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HomeMy WebLinkAbout03-0735PETITION FOR PROBATE and GRANT OF LETTERS al, so known as ~ laror~ 0 t ~ ho.r+ Deceased. Social Security No. / ~ q - 3 ~" ~ / ~- I No. 2/-03-¢'735 To: Register of Wills for the County of ~ctm-bq rlO~r~d. Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 1 8 years of age or older an the execut Q01.co I in the last will of the above decedent, dated ,~ ~ r~ u O_r c/ ~j ~00,-~ and codicil(s) dated in the g, ~oode (4named ,~t~x.~ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in 0cc rs-ID t c- { O r~c~ County, Permsylvania, v0th h 15 last family or principal residence at 3lb ~oso~ .c,¢.ood ~ , C.;fio lo, l~¢c / (list street, number and muncipality) Decendent~[hen S,~ .years of age, died ~ ]Qcccl I),~.'(" C~¢'¢/ ¢t~Ct~ 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: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: i3 It~ '/")'~osa ~.Ooo,¢:,(. /,_art.o_,, cc, nO/o, ~ $ $ / 7o0~ C- WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA -/ COUNTY OF 0_.il Orl 1~ V___N'~ CPd4 D f ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed ,~before~me this ~ TI-{-ix, day ~r ~ ~ ~, I1/. tt~l ~~, Estate Of 0._.i.~x~C~ j~.k_~ou_t3er~:~ A-~ , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated ~"~ M~.Ooef~x4 ~ c~C'0 ~ described therein be admitted to probate and filed of record as the last will of ~~C~ ~ · ~d Letters '~E~T~ ~EN~ ~e hereby granted to ~k ~M~0L~ , in consideration of the petition on FEES Probate, Letters, Etc .......... Short Certificates(ID) ...' ....... ....... s TOTAL Filed . ~'. 6.,. ~ ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE E'AEC ~T~I ~ his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 No. Local Registrar ~'/ [)ate ;43 Rev 2/87 COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH ,. Clarence A. AGE (LaM B~ay) I, UNDER 1 YEAR I 52 w,. ~ Cumberland ~ ~ m:~ing me; ~ l~x use ~'~e:l } uata ease AnnaList 318 Rosewood Lane ~Enola, PA 17025 ISEX I'~X~IAL S~CURITY NUM6ER JDAT E OF D~ATH t Mom~. Oa¥. '*'e~j Souders ,.Male ~. 169- 38-- 6151 ~. August 9, 2003 ; ,3/26/51 J, McConnellsburg ,~,~ e~,,.~ ~ ~ ~ ~ ~,~ a~ Eas: ~ennsbo~o I. 318 ~ose~ood Lane ' "' , · I.~-'~" I,.. ~ite I,~echanicsburg ~avy I ~ ~ I~~1 ~ ~ I,,. I,,. I4 { 5, i,.Married ,,. Carol Stailey ~c~m's PA ~u~ ,..~ ~ ,~..~.~ East Pennsboro ~ ,m.~ Cumberland ~' 1,,.~ ~~ C~i~ Gu- S 0 ~ 1 rl m 'r' e IMOTHER'$ NAM~ (F~a. M~Ie. Ma,~le~ ~) ,L ~ ..... I,e Eleanor Hoover ~. - ......... J~ 318 Rosewood Lane Enola, PA 17025 "~ [,,~ August 14, 2003 ~,,c Enola Cemetery La Enola PA 17025 ~/~/~~./~~ ]m -012774-L ~Rxchardson F.H. 29 S. Enola Dr. Enola PA 17025 k 3.45 Aa ~august 9, 2003 *.D m ,/ DATE FILED(Mor~ oay. Yea~) LAST WILL AND TESTAMENT OF CLARENCE A. SOUDERS I, Clarence A. Souders, of Enola, Pennsylvania, revoke my former Wills acrid Codicils and declare this to be my Last Will and Testament. ARTICLE I IDENTIFICATION OF FAMILY I am married to Carol Ann Souders and all references in this Will to "my spouse" are references to Carol Ann Souders. The names of my children are Michelle B. Souders and Karen A. Souders. All references in this Will to "my children" are references to the above-named children. ARTICLE II PAYMENT OF DEBTS AND EXPENSES I direct that my just debts, funeral expenses, and expenses of last iliness be first paid fi.om the joint accounts help by my wife Carol and I. ARTICLE III DISPOSITION OF PROPERTY I give, devise and bequeath to my wife Carol Ann Souders for the duration and term of her natural life the property that I own at 318 Rosewood Lane, Enola Pa. Cumberland County to have the use of during the term of her natural life on the condition that she keep the property in repair and pay the taxes and insurance thereon and at her death I give, devise and bequeath said property equally to my children Michelle B. Souders and Karen A. Souders. My children may live in the property with my wife, however, if they are finished with their education and have a job they must contribute to the expenses. If either daughter should die before my wife Carol the remaining daughter is to receive the entire property. I give, devise and bequeath all stock in any company which I own and are registered in my name, the name of my first wife Sheila B. Souders, or my name and Sheila B. Souders be devided equally between my children Michelle B. Souders and Karen A. Souders. I give, devise and bequeath all United States Saving Bonds I own and are registered in my name, the name of my first wife Sheila B. Souders, or my name and Sheila B. Souders be devided equally between my children Michelle B. Souders and Karen A. Souders All joint accounts with my wife Carol are to become her property. All contents of the property at 318 Rosewood Lane Enola Pa. Cumberland County are the joint property of my wife Carol and I and to be her property. Let it be known that all the jewelry located in the safety deposit boxes which I have access to is the property of my daughters and it is stored in the safety deposit boxes until they become of age or have a need to have their own safe deposit boxes. ARTICLE IV NOMINATION OF GUARDIAN Should it become necessary to appoint a guardian of the person of a minor child, I nominate Carol Ann Souders, of Enola, Pennsylvania, to serve as the Guardian of my surviving children who are minors at the time of my death. If such person is unable to serve as Guardian, I nominate Francis Anthony, of Harrisburg, Pennsylvania, to serve as the Guardian. ARTICLE V NOMINATION OF EXECUTOR I nominate Carol Ann Souders, of Enola, Pennsylvania, as the Executor, without bond or security. If such person or entity does not serve for any reason, I nominate Michelle B. Souders, of Enola, Pennsylvania, to be the Executor, without bond or security. ARTICLE VI EXECUTOR AND TRUSTEE POWERS My Executor, with respect to my estate, and my Trustee with respect to my trust, in addition to other powers and authority granted by law or necessary or appropriate for proper administration, shall have the following rights, powers, and authority without order of court and without notice to anyone: 1. Receive Assets. To receive, hold, maintain, administer, collect, invest and re-invest the estate and trust assets, and collect and apply the income, profits, and principal of the estate and lxust in accordance with the terms of this instrument. 2. Receive Additional Assets. To receive additional assets from other sources, including assets received under the Wills of other persons. 3. Standard of Care. To acquire, invest, reinvest, exchange, retain, sell, and manage estate and trust assets, exercising the judgment and care, under the circumstances then prevailing, that persons of prudence, discretion and intelligence exercise in the management of their own affairs, not in regard to speculation but in regard to the permanent disposition of their funds, considering the probable income as well as the probable safety of their capital. Within the limitations of that standard, the Executor and Trustee are authorized to acquire and retain every kind of property, real, personal or mixed, and every kind of investment, specifically including, but not by way of limitation, bonds, debentures and other corporate obligations, and stocks, preferred or common, that persons of prudence, discretion and intelligence acquire or retain for their own account, even though not otherwise a legal investment for trust funds under the laws and statutes of the United States or the state under which this instrument is administered. 4. Retain Assets. To retain any asset, including uninvested cash or original investments, regardless of whether it is of the kind authorized by this instrument for investment and whether it leaves a disproportionately large part of the estate or trust invested in one type of property, for as long as the Executor or Trustee deems advisable. 5. Dispose of or Encumber Assets. To sell, option, mortgage, pledge, lease or convey real or personal property, publicly or privately, upon such terms and conditions as may appear to be proper, and to execute all insmunents necessary to effect such authority. 6. Settle Claims. To compromise, settle, or abandon claims in favor of or against the estate or trust. 