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HomeMy WebLinkAbout03-0597Register of Wills of PETITION Estate of Jessie B. Raffensperger also known as CUrB ERL_A D County, Pennsylvania FOR GRANT OF LETTERS , Deceased Social Security No. 152-16-6708 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut or named in the last Will of the Decedent, dated 3 / 2 0 / 0 6 and codicil(s) dated [~/A ~_ See.. Renunciation of Shirley Warrick. and Death Cemtificate for William C. Warrick State relevant circumstances, e.g., reflunciation.~l~.~.~or, etc. Except as follows, Decedent did not merry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: B. Grant of Letters of Administration (c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her last family or principal residence at 824 Lisburn Road, Decedent, then 98 years of age, died 6/27/03 Lower Allen Township (liststreetnumber, and municipality) at Manor Care Health Services Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania (Location) $ N/A $ N/A $ -0- situated as follows: Wherefore,~._~ Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of le.~rs.~ the appropriate form to the undersicjned: VII'// L Si_c,]nat_u~e///.~ Typed or printed name and residence J ~ ~//~~, .~~z/~ ~ Sandra Drummond, Fulton Bam~ ~---',r~¢.~,"~, ,,,._0_ J~lT~tJl,,L~(~'/~__¢~ I Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991) Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true ~hned~)~reedc~, tpheetit~oenSter~fs t)hweil~nwOeTi I:~dg~rt~ydabf Imi~nfisOlfe~iteiO?er( s~tsta~ ~::cordh~nt,g ~: iPfwr~onal representative(s) of Sworn to or affirmed and subscribed ~~tt/A~ ~..._ ~7~ ~~ ~ ~~ before me this 24~y of July , 2003 Donna M. Otto, 1st ~fy g' .~r No. 21-2DDR-5q7 Estate of Jessie B. Raffensperger Social Security No: 152-16-6708 Date of Death: AND NOW, July 24th 6/27/03 Deceased , 200_~ , in consideration of the Petition on the reverse,~e hereon, satisfactory proof having been presented before me, IT IS DECREED that Letter~'~_~,X Testamentary I~1 Of Administration (c.t.a.; d.b.n.c.ta.; pendente lite; durante absentia; durante minoritate) are hereby granted to in the above estate and that the instrument(s) dated March 20 ~ 1996 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........... $ Short Certificate(s) ..... $ Register of Wi~ ~' · Donna M. Otto, 1st Deputy Renunciation ........ $ ,~..-.~. ~)(~3 Attorney: Ronald M. Katzman, Esquire Affidavits ( ) .... $ Extra Pages ( Codicil ........... $ JCP Fee .......... $ I.D. No: 07198 Address: Goldberg~ Katzman & Shipman, P.C. 320 Market Street, P.O. Box 1268 Harrisburg~ PA 17108-1268 Telephone: 717/234-4161 Inventory .......... $ Sent Letters to Bank on 7/24/03 Other ........... , I , Pre frOJbAyL;h ~ p~n,n~.~/l~a~ia.B~¢ Ass~iation.~Cc F y~l r"~l~.~t ~ form o f t~ware only C PSystems, i nc.' ' Fulton Financial Advisors Form RW-1 (1991) Estate of also known as Register of Wills OfCumberl and County, RENUNCIATION Pennsylvania Jessie B. Raffensperger ' No. 21-2003-597 , Deceased The undersigned, Shirley 'Warrick, daughter of (Relation shill) (Capacity) the above Decedent, hereby renounce(s) the right to administer the es[ate and resp. ect.fuJly request(s) that Fulton ~inancia/ AdViSOrS, N. A. Letters Testamentary beissuedto ~unr. P~nr tn Fulton B~llk Witness her handthis [O'J~ day of ~]"L)IL~ 2003 ~j ~ ~ '~'- ' ' ~ (Signature) (Addresa) (Signature) (Address) (Signa~re) (A d dress) Sworn to or affirmed.qn_d subscribed befor,; .me this I[{~~.. day of De.rah H. Lo~ No~ ~u~l~ ~thtown ~r~z, ka~[~~ ~Y ~mi~ion ~xpires Member, Penn~lvanm AS~iation o1 NO~ (Signature and seal of Nela~ o~ other off~ai quallr~d m admJnis~r oa~hs. Show date o~expka~on NOTE: Renunciations executed outside the Office of Register el Wills are required in some counties to be notarized. RW.3 his is to certi~ that the information here given is correctly copied from an original certificate of death duly filed with me as l,ocal Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent ~ling. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 ~ No. ~ F~ /Date Local Registrar, ~/z~7 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH .... Sc~.~. ~ h,,. ~,.=~./.o.,,. I,,. -~ -~ l,,. ~ ~' I~/"'"' I,,.~.vo,~ea J,, --- - ARNING: IT IS ILLEGAL TO ALTER THIS COPY OR TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. CERT. NO. T 4 S 1318 5 I 0-l')g- f'll Date of I~sue of This Certification Name of Decedent Sex _ ~__ _Social Security No. _ . 3C):2.=22-_0_938 ....... Date of Death 10-05-0Z Date of Birth _ 3--08-2,,J~ .......... Birthplace ~_.BPATT); TN' Place of Death ....~0_~ ~TTT,T,A .......... L~N~~ W. DOI~E~G_A_~ ~PL Race ...... ~T~ _~ Occupation ~~CO~~ _. Armed Forces? (Yes or No) ~.~S Decedent's Marital Status __ ~~ .... Mailing Address 50 ~T~ ~ ..... ~E~~O~ __ ~R~C~ ...... Funeral Director ....... g~g ~. S~ Informant ._qRTR T ,'R,¥ Name and Address of Funeral Establishment Pennsylvania PA State Part I: .... 1313L N .-.I~.~.R.KE~-S.TREET. _ I~.T,T'7, ARI~.'T'R"T','b~XT; PA Immediate Cause (a) .......... META,qTATIC LT3NG _~ Interval Between Onset and Death (b) Part I1: (d) Other Significant Conditions Manner of Death Natural ~i Homicide Accident ~ :, Pending Investigation Suicide '-~ Could not be Determined Describe how injury occurred: Name and Title of Certfier .......... JAMES 1~.. _K.ZP.~P_, ~ Address ........... Zl-_LL8 .~ T, F..,/~F _.R.O_~D F.~T %L~_~TOWN (M.D., D.O., Coroner, M.E.) This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar The original certificate will be forwarded to the State Vital Records Office for permanent filing..` /~,~ _~ ~/,~ /,~ ~,~_.~ ......... ~6-338 1Q-O2-O1 25 .ZRZS CLT_RCI.