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Home My WebLink About04-0110PETITION FOR PROBATE and GRANT OF LETTERS Estate of LeRoy J. Davis also known as Social Security No. Deceased. 180-26-52~8 To: Register of Wills for the County of Gumberland Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(x), who is/~m 18 years of age or older an the execut rix in the last will of the above decedent, dated September 8 and codicil(s) dated none in the named ,1998 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with h is last'family or principal residence at 599 Baltimore Road, Shippensburg, Shippensburg Township (list street, number and muncipality) Decendent, then 71 years of age, died December 24 at Shippensburg Health Care Center, Shippensburg, PA 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: none 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: 599 Baltimore Road, Shippensburg, Shippensburg Township. Cumberland County $ 93,800.00 $ 116.200.00 WHEREFORE, petitioner(s) respectfully presented herewith and the grant of letters. theron. request(s) the probate of the last will and codicil(s) testamentary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) ~ ~/~.,/~.~ .~//~ i)/d.'~/z.,/z,-d./ 6 Brookview Drive '~' ~7 -L~b°nah/Le~ Darhower Newville. PA 17241 ,~.~ 717-776-7555 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF CUMBERLAND The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed ~ before me this ~,'~'*' day of f ...LO, Donna LEe DO-lchower ~' No. ~-~ Estate Of LeRoy J. Davis , 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 September 8, 1998 described therein be admitted to probate and filed of record as the last will of LeRoy J. Davis and Letters Testamentary are hereby granted to LaDonna Lee Darhower ,]~'~', in consideration of the petition on FEES Probate, Letters, Etc .......... ShorLCertifiCates( )...' ....... ~enuncmtion ................ TOTAL Jerry A. Weigle, Esquire ^rrORNE¥~u~. C~. ~D~No.) WEIGLE & ASSOCIATES, , . 126 East King Street #01624 ADDRESS Shippensburg, PA 17257 717-5q2-7qg~ 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. Fee for this certificate, $2.00 WARNING: It is illegal to duplicate this copy by photostat or photograph. ~ocal Registrar P 9450931 No. Date H105.143 Rev 2/87 TYPE/PRINT PERMANENT BLACK INK 599 Baltimore Rd. Shippensburg, PA 17257 Robert F. Davis LaDonna D. Darhower COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH I' ^ L~.--~.~"oEILesR°¥, 'J'u.Davis~R.¥t~R ' U,DER, ' .Male "180 -- 26 -- 5248 ~. C~ber~and I~~ ~P I~~ ~ ~' ~ [,~ ...... ~ .... J,o. .... ~-~ ~ [,,~t~ ~ ~ 1,, I',. 12 yrs. I 1 yrg 1,. Widowed ACTUAL 11t m~. Pennsylvania ~ ~c.~ ~ ~m.~ C~berland ~i.~ ~.~ B. Williams 6 ~w Dr. Newville, PA 17241 20O3 011776-L LOCATION - Cilyrrow~, State, Z~p F.H. Inc. P.O. Box 336. ,tN 3z' ~ ~ ~:7 L 127 Walnut Bottom Road ,,. ~ Shippensburg, PA 17257 LAST WILL AND TESTAMENT I, LEROY J. DAVIS, of 599 Baltimore Road, Shippensburg, Shippensburg Township, Cumberland County, Pennsylvania, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void all wills by me at any time heretofore made. FIRST. I order and direct the payment of all my legally enforceable debts and funeral expenses as soon as may be convenient after my decease. SECOND. I give, devise and bequeath all my estate, real, personal and mixed, whatsoever and wheresoever situate, to my daughter, LADONNA LEE DARHOWER, presently of 6 Brookview Drive, Newville, Cumberland County, Pennsylvania. THIRD. In the event my said daughter, LADONNA LEE DARHOWER, should predecease me or is not living on the sixtieth (60th) day following my death, I then give, devise and bequeath my said estate to my niece, CAROL RUSSELL, presently of 32 Thompson Creek Drive, Shippensburg, Southampton Township, Cumberland County, Pennsylvania, on a per stirpes distribution basis. FOURTH. I nominate, constitute and appoint my daughter, LADONNA LEE DARHOWER, to be the Executrix of this my Last Will and Testament; if LADONNA LEE DARHOWER be unable to fulfill the duties of Executrix, I then nominate, constitute and appoint the ORRSTOWN BANK to be the Executor of this my Last Will and Testament. FIFTH. I direct that my personal representatives shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, LEROY J. DAVIS, have hereunto set my hand and seal to this my Last Will and Testament this f,r_~ day of ,5'~FFe~'~,~ ,1998. (SEAL) MARK, WEIGLE AND PERKINS --ATTORNEYS AT LAW -- 1 26 EAST KING STREET --SHIPPENSBURG, PA 1 7257-1 397 This instrument was by the Testator, on the date hereof, signed, published and declared by him to be his Last Will and Testament, in our presence, who at his request and in the presence of each other, we believing him to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. ,,"[c. ff.-.._ COMMONWEALTH OF PENNSYLVANIA · COUNTY OF CUMBERLAND · SS. I, LEROY J. DAVIS, the person whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed· Sworn or affirmed to and acknowledged before me by LEROY J. DAVIS, the Testator this ~q41dayof ~qTl~ ,1998. MARK, WEIGLE AND PERKINS -- ATTORNEYS AT LAW -- 126 EAST KING STREET -- SHIPPENSBURG, PA 17257-1397 COMMONWEALTH OF PENNSYLVANIA · COUNTY OF CUMBERLAND · SS. the witnesses whose names are sign)/d to the foregoing instrument, being duly qualified according to law, do depose and say that we Were present and saw LEROY J. DAVIS, the Testator, sign and execute the instrument as his Last Will; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the heating and sight of the Testator, signed the will as witnesses; and that to the best of our knowledge the Testator was at the time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed before__me by ./~-(~A..~___e~ 'fir/Ir:Zc/ witnesses, this ~ ¢~ day of x,~e ~t~ ,1998. MARK. WEIGLE AND PERKINS -- ATTORNEYS AT 1AW -- 126 EAST KING STREET -- SHIPPENSBURG, PA 17257-1397 LEROY J. DAVIS MARK, WEIGLE AND PERKINS ATTORNEYS AT LAW 126 EAST KING STREET SHIPPENSBURG, PA. 17257-1397 WEIGLE & ASSOCIATES, P.C. · ATTORNEYS AT LAW 126 EAST KING STREET, SmH'ENSBURG, PA 17257-1397 · TELEPHONE: (717) 532-7388 FAX: (717) 532-6552 IN RE: ESTATE OF LE ROY J. DAVIS, late of the Township of Shippensburg, Cumberland County, Pennsylvania, deceased : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY : PENNSYLVANIA : ORPHANS' COURT DIVISION : ESTATE NUMBER 21-04-0110 CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: LeRoy J. Davis Date of Death: December 24, 2003 Will No. 21-04-0110 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above- captioned estate on February 5, 2004: LaDonna Lee Darhower 6 Brookview Drive Newville, PA 17241 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except NONE. February 5, 2004 Signa~/~ O * [/~.