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Home My WebLink About02-0241PETITION FOR PROBATE and GRANT OF LETTERS Estate of ETHEL IRENE MARKS also known as Deceased. Social Security No. 199-32-2291A No._~. ]-t~9-~. ~1 To: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioners are 18 years of age or older and the Co-Executors named in the last will of the above decedent, dated January 26, 1992 and codicil(s) dated [none]. Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 1212 Goodyear Road, Dickinson Township, Gardners, Pennsylvania. Decedent, then 91 years of age, died February 12, 2002, at 1212 Goodyear Road, Dickinson Township, Gardners, Pennsylvania. Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: [none] 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 of real estate in Pennsylvania situated as follows: 1030 Myerstown Road, Gardners, PA 17324 $ 30,000.00 $ $ 300,000.00 WHEREFORE, petitioners respectfully request the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary thereon. Irene Gel~ger ~ Clair E. Marks 1212 Goodyear Road, Gardne'r~, PA 17324 4369 Carlisle Road, Gardners, PA 17324 Carr O. Ma~s. , a/k/a Cart B. Marks / Charles O. Marks 1971 Shippensburg Road, Biglerville, PA 17307 1155 Goodyear Road, Gardners, PA 17324 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF CUMBERLAND ) The petiOoner above-named swears or affirms that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner and that as personal representative of the above decedent, petitioner will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this 6th day of ~4gaRCH ,2002 '~Y ~~-- ,/ ~egister // ar~ Irene Gelsin~r OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF CUMBERLAND ) The petitioner above-named swears or affirms that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner and that as personal representative of the above decedent, petitioner will well and truly administer the estate according to law. Sworn to or affirmed and suosc.~bed before me this 6th day of 2/H ,2002. R&istev/ MAI~C LEW:S' ' ' ' '/ Clair E. Marks OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF CUMBERLAND ) The petitioner above-named swears or affirms that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner and that as personal representative of the above decedent, petitioner will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this 6th da3, of k~CH , ,2002. Carr O./Marks, a/k/a Carr B. Marks OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF CUMBERLAND ) The petitioner above-named swears or affirms that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner and that as personal representative of the above decedent, petitioner will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this 6th daY of Charles O. Marks MARCH ,2002. l~egist~/ ~ C ~!~ ' / No. ! Estate of ETHEL IRENE MARKS, Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW, MARCH 7 ., 2002, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated January 26, 1992, and described therein be admitted to probate and filed of record as the last will of Ethel Irene Marks and Letters Testamentary are hereby granted to Carolyn Irene Gelsinger, Clair E. Marks, Carr O. Marks, a/k/a Carr B. Marks, and Charles O. Marks. Will Book # 17 Page 47 '1~¥ C ~EhrlS '~'/ Regist~;Of W~lls - > ~ FEES Probate, Letters, Etc. $ 305.00 Short Certificates(4 ) $ 12.o0 X~ ~ PAGES $ 6.00 JCP $ 5.00 TOTAL $ 328.00 Filed MARCH 6, 2002 called attorney on 3-7-02 Stephen L. Bloom, Esquire Sup. Ct. I.D. No. 49811 2100 Longs Gap Road Carlisle, PA 17013 (717) 249-7717 {2_ I C:kLAS~ESTATES\ 10157-2pet I ARNING: IT IS ILLEGAL TO ALTER THIS COPY OR TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS LOCAL REGISTRAR'S CERTIFICATION OF DEATH CERT. NO. T 5074[;22 Februa~ 13, 2002 Date of Iss~e of Thi~ Certification Name of Decedent Ethel Irene Marks Female 199-32-2291A Sex. Social Security No. Date of Birth 5-21-1910 __ Birthplace 1212 Goodyear Road, Cumberland County, Place, of Death White Housewife Race .. Occupation Widowed Decedent's Date of Death February 12, 2002 Gardners, Adams County, Pennsylvania Penns' South Dickison Township No Armed Forces? (Yes or No) Marital Status ............... Mailing Address Carolyn I. Gelsinger !nforrnant Funeral Director Name and Address of Dugan Funeral Home, Inc., Bendersville, PA 17306 Funeral Establishment Immediate Cause Lymphoma. (a) (b) (c) Part I: Chronic lymphocytic leukemia. Part I1: 1212 C,-oodyear Road, Gardners, PA 17324 M. Lee Dugan (d) Other Significant Conditions Manner of Death Natural Accident Homicide /Ivania Interval Between Onset and Death · Describe how injury occurred: Pending Investigation Suic:ide ~ Could not be Determined L~ Name and Title of Certfier Adclress Terry A. Robisom D.O. 220 Wilson Street, Carlisle, PA 17013 (M.D., D.C., Coroner, M.E.) 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. T,b~original certificate will be forwarded to the State Vital Records Office for permanent fil(ng/~,~ / /'~ /,~ F~m~ 13, 2~2 ' 124 ~ce Av~e, ~¢e~le, PA 17307 ~~~t ~i11 ~rc~ C~1P~t~mPnt I, ETHEL IRENE MARKS, of Dickinson Township, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. I. I bequeath the sum of Five Thousand ($5,000) Dollars in memory of my husband, JOHN O. MARKS and myself to the URIAH UNITED METHODIST CHURCH of Gardners, Pennsylvania, to be used as the church desires and for the upkeep of the cemetery. II. All the rest, residue and remainder of my estate of every nature and whereon situate I devise and bequeath in equal shares to such of my children, CARR B. MARKS, CAROLYN IRENE GELSINGER, CHARLES O. MARKS, and GLAIR E. MARKS as survive me by thirty days. III. Should any of my sons, CARR B. MARKS, CHARLES O. MARKS and GLAIR E. MARKS, or my daughter, CAROLYN IRENE GELSINGER, predecease me or die on or before the thirtieth day following my death, I devise and bequeath the share of such child to his or her issue per stirpes living on the thirty-first day following my death; and should any of my said children leave no such issue living on the thirty-first day following my death, I devise and bequeath the share of such child or children in equal shares to my other children or to their issue per stirpes living on the `~' `~.~ =~~ J r~:. ,-~. .~ ~~ .1~ -: i; .1, thirty-first day following my death. IV. If any income or principal shall be payable to any person who shall be a minor or who shall be incapacitated for any reason, my executor as trustee shall hold such income and principal during minority or incapacity and shall be entitled to apply such income and principal to the health, maintenance, support and education of such person during minority or incapacity without the appointment of any guardian or committee or any authority of court. My executor as trustee shall be entitled to make direct application hereunder or to make application by payment of income and principal to the parent or other person in charge of such minor or incapacitated person, or to his or her guardian or to a custodian under the Uniform Gifts to Minors Act. Any remaining income and principal to which such person shall be entitled shall be distributed to such person upon the termination of minority or incapacity. My executor as trustee shall have the same powers as my executor and shall serve without bond. V. I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. VI. I appoint my four children, CARR O. MARKS, CAROLYN IRENE GELSINGER, CHARLES O. MARRS, and CLAIR E. MARRS, or the survivors of them co-executors of this my last will. VII. I direct that none of my executors shall be required to give bond for the faithful performance of their duties in any J ~~~~~ a .~:~ ~. _-_.1 ~~ ~J ~J :~ jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand this.-,~;. z, day of ,T~n~,:~r~ 199. ~_ is ~ 'I / ' ~' ~ ~ s ETHEL IRENE MARK3? The preceding instrument, consisting of this and two other typewritten pages identified by the signature of the testatrix, ETHEL IRENE MARKS, was on the day and date thereof signed, published and declared by ETHEL IRENE MARKS, the testatrix therein named, as and for her last will, in the presence of us, who, at her request, in her presence, and in the presence of each other have subscribed our names as witnesses hereto. CARQg 1~;~ ~niv~ ~ ' ~ Ca e~ i,i ~fl'3 Ai'I ~Ctntt~ ~- i.~ ~~ ~' `~~ /ff/,. ~t~'id ~1 _ ~,i.-~!/~.^--~ ,a~E_?~ C ~ CJi = ~o..i ~:..R.e-A-! ':f , ~ ~ _' ~;? - / ~` t,/ /1 7 STEPHEN L. BLOOM ATTORNEY AND COUNSELLOR AT LAW 2100 LONGS GAP ROAD CARLISLE, PENNSYLVANIA 17013 717-249-7717 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: ETHEL IRENE MARKS Date of Death: February 12, 2002 File No. 21-02-0241 To the Register: I certify that Notice of Beneficial Interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above estate on March 15, 2002: Name Address Uriah United Methodist Church Carolyn I. Gelsinger Carr B. Marks Charles O. Marks Clair E. Marks 925 Goodyear Road, Gardners, PA 17324 1212 Goodyear Road, Gardners, PA 17324 1971 Shippensburg Road, Biglerville, PA 17307 1155 Goodyear Road, Gardners, PA 17324 4369 Carlisle Road, Gardners, PA 17324 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: N/A Date:March 19,2002 ~ ~-~--~- tep en L Boom, Esquire 2100 Longs Gap Road Carlisle, PA 17013 (717) 249-7717 Capacity: Counsel for Personal Representatives C:\LAS~Estates\ 10157-2cert.not COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 0011 57 BLOOM STEPHEN L 2100 LONGS GAP ROAD CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 199-32-2291 FILE NUMBER: 2102-0241 DECEDENT NAME: MARKS ETHEL IRENE DATE OF PAYMENT: 05/09/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 02/12/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $16,966.06 REMARKS: TOTAL AMOUNT PAID: STEPHEN L BLOOM ESQUIRE $16,966.06 SEAL CHECK# 104 INITIALS' JA RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT, 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD REV-1162 EX(11-96) 001 528 BLOOM STEPHEN L ~.SQUZR~. 2100 LONGS GAP ROAD CARLISLE, PA 17013 ........ foid ESTATE INFORMATION: SSN: 199-32-2291 FILE NUMBER: 2102-0241 DECEDENT NAME: MARKS ETHEL IRENE DATE OF PAYMENT: 08/15/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 02/12/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $856.10 TOTAL AMOUNT PAID: $856.10 REMARKS: CAROLYN I GELSINGER,CLAIR E & CARR O & CHARLES O MARKS C/O SEAL CHECK# 112 INITIALS: SK RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS ,REV-~oo EX, (6-00) REV-1500 INHERITANCE TAX RETURI~ COMMONWEALTH OF PENNSYLVANIA DEPT. 28060~ n~,DENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 21-02-0241 NUMBER COUNTYCODE YEAR CAJ HP' EP CR KO C O R R E S 199-32-2291A THIS RETURN MUST liE FILED IN DUPLICATE WiTH THE REGISTER OF WILLS 4; Supplemental Return ~er Return 1. Original Return 2. Future Interest Comprom s~'e (date of death after 12-1:>-82) [~ 5. Federal Estate Tax ~ 4. Limited Estate , __ Return Required 6. Decedent Died Testate Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach copy of Will) (Attach copy of Trust) - ~ [] 9. Lit/gation Proceeds Received J~ 10. Spousal Poverty Credit E~ 11. Election to tax under Sec. 9113(A) NAME ~hen L. Bloom, Esquire FIRM NAME (If Applicable) )hen L. Bloom, Esquire TELEPHONE NUMBER (date of death between 1Z~31-~[~?