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Home My WebLink About04-0147PETITION FOR PROBATE and GRANT OF LETTERS Estate of Orpha G. Wolge~uth also known as , Deceased. Social Security No.. 2 0 3- 3 6 - 2 5 7 0 No. ~./- t~z-//-/z//7 To: Register Of Wills for the County of Cumberland in Commonwealth of Pennsylvania the The petition of the undersigned respectfully represents that: Your petitioner(a), who is/~amxl8 years of age or older an the executor in the last will of the above decedent, dated. June 2 and codicil(s) dated n [ il Abner M. Wolgemuth, spouse .and 'first .named on F~bruary 17, 1994. named ,19 93 Executor, died (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with h ~_r last family or principal residence at 634 Messiah Village, P. 0. Box 2015, Mechanicsburg, PA (Lo. wer Allen Township) -- (list street, number and muncipality) Decendent, then 88 years of age, died January 24, :t~- 2004 at Messiah Village, Mechanicsburg, PA ~7055-2015. ' Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent:.. n / a Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled ia Pa.) Personal property in Pennsylvania (If not domiciled i.n Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: n / a 10,000.00 WHEREFORE, petitioner(sO respectfully request(s) the probate of the last will lii~dtg~tt0ilt~ presented herewith and the grant of letters t ~,q ~ ~ m o n r a r y theron. (testamentary; administration c.t.a.; administration d.b.n.c.t,a.) Wachovia Bank, N.A., successor Hmmi]t. mn Ba. nk -Kim E. Garrett- by' , .~. ~r~_t~xl o~ficer'i PAfQO.7 !00 ~orth Queen Street __ Lancaster, PA 17604 to OATH OF' PERSONAL REPRESENTATIVE COI~MONWEALTH OF PENNSYLVANIA h C~UNTY OF_ CUMBERLAND The petitioner(g) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(~) and that as personal represen- tative(~ of the above decedent petitioner~) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this ./nZgz-'4/ day of tz~a /J~E~ ' ~ ~ Reg~er No. Estate Of 0RPHA G. WOLGEMUTH , Deceased DECREE OF PROBATE AND GRANT OF LETTERS % ~1~ 200,4in consideration of the petition on ASO SOW., /? the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instmment(~) dated_ Sun e 2, 1 q 9 3. described therein be admitted to probate and filed of record as the last will of 0rpha G. Wolgemuth ; and Letters Testamentary are hereby granted to Wachovia Bank, N.A. FEES Probate, Letters, Etc .......... $ 40.00 Short Certificates(4) .......... $ 12.00 Renunciation ................ Filed .~. ',~'..../.?.... ~/.~:~..~.. .......... Carl R. Hal].gren 06952 ~,, AI-g, OR~ES( (Sup,~ .Ct. I.D..No.) 700 ~or~n oulce ~tree~, P.O. Box 4686 Lancaster, PA 1'7604-4686 ADDRESS ('717) 299-5251 PHONE 105.112 REV. 8/88 (FEE FOR THIS CEF~TIFICATE $2.00) WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS LOCAL REGISTRAR'S CERTIFICATION OF DEATH CERT. NO. T 5547737 1-27-04 Date of tssue of This Certification Name of Decedent ORPHA G. WOLGEMUTH First Sex FEF~LE Social Security No. Date of Birth 5 - 16 - 15 Birthplace Place of Death MESSIAH VILZJ~_G'~ Middle Last 203-36-2570 Date of Death PENNSYLVANIA 1-24-04 CUMBERLAND LOWER ALLEN TWP. Pennsylvania Facilib/Name Couniy City, Borough or Township Race WHITE Occupation HOUSEWIFE Armed Forces? (Yes or No) Decedent's Marital Status WIDOWED Mailing Address 100 MT. ALLEN DR. MECHANICSBURG Number Street City or To~vn Informant JOYCE HEISEY Funeral Director ANDREW F. REYMER Name and Address of Funeral Establishment NISSLEY FUNERAL HOME, LTD. E. MAIN STREET, MOUNT JOY NO PA State Part h Part I1: Immediate Cause (a) MYOCARDIAL INFARCTION (b) CAD (c) (d) Other Significant Conditions CVA Interval Between Onset and Death Manner of Death Natural [~ Accident [] Suicide [] Homicide [] Pending Investigation [] Could not be Determined [] Describe how injury occurred: Name and Title of Certfier L. ZIMMERMAN, M.D. Address L~tv~OYNE (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. ,~' . _,,,/ ~ 36-338 L~I~I Regisi~ar of Vita~ R~l~ords District No. 1-27-04 25 IRIS CIRCLE ELIZABETHTOWN Date Received by Local Registrar Street Address City, Borough, Township 55\$T1-~3752 tenants by absolutely. THIRD: WOLGEMUTH, I, ORPHA G. WOLGEMUTH, of 634 Messiah Village, P.O. Box 2015, Mechanicsburg, Pennsylvania, 17055-2015, make and publish this my Last Will and Testament, hereby revoking and making void all former Wills by me at any time heretofore made. FIRST: I direct that my just debts and funeral expenses shall be paid out of my estate as soon as conveniently may be done after my death. SECOND: I declare that my husband, ABNER M. WOLGEMUTH, and I own all of the furniture, rugs and other household effects as the entireties, and the same shall pass to him I give and bequeath to my husband, ABNER M. all tangible personal property, including any automobiles which I may own at the time of my death, together with any policies of insurance thereon; PROVIDED, however, that if my said husband shall fail to survive me for a period of thirty (30) days, I give and bequeath to my surviving children and to the issue of any of my children then deceased, so much of said property as they or the person having custody of any of them may select, in equal value shares per stirpes, (unless they or the person having custody of any of them shall otherwise agree) and the rest of said property shall be sold and the proceeds added to my residuary estate. In the event that such beneficiary should then be a minor, I authorize my Executor to deliver such minor's share of said property, without bond, to the person having custody of such minor, and the receipts of such person shall be a complete discharge of all obligations of my Executor with regard to such minor's share of said property. FOURTH: All the rest, residue and remainder of my estate, real and personal, and wherever situate, I give, devise and bequeath to HAMILTON BANK, in trust, to be added to and form a part of the trust or trusts under that certain Trust Agreement already created by me and date the ~ day of ~ , A.D., 1993, as amended from time to time, by a complete Restatement or otherwise, whether prior to or subsequent to the date of the execution of this Will, or in the event that such trust should not be in existence at the time of my death, to be held by said Trustee under and subject to the terms and conditions of a trust, which terms and conditions shall be exactly the same as those specified in my aforesaid Trust Agreement as it existed at the time of the execution of this my Will, or of the last Codicil hereto, with like effect as if said terms and conditions were set forth and incorporated herein verbatim. FIFTH: I appoint HAMILTON BANK, Guardian of any property which passes to a minor with respect to which I am authorized to appoint a Guardian and have not otherwise specifically done so. The Guardian is also authorized to receive and manage the proceeds of any life insurance policy