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HomeMy WebLinkAbout02-0020PETITION FOR PROBATE and GRANT OF LETTERS Estate of Th a ~ as G• Wa t>ze rs ~ .Jr. also known as Deceased. Social Security No. ~~ 9 - `f `/- 33 9,3 No. 21-02:-20 To: Register of Wills for the County of ~r±'~ b e r I an o1 in the Commonwealth ~~f Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut r ~ x named in the last will of the above decedent, dated 7e c eir+ber l l , 19~- and codicil(s) dated (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in C u m b e r~ pnd County, Pennsylvania, with h'~s .last family or principal residence at al5 5. Norwav &F. ~_1~11er.hanj~s 6,~- (list street, number and muncipality) SOD 1 Decendent, them ___ N 9 years of age, died Dee c.n b e r- a 9 , ~ , at CIS 5. Norcvas Sf, Mechani~sbµra Ph Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offer d for probate; was not the victim of a killing and was never adjudicated incompetent: fFs o~ dar o~ w:/1 clecerlenf was %~ vrecess o{ d; yvrce wb%cti beeu-nr ~i;,al~'~~. FoMn1[I' 6/~iaSP i$ Since rYMw~riG4~ i~1 /¢+^~ZO~+e D/1 .q trn4/~+o.~ Clq~r/iL°f Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ S~ °OD' o0 (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ ~°~ oy°' °v situated as follows: 2 /S 5. /t/OrWR y ~St'. ~ fylecka niCSba ~ ~rouAl, WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters ~L'StaMC11 t"arN (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. yam-- ~ - ~v ~ X . ,t ~ c nix-Q.4._./ew ~ k~ t`~ ~ ~-~.~-- ~, ~~(Lne S1'e»Ser Kci C. Dianne. ~ >r ~ o ~ ~D FS ex I O ~ c _ Na rYlcConl-ellsbarcr Pf} 11~ 33 v~ ~o m "v-~C.~' OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 1 ss COUNTY OF Cum ~ETZLiIN~ The petitioner(s) above-named swear(s) or 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 represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed ~ ~ {~~ ~-~'~`-t ~~~ before me this 8th day of ~,a N < ~~ r.~ - r(e f>c~~ ~'~ ,Ati;ve S-rev~ e'~- JANUAR ~8~ SLQ2 ~ ~o ' Registe rte- ~~ - ~' ~~.('~1 f~T ~/~l/c~T G!~ ~~G L. , A~,o t=7Tin-eNe~~ No. Estate of 21-02-20 THOMAS G WATTERS JR Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW JANUARY 9 }~ 2002 in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated DECEMBER 11, 1995 described therein be admitted to probate and filed of record as the last will of THOMAS G WATTERS JR ; and Letters TESTAMENTARY are hereby granted to DIANE STENGER (aka C. Dianne Stenger) ~~ Re 'ter of Wills FEES Probate, Letters, Etc. ......... $ > > s . nn Short Certificates( ) .......... $~~ x-pages. Renunciation ................ $ JCP FEE $ 5.00 TOTAL $ 138.00 .Filed ...~~1~IUAk~X.$x..2001 .............. ATTORNEY (Sup. Ct. I.D. No.) ~$'S/3 (~ C/ouser ,Pa! l~lec6iar~tcs~burw, /rf l7osS v ADDRESS ~/7 - 7lo~O --0209 PHONE ~ ~..~ w ~ 0 ~,~ 4U ~~ ~` (~. _ T t _.,~ llJ ,. ._ .A` : - . f,,.3 his is to certith' that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the Stare Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. fee for this certificate, $2.00 P I ~.J ,J ~ 0 ~ I No. 21-02-20 ~~ . N,O6.1HS4v. 1N1 Tr-P~PwNT N PEIWAIBIT !LACK EEC .. e{r . Local Registrar ,2 0 Dare COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS r.~ CERTIFICATE OF DEATH (Coroner) ~ .. . NAME Of DECEDENT 6ir. µoA~, Lrq .. - .. .. .. .. :... .. ~ . ~ SEX S[CURRV NUMBER DwE OF DERH Pvr+. Dq. Mr) ,, ' - ,.... .. ,. Thomas .. G Wa ~.. ,... ,+ . .., _ . ... ~ December 29 2001 :-.Mae '• - 3393° AOE RAr BTtl,y) uNOER,rEAR uNDEA,Da owe awnr. sElrwucE rd .~ ~ w~ccof DEaH~wyw»-r.rw~o~.o~, an«xa.~ MaVlr Dy, 1~ 11k,rr ~MK~~~ 9r~«F«•Ipn CawtrY) Hpgp~TliL• pT11Eit ~ " . +^ Ew~Owrrrr^ _ DoA^ „~ ^ RrMrr~ ~m^ " 12-30- f 49 1 kMrL Orrt wnlM. ac. .!0110. oP DERV rAaurr NAMEa,w nrYJhLa••rNr rW,,,ro.,~ cnl,rtr DF OERN _, _ 1Mo L1Ar4 (30w r'"" "'° " • Norwa Street ' " 1 5 Sout l i ` , Whfte Mechanicabur 2 eE vv r u EERn "u1LANMAI'011CEiT~ DECEDOR'SEDUCJE,ON ~ ~ > ~ d„a..o~+~rw«y M p1,.Nrod.ake,•.ark~mal •~ w ^ N, kJ ... ,,. .> , Rehab Cou oEr~DExr•arulLrK,AOORESBp,rrl.CY„'4w491W.21PCa]y DECEDE!!f'S n PA qa 17 rerrN,wer w ^ WA B • 215 South No~uvay S,tneet p , ,, ~ s. rM 1leChan~i.cabung, PA 17055 ~ ~ m•+rrow ,mb hart ~" b1"""'1' au E l ~ x ~~ aurr na C w+~. a RENER'E NAIE T+n woa.,,r0 .. MDTIIEA'E NAM[~r. wtlW, MrurlSurnW .. , ,.. 7homae G. w - ;..° M "oni•e L: .rowwrt•a NAVE Ow•~b x+ranrANrs-uwriD ADOHESi R-r1. CM1Irw~. Srr. Zp ,.. D.ta-te Step en , 11ETrgDOf OISPPOBfi,O M DwE DISP'08fT10N PLACE OF - d Curvy .CU1Ifo.v, Slr,. I~ 7 pw„on^ RrrWkor Srr^ • ErY L •DM. •r•d . . OUr ~• _.. ~ ~.. ,y ~^ a~rF~~1 ^ ._ . .. 1-5-2002 '- ' ' . ' Ro.eP.fn Green Cemet~L „Meeha-u:cebun PA 17055 StlNRUiIE sEnncE oR ACTNO ABSUaL LX:ENSE NUMeeR NAME ANOAOOREeaaP Flw.w+.. n o- o~(.n unQ/ ome,.: rrt~ FU 012050E ~ 725 Non.eand Ave- Cor,ru rrr «M.nrri«,Yw r r ar nr T,Ir kwrry Wr+Ylu•.awnoxvra ru~tlr..d.,, r0 p.o,rr,a .. NUMBER ... m T ORE ... Pwn D•K ~r•0 ~ r pl„rr, r.anrk r r , w1 . r i~ alryrwaaw.~ . a ~ • Ilrr]E2Errl k••••aM•u kI °rr"w"rrrr»°.w` Of DRE pb11~. Vrr) - CASE REPEA ED MEDI EXAMYVE ONER1 , .. ~+ . , ~ ~.3 ~ "~ "°0 e x 8:00 ' a r .30, .2001. Decemb 37.MRTk Err Br a..r•EM«r•«mmPErunr wMr uln,0 ur rr.D„a1rw,M•rrdtlyYp,rrraWr«n,pkray •nrl rrd«Mrf Wr•. ~APNrinr• MRf u: OuwcadbrrrMii»rrR kr W aN/«rcrrrra~ir ~rvirlbrw,r - rrrrNirre na, rwJtlrgrtlrwWY,Yp taiMpiwnYMRTL w®WEDAUBE~1rl ~ _ E ,:,;~"~ Pendinst Investigation ~ DUE 10laR ASACONSEOUFHCE Drk .. i s.Prrr,rm•mr k I Bp,r,igbYlrrAW q1E TO (ORASAC016EOUENCE DPk arErr111O6B7fB/D .. CAYBEprr,a YM+1' ~ ~ i ar rBrr rnr•, DUEm(CN ASACONSEOUENCE CFk _ _ .. I ~VlnOruV ULBT 1 WN AM AUR7PBY WERE M170PSY F,rDYiDB MANNEJI OF DERV ORE OP YLIURY - TYrL Of YiAJRY YiIURYR WORN? OE9Oi,IBE YIOIM MUURY OCCVRRED. PERFOIWEDT AV1MBlE PR101170 fMOi+I~, D•Y.NV) OP OE/DIIT ~~ Nr«r ^ MaMtlr ^ ,M ^ No^ yy ~,, Ma10,a ^ /Mdq M,riprvl /LJ 01 M, ~ N, ^ Wr ^ N, ~ swag i a ^ ^ C r -IADE OP YIJURY•AI lia~r,,rr, rr.L ra«T, aar ara r a LOCATION (a,rl CYy06+n. Sr1y 'L- „r.• . ir a urtrtl,wr 17. ~q, e.~. p 7r. 06RMIO11CJrCk a~ly arl egNRIWE •wmrrBa r1LL•B,cIAN a~ti.ar o.w;.q ~.. a a..n.,r~.,r~. Pny.lo.•n.. n«r~.c.e a.n w m~arrn ari xLl ^ Coroner li ur raM rplr•~IMy,,~„Ill e•„nNAI1,rBr w,(,)r/rrrMr r,IM ..................................................... ~ • l1CEN8E NIUABeA ORE 3NiNED PAOr1~, D•y.Yrr1 •nlolwurcroANDCERmrannaDUN~lr.k+.~mnao~r~+~wa.r~wrwwnac.raa..+a WOr r,Ma,u„(,)rM rrwrrrr,4 ......................... ^ A Br krAMr,M,~4,B, l,rll e•r.,wrBr tlr, rr •n/PI,e, January 1,.2002 , , , , ' .. NAME ANOADORESS OF PERSON 1YIq~M~ErED CAUSE OF OERN m«IImTTw«P~kN Michael L. Norris, Coroner • ~r'LL,r.°a "a',Rear„hwrgrw~,h,.y,p„Ir,,aw„a,,,,wrm.ul•.,ar.,.,,ap,~.,.,,ae,,.,,m.av..l.l,,,n rrw ~ 6375 Basehore Road, Suite #1 70 ................................................................................................. a,.rr.»... 50 a:. Mechanicsburg, Pa. 1 REOISI,WY88NWRURE AND NUMBER LGJ_JeJ1Y LLJ DRE FlIED QAOrMI~, O,y.1Yr) ~ a sr. ' .~ Od n ~ r v LAST WILL AND TESTAMENT 21-02-20 of THOMAS G. WATTERS, JR. I, THOMAS G. WATTERS, JR., of Mechanicsburg, Cumberland 'County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish a;nd declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time herei~ofore made. ~. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. All the rest, residue and remainder oi: my Estate, real, personal and mixed, whatsoever and where:~oever situate, I give, devise and bequeath to my cousin, Diane Stenger, to her own use and benefit absolutely. 3. In the event, however, that my cousin, Diane Stenger, should predecease me, or should die at about the same time as I die, such as in a disaster common to both of us, I give, devise and bequeath my said estate in equal shares unto my father, Thomas G. Watters, Sr. 4. I nominate, constitute and appoint my cousin, Diane Stenger, to be the executrix of this my Last Will and Testament. In the event that she should predecease me or for any reason be unwilling or unable to act as such Executrix, I nominate, constitute and appoint my father, 'Phomas G. Watters, Sr., to be the Executor in her place and stead. In the event that he should predecease me or for any reas~~n be unwilling or unable to act as such Executor, I nominat~a, constitute and appoint my cousin, Sue A. Bruno, to be Executrix in his place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. IN WITNESS WHEREOF, I have hereunto sE~t my hand to this my Last Will and Testament, which consists of ~ pages, to each of which I have affixed my signature this ~_ day of \~~~~ ° "", ~ one thousand nine hundred. and ninety-five (1995). ~",~. Thomas G. utters, J •' .. i'COMMONWEALTH OF PENNSYLVANIA ss .. COUNTY OF j ~rr~ , W e , _ ~l/c .~sa E ~ ,c>. Fti s ~ rr z _2 _ _ a n d xiEf'~iEN ~,~ i~EG~~ and the testator and the witnesses respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his Last Wi]_1 and that he had signed willingly, and that he executed it. as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the Will as witness and that to the best of their knowledge the testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Thomas G.I~nlatters,UJr., Testator ~i' s Witness TM _ . ~ . , _..,... -----_ n t. o .; UI ~..•,~ .. Wi ne Subscribed a d sya r~ to and acknowledged before me by~-~; ~1-fi ~ ~, estato and subscribed and sworn to and acknowledged before me by ~?1,;;~ ~~~ ~ t?, ,~ „~(-j~l,-~,~ and ~~~ ~~-~~ witnesses this ( _ clay--~~. T).E ~. tie~-e i~-- , 19~(~ r ,> - 7 Notary Public ~?`- CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Thomas G. Wafters, Jr. Date of Death: Will No. TO THE REGISTER: Admin. No. 21-02-0020 I certify that notice of beneficial interest 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 January 10, 2002: Name Address Ms. C. Dianne Stenger P O Box 102 McConnellsburg, Pennsylvania 17233 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: January 10, 2002 CHARLES E. SHIELDS, III 6 Clouser Road Mechanicsburg, PA 17055 Telephone: (717) 766-0209 Counsel for Personal Representative .