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Home My WebLink About03-0895PETITION FOR PROBATE and GRANT OF LETTERS Estate of ~¢. ,e~.g R. I~ ps) m 5 No. also known as To: Register of Wills for the County of ~.'6,~, _a~-~ ~ n,~ ~0 Commonwealth of Pennsylvania in the Deceased. Social Security No. ~'¥ ci ' '~¢ '° ff. lO g The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executtrR_ in the last wilt of the above decedent, dated and codicil(s) dated named ~v,og' 9-1 ,19_fl ~ (state relevant circnmstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in C.'o ,~, O'e~a a,-,~O County, Pennsylvania, with h t_¢ last'family or principal residence at (list street, number and muncipality) Decendent, then ~ years of age, died Oc.?- ~2. o .,~,f , at 14o t'ht~ S r' tc~ ~e~.. I~wc., Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters y'//$'t,n,'~ e~ ,-r~ ~. y (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and true%administer the estate according to law. Sworn to or affirmed and subscribed befo-r~e me this ~ ~-'~/ dayof Estate Of , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated described therein be~xl~nitted to probate and filed of record as the last will of and Letters"~-~"T~ v-~---~-:la are hereby granted to 0 k~t:~a.! ~ ~-.~. --~ff3 ~r~.% ~0'~:~ in consideration of the petition on FEES Probate, Letters, Etc .......... Short~¢.ertificates( ) .......... ation ................ Filed TOTAL ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 ~ P 9640867 O~ Date Local ~e~istrar COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH '. ~-.F.~O~z~ R Adams I: MaeI: 549-- 36 -2106 , 85 .. ~ { : }Feb23 1918 { Highland Fall, ~ew.{,___~ ~_ ~ ~ .~__ ;2 _ , : ~ { 1.. 1. ~OFK{~. i~ ~ .~ ,s~,~ W . ~ ~ ~.~.~.. ;s~ . Montgomery ~ yncote M Hopkins Center ~.~.~o.~.... White E--i-,~-, ~--~'~"~, ] Federal Government ] ~ ~ ~ Q ~ ~ ,~ ... ~ ,,.. .~ ........ ~ ........ I,,~ I, I,, '" 12 I ~ ~" I,, Wlooweo ttuz oycamore ~ve. I.~ ' , Elkins Park, Pennsylvania 19027 ~ Mont oma ~ ' ~ ~ " ..... ,,. Robe~ Ad~ms {,mmt.'s.~t{~,..~~, .Juliet Orans ~. Ghat{es J. Adams ~. 7702 Sycamore Ave. E{kins Park, Pa ~9027 I I ~ O Oct 2a, ~,,. / / ~ . . ., Rollin~ Green Memorial Park ,,~ Camp Hill Pa 170~ ~'"'~<~;.-~ ~ ~ ~. FD-014318-L ~. Myers Funeral Home, Inc. 37 East Main Street Mechanicsburg, Pa 17055 ...... ........... ~ ~..~:'~-~" ~---. I'°~' ..... ...................... ' ,F'~ ' ..o '" ~ Ir t " "r ' O ~. O ~ . O ~,.~,~ O ~' ' LAST WILL AND TESTAMENT OF GEORGE R. Alla2zM I, GEORGE R. Ai1AMM, of the Township of Hampden, County of Cun- berland and State of Pennsylvania, being of sound and disposing mind, mmnory and understanding, do make, publish and declare this my Last Will and Testament. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same may conveniently be done. I give and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever nature and wheresoever the same may be situate, to my wife, ~.F~N R. AI1A2vM, absolutely and uncondi- tionally. In the event that my wife, H~F~N R. ADAFM, should predecease me, or should she die at about the same time as I do, such as in an acci- dent c~mon to both of us, then in such event, I give, devise and bequeath my entire estate, real, personal and mixed, whatsoever and wheresoever situate, to my two sons, to wit, ROBERT G. ADA~S and CHARLES J. ADAMS, share and share alike, per stirpes. LASTLY, I nominate, constitute and appoint my wife, ~.~N R. -1- ADAPt, Executrix of this, my Last Will and Testament, and in the event that she should predecease me, or should she be unable or unwilling to serve in such capacity for any reason, then I nominate, constitute and appoint my son, CHARLES J. ADAMS, to be the Executor in her place and stead, and if my said son, CHARLES J. ADAMS, should also predecease me or be unable or unwilling to serve in this capacity, then I nominate, constitute and appoint my son, ROBERT G. ADAMS, to be the Executor of this, my Last Will and Testament, in his place and stead. IN WITNESS WHEREOF, I have hereunto set my band and seal this day of June, A. D. 1988. George R. Adams (sggn) Signed, sealed, published and declared by the above-named G~OR~E R. ADAMS, as and for his Last Will and Testament, in the presence of us, who, at his request and in his presence, and in the presence of each other, have hereunto subscribed our names as witnesses. -2- OF VANIA) )SS: OOUNTYOF cem , ) I, GEDRG~ R. Alla2w~ , ~e t~or , ~se ~ ~ si~d ~ ~e a=~d or for~o~ ~~=, ~ ~ ~ly ~ied accor~ ~ ~, ~ h~eby ac~le~e ~ I s~ed ~ ~ted ~ ~~~ ~ ~ ~= W~I ~ T~~; ~ I s~ it ~l~ly; ~ ~ I s~ i~ as ~ ~ee ~ ~1~~ act ~d d~d f~ ~e ~s~ ~a~ ~ressed. ~ ~ ~f~ ~ ~ ac~le~ b~ore ~, ~ 21st ~y of · ,l~e , A. D., 1988 · V ?ALIH OF PENNSYLVANIA) We, the undersigned, MARTT.VN WAY FAWTN )SS: ) My Commiss~ Expires: September 21, 1991 (SEAL) J. ROBERT STAUFFER and , the witnesses whose names are signed to the attachmd or foregoing irm~xnent, being duly cp~!ified according to law, do depose and say that we were present and saw the testatDr , GEORGE R. ADAMS, sign and ex, cute the instzument as his/h~ Last Will and Testament; that the said tastatpr , GEORGE R. ADAMS ., s~ned the same willingly and t_hat the said GEORGE ~, AI~ , executed it as his/~ free and v~lun~y act for the purposes therein expressed; that each of us, in the b~mring and sight of the testator , signed the Will as witnesses; and that to the best of our knowledge the testat or , was, at the tinm, 18 or m~re y~mvs of age; of sound m~nd; and under r~ constraint, duress or ur~luence. ~w~rn and subscribed to before ma ~s 21~t day of June , 19 88 . _ ~tary P6blic My Ccn~ssion F_xTires: September 21, 1991 LAST WILL AND TESTAMENT OF GEORGE R. ADAMS j. ROBERT STAUFFER ATTOP,.NI~Y AT LAW MAI~K.~T SQU/~.It.I~ BUILDINC MECHANICSBURG, PA. 17055 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: ~-~' ~-V/~ (_t.r- ~. /cjff/~ ,~ ~ Date of neath: To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on /,,,,~¢ O ,L / o 23 : Name Address fio~i, rev ~ ~d~r, $'; 3 3.3 t 5u;.ae_ ,oc, L Notice has now been given t.o all'persons entitled thereto under Rule 5.6(a) except Date: Signature Name C/Jlqg ted .. T. Address 7 7~ 5'~C~ Telephone (~: 75Z Z Capacity: ~ 'Personam Representative Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-O601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003790 ADAMS CHARLES J 7702 SYCAMORE AVE ELKINS PARK, PA 19027 ........ fold ESTATE INFORMATION: SSN: 549-36-2106 FILE NUMBER: 2103-0895 DECEDENT NAME: ADAMS GEORGE R DATE OF PAYMENT: 04/08/2004 POSTMARK DATE: 04/05/2004 COUNTY: CUMBERLAND DATE OF DEATH: 10/20/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 04104901 $31.17 REMARKS: TOTAL AMOUNT PAID: $31.17 SEAL CHECK# 2360 INITIALS' JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMNONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z80601 HARRISBURG, PA 171Z8-0601 R£V-1S~i$ EX AFP INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 03-0895 ACN 0ql0q901 DATE 02-12-200q ROBERT ADAMS $851SURFRIDER LN LAS VEGAS NV 89110 MST. OF GEORGE R ADAMS ::~.S. HO. 5q9-$6-2106 DATE OF DEATH 10-20-2005 'C)~ APR -8 P2.C~NTY CUMBERLAND TYPE OF ACCOUNT []SAVINGS E~CHECKING [-]TRUST []CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF NILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 has provided the Department with the information listed below which has been used in tax due. Their records indicate that at the death of the above decedent, you mere a joint omner/beneficiary of is account If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This ~ccount is taxable in accordance with the Tnheritance Tax Laws of the Commonwealth of Pennsylvania. guastions may bo answered by calling R717) 787-83Z7. COMPLETE PART 1 BELON x x # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5706-00 Date 01-25-1987 Established Account Balance q, 155.79 Percent Taxable X 16. 667 Amount Subject to Tax 692.65 Tax Rata X . 0~'5 Potential Tax Due $1.17 To insure proper credit to your account, two (Z) copies of this notice must accompany your payment to the Register of Nills. Make check payable to: "Register of Nills, Agent". NOTE: If tax payments are made within three (3) months of the decedent's date of death, you may deduct a 5Z discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. PART TAXPAYER RESPONSE A. [] Tha above information and rex due is correct, 1. You may choose to remit payment to the Register of Nills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of CHECK ~ ~iXls and an official assessment will be issued by the PA Department of Revenue. ONE BLOCK J B. [] The above asset has been or will be reported and tax paid with the Pennsylvania TnherJtance Tax return ONLY to be filed by the decedent's representative. C. [] The above information is incorrect and/or debts and deductions were paid by you. You must complete PART [] and/or PART [] below. PART Tf you indicate a different tax rate2 please state your relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS PART ~~ ~ sC ~'~ DEBTS AND DEDUCTIONS CLAIMED ' " . ~-~.- , ..OUNT DATE PAID ION i~'qJr PAID TOTAL (Enter on L[ne$ of Tax Computation) $ r ~ .... ~_~------~---/Jl~e. Ile_~e. nal r3ury, I daclare~....+Jam~"~l;.~facts T have reported abov, are true, correct and ~0,~ ~AY~,3~_AT~ TELEPHONE NUMBER DATE L/NE 1. Data Established 1 2. Account Balance 2 $. Percent Taxable $ ~ ~. Amount Subject to Tax ~ $. Debts and Deductions $. - 6. Amount Taxable 6 7. Tax Rate 7 ~ 8. Tax Due 8. 3831 Surfrider Ln. Monday, April 5, 2004 702.452.0856 Register of Wills Cumberland Co. Court House Carlilsle, PA 17013 A checks enclosed. Maybe you can answer a few questions. I had asked the same questions in a letter to the Dept. of Revenue. An envelope with their address on it was sent with the att'd. They highlighted a stuff, signed it & returned it. I don't have a 1099 on this. I assume Members 1st FCU is in Cumberland Co,, in PA. Can you narrow that down a little more. Your reply would be appreciated. Law Offices of Craig A. Diehl 3464 Trindle Road Camp Hill, Pennsylvania 17011-4436 Telephone (717) 763-7613 Telecopier (717) 763-8293 Craig A. Diehl, Esquire, C.RA. Linda A. Clotfelter, Esquire In Spring Grove, Pennsylvania 119 West Hanover Street Spring Grove, PA 17362 Telephone: (717) 225-1929 April 27, 2004 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Dear Representative: Estate of George Adams~ No. 21-03-895 ~.~ Please find enclosed for filing an original and two copies of a Claim Against Decedent's Estate on behalf of Cedar CliffLP. I have also enclosed a check in the amount of $5.00 for the filing fee. Kindly return the time-stamped copies of the Claim and a receipt for the filing fee to our Camp Hill office in the envelope provided. Thank you for your attention to this matter. /her Enclosures Sincerely, ~ussen Legal Assistant cc: Charles J. Adams, Executor IN THE ORPHANS' COURT OF CUMBERLAND COUNTY, PENNSYLVANIA IN THE ESTATE OF: : ESTATE NO. 21-03-895 GEORGE ADAMS, : Deceased : DATE OF DEATH: October 20, 2003 CLAIM AGAINST DECEDENT'S ESTATE The Claimant certifies that there is due and owing by the Estate of George Adams, deceased. In accordance with the attached statement of account, the sum of $2,072.16, together with interest at the rate of six percent from March 15, 2004 until paid. On behalf of the Claimant, I do solemnly declare and affirm under the penalties of perjury that the information and representations made herein are tree and correct to the best of my knowledge, information and belief. Claimant: Cedar Cliff LP 2555 Kingston Road, Suite 180 York, PA 17402 Phone (717) 757-4036 LAW OFFICES OF CRAIG A. DIEHL Dated: April 27, 2004 By: Craig A/~Diehl, Esquire Attorney ID No. 52801 3464 Trindle Road Camp Hill, PA 1701t~4436 (717) 763-7613 Counsel for Claimant 04/~6/2884 18:15 7177575812 PENN STATE INV GROUP PAGE 82 CEDA~ CLIFF LP 2555 KINGSTON RD SUITE 180 YORK, PA 17402 Voice: 717-757-4036 Fax: 717-757-5012 Statement Statement D~te: Apr 5, 2004 Customer Accou~ ID: STUDIO Accoum Of: STUDIO DEGEORJ ATTN: GEORGE ADAMS 1104 CARLISLE RD CAMP HILL, PA 17011 Amount Enclosed Date 10/1/03 1/1/04 /14/04 /14/04 /J./04 !3/9/04 319/04 3/9/04 3/10/04 Due D~e 10/6/03 ~/6/o4 L/19/04 L/19/04 3/6/04 3/14/04 3/14/04 /14/04 /15/04 Reference :70 ~55 76 91 :003CAM-5 ;43 71 84 D~ril~iOn Amount 398.57 1,828.'57 60.2E 51.3C -466.48 47.52 48.1~ 44.1-= 60.0S To~i Balance 398.57 2,Z27.14 2,287.4 2,338.7 1,872.2 1,919.74 1,967.92 2,012.07 2,072.16 0 - 30 31 - 60 61 - 90 -Z66.54 0.00 1,940.13 Over 90 days 398.57 IN THE ORPHANS' COURT OF CUMBERLAND COUNTY, PENNSYLVANIA IN THE ESTATE OF: GEORGE ADAMS, Deceased ESTATE NO. 21-03-895 DATE OF DEATH: October 20, 2003 CERTIFICATE OF SERVICE AND NOW, this 27th day of April, 2004, the undersigned hereby certifies that a true and correct copy of the foregoing CLAIM AGAINST DECEDENT'S ESTATE was served upon the following parties by way of United States first class mail, postage prepaid, addressed as follows: Charles J. Adams, Executor 7702 Sycamore Avenue Elkins Park, PA 19027 LAW OFFICES OF CRAIG A. DIEHL ~e~e~"E.