or policies payable to said minor. Such Guardian shall have the power to use principal as well as income, from time to time, for the minor's support, welfare, and education or to make payment for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor. The Guardian shall have authority to invest the principal and any accumulated income in income- producing real estate and in any securities, stocks or other personal property which the Guardian may deem for the best interests of the minor according to the standards of prudent investment without being confined to so-called legal investments. SIXTH: I direct that all inheritance and estate taxes which may become payable by reason of my death, including taxes on any property not passing under this Will, shall be paid out of the principal residue of my estate, and no part thereof shall be collected from or charged against any beneficiary, provided, however, that the terms of this paragraph shall not apply to any such death taxes imposed with respect to any retirement benefits, unless the beneficiary is either my trust or my estate. 2 SEVENTH: I constitute and appoint my husband, ABNER M. WOLGEMUTH, Executor of this Will; and if he should die or be unwilling or unable to act, then I constitute and appoint HAMILTON BANK, Executor of this Will. Except as may be specifically stated to the contrary in other provisions of this Will, I authorize any personal representative of my estate to exercise the following powers, in addition to those given by law, to be exercised in the sole discretion of my personal representative: to retain any real and personal property which may at any time form part of my estate for as long as my personal representative may deem advisable; to repair, alter, improve or lease, for any period of time, any real or personal property and to give options for leases; to sell any real or personal property at public or private sale, for cash or credit, with or without security; to exchange or to partition any real or personal property and to give options for sales or exchanges; to compromise claims without court approval; to continue any business which I may own or in which I may have an interest for as long as appropriate under the circumstances; to retain and pay agents, employees, accountants and counsel for advice and other professional services; to make distribution in kind; and to invest and reinvest according to the standards of prudent investment without being confined to so-called legal investments. No Executor, Guardian or Trustee named herein shall be required to give bond or security in order to qualify as such or to perform any duties of such appointment, regardless of place of residence. IN WITNESS WHEREOF, I have to this Will, typewritten on five (5) sheets, set my hand and seal this ~ day of ~ , A.D., Nineteen Hundred and Ninety-Three (1993). ORP~A G. WO~GE~TH ' Signed, sealed, published and declared by the above named ORPHA G. WOLGEMUTH, as and for her Last Will and Testament in the presence of us, who at her request and in her presence and in the presence of each other, have subscribed our names as witnesses thereto. COMMONWEALTH OF PENNSYLVANIA ) ) ss: COUNTY OF LANCASTER ) I, ORPHA G. WOLGEMUTH, Testatrix, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ORPH~ G. WOLGF~TH me, Sworn or affirmed to, subscribed to and acknowledged before by ORPHA G. WOLGEMUTH, the Testatrix, this ~W_ day of _ , 1993 . Penny E. Ke~ed~. N0m~ Pu~ic ~otary Pub~lic/ L~er. L~er Coun~ ._?y Commission Expires May 24, 1997 Member, Penns~ania~ o~ ~ COMMONWEALTH OF PENNSYLVANIA ) ) ss: COUNTY OF LANCASTER ) We, ~~/.~)~/(~_./y~j~J~ ~ ~~/V~.~~ , the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her Last Will; that ORPHA G. WOLGEMUTH 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 4 Testatrix, signed the Will as witnesses; and that, to the best of our knowledge, the Testatrix was at that time 18 or more years of age, of sound mind, and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by ~ ~~ ~ ~ ~. ~~__ , witnesses, this day of ~ , 1993. NotadaJ Seal Penny =_. Ke~edng, Notary Public Lancaster, Lancaster' County f. i,:,, Comrni~ ~sr- E×pires May 24, 1 .°..97 j~m~r, Pennsylvania ~on of Notanes 5 jtlill OF ORPHA G. WOLGEMUTH CARL R. HALLGREN ATTORNEY AT LAW LAW OFFICES MOR.GAN, HALLGR. EN, CR.OSSWELL ~ KANE, P.C. R O. BOX 4686 LANCASTER., PENNSYLVANIA 17604-4686 Name of Decedent: Date of Death: January 24, 2004 To the Register: CERTIFICATION OF NOTICE ULE . a ,~ Estate of Orpha G. Wolgmuth, deceased '04 i~/~ -4 /~ll :47 Estate No.: 21-04-0147 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 March 2, 2004: Ms. Janet G. Wolgemuth 2436 Meredith Street Philadelphia, PA 19130-2522 Ms. Joann Sider 654 Hunter's Lane Lewisberry, PA 17339 Mrs. Joyce Heisey 523 North Strickler Road Manheim, PA 17545 Dr. June C. Wolgemuth 13320 S.W. 95th Avenue Miami, FL 33176 Mr. Dwight L. Wolgemuth 721 Kraybill Church Road Mount Joy, PA 17552 Notice has now been given to all persons entitled thereto under Rule 5.6(a), except Abner M. Wolgemuth, husband of decedent, who died on February 17, 1994. Date:_ March 3, 2004 Capacity: ~ Personal Representative Morgan, Hallgren, Crosswell & Kane, P.C. __X_._X Counsel for Personal Representatives Signature- / Carl R. Hallgren 700 North Duke Street P.O. Box 4686 Lancaster, PA 17604-4686 CERTIFICATION OF NOTICE UI~...R, _ULE Name of Decedent: Date of Death: January 24, 2004 To the Register: Estate of Orpha G. Wolgrnuth, deceased '04 I'1/~ -4 /~11:47 Estate No.' 21-04-0147 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 March 2, 2004: Ms. Janet G. Wolgemuth 2436 Meredith Street Philadelphia, PA 19130-2522 Ms. Joann Sider 654 Hunter's Lane Lewisberry, PA 17339 Mrs. Joyce Heisey 523 North Strickler Road Manheim, PA 17545 Dr. June C. Wolgemuth 13320 S.W. 95th Avenue Miami, FL 33176 Mr. Dwight L. Wolgemuth 721 Kraybill Church Road Mount Joy, PA 17552 Notice has now been given to all persons entitled thereto under Rule 5.6(a), except Abner M. Wolgemuth, husband of decedent, who died on February 17, 1994. Date: March 3, 2004 Capacity: __ Personal Representative Morgan, Hallgren, Crosswell & Kane, P.C. X .Counsel for Personal Representatives Carl R. Hallgren 700 North Duke Street P.O. Box 4686 Lancaster, PA 17604-4686 Wachovia Bank, N.A. Estate Tax Division PA1308 Post Office Box 7558 Philadelphia, PA 19101-7558 Fax 215 670-6422 April20,2004 '04 ~PR 22 WACHOVIAWEALTH MANAGEMENT Register of Wills of Cumberland County 1 Courthouse Square Carlisle, PA 17013 Estate of Orpha G. Wolgemuth Date of Death: January 24, 2004 Social Security Number: 203-36-2570 File Number: 21-2004-00147 Dear Sir or Madam: We wish to make payment on the account of this estate's PA Inheritance Tax liability within the three month discount period, and, accordingly, enclose our check in the amount of $27,360.00, calculated as follows: $640,000. X 4.5% Less: 5% Discount Net Discount Payment = $28,800.00 = (1,440.00) $27,360.00 Please date-stamp the enclosed copy of this letter and return it to us using the enclosed self- addressed prepaid envelope. Please send us your usual receipt covering this payment of tax. Very truly yours, Fred S. Bachman Assistant Vice President cc: Carl R. Hallgren, Esquire Patty Jackson, Vice President Certified Mail - Receipt # 7003 3110 0000 3488 0770 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD REV-1162 EX(11-96) 003857 HALLGREN CARL R ESQ MORGAN HALLGREN CROSSWELL&KANE P O BOX 4686 LANCASTER, PA 17604-4686 ........ fold ESTATE INFORMATION: SSN: 203-36-2570 FILE NUMBER: 2104-01 47 DECEDENT NAME: WOLGEMUTH ORPHA G DATE OF PAYMENT: 04/22/2004 POSTMARK DATE: 04/22/2004 COUNTY: CUMBERLAND DATE OF DEATH: 01/24/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $27,360.00 TOTAL AMOUNT PAID' $27,360.00 REMARKS: SEAL CHECK//48535767 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA OEPARTMENTOFREVENUE BUREAU OFINDIVIDUAL TAXES OEPT, 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX{11 96) NO. CD 004220 WACHOVIA BANK, N.A. SUCCESSOR TO HAMILTON BANK 100 NORTH QUEEN STREET LANCASTER, PA 17604 SSN: 203-36-2570 2104-0147 DECEDENT NAME: WOLGEMUTH ORPHA G DATE OF PAYMENT: 08/02/2004 POSTMARK DATE: 07/30/2004 COUNTY: CUMBERLAND DATE OF DEATH: 01/24/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $591.15 TOTAL AMOUNT PAID: .~591.15 REMARKS: CHECK# 48687985 SEAL INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS Wachovia Bank. N.A, PA1308 Post Office Box 7558 PhilaOelphia, PA 19101-7558 Fax 215 670 6422 WACHOVIA TRUST July 30, 2004 Register of Wills of Cumberland County 1 Courthouse Square Carlisle, PA 17013 Estate of Orpha G. Wolgemuth Date of Death: January 24, 2004 Social Security Number: 203-36-2570 File Number: 21-2004-00147 Dear Sir or Madam: Enclosed, for filing with your office, is the PA Inheritance Tax Return in duplicate for the above estate, together with the following: Copy of Will of Orpha G. Wolgemuth, dated June 2, 1993 Copy of Trust Agreement of Orpha G. Wolgemuth, dated June 2, 1993 Copy of Trust Agreement of Abner M. Wolgemuth, dated February 12, 1985 Our check in the amount of $591.15, representing the balance of PA Inheritance Tax due Please date-stamp the enclosed copy of this letter and return it to me using the prepaid envelope provided. Please send us your usual receipt covering this payment of tax. Very truly yours, Fred S. Bachman Assistant Vice President cc: Carl R. Hallgren, Esquire Patty Jackson, Vice President Certified Mail - Receipt # 7003 3110 0000 3494 7596 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT iii r~ iii UJ DECEDENTS NAME (LAST, FIRST, AND MIDDLE INIT~,L) Wolgemuth, Orpha, G. DATE OF DEATH (N~t-DD-YEAN) DATE OF BIRTH (MM-DD.YEAR) 01-24-2004 05-16-1915 IF APPLICABLE) SURVMNG SPOUSES NAME (LAST, FIRST, AND MIDDLE INITIAL) [] 4. Limited Estate [] 6. DecedentDiedTestateWtechcepyofwtl) [] 9. LJ~galJon Roceeds Recked [] 2, SupplementalRe{um [] 10. SpousaJ Pov~Crsdit(d~ea'a~hbet~ea12~11-91 axl 1-1~5) Fred S. Bachman, Asst Vice President F~MNAMECA~) Wachovla Bank, N.A. TELEPH~E NU~ER (215) 670-6394 1. Real Estate(Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corp~elim, P~ip or Sde. Propdd:or~p (3) 4. Medgages & No~s Receivable(Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Propsdy (5) (Schedule E) 6. JoinllyOwned Property(ScheduleF) (6) [] se~te E~,ir~ Requited 7. ~er-~vos Transfers & t,~sc~l~eous Nm-Probate Prol:mlly (7) (Schedule G or L) 8. T~ial C~o~s Ass~ (totul Unes ~-7) 9. Funeral Expenses & M minis~rative Cmts (Schedel~ H) (9) 10. Debts of Decede~, Me~a~e U~bilit~, & LJens (Schedule I)(10) 11. T~al Dedu~ens (telal Unes 9 & 10) 12. N~ Value ef E~mm (Une $ minus Une 11) 13. ~le and C,~¥a'r, mentel Bequssts/Sec 9113 Trusts for which a~ dec,on to tex has not been made (Schedule J) t4. Ne~ Wlue Subject to Ta~ (Une 12 minus Une 13) OFFICIAL USE ONLY FILE NUMBER 21 _ 2004 00147 SOCLAL SECURITY NUMBER 203-36-2570 THIS RETURN MUST BE FILEO IN DUPUCATE ~MTH 'THE REGISTER OF VVILLS SOCIAL SECURITY NUMBER [] 3. Ranal~erReturn(dateold, a~hp~.to12.~3-s2) [] 5. FederaJEsteteT~RetumRequlred 0 & TdalNumberofSa~eDepesitBo~s [] 11. Becfiontotaxunder Sec. 9113(A),;~:~s~o) COMPLEIE MAILING ADDRESS 123 S. Broad Street - PA1308 Philadelphia, PA 19109 None None NoV No~ 1,360..... 6 7 4, 3 8 9.',~. ~:: (8), 30,296.73 5,830.37 (11) (12) (13) OFFICIAL USE ONLY 689,263.66 36,127.10 653,136.56 (14) 653,136.56 15. Amen{ d Une 14 tax~e at the sp<3usal tax rate, or tmnsfas under Sec. glt6 (a)(1.2) x .0 (15) 16. Amc~ntofUne14texableatlinealrate 653, 136. 56 X .0 45 (16) 17. Am~m of Une 14 taxable at sibling rate x .12 (17) 18. h~ountof Um 14 ta~bleat ~lata'al rate X .15 (18) 19. T~x Due (19) 29~391.15 29,391.15 Estate of: OrphaG. Wolgenuth 21-2004-00147 SU~V~Ry OF ALLOflATICNS TO BEN~'iCIARIES Taxable at lineal rate Janet G. Wolger~/th Joann Sider Joyce Heisey June Wolge~uth Dwight L. Wolgenuth 132,315.76 130,955.20 130,955.20 130,955.20 127,955.20 653,136.56 PA REV-1500 EX (6-00) Page 2 Decedent's Complete Address: STREET ADDRESS Messiah Village 100 Mt. Allen Drive CITY ISTATE I Z~P Mechanicsbur~ PA Tax Payments and Credits: 1. Tax Due (Page l Line19) (1) 29,391.15 2. CredEs/Payments A. Spousal Poverty Credit B. Prior Payments 27,360.00 C. Discount 1,440.00 Total Cred~ (A + B + C) (2) 28,800.00 Interest/Penalty if applicable D. Interest E. Pertain Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greatar than Line 1 + Line 3, enter the difference. 3?tis is the OVERPAYMENT. Cheak box on Page 1 Une 20 to request a I~fund (4) 5. If Line 1 + Une 3 is greater than Line 2, enter the difference. 'Fnis is the TAX DUE, (5) 591.15 A. Enter the interest on the tax due. (SA) 0.00 B. Enter the total of !Jne 5 + 5A. This is the BALANCE DUE. (5B) 591.15 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retsln the use or income of the proparty tranaferred; ....................................... I 1 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? .............................. 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? ... ~ ~ 4.Did decedant own an Individual Retirement Account, annuity, or other con-propate property which contains a beneficiary designation? ........................................................ D 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 p~ of J39rj.~y, I declare that I have examined this mtum~ including accompanying schedules and statements, and to the best of my k, .r?