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HomeMy WebLinkAbout04-0057PETITION FOR PROBATE and GRANT OF LETTERS also known as To: Social Security No. [ ~8 0q ~ ?ff~l Deceased. The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut~/~ in the last will of the above decedent, dated -~ ~/~'r-e m/~ e,o.. ~ ~, and codicil(s) dated l~&l~ P~o/~lO.y ~ ~ , ~.e,o I ~ v/~ ~,~,o6 -/ -~oo0 Register of Wills for the County of J~O~ i~,~k~cA~lb in the Commonwealth of Pennsylvania named ,19~'7 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in C o ~ R &~ c. ~ t~/~ County, Pennsylvania, with h f- ~. last family or principal residence at ~ ,~ .~'o_~-rt~ 6 "t t.. (._ ...... ~ A .0 (list street, number and muncipality) Dneendent,then ~' ~--_yearsofa e, t ~O~At$~dt~, ~o~ ~1~ Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: WHEREFORE, petitioner(s) respectfully,.?equest(s) the probate of the last will and codicil(s) presented herewith and the grant of letters. ! ~..n~t/tv? t,~-rn ,~ 3' theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) OATH OF' PERSONAL REPRESENTATIVE COMMONWEALTH OF.PENNSYLVANIA COUNTY OF C..L c~ ~ ~_ ~.,t..6d/k , ~ ~8 The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well ~ truly administer the estate accordipg to law. ~rn to .or ~firmed ~d subscribed c ~~ ~ /~re me this ~ 7~ day of [~ / /~" · No. Estate O~ ~ c~,~ ~ ~'~\~4 , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~//,~z/~'./~7.9/ ..~~, in consideration of the petition on the reverse side her~, satisfactor~proof having b~en presented before me, IT IS DECREED that the instrument(s) dated described .... cord as the last will of and Letter''--'-- are hereby granted to FEES /~r~.~ate,/Letters, Etc.... ....... C~o~ertificates( ) .......... TOTAL _ Fil~~-~,~, .c~d,... ~eT..~. · ......... ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS codicil (o~ch) a subscribing witness to the ~ presented herewith, (e, ac~) being duly qualified according to law, depose(s) and say(s) that .._~-~¼e. ~ ~-~£ present and saw the testat ~.~ , sign the same and that .~]~e. signed as a witness at the request of testat v~i. in hc_~ presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this z~-./)o/ day of (Name) (Address) (Name) (Address) · REGISTER OF WILLS OF COUNTY OATH OF NON-SUBSCRIBING WITNESS (each) a subscriber hereto, (each) being duly qualified according ~law, depose(s) and say(s) that -~_ ~rr~ familiar with the signature of [-~'~-~-~4,, codicil I ' testat~x of ~nz ~f the~aubscribing witne~e~.4h¢ ~i~ presented herewith and codicil that ~-' believ4~sx~the signature on the will is in the handwriting of to the best of r-r~ ~ knowledge and belief. ~ Sworn to or affirmed and subscribed before me this ,~9~ r~c~ day of J ~ /-~m~ (Name) (Address) his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as I,ocal Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filingl WARNING: It is illegal to duplicate this copy by photostat or photograph. P 9813979 , No. '~ Date O~ev wa7 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH ,. ~ '"'1 ~ I i ~-~,~ ~,~ I~'~ ~"~ ~ I~s ~ · ~Lm~) I ~ ~ I E~~ I ~ . ~ ~*~ '- ~lst~ n=~ ,,,.h~l~ ~e I,,. ~ 1,12 '~'~ 12 ' .... '" I,,.w~ I,,. 335 S. Sporting Hill Rd. ,,.Mechanicsburg,PA 17055 Cumberland ,,. ' ~rank ROush ,,. Sally Rigle ,~'s,~,,~. R~ Rohl~d ~. · ~x~45, d~S ~k,PA16657 . ~, 2004 '~ ~r~ ~te~ ~Im ~. ,PA17011 ~~~l ~-01~63-L ~--~ ~&=,324 H--1 Ave.tl~e,PA ~~' / ~ / M / I/ I I~' ~ ~ I~ ~ A C~E~E ~: Ic~ ~ cau~ I ~ I~' ~' '~l I I I I~"' I--' ~ ~- nt · ~, b~- ~O~f~N~O~~.~_~ I ~ ~ II ~ Ihe ~5~ e~init~..~ Invlsflgal~n in my opl. on. deilh ~cuRed Il the time d.t, and plac, ,~ du, l0 the ciuu(,) ............................. , ......................................................... . // CODICIL TO THE WILL OF DOROTHY C. ROHLAND I, Dorothy C. Rohland, of Hampden Township, Cumberland County, Pennsylvania, the within named Testatrix, do hereby make and publish this Codicil to my Last Will and Testament dated February 28, 2001. I hereby modify said Last Will and Testament as follows: ITEM I: follows: ITEM Xlll of said Last Will and Testament is amended to read as ITEM XIII: I hereby nominate, constitute and appoint JOSEPH J. MACK to be the Executor. In the event of his death or his inability or refusal to serve as Executor or Trustee, his Associate, Peter A. Gerberich, shall serve as Executor. In the event of the death, inability or refusal of Joseph J. Mack to serve as Trustee, he shall have the power to nominate his successor Trustee, his Associate, Peter A. Gerberich, shall serve as successor Trustee. If he does not appoint a successor Trustee, his Associate Peter A. Gerberich, shall serve as successor trustee. The Executor and Trustee are specifically relieved from the duty or obligation of filing any bond or other security. In all other respects I confirm and ratify my aforesaid Last Will and Testament. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 28th day of February, 2001. DOROTHY A C. RO We, the undersigned, hereby certify that the foregoing Codicil was signed, sealed, published and declared by the above named Testatrix as and for a Codicil to her Last Will and Testament, who, at her request and in her presence and in the presence of each other, have hereunto set out hands and seals the day and year above written, and we certify that at the time of the execution thereof, the said Testatrix was of sound and disposing mind and memory. (SEAL) Residing (SEAL) Residing at 9/29/97 WILL OF DOROTHY C. ROHLAND I, DOROTHY C. ROHLAND, of Cumberland County, Pennsylvania, declare this to be my will and hereby revoke all prior wills and codicils made by me. 1. Personalty. I bequeath such items of my tangible personal property as are specifically itemized on a list in my handwriting signed and dated by me at the end thereof, and attached to this my Will to the person(s) named thereon to receive such items and I bequeath equally to such of my children as survive me, all of my remaining tangible personal property (or all in the absence of such list) not used in business or for the production of income, including without limitation furniture, furnishings, clothing, jewelry, objects of art and decoration, and the like, and any motor vehicles which I own, together with the insurance thereon. 2. Residue. I bequeath, devise, and appoint all the rest of my property, of whatever nature and wherever situated, including property over which I hold a power of appointment, to my issue per stirpes. 3. Survival Clause. If any beneficiary hereunder should die within sixty (60) days after me or within sixty (60) days after any other person the survival of whom determines his rights hereunder, then such beneficiary shall be deemed to have predeceased me or such other person for all purposes hereunder. 