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HomeMy WebLinkAbout04-0103PETITION FOR PROBATE and GRANT OF LETTERS also known as To: Deceased. Social Security No. Register of Wills for thc County of Commonwealth of Pennsylvania in the The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older a~he execut/~iX ~-~1~'/q/--~/~/f~- named inthelastwilloftheaboved~cedeot, dated, ,~;Lu I~; IQ~' ' ,l~ . (state relevant circumstances, e.g. renunciation, death of ex~utor, etc.) .Decendent was domiciled at death in ~m~¢~m~ County, Pennsvlvania, wi~ h ~q last family or principal resi.dence at ~ ~ ~/~ k ~ F~H ~ ~ ,~o ~ i/,~ 19011 ~t strut, numbdr and muncipality) Dgcgndent, then ~ ]. years of age, died E~C~pi ~s foliows, d~en[ did not mh~ry,~as n~t ~vorcedan' d did not have a child born or adopte~ after execution of the ~11 offered fo~ prob~e; was no~ the victimo[a gilling and ~s never a~judicated o~enaent at aeam ownea Property with estimated v~ues as follows: (If domiciled in Pa.) All person~ property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property V~ue of real ~tate in Pennsylv~aOW~a ~s~n~_ f~ff~~f~~ situated. ~ follows- ~ ~ Z~E~ ~T~N Z~,~ . · . _ ~ ...... , WHEREFORE, petitioner(s) res~ctfully~quest(s) the probate of the last will and codicil(s) presented herewith and the ~ant of letters ! fL5 theron. (t~tmentary; adm~stration c.t.a.; a~iMstration d.b.n.c.t.a.) OATH OF' PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF The petitioner(s) abOve-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal repreSen- tative(s) of the above decedent petitioner(s) will welI and trUly administe~ the estate according to law. Sworn to or ~irmeJt and subscribed 'c ~ before me this ,-~c'7_../~ff-- day of ! [ ] ~' .z egister ~[. ~_ ~. . .~ fi . j 1 ~~ .t"). 1", I"') t ,I 4:::. (:. ~ Register of Wills of Cumberland County, Pennsylva,Q,a,.i~- \')1 d ; , AMENDED INVENTORY Estate of Langdon A. Jackson. Jr. also known as , Deceased No. 2004-00103 Date of Death November 26.2003 Social Security No. 236-62-0967 Personal Representative(s) of the above Estate. deceased. verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent. that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. l!We verify that the statements made in this Inventory are true and correct. l!We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Address: Keefer Wood Allen & Rahal, LLP 635 N. 12th Street, Suite 400 Lemoyne, PA 17043 Telephone: 717-901-7786 Dated Name of Attorney: Stephanie Kleinfelter 1.0. No.: 80089 Description Value See Attached Sheets Constituting The Amended and Restated Inventory $734,186.31 (Attach Additional Sheets if necessary) Total: $734 186.31 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may. at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. Form RW-7 (Cumberland County - Rev. 9/92) \~ ... RECEIPTS OF PRINCIPAL Estate of Langdon A. Jackson, Jr. As of 12/31/2006 Assets Listed in Inventory (Valued as of date of death) Cash on Hand Replacement Dividend Checks Checking Accounts PSECU Savings Accounts PSECU-accrued income PSECU-savings $ 23.30 45,859.13 Common Stocks 3M Co 501.29 units $165.00 Accrued Dividend AT&T Corp 545 Units AT&T Wireless Svcs Inc. 482 Units Additional Shares 3M 500 Units Agere Systems Class A 13 Units Agere Systems Class B 342 units American Elec Pwr 300 units $105.00 Accrued Dividend Avaya Inc. 108 units Baxter Intl Inc. 600 units BellSouth Corp 1,188 Units Biomet, Inc. 2,025 units Caremark Rx Inc. 106 units Centerpoint Energy Inc. 200 Units $20.00 Accrued Dividend Citizens Communications Co. 975.69 units Comcast Corporation 363.5 Units Diagnostic Prods Corp 400 Units Edwards Lifesciences Corp 60 Units $ 39,804.51 10,815.53 3,578.85 39,537.50 46.09 1,155.96 8,394.00 11448.28 16,497.00 311202.82 71,857.13 2,800.52 1,951.00 10,644.78 7,666.22 17,800.00 1,796.10 Page 1 Fiduciary Acquisition Value $ 1,ll3.02 0.78 45,882.43 ... RECEIPTS OF PRINCIPAL Estate of Langdon A. Jackson, Jr. As of 12/31/2006 Assets Listed in Inventory (Valued as of date of death) Exxon Mobil Corp 2,928 Units $732.00 Accrued Dividend Fortune 800 Units $240.00 Accrued Dividend Gallaher Group PLC 800 Units $513.12 Accrued Dividend ReA Inc. 150 units $3.00 Accrued Dividend Healthsouth Corp 126 Units Humana Inc. 100 Units IBM Book Entry Account 153 Units International Business Machs 51 Units $8.16 Accrued Dividend Ivax Corp 303 Units Lifepoint Hospitals, Inc. 7 units Lucent Technologies Inc. 1,296 Units NCR Corp 62.5 units Pepco Holdings Inc. 100 units Reliant Resources, Inc. 157 Units SBC Communications Inc 468 Units SBC Communications Inc. 1,179 Units Sysco Corp 1,600 Units TXU CORP 100 Units Teco Energy, Inc. 100 Units Telephone & Data Sys Inc. 225 Units Tenet Healthcare Corp-636886103 610 Units Tenet Healthcare Corp-88033G100 305 Units Texas Genco Hldgs Inc 10 Units $2.50 Accrued Dividend Triad Hospitals Inc. 7 Units $106,462.08 55,304.00 32,781.12 6,261.00 500.85 2,186.50 31,264.02 4,577.76 6,502.38 207.62 4,030.56 2,167.50 1,842.50 977.33 10,930.14 27,535.55 57,376.00 2,207.50 1,295.00 14,068.13 8,960.90 4,480.45 304.85 239.26 Page 2 Fiduciary Acquisition Value ~ ,. Assets Listed in Inventory (Valued as of date of death) Tyeo IntI LTD New 304 Units Ventas Ine. 93 Units Verizon Communications 584 Units XCEL Energy 147 Units RECEIPTS OF PRINCIPAL Estate of Langdon A. Jackson, Jr. As of 12/31/2006 Mutual Funds American Century 021-000915640 185.496 Units TOTAL INVENTORY $ 6,882.56 1,844.19 19,126.00 2/455.64 Page 3 Fiduciary Acquisition Value $679,767.68 6,319.85 $733/083.76 ,..1 .. RECEIPTS OF PRINCIPAL Estate of Langdon A. Jackson, Jr. As of 12/31/2006 Receipts Subsequent to Inventory (Valued when received) Med Partners, Inc. 12/10/2003 Mutual of Omaha refund 10/31/2006 PA Department of Revenue 11/08/2005 Pennsylvania Department of Revenue 10/31/2006 u.S. Treasury TOTAL RECEIPTS SUBSEQUENT TO INVENTORY SUMMARY Total Inventory Total Receipts Subsequent To Inventory TOTAL RECEIPTS OF PRINCIPAL $ 21.19 46.36 692.00 27.00 316.00 Page 4 $ 1,102.55 ----------- ----------- $733,083.76 1,102.55 $734,186.31 CHARLES W. RUBENDALL II ROBERT L. WELDON EUGENE E. PEPINSKY. ..JR. ..JOHN H. ENOS m GARY E. FRENCH DONNA S. WELDON BRADFORD DORRANCE ..JEFFREY S. STOKES ROBERT R. CHURCH STEPHEN L. GROSE R. SCOTT SHEARER ELYSE E. ROGERS CRAIG A. LONG YEAR ..JOHN A. FEICHTEL DONALD M. LEWIS m STEPHANIE KLEINFELTER ERIC R. AUGUSTINE TODD F. TRUNTZ CAROL L. VERISH KEEFER WOOD ALLEN & RAHAL, LLP ATTORNEYS AT LAW 635 NORTH 12TH STREET, SUITE 400 LEMOYNE, PA 17043 ESTABLISHED IN 1878 PHONE 717-612-5800 FAX 717-612-5805 OF COUNSEL: HEATH L. ALLEN N. DAVID RAHAL SAMUEL C. HARRY EIN No. 23-0716135 www.keeferwood.com HARRISBURG OFFICE: 210 WALNUT STREET HARRISBURG. PA 17101 PHONE 717-255.8000 717 -901-7786 skleinfelter@keeferwood.com Fax: 717-612-5805 June 11, 2007 Cumberland County Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, P A 17013 RE: Estate of Langdon A. Jackson, Jr., Deceased Amended Inventory No. 21-04-0103 r:-) ~;:: 0 . "-;1 i"\o.___; -r' f'.,) 1'<' r'"" Dear SirlMadam: Please file one of the enclosed Amended Inventories, and date stamp and return the other for my records. I have enclosed a $15 check in payment of your fees and a self-address envelope for your convenience. Thank you. Sincerely, KEEFER WOOD ALLEN & RAHAL, LLP By SKlwaw Enclosures cc: Sandra L. Jackson, Executrix (w/enel.) i 3E>Y.LSOd SO) ~I~I~~.I l/') I "': ;: ~ I ..... ..... :::: &1.., ! - 8 II o 'I H3lSVH '- ~ ~:t. 4 ~l I~~-;~ '~\:.r'~~i,,~ ,'... '~,;.' ~:..L~' ': ~~. ~ '~~~ ~.t)~'J&.:.'t ..I - II( :i a: - LL o o ~ ~ ...j,.j '3M U)~ o ...j,.j"'t- ~......t ~ .b~ U) ..c ~"' ...j,.jS:: C\J:>' ......to ..cE ...j,.j ~ 8~ z t.n M ~ 00 S ~ ~ Q) o 00 $.t ::l Q) 0 ~..s:::= oo~ '6h ~ Q) 0 ~C) t> ~ ~ $::l~(ljC'l:l ::l::l::ll"""'i o 0 040 C,:H;,,) 00 ~ Q)l"""'i "'0"'000< a $::l ::l 1"\, _(ljO_ $.t~..s:::= ~ Q)Q)~Q) ..o..o~a1 S S 5 ~ ::l ::l Q $.t QUl"""'i8 s . . ~'.~\.X',: ;<'.,~', ;'-"~"._~- , .. ::t't, '.,,:." -~---- :...... . .. ,"':t" ,;. 'iF : ~ .-.:' ' , "::-=- ' ' . 'TilE' f/;-$ . ':.~ ""', ,,'- .:::i:"'" ; A. ~ Estate Of No. , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~,Q00'~, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, , IT IS DECREED that the instrument(s) dated described therein be admitted to probat~and filed of re.rd as the last will of ~d Letters ~e hereby ~aated to ~/'~f~ FEES Probate, Letters, Etc .......... Short Certificates~.~. '.0~).. .... Renunciation ................ TOTAL ~ Filed..,~.~..'..,~.:.. ~~ ........... .--- Register of Wills of ~'0/~/.L~,'~ County, Pennsylvania RENUNCIATION aL~o knowfl H · Deceased above Decedent. hereby renounce(s) the right t~ administer lhe estate ~ respecttully request(s) thm~ WITNESS hand this J day of ~-cP> P"~'L .~ ~ .~ (Signature) (Address) (Signature) Sworn to or alfirrned and sub__.~nl3ed befor, me this ~) day Notary Public My Commission Expires: (S~gflan~m and meal of Nolne/or o~ ollicid ex~a;~ oJ Noto~'/c~wdniuio~) (Address) M~y NOTARIAL CHARLES A. HARBOLD, Notary Public Camp Hill Bom, Cumberland County Commission Expire8 Dec. 30, 2006 NOTE: Renunciations executed outside tho Office of Register o~ Wills in ~rno counties are required lo be notarized. Ferrn eRW-4 Prepared by ~e P~nsytv-a~m Ba~ A--m=imlm~ 1~81 his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee £or this certificate, $2.00 P 88107 1 No. COMMONWEALTH OF PENNSYLVANIA CERTIFICl NAME OF DECEDENT (F~¢sl, M ~;~le. LaSl} ,. Langdon Andrew AGE (La~ 8.1t~lay) J UNDER I yEAR 91 Y,,. Jackson, Jr. ,. male *-236 -- 62 -- 6967 14. I October 11 ~ J,. 1912 ' . ynchburg, VA ~. Dauphin ~. Harrisburg ~. Harrisburg Hospital [~.~.P~o~.~. ,0. white ,,.. Colonel ],,~.US Armed Forces ~. JACTUAL ll..S~e Pennsylvania ~ ,,.~ ~.~ Lower Allen 402 Blacklatch Lane ~mm~ Camp ~11, PA 17011 ,,. Lan~don Andrew Jackson, Sr. INF~MANT'S NAME Carolyn Jackson ,m co~.~ Cumberland MOTHER'S NAME (F~rsl M~(~e. Mad~ S~name) ,,. Elsie Horner ~. 402 Blacklatch Lane, Camp Hill, PA 17011 ;~o~,~,,01 o~,~""1-1 c,~mmlX1 R..~a,,~s~,.~ ~l,~b~vember. 29, 2003 ,,~.Y°rkt°~e Crematory J2'd. York, PA 17404 SS~H L~N~NUM~R NAME~DAOD~IU~ Parthemore FH & mq T ~,~.FS 012 849 L .~.P.O. Box 4~1, New Cumberland, PA 17070-0~1 ,, , ,,. l.. INJURY A? WORK? ~ dOATE OF INJURY I TIIVlE OF INJURY (Mo~ffi. Day. Yeaq rm [30.. 17o~. u. I NAME ~ ADO~E2~'O~ PERSON WHO CO~IPJ.:ETED CAI.~,~ OF O~H ~v~/, ~ - ~ ~ ,,. ~..?~/~ /~ /~ ~TE FILED (M~ ~a,) / - ( OF LANGDON A. JACKSON, JR. BE IT REMEMBERED, that I, LANGDON A. JACKSON, JR., of the Township of Lower Allen, County of Cumberland, and Commonwealth of Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof by me at any time heretofore made. ITEM 1: I direct that my hereinafter named Executrix pay all my just debts, my funeral expenses, and the expenses of the administration of my estate. With this direction, I authorize and empower my Executrix to expend for my funeral expenses and interment such amounts as she may consider necessary and proper, without regard to any limit that may be prescribed by a court of law. ITEM 2: I direct my Executrix to pay all inheritance, estate, succession, and legacy taxes of whatsoever nature and kind, to which my estate, or the transfer of any property passing hereunder or otherwise passing by reason of my demise, may be subject, and to charge such taxes against my residuary estate, it being my intention that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross estate, under the provisions of any state or federal law now in force or hereafter enacted, shall be prorated among the persons interested in my estate to whom such property is or may be transferred or to whom any benefit accrues. ITEM 3: ARTICLES. I give and bequeath unto my wife, CAROLYN W. JACKSON, all of my tangible personal property not used in business or for the production of income, including without limitation, furniture, furnishings, clothing, jewelry, objects of art and decoration, and the like, and motor vehicles which I own, together with insurance thereon, if she survives me for a period of thirty (30) days. If my wife does not survive me for thirty (30) days, I then bequeath all said property, together with insurance thereon, to my daughters, SANDRA L. JACKSON and SHARON J. YUNGSHTEN, in equal shares, or to whichever of them survives both my wife and me for a period of thirty (30) days. ITEM 4: EXEMPTION EQUIVALENT TRUST. If my wife, CAROLYN W. JACKSON, survives me, I devise and bequeath unto my Trustee hereinafter named, property with the value equal to the exemption equivalent permitted my estate under the federal estate tax provisions of the Internal Revenue Code of 1954, as amended, and enforced at the time of my demise, which property may be transferred free of tax using the estate tax credit as provided for in IRC §2010 or other appropriate sections. It is my intention to fund this Trust with the largest amount of property which could pass from my estate to this Trust free of federal estate tax by utilizing the unified credit exemption equivalent. My Trustee shall keep the corpus of the Trust invested and shall distribute the income and principal of the Trust as follows: 2 Ae Co During my wife's lifetime the entire net income shall be paid to my wife in at least quarter annual payments. In addition to the income, my wife shall have the power to direct the Trustee to pay to her or apply for her use the principal of the Trust in each calendar year including the year in which my death occurs, in an amount not in excess of the greater of Five Thousand Dollars ($5,000.00) or five percent (5%) of the aggregate value of the principal of the Trust on the last day of the calendar year for which payment may be directed. Such power shall not be cumulative, but shall expire on the last day of each calendar year. This shall be exercised by an instrument in writing, subscribed by my wife, or her duly authorized agent, and delivered to the Trustee. I authorize my Trustee, acting solely and without consultation with my wife, in my Trustee's sole discretion, at any time, and from time to time, to pay or apply to or for the use of my wife such portion of the principal of this Trust, even to the point of completely exhausting the same, as my Trustee may deem advisable to provide for the proper support, maintenance and health care of my wife, and for the continuance of the standard of living maintained by her during my lifetime. In determining the amount of principal to be so disbursed, my Trustee shall take into consideration any income which my wife may have from any other source, and the Trustee's discretion shall be 3 conclusive as to the advisability of any such disbursement, and shall not be subject to judicial review. D. Upon the death of the survivor of my wife and me, all principal remaining in the Trust shall be divided into two (2) equal shares to be distributed outright to my daughters, SANDRA L. JACKSON and SHARON J. YUNGSHTEN. ITEM 5: PROHIBITED POWERS. A. No Trustee or Executrix who is beneficiary hereunder shall ever participate in: 2) 3) 4) 5) 6) 7) The exercise of, or decision not to exercise, any discretionary power to pay income or principal to, or to apply income or principal for the benefit of any beneficiary [including discretion to allocate funds among a group of beneficiaries and discretion to accumulate income]; The determination of whether any beneficiary is disabled; The decision of when to pay death taxes on any future interest; The decision to terminate any Trust hereunder; The exercise of discretion to allocate receipts or expenses