7. Manage Property. To manage real estate and personal property, borrow money, exercise options, buy insurance, and register securities as may appear to be proper. 8. Allocate Between Principal andlncome. To make allocations of charges and credits as between principal and income as in the sole discretion of the Executor or Trustee may appear to be proper. 9. Employ Professional Assistance. To employ and compensate counsel and other persons deemed necessary for proper administration and to delegate authority when such delegation is advantageous to the estate or trust. 10. Distribute Property. To make division or distribution in money or kind, or partly in either including disproportionate in-kind distributions, at values to be determined by the Executor or Trustee, and the judgment of either in such respect shall be binding upon all interested parties. 11. Enter Contracts. To bind the estate or trust by contracts or agreements without assuming individual liability for such contracts. 12. Exercise Stock Ownership Rights. To vote, execute proxies to vote, join in or oppose any plans for reorganization, and exercise any other rights incident to the ownership of any stocks, bonds or other properties of the estate or trust. 13. Duration of Powers. To continue to exercise the powers provided in this Article notwithstanding the termination of the trust until all the assets of the trust have been distributed. 14. HoM Trust Assets as a Single Fund. To hold the assets of the trust, shares, or portions of the trust created by this instrument as a single fund for joint investment and management, without the need for physical segregation, dividing the income proportionately among them. Segregation of the various trust shares need only be made on the books oftbe Trustee for accounting purposes. 15. Loans to Beneficiaries. To make loans to any trust beneficiary for the purpose of providing the beneficiary with the funds necessary to take advantage of exceptional business opportunities or to provide for the needs of the beneficiaries and their families. 16. Methods of Distribution. To make payments to or for the benefit of any beneficiary (specifically including any beneficiary under any legal disability) in any of the following ways: (a) directly to the beneficiary, (b) directly for the maintenance, welfare and education of the beneficiary, (c) to the legal or natural guardian of the beneficiary, or (d) to anyone who at the time shall have custody and care of the person of the beneficiary. The Executor or Trustee shall not be obliged to see to the application of the funds so paid, but the receipt of the person to whom the funds were paid shall be full acquittance of the Executor or Trustee. 17. Informal Administration. My Executor shall have the right to administer my estate using "informal", "unsupervised", or "independent" probate or equivalent legislation designed to operate without unnecessary intervention by the probate court. ARTICLE VII MISCELLANEOUS PROVISIONS A. Paragraph TRies and Gender. The tries given to the paragraphs of this Will are inserted for reference purposes only and are not to be considered as forming a part of this Will in interpreting its provisions. All words used in this Will in any gender shall extend to and include all genders, and any singular words shall include the plural expression, and vice versa, specifically including "child" and "children", when the context or facts so require, and any pronouns shall be taken to refer to the person or persons intended regardless of gender or number. B. Thirty Day Survival Requirement. For the purposes of determining the appropriate distributions under this Will, no person or organization shall be deemed to have survived me unless such person or entity is also surviving on the thirtieth day after the date of my death. C. Liability of Fiduciary. No fiduciary who is a natural person shall, in the absence of fraudulent conduct or bad faith, be liable individually to any beneficiary of my estate or any trust estate, and my estate or the trust estate shall indemnify such natural person from any and all claims or expenses in connection with or arising out of that fiduciary's good faith actions or nonactions of the fiduciary, except for such actions or nonactions which constitute fraudulent conduct or bad faith. No successor trustee shall be obliged to inquire into or be in any way accountable for the previous administration of the trust property. D. Beneficiary_ Disputes. If any bequest requires that the bequest be distributed between or among two or more beneficiaries, the specific items of property comprising the respective shares shall be determined by such beneficiaries if they can agree, and if not, by my Executor. S WHEREOF, I have subscribed my name below, this , oo3 . day of Testator Signature: ~ c~ ~ Clarence A. Souders We, the undersigned, hereby certify that the above instrument, which consists of pages, including the page(s) which contain the witness signatures, was signed in our sight and presence by Clarence A. Souders (the "Testator"), who declared this instrument to be his/her Last Will and Testament and we, at the Testator's request and in the Testator's sight and presence, and in the sight and presence of each other, do hereby subscribe our names as witnesses on the date shown above. Witness Signature: Name: City: State: Wimess Signature: Name: City: State: PENNSYLVANIA Self-Proving Clause COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND I, Clarence A. Souders, the Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly and as my free and voluntary act for the purposes expressed in the instrument. Sworn to or aff'mned and acknowledged before me by Clarence A. Souders, the Testator, this ~r~ dayof ~,(~,~~ , ;~00~. Testator Signature ClarenceA. Souders Signature of officer Official capaciW of officer INOTARIAL SEAL ~ ROBERT L GILL, Nolary Public ! Easl Pennsboro Twp., Cumberland Co. { My Cnmmi~inn g~pir~.~ I~.v 10, (Seal) Member, Pennsylvania Association of Notaries AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as the Testator's Last Will; that the Testator signed willingly and executed it as the Testator's free and voluntary act for the purposes expressed in it; that each of us in the hearing and sight of the Testator signed the Will as a wimess; and that to the best of our knowledge the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by. ~d)F~ ~ and ..TYq Cc~t ~ £/g6 ¢ O.~Lrmc-.~ , wimesses, this , ~dayof Witness Signature: ~ ~..~ ~t~~.~ Name: ~tz~c~.~ (~ '--~"¼o.¢n...-~,,-~ City: ~n~ l~ S~te: ~a Signature Seal and official capacity of officer i"-:':: I~IOTAFItAL SEAL ROBERT L GILL, Nolary Public Easl Pennsboro Twp., Cumberland Co My Commission Expires May 19, 2005 ~.eml~.r, Pennsylvania Association ol No~aries CERTIFICATION OF NOTICE UNDER RULE 5.6(a) ~~ Admin. No. Date of Death: Will No. {~, ~' To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a)~f the ~)rphan~' Court ~ wa~..~_ served on or mailed to the following beneficiaries of the above-captioned estate on Name Address Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: ~.. .... , ~ . _ Signature Name Address ~.~/~} Capacity: b,' Personal Representative Counsel for personal representative STATUS REPORT UNDER RULE 6.12 Name of Decedent: DOROTHY K. HOCH Date of Death: JUNE 14, 2003 No. 21-03-0635 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: X Yes No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes X No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? X Yes No do Date: 3/16/04 Copies of receipts, releases, joinders and approvals of formal or informal accounts may beCleyJcqf Orphan'sfiled with the Court and may be attached to thisreport.~_~~ ~ / Sig~ SAL/~M~N HUGHES & FISHMAN ~4~es D. Hughes, Esquire ame (please type or print) 95 Alexander Spring Road Address Carlisle, PA 17013 City, State, Zip (717) 249-6333 Telephone Number Capacity: X Personal Representative Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT, 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003913 SOUDERS CAROL ANN 318 ROSEWOOD LANE ENOLA, PA 17025 ........ fold ESTATE INFORMATION: SSN. 169-38-6151 FILE NUMBER: 2103-0735 DECEDENT NAME: SOUDERS CLARENCE A DATE OF PAYMENT: 05/07/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 08/09/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $10,085.75 REMARKS: CAROL ANN SOUDERS TOTAL AMOUNT PAID: $10,085.75 SEAL CHECK# 00011815 INITIALS: VZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS May 17, 2004 Dissinger & Dissinger 28 N. 32nd St Camp Hill ,PA 17011 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPARTMENT 280601 HARRISBURG, PA 17128-0601 '04 ray 24 ;,S:05 Telephone (717) 787-3930 FAX (717) 772-0412 Dear SidMadam: Re: Estate of Clarence Souders File Number 21032]3'235 This is in response to your request for an extension of time to file the Inheritance Tax Return for the above estate. In accordance with Section 2136 (d) of the Inheritance and Estate Tax ,&ct of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before 11/09/04. Because Section 2136 (d) of the 1995 ,&ct allows for only one extra period of six (6) months, no additional extension(s) will be granted that would exceed the maximum time permitted. Sincerely, Claudia Maffei, Supervisor Document Processing Unit Inheritance Tax Division COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 OFFICtN_ USE ONLY I'- LU .~oo HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT 08-09-2003 03-26-1951 Souders, Carol A. 03 0735 FtLE NUMBER 2 i -- COL~IT~ CODE yEN~ NUMBER ;w,,. SOCIAL SECURITY NUMBER r~J~l. Original Return ~ 2. Supplemental Return r'~ 3. Remainder Retum (dale of death prior lo 12-13-82) [~ 4. Limited Estate r'~ 4a. Future interest Compromise (date of ~Jeath after 12-12-82) r~ 5. Federal Estate Tm( Ratum Required [~ 6. Decedent Died Testate {Attach ccf)y of Will) ~ 7. Decedent Maintained a Living Tnlst (Attach c~py of Trust) -- 8. Total Number of Safe Deposit Boxes I~ 9. Litigation Proceeds Received ['---] 10. Spousal Po~rty Credit (date of death between 12-31-91 a.d t-1-F~} I~ 11. Election to tax under Sec. 9113(A) ( At ~i¢tl Sch O) Z O Karen L. Koenigsberg FIRMNAME(If~plICeble) Dissinger and Dissinger ~LE~ONE NUMBER 717-975-2840 COMPLE~ MAILING ADDRESS 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 108,16 6.87 3. Closely Held Coq)oration, Partnership or Sole-Proprietomhlp (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Oeposits & Miscellaneous Personal Properly 9,063.85 (Schedule E) (5) 6. Joi~_lly Owned Property(Schedule F) (6) 146,743.60 L.~ Separate Billing Requested 7. inter-Vivos Transfers & Miscellaneous Non-Probate Proper{y (7) 29,611.33 (Schedule G or L) 8. Total Gross Aseete (total Lines 1-7) (8) 9. Funerai Expenses & Ad minlstroti~ Costs (Schedule H ) (9) 51,434.35 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 3 ~ 8 02 . 53 11, Total Deductions (total Lines 9 & t 0) (11 ) t 2, Net Value of Estata (Line 8 minus Line 11 ) (12) t3. Chadtabte and Govemmentel Bequests/Sec 91t3 Trusts for which an eleotlon to tex has not been made (Schedule J) (13) 28 North Thirty-S .e~p~..d Street 215,743.5~ir' u~ 509,329.15 55,236.88 454,092.27 14. Net Value Subject to Tax (Line 12 minus Line t3) (t4) 454,092.27 BEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. AmountofLine14taxableatthespousartax 260,315.95 x.0 000 (15) rate, ~r transfers unrter Sec. 9116 (aX1.2) 16. Amount of LIne14 taxable ot llneal rate 193,776.32 x.0 045 (16) 17. Amount of Line 14 taxable at sibling rate x .12 (17) 8,719.93 18. Amount of Line 14 taxable at collateral rate x.15 (t8) 19. Tax Due (19) 8,719.93 3W4645100(} Decedent's Complete Address: 318 Rosewood Lane Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penaltyif applicable D. Interest E. Penalty 10,085.75 Total Credits (A + B + C) (2) Total Interest/Penalty (D + E) (3) (1) 8,719.93 10,085.75 1,365.82 .00 4. If Line 2 is greater than Line I + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (4) (5) A. Enter the interest on the taxdue. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTF__R OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS .00 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ....................... r'~ ~ b. retain the right to designate who shall use the property transferred or its income; ......... [~ r~ c. retain a reversiesary interest; or ................................ r'~ [3Lr] d. receive the promise for life of either payments, benefits or care? ................. [~ r~ 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? r3~ ~] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probete 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. 318 Rosewood Lane, Enola, PA 17025 SIGNA3]JRE OF PREPARER O~-IER THAN REPRESENTATIVE DATE 3601 North Front Street, Harrisburg, PA 17110 For dates of death on or after July 1, 1994 and before January 1, t 995, the tax rate imposed on the net value of transfers to or for the use of the suwMng spouse is 3% [72 P.S. § 9916 (a) (1.1) (I)]. For dates of death on or after Jan uary 1, 1995, the tax rate Imposed 0~1 the net value of transfers to Or for the use of the surviving spouse ~s 0% [72 P.S. § 9116 (a) ( 1.1 ) (ii)] The statute d (:es not exempt a transfer to a surviving spouse from tax, and the atatutoly requirements for disclosure of assets and filing a tax ratum are still applicable even if the surviving spouse is the only beneffola~. For dates of death on or after July 1,2000: The tax rate im posed on the net value of transfers from a deceased child t~enty-~e years of age or younger at death to or for the use of a natural parent, an edopth~e parent, or a stepparent of the child is 0% [72 P.S, § 9116(a)(1~2}], The tax rate imposed on the net va[ue of transfers to or for the use of the decedenfis lineal beneficiaries Is 4.5%, except as noted In 72 P.S. § 9116( 1.2) [72 P.S. § 9116(a)( 1 )]. The tax rate im posed on the net value of transfers to or for the use of the decedenfis siblings Is t 2% (72 P.S. § 9 t 16(a)( 1.3 )]. A sibling Is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 3W4646 5000 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Clarence A. Souders 21-03-0735 All real properly owned solely or al a tenant In common must be repo~ted at fair market value. Fair market value Is defined as the pdce at wh kT.h pmbeny would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which le Jointly-owned with right of survlvomhlp must be dllclosed on Schedule F. ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1. Decedent~s residence -- House and lot situate at 318 Rosewood Lane, Enola, East Pennsboro Township, Cumberland County, PA; more fully described as lots 19 and 20 PB 34 PG 131 C~m~erland County assessment 205,470.00 Common level ratio factor 1.05 Calculated value 215,743.50 TOTAL (Also enter on line 1, Recapitulation) 215,743.50 3w46e$1.00o (Jr more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Clarence A. Souders 21-03-0735 All property Jointly-owned with right of survlwwshlp must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPI~ON OF DEATH 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 63 shares AT&T Corp @21.01 271 shares BellSouth Corporation @25.6725 710 shares First National Bank of McConnelsburg @24.00 800 shares Fulton County National Bank and Trust Co. @51.00 20 shares Lucent Technologies @1.7675 500 shares PPL Corp @39.16 482 shares SBC Communications, Inc @23.42 78 shares Verizon Communications @35.18 50 shares College Town, Inc (redeemed by the company @50.00) $1,000 College Town, Inc Bond (redeemed by the company) $1,025 United States Savings Bonds Series E and EE TOTAL (Also enter on line 2, Recapitulation) $ 1,323.63 6,957.25 17,040.00 40,800.00 35.35 19,580.00 11,288.44 2,744.04 2,500.00 4,873.16 1,025.00 108,166.87 3W46961.000 (Ifmorespa~isneeded, inse~additi~alsh~ ~thesamesl~) COMMONVVEAL'IH OF PENNSYLVANIA INHERITANCE TAX RE'I~JRN RESIDENT D~CED~NT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Clarence A. Souders 21-03-0735 Include the proceeds of litigation and the da~ the proceeds w~re received by the estate. Nm property Jointly-owned with the Hght of survlvomhlp must be disclosed on Schedule F, ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 2. 3. 