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HomeMy WebLinkAbout12-30-09 REV 1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO Box 280601 Harrisburg, PA 17128-0601 15056041169 OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN ~ ~ 1 ~S RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 172-28-9615 01252009 02151935 Decedent's Last Name Suffix Decedent's First Name MI TESNO EDITH M (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 prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 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 CORRESPONDENCEAND CONFIDENTIAL. TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number RYAN R. GAGER 717-257-7524 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 REGISTE~F WILLS US~NLY ~_ O ~ ~ ~~ _ ~. . ,_,:. ~ ~~rn W ~ s ,r:., _ _-": J~i ~.3 %.,.. ~DAT~ FILED ~ i HARRISBURG PA 17101 Correspondent's a-mail address: ._~ `~ _Jry ,' .--~ .; -Y- -. Under penakies of perjury, I declare that I have examined this return, inducting accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS 170 FAIRWAY DRIVE, ETTERS, PA 17319 SIGN/# E OF PREP//~e//!/~/~-R OTHER HAN REPRESENTATIVE //~/D~J~A~ \/+/~/ 2 T RTH SECOND ST EET, 7TH FLOOR, HARRISBURG, PA 17101 PLEASE USE ORIGINAL FORM ONLY Side 1 15056041169 15056041169 ~ 15056041169 REV-1500 Ex (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of IndividualTaxes INHERITANCE TAX RETURN PO Box 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 172-28-9615 01252009 02151935 Decedent's Last Name TESNO Suffix Decedent's First Name EDITH MI M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number FILL IN APPROPRIATE BOXES BELOW © 1. Original Retum 4. Limited Estate '~ 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS MI 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Retum Required 0 8. Total Number of Safe Deposit Boxes 2. Supplemental Return 11. Election to tax under Sec. 9113(A) (Attach Sch. O) 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INfORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number RYAN R. GAGER 717-257-7524 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 Correspondents a-mail address: Under penalties of perjury, I declare that I have examined this return, inGuding axompanying schedules and statements, and to the best of my Knowieage ana caner, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all infom~ation of which preparer has any knowledge. SIC~TURE OF PERSON R SPONSIBLE FQjZ FILING RETURN DATE `L--~ ~ ~ ~ i B _ -, 170 FAIRWAY DRIVE, ETTERS, PA 17319 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS 2 NORTH SECOND STREET, 7TH FLOOR, HARRISBURG, PA 17101 PLEASE USE ORIGINAL FORM ONLY REGISTER OF WILLS USE ONLY DATE FILED Side 1 1556041169 1505641169 J 15056042160 REV-1500 EX Decedent's Soaal Security Number 172-28-9615 Decedent's Name: EDITH M TE SNO RECAPITULATION 0.00 1. Real estate (Schedule A) ............................................. 1. 2. Stocks and Bonds(Schedute 8) ........................................ 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages 8 Notes Receivable (Schedule D) ............................. 4. 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ........ 5. 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ....... 7. 8_ Total Gross Assets (total Lines 1 - 7) ................................... 8. 0.00 0.00 0.00 116,158.93 84,848.94 47,843.78 248,851.65 9. Funeral Expenses 8~ Administrative Costs (Schedule H) ..................... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............... 10. 11. Total Deductions (total Lines 9 8~ 10) .................................. 11. 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 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. 35,919.49 23,983.83 59,903.32 188,94$.33 188,948.33 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .00 0 15. 16. Amount of Line 14 taxable 0 at lineal rate x .04 5 16. 