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HomeMy WebLinkAbout02-1105PETITION FOR PROBATE and GRANT OF.../L)ETTE LUCINDA C GOSSETT _ No. ~ `~ ~ ' Estate of To: also known as Register of Wills for the Deceased. County of rTTMT3Ta.>; ~„E1~TI~ in the Social Security No. 6976 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut °T ~ 19named AUGUST 11 1999 in the last will of the above decede°ntedated and codicil(s) dated (state relevant circumstances, e.g. renunciation, death of executor, etc.) TTMT2 T7TJT ATTT) County, Pennsylvania, with Decendent was domiciled at death in ~ h er last family or principal residence at MF.f'J3A3. (list street, number and muncipality) grs of age died , 19 , Decenden~,~e~L~~ yll~IVE G'ARLISL at was not divorced and did not have a child born or adopted Except as follows, decedent did not marry, after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania Ar~Tr*T mnr.TArevTU situated as follows: ^~' '~' LOWER ALLEN TOWHbHlr ~ESTAMEN~AgRbY to of the last will and codicil(s) WHEREFORE, petitioner(s) respectfully req presented herewith and the grant of letters (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. c ,~ ~ , o., T NN M_ FeTrTt~T ~ ~ l/NIQRYFT C f11TARF Rll_t.1111A1h- ~ ~ MF!'T7 •rrT /', C~DT7D /"~ 7']A ~ ~ u . -__- cC ~.+ r-. ~ ~a N w a O G bD OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF _c~MS>17LA1`m 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 11 wellland t p ytadmini ternthehat as according po law. tative(s) of the above decedent petitioner(s) ~ T ~ ~ r~ ~ ~ ~ Sworn to or affirr~~ and subscribed ~' before me this ~ day of a Decemb r 1$~~42 ~ 0 T,...,,, ~ nn n+tn . 1 Gt DeT~uty Register ~" $ 1,000,000 $ --- 1 7_ /PJ/_ _ f ~ No. 21-200 -~io5 Estate of Lucinda c, Gossett ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW December 6th x~g 2002, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated August 1,1999 described therein be admitted to probate and filed of record as the last will of Lucinda C. Gossett and Letters Testamentary are hereby granted to John M. Eakin FEES Probate, Letters, Etc.......... $ 270.00 Short Certificates(ld .......... $ 30.00 ~~P~~ •s-pages• •(•5) .. $ 10 00 TOTAL $ 325.00 Filed .Dee~ber• •6th•, 2~00'~• • • • • /~ ~""" Register of Wills i~~7~~~'~'G/ Donna M. Otto,lst Deputy JOHN M. EAKIN ESQUIRE # 06351 AT~~TppOUURN~~E~~Y (Sgu~p. Ct. LD. No.) ME~ICSBURG, P~LD~~~55 ADDRESS (717) 766-3172 PHONE MAILED LETTERS TO ATTORNEY ON DECEMBER 6th, 2002 i ... ~. !Zf A ~i_.o - :'7' i hts rs to eern~v that the intr,rc~rit~t~n her:: ~,iven is LL!rre~~~ . ~ , _ - ,. ,~ ' . Loa~L fZegisirar. 'The orrginal L..tific<ite will he For~,~°~~~c~eci f~> >>L :,_.'-_ ~~ _ r,,. e _ WARNING: It is iiiegal tts dupii~ata ~~ia ~ - . [~cc' for this Lerci? c.:[c. ~~.U'? _.._ i J V !~1 ~ f tl ~~ V _._ i). ~~~~ .~ ~~~.: '. ' k a ~~. ~ ~. ._ ,~ ~ ~ _~" COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS - -'°~ -p' CERTIFICATE OF DEATH SLATE FILE :vUMBER ____ _.._ __-_._.___-_-- -~ ~ - Y~'EPHIHI SE% SOCIAL SECURITY NUMBER pA7E OF DEAIH,MCnN. Day. roar! ,N __.____..__ Ef~MANEII! NAME JF DEGECENT I1xst Miaele. Last! ,, Femal 192- 3fi 69 6 December 2, 2!102 )L ApK 111K ~,. Lucinda C. Gossett _ _ _____- ____. -.__ BIRTHPLACE IGIy arse PLACE OF DEATH (CnecF qay n"n- 5ee:nslrucl~Oro on'M'e' siael AGE a nv H~nr„laYl UNDER 1 DAY DATE OF BIReTN >ule,N Fcre~ L;a,nav) UNDEN 1 YEAR Howe ' Minute iMOnm. Dav l 9n HOSPITAL'. nm• r Data ^ M auam ^ OOA ^ ERIOul OTHER. Nure,rp 11 OIMI ' Noma ^ XRaaA•nu LJ ,Specnyl LJ 98, o Inparaml PA May 29, 19 9 a. r ° p VMS DECEDENT Of HISP ANIC ORIGIN? Ip RACE-Amera:anlM~an. Black. Wnrtas S. ~ L>t1R0, TWP OF DEATN CDY soeel and nulnuri FACILITY NAME 171 npl my NUOn. Grve ' ~ ^ ^ ° ~, •Pap,N Cu6sn. ISpecMl , COUNTY OF DEATH & Rehabilitation t Nursin pRican, alp. ; •A'p°^ White ,o Cumberland Middlesex Twp. °C Claremon ~ g DECEDENT'S EDUCATION MARITAL STATUS ~ Marna,! . sDRY1VING SPOUSE Jne maxun name! ,n «ne ' IM. DECEDENT'S USUAL OCCUPATION KINOOF BUSINESSlINDUSTRV VMS DECEDENT EVER IN U. B. ARMED FORCES? S onl n. et am Naves Manlse. Wiepwaa. 1 Orvorc•d l5pecM1 C . lOiv~ibd wwk UOne AUr'ng rtxat e Lee) I Yea ^ No ^ x ElsmenterylS•conei 1012) ry 1 AIL! I' y y ~dQl/Ved 1S. us 1 rAlrq nls, ao lw Register Nurse 116. +_ 11. {-~'~m r+avaa in e ^ ___ - l~F1_ _ --n"P n Ile. DECEDENT'S MAILING ADDRESS (SreM.GryrT n, SUre. Zip Coael DECEDENT'S Dp ACTVAL 17a. Slale__---1~' ~~r • ~eaca pip t7e. eaceawa 5138 East Trindle Road RESIDENCE Sea mvruclens mwslael Cumberland INa ina -- - ta«nM,p7 NO• ~i°•`• 6.ad _ - -ury/6wo ,Td.^ wanin aCllw NnAa pt - Mechanicsburg, Pa. 17050 ,7p.ppnnN- Maxlen Surname! eal M ' 1 ° - S NA MOTHER i e. ME IFxM. Grace Ashenfelter FAT"ERSNAMEIFxsLMaalnLavl John Fager 19. Cope) Z p INFORMANT'S MAILING ADDRESS ISKeeI.CM/i ,Slala. 19 INfORMANT'SNAMEIType~PmV) John M Eakin 206. a'n n k r u LOCATION ~Ciry~T .State, Zip Guoa PIACE OF DISPOSTION-Nama of CamHary. Cramalwy 2M. METHOD OF DISPOSITION ^ R.morallromsreL^ ^ DATE OF DISPOSITION (MOnm pay year) or Omer Placs p Camp Hill, Pennsylvania 1701 Green Memorial Park Rollin ^ B°r", ~ ar Dec 6, 2002 zm. =, g pon.uonC~ anarlsraM zm. NAME AND AODRESSOF FACILITY ]Ia. "r LICENSE NUMBER _ SIGNATURE FFUNE SER LIC RPERSON ACTT AS SUCH RAPfhan~rchl m 2tc ED _ ~` ~,/ (G ==b a,alaa l (/ . DATE SIGN LI ENSE NUMBER (MUr +. p' V veal . ace 32a. ~ co me rem 2 a c only wrren cemNir'q T I»a1 a mr Arwwleage, seam pcpurree al Ina a. pale ana p Talal w \ ~ ~ ~ 1 ~-~ ~ ~`, ~ z~'~ L i zx C C C I~ ~~ ola an,ma of aam to prawe pnys~~~an se of a•am -1~ . nlty rau q7a Pearl pa M h . `V z76. VMS CASE REFERRED TO MEDICAL EXAMINERICORONER7 `A OnI y. . va• ^ ~ W , ms 2a-26 muss Drs complelee by TIME OF/ ATN DATE PRONOUNCED O~EAyO I OIMr sign~lcanl conolums wmri6uri,q to as ronounces eeaN. - r Z- Z'~ L'' 2' N. m n ~ ART II ! ^ p =1 1 ^ w : parso M. ]a. QA_ , ~. `~ PANT 1 ~r n a: careiap or reso'ral mock or Men la'llura. l Approaimtla P ,ntarval6alwaa rwl raauningn ma urwerlyxg cause Prvanm suc moaa of ayirp n , _ _ a 27. PART 1'. Ln1a'lnn alsnas•a. inlurresacpmpNCalwne wnicn uusaa lna anal Do nog enter l Ipn.., arse eaaPl 1 L -only au cause on each I,ne. .,. I IYNEDIAIE CAUSE It al r ~~, ~ ~ h- 1 1 _ ' - ul n,l aml ~ a.___-~-pU~ c EOUENCE OFI: _ -._ _----. _.--._ -_- ______-. - _--___._._ Sequenuallr nz wlana>nn a-- DUE TO (aI ASACONSEOUENCE OF). 1 I _.. ___.-_...-__-__.--._.. _. -___ __..-. I ,I Y a 9 mnMale c E UNDERLYING - - - "' __ ~ CAUSE DUE TOIOR A$ACONSEOUENCE IX)'. ',, ..nip na.urt llA3T __ __ - _ -_ -___.__ __.--- - -- - 71ME Of INJVRY INJURY AT WORKS DESCRIBE HOWINJURY OCCURRED _ WAS AN AUTOPSY a - WERE AUTOPSY FINDINGS GATE OF INJURY - MANNER Of DEATN IMUnm. Day. year) PERFORME07 GOMPLEfION Of CTAOUSE ~iA ^ Momlclea Narwel ° yM ^ No^ OF DEAN? Y lnvesligalion ^ nein ^ P M. °°°• q ~p,a,q e ]Ob. LOCATION (SI reM. CMROVm, Sate/ 7 ~ ^ ~p No LY ^ Coula ltal W aalnrm'nea ^ PLACE OF INJVRY - AI Sucias 6uJ,anq, alC. ISpecllvl tame. farm. Mre,p, rectory, ollipa ]q. Yea ^ No 2M. Yee _~ n 29. CERTIFIER SIGNATURE ANOT ~ ,-' ~ / CERi1f1ER ICnerk only one! CenM,nq causedeeam wnen anwher pnvsx:an naspwaunp,stl seam ana complelea glean 211 ....... .... 'CERTIFYING PHYSICIAN IPnyscNn ........ ToB+e Wal of mY knowreaga. daaN eccurrad ewbWcau•Nal arW manners sLlae .......................... ........ 71 b. / art DATE SIG II'. paY. ya' N S E LICEN UM / ~,1 ~1 ~~/~~ ,N aealnl s , / ~ Ls . a/ ~ L~~' t-L ]le. _ ^ 71e F DEATH---N ~---- y qlo cau e 'PRONOUNCING AND CERTIFYING PNYSICIANIPnyscan taln p'°^°"nun9 aealh ana cnLl m aN occurred at P'• Lime, 0a1a, arW puce, and eua Lo LM eaua•la) errd manner as .Cared ................. a _ .. .. ~ NAME AND ADDFLESS Of PERSON WMO COMPSETED CAUSE O 7 ~7 1 ri M / ~// { P OI a 271 T I ~ ' /' e To Ina plel of mY Arwwredge, dale, ene place, and due Lo the cau DRONER l Lhe Llma E%AMINER( d ' ' . 1 , yp ( tem tCK " ~ y ( y~ sa(a) ene ^ I CT ~ ~7r(` pl ~f~p fJ r ~~ O , n s MEDICAL 9 In m on, death occurre ........................ .... .. f •AartN anon and/or InveaB anon, Y oPini i .. .... a o On Lne 6n manner as atalad ............................................................ DATE FILED IMOrim. DaY. Years ]1a REGISTRAP'SSIGNATUREANDNUMBER j~~!~~ 3L-r~l D~@,er~'ib-e~--3 ~ ~o ]~2~i.~,t~ ~~~~~-~ 71. ~~~# Dili ~czt~ `C .~~~~xxcte~tt OF LUCINDA C. GOSSET'P I, LUCINDA C. GOSSETP, of Lower Allen Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void all former wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. I direct that there shall be paid out of my residuary estate all estate, inheritance and like taxes together with any interest or penalty thereon imposed by the Government of the United States, or any state or territory thereof, or by any foreign government or political subdivision thereof, in respect to all property required to be included in my gross estate for estate, inheritance or like tax purposes by any of such governments, whether the property passes under this will or otherwise. ~1 -~- 3. I give and bequeath the sum of Three Hundred Thousand ($300,000.00) Dollars to my brother, RAY D. FAGER, if he survives me; in the event he predeceases me the gift shall lapse and fall into the residue of the estate. 4. I give and bequeath the sum of Three Hundred Thousand ($300,000.00) Dollars to my niece, CAROLYN ALEXANDER, if she survives me; in the event she predeceases me the gift shall lapse and fall into the residue of the estate. 5. I give and bequeath the sum of Three Hundred Thousand ($300,000.00) Dollars to my nephew, THOMAS E. CORPENNING, JR., if he survives me; in the event he predeceases me the gift shall not lapse but shall go in equal shares to his heirs per stirpes. 6. All the rest, residue and remainder of my estate, I give, devise and bequeath in trust under and subject to the following terms and conditions: A.) The name of the trust shall be the LUCINDA C. GOSSETT CHARITABLE TRUST. B.) I name, constitute and appoint JOHN M. EARIN trustee and direct that no bond be required to guarantee faithful performance of his duties. ~i Al~ C.) The term of the trust shall be ten (10) years from the date the trust corpus is received from decedent's estate; in the event the corpus together with interest has not been distributed by that date, the term of the trust shall be extended for a reasonable time to permit the trustee to wind up the trust by making complete distribution to Section 501(c)(3) entities and file a final accounting with the Court of Common Pleas, Orphans' Court Division. D.) I authorize, empower and direct the trustee to make payments of principal and interest from time to time during the continuance of the trust to those beneficiaries which in his sole discretion are deemed to be qualified recipients provided that all distribution shall be for tax exempt purposes and none other. E.) The trust is created to devote and apply the trust fund exclusively for charitable purposes by contributions duly authorized to carry on charitable activities and which have established their tax exempt status under the provisions of Section 501(c)(3) of the Internal Revenue Code and its regulations as they now exist or may hereafter be amended and the trust assets, profits and net income thereof are irrevocably dedicated to such purpose. F.) No part of the net earnings of the trust shall inure to the benefit of any private individual having a personal or private interest in the activities of the trust within the meaning of Section 501(c)(3) of the Internal Revenue Code and the `1 ;-~ c 1.