between principal and income; The decision of whether to use expenses as income or estate tax deductions; The decision to make payment to aid in the settlement of my estate; or 4 8) The selection of the property to be allocated to the marital deduction Trust. B. Any Trustee or Executrix may resign at any time without court approval. ITEM 6: CAPTIONS. Paragraph and subparagraph captions contained in this Will shall not be construed as part thereof, but are used merely for ready reference purposes. ITEM 7: PROTECTIVE CLAUSE. No gifts hereunder shall be subject to anticipation, assignment, pledge, obligation or beneficiaries, execution or attachment. ITEM 8: POWERS. I authorize my Executrix and Trustee as follows: A. To retain and invest in all forms of real and personal property, including stocks or other securities of the corporate fiduciary or the holding company controlling the corporate fiduciary, regardless of any limitations imposed by law on investments by fiduciaries; B.To compromise claims; C. To join in any merger, reorganization, voting trust plan or other concerted action of securities holders, and to delegate discretionary duties with respect thereto; D. To sell at public or private sale, to exchange or to lease for any period of time, any real or personal property, and to give options for sales or leases; E.To borrow and to pledge property as security for any funds borrowed; F. To allocate any property received or charge incurred to income or principal or partly to each, without regard for any law defining principal and income, 5 provided that all decisions under this paragraph shall be made by my Executrix or my Trustee alone; G. To exercise any law given option to treat administrative or other expenses of my estate as income tax deductions, even if they were paid from principal, and to value my estate for tax purposes by an optional method permitted by the law enforced when I die, without requiring adjustments between income and principal for any resulting effect on income or estate taxes; and H. To distribute in cash or in kind. These authorities shall extend to all real and personal property at any time held by my Executrix or my Trustee, and shall continue in full force until the actual distribution of such property is accomplished. All powers, authorities and discretions granted by this Will shall be in addition to those granted by law and shall be exercisable without leave of court. ITEM 9:. TRUSTEE. I appoint my daughter, SANDRA L. JACKSON, to serve as Trustee of the Trust hereinbefore established. In the event that my daugther, SANDRA L. JACKSON, should fail to survive me, or cease to act in the capacity as Trustee, I then appoint my daughter, SItARON J. YUNGHTEN, as successor Trustee of said Trust. ITEM 10: EXECUTRIX. Lastly, I nominate, constitute and appoint my wife, CAROLYN W. JACKSON, to serve as Executrix of this my Last Will and Testament. If my wife, CAROLYN, should fail to survive me, or be unable to qualify, I then appoint my daughter, SANDRA L. JACKSON, to serve as first alternate Executrix of this my Last Will and Testament; and in the event that she is unable or unwilling to serve, I appoint my 6 daughter, SHARON J. YUNGHTEN, as second alternate Executrix of this my Last Will and Testament. I give to my Executrix the power to file any qualified disclaimer that I could have filed if living. ITEM 14: I direct that my hereinbefore named Executrix shall not be required to give bond for the faithful performance of her duties in this or any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, this /~ ~ day of ~(~~ , 1996. j¥/ The preceding instrument, consisting of this and six (6) other typewritten pages, was on the day and date thereof signed, sealed, published, and declared by the Testator herein named, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence and in the presence of each other, have subscribed our names as witnesses here COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~ We, LANGDON A. JACKSON, JR., : SS. · ~ and , the ~estator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament, and that he signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator signed the Will as witnesses, and that to the best of their knowledge, the Testator was at the time eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence. SWORN TO AND SUBSCRIBED BEFORE ME THIS /~ DAY Notarial Seal Janet S. Gore, Notary Public Dillsburg Boro, York County My Commission Expires Oct. 25, 1998 Member, Pennsylvania Association of Not~.ries LAN(tXIN A. JA(I<SON, JR. ~IVI. D. SCI-IK&CK, III, ESQUIRE 124 West Harrisburg Street Post Office Box 310 Dillsburg, Pennsylvania 17019 Name of Decedent: Date of Death: CERTIFICATION OF NOTICE UNDER RULE 5.6(a) To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on ,_'r'_O,t/~ t~! ~-~OO ~ : Naille / d l Address Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: &A/~.a 8/ ~OOg'/'' Signature I Telephone~t~7~ ~"Z/LS--9 9~ ff" Capacity: ~.~0n ai R e p~'~ati v~ Counsel for personal representative September 2, 2004 Keefer Wood Allen & Rahal LLP Attorneys At Law 415 Fallowfield Road, Suite 301 Camp Hill, PA 17011-4906 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPARTMEN, T,280601 ~ HARRISBURG, PA--1~7,128-0601 ~:~ '04 SEP 15 :~8:25 Telephone (717) 787-3930 FAX (717) 772-0412 Dear Sir/Madam: Re: Estate of Langdon A. Jackson Jr. File Number 2104-0103 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 03/26~05. 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. S~ncerely,"-- ........... Claudia Maffei, Supervisor Document Processing Unit Inheritance Tax Division F","V-I500U-I6-'WI. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 1712B-0601 bIJC 1_' '0. C0 (\ :;:>.b 3 . A1\ ~. 31~-UD H Suu 1M REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT COUNTY CODE YEAR ----- NUMBER w .... x:.SCI) "",,,, w"" :cog U~tO .. '" FILE NUMBER 21 04 0103 I- Z W C W U W C DECEDENT'S NAME (lAST, FIRST, AND MIDDLE INITIAL) Jackson, Langdon A Jr. DATE OF DEATH (MM-DD-YEAR) 11/26/2003 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER SOCIAL SECURITY NUMBER 236-62-0103 DATE OF BIRTH {MM.OD.YEAR} 10/1111912 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (lAST. FIRST. AND MIDDLE INITIALI Jackson, Carolyn ~ 1. Original Return o 4, Limited Estate o 6. Decedent Died Testate (Nlaclloop'1olWil) o 9. litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date or death after 12.12-82) o 7. Decedent Maintained a Living Trust (AllachcopyorTnJSt) o 10. Spousal Poverty Credit (date ofdealtJ between 12-31-91 and 1.1.95) o 3. Remainder Return {dale of death prior to 12-13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec, 9113(A) \M\at.r, SchO) .... z w c z o .. U) w '" '" o " THI$'SECiJqN'MUSTaE':cqMI!l';!;l'E~i'~'Qti'qt:1~Bl!$pt:1fiipENC;:E,A.NP'C;:pll~IQ~fiiT~l...TAJ< INFqRMATiqN"'$flqp.~O .B.E .OIR.ECTE 0 TO: NAME COMPLETE MAILING ADDRESS Elizabeth J. Goldstein, Esquire 415 Fallowfield Road Suite 301 FIRM NAME ('..._1 C H'I PA 17 11' Keefer, Wood, Allen & Rahal, LLP amp II, 0 TELEPHONE NUMBER (717) 612-5803 z o ~ ..J => l- ii: c( u W 0:: t Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Cmse\y Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non~Probale Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) II) (2) (3) (4) (5) 0.00 601 ,400.99 0.00 0.00 45,883.21 (6) 0.00 (7) 0.00 9. Funeral Expenses & Administrative Costs (Schedule H) (9) (10) (8) 3,500.00 0.00 647,284.20 1 Q. Debts of Decedent, Mortgage Uabih~s, & Liens (Schedule \) 11. Total Deductions (total Lines 9 & 10) (11) (12) (13) 3,500.00 643,784.20 0.00 12. Net Value of Estate (Une 8 minus Une 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to lax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ I-' => Q. :i: o u >< ~ 15. Amount of Une 14 taxable at the spousal lax 643,784.20 0.00 rate, Of transfers under Sec. 9116 (a)(1.2) x.O_ (IS) 16. Amount of Une 14 taxable allineal rate x.O_ (16) 0.00 17. Amount of line 14 taxable at sibling rate x .12 (17) 0.00 18, Amount of Une 14 taxable al collateral rate x .15 (18) 0.00 19. Tax Due (19) 0.00 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO.ANSWERAL.l QUESTION$"ON.!:tEV;ERSE SIDE AND RECHECK MATH < < '"A II Decedent's Complete Address: STREET ADDRESS 402 Black Latch Lane CITY Camp Hill I STATE FA I ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 191 2. Credits/Payments A. Spousal Poverty Credit B, Prior Payments C. Discount (1) 0.00 0.00 0.00 0.00 Total Credits (A + 8 + C ) (2) 0.00 3. InteresVPenal1y if applicable O. interest E. Penally 0.00 0.00 A. Enter the interest on the tax due. (SA) (58) 0.00 0.00 0.00 0.00 0.00 TotallnteresVPenal1y ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. 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: 8. retain the use Of income of the property transferred;....... .................................... b. retain the right to designate who shall use the property transferred or its income; ............................ c. retain a reversionary interest; or..,.......... ................... ................. .........,................... d. receive the promise for life of either payments, benefits or care? ................. ..m'.....'............ 2. If death occurred after December 12, 1982. did decedent transfer property within one year of death without receiving adequate consideration? ."".. .............................................................................,.......... 0 3. Did decedent own an "In trust fo~ or payable upon death bank account or security at his or her death? .............. 0 4. Did decedent own an individual Retirement Account, annuily, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, Yes o o ....0 .0 No ~ ~ ~ ~ ~ ~ Under pe.nalli~$ oi perjury, I declare \hat I have examined this return, including accompanying schedules and statements, and to the besl of my knowledge and belief, It is true, correct and complete. Declaration of preparer other than Ih~ personal representative is based on alllnformalion of which preparer has any knowledge. SIGNATURE OF ONSIBL)' FOR FILING RETURN {R.-V~ 3 Di\]:E. (\ S ADDRESS I DATE IrltJJ For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 PS. 99116 (a) (1.1) (i)). For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P,S. 99116 (a} (1.1) (iill. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements tor disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)). The tax rate imposed on the net vaiue of transfers to or for the use of the decedent's Hneal beneficiaries is 4.5%, except es noted in 72 P.S. 99116(1.2) [72 P.S. \9116(a)[1 )). The lax rate imposed on the net value of transfers to or for the use of Ihe decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A slbiing is defined, under Section 9102, as an individual who has at least one parent in common with the decooent, whether by blood or adoption. REV"503 EX+ (6-98* COMMONVVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOE:NT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Langdon A. Jackson, Jr. FILE NUMBER 21-04-0103 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER ,. DESCRIPTION VALUE AT DATE OF DEATH See attached schedule. 601,400.99 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 601,400.99 E~tate qf: Langdon A. Jackson, Jr. Schedule B -- Stocks and Bonds Page 2 236-62-0967 Item No. Description Uni t Val. CUSIP 79.075 604059105 Alternate Val. Date Alternate Value Value at Date of Death 39,639.51 1 3M Co Accrued on above asset as of decedent's date of death 165.00 2 AT&T Corp 19.845 030177109 5,953.50 3 AT&T Wireless svcs Inc. 7.425 00209A106 3,578.85 4 American Century 021-000915640 34.07 6,319.85 5 American Elec pwr 27.63 025537101 8,289.00 Accrued income on above account as of decedents date of death 105.00 Accrued income on above account as per decedents date of death 13.41 1,448.28 053499109 27.495 16,497.00 071813109 26.265 31,202.82 079860102 35.485 71,857.13 090613100 9.655 1,931.00 442161105 20.00 6 Avaya Ine. 7 Baxter IntI Inc. 8 Bel1South Corp 9 Biomet, Ine. 10 Centerpoint Energy Ine. 11 Citizens Communications Co. 10.91 177342201 10, 644.7 8 12 Continental Mortgage Investors 0.00 13 Diagnostic Prods Corp 44.5 252450101 17,800.00 14 Edwards Lifesciences Corp 29.935 28176E108 1,796.10 15 Exxon Mobil Corp 36.11 30231GI02 105,730.08 Accrued income on above 732.00 TOTAL. (Carry forward to main schedule) 323,709.90 Estate Qf: Langdon A. Jackson, Jr. Schedule B -- Stocks and Bonds Page 3 236-62-0967 Item No. 15 account as of death Description of decedents date Uni t Val. CUSIP Alternate Val. Date Alternate Value Value at Date of Death 16 Fortune Brands, Inc. 68.83 024703100 55,064.00 Accrued income on above account as of decedents of death 240.00 date 17 Gallaher Group PLC 40.335 363595109 32,268.00 Accrued income on above account as of decedents of death 513 .12 date 18 HCA Inc. 41.72 197677107 6,258.00 Accrued income on above account as of decedents of death 3.00 date 19 Healthsouth Corp 3.975 421924101 1,140.83 20 Humana Inc. 21. 865 444859102 2,186.50 Accrued income on above account as of decedents of death 0.00 date 21 Int. Business Machs-accrued income 8.16 Dividend on above stock declared prior to decedentls death 8.16 22 International Business Machs 89.6 4,569.60 459200101 21.46 5,472.30 465823102 29.66 207.62 53219LI09 3.11 4.030.56 549463107 18.425 1.842.50 713291102 23 Ivax Corp 24 Lifepoint Hospitals, ~nc. 25 Lucent Technologies Inc. 26 Pepco Holdings Inc. and Potomac Electric Power Company (100 shares each) TOTAL. (Carry forward to main schedule) 113,812.35 Eatate qf: Langdon A. Jackson, Jr. Schedule B -- Stocks and Bonds Item No. Unit Val. CUSIP 23.355 84533103 Description 27 SBC Communications Inc 28 sac Communications Inc. 23.355 78387GJ.03 29 Sysco Corp 35.86 871829107 30 Teco Energy, Inc. 12.95 872375100 3J. Telephone" Data Sys Inc. 62.525 879433100 32 Tenet Healthcare Corp-636886103 14.69 882848104 33 Tenet Healthcare Corp 14.69 88033G100 Accrued income on above account as of decedents date of death 34 Texas Genco Hdgs-accrued income Dividend on above stock declared prior to decedent's death 35 Texas Genco Hldgs Inc 30.235 882443104 36 Triad Hospitals Inc. 34.J.8 87579KJ.09 37 Tyco Intl LTD New 22.64 902124106 38 Ventas Inc. 19.83 92276FJ.00 39 Verizon Communications 32.75 077853J.09 40 XCEL Energy J.6.705 99389B100 41 Agere Systems Class A 3.545 00845V100 42 Agara Systems Class B 3.38 00845V209 43 Caremark Rx Inc. 26.42 TOTAL. (Carry forward to main schedule) Alternate Val. Date page 4 236-62-0967 Alternate Value Value at Date of Death 10,930. J.4 27,535.55 57,376.00 J.,295.00 14,068.J.3 8,960.90 4,480.45 2.50 0.00 2.50 302.35 239.:2 6 6,882.56 1,844.J.9 19,126.00 2,455.64 46.09 1,155.96 2,800.52 159,503.74 Es~ate ~f: Langdon A. Jackson, Jr. Schedule B -- Stocks and Bonds Item No. Uni t Val. CUSIP 141705103 Description 43 44 NCR Corp 34.68 62886E108 45 TXU CORP 22.075 882848104 Alternate Val. Date TOTAL. (Carry forward to main schedule) . . . . . . Alternate Value Page 5 236-62-0967 Value at Date of Death 2,167.50 2,207.50 4,375.00 REV-1SO' EX+ (6-9') .