17. Amount of Line 14 taxable 10 0 , 7 51.0 2 17. at sibling rate x .12 18. Amount of Line 14 taxable g g ~ 19'7 , 31 18, at collateral rate x .15 19. TAX DU E ........................................................ 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0.00 ~0 . 00 12,090.12 13,229.60 25,319.72 Side 2 L 15056042160 15056042160 REV 1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME EDITH M. TESNO STREETADDRESS 6011 ROBERT DRIVE CITY MECHANICSBURG Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit File Number 21 0 9 015 5 STATE ZIP pp, 17055 B. Prior Payments 2 0 , 18 8.91 C. Discount 1 , 0 0 9 .4~ Total Credits (A + B + C) 3. Interest/Penalty ifapplicable D. Interest E. Penalty Total InteresUPenalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (1) 25, 319.72 (2) 21, 198 .36 (3) (4) 0.00 (5) 4 , 121 .3 6 (~) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) 4 , 121.3 6 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes ^ No a. retain the use or income of the property transferred : ........................................ it i d .. ^ ncome : .................. or s b. retain the right to designate who shall use the property transferre .. c. retain a reversionary interest; or ....................................................... ? .. ^ ^ .............................. d. receive the promise for life of either payments, benefrts or care .. If death occurred after December 12,1982, did decedent transfer property within one year of death 2 . without receiving adequate consideration? .................................................. ath? d h t hi .. ^ ^ .. er e s or 3. Did decedent own an "in trust for" or payable upon death bank account or security a ... Did decedent own an Individual Retirement Account, annuity, or other non-probate property which 4 . contains a benefiaary designation? ....................................................... ... ® ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1,1994 and before January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116(a)(1.1.)(i)]. For dates of death on or after January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116(a)(1.1)(ii)).The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for ~e use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's- lineal beneficiaries is four and one-had (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)j. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV 1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER EDITH M. TESNO. ~ 21 09 0155 Indude the proceeds of litigation and the date the proceeds were received by the estate. . ~~ ...,...e..., i~i~Nv~,u,naer with r~eht of survivorship must be disclosed on Schedule F. (If more space is needed, insert add'dional sheets of the same size) REV 1509 EX+ (6-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT _ _ _ EDITH M. TESNO Z1 uy ul~~ If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINTTENANT(S) NAME ADDRESS RELATIONSHIPTO DECEDENT A. Helen J. Tesno 6011 Robert Drive sister Mechanicsburg, PA B C. I I JOINTLY-0WNED PROPERTY: ITEM LETTER FOR JOINT DATE MADE DESCRIPTION OF PROPERTY INCLUDE NAME OF FprANCY1L MrSTIMION AND BANK ACCOUNT NUMBER OR Sw11LAR ATTACH DEED FOR JOINTLY~IELD REAL ESTATE. IDENTIFYING NUMBER GATE OF DEATH VALUE OF ASSET % OF OECD'S INTEREST DATE OF DEATH 1p1LUE OF _ DECEDENTS MEREST NUMBER ~~ JOINT . 1. A. 07-10-70 6011 Robert Drive 150,000 50~ 75;000.00 Mechanicsburg, Pa See Deed Book S-23 Pg. 110 2 A 1970 Wachovia Account 15,706.99 50~ 7,853.50 1010188153761 3 A 1970 M&T Account 3,990.87 50~ 1,995.44 85228052 TOTAL (Also enter on line 6, Recapitulation) I i 8 4, 8 4 8 .9 4 (if more space is needed, insert additional sheets of the same size) REV 1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & . MISC. NON-PROBATE PROPERTY FILE NUMBER ESTATE OF 21 09 0155 EDITH M. TESNO .. _ , r._ ~ :~.