} (Attach Sch O) COMPLETE MAILING ADDRESS .!~i!~iiiiiiiii R E C A P I T U L A T I O N 2100 Longs Gap Road Carlisle, PA 17013 (1) 374,000.00 (2) None (3) None (4) None ($) 42,255.79 (6) Nona (7) 26,489.68 19,510.26 1,342.57 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) Total Gross Assets (total Lines 1-7) (8) 442,745.47 (11). (12) (13)_ 20,852.83 421,892.64 5,000.00 (14) 416,892.64 C 8o 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortga§e Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) T A X SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES O M 15. Amount of Line 14 taxable at the spousal tax AT rate, or transfers under Sec. 9116(a)(1.2) T 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate O N 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 0.00 x .0 0 416,892.64 x .o'45 0.00 x ]12 0.00 x .15 (16) (16) (17) 0.00 18,760.17 0.00 18,760.17 Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 1212 Goodyear Road CIIY Gardners Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 0.00 16,966.06 938.01 Interest/Penalty if applicable D. Interest E. Penalty STATE ZIP PA 17324 (1) 18,760.17 Total Credits ( A + B + C ) (2) 17,904.07 0.00 0.00 856.10 0.00 856.10 Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to re(luest 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. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ......................... ~ F~ b. retain the right to designate who shall use the property transferred or its income; ........... c. retain a reversionary interest; or .................................... d. receive the promise for life of either payments, benefits or care? ................... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................ E~ [~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............................................. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................ E~ E~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Carolyn I. Gelsinger, Co-Executor DATE · ~ ~ 1212 Goodvear Road S NCG..NCG..NCG..NCG.~U EI~PRE~I'H~E~RE%ENTATIVE Stephen L. Bloom, Esquire ~ ~ - ~' 2100 Longs Gap Road i -7- l---iydi ........................... For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2) [72 P.S. 9116(a)(1 )]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(a){1.3)]. A sibling is defined, under Section 9102., as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (c) Z000 form software only The Lackner Group, Inc. Form REV- 1,~00 EX (Rev. 6-00) ADDITIONAL Personal Representatives Estate of Ethel I. Marks SS# 199-32-2291A 02/12/2002 Under penalties of perjury, the undersigned declare that they have examined this return, including accompanying schedules and statements, and to the best of their knowledge and belief, it is true, correct and complete. Signature Name Address Line 1 Address Line 2 City, State, Zip Date Clair E. Marks, Co-Executor 4369 Carlisle Road Gardners, PA 17324 Signature Marne Address Line 1 Address Line 2 City, State, Zip Date 1971 Shippensburg Road Biglerville, PA 17307 Signature Name Address Line 1 Address Line 2 City, State, Zip Date Charles O. Marks, Co-Executor 1155 Goodyear Road Gardn~rs,! PA 17324 REV-I$0Z EX + (1-97) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Ethel I. Marks SS# 199-32-2291A 02/12/2002 21-02-0241 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 140.87 Acre farm located at 1030 Myerstown Road, Gardners, PA (single-family dwelling, barn and outbuildings). See attached Appraisal Report. TOTAL (Also enter on line 1, Recapitulation) VALUE AT DATE Of DEATH 374,000.00 374,000.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1502 EX (Rev. 1-97) REV-1508 EX + (1-97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Ethel I. Marks SS# 199-32-2291A 02/12/2002 21-02-0241 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 2 3 4 5 6 7 8 Certificate Certificate Certificate Certificate of Deposit #640107769, Adams County National Bank of Deposit #153927, Adams County National Bank of Deposit #640107769, Credit interest of Deposit #153927, Credit interest Checking Account #1967835, Adams County National Bank Conseco Insurance, Refund State Employee's Retirement System Personal Property 14,027.85 15,000.85 39.24 47.13 7,158.33 872.79 116.60 4,993.00 TOTAL (Also enter on line 5, Recapitulation) $ 42,255.79 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) REV-lSl0 EX+(1-97) SCHEDULE G INTER-VIVOS TRANSFERS & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAXRETURN MlSC, NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF Ethel I. Marks SS# 199-32-2291A 02/12/2002 FILE NUMBER 21-02-0241 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. DESCRIPTION OF PROPERTY % OF ITEM INCLUDE THE NAME OF THE TRANSFERE~THEIR DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE RELATIONSHIP TO DECEDENT AN D THE DATE OF TRANSFER. NUMBER ATTACH A COPYOF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST 0F APPLICABLE) 1 Erie Tax-Deferred Annuity, 25,055.83 100.00% 0.00 25,055.83 Acct. #0602689 2 Unimproved agricultural 4,433.85 100.00% 3,000.00 1,433.85 land conveyed from Decedent's main farm property in Deed Book 246, Page 279 (0.17 acres) and Deed Book 246, Page 282 (1.50 acres) based on appraised value of $2,655 per acre (see page 10 of Appraisal Report attached). TOTAL(Alsoenteronline7, Recapitulation) $ 26,489.68 (If more space is needed, insert additional sheets of the same raze) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1510 EX (Rev. 1-97) REV- 1511 EX + (1-97) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Ethel I. Marks SS~/ 199-32-2291A 02/12/2002 21-02-0241 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION 1 2 3 4 5 6 FUNERAL EXPENSES: Dugan Funeral Home, Inc. Word & Song ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: Attorney's Fees Stephen L. Bloom, Esquire Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Carolyn I. Gelsin~er $treet Address 1212 Goodyear Road City Gardners State PA Zip 17324 Relationship of Claimant to Decedent Daughter Probate Fees Register of Wills Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Charles O. Marks, Reimbursement for Death Certificates Diversified Appraisal Services Real Estate Appraisal GPU, Utility bill Harland Checks, Estate checks Met-Ed, Utility Bill Roy D. Gottshall - Personal Property Appraisal Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT 6,875.60 17.90 8,000.00 3,500.00 328.00 65.00 8.00 350.00 48.32 11.60 58.77 75.00 172.07 $ 19,510.26 Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) Estate of: Ethel I. Marks Soc Sec #: 199-32-2291A Date of Death: 02/12/2002 Item Description Continuation of Schedule H-B7 (Other Administrative Costs) Amount The Cumberland Law Journal - Publication of Legal Notice The Sentinel - Publication of Legal Notice 75.00 97.07 172.07 REV-151Z EX + (1-97/ SCHEDULE I COMMONWEA,TH OF PENNS¥'VAN~A DEBTS OF DECEDENT, INHERITANCE TAX RETURN RESIDENT DECEDENT MORTGAGE LIABILITIES, AND LIENS ESTATE OF FILE NUMBER Ethel I. Marks SS# 199-32-2291A 02/12/2002 21-02-0241 Include unreimbursed medical expenses. ITEM NUMBER AMOUNT 1 2 3 4 5 DESCRIPTION 2002 County/Township Real Estate Taxes Carlisle Imaging, Final Illness Everett Cash Mutual Ins. Co. Masland Associates, Inc., Final Illness State Employees' Retirement System, Refund of overpayment TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) 664.11 15.36 508.50 84.64 69.96 $ 1,342.57 Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) REV- 1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE ]'AX RETURN RESIDENT DECEDENT ESTATE OF Ethel . Marks SS~ 199-32-2291A NUMBER 4 SCHEDULE J BENEFICIARIES FILE NUMBER 02/12/2002 21- 02- 0241 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE II. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under S~. 9116~)(1.2)] Carolyn I. Celsinger 1212 Goodyear Road Gardners, PA 17324 Carr B. Marks 1971 Shippensburg Road Biglerville, PA 17307 Charles O. Marks 1155 Goodyear Road Gardners, PA 17324 Clair E. Marks 4369 Carlisle Road Gardners, PA 17324 Daughter Son Son Son 1/4 Estate Residue 1/4 Estate Residue 1/4 Estate Residue 1/4 Estate Residue ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 5,000.00 B. CHARITABLEAND GOVERNMENTALDISTRIBUTIONS Uriah United Methodist Church $ 5,000.00 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET (If more space is needed, insert additional sheets of the same size) Copyright (c) Z000 form software only The Lackner Group, Inc. Form REV- 1513 EX (Rev, 9-00) I, ETHEL IRENE MARKS, of Dickinson Township, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. I. I bequeath the sum of Five Thousand ($5,000) Dollars in memory of my husband, JOHN O. MARKS and myself to the URIAH UNITED METHODIST CHURCH of Oardners, Pennsylvania, to be used as the church desires and for the upkeep of the cemetery. II. All the rest, residue and remainder of my estate of every nature and whereon situate I devise and bequeath in equal shares to such of my children, CARR B. MARKS, CAROLYN IRENE OELSINGER, CHARLES O. MARKS, and CLAIR E. MARKS as survive me by thirty days. III. Should any of my sons, CARR B. MARKS, CHARLES O. MARKS and CLAIR E. MARKS, or my daughter, CAROLYN IRENE GELSINGER, predecease me or die on or before the thirtieth day following my death, I devise and bequeath the share of such child to his or her issue per stirpes living on the thirty-first day following my death; and should any of my said children leave no such issue living on the thirty-first day following my death, I devise and bequeath the share of such child or children in equal shares to my other children or to their issue per stirpes living on the thirty-first day following my death. IV. If any income or principal shall be payable to any person who shall be a minor or who shall be incapacitated for any reason, my executor as trustee shall hold such income and principal during minority or incapacity and shall be entitled to apply such income and principal to the health, maintenance, support and education of such person during minority or incapacity without the appointment of any guardian or committee or any authority of court. My executor as trustee shall be entitled to make direct application hereunder or to make application by payment of income and principal to the parent or other person in charge of such minor or incapacitated person, or to his or her guardian or to a custodian under the Uniform Gifts to Minors Act. Any remaining income and principal to which such person shall be entitled shall be distributed to such person upon the termination of minority or incapacity. My executor as trustee shall have the same powers as my executor and shall serve without bond. V. I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. VI. I appoint