4. Powers. In addition to such other powers and duties as may be granted elsewhere herein or which may be granted by law, the fiduciaries hereunder shall have the following powers and duties, without the necessity of notice to or consent by any Court: (a) To retain all or any part of my property, real or personal, in the form in which it may be held at the time of its receipt, including any stock of any corporate fiduciary hereunder, as long as in the exercise of their discretion it may be advisable so to do, notwithstanding that said property may not be of a character authorized by law. (b) To invest and reinvest any funds held hereunder in any property, real or personal, including, but not by way of limitation, bonds, preferred stocks, common stocks, and other securities of domestic or foreign corporations or investment trusts, mortgages or mortgage participation, and common trust funds, even though such property would not be considered appropriate or legal for a fiduciary apart from this provision. (c) To sell, convey, exchange, partition, give options to buy or lease upon, or otherwise dispose of any property, real or personal, at any time held by - 2 - them, with or without order of court at their option, at public or private sale or otherwise, for cash or other consideration or for such credit terms as they think proper, and upon such terms and for such prices as they may determine, and to convey such property free of all trusts. (d) To borrow money from any person, including any fiduciary hereunder, for any purpose in connection with the administration hereof, to execute promissory notes or other obligations for amounts so borrowed, and to secure the payments of such amounts by mortgages or pledges of any property, real or personal, which may be held hereunder. (e) To make loans, secured or unsecured, in such amounts, upon such terms, at such rates of interest, and to such persons, firms or corporations as they may deem advisable. (f) To renew or extend the time for payment of any obligation, secured or unsecured, payable to or by them, for as long a period of time and on such terms, as they may determine, and to adjust, settle and arbitrate claims or demands in favor of or against them. (g) In dividing or distributing any property, real or personal, included herein, to divide or distribute in cash, in kind, or partly in cash and partly in kind. - 3 - (h) To hold, manage, and develop any real estate which may be held by them at any time, to mortgage any such property in such amounts and on such terms as they may deem advisable, to lease any such property for such term or terms, and upon such conditions and rentals as they may deem advisable, whether or not the term of any such lease shall exceed the period permitted by law or the probable period of retention under this instrument; to make repairs, replacements and improvements, structural and otherwise, in connection with any such property, to abandon any such property which they may deem to be worthless or not of sufficient value to warrant keeping or protecting, and to permit any such property to be lost by tax sale or any other proceed- ings. (i) To employ such brokers, banks, custodians, investment counsel, attorneys, and other agents, and to delegate to them such duties, rights and powers as they may determine, and for such periods as they think fit. (j) To register any securities at any time in their names as fiduciary, or in the names of nominees, with or without indicating the trust character of the securities so registered. (k) With respect to any securities held hereunder, to vote upon any proposition or election at any meeting of the person or entity issuing such - 4 - securities, and to grant proxies, discretionary or otherwise, to vote at any such meeting; to join or become a party to any reorganization, readjustment, merger, voting trust, consolidation or exchange, and to deposit any such securities with any committee, depository, trustee or otherwise, and to pay out of the trust created herein, any fees, expenses, and assessments incurred in connection therewith; to exercise conversion, subscription or other rights, and to receive or hold any new securities issued as a result of any such reorganization, readjustment, merger, voting trust, consolidation, exchange or exercise of conversion, subscription or other rights and generally to take all action with respect to any such securities as could be taken by the absolute owner thereof. (1) To engage in sales, leases, loans, and other transactions with my estate, or any trust established by me or by my husband, even if they are also fiduciaries or beneficiaries thereof. (m) To make all necessary proofs of death under the insurance policies of which they are the beneficiary, to execute any receipts for the proceeds and to institute any action to collect said proceeds and to make adjustments of any claim thereunder, provided, however, that they need not institute any - 5 - action unless they shall have been indemnified against all expenses and liabilities to which they may become subject as a result thereof. If, however, they desire to institute such action without indemnification, they are hereby authorized to be reimbursed for all expenses and liabilities incurred as a result thereof from any amounts which may be held in trust hereunder then or thereafter. (n) To exercise all elections which they may have with respect to income, gift, estate, inheritance or other taxes, including without limitation election to deduct expenses in computing one tax or another, and election to pay or to defer payment of any tax, in all events without their being bound to require contribution from any other person. (o) To operate, own, or develop any business or property held hereunder in any form, including without limitation sole proprietorship, limited or general partnership, corporation, association, tenancy in common, condominium, or any other, whether or not they have restricted or no management rights, as they in their discretion think best. 5. Spendthrift Clause. No interest (whether in income or principal, whether or not a remainder interest, and whether vested or contingent) of any beneficiary hereunder shall be subject to anticipation, pledge, assignment, sale or transfer in - 6 - any manner, nor shall any beneficiary have power in any manner to charge or encumber his said interest, nor shall the said interest of any beneficiary be liable or subject in any manner while in the possession of the fiduciaries for any liability of such beneficiary, whether such liability arises from his debts, contracts, torts, or other engagements of any type. 6. Facility of Payments for Minors or Incompetents. Any amounts or property which are payable or distributable hereunder to a minor or incompetent may, at the discretion of the fiduciaries, be paid to the parent or guardian of such minor or incompetent, to the person with whom such minor or incompetent resides, or directly to such minor or incompetent, or may be applied for the use or benefit of such minor or incompetent. 