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HomeMy WebLinkAbout04-0055 Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of William .. Lundquist No. o,~/~0/7/''','~'''/ also known as , Deceased Social Security No. 502-54-3633 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/are the executor named in the Last Will of the Decedent, dated June 20, 2002 and codicil(s) dated Sta e re evant cimumstances e.~.~ 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 incompetent: E~ B. Grant of Letters of Administration (c.t.a., d.b.n.c,t,a.: pendente lite; durante ~bsentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any1 and heirs: Name Relationship Residence I (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at 832 Mandy Lane, Camp Hill, PA 17011 (Hampden Township) (list street, number and municipality) Decedent, then 59 years of age, died December 22, 2003, at Unity Medical Center, Graftont Walsh County, North Dakota (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property ....................................... $ 20,000 (If not domiciled in PA) Personal property in Pennsylvania ........................... i. $ (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania .................................. $ Total ........................................................... $ Real Estate situated as follows: land in Walsh County, North D~kota ................... $ 20,000 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: I Si~lnature Typed or printed name and residence I Carol A. Lundquist ~'~,,~ ~?_ 4:~ C~~~ 832 Mandy Lane _ __/5 , Camp Hill, PA 17011 Form RW*I Page 1 of 2 (Dauphin County - Rev. 9/92) 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 before me this 16th day of January 2004 Glenda Farner Strasbaugh DECREE OF REGISTER Estate of William H. Lundquist Deceased No. 21-2004-55 also known as Social Security No: 502-54-3633 Date of Death: December 22, 2003 AND NOW, Januar~ 22nd ,2004, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [] Testamentary [] of Administration (c.t a,; d.b.n.c.t.; pendente lite; durante absentia; durante minoritate) are hereby granted to Carol A. Lundquist in the above estate and that the instrument(s), if any, dated 3un~ 20:2002 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES ........................... o.oo Letters - Register of Wills Short Certificate(s) (1~l.. $ 3.00 Glenda Farrier Strasbaugh Renunciation ( ) ............ $ Affidavit ( ) .................. $ Extra Pages (12) ........... $ 36.00 Codicil ........................... $ JCP Fee ........................ $. 10.00 Attorney: Elyse E. Rogers Inventory & Tax Forms... $. I.D. No: 41274 Other...~o~.],'~..i.~......cop¥$ 55.00 Address: 415 Fallowfield Rd. Suite 301 Camp Hill, PA 17011 TOTAL ................ $ -154-00 Telephone: 717-612-5801 DATE FILED: January -22fi0, 2004 Called Attorney on 1/22/04 -/~~~~,,~ ~ I NORTH DAKOTA DEPARTMENT OF HEALTH LOCAL /~,O-- 2©0 3 CERTIFICATE OF DEATH REGISTRAR'S NO. ~ STATE FILE NO. 1. DECEDENT'S NAME (First, Middle, Last) ~ ~ATH (Month, Day, Year) 502-54-3633 Grafton, North Dakota '~ Yes [] No ' [] Nursing Home [] Residenc ~pec/fy)  9b. FACILITY NAME (If not institulion, give street and number) 9c. CITY, TOWN, OR LOCATION OF DEATH DEATH Unity Medical Center ----------- Grafton Walsh 10. MARITAL STATUS * Married, ~ 12e. DECED'--'--'-----~NT USUAL OCCUPATION ---"---"'--' Never Married, Widowed, (if wife, give maiden name) 12b. KIND OF BUSINESS/INDUSTRY Divorced (Specify) (Give kind of work done during most of working life. Do not use retired.) Mar~ed Carol Boyd United States Air Eorce Retired 13~. RESIDENCE - STATE 13b. COUNTY 13co CITY, TOWN, OR LOCATION 13d. STREET AND NUMBER l~E Cumberland ~Y la 0 Cu~n Mexican P Hill ~ Lane LIMITS? I -- I --' ~"~..~'"_' · · , , uerio Rican,15. RACE (American Indian, 10. DECEOENT'S EDUCATION ~_ ~E~;I:~G: ..... Norwegi .... Icj(Specify) Biack, Whrie, etc.) (Specify) ' highest grade completed) _ Swedish, Czech White 17. FATHER'S NAME (First, Middle. Last) ~ Robert H. Lundquist Sr. Anne Jane Grant 16. MOTHER'S NAME (First, Mk~lie, Maiden Surname)  19a. INFORMANT'S NAME (Type/Print) ~uist 19b. MAILING ADDRESS (Street and Number or RuraI Route Number. City or Town, State, Zip Code) 832 Man, 20e. METHOD OF D'SPOSITION 17 011 20b. PLACE OF D)SPOSITiON ~Burial []Cremation [] Removal from Stateor other place) 20c. LOCATION (City or Town, State) [DISPOSITION- [-]Do~alion [~Other(Specify) Sarepta Lutheran Ceme' rUral Adams ND 21a. SIG~JATURE OF FUNERAL SERVICE LICENSEE OR ~ P~ISON .A.C~INCy~ SUCH /.) ~ 21b. UCENSE NUMBER 22. NAME AND ADDRESS OF FACiMTY ~/~//~ (otLicensee) Tollefson Funeral Home 1009 Grafton, North Dakota 58237 TO BE COMPLETED BY CERTIFYING PHYSICIAN i ~TH ~EXAM/NER NOTIFIED? TO BE COMPLETED ONLY BY MED,CAL EXA.INER/CORONER  ..... ,~n ,~H~CU r 26. TIME OF DEATH  NOUNCED DEAD (Month, Day, Year) ~Dr. Abdul Hafeez, 164 W 13th St. Grafton, ND 58237 uM 31. PART I. Enter Ihe diseases injuries or com-'ication" ' . . . I-~ s~n sedth eath. onotenlert oldymg, s hascardlaco~ pirator~ rest.~ List only one cause on each hne ·'Between Onset and Sequentially lisl conditions ii b"=~T~ ) (OR AS A C any, leading I0 ,mmediale ' cause. Enter UNDERLYING c ~~* CAUSE (Disease o~ injury ' v ~ I thal initiated events resulting[1~ [' CAUSE OF in death) LAST d..~__.~ DEATH PART II e Olher si nificant conditions contributing to death bu1 nol resulting in Ihe underlying cause given in Part I. ~~SED DIABETIC? J []Yes [~o []Unknown ~ I o. In your opinion, did tobacco use by the decedent contribute Io death? 32a. WAS AN AUTOPSY PERFORMED?[]Yes~o ~0 []Yes []No []Probab,y .~nk .... ~ PSY FINDINGS AVAILABLE PRIOR TO COMPLETION OF CAUSE OF DEATH? r-}Yes[] No 33. MANNER OF DEATH~Nalural []Accident E] Suicide[]Homicide []Pending Investigalion I--] Undetermined 34a'~MAoTnEthO,~;y~.yUeRaYr) 34d. DESCRIBE HOW INJURY OCCURRED N ,35. WAS DECEASED PREGNANT SFN 8156 ~ WITHIN 18 MONTHS OF DEATH? Rev. 1999 ~. L(JCATlON (Str. t and , umber or R ..... City or Town. State) OF WILLIAM H. LUNDQUIST I, WILLIAM H. LUNDQUIST, of Hampden Township, Cumberland County, Pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils by me heretofore made. ITEM I: I direct that all inheritance and estate taxes becoming due by reason of my death, whether payable by my estate or by any recipient of any property, shall be paid by the Executor out of the residue of my estate, as an expense and cost of administration of my estate. The Executor shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. ITEM II: I direct the Executor to pay the expenses of my last illness and funeral expenses from the residue of my estate as an expense and cost of administration of my estate. ITEM III: If I die before my wife, CAROL A. LUNDQUIST, I give to her all of my household furniture and furnishings, books, pictures, jewelry, silverware, automobiles, wearing apparel and all other articles of household or personal use or adornment and all policies of insurance thereon. If I do not die before my wife, I may leave a written list in my safe deposit box or elsewhere disposing of certain items of my tangible personal property. The Executor shall dispose of items of my personal property as specified in the written list. If no written list is found in my safe deposit box or elsewhere and properly Page l ~/~(~ identified by the Executor within thirty (30) days after the probate of my Will, it shall be presumed that there is no other statement or list. Any subsequent discovered list shall be ignored. If I survive my wife, I give any property of the type described in this Item and not set forth in a written list to my brothers-in-law, GERALD L. BOYD and DAVID J. BOYD, and my parents-in-law, HELEN BOYD and FRANKLIN BOYD, to be divided among them as they shall agree. ITEM IV: I give the residue of my estate, not disposed of in the preceding portions of this Will, to my wife, CAROL A. LUNDQUIST, if she survives me. If my wife does not survive me, the residue shall be distributed as provided in ITEM V(c). If my wife disclaims any property or interest in property to which she would be entitled under the provisions of this Item, the disclaimed property shall be held by my wife, CAROL A. LUNDQUIST, as Trustee, IN TRUST, and shall be administered and distributed as provided in ITEM V. ITEM V: The following provisions shall apply to any property payable to the Trustee named in ITEM IV as a result of the disclaimer of that property by my wife: (a) The Trustee shall pay to or for the benefit of my wife, CAROL A. LUNDQUIST, all of the net income of this Trust in convenient installments, but not less frequently than annually. (b) The Trustee shall pay to my wife so much of the principal of this Trust as may be necessary in the discretion of the Trustee for the proper support, maintenance and medical care of my wife. (c) Upon the death of my wife, the Trustee shall distribute the principal as follows: (i) All real property located in the State of North Dakota shall be distributed to my brothers and sisters, in equal shares. If any of my brothers or sisters is not living at the time of distribution, his or her share shall be distributed to his or her then living issue, per stirpes; (ii) TEN (10%) PERCENT of the balance to TRINITY EVANGELICAL LUTHERAN CHURCH, 2000 Chestnut Street, Camp Hill, Pennsylvania; (iii) TEN (10%) PERCENT of the balance to INDIANA UNIVERSITY OF PENNSYLVANIA, Indiana, Pennsylvania; (iv) TEN (10%) PERCENT