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03-0922
STATUS REPORT UNDER RULE 6.12 BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND , PENNSYLVANIA Name of Decedent: Galen W. Hershey, a/k/a Galen W. Hershey, Sr. Date of Death: 10/24/2003 File No. 21-03-0922 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to the completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: YES X NO .... 2. If the answer is "No", state when the personal representative reasonably believes that the administration will be complete: 3 If the answer to No. 1 is "Yes", state the following: a. Did the personal representative file a final account with the Court? YES .... NO X b. The separate Orphan's Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? YES × NO d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: 11/22/2004 .:.~. -~/,~ ,~"'~'~"~"'/,~,~'-/ .l _ Joel~l~/. Zullinger '/ Name (Please type or print) 14 North Main Street, Suite 200 Address .~- ':: Chambersburg PA 17201 (717)264-6029 Tel. No. Capacity: Personal Representative X Counsel for personal representative Estate of Galen W. Hershey, a/k/a Galen W. Hershey, Sr. Cumberland County PETITION FOR GRANT OF LETTERS Estate of Galen W. Hershey No. also known as Galen W. Hershey, Sr. , Deceased Social Security No. 198229555 Galen W. Hershey, Jr., Angela Railing and Rebecca Hershey Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut ors named in the Last Will of the [] Decedent, dated 4/23/1990 and codicil(s) dated the decedent's spouse, Jacqueline R. Hershey, predeceased the decedent on April 14, 1999 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 incapacitated: B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minodtate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at 11 Broad Street, Shippensburg, Southampton Township, Cumberland County, PA (list street, number and municipality) Decedent, then 72 years of age, died October 24 ,2003 , at Chambersbur~] Hospital (Location) Decedent at death owned property with estimated values as follows: (if domiciled in PA) All personal property ......................................... $ 120,000.00 (if not domiciled in PA) Personal property in Pennsylvania .................... $ (If not domiciled in PA) Personal property in County .............................. $ Value of real estate in Pennsylvania ........................................................................................ $ 110~000.00 Tota~ ..................................................................................................................... $ 230,000.00 Real Estate situated as follows: 11 Broad Street, Shippensburg, Southampton Township, Cumberland County, PA 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: I Signature Typed or printed name and residence "~ ~ ~P' ::~~-', ,~ Galen W. Hershey, Jr., 5783 White Church Rd., I Shippensbur,cj, PA 17257 %, ~ r'LX~.~..,O_ "j~-"-~-'~..C~ Angela Railing, 1031 Kessler Dr., Shippensburg, PA 17257 ~z '~,.L~.~CC~_ ~. ~t~ t~ ,, I Rebecca Hershey, 98 White House Rd., Shippensburg, PA ~ 17257 Rw-, Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the esta~di,~/to ~w~ Sworn to and affirmed and subscribed · . ~ - Galen W. Hershey, Jr. ,/' ~' before me this : 6th day of November, 2003 ,~. _ J'~/"LOJ~.,O,.. '"~r~, 7~ ~ .'~ ~ ./~ ~ ~ , Angela R~iling · [ ~nna M Otto,lst ~ utv~ '[f.~ ~ % ~ . ' ' ~Rebecca Hershey ~ DECREE OF REGISTER Cumberland Coun~ Estate of Galen W. Hershey Deceased No. 21-2003-922 also known as Galen W. Hershey, Sr. Social Securi~ No: 19822955~ Date of Death: 10/24/2003 AND NOW, November ~ 6th 2003 , in consideration of the Petition on the reverse side hereon, satisfactou proof having been presented before me, IT IS DECREED that Le~ers ~ Testamentau ~ of Administration (c.ta., d.b.n.c.t; pendente lite; durante absentia; durante minodtate) are hereby granted to Galen W. Hershey, Jr., Angela Railinq, Rebecca Hershey in the above estate and that the instrument(s), if any, dated April 23, 1990 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Donna M. Otto, ls%eg~::~]~-~s / / ' - // Short Certificate(s) ............... $ 16.00 Renunciation .......................... $ Affidavit() ....................... $ Extra Pages (6 ) .............. $ 18.00 Codicil ................................. $ JCP Fee ................................. $ 10.00 Attorney: Joel R. Zullinger Inventory & Tax Forms ............. $ I.D. No: 17516 Other ...................................... $ Address: 14 North Main Street, Suite 200 Chambersburcj PA 17201 TOTAL ............................. $ 310.00 Telephone: (717)264-6029 Mailed Letters to Attorney on 11/06/03 DATE FILED: 11/06/03 RW-TA l05.805 REX,' 9/86 This is to certifi/that the information here given is correctly copied t~rom an original certificate o£ death duly filed with me as Local Registrar. The original certificate will be £orwarded to the State. Vital Records O£fice ~or permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. P ~ 4 5 0 4 3 4 ~-a~~ ~ ~ ..... , No. ~ D~. H105.143 Rev 2/87 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS TV.~..,.. CERTIFICATE OF DEATH IN ST~'E F~LE NUMBER ~ ' ~ , ' ' " · Sh ~ ~ Franklin Chambersbur~ T ......... ~ ~ ~ ~ ,~.~. I~} .... u ,,.. ~ Pennsylvania . ,~.~ Southampton Township 11 Broad St. ,~s,~ ~ ~.~ . ,~ Shippensburg, PA 17257 ~' ~") ~.~ C~berland ~ ~.~ ,a. ~r~er u. aersney ~ Sr. I,~ Lulu G. Nye ~~V,~N' Rallln~ '~E~mS~V~ ~. 1031 Kessler Dr., Shippensburq, PA 17257 ~ ~ .