~4. edge and beher, ~ ~ true, correct and complete. Declaration or preparer other than me personal representative is based on information 6f wnioh preparer has any knowledge. SIGNATURE OF PE~SQN. RESPGINSIBLE FOR FILING RETURN ADDRESS . DATE / SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS REV-1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA iNHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Orpha G. Wolgenuth 21-2004-00147 ~ must be disclosed on Sch. F. ri'EM NO. DESCRIPTION 1 Wachov~a Bank, N.A. f~ecking Account # 1000390124569 2 GE Capital Assurance - Final reimbursement under nursing home coverage policy, covering 01/10/2004 - 01/24/2004 3 PA Department of P~=veuue - Refund of the decedemt's 2003 PA State Income Tax liability 4 AARP Health Care Opticms - Refund of unearned portion of medical insurance premium 7 CPA81 NW= 10~08 Copyright Fomts Software Only, 1997 Nelco, inc. TOTAL (Also enter on lina 5, Recapitulation) (If more space is needed, Insert additional sheets of the same size) VALUE AT DATE OF DEATH 9,767.31 2,550.00 218.00 978.75 13,514.06 WACHOVr_.A Wachovia Bank N.A. Balance Confirmation Services P O Box 40028 Roanoke, VA 24022-7313 Reference ID: 839190 February26, 2004 PA 6907 WACHOVIA ATTN: KlM E GARRETT SUBJECT: Verificagon / Confmnafion of Account and Balance Information provided for: Customer: ORPHA G WOLGEMIJTH (SSN# 203-36-2570) Date of Death: January 24, 2004 Deposit Account Information Account Account Date of Death Average Date MatufiW Interest Accrued Type Number Balance Balance* Opened Date Rate Interest CHECKING 1000390124569 $9,767,31 4/15/1971 $0.00 LEGAL TITLE: ORPHA G. WOLGEMUTH YTD Interest Paid $0.00 Date Closed Due to system limitations, we can only provide a twelve month average balance on depository accounts. Revolvine Credit Information Account Account Date of Death Credit Date Date Times Legal Title Type Number Balance Limit Opened Closed Late VL~A 4264298809101036 MBNA - Revolving credit aceount~ are no longer serviced by Wachovia Bank. Please contact MBNA at 800-~41-7048. Other Account Information Account Account Date of Balance Date Type Number Opened TRUST 1519186200 9/4/1998 LEGAL TITLE: ABNER M. WOLGEMUTH RESIDUAL TRUST WACHOVIA BANK NA TRUSTEE UNDER AGREEMENT DATED 2/12/85 PL]~.SE CALL OUR TRUST DEPARTMENT @ 888-216-2308 FOR TRUST ADMINISTRATOR INFORMATION. Date Closed Ledger Collected TRUST 1519186219 9/4/1998 LEGAL TITLE: ORPHA G. WOLGEMUTH TR WACHOVIA BANK NA TRUSTEE UNDER AGREEMENT DATED 6/2/93 PLEASE CALL OUR TRUST DEPARTMENT ~ 888-216-2308 FOR TRUST ADMINISTRATOR INFORMATION. 0000 000614 REV-1509 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Orpha G. Wolqe~uth 21-2004-00147 If an asset was made Joint within one year of the decedent's date of death, It must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A Ja~t G. Wolge~uth 2436 Meredith Street Philadelphia, PA 19130-2522 Daughter JOINTLY-OWNED PROPERTY: LE'I3~R DATE DESCRIPTION OF PROPERTY Include name of finar~cial institution and bank % OF DATE OF DEATH ITEM JOINTFOR MADE account number or similar identifying number. DATE OF DEATH DECD'S VALUE OF NO. TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERE.( 1 A 10/02/00 PNC Bank 2,721.11 50% 1,360.55 Cb~vRin~ Account Acct. # 5070101715 TOTAL (Also enter on line 6, Recapitulation) $ 1,360.55 7 CPA91 NTF 10909 (If more space is needed, insert additional sheets of the same size) APR-iS-2804 i7=48 PNCB~NK 412 76S 345S P.Oi Ol PNCBAhK Apd] l~, :2004 Klm E. Garrett Wachovia Bank P,O. Box 3959 t~castea', PA 17604 Estale of Orpha G. Wolge~uth, dece~ed $SN: 203-36-2570 DOD: 1/24/2004 Dear Ms. Gmtett: In respome to your request for Date o£Death bal~mces for the customer noted above, our re~ords show the following: Checking Accoum Account #5070101715 ORPHA G WOLQEMUTH IA_NET O WOLGEMUTH DOD balance: $2.,721.11 (non-int~--st bearing) Established 10[02/2000 Please note that this office only provides date of death balances for deposit accounts (IRAS, CDs, Checking and Savings accounts). We de not process any financial transactions or provide s~atements, ffyou need assistance with any of these items, please call 1-888-PNC-BANK (1.,888-762-2265) or stop by your lo~al PNC Bank branch office. Sincerely, 1-800-762-1775 PT-PFSC-04-F 500 first Aw. Pittsburgh PA 15219 M~nbet FDIC TOTAL p. REV-1510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Orpha G. Wolge~mth FILE NUMBER 21-2004-00147 This schedule must be completed and flied if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes, DESCRIPTION OF PROPERTY % OF EXCLUSION INCLUDE NAME OF THE TRANSFEREE, THEIR ITEM RELATIONSHIP TO DECD & DATE OF TRANSFER. DATE OF DEATH DECD'S (IF TAXABLE VALUE NO. ATTACH COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST APPLICABLE) Orpha G. Wolgemuth created a Revocable Trust Agreement with Hamiltc~ Bank, N/K/A Wac_bovia Bank N.A., trustee, dated 6/2/93. (Account # 1519186219 - Copy of Trout ~z~ment enclosed) ) The assets that Cu~rised this trust as of date of death have beed~ revalued as of 1/24/04, as follows 1 26,852.63433 Sha. Evergreen 314,175.82 Municipal B~nd Fun~, C1 I (Fd #216) Iox~u~ accrued to 01/24/2004 925.11 2 1,976.967279 shs. Evergreen 50,116.12 Strategic G~owth Fund, C1 I (Fd ~440) 3 3,090.57106 Shs. Evergreen 67,930.75 Strategic Value Fund, C1 I (Fd $450) Income accrued to 01/24/2004 33.02 4 14,314.384 Shs. Evez~jreen Larcje Cap 196,679.64 Equity Fund, C1 I (Fd #716) Inco~ accrued to 01/24/2004 131.88 5 Principal Cash balance as of 17,229.79 01/24/2004 6 Incom~ C~h balance as of 336.09 01/24/2004 7 Interest accrued to 01/24/2004 on 7.94 Principal and Income Cash balances Total frcrd continuation page (s) 26,822.89 TOTAL (A;so sntsr on ~ine ?. Recapifu~at~n) $ 674,389.05 7 CPAO1 NTF 10910 Cenydght Fom~s Soi'~vare Only, 1997 Nelco, Inc. (If more space is needed, insert additional sheets of the same size) Estate of: Orpha G. Wolgemuth SC2-m2uUT~ G -- Inter-Vivos Transfers and Non-Probate Property %Of Date of Death Decd' s Dascripticn Value of Asset Interest Exclusion Page 2 21-2004-00147 Taxable Value 8 Investment advisory fee rebate for the period coverin~ 01/01/2004 - 01/24/2004 frcm theEvergreenFunds 9 WachoviaBank, N.A. - Incc~ae and principal co~missions accrued to 01/24/2004 10 The following cashgiftsweremade to Janet G. Wolge~uthwithinone year of death: 08/21/2003 - 6,000.00 12/01/2003 - 3,000.00 11 The follcwin~ cash gifts were made to Joann Sider within one year of 08/21/2003 - 6,000.00 12/01/2003 - 3,000.00 12 The following cash gifts were made to Joyce Heisey within one year of 08/21/2003 - 6,000.00 12/01/2003 - 3,000.00 13 The follcwin~cashgiftsweremde to June Wolg~thwithinoneyear of death: 08/21/2003 ~ 6,000.00 12/01/2003 - 3,000.00 9,000.00 100% 3,000.00 9,000.00 100% 3,000.00 9,000.00 100% 3,000.00 9,000.00 100% 3,000.00 181.18 (358.29) 6,000.00 6,000.00 6,000.00 6,000.00 TOTAL.(C~rry foIward to main schedule) ...... 23,822.89 Estate of: Orpha G. Wolgemuth S~ G -- Inter-Vivos Transfers and Non-Probate Property Item No. Description %Of Date of Death Decd's Value of Asset Interest Page 3 21-2004-00147 Taxable Value 14 The followingcashgiftwasmade to Dwight Wolge~uthwithinoneyearof 08/21/2003 - 6,000.00 For Informational Purposes - On 12/01/2003 a checkwas issued to Dwight Wolge~uthintheammunt of 3,000.00. Since this check was not redeemed until 02/24/2004, after date of death, thiswasnot a completed gift, thus, the 3,000.00 w~s J_n~ludedaspart of the date of death balance of the decedent's WachoviaCheckin~account. 