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HomeMy WebLinkAbout04-0148Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Guy G. Moyer also known as , Deceased Social Security No. 164-12-4743 Petitioner)s), who is/are 18 years of age or older, apply(les} for: (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner is the executor named in the Last Will of the Decedent, dated February 3, 1998 and codicil(s) dated None State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: NONE B. Grant of Letters of Administration (d.b.n~c.t,a.: pendente lite; durante absentla; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and v~urvived by the follewing spouse (if any) and heirs: ~ i? ~ ~Z; ~??' I Name Relationship J (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death at Claremont Nursing Home, Middlesex Township, with his last family or principal residence at 1000 Claremont Road, Carlisle, Pennsylvania 17013 (list street, number and municipality) Decedent, then 89 years of age, died February 6, 2004, at Claremont Nursing Home, Carlisle, Pennsylvania (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property .............................. $ 74~000.00 (If not domiciled in PA) Personal property in Pennsylvania ..................... $ (If not domiciled in PA) Personal property in County ......................... Value of real estate in Pennsylvania ............................................... Total .............................................................. $ 74~000.00 Real Estate situated as follows: None Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Signature Typed or printed name and residence Darryl C. Moyer, 506 Eutaw Avenue, New Cumberland, PA 17070 Form RW-1 Page 1 of 2 (Dauphin County) - Rev. 9/92 Oath of Personal Representative Commonwealth of Pennsylvania County of Dauphin The Petitioner above-named swears and affirms that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner and that, as personal representative of the Decedent, Petitioner will well and truly administer the est,a,T~_,~ccording to law. Sworn to and affirmed and subscribed ~i ~"~~ C L-)"~~~Darryl C. M(:~c~r before me this 11th day of February 2004. No, Estate of Guy G. Moyer Deceased Social Security No: 164-12-4743 Date of Death: February 6, 2004 AND NOW, ,2004, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Darryl C. Moyer in the above estate and that the instrument dated February 3, 1998 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........................... $ Short Certificate(s)...(..~.).... Renunciation .................. Affidavit ( ) ................. Extra Pages ( ) ............ Codicil .......................... JCP Fee ........................ Inventory ....................... Other...records mgmt ...... 115.00 9.00 6.00 10.00 TOTAL ................ $ 140.00 Attorney: I.D. No: Attorney Signature Earl Richard Etzweiler, Esquire 06398 Address: 105 North Front Street Harrisburq, PA 17101 Telephone: (717) 234-5600 Form RW-1 Page 2 of 2 (Dauphin County) - Rev. 9/92 Register of Wills, of Cumberland County, Pennsylvania OATH OF SUBSCRIBING WITNESS Estate of Guy G. Moyer We, EARL RICHARD ETZWEILER and KAREN L. PAUL, subscribing witnesses to the Last Will and Testament presented herewith, being duly qualified according to law deposes and says that the were present and saw the above Testator sign the same and that they signed as a witness at the request of Testator in his presence and in the presence of each other. 274 Creek View Drive, Millersburg, PA 17061 (Address) Karen L. Paul R.R. Itl, Box 55, Dalmatia, PA 17017 (Address) Sworn and subscribed to before me this 13th day of February, 2004. N~ublic NOTARIAL SEAL PATTY L. STROHECKER, Notary Public City of Harrisburg, Dauphin County My Commission Expires Jan. 6, 2007 LAST WILL AND TESTAMENT OF GUY G. MOYER I, GUY G. MOYER, a resident of Lykens Township, Dauphin County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this instrument to be my Last Will and Testament, hereby revoking any and all wills by me at any time heretofore made. ITEM I: I direct my hereinafter named CoExecutors to pay all my just debts, funeral expenses, administration expenses and inheritance, estate, succession or excise taxes, which I owe or may become due on account of my death, as soon as may be convenient after ITEM II: I give, devise and bequeath my 1989 Chevrolet pickup truck to my son, Darryl Charles Moyer, of 506 Eutaw Avenue, New Cumberland, PA 17070. ITEM III: I give, devise and bequeath the sum of One Thousand Dollars ($1,000.00) to each of my four (4) hereinafter named grandchildren: 1. Darryl C. Moyer, Jr. 2. Linda Louise Moyer Lee 3. Charles Michial Moyer 4. Jill Renee Moyer ITEM IV: I give, devise and bequeath the sum of Five Thousand Dollars ($5,000.00) to St. Peter's Evangelical Lutheran Church of Highspire, Pennsylvania. ITEM V: All the rest, residue and remainder of my estate, be it real, personal or mixed, of whatever nature and wheresoever situate which I may own or have the fight to dispose of at the time of my decease, ! give, devise and bequeath to be divided as follows: Gu~G. Moyer L/ my decease. 