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Home My WebLink About02-0819 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of !?()(J,~f.,r !J)1~~i414 Geh!<.!.AI a/so known as No. ctZl-O.a - RI9 To: Register of Wills for the County of C!IJ/II,?,LtU-API7 in the Commonwealth of Pennsylvania Deceased. Social Security No. A.:ZJ - A z. - 1977 The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl I.!:oS for letters of administration on the estate of (d.b.n.; pendente lite; durante absentia; durante minoritate) the above decedent. Decendent was domiciled at death in Cu/1t6e4Z.t-/fAlO County, Pennsylvania, with hi,'> lastfamilyorprincipalresidenceat f70X 55, 1S"';,"')IH..eftl CH~<L~f?p ~<"Hk.'''eGa<.U<G PA (list street, number and municipality) " Decendent,then -:;3 yearsofage,died flt.u::U61 /3 ,~~COz., at H4J1Ah!;rU/.()AJ Hcs;?;T/jo<.... (',....,I,!/ OLI.-/'H',A p,q . , Decendent at death owned property with estimated values as folllows: (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: $ 4.6- 0"0 , $ $ $ Petitioner_after a proper search h~ ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: Name Relationship Residence ~ '"' tf.(J<.t?. &- /G3gcr , IL- V""., ~o'7e- @'A.k';u.. -to THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. i/~~.. ' " /-<,,-U :g3 "- "'~ ,,0 ;:g ~ct "~ ZO . c '" Vi /-:J- 6"'-?- 9' OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF Clarion } 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 "",'=wi",) of ,", ""''' _, "";o~~' truly administer the estate according to law. . ~ ' Sworn to or affirmed and subscribed .It <- ~ befo me this __ 5 th day of '\.: Se te r 2002 ~ 00 ~ " ~ ;:l ;;; " bJ) Vi l No. Estate of /) Ii'o t81ZfL;/ 0. 0~ /!. f4C.d , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NO~;h~.o.r', /1 ~y,..,-'r'in consideration of the petition on the reverse si e hereof, satisfactory proof having been presented before me, IT IS DECREED that islare entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to ~''1L,,-/'/?//J/~) ~'~~ Register of Wills in the estate of FEES Letters of Administration $ ;;;0. 0 <) Short Certificates( ) 0l9. . . . . .. $ hO .0& Renunciation ................ $ ;:}c.~ $ ~-. 00 TOTAL _ $/'(6. 00 Filed~. /. I........ A.D. ~~.::V ATTORNEY (Sup. Ct. J.D. No.) ADDRESS PHONE HIIl'i.ilO'i HEV')!s(, """115 IS to cerri;,. cut t:1C mrormatlon nert' given ;s cOITectly copied from an original certificate of death duly filed with me as l.ocal 1~-=,gi.';(L1I" The origin,ll cenificare will be f{)rwarded to the State Vira] Records Office (or pcrmanent'1"lling. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. 'l~"jjiii;;;;;:.,,.,.,. ","~\-.\.1H OF Prj;----__ ,"'''I''/~'''- ,\~..... . "'J'.--:. l~~r. ~I;. ~\ ~:E'I . -"-' \~~ ~QI -,.i' I-~ ..c,..) .~...' 'b~ \*\~ "..~""':.. -~/'*i ';.~L /."""'i ,,-;c, / '.S>\,' '--_~,fr~.{~\.'::"" ""',,~....;"ENl \): IIflll ..,.........,......../JIJI ki~~. ~ Lool Registrar h:\:' f~)r (hj~ CCJTi-1Gltt', 52.00 P 8606149 ((IS Gu ~+ l~~j 2002 Daft' H'O~.lOJA.. 2181 COMMONWEALTH OF PENNSVLVANIA . OEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF OEATH llH.,PAIWl '" Pi:fl'UNHIT 8lACKINI( ST"'lf'~IHU_1l :~OFOECEDENT'f~"~~---ROb~rt'~-~~;ken------------~ ~.Male Y2f\J~':32 _ AOEI1-...._... UNOEA1YEAA UH(lII!R1DM' OAfEOF BlAfH BIRTtlPUCE,O...-<l PlACiOFDlERI'1IC/>ed<......"""'--_....'ucl......".__1 _. 00"" ~ I """- ".........~'...., 5la<e.",fOC""l"COt._1\ IiOSPITA~, 53 v,. : Valparaiso, Indiana 1"9'11_ 0 5 1.... COUWTYOFOEJ'JH fACIl1TVNAME~I""'...................roeo<'IOd"""""'" :=.wo .. ..... Pa. Lee Hahnemann UniversityHospital IIO.S()(l;EPENTEVEAIH ~ltT'S.(OIJCMlOl< U.5.AAUfOFOACE51 ....0 HoG White ~ Phila. ~ Phila. E_....ryI~ ~'. IoUoR\lJol..SllOlU$........... _.....;M.W_ "'"'It:r~ SUfM\IlHGSPOUlIE Id_,QNOO"'-_ Sheila L. Q"Neill OECEOENT.SUSU"lOCCUp,Q1QH 1~"'_al_"""'Wr:':l._ af-1l'e~h"ng EXa''''tner . ".. 1111. OECEOf.NT.S~IoOOI'lER$I_,~.~q,.Code', 155 Salem Church Road Box 55 Mechanlcsburg, Pa. 17050 IQHOQFQUSlNf.SS/INOUSTA'I" ,. ... c,,{)EMt'1I ACTUAl AESI[lENCE --- ""__I IT,.SIlII. a. .. - -.. --'1 11..0 ::':=':::ol MOTtlE"'SNAUEIF_ol,_.",-s,,onomej Nancy M. Anderson .. 'NFOAw.wT"S~~-S:~'lWo~live Pewaukee, \/Vlsconsin 53072 ,~ PlACEOFOISPOSlTION."'-alCemelIfY,C.....--. otOlheo"""'. Conolite Crematory .. Cumberland '.. FIlIlltA.S"'........CFirol.U_,hlll ,~. ... _OAM.lM1.SM"'WE(l~ Martin F. Gerken Martin J. Gerken , 8 ~ o ~ '! , - r.E'THOOOFDlSl'OSIllC>>i O _0 c.._....cf_II_St...O 00n0I.... 00_15,""""" ~". ~UAEQFF\JNE lQCR1ON.~.St_.v.c..so. Schaefferstown, Pa. 17088 \- '-- ~ (', \ ,< 21.. llCENSEtfUUBEA fD-012755~L ,~ ti>...._"'....,l~.do....occur'Od""'"lW'Il..d.I.I""p1...OIo1Od ......li11. 2101. ........EAMO~or:~ Home, Inc. 37 East Main Street Mechanicsburg, Pa 17055 U~. ~ICEfoISEHUUBEA OIlfESlGNED (OooIooWl.o..._, TlUEOFDERH '. 'IT 7- . n. 21. Hofl'T I: Enl......_.....inpJ,~"'tomplical__~.,.,.-IIII.,.."' 0<1..... "'tef...._o. li"""'Y_~I_on."""""" UIl. 2 wr.sCASEAEFEAAEOTOUEDp~f\ICOROHE'" ., Ye'~ HoD ~ ,,,,,,,,,,,.un... """,":ou..,liQrIJltlltll~_,,10dll'~."'" :In!__n .....lMIlIIirIQin....-...."Il_....inPl>Krl ,...--~ : ., , Lon'''''''''''" /!/,.~y,~ /Ji= DUElD(Of1ASACotplOlJ(..c~ / >. . 1:-:;::::::::;- "< \',,,,, WlAE'UlOI'SVFONOIf'GS .......UBlEPAtOIIltI CQUPlETIOfIOI'CAU$E OFOEAfHT UNlNEA(J#()(MH DAfEOf IttJUAV IU"""',O'V'....II) , , , "t- l TIUEQFINJURY INJUAVATW'OAI<:1 DESC_EHOW/ttJUAYOCCUR/IED ~.. IiJ o o -- f'endong........~'ion o o .. OI't.ACEOF'"-lUAV."'...._".."'..'....l~O_ b""dln9."C,ISpecoO., - _ 0 NoD \J --. _0 -!jl $o.>W<. C<do)_....tIe\l!"'...... lel~,2nl tOCQION/SI'_.C.....-..SWel ,~. Q1!TIFIEA,C..",,'""'."""' .CEIIT""'.N(lPHV6OC..N(pt,....-.'"....""lcao_Ql___""......-.~"''''''''''''"'"'_''''''<'''''..__'''''''7.Jl T.....be..."....,.no......Q.."'".,~occu.__.....ceu...l.).n<I..."".......I_. ~. - .PI'IONOUNGlNG .u<<)CE"T1f"ItoIDPHlSlCr...NIpt,_...,_;>"'''''''''''''lIae.I~.....c..'''V'''\lIO<Iu..dne.'''' T..'he_'..,"',~no.....dQ.,do....t>C~..._.tU'O_.dI"'._Jl...,__...._.._"}_....nn....".11<1 ... DAJE FIt.i:OC"'''''"'', Ooy I " (tu6<.J >:! Jf5, '20()~ ~ TERI The Education Resources Institute November 7,2002 Orphans Court Registar of Wills 1 Courthouse Sq. Carlisle PA 17013 Re: Estate of: Robert Gerkin SSN# 221 329877 Estate Docket#: 2102-819 Dear Sir/Madam: Enclosed for filing in the above-referenced matter is the Claim Against Decedent's Estate for The Education Resources Institute, Inc. (liTERI"). Please date-stamp the enclosed copy of this Claim and send it back to me in the self-addressed stamped envelope provided. Thank you for your assistance with this matter. ~ Tr~IY Y~~rs, / i?i fl LLI/~fEtJ/~f ( 100atlieile B~' Legal Assistant Decedent Estates Dept./FMER Agent for TERI TERI (800)-255-8374 Ext. 4263 Encl. 330 Stuart Street, Suite 500, P.O. Box 9123, Boston, Massachusetts 02117-9123 617-426-0681 . 1-800-255-TERI . Fax 617-426-7114 rnrI . d . >'.,I,.,;"f.:AW;ACC:ESS@,1991-:-92APPUCATlON . 1.::.1- STAFFORD LOAN (GSEt. >< "SUPPL.EMENT,ALLOANSFOR.STUDENTS(SL5), THE LAW ACCESS LOAN (LAL) PLEASE TYPE OR PRINT I~ .NK BORROWER..sECTION ,. Legal Name GERK EN YOU MAY APPLY FOR A lOAN IN YOUR NAME ALONEI REGARDLESS OF YOUR MARITAL 51 ROBERT (Last Name) {First Namel 2. Social Security Number 2 '2 1 8 977 3. Telephone 2 1 5 2 5 9 6 2 5 7 Number ( ) - 3 2 S. Permanent (U.S.) Address S',,""omO" 739 STANBRIDGE ROAD (P.Q. 80x NumberNol Accepted) DREXEl HTf I City State 6. Driver's License Number State of Issuance 7. Citizenship Status cXU.S. Citizen/National o Eligible Non-Citizen (Attach Proof of Residency from INS - See Instructions} 1'1 411 41fi -EA w (Middlelnilial) 4. Date of Birth 01 /07/49 Mo/DaY/YI PA Zip Code 1 On? h 8. Are You Currently in Default on an Education Loan? DYes No 9. U.S. Address of ParenUSpouse or Nearest Living Relative U.S. Address of Adult Relative Not Residing at Address to Left Name SHEILA I.. O'NETf.T Name MARTIN F r.FRKFN Add,e" 739 STANBRIDGE ROAD Add,e" 20540 ORC:HARD ROAD City/StalelZip COde DREXEL HILL, FA 19026 CitylStale;Z;p Code MARYSVILLE , OHIO 40430 TelephooeN,mbe, ( 2 1 5 ) 2 5 9 6 2 5 7 TelephooeN,mbe, (5 1 3 3 4 9 .3 6 0 1 10. 00 you have any educational debts? (e.g., Stafford [GSl], SlS, Perkins [NDSl], private and institutional loans) 0 No riQ...Yes If Yes, list below. 