my four children, CARR O. MARKS, CAROLYN IRENE GELSINGER, CHARLES O. MARKS, and CLAIR E. MARKS, or the survivors of them co-executors of this my last will. VII. I direct that none of my executors shall be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand this day of ~n~r~ , 199~. ETHEL IRENE M~RK~ The preceding instrument, consisting of this and two other typewritten pages identified by the signature of the testatrix, ETHEL IRENE MARKS, was on the day and date thereof signed, published and declared by ETHEL IRENE MARKS, the testatrix therein named, as and for her last will, in the presence of us, who, at her request, in her presence, and in the presence of each other have subscribed our names as witnesses hereto. APPRAISAL REPORT OF A 140.87-ACRE FARM LOCATED AT 1030 MYERSTOWN ROAD GARDNERS, PENNSYLVANIA PREPARED FOR THE ESTATE OF ETHEL I. MARKS AS OF FEBRUARY 12, 2002 BY LARRY E. FOOTE DIVERSIFIED APPRAISAL SERVICES EAST HIGH STREET, SUITE 101 CARLISLE, PENNSYLVANIA 17013-3052 (717) 249-2758 SUMMARY OF IMPORTANT FACTS AND CONCLUSIONS LOCATION: TAX PARCEL NUMBERS: IMPROVEMENTS: PROPERTY RIGHTS: SCOPE OF THE ASSIGNMENT: OBJECTIVE: EFFECTIVE DATE: HIGHEST AND BEST USE: COST APPROACH: SALES APPROACH: INCOME APPROACH: FINAL VALUE CONCLUSION: 1030 Myerstown Road Gardners, Pennsylvania 08-15-0199-011 and 08-16-0210-031. A single-family dwelling, barn and outbuildings. Fee simple interest. The scope of the assignment included an analysis of the subject's area, an inspection of the subject property, an estimation of the property's highest and best use, consideration of all three approaches to value, and the application of those relevant to the valuation of the subject. To estimate the market value of the subject property as unencumbered. February 12, 2002. Continued use as a farm. N.A. $374,000 N.A. $374,000 2 05~08/2002 16:01 FAX 717 249 7757 $~ephen L, Bloom, Esq ~ ~orl Sulllva PURPOSE OF THE APPRAISAL The purpose of this appraisal is to estimate the Market Value of the subject property as of February 12, 2002. Market Value, as defined by the courts, is the most probable price estimated in terms of money which a property will bring if exposed for sale in the open market, allowing a reasonable time finding a purchaser who buys with knowledge of all the uses to which it is adapted and for which it is capable of being used. Frequently, it is referred to as the price at which a willing seller would sell and a willing buyer would buy, neither being under abnormal pressure. HIGHEST AND BEST USE Highest and Best Use is defined by the Appraisal Terminology and Handbook, published by the Appraisal Institute, as "the most profitable likely use to which a property can be put". The opinion of such use may be based on the highest and most profitable continuous use to which the property is adapted and needed, or likely to be in demand, in the reasonable near future. However, elements affecting value that depend upon events or a combination of occurrences which, while within the realm of possibility, are not fairly shown to be reasonably probable, should be excluded from consideration. Also, if the intended use is dependent on an uncertain act of another person, the intention cannot be considered. Based on the above definition and after seeing the site, neighborhood, and area, it is my opinion that the present use of the subject is its Highest and Best Use. SITE DATA ADDRESS: TOWNSHIP: COUNTY: STATE: LOT SIZE: SEWERS: WATER: ELECTRICITY: LANDSCAPING: 1030 Myerstown Road Dickinson Cumberland Pennsylvania Approximately. 140.87 acres of hilly land with some woodland. On-site septic system. On-site well. GPU Typical for the area, with a sodded lawn, trees and shrubs around the dwelling. None. DETRIMENTAL INFLUENCES Pride of ownership is evident throughout the general area. DESCRIPTION OF IMPROVEMENTS GENERAL DESCRIPTION: Two-story detached 112 year old single-family dwelling containing approximately 1,144 square feet of gross living area above grade, with two one- story attached storage rooms attached to the rear of the dwelling. CONDITION: Exterior: Fair to average. Interior: Fair ROOMS: First Floor: Living room, kitchen and full bathroom. Second Floor: Three bedrooms and one-half bathroom. Basement: Full, with a concrete floor. EXTERIOR: Foundation: Walls: Sash: Gutters: Roofi Storm units: Stone Asbestos shingles. Wood-framed, double-hung and some replacement windows. Steel, painted. Metal Combination throughout. INTERIOR, PRINCIPAL ROOMS: Flooring: Carpet Walls: Plaster Ceilings: Piaster and acoustical tile blocks. Trim: Wood, painted. KITCHEN: Cabinets: Counters: Walls: Flooring: Sink: Knotty pine. Vinyl Painted wood and plaster. Vinyl Double-bowl, stainless steel. BATHROOMS: Flooring: Walls: Bathtub: Lavatory: Water closet: Vinyl Painted plaster and painted drywall. Built-in, with shower. Wall-mounted. Two-piece. Medicine Cabinet: Built-in. CONSTRUCTION: Joists: Wood Beams: Wood Columns: Steel Plumbing: Copper HEATING: Baseboard electric. HOT WATER: Electric, 80-gallon. ELECTRIC: Circuit breaker system, 200-ampere. OTHER: Also located on the site is a wooden barn in poor condition, wooden smoke house in average condition, wooden two-car garage with two storage levels above the garage in average condition, wooden stable in fair condition, wooden wagon shed in fair condition, wooden equipment storage building in fair condition, and a wooden poultry house in fair condition. GENERAL CONDITION: All improvements are considered to be in fair to average condition on the interior and on the exterior, with mechanical systems appearing to be adequate and 6 functioning properly. There is pealing paint on the exterior wood trim of'the dwelling and thereare no closets in the bedrooms. 7 SALES COMPARISON APPROACH In arriving at this conclusion of the value of the subject property, the appraiser made a survey of properties that have sold in the area of the subject property. Consideration was given and adjustments were made on each comparable sale as to time of sale, size, location, as well as all other factors that might affect value. A resume of some of the sales considered by the appraiser is as follows: SALE NO. 1: Location: Date of Sale: Sale Price: Buildings: Land Size: Unit Price: 1137 Spring Garden Street, Carlisle. (South Middleton Township) March 23,2001 $400,000 2,000 square foot brick dwelling built in 1873, in average condition; garage, barn, corn crib, 8 storage buildings and 3 silos in poor to fair condition. 103.50 acres. $3,865 per acre. SALE NO. 2: Location: Date of Sale: Sale Price: Buildings: Land Size: Unit Price: 1610 Enola Road, Carlisle. (North Middleton Township) October 2, 2000. $450,000 2,836 square foot stone dwelling built in 1845, in good condition; garage, barn and 4 storage buildings in average condition. 141.82 acres. $3,173 per acre. SALE NO. 3: Location: Date of Sale: Sale Price: Buildings: Land Size: Unit Price: 80 Wildwood Road, Newville. (Upper Frankford Township) October 12, 2001. $265,000 1,730 square foot frame dwelling built in 1881, in average condition; garage, 2 barns, wagon shed and riding ring in good condition. 80.00 acres. $3,313 per acre. The appraiser, in addition to the sales listed, also considered several additional sales in arriving at his final opinion of value. On the Sales Comparison Analysis,form that folloWSthis page are dollar adjustments reflecting market reaction to those items of significant variation between the subject and comparable properties. If a significant item in the comparable property is superior to, or more favorable than, the subject property, a minus (-) adjustment is made, thus reducing the indicated value of the subject; if a significant item in the comparable is inferior to, or less favorable than, the subject property, a plus (+) adjustment is made, thus increasing the indicated value of the subject. After making all of the necessary adjustments, it is the appraiser's considered opinion that the indicated value of the subject property by the Sales Comparison Approach is $374,000. 9 SALES ADJUSTMENTS The appraiser has analyzed comparable sales and has developed dollar adjustments, reflecting market reaction to those items of significant variation between the subject and comparable properties. If a significant item in the comparable property is superior to, or more favorable than the subject property, a minus (-) adjustment is made, thus reducing the indicated value of the subject. Ifa significant item in the comparable is inferior to, or less favorable than the subject property, a plus (+) adjustment is made, thus increasing the indicated value of the subject. SALE #1 SALE #2 SALE Sale Price Location Land Size Soil Quality Dwelling Size Dwelling Quality and Condition Farm Buildings Net Adjustment Indicated Value of Subject $400,000 $450,000 $265,000 -40,000 45,000 +74,700 -1,900 +121,700. *45,000 +26,500 -17,100 -33,800 -11,200 -10,000 -20,000 -5,000 -20,000 -40,000 +7,600 -75,700 +92,000 $407,600 $374,300 $357,000 Final Indicated Value of the Subject Property: $374,000 ($2,655 per acre) 10 NATIONAL BANK March 22, 2002 Stephen L Bloom 2100 Longs Gap Road Carlisle, PA 17013 Re: Estate of Ethel Irene Marks Dear Mr. Bloom: The following information is being provided as per your request: Acct. Type Acct. Acct. Acc. Int. Ownership Date Number Principal to D.O.D. Opened On D.O.D C.D. C.D. Checking 640107769 $14,000.00 $27.85 Individual 3-21-94 153927 $15,000. O0 $0,85 Individual 8-11-00 1967835 $7,155.34 $2.99 Individual 1-01-60 Inquiries concerning ACNB Corporation stock information should be directed to the Registrar and Transfer Company at 1-800-368-5948, If you need any additional information, please feel free to contact me. Sincerely, Lois A. Kime Certificate of Deposit Coordinator LAK/Ik This appraisal competed 06/11/02 09:46 FAX 7176372454 Miller-Hanover MI'LLE _ _, ,IOVEtL FAX TRANSMITTAL 334 Hi{Ih Street; Hanover, PA '17'331 · of I!a{tes Ind.ding Cover Sheet: ~01 rhouet 7~ Il J{llOIle, , REMARKS: ax Phone: Reply AScii' , {71'0 ¢71T~ I'llI ImemIII L FROM 7176372454 TO Lori A. Sullivan 6/11/02 10:39 AM Page 1 ETHEL I. MARKS 12/12/94 25000.00 PER ATTACHED APPLICATION 12/12/2004 365-712 84 369.19 EFL-1225 GENERAL PROVISIONS INCOME BENEFITS DEATH BENEFIT CONTRACT OWNERSHIP AND BENEFICIARY INCONTESTABILITY We will pay the Annuitant, if living, a monthly income: 1. Beginning on the Retirement Date, as shown on the policy cover page or an endorsement; and 2. Computed on the Accumulated Value as of that date. If you do not want this monthly income, you may elect, by written request prior to the Retirement Date, either: 1. To receive payment of the Cash Surrender Value of this Policy; or 2. To apply the Accumulated Value to Payment Options A, B, C, D, E or F; or 3. To defer the Retirement Date. Upon receipt of proof that the Annuitant died prior to the termination of this Policy, we will pay the Beneficiary the Accumulated Value as of the date we received such proof. The benefit will not be less than the Single