~ ~ - ~ ~ Shippensbur g ~ ~ ..... ~UN[~LS~,V~__~__ // ~,,,. ]0--28--2003 ~,~. Sprinq Hill Cemetery ~,,, C~be . j~, "MEDICALEXAMINE~CO~ONER (llem27)T~mPrint Dr. Imtiaz Khurshid 21-2003-922 ~RZ:cb - April 6, 1990 21-03-qRA LAST WILL AND TESTAMENT I, Galen W. Hershey, of Southampton Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby declare this to be my will, hereby revoking any and all former wills and codicils thereto by me heretofore made. FIRST I direct that all my just debts and funeral expenses, including all expenses of my last illness, shall be paid from my estate as soon as practicable after my decease as a part of the expense of the administration of my estate. SECOND I give, devise and bequeath the residue of my estate of every nature and wherever situate to my wife, Jacqueline R. Hershey, providing she shall survive me by thirty days. THIRD Should my wife predecease me or die on or before the thirtieth day following my death I give, devise and bequeath the residue of my estate of every nature and wherever situate as follows: Page 1 A. My grandmother,s clock made by Galen W. Hershey to my daughter, Rebecca Hershey, provided, however, if my said daughter predeceases me the same shall be distributed to my daughter, Angela Railing. B. My J. Raymond Smith bedroom suite to my daughter, Angela Railing, provided, however, should my said daughter predecease me, said bedroom suite shall be distributed to my daughter, Rebecca Hershey. C. All of my rings, including my wedding and engagement ring, to my daughter, Angela Railing, provided, however, should my said daughter predecease me, my rings shall be distributed to my daughter, Rebecca Hershey. D. My painting which is a reproduction of the blacksmith shop by Currier and Ives which currently hangs above my living room sofa to my daughter, Rebecca Hershey, provided, however, should my said daughter predecease me, distributed to my daughter, Angela this painting shall be Railing. E. All of the residue of my estate of every nature and wherever situate to my children, namely Galen W. Hershey, Jr., Angela Railing and Rebecca Hershey, in equal shares, provided that the share of any child who predeceases me or dies on or before the thirtieth day following my death shall be distributed to said beneficiary,s issue, per stirpes, living on the thirty-first day following my death, and in default of any such then-living issue, such Page 2 share shall be added to the share or shares of my other children. FOURT~ In the event that anyone entitled to a share of my estate should be under the age of twenty-one years at the time for distribution to him or her, I constitute and appoint the Commonwealth National Bank of Shippensburg, Pennsylvania, trustee of any property which passes either under this will or otherwise to said beneficiary. Said trustee shall in the trustee's sole discretion and without order of court, use principal as well as income from time to time as may appear to be necessary for the beneficiary,s welfare, comfort, medical care, recreation, support and education, without responsibility to the beneficiary or to any person taking care of the beneficiary; and the remaining balance in the hands of said trustee shall be distributed to said beneficiary when he or she attains the age of twenty-one years. If such beneficiary dies prior to attaining the age of twenty-one years, said trustee is authorized in the trustee's discretion to pay part or all of his or her funeral expenses and the remaining balance in the hands of said trustee shall be distributed to his or her personal representative. In the event the funds held by the trustee for any beneficiary become in the opinion of the trustee too small for proper and efficient administration, the trustee, in the trustee,s sole discretion, may deposit such funds in a savings account in the name of the beneficiary. Page 3 FIFTH Any fiduciary under this will shall have the following powers in addition to those vested in them by law and by other provisions of my will applicable to all property whether principal or income, including property held for minors, exercisable without Court approval, and effective until actual distribution of all property: A. To retain any and all of the assets of my estate, real or personal, without regard to any principle of diversification of risk. B. To invest in all forms of property including stock, common trust funds and mortgage investment funds without restriction to investments authorized for Pennsylvania fiduciaries as they deem proper, without regard to any principle of diversification of risk. C. To sell at public or private sale, to exchange or to lease for any period of time any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms or conditions as they deem proper. D. To allocate receipts and expenses to principal or income or partly to each as they from time to time think proper. E. To compromise any claim or controversy. F. To distribute in cash or in kind or partly in each. G. To hold property in their names without designation of Page 4 any fiduciary capacity or in the name of a nominee or unregistered. SIX?H I direct that all taxes that may be assessed in consequence of my death of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. SEVENTH I appoint my wife, Jacqueline R. Hershey, as executrix of this my will. Should my wife predecease me, fail to qualify or cease to act, I appoint my children, Galen W. Hershey, Jr., Angela Railing and Rebecca Hershey, as co-executors of this my will. EIGHTH NO bond shall be required of any fiduciary hereunder in any jurisdiction. IN WITNESS WHEREOF, I hereunto set my hand and seal to this my last will and testament, consisting of seven typewritten pages, the first four of which bear my signature in the margin for the purpose of identification this _~_--_'~ day of , 19 . Page 5 Signed, sealed, published and declared by the above-named testator, as and for his last will and testament in our presence, who in his presence, at his request and in the presence of each other have hereunto set our hands as attesting witnesses. We, Galen W. Hershey, ~-~. Z~c/w,,~-~ , and /~6S~ C~.~WK~~6) , the testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn do hereby declare to the undersigned authority that the testator signed and executed the instrument as his last will and that he had signed willingly (or directed another to sign for him), and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testator signed the will as witnesses and to the best of their knowledge, the testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Testator 67 Page 6 Witne~is Subscribed, sworn to and acknowledged before me by the above-named testator and subscribed and sworn to before me by the above-named witnesses thi_s ~3~. day of ~ , 19 ~0 · Notary Public NOTARIAL SD& %~LDA M, S~SE, N~ry Public Shg~pensbu~ Bc.