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Home My WebLink About03-0706 Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Patricia Ann Gingrich No. ':;'I-~.. 7b' also known as , Deceased Social Security No. 168-24-3244 John William Gingrich Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE "A" OR "B" BELOW:) GJ A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut or named in the Last Will of the Decedent, dated 11/30/1985 and codicil(s) dated State relevant circumstances, e,g., renunciation, death of executor, etc Except as follows, Decedent did not marry, was not divorced and did not have a child bom or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: 0 B. Grant of Letters of Administration (c.I.a., d.b,n.c.l.a.: pendente lite, durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: r Name Relationship Residence 1 (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with'his/her last family or principal residence at 405 5th Street, Summerdale. Cumberland County, PA 17093 (list street, number and municipality) Decedent, then 72 years of age, died July 31 ,2003 ,at Kinkora Pythian Home, 25 Cove Rd, Duncannon, PA (Location) Decedent at death owned property with estimated values as follows: (if domiciled in PA) All personal property ......................................... $ (if not domiciled in PA) Personal property in Pennsylvania .................... $ (If not domiciled in PI>.) Personal property in County .............................. $ Value of real estate in Pennsylvania ........................................................................................ $ 0.00 T ota. ... .................................................................................................................. $ Real Estate situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Typed or printed name and residence John William Gin rich RW-7 1"/-/0/--3 Oath of Personal Representative Commonwealth of Pennsylvania County of Dauphin The Petitioner(s) above-named swear(s) and 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 representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to and affirmed and subscribed before me this c::2/,74 day of ~ = I ~ A '- ,.. ~u.<z:::: Jy~ ~ Ii / L .---. 7";; L .,{'d$/.Y~ .1/::/. t',JrA. loe. ~ . ~A-U/6J~~~y DECREE OF REGISTER Estate of Patricia Ann Ginarich Deceased No. ~/- ~~- ~LJ~ also known as Date of Death: 7/31/2003 AND NOW, 2003 , in consideration of the Petition , on the reverse side hereon, satisfa ory proof having been presented before me, IT IS DECREED that Letters ~ Testamentary Q of Administration (c.I.a., d.b.n.c.l.; pendente lite; durante absentia; durante minoritate) are hereby granted to John William Gingrich in the above estate and that the instrument( s), if any, dated November 30 , 1985 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters.,............... .,.. ..... .... ". ... $ /l2rY7 O~'h?d )&;2~ /M~"o/ Short Certificate( s) .... - -......... $ C\-::?n.rY'J Regi~fiU~ Renunciation ........ ............. ..... $ Affidavit ( ) ....................... $ ~ 'fY\ ~ Extra Pages ( ).............. $ , wi A . ~ Attomey ", Codicil .,....,........ ,....... ....,.. .-. $ JCP Fee ................................. $ //,?, r-r:; 9[: tt~rn~~: iWJry !tr. Baturin, Esquire Inventory & Tax Forms............. $ I.D.No: 83006 Other ...................................... $ Address: 717 North Second Street Harrisburg, PA 17102 TOTAL .............................$ ~b6 Telephone: 717-234-2427 DATE FILED: RW-7A Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 6/15/2005 BATURIN HARRY M 717 NORTH SECOND STREET HARRISBURG, PA 17102 RE: Estate of GINGRICH PATRICIA ANN File Number: 2003-00706 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6,12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration, This filing is due by: 7/31/2005 Your prompt attention to this matter will be appreciated. Thank You, Sincerely, ~~~ GLENDA FARNER STRA AUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge ~ c:)/-O.3- ?Oh REGISTER OF WILLS OF COUNTY OATH OF SUBSC ING WITNESS , codicl (each) a bscribing witness to the will pre ly qualified according to law, depose and say(s) that present and saw , the testat , s' n the same and that signed a witness at the request of testat_ 1 h presence and (in the pres ce of each other) (in the p sence of the other subscribing witness( es . Sworn to or affirmed and subscn me this Register (Name) ) C"--"I (Address) ~, (--- N = L~:J REGISTER OF WILLS OF COUNTY p ()-ATH OF NON-SUBSCRIBING WITNESS ~)-/N v), G/N(~/C.k ~)Qc~ue-L'Yl~ rh, U,I...sOYl , (each) a subscriber hereto, (each) being duly qualified accordi~lav:, de~n~S) that I h~u P\R,or...- familiar with the signature of '"T"'R J (' , "" ., "1(' ~ \ oo~ testat~ of (ane of tl,G st1b3eribin~ v.itResii~~ t-e) the will presented herewith and codicil that \ he'-t believ, the signature on the will is in the handwriting of ~\(~I~h G~~~J, to the best (;f \ h~ It. knowledge and belief. ~0~7/ Sworn to or affirmed and subscribed before me this ~7,4 day of V/!:!~0'7" ~,~~~ ~ _ J' (AddreSS)LJ . ~ ~~ Register ~ ~(Y)- ~~ (Name) (Address) No. Date 43 Rev, 2187 COMMONWEALTH OF PENNSYLVANIA' OEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH STAll FilE NUMBER NAME Of DECEDENT (flrSl. Middle. Las) SEX SOCIAL SECURITY NUMBER .. ..Female .. 168-24 - 3244 AGE (La.. 8if1hoav) UNDER 1 YEAR UNDER 1 DAY PlACE OF DEATH 10',<<" Of'ly t)(\8 -- ~ ,nSlrUChou$ on _o&nel SlQe) MeNo. ! 0... Hour. ~ ....inu1.. HOSPITAL: ERIOuIpaII.na ~ 72 v... Penbrook, Pa Inpal_ 0 001\0 =:dy,o . . 