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Home My WebLink About03-0506PETITION FOR PROBATE and GRANT OF LETTERS Estate of Anna K. Lehman also known as N/A, Deceased. Social Security No.: 209-12-8646 No. 21 -03 -~0~ To: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioners who are 18 years of age or older and the Executrices named in the last will of the above decedent, dated October 26, 1993, and codicil(s) dated: None. Decedem was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 733 Sandbank Road, Mount Holly Springs, Pennsylvania 17065 (Dickinson Township. Decedent, then 89 years of age, died June 7, 2003, at Green Ridge Village, 210 Big Spring Road, Newville, Pennsylvania 17241-9486. Except as follows, decedent did not marry, was not divorced and did not have a child bom or adopted afar execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: No exceptions. Deced~t 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: $ 45,000.00 $ $ $ 100.00.090 WHEREFORE, petitioners respectfully request the probate of the last will and codicil(s) presented herewith and the grant of letters Testamentary thereon. Donna M. Yeingst 1136 Goodyear Road Gardners, PA 17324 717-486-7238 Carold~e B. N~ew6a~er 383 Burgners Road Carlisle, PA 17013 717-240-0528 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ) ) SS COUNTY OF CUMBERLAND ) The petitioners above-named swear or affirm that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioners and that as personal representatives of the above decedent petitioners will well and truly administer the estate according to law. Sworn to-or affirmed and subscribed before me z¢.,~ ....... ~ ~ thih0 ~ da3, of _~ Donna M. Yeingst ~. Otto, i~?rst l~p~..'~g~ter ~ Carolin~ ti. Newamer NO. 2 1- 03-..~0~ Estate of Anna K. Lehman, Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW June _a~d~)~, 2003, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated October 26, 1993, described therein be admitted to probate and filed of record as the last will of Anna K. Lehman and Letters Testamentary are hereby granted to Donna M. Yeingst and Caroline B. Newcomer. FEES Probate, Letters, Etc ...... Short Certificates ( ) ..... ~,~~.30_.p' ° ..$ ~.00 $ lO TOTAL $ ,eqlaq . o0 Filed: June ,e,O0 ,2003 Robert R. Black, Esquire 36 South Hanover Street Carlisle, PA 17013 (717) 243-3727 (06267) 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 P 8283907 No. JUN 1 Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH Anna K. Lehman 5/20/1914 733 Sandbank P,d. ~.0 ~/0 ~,~ Cumberland Whlte 6/11/03 ~e~0~inster Cemetery Car~iste PA 17013 :ory 501N. Batti t\ LAST WILL AND TESTAMENT OF ANNA K. LEHMAN I, ANNA K. LEHMAN, of Dickinson Township, Cumberland County, Pennsylvania, make this Will, revoking all my former wills and codicils. ITEM I: I direct that all my just debts, funeral expenses, and administration expenses, including my grave marker, shall be paid from the assets of my estate as soon as practicable after my decease. ITEM II: I devise and bequeath all of the residue of my estate, of every nature and wherever situate, to my children and step-children in the following percentages: B. C. D. E. F. Donna M. Yeingst, twenty percent. Ronald C. Matthews, twenty percent. William F. Matthews, twenty percent. Caroline B. Newcomer, twenty percent. Richard S. Lehman, ten percent. Jean C. Levin, ten percent. The share of any of my children or step-children who do not survive me shall be added to the shares of my surviving children and step-children in the same proportion as set forth herein. ITEM III: I direct that all taxes which may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. ITEM IV: I appoint my daughters, Donna M. Yeingst and Caroline B. Newcomer, or the survivor thereof, as Executrixes of this, my Last Will. ITEM V: I direct that neither my Executrixes, Guardian, Trustee, nor their successors shall be required to give bond for the faithful performance of their duties in any jurisdiction. initials IN WITNESS ave hereunto set my hand this ~-~ , 1993. Anna K. Lehman, Testatrix (SEAL) The preceding instrument, consisting of this and other typewritten pages, each identified by the signature of the Testatrix, Anna K. Lehman, was, on the day and date thereof, signed, published, and declared by Anna K. Lehman, the Testatrix therein named, as and for her Last Will, in the presence of us, who, at her request, in her presence and in the presence of each other, have subscribed our names as witnesses thereto. COMMONWEALTH OF PENNSYLVANIA ) : COUNTY OF CUMBERLAND ) We, Anna K. Lehman, Robert R. Black, and Li~D~ ~ ~. , the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will, and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness, and that to the best of their knowledge the Testatrix was at the time eighteen years of age or older, of sound mind and under no constraint or undue influence. Testatrix Anna K. Lehman Witness Robert R. Black Witness Subscribed, sworn to and acknowledged before me by Anna K. Lehman, Testatrix, and subscribed and sworn to before me by Robert R. Black~n~ i_,~0~ ~ ~. . , witnesses, this ~/ day of ~ 1993. ANNA K. LEHMAN '03 JUN 20 ~]0:38 LAW OFFICES LANDIS BLACK ~ $CHORPP 3~ SOUTH HANOVER STREET CARLISLE, PENNSYLVANIA I7013 CERTIFICATION OF NOTICE UNDER RULE 5.6 (c) Name of Decedem: Anna K. Lehman Date of Death: June 7, 2003 Will No.: 21-03- To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on · June ~O, 2003 Name Donna M. Yeingst Caroline B. Newcomer William F. Matthews Ronald C. Matthews Richard S. Lehman Jean C. Lehman Address 1136 Goodyear Road, Gardners, PA 17324 383 Burgners Road, Carlisle, PA 17013 17355 Hilltop Ridge Drive, Eureka, MO 63025 23 Kitszell Drive, Carlisle, PA 17013 105 Day Break Drive, Kemersville, NC 27284 1833 Laurel Oak Drive, Modesto, CA 95354 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None Date: (p/~O/O~ Robert R. Black, Esquire 36 South Hanover Street Carlisle, Pennsylvania 17013 Telephone (717) 243-3727 Capacity:.