~o, Cumb~r]and Co., Pa. Page 7 Estate of Galen W. Hershey, a/k/a Galen W. Hershey, Sr. Cumberland Coutny CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Galen W. Hershev. a/k/a Gelen W. Hershey, Sr. Date of Death: 10/24/2003 Will No. 2003-00922 Admin. No. 21-03-0922 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 11/14/2003 . Name Address Galen W. Hershey, Jr. 5783 White Church Road Shippensburq PA 17257 Angela Railing 1031 Kessler Drive Shippensburq PA 17257 Rebecca Hershey 98 White House Road Shippensburq PA 17257 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: no exceptions Date: 11/14/2003 Name: Joel R. Zullinqer Address: 14 North Main Street, Suite 200 Chambersburq PA 17201 Telephone(264) - 6029 _ Capacity: Personal Representative X Counsel for Personal ~-.- Representative LAW OFFICES OF ZULLINGER- DAVIS PROFESSIONAL CORPORATION JOEL R. ZULLINGER HAMILTON C. DAVIS 14 North Main Street Dale F. Shughart, Jr. 20 East Burd Street, Suite 6 Suite 200 of counsel P.O. Box 40 Chambersburg, PA 17201 Shippensburg, PA 17257 717-264-6029 717-532-5713 Fax: 717-264-1884 Fax: 717-530-5222 zulngrlaw@earthlink.net davish~cvn.net March 19, 2004 Register of Wills Cumberland County Courthouse Carlisle, PA 17013 Gentlemen: RE: Estate of Galen W. Hershey a/k/a Galen W. Hershey, Sr. In connection with the above estate, enclosed are the following: · Original and one copy of the PA Inheritance Tax Return; · One copy of the Inventory; · Check payable to Register of Wills, Agent in the amount of $3,377.78 for the balance of inheritance tax due; and · Check payable to Register of Wills in the amount of 28.00 for filing fee. Thank you. lo~R~y°urs' /'-- . ., " · Zullinger ~J ffJ Ends. REV-1500 E.X + (8-00) REV-1500 PENNSYLVANIA DEP^RTME T OF REVENUE INHERITANCE TAX RETURN DEPT. 280601 "ARRISBURG. PA17128-060, RESIDENT DECEDENT 2 1-0 3 0 9 2 2 COUNTY CODE YEAR -- NUMBER' DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL SOCIAL SECURITY NUMBER Z Hershey, GalenW.,a/k/aHershe¥,GalenW.,Sr. 1 9 8 - 2 2 - 9 5 5 5 ~ DATE OF DEATH (MM-DD.Year) I DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE I r..) 10/24/2003 11/04/1930 REGISTER OF WILLS III (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FJRST, AND MIDDLE iNITIAL) t""l SOCIAL SECURITY NUMBER ~-"' r~l 1. Odginal Return ~-1 2. Supplemental Return r~ 3. Remainder Return (date of death p~r to t2-13-82) r-'-i O r,'a.o,,.. L._J 4. Limited Estate L.J 4a. Future Interest Compromise (date oldeath attar 12-12-82) r'""l 5. Federal Estate Tax Return Required [ m ~ 6. Decedent Died Testate (A~:ach copy of Will} L._J 7, Decedent Maintained a Living Trust (Attach copy of Trust) 0.~ 8. Total Number of Safe Deposit Boxes O LJ 9, Litigation Proceeds Received L~ 10. spousal Povedy Credit (date of death between 12-31-91 and 1-1-95) [~ 11. Election to tax under Sec. 9113(A) (A~ch Sch O) ~_ ; THIS SECTION MUST BE COMPLy-I ~-D; A[.L cORRESPONDENCE AND CONFIDENTiA~ TAX iNFORMATiON SHOULD BE DIRECTED TO: i ; z NAME uJ COMPLETE MAILING ADDRESS z Joel R. Zullinger 14 North Main Street, Suite 200 o a. FIRM NAME (IfApplicable) ,,,"'Zullinqer-Davis, P.C. o TELEPHONE NUMBER (717)264-6029 Chambersburg ;.2~ ~ , ?~..~ 17201 1. Real Estate (Schedule A) (1) 86,980.09 ! · 2. Stocks and Bonds (Schedule B) (2) 14,426.13 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4, Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 128,866.76 (Schedule E) z ~O 6. Jointly Owned Property (Schedule F) (6) 1,332.37 I..- [~ Separate Billing Requested :::) 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 17,578.03 (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (8) 249,1 83.38 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 18~686.95 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 434.65 11. Total Deductions (total Lines 9 & 10) (11) 19,121.60 12. Net Value of Estate (Line 8 minus Line 11) (12) 230,061.78 13, Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) O, 0(3 made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 230,061.78 SEE INSTRUCTIONS ON REVERSE SIBE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X __ (15) 16. Amount of Line 14 taxable atlineal rate 230,061.78 x .045 (16) 10~352.7R 17. Amount of Line 14 taxable at sibling rate X .12 (17) 18. Amount of Line 14 taxable at collateral rate X .15 (18) 19. Tax Due (19) 10,352.78 Decedent's Complete Address: STREET ADDRESS 11 Broad Street CITY Shippensburg I STATE PA I ziP 17257 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments (1) 10,352.78 A. Spousal Poverty Credit B. Prior Payments 6,626.25 C. Discount 348.75 Total Credits (A + B +C) (2) 6,975.00 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 Page I Line 20 to request a refund (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 3,377.78 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + EA. This is the BALANCE DUE. (ED) 3,377.78 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ........................................ [] [] c. retain a reversionary interest; or ...................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ............................................................. [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................. . ..................... [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a benefic ary des gnat on? 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 peJief, it is true, correct and complete. Dec ara%n of preparer other than the personal representative is based on all information of which preparer has any knowledge. ADDRESS Galen Hershey,'~r.,"~783 White Church Rd., Sl~ppensburg, PA '1~?~-~; A~gela Railing, 1031 Kessler Dr., - Shippensburg, PA 17257; Rebecca Hershey, 98 White House Rd., Shippensbur§ PA 17257 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS 14 North Main Street, Suite 200 Chambersburg PA 17201 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. 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. REV-1502 EX + (6-98) SCHEDULE l ' COMMOI~WEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE Of FILE NUMBER Hershey. Galen W., a/k/~ Hershey, Galen W., Sr. 21 03 0922 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the pdce at which proper'b/would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with ri~]ht of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Gross proceeds from sale of real estate situate at 11 Broad Street, Southampton 86,500.00 Township, Cumberland County, PA, to Robert A. Carbaugh 2. Received on proration of real estate taxes on above sale 480.09 TOTAL (Also enter on line 1, Recapitulation) $ 86,980.0,¢1 (If more space is needed, insert additional sheets of the same size) REV-1503 EX + (6-98) ' ' ~ SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS& BONDS iNHERITANCE TAX RETURN RES,DENY DECEDENT ESTATE OF FILE NUMBER Hershey. Galen W., a/Ida Hershey. Galen W., Sr. 21 03 0922 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. 