~as~-s-sen, 3464 Trindle Road Camp Hill, PA 17011-4436 (717) 763-7613 Legal Assistant Rbbert Adams _3831 Sudrider In. ,~- Las Ye~as, NV 89110-3031 Fa r F;u: ;\w IN THE ORPHANS' COURT OF CUMBERLAND COUNTY, PENNSYLVANIA IN THE ESTATE OF: : ESTATE NO. 21-03-895 GEORGE ADAMS, : Deceased : DATE OF DEATH: October 20, 2003 WITHDRAWAL OF CLAIM AGAINST DECEDENT'S ESTATE TO THE CLERK OF THE ORPHANS' COURT: Kindly withdraw the claim filed on behalf of Cedar Cliff LP in the above-captioned estate. LAW OFFICES OF CRAIG A. DIEHL Dated: June 10, 2004 By: Craig A.{]Diehl, ~s-q~ire Attorney ID No. 52801 3464 Trindle Road Camp Hill, PA 17011-4436 (717) 763-7613 Counsel for Cedar Cliff LP IN THE ORPHANS' COURT OF CUMBERLAND COUNTY, PENNSYLVANIA IN THE ESTATE OF: : ESTATE NO. 21-03-895 GEORGE ADAMS, : Deceased : DATE OF DEATH: October 20, 2003 CERTIFICATE OF SERVICE AND NOW, this I ] ~ day of June, 2004, the undersigned hereby certifies that a true and correct copy of the foregoing WITHDRAWAL OF CLAIM AGAINST DECEDENT'S ESTATE was served upon the following parties by way of United States first class mail, postage prepaid, addressed as follows: Charles J. Adams, Executor 7702 Sycamore Avenue Elkins Park, PA 19027 LAW OFFICES OF CRAIG A. DIEHL Helen E. Rasmussen, Legal Assistant 3464 Trindle Road Camp Hill, PA 17011-4436 (717) 763-7613 ~,, COMMONWEALTH OF ~ ,,~,' ~ PENNSYLVANIA l~¢.d'~"~.'?~ ~,_J'N~'~ DEPT. 280601 '~J~A~"~,,~'~ HARRISBURG, PA 17128-0601 REV-1500 iNHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 2. SOCIAL SECURITY NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) _ _ ~/~ ~' CATE OF DEATH (MM-DD-YEAR) D~E OF BIRTH (MM-DD-~EAR THIS RETURN MUST BE FILEC iN DUPLICATE WITH THE / / / ~ ~ ,> ~ ~ ~ .~ ~ ~/ i ~ / ~ REGISTER OF WILLS ~ABLE) S~RVIVING SPOUSE'S NAME (LAST, FIR~ I, AND MIDDLE iNITIAL) SOCIAL SECURITY NUMBER _ UJ ~oo 0 0 LU --~1. Odghlal Return [] 2. Supplemental Return [] 3. Remainder Return idate [] 4. Limited Estate ~ 4a. Future Interest Compromise (date ol death alter 12-12-82) [] 5, Federal Estate Tax Return Required ~ 6 Decedent Died Testate (Atm:h ;;py ~ Will) ~ 7 Oeceden~ Maintained a Living Trust (Altach ~py of Trust) ~ 8 Tolal Number of Sa(e Deposit Boxes ~ 9. Litigation Proceeds Received ~ 10. Spousal Povedy Credit (dam ofdeam be~veer~ 12-31 91 a.d I 1-95) ~ 11. Bection to tax under Sec. 9113(A) (A,~ch Sd~ O) THIS SECTION MUST BE C ~ - ~ [ COMPLETE M~LING ADDRESS TELEPDONE NUMBER (1) ~/0~~'~ 1. Heal Estate (Schedule A) 2. Stocks and Bo.ds (Schedub B) (2) 3 Closely Held Corporation, Partnersbip or Sole-Proprietorslgp (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 6. Jointly Owned Property (Schedule F) (6) [] Separate Billing Requested 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8, Total Gross Assets (total Lines 1 9 Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12 Net Value of Estate (Line 8 minus Line lt) 13, Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has eot been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (8) (14) / 7 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line t4 taxable at the spousal tax rate, or transfers under Sec 91t6 (a)(1.2) 16 Amount of Line 14 taxable at lineal rate 17. Arllount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due (19) > · BE SURE TC COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENTDECEOENT SCHEDULE B STOCKS& BONDS /03 - ESTATE OF All property jointly-ovmed wfth rigM of su~ivorship must be disclosed on Schedule F. FILE NUMBER ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH fiq C/ ~O.P L /~r'rgR TOTAL (Also enter on line 2, Recapitulation) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Include the pm~s of I~ation and ~e date the pr~eds were ~iv~ by the estate. All prope~ ~in~ed ~ the r~ht of suwivo~hip must ~ disclos~ on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF D~TH 1. ,./ TOTAL (Also enter on line 5, Recapitulation) 07/15/2004 10:20 717-772-04i2 PA INHERITANCE TA~ PAGE 02/02 ESTATE ~ ~L~ NUM~ JOINTLY-OWNE~ PROPERTY: TOTAL (AIso,~nter Ce line 6, ReCal~lul,.lion (if m~'e .P~e is re~, i~r,e~ a~ditimal s fl ee~ ~ +~"~/'~'~'~'~-~ amc size) COMMONWFJ~LTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEBULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER This schedule must ~ ~mpleted and filed ~ ~e answer to any of questions I through 4 o~ ~e revere side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY % OF ITEM ~NCLUDE THE NAME OF THE TRANSFEREE' THEIR RELATIONSHIP TO DECEDENT ~qD THE DATE OF T~NSFER DATE OF DEATH DECD'S EXCLUSION TA~BLE VALU[ NUMBER VALUE OF ASSET INTEREST {IF APPLIC~E) ct~c~ F~ ~'1/,~,, ~'~/~j~[ ~1/,~ o Z,'~ ~ ~o~ ~ ~pn~ ~'~'~ ~ll, OO~ o ~oo ~oo~. O~ Ge~ ~. ~0~ ~ TOTAL (Also enter on line 7, R~apitulation) $ / ~ ~, ~ ~ ~, ~ V (if more space is needed, insert additional sheets of the same size) SCHEDULE H COMMONWEAL]H OF PENNSYLVAN'A FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. 1. FUNERAL EXPENSES: ADMINISTRATIVE COSTS: Personal Representative's Commissions NameoiFersonaIRepmsentative(s) .~/f/~l,Z~-.'r.~ .~ Social Secudly Number(s) / EIN Number of Femonal Representative(s) J ~ ~ S[reetAddress 7 70 ~ ~ ~' C~' ~-~ ~'l ~ ~ State ~ Year(s)CommissbnPaJd: "¢~ '~2 Z V .J Altorney Fees Family Exemption: (If decedent's address is not the same as claimant's, a~ach explanation) Claimant Cif~ fl ~j' ~ ~ J Street Address 77~ 5' y~l,~,~ ~ Ci~ ~L~ State ~ Relationship o[ Cbimant to Decedent --~ ~ ~ Fees ~ ~ O. Probate Zip J~z',2. 7 Accountant'sFees $ ,.~-/ (~ . Tax Return Preparer's Fees · TOTAL (Also enter on line 9, Recapitulation $ I C;]'/ / 0 4~', 7 ~ (If more space is needed, insert additional sheets of the same size) 07/i5/208~ 15:37 717-772-0412 PA INHERITANCE TA~ SCHIDULE I DEBTS OF DECEDENT, PAGE 81/01 ITEM N~NISER OE$CRIPTION REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER ~L:'o~c~.- ~, f'-'qz~j "~ lO3 - o~' ~- RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(e) OF ESTATE I 1. I1 1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 91t6 (a) (1.2)l '3 ;73 i ~'~o,.-/t LAs v'~(,-/~ /v~, ~?/io ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART ]I - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) his is to certify that the information here given is correctly copied from 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. L Fee for this certificate, $2.00 P 9640857 No. ~egistrar - D~tc COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAl. RECORDS CERTIFICATE OF DEATH ams ,, Male ,. 549-- 36 -2106 .~X'tL~kx'W ~[l~ ~]~ Wyncote ~. Hopkins Center ,~,~..