4. American General Life Insurance Co -- disablity benefit Decedentts vehicle -- 1994 Chevy Suburban per Kelley Blue Book Commerce Bank savings account Dl,mher 0410001914 Uncashed travlers checks 1,450.37 6,005.00 1,392.48 216.00 TOTAL (Also enter on line 5, Recapitulation) $ 9,0 63.8 5 3W46AD 1.000 (if more space is needed. Insert additional sheets of the same size) COIV/dONWEAL ~1~ OF PENNSYLVANIA INHERITANCE TAX RE~JRN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Clarence A. Souders 21-03-0735 If an asset was made Joint within one year of the decedenrs date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME .N~ORESS RELA'nONSHIP TO DECEDENT A. Carol A. Souders Spouse C 318 Rosewood Lane Enola, PA 17025 JOINTLY-OWNED PROPERTY: [=~rn~ DATE CESCRIP~ON OF PROPER~ % OF DATE OF DEATH ITEM FOa~ MADE ~kCL~E ~ME OF FINARC~AL I~T~ION A~O BAI~K ACCOUNT DATE OF DEATH DECO'S V~UE OF NUMBER TEHANT JOINT ,Rl~N1Lyd~dJ) REAL ESTA~, V~UE OF ASSET II',q~REST ~CE~NTS IKqEREST 1. A. More than Belco Community Credit Union one year savings account 2,804.97 50 1,402.4~ 2. A More than Belco Community Credit Union one year checking account 39,041.13 50 19,520.5~ 3. A More than Belco Community Credit Union one year money market account 45,084.97 50 22,542.4~ 4. A More than M~m~ers 1st Federal Credit one year savings account 216.25 50 108.1] 5. A More than Members 1st Federal Credit one year money market account 57,350.38 50 28,675.1~ 6. A More than Members 1st Federal Credit one year checking account 13,043.10 50 6,521.5~ 7. A More than M~bers 1st Federal Credit one year 4 year share certificate 23,887.42 50 11,943.7] 8. A More than Pennsylvania State Employees one year Credit Union -- savings 126.08 50 63.0~ 9. A More than Pennsylvania State Employees one year Credit Union -- 36 month share certificate 48,400.03 50 24,200.0~ 10. A More than 331.331 shares Putnam New one year Opportunities C1 A @32.90 10,900.79 50 5,450.4( 11. A More than 495.772 shares Putnam New one year Opportunities C1 B @30.04 14,892.99 50 7,446.5( 12. A More than 1,482.784 shares Putnam one year Voyager Fund Class A @14.19 21,040.71 50 10,520.3( 13. A More than 932.135 shares Putnam one year Voyager Fund Class B @12.5~ 11,698.29 50 5,849.1~ 14. A More than Household effects and one year furnishings -- no items with a collector's value 5,000.00 50 2,500.0( TOTAL(Alsoenteronline6. Re~pitu~afi~) $ 146,743.6~ 3W46AE 1.000 (If more space is needed, Insert additional sheets of the same size) COMMONWEAL~'I OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G r INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Clarence A. Souders FILE NUMBER 21-03-0735 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET Is yes. L.lt:~,:~;~ PTION OF ~u~=N ~ Y I~M ,~uz~ T~ N'~VZ ~ ~ m*.NSFS~[. 'r~lR ~.~ TO ~ m Am DATE OF DEATH %OF DECD~ EXCLUSION TAXABLE I~JMBER "~t~ ~ ~ ~l~ A~AC~ A C(~Y OF 'I~'E ~ ED FOR REAL E ~A~. VALUE OF ,~SET INqEREST ~F ~C~ABLE) VALUE 1. Belco Community Credit Union variable rate IRA 1,241.04 100 1,241.04 2. Members 1st Federal Credit Union IRA savings account 10,740.22 100 10,740.22 3. 287.627 shares LB Opportunity Growth Fund-A transferable on death to Carol A. Souders, spouse @7.625 2,193.16 100 2,193.16 4. 8,940.34 shares LB Money Market Fund-A transferable on death to Michelle B. Souders, daughter and Karen A. Souders, daughter 8,940.34 100 8,940.34 5. 84.903 shares Investment Company of America 529B Fund #1204 in s Section 529 Plan FBO Karen A. Souders, daughter @25.385 2,155.26 100 2,155.26 6. 83.227 shares Washington Mutual Income 529B Fund #1201 in a Section 529 Plan FB0 Karen A. Souders, daughter @25.49 2,121.46 100 2,121.46 7. 144.757 shares Income Fund of America 529B Fund # 1206 in a Section 529 Plan FBO Karen A. Souders, daughter @15.335 2,219.85 100 2,219.85 TOTAL(Alsoenteronline7. Recapitulatico) $ 29,611.33 (If mom space is needed, insert additional sheets of the same see) 3W46AF 1.000 OMMONI~EAJ_'IH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Clarence A. Souders SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-03-0735 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIP3']ON A. 1. 5. 6. 7. 8. 9. 10. FUNERAL EXPENSES: Richardson Funeral Home, Inc. -- Funeral goods and services ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Carol A. Soudars Social Security Number(s)/EIN Number of Persenal Repreaentatlve(s) 191-46-4006 Street Address 318 Rosewood Lane City Enola State PA Zip17025 Year(s) Commlsslen Paid: 2004 Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Carol A. Souders Street Address 318 Rosewood Lane City Enola StataPA Zip17025 Relationship of Claimant to Decedent Spouse Probate Fees C~m~erland County Register of Wills Accountant's Fees Boles, Metzger, Brosius and Ritter, P.C. Tax Return Preparers Fees Boles, Metzger, Brosius and Ritter, P.C. C,,m~erland County Register of Wills -- probate fee to reopen the Estate of Shelia B. Souders, deceased former spouse The Patriot News advertising estate notice C,,~erland Law Journal - advertising estate notice McConnellsburg National Bank - fee Reserve for filing fees and related expenses AMOUNT 6,485.00 27,000.00 8,500.00 3,500.00 473.00 2,500.00 2,500.00 39.00 122.35 75.00 40.00 200.00 TOTAL (Also enter on line 9, Recapitulation) 51,434.35 3W4§AG 1 000 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (1243) COMMOI~NEAL'0-1 OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Clarence A. Souders 21-03-0735 Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, Including unrelmbureed medical expenses. ITEM NUMBER 2. 3. 4. 5. 6. 7. 8. DESCRIPTION Holy Spirit Hospital -- hospital care Quantum Imaging -- medical care Apria Healthcare -- medical care Orthopedic Institute of PA -- medical care V~M Homelink -- medical care Pinnacle Health -- home physical therapy Quantum Imaging -- medical care East Pennsboro Township -- taxes VALUE AT DATE OF DEATH 34.32 371.16 440.10 15.00 17.00 172.50 171.00 2,581.45 TOTAL (Also enter on line 10. Recapitulation) $ 3,802.53 3W46AH 2000 (If more space Is needed, insert additional sheets of the same si~e) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Clarence A. Souders 21-03-0735 RELA33ONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outdght spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Carol A. Souders Michelle B. Souders Karen A. Souders Spouse Daughter Daughter 260,315.95 93,937.94 99,838.38 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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 TOTAL OF PART II - ENTER TOT~J. NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (If more space is needed, insert additional sheets of the same size} REV-t514 EX+ (12-03) SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENTDECEDENT (Check Box 4 on REV-t500 Cover Sheet) ESTATE OF FILE NUMBER Clarence A. Souders 21-03-0735 This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit, Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. [] Will [~ Intervlvos Deed of Trust [--'-] Other NAME(S) OF LIFE TENANT(S) DATE OF BIRTH NEAREST AGE AT TERM OF YEARS DATE OF DEA'rH LIFE ESTATE IS PAYABLE .~arol A. Souders 06/21/1955 48 iX ILifeor r'--~ Term of Years I ILifeor [~ Term of Yeara I I Life or ~-] Term of Years I I Life or ~ Term of Years I ILifeor ['--l Term ofYears 1. Value of fund from which life estate is payable ............................... $ 2. Actuarial factor per appropriate table ..................................... Interest table rate- [~ 3 1/2% [] ~/o [-~ 10% [] VadableRate 3.2 % 3. Value of life estate (Line I multiplied by Line 2) ............................. $ 215,743.50 59.1530 127,618.75 NAME(S) OF LIFE ANNUITANT(S) DATE OF BIRTH NEAREST AGE AT TERM OF YEARS DATE OF DEATH ANNUITY IS PAYABLE '~ Life or r~ Term of Years ~ Life or [~ Term of Years ---] Life or r~ Term of Years -~ Life or [~ Term of Years 1. Value of fund from which annuity is payable ............................... $ 2. Check appropriate block below and enter corresponding (number) ................... Frequency of payout -[~] Weekly (52) J--~ Bi-weekly (26)[~ Monthly (12) [~ Quarterly (4) [] Semi-annually (2) [] Annually (1) [~]~ther ( )_ 3. Amount of payout per period 4. Aggregate annual payment, Line 2 multiplied by Line 3 ......................... 5. Annuity Factor (see instructions) Interest table rate -[] 3 112% [] 6% [] 10% ~'--]VadableRate % 6. Adjustment Factor (see instructions) ................................... 