327 shares common stock Sun Life Financial @31.39 per share 10,264.53 2. 68 shares common stock Prudential Financial @61.20 4,161.60 TOTAL (Also enter on line 2, Recapitulation) $ 14~426.13 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) SCHEDULE E ' COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RES, EN ECE EN¥ PERSONAL PROPERTY ESTATE OF FILE NUMBER .Hershey, Galen W., a/k/a Hershey, Galen W., Sr. 21 03 0922 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. ITEM NUMBER DESCRIPTION VALUE AT DATE 1. Prime Share Account, Patriot Federal Credit OF DEATH Union, including interest accrued to date of death 2,345.15 2. Money Market Account, Patriot Federal Credit Union, including interest accrued to 95,362.58 date of death 3. Draft Account, Patriot Federal Credit Union 4,507.37 4. One Year Certificate, Patriot Federal Credit Union, including interest accrued to 10,672.05 date of death 5. 1999 Subaru Legacy AWD, appraised by Shively Motors, Inc., copy attached 8,925.00 6. Gross proceeds from sale of pesonalty by Carl E. Ocker 5,841.50 7. Refund, Senteniel 4.92 8. Refund, Comcast 12.16 9. SKF, pension check received after death 745.52 10. Refund, State Farm Insuracnce 68.02 11. Refund, Adams Electric 18.75 12. Refund, Leffier, Inc. for fuel oil 146.74 13. Refund, homeowners insurance 217.00 14. TOTAL (Also enter on line 5, Recapitulation) $ 128,866.76 (If more space is needed, insert additional sheets of the same size) REV-1509 EX + (6-98) COMMONWEALTH OF PENNS¥'VAN,A JOINTLY'OWNED PROPERTY 'NHER,TANCE TAX R TURN RESIDENT DECEDENT ESTATE OF FILE NUMBER .Hershey. Galen W., a/~a Hershey. Ga)en W., Sr. 21 03 0922 If an asset was made joint ~thin one year of the decedent's date of death, it must be repoded on 8chedule SURVIVING JOINT TENANT(S) NAME ADDRESS RE~TIONSHIP TO DECEDENT A. Angela 1031 Kessler Drive daughter Shippensburg, PA 17257 c JOINTLY.OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAF DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. A'FFACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTERE~ 1. A. 12/1972 Account #6140-288746, Citizens Bank, including interest 2,664.74 50. 1,332.3; accrued to date of death TOTAL (Aisc enter on line 6, Recapitulation) $ ~lW mnr ...... i .... H~,,.t ~ ........................... 1,332.3 / iai sheets of the same size) REV-1510 EX + (6-98) ~ SCHEDULE O INTER-VIVOS TRANSFERS & · COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURNMISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Hershey, Galen W., a/k/a Hershey, Galen W., Sr. 21 03 0922 This schedule must be completed and filed if the answer to an)' of questions 1 throu~ Ih 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATF % OF DECD'S EXCLUSION TAXABLE NUMBEF THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE, -. VALUE OF ASSET INTEREST (~EA~JCA~LE) VALUE 1. Annuity Acct. #26233575, Transamerica, named beneficiaries 9,531.07 100. 9,531.0; are decedent's children, Galen W. Hershey, Jr., Angela E. Railing and Rebecca G. Hershey 2. Annuity Acct. #073 388 127AB, MetLife, named beneficiaries 8,046.96 100. 8,046.96 are decedent's children, Galen W. Hershey, Jr., Angela E. Railing, and Rebecca G. Hershey TOTAL (Also enter on line 7 Recapitulation) $ 17,578.03 ~1 needed, insert additional sheets of the same size) REV-1511 EX + (12-99) ' COMMO~IWEALTH OF PENNSYLVANIA FUNERAL EXPENSES& INHERITANCE TAX RETURN RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER .Hershey, Galen W., a/k/a Hershev. Galen W., St. 21 03 0922 Debts of decedent must be reported on Schedule ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: AMOUNT 1. Fogelsanger-Bricker Funeral Home, funeral expenses 8,024.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) O. O0 Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. AttomeyFees Joel R. Zullinger 5,000.00 3. Family Exemption: (if decedent's address is not the same as claimant's, attach explanation) Claimant 0.00 Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees probate petition 270.00; short certificates 15.00; extra pages 18.00; JCP 341.00 fee 10.00; filing return 28.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7. Cumberland Law Journal, advertise letters 75.00 8. Carl Ocker, commission on sale of real estate at public sale 1,730.00 9. Carl Ocker, commission and expenses of sale of personalty 2,356.38 10. News-Chronicle, advertise letters 11. C.F.J.MA., sewer service to residence 134.00 12. Adams Electric, utility service to residence 26.00 13. Borough of Shippensburg, water service to residence 53.00 14. Proration of county real estate taxes, sale of residence 31.99 15. 1% realty transfer tax on sale of residence 24.08 16. C.F.J.M.A., final bill for sewer service to residence 865.00 26.50 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 18,686.9b REV-1512 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN RESIDENT DECEDENT MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER _Hershey. Galen W., a/k/a Hershey, Galen W., Sr. 21 03 0922 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. C.F.J.M.A., sewer service to decedent's residence 26.00 2. Adams Electric, utility service to decedent's residence 47.00 3. Sprint, telephone service to decedent's residence 43.02 4. Borough of Shippensburg, water service to decedent's residence 35.98 5. Carlos R. Leffler, Inc., fuel oil to decedent's residence 272.22 6. Chambersburg Imaging, medical services due at death 10.43 TOTAL (Also enter on line 10, Recapitulation) $ 434.6b (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-00~) ~, .,~ SCHEDULE J *COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Hershey, Galen W., a/k/a Hershey, Galen W., Sr. 21 03 0922 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE [. TAXABLE DISTRIBUTIONS [include outdght spousal distributions, and transfers under Sec. 9116 (a)(1.2)] 1. Galen W. Hershey, Jr. son one-third of residue 5783 White Church Road Shippensburg, PA 17257 2. Angela Railing daughter one-third of residue 1031 Kessler Drive Shippensburg, PA 17257 3. Rebecca Hershey daughter one-third of residue 98 White House Road Shippensburg, PA 17257 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 1. 