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HomeMy WebLinkAbout02-0196ReV-~O0 ex (r~oo) · COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 I OFFICIAL USE ONLY INHERITANCE TAX RETURN / j_- ¢_;. RESIDENT DECEDENT Imm DECEDENT'S NAME (LAST, FIRST, AND ~IIDDLE INITIAL) ~DA'~E Of DE/ATH (MM-DD-YEAR) -DATE Of BIRTH (MM-DD-YEAR) (IF APPLICABLE) SURVIVING SPOUSE'S NAME (~ST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ~]~1. Original Return r--~ 4. Limited Estate [] 6. Decedent Died Testate (Attach copy of Will) [~9. Litigation Proceeds Received r-~2. Supplemental Return ~---1 4a. Future Interest Compromise (date of death after 12-12-82) [~7. Decedent Maintained a Living Trust (Altach copy of Trust) r--~ 10. Spousal Poverty Credit (dale of death belween 12-31-91 and 1-1-95) FIRM NAME (IfAl~plicable) '~ TELEPHONE NUMBER E~3. Remainder Return (date of death prior to 12-13-82) [~]5. Federal Estate Tax Return Required O 8. Total Number of Safe Deposit Boxes ~m 11. Election to tax under Sec. 9113(A) (Attach Sch O) 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) ~m 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 Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) (8) 12. Net Value of Estate (Line 8 minus Line 11) 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 Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(12) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate (11) (12) (13) (14) OFFICIAL USE ONLY x .0 ...... (15) int nl. 6q x .oq ¢6) x .12 (17) x .15 (18) 19. Tax Due (19) 20. [~] Decedelnt's Complete Address: STREETADDRESS Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Pdor Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty ISTATE (1) Total Credits (A * B * C ) (2) Total Interest/Penalty ( D + E ) 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE, (3) (4) (5) (5A) (5B) IzIP / '~2/,/ A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWlNO QUESTIONS BY PI_~ClNG AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ............................................ [] [] c. retain a reversionary interest; or .......................................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ...................................................................... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate 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. Under penalties of perjury, I declare that I have examined this retum, 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. S!~J)IATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ' AI;)DRES~' - / / ./ /'~.~,.//-'"' - '~(~: ('-''/" - - SI~URE OF PI~PAREROTHER THAN R~ESENTATIVE ~ ~ DATE For dates of death on or after July 1, 1994 and before Janua~ 1, 1995, the tax rate imposed on the net value of transfem to or for the use of the sullying spouse is 3% [72 P.S. {9116 (a) (1.1) (i)]. For dates of death on or after Janua~ 1, 1995, the tax rate imposed on the net value of transfem to or for the use of the su~iving spouse is 0% [72 RS. {9116 (a) (1.1) (ii)]. The statute does not exemDt a transfer to a su~iving spouse from tax, and the statuto~ requirements for disclosure of assets and filing a tax return are still applicable even if the su~iving spouse is the only beneficial. For dates of death on or a~er July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child ~en~-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a steppamnt of the child is 0% ~2 P.S. {9116(a)(1.2)]. The ~x rate imposed on the net value of transfem to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 RS. {9116(1.2) [72 RS. {9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 RS. {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-1502EX~ (1-97) j~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE .~._ FILE NUMBER ESTATEOF g~ O---~.lq~- /~- ~j-O~-- 4)C~ /~/~/ All real property ~v/ned 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 jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION TOTAL (Also enter on line 1, Recapitulation) VALUE AT DATE OF DEATH (If more space is needed, insert additional sheets of the same size) REV-1503 EX + (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF ~'jOy! ,~ ~'1P~ 7~E.-~ ~. FILE NUMBER All property jointly-owned with right of sun~ivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1, TOTAL (Also enter on line 2, Recapitulation) $ z.~ ~',,~ ~'o 3 '*~'- (if more space is needed, insert additional sheets of the same size) " REV-1508 EX + {1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~. .~/- ~oo/- '7 ¢/? TOTAL (Also enter on line 5, Recapitulation) 5~c~oo,~o (If more space is needed, insert additional sheets of the same size) R~-1511EX + (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Secudty Number(s) / EiN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: Attomey Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Zip Street Address city Relationship of Claimant to Decedent Probate Fees Accountant's Fees State Zip 7~ X o'l TOTAL (Also enter on line 9, Recapitulation) 35".o0 3 (If more space is needed, insert additional sheets of the same size) ~OMM©NWEALTH OF PENNSYLVANIA ~NdERITANCE TAX RETURN RESIDENT DECEDENT Debts of decedent must be reported on Schedule I. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER ~/--o~- - iTEM DESCRIPTION TOTAL (Also enter on line 9, Recapitulation) AMOUNT more space is needed, insert additional sheets of the same size) REV-l§12 EX * (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES,& LIENS Include unreimbursed medical expenses. FILE NUMBER ITEM NUMBER DESCRIPTION AMOUNT 1. ~ TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) ~.?o i/. ~.~ REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER NUMBER o II NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE ~; 3o0o t ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (If more space is needed, insed additional sheets of the same size) s Iooo.o I REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF NUMBER .,,,,-' II ~ FILE NUMBER ,/., .- Ad. oo/9 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] al~- go.,,, eo 1~) ova.,~_, cT oeqv-1 lt. 30o0..i)o ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) US DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT B. Type of Loan (OMB # 2502-0265) 1.[ ] FHA 2.[ ] FmHA 3.[ ]Conv. Unins. 6. File Number: 17. Loan Number: 18 Mortgage Insurance Case Number: 4.[]VA 5.