~ Personal Representative X 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 002943 BLACK ROBERT R 36 S HANOVER STREET CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 209-12-8646 FILE NUMBER: 2103-0506 DECEDENT NAME: LEHMAN ANNA K DATE OF PAYMENT: 08/26/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 06/07/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I 96,000.00 REMARKS: TOTAL AMOUNT PAID: CAROLINE B NEWCOMER,EXECUTRIX C/O ROBERT R BLACK ESQUIRE 96,000.00 SEAL CHECK# 118 INITIALS: JA RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003463 BLACK ROBERT R 36 S HANOVER STREET CARLISLE, PA 17013 fold ESTATE INFORMATION: SSN: 209-12-8646 FILE NUMBER: 21 03-0506 DECEDENT NAME: LEHMAN ANNA K DATE OF PAYMENT: 01/21/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 06/07/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $1,939.61 ~REMARKS: TOTAL AMOUNT PAID: RECEIVED OF CAROLINE B NEWCOMER IN C/O ROBERT BLACK $1,939.61 SEAL CHECK# 128 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH DEPUTY REGISTER OF WILLS REGISTER OF WILLS I-- Z UJ I.U 0 CO z z 0 O 0 O X REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FiLE NUMBER 21 . 03 - 0506 , ~,. ~.SEuUR~ Y NuMBE,~ DECEDENT S i'~A!;iE 'LAZ FIRST. kND Mi2.OLE ihiITIAL ..... ~~~?~ ............ r ........................ ' 209 - 1Z.___- 86_~_6 ..... D~TE ,DF DEATH ~ ?,,".-DD-', EAR, DATE DF BIRTH ,f~&!~DD-¥E,:~R THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 06/07/2003 ~, 05/20/1914 REGISTER OF WILLS dF APPLICABLE) SijR'~ ~,~NG SPOUSE'S NA~,,IE ,.LAST. FIRST AND ~4, iDDLE iNIT!ALi { SOCIAL SECURITY NUE,!BER ~_~ 2. Supplemental Return ~, 3 Remainder Return :ia!e of ?,at~, F/io, :o !~ i'~ 82 ~4a. Future Interest Compromise r~te ,~f :~e~h ~,~¢ 12-!2-,32 ~ 5 Federal Estate Tax Return Required ~ 7 Decedent Maintained a Living Trust attacr, :sp~, :f rr:,s:) ~0 8. To,a Number of Safe Depos~ Boxes ~I0 Spousal Poverty Credt date }f :oath beu,,een !2 31-9~ ,and I 1-95) ~ !i. Eiect~on to tax under Sec 9113(A)i:qta, h s,:~ ,s NONg ~I Original Return ~ 4 Limited Estate _~6 Decedent Died Testate ,~tt:~¢ c~F~? :~f','~ ~ ~9. Litigation Proceeds Received THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME Robert R. Black, Esquire FIRM NAME UfApplicable) Landis & Black TELEPHONE NUMBER 717 -243-3727 COMPLETE MAILING ADDRESS Robert R. Black, Esquire Landis & Black 37 South Hanover Street Carlisle, PA 17013 14. t. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 25,528. O0 3. Closely Held Corporation, Padnership or Sole-Proprietorship (3) 0. O0 4. Mortgages & Notes Receivable (Schedule D) (4) 0. O0 5. Cash. Bank Deposits & Miscellaneous Personal Property (5) 15,551,82 (Schedule E) 6. Jointly Owned Property (Schedule F) (6) 0 · 00 [~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 13,137.99 (Schedule G or L) 8, Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 19,726.92 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule i) (10) 145.92 11, Total Deductions (total Lines 9 & 10) 12, Net Value of Estate (Line 8 minus Line 11) !3. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) 149,108.00 .' (8) 203,325.81 (11) 19,872.84 (12) 183,452.97 (13) 0.00 (14) 183,452.97 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a (t.2) 16. Amount of Line !4 taxable at lineal rate 183,452.97 x .o 45 (15) (16) ............. _8,25~_5.:.39__ !7 Amount cf Line 14 taxable at sibling rate 18. Amount of Line !4 taxable at collateral rate x ~2 x !5 19. Tax Due ¢8) > > 8E SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Decedent's Complete Address' · .... ~ ISTREET ADOR~A:q _~a K. Lc~bman f.... 733 Sand Ba~ Road ~i~' Mount Holly Springs ' PA zip 17065 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty 6,000.00 315.78 Total Credits ( A + B + C ) (2) 6,315.7 8 Total tnterestJPenalty ( D + E ) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (5A) _ B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB) Make Check Payable to: REGISTER OF WILLS, AGENT (3) 0.00 (5) 1,939.61 R.RR 1,939.61 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... [] [] 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 decedent own an Individual Retirement Account, annuity, or other non-probate properly which contains a beneficiary designation? ........................................................................................................................ [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and betief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS Donna M. Ya~ngs~ ' 1136 Goodyear Road, Gardners, PA . ~,~,;¢(~,~~;~ DATE caroline ¢. Newc~e 393 Bur~ers Road, Carlisle, PA SIGNATURE OF~E.P/~ER (~T_HE~R T~,N REPRESENTATIVE ADDRESS R~ R. Black, Es~ire 36 Sou~ H~over S~eet, Carlisle, PA 17013 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1)(i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)l The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still app!icable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9!16(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Estate of Anna K. Lehman SCHEDULE A REAL ESTATE File Number 21-03-0506 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defmed as the price at which property 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 jointly-owned with fight of survivorship must be disclosed on Schedule F. Item Number Description All that certain tract of land with the buildings and improvements erected thereon situate in Dickinson Township, Cumberland County, Pennsylvania, known as and numbered 733 Sand Bank Road, Mount Holly Springs, Pennsylvania 17065, parcel # 08-32-2332-006. See HUD, attached hereto, and net proceeds of sale set forth therein. Value at Date of Death $149,108.00 TOTAL (Also enter on line 1, Recapitulation) $149,108.00 Estate of SCHEDULE B STOCKS AND BONDS Anna K. Lehman All property jointly-owned with Right of Survivorship must be disclosed on Schedule F. Item Value at Date Number Description of Death 1. $988.80 File Number 21-03-0506 32 trust units of MetLife at $30.90 per unit. See attached trust statement. Investor ID 8065-4699-8958. Wachovia Securities Financial Network, investment account #5143-5732. Account Value 5/31/2003 = $24,297.66 Account Value 6/30/2003 = $24,780.73 See attached statements, average balance = $24,539.20 $24,539.20 TOTAL (also enter on line 2, Recapitulation) $25,528.00 Estate of Anna K. Lehman SCHEDULE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY File Number 21-03-0506 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. Item Number 2. 