112 Year(s) Commission paid 2003 Attorney's Fees The Law Offices of Gary L. Rothschild Family Exemption: (If decedenrs address is not the same as claimant's, attach explanation) Claimant predeceased Street Address 770 Poplar Church Road City Camp Hill State PA Zip Relationship of Claimant to Decedent Spouse Probate Fees Advertising fees, letters testamentary, short certificaites, etc. Dailey Funeral Home-death certificates 17011 Accountant's Fees .Tax Return Preparer's Fees Carol A. Schreckengaust, CPA Other Administrative Costs AMOUNT 3,400.00 3,400.00 236.65 13.00 150.00 TOTAL (Also enter on line 9, Recapitulation) 7,199.65 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Wisgirda, Eugene E 21 - 02 - O O O/5 Include unreimbumed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 34,697.25 Commonwealth of PA- Department Of Public Welfare-nursing home care claim (See attached letter fi.om Commonwealth of PA) Pharmerica-medical costs U.S. Treasury-balance due on 2001 personal income tax return TOTAL (Also enter on Line 10, Recapitulation) 86.09 59.00 34,842.34 SCHEDULE J BENEFICIARIES RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE Do Not List TrusteelRt Io TAXABLE DISTRIBUTIONS (include outright spousal distributions) I Mr. David Walter Grand Stepchild one-fourth (1/4) Way-Lin Manor, Apt. 311 2020 Garrett Road Landsdowne, PA 19050 2 Mr. Douglas Walter Grand Stepchild one-fourth (1/4) 2456 Aspen Way Harrisburg, PA 17110 3 Mr. Michael Walter Grand Stepchild one-fourth (1/4) 703 Moores Mt. Road Mechanicsburg, PA 17055 4 Ms. Linda Wood Grand Stepchild one-fourth (1/4) 5007 Mt. Ridge Lane Harrisburg, PA 17112 Enter dollar amounts for distributions shown above on lines 15 through 17, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. C'HARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Wisgirda, Eugene E 21 - 02 - 0 0 01 5 ( )-:Mellon' Bank PERSONAL BANKING STATEMENT ;,'-,"'.",.f: ;~:;.'~ DIRECT INQUIRIEs TO= MELLON BANK NA 0 · . " .. ~ COMMONHEAETH REGION LINGLESTOHN .... ' .................................., Z005 "L"INGL ESTOHN' RD 717-SfiO-731fi EUGENE E ~ISGIRDA 00152 THE ~IO'ANNUAL FEE FOR YOUR DEBIT CARD HAS BEEN ELIMINATED." ................. .-AND*,*'"BEGZNNZNG *ZN.'DECEMBER"200I;' THE"~I-MONTHLY-FEE 'FOR THE"ATM CARD' 14ILL ALSO BE ELZNINATED~./-:~?/T'".:;~f.,,-.~.:-'*: 14,.;*~'T ',:",:,,'. ::*/, ;~:~'.~t!~'i::~(~::: :?\;'::,~ ':!" ~::. ~, ~,. ;,..,~.., .... -.. ,.,,.. RELATIONSHIP SUMMARY DEPOSIT ACCOUNTS BALANCE LOAN ACCOUNTS CHECKING HITH INTEREST 5Z633.7~ TOTAL 5,633.7~ OUTSTANDING CHECKING WITH INTEREST, ACCOUNT 100-010-5211 OPENING BALANCE AS OF 10/Z5/01 8,6~.38 TOTAL DEPOSITS AND OTHER ADDITIONS INCLUDING INTEREST CREDITED THIS PERIOD +1,51~.~9 TOTAL CHECKS AND OTHER HITHDRANALS INCLUDING FEES AND CHARGES THIS PERIOD -~525.13 CLOSING BALANCE AS OF 11/Z7/01 .5,633.7q. AVERAGE ACCOUNT BALANCE 6,258.2:8 AVERAGE COLLECTED BALANCE FOR ANNUAL PERCENTAGE YIELD EARNED 6,Z2:8.13 YOUR ANNUAL PERCENTAGE YIELD EARNED FOR THIS STATEMENT PERIOD IS O.ZSZ DEPOSITS CHECKS DATE AND OTHER AND OTHER DAILY pOSTED DESCRIPTION ADDITIONS HITHDRANALS BALANCE 10/Z$/01 OPENING BALANCE 11/01/01 MZSC AUTOMATED CRED JOHN HANCOCK · 101111fi660PENSlON 0000060000~0~19 ~87.95 11/02:/01 CHECK t 181 ........... ' ....... ~,375.17 11/08/01 DEPOSIT REF ~000002:3000038Z8 1~02:$.10 11/Z1/01 11/Z7/01 11/2:7/01 CHECK It 18~' ............. ~. lq9.96 INTEREST CREDIT .' -// I.~4' SERVICE CHARGE ........ CLOSING BALANCE 8~6~-14.38 %13~.33 5,78Z. 26 5,63Z.30 COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS ESTATE RECOVERY PROGRAM, PO BOX 8486. ' HARRISBURG. PA 17105-8486 March-~28;~.?,~6.02 GARY L ROTHSCHILD ESQUIRE 2215 FOREST HILLS DRIVE SUITE 35 NORTHWOOD OFFICE'"CENTER HARRISBURG PA '-17112~?.~.~i Dear ·Attorney Rothschild: Re:"EUGENE WISGIRDA.