-, ,-~. ~., m ~ ~ ~ -~ ~. ~ ,~ r,- _. ~ . -> a -~ ~~ ~,.tt December 29, 2001 CHARLES E. SHIELDS, III ATTORNEY-AT-LAW 6 CLOUSER ROAD Corner of Trindle and Clouser Roads MECHANICSBURG, PA 17055 GEORGE M. HOUCK (1912-1991) March 26, 2002 Attn: Ann Register of Wills Cumberland County Court House 1 Court Square Carlisle, PA 17013 Re: Estate of Thomas G. Watters, Jr. 21-02-20 Dear Ann: TELEPHONE (717) 766-0209 FAX (717) 795-7473 Enclosed is check number 1026, drawn on the account of the Estate of Thomas G. Watters, Jr., in partial payment for taxes. Thank you for your kind attention to this matter. Very truly yours, Charles E. Shields, I I CES:dab -, ;~.. r-a i~.k O ~r~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SHIELDS CHARLES E III 6 CLOUSER ROAD MECHANICSBURG, PA 17055 -------- fold ESTATE INFORMATION: ssrv: i6s-44-3393 FILE NUMBER: 2102-0020 DECEDENT NAME: WAITERS THOMAS G JR DATE OF PAYMENT: 03/27/2002 POSTMARK DATE: 03/26/2002 couNTY: CUMBERLAND DATE OF DEATH: 12/29/2001 REV-1162 EX(11-96) N0. CD 001007 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 525,650.00 TOTAL AMOUNT PAID: REMARKS: CHARLES E SHIELDS III ESQ CHECK#1026 SEAL INITIALS: AC RECEIVED BY: MARY C. LEWIS 525,650.00 REGISTER OF WILLS REGISTER OF WILLS I rn- i~i/ ~_ ~. r m s m ~ N Q i G~ III ,1] fl .:~~''~ r MI !""' M f G p ~ ~ ~ O r' U °~' ~a 6 o ~ UI Q ~ i~ m ''n ~ o '~ ,y.,~~~U ~~U tin u-~ O C" .~ "' a ~ ~ '~ ° s~ y `~, ~, ~ T o ~ ~ U U 'd ~D ~ Y ~~ ..~~ ~, '~ M N ::. , =ts~ .~~ ..,., .i•.F ~.... r)" ;:~ .~~. y;~ iA S~a~ 4.. .r'~ CHARLES E. SHIELDS, III ATTORNEY-AT-LAW 6 CLOUSER ROAD Corner ofTruulle and Clouser Roads MECHANICSBURG, PA 17055 GEORGE M. HOUCK (1912-1991) March 28, 2002 Ms. Cheryl Winters Register of Wills Cumberland County Court House 1 Court Square Carlisle, PA 17013 Re: Estate of Thomas G. Watters 21-02-0020 Dear Cheryl: TELEPHONE (717) 766-0209 FAX (717) 795-7473 Enclosed is a final death certificate for Thomas G. Watters. Thank you for your help with this matter. Very truly yours, G, Charles E. Shields, III CES:dab 105.905 REV.(09I001 This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records in accordance with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953. WARNING: It is illegal to duplicate this copy by photostat or photograph. ~oB.Q.,,c~S . ,~-,- . Robert S. erman, Jr., MPH Secretary of Health Charles Hardester State Registrar ~v~;^~{4 ~, V ~UO~ N o. H105.164 Rev. 1N1 t TVPE/PRINT ~' w \ IN 'v PERMANENT BLACK INK ~/ ~~ I H w U 0 a z Date COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH '`'~~Q•~ i Coroner ` NAME OF DECEDENT (First. Middle, Lasp SEX SOCIAL SECURITY NUMBER DATE OF DEATH (Marnh. Day, Year) ,. Thomas G Watters z. Male 3.)69-44-3343 4. December 29, 2001 AGE(Lasl E;nhday) UNDER,VEAR UNDERI DAY DATE OF BIRTH BIRTHPLACE (Cny antl PLACE OF DEATH(Check only one-see insrructionstn other side) Months Deys Hours Minutes (MOnln. Day. Veer) State or Foreign Ca,nayt HOSPITAL'. OTHER: 49 Yrs. Dec. 30, 1951 / Inpatienl^ ERlOUlpatienl^ DDA^ Nursing Olner ^ H ^ s ,, {~ 5. 8. 7.IIl~.~~.(-~J U((~(. Pa. Oma Residence tSpecily) 8a. COUNTY Of DEATH CIT BORO P OF DEATH FACILITY NAME (II not inslitulron, give street antl number) WAS DECEDENT OF HISPANIC ORIGIN? RACE -American Intlian, Black. While. etc. Cumberland Mechanicsburg 215 South Norwa Street "°~ re,^nyea.apetiyaban, ($P~"y) S i }' Mex can, PUeno Rlcan. etc. r11'_-y 90. 6a 6d wh,<.te 9 . 10. DECEDENT'S USUAL OCCUPATION KIND OF BUSINESSIINDUSTRV WAS DECEDENT EVERIN DECEDENT'S EDUCATION MAAITAL STATUS-Married SURVIVING SPOUSE (Give kintl W work tlone tluring most U.S. ARMED FORCES? S it onl hi nest rade cdm leled Never Marrie0, Widowed, (II wile, give maiden name) I working life; do rwt use reared.) Elementaryl$econtlary Collage Dlvometl (Specityj Y ^ N LyJ es ° (D,2, na 5., Rehab. Cvunee~a.t Caurr.sl.een 2' . „,. ,,,- t2. ,3. ,4.a-(.VU1LCe(t ts. DECEDENT'S MAILING ADDRESS {Street. CirylTOwn. Stale, Lp Cotle) 215 South Nonwac{ S tlLeet DECEDENT'S peYin ~y.~vani.a ACTUAL ne. wale old ne.^ r ,, datedenmyad in twp, RESIDENCE tletetl t . Mechan.i.CebwLy, Pa. 17055 en (See instruction Ilva in a nc:nerade, e C b n ~ d `°""an'°' ~T1 NoeBCetlB1"°°" ,e ' um e . an Mecharue~sbun ,7b. Coun 116.tJ within actual limits of G cirylbor0. FATHER S NAME (first, Mitldle, last) MOTHER'S NAME (FIlsI, Mitltlle. Maiden Surname) ,,. Thamae G. Ulattene ,,. McvL~a/u:e L. Bnuno INFORMANT'S NAME (TypelPrint) 2D..D.i.ane S.tenget INFORMANT'S MAILING ADDRESS (Street, Cn rtown Star pCOtle) 20D P.U- F3ax T02, Me~unne~.sbwLg, Pa. 17233 METHOD OF DISPOSITION DATE OF DISPOSITION PLACE OF DISPOSITION~Name of Cemelenr,Crematory LOCATION-C4yROwn, Stare, 2lp Code ^ (MOnlh Day Year) r Oth r Pl ~ ^ , , o e eca , Burial Crematbn Removal Irom State Donalion^ aMr,spec,lyt ^ 2, b. ; -5-02 21C, Re.E2i.)t Green Ceme~eny zte 21e. 1~1eCh.aVU,C41JlUty, ~ Pa. 17055 . SIGNATURE ERAL SERVICE LIC E OR PER ACTING AS SUCH LICENSE NUMBER NAME AND ADDRESS OF FACILITY ` 22a. 'd '.-.-w -«~~ 32b.FD 012050E 2~Ce•P.sv-l'ox.ne.P,t.l.u~ Fun. Home, L.td, C{tambe/I.~buny,Pa. Complete aems2 only when ceditying To the Cell of my knowledge, tleath occurred at the lime, dare and place stated. LICEN$1=NUMBER - DATE SIGNED pry:miani:nora~aitaobatrmeoldaamto cenity cause of tleeth. (si9nawreanarnlel (MOnth. Day. Year) 23a. 23D. 23c. d Dy ( un~ TIME OF DEAT H AprX. DATE PRONOUNCED DEAD (MOnln. Day, Ve ar) WAS CASE REFERRED TO iv1EDICAI E%AMINEWCORON: .? - person who prono tleath O 8 0 n D b 30 2001 Vas No^ 24. : ~ A. M. ecem er , 25. ,6 2T. PART 1: Enter the tliseeses, injuries orcomplications which tausrMtne tleatn. DO not enter Me mpde 0ttlymg, such as cardiac or resprratoryarresl. shock or near failure. iApproximate PART II: Other signilicdnt cpMitions contributing to death bW List only one Cause on each llne_ ~intervaltretween , not resulting in lha undedyinq cause given in PART(. IMMEDIATE CAUSE (Final nsel and death d~a,e°"°neilinn Subdural Hematoma Associated with Coaeulopathy mrg.n dealnj-~ a WE TO O ( R AS A CONSEQUENCE OF): seReenaalyaattDnmadne b. Severe Heuatic Cirrhosis it an l din im l di t D E y, ea g D me a e U TOIOR ASACONSEOUENCF OF)~ tau%. Enter UNDERLYING CAUSE (Disease or injury c In ) initi t d t a a e even s DUE TO (OR AS A GDNSEQUENCE OF): ewlting in death) LAST d. WAS AN AU70PSV PERFORMED? WEREAUTOPSY FINDINGS AVAILABLE PRIOR TO MANNER OF DEATH GATE OFINJURY TIME OFINJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED. COMPLETION OF CAUSE ~/ (Mdmn, Day. Year) OF DEATH? Natural ICS Homkide ^ Yes ^ No ^ V ~ ^ y~y l ^ Accident ^ Pantlinq Investigation ^ 30s. 30b. M. 30c. 30tl. as N° Yes lZ No ' ` Suicide ^ c w a t m ^ C 90F INSPR YY At home, farm, scree, ladory, office LOCATION tSlreel. CilyR wn, Stare) Zee. 28b. °I, rwt ba e erm ed 29. ~ O I builtl 30e, 30,. CERTIFIER (Crack Only one) SIGNATURE AND T tER CERTIFYING PHYSICIAN (Physwian certilying cause °I tleatn when another phys~ian has pronounced tleatn and completed Item 23) T M b l r ~ o, eet e my knowledge, death oe0urred due to the cause(e)and msnnerae etatetl .................................... ................. ^ Coroner / 31 b. ' 'PRONOUNCING AND CERTIFYING PHYSICIAN (Physoian both prpnouncinq dearh and cerlHying l0 cause of death) LICENSE NUM ER DATE SIGNED (MOnlh, DaY. Year) To,M beet of myknewbdge, tleeth occurred el(M time, tlale, arM place, antl tlue lo,MCwaa(s)entl mannsras,laced .......................... ^ 31 t. 3,e February 11, 2002 NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH 'MEDICAL EXAMINER/CORONER - (Item 27)Type or Print Michael L. Norris, Coroner ' OneMbeeleofexaminaclonend/orlnveellgetlon,inmyoplnlon,tleethoccurredetthetlme,dete,andplace.andduetotMCeuse(s)and , a 6375 Basehore Road Suite 111 ~ A,e 3,.m.nner ee s ..................................... ....................... , Mechanicsburg, Pa. 17050 32 REGISTRAR'S SIGNq~REA~l1MB~ 0~~~~ ~/ ~~po I T TT 33 . „TE FILED (MOnth~ay, ye~ ~ ~ 2002 // v!,j . ~~ Name of Decedent: Date of Death: ~a -a ~ -ate ~ Will No. Adm i n . No . ~-~ Q~ -' ~©oC.~/ 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: 1. State whether administration of the estate is complete: Yes~_ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Date l~ ~~(~ ~~~"_ ~~ ~~ Signature i ,~ ~ n - ~ 1. Charles E . Shield: , III Name (Please type or print) 6 Clouser Road, Nl~~chanicsburg, PA 17055 Address (717) 766-0209 Tel. No. Capacity: Personal Representative _~Coun:>el for personal representative (MAH:rmf/AM3) STATUS REPORT UNDER RULE 6.12 ~i CHARLES E. SHIELDS, III ATTORNEY-AT-LAW 6 CLOUSER ROAD Corner of Trindle and Cloreser Roads MECHANICSBURG, PA 17055 GEORGE M. HOUCK (1912-1991) TELEPHONE (717) 766-0209 FAX (717) 795-7473 June 27, 2002 Attn: Cheryl Register of Wills Cumberland County Court House 1 Court Square Carlisle, Pennsylvania 17013 Re: Estate of Thomas G. Watters, Jr. 21-02-20 Dear Cheryl: Enclosed are two (2) Inheritance Tax Returns (REV -1500) and the following checks drawn on the account of the Estate of Thomas G. Watters, Jr.: Check # 1038 - $155 -Additional Probate Fee Check # 1039 - $15 -Filing Fee Check # 1040 - $7921.21 -Balance Due on Taxes; Thank you for your kind attention to this matter. Very truly yours, e~~ Charles E. Shields, III CES:dab 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. CD 001343 SHIELDS CHARLES E III 6 CLOUSER ROAD MECHANICSBURG, PA 17055 ,ola ESTATE INFORMATION: sSN: 1 ss-44-33x3 FILE NUMBER; 2102-0020 DECEDENT NAME: WATTERS THOMAS G JR DATE OF PAYMENT: 06/27/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 12/29/2001 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 57,921.21 TOTAL AMOUNT PAID: REMARKS: C/O C DIANNE STENGER CHECK#1040 SEAL INITIALS: SK RECEIVED BY: MARY C. LEWIS REV-1162EXI11-96) 57,921.21 REGISTER OF WILLS REGISTER OF WILLS - _ _ ..-- -_... l~ eev.,eoaexte-cot 10NWEALTH OF COMi REV -15 0 0 ~~~t~t~~ ~~~ ~~.,~z ~/ ~ ~ PENNSYLVANIA l7 ~~-----..