3. 4. 5. 6. 7. o 10. Description PNC checking account #51-4018-7113. Balance as per attached statement. PNC savings account #51-3032-2844. Balance as per attached statement. Harman's, sale of coins. Commonwealth of Pennsylvania, property tax refund. Shipley Oil Co., refund. Shipley Oil Co., refund. Roy Guttshall, Auctioneer. Public sale of personal property less expenses of sale. See attached summary. Highmark Insurance Co., refund of premium. MetLife Insurance Co., policy 22274097-A. Life insurance proceeds $3,260.52 divided among four beneficiaries. Non-taxable. See attached. Miscellaneous cash. TOTAL (also enter on line 5, Recapitulation) Value at Date of Death $686.74 $1,626.38 $467.00 $50O.OO $262.49 $140.00 $11,507.75 $343.46 $0.00 $18.00 $15,551.82 Estate of SCHEDULE G TRANSFERS File Number This schedule must be completed and filed if the answer to any ofquestiom 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM DRSCI/IPTION OF PROPERTY DATE OF DEATH % of NUMBER Include name of the transferee, their re4~tiomhip to decedent, VALUE OF ASSET DECD'S EXCLUSION TAXABLE date of tramfer INTEREST Of al~a~t'~ie) VALUE 1. Thrivent Financial for Lutherans $19,060.93 annuity contract #3846209. Total death claim proceeds, $19,060.93, payable in equal shares to: A. Caroline B. Newcomer, daughter $9,569.00 50% $3,000.00 $6,569.00 383 Burgners Road Carlisle, PA 17013 B. Donna M. Yeingst, daughter $9,568.99 50% $3,000.00 $6,568.99 1136 Goodyear Road Gardners, PA 17324 See attached documents. TOTAL(Also enter on line 7, Recapitulation) $13,137.99 Estate of ITEM NUMBER 2. 3. 4. B. 2. 3. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Anna K. Lehman SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS File Number 21-03-0506 DESCRIPTION Funeral Expenses: Hollinger Funeral Home, funeral bill. Westminister Cemetery, grave opening. Westminister Cemetery, marker. Eby Granite Works, marker. Administrative Costs: Personal Representative Commissions Attorney Fees Family Exemption Claimant: NONE Probate Fees, advanced by Landis & Black. Accountant's Fees Tax Return Preparer's Fees MetEd, invoice. Sprint, invoice Comcast Carolyn McQuillen, Tax Collector, school real estate taxes. MetEd, invoice. Sprint, invoice. Borough of Mount Holly Springs, water invoice. Orrstown Bank, check order. Sprint, invoice. TOTAL (Also enter on line 9, Recapitulation) AMOUNT $7,370.60 $945.O0 $185.00 $756.00 $0.00 $7,500.00 $432.43 $0.00 $0.00 $32.08 $40.54 $39.80 $1,171.81 $69.34 $92.62 $41.48 $15.75 $0.76 continued next page Estate of: Anna K. Lehman Item Number 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. CONTINUATION SCHEDULE Continuation of Schedule H Description Barrett Real Estate, appraisal. Sprint, invoice. MetEd, invoice. Terminex, contract. Borough of Mount Holly Springs, water invoice. MetEd, invoice. Terminex, contract. MetEd, invoice. MetEd, invoice. Reserve for closing and filing Releases. Amount $275.00 $48.71 $26.58 $58.30 $18.68 $13.67 $58.30 $14.12 $20.35 $500.00 TOTAL (also enter on line 2, Recapitulation) $19,726.92 Estate of SCHEDULE I DEBTS OF DECEDENT MORTGAGE LIABIIJTIES AND LIENS Anna K. Lehman File Number 21-03-0506 Include unreimbursed medical expenses. Item Number 1. 2. Description Yellow Breeches EMS, invoice. Presbyterian Homes, care. TOTAL (Also enter on line 10, Recapitulation) Amount $81.75 $64.17 $145.92 r~ate of Anna K. Lehman SCHEDULE J BENEFICIARIES File Number Number I. Name and Address of Person(s) Receiving Property TAXABLE DISTRIBUTIONS (include outright spousal distributions) Donna M. Yeingst 1136 Goodyear Road Gardners, PA 17324 SSN: Ronald C. Matthews 23 Kitszell Drive Carlisle, PA 17013 SSN: William F. Matthews 17355 Hilltop Ridge Drive Eureka, MO 63025 SSN: Caroline B. Newcomer 383 Burghers Road Carlisle, PA 17013 SSN: Richard S. Lehman 105 Day Break Drive Kemersville, NC 27284 SSN: Jean C. Lehman 1833 Laurel Oak Drive Modesto, CA 95354 SSN: ' Relationship to Decedent Do Not List Trustee(s) Daughter Son Son Daughter Son Daughter ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN AaOVE OR LINES 15 THROUGH 17 AS- --.-------.---. , ~PROI~IATE, ON REV 1 ~00 COVER SHEET NON-TAXABLE DISTRIBUTIONS A. Spousal distributions under Section 9113 for which an election to tax is not being made. 1. NONE B. Charitable and Govemrnental Distributions 1. NONE _____TOTAL OF PART II - Enter Total NomTaxabis Distributions on Line 13 of REV 1500 Cover Sheet 21-03-0506 Amount or Share of Estate 20% 20% 20% 2O% 10% 10% L~ST WILL AND TESTAMENT OF ANNA K. LEHMAN I, ANNA K. LEHMAN, of Dickinson Township, Cumberland County, Pennsylvania, make this Will, revoking all my former wills and codicils. ~TEM I: I direct that all my just debts, funeral expenses, and administration expenses, including my grave marker, shall be paid from the assets of my estate as soon as practicable after my decease. ITEM II: I devise and bequeath all of the residue of my estate, of every nature and wherever situate, to my children and step-children in the following percentages: ae B. C. D. E. F. Donna M. Yeingst, twenty percent. Ronald C. Matthews, twenty percent. William F. Matthews, twenty percent. Caroline B. Newcomer, twenty percent. Richard S. Lehman, ten percent. Jean C. Levin, ten percent. The share of any of my children or step-children who do not survive me shall be added to the shares of my surviving children and step-children in the same proportion as set forth herein. ITE~M III: I direct that all taxes which may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. ITEM IV: I appoint my daughters, Donna M. Yeingst and Caroline B. Newcomer, or the survivor thereof as Executrixes of this, my Last Will. ' ITEM V: I direct that neither my Executrixes, Guardian, Trustee, nor their successors shall be required to give bond for the faithful performance of their duties in any jurisdiction. initials day of ~ , 1993. Anna K. Lehman, Testatrix (SEAL) The preceding