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HomeMy WebLinkAbout12-30-09~. 15D56D41169 REV-1500 EX (os-05) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po Box2sosot INHERITANCE TAX RETURN /~ Harrisburg, PA 17128-0601 RESIDENT DECEDENT of ~ aq ~~~ ~ . ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 171-26-6404 02282009 10161930 Deoedent's Last Name TESNO Suffix Decedent's First Name HELEN (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number FILL INAPPROPRIATE BOXES BELOW ® 1. Original Return Spouse's First Name MI J• ~. MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return 3. Remainder Return (date of death 4. Limited Estate prior to 12-13-82) 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) a 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTWL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number RYAN R. GAGER Firm Name (If Applicable) SAUL EWING LLP REGIST~t OF WILLS ~ ONLY ,., .arm First line of address ~ -; i -~ - C7 c~"~ 2 NORTH SECOND STREET g_ i --' ~~ ~--- - Second line of address _ ~ :.;',~' !~~ ~-- ~ - -~, 7TH FLOOR _. ;^ ~.. _~ --i~~ :` -_.' ,' City or Post Office ~ •• ~ - - r ~ , , FILED ' ;,:r _~ State ZIP Code ~- HARRISBURG PA 17101 ~ Correspondent's a-mail address: RGAGER@SAUL . COM Under penalties of pery'ury, I deGare that I have examined this return, inGuding acxompanying schedules and statemenffi, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS 170 FAIRWAY DRIVE, ETTERS, PA 17319 SIG RE OF PREPARER HER THAN REPRESENTATIVE ~~ DATE ADDR I z j ~ CJ 2 RTH SECOND ST., 7TH FLOOR, HARRISBURG, PA 17101 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041169 15056041169 J J 15056041169 REV-1500 EX (o6_os) . PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year .' File Number Po box 2sosol INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth ~ . 171-26-6404 02282009 10161930 ~ . Decedent's Last Name Suffix Decedent's First Name ~ ' MI TESNO HELEN J. (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name ~ `, Suffix Spouse s First Name ' MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ' REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW . ® 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death ^ 4. Limited Estate prior to 12-13-82) ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required 6 Deced t Di d T death after 12-12-82) - . en e estate (Attach Copy of Wilq ~ 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCEAND CONFIDENTWL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number RYAN R. GAGER Firm Name (If Applicable) SAUL EWING LLP First line of address 2 NORTH SECOND STREET Second line of address 7TH FLOOR City or Post Office State ZIP Code HARRISBURG PA 17101 Correspondent's a-mail address: RGAGER@SAUL . COM REGISTER OF WILLS USt~ANLY :.- _ - . ~. ~ r ,,,_;..~ .;I. C~ ~ ,.. C5 y -_ .`jr ...J- ~ -~ '^~ ~~_ :; ;:t T'EiFILED ~f? C? -a Under penalties of perjury, I deGare that I have examined this return, inGuding acxompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. DeGaration of preparer other than the personal representative is based on all information of which S RE OF PERSON RESPONSIBLE FOR FILING RETURN preparer has any knowledge. DATE A RESS 7 ` d 170 FAIRWAY DRIVE, ETTERS, PA 17319 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS 2 NORTH SECOND ST., 7TH FLOOR, HARRISBURG, PA 17101 PLEASE USE ORIGINAL FORM ONLY Side 1 15056041169 15056041169 J J 15056042160 REV 1500 EX Decedent's Social Security Number decedent's Name: HELEN J TESNO 171- 2 6- 6 4 0 4 RECAPITULATION 1. Real estate (Schedule A) ............................................. 1. 14 9 , 9 0 0 . 0 0 2. Stocks and Bonds (Schedule B) ........................................ 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ............................. 4. 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ........ 5. 3 9 , 3 7 2 .4 2 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ...... . 6. 7. Inter-vvos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ...... . 7. 3 0 , 6 4 3 .4 2 8. Total Gross Assets (total Lines 1 - 7) ................................... 8. 219 , 915.8 4 9. Funeral Expenses 8 Administrative Costs (Schedule H) .................... . 9. 12 9 , 5 3 7 .2 2 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule t) ............... 10. 3 , 9 51.9 0 11. Total Deductions (total Lines 9 & 10) .................................. 11. 13 3 , 4 8 9.12 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 8 6 , 4 2 6 . 7 2 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. 8 6 , 4 2 6. 7 2 TAX COMPUTATION - SEE fNSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 15. 16. Amount of Line 14 taxable at lineal rate x .0 16 17. Amount of Line 14 taxable at sibling rate x .12 17 18. Amount of Line 14 taxable at collateral rate x .15 8 6, 4 2 6. 7 2 18 19. TAX DUE ........................................................ 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056042160 12,964.01 12,964.01 15056042160 J REV-1502 EX+ (11-08) ~ pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT e~ i a i e vF FILE NUMBER Helen J. Tesno 21-09-0245 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real arooertv that Is inintw-ewna~l with rinht .,~ ~.....:...,...~:_ _.._L ~_ ..,__.___, _ _ . .. _ .~ ~~~~~c ~Na~c ~a ncwcu, uiser~ aaaitionai sneers or Uie same size. REV 1508 EX+ (6-98j COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Helen J. Tesno SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21-09-0245 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION ~ VALUEAT DATE OF DEATH 1 • Net Residue from Edith Tesno s Estate (exc u~es rea estate ) 9, 827.94 2. Wachovia credit card adjustment 76.70 3. Liberty Mutual - Insurance proceeds paid as 5,055.14 contract no. 810650 4. Wachovia - checking account #1010188153761 14,229.04 5. Cable Refund ~ 2.68 6. Insurance Refund 69.30 7. 1996 Toyota Camry LE VIN 4T1BG12KXTU942056 1,775.00 8 M&T Bank - checking account #85228052 3 349:76 9. AARP Refund .38.98 10 Genworth contract no. 3846985 4,947.88 TOTAL (Also enter on line 5, Recapitulation] I $ 3 9 , 3 7 2 .4 2 (If more space is needed, insert additional sheets of the same size) REV 1510 EX+ (6-98) SCHEDULE G COMMONWEALTH OF PENNSYLVANIA INTER-ViVOS TRANSFERS & INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Helen J. Tesno 21-09-0245 ' This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ' DESCRIPTION OF PROPERTY ITEM NUMBER INCLUDE THE WIME OF THE TRANSFEREE, THEE RELATIONSH~ TO OECEDENTAND DATE OF DEATH °~ OF DECD'S EXCLUSION TAXABLE THE DATE OF TRANSFER ATTACHACOPY OF THE DEED FOR REAL ESTATE. VALUE OFASSET INTEREST (IF AQPLICABLE) VALUE 1. John Hancock Annuity-Payable to Estate 11, 014.17 100$ 11, 014.17 2 . Jackson National Annuity No . 081.0660 19, 629.25 100$ 19, 629.25 Payable to Joann Miller 0810660 TOTAL (Also enter on line 7, Recapitulation) I S 3 0, 6 4 3 .4 2 (If more space is needed, insert additional sheets of the same size) REV 1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Helen J. Tesno FILE NUMBER 21-09-0245 Debts of decedent must be reported on Schedule [. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~~ Myers Harner Funeral Home 8,562.00 2. Sauser Monument & Memorial Co. 1,172.00 B. ADMINISTRATIVE COSTS: 1. Personal Representatnre's Commissions Name of Personal Representative(s) JO a ri ri M i 11 e r StreetAddress 170 Fairway Drive city E t t e r s State PA zIP 17 319 Year(s) Commission Paid: 2 0 0 9 2. Attorney Fees 3. Famiy Exemption: (If decedent's address is not the same as daimant's, attach explanation) Claimant StreetAddress Ctty State ZIP Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Net expenses from sale of real :estate (see attached) 8. Advertise Grant of Letters 9. Fed Ex 10. PPL-Final 11. PA Water-Final 12. See Attachment 9,383.25 12,000.00 306.00 92,815:96 166.30 8.67 32.60 28.47 5,061.97 TOTAL (Also enter on line 9, Recapitulation) $ 12 9 , 5 3 7.2 2 (If more space is needed, insert additional sheets of the same size) HELEN J. TESNO SCHEDULE H ATTACHMENT 153851.1 12/10/09 REV-1512 EX+ (12-08) ~ enns lvania SCHEDULE I p y DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Helen J. Tesno 21-09-0245 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH i. M&T checking acct.-outstanding checks issued 535.08 prior to death 2. Pinnacle Health 3. Tom Muranick-lawn service 4. Wachovia-March mortgage payments 5. Hampden Twp.-sewer-trash 6. PPL 7. UGI 8. Nationwide Insurance-Homeowners 9. Heritage Medical Group 10. Pinnacle Health 11. PA Water 12. American Home Medical Equipment 13. Vascular Associates 14. Real Estate Taxes-county/township 15. Comcast 16 . Verizon 17. PA Dept. of Revenue-2008 Tax Liability 39.42 350.00 678.40 80.53 133.23 396.04 360.00 195.10 585.00 174:55 39.95 6.11 291.39 13.75 40.35 33.00 TOTAL (Also enter on Line 10, Recapitulation) I ; 3 , 9 51.9 0 If mare space is needed, insert additional sheets of the same size. REV-1513 EX+ (11-08) ~ pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF Helen J. Tesno FILE NUMBER 21-09-0245 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. Harold Tesno Jr. Nephew 16.67 86 Blue Ridge Dr. Levittown, PA _19057 2. Linda Hochtman Niece 16.67 8590 New Falls Rd., Apt. J10 Levittown, PA 19054 3. Andrea Clise Niece 16.67$ 1416 Washington Road Westminster, MD 21157 4. William Tesno Nephew 16.67 31630 Trails.Park ~ ~ - Conroe, TX 77385 5. Lorraine Miller Niece 16.67 170 Fairway Drive Etters, PA 17319 6. . Doris McElhenie ~ Niece 16.67$ 454 Elder Trail New Cumberland, PA 17070 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE. II NON TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is .needed, insert additional sheets of the same size. ~' W"t+~~-+~~ii L,i~i~iii y ~vf S~~~~er B^^~n~ B~aare Mechaniesb~~~ ~~T'Q.~.riT Tii i~i~~T~ ~~''`..'~.~i~.~~.h~i.'~`iu~sti} K PMUUNT ~~4,~~9.u4 vu~i~i {'~~ l~.t.aitJll {{r;C:~ 1} illi~l~Ifl '~' T -^ it ~1~~~ ~~it11 U~ ~ ~-~ r~ ~ ~~ 1 r ~ fro ~r.~ycif Gf~'~r~ii LL rl,,-.11}^~ Tl~~~~.Itt~l ("' V J l L L 1 L 1 ~l lh.i L-` i 'J U: 1 ~.y.! V J Thant; Yaa Far Yaar Bali; tens Ada; ha~,~~ a ice"'"~" ~ ~~ 58j446 (100/pkg Rev 01) ~ ~~~" m d * ~~ i 3 d 7 'T1 Q~ ~ _ O 3 ~ `, o x M 3 ~ m ~ W m O ~ tT1 hO`I ~ ` ~ -f, ~ z ~' ~ '~ - D =~ rn r D y -I Out o fl ~. _ rv c* _ O f1 o O ~ iL m ru o = c o ~ ~ - o, o cn ~ ~ ~ ~ ~ --1 fP D 3 -n N ~rr, < ~ ~,,,,, O -i N S .O F-•' ~ F-' ~D ~ m ~ a o o-~ w i ~D 1 ~D '~ ~ 2 ~ ~ c n ~ .. z a -•i ^~ a ~ ~ ~` ~ ~ N•cn -1~`` ~.. 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YFiF ~~. ~~EFM1~ T"~ µ : Y ' . e ~ ~ V "`~ ~ '" F r ~ ` . ' . {~ i ~ ~1Y J ~ ~ ~' ~~ ~ ~ t ~~ y V. ' M S < QF ~ f ~ / •~ '• nr +. Y 1 ~~~ k ~ b ~ ° ~ Z w r . 1~ ^ 1 . !fw/ fy Mn F~ 11 f i ~ ~ T J r ..4yi 33 sF i ~ f ,~4. .-.J~tn y.~..ys. tip" f Fs.."n 4. ::.'' X ~~'~rchcn~ia Carl Si~n•icc:s. N..'1. Charlattr, NC: 252;(">. ~~6? June I S, ?009 ~::~;r r Estate Ofi Edith M Tesno 454 Elder Trl New Cumberland, PA 1707f}-100 w~,cxovrA Re: Credit Card account number ending; in 85U4 near Estate Of Edit1~ M "T'esno. Attached below is a check in the amount of~~b,"70, which adjusts your account that had. a credit balance. l f' you have any questions about this adjustment, please call. 1-8b~~2U I -57U2 {E~n~lish or Espanol), ~4 hours a day, 7 days a Lveek and one of our Customer Service .Assc~eiates aril be happy to assist you. Sincerely, ,Iim Capuano Senior Vice President Wacho~va __ .............. PLEASE lvt ,~ CBRREFEXA01!! k ~~ ~ x " W ~ ~ .~ x ~ ~~~ ~~ ~ ~ ~ a.M , ' ,, ~ ~ ~e s ..,. :r Cit ~ r ~ '~! a .~ -ate r~ "„b.~ - aa.. k.. `1"~ 1 :.:~;~ L c f.. C3 *~ C r: ;~s t'C~ Y.7 7 ,s . Rte r "!"~ y F-^i r • l t~ 4f ~~i ..,..1 ,~' Q f i 4.K, L, k._ ~ ;~ t"~ ,~ ~ f7~ f t ~' C.v ZI.* ~d~. t... ~ ..y . ~.~ , ~x ~:: {~ z...3~ f+'y C11 Y i.L l s l i ~ ~ ..., ~. „Y'; ~; LJ't 2 ;~ `~ ~ ,F .-~ ~ td ;.~, ~ m s;~,.. ~ as ..,,,~ ~ ~ ~' ~ ~ ~ ~ ~ ~~ ~ ~, ` ~ ;-~: 'Q }< ~ CCU ~ ~ ~;,.~ iya: ~~ z ~ ~'~ ~~ ~~ ~~ £ F L SQL ~~ _, ~V • ~ r ~,,';~~ ;~.~',:~ •~ '•., - . , . t c': FEE~SIMPLE DEED--Typewrites . ~~ ~ ~~ ~~~ ~~~ C~~~e Q t day of k ~ y iw the year o f oar Lord Oxe Thousand Nine Hundred and seventy (1970) ~,pt~tppn WILLIAM H. NELSON and LcrPTIE 'M. NELdON, his wife, of the City of Harrisburg, County of Dauphin sad State of Pennsylvania, parties of the firBt part A N D EDITH M. TESNO and HELEN J. TESNO, Sisters, of the City of Harris- burg, County of Dauphin and State of ,Pennsylvania, as joint.teaants with right of survivorq~ip t-and not tenants in common _...._ _..._.. °f !~: second !M'~ _~~~~~~#~ That the laid parties of the firs! part, for and in considerat~ow of the sum of Nineteen Thousand, Nine Hundred ($19,900.00)x«---------_~_______~_ bollars, ta~mful mone~r of the Ignited States of dmerica, smell and trrl' paid by the.ssid part of the ssoo~d part to the said part ies-f the first part, at and before the sealing asd delivsrp of these presenls, the reotip; tanhereof is hereby aekno~annledged, have ~-ranted, ~8~~• sold, aliened, enfeoffed, released, con~ve~red, and aonfirtued and by thus presests do gran!, bsrgaix, eels; alien, sufsof f, release, cottt~ey, and confirm unto the said part of the second part hors and assepns,~ as joint tenants with right of survivorship and tenants in commmon. ~~~ that certain lot or .piece of land situate in the Township of Hampden, County of Cumberland and State of.Peansylvaaia, more particularly bounded and described as follows, to wit:- BEGINNING at a point on the northern side of Robert Drive which point is at the division line of Lots Nos. 150 Bad 151 on thQ hereinafter mentioned plan of lots; thence north 27 degrees 54 minutes east along said division line one hundred eleven and forty-five hundredth (111.45) feet to a point at the division line of Lots Nos. 134 and 151 on said plan; thence south 60 degrees 32 minutes east along said divisionline and beyond a distance of seventy-five and three hundredth (75.03) feet to a point at the division line of Lots Nos. 151 and 152 on said ----~p~ , a~south 27 .degrees 54 minutes west along said division line a distance of one hundred nine and forty hundredth (109.40) feet to a point on the northern side of Robert Drive; thence north b2 degrees 06 minutes .west along said Robert Drive a distance of seventy-five (75) feet to a point, the PLACE OF BEGINNING. IT BEING Lot No. 151 on Plan of Noll Acres which plan is recorded in Plan Book 10, page 17, .Cumberland County Recozds. ~~~ ~~~~~ ~ ~o~~ ~ ~ ~ ,~ ~,` ~ .. .; ,< ,. ~~~~~ ~ ~ ~~. ~:.., ;. F~, ,~ .: ,. a ~. ~~~ .' r. ~~ ,~~ . ... , .` ", ~ .. s R .... r . r :? ~ ~. ~. ~, ~,: ~ .___~._, ~s° _ ,tea .~~t - . '~ A. ~ettierne~~ ~tat~ez~t s. U.S. t3epa,rtment of t-bctstng a~ tJs ban a~n,ertt [ulr2 x...........1 iY~ n~nn n.vsr ,___,_._ -_ ••.~w, r.v. ~.w~.-vow a+~ rcra ~ t~ralWGtJt-5i i. ~IFMA 2 flFmHA 3. ^Conv. tlrans. 6. Fie t+l~rtber 7 Loan t+tumtier 8. Mortgage>hlsurartce Case Number ~. VA 5. Conn tns. 09-1638tVM D472~21 441=82~&3~8~7D~ C_ Note: I~r~s --~ack~d ~tpo c,~'rw~ne valet or~de ~h.. ,they:ar+tr stwwn t~,tp~ tr~dor- aurgwes atwa ar« na traexMea In tnr tok+Is. 7~ieEXpt~S Se{f~m6tlt Sy~tBm wARNWQ; a ie a crkrNt tar krwwtigty nwt~arr ~Is.~~ i~~Ns #s rw thud s t~ 1!