11. List all educational debt, by loan type and lender, include both undergraduate and graduate debt. If more space is needed use attached worksheet. You must complete .!ill of the information requested. Loan Interest Name, City and State Loan Period Amount Current Type Rate of Lender Mo/Yr to Mo/Yr Borrowed Balance 12, For.)that aca~ p.."eriod are you requesting the following loan(s)?: From _B_J.9.L (Mo/Yr) "Lo~.?m~nt1lequ~tea5-.;Lc:::,-'1/ sL'S ,-/00 D5-.;Lt) -i I Stafford Loan (GSL} Supplemental Loans for Students (SLS) ($7,500 Maximum Annual Amount) 1$4,000 Maximum Annual Amount) To ---5-/--9.2 (Mo/Yr) L ""'C- D I wish to begin repayment of both principal and interest while in school. $ _L5_ QJL_oo $ lLG..lLD_.oo 14. SLS Deferment Options (Check one) o I wish to defer principal payments and have the interest capitalized while in school. ~ I wish to defer principal payments but pay the interest while in school. l--A-i-- 5DD a ::>-0;).0 -7; Law Access loan (LAl) ($14,500 Maximum Annual Amount) 5 0 0 0 $ _____.00 15. I have read, understand, and agree to the terms of the Borrower's Certification printed on the back of this application, I authorize the lender to investigate my creditworthiness, and to furnish information concerning my loan to consumer reporting agencies and other persons who may legally receive such information. The lender is Ameritrust Company National Association, Cleveland, Ohio. By my signature, I hereby authorize my school to transfer the proceeds of each of my Stafford, Supplemental Loans for Students (SLS) and or Law Access Loan (LAL) disbursements to my student account at my school. I understand that my student account at my school will reflect the credit each time a transfer of the loan proceeds is made. If my lender or school does not participate in the electronic transfer of funds, a check will be sent to y SChO~1 g:. et. Law Access program disbursement. Sign Here: Student Signature Today's Date -S'.- cJD -<1 ( SCHOOL CERTIFICATION SECTION ED le"(t ~d~ 1 I School Name TEMPLE UNIVERSITY hone NUmjr I, 1'5....) 'L1-.i"1U.5 .00 ( Grade Level' 0 6 0809010 011 ss/Aid 'L LL {Loo SLS $ ....Q Jl J... ..Q... (L .00 Other Loans for this Period: Othe' $ 11 ~ ...Il ~ (J' .00 Third Disbursement (M/DIY) Suggested Disbursement Dates: Stafford (GSL) ]JLb;rSlftnt (~/~YI) ~ /.JLL /~ -DJ4- /~ /-4-L Seco/jd Disbur~ment (M/D/Y) ~/Ll/~ ....Jl / '1 J /--1L . -L1 1-_11 /.JjL 'Date cannot be prlO' TO t/3 ot the loan period Supplemental Loans for Students (SLS) Law Access Loan (LAL) ~~~~~:t~~~llderstand angj ag~ree to the School Certification printed on the rev;;; ~Slde of this Slgnatur"1!WnM -.,,)\l Date C LU q J Print Name:J "-.ldYlI'O H Wh \ I ~ Tille Ul.1J, .J REVDATE2'9! /eU /JW!J- ~ NJ6 3 0 1991 it;.." ...""', '. LAW ACCESS USE ONLY ILlAlwJ .. . ) 0 245 In this Note the words "I", "me", "my" and "mine" mean the undersigned borrower. "You", "your" and "~'burs" mean Ameritrust Company National Association and any other holder of this Promissory Note. LAW ACCESS@ 1991-92 LOAN (LAL) PROMISSORY NOTE l'lO-u. I. IMPORTANT - READ THIS INFORMATION CAREFULLY 1. When you receive my signed Promissory Note with my application, you are not agreeing to lend me money. You will not have agreed to lend me money and I will not be obligated on this Promissory Note until you mail a loan check or electronically transfer the loan funds to my school for me. You have the right notto make a loan orto lend an amount less than the LoanAmount Requested. I agree to accept an amount less than the Loan AmountRequested and to repay that portion of the Loan Amount Requested that you actually lend to me. 2. AfterThe Education Resources Institute, Inc. (hereinafter referred to as "TERI") agrees to guarantee any loan you agree to make to me, you will send me a Dis- closure Statement. In addition to other information, the Disclosure Statement, which I agree shall be incorporated in and made a part of this Note, will tell me the amount of my disbursement and the amount of your origination fee and the guaranty fee. 3. I will review my Disclosure Statement upon receiving it and will contact you if I have any questions. NOTE: NOSCRATCH'wOUTS OR WHITE-OUTS WILL BE ACCEPTED BELOW SECTION I. II. PROMISE TO PAY promise to pay to your order on the terms of this Promissory Note all of the principal sum of I $ ~ ODO .00 I Loan Amount Requested to the extent it is advanced to me and as set out below, interest on the principal sum to the extent it is advanced to me, interest on any unpaid accrued interest added to the principal balance, late charges, and, in the event of default, costs of collection and reasonable attorney's fees. I. R..OOl,:lr c'HY,c.,J (Print your Name as Borrower) III. DEFINITIONS 1. DisbursementDate- The "Disbursement Date" is the date on which you lend money to me in consideration for my Promissory Note and will be the date shown on my loan check or the date the loan funds are elec- tronically transferred to my student account at my law school. 2. Interim Period - The "Interim Period" will begin on the initial Disburse- ment Date and will end on the earlier of the following dates: (a) Six months after I cease to be enrolled (for any reason other than graduation) in at least half-time study atthe law school named above or any other law school participating in the Law Access Loan pro- gram; or (b) Six months after I graduate from the law school listed above or any other law school participating in the Law Access Loan program. 3. Repayment Period - The "Repayment Period" will begin on the day after the Interim Period ends and will continue for 180 months. 4. Statement Period - I will receive statements on my loan at the address shown on your records (see Paragraph XIII., Notices). The period of time covered by a statement is called a "StatementPeriod."Duringthelnterim Period, I will receive quarterly statements on my Joan. The quarterly statements will cover Statement Periods beginning on theDisbursement Date and thereafter on the first day of each January, April, July and October. During the Repayment Period I will receive monthly statements on my loan. The monthly statements will cover Statement Periods beginning on the first day of the Repayment Period and onthe same day of each following month. IV. INTEREST 1. Accrual- Interest on this Promissory Note will accrue at the Variable Rate. Interest begins to accrue on the Disbursement Date and will continue to accrue until the principal is paid in full, Interest will accrue on the unpaid principal sum to the extent it is advanced to me and on unpaid accrued interest added to the principal balance in accordance with Paragraph V.1. Interest will be calculated on the basis of the actual number of days in the year and the actual number of days elapsed including holidays and days on which you are not open for the conduct of banking business. If I am obligated,to pay interest during the Interim Period but fail to do so, you may at your option, add such interest to the principal balance of the loan at repayment, 2. Variable Rate- The Variable Rate is equal to 3.25 percentage points plus the Current Index, but in no event more than the maximum rate allowable under applicable law. The Variable Rate will change quarterly on the first day of each January, April, July and October (the "Change Date(s)") if the Current Index changes. The "Current Index" for any calendar quarter beginning on a Change Date (or for any shorter period beginning on the Disbursement Date and ending on the first Change Date) is the most recent I ndex as oftheChangeDate. The Index is the average bond equiv- alen! rate of the final auction for 91-day United States Treasury Bills during the previous calendar quarter. (The bond equivalent rate of the weekly auction average for g1-day United States Treasury Bills is published by the Federal Reserve Board in Statistical Release H.15 (51 g) under the designation "AuctionAverage(lnvestment) -- 3-month.") lithe Index is no longer available, you will choose a comparable substitute. V. TERMS OF REPAYMENT 1. Interim Period - I am not required to make payments during the Interim Period. You will add unpaid accrued interest to the principal balance of the loan at repayment. I may, however. make payments of interest which accrues duri"g the Interim Period in the amounts and on the payment due dates shown on my quarterly statements. 