> ' X11 ~. - 3 - trust shall not be operated for the benefit of private interests such as the heirs of the decedent, the trustee or any person or persons controlled directly or indirectly by such private interests. G.) The trustee shall invest, reinvest and keep invested the trust corpus in obligations which men of prudence, discretion and intelligence acquire for their own account provided that no investment shall be made which is a prohibited transaction under the provisions of this trust. H.) The trustee shall not engage in any act of self-dealing as defined by Section 4941(d) of Internal Revenue Code nor retain any excess business holding as defined in Section 4943(c) of the Internal Revenue Code nor make any investments in such manner as to incur tax liability under Section 4944 of the Internal Revenue Code nor make taxable expenditures as defined by Section 4945(d) of the Internal Revenue Code. I.) The trustee shall distribute the income of the trust for each taxable year at such time and in such manner as not to become subject to the tax on undistributed income imposed by the Internal Revenue Code. J.) The trustee may incur expenses on behalf of the trust which he may consider necessary and proper for the effective administration of the trust including reasonable attorney and accountant fees, subject to the provisions of this trust. ~, ~-~ - 4 - ~. Lastly, I nominate, constitute and appoint, JOHN M. EARIN, to be Executor of this my Last Will and Testament. I further ersonal direct that no bond or other security be required of my p representative to guarantee faithful performance of his duties. IN WITNESS ~gZEOF, I have hereunto set my hand and seal this t~ day of August, 1999. r~G'~ ~~~ ~ ~,~.`'t~°_i~ ~ ( SEAL) Lucinda C. Gossett Signed, sealed, published and declared by the above named LUCINDA C. GOSSETT as and for her Last Will and Testament, in the presence of us who have subscribed our names hereto as witnesses, at her request, in her presence and in the presence of each other. ~ _. ~ ~"~ ~~ - 5 - COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND I, LUCINDA C. GOSSETT, the testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament: that I signed it willingly, and that I signed it as my free and voluntary act and deed, for the purposes therein expressed. '~?:l~rrY~.~TL' 1', ( SEAL) Lucinda C. Gossett Sworn and subscribed to before me this f` ~ ~aY of August, 1999. ~ ~~.~ ~ . Nota y Public Notarial Seat Ail~rilyn E. WGtiams, Notary Public Mectrert~dug Boro, Cumberland County ~ GonMnission Expires Nov. 6, 2001 Hamper, Pamsylvanra Association of Notaries COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND We, the undersigned, ~}+~up~3t-- ~~ ENC ~ and ~'E3F~ ~ ,.Eys~~,i , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the within testatrix, LUCINDA C. GOSSE'I'T, sign and execute the instrument as her Last Will and Testament; that the said testatrix, LUCINDA C. GOSSET'P executed it as her voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the testatrix, signed the Will as witnesses; and that, to the best of our knowledge, the testatrix was, at the time, eighteen (18) or more years of age, of sound mind, and under no constraint, duress or undue influence . .--~-. ~) l Sworn and subscribe_,c~ to before me this ~~ T"' day of August, 1999 Not ry Public Notarial Seal Mltrilyn E. Williams, Notary Public Motlhdrticsburg Bora, Cumberland County µY Commission Expires Nov. 6, 2001 Member, Pennsylvania Association of Notaries - 6 - ~~ CERT'IF'LCA'TIL)N OF NOTICE UNUGR RUhE 5~a Name of Decedent: Lucinda C. Gossett Date of Death: 2 December 2002 Will No. 2002-1105 Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on December 18, 2002 __. Name Carolyn Alexander Thomas E. Chorpenning Address 13200 Doty Ave., Hawthorne, CA 960 Pleasant Dr., York Haven, PA Attorney General of PA 14th Floor Strawberry Sq., Harrisburg, PA Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None Date: 5 May 2003 ~ ~, o, ,, ~ ~i •;~ o > , . ,,. •J Lr Signature ~.. _ ~7° Name ~~ Vt~~ ~ Address ~rtket Sq Building Mechanicsburg, PA 17055 Telephone ( ) ~ ~ ~ / "7 ~- --/ Capacity: % Personal Representative Counsel for personal representative 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 002237 EAKIN JOHN M ESQUIRE MARKST SQUARE BUILDING MECHANICSBURG, PA 17055 fold ESTATE INFORMATION: ssrv: ~ s2-34-6s~6 FILE NUMBER: 2102-1 105 DECEDENT NAME: GOSSETT LUCINDA C DATE OF PAYMENT: 02/28/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 12/02/2002 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ $75,000.00 TOTAL AMOUNT PAID: REMARKS: JOHN M EAKIN ESQUIRE CHECK# 101 1 SEAL INITIALS: VZ RECEIVED BY: DONNA M. OTTO REV-1162 EX111-96) 575,000.00 DEPUTY REGISTER OF WILLS REGISTER OF WILLS 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 002846 EAKIN JOHN M ESQUIRE MARKET SQUARE BUILDING MECHANICSBURG, PA 17055 fold ESTATE INFORMATION: ssN: ~s2-34-6s76 FILE NUMBER: 2102-1 105 DECEDENT NAME: GOSSETT LUCINDA C DATE OF PAYMENT: 07/28/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 12/02/2002 ACN ASSESSMENT CONTROL NUMBER REV-1162 EX(11-96) AMOUNT 101 ~ $1 1,250.00 TOTAL AMOUNT PAID: REMARKS: JOHN M EAKIN ESQUIRE CHECK#1026 SEAL INITIALS: AC RECEIVED BY: DONNA M. OTTO S 1 1,250.00 DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1547 E% AFP (P1-037 DATE 09-09-2003 ESTATE OF GOSSETT LUCINDA C DATE OF DEATH 12-05-2002 FILE NUMBER 21 02-1105 ; __ COUNTY CUMBERLAND ,.. _ JOHN M EAKIN ACN 101 MARKET SQUARE BLDG Amount Remitted MECHANICSBURG PA 17055 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT H OUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS -•~ -------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE -------------------- OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF GOSSETT LUCINDA C FILE N0. 21 02-1105 ACN 101 DATE 09-09-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 382,000.00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) 85,699.12 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this fore with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 1 , 559 , 230 .30 tax payment. 6. Jointly Owned Property (Schedule F) (6l .00 7. Transfers (Schedule Gl (7) .00 8. Totai Assets (g) 2,026,929.42 APPROVED DEDUCTIONS AND EXEMPTIONS: 88,644.00 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 1,18 4.00 11. Total Deductions (11) 89.828.OD 12. Net Value of Tax Return (12) 1,937,101.42 13. Charitable/Governmental Bequests; Nonelected 9113 Trusts (Schedule J) (13) 1,337,1 01.42 14. Net Value of Estate Subject to Tax (14) 600, 000.00 NOTE: if an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) • 00 X 00 = . 00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) .00 X 045 = .00 17. Amount of Line 14 at Sibling rate (17) .00 X 12 .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 600,000.00 X 15 - 90,000.00 19. Principal Tax Due (19)= 90,000.00 ter roenrTC. DATE NUMBER + INTEREST/PEN PAID (-) AMOUNT PAID 02-28-2003 CD002237 3,947.37 75,000.00 07-28-2003 CD002846 .00 11,250.00 TOTAL TAX CREDIT 90,197.37 BALANCE OF TAX DUE 197.37CR INTEREST AND PEN. .00 TOTAL DUE 197.37CR * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN 51, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.] REV-15ImEXlf,.On 1<'_ (~,r'/< ~ i ,/ COMMONWEALl H OF PENNSYLVANIA DEPARI MENT OF REVENUE OEPl280601 HARRISBURG, PA 17128,0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT 'I) ".".,il.' Il(:I,"_!'I", W J... ~~rn v""" w"V ",00 v"''''' ..III .. '" k'" <l.':, ,', FILE NUMBER 2 1 - 0 5 o 1 2 1 o COUNTY COOE YEAR NUMBER I- Z W o W o W o DECEDENT'S NAME (I.AST, FIRST. AND MIDDLE INITIAL) Lucinda C. Gossett DATEOFDEATHIMM DD -YEAR) --- - --- - -I DATE -OF 8iRTH (MM 00 YEAR)- - ----- 12-02-02 5-29-1909 ---- - - -- - - (IF APPLICABLE) SURVIVING SPOUSES NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 192 - 34 - 6976 THIS RETURN MUST BE FILED IN DUPLICATE WITH THI REGISTER OF WILLS SOCIAL SECURITY NUMBER [ill Original Return o 4. Limited Estate [Xl 6. Decedent Died Testate {Atlach cooy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Retum [J 4a. Future Interest Compromise (~ato of rleatll after 12-12-82) o 7. Decedent Maintained a Living Trust (Mach copy of Trust) o 10. Spousal Poverty Credit (dale of death belween 12.31.91 and J.j.95) o 3. Remainder Return Idale olde$lh prior to 12.13-82) CXI 5. Federal Estate Tax Return Required 1 8. Total Number of Safe Deposit Boxes Election to tax under Sec. 9113(A) (Attach Sch 0) J... Z W C Z o .. 0) w '" '" o v 011. fHllI SEctioN MUST BE COMPLETED, ALL CORRESPONDENCE AND eON ll:l AI. '1' 1101 OFt COMPLETE MAILING ADDRESS 0; NAME John M. Eakin FIRM NAME (If Applicable) Market Square Building Mechanicsburg, PA 17055 TELEPHONE NUMBER (1) 382,000.00 OFFicIAL USE ONLY (2) 85,699.12 (3) (4) (5) 1,559,230.30 (6) c '. ,.) (7) (B) 2,026,929.42 (9) 88,644.00 (10) 1,184.00 1. Real Estate {Schedule A) 2. Stocks and Bonds (Schedule B) z o ~ :J l- ii: c( o w 0:: 3 Closely Held Corporation, Partnership or Sole.Proprietorship 4. Mortgages & Notes Rer,eivable (Schedule D) 5. Cash, Bank Deposits &. Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. InterNivos 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 Oeductions (total Lines 9 & 10) 12. Net Value of Estate lline a minus line 11) (11) 89,828.00 (12) 1,937,101.42 (13) 1,337,101.42 (14) 600,000.00 13 Charitable and Governmental Bequests/See 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 SlOE fOR APPLICABLE RATES z o < I-' :J ll.. :iE o o ~ 15 Amount or Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) ------~-_._"---~'--'_.._._-- x.O~ (15) 16 Amoont of Line 14 taxable at lineal rate x.O_ (16) 17, Amount of Line 14 taxable at sibling rate ' ,12 (17) 1B, Amount of Line 14 taxable at collateral rate 600,000.00 x .15 (1 B) 19, Tax Due (19) 90,000.00 90,000.00 CHECK HEilE IF YOU AilE IlEQUESTlNG A REFUND OF AN OVERPAYMENT 200 "(,; fHe" "," > >OJ:!!! llURETO ANSWER ALL QUElltlONll 0 R Decedent's Complete Address: STREET ADDRESS 5385 Trindle Road I ZIP 17055 -- -------.ISTATE PA ".. ------ '. Mechanicsburg-' CITY Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. Credils/Paymenls A. Spousal Poverty Credit B. Prior Paymenls C. Discount (1) 90,000.00 15,uu1J.mJ ~,750.00 Tolal Credils (A + B + C ) (2) 78,750.00 3. InteresUPenalty If applicable D. Interest E. Penally TotallnteresUPenalty ( D + E ) (3) 4. If Une 2 is greater than Une 1 + Une 3, enter the difference This Is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 11,250.00 5. If Line 1 + Line 3 is grealer Ihan Line 2, enler Ihe difference. This is Ihe TAX DUE. (5) A. Enter (he interest on the tax due. (5A) (5B) B. Enler Ihe lolal of Line 5 + 5A. This is Ihe BALANCE DUE. 11,250.00 Make Check Payable to: REGISTER OF WILLS, AGENT 11,250.00 r;~"Jt.r,~lf,:'<J;'~~~~,:'r-:~w,~~:",n~:rF:~,f~'l~';,':::J~~:~~(:?"n'i;r'i.~f.l~~',,".\'i'l,;).c'f''7":,IJ'i;~{.;~r\;!n~l~.;:;,I'!;~:<,:f,"',f-~"'~T~~'~'~;~r.J!l'~,~"'!"~'r~;~,'liI!I~~'~~'>~'". ~ ~~."...-M',e:_'I!"'_r.'>:.''''~,,,,_"'l'III PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedenl make a Iransfer and: 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? .. . m"'''''.'.... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .. .......".. 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .... ... 0 4. Did decedent own an Individual Retirement Account. annuity, or other non-probate property which contains a beneficiary designation? . ... 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Yes ............0 .......0 .......0 uO No I!J I!J I!J I!J Q9 ~ ~ Under penalties of pe~ury, I declare that I have examined this return, including accompanying schedules and statements, and to the besl of my knowledge and belief, it is true, correcl and complete. Declaration of preparer other lhan the personal representalive is based on all informaUon of which preparer has any knowledge. SIGNATURE OF P~R~is)N RE. PO;;IBLE F~8NG RETURN ADDRESS DATE July ~ ,j-' 03 Mark Square Building, Mechanicsburg, Fa 17055 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS DATE C.~.'''' ..,0:<',,,,",,", "'"I~ ~;'Ii"i",;rr'.Jr~,:l~Wf~'!libllif.:\$!1\'~<~:l\tlt~~~~~:Z~.."I-~~";l'~''I\''J1...,,,",,,..,.. _. ,.,"~,"" ...". ~ ",.,. ..'.,.~_"""'.'i."""'''''',~,~''''' '"".,.r.'",....,.'.r.,....'"'.....~'".d..""'! For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (al (1.1) (ill. For dales of dealh on or arter January 1, 1995, the lax rate imposed on Ihe nel value of Iransfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (iill. The statute does not exem[Jt a transfer to a surviving spouse lrom lax, 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 dealh on or after July 1, 2000: The tax rale imposed on Ihe net value of transfers from a deceased child Iwenly-one years of age or younger al death to or for Ihe use of a natural parent. an adoplive parent, or a slepparent of the child is 0% [72 P.S. 99116(a)(1.2)]. The lax rate imposed on the net vallie of transfers to or for the use of the decedent's lineal beneficiaries Is 45%, except as noted in 72 P.S. 99116(1.2) \72 P.S. ~9115Ia)(1)]. The lax rale imposed on Ihe nel value of Iransfers 10 or for Ihe use of Ihe decedent's siblin9s is 12% [72 P.S. 99116(a)(1.311. A sibling is defined, under Section 9102, as an individual who has alleas! one parenf in common wilh Ihe decedenl, whelher by blood or adoption. ''''~2'''.'''''