7. Taxes. I direct that all estate, inheritance, and succession taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, other than generation-skipping taxes, shall be paid out of the principal of my general estate to the same effect as if said taxes were expenses of administration, except that any such additional taxes (and interest and penalties thereon) imposed on account of my interest in or power over any trust established by my husband shall be paid out of the property held in such trust, and all other property includible in my taxable estate for federal or state tax purposes, whether or not passing under this will, shall be free and clear thereof; provided, however, that no - 7 - such taxes shall be paid out of assets that are not includible in my federal gross estate. 8. Fiduciaries. I appoint as executrix hereunder my daughter, REBECCA ROHLAND, and if she is unable or unwilling to serve, then my son, DONALD V. ROHLAND, JR., shall serve in her place. If neither of my children should be able or willing to serve or to complete the administration of my estate, then PNC BANK, N.A. (or successor), with offices in Camp Hill, Pennsylvania, shall serve in their place. My executor(s) shall serve as guardian of the property of any minor beneficiaries hereunder, under any instrument of trust executed by me, under any policies of insurance on my life, and in any other situation in which the power to make such appointment exists under the laws of Pennsylvania. No individual fiduciary shall be liable for the acts, omissions or defaults of any agent appointed and retained with due care or of any co-fiduciary. No fiduciary shall be required to furnish bond or other security for the proper performance of his duties hereunder. 9. Gender. Unless the context indicates otherwise, any use of the masculine gender herein shall also include the feminine gender. IN WITNESS WHEREOF, I, DOROTHY C. ROHLAND, herewith set my hand to this, my last Will, typewritten on ten (10) sheets of - 8 - paper including the self-proving attestation clause and signatures of witnesses, this 29th day of September, 1997. Dorothy'. 1ohl and (SEAL) residing at /~-~J~J /~ residing at ~~~ - 9 - COMMONWEALTH OF PENNSYLVANIA : : COUNTY OF DAUPHIN : SS: Dorothy C. Rohland (the testatrix), ~~. ~~ (the witnesses), whose names are signed to the fo~Wegoing instrument, being first duly sworn, each hereby declares to the undersigned authority that the testatrix signed and executed the instrument as her last will in the presence of the witnesses and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as witness and that to the best of his knowledge the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. TESTATRIX: Dorothy C. ~Rohland WITNESS: WITNESS: Subscribed, sworn to and acknowledged before me by Dorothy C. Rohland, the testatrix, and subscribed and sworn to before me by ~~, ~'~¢W~ the witnesses, this ~%~" day of September, 1997. Notary Publgc NOTARIAL SEAL 1 ( SEAL ) P ty CERTIFICATION OF NOTICE UNDER RULE 5.6(a} Name of Decedent: Date of Death: Will No. o~ Od)t/ To the Register: Aa~'n~No ~ I o t4. -- 00.$' 7 I certify that notice of (beneficial interest) 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 ..7-A~,tt/,q~ge' .7.~t, ..~Oo~/~: Name Address Notice has now been given ,to all persons entitled thereto under Rule 5.6(a) except Address Capacity: ~ Personal Representative Counsel for personal representative MACK GERBERICH & ASSOCIATES, RC. CERTIFIED PUBLIC ACCOUNTANTS & CONSULTANTS ooo, ~. ~ 1342 NORTH MOUNTAIN ROAD/RO. BOX 6595/HARRISBURG, PA 17112 (717) 652-9692 FAX (717) 652-7368 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003783 MACK JOSEPH J 1336 N MOUNTAIN ROAD HARRISBURG, PA 17112 ........ fold ESTATE INFORMATION: SSN: 188-09-5754 FILE NUMBER: 2104-0057 DECEDENT NAME: ROHLAND DOROTHY C DATE OF PAYMENT: 04/07/2004 POSTMARK DATE: 04/06/2004 COUNTY: CUMBERLAND DATE OF DEATH: 01/13/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $21,000.00 TOTAL AMOUNT PAID: $21,000.00 :REMARKS: .......... SEAL CHECK# 107 INITIALS' JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS MACK GERBERICH & ASSOCIATES, RC. CERTIFIED PUBLIC ACCOUNTANTS & CONSULTANTS RO. BOX 6595 HARRISBURG, PA 17112 REV-15ff" EX  COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 I-- Z LLI U.I Ltl ~oo n~ 0 X REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER SOCIAL SECURITY NUMBER [~1. Original Return --'-] 4. Limited Estate []6. Decedent Died Testate (Attach copy of Will) F----I 9. Litigation Proceeds Received FIRM NAME (IfApplicable) A ~ ~,, ~,.~ TELEPHONE NUMBER i~ 55oC t P,'r ~ 5, E~2. Supplemental Return E~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) COMPLETE MAILING ADDRESS [-'-~ 3. Remainder Return (date of beath 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) I"t 117-. 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 Recei?able (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) f--'"~ Separate Billing Requested 7. Inter-Vivos Transfers 8, 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. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) ,,I o Io3 gz. OFFICIAL USE ONLY (8) (11) (12) (13) %'/2. 75- (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 ¢'~-¢- 2 q ¢~ ,,~ '2., 17. Amount of Line 14 taxable at sibling rate x .0_ (15) x .0 de.~ (16) x .12 (17) 2,0 s- 3. ,-/'7 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) DATE Of DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 2" o Ay/X, 200,/ .2-u y /?, (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS COUNTY CODE YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Decedent's Complete Address: ISTREETADDRESS CITY 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 <~_ l 7 If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT, Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Total Credits ( A + B + C ) (2) A. Enter the interest on the tax due. (3) (4) (5) (5A) (5B) Total Interest/Penalty ( D + E ) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (1) 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? ........................................................................................................................ ~] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE(~SON RES PONSIB.]~.,~~ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ,/0,4 /7//7-- DATE ADDRESS For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. {}9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-~SOS ~X + (1.9Z) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E -' o: ~ CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER ~O~L~,-AJb I [~°P'.OTIJr"I'' ~-,, .,,'~.1 0(1t oaaS"7 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of sun~ivorshi ITEM NUMBER DESCRIPTION TOTAL (Also enter on line 5, Recapitulatio~ (If more space is needed, insert additional sheets of the same size) ) must be disclosed on Schedule F. VALUE AT DATE OF DEATH REV-1508 ~X + (1-97) ~'~~ SCHEDULE E ~ c,~ ~ COMMONWEA~T. OFPENNS~,VANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER Include the )mceeds of litigation and the date the proceeds were received by the estate, All property jointly-owned with the right of survivorshi must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) oooS7 REV-1510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes, DESCRIPTION OF PROPERTY % OF ITEM INCLUDETHE NAblEOFTHE?RANSFEREE. THEIRRELATIONSHIPTO DECEDENTANOTHE DATE OF TR~NHFER. DATE OF DEATH DEED'8 EXCLUSION TAXABLE VALUE N U M[~ER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) TOTAL (Also enter on line 7, Re~pitulation) $ [O g ~ I~ ~ (If mom space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99)~_~, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT 5. 