2. Repayment Period - I will make consecutive monthly payments in the amounts and on the payment due dates shown on my monthly state- ments until I have paid all of the principal and interest and any other charges I may owe under this Promissory Note. .: ~ "k 199' 3. RepaymentTerms -I will repay my loan in consecutive monthly install- ments of principal and interest calculated each Change Date to equal the amount necessary to amortize the unpaid principal balance (including capitalized interest) of my loan (as of the date of calculation) in equal monthly Installments of principal and interest at the Variable Rate then in effect over the number of months remaining in the Repayment Period. 4. Amounts Owing at the End of tlie Repayment Period - Since interest ac- crues daily upon the unpaid principal balance of my loan, if I make payments after my payment due dates, I may owe additional interest. If I have not paid my late charges, I will also owe additional amounts for those late charges. In such case you will increase the amount of my last monthly payment to the amount necessary to repay my loan in fult. 5. Minimum Repayment- Notwithstanding paragraph V.31 agree to pay at least $50 each month (principal and interest) or the unpaid balance, whichever is less. VI. LATE CHARGES If permitted by law (which shall include the law of New Jersey), I will pay a late charge if I fail to make any part of an installment payment within 15 days after it becomes due. I will pay only one late charge for an installment payment, regardless of the number of days it is late. A late charge may not exceed the lesser of $5.00 or 5% of the unpaid amount of the installment. VII. PREPAID FINANCE CHARGES 1. Guaranty Fee-I will pay a guaranty fee to you, a portion of which you will forward to TERI to pay for its guarantee of this Promissory Note. The amount of this guaranty fee will be identified on my Disclosure Statement. 2. Origination Fee -I will pay an origination fee to you equal to .25% of the amount of each disbursement. If I reside in Louisiana, the origination fee will not exceed $25.00. 3. Deducted from Disbursements - At the time you issue any disburse- ment, you will deduct the guaranty fee and origination fee from the disbursement. If you do not withhold a fee from the proceeds of the loan and I have notalready paid that fee, I agree to pay itwhenyou bill meforit. I will not be entitled to any refund of any guaranty fee or origination fee. VIII. RIGHT TO PREPAY I have the right to prepay all or any part of my loan at any time without penalty. (PLEASE TURN OVER - CONTINUED ON REVERSE SIDE) I WILL NOT SIGN THIS PROMISSORY NOTE BEFORE READING BOTH SIDES OF IT, EVEN IF OTHERWISE ADVISED. I WILL NOT SIGN THIS PROMISSORY NOTE IF IT CONTAINS ANY BLANK SPACES. BY SIGNING THIS PROMISSORY NOTE I ACKNOWLEDGE THAT I HAVE READ IT, IT CONTAINS NO BLANK SPACES AND THAT I HAVE RECEIVED AN EXACT COPY. I HAVE THE RIGHT AT ANY TIME TO PAY IN ADVANCE THE UNPAID BALANCE DUE UNDER THIS PROMISSORY NOTE WITHOUT PENALTY. ~+~ Borrower's Signature S-;J.Q-g f Date Signed AMERITRUST COMPANY NATIONAL ASSOCIATION 900 Euclid Avenue, Cleveland, Ohio 44101 By: ~ ~. -:5L LAW ACCESS"' PROGRAM (1991-92) Randall M. 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(apls J84l0 WOJ} panullu /"t;;;C'ci j\: '~l ) &qSII~elS8eUual ~j:.j) tW'" OllOU popad e JOj lilUO pue Se::lU81 pO!.lad luawAedaJ aLfl JaljB U801 STATEMENT OF ACCOUNT In the Estate of: Robert Gerkin Claimant: The Education Resources Institute, Inc. (TERI) 330 Stuart Street Suite 500 Boston, MA 02116 Nature of Claim: Guarantor of below referenced student Loan(s); original lender Key Bank promissory note copies enclosed Account Number(s): 221328977/001/001 Disbursement Date(s): 9/17/91 Total Principal Balance: .$4.304.99 Total Outstanding Balance through date of death: .$50.02 .$4,355.01 Total Accrued Interest through date of death: Current Contractual Interest Rate: Prime plus 2% (variable rate of 4.875%) In The Estate Of: Robert Gerkin Estate Docket#: 2102-819 Date: November 7, 2002 Claim Against Decedent's Estate By Claimant: The Education Resources Institute Inc. ("TERI") The Education Resources Institute, Inc. (TERI ) certifies that there is due and owing by the decedent in accordance with the attached statement of account the sum of _$4,355.01 together with interest as of the date of this claim. The above referenced balance continues to accrue interest at the contractual rate. I do solemnly affirm under penalties of perjury that the contents of the foregoing claim are true and correct to the best of my knowledge, information, and belief. Claimant: The Education Resources Institute, Inc. (TERI) Claimant Address: 330 Stuart Street, Suite 500 Boston MA 02116 (617) 426-0681 Claimant Authorized Signature: ?z"i- L- a' I Michael A. Beatty, Esq. Manager, Bankruptcy/Estate pt. TERI, (617) 426-0681 Ext. 4015 FAX (617) 422-8880 CERTIFICATE OF SERVICE I, Danielle Bentley, Legal Assistant for the Bankruptcy & Decedent Estate Department of First Marblehead Education Resources, agent for TERI, hereby certify that on Thursday, November 07, 2002, a true copy of the within a Claim Against Decedent's Estate was served upon the following by Certified Mail/Return Receipt Requested: Sheila L. O'Neill 13935 Route 208 Marble PA 16334 Personal Representative; Executor/Executrix; Administrator/ Administratrix N/A Attorney for the Estate - . /1 If t 4!7(f \~fy){j Danielle Bent ey First Marblehead Education R ources Agent for TERI September 4, 2002 Donna Otto Register of Wills & Clerk of Orphan's Court Cumberland County Courthouse Carlisle, PA 17013 ATTN: Anne Dear Anne, Enclosed please find a Petition for Grant of Letters of Administration, an Estate Information Sheet, death certificate for my husband, Robert W. Gerken, and a check in the amount of$145.oo for fees. I am requesting a grant of Letters of Administration to settle Robert's estate. As I told you during our phone conversation, Robert and I were separated and I now live in Clarion County. Unfortunately, I am limited as to my ability to travel to Cumberland County as I am sole caregiver to my mother who is ill and bedridden. Therefore, I have been sworn in as Robert's personal representative by the Register of Wills in Clarion County. Robert had no children and his only other surviving relative is his brother who lives in Wisconsin. Should you have any questions you can reach me at (814) 782-3916. Thank you very much for your help. Sheila 1. O'Neill 13935 Rte. 208 Marble, PA 16334 v' IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF R W GERKEN Register's ~ 21~~9 Deceased CLAIM To the Clerk of the Orphans' Court Division: Index and make proper entry in your official records of the claim of CITIBANKrSOU1HDAKOTA1NA in the amount of $501.75 against the estate of the above-named decedent. This claim is filed under Section 3532 (b) (2) PEF Code, 20 Pa. C.S. ss. 3532 (b) (2). The said decedent, whose last known residence was at BOX 55 155 SALEM CHURCHRD MECHAN1CSBURG PA 170550055 Written notice of this claim was given to SHEILAONEILL. Executor. 13935 R208 MARBLE. PA 163340000 on October 8.2002. (C KRISTEN WELLS, Manager of Citicorp Credit Services, Inc., USA under limited power of attorney for CITIBANK (SOUill DAKOTA) NA 1930 NW 110 Street, Kansas City, MO 64153 (Claimant's Address) 10108f2oo2-58 Acct. #5424180545231075 09/09/02 M@~Mi#jmt~ $517.B3 ",'-'-'-'-"-'="-"-'-'---<"" ':'m!!!";=-!I,~" SITE: KC-CL $20.00 Wi~::~Wiiit:::~ R W GERKEN BOX 55 155 SALEM CHURCH RD MECHANICSBURG 17055-0055000 CITI CARDS P.O. BOX BI09 S HACKENSACK. NJ 07606-BI09 PA TM:CO-6375 09/25/02 ACID:K~ 05:11:52: Cltt Card For CustOJMT ServIce, can or writ. 1-800- 950- 5114 Account Numbe, 5424 1805 4523 1075 PayMent must be received bV 1:00 pm local t1_e Gn 09/09/2002 TD report IIIllInq en... M'tte tothls~nIlIl'IlJ"l not prllHflre rllUl' rlqhtL BOX 6500 SIOUX rAllS. SD 57117 Statement/Closing Date OB/14/2002 Cash Advance limit $3200 AI/ailable Cash Umit $26B2 PurchjAdv Minimum Due $20.00 Total Credit Line $6700 Available Credit Une $61B2 Amount Over Credit Llnli $0.00 Activity SlnC9 Lest statement Past Due $0.00 Sa. Oat. Post Dat. Rel.r.nc. Number New Balance $517.B3 Minimum Amounl DUll $20.00 Amount 8/14 0.00 0000000000 ~ \0 0 ~! <(1n I\~ / /~ Y ,/ f ? Thank vou for being a valued customer. L We built your new Citi MasterCard around you and e wa you.l1ve. R~MEMBER: Notify an merchants who // aulomat 1 call y bl11 your account or your new acco t "",' number. /' Teach your kids money management and give them more of the freedom they want wlth Citi(R) Cash Card, a new pre-paid card. You set their spending limit, they get the convenience of a MasterCard(R) card. Enroll at www.cashcard.citicards.com 8/12 B/12 00000700 8/14 8/14 standard Purch MEMBERSHIP rEE AUG OZ-JUl 03 74 0000 Standard Adv PNC BANK MAIN & MARKET STS MECHANICS PA 60 r7778 8001 ADVANCES'rINANCE CHARGE'rOR TRANSACTIONS 86 0000 AOVANCES'rINANCE CHARGE'PERIODIC RATE 84 0000 Each Cash Advance is subject to a one-time transaction fee. This fee will cause your Annual Percentage Rate to exceed the nominal Annual Percentage Rate listed on this statement. Our records show home phone 717-791~0272 and business phone 717-783.9454. Please update above coupon if incorrect. Get 30 days of optional Citibank Credit Protector rREE when you enroll today! Simply initial as indicated 1n the lower left-hand corner of your billing statement coupon. Remember to return the coupon with your payment. 