of the balance to NORTH DAKOTA STATE UNIVERSITY AT FARGO, Fargo, North Dakota; (v) TEN (10%) PERCENT of the balance to OAK GROVE HIGH SCHOOL, Fargo, North Dakota; (vi) FIVE (5%) PERCENT of the balance to WEST SHORE PUBLIC LIBRARY, 30 North 318t Street, Camp Hill, Pennsylvania; (vii) FIVE (5%) PERCENT of the balance to the HUMANE SOCIETY OF HARRISBURG/WEST SHORE SHELTER, Sinclair and Eppley Roads, Mechanicsburg, Pennsylvania; (viii) TEN (10%) PERCENT of the balance to MOUNTAIN LUTHERAN CHURCH, Adams, North Dakota; (ix) TWENTY (20%) PERCENT of the balance to my brother-in-law, GERALD L. BOYD. If he does not survive me, this gift shall be paid to his then living issue, per stirpes; and (x) TWENTY (20%) PERCENT of the balance to my brother-in-law, DAVID J. BOYD. If he does not survive me, this gift shall be paid to his then living issue, per stirpes. (d) Notwithstanding any other provisions in this Will, the Trustee shall have the power to sell any real property located in the State of North Dakota and the decision to make such sale shall be without liability to my brothers and sisters or their issue. It is my hope that the real estate would be sold only if necessary for the support of my wife and it is also my hope, but not my direction, that the Trustee would offer this land first to some or all of my brothers and sisters. To the extent that the real property is sold, the gift to my brothers and sisters shall lapse. ITEM VI: My wife, CAROL A. LUNDQUIST, shall have the noncumulative right to withdraw FIVE THOUSAND ($5,000) DOLLARS from the principal of the Trust established under ITEM V of this Will each calendar year during which she is entitled to receive income. If she is living on the last day of such year, she shall also have the right to withdraw an amount equal to five (5%) percent of the net market value of the principal on the last day of the year, less the amount, if any, previously withdrawn during the year. The Trustee shall make this payment within thirty (30) days of the close of the year. This right of withdrawal is noncumulative and may be exercised only in writing delivered to the Trustee within thirty (30) days prior to the last day of each calendar year. ITEM VII: No part of the income or principal of any Trust created by this Will shall be subject to attachment, levy or seizure by any creditor, spouse, assignee or trustee or receiver in bankruptcy of any beneficiary prior to his or her actual receipt of income or principal distributed. The Trustee shall pay the net income and the principal to the beneficiaries specified by me, as their interests may appear, without regard to any attempted anticipation, pledging or assignment, and without regard to any claim or attempted levy, attachment, seizure or other process against the beneficiary. ITEM VIII: In addition to the powers granted at law, the Executor and the Trustee shall each possess the following powers, each of which may be exercised without court approval and in a fiduciary capacity only: (a) To retain any investments I have at my death, including specifically those consisting of stock of any bank even if I have named that bank as the Executor or Trustee. (b) To vary investments, and to invest in bonds, stocks, notes, real estate mortgages or other securities or in other property, real or personal, without being restricted to so-called "legal investments", and without being limited by any statute or rule of law regarding investments by fiduciaries. (c) In order to divide the principal of a Trust or for any other purpose, including final distributions, the Executor and Trustee are authorized to divide and distribute personal property and real property, partly or wholly in kind, and to allocate specific assets among beneficiaries and Trusts so long as the total market value of each share is not affected by the division, distribution or allocation in kind. The Executor and Trustee are each authorized to make, join in and consummate partitions of lands, voluntarily or involuntarily, including giving of mutual deeds, or other obligations, with as wide powers as an individual owner in fee simple. (d) To sell either at public or private sale real and personal property severally or in conjunction with other persons, and to consummate sale(s) by deed(s) or other instrument(s) to the purchaser(s), conveying a fee simple title. No purchaser shall be obligated to see to the application of the purchase money or to make inquiry into the validity of any sale(s). The Executor and Trustee are authorized to execute, acknowledge and deliver deeds, assignments, options or other writings as necessary or convenient to any of the power conferred upon the Executor and Trustee. (e) To mortgage real estate, and to make leases of real estate. (f) To borrow money from any person, including the Executor or Trustee, to pay indebtedness of mine or of my estate, expenses of administration or inheritance, legacy, estate and other taxes, and to assign and pledge assets of my estate or any Trust established by this Will. (g) To pay all costs, taxes, expenses and charges in connection with the administration of my estate or any Trust established under this Will. (h) To make distributions of income and of principal to the proper beneficiaries, during the administration of my estate, with or without court order, in such manner and in such amounts as the Executor deems prudent and appropriate. (i) To vote shares of stock which form a part of my estate or any Trust established under this Will, and to exercise all the powers incident to the ownership of stock. (j) To unite with other owners of property similar to property in my estate to carry out plans for the reorganization of any company whose securities form a part of my estate. (k) To disclaim any interest in property which would devolve to me or my estate by whatever means, including but not limited to the following means: as beneficiary under a will, as an appointee under the exercise of a power of appointment, as a person entitled to take by intestacy, as a donee of an inter vivos transfer, and as a donee under a third-party beneficiary contract. (1) To prepare, execute and file tax returns of any type required by applicable law, and to make all tax elections authorized by law. (m) To employ custodians of property, investment or business advisors, accountants and attorneys as the Executor or Trustee deems appropriate, and to compensate these persons from assets of my estate or trust, without affecting the compensation to which the Executor and Trustee are entitled. (n) To divide any Trust created in this Will into two or more separate Trusts so that inclusion ratio for purposes of the generation- skipping transfer tax shall be either zero or one, in order that an election under Section 2652(a)(3) of the Internal Revenue Code may be made with respect to one of the separate Trusts, or for any other reason. (o) To allocate administrative expenses to income or to principal, as the Executor or Trustee deems appropriate. However, no allocation to income shall be made if the effect of the allocation is to cause a reduction in the amount of any estate tax marital deduction or estate tax charitable deduction. (p) To do all other acts in their judgment necessary or desirable for the proper and advantageous management, investment and distribution of the estate and Trusts established under this Will. ITEM IX: The Trustee, on an annual basis, shall provide each income beneficiary who has attained the age of eighteen (18) years, Page8 f~~ and the Guardian of the person of any income beneficiary who has not attained the age of eighteen (18) years, statements showing transactions each Trust established for the benefit of that beneficiary. The beneficiary, or the Guardian of the person of such beneficiary, may waive this right to receive an annual accounting. The Trustee may, at any time, settle any account, or questions concerning the administration of any Trust established under this Will, by agreement with the then current income beneficiaries of the Trust, if legally competent, or if not legally competent, with the Guardian of the person of the beneficiary, the legally competent spouse of the beneficiary, or the oldest legally competent relative of the beneficiary who would take a portion of the estate of the beneficiary were the beneficiary to die at that time intestate under the laws of the Commonwealth of Pennsylvania. Any settlement made in accordance with this Item shall bind all persons who have an interest in the Trust, and shall constitute a release and discharge of the Trustee with respect to transactions specified in the settlement. ITEM X: The Trustee is authorized to distribute principal and/or income in any one or more of the following ways if the Trustee, in the discretion of the Trustee, considers the beneficiary unable to apply distributions to the beneficiary's own best interests, or if the beneficiary is under a legal disability: (a) Directly to the beneficiary; (b) To the legal guardian or conservator of such beneficiary; (c) To the Trustee, or to another person selected by the Trustee, as custodian under the Pennsylvania Uniform Transfers to Minors Act as to a beneficiary under the age of twenty-one (21) years; (d) To a relative of the beneficiary, to be expended by that relative for the benefit of the beneficiary; or (e) By directly applying distributions for the benefit of the beneficiary. ITEM XI: Any person