~ ~ ~' White Equiptment Specialist Federal Government 7702 Sycamore Ave. ~.c~ Elkins Park, Pennsylvania 19027 Robert Adams Chades J. Adams ,~ c~,,~ Montgomery ""'~" ,,.~,=~,~,..~ Elkins Park Juliet Crans Pa. 19027 Oct 23, 2003 Rolling Green Memorial Park ,,., Camp Hill, Pa. 17011 FD*014318-L Myet~ Funeral Home, Inc. 37 Ea$1 Main Slreet Mechanicsbu~g, Ps ~7055 PNCBAN( July 7, 2004 Charles J Adams 7702 Sycamore Ave. Elkins Park, PA 19027-1026 RE: Estate of George R Adams (Deceased) SSN: 549-36-2106 DOD: 10-20-2003 Dear Mr. Adams: scp In response to your request for Date of Death balances for the customer noted above, our records show the following: Established 06-26-2001 Established 08-25-2000 Established 08-25-2000 Certificate of Deposit Account #31900212419 GEORGE R ADAMS DOD balance: $5,759.53 + $87.86 accrued interest Checking Account Account #5003215704 GEORGE R ADAMS DOD balance: $21,527.35 + $0.00 accrued interest Savings Account Account 5002037934 GEORGE R ADAMS DOD balance: $6,351.83 + $0.26 accrued interest Page 1 of 2 Please note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not process any financial transactions or provide statements. If you need assistance with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch of~ce. Sincerely, Erica L Schlegel 1-800-762-1775 P7-PFSC-04-F 500 First Ave. Pittsburgh PA 15219 Member FDIC Page 2 of 2 st MEMBERS FEDERAL CREDIT UN~ON REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 5706 -00 01/23/1987 $4,153.63 $2.16 $4,155.79 Robert S. Adams Charles Adams 03/22/1989 5706 -11 11/30/1999 $6,031.24 $.78 $6,032.02 None Insurance Supervisor June 30, 2004 Estate of: GEORGE R. ADAMS Date of Death: 10/20/2003 Social Security Number: 549-36-2106 5000 Louise Drive · EO. Box 40 · Mechamicsburg, Pennsylvania 17055 · (717)697-i161 ° w~vw. metnberslst.org Essex Corporation 275 GATEWAY ROAD WEST NAPA, CA 94550 (707) 258-5000 July 7, 2004 ESTATE OF GEORGE R. ADAMS CHARLES J. ADAMS ADMINISTRATOR 7702 SYCAMORE AVE ELKINS PARK PA 19027-1026 Ref: Date of Death Value for Account Number 5ER-039707 George R. Adams Deceased The following is the date of death value as of October 20, 2003 for George R. Adams' Brokerage account, 5ER-039707: Fund Symbol: OMSBX Number of Shares: 133.276 Price Per Share as of 10-20-03: Value: 30.05 $ 4,004.94 QGRBX 361.312 15.54 $ 5,614.79 Total Value of Mutual Funds Less Debit Balance Total Value of Account $ 9,619.73 $18.55 $ 97601.18 Operations Manager Essex Corporation ABINGTON BANK since 1867 Estate of: George R. Adams Date of Death: October 20, 2003 Account Number Type of Account Name(s) on Account Date Opened Date Made Joint (if applicable) Balance to Date of Death Including Accrued Interest Current Year Interest Earned to Date of Death for Income Tax (1099) 0280613217 Money Market George R. Adams Trust Robert G & Charles Adams Ttees September 19, 2003 $90,042.56 $42.56 0.00 Account Number Type of Account Name(s) on Account Date Opened Date Made Joint (if applicable) Balance to Date of Death Including Accrued Interest Current Year Interest Earned to Date of Death for Income Tax (1099) Account Number Type of Account Name(s) on Account Date Opened Date Made Joint (if applicable) Balance to Date of Death Including Accrued Interest Current Year Interest Earned to Date of Death for Income Tax (1099) 0.00 ~__---.~.~_.~...<. / of AUthorized Bank 0~~/~ Signature Prepared: 15, 2/004 ' Register of Wills of CUMBERLAND County, Pennsylvania Certificate of Grant of Letters WHEREAS, on the 29th dated June 21st 1988 No. 2003-00895 PA No. ESTATE OF ADAMS GEORGE R 21-03-0895 Late of HAMPDEN TOWNSHIP CO~J.,~J.~ ~UU~'f~, Deceased Social Security No. 549-36-2106 day of October 2003 an instrument was admitted to probate as the last will of ADAMS GEORGE (~i', b'i~'i', late of H3LMPDEN TOWNSHIP , CUMBERLAND County, who died on the 20th day of October 2003 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, DONNA M. OTTO Register of Wills in and for the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to ~UDAMS CHARLES J who has and has appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed of my Office the 29th day of October 2003. __ duly qualified as Executor(rix) agreed to administer the estate according to law, all of which fully the seal ~eglsner oz wi±is / **NOTE** ALL NAF~ES ABOVE APPEAR (LAST, FIRST, MIDDLE) LAST Wrrr~ AhD "m'.q~ OF ~ R. ~ I, G~OR~E R. AI~, of the To~ship of Em~pden, Cot~ty of CYan- he.land and State of P~u.-ylvania, being of sound and disposing mind, ~m~ory and understanding, do make, publish and declare this my Last Will and Testamm~t. Ii direct the payment of all my just debts and funeral expenses as soon after my decease as the same may conveniemtly be dorm. I give and bequeath all the rest, resi~,e and remainder of my estate, real, personal and mixed, of whatsoever nature and wheresoever the s-m~ may be situate, to my wife, .W~xN R. ADAb~, absolutely and u~com~ii~ tionally. In the event that my wife, N~F~N R. ADAb~, should predecease ~, or should she d~e at about the ss~e time as I do, such as in an acci- dent ~ to ~oth of us, then in such event, I give, devise and bequeath my entire estate, r~a!, personal and mixed, whatsoever and ~heresoever situate, to my tw~ sons, to wit, ROBER~ G. ADAb~ and CMARLES J. ADAMS, share and share alike, per stirpes. IAS/LY,. I n~minate, constitute and appoint my wife, }r~k~N R. -1- AILS, Executrix of .this, my T~mt Will and.Testament, and ~n the event that she should predecease me, or should she be unable or unwilling to serve in such e ~,~T?~city for any reason, th~ I r~dnate, constitute and appoint my son, C~-IAR]'~.q J. AILS, to be the Executor in her place and stead, and if my said son, CHAN~F.R~J. ADA~, should also predecease me or be unable or urm~illing to serve in this capacity, tb~ I nominate, cor~titute a~d sppo/nt ~y. son, ROBE~ G. ADA~, to be the Executor of this, my Last Will and Testament, in his.: pl-ce and. stead, IN WITb~SS ~MEREOF, I have. hereunto set my hand and seal this day of Jtwm, A. D. 1988.. Gsor~e R. A~,,,~ Signed, sealed, published and declared by the above-named G~DRGE R. ~, aa and for his Tm~t Will and Testament, in the presence of ua, %~no, at h/$ re~t add in his presence, aDx~ in ~ presence of each otbmr, have b~reunto soSscrfbed ~ur names as witnesses. -2- ~~m OF )SS.. , Sworn and affirmed to and acknowledged before me, the... 21st day of , A. D., 19 22 )SS: ~SOF Ct~ ) We, the unders~.ed, J. My Cc~aission Exp/res: September 21, 1991 ~.v~ way w~;T~, , the witnesses ~hose rmmes ~e s~ ~ ~e aC~ or ~o~ ~:, ~ ~y ~i~ accor~ W ~, ~ de~se ~ say ~t :~e ~es~t ~ ~ ~e t~r , ~ R. ~ s~r , ~ R. ~ , ~C~ i~ as ~/~ ~ee ~ l~ acc for ~ ~ses ~e~ ~ress~; ~C ~chof ~, m ~ ~ ~ ~=of ~ :es~=~ , s~ ~W~i as ~s~; ~d ~ ~ ~ebes: of ~ ~l~e ~e =es~= or , ~, at ~e ~, 18 or.re y~s of ~e; of s~; t ~ ~ c~=~, ~s Or~lu~e. ~ ~ ~s=~ed to b~ore ~ ~s day of .