15 For Informational Purposes Only At time of death the decedent was the sole beneficiary under the Abner M. Wolge~uth (pre-deceased spouse) Residuary Trust Agreement. (Account # 1519186200) All of her interests in this trust terminated upon death, thus, this is being disclosed for informaticrk3l purposes only. (Copy of Trust /kgreemmnt enclosed) 6,000.00 100% 3,000.00 3,000.00 0.00 TOTAL. (Carry forward to main schedule) ...... 3,000.00 REV-1511EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Orpha G. Wol~emuth 21-2004-00147 Debts of decedent must be reported on Schedule I. ITEM NO. DESCRIPTION A. FUNERAL EXPENSES: 1 Nissley Funeral Hom~, Ltd. - ProfessiQnal services B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Pemonal Representative(s) Wachovia Bank, N.A. Social Security Number(s)/EIN No. of Personal Representative(s) Sffest Address City State Zip Year(s) Commission Paid: 2. Attorney Fees Nam~: Carl R. F,c-~-Li~_, F. squ~re 3. Family Exemption: (If desedent's address is not the same as claimant's, attach explarmtion) Claimant Street Address City State Zip Relationship of Claimant t~ Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Rotum Preparers Fees 7 The Patriot News - Legal advertisin9 e~ 8 Cumberland Law Journal - Legal advertising e~pense TOTAL (PJso enter on line 9, Recapitulation) $ AMOUNT 9,384.00 13,625.00 7,000.00 0.00 74.00 0.00 0.00 138.73 75.00 30,296.73 7 CPA11 NTF ]0911 (If mere space is needed, insert additional sheets of the same size) · . _ STATEMENT JANUARY 31,2004- ORPHA G. WOLGEMUTH, ESTATE %GEORGE GEORGE,P.O. BOX 3959, WACHOVIA BANK, LANCASTER,PA. 17604 C/ss qeunera£7 ome, £ 228 E. MAIN ST., MOUNT JOY, PA 17552 (717) 653-1151 TRADITIONAL FUNERAL SERVICE WITH ONE & HALF HOUR PRiOR VISITATION $3,316.00 SOLID OAK FULL COACH CASKET WITH BLANKET 2,797.00 CONCRETE TOP SEAL EAGLE SEVILLE VAULT 1,495.00 MEMORIAL BOOK & MEMORY FOLDERS 135.00 FOOTRINT LAMINATIONS 30.00 CLASSIFIED FUNERAL NOTICES 80.00 CLERGY HONORARIUM'S 300.00 ORGANIST & PAINIST HONORARiUMS 150.00 CERTIFIED COPIES OF THE DEATH CERTIFICATE 24.00 CASKET SPRAY PLUS TAX 212.00 STONE LEITERING 150.00 HAIR DRESSER 45.00 OPENING & CLOSING OF THE GRAVE 475.00 RENTAL OF CEMETERY EQUIPMENT PLUS SNOW REMOVAL 175.00 TOTAL DUE $ 9,384.00 REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES,& LIENS ESTATE OF FILE NUMBER Orpha G. Wolgemuth 21-2004-00147 Include unreimbursed medica~ expenses. DESCRIPTION AMOUNT ITEM NO. 2 3 5 6 7 8 AT&T - Balance due for lc~g distance telephcne charges frc~ October 2003 - January 2004 Verizon - Balance due for telephone services Phazmerica - Balance due for prescription purchases f~uL~ 01/19/04 - 01/23/04 Messiah Village - Balance ~e for rocm and board services Paul D. E~lhey, ~D - Balance due for medical services Hess and Hess - Balance due for preparation of decedent's 2003 incc~m tax returns United States Treasury - Balance due for the decedent's 2003 Federal Incc~m Tax liability, per return filed Internists of Central PA - Balance due for medical services TOTAL (PJso enter on line 10, Recapitulation) 65.31 8.22 523.62 4,873.00 32.00 260.00 39.00 29.22 5,830.37 7 CPA12 NTF ~0912 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Orpha G. Wolge~uth 21-2004-00147 RELATIONSHIP TO DECEDENT AMOUNT OR No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Est Trustee(s) SHARE OF ESTATE TAXABLE DISTRIBUTIONS (i~lude oub'[ght spousal distribut~3ns) 2 3 4 5 I1. Janet G. Wolge~uth 2436 Meredith Street Philadelphia, PA 19130-2522 Joann Sider 654 ~nter's T~e Lewisberry, PA 17339 Joyce Heisey 523 N. Strickler Road Manheim, PA 17545 June Wolge~uth 13320 S.W. 95th Avenue Miami, FL 33176 Dwight L. Wolge~uth 721 Kraybill C~urch Road Mount Joy, PA 17552-9111 Daughter Daughter Daughter Dau3hter 132,315.76 130,955.20 130,955.20 130,955.20 127,955.20 ENTER DOLLAR AM'TS, FOR DISTRIBS, SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS None TOTAL OF PART ii .. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00 7 CPA13 NTF 10913 (If more space is needed, insert additional sheets of the same size) Copyright For~ Software Only, 1997 Nelco, inc. Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Orpha G. Wolgemuth No. 21-04-00147 also known as , Date of Death 1/24/04 ,Deceased Social Secudty No. 203-36-2570 personal Repreaentative(s) of the above Estate, deceased, vedty that the items appeaflng in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventopj represents its fair value as of the date of the Decedent's death, and that Decedent owned no reel estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/INe verify that the statements reade in this inventory are true and correct, i/We understand that false statements herein reade subject to the penalties of 18 Pa. C.S. Section 4904 relating to unswore falsification to authorities. Name of Attorney: Cad R. Hallgren, Esquire I.D. No.: 06952 Address: Mo~lan, Hallgren, Crosswell & Kane, P.C. 700 North Duke Street Lancaster, PA 17604 Personal Representative: Wacho~a Bank, N~ Executor ~' ~Kim F Garrett, Trust Officer Telephone: 717-299-5251 See Attached Schedule Description Total $13,514.06 Value (Attach Additional Sheets if necessary) Note: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the include the value of each item, but such figures should not be extended into the total of the Inventory. personal representative, Sworn to and subscribed before me this__5th__ day of October Notary Public Notarial Seal Rose M. Uebl, Notary Public Lancaster, Lancaster County My Corereission Expires Jan. 29, 2005 Member, PennsylVania Association ot Notaries A.D, 2004 FILE NUMBER: 21-04-0147 INVENTORY FOR THE ESTATE OF Orpha G. Wolgemuth Who Died on Januar3t 24, 2004 Cash Wachovia Bank, NA Checking Account Number 1000390124569 9,767.31 GE Capital Nursing Home Insurance Policy# PFN7767098 Payment Coverage til 1/24/04 2,550.00 Miscellaneous Pennsylvania Department of Revenue 2003 Individual Income Tax Refund 218.00 AARP Health Care Options Premium Refund 978.75 Total $ 13,514.06 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-IE47 EX &FP FRED S BACHMAN '04, L~CT 13 WACHOVIA BANK NA lZ:3 S BROAD ST :~ PHILA ~{A:'iT~A 19109: ORPHA G DATE 10-11-200q ESTATE OF WOLGEMUTH DATE OF DEATH 01-2q-ZOOq FILE NUMBER 210q-Olq7 COUNTY CUMBERLAND ACN 101 Amount RaeLtted HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THZS LZNE ~'* RETAZN LOgER PORTZON FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAZSEMENT, ALLOHANCE OR DISALLOWANCE OF DEDUCTZONS AND ASSESSMENT OF TAX ESTATE OF WOLGEMUTH ORPHA GFZLE NO. 21 04-0147 ACN 101 DATE 10-11-2004 TAX RETURN NAS: (X) ACCEPTED AS FTLED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks end Bonds (Schedule B) (2) $. Closely Held Stock/Partnership Interest (Schedule C) ($) ~. Mortgages/Notes Receivable (Schedule D) (~) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expansas/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Dabts/Hortgage Liabilities/Liens (Schedule ~) (10) 11. Total Deductions 12. Not Value of Tax Re~urn O0 O0 O0 O0 13~514.06 1~$60.55 674~$89 05 (8) $0,296.75 5~850.