---- EVENUE DEPAR INHERITANCE TAX RETURN FILE NUMBER DEPT. 80 O a. ~ - ~ 2 ~ o o Z ~ HARRISBURG, PA 17128-0601 RESIDENT DECEDENT COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER z Tae. 7Hoir/~}5 G W/}TTERS /69 - ~~ - 3393 , ., W DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE w 1 2 - a q- Zoo I l a-~ D- I ~l S I REGISTER OF WILLS W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ ~/~ - - ®1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Retum (dateotdeam priorco t2-is-sz) ~ a ~, w a ~ ^ 4. Limited Estate ^ 4a. Future Interest Compromise (dace or death aner t2-cz-az) 5. Federal Estate Tax Return Required ~ a m ®6. Decedent Died Testate (Anacb copy of w~ip ^ 7. Decedent Maintained a Living Trust (Attach spy of Truat) ~ 8. Total Number of Safe Deposit Boxes a ^ 9. Litigation Proceeds Received ^ 1 O. SpoUSal POVerty Credlt (date of death between 12-31-91 and 1-1-95) ^ 11. Election to tax under Sec. 9113(A) (nnacb scb o) c NAME S ~: S/-l/EL DS Tlf ¢ ~LC CN COMPLETE MAILING ADDRESS Z ~ , , ( CLO USE/Z /11~ 0 ~ . ~ ~ FIRM NAME pt Applicable) M ~' CHIN / C S ,Ci u ~ G, f~fR / 7 o sS o TELEPHONE NUMBER 7/7-7Gd - oao4 QOO. °O (1) ~~3p OFFICIAL USE ONLY ~ 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (2) ~ 9~~ S/D, 2 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) - O - - 4. Mortgages & Notes Receivable (Schedule D) (4) - O - 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) ~ ~ 9 378 67 Z (Schedule E) ` ~ 6. Jointly Owned Property (Schedule F) (8) .. ~ - ~ ^ Separate Billing Requested J F 7 Infcr_\/ivnc Trancfarc R Micrellananus Nnn-Pmhate PfnnertV (7) J ~` ~ / ~~• ~~ H a Q U W Z 0 Q a X H .. (Schedule G or'L) ._ _ ....----.-.___-- _ ~ • C 8. Total Gross Assets (total Lines 1-7) (8) ~ 7 6 D(o a?, ~~ ~ r 9. Funeral Expenses 8 Administrative Costs (Schedule H) (9) -3Y~~ ~ 8'. /7 __ Mortgage Liabilities, & Liens (Schedule I) (10) ~ y7G- /6 Debts of Decedent 10 , . ~ 11. Total Deductions (total Lines 9 8 10) (11) ~f3, ~ S`f. 33 12. Net Value of Estate (Line 8 minus Line 11) (12) f a 3 Z --, . 80 d'. /D 13. Charitable and Governmental BequestslSec 9113 Trusts far which an election to tax has not been (13) O made (Schedule J) ~ 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) o~,j a~ p D~: /D SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax 0 rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate ~ O 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate ~a 3 ~, S~o ~r• to 19. Tax Due x,: y; f x .0 0 (15) ~ x .o y5 (1s) O x .12 (17) O (19) ~ 3Y 92i. Z/ .z Decedent's Complete Address: ~inLL1 I'\UVI\LJJ a ~S J. .l D'1 ~•• / s~ ~~ cITY /1'Icef1/.4N/~'s.BuRG STATE /J~ ZIP ~ 7Q SS Tax Payments and Credits: /" 1. Tax Due (Page 1 Line 19) (1) g3 `f, 9L/. Z/ 2. Credits/Payments A. Spousal Poverty Credit ~ B. Prior Payments f a S 6 SD • 00 C. Discount /, 3 so • 00 y Total Credits (A + B + C) (2) ~ 7, 000. 00 3. Interest/Penalty if applicable D. Interest ~ E. Penalty Total InterestlPenalty (D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (3) O (4) O (5A) D B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) ~7, ~ 2!. Z/ 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 :................................................................................... ....... ^ b. retain the right to designate who shall 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 consideration? ............................................................................................ ............ ^ ...... 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ........ ...... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ...... ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G 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 knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATl~2E OF PERSON RESPONSIB E FOR FILING RETURN _ DATE X <1 ~~ ~ Z7 • o~ ADDRESS C • D t hNNE STENG~7P, duo D/,¢/yE S7~N(y,tJ? TAO ~3oX /0 2, /l1c CONl~'EL G 5 .$ u,7G, />,g / ~~ 33 SIGNATU OF PREPARER OTHER THA F PR€S TATIVE DATE ADDRESS CHftlZLES E.' SH/EZDS ~ G Cl,ous~~t ~2n., ~/ E cyl~ N/C S,aur~G, pal / 7o sS ,- .- - Y ~ ~ ,,.. ~ .. {:~ , For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (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 the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)J. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502E%. (1-97) f SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN ESTATE OF FILE NUMBER /r~ ~ ~ TE1l S, 7ilD/rl~,f G. ~ ~/~ 2 / -O.Z - ,ZO All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a wilting buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. /fLl %iy,¢T CE,~Tff/N Ld T ~F G-i?ouN~ aM d tie i m~rove- ~'Y/ents ~iereoh erected s~ ~-ua.fe a,~- ~ sowtheast cerh~>,•- Df rPvbert ~Sf• ~~ Nor~irar~ Sf ; h ~ 3orou~G, o~ /Ylechcin - ics~iur~, Cu.rnberlarid County , ~cnnsyl~knia, be+n~ Known anc~ r)un~bere~ us al s s, Norway cSfreet, be~nf more ~~erf-~eularly deSC~-~6~d i-~ ~u.~ Cerfa-'vr deed {cowl -Jhorrtas G. Wat1-ers,Tr. , L: xec.u,~-o-- of ~e Lash lvi fl atit~ -Tsfamertt o~ `lrhamas G• GUa tt~rs, ~Sr. ~ `~ Sa.l.~ I hory~as G. wa,~Fe--Y, .Jr-. -.i~ h~'.s ac~h r~5ht ~ afied Jkne ;ZD, l9ct (~ a..yrc~ r~.cnrdcc~ .n '~+¢ D tC1Scz o f' ~FPe R~rder of .Deeds ~n and ~r Cumberland L'occnt~. ~cnnsylvahc4. ir! c%ec;/ look /5~/, paw ~'/~ S~ei~1 ~Orerr/i,res were ~ranf~ qn~/ G'ogver«/ ~Oursuaaf f ~e 7~2~YhS Of q// /~q~ee~le~lf o7~ SA/e ~` c/<ea/ ~a fe a~ /yl~ /7, cZDoa f G'~~is7~a/~~er T (~verf a~t~ ~r~'/hGh /1'i. nn ~~' ~ (.OVe~'t~ ~/S !.(/i7"t° ~ ~/' ~ ~Oticc o~ /3D~ OvD, °O - See ~~.jv~ ppp. °o ~ru e aid C'orreef (!ago y o1~ ~t Se1~/essl~i~f .S~i e e ~ a t~aclkc/J- TOTAL (Also enter on line 1, Recapitulation) ~ ~3~, 000. p° (If more space is needed, insert additional sheets of the same size) nAID \In nrnn nnrr ~~~ A. t ~ v. LVVL-VGVJ ,~ B. TYPE OF LOAN: U.S~ DEPARTMENT OF HOUSING 8 URBAN DEVELOPMENT 1.^FHA 2.QFmHA 3. ^X CONV. l1NINS. 4. ~VA 5. QCONV. INS. SETTLEMENT STATEMENT 6. FILE NUMBER: COVERT 7. LOAN NUMBER: 0013306790 8. MORTGAGE INS CASE NUMBER: OLD MORTGAGE INS CASE NUMBER: 6.875%1F1683 JSG C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked '(POC]" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. 1.0 3/98 (Covert.pfd/COVERT/9) D. NAME AND ADDRESS OF BORROWER: CHRISTOPHER J. COVERT and GILLIAN M. COVERT 215 NORWAY STREET MECHANICSBURG, PA 17055 E. NAME AND ADDRESS OF SELLER: ESTATE OF THOMAS G. WATTERS JR F. NAME AND ADDRESS OF LENDER: CHARTER ONE MORTGAGE G. PROPERTY LOCATION: 215 NORWAY STREET MECHANICSBURG, PA 17055 H. SETTLEMENT AGENT: 25-1857112 Midstate Abstract Company I. SETTLEMENT DATE: M 17 2002 CUMBERLAND County, Pennsylvania PLACE OF SETTLEMENT 2331 Market Street Camp Hill, PA 17011 ay , J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE 1'O SELLER: 101. Contract Sales Price 130,000.00 401. Contract Sales Price 130,000.00 102. Personal Pro ert 402. Personal Pro ert 103. Settlement Char es to Borrower Line 1400 4,573.95 403. 104. 404. 105. 405. Ad'ustments For Items Paid B Seller in advance Ad'ustments For Items Paid B Seller in advance 106. Cit !Town Taxes to 406. Cit !town Taxes to 107. Count Taxes 05/17/02 to 01/01/03 262.38 407. Count Taxes 05/17/02 to 01/01/03 262.38 108. School Taxes 05/17/02 to 07/01/02 154.72 408. School Taxes 05/17/02 to 07/01/02 154.72 109. Sewer & Refuse Pro Ration 05/17/02 to 07/01!02 46.48 409. Sewer & Refuse Pro Ration 05/17/02 to 07!01/02 46.48 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 135,037.53 420. GROSS AMOUNT DUE TO SELLER 130,463.58 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. De osit or earnest mone 2,000.00 501. Excess De osit See Instructions 202. Princi al Amount of New Loans ' 104,000.00 502. Settlement Char es to Seller Line 1400 9,718.21 203. Existin loans taken sub ect to 503. Existin loans taken sub'ect to 204. 2ND MTG - $19,500 -PROCEEDS 19,363.37 504. Payoff of first Mortgage 205. 505. Pa off of second Mort a e 206. 506. 207• 507. De osit disb. as roceeds 208. 508. 209. 509. Ad'ustments For Items Un aid B Seller Ad'ustments For Iten•rs Un aid 8 Selter 210. Cit !Town Taxes to 510. Ci /Town Taxes to 211. Count Taxes to 511. Count Taxes to 212. School Taxes to 512. School Taxes to 213. 513. 214. 514. • 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 125,363.37 520. TOTAL REDUCTION AMOUNT DUE SELLER 9,718.21 300. CASH AT SETTLEMENT FROM/TO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER: 301. Gross Amount Due From Borrower Line 120 302. Less Amount Paid By/For Borrower (Line 220) 135,037.53 ( 125,363.37) 601. Gross Amount Due To Seller Line 420 602. Less Reductions Due Seller (Line 520) 130,463.58 ( 9,718.21 303. CASH (X FROM) ( TO) BORROWER 9,674.16 603. CASH (X TO) ( FROM) SELLER 120,745.37 The undersigned hereby CHR ge rec ' t of a c leted copy of pages 1&2 of this statement & any attachments referred to herein. ~ Seller ~ . ~~~ J R J~OVERT, ESTATE OF THOMAS G. WATTERS JR . i GILLIAN M. rage t L. SETTLEMENT CHARGES ~ ~ 70C TOTAL COMMISSION Based on Price $ % 7,800.00 PAID FROM PAID FROM Division of Commission Line 7OO aS FOIIOWS: BORROWER'S SELLER'S 701. $ 3,925.00 to CENTURY 21 PISCIONERI FUNDS AT FUNDS AT 702. $ 3,875.00 to RE/MAX REALTY ASSOCIATES SETTLEMENT SETTLEMENT 703. Commission Paid at Settlement 704. to 7,800.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Ori ination Fee % to 802. Loan Discount % to 803. Tax Related Service Fee to FIRST AMERICAN 48.00 804. Document Preparation Fee to CHARTER ONE MORTGAGE 250.00 805. Flood Cert. Fee to GEOTRAC 13.50 806. Mort a e Ins. A .Fee to 807. Assumption Fee to f 808. 809. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 05/17/02 to 06/01/02 @ $ 19.589000/da ° y ( 15 days /o) 283,64 902. Mort age Insurance Premiumfor months to 903. Hazard Insurance Premium for 1.0 ears toERIE INSURANCE POC $256.OOb 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance 3.000 months $ 21.33 er month 63.99 1002. Mort a e Insurance months $ er month 1003. Cit /Town Taxes months $ er month 1004. Count Taxes 5.000 months $ 34.85 er month 174.25 1005. School Taxes 12.000 months @ $ 102.49 per month 1,229,88 1006. months $ er month 1007. months er month 1008. A re ate Ad'ustment months $ er month -238.26 1100. TITLE CHARGES 1101. Settlement or Closin Fee to 1102. Abstract or Title Search to 1103. Title Examination to 1104. Title Insurance Binder to 1105. Document Pre aration to 1106. Closin Service Letter to Midstate Abstract Com an 35.00 1107. Attorney's Fees to CHARLES SHIELDS, ESQURE POC includes above item numbers: 1108. Title Insurance to MIDSTATE ABSTRACT 1 008.75 includes above item numbers] 102, 1103 & 1104 1109. Lender's Coverage $ 104,000.00 1110. Owner's Coverage $ 130,000.00 1111. Endorsements 100, 300, 8.1 to Midstate Abstract Company 150.00 1112. Notary Fee to Cash 10.00 1113. Notary-Fee to Cash 5,00 1114. 