6. 7. FUNERAL EXPENSES: ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address P~ &~X 6~w- Year(s) Commission Paid: ~ O O ~ State __ Zip / 711~,.-- Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent Probate Fees ~ ~¢,~t~ ~,¥,~C~./,~,~ Accountant's Fees Tax Return Preparer's Fees /d, oo0, oo q-6, oo 7-.~'q.oo ! 2 7, '--b~' TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) REV-1512EX+(12-03) COMMONWEALTHOFPEN NSYLVANIA INHERITANCETAXRETURN RESIDENT DECEDENT EST~TEOF R, SCHEDULEI DEBTSOFDECEDENT, MORTGAGELIABILITIES,&LIENS )o rtd e b tsin c u r red b y t h e dec e de n t p rio rto d e a th w hic h re m ained u n pa id as of th e d ate of death, i nclu ding u n reimb u rse d rn e d i ITEM NUMBER DESCRIPTION FILENUMBER calexpenses. VALUEAT DATE OFDEATH .~ o,.5'. Oo TOTAL (AlsoenteronlinelO,Recapitulation) $ i (Ifmorespaceisneeded,insertadditionalsheelsofthesamesize) REV;1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY ] TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ? o 8ox FILE NUMBER 04 RELATIONSHIP TO DECEDENT DO Not List Trustee(s) AMOUNT OR SHARE OF ESTATE 1] TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS $ (If more space is needed, insert additional sheets of the same size) wag LOOK FOR US. WI?LL GET YOU THERE. 3/17/2004 JOSEPH J MACK 1342 N MOUNTAIN RD PO BOX 6595 HARRISBURG PA 17112 The information which you requested on the account(s) of DOROTHY C ROHLAND (Social Security Number 188-09-5754) is/are as follows: Account Number 100014694 2100012302 416006656 Class of Account RETIREMENT CERTIFICATE CERTIFICATE Date Opened 052600 090899 052980 Principal Balance 60535.69 23370.84 5672.50 Accrued Interest 56.92 12.98 14.56 Balance at Date of 60592.61 ~ 23383.82 ~ 5687.06 0c Death Account Ownership SOLE Name of Joint Owner, if any Date Ownership 052600 Was Established JTO JTO DONALD V DONALD V ROHALDN ROHLAND 090899 052980 Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established Additional Information Requested Sin, cere~ly, , SENIOR SERVICES REP. P.O. Box 171 I. HARRISBURG, PENNSYLVANIA 17105-1711 Toll Fr~E 1-866-WAYPOINT (I-866-929-7646) · IN YORK AREA 717/815-4500 · ~vw. wagpointbank.com O. PN CBAN< March 23, 2004 Joe Mack P.O. Box 6595 Harrisburg, PA 17112 sop Estate of Dorothy C Rohland (Deceased) SSN: 188-09-5754 DOD: 01-13-2004 Dear Mr. Mack: In response to your request for Date of Death balances for/he customer noted above, our records show the following: Certificate of Deposit Account#31400216768 Established 08-02-2001 DOROTHY C RoHLAND DOD balance: $130,528.26 + $2,654.65 accrued'interest Account#31000214376 Established 08-03-2001 DOROTHY C ROHLAND DOD balance: $133,708.27 + $2,702.84 accrued interest Account#31000221706 'Established. 02-04-2002 DOROTHY C ROHLAND DOD balance: $42,650.34 + $39.04 accrued interest .-- Checking Account Account#5140053596 EstabliShed 12-01-1957 DONALD VROHLAND- ~ f/~c.,~4~6:~ DOROTHY C ROHLAND DOD balance: $3,205.85 + $0.09 accrued interest Savings Account Account#5130080603 DOD balance: Established 03-31-1983 DONALD V ROHLAND DOROTHY C ROHLAND $15,154.12 + $2.34 accrued interest Page 1 of 2 Please note that this office 0rtly provides date ofdeatl3, balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not process any financial transactions or provide statements'., ifyouneed assistanee.with"any 0fthese items, please call 1 - 888-PNC-BANK ( 1-888 -762 -2265) or stop by. your local 'PNC Bank branch office. Sincerely, Helen A Cozad 1-800-762-1775 P7-PFSC-04-F PiRsburghPA 15219-3128 Member FDIC Page 2 of 2 ' 712 Form (Rev. May 2000) Life Insurance Statement OMB No. 1545-0022 Department of the Treasury Internal Revenue Service ~ Decedent-- Insured (To be filed by the executor with Form 706, United States Estate (and Generation-Skipping Transfer) Tax Return, or Form 706 - NA, United States Estate ~nd Generation-Skipping Transfer) Tax Return, Estate of nonresident not a citizen of the United States.) I Decedent's first name and middle initial 2 Decedent's last name 3 Decedent's social security number I 4 Date of death DOROTHY C ROHLAND (if known) 188-09-5754 I 1/13/2004 $ Name and address of insurance company 3ACKSON NATIONAL LIFE INSURANCE COMPANY ONE CORPORATE WAY LANSING~ MI 48951 6 Type of policy 7 Policy number SPDA 0038905330 8 application.Owner's name. If decendent is not owner, attach copy Of ROHLAND, DOROTHY C r 9 12/2/1996Date issued 10 assignment.Assign°r's name. Attach copy of Ill Date assigned I I 12 Value of the policy at the time / 13 Amount of premium (see instructions) ! 14 Name of beneficiaries of assignment ~ $87,297.10 ANNUAL [ SUSAN SATTEL MAZI~ REBECCA ROHLAND, DONALD ROHLAND 15 Face amount of policy ............ 16 Indemnity benefits ............... $ 17 Additional insurance .............. $ 0.00 18 Other benefits ....... . . . 19 Principle of any indebtedness to the company that is deductible in determining net proceeds Loat7 Pril~ciple $ 0.00 20 Interest on indebtedness (line 19) accrued to date of death . Lo. an Irltere. st . $ 0.00 21 Amount of accumulated dividends ...... 22 Amount of post-mortem dividends ....... · . $ 23 Amount of returned premium .............. $ O.OO 24 Amount of proceeds if payable in one sum $ 43,O23.21 25 Value of proceeds as of date of death (if not payable in one sum) $ 26 Policy provisions concerning deferred payments or installments. Note: If other than/urnp-sum settlement is authorized for a surviving spouse, p/ease attach a copy of the insurance po/icy. 27 Amount of installments ................ $ O.OO 28 Date of birth, sex, and name of any person the duration of whose life may measure the number of payments. 29 Amount applied by the insurance company as a single premium representing the purchase of $ installment benefits 30 Basis (mortality table and rate of interest) used by insurer in valuing installment benefits. 31 Were there any transfers of the policy within the three years prior to the death of the decedent? [] Yes [] No 32 Date of assignment or transfer: / / Month Day Year 33 Was the insured the annuitant or beneficiary of any annuity contract issued by the company? ..... [] Yes [] No 34 Did the decedent have any incidents of ownership on any policies on his/her life, but not owned by him/her at the date of death? ........ [] Yes [] No 35 Names of companies with which decendent carried other policies and amount of such policies if this information is disclosed by your records. The undersigned officer of the above-named insurance company (or appropriate Federal agency or retirement system official) hereby certifies lhat this statement sets forth true and correct information. Signature Assistant Vice President Title I~ March 05, 2004 Date of Certification I~ Cat. No. 10170V Form 712 (Rev. 5-2000) O /04/ZOU4 THU ll:U1 001/001 NATIONAL LIFE To: $osephMack Date: 03/04/2004 FAX Number: 717-652-7368 From: Robin L. Davis Maildrop: M310 FAX Number: 802-229-3868 D~pt.: Title Department Telephone Number: 802-229-3045 Number of pages including this cover sheet: 1 If you have trouble with this transmission, please call: 802-229-3054. Message: Re: 09~6053 - Susan D. Rohland Mr. Mack, Your request for the cash value ofthe above policy as of certain dates has been completed: The information is az follows: Cash value as of January 13, 2004 is $2,776.99 Cash value as of April 16, 2000 is $2,208.68 If you require further information or azslstance with this matter, pleaze contact this office at your cenvenience. Sincerely, Robin L. Davis Title Services Represenlative Confidentiality Notice: This facsimile transmission contains confidential information belonging to hbo senders, which may be legally privileged information. The information is intended only for the use of the individual or entity named above. If you are not the intended recipient, or an employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any disolosure, copying, distribution, or the taking of any action in reliance on the contents of the faosimile document(s) is striotly prohibited. If you have received this transmission in error, please immedlntely notify us by telephone to arrange for return of the original facsimile document(s) to us. 734OA(0597) NATIONAL LIFE INSURANCE COMPANY · MONTPELIER, VERMONT 05604 Any Payments Or Charges After The Above Billing Date Will Appear Qn Your Next Statement. 101/04 ~02~04 /06/04 /29/04 /29/04 /29/04 /29/04 /29/04 /02/04 /02/04 99255' DX: 99232 DX: INITIAL 789.09 FOLLOWUP HOSPITAL CARE~ 789.09 MEDICARE PA BLUE SHIELD ,PA' INPATIENT CONSULT, COMPR INTERMED Co-ins 28.33 )F MEDIC, # # 459681 c# 459681 c# 459682 220.00 80.00 459681 Filed 459682 Filed 220.00 300.00 113.30- 186.70 58.37- 128.33 28.33- NSURANCE: ~rt Number ce Of Service 141.63 MW3109 RHOLAND ~ DOROTHY C HARRISBURG HOSPI 717 761 0930 Referring Physician INS r~PLACE OF SERV. CODES 11 12 21 22 23 24 31 32 81 Office Patient's Home Inpatient Hospital Outpatient Hospital Emergency Room-Hospital Ambulatory Surgical Center Skilled Nursing Facilily Nursing Facility Independenl Laboratory Olher Unlisted Facility Phone #: WEST SHORE EMS - ALS. 205 GRANDVIEW AVE CAMP HI[,t..~ PA tT0it (~100) 357-05"1Z Fe_~erai Tax ID: [ORE INVOICE PATIENT NAME: DOROTH'Y ROHLA!'.!E; PATIENT NUMBER: 2394 MDEN CALL NUMBER: 30,! 7~28A I,,*. r',~;:, ,._. ~, INSURANCE: ~.,~P,! '--/: ~,~ ~ i ~ ~ ~'i r~F~ DATE OF CALL: ! 2/30/2003 TIME OF CALL: CALLER: "30 ~ ~t, 7428A ' F R 0 M: ~:: 0 U N TR '~¢' M E.A D 0 'Wt~: TO: H ARRd SSU RG H O SPiTAL DOROTHY R©HLAND 4337 TRtNDLE RD NtE:CHANICSE~URG, PA t7055 REASON(S) *' '~' .... ' - FOR TRANSPORT ....... · ...-F, 488.08 48:-3.[J8 !0'3~ TU~i['~G A0394 ! .0 7.58 738 EKG EL.EC:TR,DOES ~0396 ! .O 4.02 4.02 OP SITE A03~.4 I.Q 4.47 4.47 ¢:.~ORM.AL S¢.L?.~E 50i'JC~3 .AQ39.~- ~ .0 2.84 2.84 'o~! Charo~ flf,74 · ' " ' ' r' ' ' '; ' · :-'~ " ' "'"":::'l~;';'r:::"~' ~: PLEASE PAY THIS AMOUNT ~ ' BLUE SHIELD Keep For Your Records EXPLANATION OF BLUE SHIELD BENEFITS (These Benefits Are In Addition To Your Medicare Part B Benefits) PATIENT INFORMATION Name of Patient: Medicare Number. Member ID: Claim Number: DOROTHY C ROHLAND 198125510D 188095756 0066790170600 SERVICES WERE PROVIDED BY: t~EST SHORE ALS Page: I OF Date of this Explanation: MARCH 26, 2006 TYPE OF SERVICE (SERVICE CODE) DATE (S) MEDICARE BLUE SHIELD OF SERVICE CHARGE APPROVED APPROVED GENERAL AMBULANCE SERVICE (A0999) 12/50/03 511.76 0.00 0.00 See Note $0.00 Note 1 This service ~as not covered by Hedicaro Part B~ therefore, no payment can be made. Please contact your Medicare Carrier if you have any questions, IGHMARK. BLUE SHIELD Camp Hill. PA 170e9 If you have a question, please call 1-800-367-6565 Monday through Friday 8:00 a.m. to 5:00 p.m. Please have a pen or pencil available to take notes. For text tdephoue users, please call 1-800-345-3816 (TTY only). If you prefer to write, please send your question to Highmark Blue Shield, P.O. Box 890052, Camp Hill, PA 17089-0052. I,,,111,,,I,,,11,,,11,,I,II1,,,,I,1,1,1,,,I,1,1,1,,I,1,,,,,111 tB~NDBQH lCOS8119062656212# DOROTHY C ROHLAND HACK 6ERBERXCH ASSOC PO BOX 6595 HARRISBURG PA 17112-0595 To make changes to your address, please contact your local Social Security office. Your address shown on this EOB was sent to us directly from your Medicare Carrier. Any questions should be directed to the Natidnal Social Security Office at 1-800-772-1213 THIS IS NOT A BILL Mack Gerberich & Associates, P.C. P. o. Box 6595 Harrisburg PA 17112-0595 Phone: (717) 652-9692 Fax: (717) 652-7368 DOROTHY ROHLAND COUNTRY MEADOWS OF WEST SHORE V-RM 557 4833 E TRINDLE RD MECHANICSBURG PA 17055 Invoice #: 5558 Date: January 13, 2004 Date Due: February 12, 2004 Client lD.. 1080 For professional services rendered: Apply for prescription reimbursement. Telephone calls to Health South re: statement and Holy Spirit Hospital re: reimbursement. Payment of checks, make deposits, reconcile bank statement. Please pay this amount $305.00 A 1.5% per month, 18% per annum, interest charge will be applied to all invoices over 30 day. Mack Gerberich & Associates, P.C. Page 1 Register of Wills of CUMBERLAND County, Pennsylvania Certificate of Grant of Letters No. 2004-00057 PA No. 21-04-0057 ESTATE OF ROHLAND DOROTHY C (~A~'i', ~'i~S'l', ~±u~) WHEREAS, on the 21st dated September 29th 1997 to probate as the last will and codicil of Late of HAMPDEN TOWNSHIP ~UM~.I_~Y_ND ~UU~'I'~, Deceased Social Security No. 188-09-5754 day of January & February 28th 2001 ROHLAND DOROTHY C 2004 instruments were admitted late of HAMPDEN TOWNSHIP , CUMBERLAND County, who died on the 13th day of January 2004 and, WHEREAS, a true copy of the will & codicil as probated is annexed hereto. THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of Wills in and for the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to MACK JOSEPH J who has duly qualified as Executor(rix) and has agreed to administer the estate according to law, all of which fully appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my Office the 21st day of January 2004. ~ / gzs~e~ or Wills- **NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE) 9/29/97 .,WILL O_~F .DOROTHY C. ROHLAND I, DOROTHY C. ROHLAND, of Cumberland County, Pennsylvania, declare this to be my will and hereby revoke all prior wills and codicils made by me. 1. ~. I bequeath such items of my tangible personal property as are specifically itemized on a list in my handwriting signed and dated by me at the end thereof, and attached to this my Will to the person(s) named thereon to receive such items and I bequeath equally to such of my children as survive me, all of my remaining tangible personal property (or all in the absence of such list) not used in business or for the production of income, including without limitation furniture, furnishings, clothing, jewelry, objects of art and decoration, and the like, and any motor vehicles which I own, together with the insurance thereon. 