~ u~ ter r:W+Ma- wnn: Fsrt upon convtwon ran. irciude a ttne end. Foc ael~s tit1~`Ttlte 1t3 t1. s. Coda Sectiort~i~Ot and Ser~Foei tot0. Prrtrttt$d {38113!2009 8t 14:49 DB ' D. NAME OF BURROWER; ~egory M, Kahn ADDRESS: E. NAME OF SELLER: Helen J. Tesno, Estate ADD ,~ SS __ ~. NAME OF !.ENDER: ti~t~:C~e HcrM~~tb8n~' a b~v .ian of Meti.l~e Eat-k, N.A. ADDRESS: 681 Ares t3riv ice 4 Pitt bur. PA 15 G. PROPERTY ADDRESS: 611 Rti'b+er~~t3~tvel~ni~a~bt~r~, PA i7( He»t en H. SETTLEMENT AGENT: North ~toc~tettn Setttamlent Slenric~es,, L.P., Telephone: 717;64-3140 Fax: T'17-~4-~'t PLACE Of S E TR.EMEHT: 12~ North'M~wnt~in Road Hsrrfsbur PA 17112 ~'`~ }' ' !. SETTLEiIII~./~ 1 ~ ,~ R Y l.~t' RA A 1t~. GRQ5~5 AMOUN'~ DUE`FAQM B~3RRflwER • 4 t ~1: GgC~SS AMC~UN'' DUtM Tfl ~~LL~A 1~~. ~ 19.7`aV~/ y ~ 401. .Contra~ctsales i~~~LiV•~ 1 P ~ 402.. P P a~ ,_, 103. Seftie J ~~ t 04. - 404, 105. _ Alt us~'iertts for isms seller to aitfiranre t~nts;f~rr ttt ~etG~r ~ a '107. Coup taxes tM/14169 ta1?l31i~9 114.t~ 407: Ctx~ri taixes tt~ to 1 1" 114 ~5i 108, school taxes t83l1#o~Yt© 888.10: . _408. Sdwbl t~wces 08t1+f~t)61~301ffl . 888,1fl 109. Se r C~I14`to0.9i~VQ9 ~ 409. Sewer t1~pg~. 7-2, t10. ..410. ifi. 411. 112. 4"12. '120. GROSS:AMOt1NT DUE FROM t~flRR~}wER 163 5x5.9) 4~? GR{?SS AMt#UNT ~IIE 'i`~3 ELLEN- 15ti 974 48 2{m. AMQ~tNTS PAIL? BY t?A flN BEHALF flt!'BQR R~DwER . 5tt6. REi?UCTlat+iS tN'AMQt1t~'i' ~~E TQ SELLER 201. De ' nr eamast mans 1'Oilt?.t~ 501. Excess Q~e sae.:...... 202. Princi amamt nt Herr loans 1471.84.06 502. 58ttlemerl~ to aver Itee 1400 17389.81 203. Exist! than s taken sub act t+~ 503. EaClst Iran s tam to 204. Pa : ~ 7572.27 waehv~ Bank NA 205. 206. 505. . 207. 5a~. 208. 209. A{i tlstli~18ntS SOP tl~@n18 UR atdb serer Ad us#ments fnr iietns urn ald b salter 213. Seller CresBt Tax Prnration$ 928.36 513. er: t Tax Prorattnns 928 36 214. 514. . 215. 515. 216. 516. 217. 5i7~ 218. 518, 219. 51 S. 22Q. Tt~TAL PAifi3 EY/f-tiR BaRROwER 14~ 1~23fi a2~.'T©TAL REt7~L~tpN AMt~U~IT ~~fE SELLER 93 89!1 44 340. CASH AT SETTLEMENT FRAM t3R 1'Q Bt~RROwER ... , 60Q. CASH AT SETTLEMENT T£f QR'~ROM SfLR 301. Gross amount due tram bnrrawer (tne i 20 153505,91 601. Qross amt due to setter one d20 16Q 974 48 302. Less amounts id b /for batrower tine 220 149112,36 602. Less redtrcttott amouryt tie setter ttrte 520 . 93 89t?,44 303. CASH FRflM 80RR41NER 4 393,55 ~3. CASH TC~ SELLER 57,084,04 SVEiSTRU7E FORM 1t3H9 SELLER S'tA'lEMENT: 'the ktfaret~ation conte~nttd tuxepr is irr+parlant tent tn[arrrratlon arkf i3 bainp mad to the kstarnat Rewerrw 5ervtce.. N ars a n snce 3>.nakY or ott-sr aar~t-on rrNt Oa Impo~sad on you N Utta ilern is nquirss! to be «rparted and ttw IRS detenr-bres-that a !tae rwt been r Yn++ required to cite a reYun, iirHa 0 atwve constitutes the t3rtiss proceeds d ihts transaction. ~ Ttse Contract Sates price desaibed on You are required by Ilwr to providt the tatdemttnl spent ed. Tax tp No; ) riith your txxred tair~ryer identdiCa~n rWrMber. N you do nwt vwie r correct kp number, you may be subject to cfvd ar pimina- Derrantes by taw. der pana~e "s o"7~~srJury~ l !~ y~ xpa-Yat' ktaaliNcat~in tutlly U1at ttse rrtrrr>l~r sttows- on >MS statement is my oerrwel rfCYrm.,.r ie~.,dtA..sw..........w~.. T1N: SELt.ER(S) NEW trV1~.iN(3 AOF#tESS: SELIER(3) pi3pNE N1IMBERS: ------ ~--....~..._._ ......._,,.,.,, SELLER{S) StCyNATl1Ri=(S U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT FIIe Number. ~-~1 ti38Hl~ PAGE 2 t.'t~TTI Rt1i1~11fT RTA'Tt~IIAFIttT Tit~eC;r,s'ner CetNaenant Cvc~orn Printaci 11R/1_'i~rl~Q of id~:dA t~R L. ~iETTtENT CI~ARGES ~__~ _ PA;tf3,FROM PAID FROM 704. TOTAL. SAL.ES/BRt}NCER'S CAMMiSStC3N t~tsed on S14 't~00.00 = 91139.00 t30RROt1Sfi=R'S SELLER'S DIVi8fotl of ~ 700 axa lo~nNS: FUNDS AT FUNDS AT 701. 4 717.1x? to Pfudentlal Homeaale Senrl~ee Grou SETTLEMENT SETTLEMENT 702 4 x72.00 to Remt~c ~ Prolormis 703. Cmm~u at Sett~ment 9189.00 704. Prot Fee to Remax Rfoiession~l~ 175.00 800. ITEMS PAYABLE IN GQNNEtTIflN WITH L4tt<~1 801. town 0 ,.. ~~ ~ 802 Limn Di < 96 _ 843. sal Fee to fl U[sh L~ 350.00 804. tredit to Tot~1 ~dtt Sr~rv~ce 1»A 2G.35 805. nder'a t=ee $O6. Gourter to MBtl.lt'e i~~rt l~ariS LR 25.00 807. Unc~rwritt Fee to MBt~...118 Home Loans L.R 250.0 . Tex Sen~ice Fea to Tcta1 M>:. Sohttlona CR 90,00 849. Wire Fee to l~etLlfe Nott<ta Laatts LR 3~r.W 814. Flood Oet Bon to Fetfetaf Flood- LR: .00 811 F to etLlte Home Laana l 250:00 900, ITEMS REaUtRED 8Y LENG~R TtJ Bl: ~+AIC~ IM=Ab1tAl'l~E 941. Intermit From 08~14l2009 '~r OS~t?f1 _ 21.1T~'1 18 „R 3~:0$ 2. t prernlurr~ for to ~lUl~ L.R 31.3 943. Haxard tnsu i~nerr~um for to Suite Auto ~d t~l 488.00 904. 905. 1000. RESERVES t~E1~15lTEC? ~ LENDER- l=~R t 001 . Ha Insu 3 rrro. 4{I.6? Imo l.A 122.01 1402. Mort fn~rarwe mo . C~. Irr~ 1003. Ci P Tax rno. ~ frrxa 1404, un Pr Tax T mo. ~ 2~.~'8 Imv LR 173.46 1445. Scholl taxes 3 tno. ~ 5"1`.30 t l~ 261.90 1009, ate. Anal. s A " meet to Metl.tte Hama tans - L~ Oaf .99.15 1100. TITLE ~HAR~F.S 1101. Settlement or _ fae 1102. Abs search 1.103. Tlge examination 1144. Title irtsutsnc~g binder. 1105. Document Pre 'on o William>plnltel Es ~it'e 115,00 1100. Nota -Fees to ~eborah'K. Bolan ~ 45.00 1147. Atiome s tees includes above items Np: t 148. Title Insurance to Nof~l1 Mountain Settt~mant Sefvlct~ t.P. 987.88 lnctudes above Items No: 1101.1104 Relsstie Rate Helan J. Teuw; testate • r WARNINQ IT iS A CRIME TO IWO1NtN61.Y MAKE F11LSE STA'I'i~i'T$ 7K3 T1~ TIr HtlG.1'SstgilltkerN StetemsrN which 1 htnnlt' It a tn~ and. aodxste aCYOiMN et thts lltilTED BTATEB ON THIS OR ANY SII~AR Fgl~1.'P~.T~S UP'C~N ~lVIC1'lpN ~: I have cattsttd ~ catue thr _ bt ~abwa+ad k~ p wilh tNs sbtarr~-t. CAN NVCLUOE A FINE ANb ihMRiSOi,IMENT: qR tiETJt~ SEE TITLE 18; U.B. COOE BECTK3N 1001 AND SECTION #010. ,;~ r' .~rv: ~~rR:wrti~ ~ stl~R~M SELLER ~ I ttN0~ie1r Cep ~ arks: ~ ~- heat aC knbr,+.dp. ana a~Nla~ Is. Iht-e wxt a~aa st~itarnwnl of Nt -~Npts and its maps on m~, at~xu ~ ~,-~+«~,-~"b.t sty. ~~~"~' •SEP. 1 b. 2aag~1 a ;19AN~rade 7WACHOVIA TRUSTok value - Ks11ey Blue Book ~~~~~ YH~'1t~tttST~O R~SO~ advertisement ' . k! It~ r X108 ~~ +~ ~~~ N0. 41 a4Pag+P. Zt 2 SE ~V1~~7~~~57 ~7~~~f~~ ~~ ~Ui ~lfY RiL~~ ~~ ~ I~f ~i7 ...` . i _ ._ . ~~9 YUMtON FtYBIt~D 1~9f Toyota Camry LE 5~dan ~D Bl.l~~ BOOKS ~~A~E~IN'~A~.U~ Condition Value Excellent $Z, x.00 ~ Good $1,775 (Selected) Fair $x.,275 ...iy~!u.~L1l::~i:!.J..~,i:-1~-w~~ 1 1:~ r '!~:i:rlt.'N~S.,rf, f!.~-,L+~'.b2S.r:~.fr~r.I.tR.r1 t1~+~7!:W.UQLkl11/ 1ih`i.1.11.:.11:..?il:..! .~/1!.j Jt.. f~.!!~! . .4/N.N~~ 'vehicle Highlights Mileage: 13'x,000 bngine: 4-Cyl. Z.2 Liter Transcr-ission: Automatic rDriva_t_rain: FWD _ ~tn R ~~~ry~ ( 1tp {~~ h 1 ~~ r N.~. ~~ r-1 , ~ 3 ..".i~T.fr'~~r',<...-~+.u.IR•NL.I~LllftflliSr~3EfYk~~ r,''nN r(.1• r~ .»r~~~!F ~ J?Ri ~irr ,'.~ ~ A di:1./1 Jil4 f! 1 r, ,ii ! ,,!,., Tr fr Jk ~ .i...fi/. .NH 1 €geiected Equipment 'Standard ~Alr Conditionlnp AM/FM Stereo (Power Steering Dual Front Air Bags ~Opti011a~ ~,POwer Windows Tilt Wheel Ca55ette 'Power Door Locks Cruise Control Blue Book Tirade~In Vaiue Trade-irt Vplue Is what tonSumers can expect to receive from a dealer for etrade-in vBhiCle assuming an accurate appraisal of condition. This valve will likely be 1855 than the Private Party Value beta use the re5elling dealer intClrS the cost Of safety inspections, reconditionlnQ and other,costs of doing bu~lness., ,,,, Vehicte Condition Ratings ExCei~en~ ~ $~,,1b0 looks new, is in eXCellent mechanical condition and needs no reconditioning. • Never had any paint or body work and Is free of rust. Clean title history and wtll pass a smog and safety inspection. • Engine compartment is clean, with no Huid leaks and is free OP any wear Or vigible defects. --,- advertisement ~-- i f f I f I ~1ias ~~nc si~~a ~ W)th aA ~P{4~t. ~11111PG cii 1~ sberra~ NYb~ !