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HomeMy WebLinkAbout03-0544Estate of Lloyd C. Weiss No. abo known as To: PETITION FOR PROBATE and GRANT OF LETTERS · Deceased. Social Security No.. 174 - 2 O- 1047 : The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executor in the last will of the above decedent, dated November 4, 1993 and codicil(s) dated none Register of Wills for the County of Cumberland in the Coramonwealth of Pennsylvania named ,19 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with h last family or principal residence at 2421 Massachusetts Avenue Camp Hill. PA 17011 (list street, number and muncipality) Decendent, then 74 years of age, died June 20 o 2003 ., 19. ., at Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ (If not domiciledi~ Pa.) Personal proPerty in Pennsylvania $ (If not domiciled in Pa.) ~ Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: 32,000.00 WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters Testamentary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. L. Weiss 845 Torway Road Gardners, PA 17324 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA q COUNTY OF ~ ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are truc and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedemt petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed befro~ me this /,<9.~ day of Estate of L_L,~ ~/ C. C~C~ ~s , Deceased DECREE OF PROBATE AND GRANT OF LETTERS -Su~H ~ AND NOW the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated November 4, '1993 described therein be admitted to probate and filed of record as the last will of lloyd C. Weiss and Letters Testamentary are hereby granted to Randy L. Weiss 2003 ~x ; in consideration of the petition on FEES Probate, Letters, Etc .......... $ '~t~)0 c)o Short ~ertificates( )'. ......... $~ Renunciation ................ $ TOTAL __ $~ .... .............. Michael Cherewka PA35073 ATTORNEY(Sup. ~.LD. No.) 624 North Front Street ADDRESS Wormleysbur~,,PA 17043 PHONE 717-232-4701 ff~c: 61I 1.- -il'ir' f0. LAST WILL AND TESTAMENT KNOW ALL MEN BY THESE PRESENTS, that I, LLOYD C. WEISS, presently residing at 2421 Massachusetts Avenue, Camp Hill, Cumberland County, Pennsylvania, being in good health and of sound and disposing memory, do hereby make, declare and publish this as my Last Will and Testament, hereby revoking all former Wills and Codicils heretofore made by me. FIRST= I direct that all my just debts, expenses of last illness and funeral expenses shall be paid by my Executor, hereinafter named, from my estate as soon after my decease as shall be found convenient. SECOND: I bequeath my residence at 2421 Massachusetts Avenue, Camp Hill, Cumberland County, Pennsylvania, to my son, RANDY L. WEISS. THIRD: I bequeath my automobiles, vans, other vehicles and gun collection to my son, RANDY L. WEISS. FOURTH: I bequeath my antique soap collection to my daughter, MARILYN L. SANTO. FIFTH: I bequeath my household and personal effects and other tangible personalty of the like nature (not including cash or securities), together with any existing insurance thereon, to be distributed to my children, RANDY L. WEISS and MARILYN L. SANTO, as are living on the sixty-first day after my death to be divided among them by my Executor with due regard to their personal preferences in as nearly equal shares as practical. Should either of my children fail to survive me by sixty days, I devise and bequeath his or her share to his or her issue, per stirpes, who survive me, and in default of such issue I devise and bequeath my entire personalty property to my other child or his or her issue as described above. SIXTH: I give, devise and bequeath all of the rest, residue and remainder of my property, whether real, personal or mixed, and of any nature whatsoever and wherever situate to my children, RANDY L. WEISS and MARILYN L. SANTO, in equal shares. Should either of my children fail to survive me by sixty days, I devise and bequeath his or her share to his or her issue, per stirpes, who survive me, and in default of such issue I devise and bequeath the entire residue to my other child or his or her issue as above described. SEVENTH= I hereby nominate, constitute and appoint my son, RANDY L. WEISS, as Executor of this, my Last Will and Testament, without the necessity for posting security regardless of his state of residence. In the event that my said son shall predecease me, or be unwilling or unable to act as my Executor as aforesaid, then I nominate, constitute and appointmydaughterMAR~LYNL. SANTO, as Executrix without the necessity for posting security regardless of her state of residence. Ail references to the Executor herein shall be applicable to said substitute Executrix. EIGHTE: My Executor shall have, in addition to the powers and authority conferred upon him by law, the following additional powers and authority= 1. To sell at public or private sale, exchange, lease, mortgage or pledge any property, real or personal, at any time constituting a portion of my estate, and upon such terms and conditions as the Executor shall deem wise. 2. To invest any money at any time in such bonds, stocks, notes, real estate, mortgages, life insurance, annuities or other securities, or such property, real or personal, as the Executor shall deem wise, without being limited by any statutes or rule of law regarding investments by an executor. 3. To retain, without incurring any liability, as invest- ments, any property owned by me at the time of my death, as long as he deems it wise, and even though such property is not the kind of property an Executor would purchase as an investment; and even though to retain such property might violate sound diversification principles. 4. To cause any security or other property which may constitute a portion of my estate to be issued, held, or registered in his own name, or in the name of a nominee, or in such form that title will pass by delivery. 5. To consent to the reorganization, consolidation, readjustment of the financial structure, or sale of the assets of any corporation or other organization, the securities of which constitute a portion of my estate, and to take any action with reference to such securities which, in the opinion of the Executor is necessary to obtain the benefit of any such reorganization, consolidation, readjustment or sale; to exercise any conversion privilege or subscription right given to his as the owner of any securities constituting a portion of my estate; / to accept and hold as a portion of my estate securities resulting from any reorganization, consolidation, readjustment, sale, conversion or subscription. 6. To pay all costs, taxes, charges and expenses in connection with the administration of my estate, including such compensations to Executor which shall be in accordance with established fees throughout the period of administration. 7. To determine what is "income" and what is "principal" hereunder, and his decision thereon shall be final; and to purchase securities at a premium or discount, and to apply or charge said premium or discount against income or principal as the Executor may determine. 