2. Residue. I bequeath, devise, and appoint all.the rest of my property, of whatever nature and wherever situated, including property over which I hold a power of appointment, to my issue per stirpes. 3. ~urvival Clause. If any beneficiary hereunder should die within sixty (60) days after me or within sixty (60) days after any other person the survival of whom determines, his rights hereunder, then such beneficiary shall be deemed to have predeceased me or such other person for all purposes hereunder. 4. Powers. In addition to such other powers and duties as may be granted elsewhere herein or which may be granted by law, the fiduciaries hereunder shall have the following powers and duties, without the necessity of notice to or consent by any Court: (a) To retain all or any part of my property, real or personal, in the form in which it may be held at the time of its receipt, including any stock of any corporate fiduciary hereunder, as long as in the exercise of their discretion it may be advisable so to do, notwithstanding that said property may not be of a character authorized by law. (b) To invest and reinvest any fUnds held hereunder in any property, real or personal, including, but not by way of limitation, bonds, preferred stocks, common stocks, and other securities of domestic or foreign corporations or investment trusts, mortgages or mortgage participation, and common trust funds, even though such property would not be considered appropriate or legal for a fiduciary apart from this provision. (c) To sell, convey, exchange, partition, give options to buy or lease upon, or otherwise dispose of any property, real or personal, at any time held by - 2 - them, with or without order of court at their option, at public or private sale or otherwise, for cash or other consideration or for such credit terms as they think proper, and upon such terms and for such prices as they may determine, and to convey such property free of all trusts. (d) To borrow money from any person, including any fiduciary hereunder, for any purpose in connection with the administration hereof, to execute promissory notes or other obligations for amounts so borrowed, and to secure the payments of such amounts by mortgages or pledges of any property, real or personal, which may be held hereunder. (e) To make loans, secured or unsecured, in such amounts, upon such terms, at such rates of interest, and to such persons, firms or corporations as~they may deem advisable. (f) To renew or extend the time for payment of any obligation, secured or unsecured, payable to or by them, for as long a period of time and on such terms, as they may determine, and to adjust, settle and arbitrate claims or demands in favor of or against them. (g) In dividing or distributing any property, real or personal, included herein, to divide or distribute in cash, in kind, or partly in cash and partly in kind. - 3 - (h) To hold, manage, and develop any real estate which may be held by them at any time, to. mortgage any such property in such amounts and on such terms as they may deem advisable, to lease any such property for such term or terms, and upon such conditions and rentals as they may deem advisable, whether or not the term of any such lease shall exceed the period permitted by law or the probable period of retention under this instrument; to. make repairs, replacements and improvements, structural and otherwise, in connection with any such property, to abandon any such property which they may deem to be worthless or not of sufficient value to warrant keeping or protecting, and to permit any such property to be lost by tax sale or any other proceed- ings. (i) To employ such brokers, banks, custodians, investment counsel, attorneys, and other agents, and to delegate to them such duties, rights and powers as they may determine, and for such periods as they think fit. (j) To register any securities at any time in their names as fiduciary, or in the names of~nominees, with or without indicating the trust character of the securities so registered. (k) With respect to any securities held hereunder, to vote upon any proposition or election at any meeting of the person or entity issuing such - 4 - securities, and to grant proxies, discretionary or otherwise, to vote at any such meeting; to join or become a party to any reorganization, readjustment, merger, voting trust, consolidation or exchange, and to deposit any such securities with any committee, depository, trustee or otherwiSe, and to pay out of the trust created herein, any fees, expenses, and assessments incurred in connection therewith; to exercise conversion, subscription or other rights, and to receive or hold any new securities issued as a result of any such reorganization, readjustment, merger, voting trust, consolidation, exchange or exercise of conversion, subscription.or other rights and generally to take all action with respect to any such securities as could be taken by the absolute owner thereof. (1) To engage in sales, leases, loans, and other transactions with my estate, or any trust established by me or by my husband, even if they are also fiduciaries or beneficiaries thereof. (m) To make all necessary proofs of death under the insurance policies of which they are the beneficiary, to execute any receipts for the proceeds and to institute any action to collect said proceeds and to make adjustments of any claim thereunder, provided, however, that they need not institute any - 5 - action unless they shall have been indemnified against all expenses and liabilities to which they may become subject as a result thereof. If, however, they desire to institute such action without indemnification, they are hereby authorized to be reimbursed for all expenses and liabilities incurred as a resUlt thereof from any amounts which may be held in trust hereunder then or thereafter. (n) To exercise all elections which they may have with respect to income, gift, estate, inheritance or other taxes, including without limitation election to deduct expenses in computing one tax or another, and election to pay or to defer payment of any tax, in all events without their being bound to require contribution from any other person. (o) To operate, own, or develop any business or property held hereunder in any form, including without limitation sole proprietorship, limited or general partnership, corporation, association, tenancy in