~ ap la 40~i- bert~r cal lNo1 fecv~ thin 8ny full-sty pi~C>I~p `f, i'n Iftu claas~ F ' ~~IJ~~Q spur Ov+fT! Re uesx 21 Quote ' Lorote a Retailer f 4 Close Wintlow htt~://~www.kbb.corn/~.BB/UsedCaxSJ~'ricingReport.aspx?Yea~rZd=1996&N~x~eage-133000... 9/t 6/2009 ~~ 15 E P 14 ~~ G 0 y~ I 0 ;l 0 A~'rade IWA ~ H UV I,A T k U ~ Tok vl~Iue - Kelley Blue book N t1. ~ I 0 4.'agf P , 3f z • Complete and verifiable service reErords, Less than 5% of al! used vehicles fall into this category. 1Ir Good (581ected) Q~ti3~~~.:~ ~ ~.r775 • Free of any major defects. • Clean title history, the paints, body, and interior have only minor (if any) blemishes, end there are no major mechanical problems. ~ Little or no rust on this vehlcte, • Tires match and have substantial tread wear left, • A "good" vehicle wit{ need some retondltloninq CO be sold at retail. Most Consumer owned vehicles tall Into this Category. Fair • Some mech~niCal or cosmetic del`eGts and needs servicing but is 5ti11 In reasonable running Condition. • Clean title history, the p8int, body dnd/or Interior need work performed by a profe5slonal. r Tires may need to be replaced. ~ 7here may be some repairable rust damage. Qoor /11R~"v~ r Mqf N /~ ~.1i i ~l.a..l . E! • Severe mechanical and/or cosmetic defects and is In poor running condition. • MeY have problems that cannot be readily flied such as a damaged frame or crusted-through body. • Branded title (salvage, flood, etc.) or unsubstantiated mileage. Kelley I3fue Book does not attempt to report a value 4h a "poor" vehlcte because the value of these vehicles varies greatly. A vehicle In poor Condition may require an Independent appraisal to determine its valve. * pennsylvdnia 9/1612009 http://www.kbb.com/KBB/UsedCarsll'xicingRepo~rt.aspx?YeaxXd=1996&Nlilea~e=133000... 9/16!2009 SEP. 16.269 10:14AM WACHUVIA TRUST NU. 4104 P. Fax Cover Sheet WACHOV~A Tx'ust Centex-Lancaster Date: ~~' ~~ ` ~~ Time: ro: ~ ~r , To: M,~~~,v~~r7~ ov1~~/~r~ Compax~~r: ~ ~l ~,~, Phone#: . Fay#: ~r7 . ~~ - ~~~ ~ Nuambe~- o~ Pages ~ncXudix~g Tk~is Wage: ~ Fxorn: ;,~. Compa~~': ~acliovia Trust Phone#: ~ --$OO~S31-6162 ~a~c#: 1-717-29 ~ -347a Con-~ment~: Fax Cover Sheet ~' LAST WILL AND TESTAMENT OF HELEN J. TESNO I, HELEN J. TESNO, of Mechanicsburg, Cumber land County, Pennsylvania, do hereby make this as and for my last Will and Testament, hereby revokin all g other Wills and Codicils heretofore made by me. F-~= ~ I direct the Payment of my debts and the expenses of my last illness and funera 1 from my estate as soon after my death as conveniently may be. SE-_COND: I give and bequeath all tan ible sonal p y g per- pro ert owned by me at the time of my death with all insurance ~ together policies thereon, unto my sister, Edith M. Tesno, if she survives me by thir event she fails t tY days. In the o survive me by thirty days, I give and bequeath said tangible personal propert y and all insurance policies thereon in as nearly equal shares a s is practicable unto such of my following nephews and nieces as shall sur- vive me by thirty days: Harold W. Tesno J ~ r•, Linda L. Tesno, William L. Tesno, Andrea G. Tesno Lorraine E. Miller and Doris K. Miller. I authorize my Executrix to deliver such ar ticles to which a minor may be entitled under this paragraph to the guardian of the minor or to the person h awing custody of the minor, or to retain such propert unti y 1 an age ~t which my Executrix considers it appro riate P to deliver :he property to him or to her, provided in no event shall such property be retained by my Executrix be yond the time Page 1 of 4 Pages ~- the minor attains his or her majority. The recei t p of such of the above enumerated persons as may be selected to receive delivery of such property shall be a full and complete discharge to my Executrix. In the event m Y Executrix at any time decides it is desirable to sel 1 any item or items of tangible personal property held hereunder for a minor, the proceeds of such sale or sales shall be delivered to the Guardian of the property of the minor appointed in Paragraph SIXTH hereinafter to be held under the terms and conditions thereof. ~ T..~_~ I give, devise and bequeath all the rest, residue and remainder of my estate unto m si Y stet, Edith M. Tesno, if she survives me by thirt da Y Ys. In the event she fails to survive me by thirt da Y Ys. I give, devise and bequeath all the rest, residue and remainder of my estate unto such of my following ne hews P and nieces as shall survive me by thirty days: Harold W. Tesno, Jr., Linda L. Tesno, William L. Tesno, Andrea G. Tes no, Lorraine E. Miller and Doris K. Miller. FO....U. RTH: I direct that any and all Inheritance Estate and Transfer Taxes imposed upon m es / Y tats passing under my Will or otherwise, shall be paid out of th e principal of my residuary estate. FI. FTH~ In addition to the powers conferred b law, I authorize my Executrix in Y her absolute discretion: (a) To retain in the form received, and Page 2 of 4 Pages to sell either at public or private sale any real or ersona P 1 property. (b) To manage real estate, (c) To invest and reinvest in all forms of property without being confined to legal investments and without regard to the principle of diversification. (d) To exercise any option or rights arising from ownership of investments. (e ) To compromise claims without court approval, and without the consent of any beneficiary. (f) To distribute in cash or in kind. -_._.. SIXTH: I appoint my sister, Joann Tesno Miller Guardian of any property, including but not limited to all proceeds of insurance on my life, which passes to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so. I n addition to the powers given by law, I authorize the guardian (a) to use such amounts of both income and princi al P as she, in her sole discretion, deems proper for the su or pp t, education and welfare of such minor without leave of a ny court, and (b) to invest in any property without restricts on to legal investments. The guardian shall not be re uir q ed to give bond or furnish sureties in any jurisdiction. SEVENTH: In the event of the inability of Joann Tesno Miller to act for any reason whatsoever urs P uant to my appointment of her in Paragraph SIXTH herein I appoint my sister, Edith M, Tesno, Guardian of any ro er P P ty Page 3 of 4 Pages ~. ~ fr which passes to a minor. EI--~H~ I nominate, constitute and a ppoint my sister, Edith M. Tesno, Executrix of this my last Will and Testament. In the event of the re resignation or in nunciation, death, ability to act for any reason whatso of my said sister, Edith M. Tesno ever I nominate, constitute and appoint my sister, Joann Tesno Mi ller, Executrix of this my last Will and Testament. I hereb Y relieve my Executrix from the necessity of posting secur ity in connection with her duties as such in any jurisdict ion in which she may be called upon to act insofar as I am able by law to do so. IN WITNESS WHEREOF, I.have hereunto and seal this) set my hand c~C v~, day o f ~/ . L~ l . ,,~., ~ 9 75 . ~~,Pe.,, " ~'~~ (SEAL) SIGNED, SEALED PUBLISHED and DECLARE above-named HELEN J. TESNO D by the as and for her last Will and Testament, in the presence of us who at her request, in her presence and in the presence of each other have hereunto subscribed our names as witnesses: ,- --~ ~, ' ' ~~ Address ~~~ ~ n ~~,...~,~, ~ ,,_ ~ -, ~ r ~ \ . . Addres s ~ ~, ~ ~ .