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HomeMy WebLinkAbout04-0222Register of Wills of Cumberland PETITION FOR GRANT OF Estateof Forrest E. Richert also known as , Deceased Richard J. Worrall County, Pennsylvania LETTERS .o. Social Security No. 513 - 09- 7922 Petitioner(s), who is/are 18 years of age or older, apply(les) for: (COMPLETE 'A' or 'B' BELOW:) A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut nao~l in the last Will of the Decedent, dated 07/06/1°~ codicil(s) dated None State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: r--] B. Grant of Letters of Administration C: (c.ta.; d.b.n.c.t.a; pendente lite; durante _~, s~tia; du~ltto mino~ Petitioner(s) after a proper search has/have ascertained lhat Decedent left no Will and was survived by the follo~g sPOuse ~ny) and/ Name Relationship Residence heirs: I (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her last family or principal residence at 506 Brighton Place, U~3iger Allen Township, Mechanicsbur~, (list street, number, and municipality) Decedent, then 89yearsofage, died 01/24/2004at Messiah Villas;e, PA PA Decedent 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 17055 (Location) 1,500.00 situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersi~;ned: I Si~;nature T~,ped or printed name and residence /~'-~ ~/~/ , 2. 7 Richard J. Worrall ~Z.~f~f_.~/~~~ 506 Brishton Place, Mechanicsburs, Pa 17055 Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW- 1 (1991) Oath of Personal Representative Commonwealth of Pennsylvania 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 representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate_~7,c..~ding to law. Sworn to or affirmed and subscribed ~~/~.~,~-/ -~ Riehar-'d J. Worr~lZl~ before me this/-/' ;:lay of Foi' the Register NO, Estateof Forrest E. Richert Deceased Social Security No: 513 - 09- 793~,te of Death: 01/24/2004 ~'~.//.~ /.~ ,~O~//, in consideration AND NOW, / of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters F-'l~---t~tamentary ~ministration (c,t.a,; d,b.n,c.t.a.; pendents lite; durante absentia; durante minoritate) are hereby granted to Richard J. Worrall in the above estate and that the instrument(s) dated 07/06/1993 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........... $ Short Certificate(s) ..... $ Renunciation ........ $ Attorney: John E. Slike 06262 Saidis, Shuff, Flower & Lindsay 2109 Market Street Affidavits ( ) .... $ I.D. No: Extra Pages ( ) .... $ /k~?, 4:Q~'3 Address: Codicil ........... $ Camp Hill, PA 17011 JCP Fee .......... $ ,/~ .,f?<'_P Telephone: 717/737-3405 Inventory .......... $ Other ........... $ TOTAL ......... $ Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991) 105.81)5 REX,' 9/86 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as l.ocal 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, $2.00 P 9961509 No. Local Registrar -- - ~ ~ Date COMMONWEALTH OF PENNSYLVANIA o DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH NAME OF ~CEOENT (F~rst. M~dOle, LaSl) STATE FILE :~gMBEfl Forrest E..Richert .. le ,513 --09 --7922 ,Jan.24,2004 89 : ' : 18,1914 ,Kansas ,,.., [~] Cumberland OD. Upper Allen oil company DECE~NT'$ MAIL~4G AOOF~ ~,~, C~n. ~. Z~ ~e) 506 ~ighton Pla~ PS, ED FORCES? 8 (t.4or 5+) Cumberland ,-.~? ,,,.O ,~.,- ~-~_._,~ MOTHER'S NAME (F~. M~. MG~ ~n~) J,,~ude Z~n~ I,~,'s ~u~ ~ss~.c~. ~.z~c~ J~ Brighton Place, ~h~icsb~,PA 17055 [,~olling Gr~ ~t~ ~r ~1~ ~ ,PA17011 Mechanicsburg, PA17055 FATHER'S NAME (F~'~, M~d~e. Las~) ,.. John Richert Richard Worrall C~,,,~k~ E] .2004 LAST WILL AND TESTAMENT OF FORREST E. RICHERT I, FORREST E. RICHERT of Camp Hill, Cumberland County, Pennsylvania, make this Will, hereby revoking alll '~y f~mer~_~ls and Codicils. Article One Tangible Personal Property Sl.1 I bequeath all my tangible personal property, including by way of illustration but not by way of limitation, my household furniture and furnishings, paintings, books, automobiles, jewelry and personal effects, exclusive of any such property used in a trade or business, to my son, RICHARD J. WORRALL ("My Son"), if he survives me. If My Son does not survive me, such assets shall be sold and the proceeds shall pass as a part of my residuary estate. §1.2 To the extent practicable in the Executor's sole discretion, I bequeath any policies of insurance on such property to the beneficiary entitled to such property. §1.3 I direct that the expenses of storing, packing, shipping, insuring and delivering any such property to the beneficiary entitled thereto shall be paid by the Executor as an administrative expense of my estate. Article Two Residue §2.1 I devise and bequeath all the residue of my estate to the then serving trustee of "The Forrest E. Richert Revocable Trust" created under Agreement dated the same date as this Will by myself, as Settlor and Trustee (the "Trust Agreement"), as the same may be further amended or restated from time to time, to be distributed in accordance with the terms of said trust agreement, or if said trust agreement is not in effect at the time of my death, in accordance with the terms specified therein on the date of this Will or of its last publication by Codicil or otherwise. Article Three Appointment of Fiduciaries S3.1 I appoint My Son, RICHARD J. WORRALL, as Executor of this Will. If he is unable or unwilling to act or continue to act, for any reason whatsoever, I appoint My Son's sister, MARLENE WORRALL MoHALE, as successor Executrix. If she is unable or unwilling to act or continue to act, for any reason whatsoever, I appoint her husband, THOMAS M. MoHALE, as successor Executor. All references herein to the "Executor" shall mean my originally appointed Executor or my successor Executrix, as the case may be. -2- Article Four Powers of Fiduciarie~ §4.1 No fiduciary under this Will shall be required to give bond or other security for the faithful performance of the fiduciary's duties. §4.2 Any such fiduciary shall have the following powers, in addition to those given by law: S4.2.1 To invest in, accept and retain any real or personal property, including stock of a corporate fiduciary or its holding company, without restriction to legal investments; §4.2.2 To sell, exchange, partition or lease for any period of time any real or personal property and to give