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE , ESTATE OF Lucinda C. Gossett FILE NUMBER 21-02-01105 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seifer, neither being compelled to buy or sell, both having reasonable knowledge of the relevanl facts. Real property which is jointly-owned with right sUlVivorshin must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH House and Lot of ground in Hampden Township 2 acres more or less improved with single family dwelling, sold May 22, 2003. sale price reported $143,000.00 2. Vacant lot Hampden sold June 2, 2003. Township 60 X 400 Sale price reported $24,000.00 3. 19.74 acre tract unimproved land Lower Allen Township, Cumberland County $215,000.00 TOTAL (Also enter on line 1, Recapitulation) $ 382,000.00 (If more space is needed, insert additional sheets of the same size) " " I" I' ," ,,,,,,,01 ,,' "",,~I"\I ",,,,,,,,,,,,,1,,.,,,1,,,,,,,,,,,1 I/o II !:,'III"""",I !:II,I"II"I"11 I lr.lfl "" ?~, ". ",,,,,,,,,,,,,, t 1/1111 .1 II \'1\ " r 1 1",'" , I, ..,.', ,,,'" !." I ,j '!,;;;,,;,j; I ;;;;, ~;:;; F;;; li,;:;;I;, .."",,1,.,.1 'I""",,,, ,',,,d,, 11"'''''111', ,,,d,' 1-" I""i i'r -,i'I" ~,,,ii;,,;',',;;;i ;;--,. II,,,, '",,1"11 H,,,I' Ill" .,1"". 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Ihlclhm It} I (} UIII hn~II1' Illy Imowhll'!}", 11m I tllll-l !1ltllll'lItf'1l1 ~'nl"''''lItl wl,ldl I IrIlYIII"f'I'llIll1l r~ ,,!tuo ol,tl occlJIblu IIcv01J1I1 ulUm '1/1lt1S whlchWlltO IllClllyou nud llnva 11Il1l1l tll will 1m .H~hut~l!d hy IIltlIltHJI!I~I!IIIl'd nq pml tllltul ~tlllh'llIhlll (I' IIlls hnll5nctltm. 1),1)' (;;)L____________ __~~d ~---r_ ;;m;;;;;''''~ ilL f4.1 v'" -----~----~--_._~---~-_.__.~_._---~--- - '~ . '%~ 9sr.ll! ~!.>UKEMKl'(LQF SAkE MADE TIllS (///'day O/~tle) ,200], by and belween ( .'OIlN M. '~AKIN, Executor or lhe I,asl Will ami Testmnenl or LUCINJ)A C. GOSSETT, laIc or! laJ1lpden Township, Counly olTlIInberland, and State or Pennsylvania, lleceased, SELLER ANI> HOBlmT J(, IlANZIIOFF, .'OllN S. IlOSWELL allll ,'AMES A, PERRY, co- parlners lrading as Twenly FOIIr Wes\, a I'cnnsylvania general parlnership, wilh its place of business in Shiremanslown, Cumberland Counly, Pennsylvania, PURCHASER W"'~HEAS, Lucinda C. Gussell owncd lhe real eslate siluate in Lower Allen Township, Cumberland County, I'ennsylvmlia, described in Exhibit A auached hereto at the time or her dealh on December 2, 2002, allll \VIIEHEAS, Letters Teslmllentary on her eslale were issued to .1ohn M. Eakin, by lhe Regisler or Wills or Cumberland Counly on December 6, 2002, Estale No. 2002- 01105, and W"EIH~AS, the real eslate was not speciJicaJly devised by decedent's Will, and WIII~IU~AS, in reliance onlhe power to sell real estale granted 10 decedent's personal represenlative by Section 3351 or the Probate, Estales and Fiduciaries Code, the - I - Scller dcsircs to convcy s,lid IT<l1 cst<llc to Ihc Purch<lser. NOW, TI"~REFORI~, inl'()I]sideration of the lllutual covenants contained herein and intending to be legally bound, hercby thc parties agree as /()lIo\Vs: I. !'REMISES SOLD. SELLER agrees to sell and convey to the PURCIIASER and the PURCIIASER agrees to purchase from the SELLER the unimproved real estate described in Exhihit A. 2. PURCHASE PRICE. Purchase price shall be Two Hundred Fifteen Thousand ($215,000.00) f)oll<lrs payahle Five Thousand ($5,000.00) Dollars upon the execution of this agreement. receipt hcrcof is hereby acknowledged, and the balance in cash at the time 0 f selllemenl. 3. SETTLEMENT. Settlement shall be held on or be/()re August 22, 2003. 4. TAXES AND UTILITIES. All realty transfer taxes shall be paid halfby SELLER and halfby PURCHASER. All real estate taxes and assessments shall be prorated on the basis of the fiscal year for which assessed. 5. DEE 1>. At Settlement, SELLER shall deliver to PURCHASER a special warranty deed. The Property is to be conveyed fi'ee and clear of all liens, encumbrances, and easements, excepting: (I) easement fix roads or rights of public service companies if any (2) agreements of record and (3) easements visible upon the ground. Title to the Property shall be good and marketable and as such will be insured at regular rates by a Title Insurance Company licensed to do business in Pennsylvania. - 2 - 6. POSSESSION. I'URCIIASER has inspecled the Property, or hereby waives the right to do so. and agrees tu purchase 1he Property as a result of such inspeclion mal not because of or ill reliann' IIpon any representat;onmade hy the SELLER or any other party. Except as specilically provided in this Agreement, PURCIIASER has agreed to purchase the Property in its present condition. This Agreement contains the whule agreement bet ween the parties and there are no other terms obligations, covenants, representations, statements or conditions, oral or otherwise, of any kind whatsuever concerning this sale. Thc parties acknowledge that PURCHASER is a licensed real estate broker and purchases the land Iilr development and resale to others for profit. .K 7 DEFAULT BY SELLER, In the evenl Sr-:LLER fails or refuses to convey good and marketahle title and such as will be insured by a licensed title insurance company at regular rates, PURCIIASER shall have the option to either ( a) take the title SELLER can give without abatement of price, (b) rescind the contract whereupon the down payment shall be returned and the rights ofthe parties shall be at an end, or ( c ) proceed by an appropriate action at law or equity. ;I f; DEFAULT BY PURCHASER. In the event PURCHASER fails or refuses to make setllement all contingencies having been met, time being 0 the essence, the amount already paid shall be fi.>rfeited as liquidated damages and the rights of the parties shall he at end and the SELLER may convey the premises free and clear of any - 3 - claims oflhe PURCHASER. IN WITNESS WHEREOF, the parties hereto set thcir hands and scals thc day and year Jirst above writkn. WITNESS: WITNESS: -B~ll1fl~ ~_ . ~.~ ~'~M.. SELLER: Lucinda C. Gosset( Estatc By:_~_~/Y\i.ffl1~_-<SEAL) .Ioiii-l~. Eakin, Executor PURC) lASER: Twcnty Four West BY:~V I (S~^L) ""be" alT. p """ l3y:_~__ (SEAL) .I hn S. oswell, Partncr By: (SEAL) - 4 - lli~'iC!{II'T1 0 N ALl, TIIAT emU'AI N (nil'! 01' land si\uate in I.ower Allen Township, County of ClIInberl,lIld ami State of Pennsylvania, bounded aml described as follows: [3EGINNING at a post onllle south side or Township Road No. T-639 land now or llll'lnerly or M. II. Bakel'; TIIENCE South Ii I degrees 57 minutes East 747.43 feet to a point in the center of said Township Road; THENCE along the center line ofsnid Township Road South 74 degrees 46 minutes East 346.57 feet to a point at lands now or Ii.mnerly of [3ral1dl; TIIENCE along the line or said land south 07 degrees 56 minutes West 16.59 feet to n stake on the South side of the aforementioned Township road No. '1'-639; TIInNCE continuing South 07 degrccs 56 Ininutes Wesl along the line ofland now 01' limllcrly of Brandt 974.lW feet to a point on the norlhern hank of the Yellow Breeches Creek; THENCE along the northern bank of said Creek the following courses and dislnnces; North 61 degrees 32 minutes West XII.S feet to n point, North 65 degrees 2') ,,,inutes West 2112.1)3 ket to a poi"t, North 7') degrees 0 I minute West 129.0 leet to a point South X4 degrees J X minutes West 190.0 feet to a point; TlIENCE North 31i degrees West along the land now or formerly of said M. H. naker 261i.09 feet to a stake; THENCE North 13 degrees 31 minutes Wesl along the line of said land 863.85 feet to a post, the place of BEGINNING. Containing 19.74 acres. E'} I( (I~ (r . ;..) RfV,t503f)('(!97l~Y, f .~ I . '\ ~". f COMMONWI:ALl H or rFNNSYLVANIA . INHERITANCE lAX Rr:1UHN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Lucinda C. Gossett FILE NUMBER 21-02-01105 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. 912 shares PNC FINL SVCS GRP INC. @ 42.01 2. U.S. Series EE Number Denomination Issue Date Value X5001854EE 10,000.00 10/27/95 6,972.00 X5001855EE 10,000.00 10/27/95 6,972.00 X5001856EE 10,000.00 10/27/95 6,972.00 X5083565EE 10,000.00 2/25/97 6,480.00 X5083566EE 10,000.00 2/25/97 6,480.00 X5083567EE 10,000.00 2/25/97 6,480.00 MI0332570EE 1,000.00 10/17/85 1,406.00 M10332574EE 1,000.00 10/17/85 1,406.00 M10332575EE 1,000.00 10/17/85 1,406.00 M10332576EE 1,000.00 10/17/85 1,406.00 M103325 nEE 1,000.00 10/17/85 1,406.00 VALUE AT DATE OF DEATH $38,313.12 $47,386.00 TOTAL (Also anlar on lina 2, Racapilulation) $ 85,699.12 (If more space is needed, insert additional sheets of the same size) nfV l'{1nrx. (I 01) .~ I~~~~' C(JMM(llJ\\'FAlIII (lr ITHIJSYl VMJIA IH\\FnnNII.',r l^:< nr:lUHIl nESIUEUI UECEUEIH EStATE OF SCIIEOULE E CASH, BANI{ lJEPOSITS, & MISC. PEHSONAL PHOPERTY Lucinda C. Gossett ,-- filE NUMBER ;J,I -6L "-01l05 Include Ihe prncerds ollHiq.1linll mHlltm dfltf! Ihe fllflCpeds Well' rrcF'ivp(/ by thr f'!<;!i1111 ^" propp'ly Jolnlly-owllt'd with lIu~ Ilghl 0' ~lIIVIVOI..hlp II1I1St he dl~c'osed on Scllf~dule r VALUE-AT DATE- OF DEA TII IIFM NUMBEr< 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. IIFSClllI'IIUI-1 Lucinda C. Gossett revocable Trust See attached PNC Bank Trustee Securities $833,886.27 Cash $ 19,410.68 $853,296.95 $ 70,068.56 $ 25,012.27 $ 6,109.36 $537,123.99 $ 58,682.40 $ 4,416.24 $ 560.00 $ 2,466.00 $ 563.70 $ 622.00 $ 308.97 Orrstown Bank Certificate of Deposit # 60133 $70,000.00 3.25% issued 5/21/2002 matures 5/21/03 interest paid quarterly Principal $70,000.00 Interest $ 68.56 Bank Certificate of Deposit # 306509 $25,000.00 issued 6/24/1996 $ 12.27 See attached AlHirst Principal Interest Allfirst Bank, Checking Account # 410240, See attached Orrstown Bank, Account # 111-000279, See attached Principal $537,067.90 Interst $ 56.09 1/24-12/2/02 M&T Bank Certificate of Deposit # 449981, See attached Orrstown Bank, Checking Account # 000662 Miscellaneous coins, sale price reported Jewelry, See attached Claremont Nursing Home, Patients Fund Pa 2002 Income Tax refund Cash -------~----~ --~m:::=::-ft-=,::,.._:_:.:::_I;:,.l._:::;:.-.I~,IiIl"n"l d.oolC! nl ll.t! ~~lllA o:l7p\ TOTAL (AI,o enter on line 5, f1ecapilulalion) $1,559,230.30 Date of Death: Valuation Date: proceaainq Date: Ulu(D Eatate Valuation 1U02nQ~ - 12/02/2002 12/11/2002 Shares or Par Security Description 8igh/Ask LoW/Bid 11 15000 DEER LAKES SCH DIST PA G.O. BOS (243859BT!) FT Intr. DTD: 02/01/1995 Hat: 01/15/2008 6.2\ 12/02/2002 115.20900 115.20900 A/B Int: 07/15/2002 to 12/02/2002 21 10000 PROVO UTAH ELEC REV ELEC SYB (744176AX6) FT Intr. DTO, 12/01/1990 Kat: 04/01/2015 10.125' 12/02/2002 139.26400 139.01400 A/S Int: 10/01/2002 to 12/02/2002 39115.661 BLACKROC~ FOS (0919286221 PA TAXFREE INS NASDAQ 12/02/2002 3) 10. ?i000 Bid ') 29585.799 ALLIANCE .GROWTH , INCH (018597104) CL A NASDAQ 12/02/2002 2.75000 Bid 51 1763.668 BERGER INVT PORTFOLIO TR (084045608) MID CAP VALUE NASDAQ 12/02/2002 15.49000 Bid 6) 14925.718 BLACKROC~ FDB (091927566) LR CP VL EQ INC NASDAQ 12/02/2002 10.41000 Bid 1) 7232.731 BLACKROCK FDS (091927624) LRG Gmf' EQ INC NASDAQ 12/02/2002 7.73000 aid 9) 2556.237 TIP FOS (87252R300) TURNER SMCP VL NASDAQ 12/02/2002 ~ 16.24000 Bid 91 19410.68 PRINCIPAL CASH INVESTED (EVPOOOll 12/02/2002 1.00000 Total Value: Total Accrual: Total: $833,886.27 Page 1 E_tate ot: LUCINDA GOSSE'I'T Report Type: Dat. ot Death Number ot Securities: 9 File 10: 3214004 Mean and/or Div and Int Security Adjuatments Accruals Value 115.209000 17,281.35 v 353.92 139.139000 13,913.90 v 171.56 10.770000 421,275.67 ./ 2.750000 81,360.95 v 15.490000 21,319.22/ 10.410000 155,316.72 J 7.7JOOOO ,/ 55,909.01 16.240000 ,/ 41,513.29 1.000000 19,410.68 $833,360.79 $525.48 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300. (Revision 6.4.1) -""'.,,>I<.'!....., "':.'" .'