$7 (11) (12) 13. NOTE: Charitable/Governmental Bequests; Non-elected 911:3 Trusts (Schedule J) (13) Net Value of Estate Sub,~oct to Tax (lq) :Zf an assessment .as lssued previously, llnes 1~, 15 and/or 16, 17, reflect f/gures that lnclude the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line lq at Spousal rate 16. Amount of Line lq ~axable at Lineal/Class A rate 17. Amount of Line lq at Sibling rata 18. Amount of Line 1~ taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: ! PAYNENT KECE/PT DISCOUNT (+) DATE NUNBER INTEREST/PEN PAZD (-) 04-22-2004 CD005857 1,440.00 07-30-2004 CD004220 .00 NOTE: To insure proper credit to your account, submi~ the upper portion of this form with your tax payment. 689,263.66 36.127.10 653,156.56 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .00 653,1~6.56 18 and 19 will (15) .00 x O0 : .00 (16) 655,156.56 x 045= 29,$91.15 (17) .00 x 12 = .00 (18) .00 x 15 = .00 (19)= Z9,~91.15 AMOUNT PAID 27,360.00 591.15 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 29,391.15 .00 .00 .00 ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT 1S RE;)UZRED. A REFUND. SEE REVERSE SI'DE OF TH'rS FORM FOR TNSTRUCTTONS. ' RESERVATION: Estates of decedents dying on or before December II, 19DZ -- if any future interest in the estate is transferred in possession or enjoyment to Class D (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collatara1) rate on any such future interest. PURPOSE OF NOTICE: PAYMENT: REFUND (CA): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (?Z P.S. Section 91q0). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Hills, any of the 23 Revenue District Offices, or by calling the special Iq-hour answering service for forms ordering: 1-800-36Z-2080; services for taxpayers with special hearing and / or speaking needs: 1-800-q~7-30ZO (TT only). Any party in interest not satisfied aith the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object aithin sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 2DIOZ1, Harrisburg, PA 171ZD-lOZ1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should bm addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6508. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (EX) discount of the tax paid is allowed. The 15X tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6X) percent par annum calculated at a daily rate of .00016~. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 19Di through ZOOq are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20X .0005q8 ~'~'&-1991 1lX .000301 ~ 9Z .O00Zq7 1983 16Z .OOOq38 199Z 9Z .0002~7 ZOO2 6X .00016q 198q llZ .000301 199~-199~ 7Z .OOO19Z ZOO3 SZ .OOOl3? 1985 ISZ .000356 1995-1998 9Z .O00Z~7 ZOO~ qX .000110 1986 10~ .O00ZT~ 1999 7Z .O0019Z 1987 lOX .O00Z?q ZOO0 7X .O0019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAIL¥ INTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. 22-41860 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN THE ESTATE OF: ) ) ) ) ) , ~::;:" ;::,~ ORPHA G. WOLGEMUTH, DECEASED LATE OF LOWER ALLEN TOWNSHIP CUMBERLAND COUNTY, PENNSYLVANIA NO. 21-04-0147 Q ",0 ",.-.:J )~I-:J \.....rG -~:]~gi ,-..> C? ~.:..~ ~1 f') 0-' '-, '-0 :::';-1 :1':': STATEMENT RELEASE r~....) C,) ~ ::""l"'l KNOW ALL MEN BY THESE PRESENTS, that W achoviaBank, N.A, Trustee under Trust Agreement dated June 2, 1993 between Orpha G. Wolgemuth and Hamilton Bank (now by succession of mergers, consolidations and name changes, WachoviaBank, N.A), Trustee, being the beneficiary of the residue of the Estate ofOrpha G. Wolgemuth under paragraph FOURTH of her Last Will and Testament acknowledges that the only assets in the Estate ofOrpha G. Wolgemuth were a checking account and certain refunds having a total value of Thirteen Thousand Five Hundred Fourteen Dollars and Six Cents ($13,514.06), all of which have been reduced to cash. Wachovia Bank, N.A, Trustee, hereby states that all of the expenses ofthe Estate were paid by the Trust as authorized by the Trust Agreement. Wachovia Bank, N.A. Trustee, has combined the assets received from Wachovia Bank, Executor, for the purpose of making ultimate distribution to the children of Orpha G. Wolgemuth. Wachovia Bank, N.A. hereby ackuowledges receipt of the probate assets of cash in the amount of Thirteen Thousand Five Hundred Fourteen Dollars and Six Cents ($13,514.06) from Wachovia Bank, N.A, Executor, and hereby discharges Wachovia Bank, N.A, Executor of the Estate ofOrpha G. Wolgemuth, deceased, from its duties as Executor. .J 2005. Wachovia Bank, N.A. has executed this Statement Release this J.:/!!ldayof JC.r1'-'O.V 0-' by: OVIA BANK, N.A. ~ .:- / c>tl- . f"lb1 of.h o represents that he or she is authorized to sign this Statement Release on behalf of Wachovia Bank, N.A. 1;irYI E Go.mit Print Name r . Ie., "'-\ O\-C. U>.-y Title 2 22-41860 RECEIPT AND RELEASE FOR PARTIAL DISTRIBUTION IN RE: TRUST UNDER TRUST AGREEMENT DATED JUNE 2, 1993 BETWEEN ORPHA G. WOLGEMUTH AND HAMILTON BANK (NOW BY SUCCESSION OF MERGERS, CONSOLIDATIONS AND NAME CHANGES, W ACHOVIA BANK, N.A.), TRUSTEE WHEREAS, Orpha G. Wolgemuth (hereinafter referred to as the "Decedent") executed a Trust Agreement dated June 2, 1993 wherein she appointed Hamilton Bank (now by succession of mergers, consolidations and name changes, Wachovia Bank, N.A.), (hereinafter referred to as the "Trustee"); and WHEREAS, the Trust was for the benefit of the Decedent during her life and upon her death, for the benefit of the Decedent's husband, Abner M. Wolgemuth for life, and upon his death, provided for distribution to his children in equal shares; and WHEREAS, Abner M. Wolgemuth predeceased the Decedent, having died on February 17, 1994, and the Decedent died on January 24,2004, whereupon the remaining assets of the Trust are to be distributed to the Decedent's children in equal shares; and WHEREAS, the Decedent has five children, all of whom are living, namely, JANET G. WOLGEMUTH, JOANN SIDER, JOYCE HEISEY, JUNE C. WOLGEMUTH and DWIGHT L. WOLGEMUTH, ; and WHEREAS, the Trustee is currently engaged in the process of settling the Trust for the purpose of ultimately making final distribution to the beneficiaries; and WHEREAS, the Trustee is wiIJing to make a partial distribution of the Trust assets in the amount of Eighty Thousand DoIlars and 00/100 Cents ($80,000.00) cash to each of the five beneficiaries after the execution of a Receipt and Release For Partial Distribution from