7. Value of annuity - If using 3 112%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 .................... $ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 ..................................... $ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) shoutd be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If more space is needed, insert additional sheets of the same size) 3W48AJ 3.000 CLARENCE A. SOUDERS ESTATE ALLOCATION OF PA TAXABLE ESTATE TO BENEFICIARIES ASSETS AND DEDUCTIONS Real estate Stocks and bonds Stocks U.S. Savings Bonds Cash, bank deposits and miscellaneous personal Disability benefit Suburban Commerce Bank Travelers checks Jointly owned property Intervivos transfers IRAs LB Opportunity Growth Fund LB Money Market Fund Section 529 plan assets Totals Funeral expenses Administrative costs Debts of decedent Taxable estate CAROL MICHELLE KAREN TOTAL 127,618.75 44,062.38 44,062.37 215,743.50 53,570.93 53,570.94 107,141.87 525.00 500.00 1,025.00 1,450.37 1,450.37 6,005.00 6,005.00 696.24 348.12 348.12 1,392.48 108.00 54.00 54.00 216.00 146,743.60 146,743.60 11,981.26 11,981.26 2,193.16 2,193.16 4,470.17 4,470.17 8,940.34 6,496.57 6,496.57 296,796.38 103,030.60 109,502.17 509,329.15 6,485.00 6,485.00 26,192.90 9,092.66 9,663.79 44,949.35 3,802.53 3,802.53 260,315.95 93,937.94 99,838.38 454,092.27 Amount taxable at spousal rate of 0% Amount taxable at lineal rate of 4.5% 260,315.95 193,776.32 Taxable estate 454,092.27 LAST WILL AND TESTAMENT OF CLARENCE A. SOUDERS I, Clarence A. Souders, of Enola, Pennsylvania, revoke my former Wills and Codicils and declare this to be my Last Will and Testament. ARTICLE I IDENTIFICATION OF FAMILY I am married to Carol Ann Souders and all references in this Will to "my spouse" are references to Carol Ann Souders. The names of my children are Michelle B. Souders and Karen A. Souders. All references in this Will to "my children" are references to the above-named children. ARTICLE II PAYMENT OF DEBTS AND EXPENSES I direct that my just debts, funeral expenses, and expenses of last illness be fa-st paid from the joint accounts help by my wife Carol and I. ARTICLE III DISPOSITION OF PROPERTY I give, devise and bequeath to my wife Carol Ann Souders for the duration and term of her natural life the property that I own at 318 Rosewood Lane, Enola Pa. Cumberland County to have the use of during the term of her natural life on the condition that she keep the property in repair and pay the taxes and insurance thereon and at her death I give, devise and bequeath said property equally to my children Miehelle B. Sou&rs and Karen A. Souders. My children may live in the property with my wife, however, if they are £mished with their education and have a job they must contribute to the expenses. If either daughter should die before my wife Carol the remaining daughter is to receive the entire property. I give, devise and bequeath all stock in any company which I own and are registered in my name, the name of my first wife Sheila B. Souders, or my name and Sheila B. Souders be derided equally between my children Miehelle B. Souders and Karen A. Souders. I give, devise and bequeath all United States Saving Bonds I own and are registered in my name, the name of my fa:st wife Sheila B. Souders, or my name and Sheila B. Souders be devided equally between my children Michelle B. Souders and Karen A. Souders All joint accounts with my wife Carol are to become her property. All coments of the property at 318 Rosewood Lane Enola Pa. Cumberland County are the joint property of my wife Carol and I and to be her property. Let it be known that all the jewelpy located in the safety deposit boxes which I have access to is the property of my daughters and it is stored in the safety deposit boxes until they become of age or have a need to have their own safe deposit boxes. ARTICLE IV NOMINATION OF GUARDIAN Should it become necessary to appoint a guardian of the person of a minor child, I nominate Carol Ann Souders, of Enola, Pennsylvania, to serve as the Guardian of my surviving children who are minors at the time of my death. If such person is unable to serve as Guardian, I nominate Francis Anthony, of Harrisburg, Pennsylvania, to serve as the Guardian. ARTICLE V NOMINATION OF EXECUTOR I nominate Carol Ann Souders, of Enola, Pennsylvania, as the Executor, without bond or security. If such person or entity does not serve for any reason, I nominate Michelle B. Souders, of Enola, Pennsylvania, to be the Executor, without bond or security. ARTICLE VI EXECUTOR AND TRUSTEE POWERS My Executor, with respect to my estate, and my Trustee with respect to my trust, in addition to other powers and authority granted by law or necessary or appropriate for proper administration, shall have the following rights, powers, and authority without order of court and without notice to anyone: 1. Receive Assets. To receive, hold, maintain, administer, collect, invest and re-invest the estate and trust assets, and collect and apply the income, profits, and principal of the estate and trust in accordance with the terms of this instrument. 2. Receive AdditionalAssets. To receive additional assets from other sources, including assets received under the Wills of other persons. 3. Standard of Care. To acquire, invest, reinvest, exchange, retain, sell, and manage estate and trust assets, exemising the judgment and care, under the circumstances then prevailing, that persons of prudence, discretion and intelligence exercise in the management of their own affairs, not in regard to speculation but in regard to the permanent disposition of their funds, considering the probable income as well as the probable safety of their capital. Within the limitations of that standard, the Executor and Trustee are authorized to acquire and retain every kind of property, real, personal or mixed, and every kind of investment, specifically including, but not by way of limitation, bonds, debentures and other corporate obligations, and stocks, preferred or common, that persons of prudence, discretion and intelligence acquire or retain for their own account, even though not otherwise a legal investment for trust funds under the laws and statutes of the United States or the state under which this instrument is administered. 4~ Retain Assets. To retain any asset, including uninvested cash or original investments, regardless of whether it is of the kind authorized by this instrument for investment and whether it leaves a disproportionately large part of the estate or trust invested in one type of property, for as long as the Executor or Trustee deems advisable. 5. Dispose of or Encumber Assets. To sell, option, mortgage, pledge, lease or convey real or personal property, publicly or privately, upon such terms and conditions as may appear to be proper, and to execute all instruments necessary to effect such authority. 6. Settle Claims. To compromise, settle, or abandon claims in favor of or against the estate or trust. 7. Manage Property. To manage real estate and personal property, borrow money, exercise options, buy insurance, and register securities as may appear to be proper. 8. Allocate Between Principal andlncome. To make allocations of charges and credits as between principal and income as in the sole discretion of the Executor or Trustee may appear to be proper. 9. Employ Professional Assistance. To employ and compensate counsel and other persons deemed necessary for proper administration and to delegate authority when such delegation is advantageous to the estate or trust. 10. Distribute Property. To make division or distribution in money or kind, or partly in either including disproportionate in-kind distributions, at values to be determined by the Executor or Trustee, and the judgment of either in such respect shall be binding upon all interested parties. 11. Enter Contracts. To bind the estate or trust by contracts or agreements without assuming individual liability for such contracts. 12. Exercise Stock Ownership Rights. To vote, execute proxies to vote, join in or oppose any plans for reorganization, and exercise any other rights incident to the ownership of any stocks, bonds or other properties of the estate or trust. 13. Duration of Powers. To continue to exercise the powers provided in this Article notwithstanding the termination of the trust until .all the assets of the trust have been distributed. 