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03-0671
JERRY A. WEIGLE Associates JOSEPH P. RUANE RICHARD L. WEBBER, JR. Of Counsel THOMAS L. BRIGHT WEIGLE & ASSOCIATES, P.C. Attorneys-at-Law 126 EAST KING STREET SHIPPENSBURG, PENNSYLVANIA 17257-1397 TELEPHONE (717) 532-7388 or (717) 776-4295 FAX (717) 532-$289 weillleassociates~earthlink, net August 7, 2003 Donna M. Otto Acting Cumberland County Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Estate of Pearl M. Bums DOD July 16, 2003 Dear Donna: This firm has been requested to represent the estate of Pearl M. Bums, deceased, by Edna M. Martin, who is named as Executrix under a Last Will & Testament, dated February 21, 2003. A copy of that document is enclosed for your reference. The original is presently in the possession of David P. Perkins, Esquire, who prepared the document. It is requested that the Cumberland County Register of Wills issue an order to Attorney Perkins requiring him to produce this document at your office. Once accomplished and upon notification, the Executrix will appear and present a proper petition for letters testamentary to be issued. Both myself and David Perkins have discussed this matter with Ralph Wright, Esquire, who has suggested that we proceed in this manner. Thank you for your cooperation. Very truly yours, /I ~ WEIGLE & ASSO, CIAT]~S~ P.~ ~-~~Wei~le: Esquir:~~.~ Enclosure cc: Edna M. Matin (without enclos~e) Ralph H. Wright, Jr., Esq. (without enclos~e) David P. Perkins, Esq. (without enclos~e) JAW/plt LAST WILL AND TESTAMENT I, PEARL M. BURNS, of 330 East Orange Street, Shippensburg Borough, Shippensburg, Cumberland County, Pennsylvania, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void all wills by me at any time heretofore made. FIRST. I order and direct the payment of all my legally enforceable debts and funeral expenses as soon as may be convenient after my decease. SECOND. I give the sum of five hundred dollars ($500.00) to my friend Betty Wells presently of Route 9, Box 275, Hagerstown, Maryland. THIRD. I give the total sum of five hundred dollars ($500.00) to my niece Joan Burns Coy and Edgar Coy, her husband, or the survivor thereof. FOURTH. I give, devise and .bequeath all of the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever situate as follows: A. One half (1/2) to my friend Merry Jean Beres presently of 317 East Orange Street, Shippensburg, Pennsylvania 17257. In the event that the said Merry Jean Beres should predecease me, I then give, devise and bequeath her share of my estate to her issue on a per stirpes distribution basis. B. One half (1/2) to my friend Edna M. Martin presently of 2298 Ritner Highway, Shippensburg, Pennsylvania 17257. In the event that the said Edna M. Martin should predecease me, I then give, devise and bequeath her share of my estate to her issue on a per Stirpes distribution basis. FIFTH. ! direct that all taxes that may be assessed in consequence of my death of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. SIXTH. I nominate, constitute and appoint my friend EDNA M. MARTIN to be the Executrix of this my Last Will and Testament. If Edna M. Martin be unable to fulfill the duties of Executrix I then nominate, constitute and appoint my friend Merry Jean Beres to be the Executrix of this my Last Will and Testament. SEVENTH. I direct that my personal representatives shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, PEARL M. BURNS, have hereunto set my hand and seal to this my Last Will and Testament, written on two (2) pages, the first page signed for identification only, this ~, .day of February, 2003. / This instrument was by the Testatrix, on the date hereof, signed, published and declared by her to be her Last Will and Testament, in our presence, who at her request and in the presence of each other, we believing her to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND I, Pearl Bums, the person whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposestherein expressed, Sworn or affirmed to and acknowledged before me by Pearl Burns, the Testatrix, this ~..~/;~ day of February, 2003. ~.. V~ No~adaJ Seal ctoria N. Perkins, Notary Public J Shippensburg Boro Cumber]and Cou ~ My Commission ~'xpLrc$ Oci 15 2 nty · , Member, Pennsylvania Association ot Nora ties CITATION Office of Register of Wills Cumberland County, Pennsylvania IN RE: Estate of Pearl M. Burns, Deceased No. 21- O'$- L~q 1 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS. TO: David P. Perkins, Esquire Greetings: At the instance of Jerry A. Weigle, Esquire, you are hereby cited to appear before the Deputy Register of Wills for the County of Cumberland, at her office, Room 102, in the City of Carlisle, on the Second day of September, 2003, at !:00 P.M., and to show cause why you should not deposit with this office the undated instrument, a copy of which is attached hereto, which may be offered as a Will of Pearl M. Burns, deceased. WITNESS, Donna M. Otto, First Deputy Register of Wills, and the seal of her office at Carlisle, in said County, the !."~ day of ~ , 2003. First Deputy Register of Wills :155592 CITATION Office of Register of Wills Cumberland County, Pennsylvania IN RE: Estate of Pearl M. Burns, Deceased No. 21- O5 -- (~l[ COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS. TO: David P. Perkins, Esquire Greetings: At the instance of Jerry A. Weigle, Esquire, you are hereby cited to appear before the Deputy Register of Wills for the County of Cumberland, at her office, Room 102, in the City of Carlisle, on the Second day of September, 2003, at !:00 P.M., and to show cause why you should not deposit with this office the undated instrument, a copy of which is attached hereto, which may be offered as a Will of Pead M. Bums, deceased. WITNESS, Donna M. Otto, First Deputy Register of Wills, and the seal of her office at Carlisle, in said County, the ~ day of ("~/_~/~_/~d'-J-' , 2003. First Deputy Registe~ of Wills :155592 DAVID P. PERKINS ATTORNEY AT LAW ~ James Circle Shippensbur~, PA 17257-2165 Telephone: (717) $32-6629 E mail: dppesq ~ comcast.net August 18, 2003 Re: Estate of Pearl M. Burns, Deceased No. 21-03-671 Donna M. Otto, First Deputy Register of Wills Cumberland County Courthouse Carlisle, PA 17013 Dear Ms. Otto, Pursuant to Citation dated August 13, 2003 issued to me in the above matter I hereby deposit with the Register of Wills the original Last Will and Testament of Pearl M. Bums dated February 21, 2003 to be entered for probate. Please provide me with a time-stamped copy of the Will as proof of filing. Sincerely, David P. Perkins WEIGLE & ASSOCIATES, P.C. * ATTORNEYS AT LAW 126 EAST KINe STm~ET, SmPPV, NSBtraG, PA 17257-1397 · TELEPHONE: (717) 532-7388 FAX: (717) 532-6552 IN RE: ESTATE OF PEARL M. BURNS, late of the Borough of Shippensburg, Cumberland County, Pennsylvania, deceased : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY : PENNSYLVANIA : ORPHANS' COURT DIVISION : ESTATE NUMBER 21-03-0671 CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Pearl M. Burns Date of Death: July 16, 2003 Will No. 0671 of 2003 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above- captioned estate on September 18, 2003: Edna M. Martin 2298 Ritner Highway Shippensburg, PA 17257 Merry Jean Beres 317 East Orange Street Shippensburg, PA 17257 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except September 18, 2003 ~ Sign / Name: Jerry A. Weigle, Esquire Address: Weigle & Associates, P.C. ~': 126 East King Street Shippensburg, PA 17257 Telephone': (717) 532-7388 Capacity: Personal Representative X Counsel for Personal Representative WEIGLE & ASSOCIATES, P.E. -- ATTORNEYS AT LAW -- 126 EAST KING STREET -- SHIPPENSEIURG, PA 17257-1397 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD OO3139 WEIGLE JERRY A 126 E KING STREET SHIPPENSBURG, PA 17257 ........ fold ESTATE INFORMATION: SSN: 179-10-3945 FILE NUMBER: 2103-0671 DECEDENT NAME: BURNS PEARL M DATE OF PAYMENT: 1 O/17/2003 POSTMARK DATE: 10/16/2003 COUNTY: CUMBERLAND DATE OF DEATH: 07/16/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $35,000.00 TOTAL AMOUNT PAID: $35,000.00 REMARKS: EDNA M MARTIN C/O JERRY WEIGLE ESQUIRE SEAL CHECK# 107 INITIALS: AC RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS WEIGLE & ASSOCIATES, EC. Attorneys At Law 126 East King Street Shippensburg, PA 17257-1397 Cumberland County Register oJ Cumberland County Courthouse Carlisle, PA 17013 i ? o i ~+.~30 i I,,,lll,.ill,,,,.Ih,ii,,,Ih,,Ihil,.,.ll COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 03 0671 COUNTY CODE YEAR NUMBER uJ O0 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Bums, Pearl M. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-OD-YEAR) 07/16/2003 09/27/1917 SOCIAL SECURITY NUMBER 179-10-3945 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER [] 1. Original Return [] 2. Supplemental Return [] 3. Remainder Return (date of death prior to 12-13-82) [] 4. Limited Estate [] 4a. Future Interest Compromise (date of death after 12-12-82) [] 5. Federal Estate Tax Return Required [] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach 1 8. Total Number of Safe Deposit Boxes of Will) copy of Trust) [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between [] 11. Election to tax under Sec. 9113(A) (Attach Sch O) 12-31-91 and 1-1-95) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: 4AME Jerry A Weigle "IRM NAME (If applicable) Weigle & Associates, P.C. tELEPHONE NUMBER 717/532-7388 COMPLETE MAILING ADDRESS 126 East King Street Shippensburg, PA 17257 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) [] 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) 12. 13. 14. 56,000.00~- None~' None None 133,556.97 None 122,234.53 26,060.17 24,179.47 Net Value of Estate (Line 8 minus Line 11) Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) (8) 311,791.50 50,239.64 261,551.86 261,551.86 (11) (12) (13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, x .00 or transfers under Sec. 9116(a)(1.2) 16.Amount of Line 14 taxable at lineal rate x .045 17. Amount of Line 14 taxable at sibling rate x .12 18. Amount of Line 14 taxable at collateral rate x .15 19. Tax Due 261,551.86 20. [] ........ , ...... (15) (16) (17) (18) (19) 39,232.78 39,232.78 >> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH << Copyright 2000 form software only The Lackner Group, Inc. Form REV-'IS00 EX (Rev. 6-00) Decedent's Complete Address: ]STR~I~T ADDRESS c/o Weigle & Associates, P.C. 126 East King Street ICITY PA 17257 Shippensburg STATE Z1P Tax Payments and Credits: 1. Tax Due (Page I Line 19) 2. Credits/Payments A. Spousal Poverty Credit B, Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty 35,000.00 1,842.11 (1) Total Credits (A + B + C) (2) Total Interest/Penalty (D + E) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page I Line 20 to request a refund If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 39,232.78 36,842.1 l 0.00 2,390.67 2,390.67 PLEASE ANSWI~R THE FOLLOVVlNG QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ............................................................................. [] [] b. retain the right to designate who shall use the property transferred or its income; ................................ [] [] c. retain a reversionary interest; or ............................................................................................................ [] [] d. receive the premise 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 Uin 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 ANSWI~R TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Urn:let 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. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE Edna M. Martin, Executrix SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE 2298 Rimer Hie. hway Shippensburg, PA 17257 126 East King Street Shippensburg, PA 17257 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. {}9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. {}9116 (a) (1.1) (ii)]. 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. {}9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. {}9116 1.2) [72 P.S. {}9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. {}9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Burns, Pearl M. FILE NUMBER 21 - 03- 0671 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 willingbuyer 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Real Estate at 330 East Orange Street, Borough of Shippensburg, Cumberland County, Pennsylvania - 56,000.00 gross proceeds of sale 2/20/04 TOTAL (Also enter on Line 1, Recapitulation) 56,000.00 SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONV~cALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Burns, Pearl M. 21 - 03 - 0671 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivomh,p must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Citizens Bank Checking Account #6100625346 2 5 6 7 8 9 10 11 12 13 Accrued interest to date of death Citizens Bank Savings Account #6140233615 Accrued interest to date of death Citizens Bank Certificate of Deposit #6140737176 Accrued interest to date of death Citizens Bank Certificate of Deposit #6140768292 Accrued interest to date of death Fogelsanger-Bricker Funeral Home refund received 9/25/03 Sprint refund received 10/15/03 Prudential Financial Acct. #KZC-595182-01 (proceeds of liquidation) MetLife - total control acct. #403-1313905 (proceeds of liquidation) Gross receipts of personal property at Public Sale on 1/10/04 Cash on hand at date of death Orthopaedic Associates refund received 3/11/04 County Tax Proration at real estate settlement on 2/20/04 School Tax Proration at real estate settlement on 2/20/04 TOTAL (Also enter on Line 5, Recapitulation) 1,667.90 0.00 1,263.85 0.14 49,819.55 2.70 26,613.48 1.44 336.18 8.26 15,323.35 24,896.68 12,865.00 342.00 18.22 220.40 177.82 133,556.97 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Bums, Pearl M. FILE NUMBER 21 - 03 - 0671 This schedule must be completed and filed if the answer to any of questions '1 through 4 on page 2 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF NUMBER Include the name of the transferee, their relationship to decedent and the date of transfer. VALUE OF ASSE'r DECD'S EXCLUSION TAXABLE VALUE Attach a copy of the deed for real estate. (IF APPLICABLE) INTEREST 1 Transamerica Life - Annuity #26254480 Paid to Joan Bums 122,234.53 122,234.53 Coy, niece of decedent 8/4/03 I TOTAl {Aleo enter on line ?, Recapitulation) 122,234.53 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMIMS'1RATNE COS'TS ESTATE OF Bums, Pearl M. FILE NUMBER 21 - 03 - 0671 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT Bo FUNERAL EXPENSES: ADMINISTRATIVE COSTS: Personal Representative's Commissions Edna M. Martin, Executrix Street Address 2298 Rimer Highway City Shippensburg State PA Zip 17257 Year(s) Commission paid 2003 & 2004 Attorney's Fees Weigle & Associates, P.C. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Register of Wills, Cumberland County - letters testamentary and short certificates Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Register of Wills, Cumberland County - filing PA Inheritance Tax Return Register of Wills, Cumberland County - filing Family Settlement Agreement Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) 12,353.75 13,103.75 316.00 15.00 75.00 196.67 26,060.17 · COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SchedubH ESTATE OF FILE NUMBER Bums, Pearl M. 21 - 03 - 0671 3 News-Chronicle - Advertising cost 84.50 Cumberland Law Journal - Advertising cost Weigle & Associates, P.C. - reimbursement for long distance telephone calls, copies & postage Weigle & Associates, P. C. - Notary fee Postmaster - certified mail to Department of Public Welfare 75.00 23.75 9.00 4.42 Page 2 of Schedule H COMMONWF-ALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Burns, Pearl M. 21 - 03 - 0671 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT l 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Penelec - 9/29/03 Lisa L. Helm, Tax Collector - 2003-2004 School Real Estate Taxes - 9/29/03 Borough of Chambersburg - ambulance bill - 9/29/03 Greencastle Family Practice - 9/29/03 Orthopaedic Associates - 9/29/03 Chambersburg Imaging Associates - 9/29/03 Diamond Pharmacy Services - 10/7/03 Falling Spring Nursing & Rehabilitation Center - 10/7/03 Chambersburg Hospital - 10/7/03 Horn & Company (real estate appraisal) - 10/7/03 Waynesboro Hospital - 10/7/03 Penelec- 10/15/03 Borough of Shippensburg (water, sewer bill) - 10/16/03 Timmons Oil, Inc. - 10/16/03 Mobile X USA - 11/10/03 Citizens Bank Checking Account #6100625346 - checks clearing after date of death Penelec - 11/17/03 Comcast Cable - 11/25/03 Diamond Pharmacy Services - 12/3/03 Penelec - 12/18/03 Total of Continuation Schedule(s) TOTAL (Also enter on Line 10, Recapitulation) 19.11 491.72 65.93 72.12 2.12 2.12 1,190.81 9,036.73 120.03 350.00 29.96 18.56 86.53 25.68 18.15 212.30 20.38 45.82 1,061.17 23.00 11,287.23 24,179.47 SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Bums, Pearl M. 21 - 03 - 0671 Include unreimbumed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 21 22 23 24 25 26 27 28 29 30 Timmons Oil, Inc. - 12/23/03 Carl L. Cramer Insurance - fire insurance premium - 12/29/03 Borough of Shippensburg (water, sewer) - 1/5/04 Timmons Oil, Inc. - 1/6/04 Expenses of Public Sale held on 1/10/04 - paid on 1/13/04 Penelec - 1/15/04 Penelec - 2/18/04 Real Estate settlement expenses 2/20/04 Penelec (final bill) Timmons Oil, Inc. 75.69 605.00 122.53 72.96 9,027.05 28.36 28.87 1,066.27 5.18 255.32 Page 2 of Schedule I REV-1513 EX+ {9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bums, Pearl M. SCHEDULE J BENEFICIARIES FILE NUMBER 21 - 03- 0671 NUMBER II. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) Edna M. Martin 2298 Rimer Highway Shippensburg, PA 17257 Merry Jean Beres 317 East Orange Street Shippensburg, PA 17257 Betty Wells Route 9, Box 275 Hagerstown, Maryland 21740 Joan Bums Coy and Edgar Coy 20 White House Road Shippensburg, PA 17257 RELATIONSHIP TO DECEDENT Do Not List Friend Friend Friend Niece/Nephew See Continuation Schedule(s) attached Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover she~ 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 SHEI T AMOUNT OR SHARE OF ESTATE $69,158.67 g69,158.66 ;500.00 ;500.00 SCHEDULE J BENEFICIARIES continued COMMONVVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF I FILE NUMBER ~'~ums, Pearl M. 21 - 03 - 0671 I RELATIONSHIP TO NUMBER i NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE [include outright spousal distributions, and transfers under FAXABLE DISTRIBUTIONS z. Sec. 9116(a)(1.2)] 5 Joan Bums Coy Niece $122,234.53 20 White House Road ,Shippensburg, PA 17257 Page 2 of Schedule J LAST WILL AND TESTAMENT I, PEARL M. BURNS, of 330 East Orange Street, Shippensburg Borough, Shippensburg, Cumberland County, Pennsylvania, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void all wills by me at any time heretofore made. FIRST. I order and direct the payment of all my legally enforceable debts and funeral expenses as soon as may be convenient after my decease. SECOND. I give the sum of five hundred dollars ($500.00) to my friend Betty Wells presently of Route 9, Box 275, Hagerstown, Maryland. THIRD. I give the total sum of five hundred dollars ($500.00) to my niece Joan Burns Coy and Edgar Coy, her husband, or the survivor thereof. FOURTH. I give, devise and .bequeath all of the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever situate as follows: A. One half (1/2) to my friend Merry Jean Beres presently of 317 East Orange Street, Shippensburg, Pennsylvania 17257. In the event that the said Merry Jean Beres should predecease me, I then give, devise and bequeath her share of my estate to her issue on a per stirpes distribution basis. B. One half (1/2) to my friend Edna M. Martin presently of 2298 Ritner Highway, Shippensburg, Pennsylvania 17257. In the event that the said Edna M. Martin should predecease me, I then give, devise and bequeath her share of my estate to her issue on a per Stirpes distribution basis. FIFTH. I direct that all taxes that may be assessed in consequence of my death of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. SIXTH. I nominate, constitute and appoint my friend EDNA M. MARTIN to be the Executrix of this my Last Will and Testament. If Edna M. Martin be unable to fulfill the duties of Executrix I then nominate, constitute and appoint my friend Merry Jean Beres to be the Executrix of this my Last Will and Testament. SEVENTH. I direct that my personal representatives shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, i, PEARL M. BURNS, have hereunto set my hand and seal to this my Last Will and Testament, wdtten on two (2) pages, the first page signed for identification only, this ;~"~ day of February, 2003. This instrument was by the Testatrix, on the date hereof, signed, published and declared by her to be her Last Will and Testament, in our presence, who at her request and in the presence of each other, we believing her to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND I, Pearl Bums, the person whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes-therein expressed. Sworn or affirmed to and acknowledged before me by Pearl Burns, the Testatrix, this _..~/~t~ day of February, 2003. Notarial Seal Victoria N. Perkins, Notary Public Shippcnsburg Boro, Cumberland County My Commission Expires Oct, 15, 2 Member, Pennsylvania Association ol Notaries . ^. Settlement Statement ,~, .i:: O.S. Department of Housing and Urban Development ~i OMB No. 2502-0265 REV. HUD-1 (3/86) FRANKLIN REAL ESTATE SERVICES AND ABSTRACTING COMPANY, INC. B. TYPE OF LOAN 1035 WAYNE AVENUE · CHAMBERSBURG, PA 17201 1. I-]FHA 2. FIFmHA 3. I-1Conv. Unins. TEL, 717-264-3290 FAX: 717-264-1985 4. [~VA 5. ~Conv. Ins. 6. FILE NUMBER 1 7. LOAN NUMBER CTA0121 I 8. MORTGAGE INSURANCE CASE NUMBER [his form IS turnlsl~e~l to give you a =,~.,~i,,~nt ot actual settlement costs. ~oun? pal?.to an~l I~y tim se.tti~n[..age, nt.ar.e.s~.ow.n._. TitleExpress Settlement System C. Note: Items marked "{p.o.c.)" were paid outside the closing; they are shown here for Imormat,on purposes and are nor inc~uaeu m me tom,s. WARNING: It Is a crime to knowingly make false statements to the United States on this or a.n]~ ~.ther.s_lml~r fo.r..~...Penaltlas upon Printed 02/20/2004 at 08:57 RAD conviction can I~,c,,,a,, a fine and Imprisonment. For details see: Title 18 U. S. Code Section 1001 anD aecuon lulu. D, NAME OF BORROWER: Keith A. Swartz and Hestherlee B. Swartz ADDRESS: 411 William Drive, Shippensburg, PA 17257 E. NAME OF SELLER: Estate of Pearl U. Burns ADDRESS: 330 East Dram;la Street, Shippensburg, PA 17257 F. NAME OF LENDER: Orrstown Bank ADDRESS: P.O. Box 250, 77 East Kin(j Street, Shippensburg, PA 17257 G. PROPERTY ADDRESS: 330 East Orange Street, Shippensburg, PA 17257 Shippensburg borough H. SETTLEMENT AGENT: Franklin RE Services and Abstracting Co., Telephone: 717-243-2517 Fax: 717-243-1472 PLACE OF SETTLEMENT: 19 South Hanover Street, Carlislel PA 17013 I. SETTLEMENT DATE: 02/20/2004 J, SUUUARY OF BORROWER'S TRANSACTION: K, SUUUARY OF SELLER'S TRANSACTION: 100. GROSS AUOUNT DUE FROU BORROWER 400. GROSS AUOUNT DUE TO SELLER 101. Contract sales price 56,000.00 401. Contract sales price 561000.00 102. Personal Property 402. Personal Property 103. Settlement char.qes to borrower (line 1400) 2,277.75 403. 