common, condominium, or any other, whether or not they have restricted or no management rights, as they in their discretion think best. 5. Spendthrift Clause. No interest (whether in income or principal, whether or not a remainder interest, and whether vested or contingent) of any beneficiary hereunder shall be subject to anticipation, pledge, assignment, sale or transfer in - 6 - any manner, nor shall any beneficiary have power in any manner to charge or encumber his said interest, nor shall the said interest of any beneficiary be liable or subject in any manner while in the possession of the fiduciaries for any liability of such beneficiary, whether such liability arises from his debts, contracts, torts, or other engagements of any type. 6. Facility of Payments for Minors or Incompetent~. Any amounts or property which are payable or distributable hereunder to a minor or incompetent may, at the discretion of the fiduciaries, be paid to the parent or guardian of such minor or incompetent, to the person with whom such minor or incompetent resides, or directly to such minor or incompetent, or may be applied for the use or benefit of such minor or incompetent. 7. Taxes. I direc~ that all estate, inheritance, and succession taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, other than generation-skipping ~axes, shall be paid out of the principal of my general estate to the same effect as if said taxes were expenses of administration, except that any such additional taxes (and interest and penalties thereon) imposed on account of my interest in or power over any trust established by my husband Dhall be paid out of the property held in such trust, and all other property includible in my taxable estate for federal or state tax purposes, whether or not passing under this will, shall be free and clear thereof; provided, however, that no - 7 - such taxes shall be paid out of assets that are not includible in my federal gross estate. 8. Fiduciaries. I appoint as executrix hereunder my daughter, REBECCA ROHLAND, and if she is unable or unwilling to serve, then my son, DONALD V. ROHLAND, JR., shall serve in her place. If neither of my children should be able or willing to serve or to complete the administration of my estate, then PNC BANK, N.A. (or successor), with offices in Camp Hill, Pennsylvania, shall serve in their place. My executor(s) shall serve as guardian of the property of any minor beneficiaries hereunder, under any instrument of trust executed by me, under any policies of insurance on my life, and in any other situation in which the power to make such appointment exists under the laws of Pennsylvania. No individual fiduciary shall be liable for the acts, omissions or defaults of any agent appointed and retained with due care or of any co-fiduciary. No fiduciary shall be required to furnish bond or other security for the proper performance of his duties hereunder. 9. .Gender. Unless the context indicates otherwise, any use of the masculine gender herein shall also include the feminine gender. IN WITNESS WHEREOF, I, DOROTHY C. ROHLAND, herewith set my hand to this, my last Will, typewritten on ten (10) sheets of - 8 - paper including the self-proving attestation clause and signatures of witnesses, this 29th day of September, 1997. Dorothy [~. Rohland (SEAL) residing at~~~ residing at ~-~~ /~ residing at ~~% ~ COMMONWEALTH OF PENNSYLVANIA : COUNTY OF DAUPHIN : : SS: Dorothy C. Rohland (the testatrix), ~v~ ~'$~9~ ' -~¢ ~'L~ and - ' ~~' ~er~H (the witnesses), whose names are signed to the forgoing instrument, being first duly sworn, each hereby declares to the undersigned authority that the testatrix signed and executed the instrument as her last will in the presence of the witnesses and that she had signed willingly, and that she executed it as her free and voluntary act for the pu~oses therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as witness and that to the best of his knowledge the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. / TESTATRIX: orothy C. ~Rohland WITNESS: WITNESS: Subscribed, sworn to and acknowledged before me by Dorothy C. Rohland, the testatrix, and subscribed and sworn to before me by - ~~. ~'~'{'~¢~%~ _ the witnesses, this ~%~ day of September, 1997. CODICIL TO THE WILl OF DOROTHY C. ROHLAND I, Dorothy C. Rohland, of Hampden Township, Cumberland County, Pennsylvania, the within named Testatrix, do hereby make and publish this Codicil to my Last Will and Testament dated February 28, 2001. I hereby modify said Last Will and Testament as follows: ITEM I; follows: ITEM Xlll of said Last Will and Testament is amended to read as ITEM XIII; I hereby nominate, constitute and appoint JOSEPH J. MACK to be the ExecUtor. In the event of his death or his inability or refusal to serve as Executor or Trustee, his Associate, Peter A. Gerberich, shall serve as Executor. In the event of the death, inability or refusal of Joseph J. Mack to serve as Trustee, he shall have the power to nominate his successor Trustee, his Associate, Peter A. Gerberich, shall serve as successor Trustee. If he does not appoint a successor Trustee, his Associate Peter A. Gerberich, shall serve as successor trustee. The Executor and Trustee are specifically relieved from the duty or obligation of filing any bond or other security. In all other respects I confirm and ratify my aforesaid Last Will and Testament. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 28t~ day of February, 2001. DOROTHY A C. RO We, the undersigned, hereby certify that the foregoing Codicil Was signed, sealed, published and declared by the above named Testatrix as and for a Codicil to her Last Will and Testament, who, at her request and in her presence and in the presence of each other, have hereunto set out hands and seals the day and year above written, and we certify that at the time of the execution thereof, the said Testatrix was of sound and disposing mind and memory. ~ /~'/~ (SEAL) / Residing at.,, Residing at I,~ ~,1 .~-I-o,~ C/¢,-, I~d Residing at ?/o BUREAU OF TNDZVTDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-D601 JOSEPH J MACK MACK ETAL PO BOX 6595 HBG PA 17112 COHHONWEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOT/CE OF INHERTTANCE TAX APPRATSEHENT, ALLONANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX DATE 08-09-2004 ESTATE OF ROHLAND DATE OF DEATH 01-15-2004 FILE NUNBER 21 04-0057 COUNTY CUHBERLAND ACN 101 Amount RemArked DOROTHY C HAKE CHECK PAYABLE AND REHZT PAYNENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LTNE ~'~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF TNHERZTANCE TAX APPRAISEHENT, ALLOWANCE OR DTSALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF ROHLAND DOROTHY C FILE NO. 21 04-0057 ACN 101 DATE 08-09-2004 TAX RETURN #AS: (X) ACCEPTED AS F/LED ( ) CHANGED RESERVATION CONCERNING FUTURE TNTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Sohedula A) 2. Stocks end Bonds (Schedule B) 5. Closely Held S~ock/Par~nershAp Xn~eras~ (Schedule C) ($) ~. Hortgages/No~es ReceAvable (Schedule D) (~) 5. Cash/Bank DaposA~s/MAsc. Personal Propar~y (Schedule E) 6. Jointly Owned Proper~y {Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Tote1 Assa~s APPROVED DEDUCTIONS AND EXEHPTIONS: 9. Funeral Expanses/Adm. Cos~s/Hisc. Expenses (Schedule H) (9) 10. Dab~s/Hor~gage LAabilA~Aas/L/ans (Schedule Z) (10) 11. To,al Deductions 12. Ne~ Value of Tax Ra~urn $68~925.95 .00 .00 NOTE: To Ansure proper .00 credAt ~o your account, .00 submi~ ~he upper por~Aon .00 of *hAs form wi~h your ~ax payment. 