~ ....... ~~ 21-2003-597 ep\wills\rafnsprg.jb\3-96 LAST WILL AND TESTAMENT OF JESSIE B. RAFFENSPERGER o 3-- I, JESSIE B. RAFFENSPERGER, of Lower Allen Township, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I direct that my Executors hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease. ITEM II: I devise and bequeath my household goods and personal effects, and other tangible personalty of like nature to my daughter, SHIRLEY WARRICK, and my son-in-law, WILLIAM WARRICK, or to the survi- vor of them. Should neither my daughter, SHIRLEY WARRICK, nor my son- in-law, WILLIAM WARRICK, survive me, I make said bequest in equal shares to my then living grandchildren. To the extent that my living grandchildren become entitled to such property, it shall be divided by my said beneficiaries as they shall agree. As to those items upon which they shall not agree, distribution shall be determined in the sole discretion of my Executors, whose decision shall be final. ITEM III: I devise and bequeath the residue of my estate, of every nature and wherever situate, to the FULTON BANK of Lancaster, Pennsylvania, or its successors in interest, as my Trustee, IN TRUST NEVERTHELESS, to be held, administered, governed and distributed under the terms and conditions of that a certain Intervivos Trust Agreement Page 1 of 4 dated November 18, 1991, as may be superseded or amended by such other trust agreement or amendment as I might make hereafter from time to time in replacement or amendment thereof until the time of my death. ITEM IV: The interest of beneficiaries hereunder shall not be subject to anticipation or to voluntary or involuntary alienation. ITEM V: I appoint my daughter, SHIRLEY WARRICK, and my son-in- law, WILLIAM WARRICK, Co-Executors of this my last will. Should my daughter, SHIRLEY WA~RICK, and my son-in-law, WILLIAM WARRICK, fail to qualify or cease to act as Co-Executors, I appoint FULTON BANK of Lancaster, Pennsylvania, or its successors in interest, Executor of this my last will. ITEM VI: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his/her duties in any jurisdiction. ITEM VII: My corporate fiduciary shall receive compensation for the performance of its functions hereunder in accordance with its standard schedule of fees in effect from time to time during the period under which its services are performed. IN WITNESS WHEREOF, I, JESSIE B. RAFFENSPERGER, have hereunto set my hand and seal this ~ day of ~~ , 1996. ~ JESSIE B.~FE~E~GER SIGNED, SEALED, PUBLISHED and DECLARED by JESSIE B. RAFFENSPERGER, the Testatrix above named, as and for her Last Will and Page 2 of 4 Testament, and in the presence of us, who at her request, in her pres- ence and in the presence of each other, have subscribed our names as Address Witness Addre s s ' COMMONWEALTH OF PENNSYLVANIA: :SS: COUNTY OF CUMBERLAND : I, JESSIE B. RAFFENSPERGER, 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 this instrument as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein con- tained. Sworn to or affirmed to and acknowledged before me by JESSIE B. RAFFENSPERGER, the Testatrix, this ~O~ day of '~'~ , 1996. Notary Pub~ i~ Page 3 of 4 ,,,.., NO'D~:~IAL SEAL COMMONWEALTH OF PENNSYLVANIA : :SS: COUNTY OF CUMBERLAND : and 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 Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. __~itne Js ~-~' - Witness Sworn to or affirmed to witnesses, this ~O day of l' ~OTARIAL SEAl lay uOmmlSSion ~pir~ ~ri113, 1999 and acknowle_dged before me by and ~~ x,~, /~~~ Notary Public Page 4 of 4 LAST WILL AND TESTAMENT OF JESSE B. RAFFENSPERGER STONE, LAFAVER ~ STONE A PROFESSIONAL (:ORPORATION ATTORNEYS AT LAW 414 BRIDGE STREET NEW CUMBERL.%-ND, PA 17070 21-2003-597 FULTON FINANCIAL ADVISORS~" Mal~'ng Success Personal:" (717) 291-2854 September 10, 2003 Register of Wills Cumberland County Court House Hanover and High Street Carlisle, PA 17013 RE: Estate of Jessie B. Raffensperger, Deceased No. 21-0.3-Or'o'?~ ~':2 Dear Sir or Madam: Enclosed please find our check no. 1053189 in the amount of $15,176.25 that represents prepayment of inheritance tax in the above referenced estate. Thank you for your assistance. contact my. office. Should you have any questions, please Beth FI. Hawk Estate Settlement Officer brh enclosure c Ronald M. Katzman, Esquire One Penn Square, Lancaster, PA 17602 · www. fultonfinancialadvisors.com Investments · Wealth Management ° Corporate and Retirement Services ° Private Banking · Insurance FULTON FINANCIAL ADVISORS' P.O. BOX 3215 LANCASTER, PA 17604 NEW ADDRESS OR NAME REGISTER OF WILLS AGENT FOR THE COMMONWEALTH OF PA ACCOUNT NUMBER: 41 -Fl 18-01-6 PLEASE INDICATE ADDRESS OR NAME CHANGES AND RETURN FULTON FINANCIAL ADVISORS' 1053189 41-Fl18-01-6 JESSIE B RAFFENSPERGER D/T BRH INC: $0.00 PRIN: $15,176.25 TOTAL: $15,176.25 '0.3 5 .i 11 DATE 09/10/03 03091009639 REGISTER OF WILLS AGENT STATE INHERITANCE TAX OR ESTATE TAX PREPAYMENT OF INHERITANCE TAX ON $355,000 @ 4.5% NO. 21-03-0597 ESTATE OF JESSIE B. RAFFENSPERGER CHECK NUMBER: 1053189 FULTON FINANCIAL ADVISORS' One Penn Square, Lancaster, PA 17602 Register of Wills Cumberland County Court Hanover and High Street Carlisle, PA 17013 House 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. REV-1162 EX(11-96) CD 003003 FULTON FINANCIAL ADVISORS ONE PENN SQUARE LANCASTER, PA 17602 ........ fold ESTATE INFORMATION: SSN: 1 52-1 6-5808 FILE NUMBER: 2103-0597 DECEDENT NAME: RAFFENSPERGER JESSIE B DATE OF PAYMENT: 09/11/2003 POSTMARK DATE: 09/10/2003 COUNTY: CUMBERLAND DATE OF DEATH: 06/27/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $15,176.25 TOTAL AMOUNT PAID: $15,176.25 REMARKS: FULTON FINANCIAL ADVISORS SEAL CHECK# 1053189 INITIALS' SK RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS /~- REV-1500 EX (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 21 COUNTY CODE -- 2003 0597 YEN~ NUMBER DECEDENT~ NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ Raffensperger, Jessie B 152-16-6708 Z ' LLI DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS ~ MUST BE FILED IN DUPLICATE WITH THE I u.I 06/27/2003 09/11/1904 REGISTER OF WILLS LU 0F APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURI3Y NUMBER r~l. odginal Return E~ 2, Supplemental Return r~ 3. Remainder Return (date of death pdo~ to 12-13-82) ----]4. Limited Estate ~ 4a. Future Interest Compromise (date of death after 12-12-82) r~ 5. Federal Estate Tax Return Required [~] 6. Decedent Died Testate (Attach copy of Will) r~ 7, Decedent Maintained a Living Trust (Attach copy of Trust) ~ 8. Total Number of Safe Deposit Boxes E~] 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (da~e of death between 12-31-91 a~d 1-1-95) E~ 1 1. Election to tax under Sec. 9113(A)(Attac~ Sch o) THiS SECTION MUST BE C~PLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SH~ BE DIRECTED TO: COMPLETE MAILING ADDRESS Fulton Financial Advisors, NA P.O. Box 3215 Lancaster, PA 17604-3215 0.00 0.00 0.00 0.00 6,993.27 0.00 369,678.88 (8) 4,909.55 369.22 NAME Thomas W. Shields (11) FIRM NAME (If Applicable) Fulton Financial Advisors, NA = OO TELEPHONE NUMBER 717 -291-2726 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (12) (13) z Z O (1) (2) 3. Closely Held Coqx3mtion, Partnership orSole-Pmpdetorehip (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 6. J~ Owned Property (Schedule F) (6) g_J Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Sohedule I) (10) 1 1. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been mede (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Amount of Line 14 taxable at the spousal tax rate, or transfem under Sec. 9116 (aX1.2) Amount of Line 14 taxable at lineal rate Amount of Line 14 taxable at sibling rate Amount of Line 14 taxable at collateral rate. Tax Due (14) 0.00 x .00__ (15) 371,393.38 x .o4.~ (18) 0.00 x .12 (17) 0.00 x .15 (18) (19) 15. 16. 17. 18. 19. 20. > > BE 8URETO.a~"SWER ALL QUE~ ~ ~$E ~iDE AND RECHECK ~ ~-H ,~ <, OFFICIAL USE ONLY 376,672.15 5,278.77 371,393.38 0.00 371,393.38 0.00 16,712.70 0.00 0.00 16,712.70 2W4645 1.000 Decedent's Complete Address: ADDRESS 824 Lisburn Road CITY Cam~ Hill Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 0.00 15,176.25 798.75 0.00 0.00 Interest/Penalty if applicable D. Interest E. Penalty STATE (1) Total Credits (A + B + C) (2) IZIP 17011 Total Interest/Penalty (D + E) (3) 16,712.70 15,975.00 0.00 737.70 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5Al 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Ch~ to: REGISTER OF ~S, AGENT (5B) 737.70 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ....................... r~ r--] b. retain the right to designate who shall use the property transferred or its income; ......... ['~ r'~ c. retain a reversionary interest; or ................................ r~ r~ d. receive the promise for life of either payments, benefits or care? ................. [~ ['~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................ [---] [~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ~'J ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................ ['---] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have e~,.~.~'d this return, including accompanying schedules and statements, and to the best of rny know~edge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADORESS One Penn square Lancaster, PA 17602 SIGNATURE OF PREPARER OTHER THAN r-~PwJ~SENTA'I3VE m~ .... i Ill'l L~,IIII'I I I ii IIIIIIIII I ~L_~ 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 sur~ving spouse is 3% [72 P.S. § 9916 (al (1.1) (i)]. For dates of death on or after Jan u ary 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. § 9116 (al (1.1) (ii)] The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax ratum ara still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. § 9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. § 9116(1.2) [72 P.S. § 9116(a)(1 )]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% (72 P.S. § 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common w~th the decedent, whether by blood or adoption. 2W4646 1.000 REV-15~8 EX * (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Raffensperger, Jessie B. 21-2003-0597 Include the )roceeds of litigation and the date the proceeds were received by t~e estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 2W46AD 2.000 DESCRIPTION West Shore EMS - refund of overpayment Woods at Cedar Run - refund of security deposit, rent and interest United American Insurance Co reimbursement for unearned insurance premium United American Insurance Co reimbursement for unearned insurance premium Pennsylvania Neurological Association - refund of overpayment State of New Jersey Teachers' Pension & Annuity Fund - final pension payment Silver Spring Ambulance refund of overpayment Conseco Senior Health Insurance refund of unearned premium TOTAL (Also enter on line 5, Recapitulation} (If more space is needed, insert additional sheets oi' the same size) VALUE AT DATE OF DEATH 9.65 2,036.14 72.44 478.14 39.35 1,235.12 17.50 3,104.93 6,993.27 REV-1510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERiTANCE TAX RE"I~JRN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Raffensper~er, Jessie B. FILE NUMBER 21-2003-0597 This schedule must be completed and filed if the answer to any of questions I through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY %OF ITEM INCLUDE THE NNV~ OF 'THE TRANSFEREE. THEIR RELATIONSHIP TO DATE OF DEATH DECD'S EXCLUSION DC-CE. DE.NT AND'rilE DATE OF TRANSFEFL ATTACH A COPY OF THE TAXABLE VALUE NUMBER DEED FOR REAL ESTATE, VALUE OF ASSET INTEREST (~F APPLICABLE) 1. Jesse B. Raffensberger 0.00 100.00 0.00 0.0C Revocable Estate Trust under agreement dated February 25, 1991 with Fulton Bank, Trustee. SAee copy of said agreement attached. The assets held in this trust are as follows: 2 8,586 units Fulton Financial 92,041.92 100.00 0.00 92,041.92 Advisors Tax Exempt Income Fund 3 26,207 units Fulton Financial 264,952.77 100.00 0.00 264,952.77 Advisors Government Income Fund 4 12,684.19 units Federated 12,684.19 100.00 0.00 12,684.19 Treasury Money Market Fund TOTAL (Also enter on line 7. Recapitulation) $ 369,678.88 (If more space is needed, insert additional sheets of same size.) 2W46AF 2,000 EV-1511 EX + (1-97) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Raffensperger, Jessie B. 21-2003-0597 Debt of decedent must be reported on Schedule I. DESCRIPTION ITEM NUMBER 5. 6. 