104. 404. 105. 405. Adjustments for items paid by seller in advance Adjustments for items paid b), seller in advance 107. County taxes 02/20/04to12/31/04 220.40 407. County taxes 02/20/04to12/31/04 220.40 108. School Taxes 02/20/04to06/30/04 177.82 408. School Taxes 02/20/04to06/30/04 177.82 109. 409. 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 58~675.97 420. GROSS AMOUNT DUE TO SELLER 56~398.22 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. Deposit or earnest money 5~600.00 501. Excess Deposit (see instructions) 5,600.00 202. Principal amount of new loans 44,800.00 502. Settlement char,qes to seller (line 1400) 1,066.27 203. Existin.q loan(s) taken subiect to 503. Existin.q loan(s) taken subiect to 204. 504. Payoff of First Mort.qa.qe Loan 205. 505. 206. 506. 2O7. 507. 208. 508. 209. 509. Adjustments for items unpaid by seller Adjustments for items unpaid by seller 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 50,400.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 6,666.27 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER 301. Gross amount due from borrower (line 120) 58,675.97 601. Gross amount due to seller (line 420) 56,398.22 302. Less amounts paid by/for borrower (line 220) 50,400.00 602. Less reduction amount due seller (line 520) 61666.27 303. CASH FROM BORROWER 8,275.97 603. CASH TO SELLER 49~731.95 SUBSTITUTE FORM 1099 SELLER STATEMENT: The Information contained herein Is Important tax Information and la being furnished to the Internal Revenue Service, If you ara required to file a return a negligence penalty or other sanction will be Imposed on you If this item Is required to ua reported and the IRS determines that It has not been reported. The Contract Sales Pr ce described on line 401 above constitutes the Gross Proceeds of this transaction. You are required by law to provide the settlement agent (Fed. Tax ID No: ) with your correct taxpayer Identification number. If you do not provide your correct taxpayer Identification number, you may be subject to civil or criminal penalties Imposed by law. Under penalties of perjury, I certify that the number shown on this statement Is my correct taxpayer identification number. TIN: __ __ __ I__ __ __ SELLER(S) SIGNATURE(S): I SELLER(S) NEW M,adLING ADDRESS: SELLER(S) PHONE NUMBERS: (H) (W) U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: CTA0121 SETTLEMENT STATEMENT ! PAGE 2 L, SETTLEMENT CH~- ................ -, o, oo I itleEx tess Settlement S stem Printed 02/20/2004 at_08:57 RAD - PAID FROM ' PAID FEOM 700. TOTAL SALES/BROKER'S COMMISSION bas. ed on price $ = BORROWER'S SELLER'S' Division of commission Iline 700) as follows: 701. $ to FUNDS AT FUNDS AT ~ to SETTLEMENT SETTLEMENT 703. Commission~aid at Settlement -- 800. ITEMS PAYABLE IN CONNECTION WITH LOAN J 801. Loan. q.~D_~_~qination Fee % 802. Loan Discount % 803. A_p_pj_aisal Fee to Orrstown Bank 804. Credit Report 250.00 805. Lender's Inspection Fee 806. Mort¢la.qe Application Fee 807. Assumption Fee 808, Underwriting Fee to Orrstown Bank 200.00 809. Document Preparation to Orrstown Bank 200.00 810. Flood Ced to Orrstown Bank 30.00 811. Application Fee to Orrstown Bank 200.00 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to @$ /day 902. Mortgage Insurance Premium for to 903. Hazard Insurance Premium for 1 year to Everett Cash Mutual Ins, Co, {P.O.C,) 273.00 Buyer 904. 905. 1000. RESERVES DEPOSITEB WITH LENDER FOR 1001. Hazard Insurance mo. @ $ /mo 1002. Mortgage Insurance mo. @ $ /mo 1003. City Property Tax mo. @ $ /mo 1004. County Property Tax mo. @ $ /mo 1005. School Taxes mo. @ $ /mo 1009. A~ore,qate Analysis Adjustment 0.00 0.00 1100. TITLE CHARGES 1101. Settlement or closing fee to Franklin Real Estate Services 100.00 1102. Abstract or title search to Franklin Real Estate Services 260.25 1103. Title examination _.1104. Title insurance binder 1105. Docur~er~t Preparation 1106. Notary Fees to Malina S. Ray 10.00 1107. Attorney's fees to Weigle & Associates, P.C, 150.00 (includes above items No: ) 1108. Title Insurance to Bankers Settlement Services 209.50 {includes above items No: ) 1109. Lender's Coverage $ 44,800.00 - 1110. Owner's Coverage $ 56,000.00 - 209.50 1111. Endorsements PA 100, 300, 900 to Bankers Settlement Services 150.00 1112. Commitment Fee to Bankers Settlement Services 25.00 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201, Recording Fees Deed $ 38.50 ; Mortgage $ 44,50 ; Release $ 83.00 1202. City/County tax/stamps Deed $560.00 ; Mortgage $ 560.00 1203. State Tax/stamps Deed $560,00 ; Mortgage $ 560.00 1204. 1205. 1300, ADDITIONAL St:t t LEMENT CHARGES 1301. Survey 1302. Pest Inspection 1303. Final Water/Sewer to Borough of Shippensburg 101,69 1304. 2004 County Tax to L_!$,3_ L, Helm ...1305. 254.58 1307. 1400. TOTAL SETrLEMENT CHARGES {enter on lines 103, Section J and 502, Section K) 2,277,75 1,066.27 HUD CERTIFICATION OF BUYER AND SELLER I have carefully reviewed the HUD.1 Settlement Statement and to the best of my knowledge and belief, It Is a true and accurate statement of all receipts and disbursements made on my account or by r in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement. / : / l ' W~NG: IT IS A ~IME TO KNOWINGLY M~E F~SE S~AT~MENTS TO THE UNIT~ STATES ON ~tS OR ANY SIMI~ FORM. PEN~TIE~ UPON CONVICTION C~ INCLUDE A FINE AND IMPRISONMENT. FOR DETNL, S~ ~E 18: u.s. The HUD-1 Set. flUent Statement which I~have pr~~e and accurate account of this I ha>Taus~/~'r, wlll cause the funds ~13e dls/b.~rs~l' In accorfance with this statement. transaction. CITIZENS B A IK Account Number 6100625346 Account Title Pearl M Burns Date Opened 5/17/99 Account Type Principal Balance as of DOD Interest from Last Posting to DOD Account Balance as of DOD ! YTD Interest to DOD Checking $1667.90 $1667.90 CITIZENS BANK Account Number 6140233615 Account Title Pearl M BUms Date Opened Account Type Principal Balance as of DOD 4/12/99 Savings $1263.85 Interest from Last Posting to DOD $. 14 Account Balance as of DOD $1263.99 YTD Interest to DOD $5.53 CITIZENS BANK Account Numb er 614073717.6 Account Title Pearl M Bums 2/16/99 ..Date Opened Account Type Principal Balance as of DOD Interest from Last Posting to DOD Account Balance as of DOD Time Deposits $49816.85 $2.70 $49819.55 YTD Interest to DOD $548.69 CITIZENS BANK Account Number 6140768292 Account Title Pearl M Bums 6/16/00 Date Opened Account Type Principal Balance as of DOD Interest from Last Posting to DOD Account Balance as of DOD Time Deposits $26613.48 $1.44 $26614.92 YTD Interest to DOD $304.06 July 1 - July 31, 2003 Prudential Financial Statement Prudential Financial is a service mark of The Prudential Insurance Company of America, Newark, NJ, and its affiliates· $15,288.76 $15,323.35 Account Number: KZC-595182-01 Page 1 of 3 Account Servicing Information: FOR ACCOUNT BALANCE AND ACTIVITY INFORMATION 24 HOURS A DAY CALL THE ALLIANCE SERVICE CENTER AT 1-877-ALLIANCE (255-4262). Total Net Worth $15,288.76 $15,323.36 ~:~:~'il;;Gi;; i~;'~'~;~;l~'i~ ~ .................................................................................. ~'~'~:~;§:?