instrument, consisting of this and other typewritten pages, each identified by the signature of the Testatrix, Anna K. Lehman, was, on the day and date thereof, signed, published, and declared by Anna K. Lehman, the Testatrix therein named, as and for her Last Will, in the presence of us, who, at her request, in her presence and in the presence of each other, have subscribed our names as witnesses thereto. COMMONWEALTH OF PENNSYLVANIA ) : COUNTY OF CUMBERLAND ) We, Anna K. Lehman, Robert R. Black, and ~i~ ~ Rc~ , the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will, and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness, and that to the best of their knowledge the Testatrix was at the time eighteen years of age or older, of sound mind and under no constraint or undue influence. Testatrix Anna K. Lehman Witness Robert R. Black Subscribed, sworn to and acknowledged before me by Anna K. Lehman, Testatrix, and subscribed and sworn to before me by Robert R. Black an~% i_~.~ ~ ~r.~ · witnesses, this ~ day of ~~ 1993. ' ~ Notary' Publi6 Carlisle, {~:, ay Commi$$io~ ~~1, 4,1995 OMB NO. 2502-0265 ~ A. B. TYPE Of LOAN: U.S.'DEPAR'r'I~IENT OF HOUSING & URBAN DEVELOPMENT 1.r--IFHA 2.[--IFmHA 3.~-ICONV. UNINS. 4.[-IVA 5. E]CONV. INS. I~ 6. FILE NUMBER: t 7. LOAN NUMBER: 10734-3.MALLIOS SETTLEMENT STATEMENT 8. MORTGAGE INS CASE NUMBER: I C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "[POC]" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. 1.0 3/98 (10734-3.MALLIOS.PFD/10734-3.MALLIOS/8) D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: Constantinos J. Mallios and Estate of Anna K. Lehman Integrity Bank Chester A. Riley, III. 3345 Market Street 733 Sandbank Road Camp Hill, PA 17011 Mt. Holly Springs, PA 17065 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: I. SETTLEMENT DATE: 733 Sandbank Road Martson Deardorff Williams & Otto Mt. Holly Springs, PA 17065 December 23, 2003 Cumberland County, Pennsylvania PLACE OF SETTLEMENT 10 East High Street Carlisle, PA 17013 J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SE~R: 101. Contract Sales Price 150,000.00 401. Contract Sales Pdce 150,000.00 102. Personal Property 402. Personal Property 103. Settlement Char~les to Borrower (Line 1400) 14,100.75 403. 104. 404. 105. 405. Adiustments For Items Paid Bt/Seller in ad¥~p¢~ Adiustments For Items Paid Bv Seller in ad¥~ 106. County/l'wp. Taxes 12/23/03 to 01/01/04 4.68 406. County/Twp. Taxes 12/23/03 to 01/01/04 4.68 107. School Taxes 12/23/03 to 07/01/04 608.32 407. School Taxes 12/23/03 to 07/01/04 608.32 108. Assessments to 408. Assessments to 109. 409. 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER . 164,713.75 420. GROSS AMOUNT DUE TO SELLER 150,613.00 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCT. IONS IN AMOUNT DUE TO SELLER: 201. Deposit or earnest money 10,000.00 501. Excess Deposit (See Instructions) 202. Principal Amount of New Loan(s) 128,000.00 502. Settlement Char~les to Seller (Line 1400) 1,505.00 203. Existin~j loan(s) taken subject to 503. Existing loan(s) taken subject to 204. 504. Payoff of first Mortgage 205. 505. Payoff of second Mortcja~e 206. 506. :207. 507. (Deposit disb. as proceeds) 208. 508. 209. 509. Adjustments For Items Unpaid By Seller Ad/ustments For Items Unpaid By Seller 210. County/Twp. Taxes to 510. County/Twp. Taxes to 211. School Taxes to 511. School Taxes to 212. Assessments to 512. Assessments to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. '220. TOTAL PAID BY/FOR BORROWER 138,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER I 1,505.00 300. CASH AT SETTLEMENT FROMrro BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER: 301. Gross Amount Due From Borrower (Line 120) 164,713.75 601. Gross Amount Due To Seller (Line 420) 150,613.00 302. Less Amount Paid By/For Borrower (Line 220) ( 138,000.001 602. Less Reductions Due Seller (Line 520) ( 1,505.00', 303. CASH( X FROM)( TO)BORROWER 26~713.75 603. CASH( X TO)( FROM)SELLER 149,108.00 cles 1&2 of this statement & attachments referred to herein. any Borrower ::~ Seller Estate of, An~e K.,L-ehman _ C sg;A. ' HUD-1 (3-86) RESPA, HB4305.2 Pa,~e 2 L. St: ! ! LEMENT CHARGES 700. TOTAL ~OMMISSION Based on Price $ ~. 0.000(~ % PAID FROM PAID FROM ' Divisio'n of Commission (line 700) as Follows: BORROWER'S SELLER'S o 701. $, to 702. $ to FUNDS AT FUNDS AT 703. Commission Paid at Settlement SETTLEMENT SETTLEMENT 704. to 800. I'I't=MS PAYABLE IN CONNECTION WITH LQAN 801. Loan Origination Fee 0.5000 % to Integrity Bank 640.00 802. Loan Discount % to 803. Appraisal Fee to George Clauser 350.00 804. Document Preparation to Integrity Bank 250.00 805. Flood Certification to Integrity Bank 15.0( 806. Mortgage Ins. App. Fee to 807. Assumption Fee to 808. 809. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVAN(~E 901. Interest From 12/23/03 to 01/01/04 @ $ /day ( 9 days %) 902. Mort~la~ye Insurance Premium for months to 903. Hazard Insurance Premium for 1.0 years to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance months ~ $ per month 1002. Mortgage Insurance months (~ $ per month 1003. County/Twp. Taxes months (~ $ per month 1004. School Taxes months ~ $ per month 1005. Assessments months @ $ per month 1006. months (~ $ per month 1007. months @ $ per month 1008. months ~ $ per month 1100. ~1 i'LL CHARi~ES 1101. Settlement or Closing Fee to 1102. Abstract or Title Search to 1103. Title Examination to 1104. Title Insurance Binder to 1105. Document Preparation to 1106. Notary Fees to 1107. Attorney's Fees to Robert Black, Esquire POC (includes above item numbers: 1108. Title Insurance to Lawyers Title Insurance Company 1,108.75 (includes above item numbers: 1109. Lender's Coverage $ 128,000.00 ) 1110. Owner's Coverage $ 150,000.00 1111. Endorsements 100/300/900 to Lawyers Title Insurance Company 150.00 1112. 1113. 12 . VERNMENTR RDIN AND RAN FE CHAR E 1201. Recording Fees: Deed $ 38.50; Mortgage $ 48.50; Releases $ 87.00 1202. Ci~ Deed 1,500.0~e 1,500.00 1203. State Tax/Stamps: Revenue Stamps 1,500.00; Mortgage 1204. 1,500.00 1205. 1 00. ADDI I NAL E'i-FLEMENT CHARGES 1301. Survey to 1302. Pest Inspection to 1303. Final Water/Sewer to Mt. Holly Springs-Water/Sewer acct #1301 5.00 1304. Septic to Stanley Dye 1305. 