who has died within thirty (30) days of my death, or under such circumstances that the order of our deaths cannot be established by proof, shall be deemed to have predeceased me. Any person (other than myself) who has died at the same time as any beneficiary under this Will, or in a common disaster with that beneficiary, or under such circumstances that the order of deaths cannot be established by proof, shall be deemed to have predeceased that beneficiary. ITEM XII: I appoint my wife, CAROL A. LUNDQUIST, to be the Executrix, referred to in this Will as "Executor". In the event of her death, inability or refusal to serve as Executor or Trustee, ! appoint GERALD L. BOYD to be the Executor, Trustee, or both. In the event both are unable or unwilling to serve as Executor, I appoint DAVID J. BOYD to be the Executor, Trustee, or both. The Executor and Trustee are specifically relieved from the obligation of filing bond or entering security. IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will and Testament, consisting of this and the preceding nine (9) pages, at the end of each page of which I have also set my initials for greater security and better identification this ~;f;~ day of ~ , 200 ~. WILLIAM H. We, the undersigned, hereby certify that the foregoing Will was signed, sealed, published and declared by the above-named Testator as and for his Last Will and Testament, in the presence of us, who, at his request and in his presence and in the presence of each other, have hereunto set our hands and seals the day and year first above written, and we certify that at the time of the execution thereof, the said Testator was of sound and disposing mind and memory. ~4~_//~. ~~/'~ (SEAL) Residing at ~~z~ ~ ~~) (SEAL)Residing at ~=~g( _~ ' t - - ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA )  ) SS: COUNTY OF ) I, WILLIAM H. LUNDQUIST, Testator, 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 and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ]~~4 ,/k/~: '(SEAL) WILLIAM H. L~~ Sworn to and subscribed before me this ~o+~ day of ~ ,20oL My Commission Expires: (SEAL) ~L SEAL AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) ) SS: COUNTY OF ~ ) We, ~/.4//C~/'/. ~_ ff-e~'/ and ~3C" f ~7)~c~C-J , the Witnesses whose names are signed to the attached or fo oing instrument, being duly qualified according to law, do depose and say that we were present and saw Testator, WILLI~ H. LUNDqUIST, sign and execute the instrument as his Last Will and Testament; that Testator signed willingly and that he executed said Will as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as Witnesses; and that to the best of our knowledge the Testator was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. Witnes; ~ f ~tne~ Sworn to and subscri~ before me this ~ day of ~ ,20~L My Commission Expires: (SE~L)  NOTARIAL S~L [ CYNTHIA j. RULE, Nota~ Public j Camp Hill B~o., Cumberland Coun~ ~ ~.. MY Commission Expires Jan. 24, 2004 ~ 173649 CERTIFICATION OF NOTICE UNDER RUIJF~ 5.6(a) Name of Decedent: William H. Lundquist Date of Death: December 22~ 2003 Will No. Admin. No. 21-04-0055 To the Register: 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 ~ Name ..kddress Carol Lundquist 832 Mandy Lane, Camp Hill, PA 17011 Notice has now been given to all persons entitled t~ under Rule 5~a). -- ~ Signature ~ Elvse E. Rogers, Esquire Name 415 Fallowfield Road, Suite 301 .Camp Hill, PA 17011 Address (717) 612-5801 Telephone Capacity: Personal Representative X Counsel for Personal Representative IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF WILLIAM H. LUNDQUIST, Orphans'Court Division Deceased No. 21-04-55 NOTICE OF CLAIM PURSUANT TO 20 PA. CONS. STAT. § 3532 To the Clerk of the Orphans' Court: Enter the Claim o£ Oscar Lundqulst and Tim Lundquist in an amount to be determined against the above entitled estate. The Decedent, who resided at 832 Mandy Lane, Camp Hill, Cumberland County, Pennsylvania 17011, died on December 22, 2003. On July 23, 2004, written notice of said Claim was given to Elyse E. Rogers, Esquire, at 415 Fallowfield Road, Suite 301, Camp Hill, Pennsylvania 17011, counsel to the Executor and/or the Estate. Respectfully submitted, HANFT & KNIGHT, P.C. Date: July 23, 2004 M'c ae J Hanft, Esquire Attorney ID No. 57976 James I. Nelson, Esquire Attorney I.D. No. 91144 19 Brookwood Avenue, Suite 106 Carlisle, Pennsylvania 17013_z91~42 (717) 249-5373 Attorneys for Claimants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF WILLIAM H. LUNDQUIST, Orphans'Court Division Deceased No. 21-04-55 CERTIFICATE OF SERVICE AND NOW, this 23nd day of July, 2004, I, Michael J. Hanft, Esquire, hereby certify that I have this day served the following person with a copy of the foregoing Notice of Claim, by first class, United States Certified Mail, postage pre-paid, addressed as follows: Elyse E. Rogers, Esquire 415 Fallowfield Road Camp Hill, PA 17011 Attorney for Executor HANF~ & KNIGHT, P.C. Attorney ID No. 57976 James I. Nelson, Esquire Attorney I.D. No. 91144 19 Brookwood Avenue, Suite 106 Carlisle, Pennsylvania 17013-9142 (717) 249-5373 Attorneys for Plaintiff · COMMONWEALTH OF PEN.svLv^.,^ REV-1500 DEPARTMENT OF REVENUE DEPT. 280601 INHERITANCE TAX RETURN FILE NUMBER HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 -- 2004 _00_55 ~.undquist, William H. 502-54-3633 DA3~ OF DEATH (MM-DO-YEAR) DA3~ OF BIRTH (MM~D-YEAR) THIS RETUR~I MUST BE FILED IN DUPLICATE WITH THE 12/22/2003 01/14/1944 REGISTER OF WILLS (IF APPLICABLE)SURVIVING SPOUSE~ NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECU PJ~ NUMBER Lundquist, Carol A. 530-30-8630 ~ 1. Original Return [~] 2. Supplemental Return r--] 3. Remainder Retum (date of death pdor to 12-13-82) ~ 4. Limited Estate ~ 4a. Future Interest Compromise (date of death after 12-12-82) r~] 5. Federal Estate Tax Ratum Required ~ 9. Litigation Proceeds Receiwd ~ 10. Spousal Poorly Credit (~e of ~..~h b.~,~.e, ~2-3~-9~ am ~-~ ~S) E~] I 1. Election to tax under Sec. 9113(A) (Attach ~ O) : Elyse E. Rogeris, Esc/uire FIRM NAME (IfApplicable) 415 Fallowfield Road, Suite 301 Keefer Wood Allen & Rahal, LLP Camp Hill, PA 17011 717-612-5801 1. Real Estate (Schedule A) (1) 0 . 0 0 OFFIOAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) 1 8,3 9 3 · 4 8 >~ BE;SuRE TO ANSWER ALL QUESTiON$ ON REVERSE SiDE ANri RECHECK MATH <~ [[ -)W4645 1000 Decedent's Complete Address: 17011 Tax Payments and Credits: J. Tax Due (Page t Line lg) (1) 0.00 2, Credits/Payments A. Spousal Pove~y Credit 0.00 B. Prior Payments 0.00 C. Discount 0.00 Total Credits (A + B + C) (2) 0.00 3, Interest/Penalty if applicable D. Interest 0,00 E. Penalty 0.00 Total Interest/Penalty (D + E) (3) 0o00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. Th~ is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due, (5A) 0,00 B. Enter the total of Line 5 + 5A, This is the BALANCE DUE. (5B). 0.00 ................. Make Check Pa able to: REGISTEROFI41ILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE .4PPROPRIATE BLOCKS c. retain a reversionary interest; or ................................ ~'~ r~] without receiving adequate consideration? ............................ r~ r~ contains a beneficiary designation? ................................ ~] [] Camp Hill, ~A 17011 S,GNATUEE O~E~TH~~A~VE DATE '/ Camp Hill, ~A REV*1503 EX + (1-971 SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS · INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Lundquist, William H. 21-2004-0055 All property jointly-owned with right of survivorship must be disclosed on Schedule F. II~M VALUE AT DATE NUMBER DE$CRIP~ON OF DEATH 1. US Savings Bonds, Series E 12,694.80 2 US Savings Bonds Series EB 5,698.68 TOTAL (Also enter on line 2, Recapitulation) $ 18.393.48 (If more space is needed, insert additional sheets of the same size) Savings Bond Calculator Page 1 of 4 ~ Savinc 112/2003 ~ ~ Series Denomination Serial Number Issue Date IE Bonds -_j $~ I ............ I # Bonds Total Price Total Interest Total Value YTD In~ 109 $2,043.75 $10,651.05 $12,694.80 $360. Issue Interest Next Final SeriaINumber IssueDate Series Dehorn Price Interest Value Rate Accrual Maturit3 Q5196049648E 04/1975 E $25 $18.75 $105.23 $123.98 4.00% 04/2004 04/2005 Q2583939172E 09/1971 E 25 18.75 107.61 126.36 09/2001 Q2608616096E 01/1972 E 25 18.75 107.13 125.88 01/2005 Q2620680355E 03/1972 E 25 18.75 107.44 126.19 03/2005 Q2614127646E 02/1972 E 25 18.75 107.42 126.17 02/2005 Q5101797297E 12/1973 E 25 18.75 109.73 128.48 12/2002 Q5101741758E 11/1973 E 25 18.75 113.01 131.76 11/2002 Q5094409905E 10/1973 E 25 18.75 113.01 131.76 10/2002 Q6323063287E 02/1979 E 25 18.75 68.34 87.09 4.00% 02/2004 02/200c~ Q6322746941E 01/1979 E 25 18.75 68.34 87.09 4.00% 01/2004 01/200~c Q6386008757E 02/1980 E 25 18.75 66.76 85.51 4.00% 02/2004 02/201( Q6385959391E 01/1980 E 25 18.75 66.76 85.51 4.00% 01/2004 01/201( Q2537429238E 03/1971 E 25 18.75 107.85 126.60 03/2001 Q2531312566E 02/1971 E 25 18.75 107.85 126.60 02/2001 Q2531056993E 01/1971 E 25 18.75 107.55 126.30 01/2001 Q2568828731E 07/1971 E 25 18.75 107.31 126.06 07/2001 Q2575575597E 08/1971 E 25 18.75 107.61 126.36 08/2001 Q2550606589E 04/1971 E 25 18.75 107.85 126.60 04/2001 Q2557069206E 05/1971 E 25 18.75 107.85 126.60 05/2001 Q2561999791E 06/1971 E 25 18.75 108.20 126.95 06/2001 Q5034092401E 12/1972 E 25 18.75 109.58 128.33 12/2005 Q5026592428E 11/1972 E 25 18.75 109.30 128.05 11/2005 Q5026010799E 10/1972 E 25 18.75 109.30 128.05 10/2005 