~g" '~'/~;;;;nce interest Paid Si~~ce I ~"~"~--~~ ..................... ':;~':'~';;.'1 ~ I Alliance Interest Rate for Current S~tement Period: 2.50% _ I Your VRU access number: 4351000190418 Interest $34.59 $220.89 Total Income $34.59 $220.89 Opening Alliance Balance $15,288.76 Income & Distributions In Cash $34.59 $220.89 Funds Added $.00 $.00 Checking $.00 $.00 Miscellaneous $.00 $.00 Closing Alliance Balance $15,323.35 PEARL H BURNS 33D E ORANGE ST SHIPPENSBURG PA 17257-2008 I,,,111,,,I,,I,1,1,1,1,,,I,,I,II1,,,11,,,I,,I,,,11,11,,,,I,1,1 Questions? Call us at 1-877-ALLIANCE (1-877-255-4262). (MRA~ 1998-A033468) ,.ifc© F.~mily oF Compamies No. 403-1313905 Total Control Account® August 2003 Statement Period From 8/01/03 To 8/31/03 Page 1 of 1 PEARL M BURNS 330 E ORANGE STREET SHIPPENSBURG PA 17257 Customer Service: (800) 638-7283 Our Customer Service Representatives are available to assist you from Monday through Friday, 8:00 a.m. to 6:00 p.m. Eastern Time, and our busiest day usually is Monday. You can receive prompt, automated assistance 24 hours a day, seven days a week. Please remember to have your account number handy when you call. Thank you. TCA MONEY MARKET OPTION (MMO) Effective Annual Yield 3.00% as of 08/31/03 Account Summary Interest Transaction Details $24,896.68 $62.62 $24,959.30 $486.99 8/31 Interest $62.62 ML-5620197-1110018-0001 Terry L. Shetter Auctioneer 365 Musser Road Shippensburg, PA 1 7257 71 7-264-3885 SETTLEMENT Proceeds of sale: Cash: Checks' I0, Setlers's Sale Expenses: Advertising: Tent: Building: Port-a~pot: 3. Real Estate: Selling Price $ ~ Lc, Or)O, b'~O Commission J"; % 4. Auctioneer's fee/percentage: 10 % TOTAL: TOTAL: TOTAL: TOTAL: TOTAL NET PROCEEDS TO SELLER': $ TOTAL PAYMENT TO AUCTIONEER: Terr~ L. Shetter, Auctioneer/Date Seller/Date KMOM¢ [ / ! / Terry L. Shel;ter Mu~er Road, 5hlppen~burg, FA 17257 DESCRIPTION " PRICE AMOUNT ~ U CASH U AMOUNT CHECK ~ RECEIVEB PAYMENT ' IX · October 7, 2003 Transamerica Life Insurance and Annuity Company Home Office: Charlotte, North Carolina Administrative Office: 4333 Edgewood Road NE PO Box 3183 Cedar Rapids, Iow~ 52406-3183 Weigle & Associates, P C Attn: Jerry A Weigle 126 East King Steet Shippensburg, PA 17257-1397 RE: Annuity Number(s) 26254480 Dear Mr. Weigle: Thank you for the recent inquiry on the above listed non-qualified annuity for Pearl Burns. Our records indicate this annuity was paid out in full as a death claim on August 4, 2003, to the beneficiary, Joan Burns Coy. Transamerica Life Insurance and Annuity Company is a member of the Insurance Marketplace Standards Association (IMSA), an organization committed to high ethical marketplace standards in the sale and service of individual life insurance and annuities. If you have any questions or concerns, you may call our customer service line. Our toll free customer service line, 1-800-553-5957, is available Central Time from 7:00 AM to 5:30 PM Monday-Thursday and Friday 7:00 AM to 4:30 PM. You may also visit us on our website at. Sincerely, Customer Care Group/cap Transamerica Life Insurance and Annuity Company / o-I ~-~ 3 - 77- 7-/6-0 ~ = / z~ ~-3~/. r3 Member of the ~F..GON. Group Annuity Products and Services ATI-N: Customer Care Group 4333 Edgewood Road NE Cedar Rapids, IA 52499 Select Value Plus Annuity March 16, 2003-June 16, 2003 Pearl Burns 330 E. Orange St. Shippensburg, PA 17257 Contract Number: 26254480 Annuitant: Pearl Burns Owner: Pearl Burns Issue Date: June 16, 2000 Type: Non-Qualified This Period Since Inception Total disbursements include annual service charges and rider charges, if applicable. Accumulation Value as of 3/16/2003 Total Premium Payments Total Withdrawals Total Interest Earned Accumulation Value as of 6/16/2003 S! I g,782.~ $o.oo 0.00 1,844.42 $121,626.98 $0.00 $100,000.00 0.00 21,626.98 $ i 21,626.98 Values as of 6/16/2003 Cash Surrender Value $1t6,626.98 Interest Rate % Dollar Value 6.000 Total Value $121,626.98 $ ! 21,626.98 Effective Date Transaction Amount 3/31/2003 4/30/2003 5/31/2003 Additional Interest Credited Additional Interest Credited Additional Interest Credited $24.03 $23.36 $24.27 Transamerica Life Insurance and Annuity Company Member of the AEGON Group 3008580 Page 1 of 2 WEIGLE & ASSOCIATES, P.C. * ATTORNEYS AT LAW 126 EAST KING STREET, SHIPPENSBURG, PA 17257-1397 · TELEPHONE: (717) 532-7388 FAX: (717) 532-6552 IN RE: ESTATE OF PEARL M. BURNS, late of the Borough of Shippensburg, Cumberland County, Pennsylvania, deceased : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY : PENNSYLVANIA : ORPHANS' COURT DIVISION : ESTATE NUMBER 21-03-0671 SUPPLEMENTAL CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Pearl M. Bums Date of Death: July 16, 2003 Will No. 0671 of 2003 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above- captioned estate on March 18, 2004: Betty Wells Route 9, Box 275 HagerstoWn, Maryland 21740 Joan Burns Coy and Edgar Coy 20 White House Road Shippensburg, PA 17257 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except NONE. March 18, 2004 Sign at~~~ Name: Jerry A. Es uire < Wetgle, ' Address: Weigle & Associates, P.C. ~ 126 East King Street Shippensburg, PA 17257 <3) 132 ~ Telephone: (717) 532-7388 Capacity: Personal Representative X Counsel for Personal Representative COMr~"3NWEALTH OF PENNSYLVANIA ~EPAR~MENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003737 WEIGLE JERRY A 126 E KING STREET SHIPPENSBURG, PA 17257 ........ fold ESTATE INFORMATION: SSN: 179-10-3945 FILE NUMBER: 2103-0671 DECEDENT NAME: BURNS PEARL M DATE OF PAYMENT: 03/30/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/1 6/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $2,390.67 REMARKS: TOTAL AMOUNT PAID' $2,39O.67 SEAL CHECK//133 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS PETITION FOR PROBATE and GRANT OF LETTERS Estate of Pearl M. Burns No. also known as To: Social Security No. Deceased. 179-10-39~5 Register of Wills for the County of Cumberland Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(X), who isX01~ 18 years of age or older an the execut in the last wilt of the above decedent, dated February 21 and codicil(s) dated none in the named , I~ ?o03 (state relevant circumstances, e.g. renunciation, d~eath of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with h er last family or principal residence at 330 East Orange. Street, Sh~ppen.~burg, Gumberland County (list street, number and muncipality) Decendent, then 85 years of age, died July 16 ,~ ?O0~ , at Falling Spring Nursing & Rehabilitation Center. Chambersburg, PA . Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: none Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ 21/4,300.00 (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania Cumberland Co. $ 30,000.00 situated as follows: 330 East Orange Street. Shippensburg, PA WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters Testamentary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. Edna M. Martin Shippensburg, PA 17257 OATH OF' PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF Cumberland The petitioner(I) 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 petitioner00 and that as personal represen- tative(~) of the above decedent petitioner(X) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed ,- C-~~~~~ r~ · 28th Edna M Martin ' ~t%fore me this ____ __day of ! __' _ ~'.. /. I Auaus~ . _ ..,: Y,~ 2003 J · ~ ' ffo~na- M. Otto, l~t Deputy' -R/e~i-std~r~.