~'~' Name: Jerry A.'Weigle, Esquire Address: Weigle & Associates, P.C. 126 East King Street Shippensburg, PA 17257 Telephone: (717) 532-7388 Capacity: Personal Representative X Counsel for Personal Representative WEIGLE & ASSOCIATES, P.C.-- ATTOP.NEYSAT LAW -- 126 EAST KING STREET -- SHIPPENSBURG, PA 17257-1397 CO?.~C~N'~/EALTH OF PENNSYLVANIA "uEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003686 WEIGLE JERRY A 126 E KING STREET SHIPPENSBURG, PA 17257 fold ESTATE INFORMATION: SSN: 180-26-5248 FILE NUMBER: 2104-0110 DECEDENT NAME: DAVIS LEROY J DATE OF PAYMENT: 03/17/2004 POSTMARK DATE: 03/16/2004 COUNTY: CUMBERLAND DATE OF DEATH: 12/24/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 98,500.00 REMARKS' SEAL CHECK#109 TOTAL AMOUNT PAID: 98,500.00 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS DEPARTMENT OF REVENUE WEIGLE & ASSOCIATES, RC. Attorney8 at Law 126 East King Street Shippensburg, PA 17257 RecorO? ' ReDs,,:, '04 H/tR17 Pl:(~2 ['~t:tnb(;! . Re§±S~er of Wills, Cumberland County Courthouse Carlisle, PA 17013 i '?0 i 3+,330 ':, 02 h,,lih,,lli,,,,,,Ih,ih,,ll,,,Ihll,,,,,,tli,l,,hh,,,ll,I COMMONWEALTH OF PENNSYLVANIA DEPARTMENTOFREVENUE BUREAU OFINDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128 0601 RECEIVED FROM: PENNSYLVANIA INNERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV 1162 EX(11 96) NO. CD 004289 DARHOWER LADONNA LEE 6 BROOKVIEW DRIVE NEWVlLLE, PA 17241 fold ESTATE INFORMATION: SSN: 180-26 5248 FILE NUMBER: 2104-01 10 DECEDENT NAME: DAVIS LEROY J DATE OF PAYMENT: 08/18/2004 POSTMARK DATE: 08/1 8/2004 COUNTY: CUMBERLAND DATE OF DEATH: 12/24/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $29.09 TOTAL AMOUNT PAID: $29.09 REMARKS: LD LDARHOWER SEAL CHECK// 127 INITIALS: VZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REV-1500 EX + (6~}0) I COMMONWEALTH OF PENNSYLVANIA I DEPARTMENT OF REVENUE ~ DEPT 280601 HARRISBURG, PA 17128-0601 DEC606NT'S ~AM~ (LAST, FIRST, AND MIDDLE INITIAL) ~- Davis, LeRoy J. Z u~ 2-24-2003 11-08-1932 UJ §uRVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) 1 Qriginal Return FILE NUMBER 2~ L4 011 0 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBE~ 180-26-$248 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURFTY NUMBER REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT 2 Supplemental Return , 49 Future Interest Compromise (date of death after 12 1242) i 7 Decedent Maintained a Living Trust (Atlach copy of Trust) 4 Limited Estate x B Decedent Died Testate {Attach copy of Will) 9 Litigation Proceeds Received I-n Spousal12.31_91 andPoverty~-~-95)Credit (date of death between Jerry A. Weigle, Esquire Remainder Return (date of death prior to 12~1~82) Federal Estate Tax Return Required Total Number of Safe Deposit Boxes 11ElectiontotaxunderSec 9113(A)(AtlachSchO) Z ~IRM NAME (If applicab e) Weigle & Associates, P.C. TELEPHONE NUMBER = 717-532-7388 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4 Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10 Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11 Total Deductions (total Lines 9 & 10) 126 East King Street Shippensburg, PA 17257 (1) 1t6,200.00 (2) 16,728.94 (3) None (4) None (5) 83,263~-~8~ (6) N~t~e (7) N ~n e (9) 10,839.28 (lO) 5,876.38 (8'~ 216,t92.52 (11T''1 16,715.66 Z 12· Net Value of Estate (Line 8 minus Line 1 I) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, 0.00 or transfers under Sec. 9116(a)(1.2) t6 Amount of Line 14 taxable at lineal rate 199,476.86 x .00 (~5) x .045 (16) 17 Amount of Line 14 taxable at sibling rate 0.00 x .12 (17) 18 Amount of Line 14 taxable at collateral rate (12) 199,476.86 (13) 0.00 (14) 199,476.86 0.00 8,976.46 0.00 0.00 x .15 (18) 0.00 19 Tax Due (19) 8,976.46 Copyright 2002 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-0 Decedent's Complete Address: STREE;;~D~EaSI~i m o r e Road CITY ~h Ppensburg iSTATE PA z~P 17257 Tax Payments and Credits: 1 Tax Due (Page 1 Line 19) 2 Credits/Payments A. Spousal Poverty Credit B. Prior Payments C Discount (t) 8,976.46 Interest/Penalty if applicable D Interest E Penalty 8;500.00 447.37 Total Credits (A + B + C) (2) 8,947.37 Total Interest/Penalty (D + E) (3) 4 If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT (4) Check box on Page 1 Line 20 to request a refund 5 IfLinel+Line3isgreaterthanLine2, enter the difference This is the TAX DUE. (5) 29.09 A Enter the interest on the tax due. (5A) B Enter the total of Line 5 + 5A This is the BALANCE DUE (5B) 2 9,0 9 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; x b retain the right to designate who shall use the property transferred or its income; x, c retain a reversionary interest; or x, d. receive the promise for life of either payments, benefits or care? x ! 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiweg adequate consideration? x I 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ..... x I 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? x ! 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 accom panylng schedules and statements, and to the best of my knowledge and belief, it is true correct and complete Declara!!on e! p!eparer other than the personal representative is based an a!l inform a!ion of which preparer has anyknewledge ADDRESS DATE 6 Brookview Drive Newville, PA 17241 ~r)_ ~ r '7__ ADDRESS DATE SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN baDonna Lee Darhower ~ire ADDRESS 126 East King Street Shippensburg, PA 17257 J6 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 PS. {}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 PS §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 PS. §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 45%, except as noted in 72 PS. §9116 12) [72P.