~(ESTATE)'' SSN:.208-1'4-3447 Date'of Death:,:11~19/2001 Please:be,'advised that ~he Department'of Public Welfare maintains a claim in th~ amgunt of $34,697.25 ~gainst the above-mentione~.estate.~,'This claim is fori~reStitution'.pf..medical assistance granted..~n behalf.of,'~the decedent for whfch.~e'Proba~e Estate is n0w'resp6nsible .t9 rei~urse'the Department accordf~g't0 A~t 49, 62 'PIS. 1412, effective August:'15~ '1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the.~Department's itemized statement of claim. '~. . A portion of this'medical expense, namely $.00, was incurred during the last..sixymonths of the decedent's life; therefore, it is a Class. 3 claim pursuant to Section 3392.of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim~ .namely,.$34,697.25, is to be entered as a priority Class 6 claim against the estate. -~ Please acknowledge receipt ~f this letter and advise whether the Commonwealth's claim.is admitted and when payment may be expected.. If the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a current appraisal, if available. Sincerely, · Elaine L. Andrews Claims Investigation A~ent 717-772-6608.: '.'~ 21-200~-0015 WIL//, AND' TESTAMENT l~io. 6:].6 in the Count-y of "5~'~)~ekc~'7:v/'b~ ~d and State of Pennsylvania, being of sound mind, memory and understanding, do make and publish this my last will and .testament, hereby revoking ,and making void all former wills by me at any time heretofore made. And first, I direct that my funeral be conducted in manner corresponding with my estate and situation in life and that all my just debts and funeral expenses be fully paid and satisfied as soon as con'veniently may be after my decease. /ks to such estate as it hath Pleased. God to intrust me with, ! dispose of the same as follows, ViZ: And I hereby nominate, constitute and appoint Exec't~t~tx of this my last will and testament. In Witness Whereof, I ~'d~'~-o'4~' ~'~4~_~ ~/..~'~ : the Testat~m ,have to this, my will, written on one sheet of paper, set my hand and seal, this One Thousand Nine Hundred and ~'~¢~ 7-~" Ajt,, ~,/£ (7~.}  "'~i ........ ( SEAL ) Signed, sealed, published and declared - - 'Cd t~gt//2__~- as and for ,v¥] ,~ last will and testament, in ~he presence of us, who have hereunto subscribed our name~ at request as witnesses tJ~ereto, in the presence of the sai, ~Testao~ I' and of each 'other. FIRST CODICIL TO LAST WILL AND TESTAMENT _OF EUGENE EARLE WISGIRDA_ 21-20o2-0015 I, EUGENE EARLE WISGIRDA, now a resident at Blue Ridge Haven West, Camp Hill. Pennsylvania, hereby, declare this to be the First Codicil to my Last Will and Testament previously executed by me on February 25, 1979. 1. If my wife, ALMA NAOMI WISGIRDA, predeceases me, or dies at such time that the order of our respective times of death cannot be determined, then, and in either such event, I give, bequeath and devise all of my estate, of whatever nature and wherever situate, unto the grandchildren of my said wife, DAVID WALTER, of West Chester, Pennsylvania. DOUGLAS WALTER, of Harrisburg, Pennsylvania, MICHAEL WALTER, of Mechanicsburg, Pennsylvania, and LINDA WOOD, of Harrisburg, Pennsylvania, share and share alike, or their issue, per stirpes. ' 2. I revoke the appointment of my wife, ALMA NAOMI WISGIRDA, as Executrix of my will, and in her stead, I appoint as my Executor my wife's son-in.law, MARVIN W. WALTER, of Harrisburg, Pennsylvania. If for any reason he should be unable to serve or to continue to so serve, I appoint in his stead, with the same powers and duties, my wife's granddaughter, LINDA WOOD, of Harrisburg, Pennsylvania. ' 3. Except as herein modified, all other provisions of my Last Will and Testament shall be and remain in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand and seal this "2/o'B'~day of March, 1997. Signed, sealed, published and declared