Premium less any withdrawals. Upon written request, the Beneficiary may apply all or part of the Death Benefit under any Payment Option. This Policy and the attached application are the entire contract. All statements in the application are deemed representations and not warranties. No statement will be used to void this Policy or in defense of a claim under it unless: 1. Such statement is contained in the original application; and 2. A copy is attached to this Policy at the time of issue. Only the President, a Vice-President, a Secretary, or Assistant Secretary of the Com- pany has the power to change, modify, or waive any provisions of this Policy. Any changes, modifications, or waivers must be in writing. We will not be bound by any promises or representations made by any agent or other person except as above. Ownership--The Annuitant is the Owner unless otherwise stated in the appli- cation or Unless changed as provided under the Change of Ownership provision. Dur- ing the lifetime of the Annuitant, the Owner may exercise any right, privilege or option contained in this Policy. Beneficiary -- The Beneficiary will remain as stated in the application unless changed as provided under the Change of Beneficiary provision. If no Beneficiary is living, the Owner will be the Beneficiary, if living; otherwise, the Owner's estate. Change of Ownership or Beneficiary -- While the Annuitant is living, you may change the Beneficiary or the Owner by written request. When a request satisfactory to us is received, the change will be effective on the date the request was signed. The change will be subject to any payment we made or actions we may have taken before we received the request. We cannot contest this Policy after it has been in force during the lifetime of the Annuitant for two years from the Policy Date. EFL-7505-1 2~86 (R) Page 1 Page 2 MISSTATEMENT OF AGE OR SEX ASSIGNMENT PREMIUMS NET ANNUITY PURCHASE PAYMENT INTEREST GUARANTEED POLICY VALUES NOTIFICATION OF CURRENT VALUE If the age or sex of the Annuitant has been misstated in this Policy, benefits will be adjusted to the amount that the premium paid would have purchased for the correct age or sex. If such misstatement is discovered after payments have begun: 1. Any overpayment by us with interest at 5% compounded annually will be deducted from any subsequent payments becoming due; or 2. Any underpayments by us with interest at 5% compounded annually will be paid in one sum to the Annuitant. If this Policy is a part of a qualified plan under the Internal Revenue Code, it may not be sold, assigned, transferred, discounted, or pledged as collateral for a loan or as security for the performance of any obligation or for any other purpose. However, if this Policy is owned by a trust or a custodian or an employer as part of a qualified plan, the trust, custodian or employer may assign ownership of this Policy to the person eligible to receive payments under the plan. No assignment of this Policy is binding on us until it is filed with us. We assume no responsibility for the validity of any assignment. The single premium may be paid to our agent at or prior to the time this Policy is delivered. The Net Annuity Purchase Payment is: 1. A premium payment received; less 2. Any applicable premium taxes. Before annuity payments begin, interest on the Accumulated Value is compounded to yield the guaranteed rate of 41/2% for the first five policy years, then 4% for the sixth through the tenth policy years, then 31/2 % for the eleventh and all following policy years. When our Board of Directors declares a higher rate of interest to be paid, the excess interest earned will be credited at that rate starting on the announced effective date. Interest is calculated on a daily basis. The Accumulated Value on any date prior to the first income payment is equal to: 1. The sum of all Net Annuity Purchase Payments; plus 2. All interest earned and credited; less 3. Any amounts you have previously withdrawn. At least once each year we will send you a statement of the current Accumulated Value of this Policy. The statement will also show how much was credited during the year. EFL*7505-1 8/88 (R) CASH SURRENDER VALUE PARTIAL SURRENDER VALUE VALUES NOT LESS THAN STATUTORY MINIMUMS TERMINATION The Cash Surrender Value of this Policy on any date shall be its Accumulated Value on that date less a surrender charge (based on the time elapsed since the Policy Date) as follows: During the During the During the During the first policy year second policy year third policy year fourth policy year During the fifth policy year 8% of the Accumulated Value 5% of the Accumulated Value 3% of the Accumulated Value 2% of the Accumulated Value 1% of the Accumulated Value After five years from the Policy Date, no further surrender charge will be applied. Any portion of the Accumulated Value withdrawn during the first five policy years will be subject to the surrender charge set forth above. The Company reserves the right to defer payment of any withdrawals for not more than six months from the date of the request, during which time interest will continue to accumulate. The Company will waive the surrender charge and pay or apply the full Accumulated Value under the following circumstances: 1. If the annuitant submits a notarized statement that he/she is substantially retired from regular employment, and either (a) this Policy was issued before the annui- tant's age 60, or (b) this Policy is at least three years old. 2. If the Accumulated Value is applied under one of the Payment Options described on page 5 or otherwise made available by the Company, provided such option lasts at least five years. The Company reserves the right to defer the cash payment for not more than six months from the date of the request. The Guaranteed Policy Values, Paid-up Annuity Values and Death Benefits that may be available under this Policy are not less than the minimum benefits required by any statute of the state in which this Policy is delivered. This Policy will terminate if: 1. It is surrendered for the total Cash Surrender Value or a Payment Option; or 2. The Annuitant dies; or 3. The Accumulated Value decreases to zero. EFL-7505-1 2186 (R) Page 3 Page 4 TABLE OF GUARANTEED VALUES The amounts shown are calculated as of the end of the policy year indicated assum- ing that a single premium payment of $10,000 was paid on the Policy Date. If a pay- ment of more or less than $10,000 was paid, the amounts in the table are proportional. TABLE OF GUARANTEED VALUES GUARANTEED GUARANTEED POLICY ACCUMULATED CASH SURRENDER YEAR VALUE VALUE 1 $10,450.00 $ 9,614.00 2 10,920.25 10,374.24 3 11,411.66 11,069.31 4 11,925.19 11,686.69 5 12,461.82 12,337.20 6 12,960.29 12,960.29 7 13,478.70 13,478.70 8 14,017.85 14,017.85 9 14,578.57 14,578.57 10 15,161.71 15,161.71 11 15,692.37 15,692.37 12 16,241.60 16,241.60 13 16,810.06 16,810.06 14 17,398.41 17,398.41 15 18,007.35 18.007.35 16 18,637.61 18,637.61 17 19,289.93 19,289.93 18 19,965.08 19,965.08 19 20,663.85 20,663.85 20 21,387.09 21,387.09 21 22,135.64 22,135.64 22 22,910.38 22,910.38 23 23,712.25 23,712.25 24 24,542.17 24,542.17 25 25,401.15 25,401.15 26 26,290.19 26,290.19 27 27,210.35 27,210.35 28 28,162.71 28,162.71 29 29,148.40 29,148.40 30 30,168.60 30,168.60 31 31,224.50 31,224.50 32 32,317.36 32,317.36 33 33,448.47 33,448.47 34 34,619.16 34,619.16 35 35,830.83 35,830.83 36 37,084.91 37,084.91 37 38,382.88 38,382.88 38 39,726.28 39,726.28 39 41,116.70 41,116.70 40 42,555.79 42,555.79 41 44,045.24 44,045.24 42 .45,586.82 45,586.82 43 47,182.36 47,182.36 44 48,833.75 48,833.75 45 50,542.93 50,542.93 46 52,311.93 52,311.93 47 54,142.85 54,142.85 48 56,037.85 56,037.85 49 57,999.17 57,999.17 50 60,029.14 60,029.14 EFL-7505-1 2/86 (R) PAYMENT OPTIONS If this Policy has not been assigned, we will pay the proceeds under the Option you select provided: Each annual periodic payment is $20.00 or more; and if each annual periodic payment is not $20.00 or more, the proceeds will be paid in one lump sum. The amount of each payment will depend upon the sex and adjusted age of the Annuitant and the Beneficiary if any. The adjusted age is determined from the actual age last birthday at the time the first annuity installment is due in the following manner: Calendar Year of Birth Adjusted Age Before 1900. ........................................ Actual Age increased by 1 1900- 1919 ........................................ Actual Age 1920 -- 1939 ........................................ Actual Age decreased by 1 1940 -- 1959 1960 -- 1979 ........................................ Actual Age decreased by 2 ........................................ Actual Age decreased by 3 PAYMENT OPTION A: Payments for a Specified Period and Life Thereafter --Payments will be made monthly for a guaranteed period of 10 years. The first installment is payable one month from the date the payment option is selected. If the Annuitant entitled to receive the first installment is living at the end of the guaranteed period, payments will continue until the Annuitant's death. The amount of each pay- ment is based on the sex and adjusted age of the Annuitant at the time the first pay- ment is due. The amount of the monthly payment for each $1,000.00 of proceeds is shown in the following Table. PAYMENT OPTION B: Payments for a Specified Period and Life Thereafter--Payments will be made monthly for a guaranteed period of 20 years. The first installment is payable one month from the date the payment option is selected, if the Annuitant entitled to receive the first installment is living at the end of the guaranteed period, payments will continue until the Annuitant's death. The amount of each pay- ment is based on the sex and adjusted age of the Annuitant at the time the first pay- ment is due. The amount of the monthly payment for each $1,000.00 of proceeds is shown in the following Table. PAYMENT OPTION C: Payments for Life with Guaranteed Installment Refund- Payments will be made monthly for as long as the Annuitant shall live with a guaranteed minimum total amount of payments equal to the Guaranteed Accumulated Value of this Policy on the anniversary on which payments start. PAYMENT OPTION D: Payments for Life -- Payments will be made monthly as long as the Annuitant shall live, but without any guaranteed number of payments. PAYMENT OPTION E: Joint and Two-thirds to Survivor Life Payments -- Payments will be made monthly during the joint lifetime of the Annuitant and a Beneficiary. At the death of either the Annuitant or Beneficiary, a monthly payment of two-thirds of the joint payment will continue for the lifetime of the survivor. PAYMENT OPTION F: Payments for a Guaranteed Period -- Payments will be made in equal annual, semi-annual, quarterly or monthly installments for a guaranteed period of I to 30 years. The amount of each payment for each $1,000.00 of proceeds is shown in the following Table. EFL-7505.1 2/86 (R) Page 5 Page 6 ELECTION All or part of the amount