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HomeMy WebLinkAbout03-0733Estate of Cledyth M. Clark also known as REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA PETITION FOR GRANT OF LETTERS , Deceased Social Security No. 182-22-9381 James E. Clark, Jr. Petitioner(s), who is/are 18 years of age or older, apply)ies) for: (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/me the execut or [-~ Decedent, dated 11/9/2001 and codicil(s) dated named in the Last Will of the State relevant circumstances, e.g., renunciation, death of executor, etc Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland residence at 43 Westfield Drive, Mechanicsburg, PA 17055 (list street, number and municipality) Decedent, then 74 years of age, died August 31 ,2003 , at Manor Care, Carlisle, PA (Location) Decedent at death owned property with estimated values as follows: (if domiciled in PA All personal property ......................................... $ (if not domiciled in PA Personal property in Pennsylvania .................... $ (if not domiciled in PA Personal property in County .............................. $ Value of real estate in Pennsylvania ........................................................................................ $ Real Estate situated as follows: 43 West[ields Dr., Mechanicsburg, PA 17055 Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: _?~,p_,4,~._~ ~ ~nature Typed or printed name and residence (,~_(" ~ James E. Clark, Jr. County, Pennsylvania, with his/her last family or principal 14610 W. Fairfield Dr., New Berlin, WI 53151 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to and affirmed and subscribed September 2003 , Donna M.Otto, 1st Deputy~~w , DECREE OF REGISTER Estate of Cledyth M. Clark Deceased No. 21-2003-7:~ also known as Cledyth E o C18rk Social Security No: 182-22-9381 Date of Death: Au.qust 31st, 2003 AND NOW, September 8th , 2003 , 2003 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters I~ Testamentary (~ of Administration ((c.t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minoriate) are hereby granted to James E. Clark, Jr. in the above estate and that the instrument(s), if any, dated November 9, 2001 described in the Petition be admitted to probate and filed of record as the Last Will of Decedent. FEES Letters .................................... Short Certificates(s) .... 6 ......... Renunciation .......................... Extra Pages ( 3 ) ............... I.T.R ....................................... JCP Fee ................................. Inventory ................................ Other ...................................... $ 349.00 $ 18.00 $ 9.00 $ 10:nq $ TOTAL ............................. $ 377.00 ~a±led getters To Atto~ey on 9/8/03 q Regi~er of W, ills ~ Donna M. Otto, 1st sepu~y ~/ F Signature Attorney: R. Mark Thomas I.D. No: 41301 Address: 101 S. Market Street Mechanicsburg Telephone: (717) 796-2100 DATE FILED: 09-05-03 PA 17055 105.805 REV 9/86 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local,Registrar.· The original certificate will be forwarded to thc State Vital Records Office for permanent ~ling. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 9496352 No. / Local l~egist-ra r Date 74 w, ~ Cumberland COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH .......... u,eaytn M. ~arK ],. emale ]"f¢~ --~ --¢~/ J,. August 31, 2003 I I I I~'~ ~"~,c~ ~.~ I Nov16 19281 Harrisburg 1.. ' I~. ~ ...... ~,,~,~ Carlisle j Manor Care I~~,~". J .... ,~,~', ~'~'~;*'~ ~"~'~ J Own Home Homemaker ,,~ 43 Westfields Drive ,.. Mechanicsburg. Pennsylvania 1705F~--~""' ~,. ,3. ,' I ,,. Widowed ,,. ,~s~. Pennsylvania ~ ,;,.~ ~... ~.,~.~ ~,~ Silver Spring ,~.~ Cumberland ~, ,,~0 ~ ~ Jesse D. Meadath ,,. Cledyth Duey I Janis L. Clark J~ 43 Wesffields Drive Mechanicsburg. Pa. 17050 ~_~ ~.~-, I~~'''~'~.~ I~-~.~.~ / DI,,~ Sop 4, 2003 J,,~. N~n Cemete~ J,,,. Newtown, Pa. J~. FD-012~2-L I~ Myem Funeral Home, Inc. 37 East Main Street Mechanicsburg, Pa 17055 ~m~a~~ .... , I I ....... I I ' I~ I- I ~. ~ ~.*,-~,~.*,-=~ ~,~ ~.~.~. ~ .................................................. ..................................... g ,. I I · --~l .... ............................................................. '....., ........ : ....................... ~ Dr. Dar~l Gmspwlte ~ ,. 522 Pi. Street Cad isle, Pa. BE IT REMEMBERED THAT I, cLEDYTH M. CLARK, a resident of Cumberland County, pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my LAST wILL and TESTAMENT, hereby revoking any and ali Wills and Codicils previously made by me. I I declare that I am not married, my beloved husband, JAMES E. CLARK, SR. having predeceased me, and that I have two (2) children, JAMES E. CLARK, JR., bom September 17, 1958 and JANIS L. CLARK, born December 6, 1960. II I direct that all my iust debts and funeral expenses shall be paid [rom my residuary estate as soon as practicable after my decease. III I direct that all taxes that may be assessed in consequece of my death, of whatever nature and by whatever jurisdiction imPosed, shall be paid from !Y residuary estate as a part of the expense of the administration of my estate. IV I give, devise and bequeath all my property, whe*r real or personal, wherever situate, including any property over which I may have a power of pointment to my children, JAMES E. CLARK, JR. and JANIS L. CLARK, in equal shares, perrpes. If either of'my children should predecease or fail to survive me by thirty (30) days leaving issue then their share shall pass to my surviving child. That portion of my Estate which passes to my dauF-r, JANIS L. CLARK shall pass to her pursuant to the terms of the hereinafter included Trust. V If both of my children should predecease me or fai~ to sum me by thirty (30) days leaving no issue, then I give, devise and bequeath all my property, wIer real or personal, wherever situate, including any property over which ! may have a power ofointment to my niece, LINDA VICONIK and my nephews, JOSEPH KRULOCK and JOHNULOCK, in equal shares, per stirpes. VI If my daughter, JANIS L. CLARK, shall survive me and inherit property pursuant to the terms of this Will, I appoint my son, JAMES E. CLARK, JR., as Trustee of the property that I have given to my daughter, JANIS L. CLARK. If my son, JAMES E. CLARK, JR., is unable or unwilling to act in that capacity I appoint my nephew, JOSEPH M. KRULOCK as Trustee. A. The assets that are transferred to the Trust shall be used to pay to or apply for the benefit of my daughter, JANIS L. CLARK. B. The Trust Estate shall be administered for the life of my daughter, JANIS L. CLARK. Until such time as JANIS L. CLARK is deceased, the Trustee shall pay to or apply for the benefit of my daughter all of the net income from the Trust Estate during her lifetime, payable monthly or in other convenient installments but in no event less than qUarte;ly. At a minimum, I hereby direct the Trustee to pay either out of income or principal a sum equal to three thousand ($3,000.00) dollars per month to my daughter during her lifetime. C. The Trustee shall at anytime pay to or apply for the benefit of my daughter such additional sums from the principal of the Trust Estate, up to the whole thereof, as the Trustee in his discretion deems appropriate for her comfortable care, support, maintenance, and recreation at the standard of living to which she was accustomed at the time of my death. D. This Trust shall terminate on the death of my daughter and the Trustee shall immediately distribute the balance of the Trust Estate to my surviving child. If I have no surviving child then the balance of the Trust shall be distributed according to Paragraph V 'of this Will. VII I nominate, constitute and appoint my son, JAMES E. CLARK, JR. as Executor of this LAST WILL, to serve without bond. If my son is unable or unwilling to act in that capacity I nominate, constitute and appoint my daughter, JANIS L. CLARK as Executrix of this LAST WILL. to serve without bond. 2 IN WITNESS WHEREOF, I, CLEDYTH M. CLARK, have set my hand to this LAST WILL this /2z"'~ C¥~day of ,2001. CLEDYTHM. CLARK Signed, sealed, published and declared by the above-named CLEDYTH M. CLARK, as and for her Last Will and Testament, in the presence of us, who, at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND · I, CLEDYTH M. CLARK, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my LAST WILL; that I signed it as my free and voluntary act for the purposes therein expressed. CL~D~H/M. CLARK Sworn or affirmed to and acknowledged before me by CLEDYTH M. CLARK, Testatrix, this c'~ day of~/~9~~/''', 2001. ublic ~ AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA · SS. COUNTY OF CUMBERLAND · Notarial Seal Anne Carmody, Notary Public . Mechan csburg Boro, Cumberland County My Commission Expires Mar. 11,2002 the witnesses whose names are signed to the attached or foregoing instrument being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her LAST WILL; that CLEDYTH M. CLARK signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the Testatrix was at the time 18 years of age or more, of sound mind and under no constraint or undue influence. 4 lic N~i'a~a~ Sea~/7 - ' - K,~ - [- Anne Carmody, Nota~LP'ublic - I Mechanicsburg Boro, Cumberland County ! My Commission Expires Mar. 11, 2002 LAST WILL AND TESTAMENT BE IT REMEMBERED THAT I, CLEDYTH M. CLARK, a resident of Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my LAST WILL and TESTAMENT, hereby revoking any and all Wills and Codicils previously made by me. I I declare that I am not married, my beloved husband, JAMES E. CLARK, SR. having predeceased me, and that I have two (2) children, JAMES E. CLARK, JR., bom September 17, 1958 and JANIS L. CLARK, bom December 6, 1960. II I direct that all my just debts and funeral expenses shall be paid from my residuary estate as soon as practicable after my decease. III 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. IV I give, devise and bequeath all my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment to my children, JAMES E. CLARK, JR. and JANIS L. CLARK, in equal shares, per stirpes. If either of my children should predecease or fail to survive me by thirty (30) days leaving no issue then their share shall pass to my surviving child. That portion of my Estate which passes to my daughter, JANIS L. CLARK shall pass to her pursuant to the terms of the hereinafter included Trust. V If both of my children should predecease me or fail to survive me by thirty (30) days leaving no issue, then I give, devise and bequeath all my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment to my niece, LINDA VICONIK and my nephews, JOSEPH KRULOCK and JOHN KRULOCK, in equal shares, per stirpes. CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Cledyth M. Clark Date of Death: 8/31/2003 SSN: 182-22-9381 Date Letters Granted: 9/8/2003 To the Register: Estate No. 21-03-733 File No. 2003-733 Will or Administration No. I certify that Notice of Estate Administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on Name Address Janis Clark 43 Westfield Drive Mechanicsburg PA James E. Clark, Jr. 14610 W. Fairfield Dr. Nw Berlin WI 17055 53151 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: Capacity: X Personal Representative Counsel for Personal Representative Signature Name (Please type or print) R. Mark Thomas, Esq. ' '~ddress 101 S. Market Street Mechanicsburg Telephone No. 717-796-2100 PA 17055 REV-15OO EX , (6-OO)  COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 I-- Z UJ uJ F- Z Z 0 13: n"' o (.> Z DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT Clark, Cledyth M. DATE OF DEATH (MM-DD-Year) 08/31/2003 DATE OF BIRTH (MM-DD-Year) 11/16/1928 OFFICIAL USE ONLY FILE NUMBER 2 1 -0 3 7 3 3 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 1 8 2-2 2-9 3 8 1 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE iNITIAL) SOCIAL SECURITY NUMBER r~l. Original Return r-J4. Limited Estate r~6, Decedent Died Testate (Attach copy of Will) E~9. Litigation Proceeds Received El2, Supplemental Return [~4a. Future Interest Compromise (date of death after 12-12-82) F'~7. Decedent Maintained a Living Trust (Attach copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) E~3, Remainder Retum (date of death pdor to 12-13-82) [~5. Federal Estate Tax Return Required __ 8. Total Number of Safe Deposit Boxes [~ 11. Election to tax under Sec, 9113(A) (Attach Sch O) NAME R. Mark Thomas, Esq. FIRM NAME (If Applicable) TELEPHONE NUMBER 717-796-2100 COMPLETE MAILING ADDRESS 101 S. Market Street Mechanicsburg PA 17055 1. Real Estate (Schedule A) (1) 2, Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4, Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6, Jointly Owned Property (Schedule F) (6) D Separate Billing Requested 7, Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11, Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. 14. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) 135,000.O0 2,562.30 2i530 111,066.15 216,958.12 (8) 12,582.21 840.00 (11) (12) oFFICIAL USE ONLY 468,116.57 13,422.21 454,694.36 454,694.36 (13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1,2) 16, Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. x ~ (15) 454,694.36 x .045 (16) 20,461.25 x .12 (17) X .15 (18) (19) 20,461.25 > >i BE SURE TO ANSWER: AEL QUESTIONS ON R~RSE SiDE ~ND RECHEGKiMATH < ~ :; DEcedent's Complete Address: STREET ADDRESS 43 Westfield Drive CITY Mechanicsburg IsTATE PA IzIP 17055 Tax Payments and Credits: 1, Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty (1) Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) 20,461.25 (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 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; ........................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ........................................[] [] c. retain a reversionary interest; or ...................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ............................................................. [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................................................................................... [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... [] [] 20,461.25 20,461.25 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 repr, j~tative is based on all information of which preparer has any knowledge. SI G N ATt~,.R E 0~.~0 N R~N ~~N DATE ADDRESS 14610 W. Farifield Dr. New Berlin WI 53151 SIGNATURE ~/~~IVE ADDRESS 101 S. Market St. Mechanicsburg DATE . PA 17055 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)1. The tax rate imposed on the net value of transfers to or for the use of the decedenrs 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. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN R~ID~NT D~G~D~NT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Clark. Cledyth M 21 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1, Semi-detached 2 bedroom townhouse 135,000.00 TOTAL (Also enter on line 1, Recapitulation) $ 135,000.00 REV I~03EX *(1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Clark. Cledyth M, All property jointly-owned with right of survivorship must be disclosed on Schedule F. FILE NUMBEE 21 03 733 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 2,562.30 90 Shares MetLife, Inc. Date of death value 28.47 per share TOTAL (Also enter on line 2, Recapitulation) $ 2,562.30 (If more space is needed, insert additional sheets of the same size) REV ~508 EX + (1 97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Clark. Cledyth M. 21 03 733 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. Personal furnishings 2,530.00 TOTAL (Also enter on line 5, Recapitulation) $ 2,530.00 (If more space is needed, insert additional sheets of the same size) REV~509 E~( + (~-97) ,~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Clark. Cledyth M 21 03 733 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. James E. Clark, Jr. Son B Janis L. Clark c 14610 W. Fairfield Dr. New Berlin, WI 53151 43 Westfield Dr. Mechanicsburg, PA 17055 JOINTLY-OWNED PROPERTY: Daughter LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate VALUE OF ASSET INTEREST DECEDENT'S INTEREE 1. A. 4/4/95 Capitol Resource Acct. 219,883.28 50. 109,941.6z #2252-0394 2. A,B 2/23/82 Checking Acct. #1000323837771 3,407.60 33. 1,124.51 Wachovia Bank, N.A. TOTAL (Also enter on line 6, Recapitulation) $ 111,066.15 (If more space is needed, insert additional sheets of the same size) REV. I~10 EX + (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Cl~rk, Cleclyth M gl 03 733 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is ~es. DESCRIPTION OF PROPERTY % OF ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMBER ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST CE AP~_~CA~LEI 1. Decedent maintained two (2) separate IRA accounts with 92,976.16 100. 92,976.1 ~ Wachovia Securities. Decedent's two (2) children were each 50% beneficiaries on each IRA account. (a) James E. Clark, Jr. 123,981.96 100. 123,981.96 (b) Janis L. Clark TOTAL (Also enter on line 7, Recapitulation) $ 216,958.12 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Clark. Cledyth M Debts of decedent must be reported on Schedule I. FILE NUMBER 21 03 733 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Myers Funeral Home 8. 9. 10. 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 Year(s) Commission Paid: Attorney Fees R. Mark Thomas Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Janis L. Clark Zip Street Address 43 Westfield Drive City Mechanicsburg Relationship of Claimant to Decedent Daughter Probate Fees Cumberland County Accountant's Fees Tax Return Preparer's Fees Patriot News Company Cumberland Law Journal S.W. Barrett Real Estate Appraisals Chuck Bricker, Auctioneer/Appraisals State PA Zip 17055 662.48 7,500.00 3,500.00 389.00 105.73 75.00 275.00 75.00 TOTAL (Aisc enter on line 9, Recapitulation) $ 12,582.21 (If more space is needed, insert additional sheets of the same size) REV 1512 EX * (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIESI & LIENS ESTATE OF Clark. Cledyth M, Include unreimbursed medical expenses. FILE NUMBER 21 0;~ 733 ITEM NUMBER DESCRIPTION AMOUNT 1. HCR Manorcare 840.00 TOTAL (Also enter on line 10, Recapitulation) $ 840.00 (If more space is needed, insert additional sheets of the same size) FtEV. 1513 EX + (,9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Clark. CI, dyth M. NUMBER [. 2. 1[. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a)(1.2)] James E. Clark, Jr. 14610 W. Fairfield Dr. New Berlin, WI 53151 Janis L. Clark 43 West-field Drive Mechanicsburg, PA 17055 Son FILE NUMBER 21 03 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter 1/2 1/2 733 AMOUNT OR SHARE OF ESTATE CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 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) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET S. W. BARRETT REAL ESTATE & APPRAISAL SERVICES File No. 04-0072. APPRAISAL oF LOCATED AT: 43 Westfields Drive Mechanicsburg, PA 17050 FOR: Mark Thomas, Esquire 101 South Market Street Mechanicsburg, PA 17055 BORROWER: CLARK, Cledyth M. AS OF: S. W. BARRETT REAL ESTATE & APPR/-~ISAL SERVICES File No. 04-0072 02/17/2004 Mark Thomas, Esquire 101 South Market Street Mechanicsburg, PA 17055 File Number: 04-0072 In accordance with your request, I have personally inspected and appraised the real property at: 43 Westfields Drive Mechanicsburg, PA 17050 The purpose of this appraisal is to estimate the market value of the subject property, as improved. The property rights appraised are the fee simple interest in the site and improvements. In my opinion, the estimated market value of the property as of August 31, 2003 is' $135,000 One Hundred Thirty-Five Thousand Dollars The attached report contains the description, analysis and supportive data for the conclusions, final estimate of value, descriptive photographs, limiting conditions and appropriate certifications. Respectfully submitted, Cassandra J. Crockett Certified Residential Appraiser Historical Price Lookup Date requested: 8/31/2003 Security: MET (Common Stock) Data is not available for the requested date. The previous trading date (8/29/2003) is displayed. Select Date: Closing Price 28.42 Day's High 28.52 Day's Low 28 Day's Volume 1,414,600 shares Actual Price 28.42 Split Adjustment Factor 1: :1 NOTE: The Closing Price, Day's High, Day's Low, and Day's Volume have been adjusted to account for any stock splits and/or dividends which may have occurred for this security since the date shown above. The Actual Price is not adjusted for splits or dividends. The Split Adjustment Factor is a cumulative factor which encapsulates all splits since the date shown above. The closing price above is not necessarily indicative of future price performance. APPRAISAL Personal Propertyof CL~c/?7-~ /~, ~L.4/2../C //.~ Z.~'£~7-/~I~L,J.S /D/~,/~cc~ff'B.~ ?,~/ Appraised by Chuck E. Bricker AU094-L Date ~G_-/~--0 ~ ITEM VALUE ITEM VALUE c o~ ~, p~ sK, ,~,~ CO~ PO~ [~ ~,~ ~ Account Summary for August 1, 2003 - August 31, 2003 Your Financial Advisor: BERNE/SCHILLING ONE SUMMIT SQUARE SUITE 300 ROUTE 413 & DOUBLE WOODS ROAD LANGHORNE PA 19047 215 -504-9702 / 800 -504-9702 Message from Wachovia Securities DID YOU KNOW THAT YOUR WACHOVIA SECURITIES FINANCIAL ADVISOR CAN HELP YOU ACCESS A VARIETY OF LENDING SERVICES THROUGH SEPAR~,TE AFFIUATES OF WACHOVIA CORPORATION? CALL TODAY TO LEARN MORE ABOUT THE BROAD ARRAY OF SERVICES AVAILABLE THROUGH YOUR FINANCIAL ADVISOR. At a Glance If ~ou have more than one account with us. why not get them linked? Your summary below will list them all. Contact Your Financial Advisor today. Accounts Branch Rep Account no. Previous portfolio value Currenf portfolio vaJue Individual Retiremer~tAccount NT NT55 2252-0427 $124,165.05 $123,981.96 Total $124,165.05 $123,981.96 ~01562 242165533223 NNNNfl NNNNN NNNNNNNN 0E,3001 Wachovia SecudUes, LLC, member NYSE/SIPC. 9rol~rage accounts are carried by First Clearing, LLC (FCC), member NYSE/SIPC. Regulatory Disclosure Estimated portfolio values Your po~olio value Is an estimate. The prices First Clearing, LLC uses to value certain securities are provided by outside services and do r~ol aJw~.ys represent the exact market price. Pricing melhod Prices for listed end NASDAQ securl~es are as el the close of business on the lasl day of Ihe period. Prices for EverGreen Hedge ~nds are provided on a month delay basis. Corporate and municipal bonds and other fixed income securities are priced by a compulerized pricing service or, for less actively traded securities, by utilizing a yield-based matrix system io arrive al an estimated market value. For current prices, call Your Financial Advisor. Effective Seplember 30,2001, Iong-tsrm cerlificatas el deposit will be priced using a markel value pricing model, The price shown may be different than lhe price received if the CD is held to maturity. SIPC protection Coverage Ior cash and securities in protected client accounts is provided lrom two soumes. The Securities Investor Protection Corporation (SIPC) prolacls up to $500,000, of which $100=000 may be cash. Wachovia Corporation has obtained additional protection, at no cost Io you, for the remaining net equity baJance, if any, of the cash and sacurilies in your accounts. This coverage does not prelect against losses from any change in market values of Investmenls. Margin account If you have a margin account. Ihis is a combined statement cf your general account and the Special Memorandum Account mainlalned for you trader Secllon 220.6 of Regulalion T, issued by the Board of Governors of the Federal Reserve system. The permanent record of the separate account is available for your inspection. Option information Information on commissions ard other charges assceiated with option Iraosaclions has be~ sent to you separately in transaction conlirmetions. Copies are available upon request. Financial statements Twice a year, First Clearing, LLC will update and have available, on-line, a statement of the firm's financial condition at www.firstclearingcorp, oom. The meal recent printed statement Is available upon request. Free credit balance Free credit balances and fully-paid securities are available Io clients upon request. Free credit balances are not segregaleq and may be used by Ihe firm, but only to Ihe exlent permitted by federal regulalions (Rule 15o3 on customer protection). Tax reporling I1 you are subjecl lo 109g reporting, we will provide you with any applicable 1099 forms. Cost basis and unrealized gain/loss are provded Ior informational purposes only and should not be used Ior tax prel:~u'ation without assistance from your tax advisor. In addition, separale purchases el the same security may have been combined. To update your cost data or provide costs that ere missing, contact Your Financial Advisor. Financial situation You must inform Your Financial Advisor promptly of any material change in your investment objective or financial situation so that they can meet your needs. Sweep Option Your account citers a variety el different daily sweep options. If you have any questions about sweep oplions including rates, or you would like to change your sweep oplion, please contact your Financial Advisor. Direct Participation Programs girecl