~_ ___..._..,..,.,., ..a.,,,e~+c,.,,~ ~ th-~~ ~~h a nn fne reverse side of the REV 1500 COVER SHEET is yes. (If more space Is neeaea, insert aaaawna~ meets v~ ~~~ ~eme ~~~1 REV 1511 EX+ (10-os) SCHEDULE H FUNERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA Tp /~T INHERITANCE TAX RETURN ADMINIS 1 1~~"~ 1 ~VE CQSTS RESIDENT DECEDENT ESTATE OF EDITH M. TESNO ITEM NUMBER A. FUNERAL EXPENSES: ~• Myers-Harner 8,632.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Joann Mi 11 e r StreetAddress 170 Fairview Drive CityEtters State PA ZIP17319 Year(s) Commission Paid: 2 0 0 9 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as daimant's, attach explanation) Claimant Helen J. Tesno . StreetAddress 6011 Robert Drive C;tyMechanicsburg State PA zIP17055 12,500.00 10,500.00 3,500.00 Relationship of Claimant to Decedent S i s t e r 4. Probate Fees 3 4 4 .0 0 5. Axountant's Fees g. Tax Return Preparer's Fees ~. Saul Ewing LLP, reimbursement of copies, postage, mileage, parking, advertisement grant of letters, Federal Express 8. Register of Wills -.Short Certificates TOTAL (Also enter on line 9, Recapitulation) 5 35,919.49 FILE NUMBER 21 09 0155 Debts of decedent must be reported on Schedule [. n~croicTinti AMOUNT 435.49 8.00 (If mon: space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-08) SCHEDULE I ~ pennsylvania - DEPARTMENT OF REVENUE DEBTS OF .DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT FILE NUMBER ESTATE OF 21 09 0155 EDITH M. TESNO Report debts incurred by the decedent prior to death that remained unpaid at tfie date of death, including unreimbursed me VALUE ATeDATE ITEM DESCRIPTION OF DEATH NUMBER - 16,132.01 1. DCM Service - Mastercard - 2, 093".97 2. Bank of America 1,354.01 3, pCM - Citibank Visa 194.78 4. Kohl's3,748.91 5. Wachovia 460.15 6 Belco Visa TOTAL (Also enter on Line 10, Recapitulation) I $ 2 3 , 98 3 ~. 8 3 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (11-08) ~ pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF 21 09 0155 EDITH M . TESNO RELATIONSHIP TO DECEDENT AMOUNT OR SHARE ' Do Not List Trustee(s) OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) RECENING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] sister 53.322 i. Helen J . Tesno c/o 170 Fairway Drive. . Etters, PA 17319 2 Harold Tesno, Jr. nephew 86 Blue Ridge Drive Levittown, PA 19057 3 Linda Hochtman niece 8590 New Falls Road, Apt. J 10 Levittown, PA 19054 4 Andrea Clise niece 1416 Washington Road Westminster, MD 21157 5 William Tesno nephew 31630 Trains Park Conroe TX 77385 6 Lorraine Miller and Doris McElhenie nieces 170 Fairway Drive Etters, PA 17319 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS 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. I $ 7.779 7.779 7.779 7.779 15.562 If more space is needed, insert additional sheets of the same size. 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 policie$ 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 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~IRlD s 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'G~: I dixect that any and all Inheritance, Estate and Transfer Taxes imposed upon my estate passin g under my Will or otherwise, shall be paid out of the rinci p pal of my residuary estate. ~h: 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 a 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 apraointment of her in Paxac~rraph SIXTH hereir_, I appoint my sister, Helen M. Tesno, Guardian of any property Page 3 of 4 Pages '. , . . which passes to a minor. EhGHTH: 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 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 r x,~,.±~ and seal this day of ~~ ~ ~~~~ , 1975. ;~~~.~~~ ~ .~~ „-;.,~'~ ( 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 a~s witnesses: ~- ;,,,_,,,_._.......~ ~ /.(.Y , ~, jai Address ~ r.,~ ,~,~;,_ ; ; r ,V~~, / '.~ Page 4 of 4 Pages ~1 ~~ ~~~ ~, iu '~~ 1 ~~ i ~~ti-~ ~ ~ , , •,,; FEIiSII~IPLE DEED--Typewriter • ,~,.