by the said EUGENE EARLE WISGIRDA, the above testator, as and for the First Codicil to his Last Will and Testament, in the presence of us, who have hereunto subscribed our names at his request as witnesses thereto, in the presence of the said testator and each other. THE LAW OFFICES OF GARY L. ROTHSCmLt) 221S Forest Hills Drive Telephone (717) $40-35i0 Suite 35 Northwood Office Center Harrisburg, PA 17112 Facsimile (717) 540-3512 August 15, 2002 Ms. Mary C. Lewis, Register of Wills REGISTER OF WILLS' OFFICE Cumberland CoUnty Courthouse 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Eugene Earle Wisgirda, Deceased, No. 21-02-00015. Dear Ms. Lewis, Enclosed please find an original and two copies of the Inventory and Inheritance Tax Return (REV-1500) for the above-referenced estate. Please accept the original and one copy for filing with your office and return the extra copies to me i~ the enclosed, self-addressed, poStage prepaid envelope. Please time-stamp all documents prior to processing them. Also enclosed is a check in the amoUnt of $1,232.94, payable to the Register of Wills, Agent, representing full payment On the Inheritance Tax. Please include a receipt for this payment. Finally, please bill me or advise, me as to what is owed, for the additional fee for the letters which were issued, as the estate has exceeded the originally estimated value of $ 30,000.00. If you have any questions regarding this letter or the enclosed please contact me, Thank you for your attention to this matter. Very truly yours, ary Rothschild, Esqmre _ Enclosures cc: Mr. Marvin W. Walter (w/enclosures) o~ CUMBERLAND RegiSter of Wills of 5;)~u~b~ County, Pennsylvania INVENTORY Estate of Eugene E. Wisgirda No. 21 - 02 - 0001 5 also known as Eugene Earle Wisqirda , Deceased Date of Death 11 / 19 / 2001 Social Security No. 208-14-3447 I, Marvin W. Walter,4 the authorities. Name of Attorney: I.D. No.,: Address: Personal RePresentative~) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the' end of this inventory. I/~V~ verify that tho statements made in this Inventory are true and correct. 1/31~6 understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to Personal Representative: -,) .~/. _ Gary L. Ro ths child ~-- r.~,//,~~ ~/.~//~ 62041 Marvin W. Walter 2215 Forest Hills Dr., Suite 35 Harrisburg, PA 17112 Dated Telephone: ( 7 1 7 ) 5 4 O-- 3_5 1 0 RW-8 Description 1) 221 shares -John Hancock Financial Servic~ 2) Checking account- Mellon Bank 3) Personal account- West Shore Health & Reh~ 4) 5) 6) Refund for prepaid care- West Shore H & R Refund-long term care insurance Annuity-Mellon Bank/Transamerica Life and Annuity LZ:ZM 6L 9Rd ZO. (Attach Additional Sheets if necessary) Value 8,652.15 5,632.30 796.61 1,620.42 22,305.56 30,433.51 Torah $ 69,440.55 NOTE: The Memorandum of real estate outside the ComrnonweaKh of Per~ns¥1vania may. at the election of the personal representative, include th~ value of each item, but such figures should not be extended into the total of the Inventory. THE LAW OFFICES OF GARY L, ROTHSCHILD 2215 Forest Hills Drive Suite 35 Telephone (717) 540-3510 Northwood Office Center Facsimile (717) 540- 3512 Harrisburg, PA 17112 August 19, 2002 Attemion: Cheryl REGISTER OF WILLS' OFFICE Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Eugene Earle Wisgirda, Deceased, No. 21-02-00015. Dear Cheryl, Thank you for your telephone call today concerning the above-captioned matter. Per your instructions, I am enclosing a check, in the amount of $ 35.00, to cover the filing fee for the Inheritance Tax Return ($15.00), the Invemory ($10.00) and additional probate costs ($10.00). If you have any questions regarding this letter or the enclosed please contact me. Thank you for your attention to this matter. Very tm_ly yours, Gary . Rothschild, Esquire Enclosure cc: Mr. MarVin W. Walter (w/o enclosure) ~' BUREAU OF ZNDZVZDUAL TAXES INHERITANCE TAX DIVISION DEPT. 180601 HARRISBURG, PA 1711~-0601 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX GARY L ROTHSCHILD G L ROTHSCHILD LW OFCS 2215 FOREST HLLS HBG P~*~1'711.2: DATE ESTATE OF DATE OF DEATH FILE NUNBER COUNTY ACN 09-50-2002 WISGIRDA 11-19-2001 11 02-0015 CUMBERLAND 101 REV-l;4? EX t~FP (01-02) . EUGENE E ... Amoun'~ Remi'l"l:ed I HAKE CHECK PAYAI~LE AND REMIT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER pORTION FOR YOUR RECORDS DISALLOWANCE OF DEDUCTZONS AND ASSESSHENT OF TAX ESTATE OF WISGIRDA EUGENE E FILE NO. 21 02-0015 ACN 101 DATE 09-'$0-2002 TAX RETURN WAS: (X) ACCEPTED AS FTLED ( ) CHANGED RESERVATTON CONCERNZNG FUTURE ZNTEREST- SEE REVERSE APPRAISED VALUE OF RETURN DASED ON: ORIGINAL RETURN 1. ~aal Es~a~a (Schedule A) (1) 2. S~ocks and Bonds (Schedule B) (2) $. Closely Held S~ock/Par~narSh/p In~eres~ (Schedule C) ($) ~. Hor~gagas/No~as Receivable (Schedule D} (~) $. Cash/Bank DaposA~s/Hisc. Personal Proper~y (Schedule E) (5) 6. JoAn~ly Owned Propar~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al Asse~s APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expansas/Adm. Cos~s/HAsc. Expanses (Schedule H) (9) 10. Dab~s/Nor~gaga LAabAli~Aas/LAans (Schedule ~) (10) 11. To~al Daduc~Aons 12. Na~ Value of Tax Re~urn .00 8~652.15 .00 .00' 30~$54.89 .00 3'0 ~ ~33.51 (8) 7,199.65 (11) (12) 13. NOTE: ASSESSHENT OF TAX: 15. Amoun~ of L/ne 1~ a~ Spousal ra~a 16. Amoun~ of LAne 1~ ~axable a~ LAneal/Class A ra~e 17. Amoun~ of LAne lq a* SAbl/ng ra~e 18. Amoun~ of L/ne 1~ ~axable a~ Collateral/Class B ra~e 19. Principal Tax Due TAX CREDITS: PAYHENT RECEZPT DZSCOUNT (+) DATE NUHBER INTEREST/PEN PA/D (-) 08-16-2002 CD001558 .00 Char/~able/Govarnmen~al Bmquas~cs; Non-elected 9113 Trusts (Schedule J) (13) Na~ Value of Es~a~e Sub.~ec~ ~o Tax (lq) Zf an assessment ~as issued previously, lines la, 15 and/er 16, 17, reflect figures that include the tota! of ALL returns assessed to date. NOTE: To Ansura proper credA~ ~o your account, submi~ ~ha upper portion of ~hAs form w/~h your ~ax payment. 69,~0.55 ~2.0~1.99 17,398.56 1F PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .00 27,398.56 18 and 19 w111 · ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT 1S REQUIRED. 1F TOTAL DUE [S REFLECTED AS A 'CREDIT" (CR}, YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) TOTAL TAX CREDIT I · ALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 1,ZSZ.9~ ANOUNT PAZD 1,232.9~ .00. .00 .00 (16) 27,598.56 x Oq5 = 1,232.9~ (17) . O0 x 12 .= .00 (18) .00 x 15 = .00 (19)= 1,232.9~ RESERVATION: PURPOSE OF · NOTICE: PAYHENT: REFUND OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 11, 19BI-- if any future interest in the estate is transferred Jn possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life er for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawfuI CIass B (collateral) rate on any such future interest. To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act Z~ of ZOOD. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Hake check or money order payable to: REGISTER OF NILLS~ AGENT . A refund of a tax credit, which mas not requested on the Tax Return~ may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office of the Register of Nills, any of the 13 Revqnue District Offices, or by calling the special Z4-hour answering service for fores ordering:'I-800-56Z-ZO50; services for taxpayers eith special hearing and / or speaking needs: 1-800-447-3010 ITT only).. Any party in interest not satisfied with 'the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of. receiEt of this Notice by: --written pretest'to the PA Department of Revenue, Board of Appeals,,Dept. 281011, Harrisburg, PA 17118-1011, OR --election to have tho matter determined at