[]Conv. lns., · i~i' ':,', ~ · , .' C. NOTE: This form furnishes a statement of settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)" were paid outside the closing; they are shown for informational purposes and are not included in the totals. D. Name & Address of Borrower: Thomas N. Gensbigler and Letitia Gensbigler G. Property Location: 2901 Maple Road Borough of Camp Hill, Cumberland Cou'ntY; Pennsylvania 17011 · E. Name, Address & TIN of Seller: Estata of Jeanette M. Eby, Deceased Executors: Eloyd H. Eby,. Jh, and Bevedy F.. Appley J. Summary of Borrower's Transaction TIN of Seller: Place of Settlement 44 WeSt Main Street,, Mech'ahicSburg, isA ,117055ii. F. Name & Address of Lender: none H. Settlement Agent: Keith O: Brenneman . I. Settlement Date: K. Summary of Seller's Transaction ISeptember 6, 2002 100. Gross Amount Due from Borrower: 101. Contract sales pdce 102. Personal Property 103. Borrower's settlement charges (line 1400) 104. 105. Adjustments for items paid by seller In advance 106. City/town taxes 9/6/02 to 12/31/02 107. County taxes to 108. Assessments to 109. School Tax: 9/6/02 to 6/30/03 110. Sewer Charge 9/6/02 to 12/31/02 111. 400, Gross Amount Due to Seller: 401. Contract sales price II $182,500.00 402. Personal Properly 403. 404. · 405. Adjustments for Items paid by seller in advance 406. City/town taxes 9/6/02 to 12/31/02 $216.47 407. County taxes to $ 0.00 408. Assessments to $ 0.00 409. School Tax 9/6/02 to 6/30/03 $1,443.66 410. Sewer Charge 9/6/02 to 12/31/02 $38.03 411. 112. 412. 113. 413. 120. Gross Amount Due from Borrower 420. Gross Amount Due to Seller $184,198.16 200. Amounts Paid by or In Behalf of Borrower: 500. Reductions In Amount Due to Seller: 201. Deposits or earnest money 501. Excess deposit (see instructions) $5,000.00 202. Principal amount of new loan(s) 203. Existing loan(s) taken subject to 204. 205. 206. 207. 208. 209. Adjustments for items unpaid by seller 210. City/town taxes to 211. County taxes to 212. Assessments to 213. to $182,500.00 $216.47 $ 0.00 $ o.oo $1,443.66 :~ ..... '.' $38.03 t? .. :.."..', ~ $187,325.41 ,. $5,000.00 ~ , ',,, 506. 507. 508. 509. $ 0.00 $ 0.oo $ 0.0o $ 0.00 513. 515, 516, . ',, 517. 518. 519. 214. 215. 216: 217. 218. 219. 220. Total Paid By/for Borrower $5,000.00 520, 300. Cash at Settlement From/to Borrower 600. 301. Gross amount due from borrower (line 120) $187,325.41 601. 302. Less amounts paid by/for borrower (line 220) $5,000.00 602. 303. Cash Ir~l from I['-~lto Borrower $182,325.41 603. 502. Settlement charges to seller (line 1400) 503. Existing loan(s) taken subject to 504. Payoff of first mortgage 505. Payoff of second mortgage Adjustments for items unpaid by seller 510. City/town taxes to 511. County taxes to 512. Assessments to to 514. Escrow for Pa. Inheritance Tax Total Reduction Amount Due Seller Cash at Settlement To/from Seller Gross amount due to seller (line 420) Less reductions in amount due seller (line 520) Cash ~J to ~ from Seller $2,342.00 $ 0,00 $ 0.00 $ 0.00 $ o.oo $8,212.50 $15,554.50 $184,198.16 $15,554.50 $168,643.66 The information in Blocks E, G, H, I & line 401 (or, if line 401 is asterisked, line 403 and 404) is important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a sanction will be imposed on you if this item is reauired to be % 7bO. Total SaleslBroker's Commission: Ibased on price) Division of Commission (line 700) as follows: 701. 702. 703. Commission paid at Settlement 704. 800. Items Payable in Connection with Loan 801. Loan Origination Fee 802. Loan Discount 803. Appraisal Fee 804. Credit Report 805. LendeCslnspection Fee 806. Mortgage Insurance Application Fee 807. 808. 809. 810. 811. 812. 813. 814. 900. Items Required by Lender to Be Paid in Advance 901. Interest from t{p 902. Mortgage insurance Premium for 903. Hazard Insurance Premium for 904. 905. 1000. Reserves Deposited with Lender 1001. Hazard insurance months (~ $ 1002. Mortgage insurance 1003. City property taxes 1004. County property taxes 1005. Annual assessments months (~ $ months (~ $ months (~ $ months (~ $ perda¥ per month per month per month per month per month 1006. months (~ $ per month 1007. 1008. 1009. Aggregate Accounting Adjustment 1100. Title Charges 1101. Settlement/closing fee 1102. Abstract/title search 1103. Title examination 1104. Title insurance binder 1105. Document preparation 1106. Notar7 fees 1107. Attorney's fees to Ira H. Weinstock, P.C. (includes above item numbers 1108. Title insurance to Keith O. Brenneman, Agent, Conestoga Title Insurance Company Paid from Borrower's Funds at Settlement $ o.oo $ 0.00 $ 0.00 $ 0.00 $ 0.001 $ o.oo! Paid from Seller's Funds at Settlement $ 0.00 $1,273.75 $500.00 I, JEaNRITE ~ ]~y, of Camp Hill, Cunberland County, Penn~ylvania, declare this to be my,. last will and revoke any will previously made by me. IT~ I. I direct that all my just debts and f~meral expenses, including my grave~arker and all expenses of my last il.lness, and any and all. taxes and assessments ~ ~n~osed by any ~ovennnental body as a result of my death, whether on property passing under this will or otherwise, shall be paid from my residuary estate as soon as practi- cable after m~ decease as a part of the expense of the administr~tio~ of my estate. ~ II. I give and bequeath the sum of One Thousand ($1,000.00) Dollmrs to the Camp Hill Presbyterian Church, North 23rd and ~alnut Streets, Camp Hill, O_,~berland County, Pennsylvania. IT~ III. I give, and bequeath the sum of ~hree Thousand ($3,000.00) Dollars to each of my grandchildren, KENNEIH E. APPLEY, JR., KRISTINE E. APPLEY, KATHRYN E. APPLEY, I)GJGLAS S. EBY and BARBARA M. EBY and any other of my grandchildren who may be born after the date of this will. ~ IV. I give and bequeath all of my household goods, automobiles, jewelry, and all other articles of household and personal use, eqmi?