1115. Overnight Fee to Midstate Abstract Company Pak. 15.00 1116. Wire Fee to Midstate Abstract Company 18.00 1117. 1118. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 25.50; Mortgage $ 51.50; Releases $ 77.00 1202. Cit /Count Tax/Stam s:Deed 1,300.00• Mort a e 1,300.00 1203. State Tax/Slam s: Revenue Stam s 1,300.00; Mort a e 1,300.00 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Surve to 1302. Pest Ins ection to PENN PEST, INC. POC 1303. Transaction Fee to RE/MAX REALTY ASSOCIATES 125.00 1304. 2002 Coun /Boron h Taxes to BARRY L. HECKARD, TREASURER #172305630 418.21 1305. Service Fee to CENTURY 21 PISCIONERI 195.00 1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Se io K) Rv einninn n~nu 1 of lhic el~lomanl the r ...........:........~......,i..w.... ...,._:... _s _ ____~_._~ ___.. _. ____ .. _.... _ 4,573.95 9,718.21 Midstate Abstract C any Settlement Agent Certified to be a true copy. (COVERT/COVERT/9) Tax Parcel # THIS INDENTURE MADE THE day of in the year of our Lord two thousand and two (2002). BETWEEN DIANE STENGER, also known as C. DIANNE STENGER, as Executrix of the Estate of THOMAS G. WATTERS, JR., Deceased, late of the Borough of Mechanicsburg, Cumberland County, Pennsylvania, Grantor, AND CHRISTOPHER J. COVERT and GILLIAN M. COVERT, his wife, of the Borough of Mechanicsburg, Cumberland County, Pennsylvania, Grantees. WHEREAS, the said Thomas G. Watters, Jr. was vested in his lifetime with title to the premises hereinafter described in the Borough of Mechanicsburg, Cumberland County, Commonwealth of Pennsylvania; and WHEREAS, the said Thomas G. Watters, Jr. died, testate, on the 29th day of December, 2001, and Letters Testamentary were duly issued to Diane Stenger, also known as C. Dianne Stenger, as Executrix, by the Register of Wills of said Cumberland County, docketed to No. 21-02-0020; and WHEREAS, the lands herein-mentioned were not specifically devised. NOW, THEREFORE, THIS INDENTURE WITNESSETH, that the said Diane Stenger, also known as C. Dianne Stenger, Executrix, as aforesaid, for and in consideration of the sum of ONE HUNDRED THIRTY THOUSAND and No/100 ($130,000.00) DOLLARS, and other good and valuable considerations, to her in hand paid by the said Christopher J. Covert. and Gillian M. Covert, his wife, at and before the ensealing and delivery hereof, the receipt whereof is hereby acknowledged, has granted, bargained, sold, aliened, released, and confirmed, and by these presents, by virtue of the power and authority in her vested by the Fiduciaries Act of the Commonwealth of Pennsylvania, does grant, bargain, sell, alien, release, and confirm unto the said Christopher J. Covert and Gillian M. Covert, their heirs and assigns, ALL THAT CERTAIN LOT OF GROUND situate at the southeast corner of Robert Street and Norway Street in the Borough of Mechanicsburg, County of Cumberland, and Commonwealth of Pennsylvania, bounded and described as follows, to wit: BEGINNING at a point at the property line on the south side of Robert Street at the intersection of the property line on the east side of Norway Street; thence along the property line on the south side of Robert Street, north 65 degrees 32 minutes east, 100 feet to a point at the corner of lot number 49 in the plan of lots hereinafter mentioned; thence along the line of said lot number 49 south 20 degrees 37 minutes east, 104.62 feet to a point; thence along the line of land formerly of Wilbur H. Fought and Elizabeth M. Fought, his wife, south 65 degrees 18 minutes west, 100 feet to a point at the property line on the east side of Norway Street; thence along the property line on the east side of Norway Street north 20 degrees 38 minutes west, 105.03 feet to a point at the property line on the south side of Robert Street, the place of BEGINNING. BEING Lot No. 48 in the plan of lots of Wilbur H. Fought and Elizabeth M.:Fought, his wife, in Blackburn Village, made May 4, 1957 by William B. Whittock, Registered Professional Engineer, and recorded in the Recorder's Office in and for Cumberland County in Plan Boolc 10, Page 30. BEING THE SAME PREMISES which Thomas G. Watters, Jr., as Executor of the Last Will and Testament of Thomas G. Watters, Sr., late of the Borough of Mechanicsburg, by deed dated June 20, 1996, and recorded in the Recorder's Office in and for Cumberland County, Pennsylvania in Deed Book 141, Page 314, granted and conveyed to Thomas G. Watters, Jr., as. Grantee. FOR FURTHER RECORD PURPOSES: THE PREMISES HEREIN CONVEYED were a part of the same tract of land which John H. Coover, et al, by deed dated April 3, 1948, and recorded in the said Recorder's Office in Deed Book "T", Volume 13, Page 381, granted and conveyed unto Wilbur H. Fought and Elizabeth M. Fought, his wife. BEING THAT SAME TRACT of land which the said Wilbur H. Fought and Elizabeth M. Fought, his wife, by deed dated May 29, 1959, and recorded in the said Recorder's Office ;in Deed Book "E", Volume l9, Page 28, granted and conveyed unto Thomas G. Watters and Marjorie L. Watters, his wife. NO RECITAL WAS PROVIDED TO ESTABLISH THE APPROPRIATI; AND NECESSARY LINKAGES IN THE CHAIN OF TITLE in the aforesaid deed from Thomas G. Wafters, Jr., as Executor of the Last Will and Testament of Thomas G. Watters, Sr., to the said Thomas G. Watters, Jr., as grantee. THE APPROPRIATE RECITALS ARE ACCORDINGLY HEREIN SUPPLIED: Thomas G. Watters, the elder, departed this earthly life on December 31, 1995. Although his birth name and legal name were Thomas G. Watters, his duly probated last will and testament used the name Thomas G. Watters, Sr. For some reason, the Petition. for Probate and Grant of Letters was not made in both names with the use of an "also known as" clause. Nevertheless, the appropriate death certificate in the name of Thomas G. Watters is part and parcel of the entire probate docket and is accepted as evidence that Thomas G. Watters and Thomas G. Watters, Sr. are one and the same person. The originals of these items are public record and can be found in the Register of Wills Office in and for Cumberland County, Pennsylvania in file docket No. 21-96-0067. ADDITIONALLY, DESPITE THE LACK OF PREVIOUS RECITAL, the aforesaid Marjorie L. Watters predeceased her husband, the said Thomas G. Watters, also known ass Thomas G. Watters, Sr. She departed this earthly life on August 12, 1994, whereupon full and absolute title vested in her said surviving husband by virtue of the laws of the Commonwealth of Pennsylvania incident to tenancies by the entireties. An original death certificate for the said Marjorie L. Watters is accordingly attached to this deed for official recording purposes. TO HAVE AND TO HOLD the said messuage or tenement and tract of land, hereditaments and premises hereby granted and released, or mentioned and intended so to be, with the appurtenances, unto the said Grantees, their heirs and assigns, to and for the only proper use and behoof of the said Grantees, their heirs and assigns, forever. AND THE SAID GRANTOR, Executrix as aforesaid, her heirs, executors and administrators, do covenant, promise and agree to and with the said Grantees, their heirs and assigns, by these presents, that the Grantor has not done, committed any act, matter or thing whatsoever whereby the premises hereby granted, or any part thereof, is, are, shall or may be impeached, charged or encumbered in title, or otherwise howsoever. IN WITNESS WHEREOF, the said Executrix of the Estate of Thomas G. Watters, Jr., deceased, Grantor herein, has hereunto set her hand and seal the day and year first above written. Witnessed by: `~- ~l!i ~~~ ~~ (SEAL) DIANE STENGER, Executri Estate of Thomas G. Watters, Jr., Deceased - ,~ (SEAL) a/k/a C. DIANNE ST]1NGER, xecutrix Estate of Thomas G. tiVatters, Jr., Deceased COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND On this, the /7 day of , A.D. 2002, before me, a Notary Public in and for said County and State, the u ersigned officer, personally appeared DIANE STENGER, also known as C. DIANNE STENGER, known to me (or sal:isfactorily proven) to be the person described in the foregoing instrument, and acknowledged that s1-~e executed the same in the capacity therein stated and for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. (' Notary Public Notarle-I 5a1 Jennifer (dross, Notary PubIIC Camp Hill 6aro, CumbiA~lltl County My CommisslC~n Expires ®®pt. i t , 2004 Member, Pennsylvanle A~roala~fi®n of Nbt8lfAs CERTIFICATE OF RESIDENCE I do hereby certify that the precise and exact post office address of the within Grantees is _. _. REV-i503 Fx. (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER All property jointty-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1~ /1')erri l!' LY`1c/i ~ C/ylf~ sub ~Cr~' /Uo. 87~- S32o7 ~ 98, S/o.zl see /efter a.~r~f enc/dsuras ~i^o.,.~ /Yl~rr'~'ll Lr~~tel~ aff~zc6icd, esp- eei a /!y /~a~ts G ~irvu~b /S. > ~ 1n><vi'Ma~prta~ {tote 1V1a5fer CMI?- ~Ct' /Vo. Fr~~-~/'~o~/ is ~'e-~ortecl oh Schad. G. TOTAL (Also enter on line 2, Recapitulation) I $ 9~i ~j /O- z / (If more space is needed, insert additional sheets of the same size) „ ~ .cGS~'~L-1 ~-at~ Private Client Group Merrill Lynch April 4, 2002 Charles E. Shields, 111 6 Clouser Road Corner of Trind/e and C/ouser Roads Mechanicsburg, PA 17055 Re: Estate of Thomas Watters Date of Death Values Dear Mr. Shields: 214 Senate Avenue Suite 501 P.O. Box 0810 Camp Hill, Pennsylvania 17001-0810 717 975 4600 800 937 0735 Enclosed are the December month end statements for Mr. Watters accounts. Since Mr. Watters died on a Saturday, the monl:h end statements should be sufficient for date of death values. Please let me know if you need anything else. Sincerely, Cori Tobias Client Associate for Sharon Steiner <7N W tQ tD tP (D 7 .