~ /-~ ~. i ~, Page 4 of 4 Pages E X GRANTED TEMPLATE Miller, Maronetta F. Page 1 of 2 From: Gager, Ryan R. Sent: Tuesday, December 01, 2009 9:04 AM To: Miller, Maronetta F. Subject: FW: HELEN TESNO EST FYI From: RV, Inheritance Tax Extension [mailto:RA-InheritanceTaxExt@state.pa.us] Sent: Tuesday, December 01, 2009 8:52 AM To: Gager, Ryan R. Cc: 'gfarner@ccpa.net' Subject: HELEN TESNO EST ~~ ~~ Dear Sir or Madam: tRARX~~" flft~ ~E:~OE __ _ The following message is being sent from an unmonitored account. Please do not reply. Re: Estate of HELEN TESNO File Number 2109-0245 This is in response to your request for an extension of time to file the Inheritance Tax Return for the above estate. In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before 05/28/2010. Because Section 2136 (d) of the 1995 Act allows for. only one extra period of six (6) months, no additional extension(s) will be granted that would exceed the maximum time permitted. We now offer you the option to request your extension request via a-mail. Please use the following e-mail address: RA-inheritanceTaxExt~state.pa.us. Please contact me with any questions or concerns at 717-787-8327. Sincerely, Claudia Maffei, Supervisor Document Processing Unit Inheritance Tax Division 12/ 1 /2009 oC~ ~ s za~~~ /-~ ~~ I i~ ce: IN THE COURT OF COMMON PLEAS OF ESTATE OF HELEN TESNO CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION DECEASED NO. 21-09-0245 ORDER AND NOW, this ~o~ day of ~ ~ ~ ~,,~ e, ~ , 2009, upon consideration of the annexed Petition, it is hereby ORDERED that Joann Miller, Executrix of the Lstate of f~elen Tesno, is authorized to disclaim assets on behalf of the Estate as set forth in the Disclaimer attached hereto. By the Court: J. c O •o -x ~~- - -~ ,---; -:~ ~_~ cri ~ a~ ~-: ~~.~ ' ~~~: ~~:.~~''~ ~~OM RECORD -~ ,"~-st ~~ ~ . i~-~ ~e~t~noray wherof, I hereunto v --~ v w •- ~~Y - ^ set Amy hand and the seal ~ `' ' '= •' -~ rlisle, PA a t4 ~4un a t i of s a ~'`~ ~ /~~//'1 // ~). ~/7 / ~ / A ~';lerk cif tt~+~ rp ns Ca~urt Gu ~+ot~~ d County In re: IN THE COURT OF COMMON PLEAS OF ESTATE OF HELEN TESNO CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION DECEASED ~ ~' ~_.-- N0.21-09-0245 =_ ~ ~ ~:~.~ ~ ~:~ `~' o . - ` f , = ~ c~ ._._, ~ ~, - PETITION FOR AUTHORIZATION TO DISCLAIM A PORTICf1~I~~Q'l~' ~.. ~ _~ ESTATE IN ACCORDANCE ~;.~ = i ~ WITH ~ 6202 OF THE PROBATE, ESTATES AND FIDUCIARIES~'CODE ~ `' .,., TO THE HONORABLE, THE JUDGES OF THE SAID COURT: The Petitioner, Joann Miller, Executrix of the Estate of Helen Tesno, respectfully represents that: 1. Edith M. Tesno ("Edith") died a resident of Cumberland County on January 25, 2009, leaving a Last Will and Testament dated July 22, 1975 ("Edith's Will"), which was duly probated by Decree of the Register of Wills of Cumberland County on February 12, 2009, and Letters Testamentary thereon were granted to Helen Tesno ("Helen"). A copy of Edith's Will is attached hereto, marked Exhibit "A", and made a part hereof. Helen died on February 28, 2009. On March 13, 2009, Petitioner, Joann Miller, was appointed Administratrix CTA DBN of Edith's Estate. 2. Under the terms of Edith's Will, the residue of her estate is left to her sister, Helen. The Will further provides that if Helen does not survive Edith by thirty days, Edith's entire estate is to be distributed in equal shares to her nieces and nephews, Harold W. Tesno, Jr., Linda L. Tesno, William L. Tesno, Andrea G. Tesno, Lorraine E. Miller and Doris K. Miller (collectively, the "Beneficiaries"). 3. Helen died February 28, 2009, more than thirty days after her sister, Edith, leaving a Last Will and Testament also dated July 22, 1975 ("Helen's Will"), which was duly probated 154hbG. 110/2i/09 by Decree of the Register of V~,~ills of Cumberland County on March 13, 2009, and Letters Testamentary thereon were granted to the Petitioner. A copy of Helen's Will is attached hereto, marked Exhibit "B," and made a part hereof. 4. Helen's Will is a mirror of Edith's Will and provides that the residue of her estate be distributed to her sister, Edith, and if Edith does not survive Helen by thirty days, then Helen's residue is to be distributed in equal shares to the Beneficiaries. 5. The contingent Beneficiaries of Edith's estate are the exact Beneficiaries of her sister, Helen's estate. 6. There will be significant tax savings to the Beneficiaries if Petitioner, as Executrix of Helen's Estate, disclaims a portion of the property in Edith's Estate. The Petitioner has ~_ executed a disclaimer, subject to this Court's approval, describing the property that will be disclaimed, which has a value equal to $116,158.93. A copy of the proposed Disclaimer is attached hereto, marked Exhibit "C," and made a part hereof. By making the disclaimer, the disclaimed amount will avoid being taxed first in Edith's estate and then immediately again in Helen's estate. 7. Helen's will is silent on the question of her executrix making a disclaimer on behalf of Helen's estate. However, Section 6202 of the Probate, Estates and Fiduciaries Code provides that "[a) disclaimer on behalf of a decedent ...may be made by his personal representative ... if ...the court having jurisdiction of the estate authorizes the disclaimer after finding that it is advisable and will not materially prejudice the rights of creditors, heirs or beneficiaries of the decedent ...." 9 The Disclaimer will not prejudice the Beneficiaries or any creditor of Helen's estate. Indeed, the Beneficiaries will ultimately receive more property by reason of the substantial tax savings generated by the Disclaimer. In addition, all known creditors (other than -2- Legal counsel) of Helen's estate have already been paid and it is estimated that Helen's estate will still have in excess of $115,000 net of the payments to creditors after the Disclaimer. 10. Each of the Beneficiaries has joined in the prayer of this petition and their joinders are attached. NOW THEREFORE, Petitioner respectfully requests that this Court enter an Order allowing Petitioner to make a disclaimer on behalf of Helen's estate and approving the proposed Disclaimer as set forth in Exhibit "C". Respectfully submitted, ,~'- ,~' R. Gager, Esquire~(ID# 93990) UL EWING LLP Saul Ewing, LLP Penn National Insurance Tower 2 North Second Street, 7~' Floor Harrisburg, PA 17101 Attorneys for Petitioner, Joann Miller -3- VERIFICATION I, Joann Miller, Executrix of the. Estate of Helen Tesno, verify that I am the Movant in the within Motion, and verify that the facts contained in the foregoing Motion are true and correct to the best of my knowledge, or information and belief, and that this Verification is subject to the penalties of 18 Pa. C.S.A. Section 4904 relative to unsworn falsification to authorities. Estate of Helen Tesao By: Joann Miller, Executrix Dazed: /O - ~ / - ~C~D ~~.> >~~ ESTATE OF ~~ IN THE ORPHANS COURT DECEASED CUMBERLAND COUNTY, PENNSYLVANIA N0.21-09-~5 JOINDER I, Harold W. Tesno,~Jr. beneficiary, hereby join i prayer of the within Petition. Dated: October /~, 2009 _ Harold W. Tesno, Jr. ~ sst~cs~. ~ ion 9io~ -S- ESTATE OF ~~ TESNO, IN THE ORPHANS COURT DECEASED CUMBERLAND COUNTY, PENNSYLVANIA N0.21-09-0. 245 JOINDER I, William L. Tesno, beneficiary, hereby join in the prayer of the within Petition. Dated: October/, 2009 William L. Tesno is+v~.i ~ai~ -6- ESTATE OF _~ -. TESNO, IN THE ORPHANS COURT DECEASED CUMBERLAND COUNTY, PENNSYLVANIA NO.21-09-5 JOINDER I, Linda Tesno Hochtman, beneficiary, hereby join in the prayer of the within Petition. ~, , ~,,, . Dated: October , 2009 ,~- Linda Tesno Hochtman t 54066. 