payable at the death of the Annuitant or any other termina- tion of the Policy may be applied to a Payment Opt on. During the lifetime of the Annuitant, the Owner may elect a Payment Option and may change any previous elec- tion if the Owner has reserved the right to change the manner of payment. At the time proceeds are payable, a Beneficiary may elect or change a Payment Option if proceeds are available to the Beneficiary in one sum. An election or change must be in writing in a form acceptable to the Company. DOLLAR AMOUNT OF THE FIRST MONTHLY ANNUITY PAYMENT WHICH IS PURCHASED WITH EACH $1,000 OF ACCUMULATED VALUE SINGLE LIFE ANNUITY Option A Option B Option C Option D Ufe With Life With Life With Life Adjusted Age 120 Months 240 Months Installment No Term Male Female Certain Certain Refund Certain 50 54 $4.69 $4.52 $4.53 $ 4.74 51 55 4.78 4.58 4.60 4.84 52 56 4.87 4.65 4.67 4.94 53 57 4.97 4.71 4.75 5.04 54 58 5.07 4.78 4.84 5.16 55 59 5.18 4.85 4.93 5.28 56 60 5.29 4.91 5.02 5.40 57 61 5.41 4.98 5.12 5.54 58 62 5.53 5.05 5.22 5.69 59 63 5.66 5.11 5.32 5.84 60 64 5.79 5.18 5.44 6.01 61 65 5.94 5.24 5.56 6.18 62 66 6.08 5.30 5.68 6.37 63 67 6.24 5.36 5.82 6.57 64 68 6.40 5.41 5.96 6.79 65 69 6.57 5.46 6.10 7.02 66 70 6.74 5.51 6.26 7.27 67 71 6.91 5.55 6.43 7.54 68 72 7.10 5.59 6.60 7.83 69 73 7.28 5.62 6.78 8.14 70 74 7.47 5.65 6.98 8.48 71 75 7.66 5.68 7.19 8.84 72 76 7.85 5.70 7.41 9.23 73 77 8.04 5.71 7.65 9.65 74 78 ' 8.23 5.72 7.89 10.11 75 79 8.41 5.73 8.16 10.61 Options A, B, C and D are based on the Progressive Annuity Table with interest at 31/2%. EFL-7505-1 2/86 (R) OPTION E JOINT AND TWO-THIRDS TO SURVIVOR LIFE ANNUITY Adjusted Age of AdJuated Age of Annuitant Nominee Male 51 Male 56 Male 58 Male 61 Male Female Female 55 Female 60 Female 62 Female 65 50 54 $4.58 $4.79 $4.89 $5.03 $5.13 55 59 4.80 5.06 5.17 5.35 5.47 57 61 4.89 5.18 5.30 5.49 5.63 60 64 5.04 5.36 5.50 5.72 5.87 62 66 5.14 5.49 5.64 5.88 6.05 65 69 5.30 5.68 5.85 6.13 6.33 Male 63 Male 66 Male 71 Female 67 Female 70 Female 75 $5.29 $5.56 5.67 6.00 5.84 6.2O 6.12 6.54 6.32 6.79 6.64 7.19 70 74 5.58 6.03 6.23 6.57 6.82 7.21 7.95 The dollar amount of the first monthly annuity installment for any age or combination of ages not shown in the above tables will be calculated on the same basis as the installments for those shown and may be obtained from the Company. Option E is based on the Progressive Annuity Table with interest at 3~/2 %. OPTION F INSTALLMENTS FOR A GUARANTEED PERIOD No. of Years Monthly No. of Years Monthly Payable Installment Payable Installment 1 $84.37 16 $6.41 2 42.76 17 6.11 3 28.89 18 5.85 4 21.96 19 5.61 5 17.80 20 5.39 6 15.03 21 5.20 7 13.06 22 5.02 8 11.57 23 4.86 9 10.42 24 4.72 10 9.50 25 4.59 11 8.75 26 4.46 12 8.13 27 4.35 13 7.60 28 4.24 14 7.15 29 4.15 15 6.75 30 4.06 The annual, semi-annual, or quarterly installment under Settlement Option F shall be the monthly installment shown above multiplied by 11.85, 5.97, or 2.99, respectively. Option F is based on interest at 21/2%. DEFINITIONS ATTAINED AGE means the Annuitant's age last birthday. WE, OUR, US, COMPANY or HOME OFFICE refers to Erie Family Life Insurance Company of Erie, Pennsylvania 16530. WRITTEN REQUEST means a written request in a form satisfactory to us signed by the Owner and filed at the Home Office. YOU, YOUR refers to the Owner of the Policy. EFL-7505-1 2/86 (R) Page 7 PART I Use black ink only. Proposed Annuitanl: Annuity Application made to: ERIE FAMILY LIFE INSURANCE COMPANY ERIE, PA 16530 13. Waiver of Premium (Ages 15-55) 2. Sex [] Male [~---P~male ,¥, / ID 4. State of Birth 5. Social Security Number 6. Address Phone Number,(,{ 9. Will this policy r~3~,a~e annuities with any company? I"] Yes I~N~' (If "Yes," complete appropriate replacement forms in duplicate and mail one copy to EFL.) 10. Annuity Plan [] Flexible Premium [] Single~remium ~e Premium Immediate (Attach Supplementary Contract Request Form EFL-9004.) 11. A,_~n n.ux~_Type ~'Non-Qualified (Regular Tax-Deferred Annuity) [] IRA [] Spousal IRA (Non-working spouse only) [] IRA Rollover/Transfer (Single Premium Only-- Complete Question 12 Below) [] SEP (Simplified Employee Pension Plan) [] Keogh (Prototype HR-10 Money Purchase Pension Plan) [] TeA (Tax-Sheltered Annuity 403(b)) I-'l Other 12. IRA Rollovers Only I hereby elect to treat this contribution to an Erie Family Life IRA as a rollover contribution from [] Yes [] No If "Yes," complete Part II on back. 14. Payment Plan (If other than Single Premium) [] Annual [] Semi-Annual [] Quarterly [] Chek-matic (Attach Authorization) [] Commission Deduction (ERIE Agent # [] Other [] Monthly Modal premium billing amount $ 15. Initial cash with application 16't. Primary Beneficiary Contingent Beneficiary Relationship Relationship 17. If owner is other than Annuitant: Owner Name Owner Soc. Sec. No. Age DEC 2 7994 · ..... ,._., EFL Signed at ./~.~'/l ~/ F'''L~ ~ /'"'~_--.-~ .... ~ -- ~ ..-," ~ .... ~ ............. . .--~d~: ~. /~/ Date . ~ /~ :" , ) ,1_ ,.P s~nnuitA~" ," ~ ~--~ ....... sig~"ore of Owner--if o,~,~-¥h'a, -,~8~,~-'~h-~-~,{,-~- .......... EFL-2013 4/89 IR) e · ~ .~ ~ ~ m~s policy~~~ existing angry[les)? PART II Complete this section if Waiver of Premium is requested. (Not available on Keogh Plans) Height. Weight. Have you lost 15 lbs. or more in the past year? [] Yes [] No Reason: ............................................................................................................................................................. 2. Personal Physician: Name .............................................................................. Phone No. Address ........................................ 3. Primary occupation (Describe duties.) ~ Any other occupation? [] Yes [] No (If "Yes," describe duties.) 4. Have you ever received or applied for disability benefits?.. YES NO 5. Has your driver's license been suspended or revoked or have you had any driving while intoxicat the ast 3 ear '~ ed wolations w~th n P y s .................... 6. In the past 5 years, have you ever used: [] [] a. barbiturates, sedatives or tranquilizers without a medical prescription? b. L.S.D., marijuana, cocaine or other drugs? .......... ' .................................... [] [] 7. Have you ever been treated for alcoholism or drug habit~ ................................................... [] [] 8. Have you ever had or been told you had: [] [] a. fainting spells, stroke, epilepsy, mental illness or nervous condition or any disease or disorder of th or nervous system'~ e brain b. any disease ;:)r disorder of the lungs, stomach, intestines, liver, kidneys, gl;n'c~; ~;'l~l'o'~c~'~ .................... [] [] c. high blood pressure, chest pain, heart murmur or any disease or disorder of the heart or'c'i;~t~l~i~)~ 's;'si~'~ ' ' ' [] d. diabetes or sugar, albumin or blood in the urine?. [] e. any disease or disorder of the back, bones, joints or muscles? ......................................... [] [] f. cancer, tumor, ulcer or venereal disease? .............................................................. g. any serious impairments of hearing or sight? ........................................................... [] [] 9. Are you now pregnant? (Expected Delivery Date [] [] ) ................................. [] [] 10. Have you received treatment for or been diagnosed as having Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC) by a member of the medical profession or tested positive for antibodies to the AIDS virus? [] [] 11. Do you have any disease or disorder not mentioned above or are you taking medication or receiving treatment?... [] [] 12. Have you been hospitalized or had medical treatment or EKG or other diagnostic testing in the past 5 years or do you anticipate surgery in the next 6 months? DETAILS: (Questions 4-12) ........................................................ [] [] NAME. ADDRESS AND PHONE N0, 0F PHYSiCiAN declare that I have read and understood all the statements shown above and on the front of the application, that they are true an, complete to the best of my knowledge and correctly recorded. I hereby authorize any licensed physician, medical practitioner, hospital, clinic or other medical or medically related facility, insurance company, the Medical Information Bureau, Inc. or other organization, institution or person, that has any records or knowledge of any person proposed for insurance, to give to the Erie Family Life Insurance Company or its reinsurers, any such information. I hereby acknowledge receipt of the Notice Regarding The Medical Information Bureau, Inc. and the Notice Regarding The Fair Credit Report- lng Act. (A photographic copy of this authorization shall be as valid as the original.) I agree that no Insurance shall be effective until a policy is Issued and delivered and the first premium paid all within the lifetime and good health of the proposed insured. Signed at x AGENT NOTE: Are you arranging for a medical examination? [] Yes [] No EFL-2013 4~89 (R) MADE THE Part of Parcel No.: 08-16-0210-031 THIS DEED ~L'k day of June in the year of our Lord two thousand one (2001). BETWEEN ETHEL IRENE MARKS, widow, of 1030 Myerstown Road, Gardners, Cumberland County, Pennsylvania, hereinafter referred to as: Grantor, and CHARLES O. MARKS and PHYLLIS L. MARKS, his wife, of 1155 Goodyear Road, Gardners, Cumberland County, Pennsylvania, hereinafter referred to as: Grantees, WITNESSETH, that in consideration of ONE AND XX/100 ($1.00) Dollars in hand paid, the receipt whereof is hereby acknowledged, the said Grantor does hereby grant and convey to the said Grantees, their heirs and assigns, as tenants by the entireties: ALL THAT CERTAIN tract of land situate in Dickinson Township, Cumberland County, Pennsylvania, more particularly bounded and described on the Preliminary/Final Subdivision Plan for E. Irene Marks, prepared by Larry V. Neidlinger, P.E.R.S., on September 20, 2000, revised on March 3, 2001, and recorded in the Office of the Recorder of Deeds in and for Cumberland County, Pennsylvania, in Plan Book 83, Page 25, as follows: BEGINNING at a bolt in the centerline of Myerstown Road (T-524) at the southeast corner of Tract No. 2 on the aforesaid Plan; thence .by said Tract No. 2 and passing through a concrete monument, North 55 degrees 45 minutes 00 seconds East, a distance of 228.62 feet to an iron pin set; thence by said Tract No. 2, South 32 degrees 45 minutes 00 seconds East, a distance of 37.45 feet to a point; thence by lands of the Grantees herein, South 58 degrees 30 minutes 00 seconds West, a distance of 227.91 feet to a point in the centerline of Myerstown Road (T-524); thence by said centerline, North 34 degrees 15 minutes 00 seconds West, a distance of 26.50 feet to a bolt in said centerline, the point and place of BEGINNING. BEING Tract No. 3 on the aforesaid Plan and containing 0.1675 acres. AND BEING a portion of the premises which was conveyed to John A. Marks and Ethel Irene Marks, his wife, by Lizzie May Shambaugh Myers, widow, by Deed dated