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX ReTURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Langdon A. Jackson FILE NUMBER 21-04-103 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 r. ITEM NUMBER DESCRIPTION 1 PSECU-Acccunt No. 0236620967 VALUE AT DATE Of DEATH 45,883.21 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 45,863.21 PSEC~ l'r"<("'1'\~ ,."flI"."IJ ~ i-\~'''''', iI\'X11 the financial /ink TM June 29, 2004 Account # 0236620967 SANDRA L JACKSON 402 BLACK LATCH LANE CAMPHIll,PA 17011 Dear MS JACKSON: The following is the status of LANGDON A JACKSON ]R's account with PSECU as of the date of death. Joint Owner's Name Date Established Date of Death Date of Birth . NONE 03.29.1988 11.26.2003 10.11.1912 Share(s) Regular Shares (Sl) Checking Shares (S4) BALANCES 05.26.2004 Share(s) Regular Shares (S 1) Checking Shares (S4) Balance $45,859.13 0.78 911 Accrued Dividend $23.30 $ 0.00 Balance $46,030.63 0.78 Accrued Dividend $23.65 0.00 The dividend earned from January 1,2003 through the date of death was $338.70. The decedent had no loans with us. We do not have safe deposit boxes for our members. We need you to complete and return the enclosed PSECU Membership Application to establish an Estate Account with us. If you have any questions, please call 234-8484 in Harrisburg or our toll-free number, (800) 237-7328. At the menu prompt, enter 6 and then extension 2227. Sincerely, '21:t:i~ Member Service Representative Finance Support Unit PENNSYLVANlA STATE EMPLOYEES CREDIT UNtON Main Address: 1 Credit Union Place. Harrisburg, PA 17110-2990. (717) 234-8484. (BOO) 237~7328 Mailing Address: P.O. Box 67013, Harrisburg, PA 17106-7013. (717) 777-2100 (TOO). (800)472-1967 (TOO) Web Address: www.psecu.com REV.1511 EX + (1.97) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMArtONWEAL TH OF PENNSYLVA.NIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Jackson, Jr., Langdon A. FILE NUMBER 21-2004-0103 Debts of decedent must be r90ortoo on Schedule t. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 0.00 Name of Personal Representati\le(s) Social Security Number(s) I EIN Number of Personal Representati\le(s) Street Address City Slate Zip Year{s) Commission Paid: 2. Attorney Fees 0.00 3. Famlly Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3 , 500 .00 Claimant Jackson, Carolyn Street Address 402 Black Latch Lane City CalIlp Hi 11 State FA lip 170lJ. Relationship of Claimant to Decedent Spouse 4. Probate Fees 0.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7. TOTAL (Also enter on line 9, Recapitulation) $ 3,500.00 2W46AG2.QOO (If more space is needed, insert additional sheets of same size) REV-1S'13 EX+ (9-00) '* SCHEDULE .. BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Langdon A Jackson, Jr. FILE NUMBER 21-04-103 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIV[NG PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.211 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPR[ATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTR[BUTIONS: A. SPOUSAL D[STR[BUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX [S NOT BEING MADE 1 Langdon Jackson Trust; clo Sandra Jackson; P,O. Box J; Ironia, NJ 07845 635,667.11 B. CHAR[TABLE AND GOVERNMENTAL DISTR[BUT[ONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DlSTR[BUT[ONS ON LINE 13 OF REV-1500 COVER SHEET $ 635,667.11 (If more space is needed) insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPARTMENT 280601 HARRISBURG, PA 17128-0601 September 2, 2004 Telephone (717) 787-3930 FAX (717) 772-0412 Keefer Wood Allen & Rahal lLP Attorneys At law 415 Fallowfield Road, Suite 301 Camp Hill, PA 17011-4906 SEF 0 tJ 'riGIt ,. 4,~ f , ,~"" Re: Estate of Langdon A. Jackson Jr. File Number 2104-0103 Dear SirlMadam: 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 retum. 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 03126105. 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. ~ ",/J ,...- I ... Sincerely(/" L..--./--'' /l -..----;." (ilif 1__' /'::; (/ ././'_ ,. /4 of'" ,," (,"-;"-~c:'.'_'~~'~ ,_~ r l' / 0'...."--'..;...--- / "_.-- ?-,. ,- ../,_.A. v/~ / J /) Claudia Maffei, Sup~isor Document Processing Unit Inheritance Tax Division 11U:; J:; to cernry rnat tnlS 15 a true copy ot the record which is on file in the Pennsylvania Division of Vital Records In accordanc~ with An 66, P.L. 304, approved by the General Assembly, June 29, 1953. WARNING: It is illegal to duplicate this copy by photostat or photograph. ~ ctJ.. !/~ No. Charles Hardester State Registrar Calvin B. Johnson, M.D., M.P.H. Secretary of Health 3425982 FE B 2 4 Zen5 Date tl105.'''''''''''.V!T CORRECTED ITEM( S) : 3 COMMONWEALTH OF PENNSVLVANIA . OEPARTMENT OF HEALTH. VITAL RECORDS PER:FD DATE:2-19-04 bas CERTIFICATE OF DEATH Jr. ." ~ male ~~l..EM.IMIIER SOCI.....SECUf'lITYNUMlref'l "......... - ..,"""'" """'OM AAMEOFOICeDENf"",",-_.~ I. Langdon Andrew M3El\..--';' \JNDEAIVEN'I - - 1. 236 - 62 0967 8Il'I1HPI..ACE1COIv_ Sl.-..F_C........,., P\..ACfOFOE.IO'HlO*""""'_ _""'"""",,""""""'-' I'4OSPITI,1.; -~ 91 Y",- Lynchburg~ VA ,. FAClUT'r'NME!Il"'"InOM.JIioI'._....._.........., . WlYClFDERli ), .~ Dauphin DECEDe~SUSUAL.OCCIJM'lON ......=:~c::'.::=.:::r ,,.. Colonel 1111. US Armed Forces DIlCEllEfrtrSWoIUNGIolXlReSSJSl__OIvI'i>wn.sa..ZipCoooI DEUDENrS 402 Blacklateh Lane ~~ ...- IL Camp Hill~ PA 17011 ""......_ I'iIll1ER'SNA/lIE/Frc._.LMII Lan don Andrew Jackson, Sr. OfIW\H'rS_(r~ Carolyn Jackson ~""""'""'" __0 ~~ ~_SIoI.O '"- k. Harrisburg 1UND000IllJSlNEs.snHOOSTf'lY " white -~..... !H__...-_ IIoIAAItAl.SWUS.~ -~.~. -- married 17.,_ Pennsylvania ~ - h" Cumberl;:mrr -""1 '7cl.O:;"-=~1II IIOTliEIl.StlAYE.\f....._._s.,.~ '" Elsie Horner lNFt:lAMAHT'SIlWUNGIoODl'lUSISIr_Cily/li>oooo.sa....A>Ccoool :MIL 402 Blacklatch Lane Cam Hill PA 17011 Pl..AC:EOFOlSPOSlTJON._olc.n.tOtl'.Cr-">ry LOC.Q1OlO.CiI)ofIbM>.Slol..llI>C<xIoo ._- Yorktowne Crematory York~ PA 17404 :n~. 2'''. IIWoIEANOAOOf'lE:SSOF'MCIUTY Parthemore FH & CS ~ Ine. 2Zc. P.O. Box 4 1 New C m erland P 7 _ UCENSii NUMBER OAI'E SIGNED (MoIWl.o.r._ lh.IiI-.__1o T(}WPT t. Carol A11PM Williams ., ,~ ..... ~ ~ ~ ~ . , ~ ;; OI'lPEJUlOIoIACTINOASSUCJ.t 2003 Ua:t/SEHUMIICR . F 012 84 L 1M_"''''l'~~__''''''I'''_.'''."",,,,-__ ._"I~ 1 - ~ -.sc.<$EREFe.RP.Etl'fO~~ ~ID ~ ~O H. ,- l=-":= , I PART~, 0I....0iIInIIW*M_~"'_._ .....-.irt1l'lol~_g;,...,inl'l'RTl. s: <9 .~ -? Wl!REAUTOI"SY'F1NDlNGS IoUIHHEIIOf'DE.,li;f1l --......'" l!l1 ~OFC4IJSE - - 0 ~"""" - 0 Pilnding--....", 0 ~O ., 0 - 0 CoooIId__clM......... 0 I;IR'EOFINJUf'lY (....."..,.o.y._l ~lWEQIF~ lM.lVJlYRWORI(1 tlESCRlIlEHOWlIUJflYOCCUIlfIED. _ 0 HoD .. - ~IClwcI<......on.l 'c::uI'I1FVlN(l""&Il::IAN~c.nIvn;l_OI__"-"''''''''M:""hql'O'''''''''''''''_aIl(I'''''''''''''_23J To....to.I..""'~.___......~.I.""___........ H. I"I..ACeOFIJ\lJUf'lV....._.........-.r..,.....,._ -"eIc,I~~ ,... /rtJlCf' - ~ z . ~ ~ ~ o . , < z .~N<<lCEtQlnINlOf'1nSlClMl~_~d....,.nclc__"'''"''....<lu",\ ""-_..""'~._DCC........,II.-_._._pIKoo......_Ia.."""'"'.I.........____ "IIIED1CA1.EXAMIlERICOftOHP ::::..~...."'~~~.~~...lnn.ng.llol\.lnm1opi...<>n.cl..fh"::'~.~~~~~~..d.f....ndpJ.c.._"...IOI"-""u~.I.nd 0 21.. ...I'IECiISTIWl.SSlG~REA>tO,..UM~_~ _ ~ "C '7.:u.. .1-1, ,toi/,11 last _ill mtO illtstcttttettt OF LANGDON A. JACKSON, JR. BE IT REMEMBERED, that I, LANGDON A. JACKSON, JR., of the Township of Lower Allen, County of Cumberland, and Commonwealth of Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last Will anel Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof by me at any time heretofore made. ITEM 1: I direct that my hereinafter named Executrix pay all my just debts, my funeral expenses, and the expenses of the administration of my estate. With this direction, I authorize and empower my Executrix to expend for my funeral expenses and interment such amounts as she may consider necessary and proper, without regard to any limit that may be prescribed by a court of law. ITEM 2: I direct my Executrix to pay all inheritance, estate, succession. and legacy taxes of whatsoever nature and kind, to which my estate, or the transfer of any property passing hereunder or otherwise passing by reason of my demise, may be subject, and to charge such taxes against my residuary estate, it being my intention that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross estate, under the provisions of any state or federal law now in force or hereafter enacted, r;--- ~; '~:c~. shall be prorau:d among the persons interested in my estate to whom snch property is or may be transferred or to whom any benefit accrues. ITEM 3: ARTICLES. I give and bequeath unto my wife, CAROLYN W. JACKSON, all of my tangible personal property not used in business or for the production of income, including without limitation, furniture, furnishings, clothing, jewelry, objects of art andc:lec;g!~tion.al1d theJike, andmotor vehicles ~lrich Iown,ct()get)1er;Fitll,insurance .' .'. '- -- -c",' ':..':-" _" -',. -'i- -:_.-__,:_",0,:_:' '~" ",- :;- _~_, - ,'," ',:_"-,-" -_~. "':. -:_';:<' ;'--:':::,i-'~___ ;~'f:::c:::'~:::..:.:~';f':.:-;;:;~:;:',-' -::::-:."; .. -~- thereon, if she survives me for a period of thirty (30) days. If my wife does not SUMve me for thirty (30) days, I then bequeath all said property, together with insurance thereon, to my daughters, SANDRA L. JACKSON and SHARON J. YUNGSHTEN, in equal shares, or to whichever of them survives both my wife and me for a period of thirty (30) days. ITEM 4: EXEMPTION EQUIVALENT TRUST. If my wife, CAROLYN W. JACKSON, survives me, I devise and bequeath unto my Trustee hereinafter named, property with the value equal to the exemption equivalent permitted my estate under the federal estate tax provisions of the Internal Revenue Code of 1954, as amended, and enforced at the time of my demise, which property may be transferred free of tax using the estate tax credit as provided for in IRe 92010 or other appropriate sections. It is my intention to fund this Trust with the largest amount of property which could pass from my estate to this Trust free of federal estate tax by utilizing the unified credit exemption equivalent. My Trustee shall keep the corpus of the Trust invested and shall distribute the income and principal of the Trust as follows: 2 / L , ; A. During my wife's lifetime the entire net income shall be paid to my wife in (",,~~ at least quarter annual payments. B. In addition to the income, my wife shall have the power to direct the Trustee to pay to her or apply for her use the principal of the Trust in each calendar year including the year in which my death occurs, in an amount not in excess ..... .,,~. "'.Clf,the greater of Five Thousand Dollars ($5,000.00) or five percent (5%) of the aggregate value of the principal of the Trust on the last day of the calendar year for which payment may be directed. Such power shall not be cumulative, but shall expire on the last day of each calendar year. This shall be exercised by an instrument in writing, subscribed by my wife, or her duly authorized agent, and delivered to the Trustee. C. I authorize my Trustee, acting solely and without consultation with my wife, in my Trustee's sole discretion, at any time, and from time to time, to payor apply to or for the use of my wife such portion of the principal of this Trust, even to the point of completely exhausting the same, as my Trustee may deem advisable to provide for the proper silpport, maintenance and health care of my wife, and for the continuance of the standard of living maintained by her during my lifetime. In determining the amount of principal to be so disbursed, my Trustee shall take into consideration any income which my wife may have from any other source, and the Trustee's discretion shall be 3 r<<"'=""-'.' , /'--- , . ;' / "'-"~'~~':"!f.;,~-;;C;~:,:~~,_~:&~~~~t!~"':""':' -,~::=;,"~'::~~,~:r~_~.;I~~~~,~4<~~~~~~~""'~"'~~~'1~~~ conclusive as to the advisability of any such disbursement, and shall not be \ subject to judicial review. D. Upon tbe deatb of the survivor of my wife and me, all principal remaining in the Trust shall be divided into two (2) equal shares to be distributed outright to my daughters, SANDRA L. JACKSON and SHARON J. YUNGSHTEN. ITEM 5: PROHIBITED POWERS. A No Trustee or Executrix who is beneficiary hereunder shall ever participate in: 1) The exercise of, or decision not to exercise, any discretionary power to pay income 'or principal to, or to apply income or principal for the benefit of any beneficiary [including discretion to allocate funds among a group of beneficiaries and discretion to accumulate income); 2) The determination of whether any beneficiary is disabled; 3) The decision of when to pay death taxes on any future interest; 4) The decision to terminate any Trust hereunder; 5) The exercise of discretion to allocate receipts or expenses between principal and income; 6) The decision of whether to use expenses as Income or estate tax deductions; 7) The decision to make payment to aid in the settlement of my estate; or 4 / , , / / , 8) The selection of the property to be allocated to tbe marital deduction Trust. B. AJly Trustee or Executrix may resign at any time without court approval. ITEM 6: CAPTIONS. Paragrapb and subparagraph captions contained in this Will shall Dot be construed as part thereof, but are used merely for ready reference purposes. ITEM 7: PROTECI1VE CLAUSE. No gifts hereunder shall be subject to anticipation, assignment, pledge, obligation or beneficiaries, execution or attachment. ITEM 8: POWERS. I authorize my Executrix and Trustee as follows: A. To retain and invest in all forms of real and personal property, including stocks or other securities of the corporate fiduciary or the holding company controlling the corporate fiduciary, regardless of any limitations imposed by law on investments by fiduciaries; B. To compromise claims; c. To join in any merger, reorganization, voting trust plan or other concerted action of securities holders, and to delegate discretionary duties with respect thereto; D. To sell at public or private sale, to exchange or to lease for any period of time, any real or personal property, and to give options for sales or leases; E. To borrow and to pledge property as security for any funds borrowed; F. To allocate any property received or charge incurred to income or principal or partly to each, without regard for any law defining principal and income, 5 provided that all decisions under this paragraph shall be made by my Executrix or my Trustee alone; G. To exercise any law given option to treat administrative or other expenses of my estate as income tax deductions, even if they were paid from principal, and to value my estate for tax purposes by an optional method permitted by the law enforced when I die, without requiring adjustments between income and principal for any resulting effect on income or estate taxes; and H. To distribute in cash or in kind. These authorities shall extend to all real and personal property at any time held by my Executrix or my Trustee, and shall continue in full force until the actual distribution of such property is accomplished. All powers, authorities and discretions granted by this Will shall be in addition to those granted by law and shall be exercisable without leave of court. ITEM 9: TRUSTEE. I appoint my daughter, SANDRA L. JACKSON, to serve as Trustee of the Trust hereinbefore established. In the event that my daugther, SANDRA L. JACKSON, should fail to survive me, or cease to act in the capacity as Trustee, I then appoint my daughter, SHARON J. YUNGHTEN, as successor Trustee of said Trust ITEM 10: EXECUTRIX. Lastly, I nominate, constitute and appoint my wife, CAROLYN W. JACKSON, to serve as Executrix of this my Last Will and Testament If my wife, CAROLYN, should fail to survive me, or be unable to qualify, I then appoint my daughter, SANDRA L. JACKSON, to serve as first alternate Executrix of this my Last Will and Testament; and in the event that she is unable or unwilling to serve, I appoint my 6 daughter, SHARON J. YUNGHTEN, as second alternate Executrix of tbis my Last Will and Testament. I give to my Executrix the power to file any qualified disclaimer that I could have filed if living. ITEM 14: I direct that my hereinbefore named Executrix shall not be required to give bond for the faithful performance of her duties in this or any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, this / f iT day of CN& ,1996. "_.