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-l$02 EX+ (6-98) SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Davis, LeRoy J. 21-04--0110 All real proper~y owned solely or as a tef~ant in common must be reported at fair market value. Fair marke~ value is defined as the price at which property would be exchanged between s willing buyer and a willing selier neither being compelled to buy or sell both having reasonable knowledge of the relevant facts Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER 1 Residence at 599 Baltimore Road - Shippensburg Township, Cumberland County, 116,200.00 PA TOTAL (Also enter on Line 1, Recapitulation) 116,200.00 Form PA-1500 Schedule A (Rev. 6-98) (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc Rev-1503 EX+ (6-98) SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Davis, LeRoy J. 21-04--0t10 VALUE AT DATE ITEM DESCRIPTION UNIT VALUE OF DEATH NUMBER 1 MetLife Common Stock Shares 34.5803 2,558.94 2 218 shares Orrstown Bank Common Stock 65 14,170.00 TOTAL (Also enter on Line 2, Recapitulation) 16,728.94 (If more space is needed, addit(onal pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc Form PA-1500 Schedule B (Rev. 6 98) Rev-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMON~V~-ALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF FiLE NUMBER Davis, LeRoy J. 21-04--0110 VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER 24.23 1 2 3 4 5 6 7 8 9 10 11 12 13 14 2003 1040 federal income tax refund AAA - refund AARP - refund Andorra Radiology - refund of overpayment Cash (coins) from safe deposit box Check on hand at date of death - MetLife dated 12/15/2003 Erie Insurance - refund of automobile insurance at cancellation Estate of Pearl Russell - reimbursement for funds advanced by decedent prior to late of death )eposit in transit at date of death - to Orrstown Bank Club Account MetLife Total Control Account #403-1048373 Orrstown Bank Checking Account #5'13873 Accrued income on Item 11 through date of death Orrstown Bank Club Account #960286 Accrued income on Item 12 through date of death Orrstown Bank Savings Account #15826 Accrued income on Item 13 through date of death Patriot Federal Credit Union Account #310620 Accrued income on Item 14 through date of death 17.50 29.50 82.00 582.39 17.02 57.00 597.46 240.00 1t ,543.45 t2,107.11 2.40 240.00 0.34 40,664.95 33.14 382.40 0.44 Total of Continuation Schedule(s) See attached page TOTAL (Also enter on Line 5, Recapitulation) 83,263.58 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form sof~ware only The Lackner G;ou~3, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY continued ESTATE OF FILE NUMBER Davis, LeRoy J. 21-04--0110 VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER 15 16 17 18 1988 Cadillac - proceeds of sale 03~05~04 2001 Oldsmobile Intrigue - proceeds of sale 04/01/2004 Gross proceeds of public sale 06~05~2004 Yamaha Motorcycle - proceeds of sale 06~22~2004 3,500.00 5,800.00 6,842.25 500.00 TOTAL (Also enter on Line 5, Recapitulation) 83,263.58 Form PA-1500 Schedule E (Rev. 6-98) Copyright (c) 2002 form software only The Lackner Group, Inc. REV-1151 EX+ (12-99} ,h~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Davis, LeRoy J. 21-04--0110 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: None ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / FIN Number of Personal Representative(s): Street Address City State __ Zip Year(s) Commission paid Attorney's Fees See continuation schedule(s) attached Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip Probate Fees See continuation schedule(s) attached Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) Copyright (c) 2002 form software only The Lackner Group. Inc 10,235.78 310.00 293.50 10,839.28 Form PA-1500 Scheduie H (Rev 6-98) Rev-1502 EX+ (6-98} SCHEDULE H-B2 ATTORNEY'S FEES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN R£S~DENT DECEDENT ESTATE OF FILE NUMBER Davis, LeRoy J. 21-04--01 ~10 ITEM DESCRIPTION AMOUNT NUMBER 1 Weigle & Associates, P.C. - attorney fee 10,235.78 Subtotal 10,235.78 Copyright (c) 2002 form software only The Lackner Group. Inc Form PA-1500 Schedule H-B2 (Rev. 6 98) Rev-'~502 EX+ (6-98) SCHEDULE H-B4 PROBATE FEES continued ESTATE OF FILE NUMBER Davis, LeRoy J. 21-04--0110 ITEM DESCRIPTION AMOUNT NUMBER Register of Wills, Cumberland County - Letters Testamentary and Short Certificates 292.00 1 2 Register of Wills, Cumberland County - 6 Short Certificates Subtotal 18.00 310.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-'IS00 Schedule H-B4 (Rev. 6-98) Rev-1502 EX+ (6-98) SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Davis, LeRoy J. 21-04--0110 ITEM DESCRIPTION NUMBER 1 2 3 4 5 6 Cumberland Law Journal - advertising Letters Testamentary Linda K. Klein - notary fees News Chronicle - advertising Letters Testamentary Register of Wills, Cumberland County - filing PA inheritance Tax Return Register of Wills, Cumberland County - filing Family Settlement Agreement Weigle & Associates, P.C. - postage, xerox copies, and long distance telephone calls AMOUNT 75.00 10.00 92.75 15.00 75.00 25.75 Subtotal 293.50 Copyright (c) 2002 form software only The Lackner Group, Inc Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev-1512 EX+ (6-98} SCHEDULE -' DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS REStDENT DECEOENT ESTATE OF FILE NUMBER Davis, LeRoy J. 21-04--0110 Include unreimbursed medical expenses. VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER 83.78 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Andorra Radiology - 02112/04 statement Barry L. Negley, Tax Collector - 03/01/04 real estate taxes Barry L. Negley, Tax Collector - school real estate taxes Borough of Shippensburg - 04/01104 billing Borough of Shippensburg - 07101/04 billing Central Penn Medical Group Emergency - 01/29104 statement CFJMA - January - March sewer service CFJMA - April - June sewer service Commonwealth of PA - Cadillac registration Erie Insurance - homeowner's premium Expenses of public sale Jennings Chevrolet/Oldsmobile - Cadillac inspection LaDonna Lee Darhower - reimbursement for expenses paid prior to opening of estate, including Penelec - 161.98; Sprint - 123.86; CFJMA - 78.00; Erie Insurance - 285.00; Pharmacare - 23.63; Borough of Shippensburg - 35.98; and Orrstown Bank 40.00 Orrstown Bank Checking Account #513873 - checks clearing after date of death Penelec - 02/05/04 billing Penelec - 03~04~04 billing Penelec - 04/01/04 billing 363.51 1,306.78 35.98 35.98 28.40 78.00 78.00 36.00 25.00 1,912.30 61.37 748.45 235.97 105.22 47.33 21.98 Total of Continuation Schedule(s) See attached page TOTAL (Also enter on Line 10, Recapitulation) 5,876.38 (If mere space is needed, additiena~ pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) Rev-1512 EX+ SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS continued ESTATE OF FILE NUMBER Davis, LeRoy J. 21-04--0110 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 18 Penelec - 05~03~04 billing 19 20 21 22 23 24 25 26 27 28 29 Penelec - 06~03~04 billing Penelec - 07~07~04 billing Sprint - 02/04/04 billing Sprint - 03/04/04 billing Sprint - 04/04104 billing Sprint - 05104104 billing Sprint - 06/04/04 billing Sprint - 07~04~04 billing Timmons Oil, Inc. - 03~05~04 delivery Waste Management - 03/01/04 invoice Waste Management - 06/01104 invoice 21.98 24.34 55.34 58.86 58.30 39.61 44.29 44.29 43.68 166.19 55.19 60.26 TOTAL (Also enter on Line 10, Recapitulation) 5,876.38 Copyright (c) 2002 form software only The Lackner Group, Inc Form PA-1500 Schedule I (Rev. 6-98) SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: LeRoy J. Davis 180-26-5248 1212412003 Item Name and Address of Person(s) Number Rece ving Property I LaDonna Lee Darhower 6 Brookview Drive Newville, PA 17241 Relationship Share of Estate (Words) Daughter 100% residuary Amount of Estate ($$$) 199,476.86 Total Sailhamer Real Estate,lne 494 East King street Shippensburg,Pa. (717) 532-6059 Fax: (717) 530-5181 Estate of: Leroy J. Davis 599 Baltimore Road Shippensburg,Pa. 17257 January 7, 2004 This analysis has not been performed in accordance with the uniform Standards of professional practice which requires valuers to act as inbiased,disinterested third parties with impartiality,objectivity and independence and without accommodation of personal interest,it is not to be construed asan appraisal and may not be used as such for any purpose. In response to your request for a comparable market analysis of Real Estate for the Estate of Leroy J. Davis. I am sending you my estimation Of current market value. The property is located in the Tova~ship of Shippensburg,Cumberland County,Pennsylvania. Located at 599 Baltimore Road. Real Estate parcel # 36-35-2385-016 ,parcel #36-12-2385-016A. See attached pages .Listing price range $112,500, to $119,900. Sailhamer Real Estate ,Inc. Barry Negley - Realtor 494 East King Street Shippensburg. Pa 17257 //,?, c.c to Linda Klein LaDonna Darhower 3le. as~ote: Your Sale Proceeds Check is Attact~ea BI4OKEITS Name Address. ZIP Code. Federal i 85 Challenger Road Ridgefield Pa~k N107660 Form 1099-B COPY B FOR RECIPIENT -**IMPORTANT ~ AX NFORMATIO TO WHOM PAID Ladonna Lec Darhower Ex Uw LeRoy I Davis 126 East King Street Slfippensburg, PA 17257 Proceeds From Broker and Barter Exchange. Transactions ILS. ILi r ~, .,~,l~ · ·,.~J, OMB NO. RETURN FOR 2004 1545 0715_ ~a Date of Sale lb CUSIP Number ~ 59156R10~ 2. Stocks. Bonds etc 13. Bartering 4. FEDERAL INCOME TAX WITHHELD $0.00 REPORTED } TOIRS ~] Gross proceeds ~MetLife, Inc~..~ tvestor ID 8064 3364 2860 20-6103910 Dale · IMPORTANT TAX RETURN DOCUMENT ATTACHED · Sale Price Gross Proceeds Tax Withheld Net Proceeds Trust Interest Balance Description Shares Sold ($) ($) ($) ($) 74.0000 Balance 2,558.94 0.0000 Shares Sold 74.0000 34.5803000 2,558.94 0.00 YOUR ACCOUNT HAS BEEN CLOSED. THE ATTACHED CHECK REPRESENTS THE FULL VALUE OF YOUR ACCOUNT. Retain this number for future reference: Investor ID: 8064 3364 2860 For information concerning this statement, call MetLife, Inc.'s Transfer Agent, Mellon Investor Services toll free at 1-800-649-3593 F 0324 0000090 SFULL (07-03) PLEASE DETACH ALONG THE PERFORATION WATERMARK HOLD Ar ANGLE TO V EW Check No. 00567032 50-937 t4etLife Pay ~6 The Ofd~r Of: Description: Sale Proceeds Check Date hwestor 1D Pa5' 03/25/04 8064 3364 2860 ** ** $2,558.94 Ladonna Lee Darhower Ex UwLeRoy J Davis 126 East King Street Shippensburg, PA 17257 213 Payable at Chase Manhattan Bank, Syracuse; NYor The Chase Manhattan Bank, New ~ or Authorized Officer Signature u. OElCiR?OtDt" IlO~l, tOCttTq': r=i31Sqi~OOq"' O -g- owN FINANCIAL SERVICES INC. January5,2004 To Whom It May Concern: This is to verity that Leroy Davis was the owner of 218 shares of common stock of Orrstown Financial Services, Inc. on December 23, 2003 and the selling price was $65.00 per shares. Should you have any questions, please feel free to contact me at (717)530-2607. Sincerely, Patricia Corwetl Vice President & Transfer Agent PO. BOX 60 ~ ORRSTOWN, PA 17244 ~ TEL. (717) 532 6114 Control Account® junt No. 403-1048373 January 2004 Statement Period From 1/01/04 To 2/1 /04 Page 1 of 1 LEROY J DAVIS 599 BALTIMORE ROAD SHIPPENSBURG PA 17257-9404 Customer Service; (800) 638-7283 If you need information on your account, try our easy-to-use automated phone system. You can get your account balance and information on recent transactions, 24 hours a day, 7 days a week. Just call 1-800-638-7283 from a touch-tone phone, have your account number ready, and select the options you need. TCA MONEY MARKET OPTION (MMO) Effective Annual Yield 3.00% as of 01/31/04 Account Summary Interest End~ngBalan Transaction Details $11,543.45 $30.08 $11,573.53 $30.08 2/1 Interest $30.08 2 9 200 TO: Weigle & Associates, PC. Attorneys at Law 126 East King Street Shippensburg, PA 17257 FROM: ORRSTOWN BANK P.O. BOX 250 SHIPPENSBURG PA 17257-0250 RE: ESTATE OF Leroy J Davis DECEASED DATE OF DEATH: December 24, 2003 IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD, ON THE ABOVE DATE, THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK: (1) CHECKING ACCOUNTS ACCOUNT NO. TITLE OF ACCOUNT 513873 Leroy J Davis 11/1/82 SAVINGS ACCOUNT ACCOUNT NO. TITLE OF ACCOUNT 15826 Leroy Davis 11/12/82 960286 Leroy Davis 11/2/83 DATE OPENED DATE OF DEATH PRINCIPLE & ACCRUED INTEREST 12,107.11 2.40 DATE OPENED DATE OF DEATH PRINCIPLE & ACCRUED INTEREST 40,664.95 33.14 240.00 .34 (3) CERTIFICATES OF DEPOSIT ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED DATE OF DEATH PRINCIPLE & ACCRUEDINTEREST Date: 1/28/04 By: Timothea Customer Service Operator March 3, 2004 Weigle & Associates, P.C. Attorneys-at-Law 126 East King Street Shippensburg, PA 17257-1397 RE: Estate of LeRoy J. Davis Dear Mr. Weigle: I am writing in response to your request for date of death values on the above referenced member. This account was owned individually. Account 310620 Prime Share (00) Date of Death Principal $382.40 AccruedDOD$0.44 Interest to Date Account Opened 1/14/1970 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. Sincerely, Dixie Kelley Manager of Administrative Services 800 Wayne Avenue. Chambersburg, PA · (717) 263-4444 · Mailing Address: P.O. Box 778, Chambersburg, PA I7201-1)778 FINAL SETTLEMENT DATE OF SALE .. ~/"~'/'~"'~ y PHONE ? ?