~,9., ~ / Ii NO. 21-2003-671 Estate 0f~ Pearl M. Burns , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW Auqust 29th 1¢~ 2003., in consideration of the petition on the reverse side hereof, satisfactory proof having bo~n presented before me, IT IS DECREED that the instrument(s) dated February 21~ 2003 described therein be admitted to probate and filed of record as the last will of Pearl ]v[. Burn,q and Letters Testamentary are hereby granted to Edna M. Martin FEES Probate, Letters, Etc .......... $ 270.00 Short Certificates(2) .......... $. 6.00 ~ x~Pao~ms ¢ 3~ .... $ 9.00- JCP $ 10.00 TOTAL __ $. 295.00 F~led Augus.t .29~h,.2003. ............... PUT LE~I~RS IN WEIGLE & ASSOCIATES FILE IN PROTHONOTARY ON 8/29/03 Donna M.Otto, 1st Deputy Jerry A. Weigle, Esquire #01624 A.TTORNEY(Sup. Ct.I.D. No.) WEIGLE & ASSOCIATES, P.C. 126 East King Street ADDRESS Shippensburg, PA 17257 (717) S32-7388 PHONE 21-2003-671 LAST WILL AND TESTAMENT I, PEARL M. BURNS, of 330 East Orange Street, Shippensburg Borough, Shippensburg, Cumberland County, Pennsylvania, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void all wills by me at any time heretofore made. FIRST. I order and direct the payment of all my legally enforceable debts and funeral expenses as soon as may be convenient after my decease. SECOND. I give the sum of five hundred dollars ($500.00) to my friend Betty Wells presently of Route 9, Box 275, Hagerstown, Maryland. THIRD. I give the total sum of five hundred dollars ($500.00) to my niece Joan Burns Coy and Edgar Coy, her husband, or the survivor thereof. FOURTH. I give, devise and bequeath all of the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever situate as follows: A. One half (1/2) to my friend Merry Jean Beres presently of 317 East Orange Street, Shippensburg, Pennsylvania 17257. In the event that the said Merry Jean Beres should predecease me, I then give, devise and bequeath her share of my estate to her issue on a per stirpes distribution basis. B. One half (1/2) to my friend Edna M. Martin presently of 2298 Ritner Highway, Shippensburg, Pennsylvania 17257. In the event that the said Edna M. Martin should predecease me, I then give, devise and bequeath her share of my estate to her issue on a per stirpes distribution basis. FIFTH. I direct that all taxes that may be assessed in consequence of my death of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. SIXTH. I nominate, constitute and appoint my friend EDNA M. MARTIN to be the Executrix of this my Last Will and Testament. If Edna M. Martin be unable to fulfill the duties of Executrix I then nominate, constitute and appoint my friend Merry Jean Beres to be the Executrix of this my Last Will and Testament. SEVENTH. I direct that my personal representatives shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, PEARL M. BURNS, have hereunto set my hand and seal to this my Last Will and Testament, written on two (2) pages, the first page signed for identification only, this ~ .day of February, 2003. / COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND We ~::),kv,:b ?o -toCP. tZl~J..~ and the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Pearl Burns, the Testatrix, sign and execute the instrument as her Last Will; that she signed 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 the time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed before me by and witnesses, thisbe7__.~ ~r day of February, 2003. (SEAL) Notarial Seal ~ Victoria N. Perkins, Notary Public ShippensburgMy Boro, Cumberland Count Commission Expires Oct. 15, 2006Y~ Member, Pennsylvania Association of Notaries / This instrument was by the Testatrix, on the date hereof, signed, published and declared by her to be her Last Will and Testament, in our presence, who at her request and in the presence of each other, we believing her to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND I, Pearl Burns, the person whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me by Pearl Burns, the Testatrix, this ~/.~¢' day of February, 2003. Notarial Seal Victoria N. Perkins, Notary Public Shippensburg Boro, Cumberland County My Commission Expires Oct. 15, 2006 Member, Pennsylvania Association of Notaries REGISTER OF WILLS, CU~fBERLAND COUNTY STATUS REPORT UNDER RULE 6.12 Name of Decedent: Pearl M. Burns Date of Death:_ July 16,. 2003 Will No. 21-03-0671 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 administratidn of the estate is complete: Yes x No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes~ No X ~C~ b. The separate Orphans' Cour~=~o ~i .~ . f any) for the personal representative's account is: -. ~ c. Did the personal representative ~tate an account informally to the parties in interest? Yes-ox No d. Copies of receipts, releas~;~ jo~ders and approvals of formal or informal accounts may be filed with the .Cerk of the Orphans' Court and may be attached to AuKust 31, 2004 Date: _ Signature~ Jerry A. Weigle, Esquire ~ Name (Please type or prin{) WE!GLE & ASSOCIATES, P.C. 126 East KinE Street Address Shippensburg, PA 17257 (717) 532-7388 Tel. No. this re~ort ~ i / Capacity: Personal Representative ( H-~.H: rm f/AM3 ) X __Counsel for personal representative BUREAU OF ZNDZVZDUAL TAXES /NHERITANCE TAX DZVTS/OH DEPT. 280601 HARRTSBUR(~, PA 17128-060! JERRY A WEIGLE WEIGLE & ASSOCS 126 E KING ST SHIPPENSBURG COHHONgEALTH OF PENNSYLVANZA DEPARTHENT OF REVENUE NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLONANCE OR DZSALLO#ANCE OF DEDUCTZONS AND ASSESSHENT OF TAX REV-1547 EX AFP PA 17257 DATE 05-17-200~ ESTATE OF BURNS PEARL H DATE OF DEATH 07-16-2005 FILE NUHBER 21 05-0671 COUNTY CUHBERLAND ACN 101 Amount Remitted HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF NILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG TH]:S L]:NE ~ RETA]:N LONER PORT/ON FOR YOUR RECORDS ~ REV-15&7 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAZSENENT, ALLONANCE OR DISALLONANCE OF DEDUCTZONS AND ASSESSHENT OF TAX ESTATE OF BURNS PEARL H FZLE NO. 21 0:5-0671 ACN 101 DATE 05-17-200q TAX RETURN NAS: (X) ACCEPTED AS FZLED ( ) CHANGED RESERVATION CONCERNZNG FUTURE ZNTEREST - SEE REVERSE APPRA/SED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate {Schedule A) (1) 2. Stocks and Bonds (Schadule B) 3. Closely Held Stock/Partnership Znterast (Schedule C) ~. Hortgages/Notes Receivable (Schedule D) E. Cash/Bank Daposits/Nisc. Personal Property (Schedule E) 6. Jointly O~nad Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXENPTZONS: 9. Funeral Expanses/Ad-. Costs/N~sc. Expanses (Schedule H) (9) 10. Debts/Hortgaga Liabilities/Liens (Schedule Z} (10) 11. Total Deductions 12. Nat Value of Tax Return 56/000.00 .00 .00 .00 15:5~556.97 .00 122 ~2:5~.55 26,060.17 2~,, 179 .c~7 (11) (12) 13. 