--:;" ...~~:~~-~ -;.c~ ---c~-c -:or..-- 1-1. .Jb::'-t:~";l1-.-:z-c::':"'"?- ~ LANf;DON A. !ACKSON, JR. // - The preceding instrument, consisting of this and six (6) other typewritten pages, was on the day and date thereof signed, sealed, published, and declared by the Testator herein named, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence and in the presence of each other, have subscribed our names as witnesses hereto. .,/ i / / j' /,] : I / / I . ~0.U.(/ /. 1 . ;/ " /;, .. . . .J ;' ! " ,",,;> /' ..!' ..c- -."...:..:. ,'. 'I/. A .7 ~.~ , /-,~ iL_ ., _"'.-' A J'./ OF / '. III. / / /...." _;' ~," _"'., :,L---// /,/7::' '....-; .' _'7 ./._., ,~ ,,_ ,/. C. /;__.:</Ll,,--:.--'v-~(>'z\ _' I (::r .1/.:.../'// ~, (;;fJ //Je;; { OF 7 COUNTY OF COMMONWEALTH OF PENNSYLVANIA ~iJ;Jr () 55. We, IANGDON f- JACKSON, JR., ({udy 1L ~UtAAdr "--"'-- , \ respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament, and that he signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator signed the Will as witnesses, and that to the best of their knowledge, the Testator was at the time eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence. JIk A/y{~ the testator and the / -- and witnesses, _,_~ ;,-- f -~- --'.:1t-....-:rc':/::-- .?~j...,;,:';~-,z::....;-;i-~,~ ......~----- LANZ)!~~~Q/ ,/i;- <' :/7'; l><,{ -~/.t. j,;" _..{..~_) _ .j, ..)-:[/<:"h":l..,''- ,h'/- // f j /1 f f j I, " SWORN TO AND SUBSCRIBED BEFORE ME THIS If IE. DAY OF ~U~. ,1996. (/~ I A NO-TARY P;UBUC Notarial Seal Janet S. Gore, Notary Public Dlllsburg Boro, York County My Commission E:<pires Oct. 25, 1998 MAmhP.r. P~nn.c;vlvania Association of No!.:::r'es Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Langdon A. Jackson, Jr. No. 21-2004-0103 also known as Date of Death 11/26/2003 Deceased Social Security 236-18-2671 No. Sandra Jackson Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. IlWe verify that the statements made in this Inventory are true and correct. IlWe understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: Personal Representative: Elizabeth J. Goldstein Sandra Jackson. I.D. No.: 73779 Address 415 Fallowfield Road, Suite 301 Camp Hill, PA 17011 717-612-5803 Dated: Telephone DESCRIPTION VALUE 1. NCR Corp 2. TXU Corp 3. PSECU - Account No. 0236620967 $ 2,167.50 $ 2,207.50 $45,859.13 $ 7,685.00 $ $ $ $ 4. 2000 Chevrolet Prism 5. 6. 7. 8. (Attach Additional Sheets If Necessary) See Attached Sheet NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. Form llW-7(Dauphin County)-Rev. 9/82 (; 11927_1 REV-1503 EX.. (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS Jackson, Jr., Langdon A. FILE NUMBER 21-2004-0103 All property jo\ntly~wned with right of sUl'\llvorship must be disclosed on Schedule F. ITEM NUMBER 1. 3M Co DESCRIPTION VALUEI\TDATE OF DEATH 39,702.50 2 AT&T Corp 19,845.00 3 AT&T Wireless Svcs Inc. 3,578.85 4 American Century 021-000915640 6,U9.85 5 American Elec pwr 8,394.00 6 Avaya Inc. 1,448.28 7 Baxter Intl Inc. 16,497.00 8 BellSouth Corp 15,60L41 9 Biomet, Inc. 7~, 857. ~3 10 Centerpoint Energy Inc. ~,951.00 11 Citizens Communications Co. 8,237.05 12 Continental Mortgage Investors 0.00 13 Diagnostic Prods Corp 8,900.00 14 Edwards Lifesciences Corp 1,796.10 15 Exxon Mobil Corp 106,462.08 16 Fortune Brands, Inc. 54,880.00 17 Gallaher Group PLC 32,78L12 18 HCA Inc. 6,261.00 19 Healthsouth Corp 1,140.83 20 Humana Inc. 2,186.50 21 Int. Business Machs-accrued income 16.32 22 International Business Machs 4,569.60 Total from continuation pages.... TOTAL (Also enter on line 2, Recapitulation) $ 152,469.83 564,895.45 2W46963.0QO (If more space is needed, insert additional sheets of the same size) gstate-of: Jackson, Jr., Langdon A. Schedule B -- Stocks & Bonds Item No. Description Value at Date of Death 23 23 Ivax Corp 24 Lifepoint Hospitals, Inc. 25 Lucent Teehnologies Inc. 26 Pepco Holdings Inc. and Potomac Electric Power Company {100 shares eaeh} 27 SBC Communications Inc 28 SBC Communications Inc. 29 Sysco Corp 30 Teco Energy, Inc. 31 Telephone & Data Sys Inc. 32 Tenet Healthcare Corp-636886103 33 Tenet Healthcare Corp 34 Texas Genco Hdgs-accrued income 35 Texas Genco Hldgs Ioc 36 Triad Hospitals Inc. 37 Tyco Intl LTD New 38 Ventas Inc. 39 verizon Communications 40 XCEL Energy 41 Agere Systems Class A 42 Agere Systems Class B 43 Caremark Rx Inc. Page 2 21-2004-0103 5,472.30 207.62 1,007.64 3,685.00 5,465.07 27,535.55 57,376.00 1,295.00 14,068.13 2,207.50 4,482.95 2.50 302.35 239.26 6,882.56 1,844.19 9,563.00 2,455.64 46.09 1,155.96 2,800.52 Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: 303 4/8/2005 TACKS ON A LANGDON TR 21-04-0103 ELIZABETH] GOLDSTEIN, ESQUIRE 415 FALLOWFIELD RD SUITE 301 JA CAMP I-llLL, PA 17011 Qty 1 Fee Description Additional Probate Fee Total 35.00 $35.00 Total: $35.00 Cl1ecks should be made payable to the Register of Wills. Terms: Net 30. Please rerum one copy of this invoice with your payment. Thank you. Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: 303 4/8/2005 TACKS ON A LANGDON lR 21-04-0103 EUZABETIIJ GOLDSTEIN, ESQUIRE 415 FALLOW'FIELD RD SUITE 301 JA CAMP HILL, PA 17011 Qty 1 Fee Description Additional Probate Fee Total 35.00 $35.00 Total: t/~ (~dl( $35.00 l"'~) Checks should be made payable to the Register of Wills. Tenns: Net 30. Please return one copy of this invoice with your payment. Thank you. v--- Glenda Farner Strasbaugh Register of Wiils and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Soljcitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: 322 4/19/2005 LANGDON A. TACKS ON. TR 21-04-0103 KEEFER WOOD ALLEN & RAHAL, LLP 415 FALLOWFIEW RD, SUITE 301 JA CAMP HILL, PA 170114906 Qty 24 Fee Description PHOTOCOPIES Fee Total 0.50 $12.00 Total: $12.00 Checks should be made payable to the Register of Wills. Terms: Net 30. Please return one copy of this invoice with your payment. Thank you. Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: 322 4/19/2005 LANGDON A TACKSON. TR 21-04-0103 KEEFER WOOD ALLEN & RAHAL, LLP 415 FALLOWFIELD RD, SUITE 301 JA CAMP HILL, PA 170114906 Qty 24 Fee Description PHOTOCOPIES Fee Total 0.50 $12.00 Total: Pd -1# 7&'lSq ~ $12.00 r '1 C:,. Checks should be made payable to the Register of Wills. Terms: Net 30. Please return one copy of this invoice with your payment. Thank you. 0" 07-04-2005 JACKSON JR 11-26-2003 21 04-0103 CUMBERLAND 101 APPEAL DATE: 09-02-2005 ( See rlNerse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE _ RETAIN LOWER PORTION FOR YOUR RECORDS _ REV:i54;-EX-AFP-io3:OSj-NOTicE"OF-iNHERiTANCE-TAX-APPRAiSEHENT:-ALLOWANCE-OR--------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX LANGDON A FILE NO. 21 04-0103 ACN 101 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX Z8D601 ~RRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX A~PRAISEHENT, ALLOWANCE OR OISALLOWANCE OF OEOUCTIONS ANO ASSESSHENT OF TAX ELIZABETH J GOLDSTEIN ESQ KEEFER HAL 415 FALLOWFIELD CAMP HILL DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN RD 30 PA 17011 ESTATE OF JACKSON JR TAX RETURN WAS: I I X) CHANGEO ) ACCEPTEO AS FILEO SEE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R.al Estate (Sch~l. .J 2. Stocks _ Bonds ISchedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule DJ 5. CashlBank DepositslMisc. Personal Property (Schadule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) 17l .00 564.895.45 .00 .00 53.544.13 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. funeral Expenses/Ad.. Costs/Misc. Expanses (Schedule H) 10. Debts/Kortgage Liabilities/Liens (Schedule Il 11. Total Deductions 12. Net Value of Tax R.turn 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Est.te Subject to Tax I') (10) 3,500.00 00 Ill) (12) (13) (14) NOTE: I~ an assessment was issued previouslY. lines reflect figures that include the total of ALL ASSESSMENT OF TAX: 15. ~ount of Line 14 at Spousal r.t. (15) 16. Aaount of Line 14 taxable .t lineal/Class A rate (16) 17. Amount of Line 14 et Sibling rat. (17) 18. A.ount of line 14 taxable at tolleterel/Class B rete (18) 19. Principal Tex Due X S. '* REV-1547 EX AFP (06-05) LANGDON A DATE 07-04-2005 ATTACHED NOTICE NOTE: To insure proper c~edit to your account, subM1 t the upper portion of this form with your tll)( paytlent. 618,439.58 3.linn no 614,939.58 614,939.58 .00 14. 15 and'or 16. 17. 18 and 19 will returns assessed to date. .00 X 00 = .00 X 045= .00 X 12 = .00 X 15 = 11')= INTEREST/PEN PAlO 1-) AI1llUNT PAIO OATE NUI1BER ~ TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE . IF PAlO AFTER OATE INDICATEO, SEE REVERSE FOR CALCULATION OF AODITIONAL INTEREST. .00 .00 .00 .00 .00 .00 .00 .00 .00 I IF TOTAL OUE IS LESS THAN U, NO PA YHENT IS REl/lIIRED. IF TOTAL OUE IS REFLECTEO AS A "CREOIT" ICR), YOU HAY BE OUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) REV-1<470 EX (6..88) . INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES PO Box. 280601 HARRISBURG PA 17128-0601 DECEDENrS NAME FILE NUMBER Langdon A. Jackson, Jr. 2104-0103 REVIEWED BY ACN Harry Herr 101 SCHEDULE ITEM EXPLANATION OF CHANGES NO. - - Changed per systems requirements. ROW Page 1 p:r"1p;yr, nqr: r: BUREAU OF INDIVIDIlAl'-''FAllE~j '"' , "- ,j' INHERITANCE TAX DIYISIO~::-'--"'-":-'-c-, ,'- ;',':' ;' PO BOX 280601 ' HARRISBURG PA 17128-0601 ?pnr: ~rp -2 c:'~ I?" ("'tuB ......'..'u ....,,_1 I I! 1,_' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN *' REV-483 EX AFP (06-05) C!_E~'< r:rr' ;" '-"', DATE 09-05-2005 ESTATE OF JACKSON JR LANGDON A DATE OF DEATH 11-26-2003 FILE NUMBER 21 04-0103 COUNTY CUMBERLAND ACN 201 APPEAL DATE: 11-04-2005 (See reverse side under Objections) Amount Remitted I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: ELIZAB~H J GOLDSTEIN i'ESQ KEEFER ETAL 415 FALLOWFIELD RD 30 CAMP HILL PA 17011 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this for. with your t.x pay..nt. CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR FILES +- ------------------------------------------------------------------------------------------ REV-483 EX AFP (03-05) .. NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN .. ESTATE OF JACKSON JR LANGDON A FILE NO.21 04-0103 ACN 201 DATE 09-05-2005 ESTATE TAX DETERMINATION 1. Credit For State Death Taxes as Verified .00 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) .00 3. Inheritance Tax Assessed by Other Statas or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed .00 5. Pennsylvania Estate Tax Due .00 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 _IF PAID AFTER THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN 81, NO PAYMENT IS REQUIRED ~__ FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRJ, YOU NAY BE ~ DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR TNSTRIlr:TTnN~ 1 CLEP\ ELIZABETH J GOLDSTEIN r~.{'i .. KEEFER ETAL ,~. 415 FALLOWFIELD RD 30 CAMP HILL PA 17011 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE "-n-~_M~~O! DETERMINATION AND rttd<UtlJlS5eSSHtNT OF PENNSYLVANIA Ci'-" cTESTATE 'tAX BASED ON FEDERAL I :';; .... '..' CLOSING LETTER DATE zans SEP I 3 PH I: 45 ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN *' IlIIREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 REV-7UEll AFP 1I,-lIS) \ -: ~ 09-13-2005 JACKSON JR 11-26-2003 21 04-0103 CUMBERLAND 202 APPEAL DATE: 11-12-2005 (See reverse side under Objections) Amount Remi.tted. I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: LANGDON A REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To in~ur. proper credit to your account, sub_it the upper portion of this form with your tax P8YbBnt. CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR FILES +- REY=736'-EX"iiWT6F-oz'i-----..-NirficriiF-JJETUiiiNiifIiiN-AiiKniSSESSMENy---------------------------- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER .. ESTATE OF JACKSON JR LANGDON A FILE NO.21 04-0103 ACN 202 DATE 09-13-2005 ESTATE TAX DETERMINATION 1. Credit For State Death Taxes as Verified .00 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) .00 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed .00 5. Pennsylvania Estate Tax Due .00 6. Amount of Pennsylvania Estate Tax Previously Assessed Based on Federal Estate Tax Return .00 7. Additional Pennsylvania Estate Tax Due .00 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 -IF PAID AFTER THIS DATE, SEE REVERSE SIDE (IF TDTAL DUE IS LESS THAN '1, NO PAYHENT IS REQUIRED ,Cf FDR CALCULATION DF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE \l \. DUE A REFUND. SEE REVERSE SIDE OF TNIS FORM FOR INSTRUCTIONS.) Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 10/11/2005 JACKSON SANDRA L 402 BLACKLATCH LANE CAMP HILL, PA 17011 RE: Estate of JACKSON LANGDON A JR File Number: 2004-00103 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 11/26/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, .~~.~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge t- Lr Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 10/11/2005 JACKSON S.L. PO BOX J IRONIA, NJ 07845 RE: Estate of JACKSON LANGDON A JR File Number: 2004-00103 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of wills a Status Report of completed or uncompleted administration. This filing is due by: 11/26/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, b~~~ GLENDA FARNER STP~.SBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge I ........ cr- u.. C) LLJ U G:. f.J,,," c;, a LLJ C- J cc o C) " 1 cr::' Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: jfJN (i.pol'l Ii.. "J',4ckS 0 /'I, J p., a. ~ I {}./TO 3 PR f1/ 0 # ;J. I - 0 if- - 0 I 03 Date of Death: fJ ev i I't't\ 8 ~ ..{ Estate No.: ,1..004--00103 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether ad~tration of the estate is complete: Yes 0 No ~ 2. lfthe answer is No, state when the personal representative reasonably believes that the administration will be complete: /.u;+/"/I\J ~f~"iAlntL_~ &t~ Ih\7)JT'Its FP-oh1 -fhf.J:Mff.; "po ,.1 p..V~~.;t}J 3. lfthe answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes 0 No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes 0 No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: ~3; dd6~ ~~ S,4NIJ!..A t~ ~CkSdN Name m po. BCTff \f I I {(oN fA . IV J 0'7 '3lfS' ., ~ Address . ':~/JIt fil'lj()Jt~ 'q'7~ r!3-?9 8t- C5F1'iPI (l..iJI?~ Te ephone No. I Capacity: ~ersonal Representativ~ &'l' tcw+~;~ o Counsel for personal representative 6 fF' c.V IL~~ (q '1~ 3~8"s", ---''-- CL 0"\ I ;::-"::1... s: ,."