10,000.0C '1400. TOTAL S= I I LEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K) 14,100.75 1,505.00 By signing 13aQe 1 of this statement th~_ ~inn~fnri~ ~'-bnn~A,l~a ...... I,~- ~,~ ..... ~-& .......... Certified to be a true copy. pt of a completed copy of page 2 of this two page statement. son Deardorff ~¢~liams & (~lt~o ' Settlement Agent ( 10734-3.MALLIOS / 10734-3.MALUOS / 8 ) MetUfe Policyholder Trust Statement RETAIN FOR YOUR RECORDS INA K LEHMAN Account Market Value Stock F~ce as of Total Market ,/o7/2003 v~ue 2003 Dividend Summary Reoord Dme Tolal Trust ~ per Current Interests Trust Interest Distribulion Payable Date Tax W'~hheld Net ~ Prior Year Distribution de Program, as amended. A copy of the brochure describing the program is ailable oc the Internet at www.metiife.com by selecting Investor Relations d then the Shareholdar Services Information page, or by calling the number ted be~w. You are pe~nitted to transfor your Trust Interests only in the ~cumstances described in the brochure. You may also instruct that all (but ~ le~ than all) of your shares of MetLife, Inc. common stock held by the ust be ~hdrawn from the Trust. Information regarding your ~l~lra~al Ihts may be found in the Purchase and Sale B~ochure m by calling the An annual shareholders' meeting to elect members of the Board of Directors on April 27, 2004. The deadline for submitting shareholder proposals for consideration at this meeting was November 28, 2003. A copy of MetLife. Inc.'s annual repo~ and proxy statement will be available free d charge on or before March 31, 2004, along with othar MetLife, Inc. and Policyholder Trust filings undar fedaral securities laws, (i) on the intemet at www.m~;;;u.com on the Investor Relations portion of the website, (ii) by writing to MetLife, Inc. at the address listed below or (iii) by calling the number listed below. These and other securities fiiings by MetLife and the Policyholder Trust am also available inquiries about your account, the stetus of your Trust Interests, or discrepancies on this statement, contact inforrn~k~ is listed below: '5861 Internee m~v. melloninvestor.c~lVisd Geeend Mall:. MelLIfe, Irt. ~ 1-800-64g-3693 P.O. Box 4412 South Ha~kensaek, NJ 0760~2012 ~u are receiving the enclosed check because you are a Beneficiary of the MetUfe Por~jholder Trust. Your Trust temsts (shares) receive dividends paid on MetUfe, Inc. common stock. The Trust wes established in connection ith the conversion of Metropolitan Life Insurance Company from a mutual comparE to a company with vestor ID located in the upper right hand corner above. The automated system will instruct you on how to ~oflerly update your account. The automated system is available 24 hours a day, 7 days a week. I~e miginal account ltolOer 18 ~lecealled. How do I transfer the account? ; order to transfer the account, pleese provide us with the following information to the addmss listed above: A letter of instruction c~ the transfer you would like to complete; 2) The name, address and taxpayer ID 3wer form, signed by the legal n~ and guaranteed with a medallion stamp* and, 4) A ~ copy the death ce~iflcate. You may also need an original Inheritance Tax Waiver if required by your State. For quick and easy access to your account information log on to www.melloninvestor.com/isd M WACHOVIA FINANCIAL Investment Account ...................................................... Statement for .................................................. ~ ...... ANNA K LEHMAN Page4 of 3 ur Registered Representative: :HARD'PUlE;ELL 3 YORK ROAD RUSLE PA 17013 ~-243:b619 irrent Investment Objective: Growth & Income + Moderate 'ortfolio Summary Sub / Rep Account No. 072 / EA01 5143-5732 ~rtfolio assets Est. Ann. % total Value on Apr 80 Value on May 31 Income assets ~sh and money market $2,271,81 $2.276.06 5.56 9.37 3cks and options $0.00 $0.00 0.00 sferred stgcks $0.00 $0.00 0.00 ,nds $15,614.10 $15,921.60 1,125.00 65.53 Jtual funds $6,025.00 $6,100.00 600.00 25.11 ~nultias $0.00 ~;0.00 0.00 tit investment trusts $0.00 $0.00 0.00 ,tal eeeete $23,910.91 $24,297.66 1,730.56 100% ltstandina marain balance $0.00 $0.00 0..00 ~t portfolio value $23,910.91 $24,297.66 her asset6 ~e.s.e posi.t}ons, reflect purcha, sas..made th,rough us or information supplied to us; .they are d splayed · m~ormat~oneJ purposes only. ii' you no ;onger own any of these investments, please tell us so we ~eUc~at~y S~l~.ectlon. These assets are not indud,kl in the net portfolio value, and are not Value/Cost on Apr 30 Value/Cost on May 31 rect investments $0,00 $0,00 ,aclal products ~0.00 ~).(~ )tal other assets $0.00 . E~N01 007330 151152022133 NNNNN NNNNN NNNNNNNN 000002 Statement period: May 1 - May 31,2003 /resets allocation (portfolio assets) ] Cash and money market B Bonds Mutual funds Cash Activity Summary Total cash and money market funds on Apr 30: Credits .~;~71,81 Debits Year-to-d_~_t~ Securities purchased Securities sold and redeemed $0.00 $0.00 Deposits and withdrawals $0.00 withdrawals by check $0.00 Electronic banking activity $0.00 Dividends $50.00 Interest $93.75 Money market income $0.50 Short term distributions $0.00 Long term distribuUons $0.00 Return of principal $0.00 Partnership Distributions $0.00 Interest cha~ed $0.00 Withholding $0.00 Other activity $0.00 Total activity $144.25 Total cash and money market funds on May 31: $0.00 $0.00 $o.oo $o.oo $o.oo $o.oo - $140.00 - $700.0n $o.oo $o.oo $o.oo $250.00 $0.00 ,$468.75 $0.00 $3.