14. HoM Trust Assets as a Single Fund. To hold the assets of the trust, shares, or portions of the trust created by this instrument as a single fund for joint investment and management, without the need for physical segregation, dividing the income proportionately among them. Segregation of the various trust shares need only be made on the books of the Trustee for accounting purposes. 15. Loans to Beneficiaries. To make loans to any trust beneficiary for the purpose of providing the beneficiary with the funds necessary to take advantage of exceptional business opportunities or to provide for the needs of the beneficiaries and their families. 16. Methods of Distribution. To make payments to or for the benefit of any beneficiary (specifically including any beneficiary under any legal disability) in any of the following ways: (a) directly to the beneficiary, (b) directly for the maintenance, welfare and education of the beneficiary, (c) to the legal or natural guardian of the beneficiary, or (d) to anyone who at the time shall have custody and care of the person of the beneficiary. The Executor or Trustee shall not be obliged to see to the application of the funds so paid, but the receipt of the person to whom the funds were paid shall be full acquittance oftha Executor or Trustee. 17. Informal Administration. MyExecutorshallhavetherighttoadministermyestateusing "informal", "unsupervised", or "independent" probate or equivalent legislation designed to operate without unnecessary intervention by the probate court. ARTICLE VII MISCELLANEOUS PROVISIONS A. Parama~h Titles and Gender. The titles given to the paragraphs of this Will are inserted for reference purposes only and are not to be considered as forming a part of this Will in interpreting its provisions. All words used in this Will in any gender shall extend to and include all genders, and any singular words shall include the plural expression, and vice versa, specifically including "child" and "children", when the context or facts so require, and any pronouns shall be taken to refer to the person or persons intended regardless of gender or number. B. Thirty Day Survival Requirement. For the purposes of determining the appropriate distributions under this Will, no person or organization shall be deemed to have survived me unless such person or entity is also surviving on the thirtieth day after the date of my death. C. Liability of Fiduciary. No fiduciary who is a natural person shall, in the absence of fraudulent conduct or bad faith, be liable individually to any beneficiary of my estate or any trust estate, and my estate or the trust estate shall indemnify such natural person from any and all claims or expenses in connection with or arising out of that fiduciary's good faith actions or nonactions of the fiduciary, except for such actions or nonactions which constitute fraudulent conduct or bad faith. No successor trustee shall be obliged to inquire into or be in any way accountable for the previous administration of the trust property. D. Beneficiary Disputes. If any bequest requires that the bequest be distributed between or among two or more beneficiaries, the specific items of property comprising the respective shares shall be determined by such beneficiaries if they can agree, and if not, by my Executor. WITNESS WHEREOF, I have subscribed my name below, this __ Testator Signature: ~ ct~ Clarence A. Souders day of We, the undersigned, hereby certify that the above instlument, which consists of pages, including the page(s) which contain the witness signatures, was signed in our sight and presence by Clarence A. Souders (the "Testator"), who declared this instrument to be his/her Last Will and Testament and we, at the Testator's request and in the Testator's sight and presence, and in the sight and presence of each other, do hereby subscribe our names as witnesses on the date shown above. Witness Signature: Name: City: State: Wimess Signature: Name: City: State: PENNSYLVANIA Self-Proving Clause COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND I, Clarence A. Souders, the Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the insmnnent as my Last Will; that I signed it willingly and as my free and voluntary act for the purposes expressed in the instrument. Sworn to or affirmed and acknowledged be~re m~e by Clarence A. Souders, the Testator, this 9r~ day of Qi~L~x/ , 5100~ · Testator Signature Clarence A. Soude~ Signature of officer Official eapaci ~v of officer NOTARIAL SEAL ROBERT L. GILL, Notary Public Easl Pennsboro Twp., Cumberland Co, My P. nmmi~inn F~?ir~ Mny lQ, (Seal) Member, PennsyJvaeia Associalion ol Nolades AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the instrument as the Testator's Last Will; that the Testator signed willingly and executed it as the Testator's flee and voluntary act for the purposes expressed in it; that each of us in the hearing and sight of the Testator signed the Will as a wimess; and that to the best of our knowledge the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn to or affmned and subscribed to before me by ~)~-~O/~/~ ?'~ /9, Fl* 6t~ F0 d ~d ~ C~t 6 L~ 6 ~ ~ Lrm~ , wimesses, ~is 8 ~ day of U u Witness Signature: Name: City: State: Witness Signature: Salne City: State: Signature Seal and official capacity of officer I NOTARIAL SEAL ] ROBERT L. GILL, Notary Public J Easl Pennsboro Twp, Cumberland Co. { My Commission Exp res May 19, 2005 ¥~P.m~r, Pennsylvar~ia Association of Notaries BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVIS~"'._("l"""'JI~:l';:~:--~ PO BOX 280601 i ,'_.\) , .__._,.c' HARRISBURG, PA 17128-06~:r::'::'- (v... \jl- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* REV_1547 EX (f2-9T) PC ^OOC I,HI ')[ L FJ.J "" J,i'i L } t\l"J ,. . c NOTICE OF INHERITANCE TAX , APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX 8: 19 DATE ESTATE OF DATE OF DEATH FILE NO. COUNTY ACN 01-10-2005 SOUDERS CLARENCE A 08-09-2003 21 03-0235 ~ Cumberland 101 C',1 r.,1/ _tt"ii\ KAREN L ~~)&j~$$i;~~' DISSINGE~~'jjISSINGER 28 N 32ND STREET CAMP HILL PA 17011 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: Register of Wills Cumberland County Courthouse Carlisle, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS <::0 . .REii:i547 EX '(iiif-97)'PC...'..'...'" Hotit'E'iiF 'IHl-fER!f i,licnAl( APpifAjS'EMElit~ -A"LL.OWANCif OR..,.......... h, --'''''''. -, DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SOUDERS CLARENCE A FILE NO. 21 03-0235 ACN 101 DATE 01-10-2005 TAX RETURN WAS: (181) ACCEPTED AS FILED ( 0 ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/ Misc. Personal Properly (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: g. Funeral Expenses/Adm. CostslMisc. Expenses (Schedule H) (g) 51,434.35 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 3.802.53 11. Total Deductions (11) 55,236.88 12. Net Value of Tax Return (12) 454,092.27 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) 0.00 14. Net Value of Estate Subject to Tax (14) 454,092.27 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17 and 18 will reflect figures that include the total of ALL returns assessed to date. (1) (2) (3) (4) (5) (6) (7) 215,743.50 108,166.87 0.00 0.00 9,063.85 146,743.60 29,611.33 (8) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 509,329.15 ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 taxable at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 1 g. Principal Tax Due TAX CREDITS: (15) 260,315.95 X .00 0.00 (16) 193,776.32 X.045 8,719.93 (17) 0.00 X .12 0.00 (18) 0.00 X .15 0.00 (19) 8,719.93 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 05-07-2004 CD003913 0.00 10,085.75 TOTAL TAX CREDIT 10,085.75 BALANCE OF TAX DUE 1,365.82 CR INTEREST 0.00 I TOTAL DUE 1,365.82 CR * IF PAID APTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. (IP TOTAL DUB: IS LESS THAN $1, NO PAYKENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A CREDIT (CR), YOU MAY BE DUE A REFUND. SEE :REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ~><;,L. IN THE MATTER OF THE STATE OF CLARENCE A. SOUDERS, ECEASED t,,,, '.' ;, IN THE COURT OF CQ~ON P'p,~AS OF CUMBERLAND COUNTY, c,pg~S~VANIA: ORPHANS' COURT DIVISION NO'03-135 '- ESTATE SETTLEMENT AGREEMENT/RELEASE, RECEIPT A.NI).: REFUNDING. r",) AGREEMENT _1 THE CIRCUMSTANCES leading up to the execution of this Agreement re as follows: 1. Clarence A. Souders (the "Decedent"), died testate on 9, 2003, and Carol A. Souders duly qualified with the egister of wills of Cumberland County, Pennsylvania, as the (the "Executrix") of the Decedent's probate estate (the "Estate") . 