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Home My WebLink About04-0542 PETITION FOR PROBATE & GRANT OF LETTERS Estate of FRANCIS P. MENTZER No. 21-04-~,~'~,,.~/ also known as To: Register of Wills for the , deceased. County of Cumberland Social Security No. 193-12-9856 Commonwealth of Pennsylvania The Petition of the undersigned respectfully represents that: Your Petitioners, who are 18 years of age or older and the Co-Executors named in the Last Will of the above decedent dated February 12, 1993 , and codicils dated none . The Executor named none died Renunciations for none attached hereto. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his last family or principal residence at 826 W. North Street, Carlisle Borou.qh, Pennsylvania Decedent, then 84 years of age, died May 31 ,2004, at Sarah A. Todd Memorial Home Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the Will offered for probate; was not the victim of a killing and was never adjudicated incompetent: N/A Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $1,000.00 (If not domiciled in PA) Personal property in PA $. (If not domiciled in PA) Personal property in County $. Value of real estate in Pennsylvania, situated as follows: $100,000.00 826 W. North Street, Carlisle Borouqh, PA ~ .:;. ~. 7' c~ WHEREFORE, Petitioners respectfully requests the probate of the Last Will and G~odicil(s) presented herewith and the grant of letters testamenta.ry thereon. ~: Signature(s) and Residence(s) of Petitioner(s): ! Patti A. Hockenbery ~ .... 340 Bonnybrook Road c: Carlisle, PA 17013 (717) 249-6152 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA : : SS COUNTY OF CUMBERLAND : 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 representative of the above decedent, petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed r...~~~ before me this 9th day of June, 2004. Patt~ A. Hockenbery No. 21-04-~'~'~,.~ Estate of FRANCIS P. MENTZER, deceased. DECREE OF PROBATE & GRANT OF LETTERS AND NOW, this 9th day of June, 2004, 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 February 12, 1993, described therein be admitted to probate and filed of record as the Last Will of Francis P. Mentzer; and Letters Testamentary are hereby granted to Patti A. Hockenbery. IRWIN & McKNIGHT FEES Probate, Letters, Etc ........ $ 235.00 Markus A. McKniqht, I~1, Esquire (25476) Short Certificates(-2-) ....... $. 6.00 ATTORNEY (Sup. Ct. i.D. No.) Renunciation(s) ........... $ JCP .................... $ 10.00 60 West Pomfret St., Carlisle, PA 17013 Other Will Paqes (-2-) .... $ 6.00 ADDRESS TOTAL: .... $. 257.00 Filed ............................ 717-249-2353 PHONE TEST /E /T I, FRANCIS P. MENTZER, of North Middleton Township, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me. ONE: I direct my Executrix to pay all of my debts, funeral and administrative expenses as soon as may be done conveniently after my decease. TWO: I give, devise and bequeath all of my estate of every nature and wherever situate to my children as follows: a. To my daughter, Sharyn L. Kepner ........................... 35 %; b. To my daughter, Patti A. Hockenbery ......................... 35 %; c. To my son, Jack F. Mentzer ............................... 30 %; If any of my children named above have predeceased me, the share of my deceased child will be divided equally, per stirpes, by the living issue of said child. If one of my children named above has predeceased me without living issue, then the share of said deceased~':Child vdll be di..~ed equally by my children who survive me. I THREE: I appoint my daughter, Patti A, Hockenbery, Executrix of this my Last Will. FOUR: My Executrix may, at her discretion, compromise claims, borrow money, retain property for such length of time as she may deem proper; lease and sell property for such prices, on such terms, at public or private sales, as she may deem proper; and invest estate property and income without restriction to legal investments. FIVE: No Executrix acting hereunder shall be required to post bond or enter security in this or any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this /,2 )M_ day of February, 1993. FRANCIS P. MENTZER (~ Signed, sealed, published and declared by FRANCIS P. MENTZER, the above named Testator, as and for his Last Will and Testament, in the presence of us, who, at his request