7. ... COUNTY OF OEATH . Wife SCree! and number. RACE . Amencan kwMn. 8Ial;k, WhiI.. ek;. PI r< IT Ht6PrIAL ,5_1 . Cumberland Ic~ White ... MARITAl STATUS. Mamlld SUAVIV1HO SPOUSE N.......Marr'-d. w~. III '.w.. gn.oe~ namtI) IlM><cod lSpecdyl . u.. ~~bb Car Dealer ... Widow ... DECEOENT'S MAlUNG ADDRESS (51,.. CilyllOwn. SIaIe. Zip COde) DECEDEN7'S Pennsylvania l7.JOc,..,-......in East Pennsboro . ACTUAl 11.. ~Ia l);d ..... 405 5th street RE5IDENCE -- lSee onslruchans w...... ... Summerdale Pa 17093 on other Sldel Cumberland lownship? 17d.O :~=oI 17b. Cou C"Y-" FAJ"HER'S NAME (FifSi. MKkh. lasll MOTHER'S NAME IFIISI. Middle. Malden SUlnalTl6J) II, S Ivester Brou her ... Sarah E. Smith INFORMANT'S NAIoIE (T ypelp,inl) Gingrich INF'''ANT'~ MA'llNG ~" 150tt'~1Town. t. 4> atl b Pa 17040 John W. P1ne H1 ., an 1S urg, 2Gb. METHOD Of' DISPOSITION PLACE OF DISPOSITION. Name of Cemetary. C,emalOfy lOCIO"IQN. City/bM1. 51.... Zip ~ _0 Cremalion GO or OIher Plac. 0Ih00 (Specdy' 1 2003 2l..East Hb Crematory 2ld. Hbg, Pa LICENSE NUMBER NAME AND AOORESS OF FACILITY "b. F.D.011897 L i.ullivan F.H. 51 N. LICENSE NUMBER NoD H. e or t.spiralory au.sl. shock or heal1lallur. I Approaimal. 0Ih00 signo/lcant......... conInbuIlng 10 _..... I iNeMII behween noI mulling in 1M ~ cauee given in PMT I. : onset and dNltI I .. i , [ . , I I c. , DUE I . . WERE AUTOPSY FINDINGS UANNER Of DEATH DATE Of INJURY TIME OF INJURY INJURY AT WORK? DESCRIBE HOW lNJURY OCCURRED. AWLABLE PRIOR 10 .zf IMonlh, Day, Year, COUPlETION fY CAUSE 0 OF DEATH? NatUl'aI Homi<:ide _0 NoD Ace..... 0 Pending Io......tgalon 0 NoD 0 o PlACE Of tNJUAY. AI homa. 'arm,a:;eel. factory, office ... .... SuK:tde Coutd not be delafmlned building, .Ic_ (Spec"v) _. 'Ib. ZO. 200. CDlTIFIER ICheck only one) -CERTIFYING PHYSICIAN WhySICI30 cerllfy..-.g cause ~ death whetl dnolhef phVSlClan has plonounced deal'" ana compieled Item 231 TOUMbeeto'",yknowledge,ct.athoccumtdduetolh4lcaUM(S,andmanMra.s.atect. -.... ...... -......................... ........... .PRONOuNCING AND CERTIFYING PHYSICIAN (Ph'f!iCtan boIh O}fOflOUOClOlJ lJealh dnd Cer1dyll"lg 10 cause of aealh\ To.... best o. my knowledge, death occurr" at the Umit. dale, ilnd plec., and dU.1a the CaUH(s) and manner as stillled.. .MEDICAL EXAMIHER/CORONER 108 Lowther Street On the ~.i. o'e.amina.ion and/or invesligalion. in my opinion, death occurred lIthe 11m., da.e, and place, "nd due to Ihe eause(.) and 0 Lemoyne, Pa 17043 mann., a. atated.. . . . . . . , , . . . _ . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . , . . . . . , . . , , . . . . . . , . . . . . . . . . . :11.. ... ~"TRAR'S SIG~~U;')E A~,.~!Jj-R 'd~P(I{ I DATE FilED (Month. Day. Yearl ~.--.......".::.."";!'../ /~"r..- !:"-"':-:!.#'~/!..~;:1-=-::-~~)JL-- -~~- c:;21-CJ8.?~ ~;U~;,~) . ! ",-~, '. Q -. ,-; L Z 09i1 r.o _ t." (. (J _ v ... ,;2/- 08- 706 WILL AND TESTAMENT No. 616 lJ~ PATRICIA ANN GINGRICH of Summerdale in the County of Cumberland and State of Pennsylvania, being of sound mind, memory and understanding, do make and publish this my last will and testament, hereby revoking and making void all former wills by me at any time heretofore made. And first I direct that mv funeral be conducted in manner corresponding with my estate and , . situation in life and that all my just debts and funeral expenses be fully paid and satisfied as soon as conveniently may be after my decease. As to such estate as it hath pleased God to intrust me with, I dispose of the same as follows, VIZ: I give, devise and bequeath unto my beloved husband, JOHN McKINLEY GINGRICH, JR. , all my property, real, personal and mixed, of what nature or kind soever, and wheresoever the same shall be at the time of my death. In the event my husband predeceases me, then I give, devise and bequeath my entire estate to my three beloved children, JOHN WILLIAM GINGRICH, JACQUELINE MARIE WILSON and DEBORAH ANN PITZER, in equal shares, share and share alike. I hereby waive any requirement which may have been other- wise imposed upon the Executor of my estate to post a bond in connection with the administration of said estate in this or any other jurisdiction where permitted by law. '....C1 ~...-} fYl el- f'- N c::J L.:J ;:..;.:....- . - '"" ' - 9 -- - M -~ I' ... ..J ...... r And I hereby nominate, constitute and appoint my beloved husband, JOHN McKINLEY GINGRICH, JR. Exeeut or of this my last will and testament, and JOHN WILLIAM GINGRICH, alternate rr;xWJ.ltor 'w the n Itness hereof, I PATRICIA ANN GINGRICH 'festat r ix ,have to this, my will. written on one sheet of paper. set my hand and seaL this 30th day of November A. D. OIlt: Thousand Nine Hundred and Eighty-five (1985). ~~~(SEAL) ATRICIA ANN GINGRICH Signed, sealed, published and declared by the ahove named PATRICIA ANN GINGRICH as and for her last will and testament, in the presence of us, who have hereunto subscribed our names at her request as witnesses thereto, in the presence of the said Testatrix and of each other. a; jm B ~- , 'm . :';rdO~~.~~y,j ~ . ....... N 0 r-I r-- r-I oi -I-' Cl. Q) co ti I ....... ;:r:: Q) .r-! .. - U 1-1 C :I - .c ~ H Z-l-'CO .. a 0::: Hrn> 'f: 0 0::: r-I It = Z ~ 'd >t r-- :I: ..... H ~CcnN vi~ \It 0 ,c:Coc~ Cot o::l C) eN >-, a ...... z Q) Q) I l:: ~ = Z c..<lrnp.,~ QU'I ,c:C (V) IQ z.c ~N Q ~ = ,c:C H -I-' 01 ~ c "'. .c = H 0:::1-11-1...... ~Cl. U ~O::lr-- <5 H ~z'Or-l U - - 0::: ,c:C cnr-- t .- ~ o::l r-I .r-! - ~ ~ ,c:C r-I 1-1 p., r-- 1-1 QIl co iii ::r: 0 Register of Wills. of Cumberland County, PA CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Patricia Ann Ginarich Date of Death: 7/31/2003 Will No, ~/-08- ?