~.; ,,~` ~' i ;, 1 ~, C day ~ ~ ~ ~ in tlee year of our Lord Ows y Thousand Nixe Hundred and seventy (1970) ._ _ - __ f~.ptl~tQ~tt WILLIAM H. NELSON sad LorrlE ~M. NELSON, his rife, of the City of Harrisburg, County of Dauphin and State of Pennsylvania, parties of the first 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 tenants witR right of survivors~hip,_and not tenants in co®on J .. s~ the ssaoMd ~!. j~YiPBB~t~ Th.t the laid parties of the firm part, for and in consideration --- - - ofthesum of Nineteen. Thousand, Nine Hundred ($19,900.00)*---------------------- bollars, lanvful mone~r of tht Unittd States of dmerica, tivell and truly paid by tht said part of the sserond part to fhe said part ie~f the first part, at and before the staling and detiver~r of these presents, the receipt anhereof is hereby aeknotanledged, have granted, ba*gaisc~d, cold, aliened, enfeoffed, released, co+~~e~red, and confirmed and by these presents do grant, bargain, seu; alien, tnfsof f, release, con+vay, and confirm Lento tl~s Laid part of the sseond part heir. and sssigns,'~ as joint tenants with right of survivorship and itenants in comemon. ~~i that certain lot or .piece of land situate in the Tawnshi of H den Count p ~ ~ y of Cumberland and State of Pennsylvania, 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 Lota Nos. 150 and 151 on the hereinafter mentioned plan of lots; thence north 27 degrees S4 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 - - -~ptaa~; ttrenaa~ south 27 degrees 5~i m3.nutes 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 62 iegrees 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 recoried in Plan Book 10, page 17, Cumberland County Records. ~G e!' M O O (C CO ~ O M tG 1~ tt) C M CO N O O ~ f~ t7 N ~A ~ ER~t~I~ °w cn > w U Z Q W a w ~w ~ o as zw~Z zww0 aaZLL ~W~-> ~Q~w ao=w ,J 1- Z ~ ~ N (~ ~ O W W W F-JJJ a m x w w J W U z 0 m 0 m 0 v w c a~ m Q QSecarif~, e_-.ahaoce - ---~_ `. Citizen ---~-_ d d~ m`S ° e back ! v ~ "- --'_ __-'------- s Bank details-~ P+~r~nsyiwnla "o. 1032 PAY TO THE 3-~sisr,~so ORDER OF DATE L -- _ ~ 9 ~ . - ~srarE of ~'" "~ ~'~`Ue pONALD F, ROL.ANp R, ENO ESTATE OF TESNO CO-EXEC JOHN ~ VI-. HORN CO-E~CEC 372 ~INO7 OM WAY FOR ~i-ESTO'WN, PA 1T340 f ` L ~ a'00 LO 3.2n~ t;0 360 ?~ i SOt; ~N $ ~ 8~ Scb f DOLLARS _.~~ __ '' -.-~ ~----r_ ` - ~..~__-_..._._.__ -------.-.._._~___.----~----___-- _.. _._._ __.._-__.----•-~ ~ .REPR~~fESEWTI~ AT1VE 62163?22?t,a~ E TLR BRN TER T/C AMOUNT TRAN # ACCOUNT# Q# SEQ 1C C 486 W 12,681.65 70 164290 0 DIRECT DATE TRANSACTION TELLER 021209 WITHDRAWAL Kristy C. BALANCE TYPE OLD BALANCE AMOUNT NEW BALANCE S1 - SAVINGS 12,686.65 12,.681.65 5.00 nGLCrv J. I C~IVV, t7CtC:U'I I~IX FOR ESTATE OF EDITH M. TESN,O CHECK NO: 03000095 -DATE: 02/12/09 DETACH THIS PORTION BEFORE. DEPOSITING B~ BELCO COMMUNi7TY CRE~I7 UNION E~A-TE L~~ P.O. Box 82 Harrisburg, PA 17108 02/12/09 COMMUNITY CREDIT UNION 1_800_642-4482 www.belco.org PAY TWELVE THOUSAND SIX HUNDRED EIGHTY ONE AND 65/100 DOLLARS TO' :HELEN J. TESNQ, EXECUTF~tX THE FOR ESTATE OF EDITH M. TESNO ORDER OF Official Check No. 03000095 AMOUNT VOID AFTER 90 GAYS UT11 ED SIGNATt1RE ~I' 30000 9 5~~' I: 2 3 L 380 9 9 ?~:u' 900000 4 5~~' ?8 ANNUITY s0 Statement Date: August 14, 2008 Provided by Jacksons"" For the period August 14, 2007 to August 14, 2008 www.jnl.com Prepared for. Edith M Tesno 6011 Roberts Dr Mechanicsburg PA 17055 Activity Summary Beginning Period Policy Value $1fi,580.38 + Interest Eamed for Period g~.92 - Withdrawals for Period x_00 Ending Period Policy Value $17,247.30 Your Transaction Detail SM NATIONAL LIFE INSURANCE COMPANY Your Representative: MARUN WEDDE 455 SCOTCH PINE RD DILL.SBURG PA 17019-0000 Account Information Policy Number. 