1~. NOTE: Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (13) Net Value of Estate Sub~ect to Tax (14) Zf an assess;ent ~as ~ssued previously, l~nes 14, 15 and/or 16, reflect f~gures that ~nclude the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Amount of Line lq et Spousal rate (15) 16. A~ount of Line 14 taxable at Lineal/Class A rata (16) 17. A.ount of LAne 14 et Sibling rata (17) 18. A.ount of Line 14 taxable et Collateral/Class B rata (18) 19. Prlncipal Tax Due .00 x 00 = · 00 x 0~5 = · 00 x 12 = 261,551.86 x 15 = (19)= RECEIPT ' NUHBER CD003139 CD005737 UXSCOUNT (+J /NTEREST/PEN PA/D (-) 1,8~2.11 .00 ANOUNT PAZD :55,000.00 2,:590.67 TAX CREDTTS: IPAYNFNT DATE L0-16-200:5 )$-30-200~ IF PAID AFTER DATE /NDZCATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. NOTE: To insure proper credit to your account, sub. it the upper portion of thls form .ith your tax payment. :511,791.50 50.239.6~ 261,551.86 .00 261,551.86 18 and 19 ~ill .00 .00 .00 39,232.78 39,232.78 TOTAL TAX CREDZT BALANCE OF TAX DUE ~NTEREST AND PEN. TOTAL DUE :59,2:52.78 .00 .00 .00 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS RE~UZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SZDE OF THZS FORN FOR ZNSTRUCTZONS.) RESERVATION: PURPOSE OF NOTICE: PAYHENT: REFUND (CR): OBJECTIONS: ADHIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 11, 1981 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collatoraI) beneficiaries of tho decedent after tho expiration of any estate for life or for years, the CoeoonNoalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section 2140 of tho Inheritance and Estate Tax Act, Act 23 of ZOO0. (71 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to tho Register of NilZs printed on the reverse side. --Hake chock or money order payable to: REGISTER OF NILLS, AGENT A refund of a tax credit, which was not requested an the Tax Return, may bo requested by completing an "Application for Refund of Pennsylvanio Inheritance and Estate Tax" (REV-1313). Applications are ovailable at the Office of the Register of Nills, any of the 23 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-$62-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3010 (TT only). Any party in interest not satisfied aith tho appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Baparteont of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, --election to have the matter determined at audit of the account of the personal representative, OR --appall to tho Orphans' Court. OR Factual errors discovered an this assessment should be addressed in writing to: PA Dapartaant of Revenue, Bureau of Individual Texas, ATTN: Post Assessment Review Unit, Dept. 180601, Harrisburg, PA 17118-0601 Phone (717) 787-6505. Soo 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 (3) calendar months after tho docodont's death, a five percent (51) discount of tho tax paid is allowed. Tho 151 tax amnesty non-participation penalty is computed on the total of tho tax and interest assessed, end not paid before January 18, 1996, the first day after the end of tho tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appall the tax and interest that has been assessed as indicated on this notice. 1983 1984 1985 1986 1987 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to tho date of payment. Taxes which became delinquent before January 1, 1982 bear interest at tho rate of six (61) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 alii bear interest at a rate which will vary from calendar year to calendar year with that rate announced by tho PA Department of Revenue. The applicable interest rates for 1982 through Z004 ara: Interest Daily Interest Daily Interest Daily Rate Factor Year Rate Factor Year Rate Factor 20X .000548 ~)'"~'"8-1991 111 .OO03Ol 2001 9Z .000247 162 .000438 1992 92 .000247 2002 62 .000164 112 .000301 1993-199q 72 .000192 2003 52 .000137 131 .000356 1995-1998 91 .000247 2004 41 .000110 lOZ .000274 1999 7Z .000191 IOZ .000274 2000 7Z .000192 X NUHBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after tho tox becomes delinquent mill reflect an interest calculation to fifteen (15) days beyond the data of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. ESTATE OF PEARL M. BURNS File No. 21-03-0671 FAMILY SETTLEMENT AGREEMENT BETWEEN: EDNA M. MARTIN and M RES, being the legatees under the Last Will and Testament of Pearl M. Bums, late of the Borough of Shippensburg, Cumberland County, Pennsylvania, AND EDNA M. MARTIN, Executrix of the Estate under the Last Will and Testament of Pearl M. Bums, deceased, .:~ WHEREAS, Pearl M. Bums died July 16, 2003, testate, and under her Will left her estate to the party herein; and WHEREAS, Letters Testamentary were granted to Edna M. Martin on August 29, 2003, by the Register of Wills of Cumberland County, Pennsylvania; and WHEREAS, all assets of the late Pearl M. Bums have been liquidated or distributed and all her debts paid in full, and further the period of four months having been terminated since the first advertisement of the issuance of Letters to the said Executrix, the said party hereto desires to waive the duties of Executrix to file a First and Final Account with Proposed Schedule of Distribution for purposes of confirmation by the Court of Common Pleas of Cumberland County, Orphan's Court Division, AND FURTHER desires that a Family Settlement Agreement be executed, which Family Settlement will be duly recorded among the deed records in and for Cumberland County. WEIGLE /:2 ASSOCI.~ES, RC. -- ATTORNEYS AT LAW -- 126 EAST KING STREET -- SHIPPENSBURG, PA 17257H397 NOW, THEREFORE, WITNESSETH, that the party hereto, in consideration of the premises above stated, and of the Accounting and Proposed Schedule of Distribution attached hereto and made a part hereof, and the receipt of her distributive share as therein shown, does mutually bind herself to the said Distribution and Accounting as set forth and further mutually releases Edna M. Martin, Executrix, from all claims and demands whatsoever arising out of settlement of the Estate of Pearl M. Bums. The party hereto does further agree that should any liability come due to the estate of the said decedent after the signing of this agreement, she does hereby covenant and agree with the aforesaid personal representative that she will contribute pro rata her share of the estate to satisfy any and all claims, demands, suits, or causes of action which may be successfully prosecuted against the said estate or the aforesaid personal representative after the signing, sealing and delivery of this family settlement agreement and final release. IN WITNESS WHEREOF, the parties have hereunto set their hands and seals the day and year first above written. ESS: (f~~ Edna M. Martin, Executrix Estate of Pearl M. Bums ~~. (~,'x,. ~ (SEAL) Marry Je~ gteres '~NEIGLE & ASSOCIATES, RC. .-- ATTORNEYS AT LAW -- 126 EAST KING STREET -- SHIPPENSBURG, PA 17257-1397 COMMONWEALTH OF PENNSYLVANIA · COUNTY OF CUMBERLAND · SS Onthis, the %(,~ day of ~ ,2004, before me, the undersigned officer, personally appeared~EDNA M. MARTIN, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained· IN WITNESS WHEREOF, I hereunto set my hand and official seal~ /ff NOTARIAL SEAL q Jerry A. Weigle, Notary Public Shippensburg, PA Cumberland County My Commission Expires October 7, 2008 COMMONWEALTH OF PENNSYLVANIA · COUNTY OF CUMBERLAND · SS On this, th day of , 2004, before me, the undersigned officer, personally appearktt MERRY JEAN BERES, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal./ A~SEA L ' [ Shippen~bu[? PA Cumberland Count¢ Mb..~_C_o~rnm__iS.~!.~ri Ex.x~ 'es October 7 2008 WEI6LE ('~ AS.'50(:IATES, RC. -- ATTORNEYS AT LAW -- 126 EAST KING STREET -- SHIPPENSBI.)RG, PA 17257-1B97 Court of Common Pleas of Cumberland County, Pennsylvania Orphans' Court Division No. 21-03-0671 Estate of Pearl M. Burns, Deceased Account of Edna M. Martin, Executrix Date of Death: Date of Executor's Appointment: Date of First Advertisement of Letters: Accounting for the Period: 07/1612003 08/2912003 09109/2003 07/16/2003 to 08/31/2004 Purpose of Account: Edna M. Martin, Executrix, offers this account to acquaint interested parties with the transactions that have occurred during this administration. It is important that the account be carefully examined. Requests for additional information or questions or objections can be discussed with: Jerry A. Weigle Esquire Attorney Identification No. 01624 Weigle & Associates, P.C. 126 East King Street Shippensburg, PA 17257 GROSS ESTATE (Principal Receipts + Income Receipts) 190,048.76 suMMARY OF ACCOUNT Estate of Pearl M. Burns For the period of July 16~ 2003 throuRh Au.qust 31~ 2004 Proposed Distributions to Beneficiaries Pa.qe 10 PRINCIPAL Receipts: This Account Net Gain (or