501. 75 00000000000 15.05 0000000000 1.03 0000000000 Account Summary PrevIous ( +) Purchases (-) Payments (+) FINANCt. (=) New Balance & Advances & CredIts CHARGE Balance PURCHASES r.OO $0.00 10.00 $0.00 $0.00 ADVANCES 0.00 1501. 75 0.00 116.08 1517.83 TOTAL 0.00 501. 75 0.00 16.08 517 . 83 R.t. Summary Balance Subject to PeriodIC Nominal ANNUAL Finance Charge Rate APR PERCENTAGE RATE PURCHASES Standard Purch $0.0<1 <I.06847%(D) 24.990% ADVANCES P6&illdAtJ1lRAA:.vTHE REVERSE SIDE OF' THES::flQ6iWAL STATEMENT F'~ft)'Mi"6IUORMATlO". 24.990% Maki;l chi;l.:k or money order payable In U.S. dollars ona U.5. bal'lk to cltl Cards. Il'ldude acCOUl'lt numbi;lr on cMck or mol'l9V ordi;lr. No cash please. 24.990% 38.456% u.s. Postal Service CERTIFIED MAIL RECEIPT (Domestic Mall Only, No Insurance Coverage ProvIded) cO ,..." ,..." ,..." ru -" ... U1 I . I Postage $ Certified Fee Postmark Return Receipt fee Here (Endorsement Required) Restricted Delivery Fee (Endorsement Required) Total P-ostage & Fees $ -" o o o o ,..." U1 ruS'_"t_Tlv~_d_~ Street, Apt. No_: or PO Box No ,..." o o -ijtY,"St;'-ii:zip+4-- ['- . Comple1e items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. . Print your name and address on the reverse so that we can return the card to you. . Attach this card to the back of the mailpiec9, or on the front jf space permits. 1. Article Addressed to: A. s~.gna reo o Agent X t" 0 Addressee 8. Received by ( Printed Name) C, Date of Delivery WllLlAr~ L. Get) 1-7-0 D. Is delivery address different from item 1? 0>>$ If YES, enter delivery address below: i1' No W\\\\tMn 'I.... ~b 6105 O\?- ~~M... ~.~ Po:: \1011 3. Seryn::e Type [g' Certified Mail 0 Express Mail o Registered 0 Return Receipt for Merchandise o Insured Mail 0 C.O.D. . 4. Restricted Delivery? (Extra Fee) 0 Yes 2. Article Number (Transfer from service label) PS Form 3811 , August 2001 700J d),5/() POO(~ OR1.o:L J/I~ Domestic Return R~ 1Q2595-02-M-0835 U.S. Postal Service CERTIFIED MAIL RECEIPT (Domestfc Mall Only; No Insurance Coverage Provided) .-"I Cl .-"I .-"I I I Postage $ Certified Fee Postmark Return AecaiptFee Here (Endorsement Required) ReWicled Delivery Fee (Endorsement Required) Total Postage & Fees $ ru ..ll '" U1 ..ll Cl Cl Cl Cl .-"I U1 ru 5",'To ~ J. ..-:l 'St;eet,-AjiCNo.;----.- _n_n_n__ wo CJ or PO Box No. Cl f'- O'Il'An -----~---~----- -citY.-siaie:zip+4---~- . Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. . Print your name and address on the reverse $0 that we can return the card to you. . Attach this card to the back of the mail piece, or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item 11 Ofls If YES, enter delivery address below: fIt No ~ -J, O'~ 1311&5 Rrf:.c;l.OS" M~ Pc.-- \to33L/ I 3. Sel)iPe Type B""Certified Mail 0 Express Mall o Registered 0 Return Receipt for Merchandise o Insured Mail 0 C.O.D. 4. Restricted Defiv6ry? (Extra Fee) 0 Yes 2. Article Numb6r , ;,:. .; ..':. /Transfer ""m SfIN''''';!.'''.)'.' ::", DC>Q c;:lE; 10 Oocl.a PS form.3&t1-;'ilfugUSl 2001 Domestic Ret"," R_pt S~(p>Q..... /)0/ 102595-02-M.0835 NOTICE TO: Sheila O'Neill, Personal Representative FROM: Kirk Sohonage, Solicitor for the Register of Wills DATE: January 14,2005 SUB: Additional Probate Fees Decedent: Robert Gerken Estate No.: 21-02-819 In an annual review of all estates and accounts, it has come to our attention the above listed estate owes additional probate fees in the amount of$ 120.00. Our records indicate that you are the personal representative or counsel for the same in the above listed estate. Probate fees are estimated at the time of petitioning for letters. Final probate fee amounts are determined by the value of the estate as reported on the inheritance tax return filed in our office for the Department of Revenue. The additional probate fee should be made payable to "Register of Wills" and be forwarded in the enclosed envelope within 15 days of this notice. If you feel you have received this notice in error, kindly contact the Register of Wills directly at (717) 240-5411 and she will be happy to review the matter. STATEMENT OF ACCOUNT In the Estate of: Robert Gerkin Claimant: The Education Resources Institute, Ine. (TERI) 330 Stuart Street Suite 500 Boston, MA 02116 Nature of Claim: Guarantor of below referenced student Loan(s)j original lender Key Bank promissory note copies enclosed Account Number(s): 221328977/001/001 Disbursement Date(s): 9/17/91 Total Principal Balance: $4,304.99 Total Outstanding Balance through date of death: _$50.02 $4,355.01 Total Accrued Interest through date of death: Current Contractual Interest Rate: Prime plus 2% (variable rate of 4.875%) JRD/Junc30, 1992/17858 ~ Estate No,: 21-02-819 ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA In Re: Estate of ROBERT WILLIAM GERKEN: Late of HAMPDEN TOWNSHIP NO. 21-02-819 NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT ORPHANS' COURT RULE Personal Representative: SHEILA L O'NEILL Counsel for Personal Representative: Date of Grant of Original Letters: 09-14-2002 Date of Delinquency Notice: 12-24-2002 The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk ofthe Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court Orphans' Court Rules, was given by the Register of Wills on DECEMBER 24,2002, and that the ten (10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e) the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 01-02-2003 l:= ~~\I~ ,l)~'~'r~ tKru~ ~ T ~m;o., Register f II ~ Distribution: Personal Representative Counsel for Personal Representative Estate File A hearing is scheduled for d -Ii(. (J.3 at 9' 3 v)7,&;Jn Courtroom No.3. If the Certification of Notice is filed prior to the hearing date, the heari wi a to atically be cancelled. 0' CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent .,-j! /. ) AtJ .6S/!.-r ?U'td._/ .hfl. G;~~ Date of Death ~ 1/3 I(f -2-- I ( Will No. Admin No. ft. ,.de. J?J~o2-0fj/7' To the Register: J certilY that notice of (beneticial iIIterest) estate administration required by Rule 5.6(a) of the Orphan's Court Rules W7sJiT"ed on or mailed to the following beneficiaries of the above-captioned estate on ~ff . Name Address DMI/rJr t.. 0 lJac.-r- .7 /J1 /? I~ #(/2i ,:20f', /'04U>><.e; fA- /<337'" Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: Date: d!/d/{f:'J I f ~ ~ .. Signa~ Name S /.b; 7 L/f t-. tf /fIch.<-. Address /31 7.55- l! r6 6(0 r /lfvJ~u;, fA. I (.3~V Telephone 0'1 y) 181. - 371 {,. Capacity y" Personal Representative Counsel for Personal Representative (IT Sales financing Asset Service Center 715 South Metropolitan Avenue Suite 150, PO Box 24610 Oklahoma City, OK 73124.0610 T: 405 945-1400 f: BOO 621-1433 In the Matter of the Estate / of ROBERT W. GERKEN CiT Case No: 21-02-0819 CIT Account No. 00009358166362 CLAIM AGAINST ESTATE THE cn GROUP/SALES FINANCING INC., creditor of the estate of ROBERT GERKEN deceased, hereby states that said estate is indebted to said creditor in the amount of $23,199.42 for RETAIL INSTALLMENT CONTRACT signed by Robert Gerken on 8/10/98. 03/06/2003 claim due if not yet due; if contingent or unliquidated 68X16 FLEETWOOD, Mobile Home, Serial #P AFLS22A077900L13 security. DATED this 6th day of February 2003 The cn Group/Sales Financing, Inc. Claimant PO Box 24610 Address Oklahoma City, OK 73124 By: ~1O\o.