participation program securrlles (e.g. partnerships, limited liability companies and real estate inveslment trusts which are not listed on national exchanges or NASDAQ) are generally illiquid; no formal trading market e)dsts for these securities; and Iheir values will be different than the purchase price. Unless otherwise indicated, the values shown herein Ior such securilies have been provided by the management of each program and represent managemenrs eslimale el the investor's inlerasl in the net assets of the program. Therefore, the estimated values shown herein may not necessarily be realized upon sale. IRA Withholding Notice Form W-4P/OMB No. 1545-0415 The withdrawals you receive lmm your IRA (except Education IRA) are subject to Federal income tax withholding unless you elecl not tc have wilhholding apply. If you have a periodic, or an "on demand" distribution, your election regarding our withholding of Federal income tax on your behall stays in eflecl u~lll you change i1. You may change or revoke your elaclion at any time and as often as you wish by completing a new election form. If you elect check-writing privileges you will also have previously elected to have no wilhholding on your wilhdrawals. If you decide to have taxes withheld you will riel be eligible for check willing from your IRA. If you elect riel to have taxes wilhheld you will be liable Ior payment el all taxes due on Ihe taxable porlion ct your distribution and you may be responsible for payment of estimated tax. You may be subject to tax penalties under the estimated lax payment rules ff your payments of esrimated tax and withholding, if any, are not adequate. Trading Activity The time el transact;on herein, the sacurilies market on which the Irensaction was made. or Ihe name of the buyer or sailer and the source and amount of any commission or fee receivable by the firm will be furnished Io Ihe Client upon written requesl. Clients may elect in wriling riel to receive conlirmalions for transactio, ns entered by investment advisors on their behalf. Clients may receive, on request and al no addltlona~ cost: transaction confirmations for any prior transact ons elfected during e waiver period end if desired, immediate cunlirmations for all subsequent transactions including details of any transaction eflecled for their accounts between periodic statements. Clearing services First Clearing, LLC (FCC), a registered broker-dealer, a member of the New York Stock Exchange and a member of the National Association of Securities Dealers, Inc., carries your account and acts as your custodian for funds and securities deposiled with us directly by you, through your Inlroducing Firm as ideetilied on the trontof this statement, or as a resull el transactions we process for your account. Unless and umll we receive wrllten nolica Irom you lo the cenlrery: FCC may accept from the Introducing Firm, without injury or invasligation: - orders for the purchase or sate o! securities for your accounl on margin or otherwise, and - any other instruclions concerning your account. Questions and Complaint~ about Your Account This account statement contains important information el:x:ul your brokerage account, including recent transactions. We encourage you to review the datells in this statement. It you do nol understand any of the information in your stalemant, please contacl us immediately. If you do col ob~ecl to the information reported on this statement w~lhin 10 days, we consider tl conclusive. In other words, we will assume you have agreed to, and ratified, all oi Ihs activily in this statemem. Inquires or complaints concerning positions and balances in your account may be directed lo: FCC Client Services Department, P.O. Box 6~J00, Glen Allen, VA 23508. All other inquiries or complaints regarding your account or Ihe activity therein s~ould be diracled to the Branch Manager at the address or phone number listed on the front ct this statement. You may reach tbe National Associalion of Securities Dealers (NASD) by c~lling the NASD Regulation Public Disclosure Program Holllne at 1-900-289-§999 or at the NASD Regulation I~lernel Web Site address, www.nasdr.com. A brochure describing the NASD Regulation Public Disclosure Program is g,546 Individual Retirement Account ............................................................. Statement for .................................................. CLEDYTH M CLARK IRA Page 10f3 FCC AS CUSTODIAN U/A DTD 4/10/95 Sub i Branch / Rep Account No. 001 / NT t NT55 2252-0427 Stalement period: August 1 - August 31, 2003 Account Summary Statement Period Year-lo-date Opening value of securities Opening value of cash Total openine value Closing value of securities Closing value of cash % total Total cloaqng value assels Change In value Your Financial Advisor, BERNE/*SCHILUNG ONE SUMMIT SQUAF~ SUITE 300 ROUTE 413 & DOUBLE'WOODS ROAD LNqGHORNE PA 19047 215-504-9702 t 800-504-9702 Current Investment Objective: Growth & Income + Moderate Portfolio Summary Portfolio assets Est. Ann. Value on July 31 Value on Aug 31 Income Cash and money market $4,156.08 $2,156.17 1.07 1.74 Stocks and options :~0.00 $0.00 0.00 Preferred stocks $0.00 $0.00 0.00 Bonds ~;0.00 :~0.00 0.00 Certificates of Deposit $0.00 $0.00 0.00 Mutual funds $0,00 $0.00 0.00 Annuities * $120,008.97 $121,825.79 0.00 98.2R Unit investment trusls $0.00 $0.00 0.00 Total aaaeta $124,165.05 $123,981.96 1.07 100% Outstanding margin balance $0.00 $0.00 0.00 Net portfolio value $124,165.05 $123,981.96 *Annuities are held directly by the issuing insurance company, not in the brokerage account. Annuities are not protecled by SIPC. Other assets ~cT~re. Sp posi!)ons, reflect purcha, se~..rnade through us or information s, upplled to. us; .they are displayed inlormaaona~ purl._ sea only. IT you no ~onger own any of these mveetmenTs, please tell us so we can. upda. ta ~!~..section. These assets are not includ~d In the nat portfolio value, and ara not protected by ~m~'~. Valu~'Cost on July 31 Value/Cost on Aug 31 Direct investments $0.00 $0.00 Special products ~0.00 ~0.00 Total other assel-,~ $O.00 $0.00 Realized Gain/Loss Summary This period Year 1o dalR Short-term $0.00 - $4,041.31 Lan.q-term $0.00 - $22,011.45 Total Realized gain/lose $0.00 - $26,052.76 $120,008.97 $236,188.83 $4,156.08 $2,673.7,3 j 124,165.05 ~238,862.5~ 121,825.79 $121,825.79 $2,156.17 $2,156.17 $123,981.96 $123,981.96 - $183.09 - $114,880.60 Cash Activity Summary Total cash and money market funds on July 31: Credits Debits S4,156.0~ Year-io-dAt~ Securities purchased $0.00 Securities sold and redeemed $0.00 Deposits and withdrawals $0.00 Withdrawals by check $0.00 Electronic bankin,~ activ~ $0,00 Dividends $0.00 Interest 90.00 Money market income 90.09 Short term distributions $0.00 Long term disbibutions $0.00 Return of principal $0.00 Partnership Distributions $0.00 Interest charged $0.00 Withholding $0.00 Other activity $0.00 Total activity $0.09 Total cash and money market funds on Aug 31: $0.00 - $100.000,00 $0.00 $101,437.48 - $1,800.00 - $8,701.20 $0.00 $0.00 $o.oo $o.oo 90.00 $o.oo $o.oo $o.oo $0.00 $12,9~ 90.00 $o.oo $o.oo $o.oo 90.00 $o.oo $o.oo $o.oo $o.oo $o.oo - $200.00 - $3,266.80 $0.00 $10,000.00 - $2,ooo.o0 $2,156.17 L~ENO1 001562 242165533223 NNNNN NNNNN NNNNNNNN 000002 g,548 ............................................................. Statement for .......................................................... CLEDYTH M CLARK IRA Page 2 of 3 FCC AS CUSTODIAN U/A DTD 4/10/95 Sub t Branch / Rep Accounl No. 001 / NT / NT55 2252-0427 Statement period: August 1 - August 31,2003 Portfolio Assets Th;s section includes estimated or unrealized gains or losses for your information only and should not be used for tax purposes. If ~cquisi~n inforn~tion is not a,railable, the gain/lass information may not be displayed and section and summary totels may not reflect your complete portfolio. Cost ~asis information provided by the account o~,mer is not vedfied by First Clearing, LLC and should not ~ relied upon for legal or tax purposes. Bonds purchasedat a premium or O.I.D. (Original Issue Discount) will be carried at the odginal cost basis. Factored bonds (GNMA, CMO, etc.) will be adjusted for paydown of principal. Systematic investments in mutual funds and reinvested dividends for mutual funds and sl~cl~ ham been consolidated for each position. Unit cost data for systematic investments and dividend reinvestment securities is provided for informational purposes only and is a non-weighted average. To update your cost inforn~tion or provide omitted cost information, contact your Financial Advisor. EsUmated Annual Income, ~,/nen available, reflects the estimated amount ~ou would earn on a security if your current position and ils related income remained constant for a year. Estimated Annual ~leld, when available, reflects the currentestimated annual income divided by the currentvalue of the security as of the statement closing date. The information used to derive these estimates is obtained from various outside vendors; FCC is not responsible for incorrect or missing estimated annual income and y~slds. Cash and money market funds Est current Description Current market vaJue Est. ann. income yield(%) EVERGREEN MONEY MKT FD $2,156.17 $1.07 0.05 CLA Interest Period 06!01/03 - 0g/01!03 Total cash and money market funds $2,156.17 Curious how y3ur securities are performing?. The "Unrealized gain/loss" column lolls you how much each stDck has increased or decreased in value since you bought it (based cn cost data supplied by you or by outside son, cos, which may not be complete). Revisions to ti, is information (because of corporate mergers, tenders and other reorganizations, for example) may be necessary from time to time. To update your cost information or provide orni~d costs, contact Your Financial Advisor. ' Annuities Annuity values and all sub fund information is provided direcify I'rom the nsurance companies. Accuracy is not guaranteed and surrender charges may apply. Annuiifes are not protected by SIPC. Please contact your Financial Advisor if you no longer own ~ny of the annuity positions listed below. Description As of value dale Total cost Estimated rnarkel valu~ AM LEGACY Ill PLUS LINCOLN NATL LIFE VAR CONTR# 95971518000000000 Sub Funds AMERICAN FUNDS GROWTH - CLASS AMERICAN FUNDS GROWTH*INCOME-C Unils Estimated Value % market value 4,022.86490 $2,654.98 23.54 8,732.77540 $8,622.85 76.46 00/27/03 $158,253.16 $11,277.83 MANUFACTURERS LiFE INS SCUDDER WEALTHMARK ML3 VARIABLE ANNUITY CONTR# 55101889 Sub Fur'ds Unils Estimated Value % marks! value SCDR HIGH INCOME 1,377.13260 $20,462.71 ~ 8.51 SCDR GLOBAL DISCOVER 1,337.94200 $23,747.79 21.48 DREMAN HIGH RETJRN 1,019.42190 $16,465.00 ~ 4.89 DAVIS VENTURE VALUE 1,041.52030 $16,328.98 14.77 JANUS G RTH & INCOME 1,055.48490 $15,880.12 t 4.36 08/27/03 $100,000.00 $110,547.96 IIIIIIIlillllllllBIIIIIIIIIIIIIIIIIIl lllli ............................................................. Slatement for ..................................................... CLEDYTH M CLARK IRA Page3 of 3 FCC AS CUSTODIAN U/A DTD 4/10/95 Sub / Branch / Rep Accounl No. 001 / NT / NT55 2252-0427 Statement period: August ! - August 31, 2003 Annuities continued Description As of value date Total cost Estimated markel value · qCDR .CMALL CAP GROWl' 1,006.21890 $17,663.36 ? 5.97 Total Annuilie~ $258,253JI6 $121,825.79 Activity Detail Date Account Type Transact!on Quantity Description Price Amou.