~..nt, and ornament, together with all insurance thereon and relating thereto in equal shares to those of my 'children living on the sixty-first day following my death. If neither of my children survive my death by sixty (60) days, I give and bequeath all such items and insurance thereon in equal shares to such of m~ grandchildren who are living on the sixty-fii~st day following my death. AlthouEh I have left all of my personal property, including my jewelry, to my children or grandchildren, as the case may be, it is m~ wish that any diamond rings which I own at the time of my death be divided _~m~ng those of my daughter and granddaughters who are living on the sixty-first day following my death and that any gold chains which I own at the time of my death be divided ~m~ng those of my granddaughters living on the sixty-first day following my death. ~ V. I give, devise, and bequeath all the rest, residue, and remainder of my possessions and estate of every nature and wherever situate in equal sb~res to those of my 'children who are living on the sixty-first day following my death. If neither of my children survive my death by sixty (60) days, I give, devise,' and bequeath all the rest, residue, and remainder of my possessions and estate of every nature and wherever situate in equal shares to such of my ~-~ndchildren who are living on the sixty-first day following my death. ~ VI. I appoint my son, LLOYD H. EBY, JR., of Harrisburg, Pennsylvania, and my daughter, BEVERLY E. APPLEY, of Orange, Connecticut, or the survivor of them, co- executor and co-executrix of this my last will. ~ ViZ I direct that my perso~al representatives and fiduciaries shall not be required to give bond for the faithful performance of their duties in any jurisdiction. of I have hereunto set my hand and seal this The preceding instrument, consisting of this and two other typewritten pages, each identified hy the signature of the testatrix was on the date thereof signed, published, and declared by JEANEITE M. EBY, the testatrix therein n..~d, as and for her last will, in the presence of us, who at her request, in her presence, and in the presence of each other, have subscribed our names as witnesses hereto. - 3 The undersigned, being the testatrix whose name is signed to the attached or foregoing instrtanent, having been duly qualified according to law, does hereby acknowledge that I signed and executed the foregoing in.wtz, m~-nt as m~ last will, that I signed it willingly; and that I signed it as my ~ree and voluntary act for the purposes therein expressed. S~orn or affirmed to and acknowledged befOre 1~ by the testatrix named above , '-WENDY'K.'S.T. RAUB, Notary Public ~ temoyne, Cumberland Co., Pa. My Commission Expire~ May 6, 1991 ) ( SS'.': ) WE, GECI:K;E A. VAUGHN, III, and MICHAk~r, L. BANGS, the witnesses whose names are signed to the attached or foregoing instx, wn~-nt, being duly qualified accordi~ to law, do depose and say that we were present and saw the testatrix sign and execute the instrument as her last ,will; that she signed it willingly and that she executed it as her ~ree and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the will as witnesses; and that to the best of our knowledge, the testatrix was at that ti.~_ 18 or more years of age, of sound mind, and under no con.straint or undue influence. S~orn or a~firmed to and acknowledged be.:f,Q.re,, me this WENDy K. STRA"dB, Notary Public Lerno~;ne, Cumberland Co., Pa. My Commission Expires May 6, 1991 21-02-196 I, 0~.~I~IT~ M. ~¥, of Can~p Hill, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. IT~ I. I direct that all my just debts and funeral expenses, including my gTavemarker and all expenses of my last illness, and any and all taxes and assesmments imposed by any governmental body as a result of my death, whether on property passing under this will or otherwise, shall be paid from my residuary estate as soon as practi- cable after my decease as a part of the expense of the administration of my estate. IT~ II. I give and bequeath the sum of One ~housand ($1,000.00) Dollars to the Camp Hill Presbyterian Church, North 23rd and Walnut Streets, Camp Hill, Cumberland County, Pennsylvania. IT~ III. I give, and bequeath the sum of Three Thousand ($3,000.00) Dollars to each of my grandchildren, KENNETH E. APPLEY, JR., KRISTINE E. APPLEY, KATHRYN E. APPLEY, DOJGLAS S. EBY and BARBARA M. EBY and any other of my gTandchildren who may be born after the date of this will. IT~ IV. I give and bequeath all of my household goods, automobiles, jewelry, and all other articles of household and personal use, equipment, and ornament, together with all insurance thereon and relating thereto in equal shares to those of my children living on the sixty-first day following my death. If neither of my children s~rvive my eath by sixty (60) days, I give and bequeath all such items and insurance thereon in equal shares to such of my grandchildren who are living on the sixty-first day following my death. Although I have left all of my personal property, including my jewelry, to my children or grandchildren, as the case may be, it is my wish that any diamond rings which I o~ at the time of my death be divided among those of my daughter and granddaughters who are living on the sixty-first day following my death and that any gold chains which I own at the time of my death be divided among those of my granddaughters living on the sixty-first day following my death. IT~ V. I give, devise, and bequeath all the rest, residue, and remainder of my possessions and estate of every nature and wherever situate in equal shares to those of my children who are living on the sixty-first day following my death. If neither of my children survive my death by sixty (60) days, I give, devise, and bequeath all the rest, residue, and remainder of my possessions and estate of every nature and wherever situate in equal shares to such of my grandchildren who are living on the sixty-first day following my death. IT~ VI. I appoint my son, LLOYD H. EBY, JR., of Harrisburg, Pennsylvania, and my daughter, ~ERLY E. APPLEY, of Orange, Connecticut, or the survivor of them, co- executor and co-executrix of this my last will. IT~ VI~ I direct that my personal representatives and fiduciaries shall not be required to give bond for the faithful perforr~nce of their duties in any jurisdiction. of I have hereunto set my hand and seal this day 2 The preceding instrument, consisting of this and two other typewritten pages, each identified by the signature of the testatrix was on the date thereof signed, published, and declared by JEANETrE M. EBY, the testatrix therein named, as and for her last will, in the presence of us, who at her request, in her presence, and in the presence of each other, have subscribed our names as witnesses hereto. 3 OOMMONWEAL~t{ OF PENNSYLVANIA ) ( SS.- COUNTY OF CUMBERLAND ) The undersigned, being the testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, does hereby acknc~ledge that I signed and executed the foregoing instrument as my last will, that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. S~3rn or affirmed to and acknowledged before me, by the testatrix named above this ~ day of ,~ ; , , 198~. Notary. ~u~lic W£ND~rK.'