\\'~lu"~' MARY NCH PROOF OF SERVICE The undersigned certifies that a complete copy of this instrument was sent by certified mail to The Cumberland County Probate Office; and Estate Administrator, Sheila L. O'NeIl. www.cit.com .. Note: This contract is intended to be assigned only to The CIT Group/Sales Financing, Ine. Date: Mo/llh / Day / Year fr3 / (." ~il--- SECURITY AGREEMENT For Office Use Only RBe Dealer Transaction # Note: Customer(s) Must Also Sign Separate Credit Insurance Election On Page 5 Customer-is) Name(s) and Address(es) ROBERT W. GERKEN .55'"8 ~!f3& 55 LINKS MHP MECHANICSBURG, PA 17055 Seller Name and Address CIT GROUP/SALES FINANCING, INC 715S.METROPOLITAN AVE STE 150 OKLAHOMA CITY, OK 73108 The words "I". "me" and "my" refer to the Customer and Co-Customer signing this contract jointly and severally. The words "you" and "your" refer to the Seller (or Holder if this contract is assigned). ANNUAL PERCENTAGE RATE 8.00 % - The cost of my credit as a yearly rate. FINANCE CHARGE $ 25.832.70 - The dollar amount the credit will cost me. Amount Fmanced ..... $ 25.642.50 - The amount of credit provided to me or on my behalf. Total of Payments ..... $ 51.475.20 - The amount I will have paid after I have made all payments as scheduled. Total Sale Price ..... $ 51. 975.20 - The total cost of my purchase on credit, including my downpayment of $ 500.00 My payment Number of Payments Amount of Payments When Payments Are Due schedule $214 .48 Moolhly, bcginnJng ;t~ (,..~--;c. 10 i will be 240 ~e ffJZMBER ItJr1"T"'Af SECURITY . I am giving you a security interest in the commodity purchased in this ~clion. o If this box is checked, I am also giving you a mortgage or a deed of lnJSt in the real estate described in the attached Exhibit A. LATE CHARGE. Ifa payment is more than 10 days late, 1 will pay you 2% per month of the late amount for each month or fractional part of a month exceeding 10 days. PREPAYMENT. If I payoff early, I will not have to pay a penalty. ASSUMPTION. Someone buying my commodity may, subject to conditions, be allowed to assume the remainder of the contract on the original terms. See the contract document for any additional information about nonpayment, default, and any required repayment in full before the scheduled date. IF I DO NOT MEET MY CONTRACT OBLIGATIONS, I MAY LOSE MY MOTOR VEmCLE AND ANY OTHER PROPERTY THAT I BOUGHT UNDER TmS CONTRACT. Commodity and Equipment (Describe) I have today bought and received in satisfactory condition the commodity described below, including attachments, equipment, accessories and related services (referred to collectively in this contract as "commodity"), under the terms and provisions of this contract. I New or Used Year and Make Series, Make or Trade Name (Also No., ifapplicablel Description USED 1995 FLEETWOOD Identification No. (Serial or Motor No.) PAFLS22A077900L13 D Air Cond.fSerial No. D Washer/Serial No. [9-RangefSerial No. "Z.. i-~ 7 7 '/:!. /-) J3 o Other (Describe) Will be kept at ~;3.-' .s/:>o( .L...1''''/o /\.t c.' c'.""l 8 f'./(( -'-I9~fJ County (Continued on ncx! page) ~1)98 o,u. 2-J/d2A (~) M(Jtlufac'ured Hou$inBlRV - PennsyllJOnia. Accnmi Jnttrr.~ J72137 MH 68 X 16 IState Registration No. D Dryer/Serial No. .. D Refrigerator/Serial No. D Awnings DSkirting DFurnilure i- L! ..L H /) '1>~ F'1 ;::c:../ {[F:}-", ,<...<;. -A ~M~ ;. jC~N~ ~ Slate t. . (/~ Initial(sl~X Page 1 of6 Liens - Use of Commodity - Proceeds - Notices - I agree to keep the commodity free from all liens, and I won't move it from my address unless you agree in writing. I won.t sell or give the commodity away, or rent it out, or use it illegally. You are entitled to any proceeds from the sale of the commodity, but this right does not waive any rights you have in the commodity and does not permit me to sell or transfer the commodity in violation of this contract. Any notices you send me are sufficient if sent to my address as shown on this contract. Tues' and Ass, .uents C I will pay all taxes aDd IS!' ,_ts on the .commodity as they become due. If I fail.to pay any taxes or assessments on the eommodity you may pay the taxes and assessments. I Igree to refund to you any such taxes or assessmenlS which you pay upon receipt of wrillen demand together with interest thereon from the date of your payment at the highest rate permilled by law. You may, however, in lieu of making a demand for payment and in your sole discretion, add any amount you pay for taxes and assessments to bear interest at the Arumal Percentage Rate shown on page 1 to the unpaid Amount Financed, in which event you may send me a revised schedule of monthly paymenlS. Assjgnment of Contract - Representations - Modifications - If you assign this contract to someone else, I understand that you will not act for the other party to receive paymenlS or for any other purposes. No agreement, representation or warranty is binding on you unless included in this contract. No change in this agreemenl will be binding if il isn't in writing and signed by you and me. All of your rights are cumulative, If anything in this contract is not valid or consistent with law or regulations, it can be considered modified or deleted so that it complies. Required Insurance - I understand that I am responsible for any damage to the commodity, and I agree to buy insurance for the term of this contract covering the commodity against all damage, In addition, if I have given you a mongage or deed of trust in my real estate, I will buy insurance in a form and amount satisfactory to you covering the real estate against risk of loss or damage for the duration of this contract. The insurance I obtain, which must be satisfactory to you, will contain a loss payable clause naming you or anyone to whom you assign this contract. If I do not buy insurance, or the insurance included in this contract is cancelled or cannot be obtained for any reason or if the insurance lapses during the term of the contract, I understand that you may, if you chO<>!C, obtain insurance protecting both or either of us, apply any premium refund to the premiums for such insurance, and add the premium less any premium refunds 10 the arnounlS I owe under this contract, which shall bear interest at the Annual Percentage Rate shown on page I of this contract. Governing Law - Except as pre-empted by federal law, this contract will be governed in all respects by the laws of the Stale of Pennsylvania. Original and True Copies of this Contract - 'This contract may be signed and then multiple copies made thereof as necessary, but only the contract bearing original signatures shall be deemed the Original. No ownership interest in this contract or security interest in the commodity may be created other than through possession of the Original and, if applicable, a mongage or deed of trust. Insurance Coverages - No Coverages Included Except as Shown Below and Under Item 4 on Page 2, Manufactured Housing, Recreational Vehlele and Automobile ~. $ 70S: ., Deductible Comprehensive $ Deductible Collision P'11'e and Theft <. Combined Additioual Coverage . Personal Effects Protection (except Automobile) o Single Interest Propeny Insurance covering Holder's interest only, subject to policy terms, o Other Insurance (Describe) O/VO~ 08:59 2-1162D aBRK/i.N, ROBERT J72311 Manufactured Housing Only ~ Natural Disaster Protection Comprehensive Persoual liability Insurance Umit of liability - Each Occurrence 0$25,000 .a $50,000 0$ Recreational Vehicle and Automobile Only ~TOwing and LAbor Costs Bodily Injury and Propertyt)amage liability Umit of liability - Each Occurrence 0$25,000 0 $50,000 0$ (Continued on next page) {nitia{(s} X~CC t'- X Page 4 0/6 For term of 12 months from the date hereof. Customer may choose the agent and insurer through or by which the insurance described above is to be placed. Total Premium for insurance coverages described above if obtained from or through Seller $ 215.00 Unless .. Premium for Uability Insurance is Disclosed above: . '. . INSURANCE COVERAGES ABOVE DO NOT INSURE AGAINST LIABILITY FOR BODILY INJURY OR PROPERTY DAMAGE CAUSED TO OTHERS. If insurance on the commodity is not included herein, 1 will furnish copy of policy, with long form loss payable clause, purchased from: Agent's Name andAddress: Name a/Insurance Company: . . J . "".'-:1 k ':::, I J:;/~ ~-J;v '-,...""'