/Jb Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on Name Address John William Gingrich 9 Pine Hill Road Landisbura. PA 17040 Jacqueline Marie Wilson 406 Boyer Street Summerdale. PA 17093 Deborah Ann Pitzer 732 Waltonville Road Hummelstown. PA 17036 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: Date: D6/)/a~ ~' (11. ~ Signature Harry M. aturin, Esquire Name: Harrv M. Baturin. Esauire , ;'~"'_ i --"', Address: 717 North Second Street - Harrisbura PA 17102 ;i" Telephone(717) 2342427 Capacity: Personal Representative X Counsel for Personal Representative IN RE: ESTATE OF IN THE COURT OF COMMON PLEAS PATRICIA ANN GINGRICH CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION No. NOTICE OF BENEFICIAL INTEREST BEFORE THE REGISTER OF WILL, COUNTY OF CUMBERLAND, PENNSYLVANIA In re Estate of Patricia Ann Gingrich , deceased, No. of TO: Mr John Gingrich (Beneficiary) 9 Pine Hill Road (Address) Landisburg, P A 17040 Please take notice of the death of decedent and the grant of letters to the personal representatives named below. You may have a beneficial interest in the estate as follows: Name of decedent Patricia Ann Gingrich Last known address of decedent 405 5th Street, Summerdale, P A 17093 Place of death Kinkora Pythian Home, 25 Cove Road, Duncannon, P A County of grant of original letters Cumberland County A copy of the will IS X is not attached. (Will was delivered previously.) Names, addresses, and telephone numbers of all personal representatives appointed: Name Address Telephone John William Gingrich 9 Pine Hill Road 717-789-4689 Landisburg, P A 17040 Name, address, and telephone number of counsel: Name Address Telephone Harry M. Baturin, Esq. 717 North Second Street 234-2427 Harrisburg, PAl 71 02 Additional information may be obtained from the undersigned. Date: Signature Name Harry M Baturin, Esq. Address BATURIN & BATlJRIN 717 North Second Street Harrisburg, FA 17102 Telephone (717) 234-2427 Capacity _ Personal Representative --X- Counsel for the Estate IN RE: ESTATE OF IN THE COURT OF COMMON PLEAS PATRICIA ANN GINGRICH CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION No. NOTICE OF BENEFICIAL INTEREST BEFORE THE REGISTER OF WILL, COUNTY OF CUMBERLAND, PENNSYLVANIA In re Estate of Patricia Ann Gingrich , deceased, No. of TO: Ms. Jacqueline Marie Wilson (Beneficiary) 406 Boyer Street (Address) Summerdale, P A 17093 Please take notice of the death of decedent and the grant of letters to the personal representatives named below. You may have a beneficial interest in the estate as follows: Name of decedent Patricia Ann Gingrich Last known address of decedent 405 5th Street, Summerdale, P A 17093 Place of death Kinkora Pythian Home, 25 Cove Road, Duncannon, P A County of grant of original letters Cumberland County A copy of the will IS X is not attached. (Will was delivered previously.) Names, addresses, and telephone numbers of all personal representatives appointed: Name Address Telephone John William Gingrich 9 Pine Hill Road 717-789-4689 Landisburg, P A 17040 Name, address, and telephone number of counsel: Name Address Telephone Harry M. Baturin, Esq. 717 North Second Street 234-2427 Harrisburg, PA 17102 Additional information may be obtained from the undersigned. Date: Signature Name Harry M. Baturin, Esq Address BATURIN & BATlJRIN 717 North Second Street Harrishurg, FA 17102 Telephone (717) 234-2427 Capacity _ Personal Representative ~ Counsel for the Estate INRE: ESTATEOF IN THE COURT OF COMMON PLEAS PATRICIA ANN GINGRICH CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION No. NOTICE OF BENEFICIAL INTEREST BEFORE THE REGISTER OF WILL, COUNTY OF CUMBERLAND, PENNSYLVANIA In re Estate of Patricia Ann Gingrich , deceased, No. of TO: Ms. Deborah Ann Pitzer (Beneficiary) 732 Waltonville Road (Address) Hummelstown, P A 17036 Please take notice of the death of decedent and the grant of letters to the personal representatives named below. You may have a beneficial interest in the estate as follows: Name of decedent Patricia Ann Gingrich Last known address of decedent 405 5th Street, Summerdale, P A 17093 Place of death Kinkora Pythian H011Je, 25 Cove Road, Duncannon, P A County of grant of original letters Cumberland County A copy of the will IS X is not attached. (Will was delivered previously.) . Names, addresses, and telephone numbers of all personal representatives appointed: Name Address Telephone John William Gingrich 9 Pine Hill Road 717-789-4689 Landisburg, P A 17040 Name, address, and telephone number of counsel: Name Address Telephone Harry M. Baturin, Esq. 717 North Second Street 234-2427 Harrisburg, PAl 71 02 Additional information may be obtained from the undersigned. Date: Signature Name Harry M. Baturin, Esq Address BATlJRIN & BATlJRIN 717 North Second Street Harrishurg, PA 17102 Telephone (717) 234-2427 Capacity _ Personal Representative --X- Counsel for the Estate COMMONWEALTH OF PENNSYLVANIA REV-1162 EXI11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 003876 GINGRICH JOHN WILLIAM 9 PINE HILL ROAD LANDISBURG, PA 17040 ACN ASSESSMENT AMOUNT CONTROL NUMBER ___nn_ fold ---------- -------- 101 I $832.45 ,. ESTATE INFORMATION: SSN: 168-24-3244 I FILE NUMBER: 2103-0706 I DECEDENT NAME: GINGRICH PATRICIA ANN I DATE OF PAYMENT: 04/29/2004 I POSTMARK DATE: 00/00/0000 I COUNTY: CUMBERLAND I DATE OF DEATH: 07/31/2003 I I TOTAL AMOUNT PAID: $832.45 REMARKS: JOHN W GINGRICH INITIALS: AC SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS . ., REV-1500 EX + (6-00) REV-1500 