and in his presence and in the presence of each other have subscribed our names as witnesses hereto. A CKNO WLEDGMENT AND AFFIDA FIT WE, FRANCIS P. MENTZER, SHARON L. SCHWALM and KATHLEEN M. KENNEY, witnesses respectively, whose names are signed to the 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 that he had signed willingly, and that he executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the Will as a witness and that to the best of their knowledge the testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. FRA c s P. ON L. SCHWALM COMMONWEALTH OF PENNSYLVANIA: :SS: COUNTY OF CUMBERLAND : Subscribed, sworn to and acknowledged before me by FRANCIS P. MENTZER, the testator, and subscribed and sworn to before_ me by SHARON L. SCHWALM and KATHLEEN M. KENNEY, witnesses, this ]~:~ day of February, 1993. Notarial SeaJ Betzi A. Monison. Notary Public Cadisie Bom, Cu,m~d~..qd County My CommL~ion Ex~)i~'es D3c. i 5, 1998 Member, Pen~sytvaniaAssoci&~Jon of Nota~'ies his is to certify that the information here given is correctly copied from all original certificate of demh duly Local Registrar. The original certificate will be lbrwarded to the State Vital Records Office for permanent WARNING: It is illegal to duplicate this copy by photostat or photograph. No. Dale I H105.143R~.~7 COMMONWEALTH OF PENt SYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS ( ERTIFICATE OF DEATH ~. Fr~cis P. ~t~r ~$EX ~UMBER ~(M~ ~ 0 ~ Y ~ OF_I..... :4~/HP~CE (~ a~ ~ · I I I I J,.2/29/1920 I,. Carlisle, PA ~.~-.~e~ ~. ......... I~:F::;'" ~'""- ~~~ ~ ~l&sle, PA 17013 ~m)' ~7, co.~ ~l~d ~Z~.,~? '"'~ ~%~,~:?~o~ ~rl~sle ~ro. O*~m.OS,T~O~ ~'"' u:~ ~O; ~rllsie, PA 17013 iLTM --~l.Z-~ -a I~ ~ ~"~"" ..... ,.- ~ ~~~~~:.'~ '"" .................... ~ ,,. CERTIFICATION OF NOTICE-UNDER RULE 5.6 a Name of Decedent: Francis P. Mentzer Date of Death: May 31, 2004 Estate No.: 21-04-00542 ('/' ~' To the Register: I certify that notice of the beneficial interest required by Rule 5.6(a) of the O ' rphan s Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on June 10, 2004. Nam____~e Address Patti A. Hockenbery 340 Bonnybrook Road, Carlisle, PA 17013 Sharyn L. Kepner 652 Poplar Road, New Oxford, PA 17350 Jack F. Mentzer 401 Persimmon Lane, Elizabethtown, PA 17022 Notice has now been given to all persons entitled thereto underRule 5.6(a)_except none . Date:_ 06-10-04 Name~ Marcus A. 1Vec'qQli~~ Address~60 West Pomfret Street -- Car/isle, PA 17013 Telephone (717) 249-2353 Capacity: -- Personal Representative _. X . Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA REV-1162 EX{11 96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128 O601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004316 MCKNIGHT MARCUS A III 60 W POMFRET STREET CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold 101 $2,475.00 ESTATE INFORMATION: SSN: 193-12-9856 FILE NUMBER: 2104- 0542 3ECEDENT NAME: MENTZER FRANCIS P ;)ATE OF PAYMENT: 08/27/2004 POSTMARK DATE: 08/27/2004 COUNTY: CUMBERLAND DATE OF DEATH: 05/31/2004 TOTAL AMOUNT PAID: $2,475.00 REMARKS: CHECK# 021476 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS I REV OFF,C,AL USE 00E×+/6-O0 --1500 IINHERITANCE T/D( RETURN F LE.UUBER COMMONWEALTH OF PENNSYLVANIA 21- 04- 00542 DEPARTMENT OP REVENUE / RESIDENT DECEDENT DEPT. 280601 COUNTY CODE YEAR NUMBER HARRISBURG, PA 171;>8-0601 SOCIAL SECURITY NUMBER DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL) 193-12-9856 Mentzer Francis P. DATE OF DEATH (M M- DD-YEAR) ~ DATE OF 131RTH (M M-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 02/29/1920 REGISTER OF WILLS tlF05/31/2004APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER .{ (date of .cl~ea t h ~ 1. Original Return ~ 24i Supplemental Return 3' Remainder Return Pri°r t° '~- 13-87) P B 4. Limited Estate . Future Interest Compromise (date of death after 12:- 12-82:) 5. Federal Estate Tax Return Required R L 8. Total Number of Safe Deposit Boxes O 6. Decedent Died Testate Decedent Maintained a Living Trust A C (Attach copy of Will) /Attach copy of Trust) T K ~ 11. Election to tax under Sec. 911 KeNS [~ 9. Litigation Proceeds Received [---]10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) (Attach Sch O) THIS SECTION MUST BE COMpLETED~ ALL CORRESPONDENCE& CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME :OMPLETE MAILING ADDRESS ~ Marcus A. McKnight Esq. 60 West Pomfret Street N~ FIRMNAME(IfApplicable) West Pomfret Professional Bldg. u McKNIGHT Carlisle, PA 17013 EN IRWIN & T TELEPHONE NUMBER 717,/249- 2353 1. Real Estate (Schedule A) (1) 114 , 000. 