~ 08/01 Cash IRS W/H FED TAX W/H REG DIST -$200.00 08/01 Cash DISTRIBUTION REGULAR DIST PARTIAL -$1,800.00 TRACE # 051400542001501 08/01 Cash TRANSFER FROM EVERGREEN MONEY MKT FD 1.0000 $2,000.00 CLA 08/29 Cash DIVIDEND EVERGREEN MONEY MKT FD $0.09 CLA 082903 2,156 08/29 Cash REINVST DIV/INT EVERGREEN MONEY MKT FD -$0.09 CLA Retirement Transactions ContribuUon Summary Amounl Distribution Summary A~ount 2003 FOR 2003 $100,000.00 2003 FOR 2003 -$37,668.00 Thank you for allowing Wachovia Securities, LLC to serve you. If you have any questions regarding your account or this statement, please contact your Financial Advisor. E'vEN01 001~2 242155533223 HNNNN NNNNN NNNNNHNN 000003 9,533 Account Summary for August 1, 2003 - August 31,2003 Your Financial Advisor: BERNE/SCHILLING ONE SUMMIT SQUARE SUITE 300 ROUTE 413 & DOUBLE WOODS ROAD LANGHORNE PA 19047 215-504-9702 / 800-504-9702 Message from Wachovia Securities DID YOU KNOW THAT YOUR WACHOVIA SECURITIES FINANCIAL ADVISOR CAN HELP YOU ACCESS A VARIETY OF LENDING SERVICES THROUGH SEPARATE AFRUATES OF WACHOVIA CORPORATION? CALL TODAY TO LEARN MORE ABOUT THE BROAD ARRAY OF SERVICES AVAILABLE THROUGH YOUR FINANCIAL ADVISOR. At a Glance If y3u have more than one account with us, why not oet them linked?. Your summary below ~,411 list them all. Contact Your Financial Advisor today. Accounts Branch Rep Account no. Previous podlolio value Current portfolio value Individual RetiremenlAccount NT NT55 2043-4816 $92,976.16 $95,424.67 Total $92,976.16 $95,424.67 EVEN01 001580 242165533223 NNNNN ,"INI'INN NNNNNNNN 000001 Wachovia Securities, LLC, member NYSE/SIPC. Broterage accounts are carried by First Clearing, LLC (FCC), member NYSE/SIPC. Regulatory Disclosure Estimated portfolio values Your portlolio value is an estimate. The prices First Clearing, LLC uses to value certain securities are provided by outside services and do not always represent the exact market price. Pricing] method Prides mr listed end NASDAQ securities are as of the dose of business on the lasl day of he Der od. Prices for Evergreen Hedge funds are provided on a month delay basis. Corporale and municipal bonds and other rLxed income securities are priced by a computerized pricing service or, for less actively traded securities, by utilizing a yield-based matrix system to arrive al an estimated market value. For current prices, call Your Financial Advisor. Effeclive Seplember 30,2001, Iong-tenn cerlificales gl deposit will be priced using a markel value pdcing model. The price shown may be different than Ihe price received if the CD is held to maturity. $1PC proleclion Coverage for cash and securities in protecleci client accounts is provided from two sources. The Securities Investor Protection Corporation (SIPC) prelects up to $500,000, of which $100,000 may be cash. Wachovia Corporation has obtained additional protection, at no cost to you, {or the remaining net equi~ balance, if any, of the cash and securities in your accounts. This coverage does not prelect against losses Irom any change in market values of Investments. Margin accounl Il you have a margin account, Ihis is a combined statement cf your general account and Ihs Special Memorandum Account maintained for you under Section 220.6 of Regulalion T, Issued by the Board of Governors of the Federal Reserve system. The permanent record of the separale accounl is available for your inspection. Option information Infon-nalien on commissions ar, d olher charges associated with option transactions has been sent to you separately in Iransection confirmations. Copies are available upon request. Financial statements Twice a year, First Clearing, LLC will update and have available, on-line, a statement of the firm's financial condition at www.firstcleeringcorp.com. The most re~ent printed statement la available upon request. Free credit balance Free credit balances and fully-paid securilies are available to clients upon request. Free credit balances are not segregated and may be used by the firm, but only to the ex'lent permitled by federal regulalious (Rule 15c3 on cuslomer proteclion). Tax reporting If you are subject to 10gg reporting, we will provide you with any applicable 10.99 forms. Cost basis end unrealized gain/foss are provided Ior informational purposes only and should not be used for tax preparatior~ wilhout assistance from your ;ax advisor. In addition, separale purchases gl the same security may have been combined. To update your cost date or provide costs that are missing, conlact Your Financial Advisor. Financial situation You must inform Your Financial Advisor promplty gl any material change in your investment objective or financial situation so Ihal they can meet your needs. Sweep Option Your account oilers a variety of different daily sweep options. If you have any questions about sweep options including rates, or you would like Io change your sweep option, please contact your Financial Advisor. Direct Participation Programs Direct parllclpatlon program securities (e.g. partnerships m ted liability companies and rea estate inveslmenl trusts whmh are not listed on national exchange~ or NASDAQ) are generally illiquid; no formal trading markel exists for Ihese securities; and their values will be ditferenl than the purchase price. Unless otherwise indicated, the values shown herein Ior such securilies have been provided by the manegemenl gl each program and represent managemenrs estimale gl the Investor's interest in the net assets of the program. Therefore, the estimated values shown herein may not necessarily be realized upon sale. IRA Withholding Notice Form W-4P/OMB No. 1545-O415 The wilhdrawais you receive tram your IRA (except Education IRA) are subject to Federal income tax wilhholding unless you elecl nol to have withholding apply. If you have a periodic, or an "on demand" distribulion, your election regarding our withholding of Federal income tax on your behaiI stays in effect ur~til you change il. You may change or revoke your eleclion at any time and as ellen as you wish by completing a new election form. If you elect check-writing privileges you will also have previously elected to have no withholding on your withdrawals, ii you decide to have taxes withheld you will not be eligible for check writing from your IRA. If you elect riel to have laxes withheld you will be liebla for payment of all taxes due on Ihe taxable porliorl of your distribution and you may be responsible for payment gl estimated tax. You may be subject te lax peneltles under the estimated tax payment rules if your paymenls et estimated tax and withholding, if any, are not adequate. Trading Activity The time of transaction herein, the securilJes market on which the transaction was made. or the name of the buyer or sailer and the source and amount of any commission or fee receivable by Ihe firm will be furnished to the Clienl upon wrilten request. Clients may elect in writing not to receive confirmations for transactions entered by investment advisors on their behalf. Clients may receive, on request and al no additional cosl. transaclion confirmalions for any pdor transactions elfected during e waiver period and if desired, irnm~diata confirmations for all subsequent transactions including detaJls gl any transaction effecled for their accounls between periodic statements. Clearing services First Clearing, LLC (FCC), a re~:Jislered broker-dealer a member of the New York Stock Exchange and a member o! the Nations Assec~alion of Securities Dealers, Inc., carries your account and acts as your custodian for funds and securities deposiled wilh us directly by you, through your Introducing Firm as identified on the front of this statement, or as a resull of transactions we process for your account. Unless and until we receive written notice from you to the contrary, FCC may eccepl from the Inlroduclng Firm, without injury or investigation: - orders lor the purchase or sale of securities for your acoounl on margin or olherwise, and - any other instructions concerning your account. Questions and Complaints about Your Account This account statement contains important intormalion about your brokerage account, including recent transactions. We encourage you Io review the details in Ihi6 statement. If you do not understand a. ny of the information in your stalernent, please contacl us immediately. It you do ncl object to the information reporled on this statement wilhln 10 days, we consider it coflcluslve. In olher words, we will assume you h.=ve agreed to, and ratified, all of the activity in this statement. Inquiries or complaints concerning posilions and balances in your account may be directed Io: FCC Client Services Departmenl, P.O. Box 6600, Glen Allen, VA 23508. All other inquiries or complaints regarding your account or the a~.tivity ~nerein should be direcled to the Branch Manager at the address or phone number listed on the front of this statement. You may reach the National Association of Secur,ties Dealers (NASD) by calling the NASD Regulalion Public Disclosure Program Hotllne at 1-800-269-9999 or et the NASD Regulation tnlernel Web Site address, www,nasdr.com. A brochure describing I!'e NASD Regulation Public Disclosure Program is 9,534 Individual Retirement Account g,53 ............................................................. Statement for ......................................................... CLEDYTH M. CLARK (IRA) Page 10f4 FCC AS CUSTODIAN (PILOT PLUS) Sub / Brench / Rep Acoounl No. 001 / NT i NT55 2043-4816 Statement period: August 1 - August 31, 2003 Account Summary Statement Pmiod Year-lo-date Your Financial Advlson BERNE,~CHILUI~ ONE SUMMIT SQUAFE SUITE 300 ROU1E 413 & DOUBLE WOODS ROAD LN~GHORNE PA 19047 215-504-cJ702 / 800-504-g702 Currelll Inveslment Objective: Growth + Moderate Portfolio Summary Portfolio assets Est. Ann. % tolal Value on July 31 Value on Aug 31 Income assel~ Cash and money market $24,987.16 $25,026.67 12.51 26.2,3 Stocks and options ~37,829.00 ~;39,958.00 490.40 41.87 Preferred stocks $30,160.00 $30,440.00 2,330.00 31.90 Bonds ~;0.00 90.00 0.00 Certificates of Deposit 90.00 $0.00 0.00 Mutual funds 90.00 $0.00 0.00 Annuities $0.00 $0.00 0.00 Unit investment trusts 90.00 $0.00 0.00 Total asael,, $92,976.16 $95,424.67 2,832.91 100% Outstanding margin balance $0.00 $0.00 0.00 Net portfolio value $92,976.16 $§5,424.67 Other assets foTl~re.S.e posi!!ons, reflect pumha, ses made th.rough us or information supplied to us; they are displayed inmr .ma[mna~ purposes omy. If you no tonger own any of these investments, p ease tell us so we can update this section. These assets are not nc uded In the net portfolio value and are not protected by SIPC. ' Value/Cost on Jul,/31 ValueJCost on Aug 31 Direct Investments 90.00 $0.00 Special products $0.00 $0.00 Total other assets $0.00 $0.00 Realized Gain/Loss Summary This period Year to data Shod-term $0.00 $3,835.78 Long-term $0.00 $0.00 Total Realized gain/lose $0.00 $3,835.78 Opening value of securities $67,989.00 $0.00 Opening value of cash $24,987.16 $0.00 Total openin~l value $92,976.16 $0.00 Closing vaJue of securities $70,398.00 $70,398.00 Closing value of cash $25,026.67 $25,026.67 Total closing value $95,424.67 $95,424.67 Change In value $2,448.51 $95,424.67 Cash Activity Summary Total cash and money market funds on July 31: Credits Debils $24,g87.16 Year-lo-d~t~. Securities ~)urchased $0.00 Securities sold and redeemed $0.00 Deposits and wilhdrawals $0.00 Withdrawals by check $0.00 Electronic banking activity $0.00 Dividends $38.50 Interest $0.00 Money market income $1.01 Short term distibu~ons 90.00 Lon.q term distributions 90.00 Return of ~rin¢i~al $0.00 Partnership Distributions $0.00 Interest chan:led $0.00 Withholding $0.00 Other activity $0.00 Total activtty ,~39.51 Total cash and money market funds on Aug 31: $0.00 - $93.554,00 $0.00 $44,832.7R $0.00 $74,300.00 $o.oo $o.oo $o.oo $o.o0 $0.00 $373.7.~ $0.00 $0.00 $0.00 976.29 $o.oo $o.o0 $o.oo $0.0o $o.oo $o.oo $o.oo $o.oo $o.oo $o.oo $o.oo $o.oo $0,00 - $1,002.15 $o.oo $25,026.67 00156_,0 ~42165533223 HNNNN NNHNN NNNNNNNN 000002 9,538 ............................................................. Statement for .......................................................... CLEDYTH M. CLARK (IRA) Page 2 0f4 FCC AS CUSTODIAN (PILOT PLUS) Sub t Branch / Rep Accounl No. 00! / NT /NT55 2043-4816 Statement period: August 1 -Auguat 31, 2003 Portfolio Assets This section includes estimated or unrealized gains or losses for ysur information only and should not be used for lax purposes. If acquisilion informaUon is not available, the gain/less information may not be displaysd and section and summary totals may not reflect ~ourcomplete portfolio. Cost basis information pro,Aded by the account o~'mer is not verified by First Clearing. LLC and should not be relied upon for legal or tax purposes. Bonds purchasedat a premium or 0.I.D. (0dginal Issue Discount) will be carried at the original cost basis. Factored bonds (GNMA, CMO, etc.) will be adjusted for paydown of principal. Systematic invastmants in mutual funds and reinvested dividen~ for mutual funds and s'~ocks have been consolidated for each posit~on. Unit cost data for systematic investmente and dividend reinvestment securities is provided for informational purposes only and is a non-weighted average. To update your cost information or provide omi~d cost information, contact ysur Financial Advisor, Estimated Annual Income, ~'/non available, mftects the estimated amount Wu ~veuld earn on a securityif your current position and its related incorne~ remained constant for a ~e, ar. Estimated Annual '~1eld, when available, reflects the currentestimated annual income divided by the currentvatue of the security as of the statement closing date. The information used to derive these estimates is obtained from various outside ~endors; FCC is not