each beneficiary. KNOW ALL MEN BY THESE PRESENTS that we, Janet G. Wolgemuth, Joann Sider, Joyce Heisey, June C. Wolgemuth and Dwight L. Wolgemuth, acknowledge and agree that upon receipt from the Trustee of a check in the amount of Eighty Thousand DoIlars and 00/1 00 Cents ($80,000.00) by each of us, that negotiation of such check by each of us shall constitute receipt of payment of the aforesaid partial distribution. We agree to the amount ofthe partial distribution and we waive our right to have an account adjudicated by the Orphans' Court of Lancaster County. .22-41860 IN RE: TRUST UNDER TRUST AGREEMENT DATED JUNE 2, 1993 BETWEEN ORPHA G. WOLGEMUTH AND HAMIL TON BANK (NOW BY SUCCESSION OF MERGERS, CONSOLIDATIONS AND NAME CHANGES, W ACHOVIA BANK, N.A.), TRUSTEE SEPARATE SIGNATURE PAGE The undersigned has reviewed and approved the foregoing Receipt and Release for Partial Distribution of the Trust between Orpha G. Wolgemuth and Hamilton Bank (now by succession of mergers, consolidations and name changes, Wachovia Bank, N.A.), Trustee, attached hereto and executes this Separate Signature Page intending to be legally bound. Executed this d. N'-J day of ~~ ' 2004. (SEAL) . .. 22.41860 IN RE: TRUST UNDER TRUST AGREEMENT DATED JUNE 2, 1993 BETWEEN ORPHA G. WOLGEMUTH AND HAMILTON BANK (NOW BY SUCCESSION OF MERGERS, CONSOLIDA nONS AND NAME CHANGES, W ACHOVIA BANK, NA), TRUSTEE SEPARATE SIGNATURE PAGE The undersigned has reviewed and approved the foregoing Receipt and Release for Partial Distribution ofthe Trust between Orpha G. Wolgemuth and Hamilton Bank (now by succession of mergers, consolidations and name changes, Wachovia Bank, N.A), Trustee, attached hereto and executes this Separate Signature Page intending to be legally bound. Executed this 3),i day of ~1 ,2004. ~. ~. , ~-- / JOANN SIDER (SEAL) 22-41860 IN RE: TRUST UNDER TRUST AGREEMENT DATED JUNE 2, 1993 BETWEEN ORPHA G. WOLGEMUTH AND HAMILTON BANK (NOW BY SUCCESSION OF MERGERS, CONSOLIDATIONS AND NAME CHANGES, W ACHOVIA BANK, NA), TRUSTEE SEPARATE SIGNATURE PAGE The undersigned has reviewed and approved the foregoing Receipt and Release for Partial Distribution of the Trust between Orpha G. Wolgemuth and Hamilton Bank (now by succession of mergers, consolidations and name changes, Wachovia Bank, N.A.), Trustee, attached hereto and executes this Separate Signature Page intending to be legally bound. Executed this S#, dayof ~ ,2004. ~,.~~ ~ JOY E HEISEY (SEAL) 22-41860 , . . IN RE: TRUST UNDER TRUST AGREEMENT DATED JUNE 2, 1993 BETWEEN ORPHA G. WOLGEMUTH AND HAMILTON BANK (NOW BY SUCCESSION OF MERGERS, CONSOLIDATIONS AND NAME CHANGES, W ACHOVIA BANK., N.A.), TRUSTEE SEPARATE SIGNATURE PAGE The undersigned has reviewed and approved the foregoing Receipt and Release for Partial Distribution of the Trust between Orpha G. Wolgemuth and Hamilton Bank (now by succession of mergers, consolidations and name changes, Wachovia Bank, N.A.), Trustee, attached hereto and executes this Separate Signature Page intending to be legally bound. Executed this 1- Y day of .4 0-Ju <:>T ,2004. ~.. (J, lL/1:f6JHull JUNE C. WO EMUTH (SEAL) 22-41860 IN RE: TRUST UNDER TRUST AGREEMENT DATED JUNE 2, 1993 BETWEEN ORPHA G_ WOLGEMUTH AND HAMILTON BANK (NOW BY SUCCESSION OF MERGERS, CONSOLIDATIONS AND NAME CHANGES, W ACHOVIA BANK, NA), TRUSTEE SEPARATE SIGNATURE PAGE The undersigned has reviewed and approved the foregoing Receipt and Release for Partial Distribution of the Trust between Orpha G. Wolgemuth and Hamilton Bank (now by succession of mergers, consolidations and name changes, Wachovia Bank, N.A.), Trustee, attached hereto and executes this Separate Signature Page intending to be legally bound. Executed this b day of ~, 2004. ~~WEMUTH (SEAL) 22-41860 IN RE: TRUST UNDER TRUST AGREEMENT DATED JUNE 2, 1993 BETWEEN ORPHA G. WOLGEMUTH AND HAMILTON BANK (NOW BY SUCCESSION OF MERGERS, CONSOLIDATIONS AND NAME CHANGES, W ACHOVIA BANK, N.A.), TRUSTEE RECEIPT AND RELEASE FOR FINAL DISTRIBUTION WHEREAS, Orpha G. Wolgemuth (hereinafter referred to as the "Decedent") executed a Trust Agreement dated June 2, 1993 wherein she appointed Hamilton Bank (now by succession of mergers, consolidations and name changes, Wachovia Bank, N.A.), Trustee (hereinafter referred to as the "Trustee"); and WHEREAS, the Trust was for the benefit ofthe Decedent during her life and upon her death, for the benefit of the Decedent's husband, Abner M. Wolgemuth for life, and upon his death, provided for distribution to his children in equal shares; and WHEREAS, Abner M. Wolgemuth predeceased the Decedent, having died on February 17, 1994, and the Decedent died on January 24,2004, whereupon the remaining assets of the Trust are to be distributed to the Decedent's children in equal shares; and WHEREAS, the Decedent owned assets having a value of Thirteen Thousand Five Hundred Fourteen Dollars and Six Cents ($13,514.06) comprised of a checking account and various refunds which assets were subject to probate in the Office of the Register of Wills in and for Cumberland County, Pennsylvania by Wachovia Bank, N.A. as Executor of the Decedent's Last Will and Testament dated June 2,1993; and WHEREAS, the Decedent's Last Will and Testament provided in paragraph FOURTH thereof that her assets be distributed to Wachovia Bank, N.A. as Trustee in accordance with the terms of the Trust Agreement; and WHEREAS, Wachovia Bank, N.A. has combined the assets of the Decedent's Estate with those of the Trust for the purpose of distribution; and WHEREAS, the Decedent has five children, all of whom are living, namely, JANET G. WOLGEMUTH, JOANN SIDER, JOYCE HEISEY, JUNE C. WOLGEMUTH and DWIGHT L. WOLGEMUTH; WHEREAS, the Trustee had made partial distribution of the Trust assets in the amount of Eighty Thousand Dollars and 00/100 Cents ($80,00000) cash to each of the five beneficiaries (the Decedent's children, named above) who also executed a Receipt and Release for Partial Distribution in July, 2004; and WHEREAS, the Trustee is currently engaged in the process of settling the Trust for the purpose of making final distribution to the beneficiaries; and WHEREAS, the beneficiaries have been receiving monthly account statements from the Trustee which state that all of the assets are invested in Money Market Funds which earn monthly interest; and WHEREAS, the beneficiaries do not believe that it is necessary to prepare a formal accounting of all ofthe transactions ofthe Trustee. KNOW ALL MEN BY THESE PRESENTS, that we, Janet G. Wolgemuth, Joann Sider, Joyce Heisey, June C. Wolgemuth and Dwight L. Wolgemuth, acknowledge and agree that upon execution ofthis Receipt and Release by all of us, we shall receive from the Trustee the balance of our distributive share as shown on the Proposed Schedule of Distribution attached hereto and marked Exhibit "A". We also acknowledge that each of us shall receive one-fifth (1/5) ofthe balance