///.... On F-X~ires: September 21, 1991 , 1988 TRUST AGREEMENT THIS AGREEMENT, made, this ~; day of ~6, 2003, by GEORGE R. ADAMS, of i!Cumberland Cotmty, Pennsylvania (hereinafter called "Settlor") by his attorney-in-fact, CHARLES J. 'ADAMS, and ROBERT G. ADAMS and CHARLES J. ADAMS (hereinafter called "Trustees"). WITNESSETH: Settlor has transferred, set over, assigned and conveyed unto Trustees the property listed in Schedule A annexed hereto and made a par~ hereof, and Trustees agree to hold such property, . together with any other property, real or personal, that may be added to this Trust by any person, by Will, Deed or otherwise, such proceeds and additions, being hereinafter called principal, IN TRUST, upon the following temps and conditions: FIRST: A. Trustees shall pay the net income, in whole or in part or apply the same~ to or ~'or the benefit of Settlor, GEORGE R. ADAMS, in quarterly or more fi'equent installments. Any income not so distributed shall be added to principal. B. Settlor shall have the power, at any t/me and from time to time, to make :gifts of the principal of this trust estate, in whole or in part, and in any manner and in snch proportions as he sees fit, to Settlor's children, and their issue, or any of them. SECOND: This Trust shall terminate upon the death of Settlor, GEORGE R. ADAMS, and thereupon Tmstees shalI determine the remaining principal (including accumulated income) and the amount so detemained shall be distributed to such of Settlor's issne, in such proportions and estates, as Settlor shall appoint by specific reference to this power of appointment in the Last Will of Settlor, or in default thereof or insot~ar as it is ineffective, the remaining principal shall : be evenly divided and equally distributed to Settlor's children, ROBERT G. ADAMS and CHARLES :J. ADAMS, absolutely, the issue of any deceased child of Settlor to take the parent's share, per stirpes. THIRD: The distributive share of income or principal passing hermmder to which a ,~i!!' minor becomes lega y entitled shall be retained by Trustees in fitrther Trust during the minority of such distribntee; but so moch of the income and principal as Trustees may decide to be reasonable, necessary, or appropriate shall be applied by Trustees to the health, support and education of such minor du~ing his or her minority, either by payment of bills for such purposes or by the making of payments shall be for tbe of such and the of such to the person who responsible receipt !person shall be a full and complete discharge to Trustees. Any income not so applied shall be I i acctmaulated an, d added to principal. The unexpended principal and income shall be paid to the minor !at majority, or if the minor dies prior thereto then upon his or her death to his or her estate. In the event that at the time any mist established for a minor hereunder shall in the sole opinion of Tnkstees become too small for efficient administration, the Trustees may declare such Trust ~to be terminated, and thereupon, the principal and acctmmlated income shall be deposited in an interest ?bearing account in the name of the minor to be paid to such at majority or upon earlier order of the i Court having jtttisdiction thereo£ For purposes of this Trust agreement, a minor shall be deemed to reach majority at age twenty-one (21) years. FOURTH: The interest of the beneficiaries hereunder in both income and principal, until actnally distributed, shall not be subject to anticipation or to vohmtary or iovoluntary alienation. FIFTH: Trustees shall, in addition to the powers given by law, have the following powers applicable to all properly held in trust whether principal or income, and exercisable withont order of Court: A. To retain any property transferred to this Trust, and to make snch investments and reinvcstments and in such proportions, withont limitation to what are known as legal investments, as i Trustees shall consider beneficial. B. To make such investments and reinvestments and m such proportions, withont limitatioo to what are known as legal invesUnents, as nay Executors and Trustees shall consider 'beneficial to nay estate or to any Trust hereunder. C. To (1) participate in any merger or rcorgauization affecting securities held hereunder at any time; (2) deposit stock under voting agreements, (3) exercise any option to sabscribe for stocks, bonds or debentures, (4) grant proxies, discretionary or otherwise, to vote shares of stock. D. To manage, operate, repair, alter or improve real estate or other property, and to lease real estate and other property upon such terms and for such period as Trustees deem advisable. E. To sell (and to grant options for the sale of) any real or personal property at public i or private sale for such prices and upon such terms as Trustees may think proper, without liability on the purchaser to see to the application of the purchase monies. F. To borrow money without liability on the part of the lenders to see to the application thereof, and to mortgage or pledge any real or personal property. G. To register securities and other property held by them in the name of nominee or in i bearer form. H. To make distribution in kind and in shares different in kind from other shares, but only at fair market values prevailing at the time of distribution. In making such distributions, Trustees shall not take into accotmt any tmrealized gain or loss attributable to the property being distributed nor shall the interest of any beneficiary heretmder or the principal or income accotmt of any trust established heretmder be adjusted on account of any unrealized gain or loss attributable to property :being distribttted. I. To compromise claims without the consent or joinder of any beneficiary. J. To purchase as an expense of the Trust, insttrance indemnifying themselves against public liability aud other hazards to which they may be subject as Trustees. K. Compeasation may be paid to the individual Trustees and the indix idual Trustees !ishall be reimbursed for all expenditures incident to their duties as a Trustees. Compensation to Trustees, expense reilnburscmcnt, and insurance premituns (as atahorized under (1) above) shall be i charged opon the principal or income of the Trusts established herennder as Trustees. iii their sole ! discretion, shall detemfine. L. Ill