Q2590544059£ 10/1971 E 25 18.75 107.61 126.36 10/2001 Q2602548449E 11/1971 E 25 18.75 107.61 126.36 11/2001 Q2608466843E 12/1971 E 25 18.75 107.91 126.66 12/2001 Q2627749230E 06/1972 E 25 18.75 107.79 126.54 06/2005 Q2621222424E 05/1972 E 25 18.75 107.44 126.19 05/2002 http ://wwws.publicdebt.treas.gov/BC/SB CPrice 2/27/2004 Savings Bond Calculator Page 2 of 4 Q2621143921E 04/1972 E 25 18.75 107.44 126.19 04/2005 Q5010488198E 09/1972 E 25 18.75 109.30 128.05 09/2005 Q5010145876E 08/1972 E 25 18.75 109.30 128.05 08/2005 Q2633931187E 07/1972 E 25 18.75 109.02 127.77 07/2002 Q5067019073E 06/1973 E 25 18.75 111.45 130.20 06/2002 Q5061164399E 05/1973 E 25 18.75 111.14 129.89 05/2002 Q5054398890E 04/1973 E 25 18.75 II1.14 129.89 04/2002 Q5087383174E 09/1973 E 25 18.75 113.01 131.76 09/2002 Q5080249083E 08/1973 E 25 18.75 112.99 131.74 08/2002 Q5073082344E 07/1973 E 25 18.75 112.71 131.46 07/2002 Q5179774954E 12/1974 E 25 18.75 107.73 126.48 4.00% 06/2004 12/200,q Q5179662563E 11/1974 E 25 18.75 107.41 126.16 4.00% 05/2004 11/2004 Q5164970677E 10/1974 E 25 18.75 106.22 124.97 4.00% 04/2004 10/200,~ Q5051929676E 03/1973 E 25 18.75 111.14 129.89 03/2002 Q5040884524E 02/1973 E 25 18.75 111.14 129.89 02/200_~ Q5040807672E 01/1973 E 25 18.75 110.81 129.56 01/2002 Q5143520055E 06/1974 E 25 18.75 108.72 127.47 4.00% 06/2004 06/200,~ Q5136398661E 05/1974 E 25 18.75 108.42 127.17 4.00% 05/2004 05/2004 Q5129584221E 04/1974 E 25 18.75 107.21 125.96 4.00% 04/2004 04/200zl Q5164533840E 09/1974 E 25 18.75 106.22 124.97 4.00% 03/2004 09/2004 Q5164416549E 08/1974 E 25 18.75 106.22 124.97 4.00% 02/2004 08/2004 Q5149963254E 07/1974 E 25 18.75 106.22 124.97 4.00% 01/2004 07/2004 Q6021919030E 12/1975 E 25 18.75 105.74 124.49 4.00% 06/2004 12/2005 Q6004570747E 11/1975 E 25 18.75 I05.47 124.22 4.00% 05/2004 11/2005 Q5248582021E 10/1975 E 25 18.75 104.26 123.01 4.00% 04/2004 10/2005 Q5122898155E 03/1974 E 25 18.75 I07.21 125.96 4.00% 03/2004 03/2004 Q5116219228E 02/1974 E 25 18.75 107.21 125.96 4.00% 02/2004 02/2004 Q5109411337E 01/1974 E 25 18.75 107.21 125.96 4.00% 01/2004 01/2004 Q5215390667E 06/1975 E 25 18.75 106.72 125.47 4.00% 06/2004 06/2005 Q5202955741E 05/1975 E 25 18.75 106.42 125.17 4.00% 05/2004 05/2005 Q5235339238E 09/1975 E 25 18.75 104.26 123.01 4.00% 03/2004 09/2005 Q5223106763E 08/1975 E 25 18.75 104.26 123.01 4.00% 02/2004 08/2005 Q5215960566E 07/1975 E 25 18.75 104.26 123.01 4.00% 01/2004 07/2005 Q6140311886E 12/1976 E 25 18.75 103.82 122.57 4.00% 06/2004 12/200~ Q6125734925E 11/1976 E 25 18.75 103.48 122.23 4.00% 05/2004 11/200~ Q6125658790E 10/1976 E 25 18.75 102.30 121.05 4.00% 04/2004 10/200~ Q5195723283E 03/1975 E 25 18.75 105.23 123.98 4.00% 03/2004 03/2005 Q5188205848E 02/1975 E 25 18.75 105.23 123.98 4.00% 02/2004 02/2005 http://wwws.publicdebt.treas.gov/BC/SB CPrice 2/27/2004 Savings Bond Calculator Page 3 of 4 Q5187936742E 01/1975 E 25 18.75 105.23 123.98 4.00% 01/2004 01/2005 Q6096079959E 06/1976 E 25 18.75 104.74 123.49 4.00% 06/2004 06/200~ Q6079868270E 05/1976 E 25 18.75 104.47 123.22 4.00% 05/2004 05/200~ Q6072670080E 04/1976 E 25 18.75 103.31 122.06 4.00% 04/2004 04/200{ Q6103372968E 09/1976 E 25 18.75 102.30 121.05 4.00% 03/2004 09/200~ Q6103262113E 08/1976 E 25 18.75 102.30 121.05 4.00% 02/2004 08/200~ Q6096183870E 07/1976 E 25 18.75 102.30 121.05 4.00% 01/2004 07/200~ Q6214489855E 12/1977 E 25 18.75 90.88 109.63 4.00% 06/2004 12/200~ Q6194841013E 11/1977 E 25 18.75 90.58 109.33 4.00% 05/2004 11/2005 Q6194759365E 10/1977 E 25 18.75 100.46 119.21 4.00% 04/2004 10/2005 Q6045009181E 03/1976 E 25 18.75 103.31 122.06 4.00% 03/2004 03/200{ Q6038134064E 01/1976 E 25 18.75 103.31 122.06 4.00% 01/2004 01/200{ Q6038204941E 02/1976 E 25 18.75 103.31 122.06 4.00% 02/2004 02/200~ Q6061128958E 05/1977 E 25 18.75 102.61 121.36 4.00% 05/2004 05/2005 Q6159087228E 04/1977 E 25 18.75 101.42 120.17 4.00% 04/2004 04/200~ Q6158989709E 03/1977 E 25 18.75 101.42 120.17 4.00% 03/2004 03/2005 Q6194520995E 09/1977 E 25 18.75 100.46 119.21 4.00% 03/2004 09/2005 Q6175288213E 08/1977 E 25 18.75 100.46 119.21 4.00% 02/2004 08/200~ Q6175206486E 07/1977 E 25 18.75 100.46 119.21 4.00% 01/2004 07/2005 Q6307994001E 11/1978 E 25 18.75 69.83 88.58 4.00% 05/2004 11/200~ Q6295353356E 10/1978 E 25 18.75 69.00 87.75 4.00% 04/2004 10/200~ Q6267639191E 09/1978 E 25 18.75 69.00 87.75 4.00% 03/2004 09/200~ Q6140486800E 02/1977 E 25 18.75 101.42 120.17 4.00% 02/2004 02/2005 Q6140413430E 01/1977 E 25 18.75 101.42 120.17 4.00% 01/2004 01/2005 Q6308277946E 12/1978 E 25 18.75 70.07 88.82 4.00% 06/2004 12/200~ Q6250941687E 05/1978 E 25 18.75 70.51 89.26 4.00% 05/2004 05/200~ Q6242986547E 04/1978 E 25 18.75 75.01 93.76 2.51% 04/2004 04/200fi Q6242886833E 03/1978 E 25 18.75 75.01 93.76 2.51% 03/2004 03/200~ Q6260025422E 07/1978 E 25 18.75 69.00 87.75 4.00% 01/2004 07/200~ Q6260109958E 08/1978 E 25 18.75 69.00 87.75 4.00% 02/2004 08/2008 Q6251043319E 06/1978 E 25 18.75 70.73 89.48 4.00% 06/2004 06/200fi Q6377425475E 11/1979 E 25 18.75 68.47 87.22 4.00% 05/2004 11/200~c Q6376920301E 10/1979 E 25 18.75 67.66 86.41 4.00% 04/2004 10/200~c Q6376785809E 09/1979 E 25 18.75 67.66 86.41 4.00% 03/2004 09/200c~ Q6220652341E 02/1978 E 25 18.75 88.73 107.48 4.00% 02/2004 02/200~ Q6220573886E 01/1978 E 25 18.75 88.73 107.48 4.00% 01/2004 01/200~ Q6383914033E 12/1979 E 25 18.75 68.47 87.22 4.00% 06/2004 i2/200~c Q6343612986E 05/1979 E 25 18.75 69.18 87.93 4.00% 05/2004 05/200.c http://wwws.publicdebt.treas.gov/BC/SBCPrice 2/27/2004 Savings Bond Calculator Page 4 of 4 Q6343392486E 04/1979 E 25 18.75 68.34 87.09 4.00% 04/2004 04/200~c Q6323161237E 03/1979 E 25 18.75 68.34 87.09 4.00% 03/2004 03/200~c Q6367100766E 08/1979 E 25 18.75 67.66 86.41 4.00% 02/2004 08/200~c Q6344460591E 07/1979 E 25 18.75 67.66 86.41 4.00% 01/2004 07/200~c Q6344014358E 06/1979 E 25 18.75 69.39 88.14 4.00% 06/2004 06/200~c !view ~ [ Viewing Bonds 1-109 Note Description NI Not Issued NE Not Eligible for Payment P5 Includes 3-month interest penalty ME Matured (Exchangeable for HH) MN Matured (Not Exchangeable for HH) Please rate this service. (Please print and/or save this page before submitting your survey) Service Excellent Good Fair Poor Savings Bond Calculator C (' ~ C http://wwws.publicdebt.treas.gov/BC/SBCPrice 2/27/2004 Savings Bond Calculator Page 1 of 3 Savin¢ 2/2003 ~ j~T-f.lelp, 'I Series Denomination Serial Number Issue Date lEE Bonds ~ $150 I [ ..... # Bonds Total Price Total Interest Total Value YTD In~ 70 $1,925.00 $3,773.68 $5,698.68 $222. Issue Interest Next Final SerialNumber IssueDate Series Denom Price Interest Value Rate Accrual Maturity L217793953EE 06/1985 EE $50 $25.00 $48.14 $73.14 4.00% 06/2004 06/2015 L212026167EE 04/1985 EE 50 25.00 48.14 73.14 4.00% 04/2004 04/2015 L209679097EE 02/1985 EE 50 25.00 48.14 73.14 4.00% 02/2004 02/2015 L231559311EE 12/1985 EE 50 25.00 46.70 71.70 4.00% 06/2004 12/2015 L228585457EE 10/1985 EE 50 25.00 46.70 71.70 4.00% 04/2004 10/2015 L217882833EE 08/1985 EE 50 25.00 46.70 71.70 4.00% 02/2004 08/2015 L10284046EE 10/1980 EE 50 25.00 101.88 126.88 4.00% 04/2004 I0/2010 L10032999EE 08/1980 EE 50 25.00 101.88 126.88 4.00% 02/2004 08/20112 L9529992EE 06/1980 EE 50 25.00 104.40 129.40 4.00% 06/2004 06/20112 L10573895EE 12/1980 EE 50 25.00 91.28 116.28 4.00% 06/2004 I2/20113 L59259588EE 12/1981 EE 50 25.00 82.00 107.00 4.00% 06/2004 12/2011 L59124832EE 10/1981 EE 50 25.00 82.00 107.00 4.00% 04/2004 10/2011 L54155897EE 08/1981 EE 50 25.00 82.00 107.00 4.00% 02/2004 08/2011 L9423122EE 04/1980 EE 50 25.00 103.12 128.12 4.00% 04/2004 04/20112 Ll16944029EE 12/1982 EE 50 25.00 73.14 98.14 4.00% 06/2004 12/2012 Llll182813EE 10/1982 EE 50 25.00 77.86 102.86 4.00% 04/2004 10/2012 L106561038EE 08/1982 EE 50 25.00 77.86 102.86 4.00% 02/2004 08/2012 L45276079EE 06/1981 EE 50 25.00 84.14 109.14 4.00% 06/2004 06/2011 L45129144EE 04/1981 EE 50 25.00 89:00 114.00 4.00% 04/2004 04/2011 L10815958EE 02/1981 EE 50 25.00 89.00 114.00 4.00% 02/2004 02/2011 L88690535EE 06/1982 EE 50 25.00 79.90 104.90 4.00% 06/2004 06/2012 L84802694EE 04/1982 EE 50 25.00 79.90 104.90 4.00% 04/2004 04/2012 L84593170EE 02/1982 EE 50 25.00 79.90 104.90 4.00% 02/2004 02/2012 L150288659EE 12/1983 EE 50 25.00 56.24 81.24 2.73% 06/2004 12/2013 L145398569EE 10/1983 EE 50 25.00 58.80 83.80 2.48% 04/2004 10/2013 L143789585EE 08/1983 EE 50 25.00 58.80 83.80 2.48% 02/2004 08/2013 L143724237EE 06/1983 EE 50 25.00 59.84 84.84 2.30% 06/2004 06/2013 LI17106989EE 04/1983 EE 50 25.00 63.46 88.46 2.51% 04/2004 04/2013 http://wwws.publicdebt.treas.gov/BC/SB CPrice 3/1/2004 Savings Bond Calculator Page 2 of 3 Ll17030432EE 02/1983 EE 50 25.00 71.22 96.22 4.00% 02/2004 02/2013 L195553717EE 12/1984 EE 50 25.00 49.60 74.60 4.00% 06/2004 12/2014 L192495383EE 10/1984 EE 50 25.00 51.60 76.60 2.88% 04/2004 10/2014 L174281515EE 08/1984 EE 50 25.00 51.60 76.60 2.88% 02/2004 08/2014 C331419638EE 10/1991 EE 100 50.00 51.64 101.64 4.00% 04/2004 10/2021 C299417846EE 06/1991 EE 100 50.00 53.68 103.68 4.00% 06/2004 06/2021 C284478170EE 02/1991 EE 100 50.00 53.68 103.68 4.00% 02/2004 02/2021 L447697170EE 12/1989 EE 50 25.00 30.02 55.02 4.00% 06/2004 12/2019 L430006776EE 10/1989 EE 50 25.00 30.02 55.02 4.00% 04/2004 10/2019 L410587494EE 08/1989 EE 50 25.00 30.02 55.02 4.00% 02/2004 08/2019 L410465411EE 06/1989 EE 50 25.00 31.12 56.12 4.00% 06/2004 06/2019 LA03347240EE 04/1989 EE 50 25.00 31.12 56.12 4.00% 04/2004 04/2019 L397544924EE 02/1989 EE 50 25.00 31.12 56.12 4.00% 02/2004 02/2019 L461237749EE 06/1990 EE 50 25.00 28.94 53.94 4.00% 06/2004 06/2020 L453076061EE 04/1990 EE 50 25.00 28.94 53.94 4.00% 04/2004 04/20213 L447812928EE 02/1990 EE 50 25.00 28.94 53.94 4.00% 02/2004 02/202(3 L174202481EE 06/1984 EE 50 25.00 52.70 77.70 2.33% 06/2004 06/2014 L159297571EE 04/1984 EE 50 25.00 55.24 80.24 2.50% 04/2004 04/2014 L159222053EE 02/1984 EE 50 25.00 55.24 80.24 2.50% 02/2004 02/2014 L280458763EE 12/1986 EE 50 25.00 37.06 62.06 4.00% 06/2004 12/2016 L280325450EE 10/1986 EE 50 25.00 43.92 68.92 4.00% 04/2004 10/2016 L269029735EE 08/1986 EE 50 25.00 43.92 68.92 4.00% 02/2004 08/2016 L268914541EE 06/1986 EE 50 25.00 45.30 70.30 4.00% 06/2004 06/2016 L265146433EE 04/1986 EE 50 25.00 45.30 70.30 4.00% 04/2004 04/2016 L265049873EE 02/1986 EE 50 25.00 45.30 70.30 4.00% 02/2004 02/2016 L397412119EE 12/1988 EE 50 25.00 32.24 57.24 4.00% 06/2004 12/2018 L377346330EE 10/1988 EE 50 25.00 32.24 57.24 4.00% 04/2004 10/2018 L377214279EE 08/1988 EE 50 25.00 32.24 57.24 4.00% 02/2004 08/2018 L359348147EE 06/1988 EE 50 25.00 33.38 58.38 4.00% 06/2004 06/2018 L359224023EE 04/1988 EE 50 25.00 33.38 58.38 4.00% 04/2004 04/2018 L349390643EE 02/1988 EE 50 25.00 33.38 58.38 4.00% 02/2004 02/2018 L336681925EE 12/1987 EE 50 25.00 34.56 59.56 4.00% 06/2004 12/2017 L336543012EE 10/1987 EE 50 25.00 34.56 59.56 4.00% 04/2004 10/2017 L324638429EE 08/1987 EE 50 25.00 34.56 59.56 4.00% 02/2004 08/2017 L324511891EE 06/1987 EE 50 25.00 35.74 60.74 4.00% 06/2004 06/2017 L293061132EE 04/1987 EE 50 25.00 36.20 61.20 2.80% 04/2004 04/2017 L292936169EE 02/1987 EE 50 25.00 36.20 61.20 2.80% 02/2004 02/2017 C386373260EE 10/1992 EE 100 50.00 45.84 95.84 6.00% 04/2004 10/2022 http ://wwws.publicdebt.treas. gov/B C/SB CPrice 3/1/2004 Savings Bond Calculator Page 3 of 3 C362454807EE 06/1992 EE 100 50.00 48.68 98.68 6.00% 06/2004 06/2022 C343415720EE 02/1992 EE 100 50.00 48.68 98.68 6.00% 02/2004 02/2022 C266187509EE 10/1990 EE 100 50.00 55.76 105.76 4.00% 04/2004 10/20213 L461333922EE 08/1990 EE 50 25.00 27.88 52.88 4.00% 02/2004 08/20213 Viewing Bonds 1-70 Note Description NI Not Issued NE Not Eligible for Payment P5 Includes 3-month interest penalty ME Matured (Exchangeable for HH) MN Matured (Not Exchangeable for HI-I) Please rate this service. (Please print and/or save this page before submitting your survey) Service Excellent Good Fair Poor Savings Bond Calculator C C C C http://wwws.publicdebt.treas .gov/BC/SBCPrice 3/1/2004 SCHEDULE E ~3OMMgNWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER Lundquist, William H. 21-2004-0055 Include the )roceeds of I~tigation and the date the proceeds w~m received by the estate. Ail property Jolnfly-~wned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Choice Financial Account #30-269 28,417.25 2 Choice Financial Certificate of Deposit #30009333 9,242.49 3 Wells Fargo Account #884-0110613 joint with Carol Lundquist 0.00 and Kelly Lundquist Value $23,391.52 FOR INFORMATIONAL PURPOSES ONLY: This account was actually a fiduciary account for the estate of Robert H. Lundquist TOTAL (Also enter on line 5, Recapitulation) 2W46AD 2000 (If more space is needed. Inser~ additional sheets of the same size) 16 O~ 03:18p Choioe Fin~nciml Wmlhallm ?01-549-3S22 p.l January 12, 2004 To Whom It May Concern: Re: William H. Lundquist Estate Date of Death 12/22/2003 The following are the accounts we held for Mr. Lundquist at the time of his death. Checking account # 30-269. This account was held in the name o£Willimn H. Lundquist and was soley owned by him. Value was 28,417.25. This was non-interest bearing. Certificate of Deposit # 30009333 titled William I-I. Lundquist Escrow Account. Value of this account was $9 214.21 with accrued interest of 528.28. We have a real estate loan # 300010989 issaed to William Lundquist, Carol Lundqui~, Omar Lundquist and Kathleen Lundquist which has a balance owing of $55,474.18 witl~ accrued interest payable of 5242.4I. We also had a safety deposit box which wag held only in his name. We do have the abstracts for the land mortgaged in our vaulr. I trust this information will be helpful to you. Very truly yours, -?--- /. .~' ~a~y A~n Sls. rdson ,.(/ . P.O. I~ox 468 · Walhalla, ND 58282-0~.68 · 701-549-3761 your hometown banking choice SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMI N ISTRATIVE COSTS Lundcluist, william H. 21-2004-0055 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Tollefson Funeral Home 6,667.38 2 Musselman Funeral Home, memorial service 553.00 3 Funeral meal 218.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 0.0 0 Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees Name.' Keefer Wood/Hodny Currie 3,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach e)~lanation) 3,500.00 Claimant Lundguist, Carol A. Street Address 832 Mandy Lane City Camp Hill State PA Zip 17011 Relationship of Claimant to Decedent Spouse 4. Probate Fees 1=;4 . 00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7. Appraisal costs estimated 1,400.00 8 The Sentinel, legal advertising 108.95 9 Register of Wills, short certificate 3.00 TOTAL (Also enter on line 9, Recapitulation) 16,104.33 2W46AG 2000 (If more space is needed, inser~ additional sheets of same size) REV-1512~EX + (1-97) SCHEDULE I ,COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RE'~JRN RESIDENTDECEDENT MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Lundquist, William H. 21-2004-0055 Include unrelmbursed medical expenses. ~TEM NUMBER DESCRIPTION AMOUNT 1. 2003 GS Income tax 3,774.00 2 2003 North Dakota income tax 160.50 3 PA income tax 298.50 4 Legal fees allocated from Robert Lundquiest estate 1,$95.00 TOTAL (Also enter on line 10. Rscapitulation) 5,82 8.0 0 2W46AH 2000 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) SCHEDULE J COMMONVVEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Lund( LiSt. William H. 21-2004-005! RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Lundquist, Carol A. Spouse 34,120.89 832 Mandy Lane Camp Hill, PA 17011 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET I1. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.0 0 2W46A11000 (If mare space is needed, insert additional sheets of the same size) OF WILLIAM H. LUNDOUIST I, WILLIAM H. LUNDQUIST, of Hampden Township, Cumberland County, Pennsylvania, do make, publish and declare this to be my Last Will and T ~* e~ament, hereby revoking all Wills and Codicils by me heretofore made. ITEM I: I direct that all inheritance and estate taxes becoming due by reason of my death, whether payable by my estate or by any recipient of any property, shall be paid by the Executor out of the residue of my estate, as an expense and cost of administration of my estate. The Executor shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. ITEM II: I direct the Executor to pay the expenses of my last illness and funeral expenses from the residue of my estate as an expense and cost of administration of my estate. ITEM III: IfI die before my wife, CAROL A. LUNDQUIST, I give to her all of my household furniture and furnishings, books, pictures, jewelry, silverware, automobiles, wearing apparel and all other articles of household or personal use or adornment and all policies of insurance thereon. IfI do not die before my wife, I may leave a written list in my safe deposit box or elsewhere disposing of certain items of my tangible personal property. The Executor shall dispose of items of my personal property as specified in the written list. If no written list is found in my safe deposit box or elsewhere and properly Page l identified by the Executor within thirty (30) days after the probate of my Will, it shall be presumed that there is no other statement or list. Any subsequent discovered list shall be ignored. If I survive my wife, I give any property of the type described in this Item and not set forth in a written list to my brothers-in-law, GERALD L. BOYD and DAVID J. BO~'D, and my parents-in-law, HELEN BOY1) and FRANKLIN BOYD, to be divided among them as they shall agree. ITEM IV: I ~ve the residue of my estate, not disposed of in the preceding portions of this Will, to my wife, CAROL A. LUNDQUIST, if she survives me. If my wife does not survive me, the residue shall be distributed as provided in ITEM V(c). If my wife disclaims any property or interest in property to which she would be entitled under the provisions of this Item, the disclaimed property shall be held by my wife, CAROL A. LUNDQUIST, as Trustee, IN TRUST, and shall be administered and distributed as provided in ITEM V. ITEM V: The following provisions shall apply to any property payable to the Trustee named in ITEM IV as a result of the disclaimer of that property by my wife: (a) The Trustee shall pay to or for the benefit of my wife, CAROL A. LUNDQUIST, all of the net income of this Trust in convenient installments, but not less frequently than annually. (b) The Trustee shall pay to my wife so much of the principal of this Trust as may be necessary in the discretion of the Trustee for the proper support, maintenance and medical care of my wife. Page 2 /z~///~ (c) Upon the death of my wife. the Trustee shall distribute the principal as follows: (i) All real property located in the State of North Dakota shall be distributed to my brothers and sisters, in equal shares. If any of my brothers or sisters is not living at the time of distribution, his or her share shall be distributed to his or her then living issue, per stirpes; (ii) TEN (10%) PERCENT of the balance to TRINITS' EVANGELICAL