8. To transfer, sell, exchange, partition, lease, mortgage, pledge, give options upon, or otherwise dispose of any property at any time held by him, at public or private sale, or otherwise. 9. To employ legal counsel, accountants, brokers, investment advisors, custodians, managers and other agents and employees and to pay them reasonable compensation out of my estate or any funds held hereunder to which said compensation is attributable. 10. To do all other acts in his judgment necessary or desirable for the proper and advantageous management, investment and distribution of my estate. NINTH: I direct all transfer and inheritance taxes, state or federal, assessed because of my death, whether the funds, property or insurance proceeds to which such taxes are attributable pass under this Will or not, shall be paid out of my residuary estate; that my Executor pay, or provide for payment of all such taxes at such time, or times, and in such manner as my Executor deems best. IN WITNESS WHEREOF, I, LLOYD C. WEISS, the Testator to this, my Last Will and Testament, typewritten on three sheets of paper signature which I have identified at the bottom of each page by my hereunto set my hand and seal the ~ day of LLOTC. WEISS The preceding instrument consisting of this and three other typewritten pages each identified by the signature of the Testator, LLOYD C. WEISS, was on this day and date thereof signed, published, and declared by LLOYD C. WEISS, the Testator therein names, as and for his Last Will, in the presence of us who, at his request, in his presence, and in the presence of each other have subscribed our names as witnesses. COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN I, LLOYD C. WEISS, Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me, by LLOYD C. WEISS, the Testator, this ~/~ day of ~~ 1993. Notary Public Michael Cherewt~, ~/. Public .$u~uehanna T_wp., Dauphin County My t;ommission EN3ires Jan. 13, 1997 Member, Paqns)~a~ia ~l~mq ot Notaries COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN and /~ g' ~Y~ , the witnesses whose n~es are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say the we were present and saw Testator sign and execute the instrument as his Last Will; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge the Testator was at that time eighteen or more years of age, of sound ~nd and under no constraint or undue influence. and worn of affirmed to and subscribed to before me by ~ Z. ~t~y and ~ 2. ~/~v~r~ {~F~ ~/~y~ , witnesses, this ~ day of /V~/~ , 1993. (SEAL) Notary Public Michael Cherewka Notary F'ub~ ..Susquehanna Twp., ~n County My Commission Expires Jan. 13, 19~7 Me~ber, Pennsylvania As,~::iatJon of Nolarie~ LLOYD C. WEISS 1AW OFFICES Of MICHAEL CHEREWkA 3905 north FRONT STREET HarriSbURg. PA 17110 CERTIFICATION OF NOTICE UNDER RULE $.6(a) Name of Decedent: LLOYD C. WEISS Date of Death: June 20, 2003 No. 2003 -00544 To the Register: I certify that the Notice of Estate Administration required by Rule 5.6(a) of the Orphans' Court Rules was served or mailed to the following beneficiaries of the above-captioned estate on July 14, 2003. NAMES Randy L. Weiss Marilyn L. Santo ADDRESS Randy L. Weiss Gardners, PA 17025 920 Belle Vista Drive Enola, PA 17025 Date: July 14, 2003 The Law Offices of Michael Cherewka Michael Cherewka, Esquire 624 North Front Street Wormleysburg, PA 17043 (717) 232-4701 Capacity: Personal Representative X Counsel tbr personal Representative Law Offices of Michael Cherewka 624 North Front Street Rc Wormleysburg, Pennsylvania 17043 (717) 232-4701 (717) 901-3770 '04 Fax (717) 232-4774 P1:01 March 10, 2004 Register of Wills Cumberland County Courthouse One Courthouse Square Cariisle, PA 17013 Re: Estate of Lloyd C. Weiss No. 21-03-00544 Our File No. 2236.00 Enclosed please find a Status Report under Rule 6.12 for the Estate of Lloyd C. Weiss. If you have any questions please contact our offices. Very truly yours, Michael Cherewka MC/ll Enclosure STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: Will No.: LLOYD C. WEISS June 20, 2003 21-03-00544 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 the administration of the estate is complete: X Yes No 2. If the answer is "No", state when the personal representative reasonably believes that the administration will be complete: If the Answer is "Yes" to No. 1, state the following: ao Did the personal representative file a final account with the Court? Yes X No The separate Orphans' Court No. (if any) for the personal representative's account is: Co Did the personal representative state an account informally to the parties in interest? X Yes No Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be ~ached to this report. THE LAW OFFICES OF MICHAEL CHEREWKA Michael Cherewka, Esquire Capacity: X __ Personal Representative Counsel for Personal Representative STATUS REPORT UNDER RULE 6.12 Name of Decedent: HUGH L. HELMAN Date of Death: DECEMBER 30, 2000 No. 21-01-0015 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: X 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 X 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? X Yes No Date: gd LL Capacity: d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphan's C.4ourt and may be att ac he dto this rep ort.~*/~ ~--"~~~ -4/~/~..2 ~/~ 3/16/04 'fSigna~e4~ . ~ IRW~ & Mc~IGHT X M~c~. Mc~ight m, Esquire Name (pleasant) - J 60 West Pomfret ~~ Address ~,,~ ~- -~i~lisle, PA 17013 :~ ~ State, Zip (717) 249-2353 lephone Number . Person~ Representative Counsel for Person~ Representative The I. ow Offices of Michael Cherewka 624 Noah Front Street Wormleysburg, Pennsylvania 17043 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 COOS I,,,llh,,llh,,,,,th,li,,,th,,ii,li,,,,,,llhh,hh,,,iJ,i COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES ,~,'~T. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD REV-1162 EX(11-96) OO3766 CHEREWKA MICHAEL 624 NORTH FRONT STREET HARRISBURG, PA 17043 ........ fold ESTATE INFORMATION: SSN: 174-20-1047 FILE NUMBER: 2103-0544 DECEDENT NAME: WEISS LLOYD C DATE OF PAYMENT: 04/05/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 06/20/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $100.12 R;EMARKS: SEAL CHECK# 1891 TOTAL AMOUNT PAID: $100.12 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS Honorable Mary C. Lewis Register of Wills Cumberland County Courthouse Carlisle, PA 17013 Re: Law Offices of Michael Cherewka 624 North Front Street Wormleysburg, Pennsylvania 17043 (717) 2324701 (717) 901-3770 Fax (717) 232-4774 March 15, 2004 Estate of Lloyd C. Weiss Estate No. 21-0300544 Our File No. 2236.00 Honorable Mary C. Lewis: Enclosed please find REV 1500, Inheritance Tax Retum for Resident Decedent, Inventory and Estate check no. 1891 in the amount of $100.12 representing the final payment of the .Pennsylvania Inheritance Tax in the above referenced Estate. Also enclosed is our check in the amount of $25.00 to cover the cost of filing the Inventory and the Return. We have enclosed a copy of the front page of the retum and a copy of the Inventory. We ask that you time-stamp the copies and return them to us in the enclosed stamped envelope. If you have any questions, please call the undersigned. Thank you for your consideration in this matter. Very truly yours, ichael Cherewka MC/ll Enclosures . V-15' ~~ PENNSYLVANIA ~~~ DEPARTMENT OF REVENUE ,r~-~~. DEPT. 280601 ..