~X, .. ?S_CS-- ~ .PROFESSIONAL FEES AUCTIONEER CLERK $ CASHIER $ OTHER EXPENSES $ CASH CHECKS OTHER RECEIPTS $ TOTAL RECEIPTS LESS TOTAL EXPENSES I (or we), the seller, accept this settlement and acknowledge receipt of the above specified net proceeds from the auction of my goods and property sold on the above date. I accept oll responsibility for providing mercha~,table title to all goods, and properly sold, and for delivery of title to the purchaser· - Auctioneer or Cashier's Signature - (_../r - ' (S~r;s Signature) -/ ,' MAR-12-2004 FRI 05:53 PM ORRSTO~N KING ST ~7175309304 P, 001 SAFE DEPOSIT BOX INVENTORY COUNTY CODE ~ FILE NUMBER i DECEDENT'~ HAME ILAST,'FIRST, MI~DL~I ,r~ ADDRESS ~F D~CEDEH~E~ . ~ ~N~E AND ADDRESS OF PERSON REQUESTING THE OPENING OF TH~ SA~ DEPOSIT ~OX ~gJ~EGT AOORi~SE} (C~rd1 JSTXTE) ~Z~P ~oDq ~1 NAME, ADDRE.S,$ ANp RELATIONSHIP (iP ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING .. ,,,,',,~,~/.~ ~ \ k (,~^~,o.~.,,) "'. ..... ~.,~ a d/ ISTAT~I N (ZIP CO~Et [] NAME AND AODRES$ OF FINANCIAL INSI~ITUTION WHERE THE SAFE DEPOSIT BOX IS LOCA~D ~ HAM~ OF PERi~N MAKI~ ~IT E~RY ~ / ~ DATt ~NO TIME OF LA.ENTRY - ~/ ~ ~¢/~ ~ -- ~ '7-/~ - 0,~ , ' ~OflTRk~lO RENT BOX ~ HUMBGR O~ BOX ~ TITLE UNDER WHICH BOX 1~ ~ NAME AND ADDREES OF PERSON(S) HAVING ACCfSS TO BOX / 05:58 PM ~ST~K[NGST ~7175309304 P. 002 Page~of SAFE DEPOSIT BOX ;INVENTORY ~NSTRUCTION$ (1) Co,b: Reporl tolal only, ' .... · (2} Stock.z Llsl tn detail every common a~' preferred Iertificale, warrant ar other rlghll' found, n box Stocks ar~ to be deslgnaled by ~ame al company, certificate number, date of cerllfi~at~, name In which slack Is regisl~red, and number of shares and cia, of (3) Obligations el U: S. Gavemme~t1 ~umber o~ ~l~ms, date al issue, face value, hemal in which registered and type of ownership, 1.e., Jointly held, payable on death~ tic. (4) Bond~s Deslgnal~ by name, amount, serial number, or other designation· (Bearer Bonds) (S} ~nk and Savings and Loan Pallbook~ Slate name of depositor, cumber of book~ lost date appearing in book, name af bank and bra~ch, and balance. (6~ Jewelry~ Colnt~ Slamp~, Manu~dpts~ e~c~ Ud and describe as ~u~ly as po~ble. (7}.Deedl~ Mortgagel~ Current Inlurane~ PoIIclt. or other evldence~ of ~ully as (B) All oth.r conltntl. 05:58 PM ~KI~S~ ~7175809804 P. 003 ITEM DESCRIPTION ~o ~ - _ .~.- ., , .... ~e.oo LAST WILL AND TESTAMENT I, LEROY J. DAVIS, of 599 Baltimore Road, Shippensburg, Shippensburg Township, Cumberland County, Pennsylvania, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void all wills by me at any time heretofore made. FIRST. I order and direct the payment of all my legally enforceable debts and funeral expenses as soon as may be convenient after my decease. SECOND. I give, devise and bequeath all my estate, real, personal and mixed, whatsoever and wheresoever situate, to my daughter, LADONNA LEE DARHOWER, presently of 6 Brookview Drive, Newville, Cumberland County, Permsylvania. THIRD. In the event my said daughter, LADONNA LEE DARHOWER, should predecease me or is not living on the sixtieth (60th) day following my death, I then give, devise and bequeath my said estate to my niece, CAROL RUSSELL, presently of 32 Thompson Creek Drive, Shippensburg, Southampton Township, Cumberland County, Pennsylvania, on a per stirpes distribution basis. FOURTH. I nominate, constitute and appoint my daughter, LADONNA LEE DARHOWER, to be the Executrix of this my Last Will and Testament; if LADONNA LEE DARHOWER be unable to fulfill the duties of Executrix, I then nominate, constitute and appoint the ORRSTOWN BANK to be the Executor of this my Last Will and Testament. FIFTH. I direct that my personal representatives shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, LEROY J. DAVIS, have hereunto set my hand and seal to this my Last Will and Testament this ~,v? day of ~Fe~tJ,-'~R ,1998. (SEAL) This instrument was by the Testator, on the date hereof, signed, published and declared by him to be his Last Will and Testament, in our presence, who at his request and in the presence of each other, we believing him to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS. I, LEROY J. DAVIS, the person whose name ~s signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me by LEROY J. DAVIS, the Testator this ~Tt)~lq day of ~QT~)~/1,) ,1998. MARK, WEIGLE AND PERKINS ATTORNEYS AT LAW ] 26 EAST KING STREET SHIPPENSBURG, PA 172S7 1397 COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF CUMBERLAND : We, ,/-/>:(?'f.-..t,, ('~',i' ,: .~5c/ and C/,,~.~-<~'-- ~:--." ':'~'7;~'"'-"e:"--' , the witnesses whose names are sign~ to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw LEROY J. DAVIS, the Testator, sign and execute the instrument as his Last Will; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator, signed the will as witnesses; and that to the best of our knowledge the Testator was at the time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence, Sworn or affirmed to and subscribed before me by ~F/'k,/~/-c,;' ~;r g / witnesses, this ~ ¢~ day of ~e~ ,19,98.~ ESTATE OF LE ROY J. DAVIS File No. 21-04-0110 FAMILY SETTLEMENT AGREEMENT THIS AGREEMENT made this ,.,~,~ day of '!