-' .+ O ~G 41 } v m N m N m m V ~ ~° rn m ~ N C3 m N O N 61 O cD 3 ~~ 0 ~ ~ ~ N ~ ~O Q. G ~q N 0 ~~ o ~" ~'o a N A W Np~ ar °' ~ 3 °u'mv N mo° p G C c ~ ~' a w ~ ~ N ~~; ro -~ N K ~. ~ ~? ~F ~= o _~ O N p o v ~~ v ~, G n~i ?. ~ K K 3 C~C~C~n y 7 ~m~t.- p.0~~ ~o o fl s ~ ~ fD 6 ~ a.f~G ~ ~ ~ ~•~- 9 ~ ~ Q •Q O N 3 43ro ~O1 N N .+ ~ C, -n ~D~2m ~ ~ O '~ ~ o~ G ~ym_~?. ~ m ooN~D N n N c p ~ G G N p0 C ~~ W mCC O. ~ ~ = ~ N N 3 ~ G. CD N ~ ~ N N ~ W N tP N -.] p1 UI O ,,~ -] N a a> N N O O N W N O ltt 111 N ~~ -n A 3 "~ 0 ~ro~ ~ ~ ro ~ ~ ~ o , . . o~ N ~ N ~ 7 ~ ~ '. 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N ~ ~ m . + '- ~ ~ w a d o ti a d w m • ~. ~ n a n a n a m • H H . ~ < m r m N m O~ m ~ n n ~ -,co ~ ~. a w ~• N- ~. ~~ m ~ ~ C ~ C ~ < ~ ~ ~ G] 4~ rr ct rr ~ p N O (n ~~ O (D O~ N <D r N r ~n r r W O. ~ Q O ~D Nn n7G~n3tn n3 ']Cm ~~Oxl~tcmn] nro yiox:~n ~~c~ y,ozz~c~,o C ~[ ~OCC~ CC CC~ ~CHHC~C30 ~C O ~~rH7 ~ ~ i HH~O ~ w~ erym ~c n r~n o~ZZ~z~anr z .~ e H~r o' z~z~ ZZ~z~dd~• o c ~ 3b ~ ~ ~ o ~ C . ~b~ tr ~~3 ~ v nri~yC~3z ~~~ nrik~~~ ~3 CnV] tn r C 'tiC~: v ~0 ~ \ HOCx ~ ] L \ F-lO H2' `AU]VS \ HO CnCn U' ~ r ~ ~ C Z i C ~O 7zr~S~~ C NO[+JZ~nO n yx ~ rom ~ ro ~-3C yky rOttlZHC H H~Cyy d [ n H H4] yyx ~-] HyxH m •~ n z zn zHn ~ cn C C nHc~ H4]n H O~n H ~ " y Cz~, ~ zee ~ z ~~ N ~ H z z ~ H r z z H t C C C 3 Cn Hn r Cn N•vrHn n a•vrxH H ~~ H r ~ e~ ry wry ~ H r N r ro NaN ro tnaNn7[~] r~oa Q~ o ~^ t ] i0 'TJ C '~] C n C ~n Cl cn o o t+ to • l7 H [ri in o a x i0 to tai • m o ao i0 a~ n°, z z rom ro~a mom r ° CJ C7 61 O lT O N O O m N W O O O O r N U1 V1 a m m W ~ o 0 v v ~ ~ ~ ~ :Ll ~ ~ a o ~ ~ D `~ G7 d D m ~ ~ p c su 'G O e~ N A =. ~~ Flo 7 ~~. co a Iv fD a I ~ u~ w I O ~w y r ~ n 0 y ro r m D m m m ~ ~7 ~c~ ?J ~~ ~ ~ m w 0 m N O Cn ~ ~ O ~p O' N (p W O. -' a 0 ~D No w~ N 00 0 N 0 a m N z O z v ~ r r r r r r r~ -~ r r r rQ- G N N N N N N N ~ N N N N~ 0) N N P N A r J r W r O r p O 61 w N N P H n• ] N J r i ~ ~ r J _ ~ ~ Gl `~ . o, 5 z d ~a x z x (D x~ ( n d N d N- d y r- tD N- r- C N w (D w N N- ~- D N• A~ m • C C .. C ~ a b p p p ~ p' w N- r- N N N N N N N N a ~ l7 l D ~ ~• n n n n n c a a a m < m m ~ m m a ~ ~ p p ~ ~ m cr rr ~r rt rr rr a co~~~ozxnronron~~c~n~n3 ~rrnae~~oHoH~~r~orrrr r~ HH~O~OZL~] r Cnxo ~~ z zy rs~~m~cn t]Or.H-]ro ~ ~H~nc ,onNkx~s ze~~ r r axe Ho ~ ~yzmm H Nwnr~ ~ r~ryv~~ n n ~~Ho[~~-3 d dc1~~x +n ro ~ ~ ~ ~ Cz» ~ w n n H z z C C C~ ~ N x H C m C[+] nro °', `° ea ~ ro m r ~o~ x ,o oo~a wo d d O w r w w r ~ N cn ~n J N ~ N J 61 W in o m a m m m as m ~ ~ ~ ~ o roncmnron~y n~ZHni ~ 3 C ~ ~x ~K s ~ ° ~ ~ zr~o Hn e~ ,o n z ~, w~CCx '~] H O H ~ C H ' T J H C ~: " C~ ~ii ~ x ~ d~ x1 Z ~3 ~ ~ C Zt 1J z~~i (n n H ~' r ~ n x H N C ,'b H ro ro ~~ W n d ~3 r r x; w w w r-~ 'a J N ~D N U7 O O Ol ~] ~o ui ao .a ~ 0 ~ ~. ~ ~~ ~ a O D 'C +n '•'~ d D 7 N ~ m 0 ~ ~ Q v so m 0 i~ n Iv a I ~ ql~ u m O l J r y O r-] + N r N r N ~~ N N N N N N j \ \ \ \ \ \ ~ j r-~ N N r N N p 0 0 0 0 0 0 v r m D m d d m ~' m w a m ' N m < a a S ~ c ~'- 3 ~ v ~ m ,TJ x7 (D (D tO w~ ~ ~ m ~- ~- K ~ ~ K W 27 m ~ C < m rt ~ m n w o ~ m ~ ~• m N o ~ o~ ~~ ~i ~ O ~ m w u'o iOx7'u~n3+Oxlro~in3n3n3n3~ n3 ~a ~c~rrrrrrrrk ae ~e ~c~rr c e ~ rr c y z z z z z H~ ~ ~ z ~ ~ ~ ~ CC l ~HCC~ ~ ~ ~ ~z ~ H ro y C H ro C C C C C ~~o rKH~ r r r r~ r aun O Cpl ~ Ti mm~~~-++ ,1v O ti] 7, ,'b n '~ n 'fi n b no ,~ • n b 00 ~ H H cn ro H H cn ro ro ro ro co ro ~ IV ~ ~ ' s] ~ ~ ~ ~ ~/ ~ om C C ~ ~ Q C - N ter r ~ ~ ~ ~ ~ ~ ~ OZ 61NU7\ N N U7\ O W Ol O 'zJ W OD O '~J hl h9 ~TJ '~J ~~ ~ ~ oo~o ooo o r-• o r N a N r ~, m ~, ~ ~ ~P O ~P $0 O ',rJ ~P n to ~A ~A N N v fl ~ d n n r-• ... ;: ~K -i ~ y ~. ~ ~ N d O 1D c w 3 K v m fR n ~. a 0 A !9 a 0 c 7 d ('~ d Di ~ S ono ~ O 7 ~ .C3..~ -1 D X ~ mo x ~ m `° ~~ ~~ o ~ n n ~a yam ~~ mdc n ~d2 a~ ~ x ~ ~ x ~ m~ A ~~ m ~~ m `~ CD a f°a a `D~ m ~ N H w A ~ . . i (U ~ ~ ~. ~ mo A d ~ ~ °~' ° ' lD a p, o n: 3~ n .•.. a~ (D O 4 ~ ~ ~ a. ~Q o" D ~ ~ ~~ c m n a~ c ~ n ~ m •G .~ C ~ I ~ ~ -a °, n ~ ~, ~~w a~ N m ~ y d W ~~~ v~ 7 ~ ~ N Q N 7 Q 2 O D D Id ~ k ~ ~ ~ 0 0 y G S N y o"i 0 d ui~ r N n 0 •f N N H N H H H H H F-' H N H ~ N N N N N N N N N N N N N ' N N N N N N N H H H H H H J J ~A ~P ~A ~P J J J W W W W i • M +F m m ~' m ~ d ~ d i d d z d ~, e x ~ m co w o ~- co w ~• m w o ~• m ~• ~• C G C ~- C C ~• C c C ~• C ~ ~ ~• n a a ~• a ~ µ- n a ~ ~- w ~" c a ~ < a < a ~ e a -o < m m a ~ m m ~ m m a ~ m m ~ 'J N (D N 'J (D UI 7 N (D i0 .7 O ~~ ~ ~ ~ ~ a t] ~ 3 a ~ 9 a t] p ~ a ~ m n C C ~ n C ~ ~ ~ p cr cr rr ~ r* ~ 1 N O (n ~ v O ~p '~ 7 O '+ H to r H N ~ ~^'o cmcmmnro~,o~znronronro~,axxn~n~n~ c~~ac~ ~roc~~~oxxroc~ ro O a ~ ~ ~ H H ~ z H H ~ ~ ~ C z d H H C r Cn~nr z zzHro 3ro zOZZ zO~zz ;vH ~y z ro~ z z Z z z O~zz C ztJt7tJt7t717 G to to U] t+7n]y C C+] H t+i ~ [+7 C=J []'~]HCC~GZ~CZ~CZ C 7 H ~'~]HCC m n H n n n [70[70 ~ ;nrHro~i N 1$ (v x'l ;vHyro HnHnHn N CSU 'zC1Zt7'z 7 r Hyro~C [" ~~ N CSV3~ y ~y ,on~on Qxdx~ i-Cx '7~\ HqqO n NO '~] '~ r t ny\ H[OHZHZHZ n ~ r xICncn\ HCOZ[ncncntnC7tn N aoy y~ryy~Cyy. 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Z H N Hn~-3(] ~~ ~~+xHxyx y ~~+ H H O C~ C~ H ~ H H H C N C C C ~o ro ro ~ N ~ ~ y H~ H r-~ ~ ~o n n ~ i u G d d u i [7 t7 [~ [~ • C C room tno~ x x x +O m o m +O b b oo~c row rno~a OD O lf~ O N O O O O 0 cn A N W N N O m m ~ H l0 N H .A 10 O1 N J ~A iP ~P ~ ~ ',i7 J .A rP ~P ~ N ~ 'rti r'C1 ~ ~ ~ ~ N N N N J W ~P ~ ~ 0 0 1 w `~ g n ~ n = M ~w 0 `c D ~ ~ G7 ~ ~ w ~' D 3 N m m _M ~ O 3 ~ i 61 :i i ~ Iv ~~ tD N A 7 n n C 7 .~- W 01 ('~ ~ ~ AI A ? fD Wn3 no ~ ~ 3 V O r y 61 n n 0 y ~,, + N N N N N \ \ \ 3 ~ W N N ~ r ~ ~ ~ N m Z '~° m m o m ~ m ~ ~ ~ a a ~ T ~ ~ O v m ~ ° ~ -' ~ CD _ ~ m ~ ~ m r' ~ ~ ~ cn n ~ m m ~ ~ ° = ~~ ~ a ~ m °' ~ ~a ~~ 0 o~ o N O U1 rn N C ~" ~~ ~~ o~ ~~ -~ ~ w O~ ~ N C r N N ''a . ~J~yC C~CtnC t U[ ~ G ~ ~ ~ ii z zz zz 3 [ O y C d to s]~ C CCf~7x 3 "~l ' ~ .~d1 Nzx~[~]OrHhiyp70 ~ t ] yy +O C] N *C x1 3 K) f] ~ ~ ~ O x NU1 (']gq O LsJH H rOtrJyH n] H C ~D ~ H ~ ~ C~ x~ ~~z n~io o n ~ :nt7nHG~ HG7 m ~ ~ ~ vi ~ai N ~ m r C~ NwC~ 0 .Z 1 t i V ~ w ro N~]N ro p r r C tnooC r r o ao mo i 0 00 0 0 a~ w o -J ~ o C J1 a m N (J ...I Q 0 r 0 ~ i o n ~ n n o ~ x m ' ~ m n v a 0 n m to ~ ~ o in ~ ~ ~ ~ ~ N N 0 Ol A n .U n ~ ~ 0 ~ D ~ ~ fD ~ -i ~ t 3 ~' D N ~ m ~, vii 0 ~ ~ A c ~d r: D !D '~ O 3 n I ~ N D 3 O .. W do I ~ ~ °it~'ro ~ 7 `~G ~~ 1 u 'l~ r F-7 r 1 ~r r`~` l J O H ~~~QN SO.. ~^~o-sue Gp7 ~~'t1 q ~ ~ N ~,. 7 Ow ~ ~ N -' 'D go W 3 O ~ O O ~ 0 O'1„ 'O u ~ ~~ 3 ~O d N -n'(L~ O O $ O-GO 3 ~i }~ ~ '.'•. ]y vp N41, ~O .. N ° OG tl (D ~ ?O ~< o~~ ~~ 3N^•• NC 4<N ~O no S-" 3 N~ n CJ~m oG3 °~ N O 3 qt~ ~Otfl 7N Z°',~' tD .-CD N Q ~ ~ 'tS d p fl'6 F ..~G y C~ N p ~ci CJ C'~p0 >"'.CO CNCG~ t ~ D n ~~. O~OhO C ~ cm c NOON -` N ' i 7 , [ ~ O O N i~Np jNT ~ O NG ~ 1 pSU0 y~A m QCD (pCwN N~ 07m~n~ G7m .+r in~m0 30 0 ,~co N ^ - W o`°m C3Nn ~ a op N~NC~~~ i v i c c . ~~~~ ~.~ab gm~o~ N~ (D O•~00'~7 ~ NCON NNr~.. Nry3 NN ~ ~ .nom NN N~"2=" ; ~..N N<pN~ ~ ~~'•NC ~ 4 O ;Ofl Ow NN~. t9 ..Q~ Gd G 0 O O O C i1•E' ?C A N O~? O n y ~'N ~ ~ . 7 ip~.3. t9p¢ O O ` .N~,O~9~ „C Np "•Q C~~.. 0 ~' p~3 ~ ? N~~~ ~3N~ ~N r '?~ ~ ~ ~ S '"{ ~ O~ ~ O 7 ti- C ~ ~ ~ o -• _ ~~ N~ O C ~ O ~ C O~ No N 7 _ 4; N it ¢ O C, pFN u~ ~ ~, . c J~ c a N m N ~r 'D i .sCSN •p ~o ~• - "~ o~~m ~~ ~ ~ ~~0~ ~ ~~ b `~ "~ ~,®. Cr'~ n n ~¢ m =". ~ Q'~ 7hcQ ~ ci 7~'0' C~ r~ ~LNN 9N --"1~••0,~910 X00 =NC3- ~< ~7'i~C~ C: Nif7p~. n c ~ ¢°~ ¢;~. ~ moN(PNCSv N~ 3m Wo ~ O ~ Q•~~ ¢o »N ~• wpm ~m ~~o ~~; ~ 03 ~ mm <_ o ~.a. ~ ^ S~ m O @ N N Ncn~ ~~, O 7 N 47 ~ N ~ °pc.~ 3 o.Q ~ 6rq •a ac: c9 T N~ ~` NS .cca`~o. !~ F° $ t7 (J1 • .< u~ m g C. (U N ~ Q N ~o G? ~ ~ n ip7 0.~. t7~ ~ cN"'t=• ~ ~ 01"O ~ d'" ~ G ~co-+ m-mm~' NN= 3 N = 0119 ro^O p N „<~N~Op7 3 0 = ~ c. ?• ,.C 3oovN~~N~ 3 i!N O tO~ ^ ~O•np ONO-C ~O -p N •"'~ tD - Gp ~ 7 CD N ~.¢~N 7N ~N Q pit?, O'n r~N N7 N 3CS7 ~~NN~ 9 O Nfl?Cy ~cNJ1>N 4^, ' N-p N 7 O'' N N ~ -~ D 7-- 'O ...din WN ANN n ~w cD °"c~ ~mm3c ~ ac ~ w `^ a m ~ ~ "" oN aK ~.?~- c»mo•c o~ o~ p 6~M ..coa 3 z ~ ~ ~ p fl~ ~~~ N n m N ~: ~ ICNipr a ..c Q<cf -• N m ~ o ° ~ ~fl~ ~ N.CO n ~ 7 ~''- cdi t0 ~~ 5 n ~ c0 6; REV•150H ~ . i7-s7) SCHEDULE E CQMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER W1~ TTC-'t2 S 7No~!•¢S G., ~.T.Q ~i- o~ - a?o Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ,. ~Y t ~„- she o~ `Truck C/ylazca/a~/rY'f~ ~iN 5~f=~fcRlau~- a »f G» R".I ga?30l0 -Ev (~,onal d S. En~lart ~~•¢/~P l~d~ ~seG .S~`I~e1` a~aclre~~ 3, ooa. °° a. /~/f/C QgitlC, ~ ft., ~ e e%;.ey ~et+~' AJo. .5"aoo 6 3! 5t 3 S ~`f. 3°0- 3z 3, .~ccr. ~rlf ~ d o.d. off i0~i ~o . z . z7 ~5 ce ~etY~" I r'o/~1 /a/~C /~nk~ •U..¢ a7~a r~ied) fro-t-a cS on s apt d re; m 6 u r s e m e ~ is per sir. I~ o~ ~-e ul es fafc: Q~ cou,n Ty -l-a,xe s ~~~o.?. 3~ !j, SGy oo ~ -1-a~.1ce5 ~l S ~/. 7,~ (l e use ~~6• y~ G) Sewer See ~efFlemenl' sheer' ct~-a~hed -f~ Sche.d. ~1. .3'• ~e,fzc~c~ ~oirt ~'. ~, S, ~ ~personrt 1 i n cv~vra ~xx e s ¢/roo, o0 ~, ~@~~/ fC,~est, Pa. l~epf of i4eveaue j5z~0,oo 7. ESQ/e o~ ~ersonaftY by lle~~rys ~uc>'ioh, ~~o/ Pti•%c%l~~cq ~q,S83 so fkencce, C~ia~t 6cr5~urJc~ ~~ /~zo/ (see CapY of /lroeeea/s ~ /datrolif C6iec/l .brea,C~r~o~ ~~acl.t~). ~', .Z'~e~ts m~ Prrsona~~. Kepf {nr c/isfridu~o~ ~ ~~c°siduar~ q) -Te/evisioh ~/DO, OD ~) yllc~rnw4ve f 3S,aD c~ Food G'h° j~'~°~' ~S', ov G) G~`tLYt~! MOs (.tOG~C '/O 4 , eo ~l Lea ~ ,~~owe/' ~ mss, ao ~~ ~ tawh ~ha;~s ~ ~.no ~, /j'Ia~ey i~l h/a//ef ~i/.oo /( ~e ~ua~/ o~ f~o~reow~e~ s .Zip S urance ~..Z b 6 , 00 TOTAL (Also enter on line 5, Recapitulation) $ / q~ 3'78% (07 (If more space is needed, insert additional sheets of the same size) tTI PIUNrED oN gHOENIdd• vWr c0118uuEP rECVCIED iNlR - - -~ Vo.g173674 ~. A. PA TITLE N UMB E R (AS SHOMrtJ ON AT TA CH TITLE) MAKE OF YE}IICLE /l ~ / r ~ , / , ~ ~T T / ~ ~ ~ T d ~-- W Q ( (swe a, ~~,~e~e) D ~ D ^ ^ „< / ~ VEHI LE IDENTIFlCATION UMBER CONDITION o: ° (~ ~ ~~ T~'~ / UL i~ i O dJ ~i OOD FAFt ^ POOR • • B LAST E (OR B ES NAME) NAME MIDDLE INITIAL TAXABLE W J ~ ~ AMOUNT D ~ d • ~J (, • ~++ ~ COSELLER 1. Sales Tax Due x 6X (.O6~ ar x~( .07) ff / a^QO ~ mneuersel• 0 ^ fr. LAST NAM FULL BUSINESS NAME MJDOI.E MTE ACQUIRE / to E PU ~ ~(msj b23CrO) D: W 2 V CO-PURCHASER 1B First Assipimrarit 18 Second Aseiprrrlent STfjE n COUMY CODE ° m /~~ P ~ ~ ~ 7 K ~ 2 Title Fee ~~ Qn `.