.:.... -1~1 ~ y'~.i.:' (, t <.:>. ~~-,..... ~ > c... (., , ',,' ,'( r Credit Insurance Election Credit Insurance is not required by Seller. The undersigned (check applicable boxes): o Request(s) Credit Ufe Insurance on the life of the Customer who first signs below, the cost of which is shown in Item 4c in the Itemization of Amount F"tnanced on page 2 for the term of months. o Request(s) Joint Credit Ufe Insurance on the lives of both Customers, the cost of which is shown in Item 4c on page 2 for the term of months. o Request(s) Credit Accident and Health Insurance on the Customer who frrst signs below, the cost of which is shown in Item 4d on page 2 for the term of months. o Do(es) not want any Credit Insurance. , l" Customer's Signature to above statement >::,", Co~Customer's Signature to above statement Date Date Used VehIcle Notice: If this is a credit sale of a used motorized vehicle, other than a motorcycle, with a gross vehicle weight rating (GVWR) of less than 8,500 100., a curb weight of less than 6,000 100., and a frontal area of less than 46 sq. fl., then the following statements about the window form apply to this contract: The information you see on the wIndow form for this vehicle is part of this eontraet. Information on the window form overrides any contrary provisions in the contract of sale. Disclaimer of Warranties: No warranties, express or implied, representations, promises or statements as to the condition, fitness or merchantability oUhe commodity have been made by you unless covered hy a separate statement delivered to me. A statement as to year model is for identification only. No changes may be made in the requirements of this paragraph unless in writing and signed hy you and me, If any ~art of this paragraph is not permitted hy law, that part will be Ineffective, but the remainder oUhe paragraph will remaIn In roree.. 0<'t'07,1V8 08:59 2-1162E (iERKEN. ROBERT .J72JJ7 . (Co~tlnue1d on next page) Inltial(s) X ,l'>L~- X Page 5 of6 --,.... . G:,-~~~ \ Qo\ \'~ \ \ \ ~ ~ ~ ~ \ ~ ~ ~ ~ ~- \\ I;;;" ~~~~ ~ ~ - \ ~ ~ ~ ~ ~ ~ \A ~ "'\ ~ \ ~ \': i l~O) -6// ~~ ('d~ ~ ~ \t .... "\ ~~) 't ~~ ~ ~ \" '\ " ,. , g \~~ ~~ (;) <~U ~~ -----~ '" ,~~~ ~ - ~ IN __ :....:, ....-- - ~ 'f ~, ;; c:: -u ~ '1,,"1 ",,~ 1i"-"'~' 0.,.,.... 01:'-l(11.c.:t>-) B.......... ~-:-th'28o tJ1. ...--I ...t>-r: 1,,"1 ?1-....1 c> 'r"' ;i >..n ..1'-':..0 Co') .""""_ :0 r""' '" CO TO: Date: Please be advised of an address change for Sheila L. O'Neill, from 13935 Route 208, Marble 16334, to Sheila L. O'Neill 1330 Fieldpoint Drive West Chester, PA 19382 Comments: Sheila L. O'Neill REV-I~!O EX (soo) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 6OUNTY CODE YF_~ NUMBER Z UJ UJ UJ uJ Z O DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) DATE OF DEATH (MM-BD-YEAR) I DATE OF BIRTH (MM-DB-YEAR) 08-13-2002 I 01-07-1949 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INiTIAL) O'NEILL, .SHEILA [] 1. Original Return [] 4. Limited Estate [] 6. Decedent Died Testate (Attach copy of Will) [] 9. Litigation Proceeds Received [] 2. Supplemental Retum ] 4a. Future Interest Compromise (date of death alter 12-12-82) [] 7. Decedent Maintained a Living Trust (A~ch c~,~y ol Trust) SOCIAL SECURITY NUMBER 221-32-8977 THIS RETURN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WILLS [] 5. Federal Estate Tax Retum Required 8. Total Number of Safe Deposit Boxes -13-82) [] 10. Spousal Poverty Credit (date ol death betwem) 12,-$1-91 and 1-1-95) [] 11. Election to tax under Sec. 9113(A) (Attach Sch O) ~%G B. RHOADS TELEPHONE NUMBER (814) 226-4039 COMPLETE MAILING ADDRESS 160 S. SECOND AVENUE, CLARION, PA 16214 SUITE 4 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Modgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1 - 7) 9. Funeral Expeosas &AdministrativeCosts(ScheduleH) (9) 10. Debts of Decedent, Mortgage Uabilities, & Ueos (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Une 8 minus Line 11) 13. 18,000~ 46,449 30,600 ,~ '.. 5,299 OFFICIAL USE ONLY -,..j 38,494 (11) (12) (13) Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Une 13) (14) 95,049 43,793 51,256 51,256 SEE INSTRUCTIONS FOR APPUCABLE RATES 15. Amount of Line 14 taxable at the spousal tax 5 1, 2 5 6 × .00 0 rate, or transfers under Sec. 9116 (a)(1.2) ' (15) 16. Amount of Line 14 taxable a lineal rate . X .0 (16) 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate X .15 (18) 19. Tax Due (19) O 20.[] CHECK HERE!I~ ~Ou ARE REQOEST NG ~RE~U~D OF ;AN OVERPA¥~ Et'~'T : ,; .~ ~ BE SURETO ANSWER AE~ QUES? ONSON RE~ER3-E $ DE AND RECHECK MAT H~ STF PA42021F. 1 D~cede~t's Complete Address: STREET ADDRESS BOX 5 5, CTY MECHANICSBURG 155 SALEM CHURCH ROAD STATE PA IZlP 17055 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 Total Credits (A + B + C) (2) Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page '1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) (1) O O O A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) O Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................ [] [] b. retain the dght 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 secudty at his or her death? ..... [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................... [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. UDnd,er p~nalti.es of perju~, I~lare that I have, examined this ret?m, in,cluding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. ecmrat~ o~ prep~....~:~per/man the persona representative is Dase~ on all information of which preparer has any knowledge. SIGNAII'~RE ~F ~ON RESPQ~II~LE FOR FILlinG RETURN DATE , ADDRESS ADDRES~ ~ .... ' For dates of death on or after July 1, 1994 and before Janua~ 1, 1995, the t~ rote im pos~ on the net value of transfem to or for the use of the su~iving spouse is 3% [72 P.S. {9116 (a) (1.1)(i)]. For dates of death on or a~er Janua~ 1, 1995, the t~ rate impos~ on the net value of transfers to or for the use of the su~iving spouse is 0% [72 P.S. {9116 (a) (1.1) (ii)]. The statute does not exempt a t~nsfer to a su~iving spouse Eom t~, and the statuto~ r~uirements for disclosure of assets and filing a t~ retum are still applicable even if the suMving spouse is the only beneficial. For dates of d~th on or a~er July 1, 2000: The t~ rate impo~ on the net value of transf~s from a dec~sed child ~en~-one y~m of age or younger at d~th to or for the use of a natural parent, an adoptive parent, or a steppamnt of the child is 0% [72 P.S. {9116(a)(1.2)]. The t~ rate impos~ on the net value of transfem to or for the use of the d~ent's lineal beneficiaries is 4.5%, except as not~ in 72 P.S. {9116(1.2) [72 RS. {9116(a)(1 )]. The t~ rate impos~ on the net value of tmnsfem to or for the use of the d~ent's siblings is 12% [72 FS. {9116(a)(1.3)]. A sibling is define, under S~tion 9102, as an individual who has at least one parent in common with the dec~ent, whether by blood or adoption. STF PA42021F,2 REV-1502' EX + (1-97) (I) SCHEDULE A I COM O.V LTH OF,E..SY,VAN REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ROBERT W. GERKEN All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the prica at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowiedge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MOBILE HOME 18,000 TOTAL (Also enter on line 1, Recapitulation) $ I 8, 0 0 0 (If more space is needed, insert additional sheets of the same size) STF PA42021F.3 · I~EV-1503 I~ + (1-97)(I) COMMONV~I~ALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERT W. GERKEN SCHEDULE B STOCKS & BONDS I FILE NUMBER All property jointly-owned with the right of survivorship must be disclosed on Schedule £ ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1446.589 SHS AMERICAN MUTUAL FUND 201.69 SHS GOLDMAN SCHS SMALL CAP VALUE-CL A 590.701 SHS NEW PERSPECTIVE FUND 30,407 5,427 10,615 TOTAL (Also enter on line 2, Recapitulation) $ 4 6,4 4 9 (If more space is needed, insert additional sheets of the same size) STF PA42021F.4 'REV-1504 ~:X + (1-97) (I) COMMONWEALTH OF PENNSYLVAN~ iNHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERT W. GERKEN SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP or SOLE-PROPRIETORSHIP FILE NUMBER Schedule C-1 or C-2 (Including all suppoding information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) STF PA42021F.5 ~EV-1505 ~:X + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERT W. GERKEN SCHEDULE C-1 CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT FILE NUMBER Name of Corporation Address City 2. Federal Employer I.D. Number 3. Type of Business State Zip Code Product/Service State of Incorporation Date of Incorporation Total Number of Shareholders Business Reporting Year TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE STOCK Voting / Non-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK Common $ Preferred $ Provide all dghts and restrictions pertaining to each class of stock. 