~ $o.oo $o.oo ~.0o SO.On ~.oo $o.oo $o.oo $o.oo $o.oo $o.oo $0.o0 $o.oo ~.oo $o.oo · $140.00 Tax-exempt Income year-to-date: $0.00 Other income year-to.date: $718.75 Tax-ex .empt. in.c,?m? .an~l.. other i.n. come year-to-date .totaJ. s ara.taken from the tax reporting system. They may.no~ ...match. DaC. K TO ~'? a~tivily s. ummary aDov.e aue to reaasslflcation activity. Money market income .can. os. e~n .er .ta~l:)le o..r ~ ex. er[1. pt and is not reflected I_n these totals. The YTD Money market income !.s a). s.p~ay.ea aDo.va in me ~.asn Activity Summary. ~ ne uash Activity Summary is based on the activity mat nas..t~en shown on mis statement, not what will be reportadto you on your forms 1099. This statement ~s not a tax document, and should be used for informational purposes only. FINANCIAL I~TE T'WORIt ANNA K LEHMAN Page,. Your Registered Represental~ve. RICHARD -PURSELL ' 205 YORK ROAD CARLiSLE PA 17013 717-243~61g Current Investment Objective: Growth & Income + Moderate Portfolio Summary L!onds .Mutu~ ~.d~---~ _Annuities Unit investment trusts Total easels Outstandin.q mar~alance Net portfolio · positions reflect purchases mede through us or info for informational purposes onl If o rrnation s. upplied to us' the ?.?, u ate this sec,on Th~eY~e ~ u no longer o.._wn any of th.e. se ,nvestments. prote~ by $1PC ' sets are not ,ncluded n me , . ne, ~,,,,,~,.u value, ana are not ~ Value/Cost on May 31 Value/Cost on June 30 .~pecial produc- ' ' ~ $0 O0 -- . Total other assets ~ - $0 O0 so.aa Sub / Branch / Rep Account No. 072 / EA / EA01 5143-5732 ~ Statement period: June 1 June 30, 20~ Cash and money market Bonds Mutual funds ~Valu_e_on__M_a 31 Value on '--~ o- E.st. Ann. % total $15,921.60 $15,~85.60 $6,100.00 $o. oo ;o,0o . oloo _ Cash Activity Summary $24,297.66 ?____~.00 ~~~ T t ~ s-~L~)~L~ney on $24,297.66 $24~ E~N02 011627 182172712133 Credits _Debits Year-to-date _~_~curitles purchased ~ $0. O0 Securities sold and redeemed ---- OL.O~ D__eposits and wi_____._~drawals $0.00 $0.00 OL.Oc Withdrawals b check $0.00 $0.00 $0.00 Electronic bankin activit~ $0.00 $0.00 -- $0.00 - $700.00 Dlvide..____._nds $0,00 $0.0~ Interest $50.00 $0.00 $300.0~ ~come $93.75 $0.00 _$_562.5~ -- $0.32 $0.00 Shjrt term distributions $0.00 $3.55 L._OnCl term distributions $0.00 $0.0~ ~a~---~ $o. oo ~o.oo _~o.o-~ $o.oo $o.oo P_artnership Distributions $0.00 __ $0.00 [merest charged $0.00 $0.00 ~ $o.oo $o.oo Other_.__~activity _ _$_0. 00 $0.00 __ $0.~ ~ $o.oo__ $o.oo so.od $144.07 $0.00 Total cash and money market funds on June 30: Tax-exempt income year-to-date: $2,420.13 Other Income year-to-date: $0.00 TmaX'exe. mpt income and other income ,,ear t^,~ ........... $862.50 ay not match back to the activi summa ' "'~= ~o~a~s are ~aKen tram the tax reportin s stem .can be either taxable or ~ ..... ~-"- ~. ry a~. ov.e d.ue.to reclassification activi*,, ~^~!.g-~:-Y .... . They ,,~ ,~x~mp[ ano IS no! rerlec~e(:l ' · .,,,,.,,~,y mar~e[ Income ~_d. ls, play.ed abe.ye in the Cash Activity Summ.~, 'r~., ~t~.~es.e !.o~ls;.The ~5 Money market Inc YY, NN NN,NNNNNNNNNN 000002 ~te~l~nt?nno~an~xn~u~mieSn~.tltr~dms~l~ot~j~i?~:et ~/!~ .~;;~J~r~l~yto~uymoumoar~n ~obu~oe~rrn°~ ltho~a.c~Mn~sY , usaa tar inrormational purposes only. ' Page: 1,Document Name: untitled STMT CO ACTION PROD CODE DDA ACTN STFD 1 THF TRANSACTION STATEMENT FORMAT 03/06/24 11.44.48 40 OP MS 50861 LAST PAGE OF TRANSACTIONS PAGE 5 SEARCH FROM 03/04/07 THRU 03/06/24 ACCOUNT 5140187113 SHORT NAME LEHMAN ORRIE S .13 I-GEN103060500005391 INTEREST PAYMENT 06/24 .05 C I-GEN103062400000001 INTEREST PAYMENT 06/24 .00 D PH01231 OUTSTANDING ITEM CLOSE POST EFFECTIVE TRACE ID * 06/04 028445125 XMKT * 06/04 029123616 * 06/05 028704477 * 06/05 00020031555946798 * 06/05 CHECK NUMBER TRAN AMOUNT D/C DESCRIPTION 3751 140.00 CHECK 3751 REFERENCE NO. 3753 63.80 CHECK 3753 REFERENCE NO. 3752 125.00 CHECK 3752 REFERENCE NO. 4.00 019072100000 JUN DUES C BALANCE D 879.36 028445125 XMKT D 815.56 029123616 D 690.56 028704477 D 686.56 PRIORITY 50 PLUS 686.69 686.74 686.74 PF: 4-TOP 5-BOTTOM 6-INQ 7-SB 8-SF 9-ASUM 10-TRIG ll-CUTO 12-XTFD -STSM Page: 1.Document Name: untitled STMT CO ACTION PROD CODE DDA STFD 1 THF TRANSACTION STATEMENT FORMAT 03/06/24 11.45.08 40 OP MS 50852 ACTION COMPLETE PAGE 1 SEARCH FROM 03/01/31 THRU 03/06/24 ACCOUNT 5130322844 SHORT NAME LEHMAN ANNA K ACTN POST D/C TRACE ID DESCRIPTION * 01/31 .48 C I-GEN103013100016657 INTEREST PAYMENT * 02/28 .43 C I-GEN103022800016299 INTEREST PAYMENT * 03/31 .49 C I-GEN103033100016474 INTEREST PAYMENT 04/30 .46 C I-GEN103043000015922 INTEREST PAYMENT 05/31 05/30/03 .49 C I-GEN103053000015627 INTEREST PAYMENT 06/24 .32 C I-GEN103062400000001 INTEREST PAYMENT 06/24 .00 D PH01231 OUTSTANDING ITEM CLOSE EFFECTIVE CHECK NUMBER TRAN AMOUNT BALANCE 1,624.19 1,624 . 62 1,625.11 1,625.57 1,626.06 1,626.38 1,626.38 PF: 4-TOP 5-BOTTOM 6-INQ 7-SB 8-SF 9-ASUM 10-TRIG ll-CUTO 12-XTFD -STSM OWNER ~..~/~/~, Address FINAL SETTLEMENT Date Date of Sale Auctioneer Other Sale Location Clerk Cashier PROCEEDS OF SALE: Cash .............................................. Checks ............................................ Other .......................................................................................... Miscellaneous (see attached list) ............................................ TOTAL PROCEEDS OF SALE ...................... $ LESS SELLER'S SALE EXPENSE: · ~ Auctionee~sFee__~_~_~_ ........................................................ $ ET/~', ~) f Other Seller's Expenses Advanced by Auctioneer: Miscellaneous (see attached list) .............................................. DEDUCT TOTAL SELLER'S SALE EXPENSE ............................... $" I, (or we), the seller of goods, merchandise, and/or property sold at public auction on above date and location, a~ this settlement of proceeds of sale. I (or we) agree to accept all responsibility for providing merchantable title to all goods, merchandise, and/or property sold, and for delivery of title to the purchaser. (Date) (Seller's Signature) (Seller's Signature) Auctioneer or Cashier's Signature Form No. FS Reorder from: MISSOURI AUCTION SCHOOL Phone 1-800-835-1955 MetLife' P..D. BOX 316 WARWICK, RI O2886-O316 Notice of Claim Payment Br/Oist ~ I Date of Notice NAME OF DECEASED ~NNA K [FHMAN DATE OF DEATH CAROLINE B NEWCOMER 383 BURGNERS ROAD CARLTSLE PA 17013-8921 Please See Important Notice on Reverse Side )licy Number des Refer to ~ages Below. ~ms Payable licy Amount e-Year Term Insurance ditional Insurance qdends With Interest idend to Policyholder 'minal Dividend ~mium in Advance ~rest on Claim ductions mium in Arrears n n Interest 22274097 A A,B 2500. O0 535.79 101.05 1OO.OO 23.6~ 'OTAL ;HARE 3260.52 815.13 · OUR CHECK FOR TNE BALANCE DUE IS ATTACHED