of the reserve for closing in the amount of Five Hundred Dollars and 00/1 00 ($500.00) after payment of expenses, such as additional filing fees, photocopies and postage therefrom. This Receipt and Release shall also cover the subsequent payments from said reserve account. We waive our right to have an account adjudicated by any court having jurisdiction. We also waive our right to have an accounting of all of the transactions of the Trustee prepared by the Trustee and delivered to us. And now, therefore, we, by these presents, remise, release, quitclaim and forever discharge the Trustee and its successors and assigns, of and from the money distributed from the Trust and from all actions, reckonings, claims and demands whatsoever for or by reason thereof, and of and from every other act, matter, cause or thing touching or covering the same. And we, and each of us, agree that we at all times in the future and whenever necessary, appropriate or convenient, shall make, execute and deliver to the said Trustee and/or to the other party or parties, any and all instruments, documents, conveyances, deeds, releases, or other instruments of any kind necessary or convenient to carry out the intention ofthis Receipt and Release 2 and/or to permit, assist and enable the Trustee to fulfill its duties with reference to the said Trust and all of the assets thereof. And we, and each of us, in consideration of the distribution as aforesaid, hereby agree to indemnify and hold harmless the Trustee, and its successors and assigns, from and against any and all claims, loss, liability or damages which it may suffer or to which it may be subjected (including all tax liability and including liability, loss and expense resulting from its own negligence) to the extent that monies and/or property or anything of value has been or will be received by us as a result of such negligence; and we do further declare it to be our intention to be legally bound by the execution of this instrument. We have hereunto executed this Receipt and Release for Final Distribution on Separate Signature Pages which are incorporated herein as of the dates set forth therein. 3 .' 22-41860 EXHIBIT "A" IN RE: TRUST UNDER TRUST AGREEMENT DATED JUNE 2, 1993 BETWEEN ORPHA G. WOLGEMUTH AND HAMILTON BANK (NOW BY SUCCESSION OF MERGERS, CONSOLIDATIONS AND NAME CHANGES, W ACHOVIA BANK, N.A.), TRUSTEE SCHEDULE OF DISTRIBUTION OF THE ORPHA WOLGEMUTH TRUST/ESTATE Principal Balance as of December I, 2004 Pending Disbursements: Balance ofWachovia Executor's Commission Balance of Morgan, Hallgren, Crosswell & Kane, P.C. counsel fee Reimbursement to Morgan, Hallgren, Crosswell Kane, P.C. for expenses Reserve for Closing Amount Available for Final Distribution: $ 211,673.84 $ 9,309.00 4,667.00 29.90 500.00 14,505.90 $ 197,167.94 Final Distribution: Janet G. Wolgemuth June C. Wolgemuth Dwight L. Wolgemuth Joyce Heisey Joann Sider Amount of Final Distribution: $ 39,433.59 39,433.59 39,433.59 39,433.59 39.433.58 $ 197.167.94 22-4] 860 IN RE: TRUST UNDER TRUST AGREEMENT DATED JUNE 2, 1993 BETWEEN ORPHA G. WOLGEMUTH AND HAMILTON BANK (NOW BY SUCCESSION OF MERGERS, CONSOLIDA TrONS AND NAME CHANGES, W ACHOVIA BANK, N.A.), TRUSTEE SEPARATE SIGNATURE PAGE The undersigned has reviewed and approved the foregoing Receipt and Release for Final Distribution and Schedule of Distribution of the Orpha Wolgemuth Trust/Estate, all of which are attached hereto and executes this Separate Signature Page intending to be legally bound. Executed this HeeL day of I 0 ,2005. /; , , Cf ,~, ,t fJ 'fftf,,,.,,,,u-t / JANET G. WOLGE j H .. 22-41860 IN RE: TRUST UNDER TRUST AGREEMENT DATED JUNE 2, 1993 BETWEEN ORPHA G. WOLGEMUTH AND HAMILTON BANK (NOW BY SUCCESSION OF MERGERS, CONSOLIDA nONS AND NAME CHANGES, W ACHOVlA BANK, N.A.), TRUSTEE SEPARATE SIGNATURE PAGE The undersigned has reviewed and approved the foregoing Receipt and Release for Final Distribution and Schedule of Distribution of the Orpha Wolgemuth Trust/Estate, all of which are attached hereto and executes this Separate Signature Page intending to be legally bound. (7~ r'\ Executed this)! day of /~~ ,2005. (-I ~- \..,$a-1Ut/, i .~ , () JOANN SIDER 22-41860 IN RE: TRUST UNDER TRUST AGREEMENT DATED JUNE 2, 1993 BETWEEN ORPHA G. WOLGEMUTH AND HAMILTON BANK (NOW BY SUCCESSION OF MERGERS, CONSOLIDA nONS AND NAME CHANGES, W ACHOVIA BANK, N.A.), TRUSTEE SEPARATE SIGNATURE PAGE The undersigned has reviewed and approved the foregoing Receipt and Release for Final Distribution and Schedule of Distribution of the Orpha Wolgemuth Trust/Estate, all of which are attached hereto and executes this Separate Signature Page intending to be legally bound. Executed this q-tJ, day of ?-tUU-O' 2005. ~C<-J;1- · "l . JOYCE HEISE . 22-41860 IN RE: TRUST UNDER TRUST AGREEMENT DATED JUNE 2, 1993 BETWEEN ORPHA G. WOLGEMUTH AND HAMILTON BANK (NOW BY SUCCESSION OF MERGERS, CONSOLIDA TrONS AND NAME CHANGES, W ACHOVIA BANK, N.A.), TRUSTEE SEPARATE SIGNATURE PAGE The undersigned has reviewed and approved the foregoing Receipt and Release for Final Distribution and Schedule of Distribution of the Orpha Wolgemuth Trust/Estate, all of which are attached hereto and executes this Separate Signature Page intending to be legally bound. Executed this j-fh.. day of Jo-7tlL<Ll'j' 2005. ~ iJ ~~ JUNE C. W GEMUTH ., ~"N 1 n ?no,,]! ,J k ,... .Y n" -.,> J,.~} 2~-41860 IN RE: TRUST UNDER TRUST AGREEMENT DATED JUNE 2, 1993 BETWEEN ORPHA G. WOLGEMUTH AND HAMILTON BANK (NOW BY SUCCESSION OF MERGERS, CONSOLIDATIONS AND NAME CHANGES, W ACHOVIA BANK, N.A.), TRUSTEE SEPARATE SIGNATURE PAGE The undersigned has reviewed and approved the foregoing Receipt and Release for Final Distribution and Schedule of Distribution of the Orpha Wolgemuth Trust/Estate, aU of which are attached hereto and executes this Separate Signature Page intending to be legaUy bound. Executed this day of ,2005. {Jtw-d DWIGHT L. WOLGEMUTH u_ ,--""-, ~-' U"l en) ~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: Oroha G. Wolgemuth Date of Death: January 24.2004 21-04-0147 Estate Number 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: Date: Yes -1L- No 1. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 2. 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--1L- B. Did the personal representative state an account informally to the parties in interest? Yes---X- No C. Did the personal representative file approvals of the account, receipts, joinders and releases with the Orphans' Court? Yes --1L- No. D. Did the personal representative complete final distribution: Yes~ No. January 24.2005 Si,"""~ C~) ('",J Carl R. Hallgren Name (Please type or print) 0.... L~__ C) UJ '" t~Z; :....~ ,::~'",; o:J:=' n c~: 0". Co (717)299-5251 Telephone Number _ Personal Representative P.O. Box 4686. Lancaster. PA Address ) .. ,..~ .,...,.~ -3 ~ (;,:".;, C:::.:J <-./ Capacity: --1L- Counsel for personal representative