0000810650 Annuity Type: Nonqualified Issue Date: August 14, 1977 Owner(s): Edith M Tesno Annuitant(s): Edith M Tesno Date Transaction Type Transaction Amount 8/14/2008 Interest Earned for Period 5666.92 ;~R~: ~ ~ _____________ ~ ~ ~ L C, Your annuity earned an annual effective rate of 4.02% Burin this statem ' ~ ~ ~ ~~ ~ -~ 9 ent period. The annual effective rate represents the average credited rate on your policy in the last year. Congratulations! You're putting the power of tax deferral to work for you. You're saving the smart way, you don't pay taxes until money is withdrawn! Tax penalties may be levied by the internal Revenue Service for surrender prior to age 59 1/2. Questions? Please, contact your Jackson representative, or call us at 800-644-4565 x Monday-Friday, 8:00 a.m. to 8:00 p.m. (ET). .. Write us at Jackson Service Center, P.O. Box 24068, Lansin , MI 48909-4 Email us at CustomerCare@jnli.com. g 068 u~oF~ twbUOO-+ rN m oc: sr oooorna~o oo05ce7 ac~ryzoae fncx f4Sr Al l i an z it ~ P.O. Box 59060 Minneapolis, Minnesota 55459-0060 1-800-950-1962 June 18, 2009 Re: EDITH M TESNO, deceased Policy Number: 6768082 Taxable Amount: $30,137.89 Dear ESTATE OF HELEN TESNO: No. 5763181 Check Date: 06/18/2009 Please accept our sincere sympathies and thank you for providing the necessary information to process your claim. Attached is a check in the amount of $30,13 7.89 representing your net benefit. You will be receiving a 1099-R early next year indicating your gross distribution amount and the taxable amount of $30,137.89. Should you have any questions, please do not hesitate to contact your agent or call the Claims area at (800) 950-1962. Thank you. Sincerely, Claims Department Allianz Life Insurance Company of North America C: JAMES MCELHENIE Office #000044429 Allianz il~ Wells Fargo Bank Ohio. N.A. 195 Hospital Drive Check # 5763181 P.U. Box 59060 Van Wert, OH 45891 Minneapolis, Minnesota 55459-0060 ss-3s2ia~2 Vendor Number Check Date 1-800-950-1962 00006768082 06/18/2009 VOID AFTER 120 DAYS PAY_'I!'Gtt~ 7lr~ousa,.rd du ~urc~ed '1l~utty $euec r~2D ~9/l Check ~trnouraf TO THE ESTATE OF HELEN TESNO ORDER C/O JOANN TESNO MILLER ~~ OF 2 NORTH 2ND ST 7TH FLOOR HARRISBURG, PA 17101 II'000 5 ? 6 3 L8 l++' ~:0 ~. L 20 38 2 4~: 9 6000 X88 5 t,i+' Consolidated Statement ~~ ~i~ 02 1010188153761 752 30 WA~HOVIA 0 12 53,681 1 /21 /2009 thru 2/18/2009 Crown Classic Banking Account number: 1010188153761 Account owner(s): HELEN TESNO Account Summary Opening balance 1/21 _ $16,426.35 Interest paid 0.64 + Checks 720.00 - Closing balance 2118 515,706.99 Deposits and Other Credits Date Amount Description 2/18 0.64 INTEREST FROM 01/21!2009 THROUGH 02/18/2009 ota Interest Number of days this statement period 29 Annual percentage yield earned 0.05% Interest eamed this statement period $O.fi4 Interest paid this statement period $0.64 Interest paid this year $x.41 Checks Number Amount Date Number Amount Date Number Amount Date 1013 520.00 2/06 1014 200.00 2/1.7 ota 7 .00 Effective April 1, 2009, Section 6 of your Debit Card Agreement and Disclosure is amended to show the International Service Assessment fee as 396. WACHOVIA BANK, N.A. , HARRISBURG CAPITOL page 2 of 3 .. a -_: ; . .. ~ i ~ • _ __ °• ; CHECK NUMBER: s2-a i ~apita~ BlueCrass 30020272 31 ~~ Capital Advantage Insurance Company' serves as claims paying agent an beha!t of itself. Ca;:,tai BfuaCrass: and k:eystane Health Pfan"" Central 0~~5~09 Independent Licensees of the Blue Crass and Blue Shield Assaciatian PAY TO THE ORDER OF: EDITH M TESNO C/0 TI#f ESTATE OF EDITH M. TESNO 6011 ROBERT DR 26-01 MECHANICSBURG PA 17050-6853 ~rrr~~~rrr~~~rrrr~r~r~~rrrr~~rr~rr~rr~r~rrr~~rrrr~~rrr~~rr~~r~ The Bank of New York Mellon., Philadelphia, PA VOID AFTER 180 DAYS CHECK AMOUNT: **#**Y#~**$126.00 ~ o~- ~~' 300 20 2? 2u• ~:0 3 i i000 4 ?~: 2•u 9 6 7 6 3 6u• z~'„~ l~uu~ '--•~:~t)7~~ i`'iF. ~5~~ F<:GiW Ii"` Fti "-L•F= Ui~II -- ~ ~.~3~~~i•~•3 ~~Er w ~c"~.. ~ Ii7 TL7 p EIS ]:Tip ~ •i•Irwii~lC2 Tf~TA(... i} I~T~ . ~ yF~~ u x ~~ 2ri• „ ~•#~ - N ~ ~ D P.O. BOX 3261 ® WACHOVIA, 30/310 HARRISBURG, PA 17105 Central Penn DATE OUR REF. NO. CHECK NO. AMOUNT OF CHECK 4~~r!{11lt}9 i~II~C.i~i~:i~# 197~ib7 ~u~~~~~a~24p3?~ 'i'~iC~l~'Y•-•F"CIUF ~?pl.-l..