June 30, 1953, and recorded in the Office aforesaid in Deed Book "J", Volume 15, Page 100. The said John A. Marks having died January 29, 1987, thereby vesting title solely in the said Ethel Irene Marks, Grantor herein, by operation of law. THE PREMISES BEING CONVEYED HEREBY (TRACT NO. 3) ARE CONVEYED STRICTLY AS A LOT ADDITION TO THE EXISTING PROPERTY OF GRANTEES (SAID PROPERTY BEING MORE FULLY DESCRIBED IN DEED RECORDED IN THE OFFICE AFORESAID IN DEED BOOK "W", VOLUME 21, PAGE 278) AND SHALL, UPON THE RECORDING HEREOF, BECOME CONSOLIDATED WITH AND AN INTEGRAL PART OF SAID PROPERTY, AND SAID PREMISES SHALL NOT BE SEPARATELY CONVEYED WITHOUT ALL NECESSARY GOVERNMENTAL APPROVALS. THIS IS A CONVEYANCE FOR NO OR NOMINAL ACTUAL CONSIDERATION FROM MOTHER TO SON AND SON'S WIFE AND IS THEREFORE EXCLUDED FROM REALTY TRANSFER TAX. AND the said Grantor hereby covenants and agrees that she will warrant specially the property hereby conveyed. IN WITNESS WHEREOF, said Grantor has hereunto set her hand and seal the day and year first above written. SIGNED, SEALED AND DELIVERED IN THE PRESENCE OF / Ethel Irene Marks COMMONWEALTH OF PENNSYLVANIA ) ): SS. COUNTY OF CUMBERLAND ) On this, the 5th day of June 2001, before me, the undersigned officer, personally appeared, ETHEL IRENE MARKS, known to me or satisfactorily proven to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. I hereby certify that the precise residence and complete post office address of the within Grantees is: 1155 Goodyear Road, Gardners, PA 17324 Attorney for Grantees (N.T.S.) COMMONWEALTH OF PENNSYLVANIA ) ); SS. COUNTY OF CUMBERLAND ) RECORDED on this said County in Deed Book day of , Page A. D. 2001, in the Recorder's Office of the Given under my hand and the seal of the said office, the date above written. ! Certify this to be recorded In Cumberland County PA STEPHEN L. B LOOM ATTORNEY AND COUNSELLOR AT LAW 2100 LONGS GAP ROAD CARLISLE, PENNSYLVANIA 17013 717-249_7717 CSSLB\Real Estate\ 10242. ldeed. I .doc Part of Parcel No.: 08-16-0210-031 THE THIS DEED '~"~ day of June in the year of our Lord two thousand one (2001). BETWEEN ETHEL IRENE MARKS, widow, of 1030 Myerstown Road, Gardners, Cumberland County, Pennsylvania, hereinafter referred to as: Grantor, and CHARLES O. MARKS and PHYLLIS L. MARKS, his wife, of I 155 Goodyear Road, Gardners, Cumberland County, Pennsylvania, hereinafter referred to as: Grantees, WITNESSETH, that in consideration of ONE AND XX/100 ($1.00) Dollars in hand paid, the receipt whereof is hereby acknowledged, the said Grantor does hereby grant and convey to the said Grantees, their heirs and assigns, as tenants by the entireties: ALL THAT CERTAIN tract of land situate in Dickinson Township, Cumberland County, Pennsylvania, more particularly bounded and described on the Preliminary/Final Subdivision Plan for E. Irene Marks, prepared by Larry V. Neidlinger, P.E.R.S., on September 20, 2000, revised on March 3, 2001, and recorded in the Office of the Recorder of Deeds in and for Cumberland County, Pennsylvania, in Plan Book 83, Page 25, as follows: BEGINNING at a bolt set in the centerline of Myerstown Road (T-524) at the southeast comer of Tract No. 1 on the aforesaid Plan; thence by said Tract No. 1 and passing through a concrete monument, North 55 degrees 45 minutes 00 seconds East, a distance of 342.17 feet to an iron pin set; thence by said Tract No. 1, South 35 degrees 21 minutes 08 seconds East, a distance of 282.57 feet to an iron pin set; thence by lands now or formerly of Jennie L. Kuhn, South 47 degrees 00 minutes 00 seconds West, a distance of 24.64 feet to a point; thence by said lands now or formerly of Jennie L. Kuhn, South 60 degrees 00 minutes 00 seconds West, a distance of 88.50 feet to an iron pin set; thence by lands of the Grantees herein and Tract No. 3 on the aforesaid Plan, North 32 degrees 45 minutes 00 seconds West, a distance of 129.75 feet to an iron pin set; thence by Tract No. 3 on the aforesaid Plan and passing through a concrete monument, South 55 degrees 45 minutes 00 seconds West, a distance of 228.62 feet to a bolt in the centerline of Myerstown Road (T- Boo, 246 282 524); thence by said centerline, North 37 degrees 14 minutes 11 seconds West, a distance of 120.03 feet to a point; thence by said centerline, North 40 degrees 53 minutes 39 seconds West, a distance of 30.34 feet to a bolt set in said centerline, the point and place of BEGINNING. BEING Tract No. 2 on the aforesaid Plan and containing 1.4994 acres. AND BEING a portion of the premises which was conveyed to John A. Marks and Ethel Irene Marks, his wife, by Lizzie May Shambaugh Myers, widow, by Deed dated June 30, 1953, and recorded in the Office aforesaid in Deed Book "J", Volume 15, Page 100. The said John A. Marks having died January 29, 1987, thereby vesting title solely in the said Ethel Irene Marks, Grantor herein, by operation of law. THIS IS A CONVEYANCE FOR NO OR NOMINAL ACTUAL CONSIDERATION FROM MOTHER TO SON AND SON'S WIFE AND IS THEREFORE EXCLUDED FROM REALTY TRANSFER TAX. AND the said Grantor hereby covenants and agrees that she will warrant specially the property hereby conveyed. IN WITNESS WHEREOF, said Grantor has hereunto set her hand and seal the day and year first above written. SIGNED, SEALED AND DELIVERED IN THE PRESENCE OF Ethel Irene Marks COMMONWEALTH OF PENNSYLVANIA ) ): SS. COUNTY OF CUMBERLAND ) On this, the 5th day of June 2001, before me, the undersigned officer, personally appeared, ETHEL IRENE MARKS, known to me or satisfactorily proven to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. I hereby certify that the precise residence and complete post office address of the within Grantees is: 1155 Goodyear Road, Gardners, PA 17324 '~'~rne~ for Grantees (N.T.S.) COMMONWEALTH OF PENNSYLVANIA ) )~ SS. COUNTY OF CUMBERLAND ) RECORDED on this said County in Deed Book day of , Page A. D. 2001, in the Recorder's Office of the Given under my hand and the seal of the said office, the date above written. 1 Certify this to be recorded In Cumberland County PA STEPHEN L. B LOOM ATTORNEY AND COUNSELLOR AT LAW 2100 LONGS GAP ROAD CARLISLE, PENNSYLVANIA 17013 717-249--7717 C AS LB\Real Estate\ 10242. I deed.2.doc 246 ~',~c[ 284 P,o,E: DU£ FL NERAL HOME I "C. - 717-677-8215 717-677-4354 M. LEE DUG,AN, FUNERAL DIRECTOR P.O. BOX 393 ° Ill SOUTH MAIN ST. BENDERSVILLE, PA 17306 STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED Charges are only for those items that you selected or that are required. If we are required by law o£ by a cemetery or crematory to use any items, we will explain in writing below. If you selected a funeral that may require embalming, such as a funeral with viewing, you may have to pay for embalmin8. You do not have to pay for embalming you did not approve if you selected arrangements such as a direct cremation or immediate burial. If wc charged for embalming, we will explain why below. For the Serelce of -~-'~'f~ * t/ ~-- ;, .... · ," / '. ~' ~. ;; Date of Death Name A. CHARGE FOR SERViC£S SELECTED: 1. PROFESSIONAL SERVICES Services of Funeral Director/Staff .... Embalming ...................... Other preparation of body Address SUB-TOTAL OF PROFESSIONAL SERVICES ......... A1 2. FACILITIES AND SERVICES Use of facilities and services for viewing (Visitation/Wake) ......... Use of facilities and services for funeral ceremony ............ $ Use of facilities and services for Memorial Service ............... Use of equipment and services for graveside service ............. Other use of facilities SUB-TOTAL OF FACILITIES/EQUIPMENT ........... A2 3. AUTOMOTIVE EQUIPMENT Vehicle to transfer remains to Funeral Home. Local ........................... Hearse (Casket Coach) Local..; ...... .................. $ ~ .,' Limousine .~ Local ........................... Family car Local ........................... Flower car or floral disposition Local ........................... Lead car/clergy car Local ........................... $ Car for pallbearers Local ........................... Out of town transportation ......... SUB-TOTAL OF AUTOMOTIVE EQUIPMENT ........ A3 $.~ TOTAL OF PROFESSIONAL SERVICES, FACILITIES AND AUTOMOTIVE EQUIPMENT ................................... A $ B. CHARGE FOR MERCHANDISE SELECTED: Casket.../'..'.~ .'~_'.~.,,;. ~ .~.,~, ........... (Description) ,%~ ~, ,~ Other Receptacle ................. $ (Description) Outer burial container ............. (Desvription) /'i-,, ~, ,.~ Acknowledgement cards ...' ........ $ Register book(s) .................. $__ Memory folders .................. $ Prayer cards ..................... $_ Temporary grave marker ........... $ Burial clothing ................... $ City State Other clothing Cremation urn ................... (Description) OTHER $__ $ $ TOTAL MERCHANDISE SELECTED .................. B $ C. SPECIAL CHARGES: Forwarding of remains to (Funeral Home) Receiving of remains from (Funeral Home) Immediate Burial ................. Direct Cremation ................. SUB-TOTAL OF SPECIAL CHARGES ................ C $.__ D. CASH ADVANCED Opening Grave .................. $ . _~,'2 '~-. ~ o Ccmetery Equipment .............. $ . Lot and Deed .................... $__ Newspaper Notices--Local ......... Newspaper Notices--Out-of-town .... Telephone & Telegrams ........... $ Airfare ......................... $ Clergy~Mass Offering .'~ ........ ,..... $ Pallbearers ...................... $ Certified Copies of the Death Certificate .................. ~.. $ // Police Escort .................... $ Flowers ....................... $ Vault Service Charge .............. $ SUB-TOTAL OF ADVANCES ....................... D We charge you for our services in obtaining: (specify cash advances that are marked, up) SUMMARY OF CHARGES A. Professional Services, Facilities and Equipment, and Automotive Equipment ...................... B. Merchandise ..................... $ ~e -~ e. tLC)` O ,-~ C. Special Charges .................. D, Cash Advances ................... $ C;, .~ L:~ ,. ~ .'-~ TOTAL OF ALL SECTIONS ......................... $ (~ ~ '/' ~ ~,~-"' ' .-~ PAID AT TI~ OF OR PRIOR TO AR~NGEME~S ................................ $ BALANCE D~ .................................. ~- 5i';".,'.',/~ .;:~ if any law, cemete~, of crematory requirements have required the pufch~ of any of the items listed a~vc the law or requirement is explained below.. I agree that I have examined the items of goods and Services selected above and found thcm to be correct and according to the arrangements I have requested. I acknowledge receipt of a copy of this Statement of Funeral Goods and Servico Selected. l represent that I have sufficient funds available for payment of the cash price for the goods and services selected I also agree to ake a ment ors ~- ~' -~ ~ w~thm '~ -' da s I a reetobe omtl and seve 11 I .... ' .. ~, p y . ~ - o - ' y. g ' j ' y ra yliabewthanyoneeisewho signs ~eiow. a late charge of $ ,!,. ~/: per month amounting to $ ~:. / -" per year will be applied to the unpaid balance beginning ,~¢~' days from the date of this agreement. I w{ll ~l~o~pay to the Funeral Director all reasonable costs paid by the Funeral Director to collect amounts I owe under this agreement Those costs may include attorneys' fee~r, court costs and other costs. Any additional services or merchandise ordered or requested after the date of this agreement will be con$1d~.