$I~AUB, N0taW Public temoyne, Cumberland ~0., ~. COMMON-WEALtH OF PENNSYLVANIA ) ( ss.- ) WE, GEORGE A. VAUGHN, III, and MICHAEL L. BANGS, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the testatrix sign and execute the instrtm~nt as her last will; that she signed it willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the will as witnesses; and that to the best of our knowledge, the testatrix was at that time 18 or more years of age, of sound mind, and under no constraint or undue influence. Sworn or affirmed to and acknowledged befgre^ me this of ' WENDY K. STRA~B, Notaw Public Lemoyne, Cumberland Co., Pa. My Commission Expires M~y 6, 19~1 I,l,I ! t t U BUREAU OF INDIVIDUAL TAXES TNHERZTANCE TAX DZVTSTON DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ZNHERZTAHCE TAX STATEHENT OF ACCOUNT REV-i~07 EX AFP C01-03) LLOYD H EBY JR 4104 HILLSDALE RD HBG PA 17112 DATE 01-21-2005 ESTATE OF EBY DATE OF DEATH 02-17-2002 FILE NUMBER 21 02-0196 COUNTY CUMBERLAND ACN 101 Amoun~ JEANETTE M HAKE CHECK PAYABLE AND REMIT PAYHENT TO: REGISTER OF WTLLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credi~ ~o your accoun*, submi~ ~he upper portion of *his for. wi*h your ~ax peymen*. CUT ALONG TH'rS LINE ~ RETA'rN LONER PORT'rON FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) #x~ INHERITANCE TAX STATEMENT OF ACCOUNT ### ESTATE OF EBY JEANETTE M FILE N0.21 02-0196 ACN 101 DATE 01-21-2005 THIS STATEHENT TS PROVTDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACM IN THE NAHED ESTATE. SHO#N BELO# IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE,, AND., IF APPLICABLE,, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-06-Z005 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 7,721.65 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-) .00 11-18-2002 01-08-Z00~ CD001851 CD002023 .27- 7,721.63 1.27 IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE ZS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), TOTAL TAX CREDIT 7,721.65 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF lYILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COHMONNEALTN OF PENNSYLVANIA. 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-IS15). Applications are available at the Office of the Register of Hills, any of the Z3 Revenue District Offices or from the Department's Z~-hour answering service for forms ordering: 1-800-36Z-ZOSO; services for taxpayers with special hearing and / or speaking needs: 1-800-qq7-30ZO (TT only). REPLY TD: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. ZB0601, Harrisburg, PA 171ZB-0601, phone (717) 787-6SOS. DISCOUNT: any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SI) discount the tax paid is allowed. PENALTY: The 1SI 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. 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, 198Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .OOO16q. All taxes which became delinquent on and after January 1, 198Z mill bear interest at a rate mhich will vary from calendar year to calendar year mith that rate announced by the PA Depar~ent of Revenue. The applicable interest rates for 198Z through 2003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 202 .0005q8 19B7 92 .0002q7 1999 72 .000192 1983 162 .000~38 1968-1991 llg .000301 ZOO0 82 .000219 198q 112 .O0030X 1992 92 .O00Zq7 2001 9X .O00gq7 xgBs 132 .000356 1993-199q 7g .O0019Z ZOOZ 6X .O0016q 1986 102 .O00gTq 1995-199B 92 .O00Z~7 ZOO3 52 .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER 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 shomn on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 LLOYD H EBY JR 4104 HILLSDALE RD HBG COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP (01-03) DATE 01-06-2005 ESTATE OF EBY JEANETTE H DATE OF DEATH 02-17-2002 FILE NUMBER 21 02-0196 -.COUNTY CUHBERLAND *ACM 101 Amount Remitted HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 PA 17112-1410 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP C01-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF EBY JEANETTE M FILE NO. 21 02-0196 ACN 101 DATE 01-06-2005 TAX RETURN WAS: C X) ACCEPTED AS FILED ( } CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A} (1} 2. Stocks and Bonds (Schedule B} (2} 3. Closely Held Stock/Partnership Interest (Schedule C} ~. Mortgages/Notes Receivable (Schedule D} 5. Cash/Bank Deposits/Misc. Personal Property CSchedule E} 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} 10. Debts/Mortgage Liabilities/Liens (Schedule I) C10) 11. Total Deductions 12. Net Value of Tax Return 181r856.16 .00 .00 12t785.96 .00 .00 C8} 24,694.87 MOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 13. 14. NOTE: ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate C17) lB. Amount of Line 14 taxable at Collateral/Class B rate Cl8) 19. Pr/nc/ ~al Tax Due TAX CREDITS: PAYMENT RECEIPT DISCOUNT DATE NUMBER INTEREST/PEN PAID (-) 11- 18-2002 CD001851 . O0 199,518.44 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. BALANCE OF UNPAID INTEREST/PENALTY AS OF 11-19-2002 AMOUNT PAID 7,721 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE reflect figures that include the total of ALL returns assessed to date· · O0 x O0 = 171,591.68 x 045 = . O0 x 12 = · O0 x 15 = (19)= 1,000.00 .00 7,721.65 .00 .00 7,721.65 7,721.65 o00 1.27 1.27 ( IF TOTAL DUE IS LESS THAN 41, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR}, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.} Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J} C15) Net Value of Estate SubSect to Tax C14) 171,591.68 If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 wtll 2,251.89 (11) ?K.92~.7~ ([2) 172,591.68 RESERVATION: PURPOSE OF NOTICE= PAYMENT: REFUND OBJECTIONS= ADMIN- ISTRATIVE CORRECTIONS= DISCOUNT= PENALTY= INTEREST= 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 Ccollateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B Ccollatera1) rate on any such future interest. To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Make check or money order payable to= REGISTER OF NILLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available at the Office of the Register of Nills, any of the 23 Revenue District Offices, or by calling the special 24-hour answering service for fores ordering: 1-800-362-2050; services for taxpayers with special hearing and / or speaking needs= 1-800-447-3020 CTT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax Cincluding discount or interest) as sho~n on this Notice must object within sixty (&O) 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. 