options therefor for cash or credit, with or without security; ~4.2.3 To borrow money from any person including any fiduciary acting hereunder, and to mortgage or pledge any real or personal property; ~4.2.4 To hold shares of stock or other securities in nominee registration form, including that of a clearing corporation or depository, or in book entry form or unregistered or in such other form as will pass by delivery; ~4.2.5 To engage in litigation and compromise, arbitrate or abandon claims; S4.2.6 To make distributions in cash, or in kind at current values, or partly in each, allocating specific assets to particular distributees on a non-pro rata basis, and for such purposes to make reasonable determinations of current values; -3- §4.2.7 To make elections, decisions, concessions and settlements in connection with all income, estate, inheritance, gift or other tax returns and the payment of such taxes, without obligation to adjust the distributive share of income or principal of any person affected thereby; S4.2.8 To allocate, in the Executor's sole and absolute discretion, any portion of my exemption under Section 2631(a) of the Internal Revenue Code (which statutory exemption is presently $1,000,000), to any property as to which I am the transferor, including any property transferred by me during my lifetime as to which I did not make an allocation prior to my death; and §4.2.9 To disclaim any interest I may have in any estate if the Executor deems such disclaimer to be in the best interests of my estate and the beneficiaries thereof. Article Five Provision For Taxes ~5.1 Ail estate taxes, inheritance taxes, transfer taxes and other taxes of a similar nature payable by reason of my death to any government or subdivision thereof upon or with respect to any property subject to any such tax, and any penalties thereon, shall be paid by the Executor out of the principal of that portion of my estate disposed of by Article Two of this Will, and all interest with respect to any such taxes shall be paid by the Executor out of the income or principal or partly out of the income and partly out of the principal of such portion of my estate, in the absolute discretion of the Executor, without reimbursement from or apportionment among the -4- beneficiaries, recipients or owners of such property for any such taxes, penalties or interest. Article Six Provision for Debts and Expenses §6.1 I direct that any of my legally enforceable debts, any expenses of my last illness, funeral and burial, and any of the administrative expenses of my estate, shall be paid from the principal of that portion of my estate disposed of by Article Two of this Will. Article Seven Miscellaneous Provision~ S7.1 As used in this Will, the term "Internal Revenue Code" shall mean the Internal Revenue Code of 1986, as amended from time to time, or the corresponding provision of subsequent law. IN WITN~.B8 W~.R~.OF, I have hereunto set my hand and seal this ~ day of ~ , 1993. Forrest E. Richert (SEAL) Signed, sealed, published and declared by the above named Forrest E. Richert as and for his last Will, in the presence of us and each of us, who, at his request and in his -5- presence and in the presence of each other, have hereunto subscribed our names as witnesses thereto the day and year last above written. -6- COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF _1~_ ~Qp~ : We, Forrest E. Richert, the testator, and ~L~ ~. [k)oLg~_ , ~%~6f~LV ~ ~.%~L£ and ~v?£~ ~. ~£~k% the witnesses whose names are signed I ' ' ' to the attached or foregoing instrument, being ~irst duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his last Will; that the testator signed willingly and executed it as his ~ree and voluntary act for the ~ur~oses therein e×~ressed; that each subscribing witness in the hearing and sight o~ the testator signed the Will as a witness and that to the best of his or her knowledge the testator was at that time ~8 ~ears of age or older, of sound mind and under no constraint or undue influence. Forrest E. Richert ~ Witness Witness Subscribed, sworn to and acknowledged before me by Forrest E. Richert, the testator, and subscribed and sworn to befo~ me by ~LVN ~'. ~3Ok~ , k~i~k\/ i~. ~)~d:)~q-T'L~V' and ~kY~ ~. ~~ , witnesses, this I ~ da~of ~u~ / ,'1993. 7 ~ Notir~ /P~lic (SF~%L) My Commission Expires: -7- NOTARIAL SEAL LINDA D. SPE;DE/, Notary Public Harrisburg, Dauphin County, Pa. My C.__._.ommission Expires May 16, 1994 JOHN E. SLIKE ROBERT C. SAIDIS GEOFFREY S. SHUFF JAMES D. FLOWER, JR. CAROL J. LINDSAY MATTHEW J. ESHELMAN KIRK S. SOHONAGE THOMAS E. FLOWER LINDSAY GINGRICH MACLAY JACLYN SMITH LAW OFFICES SAIDIS, SHUFF, FLOWER & LINDSAY A PROFESSIONAL CORPORATION 2109 MARKET STREET CAMP HILL, PENNSYLVANIA 17011 TELEPHONE: (717) 737-3405 - FACSIMILE: (717) 737-3407 EMAIL: attomey@ssfl-law.com OF COUNSEL ALBERT H. MASLAND CARLISLE OFFICE: 26 WEST HIGH STREET CARLISLE, PA 17013 TELEPHONE: (717)243-6222 FACSIMILE: (717)243-6486 REPLY TO CAMP HILL April 15, 2004 Register of Wills Cumberland County Courthouse Carlisle, PA 17013 Re: The Estate of Forrest E. Richert File No. 21-04-0222 Dear Ladies: Enclosed please find a check in the amount of $44,500.00 representing a payment at discount towards inheritance taxes in the above-referenced estate. Kindly issue a receipt at your earliest convenience. Very truly yours, SAIDIS, ~tHUFF,FLg~ER & LINDSAY Shelby L./Ying,~J6g, Estate Paralegal /sly Enclosure cc: Richard Worrall REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE $.6(A) Name of Decedent: Forrest E. Richert Date of Death: January 24, 2004 Will No. 21-04-0222 Admin. No. To the Register: I certify that notice of Estate Administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiary of the above- captioned estate on March 12, 2004. malBe Richard J. Worrall Address 506 Brighton Place, Mechanicsburg, PA 17055 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except none Date: john E. Slike} Esquire g~ 09 Market Street Camp Hill, PA 17011 (717) 737-3405 Capacity: X Personal Representative Counsel for Representative Personal COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD REV-1162 EX(11-96) 003835 SLIKE JOHN E 2109 MARKET STREET CAMP HILL, PA 17011 fold ESTATE INFORMATION: SSN: 513-09-7922 FILE NUMBER: 2104-0222 DECEDENT