[iNHERITANCE'TAX RETURN 'REsiDENT DECEDENT . DECEDENTS NAME (~S~ FIRS~ ~D MIODLE INE~L) WEISS, .LLOYD C. · DATE OF DEATH (MM.OD.yEAR). .' '" "0~-'20'2003 ' ' I 09~04-i928 '" ' {IF A~P'LI(.,~LE)SurViViNG sPOUse,S· NAME iLAsT, 'FIRST, AND MID6~.E INITIAL) ,' ..... N/A OFFICIAL USE ONLY F!LE NUMBER.,. -.22-L~0..~_3.: 0 O. ,5 co~E . y~ -- ~-.. SOCIAL SECURITY NUMBER t74 - 20 - 1047 T"iS w '. REGISTER OF WILLS SO~i~L'SECURi~ NU~BE~' -~ ........ ; J~]4. Umited Estate [~ 6. Decedent Died Testete (A~ ~. ~f w~ [~ g. Uligalion Proceeds Received r-'~ 4a. Future Interest Compromise H=~ o~,~am afar 12:12-82) "-J 7, Decedent Maintained a Living Trust (A~t~ c~w dTmsl) 10. Spousal poverty Credit (~,i ~'~a'~ ~ 12-31-91 NAME Michael Cherewka, Esquire FIRM NAME Of&~plcm,) 'rELEPHONE NUMBER 7'17' 232- 470 i 1. Real Estate (Scbedule A) (1) 2. Slocks and Bonds (schedule B) (2) 3. Closely Held Col~orafion, Partnership or Sote-Propdetorsh¥ (3) 4. Mollgages & Notes Receivable (Schedule D) (4) 5. Cash, Ba~ Deposits & Miscellaneous Personal Property (Schedule E) (5) §. J?~nlly Owned Properly (Schedule F) I I sePaaje Billing Requested (6) 7. Inter. Vivos Transfers & Mlscelleneous Non-Probate Property (7) (SchedUle G or L) 8. Total Gro~a Aaaeta (total Lin~s 1-7) 9. Funeral EXpenses & Adminislralive Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage LlebllilJas,& Liens (Schedule I) (10) 11. To,al Deductlon~ (total Lines 9 & 10) 12. NetValue of Estate (Une 8 minus Une 11) · ' ["--] 3. Remainder Reium (da~ ~ ~ ~ ~o 12-,3-~2) J~J 5, Federal Estate ~ax Relum Required· ~O 8. Totei Number of SafeDeposit Soxes ' J~ 11. Election totex under Sec. 91i3(A) 624 North Front Street Wormleysburg, PA 170~3 O %' . 6~E? ". ....... 13. Charitable and Govemmentsl Bequests/Sec 9t13 Trusts for Which an elecllon to tax has not been made (Schedule j) 14. Net Value Subject to Tax (Line 12 minus Une 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 0 0 7,970.93 8,609.95 (8) 13,972.88 383.10 (11) (12) (13) 16,580.88 14~355.98 2,224.90 (14) 2 224..90 15. Amountof Une i4 [axabte al lbe spousal tax rate, or lransfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 texable at lineal rate ~ 17. Amount of Line 14 taxable at sibling rote O (.,3 18. Amount of Une 14 taxable at col~teml rate 19. Tax Due 2,224.90 x.0. .0 45 .12 .15 (15) (la) __ (17) 100.12 (18) _ Decedent's COmplete Address: ISTREET ADDRESS 2'421' Massachusett s Avenue CITY 'Camp Hill ' I"ZIP'.]~701'i ' ' ' Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credite/Payme~ts A. SpouSal Poverty Credit 8; Prior Payments C. Discount (~) Interest/Penalty if applicable Total Credits ( A + B + C ) D. Interest E. Penalty . ' ' Total InteresUPenalty ( D * E.) 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 If Line 1 + Line 3 is greater than Line 2, enter the differenoe. This is the TAX DUE, (2) (3) (4) (5) ' 100.12 0.00 0.00 0.00 A. Enler the interest on the tax due. (5A) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) 100, 1 2 · · Make Check PaYable to: REGISTER OF WILLS, AGENT . PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" Ii~ ;I-HE ..... APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property ~nsfermd; ~ No b. retain the right to designate who shall Use the property transferred or its i~come;...': ........ ZJ.' : · , ""'. [] [~-'J c. retain a revereionmy interest; or .. - d. receive the premise 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. 'receMng adequate consideration? .................... . .... . .......... [] . [] 3. Did decedent own an "in trui~t for" or payable upon death bank account or security at his or'her death?'z...i..:.... [] · [] · 4. Did decedent own an IndMdual Retimrnent Account, annuity, or other non-probate property whlcLl' contains a beneficiary designation?; ............................................................. ~ ....... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE fi'AS PART OF THE Dedmeon ~f .preparer ae~er ~n ~ permn~ mpre*e~a~,e ~ based en al hi~a,,... .......... . . . . ' '""'J mm mmenmnt~, and to the best of my knowledge and beief Itl~lme ~3rredand~o~n] te SIGNATURE OF PERSON RESPONSIBLE FOR F LING RETURN ~ DATE 03/.12/2004 ADDRESS 845 torway Road, ga.rdners, PA 1832'4 -- . ...... 81QN~;ruRE'O~:'PI~Ei~ARERoTHERTH^NREP,EsENT^TivE ~/z/~,,v/~ - '..: . .' ' ... -ADDRE8~' 624-north Front Street', Wormleysburg,. PA 17043 .... . ................. 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 Rs. §9116 (a) (1.1)(~]. ' For dates of death o~ or after January 1, 1995, the tax rate imposed on the net value of transfers lo or for lhe use of the surviving spouse is 0% [72 RS. {}9116 (a) (1.1) (ii)]. The stetute does not exempt a transfer to a surviving spouse from tax, and the stetutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is Ihe only beneficiary. For dates of death on Dr 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 stepperenl of the child is 0% [72 RS. §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 decedenrs siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. RE¥~-1502 FX+ (6-98) I ' oo *~ J SCHEDULE A MMO.WE^.T.O~.E..SVLV^N,^ ~ REAL ESTATE Llo?d C. ~elss FILE NUMBER All real pmp~ owned ~olely or a~ a tenant In common must be re .............. 2 ~-03-00544 ex~anged be~een a willing buyer and a ~llinn ~.#. ....... ?.~.u .~ ~a~,mar~et vame ~air market value is d~ned~ . ......... ~ ..... ~, n. ruer being compelled to bu,, or ~11 ~-,~ ~-, ....... -- :'~ ~"~ a~ ~lcn property would be Real pmpe~y which s jointly-owned with ri-h*'~ ..... ~..~- ..... u~,. nav~n~ masonite Know~eoge ot ~e relevant fa~s. ~EM . ......... ...hip must be d sclosea on Schedule F. NUMBER DESCRIPTION 1. ~o~e OF DEATH ¢ TOTAL (Also enler on line 1, Recapilulation) $-~~ (If more space is needed, insert additional sheets of the same size) REV-1503 EX+ (6-98) C I "~ I SCHEDULE B COM~ONWEALT, OF PE..S~LVA, A ISTOCKS & BONDS INHERITANCE TAX RETURN ESTATE OF ' T,loyd C, Welss FILENUMBER 21-03-00544 All property jointly-owned with right of sun/tvorshlp must be disclosed on Schedule F. ITEM NUMBER 1. None DESCRIPTION VALUE AT DATE OF DEATH TOTAL (Also enter on line 2, Recapitulation) (If more space is needed, insert additional sheets of the same size) REV-ti 504 EX+ (6-98) J SCHEDULE C CO""O~;'~)"~ENNSYLVAN,A I CLosELY'HELD CORPORATION, J . INHERITANCE TAX RETURN J PARTNERSHIP OR Lloyd c. Weiss FILE NUMBER Schedule C-1 or C-2 (including all supporting intonation) must be . 2 ]. - 0 3 - 0 0 5 4 4 attached for each closely-held corporation/partnership interest of the decedent, other than a ITEM NUMBER NUMBER 1. None sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. DES.___g.CRIPTION VALUE AT DATE ........~OF DEATH TOTAL (Also enter on line 3, Recapitulation) (If more space is needec/, insert additional sheets of the same size) REV-1507 EX+ (6-98) ~ SCHEDULE D coMMo~E^~. OF PE.NS~LV^.,^ I MORTGAGES & NOTES I IV~UI( OTESINHERITANCE TAX RETURN I RECEIVABLE ESTATE OF Lloyd C. Weiss FILE NUMBER 21-03-00544 All property Jointly-owned with right of survivorship roust be disclosed on Schedule F. ITEM NUMBER NONE DE._..8OR)PT)ON TOTAL (Also enter on line 4, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF D...__..~EATH REV-~I508 EX+ (6-98) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Lloyd C. Weiss SCHEDULE E CASH, BANK DEposITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21-03-00544 ITEI~ NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. 0ESCRIPTION Public Auction - Kevin M. Wickand, Auctioneer August 30, 2003 - Net Proceeds Automobile - 1994 Fl50 Ford Pick-up Truck Health Management Associates, Inc. - Refund Allstate Homeowners Insurance - Refund ~LUE~D~E OFDE~H $ 3,317.40 4,500.00 144.40 9.13 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 7,970.93 ~ELLER NAME ~DDRESS CC . F W' t, .OCATION OF SALE kUCTIONEER I"I_NAL SETTLEMENT PHONE zip i"/011 PHONE Rdl- ~ ¢1 PROFESSIONAL FEE~ AUCTIONEER 'i ~ CASHIER OTHER EXPENSES CASH CHECKS OTHER RECEIPTS TOTAL RECEIPTS $ ~0~. ~-~'- LESS TOTAL EXPENSES $ ,~"(~' ~'~' I (or we), the seller, accept this settlement and acknowledge receipt of the above specified net proceeds from the auction of my' goods and properly sold on the above date. I accept all responsibility for providing merchantable title to all goods, and properly sold, and for delivery of title to the purchaser. Auctioneer or Cashier's Signature :~ ~' ~'~- ~ ~ Date eller s SignatureJ JSeller's Signature) · ! Date HEALTH MANAGEMENT ASSOCIATES, INC. HMA PHYSICIAN PRACTICE 80007810 0290170 06/30/2003 264279 ~/DOS 5/20/03 LASI2AST 144.40 Homeowners Insurance Refund Policy Number: 9 01 140239 09/20 10815 DA VID TAYLOR DRIVE CHARLOTTE NC 28262-1045 Type of Policy )AIIstate. You're in good hands. HOMEOWNERS I,,,lll,,,I,,ll,,,I,I,h,ll,l,,ll,,, hi,, h,,I,l,,I,l,I, hh, I RANDY WEISS 845 TORWAY ROAD GARDNERS PA 17324-9097 Loan Number NONE Policy Issued To RANDY WEISS 845 TORWAY ROAD GARDNERS PA 17324-9097 Policy Number 9 01 140239 09/20 Description 2421 MASSACHUSETTS A CAMP HILL PA 17011 Agent And Telephone Number JAN VAJDA AGENCY (717) 731-1300 Important Information As you requested, we have terminated your policy effective October 11,2003. Attached is your refund check. We thank you for the opportunity to serve you and hope we can provide your insurance protection in the future. If you have any questions, please contact your agent or producer of record. This statement as of October 1 I, 2003. ( OVER ) Please detach the check below before depositing. 031012000261 C ESTATE OF Lloyd C. WEiss FILE NUMBER 21-03-00544 If an asset was made joint within one year._..._..~of the decedent's date of death, It must he reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A. Randy L. Weiss JOINTLY-OWNED PROPERTY: ADDRESS 845 Torway Road Gardners, PA 17324 RELATIONSHIP TO DECEDENT Son ITEM 1. me DATE MADE 10-01- 2001 DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR PNC Bank, Certificate of Deposit Account #31200220152 + Accrued Interest PNC Bank, Checking Account Account #5140067576 Accrued Interest DATE OF D~TH $5,000.00 8.63 $12,209.82 ,. 1.44 DATE OF DEATH VALUE OF $'2,500.00 4.32 $6,104.91 0.72 TOTAL (Also enter on line 6, Recapitulation) $ 8,609.95 (if more space is needed, insert additional sheets of the same size) PNCBAN( ?68 3458 P.01 August 26, 2003 Michael Cherewka Attorney at Law 624 N Front St. Wormleysburg, PA ! 7043 Estate of Lloyd C Weiss (Deceased) SSN: 174-20-1047 DOD: 06-20-2003 Your file #2236.00 Dear Mr. Cherewka: In response to your tOClucst for Date of Death balances for the customer noted above, our records show the following: Certificate of Deposit Account~31200220 ] 52 Established I 0-01-2001 LLOYD C WEISS RANDY L WEISS DOD balance: $$,000.00 + $8.63 accrued interest Checking Account Account#5140067576 Established,12-01 - 1975 LLOYD C WEISS RANDy L WEISS DOD balance: $12,209.82 + $I.4~ accrued interest Page 1 of 2 Please note that Ibis office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not process any financial transactions or pm,tide statements. If you need assistance with any of these/terns, please call 1 '885-PNC-BANK (1-858-762.2265) or stop by your local PNC Bank branch office. Sincerely, Erica L Schlegc[ PNC Decedent Reporting Firstside Center $00 First Ave, 4a~ FI CIF Pittsburgh PA 15219-3 ! 28 1 - 800-762.1775 Mernber FDIC Page 2 of'2 TOTAL P.02 REV-1510 EX+ (6-98~ SCHEDULE G COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS & INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DEOEDENT ESTATE OF Lloyd C. Weiss FILE NUMBER 21-03-00544 This schedule must be completed and filed If the answer to any of questions 1 through 4 on the reverse side of tb REV-1500 COVER ITEM DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, 3'HEIR RELKrlONSHIP TO DECEDENT ^NO DATE OF DEATI. % OF DECD'SI NUMBER ! EXCLUS ON TAXABLE THE DATE OF TRN~I~ER. ATTACHACOPYOF'II'EDEEDFORREALESTATE. VALUE OFASSET INTEREST IIFAPPUC~BLE~ VALUE '. NONE 0 {~ TOTAL (Also enter on line 7 Recapitulation) $ 0 , insert additional sheets of the same size) REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Lloyd C. Weiss SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-03-00544 Debts of decedent must be reported on Schedule ITEM NUMBER DESCRIPTION 2. 3. 4. 5. 8. 9. 10. FUNERAL EXPENSES: Myers Funeral Home, Inc. James R. Gingrich Memorials Stone Church Cemetery ~ornerstone Independent Baptist Church Hospice of Central Pennsylvania ADMINISTRATIVE COSTS: Pemonal Representative's Commissions Name of Personal Representative(s) Sodal Security Number(s)/EIN Number of Personal Representalive(s) Street Address City State Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Zip Street Address Cily Relationship of Claimant to Decedent State Zip Probate Fees Accountant's Fees Tax Return Preparer's Fees Advertising - Public Auction - The Guide Parking & Miscellaneous Costs - Public Auction The Sentinel Cumberland Law Journal TOTAL (Also enter on fine 9, Recapitulation (If more space is needed, insert additional sheets of the same size) AMOUNT $ 9,404.45 100.00 525.00 200.00 1,000.00 $ 2,000.00 122.00 158.00 300.00 88.43 75.00 $ 13,972.88 Myers Funeral Home, Inc. 37 East Main Street Mechanicsburg, Pa. 17055 Boyd L. Myers Jr., Supervisor (717) 766-3421 A STANDARD OF EXCELLENCE SINCE 1910 Tuesday, June 24, 2003 Mr. Randy L. Weiss 845 Torway Road Gardners, Pennsylvania 17324 Dear Mr. Weiss, Thank you for selecting our funeral home to provide services for your family during your bereavement. I hope that you found our services to be of the highest standards and that they met your needs and those of your family and friends. The following is a summary of the service charges as previously explained and provided in written form and herein indicated as PAID-IN-FULL. Lloyd C. Weiss SUMMARY OF EXPENSES TOTAL OF SERVICE RENDERED LESS: Credits granted LESS: Total Payments CURRENT BALANCE Credits Granted: $14.45 Early Pay Discount $1,740.0 Package Price Discount If there are any questions or concer/~, that remain unanswered, please call me. Sincerel' / ~ /// /?' ' $9,404.45 1,754.45 7,650.00 $0.00 INSCRIPTION ORDER FORM ~ James R. / ingrich MEMORIALS' "A Tribute zo LOre'` 5243 Simpson Ferry Road, Mechanicsburg, PA 17050 · (717) 766-5622 CEMETERY ~.1, "~,.'