-- '" . J . ." . o ADVISORS Decelllber 27, 2002 John Eakin, Esq. Market Square Building Mechanicsburg, P A 17055 RE: LIICiluhl Gossett Trust Dear John: Enclosed is a date of death valuation of the Lucinda Gossett Trllst. In addition to the assets listed un this schedule, the trust had a cash balance uf$19,410.68. Please do not hesitate to call with any questions or concerns. 7(1::" David A. Brown Vice-President ^ member 1..,( The l'NC nll.H\(\';" Sl.'r\'h:c~ llHlllp -12,12 C<lllisk' Pike Cnll1p J till ['etll\:;yki111i;l 1"(11 t J6.~;;]!l'F_i.;~~Hi:.'.::ti1ii~:.3' 5/~ NOL'.1L!P (",(')' ,] ~)') --- - > -. ...) ,) UEPOSrwn(,'l1 LIJCINI>A C CO~;SI':TT _~. _~~~~_'~.~:l!"J_'~.~~~_I~~~_~~~~~ISi~_~~t1LE"-~_J~~b...~:~~-~~--~. lIME CEIlIJrICME OF UEPOSIT OIZl~IOWN Ui\NK po, BOX 60 SfllPPENSBUI1G, P^ 17257 717-532-6114 ;;;~;ti;;;;::r.;;u;;'- !,,~~:~l.~'~~.~<:~.?~T. "cON~~ -..-.- KJ""~\llllIJM 1. ].1' )Illl Willi rllllrJ1V"'l';"IP \~::{,:r;:\;~~'~I""""l I I II lIT II llfl SI I1M\If '11'11 Ill' !,~~,':;::,~~'~;~) II -"- (l7;~miiW-~iIIl'--~ $[ 70,000.00 1'12-\1,-(,(17(, -. ---~-"---'-'- ''''''I,'''"''""'''''' ^OUnESS P q LllIX 5(\!. NEC//ANIC01 UIW, 60- 1503 ~ MEM8En rOle FA. I Ill';'; 'I'/'Il: SlIU'....I. """I tN' ("I """I P'l' .r' (,'""/ ,." CT1; _ . 1"1 ~ 1'11111 '111,1 '/11" '1ll1l1 ,,,II,, L.d I1W' f111.,1 ," '" liAS OfPOSI f FI' "., l' II.'> nAl,J){ __~______________,~____,__"_,_________~ rAYBlE -'0 S^JU tJEf'OSIIOI1(S), SUBJECI TO II IE CUrJDI1IOI-jS ,'nUllED orr II IE (fEVErISf: SIDE or CEnJlrlCATE. ISSUE 1 '1 ErlM or MA1UflllY rFnCfJHN;E nAfE IN I EtlESl PAYABLE Ll M^'L CHECK DME CEnllrlCATE VAlE rtnA'jfjUM ..,.-" '"'(J~"'-'-"--'------'-- -,;~/ ,-/-":;-( .-( '-'-"-.~I '~--:-I'------' "--I'.J-;--/"~;-I--/-I)-~~ Y:" ,2 5 IT ~C ~: ~I)~~ ~ ~~LY ~J ~~~,~;~I,~ ~~~U^LLY fJ COMrOUI JDJ'-JG 0) 2 L IJ; _/_N{)N, I' _ _J L J utrJ~I:\\XlllVII U^vuorj KtcnEDITACCf.No. -1-l.kOUOll( lii-iiliiilPfi"i~ii"ifF, tlll1"ililii"'iYf(';riiTif7"ill/ ,,;;--;;i'1ilvT/iiii"jfif:ll ~ M;:-r:liIiittllAxr:r:.7rii UlUlllFICAIION 19{ SINGLE MAlUnlTY CFnTlnC"TE (ITEM:J all BACKI NUMUEIl ".\J " ,'}5 IJl1fllnllt'AIIlIS{1! t[ll'\J!WllIIlIUY IItMfAHflll/ 'llll1llf I lOI1MI'U!'WlllnIUll,UIQ Ill1ttllllECAUSE I:J LJ UI"V;-NUI /1,'1)1)')/1/11 H "'/'II IAM','111H U 1')'IN l<l/1 YVllll1'f)l IlltU;/I" All' ',tnl ur A 'All 'JIlf 'OnO'Uffr ^~~~^~IC^llYnE'~EW^nlECF.:'mFl ?EIIJr;:M40NB^ I\ll1l-.rrI"lU"'-1 f)II"IVI"rtl(l'~ OIl"" IlJ1fItIlJ\1 IuvrlNrr ',fUVI'IIII\'ll)!l/J/llJlMf 1"^1 '^Mll!.UUNGFn --_.- ~ ' <'llJllIT' f ,rlflf\f I<III'WIIIlIltljf!JtJIl - '" . r UEPOSIIUl1S ^lllll(JI1IZ~I1/"~/ z--~:"- :7jt9' SIGtJMUnE ----~~~------------ ------ - _ '~I\)II^'\Jll/if~..:..-~ ---r~ ?'1i"~-....;... ~~~~'- ~_'......-c>'~.....nt'I'-:::r...."_.:.oorr:~'_~~....~~,..........,..,_:lInr~~~~,_ ___,...,...... - '-, Il allhrst LUCINDA C GOSSETT PO BOX 594 MECHANICSBURG PA 17055-0594 1",111",111,".1,1.,1,1,11""1,1,1,1",1"11,1,,,',,1,,,III PlJg~ 1 of 4 Statement Summary November 6, 2002 thru December 4, 2002 Lucinda C Gossett Q annrst.com 6' 24.hour Customer Service 1-600-533-4630 Your money In the bank Account Name Accounl Number Balance on 12104 . Classic Money Market Fixed Rate CD 00944-1024-0 8-700-814-0306509 $6,109_62 25,000.00 $31,109.62 pg 3 pg 4 What your Icons mean o Customer Service CI) Credit to your account o Important reminder C) Charge to your account .. Other banks' ATM transaction For questions about your sratement or change of address information. please see page 2. 001262 OOOt-9B'3179'3011tl 050 C /11l / \\ \ [,[ICIND/I (' 1:1 );:;:1-:'1"[' Closed. Messages LasL "Lilli l1aldll<'C: CUI'relll 11;] I 81l<:<': ]=Vlew l,cl'lilll '1"'J'sel Posted Check No S (JOc,/Dl ]0/00/02 10/21/0') 10/n/\\') IO/ll/l)) 1] /05/0') Il/OC/O') 11/07/02 11/21/02 11/24/02 .11 /2 4j.O ') 12i20/02 12/25/02 12/2C,/O,) I' I Tic ]C) ] \\20 1 ~1 \-) ICIl 1',1 O')IJ 1 'j I 151 1 ~1~) leU 151 l~) ~) 160 1 ", I Deposit Inquiry /\r:C()\JIll .1l1) .Illl 1,,),5 I .S 11111 ;-;1 ,"I ( erncnt 1(11: l;'rom Debit l' 1 I C>_ll\ I AFF C J c: IJ (' IJ I' 1\ (' I (' B C J C I C B C [1, C I C B C l\ C [ F'4=P.edisplay 1")=~;Cdll [orwal d E'16<,oLl, 1,'1)'Top E'18c'L\oLLoll\ F'1I=~;call l1ackwards F'20=\J1l [old n 111nhf:~ r : da LE?: cycle: '1'0 CreiH t ') . 7 ~)OO 513.00 186.99 1,2Wi.71 2. 'I C)OO 9'jO. 76 2.5000 2.3000 193.22 1, IJO') .29 2.3000 186.98 1,049.19 2.3IJOO J"ll=PrJor ba1 F22=T/C 12:04:47 1110()(1?79 1 of 1 3/2~j/03 -. . 25 uBalance 532,930.93 533,443.93 533,630.92 534,916.63 534,916.63 535,867.39 535,867.39 535,867.39 536,060.61 537,067.90 537',067.90 S37,254.g9 538,304.07 538,304.07 More.. . F'15=EF'T F23=Checks Page: 1 "Du(;Ument Name: Sessiona II" \ 'T" , . STFT 1 THF TR!\NSAC'l'ION STMT FORMAT 02/12/09 11.02.07 STMT CO 96 OP EBRN MS 50852 ACTION COMPLETE ACTION COLD PROD CODE CDl\ ACCT 31003910449981 SHORT NAME GOSSETT LUCINDA CURR CODE PAGE 1 SEARCH FROM 100/10/06 THRU ACTN POST EFFECTIVE CHECK NUMBER TR!\N AMOUNT D/C TRACE ID DESCRIPTION " 10/06 50,375.43 00000000000000000000 CONVERTED PRINCIPAL, " 10/06 3,100.15 00000000000000000000 CONVERTED INTEREST 10/06 35.94 I-GEN100100600002332 INTEREST PAYMENT GENERATED 10/05 10/06/01 3,355.63 I-GEN101100600004225 INTEREST PAYMENT GENERATED 11/06 297.79 I-GEN101110600003927 INTEREST PAYMENT GENERATED 11/06 57,164.94 C CDSGN101110600004143 "RENEWED AT 2.62%, MATURES ON 11/06 1,517.46 C I-GEN102110600002962 INTEREST PAYMENT GENERATED 12/09 139.16 I-GEN102120900000001 INTEREST PAYMENT GENERATED PF: I-HELP 3-PI,vL 6-INQ 7-SB 8-SF 9-l\SUM ll-CUTO . .-STSM C 102/12/09 BALANCE C 50,375.43 C 53,475.58 C 53,511. 52 c 56,867.15 c 57,164.94 57,164.94 11/06/03 58,682.40 c 58,821. 56 Date: 12/9/ 2 Time: 11:03:06 AM Customer: Address: Deceased: Jewelry: Mumma's Jewelry Store 34 W Main St, Mechanicsburg, PA 17055 Estate Appraisal 52522 Mumma's Jewelry Store Lucinda Gossett Neck""ce February 27, 2003 , i One lady's diamond pendent. The 14 karat wMe gold pendent contains 22 round single cut diamonds set into a heart shape design. The bail is a single loop and he<; a sterling siMlr open link chain attached 10 fue pendent. Dlamond(s): Shape: Single cut Quantity: 22, Mounted Average Clarity: SI1 . Average Color: J Symmetry: Fair Polish: Fair FluGrescence: Faint Estimated Weight: 0.33 carat Description: Metal(s): Total Value: Replacement Value: $78.00 Metal: Sterling Silver, Stamped Condition: Used Finish: Mixed polish Manufacturing Method: Die struck Weight: 3.7 dwt, gemstones included length: 18 inch Style: open link ite Professional Gemologls a's Jewelry Store The appraber as.fumes no nobility regarding any action taken on the basis of this ApprauaL $78.00 Mumma's Jewelry Store 34 W Main St, Mechanicsburg, PA 17055 . Estate Appraisal 52522 I March 1, 2003 Customer: Mumma's JewelTy Slore Address: Deceased: Lucinda Gossett Jewelry: Earrings Description: One pair Df diamDnd earrings. The 14 karat white gDld earrings are a pierced design wtth matching round cu1 diamDnds set into an musiDn setting which dangle from the lop Df the pDst which is a ball design. The backs flip up to. enclose the back of the pDSt. Diamond(s): Shape: Old European cut Quantity: 2, MDunted Average Clarity: VS2 Average Color: H Srmmetry: Fair Polish: GDod Fluorescence: NDne Estimated Weight:.0.84 caral Metal(s): . Metal:GDId; Slamped Purity: 14K Colar: Whtte Candition: Used Finish: Mixed pDlish Manufacturing Methad: Die struck Weight: 3.1 dwt, gemstDnes included Style: dangle pierced earrings Replacement Value: $200.00 $200.00 The appraiser assumes no liability regarding any acdon taken on the basis oJ this Appraisal Customer: Address: Deceased: Jewelry : Description: Diamond(s): Metal(s): Mumma's Jewelry Store 34 W Main Sf, Mechanicsburg, PA 17055 Estate Appraisal 52522 Mumma's Jewel,,! Store Lucinda Gossett February 27, 2003 Ring One lady's diamond engagement ring. The 14 karat wMe gold ring is designed with a round cut diamond set into a lour prong head with two round brilliant cut diamonds set on each side. (1) Diamond Shape: Full cut Quantity: 1, Mounted Dimensions: Diameter-7.15mm. ; Depth-4.25mm. Depth Percentage: 59.4% Table Percentage: 68% Crown Angle (in degrees): 31 degrees Girdle: Medium - Slightly Thick, Rough Clarity: VS2 Color: H Symmetry: Fair Culet: Ve"! Small Polish: Fair Fluorescence: None Intemallnclusions: (21 C,,!stal Estimated Weight: 1.33 carat (2) Diamond Shape: Full cut Quantity: 4, Mounted Average Clarity: 511 Average Color: I Symmetry: Good Polish: Good Fluorescence: None Estimated Weight: 0.08 carat Metal: Gold, Stamped Purity: 14K Color: WMe Condition: Used Finish: High polish Manufacturing Method: Die struck Weight: 1.7 dwt, gemstones included Replacement Value: $1,988.00 Total ~:Iue: ""'J / / -'[ ~/ r';;/ // '. --..--. / " -- Jo' ". hitet:;r,;;;.SSional demol0 Mumma's-4'ewelry Store / ---" - The appraiser assumes no (iabUily regarding any action taken on the basis of this AppraisaL $1.988.00 Customer: Address: Deceased: Jewelry : Description: Diamond(s): Metal(s): Total Value: Mumma's Jewelry Store 34 W Main St, Mechanicsburg, PA 17055 Estate Appraisal 52522 Mumma's Jewelry Store Lucinda Gossett Ring . Page Number: 1 March 1, 2003 One lady's diamond band. The platinum band is designed wijh five round llrilliant cut diamonds selinto four prong fishtail style of mounting. The ring has a gold filled ring guard attached. Shape; Round Brilliant cut Quantity: 5, Mounted Avenlge Clarity: VS 1 Avenlge Color: F Symmetry: Good Polist1: Good Fluorescence: Faint Estimated Weight: 0.80 carat Metal: Platinum, Stamped Condition: Used Finish: High polish Manufacturing Method: Die struck Weight: 2.7 dwt, gemstones included Replacement Value: $200.00 / $200.00 / / / ~~4ess~on~ Munyn6's'JeWelty Store ,// The appratfer Q.fsumes no /lab/Dty regarding any acdon taken on the ba.ftf of thtf A.ppraisaL REV-1511EX+(1-97) ~~ SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER T~lcind~ c. Gn~R~tt 21-02-01105 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Myers Funeral Home Mechanicsburg, PA $3,899.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) John M. Eakin Social Security Numbe~s) I EIN Number of Personal Representative(s) Street Address 322 Scenic Drive City Mechanicsburg Slate PA Zip 17055 Yea~s) Commission Paid: 2003-2004 53,000.00 Attorney Fees 27,000.00 2. 3. Family Exemption: (If decedent's address is nollhe same as claimant's, attach explanation) Claimant Street Address City Slate Zip Relationship of Claimant to Decedent 4. Probate Fees 325.00 5. Accountant's Fees 450.00 6. Tax Return Preparer's Fees 7. Cost of selling real estate - 1% Transfer Tax (See Schedule A) 3,&20.00 8. Reserved for cost of filing Account 150.00 TOTAL (Also enter on line 9. Recapitulation) $ 88,644.00 (If more space is needed, insert additional sheets of the same size) IlFvI511n.p~11 , r~ k" ,-, h 'f f~"~ 1Y 11:h}llM>>' COM~'~11IWr.^L11' or !'[tHISYI V.lIII!^ IIIHrtltlAIWF 'AX nnuml ==_ _ __ ~ ",-='~!;~!VJ:1!UJE~~~U:IJ~____. ESTAlEOF SCHEDULE I DElJTS OF DECEDENT, MOH[GAGE L1AlJILI f1ES,& L1~N~ Lucinda C. Gossett Include tll1lcllllhulsed medical expe"se~. ___~.______ __ _ ___.no ___ _'_~'____'_'__'_ I!EM NUMBER I. 2. 3. 4. 5. 6. 7. UESCI1IPIIUII -- --_.._._------_.._--_._~---------_..__._---------.._----.._--- P P & L Hampden Township, Sewer UGI Inc. PA- American Water Company Lower Allen Real Estate Tax Hampden Township REal Estate TAx Yellow Breeches EMS, ambulance riLE iiuMBER 21-02-01105 AMOUIIT $ 59.90 $ 60.62 $ 133.53 $ 164.87 $ 292.80 $ 402.53 $ 69.75 lOT AL (Also elller on \ille 10, Recopilula\ion) $ 1,184.00 ---.--------.----------~- -----~ .------ (1I-;l~{;~B-si~ac; is ;.\ee(Je~j:ill~p'.1 ~;jtiitio'l-a1"si;eeisoflilf'! smIle-size) REV.151lEX> (1-9T) . SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Lucinda C. Gossett NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. Carolyn Alexander FILE NUMBER 21-02-0 II 05 RELATIONSHIP TO DECEDENT Do Not List Trusteels) Niece Nephew AMOUNT OR SHARE OF ESTATE $300,000.00 $300,000.