NAME: RICHERT FORREST E DATE OF PAYMENT: 04/16/2004 POSTMARK DATE: 04/1 6/2004 COUNTY: CUMBERLAND DATE OF DEATH: 01/24/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $44,500.00 ~I'.EMARKS: SEAL CHECK//134 TOTAL AMOUNT PAID: $44,500.00 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS JOHN E. SLIKE ROBERT C. SAIDIS GEOFFREY S. SHUFF JAMES D. FLOWER, JR. CAROL J. LINDSAY MATTHEW J. ESHELMAN KIRK S. SOHONAGE THOMAS E. FLOWER LINDSAY GINGRICH MACLAY JACLYN SMITH LAW OFFICES SAIDIS, SHUFF, FLOWER & LINDSAY A PROFESSIONAL CORPORATION 2109 MARKET STREET CAMP HILL, PENNSYLVANIA 17011 TELEPHONE: (717) 737-3405 - FACSIMILE: (717) 737-3407 EMAIL: attomey@ssfl-law.com April 29, 2004 OF COUNSEL ALBERT H. MASLAND CARLISLE OFFICE: 26 WEST HIGH STREET CARLISLE, PA 17013 TELEPHONE: (717)243-6222 FACSIMILE: (717)243-6486 REPLY TO CAMP HILL Register of Wills Cumberland County Courthouse Carlisle, PA 17013 Re'. The Estate of Forrest E. Richert File No. 21-04-0222 Dear Ladies: Enclosed please find an original and two copies of an Inheritance Tax Re{i~rn in reg~d to the above estate. Also enclosed is a check for the filing fee. Please return a time-stamped copy of the return in the envelope provided. /sly Enclosures Very truly yours, SAID~S~, SHUFF, FLOWER & LINDSAY Shelby L.}Yingfing, Estate Paralegal OFFICIAL USE ONLY R - 5ooEx+(6-oo REV-1500 COMMONWEALTH OF PENNSYLVAN,A INHERITANCE TAX RETURNFILE NUMBER DEPARTMENT OF REVENUE DEPT. 260.01 RESIDENT DECEDENT 21- 04- 0222 HARRISBURG, PA 17128-0601 i COUNTY CODE YEAR NUMBER Dt:C~-uENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Richert Forrest E. 513 - 09- 7922 DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPUCA 0T Z 7 04 o8/18/1914 REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ 1- OdginalRetum ~2. Supplemental Return J~ 3. Remainder Return (pC~a 4. Limited Estate 4a. f ~l~r~p~ Compromise (date of death after 12-12- 5. Federal Estate Tax Retum 6. Decedent Died Testate 7. Beqeb~dt Maintained a Living Trust 0 8. Total Number of Safe Depo (Attach copy of Will) (~4~Jmsopy of Trust) ~ 9. Litigation Proceeds Received~-'--] 10. Spousal Poverty Credit [] 11. Election ,o tax under Sec. 9 ,art~f death between 12-31-91 and 1-1-95) NAME COMPLETE MAILING ADDRESS John E. Slike FIRM NAME (If Applicable) 2109 Market Street Saidis, Shuff, Flower & Lindsay Camp Hill, PA 17011 TELEPHONE NUMBER ' 717/737- 34,05 1Real Estate (Schedule A) (1) None OFFICIAL USE ONLY 2Stocks and Bonds (Schedule B) (2) None 3Closely Held Corporation, Partnership or (3) Sole-Proprietorship .... c:~ '~'~ 4Mortgages & Notes Receivable (Schedule D) (4) N&ne $Cash. Bank Deposits & Miscellaneous Personal Property (5) 100,00 (Schedule E) 6Jointly Owned Property (Schedule F) (6) 8,320.37 F~eparate Billing Requested 7inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 1,042,362,55 (Schedule G or L) 8.Total Gross Assets (total Lines 1-7) (8) r.,a 1,050,782.92 9Funeral Expenses & Administrative Costs (Schedule H) (9) 11,325.81 1O3ebts of Decedent. Mortgage Liabilities, & Liens (Schedule I) (10) 1,446.73 111'otal Deductions (total Lines 9 & 10) (11) 12,772.54 1;adet Value of Estate (Line 8 minus Line 11) (12) 1,038,010.38 13Dharitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13). made (Schedule J) l~let Value Subject to Tax (Line 12 minus Line 13) (14) 1,038,010.38 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15~mount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) X .0 0 (15) 0.00 16ikmount of Line 14 taxable at lineal rate 1,038,010.38 X .0"45 (16) 46 710.47 17Amount of Line 14 taxable at sibling rate ' X .12 (17) 0.00 180,mount of Line 14 taxable at collateral rate X .15 (18) 0o 00 19Tax Due 20 :..~,~ ................ , ............................................ (19) 46,710 47 Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV- 1500 EX (Rev. 6-00) Decedent's Complete Address: iS~HEET ADDRESS 506 Brishton Place CITY Mechanicsbur8 Tax Payments and Credits: 1.Tax Due (Page 1 Line 19) 2Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3Jnterest/Penalty if applicable D. Interest E. Penalty STATE ZIP PA 17055 0.00 44,500.00 2,335.52 (~) Total Credits ( A + B + C ) (2) 46,710.47 46,835.52 0.00 125.05 0.00 0.00 0.00 Total Interest/Penalty ( D + E ) (3) 4Jf Line 2 is greater than Line I + Line 3, enter the difference. This is the OVERPAYMENT, Check box on Page 1 Line 20 to request a refund 5Jf Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE, A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE, (4) (s) (SA) (SB) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING GUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ......................... ~ ~ b. retain the right to designate who shall use the property transferred or its income; ........... c. retain a reversionary interest; or .................................... d. receive the promise for life of either payments, benefits or care? ................... 21f death occurred after December 12, 1982, did decedent transfer properly within one year of death without receiving adequate consideration? ................................ r'~ ~] 3Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ~] 4Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................ [--1 ~ IF THE ANSWER TO ANY OF THE ABOVE GUESTIONS 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 retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge, SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN R f chard J Worrall . D ~'~ '.~'_., ,? ~ .... ' 506 Bri~h;on Place ~/~Z/~? ^ S~G NA~J.IRE'~F PRE PAR F~t~:rH E.~ THAN R EPRESE NTATiVE Saidis qk,,FF ~l ...... .c. T;~.4~.. ~ ! ~ /.~ .... . , ...... , ..... ~. ~ ~.L~L,.~C~y Z// e / ~/~,' /~ '~ / / 2109 Market Street ~/~t~./~ / A .... ......................... T For d~tes of death on or after July 1, 1994 and before January 1,'1995,'the tax rate imPosed on the net valu~ of tra~sfeis't~' oi f~i'the ~e 0f't~e ....... surv~wng spouse is 3% [72 P.S. 9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2) [72 P.S. 9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) II REV-1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER Forrest E. Richert SS~/ 513-09-7922 01/24/2004 21-04-0222 Include the proceeds of litigation and the date theproceeds were received by the estate. All I~rol~erty jointly-owned with the right of survivorsh,p must be disclosed on Schedule F. ITEM NUMBEF VALUE AT DATE DESCRIPTION OF DEATH 5 American Express Travelers Cheques, $20 denomination 100.00 TOTAL (Also enter on line 5, Recapitulation) $ 100.00 Copyright (c) 1996 form software only CPSystems, Inc.