+.1 ^ q'rY ATE ZP COO£ REFER 7D COINiTY CADES Y t ~ l °( Llsrtr~ or+REVERSE soE a t:ien Fee „_ aF R« coPY . D. LAST NAME IOR FULL BUSINESS NAME) FlRSi NAME MIDDLE NHnAL D P ATE ACOUWED/ URCHASED 4. Registration or Processing Fae ^ CO-PURCHASER Fee Exerrp Nurrrber w as assigned bq the W Bla~V = STREET COUNTY CODE 5 Duplicate flaf~ N U . . Fee _ ~ N0. Of Cards ^ ^ = CITY STATE ZIP CODE pffEq Tl) COIIMrY caoEs tJSTM1O ON REVERSE SDE 6. Transfer Fee OF PlYC COPY • • E. MAKE OF vEHICLE VEHICLE IDENrlFICATION Nt1MBER 7. lnaeasse Fee wo ^ s < MODEL YEAR BODY TYPE {CP. TK, ETC.) CONDITION ~ ~ ^ ^ ^ a i Fee FAIR POOR GOOD ^ ^ F. ORIGINAL PLATE ~ Check One ^ TRANSFER OF PREVKx1SLY ISSUED PLATE TOTAL PAID 9. 10. PLATE TO BE ISSUED BY ^ TRANSFER & RENEWAL OF PLATE (Add 1 ttru el ^ Q ^ BUREAU (PROOF OF IN- ^ TRANSFER 8 REPLACEMENT OP PLATE SURANCE MUST BE AT- ^ 11.GRAND TOTAL Check in TACHED.) TRANSFER OF PLATE & REPLACEMENT OF STICKER (Add 9 d 101 This Amcunt y ^ EXCHANGE PLATE TO BE ISSUED 8V BUREAU PLATE ~- REASON FOR REPIACFJdENT pLOSr ^ oEFACEII ~ sloLerl a: ~ TEMPORARY PLATE EXPWES ~NEYER RECENED ILOSTwMMII) u p ISSUED BY FULL AGENT Month Year NOTE tl "NEVER RECEIVED" block is cfiedled, aOPlicaM rrerst Form MV-44. TRANSFERRED FROM TITLE NO VN . o ¢ YJL 3 4 51 r SIGNATURE of PE FRDM SIGH r~TE REUITIONSHP To APPUCAtiT ~ 8 5 8 4 0 FEAR ED iF oTHEfl ~APPL~ vE . _ _ . _ .. _..._-- _...R WFO E FBI 1 VyFJygHr aEa REG. GROSS wT. ~~ ~ MCLUDwG LOAD REQ REG. GROSS coMB. WT ~ APPLICABLE . ~ ~ ~~ ! j O . ( ) COMPANY NAME t~10, (OF3,.i POLICY _ Y X j aJ ~ ~ Q ~ ISSUING I CERTIFY THAT ON MONTH DAY YFJW 6 I G ENT ( RINi M ~ AGENT I HAVE CHEp(ED TO DETERMII~ THAT THE VEHICLE I INSl1RED ANO 1NFOR- ISSUED TEMPORARY REGISTRATION TO THE ABOVE APPLIGWi, W AGENT 81 '1 7ELEPH MATK)N COMPL.UWCE WITH ALL APPLICABLE PROVISIONS f~ THE VEHICLE CODE _ .J AND DEPARTMENT REGULATIONS. ( ~ 1 G I/WE CERTIFY THAT VWE HAVE EXAMINED AND SIGNED THIS FORM AFTER fT5 COMPLETION ANO TW+T T}E INFORMATION GIVEN IS TRUE AND CORRECT. P AN EXEMPTION . IS CLAIMED, THE PURCHASER FURTHER CERTIFlES THAT HE/SHE IS AUTFIOPoZED TO CLAIM TIi13 EXEMPTION. l/WE AgCfVOWLEDGiE THAT 1/WE MAY LOSE MY/GLIB OPERATgVG PRMtFGE(S) OA VEFYCLE REGISTRATION(S) FOR FAILURE 70 MAINTAW FwANCIAL RESPONSEIUTY ON THE CURRENTLY REGISTERED VEHICLE FOR THE PERIOD OF REGIS7RAT1Cti. 1711VE ACKNOWLEDGE THAT I/WE MAV BE SUBJECT TO A FwE NOT EXCEEIXNG 35,000 AND IMPRISONMENT (~ NOT MORE THAN TWO YEARS FOR ANY FALSE STA Ni THAT 1/WE MAKE ON THIS FORM Z FirslPurchaser ~ed ~ ,Il TEL.E ~ of F 1ST ~~ ~~ / ~ !!!11 L~eCJ~ /w ~/w / i . _- _ _ v ASSIGN- MEN7 re of Co-PUrdraser/ tnoraed ~ ~ 9 Of Co.Seller O Sgnature d Second Purchaser a Authorized Signer TELEPHONE NUMBER Signature d Seller 2ND ASSIGN ( ) - MENT Signature of Co-PurchaserlTitle of AuthDrizeti Signer SgnaNre of Co~eller H. Z NOTE: If a co-purchaser other than your spouse is listed and you want the title to be listed as 'Joint Tenants With ~ oWa Right of Survivorship" (On death of one owner, title goes to surviving owner.) CHECK HERE ^. Otherwise, the title F~~ wil- be issued as "Tenants in Common' (On death of one owner, interest of deceased owner goes to his/her heirs or $ Z estate). NOTE: IF THE VEHICLE IS TO 8E USEO AS A GAILY RENTAL OR LEASED VEHICLE, CHECK THIS BLOq( ^ . IF BLOCK IS giECKED. COMPLETE AND ATTACH FOAM MV-IL. MESSENGER NUMBER: `~111r,> ~l l.~ ,f. RONALD J. ENGLERT 1. DIANE ENGLERT 717-485-4108 7157 PLEASANT RIDGE RD. ,;~ tiARRISONVILLE, ~ 17228 (a f~e i ler of ?'' ' = . > > ,, ~~ 704 ' 60-1051/313 rDate o a, ~~ =c • v :.ci ~~ c~ 4 t.v~~.~ ~ r -Uw v war i ,~ i~llarS 8 ~ °"`°'° { ~ma. 'rHE ~ `IrS~NATIONAL BANK FIRST ADVANTAGE CLtfB a ~ ~ ~-rc~c,y McCONNELLSBURG, PENNSYLVANIA - -i `Far, ~~~~" -~ ->G„ ~ 7 ~ `--'`-r - ~G=-~-- ----"-" x:03 i3 105 i0~: 53"' 1831711' 0704 ~' O('IarMe M.vxw .. .. AEGALOWRG °~( ` ~ ~~ r~~ `, f'1HF'-1=tF,-~G~~=~~ Gr : ~~,_~ ;'P'sc_ P~HP lI : CIF L:~EF'HF'Tf~lEh IT 41 ~' ~ i iC t_~~_~~ ~ F' . i~ 1:'~=t 1 (~ PNCB~~K March 5, 2U02 Charles E. Shields, !II o Clouser Road Mechanicsburg, PA 17U55 IZE; Estate' of Thomas G. VJatters, rr,, deceased SSN: 169-~-3393 DOD: 12/291200 1 Dear Mr. Shields: In response to your request for Date of Death balances for the custofil~~r noted above, our records show the following: Checking Account :\ceoune #5000631438 Established OZi01/1996 THOMAS G WATTERS JFL DOD balance: $4,300.32 = $0.27 accraed interest Please note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not process any financial transactions or provide statements. If you need assistance with a.ny of these items, please call 1-888-PNC-BANK (1-888-762-22b5) or stop by your local PNC :Bank branch office. Sincerely, Rochelle Wells 1-8UU-762-].775 1~7-PFSC-04-F 'i0Q fiat Ati'e. Pittsburgh PA 15:19 Member FDIC TOTHL F'. ~=~i ~' «w~. _ - - - ___- ._ .. ,-,tom KENNY'S AUCTION 110 9 , CARL E. OCKER • OWNER ailfirst Allfirsc Bank 4401 PHILADELPHIA AVENUE Harrisbuc~, PA 17101 CHAMBERSBURG, PA 17201 PH. 717-2sa-ss7a 3-25-02 so-es~e DATE S Y PAY DOLLARS ~ 6952.38 ~n ,... p , ~ } . . I :. Estate of Thomas G. Watter~;{~L~Qr;dd_f ` °-~ ~°~' "~~~~' ~°"~~ °"°' ~~~°~ ~o C. Dianne Stenger ''~ ©RDER POB 102 ESCROW ACCOUNT w;.{ ~F McConnellsburg PA 17233 _I _._, ----.------._..... ___ ___ ._ _.__ _.._ __.__.. _ __._.._.._._. lz I~'0 L 3109 i~~' ~:0 3 1 3008 34~: 3 3 5 548 38~-' _ __ __ _ - :~ - ~ - - -= KENNY'S Au07{ON DETACH AND RETAIN THIS STATEMENT CARL E. OCKER -OWNER THE ATTACHED CHECK IS IN PAYMENT OF ITEMS DESCAIBED BELO~N CFiAMBER$BURG, PA f 7201 IF NOT CORRECT, PLEASE NOTIFY US PROMPTLY. NO RECEIPT DESIRED DATE ~ DESCR{PTiON AMOUNT gross 9589.50 less 27.57 2637. I1 net 6952.38 >~ ~ ~1 ~~, ~~ ~~~~ ~ `~ /} ~, _ ~ ~, c~~--~'...~.```~ !.~ ~-.n ~.~-~,~ a (i~ -, r r ! ~,~,~~ l L~ Lt.Zy,"-yam) l~L'C_.e"._..c..~~•.~. ~~. ~1 CJ--c7 =~~ ~ r- '1'-r ~ ~~ f1(~ ntv-~°iu en + p-yq COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Gt/ A TTE'R S, ~"/~a SAS' G. , ,I,p. a / - aZ - z o This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side ofi the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE. THEIRREUlTI0N5HIPTODECEDEN7ANDTHEDATEOFTRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE . DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IF APPIICgBLE TAXABLE VALUE t /n~ Mertz l~ L yrvl car Fvr>I cr 5 rce f'! re MGn'~ (~I4 s ~nnu~tY Confi-a~f No. rn 4+e I o~ ~ ssy (See ,r3~-r; 11 Lyhc~i sf0-femen f a"~tt cbted~ ~ Tn-~vriv-m~'ona.l Nor : Th ~ s llr{--nn ui ~ ~.Lso apnearS ~n -fP,~ lYle~r;11 L ar~t~ 51'x.1 erv~enr* y 1t ~~; I73.SS Ia0/~o nohe ~ a~ /73.SS a.-tfactn¢ d ~-r sc~lne d . B , ; r1 rny~s I f'G-rart~+ S 11n,cre:n.~ TOTAL (Also enter on line 7, RE~capitufalion) , $ ~8, 173, SS (If more space is needed, insert additional sheets of the same size) v r m m m m -~ ~ o~ < ~ro m ~ ~ cn N O m N O (A ~ N O W ~~ ~~ O~ i ro N ~. wa 0 ~ D V N V7 o -- ~z ~d 0 A m w mm D ~~ ~ N N (y i~ O Vi~P C WJ ~ N O •'- O OJ '' ~ o N ~ o N o y ~ ~ n :° ~ ~ ~ ~ D co ~ ~ a ~~ cD o ~ C!1 U] ~ .~~- r- ,n G] ~ 7 ~ 7 N -w ~ a~ ~ ~ +-3 H ~ d ~' Cr1 C ] , .' O ~~ ~ ~ ~ 4~ w ~~ ~~ o ~. m' 01N ~ ~ ~ ~ N u~ uti NN D ...{ n ~ n ~ ~rt ~ to m ~+ ~n ~ n `~ ~~ ~ n 0 rt y 3 N ~O N ~ 3 ~ m m co co in w » o '~ ~, ~ ~, ~ .. ~n o io ~ Oy. ~ D r~ ~ O N ~ .w ~ N N 10 W l0 01 N O fA O W O~ M U7 J J 3 w m ~t N N -1 w ui d N ~ ~ m ..-~ m N ~ d ~• N ~. ~~. \~ ~ ~ c ~n. '~ a mN a ~. N ro w W ~ roy. a r N 0 N a m m N O N 0 N W w ti 0 N N N N rt d c n 0 3 N O 7 EA O C f!1 d 7 Q U! m~~` = Ul -1 S Z Q ~ ~~a WD~ ~~~ ~~~ 'O D m V ~ o N ~ ~ ~ ~ w O A ~ O ^~ CD 1 ~'~ 3 , d aC! ~ ` o ~~ ~ 3 3 Z ?~ vi ~ 1 R ~ rt Z ~ Ul N ~ ~ a~ ~ - l n Q' ~ m- D ~,~ ~zr W ~ ~ Q ~ ~P N ~ C71 n w ~~ N O 0 () N Q 3A~ ~mtD = Z N gym? ~ D f° C ~ mo ~~ oma ~ ~ n ~ O O ~ O 7 yu~ l r x H ~yH r~ z *~ r z x C'=i Annuities Merrill Lynch Funds Retirement Plus® Thomas G Waters Jr 215 South Norway Street Mechanicsburg PA 17055-3445 •v F Statement Transactions and holdings for the period September 30, 2001 to December 31, 2001 Contract Information Contract number: M961061554 ~ - Date of issue: April 29, 1996 ML account number: 872-47081 Owner: Thomas G Wafters Jr Annuitant: Thomas G Waters Jr Values as of Total premiums since issue: $20,000.00 December 31, 2001 Total withdrawals since issue: $0.00 Contract value: $28,173.55 Surrender value: $27,733.55 GMDB of Sep. Acct. A: $26,378.94 Value of Sep. Acct. B: $0.00 Death Benefit: $28,173.55 Summary of Contract Statement Period Year to Date LSSUe to Date Performance 09/30/2001 O1/O1/2001 04/29/1996 ' to to to 12/31/2001 12/31/2001 12/31/2001 Beginning contract value $ 25 , 237.12 Additional premiums 0.0 0 Withdrawals 0.00 Contract maintenance charge 0.0 0 Investment results 2, 936.43 Ending contract value Rate of return Avg. annual rate of return 11.64% N/A -1.64'% N/~- 42.05% 6.38% Summary of Transactions Total new premiums for the period $ 0.00 for this Statement Period Total withdrawals for the period $ 0.00 Me:rill L ch Yn Merrill Lynch Lile Insurance Comparry 28, 682.6(1 0.0(1 0.00 -40.00 -469.0 fi 20,000.00 0.00 0.00 -200.00 8,373.55 $ ~ 28 ~ 173.55 --- $ - 2$-,173 ~ S:i - -$ 28 , i7~ . 