~F~`~ T>~S If~TY-Ti~,l~ CE~IT~ PAY ~i4 ~.1 F4QL~~I:iT~i ~F~ oROE of I~IE~Hl1i~lI~ri~tUF~Gg r-`p ~.70~ ~-•~~~~ voio AFTER 60 DAYS.. ~" ~ •r 't ~ • • , _... .. .. .: .. .~: ~n ..... TiJRE ~~' 2 ?6 L4 3~~' ~:0 3 L000 50 3~: 20006 L i L 285 5 ?~~' THE PATRIOT-NEWS PO Box 2265 Harrisburg, Pq 17105 Check Date: 04/03/2009 Invoice Number Vendor Number: 0000005686 040109EMT Invoice Date Voucher ID Check No. 0900035645 04/01/2009 Gross Amount Discount Taken SUBSCRIPTION REFUND 00110998 Paid Amount 78.50 0.00 78.50 c c r c i n u Receive your payments faster! Ask how! Ca!! us (866) 21 I -2620 opt j Questions regarding this check contact the AP Dept 717/255-8260 Check Number 0900035645 Date Total Total 04/03/2009 Gross Amount Total Discounts Paid Amount $78.50 $0.00 $78.50 ~ ~` - -_ ~ '~ ~~~ Oa, .~~~.. ~ ~ r~i ~ ~ ! ~,. '-_ U U .~ ~_ cr a~ ~ T Ski ~~ i] ~~ ~~ ~ ( f ~ r, Q ~' _- __ T-~ ~-~ € '.y i ! - ~ f ._ ~ ~ ~r.1~ ~;~•,~~ # .~ gg ' f ~ '" l1 i ~ ,~ - 'c - M - - ~,._ - y~~?• JJ ~~ Y 1 'K .t .,..- ~ ~ ISl ~~ - z m * N ~ a-- '~ ~ ~ ~ y ,R i i rep: c _ ~-- a yc .t. •c 4O• a ~ ~ O t ; N F M r~ ~.a~~ {_uL.. ~ ' ~ t: ~' y ~ ~ t~'1 ~% E i y } ~`_ y ~ m ~ is:..,;,.ti. ~:f ; ~ .~--~~, ... 3 Q v ii _ iiZ CL C} ~ z+ ~~ fl.s C'1I G IL W *~1 i.V +~'•~ ,~ ~ a w OG W ~ u n LsJ ~/? !Y Z i3y' _._ _ 54"'!i w, ' ~ - ~ ~ ~ i s@ ~ M C Z O C2oW C i 1- ~D S ~ F- U . ~ DOUBLEDAY ENTERTAI(~MENT LLC 501 FRANKLIN A~N~ GARDEN CITY, NEW Y01~ 11530 Estate of 2198 0031-10-17-MAAD MS EDITH TESNO 6011 ROBERT DR MECHANICSBURG, pA 17050-6853 ~~~~~~~~r~ll~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~i~~~~~~~~~~1~~~~~~ ---~-~~+~~ ~ nvMt3ER: CHECK NUMBER: 891301731 0030633173 PAY11rIENT SUM~gRY CHECK DATE: 0 3 / 19 / n A CLUB NAME: Doubleday Large Print DEAR MEMBER, THE ATTACHED REFUND CHECK IS REIMBURSEMENT O YOUR CANCELLED BOOK CLUB ACCOUNT. FAN OUTSTANDING CREDIT BALANCE ON REGARDS, MEMBERSHIP SECRETARY (DOta~ HYrly DOUBLEDAY ENTERTAI(~MENT LLC 501 FRANKLIN AVENUE GARDEN CITY, NEW YORK 11530 Estate of 2198 0031-10-17-MAAD MS EDITH TESNO 6011 ROBERT DR MECHANICSBURG, PA 17050-6853 ~~~~~~~~~il~~~~~~~~~~~~~~~~~l~~l~i~~~~~l~i~l~~~~~1~~~~ll~~l~~l PAYMENT SUMMARY ACCOUNT NUMBER: 8913017 31 CHECK NUMBER: 003063317 3 CHECK DATE: 03 / 19 /09 CLUB NAME: Doubleday Large Print DEAR MEMBER, THE ATTACHED REFUND CHECK IS REIMBURSEMENT OF AN OUTSTANDING CREDIT BALANCE ON YOUR CANCELLED BOOK CLUB ACCOUNT. REGARDS, MEMBERSHIP SECRETARY ... ................. _... ......... ............. .... ............. N.fad~ Hrr.~ .: DQ~~LE,~?aY ~~1'TERTA~(~Il~EI~T LLB ..... ~ . ... .. :. ..: . 50~:FRANKLIN AVENUE :: GARDEN CLTY NEW YORK 11530 :;~ ~ :.. . ::. 60--150/433 :: .....:. .. ... ..... 1•: 7• ...... .... ..L .... 1......... .::.... .... .... ., c r~ • .~~ 03/19/2049 0030633173 TO THE Estate of $********22.25 ORDER 1~LS EDITB TESNO OF: , 6011 ROBERT DR MECHANICSBURG, PA .17050-6853 { THE -BANK OF 'NEW YORK. MELLON ~ PITTSBURGH, PENNSYLVANIA ~~'00 30 6 3 3 L? 3~i' ~:O ~ 3 30 L 60 L~: O 2 2~~~ 3 9 68ii' ~ M&T Banlc 5528 Carlisle Pike, Mechanicsburg, PA 17050 717 766 0507 Fax 717 766 1793 Apri13,2009 Mr. Kevin Scott Saul Ewing 2 North Second Street, 7th Floor Harrisburg,Pa 17101 Dear Mr Scott, In reference to your request for information on Edith Tesno we show the following account with our bank: M&T Classic checking with interest account #85228052 Date opened June 28,1970 Balance on date of death $3990.82 Accrued interest to date of death .OS Total $3990.87 Account in the name of Edith Tesno or Helen Tesno If you need any additional information please let me know. Thanks. Yours truly, Margie H Fealtman Personal Banker Hampden Branch ~~~ ~ 6 20~~ (~ /.~ W~ I ~~ re: IN THE COURT OF COMMON PLEAS OF ESTATE OF HELEN TESNO CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION DECEASED NO.21-09-0245 ORDER ~1 AND NOW, this ~ day of ~y ,~~ ~,~' , 2009, upon consideration of the annexed Petition, it is hereby ORDERED that Joann Miller, Executrix of the L.state of f~Ielen Tesno, is authorized to disclaim assets on behalf of the Estate as set forth in the Disclaimer attached hereto. By the Court: ~~ J. ~~ ~ .j ~~t;nor:Y ~+herof, I here+~nio ~~:~ ~r~ trend and the seal of said ~dUrt at ~ariisle, PA c~ C O ~, ° . r`, ~~~~ - . o L'."" t -~.