(If more space is needed, insert additional sheets of the same size) Form REV-1508 EX (Rev. 1-97) REV-1509 EX + (1-97) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Forrest E. Richert SS~/ 513-09-7922 01/24/2004 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. FILE NUMBER 21-04-0222 SURVIVINGJOINTTENANT(S) NAME ADDRESS RELATIONSHIPTO DECEDENT A. Richard J. Worrall 506 Brighton Place son Mechanicsburg, PA 17011 JOINTLY-OWNED PROPERTY: L~- ~ I ER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bani DATE OF DEATH DECD'S VALUE OF account number or similar identifying numbe NUMBEF TENANT JOINT Attach deedforjointly-held realestate. VALUE OF ASSET INTEREST DECEDENT'S INTERE,~ 1 A 07/28/80 M&T Bank, checking acct. 71784055 7,728.06 50. 0070 3,864.03 2 A 10/28/80 M&T Bank, checking acct. 91653622 8,912.68 50.0070 4,456.34 TOTAL (Also enter on line 6, Recapitulation) $ 8,320.3 7 ~T (If more space is needed insert additional sheets of the same size) Copyright (c) 1996 form software only CPSysterns, Inc. Form REV- 1509 EX (Rev. 1-97) REV-1510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Forrest E. Richert SS~/ SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY 513-09-7922 01/24/2004 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is es. FILE NUMBER 21-04-0222 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1510 EX (Rev. 1-97) DESCRIPTION OF PROPERTY % OF ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE RE~TIONSHIP TO DECEDENT AND ME DATE OF TRANSFER. NUMBER A~ACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST 0F APPLICABLE) 1 Revocable Inter Vivos Trust Dated 7/06/93, containing the following: M&T Bank, chking act. 10442952 8,021.25 100.00% 8,021.25 5411.353 TRP, Equity Inc. Fd. 134,688.58 100.00% 134,688.58 5411.015 I~RP, Growth and Inc. Fd 121,314.96 100.00% 121,314.96 10517.35 TRP, New Income Fd. 95,813.06 100.00% 95,813.06 17173.39 TRP, Tax Free Hi Yd Fd 201,615.60 100.00% 201,615.60 259177 Summit Cash Reserve 259,177.00 100.00% 259,177.00 14172.93 Evergreen Str. Inc. Fd. 94,108.26 100.00% 94,108.26 2122.739 Putnam Funds 36,808.29 100.00% 36,808.29 7393.421 Vanguard Hi Yd Fd 80,295.55 100.00% 80,295.55 10520 sh. Wachovia 10,520.00 100.00% 10,520.00 TOTAL(Alsoenteronline7, Recapit~ation) 1,042,362.55 REV-1511 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Forrest E. Richert SS# SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS 513-09-7922 01/24/2004 Debts of decedent must be reported on Schedule I. ITEM NUMBEF 5. 6. 7. FILE NUMBER 21-04-0222 =UNERALEXPENSES: Musselman Funeral Home Rolling Green Cemetery DESCRIPTION ~,DMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: Attorney's Fees Saidis , Shuff, Flower & Lindsay Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address C~ty Relationship of Claimant to Decedent Probate Fees Re§ister of Wills Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Cumberland Law Journal, estate notice The Patriot News, estate notice The Register of Wills, filing fee State Zip (If more space is needed, insert additional sheets of the same size) TOTAL (Aisc enter on line 9, Recapitulation) 7,383.36 2,146.00 Form REV-1511 EX (Rev, 1-97) $ 11,325.81 62.00 75.00 144.45 15.00 Copyright (c) 1996 form software only CPSystems, Inc. AMOUNT 1,500.00 REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Forrest E. Richert SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS SS# 513-09-7922 01/24/2004 FILE NUMBER 21-04-0222 Include unreimbursed medical expenses. NUMBER 1 2 3 4 5 Copyright (c) 1996 form software only CPSystems, Inc. II DESCRIPTION Elite Staffing Services, in-home nursing care Quantum Imaging Quantum Imaging Internists of Central PA Internists of Central PA AMOUNT 1,160.00 29.49 25.62 50.48 181.14 TOTAL (Also enter on line 10, Recapitulation) 1,446.73 (If more space is needed, insert additional sheets of the same size) Form REV-1512 EX (Rev, 1-97) REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Forresl E. Richert SS# NUMBEF I. II. SCHEDULE J BENEFICIARIES 513 - 09- 7922 01/24/2004 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY rAXABLE Di$¥~IBUTIONS [include outfight spousal distributions, and transfers under Sec, 9116(a)(1.2)] Richard J. Worrall 506 Brighton Place Mechanicsburg, PA 17055 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) s on FILE NUMBER 21-04-0222 AMOUNT OR SHARE OF ESTATE entire estate (benef. of inter vivos trust) ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 181 AS APPROPRIATE1 ON REV 1500 COVER SHEET qON-TAXABLE DiStRIBUTIONS: ~. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00) Name Symb TRPEquity Income prfdx TRP Growth and Income prgix TRP New Income prcix TRP Tax Free High prfhx Summit Cash Reserve Tscxx Evergreen Strategic George Putnam A Vanguard High Yield T-E Wachovia Total eksax pgeox vwahx 1/23/04 24.78 22.33 9.12 11.75 1.00 6.65 17.29 10.87 1/26/04 # shares Value 1/23 value 1126 24.99 5411.353 $134,093 $135,230 22.50 5411.015 $120,828 $121,748 9.10 10517.35 $95,918 $95,708 11.73 17173.39 $201,787 $201,444 1.00 259177 $259,177 $259,177 6.63 14172.93 $94,250 $93,967 17.38 2122.739 $36,702 $36,893 10.84 7393.421 $80,366 $80,145 $10,520 $10,520 $1,033,642 $1,034,830 / 499 Mdc:hell Road Millsboro, DE 1 Mad code DF MB 12 Phone 888-502-4349 Fax: 302-9~ 2955 Fax -CommentS: Attached, plea$c find the irffOrm;dt()r~ ',,,~ .: requested foF '(ho E:stato of Forr(:jt E Riched. cllq :C.O ~,0 9[ JeW Ill c~n be et flJdher assistance, please do not hosit;~i,: ~o c~ll mc; ,3t 30? 9~-29t.)9. Thank you and have a gmat ciay~ Sue Kimble ~ M & T Bank This oommunicallon oontainA irflormahon wh~Gh may be conhdenfJal and pfopri(.~tl¥ You may not u.