audit ef the account of the personal representative, OR --appeal to the Orphans' Court. " Factual errors discovered an this assessment should be addressed in writing to: PA Department of RevenUe,; Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 180601~ Harrisburg, PA 1711B-0601 Phone (717) 7B7-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return fo~ a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three [5) calendar months after the decedent's death, a' five perCent [5X) discount of the tax paid is alloeed. The 15Z tax amnesty non-participation penalty is computed on th~ total of the tax and interest assessed, and not paid before January lit, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is. charged beginning with first day of delinquency, or nine (9) months and one (13 day from the date Of death, to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of six (613 percent per annum calculated at a daily rate of .000164. Al1 taxes ahich became delinquent on and after January 1, 198Z will beer interest at a rate.which will vary fram calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOZ are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1982 ZOZ .000548 1992 92 .000247 1985 162- . 000438 1995-1994 72 * . . OOOlYZ 1984 112 .000301 1995-1998 92 .000147 1985 132 . 000356 1999 72 . 000192 1986 101 .000Z74 '. ZOO0 81 .000119 1987 9Z . 000147 ' 2001 9Z . OOOZ~7 1988-1991 11Z .OD0501 ZOOZ 61 .00016~ --Interest is calculated as folloas: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DALLY ]:HTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. ESTATE SETTLEMENT AGREEMENT AND RELEASE THIS AGREEMENT by and between Marvin W. Walter, as Executor of the Estate of Eugene E. Wisgirda, deceased, of East Pennsboro Township, PA (hereinafter referred to as "the estate") and Mr. David Walter of Landsdowne, PA, Mr. Douglas · Walter of Harrisburg, PA, Mr. Michael Walter of Mechanicsburg, PA and Ms. Linda Wood of Harrisburg, PA as testate residuary beneficiaries of the said estate (hereinatSer referred to collectively as "the beneficiaries"). In accordance with their desire that the administration of the Estate be terminated without the expense and delay of any court accounting, the parties hereto, in consideration of the mutual covenants herein expressed, and intending to be legally bound hereby, agreed that: The Estate of Eugene E. Wisgirda, who died on November 19, 2001, is now in the process of administration, Letters Testamentary having been duly granted to the Executor.by the Register of Wills of Cumberland County on February 22, 2002. ga Pursuant to the Last Will and Testament of Eugene E. Wisgirda as amended · ~- by ttie~_First Codicil to the Last Will and Testament of Eugene Earle Wisgirda, m d~stnb.~t~on of the resid~ary estate is as follows: Ct.- M~2David Walter z_, ,M~Douglas Walter '~Michael Walter ~Linda Wood 3. The parties acknowledge that the Executor has received the assets set forth in the Inventory, a copy of which is attached hereto and made a part hereof, and the parties approve the said Inventory in its entirety. 25 % (twenty-five percent) 25 % (twenty-five percent) 25 % (twenty-five percent) 25 % (twenty-five percent) The parties acknowledge that the Executor has received the assets and made the payments as set forth in the First and Final Account of the Executor, a copy of which is attached hereto and made a part hereof, and the parties approve the said Account in its entirety. The parties hereto agree that the remaining balance of the estate assets shall be distributed as set forth in the Schedule of Distribution, a copy of which is attached hereto and made a part hereof. Without intending to limit the rights or remedies of the Executor, the parties further agree to indemnify the Executor and save the Executor harmless