7. FUNERAL EXPENSES: Prepaid ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Fulton Financial Advisors, NA Social Security Number(s) / EIN Number of Personal Representative(s) 2 3 - 3 03 2 4 7 3 Street Address One Penn SoD.tare City Lancaster State PA Zip 17602 Year(s) Commission Paid: A~orney Fees Name: Goldberg Katz~an & Shipman Family Exemption: (If decedent's address is not the same as c~aimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Retum Preparer's Fees C~erland County Register of Wills - short certificates Patriot News - legal advertising C~mhridge County Law - legal advertising Zip AMOUNT 0.00 2,466.00 2,184.00 0.00 55.00 0.00 0.00 6.00 123.55 75.00 4,909.55 TOTAL (Also enter on line 9, I:~ece__~nitulation) $ 2W46AG 2.000 (if more space is needed, insert additional sheets o~ same size) REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES,& LIENS ESTATE OF FILE NUMBER Raffensperger, Jessie B. 21-2003-0597 Include unrelmbursed medical expenses. ITEM NUMBER 2 3 4 5 6 DESCRIPTION Verizon - phone service Sue Tobias - beautician services West Shore EMS - transportation services AT&T - phone service Fulton Financial Advisors - accrued trustee fees Douglas A. Bream, D.P.M. - medical services 2W46AH 2.000 TOTAL (Also enter on line 10, Recapitulation} (If more space is needed, insert additional sheets of the same size) AMOUNT 11.23 12.00 43.45 2.65 291.67 8.22 $ 369.22 REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERIT,N~ICE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Raffensperqer, Jessie B. NUMBER L I1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLEDISTRIBUTIONS[indude~tdghtspousaldistri~tions, andtmnsfen underSec. 9116(a)(1.2)] Warrick, Shirley 50 Timber Villa Elizabethtown, PA 17022 FILE NUMBER 21-2003-0597 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter AMOUNT OR SHARE OF ESTATE 371,393.38 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE Di:5¥~IBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON UNE 13 OF REV-1500 COVER SHEET $ 0.00 2W46AI 1.000 (If more space is needed, insert additional sheets of the same size) INTERVTVOS TRUST AGREF~EI~ THIS TRUST AGREEMENT is made this /~ day of /~'~, 1991, by and between JESSIE B. RAFFENSPERGER, an a~ult individual now of Camp Hill, Cumberland County, Pennsylvania (the "Settlor"), and the FULTON BANE, a banking institution with trust powers having its executive office in Lancaster, Lancaster County, Pennsylvania (the "Trustee"). 1. Trust property. The Settlor hereby transfers and delivers to the Trustee the property listed in the attached Schedule "A", to hold the same, as well as any cash, securities, or other property that the Trustee may receive at any time pursuant to the provisions of this Trust Agreement and thereafter hold or acquire (collectively, the "Trust Estate"), for the uses and purposes and upon the terms and conditions set forth in this Trust Agreement. 2. Dispositive Provisions During Life of Settlor. Settlor and Trustee have entered into a Trust Agreement dated February 25, 1991, which is herein incorporated as if fully set forth in full. During the lifetime of the Settlor, the Trustee shall hold, manage, invest, and reinvest the Trust Estate, shall collect the income, and shall dispose of the net income and principal as follows: A. The Trustee shall pay to the Settlor, or to such others as she may designate, as much of the net income and principal as the Settlor may, from time to time, direct in writing. B. If any time the Settlor should become incompetent or for any other reason be unable to act in her own behalf, the Trustee may, in its absolute discretion, pay to or apply for the benefit of the Settlor, in addition to the payments provided for her, such amounts from the principal of the Trust Estate, up to the whole, as the Trustee may from time to time deem necessary or advisable for the Settlor's welfare, comfort, support, or benefit. C. Any undistributed net income shall be accumulated and then be added to the principal of the Trust. 3. Dispositive Provisions After Death of Settlor. A. Upon the death of the Settlor, ninety-five per cent (95%) of the Trust Estate shall be distributed outright to the Settlor,s daughter, SHIRLEY R. WARRICK, and to the Settlor,s son-in-law, WILLIAM WARRICK, now of Harrisburg, Pennsylvania, or to the survivor of them, if they survive the Settlor by thirty (30) days. B. If the Settlor,s daughter and son-in-law, do not so survive the Settlor, then the Trust Estate shall be distributed in equal shares to the Settlor,s grandchildren and great grandchildren, KATHRYNL. ROSE of Basking Ridge, New Jersey; MELINDA A. ROSE of Bloomingdale, New Jersey, DOUGLAS C. ROSE, of Bloomingdale, New Jersey, WILLIAM C. WARRICK, JR. of Camp Hill, Pennsylvnaia, DAVID WARRICK of Edgewood, Maryland, and KATHERINE WARRICK, of Camp Hill, Pennsylvania, per ~, subject, however, to the further trust provisions set forth in Section 4., if applicable to a particular beneficiary. C. Upon the death of the Settlor, the remaining per cent (5%) of the Trust Estate shall be divided equally among the then living grandchildren and great- grand children of the Settlor. 4. Further Trust For Certain Beneficiaries. Any property passing hereunder to a beneficiary under 3 B., who, at the time of the Settlor,s death, is under the age of twenty-five (25) (the "Beneficiary,,), shall be held further IN TRUST, NEVERTHELESS, by the Trustee for the benefit of such Beneficiary, upon the terms and for the purposes and uses, as follows: A. The Trustee shall hold and invest the principal of the Trust corpus, collect the income therefrom, and expend and apply so much of the net income (any income not so expended or applied to be accumulated and added to principal), and so much of the principal and accumulated income, as the Trustee shall deem necessary or advisable, in the sole and absolute discretion of the Trustee, for the support, maintenance, and education (including trade or vocational school, or college, both graduate and undergraduate) of the Beneficiary, after taking into consideration other readily available assets and sources of income. During illness or emergency, the Trustee may 2 either pay a distribution to the Beneficiary, or may make a distribution for the benefit of the Beneficiary. B. At the time any Beneficiary under 3 B. attains the age of twenty-five (25), the