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 C717) 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. If any tax due is paid within three CS) calendar months after the decedent's death, a five percent CSX} discount of the tax paid is allowed. 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 is charged beginning with first day of delinquency, or nine (9) months and one C1) 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 C&X) 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 2003 are= Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor m m m 1982 20Y. .000548 1987 9~ .000247 1999 7Y. . O00192 1983 16~. .000458 1988-1991 llY. .000301 2000 8Y. .000219 1984 llY. . 000301 1992 9~. . 000247 2001 9Y. . 000247 1985 15~. .00055& 1995~ 1994 7~. .000192 2002 &~ .000lA4 1986 10Y. .000274 1995-1998 9Y. .0002~7 2003 5Y. .000137 --Interest is calculated as follows= INTEREST = BALANCE OF TAX UNPAID X NUNBER 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, additiona! interest must be calculated. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD REV-1162 EX(11-96) O01851 SNELBAKER BRENNEMAN & SPARE 44 W MAIN STREET MECHANICSBURG, PA 17055 ........ fold ESTATE INFORMATION: SSN: 192-34-6543 FILE NUMBER: 2102-01 96 DECEDENT NAME: EBY JEANETTE M DATE OF PAYMENT: 11/18/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 02/17/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $7,721.63 TOTAL AMOUNT PAID: $7,721.63 REMARKS: BEVERLY E APPLEY C/O SNELBAKER ET AL SEAL CHECK//1661 INITIALS: JA RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS his is to certify that the information here given is correctly copied from an original certificate of death dqly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. ~ Local Registrar (~ P 8068476so. T YPE;PRINT PERMANENT 8LACK INK COMMONWEALTH OF PENNSYLVANIA o DEPARTMENT OF HEALTH" VITAL RECORDS CERTIFICATE OF DEATH 'MEDIAL EXAMINE~CORONER Off Ihl belie of exlmlnlll~ aim iflveltlgalmn, in my op n on. death ~curred it Ihe time. date and place, a~ due Io the CIU~{I) I~ 21-02-196 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Will No. To the Register: Jeanette M. Eby February 17, 2002 Admin. No. I certify that notice (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Court Rules was served on the following beneficiaries of the above-captioned estate on February 19, 2002 Name Address Lloyd H. Eby, Jr. 4104 Hillsdale Road Harrisburg Pennsylvania 17112 962 Corn Cob Lane Beverly E. Appley Oranl~e Connecticut 06477 Barbra M. Burke 208 April Drive Camp Hill Pennsylvania 17011 Douglas S. Eby 242 Marlette Drive Mecbanicsburg Pennsylvania 17055 Kathryn E. Appley-Brown 20 St. Andrews Way Etters Pennsylvania 17319 Kenneth E. Appley, Jr. 962 Corn Cob Orange Connecticut 06477 Kristine E. Appley-Paddock 38 Park Terrace Caldwell New Jersey 07006 Camp Hill Presbyterian Church 101 North 23rd Street Camp Hill Pennsylvania 17011 Notice has been given to all persons entitled thereto under Rule 5.6( .., Si Name: Lloyd H. Eby, Jr. Address: Telephone: Capacity 4104 Hillsdale Road Harrisburg, PA 17112 717-652-7047 Personal Representative PETITION FOR PROBATE and GRANT OF LETTERS I To: also ]~llOWFI as Deceased. Social Security No. &l' Register of Wills for the . County of Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your pelitionerts), who is/are 18 years of ageor older an lhe execulO~'.t in the lasl will ot the above decedent, dated fi'~,~,.,..~ tli' and codicil(s) dated I in the named ,19 '~'~ (stale relevanl circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in (-5.,.,,t.,'ko,,--~.-,..-. ~. County, Pennsylvania, with last family or principal residence at ~o-t r~xe,~ ~.-e~ g.o-,~k i ~cx,,.,.f~ _1-/.; It i (list street, number and muncipality) Decendent, then qO years, of age, died ~"-~..~v'c,~_o--q"-I I ? ~ , ]~if,~OO.),. ,, Excepi as follows, ~tecedent did not marry, was not divorced and did not have a child born or adop{~ after execution of the will offered for probate; was no~ the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsyl_g.vania $ '~'0 co O . 00 situated as follows: _c-~g'O;OOO . oo 5~,~OdO, O0 WHEREFORE, petitioner(s) respectfully presented herewith and the grant of letters theron. request(s) the probate of the last will and codicil(s) (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF ~z//z~z.,/~'/lg. The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will Sworn to or affirm, ed _a_n,d subscribed before., me, this __ ,~o~''~r''' day of well.and/ffJal~.adminiiW, r-4he estate according to law. 21-02-196 Estate Of JEANETTE M. EBY , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW JEANETTE M. EBY ~!g2002 , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated MAY 18. 1998 described therein be admitted to probate and filed of record as the last will of JEANETTE M. EBY ; and Letters TESTAMENTARY are hereby granted to LLOYD H. EBY, JR AND BEVERLY E. APPLE¥ FEES Probate, Letters, Etc .......... $ 200.00 Short Certificates(3 ) .......... $ 9.00 ~ ~..X?.?...e.C.S..3.... $ 9. O0- JCP $. 5.00 TOTAL __ $. 223.00 Filed . FEJ~RUAKS~. 22 o..2002 .............. Register of Wills ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE CALLED EXECUTOR FEBRUARY 25, 2002 ORDERS ATTACHED Name of Decedent: Date of Death: Will No.: STATUS REPORT UNDER RULE 6.12 / / 7, Admin. 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: State whether administration of the estate is complete: Yes [] No If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the an.~wer to No. 1 is Yes, state the following: ao Did the personal representative file a final account with the Court? Yes _ No ['] b. The separate Orphans' Court No. (if any) for the personal representative's account is: ~ c. Did the personal representative state an account informally to the parties in interest? Yes ~Z] No 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 thi~ Name Address Telephone No. ,,, ,~ <~::iC~l~acity: [~l~ersonal Representative JO ;~:)i:!?