responsible for incorrector missing estimated annual income and yields. Cash and money market funds Est current Description Current market value Est. ann. income yield(%) EVERGREEN MONEY MKT FD $25,026.67 $12.51 0.05 CLA Interest Period 08/01/03 - 09/01103 Total cash and money market funds $25,026.6~ Curious how ysur securities are performing?. The "Unrealized gain/loss" column lalis ~ou how much each stock has increased or decreased in value since you bought it (based on cost data supplied by ysu or by oulside sen4cos, which may not be complete). Revisions to this information (because of corporate mergers, tenders and other reorganizations, for example) may be necessary from time te time. To update your cost information or provide omi~d costs, contact Your Financial Advisor. ' Stocks and options Stocks Cost Current Current Unrealized Est. ann. Esl. ann. Description Symbol # of shares per share Total cost share price markel value galnfloss income yield {%} ATI TECH INC ATYT Acquired 04!24/~3 400 $6.49 $2,596.00 $15.1 Oeo $6,O40.00 $3,444.00 N/A N/A BAX ~ EH INTERNATIONAL INC BAX Acquired 06/27/03 200 $25.23 S5,046.00 $28.1000 $5,620.00 $574,00 $116.4~ 2.07 CISCO SYSTEMS INC OSCO Acquired 11/17/00 200 $52.87 $10,772.80 $19.1400 Acquired 11/28/'00 400 $52.06 $21,181.91 Total 600 $31,954.71 $19.1400 CORNING INC GLW Acquired 04/24/03 400 $5.98 S2,392.00 $8,2500 FCRD MTR CO DEL F COM PAR $0.01 Acquired 04/24/03 300 $10.52 S3,156.00 $11.5600 GOODYEAR TIRE & :lUBBER GT Acquired 04/24/.q3 500 $5.72 $2,860.00 $7.1200 $3,828.00 - $6,944.80 N/A N/A $7,656.00 - $13,52591 $11,484.O0 -$20,470.71 $3,300,00 $908.00 $3,468.00 $312,CO $3,560.00 $700.00 N/A N/A N/A N/A $120.00 3.46 N/A N/A 9,53T ............................................................. Statement for ....................................................... CLEDYTH M. CLARK (IRA) Page3 of 4 FCC AS CUSTODIAN (PILOT PLUS) Sub / Branch / Rep Accounl No. 001/ NT iNT55 2043-4816 Statement period: August 1 -August 31, 2003 Stocks and options Stocks conUnued Cost Current Current Unrealized Est. ann. Esl. ann. Description Symbol # of shares per share Total cosl share price market value gain/loss income yield (%) SPRINT CORP FON Acquired 0~/27/03 200 $14.43 S2,886.00 $14.7700 $2,954.00 $68.00 $100.00 3.38 VERIZON COMMUNICATIONS VZ COM _Ac~quired 04/~473 .. 100 $36.21 S3,621.00 $35.3200 $3,532.00 - $89.00 $154.00 4.36 Total Stooks $54,511.71 $39,958.00 - $14,553.71 $490.40- 1.23 Total Stocks and option~ $54,511.71 $39,958.00 - $14,553.71 $490.40 1.23 Preferred stocks Cost Current Current Unrealized Est. ann. Esl. ann. Description Symbor # of shares per share Total cost share price market value gain/loss income yield {%) ACE LTD 7.8% ACE'C CUM PERP DEP SHS CALLABLE 5/30;08 Acquired 05/07/03 400 $25.00 $10,000.00 $25.4500 $10,180.00 $180.00 $780.00 7.66 COLONIAL PROP TR 8.125% CLP'D CUM PERPETUAL PFD CALLABLE 4/30/08 Acquired 04/03/03 400 $25.00 $10,000.00 $25.7500 $10,300.00 $300.00 $812.52 7.88 DEVELOPERS DIVERS 7.375% DDR'H PERP CUM PFD CALLABLE 7/28/08 Acquired 08/27/03 400 $25.00 $10,000.00 $24.9000 $9,960.00 - $40.00 $737.48 7.40 Total Preferred stocks $30,000.00 $30,440.00 $440.00 $2,330.00 7.65 001560 242185533223 HNNNN NNNNN NNNr'~NNNN 0C¢J003 9,538 ............................................................. Statement for .......................................................... CLEDYTH M, CLARK (IRA) Page 4 of 4 FCC AS CUSTODIAN (PILOT PLUS) Sub / Branch / Rep Account No. 001 / NT t NT55 2043-4816 Statement period: August 1 - August 31, 2003 Activity Detail Date Account Type Transaclion Quantily Description Price Amount 08/01 Cash DIVIDEND VERIZON COMMUNICATIONS $38.50 COM 080103 100 08/01 Cash TRANSFER TO EVERGREEN MONEY MKT FD 1.0000 -$205.36 CLA 08/04 Cash TRANSFER TO EVERGREEN MONEY MKT FD 1.0000 -$38.50 CLA 08/29 Cash DIVIDEND EVERGREEN MONEY MKT FD $;1.01 CLA 082903 25,025 08/29 Cash REINVST DIV/1NT EVERGREEN MONEY MKT FD -$;1.01 CLA Thank you for allowing Wachovla Securilies, LLC to serve you. If you have any questions regarding your account or this statement, please contact your Financial Advisor. IIIIIIIIIIIIIIIIIIIIIIIIII Illllllllll#llllllll 9,539 Account Summary for August 1, 2003 - August 31,2003 Your Financial Advisor: BERNE/SCHILLING ONE SUMMIT SQUARE SUITE 300 ROUTE 413 & DOUBLE WOODS ROAD LANGHORNE PA 19047 215-504-9702 / 800-504-9702 Message from Wachovia Securities DID YOU KNOW THAT YOUR WACHOVIA SECURITIES FINANCIAL ADVISOR CAN HELP YOU ACCESS A VARIETY OF LENDING SERVICES THROUGH SEPARATE AFFIUATES OF WACHOVIA CORPORATION? CALL TODAY TO LEARN MORE ABOUT THE BROAD ARRAY OF SERVICES AVAILABLE THROUGH YOUR FINANCIAL ADVISOR. At a Glance If ~u have mom than one account with us, why not get them linked?. Your summary below will list them all. Contact Your Financial Advisor today. Accounts Branch Rep Account no. Previous portlolio value Current porlfolio vaJue Capita~ Resource Account NT NT55 2252-0394 $216,500.87 $219,883.28 Total $216,500.87 $219,883.28 ~01561 242165533223 NNNNN NNNNN NNNNNNNN 0E"3001 Wachovia Securities, LLC, member NYSE/SIPC. ~rokemge accounts are carried by First Clearing, LLC (FCC), member NYSE/SIPC. Regulatory Disclosure Estimated portfolio values Your po~olio value is an eslimale. The prices First Clearing, LLC uses to value certain securities are prov deal by outside sarvices and dc, ~'ot always represent the exacl m~rket price. Pricing method Prices for Ilsled end NASDAQ securities ere as of the close of business on the last day of Ihs period Prices for Evergreen Hedge funds are provided on a n~nth delay basis. Corporals and municipaJ bonds and other fixed income securilies are priced by a computerized pricing service or, for less aclively traded securities, by utilizing a yield-based matrix system to arrive al an estimated market value. For current prices, call Your Financial Advisor-. Effective Seplember 30,2001, icing-term certificales of deposil will be priced using a markel value pricing model. The price shown may be different than the price received if the CD is held to maturily. SlPC protection Coverage for cash a'~d securities in protecie(J client accounts is provided from two sources. The Securities Investor Protection Corporation (SIPC) pro,eels up ~, $500,000, of which $100,000 may be cash. Wechovia. Corporalion has obtained additional pm~estion, at no cost Io you, lot the remaining net equity balance, if any, of the cash and securilias in 3~ur accounts. This coverage does not protect against losses from any change in market values of Invaslments. Margin accounl II you have a margin account, lhis is a combined statement cf your general account and lhe Special Memorandum Account. maintained for you under Section 2:>0.6 gl Regulalion T, issued by the Board of Governors of the Fedoral Reserve system. The permanent record of the separate account is avai!able for your inspection. Option information Infonmation on commissions and other charges associated with option transactions has been sent to you separately in Iransection confirmations. Copies are available upon request. Financial statements Twice a year, Firsl Clearing, LLC will update and have available, on-line, a statemenl of the firm's financial condition st www.firstclearingcorp, com. The most recent printed statement Is available upon requeeL Free credit balance Free credit balances and fully-paid securities are available lo clients upon request. Free credil balances are not segregated and may be used by the firm, but only to the exlent permitled by federal regulations (Rule 15c3 on customer protection). Tax reporting If you are subject to 1099 reporting, we will provide you with any applicable 1099 Iorms. Cost basis and unrealized gain/loss are provided Ior informational purposes only and should not be used for lax preparation without assistance from your tax advisor. In addition, separate purchases of the same securily may have been combined. To update your cost dale cr provide costs that are missing, contact Your Finan"ial Advisor. Financial situation You must inform Your Financial Advisor promplly gl any material change in your investment objective or financial situation so that they can meal your needs. Sweep Option Your account offers a variety of different daily sweep options. If you have any questions about sweep options including ralas, or you would like Io change your sweep option, pies. sa conlact your FinanciaJ Advisor. ' Direct Participation Programs Direcl parlicipatlon program securities (e.g. partnerships limited liability companies and real estate invaslmanl trusts which are not listed on national exchanges or NASDAQ) are generally rltiquid; no formal trading market e~sts for these securities; and their values will be differenl than the purchase price. Unless otherwise indicaled, the values shown herein lot such securities have be~ provided by the management gl each program and represent manegement's eslimale of the Investor's inleresl in the net assets of the program. Therefore, the estima'led values shown here n may not necessarily be realized upon sale. IRA Withholding Notice Form W-4PIOMB No. 1545-0415 The withdrawals you receive from your IRA (excepl Education IRA) are subject to Federal income lax withholding unless you elecl not tc have wilhholding apply. If you have a periodic, or an "on demand" distribution, your election regarding our withholding of Federal income tax on your behall stays in eflecl unlil you change it. You may change or revoke your election at any time and as cites as you wish by completing a new election form. If you elect check-writing privileges you will also have prey ously elected Io h.ave .no withh.olding on your withdrawals. H you decide to have taxes w thhe dyou will nol be eligible or check wnl;ng from your IRA. If you elect not to have taxes wilhheld you will be ~able for payment of all taxes due on the taxable poflion of your distribution and you may be responsibio for payment of estimated '~ax. You may be subject tc lax penalties under the estimated tax paymecl rules I1 your payments of estimated tax and withholding, if any, are not adequste. Trading Activity The time of transaction herein, the securtiies market on which the transaction was made. or the name gl the buyer or sarler and the source and amount of any commission or fee receivable by the firm will be furnished Io the Clienl upon written raguesl. Clienls may elect in wriling not to receive confirmations for transactions entered by investmant advisors on their behalf. Clients may receive, on request and al no addl~3nal cost: Iransactlon confirmations for any prior transactions effected during e waiver period and Il desired, immediate confirmations for all subsequent transactions including de~ls gl any Iransaclion effected for their accounts between periodic statements. Clearing services First ,Clearing, L.I.C (FCC), a registered broker-dealer, a member of the New York Brock Exchange end a memoer gl the National Association o~ Securilias Dealers, Inc., carries your account and uts as your custodian for funds and securities deposiled wilh us directly by you, through your Introducing Firm as identified on the front of this slatemant, or as a resull of transactions we process for your account. Unless and until we receive written notice from you to the contrary= FCC may accept from the Introducing Firm, without injury or investigation: - orders lor the purchase ~ sale of securilies for your a~ounl on margin or olherwise, and - any other instructions concerning your account. Questions snd Complaints about Your Account This account stalemant contains important inlormalion about your brokerage account, including recent transactions. We encourage you to review the details in this statement. If you do not understand any of the information in your stalemant, please contact us immediately. If you do nol objecl to the information reported on this statement within 10 days, we consider it conclusive. In giber words, we will assume y. ou hsve agreed to, and ratified, all of the activily in this statement. Inquiries cr co'm~lainls concarmng posilions and balances in your accounl may be direcled Io: FCC Clienl Services Department, P.O. Box 6,600, Glen Allen, VA 23508. All olher inquiries of complai~ s regarding your acccun! or Ihs activity therein should be direcled to the Branch Manager at the address or phone number lisled on the front of this statement. You may reach the National Associalion of Securilies Dealers (NASD) by calling the NASD Regulation Public Disclosure Program Hollina at 1-~00-289-9999 or at the NASD Regulation I~lernet Web Site address, www.nasdr.com. A brochure describing Ihs NASD Regulation Public Disclosure Program is 9,540 Capital Resource Account ............................................................. Statement for ........................................................ CLEDYTH M CLARK Page 1 of 3 JAMES E CLARK JT TEN Your FinanclaJ Advl~oc BERNDSCHlUJNG 01~ SUMMIT SOUAFE SUITE 3OO ROU1E 413 & DOUE~E WOODS ROAD LANGHOR~'tE PA 19047 215-504-9702 / 800-504-g?02 Currenl Investment Objective: Growth & Income + Moderate Portfolio Summary Portfolio assets Value on July 31 Value on AL~ 31 Cash and money market $6,064,86 94,899.48 Stocks and options ~;0.00 ~;0.00 Preferred stocks $0.00 $0.00 Bonds ~;0.00 ~;0.00 Certificates of Deposit 90.00 $0.00 Mutual funds 90.00 $0.00 Annuities * $210,436.01 $214,983.80 Unit investment trusts 90.00 $0.00 Total assets $216,500.87 $219,883.28 Outstanding margin balance $0.00 $0.00 Net portfolio value $216,500.87 $219,883.28 *Annuilies are held directly by the issuing insurance company, not in the brokerage protected by SIPC. Sub i Branch / Rep Account No. 001 / NT I NT55 2252-0394 Statement period: August 1 - August 31, 2003 Account Summa Statement Period Yem-to-date Opening value of securities $210,436.01 Opening value of cash $6,064.86 Total openinQ value $216,500.87 Closing value of securiUes $214,983.80 Closing value of cash $4,899.48 Est. Ann. % tolal Total closing value $219,883.28 $219,883.2R Income asset~ 2.44 2.23 Change In value $3,382.41 $30,576.90 0.00 0.00 0.00 0.00 0.00 Cash Activity Summary $185,016.98 $4,289.40 189,306.38 214,983.80 $4,899.48 account. Annuities are no1 Other assets These positions reflect purchases made through us or information suppl ed to us; they are displayed for informational purl:~., see only. If you no longer own any of these investments, please tell us so we can. up<late this section. These assets are not includ~l In the net portfolio value, and are not projected by SIPC. Value,'C~st on July 31 Value/Cost on Aug 31 Direct investments $0.00 90.00 Special products ~;0.00 ~;0.00 Total other assets $0.00 $0.00 Realized Gain/Loss Summary This period Short-term $0.00 Lonq-term $0.00 Total Realized gain/lose $0.00 EVENO 1 001561 2421655.33223 Year to daln $0.00 $o.o0 $o.oo NNNNN NNNNN NNNNNNNN 000002 2.44 100% Securities purchased $0.00 0.00 Securities sold and redeemed $0.00 Deoosits and withdrawals 90.00 Withdrawals by check $0.00 Electronic banking activity $0.00 Dividends $0.00 Interest $0.00 Money market income 90.22 Short term distributions 90.00 Lon.q term distributions $0.00 Return of principal $0.00 Partnership Distributions $0.00 Interest chaq:led $0.00 Withholding $0.00 C~her activity $0.00 Total activity $0.22 Total cash and money market funds on Aug 31: $0.00 - $23,000.00. $o.oo $o.oo $0.00 $45,123.30 - $1,165.60 - $21,522.57 90,00 $o.oo $o.oo $o.oo $o,oo $o.oo 90.00 $9.35 90.00 90.00 $o.oo $o.oo $o,oo $o.oo $o.oo $o.oo $o.oo $o.oo $o.oo $o.oo $o.oo $0.0o - $1,165.60 $4,899.48 Tax-exempt Income year-to-date: $0.00 Other income year-to-date: $0.00 Tax-exempt income and other income year-lo-date totals are laken from the tax reporting system. They ~m~nYl~t..ma~ .t?h' back, to the activity .sumn?.ary a.bov.e d.ue.t.o r..eclass, if.ma, tion activity. Money market income , _. : m~n,er !axao,m o.,r taxx ex. amp( eno Is not renactea In mess totes. The YTD Money market Income [,s a!s,p~ay,ea aoo,ve In me .~:~a,,sh .A~.tlvlty .Summa~. The Cash Activity Summary is based on ~ activ ty .ma.~ r~s Reen .sn.own.c~ mis .state.me. nT, no! what will ,be. reportedto you on your forms 1099. This statement ~s not a tax aocument, ana Should oe used for mrormaflonal purposes only. 0.00 97.77 Total cash and money market funds on July 31: S6,064.8~ 0.00 Credits Debits Year-lo-daln 9,542 ............................................................. Statement for ....................................................... CLEDYTH M CLARK Page2 of 3 JAMES E CLARK JT TEN Sub t Branch i Rep Accounl No. 00! / NT /NT55 2252-0394 Statement period: August ! -August 31, 2003 Portfolio Assets Thls secUon includes estirral~d or unrealized gains or losses for your information only and should not be used for lax purposes. If acquisiUon informatfon is not available, the gainAoss information may not be displayed and section and summary fotals may no.'. reflect your complete portfolio. Cost 13asis information provided by the account owner is not verified by First Clearing, LLC and should not be relied upon for legal or tax purposes, Bonds purchased at a premium or 0.I.D. (Original Issue Discount) wilt be carried at the original cost basis. Facfored bonds (GNMA, CMO, etc.) will be adjusted for paydown of principal. Systematic investmenls in mutual funds and reinvested dividsnds for mutual funds and s~ocl~ have been consolidated for each position. Unit cost data for syelgmatic investmen~ and dividend reinvestment securities is provided for informational purposes only and is a non-weighted average, To update your cost informalfon or provide omitted cost information, contact your Financial Advisor. EsUmated Annual Income, ~'ahen available, reflects the estimated amount you would earn on a security if your current position and its related income remained constant for a year, Estimated Annual ~leld, when available, reflects the currentestirnated annual income divided by the currentvalue of the security as of the statement closing date. The informaUon used to derive these estimates is obtained from ~arious outside venders; FCC is not responsible for incorrector missing esl~mated annual income and yields. Cash and money market funds Est current Description C.~rrent market value Est. ann. income yield(%) EVERGREEN MONEY MKT FD $4,899.48 $2.44 0.05 CLA Interesl I=eriod 08/01!03 - 09/01/03 Total cash and money market funde $4,899.48 Curious how your securities are performing? The "Unrealized gain/loss" column tells you how much each stDck has increased or decreased in value since you boughtit (based cn cost data supplied by you or by oulside senses, which may not be comple':e). ~visions to this information (because cf corporal9 mergers, tenders and other reorganizations, for example) may be necessary from Ume to time, To update your cost information or provide omi~d costs, contact Your Financial Advisor. Annuities Annuity values and alt sub fund information is provided directly from the nsurance companies. Accuracy is not guaranteed and surrender charges may apply. Annuities are not protected by SIPC. Please contact your Financial Advisor if you no longer own any of '~e annuity positions listed below. Description As o! value date Total cost Eslirnated market valu,', AM LEGACY ~ll PLUS LINCOLN NATL LiFE VAR CONTR# 95971518100000000 Sub Funds AMERICAN FUNDS GROWTH - CLASS AMERICAN FUNDS GROWTH-INCOME-C Unils Estimaled Value % market value 67,616.50300 $44,825.07 23.54 46,780.37120 $144,932.70 76.46 08/27/03 $233,221.02 $189,557.77 MANUFACTURERS UFE INS 08/27/03 $23,000.00 $25,426.03 SCUDDER WEALTHMARK ML3 VARIABLE ANNUITY CONTR# 55101823 Sub Fur'ds Units Estimated Value % market value SCDR HIGH INCOME 316.74050 $4,706.42 ~8.51 SCDR GLOBAL DISCOVER 307,726g0 $5,461.99 21.48 DREb'AN HIGH RETURN 234.46700 $3,786.95 ~ 4.8g DAVIS VENTURE VALUE 239.54970 $3,755.67 14.77 JANUS GRTH & INCOME 242.76150 $3,652.43 14.38 IIIIIII I IIIIIIII1 i111111111111111111111111111 9,543 ............................................................. Statement for ......................................................... CLEDYTH M CLARK Page 3 of 3 JAMES E CLARK JT TEN Sub / Branch / Rep Account No. 00! / NT / NT55 2252-0394 Statement period: August t - August 31, 2003 Annuities continued Description As of value date Total cost Estimated markel value · qCDR 8MALL CAP GROW3' 231.43030 $4,062.57 ~5.97 Total Annuities $256,221.02 $214,983.80 Activity Detail Date Account Type Transecl~on Quanlily Descriplion Price Amount 08/15 Cash CHECK CRA CHECK #00298 -$1,165.60 08/15 Cash TRANS=ER FROM EVERGREEN MONEY MKT FD 1.0000 $1,165.60 CLA 08/29 Cash DIVICEND EVE RGREEN MONEY MKT rD $0.22 CLA 082903 4,899 08/29 Cash REINVST DIV!INT EVERGREEN MONEY MKT FD -$0.22 CLA Checking Transactions Date Paid Chec~ # Amourl Date Paid Check # Amount 08/15 298 $1,165.60 Total Check Activily 1 Itema $1,1 65.60 Thank you for allowing Wachovia Securities, LLC to serve you. If you have any questions regarding your account or this statement, please contact your Financial Advisor. EVEI~I 001561 242165533223 HNNNN NNNNN NNNNNNNN OC~JO03 Wachovia Bank N.A. Balance Confirmation Services P O Box 40028 Roanoke, VA 24022-7313 Reference ID: 709798 September 23, 2003 R MARK THOMAS ATTORNEY AT LAW 101 SOUTH MARKET STREET MECHANICSBURG, PA 17055-3851 SUBJECT: Verification / Confn-mation of Account and Balance Information provided for: Customer: CLEDY'IIt M CLARK (SSN# 182-22-9381) Date of Death: August 31, 2003 Account Type Deposit Account Information Account Date of Death Average Date Maturity Interest Accrued Number Balance Balance* Opened Date Rate Interest YTD Interest Paid Date Closed CHECKING 1000323837771 LEGAL TITLE: CLEDYTH M. CLARK JANIS CLARK JAMES E. CLARK, JR. 09/17/03 $3,407.60 2/23/1982 $0.11 $3.68 Account Type BROKERAGE LEGAL TITLE: CLEDYTH M. CLARK FCC AS CUSTOMER (PILOT PLUS) CONTACT BEANE / SHILLING ~ 215-504-9702 * Due to system limitations, we can only provide a twelve month average balance on depository accounts. Other Account Information Account Date of Balance Date Date Number Opened Closed 20434816 2/4/2003 Ledger Collected BROKERAGE 22520394 LEGAL TITLE: CLEDYTH M. CLARK JAMES E. CLARK CONTACT BEANE / SHILLING ~ 215-504-9702 4/4/1995 BROKERAGE 22520427 LEGAL TITLE: CLEDYTH M. CLARK IRA FCC AS CUSTODIAN DATED 04/10/95 CONTACT BEANE / SHILLING ~ 215-504-9702 4/4/1995 0000 000614 No Safe Deposit Box found for customer. Reference ID: 709798 * Date of death balance does not include accrued interest. * If date of death occurrs on a weekend or a holiday, date of death balance does not include any transactions that were ulia Sorrells Servicenter Associate Phone: (540)563-7323 sss; at oooo 000614 (717) 766-3421 Myers Funeral Home, Inc. Boyd L. Myers Jr., Supervisor 37 East Main Street Mechanicsburg, Pennsylvania 17055 A standard of excellence in Central Pennsylvania since 1910 Fax (717) 795-7291 Monday, September 22, 2003 Miss Janis L. Clark 43 Westfields Drive Mechanicsburg, Pa. 17050 Dear Miss Clark, Thank you for selecting our funeral home to provide services for your family during your bereavement, I hope that you found our services to be of the highest standards and that they met your needs and those of your family and friends, The following is a summary of the service charges as previously explained and provided in written form on the services for: Cledyth M. (Kim) Clark SUMMARY OF EXPENSES TOTAL OF SERVICE RENDERED $8,925.00 LESS: Credits granted 1,97817 LESS: Total Payments 6,94683 PLUS: Items ordered later 662.48 CURRENT BALANCE $662.48 Credits Granted: $23817 Preneed Adjustment $1,740.0 Package Price Discount PLUS: Items ordered later Register Book 55,00 Patriot News 75,48 Newtown& Additional Certs 112.00 (TICI'~.x 175.00 Stone 10000 & }:'lrmers 145.00 245.00 Interest at the rate of 1,5 % per month ( 18 % per annum) will be added to balance after 30 days, If there are any questions or concerns that remain unanswered, please call me. Sincerely, Boyd L, Myers Jr. RECEIPT FOR PAYMENT Cumberland County - Register Of Wills Hanover and Hiqh Street Carlisle, PA ~7013 Receipt Date Receipt Time Receipt No. 9/o8/2oo3 08:35:04 1033973 CLARK CLEDYTH M File Number Remarks 2003-00733 THOMAS R MARK SK Transaction Description PETITION FOR PROBA SHORT CERTIFICATE EXTRA PAGES JCP FEE Check# 5034 Total Received ......... Distribution Of Receipt ........................ Payment Amount Payee Name 340.00 18.00 9.00 10.00 CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN BUREAU OF RECEIPTS & CNTR M.D 77.00 77 00 RECEIPT FOR PAYMENT Cumberland_County - Register Of Wills Hanover and Hiqh Street Carlisle, PA I7013 Receipt Date 12/04/2003 Receipt Time 09:23:36 Receipt No. 1034853 CLARK CLEDYTH M File Number Remarks 2003-00733 R MARK THOMAS SK Transaction Description SHORT CERTIFICATE Check# 5161 Total Received ......... Distribution Of Receipt ........................ Payment Amount Payee Name 12.00 CUMBERLAND COUNTY GENER3tL FUN  12.00 12 00 - ~ ~'~ ~.