Trust pertaining to the Beneficiary shall terminate, and the Trustee shall distribute the then-remaining principal and accumulated or undistributed income to the Beneficiary. C. If any Beneficiary under 3 B. should die during the existence of this Trust, it shall be divided and then continued for the benefit of any then-living issue of the Beneficiary, ~, with such beneficiaries being substituted for the Beneficiary for all purposes including distribution at certain ages as set forth above. D. If any Beneficiary under 3 B. should die before attaining the age of twenty-five (25) without leaving issue surviving as aforesaid, then that Trust shall terminate, and its assets shall be divided among my then living grandchildren and great-grandchildren under Section 3. hereof for the benefit of those grandchildren or great grandchildren of mine, or their issue, per str~, living at the time of the death of said Beneficiary, and then distributed to such beneficiaries; Provided, however, that if a Trust established hereunder for any such beneficiaries exists at the time of such distribution, then such distribution shall be made to that Trust for such beneficiary. 5. Rule Against Perpetuities. Notwithstanding anything herein to the contrary, no trust created by this Agreement shall continue for more than twenty-one (21) years after the death of the last survivor of the Settlor or of those descendants of the Settlor who are in being at the date of the death of the Settlor. If, at the expiration of this period, any property is still held in trust, that property shall immediately be distributed among the persons then receiving or enti'tled to have the benefit of the income in the same proportions in which they are receiving or entitled to have the benefit of the income. 3 6. Trustee ' s powers. Without regard to any legal restrictions otherwise applicable to trustees, the Trustee, during the time the Trustee holds any property hereunder and until the time of actual distribution of all such property, is empowered in its sole and absolute discretion, to exercise the following discretionary powers, without court authorization, in addition to any other powers conferred by law: A. To retain, whether originally a part of the Trust Estate or subsequently acquired, and to purchase or otherwise acquire and to retain, any property, whether or not the property is authorized for investment by law, or is unsecured, unproductive, or of a wasting nature, all without diversification as to kind and amount. B. To retain and invest in accounts issued or common trust funds managed by Hamilton Bank or its affiliates and in the stock or other securities of Fulton Bank or of a holding company controlling it. C. To transfer, sell, exchange, partition, lease, mortgage, create a security interest in, pledge, give options upon, or otherwise dispose of any property at any time held by it, at public or private sale or otherwise, for cash or other consideration or on credit, and upon such terms and conditions, with or without security, and for such price, as it may determine. D. To hold reasonable amounts of cash uninvested in any bank or trust company, including Fulton Bank, for such periods of time as my Trustee deems reasonable for the efficient administration of any trust created hereunder. E. To extend, modify, or waive the terms of any bond and mortgage at any time forming part of the trust; to foreclose any mortgage or take title to the property securing it by deed in lieu of foreclosure or otherwise; to protect or redeem any property from forfeiture for nonpayment of taxes or other liens; and generally to exercise as to the bond and mortgage or property all powers that an absolute owner might exercise. F. To exercise any option, right, or privilege to convert bonds, notes, corporate shares, or other securities, or to subscribe for additional or other bonds, notes, corporate shares, or other securities; to make such conversions or subscriptions; to make payments 4 therefor, and to advance or borrow money for the purpose of exercising any option, right, or privilege; and to hold as investments, bonds, notes, corporate shares, and other securities so acquired, notwithstanding that they are not of a character authorized for investments by law or by other provisions of this Trust Agreement. G. To vote any corporate shares held by it in person, through its designees, or by proxy, with or without power of substitution, and to execute authority or proxies to one or more designees or nominees. H. To borrow money for any trust purpose and to pledge all or part of the Trust Estate to secure the borrowing, without incurring any personal liability. I. To pay, extend, renew, modify, or compromise, upon the terms as it may determine, and upon such evidence as it may deem sufficient, any obligation or claim, including taxes, either in favor of or against the Trust Estate. J. To hold or register any securities or other ~roperty of the Trust Estate in the names of a nominee or in the form as to pass by delivery, with or without indicating the fiduciary character of such securities or other property. K. To hold any separate parts or shares of the Trust Estate wholly or partly in undivided form for convenience of investment and administration. L. To divide and distribute the Trust Estate in kind or in money, or partly in each, or by way of undivided interests, and for such purposes to value any property to be thus divided or distributed at fair market values at the date or dates of distribution. 7. Power of Amendment and Revocation. The Settlor reserves the right to amend, modify, or revoke ~s Trust Agreement and the resulting Trust, in whole or in part, any time, by'notice in writing, delivered to the Trustee. Any :h amendment, modification, or revocation shall be effective ~ediately upon delivery to the Trustee, except that changes with ~pect to the Trustee,s duties, liabilities, or compensation shall 'be effective without its consent. 5 The Settlor also may name a replacement or successor trustee at any time by notice in writing, which shall be effective thirty (30) days from the date of the receipt of such notice, unless otherwise agreed by the Trustee. 