2. Article III of the Decedent's Last will and Testament (the "Will") provides for the distribution of the Decedent's tangible ersonal property to Carol A. Souders. 3. Shortly after the Decedent's death, the Executrix istributed the Decedent's tangible personal property to Carol A. ouders in satisfaction of her rights under Article III of the Will. 4. Carol A. Souders is the Decedent's surviving spouse, and aren Souders and Michelle Souders are the Decedent's issue (collectively, the "Beneficiaries"). The Beneficiaries desire the xecutrix to settle the Estate informally in order to avoid the xpense and delay involved with the formal adjudication of a First nd Final Account by the Orphans' Court Division of the Court of ommon Pleas of Cumberland County, Pennsylvania (the "Court"). 5. The Beneficiaries desire to forever settle and compromise .~ any and all claims and rights which they may possess, now or hereafter, in the Estate and to confirm their acceptance of the Informal Account (the "Account"), attached hereto as Exhibit "A" and incorporated herein by this reference, and the Schedule of Proposed Distribution (the "Schedule"), attached hereto as Exhibit "B" and incorporated herein by this reference. The Beneficiaries desire that the distributions, as set forth on Exhibit "B," be in full satisfaction of their rights in the Estate. 6. The Beneficiaries wish to release the Executrix, acting in er official capacity as Executrix of the estate only, and to indemnify her against any and all claims that they may be asserted against the Estate or the Executrix for the time period up through and including the date this Estate Settlement Agreement/Release, eceipt and Refunding Agreement is Executed. The Beneficiaries also esire waive their right to a formal adjudication of a First and Final Account of the Executrix. 7. The Executrix is willing to settle the Estate informally in onsideration of the indemnifications hereinafter provided by the eneficiaries. NOW THEREFORE, in consideration of the foregoing and intending o be legally bound, jointly and severally, the and the eneficiaries, for themselves, their successors and assigns: 1. Represent and warrant that they have read and understand this Agreement and confirm that the facts set forth above are true and correct, to the best of their knowledge, information and belief. 2. Declare that they have sufficient information to make an informed waiver of their right to a formal accounting with the Court, and do hereby waive the filing and auditing of the same. 3. Acknowledge that the distributive share or amount set forth on the Schedule shall be in full satisfaction of their respective entitlements under the Will. 4. Release, remise, quitclaim and forever discharge the Executrix, her heirs, personal representatives, successors and assigns, from and against all claims that they, as legatees of the Estate, and in connection with the Estate, had, now have or may in the future have in connection with the Estate. 5. Agree to refund, on demand, all or any part of any aforesaid distribution, which has been determined by any court of competent jurisdiction, to have been improperly made. 6. Agree to indemnify and hold harmless the Executrix, acting in her official capacity only, her heirs, personal representatives, successors and assigns, from and against any and all claims, loss, liability or damage (whether or not related to the negligence of the Executrix), for the time period up through and including the date this Estate Settlement Agreement/Release, Receipt and Refunding Agreement is Executed, that may hereafter be asserted against the Estate or against the Executrix. 7. Agree to execute such other or additional documents as may be necessary to effectuate the agreements set forth herein. 8. Acknowledge that this Agreement shall be governed by and constructed in accordance with the laws of the Commonwealth of Pennsylvania. 9. Consent to the Court exercising personal jurisdiction over them in any suit or action arising out of the enforcement of this Agreement. IN WITNESS WHEREOF, the Beneficiaries have placed their hands and seals on the Consents to Estate Settlement Agreement attached ereto as exhibit "C." Respectfully Submitted, DISSINGER AND DISSINGER / !I en L. Koe i S preme Court ID 28 N. 32~ Street Camp Hill, PA 17011 (717) 975-2840 Informal Account Date of Death Date of Executrix's Appointment Accounting for the Period Auqust 9. 2003 September 8. 2003 Auqust 9. 2003 Summary of Account Total gross value of Estate $509.329.15 Less disbursements $ 60,963.69 J".,. . .:.'t,t Remainder to be distributed $448.365.46 Inventorv Item Number Description Value at Previous Date of Distributions Death or Transfers 1. Real Estate $215,743.50 318 Rosewood Lane, Enola, PA 17025 2. 63 Shares of $1,323.63 AT&T 3 . 271 Shares $6,957.25 Bell South 4 710 Shares of $17,040.00 355 shares to First National Michelle; 355 Bank of shares to McConnellsburg Karen (Executrix is holding certificates) 5. 800 Shares of $40,800.00 400 shares to Fulton City Michelle, 400 National Bank shares to & Trust Karen (Executrix is holding certificates) 6. 20 Shares of $35.35 Lucent Technologies 7 500 Shares of $19,580.00 PP&L 8 . 482 Shares of $11,288.44 SBC Communications 9. 78 Shares of $2,744.04 Verizon Communications 10. 50 Shares of $2,500.00 College Town, Inc. 11. College Town, $4,873.16 Inc. (Bond) 12. US Savings $1,025.00 $525 to Bonds, Series Michelle, E and EE $500 to Karen (Executrix is holding reissued bonds) 13. American $1,450.37 General Life Insurance Disability Benefit (payable to Carol) 14. 1994 Chevy $6,005.00 $6,005.00 to Suburban Carol 15. Commerce Bank $1,392.48 Savings Account 16. Travelers $216.00 Checks 17. Belco $1,402.49 $1,402.49 Community (to Carol) Credit Union Savings Account (50% Interest) 18. Belco $19,520.57 $19,520.57 Community (to Carol) Credit Union Checking Account (50% Interest) 19. Belco $22,542.49 $22,542.49 Community (to Carol) Credit Union Money Market Account (50% Interest) 20. Members 1st $108.13 $108.13 Federal Credit (to Carol) Savings Account (50% Interest) 21. Members 1st $28,675.19 $28,675.19 Federal Credit (to Carol) Money Market Account (50% Interest) 22. Members 1st $6,521.55 $6,521.55 Federal Credit (to Carol) Checking Account (50% Interest) 23. Members 1st $11,943.71 $11,943.71 Federal Credit (to Carol) 4 year share Certificate (50% Interest) 24. Pennsylvania $63.04 $63.04 State (to Carol) Employees Credit Union Savings Account (50% Interest) 25. Pennsylvania $24,200.02 $24,200.02 State (to Carol) Employees Credit Union 36 Month Share Certificate (50% Interest) 26. 331.331 Shares $5,450.40 $5,450.40 Putnam New (to Carol) Opportunities CL A (50% Interest) 27. 496.772 Shares $7,446.50 $7,446.50 Putnam New (to Carol) Opportunities CL B (50% Interest) 28. 1,482.784 $10,520.36 $10,520.36 Shares Putnam (to Carol) Voyager Fund Class A (50% Interest) 29. 932.135 Shares $5,849.15 $5,849.15 Putnam Voyager (to Carol) Fund Class B (50% Interest) 30. Household $2,500.00 $2,500.00 effects - no (to Carol) items with a collector's value (50% Interest) 31. Belco Community Credit Union Variable Rate IRA 32. Members 1st Federal Credit Union IRA Savings Account 33. 287.627 Shares LB Opportunity Growth Fund-A Transferable on death to spouse 34. 8,940.34 Shares LB Money Market Fund-A Transferable on death to Michelle B. Souders and Karen A. Souders 35. 84.903 Shares Investment Company of America 529 Plan FBO Karen A. Souders 36. 83.227 Shares Washington Mutual Income 629B Fund #1204 in a Section 529 Plan FBO Karen A. Souders $1,241.04 $1,241.04 (Non-probate, to Carol) $10,740.22 $10,740.22 (Non-probate, to Carol) $2,193.16 $2,193.16 (Non-probate, to Carol) $8,940.34 $8,940.34 (Non-probate, to Michelle and Karen) $2,155.26 $2,155.26 _ (Non-probate, . to Karen) $2,121.46 $2,121.46 (Non-probate, to Karen) 37. 144.757 Shares $2,219.85 $2,219.86 Income Fund of (Non-probate, America 529B to Karen) Fund #1206 in a Section 529 Plan FBO Karen A. Souders TOTAL $509,329.15 Disbursements Debts of Decedent Amount 1. Holy Spirit Hospital 2. Quantum Imaging 3. Apria Healthcare 4. Orthopedic Institute of PA 5. VGM Homelink 6. Quantum Imaging . 