~t.~,~, s g~,~ r ' ~,~ wr c.,~.'t LOCATIO N NAME OF DECEASED L.~ o~'(! ~ ~:,** LETTERING REQUIRED: ORDER NO. 125284 TypE OF MONUMENT U~: COLOR OF GRANITE LOCATION: DRAW A PRECISE MAP OF LOCATION OF MEMORIAL ON CEMETERY (Use back of work order copy if necessary) BILL TO: DATE OF ORDER ORDERED BY UPON EXAMINING THE ABOVE INSCRIPTIONS, I/WE THE UNDERSIGNED, FIND THE SPELLING AND DATES TO BE CORRECT. THE WORK WILL BE COMPLETED AS IT IS ACCUMULATED. NO SPECIFIC COMPLETION DATE IS GUARANTEED. SIGNED SOLD BY !\~ ~*,~, SIGNED DEPOSIT $ BALANCE DUE DATE ENTERED i.~ T Y .00 .00 . .0 {3 1 5 b ?RY COMMUNICATIONS, INC. 800 w. CHURCH RO. MECHANICSBURG, PA 17055 PLEASE PAY THIS AMOUNT RE~/-1512 EX+ (6'-98) ~ COMMONWEALTH OF PENNSYLVANIA ) DEBTS OFDECEDENT, J INHERITANCE TAX RETURN M '"".~',';~'~O'~CE~N MORTGAGE LIABILITIES, &'LIENS I ~ . ESTATE OF Lloyd c. Weiss FILE NUMBER 21-03-00544 ITEM NUMBER DESCRIPTION 1. Bonnie K. Miller, Tax Collector 2. Lower Allen Township 3. Lanc EMA Physician Mgmt/Cent Pen 4. Dominion Products and Services 5. Quantum Imaging & Therapeutic 6. Lanc EMA Physician Mgmt/Cent Pen 7. Central Penn Medical Group Emergency 8. PPL Electric Utilities 9. PPL Electric Utilities 10. Pennsylvania American Water Co. 11. Pennsylvania American Water Co. 12. Pennsylvania American Water Co. i Include unrelmbursed medical expensee. ~LUE ~ D~E OF DEATH 9.80 73.35 31.75 39.00 28.47 104.30 18.22 21.36 21.53 12.23 11.19 11.90 TOTAL (Also enter on line 10, Recapitulation) $ 383.10 (If more space is needed, insert additional sheets of the same size) -- JULY 01s 2003 TAX NOTICE WEST SHORE SCHOOL DISTRICT LOWER ALLEN TOWNSHIP PER CAPITA THESE T~ES ARE DUE AND PAYABLE DISCOUNT NET PENAL~ PER CAPITA-'511 4.90 5.06 5.50 PER ~AP~TA-679 ~.90 5.0C 5, 50 PAY ABOVE A'~OU~T DUE BY DUE BY ~E AFT[R WEISS ~LLOYD C 2421 NASSAC~JSETTS AVENUE CAMP HILLs PA 17011 TAX PAYER 2003-2004 TOR 12/1/03. ID # 25 ~)/~"~' 0t.300039 1993 HU~NEE~O~'L~'t~LLE .;cAMP (717) 975-7575 ~ON~ 'TUES ~ THURS 9AM BY APPT~ SAT AUG 30 CLOSED ROLIDAYS (717) PLEASE ENCLOSE BOTH COP 'TAX BILL & A SELF~ADDRE STAMPED ENVELOP~ FOR LOWER ALLEN TOWNSHIP 1993 HUMMEL AVENUE Telephone CAMP HILL, PA 17011 717-975-7575 ACCOUNT NO.. I BILLING DATE 1041050--0 07/01/03 SERVICE ADDRESS 2 4 21 --~. ~; S'.~.C Hrd S E'T ? S A BILLING PERIOD 07/01/03 -- 09/30/03 $1~WlliR RaFUSf CURRENT 2 4 . 0 0 CURRENT 4 9. 3 5 ARREARS ARREARS PENALTY PENALTY ADJUSTMENTS ADJUSTMENTS Total Total Sewer 2 4. 0 0 Refuse 4 9. 3 5 DUE DATE 08/01/03 73.35 A 10% Penalty on Sewer AND a 10% Penalty on Refuse are added if full payment is NOT made within 30 Days of the Billing Date. Adjustments include Lien Fees, NSF charges, etc. 'CHARG~'A¢~EkRiNG Oh' THI~ S~ATEMENT ARE NOT INCEU DEB ON ANY HOSPITAL SILL OR STATEMENT ...... -.. ~D WEISS, L 177.73 TO 6/3/03 061003 LONGTONI~) CHECK PYM~ M~IL THANK YOU 0.00 061003 LONGTON~ BALANCE CORP~ECTION - I/R 0.00 (S;~(~IENMGEND,~TE: 06/2§/03 PLEASE INDICATE YOUR ACCOUNT NUMBER WHEN CALLING OUR OFFICE: I 'lr~'g pEN~"r~G P,ATZE~ B,AL TOTAI[., ~ ~ BAT., P,~,.,~T DfJE 145.98 31.75 SEND INQUIRIES TO: LA.NC Hl~.PHYS ]~M~/CENT PEN 1104 ~D~-TORRD LOYSVILLE PA 17047 IRS ~: 233013255 177.73 31.75 (717) 789-4328 264279 NEWBALANCE PAY THIS AMOUN"f 31.75 Dominion Products and Services LLOYD G WEISS 2421 MASSACHUSETTS AVE CAMP HILL PA 17011 CustomerAcct No. 8700090409465 ~B~~ DominionTM For Billing Questions: 1-800-562-8419 QUANTUM IMAGING & THERAPEUTIC BILLING OFFICE / A93 2527 CRANBERRY HIGHWAY WAREHAM, MA 02571-1046 800-299-9770 OR 508-295-5556 EIN 25-1792806 *PO02QF00107362*** LLOYD WEISS A93'041407 2421 MASSACHUSETTS A CAMP HILL, PA 17011-7313 . ,47 05/08/03 06/12/03 06/12/03 05~08~03 06/12/03 06/12/03 HOLY SPIRIT HOSPITAL HOLY SPIRIT HOSPITAL 054: WE HAl PLEASE RE~, 49180 7636026 ~E NOT RECEIVE ;OLVE BY CALLIN 785.6 785.6 PAYMENT FR( G YOUR INSUR If yOU have an HMO please reply promptly PAGE 1 ABDOMEN/RETROPERITON MEDICARE PAYMENT MEDICARE ADJUSTMENT CT GUIDANCE NEEDLE B MEDICARE PAYMENT MEDICARE ADJUSTMENT )M INSURANCE LISTED BELOW. M~ICE COMPANY. THANK YOU. 480.00 -68.30 -394.62 235.00 -45.56 -178.05 054 05/06/03 LLOYD CONSULT INITIAL INPATI 165.00 54.27 .00 .00 79.08 INSURANCE REJECTED 05/07/03 LLOYD CONSULT FOLLOW-UP INPA 90.00 50.45 .00 .00 12.61 INSURANCE REJECTED 05/08/03 LLOYD CONSULT FOLLOW-UP INPA 90.00 50.45 .00 .00 12.61 INSURANCE REJECTED SPECIAL COMMENT: Please note any insurance due (~) monies. If balance due is over 45 days please notify your employer and your insurance carrier. We abate payment for 60 days and then you are responsible for payment in full. Please review your copy of our financial policy. .................... ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ........................................ i::::!::i!::!ii::iii., .i~El~iii?i!!!iiiiii::i::~i ~ . ........ ~ ~ 0430 .00 .00 .00 .00 ~ 0430 .00 ~ 04.~0 * BALANCE IS DUE UPON RECEIPT * THANK YOU * 'Central Penn Medical Group Emergency P. O. Box 468 East Petersburg, PA 17520-0468 Phone 866-247-3141 Fax 1-405-607-1326 TAX ID# 23-3013255 patientinquiry~mj ca.net WEISS, LLOYD C 2421 MASS AVE CAMP HILL, PA 17011 18.22 WEISS, LLOYD C WEISS, LLOYD C ~o~,~ GRIM M.D., LAURA E s ~Rm~S CARDSLE REGIONAL MEDICA CARLISLE, PA [] vtsA' [] PLEASE DETACH AND RETURN THIS PORTION WITH REMITTANCE PLEASE KEEP THIS PORTION FOR YOUR RECORDS DATE TREATING PROVIDER DESCRIPTION OF SERVICE CHARGES/CREDITS BALANCE I 06/03/03 1102 CRIMM. EMERGENCY DEPT VISIT 248.00 07/11/03 1102 CRIMM. PENNSYLVANIA MEDICARE 07/11/03 1102 CRIMM. INSURANCE WRITE-OFF WE HAVE FILED MEDICARE AND ACCEPT ASSIGNMENT. ANy PORTION ABOVE THE MEDICARE ALLOWABLE IS WRITTEN OFF. ANY BALg_NCE REMAINING IS A REFLECTION OF YOUR 20% CO-PAY OR DEDUCTIBLE PORTION OWED TO THE PROVIDER. PLEASE REMIT BALANCE TO THE ADDRESS INDICATED ON THIS STATEMENT. THAi~K YOU FOR YOUR COOPERATION. Referred by CRIM M.D., LAUHA E -72.88 -156.90 18.22 Please Remit Payment to: CENTRAL PENN MEDICAL GROUP EMERGENCY PO BOX 468 EAST PETERSBURG, PA 17520-0468 If you have questions regarding this bill please call 1-866-247-3141 (toll free) or email patientinquiry~mjca net. THANK YOU. For: LLOYD WEISS 2421 MASSACHUSETTS AVE CAMP HILL PA 17011 Page 1 78130-74008 Summary Page Balance as of Jul 21, 2003 $ 0.00 Charges: · TotaFPPL ELECTRIC UrHLITIES Charges $ 21.36 Total Charges $ 21.36 i::~"::~!ii::.~:::' '"~ :':~!~;:i:{~'~i~: .~'. :*~'.:..4~-?~'::-: "::~::?i{ ' ";<: :-':" ~:.':<."~;~;C~:.i~,i~:~'~:(¢.~!F;~!~i~.E~:~:~::~:5~'¢:: ":'?;?':":~'~! :""-'~ ' "'F: : .... .' ~ ~:~ ~ :.~' ,:; ~ '. .~& c'"?~ :. ~;..': :. :~;~:.~.5~:~,~;~:~F.. $:~ · ~, : ' Account Balance $ 21.36 484-634-4900 or write to: Customer Service 827 Hausman Rd. Allentown, PA 18104-9392 www.pplweb.com Electric Use 36 30 This graph shows your electric use over the last 13 24 months. 