computing the net income of the Trusts established hereunder, the Trustees may or may uot include depreciation or depletion as all expense as they in their sole discretion detem~ine to be in the best interest of the beneficiaries. M. To commingle any fitnds held in a Trust herennder for investment ptuposes and to conmfingle such fm~ds with funds held iii any other Trust or Trusts established hermmder and/or ftmds held iii any other Trust or Trusts established by Settlor for the benefit of any beneficiary or beneficiaries of the Trusts established hereunder. In the event such Trust ftmds shall be commingled, 3 separate accounts shall be maintained setting forth the separate interests of each beneficiary in each Trust. SIXTH: Trustees shall have the power, but not the duty~ upon the death of Settlor, !iGEORGE R. ADAMS to make expenditures out of the principal of this Trust to facilitate the settlement of his estate. SEVENTH: Settlor, may at any time, or from time to time, transfer to Trustees by i lifetime gift or by Will, any additional property, including life insurance policies. All such additions shall be added to and treated as a part of the Trust or Trusts established heretmder, subject to all of the I terms and conditions of this Trust Agreement. EIGHTH: This Trust shall be irrevocable, and Settlor sball not have the right to' alter, :amend or revoke this Trust Agreement, or any provision hereofi NINTH: A. In the event there shall only be one Trustee serving and no successor shall be provided for heretmder, the surviving Trustee shall appoint an individual or corporate fiduciary to smw'e as Co-Trustee hereun'der. Ifa corporate fiduciary is appointed, it shall be a bank or trust company doing business in the United States with assets in excess of One Hundred Million Dollars. B. Each trustee shall have the power to act separately without the joinder of the other Co-Trustee and shall rely upon the actions or decisions of the other Co-Trustee. Each Co- : Trustee shall be held hamqless for any loss suffered or liability which may be incnn'ed hereunder as a i resnlt of any actions or decisions of the other Co-Trastee. C. No Trnstee hereunder sball be required to enter bond or other secnrity iu any Coust or jurisdiction in which called upon to act in a fiduciary capacity. TENTH: For purposes of this Trust Agreement, no distinction shall be made between lawfidly adopted issue and natural descendants, and all references to children, grandchildren or issue or any other group of desccndauts is inteuded to include any and all lawfitlly adopted children. ELEVENTH: For purposes of this Agreement, the masculine shall inclnde the Iifeminiue, the shall include the plural, and vice versa. singular 4 TWELFTH: This is a Pennsylvania Trust, and questions as to the validity, !construction and administration thereof shall be determined in accordance with the laws of the .Conunonwealth of Pennsylvania. IN WITNESS WHEREOF, I, GEORGE R. ADAMS, Settlor, by his attorney-in-fact, CHARLES J. ADAMS has hereunto set his hand and seal and ROBERT G. ADAMS and CHARLES J. ADAMS, Trustees, have hereunto set their hands and seals the day and year first above written. iSIGNED, SEALED AND DELIVERED In the Presence of: GEORGE R. ADAMSfgettlor, b-y his attorney-in-fact, CHARLES J. ADAMS ~IJ~RLES J. A45AMS attorney-in-fact for GEORGE CHARLES J. Ar~,heMS~ Ti~lst~e -- STATE OF ~ : : SS COUNTY OF ~/~-'~Or'~3 ~ : On this (~ day of /-qW~ ,2003, before me personally appeared GEORGE R. ADAMS, Settlor, by his attorney-in-fact, CHARLES J. ADAMS, to me known to be the iperson described in and who executed, the foregoing Agreement, and acknowledged that he executed the same as his free act and deed. ,'-' ,, Nofary Public · X/VI'~lh~,.~ My Commission Expires: Notmlal Seal "- ;J Mellesa Raphun, Notary Public I AbingtonTwp,, Mor~ty I My Conwnisslon Expli'~e Ma~ 18, ~005 ~ Member, Pennsylvania A~secatio~ of Notai'ies 5TATE OF ~ o,.,., : COUNTY OF : On this ~ day of !!CHARLES J. ADAMS, attorney-in-fact for GEORGE R. ADAMS, to me known to be the person i~descnbed in, and who executed, the foregoing Agreement, and acknowledged that he executed the same as his free act and deed. ,2003, before me personally appeared IN WITNESS WHEREOF, I have herennto set my hand and affixed my official seal. Notfil3~ ~Public My Commission Expires: Notarial Seal Me#ssa Rephun, Notary Public Abington Twp., Montgomery County My Commission Expires May 18, 2005~ MemDer, Pennsylvania A~ociatlon ct Notaries STATE OF ~ ~Af'C~ C2~ ~ : : SS COUNTY OF 0-~/Ow ~ : Onthis/4 dayof ~IE.,{D~g~.p_._.. ,2003, before me personally appeared ROBERT G. ADAMS, Trustee, to me known to be tbe person described in, m~d who executed, the foregoing Agreement, and acknowledged that he executed tbe same as bis free act and deed. IN WITNESS WHEREOF, I have bereunto set my hand and affixed my official seal. Notary Public My Commission Expires: Public $~te Qf Neveclo o. 03-79624-1 STATE OF /-'O~-' : :ss COUNTY OF : Onthis ~day of ~ ~CHA~ES 2. ADAMS, Tmste~, to me known to b~ the p~rson d~scfibed in, ~d who executed, the :foregoing Agr~ment, and acknowledged that he ~xecuted th~ sam~ ~ his ff~ act and d~ed. ,2003, before me personally appeared IN WITNESS WHEREOF, I have hereunto set my hand and affise~t my official seal. Not~ary 9ublic W(~ My Commission Expires: Notmial Seal Mellssa Raphufl, Notary Public My ~C,~lY~on E~pi~ 16, ~5 Member, Pennsytvar~ia A~sestatlofl ot Notaries POWER OF ATTORNEY GEORGE R. ADAMS TO CHARLES J. ADAMS KNOW ALL MEN BY THESE PRESENTS, that I, GEORGE R. ADAMS, of the Borough of Camp Hill, Cumberland County, Pennsylvania, have made, constituted and appointed and by these presents do make, constitute and appoint my son, CHARLES J. ADAMS, of Philadelphia, Philadelphia County, Pennsylvania, my true and lawful attorney, for me and in my name, place and stead: To draw checks or make withdrawals against my accounts in any bank, trust company, savings association, savings and loan association, credit union or other financial institution for all or any part now or hereafter deposited, of the money standing to my credit on the books thereof. To endorse notes, checks, drafts and bills of exchange which may require my endorsement for deposits as cash or for collection. To ask, demand, sue for and receive all sums of money and securities now due or which may become due and payable to me in any manner whatsoever, and upon receipt of the same to sign, seal, execute and deliver all necessary acquittances and discharges therefor. To manage, let and