1 10/ 19/09 ~7 -/- ESTATE OF ~ - TESNO, DECEASED . IN 'T`HE ORPHANS COURT CUMBERLAND COUNTY, PENNSYLVANIA N0.21-09- 0245 JOINDER T, Andrea Tesno Clise, beneficiary, hereby join in the prayer of the within Petition. Dated: October ~ , 2009 Andrea Tesno Clise i~a~.~ iarero~ -g- ESTATE OF ~~ ~ TESNO, IN THE ORPHAI~tS COURT DECEASED CUMBERLAND COUNTY, PENNSYLVANIA N0.21-09- 0245 JOINDER I, Lorraine Miller, beneficiary, hereby join in the prayer of the within Petition. Dated: October fit; 2009 r Lo~iller . -9- ESTATE OF . ~ TESNO, IN THE ORPHANS COURT DECEASED CUMBERLAND COUNTY, PENNSYLVANIA N0.21-09-5 JOINDER I, Doris Miller McElhenie, beneficiary, hereby join in the prayer of the within Petition. Dates: October~,c? , 2009 j Doris Miller McElhenie ~~.> > -10- ESTATE OF ~T TESNO, II'+T TIC ORPHANS COURT DECEASED CUMBERLAND COUNTY, PENNSYLVANIA N0.21-09--' 0245 JOINDER I, Joann Miller, Executrix of the Estate of Helen Tesno, beneficiary, hereby join in the prayer of the within Petition. Dated: October ~/, 2009 ~~.~ -11- Joann Miller, Executrix LAST WILL AND TESTAMENT OF EDITH M . TESNO~ I, EDITH M. TESNO, of Mechanicsburg, Cumberland County, Pennsylvania, do hereby make this as and for my last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST: I direct the payment of my debts and the expenses of my last illness and funeral from my estate as soon after my death as conveniently may be. SECOND: I give and bequeath all tangible per- sonal property owned by me at the time of my death, together with all insurance policies thereon, unto my sister, Helen J. Tesno,_if she survives me by thirty days. In the event she fails to survive me by thirty days, I give and bequeath said tangible personal property and all insurance policies thereon in as nearly equal shares as is practicable unto. such of my following. nephews and nieces as shall sur- vive me by thirty days: Harold W. Tesno, Jr., Linda L. Tesno, William L. Tesno, Andrea G. Tesno, Lorraine E. Miller and Doris R. Miller. I authorize my Executrix to deliver such articles to which~a minor may be entitled under this p'ara'graph to the guardian of the minor or to the person having custody of the minor, or to retain such property until an age at which mY Executrix considers .it appropriate~~to deliver. the property to him or to her, provided in no. event shall .such property be retained by my Executrix beyond the time Page 1 of 4 Pages the minor attains his or her majority. The receipt of such of the above enumerated persons as may be selected to receive delivery of such property shall be a full and complete discharge to my Executrix. In the event my Executrix at any time decides it is desirable to sell any item or items of tangible personal property held hereunder for a minor, the proceeds of such sale or sales shall be delivered to the Guardian of .the property of the minor appointed in Paragraph SIXTH hereinafter to be held under the terms and conditions thereof. TH_: I give, devise and bequeath all the rest, residue and remainder of my estate unto my sister, Helen J. Tesno, if she survives me by thirty days. In the event she fails. to survive me by thirty days, I give, devise and bequeath all the rest, residue and remainder of my estate unto such of~my following nephews and nieces as shall survive me by thirty days: Harold W. Tesno, Jr., Linda L. Tesno, William L. Tesno, Andrea G. Tesno, Lorraine E. Miller and Doris K. Miller. ~~_: I direct that any and all Inheritance, Estate and Transfer Taxes imposed upon my estate passing under my Will or otherwise, shall be paid out of the principal of my residuary estate. FIFTH: In addition to the powers conferred ~y law, I authorize my Executrix, in her absolute discretion: (a) To retain in the form received, and Page 2 of 4 Paqes to sell either at public or private sale any real or personal property . (b) To manage real estate. (c) To invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principle of diversification. (d) To exercise any option or rights arising from ownership of investments. '(e) To compromise claims without court approval, and without the consent of any beneficiary. (f) To distribute in cash or in kind. j SIXTH: I appoint my sister, Joann Tesno Miller, Guardian of any property, including but not limited to all proceeds of insurance on my life, which passes to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so. In addition to the powers given by law, I authorize the guardian (~a) to use such amounts of both income and principal as she, in her sole 'discretion, deems proper for the support, education and welfare of such minor without leave of any court, and (b) to invest in any property without restriction to. legal investments. The guardian shall not be required to give bond or furnish sureties in any jurisdiction. ~_: Tn the event of the inability. of Joann Tesno Miller to act for any reason whatsoever pursuant to my appointment~of her in Paragraph SIXTH herein, I appoint my sister, Helen M. Tesno, Guardian of any property Page 3 of 4 .Pages which passes to a minor. EIGHTH: I nominate, constitute and appoint my sister, Helen J. Tesno, Executrix of this my last Will and Testament. In the event of the renunciation, death, resignation or inability to act for any reason whatsoever of my said sister, Helen J. Tesno, I nominate, constitute and appoint my .sister, Joann Tesno Miller, Executrix of this my last Will and Testament. I hereby relieve my Executrix froaa the necessity of posting security in connection with her duties as~such in any jurisdiction in which she may be called upon to act insofar as I am able by law to do so. IN WITNESS WHEREOF, Iihave hereunto set my hand and seal this ~~ day of --~! , 1975. l-+ lJG~C~-yv ~?~ ~ (SEAL) SIGNED, SEALED; PUBLISHED and DECLARED by the above-named EDITH M. TESNO as and for her last Will and Testament, in the presence of us who, at her request, in her presence and in the presence of each other have hereunto subscribed our names as witnesses: ~.rihG4f `YI-~itD-G+.~,~cli ~ Addresses j ~.-fi4~Pi `~/,+iu- ~.,rr..t~~a~t/~~ 1 Address ~U. ~~ - i ~ ~~ _ ~ i Page 4 of 4 Pages LAST WILL AND TESTAMENT OF HELEN J. TESNO I, HELEN J. TESNO, of Mechanicsburg, Cumberland County, Pennsylvania, do hereby make this as and for my last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST: I direct the payment of my debts and the expenses of my last illness and funeral from my estate as soon after my death as conveniently may be. SECOND: I give and bequeath all tangible per- sonal property owned by me at the time of my death, together with all insurance policies thereon, unto my sister, Edith M. Tesno, if she survives me by thirty days. In the event she fails to survive me by thirty days, I give and bequeath said tangible personal property and all insurance policies thereon in as nearly equal shares as is practicable unto such of my following nephews and nieces as shall sur- vive me by thirty days: Harold W. Tesno, Jr., Linda L. Tesno, William L. Tesno, Andrea G. Tesno, Lorraine E. Miller and Doris K. Miller. I authorize my Executrix to deliver such articles to which a minor may be entitled under this paragraph to the guardian of the minor or to the person having custody of the minor, or to retain such property until an age at which my Executrix considers it appropriate to deliver the property to him or to her, provided in no event shall such property be retained by my Executrix beyond the time Page 1 of 4 Pages ~ EXHIBIT the minor attains his or her majority. The receipt of such of the above enumerated persons