-,,, ':::-.7) = 00..l \ft Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 phone: (717) 240-6345 Date: 11/09/2006 JACKSON S.L. PO BOX J IRONIA, NJ 07845 RE: Estate of JACKSON LANGDON A JR File Number: 2004-00103 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date, As per the AMENDMENTS TO SUPREME COURT ORPHANS' COUFa RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing lS due by: 11/26/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, Glenda Farner Stra Clerk of the Orphans' Court cc: File Personal Representative(s) Cumberland County - Register ot Wllls One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 11/09/2006 JACKSON SANDRA L 402 BLACKLATCH LANE CAMP HILL, PA 17011 RE: Estate of JACKSON LANGDON A JR File Number: 2004-00103 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of wills a Status Report of completed or uncompleted administration. This filing is due by: 11/26/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregar~ this notice. Sincerely, Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File ('nllTlSpl STATUS REPORT UNDER RULE 6.12 Name of Decedent: Langdon A. Jackson. Jr. Date of Death: November 26.2003 Will No. 00103-2004 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes No-X 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: Early 2007 3. If the answer to NO.1 is Yes, state the following: a. Did the personal representative file a final account with the court? Yes No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: November 29, 2006 '\ ' -"',' j ~'~," I' , ""'\ Sig~a\~'~e: , . , ! l i.. I ,I ,/ it, , rr-r-'~'---' , .1 \ ., ,r d .~ . ,~ " ',' r ,~ .' - Stephanie Kleinfelter. Esquire Name (Please type or print) 1.0. No. 80089 Keefer, Wood, Allen & Rahal LLP 635 N. 12th Street, 4th Floor Lemoyne. PA 17043 Address (717)901-7786 Tel. No. Capacity: _ Personal Representative ..L Counsel for Personal Representative 07.") /11 C"., ':~~ 'v ~v t"~:(] ! ~ ~- CHARLES W. RUBENDALL II ROBERT L. WELDON EUGENE E. PEPINSKY. JR. JOHN H. ENOS ill GARY E. FRENCH DONNA S. WELDON BRADFORD DORRANCE JEFFREY S.STOKES ROBERT R. CHURCH STEPHEN L. GROSE R. SCOTT SHEARER ELYSE E. ROGERS CRAIG A. LONG YEAR JOHN A. FEICHTEL DONALD M. LEWIS III STEPHANIE KLEINFELTER ERIC R. AUGUSTINE TODD F. TRUNTZ CAROL L. VERISH KEEFER WOOD ALLEN & RAHAL, LLP ATTORNEYS AT LAW 635 NORTH 12TH STREET, 4TH FLOOR LEMOYNE, PA 17043 ESTABLISHED IN 1878 OF COUNSEL: HEATH L. ALLEN N. DAVID RAHAL SAMUEL C. HARRY PHONE 717-612-5800 FAX 717-612-5805 EIN No. 23-0716135 www.keeferwood.com HARRISBURG OFFICE: 210 WALNUT STREET HARRISBURG. PA 17101 PHONE 717-255-8000 901-7786 255-8037 skleinfel te:r@keeferwood.com Fax: 612-5805 November 29, 2006 Register of Wills Cumberland County Pennsylvania One Courthouse Square Carlisle, PA 17013-3387 Re: Estate of Langdon A. Jackson, Jr., Deceased Dear Sir/Madam: Please file the enclosed Status Report Under Rule 6.12, and date stamp and return the enclosed copy thereof for my files. I have enclosed a self-addressed stamped envelope for your convenience. Sincerely, KEEFER WOOD ALLEN & RAHAf' LLP , ;' / f ,', rr--" /, '(,! ,/' It=" -,-, ) . ,'- II ,,- By ,~. C l, ,/ C.- . (< 1 . .-,- Steph$.nie Kleinfelter \.i ' SK/waw Enclosure cc Sandra L. Jackson, Executrix 8Z :Z rt~d OS " P.O. Box J Irania, NJ 07845 AJJ1~.~~ Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 Dear Register: RE: the Estate of Langdon A. Jackson, Jr. - Docket # 21-04-0103 Please send me 7 short certificates. I understand that the current fee rate is @$4.00 per certificate. Enclosed in payment is a check @ $ ~ g r at) _ Sincerely yours, ft~ Executrix enclosure: check in payment '-rrt ett lcol IW01~ o Co .~~ ,-,-0 jI~~ -~\ (i~~ C?! =';(= .~S r--.) = = --I <- ::D" % I W -0 :l'C N .. c.n u::> ''0 i-n C') ,-'-) ~'"J CJ C11 CJ (' ~.,~ <=:> -" ;-I~'T' -'n - ice"') fn r i I If{ I,~ 1 ....... ,,,Ii~\ JJ, ~."'" "f"i(;', "ir,C: ....\" -J " ' ,', "':_,1- )QIBV .,.. l:: ~ ?il 0 ~.......... ~><:Z , .....dS!r ....:iO.S czio.....!:l IE - - ~ J ~ '-f-,: ~., M _ ~ ~, , (j ct-.~ - ~~%~ -:- ~ -~~i ~ ~ ~ ;::, -t u ~ (j ~ (~ '--C, ~ '~~.'.J 14 ~ '\, (1) . '. ~ ~ 'Z'. Or \ Q (}L \..J ':; - ;. - -:: \" , " ,';.;i,. ",j. \l~\~S.Sd-~ ~ <6500. \~- \) FIRST AND FINAL ACCOUNT OF SANDRA L. JACKSON, EXECUTRIX OF THE ESTATE OF LANGDON A. JACKSON, JR., DECEASED DATE OF DEATH: DATE OF APPOINTMENT OF EXECUTRIX: DATE FIRST ADVERTISEMENT COMPLETED: ACCOUNTING PERIOD: November 26, 2003 February 2, 2004 June 26, 2004 November 26, 2003 to December 31,2006 Purpose of Account: Sandra L. Jackson, Executrix, offers this account to acquaint interested parties with the transaction that have occurred during the administration of the Estate of Langdon A. Jackson, Jr., Deceased. It is important that the account be carefully examined. Requests for additional information or questions or objects can be discussed with: Stephanie Kleinfelter, Esq. Keefer Wood Allen & Rahal, LLP 635 N. 12th Street, Suite 400 Lemoyne, P A 17043 Telephone: 717-901-7786 1"--) C::l = --.J (-- C r- N U1 ,..---) ~ .-Tl -~,~~ co .s::- co SUMMARY OF ACCOUNT Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 Page Principal Receipts Net Gain (or Loss) on Sales or Other Dispositions Other Receipts 1-4 5-6 Less Disbursements: Administration Expenses (Prin) Fees and Commissions (prin) Other Expenses (prin) 7-8 8 8 $ 5,584.57 36,612.32 1,078.02 Balance before Distributions Distributions to Beneficiaries 9-12 Principal Balance on Hand For Information: Changes in Investment Holdings 13-17 Income Receipts Less Disbursements: Income Taxes 18-30 31 Balance before Distributions Distributions to Beneficiaries 32 Income Balance on Hand Combined Balance on Hand Fiduciary Acquisition Value $736,014.31 2,581.60 0.00 $738,595.91 43,274.91 $695,321. 00 695,321.00 $ 0.00 $ 37,589.61 9,056.48 $ 28,533.13 28,533.13 $ 0.00 $ 0.00 ----------- ----------- RECEIPTS OF PRINCIPAL Estate of Langdon A. Jackson, Jr. As of 12/31/2006 Assets Listed in Inventory (Valued as of date of death) Cash on Hand Replacement Dividend Checks Checking Accounts PSECU Savings Accounts PSECU-accrued income PSECU-savings $ 23.30 45,859.13 Common Stocks 3M Co 501.29 Units $165.00 Accrued Dividend AT&T Corp 545 Units AT&T Wireless Svcs Inc. 482 Units Additional Shares 3M 500 Units Agere Systems Class A 13 Units Agere Systems Class B 342 Units American Elec Pwr 300 Units $105.00 Accrued Dividend Avaya Inc. 108 Units Baxter IntI Inc. 600 Units BellSouth Corp 1,188 Units Biomet, Inc. 2,025 Units Caremark Rx Inc. 106 Units Centerpoint Energy Inc. 200 Units $20.00 Accrued Dividend Citizens Communications Co. 975.69 Units Comcast Corporation 363.5 Units Diagnostic Prods Corp 400 Units Edwards Lifesciences Corp 60 Units $ 39,804.51 10,815.53 3,578.85 39,537.50 46.09 1,155.96 8,394.00 1,448.28 16,497.00 31,202.82 71,857.13 2,800.52 1,951.00 10,644.78 7,666.22 17,800.00 1,796.10 Page 1 Fiduciary Acquisition Value $ 1,113.02 0.78 45,882.43 RECEIPTS OF PRINCIPAL Estate of Langdon A. Jackson, Jr. As of 12/31/2006 Assets Listed in Inventory (Valued as of date of death) Exxon Mobil Corp 2,928 Units $732.00 Accrued Dividend Fortune 800 Units $240.00 Accrued Dividend Gallaher Group PLC 800 Units $513.12 Accrued Dividend HCA Inc. 150 Units $3.00 Accrued Dividend Healthsouth Corp 126 Units Humana Inc. 100 Units IBM Book Entry Account 153 Units International Business Machs 51 Units $8.16 Accrued Dividend Ivax Corp 303 Units Lifepoint Hospitals, Inc. 7 Units Lucent Technologies Inc. 1,296 Units NCR Corp 62.5 Units Pepco Holdings Inc. 100 Units Reliant Resources, Inc. 157 Units SBC Communications Inc 468 Units SBC Communications Inc. 1,179 Units Sysco Corp 1,600 Units TXU CORP 100 Units Teco Energy, Inc. 100 Units Telephone & Data Sys Inc. 225 Units Tenet Healthcare Corp-636886103 610 Units Tenet Healthcare Corp-88033G100 305 Units Texas Genco Hldgs Inc 10 Units $2.50 Accrued Dividend Triad Hospitals Inc. 7 Units $106,462.08 55,304.00 32,781.12 6,261.00 500.85 2,186.50 31,264.02 4,577.76 6,502.38 207.62 4,030.56 2,167.50 1,842.50 977.33 10,930.14 27,535.55 57,376.00 2,207.50 1,295.00 14,068.13 8,960.90 4,480.45 304.85 239.26 Page 2 Fiduciary Acquisition Value Assets Listed in Inventory (Valued as of date of death) Tyco IntI LTD New 304 Units Ventas Inc. 93 Units Verizon Communications 584 Units XCEL Energy 147 Units RECEIPTS OF PRINCIPAL Estate of Langdon A. Jackson, Jr. As of 12/31/2006 Mutual Funds American Century 021-000915640 185.496 Units TOTAL INVENTORY $ 6,882.56 1,844.19 19,126.00 2,455.64 Page 3 Fiduciary Acquisition Value $679,767.68 6,319.85 $733,083.76 ----------- ----------- RECEIPTS OF PRINCIPAL Estate of Langdon A. Jackson, Jr. As of 12/31/2006 Receipts Subsequent to Inventory (Valued when received) Med Partners, Inc. 12/10/2003 Mutual of Omaha refund 10/31/2006 PA Department of Revenue 11/08/2005 pennsylvania Department of Revenue 10/31/2006 U.S. Treasury TOTAL RECEIPTS SUBSEQUENT TO INVENTORY SUMMARY Total Inventory Total Receipts Subsequent To Inventory TOTAL RECEIPTS OF PRINCIPAL $ 21.19 46.36 692.00 27.00 2,144.00 Page 4 $ 2,930.55 ----------- ----------- $733,083.76 2,930.55 $736,014.31 ----------- ----------- GAINS AND LOSSES ON SALES OR OTHER DISPOSITIONS Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 05/05/2004 Redemption of 0.346 shares of American Century 0.346 Units Net Proceeds Fiduciary Acquisition Value $ Net Gain 12.50 11.79 $ 03/04/2005 Cingular Wireless Services Inc. - Compulsory Buy-out Of AT&T wireless 482 Units Net Proceeds Fiduciary Acquisition Value $ 7,230.00 3,578.85 Net Gain 05/06/2005 Redemption of 0.348 shares of American Century 0.348 Units Net Proceeds Fiduciary Acquisition Value $ Net Gain 12.50 11.86 11/04/2005 Sold .334 Shares American Century Investments 0.334 Units Net Proceeds Fiduciary Acquisition Value $ Net Gain 12.50 11.38 05/05/2006 Sold .323 Shares American Century Investments 0.323 Units Net Proceeds Fiduciary Acquisition Value $ Net Gain 12.50 11.00 Page 5 Gain Loss 0.71 3,651.15 0.64 1.12 1. 50 GAINS AND LOSSES ON SALES OR OTHER DISPOSITIONS Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 Gain 08/21/2006 Sold 185.789 Shares American Century Investments 185.789 Units Net Proceeds Fiduciary Acquisition Value $ 6,450.59 6,337.45 Net Gain $ 113 . 14 09/05/2006 Sold 220.69 Shares Citizens Communications Co. 220.69 Units Net Proceeds Fiduciary Acquisition Value $ 3,017.04 2,407.73 Net Gain 609.31 09/05/2006 Sold 188 Shares Acco Brands 188 Units Net Proceeds Fiduciary Acquisition Value $ 4,136.04 3,314.63 Net Gain 821.41 09/18/2006 Sold 2.727 Shares 3M Held In Book Entry Account No. 4000631210 2.727 Units Net Proceeds Fiduciary Acquisition Value $ 230.00 215.48 Net Gain 14.52 09/18/2006 Sold Additional Shares 3M Held In Book Entry Account No. 4000137964 500 Units Net Proceeds Fiduciary Acquisition Value $ 36,905.60 39,537.50 Net Loss Total Gains and Losses $5,213.50 Less Loss (2,631.90) Net Gain $ 2,581.60 ----------- ----------- Page 6 Loss $ 2,631.90 $2,631.90 DISBURSEMENTS OF PRINCIPAL Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 Administration Expenses (prin) 05/05/2004 Account maintenance fee of American Century 06/08/2004 Payment to Cumberland Law Journal for advertisement Check number 101 06/08/2004 Payment to The Sentinel for advertisement Check number 103 06/08/2004 Register of wills for 25 short certificates Check number 104 06/08/2004 Staples Check number 105 06/23/2004 Check order to Clarke American (debit to account) 10/13/2004 Mark E. Hilbet & Associates Appraisal of 402 Black Latch Lane, Camp Hill Check number 502 05/06/2005 Account Maintenance Fee of American Century 09/24/2005 Register of Wills - 20 short certificates Check number 510 09/26/2005 Keefer Wood Allen & Rahal, LLP Miscellaneous Disbursements (i.e., photocopies, filing fees, long distance telephone call, postate, etc.) Check number 511 11/04/2005 American Century Investments - Account Maintenance Fee 05/05/2006 American Century Investments - Account Maintenance Fee 07/11/2006 Register of wills - Short Certificates 09/09/2006 Mellon Investor Services - $117 Surety Bond And $200 Service Fee To Recover Diagnostic Products Corportion Stock 10/20/2006 Keefer Wood Allen & Rahal, LLP Miscellaneous bisbursements - Telephone, Postage and Duplication Costs Page 7 $ 12.50 75.00 95.27 75.00 68.17 24.14 300.00 12.50 80.00 282.43 12.50 12.50 72.00 317.00 35.49 DISBURSEMENTS OF PRINCIPAL Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 Page 8 10/28/2006 Sandra L. Jackson - Reimbursement Of Out-Of-Pocket Expenses and Mileage Expenses $ 4,109.07 12/31/2006 Miscellaneous Charge 1. 00 $ 5,584.57 Fees and Commissions (prin) 03/17/2005 Keefer Wood Allen & Rahal - Attorney Fees Check number 506 $ 3,000.00 06/20/2005 Kern and Company, P.C. - Accountant's Fee 190.00 09/26/2005 Keefer Wood Allen & Rahal, LLP - Attorneys Fees Check number 511 2,304.50 03/17/2006 Kern & Company - Accountant Fees 06/13/2006 Keefer Wood Allen & Rahal, LLP - Legal Fees 08/09/2006 Masland and Barrick - Investment Consultant Fees 10/19/2006 Sandra L. Jackson - Executor's Commissions 10/20/2006 Keefer Wood Allen & Rahal, LLP - Legal Fees 1,000.00 3,335.82 750.00 22,000.00 4,032.00 36,612.32 Other Expenses (prin) 06/26/2004 Return Of Annuity Payment From The State Employees Retirement System (Period 11/27/03 to 11/30/03) Check number 501 $ 70.02 02/13/2006 Pennsylvania Department of Revenue Estimated Payment Of Fiduciary Income Tax Fiscal Year 11/01/05-10/31/06 346.00 07/14/2006 Pennsylvania Department of Revenue - Estimated Fiduciary Income Tax Payment 173.00 11/24/2006 United States Treasury - Estimated Fiduciary Income Tax Payment 316.00 11/24/2006 PA Department of Revenue - Estimated Income Tax Payment 173.00 1,078.02 TOTAL DISBURSEMENTS OF PRINCIPAL $ 43,274.91 ----------- ----------- DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 Page 9 To: Exemption Equivalent Trust Pursuant To Item 4 Of Last will and Testament 10/03/2005 3M Co 340 Units $ 26,815.96 10/03/2005 3M Co 160 Units 12,619.27 10/03/2005 Agere Systems Class A 13 Units 46.09 10/03/2005 Agere Systems Class B 342 Units 1,155.96 10/03/2005 American Elec Pwr 300 Units 8,289.00 10/03/2005 Avaya Inc. 108 Units 1,448.28 10/03/2005 Baxter IntI Inc. 600 Units 16,497.00 10/03/2005 BellSouth Corp 1,188 Units 31,202.82 10/03/2005 Biomet, Inc. 2,025 Units 71,857.13 10/03/2005 Centerpoint Energy Inc. 200 Units 1,931.00 10/03/2005 Citizens Communications Co. 755 Units 8,237.05 10/03/2005 Diagnostic Prods Corp 200 Units 8,900.00 10/03/2005 Edwards Lifesciences Corp 60 Units 1,796.10 10/03/2005 Exxon Mobil Corp 2,928 Units 105,730.08 DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 Page 10 10/03/2005 Gallaher Group PLC 800 Units $ 32,268.00 10/03/2005 HCA Inc. 150 Units 6,258.00 10/03/2005 Healthsouth Corp 126 Units 500.85 10/03/2005 Humana Inc. 100 Units 2,186.50 10/03/2005 International Business Machs 51 Units 4,569.60 10/03/2005 Ivax Corp 255 Units 5,472.30 10/03/2005 Lifepoint Hospitals, Inc. 7 Units 207.62 10/03/2005 Lucent Technologies Inc. 324 Units 1,007.64 10/03/2005 Pepco Holdings Inc. 100 Units 1,842.50 10/03/2005 SBC Communications Inc 468 Units 10,930.14 10/03/2005 SBC Communications Inc. 1,179 Units 27,535.55 10/03/2005 Sysco Corp 1,600 Units 57,376.00 10/03/2005 TXU CORP 100 Units 2,207.50 10/03/2005 Teco Energy, Inc. 100 Units 1,295.00 10/03/2005 Telephone & Data Sys Inc. 225 Units 7,209.57 10/03/2005 Telephone Data Systems Special 225 Units 6,858.56 10/03/2005 Tenet Healthcare Corp-636886103 610 Units 8,960.90 DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES Estate of Langdon A~ Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 Page 11 10/03/2005 Tenet Healthcare Corp-88033GI00 305 Units $ 4,480.45 10/03/2005 Triad Hospitals Inc. 7 Units 239.26 10/03/2005 Tyco Intl LTD New 304 Units 6,882.56 10/03/2005 Ventas Inc. 93 Units 1,844.19 10/03/2005 Verizon Communications 292 Unjr", 9,563.00 10/05/2005 NCR Corp 125 Units 10/06/2005 Fortune 800 Units 10/18/2006 Cash 10/26/2006 Cash 12/08/2006 Lucent Technologies Inc. 972 Units 2,167.50 51,749.03 7,622.28 41,000.00 3,022.92 12/09/2006 Cash 12/29/2006 Cash 12/31/2006 Cash 12/31/2006 AT&T Corp 545 Units 12/31/2006 Caremark Rx Inc. 106 Units 12/31/2006 Comcast Corporation 363.5 Units 10,350.44 3,485.73 I, 113 . 