demise any real estate now belonging or which hereafter may belong to me. To sell, either at public or private sale, or exchange all or any parts of my personal property, wheresoever located, for such consideration and upon such terms as he shall see fit, and to execute and deliver good and sufficient bills of sale or other instruments for the conveyance or transfer of the same, with such covenants of warranty as he shall see fit. To sell, assign and transfer any stock, bonds, loans or other securities now standing or that may hereafter stand in my name on the books of any and all corporations, national, state, municipal or private; also to represent me and in my behalf to vote and act for me at all meetings connected with any company in which I may own stock or bonds or be interested in any way whatever; to collect receipt for all interest and dividends on loans, stocks or other securities, now or hereafter belonging to me. To receive the principal and interest due on any judgments, bonds, mortgages or other obligations given to me by any person or persons, natural or artificial, who have heretofore or shall hereafter secure the payment of the same by any judgment, bond, mortgage or other obligation, and said judgment, bond, mortgage or other obligation shall heretofore or may hereafter be entered of record in the Office of the Prothonotary or of the Recorder of Deeds and Mortgages or of the Clerk of Courts in and for any County in the State of Pennsylvania, as well as in and for any other County of any State in the United States of America; and on the receipt of said principal, interest and costs due on said judgment, bond, mortgage or other obligation, appear for me and in my name acknowledge and enter satisfaction in whole or in part by instrument in writing or on the margin of the record of said judgment or mortgage, or to assign the same by instrument in writing or on the margin thereof to any person or persons paying to my said attorney-in-fact the interest or principal due thereof and thereon; and also by instrument in writing or on the margin of the record thereof or otherwise, to release from the lien of any judgment, mortgage or other lien standing in my name as above described, with or without consideration, any portion of the premises described or bound by said mortgage, judgment or other lien; to extend due dates of judgments and mortgages and other liens of record, and to postpone liens thereof to others, on the record thereof or by instrument in writing. To open and enter any and all safe deposit boxes rented by me at any banking institution, and to deposit articles ther~n all contracts, deeds, writings, assurances and instruments which may be requisite or proper to effectuate any matter or thing appertaining or belonging to me. with the same powers, and to all intents and purposes with the same validity as I could if personally present; hereby ratifying and confirming whatsoever my said attorney shall and may do, by virtue hereof. This power of attorney shall not be affected by the disability or incompetency of the principal; it being my intention that the authority conferred hereby on my attorney-in-fact shall be exercisable notwithstanding my subsequent disability or incompetency. IN WITNESS WHEREOF, I have hereunto set my hand and and here~y sign~ify my intention to be legally bound, this day of ~U~s~ , nineteen hundred and eighty-nine (1989). WITNESSED BY: ~(~ (SEAL) Adams COMMONWEALTH OF PENNSYLVANIA) : SS. On this, the ~F-~ day of ~J , 1989, before me, a Notary Public in and for the aforesaid County and Commonwealth, personally appeared GEORGE R. ADAMS, known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing Power of Attorney, and acknowledged that he executed the same of his own volition and free will, and for the purposes therein contained. WITNESS my hand and official seal the day and year aforesaid. COMMONWEALTH OF PENNSYLVANIA OEPARTMENTOFREVENUE BUREAU OFINOIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11 96) NO. CD 004184 ADAMS CHARLES J 7702 SYCAMORE AVE ELKINS PARK, PA 19027 fold ESTATE INFORMATION: SSN: 549-36-2106 FILE NUMBER: 2103-0895 DECEDENT NAME: ADAMS GEORGE R DATE OF PAYMENT: 07/21/2004 POSTMARK DATE: 07/19/2004 COUNTY: CUMBERLAND DATE OF DEATH: 10/20/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 97,905.64 TOTAL AMOUNT PAID: 97,905.64 REMARKS: SEAL CHECK# 3319704 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS 7004 0750 0000 4638 5102 7004 0750 0000 4638 5102 0000 U.S. POSTAGE ELKfNS PARK.PA AMOUNT $5.4:3 800J7977-05 STATUS REPORT UNDER RULE 6.12 Name of Decedent: ~- EO t~ ~-.~ /~. Date of Death: Io/;I,o/~C oo 3 WillNo.: '~O0 ~ - OO 8'/5' Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes No V1 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: Did the personal representative file a final account with the Court? Yes _ No [~ b. The separate Orphans' Court No. (if any) for the Personal representative's account is: c. Did the personal re~12resentative state an account informally to the parties in interest? Yes ~[ No ~-] c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the. Orphans' Court and may be attached to this report. Date:J~$/~.oo¥ ~ Signature Capacity: Name Address I S')~ ' 7~'~, - 9..0 9 -% (~°'"0 Telephone No. [~ Personal Representative [--] Counsel for personal representative I?oz7 BUREAU OF INDIVIDUAL TAXES ZNHERTTANCE TAX DZVZSTON DEPT. ZSO6Ol HARRTSBURG, PA 171Z8-060! ROBERT ADAMS $851SURFRIDER LN LAS VEGAS 89110 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOT/CE OF INHERITANCE TAX APPRAISEHENT, ALLOHANCE OR DISALLOHANCE OF DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-25-2004 ESTATE OF ADAMS DATE OF DEATH 10-20-2003 FILE NUMBER 21 03-0895 COUNTY CUMBERLAND SSN/DC 549-36-2106 ACN 04104901 Amoun~ Rem/~ed RE¥-lggi8 EX AFP CB'B-OS) GEORGE R HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~'~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1548 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 10-25-2004 ESTATE OF ADAMS GEORGE R DATE OF DEATH 10-20-2003 COUNTY CUMBERLAND FILE NO. 21 03-0895 S.S/D.C. NO. 549-36-2106 ACN 04104901 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. 