~!;¥'J'}9~''''' ,2004, BETWEEN: LA DO~A LEE DA~OWER, being the legatee under the Last Will and Testament of LeRoy J. Davis, late of the Township of Shippensburg, Cumberland County, Pennsylvania; AND LA DONNA LEE DARHOWER, Executrix of the Estate under the Last Will and Testament of LeRoy J. Davis, deceased, WHEREAS, LeRoy J. Davis, died December 24, 2003, testate, and under his Will left his estate to the p~y herein; and WHEREAS, Letters Testamentary were grated to LaDonna Lee Darhower on February 5, 2004, by the Register of Wills of Cumberl~d County, Pennsylvania; and WHEREAS, all assets of the late LeRoy J. Davis have been liquidated or distributed and all his debts paid in fhll, and fu~her the period of four months having been terminated since the first advertisement of the issuance o~' Letters to the said Executrix, the said party hereto desires to waive the duty of the Executrix to file a First and Final Account with Proposed Schedule of Distribution fiw purposes of confirmation by the Court of Common Pleas of Cumberland County, Orphan's Court Division, AND FURTHER desires that a Family Settlement Agreement be executed, which Family Settlement Agreement will be duly recorded among the deed records in and for Cumberland County. NOW, TIIEREFORE, WITNESSETH, that the party hereto, in consideration of the premises above stated, and of the Accounting and Proposed Schedule of Distribution attached hereto and made a part hereof, and the receipt of her distributive share as therein shown, does mutually bind herself to the said Distribution and Accounting as set fbrth and further releases LaDonna Lee Darhower, Executrix, from all claims and demands whatsoever arising out of settlement of the Estate of LeRoy J. Davis. The party hereto does further agree that should any liability come due to the estate of the said decedent alter the signing of this agreement, she does hereby covenant and agree with the aforesaid personal representative that she will contribute pro rata her share of the estate to satisfy any and all claims, demands, suits, or causes of action which may be successfully prosecuted against the said estate or the atbresaid personal representative alter the signing, sealing and delivery of this family settlement agreement and final release. IN WITNESS WHEREOF, the party has hereunto set her hand and seal the day and 3'ear first above written. WITNESS: ~"~/~- -/ '~' ~ ~ /' ~ (SEAL) LaDonna ~ee ISarhower COMMONWEALTH OF PENNSYLVANIA : : SS COUNTY OF CUMBERLAND : On this, the 3 -' day of / ;-~ ~4.-, , 2004, beibre me, the undersigned officer, personally appeared LA DONNA LEE DARHOWER, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, 1 hereunto set my hand and official seal. ] Notarial Soa~ ~ Linda K. ??, Nota~ Public ~ Shippensburg, P~ Cumberland Coun~ ~ommission Ex~re~ A2j~st 15, Court of Common Pleas of County, Pennsylvania Orphans' Court Division No. 21-04--0110 Estate of LeRoy J. Davis, Deceased Account of LaDonna Lee Darhower, Executrix Date of' Death: Date of Executor's Appointment Date of First Advertisement of Letters: Accounting for the Period: 12/24/2003 02~05~2004 02/10~2004 1 Z/24/2003 to 10128/2004 Purpose of Account: LaDonna Lee Darhower, Executrix, offers this account to acquaint intereste parties with the transactions that have occurred during this administration. It is important that the account be carefully examined. Requests for additional information or qu~ or objections can be discussed with: GROSS ESTATE (Principal Receipts + Income Receipts) Jerry A. Weigle, Esquire Attorney Identification No. 01624 Weigle & Associates, P.C. 126 East King Street Shippensburg, PA 17257 717-532-7388 tions 219,5(1.13 SUMMARY OF ACCOUNT Estate of LeRoy J. Davis, Deceased For the period of December 24, 2003 throuqh October 28, 2004 Proposed Distributions to Beneficiaries PaRe 12 PRINCIPAL Receipts: This Account Net Gain (or Loss) on Sales or Other Dispositions 1-2 Less Disbursements: Debts of Decedent 3 - 4 Funeral Expenses Administration Expenses 4 Federal and State Taxes 4 Commissions Fees 5 Family Exemption Balance Before Distributions Transfer from (to) Income Distributions to Beneficiaries 6 Principal Balance on Hand 7 For Information: Investments Made Changes in Investment Holdings 8 INCOME Receipts: This Account Net Gain (or Loss) on Sales or Other Dispositions 9 -10 Less Disbursements Balance Before Distributions Transfer from (to) Principal Distributions to Beneficiaries Income Balance on Hand For information: Investments Made Changes in Investment Holdings COMBINED BALANCE ON HAND 11 Current Value 5,876.38 0.00 643.00 8,529.09 0.00 10,235.78 0.00 Fi ~uciary Ac, luisition /alue 1 324.49 2' 9,260.52 0.00 2' 9,260.52 25,284.25 1-q 3,976.27 18 952.39 023.88 300.61 0.00 300.61 0.00 300.61 0,00 300.61 1:324.49 12/24/2003 12124/2003 12/24/2003 12124/2003 12/24/2003 1212412003 t2/24/2003 12/24/2003 12/2~2003 12/24/2003 12124/2003 12/2~2003 12/24/2003 1212412003 1212412003 1212412003 12/24/2003 1212412003 12/2412003 74.0000 218.0000 SCHEDULE A RECEIPTS OF PRINCIPAL Cash Cash (coins) from safe deposit box Check on hand at date of death - MetLife dated 1211512003 Deposit in transit at date of death - to Orrstown Bank Club Account MetLife Total Control Account ~403-!048373 Orrstown Bank Checking Account #513873 Accrued income on above item through date of death Orrstown Bank Club Account #960286 Accrued income on above item through date of death Orrstown Bank Savings Account #15826 Accrued income on above item through date of death Patriot Federal Credit Union Account #310620 Accrued income on above item through date of death Personal Property 1988 Cadillac - proceeds of sale 03~05~04 2001 Oldsmobile Intrigue - proceeds of sale 04101/2004 Gross proceeds of public sale 06/05/2004 Yamaha Motorcycle - proceeds of sale 06~22~2004 Stock / Listed MetLife Common Stock Shares shares Orrstown Bank Common Stock Real Estate in PA Residence at 599 Baltimore Road - Shippensburg Township, Cumberland County, PA 1 582.39 17.02 240.00 11,543.45 12,107.11 2.40 240.00 0.34 40,664.95 33.14 382.40 0.