55 872J8123 January 2, 2002 M961061554 page 1 of 4 . ~ Annuities Merrill Lynch Funds Retirement Plus® Statement Summary of Contract Value Units held as Unit value as Value as of As of December 3l , 2001 of 12/31 /2001 X of 12/31 /20fi 1 - 12/31 /2001 Separate Acct A (ML Retirement Plus Advisor) ML Basic Value Focus ML Core Bond Focus ML Domestic Money Mkt ML Global Growth Focus ML Government Bond ML Highh Curt Income ML Small Cap Yal Focus Alliance Premier Growth Alliance Quasar Mercury HW Intl Value VIP MFS Research Total Separate Acct A Value Total Contract Value 149.5826 $ 28.419751 $ 4,251.10 299.1575 16.819253 5,031.61 18.5576 13.749842 255.16 151.5368 9.354531 1,417.56 204.4292 15.037940 3,074.19 84.0048- _ . __ _ - 15.913161 1, 336.78 134.0749 29,66178'7 3,976.90 247.9353 16.922037 4,195.57 214.3794 7.891479 1,691.77 143.5255 9.933124 1,425.66 116.7612 12.994504 1,517.25 S 28,173.55 S 28,173.55 Summary of C~tract Value Units held as Unit value as Value as of As of September 30, 2001 of 09/30/2001 R of 09/30/2001 - 09/30/2001 Separate Acct A (ML Retirement Plus Advisor) ML Basic Value Focus ML Core Bond Focus ML Domestic Money Mkt ML Global Growth Focus ML Government Bond ML High Curet Income ML Small Cap Val Focus Alliance Premier Growth Alliance Quasar Mercury 1;vJ Intl- Value VIP MFS Research Total Separate Acct A Yalue Total Contract Value ~'~.~ 126.0293 $ 24.05403:1 $ 3,031.51 147.7038 16.98155'1 2,508.24 18.5576 13.71963:1 254.60 239.9060 8.83871'7 2,120.46 247.9129 15.168922 3,760.57 84.0048 15.469397 1,299.50 185.0545 22.54583'_1 4,172.21 132.0759 14.833011 1,959.08 169.8045 6.193602 1,051.70 306.0601 9.258372 3,389.12 146.5102 11.5359496 1,690.13 S 25,237.12 S 25,237.12 872/8123 January 2, 2002 M9b1061554 page 2 of 4 Annuities Merrill Lynch Funds Retirement Plus® Statement At Your Service If you have any questions or would like to make changes to your annuity, please contact your Merrill Lynch Financial Consultant or contact us at: Our business hours are Our mailing address: Our address for overnight maiL• 8:30 a.m. to 6:00 p.m. Eastert- Memll Lynch Life Insurance Company Merrill Lynch Life Insurance Company Time, Monday through Friday. P.O. Box 44222 4804 Deer Lake :Drive East Jacksonville, FL 32231-4222 Jacksonville, FL 32246 Our automated voice response system is available 24 hours a day, 7 days a week. Our telephone number. Our FAX number: 1-800-535-5549 1-888-329-6544 Your Financial Consultant: Telephone number: SHARON J STEINER 1-(?17) 975-4600 872/8123 January 2, 2002 M961061554 page 4 of 4 ~~uz3 REV-1511 EX+ (12-99) - , ~~ SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Gv~ 7TE72S, %~oih~s G. , .T•E? ~ / - o ~ - z o Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t. ,g 1r ~~G~So - r,Op~g2~ruS ~c-tritra( f-~nwtt oaf CiZiGi.m~7GYSbur~ , /J ~ O(c.3.00 a?. ,Qo/1,'rly Greer ~'cmetory fi.~, 7.Zo, 00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) C. Dltnn¢ ~f¢a~rer' riKa ~I QnG ~>t'erlge.r N Social Security Number(s)/EIN Number of Personal Representative(s) /9~- 3y- 6,> o ~ Street Address /moo $Ox / o ~ City 1LlC (~o~~C /~S ~ u ry State ~~_ Zip / 7~ 3 3 Year(s) Com is m sion Paid: ~~f/{~E7~ LrJi¢/IiED 2. / ~ r Attorney Fees l.. K ar fes ~, J~~1 ~ el ds ~ qp J~ ~,DO 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant NDNE /NONE Street Address City _ State Zip Relationship of Claimant to Decedent 4. /~ tI pri grno~ - SSuc o7' S~or~' ce,~f~ ~i cn,~e5 Probate Fees LtM ~! , a I,3 ~. OD 5. Accountant's Fees 6. S ShR f~Gr , Tn,X /dreP. ~~ose-out /p40~ IOyJ, ~ic~ Tax Return Preparer's Fees 17t~orC ' ~3 Sa , 00 1 Rob6rl ~~,rk~ ~Q,rIG FlTignci4l ~VIC.25 ~hGscrrec~ ~. ,¢d~. iia`ta/ ~~ohafP 1~s ~ /SS o ,p 8 /fJ~trk C ~f.~~rf }~ l~SSoCS. -/P~°m/ ES~iite ~pi-u,s~t/ 'g27S.vo y, ,4 TF~T t/. 3s /O- llnr Leo/ GUafer lo. f3~. StD rr. PPS L. ~`ss.89 TOTAL (Also enter on line 9, Recapitulation) $ 3 y, 778: /] (If more space is needed, insert additional sheets of the same size) ~~~~~. ~' s~ti~~ Gti~ TTEYS, T os~~s G. , Ja. ~ t -a z -zo J ~. ~cn Hn ss; n~er Snow ~t'ernoval 3`~S. 00 t3. ~rr's ~unk IPemova-1 ~;n pip ~z,.- she of rya/~`y ¢195. !~. ~i¢f~ ~e2hir~ j 'vice ~/ 8 S..SD /S. GCnrfe~ LV~LILCr 0 G. ~l /6. i°PtG 9.sz / ~ 6i/~t><cr- Cln~~ca~ Rio. ~S J8 // // / ,~orDUgrf v>` ~tC~QrlicS~7u~^~i -~'[wer/~e1~SC cc /I 9~/~. QO / ~. i IIQ f/1C Ty~~", ~l'Q55 ~O!!/ O 100.0° 2.0. /t'dyer'{~Siitq i~ ~e Cu~,~rlwr~~vfuraa/ U f7S.a0 s~ ~s'er>Ss. :r~ i~ /Pu f/~~•rs6ur~ ~ii~.of /1J~rv -Gricsf ~ 8539 a~ ~P/~i2oq tl%/P~ofJo~le ~yP.7Z 023- Rea Jars ~ol1JI71 i s5i on aei ~a~e ~ /deal ~sfate -- Cen fury ~l t~ise; o h e rt ~ ~7, boo, bo fir/ l1/0 Marys fees rrn oSa1e o~ rQ~al ~ sfure s o0 ~. ji ea /fy Tray sir l ayc ~famrs fil, Soo . ao ab. / aoo~2 (%BU~vurll~YOU4~j Tres ~o ,~~r~r~ L. f><~c/lard O ~ ~tS.2! 21 furr ~I P~sc%oneri 5~rv~co Fee ~ Cert ¢ 1ys,~o 2 8- /~dd,15o~~tl' SttD~t C'e!rfrii~irr s 'g 9. o0 a 9, fjd~>ri0/lal sj~0~2~ Cerf. {, ca?es ~p en ~, ~~ tL ~~. ~f 3l. ~~~~ ~4.~~ .3.~. .dmfQry, er, ~e~s i~ ~oaneetSoh iu~fl, ~sala or ~ra~k ~ch~a'•E:/ .' ~dS no 33_ ~ Re~M6ursamenf,G'~ed~'f ~ ~xeeufrix ~vr m~/ea9e ~~6rh:~lase ~' ~a/s >lv~ he%n ii1 c~echi"rtq u~ ,o~r~er y, ~r~~ ~~~~s, e~;: %l70~ see b~akdawti sheet a ff a~Grea' 1 ( See S~lee~ a /faeliecr ~a sc~ierl ~: 3S_ ~ei~rL'urse~lerlt' ~ C'LtQrIPS ~ Sl,. •e~d5 111. ~ v ~~>~~pPr'e s, ~os~ ~Srrttice-mil/s, C~erEi ii •e~ ayt~/ ~9ular /mar'/.'n~s, ~~. ,~ta ~ii~.,•~ O f 37. So ~G . ~ %,%rq .Zti~ieri~i2h~e ~u.~ /~c/frUrr/ Sze ><o /~~~, of Lri~i%s ~s . av ~7. /~eim~urseaee~ r~ G xeCu fry"x {pr ~`aoae c'4 //s , /eiry c1,:sl`a~tce, A~ e Jan. (/ ~` / ~. s~ ~~. /~e~,nd ursemen¢ r~ ~xeCUt~~x ~r /oosT`a~C' P~c~ses "~~ . o0 39. Tune Ty/or~, mow;~~ ~'~o,eo Con~i'~. ~f Sc~ier/. y. Gri~4 T7E.~S %yo~.¢ ~S' G., X1/1 yi. un,%d lvrcfer a~-o ~ -zo ~, 7n i, s 7 REV-1513 EX. (1-97) , ' ` ~~5-~ ~ SCHEDULE I .~~.:~ _ COtviMOMNEA.~THOFPENNSYLVANIq DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABiL1TIES & LIENS RESIDENT DECEDENT ~ ESTATE OF ~ F'ILE NUMBER Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. l~Cri ton. ,o/~vo~s P~io~c 6. %/s ~ S?.39 .2. leer:Zon tt/;re/ss, ee// p/iones moo. /~ 3. ~:%-sf Card C.r~f C'a~^~ a~edf ~5', o7y. 9f /r ,~rOp~L, .~ ~ICLl~lil~~St7~fry, ,~~er ~ .Pc~uS~ p/D3- SAD 6. lta.~ca' I~Qtc.-~ of ~°. ~~s. ~q T. f~NC ,Bae ~l, ~ard ~ fvrr.'r~ s a, la ~{ ~4 8. G'llasc, Cr~~,f ('ate /¢c~~t. s/, e ys, ~/ p. (~'.~casf (~'id/e i ~' 4 a s 70 /a• /"ea/~rS ~/oir/C/s, c~C.6f ~r ~'~Ir~J~/uS ~/osrxi'.~ ~7G . /6 //. P//~fL F/ecfr,~ ~6~.~3 ~~ CGIa se C'i^ecl f bra! beef' d o7 S: G6 ~~ C'o~1c~15~ 6.20 15~. /~~~re~a.~c od~NSfine.,t fn d.o.~. dalut of cbeck~ ~ ,ccc,E'. ~n sehea~- E ~ ref/ecf ~ hceks uiri/tt'h by ~/ecedCS1f u~k~;., ~ ` / `1iS ji~iinB ~t/hiG/i c%A~ i10t Clear acct KH15 ~ Gtt~J~u^ d. c~. a! ~ ~aS.OO TOTAL;Alsoenteroniinel~,Recapitulation} I $ (If more space is needed, insert additional sheets of the same sizel _ tr cr ~ ~ Q~n( S ~Et ~ . ~~~ / ~~~, ~, ~. ~_, ~! ~ , , ``~ ~~~~ _ ~:s 1~ 1/a ~ l ° ~ ~. s~ °`~a- ~Ll ~-- -~ ~-~`" (1 , .cam--Z~ a f ~ ~ ~ ~_ ~~ ~ `t ~~~ a ~ ~ ~ ~,~ H` `/~ REV-1573 EX + (1-97) l ~ SCHEDULE J COMMONWEALTH OF PEN4JSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER GrJ.9TT~~1S, ~~a~.~S ~r,, T. ~l -o z - zo RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. -D ~ ce..ne ~~"et~gGr r,. Ka C. ~ ~ a n ~ e 5~~1 qer J p- D, ~~X l d.! 2 C.`o UL S i n 10 0 yo >~~ Cmnnel4s~~J~, ~'`~' t7~ 33 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINE S 15 THROUGH 17, A,S APPROPRIAT E, 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 1. 1. I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT of THOMAS G. WATTERS, JR. I, THOMAS G. WATTERS, JR., of Mechanicsburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish ar~d declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. i. I direct the payment of all my just d'.ebts and funeral expenses as soon after my decease as the same can conveniently be done. 2. All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, I give, devise and bequeath to my cousin, Diane Stenger, to her own use and benefit absolutely. 3. In the event, however, that my cousin, Diane Stenger, should predecease me, or should die at about the same time as I die, such as in a disaster common to both of us, I give, devise and bequeath my said estate in equa~' shares unto my father, Thomas G. Watters, Sr. 4. I nominate, constitute and appoint my cousin, Diane Stenger, to be the executrix of this my Last Will and Testament. In the event that she should predecease me or for any reason be unwilling or unable to act as such Executrix, I nominate, constitute and appoint my father, Thomas G. Watters, Sr., to be the Executor in her place and stead. In the event that he should predecease me or for any reason. be unwilling or unable to act as such Executor, I nominate, constitute and appoint my cousin, Sue A. Bruno, to be Executrix in his place and stead. 1 further direct that they shall not be required " , to file bond or other security in the Office of the Register of Wills for the purpose of administering may Estate. IN WITNESS WHEREOF, I have hereunto seat my hand to this my Last Will and Testament, which consists of a- pages, to each of which I have affixed my signature this ~_ day of -~~~~, _~, ~,,~ one thousand nine hundred and ninety-five (1995). ., ,,\ _ __._ , Thomas G. utters, J . ~• COMMONWEALTH OF PENNSYLVANIA ss .. ~~ COUNTY OF )~ `~-~ We, -~j'/Gr/.4EG _.~_~~E't';~s~rr~r? --- , and ~~~,~~,y r, ,c~EGy and the testator and the witnesses respectively, whose names are signed to the attached or foregoing instrument, beina first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his Last Will and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the Will as witness and that to the best of their knowledge the testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~ ) /,.... Thomas G.1 atters, Jr., Testator Witness b .. r,. .'.. -., A. ~I : )...1: Wi nes Subscribed and savor to and acknowledged before me b~-~-,' Testato~ and subscribed and sworn to and acknowledged before me by ;k?, ,,.~.~~-~;~ u, ,4~~{"c~-4.~ and ~~~~~-~' witnesses this i ' -- day ol~ ~).