5706-00 TYPE OF ACCOUNT: (~ SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 01-23-1987 Accoun~ Balance .00 Percen~ Taxable X 0.166 Amoun~ SubSec~ ~o Tax .00 Debts and Deductions - .00 Taxable Amoun~ .00 Tax Ra~e X .45 Tax Due .00 TAX CRED/TS: NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. HAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 04-05-2004 10-18-2004 CD005790 REFUND .00 .00 31.17 31.17- TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ZF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ ( ZF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REI~UIRED. IF TOTAL DUE IS REFLECTED AS A -CREDTT' (CR), YOU NAY BE DUE A REFUND. SEE REVERSE STDE OF THIS FORM FOR INSTRUCTIONS. ) .00 .00 .00 .00 PURPOSE OF NOTICE: To fulfill the requirements of Section II40 of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (TI P.S. Section PAYHEHT: REFUND (CR): OBJECTIONS: ADHIN- ISTRATZVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. -- Neke check or money order payable to: REGIST£E OF HILLS, AGENT. A refund of a tax credit, which was not requested on the tax return, may be requested by completing an "Application far Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office of the Register of Hills, any of the Z3 Revenue District Gffica$ or by calling the special Z4-hour ansaering service for forms ordering: 1-800-36Z-lOS0; services for taxpayers with special hearing and or speaking needs: 1-800-447-3020 (TT only). Any party in interest not satisfied with tho appraisement, a11oaanca, or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZBIOZ1, Harrisburg, PA 17128-10Z1, OR --electing to have the matter determined at the audit of the account of the personal representative, OR --appeal to the Orphans' Court Factual errors discovered on this assessment should be addressed in ariting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, DEPT. 280601, Harrisburg, PA 171ZB-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid aithin three (3) calendar months after the decedent's death, a five percent discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 15, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you wouZd appeal the tax and interest that has been assessed as indicated on this notice. [nterest is charged beginning with first day of delinquency, or nine (9) months and one (1) day fram the date of death, to the date of payment. Taxes which became delinquent before January l, 19BI bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on or after January 1, 1982 will bear interest at a rate which will vary fram calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rotes for 198Z through 2004 are: Interest Daily Interest Daily Interest Dally Year Rate Factor Year Rate Factor Year Eats Factor 198~ 20Z .000548 19B'~-8-1991 Ill .O003Ol 2009 9Z .000247 1983 Z6Z .000438 1992 9Z .000247 ZOOZ 6Z .000219 1984 llZ .000301 1993-1994 7Z .00019Z 2003 5Z .000137 1985 132 .000356 1995-1998 92 .000247 2004 4Z .000110 1986 1gl .000274 1999 7Z .00019Z 1987 9Z .000247 2000 BZ .O00Zl9 --Interest is calculated as follows: TNTEREST = BALANCE OF TAX UNpATD X NUNBER OF DAYS DELTNQUENT X DATLY TNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the data of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF /NDZVTDUAL TAXES TNHER1[TANCE TAX DTVTSTON DEPT. Z80601 HARRXSBURG, PA 171Z8-0601 COMMONgEALTH OF PENNSYLVANZA DEPARTHENT OF REVENUE ZNHERZTANCE TAX STATEMENT OF ACCOUNT REV-1607 EX AFP ROBERT ADAMS $8~1SURFRIDER LN LAS VEGAS NV 89110 DATE ESTATE OF DATE OF DEATH FZLE NUMBER COUNTY ACN 11-01-2004 ADAMS GEORGE 10-20-200:5 21 0:5-0895 CUMBERLAND 04:t. fl. q9 01 Amou~ Rem i'1:'1: " HAKE CHECK PAYABLE AND RL'~'~'rT PAYMENT TO: REGISTER OF V/ILLS CUMBERLAND CO COURT ..~?~OUSE CARLISLE, PA 1701:5 .. NOTE: To insure proper credi~ ~o your account, submi~ ~he upper portion of ~his form ~]~h your ~ax payment. CUT ALONG THZS L*rNE ~,~ RETAZN LOt*/ER PORTZON FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) ff~ ZNHER'rTANCE TAX STATEHENT OF ACCOUNT ~ ESTATE OF ADAMS GEORGE R FZLE N0.21 0:5-0895 ACN 04104901 DATE 11-01-2004 TH'rS STATEHENT TS PROVTDED TO ADVZSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAHED ESTATE. SHOI'/N BELOt'/ 1'S A SUHNARY OF THE PRZNCZPAL TAX DUE, APPLZCAT'rON OF ALL PAYHENTS, THE CURRENT BALANCE, AND, 'rF APPLXCABLE, A PROJECTED ZNTEREST FZGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 10-18-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): .00 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-05-2004 10-18-2004 CD00:5790 REFUND .00 .00 :51.17 :51.17- ZF PAZD AFTER THZS DATE, SEE REVERSE SZDE FOR CALCULATZON OF ADDZTZONAL ZNTEREST. ( ZF TOTAL DUE 1S LESS THAN $1, NO PAYHENT ZS REQUZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDZT' (CR), TOTAL TAX CREDZT .00 BALANCE OF TAX DUE .00 XNTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE A REFUND. SEE REVERSE S'rDE OF THTS FORH FOR XNSTRUCTXONS. ) PAYMENT: Detach the top portion of this Notice and submit eith 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 WILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONWEALTH OF PENNSYLVANIA. REFUND (CA): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS15). Applications are available at the Office of the Register of Wills, any of the 25 Revenue District Offices or from the Department's Iq-hour answering service far forms ordering: 1-800-36Z-ZOSO; services for taxpayers with special hearing and / or speaking needs: 1-SO0-4qT-~OZO (TT only). REPLY TO: guestions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Revise Unit, Dept. 280601, Harrisburg, PA 17128-0601, phone (717) 787-6505. DISCOUNT: If any tax due is paid aithin three (3) calendar months after the decedont's death, a five percent (SI) discount of the tax paid is alloaed. 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 aith first day of delinquency, or nine (9) months and Dna (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, i98Z bear interest at the rate of six (6X) percent per annum calculated at a daily rate of .000164. Ail taxes which became delinquent on and after January l, 198Z mill bear interest at a rate ehich mill vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZOO4 are: Interest Dally Interest Dally Interest Dally Year Rate Factor Year Rate Factor Year__ Rate Factor xgsz ZOX .000548 1988-1991 XXZ .000301 gOOX 92 .000247 1983 16Z .000438 199Z 92 .000247 ZOOZ 62 .000164 1984 llZ .OOO301 1993-1994 72 .O00XeZ ZO0~ 5Z .0001~7 1985 132 .000356 1995-1998 92 .000247 2004 42 .000110 1986 lOX .000274 1999 72 .O0019g 1987 92 .000247 ZOO0 8Z .000Z19 --Interest is calculated as follows: I'NTEREST = BALANCE OF TAX UNPATD X NURBBR OF DAYS DBLXNQUBNT X DATLy XNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen [153 days beyond the date of the assessment. If payment is made after the interest computation date sheen on the Notice, additional interest must be calculated.