5. Was the decedent employed by the Corporation? [] Yes [] No If yes, Position Annual Salary $ 6. Was the Corporation indebted to the decedent? [] Yes [] No If yes, provide amount of indebtedness $ ']qme Devoted to Business 7. Was there life insurance payable to the corporation upon the death of the decedent? [] Yes [] No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 8. Did the decedent sell or transfer stock of this company within one year pdor to death or within two years if the date of death was pdor to 12-31-827 [] Yes [] No If yes, [] Transfer [] Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 9. Was there a wdtten shareholder's agreement in effect at the time of the decedent's death? [] Yes [] No If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? [] Yes [] No If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedent's death? [] Yes [] No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? [] Yes [] No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedenrs stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. STF PA42021F.6 ' ~EV-1506 I~ + (1-97)(I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERT W. GERKEN SCHEDULE C-2 PARTNERSHIP INFORMATION REPORT FILE NUMBER Name of Partnership Address City 2. Federal Employer I.D. Number 3. Type of Business 4. Decedent was a [] General State Zip Code Date Business Commenced Business Reporting Year Product/Service [] Limited partner. If decedent was a limited partner, provide initial investment $ PERCENT OF PERCENT OF BALANCE OF PARTNER NAME INCOME OWNERSHIP CAPITAL ACCOUNT A. B, C. D. 6. Value of the decedenrs interest $ 7. Was the Partnership indebted to the decedent? [] Yes [] No If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? [] Yes If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy []No 9. Did the decedent sell or transfer an interest in this partnership within one year pdor to death or within two years if the date of death was pdor to 12-31-827 []Yes [] No If yes, []Transfer [] Sale Percentage transferred/sold Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 10. Was there a written partnership agreement in effect at the time of the decedent's death? [] Yes [] No If yes, provide a copy of the agreement. 11. Was the decedent's partnership interest sold? [] Yes [] No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedenrs death? [] Yes [] No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? [] Yes [] No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? [] Yes [] No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax retums (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. STFPA42021F.7 REV-1507 ~X + (1-97) (I) SCHEDULE D I COMMO.WEALT, OFPE,,SY'VAN~ MORTGAGES & NOTES INHERITANCE TAX RETURN RESIDENT DECEDENT RECEIVABLE ESTATE OF FILE NUMBER ROBERT W. GERKEN All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. TOTAL (Also enter on line 4, Recapitulation) $ (if mom space is needed, insert additional sheets of the same size) STF PA42021F.8 'REV-1508'EX + (1-97) (I) COMMONV'FcALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERT W. GERKEN SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER Include the proceeds d litigation and the date the proceeds were received by the estate. All property jointly-owned with the fight of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH FURNISHINGS 2. 3. 4. HOUSEHOLD GOODS & 2002 TRAILBLAZER 1993 HONDA CIVIC PERSONAL TOOLS 4,600 25,000 500 500 TOTAL (Also enter on line 5, Recapitulation) $ 3 O, 6 0 0 (If more space is needed, insert additional sheets of the same size) STF PA42021F.9 REV-1509'EX + (1-97) (I) COMMONV~_ALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERT W. GERKEN SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER If an assat was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT Altach deed forjointly-heU malestate. VALUE OFASSET INTEREST DECEDENT'S INTEREST 1. A. TOTAL (Also enter on line 6, Recapitulation)$ (If more space is needed, insert additional sheets of the same size) STF PA42021 F. 10 I~EV-1510 I~X + (1-97)(I) SCHEDULE G I COMMONV~r_ALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS & INHERiTANCE TAX RETURN MISC, NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER ROBERT W. GERKEN 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. DESCRIPTION OF PROPERTY % OF iTEM INCLUDE THE NAME OF THE TRANSFEREE, TFEIR RELATIONSFIP TO DECEDENT AND THE DATE DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMBER OF TRANSFER. ATTACH A COPY OF TFE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) 1. TOTAL (Also enter on line 7, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) STF PA42021 F 11 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERT W. GERKEN SCHEDULE H FUNERAL EXPENSES & ABMINISTRATIVE COSTS FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. 5. 6. 7. FUNERAL EXPENSES: MYERS FUNERAL HOME, INC. 37 EAST MAIN STREET MECHANICSBURG, PA 17055 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Zip Street Address C~y Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees State Zip 4,849 450 TOTAL (Also enter on line 9, Recapitulation) $ 5,2, 9 9 (If more space is needed, insert additional sheets of the same size) STF PA42021 F. 12 REV-151~'EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERT W. GERKEN SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER Include unreimbursed medical expenses. ITEM NUMBER 2. 3. 4. 5. 6. DESCRIPTION CIT FINANCIAL-MORTGAGE 2002 REAL ESTATE TAXES CITIBANK-CREDIT CARD AMERICAN EXPRESS-CREDIT CARD PSECU-PERSONAL LINE OF CREDIT AES-STUDENT LOANS TOTAL (Also enter on line 10, Recapitulation) i $ AMOUNT 23,287 1,001 501 512 8,838 4,355 38,494 (If more space is needed, insert additional sheets of the same size) STF PA42021 F.13 ~EV-1513~X + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERT W. GERKEN SCHEDULE J BENEFICIARIES FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. II. 1. TAXABLE DISTRIBUTIONS [include outdght spousal distributions, and transfers under Sec. 9116 (a)(1.2)] 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 H - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) STF PA42021 F. 14 REV-1514 EX + (1-97) (I) COMMONV~r_ALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERT W. GERKEN SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN (Check Box 4 on Rev-'l$O0 Cover Sheet) FILE NUMBER 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 on or after 5-1-89. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. [--]VVill I--Ilntervivos Deed of Trust [~Other NAME(S) OF NEAREST AGE AT TERM OF YEARS LIFE ESTATE IS LIFE TENANT(S) DATE OF BIRTH DATE OF DEATH PAYABLE [] Life or [] Term of Years__ [] Life or [] Term of Years__ [] Life or [] Term of Years__ [] Life or [] Term of Years__ 1. Value of fund from which life estate is payable 2. Actuarial factor per appropriate table Interest table rate - [] 3 1/2% [] 6% 3. Value of life estate (Line I multiplied by Line 2) [] 10% [] Variable Rate % ............ NAME(s) oF ............................. NEAREST AGE AT TERM OF YEARS ANNUITANT(S) DATE OF BIRTH DATE OF DEATH ANNUITY IS PAYABLE [] Life or [] Term of Years__ [] Life or [] Term of Years__ []Life or []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) [] Bi-weekly (26) [] Quarterly (4) [] Semi-annually (2) []Annually (1) 3. Amount ofpayout per period 4. Aggregate annual payment, Line 2 multiplied by Line 3 5. Annuity Factor (see instructions) Interest table rate [-13 1/2% []6% [] 10% Adjustment Factor (see instructions) [] Monthly (12) []Other ( ) [] Variable Rate % Value of annuity - If using 3 1/2%, 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: (Line4 x Line5 x Line 6) + Line3 $ 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) should be reported at the appropriate tax rate on Lines 13, 15, 16 and 17. (If more space is needed, insert additional sheets of the same size) STF PA42021 F. 15 REV-1647 EX + (9-00) COMMONWF-ALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ROBERT W. GERKEN SCHEDULE M FUTURE INTEREST COMPROMISE (Check Box 4a on Rev-1500 Cover Sheet) FILE NUMBER This schedule is appropriate only for estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. [] Will [] Trust [] Other I. Beneficiaries AGE TO NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH NEAREST BIRTHDAY '1. 