02 10,793.49 2,800.52 7,666.22 12/31/2006 Diagnostic Prods Corp 200 Units 8,900.00 12/31/2006 IBM Book Entry Account 153 Units 31,264.02 12/31/2006 Ivax Corp 48 Units 1,030.08 DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 12/31/2006 Reliant Resources, Inc. 157 Units 12/31/2006 Texas Genco Hldgs Inc 10 Units 12/31/2006 Verizon Communications 292 Units 12/31/2006 XCEL Energy 147 Units 12/31/2006 PA Department of Revenue 12/31/2006 U.S. Treasury Total for Exemption Equivalent Trust TOTAL DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES $ 977.33 302.35 9,563.00 2,455.64 692.00 2,144.00 Page 12 $695,321. 00 $695,321. 00 ----------- ----------- INFORMATION SCHEDULES Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 Changes in Investment Holdings 3M Co 01/31/2004 Dividends 1.3 Units 03/17/2004 Dividends 0.012 Units 06/17/2004 Dividends 0.011 Units 09/16/2004 Purchased .011 Shares 3 M via Dividend Reinvestment Account 0.011 Units 12/16/2004 Purchased .012 Shares 3 M via Dividend Reinvestment Account 0.012 Units 12/30/2005 Estimated Dividends and Reinvestments in Year 2005 0.058 Units 03/16/2006 Purchased .017 Shares 3 M via Dividend Reinvestment Account 0.017 Units 06/16/2006 Purchased .016 Shares 3 M via Dividend Reinvestment Account 0.016 Units 09/18/2006 Sold 2.727 Shares 3M Held In Book Entry Account No. 4000631210 2.727 Units 3M Co - accrued income 12/12/2003 Dividend accrued to dod ACCO Brands Corp. 08/17/2005 Received 188 Shares Acco Brands in Spin Off From Fortune Brands, Inc. 188 Units Page 13 $ 204.28 0.00 0.93 0.94 0.94 0.94 4.96 1. 24 1. 25 -215.48 $ 0.00 $ 165.00 -165.00 0.00 $ 0.00 3,314.63 INFORMATION SCHEDULES Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 09/05/2006 Sold 188 Shares Acco Brands 188 Units $ -3,314.63 AT&T Corp $ 10,815.53 12/28/2005 AT&T - Cash In Lieu Of Fractional Shares -22.04 AT&T Wireless Svcs Inc. $ 3,578.85 03/04/2005 Cingular Wireless Services Inc. - Compulsory Buy-out Of AT&T Wireless 482 Units -3,578.85 Additional Shares 3M $ 39,537.50 09/18/2006 Sold Additional Shares 3M Held In Book Entry Account No. 4000137964 500 Units -39,537.50 American Century 021-000915640 $ 6,319.85 05/05/2004 Redemption of 0.346 shares of American Century 0.346 Units -11.79 12/28/2004 Dividends 0.398 Units 15.16 05/06/2005 Redemption of 0.348 shares of American Century 0.348 Units -11.86 11/04/2005 Sold .334 Shares American Century Investments 0.334 Units -11.38 12/13/2005 Received 1.246 shares Of American Century Dividend Reinvestment 1.246 Units 48.47 05/05/2006 Sold .323 Shares American Century Investments 0.323 Units -11.00 Page 14 $ 0.00 10,793.49 0.00 0.00 INFORMATION SCHEDULES Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 08/21/2006 Sold 185.789 Shares American Century Investments 185.789 Units American Elec Pwr - Accrued income 12/10/2003 Dividend accrued to dod Centerpoint Energy-accrued income 12/10/2003 Received Accrued Income Citizens Communications Co. 09/05/2006 Sold 220.69 Shares Citizens Communications Co. 220.69 Units Exxon Mobil Corp - accrued income 12/10/2003 Dividend accrued to dod 12/10/2003 Dividend accrued to dod Fortune 08/17/2005 Received $.34 in lieu of fractional share of Acco Brands 08/17/2005 Received 188 Shares Acco Brands in Spin Off From Fortune Brands, Inc. Fortune Brands - Accrued Dividends 03/01/2004 Dividends accrued to dod $ -6,337.45 $ 105.00 -105.00 $ 20.00 -20.00 $ 2,407.73 -2,407.73 $ 732.00 -132.00 -600.00 $ 55,064.00 -0.34 -3,314.63 $ 240.00 -240.00 Page 15 $ 0.00 0.00 0.00 0.00 0.00 51,749.03 0.00 INFORMATION SCHEDULES Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 Gallaher Group PLC-accrued income 11/28/2003 Dividend accrued to dod HCA, Inc. - accrued income 12/01/2003 Dividend accrued to dod Int. Business Machs-accrued income 12/10/2003 Dividend accrued to dod NCR Corp 10/05/2005 Stock Split Prior To Distribution/Transfer To Trust 62.5 Units Telephone & Data Sys Inc. 05/13/2005 Received 225 Shares Of Telephone Data Systems Special Common Stock In Stock Dividend Telephone Data Systems Special 05/13/2005 Received 225 Shares Of Telephone Data Systems Special Common Stock In Stock Dividend 225 Units Texas Genco Hdgs-accrued income 12/19/2003 Dividend accrued to dod $ 513.12 -513.12 $ 3.00 -3.00 $ 8.16 -8.16 $ 2,167.50 0.00 $ 14,068.13 -6,858.56 $ 0.00 6,858.56 $ 2.50 -2.50 Page 16 $ 0.00 0.00 0.00 2,167.50 7,209.57 6,858.56 0.00 INFORMATION SCHEDULES Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 Med Partners, Inc. $ 05/11/2005 Med Partners, Inc. - re-issue of uncashed check Mutual of Omaha refund 12/10/2003 Mutual of Omaha refund of premium paid Pennsylvania Department of Revenue 11/08/2005 Received Requested Refund Of Pennsylvania Fiduciary Income Tax Fiscal Tax Year 11/26/03-10/31/04 21.19 -21.19 $ 46.36 -46.36 $ 27.00 -27.00 Page 17 $ 0.00 0.00 0.00 Dividends 3M Co RECEIPTS OF INCOME Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 03/12/2004 Dividends 12/12/2003 Dividend accrued to dod 03/17/2004 Dividends 06/12/2004 Dividends 06/17/2004 Dividends 09/12/2004 Dividends 09/14/2004 Dividends 12/12/2004 Dividends 12/14/2004 Dividends 03/12/2005 Dividends 06/12/2005 Dividends 10/11/2005 Dividends 12/28/2005 Dividends 12/30/2005 Estimated Dividends and Reinvestments in Year 2005 03/16/2006 Dividends 03/18/2006 Dividends 06/15/2006 Dividends 06/15/2006 Dividends AT&T Corp 02/02/2004 Dividends 02/02/2004 Dividends 08/02/2004 Dividends Page 18 $ 165.00 360.00 0.93 360.00 0.94 360.00 0.94 360.00 0.94 420.00 420.00 420.00 210.00 4.96 1. 24 230.00 230.00 1. 25 3,546.20 $ 71.25 71.25 71.25 11/01/2004 Dividends 02/01/2005 Dividends 05/02/2005 Dividends 11/07/2005 Dividends 12/28/2005 Dividends 03/18/2006 Dividends 06/15/2006 Dividends 08/01/2006 Dividends 11/01/2006 Dividends RECEIPTS OF INCOME Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 12/28/2004 Dividends American Century 021-000915640 12/13/2005 Received 1.246 shares Of American Century Dividend Reinvestment Page 19 $ 71.25 71.25 71.25 71.25 390.00 181.21 181.21 181.21 181.21 1,613.59 $ 15.16 48.47 63.63 American Elec Pwr 03/10/2004 Dividends $ 105.00 03/31/2004 Dividends 25.00 06/10/2004 Dividends 105.00 09/10/2004 Dividends 105.00 12/10/2004 Dividends 105.00 03/10/2005 Dividends 105.00 06/10/2005 Dividends 105.00 10/11/2005 Dividends 105.00 ----------- 760.00 RECEIPTS OF INCOME Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 Page 20 Baxter Intl Inc. 01/05/2004 Dividends $ 349.20 01/05/2005 Dividends 349.20 698.40 BellSouth Corp 02/02/2004 Dividends $ 297.00 05/03/2004 Dividends 297.00 08/02/2004 Dividends 320.76 11/01/2004 Dividends 320.76 02/01/2005 Dividends 320.76 05/02/2005 Dividends 320.76 08/01/2005 Dividends 344.52 ----------- 2,221.56 Biomet, Inc. 07/23/2004 Dividends $ 405.00 07/22/2005 Dividends 506.25 ----------- 911.25 Caremark Rx Inc. 09/05/2006 Dividends $ 10.60 10/16/2006 Dividends 10.60 21.20 Centerpoint Energy Inc. 03/10/2004 Dividends $ 20.00 03/19/2004 Dividends 2.50 06/10/2004 Dividends 20.00 RECEIPTS OF INCOME Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 09/10/2004 Dividends 09/20/2004 Dividends 12/10/2004 Dividends 12/20/2004 Dividends 03/10/2005 Dividends 03/31/2005 Dividends 06/09/2005 Dividends 06/30/2005 Dividends 10/11/2005 Dividends Citizens Communications Co. 09/02/2004 Dividends 12/31/2004 Dividends 03/31/2005 Dividends 06/30/2005 Dividends 10/11/2005 Dividends 03/18/2006 Dividends 06/15/2006 Dividends Page 21 $ 20.00 2.50 20.00 2.50 20.00 20.00 470.00 14.00 14.00 625.50 $ 2,195.30 243.92 243.92 243.92 243.92 55.17 55.17 3,281.32 RECEIPTS OF INCOME Estate of Langdon A.. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 Page 22 05/13/2005 Dividends 10/11/2005 Dividends 12/28/2005 Dividends 03/18/2006 Dividends 06/15/2006 Dividends 07/26/2006 Dividends $ 28.00 28.00 14.00 14.00 14.00 14.00 240.00 Exxon Mobil Corp 03/10/2004 Dividends $ 600.00 03/10/2004 Dividends 132.00 06/10/2004 Dividends 648.00 06/10/2004 Dividends 142.56 09/10/2004 Dividends 648.00 09/10/2004 Dividends 142.56 12/10/2004 Dividends 142.56 12/10/2004 Dividends 648.00 03/10/2005 Dividends 142.56 03/10/2005 Dividends 648.00 06/10/2005 Dividends 696.00 06/10/2005 Dividends 153.12 10/11/2005 Dividends 153.12 10/11/2005 Dividends 696.00 ----------- 5,592.48 Fortune 06/01/2004 Dividends $ 240.00 RECEIPTS OF INCOME Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 Page 23 09/01/2004 Dividends 12/01/2004 Dividends 03/01/2005 Dividends 06/01/2005 Dividends 10/11/2005 Dividends $ 264.00 264.00 264.00 264.00 288.00 1,584.00 Gallaher Group PLC OS/28/2004 Dividends $ 1,144.48 11/30/2004 Dividends 592.00 05/31/2005 Dividends 1,258.00 12/28/2005 Dividends 580.06 3,574.54 HCA Inc. 03/01/2004 Dividends $ 3.00 06/01/2004 Dividends 19.50 09/01/2004 Dividends 19.50 12/01/2004 Dividends 19.50 03/01/2005 Dividends 19.50 06/01/2005 Dividends 22.50 10/11/2005 Dividends 22.50 ----------- 126.00 International Business Machs 12/10/2003 Dividend accrued to dod $ 24.48 02/10/2004 Dividend accrued to dod 32.64 05/10/2004 Dividends 36.72 08/10/2004 Dividends 12/10/2004 Dividends 02/10/2005 Dividends 05/10/2005 Dividends 10/11/2005 Dividends 12/28/2005 Dividends 03/18/2006 Dividends 06/15/2006 Dividends 08/10/2006 Dividends Ivax Corp 08/24/2004 Dividends Pepco Holdings Inc. 12/31/2003 Dividends 06/30/2004 Dividends 09/30/2004 Dividends 12/31/2004 Dividends 03/31/2005 Dividends 06/30/2005 Dividends 10/11/2005 Dividends SBC Communications Inc 11/07/2005 Dividends SBC Communications Inc. 02/02/2004 Dividends RECEIPTS OF INCOME Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 Page 24 $ 36.72 36.72 36.72 40.80 40.80 30.60 30.60 45.90 45.90 438.60 $ 14.97 25.00 25.00 25.00 25.00 25.00 25.00 25.00 175.00 $ 682.09 660.94 RECEIPTS OF INCOME Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 Page 25 05/03/2004 Dividends 08/02/2004 Dividends 11/01/2004 Dividends 02/01/2005 Dividends 05/02/2005 Dividends 08/01/2005 Dividends $ 660.94 660.94 660.94 682.09 682.09 682.09 4,690.03 Sysco Corp 01/23/2004 Dividends $ 208.00 04/23/2004 Dividends 208.00 07/23/2004 Dividends 208.00 10/22/2004 Dividends 208.00 01/28/2005 Dividends 240.00 04/22/2005 Dividends 240.00 07/22/2005 Dividends 240.00 11/07/2005 Dividends 240.00 ----------- 1,792.00 TXU CORP 01/02/2004 Dividends $ 12.50 04/01/2004 Dividends 12.50 07/01/2004 Dividends 12.50 10/01/2004 Dividends 12.50 01/03/2005 Dividends 56.25 04/01/2005 Dividends 56.25 07/01/2005 Dividends 56.25 RECEIPTS OF INCOME Estate of Langdon A.. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 Page 26 10/11/2005 Dividends $ 56.25 275.00 Teco Energy, Inc. 02/15/2004 Dividends $ 19.00 05/15/2004 Dividends 19.00 08/15/2004 Dividends 19.00 11/15/2004 Dividends 19.00 02/15/2005 Dividends 19.00 05/16/2005 Dividends 19.00 08/15/2005 Dividends 19.00 08/26/2005 Dividends 67.00 ----------- 200.00 Telephone & Data Sys Inc. 12/30/2003 Dividends $ 34.88 03/31/2004 Dividends 37.13 06/30/2004 Dividends 37.13 09/30/2004 Dividends 37.13 12/30/2004 Dividends 37.13 03/31/2005 Dividends 39.38 06/30/2005 Dividends 39.38 10/11/2005 Dividends 39.38 ----------- 301.54 Texas Genco Hldgs Inc 06/18/2004 Dividends $ 2.50 RECEIPTS OF INCOME Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 Page 27 Tyco IntI LTD New 02/02/2004 Dividends $ 3.80 05/01/2004 Dividends 3.80 08/02/2004 Dividends 3.80 11/01/2004 Dividends 3.80 02/01/2005 Dividends 30.40 05/02/2005 Dividends 30.40 08/02/2005 Dividends 30.40 11/07/2005 Dividends 30.40 ----------- 136.80 Ventas Inc. 01/13/2004 Dividends $ 24.88 03/25/2004 Dividends 30.23 06/29/2004 Dividends 30.23 09/30/2004 Dividends 30.23 01/13/2005 Dividends 30.23 04/05/2005 Dividends 33.48 06/29/2005 Dividends 33.48 10/11/2005 Dividends 34.48 ----------- 247.24 02/01/2005 Dividends 05/02/2005 Dividends 08/01/2005 Dividends 11/07/2005 Dividends 03/18/2006 Dividends 06/15/2006 Dividends 08/01/2006 Dividends 11/01/2006 Dividends RECEIPTS OF INCOME Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 Page 28 $ 224.84 236.52 236.52 236.52 118.26 118.26 118.26 118.26 2,306.80 XCEL Energy 12/31/2003 Dividends $ 27.56 01/20/2004 Dividends 27.56 04/20/2004 Dividends 27.56 07/20/2004 Dividends 30.50 10/20/2004 Dividends 30.50 01/20/2005 Dividends 30.50 04/20/2005 Dividends 30.50 07/20/2005 Dividends 31.61 11/07/2005 Dividends 31.61 03/18/2006 Dividends 31.61 06/15/2006 Dividends 31.61 09/05/2006 Dividends 32.71 10/20/2006 Dividends 32.71 ----------- 396.54 Miscellaneous RECEIPTS OF INCOME Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 Total Dividends 02/06/2004 USAA refund of premium Interest PSECU-savings 11/30/2003 Dividend 12/31/2003 Dividend 01/31/2004 Dividend 02/29/2004 Dividend 03/31/2004 Dividend 04/30/2004 Dividend 05/31/2004 Dividend 06/30/2004 Dividend 07/31/2004 Dividend 08/31/2004 Dividend 09/30/2004 Dividend 10/31/2004 Dividend 11/30/2004 Dividend 12/31/2004 Dividend 01/31/2005 Dividend 02/28/2005 Dividend 03/31/2005 Dividend 04/30/2005 Dividend 05/31/2005 Dividend 06/30/2005 Dividend Page 29 $ 93.10 $ 36,611.88 4.70 29.23 29.25 27.38 29.28 28.36 29.32 28.39 29.36 29.38 28.45 29.41 28.48 29.45 29.47 26.63 29.50 28.57 29.54 28.61 07/31/2005 Dividend 08/31/2005 Dividend 09/30/2005 Dividend 10/31/2005 Dividend 11/30/2005 Dividend 12/31/2005 Dividend 01/31/2006 Dividend 02/28/2006 Dividend 03/31/2006 Dividend 04/30/2006 Dividend 05/31/2006 Dividend 06/30/2006 Dividend 07/12/2006 Dividend Total Interest TOTAL RECEIPTS OF INCOME RECEIPTS OF INCOME Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 Page 30 $ 29.58 29.60 28.66 29.63 28.70 29.67 39.59 35.79 39.65 38.40 39.72 38.47 17.51 977.73 $ 977.73 $ 37,589.61 ----------- ----------- DISBURSEMENTS OF INCOME Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 Income Taxes 02/11/2005 U. S. Treasury Estimated Payment of Fiduciary Income Tax Fiscal Tax Year 11/26/03-10/31/04 Check number 504 02/11/2005 Pennsylvania Department of Revenue Estimated Payment Of Fiduciary Income Tax Fiscal Tax Year 11/26/03-10/31/04 Check number 504 OS/24/2005 United States Treasury Refund Of Overpayment of Fduciary Income Tax Fiscal Tax Year 11/26/03-10/31/04 08/25/2005 Pennsylvania Department of Revenue - Estimated Payment Of Fiduciary Income Tax Fiscal Tax Year 11/01/04-10/31/05 Check number 508 08/25/2005 U.S. Treasury Estimated Payment Of Fiduciary Income Tax Fiscal Year 11/01/04-10/31/05 Check number 509 02/13/2006 Pennsylvania Department of Revenue - Fiduciary Income Tax Fiscal Year 11/01/04-10/31/05 Check number 512 TOTAL DISBURSEMENTS OF INCOME Page 31 $ 4,267.00 446.00 -346.52 412.00 4,000.00 278.00 $ 9,056.48 $ 9,056.48 ----------- ----------- DISTRIBUTIONS OF INCOME TO BENEFICIARIES Estate of Langdon A. Jackson, Jr. For Period 11/26/2003 Through 12/31/2006 To: Carolyn Jackson Income Distribution - Check Written By Carolyn W. Jackson 12/08/2005 Citizens Bank checking account Check number 527 12/15/2005 Citizens Bank checking account Check number 528 12/16/2005 Citizens Bank checking account Check number 529 12/16/2005 Citizens Bank checking account Check number 530 Total for Carolyn Jackson To: Exemption Equivalent Trust Pursuant To Item 4 Of Last will and Testament 10/18/2006 Cash 12/29/2006 Cash Total for Exemption Equivalent Trust TOTAL DISTRIBUTIONS OF INCOME TO BENEFICIARIES $ 119.00 85.00 107.30 42.32 27,377.72 801.79 Page 32 $ 353.62 28,179.51 $ 28,533.13 ----------- ----------- IN THE MATTER OF THE ESTATE OF LANGDON A. JACKSON, JR. DECEASED : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : No. 00103 Of 2004 AFFIDAVIT OF ACCOUNTING PARTY Subject to the penalties of 19 Pa. C.S.A. 94904, relating to unsworn falsification(s) to authorities, Sandra L. Jackson, as Executor of the Estate of Langdon A. Jackson, Jr., Deceased, hereby declares under oath that the Executor has fully and faithfully discharged the duties of her office; that the foregoing First and Final Account (the "Account") is true and correct, and fully discloses all significant transactions occurring during the accounting period; that all known claims against the Estate have been paid in full; that, to her knowledge, there are no claims now outstanding against the Estate; and that all taxes presently due form the Estate have been paid. STATE OF NEW JERSEY lV' OR.. R tS SS. COUNTY OF On this / 57 day of ~UA1 E , 2007 before me, the undersigned officer, personally appeared Sandra L. Jackson, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same in the fiduciary capacity indicated above for the purposes therein contained. IN WITNESS WHEREOF, I hereunder set my hand and official seal. Not~~ NOTARY PUBLIC OF NEW JERSEY M'I COmmIulon ExpiI88 Feb. 18. 