as may be selected to receive delivery of such property shall be a full and complete discY~arge to my Executrix. In the event my Executrix at any time decides it is desirable to sell any item or items of tangible personal property held hereunder for a minor, the proceeds of such sale or sales shall be delivered to the Guardian of the property of the minor appointed in Paragraph SIXTH hereinafter to be held under the terms and conditions thereof. THIRD: I give, devise and bequeath all the rest, residue and remainder of my estate unto my sister, Edith M. Tesno, if she survives me by thirty days. Zn the event she fails to survive me by thirty days, I give, devise and bequeath all the rest, residue and remainder of my estate unto such of my following nephews and nieces as shall survive me by thirty days: Harold W. Tesno, Jr., Linda L. Tesno, William L. Tesno, Andrea G. Tesno, Lorraine E. Miller and Doris K. Miller. FOURTH: I direct that any and all Inheritance, Estate and Transfer Taxes imposed upon my estate passing under my Will or otherwise, shall be paid out of the principal of my residuary estate. FIFTH: In addition to the powers conferred by law, I authorize my Executrix, in her absolute discretion: (a) To retain in the form received, and Page 2 of 4 Pages to sell either at public or private sale any real or personal property. (b) To manage real estate. (c) To invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principle of diversification. (d) To exercise any option or rights arising from ownership of investments. (e) To compromise claims without court approval, and without the consent of any beneficiary. (f) To distribute in cash or in kind. SIXTH: I appoint my sister, Joann Tesno Miller, Guardian of any property, including but not limited to all proceeds of insurance on my life, which passes to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so. In addition to the powers given by law, I authorize the guardian (a) to use such amounts of both income and principal as she, in her sole discretion, deems proper for the support, education and welfare of such minor without leave of any court, and (b) to invest in any property without restriction to legal investments. The guardian shall not be required to give bond or furnish sureties.in any jurisdiction. SEVENTH: In the event of -the inability of Joann Tesno Miller to act for any reason whatsoever pursuant to my appointsaent of her in Paragraph SIXTH herein, I appoint my sister, Edith M. Tesno, Guardian of any property Page 3 of 4 Pages which passes to a minor. EIGHTH: I nominate, constitute and appoint my sister, Edith M. Tesno, Executrix of this my last Will and Testament. In the event of the renunciation, death, resignation or inability to act for any reason whatsoever of my said sister, Edith M. 'Tesno, I nominate, constitute and appoint my sister, Joann Tesno Miller, Executrix of this my last Will and Testament. I hereby relieve my Executrix from the necessity of posting security in connection with her duties as such in any jurisdiction in which she may be called upon to act insofar as I am able by law to do so. IN WITNESS WHEREOF, I.have hereunto set my hand and seal this ~ ~ day of `~~~ , 1975. ~' ~~~2-,~ ~__-~~~ SEAL) SIGNED, SEALED PUBLISHED and DECLARED by the above-named HELEN J. TESNO as and for her last Will and Testament, in the presence of us who, at her request, in her presence and in the presence of each other have hereunto subscribed our names as witnesses: ~. ., ~.. ., !. ;,, 4. ~/~~ S•~ J Address.,~IG /n ~~./~t~ /.~c,~..,~~ //[~c~ ~'~~,c~.erfa4Q //~% i ~j"' Addres s P ~~, .~ , ~-~ Page 4 of 4 Pages In re: IN THE COURT OF COMMON PLEAS OF ESTATE OF EDITH M. TESNO, CUIti'IBERLAItiTD COUNTY, PEI~~TSYLVANIA DECEASED ORPHANS' COURT DIVISION N0.21-09-0155 DISCLAIMER AND RENUNCIATION OF CERTAIN PROPERTY UNDER WILL OF EDITH M. TESNO, DECEASED IN ACCORDANCE WITH 20 Pa.C.S. §6201 et seq 1. Edith M. Tesno, deceased (the "Decedent"), a resident of Hampden Township, Cumberland County, Pennsylvania, executed a will dated July 22, 1975 (the "Will"). 2. The Decedent died January 25, 2009. The Will was probated February 12, 2009 with the Register of Wills of Cumberland County, Pennsylvania and Helen Tesno was appointed Executrix. On February 28, 2009, Helen Tesno died. On March 13, 2009 Joann Tesno Miller was appointed Administratrix CTA DBN of the Estate of Edith M. Tesno. 3. On March 13, 2009 Helen Tesno's Will dated July 22, 1975 was probated in Cumberland County, Pennsylvania and Joann Tesno Miller was appointed Executrix of the Estate of Helen Tesno. 4. Under the terms of the Will, the residue of the Decedent's estate is left to her sister, Helen. The Will further provides that if Helen does not survive the Decedent by thirty days, the Decedent's entire estate is to be distributed in equal shares to her nieces and nephews, Harold W. Tesno, Jr., Linda L. Tesno, William L. Tesno, Andrea G. Tesno, Lorraine E. Miller and Doris K. Miller. 5. At the time of Edith M. Tesno's death she also owned the following: Belco Account No. 1642900, IRS Tax Refund, Blue Cross reimbursement, AAA reimbursement, Patriot News reimbursement, ATT reimbursement, Doubleday reimbursement, Wachovia reimbursement, inheritance from brother Roland R. Tesno (the "Accounts"). 6. A full description of the Accounts, which are subject of this Disclaimer are as follows: Belco Account No. 1642900 IRS 2008 Refund Blue Cross Reimbursement AAA Reimbursement $12,68 l .65 $1,202.00 $126.00 $24.32 D(HIBIT C Patriot New Reimbursement $78.50 ATT Reimbursement $9.16 Doubleday Reimbursement $22.25 Wachovia Reimbursement $76.70 Inheritance from Estate of Roland R. Tesno $101,938.35 7. Joann Tesno Miller, as Executor of Helen Tesno's Estate, desires to make an irrevocable and unqualified disclaimer of Helen Tesno's (and her Estate's) interest in the Accounts and Real Estate described in Item 7 above. 8. Fewer than nine months have elapsed since the Decedent's death and neither Helen nor her estate has accepted or received any interest in the Accounts described in Item 6 above. 9. As a result of this Disclaimer, Helen Tesno's interest in the Accounts will pass to Decedent's six nieces and nephews in equal shares in accordance with Decedent's Will. The names of the six nieces and nephews and their interests in the Decedent's estate are: Name Address Harold Tesno, Jr. 85 Blue Ridge Drive 12.803% Levittown, PA 19057 Linda Hochtman 8590 New Falls Road, 12.803% Apt. J 10 Levittown, PA 19054 Andrea Clise 1416 Washington Road 12.803% Westminster, MD 21157 William Tesno 31630 Trains Park 12.803% Conroe TX 77385 Lorraine Miller 170 Fairway Drive 12.804% Etters, PA 17319 Doris McElhenie 454 Elder Trail 12.804% New Cumberland, PA 17070 Percentage NOW, THEREFORE, pursuant to 20 PA. Cons. Stat. Ann. §6201, I Joann Tesno Miller, Executrix of the Estate of Helen Tesno, acting on behalf of the Estate of Helen Tesno, do hereby irrevocably renounce, disclaim and refuse to accept any right, title and interest in and to the Accounts itemized in Item 6 above. While not a condition of this disclaimer, it -2- is understood that, by reason of this Disclaimer, the disclaimed property wi11 now pass under the Wilt of Edith M. Tesno as follows: in equal shares to. those named in Itan ~ above. IN WITNESS WHEREOF, I have hereunto set my hand and seal this oZ a~i day of October, 2009. ESTATE OF HELEN TESNO tisasu.