~m ~ 1:7~ ~ ~ ~~ ~ --~ w .. ct~ w ~~ f'f'y '} f .~'} r ` ~.~ ~;._ - ~=~ ..~-=- c..., ., In re: IlV THE COURT OF COMMON PLEAS OF ESTATE OF HELEN TESNO CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION DECEASED ; ~ N N0.21-09-0245 ;,-, : .,:a ~, ,: ,.~ . , ;-~ ~~~ _ PETITION FOR AUTHORIZATION TO DISCLAIM A PORTICFN f~l~-' -~~ i ~ ~. , ESTATE IN ACCORDANCE --= - ~-~ ~ - ; ~ ~- _.__, WITH ~ 6202 OF THE PROBATE, ESTATES AND FIDUCIARIES`~CODE ~ . `t 3 rt~ ~ - :_ 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 isarw i ioizsro~ by Decree of the Register of Wilis 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, Esquir~(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 unswom falsification to authorities. Estate of Helen Tesno By: Joann Miller, Executrix Dated: /O ~ ~ / -- ~D~ ~~.> >~~ ESTATE OF ~~ T~ 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 f ~, 2009 Harold W. Tesno, Jr. i sac,~b. i i an sio~ -~- ESTATE OF I~ 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~f , 2009 William L. Tesno 154G66.1 !0119/09 -6- ESTATE OF .~~ -. TESNO, IN THE ORPHANS COURT DECEASED CUMBERLAND COUNTY, PENNSYLVANIA N0.21-09-x+5 JOINDER I, Linda Tesno Hochtman, beneficiary, hereby join in the prayer of the within Petition. ~ ~A ,/ ~~ ~ Dated: October , 2009 Linda Tesno Hochtman 154fiG6. 110/ 19/09 _7_ ESTATE OF ~~~ ~ TESNO, IN THE ORPHANS COURT DECEASED CUMBERLAND COUNTY, PENNSYLVANIA N0.21-09- 0245 JOINDER I, Andrea Tesno Clise, beneficiary, hereby join in the prayer of the within Petition. Dated: October ~ , 2009 Andrea Tesno Clise 154666.1 10/19/09 p -O- ESTATE OF ~i ~ TESNO, IN THE ORPHANS COURT DECEASED CUMBERLAND COUrNTY, PENNSYLVANIA N0.21-09- 0245 JOINDER I, Lorraine 11/Iiller, beneficiary, hereby join in the prayef of the within Petition. Dated: October 1.0~; 2009 r Lon~a~:~Miller -9- ESTATE OF : ~ TESNO, IN TIC ORPHANS COURT DECEASED CUMBERLAND COUNTY, PENNSYLVANIA NO.21-09-p245 JOINDER I, Doris Miller McElhenie, beneficiary, hereby join in the prayer of the within Petition. Dated: October~,c~ , 2009 r ~N1~~~1~~~w Doris Miller McElhenie ,~.> > -10- ESTATE OF ~~ TESNO, IN T~ 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 Joann Miller, Executrix ~., -11- 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 hand 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 K. 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 • coartplete 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. .-_ THIRD: 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. ~FOT3RTH: 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. _: In 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 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 ~c,~ and seal this ~~ day of --~.i , 1975. i„ l.G~-~y ~'1~ ~ llir-~:CJ (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: `/~~y~v'~ .~~a-'ai,~~~ Address~i ~-~~ `~/,~iv-~„-y~wr~~.~~/~ ~ ~ Address ~U. ~ !! " ! ~j _ / ~~ 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 i 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 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. 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. 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. 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 i 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 appointment 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. EI,~: 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 `~jGC~ , 1975. ~' ~{~C2-,~ Gy( • .~~~ (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: '"i/ ~ ;,,~~- ,f"' ~%'/ ,.. ~ Address ,~ ':,. ~ Gl~y~+r -~ 4. + ~ L~• r Addres s ~ ~7, .