~;e, dls:;emu~at(~. distribute or copy all or any pad of this communication w,thout the ~press c~nsenI of M & [ Bank, AIIf~mt [ ~nanoal Inc or their ms.dive subsidiaries or affiliates. In addison, ~ you are hal the addressee (or are authonzed ~o fe~vo this information ~ the addms~e), you are not au~onzed to ~e~ive o, ~ev~ew the ~ntents of this ~n)muni~tfOn. if you have r~lved ~is ~mmunm~tion ~r} cfoL ple85o ~OtL~rn it to M & T 0~nk ~ P.O. 0~ 15~, ~ltimore, MD 21203 and delet~ any ~py of this communic'iliori ~om your systems Thank you ~,0 9I · .J e i4 6263 CO~,~ONV~ALTH of PENNSYLVANIA C~: urt~f of CUMBERLAND ~'%ob~rt P. Ziegler, Recorder, do herel~ C¢-rtif.? that the foregoing Is a true a~l cr:.rree~copy as appears i~1. ./~ ~JC Vol. '7~ Pa~ ! ~ Witness my hand oJ/Jcial seal ~ ~.~r.) _ D..ayof_ f-~-~,.,~ ' R~order of Deeds Commission Expires. 1st Monday, Jam~my 2006 THE FOP. REST E. RICHERT REVOCABLE TRUST THIS AGREEMENT is made and entered into this ~ day of ~ , 1993, by and between FORREST E. RICHERT, of Camp Hill, Cumberland County, Pennsylvania, as settlor (the "Settlor"), and FORREST E. RICHERT, as trustee (the "Trustee"). WITNESSETH: WHEREAS, the Settlor desires to transfer certain assets to the Trustee to be managed by the Trustee for the benefit of the Settlor for his life, and upon his death, to be distributed as set forth herein; and WHEREAS, the Settlor hereafter may make additional transfers of assets to the Trustee. NOW, THEREFORE, for and in consideration of their mutual covenants and promises, the Settlor and Trustee agree as follows: Article One Trust Assets §1.1 The Settlor, or any other party or person, may from time to time make policies of insurance on the Settlor's life, individual retirement account benefits, and/or qualified or non-qualified retirement plan benefits payable to the Trustee, or may transfer other assets to the Trustee, subject to the terms of this Agreement, by inter vivos grant or by Will. The trust assets shall include the proceeds of all insurance policies payable to the Trustee and all such other benefits or added assets (collectively, the "Trust Assets"), which shall be held, administered, distributed and governed by the Trustee, IN TRUST NEVERTHELESS, in accordance with the provisions of this instrument and any amendments hereto. Article Two Durinq the Settlor's Lifetime §2.1 During the Settlor's lifetime, the Trustee shall have, hold, manage, invest and reinvest the Trust Assets, collect the income, and §2.1.1 The Trustee shall pay or apply all or a portion of the net income of the Trust Assets as the Settlor may from time to time direct in -2- writing. The Trustee shall also pay to the Settlor such sums from or portions of the principal of the Trust Assets as the Settlor may from time to time request in writing delivered to the Trustee during the Settlor's lifetime. S2.1.2 The Trustee shall pay and use such portion or all of the income and principal of the Trust Assets as the Trustee, in the Trustee's sole discretion, shall deem necessary from time to time to provide for the proper maintenance, support, medical, hospital, nursing or nursing home care of the Settlor. Article Three Upon the Settlor's Death §3.1 Upon the death of the Settlor, the Trustee shall distribute the Trust Assets to or for the benefit of the Settlor's adopted son, RICF~%RD J. WORRALL (the "Settlor.s Son"), if he is then living. If the Settlor's Son is not living at the Settlor's death, the Trust Assets shall be distributed to or for the benefit of the Settlor's Son's sister, MARLE~E WORRALL Me.ALE, if she is then living. If she is not living at the Settlor's death, the Trust Assets shall be distributed to or for the benefit of her husband, THOMAS M. Mc~ALE, if he is then living. If he is not living at the Settlor's death, the Trust Assets shall be distributed to or for the benefit of the then living issue of MARLE~E WORRALL Mc~ALE, per stirpes. -3- BOOK 706 CE.t478 Article Four Appointment of Fiduciaries §4.1 If the Trustee is unable or unwilling to act or to continue as Trustee, for any reason whatsoever, the Settlor's Son, RICHARD J. WORRALL, is appointed as successor Trustee. If the Settlor's Son is unable or unwilling to act or to continue as Trustee, for any reason whatsoever, the Settlor's Son's sister, MARLENE WORRALL McHALE, is appointed as successor Trustee. If she is unable or unwilling to act or continue to act as Trustee, for any reason whatsoever, her husband, THOMAS M. McHALE, is appointed as successor Trustee. All references herein to the "Trustee" shall mean the originally appointed Trustee or a successor Trustee, as the case may be. Article Five Powers of Fiduciaries §5.1 No fiduciary under this Agreement shall be required to give bond or other security for the faithful performance of the fiduciary's duties. §5.2 Any such fiduciary shall have the following powers, in addition to those given by law: -4- 706 , E1479 §5.2.1 To invest in, accept and retain any real or personal property, including stock of a corporate fiduciary or its holding company, without restriction to legal investments; §5.2.2 To sell, exchange, partition or lease for any period of time any real or personal property and to give options therefor for cash or credit, with or without security; §5.2.3 To borrow money from any person including any fiduciary acting hereunder, and to mortgage or pledge any real or personal property; §5.2.4 To hold shares of stock or other securities in nominee registration form, including that of a clearing corporation or depository, or in book entry form or unregistered or in such other form as will pass by delivery; §5.2.5 To make distributions in cash, or in kind at current values, or partly in each, allocating specific assets to particular distributees on a non-pro rata basis, and for such purposes to make reasonable determinations of current values; S5.2.6 To execute any agreement relating to the disposition or redemption of any business interest that may be a part of the trust estate, whether the same involves a proprietary interest, a partnership interest or stock in a closely held corporation; §5.2.7 To operate or arrange for the operation of any business interest held hereunder, and to join or become a party to, or to oppose, any reorganization, readjustment, foreclosure, merger, voting trust, dissolution, consolidation or exchange relating to any such business interest; §5.2.8 To engage in litigation and compromise, arbitrate or abandon claims; -5- bOOK 706 §5.2.9 To determine the apportionment of receipts and expenses, including extraordinary cash dividends, stock dividends, capital-gain