1. 1/3 to my son, Darryl Charles Moyer, of 506 Eutaw Avenue, New Cumberland, PA 17070 2. 1/3 to my grandson, Ricky Moyer, per sfirpes, of 109 Market Street, P.O. Box 210, Lewisberry, PA A. If either my son or my grandson should predecease me or die simultaneously with me leaving issue to survive, then such share shall pass to his issue per s[~rpes. B. If either of my sons should predecease me or die simultaneously with me without leaving issue to survive, then such share shall be divided between my other children or their issue, per stirpes. 3. 1/3 to be equally divided among the following four children of my deceased daughter, Linda Engle: a. b. Karen Kay Engle Klouser Eileen Michelle Engle Daniel Robert Engle, Jr. Beth Ann Engle A. If any of my grandchildren should predecease me or die simultaneously with me leaving issue to survive, then such share shall pass to his or her issue per sfirpes. B. If any of my grandchildren should predecease me or die simultaneously without leaving issue to survive, then such share shall be divided among the other children of my deceased daughter, Linda Engle, per stirpes. G. Moyet./ (SEAL) ITEM VI: I hereby nominate, constitute and appoint my son, Darryl C. Moyer, Executor of this my Last Will and Testament, with full power in their discretion to do any and all things necessary for the complete administration of my estate, without being required to file bond for the performance of their duties, with full power to sell at public or private sale and without order of court any real or personal property belonging to my estate, and to compound, compromise or otherwise settle or adjust any and all claims, charges, debts and demands whatsoever against or in favor of my estate as fully as I could if living. A. If my son should predecease me, die simultaneously with me or be unable or unavailable to serve or complete his duties, then I nominate, constitute and appoint my grandson, Ricky Moyer, Executor, with the same power and authority as given my said son. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament this 3rd day of February, 1998. Signed, sealed, published and declared by the above-named Guy G. Moyer as and for his Last Will and Testament, in the presence of us, who at his request, in his presence and in the presence of each other, we believing him to be of sound and disposing mind, memory and understanding, have hereunto subscribed our names as wimesses this 3rd day of February, 1998. '~Guy(~. Moyer (SEAL) LAST WiLL AND TlgSTAHENT OF GUY G. MOYI~R ETZWEILER AND ASSOCIATES ATTORNEYS AT LAW 105 NORTH FRONT STREET HARRISBURG, PENNSYLVANIA 17101 (717) 234-5600 HALIFAX LIN[; (717) 896-3737 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) NAME OF DECEDENT: DATE OF DEATH: WILL NO.: Guy G. Moyer February 6, 2004 2004-00148 ADMIN. NO.: TO THE REGISTER: 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 March 10, 2004: Darryl C. Mover, Jr., 423 6th Street, New Cumberland, PA 17070 Linda Louise Mover Lee, 128 N. 32na Street~ Camp Hill, PA 17001 Charles Michael Mover, 782 Heck Hill Road, Lewisberry, PA 17070 Jill Renee Mover (Monales), 1036 Teakwood Lane, Enola, PA 17025 St. Peter's Evangelical Lutheran Church, 240 Broad Street, Highspire, PA 17034 Darrvl C. Moyer, 506 Eutaw Avenue, New Cumberland, PA 17070 Rick,( Moyer, of 270 Butter Road, York, PA 17404 Karen Kay Engle Klouser, 3931 East Iron Horse Road, Gilbert, AZ 85297 Eileen Michelle Engle (Price), 316 Shady Glen Drive, Coraopolis, PA 15108 Daniel Robert Engle, Jr., 154 Davis Bridge Road, Bernville, PA 19506 Beth Ann Engle (Rogers). 146 Wolf Cub Trail, Canon City, CO 81212 Notice has been given to all persons entitled thereto under Rule 5.6(a) except Date: March 10, 2004 NONE Signature '~ Name Earl Richard Etzweiler, Esquire Address 105 N. Front Street Harrisburg, PA 17101 Telephone (717) 234-5600 X Counsel for Personal Representative F:\WP\ DOC\H A F~2004\March\3-I 0-04 .It Earl Richard Etzweiler, Esquire Christian S. Daghir, Esquire 225 Market Street Millersburg, PA 17061 (717) 692-2519 Office hours: Tues. and Fri. 4:00 p. n~-8:OO p. r~ Sat. 10:00 a.m.-12:00 noon ETZWEILER AND ASSOCIATES ATTORNEYS-AT-LAW 105 NORTH FRONT ~,~yEET HARRISBURG, PA 171 ~1:~ 143'6 Office hours: Mon.-Fri. 8:00 a.m.-$:OO p. tr~ (717) 234-5600 ...... ~ I~?f~ 12 HALIFAX LINE (717) 896-3737 Fax Line: (717) 234-56[L0 .... Email Address: retzweiler(~c~m~it,4.~et. West Main Street Elizabethville, PA 17023 (717) 362-8395 Office hours: Thurs. 7:00 p. m.-9:OO p. m. April 9, 2004 Register of Wills Cumberland County Courthouse Hanover and High Streets Carlisle, PA 17013 R .'~ESTATE OF GUY G. MOYE~~ ~,,,~_ FILE NO. 2004-00148 Dear b~:,ar_Madam: Please find enclosed for processing the following: 2. 3. 4. The original and one copy of an Inheritance Tax Return; The original Inventory; Our check in the amount of $25.00 representing your fee for filing estate papers; A check made payable to the Register of Wills, Agent, in the amount of $2,248.63, representing inheritance tax paid within the three-month discount period. Please also find enclosed copy of the face sheet of the Inheritance Tax Return and Inventory. Please time-stamp these copies and return them to our office with the receipts of payment in the self-addressed, stamped envelope provided. As always, thank you for your assistance in this regard. Sincerely, E~l~Ri~h~-~tiweiler ERE:haf Enclosure REV-1162 EX(11-96) 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 003796 ETZWEILER EARL RICHARD ESQ 105 N FRONT ST HARRISBURG, PA 17101 ........ fold ~ SSN: 164-12-4743 ESTATE INFORMATION: __------- FiLE NUMBER: 2104-0148 DECEDENT NAME: MOYER GUY G DATE OF' PAYMENT: 04/1 2/2004 ~OSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 02/06/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $2,248.63 RtEMARKS: SEAL CHECK# 997 TOTAL AMOUNT PAID' ~2,248.63 INITIALS' JA RECEIVED BY' GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS 60-72381 2313 DATE Z"'[' -- C~ -- 0 L-'~' t OO DOLLARS PAY TOTHEoRDER OF REV-1500 E×+i6-00/ REV- 1500 COMMON VEALT, OFPENNSYLVAN,A INHERITANCE TAX RETURN DEPARTMENT OF REVENUE DEPT. 28060 RESIDENT DECEDENT HARRISBURG. PA 171;>8-0601 D ] DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAL) E I Moyer Guy O C DATE OF DEATH (MM-DO-YEAR) DATE OF BIRTH (MM-OD-YEAR) E D 02/06/2004 05/04/1914 E (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST. AND MIDDLE INITIAL) N T ~ 1. OriginalReturn ~ 247! SupplementalReturn C A P a 4. Limited Estate . Future Interest Compromise (date of death after 1;>- 12-87) HpRL E P I O 6. Decedent Died Testate Decedent Maintained a Living Trust C R A C (Attach copy of Will) (Attach copy of Trust) KOTK ES ~-~ 9. Litigation Proceeds Received E~10. Spousal Poverty Credi, I---] (date of death between 12-31 ~91 and 1 - 1-95) C g NAME o Earl Richard F~tzweiler R DN FIRM NAME (If Applicable) R E NE Etzweiler and Associates S T TELEPHONE NUMBER 717/234-5600 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (:~) 3. Closely Held Corporation, Partnership or (3) Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (4) R ,5. Cash, Bank Deposits & Miscellaneous Personal Property (5) E (Schedule E) C A 6. Jointly Owned Property (Schedule F) (6) P I [---1 Separate Billing Requested T U 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) L (Schedule G or L) A T 8. Total Gross Assets (total Lines 1-7) I O 9. Funeral Expenses & Administrative Costs (Schedule H) (9) N 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11 ) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) C O SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES M T UP 15. Amount of Line 14 taxable at the spousal tax A T rate. or transfers under Sec. 9116(a)(1.2) 0 00 X .0 0 X A ' T 16. Amount of Line 14 taxable at lineal rate 52,599.55 X .0 45 I 17. Amount of Line 14 taxable at sibling rate 0 00 X .12 O · N 18. Amount of Line 14 taxable at collateral rate 0.00 X 19. Tax Due 20. OFFICIAL USE ONLY FILE NUMBER 21-04-0148 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 164-12-4743 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER (date of death 3. Remainder Return prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch O) COMPLETE MAILING ADDRESS 105 North Front Street Harrisburg, PA 17101 o~e $o e None 79,46'5.20 None None 16,062.10 5,803.55 OFFICIAL USE ONLY (8) 79,465.20 (11) 21,865.65 (12) 57,599.55 (13) 5,000.00 (14) 52,599.55 (15) 0.00 (16) 2,366.98 (17) 0.00 (18) 0.00 (19) 2,366.98 Copyright (c) ZOO0 form software only The Lackner Group. Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS "Claremont Nursin~ Home 1000 Claremont Road CiTY Carlisle STATE ZIP PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit a. Prior Payments 2,248.63 C. Discount 118.35 Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT, Check box on Parle I Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line $ + SA. This is the BALANCE DUE. (SB) 2,366.98 2,366.98 0.00 0.00 0.00 0.00 0.00 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. retaintheuseorincomeofthepropertytransferred; ......................... ~ ~ 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? ................................ r~ [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............................................. E~ E~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a benef ciary designation? ................................ J~l i~ 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. ~~ ~ ~S TURE OF PERSON RESPONSIBLE FOR FILING RETURN Darryl506 Eutaw AvenueC' Moyer DATE/ / SIGNATURE OF PREPARER OTNER THAN REPRESENTATiVE~ Etzweiler and Associates DATE ~," ff /~ ~ 105 North Front Street ~/9/~ 7 ........................ For da~es of death on or a~sr Ju]y 1. 1994 aad before January 1, 1995, the tax rate imposed on the net va[ue of transfers to or for the use of the su~vivin9 spouse is 3% [72 P.S. 9116 (a) (1.1) (i)]. ~or dates o~ death on or a~er January 1. 1995, the tax rate imposed on th~ net value of transfers to or [or the use of the survivin9 spouse is 0% [72 P.S. 9116 (a) (1.1} (ii)I. The statut~ does not exempt a transfer ~o a survivin9 spouse from tax, and the statuto~ requkements for disclosure of assets and fi[in9 a tax return are stir app[icabl~ even if the survivin9 spouse is the only beneficial. ~or dates o~ death on or a~er Ju[y 1, 2000: The ~ax rate imposed on the ne~ va[ue o~ transfers from a deceased chi[d twenty-one years of age or younger at death to or for the use o[ a natural parent, an adoDtiw parent, or a stepparent o~ th~ child is 0% [72 P.S. 9116 (a) (1.2)]. The ~ax rate imposed oa the net value o[ ~ransf~rs to or ~or the use o~ the decedent's [in~a[ beneficiaries is 4.5%, except as noted ~n 72 P.S. 9116(1.2) [72 P.S. 9116(a)(1)]. The tax raie imposed on ~he net value of transfers to o~ ~or the use o~ the decedent's siblings m 12% [Ta m,S. 9116(a){1,3)]. A sib~in9 is defined, Section 910~. as an indiv~dua[ who has at [east one parent in common with the decedent, whethe~ by b[ood or adoption. Copyright lc) ~000 form software o,ly The tackner Group, Inc. ~orm ~-1500 ~X (~ev. 6-00} LAST WILL AND TESTAMENT OF GUY G. MOYER I, GUY G. MOYER, a resident of Lykens Township, Dauphin County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this instrument to be my Last Will and Testament, hereby revoking any and all wills by me at any time heretofore made. ITEM h I direct my hereinafter named CoExecutors to pay all my just debts, funeral expenses, administration expenses and inheritance, estate, succession or excise taxes, which I owe or may become due on account of my death, as soon as may be convenient after ITEM II: I give, devise and bequeath my 1989 Chevrolet pickup track to my son, Darryl Charles Moyer, of 506 Eutaw Avenue, New Cumberland, PA 17070. ITEM III: I give, devise and bequeath the sum of One Thousand Dollars ($1,000.00) to each of my four (4) hereinafter named grandchildren: 1. Darryl C. Moyer, Jr. 2. Linda Louise Moyer Lee 3. Charles Michial Moyer 4. Jill Renee Moyer ITEM IV: I give, devise and bequeath the sum of Five Thousand Dollars ($5,000.00) to St. Peter's Evangelical Lutheran Church of Highspire, Pennsylvania. ITEM V: All the rest, residue and remainder of my estate, be it real, personal or mixed, of whatever nature and wheresoever situate which I may own or have the right to dispose of at the time of my decease, I give, devise and bequeath to be divided as follows: , .-.- ,- ~ / · (SEAL) Gu~' G. Moyer my decease. 1. 1/3 to my son, Darryl Charles Moyer, of 506 Eutaw Avenue, New Cumberland, PA 17070 2. 1/3 to my grandson, Ricky Moyer, per stirpes, of 109 Market Street, P.O. Box 210, Lewisberry, PA A. If either my son or my grandson should predecease me or die simultaneously with me leaving issue to survive, then such share shall pass to his issue per Stil'pes. B. If either of my sons should predecease me or die simultaneously with me without leaving issue to survive, then such share shall be divided between my other children or their issue, per stirpes. 3. 1/3 to be equally divided among the following four children of my deceased daughter, Linda Engle: a. b. C. d. Karen Kay Engle Klouser Eileen Michelle Engle Daniel Robert Engle, Jr. Beth Ann Engle A. If any of my grandchildren should predecease me or die simultaneously with me leaving issue to survive, then such share shall pass to his or her issue per stirpes. B. If any of my grandchildren should predecease me or die simultaneously without leaving issue to survive, then such share shall be divided among the other children of my deceased daughter, Linda Engle, per stirpes. (SEAL) ITEM VI: I hereby nominate, constitute and appoint my son, Darryl C. Moyer, Executor of this my Last Will and Testament, with full power in their discretion to do any and all things necessary for the complete administration of my estate, without being required to file bond for the performance of their duties, with full power to sell at public or private sale and without order of court any real or personal property belon~ng to my estate, and to compound, compromise or otherwise settle or adjust any and all claims, charges, debts and demands whatsoever against or in favor of my estate as fully as I could if living. A. If my son should predecease me, die simultaneously with me or be unable or unavailable to serve or complete his duties, then I nominate, constitute and appoint my grandson, Ricky Moyer, Executor, with the same power and authority as given my said son. IN WITNESS WltEREOF, I have hereunto set my hand and seal to this my Last Will and Testament tiffs 3rd day of February, 1998. Signed, sealed, published and declared by the above-named Guy G. Moyer as and for his Last Will and Testament, in the presence of us, who at his request, in his presence and in the presence of each other, we believing him to be of sound and disposing mind, memory and understanding, have hereunto subscribed our names as wimesses this 3rd day of February, 1998. 'Guy.-~3. Mr~yer 'c ,j REV- 1508 EX + (1-97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Guy G Moyer SS~/ 164-12-4743 02/06/2004 21-04-0148 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 4,500.00 Claremont Nursing Home refund expected Highmark Blue Shield - refund Waypoint Bank - checking account no. 100628189. 339.15 74,626.05 TOTAL (Also enter on line 5, Recapitulation) $ 79,465.20 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems. Inc. Form REV-1508 EX (Rev. 1-97) way LOOK FOR US. WE'LL GE~T YOU THERE. 3/9/2004 ETZWEILER AND ASSOCIATES 105 N FRONT ST HARRISBURG PA 17101-1436 The information which you requested on the account(s) of GUY G MOYER (Social Security Number 164-12-4743) is/are as follows: Account Number 100628189 Class of Account CHECKING Date Opened 071603 Principal Balance 74625.44 Accrued Interest .61 Balance at Date of 74626.05 Death Account Ownership SOLE Name of Joint Owner, if any Date Ownership 071603 Was Established Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established Additional Information Requested ~ENIOR SERVICES REP. P.O. Box 171 I. HARRISBURG. PENNSYLVANIA 17105-1711 Toll Free 1-866-WAYPOINT (I-1~66-9;39-7646) · IN YORK AREA 717/815-4500 · vvww. wagpointbank.com REV- 1511 EX + (1-97) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Guy G Moyer SS~/ 164-12-4743 02/06/2004 21-04-0148 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT 2 1 2 3 4 5 6 FUNERAL EXPENSES: Stephenson' s Flowers casket spray Stone-Murray Funeral Eome - funeral service ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Darryl C. Moyer Social Security Number(s) / EIN Number of Personal Representative(s) Street Address 506 Eutaw Avenue City New Cumberland Year(s) Commission Paid: State PA Zip 17070 Attorney's Fees Etzwe i ler and Ass oc lares Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip advertise Letters Testamentary notary fee, postage and photocopies. Relationship of Claimant to Decedent ProbateFees Register of Wills Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Cumberland Law Journal Etzweiler and Associates Karen L. Paul witness will Register of Wills DauPhin County (out of Register of Wills two short certificates Register of Wills file estate papers county oath) 185.50 6,432.00 4,559.30 4,559.30 140.00 75.00 50.00 15.00 15.00 6.00 25.00 TOTAL (Also enter on }ine 9, Recapitulation) $ 16,062.10 (if more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems Inc, Form REV-1511 EX (Rev. 1-97) REV-1512 EX +(1-97) SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Guy G Moyer SS~/ 164-12-4743 02/06/2004 21-04-0148 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT Claremont Nursing Home - balance due on account West Shore EMS - services provided 5,779.87 23.68 TOTAL (Also enter on line 10, Recapitulation) $ 5,803.55 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems. Inc. Form REV-1512 EX (Rev. 1-97) IClaremont Nursing & Rehat 1009 Claremont Drive Carlisle PA 17913 (7-7) ~=~.-_03. 12 PATIENT NAME BIRTHOATE ~? BATE (~5~)4191 1!i~02 OCCURRENCE OCCURRENC~ BATE GUY G MCYER DARRYLE C MOYER 506 EUTAW AVENUE NEW CUMBERLAND, PA 17070 2 8 STATEMENT COVERS PEPJOO 7 COVD. 8 5 FED. TAX NO. FRO~ 'mROUC~ 23-6003119 010104 013104 031 13 PATIENT ADDRESS 23 MEDICAL RECORD NO. J 24 I 4388 43 DESCRIPTION 44 HCPCS / RATES 45 SERV. DATE PHARMACY ~ PAYER PRIVATE PAY 57 58 INSURED'S NAME Moyer Guy 63 TREATMENT AUTHORIZATION CODES 67 PRIN. DIAG. CD ~ C;Go~ 80 PRINCIPAL PROCEDURE CODE DATE 3 PATIENT CONTROL NO 4388 '4.CD. [ 9C-ID. 10L-RQ[ll 51 PROVIDER NO. ~ 54 PRIOR PAYMENTS CLAREMONT 64ESC 65 EMPLOYER NAME t 61 GROUP NAME EMPLOYER LOCAl']ON 47 TOT~ C~RGES ~ NON.COVERED C~RGES 11 5735~00 345 12 , ':6080112 - 55 EST. AMOUNT DUE i 49 62 INSURANCE GROUP NO. 74 82 ATTEN~NG PflYS. IO 76 ADM. DIAG CD. ,"7 E-CODE 78 REMARKS Oll~ER PROCEDURE COOE I BATE 83 OTHER PHY$. ID OI%IER PHYS. ID X 02/11/2004 UB-g2 HCFA-t 450 APPROVED OMB NO. O~279 OCR/ORIGINAL SCHEDULE J BENEFICIARIES REV- 1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Guy G Moyer SS~ 164-12-4743 02/06/2004 21-04-0148 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. I1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.?)] See attached summary ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS St. Peters Evangelical Lutheran Church pecuniary bequest 5,000.00 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET 5,000.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00) Gu? G. Mover Estate - Schedule J- Beneficiaries Name/Address Relationship Share/Interest Darryl C. Moyer, Jr. 423 6th Street New Cumberland, PA 17070 Grandchild $1,000.00 Linda Louise Moyer Lee 128 N. 32"d Street Camp Hill, PA 17001 Grandchild $1,000.00 Charles Michael Moyer 782 Heck Hill Road Lewisberry, PA 17070 Grandchild $1,000.00 Jill Renee Moyer (Monales) 1036 Teakwood Lane Enola, PA 17025 Grandchild $1,000.00 Darryl C. Moyer 506 Eutaw Avenue New Cumberland, PA 17070 Son 33.3333333% (1/3 residue) Ricky Moyer 270 Butter Road York, PA 17404 Grandson 33.3333333% (1/3 residue) Children of daughter, Linda Engle (Deceased) / Share in 1/3 residue: Karen Kay Engle Klouser 3931 East Iron Horse Road Gilbert, AZ 85297 Grandchild 8.3333333% Eileen Michelle Engle (Price) 316 Shady Glen Drive Coraopolis, PA 15108 Grandchild 8.3333333% Daniel Robert Engle, Jr. 154 Davis Bridge Road Bemville, PA 19506 Grandchild 8.3333333% Beth Ann Engle (Rogers) 146 wolf Cub Trail Canon City, CO 81212 Grandchild 8.3333333% o o Register of Wills of Estate of Guy G Moyer also known as CUMBERLAND INVENTORY County, Pennsylvania , Deceased No. 2004-00148 Date of Death_..02/06/2004 Social Security No. 164-12-4743 Darryl C. Moyer, Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unswom falsification to authorities. Name of Attorney: I.D. No.: Address: Telephone: Earl Richard Etzweiler 06398 Signature: 105 North Front Street Address: Harrisburg, PA 17101 717/234-5600 Personal Rep~ Darryl ~ Moyer Telephone: Dated: 506 Eutaw Avenue New Cumberland, PA 17070 717/774-1328 Description (See continuation page(s) attached) (Attach additional sheets if necessary) NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the electio include the value of each item, but such figures should not be extended into the total of the Inventory. ~Prepared by the Pennsylvania Bar Association '~/~C, opyright (c) 1996 form software only CPSystems, Inc. Value Total: 91,186.08 of the personal representative, Form #RW-7 (1992) Estate of: Date of Death: County: Guy G Moyer 02/06/2004 Cumberland INVENTORY CASH: Claremont Nursing Home refund expected Highmark Blue Shield - refund Prudential Insurance - life insurance payable to estate Prudential Insurance life insurance payable to estate Waypoint Bank checking account no. 100628189. 4,500.00 339.15 6,611.10 5,109.78 74,626.05 91,186.08 TOTAL RECEIPTS OF PRINCIPAL ............... 