105~615.82 (8} 15,319.69 472,541.75 922.74 (11) 1&.242.43 (12) 456,299.$Z 15. CharA~ebla/govarnmantal Bequests; Non-alac*ad 9115 Trusts (Schedule J) (13) .00 lq. Na~ VaZua of Es~a*e Sub~ac~ *o Tax (1~) 456,299.$2 NOTE: Z~ an assessment was issued previously, 11nas 14, 15 and~p-16, 17, 18 a~d 19 will reflect flgures that lnclude the total of ALL returns as~d~ed t~ date~:~ ASSESSNENT OF TAX: ~ ~ ~ ~,?~ ~ 16. Amoun* of L~n. lq a~ Spousal rm(m (lS) ~: X O0 = c::~::' ~: . O0 (16) q56,299~:52 X O~ 5~5.q7 (17) ~00 X 121 = 16. Amount of L/ne 1~ taxable at Lineal/Class A rata 17. Amount of LAne 1~ at SAblAng rate 18. Amoun* of LAne 1~ ~axabla a~ Colla*ara1/Class B ra~a 19. PrAncApel Tax Due DISCOUNT INTEREST/PEN PAID (-) 1,026.67 TAX PAC~Y~H~E~ TS: 04-06-20041 .0O o ,: (1~= :::i!i:28 , 553. ANOUNT P ~ "+, 21,000.00 RECEIPT NUNBER CD003785 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDZT/ONAL INTEREST. TOTAL TAX CREDIT 22,026.67 BALANCE OF TAX DUEI 1,49=.20CRI :iNTEREST AND PEN. ( TF TOTAL DUE TS LESS THAN $1, HO PAYHENT [F TOTAL DUE TS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE '-~ A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. RESERVATION: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred in possess[an or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for lifo or for years, the Commonaaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the laafut Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Sect[an ZlqO of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S. Section 9IqO). Oetach the top portion of this Notice and submit with your payment to the Register of H[lls printed on the reverse side. --Make check or money order payable to: REgIgTER OF MILLS, AGENT A refund of a tax credit, ah[ch was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications are available at the Off[cs of the Register of Ntlls, any of the Z3 Revenue Oistr[ct Off[cas, or by calling the special 2q-hour answering service for forms ordering: 1-800-36Z-ZOSO; services for taxpayers with special hearing and / or speaking needs: 1-aO0-qqT-3OZO [TT only). Any party in in[aras[ not satisfied with the appraisement, allowance, or d[salloaance of deductions, or assessment of tax (including discount or interest) as shown on this Not[ce must object within sixty (603 days of receipt of this Not[ca by: --written protest to the PA Department of Revenue, Board of AppeaIs, Dept. ZaIOZI, Harrisburg, PA 171Z8-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Un[t, Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (7173 787-6505. Sam page S of the booklet "Instructions for Inheritance Tax Return for a Res[dent Decedent" [REV-1501) for an explanation of administratively correctable errors. If any tax due is paid w[th[n three (5) calendar months after the decedent's death, a five percent (SX) discount of the tax paid is allo~ed. The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assmssed~ 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 mould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning a[th first day of delinquency, or nine (9) months and one (l) day from the date of death, to the date of payment. Taxes ~h[ch became delinquent before January 1, 19az bear interest at the rate of six (6X) percent per annum calculated at a daily rate of .000164. AIl taxes which became delinquent on and after January l, 1982 Nil1 bear interest at a rate which ~[11 vary fram calendar year to calendar year aith that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ['~ 2DZ .00054& 1988-1991 llX .000501 ZOO1 9Z .O00Zq7 1983 16Z .O00q~8 199Z 9X .000247 200Z 6Z .000164 1984 llZ .000301 1993-1994 7Z .00019Z ZOO3 5Z .000137 1985 13X .000356 1995-1998 9Z .000247 2004 4Z .000110 1986 lOX .000274 1999 7Z .OOO19Z 1987 IOZ ,O00Z7q ZOO0 7X .O0019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent Hill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date sheen on the Not[ce, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES I*NHERTTANCE TAX DTV'rSTON DEPT. Z80601 HARR'rSBURG, PA 171Z8-0601 COMHONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT REV-1607 EX AFP (01-05) JOSEPH J MACK MACK ETAL PO BOX 6595 HBG PA 17112 DATE 08-2$-ZOOq ESTATE OF ROHLAND DATE OF DEATH 01-1~-Z00q FILE NUMBER 21 0R-0057 COUNTY CUMBERLAND ACN 101 Amoun'l: Remi'l:'l:ed DOROTHY C MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA~,~.?~,~01$ ~. paymen~. REV-Z607 EX AFP (01-03) ~x# INHERITANCE TAX STATENENT OF ACCOUNT ESTATE OF ROHLAND DOROTHY C FILE NO. 21 04-0057 ACN 101 DATE..O8-Z$-ZOOq THIS STATEMENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACH ZN THE NAHED ~ATE. SHONN BELOI,/ ZSA SUNMARY OF THE PR/NCZPAL TAX DUE, APPL/CATZON OF ALL PAYHENTS, THE CURRENT BALANCE, AND,, ZF APPk!CABLE, A PROJECTED INTEREST F/gURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT= 08-OZ-ZO0~ PRINCIPAL TAX DUE= ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 20,535.q7 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID Oq-O6-ZOOq 08-O$-ZOOq CD005785 REFUND 1,026.67 .00 21,000.00 1,q95.20- ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULAT/ON OF ADDITIONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT IS REQUIRED. ZF TOTAL DUE 1S REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR ZNSTRUCTIONS. ) TOTAL TAX CREDIT 20,555.q7 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION Name of Decedent: Date of Death: STATUS REPORT UNDER RULE 6.12 b 0 ~o '\ l-4 Y c... , eo H LAN 1J i- 13,- 01-- Estate No.: F I \.- ~ No - z C)oLf - 000 5" -, 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 ~ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: (date) 3. If the answer to No. 1 is yes, state the following: D. Did the personal representative file a final account with the court? Yes No X The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) Did the personal representative state an account informally to the parties in interest? Yes X No Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. A. B. c. Date: 11- J.. [/ - 0 S si:".;2~:Jt9 jJ~J t/ Ie> .s 'E- P ;.-( J fJ1. A C K Name (Please type or print) '~O I.' If) C' .~ LU c:) I."L _ . (~) ~ C~~, ' " m 1..0.; , ! ' C-J fi3 . '. : (~A.tr;~tJ AID) l~! C:i. Lf":) CC c:..;J c~:;) c--l Po 80>< 0Sq~ Address 1+ A. R.. ~ I S B U k (:;; {-J A ( [ ( ( 2- 1 17 e:, s.- 2- c:r l.a q 2,- Telephone No. Capacity: x Personal Representative Comisel for Personal Representative R.W. - 58 'Jt'