8. Additional Property. The Settlor reserves the right for herself or any other person to increase the Trust Estate by delivering property to the Trustee, or by having the proceeds of insurance policies made payable to the Trustee, or by bequest or devise by will. The Settlor will notify the Trustee in writing of any policies so made payable to it, or deliver such policies to the Trustee as custodians. The duties and liabilities of the Trustee shall under no circumstances be substantially increased except with its written consent. 9. Accounting by Trustee. The Trustee shall keep all the accounts and records of the trusts and, during the Settlor.s lifetime, at least semiannually, shall render to the Settlor statements showing all receipts, disbursements, and investment transactions. After the death of the Settlor, the Trustee shall render, at least annually, to each adult beneficiary then entitled to income under the terms of any trust, a statement showing in detail receipts, disbursements, and distributions of both principal and income of the Trust Estate so administered. 10. Compensation of trustee. The Trustee shall be entitled to receive compensation in accordance with its standard schedule of fees in effect while its services are performed. 11. Spendthrift clause. No interest of any beneficiary under any trusts, either in income or in principal, shall be subject to pledge, assignment, sale, or transfer in any manner, nor shall any beneficiary have the power in any manner to anticipate, charge, or encumber his or her interest, either in income or principal, nor shall such interest of any beneficiary be liable or subject in any manner for the debts, contracts, liabilities, engagements, or torts of such beneficiary. 6 12. Tax Payment. Upon the death of the Settlor, the Trustee shall pay all taxes that are properly charged against the Trust Estate by reason of the death of the Settlor. If any executor, administrator, or other person acting in a fiduciary capacity shall have paid any estate, inheritance, or succession tax upon or with respect to any or all of the Trust Estate required to be included in the gross estate of the Settlor, the Trustee shall reimburse that executor, administrator, or other person acting in a fiduciary capacity for the amount of those taxes. 13. Situs. This trust shall take effect only upon the execution of this Agreement by both the Settlor and the Trustee, and it shall be governed and construed in all respects according to the laws of the Commonwealth of Pennsylvania. IN WITNESS WHEREOF the Settlor and the Trustee have executed and sealed this Agreement on the date set forth above. Witness: Attest: (Assistant) Secretary (SEAL) By: SETTLOR: TRUSTEE: FULTON, .~ ,..-.'"/ ./- · ,_.___.,./ Vice President & "Trus~ Officer B:Raffensp. tst 7 ASSETS FOR JESSIE B. I~'FENSP~.R~ DEED OF TRUS? CASH 7,826 UNITS TAX EXEMPT INCOME FUND 23,418 UNITS GOVERNMENT INCOME FUND 3,208.28 80,391.39 243,148.70 ep\~rs\rafnsprg.amd\3-96 AMENDMENT TO INTERVIVOS TRUST AGREEMENT THIS AMENDS, made this ~0~ day of ~~ , 1996, unto a Intervivos Trust Agreement between JESSIE B. RAFFENSPERGER of the Lower Allen Township, Cumberland County, and Commonwealth of Pennsylvania ("Settlor") and FULTON BANK, of Lancaster, Pennsylvania, ("Trustee"); W I T N E S S E T H: WHEREAS, the parties hereto entered into a Intervivos Trust Agreement dated November 18, 1991; and WHEREAS, under Paragraph 7 of said Intervivos Trust Agreement the Settlor reserved the right to revoke and amend the said trust; NOW THEREFORE, it is agreed between the parties hereto that Paragraph 3 of the said Intervivos Trust Agreement is revoked, and in its place the following is substituted: "3. Dispositive Provisions After Death of Settlor. A. Upon the death of the Settlor, the then remaining principal and any accumulated and undistributed income shall be distributed outright to Settlor's daughter, SHIRLEY R. WARRICK, and to Settlor's son-in-law, WILLIAM WARRICK, or to the survivor of them. Page 1 of 3 B. If both Settlor's daughter and son-in-law do not survive the Settlor, then the Trust estate shall be distributed in equal shares to the then living grandchildren of Settlor." In all other respects Settlor hereby ratifies and confirms the Intervivos Trust Agreement dated November 18, 1991, together with this amendment, which now constitute the entire Intervivos Trust Agreement. IN WITNESS WHEREOF, intending to be legally bound hereby, the parties have executed this Amendment to Intervivos Trust Agreement the day and year abo~ze written. ATTEST: FULTON BANK / Page 2 of 3 COMMONWEALT~ OF PENNSYLVANIA) ) ss. COUNTY OF CUMBE~ ) On this, the .~D ~ day of ~~ , 1996, before me the undersigned officer, a Notary Public, personally appeared JESSIE B. RAFFENSPERGER, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument and acknowledged that she executed the same for the purposes therein contained. IN WITNESS W~EREOF, I have hereunto set my hand and official seal the day and year first above written. N6tary P~blic COMMONWEALTH OF PENNSYLVANIA) ) SS. ) ! ~,=,.u.,~.~'~P~ ~ I i New C~ Bero, Cum.~reno ~= .y I i. MyCommiss~resMaJ'ct127,1997 i On this the I~-~f% day of '~{[ , 1996, before' me, the undersigned officer, a Notary Pubic, personally appeared that he-~ as such officer, being authorized to do so, executed the foregoing instrument on behalf of Fulton Bank. IN WITNESS WHEREOF, I have hereunto set my hand and notarial seal. Page 3 of 3 NOTARIAL SEAL KRIS L. YOUNG, NOTARY PUBLIC LANCASTER LANCASTSR CO., PA My Commission Expires june 17, 1999 LAST WILL AND TESTAMENT OF JESSIE B. RAFFENSPERGER I, JESSIE B. RAFFENSPERGER, of Lower Allen Township, Cumberland Ccuntyf Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I direct that my Executors hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease. ITEM II: I devise and bequeath my household goods and personal effects, and other tangible personalty of like nature to my daughter, SHIRLEY WARRICK, and my son-in-law, WILLIAM WARRICK, or to the survi- vor