~c.d _Dart of this agreement and the cost th~?reof will be reflected on the final bill or statement. '~-' · . '¢' ~7~ .~.~' o ~. ~ ~::5~ ,,-'" (Seal) { ... . .... "., ~ ,: ".' · ¥, (Purcha.~er) (Date) ......... (Seal) '~/'c'7" L/:'~,,_.__ ~.., ,. :,',,-x.-.~C...~ , ¢Purchaser) (Licensed Funeral STEPHEN L. BLOOM ATTORNEY AND COUNSELLOR AT LAW 2100 Longs Gap Road Carlisle, Pennsylvania I 7013,'Fcl 717-249-7717 Federal EIN 25-1851818 Invoice submitted to: Marks, Ethel Irene Estate c/o Carolyn I. Gelsinger, Executrix 1212 Goodyear Road Gardners PA 17324 March 22, 2002 In Reference To: Estate Administration Invoice #870 Professional Services 2120102 SLB Preliminary Preparations for Estate Administration and Probate of Will 2/21/02 PL Preparation for probate matters 2/25/02 SLB Administrative Matters; Preparation for Conference with Executors 2/26/02 SLB 3/1/02 SLB Review real estate information; Preparation for and attend initial conference with Executors and family members; Preparations for probate Administrative Matters; Preparation for Probate 2126102 PL 2/28/02 PL 3/1/02 PL Preparation for administration and conference with executors/beneficiaries and Mr. Bloom Research Treasury Department Unclaimed Property Records; Correspondence/Notice to Social Security Administration and to Pennsylvania Department of Public Welfare; Initial preparation of Inheritance Tax return and Accounting Telephone conference with Deputy Register of Wills; Prepare Estate Information Form, Petition for Grant of Letters Testamentary and IRS Form SS-4; Prepare correspondence; Administrative Matters PRA(2TI{';/\I. (;()[INSl.;I, .i, (JIIRI:$'I'IAN PI';R:'iI'I.;( '1 IVI.; Hrs/Rate 0.33 185.00/hr 0.17 105.00/hr 0.33 185.00/hr 2.33 185. O0/hr 0.41 185.00/hr 2.25 105.00/hr 2.50 105.00/hr 3.67 105,00/hr Amount 61.67 17.50 61.67 43079 76.11 236.25 262.50 385.00 Marks, Ethel Irene Estate 3~6~02 SLB 3/5/02 PL 3/6/02 PL 3/7/02 PL Preparation for Probate; Present Petition for Grant of Letters Testamentary to Register of Wills Preparation of Inheritance Tax Return and related research re Family Exemption requirements Appearance at Register of Wills Office to present Petition for Grant of Letters; Conference with clients Correspondence with IRS re filing Form SS-4 (Request for FEIN) 3/14/02 PL 3/15/02 SLB Review correspondence from IRS re tax identification number; Telephone conference with Executrix re same and estate checking account Telephone conference with Adams County National Bank PL Preparation of IRS Forms W-9; Prepare required Notices to Beneficiaries and Certification of same; Correspondence with Beneficiaries; Preparation of Legal Notices for publication; Correspondence to Adams County National Bank re date of death account information; Telephone conference with same re FEIN; Telephone conference with IRS re same For professional services rendered Additional Charges ' 3/6/02 Probate Fee - Register of Wills of Cumberland County 3/15/02 Publishing Fee - Legal Notice - The Cumberland Law Journal Total costs Total amount of this bill Hrs/Rate 1.35 185.00/hr 1.17 105.00/hr 0.50 105.00/hr 0.08 105.00/hr 0.17 105.00/hr 0.07 185.00/hr 2.00 105.00/hr 17.33 Page 2 Amount 249.44 122.50 52.50 8.75 17.50 13.16 210.00 $2,205.34 328.00 75.00 $403.00 $2,608.34 Balance due $2,608.34 PAYABLE UPON RECEIPT - THANK YOU PI~.ACTICAI, (2()t~N.'ql';1. ,I~ (21tRIST[AN PI,2RSI)I:2CTI\ZI,2 STEPHEN L. BLOOM ATTORNEY AND COUNSELLOR AT LAW 2100 Longs Gap Road Carlisle, Pennsylvania 17013, Tel 717-249-7717 Federal EIN 25-1851818 Invoice submitted to: Marks, Ethel Irene Estate cio Carolyn I. Gelsinger, Executrix 1212 Goodyear Road Gardners PA 17324 June 11,2002 In Reference To: Estate Administration Invoice #939 Professional Services 3/26/02 PL 4/2/02 PL Review correspondence from Adams County National Bank; Review estate checking account statement; Correspondence with Executrix Telephone conference with Executrix 4/9/02 SLB PL 4/10/02 SLB 4/12/02 SLB 4/10/02 PL 4/11/02 PL 4/12/02 PL Telephone conference with Mr. Gottshall re public sale of real estate and parameters for Terms of Sale; Review Appraisal of personal property Review Proof of Publication; Disburse funds for Sentinel invoice Preliminary assembly of data/information necessary for drafting of Terms of Sale for public sale of real estate Real estate matters; Telephone conference with Mr. Foote re same Administrative and estate accounting matters; Correspondence to Executors re appraisal and sale Preparation of preliminary draft of Terms of Sale for public auction of real estate Conference with Mr. Bloom re real estate matters; Telephone conference with Mr. Foote re status of real estate appraisal Hrs/Rate 0.33 105.00/h r 0.08 105.00/hr 0.17 185.00/hr 0.17 105.00/hr 0.08 185.00/hr 0.38 185.00/hr 0.33 105.00/hr 0.50 105.00/hr 0.25 105.00/hr Amount 35.00 8.75 32.02 17.50 15.42 70.25 35.00 52.50 26.25 PRACTICAL COUNSEL ~ CHRISTIAN PERSPECTIVE Marks, Ethel Irene Estate 4/16/02 SLB 4/22/02 SLB 4/29/02 SLB 4/30/02 SLB 5/1/02 SLB 5/3/02 PL SLB PL 5/7/02 SLB PL 5/8/02 SLB PL Review real estate information in file; Conference with Mr. Foote re configuration and chain of title for real estate necessary for completion of Appraisal Report; Preliminary research re same with Mr. Foote at Cumberland County Tax Assessment and Mapping Offices; Correspondence with Title Abstractor (Tri-County Abstract) to request chain of title and adverse conveyance search; Review Proof of Publication of Estate Notice (Cumberland Law Journal) Telephone conference with Executrix; File memo re same Evaluation and analysis of real estate chain of title information/surveys in preparation for completion of appraisal and legal descriptiOns for Terms of Sale Telephone conference with abstractor re title matters Telephone conferences with abstractor re real estate title matters; Confirm and compile real estate title information; Conference with Appraiser (Mr. Foote) re same Telephone conference with Mr. Foote re real estate appraisal Administrative and estate accounting matters; Telephone conference with Mr. Daniels (potential real estate purchaser) re real estate acreage/title information; Telephone conference with Mr. Gottshall re same Evaluation and analysis of real estate title matters; Telephone conference with Ms. Gelsinger re real estate appraisal, sale and Inheritance Tax discount payment; Administrative and Inheritance Tax matters Administrative and estate accounting matters; Review written real estate appraisal report and estate sale notice; Telephone conference with Mr. Daniels (potential real estate purchaser) re configuration and content of real estate, and title source for possible conveyance thereof; Telephone conference with Mrs. Gelsinger Administrative and estate accounting matters; Real estate matters; Preparation of draft Inheritance Tax Return and Schedules for estimated discounted tax payment purposes; Administrative and inheritance tax matters; Telephone conferences with potential real estate purchaser (Mr. Shriver); Telephone conference with Mr. Foote Research at Cumberland County Tax Mapping Department and obtain copies of relevant tax maps Page 2 Hrs/Rate Amount 1.23 227.14 185,00/hr 0.17 185.00/hr 2.23 185.00/hr 0.08 185.00/h r 1.12 185.00/hr 0.17 105.00/hr 0.42 185.00/hr 1.42 105.00/hr 1.26 185.00/hr 2,17 105.00/hr 0.82 185.00/hr 0.72 105.00/hr 30.83 411.98 15.42 207.77 17.50 78.57 148.75 233.87 227.50 150.88 75.25 PRACTICAL COUNSEL ~ CHRISTIAN PERSPECTIVE Marks, Ethel Irene Estate 5~9~02 SLB PL 5/13/02 SLB 5/8/02 PL 5~9~02 PL 5/14/02 PL 5/15/02 SLB 5/16/02 SLB Administrative and real estate matters; Compile mapping information for potential real estate purchaser (Mr. Shriver); Correspondence re same Obtain additional copies of tax maps from Tax Mapping Office; Obtain copy of subdivision plan of record from Recorder of Deeds; Conference with Mr. Bloom re same Telephone conference with Mr. Daniels (potential real estate purchaser) re property configuration questions Preparation of Inheritance Tax Return and determination of estimated discount payment toward tax due; Telephone conferences with Mr. Foote re acreage figures set forth on appraisal; Telephone conference with Executrix Telephone conference with Mr. Foote re appraisal information; Telephone conference with Executrix re Inheritance Tax discount payment; Conference with Mrs. Gelsinger re same Review certification of Appraisal and Official Receipt re Inheritance Tax discount payment; Correspondence with Executrix Telephone conference with Mr. Gottshall re offers outstanding on real estate set for public sale Telephone conference with Executrix; Real estate matters 5/15/02 PL 5/17/02 SLB Telephone conference with Auctioneer re offers to purchase real estate; Conference with Mr. Bloom re same and miscellaneous estate matters Telephone consultation with client; Preliminary preparations for conveyance of real property PL Administrative and estate accounting matters 5/20/02 SLB 5/21/02 SLB 5/23/02 SLB 5/28/02 SLB Telephone conference with Mr. Brenneman (CPA for real estate purchasers); Telephone conference with Executrix Preparation of Agreement of Sale for estate real property Preparation of proposed Agreement of Sale and purchase price allocation; Correspondence with Attorney Saidis and Accountant Brenneman re same; Settlement preparations Telephone conference with Attorney Saidis re Agreement with Rowe Hfs/Rate 1.01 185.00/hr 1.75 105.00/h r 0.13 185.00/hr 0.67 105.00/hr 0.50 105.00/hr 0.25 105.00/hr 0.11 185.00/hr 0.08 185.00/h r 0,25 105.00/hr 0.37 185 00/hr 0.17 105.00/hr 0.36 185.00/hr 0.15 185.00/hr 2.67 185.00/hr 0.08 185.00/h r Page 3 Amount 187.42 183.75 23.38 70.00 52.50 26.25 21.12 15.42 26.25 69.07 17.50 66.29 28.16 494.46 15.42 PRACTICAL COUNSEL ~ CHRISTIAN PERSPECTIVE Marks, Ethel Irene Estate 5/29/02 SLB 5/30/02 PL 5/28/02 PL 5/29/02 PL Correspondence with Attorney Saidis re Agreements of Sale; Preparations for settlement Review bank account statements; Correspondence with Executor re same Preparations for Real Estate Closing; Preparation of proposed Fiduciary Deed Preparation of proposed Fiduciary Deed 5/31/02 SLB 6/3/02 SLB Prepare for Real Estate Closing; Conference with Attorney Saidis re executed Agreements and deposit check Preparation for real estate closing 5/31/02 PL 6/3/02 PL Telephone conference with Attorney Saidis' Office; Preparations for Real Estate Closing Preparation of draft legal description/Fiduciary Deed 6/4/02 SLB PL 6/5/02 PL 6/6/02 SLB PL 6/7/02 SLB Preparation of final draft Fiduciary Deed; Coordination of settlement matters Telephone consultations with client (Mr. Carr Marks); Preparation of Fiduciary Deed; Coordination of settlement and Deed execution; Preparation