2. 3. 4. $, I1. For decedents dying on or after July 1, 1994, if a surviving spouse exemised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. [] Unlimited right of withdrawal [] Limited right of withdrawal tEExplanation of Compromise Offer: Summary of Compromise Offer: 1. Amount of Future Interest .................................................................... $ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) ........... $ 3. Value of Line 1 passing to spouse at appropriate tax rate CheckOne [--~6%, [--13%, i--]0% .......................... $ (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check One []6%, [--14.5% ................................. (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 Taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) ........... $ 6. Value of Line 1 Taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) ........... $ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) ................................ $ (If more space is needed, insert additional sheets of the same size) STF PA42021 F 16 REV-1649 EX + (1-97) (I) SCHEDULE 0 I COMMONW A'T" OF PENNSY V^N ELECTION UNDER SEC. 9113(A) INHERITANCE TAX RETURN RESIDENT DECEDENT (SPOUSAL DISTRIBUTIONS) ESTATE OF FILE NUMBER ROBERT W. GERKEN Do not complete this schedule unless the estate is making the election to tax assets under Section 9'113 (A) of the Inheritance & Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Trust (marital, residual A, B, By-pass, Unified Credit, etc.). If a trust or similar arrangement meets the requirements of Section 9113 (A), and: a. The trust or similar arrangement is listed on Schedule O, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule O, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule O, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar arrangement. PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113 (A) trust or similar arrangement. DESCRIPTION VALUE Part A Total $ PART B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is being made. DESCRIPTION VALLE Part B Total (If more space is needed, insert additional sheets of the same s~ze) STF PA42021 F. 17 TO: Please be advised of an address change for Sheila L. O'Neill, from 13935 Route 208, Marble 16334, to Sheila L. O'Neill 1330 Fieldpoint Drive West Chester, PA 19382 gz: L,~! L- ,kY!.] 170. Thank you, Sheila L. O'Neill Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/08/2004 O'NEILL SHEILA L 1330 FIELDPOINT DRIVE WEST CHESTER, PA 19382 RE: Estate of GERKEN ROBERT WILLIAM File Number: 2002-00819 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 8/13/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: ~//~ /d~DO / / Will No.: Admin. No.'~d>a Z -dPOd~! ~ 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 adm~inist.~tion of the estate is complete: Yes [---] No 1_~ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: f/b.4-~- 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 _ No ["-1 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes [--] No [--] c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed wit/bqthe Clerk of the Orphans' Court be attached to this repoE/Z. / and may ~-' //d/d ~ Si g~ature D ate: Address b / o '? Vz- -/,,Fz a Telephone No. Capacity: ~ers°nal Representative ~1 Counsel for personal representative BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-15¢7 EX AFP (09-0¢) GREG B RHOADS RHOADS & ASSOCS 160 S ZND AVE STE 4 CLARION DATE 11-29-2004 ESTATE OF GERKEN DATE OF DEATH 08-15-2002 FILE NUMBER 21 02-0819 :FCOUNTY CUMBERLAND ACN 101 I Amoun~ Remi~ed ROBERT MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF GERKEN ROBERT WFZLE NO. 21 02-0819 ACN 101 DATE 11-29-2004 TAX RETURN #AS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASE]) ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) $. CZosaly HeZd Stock/Partnership Interest (Schedule C) (3) ~. Mortgages/Notes Receivable (Schedule D) (q) 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Hisc. Expenses (Schedule H) (9) 10. Dabts/Hortgage Liabilities/Liens (Schedule I) (10} 11. ToteZ Deductions 12. Ne~ Value of Tax Re~urn 18/000.00 46/449.00 .00 .0O $0/600.00 .00 .00 (8) 5,299.00 NOTE: To insure proper credit to your account, submit the upper port/on of ~his form with your ~ax payment. 15. 1~. NOTE: 95,049.00 58,494.00 (22) 4:5.79:~. 00 (22) 51,256. O0 Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) Net VaZue of Estate Subject to Tax (1~) Zf an assessment ~as lssued previously, lines 14, 15 and/or 16, 17, reflect flgures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amoun~ of Line 1~ at Spousal rate (15). 16. Amouni: of L/nm 1~ taxable at Lineal/Class A rate (16) 17. Amount of Line lq a~ Sibling re~a (17) 18. Amount of Line 1~ taxable a~ Collateral/Class B ra~e (18). .00 51,256.00 18 and 19 will TOTAL TAX CREDIT .00 BALANCE OF TAX DUEI .00 INTEREST AND PEN. .00 TOTAL DUE .00 ( IF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED. ~ ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. DISCOUNT INTEREST/PEN PAID (-) 19. Principal Tax Due TAX CREDZTS: PAYMENT RECETp1- DATE NUHBER AHOUNT PAID 51,256.00 x O0 = .00 · 00 x 045= .00 · O0 x 12 = .00 . O0 x 15 = .00 (19)= . O0 STATUS REPORT U1\1DER RULE 6.12 Name of Decedent: ~A$'~ (y.), G~L._Ii.e.d Date of Death: ~'- '7: ~/I/? If-J ~ -"11frn-1 z.. ~\e. WrtT1-Jo.: ~/-c>z - 6g, '7 Mu.:..l. Hu.~ Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration ofthe above-captioned estate: 1. State whether a~pation of the estate is complete: Yes 0 No U6 2. lfthe answer is No, state when the personal representative reasonably believes that the administration will be complete: a? ~ /}-n+S - H.,f lIe: 4sLR.-O /rCC-Ou.vrA-.r- * &.vrC-e11i P,>>4<-- rZe.~f.4?L-.-J 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 No 0 b. The separate Orphans' COUli No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes 0 No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts maybe filed with e Clerk of the Orphans' Court and may be attached to this repo Date: #0(' ~0EJV C CXJdJLL Name t. (-' .... o c"~.J _.J ~'-"'-'I =j If:1 ~-:-~j ~ 1~3o H d.. t..fl f'.:Ji--() I Address 4. {1 J~r~"57lW\ t1 , /9.tf?L C. t LLi y. u=.. u__ L (~~) ( c)," LJ.__J I C) C' C5 i:=3 cc ~/cJ I~L. ISZ 0 Telephone No. Capacity: ~onal ReDresentative n Counsel for "personal representative uf. Cumberland County - Register of Wills One Courthouse Square, Room 102 Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/13/2005 O'NEILL SHEILA L 1330 FIELDPOINT DRIVE WEST CHESTERPA 19302 RE: Estate of GERKEN ROBERT WILLIAM File Number: 21-02-0819 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 AMMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel. Within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 08/13/2005 Your prompt attention to this matter will be appreciated. Thank you. Sincerely, ~=~~ REGISTER OF WILLS cc: File Counsel Judge vA Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/05/2006 O'NEILL SHEILA L 1330 FIELDPOINT DRIVE WEST CHESTER, PA 19382 RE: Estate of GERKEN ROBERT WILLIAM File Number: 2002-00819 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.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: 8/13/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~~~ C Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel ~ " ~ ~ . Register of Wills of Cumberland County Date of Death: . S~TUS REPORT UNDER RULE 6.12 rJ(. ibe1Kf t.< ),:'-'-1 AA ~~....J RII~ I ZOO Z- , ~Ooz--aoffl Cf Name of Decedent: Estate No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State wh~ administration of the estate is complete: Yes IId"" No 0 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 0 No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes 0 No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be _ attached to this report. ~ ^ Date: (7l~/t?.(, ~ ~ Signature. '" c:; /.hif7~A- 6 ~ 1;!1 c.-f..., Name o ............ ~ c :' {;; ~9 ~~t..af, '-L ~tJ. ~~f2/K. S'1'1tI~-C Address / PA- I q 7? ~ b (0 -'YZ-- I K L () Telephone No. Capacity: ~onal Representative o Counsel for personal representative