LUTHERAN CHURCH, 2000 Chestnut Street, Camp Hill, Pennsylvania; (iii) TEN (10%) PERCENT of the balance to INDIANA UNIVERSITY OF PENNSYLVANIA, Indiana, Pennsylvania; (iv) TEN (10%) PERCENT of the balance to NORTH DAKOTA STATE UNIVERSITY AT FARGO, Fargo, North Dakota; (v) TEN (10%) PERCENT of the balance to OAK GROVE HIGH SCHOOL, Fargo, North Dakota; (vi) FIVE (5%) PERCENT of the balance to WEST SHORE PUBLIC LIBRARY, 30 North 31't Street, Camp Hill, Pennsylvania; (vii) FIVE (5%) PERCENT of the balance to the HUMANE SOCIETY OF HARRISBURG/WEST SHORE SHELTER, Sinclair and Eppley Roads, Mechanicsburg, Pennsylvania; (viii) TEN (10%) PERCENT of the balance to MOUNTAIN LUTHEP~N CHURCH, Adams, North Dakota; (ix) TWENTY (20%) PERCENT of the balance to my brother-in-law, GEtLiLD L. BOYD. If he does not survive me, this gift shall be paid to his then living issue, per stirpes; and (x) TWENTY (20%) PERCENT of the balance to my brother-in-law, DAVID J. BOYD. If he does not survive me, this gift shall be paid to his then living issue, per stirpes. (d) Notwithstanding any other provisions in this Will, the Trustee shall have the power to sell any real property located in the State of North Dakota and the decision to make such sale shall be without liability to my brothers and sisters or their issue. It is my hope that the real estate would be sold only if necessary for the support of my wife and it is also my hope, but not my direction, that the Trustee would offer this land first to some or all of my brothers and sisters. To the extent that the real property is sold, the gift to my brothers and sisters shall lapse. Page ITEIvI VI: My wife, CAROL A. LUNDQUIST, shall have the noncumulative right to withdraw FIVE THOUSAND ($5,000) DOLLARS from the principal of the Trust established under ITEM V of this Will each calendar year during which she is entitled to receive income. If she is living on the last day of such year, she shall also have the right to withdraw an amount equal to five (5%) percent of the net market value of the principal on the last day of the year, less the amount, if any, previously withdrawn during the year. The Trustee shall make this payment within thirty (30) days of the close of the year. This right ofwithdrawal is noncumulative and may be exercised only in writing delivered to the Trustee within thirty (30) days prior to the last day of each calendar year. ITEM VII: No part of the income or principal of any Trust created by this Will shall be subject to attachment, levy- or seizure by any creditor, spouse, assignee or trustee or receiver in bankruptcy of any beneficiary prior to his or her actual receipt of income or principal distributed. The Trustee shall pay the net income and the principal to the beneficiaries specified by me, as their interests may appear, without regard to any attempted anticipation, pledging or assignment, and without regard to any claim or attempted levy, attachment, seizure or other process against the beneficiary. ITEM VIII: In addition to the powers granted at law, the Executor and the Trustee shall each possess the following powers, each of which may be exercised without court approval and in a fiduciary capacity only: (a) To retain any investments I have at my death, including specifically those consisting of stock of any bank even if I have named that bank as the Executor or Trustee. Co) To vary investments, and [o invest in bonds, stocks, notes, real estate mortgages or other securities or in other property, real or personal, without being restric[ed to so-called "legal investments", and without being limited by any statute or rule of law regarding investments by fiduciaries. (c) In order to divide the principal of a Trust or for any other purpose, including final distributions, the Executor and Trustee are authorized to divide and distribute personal property and real property, partly or wholly in kind, and to allocate specific assets among beneficiaries and Trusts so long as the total market value of each share is not affected by the division, distribution or allocation in kind. The Executor and Trustee are each authorized to make, join in and consummate partitions of lands, voluntarily or involuntarily, including giving of mutual deeds, or other obligations, with as wide powers as an individual owner in fee simple. (d) To sell either at public or private sale real and personal property severally or in conjunction with other persons, and to consummate sale(s) by deed(s) or other instrument(s) to the purchaser(s), conveying a fee simple title. No purchaser shall be obhgated to see to the application of the purchase money or to make inquiry into the validity of any sale(s). The Executor and Trustee are authorized to execute, acknowledge and deliver deeds, assignments, options or other writings as necessary or convenient to any of the power conferred upon the Executor and Trustee. (e) To mortgage real estate, and to make leases of real estate. Page To borrow money from any person, including the Executor or Trustee, [o pay indebtedness of mine or of my estam, expenses of administration or inheritance, legacy, estate and other taxes, and to assign and pledge assets of my esta[e or any Trust established by this Will. : (g) To pay all costs, teuxes, expenses and charges in connection with the administration of my estate or any Trust established under this Will. (h) To make distributions of income and of principal to the proper beneficiaries, during the administration of my estate, with or without court order, in such manner and in such amounts as the Executor deems prudent and appropriate. (i) To vote shares of stock which form a part of my estate or any Trust established under this Will, and to exercise all the powers incident to the ownership of stock. (j) To unite with other owners of property similar to property in my estate to carry out plans for the reorganization of any company whose securities form a part of my estate. (k) To disclaim any interest in property which would devolve to me or my estate by whatever means, including but not limited to the following means: as beneficiary under a will, as an appointee under the exercise of a power of appointment, as a person entitled to take by intestacy, as a donee Of an inter vivos transfer, and as a donee under a third-party beneficiary contract. Page 7 //~y~//~/ (1) To prepare, execute and file tax returns of any ~ype required by applicable law, and to make all tax elections authorized by law. (m) To employ custodians of property, investment or business advisors, accountants and attorneys as the Executor or Trustee deems appropriate, and to compensate these persons from assets of my estate or trust, without affecting the compensation to which the Executor and Trustee are entitled. (n) To divide any Trust created in this Will into two or more separate Trusts so that inclusion ratio for purposes of the generation- skipping transfer tax shall be either zero or one, in order that an election under Section 2652(a)(3) of the Internal Revenue Code may be made with respect to one of the separate Trusts, or for any other reason. (o) To allocate administrative expenses to income or to principal, as the Executor or Trustee deems appropriate. However, no allocation to income shall be made if the effect of the allocation is to cause a reduction in the amount of any estate tax marital deduction or estate tax charitable deduction. (p) To do all other acts in their judgment necessary or desirable for the proper and advantageous management, investment and distribution of the estate and Trusts established under this Will. ITEM IX: The Trustee, on an annual basis, shall provide each income beneficiary who has attained the age of eighteen (18) years, Page 8 ~/~//J/~ and the Guardian of the person of any income beneficiary who has not attained the age of eighteen (18) years, statements showing transactions each Trust established for the benefit of that beneficiary. The beneficiary, or the Guardian of the person of such beneficiary, may waive this right to receive an annual accounting. The Trustee may, at any time, settle any account, or questions concerning the administration of any Trust established under this Will, by agreement with the then current income beneficiaries of the Trust, if legally competent, or if not legally competent, with the Guardian of the person of the beneficiaw, the legally competent spouse of the beneficiary, or the oldest legally competent relative of the beneficiary who would take a portion of the estate of the beneficiary were the beneficiary to die at that time intestate under the laws of the Commonwealth of Pennsylvania. Any settlement made in accordance with this Item shall bind all persons who have an interest in the Trust, and shall constitute a release and discharge of the Trustee with respect to transactions specified in the settlement. ITEM X: The Trustee is authorized to distribute principal and/or income in any one or more of the following ways if the Trustee, in the discretion of the Trustee, considers the beneficiary unable to apply distributions to the beneficiary's own best interests, or if the beneficiary is under a legal disability: (a) Directly to the beneficiary; (b) To the legal guardian or conservator of such beneficiary; (c) To the Trustee, or to another person selected by the Trustee, as custodian under the Pennsylvania Uniform Transfers to Minors Act as to a beneficiary under the age' of twenty-one (21) years; (d) To a relative of the beneficiary, ~o be exper~c~ed by that relative for the benefit of the beneficiary: or (e) By directly applying distributions for the benefit, of the beneficiary. ITEM XI: Any person who has died within thirW (30) days of my death, or under such circumstances that the order of our deaths cannot be established by proof, shall be deemed to have predeceased me. Any person (other than myself) who has died at the same time as any beneficiaw under this Will, or in a common disaster with that beneficiary, or under such circumstances that the order of deaths cannot be established by proof, shall be deemed to have predeceased that beneficiary. ITEM XII: I appoint my wife, C~OL A- LU~QUIST, to be the Executrk, referred to in this Will as "Executor". In the event of her death, inability or refusal to serve as Executor or Trustee, I appoint GE~D L. BOYD to be the Executor, Trustee, or both. In the event both are unable or unwi~ing to serve as Executor, I appoint DA~D J. BO~ to be the Executor, Trustee, or both. The Executor and Trustee are specifically relieved from the ob~gation of filing bond or entering sec~ity. IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will and Testament, consisting of this and the preceding nine (9) pages, at the end of each page of which I have also set my iMtials for greater security and better ~dent~fication this ~ d y of ~ 20 c~ ~. WILL~ H. LUNDQ~ST We, the undersigned, hereby certi~~ tha~ the foregoing %%rill was signed, sealed, published and declared by the above-named Testator as and for his Last Will and Testament, in the presence of us, who, at his request and i~ his presence and in the presence of each other, have hereunto set our hands and seals the day and year first above written, and we certify that at the time of the execution thereof, the said Testator was of sound and disposing mind and memory. ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF (f 'J I, WILLIAM H. LUNDQUIST, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to taw, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. WILLIAM H. LUND~IST Sworn to and subscribed before me this ~ day of ~ ,20oL My Commission Expires: (SEAL) ~ NOTARIAL $~L t' CYNTHIA j. ~ RU~E, Nota~ Public Oamp H~l, Bor~., Cumberland ~ommissior, Expires J~n. 24, AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA f'~ , ,~ SS: COUNT - OF the Witnesses whose names are s~gned to the attached or fo oing instrument, being duly qualified according to taw, do depose and say that we were present and saw Testator, WILLI~ H. LUND~UIST, sign and execute the instrument as his Last Will and Testament; that Testator signed willingly and that he executed said Will as his free and voluntary act for the p~oses therein expressed; that each of us in the heahng and sight of the Testator signed the Will as Witnesses; and that to the best of our knowledge the Testator was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. Witness / ~tne~ Sworn to and subscri~ before me this ~ day of ~ ,20~L ~ Notaw Public My Commission Expires: (SE~) NO~R~AL SEA~ CYNThiA J. R~LE. Nc4arv F'ubiic Camp H~ Dcm. cumbad~d Coun~ , My ~missio~ Expires Jan. 24, 20~4 173649 Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of WiJli~m H. Lundquist No. 21-04-0055 Date of Death 12/22/03 also known as Deceased Social Security 502-54-3633 No. Carol A. Lundquist - ~ -'~- 'hat the items appearing in the following inventory include Personal Representative(s) of the above Estate, aeceasea, ver~,y ~ of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Attorney: Elyse E. Rogers Carol A. Lundquist I.D. No.: 41274 Address 415 Fallowfield Road, Suite 301 Dat~' ~p ~/~, Camp Hill, PA 17011 i, ?~ Telephone 717-612-5801 DESCRIPTION i~; ~ ?~LUE 1. Choice Financial Group #30-269 $28,417.25 2. Choice Financial Group CD #30009333 $ 9,242.49 3. US Savings Bonds, Series E $12,694.80 4. US Savings Bonds, Series EE $ 5,698.68 Total $56,053.22 (Attach Additional Sheets If Necessary) NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended/nto the total of the Inventory. ~'or~ RW-7 (Dauphin Cou~ £y) - Rev 9/92 11927_1 COMMONWEALTH OF PENNSYLVANZA ~ DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES TNHERI'TANCE TAX Dlrv'rSTON NOTICE OF ZNHERZTANCE TAX po BOX 28060~ APPRAZSEHENT, ALLONANCE OR DZSALLONANCE HARRTSBURG, PA 17118-0601 OF DEDUCTIONS AND ASSESSMENT OF TAX RE¥-1;47 EX &FP (09-n4) DATE 11-15-2004 ESTATE OF LUNDQUIST WILLIAM H DATE OF DEATH 12-21-2005 FILE NUMBER 21 04-0055 COUNTY CUMBERLAND ELYSE E ROGERS ESQ ACN 101 KEEFER ETAL 415 FALLOWFIELD RD $0 I Amoun~Remi~ed CAMP HILL PA 17011 I HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1701~ CUT ALONG THZS LINE ~ RETAZN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF LUNDGUIST WILLIAH H FZLE NO. 21 04-0055 ACN 101 DATE 11-15-2004 TAX RETURN gAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNZNG FUTURE INTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~e~a (Schedule A) (1) .00 NOTE: To insure proper 2. S~ocks end Bonds (Schedule B) (2) 18;~9~.48 cradi~ ~o your account, $. Closely Held S~ock/Par~nership Zn~eres~ (Schedule C) ($) .00 submi~ ~ha upper portion ~. Hor~gages/No~as Receivable (Schedule D) (~) .00 of ~his form ~i~h your E. Cash/Bank Deposi~s/Hisc. Personal Proper~y (Schedule E) (5) ~7~659.74 ~ax payment. 6. Jointly O~ned Propar~y (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 8. Total Asse~s (8) 56,05~.2~ APPROVED DEDUCTIONS AND EXENPTZONS: 16,104.$$ 9. Funeral Expanses/Adm. Costs/Misc. Expanses (Schedule H) (9) 10. Debts/Hot,gage Liabilities/Liens (Schedule Z) (10) 5z818.00 11. To,al Deductions (11) ~!. ~ - ~ 12. Na~ Value of Tax Re~urn (12) $4,120.89 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (15) .00 lq. Ne~ Value of Es~a~e Sub~ec~ ~o Tax (lq) ~4,~20.89 NOTE: Z~ an assess, ant ~as issued prevLously, lines 14, 15 and/or 16, 17, 18 and 19 ~ill reflect flgures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 1E. Amoun~ofLinal~a*Spousalra*e (15). $4,120.89x O0 = .00 16. Amoun~ of L/ne lq ~axable e~ Lineal/Class A ra~e (16). .00 X 045 = .00 17. Amoun~ of Line lq a~ Sibling ra~e (17) .00 X ~Z = .00 18. Amoun~ of Line 1~ taxabZe a~:Co~,~ral/CZass B ra~e (18) .00 X 15 = .00 19. Principal Tax ~a -'~.~ (19)= .00 TAX CREDITS= DATE NUHBER ~'! INTEREST/PEN PAID (-1 AHOUNT PAID ' TOTAL TAX CREDIT I .00 BALANCE OF TAX DUEl .00 INTEREST AND PEN. ,00 TOTAL DUE .00 ~ IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE ZS LESS THAN $1, NO PAYHENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE S/DE OF THIS FORM FOR ZNSTRUCT/ONS.) RESERVATION: Estates of decedents dying on or before December lZ, 198Z -- if any futura interest in the estate is transferred in possession er enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years) the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class S (collateral) rate on any such futura interest. PURPOSE OF NOTICE: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 25 of ZOOD. (7Z P.S. Section PAYHENT: Detach the top portion of this Notice and submit with your payment tn thm Register of Hills printed on the reverse side. --Make check or money order payable to: REGISTER OF NILLS, AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application far Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications are available online at maw.revenue.state.om.us, any Rag[star of Nills or Revenue District Office, or from the Department's Iq-hour answering service for forms orders: 1-800-56Z-lOS0; services for taxpayers with special hearing and/or speaking needs: 1-800-~7-50Z0 (TT only). OBJECTIONS: Any party in interest not satisfied eith the appraisment, allowance or disalloaance of deductions or assessment of tax (including discount or interest) as shown on this Notice amy object within 60 days of the date of receipt of this notice by filing one of the following: A) Protest to the PA Department of Revenue, Board of Appealed You may object by filing a protest online at awe.boardofappeals.state.pa.us on or before the expiration of the sixty-day appeal period, in order for an electronic protest to be valid) you must receive a confirmation number and processed date from the Board of Appeals website. You may also send a written protest to PA Department of Revenue) Board of Appeals P.O. Box Z810Z1, Harrisburg, PA 171Z8-1021. Petitions amy not be faxed. B)Election to have the matter determined at the audit of the account of the personal representative. ADH[N- C) Appeal to the Orphans' Court. ISTRATIVE CORRECTIONS: 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, P.O. Box Z80601, Harrisburg) PA 171Z8-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (5) calendar months after the dacedent's death, a five percent (SI) discount of the tax paid is allowed. PENALTY: The 15g 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 tiaa period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate af six (SI) percent per annum calculated at a daily rate of .O00lSq. Al1 taxes which became delinquent on and after January 1, 198Z will bear interest at a rate which mill vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 200q are: Interest Dally Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ lOX .O005qB ~-8-1991 llX .000301 ~ 9Z .0002q7 1985 162 .000q58 1992 92 .OO02q7 ZOOZ 62 .O0016q 198q iix .000301 1993-199q 7Z .000192 2005 5Z .000157 1985 152 .000556 1995-1998 92 .O00Z~7 ZOOq ~Z .000110 1986 10Z .O00Z7q 1999 7Z .O0019Z 1987 lOX .O0027~ ZOO0 7Z .O0019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY 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 sheen on the Notice, additional interest must bm calculated. Marjorie A.DeputyWeVodau First Glenda Farner Strasbaugh Register of Wills and Kirk S. Sohonage, Esq Clerk of Orphans' Court Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE I Bill To: InvoiceNo: 160 Invoice Date: l- 11-05 Elyse Rogers, Esq. Estate of: Wxlliam Lundauist 415 Fallowfield Rd Suite 301 Estate No: 21-2004-0055 vz Camp Hill, Pa 17011 Qty Fee Description Fee Total 1 Short Certificates 4.00 $4.00 Total: $4.00 Checks should be made payable to the Register of Wxtls. Terms: Net 30. Please return one copy of this invoice with your payment. Thank you. Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy KirnS. Sohonage,Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: 236 2/28/2005 WILUAM H LUNDQUIST 21-2004-0055 KEEFER, WOOD, ALAN & RAHAL 415 F ALLQWFIELD RD SUITE 102 CAMP HILL, PA 17011 JA Qty 1 Fee Description Short Certificates Fee Total 4.00 $4,00 Total: $4.00 Checks should be made payable to the Register of Wills. TertnS: Net 30. Please return one copy of this invoice with your payment. Thank you. Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 11/28/2005 LUNDQUIST CAROL A 832 MANDY LANE CAMP HILL, PA 17011 RE: Estate of LUNDQUIST WILLIAM H File Number: 2004-00055 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. I, 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: 12/22/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~F~tAJL_J REGISTER OF WI~ cc: File Counsel Judge HEATH L. ALLEN N. DAVID RAHAL CHARLES W. RUBENDALL II ROBERT L. WELDON EUGENE E. PEPINSKY, .JR. .JOHN H. ENOS m GARY E. FRENCH DONNA S. WELDON BRADFORD DORRANCE .JEFFREY S. STOKES ROBERT R. CHURCH STEPHEN L. GROSE R. SCOTT SHEARER ELYSE E. ROGERS CRAIG A. LONG YEAR .JOHN A. FEICHTEL DONALD M. LEWISlII BRIDGET M. WHITLEY ELIZABETH .J. GOLDSTEIN STEPHANIE KLEINFELTER BRADLEY A. WALKER KEEFER WOOD ALLEN & RAHAL, LLP ATTORNEYS AT LAW 415 FALLOWFIELD ROAD. SUITE 301 CAMP HILL. PA 17011-4906 ESTABLISHED IN 1878 OF COUNSEL: SAMUEL C. HARRY PHONE 717-612-5800 FAX 717-612-5805 HARRISBURG OFFICE: 210 WALNUT STREET HARRISBURG, PA 17101 EIN No. 23-0716135 www.keeferwood.com PHONE 717-255-8000 November 28, 2005 717-612-5808 cswindler@keeferwood.com Cumberland County Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 Re: Dear Sir/Madam: .n l'-..:l -r:.l (~I Cfl -:<:"1 ;'" ~ ~=-'-J . ) (-:-~) ,.-") ....~ , ~ ~..,tl-_" .'.; \~~ Ie;; ~ --"-j : L=S IT: o Estate of William H. Lundquist 2004-00055 ~ . ) N W Enclosed for filing is a Status Report pertaining to the above estate. It would be greatly appreciated if you would time stamp the copy and return it to me in the enclosed envelope. Thank you. If you have any questions, please feel free to call me. /cds 91194 Enclosure Sincerely yours, Xk~~ bJe~. Swindler, Legal Assistant to Elyse E. Rogers STATUS REPORT UNDER RULE 6.12 Name of Decedent: William H. Lundquist Date of Death: December 22, 2003 Will No. Admin. No. 21-04-0055 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 X 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: December 2006 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 _ No_ d. 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. Date: / I /' d 8 -c'1 ( ~~ 2: ~) Signature Elyse E. Rogers, Esquire Name (Please type or print) ("") "J 415 Fallowfield Road, Suite 301 Address Camp Hill, PA 17011 t'<~:.",:, ,::::> C'"J (717) 612-5801 Telephone Capad~: _ ~~rsonal Representative '- "'-_n) { :. (,~--j i...---": X Counsel for Personal Representative 136187 1 ~~. Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 11/15/2005 ROGERS ELYSE E 415 FALLOWFIELD ROAD SUITE 102 CAMP HILL, PA 17011-4906 RE: Estate of LUNDQUIST WILLIAM H File Number: 2004-00055 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. 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: 12/22/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, //~ ,V .~ ,~<L f,,]~~ /, GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge STATUS REPORT UNDER RULE 6.12 Name of Decedent: William H. Lundquist Date of Death: December 22. 2003 Will No. Admin. No. 21-04-0055 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 X 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: June 2007 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 _ No_ d. 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. r;;,? Date: I /~ I - oeo Signaturi J.p f ^-"c!5'-> Elyse E. Rogers. Esquire NatTIe (Please type orprint) 415 Fallowfield Road. Suite 301 Address Camp Hill. PA 17011 (717) 612-5801 Telephone Btag4L~ty:2 - AG~~nal Representative X Counsel for Personal Representative , , _~ '~.1 I,. jJIJ~O U]CiG~OJb 13 6187 1 1 CH...RLES W. RUBEND"'LL II ROBERT L. WELDON EUGENE E. PEPINSKY, .JR. .JOHN H. ENOS m G"'RY E. FRENCH DONN'" S. WELDON BR"'DFORD DORR"'NCE .JEFFREY S. STOKES ROBERT R. CHURCH STEPHEN L. GROSE R. SCOTT SHE"'RER ELYSE E. ROGERS CR...IG .... LONGYE"'R .JOHN .... FEICHTEL DON"'LD M. LEWIS:m: STEPH...NIE KLEINFELTER ERIC R. ...UGUSTINE TODD F. TRUNTZ C"'ROL L VERISH KEEFER WOOD ALLEN & RAHAL, LLP ATTORNEYS AT LAW 415 FALLOWFIELD ROAD. SUITE 301 CAMP HILL. PA 17011-4906 EST...BLISHED IN 1878 OF COUNSEL: HE"'TH L. "'LLEN N. D...VID R"'H"'L S"'MUEL C. H"'RRY PHONE 717-612-5800 FAX 717-612-5805 EI N No. 23-0716135 www.keeferwood.com H...RRISBURG OFFICE: 210 W"'LNUT STREET H...RRISBURG, P'" 17101 October 31, 2006 PHONE 717-2!5!5-8000 717-612-5808 cswindler@keeferwood.com Cumberland County Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 Re: Estate of William H. Lundquist 2004-00055 Dear Sir/Madam: Enclosed for filing is a Status Report pertaining to the above estate. It would be greatly appreciated if you would time stamp the copy and return it to me in the enclosed envelope. Thank you. If you have any questions, please feel free to call me. /cds 91194 Enclosure Sincerely yours, e D. Swindler, 1 Assistant to Elyse E. Rogers r---.J c-:> ~ 0"" ":r CS ..-::-C I N ~ E~ -C1 i_ d ~~~~ C) ""1'. or' ;c-'') 0-\ -0 -A"'" !)? W 0) Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Name of Decedent: William H. Lundquist Date of Death: December 22, 2003 File Number: 2004-00055 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: . . . . . . . . . . . . . . . . . . .. 0 Yes III No 2. lfthe answer is No, state when the personal representative reasonably believes that the administration will be complete: December 31, 2008 3. lfthe answer to No.1 is YES, state the following: a. Did the personal representative file a final account with the Court? . . . . . .. 0 Yes 0 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? ............................... 0 Yes 0 No d. 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. Date November 15,2007 Capacity: Elyse E. Rogers Name of Person Filing this Form Vel "08 QNVlf:j38~nO llinO~ S,N\fH&IO :to >18310 Keefer Wood Allen & Rahal, LLP Address 9S :ZI Wd 91 ADN IOOZ 635 N. 12th St., Ste. 400, Lemoyne, PA 17043 717-612-5801 Telephone ~j~ 11[ \~\ .Hi ~ r=f f ~.~():~~ ) j,I~. _......, .:1,"'.;...>-,),\...._....... jO 38l::l30 G3GtJOJ3b Form RW-10 rev. 10.13.06 ~ Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Narne of Decedent: William H. Lundquist Date of Death: December 22, 2003 File Number: 2004-00055 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 ®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? ............................... ®Yes ~ No d. 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 th~eport. oate December 6, 2008 it. 1, t o;_ .~ .f ~ .. _ ~_ ;~, .;'. ~;:~~ ,J ~~ ~G~ ~~ ~ ~ ~.~~ ~~~iZ farm RW IQ~ ret_. IQ 1~3-06 ° ; i /" ~ Signature of Per on Filing this Form ,.\~ Capacity: Personal Representative ®Counsel Elyse E. Rogers, Esquire Name of Person Filing this Form Keefer Wood Allen & Rahal, LLP Address 635 N. 12th St., Ste. 400, Lemoyne, PA 17043 717-612-5801 Telephone 1;1;~~. ? ~^r^ S:FSFh1 PEARS^hd °Y ~HRISTEhdSEhJ hd7•""LF, F .. ~ EXHIBIT 3 .• ESTATE OF WILLIA1VZ kI. LUNDQUISZ', deceased IN ~'YiE COURT OF COMMON PL)JAS OF CUMBERLAND COUNTY, PENNSYL'V'ANIA ORPT~ANS' COURT DIVISION N0.21-04-55 WITI<IDRAWAL OF NOTICE OF CLAYIVY PREVIOUSLY FILED PURSUANT TQ 2Q PA C.S.A. § 3832 To: The Clerk of the Orphans' Court Please withdraw the Claim of Oscar Lundquist and Tim Lundquist which was filed July 23, 2004, against the above titled estate_ Date: ~ ~ / Z- -~ ©_ `p ~ ~ n ~ _J Cl ~ ''~ 'SJ ~~ ~ f ~ -'~'1 .w.- -~ ..~~'\ 2009-03-09 15;50 1 701 352 3405 A ~ .i C ~ -_ • } i _ _. ~ Page 9113 ~~ /' , ,~ ~__ OSCAR. LUNDQUiST 1;1cr. ~ ~r~" ~:~~Pt,1 FEAFS~PI ~ ~HFISTEhl~Ehl STATE OF COUNTY OF w~~l~ Pl ~ ^~~~ F. 10 On this, the ti ~ day of /~.°~ , 20 d't ,before me the undersigned officer, personally appearedRJSCAR LUNDQU'IST, known to me to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purpose:; therein contained.. Yn witness whereof, I hereunto set my hand and seal.. STATE Ok' couNTY of ~N ~°""`~~ ,~ '/ ~- otary Public On this, the 1 ~- day of , 20 C~ ,before me the undersigned officer, personally appeared TIM LUNDQUIST, known to me to be the person whose name is subscribed to the within instrument, tend acl~nowledged that he executed the same for the purposes therein contained. In witness whereof, I hereunto set my hand and seal. RITA J. ANDERSON NOTARY PUBLIC -MINNESOTA MY COMMISSION EXPIRESJAN.31, 2010 Notary Public 2009-03-09 15:51 1 701 352 3405 Page 10/13