18 l~eP es of ter Readings: 12 Actual / 6 Estimated ~ 0 Customer ~ KWtt - Average Per Day II J ASONDJ FMAMJ 3 2002 Months 2003 Meter Reading Information Meter 068756924 Jul 21 Actual Jun 18 Actual 33 Days KWH Billed 409 241 168 Average - Jul Temperature KWH Per Day Yearly [/se: Aug 2001 - Jul 2002 Aug 2002 - Jul 2003 2002 77F 15 2003 73F 5 Total Average Use Monthly 5394 450 6184 515 Other important intbrmation on back DDI "* Page 1 Summary Page Balance as of Jun 18, 2003 $ 0.00 Charges: Total"PPL ELECTRIC UTILITIES Charges $ 21.53 Total Charges $ 21.53 ~ ~ .... ....... .~ .: .~ .:.....~...:.? ~ . ,:~.~ .,:: ~. ~.~.~, ~.... ?: ~ ...... ~, . ~ ~:~.~.?~-~.~ ~.,.~'~%,~- .. ~..~...:~: ....~ Account Balance $ 21.53 Electric This graph shOws yOUr electric Use over the last 13 months. eS of ~er Readings: Actual / Estimated ~ Customer [---] KWH - Average Per Day Meter Reading Information 36 iMeter #68756924 30 I Jun 18 Actual 241 I May21 Actual 71 24 ]28 Days KWH Billed 1-7'0 Average - Jun 2002 2003 18 Temperature 66F 62F KWH Per Day 11 6 12 Yearly Use: Total Average 6 Use Monthly Jul 2001 - Jun 2002 5219 435 0 Jul 2002 - Jun 2003 6440 537 J JASONDJ FMAMJ 2002 Moaths 2003 Other imporlant information on back "~ Customer Account Information For Servmce To: Lloyd Weiss 2421 Massachusetts Ave Account Number: 24-0635267-0 Premise Number: 24-0375515 Billing Period & Meter Information Billing Date: Jun 11,2003 Billing Period: May 08 to Jun 09 (32 days) Next reading on/about: Jul 09, 2003 Rate Type: Residential Meter readings in current billing period: Meter Number N000038458 is a 5/8-inch meter. Present-actual 3 71/~0 0 Last-actual 3 7110 0 Gallons used 300 Billing Summary ......... Prior Balance. Balance from last bill Payments prior to Jun 11, 2003. Thanks! Total prior balance, Jun 11, 2003 ..... Current Water Charges ...... Service Charge Water Volume ($.005277x 300) STAS PAWC Water 0.07% DSI - PA WC Charge 1.17% Total water charges, Jun 11, 2003 ........ AMOUNT DUE ................ iz .2_3 Water Usage Com par/son Monthly usage in hundred gallons. 8 2 J J A S O N D J F M A M J 2 u · ¢ 0 · a 9 a u 0 00 u ~ g pn t v c n bra ~ y n 0 2 3 $13.30 -13,30 .00 10.50 1.58 .01 . lZ+ 12.23 $:[2'231 Messages to,you from Pennsylvania American . * Any portion of this water b/l/which Is not paid as of 7/07/03 will be subiect to a 1.50% anal . *It's a well-known fact that drinking water is crucial to your health, so ~J~k up and eUn~?~e ~'nefits of tap waterl * At Pennsylvania American, our customers are our top priority. Please let us know how we can serve you better. * RESIDENTS: A VOID COSTLY SER VICE LINE REPAIRS... - To fearn how you can protect yourself against unexpected and costly service line repairs, call (866) 430-0819, and ask about the WaterLine Protection Program. Your peace of mind is worth it. * Sign up for American Water's automatic payment plan. Through electronic transfer, you can take advantaoe of this convenient way to pay your bill automatically on the day it's due. No more checks, stamps, or late b/ITs! Call the 24-hour Customer Service Center to request an application. You will need your Account Number when you call. Just press 1 for the option to hear about Account and Billing Information, then choose the option to ,re~.uest an application for automatic payment. Fill out the form and mail it back to us. It's that easy! Effecb've April 1, 2003, the Distribution System Improvement Charge (DSIC) has increased from 1.12% to 1.17%. This charge funds replacement of water distribution facilities. Customer Service & Emergencies 1-800-565-7292 (24 Hours) For Hearing Impaired Customers TDD 1-800-300-6202 (24 Hours) Visit us on the INTERNET: www.pawc.com 24753 Customer Account Information F~r Service To: Lloyd Weiss 2421 Massachusetts Ave Account Number: 24-0635267-0 Premise Number: 24-0375515 Billing Period & Meter Information Billing Date: Jul 11,2003 Billing Period: Jun 09 to Jul 09 (30 days) Next reading on/about: Aug 08, 2003 Rate Type: Residential Meter readings in current billing period: Meter Number N000038458 is a 5/8-inch meter. Present-actual 3715 0 0 Last-actual 371/~0 0 Gallons used /I, Billing Summary ........ Prior Balance ..................... Balance from last bill Payments prior to Jul 11, 2003. Thanks! Total prior balance, Jul 11, 2003 ........ Current Water Charges ....... Service Charge Water Volume ($.005277x 100) STAS PAWC Water 0.07% DSI- PAWC Charge 1.34% Total water charges, Jul 11, 2003 ......... Other Current Charges ....... Late Payment Charge Total other charges, Jul 11, 2003 ..... AMOUNT DUE Water Usage Comparison Monthly usage in hundred gallons. 2 J A S O N D J F M A M J J 2 o ~ u e c o ~ a ~ ~ g P t v C n ~° ra ~ ~' ~ Y $12.23 .00 12.23 10.50 .53 .0! · 15 11, 19 · 18 · 18 I ~23.6o Messages to you from Pennsylvania American , * Any portion of this water bill which is not paid as of 8/05/03 will be subject to a 1.50% penalty. The due date pertains to current charges only. Any past due balance should be paid immediately. * At Pennsylvania American, our customers are our top priority. Please let us know how we can serve you better. * Help protect our watersheds. Dispose of household chemical wastes at a permitted hazardous material facility. Never dump old paint, solvents or used oil on the ground or in the street, where they can eventually enter local streams. * RESIDENTS: A VOID COSTLY SER VICE LINE REPAIRS... To learn how you can protect yourself against unexpected and costly service line repairs, call (866) 430-0819, and ask about the Water Line Protection Program. Your peace of mind is worth it. * Sign up for American Water's automatic payment plan. Through electronic transfer, you can take advantage o..f this convenient way to pay your bill automatically on the day it's due. No more checks, stamps, or late bills! (,'all the 24-hour Customer Service Center to request an application. You will need your Account Number when you call. Just press 1 for the option to hear about Account and Billing Information, then choose the option to request an application for autematlc payment. Fill out the form and mail it back to us. It's that easy! Customer Service & Emergencies 1-800-565-7292 (24 Hours) For Hearing Impaired Customers TDD 1-800-300-6202 (24 Hours) Visit us on the INTERNET: www.pawc.com AIM 22627 Customer Account Information 'For Service To: Lloyd Weiss 2421 Massachusetts Ave Account Number: 24-0635267-0 Premise Number: 24-0375515 Billing Period & Meter Information Billing Date: Aug 12, 2003 Billing Period: Jul 09 to Aug 08 (30 days) Next reading on/about: Sep 09, 2003 Rate Type: Residential Meter readings in current billing period: Meter Number N000038458 is a 5/8-inch meter. Present-actual 3 7 ]. 70 0 Last-actual 3 715 0 0 Gallons used Billing Summary .......... Prior Balance ................... Balance from last bill Payments prior to Aug 12, 2003. Thanks! Total prior balance, Aug 12, 2003 ......... Current Water Charges ....... Service Charge Water Volume ($.005277x 200) STAS PAWC Water 0.07% DSI - PAWC Charge 1.34% Total water charges, Aug 12, 2003 ........ AMOUNT DUE ................ Water Usage Comparison $23.60 -23.42 · 18 10.50 1.06 .01 · 15 11.72 $11.90 Messages to you from Pennsylvania American ' *~Any.po~'o.n of this water ~itl which is not paid as of 9/08/03 will be subject to a 1.50% penal~y. i ne oue oare pertains to current charges only. Any past due balance should be paid immediately. * At Pennsylvania American, our customers are our top priodtv Please let us know ho * Wi . . .,.. . . w we can serve you better. th over 100 years of water service experience. Pennsylvania American is a trusted leader in the industry. We consider it a privilege to supply water and wastewater service to more Pennsylvanians than any other provider, and we consider it a privilege to serve you and your famil . * RESIDENTS: A VOID COSTL Y SERVICE LINE REPAIR~... - Y To learn how you can protect yourself against unexpected and costly service line repairs, call (866) 430-0819, and ask about the Water Line Protection Program. Your peace of mind is worth it. * Sign up for American Water's automatic payment plan. Through electronic transfer, you can take advantage o..f t.h.i.s, co_nv, e. nien!,way to pay your bill automatically on the day it's due No more checks stamo= nr I~ hillel ua//me z4. -nour Customer Service Center to request an al~lOl[cation ~;ou will need your Yr~UuCeastlt.aJnU:?~cSaS~l for the ?pti'on.. to hear ab. ou~t..Account'~nd Billin'g Information, ~,,,'~h'~-s~"t'h;;~'tT;/~ ~. ..... pp ~on ror auromatlc paymen£, t-,~ out the form and mail it back to us. Its that easy! Effec#ve July 1, 2003, the DIstribu#on System Iml)rovement Char, e ' · -- .-. .... g (DSIC) has increased from 1.17~to 1.34%. This charge funds replacement of water distribution facilities. Customer Service & Emergencies 1-800-565-7292 (24 Hours) For Hearing Impaired Customers TDD 1-800-300-6202 (24 Hours) Visit us on the INTERNET: www.pawc.com A1M 23495 REV-1513 EX+ (9-00) RESIDENT DECEDENT ESTATE OF NUMBER ! Lloyd C. Weiss NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include oub~hi spousal distn'butions, and transfers under Randy L. S~.9116(a)(1.2)] Weiss, 845 Torway Road Gardners, PA 17324 Marilyn L. Santo, 920 Belle Vista Drive Enola, PA 17025 RELATIONSHIP TO DECEDENT Do Not List Trustee(e) Son Daughter FILE NUMBER 21-03-00544 AMOUNT OR SHARE OF ESTATE 5O% 5O% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 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 needeU, insert additional sheets of lhe same size) $ ~ LAST WILL AND TESTAMENT KNOW ALL MEN BY THESE PRESENTS, that I, LLOYD C. WEISS, presently residing at 2421 Massachusetts Avenue, Camp Hill, Cumberland County, Pennsylvania, being in good health and of sound and disposing memory, do hereby make, declare and publish this as my Last Will and Testament, hereby revoking all former Wills and Codicils heretofore made by me. FIRST: I direct that all my just debts, expenses of last illness and funeral expenses shall be paid by my Executor, hereinafter named, from my estate as soon after my decease as shall be found convenient. SECOND: I bequeath my residence at 2421 Massachusetts Avenue, Camp Hill, Cumberland County, Pennsylvania, to my son, RANDY L. WEISS. THIRD: I bequeath my automobiles, vans, other vehicles and gun collection to my son, RANDY L. WEISS. FOURTH: I bequeath my antique soap collection to my daughter, MARILYN L. SANTO. FIFTH: I bequeath my household and personal effects and other tangible personalty of the like nature (not including cash or cur%ties), together with any existing insurance thereon, to be lstr~buted to my children, RANDY L. WEISS and MARILYN L. SANTO, as are living on the sixty-first day after my death to be divided among them by my Executor with due regard to their personal preferences in as nearly equal shares as practical. Should either of my children fail to survive me by sixty days, I devise and bequeath his or her share to his or her issue, per stirpes, who survive me, and in default of such issue I devise and bequeath my entire personalty property to my other child or his or her issue as described above. SIXTH: I give, devise and bequeath all of the rest, residue and remainder of my property, whether ~eal, personal or mixed, and of any nature whatsoever and wherever s~tuate to my children, RANDY L. WEISS and MARILYN L. SANTO, in equal shares. Should either of my children fail to survive me by sixty days, I devise and bequeath his or her share to his or her issue, per stirpes, who survive me, and in default of such issue I devise and bequeath the entire residue to my other child or his or her issue as above described. SEVENTH: I hereby nominate, constitute and appoint my son, RANDY L. WEISS, as Executor of this, my Last Will and Testament, without the necessity for posting security regardless of his state of residence. In the event that my said son shall predecease me, or be unwilling or unable to act as my Executor as aforesaid, then I nominate, constitute and appoint my daughter MARILYN L. SANTO, as Executrix without the necessity for posting security regardless of her state of residence. All references to the Executor herein shall be applicable to said substitute Executrix. EIGHTH: My Executor shall have, in addition to the powers and authority conferred upon him by law, the following additional powers and authority: 1. To sell at public or private sale, exchange, lease, mortgage or pledge any property, real or personal, at any time constituting a portion of my estate, and upon such terms and conditions as the Executor shall deem wise. 2. To invest any money at any time in such bonds, stocks, notes, real estate, mortgages, life insurance, annuities or other securities, or such property, real or personal, as the Executor shall deem wise, without being limited by any statutes or rule of law regarding investments by an executor. 3. To retain, without incurring any liability, as invest- ments, any property owned by me at the time of my death, as long as he deems it wise, and even though such property is not the kind of property an. Executor would purchase as an investment; and even though to retain such Property might violate sound diversification principles. 4. To cause any security or other property which may constitute a portion of my estate to be issued, held, or registered in his own name, or in the name 'of a nominee, or in such form that title will pass by delivery. 