0.00 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. 0.00 TOTAL OF PART [! - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.0(~ (If more space is needed, insert additional sheets of the same size) JRZ:cb - April 6, 1990 LAST WILL AND TESTAMENT I, Galen W. Hershey, of Southampton Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby declare this to be my will, hereby revoking any and all former wills and codicils thereto by me heretofore made. FIRST I direct that all my just debts and funeral expenses, including all expenses of my last illness, shall be paid from my estate as soon as practicable after my decease as a part of the expense of the administration of my estate. SECOND I give, devise and bequeath the residue of my estate of every nature and wherever situate to my wife, Jacqueline R. Hershey, providing she shall survive me by thirty days. THIRD Should my wife predecease me or die on or before the thirtieth day following my death I give, devise and bequeath the residue of my estate of every nature and wherever situate as follows: Page 1 A. My grandmother's clock made by Galen W. Hershey to my daughter, Rebecca Hershey, provided, however, if my said daughter predeceases me the same shall be distributed te my daughter, Angela Railing. B. My J. Raymond Smith bedroom suite to my daughter, Angela Railing, provided, however, should my said daughter predecease me, said bedroom suite shall be distributed to my daughter, Rebecca Hershey. C. Ail of my rings, including my wedding and engagement ring, to my daughter, Angela Railing, provided, however, should my said daughter predecease me, my rings shall be distributed to my daughter, Rebecca Hershey. D. My painting which is a reproduction of the blacksmith shop by Currier and Ives which currently hangs above my living room sofa to my daughter, Rebecca Hershey, provided, however, should my said daughter predecease me, this painting shall be distributed to my daughter, Angela Railing. E. All of the residue of my estate of every nature and my namely Galen W. Hershey, wherever situate to children, Jr., Angela Railing and Rebecca Hershey, in equal shares, k provided that the share of any child who predeceases me or dies on or before the thirtieth day following my death shall be distributed to said beneficiary,s issue, per stirpes, living on the thirty-first day following my death, and in default of any such then-living issue, such Page 2 share shall be added to the share or shares of my other children. FOURTH In the event that anyone entitled to a share cf my estate should be under the age of twenty-one years at the time for distribution to him or her, I constitute and appoint the Commonwealth National Bank of Shippensburg, Pennsylvania, trustee of any property which passes either under this will or otherwise to said beneficiary. Said trustee shall in the trustee's sole discretion and without order of court, use principal as well as income from time to time as may appear to be necessary for the beneficiary's welfare, comfort, medical care recreation, support and education, without responsibility to the beneficiary or to any person taking care of the beneficiary; and the remaining balance in the hands of said trustee shall be distributed to said beneficiary when he or she attains the age of twenty-one years. If such beneficiary dies prior to attaining the age of twenty-one years, said trustee is authorized in the trustee's discretion to pay part or all of his or her funeral expenses and the remaining balance in the hands of said trustee shall be distributed to his or her personal representative. In the event the funds held by the trustee for any beneficiary become in the opinion of the trustee too small for proper and efficient administration, the trustee, in the trustee's sole discretion, may deposit such funds in a savings account in the name of the beneficiary. Page 3 FIFTH Any fiduciary under this will shall have the following powers in addition to those vested in them by law and by other provisions of my will applicable to all property whether principal or income, including property held for minors, exercisable without Court approval, and effective until actual distribution of all property: A. To retain any and all of the assets of my estate, real or personal, without regard to any principle of diversification of risk. B. To invest in all forms of property including stock, common trust funds and mortgage investment funds without restriction to investments authorized for Pennsylvania fiduciaries as they deem proper, without regard to any principle of diversification of risk. C. To sell at public or private sale, to exchange or to lease for any period of time any real or personal property and to give options for sales exchanges or leases, for such prices and upon such terms or conditions as they deem proper. D. To allocate receipts and expenses to principal or income or partly to each as they from time to time think proper. E. To compromise any claim or controversy. F. To distribute in cash or in kind or partly in each. G. To hold property in their names without designation of Page 4 any fiduciary capacity or in the name of a nominee or unregistered. SIXT~ I direct that all taxes that may be assessed in consequence of my death of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. SEVENTH I appoint my wife, Jacqueline R. Hershey, as executrix of this my will. Should my wife predecease me, fail to qualify or cease to act, I appoint my children, Galen W. Hershey, Jr., Angela Railing and Rebecca Hershey, as co-executors of this my will. EIGHTH No bond shall be required of any fiduciary hereunder in any jurisdiction. IN WITNESS WHEREOF, I hereunto set my hand and seal to this my last will and testament, consisting of seven typewritten pages, the first four of which bear my signature in the margin for the purpose of identification this _ ._~_~ day of /~,..:? ~'.~' , 19 y O · Page 5 Signed, sealed, published and declared by the above-named testator, as and for his last will and testament in our presence, who in his presence, at his request and in the presence of each other have hereunto set our hands as attesting witnesses. We, Galen W. Hershey, ,,~~. Z4~Cc x.~X~ , and .