~ ~ai~ ~OANN TESNO MII., ER, -3- COMMON WEALTH OF PENNSYLVANIA cour~TY aF ~U,up{~, ~ . On this ~~p, day of October 2009, before me, the undersigned Notary Public in and for the Commonwealth of Pennsylvania, personally appeared Joann Tesno Miller, satisfactorily proven to me to be the .person described in the foregoing. Disclaimer and Renunciation, who acknowledged that she executed the same for the purposes therein contained and that she desired it to be recorded as such. Notary Public COMMO OF PENNSYL Notarial Seal toi /i. e. babe, ~f- Public ah- or . oaup~r, P~SY~nia A • 72010 o/Notaries 154G2i. l I OR3l09 -4- Receipt by Fiduciary 1, Joann Tesno Miller, Administratrix of the Estate of Edith M. Tesno, ad 't personal re o' Disclaimer and Renunciation, on this ~ of October, service upon me of the fo g ing ~_ 2009. itas~.t ~a~9ro9 Receipt by Beneficiary I, Harold Tesno, J ., admit personal service upon me of the foregoing Disclaimer and Renunciation, on this day of October, 2009. /.~ ~. Jr. iwbz3.~ ~atsros -6- Receipt by Beneficiary I, Linda Hochtman, admit personal service upon me of the foregoing Disclaimer and Renunciation, on this a J day of October, 2009. Linda Hochtman isdbr.~ ~ai9io~ -7- Receipt by Beneficiary I, Andrea Clise, admit personal service upon me of the foregoing Disclaimer and Renunciation, on this _~_ day of October, 2009. -~•-~-'sr ~111dI'CS C~I3C i:ac~33.t l0/1~/09 _g_ Receipt by Beneficiary I, William Tesno, admit personal service upon me of the foregoing Disclaimer and Renunciation, on this ~_ day of October, 2009. William Tesno ~sahza.~ iai~ro9 Receipt by Beneficiary I, Lorraine Miller, admit personal service upon me of the foregoing Disclaimer and Renunciation, on this ZOf'` day of October, 2009. ;~ 1 Lorraine Miller ~~.~ ~a,~ -10- Receipt by Beneficiary I, Doris McElhenie~ admit personal service upon me of the foregoing Disclaimer and Renunciation, on this ~`~ day of October, 2009. Doris McElhenie ~~~.~ td~~ -11- In re: IN THE COURT OF COMMON PLEAS OF ESTATE OF EDITH M. TESNO, CUMBERLAND COUNTY, PENNSYLVANIA DECEASED ORPHANS' COURT DIVISION N0.21-09-0 l 55 DISCLAIMER AND RENUNCIATION OF CERTAIN PROPERTY UNDER WILL OF EDITH M. TESNO, DECEASED IN ACCORDANCE WITH 20 Pa.C.S. §6201 et seq 1. Edith M. Tesno, deceased (the "Decedent"), a resident of Hampden Township, Cumberland County, Pennsylvania, executed a will dated July 22, 1975 (the "Will"). 2. The Decedent died January 25, 2009. The Will was probated February 12, 2009 with the Register of Wills of Cumberland County, Pennsylvania and Helen Tesno was appointed Executrix. On February 28, 2009, Helen Tesno died. On March 13, 2009 Joann Tesno Miller was appointed Administratrix CTA DBN of the Estate of Edith M. Tesno. 3. On March 13, 2009 Helen Tesno's Will dated July 22, 1975 was probated in Cumberland County, Pennsylvania and Joann Tesno Miller was appointed Executrix of the Estate of Helen Tesno. 4. Under the terms of the Will, the residue of the Decedent's estate is left to her sister, Helen. The Will further provides that if Helen does not survive the Decedent by thirty days, the Decedent's entire estate is to be distributed in equal shares to her nieces and nephews, Harold W. Tesno, Jr., Linda L. Tesno, William L. Tesno, Andrea G. Tesno, Lorraine E. Miller and Doris K. Miller. 5. At the time of Edith M. Tesno's death she also owned the following: Belco Account No. 1642900, IRS Tax Refund, Blue Cross reimbursement, AAA reimbursement, Patriot News reimbursement, ATT reimbursement, Doubleday reimbursement, Wachovia reimbursement, inheritance from brother Roland R. Tesno (the "Accounts"). are as follows: 6. A full description of the Accounts, which are subject of this Disclaimer Belco Account No. 1642900 IRS 2008 Refund Blue Cross Reimbursement AAA Reimbursement $12 681 65 , . $1,202.00 ~ ~- ~ ~; ., $126 00 ~`~' ` r, . $24.32 ::=-t';~ ~; ?~. -.. _ ~ , C~ " ~ T Patriot New Reimbursement $78.50 ATT Reimbursement $9.16 Doubleday Reimbursement $22.25 Wachovia Reimbursement $76.70 Inheritance from Estate of Roland R. Tesno $101,938.35 7. Joann Tesno Miller, as Executor of Helen Tesno's Estate, desires to make an irrevocable and unqualified disclaimer of Helen Tesno's (and her Estate's) interest in the Accounts and Real Estate described in Item 7 above. 8. Fewer than nine months have elapsed since the Decedent's death and neither Helen nor her estate has accepted or received any interest in the Accounts described in Item 6 above. 9. As a result of this Disclaimer, Helen Tesno's interest in the Accounts will pass to Decedent's six nieces-and nephews in equal shares in accordance with Decedent's Will. The names of the six nieces and nephews and their interests in the Decedent's estate are: Name Address Harold Tesno, Jr. 85 Blue Ridge Drive 12.803% Levittown, PA 19057 Linda Hochtman 8590 New Falls Road, 12.803% Apt. J 10 Levittown, PA 19054 Andrea Clise 1416 Washington Road 12.803% Westminster, MD 21157 William Tesno 31630 Trains Park 12.803% Conroe TX 77385 Lorraine Miller 170 Fairway Drive 12.804% Etters, PA 17319 Doris McElhenie 454 Elder Trail 12.804% New Cumberland, PA 17070 Percentage NOW, THEREFORE, pursuant to 20 PA. Cons. Stat. Ann. §6201, I Joann Tesno Miller, Executrix of the Estate of Helen Tesno, acting on behalf of the Estate of Helen Tesno, do hereby irrevocably renounce, disclaim and refuse to accept any right, title and interest in and to the Accounts itemized in Item 6 above. While not a condition of this disclaimer, it -2- is understood that, by reason of this Disclaimer, the disclaimed property will now pass under the Will of Edith M. Tesno as follows: in equal shares to. named in Itan ~ above. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ ~ day of October, 2009. EsTATE of HELEN TESNo ., JOANN TESNO MIL ER, EXECU is~~. i iaiw~ -3- COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~~~1,c,~, On this ~~_ day of October 2009, before me, the undersigned Notary Public in and for the Commonwealth of Pennsylvania, personally appeared Joann Tesno Miller, satisfactorily proven to me to be the person described in the foregoing Disclaimer and Renunciation, who acknowledged that she executed the same for the purposes therein contained and that she desired it to be recorded as such. Notary Public COMM ~~~ S ~ N Lori A. B. Zerbe, tVot»ryr Public city tx Ha-risburg, ~auph;n County, P~Y~ania Asao ~ 10 -~ateries 154623.1 10/23/09 -4- Receipt by Fiduciary I, Joann Tesno Miller, Administratrix of the Estate of Edith M. Tesno, ad 't personal service upon me of the foregoing Disclaimer and Renunciation, on this ,~n~1~ of October, 2009. i~us~.~ ia~sro9 -5- Receipt by Beneficiary I, Hazoid Tesno, J ., admit personal service upon me of the foregoing Disclaimer and Renunciation, on this day of October, 2009. _ l~ ~ ~~ Jr. iwaz3.i iaisvo9 -6- Receipt by Beneficiary I, Linda Hochtman, admit personal service upon me of the foregoing Disclaimer and Renunciation, on this a ~ day of October, 2009. Linda Hochtman 154G2's.l 10/19/09 ^7 -/~ Receipt by Beneficiary I, Andrea Clise, admit personal service upon me of the foregoing Disclaimer and Renunciation, on this ~_ day of October, 2009. Andrea Clise «ahzs.~ ~ai9ro~ -g- Receipt by Beneficiary I, William Tesno, admit personal service upon me of the foregoing Disclaimer and Renunciation, on this ~_ day of October, 2009. William Tesno i=aha3.i iai~ -9- Receipt by Beneficiary I, Lorraine Miller, admit personal service upon me of the foregoing Disclaimer and Renunciation, on this ?11''` day of October, 2009. _ 1~ 1,. Lorraine Miller ~swz3.~ iai~ _10_ Receipt by Beneficiary I, Doris McElhenie~ admit personal service upon me of the foregoing Disclaimer and Renunciation, on this ~~ day of October, 2009. Doris McElhenie ~~.wza.~ ~a~sro~ -11-