(7: ::::: ::~ :~ t,~:2 ~ Co.scl for personal representative FAMILY SETTLEMENT AND FINAL RELEASE IN ESTATE OF JEANETTE M. EBY KNOW ALL MEN BY THESE PRESENTS: WHEREAS, JEANETTE M. EBY, late of Camp Hill Borough, Cumberland County, Pennsylvania, died testate on February 17, 2002, having made her Last Will and Testament, which was duly executed on May 18, 1988. WHEREAS, The said, Jeanette M. Eby, by the aforesaid Last Will and Testament, named Beverly E. Appley and Lloyd H. Eby, Jr. as Co-Executors of said Last Will and Testament; WHEREAS, Beverly E. Appley and Lloyd H. Eby, Jr. applied for Letters Testamentary, and was granted the Letters on February 22, 2002. WHEREAS, Letters Testamentary, on the estate of the said decedent were duly issued by the Register of Wills of Cumberland County, Mary C. Lewis, to the said Co-Executors, hereinafter called Co-Executors; WHEREAS, the said Co-Executors have gathered the assets of the estate of the said decedent and the assets consist of both real property and personal property, to a total value of $186,586.46. WHEREAS, the debts, administrative costs, and deductions, amount to $28,816.46. WHEREAS, there is the possibility that more taxes and additional bills may become due in the next year; WHEREAS, the balance for distribution has been reduced to cash and has been distributed as herein indicated in accordance with the terms of the Last Will and Testament of the said decedent; SCHEDULE OF DISTRIBUTION NAME Beverly E. Appley Lloyd H. Eby, Jr. Douglas S. Eby Kenneth E. Appley, Jr. Kristine E. (Appley) Paddock Barbra M. (Eby) Burke Katherine E. (Appley) Brown Camp Hill Presbyterian Church SHARE OF ESTATE $ 70,884.91 $ 70,884.91 $ 3,000.00 $ 3,000.00 $ 3,000.00 $ 3,000.00 $ 3,000.00 $ 1,000.00 Total $157,769.82 NOW, THEREFORE, KNOW YE, that the heirs under the Last Will and Testament of the said decedent, have received from the aforesaid personal representatives, full satisfaction and payment of all sums or sums of money, legacies, bequests, and devises as are given, devised and bequeathed to each of them respectively by the said Last Will and Testament. Date: ~I/~ ~'~/ ,,'~,~ Name /-//o¢ /¢/ //J ~/,/e ~o/ /4/~ Address 7/7 ~- 70¢7 Telephone No. Capacity: [~ersonal Representative {-]Counsel for personal representative FAMILY SETTLEMENT AND FINAL RELEASE IN ESTATE OF JEANETTE M. EBY KNOW ALL MEN BY THESE PRESENTS: WHEREAS, JEANETTE M. EBY, late of Camp Hill Borough, Cumberland County, Pennsylvania, died testate on February 17, 2002, having made her Last Will and Testament, which was duly executed on May 18, 1988. WHEREAS, The said, Jeanette M. Eby, by the aforesaid Last Will and Testament, named Bevedy E. Appley and Lloyd H. Eby, Jr. as Co-Executors of said Last Will and Testament; W~S, Beverly E. Appley and Lloyd H. Eby, Jr. applied for Letters Testamentary, ~ was granted the Letters on February 22, 2002. WHEREAS, Letters Testamentary, on the estate of the said decedent were duly issued by the Register of Wills of Cumberland County, Mary C. Lewis, to the said Co- Executors, hereinafter called Co-Executors; WHEREAS, the said Co-Executors have gathered the assets of the estate of the said decedent and the assets consist of both real property and personal property. WHEREAS, the balance for distribution has been reduced to cash and has been distributed in accordance with the terms of the Last Will and Testament of the said decedent; NOW, THEREFORE, KNOW YE, that I, being an heir under the Last Will and Testament of the said decedent, and being that person entitled to inherent under the Last Will and Testament, do hereby, acknowledge that I have this day had and received from the aforesaid personal representative, full satisfaction and payment of all sums or sums of money, legacies, bequests, and devises as are given, devised and bequeathed to me respectively by the said Last Will and Testament, which amounts I have received this day. AND, I do hereby stipulate that in order to avoid the expense and time involved in the filing of a formal account and schedule of distribution, I agree that no account is necessary and I do hereby agree that I do consent to distribution being made without the filing of an account and schedule of distribution, the same to be with the same force and effect as if they had been filed and confirmed by the Register of Wills, Cumberland County. THEREFORE, I do hereby remise, release, quitclaim and forever dischar[le the said Co-Executors, Beverly E. Appley and Lloyd H. Eby, Jr, heirs executors, atr~ administrators and assigns, of and from the said estate and from all actions, s~its, payments, accounts, reckonings, claims and demands whatsoever for or by reason thereof, or for any other use, matter, cause or thing whatsoever touching upon the estate of the said decedent. IN WITNESS WHEREOF, I have hereunto set my hand on the date set forth below. Kenneth E. ~ppley, Jr.k t ~ Date / /4, FAMILY SETTLEMENT AND FINAL RELEASE IN ESTATE OF JEANETTE M. EBY KNOW ALL MEN BY THESE PRESENTS: WHEREAS, JEANETTE M. EBY, late of Camp Hill Borough, Cumberland County, Pennsylvania, died testate on February 17, 2002, having made her Last Will and Testament, which was duly executed on May 18, 1988. WHEREAS, The said, Jeanette M. Eby, by the aforesaid Last Will and Testament, named Bevedy E. Appley and Lloyd H. Eby, Jr. as Co-Executors of said Last Will and Testament; WHEREAS, Beverly E. Appley and Lloyd H. Eby, Jr. applied for Letters Testamentary, and was granted the Letters on February 22, 2002. WHEREAS, Letters Testamentary, on the estate of the said decedent were duly issued by the Register of Wills of Cumberland County, Mary C. Lewis, to the said Co- Executors, hereinafter called Co-Executors; WHEREAS, the said Co-Executors have gathered the assets of the estate of the said decedent and the assets consist of both real property and personal property. WHEREAS, the balance for distribution has been reduced to cash and has been distributed in accordance with the terms of the Last Will and Testament of the said decedent; NOW, THEREFORE, KNOW YE, that I, being an heir under the Last Will and Testament of the said decedent, and being that person entitled to inherent under the Last Will and Testament, do hereby, acknowledge that I have this day had and received from the aforesaid personal representative, full satisfaction and payment of all sums or sums of money, legacies, bequests, and devises as are given, devised and bequeathed to me respectively by the said Last Will and Testament, which amounts I have received this day. AND, I do hereby stipulate that in order to avoid the expense and time involved in the filing of a formal account and schedule of distribution, I agree that no account is necessary and I do hereby agree that I do consent to distribution being made without the filing of an account and schedule of distribution, the