-~~ C~. ,~K~0L~:~ , the testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn do hereby declare to the undersigned authority that the testator signed and executed the instrument as his last will and that he had signed willingly (or directed another to sign for him), and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testator signed the will as witnesses and to the best of their knowledge, the testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Testator ,:" Witnes~ .-'/ Page 6 Witne.~s Subscribed. sworn to and acknowledged before me by the above-named testator and subscribed and sworn to before me by the above-named witnesses this-~3~.Y. Notary Public Page 7 OMB NO. 2502-0265 U.S. D"'ZPARTMENT OF HOUSING & URBAN CEVELCPMENT i '~,' F'--A 2 ~FmHA 3 ,'~CCNV UNI'.JS SET'TLEMENT STATEMENT l A'04-00~'~- i 7. LOAN NUMBE~,: ~r :~,~/ =R. E. NAME .ANDACDRESSCFSE=LER: F. NAMEA,NCACCRESS ~CBERT A CARBA, L;Gr-.t GALEN W ~ERSHEY JR. REBECCA "I Broad $!rset HERSHE'/, ANGEL.:,, =,,AILING EXECT. G =ROPER,TV, LOCATiON: ¢H. SET'TLEME~FAGENT: !1E.cad Street ~. $~ ....... ~' 'T_- C;e'~ersburg PA A-1 Abstract Associates. C-.moer:a'.d County Pennsylvania PLACE OF SE'TTLEMENT i Januan/30 2004 I 1800 L;ng!estcwn Rd, S!e 102 I Harriscurg, ~,A 17110-3355 J SUMMARY OF BORROWER'S TRANSACTION K, SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101 Contract Sales Price 86500.00 401, Contract Sales Price 86 50000 !02 Personal Prcpe~ 402. Personal Propert~ 103 Sett!ement Charges to Borrower ~'Line 1400) 1 694.25 403, 404 ';,S5 405 ,4 ¢/ustments For items ,~aid ~z' Seller in advance F-or items Paid ~y Seller ~n ad~/ance 108 C;tv/-own Taxes to Taxes to :67. Count,/Taxes to / Taxes to 13~ School Tax 01,'3%'04 to 07/0!/04 48009 408 School Tax 01/31i04 ~o 07/01/04 !09. , 48009 :i0 409. 11 410. 411. · 412 120 GROSS AMOUNT DUE FROM BORROWER 88r874 34 420. GROSS AMOUNT DUE TO SELLER 86,980 09 200. AMOUNTS PAID BY OR tN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 20! Deccsit or earnest mcney 8.850. 50t Excess Deposit fSee Instructions) 202. Pr;nclpa~ Amount of New Loan(s) 502 Sett!ement Char~es to Seller (Line 1400) 891 203 Existin9 ~oan(s) ta~(en subiec to 204 ' r loan(a) taken subiect to 205 Payoff of first MoO, gage 206 off of second M~ 207 ~osit retained 'seller 8.650.00 208 507 508, '~ ' 509. Ad,'ustm, enta For .'terns Uncacd By Seller Unoaid By Softer 2 !9. Citv,To',vn ~axes to Taxes to 211. County Taxes 0!/01,'04 to 0%31/04 Taxes 0!/01/04 to 01/31/04 2438 212 Scnco~Tax to 512. School Tax 213. to 2!4 513. 2~5, 514 218 515. 217 516 2!~. 517. 518. 2~9. 539. 220. TO T~4L PAID BY/FOR BORRCWER 81874.0~ 520, TOTAL REDUCTION AMOUNT DUE SELLER 9,565.58i 300. CASH AT SETTLEMENT FROM/TO BORROWER: 800. CASH AT SETTLEMENT TO/FROM SELLER: 391 Gross Amount Due Frcm Borrower (Line120) 88,874.34 601 Gross Amount Due To Selfer (Line 420) 86980 09 392 Less Amount ~aic By;For Borrower fLirts 220~ ( 8.67408: 602 Less Seductions Due Seller (LOne 520~ ( 9 565 55 353 CASH( X FROM) ( TO) BORROWER 80 00026 603. CASH ( X TO) (FROM) SELLER 7741451 'The uncersigned hereby acknowledge receipt of a completed copy of pages 1&2 of this statement & any attachments referred to hereto ROBERT A. CARBAUGH .~ GALEN W HERSHEY JR, REBECCa' HERS~Y, ANGELA RAiLINg' EXECT, L. SETTLEMENT CHARGES 700. TCTAL COMM'ISSICN aased on Price $ ~ % 300. ?EMS PAYABLE ~N CONNECT;CN W~TH LOAN 900. ITEMS REQUIRED BY LENDER TO BE PA)D IN ADVANCE 90! interest =rcm to ~ S ,:day { days %) 902 Mc~a~e i~surance :remlum for mcnt~s to 903 Hazarc insurance Premium for years to ~04 1000. RESERVES DEPOSITED WITH LENDER 1001 Hazard )nsurance ~ S per ~CO2 Mc~ga?~nsurance ~ S set 1303 C~7~ow~ Taxes ~ S per 1004 33untv Taxes ~ S per 1005. Schc=i Tax ~ S per ~ S per !007 ,~ S per !308. A~reqate Adtustment ~ S Der 1100. TITLE CHARGES ;~01 Settlement or Ciosin~ Fee to ~C2 Abstract or T~tie Search 103 Tide Examination to t05 Documem :reparation to ZULLiNGE~-DAVIS ~C-POC 1106 No~a~ Fees to ~ ~07 A~tomey's Fees to (includes abcue ,tern numbers. 1108 Tit~e insurance to A-1 Abstract .Associates. Inc Polic' 780 75 finc]ude~ abcve .¢tem numbers. 1 !09. Leqder's Coverage ;1~0 Cwner's Coverage S 86 50000 I ~ 11. E~dorseme~ts 100.300.8 1 A-1 Abstract Associates. Inc i ~ 12 C!osmg Protect{on Letter A-1 Abstract Associates. Inc. 1; 13. Cvermgnt ~Payoffs/Package~ A-1 Abstract Associates. Inc ~4 Tax Rece~¢ts A-I Abstract Associates. lnc 115. 1200. GOVERNMENT RECORDING AND T~NSFER CHARGES 1201 ~e;ordingFees: Deed S 48.50:Modgage S Re~eases S 4850[ "202 '?tv/County Ta~Stamcs: Deed 86500; Mon~a~e ~ 855 00 ~203 State Tax]Stamcs: Revenue Stamps 86500: Motivate I 865 30~ ~204 1205 1300. ADDITIONAL SE~LEMENT CHARGES 1301. S u ¢¢e'~ to 1302. Pest fnsuection ;303 F~NALSEWER to CFJMA 1304 I 2650 1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, S~ction K) 1.694 25~ 891 50 A-1 Abstract Associates Inc. Settlement Agent Big,Charts - Historical Quotes Page 1 of 1 Home Quotes News Industries Markets Hist oric~l fluoles BigRepor~$ JAdvanced Tool~~ This Historical Quotes tool allows you to look up a security's exact closing price. 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All quotes are in local exchange time. ~2¥ ~: ~1.._.? /0, 2~~/5 ~', httP://bigcharts'markctwatch'c°m/hist°rical/dcfault.asp?det¢ct=l&symbol,o~ 2/17/2004 BigCharts - Historical Quotes Page 1 of 1 Experience all the benefits Access to of ®CilSMarketWatch Interactive Charting Home Quotes News Industries Mar~lts Historical Quotes BigReport, ~Advan~ Tool~~ This Histori~l Quotes tool allows you to look up a security's exact dosing price. Simply type in the symbol and a historical date to view a quote and mini chad for that security. ..~} · 5'~' Enter Symbol: JPFA Enter Date: J10/24/2003 ~ Prudential Finl lnc Friday, October 24, 2003 Closing Price: 61.6 Open: 61.16 High: 6~ .6 Low: 60.8 Volume: ~ 33,400 No Splits Go To Cha~ing ~ ~ ~ ~ 2-Month Daily Cha~ of Prudential Finl Inc Sponsored Matches (',,'vl~at are sponsor Matches')) _S_t0 _ck__M_a_r~_t - Find Exclusive Research & Analysis - Get Your Free Stock Report Today! 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SEHK intraday data is provided by Comstock and is at least 60-minutes delayed. All quotes are in local exchange time. http://bigcharts.marketwatch.com/historical/default.asp?detect=l &symbol=PFA&close_da_. 