~ 3,500.00 5,800.00 6,842.25 500.00 2,558.94 14,170.00 116,200.00 ~ iduciary :quisition Value 65,813.64 16,642.25 16,728.94 04/15/2004 01/23/2004 01/'16/2004 06/011200z~ 04/20/2004 08~24~2004 0t/29/2004 03~09~2004 03~23~2004 SCHEDULE A RECEIPTS OF PRINCIPAL Continued Subsequent Principal Receipts 2003 1040 federal income tax refund AAA - refund AARP - refund Andorra Radiology - refund of overpayment Erie Insurance - refund of automobile insurance at cancellation Erie Insurance Group - refu nd of homeowner's premium Estate of Pearl Russell - reimbursement for funds advanced by decedent prior to date of death Monumental Life Insurance - proceeds of 3 policies UNUM Life Insurance - proceeds of policy 24.23 17.50 29.50 82.00 57.00 68.00 597.46 2,000.00 1,000.00 Total Receipts of Principal 2 Fiduciary A, :quisition Value 116,200.00 3,875.69 219,260.52 SCHEDULE C DISBURSEMENTS OF PRINCIPAL 01124/2004 02/12/2004 02/12/2004 02/12~2004 02117~2004 02/1712004 02~24~2004 03/01 ~2004 0310212004 03~04~2004 03/11/2004 03/11/2004 03~23~2004 0410812004 04/0812004 04/1312004 04~20~2004 05111/2004 0511912004 05/19/2004 0610112004 06~05~2004 06/14/2004 06/15~2004 07108/2004 Debts of Decedent Orrstown Bank Checking Account #513873 - checks clearing after date of death Penelec - 02/05/04 billing Central Penn Medical Group Emergency - 01/29/04 statement Commonwealth of PA -Cadillac registration Sprint - 02/04/04 billing Waste Management- 03/01/04 invoice Jennings Chevrolet/Oldsmobile - Cadillac inspection Barry L. Negley, Tax Collector - 03/01/04 real estate taxes Andorra Radiology - 02/12/04 statement LaDonna Lee Darhower- reimbursement for expenses paid prior to opening of estate, including Penelec - 161.98; Sprint - 123.86; CFJMA - 78.00; Erie Insurance - 285.00; Pharmacare - 23.63; Borough of Shippensburg 35.98; and Orrstown Bank- 40.00 Penelec - 03/04/04 billing Timmons Oil, Inc. - 03105/04 delivery Sprint - 03~04~04 billing Borough of Shippensburg - 04101104 billing Penelec - 04/01104 billing CFJMA - January - March sewer service Sprint - 04~04~04 billing Penelec - 05/03/04 billing Sprint - 05/04104 billing Erie Insurance - homeowner's premium Waste Management - 06/01/04 invoice Expenses of public sale Penelec - 06/03104 billing Sprint - 06/04104 billing Borough of Shippensburg - 07101104 billing 3 235.97 t05.22 28.40 36.00 58.86 55.19 61.37 363.51 83.78 748.45 47.33 166.19 58.30 35.98 21.98 78.00 39.61 21.98 44.29 25.00 60.26 1,912.30 24.34 44.29 35.98 07~08~2004 07/14/2004 07/14/2004 07114/2004 02112/2004 02/12/2004 02/13~2004 03/09/2004 08116~2004 09~02~2004 10/2812004 10~28~2004 10/2812004 03/17~2004 08/16~2004 SCHEDULE C DISBURSEMENTS OF PRINCIPAL Continued CFJMA - April - June sewer service Sprint - 07~04~04 billing Penelec - 07107104 billing Barry L. Negley, Tax Collector - school real estate taxes Total Debts of Decedent Miscellaneous Administration Expenses Register of Wills, Cumberland County - Letters Testamentary and Short Certificates Cumberland Law Journal - advertising Letters Testamentary Register of Wills, Cumberland County - 6 Short Certificates News Chronicle - advertising Letters Testamentary Register of Wills, Cumberland County -filing PA Inheritance Tax Return Recorder of Deeds, Cumberland County - recording deed to LaDonna Lee Darhower Register of Wills, Cumberland County - filing Family Settlement Agreement Weigle & Associates, P.C. - postage, xerox copies, and long distance telephone calls Linda K. Klein - notary fees Total Miscellaneous Administrative Expenses Taxes Register of Wills, Cumberland County - PA Inheritance Tax payment at discount Register of Wills, Cumberland County - PA Inheritance Tax balance due Total Taxes 4 78.00 43.68 55.34 1,306.78 292.00 75.00 18.00 92.75 15.00 39.50 75.00 25.75 10.00 8,500.00 29.09 5,876.38 643.00 8,529.09 SCHEDULE C DISBURSEMENTS OF PRINCIPAL Continued Fees 08/t6/2004 Weigle & Associates, P.C. - attorney fee Total Fees TOTAL DISBURSEMENTS OF PRINCIPAL 5 10,235.78 '10,235.78 25,284.25 LaDonna I~ee Darhower 03/04/2004 08/16/2004 08/26/2004 0812612004 SCHEDULE D DISTRIBUTIONS OF PRINCIPAL Cash (coins) from safe deposit box Cash Orrstown Bank Common Stock Residence at 599 Baltimore Road 582.39 50,000.00 14,170.00 116,200.00 TOTAL DISTRIBUTIONS TO BENEFICIARIES 6 180,952.39 180,952.39 # Units PRINCIPAL BALANCE ON HAND Description Cash Orrstown Bank Estate Account Total Cash 7 Current Value 10/28/2004 or as Noted 13,023.88 13,023.88 13,023.88 Fiduci~ Acquisil Value 13,0: 13,0: 13,0: :3.88 :3.88 :3.88 SCHEDULE F CHANGE IN INVESTMENT HOLDINGS - PRINCIPAL # Units Cash (coinS) from safe deposit box 1212412003 Inventoried 03/04/2004 Distributed Orrstown Bank Common Stock 12/24/2003 218.0000 Inventoried 08126/2004 Distributed 218.0000 Residence Bt 599 Baltimore Road 12/2412003 inventoried 08/26/2004 Distributed Total 8 Cost 582.39 -582.39 0.00 14,170.00 -14,170.00 0.00 116,200.00 -116,200.00 0.00 0.00 Orrstown Bank Common Stock 0t/23/2004 04~23~2004 07~23~2004 MetLife Tol~al Control Account #403-1048373 03/11/2004 Orrstown Bank Club Account #960286 02/1212004 Orrstown Bank Estate Checkinq Account 03107/2004 04~05~2004 05~05~2004 06~06~2004 07/0512004 08/15/2004 09/0612004 '10/05/2004 Orrstown I~ank Savinqs Account #15826 02/1212004 Patriot Federal Credit Union Account #310620 02128/2004 SCHEDULE G RECEIPTS OF INCOME Dividends Interest/Bank 9 50.14 52.32 52.32 65.80 0.40 9.06 9.01 8,51 9.15 8.74 9.41 4.73 1.60 19.08 0.34 154.78 65.80 0.40 60.21 19.08 SCHEDULE G RECEIPTS OF INCOME Continued TOTAL RECEIPTS OF INCOME l0 0.34 300.61 # Units INCOME BALANCE ON HAND Description Cash Orrstown Bank Estate Account Total Cash 11 Current Value Fiducia~ I012812004 Acquisiti or as Noted Value Y 300.61 303.61 300.61 303.6t 300.61 30 TO: PROPOSED DISTRIBUTIONS TO BENEFICIARIES Current Value '10/28/2004 or as noted Total LaDonna Lee Darhower F[duciary A( quisition Value 13,324,49 13,324.49 13,324.49 12 Court of Common Pleas of County, Pennsylvania Orphans' Court Division No. 21-04--0110 Estate of LeRoy J. Davis, Deceased Affidavit LaDonna Lee Darhower, Executrix, under the Last Will and Testament of Estate of LeRoy J. Davis Deceased, hereby declares under oath that he/she has fully and faithfully discharged the duties ~ his/her office; that the foregoing Account is true and correct and fully discloses all significant transactions occurring during the accounting period; that all known claims against the estate have been paid in full; that, to his/her knowledge, there are no claims now outstanding against tt estate; that all taxes presently due from the estate have been paid; and that more than four months have elapsed since the first complete advertisement of the granting of letters in this estate. ./ LaDonr~Lee Darhower, Executrix Subscribed and sworn to before me this day of ~'~-~-~ ,200 4 , Notary Public IM 'Notarial Seal J Linda K. Klein, N0ta~j Public J Shippensburg, PA Cumberland Cou,ty J y Commission Expires Au~n.s_t 15, 2008J REGISTER OF WILLS, CUMBERLAND COUNI~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: LeRoy J. Davis Date of Death: December 24, 2003 Will No. 21-04-0110 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administratio~ of the above-captioned estate: 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 Orphans' Court No. (if any) for the personal representative,s account is: c. Did the personal representative state an account informally to the parties in interest? Yes x No d. Copies of receipts, releases, joinders and approvals of formal or informal~aet~ounts may be f~]=~ "~t~the Cerk 'of the Orphans' Court anti, ay\be attac~ed t'o-~-~ Date: Jerry A. Weigle, Esquire /1 Name (Please type orvprint) WEIGLE.