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 2. Thomas Chorpenning 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. Lucinda Care of C. Gossett Charitable Trust John M. Eakin, Trustee Market Square Building Mechanicsburg, PA 17055 TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $1,337,101.42 (If more space Is needed, insert additional sheets of the same size) COHNONNEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTNENT OF REVENUE INHERITANCE TAX DIVISION DEPT. Z80601 NOTICE OF DETERNZNATZON AND HARRISBURG, PA 17128-0601 ASSESSHENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN ~2r~,, : DATE 04-19-2004 [~? ESTATE OF GOSSETT LUCINDA C DATE OF DEATH 1Z-O5-200Z FILE NUHBER Z1 02-1105 JOHN H EAKIN '04 ~P~ 20~-~i ~1~ :_34COUNTYACH CUHBERLAND20 HARKET SQUARE BLDG HECHANICS]iURG PA 170~5g,. Amoun* Remi~d J HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF NILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To /nsure pPope~ c~edi~ ~o you~ =ccoun~, submi~ ~he uppe~ po~ion of *his fo~m ~i~h your ~ax p~ymen~. CUT ALONG THIS LINE I~ RETAIN LO~ER PORTION FOR YOUR FILES ~ REV-~83 EX AFP (01-03) ~ NOTICE OF DETERHZNATZON AND ASSESSNENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN ~ ESTATE OF GOSSETT LUCINDA C FILE N0.21 02-1105 ACN 201 DATE 04-19-2004 ESTATE TAX DETERHZNATZON 1. Credi* For Sta~e Death Taxes as Verified .00 2. Pennsylvania Inher/tance Tax Assessed 86~052.65 (Excluding Discount and/or Interest) $. Inher/tance Tax Assessed by 0~her States .00 or Terri~or/es of ~he United S~a~es (Excluding Discoun~ and/or Interest) 4. To~al Inheritance Tax Assessed 86z052.6~ 5. PennsylvanAa Es*a~e Tax Due .00 TAX CREDITS: PAYHENT RECEIPT DISCOUNT (+) DATE NUH~ER INTEREST/PEN PAID (-) AHOUNT PAID TOTAL TAX CRED]:T I .00 BALANCE OF TAX DUEl .00 :INTEREST AND PEN. . O0 TOTAL DUE .00 ~ZF PAID AFTER THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE ZS LESS THAN $1, NO PAYHENT TS REQUIRED FOR CALCULATION OF ADDTTZONAL INTEREST. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) ~ BUREAU OF ZNDZVZDUAL TAXES COHNONNEALTH OF PENNSYLVANZA ZNHERZTANCETAX DZV/SZON DEPARTNENT OF REVENUE DEPT. Z80601 HARRISBURG, PA 171Z8-0601 NOT!CE OF DETERHZNATZON AND ASSESSHENT OF PENNSYLVANZA ESTATE TAX BASED ON FEDERAL CLOSZNG LETTER ....... ;DATE 04-26-Z004 ESTATE OF GOSSETT LUCZNDA C DATE OF DEATH 12-05-2002 FZLE NUNBER Z! 02-1105 'O~i ~PR 2~ r:~ :'~OUNTY CUH~ERLAND JOHN N EAKIN HARKET SQUARE BLDG ACH ZOZ HECHANICSBURG PA 1705~; A.ount Remitted HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA !70!~ NOTE: To insure p~ope~ c~dit to you~ =¢count~ submit the upper portion of this form ~1th you~ tax CUT ALONG THZS LZNE ~ RETAZN LONER PORT!ON FOR YOUR FZLES REV-736 EX AFP (01-0~) ~ NOT!CE OF DETERNZNATZON AND ASSESSNENT OF PENNSYLVANZA ESTATE TAX BASED ON FEDERAL CLOSZNO LETTER ~ ESTATE OF GOSSETT LUCINDA C FZLE NO.!! 02-!105 ACN 202 DATE 04-26-200~ ESTATE TAX DETERHZNATZON !. CPedit Fo~ S~a~e Death Taxes as Verified .00 Z. Pennsy!vania Inheritance Tax Assessed 86,052.65 CExc!uding Discount and/or Interest) ~. 1nhe~itance Tax Assessed by O~he~ S~ates .00 o~ Territories of ~he United S~a~es CExcluding D1scoun~ and/or Interest) 4. To~a! Inheritance Tax Assessed 86~052.65 5. Pennsylvania Estate Tax Due .00 6. Amoun~ of Pennsy!vanla Estate Tax P~eviously Assessed Based on Federa! Estate Tax RetuPn .00 7. Additiona! Pennsy!vania Es~a~e Tax Due .00 TAX CREDZTS: PAYHENT RECEIPT DISCOUNT (+) DATE NUHBER INTEREST/PEN PAID (-) AHOUNT PA~D TOTAL TAX CRED1'T ~--- .001 I~ALANCE OF TAX DUE/ .00 'rNTEREST AND PEN. / .00 TOTAL DUE / . 00 ~ZF PA'rD AFTER TH?S DATE, SEE REVERSE S]'DE (ZF TOTAL DUE TS LESS THAN $1, NO PAYNENT IrS REI]U'rRED FOR CALCULAT'rON OF ADDTTZONAL ZNTEREST. 'rF TOTAL DUE TS REFLECTED AS A 'CREDIrT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE S*rDE OF TH'rS FORN FOR ZNSTRUCT'rONS.) Inventory of the real and personal estate of Lucinda C. Gossett deceased PERSONAL PROPERTY Lucinda C. Gosset revocable Trust PNC Bank $853,296.95 Orrstown Bank Certificate of Deposit # 60133 $ 70,068.56 Allfirst Bank Certificate of Deposit # 306509 $ 25,012,27 Allfirst Bank, Checking Account # 410240 $ 6,109.36 Orrstown Bank, Account # 111-000279 $537,123.99 M&T Bank Certificate of Deposit # 449981 $ 58,682.40 Orrstown Bank, Checking Account #000662 $ 4,416.24 Miscellaneous coins $ 560.00 Jewelry $ 2,466.00 Claremont Nursing Home, Patients Fund $ 563.00 Pa 2002 Income Tax refund $ 622.00 Cash $ 308.97 REAL ESTATE House and Lot of ground in Hampden Township $143,000.00 Vacant Lot Hampden Township $ 24,000.00 19.74 acres tract unimproved Lower Allen Township $215,00C.00 Total 1,941,22!~.74 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND John M. Eakin beincJ duly _swo~rn .... accordin9 to law, deposes and says fhaf he is th_e_ e~_cu_t.o_r_ ____ of fha Estate of Lucinda C. Gosset late of Hampden Township , Cumber]and County, Pa., deceased and fhaf fha wifh;n is an inventory made by Joico Mr Y~kin ...... the said executor of the eot;re estate of sa;d decedent, conslst;ng of all the personal property and real estate, except real estate outside fha Commonwealth of Pennsylvania, and fhaf fha f}gures opposite each item of fha Inventory represent it's fa;r value as of ~e date of decedenf's death. ~'~¢CV,q and subscribed before me, _ COMMONWEALTH OF PENNS~VANIA Market Square Building, Mechanicsburg, PA 17055 ~ -- ~ml ~al J '- Address - L '~'Y m~ E~ Ju~ ~, ~7 Date ot ueafn ~ --'~ December 2002 Day Month Year INSTRUCTIONS I. An inventory must be {i~e~ w;fhln ~hree months a~fer appo~nfmen~ o~ personalrepresenfafive. 2. A supp}emenf i.venfory must be ~;le8 wifhln fhlrfy days o~ discovery o{ additional assets. 3. A88~Honal sheets may be effache8 as ~o personalty or realty 4. See ArHcle IV, Fiduciar;es Act o~ 1949. Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 11/10/2004 EAKIN JOHN M MARKET SQUARE BUILDING MECHANICSBURG, PA 17055 RE: Estate of GOSSETT LUCINDA C File Number: 2002-01105 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 12/02/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge L~ Ll_ C;J LLl C) Ci:' .. LL c::- C~-. U5 C:-j IL C) C.") 1..1..1 CL: STATUS REPORT UNDER RULE 6.12 Name of Decedent: LvL.11.) ()(t Cos 5 E 7 r c, Date of Death: Will No.: ?.bO L -olio'> Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Comi Rules, I repOli the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes 0 No r:a--- 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: I tl h..J 6 ,- , 3. If the answer to No. I is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No 0 b. The separate Orphans' Comi 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 0 No 0 c. Copies of receipts, releases, joinders and approval offormal or informal accounts maybe filed with the Clerk of the Orphans' Court and may be attached to this report. ~m Signatur Date: ----.!..2 if" (j r ~ co N ''J Name ~ ~..,- u- .. C) t';~~/? L.:.J -~: . __.J <-" u:r.: L- ee O::~.-~ C5 Ad~i +&"J a ~ t{, Telephone No. 7/,6-'7/72-. .::r ~ ....::;: --, 1...r7.l =.~ = N Capacity: f'11Jersonal Representative o Counsel for personal representative ~ JRD/June30, 1992/17858 JAN 1 2 200~ Estate No.: 21-02-1105 ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA In Re: Estate of Lucinda C. Gossett Late of Hampden Township NO. 21-02-1105 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE Personal Representative: John Eakin Counsel for Personal Representative: John Eakin, Esquire Date of Decedent's Death: 12/02/2002 Date of Delinquency Notice: 01/10/2005 The undersigned, Glenda Farner-Strasbaugh, Clerk of Orphans' Court, in accordance with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, was given by the Clerk of the Orphans' Court on November 10, 2004, and that the ten (10) day notice to file the Status Report has expired. Accordingly, in accordance with Rule 6,12 the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 01/13/2005 &~~~~tr . Glenda Famer Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File 'Yi\~ l+ J,O()S ,,: ~O 1\'1 I A hearing is scheduled for at in Courtroom No.3. If the Status Report is filed prior to the hearing date, the hearing will automatically be cancelled. Ge vuf COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, P A ORPHANS' COURT DIVISION NO. 21- C> 2. - II 0 \- . ESTATE OF LUCINDA C. GOSSETT DECEASED ESTATE 21-02-1105 LATE OF THE BOROUGH OF MECHANICSBURG FIRST AND PARTIAL ACCOUNT OF JOHN M. EAKIN, TRUSTEE UNDER LAST WILL AND TESTAMENT OF LUCINDA C. GOSSETT, DECEASED DATE OF DEATH: DECEMBER 2,2002 DATE OF TRUSTEES' FIRST RECEIPT OF FUNDS: DECEMBER 24, 2002 ACCOUNTING: DECEMBER 24 THROUGH AUGUST 31, 2005 PURPOSE OF ACCOUNT: THE TRUSTEE OFFERS THIS ACCOUNT TO ACQUAINT INTERESTED PARTIES WITH THE TRANSACTIONS THAT HAVE OCCURRED DURING HIS ADMINISTRATION FOR THE TRUST. REQUESTS FOR ADDITIONAL INFORMATION OR QUESTIONS OR OBJECTIONS CAN BE DISCUSSED WITH JOHN M. EAKIN MARKET SQUARE BUILDING MECHANICSBURG, P A 17055 (717) 766-3172 [r-.. :'1 I" ::J . j ;.-:) b I I C _,~ \..i.J ~ "1 ~~ j I .. -'.' "I ,~. :0 j:):~LC G.3JbU:J3c1 II lUCINDA C. GOSSETT CHARITABLE TRUST ACCOUNT RECAPITULATION DECEMBER 24, 2002 THROUGH AUGUST 31, 2005 PRINCIPAL ACCOUNT PAGES RECEIPTS 2 $1,599,012.27 DISBURSEMENTS 3,4 $610,459.12 PRINCIPAL ON HAND AT AUG. 31, 2005 $988.553.15 INCOME ACCOUNT RECEIPTS 5 $69,682.27 DISBURSEMENTS 6 $69,682.27 INCOME ON HAND AT AUG. 31, 2005 $0.00 TOTAL ON HAND AT AUG. 31, 2005 $988.553.15 TOTAL ON HAND AT AUG. 31, 2005 COMPOSED OF THE FOllOWING: ORRSTOWN BANK CHECKING ACCOUNT 111000612 $25,230.41 MORTGAGE RECEIVABLE FROM ROBERT BANZHOFF $111,550.00 PNC INTEREST ACCOUNT 27-27-007-3852251 $851.772.74 TOTAL ON HAND AT AUGUST 31,2005 $988.553.15 LUCINDA C. GOSSETT CHARITABLE TRUST ACCOUNTING DECEMBER 24,2002 THROUGH AUGUST 31,2005 PRINCIPAL RECEIPTS 12/24/2002 TRANSFER FROM ESTATE ORRSTOWN BANK ACCOUNT 111-000279 11/15/2003 TRANSFER FROM ESTATE ORRSTOWN BANK ACCOUNT 111-000279 02/07/2003 TRANSFER FROM ESTATE ORRSTOWN BANK ACCOUNT 111-000279 02/28/2003 TRANSFER FROM ESTATE ORRSTOWN BANK ACCOUNT 111-000279 05/13/2003 MORTGAGE RECEIVABLE FROM ROBERT BANZHOFF SALE OF 5385 TRINDLE ROAD, MECHANICSBURG 01/12/2004 TRANSFER FROM PNC BANK ESTATE TRUST ACCOUNT 07/21/2004 TRANSFER FROM ESTATE ORRSTOWN BANK ACCOUNT 111-000279 12/23/2004 TRANSFER FROM ESTATE ORRSTOWN BANK ACCOUNT 111-000279 2004 PNC INVESTMENT ACCOUNT GAIN ON SALES 2005 PNC INVESTMENT ACCOUNT GAIN ON SALES TOTAL PRINCIPAL RECEIPTS 2. II $30,000.00 $25,000.00 $235,000.00 $180,483.92 $121,550.00 $851,692.70 $30,000.00 $30,000.00 $84,254.18 $11.031.47 $1.599.012.27 LUCINDA C. GOSSETT CHARITABLE TRUST ACCOUNTING DECEMBER 24,2002 THROUGH AUGUST 31,2005 PRINCIPAL DISBURSEMENTS 12127/2002 ALLIED ARTS FUND 12/31/2002 CHURCH OF LATTER DAY SAINTS 01/15/2003 JUNIATA COLLEGE 01/23/2003 UNIVERSITY OF MINNESOTA 02/05/2003 MECHANICSBURG FOUNDATION 05/0212003 HARRISBURG YMCA 06/13/2003 GOLDEN WEST COLLEGE 07/07/2003 NINILCHIK LIBRARY 09/16/2003 MESSIAH COLLEGE 10/16/2003 DICKINSON SCHOOL OF LAW 10/19/2003 ESTATE OF LUCINDA C. GOSSETT TRANSFER 11/19/2003 ALLIED ARTS FUND 12/24/2003 BETHESDA MISSION 12131/2003 MECHANICSBURG FOUNDATION 12/31/2003 CHURCH OF LATTER DAY SAINTS 12/18/2003 FRANKLIN & MARSHALL COLLEGE 12/18/2003 MESSIAH COLLEGE 02/16/2004 MESSIAH COLLEGE 03/19/2004 JUNIATA COLLEGE 04/16/2004 HARRISBURG YMCA 05/06/2004 MESSIAH COLLEGE 05/10/2004 DICKINSON SCHOOL OF LAW 06/15/2004 MARYLAND INSTITUTE COLLEGE OF ART 06/15/2004 MARYLAND INSTITUTE COLLEGE OF ART 06/15/2004 WILKES UNIVERSITY 06/15/2004 TRANSFER TO ESTATE OF LUCINDA C. GOSSETT 07/21/2004 TRANSFER TO ESTATE OF LUCINDA C. GOSSETT 09/09/2004 HARRISBURG YMCA 10/11/2004 NEW HOPE MINISTRIES 10/11/2004 GOLDEN WEST COLLEGE 10/12/2004 MESSIAH COLLEGE 10/19/2004 HARRISBURG YMCA 12103/2004 BETHESDA MISSION 12/03/2004 NEW HOPE MINISTRIES 12/23/2004 TRANSFER TO ESTATE OF LUCINDA C. GOSSETT 2004 PNC INVESTMENT ACCOUNT FEES 2005 PNC INVESTMENT AMORTIZATION CHARGES :J II $4,626.92 $500.00 $30,000.00 $5,000.00 $1,000.00 $150.00 $10,000.00 $1,500.00 $5,000.00 $24,000.00 $200,000.00 $5,000.00 $5,000.00 $2,000.00 $500.00 $10,000.00 $5,000.00 $15,916.68 $30,000.00 $500.00 $5,000.00 $20,000.00 $10,000.00 $5,000.00 $10,000.00 $4,664.00 $25,000.00 $30,000.00 $1,000.00 $5,000.00 $5,000.00 $1,000.00 $5,000.00 $5,000.00 $30,000.00 $9,183.12 $134.77 II PRINCIPAL DISBURSEMENTS 01/09/2005 FRANKLIN & MARSHALL COLLEGE 01/10/2005 MCCURDY SCHOOL 01/28/2005 MESSIAH COLLEGE 02/02/2005 HARRISBURG YMCA 02/16/2005 MESSIAH COLLEGE 04/26/2005 WESLEY UNITED METHODIST CHURCH 05/26/2005 JUNIATA COLLEGE 05/27/2005 EAST STROUDSBURG UNIVERSITY OS/27/2005 DICKINSON SCHOOL OF LAW 06/01/2005 EAST STROUDSBURG UNIVERSITY 06/03/2005 NEW HOPE MINISTRIES 08/10/2005 WESLEY