91,186.08 BUREAU OF TNDZVZDUAL TAXES ZNHERZTAHCE TAX DTVTSTON DEPT. 180601 HARR/SBURG, PA 17118-0601 COMMONWEALTH OF PENNSYLVANZA DEPARTHENT OF REVENUE NOTZCE OF ZNHERZTANCE TAX APPRAZSEMENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTZONS AND ASSESSMENT OF TAX REV-15~7 EX AFP C01-05) EARL RICNA.B ETZWEILE ' ETZWEILER & ASSOCS 105 N FRONT ST L~. BATE 05-2q-ZOOq ESTATE OF MOYER BATE OF DEATH OZ-06-ZOOq FZLE NUMBER 21 0~-01q8 COUNTY CUMBERLAND ACN 101 I Amount Remitted GUY 6 HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGZSTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THZS LZNE ~ RETAZN LOWER PORTZON FOR YOUR RECORBS ~ BZSALLOWANCE OF BEBUCTZONS AND ASSESSMENT OF TAX ESTATE OF MOYER GUY GFZLE NO. 21 0~-01~8 ACN 101 BATE 05-2~-ZOOq TAX RETURN #AS: (X) ACCEPTED AS F/LED ( ) CHANGED RESERVATZON CONCERNTNG FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORZGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks end Bonds (Schedule $. Closely Held Stock/Partnership Zntarest (Schedule C) (S) q. Mortgages/Notes Receivable (Schedule D) (q) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) ($) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTZONS ANB EXEHPT~ONS: 9. Funeral Expenses/Ada. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I} (10) 11. Total Deductions 12. Net Value of Tax Return .00 .00 .00 .00 79~65.20 .00 .00 (8) 16,062.10 NOTE: To insure proper credit to your account, submit tho upper portion of this form with your 79,~65.20 5~805.55 (11) 21.8~;.&~ (12) 57,599.55 1:5. 1~. NOTE: ASSESSMENT OF TAX: 15. Amount of Line lq et Spousal rate 16. Amount of Line lq taxable at Lineal/Class A rate 17. Amount of Line lq et Sibling rate 18. Amount of Line lq taxable et Collateral/Class B rate Charitable/governmental Bequests; Non-elected 911:5 Trusts (Schedule J) (1:5) Net Value of Estate Subject to Tax (lq) 5,000.00 52,599.55 Zf an assessment ~as issued previously, lines 1~, 15 and/or 16, 17, 18 and 19 Nill reflect figures that include the total of ALL returns assessed to date. 19. Princi')al Tax Due rAX CREDZTS: PAYMENT RECE/PT (1~), .00 x O0 = .00 (16), 52,599.55 x Oq5= 2,$66.98 (17) .00 X 1Z = .00 (28), .00 x 15 = .00 (19)= 2,$66.98 DATE NUMBER PAYMENT MUST ~E MADE ~Y 11-06-Z00q~. ZF PAZD AFTER DATE ZNDZCATED, SEE REVERSE FOR CALCULAT/ON OF ADDZTZONAL ZNTEREST. DZSCOUNT (+} ZNTEREST/PEN PAZD (-) AHDUNT PAZD TOTAL TAX CREBZT BALANCE OF TAX DUE ZNTEREST AND PEN. TOTAL DUE .00 Z,$66.98 .00 2,566.98 ( ZF TOTAL DUE 1S LESS THAN $1, NO PAYMENT 1S REgUZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SZDE OF THZS FORM FOR ZNSTRUCTZONS.) RESERVATION: Estates of decedents dying on or before December 1Z, 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 lawful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section il40 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYNENT: Detach fha top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGISTER OF NILES, AGENT REFUND (CR): A refund of a tax cradit, which wes not requested on the Tax Return, may be requested by completing an "Application for Refund of pennsylvania Xnharitance and Estate Tax" (REV-X313). Applications are available at tho Office of the Register of Hills, any of the 23 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: X-800-36Z-ZOSO; services for taxpayers with special hearing and ! or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied aith the appraisement, alloeanca, or disalloeanca of deductions, or assessment of tax (including discount or interest) as shoen on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revsnua, Board of Appeals, Dept. Z810Zi, Harrisburg, PA l?128-102X, OR --alaction to have tha matter determined at audit of the account of tha personal representative, OR --appeal to the Orphans* Court. PURPOSE OF NOTICE: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. lB0601, Harrisburg, PA 17128-0601 Phone (717) 767-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administrativaly correctable errors. If any tax due is paid within three (3) calendar months after the decedant's death, a five percent (Si) 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 bafore January 18, 1996, tha first day after the end of the tax amnesty period. This nan-participation penalty is appealable in the sase manner and in the the same lima period as you mould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning mith first day of delinquencyj 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 (BX) percent par annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January