~// System Date : 10/29/03 Run l~rne : 8:16:52 AM!f - ~ ~ I L-~? ~/' Page No. : 1 Patient: 201045 CLARK, CLEDYTH Detail Inquiry BitlNumn Proc Description Ser~d)ate Bto PEn Pry Fac Units Charge Pa)qnent# PmtCc~e PmtDate Paint Adjust~nt Balance 2222540 SNFLVl SNF HOSPICE LE 8/25/03 PP 0~125 045~7 6~ 7.00 1~5.00 1591096 804 8 PRIVATE PAY AD 8/31/03 O1 455.00 ~0.00 Pati~t Tota(: 1295.00 0.00 455.DD ~0.00 HEARTLAND HOHE HEALT 333 H SUHH[T ST TOLEDO, OH 43604 $-A-L-E-S D-R-A-F-I REF~ 8887 CD TYPE: UISA TR TYPE: PURCHASE DATE: OCT ~9, 83 12:~6:2B AUS: HO MAICH TOTAL :~840.00~( ACCT: 81)2 EXP: ~;/~ 836629 ~ I~RIHl CARD X~ CARDPE~ER ACKNO~EDGES RECEIPT OF 600OS AND/OR SERUICES IN TNE A~OUNT OF THE IOTAL SHOWN NEREO~ AI(D A6REES 10 PERFOR~ lHE OBLISATIONS SET FORTH BV CAP'~ER~S ASREEFENT WITH TH[ ISSUER THANKS FOR USIN$ UISA CUS!O~R £OPv BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 180601 HARRISBURG, PA 17118-0601 CONNONNEALTH OF PENNSYLVANZA DEPARTNENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLONANCE OR DZSALLONANCE OF DEDUCTZONS AND ASSESSHENT OF TAX R HARK THOHAS ESQ 101 S MARKET ST HECHANICSBURG PA 17055 RE¥-1547 EX AFP (01-05) DATE 07-26-200~ ESTATE OF CLARK CLEDYTH H DATE OF DEATH 08-$1-Z005 FILE NUNBER 21 05-0755 COUNTY CUHBERLAND ACN 101 Aeoun~ Raei~tod I HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THZS LINE ~ RETAZN LONER PORTZON FOR YOUR RECORDS ~,~ REV-1547 EX AFP (01-03) NOTICE OF ZNHERZTANCE TAX APPRAZSENENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF CLARK CLEDYTH N FILE NO. 21 05-0753 ACN 101 DATE 07-26-200~ TAX RETURN NAS: (X) ACCEPTED AS FZLED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schadulo A) {1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Hold Stock/PartnarshAp Interest (Schedule C) ~. Mortgages/Notes Receivable (Schedule D) (~) $. Cash/Bank Daposits/Nlsc. Personal Property (Schedule E) ($) 6. Jointly Owned Property (Schodulo F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXENPTzONS: 9. Funeral Expensos/Adm. Costs/Nisc. Expenses (Schedule H) (9) 10. Dobts/Nortgago Liabilities/Lions (Schedule I) (10) 11. Total Deductions 12. Net Valuo of Tax Return 135z000.00 2z562.30 .00 .0O 2z530.00 111~066.15 216z958.12 0~* (8) 1Z, oo ( 11~ 13. 1~. NOTE: NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. ~68,116.57 (12~ ~,~5~,69q.36 Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J~*~ .; (l~J_~ ~,~, i~,;~ . O0 Not Value of Estate Sub,act to Tax C~ (1~::~ © assessment ~as issued previously, lines 14, 15 and~16,~7, 18 reflect figures that include the total of ALL returns assessed ~' date.~d 19 DISCOUNT INTEREST/PEN PAID (-) ASSESSHENT OF TAX: 15. Amount of Line lq at Spousal rate 16. Amount of L/ne 1~ taxable at Lineal/Class A rate 17. Amount of Line lq at Sibling rate 18. Aaount of Line lq taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: PAYHENT RECEZP1 DATE NUHBER (1,5) .00 x O0 = .00 (16) ~5c~,69~'36 x 0~5= Z0,~61.25 (17) . O0 x 12 = . O0 (18) .00 x 15 = .00 (19)= 20,~61.25 AHOUNT PAID .00 20,R61.25 159.80 20,621.05 ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT TS REQUIRED. IF TOTAL DUE TS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) INTEREST IS CHARGED THROUGH 08-10-200~ AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORH TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. RESERVATION: Estates of decedents dying on or before December 1Z, lgBz -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent attar the expiration of any estate for lifo or for years, the Coaeonaaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the Zawful Class S (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (TI P.S. Section Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Make check or money order payable to: REGISTER OF #ILLS, AGENT A refund of a tax credit, which ams not requested on the Tax Return, say be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available at the Office of the Register of Nills, any of the Z$ Revenue District Offices, or by calling the special Z~-hour ansaaring service for forms ordering: 1-800-56Z-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-q~7-SOZO (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --aritten protest to the PA Department of Revanue~ Board of Appeals, Dept. ZelOZI~ Harrisburg, PA 17liB-lOll, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. ZeOSO1, Harrisburg, PA I?IZB-0601 Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return far a Resident Decedent" (REV-150I) for an explanation of administratively correctable errors. If any tax due is paid aithin throe (3) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18~ 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day free the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (eZ) percent per annum calculated at a daily rate of .00016~. Al1 taxes which became delinquent on and after January l, 19BI will bear interest at a rate which ail1 vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZO0~ ara: Interest Dally Interest Dally Interest Dally Year Rate Factor Year Rate Factor Year Rate Factor ~ 20Z .0005~8 ~'~-1991 Ill .OO050l ~-~ 9Z .O00Zq7 1985 1SI .O00~SB 1992 9Z .O00Z~7 200Z 6Z .00016~ 198~ Ill .DOOSO1 1995-199~ 7Z .O00lgZ 2005 5Z .000187 1985 13X .000556 1995-1998 9X .0002~? 200~ ~Z .000110 1986 IOZ .OOOZ7~ 1999 7Z .000192 1987 lOX .00027~ ZOOO 7Z .OOO19Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. t.... ..,\ ., ,.. ...,. 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Ja4lJnl AUe aJe aJa41 l! lnq 'Ja)wW a4) alllas MOU II!M S!lU )sru) I "a:>ual)ed JnOA a)epaJdde pue 'Ua~e) se4 S!41 aWl) 10 4l6ual a4) JOl NJOS we I 'u!e6'v' "Alsl1O!^aJd UMOljS leJOJ aljJ W a^!.J.le 0) Aep Jad 9Z"Z JO ateJ e )e sAep OZ~ pappe a^e4 I 'POOZ 'JaqopO 6Z JO a)ep a4) 0) dn pappe )saJa)u! a4) pue 9Z" ~9V'OZ$ 10 anp xellenpe a41 0) UO!I!ppe UI "alqel!e^e awoo AllUa:JaJ lsn! a^e4 aw)sa a4) WOJl SpurlJ a4) Ja^aM04 :)uawAed S!4) 6u!~ew U! Aelap papuajX9 AI9Ja^9S a41 JOl 9z!6010de I "L9"960' ~Z$ JO )unowe a4) U! )uawAed PUll aseald pasolOu3 :wepel/ll JO J!S Jeaa €:~OL~ 'v'd 'aIS!lJe~ aSn04lJnO~ AJuno~ puelJaqwn~ slI!M 10 Ja)s!6a~ ~el~ "1/11 4lAPal~ JO ate)s3 :a:lU9JaJ8~ 90aZ '9 lpJel/ll 0S961l<6 (Z9~) I..SI..ES 1M 'U!J19S MeN ~JQ PI9!J.l!Il.;:l \S8MO\.9tr\. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT CLARK JR JAMES E 14610 W FAIRFIELD DRIVE NEW BERLIN, WI 53151 n______ fold ESTATE INFORMATION: SSN: 182-22-9381 FILE NUMBER: 2103-0733 DECEDENT NAME: CLARK CLEDYTH M DATE OF PAYMENT: 03/11/2005 POSTMARK DATE: 03/07/2005 COUNTY: CUMBERLAND DATE OF DEATH: 08/31/2003 NO. CD 005048 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $21,095.87 I I I I I I I I TOTAL AMOUNT PAID: $21,095.87 REMARKS: CHECK# 1007 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS BUREAU OF INDlvlo\iAL.frAX~S INHERITANCE TAX DIVISIllIC.: -- PO BOX Z80601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REV-1607 EX AFP (03-05) :1: 33 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 04-04-2005 CLARK 08-31-2003 21 03-0733 CUMBERLAND 101 CLEDYTH M R MARK ryHOMAS ESQ 101 S MARKET ST MECHANICSBURG PA 17055 Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ................................................................................................................ REV-1607 EX AFP (03-05) ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT KKK ESTATE OF CLARK CLEDYTH M FILE NO.21 03-0733 ACN 101 DATE 04-04-2005 THIS STATE"ENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NA"ED ESTATE. SHOWN BELOW IS A S~ARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAY"ENTS. THE CURRENT BALANCE. AND. IF APPLICABLE. A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-26-2004 PRINCIPAL TAX DUE: 20.461.25 PAYMENTS (TAX CREDITS): BAL PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 03-07-2005 CD005048 634.62- 21.095.87 ANCE OF UNPAID INTEREST/PENALTY AS OF 03-08-2005 TOTAL TAX CREDIT 20.461.25 BALANCE OF TAX DUE .00 INTEREST AND PEN. 32.05 IF PAID AFTER THIS DATE. SEE REVERSE TOTAL DUE 32.05 . SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1. NO PAY"ENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ. YOU "AY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. J ~ ""::;;.X- Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: clydefh Ii!. C.iJt-rk Date of Death: AUt:!. 01. 200.3 ...., Estate No.: ~(}03 - 0073...3 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes 0 No ~ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: /Jpll'. IS. ,;U>>..s- f 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 0 No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes 0 No 0 c. Copies of receipts, releases, joinders and approval of fonnal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. :?"91~./ ~ ~.ate: ~/////}S- ~~ ..c;o . . SIgnature ,f. 11J,uk T ~,p1?1aS " Name (>.J i.. ~~_; /()/ ..s. ;?J;,rk8T Sf. Address m~dtlM/~~ J ~It (717) 796 -;1./IJO Telephone Mo. /'7~ Capacity: o Personal Representative ~ounsel for personal representative J cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/27/2005 THOMAS R MARK 101 SOUTH MARKET STREET MECHANICSBURG, PA 17055 RE: Estate of CLARK CLEDYTH M File Number: 2003-00733 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 8/31/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge ~ Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: Cledyth M. Clark Date of Death: 8/31/2003 Estate No.: 21-03-0733 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the acL.T.d.nistration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes 0 No )8J 2. If the ansvver is No, state '?;lhen the personal represe tative reasonably believes that the administration will be complete: I 'P 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a [mal account with the Court? Yes 0 No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes 0 No 0 Date: 7/6/06 c. Copies of receipts, releases, joinders and approval offormal or informal accounts may be filed with the Clerk ofthe...orp h. a..7;j... ' C. ourt and may be attached to this report. ~/ /.11, ,/ ~/~}~ Signature ,:-r) R. Mark Thomas, Esquire Name 101 South Market Street Address Mechanicsburg, PA 17055 717-796-2100 Telephone No. Capacity: 0 Personal Representative IE! Counsel for personal representative .......", -~-" Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/05/2006 THOMAS R MARK 101 S MARKET STREET MECHANICSBURG, PA 17055-3851 RE: Estate of CLARK CLEDYTH M File Number: 2003-00733 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing lS due by: 8/31/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, I: (...p' ,.. ~ Lt-. )!J;:;{,,~ L~dy.j j5~ "'.. ",.' l ~.j Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) '<" Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/05/2006 CLARK JR JAMES E 14610 W FAIRFIELD DRIVE NEW BERLIN, WI 53151 RE: Estate of CLARK CLEDYTH M File Number: 2003-00733 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 8/31/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, I rAJ" ~..~. ., #,d; ~i".' .~~ 'v.~~/;...J ,~A: /i . : / I Glenda Farner Strasbatigh Clerk of the Orphans' Court cc: File Counsel '<' COMMGr"WEL>L TH OF PENNSYLVANIA DEPARTlvlE~jT OF RE'/ENUE BUREAU OF Ir"jDIVIDUAL TAXES DEPT 2306C I HARRISBL:RC;, ;:',~ 1 i 128-060 1 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT CLARI< JR JAMES E 14610 W FAIRFIELD DRIVE NEW BERLIN, WI 53151 -------- k,ld ESTATE INFORMATION: SSN: 182-22-9381 FILE NUMBER: 2103-0733 DECEDENT NAME: CLARI< CLEDYTH M DATE OF PAYMENT: 07/19/2006 POSTMARK DATE: 07/18/2006 COUNTY: CUMBERLAND DA TE OF DEATH: 08/31/2003 NO. CD 006993 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $32.05 I I I I I I I I TOTAL AMOUNT PAID: $32.05 REMARI<S: CLARI< JAMES JR AJW CH ECI<# 5317 SEAL INITIALS: AJW RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS HARRISBURG DISTRICT OFFICE STRAWBERRY SQ 4TH & WALNUT STS HARRISBURG, PA 17128-0101 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE *' REV-878FO AFP (04-06) JAMES E CLARK 14610 W FAIRFIELD DR NEW BERLIN, WI 53151 DATE Estate of: CLEDYTH MI CLARK Date of Death: 8/31/2003 File Number: 21 03-0733 ACN(s): (Sel~ Reverse Side) 6/22/2006 DeM JAMES E CLARK: This is to advise you that the above estate is in a delinquent status. According to Department records, as of this date, the estate is still not settled. The Inheritance and Estate Tax Act mandates the filing of a tax return and payment of all outstanding liabilities by the personal representative, transferee, or beneficiary of the estate within nine months of the decedent's death. The Department's records show that this estate remains open because: CURRENT TAX LIABILITY OF $ 32 . 