2010 I J I I " Q"'r"-'\""",'''-''OC~'''':'-'''''\:'':~,'', ' ", ", "',C ' "\~ \ \ "', 'V" j', ' U" ~~" / ' fVv(j ~lJ ~ Register of Wills of CUMBERLAND County, pennsylva Certificate of Grant of Letters No. 2004-00103 PA No. 21-04-0103 ESTATE OF JACKSON LANGDON A JR (LA::; 1', .i:' .LI<.::; 1', jVaUUL.t; j Late of LOWER ALLEN TOWNSHIP CUjVjJ::SJ:;I<.LANU CUU.N l' Y , Deceased Social Security No. 236-62-0967 day of February WHEREAS, on the 2nd dated July 19th 1996 was admitted to probate as the last will of JACKSON LANGDON A JR (LA::; 1', .i:' .L1<::; 1', IvaUULJ:;) 2004 an instrum, late of LOWER ALLEN TOWNSHIP 26th day of November 2003 andr WHEREAS, a true copy of the will as probated is annexed hereto. CUMBERLAND County, who died on the THEREFORE, I, GLENDA FARNER STRASBAUGH r Register of Wills In and fOl the County of Cill~BERLAND in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to JACKSON SANDRA L who has duly qualified as Executor (rix) and has agreed to administer the estate according to law, all of which fully appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, of my Office the 2nd day ',J", " ",'/V, vel ;,_Ju.._,~! 1\.J I Wi-,(,ri C:[\'/'.JrliJO .1.'._"';1 Iv,_..... \,." \ ,!;w.... I "I \" . -ro '.j" ;JU /IO::J I 8fj :8 ~~V SZ lnr LOOl I have hereunto set my hand and affixed the seal of February 2004. ~ ~ ~ ~ ( .. ,~" ~~-'~ L#//f //?'/ "egls ,,0 Wl 1.S r<<./ /jc-;/~o:-y ("~ :,:1(': ,i,~:-'(Y'-r-~ *'*'f:J'OIf'E'i-"'* ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE) -- ! '-~ - - f-"~ ~~ ~ .;;)...1) b t--:) " ~ ~: ~/ 1-'. ~ -"0 b ~ ~ - 0 <" CIl CIl (1) ~ 8"-~i --- ~ ..-- >-:lO::r: ~ ..- CJq>-+, :> ..---... . J ~ f-" ~ >-+, p:J ..-....... ~ ~ !-~ G) -:J ..... ~ Q 0 ~ O"O<.l>-:l,.., ~ ~ - L' f-" (1) (1) 1-" ~ Ht <D 5 CIl ~ 0" ~ too'...... --------- ~ CIl 0 ~ ...... --- -- -- '<:X>-:l- --- ~ - --' - CJq~ --- <: w ~ ~ ~f-"C/.lt:!j O....C/.l ~ 'I' ~ ~ ;;. ;;5 '8 ~ .~~ (1) - ....~ ~ )_1. ~ '- last .ill Ctno Q[~,$tctm~ttt OF LANGDON A. JACKSON, JR. BE IT REMEMBERED, that I, LANGDON A. JACKSON, JR., of the Township of Lower Allen, County of Cumberland, and Commonwealth of Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last Will anq Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof by me at any time heretofore made. ITEM 1: I direct that my hereinafter named Executrix pay all my just debts, my funeral expenses, and the expenses of the administration of my estate. With this direction, I authorize and empower my Executrix to expend for my funeral expenses and interment such amounts as she may consider necessary and proper, without regard to any limit that may be prescribed by a court of law. ITEM 2: I direct my Executrix to pay aU inheritance, estate, succession, and legacy taxes of whatsoever nature and kind, to which my estate, or the transfer of any property passing hereunder or otherwise passing by reason of my demise, may be subject, and to charge such taxes against my residuary estate, it being my intention that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross estate, under the provisions of any state or federal law now in force or hereafter enacted, [.-- ;:~F .~~: ;~~;~:..:' :"':':;.:'.. -'> sball be prorated among the persons interested in my estate to whom such property is or may be transferred or to whom any benefit accrues. ITEM 3: ARTICLES. I give and bequeath unto my wife, CAROLYN W. JACKSON, all of my tangible personal property not used in business or for the production of income, including without limitation, furniture, furnishings, clothing, jewelry, objects of art andci~c()T<:ltion,and the like, and motor vehicles which Iown,together;with insurance - -. "." ._- --. : -.-. '~- -: --" " ..::. ;..-::".:..;'.;~"f':~::~-~r:.:::~<-\"': -. -. .' tbereon, if she survives me for a period of thirty (30) days. If my wife does not survive me for thirty (30) days, I then bequeath all said property, together with insurance thereon, to my daughters, SA1'fDRA L. JACKSON and SHARON J. YUNGSHTEN, in equal shares, or to whichever of them survives both my wife and me for a period of thirty (30) days. ITEM 4: EXEMPTION EQUIVALENT TRUST. If my wife, CAROLYN W. JACKSON, survives me, I devise and bequeath unto my Trustee hereinafter named, property with the value equal to the exemption equivalent permitted my estate under the federal estate tax provisions of the Internal Revenue Code of 1954, as amended, and enforced at the time of my demise, which property may be transferred free of tax using tbe estate tax credit as provided for in IRC 92010 or other appropriate sections. It is my intention to fund this Trust with the largest amount of property which could pass from my estate to this Trust free of federal estate tax by utilizing the unified credit exemption equivalent. My Trustee shall keep the corpus of the Trust invested and shall distribute the income and principal of the Trust as follows: 2 1'~"';:~"'i;3~~""""0'!'i'J!'~''f!'""",^,_""~;"".,,,~__n_' -,,- r j J'; / A. During my wife's lifetime tbe entire net income shall be paid to my wife in at least quarter annual payments. B. In addition to the income, my wife shall have the power to direct the Trustee to pay to her or apply for ber use the principal of the Trust in each calendar year including tbe year in wbicb my deatb occurs, in an amount not in excess the greater of Five Thousand Dollars ($5,000.00) or five percent (5%) of the aggregate value of the principal of tbe Trust on the last day of the calendar year for which payment may be directed. Such power shall not be cumulative, but shall expire on the last day of each calendar year. This shall be exercised by an instrument in writing, subscribed by my wife, or her duly authorized agent, and delivered to the Trustee. C. I authorize my Trustee, acting solely and without consultation with my wife, in my Trustee's sole discretion, at any time, and from time to time, to payor apply to or for the use of my wife such portion of the principal of this Trust, even to the point of completely exhausting the same, as my Trustee may deem advisable to provide for the proper support, maintenance and health care of my wife, and for the continuance of the standard of living maintained by her during my lifetime. In determining the amount of principal to be so disbursed, my Trustee shall take into consideration any income which my wife may have from any other source, and the Trustee's discretion shall be 3 / / conclusive as to the advisability of any such disbursement, and shall not be subject to judicial review. D. Upon the death of the survivor of my wife and me, all principal remaining in the Trust shall be divided into two (2) equal shares to be distributed outright to my daughters, SANDRA L. JACKSON and SHARON J. YUNGSHTEN. ITEM 5: PROHIBITED POWERS. A. No Trustee or Executrix who is beneficiary hereunder shall ever participate Ill: 1) The exercise of, or decision not to exercise, any discretionary power to pay income 'or principal to, or to apply income or principal for the benefit of any beneficiary [including discretion to allocate funds among a group of beneficiaries and discretion to accumulate income]; 2) The determination of whether any beneficiary is disabled; 3) The decision of when to pay death taxes on any future interest; 4) The decision to terminate any Trust hereunder; 5) The exercise of discretion to allocate receipts or expenses between principal and income; 6) The decision of whether to use expenses as mcome or estate tax deductions; 7) The decision to make payment to aid in the settlement of my estate; or 4 /..." ..... ' / / 8) The selection of the property to be allocated to the marital deduction Trust. B. Any Trustee or Executrix may resign at any time without court approval. ITEM 6: CAPTIONS. Paragraph and subparagraph captions contained in this Will shall not be construed as part thereof, but are used merely for ready reference purposes. ITEM 7: PROTECflVE CLAUSE. No gifts hereunder shall be subject to anticipation, assignment, pledge, obligation or beneficiaries, execution or attachment. ITEM 8: POWERS. I authorize my Executrix and Trustee as follows: A. To retain and invest in all forms of real and personal property, including stocks or other securities of the corporate fiduciary or the holding company controlling the corporate fiduciary, regardless of any limitations imposed by law on investments by fiduciaries; B. To compromise claims; C. To join in any merger, reorganization, voting trust plan or other concerted action of securities holders, and to delegate discretionary duties with respect thereto; D. To sell at public or private sale, to exchange or to lease for any period of time, any real or personal property, and to give options for sales or leases; E. To borrow and to pledge property as security for any funds borrowed; F. To allocate any property received or charge incurred to income or principal or partly to each, without regard for any law defining principal and income, 5 provided that all decisions under this paragraph shall be made by my Executrix or my Trustee alone; G. To exercise any law given option to treat administrative or other expenses of my estate as income tax deductions, even if they were paid from principal, and to value my estate for tax purposes by an optional method permitted by the law enforced when I die, without requiring adjustments between income and principal for any resulting effect on income or estate taxes; and H. To distribute in cash or in kind. These authorities shall extend to all real and personal property at any time held by my Executrix or my Trustee, and shall continue in full force until the actual distribution of such property is accomplished. All powers, authorities and discretions granted by this Will shall be in addition to those granted by law and shall be exercisable without leave of court. ITEM 9: TRUSTEE. I appoint my daughter, SANDRA L. JACKSON, to serve as Trustee of the Trust hereinbefore established. In the event that my daugther, SANDRA L. JACKSON, should fail to survive me, or cease to act in the capacity as Trustee, I then appoint my daughter, SHARON J. YUNGHTEN, as successor Trustee of said Trust. ITEM 10: EXECUTRIX. Lastly, I nominate, constitute and appoint my wife, CAROLYN W. JACKSON, to serve as Executrix of this my Last Will and Testament. If my wife, CAROLYN, should fail to survive me, or be unable to qualify, I then appoint my daughter, SANDRA L. JACKSON, to serve as first alternate Executrix of this my Last Will and Testament; and in the event that she is unable or unwilling to serve, I appoint my 6 daughter, SHARON J. YUNGHTEN, as second alternate Executrix of this my Last Will and Testament. I give to my Executrix the power to file any qualified disclaimer that I could have filed if living. ITEM 14: I direct that my hereinbefore named Executrix shall not be required to give bond for the faithful performance of her duties in this or any jurisdiction. Will and Testament, this /'1 ifF day of IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last r!vd4 --- ~ rJ ,1996. --_..--:;,' , /' .. / .' ....;:....:.i"C-..,. -;"~_,.rC;'~-C' ~ j I. ..~.l:~-/1-..:z<>..-:;.- . ~_.-- LANGDON A. !ACKSON, JR.~// ,/ The preceding instrument, consisting of this and six (6) other typewritten pages, was on the day and date thereof signed, sealed, published, and declared by the Testator herein named, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence and in the presence of each other, have subscribed our names as witnesses hereto. i---jl /' /,1,'} ( , , " ,/ i / __' , I f J/ :., J C", .I ' 1t' // /, ' /"" I h /,', ;(,~ ... ~':-_I" /' 1.( ~'/'" /;.- ..." /'-./ _./ ',".( ,- . , / OF / ,,' ,,' II ... / /'__" -'. / 1 ;1 \ / / /. 'J-HI //7;' //~ / '/, .7.' "/ L . r, ,,/, L II___>I"./Cc,,-~-I-o-! /~ \ _ ,1:.-.<. / /c.// '7 ~, (jf! I;JJ/y . ( OF 7 COUNTY OF COMMONWEALTH OF PENNSYLVANIA L~ () SS. We, LANGDON f. JACKS~N, JR., rlucttt 1/ d tl1~ ....J '--- IJ L I \ ' respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament, and that he signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator signed the Will as witnesses, and that to the best of their knowledge, the Testator was at the time eighteen &Ii //i~ / the Testator and the ~ ---- and witnesses, (18) years of age or older, of sound mind, and under no constraint or undue influence. .~_.- " ,,- .-<:!e...... -:~t:CL.+C'-~ ~."j. .}~_;.~~... -.;.- /"/~j::-::;:+;:-:':" __~_ ..,. ~;..... --- LANL~/ /' j I _," ,t'! / /;/~l, I /' . I :,;-' I 1/ ,.I /1 /I,' /, l/f _ /i ~)~-;/(\///::-/ // ,/ SWORN TO AND SUBSCRIBED BEFORE ME THIS /1!ti DAY OF~G~ ,1996. ( k. L 'I (;0 \ ~~~ ~ )~Jt( NOTARY P;UBLIC Notarial Seal Janet S, Gore. Notary Public Dillsburg Bora, York County My Commission Expires Oct. 25, 1998 Mpmhpr. Ppnnsvlwmia Association of No\a;t~S INRE: THE ESTATE OF LANGDON A. JACKSON, JR., DECEASED IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. OF YEAR 2004 CERTIFICATE OF SERVICE I hereby certify that on 25th day of July, 2007, a true an correct copy of the foregoing document was served by either hand delivery or certified mail, postage prepaid, upon the following, and that the requirements of Rule 6.31 (a) and Rule 6.31 (b) have been met: Carolyn W. Jackson 402 Blacklatch Lane Camp Hill, PA 17011-8414 Sharon J. Yungshten 8649 Blackpool Drive Annadale, VA 22003 Neil E. Hendershot, Esquire Counsel For Carolyn W. Jackson Goldberg & Katzman, PC P.O. Box 1268 Harrisburg, PA 17108-1268 Sandra L. Jackson P.O. Box J lronia, NJ 07845 Dated July 25, 2007 " ' . .,'iHY) "']c,! - ,,-, .'c" -j'd-"' '0 . UC'I"""" "....'H tJ leil \\j{~ '~~~(;Jlr~ c.! ) )!.J.,J ,J --\.., g~ :8 ~~\j S2 lrW lOOZ DECEDENT'S ESTATE COURT OF COMMON PLEAS OF Cumberland COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF Langdon A. Jackson, Jr. , DECEASED No. 2004-00103 PETITION FOR ADJUDICATION / STATEMENT OF PROPOSED DISTRIBUTION PURSUANT TO Pa. O.c. Rule 6.9 Ills> \ <os .sa"~ ~ % s '& 3. \ ~ .j) o ~:,:Q :--1:.::6 ;-.,-(") ~~r.- nl :n /'~ 1'0.) ~ = -. <- C I N CJ1 o .... This form may be used in all cases involving the Audit of the Account of a Decedent's Estate. If space is insufficient, riders may be attached. Attach the spouse's election, if any; the papers required under items 8-19 inclusive; and any instrument pertinent to the adjudication. INCLUDE ATTACHMENTS AT THE BACK OF THIS FORM. Name of Counsel: Stephanie Kleinfelter, Esq. Supreme Court J.D. No.: 80089 Name of Law Firm: Keefer Wood Allen & Rahal, LLP Address: 635 N. 12th Street, Suite 400, Lemoyne, PA 17043 Telephone: 717-901-7786 Fax: 717-612-5805 Form OC-OJ rev. 10.13.06 Page 1 of 10 =D ~-S C) -on +'J (g :Po ::'!: CD .J.