l, 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 Z004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ ZOZ .000548' ~'~'8-1991 IiX .000301 ~ 9Z .000247 1983 1BI .000438 1992 9Z .000247 2002 62 .000164 1984 llZ .000301 1993-1994 72 .000192 2003 52 .000137 1985 132 ,000356 199S-1998 9Z .000247 Z004 4Z .000110 1986 IOZ .000274 1999 72 .000192 1987 1DX .000274 ZOO0 72 .000192 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will raflact an interest calculation to fiftaan (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 ZNDTVZDUAL TAXES THHERZTANCE TAX DZVZSTON DEPT. Z80601 HARRTSBURG, PA 171Z8-0601 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE ZNHERZTANCE TAX STATEHENT OF ACCOUNT REV-1607 EX AFP C01-037 EARL RICHARD ETZWEILER '~ ETZWEILER ~ ASSOCS 105 N FRONT ST ~,. HBG PA 171q~i~ DATE 05-Z4-Z004 ESTATE OF HOYER DATE OF DEATH OZ-O6-Z004 F/LE NUNBER 21 04-0148 Pl "~OUNTY CUHBERLAND ~-ACN 101 Amoun~ Remi~ed GUY G HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credi~ ~o your account, submi~ ~he upper portion of ~his form wi~h your ~:ex payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) ##~ INHERITANCE TAX STATEHENT OF ACCOUNT NNN ESTATE OF HOYER GUY G FILE NO. 21 04-0148 ACH 101 DATE 05-24-2004 THIS STATEHENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NANED ESTATE. SHONN BELON TS A SUNNARY OF THE PRINCIPAL TAX DUE, APPLZCATTON OF ALL PAYNENTS, THE CURRENT BALANCE, AND, ZF APpLTCABLE, A PROJECTED INTEREST FTGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 05-24-Z004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): 2,$66.98 PAYHENT RECEIPT DISCOUNT (+) AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) 04-12-2004 CD005796 118.$5 2,248.65 ZF PAXD AFTER THXS DATE, SEE REVERSE SXDE FOR CALCULATXON OF ADDXTXONAL INTEREST. ( XF TOTAL DUE 1S LESS THAN $1, NO PAYNENT 1S REQUXRED. XF TOTAL DUE XS REFLECTED AS A "CRED/T" (CR), TOTAL TAX CREDIT Z,$66.98 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE A REFUND. SEE REVERSE STDE OF THIS FORH FOR TNSTRUCTTONS. ) 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 money order payable to: REGISTER OF NZLLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONNEALTN OF PENNSYLVANIA. REFUND (CR): A refund of a tax credit, which was nat requested on the Tax Return, may be requested by completing an "Application for Refund of PannsyIvania Inheritance and Estate Tax" (REV-1313). Applications arm avaiIable at the Office of the Register of Nills, any of the Z3 Revenue District Offices or from the Department's Iq-hour answering service for forms ordering: 1-800-361-Z050; services for taxpayers with special hearing and / or speaking needs: 1-&OO-~qT-30ZO (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 180601, Harrisburg, PA 17118-0601, phone (717) 787-6SOS. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is allowed. PENALTY: The 15Z 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 dmlinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January I, 198Z bear interest at the rate of six (61) percent per annum calculated at a daily rate of .00016~. All taxes which became deIinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year ta calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOOq are: Interest Daily Interest Daily Year Rata Factor Year Rate Factor Year 198Z ZOg .0005q8 1988-1991 llZ .000301 2001 1983 16Z .000~38 1992 9X .000247 2002 198q llZ .000301 1993-199~ 71 .000192 2003 1985 131 .000356 1995-1998 9~ .0002~7 200~ 1986 101 .OOOZ7~ 1999 7Z .000191 1987 91 .DOOZY7 200D 81 .000219 Interest Daily Rate Factor .0002~7 .000164 .000137 .000110 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY 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 calcuIated. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Guv G. Moyer Date of Death: 02/06/2004 Will No. 2004-00148 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate. 1. State whether administration of the estate is complete: Yes X No. 2. Ifthe 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. X b. The separate Orphans' Court No. (if any) for the personal representative's account is: Did the personal representative state an account informally to the parties in interest? Yes X No. c. d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. ;@ Dat~~d: ."",'1 ("'J 03/02/2005 Signature Earl Richard Etzweiler, Esquire 105 North Front Street Harrisburg, PA 17101 (717) 234-5600 Capacity: _ Personal Representative X Counsel for personal representative ~