UNITED METHODIST CHURCH $3,533.63 $5,000.00 $5,000.00 $750.00 $5,000.00 $3,000.00 $30,000.00 $5,000.00 $20,000.00 $2,500.00 $1,000.00 $3,000.00 TOTAL PRINCIPAL DISBURSEMENTS $610,459.12 l-J LUCINDA C. GOSSETT CHARITABLE TRUST ACCOUNTING DECEMBER 24, 2002 THROUGH AUGUST 31, 2005 INCOME RECEIPTS 12/31/2002 ORRSTOWN BANK ACCOUNT 111-000612INT. 02/02/2003 ORRSTOWN BANK ACCOUNT 111-000612 INT. 03/02/2003 ORRSTOWN BANK ACCOUNT 111-000612 INT. 03/31/2003 ORRSTOWN BANK ACCOUNT 111-000612 I NT. 04/30/2003 ORRSTOWN BANK ACCOUNT 111-000612 INT. 06/01/2003 ORRSTOWN BANK ACCOUNT 111-000612 I NT. 06/30/2003 ORRSTOWN BANK ACCOUNT 111-000612 INT. 07/31/2003 ORRSTOWN BANK ACCOUNT 111-000612 INT. 09/01/2003 ORRSTOWN BANK ACCOUNT 111-000612 INT. 09/30/2003 ORRSTOWN BANK ACCOUNT 111-000612 INT. 11/02/2003 ORRSTOWN BANK ACCOUNT 111-000612 INT. 11/17/2003 ROBERT BANZHOFF MORTGAGE INTEREST 5385 TRINDLE ROAD, MECHANICSBURG 11/30/2003 ORRSTOWN BANK ACCOUNT 111-000612 INT. 12/31/2003 ORRSTOWN BANK ACCOUNT 111-000612 INT. 01/22/2004 ROBERT BANZHOFF MORTGAGE INTEREST 02/01/2004 ORRSTOWN BANK ACCOUNT 111-000612 INT. 02/29/2004 ORRSTOWN BANK ACCOUNT 111-000612 I NT. 03/31/2004 ORRSTOWN BANK ACCOUNT 111-000612 INT. 05/02/2004 ORRSTOWN BANK ACCOUNT 111-000612 INT. 05/31/2004 ORRSTOWN BANK ACCOUNT 111-000612 INT. 06/02/2004 ROBERT BANZHOFF MORTGAGE INTEREST 06/30/2004 ORRSTOWN BANK ACCOUNT 111-000612INT. 08/01/2004 ORRSTOWN BANK ACCOUNT 111-000612 INT. 08/31/2004 ORRSTOWN BANK ACCOUNT 111-000612 INT. 09/30/2004 ORRSTOWN BANK ACCOUNT 111-000612 INT. 10/31/2004 ORRSTOWN BANK ACCOUNT 111-000612 INT. 11/18/2004 ROBERT BANZHOFF MORTGAGE INTEREST 11/30/2004 ORRSTOWN BANK ACCOUNT 111-000612 INT. 12/03/2004 ROBERT BANZHOFF MORTGAGE INTEREST 12/31/2004 ORRSTOWN BANK ACCOUNT 111-000612INT. 2004 PNC INVESTMENT ACCOUNT DIVIDENDS 2004 PNC INVESTMENT ACCOUNT INTEREST 2005 PNC INVESTMENT ACCOUNT INTEREST 1/1 - 8/31 2005 PNC INVESTMENT ACCOUNT DIVIDENDS 1/1 - 8/31 2005 ORRSTOWN BANK ACCOUNT 111-000612 I NT. 1/1 - 8/31 2005 ROBERT BANZHOFF MORTGAGE INTEREST 1/1 -8/31 TOTAL INCOME RECEIPTS ~ ~ $8.22 $16.30 $406.51 $779.23 $803.47 $788.31 $668.04 $616.38 $634.29 $572.11 $578.18 $1,998.08 $241.08 $262.88 $999.04 $237.12 $195.80 $156.17 $87.90 $57.64 $3,037.50 $48.61 $37.39 $63.28 $63.35 $51.03 $1,456.25 $17.05 $1,456.25 $14.15 $33,342.33 $1,477.50 $1,649.38 $13,812.53 $136.42 $2.912.50 $69.682.27 11 LUCINDA C. GOSSETT CHARITABLE TRUST ACCOUNTING DECEMBER 24, 2002 THROUGH AUGUST 31, 2005 INCOME DISBURSEMENTS 12/21/2002 HARRISBURG YMCA 12/27/2002 ALLIED ARTS FUND 12/07/2003 JOHN EAKIN TRUSTEE FEE (2003) 02/19/2004 JOHN EAKIN COST REIMBURSEMENT 02/21/2004 JOHN EAKIN ATTORNEY FEE (2003) 03/19/2004 JOHN EAKIN TRUSTEE FEE (2004) 04/16/2004 JOHN EAKIN ATTORNEY FEE (2004) 07/16/2004 ALLIED ARTS FUND 01/06/2004 NEW HOPE MINISTRIES 02/10/2004 MCCURDY SCHOOL 02/11/2004 FRANKLIN & MARSHALL COLLEGE 02/11/2004 HARRISBURG YMCA 02/24/2004 HARRISBURG SYMPHONY ORCHESTRA 02/26/2004 NINILCHIK LIBRARY 02/16/2004 MESSIAH COLLEGE 2005 PNC INVESTMENT ACCOUNT FEES 1/1 - 8/31 01/09/2005 FRANKLIN & MARSHALL COLLEGE 02/16/2005 US TREASURY EXCISE TAX 02/28/2005 GREENAWALT & CO. ACCOUNTING 08/15/2005 US TREASURY EXCISE TAX $500.00 $2,873.08 $5,000.00 $715.04 $1,500.00 $2,000.00 $1,000.00 $7,500.00 $1,000.00 $7,500.00 $1,000.00 $1,500.00 $5,000.00 $5,000.00 $9,083.32 $6,169.46 $6,466.37 $577.00 $1,250.00 $4.048.00 $69.682.27 TOTAL INCOME DISBURSEMENTS John M. Eakin, Trustee under the will of Lucinda C. Gossett, deceased, hereby declare6i under oath that he has truthfully performed his duties as trustee; that the foregoing First and Partial Account is true and correct; that it fully discloses all significant transactions occurring during the accounting period; that all known claims against the trust have been paid in full; that to his knowledge, there are no claims now outstanding against the trust and t~~t all taxes presentl}' due from the trust have been paid. ' ~ Y\ \ _ j John MEakin subscribed fjd sworn to this , q day of October, 2005. c1kidl" '-!ll. v!ll/hflt NOTARIAL SEAL HEIDI M. NELSON, ~ PublIc Mechanlcsburg Bora, Cumbirtlnd Co. My Commission expires June 27, 2007 (p 21-2002-1105 1fr~cl~Jt 'JilIJ ill ~tttb: 'Q}trttcutt~ttt OF LUCINDA C. GOSSETT I, LUCINDA C. GOSSETT, of Lower Allen Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this my Last will and Testament, hereby revoking and making void all former wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. I direct that there shall be paid out of my residuary estate all estate, inheritance and like taxes together with any interest or penalty thereon imposed by the Government of the united States, or any state or territory thereof, or by any foreign government or political subdivision thereof, in respect to all property~required to be included in my gross estate for estate, inheritance or l+ke t?x pprposes by any of such governments, whether the property passes'under this will or otherwise. ;j "(0-1\ - 1 - 3. I give and bequeath the sum of Three Hundred Thousand ($300,000.00) Dollars to my brother, RAY D. FAGER, if he survives me; in the event he predeceases me the gift shall lapse and fall into the residue of the estate. 4. 1 give and bequeath the sum of Three Hundred Thousand ($300,000.00) Dollars to my niece, CAROLYN ALEXANDER, if she survives me; in the event she predeceases me the gift shall lapse and fall into the residue of the estate. 5. 1 give and bequeath the sum of. Three Hundred Thousand ($300,000.00) Dollars to my nephew, THOMAS E. CORPENNING, JR., if he survives me; in the event he predeceases me the gift shall not lapse but shall go in equal shares to his heirs per stirpes. 6. All the rest, residue and remainder of my estate, 1 give, devise and bequeath in trust under and subject to the following terms and conditions: A.) The name of the trust shall be the LUCINDA C. GOSSETT , CHARIT~~E TRUST. - , . .', B.)' 'i.1 namef con.sti~yte and appoint JOHN M. EAKIN trustee and direct that no bond be required to guarantee faithful performance of his duties. ~~ - 2 - I[ c.) The term of the trust shall be ten (10) years from the date the trust corpus is received from decedent's estate; in the event the corpus together with interest has not been distributed by that date, the term of the trust shall be extended for a reasonable time to permit the trustee to wind up the trust by making complete distribution to section 50l(c) (3) entities and file a final accounting with the Court of Common Pleas, Orphans' Court Division. D.) I authorize, empower and direct the trustee to make payments of principal and interest from time to time during the continuance of the trust to those beneficiaries which in his sole discretion are deemed to be qualified recipients provided that all distribution shall be for tax exempt purposes and none other. E.) The trust is created to devote and apply the trust fund exclusively for charitable purposes by contributions duly authorized to carryon charitable activities and which have established their tax exempt status under the provisions of section 501(c) (3) of the Internal Revenue Code and its regulations as they now exist or may hereafter be amended and the trust assets, profits and net income thereof are irrevocably dedicated to such purpose. , F.)~t No part of the net earnings of the trust shall inure to the ben~fit of apy p~iva~e individual having a personal or private interest in the activities of the trust within the meaning of section 50l(c) (3) of the Internal Revenue Code and the ~~~ - 3 - II ........." trust shall not be operated for the benefit of private interests such as the heirs of the decedent, the trustee or any person or persons controlled directly or indirectly by such private interests. G.) The trustee shall invest, reinvest and keep invested the trust corpus in obligations which men of prudence, discretion and intelligence acquire for their own account provided that no investment shall be made which is a prohibited transaction under the provisions of this trust. H.) The trustee shall not engage in any act of self-dealing as defined by section 4941(d) of Internal Revenue Code nor retain any excess business holding as defined in section 4943(c) of the Internal Revenue Code nor make any investments in such manner as to incur tax liability under section 4944 of the Internal Revenue Code nor make taxable expenditures as defined by section 4945(d) of the Internal Revenue Code. I.) The trustee shall distribute the income of the trust for each taxable year at such time and in such manner as not to become subject to the tax on undistributed income imposed by the Internal Revenue Code. J.) I' ; The trustee may incur expenses on behalf of the trust which h~may consider nec"e. ssary and proper for the effective 'I I administration of' the trust'including reasonable attorney and accountant fees, subject to the provisions of this trust. .~, ~ Ji - 4 - II _."....'.~. 7. Lastly, I nominate, constitute and appoint, JOHN M. EAKIN, to be Executor of this my Last will and Testament. I further direct that no bond or other security be required of my personal representative to guarantee faithful performance of his duties. IN WITNESS WHEREOF, I have hereunto set my hand and seal t \ this day of August, 1999. -~~~~ Lucinda C. Gossett ( SEAL) Signed, sealed, published and declared by the above named LUCINDA C. GOSSETT as and for her Last will and Testament, in the presence of us who have subscribed our names hereto as witnesses, at her request, in her presence and in the presence of each other. ~ G~~vurH ? ;;;::th /itv.. d/ {~ :' f' ~ ~ i 'j. ',I - 5 - 1 ' .. r. ~~f:-,' t COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ) I, LUCINDA C. GOSSETT, the testatrix, whose name is signed to the attached or foregoing i.nstrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last will and Testament: that I signed it willingly, and that I signed it as my free and voluntary act and deed, for the purposes therein expressed. (~n\k~JJ;~~tt-- (SEAL) Lucinda C. Gossett Sworn and subscribed to before me this II Ttlay of August, 1999. /lIOG-.Jf, (trL<-M- Nota y Public Notarial Seal Marftyn E. WIIIlamll. Notary Public Mecha1lC:sburg Boro. Cumberland County My torrwnlsSlon EICpIIllI Nov. 6. 2001 MomlJer, Pennsyfvanta ASsociation of Notaries COMMONWEALTH OF PENNSYLVANIA ) ) COUNTY OF CUMBERLAND We, the undersigned,r..po/.qi3E:1- E. EAJc~ and i'~1t~ J. ~€JSI..~,L , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the within testatrix, LUCINDA C. GOSSETT, sign and execute the instrument as her Last Will and Testament; that the said testatrix, LUCINDA C. GOSSETT executed it as her voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the testatrix, signed the will as witnesses; and that, t..o the best of our knowledge, the testatrix was, at the time, ej.ghteen (18) or more years of age, of sound mind, and under no constraint, duress or undue influence. aV11 cf!,/~ rf G:ced (;LL--~7 (~ "--- Sworn artd'subscribed-to before me this -II.! 'f'1.r' '1 day of August, 1999.- ~~~~. , Not ry PUblic Notarial Seal Mlrityn E. Williams. Notary Public Mtdlan~rg Boro. Cumberland County My Commission Expires Nov. 6, 2001 MtmlMr, PtIlln~'vanill Associalion of Notaries - 6 - -- ~ (l1 n :t"t t.. J> 'J> 0 z~;"! (} "\ 0 UlUl?J2 ~ ~ ~ ~ "Xl ~ ...( . ~"'~I'\ \l~ J> ~ t \ ~ _ 'i 2 ~ GI o \JI \JI \ \ \ \ t.-\~ or-\ ~~ 1-'3 ~~ t<1o ~~ ~~ r-\ ~~ d ~~ ~g ~ o ~ oot<1 ~t<1tJ) (J1-'3 '$,t<1~ ~~t<1 ~~O ~" ~ r-\ (Jr'td ~~(J dt<1~ ~Oo ~';? ~(J ~. ~0 'Q:lo otJ) ~~ el-'3 01-'3 O;P" .1 ,I 1\ ~~3~~'~~~'~ ~~Q<2(DO~ ... ot~-<O 1;8- ,i 5g\~ 1\1 ,rrt . ~o..S- ~ ..?', 169..~ ____!>> \~ i i ?f -:> (J) ~!:;) ....>. Qe-\' ti~; , ~:;r5;:rOi~~o ~.....~(\)"lJL~c.~ ,\ ~(D<' a. g ~ "\ . " 9. H ~ s ~ g. , ,~~ 0 Q~ g 4~ 9 y- ~!il 3'c.;!! ~ 0. :J.) . 0 S' (\) <. t1) ,-.~~ ~ .-' ? _ ro '- J - . \1>~-o-:3~O? ..2 ~ (\) _:;!. c;;. cO . u;C':=;- 0 c) ~ ".:~ ::- .. 'g~~~ . i-tlS1 ~ ~~~ tJ) t"' (J ~'?o (Joe g(J~ ~go 1-'3~~ ~~(J ~" ~ ~t-d~ r-\~@. @.~ ~'2 ~~ ~\ r-\ ';? 1\ ~ ~ ..:: "(3 Q) 0 _' ~::: 0 ~ g' 9( ::l .;:: - (l) c:: < :.-::a;o~ca.roC '-"= Ci U (1) ~ ... E'~ '1 oS -g ~ ~ .~~ ~ ~ ~ H~d pE \'~ g;~J~~j2 ~ .{!lI~~ij1~ -- j~.815 ~iii ..~ ~ii~il il~c,:1 t~i'Bu~t~" '.~') ;8~ !