of Sellers' Title Affidavit; Telephone conference with Attorney Saidis's office; Telephone conference with client (Mrs. Gelsinger); Telephone conference with client (Mr. Charles Marks) Preparation/Revision of Fiduciary Deed and Sellers' Title Affidavit; Conference with Mrs. Gelsinger and Mr. Carr Marks for execution and acknowledgement of Agreement of Sale, Fiduciary Deed and Title Insurance Affidavit in advance of settlement Prepare for Real Estate Closing; Revise Legal Descriptions for consolidated Fiduciary Deed Finalize proposed Fiduciary Deed and correspondence with Attorney Saidis's office re same Inheritance tax deduction schedule matters PL Telephone consultations with clients (Mr. Charles Marks, Mrs. Gelsinger); Inheritance Tax Matters Hrs/Rate 0.40 185.00/hr 0.17 105.00/hr 0.62 105.00/hr 1.32 105.00/hr 0.50 185.00/hr 0.07 185.00/hr 0.25 105.00/hr 2.25 105.00/hr 0.53 185.00/hr 1.35 105.00/hr 1.38 105.00/hr 0.91 185.00/hr 0.90 105.00/hr 0.17 185.00/hr 2.75 105.00/hr Page 4 Amount 74.72 17.50 64.75 138.25 92.50 12.33 26.25 236.25 97.74 141.75 145.25 169.12 94.50 30.83 288.75 PRACTICAL COUNSEL · CHRISTIAN PERSPECTIVE Marks, Ethel Irene Estate Hrs/Rate 6/11/02 PL Prepare for Real Estate Closing; Telephone conferences (multiple) with Attorney Saidis'~s office; Correspondence with same 0.84 105.00/hr SLB Finalize Pennsylvania Inheritance Tax Return, Schedules and Exhibits; Prepare for real estate settlement and review of related financing documents; Correspondence with Attorney Saidis' office re same; Prepare counsel's estate tax/medical assistance clearance letter for real estate settlement 3.57 185.00/hr For professional services rendered 40.63 Additional Charges ' 4/9/02 Publishing Fee - Legal Notice - The Sentinel 5/3/02 Abstracting Fee - Cumberland County Courthouse Research Work - Tri-County Abstract Service 5/8/02 Copying cost - Cumberland County Tax Mapping - 2 Maps @ $2.00 each 5/9/02 Copying cost - Cumberland County Mapping - Tax Parcel Maps (x2) Total costs Total amount of this bill Previous balance 4/1/02 Payment - thank you Total payments and adjustments Balance due Page 5 Amount 87.91 661.12 $5,794.66 97.07 121.50 4.00 4.00 $226.57 $6,021.23 $2,608.34 ($2,608.34) ($2,608.34) $6,021.23 PAYABLE UPON RECEIPT - THANK YOU PRACTICAL COUNSEL ~ CHRISTIAN PERSPECTIVE Register of Wills of CUMBERLAND INVENTORY County, Pennsylvania Estate of Ethel Irene Marks also known as , Deceased No. 21-02-0241 Date of Death 02/12/2002 Social Security No. 199-32 -2291A Carolyn I. Gelsinser, Clair E. Marks, Carr B. Marks and Charles O. Marks Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: I.D. No.: Address: Stephen L. Bloom, Esquire 49811 2100 Lonss Gap Road Carlisle, PA 17013 Telephone: 717/249-7717 Personal Representative Signature: Signature: ~ ~ I. Ge~s inge~, Co-Executor Address: 1212 Goodyear Road Gardners, PA 17324 Telephone: 717/486- 7406 Dated: Description (See continuation page(s) attached) Value (Attach additional sheets if necessary) Total: 416,169.42 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form #RW-7 (1992) ADDITIONAL Personal Representatives Estate of Ethel I. Marks SS# 199-32-2291A 02/12/2002 **************************************************** Signature Maine Address Line 1 Address Line 2 City, State, Zip Date Clair E. Marks, Co-Executor 4369 Carlisle Road Gardners, PA 17324 Signature Name Address Line 1 Address Line 2 City, State, Zip Date Cart B. Marks, Co-Ex'~utor 1971 Shippensburg Road Biglerviile, PA 17307 Signature N~me Address Line 1 Address Line 2 City, State, Zip Date Charles O. Marks, Co-Executor 1155 Goodyear Road Gardners, PA 17324 Estate of: Date of Death: County: INVENTORY Ethel Irene Marks 02/12/2002 Cumberland CASH: Certificate of Deposit #640107769, Adams County National Bank Certificate of Deposit #153927, Adams County National Bank Checking Account #1967835, Adams County National Bank Conseco Insurance, Refund State Employee's Retirement System 14,027.85 15,000.85 7,158.33 872.79 116.60 PERSONAL PROPERTY: Personal Property REAL ESTATE/PA: 140.87 Acre farm located at 1030 Myerstown Road, Gardners, PA (single-family dwelling, barn and outbuildings). See attached Appraisal Report. 4,993.00 374,000.00 37,176.42 4,993.00 TOTAL R~CEIPTS OF PRINCIPAL 374,000.00 416t169.42 -1- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 001714 BLOOM STEPHEN L 2100 LONGS GAP ROAD CARLISLE, PA 17013 ........ fold ESTATE INFORMATION: SSN: 199-32-2291 FILE NUMBER: 2102-0241 DECEDENT NAME: MARKS ETHEL IRENE ....-.---.---- DATE OF PAYMENT: 10/10/2002 ~OSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 02/1 2/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I ~45.06 TOTAL AMOUNT PAID' $45.06 REMARKS: CLAIR MARKS CHARLES MARKS CARR MARKS CAROLYN GELSINGER SEAL CHECK# 119 INITIALS: SK RECEIVED BY' MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS BUREAU OF /ND/V/DUAL TAXES THHERTTANCE TAX DTVISTOH DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONMEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE STEPHEN L BLOOM ESQ 2100 LONGS GAP RD CARLISLE PA NOTTCE OF IMHERZTANCE TAX APPRA/SEMENT, ALLO#AMCE OR DISALLONANCE OF DEDUCT/OHS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FZLE NUMBER ACN REV-15~7 EX AFP 09-$0-Z002 MARKS ETHEL O2-1Z-ZOOZ Z10Z-O2ql CUMBERLAND 101 Amount Remitted __ MAKE CHECK PAYABLE AND REMIT pAYMENT TO= REGISTER OF ~ILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 THZS LINE I~ RETAZN LOgER PORT/ON FOR YOUR RECORDS ~ ...................... CUT AL?N.G_ ........................... '~: :~NHERITAN SESSMENT OF TAX _ ~.-E'~:~=~7 EX AFP (01'02)D~/L~iNANCE OF DEDUCT/OHS AND AS ACH 101 DATE 09-:50 200Z ESTATE OF HARKS ETHEL I FZLE NO. 21 OZ-Ogql( ) CHANGED TAX RETURN NAS: (X) ACCEPTED AS F/LED URE INTEREST ' SEE ~EVERSE NCERNZNG FUT ____ 0.: ORIGINAL RETURN TURN BASEU 1. Reel Estate (Schedule A) 2. Stocks and Bonds (Schedule B) $, Closely Held Stock/Partnership /nterest (Schedule C) q. Mortgages/Notes Receivable (Schedule D) 5. Cash/Dank Deposits/Misc. personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Tote1 Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule /) $7q 000.00 .00~ .00 .00 (q)_ (~)_ qZ~255.79~ · 00~ (6) (7)_ Z6zq89.68_ (8) 19,510 .Z6 (9)_ (to)_ I (11) __ 11. Tote1 Deductions (12) _ 12 Nat Value of Tax Return (15) Charitable/governmental Bequests; Non-elected 9115 Trusts (Schedule J} -- · NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. qqZ,7qS.q7 5,000.0~ q16,89Z.6q 856· 1 U ~ TOTAL DUE /S LESS THAN $1, NO PAYMENT /S REDU/RED. TOTAL DUE TS REFLECTED AS A -CREDZT' (CR), YOU MAY BE DUE REFUND. SEE REVERSE S/DE OF THZS FORM FOR ZNSTRUCT/ONS. ) /F PA/D AFTER DATE /ND/CATED, SEE REVERSE FOR CALCULAT/ON OF ADD/T/OMAL /MTEREST. 19. Principal Tax Due 13. Nat Value of Estate Subject to Tax neS l&, 15 and/or 16, 17, 18 and 19 v~111 t~. 1~ an assessmen'c was $ssued previ°usly'_.lia.! -eturns assessed ~o date. NOTE: reflect ~igures that /nclude the total UT ~- .00 X O0 - .00 ASSESSMENT OF TAX: ~ -- = 18,760.~ 15. Amoun~ of Line lq a~ Spousal ra~e q16,89Z.6q X 0q5 ~ .0~ 16. Amoun~ of Line lq ~axable a~ Lineal/Class A ra~e (16)_ .0~ X 1Z ~ .OU 17. A,oun~ of Line lq a~ Sibling ra~e (17} .0~ X ~5 ~ -- 18. kmoun~ of Line lq ~axable a~ Collateral/Class B ra~e (18)_ (19)~ ~8~760.~ BUREAU OF /NDI'VZDUAL TAXES iNHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG:. PA 171Z8-0601 STEPHEN L BLOOM ESQ IlO0 LONGS GAP RD CARLISLE PA .17013 COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ZNHERZTANCE TAX STATEMENT OF AccoUNT REV-I~;Q? EX AFP (gl-B2) DATE IO-Z8-ZOOZ ESTATE OF MARKS DATE OF DEATH OZ-tZ-ZOOZ FILE NUMDER 21 O2-OZql COUNTY CUMBERLAND 101 ETHEL ACN ~d - MAKE CHECK PAYABLE AND REMIT pAYMENT TO: REGISTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. A/N LONER PORT/ON FOR YOUR RECORDS RET ...................... CUT AL~.G__~.~.~_~_~__~__;~ ...... -;~"~'~'~CE TAX STATEMENT ~':~7 EX AFP tu~-u~, - DATE 10-28-2002 ESTATE OF MARKS ETHEL I FILE HO. Z10Z-OZql ACM 101 THIS STATEMENT 1S PROV/DED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACM ZN THE NAMED ESTATE. SHO#N BELOH IS A SUMMARY OF THE pRZNCZPAL TAX DUE, APPL/CATION OF ALL pAYMENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE, APROJECTED ZNTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 09-50-200Z PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): DISCOUNT (+) :CEIPT INTEREST/PEN PAID ~MENT NUMBER DATE 892.95 05-09-ZOOZ CD001157 .00 08-15-ZOOZ CDOO15Z8 .00 10-10-2002 CDOO171q ZF PAID AFTER THIS DATE, SEE REVERSE S/DE FOR CALCULAT/ON OF ADDITIONAL ~NTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT ZS REgUZRED. AMOUNT PAID 16,966.06 856.10 q5.06 TOTAL TAX CREDZT ~ALANCE OF TAX DUE /MTEREST AMD PEN. TOTAL DUE ZF TOTAL DUE 1S REFLECTED AS A ,,CRED/T' YOU MAY BE DUE A REFUND. SEE REVERSE S/DE OF TH/S FORM FOR INSTRUCTIONS. 18,760.17~ STEPHEN L. BLOOM ATT()RNF. Y AND (~() LINSI.;LI.()R ,'\'1' LA\X/ ~ 2100 LON(;S G:\P ROAD CARLISI. E. PI.;NNSYI. VANIA 17013 717 249 7717 REGISTER OF WILLS OF CUMBERLAND COUNTY STATUS REPORT UNDER RULE 6.12 (For Resident Decedents Dying After July 1, 1992) Name of Decedent: ETHEL IRENE MARKS Date of Death: February 12, 2002 0o2z// File No.: 21-02-0168 ~ '~: Social Security No.: 199-32-2291A Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the followi'r~g with respect to completion of the administration of the above-captioned estate: ~-~ 1. State whether administration of the estate is complete: ' Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: N/A. 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No X The separate Orphans' Court No. (if any) for the personal representative's account is: N/A. c. Did the personal representative state an account informally to the parties in interest? do Date: //7/03 C :2,AS\Estates\ 1015 7-2statrpt. 1 Yes X No Copies of receipts, releases, joinders and approvals offormal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Signature: Name: Stephen L. Bloom, Esquire Address: 2100 Longs Gap Road Carlisle, PA 17013 (717) 249-7717 Counsel for Personal Representatives STATUS REPORT UNDER RULE 6. !,2. Name of Decedent: ~-4~/'~IZ~; Date of Death: Will No.: ¢O0;z - ~ O '2 % I Admln. No.: 'P~su~t to Rul~ 6.12 of the Suprem~ Co~ O~h~' Court Rules, I repom ~ follow~g wi~ respect to completion of~e a~s~afion of ~ abow-captioned ~stat~: State whether administration of the estate is complete: Yes ~ No [~ If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the an.~wer to No. 1 is Yes, state the following: Did the personal representative file a final account with the Court? Yes _ No 1~ The separate 0rpha~s' Court No. (if any) for the personal representative's account is: ~ c. Did the personal representative state an account informally to the parties in interest? Yes ~] No' [-'] c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the. Orphans' Court and may be attached to thi~~ Date: ~2 ]~qj~2ooq Signature Name Capacity: Address 7t 7 -D-q-9 - 7'71 7 Telephone No. Personal Representative Counsel for personal representative