OFFICIAL USE ONLY '* COMMONWEALTH OF . PENNSYLVANIA , DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPT. 280601 c:L I - 03 -; 0 6 HARRISBURG, PA 17128-0601 RESIDENT DECEDENT "'COuNTY"COiiE ---vEAr- - - NuMBER-- DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ Z Gin rich, Patricia Ann 1 6 8 - 2 4 - 3 2 4 4 W DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE C W 07/31/2003 REGISTER OF WILLS () W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER C - - w !Xl 1, Original Return o 2. Supplemental Return o 3. Remainder Return (date 01 death prior to 12-13.82) I- ~~(/l o 4. Limited Estate o 4a. Future Interest Compromise (date 01 death after 12-12-82) o 5. Federal Estate Tax Return Required ua::~ w~u :I:a::g o 6. Decedent Died Testate (Attach copy of Will) o 7. Decedent Maintained a Living Trust (Attach copy ofTrusQ .Q... 8. Total Number of Safe Deposit Boxes u c..m c.. <C o 9. Litigation Proceeds Received o 10. Spousal Poverty Credit (date 01 death between 12,31-91 and 1-1-95) o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) I- THIS .'SEc.TIONI.N1\.lS,.Ii3!iE'.O.OMP/;i!iEtJiEO,AL./;;OORRJiESPOND!iENCJiE'.IiN1..I.lilglil..:r.i.fRIIRMAliIN"$IiIQIi1DI.$JiEDn~JiEO"ED."'O: z NAME.- COMPLETE MAILING ADDRESS w GIM 0 JohjJ U. I'Cte z 0 FIRM NAME (If Applicable) L . c.. (/l / POJ t!. /I, LL.. tC.fl, 41-1 iJ IS fou ~ PI! /7i> L{ w a:: a:: TELEPHONE NUMBER 0 t,Y7 u OFFICIAL USE ONLY 1. Real Estate (Schedule A) (1) ~r- 2. Stocks and Bonds (Schedule B) (2) ~.n.12 g " 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) :l=> -a 0.00 ;:J 4. Mortgages & Notes Receivable (Schedule D) (4) N 13,081,90 \0 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) :..~ Z 10,040.48 ........] 0 6. Jointly Owned Property (Schedule F) (6) (".j ~ .. o Separate Billing Requested I 0....\ ...J 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) ::::l ~ (Schedule G or L) /l. 25,399.50 < 8. Total Gross Assets (total Lines 1-7) (8) () 4,257.55 w 9. Funeral Expenses & Administrative Costs (Schedule H) (9) [t: 2,643.11 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) (11) 6,900.66 12. Net Value of Estate (Line 8 minus Line 11) (12) 18,498.84 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14, Net Value Subject to Tax (Line 12 minus Line 13) (14) 18,498.84 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Z 15. Amount of Line 14 taxable at the spousal tax 0 rate, or transfers under Sec, 9116 (a)(1.2) X _(15) i= < 16. Amount of Line 14 taxable at lineal rate 18,498,84 X .045 (16) 832.45 ~ ::::l /l. 17. Amount of Line 14 taxable at sibling rate X .12 (17) ~ 0 18. Amount of Line 14 taxable at collateral rate X .15 (18) () ~ 19. Tax Due (19) 832.45 ~ D 20. CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT , , Decedent's Complete Address: STREET ADDRESS 405 5th Street CITY I STATE I ZIP Summerdale PA 17093 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1 ) 832.46 2. Credits/Payments A. Spousal Poverty Credit B, Prior Payments C, Discount Total Credits (A + B + C) (2) . 3, Interest/Penalty if applicable D. Interest E. Penalty 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) 0.00 5. It Line 1 + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE. (5) 832.4~ A. Enter the interest on the tax due. (5A) 8, Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) 832.45 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; ........................................................................... 00 D b. retain the right to designate who shall use the property transferred or its income; ........................................ D 00 c. retain a reversionary interest; or ...................................................................................................... D 00 d. receive the promise for life of either payments, benefits or care? ............................................................. D 00 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.....,...,...........,...........,..... ............ ........... ....... ......................... D 00 3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? ................. D 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ... ..... .....,.,.,..................................................................................... D 00 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 belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge, SIGNATUR ON RESPONSIBL FOR FILING RETURN DATE Ci -c:lIf-.llCJO Y jI 9 Pine Hill Road Landisburg, PA 17040 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS 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. 99116 (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, 99116 (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 applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4,5%, except as noted in 72 P,S, ~9116(1,2) [72 P,S, ~9116(a)(1)t, 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, REV-1502 EX + (6-98) '* SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Ginarich. Patricia Ann 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 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 which is iointlv-owned with rioht of survivorshlo must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. N/A 0.