~ ~ ~-~ :• ~_ ~ ~, Page 4 of 4 Pages In re: IN THE COURT OF COMMON PLEAS OF ESTATE OF EDITH M. TESNO, CUMBERLAND COUNTY, PENNSYLVANIA 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 $12,681.65 $1,202.00 $126.00 $24.32 EXHIBIT 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 will now pass under the Witt of Edith M. Tesno as follows: in equal shares to. those named in Iten ;above. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ e~ day of October, 2009. ESTATE OF HELEAI TESNO ~. JOANN T'ESNO MIL ER, EXEC -3- COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~~~1.c.,~, 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 LTN PENNSYL NW Notarial Seal Lai A. B. Zerbe, Notary Public ~Y O/ Harrisburg. Dauphin ssion• s Jan. 7 2010 Member Pennsylvania Awn of Notaries 154G23.1 10/23/09 -4- Receipt by Fiduciary I, Joann Tesno Miller, Administratrix of the Estate of Edith M. Tesno, 't personal service upon me of the foregoing Disclaimer and Renunciation, on this ~_ of October, 2009. ,3a623.~ ~a~~ -5- Receipt by Beneficiary 1, Harold Tesno, J ., admit personal service upon me of the foregoing Disclaimer and Renunciation, on this day of October, 2009. /~,~ ~. ~~ Jr. iwea3.i iai~ -6- Receipt by Beneficiary I, Linda Hochtman, admit personal service upon me of the foregoing Disclaimer and Renunciation, on this o~ 1 day of October, 2009. Linda Hochtman 154623 1 10/19/09 _~_ Receipt by Beneficiary I, Andrea Clise, admit personal service upon me of the foregoing Disclaimer and Renunciation, on this _ E! day of October, 2009. Andrea Clise t>ac,23.t to/19ro9 p -O- 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~ahz;.i ia~~ro9 -9- Receipt by Beneficiary I, Lorraine Miller, admit personal service upon me of the foregoing Disclaimer and Renunciation, on this Z0~'` day of October, 2009. Lorraine Miller ~sabaa.t ia~~ -10- Receipt by Beneficiary I, Doris McElheni~idmit personal service upon me of the foregoing Disclaimer and Renunciation, on this ~_ day of October, 2009. Doris McElhenie ~~zs_i iai9+v9 -11- In re: IN THE COURT OF COMMON PLEAS OF ESTATE OF EDITH M. TESNO, CUMBERLAND COUNTY, PENNSYLVANIA DECEASED ORPHANS' COURT DIVISION N0.21-09-0155 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. 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: 5. At the time of Edith M. Tesno's death she also owned the following: 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 ~~ ~J , . r__=; ~ ~::~:; -~ . ~ ._ ,- $126 00 ~ -°_; ~ , , ; ! c~ . ~ -, : $24.32 ~_:: ;_~ _._, ~: ~~ :, '~ 3'. '-1 ~ti.7 - ~ , __~,, C^ ~.., 7 -- __ .':J ~ '~ ~. w , 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 Wi 11 of Edith M. Tesno as follows: in equal shares to. moose named in Iran r above. IN WITNESS WHEREOF, I have hereunto set my hand and seal this aZ ~ day of October, 2009. ESTATE OF HELEN TESNO ~- JOANN TESNO MIL ER, EXECU ~sae~.~ ~ai~ -3- COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~~~,c.~„ On this ,E~pZ 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 l PENNSYL NIA Notarial Seal Lori A. B. Zerbe, Notary public ~Y Of Ffa--lsburg, Dauphin County sslorti Ex s ~• 7 2010 Member, Pennsylvania Associapon ~ 154623.1 10/23/09 -4- Receipt by Fiduciary I, Joann Tesno Miller, Administratrix of the Estate of Fdith M. Tesno, ad 't personal service u n me of the fore o' Disclaimer and Renunciation, on this n~1a~p of October, l~ g ~ ~._ 2009. a ~ Joann Tesno Miller, -5- Receipt by Beneficiary I, Harold Tesno, J ., admit personal service upon me of the foregoing Disclaimer and Renunciation, on this day of October, 2009. i~~ ~. ~~ Jr. 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 154(123 110/ 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 ~~a~~3.- ~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 isahz3.i iai~ro~ -9- Receipt by Beneficiary I, Lon~aine Miller, admit personal service upon me of the foregoing Disclaimer and Renunciation, on this Z0~'` day of October, 2009. ' ~ C ~~ ~.. Lorraine Miller ~s~za.~ iai~ -lU- 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 t~z3.i ia~~ -~ 1-