-- co Estate of Langdon A. Jackson, Jr. , Deceased 1. Name(s) and addressees) ofPetitioner(s): Name: Sandra L. Jackson, Executrix Address: 9 Surrey Lane Mendham, NJ 07945 Identify any executors or administrators who have not joined in the Petition for Adjudication and Statement of Proposed Distribution and state reason: None Is this the first accounting by this fiduciary? . . . . . . . . . . . . . . . . . . . .. IZJI Yes D No If not, identify prior accountings, the accounting periods covered, and the date of adjudication of the prior accounting. 2. Decedent died on November 26, 2003 IZJI Letters Testamentary or DLetters of Administration were granted to Petitioner(s) on February 2. 2004 Date of Will (ifapplicable): July 19, 1996 Date(s) of Codicil(s) (if applicable): Date of probate (if different from date Letters granted): Was a bond required? DYes Ii] No If yes, state amount: Are proofs of advertising of the grant of Letters attached? ......... IZJI Yes D No Dates of advertising of the grant of Letters: The Sentinel: June 12,19,26,2004 Cumberland Law Journal: June 18,25 July 2, 2004 Form OC-OJ rev. 10.13.06 Page 2 of 10 Estate of Langdon A. Jackson, Jr. , Deceased 3. Was decedent survived by a spouse? ............................. IZIYes DNo If yes, name of the surviving spouse: Carolyn W. Jackson 4. Has the surviving spouse filed to take an elective share? ............. DYes IZI No (See Section 2201 et seq. of the Probate, Estates and Fiduciaries Code) If yes, date of election: 5. In the case of an intestacy, state the names of the decedent's surviving children or surviving issue of deceased children (ifnone, so state): 6. Did decedent marry after execution of Will or Codicil(s)? . . . . . . . . . .. DYes IZI No Were any children born to decedent after execution of Will or Codicil(s)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DYes IZI No If yes, give names and dates of birth: Name: Date of Birth: 7. If required by the Medical Assistance Estate Recovery Act, 62 P.S. S 1412, was a request for a statement of claim sent to the Department of Public Welfare? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . IZIYes D No Form OC-OJ rev. 10.13.06 Page 3 of 10 Estate of Langdon A. Jackson, Jr. , Deceased 8. Written notice of the Audit as required by Pa. O.c. Rules 6.3,6.7 and 6.8 has been or will be given to all parties in interest listed in item 9 below, all unpaid creditors and all claimants listed in item 10 below. In addition, notice of any questions requiring Adjudication as discussed in item 14 below has been or will be given to all persons affected thereby. A. If Notice has been given, attach a copy of the Notice as well as a list of the names and addresses of the parties receiving such Notice. B. If Notice is yet to be given, a copy of the Notice as well as a list of the names and addresses of the parties receiving such Notice shall be submitted at the Audit together with a statement executed by a Petitioner or counsel certifying that such notice has been given. C. If any person entitled to Notice is not sui juris (e.g., minors or incapacitated persons), Notice of the Audit has been or will be given to the appropriate representative on such party's behalf as required by Pa. O.c. Rule 5.2. D. If any charitable interest is involved, Notice of the Audit has been or will also be given to the Attorney General as required under Pa. O.C. Rule 5.5. In addition, the Attorney General's clearance certificate (or proof of service of Notice and a copy of such Notice) must be submitted herewith or at the Audit. 9. List all parties (charitable and non-charitable) of whom Petitioner(s) has/have notice or knowledge, having or claiming any interest in the estate as beneficiaries under the Will or Codicil(s) or as intestate heirs if there is a complete or partial intestacy: A. State each party's relationship to the decedent and the nature of each party's interest( s ): Name and Address of Each Party in Interest Relationship and Comments, if any Interest Sandra L. Jackson Mailing Address: P.O. Box J Ironia, NJ 07845 individually and as Trustee of Exemption Equivalent Trust Trustee (and a Remainder Beneficiary) of Exemption Trust Carolyn W. Jackson 402 Blacklatch Lane Camp Hill, PA 17011-8414 AND surviving spouse Present Beneficiary of Exemption Equivalent Trust Form OC-OJ rev.1O.J3.06 Page 4 of 10 Estate of Langdon A. Jackson, Jr. , Deceased Name and Address of Each Party in Interest Relationship and Comments, if any Interest Neil E. Hendershot, Esquire Goldberg & Katzman, PC P.O. Box 1268 Harrisburg, PA 17108-1268 Sharon J. Yungshten 8619 Blackpool Drive Annanda1e, VA 22003 Daughter Remainder Beneficiary of Exemption Equivalent Trust B. IdentifY each party who is not sui juris (e.g., minors or incapacitated persons). For each such party, give date of birth, the name of each Guardian and how each Guardian was appointed. If no Guardian has been appointed, identifY the next of kin of such party, giving the name, address and relationship of each. None C. State why a Petition for Guardian/Trustee Ad Litem has or has not been filed for this Audit (~ee Pa. o.c. Rule 12.4). N/A D. If distribution is to be made to the personal representative of a deceased party, state date of death, date and place of grant of Letters and type of Letters granted. None Form DC-OJ rev. 10.13.06 Page 5 of 10 Estate of Langdon A. Jackson, Jr. , Deceased 10. Other than the claim for the family exemption, list the names of all known claimants and the amount of their claims and state whether each claim is admitted. Name and Address of Each Claimant Amount of Claim Claim Will Claim Admitted? Be Paid In Full? None DYes DYes DNo DNo DYes DYes DNo DNo DYes DYes DNo DNo DYes DYes DNo DNo If the estate is insolvent, attach a schedule setting forth the order of preference under 20 Pa.C.S. S 3392 and the proposed payments. Was family exemption allowed? [ZIYes [ZIYes DNo DNo 11. Was family exemption claimed? Family exemption claimant's name and relationship: Name: Carolyn W. Jackson Relationship: Surviving Spouse Form OC-01 rev. /0.13.06 Page 6 of 10 Estate of Langdon A. Jackson, Jf. , Deceased 12. The amount of Pennsylvania Transfer Inheritance Tax and additional Pennsylvania Estate Tax paid, the date(s) ofpayment(s), and the interest(s) upon which paid, are as follows: Date Payment Interest 0.00 $ 0.00 13. On the date of death, was the decedent a fiduciary (personal representative, trustee, guardian, agent under power of attorney) or surety on the bond ofa fiduciary? . . . . . . . . . . . . . . . . . . . DYes IZJ No If yes, provide the name of the estate, indicate whether an account has been filed and confirmed absolutely and all awards performed, or, in the alternative, how the decedent's estate will be discharged for the decedent's fiduciary administration of the estate. 14. A. Describe in detail any questions requiring adjudication and state the position of the Petitioner( s) as to each question: None B. Has notice of the question requiring adjudication been given to the parties identified in Paragraph 9 above? .................. DYes D No 15. IfPetitioner(s) has/have knowledge that a share has been assigned, renounced, disclaimed or attached, provide a copy of the assignment, renunciation, disclaimer or attachment, together with any relevant supporting documentation. Form OC-OJ rev. JO.13.06 Page 7 of 10 Estate of Langdon A. Jackson, Jr. , Deceased 16. Had the decedent been adjudicated an incapacitated person? . . . . . . . . . . DYes IZI No If yes, attach a copy of the Order if available; otherwise state the Court, term, number, date, and name of Hearing Judge. 17. A. List or attach a separate list of additional receipts and disbursements since the closing date of the Account. None B. Has notice of the additional receipts and disbursements been given to the parties identified in Paragraph 9 above? ............. DYes IZl No 18. If a reserve is requested, state amount and purpose. Amount: Purpose: None If a reserve is requested for counsel fees, has notice of the amount of fees to be paid from the reserve been given to the parties in interest? ........................................ DYes DNo If so, attach a copy of the notice. 19. Is the Court being asked to direct the filing of a Schedule of Distribution? IZlYes DNo As to real estate only? ........................................ DIY es IZl No Form DC-OJ rev. 10.13.06 Page 8 of 10 Estate of Langdon A. Jackson, Jr. , Deceased Wherefore, your Petitioner(s) ask(s) that distribution be awarded to the parties entitled and suggest(s) that the distributive shares of income and principal (residuary shares being stated in proportions, not amounts) are as follows: A. Income: Proposed Distributee(s) Amount/Proportion B. Principal: Proposed Distributee(s) Amount/Proportion Sandra L. Jackson, Trustee of the Exemption Equivalent Trust 100% Submitted By: (All petitioners must sign. Add additional lines ifnecessary): Name of Petitioner: Form DC-OJ rev. 10.13.06 Page 9 of 10 Estate of Langdon A. Jackson, Jr. , Deceased Verification of Petitioner (Verification must be by at least one petitioner.) The undersigned hereby verifies * ~at ~~/<~D HI titlp of tw abave ftftfl1ed name oJ corporanon -amtt that the facts set forth in the foregoing Petition for Adjudication / Statement of Proposed Distribution which are within the personal knowledge of the Petitioner are true, and as to facts based on the information of others, the Petitioner, after diligent inquiry, believes them to be true; and that any false statements herein are made subject to the penalties of 18 Pa. C.S. S 4904 (relating to unsworn falsification to authorities). Signature of Petitio W{~ * Corporate petitioners must complete bracketed information. Certification of Counsel The undersigned counsel hereby certifies that the foregoing Petition for Adjudication! Statement of Proposed Distribution is a true and accurate reproduction of the form Petition authorized by the Supreme Court, and that no changes to the form have been made beyond the responses herein. Form DC-OJ rev. 10.13.06 Page 10 of 10 ""..., ~ ~ - COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNYSLVANIA ORPHANS' COURT DIVISION Docket No: 21-2004-0103 INRE: FIRST AND FINAL ACCOUNT OF SANDRA L. JACKSON, EXECUTRIX FOR THE ESTATE OF LANGDON A. JACKSON, JR., LATE OF LOWER ALLEN TOWNSHIP, CUMBERLAND COUNTY, PENNSYL VANIA, DECEASED. AND PETITION FOR ADJUDICATION/STATEMENT OF PROPOSED DISTRIBUTION ORDER OF COURT .- ... - AN NOW, this 28th day of August, 2007, the herein account is confirmed absolutely and distribution is decreed in accordance with the proposed schedule of distribution herewith. C) -:r en rr 1-- -". cr: _'M." LLn Gel-- ~.~~~'-- UJ~< --.J <( i r ....::c: '-' ""' -'. '-l..-c g:?.:: :::J o "<r" -- ..:r: co N <.!> => <1: r-- = c::;.:> ("".....; H .Iii .oJ ~ Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 10/31/2007 JACKSON SANDRA L Q 402 BLACKLATCH LANE CAMP HILL, PA 17011 """:;'~': ,........., co RE: Estate of JACKSON LANGDON A JR File Number: 2004-00103 Cv (-0 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing lS due by: 11/26/2007 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, . L; ,h-.Jj/ ~~'A~ t~~t.l J~q~t~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Cj ~'" .j ", (' " Date: 10/31/2007 ('"\ ',._ JACKSON S.L. PO BOX J IRONIA, NJ 07845 , , ~,- ,~ C,,) C,) RE: Estate of JACKSON LANGDON A JR File Number: 2004-00103 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent IS death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing lS due by: 11/26/2007 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, /1J4I/k- \.~;j~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) --------------------------- ----- ------~- In Re: Estate of JACKSON LANGDON A J ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2004-00103 NOTICE OF FAILURE TO FILE STATUS REPORT (j -0 -'] :::n -i"~'n '-~.~ ~,'~! :u :-~;,;~ '" = = --' Personal Representative: JACKSON SANDRA L Counsel for Personal Representative: JACKSON S.L. '~? '- ::J -i Date of Decedent's Death: 11/26/2003 The Orphans' Court record indicates that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report. Ifthe required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of such delinquency and the undersigned will requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: ,,}. ( h~>j:; .hO .ff '/. ~o ." ,,'J!""? ,o_ f '-'-V71l.-::t:r_ t7i~d..ljJ..~ifk5t-ve / I 11/2812007 Glenda Farner Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File -..p .,.rj:;~~ c.::) <:: N \.0 :rJ C-{"t C"J o ","TJ tS ,-Tl T CJ (-) :0'(, -:>1 "J ._ rTI S~ -0 ~~: N .. -.J /'J [lEe 1 S 2007 IN RE: ESTATE OF JACKSON LANGDON A J ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2004-00103 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE Personal Representative: JACKSON SANDRA L Counsel for Personal Representative: JACKSON S.L. Date of Decedent's Death: 11/26/2003 Date of Delinquency Notice: The undersigned, Glenda Famer-Strasbaugh, Clerk of Orphans' Court, in accordance --, N with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans':€ourt .. Division, Court of Common Pleas of Cumberland County, that neither the above named perso~ representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules was given on the above date and that the ten (10) day notice to file the Status Report has expired. Accordingly, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 12/12/2007 IA . ~.(;? . LL-..J /? X~,d~.. ~!.'t'l!.j Jr.faa:li??l.&c~, .-'1 ~ Glenda Farner Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File A hearing is scheduled Anril 28. 2008 at 11AM in Courtroom NO.2. Ifthe Status Report is filed prior to the he automatically be cancelled. /'.) = <:::::> -..... Q 1''1 C-) -l:"" ~ Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF Cum.!) "L RJ-A N P COUNTY, PENNSYLVANIA Date of Death: JIJe KsO!\l I JA'^'(j])DH ft. / / I d& / 0 3 File Number: / / ) lJR~ Name of Decedent: :;A GoLf- -- DO J 03 Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: . . . . . . . . . . . . . . . . . . . . ~ DNo 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. lfthe answer to No.1 is YES, state the following: co o C'0 W ~,J..J C"1 r- c:::> c:.:=r C"'-.l c. -' ........:.. r - Di~~'~ personal representative file a final account with the Court? . . . . . . . ';L;F'( Ui\i;~eparate Orphans' Court No. (if any) for the personal ~t~ntative's account is: D ~~;'~~; o :;::;':~~r;:~~~ ;::::~;:~~:r~~~e an ~ccou~t. d d DYes ~. :( .~ pfif.-Th2 j,,) Ik TfI'\J f "", p.--\.. >~ Ai } ~ 0J~IH .1 !1lVflL ~Du}..JT/})f} pJ-f.t tu1TA -fA (oN. , d. Copies of receipts, releases, joinders and approvals of formal or informal accoMits may be filed with the Clerk of the Orphans' Court and may be attached to this report. ~s DNo ( ~.. "::"a. ~,'if'_ d: b. Date ft~\.fi__ ?-- b I ;}o-() 1 ~ Signature of Person Filin this on Capacity: ~onal epresentative o Counsel COUN.\<L/ ::. ---.- i f.- lJ1 C S t'f D ff/IJ/I;K ki,d~ Fi l ~ -) 1 j-;r t (Jih-v q. (( f'IH/lh [tJf(1:J r'i'i. 'FvP/ uJddb. I ~ t. 5.li1~ . -::> > !vl.i(lJ"- J?---tt . / 3 to ..> '7? If ('7 0 r.f' j 'i-J1II" {j/v / ~ ~ C? (r; I 'IT --. __ It I) ~ " '1., 0 I JI1c Jc-S 01/, S,1 N-/Jf!J9 J. Name of Person Filing this Form p.o Bot< \), I!<--o H //1, IV J 0 r;J'f5 Address Form RW-I0 rev. 10.13.06 G 1~) S-~3 - IjCfJ'Lj Telephone . . + 1.1 ~1if1J ~ ilSf.."*,SJ tJlc../oS~ 5.1I.S. t- 10 {t~. 0 tf'1 , I .f,.. . n 1.i1..:. ,R51JjJd AI{f1'A-J~\ 0- diU ~ - rt',I4/11f~ Gop( l~ I -, V 8-Ir;--- ~