~!2~~ j ~:il5tJtJ;>-~mO ~ ~ ~ 5 ! ~ c: !c: 'ffi - - :> _ 0 (I) .::.: ._ .r:. ~<: OH oo~ "::I:: E-c0 ~ <::> E-cP 0 U1 ~.....:1 ~o U1 .....:1:>-< 000::: E-c 0 p..,oo 000 Z [!J t'- ZZ 0i=t:1 P Z z ~ ZZO 0 O~ Q ~ 0 <i O~H ~ U~ ~ .J ~p..,~ .::I:: UE-c <{ :; 0.. UE-c <:00 W ~ '" 0 ,,:> P w ci U:>-<H <:~ ~~ >- " I! Z <! E-cA A00 w :J :J ~Z Z 0::: H Z G m It 10 OpE-c H~p E-c " Z 0 to 00::: UE-ci=t:1 ~~ I ~ I;j [J E-cUp P<:OO 0 " z 0::: 0 .....:1.....:1U p..,~ " ""J <! <( pAU H I I OZ ~ "~ A~ [J U <:- OA ~ . w .....:100 ~::I:: ~ ~O:::~ ~OOU ::E:: ::I::~ E-c<:~ E-c E-c~ <:~::E:: ooZ p.., . E-cU O:::::I:: Z 0:::0 OO~~ HO HUOZ ~AO ~'J 1. i u ~u -c toe?: , ');:' " ';t, 8_~, ',,: .~,'{ .! (.:, . - J ~li~ ~./ COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PA ORPHANS' COURT DIVISION ESTATE OF LUCINDA C. GOSSETT DECEASED ESTATE 21-02-1105 LATE OF THE BOROUGH OF MECHANICSBURG FIRST AND PARTIAL ACCOUNT OF JOHN M. EAKIN, EXECUTOR OF THE LAST WILL AND TESTAMENT OF LUCINDA C. GOSSETT, DECEASED DATE OF DEATH: DECEMBER 2,2002 DATE OF EXECUTORS APPOINTMENTS: DECEMBER 10, 2002 DATE OF PUBLICATION OF ESTATE NOTICES: CUMBERLAND LAW JOURNAL: JANUARY 3, 10, 17,2003 THE SENTINEL: DECEMBER 30, 2002 JANUARY 6, 13, 2003 ACCOUNTING: DECEMBER 2, THROUGH AUGUST 1,2005 PURPOSE OF ACCOUNT: JOHN M. EAKIN, OFFER THIS ACCOUNT TO ACQUAINT INTERESTED PARTIES WITH THE TRANSACTIONS WHICH HAVE OCCURRED DURING HIS ADMINISTRATION. THE ACCOUNT ALSO INDICATES THE PROPOSED DISTRIBUTION OF THE ESTATE. JOHN M. EAKIN MARKET SQUARE BUILDING MECHANICSBURG, P A 17055 (717) 766-3172 ') ,', ~A ../ t',~'" ,_:::> ( .:1 r, ) -~'."I =,""] _n1 r-~ 1 , ~~~3 f;~: '; ;~~~:i - '~..-:) c:> '1 _. ~ 1 - -LJ - (.') , 1'1'1 :",-., Cj . 11 1...0 \.J o ESTATE OF LUCINDA C. GOSSETT ACCOUNT RECAPITULATION DECEMBER 2, 2002 THROUGH AUGUST 1, 2005 PRINCIPAL ACCOUNT PAGES RECEIPTS ASSETS RECEIVED AT DEATH 2 $200,751.88 TRANSFER FROM LUCID C. GOSSETT 3 $200,000.00 CHARITABLE TRUST DISBURSEMENTS NET ADJUSTMENT FOR GAINS (LOSSES) NET GAINS 4 $538.95 NET LOSSES 4 $7.300.78 NET LOSS $6,761.83 DISBURSEMENTS 5 $163,359.14 DISTRIBUTIONS TO BENEFICIARIES 6 $2,043,726.62 TOTAL PRINCIPAL DISBURSEMENTS $2,213,847.59 EXCESS PRINCIPAL DISBURSEMENTS OFFSET AGAINST INCOME RECEIPTS ($6,328.71) INCOME RECEIPTS 7 $29,188.61 UNDISTRIBUTED INCOME ON HAND $22,859.90 AT AUGUST 1, 2005 BALANCE IN PNC ESTATE CHECKING $22,859.90 ACCOUNT 50-0415-2741 ESTATE OF LUCINDA C. GOSSETT ACCOUNTING DECEMBER 2, 2002 THROUGH AUGUST 1, 2005 PRINCIPAL RECEIPTS DATE OF DEATH ASSETS INVENTORY REAL ESTATE HOUSE AND LOT, HAMPDEN TOWNSHIP, 5385 TRINDLE ROAD, MECHANICSBURG, PA LOT, HAMPDEN TOWNSHIP, TRINDLE ROAD, MECH., PA 19.74 ACRES LAND, LOWER ALLEN TWP, CUMBo CO., PA TOTAL REAL ESTATE RECEIVED PERSONAL PROPERTY 912 SHARES PNC FINANCIAL SERVICES GROUP INC. 11 US SERIES EE SAVINGS BONDS LUCINDA C. GOSSETT REVOCABLE TRUST PNC BANK TRUSTEE ORRSTOWN BANK CERTIFICATE OF DEPOSIT 60133 ALLFIRST BANK CERTIFICATE OF DEPOSIT 306509 ALLFIRST BANK CHECKING ACCOUNT 410240 ORRSTOWN BANK ACCOUNT 111-000279 M&T BANK CERTIFICATE OF DEPOSIT 449981 ORRSTOWN BANK CHECKING ACCOUNT 000662 PROCEEDS OF SALE OF COINS JEWELRY CLAREMONT NURSING HOME PATIENTS FUND PA 2002 INCOME TAX REFUND CASH TOTAL PERSONAL PROPERTY RECEIVED TOTAL PRINCIPAL RECEIVED AT DEATH 1 $143,000.00 $24,000.00 $215,000.00 $382,000.00 $38,313.12 $47,386.00 $833,886.27 70068.56 $25,012.27 $6,109.36 $537,123.99 $58,682.40 $4,416.24 $560.00 $2,466.00 $563.70 $622.00 $308.97 $1,625,518.88 $2.007.518.88 , ESTATE OF LUCINDA C. GOSSETT ACCOUNTING DECEMBER 2, 2002 THROUGH AUGUST 1, 2005 OTHER PRINCIPAL RECEIPTS 10/29/2003 TRANSFER FROM LUCINDA C. GOSSETT CHARITABLE TRUST ORRSTOWN BANK CHECKING ACCOUNT 3 $200,000.00 ESTATE OF LUCINDA C. GOSSETT ACCOUNTING DECEMBER 2, 2002 THROUGH AUGUST 1, 2005 PRINCIPAL DISBURSEMENTS GAIN LOSS 01/09/2005 SALE OF 912 SHARES PNC FINANCIAL SERVICES GROUP INC. PROCEEDS $37,695.98 DATE OF DEATH VALUE $38.313.12 LOSS $617.14 06/04/2003 ALLFIRST BANK COD 306509 REDEMPTION PROCEEDS $25,009.52 DATE OF DEATH BALANCE $25.012.27 $2.75 LOSS 06/04/2003 ORRSTOWN BANK COD 60133 REDEMPTION PROCEEDS $70,000.00 DATE OF DEATH BALANCE $70.068.56 LOSS $68.56 06/04/2003 ALLFIRST CHECKING ACCOUNT 410240 CLOSED PROCEEDS $6,310.66 DATE OF DEATH BALANCE $6.109.36 GAIN $201.30 05/13/2003 SALE OF HOUSE AND LOT, 5385 TRINDLE RD, MECH. NET PROCEEDS $143,253.65 DATE OF DEATH VALUE $143.000.00 GAIN $253.65 06/02/2003 SALE OF LOT, HAMPDEN TWP., TRINDLE RD., MECH NET PROCEEDS $23,760.00 DATE OF DEATH VALUE $24.000.00 LOSS $240.00 06/18/2003 REDEMPTION OF US SERIES EE SAVINGS BONDS PROCEEDS $47,470.00 DATE OF DEATH VALUE $47.386.00 GAIN $84.00 08/21/2003 SALE OF 19.74 ACRES LAND, LOWER ALLEN TWP. PROCEEDS $212,845.67 DATE OF DEATH VALUE $215.000.00 LOSS $2,154.33 $538.95 $7,300.74 '-/ ESTATE OF LUCINDA C. GOSSETT ACCOUNTING DECEMBER 2, 2002 THROUGH AUGUST 1, 2005 PRINCIPAL DISBURSEMENTS 12/10/2002 BRENDA SHEAFFER SEARCH FOR HEIRS 12/10/2002 JOHN M. EAKIN, LETTERS REIMBURSEMENT 12/17/2012 MYERS FUNERAL HOME 12/26/2002 CUMBERLAND LAW JOURNAL LEGAL AD 01/22/2003 PP&L 01/22/2003 HAMPDEN TOWNSHIP SEWER 01/22/2003 UGI 01/22/2003 PA AMERICAN WATER CO. 02/06/2003 THE SENTINEL, LEGAL AD. 02/06/2003 UGI 02/06/2003 PP&L 02/06/2003 JOHN M. EAKIN, DEATH CERTIFICATES 02/10/2003 REGISTER OF WILLS, SHORT CERTIFICATE 02/28/2003 REGISTER OF WILLS, INHERITANCE TAX 03/28/2003 KATHRYN FETROW REAL ESTATE TAX 03/28/2003 BONNIE K. MILLER, REAL ESTATE TAX 03/28/2003 PP&L 03/28/2003 PA AMERICAN WATER CO. 03/28/2003 YELLOW BREECHES EMS 04/18/2003 HAMPDEN TOWNSHIP SEWER 04/18/2003 GREENAWALT & CO., TAX PREPARATION 04/18/2003 PP&L 06/02/2003 PA AMERICAN WATER CO 06/02/2003 PP&L 06/16/2003 MUMMA JEWELRY APPRAISAL FEE 07/25/2003 REGISTER OF WILLS FEE 07/25/2003 REGISTER OF WILLS, INHERITANCE TAX 08/14/2003 FED EX, MAILING 09/15/2003 REGISTER OF WILLS, FEE 12/17/2003 AMS 07/17/2003 PNC BANK SERVICE CHARGES 12/31/2003 PNC ADVISORS LUCINDA C. GOSSETT REVOCABLE TRUST FEE 04/08/2003 PA DEPT. OF REVENUE FIDUCIARY INCOME TAX 04/08/2003 US TREASURY FIDUCIARY INCOME TAX 2003 JOHN M. EAKIN. EXECUTOR FEE 2003 JOHN M. EAKIN, ATTORNEY FEE 08/16/2004 REGISTER OF WILLS, FEE 08/16/2004 HEIDI NELSON, NOTARY FEE 04/08/2004 PNC BANK SERVICE CHARGE 2004 JOHN M. EAKIN, EXECUTOR FEE 02/07/2005 GREENAWALT & CO., TAX PREPARATION 2005 JOHN M. EAKIN, EXECUTOR FEE If 11 $300.00 $325.00 $3,899.00 $75.00 $14.08 $29.00 $78.28 $21.24 $71.33 $55.25 $14.03 $35.65 $3.00 $75,000.00 $402.53 $292.80 $14.73 $67.33 $69.75 $31.62 $450.00 $5.77 $76.30 $11.29 $250.00 $15.00 $11,250.00 $17.96 $945.00 $248.00 $81.40 $3,776.00 $29.00 $90.00 $21,000.00 $15,000.00 $10.00 $5.00 $48.80 $21,000.00 $750.00 $7.500.00 $163.359.14 ESTATE OF LUCINDA C. GOSSETT ACCOUNTING DECEMBER 2, 2002 THROUGH AUGUST 1, 2005 PRINCIPAL DISTRIBUTIONS TO BENEFICIARIES LUCINDA C. GOSSETT CHARITABLE TRUST 12/10/02 CASH 01/15/03 CASH 02/07/03 CASH 02/28/03 CASH 10/13/03 ROBERT BANZHOFF MORTGAGE 01/12/04 PNC ADVISORS LUCINDA C. GOSSETT TRUST ACCOUNT THOMAS E. CHORPENNING, JR. 06/20/03 CASH 08/11/03 CASH 10/29/03 CASH CAROLYN ALEXANDER 06/20/03 CASH 06/20/03 JEWELRY 09/11/03 CASH 10/29/03 CASH $30,000.00 $25,000.00 $235,000.00 $180,483.92 $121,550.00 $851.692.70 51.413.726.62 $100,000.00 $100,000.00 $100.000.00 5300.000.00 $97,534.00 $2,466.00 $100,000.00 $100.000.00 5300.000.00 ~ ESTATE OF LUCINDA C. GOSSETT ACCOUNTING DECEMBER 2, 2002 THROUGH AUGUST 1, 2005 INCOME RECEIPTS INTEREST 06/04/2003 ORRSTOWN BANK CERTIFICATE OF DEPOSIT 6013:: 06/04/2003 ORRSTOWN BANK CERTIFICATE OF DEPOSIT 6013:: 06/04/2003 ORRSTOWN BANK CERTIFICATE OF DEPOSIT 6013:: 06/27/2003 ORRSTOWN BANK CERTIFICATE OF DEPOSIT 6013:: 12/2012003 PNC BANK ESTATE ACCT. 50-0415-2741 2003 PNC ADVISORS LUCINDA C. GOSSETT REVOCABLE TRUST 2004 PNC BANK ESTATE ACCOUNT 2004 PNC ADVISORS LUCINDA C. GOSSETT REVOCABLE TRUST 08/01/2005 PNC BANK ESTATE ACCOUNT DIVIDENDS 03/14/2003 PNC FINANCIAL SERVICES GROUP INC. 2003 PNC ADVISORS LUCINDA C. GOSSETT REVOCABLE TRUST 2004 PNC ADVISORS LUCINDA C. GOSSETT REVOCABLE TRUST I $174.52 $193.32 $26.08 $186.99 $110.24 $2,186.64 $59.07 $488.96 $31.80 $440.07 $23,544.67 $1.746.25 $29.188.61 John M. Eakin, Executor under the Last Will and Testament of Lucinda C. Gossett, deceased, hereby declares under oath that he has truthfully performed his duties as executor; that the foregoing First and Partial Account is true and correct; that it 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 knowledge, there arEf'1~o claims now out~tanding against the estate and that all taxes presently due from the estat~ ~(b\1r :ai&:l John M. Eakin o sUbscribid.a{tsworn to this tj day of October, 2005. VIMf- if) ~ NOTARIAL SEAl. HBDI M. NELSON, ~ PubIc Mechanlcsburg Boro, Cumbirtlnd Co. My Commission ExpIi"es June 27, 2007 7 21-2002-1105 1fr~c\.~Jt 21Ulilr ~tltO 'Q}t!ttcUtt~ltt OF LUCINDA C. GOSSETr I, LUCINDA C. GOSSETr, of Lower Allen Township, Cumberlantl County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this my Last will and Testament, hereby revoking and making void all former wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently' be done. 2. I direct that there shall be paid out of my residuary estate all estate, inheritance and like taxes together with any intevest or penalty thereon imposed by the Government of the united states, or any state or territory thereof, or by any foreign government or political subdivision thereof, in respect to all ,. property!. required to be included in my gross estate for estate, inheritance or Itke tpx pprposes by any of such governments, whether the property passes 'under this will or otherwise. ~ '(D-l\ - 1 - I' 3 . I give and bequeath the sum of Three Hundred Thousand ($300,000.00) Dollars to my brother, RAY D. FAGER, if he surv~ves me; in the event he predeceases me the gift shall lapse and fall into the residue of the estate. 4. I give and bequeath the sum of Three Hundred Thousand ($300,000.00) Dollars to my niece, CAROLYN ALEXANDER, if she survives me; in the event she predeceases me the gift shall lapse and fall into the residue of the estate. 5. I give and bequeath the sum of, Three Hundred Thousand ($300,000.00) Dollars to my nephew, THOMAS E. CORPENNING, JR., if he survives me; in the event he predeceases me the gift shall 'not lapse but shall go in equal shares to his heirs per stirpes. 6. All the rest, residue and remainder of my estate, I give, devise and bequeath in trust under and subject to the fOllowing terms and conditions: A.) The name of the trust shall be the LUCINDA C. GOssEtT " CHARIT~liE TRUST. " B.)I <:.1 name'f con,stit;.)1te and appoint JOHN M. EAKIN truste~ and direct that no bond be required to guarantee faithful performance of his duties. ~~ - 2 - , I c.) The term of the trust shall be ten (10) years from the date the trust corpus is received from decedent's estate; in the event the corpus together with interest has not been distributed by that date, the term of the trust shall be extended for a reasonable time to permit the trustee to wind up the trust by making complete distribution to Section 501(c) (3) entities and file a final accounting with the Court of Common Pleas, OrphanS' Court Division. D.) I authorize, empower and direct the trustee to make payments of prillcipal and interest from time to time during the continuance of the trust to those beneficiaries which in his sble discretion are deemed to be qualified recipients provided that all distribution shall be for tax exempt purposes and none other. E.) The trust is created to devote and apply the trust fund exclusively for charitable purposes by contributions duly authorized to carryon charitable activities and which have established their tax exempt status under the provisions of section 501(c) (3) of the Internal Revenue Code and its regulations as they now exist or may hereafter be amended and ~he trust assets, profits and net income thereof are irrevocably dedicated to such purpose. \ F~)~'. No part of the net earnings of the trust shall inur~ to the ben~fit of ary p~iva~e individual having a personal or private interest 'in the activities of the trust within the meaning of section 501(c) (3) of the Internal Revenue Code and ithe ~~~ - 3 - trust shall not be operated for the benefit of private interests such as the heirs of the decedent, the trustee or any person or persons controlled directly or indirectly