& ASSOCIkTES,,P.C. 126'East King Street Address Shippensburg, PA 17257 ~ 717 ) 532-7388 Tel. No. Capacity: X __Personal Representative Counsel for personal representative (MAH: rmf/AM3 ) BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 180601 HARRISBURG, PA 17128-0601 JERRY A WEIGLE ESQ WEIGLE & ASSOCS 126 E KING ST SHIPPENSBURG COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLO#ANCE OR DZSALLOHANCE OF DEDUCTZONS AND ASSESSNENT OF TAX RE¥-1547 EX AFP (01-05} PA~TE~7 DATE ESTATE OF DATE OF DEATH FILE NUNBER COUNTY ACN 10-19-200~ DAVIS 12-2~-2003 21 0~-0110 CUMBERLAND 101 Amount Remitted I LEROY J MAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGTSTER OF WTLLS CUMBERLAND CO COURT HOUSE CARLTSLE, PA 17013 CUT ALONG THZS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF ZNHERZTANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF DAVTS LEROY d FILE NO. 21 0~-0110 ACN 101 DATE 10-19-200~ TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. ReaZ Estate (SchaduZa A) (1) 2. Stocks and Bonds (Schedule B) (2) $. Closely Held Stock/Partnership Interest (Schedule C) ($) ~. Nortgagas/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) ($) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXENPTZONS: 9. Funeral Expanses/Ada. Costs/N/sc. Expanses (Schedule H) (9) 10. Dabts/Hortgaga Liabilities/Liens (Schedule [) (10) 11. Total Deductions 12. Net Value of Tax Return 116~200.00 16~728.9~ .00 .O0 83~263.58 .00 .00 (8) 10,839.28 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payaent. 15. NOTE: 216,192.52 5~876.38 (11) 16 .?l_~.&6 (1:') 199,~76.86 Charitable/Governmental Bequests; Non-elected 911:5 Trusts (Schedule J) (15) Nat Value of Estate Subject to Tax (1~) ]:f an assessment ~as issued previously, lines 1~, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. .00 199,~76.86 18 and 19 wlll TOTAL TAX CREDIT 8,976.~6 BALANCE OF TAX DUEI .00 ZNTEREST AND PEN. .00 TOTAL DUE .00 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED. IF TOTAL DUE ZS REFLECTED AS A 'CREDIT" (CR), YOU NAY BE DUE l~ A REFUND. SEE REVERSE SIDE OF THZS FORN FOR ZNSTRUCTZONS.) V~, IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 8,500.00 29.09 ASSESSMENT OF TAX: 1.6. Amount of Line 1~ at Spousal rata 16. Amount of Line 1~. taxable at Lineal/Class A rate 17. Aaount of Line lq at Sibling rate 18. Amount of Line 1~ taxable at Collateral/Class B rata 19. Principal Tax Due TAX CREDITS: PAYMENT RECETpT DTSCOUNT DATE NUNBER INTEREST/PEN PAID (-) 03-16-200~ CD003686 ~7.37 08-18-200~ CD00R289 .00 ANOUNT PAZD (1.5) .00 X 00 = .00 (16) 199,R76.86 X 0c~5= 8,976.r'6 (17) .00 X 12 = .00 (~8) .00 x 15 = .00 (19)= 8,976 .~.6 RESERVATION= PURPOSE OF NOT[CE: PAYNENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decadents dying on or before December ZZ, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to CZass B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (co[lateral) rate an any such futura interest. To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (7Z P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Hake check or money order payable to: REG/STER OF HILLS, AGENT A refund of a tax credit, which was not requested on the Tax Return~ may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available at the Office of the Register of Hills, any of the 23 Revenue District Offices) or by calling the special [4-hour answering service for forms ordering: I-BOO-36Z-Z050; services for taxpayers with special hearing and / or speaking needs= [-BOO-44?-30ZO (TT only). Any party in interest not satisfied with the appraisement) allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --mritten protest to the PA Department of Revenue, Board of Appeals, Dapt. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit) Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. Sas page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is a11omed. 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 Jn the same manner and in the the same time period as you mould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death) to the date of payment. Taxes which became delinquent before January 1, 19BI bear interest at the rate of six (BX) percent per annum calculated at a daily rate of °000164. All taxes which became delinquent on and after January 1, 1962 will bear interest at a rate ahich will vary from calendar year to calendar year eith that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through 2004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ ZOX .000548 ~'~'~'8-1991 XIZ .000301 ~ 9X .0002¢7 1983 16Z .000¢38 1992 9X .000Z47 ZOOZ 6X .000164 198¢ llZ .000301 1993-199¢ 7Z .000192 2003 52 .000137 1985 13Z .000356 1995-1998 92 .0002¢7 ZO0¢ 4Z .O00110 1986 XOZ .000274 1999 7Z .00019Z 1987 lOX .000274 ZOO0 7Z .O0019Z --Xnterest is caXculatad as follows: TNTEREST = BALANCE OF TAX UNPATD X NUNBER OF DAYS DELTNQUENT X DAILY TNTERBST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after tho interest computation date shown on the Notice, additional interest must be calculated. Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: 376 5/26/2005 LEON S. SHEDLOSKY 21-2005-0110 MIa-IAEL L BANGS, ESQ. 429 SOUTH 18TH STREET JA CAMP HILL, PA 17011 100.00 Total $100.00 Qty 1 Fee Description Additional Probate Fee v~ ~ \O()~ J .~ q-/~5 $100.00 Total: Checks should be made payable to the Register of Wills. Terms: Net 30. Please return one copy of this invoice with your payment. Thank you. ::;