same to be with the same force and effect as if they had been filed and confirmed by the Register of Wills, Cumberland County. THEREFORE, I do hereby remise, release, quitclaim and forever discharge the said Co-Executors, Bevedy E. Appley and Lloyd H. Eby, Jr, heirs executors, and administrators and assigns, of and from the said estate and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever for or by reason thereof, or for any other use, matter, cause or thing whatsoever touching upon the estate of the said decedent. IN WITNESS WHEREOF, I have hereunto set my hand on the date set forth below. ..K' ry E. (Appley) Brown / Date FAMILY SETTLEMENT AND FINAL RELEASE IN ESTATE OF JEANETTE M. EBY KNOW ALL MEN BY THESE PRESENTS: WHEREAS, JEANETTE M. EBY, late of Camp Hill Borough, Cumberland County, Pennsylvania, died testate on February 17, 2002, having made her Last Will and Testament, which was duly executed on May 18, 1988. WHEREAS, The said, Jeanette M. Eby, by the aforesaid Last Will and Testament, named Beverly E. Appley and Lloyd H. Eby, Jr. as Co-Executors of said Last Will and Testament; WHEREAS, Beverly E. Appley and Lloyd H. Eby, Jr. applied for Letters Testamentary, and was granted the Letters on February 22, 2002. WHEREAS, Letters Testamentary, on the estate of the said decedent were duly issued by the Register of Wills of Cumberland County, Mary C. Lewis, to the said Co- Executors, hereinafter called Co-Executors; WHEREAS, the said Co-Executors have gathered the assets of the estate of the said decedent and the assets consist of both real property and personal property. WHEREAS, the balance for distribution has been reduced to cash and has been distributed in accordance with the terms of the Last Will and Testament of the said decedent; NOW, THEREFORE, KNOW YE, that I, being an heir under the Last Will and Testament of the said decedent, and being that person entitled to inherent under the Last Will and Testament, do hereby, acknowledge that I have this day had and received from the aforesaid personal representative, full satisfaction and payment of all sums or sums of money, legacies, bequests, and devises as are given, devised and bequeathed to me respectively by the said Last Will and Testament, which amounts I have received this day. AND, I do hereby stipulate that in order to avoid the expense and time involved in the filing of a formal account and schedule of distribution, I agree that no account is necessary and I do hereby agree that I do consent to distribution being made without the filing of an account and schedule of distribution, the same to be with the same force and effect as if they had been filed and confirmed by the Register of Wills, Cumberland County. THEREFORE, I do hereby remise, release, quitclaim and forever discharge the said Co-Executors, Beverly E. Appley and Lloyd H. Eby, Jr, heirs executors, and administrators and assigns, of and from the said estate and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever for or by reason thereof, or for any other use, matter, cause or thing whatsoever touching upon the estate of the said decedent. IN WITNESS WHEREOF, I have hereunto set my hand on the date set forth below. Ba~. (Eby) Burke Date FAMILY SETTLEMENT AND FINAL RELEASE IN ESTATE OF JEANETTE M. EBY KNOW ALL MEN BY THESE PRESENTS: WHEREAS, JEANETTE M. EBY, late of Camp Hill Borough, Cumberland County, Pennsylvania, died testate on February 17, 2002, having made her Last Will and Testament, which was duly executed on May 18, 1988. WHEREAS, The said, Jeanette M. Eby, by the aforesaid Last Will and Testament, named Bevedy E. Appley and Lloyd H. Eby, Jr. as Co-Executors of said Last Will and Testament; WHEREAS, Bevedy E. Appley and Lloyd H. Eby, Jr. applied for Letters Testamentary, and was granted the Letters on February 22, 2002. WHEREAS, Letters Testamentary, on the estate of the said decedent were duly issued by the Register of Wills of Cumberland County, Mary C. Lewis, to the said Co- Executors, hereinafter called Co-Executors; WHEREAS, the said Co-Executors have gathered the assets of the estate of the said decedent and the assets consist of both real property and personal property. WHEREAS, the balance for distribution has been reduced to cash and has been distributed in accordance with the terms of the Last Will and Testament of the said decedent; NOW, THEREFORE, KNOW YE, that I, being an heir under the Last Will and Testament of the said decedent, and being that person entitled to inherent under the Last Will and Testament, do hereby, acknowledge that I have this day had and received from the aforesaid personal representative, full satisfaction and payment of all sums or sums of money, legacies, bequests, and devises as are given, devised and bequeathed to me respectively by the said Last Will and Testament, which amounts I have received this day. AND, I do hereby stipulate that in order to avoid the expense and time involved in the filing of a formal account and schedule of distribution, I agree that no account is necessary and I do hereby agree that I do consent to distribution being made without the filing of an account and schedule of distribution, the same to be with the same force and effect as if they had been filed and confirmed by the Register of Wills, Cumberland County. THEREFORE, I do hereby remise, release, quitclaim and forever discharge the said Co-Executors, Beverly E. Appley and Lloyd H. Eby, Jr, heirs executors, and administrators and assigns, of and from the said estate and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever for or by reason thereof, or for any other use, matter, cause or thing whatsoever touching upon the estate of the said decedent. IN WITNESS WHEREOF, I have hereunto set my hand on the date set forth below. X Date FAMILY SETTLEMENT AND FINAL RELEASE IN ESTATE OF JEANETTE M. EBY KNOW ALL MEN BY THESE PRESENTS: WHEREAS, JEANETTE M. EBY, late of Camp Hill Borough, Cumberland County, Pennsylvania, died testate on February 17, 2002, having made her Last Will and Testament, which was duly executed on May 18, 1988. WHEREAS, The said, Jeanette M. Eby, by the aforesaid Last Will and Testament, named Bevedy E. Appley and Lloyd H. Eby, Jr. as go-Executors of said Last Will and. Testament; WHEREAS, Beverly E. Appley and Lloyd H. Eby, Jr. applied for Letters Testamentary, and was granted the Letters on February 22, 2002. WI~IEREA~,, Letters-Testamentary, on the estate of the said decedent were duly issued