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1503 EX + (6-98) '* SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Ginarich. Patricia Ann All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Prudential common stock .2,277.12 64 shares at $35.58 per share TOTAL (Also enter on line 2, Recapitulation) $ 2.277.12 (If more space is needed, insert additional sheets of the same size) REV-1504 EX + (6-98) SCHEDULE C * CLOSEL Y.HELD CORPORATION, COMMONWEALTH OF PENNSYLVANIA PARTNERSHIP OR INHERITANCE TAX RETURN SOLE.PROPRIETORSHIP RESIDENT DECEDENT ESTATE OF FILE NUMBER Ginarich. Patricia Ann Schedule C-1 or C-2 (including all supporting 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. N/A 0.00 TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1505 EX + (6-98) '* SCHEDULE C-1 COMMONWEALTH OF PENNSYLVANIA CLOSEL Y -HELD CORPORATE INHERITANCE TAX RETURN STOCK INFORMATION REPORT RESIDENT DECEDENT I ESTATE OF FILE NUMBER Ginarich. Patricia Ann 1. Name of Corporation State of Incorporation Address Date of Incorporation City State Zip Code Total Number of Shareholders 2, Federal Employer 1.0. Number Business Reporting Year 3. Type of Business Product/Service 4. TYPE TOT ALNUMBER'OF STOCK Voting/Non-Voting SFlARESOUTSTANDING Common $ ----..------ Preferred $ Provide all rights and restrictions pertaining to each class of stock. 5. Was the decedent employed by the Corporation? . . . . . . , , . . . . . . . . . . . . . . . . . . . . . . . . . . . . , ,0 Yes 0 No If yes, Position Annual Salary $ Time Devoted to Business 6, Was the Corporation indebted to the decedent? .....,.....................,.,......... 0 Yes 0 No If yes, provide amount of indebtedness $ 7, Was there life insurance payable to the corporation upon the death of the decedent? . . . . . . . . . . . . . . ,0 Yes 0 No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the pqlicy 8. Did the decedent sell or transfer stock in this company within one year prior to death or within two years if the date of death was prior to 12-31-82? DYes 0 No If yes, o Transfer 0 Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 9, Was there a written shareholder's agreement in effect at the time of the decedent's death? . . . . . , . . . . . . 0 Yes 0 No If yes, provide a copy of the agreement. . 10. Was the decedent's stock- sold? . . . . . , . . . ~ .. . . . . . . .' .. . . . . . '. . , . . . . . . .. . . . . . . . . . , , .0 Yes 0 No If yes, provide a copy of the agreement of sale, etc 11. Was the corporation dissolved or liquidated after the decedent's death? . . , . . . . . . . . . . . . . . . . . . .. 0 Yes 0 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? . . ... . , , , . . . . . . . . . . . . .. 0 Yes 0 No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE A Detailed calculations used in the valuation of the decedent's 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 pnncipal 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, (If more space is needed, insert additional sheets of the same size) '- REV-15G6 EX + (9-001 . SCHEDULE C-2 COMMONWEAL TH OF PENNSYLVANIA PARTNERSHIP INHERITANCE TAX RETURN INFORMATION REPORT RESIDENT DECEDENT ESTATE OF FILE NUMBER Ginarich. Patricia Ann 1. Name of Partnership Date Business Commenced Address Business Reporting Year City State Zip Code 2, Federal Employer 1.0. Number 3. Type of Business ProducUService 4. Decedent was a 0 General 0 Limited partner. If decedent was a limited partner, provide initial investment $ 5. PERCENili PARTNER NAME OFINCOME A. B. C. D. 6, Value of the decedent's interest $ 7. Was the Partnership indebted to the decedent? .........,......................0 Yes o No If yes, provide amount of indebtedness $ 8. Was there life Insurance payable to the partnership upon the death of the decedent? ........ 0 Yes o No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the poliCY 9, Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-827 DYes 0 No If yes, 0 Transfer 0 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? . . . . . . . 0 Yes o No If yes, provide a copy of the agreement. 11. Was the decedent's partnership interest sold? . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . , ., 0 Yes o No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? ................. 0 Yes o 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? . . . . . . . . . , . . . . . . . . , . . . . . . . . . . . .. 0 Yes o No If yes, explain 14, Did the partnership have an interest in other corporations or partnerships? . . . . . . . . . . . . . . . . 0 Yes o No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (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. REV-1507 EX + (6-98) *' SCHEDULE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER Ginarich. Patricia Ann All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. N/A 0.00 TOTAL (Also enter on line 4, Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) *' SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Ginarich. Patricia Ann Include the proceeds of litigation and the date the proceeds were received by the estate, All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Members First Federal Credit Union 5,052.53 Savings Account #134641-00 2. American General Life and Accident Company 1,250.00 Policy No. 862781 - Policy made payable to the Estate of Patricia Gingrich 3. Prudential Financial 2,353.16 Policy No. 500323659 - Policy made payable to the Estate of Patricia Gingrich 4. Prudential Financial 4,426.21 Policy No. D42 274 723 - Policy made payable to the Estate of Patricia Gingrich TOTAL (Also enter on line 5, Recapitulation) $ 13.081.90 (If more space is needed, insert additional sheets of the same size) REV-1509 EX + (6-98) *' SCHEDULE F JOINTL Y -OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT , ESTATE OF FILE NUMBER Ginarich. Patricia Ann If an asset was made joint within one year of the decedenfs date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. John W. Gingrich 9 Pine Hill Road Son Landisburg, PA 17040 B C 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 DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 6/11/00 Members First Federal Credit Union 6,132.99 50. 