BELOW. · WE HAVE COMPLETED A SEARCH OF OUR RECORDS, BUT WERE UNABLE TO IDENTIFY ANY ADDITIONAL INFORCE POLICIES. This claim has been approved for the total of the amounts appearing in the boxes below. Items determining these amounts are listed to the left. Amount Held fa' Deferred Payment Printed in Ug.A, ietLif Detach stub before cashing licy Number(s) 2227~097 A i:' me of Insured ' :. L : : ##A K LEHJ~AN . . to the Order of: · ~ase Manhattan Bank ,~aze ManhaP~an plaza (~ NY I~81 Met. it Pays. 623: JY451S-SCRE(~/9i ) 1¥2/210 JThrivent Financial for Lutherans' EXPLANATION OF DEATH CLAIM PAYMENT ON CONTRACT 3846209 Page 1 of I Paid To: Caroline B Newcomer 383 Burgners Rd Carlisle PA 17013 Notice Date: 07/17/2003 Claim Number: 310508 The following table summarizes the payments made on contract 3846209 held on the life of Anna K Lehman BASIC COVERAGE ADDITIONS INDEBTEDNESS TOTAL PROCEEDS $19,060.93 $0.00 $0.00 $19,060.93 Basic Coverage = Cost Basis + Taxable Gain Additions = 0 Indebtedness = 0 DATE PAID PAYMENT TYPE AMOUNT PAID ** INTEREST PAID 07/17/2003 Check $ 9,569.00 $ 38.53 **Each payment includes the amount of interest shown in Interest Paid column. You have $0.00 remaining to be distributed from the claim on this contract. If you are required to report any taxable gain or interest payment as a result of this claim transaction, a form 1099R will be sent to you by January 31 of next year. Should you have any questions about this claim, please contact your financial associate THOMAS J SHEAFFER, at phone 717-245-9515. C Caroline B Newcomer 383 Burgners Rd Carlisle PA 17013 CC: THOMAS J SHEAFFER 0165 09996 00 Deceased's Customer ID: 502080259 Caroline B Newcomer 383 Burghers Rd Carlisle PA 17013 ~lease retain this voucher for your records Check No. Date K676678 07 17 03 Amount $9,569.00 Paye~ For Caroline B Newcomer 383 Burghers Rd IN SETTLEMENT OF YOUR CLAIM UNDER CONTRACT 3846209 ON THE LIFE OF Anna K Lehman DECEASED JThrivent Financial for LutheransTM Applelon. Wisconsin · Minneapolis, Minnesota www. thrivent.com I77804 · ~' THIS MULTI-TONE AREA OF THE DOCUMENT CHANGES COLOR GRADUALLY AND EVENLY FROM RED TO BLUE TO RED. .~= ' www.lh~i:~,'~.,/:/..'~V"':~ ~ ~ ~'"":- JULY 17, 2003 ******$9,569.00 · NINE FHOUE/JVD FIVE HUNDRED $1XTY-NLNE DOLLRR$ Caroline B Newcomer 383 Burfners Rd Carlisle PA 17013 ' .J ",,. '" vOID OVER ~,kS~q. O0 ~--. .. PAY TO THE ORDER OF TORED. ,"P,, G ?~G ? ?," ,:DBL, ;l, ]- 5L.L, 3,,: 6 ~3 ell., 3, ?1.. 3, 5,r COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: BLACK ROBERT R 36 S HANOVER STREET CARLISLE, PA 17013 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003714 ........ fold ESTATE INFORMATION: SSN: 209-12-8646 FILE NUMBER: 2103-0506 DECEDENT NAME: LEHMAN ANNA K DATE OF PAYMENT: 03/25/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 06/07/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $270.47 RiEMARKS: "~ SEAL DONNA M YEINGST CHECK# 137 TOTAL AMOUNT PAID: $270.47 INITIALS: AC RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF ZNDTVTDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG,, PA 171ZB-0601 COHHONNEALTH OF PENNSYLVAN/A DEPARTHENT OF REVENUE ZNHERZTANCE TAX STATEHENT OF ACCOUNT REV-I~0? EX AFP (01-03) '04 APR 26 ROBERT R BLACK ESQ LAND/S & BLACK 37 S HANOVER ST CARLISLE PA 17{T~!~ ? DATE 04-19-Z004 ESTATE OF LEHNAN ANNA DATE OF DEATH 06-07-2005 F.rLE NUNBER Z1 05-0506 p ] :~A COUNTY CUHBERLAND ACN 101 Amoun'l: Rem'~ *~ ~ced HAKE CHECK PAYABLE AND RENTT PAYNENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To /nsure prope~ cred1~ ~o your ~ccoun~, submi~ ~he upp.,r portion of ~his form ~i~h your ~ax p~ym~n~. CUT ALONG TH'rS LZNE ~ RETA.rN LONER PORTION FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) ### ZNHERZTANCE TAX STATEHENT OF ACCOUNT ### ESTATE OF LEHHAN ANNA K F.rLE NO. 21 03-0506 ACN 101 DATE 04-19-Z004 THIS STATEHENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NANED ESTATE. SHOIfN BELON ZS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLZCATZON OF ALL PAYNENTS~ THE CURRENT BALANCE~ AND, ZF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 05-08-2004 PRINCIPAL TAX DUE= ........................................................................................................................................................................................................................... PAYNENTS (TAX CREDITS): 8,525.39 PAYNENT RECEIPT D/SCOUNT (+) AHOUNT PAID DATE NUNBER INTEREST/PEN PAID (-) 08-26-2005 01-21-2004 05-25-2004 CD0029~$ CD005465 CD005714 $15.79 .00 .48- 6,000.00 1,939.61 270.47 ZF PAZD AFTER THZS DATE, SEE REVERSE SZDE FOR CALCULATZON OF ADDZTZONAL ZNTEREST. ( ZF TOTAL DUE ZS LESS THAN $1~ NO PAYHENT IS RE~UZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR), TOTAL TAX CREDZT 8,525.39 BALANCE OF TAX DUE .00 ZNTEREST AND PEN. .05 TOTAL DUE .05 YOU NAY BE DUE A REFUND. SEE REVERSE SZDE OF THTS FORH FOR ZNSTRUCTI'ONS. ) PAYMENT: Detach the top portion of this Notice and submit aith your payment made payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check ar money order payable to: REGTSTER OF fITLLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONNEALTH OF PENNSYLVANIA. REFUND (CA): 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-IS13). Applications are available at the Office of the Register of Nills, any of the 23 Revenue District Offices or from the Department's Z4-hour answering service for forms ordering: 1-800-36Z-ZO50; services for taxpayers with special hearing and / or speaking needs: 1-800-447-~0Z0 (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. ZB0601, Harrisburg, PA 171ZB-060l, phone (717) 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SX) discount of the tax paid is allowed. PENALTY: The 15X tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January ED, 1996, the first day after the end of the tax amnesty period. INTEREST: 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 l, 198Z bear interest at the rate of six (BI) percent per annum calculated at a daily rate of .000164. 