dividends of regulated investment companies and proceeds and expenses of the sale of unproductive real estate, between income and principal, such apportionment to be made so as to balance fairly the interests of any income beneficiary and the remaindermen; §5.2.10 To make elections, decisions, concessions and settlements in connection with all income, estate, inheritance, gift or other tax returns and the payment of such taxes, without obligation to adjust the distributive share of income or principal of any person thereby affected; §5.2.11 The Settlor's Executor is authorized to allocate any of the Settlor's exemption from federal generation skipping transfer tax under §2631 of the Code to any property as to which the Settlor is the deemed transferor under §2652(a) of the Code, regardless of whether or not the property with respect to which an election or allocation is made is part of the Settlor's probate estate. Any such election or allocation shall be binding upon the Trustee and any beneficiary of any trust created hereunder. The Trustee is authorized to divide any trust created hereunder into two or more separate trusts if such separation, in the discretion of the Trustee, is advantageous to such trust and the beneficiaries of such trust for the purposes of application of the federal generation skipping transfer tax; provided, however, that such separated trusts shall be held, administered and disposed of in accordance with the terms hereunder as identical trusts in all other respects. Article Six Provision For Taxes, Debts and Expenses §6.1 The Trustee may pay any of the Settlor's legally enforceable debts, any expenses of his last illness, funeral, -6- 70(; burial and administrative expenses of his estate and estate taxes, inheritance taxes, transfer taxes and other taxes of a similar nature payable by reason of the Settlor's death to any government or subdivision thereof upon or with respect to any property subject to any such tax, and any penalties thereon, or any portion thereof, in the Trustee's sole discretion, without reimbursement, out of the principal of the Trust Assets. Article Seven Revocability §7.1 The Settlor may, by instrument in writing delivered to the Trustee, modify, alter or revoke this instrument in whole or in part; provided, however, that the duties, powers, compensation and liability of the Trustee shall not be changed without the written consent of the Trustee. Article Eight Miscellaneous ProvisioD~ §8.1 As used in this Agreement, the term "Internal Revenue Code" shall mean the Internal Revenue Code of 1986, as amended from time to time, or the corresponding provision of subsequent law. -7- 706 PAOE.[4,B2 §8.2 Whenever the Trustee is directed to distribute property to or for the benefit of any beneficiary who is under (a) twenty-one (21) years of age, or (b) a legal disability or otherwise suffers from an illness or mental or physical disability that would make distribution directly to such beneficiary inappropriate (as determined in the Trustee's sole discretion exercised in good faith), the Trustee may distribute such property to the person who has custody of such beneficiary, may apply such property for the benefit of such beneficiary, may distribute such property to a custodian for such beneficiary, whether then serving or selected and appointed by the Trustee (including the Trustee), under any applicable Uniform Transfers to Minors Act or Uniform Gifts to Minors Act, may distribute such property directly to such beneficiary's estate, or may distribute such property directly to such beneficiary (except if any of the conditions hereinbefore described in (b) apply), without liability on the part of the Trustee to see to the application of such property. This provision shall not in any way operate to suspend such beneficiary's absolute ownership of such property or to prevent the absolute vesting thereof in such beneficiary. §8.3 Except as otherwise may be provided in this Agreement, during the continuance of any of the trusts created -8- hereunder and thereafter until the property is distributed to and received by any beneficiary hereunder, the principal sums thus held in trust for any beneficiary, respectively, and the income thereof shall not be subject to or liable for any contracts, debts, engagements, liabilities or torts of such beneficiary now or hereafter made, contracted, incurred or committed, but shall be absolutely free from the same, and such beneficiary shall have no power to sell, assign or encumber all or any part of the principal sums or such beneficiary's interest therein, respectively, or the income thereof, or to anticipate the income. §8.4 A fiduciary shall be entitled to receive reasonable compensation for such fiduciary's services hereunder. This instrument and any trust created hereunder shall be governed by the laws of Pennsylvania and shall have its situs in Cumberland County, Pennsylvania. IN WI?NESS W~EREOF, the Settlor and the Trustee have hereunto affixed their hands and seals and/or caused this instrument to be duly executed on the date and year first written above. -9- WITNESS: SETTLOR: Forrest E. Richert (SEAL) TRUSTEE: Forrest E. Richert (SEAL) -10- THE FORREST E. RICHERT REVOCABLE TRUST SCHEDULE A WITNESS: SETTLOR: Forrest E. Richert (SEAL) TRUSTEE: By: Forrest E. Richert (SEAL) -11- COMMONWEALTH OF PENNSYLVANIA ) ) COUNTY OF ~[~DH1AJ ) SS: On this, the ~ day of ~[y ,1993, ! before me, a notary public, the undersigned officer, personally appeared Forrest E. Richert known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. seal. IN WITNESS WHEREOF, I hereunto set my hand and official NOTARIAL SEAL LINDA D, SPEIDEL, No~ry Public Harriq~ur~, D ..... ~ ~ ~, ~ .... County, Pa. My Commission Expires May ]6, 1994 -12- I Certify this to be recorded' In Cumberland County PA LAST WILL AND TESTAMENT OF FORREST E. RICHERT I, FORREST E. RICHERT of Camp Hill, Cumberland County, Pennsylvania, make this Will, hereby revoking all my former Wills and Codicils. Article One Tanqible Personal Property §1.1 I bequeath all my tangible personal property, including by way of illustration but not by way of limitation, my household furniture and furnishings, paintings, books, automobiles, jewelry and personal effects, exclusive of any such property used in a trade