3,066.50 Savings Account #130331-00 2. A. 6/11/00 Members First Federal Credit Union 13,947.96 50. 6,973.98 Checking Account #130331-11 TOTAL (Also enter on line 6, Recapitulation) $ 10040.48 (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) '*' SCHEDULE G INTER-VIVOS TRANSFERS & COMMONWEALTH OF PENNSYLVANIA MISC. NON-PROBATE PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT I ESTATE OF FILE NUMBER Ginarich. Patricia Ann 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 ITEM ,"CLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST VALUE (IF APPliCABLE) 1. N/A 0.00 O. 0.00 TOTAL (Also enter en line 7 Recapitulation) $ (If more space is needed, insert additional sheets of the same size) . REV-1511 EX + (12-99) *' SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT I ESTATE OF FILE NUMBER Ginarich. Patricia Ann Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Sullivan Funeral Home 2,104.00 2. Rolling Green Cemetery 485.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) John William Gingrich Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 9 Pine Hill Road City Landisburg State PA Zip 17040 Year(s) Commission Paid: 2. Attorney Fees Baturin & Baturin 1,400.00 3. Family Exemption: (If decedent's address is not the same as claimanfs, attach explanation) Claimant N/A Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Cumberland County Register of Wills 67,00 5. Accountant's Fees N/A 0.00 6. Tax Return Preparer's Fees N/A 0.00 7. Cumberland County Register of Wills - Additional short certificates 3.00 8. Cumberland County Law Journal - Legal advertising 75.00 9. The Patriot News - Legal advertising 123,55 TOTAL (Also enter on line 9, Recapitulation) $ 4.257.55 (If more space is needed, insert additional sheets of the same size) . REV-1512 EX + (6-98) '* SCHEDULE. DEBTS OF DECEDENT, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT , ESTATE OF FILE NUMBER Ginarich. Patricia Ann Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Sprint Telephone service 69.23 2. PA American 60.28 3. The Patriot News 3.02 4. Holy Spirit Hospital 22.26 5. PP&L 99.69 6. Verizon 7.94 7. Pharmerica 84.48 Final medications 8. Sewer 96.00 9. Property Taxes 1 ,261 .14 10. EPambel 40.00 11. East Pennsboro Township 96.00 Sewer - Trash 12. John Gingrich 39.42 Death Certificates & Short certificates 1 change of locks 13. Kinkora 56,33 final nursing home 14. Rolling Green 210.00 15. Pinnacle Health 57.00 TOTAL (Also enter on line 10, Recapitulation) $ 2 643.11 (If more space is needed, insert additional sheets of the same size) . ,,,.n"".',*- SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ~innrich Prltricirl Ann RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee{s) OF ESTATE I. TAXABLE Di::TRIBUTIONS [include outright spousal distributions, and transfers under Sec 9116 (a) (1.2)] 1. John William Gingrich Son 113 of estate 9 Pine Hill Road Landisburg, PA 17040 2. Jacqueline Marie Wilson Daughter 113 of estate 406 Boyer Street Summerdale, PA 17093 3. Deborah Ann Pitzer Daughter 1 13 of estate 732 Waltonville Road Hummelstown, PA 17036 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II, NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. NIA 0.00 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 N/A 0.00 TOTAL OF PART 11- 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) " EST ATE SETTLEMENT AGREEMENT RECEIPT, RELEASE & REFUNDING AGREEMENT THIS AGREEMENT, made as of the :2.. ~ day of April, 2004, by, between and among: JOHN WILLIAM GINGRICH, Executor ofthe Estate of Patricia Ann Gingrich, deceased (the "Executor"), *AND* JOHN WILLIAN GINGRICH, JACQUELINE MARIE WILSON, and DEBORAH ANN PITZER, beneficiaries under the Last Will, and in the Estate of Patricia Ann Gingrich, deceased (each a "Beneficiary", and, collectively, the "Beneficiaries"). WIINESSEIH: WHEREAS, Patricia Ann Gingrich (the "Decedent") died testate on July 31, 2003; and WHEREAS, on August 18,2003, Letters Testamentary were duly granted in the Estate of Patricia Ann Gingrich, deceased (the "Estate") to John William Gingrich, Executor; and 1 , WHEREAS, the Executor believes and avers, and represents to the Beneficiaries, that all debts and obligations of the Estate have been paid; and WHEREAS, the Executor proceeded with the administration of the Estate and has signed and filed, on behalf of the Estate, an Inheritance Tax Return (the "Return") and an Inventory of Real and Personal Property (the "Inventory"), with the required Schedules attached thereto; and WHEREAS, the parties hereto desire that the Executor shall not be required to file a formal accounting with the Orphans' Court Division, of the Court of Common Pleas of Dauphin County, Pennsylvania, but desire to distribute the net assets of the Decedent, being the balance of assets remaining in the Estate, under this Agreement with the same effect without the necessity of filing such a formal accounting. NOW, THEREFORE, the parties hereto intending to be legally bound hereby, mutually agree as follows: 1. The parties hereto, and each of them, agree and acknowledge that they have received a copy of the Return and the Inventory, with their respective Schedules attached thereto, and do not object thereto, and further that each of them has received a copy of this Agreement and of the Executor's Account with the Schedule of Distribution relating thereto for the Estate (the "Account"). 