by such private interests. G.) The trustee shall invest, reinvest and keep invested the trust corpus in obligations which men of prudence, discretion and intelligence acquire for their own account provided that no investment shall be made which is a prohibited transaction under the provisions of this trust. H.) The trustee shall not engage in any act of self-dealing as defined by section 4941(d) of Internal Revenue Code nor retain any excess business holding as defined in section 4943(c) of the Internal Revenue Code nor make any investments in such manner as to incur tax liability under section 4944 of the Internal Revenue Code nor make taxable expenditures as defined by section 4945(d) of the Internal Revenue Code. I.) The trustee shall distribute the income of the trust for each taxable year at such time and in such manner as not to become subject to the tax on undistributed income imposed by the Internal Revenue Code. ~ J .)l,'t The trustee may incur expenses on behalf of the trust which hEt'may con~ider, nec.lessary and proper for the effective administration of' the trust'including reasonable attorney and accountant fees, subject to the provisions of this trust. ,{?, '-{; $.. - 4 - I' 7. Lastly, I nominate, constitute and appoint, JOllli M. EAKIN, to be Executor of this my Last Will and Testament. I further direct that no bond or other security be required of my personal representative to guarantee faithful performance of his duties. IN WITNESS WHEREOF, I have hereunto set my hand and seal I \ this day of August, 1999. _~J~~~"-Jtr ( SEAL) Lucinda C. Gossett signed, sealed, published and declared by the above named LUCINDA C. GOSSETT as and for her Last will and Testament, in the presence of us who have subscribed our names hereto as witnesses, at her request, in her presence and in the presence of each other. .r- G~~&tN ~;&t4 /if-lAd? I~ " .r'" , ~ . '. , ,"; ~ ~,\ .i: ." - 5 - II ~lX', COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) I, LUCINDA C. GOSSE'rf, the testatrix, whose name is signed to the attached or foregoing j.nstrument, having been duly , qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last will and Testament: that I signed it willingly, and that I signed it as my free and voluntary act and deed, for the purposes therein expressed. (f!>>-rtVft~~JJ;~d(jj- ( SEAt) Lucinda C. Gossett Sworn and subscribed to before me this II Tbay of August, 1999. /%<-vJ/t (t;0K Nota y PubllC Not8rlal S8"! ....rllyn E. WlltIamll. Notary Public ~rg Boro. Cumberland County My ComllllsSfon Elcpl"'l Nov. 6. 2001 Member. Peoosytvlnla ASsociation 01 N018rles COMMONWEALTH OF' PENNSYLVANIA ) . . ) COUNTY OF CUMBERLAND We, the undersigned, r-lNI/A3f:1... E. e/tlc ~ and P~ll~ J. ~us~~,~ , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw t.he within testatrix, LUCINDA C. GOSSETf, sign and execute the instrument as her Last will and: Testament; that the said testatrix, LUCINDA C. GOSSETT executed it as her voluntary act for the purposes therein expressed; t!hat each of us, in the hearing and sight of the testatrix, signed the Will as witnesses; and that, t.o the best of our knowledge, the testatrix was, at the time, ejghteen (18) or more years of age, of sound mind, and under no constraint, duress or undue influence. at4?&/d ~ ~e~ (ic..[0)1 (~ --- Sworn artd'subscr~b~to before me this ".1 ." day of August, 1999.~ &~ ~W&. .. Not ry Public Notarial Seal Marilyn e. Williams. 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Z 0: '" [f] a o~ UE-ti=Cl0 ~~ I ~ I;; (J E-tUP poo ~ 0 " z ~ 0 H~~P p.,~ ~ "') <l <( pOU ::Ci=Cl L I 8 ~- ~ .. E-t 00 O~ (J 00 U ~ . w ~~~ ~~H }: ~ooO~ ;::E: ::c~ E-t< E-t E-t~re <~~::c ooZ E-tUE-tU ~::c Z ~ oo~<~ HO HUO ~OH;::E: ~~ . /j:c' : .... I i c,' ~ ?f- ~ G ( 1\ ~ ~ ~..I ~/. i'18 ",~ ':./n i/ if Vi CD r) ~"'l = -,1.1-) I.:!!o/ J CD . .<21:- rl CD () ~'S . ;;, '0 .--(. 4., . , ':.f" ;.. Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 11/01/2005 EAKIN JOHN M MARKET SQUARE BUILDING MECHANICSBURG, PA 17055 RE: Estate of GOSSETT LUCINDA C File Number: 2002-01105 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 12/02/2005 Your prompt attention to this matter will be appreciated. Thank You. ~i erelYy .. . . jf.:, //:'/''''''''-'' I ~~""'~ "~,v,;,<,,,y<-:~.,-,, /'O'V "--r GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge lf~ Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 11/15/2005 EAKIN JOHN M MARKET SQUARE BUILDING MECHANICSBURG, PA 17055 RE: Estate of GOSSETT LUCINDA C File Number: 2002-01105 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 12/02/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge STATUS REPORT UNDER RULE 6.12 Name of Decedent: Lucinda C. Gossett Date of Death: 12/2/2002 Will No. 21-02-1105 Admin. No. Pursuant to Rule 6. 12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1 . State whether administration of the estate IS complete: Yes No X representative complete: 2 . If the answer is No, state when the personal reasonably believes that the administration will be FebnlfUj 26, 200(p 3 . If the answer to No. 1 is Yes, state the following: a. account with the Court? Did the personal representative file a final Yes No 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 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 re ort. Date: 11/22/2005 ~+;? C-"C./ ~ John M. Ea in Name (Please type or print) Market Square Building Mechanicsburg Pa 17055 Address \ ". ."~ .~ (717 ) 7663172 Tel.No. c: Capacity : X Personal Representative ,---..._., Counsel for personal representative (~. tel- Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 11/30/2006 EAKIN JOHN M MARKET SQUARE BUILDING MECHANICSBURG, PA 17055 RE: Estate of GOSSETT LUCINDA C File Number: 2002-01105 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent1s death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 12/02/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) EAKIN JOHN M MARKET SQUARE MECHANICSBURG r, lilt ORPHAN' CII~}Br:Pi ! BUILDIN'(j' ,,_, 'LI PA 17055 COMPLETE THIS SECTION ON DELIVERY . . . . . Complete items 1, 2, and 3. Also complete. item 4 if Restricted Delivery is desired. . Print your name and address on the reve~ so that we can return the card to you. . Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: o Agent o Addressee C. Date of Delivery 3. Service Type o Certified Mall o Registered o Insured Mail 4. Restricted Delivery? (Extra Fee) 2. ArtIcle Number (Transfer from servk:e IBbeQ PS Form 3811, February 2004 7005 0390 0003 2638 9449 Domestic Return Receipt UNITED STATES POSTAL SERVICE IIIIII First-Class Mail Postage & Fees Paid USPS Permit No. G-10 · Sender: Please ~rint your .rir.'m. e, address, and ZIP+4 i~iS box · ()~-\\t)'5 _". a.~ Glenda Farner " , lavgh Register of Wills and Clerk of Orphans' Court County of Cumberland One Courthouse Square> Carlisle, PA 17013 .... ,-. .-...... \_ ~_~ t_~ ~ L 1\ \iL il iiL 11111 iL I Ii ill \it II iL II i i i i I it Li IIi Ii II it it II DEe 272006;,1 IN RE: ESTATE OF GOSSETT LUCINDA C ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2002-01105 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE Personal Representative: EAKIN JOHN M Counsel for Personal Representative: EAKIN JOHN M Date of Decedent's Death: 12/2/2002 Date of Delinquency Notice: The undersigned, Glenda Farner-Strasbaugh, Clerk of Orphans' Court, in accordance with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk ofthe Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules was given on the above date and that the ten (10) day notice to file the Status Report has expired. Accordingly, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 12/27/2006 ~~J~ Glenda Farner Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File A healing is scheduled March 12. 2007 at 11AM_.___. in Court~oom NO.2. If the Status Report is filed prior to ~lw-nearing~~ hearing will automatIcally be cancelled. ./ t " /! (~/ ... .:~ / / " \'< ~",rr,""", _ I' \,~/.t""". A '~(l;.;'1 '--J,-_t__~~_.'<'t.>? .--) i)_/', '.~ ~, ~.;...:r'\)~ Edgar B. Bayley, J. \. u.s. Postal ServiceTM CERTIFIED MAILM RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) ....=l :::r Cl U1 Postage $ ~-l\t>S Certified Fee 19 . \ d. t\eo.P"- ~ U. y Return Receipt Fee Postmark Here (Endorsement Required) \ \ ILo \UI Restricted Delivery Fee (Endorsement Required) Total Postaae & Fe"~ ~ I"- Cl :::r I"- ru Cl Cl Cl Cl ..D I"- ru ..D EAKIN JOHN M ~ MARKET SQUARE BUILDING I"- MECHANICSBURG PA 17055 J I ! SENDER: COMPLETE THIS SECTION . Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. . Print your name and address on the reverse so that we can return the card to you. . Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: EAKIN JOHN lVi ~1ARKET SQUARE BUILDING MECHANICSBURG PA 17055 2. ArtIcle Number (Transfer from service label) PS Form 3811, February 2004 COMPLETE THIS SECTION ON DELIVERY ~~ o Agent o Addressee C. Date of Delivery Dves DNo o Express Mail o Return Receipt for Merchandise o Insured Mail 0 C.O.D. 4. Restricted Delivery? (Extra Fee) 0 Ves 7006 2760 0002 7407 5041 10259 - '''540 Domestic Return Receipt · Send;;~,:,;,;~,rt your nama, address, and ZIPO-~IS box · ~ Glenda Farner Strasbaugh \/:: \\:,\.:~(~\/\JHdt:lQ Register of Wills and Clerk or::O~~~WB~Uli County of Cumberland -'/ . One Courthouse Square \ S H"Jf LuUL Carlisle, PA 17013 S~ : \ \ld ~..J -..I - C002 I.., III", III, t1", 11"11",11,,, II", I, I" II ,I, I" I, I" I, I, ,I Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF Cumberland COUNTY, PENNSYLVANIA Name of Decedent: Lucinda C. Gossett Date of Death: 12/2/2002 File Number: 2002-01105 Pursuant to Pa. O.C. Rule 6.12, 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: . . . . . . . . . . . . . . . . . . .. IZI Yes 0 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 fmal account with the Court? . . . . . .. IZJYes ONo b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account . ~ 11 h ... ? DY mlorma y to t e partIes m mterest. ............................... . es IZINo 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 February 23, 2007 /' / \ ( \ Signature of P *on Filin his Form I Capacity: I tZlPersonal Representative John M. ~akin o Counsel Name of Person Filing this Form Market Square Building Address Mechanicsburg, P A 17055 {, (' ..7 Ie., 'v L? r, " f..... ?J'::i.J L (717) 766-3172 Telephone Form RW-IO rev. 10./3.06 J COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF ;!) c ~ f,i 1 .. . On this, the /~~~~~ day of ~C ,~~:_R ~ , 1995, before me, a notary public in and for the said Commonwealth and County, personally appeared Harold Finegold, known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing Limited Durable Power of Attorney and acknowledged that he executed the same for the purposes therein contained. WITNESS my hand and notarial seal. ___. Notary Public (~ EAL) , My Commission Expires: NOTARIAL SEAL JUDY A. BOMGARONER, Notary Public Harrisburg, PA Dauphin County My Commission Expires Feb. 23,1998 - 4 - Pa. D.C. Rule 6.12 STATUS REPORT -, REGISTER OF WILLS OF !~A.-V~~J- COUNTY, PENNSYLVANIA Name of Decedent: ~e.4~ Date of Death: /Z/t.- ( '~o'-- File Number: Lvol- lib> Pursuant to Pa. O.c. Rule 6.12, 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: . . . . . . . . . . . . . . . . . . ., ffi es D No 2. If the answeris 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? . . . . . .. ~es DNo b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account infoID1ally to the parties in interest? ............................... DYes DNo d. Copies of receipts, releases, joinders and approvals of fOlmal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Address / ~ (t J! /~.jlL vvL/(viAl-i k? hi . c~-.L. Dale / /3 9--J (/1 _ "7\ \\. .\ t. \ c t' ~0 ;~'(d <.;U ,~ Telephone FormRW-10 rev.10.13.(j6 .' ) COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNYSLVANIA ORPHANS' COURT DIVISION Docket No: 21-2002-1105 IN RE: FIItST AND FINAL ACCOUNT OF JOHN M. EAKIN, TRUSTEE FOR THE THE LUCINDA C. GOSSETT CHARITABLE TRUST. AND PETITION FOR ADJUDICATION/STATEMENT OF PROPOSED DISTRIBUTION ORDER OF COURT AND NOW, this 28th day of August, 2012, the herein account is confirmed absolutely. BY THE COURT, Judge ra F ~ n- ~ ~ m ~; ~ ~, ~ ~~ n N r i ~~ v, OD ~ C' r',, ~~ ~ ; ~_~ ~~ ~ _ cn w ~~