05 CALCULATED TO 7/17/2006 INCLUDING INTEREST HAS NOT BEEN PAID. Accordingly, you are directed to pay all tax due including interest within thirty days from the date of this letter. If you fail to comply with this directive, your case will be referred for local enforcement and may result in the filing of a citation by this Department with the Orphans' Court Division of the Court of Common Pleas, requiring you to appear in court to show cause for your failure to comply with the law. In order to protect the Commonwealth's interest, the Department of Revenue may also file a lien in Cum be rIa n d Co u n t y . Under Act 40 of 2005, additional collection costs including but not limited to fees of up to twenty-nine percent (29%) of the amount due, and attorney fees incurred in securing payment, may be imposed on any liability not paid prior to referral to ~l collection agency or contract counsel. MAKE CHECKS PAYABLE TO REGISTER OF WILLS. AGENT : Sincerely, JOSEPH ROMANELLI Any questions regarding the tax liability of this estate, please CONTACT: HARRISBURG DISTRICT OFFICE STRAWBERRY SQ 4TH & WALNUT STS HARRISBURG, PA 17128-0101 TDD# 1-800-447-3020 (Services for taxpayers with special hearing and speaking needs) (717)787-9869 cc: DATE: Estate of: Date of Death: File Number: 6/22/2006 CLEDYTH M CLARK 8/31/2003 2103-0733 Page 2 ACN PLEASE SUBMIT A COpy OF THIS PAGE WITH YOUR PAYMENT. 101 Tax 0.00 Interest Penalty Total 32.05 0.00 32.05 ~ \:::> ~ --- <;l -t-. (". .. J i ~ 0 '-./-' r---. 'S- <' ~ s-' ~ r' L, '"' f" -f ~ ~ r (" h '-- ~ "- ~ '- -~ .... t .J.:>. (" 9 ( c;:, ~ ') r' ~ ~ ~ ~, ( -J ?- '+- ,> (" ~' .) ~ h ~ 8 1'. ~ 2 r J0 ~. * () ....;; \ \ .~.-::) ~ J> " -.,1 'h ". I"" " :l .~.., ,.... (/-; ...;:.- c: rn c:~, , ('-, -_/ o BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE C0lvi'-..,rn "-';-:C\01= "r C"\::\j,)"lc).,_i) \J tMliI;RITANCE TAX ~TAT~MENT OF ACCOUNT *' li REV-1607 EX AFP (03-05) 70% t\UG \!~ PIc'; 12: I 4 R MARK THOMAS ESQ 101 S MARKET ST MECHANICSBURG PA 17055 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-07-2006 CLARK 08-31-2003 21 03-0733 CUMBERLAND 101 AlloU'\t R_i Ued CLEDYTH M MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to you~ account, submit the upper portion of this fOrll with your tax pay.ent. ---------------------------,------------------------------------------------ --. RETAIN LOWER PORTION FOR YOUR RECORDS +-- CUT ALONG THIS LINE REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF CLARK CLEDYT M FILE NO. 21 03-0733 ACN 101 DATE 08-07-2006 THIS STATEMENT IS PROVIDED TO ADVISE OF HE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUHKARY OF THE PRINCIPAL TAX DUE, A PLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. I DATE OF LAST ASSESSMENT OR RECORP ADJUSTMENT: 07-26-2004 PRINCIPAL TAX DUE: 20,461.25 PAYMENTS (TAX CREDITS): , PAYMENT RECEIPT I DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 03-07-2005 CD005048 634.62- 21,095.87 07-18-2006 CD006993 32.05- 32.05 TOTAL TAX CREDIT 20,461. 25 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL ~TEREST. ( IF TOTAL DUE IS LESS THAN $I, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A nCREDI~' (CRl, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 8/09/2007 n ~--~ T'-:> <~ ::.':J c~) ---J .: t'"li "'-. =--, - -):;"':': - C~ (i) 1 \- ':) THOMAS R MARK 101 S MARKET STREET IQ MECHANICSBURG, PA 17055-3851 (_-, C) - , ,f' i ,--'I C' ';4.- RE: Estate of CLARK CLEDYTH M File Number: 2003-00733 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 8/31/2007 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~~~kJ Glenda Farner St~~;~~- Clerk of the Orphans' Court cc: File Personal Representative(s) Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 8/09/2007 (-, Co ., ,:::rJ 1-cJ "TO ~1;~ Cf>7< no ,'~-n --....r- " 1] =-':1 -:J )'-=.'" r-::> ~ = --' CLARK JR JAMES E :;:po c::: C") I 1..0 c 14610 W FAIRFIELD DRIVE NEW BERLIN, WI 53151 'P' ::!: ('~ '1 \D c:> ~ RE: Estate of CLARK CLEDYTH M File Number: 2003-00733 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 8/31/2007 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~..~4WJ~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel ~~. ~',~e ~~ ilea a•~F~ ~ ~.::T`U~ ~•~ ~L-~.~ ~~~ COL'IvTY, pEIv~ISY"LV ANI a REGISTER OF ~'~%ILLS OF T\Tan;e of Decedent: Clydeth M. Clark Date of Death: 8-31-2003 File Number: ~ ` ~y--3 `- ~ ~~ Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the administration of the above-captioned estate: . ,_ • .. [~ Yes. ~ o 1. State whether administration of the estate is complete :................. . 2. If the answeris No, state when the personal representative reasonably believes that the adlr_inisration will be complete: 3. If the answer to No. 1 is YES, state the following' a. Did the personal representative file a final•account with the Court? ...... • Yes ONo b. The separate Orphans' Court No. (if any) for the personal representative's acc.,4zt is: ...... c. Did the personal representative state an account ___ ........... Yes ~ No informally to the parties in interest? .......... • • • • : • • • - d. Copies of receipts, releases, joinders and approvals of formal or informal accounts maybe . filed with the Cierl: of the Orphans' Court and maybe attacLed to .this report. Dnte n $:~±ature of Person Filing this corm Capacit~~: ]Personal F epresentative ~] Counsel R. Mark Thomas ]Jenne of"Pe;-son: iiing axis roan. +v , ~~,,, 101 South Market Street - ~~~ ~i ~ :,i i'' 'i~~ w :actress ~U „~ J ~~ Mechanicsburg., PA 17055 J ~.~~ 717-796-2100 ~1 ~~; ~~ •, _~ - ~ ; ~~ (_ _. Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone:(717) 240-6345 ~., Date: 7/29/2008 ~? ~ ~~ -;~ c.__ THOMAS R MARK i _~_~ ~-; r= 101 S MARKET STREET ' ~-~-~ c..~ '~i ~ _ ., MECHANICSBURG, PA 17055-3851 -;=? ~-. ` ~; _U c~ ---~ ~- w ua R.E: Estate of CLARK CLEDYTH M File Number: 2003-00733 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, N0. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after Duly 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Pulls a Status Report of completed or uncompleted administration. 'T'his filing is due by: 8/31/2008 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerelyf ~ ` ~";~-~ ~~ ~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone:(717) 240-6345 Date: 7/29/2008 CLARK JR JAMES E 14610 W FAIRFIELD DRIVE NEW BERLIN, WI 53151 RE: Estate of CLARK CLEDYTH M File Number: 2003-00733 Dear Sir/Madam: h l C7 `~ _-- r. T ~ t : c-~ -~ c__ ,, ~-- _ E-- ; -~.j ., ,., _. - ~~ _~ , _, -.~ :- ~ ,,~ - --~ ~ T;:.y - ~- ~ _'~ C.~ l -'" C..3 This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, N0. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of hills a Status Report of completed or uncompleted administration. This filing is due by: 8/31/2008 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, f ~ _ , .,t ~, ~~ ~ , ,gip r ~.d Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel Pa. ®.C. ]E~uie 6.12 S'TA.T'I1S ~P®~T REGISTER OF WILLS OF (~_ (~I'~.(3 ~l~' L14(~ ~ COUNTY, PENNSYLVANIA Name of Deceden Date of Death: ~ r ~~ " c~C~~ File Number: c~ ~~~...~ -~ ~~ ~ n...-~.,..,,r r„ D., n r D,.lo ~ 1 ~ T ,-o„~,-t r1,A fnllnxx,;na ~zrit}; t-PCnect to rmm~letipn ~f the ad11~i71iStratioll of i u>.~uuiii w L u. v.~.•. i~uiv v. ~_, . i.,f.,va~ ~uv ~...~.......o r--- -- r- the above-captioned estate: 1. State whether administration of the estate is complete :.................... ~] Yes ~No 2. lfthe answeris No, state when the personal representative reasonably believes that the administration will be complete: 3. if the answer to No. 1 is YES, state the following: -. - a. Did the personal representative file a final account with the Court? ....... Yes ! No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? ............................... . Yes 0 No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts maybe filed with the Cleric of *~~e Orphans' Court and w?ay be attache to this report. Dnte ~ /~ //lJ Si~riature of Person Filing this Fornx Capacity: ~®Personal Representative Counsel ~~ -~~oN~~4 ~ Nmne of Persons Filing this Farm Y~CI y i ._ • r -'.~,Yr Yr f~ ~~~ ~~~~~~n Address TelepFrone i Form RN'-JO rev. 10.13,06 Cumberland County - Register Of One Courthouse Square Carlisle, PA 17013 Phone:(717) 240-6345 Date: 8/06/2009 THOMAS R MARK 101 S MARKET STREET MECHANICSBURG, PA 17055-3851 RE; Estate of CLARK CLEDYTH M File Number: 2003-00733 Dear Sir/Madam: Wills n CO ?~ ~ rn- ,.~: ~ m ~: CA~~- C~71 ~~~ ~ ~O ~ b N O ~p TT. c ~ c x, ~_ ~ ..; i This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by; 8/31/2009 -_ Please feel_free-to__oontact_this...office__with any_questionsyouu_may have. If you have already filed your Status Report, please disregard this notice. - --. Sincerely, i~~~~ Glenda Farner Strasbaugh~ Clerk of the Orphans Court cc: File Personal Representative(s) ~"0 Cumberland County - Register One Courthouse Sguare Carlisle, PA 17013 Phone:(717) 240-6345 Date: 8/06/2009 CLARK JR JAMES E 14610 W FAIRFIELD DRIVE NEW BERLIN, WI 53151 RE: Estate of CLARK CLEDYTH M File Number: 2003-00733 Dear Sir/Madam: Of Wills n a Q ,,~~ ?~rn- ,,`~m ci9 X +-~~i (~=C7 --1 N O Ca a. _~ '; o '-- ~` .r~.~ r ~.1 i This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 8/31/2009 Please _feel_free_to contact_ths office .with _any_que_stions_you_may have. If you have already filed your Status Report, please disregard this notice. Sincerely, Glenda Farner Strasbaugh~ Clerk of the Orphans Court cc: File Counsel Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF ~(Jhl A~ ~'Jb COUNTY, PENNSYLVANIA Name of Date of Death: _ ~ ~ ~ (- o2oy.3 File Number: a,' -B,3 - ~ 73 3 Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete :.................... ~ Yes ~1Vo 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: ~3 -3 /- ao/1~ 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 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? ............................... DYes ~ No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts maybe ~r Gfiled~twith the Clerk of the Otphans' Court and may be attached to this report. Dnre 1 (-V Signature of Person Filing this Form ~ ~ Ca~pa~city~~:1/ ©Pjerslonal Represen/ta~tiv,,e/ ~ Counsel A L3 L.~'a?r iy„: _ ~y ~~ Nnme olPerson Filing this Form ~J C~7 'Q ~U~ may/ /~,/, lJ. t u~ _ W Z `~'~ Add/reYsls C='l « W n-ci i ~:~.sa fn f]C--- , ~_~ r N ~~ 7l 7 - 79~ - a iod Telephone i 1 Form RW-/0. rev. 10.13.06 In Re: Estate of CLARK CLEDYTH M ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2003-00733 NOTICE OF FAILURE TO FILE STATUS REPORT Personal Representative: CLARK JR JAMES E Counsel for Personal Representative: THOMAS R MARK Date of Decedent's Death: 8/31/2003 The Orphans' Court record indicates that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, is hereby given that you have ten (10) days to file the Status Report. If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of such delinquency and the undersigned will request that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 9/9/2009 /~~~~~i~ Glenda Farner Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF In Re: Estate of CUMBERLAND COUNTY CLARK CLEDYTH M PENNSYLVANIA NO. 2003-00733 NOTICE OF FAILURE TO FILE STATUS REPORT Personal Representative: CLARK JR JAMES E Counsel for Personal Representative: THOMAS R MARK Date of Decedent's Death: 8/31/2003 The Orphans' Court record indicates that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of W ills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, is hereby given that you have ten (] 0) days to file the Status Report. If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of such delinquency and the undersigned will request that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 9/9/2009 ~~~:~ Glenda Famer Strasbaugh Clerk ofthe Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File Pa. Q.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Name of Decedent: CLYDETH M. CLARK Date of Death: August 31, 2003 File Number: 21-03-0733 Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the ~c~ministration of the above-captioned estate: 1. State whether administration of the estate is complete :............... . • • .. ~ Yes ©No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is YES, state the following: a. Did the personal representative file a final account with the Court? ....... Yes ®No b. The separate Orphans' Court No. (if any) for the personal representative's: account is: c. Did the personal representative state an account informally to the parties in interest? ............................... ~1Yes ^No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts maybe filed with the Clerk of the Orphans' Court and may be attached to 's report. ~t< June 30, 2010 Signature of Person Filing this Form Capacity: Personal Representative ®,~Cbunsel R. Mark Thomas, Esquire Name of Person Filing tGtr Form E3 ~ . _, rr} ~, 101 South Market Street ty, ~ ~ ~. a- Address r '= _ ~~ Mechanicsburg, PA 17055 ~ ~ ~ ~y ~~~ 717-796-2100 C___ J } 1 ~ Teiephonc ,. `-i ~ `` - -'7 iac,. ` 3= O '~ !"'t. Forne~ 10 rev. 10.