2. Except for fraud or wilful misconduct, and limited to matters disclosed in the Return, the Inventory, and the Account, the parties hereto do hereby release, remise and forever 2 discharge the Estate, the Executor, and counsel for the Estate, namely, Harry M. Baturin, individually, and the law firm ofBaturin & Baturin, and/or any of its individual members, or attorneys, of and from all manner of acts, suits, claims, accounts, accountings, debts, dues and demands whatsoever which they or any of them or their legal representatives or assigns may at any time hereafter have, against the Executor, and/or his attorneys, the Estate or the assets thereof, from, for, touching or concerning any of the assets and property of the Estate and/or any claim or interest thereto or therein, and the administration, management, collection, sale or distribution of any ofthe said assets and for or on account of any money, interest income, assets or proceeds out of same, from the time of the death of the said Decedent to and including the date of this Agreement. 3. This instrument is a full and final Estate Settlement Agreement by and among the parties hereto, both fiduciary and individual, all of the same having been arrived at, concluded and executed after the Executor's disclosures set forth in the Return, the Inventory, and the Account, as to the rights of the parties hereto; and each of them agrees to abide by the terms hereof. 4. The parties hereto, and each of them, agree that they will at all times in the future and whenever necessary, appropriate or convenient, make, execute and deliver to the Executor and/or to the other party or persons, any and all instruments, documents, conveyances, deeds, releases or other instruments of any kind necessary or convenient to carry out the intention and purpose of this Agreement and/or to permit, assist and enable the Executor to fulfill his duties with reference 3 . ~ to the Estate and all of the assets thereof. 5. This Agreement constitutes the entire understanding between and among the parties hereto, and it may be amended only in writing, as signed by all parties. 6. This Agreement shall inure to the benefit of, and shall be binding upon, the parties hereto, and each of them, their heirs, executors, administrators, successors and assigns. 7. This Agreement may be executed in multiple counterparts and, when as executed, shall be binding upon all the parties, and their respective heirs, next-of-kin, personal representatives and assigns. ~,J . it R 8. The Executor agrees to close the Estate in 20 pr~mpt1y after the recording hereof, with notice to the Beneficiaries, Jacqueline Marie Wilson and Deborah Ann Pitzer. 9. The Executor agrees to file final fiduciary income tax returns for the Estate prior to December 31, 2003, distributing all excess deductions to Beneficiaries, John William Gingrich, Jacqueline Marie Wilson and Deborah Ann Pitzer. 10. In consideration of the proposed distribution, John William Gingrich, Jacqueline Marie Wilson and Deborah Ann Pitzer, as a Beneficiaries, and as recipient of the proposed distributions under the Account, hereby agrees, upon the joint written request of the Executor and Harry M. Baturin, as counsel for the Estate, to refund to Estate pro-rata whatever portion of said payment may be necessary in the future to discharge any properly asserted and proven liabilities of the Estate. Should any such claim(s) be raised against Estate, the Beneficiaries, John William Gingrich, Jacqueline Marie Wilson and Deborah Ann Pitzer, agrees to refund to the Estate in full 4 - for any amount of c1aim(s) up to the distribution amount; Provided, however, that the Executor must first assert all applicable defenses available to the Estate to bar or to defend against any such claim(s). This indemnification is subject to the statute oflimitations applicable to estates. IN WITNESS WHEREOF, the parties hereto have hereunto set their respective hands and seals the day and year first above written. (SEAL) WITNESS NGRICH, Executor (SEAL ) WITNESS N WILLIAM G NGRICH, Beneficiary ~ f"dJ~ (SEAL) JA: ELINE MARIE WILSON, Beneficiary -i-,. . (SEAL) DEBORAH ANN PITZER, 5 . ~ COMMONWEAL TH OF PENNSYLVANIA ) . SS: . COUNTY OF DAUPIIIl"'<i ~ ~ ) ON THIS, the 2.. ~ day of April, 2004, before me, a Notary Public, personally appeared JOHN WILLIAM GINGRICH, Executor of the Estate of Patricia Ann Gingrich known to me or satisfactorily proven, to be the person whose name is subscribed to the foregoing Estate Settlement Agreement Receipt and Release, and acknowledged that he executed same for the purposes therein contained. WITNESS my hand and seal the day and year aforesaid. ~(SEAL) TARY PUBLIC My Commission Expires: COMMONWEALTH OF PENNSYLVANIA Notarial Seal . Kathleen K. Shaulis, Not~ Pubhc Carlisle Boro. Cumberlan County My Commission Expires Dec. 22, 2007 Member, Pennsylvania Association of Notaries 6 . . COMMONWEAL TH OF PENNSYLVANIA ) . SS: . COUNTY OP-DAlTPIIIN ) ~ ON THIS, the ~ day of April, 2004, before me, a Notary Public, personally appeared JACQUELINE MARIE WILSON, Beneficiary of the Estate of Patricia Ann Gingrich known to me or satisfactorily proven, to be the person whose name is subscribed to the foregoing Estate Settlement Agreement Receipt and Release, and acknowledged that she executed same for the purposes therein contained. WITNESS my hand and seal the day and year aforesaid. , ~SEAL) N ARY PUBLIC