2/18/2004 November 28, 2003 Zullinger - Davis Joel Zullinger 14 North Main Street, Suite 200 Chambersburg, PA 17201 RE: Estate of Galen W. Hershey Account #1470170 Dear Mr. Zullinger: I am writing in response to your request for date of death values on the above referenced member. Account Date of Death Accrued Joint Owner Joint Owner 1470170 Principal Interest to DOD Created Prime Share (00) $2,344.39 $0.76 Angela Railing 4-19-1999 ney Market (20) $95,355.03 $7.55 Angela Railing 4-19-1999 Draft Account (25) $4,507.37 $0.00 Angela Railing 4-19-1999 1 Year Certificate (44) $10,663.63 $8.42 Angela Railing 4-19-1999 If you have any questions with regard to the above balances, or need additional information, please feel free to contact me at 263-4444, extension 4144. Sxncerely, / Dixie Kelley/~ Manager Administrative Services CHRYSLER ~ ~ FIVE STAR 801 Lincoln Way West · Chambersburg, PA 17201 (717) 264-7134 · Fax: (717) 2646122 www. shivelymotors.com / CITIZENS BANK Account Number 6140-288746 Account Title GALEN W HERSHEY o1' ANGELA E RAILING Date Opened 12/I / 1972 Account Type Savings Principal Balance as of DOD $2,664.27 Interest from Last Posting to DOD $ .47 Account Balance as of DOD $2,664.74 YTD Interest to DOD S4.98 Other ........................................................................... Misc~{lan~us (see a~a~ list) .......................... MisceJlan~us (s~ a.a~ed llst) lC?t: "J, (or we), the seffer of goads, me~andise, and/ar pmp~W said at public au~on on ab~e dam and ~ocaTion, ac~now{~ge and a~pt th~s sentient of pr~ds of saJe. I (or we) ag~ ~ ~t MI ~ sponsibiJi~ for pray{ding me~hantabte title to ail g~ds, ~e~andise, and/or p~pe~ said, and ~r Au~ioneer or Cashier's Signamr~ (~/ler s S~nammJ :-~ ZULLINGER - DAVIS ATTN: JOEL ZULLINGER 14 NORTH MAIN ST STE 200 CHAMBERSBURG PA 17201 RE CONTRACT 073 388 127 AB ANNUITANT GALEN HERSHEY SR Dcar Mr Zu!linger Thank you for notifying us of the death of our annuitant. Please relay our sincere condolences to the family on their recent loss. This letter is in response to your letter of November 26, 2003. The beneficiary designation for the contract is Galen W Hershey Jr, Angela E Railing, and Rebecca G Hershey. To process the settlement, we will need the following items: · Completed Claimant's Statement (from each beneficiary) · Claim Election Form and Tax Withholding Form (from each beneficiary) · Contract if available Contract 073 388 127 AB is non-qualified and all monies over the cost basis are considered taxable in the year received. The date of death value as of October 24, 2003 is 88,046.96. The current value is $8,081.90. The cost basis is $ 5,151.10. The interest earned in the contract since inception is $2,930.80. If you have questions, please feel free to call our toll-free number at 1-800-638- 7732. One of our Customer Service Consultants will be happy to assist you. Sincerely Diane Kosechata Annuity Death Claims Unit Annuity Administrative Operations December 2, 2003 '"\ Transamerica Life Insurance and , / Home Office: ! / Charlotte, North Carolina ,~ ~ ~ Administrative Office: · , -' 4333 Edgewood Road NE "~- PO Box 3183 ........ Cedar Rapids, Iowa 52406-3183 November 8, 2003 Rebecca G Hershey c/o Angela E Railing 1031 Kessler Drive Shippensburg PA 17257 RE: Annuity Number(s) 26233575 Dear Rebecca G Hershey: We have received notification, Galen W Hershey, annuitant of the above listed non-qualified tax deferred annuity is deceased. Our office wishes to extend sincere condolences for your loss. Our records indicate the following annuity information: Annuitant: Galen W Hershey Owner: Galen W Hershey Primary Beneficiary(ies): Galen W Hershey Jr Angela E Railing Rebecca G Hershey Annuity Policy Date: 09/10/1999 Full Value as of 11/08/2003: $9,542.65 Taxable Portion: $1,974.11 Full Value as of 10/24/2003: $9,531.07 The attached document reflects the options available to the primary beneficiary(ies) listed above. The full value as of the date of death is for tax purposes only and is not a guaranteed death benefit amount. The attached document contains general tax information based on Transamerica Life Insurance and Annuity Company's interpretation and should not be relied upon for your personal tax planning. If you have questions concerning the direct tax consequences when selecting an option, you may wish to consult a tax advisor. Member of the ~,EGON. Gro.p -, INVENTORY Estate of Hershey, Galen W. No. 21 03 0922 also known as Hershey, Galen W., Sr. Date of Death 10/24/2003 , Deceased Social Security No. 198229555 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 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 made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unswom falsification to authorities. Persone~ Representative: Name of Attorney: Joel R. Zullinger . I.D. No.: 17516 ~ '~//' W,~~,. I - Address: 14 North Main Street, Suite 200 Dated Chambersburg PA 17201 Telephone: (717)264-6029 Description Value Stocks & Bonds 327 shares common stock Sun Life Financial 10,264.53 @31.39 per share 68 shares common stock Prudential Financial 4,161.60 @61.20 Closely-Held Corporation, Partnership or Sole-Proprietorship Mortgages & Notes Receivable ' ..... :~ · Cash, Bank Deposits, & Misc. Personal Property Total (Attach Additional Sheets if necessary) 230,272.98 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 Continuation of Inventory He?shey, Galen W. 21 03 0922 Page 1 Description of Inventory Description Value Prime Share Account, Patriot Federal Credit 2,345.15 Union, including interest accrued to date of death Money Market Account, Patriot Federal Credit 95,362.58 Union, including interest accrued to date of death Draft Account, Patriot Federal Credit Union 4,507.37 One Year Certificate, Patriot Federal Credit 10,672.05 Union, including interest accrued to date of death 1999 Subaru Legacy AWD, appraised by 8,925.00 Shively Motors, Inc., copy attached Gross proceeds from sale of pesonalty by 5,841.50 Carl E. Ocker Refund, Senteniel 4.92 Refund, Comcast 12.16 SKF, pension check received after death 745.52 Refund, State Farm Insuracnce 68.02 Refund, Adams Electric 18.75 Refund, Leffier, Inc. for fuel oil 146.74 Refund, homeowners insurance 217.00 RealEstate Gross proceeds from sale of real estate situate at 11 Mroad Street, Southampton Township, Cumberland County, MA to Robert Carbaug~ 86,500.00 Received on proration of real estate taxes 480.09 Subto~l $ 215~846.85 r.:. ~,vM~ " ' HARRISBURG JOEL R. ZULLINGER, ESQ. 200 Chambersburg Trust Co. Chambersburg, PA 17201 Register of Wills Cumberland County Courthouse Carlisle, PA 17013 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE REV-1162 EX(11-96) BUREAU OF INDIVIDUAL TAXES DEPT. 280604 HARRISBURG, PA ~ 7128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 003773 · ZULLINGER JOEL R 14 NORTH MAIN STREET,SUITE 200 CHAMBERSBURG, PA 17201 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold .'~' 101 $3,377.78 ESTATE INFORMATION: SSN: 198-22-9555 FILE NUMBER: 2103-0922 DECEDENT NAME: HERSHEY GALEN W DATE OF PAYMENT: 04/06/2004 POSTMARK DATE: 04/05/2004 COUNTY: CUMBERLAND DATE OF DEATH: 10/24/2003 .:~ TOTAL AMOUNT PAID' $3,377.78 REMARKS: '"': ' CHECK# 1010 ~- INITIALS: JA ..... SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS CONNONNEALTH OF PENNSYLVANIA BUREAU OF ZNDZVZDUAL TAXES DEPARTNENT OF REVENUE ZNHERITANCE TAX DZVISION DEPT. Z80601 HARRISBURG, PA 17118-0601 NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLO#ANCE OR DTSALLO#ANCE OF DEDUCTZONS AND ASSESSHENT OF TAX ~_~.~ DATE 05-2~-Z004 ESTATE OF HERSHEY GALEN DATE OF DEATH FZLE NUNSER 21 05-0922 JOEL R ZULLINGER '04 ?i!i~ 24 L S :{~4 COUNTY CUHBERLAND ACN 101 ZULLINGER DAVIS Amoun* Remi*~ed 14 N HAIN ST STE 200 r CHAHBERSBURG PA 17~*~iL HAKE CHECK PAYABLE AND REHZT PAYNENT TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 1701~ CUT ALONG THZS LZNE I~ RETAZN LONER PORTZON FOR YOUR RECORDS REV-Z547 EX AFP (01-03} NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLONANCE OR DZSALLONANCE OF DEDUCTZONS AND ASSESSHENT OF TAX ESTATE OF HERSHEY GALEN NFZLE NO. 21 03-0922 ACN 101 DATE 05-24-2004 TAX RETURN NAS: { X) ACCEPTED AS FZLED ( ) CHANGED RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Es~a~e (Schedule A) (1) 86/980 09 NOTE: To insure proper 2. S~ocks end Bonds (Schedule B) (2) 14/426 15 cradi~ ~o your account, $. Closely Held S~ock/Par*nership Tn~eres~ (Schedule C) ($) O0 submi~ the upper pop,/on ~. Hor~gages/No~as Rece/vabla (Schedule D) (~) O0 of *hls form with your S. Cash/Bank Deposi~s/Hisc. Personal Proper~y (Schedule E) (5) 128/866.76 ~ax payment. 6. Jointly Owned Proper~y (Schedule F) (6) 1/$$2 $7 7. Transfers (Schedule G) (7) 17/578.05 8. To~al Asse~s (8) 249,185.$8 APPROVED DEDUCTZONS AND EXEHPTZONS: 18,686.95 9. Funeral Expenses/Adm. Cos~s/Hisc. Expenses (Schedule H) (9) 10. Debis/Horigaga Liabilities/Liens (Schedule Z) (10) 12. Ne~ Value of Tax Re*urn (12) 230,061.78 15. Chari~abla/Governmen*al Bequests; Non-elac~ad 9113 Trus*s (Schedule J) (13) .00 lq. Ne* Value of Es~a~a Sub~ec~ ~o Tax (lq) 250,061.78 NOTE: Zf an assessment was issued previously, lines 1~, 15 and/or 16, 17, 18 and 19 reflect f/gures that include the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Amoun~ of Line lq a~ Spousal ra~e (15) .00 X O0 = .00 16. Amoun* of Line 1~ ~axabla a~ Lineal/Class A ra~a (16) 250,061.78 x 045 = 10,$52.78 17. Amoun~ of Line lq a* Sibling ra~a (17) .00 X 1~ = .00 18. Amount of Line 1~ taxable at Collateral/Class B rata (18) .00 X 15 = .00 19. Principal Tax Due (19)= 10,$52.78 TAX CREDZTS: PAYH~NT REC~ZPT DZSCOUNT (+) DATE NUHBER TNTEREST/PEN PATD (-) AHOUNT PATD 01-16-2004 CD005455 $48.75 6,626.25 0~-05-2004 CD005775 .00 $,~77.78 TOTAL TAX CREDZT 10,352.78 BALANCE OF TAX DUEI . O0 ZNTEREST AND PEN. . O0 TOTAL DUE . O0 TF PAID AFTER DATE TNDZCATED, SEE REVERSE ( TF TOTAL DUE TS LESS THAN $1, NO PAYHENT TS RE;)UTRED. FOR CALCULAT/ON OF ADDTT/ONAL TNTEREST. TF TOTAL DUE TS REFLECTED AS A "CREDTT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE STDE OF THTS FORH FOR TNSTRUCT/ONS.) RESERVATION: Estates of decedents dying on or before December II, 198Z -- 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 Commanmaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the laaful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfitl the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (7Z P.S. Section 9140). PAYNENT: Detach the top portion of this Notice and submit Hith 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 credit, Hhich Nas not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). 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 ansHering service for fores ordering: X-aOO-56Z-ZO50; services for taxpayers Nith special hearing and / or speaking needs: 1-BOO-447-30zg (TT only). OBJECTIONS: Any party in interest not satisfied Hith the appraisement, alloHance, or disalloNence of deductions, or assessment of tax (including discount or interest) as shoHn on this Notice must object Hithin sixty (60) days of receipt of this Notice by: --~ritten protest to the PA Department of Revenue, Board of Appeals, Dept. ZB1021, Harrisburg, PA 171Ia-lOll, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in Hriting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Asssssmant RsviaH Unit, Dspt. Ia0601, Harrisburg, PA l?lZa-0601 Phone (717) 787-~50S. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Residsnt Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid Nithin three (3) calendar months after the decedant's death, a five percent (SI) discount of the tax paid is allaNed. 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. This non-participation penalty is appealable in the same manner and in the the same tiaa period as you Hould appeal tho tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning Hith first day of delinquencY, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes Hhich became delinquent before January 1, 1982 bear interest at the rate of six (6Z) percent par annum calculated at a daily rate of .000164. A11 taxes Hhich became delinquent on and after January 1, 19BI Hill bear interest at a rate ~hich Hill vary from calendar year to calendar year Hith 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 Rata Factor Year Rate Factor Year Rate Factor ~ ZOZ .00054~ ~Y~'~-1991 XXZ .000301 ~ 9X .O00Z~7 1983 16Z .0004~8 1992 9Z .000247 2002 6Z .000164 1984 llZ .000~01 1993-1994 7Z .000192 2003 5Z .0001~7 1985 13Z .000356 1995-199B 92 .000247 2004 42 .o00110 1986 IOZ .000Z74 1999 7Z .goo19z 1987 XOZ .000274 ZOOO 7Z .OOOXgZ --Interest is calculated as folloHs: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY XNTBREST FACTOR --Any Notice issued after the tax becomes delinquent Hill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation data shoNn on the Notice, additional interest must be calculated.