of them. Should neither my daughter, SHIRLEY WARRICK, nor my son- in-law, WILLIAM WARRICK, survive me, I make said bequest in equal shares to my then living grandchildren. To the extent that my living grandchildren become entitled to such property, it shall be divided by my said beneficiaries as they shall agree. As to those items upon which they shall not agree, distribution shall be determined in the sole discretion of my Executors, whose decision shall be final. ITEM III: I devise and bequeath the residue of my estate, of every nature and wherever situate, to the FULTON BANK of Lancaster, Pennsylvania, or its successors in interest, as my Trustee, IN TRUST NEVERTHELESS, to be held, administered, governed and distributed under the terms and conditions of that a certain Intervivos Trust Agreement Page 1 of 4 dated November 18, 1991, as may be superseded or amended by such other trust agreement or amendment as I might make hereafter from time to time in replacement or amendment thereof until the time of my death. ITEM IV: The interest of beneficiaries hereunder shall not be subject to anticipation or to voluntary or involuntary alienation. ITEM V: I appoint my daughter, SHIRLEY WARRICK, and my son-in- law, WILLIAM WARRICK, Co-Executors of this my last will. Should my daughter, SHIRLEY W~RICK, and my son-in-law, WILLIAM W~RRICK, fail to qualify or cease to act as Co-Executors, I appoint FULTON BANK of Lancaster, Pennsylvania, or its successors in interest, Executor of this my last will. ITEM VI: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his/her duties in any jurisdiction. ITEM VII: My corporate fiduciary shall receive compensation for the performance of its functions hereunder in accordance with its standard schedule of fees in effect from time to time during the period under which its services are performed. IN WITNESS WHEREOF, I, JESSIE B. RAFFENSPERGER, have hereunto set my hand and seal this ~%~ day of ~¢.~ , 1996. /.'~7' JESSIE B. ~FE~E~GER / / SIG~-DD, SEALED, P~BLZS~DD and DECLARED by JESSIE B. RAFFENSPERGER, the Testatrix above named, as and for her Last Will and Page 2 of 4 Testament, and in the presence of us, who at her request, in her pres- ence and in the presence of each other, have subscribed our names as Witness Addre s s Addre s s ' COMMONWEALTH OF PENNSYLVANIA: :SS: COUNTY OF CUMBERLAND : I, JESSIE B. RAFFENSPERGER, the Testatrix whose name is signed to the attached or foregoing instrument, having been duly q~alified according to law do hereby acknowledge that I signed and executed this instrument as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein con- tained. "-'JESSIE B. R~NSPE~G.~ ~' Sworn to or affirmed to and acknowledged before me by JESSIE B. RAFFENSPERGER, the Testatrix, this ~- day of '~..~ , 1996. Notary Pub t i~,~ Page 3 of 4 ~ ~ .-.::.~.!. I COMMONWEALTH OF PENNSYLVANIA : :SS: COUNTY OF CUMBERLAND : We, 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 Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence.  itneffs ' - Witness Sworn to or affirmed to and acknowledged before me by witnesses, this day of ----~~ 1996 Notary Public ,/~ -"L~-~' Page 4 of 4 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. REV-1162 EX(11-96) CD 003347 FULTON BANK NKA PO BOX 7989 LANCASTER, PA 17604 ........ fold ESTATE INFORMATION: SSN: 152-16-5808 FILE NUMBER: 2103-0597 DECEDENT NAME: RAFFENSPERGER JESSIE B DATE OF PAYMENT: 12/19/2003 POSTMARK DATE: 12/17/2003 COUNTY: CUMBERLAND DATE OF DEATH: 06/27/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $737.70 REMARKS: FULTON BANK NA TOTAL AMOUNT PAID: $737.70 SEAL CHECK//1055707 INITIALS: VZ RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS CUMBERLAND Recjister of WilI~ of L~lo~rte~ County, Penn~ylv~i~ INVENTORY Jessie B. Raffensperger No. 21-2003-0597 - l:)~te~tOea~l~ June 27, 2003 .. ~ I~ecea.-ed 8~ciaJSe~,~tyN~. 1 52-1 6'6708 _ .... .~ ~,,-,..~s) ~ m~e ~ =.~.=am, d~a, mm~ ......... -':- -, .... ~ecada~t, ~ ~e N~e:t Goldberg, Ka'tzman & Shipman, P.C. BY~,.~_ ~: ~~. ~awK, ~state ~}emer ten ~. N: .: 071 98 320 Market Street, P.0. Box 1268 ~ December 5, 2003 Harrisburg,. PA 17108-1268 (717) 234-41 61 See Attached VaJue $10,843.27 T,,-I $1 0,843.27 RW--t IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY STATE OF PENNSYLVANIA ORPHANS' COURT DIVISION INVENTORY REAL ESTATE 1. None PERSONAL PROPERTY 2. 3. 4. 5. Refund of overpayment to West Shore A.L.S. Refund from The Woods at Cedar Run Refund of unused premium from United American Insurance Company Medical reimbursements from United American Insurance Company Prudential Insurance Co. - group life insurance benefit from State of New Jersey, Department of the Treasury, Division of Pensions and Benefits State of New Jersey, Department of the Treasury, Division of Pensions and Benefits - final pension amount Refund of overpayment from Pennsylvania Neurological Associates Refund of overpayment from Silver Spring Ambulance Conseco Senior Health Insurance - refund of unearned premium on policy no. WT 60338 TOTAL REAL AND PERSONAL PROPERTY $ 9.65 2,036.14 72.44 478.14 3,850.00 1,235.12 39.35 17.50 3,104.93 $10,843.27 FUr,TON FINANCIAL ADVISORS' P.O. BOX 7989 LANCASTER, PENNSYLVANIA 17604-7989 FULTON FINANCIAL ADVISORS' Mal~'ng Stlcce$$ Personali' Register of Wills Cumberland County Court House Hanover and High Streets Carlisle, PA 17013 IN RE: ESTATE OF JESSIE B. RAFFENSPERGER, Deceased : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : No. 200:5-00597 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Will No. Jessie B. Raffensperger, deceased June 27, 2003 Admin. No. 2003-00597 To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on January_ 8, 2004: Shirley Warrick Fulton Bank 50 Timber Villa, Elizabethtown, PA 17022 One Penn Square, Lancaster, PA 17602 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Warrick, deceased. Date Signature Name Address Telephone William o~~d'~e~,°[e;~aEnS~Ui~ipman, P.C. P.O. Box 1268 Hardsburg, PA 17108-1268 (717) 234-4161 Capacity: X __ Personal Representative Counsel for personal representative PI,EASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: Estate No.: Jessie B. Raffensperger June 27, 2003 21-2003-0597 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: State whether administration of the estate is complete: Yes X No Date: (MAH:rmt/AM3) 4/I9/2004,, If the answer is No, state when the personal representative reasonably believes that the administration will be complete: (date) If the answer to No. 1 is yes, state the following: A. Did the personal representative file a final account with the court? Yes No X B. The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) C. Did the personal representative state an account informally to the parties in interest? Yes X No D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the/~rphans' Court and may be attached to this report. Fulton IFi~~l Advirs,ors, N. A. ~ttlement Offict Signature Breth R. Hawk Estate Settlement 0fficer Name (Please type or print) Fulton Financial Advisors, N. A. Address P. 0. B o x 7989 Lancaster, PA 17604 (717) 291-2854 Telephone No. F..W. - 5t~ Capacity: X Personal Representative Counsel for Personal Representative BUREAU OF TNDIVZDUAL TAXES TNHERTTANCE TAX DTVTSTOH DEPT. 180601 HARRISBURG, PA 17118-n601 CONNONgEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX THOMAS W SHIELDS FULTON FINL ADVISORS PO BOX 3215 LANCASTER ~ ,- u~ ~c ESTATE OF DATE OF DEATH FILE NUMBER FEB 13 P 3:29COUNTY ACN PA 17((l:~l~b~i~i~a CO.. PA RE¥-1~47 EX AFP (gl-OS) 02-16-200q RAFFENSPERGER 06-27-2005 21 05-0597 CUMBERLAND 101 Amoun~ RemL~ed JESSIE HAKE CHECK PAYABLE AND REH'rT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LO#ER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF RAFFENSPERGER JESSIE B FILE NO. 21 03-0597 ACM 101 DATE 02-16-200~ TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSF APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~e (Schedule A) (1) 2. S~ocks and Bonds (Schedule B) (2) $. Closely Held S~ock/Par*narship In*errs* (Schedule C) ($) ~. Mortgages~No,es ReceivabZe (Schedule D) (~) 5. Cash/Bank Deposi~s/Misc. Personal Proper~y (ScheduZe E) (5) 6. Jointly O~ned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al Asse~s APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expanses (Schedule N) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule Z) (10) 11. To,al Deductions 6~,995.Z7 .00 .00 NOTE: To insure proper .00 credi* *o your account, .00 submi~ ~he upper portion .00 of ~his form ~i~h your ~ax payment. 569;678.88 (B) 576,672.15 q,909.55 12. 13. NOTE ASSESSMENT OF TAX: 15. Amoun~ of Line lq a~ Spousal ra~e 16. Amoun~ of Line lq ~axable a~ Lineal~Class A ra~e 17. Amoun* of Llne 1~ a~ Sibling ra~e 18. Amoun~ of L/ne 1~ ~axable a* Collateral/Class B ra*a 19. Principal Tax Due TAX CREDITS: PAYHENT J ReCeiPT DATE NUMBER 09-10-2005 CD00~00$ 12-17-2005 569.22 (11) 5.278.77 371,393.38 AMOUNT PATD (15) .00 x O0 = .00 (16) 371,39:5.38 x 0~5= 16,712.70 (17) .00 x 12 = .00 (18) .00 x 15 = . O0 (19)= 16,712.70 ZF PA/D AFTER DATE INDICATED, SEE REVERSE FOR CALCULAT/ON OF ADDITIONAL INTEREST. 798.75 .00 15,176.25 737.70 TOTAL TAX CREDIT I 16,712.70 BALANCE OF TAX DUEI .00 INTEREST AND PEN. I .O0 TOTAL DUE / .00 IF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT" (CR), YOU MAY BE DUE REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. DISCOUNT (+) INTEREST/PEN PAID (-) Ne~ Value of Tax Ra~urn (12) Charitable/Governmental Bequests; Non-alec~ed 9113 Trusts (Schedule J) (15) . O0 Na~ Value of Es~a~e Subjec~ ~o Tax (lq) $71, $95. Zf an assess.ent was issued prev$ously, 1Shes 1~, 15 and/or 16, 17, 18 and 19 reflect figures that include the total of ALL returns assessed to date. RESERVATION: PURPOSE OF NOTICE= PAYNENT: REFUND (CR): OBJECTIONS: ADHIN- [STRATIVE CORRECTZONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 11, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decadent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (71 P.S. Section 9140). Detach the top portion of this Notice and submit aith your payment to the Register of Rills printed on the reverse side. --Hake check or money order payable to: REGISTER OF NILES, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications are availabIe at the Office of the Register of Hills, any of the 13 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-361-Z050~ services for taxpayers with special hearing and / or speaking needs: 1-800-447-3010 (TT onZy). Any party in interest not satisfied eith the appraisement, alloeance, or disallowance of deductions, or assessment of tax (including discount ar interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Ravenuej 8oard of Appmals, Dept. 181021, Harrisburgj PA 17118-1011, OR --election to have the matter determined at audit of the account of the personal rapresentative~ OR --appeal to the Orphans" Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTR: Post Assessment Review Unitj Dept. 180601j Harrisburg~ PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Tnstructions for [nheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. Tf any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is allowed. The 157. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you mould appeal the tax and interest that has been assessed as indicated on this notice. /nterest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1~ 1982 bear interest at the rate of six (6X) percent per annum calculated at a daily rate of .000164o All taxes which became delinquent on and after January 1~ 1981 w111 bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1981 through Z003 are: ~rntarest Daily Interest Daily Znterest Daily Year Rate Factor Yea.~_r Rate Factor Yaa._..r Rate Factor 1982 20X .000548 1987 9Z . O00147 1999 7X .000191 1983 161 .000438 1988-1991 11X .000301 ZOO0 8X .000119 1984 111 .000301 1991 91 . 000247 Z001 97. .000147 1985 132 .000356 1993-1994 71 .000191 ZOOZ 62 .000164 1986 XOZ .000Z74 1995-1998 9Z .000247 2003 5Z .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUIIBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment, l'f payment is made after the interest computation date shown on the Notice, additional interest must be calculated.