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 198Z through 2004 are: Interest Daily Interest Daily Interest Year Rate Factor Year Rate Factor Year Rate 198Z ZOX .000548 1988-1991 llX .go0301 ZOOZ 9Z 1983 162 .0004~8 199Z 9X .O00Z~7 2OOZ 6Z 1984 llZ .O00~O1 1993-199q 72 .000192 2003 52 1985 13Z .000~56 1995-1998 9Z .000Z47 ZOO4 ~Z 1986 IOZ .O00Z7q 1999 7Z .000192 1987 9Z .O00Zq7 ZOO0 8Z .000Z19 Daily Factor .O00Zq7 .000164 .000137 .000110 --Interest is calculated as follows: TNTEREST = BALANCE OF TAX UNPATD X NUNBER OF DAYS DELTNQUENT X DALLY I'NTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. Name of Decedent: STATUS REPORT UNDER RULE 6.12 Anna K. Lehman Date of Death: June 7, 2003 '04 Will No. 21-03-506 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: State whether administration of the estate is complete: Yes [] No [] 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: ao Did the personal representative file a fmal account with the Court? Yes [] No [] bo The separate Orphans' Court No. (if any) for the personal representative's account is: C° Did the personal representative state an account informally to the parties in interest? Yes [] No [] Date: d° Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Robert R. Black, Esquire 36 South Hanover Street Carlisle, Pennsylvania 17013 (717) 243-3727 Capacity: Personal Representative X Counsel for Personal Representative BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX D~VZSTON DEPT. 280601 HARRISBURg, PA 17128-0601 COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ROBERT R BLACK ESQ LANDIS & BLACK 57 S HANOVER ST CARLISLE ~eCO~;~": ~ .?4 DATE 05-08-Z004 -- c.~!~" *.iiS~ ESTATE OF LEHMAN DATE OF DEATH 06-07-2005 FILE NUMBER 21 05-0506 HAR -5 P3:44COUNTY CUMBERLAND ACN 101 Amoun'l: Remi'l:'l:ed ANNA K HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEMENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF LEHMAN ANNA K FILE NO. 21 03-0506 ACN 101 DATE 03-08-2004 TAX RETURN HAS: ( ) ACCEPTED AS FILED (X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Es*a*a (Schedule A) (1) 2. S*ocks and Bonds (Schedule B) (2) $. Closely Held S~ock/Par~nershAp Zn~eres~ (Schedule C) ($) q. Not,gages/No,es ReceAvable (Schedule D) (~) 5. Cash/Bank DeposA~s/NAsc. Personal Proper*y (Schedule E) ($) 6. JoAn~ly O~ned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To*al Asse*s APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ad.. Costs/MAsc. Expenses (Schedule H) (9) 10. Dab*s/Mortgage LAabAIA~Aes/LAens (Schedule I) (10) 11. To,al Deduc~Aons 12. Ne~ Value of Tax Re~urn 149~108.00 25~528.00 .00 .00 15z551.82 .00 NOTE: To Ansure proper credA~ ~o your accoun*, submA~ ~he upper portion of *hls form wASh your ~ax payment. 19z157.99 (B) 209,525.81 19,726.92 145.92 15. lq. NOTE: ASSESSMENT OF TAX: 1-~. Amoun~ of LAne 1~ a~ Spousal ra~e 16. Amoun~ of LAne 1~ ~axable a~ LAneel/Class A ra~e 17. A.oun~ of LAne 1~ a~ SAbling ra~e 18. Amoun~ of LAne 1~ ~:axable e~ Collateral/Class B ra~e >al Tax Due 19. PrAncA TAX CREDTTS PAYH~NT DATE 08-26-2005 01-21-2004 (11) (12) Chari*able/Governmen~al Bequests; Non-elected 9115 Trusts (Schedule J) (15) Ne~ Value of Es~a~e Subjec~ ~o Tax (1~) If an assessment ,as issued previously, lines 1~, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. RECEZPT NUMBER 19.872.8~ 189,452.97 DISCOUNT /NTEREST/PEN PAID (-) CD002945 CD005465 INTEREST IS CHARGED THROUGH 05-25-Z004 AT THE RATES APPLICABLE AS OUTLINED ON THE 315.79 .00 REVERSE SIDE OF THIS FORM .00 189,452.97 18 and 19 #ill (~5) .00 x O0 = .00 (x6) 189,452.97 x 045= 8,525.$9 (17) .00 x 12 = .00 (18) .00 x 15 = .00 (19)= 8,525.$9 8,255.40 269.99 270.47 AMOUNT PAID 6,000.00 1,959.61 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ( ZF TOTAL DUE IS LESS THAN $1, NO PAYMENT TS REgUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR 1NSTRUCTIONS.) ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Coaaonaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the laaful Class 8 (collateral) rate on any such future interest. To ~ulfill the requirements of Section 21q0 of the Inheritance and Estate Tax Act, Act Z3 of Z000. (7Z P.S. Section 91q0). Detach the tap portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit, ahich ams not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Xnheritance and Estate Tax" (REV-X31$). Applications ara available at the Office of the Register of Hills, any of the Z3 Revenue District Offices, or by calling the special gq-hour ansaaring service for forms ordering: 1-800-SSZ-ZO50; services for taxpayers aith special hearing and / or speaking needs: 1-aO0-q47-30ZO (TT only). Any party in interest not satisfied aith the appraisement, a11oaance, or disalloaance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZalOZ1, Harrisburg, PA 17128-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 be addressed in writing to: PA Department of Revenue, Bureau of Xndividual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 17128-0601 Phone (717) 787-650S. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid aithin three (3) calendar months after the decadent's death, a five percent (57.) discount of the tax paid is allowed. The 157. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the 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 (SZ) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1~ 198Z will bear interest at a rate which will vary from calendar year to calendar year aith that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through 2003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 19aZ ZOX .000548 1987 9Z .000247 1999 7Z . O0019Z 1983 16Z .000438 1988-1991 llZ .000501 ZOO0 8Z .000Z19 1984 llX .000301 199Z 9Z . OO 0Z47 ZOOX 9X . onoz47 1985 13Z .000356 1993-199~ 77. .00019Z ZOOZ 6X .000164 1986 102 .000Z74 1995-1998 9Z .000Z47 ZOO3 5Z .000137 --Interest is calculated as follows: TNTEREST = BALANCE OF TAX UNPATD X NUNBER OF DAYS DEL'rNQUENT X DAXLY XNTEREST 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. REV-1470 EX (6-88) .- ~ INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME FILE NUMBER Lehman, Anna K. 2103-0506 REVIEWED BY ACN Daniel Heck 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES G la, b Annuities are fully taxable with no exclusion. ROW Page 1