against liability, loss and expense (including, but not limited to, costs and counsel fees) which the Executor may incur, whether due to the Executor's negligence or otherwise, as a result of his service as Executor of the Estate of Eugene E. Wisgirda, Deceased or making the above-described distributions. The beneficiaries authorize the Executor to reserve the sum of Nine Hundred Seventy Six and 11/100's Dollars ($ 976.11), pursuant to the Proposed Schedule of Distribution. Said reserve shall be held to pay for any legal and/or accounting fees due for the preparation of the final estate fiduciary tax returns and for the docum~ ents necessary to complete the administration of the estate. The Executor shall then distribute to the beneficiaries any and all remaining monies, in the proportion of their interests as set forth below: Mr. David Walter Mr. Douglas Walter Mr. Michael Walter Ms. Linda Wood 25 % (twenty-five percent) 25 % (twenty-five percent) 25 % (twenty-five percent) 25 % (twenty-five percent) Said distributions of the balance then remaining, which shall include any additional interest and/or dividends earned on the custodial estate accounts, less any additional expenditures deemed proper by the Executor, shall be made without further accounting. Should any proper liabilities of the Estate, whether for taxes or otherwise, arise or come to the attention of the Executor or any of the parties thereafter, the undersigned beneficiaries agree to be jointly and severally liable therefor. 7. The parties, and each of them, hereby forever fully release, compromise, settle and discharge any and all claims, demands, actions or causes of action, legal or equitable, absolute or contingent, vested or hereafter to accrue, which any of them may have against any other party hereto or against the Estate of Eugene E. Wisgirda, Deceased or the Executor thereof or Gary L. Rothschild, Esquire (counsel to the Executor), by reason of any matter, cause or thing growing out of or relating to any property or assets of the said estate, or growing out of or relating to any act of the Executor in his administration of the said estate, even if attributable to negligence, and agree that any period for the limitation of actions for the collection of any erroneous distribution or , distributions shall commence only at such time as the Executor shall have obtained actual knowledge of such erroneous distribution or distributions and that in no event shall the period for collection of any erroneous distribution or distributions be less than two (2) years after the actual discovery thereof by the Executor. The parties do hereby covenant, promise and agree to indemnify and save harmless the Estate, the Executor and Counsel from all loss or damage, and from the payment of any and all sums of money to any person(s), for or by any reason of this partial distribution; and will refund and repay to the Estate, upon demand by the Executor or his Counsel, all or any portion of 10. the monies distributed through this Settlement Agreement are later determined by the Executor or his Counsel to have been improperly or imprudently paid. The parties agree to execute such additional releases as the Executor may submit to them in order to confirm their discharge from any further liability to the parties in connection with the said estate. 'This Agreement may be executed in multiple counterparts and, when so executed, shall be binding upon all the parties, and their respective heirs, successors, next-of-kin, administrators, personal representatives and assigns. This Agreement shall be governed by the laws of the Commonwealth of Pennsylvania. .. this IN WITNESS WHEREOF, the parties have hereunto set their hands and seals :3}Sr dayof /~)/ ,2003. Witness: MR. DAVID WALTER, Beneficary of the Estate of Eugene E. Wisgirda, Deceased MR. DOUGLAS WALTER, Beneficary of the Estate of Eugene E. Wisgirda, Deceased , Beneficary'o{the /~tate of Ef~ne E. Wisgirda, Deceased 0(IS//~INI3.~ WOOD, Beneficary of the Estate of Eugene E. Wisgirda, Deceased' 3 RegiSter of CUMBERLAND Wills of B b -County, INVENTORY Pennsylvania coPY Estate of Eugene E. Wisgirda No. 21 - 02 - 0001 5 also known as Eugene Earle Wisqirda Date of Death 11/19/2001 , Deceased Social Security No. 208-1 4-3447 I, Marvin W. Walter,, the Personal Representative~) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/~ verify that the state~ents made in this Inventory are true and correct. I/~¢.~ understand that false statements herein are made sqbject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: I.D. No..: Personal Representative: Gary L. Rothschild ,~,,/~,//~/~'¢-~' 62041 Marvin W, Walter 2215 Forest Hills Dr., Suite 35 Dated Harrisburg, PA 17112 Address: Telephone: (717) 540-3510 RW-8 Description 1) 221 shares -John Hancock Financ±al 2) Checking account-'Mellon Bank 3) Personal account- West Shore Health & 4) Refund for'prepaid care- West Shore H 5) Refund-long term care insurance 6) Annuity-Mellon Bank/Transamerica Life and Annuity Servic. Rehi & R (Attach Additional Sheets if necessary) Value S $ 8,652.15 5,632.30 796t J61 ~'.' . ' >1 , 620';542 :.; .. ~, 305.56 :::' -340,43'3'.;'51 Total: $ 69,440.55 NOTE: The Memorandum of real estate outside the Commonwealth of Pednsylvaniamay, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DIVISION No.: 00015 Year of 2002 ESTATE OF EUGENE E. WISGIRDA, DECEASED LATE OF EAST PENNSBORO TOWNSHIP FIRST AND FINAL ACCOUNT OF MARVIN W. WALTER, EXECUTOR Date of Death: Date Letters Granted: First Complete Advertisement of Letters: Account for the period: November 19, 2001 February 22, 2002 April 12, 2002 November 19, 2001 to May 31, 2003 Purpose of Account: Marvin W. Walter, Executor, offers this account to acquaint interested parties with the transactions that have occurred during his administration. It is important that the account be carefully examined. Requests for additional information, or questions, or objections, can be discussed with: Gary L. Rothschild, Esquire 2215 Forest Hills Drive, Suite 35 Harrisburg, PA 17112 Supreme Court I.D. Number 62041 (717) 540-3510 SUMMARY OF ACCOUNT PRINCIPAL PRINCIPAL PER INVENTORY FILED PLUS: PRINCIPAL RECEIPTS LESS: PRINCIPAL DISBURSEMENTS LESS: LOSS ON SALE OF JOHN HANCOCK STOCK LESS: ANNUITY PAID DIRECTLY TO BENEFICIARIES LESS: RESERVE FOR FINAL FIDUCIARY TAXES AND MISCELLANEOUS EXPENSES NET PRINCIPAL REMAINING $ INCOME INCOME RECEIPTS LESS: INCOME DISBURSEMENTS NET INCOME REMAINING COMBINED BALANCE FOR DISTRIBUTION $ $ $ 69,440.55. 23,366.57 40,402.59 2,283.40 30,433.51 976.11 18~711.51 288.49 -0- 288.49 19~000.00 2 PRINCIPAL RECEIPTS Date Payor/Explanation 03-22-02 John Hancock life insurance proceeds TOTAL PRINCIPAL RECEIPTS Amount $ 23,366.57 $ 23,366.57 Date 03-05-02 03-05 -02 03-21-02 03 -22-02 03-25 -02 04-02-02 04-11-02 04-11-02 05-03 -02 06-05 -02 07-01-02 08-15-02 08-15-02 PRINCIPAL DISBURSEMENTS Payee Purpose Pharmerica-medical fees Gary L. Rothschild, Esquire -'legal fees and reimbursement for costs advanced: Gary L. Rothschild, Esquire - legal fees Dailey Fuunerai Home-death certificates Thomas Miller-legal fees Gary L. Rothschild, Esquire - legal fees and reimbursement for costs advanced: U.S. Treasury-balance on taxes owed Carol Schreckengaust, CPA-tax services Gary L. Rothschild, Esquire - legal fees and reimbursement for costs advanced: Gary L. Rothschild, Esquire- legal fees Gary L. Rothschild, Esquire- legal fees Register of Wills- Inheritance Tax Commonwealth of PA- reimbursement for medical services provided Amount $ 86.09 636.50 81.00 13.00 75.00 368.00 59.00 150.00 311.15 336.00 272.00 1,2'32.94 34,697.25 09-03 -02 10-02-02 11-04-02 10-02-02 01-15-03 02-05 -03 Gary L. Rothschild, Esquire - legal fees and reimbursement for costs advanced: Gary L. Rothschild, Esquire - legal fees Camp Hill Fire Co.-medical bill Gary L. Rothschild, Esquire - legal fees Holy Spirit Hospital Gary L. Rothschild, Esquire - legal fees 979.00 163.00 35.27 32.00 811.39 64.00 TOTAL PRINCIPAL DISBURSEMENTS $ 40~402.59 Date 03-05-02 03-05 -02 03 -22-02 04-12-02 05-13-02 06-13-02 07-17-02 08-13-02 09-12-02 10-04-02 11-08-02 INCOME RECEIPTS Payor Amount John Hancock-dividend $ 68.51 Interest Income 4.95 Interest Income .57 Interest Income 8.13 Interest Income 13.59 Interest Income 14.32 Interest Income 12.83 Interest Income 21.68 Interest Income 23.69 Interest Income 22.31 Interest Income 8.19 12-08-02 12-16-02 01-17-03 02-23-03 03-14-03 04-12-03 Interest Income John Hancock-dividend Interest Income Interest Income Interest Income Interest Income TOTAL INCOME RECEIPTS 2.57 70.72 4.03 4.47 3.83 4.10 288.49 ACCOUNT BALANCES: Checking Account-Waypoint $19~976.11 ESTATE OF EUGENE E. WISGIRDA~ DECEASED PROPOSED SCHEDULE OF DISTRIBUTION Total Cash On Hand: Less: Monies reserved as per Settlement Agreement and Release and First and Final Account Total Available for Distribution Under Will and Codicil 19,976.11 $ 976.11 $19~000.00 Proposed Distributions as Per Codicil: Executor's Fee- to Marvin W. Walter Mr. David Walter Mr. Douglas Walter Mr. Michael Walter Ms. Linda Wood Total Proposed Distributions $ 3,400.00 3,900.00 3,900.00 3,900,00 3,900.00 $19,000.00 Marvin W. Walter, Executor under the First Codicil to the Last Will and Testament of EUGENE E. WISGIRDA, deceased, hereby declares under oath and penalties of perjury that he has fully and faithfully discharged the duties of his office; that the forgoing Cash on Hand is true and correct; that the First and Final Account is true and correct; all known monies' owed to or · received on behalf of the estate are included in said balance; that all known claims against the estate ha~,e been paid in.full, that, to his knowledge, there are no claims now outstanding against the Estate, and that all taxes presently due from the Estate have been paid. Date: ~>'~,1o.~ '.' ~/~~ ff~r_/ff~_~~. 'Mt~R. V1N W. WALTER, EXECUTOR COMMONWEALTH OF PENNSYLVANIA · COUNTY OF DAUPHIN · SS. On this'23 1 day of ~ , 2003, personally appeared before me, a Notary Public, MARVIN W. WALTER, Executor of the Estate of Eugene E. Wisgirda, known to me (or satisfaCtorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I heretinto set my hand and official seal. \ My Commission Exp~re~' NoTASIAL SEN.. / City of Harrisburg, Dauphin County LUy, Commission Ex. pims May 21.2005 PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH. REGARDLESS OF THE STATUS OF .THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION STATUS REPORT UNDER RULE 6.12 Name of Decedent: Eugene E. Wisgirda a/k/a Eugene Earle Wisgirda Date of Death: · 11 -1 9-2001 , Will No.: 2662-00015 Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: State whether administration of the estate is complete: Yes xx No. If the answer is No, state when the personal representative reasonably believes that the administration wil}be complete: Date: If the answer to No. 1 is yes, state the following: Did the personal representative file a final account with the court? Yes No xx Co The separate Orphans' Court No. (if any) for the personal representative's account' is: Did the personal representative state an aCCount informally to the parties in interest? Yes xx No (MAH:rmffAM3) Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this >4- Gary L. Rothschild, Esq. Name (Please type or print) 2215 Forest Hills Dr., Address Suite 35 (7171 540'-3510 Telephone No. R.W. - 27 Capacity: Personal Representative Counsel for Personal Representative