Loss) on Sales or Other Dispositions 1 3 Less Disbursements: Debts of Decedent Funeral Expenses Administration Expenses Federal and State Taxes Commissions Fees Family Exemption Balance Before Distributions Transfer from (to) Income Distributions to Beneficiaries Principal Balance on Hand For Information: Investments Made Changes in Investment Holdings 4 5 5 5 5 INCOME Receipts: This Account Net Gain (or Loss) on Sales or Other Dispositions 8 Less Disbursements Balance Before Distributions Transfer from (to) Principal Diistributions to Beneficiaries Income Balance on Hand For Information: Investments Made Changes in Investment Holdings COMBINED BALANCE ON HAND Current Value 101,692.53 24,179.47 0.00 602.67 37,390.67 12,353.75 13,103.75 0.00 Fiduciary Acquisition Value 101,692.53 189,563.16 274.08 189,837.24 87,630.31 102,206.93 1,000.00 101,206.93 485.60 0.00 485.60 0.00 485.60 0.00 485.60 101,692.53 07/1612003 07116~2003 07117~2003 0711612003 0'711712003 0711612003 07117/2003 0'7116~2003 07117~2003 07116~2003 0711612003 0711612003 0711612003 02120/2004 09125/2003 SCHEDULE A RECEIPTS OF PRINCIPAL Cash Cash - on hand at date of death Citizens Bank Certificate of Deposit #6140737176 Accrued income on above item through date of death Citizens Bank Certificate of Deposit #6140768292 Accrued income on above item through date of death Citizens Bank Checking Account #6100625346 Accrued income on above item through date of death Citizens Bank Savings Account #6140233615 Accrued income on above item through date of death Gross - receipts of personal property at Public Sale on 1110104 MetLife - total control acct. #403-1313905 Prudential Financial Acct. #KZC-595182-01 Real Estate in PA 330 East Orange Street - Borough of Shippensburg, Cumberland County, Pennsylvania - gross proceeds of sale 2120/04 Subsequent Principal Receipts County Tax Proration - real estate settlement Fogelsanger-Bricker Funeral Home - refund 342.00 49,819.55 2.70 26,613.48 1.44 1,667.90 0.00 1,263.85 0.14 12,865.00 24,896.68 15,323.35 56,000.00 220.40 336.18 Fiduciary Acquisition Value 132,796.09 56,000.00 0311112004 04115~2004 02~20~2004 10115~2003 SCHEDULE A RECEIPTS OF PRINCIPAL Continued Orthopaedic Associates - refund Orthopaedic Associates - refund School Tax Proration - real estate se~lement Sprint - refund 18.22 6.19 t77.82 8.26 Total Receipts of Principal Fiduciary Acquisition Value 767.07 189,563.16 SCHEDULE B GAINS AND LOSSES ON SALES OR OTHER DISPOSITIONS - PRINCIPAL 11104/2003 MetLife - total control acct. ~403-1313905 Gain Loss 1110412003 Net Proceeds 25,074.95 Fiduciary Acquisition Value -24,896.68 Prudential Financial Acct. #KZC-595182-01 Net Proceeds Fiduciary Acquisition Value 15,419.16 -15,323.35 178.27 95.81 TOTAL GAINS AND LOSSES/PRINCIPAL LESS LOSS NET GAIN OR LOSS 274.08 274.08 SCHEDULE C DISBURSEMENTS OF PRINCIPAL Debts of Decedent 07/1612003 o9~23~2oo3 09~29~2003 09~29~2003 09~29~2003 09~29~2003 09~29~2003 10~07~2003 10~07~2003 10/07/2003 10/0712003 10/0712003 10/15/2003 1.011612003 10/1612003 11/1012003 1111712003 11/2512003 1210312003 12/1812003 1212312003 1212912003 01/0512004 0110612004 0,1 I13~2004 01 I15~2004 ()211812004 02119/2004 0212012004 03/0112004 Citizens Bank Checking Account #6100625346 - checks clearing after date of death Borough of Chambersburg - ambulance bill Chambersburg Imaging Associates Greencastle Family Practice Lisa L. Helm, Tax Collector - 2003-2004 School R. E. Taxes Orthopaedic Associates Penelec Chambersburg Hospital Diamond Pharmacy Services Falling Spring Nursing & Rehabilitation Center Horn & Company - real estate appraisal Waynesboro Hospital Penelec Borough of Shippensburg - water, sewer Timmons, Inc. Mobile X USA Penelec Comcast Cable Diamond Pharmacy Services Penelec Timmons, Inc. Carl L. Cramer Insurance - fire insurance premium Borough of Shippensburg - water, sewer Timmons, Inc. Expenses of Public Sale held on 1110/04 Penelec Penelec Timmons, Inc. Real Estate settlement expenses Penelec 212.30 65.93 2.12 72.12 491.72 2.12 19.11 120.03 1,190.81 9,036.73 350.00 29.96 18.56 86.53 25.68 18.15 20.38 45.82 1,061.17 23.00 75.69 605.00 122.53 72.96 9,027.05 28.36 28.87 255.32 1,066.27 5.18 24,179.47 SCHEDULE C DISBURSEMENTS OF PRINCIPAL Continued Miscellaneous Administration Expenses 08~29~2003 0910312003 0912912003 1012112003 03124/2004 08131/2004 08/3112004 08131/2004 Register of Wills, Cumberland County - letters testamentary and short certificates Cumberland Law Journal - Advertising cost Postmaster - certified mail to Dept. of Public Welfare News-Chronicle - advertising cost Register of Wills, Cumberland County - filing PA Inheritance Tax Return Register of Wills, Cumberland County - filing Family Settlement Agreement Weigle & Associates - P.C. - reimbursement for long distance telephone calls, copies & postage Weigle & Associates, P.C. - Notary fee 316.00 75.00 4.42 84.50 15.00 75.00 23.75 9.00 602.67 Taxes 1011612003 0312412004 Register of Wills, Cumberland County - PA Inheritance Tax at discount Register of Wills, Cumberland County - PA Inheritance Tax 35,000.00 2,390.67 37,390.67 Commissions 0312412004 Edna M. Martin, Executrix TOTAL COMMISSIONS 12,353.75 12,353'.75 Fees 0312412004 Weigle & Associates, P.C. TOTAL FEES TOTAL DISBURSEMENTS OF PRINCIPAL 13,103.75 13,103.75 87,630.31 SCHEDULE D DISTRIBUTIONS OF PRINCIPAL Betty Wells 05/2712004 Specific Bequest 500.00 500.00 Joan Burns Coy 04~20~2004 Specific Bequest 500.00 500.00 TOTAL DISTRIBUTIONS TO BENEFICIARIES 1,000.00 # Units PRINCIPAL BALANCE ON HAND Description Cash Orrstown Bank Estate Checking Account #103-004500 Total Cash Current Value or as Noted Fiduciary Acquisition Value 101,206.93 101,206.93 101,206.93 101,206.93 101,206.93 101,206.93 7 SCHEDULE G RECEIPTS OF INCOME CitiTens Bank Certificate of Deposit #6140737176 1011612003 Interest/Bank citizens Bank Certificate of Deposit #6140768292 09/2512003 Citizens Bank Savings Account #6140233615 09/2512003 Orrstown Bank Estate Checking Acct. #103-004500 10/1512003 1.1/15/2003 1211512003 01/15/2004 02/16/2004 03/15/2004 04/15/2004 05/16/2004 06/15/2004 07/15/2004 08/15/2004 TOTAL RECEIPTS OF INCOME 243.64 101.18 0.60 2.87 8.52 14.50 14.69 14.72 17.81 16.07 13.01 12.54 12.52 12.93 243.64 101.18 0.60 140.18 485.60 8 # Units INCOME BALANCE ON HAND Description Cash Orrstown Bank Estate Checking Account #103-004500 Total Cash Current Value or as Noted Fiduciary Acquisition Value 485.60 485.60 485.60 485.60 485.60 485.60 TO: Edna M. Martin PROPOSED DISTRIBUTIONS TO BENEFICIARIES Current Value or as noted TO: One-half residuary estate Merry Jean Beres One-half residuary estate Total Fiduciary Acquisition Value 50,846.27 50,846.27 50,846.26 50,846.26 01,692.53 l0 Court of Common Pleas of Cumberland County, Pennsylvania Orphans' Court Division No. 21-03-0671 Estate of Pearl M. Burns, Deceased Affidavit Edna M. Martin, Executrix, under the Last Will and Testament of Estate of Pearl M. Burns, Deceased, hereby declares under oath that he/she has fully and faithfully discharged the duties of his/her office; that the foregoing Account is true and correct and fully discloses all significant transactions occurring during the accounting period; that all known claims against the estate have been paid in full; that, to his/her knowledge, there are no claims now outstanding against the Estate; that all taxes presently due from the estate have been paid; and that more than four months have elapsed since the first complete advertisement of the granting of letters in this estate. Subscribed and sworn to before me this ~'~/ day o, O J der~ A. Weig~e, J Shippensburg, PA OLimberl~,ld ~unty J My ~mmi~ion ~F~e~ gc~o~r 7, ~0~