~ ~_ ~ ;,,~~~_ ~~ 19~`~ ~; ,~ t--etc-'~`° " :_._~_~' ~ ~ .,~ Notary Public // ~/ Name of Decedent: STATUS REPORT UNDER RULE 6.12 _'---- Date of Death: /,~~-~~'`i/ Will No. Admin. No. =~/- c~`~ - /~..:'~.LG> 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: 1. Sta e Nether administration of the estate is complete: Yes No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No '~/ b. The separate Orphans' Court Na. (if any} for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? ~i'es~ No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be failed with the Cerk of the Orphans' Court and may be attached to this report. Date : ~ • ~~ - ®~ ~ ~~l~'~~ /~ Signature Charles E. Shields, III Name (Please type or print) 6 Clouser Road, Mechanicsburg, PA 17055 Address X717) 766-0209 Tel. No. Capacity: Personal Representative Counsel for personal representative (MAH:rmf/AM3) ~, ~ 7'3O~"~ COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 NOTICE OF INHERITANCE TAX HARRISBURG, PA 17128-0601 APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 E% AFP (01-027 DATE 08-12-2002 ESTATE OF WATTERS THOMAS G DATE OF DEATH 12-29-2001 FILE NUMBER 21 02-0020 ~~'- ~ COUNTY CUMBERLAND CHARLES E SHIELDS III ACN 101 6 CLOUSER RD Amount Remitted MECHANICSBURG PA ,17055 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS t ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-021 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WATTERS THOMAS G FILE NO. 21 02-0020 ACN 101 DATE 08-12-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 131 000.00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) 98,510.21 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this fora wi#h your 5. Cash/Bank DepositslMisc. Personal Property [Schedule E) (5) 19,37 8.67 tax payment. 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) 28,173.55 8. Total Assets (g) 276, 062.43 APPROVED DEDUCTIONS AND EXEMPTIONS: 34,778.17 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) E~,476.16 11. Total Deductions (11) 43 .254 _ 33 12. Net Value of Tax Return (12) 232,808.10 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14) 232,808.10 NOTE: if an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) .00 X 00 c .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) .DO X 045 . .0 0 17. Amount of Line 14 at Sibling rate (17) .00 X 12 _ .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 232,808.10 X 15 34,921.21 19. Principal Tax Due (19). 34,921.21 PAYMtN1 ne~eir7 ~++~~~~+^~ ~T~ AMOUNT (PAID DATE NUMBER INTEREST/PEN PAID (-) 03-26-2002 CD001007 1,350.00 25,650.00 PAYMENT MUST BE MADE BY 09-Z9-2002*. TOTAL TAX CREDIT 27,000.00 BALANCE OF T'AX DUE 7,921.21 INTEREST AND PEN. .00 TOTAL D1JE 7 , 921 .21 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN ;~1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) tstates of decedents dying on or aetore uecemaer 1Z, lYBZ - 1t any tuture interest in the estate is transterred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPDSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2D00. (72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Make check or money order payable tc: REGISTER OF RILLS AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Applicaticn for Refund of Pennsylvania Inheritance and Estate Tax^ (REV-13137. Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour answering service for forms ordering: 1-800-362-2D50; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisenent, allowance, ar disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt df this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the natter determined at audit df the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should ba addressed in writing td: PA Department of Revenue, Bureau df Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return far a Resident Oecedent^ (REV-15D1) far an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent CS%l discount of the tax paid is allowed. PENALTY: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 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: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1l day from the data of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate df six (6%) percent per annum calculated at a daily rate df .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates far 1982 through 2002 are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1982 20% .000548 1992 9% .000247 1983 16% .000438 1993-1994 7% .DD0192 1984 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 7% .000192 1986 10% .OD0274 2000 8% .000219 1987 9% .000247 2001 9% .000247 1988-1991 11% .OD0301 2002 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST 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. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 28D601 HARRISBURG, PA 17128-0601 CHARLES E SHIELDS III 6 CLOUSER RD MECHANICSBURG PA 17055 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-1607 EX RFP (O1-V2) DATE 08-12-2002 ESTATE OF WATTERS THOMAS G DATE OF DEATH 12-29-2001 FILE NUMBER 21 02-0020 COUNTY (;UMBERLAND ACN ]~ O 1 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER 0F' WILLS CUMBERLAND CO COURT HOUSE CARLISLE, P'A 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1607 EX AFP (01-02) ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT *~(* ESTATE OF WATTERS THOMAS G FILE N0. 21 02-0020 ACN 101 DATE 08-12-2002 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-12-2002 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): 34,921.21 PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID 03-26-2002 CD001007 1,350.00 25,b~50.00 06-27-2002 CD001343 .00 7,921.21 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST ANA PEN. * IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY 8E DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 34,921.21 .00 .00 .00 PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or Haney order payable to: REGISTER OF WILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONWEALTH OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an °Application for Refund of Pennsylvania Inheritance and Estate Tax" CREV-13137. Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices or from the Department's 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 CTT only). REPLY TO: 4uesticns regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three C3) calendar months after the decedent's death, a five percent (5%7 discount of the tax paid is allowed. PENALTY: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged heginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment, Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar Year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2002 are: Year Interest Rate Daily Interest Factor Vear Interest Rate Daily Interest Factor 1982 20% .000548 1992 9% .000247 1983 16% .000438 1993-1994 7% .000192 1984 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 7% .000192 1986 10% .000274 2000 8% .000219 1987 9% .000247 2001 9% .000247 1988-1991 11% .000301 2002 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST 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 6e calculated. /~-`3O~ ~ ~ COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 INHERITANCE TAX HARRISBURG, PA 17128-0601 STATEMENT OF ACCOUNT REY-16 D7 E% ~FP (01-02) DATE 09-09-2002 ESTATE OF WATTERS THOMAS G DATE OF DEATH 12-29-2001 FILE NUMBER 21 02-0020 COUNTY C;UMBERLAND CHARLES E SHIELDS III ACN ].O1 6 CLOUSER RD MECHANICSBURG PA 17055 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF' WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1607 EX AFP (01-02) *~~ INHERITANCE TAX STATEMENT OF ACCOUNT *~~ ESTATE OF WATTERS THOMAS G FILE N0. 21 02-0020 ACN 101 DATE 09-09-2002 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-12-2002 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): 34,921.21 PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID 03-26-2002 CD001007 1,350.00 25,650.00 06-27-2002 CD001343 .00 7,921.21 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. * IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 34,921.21 .00 .00 .00 PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name antl address printed on the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF WILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONWEALTH OF PENNSYLVANIA. REFUNB CCR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an ^Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-13137. Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices ar fran the Department's 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (TT only). REPLY TD: puesticns regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent CS%) discount of the tax paid is allowed. PENALTY: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine C9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent an and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2002 are: Year Interest Rata Daily Interest Factor Year Interest Rate Daily Interest Factor 1982 20% .000548 1992 9% .000247 1983 16% .000438 1993-1994 7% .000192 1984 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 7% .000192 1986 10% .000274 2000 8% .000219 1987 9% .000247 2001 9% .000247 1988-1991 11% .000301 2002 6% .000164 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST 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 an the Notice, additional interest must be calculated. .~ i V r // G~ ~~ STATUS REPORT ENDER RULE G.i:' Name of Decedent: ~G~~S G. l/l~Ql~~f'Y' ~r'• Date of Death: / 2 -2~-0/ Will No. admin. No. .2.1-02 -OOZo Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the fol_cwina :pith respect to completion of the administration of the abo~-e-captioneL estate: 1. State whether administration of the estate is complete: Yes No 2. If the answer ij No, ~~3te when the personal representative reasonably believes twat the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal re resentative file a final account with the Court? Yes No~. b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal =epresentative state an account informally to the parties in i^terest? Yes No d. Copies of receipts, r=leases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may b attached to this report. Date: l-/°-D~ ~G C% Sicnature CHARLES E. SHIELDS III Name {Please 1~ype or print) 6 Clouser Road, Mechanicsburg, PA 17055 Address ~ 717 ~ 766-0209 T~1. No. Capacity: PersonaloRepresentative Counsel for personal representative (MAH:rmf/AM3)