My Commission Expires: COMMONWEALTH OF PENNSYLVANIA Notarial Seal Kathleen K. Shaulis, Notary Public Carlisle Boro, Cumberland Count)' My Commission Expires Dec. 22, 2007 Member, Pennsylvania Association of Notaries 7 . COMMONWEAL TH OF PENNSYLVANIA ) . SS: . COUNTY OF ) ON THIS, the 2j' day of April, 2004, before me, a Notary Public, personally appeared DEBORAH ANN PITZER, Beneficiary of the Estate of Patricia Ann Gingrich known to me or satisfactorily proven, to be the person whose name is subscribed to the foregoing Estate Settlement Agreement Receipt and Release, and acknowledged that she executed same for the purposes therein contained. WITNESS my hand and seal the day and year aforesaid. - ~~SEAL) NO ARY PUBLIC My Commission Expires: COMMONWEALTH OF PENNSYLVANIA Notarial Seal Kath.leen K. Shaulis, Notary Public Carlisle ~~ro, Cumberland County My Commtsslon Expires Dec. 22, 2007 Member, Pennsylvania Association of Notaries 8 COMMONWEALTH OF PENNSYLVANIA *' BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 NOTICE OF INHERITANCE TAX HARRISBURG. PA 1712B-0601 APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-1547 EX AFP COI-03) DATE 06-21-2004 ESTATE OF GINGRICH PATRICIA A DATE OF DEATH 07-31-2003 FILE NUMBER 21 03-0106 COUNTY CUMBERLAND JOHN GINGRICH ACN 101 9 PINE HILL RD I Amount Remitted I LANDISBURG PA 17040 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 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 GINGRICH PATRICIA A FILE NO. 21 03-0706 ACN 101 DATE 06-21-2004 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED S~E ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) 2,277.12 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Hortgages/Notes Receivable (Schedule D) (4) .00 of this form with your 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5) 5,052.5S tax payment. 6. Jointly Owned Property (Schedule F) (6) 10,040.48 7. Transfers (Schedule G) (7) .00 8. Total Assets (8) 17,370.13 APPROVED DEDUCTIONS AND EXEMPTIONS: 4,257.55 9. Funeral Expenses/Adm. Costs/Hisc. Expenses (Schedule H) (9) 10. Debts/Hortgage Liabilities/Liens (Schedule I) (0) 2,643.11 II. Total Deductions (11) 6.900 66 12. Net Value of Tax Return (2) 10,469.47 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (3) .00 14. Net Value of Estate Subject to Tax (4) 10,469.47 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total o f !.b.!:.. returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate OS) .00 X 00 = .00 16. Amount of Line 14 taxable at Lineal/Class A rate (6) 10,469.47 X 045 = 471.13 17. Amount of Line 14 at Sibling rate (7) .00 X ;12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate (8) ..on X 1~. = .00 \.__J 19. Principal Tax Due (tv)= 471.13 TAX CREDITS: PAYHENT RECEIPT DISCOUNT (+) AHOUNT PAID ~- DATE NUHBER INTEREST/PEN PAID (-) 04-29-2004 CD003876 .00 832.45 "--: . TOTAL TAX CREDIT ." 832.45 ,. . BALANCE OF TAX DUE 361.32CR INTEREST AND PEN. .00 TOTAL DUE 361.32CR " IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. ~7 FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE .. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) . RESERVATION. Estates of decedents dying on or before December 12. 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 Co..onwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE. To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act. Act 23 of 2000. (72 P.S. Section 9140). PAYMENT. Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Make check or money order payable to. REGISTER OF KILLS, AGENT REFUND (CR). A refund of a tax credit. which was not requested on the Tax Return. may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices. or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS. Any party in interest not satisfied with the appraise.ent, allowance, or disallowance of deductions, or assess.eot 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. 281021. Harrisburg. PA 17128-1021. OR --election to have the matter determined at audit of the account of the personal representative. OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS. Factual errors discovered on this assessment should be addressed in writing to. PA Department of Revenue. Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601. Harrisburg. PA 17128- 0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors, DISCOUNT. If any tax due is paid within three (3) calendar months after the decedent's death. a five percent (5%) discount of the tax paid is allowed. PENAL TV . The 15% 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. 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. 1982 bear interest at the rate of six (6%) 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 1982 through 2004 are. Interest Da ily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ ~ :iiiiOm T9iB-1991 --m- :Tii'O!'6T' ~ -,x- .~ 1983 16% .000438 1992 9% .000247 2002 6% ,000164 1984 11% .000301 1993-1994 7% .000192 2003 5% .000137 1985 13% .000356 1995-1998 9% ,000247 2004 4% .000110 1986 10% .000274 1999 7% .000192 1987 10% .000274 2000 7% .000192 --Interest is calculated as follows. INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice. additional interest must be calculated. . REV-l~70 EX (6-88) '* INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME FILE NUMBER Patricia A Gingrich 2103-0706 REVIEWED BY ACN Deborah Washington 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES E 1t03 The proceeds of life insurance policies on the life of the decedent are not subject to tax in the decedent's estate. ROW Page 1