5. To consent to the reorganization, consolidation, readjustment of the financial structure, or sale of the assets of any corporation or other organization, the securities of which constitute a portion of my estate, and to take any action with reference to such securities which, in the opinion of the Executor is necessary to obtain the benefit of any such reorganization, consolidation, readjustment or sale; to exercise any conversion privilege or subscription right given to his as the owner of any securities constituting a portion of my estate; / The preceding instrument consisting of this and three other typewritten pages each identified by the signature of the-Testator, LLOYD C. WEISS, was on this day and date thereof signed, published, and declared by LLOYD C. WEISS, the Testator therein names, as and for his Last Will, in the presence of us who, at his request, in his presence, and in the presence of each other have subscribed our names as witnesses. COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN I, LLOYD C. WEISS, Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that' I signed, it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~oy~ Weiss ~--~ Sworn or affirmed to and acknowledged before me~ by 'LLOYD C. WEISS, the Testator, this ~ day of ~~ 1993. Notary Public Notarial Seal _ Michael ChemvvP, a, k~)tary Public ~u~u~,anna T~,,~p., Dauphin County My C~mmis~on Expires Jan. 13, 1997 Member,, Penns~v~iaAssoda[,on of No~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN We ~£m L. ~,~s,~ and and /~ Z' ~Y~ , the witnesses whose n~es ~re signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say the we were present and saw Testator sign and execute the instrument as his Last Will; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge the Testator was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. Sworn of affixed to and subscribed to before me by and ~ Z, and ~ & ~Y~ , witnesses, this ~ day of ~~ , 1993. '(SEAL') '" Notary Publ~6 - [ ,Z , ........... ..... Member, Pennsylvania Assccia~on of Notari~ 5 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Randy L. Weiss being duly sworn according to law, deposes and says fhaf he ~.~ tha E×ecutor of the Estate of_ Lloyd C. Weiss late of -- Camp H_~_i_i ............. , Cumberland County, Pa., deceased and that the within is an inventory made by him , the said Executor of the entire estate of said decedent, consisting of all the personal property and real estate, except real estate oufslde the Commonwealth of Penn,sylvania, and fhaf the figures opposlfe each item of the Inventory represent it's fair value as of the date of decedent s death. .Sworn and subscribed before me, March /~ x~ 2004 No[arlai Seal Michael Cherewka, Nolary Public Wormleysburg Boro, Cumberland County My Commissior~ Expires Feb. 5, 2005 Date of Death Member, Pe''';*~ ?"iat~on o! Notarie'.-', ,.Tune 20, 2003 · C./ Executor - Administrator 845 Torway Road, Gardners, PA 17324 Address Day Month Year INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed w~thln thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949., 0 0 'O~ ~PR-5 Pt:30 Register of Hills Cumberland County Courthouse 1Courthous~ Square Carlisle, PA 17013 BUREAU OF ZNDZVZDUAL TAXES INHERITANCE TAX DTVZSZON DEPT. Z80601 HARRTSBURG, PA 171Z8-0601 COHHONNEALTH OF PENNSYLVANZA DEPARTHENT OF REVENUE NOTICE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLOHANCE OR DZSALLONANCE OF DEDUCTZONS AND ASSESSNENT OF TAX REV-154? EX AFP C01-05) HICHAEL CHEREWKA ESQ 624 N FRONT ST WORHLEYSBURG '04 i'iA¥ 24 /~ 8 .~3 DATE 05-24-2004 ESTATE OF NE[SS DATE OF DEATH 06-ZO-ZO0$ FILE NUHBER 21 05-0544 COUNTY CUHBERLAND ACN 101 Aeoun~ Remitted LLOYD C HAKE CHECK PAYAmLE AND REHIT PAYHENT TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTZON FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03} NOTZCE OF INHERITANCE TAX APPRAZSEHENT, ALLONANCE OR DZSALLONANCE OF DEDUCTZONS AND ASSESSHENT OF TAX ESTATE OF NETSS LLOYD CFILE NO. 21 05-0544 ACN 101 DATE 05-24-2004 TAX RETURN NAS: (X) ACCEPTED AS F/LED ( } CHANGED RESERVATZON CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~a (Schedule A) (1) 2. S~ocks and Bonds (Schedule D} (2) $. Closely Held S~ock/Par~narship In~eres~ (Schedule C} (S} ~. Nor~gagas/No~es Receivable (Schedule D) (q) $. Cash/Bank Deposi~s/Nisc. Personal Proper~y (Schedule E) ($) 6. Jointly Owned Proper{y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expenses/Ada. Costs/Nisc. Expenses (Schedule H) (9) 10. Debts/Hortgaga Liabilities/Liens (Schedule 1) (10) 11. Total Deductions 12. Nat Value of Tax Return .0O .00 .00 .00 7z970.95 8/609.95 .00 (8) 13,972.88 383.10 (11) (12} 13. 1~. NOTE: Chari~able/governeental Bequests; Non-elected 9115 Trusts (Schedule J) (13) Net Value of Estate Sub~act to Tax (1~) If an assessment ~as issued previously, lines 14, 15 and/or 16, re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSHENT OF TAX: 15. Amoun~ of Line 1~ at Spousal rate 16. Amoun~ of Line 1~ ~axable at Lineal/Class A rate 17. Amoun~ of Line 1~ a~ Sibling 18. Aeount of Line 1~ taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: PAYMENT RECEIPT DISCOUNT DATE NUNBER INTEREST/PEN PAID (-) 04-05-Z004 CD003766 .00 NOTE: To insure proper credit to your account, subei~ ~ha upper portion of this form with your ~ax payment. 16,580.88 l~ .355.9B 2,224.90 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL /NTEREST. .00 2,224.90 17, 18 and 19 ~111 (lB) .00 X O0 = .00 (26) 2,224.90 X 045= 100.12 (17) . O0 X 12 = .00 (18) .00 x 15 = .00 (19)= 100.12 AHOUNT PAID 100.12 TOTAL TAX CREDZT 100.12 BALANCE OF TAX DUEI .00 ZNTEREST AND PEN. .18 TOTAL DUE .18 ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF TH/S FORN FOR ZNSTRUCTZONS.) RESERVATION: PURPOSE OF NOTICE: PAYHENT: REFUND [CR): OBJECTIONS: ADHZN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred 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 laaful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (7Z P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of #ills printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT 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-1313). Applications are available at the Office of the Register of Nills, any of the Z3 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-~6Z-ZOSO; services for taxpayers with special hearing and / or speaking needs: 1-800-447-30Z0 (TT only). Any party in interest not satisfied with the appraisement) allowance) or disallowance of daductionsj or assessment of tax (including discount or interest) as shown on this Notice must abject within sixty (60) days of receipt of this Notice by: --written protest to the PA Deparb~ant of Revenue, Board of Appeals) Dept. 281021) Harrisburg, PA 171ZB-10Z1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenuej Bureau of Individual Taxes~ ATTN: Pest Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. Sea page S of the booklet "instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) far an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the dacedsnt's death, a five percent (5Z) discount of the tax paid is allowed. The 15X 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 is charged beginning 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, 198Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 198Z 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 198Z through 2004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ 20Z .000548 1988-1991 llZ .000301 ~ 9Z .000247 1985 16Z .0004~8 1992 9Z .OOOZ47 ZOOZ 6Z .000164 1984 11Z .O00SO1 1993-1994 7Z .000192 2003 5Z .000137 1985 132 .000356 1995-1998 92 .000Z47 ZOO4 42 .ag0110 1986 lOX .000Z74 1999 7Z .00019Z 1987 IOZ .000274 ZOO0 7Z .00019Z --Interest is calculated as follows: ZNTEREST= BALANCE OF TAX UNPAZD X NUlfBER OF DAYS DELZNQUBNT X DAXLY TNTEREST 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.