7. Pinnacle Home Physical Therapy $ 34.32 $ 371.16 $ 440.10 $ 15.00 $ 17.00 $ 171.00 $ 172.50 Funeral Expenses 1. Richardson's Funeral Home $6,485.00 Administration Expenses 1. Register of Wills 2. Boles, Grove & Metzger 3. Dissinger & Dissinger 4. Executor's Commission 5. Patriot News 6. Cumberland Law Journal 7. Bank Fee-1st National Bank of McConnelsburg 8. Reserve for anticipated filing Fees and recording fees $ 512.00 $5,000.00 $8,500.00 $27,000.00 $ 122.23 $ 75.00 $ 40.00 $ 200.00 Taxes 1. PA Inheritance Tax 2. Real estate taxes $9,226.93 $2,581.45 Total Disbursements $60,963.69 SCHEDULE OF PROPOSED DISTRIBUTION TO: Carol A. Souders Assets: Amount previously distributed -jointly owned property -non-probate property -household effects -Suburban Real Estate (life tenancy value) Disability benefit Commerce Bank Travelers checks Total Inherited: Adjustments: Total Inherited: $166,923.02 $127,618.75 $ 1,450.37 $ 696.24 $ 108.00 $296,796.38 $296,796.38 Minus portion of taxes and expenses ($26,192.90) -100% funeral expenses (per Will) - 0% inheritance taxes -58.27% administration expenses (Proportional to share of estate received) -100% debts of decedent (per Will) Minus previously distributed property -joint accounts -non-probate property -household effects -Suburban Minus in kind distribution -life tenancy value Cash due to beneficiary: Cash owed to estate on account of expenses (paid in full): ($166,923.02) ($127,618.75) s 0.00 S 23,938.29 TO: Michelle B. Souders Assets: Amount previously distributed/transferred -non-probate property $ -stocks already transferred $ -bonds already transferred $ Real Estate $ Stocks and Collegetown Bond (liquidated) $ Travelers' Checks $ Commerce Bank $ 4,470.17 28,920.00 525.00 44,062.38 30.734.35 54.00 348.12 Total Inherited: $103,030.60 Adjustments: Total Inherited: $103,030.60 Minus portion of taxes and expenses $(13,320.08) - 48.48% of inheritance taxes - 20.23% of administration expenses Minus in kind distribution: -real estate -$525 US Savings Bonds - 3 55 shares 1st National Bank of McConnellsburg -400 shares Fulton City National Bank and Trust -non-probate property $(77,977.55) Cash due to beneficiary: $ 11,732.97 TO: Karen A. Souders Assets: Amount previously distributed/transferred -non-probate property $ -stocks already transferred $ -bonds already transferred $ Real Estate $ Stocks and Collegetown Bond(liquidated) $ Travelers' Checks $ Commerce Bank $ 10.966.74 28.920.00 500.00 44.062.38 24.650.94 54.00 348.12 Total Inherited: $109.502.17 Adjustments: Total Inherited: $109.502.17 Minus portion of taxes and expenses - 51.52% of inheritance taxes - 21.49% of administration costs $(14.156.30) Minus in kind distribution: -real estate -$500 US Savings Bonds -355 shares 1st National Bank of McConnellsburg -400 shares Fulton City National Bank and Trust -non-probate property $(84,449.11) Cash due to beneficiary: $ 10,896.76 CONSENT TO ESTATE SETTLEMENT AGREEMENT AND RECEIPT OR DISTRIBUTION I, Carol A. Souders, hereby consent to and join in the Estate Settlement Agreement relating to the Estate of Clarence A. Souders, deceased, a copy of which Estate Settlement Agreement, including exhibits, has been provided to me. ~~. Q~d1~~\J0 COMMONWEALTH OF PENNSYLVANIA County of -P.e.a-r On this, the ~ day of Mll.<Vh. , 2005, before me, the undersigned officer, personally appeared Carol A. Souders, known to me (or satisfactorily proven) to the person whose name is subscribed to the within instrument, and acknowledged that she executed the same in the capacities and for the purposes therein contained. SS. IN WITNESS WHEREOF, I hereunder set my hand and official seal. iJ~~~ubh ~ NOTARIAL. SEAL LEIGH ANN SNYDER, Notary Pubfic u.. ,,~~9 80m, Perry Co~ ...1 \NIllm,ssIon Explres May 15, 2005 CONSENT TO ESTATE SETTLEMENT AGREEMENT AND RECEIPT OR DISTRIBUTION I, Karen A. Souders, hereby consent to and join in the Estate Settlement Agreement relating to the Estate of Clarence A. Souders, deceased, a copy of which Estate Settlement Agreement, including exhibits, has been provided to me. ~ Q. ..JMu1P/V./ Karen A. Souders COMMONWEALTH OF PENNSYLVANIA County of J..-UYVl ~ ~ .' On this, the ~ day of MlMrC~ , 2005, before me, the undersigned officer, personally appeared Karen A. Souders, known to me (or satisfactorily proven) to the person whose name is subscribed to the within instrument, and acknowledged that she executed the same in the capacities and for the purposes therein contained. SS. IN WITNESS WHEREOF, I hereunder set my hand and official seal. llif L/ ~ ota y Public NOTARIAL SEAL LEIGH ANN SNYDER, NotelY PubrIC Marysvilla 80m, Perry Col.'llty My Co~;'~s!on .Explres May 15, 2005 CONSENT TO ESTATE SETTLEMENT AGREEMENT AND RECEIPT OR DISTRIBUTION I, Michelle Souders, hereby consent to and join in the Estate Settlement Agreement relating to the Estate of Clarence A. Souders, deceased, a copy of which Estate Settlement Agreement, including exhibits, has been provided to me. ~Jt 164~M~ Michelle Souders COMMONWEALTH OF PENNSYLVANIA County of IJa_USI)/U;1 On this, the c;)Jf2!1 day of F€nk>~.A..j , 2005, before me, the undersigned officer, personally appeared Michelle Souders, known to me (or satisfactorily proven) to the person whose name is subscribed to the within instrument, and acknowledged that she executed the same in the capacities and for the purposes therein contained. SS. IN WITNESS WHEREOF, I hereunder set my hand and official seal. ~ap~ "fS.. AL SEAL JULlEANNE. AMETRANO, Notary Public City of Harnsburg, PA Dauphin Count'} MV Co;nmission bpires Feb. 22, 2007 ~ -'"'.:'- ,;--"r'-" :'-.: ;-""~ ;-> BUREAU OF INDIVIDlrAl.,)TAXES' INHERITANCE TAX OIVISIQ~" PO BOX Z80601 HARRISBURG PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT '* REY-ln7 EX iFP (12-041 30 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-31-2005 SOUDERS 08-09-2003 21 03-~ CUMBERLAND 101 CLARENCE A '\~s KAREN [lKOENIGSBERG DISSINGER & DISSINGER 28 N 32ND STREET CAMP HILL PA 17011 Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ~~:r~~~.!5r.A~~..CG1~.6!1.......i;...fA~f~~e1r.fl5r.~tA"~A~.b~.l~ciSO~...i[i..................... ESTATE OF SOUDERS CLARENCE A FILE NO.21 03-0235 ACN 101 DATE 01-31-2005 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-06-2004 PRINCIPAL TAX DUE:. 8,719.93 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 05-07-2004 CD003913 .00 10,085.75 01-14-2005 REFUND .00 1,365.82- TOTAL TAX CREDIT 8,719.93 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 . SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) ~'S.' STAT1.'S RE?ORT t.."Nl:'E~ R'l0l2 6.12 :-Ia.!n~ ::;fDecebnt: t\nnh. \..1.- A So v.dlX~ rJ~"fD"'h Dt~~ ~llD3-- Wirr--::\;o. ~ D~ _ L'J..S ..1.,1",;.. L40.: --- ?'..l.iSuilnt tI) Rul: 5.12 of the S:rpreme Court Orphans' Court RutS';;, I rej.h)I."! tb.;- following w:th respect to com.?letion ,)fthc a~jst:ation of6~ a~ove-ca.ptioued estate: ., swe-~'~eT administ:atbn o:-the es....ate is co:np~cte: Yes 0 No 0 2. If the mswer:5 No, st.a:~ when the perso:lal represC4:La6e reasonably be:.ie-.,.,;'s that th;;: a&.l.iu:a::ation ~iL be comp:ete: 3. If the a.n.,"wer:o No.1 i. Y~s, s:Jlle t:t~ 61lowmg: a Did the pe^~J,:::rI rep~ntative fd~ .1 fu:.al acco\ot wi:b, 6e Court? Yes _ No 0" b The separate Orphan.>' Court No. (if any) for the persMal represen:ative's a:;count is: _.IV p.. ~. ?i~ tJe pe~3~t:cJ ~sez:.t::",tiYe state aJ:. a::c:n':LI :.:1fc.m:cJJy to the pa..-:ies 1.;1 mterest. I es ~ No C c. Copies ofrecerpts, teleases,jomdeIs fmd appr;J,\'al offornal or infoI!Ilal aCC'JUllts may be fikd with the Ck::( ofrb.~ O:-pha.=s' C01.:11 and roa.y be <.ttachcd t.c tr..isrep::rt. "b,'S$'?3 <'"01' f: . '....):Jl" r Da_Lc:-2b/lo~ CAI, /~ .' ... S :g:lJ.!UI6 ~ w't/iCtvv] f D;:55;('IJ-C~ Nam~ 'If A) S 5+/.,1(' f!cJ /})ti"y~V, Ife Prt /70s 3 ~.::t'" (..:.1 Adc.ress 71/ -CjSl- 3<-( 7 Y.. Te:eph'::,n-:. >1.) C::aC3.Cit"i: r-:~"'5r;~~1 R~":>'~""'''''-,r..:.:.. :-:J Pe. V~.l.';".... -'_~_"'';'-'__'':'_\.p- C] CQ"jr.3el !o: ?::::-~(!:-:~;:.~ T~:-,:~',~~.'~:.:~!i~,':: - .:. cd Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/13/2005 SOUDERS CAROL ANN 318 ROSEWOOD LANE ENOLA, PA 17025 RE: Estate of SOUDERS CLARENCE A File Number: 2003-00735 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 8/09/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge ~