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Home My WebLink About04-0491 Social Security No. M. Lucille Dodez PETITION FOR PROBATE and GRANT OF LETTERS Estate of also known as The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older and t:h! e'~!l!f (":'r i~ in the last will of the above decedent, dated March 27, 1~95 and codicil(s) dated N/A 288-18-3199 ;. No 21-04 - -</9/ To: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania named ~-' -' (~t j: .__ Decedent was domiciled at death in Cumberland with her last family or principal residence at 1520 Shirley A venue, Borough of Carlisle (state relevenat circumstances, e.g. renunciation, death 0 executor, etc.) County, Pennsylvania, (list street, number and municipality) Decedent, then 81 years of age, died May 14,2004 at Country Meadows, 4837 E. Trindle Road, Mechanicsburg Except as ollows, decedent did not marry, was not divorced and did not have a child born or a opted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: No Exceptions Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value ofreal estate in Pennsylvania situated as follows: $ unestimated $ $ $ Total: unestimated 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.) thereon. D~O~ Daniel Derr 2293 Foxianna Road Middletown P A 17057 UATH UF P.ERSUNAL ~PRS.ENTATl V.E COMMONWEA TLH OF PENNSYLVANIA COUNTY OF CUMBERLAND The petitioner(s) above-named swear(s) or affirm(s) that the statement in the foregoing peition 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 well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this e::2~ day ofrJ'/,') May, 2004 ( ~_d., ;~(,~/~',/.6~///t-< n~/~. Register Estate of No. 21-04 .. ~?I M. Lucille Dodez , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW 20 CJ 7' ' in consideration of the petition on the reverse side hereof, atisfactory proof having been presented b~fore me, IT IS DECREED that the instrument(s) dated_ March 27, 1995 described therein be admitted to probate and filed of record as the last will of M. Lucille Dodez and Letters Testamentary are hereby granted to Daniel Derr FEES Probate, Letters, Etc. $ $ 7$' CJO Short Certificates( 1) $ 0D, OLJ ~~~;,fation $ ~<'500 . y./ $ /(J.OC) Total_ $ .y!/~L)D Filedl?)o/ a.~,... ~o.Q.r- ~.~~d~0f&#/-//~L!,~ Reg~~L//~/ Stephen D. THey #32318 ATTOP.NEY (Sup. Ct. J.D. No.) 5 South Hanover Street Carlisle, Pennsylvania 17013 ADDRESS (717) 243-5838 PHONE CJY-7'9/ LAST WILL AND TESTAMENT OF M. LUCILLE DODEZ "()/i i':iiY 26 ' Ll I' I, M. LUCILLE DODEZ, of the Borough of Carlisle (1520 Shirley Avenue), Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare thif'asand for my Last Will and Testament, hereby revoking and making void any and all Wills and Codicils heretofore made. FIRST I direct the payment of my just debts and funeral expenses as soon after my death as may be convenient. SECOND I declare that I am now a widow, having been married to George W. Dodez. We have no children, or deceased children. THIRD All the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath to the Watch Tower Bible Tract Society of Pennsylvania, 124 Columbia Heights, Brooklyn One, New York. FOURTH I hereby nominate, constitute and appoint Daniel Derr, of 2293 Foxianna Road, Middletown, Pennsylvania, as Executor of this my Last Will and Testament. In the event of the renunciation, death, resignation or inability to act for any reason whatsoever of the said Daniel Derr, I nominate, constitute and appoint Gary L. Keiter, of 50 South Geyer Church Road, Middletown, Pennsylvania, as Executor of this my Last Will and Testament. I further direct that no bond or other security shall be required of any Executor or Executrix appointed in this Will for the performance of his, her or its duties in any jurisdiction in which he, she or it may be called upon to act. FIFTH In addition to, and not in limitation of, the powers conferred by law or by other provisions of this Will, my Executor shall have the following powers, each of which may be exercised from time to time by my Executor in his sole discretion: (a) To retain in the form received, and to sell either at public or private sale, or to distribute in kind, any real or personal property. (b) To manage both real and personal property. (c) To invest and reinvest in all forms of property, notwithstanding the fact that any or all of the investments made are of a character or size which but for this expressed authority would not be considered proper for an Executor. (d) To exercise any option or rights arising from the ownership of investments. /.....'\ ~..... .....__~____~__ _1_~_~~_ ___~.L1_ ') '\ - ~ ~~ '-\ - ~ \-\ ~\ \ SECOND AND FINAL ACCOUNT OF DANIEL DERR, EXECUTOR OF THE LAST WILL AND TESTAMENT OF M. LUCILLE DODEZ, LATE OF 1520 SHIRLEY A VENUE, CARLISLE, CUMBERLAND COUNTY, PENNSYLVANIA, DECEASED FOR THE PERIOD JULY 1, 2005 TO OCTOBER 21, 2005 DATE OF DEATH: LETTERS TESTAMENTARY ADVERTISED: 14-May-04 CUMBERLAND LAW JOURNAL June 11, 18, 25, 2004 THE SENTINEL June 8, 15, 25, 2004 SECOND AND FINAL ACCOUNT PRINCIPAL RECEIVED - PERSONAL PROPERTY Accountant charges himself with the following principal amounts received: 6-Jul-05 Refund from IRS - 2004 Personal Income Tax 1,301.00 25-Jul-05 Remaining proceeds - Estate of Mildred 1. Gravereau (All allocated to principal although some income to Gravereau estate is included.) 7,940.15 PRINCIPAL RECEIVED - REAL ESTATE Accountant charges himself with the following principal amounts received: Il-Jul-05 Refund, Escrow from Sale of Personal Residence (1520 Shirley A venue, Carlisle, Pennsylvania 17013) Escrow for Radon remideation - no funds needed - total refund 550.00 INCOME RECEIVED - PERSONAL PROPERTY Accountant charges himself with the following income amounts received: 26-Jul-05 Interst on Estate Checking Account (M&T Bank #9833001077) 13.26 ~'7.16 26-Aug-05 Interst on Estate Checking Account (M&T Bank #9833001077) 26-Sep-05 Interst on Estate Checking Account (M&T Bank #9833001077) ~ '~l . /' " . I",.I'~ ' '1 ! ,7.J9 j{., Second & Final Account and Proposed Schedule of Distribution - Estate of M, Lucille Dodez ,.,j Page I (It 21-0ct-05 21-0ct -05 Interst on Estate Checking Account (M&T Bank #9833001077) Accounting Adjustment - Excess Funds in Estate Checking Acct. GROSS RECEIPTS SECOND AND FINAL ACCOUNT: DISBURSEMENTS Accoutant claims credit for the following amounts paid: 6-Jul-05 Filing Fee for First and Partial Account - To Register of Wills 30-Sep-05 Filing Fee for Second and Final Account - To Register of Wills TOTAL DISBURSEMENTS SECOND AND FINAL ACCOUNT: BALANCE A V AILABLE FOR DISTRIBUTION GROSS RECEIPTS LESS DISBURSEMENTS: Second & Final Account and Proposed Schedule of Distribution - Estate of M. Lucille Dodez 5.57 354.83 10,179.16 430.00 50.00 480.00 9,699.16 Page 2 PROPOSED SCHEDULE OF DISTRIBUTION Balance Available for Distribution Pursuant to Second and Final Account: 9,699.16 Sole Beneficiary: The Watch Tower Bible and Tract Society of Pennsylvania 100 Watchtower Drive Patterson, NY 12563-9204 100% of the Residuary Pursuant to Paragraph Third of Will: 9,699.16 9,699.16 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERALND SS.: Before me, the undersigned officer, personally appeared Daniel Derr Executor of the Last Will and Testament of M. Lucille Dodez Deceased, who, being duly sworn according to law, desposes and says that the foregoing Second and Final Account and Proposed Schedule of Distribution are true and correct to the best of his knowledge, information and belief. t~~C ~ Sworn to and subscribed before me thi~/~:YOf 061ohv, <:1005. ~. ~1~ A /~ NOTARIAL SEAl TRISHAA. UESS. NOTARY PUBLIC BOROUGH OF CARUSLE. CUMBERLAND co.. PA MY COMMISSION EXPIRES MAY 20, 2006 Second & Final Account and Proposed Schedule of Distribution - Estate of M. Lucille Dodez Page 3 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ) ) SS: ) We, M. Lucille Dodez, Stephen D. Tiley, and Theresa L. Bentzel, the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of their knowledge the Testatrix was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. 'rI) _/~L<dL: oJ rC~' M. Luc' e Dodez A;d- >>, 7~ ~7ru;y /~ .:L Theresa L. Bentzel Subscribed, sworn to and acknowledged before me by the Testatrix and the witnesses above-named, this 27th day of March , 1995. NOTARIAL SEAL KRISTA KING, NOTARY PUBLIC CARLISLE, CUMBERLAND COUNTY PA MY COMMISSION EXPIRES JUNE 27,1998 ~ K{n1 Notary blic . HII)':;,lo:ll.<; R.I~\, O/',U, This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing, WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2,00 '''';~ 0 I:; .-; ,r, rf~''j ~) ,1 oJ ~j ,) ~,l \) No, I)'" I: H10S. :43 Ae.... 2/87 26 14 ~ - 19 ~(j Y Date COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECOROS CERTIFICATE OF DEATH STATE File ~UMBER SOCIAL SECI)Rtl"Y NUMOEA DATE OF DEATH ,Mcnl1l. 0.11." 'lear) TYPE/PRINT IN PERMANENT BLACK INK NAME OF DECEOEN"f (F,rst_ Middle, La:.;) SEX t. AOE (l.a~ B.r11ld3y) UNDEft~~~ Mon'h. 1 D.yo MARY LUCILLE DODEZ 2'FE~~LE ,. 288 -- 18 3199 UN(\E~ 1 DAV:I' OATE""OFBU:UH BliHHPLACE rC.ly ..r.d PlACE OF DEATH ,:Ct,,;clo only I)f~.. -;.eo ,1l~11l>CloOl'':l on OIt>e, Sldtlol Hows : Minul-. ',Monlr'l. Day, (681'1 Stale Of FCflil<ljn COU/l!IV) HOSPITAL: r-' i .. 11'/27/22 7. ORVo~r~' ~~'","' D ERlO....'.... U OOA D CITY, BOAO, TWP OF DEATH FACilITY NAME (II not lf1Sl'fulton, give Slf('el and IlUmoorl s. 81 v". COUNTf OF DEATH .. MAY 14,2004 u, WIDOWED "'P. g'~,ty)O [WAS DECEDENT O. F HISPANIC ORIGIN? NOU v.. 0 It yeti. specify C~n, MelllCan, Pumto RICan. &Ce. .. MARITAL STATUS - Mafl1ed Nevvr Married. Widowed. Divorced (SpeocItyJ RACE - Amoflcan Indian, Black, Whit., elL" iSP<<""') CUNBERI~AND DECEDENT'S USUAL OCCUPATION (GiVli:ll-.rud 01 work done dUring n>061 of worklnt;J Ne; do nol: l,t>e rellred) ft.. HOMEMAKER, ft.. DOMESTIC DECEDENT'S MAILING ADDRESS (Slreel. CllylTown. Slatv.l,pCOdel DECEDENT'S 1520 SHIRLEY AVE. ~~;~;iNCE CARLISLE,PA 17013 ~~;:'~.~ WHITE SURVlVING SPOUSE (II Mle. gIve maiden namal ..., MECHANICSBURG KINO OF BUSINESSJINOUSTR'f Oc, 11. f'ATHER'S NAME (FilS!, MllJale, last) ALLEN BRENNEMAN 17b. County CUMBERLAND 0", ""'ode.. liv.tn" lownship? 10. N/A 11c,O 'fes.decedentlivedin , 1d;KJ :h.~ACt-:7'iIl':: 01 MECHANICSBURG citylboro MOTHER'S NAME (First Mldale. Malden !"><Jrnama) o w U) " ~ :; 0( II. INFQAt.lANT'S NAME (T \lJ)EIIPrinl) '00, DANIEL DERR METHOD OF DISPOSITION Burial (AI Cremation 0 Oth8f (Specdyl RftmO\lallrom Sial' 0 10, INFORMANT'S MAILING ADDAESStSlreo:tl. CilylTown, Slale, lip Coese) .~. 2293 FOXIANNA RD.,MIDDLETOWN,PA 17057 PLACE OF DISPOSITION. Namtl of Cem.lory. CremalOfy lOCATION _ CilyfTown. Stille. Zip coo. or Dlher Place >>.. TIME OF DEATH 14. A.... 25. 27. PAAT I; Enter the diwases. Inlurias or comphcallons which caused the dearn 00 not "nlBr tne modo of dying, such as cardiac 0' respiratory arresl, snock or hea/11adu,e Lisl only ON caus.e on each HOO N 1<l A o A 1<l H H H U :::> H >< po: ~ C~r.l/vc /1YTC,) r DUe'TOlQA ASACONSEOUENCE Of)' I: WEAE AUTOPSY FINDINGS ~ANNEA OF DEATH AVAIUSlE P'~IOA TO g~t~~~ON OF CAUSE Nalural [~ Accident 0 Yos 0 No fX SUIo;:Ide 0 18b 19 '-... . (HiT/FICA :cr'lf(':k om., ',~)t!l .CERlIFYING PHVS,CIAN (p~yslCl;;n('...!;I'I'n'J ',Iv ,~oj dt';jth wne!' J;'klI11er phys,c,an t1a~ plOflOunced ,1ealr'l .1110 ccm~~etecl Hem 23) 'To the bllllt or m,. knowledge, d..lh OCCUffeo d,j~ 10 Ih. c.u..,,(s) and manner..e ".I.ed. p.' , . . . , . .. , , . .. . .. OUE 10 (OR AS A CONSEOUENCE Of-): CUE TO (OR AS A CONSEOUENCl; Of) DATE Of INJUnV (MQf1trl. nay. Yea,) BLANCHE LUCILLE CUTTER 21d. MIDDLETOWN,PA 17057 MI3BeETOW~:P~17057 NAME ANOAOOAess OF FACILlTf MATINCHEK & DAUGHTER F.H. LICENSE NUMBt:A . c?G't1Y 20. I Approximate :lntel'\lal~ I O~I and deafh I i .- NoD PA.RTII: Or:her signIficant co~ns conlribuling 10 dealh, bU1 nOI resunillg In [he underlYIf1gcause gtven in PART I, WAf OF INJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED. Ptlnclmglr,vestigaUon D D o ~~CE OF INJURY. Al hame, lar:.~;eel, lactory, ottice building. etc. ISpoc,lv) 'Go. ~ Hom'cide Could not be del.nllitltld .... ~ fa I;j o ~ ~ 0( z .PRONOUNCING AND CERTIfYING PHYSICIAN jPtl~s;uan holtl ;J'::>l'IQUflClng ,Jedl1'14nd .::t"-'ll\l'nq 10 cause 01 dealt'} To Iha beet. 0' my knowlad']lt. de'lh occunttd.t Ihe time, date, 'nd pl,ce,.nd due to lhe c.lu!le(.I) and manner... st.fed "MEDICAL [XAMIr-IFn/COnOtlFn On Ihe baal. otc.""',';fllIon an, manner as ~t..t.d 31. REGlSHMl-n:; ::.1' invt:-.>li)aUOn, in mV opinion, death occurred at Ihe Ume. dale. and place, and due to the cause(.) and )['iE;\t; ..~'ic~f-~CJ1LLhti" ~I " v.. D No [] M. 30e, o J1b. LICENSE NUMBER ATE SIGNED (Monm, Day, Year! - 31c. /'YV) (/,)2!LtJ i- 31.. /'Y1'-:L;r 1,1'..7 C(/V NAME AN~6F PERSON WttO cm.4PlETED CAUSE OF qtATH /;';::::-/--A ~ (Item 27) TypeorPnnl ....-.-J-- &-"'-'h' // S/dvc'r ,/-Y.y>/lt:/ rr}77 ~. ,c~ ". ' :/ t/)'.,0 /Z. ,/ J 71'// .3 o 32. DATE FILED ~M0f\1f1 Oi-lY. 'f"ojlir) J"-____---.:l- \ '? - o'-L Cumberland County - Register Of wills Hanover and High Street Carlisle, PA 17013 Phone: (717)240-6345 Date: 09/01/2004 TILEY STEPHEN D 5 S HANOVER STREET CARLISLE, PA 17013 RE: Estate of DODEZ M LUCILLE File Number: 2004-00491 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 09/05/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~~~~rt cc: File Personal Representative(s) Judge Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717)240-6345 Date: 09/01/2004 DERR DANIEL 2293 FOXIANNA ROAD MIDDLETOWN, PA 17057 RE: Estate of DODEZ M LUCILLE File Number: 2004-00491 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 09/05/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~~ Clerk of the Orphans' Court cc: File Counsel Judge ----- 217 REV -1500 OFFICIAL USE ONLY REV-1500 EX (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN 21,04,0491 DEPT. 280601 FILE NUMBER HARRISBURG, PA 17128,0601 RESIDENT DECEDENT , COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER .... M. Lucille Dodez 2B8,18-3199 z DATE OF DEATH (MM-DO-YEAR) IDATE OF BIRTH (MM,DD-YEAR) w THIS RETURN MUST BE FILED IN DUPLICATE WITH THE C W 5/14/2004 11/27/1922 REGISTER OF WILLS " w (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER C ~ 0, QriginalReturn o 2. Supplemental Return 03 Remainder Return (date ordealh priorlO 12-1J-B2) :.::~~ 04 Limited Estate D 43. Future Interest Compromise {date of death after 12-12-82} 05 Federal Estate Tax Return Required ~&g ~"~ 06 D 7. Decedent Maintained a living Trust (Attach copy of Trust) u~m Decedent Died Testate (Attach copy 01 Will) 8. Tolal Number of Safe Deposit Boxes ~ - < 09 D10.SpousaIPuvertycred~(dateordeillhbetweeIl12-31.91and1-1-95l 011. Election to tax under Sec. 911 J(A} (Attach 5ch 0) Litigation Proceeds Received .... THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: z NAME w COMPLETE MAILING ADDRESS c z Stenhen D. Tilev 5 South Hanover Street 0 ll- FIRM NAME (If Applicable) Carlisle, Pennsylvania 17013 '" w Frev and Tilev 0: 0: 0 TELEPHONE NUMBER " ''717\243,5838 OFFICIAL USE ONLY 1. Real Estate (Schedule A) (1) 170,900 2. Stocks and Bonds (Schedule B) (2) NONE 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) NONE 4 Mortgages & Notes Receivable (Schedule 0) (4) NONE 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 523,512 6. Jointly Owned Property (Schedule F) (6) NONE z Dseparate Billing Requested 0 ;: < 7 Inter-Vivos Transfer & Miscellaneous Non.probate Property ..J .: :.' :J (Schedule G or L) (7) 37,313 .... ii: < B. TOTAl GROSS ASSETS (total Lines 1-7) (B) 731,725 " w 0: 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 54,562 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) :10) 24,996 11. TOTAL DEDUCTIONS (total Lines 9 & 10) (11) 79,558 12 NET VALUE OF ESTATE (Line 8 minus Line 11) (12) 652,167 13 Charitable and Governmental BequestsJSec 9113 Trusts for which an election to tax has not been made (Schedule J) i1 3) 652,167 o 14 Net Value Subject to Tax (Line 12 minus Line 13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax Z rate ,or transfers under Sec.9116 (a)(1.2) x .0 (15) 0 ;: 16. < Amount of Line 14 taxable at lineal rate X .0 (16) .... :J ll- :!! 17. Amount of Line 14 taxable at sibling rate .12 0 X (17) " X ~ 18. Amount of Line 14 taxable at collateral rate X .15 (18) o o o o 19 Tax Due (19) 20.0rgR@fSf!~~~ii~V6\J'i_~ifrfE_~~G'jAjf~Rgm1{;'~<<e~(1 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SID'E AND RECHECK MATH < < o ----- 217 M. lucille Dodez 288,18-3199 Decedent's Comple e ress: STREET ADDRESS 4837 E. Trindle Road CITY I:TATE I~IP Mechanicsburn PA 17055 I t Add Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) o Total Credits (A + B + C) (2) o 3. lnteresVPenalty if applicable D.lnteresl E. Penalty TotallnterestJPenalty ( D + E ) (3) 4. If line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5) A Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payabre to: REGISTER OF WILLS, AGENT o o o o PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 2. Did decedent make a transfer and" 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? If death occurred after December 12, 1982,did decedent transfer property within one year of death without receiving adequate consideration? Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? Did decedent own an Individual Retirement Account, annuity or other non-probate property which contains a beneficiary designation? Yes o o o o o o 3. 4. o IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, o Under penalties of perjury, I declare that I have examined this relum, including accompanying schedules and statemenls, and to the best of my knowledge and belief. il is true, and complete. Declaration of preparer other lhan the personal representative is based on ail information of which ore parer has any knowledQe. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN 7lr:.-..PI G LA- - ADDRfss ~~ - ~ DATE 7h?/ Daniel Derr SIGNATUR Executor 2293 Foxianna Road Middletown PRE AR ~R PrER THAN REPRESENTATIVE ,.-v, v-1'1 Penns Ivania 17057 ADDRESS Stephen D. Tiley, Esquire, 5 South Hanover Street, Carlisle, Pennsylvania 17013 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. Section 9116 (a)(1.1){i)]. For dates of death on or after January 1, 1995, the lax rale imposed on lhe nel value of transfers 10 or for the use of the surviving spouse is 0% [72 P.S. Section 9116 (03)(1 .1)(ii)] The statute does not exempt a transfer to a surviving spouse from tax. and the slatutory requirements for disclosure of assets and filing a tax relum are stili applicable even il 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 lhe use of a natural parenl, an adoptive parent, ora stepparenl of lhe child is 0%[72 P.S. Section 9116{a)(1.2)]. No BJ o o o o o c, , ;;z..,a:~~- t5. ..v.1' The lax 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. Section 9116{1.2) [72 P.S. Section 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. Section 9116(a}(1.3}] .A sibling is defined, under Section 9102, as an indiVidual who has alleast one parenl in common with the decedent, whether by blood or adoption. ---- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE 217 REV-1502 EX+ (6-98) ESTATE OF FILE NUMBER M. Lucille Dodez 21-04,0491 All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seUer, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jolntly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Personal Residence, 1520 Shirley Avenue, Hampden Township, Carlisle PA VALUE AT DATE OF DEATH 146,000 2. Vacant lot next to Personal Residence, 1518 Shirley Avenue, Hampden Township 24,900 TOTAL (Also enter on line 1, Recaoitulationl (If more space is needed, insert additional sheets of the same size) $ 170 900 ---- B. T;e of loan OMS No. 2502.0265 REV. HUD-1 /3/86) 1. DFHA 2. OFmHA 3. Deaov. Unlns. I 6. File Number - r 7. loan Number \ 8. Mortgage Insurance Case Number 4. nVA 5. nCoov. Ins. ST2005-03GFD 647714891 C. Nole: Ile~. m'::rked.(p.lJ.c,rw~re paid ClUlside lhe closing; thly .r. shown h~,. 10': lnrO(~~\lo~ purpo....a~d ~,. n~l ::.c~ded.ln 111:10181. \ Tll\eExpress Sell\emenl System WARNING: Il i. a alma 10 knowingly make lei,. stalemenl.lo lhe Unlled Slain On Ihi. 01 any olher .'mia~ 101m. Penalll.. upon Prin!ed01l0612005 a109:17KLl conviclloncanlr1c1udealin.andim ro.onmentFcrd.le;lsne:T11le1BU.S Code Sec:tIoo tOOl and SecllDll tOlD. D. NAME OF BORROWER: David J. Kennaly and Lynn L. Kennaly ADDRESS: E. NAME OF SELLER: Estate of Lucille Dodez ADDRESS: F. NAME OF LENDER: ABN AMRO Mortgage Group, Inc. ADDRESS: P.O. Box 57068 Irvine CA 92619.7068 G. PROPERTY ADDRESS: 1520 Shirley Avenue, Carlisle, PA 17013 Carlisle Borouah H. SETTLEMENT AGENT: Saidis, Shuff, Flower & LIndsay, Telephone: 717.243.6222 Fax: 717.243.6486 PlACE OF SETTLEMENT: 26 West Hlah Street Carlisle PA 17013 I. SETTLEMENT DATE: 0110612005 J, SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY~OF SELLER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400, GROSS AMOUNT DUE TO SELLER 101. Conlractsalesorice 146000.00 401. Contractsalesnrice 146000.00 102. PersonalProDertv 402, PersonalPronertv 103. SeHlement charnes \0 borrower 11Ine 1400 7834.79 403. 104. 404- 105. 405. Ad'uslmenls ror Ilems "aid bv seller In advance Aduslments for items paid by seller in advance 108. School Taxes 011061051006/30105 1033.79 408. School Taxes 01106/051006/30/05 1033.79 109. 409. 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 154866,58 420. GROSS AMOUNT DUE TO SELLER 147033.79 200, AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 20t Oenosilorearneslmonev 3000.00 501. Excess Demsit/seeinstructions\ 202. Princioal amount of new loans 46000.00 502. Selllementchamestoseller line 1400) 11766,16 203. Existinoloanlsllakensublecllo 503. Existinnloanls1takensubiecllo 204. 504. PavoHofFirslMortoaoeLoan 205. 505. 206. 506. 207. 507, 208. 508. 209. 509. Adlustments for items unDald bv seller Adjustments for Items unDaid bv seller 211. Count" laxes 011011051001106105 12.60 511. Counlulaxes 011011051001106/05 12.60 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 49012.60 520. TOTAL REDUCTION AMOUNT DUE SELLER 11778.78 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENTTO OR FROM SELLER 301. Gross amounl due from borrower IIIne 120\ 154668.58 6()1. Gross amounl due 10 seller Iine420\ 147033.79 302. Less amounts paid bv/lor borrower Ilne 220 49012,60 602. Lessreducllonamounlduesellerlline520l 11776.78 303. CASH FROM BORROWER 105855.88 603. CASH TO SELLER ----" 1352S5.01 FINAL A. S~tLt:ment Statement U.S. Department or Housing and Urban Developmenl SUBSTITUTE FORM 1099 SEllER STATEMENT: Thslnronmlllan c:onlalned l1Maln II lmpal'lanl I"" Inlarmellen and Is being fwnished to lhe lnlernal R1IV8I108 Service. II you era ,aquired 10 m8 e ralum. ~n~.f~.at:V~~~~I:::I:~I~'~~~~e':d;ntr~~dl~~~,i~IS hem Is requi,.d lobe rapo<1ed and Iha IRS dal.rmlnas1halII hilS nal baan '8parlad, Thi Canlract Saln Prlca dnt'lbed an ;';:;~~~.lr~~~~,~~~9aN:~~ ~I~~~ :~~ar Fo~~~2'5f~~~I~'::~bf\';:r~~11~' 5ala 01 Exth....g. al Prin<:lpal Rasidents, r...-.-,y gain. wllh yoUl lntom.,a, rallJrn: la, athal Iransacllon', Yau a,a r811ulnod by law IDpravida lhesamamanla9llr1llFed. TaxlD No; )Wilhy"..-.co"ar::llaxpaytlrldanllrlc8ll:lnnumb".WyOudllnotprovklsyaur<:orr.clla'paytl,idanlili<allen numb.... you msybs subJ8etla dYlI or crlmlnSI p8nam.S Imposed by la.... uno.r panalllas al parjuy. I esnrry Ihallha "umbar .hewnon Ihls ![alam8n1ls my <orraella'pay", 1d8nHr.r:.a"on "'rmb", TIN' SEllER(S)SIGNATURE(S): SEllER(S)NEWMAll1NGADORES5: --- _.~. ~...., ,"" "''--I'' VI. "VUvll~\;l f\l~U UKtlAN UtVtLOPMENT F1\e Number: ST2005-03 FINAL PAGE 2 SETTLEMENT STATEMENT REV. HUD-113/861 TilleE:mress Settlement Svslem Printed 01106/2005 at 09:17 KLL L. SETTLEMENT CHARGES PAID FROM PAID FROM 700. TOTAL SALES/BROKER'S COMMISSION based on "rice $146 000.00 i1i! 6.000 = B 760.00 BORROWER'S SELLER'S Division 01 commission /line 700 as follows: FUNDS AT FUNDS AT 701, I 4355.00 10 Re/Max Sterlinn SETTLEMENT SETTLEMENT 702. I 4405.00 10 Ebener & Associates 703. Commission naid at SelHemenl 8760,00 BOO. ITEMS PAYABLE IN CONNECTION WITH LOAN 80\. LoanOri inalionFee %AHMCC #2095 460.00 602. loan Discount %AHNCC #2095 920,00 B03. AnnraisalFee 804, Credit Renart 805. ProcessinaFee \0 AHMCC #2095 295,00 806. Lender Admin Fee 10 ABN AMRO Mortaaoe GrouD.lnc. LR 475,00 807. AoolicalionFee 10 AHMCC #2095 . 350,00 808. FloodCert \0 AHMCC #2095 10,00 809. ExnressMail 10 AHMCC #2095 50.00 810. 811. OeferredDisc$575.00Pdbv 10 Corres POC to ABN 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From 0110612005\00210112005 "" 6,5500 Ida' 26 Dav. LR 170,30 902. Mor1oatle Insurance Premium for 10 903. Hazard Insurance Premium for 10 Erie Insurance P,O,C.\ 4B2.00 Bu"., 904. 905. 1000. RESERVES OEPOSITED WITH LENDER FOR 1001, Hazard Insurance 3 me. ran: 40.17/mo LR 120.51 1002. Mer1aaaelnsurance mo. fin 't Imo 1003. CilvPrenertvTax ma.I1ilS Imo 1004. CounlvPraoer1vTax 13 ma.fIn't 76.70/mo LR 997,10 1005. School Taxes 9 mo.liiI!t 178.B7Imo LR 1608,03 1009. Aaoreoale Analvsis Adiustment to ABN AMRO Mortoaae GrouD.lnc. LR -547,90 1100. TITLE CHARGES 1101. Selllement orcJosino fee 1102. Abstracl or tille search 1103. Down load Fee 10 Saldis SMlff Flower & Llndsav 50.00 1104. Tille insurance binder 1105. DocumentPreoaralion 1106. NotarvFees to Said is Shuff Flower & Llndsav 14.00 1107. Attornev'sfees to Frev &Tllev POC SELLER includes above items No: I 1106. TiUelnsurance to ACCP Inc. 1088.75 includes above Items No: \ 1109. lender'sPollcv 46000.00 1110. Owner's Pollcv 14600{].OO -1088.75 1111. End 100 End 300 End 900 \0 ACCP Inc. 150.00 . 1112. 1113. ClosinnServlceLeller to ACCP Inc. 35.00 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordino Fees Deed $ 38.50 . Mort"ane 't GO.50 . ReleaseS 99.00 1202. CitvlCountvlaxlslamns 0.""1460.00 . MortnaneS 1460,00 1203. State Tax/slamos Deed't1460,OO . Morto",.' 1460.00 1204 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Courier Fee to Saidls Shuff Flower & Lindsav 20.00 1302. Final Waler/Sewer Acet #06500.AJo Borouah of Carlisle 16.16' i303.WireFee to ACCP Inc. 10.00 , ;304 RadonlPestlHomelnsoec[ to L1olld's Homelnsnection IP.O.C.\ 425.00 Bu er 1305. Radon Milloatlon 10 American Radon Solutions 990.00 1306. Radoll Escrow 10 Saldls Shuff Flower & L1ndsav 550.00 1307. 1308. 1400, TOTAL SmLEMENT CHARGES (enter on lines 103 Secllon J and 502 Seclion K\ 7834,79 11766.18 HUOCEIlTlFICATIONOFBUVEIlANDSELLEIl I ~e carel~lI~ leYlaw8d!he HUO.' SeUlllnlenl Slelmelll and 10 Ihe beSI of m~ knowIsdQII 8I1d belllll. Ills. true at\d a"9f"ete stilemane or all ,aallplI and dlsbulSemanls made on my aa:o~nl or by me ~'".".N""OO,'~""""~""'"'''..".~~''~'''''..H"D' "''''''''''''-'"'L~ -/'1'&1//", 4/ D.Qt.J ~ '~"?' / CSla\..(:?~OIllz f c. /:)~ ~J<..E C. '"'- -fc'A- WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THe UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION CAN INCLUOE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: US.COOESECT10N100IANDSECTION1010. The HUO-\ SeWameN Sl&lament whi:h 1 nava prap.,ed Is. true and 8CCJtate account oIlh18 In.nsdon. ,,'~'~'~"7r"0~~~'..""m.'" - A Settlement Statement U.S. Department of Housing and Urban Development B Tvne afLoan OMS No. 2502.0265 REV. HUO-1 /3/86' 1 OFHA 2 OFmHA 3 OConll Unlns I 6 File Number I 7 Loan Number ! 8. Mortgage Insurance Case Number 4 nVA 5 neonv Ins MEALSGFD C Note Ite~s o~~'~edl~'o ~l w~7: t~,~ ~~:,:e I~e cJo:~~ lhsee~l=~ .h~::e'e j,,..u~I~'~al",n ~~esea~~ a~el~\ ~gJ~~~~~ 1~~\alO I TilleExpress Selllemenl System WARNING 1\ 1$ a crIme 10 kncrw'ngly make rain slatemenlS (0 !he Un~B<l Sial.. en Ihu; 0' ""yother s.mLliI! form Penalll.s up"" Prinled 01127/2005 at 09:43 RLM oDnvK:l,on can,ndude a I'nll8nd ii:;~~!onmeot Fordela,Isn8 Tllla 18 U S Code Sed"," 1001 andSetl,on 1010 D. NAME OF BORROWER: Owen E. Meals, Sr, and Owen E. Meals, Jr. Karen D. Meals ADDRESS: E. NAME OF SELLER: Estate of M. Lucille Dodez ADDRESS: F. NAME OF LENDER: ADDRESS: . G. PROPERTY ADDRESS: 1518 Shirley Lane, Carlisle, PA 17013 Borouah of Carlisle H. SETTLEMENT AGENT: Saidls, Shuff, Flower & Lindsay, Telephone: 717.243.6222 Fax: 717.243.6486 PLACE OF SETTLEMENT' 26 West Hiah Street Carlisle PA 17013 I. SETTLEMENT DATE: 0112712005 J, SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 101. Conlraclsalesnrice. 24900.00 40'- Conlraclsales nrice 24900.00 102. PersonalProMr1v 402. PersonaJProner1v 103. Selllemenl charoes 10 borrower line 1400 48T.50 403. 104 404. 105 405. Adiustmenls for ilems oaid bv seller in advance Adiuslmenls for ilems naid bv seller in advance 108. School Taxes 011271051006/30/05 98,57 408. School Taxes 01/27/051006/30105 98.S7 109 409. 110. 410. 111 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 25486.07 420, GROSS AMOUNT DUE TO SELLER 24998.57 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. Oenosilorearneslmonev 24900.00 501. Excess Oeoosillsee inslruclions 202. Princinal amounl of new loans 502. SeUlemenlcha(nes 10 seller line 1400\ 1743.00 203. Exislinoloanlsllaken subiecllo 503. ExiSlinnloanlsllakensub'ecllo 204. 504. PavoH of Firsl MorlnaneLoan 205. 505, 206 506. 207. 507 208. 508 209. 509. Adjustments for items unaaid b selle( Adiustments for items unoaid bv seUer 211. Caunlvtaxes 01/01/051001/27/05 7.09 511. Counl'llaxes 01/011051001/27105 7.09 213. 513. 214. 514. 215. 515. 216, 516. 217. 517. 218. 518. 219 519. 220. TOTAL PAID BY/FOR BORROWER 24907.09 520. TOTAL REDUCTION AMOUNT DUE SELLER 17S0.09 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER 301 Gross amounl due from borrower (line 12m 25486,07 601. Gross amounl due 10 seller line 420\ 24998.57 302, Less amounts oaid bvlforborrower line 2201 24907.09 602. Less reduclion amount due seller line 520 1750.09 303. CASH FROM BORROWER 578.98 603. CASH TO SELLER ---.- 23,248.48 .--.'- -- SUBSTITUTE FORM 1099 SELLER STATEMENT: The ;nlormalion':onlained ,....in is imponant I." informalion and;s beir1!1fu,,,..h.d Ie lhe 100..nal R.yerna Se""<,, II you.ra 'lIquj(8d 10 Ida a ..turn ~"cgh!lencope".ny.orclhe's.ncllcf'l,"iIIbeimpo..def'lyoullltmllamls(8qu....dlot>ereplll18dandlheIRSdele,mlneslhalilhasnolbBent8pcrled_ TheConlrBCI Salas Pric:e desuibed on . IWre401abcye<onslllule.theG,os.P,oce8d.ellhlsl'""Saclico. ~:;:;~I;~el~~~~~;~~~:~n~ ~i}~~~ :;~:~ ;'':~~f=~I~~~ebr;I~.t:~'{o~b~~' Sale or E.cllange 01 Principal Re.;dMce. lor iIOl' gain. wilh your InCctM la. ,alum; 1m elh.r Ir."ncl;an!. You are 'equi'ed by la.. 10 provide_the .eWemen! alliin! (Fed, T;u 10 No: lw;1h your ccrreclla.peyer idanli~calOon romb81 II j'Cv do nol proylde I'W' correct lo.paye, idenl~icalien numc.er. you may M ''''''le<110 Clod or crim",al panalt;., Impond by I",", Undo' penaltoe. 01 P""''Y. I <endy lhat tho numbel .hownen IhlS .Ialemenl is my correcllo.paye, i<l81l1i1;Caho" number. TIN: SEllER(S)SIGNATURE(S) SElLER(S) NEW MAtLING AOORESS: - U.S,DEPART-iIo\ENT OF HOUSING AND URBAN DEVELOPMENT File Number: MEALS PAGE 2 SETTLEMENT STATEMENT REV. HUD-jI3186\ TiUeExoress Se\llemenl Svs\em Printed 01/2712005 at 09:43 RLM L. SETTLEMENTCHARGES PAID FROM PAID FROM 700. TOTAL SALES/BROKER'S COMMISSION based on orlce $24900.00 (a) 6.000 - 1 494.00 BORROWER'S SELLER'S Division of commission !line 700\ as follows: FUNDSAT FUNDS AT 701. $ 772.00 to Ebener & Associates SETTLEMENT SETTLEMENT 702. ~ 722.00 to RemaxRealtll 703. Commission naid at Seltlemenl 1494.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. LoanO-;-inalionFee % 802. Loan Discount % 803. AnnraisalFee 804. CredilRenorl 805 Lender'sl~tionFee 806. MortnaneA""licalionFee 807. Assumn[ion Fee B08. 809. 810. 811. - gOO. ITEMS REQUIREO BY LENDER TO BE PAID IN ADVANCE 901. Interest From 10 ,'" Idav 902. MorlnanelnsurancePremium for 10 903. Hazard Insurance Premium for 10 904. 905. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance mo. rm If: Imo 1002, Mort/'Ta/'Te Insurance mo.rm'l: 1m, T 1003. Cil" Pro""rt" Tax mo. rm If: Imo 1004. Counlv Proner1v Tax mo.rm'l: 8.3Dlmo 1005. School Taxes mo. rm If: 19.34/mo 1009.~leAnalvsisAdiuslment 11 OQ. TITLE CHARGES 1101. Selllemenl orclosinn fee 1102. Abstraclorlillesearch 1103. Titleexaminalion 1104. Tille insurance binder 1105.DocumenIP~ralion 1106, Notar"Fees 1107. Allorne"'sfees 10 Frev & TlIe" POC (includes above items No: \ 1108. Title Insurance {includesaboveilems No: \ 1109. Lender'sCovera e$ 1110. Owner's Cover;;-e $ 24900.00 1111. AHorne"Cenificalion 10 ACCP Inc. 200.00 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201, Recordin" Fees Deed $38,50 . Mor1n.<ln8 'l: . Release 38.50 1202. Cijv/Coun!"laxlslamns Deed $249.00 . Mor1"a"'e~- 249.00 1203. Slate Taxlslam"s Deed <1:249.00 . Mon/'Ta/'Te 'l: 249.00 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Surv--;- 1302. Pesllnspeclion 1303 ~ -- --,,-_. -_.---- 1305 ------.-. - 1306 1307 1308. 1400. TOTAL SETTLEMENT CHARGES lenleron lines 103 Seclion J and 502 Section Kl 487.50 1743.00 HUD CERTIFICATION OF BUYER ANa SELLER i.."::;;: 1~~~~~r.~~Vjfu~~~e~~il~a~j~~ev~%,~j~~~~";6~':\~hMD~\ ~;;,;re'::::;;iS~I~:"~lb.Ii.I. ill.. IfVe and lICCurallt .1.1 rf2k:::.F ~P'~ A. EstaleofM.LucilleOodez c~ 'C~./ ( . Ll_ ..... 1<'..." _...~ -/(.._ WARNING IT IS A CRIME TO KNQWINGL Y MAKE FALSE STATEMENTS TO THE ~~iJfJlcn~TES ON THIS ORANY SIMILAR FORM. PENALTIES UPON CONVICTION U.S_ CODE S~tT~6%El:1D':b~~g~I~~~11~~R DETAILS see TITLE \8: i~~v~U~~~;:~e:'i:~~~a:~~'~':"d~%' ~:~::b~~~~'::'cl~~~3".::~~~~:I:I:t=~:,Of this Ifansaclion 8V; rno~r.:.~L'd. 1'2.1! 0\- - 217 REV-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF M. Lucille Dodez Include the proceeds of litigation and the date the proceeds were received by the estate. All nronerlv iointlv-owned with rinht of survivorshin must be disclosed on Schedule F. FILE NUMBER 21,04-0491 VALUE AT DATE OF DEATH 21,881 10,012 10,012 10,009 5,005 5,009 5,009 15,023 10,013 5,006 5,012 5,010 5,010 5,011 10,026 5,003 5,003 5,003 , 5,006 5,000 10,032 95,289 10,004 10,004 15,006 5.449 20,017 10,019 50,036 18,984 10,022 17,102 65,126 456 177 1,987 102 21 5,150 2,705 22,443 17 1.301 $ 523,512 ITEM NUMBER DESCRIPTION 1 Waypoint Bank, Checking Acct #100698455 2 Way point Bank, C/D#1800010447 3 Waypoint Bank, C/D#1865299549 4 Waypoint Bank, C/D#186531 0369 5 Way point Bank, C/D#566238361 6 Waypoint Bank, C/D#566428986 7 Waypoint Bank, C/D#566257419 8 Waypoint Bank, C/D#8000027565 9 Waypoint Bank, C/D#8000036828 10 Waypoint Bank, C/D#8000045260 11 Waypoint Bank, C/D#8000054738 12 F&M Trust, C/D#017,2967691 13 F&M Trust, C/D#017,2967692 14 F&M Trust, C/D#017,2974712 15 F&M Trust, CID#017-2974748 16 F&M Trust, C/D#017-2974750 17 F&M Trust, C/D#017,2974751 18 F&M Trust, C/D#017-2974752 19 F&M Trust, CID#017-2974763 20 F&M Trust,C/D#017,2974776 21 F&M Trust. Checking Account #34-03548 22 Fulton Bank, C/D#252,0031786 23 M&T Bank, C/D#31003908148602 24 M&T Bank, C/D#31003908148610 25 M& T Bank, C/D#31003908148628 26 M&T Bank, C/D#31 003908148701 27 M&T Bank, C/D#31003914547187 28 M&T Bank, C/D#31003914571045 29 M&T Bank, C/D#31 003914579966 30 M& T Bank, Checking Account #28728068 31 M&T Bank, Checking Acccount #8892197024 32 PNC Bank. Account #51,4001,6701 33 PNC Bank, C/D#2001 027320 34 Fulton Bank - Interest on C/D#252,0031786 35 Cash from Personai Residence 36 Refund, Country Meadows Associates 37 Refund, Capital Biue Cross Premium 38 Refund, Meredith Publications 39 Proceeds from Auction of Automobiles 40 Proceeds from Auction of Household Goods 41 Mildred I. Gravereau Estate, Distribution to Lucille Brenneman Dodez, Est. 42 Refund, Medicare Insurance Benefits 43 IRS Refund, 2004 Personal Income Tax TOTAL (Also enter on line 5, Recapitulation) (If more space is needed. insert additional sheets of the same size) - "VI Way Rqi!lt LOOK FOR US, WE'LL GET YOU THERE. 6/3/2004 FREY & TILEY 5 S HANOVER ST CARLISLE P A 17013 The information which you requested on the account(s) of LUCILLE DODEZ (Social Security Number 288-18-3199) is/are as follow~: Account Number 100698455 1800010447 1865299549 1865310369 566238361 566248986 Class of Account CHECKING CERTIFICATE CERTIFICATE CERTIFlCATE CERTIFICATE CERTIFICATE Date Opened 010504 101598 011597 070397 050493 051994 Principal Balance 21879.66 10000.00 10000.00 10000.00 5000.00 5000.00 Accrued Interest 1.18 12.28 12,10 9.15 5.09 8.53 Balance at Date of 21880.84 10012.28 10012.10 10009.15 5005.09 5008.53 Death Account Ownership SOLE SOLE SOLE SOLE SOLE SOLE Name ofJoint Owner, if any Date Ownership 010504 101598 011597 070397 050493 051994 Was Established 566257419 8000027565 8000036828 8000045260 8000054738 Account Number CERTIFlCATE CERTIFICATE CERTIFICATE CERTIFICATE CERTIFICATE Class of Account 111094 121296 111797 101598 111099 Date Opened 5000,00 15000.00 10000.00 5000.00 5000,00 Principal Balance 8.97 22.54 13.32 6.14 12.25 Accrued Interest 5008.97 15022.54 10013.32 5006,14 5012.25 Balance at Date of Death SOLE SOLE SOLE SOLE SOLE Account Ownership Name of Joint Owner, if any Date Ownership 111094 121296 1 j 1797 101598 111099 Was Established Additional Information Requested ~~ ~ E WATTS SENIOR SERVICES REP, P.O. Box 1711. HARRISBURG, PENNSYLVANIA 17105-1711 Toll FrEE I-B66-WAVPOINT (I-B66-929-7646) , IN YORK AREA 717/BI5-4500 . www.waypointbank.com RE: LUCILLE DODEZ DATE OF DEATH 5-14-2004 ACCOUNT INFORMATION CHECKING SAFE DEPOSIT SAVINGS ~CERTIFICATE OF DEPOSIT SHARES OF STOCK DATE OPENED 10-31-2001 DATE CLOSED STILL ACTIVE ACCOUNT NUMBER 017-2967691 / ACCOUNT BALANCE AT DATE OF DEATH $5,000,00 ACCRUED INTEREST $9,66 TOTAL ACCOUNT BALANCE $5,009.66 NAME(S) ON ACCOUNT LUCILLE DODEZ REGISTRATION OF ACCOUNT INDIVIDUAL ACCOUNT --------------------------------------------------------------- ACCOUNT INFORMATION CHECKING SAFE DEPOSIT SAVINGS ~CERTIFICATE OF DEPOSIT SHARES OF STOCK . RE: LUCILLE DODEZ DATE OF DEATH 5-14-2004 ACCOUNT INFORMATION _CHECKING SAFE DEPOSIT SAVINGS ~CERTIFICATE OF DEPOSIT SHARES OF STOCK DATE OPENED 1-31-2002 DATE CLOSED ACCOUNT NUMBER 017-2974712 ACCOUNT BALANCE AT DATE OF DEATH J ACCRUED INTEREST $11,17 TOTAL ACCOUNT BALANCE STILL ACTIVE $5,000.00 NAME(S) ON ACCOUNT REGISTRATION OF ACCOUNT $5.011,17 LUCILLE DODEZ INDIVIDUAL ACCOUNT ACCOUNT INFORMATION CHECKING SAFE DEPOSIT SAVINGS ~CERTIFICATE OF DEPOSIT SHARES OF STOCK " DATE OPENED ACCOUNT NUMBER 6-26-2002 DATE CLOSED' 017-2974748 STILL ACTIVE ,~,rcornTT Bf''-.i'NCE A'"' DATE OF DEATH $10,000,00 ACCRUED INTEREST TOTAL ACCOUNT BALANCE NAME(S) ON ACCOUNT REGISTRATION OF ACCOUNT ~ RE: LUCILLE DODEZ DATE OF DEATH 5-14-2004 ACCOUNT INFORMATION _CHECKING SAFE DEPOSIT SAVINGS X CERTIFICATE OF DEPOSIT SHARES OF STOCK DATE OPENED 7-12-2002 DATE CLOSED STILL ACTIVE ACCOUNT NUMBER 017-2974750 ACCOUNT BALANCE AT DATE OF DEATH $5,000.00 "- ACCRUED INTEREST $3.04 TOTAL ACCOUNT BALANCE $5,003.04 NAME(SJ ON ACCOUNT LUCILLE DODEZ REGISTRATION OF ACCOUNT INDIVIDUAL ACCOUNT --------~------------------------------------------------------ ACCOUNT INFORMATION CHECKING SAFE DEPOSIT SAVINGS X CERTIFICATE OF DEPOSIT SHARES OF STOCK DATE OPENED 7-12-2002 DATE CLOSED' STILL ACTIVE oj ACCOUNT Nill1BER 017-2974751 ACCOUNT BALA~CE AT DATE OF DEATH $5.000,00 ACCRUED INTEREST $3,04 TOTAL ACCOUNT BALANCE $5,003,04 NAME(S) ON ACCOUNT LUCILLE DODEZ REGISTRATION OF ACCOUNT INDIVIDUAL ACCOUNT ------------------------------------------------------------------ RE: LUCILLE DODEZ DATE OF DEATH 5-14-2004 ACCOUNT INFORMATION CHECKING SAFE DEPOSIT SAVINGS X CERTIFICATE OF DEPOSIT SHARES OF STOCK DATE OPENED 7-12-2002 DATE CLOSED STILL ACTIVE ACCOUNT NUMBER 017-2974752 ACCOUNT BALANCE AT DATE OF DEATH $5,000,00 ~ ACCRUED INTEREST $3,04 TOTAL ACCOUNT BALANCE $5,003.04 NAME(S) ON ACCOUNT LUCILLE DODEZ REGISTRATION OF ACCOUNT INDIVIDUAL ACCOUNT ACCOUNT INFORMATION CHECKING SAFE DEPOSIT SAVINGS X CERTIFICATE OF DEPOSIT SHARES OF STOCK " DATE OPENED 7-12-2002 DATE CLOSED' ACCOUNT NUl-IBER 017-2974763 STILL ACTIVE !'.CC'JTT'T'" B.n.L!'.NCE l\T DATE OF DEATH $5,000,00 ACCRUED INTEREST TOTAL ACCOUNT BALANCE NAME(S) ON ACCOUNT REGISTRATION OF ACCOUNT RE: LUCILLE DODEZ DATE OF DEATH 5-14-2004 ACCOUNT INFORMATION CHECKING SAFE DEPOSIT SAVINGS x CERTIFICATE OF DEPOSIT SHARES OF STOCK DATE OPENED 12-16-2002 DATE CLOSED STILL ACTIVE ACCOUNT NUMBER 017-2974776 \J ACCOUNT BALANCE AT DATE OF DEATH ACCRUED INTEREST $0.47 TOTAL ACCOUNT BALANCE $5,000,47 $5,000.00 NAME(S) ON ACCOUNT LUCILLE DODEZ REGISTRATION OF ACCOUNT INDIVIDUAL ACCOUNT --~------------------------------------------------------------ ACCOUNT INFORMATION x CHECKING SAFE DEPOSIT SAVIl}JGS CERTIFICATE OF DEPOSIT SHARES OF STOCK DATE OPENED 1-12-2001 DATE CLOSED" STILL ACTIVE ACCOUN'T rWTv:'BER 34-03548 J:I_cr~')i~;I\l'T BALAl'JCE AT OP-_TE OF DEA~H $10,031.46 ACCRUED INTEREST $0,83 TOTAL ACCOUNT BALANCE . $10,032.29 NAME(S) ON ACCOUNT LUCILLE DODEZ REGISTRATION OF ACCOUNT INDIVIDUAL ACCOUNT ------------------------------------------------------------------ FUlton Bank CAPITAL DIVISION . LANCASTER/CHESTER DIVISION DROVERS BANK DIVISION . GREAT VALLEY DIVISION (717) 291-2437 June 11,2004 Frey & Tiley 5 South Hanover Street Carlisle, Pennsylvania 17013 Dear Mr. Tiley: RE: M, Lucille Dodez, deceased May 14, 2004 In response to your recent inquiry concerning the accounts maintained in the name of the decedent, please be advised that the following accounts were open at the date of death: CD # 252-0031786, open 1/25/1993, rollover 1/25/2001, matures 1/25/2009, balance $95,000,00 and accrued interest $288.72; paying 5,83%, Daniel C, Derr as Power of Attorney, If you should have any further questions, please do not hesitate to contact me. Very truly yours, ~Q.~~.~~ Karen D, Hillegas Credit Inquiry Processor ..,,'CONFIDENTIAL ~s Inform" III h.lr~ K B rmntr M btl~nm ~" '~nswerto YOLl, ilHilJi-ry, and i1; for Y!Jur conf:r"nhal'" responslbllrty 1$ assumed by th~ bank or ~ili of Its i: ',. OOlnlon herein eXllfe5sed is sublect to Ch3f1g~ wlthol' POBox 4887 Loncosler, PA 17604 fultonbonk.com l'800'FULTON'4 f!M&rBank 499 Mitchell Road, MiIIsboro, DE 19%6 Mail Code 501.120 Phone (302) 934-2909 Fax (302) 934,2955 June 3, 2004 Frey & Tiley Attorneys At Law 5 South Hanover Street Carlisle, P A 17013 Re: Estate of M Lucille Dodez Social Security: 288-18-3199 Date of Death: Afav 14,2004 Dear Sir or Madam: Per your inquiry dated June 1,2004, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Certificate of Deposit Account Number 3/003908148602 Ownership (Names oj) M Lucille Dodez Daniel C Derr, POA Opening Date 02/13/02 Balance on Date of Death $10,000.00 Accrued Interest $ 4.30 Total $/0,004.30 2. Type of Account Certificate of Deposit Account Number 3/003908148610 Ownership (Names oj) M Lucille Dodez Daniel C Derr, POA Opening Date 02/13/02 Balance on Date of Death $10,000.00 Accrued Interest $ 4.30 Total $/0,004.30 3. Type of Account Certificate of Deposit Account Number 31003908148628 Ownership (Names of) M Lucille Dodez Danier C Derr, POA Opening Date 02/13/02 Balance on Date of Death $15,000.00 Accrued Interest $ 6.44 ------------------------------------ Total $15,006.44 4. Type of Account Certificate of Deposit Account Number 31003908148701 Ownership (Names of) M Lucille Dodez Daniel C Derr, POA Opening Date 06/13/02 Balance on Dale of Death $5,000.00 Accrued Interest $ 449.12 Total --------------------------------------- $5,449.12 5. Type of Account Certificate of Deposit Account Number 31003914547187 '! Ownership (Names of) M Lucille Dodez Daniel C Derr, POA Opening Date 12/09/96 Balance on Date of Death $20,000.00 Accrued Interest $ 17.27 Total ------------------------------------- $20,017.27 6. Type of Account Certificate of Deposit X, Account Number 31003914571045 Ownership (Names of) M Lucille Dodez Daniel C Derr, POA Opening Date 07/01/97 Balance on Date of Death $10,000.00 Accrued Interest $ 18.54 Totar ------------------------------------ $10,018.54 7. Type of Account Certificate of Deposit '/., Account Number 31003914579966 Ownership (Names of) M Lucille Dadez Daniel C Derr, POA Opening Date 09/10/97 Balance on Date of Death $50,000.00 Accrued Interest $ 36.44 Total $50,036.44 8. Type of Account Checking Account Account Number 28728068 Ownership (Names of) M Lucille Dadez Daniel C Derr, POA Opening Date 08/28/64 Balance on Date of Death $18,983.11 Accrued Interest $ 1.29 Total $18,984.40 9. Type of Account Checking Account Account Number 8892197024 Ownership (Names of) M Lucille Dadez Daniel C Derr, POA Opening Date 02/13/02 Balance on Date of Death $10,021.82 Accrued Interest $ .62 Total $10,022.44 For further account information, closures and/or reimbursement affunds please call the Carlisle Pike Office at #717-795-1710. We were unable to locate any safe deposit box for the above-mentioned decedent. .-----."'" 41<' '(bEl 3458 P.01/01 o PNCBAN< October 26, 2004 Stephen D Tiley Attorney at Law 5 S Hanover SI. Carlisle, P A 17013 scp 1tE: Estate of Lucille Dodez (Deceased) SSN; 288-18-3199 000: 05-14-2004 Dear Mr. Tiley: In response to your request for Date of Death balances for the customer noted above, our records show the following: Certificate of Deposit Account #21001029646 Established 08-29-1994 LUCILLE DODEZ 000 balance: $65,000,00 + $12.5.90 accrued interest Interest paid 01-01-04 thru 05 -14-2004 S903.54 YTD Checking Aeeount Account #5140016701 Established 04-0 1-1964 LUCILLE DODEZ DOD balance; $17,101.37 + $0,76 accrued interest Interest paid 01-01-04 thm 05-14-2004 $12.93 YTD Please note that this office only prOvides date of death balances for deposit accounts (IRAs, CD.. Checking and Savings accounts). We do not process say fiDlUlcial tn.laotions or provide statements, If you need assistance with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC BanIc branch office. Sincerely, ~~~ Erica L Schlegel 1-800-762-1775 P7.PFSC-04_F 500 Tint A "C. Pin.burgh PA 152t9 Member FDIC TOTAL P.01 BRICKERS AUCTION Buy & Sell on Commission - Complete Sale Service 93 Texaco Rd_, Mechanicsburg, PA 17055 766-5785 Personal Property of /.- UC / Li...E Dud 1:2 Address TVL-Y :z tf 2004 0/0 O. * ~ .. "'. . ... 2,; 30500 - 00 -1- 63.00-t 1.650' 00--. 5 - 2 5 '-+ 11.00-<. 8.50-1- 76.00--". 95.00 -..J;. 15.50 <<. 8-75-,,-- 153.00 "'\ 1 9 1 . 5 0 117-00 -r 36-00~ 36.00-t 22-50 -<<, 44'00,...!.. 15.75-.;. 4 3 . 004 93-50--'" 65'50~ 33-00 + Total Sale 7 Z? S S. J- r:; Total Checks t;L)) 3. :7 ,j-- Total Cash (p 35'S-: bD Cash After Payout 7 I, ;;l S- Expenses Auctioneer & Clerks 78 () / th) J..70, 06 Adv. Cost 6.283-75 '" P,!YP"ytY ~ Sale Setup or Help )(30, () 0 Total Expenses 'S' () D , 0 a f~~F~ ~ 7/;<'(/01 ........ ~-- 45 - 0 O~ Thank You For Selecting Chuck Bricker, Auctioneer & Staff DEPARTMENT OF TRANSPORTATION CERTIFICATE OF TITLE FOR A VEHICLE ----..-----.--.------.---------.---.- ~ 3;2:>60 910090055000716-001 r~f; ",;,'~f;- it: ff~~ ;..:::::: ~ft i.~~ ;;';;' 'f~~1 ~~;:: 1B4GK44R6MX527740 91 DODGE "/ 43736963201 VEHICLE IDENTIFICATION NUMBER YEAR MAKE OF VEHICLE TITLE NUMBER SW 0 I BODY TYPE DU' SEAT CAP UNLADEN WEIGHT GVWR GCWA TITLEBAANDS 1/22/91 1/22/91 I I 1/22/91 000005 0 DATE PATITtED DATE OF ISSUE PRIOR TlTLE STATE ODOM. PAOCD. DATE DOOM_ MILES OOOM. STATUS ... .#-~ . . ODOMETER STATUS o. ACTUAL MILEAGE 1 _ MILEAGE EXCEEDS THE MECHANICAL LIMITS -~m.'c't.~~;?"';""'i~!.~li.r"'2"Io~,NOT;rHE'ACT,I,l"'LMILEAGE 3 . NOT THE ACTUAL MILEAGE. ODOMETER TAMPERINGVERIFliQ . - EXEMPT FROM ODOMETER DISCLOSURE ,r~.[ , ~~ lI!'r~:..,:: .';i.I1,~~l"""y'.'-l'.."ll\Dl:f~",""" 4'"';'" ~ AC1;UAL MILEAGE ,. REGIST~<RED OWNEA(S) LUgI 1520 " CARLI . " TITLE 'i/ '~1 FIRST ~r:r, RELEASED " ~ It iI second l1enholderis listed. upon sallstaction ollhe tirst lien ,the'flrsl !hmholder must forward this Title 10 the 8ureau of Molor Vehicles with the appropriale form and tee. .' DATE AUTHOAIZEDAEPRESENTATIVE MAILING ADDRESS' -_....J;a~1"< ",,,,- ,.,,;,,~," .. ":!."'''''];,4'4 0 0 '8" LUCILLE DODEZ 1520 SHIRLEY AVE CARLISLE PA 17013 SECOND LIEN RELEASED 'm "~~,,. ;'.,:'!.,r''''OlI'>~i=.',:,~"", "' ,t'.'o,.;~Jij'!",~". AUTHOAtlEOAEPRESENTATIVE '"o'/' r. /' h.. /1:r.:.~U,/j~/"iI'P"'~~:...r:. [t, "\ 0 ,,.;::', - ,~'i. ,", /.::!/i'.TYc;J$A'...I. !~~;! I cerlily as of the date of issue, the otficialrecordso1lhePennsylvaniaDeparlmenl of TranspOrlslionreflect Ihal the person(s) or company named herein Is the lawltll owner 01 the said vehicle D. APPLICATION FOR TITLE AND LIEN INFORMATION- Secretary of Transportation TO BE COMPLETED BY PURCHASER WHEN VEHICLE IS SOLD AND THE APPROPRIATE SECTIONS ON THE REVERSE SIDE OF THIS OOCUMENT ARE COMPLETED. ~ I ,~~;:" j'?- SUBSCAIBEO AND SWORN TOBEFDAEME: ~;:~~ggk~'.nN ~~r b~:::ki~I~~II~~uii~ ~~blll~$85~ig~ sRf~~:n,~~~c~O~~~~." A 0 JoInl Tenanl! wllh Right 01 Survlvor!hlp (on dealh 01 one owner, tiU. goe! to Ihe sUfVlving owner), B 0 T"nanlS in Common (on daalh 01 one owner, InterllSI 01 d8Ceasl!d owner goes !O his or h,r heirs ore"ale). "' '"' ,~, SI(JNJ\TUF;EOF~ERSONJ\D.\lmISTERINGaATH LIEN DATE: FIRST LIENHOLDER: IFNOUEN CHECK BOX NAME '.~;~(:.!.I;: pnESf~.!(:::: OF .!:\ NCq">1.~o"" f STAEET CITY STATE "' Theundelsigned hereby mekes appllcallan lor Canllicale 01 Tille 10 Ihevehlcledu5crlbed above, sUbiecllothel!ncumbrsllcBsandolherlugulc1almssultOr1hhUfU LIEN DATE: SECOND LIENHOLDER: IF NO LJEN CHECK BOX NAME SlGNATUReOFAPPLICANTO~AUTHDAIZeOSII3NEA STREET 'IT' DO ,u.:;, ~ -"'~.. ~i ~~ ~ o .~;, ~~~ :ll I". ~';:'l.~ '1~~1 .~~ ~ ;j1 ~ -4f \\' g~~ ~~~ D 4.jf o <0 0) ..-; "1' CO o "1' ----.,. LOGEE, HOSTETLER, STUTZMAN & LEHMAN ATTORNEYS AT LAW 2171-B EAGLE PASS D~LJ.HOSTETLER MORRIS STUTZMAN R..A.LPH E. LEHMAN JERRY S. PACKARD RONALD E. HOIJrMAN WOOSTER. OHIO 44691 TELEPHONE: (3301 264-61.15 FAX: (3301 262-5729 September 24, 2004 Stephen D, Tiley, Esq, 5 South Hanover Street Carlisle, PA 17013 RE: Your Client: Lucille Brenneman Dodez Estate Partial Distribution from Estate of Mildred I. Gravereau Dear Mr, Tiley: Enclosed is a check in the amount of $15,000,00 representing a partial distribution of your client's share of the estate of Mildred I. Gravereau. This distribution represents approximately 70% of your client's total distribution. The Federal and Ohio estate tax returns have been filed. Once the estate tax returns are approved, we will make final distribution of your client's share of the estate, I anticipate that we will be able to make such distribution sometime during the spring of 2005. The estate is on a fiscal year which will end September 30, 2004. Since the estate has taxable income, each of the beneficiaries will receive a Form K-1 from the estate later this year which will set for the amount of income each beneficiary will need to include and report on their 2004 income tax return, For tax planning purposes, we have estimated the taxable income which your client will need to report as being $600.00. If you have any questions, please let me know. Sincerely yours, )/21~ ~ Morris Stutzman MS/bmk/sgw Enclosures cc: Carole Jacops, Executor 1/4/05: TELEPHONE FROM ATTORNEY STUTZMAN: ESTIMATE FINAL AMOUNT FROM GRAVEREAU ESTATE: $22,443.00 217 REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER M. Lucille Dodez 21,04,0491 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER TRANSFER. ATTACH A COPY OF THE DEED fOR REAL ESTATE. VALUE OF ASSET INTEREST (IFAPPLlCA8l~l VALUE 1. National Guardian Life Division, Policy #00844689 3,281 100.00% 3,281 2. National Guardian Life Division, Policy #00844690 34,032 100.00% 34,032 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL (Also enter on line 7 RecaDi!ula!ion) $ 37313 (If more space is needed, insert additional sheets of the same size) ~ NGL Traditional Life Division James I. Miles, Licensed Representative November 2, 2004 PO Box 6505 Harrisburg PA 17112 Phone: (717) 652-5466 Fax: (717) 652-5467 Stephen D. Tiley, Esq, Frey & Tiley 5 South Hanover Street Carlisle PA 17013 RE: Estate ofM. Lucille Dodez, Deceased Policy # 00844689 Policy # 00844690 On September 21, 2004, my secretary faxed to your office a letter from National Guardian Life indicating the date-of-death balance and accrued interest on the above referenced policies. On September 23, 2004, I spoke with you and you indicated you had received the fax and that everything was "OK" because the beneficiary is a charitable organization, I am attaching a copy of the NGL, letter addressed to the beneficiary, on the above referenced policies which was faxed to you, which states in part: . Policy # 00844689, death benefit is $3,281.02, accrued interest to date of payment is $22.50, . Policy # 00844690, death benefit is $34,031.81, accrued interest to date of payment is $233.35. In addition, I am stating that The Watchtower Society is a non-profit entity and is recognized as such by the Internal Revenue Service. Their address is: Watchtower Bible & Tract Society of New York, Inc. 25 Columbia Heights Brooklyn NY 11201 To my knowledge, there are no other payments or reimbursements due to the estate of Lucille B. Dodez. If you need anything further, please call, Sincerely, , James I. Miles elk enels National Gliardian Life Insurance Company . Madison, WI 54701-1191 Traditional Life Division. 30 East state Street . Sharon, PA 16146 . 724~9811520 or 800~223-8821 . FAX: 724-981-7031 . www.nglic.com 217 REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER M. Lucille Dodez 21,04,0491 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ,. Matinchek and Daughter Funeral Home and Cremation Services, Inc. 5,572 B. ADMINISTRATIVE COSTS: ,. Personal Representative's Commissions Name of Personal Representative (5) Daniel Derr Social Security Number{s) I EIN Number of Personal Representative(s) 179,44-8576 Street Address 2293 Foxianna Road City Middletown State PA Zip 17057 Year(s) Commission Paid: 2005 23,943 2. Attorney Fees 23,943 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Stale Zip Relationship of Claimant to Decedent 4. Probate Fees 418 5. Accountant's Fees 6. Tax Relum Preparer's Fees 7 Cumberland Law Journal, Advertising 75 8. The Sentinel, Advertisin9 116 9. Register of Wills, Additional Probate Fees 35 10. Register of Wills, Filing Fee for Pennsylvania Inheritance Tax Return 15 11. Check cleared after date of death 15 12. Re9ister of Wills, File the First and Final Accounting 430 TOTAL tAlso enter on line 9 Recanitulation $ 54 562 (If more space is needed, insert additional sheets of the same size) - REV,1512 EX+ (12-03) 217 SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF M. Lucille Dodez FILE NUMBER 21-04-0491 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, Including unreimbursed medical expenses. ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. DESCRIPTION VALUE AT DATE OF DEATH Brian E. Walsh, Lawn Services Ebener and Associates, Commission on 1518 Shiriey Avenue & 1520 Shirley Avenue ReM ax Reaity, Commission on 1518 Shirley Avenue and 1520 Shirley Avenue Bricke~s Auction, Expenses and Commission Wonders, Ltd, Canopy for Auction American Radon Solutions Daniel Duerr, Travel and Expenses F&M Trust, Charge for Date of Death Balance of Accounts held by F&M Trust M&T Bank, Estate Account #9833001 077, Bank Charges Ohio Casualty Group Country Meadows Associates, Medical HCR-Manor Care, Medical Darlene L. Moyer, Tax Collector, School Taxes 2004-2005 2005 County Taxes, 1518 and 1520 Shiriey Avenue PPL, Utililies:Electricity Agway Petroleum, Heating Oil Borough of Carlisle, Utilities:Water Recorder of Deeds, 1520 Shirley Avenue, Carlisle Borough, Carlisle Recorder of Deeds, 1518 Shirley Avenue, Carlisle Borough, Carlisle Scott's Lawn Service, Miscellaneous Saidis, Shuff, Flower and Lindsay, Check held in escrow in reference to Radon 2,451 5,177 5,077 1,500 138 980 2,593 20 42 -19 68 2,519 1,244 20 460 282 143 1,460 249 42 550 TOTAL (Also enter on line 10, Recaoitulationl $ (If more space is needed, insert additional sheets of the same size) 24,996 --- 217 REV-1513 EX+ (9.00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER M Lucille Dodez 21,04-0491 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec, 9116 (a) (1.2)] Watch Tower Bible Tract Society of Pennsylvania 100% residue of estate 100 Watchtower Drive, Patterson, New York 12563-9204 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B_ CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 Watch Tower Bible Tract Society of Pennsylvania 652,167 TOTAL OF PART 11_ ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 652 167 (If more space is needed, insert additional sheets of the same size) --- !. / / / i / Internal Revenue Service Department of the Treasury P. O. Box 2508 Cincinnati, OH 45201 Date: Mav 16, 2003 Person to Contact: Brenda Fox 31-07209 Customer Service Representative Toll Free Telephone Number: ~:oo a.m. to 6:30 p.m. EST 877 -829-5500 Fax Number: 513-263-3756 Federal Identification Number: 11-1857820 Watch Tower Bible and Tract Society of Pennsylvania 25 Columbia Heights Brooklyn, NY 11201-1300 Dear Sir or Madam: This is in response to your request of April 9, 2003 regarding your organization's tax exempt status. In June 1946 we issued a determination letter that recognized your organization as exempt from federal income tax. Our records indicate that your organization is currently exempt under section 501 (c)(3) of the Internal Revenue Code. Your organization is classified as a publicly supported organization, and not a private foundation. because it is described in sections 509(a)(1) and 170(b)(1)(A)(i) of the Code. Donors may deduct contributions to your organization as provided in section 170 of the Code, That letter is still in effect. As of January 1, 1984, your organization is liable for taxes under the Federal Insurance Contributions Act (social security taxes) on remunerations of $100 or more paid to each of its employees during a calendar year. Your organization is not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA). If your organization is a church or a qualified church-controlled organization as defined in section 3121(w)(3) of the Code. it may elect to exclude the wages paid to its employees (other than for services performed in an unrelated trade or business) for social security taxes. This election must be made by filing Form 8274 by the day before the date the organization's first quarterly employment tax return would be due under the revised law. If your organization makes this election, its employees who earn $100 or more during a calendar year become liable for the payment of self-employment tax (under section 1402 of the Code) on the wages the organization pays them Organizations that are not private foundations are not subject to the excise taxes under Chapter 42 of the Code. However, these organizations are not automatically exempt from other Federal excise taxes. Donors may deduct contributions to your organization as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to your organization or for its use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. --- ( /' - 2- Watch Tower Bible and Tract Society of Pennsylvania 11-1857820 Your organization is not required to file federal income tax returns unless it is subject to the tax on unrelated business income under section 511 of the Code. If your organization is subject to this tax, it must file an income tax return on Form 990-T, Exempt Organization Business Income Tax Return. If your organization had a copy of its application for recognition of exemption on July 15, 1987, the law requires you to make available for public inspection a copy of the exemption application, any supporting documents and the exemption letter to any individual who requests such documents in person or in writing. You can charge only a reasonable fee for reproduction and actual postage costs for the copied materials. The law does not require you to provide copies of public inspection documents that are widely available, such as by posting them on the Internet (World Wide Web). You may be liable for a penalty of $20 a day for each day you do not make these documents available for public inspection. As this letter could help resolve any questions about your organization's exempt and foundation status, you should keep it with the organization's permanent records. If you have any questions, please call us at the telephone number shown in the heading of this letter. This letter affirms your organization's exempt status. Sincerely, g~~~ John E. Ricketts, Director, TErGE Customer Account Services ---- LAST WILL AND TESTAMENT OF M. LUCILLE DODEZ I. M. LUCILLE DODEZ. of the Borough of Carlisle (1520 Shirley Avenue). Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all Wills and Codicils heretofore made. FIRST I direct the payment of my just debts and funeral expenses as soon after my death as may be convenient. SECOND I declare that I am now a widow, having been married to George W. Dodez. We have no children, or deceased children. THIRD All the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath to the Watch Tower Bible Tract Society of Pennsylvania, 124 Columbia Heights, Brooklyn One, New York. FOURTH I hereby nominate, constitute and appoint Daniel Derr, of 2293 Foxianna Road, Middletown, Pennsylvania, as Executor of this my Last Will and Testament. In the event of the renunciation, death, resignation or inability to act for any reason whatsoever of the said Daniel Derr. I nominate.. constitute and appoint Gary L. Keiter, of 50 South Geyer Church Road, Middletown, Pennsylvania, as Executor of this my Last Will and Testament. I further direct that no bond or other security shall be required of any Executor or Executrix appointed in this Will for the perfOlmance of his, her or its duties in any jurisdiction in which he, she or it may be called upon to act. FIFTH In addition to. and not in limitation of, the powers conferred by law or by other provisions of this Will, my Executor shall have the following powers. each of which may be exercised from time to time by my Executor in his sole discretion: (a) To retain in the form received, and to sell eith~r at public or private sale, or to distribute in kind, any real or personal property. (b) To manage both real and personal property. (c) To invest and reinvest in all forms of property. notwithstanding the factthat any or all of the investments made are of a character or size which but for this expressed authority would not be considered proper for an Executor. (d) To exercise any option or rights arising from the ownership of investments. (e) To compromise claims without court approval and without the consent of any beneficiary. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament. written on one (I) page. this ;I. 7 day of ~ . 1995. 711 r/:,,, j eo ,./.!.-d,,~,I M. Lucille Dodez ?J (SEAL) --- COMMONWEALTIi OF PENNSYLVANIA COUNTY OF CUMBERLAND SS: .' We, M. Lucille Dodez, Stephen D. Tiley, and Theresa L. Bentzel, the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of their knowledge the Testatrix was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. 'P7 ,~L-<.d.Le oJ--c~ M. Lucil e Dodez a>>'?~ S ephe . Tiley . 7 Subscribed, sworn to and acknowledged before me by the Testatrix and the witnesses above-named, this 27th day of March , 1995. NOTARIAL SEAL KRISTA KING, NOTARY PUBLIC CARLISLE, CUMBERLAND COUNTY PA MY COMMISSION EXPIRES JUNE 27,1998 Notary~C- J~n1 FIRST AND PARTIAL ACCOUNT OF DANIEL DERR, EXECUTOR OF THE LAST WILL AND TEST AMENT OF M. LUCILLE DODEZ, LATE OF 1520 SHIRLEY A VENUE, CARLISLE, CUMBERLAND COUNTY, PENNSYLVANIA, DECEASED DATE OF DEATH: LETTERS TESTAMENTARY ADVERTISED: 14-May-04 CUMBERLAND LAW JOURNAL June 11, 18,25,2004 PRINCIPAL RECEIVED - PERSONAL PROPERTY THE SENTINEL June 8, 15, 25, 2004 () Co $::0 iWEp f'2:J>:m ~,:2; :0 ',,- (f) '?'- (500 -0 -") 0 -n ::r. 5~~~1.l4 (,) -:....-~ r-> c.:> c:::> CJ" (... c:: . Accountant charges himself with the following principal amounts received: &'" :::0 ~"':J fl'l r'ir(,""') <:;29 \~::~~ f":~3 ~__:2 ;::" ~"',,,) _"J C) i .-,~" :-0 c--:, , _rn :j~) (-, ~-r1 See Principal Listing Attached Hereto as Exhibit "A" ;> PRINCIPAL RECEIVED. REAL ESTATE Accountant charges himself with the following principal amounts received: 6-Jan-05 Sale of Residence of Decedent (Gross Sale Price) 1520 Shirley Avenue, Carlisle, PA 17013 146,000.00 27-Jan-05 Sale of Vacant Lot (Gross Sale Price) 1518 Shirley Avenue, Carlisle, PA 17013 24,900.00 INCOME RECEIVED - PERSONAL PROPERTY Accountant charges himself with the following income amounts received: See Interest Listing Attached Hereto as Exhibit "B" 7,074.26 DISBURSEMENTS Accoutant claims credit for the following amounts paid: See Expenses Listing Attached Hereto as Exhibit "C" (79,725.04) BALANCE AVAILABLE FOR DISTRIBUTION Principal, Plus Income, Less Disbursements 613,020.36 First & Partial Account and Proposed Schedule of Distribution - Estate of M. Lucille Dodez Page 1 PROPOSED SCHEDULE OF DISTRIBUTION Balance Available for Distribution: 613,020.36 Sole Beneficiary: The Watch Tower Bible and Tract Society of Pennsylvania 100 Watchtower Drive Patterson, NY 12563-9204 100% of the Residuary Pursuant to Paragraph Third of Will: Partial Distribution October 15,2004 425,000.00 Partial Distribution July 6, 2005 150,000,00 Distribution Upon Confirmation of Account 38,020.36 613,020.36 COMMONWEALTH OF PENNSYLVANIA SS.: COUNTYOFCUMBERALND Before me, the undersigned officer, personally appeared Daniel Derr Executor of the Last Will and Testament of M. Lucille Dodez Deceased, who, being duly sworn ~ according to law, desposes and says that the foregoing First and Fimrl. Account and Proposed Schedule of Distribution are true and correct to the best of his knowledge, information and belief. i7c~ c ~ Sworn to and subscribed before me +" this ~ day of "j'"~, ~OD ~ ~ 4.~ NOTARIAl SEAL TRISHAA UESS, NOTARY PUBLIC BOROUGH OF CARUSLE. CUMBERLAND co PA MY COMMISSION EXPIRES MAY 20. 2006" First & Partial Account and Proposed Schedule of Distribution - Estate of M. Lucille Dodez Page 2 Wednesday, July 6, '2005 Oodez Accounting for 1st & Partial - Oodez Checking Acct Page: 1 Principal Received - Personal Property 5/14/04 through 7/1/05 Date Num Payee Memo Category C I r Amount Income/Expenses Income Princioal 5/14/04 OEP M&T Bank, Checking #8892197024 Principal R 10,021.82 5/14/04 OEP M&T Bank, Checking #8892197024 Accrued Interest Principal R 0.62 5/14/04 F&M Trust C/0#017-2967691 Principal C 5,000.00 5/14/04 F&M Trust C/O#017-2967691 Accrued Interest Principal C 9.66 5/14/04 F&M Trust C/0#017-2967692 Principal C 5,000.00 5/14/04 F&M Trust C/0#017-2967692 Accrued Interest Principal C 9.66 5/14/04 F&M Trust C/0#017-297412 Principal C 5,000.00 5/14/04 F&M Trust C/0#017-2974712 Accrued Interest Principal C 11.17 5/14/04 F&M Trust C/0#017-2974748 Principal C 10,000.00 5/14/04 F&M Trust C/0#017-2974748 Accrued Interest Principal C 25.89 5/14/04 F&M Trust C/0#017-2974750 Principal C 5,000.00 5/14/04 F&M Trust C/0#017-2974750 Accured Interest Principal C 3.04 5/14/04 F&M Trust C/0#017-2974751 Principal C 5,000.00 5/14/04 F&M Trust C/0#017-2974751 Accrued Interest Principal C 3.04 5/14/04 F&M Trust C/0#017-2974752 Principal C 5,000.00 5/14/04 F&M Trust C/0#017-2974752 Accrued Interest Principal C 3.04 5/14/04 F&M Trust C/0#017-2974763 Principal C 5,000.00 5/14/04 F&M Trust C/0#017-2974763 Accrued Interest Principal C 6.23 5/14/04 F&M Trust C/0#017-2974776 Principal C 5,000.00 5/14/04 F&M Trust C/0#017-2974776 Accrued Interest Principal C 0.47 5/14/04 F&M Trust, Checking #34-03548 Principal C 10,031.46 5/14/04 F&M Trust, Checking #34-03548 Accrued Interest Principal C 0.83 5/14/04 Fulton Bank, CO#252-0031786 Principal 95,000.00 5/14/04 Fulton Bank, CO#252-0031786 Accrued Interest Principal 288.72 5/14/04 Waypoint Bank Acct #100698455 Principal R 21,879.66 5/14/04 Waypoint Bank Acct #100698455 Accrued Interest Principal R 1.18 5/14/04 Waypoint Bank C/0#180001 0447 Principal R 10,000.00 5/14/04 Waypoint Bank C/0#1 800010447 Accrued Interest Principal R 12.28 5/14/04 Waypoint Bank C/0#1865299549 Principal R 10,000.00 5/14/04 Waypoint Bank C/0#180001 0447 Accrued Interest Principal R 12.10 5/14/04 Waypoint Bank C/0#186531 0369 Principal R 10,000.00 5/14/04 Waypoint Bank C/0#186531 0369 Accrued Interest Principal R 9.15 5/14/04 Waypoint Bank C/O #566238361 Principal R 5,000.00 5/14/04 Waypoint Bank C/O #566238361 Accrued Interest PrinCipal R 5.09 5/14/04 Waypoint Bank C/O #566248986 Principal R 5,000.00 5/14/04 Waypoint Bank C/O #566248986 Accrued Interest Principal R 8,53 5/14/04 Waypoint Bank C/O #8000027565 PrinCipal R 15,000.00 5/14/04 Waypoint Bank C/O #8000027565 Accrued Interest Principal R 22.54 5/14/04 Waypoint Bank C/O #8000036828 Principal R 10,000,00 5/14/04 Waypoint Bank C/O #8000036828 Accrued Interest Principal R 13,32 5/14/04 Waypoint Bank C/O #8000045260 Principal R 5,000.00 5/14/04 Waypoint Bank C/O #8000045260 Accrued Interest Principal R 6,14 5/14/04 Waypoint Bank C/O #8000054738 Principal R 5,000,00 5/14/04 Waypoint Bank C/O #8000054738 Accrued Interest Principal R 12.25 5/14/04 Waypoint Bank, C/O #566257419 Principal R 5,000.00 5/14/04 Waypoint Bank, C/O #566257419 Accrued Interest Principal R 8,97 5/14/04 M& T Bank, C/O #31003908148602 Principal C 10,000.00 5/14/04 M& T Bank, C/O #31003908148602 Accrued Interest Principal C 4.30 5/14/04 M& T Bank, C/O #31003908148610 Principal C 10,000.00 5/14/04 M&T Bank, C/O #31003908148610 Accrued Interest Principal C 4,30 E>>IBff-..- Wednesday, July 6, '2005 Oodez Accounting for 1st & Partial - Oodez Checking Acct Page: 2 Principal Received - Personal Property 5/14/04 through 7/1/05 Date Num Payee Memo Category C I r Amount 5/14/04 M&T Bank, C/O #31003908148628 Principal C 15,000.00 5/14/04 M& T Bank, C/O #31003908148628 Accrued Interest Principal C 6.44 5/14/04 M&T Bank, C/O #31003908148701 Principal C 5,000.00 5/14/04 M&T Bank, C/O #31003908148701 Accrued Interest Principal C 449.12 5/14/04 M&T Bank, C/O #31003914547187 Principal C 20,000.00 5/14/04 M&T Bank, C/O #31003914547187 Accrued Interest Principal C 17.27 5/14/04 M&T Bank, C/O #31003914571045 Principal C 10,000.00 5/14/04 M&T Bank, C/O #31003914571045 Accrued Interest Principal C 18.54 5/14/04 M&T Bank, C/O #31003914579966 Principal C 50,000.00 5/14/04 M&T Bank, C/O #31003914579966 Accrued Interest Principal C 36.44 5/14/04 M&T Bank, Checking #28728068 Principal C 18,983.11 5/14/04 M&T Bank, Checking #28728068 Accrued Interest Principal C 1.29 5/14/04 PNC, Acct #51-4001-6701 Principal 17,101.37 5/14/04 PNC, Acct #51-4001-6701 Accrued Interest Principal 0.76 5/14/04 PNC, C/0#2001027320 Principal 65,000.00 5/14/04 PN~ C/0#2001027320 Accrued Interest Principal 125.90 6/4/04 OEP Fulton Bank, CD#252-0031786 Principal R 456.27 6/28/04 OEP Mead Living Ctr West Shore 4 Nursing Home Principal R 1,986.93 6/28/04 DEP Cash on Hand Principal R 177.00 6/30/04 OEP Refund, Capital BlueCross Principal R 97.50 7/12/04 DEP Medicare Insurance Benefits Medical Principal R 17.33 7/12/04 DEP Capital BlueCross Principal R 4.33 7/12/04 OEP Refund, Meredith Publications Principal R 21.08 7/26/04 DEP Proceeds from Auction 1991 Grand Caravan Principal R 3,500.00 7/26/04 DEP Proceeds from Auction 1984 L TO Crown Victoria Principal R 1,650.00 7/26/04 DEP Proceeds from Auction Household Contents Principal R 2,705,00 10/6/04 DEP Mildred I. Gravereau Estate Partial Distribution Principal C 15,000.00 Total Principal 514,771.14 Total Income 514,771.14 Total Income/Expenses 514,771.14 E)Q 18'''' Wednesday, July 6, 2005 Oodez Accounting for 1st & Partial - Oodez Checking Acct Page: 1 Income Received - Personal Property 5/14/04 through 7/1/05 Date Num Payee Memo Category C I r Amount Income/Expenses Income Interest Income 5/19/04 OEP Waypoint Bank C/O #56624B9B6 Interest Income R 3.90 5/22/04 M&T Bank, Checking #28728068 Interest Income C 0.26 5/26/04 OEP M&T Bank, Checking #8892197024 Interest Income R 1.85 5/27104 F&M Trust C/O #2974776, #2974748 4776 and 4748 Interest Income C 24.81 5/27/04 F&M Trust, Acct #34-03548 Interest Income C 0.84 5/31/04 DEP Waypoint Bank C/O #566248986 $3.90 AND $.89 Interest Income R 0.89 5/31/04 DEP Waypoint Bank C/D #566238361 Interest Income R 7.02 5/31/04 DEP Waypoint Bank C/O #566257419 Interest Income R 12,37 5/31/04 DEP Waypoint Bank C/D #1800010447 Interest Income R 16,94 5/31/04 DEP Waypoint Bank C/O #1865299549 Interest Income R 16.70 5/31/04 Waypoint Bank C/D #1865310369 Interest Income R 12,61 5/31/04 DEP Waypoint Bank C/D #8000027565 Interest Income R 31.07 5/31/04 DEP Waypoint Bank C/D #8000036828 Interest Income R 18.36 5/31/04 DEP Waypoint Bank C/D #8000045260 Interest Income R 8.47 5/31/04 DEP Waypoint Bank C/D #8000054738 Interest Income R 16,89 6/1/04 DEP F&M Trust C/D#017-2967691 Interest Income C 7,96 6/1/04 F&M Trust C/D#017-2967692 Interest Income C 7,96 6/1/04 DEP F&M Trust ClD#017-2974712 Interest Income C 9,21 6/1/04 DEP F&M Trust C/D#O 17 -297 4 763 Interest Income C 7,57 6/1/04 DEP F&M Trust C/D#017-2974752 Interest Income C 15.86 6/1/04 DEP F&M Trust C/D#017-2974751 Interest Income C 15.86 6/1/04 OEP F&M Trust C/0#017-2974750 Interest Income C 15.86 6/1/04 DEP F&M Trust C/D#017-2974776 Interest Income C 14.65 6/1/04 DEP PNC, Acct #51 -4001-6701 ,Cert#2 1 001 029646 Interest Income 96,28 6/1/04 DEP PNC, Acct #51 -4001 -6701 Interest Income 1.32 6/1/04 DEP M&T, #31003914571045 TO ACCT 28728068 Interest Income C 35,93 6/9/04 DEP M&T, #31003914547187 TO ACCT 28728068 Interest Income C 66.92 6/10/04 OEP M&T, #31003914579966 TO ACCT 28728068 Interest Income C 161.37 6/13/04 DEP Waypoint Bank Acct #100698455 Interest Income R 42.29 6/17/04 DEP M&T#028728068 CD#8602,8610,8628,8701 Interest Income R 116.72 6/21/04 DEP M&T Bank, #028728068 Interest Income C 1.63 6/22/04 DEP M&T, #31003914547187 TO ACCT 28728068 Interest Income C 64,77 6/25/04 DEP M&T Bank, Checking #9833001077 Interest Income R 0.88 6/25/04 DEP F&M Trust, Acct #34-03548 Interest Income C 2.15 6/28/04 DEP F&M Trust C/D#017-2974748 Interest Income C 38.22 6/28/04 DEP F&M Trust ClD#017-2967692 Interest Income C 17.05 6/28/04 DEP F&M Trust C/D#017-2967691 Interest Income C 17.05 6/28/04 DEP F&M Trust C/D#01 7-297471 2 Interest Income C 19.73 6/29/04 DEP PNC, C/D#21001029646 Interest Income 229.57 6/30/04 DEP Fulton Bank, CD#252-0031786 Interest Income R 471.52 6/30/04 DEP Waypoint Bank C/O #566238361 Interest Income R 11.72 6/30/04 DEP Waypoint Bank C/D #566257419 Interest Income R 20,66 6/30/04 DEP Waypoint Bank C/D #1800010447 Interest Income R 28.28 6/30/04 DEP Waypoint Bank C/D #1865299549 Interest Income R 27.87 6/30/04 DEP Waypoint Bank C/D #1865310369 Interest Income R 21.07 6/30/04 DEP Waypoint Bank C/D #8000027565 Interest Income R 51.89 6/30/04 DEP Waypoint Bank C/D #8000036828 Interest Income R 30,66 6/30/04 OEP Waypoint Bank C/O #8000045260 Interest Income R 14,14 6/30/04 DEP Waypoint Bank C/D #8000054738 Interest Income R 28.19 6/30/04 OEP Waypoint Bank Acct #100698455 Interest Income R 42,79 7/6/04 DEP F&M Trust C/0#017-2974763 Interest Income C 13.36 7/7104 OEP PNC, Acct #51-4001-6701 Interest Income 2,32 7/9/04 OEP M&T, #31003914571045 TO ACCT 28728068 Interest Income C 34,76 7/12/04 OEP M&T, #31003914579966 TO ACCT 28728068 Interest Income C 156.16 7/12/04 OEP F&M Trust ClD#017-2974750 Interest Income C 18,29 7/12/04 DEP F&M Trust C/0#017-2974751 Interest Income C 18.29 7/12/04 OEP F&M Trust C/0#017-2974752 Interest Income C 18,29 7/16/04 OEP F&M Trust C/D#017-2974776 Interest Income C 14.18 7/20/04 OEP M&T CO#8602,8610,8628,8701 Interest Income R 112.94 7/21/04 DEP M&T Bank, #028728068 Interest Income C 1.59 EXHIBIT V Wednesday, July 6, 2005 Dodez Accounting for 1st & Partial - Dodez Checking Acct Page: 2 Income Received - Personal Property 5/14/04 through 7/1/05 Oate Num Payee Memo Category C I r Amount 7/26/04 OEP M&T, Estate Checking #9833001077 Interest Income R 1.00 7/26/04 OEP F&M Trust C/0#017-2974748 Interest Income C 36,99 7/27/04 DEP F&M Trust, Acct #34-03548 Interest Income C 2.12 7/29/04 OEP PNC, C/0#21 001 029646 Interest Income 222,18 7/31/04 OEP Waypoint 8ank C/D #566238361 Interest Income R 12.12 7/31/04 DEP Waypoint Bank C/D #566257419 Interest Income R 21.34 7/31/04 DEP Waypoint Bank C/D #1800010447 Interest Income R 29.22 7/31/04 DEP Waypoint Bank C/D #1865299549 Interest Income R 28,79 7/31/04 DEP Waypoint Bank C/D #1865310369 Interest Income R 21.77 7/31/04 DEP Waypoint Bank C/O #8000027565 Interest Income R 53.61 7/31/04 DEP Waypoint Bank C/D #8000036828 Interest Income R 31.67 7/31/04 DEP Waypoint Bank c/D #8000045260 Interest Income R 14,61 7/31/04 DEP Waypoint Bank C/D #8000054738 Interest Income R 29.14 8/2/04 DEP F&M Trust C/D#017-2967692 Interest Income C 17.62 8/2/04 DEP F&M Trust C/D#017-2974712 Interest Income C 20.38 8/2/04 DEP F&M Trust C/D#017-2967691 Interest Income C 17,62 8/2/04 DEP M&T, #31003914571045 TO ACCT 28728068 Interest Income C 35.93 8/3/04 DEP F&M Trust C/D#017-2974763 Interest Income C 13.80 8/5/04 DEP PNC, Acct #51-4001-6701 Interest Income 2.06 8/9/04 DEP M&T Bank, C/D #31003914547187 Interest Income C 66,93 8/10/04 DEP M&T Bank, C/D #31003914579966 Interest Income C 161.37 8/12/04 DEP F&M Trust C/D#017-2974752 Interest Income C 18,90 8/12/04 DEP F&M Trust C/D#017-2974751 Interest Income C 18.90 8/12/04 DEP F&M Trust C/D#017-2974750 Interest Income C 18,90 8/12/04 DEP Waypoint Bank Acct #100698455 Interest Income R 46.20 8/16/04 D EP F&M Trust Interest Income C 14,65 8/20/04 DEP M&T Bank, #028728068 Interest Income C 1.60 8/25/04 DEP M&T, Estate Checking #9833001077 Interest Income R 1.38 8/26/04 F&M Trust, Time Deposit Credit #017-2974748 Interest Income C 38,22 8/26/04 F&M Trust, Acct #28728068 Interest Income C 2.38 8/30/04 DEP PNC, Acct #51-4001-6701 Interest Income 2,38 8/31/04 DEP Fulton Bank, CD#252-0031786 7,25.04 Interest Income R 456.27 8/31/04 DEP Fulton Bank, CD#252-0031786 8,25.04 Interest Income R 471,52 8/31/04 DEP F&M Trust C/D#017-2967692 Interest Income C 17,62 8/31/04 DEP F&M Trust C/D#017-2967691 Interest Income C 17.62 8/31/04 DEP F&M Trust C/D#017-29274712 Interest Income C 20,38 8/31/04 DEP Waypoint Bank C/D #566238361 Interest Income R 12.11 8/31/04 DEP Waypoint Bank C/D #566257419 Interest Income R 21.35 8/31/04 DEP Waypoint Bank C/O #1800010447 Interest Income R 29,22 8/31/04 DEP Waypoint Bank C/D #1865299549 Interest Income R 28.80 8/31/04 dep Waypoint Bank C/D #1865310369 Interest Income R 21.76 8/31/04 DEP Waypoint Bank c/D #188000027565 Interest Income R 53,62 8/31/04 DEP Waypoint Bank C/D #1800010447 Interest Income R 31.68 8/31/04 DEP Waypoint Bank c/D #8000045260 Interest Income R 14.61 8/31/04 DEP Waypoint bank c/O #80000054738 Interest Income R 29.14 8/31/04 DEP Waypoint Bank Acct #100698455 Interest Income R 46.69 9/1/04 OEP M&T, #31003914571045 TO ACCT 28728068 Interest Income C 36.06 9/3/04 DEP F&M Trust C/D#017-292974763 Interest Income C 13,80 9/7 /04 DEP PNC, C/D#21 001 029646 Interest Income 229,57 9/1 0/04 DEP M&~ #31003914579966 TO ACCT 28728068 Interest Income C 161.90 9/10/04 DEP M&T Bank, C/D #31003914547187 Interest Income C 67.15 9/13/04 DEP F&M Trust C/D#017-2974752 Interest Income C 18.90 9/13/04 DEP F&M Trust C/D#017-292974751 Interest Income C 18,90 9/13/04 DEP F&M Trust C/D#017-292974750 Interest Income C 18,90 9/16/04 DEP F&M Trust C/D#017-2974776 Interest Income C 14,65 9/17/04 Waypoint, Acct#100698455 Interest Income R 7,58 9/21/04 DEP M&T Bank, #028728068 Interest Income C 1.71 9/21/04 DEP Waypoint Bank C/D #566238361 Interest Income R 6.25 9/21/04 DEP Waypoint Bank C/D #566257419 Interest Income R 11.02 9/21/04 DEP Waypoint Bank C/D #1800010447 Interest Income R 15,08 9/21/04 DEP Waypoint Bank C/D #1865299549 Interest Income R 14,86 9/21/04 DEP Waypoint Bank C/D #8000027565 Interest Income R 27.67 9/21/04 DEP Waypoint Bank C/D #18000036828 Interest Income R 16.35 9/21/04 DEP Waypoint Bank c/D #8000045260 Interest Income R 7,54 9/21/04 DEP Waypoint Bank C/D #8000054738 Interest Income R 15.04 EXHIEITY Wednesday, July 6, 2005 Oodez Accounting for 1st & Partial - Oodez Checking Acct Page: 3 Income Received - Personal Property 5/14/04 through 7/1/05 Date Num Payee Memo Category CI r Amount 9/21/04 OEP Waypoint Bank C/O #1865310369 Interest Income R " .24 9/24/04 OEP M&T, #9833001077 Interest Income R 2.01 9/27/04 OEP F&M Trust ClO#017-2974748 Interest Income C 38,22 9/2 7 /04 OEP F&M Trust, Acct #34-03548 Interest Income C 2.12 9/29/04 OEP PNC, C/0#21001029646 Interest Income 229,58 10/5/04 OEP PNC, Acct #51 -4001 -6701 Interest Income 2,05 10/13/04 OEP Fulton Bank, CO#252-0031 786 Interest Income 15,33 10/13/04 OEP Fulton Bank, CO#252-0031 786 Interest Income C 471,52 10/15/04 OEP PNC, Acct #51 -4001 -6701 Interest Income 0.66 10/15/04 OEP PNC, C/0#21 001 029646 Interest Income ,14,81 10/15/04 OEP M&T Bank, #028728068 Interest Income C 1.23 10/15/04 OEP M&T, #31003914547187 TO ACCT 28728068 Interest Income C 61,01 10/15/04 M&~ #31003914571045 TO ACCT 28728068 Interest Income C 32.87 10/15/04 OEP M&T, #310033914579966 Interest Income C 147,01 10/15/04 OEP M&~ #31003908148602 Interest Income C 97.16 10/1 5/04 OEP M&T, #31003908148610 Interest Income C 97.16 10/15/04 OEP M& T, #31003908148628 Interest Income C 145.75 10/15/04 OEP M&~ #31003908148701 Interest Income C 101.47 10/15/04 OEP F&M Trust C/0#01 7-2967691 Interest Income C 8,64 10/15/04 OEP F&M Trust ClO#017-296792 Interest Income C 8,64 10/15/04 OEP F&M Trust C/0#017-2974712 Interest Income C 9,88 10/15/04 OEP F&M Trust C/0#017-2974748 Interest Income C 23,38 10/15/04 OEP F&M Trust C/0#017-2974750 Interest Income C 1.76 10/15/04 OEP F&M Trust C/0#017-2974751 Interest Income C 1.76 10/15/04 OEP F&M Trust C/0#017-29274752 Interest Income C 1.76 10/15/04 OEP F&M Trust ClO#017-2974763 Interest Income C 5.33 10/15/04 OEP F&M Trust C/0#017-2974776 Interest Income C 13.70 10/18/04 OEP F&M Trust C/0#017-2967691 Interest Income C 17,05 10/18/04 OEP F&M Trust ClO#017-2967692 Interest Income C 17.05 10/18/04 OEP F&M Trust C/0#017-2974712 Interest Income C 19.73 10/18/04 OEP F&M Trust C/0#017-2974750 Interest Income C 18,29 10/18/04 OEP F&M Trust ClD#2974751 Interest Income C 18.29 10/18/04 OEP F&M Trust C/0#017-2974752 Interest Income C 18,29 10/18/04 OEP F&M Trust C/0#017-2974763 Interest Income C 13.36 10/18/04 OEP F&M Trust, Acct #34-03548 Interest Income C 1.26 10/24/04 OEP M&~ #9833001077 Interest Income 18.22 11/26/04 M&T, #9833001077 Interest Income 11.87 12/24/04 OEP M&T, #9833001077 Interest Income 6,04 1/26/05 OEP M&T, #9833001077 Interest Income 13,57 2/25/05 OEP M&T, #9833001077 Interest Income 16.68 3/25/05 OEP M&T, #9833001077 Interest Income 15,58 4/26/05 OEP M&T, #9833001077 Interest Income 18.27 5/26/05 OEP M&T, #9833001077 Interest Income 18,52 6/24/05 OEP M& T, #9833001077 Interest Income 17,90 T otallnterest Income 7,074,26 T otallncome 7,074,26 Total Income/Expenses 7,074.26 EXHIBIT,.. Wednesday, July 6, 200S Dodez Accounting for 1st & Partial - Dodez Checking Acct Page: 1 Disbursements 5/14/04 through 7/1/05 Date Num Payee Memo Category C I r Amount Income/Expenses Expenses AdvertisinQ 5/26/04 1 Cumberland Law Journal Advertising R -75.00 7/12/04 99 The Sentinel Advertising R ,115.79 T otai Advertising ,190.79 Attorney Fee 7/1/05 Stephen D. Tiley Attorney Fee '23,943,00 Total Attorney Fee -23,943.00 Bank Charaes 7/19/04 102 F&M Trust (4)pages for DOD balance on assets Bank Charges R -20.00 10/22/04 Bank Charge Return Check Option Bank Charges C -10.00 10/26/04 Bank Charge Insufficient Funds Bank Charges C -32,00 Total Bank Charges -62,00 Executor's Fee 12/14/04 123 Daniel Derr Partial Executor's Fee -11,000.00 7/1/05 Daniel Derr Final Executor's Fee -12,943.00 Total Executor's Fee -23,943.00 E.i.=ral 6/28/04 94 Matinchek & Daughter Funeral Home Funeral R -1,102.00 11/9/04 118 Martinchek & Daughter Funeral Funeral ,4,470.00 Total Funeral ,5,5 7Z. 00 Insurance 6/8/04 3 Ohio Casualty Group Automobile Insurance R -499.82 8/25/04 DEP Ohio Casualty Group Automobile Insurance R 406,B5 Total Insurance -92.97 ~ 9/16/04 110 Country Meadows Associates Medical R .67,95 11/9/04 119 HCR,Manor Care Medical '2,518,50 Total Medical '2,586,45 Miscellaneous 5/14/04 Check cleared after Date of Death Miscellaneous -15,08 6/4/04 DEP National Guardian Life Insurance Company Refunded 7/12/04 #97 Miscellaneous R 50,00 6/4/04 DEP National Guardian Life Insurance Company Refunded 7/1 2/04 #97 Miscellaneous R 950.00 6/10/04 6 Scotts Lawn Service 6143569 Miscellaneous R -42.38 6/1 0/04 7 Brian E, Walsh Lawn Service Miscellaneous R '360.00 6/28/04 96 Brian E. Walsh Lawn Service Miscellaneous R -636.00 7/12/04 97 National Guardian Life Insurance Company Returned Miscellaneous R ,1,000.00 7/12/04 98 Brian E, Walsh Lawn Service Miscellaneous R '70.00 7/26/04 DEP Proceeds from Auction Bricker's Auction Exp & Comm Miscellaneous R -1,500.00 7/26/04 102 Brian E. Walsh Lawn Service Miscellaneous R ,300.00 8/4/04 105 Wonders, Ltd Canopy for Auction Miscellaneous R -137.80 8/24/04 107 Brian E. Walsh Lawn Service 7/19-8/12/04 Miscellaneous R -240.00 10/5/04 113 Brian E, Walsh Lawn Service 7/19-8/12/04 Miscellaneous -435.00 10/5/04 115 Daniel Derr Trip Expenses Miscellaneous C -1,858,87 1/6/05 Ebener & Associates & Remax Ebener & Assoc Commision Miscellaneous -4,405.00 1/6/05 Ebener & Associates & Remax Remax Commission Miscellaneous -4,355.00 EXHIBIT-C- Wednesday, July 6, 2005 Dodez Accounting for 1st & Partial - Dodez Checking Acct Page: 2 Disbursements 5/14/04 through 7/1/05 Date Num Payee Memo Category C Ir Amount 1/6/05 American Radon Solutions Radon Miscellaneous ,980.00 1/6/05 5aidis,Shuff,Flower & Lindsay Escrow for Radon Miscellaneous -550.00 1/12/05 128 Brian E, Walsh Lawn Service 8/29/04-11/4/04 Miscellaneous ,410,00 1/27 /05 Ebener & Associates Commission Miscellaneous ,77 2.00 1/27/05 Remax Realty Commission Miscellaneous ,722,00 4/13/05 130 Daniel Derr Expenses Miscellaneous -733,95 7/1/05 Register of Wills Filing Fee for PA Inheritance Tax Return Miscellaneous " 5.00 Total Miscellaneous -18,538,08 fJ:llbm 5/26/04 2 Register of Wills Reimburse F& T Probate R -418,00 7/1/05 Register of Wills Additional Fee Probate -35,00 Total Probate -453.00 ~ Stm 4/13/05 131 PA Department of Revenue T axes:State ,375.00 Total State -375,00 Taxes - Other 7/19/04 101 Darlene l. Moyer, T /C 2004 School Taxes Taxes R '2,376.07 1/6/05 Recorder of Deeds State Tax/stamps Taxes -1,460.00 1/6/05 Refund School Taxes 2005 to 2006 Taxes 1,033,79 1/6/05 County Taxes 1/1/5 to 1/6/05 Taxes -12.60 1/27/05 Refund School Taxes 1/27/05-6/20/05 Taxes 98,57 1/27/05 County Taxes 1/1/5 to 1/27/05 Taxes -7.09 1/27/05 Recorder of Deeds State Tax/stamps Taxes -249.00 Total Taxes - Other -2,972.40 Total Taxes -3,347.40 li1iJ.i.tW; Gas & Electric 6/1 0/04 4 PPL Utilities:Gas & Electric R -26.37 6/1 8/04 93 PPL Utilities:Gas & Electric R ,32.81 7/26/04 103 PPL Utilities:Gas & Electric R -71,30 8/4/04 104 VOIDShipley Energy Utilities:Gas & Electric R 0.00 8/24/04 106 PPL Utilities:Gas & Electric R ,103.15 9/20/04 112 PPL Utilities:Gas & Electric R -91.51 10/26/04 116 PPL Utilities:Gas & Electric C ,23,20 11/22/04 120 PPL Utilities:Gas & Electric -14.18 12/16/04 124 AgNay Utilities:Gas & Electric -395.80 12/17/04 125 PPL Utilities:Gas & Electric -19,37 1/12/05 127 PPL Utilities:Gas & Electric -75.24 Total Gas & Electric -852.93 .I'I'.aW 6/1 0/04 5 Borough of Carlisle Utilities:Water R -'5.08 7/12/04 100 Borough of Carlisle Utilities:Water R ,15.08 7/26/04 101 Borough of Carlisle Utilities:Water R ,16.18 9/1/04 108 Borough of Carlisle Utilities:Water R ,16,18 9/20/04 111 Borough of Carlisle Utilities:Water C ,16,18 10/26/04 117 Borough of Carlisle Utilities:Water -16,18 12/1/04 121 Borough of Carlisle Utilities:Water -16,18 12/29/04 126 Borough of Carlisle Utilities:Water ,16,18 1/6/05 Borough of Carlisle Final Utilities:Water ,16,18 EXHIBIT,,- Wednesday, July 6, 2005 Dodez Accounting for 1st & Partial - Dodez Checking Acct Page: 3 Disbursements 5/14/04 through 7/1/05 Date Num Payee Memo Category C I r Amount Total Water '143.42 Total Utilities ,996,35 Total Expenses ,79,725,04 Total Income/Expenses -79,725,04 EXMBrrV ---- Cii '" .w;o<g~~ :5P)C'"""" o~,.orn ::> iii :5 JJ '':< (\)al:t-~ -:::i" P) ~ c;.." ... ~ z, (fl , -.1,<.,-,. -'~ro~? tv -.1 ~ ' $>O({ls;,~ <f~<::::z ()1 (\) Cf) (\) '" ,. 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'~ ~i'~IJjl~ fJ'; j 9 i ~ ! ~ :t; Z l~s'llt~ III !i: ~r>-C: ~ l~~"'E~~ .l:: _ii ~~o ~~.~~ - 09-13-2005 DUDEZ 05-14-2004 21 04-0491 CUMBERLAND 101 APPEAL DATE: 11-12-2005 ( See reverse side under Objections) Amount R..ittedl I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE _ RETAIN LOWER PORTION FOR YOUR RECORDS _ REy:is47-EX-AFP-io3:0s3-NOTicE"OF-iNHERiTANCE-TAX-APPRAisEMENT:-ALLOWANCE-OR--------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX M L FILE NO. 21 04-0491 ACN 101 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE nnrnrnr[' i"',P('fof'{CE DF INHERITANCE TAX r[A)i'\\:~wp~J;r;~~T, ALLOIlANCE OR DISALLOIlANCE F',""C' C,' ~', OF IIEDQCTIONS AND ASSESSHENT OF TAX 3 n" 2,.[\( e'ED I' r i\ u....v ...1_J 1'- \: L~ 'J DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN ,nl r'-'/ l...).t:\'I\ O;::T~'i':':: [', L '" STEPHEN D TI LEY FREY & TILEY 5 S HANOVER ST CARLISLE "'I 1_,,_ PA 17013 ESTATE OF DODEZ *' REV-1547 EX AFP (06-05) M L TAX RETURN liAS: (X) ACCEPTED AS FILED ) CHANGED DATE 09-13-2005 RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule AJ 2. Stocks and Bonds (Schedule B) 3. Closely Held stock/P.rtnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule DJ 5. Cash/Bank >>-posJts/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule GJ 8. Total Assets (1) (2) (3) (<0) (5) (6) (7) 170,900.00 .00 .00 .00 523.512.00 .00 37,313.00 (B) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/"ortgage Liabilities/Li&ns (Schedule 1) 11. Totel Deductions 12. Net Value of Tax Return 13. Charlt8ble/Gover~ntal aequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) 110) 54,562.00 24.996 00 Ill) 112) 113) (1<0) NOTE: I~ an assess.ent was issued previoUSly, lines r.rlect ~igures that include the total o~ ALL ASSESSMENT OF TAX: IS. Aaount of line 14 at Spousal rat. (15) 16. Amount of line 14 taxable at lineal/Class A rate (16) 17. AMount of Line 14 at Sibling rat. (17) 18. Anount of line 14 taxable at Collateral/Class Brat. (18) 19. PrincipIIl Tax ~ D : NOTE: To insure proper credi t to )l'our account, submit the upper portion of this forn with your t.x pa)fllent. 731,725.00 7Q.~1]8 nn 652,167.00 652,167.00 .00 14, 15 and'or 16, 17, 18 and 19 will returns assessed to date. .00 X 00 = .00 X 045 = .00 X 12 = .00 X 15 = 119)= + INTEREST/PEN PAID (-) AHOUNT PAID DATE IlUllBER TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 .00 .00 .00 .00 .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYKENT IS REllUIRED. ~ IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FDRN FOR INSTRUCTIONS.) - ESTATE OF M. LUCILLE DODEZ Deceased IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ORPHANS' COURT DIVISION NO. 21-04-049] ORDER OF COURT AND NOW, this ~day of October, 2005, the within account is confirmed and distribution directed in accordance with the schedule. By the Court, 'mw RJ( ':'-.J C", ! " .:..."j 'S "l..." \1\ ".l1., '\\J-'~."-Js:. \)\~ \J~'X~ \~ 'S-\'X.'J~""\\\~,,\ \.<";'<. Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 3/29/2006 TILEY STEPHEN D 5 S HANOVER STREET CARLISLE, PA 17013 RE: Estate of DODEZ M LUCILLE File Number: 2004-00491 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 5/14/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~~~J Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 3/29/2006 DERR DANIEL 2293 FOXIANNA ROAD MIDDLETOWN, PA 17057 RE: Estate of DODEZ M LUCILLE File Number: 2004-00491 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 5/14/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~~~/k~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel #' <t' Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: />?" .L<< ~./~ ~hL Date of Death: /:?17 /~ 07t.Oo:?' Estate No.: de;?~ y - C/C?;:Y?/ Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes 0' No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the ~ersonal representative file a final account with the Court? Yes IB' No 0 ~A'rJ'<z'/7I~/ ?J~~.6J~ ~ ~ b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the person9presentative s~te an account informally to the parties in interest? Yes e1 No 0 fu,/~"""''''''~ ,A1~..,-,~ c./, c. Copies of receipts, releases, joinders and approval of fonnal or informal accounts may. be filed with the Cl~rk of the Orphans' Court and may be _ attached to this report. 5~ /~~ /~/ ,..-./~/~ ~~.r ~ o-r;4.e ~ e9~ ~~A'ZK~y 6-e~e'~ 4-#-~~~L -<)~ ~; k~ c-/~/ ?'~*~&'~ .3S ~- ~ .-....i.\,. I') ~~? .~W'" &~...flc:~ Signature ' ~"L~.,P,/~ 27 /~ - ~V , /' ~~ ...:r~~ ,;4/~61v~ ~ ~~L~t/ ,/J#- /7a7-3 Address / Date: 0/&6 0J I c.:::. c...._ '7/7-JJ/?- :J-~J;? Telephone No. ...~..,~: Capacity: 0 Personal Representative Q.eounsel for personal representative {:J ..~.-. t= ~. :.. Lq .' E'....!j;)~.~~.:.. I . .,r" COMMONWEALTH OF PENNSYLVANIA OFFICE OF ATTORNEY GENERAL November 2, 2005 TOM CORBETT ATTORNEY GENERAL Charitable Trusts & Organizations Section 14 th Floor, Strawberry Square Harrisburg, Pennsylvania 17120 717-783-2853/717-787-1190 (Fax) mfoerster@attomeygeneral.gov Stephen D. Tiley, Esquire Frey & Tiley 5 South Hanover Street Carlisle, P A 17013 Re: Estate of M. Lucille Dodez 21-2005-0491 Dear Mr. Tiley: This will acknowledge receipt of notice regarding the above captioned matter. I have reviewed the Second & Final Account and other information that you have supplied and have no objection. Having all the information that I need, I will now close my file. Please be advised that the above review was made pursuant to the parens patriae authority of this Office and is limited to that function. Thank you for your time and consideration of this matter. /mtf Stephen D. Tiley A ttorney at Law 5 South Hanover Street Carlisle, P A 17013-3307 WA TCBTOWER Bible and Tract Society of Pennsylvania Charitable Planning Office 100 Watchtower Drive, Patterson, NY 12563-9204, U.S.A. Phone: (845) 306-0707 Fax: (845) 306-0709 October 31, 2005 Re: Estate of M. Lucille Dodez Dear Mr. Tiley: We received your letter dated October 26, 2005, as well as the three checks totaling $47,754.52. It has been a pleasure working with you in the administration of this estate. Thank you for your efforts in bringing this to a successful conclusion. We will write to Daniel Derr, the executor, to thank him for his services. EN:cr ; . Very truly yours, ~~1,b~ Erna Neufeld Associate General Counsel A NONPROFIT CORPORATION