or business, to my son, RICHARD J. WORRALL ("My Son"), if he survives me. If My Son does not survive me, such assets shall be sold and the proceeds shall pass as a part of my residuary estate. §1.2 To the extent practicable in the Executor's sole discretion, I bequeath any policies of insurance on such property to the beneficiary entitled to such property. §1.3 I direct that the expenses of storing, packing, shipping, insuring and delivering any such property to the beneficiary entitled thereto shall be paid by the Executor as an administrative expense of my estate. Article Two Residue §2.1 I devise and bequeath all the residue of my estate to the then serving trustee of "The Forrest E. Richert Revocable Trust" created under Agreement dated the same date as this Will by myself, as Settlor and Trustee (the "Trust Agreement"), as the same may be further amended or restated from time to time, to be distributed in accordance with the terms of said trust agreement, or if said trust agreement is not in effect at the time of my death, in accordance with the terms specified therein on the date of this Will or of its last publication by Codicil or otherwise. Article Three Appointment of Fiduciaries S3.1 I appoint My Son, RICHARD J. WORRALL, as Executor of this Will. If he is unable or unwilling to act or continue to act, for any reason whatsoever, I appoint My Son's sister, MARLENE WORRALL Mc~ALE, as successor Executrix. If she is unable or unwilling to act or continue to act, for any reason whatsoever, I appoint her husband, T~OMAS M. Mc~ALE, as successor Executor. All references herein to the "Executor" shall mean my originally appointed Executor or my successor Executrix, as the case may be. -2- Article Four Powers of Fiduciaries §4.1 No fiduciary under this Will shall be required to give bond or other security for the faithful performance of the fiduciary's duties. §4.2 Any such fiduciary shall have the following powers, in addition to those given by law: §4.2.1 To invest in, accept and retain any real or personal property, including stock of a corporate fiduciary or its holding company, without restriction to legal investments; §4.2.2 To sell, exchange, partition or lease for any period of time any real or personal property and to give options therefor for cash or credit, with or without security; §4.2.3 To borrow money from any person including any fiduciary acting hereunder, and ~to mortgage or pledge any real or personal property; §4.2.4 To hold shares of stock or other securities in nominee registration form, including that of a clearing corporation or depository, or in book entry form or unregistered or in such other form as will pass by delivery; §4.2.5 To engage in litigation and compromise, arbitrate or abandon claims; §4.2.6 To make distributions in cash, or in kind at current values, or partly in each, allocating specific assets to particular distributees on a non-pro rata basis, and for such purposes to make reasonable determinations of current values; -3- §4.2.7 To make elections, decisions, concessions and settlements in connection with all income, estate, inheritance, gift or other tax returns and the payment of such taxes, without obligation to adjust the distributive share of income or principal of any person affected thereby; §4.2.8 To allocate, in the Executor's sole and absolute discretion, any portion of my exemption under Section 2631(a) of the Internal Revenue Code (which statutory exemption is presently $1,000,000), to any property as to which I am the transferor, including any property transferred by me during my lifetime as to which I did not make an allocation prior to my death; and §4.2.9 To disclaim any interest I may have in any estate if the Executor deems such disclaimer to be in the best interests of my estate and the beneficiaries thereof. Article Five Provision For Taxes §5.1 Ail estate taxes, inheritance taxes, transfer taxes and other taxes of a similar nature payable by reason of my death to any government or subdivision thereof upon or with respect to any property subject to any such tax, and any penalties thereon, shall be paid by the Executor out of the principal of that portion of my estate disposed of by Article Two of this Will, and all interest with respect to any such taxes shall be paid by the Executor out of the income or principal or partly out of the income and partly out of the principal of such portion of my estate, in the absolute discretion of the Executor, without reimbursement from or apportionment among the -4- beneficiaries, recipients or owners of such property for any such taxes, penalties or interest. Article Six Provision for Debts and Expenses §6.1 I direct that any of my legally enforceable debts, any expenses of my last illness, funeral and burial, and any of the administrative expenses of my estate, shall be paid from the principal of that portion of my estate disposed of by Article Two of this Will. Article Seven Miscellaneous Provisions §7.1 As used in this Will, the term "Internal Revenue Code" shall mean the Internal Revenue Code of 1986, as amended from time to time, or the corresponding provision of subsequent law. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of ~ , 1993. Forrest E. Richert (SEAL) Signed, sealed, published and declared by the above named Forrest E. Richert as and for his last Will, in the presence of us and each of us, who, at his request and in his -5- presence and in the presence of each other, have hereunto subscribed our names as witnesses thereto the day and year last above written. Residing at -6- COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF _l~_ ~p~;~l : We, Forrest E. Richert, the testator, and ~L~ ~. [J~OLFc:~. , ~'I~EJ~LV ~. ~--~¢¢.%~L£~/ and ~V?£kl~ ~o ~~ , the witnesses, whose names are signed t to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his last Will; that the testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testator signed the Will as a witness and that to the best of his or her knowledge the testator was at that time 18 years of age or older, of sound mind and under no constraint or undue influence. Forrest E. Richert (J Witn¢'bs Witness Subscribed, sworn to and acknowledged before me by Forrest E. Richert, the testator, and subscribed and sworn to before me by and ~V~kV~ ~. ~~ ' , witnesses, this ~ ~ de, of Notary /P~li~ My Commission Expires: (SEAL) -7- l-'-'"-'~--~ NOTARIAL SEAL L,.IND~, D. SPEIDEL, No~-ery Pul~lic My~isl~.urg, D,~uphin County, p~ rmssion Expires Mey '/6, 1994 "' IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA STATUS REPORT UNDER RULE 6.12 Name of Decedent: Forrest E. Richert Date of Death: January 24, 2004 Will No. 21-04-0222 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X ; No 2. 