by the Register of Wills of Cumberland County, Mary C. Lewis, to the said Co- Executors, hereinafter called Co-Executors; WHEREAS, the said Co-Executors have gathered the assets of the estate of the said decedent and the assets consist of both real property and personal property. WHEREAS, the balance for distribution has been reduced to cash and has been distributed in accordance with the terms of the Last Will and Testament of the said decedent; NOW, THEREFORE, KNOW YE, that I, being an heir under the Last Will and Testament of the said decedent, and being that person entitled to inherent under the Last Will and Testament, do hereby, acknowledge that I have this day had and received from the aforesaid personal representative, full satisfaction and payment of all sums or sums of money, legacies, bequests, and devises as are given, devised and bequeathed to me respectively by the said Last Will and Testament, which amounts I have received this day. AND, I do hereby stipulate that in order to avoid the expense and time involved in the filing of a formal account and schedule of distribution, I agree that no account is necessary and I do hereby agree that I do consent to distribution being made without the filing of an account and schedule of distribution, the same to be with the same force and effect as if they had been filed and confirmed by the Register of Wills, Cumberland County. THEREFORE, I do hereby remise, release, quitclaim and forever discharge the said Co-Executors, Beverly E. Appley and Lloyd H. Eby, Jr, heirs executors, and administrators and assigns, of and from the said estate and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever for or by reason thereof, or for any other use, matter, cause or thing whatsoever touching upon the estate of the said decedent. IN WITN~. / \ Dougla S~. ~ NHEREOF, ! have hereunto set my hand on the date set forth below. ~'~/~ x / ~.. Date FAMILY SETTLEMENT AND FINAL RELEASE IN ESTATE OF JEANETTE M. EBY KNOW ALL MEN BY THESE PRESENTS: WHEREAS, JEANETTE M. EBY, late of Camp Hill Borough, Cumberland County, Pennsylvania, died testate on February 17, 2002, having made her Last Will and Testament, which was duly executed on May 18, 1988. WHEREAS, The said, Jeanette M. Eby, by the aforesaid Last Will and Testament, named Bevedy E. Appley and Lloyd H. Eby, Jr. as Co-Executors of said Last Will and Testament; WHEREAS, Beverly E. Appley and Lloyd H. Eby, Jr. applied for Letters Testamentary, and was granted the Letters on February 22, 2002. WHEREAS, Letters Testamentary, on the estate of the said decedent were duly issued by the Register of Wills of Cumberland County, Mary C. Lewis, to the said Co- Executors, hereinafter called Co-Executors; WHEREAS, the said Co-Executors have gathered the assets of the estate of the said decedent and the assets consist of both real property and personal property. WHEREAS, the balance for distribution has been reduced to cash and has been distributed in accordance with the terms of the Last Will and Testament of the said decedent; NOW, THEREFORE, KNOW YE, that I, being an heir under the Last Will and Testament of the said decedent, and being that person entitled to inherent under the Last Will and Testament, do hereby, acknowledge that I have this day had add received from the aforesaid personal representative, full satisfaction and payment of all sums or sums of money, legacies, bequests, and devises as are given, devised and bequeathed to me respectively by the said Last Will and Testament, which amounts I have received this day. AND, I do hereby stipulate that in order to avoid the expense and time involved in the filing of a formal account and schedule of distribution, I agree that no account is ssary and I do hereby agree that I do consent to distribution being made without the of an account and schedule of distribution, the same to be with the same force and effect as if they had been filed and confirmed by the Register of Wills, Cumberland County. THEREFORE, I do hereby remise, release, quitclaim and forever discharge the said Co-Executors, Beverly E. Appley and Lloyd H. Eby, Jr, heirs executors, and administrators and assigns, of and from the said estate and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever for or by reason thereof, or for any other use, matter, cause or thing whatsoever touching upon the estate of the said decedent. IN WITNESS WHEREOF, I have hereunto set my hand on the date set forth below. RePresentative f~r Camp Hill Presbyterian Church Date ' Assets of Jeanette M. Eby, (died on February 17, 2002) PNC Bank - Account Number 51-4001-7819 Beginning check balance as of February 17, 2002 - Deposit (6-15-02) - Deposit (deposit on house) (9-3-02) - Deposit (balance from sale of house) (9-06-02) - Deposit (10-01-02) - Check balance Personal Property (proceeds from auction) Jewelry (rings, gold necklace/bracelet) Lucent stock (24 shares @ $0.02) Verizon stock (104 shares @ $0.385) $ 4,038.38 $ 639.97 $ 5,041.17 $ 168,643.66 $ 61.58 $ 178,424.76 3,121.00 5,000.00 .48 40.04 Total Assets - $ Debts/deductions Mary Tagoe (Home Instead) (2-17-02) $ Fissel & Co (Appraisal) (02-22-02 - $ Deb Appley (refreshments) (02-22-02) $ Register of Wills fee (02-22-02) - $ Live-In-Care (2-23-02) - $ Cumberland Apothecary (03-11-02) - $ Patriot News (03-11-02) - $ Suburban Cable (03-15-02) - $ Comcast (03-25-02) - $ Neill Funeral Home, Inc. (03-12-02) - $ Taxes (03-12-02) - $ Verizon (03-25-02) - $ Freeman Real Estate (Appraisal) 04-10-02) - $ AT&T (05-07-02) - $ State Retirement system (overpaid) (05-11-02) - $ Borough of Camp Hill (sewer) (07-23-02) - $ Taxes (08-23-02) - $ Home Inspec (Home Inspection) (8-31-02) $ Ira H. Weinstock, P.C (9-06-02) - $ State tax/stamps (transfer of property) 09-06-02) - $ Ken Wilson (Lawn Service) (02-17 thru sale of house) $ PAWC (water)(02-17 thru sale of house) - $ PP&L (Electric) (02-17 thru sale of house) $ York Waste (trash removal) (02-17 thru sale of house) - $ Bank Charges (02 thru present) $ HB McClure (4-18 & 09-07-02) $ Lloyd H. Eby, Jr. (debts owed) (09-28-02) $ Beverly Miller (preparation of taxes) - $ Total debts/deductions - $ Total Assets Total debts/deductions 186,586.28 1,552.00 35.00 106.89 258.00 460.00 14.98 17.20 33.80 11.26 7,624.00 686.03 4.29 425.00 15.39 122.87 60.00 1,774.20 250.00 500.00 1,825.00 455.80 167.10 299.32 51.84 75.00 174.79 11,816.90 ???? 28,816.46 $ 186,586.28 $ - 28,816.46 t~lrrnnf ~al,~,~ ~f,~fnf~ nc nf 1~_n1_.q9 .~ 1R7 7RQ ~9