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 accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: Si~a6ure - _ Nafm~: John E. Slike, Esquire L~. NO. 06262 SAIDIS, SHUFF, FLOWER & LINDSAY 2109 Market Street Camp Hill, PA 17011 (717) 737-3405 Capacity: Personal Representative X Counsel for Personal Representative BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX JOHN E SLIKE SAIDIS ETAL 2109 MARKET ST CAMP HILL CUT ALONG THIS LINE PA 17011 DATE 06-21-2006 ESTATE OF RICHERT DATE OF DEATH 01-26-20!06 FILE NUMBER 21 06-0222 COUNTY CUMBERLAND ACN 101 Amount Remitted FORREST MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF MILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 RETAIN LONER PORTION FOR YOUR RECORDS ~ DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF RI(HEAT FORREST E FILE NO. 21 06-0222 ACN 101 DATE 06-21-2006 TAX RETURN NAS: C X) ACCEPTED AS FILED C ) CHANGED RESERVATION CONCERNIN(~ FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate CSchedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) 4. Mortgages/Notes Receivable CScheduZe D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule 7. Transfers CSchedule G) ¢7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9) 10. Debts/Mortgage LlabtZlties/Llens (Schedule I) CIO) 11. Total Deductions 12. Net Value of Tax Return .00 IO0.OO 8~320.37 lrO62r362.55 c8~ NOTE: To insure proper credit to your account, submit the upper portlon of this form with your tax payment. I, 050,782.92 11,325.81 Cll) 12.772.56 C12) 1,038,010.38 13. 1~,. NOTE: reflect ASSESSMENT OF TAX: 15. Amount of L/ne 14 at Spousal rate 16. Amount of L/ne 14 taxable at Lineal/Class A rate 17. Amount of L/ne 14 at Sibling rate 18. Amount of L/ne 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: PAYMENT RECEIPT DISCOUNT C+) DATE NUMBER INTEREST/PEN PAID 06- 16-2006 CD003835 2,335.52 Charttable/Governmenta! Bequests; Non-elected 9113 Trusts (Schedule J) C1S) Net Value of Estate Subject to Tax C14) Tf an assessment was issued previously, lines 16, 15 and/or 16, 17, .00 1,038,010.38 18 and 19 w/Il figures that include the total of ALL returns assessed~to date. ets) .00 x O0 = .00 c16) 1,038,010.38 x 065 = 66,710.67 C17> .~)0-'x 12 = . O0 c~8) .~0 x 15~= .00 cig)= 66,710.67 C 66,500.00 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 66,835.52 125.05CA .00 125.05CA ( IF TOTAL DUE IS LESS THAN 41, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CA), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND OBJECTIONS: ADHIN- ISTRATlVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST= Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 25 of 2000. (72 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: REGISTER OF NZLLS) AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Apglication for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available at the Office of the Register of Nills, am/ of the 25 Revenue District Offices, or by calling the special 24-hour answering service for forms ordering: 1-800-$62-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-$020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty ¢60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept· 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans~ Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505° See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three ($) calendar months after the decedent's death, a five percent (5~) discount of the tax paid is allo~ed. The 15~ tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one ¢1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6X) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after Januar~j 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 are: Interest DaiZy Interest Daily Interest Daily Rate Factor Year Rate Factor Year Rate Factor 20~ .000548 ~'~'8-1991 11~ .000501 ~ 9~ .0002~7 16~ .000458 1992 9~ .000247 2002 ~ .000164 11~ .000501 1995-1994 7~ .000192 200S 5~ .000157 1995-1998 9~ .000247 2004 4~ .000110 1999 7~ .000192 2000 7~ .000192 1985 1984 1985 15Y. 1986 10~. 1987 10~. --Interest is calculated ZNTEREST = BALANCE OF · 000556 · 000274 · 000274 as follows: TAX UNPAZD X NUNBER OF DAYS DELZNI~UENT X DAZLY XNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date sho~n on the Notice, additional interest must be calculated. BUREAU OF ZNDTVZDUAL TAXES ZNHERZTANCE TAX DTVZSTON DEPT. Z80601 HARRTSBURG, PA 17128-0601 COMMONNEALTH OF PENNSYLVANZA DEPARTHENT OF REVENUE ZNHERZTANCE TAX STATEMENT OF ACCOUNT REV-I&D? EX AFP (01-OS) JOHN E SLIKE SAIDIS ETAL Z109 MARKET ST CAMP HILL PA 17011 DATE 08-02-200q ESTATE OF RICHERT DATE OF DEATH 01-2q-Z00~ FZLE NUMBER Z1 O~-OZZZ COUNTY CUMBERLAND ACN 101 Amount Remitted FORREST E HAKE CHECK PAYABLE AND RENZT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credit to your account, submit the upper portion of this fore with your tax payeent. CUT ALONG THIS LZNE ~.~ RETATN LONER PORTTON FOR YOUR RECORDS 4 REV-1607 EX AFP [01-03} ESTATE OF RICHERT ~xx ZNHERZTANCE TAX STATEMENT OF ACCOUNT x~ FORREST E FZLE NO. Z10~-OZZZ ACN 101 DATE 08-0Z-200~ THZS STATEHENT ZS PROVZDED TO ADV/SE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAHED ESTATE. SHOHN BELO# 1S A SUHHARY OF THE PRZNC/PAL TAX DUE, APPLZCATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE, A PROJECTED ZNTEREST F/GURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-21-ZOOq PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): q6,710.q7 PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 2,335.52 Oq-16-200q 07-12-200q CD003835 REFUND .00 qq,500.O0 125.05- TOTAL TAX CREDZT q6,710.q7 BALANCE OF TAX DUE .00 ZNTEREST AND PEN. .00 TOTAL DUE .00 ZF PAZD AFTER THZS DATE, SEE REVERSE SZDE FOR CALCULATZON OF ADDZTZONAL ZNTEREST. ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SZDE OF THZS FORH FOR ZNSTRUCTZONS.