00 OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) None , . 3. Closely Held Corporation, Partnership or (3) None ~ Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (4) None R 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 4,718.75 ! '. E (Schedule E) C A 6. Jointly Owned Property (Schedule F) (6) 698.43 p E~ Separate Billing Requested T 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None U L (Schedule G or L) A (8) 119 417 18 T 8. Total Gross Assets (total Lines 1-7) ' ' I 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 34,386.81 O N 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11,049.26 11. Total Deductions (total Lines 9 & 10) (11) 45,436.07 12. Net Value of Estate (Line 8 minus Line 11) (12) 73,981.11 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 73,981.11 C O SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES M P 15.' Amount of Line 14 taxable at the spousal tax U' T rate. or transfers under Sec. 9116(a)(1.2) X .0 0 (15) 0.00 ,TA 16. Amount of Line 14 taxable at lineal rate 73,981.11 X .0 45 (16) 3,329.15 el 117. Amount of Line 14 taxable at sibling rate XX .12.15 (17).) 0.000---:' 0--0-0 18. Amount of Line 14 taxable at collateral rate (18. .... N I (19} 3,~29.1b Form REV-1500 EX (Rev. 6-00) Copyright (c) ?000 form software only The Lackner Group, Inc. Decedent's Complete Address: STREET ADDRESS 826 W. North Street CITY I STATE ZIP Carlisle I PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 3,329.15 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 2,475.00 C. Discount 166.46 Total Credits ( A + B + C ) (2) 2,641.46 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 0.00 4. if Line 2 is 9rearer than Line 1 + Line 3. enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 687.69 A. Enter the interest on the tax due. (hA) 0.00 B. Enter the total of Line 5 + hA. This is the BALANCE DUE. (hB) 687.69 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ......................... r-'-] b. retain the right to designate who shall use the property transferred or its income; ........... c. retain a reversionary interest; or ................ ~ .................... d. receive the promise for life of either payments, benefits or care .................... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................... 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............................................. r-~ 4, Did decedent own an Individual Retirement Account, annuity, or ether non-probate property which contains a beneficiary designation? ................................ ~-~ [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. ,~¢~JJ7-.4'¢~10~ OF PERSON RESPONSIBLE FOR FILING RETURN ?atrecia A. Hockenbery CATE ~ , ^__~, Z% ~ i ~/~/~ 340 Bon_n~brook Road , SIGNA~UREO~/~E.~J~ROTHE~,ANj~EP,ESE~q'r~E IRWIN & McKNIGHT ~A--~--- ~ / [ ~ /~/ /. /~ 60 West Pomfret Street '.. l..k'..;2-JA-- ........................... For dates of death o ly 1, "~9~ncl before January 1, i 9951 the tax rate imposed on the net valUe Of transfers to Or fo; the use of the surviving spouse is 3% [72-I~. 1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2) [72 P.S. 9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(a)(1.3)]. A sibling is defined, under Section 9102. as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (c) 2:000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-O0i REV- 1502 EX *(1-97) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE ~NHER~TANCE T~X RETU.N RESIDENT DECEDENT ESTATE OF FILE NUMBER Francis P. Mentzer SS~/ 193-12-9856 05/31/2004 21-04~00542 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with ri~lht of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 826 West North Street, Carlisle Boro, Pennsylvania - SOLD 114 000.00 Settlement Sheet Attached. ' TOTAL (Also enter on line 1, Recapitulation) $ ~_14,000.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1502 EX (Rev. 1 REV- 1508 EX + (1-97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER Francis P. Mentzer SS~/ 193-12-9856 05/31/2004 21-04-00542 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBEF DESCRIPTION OF DEATH 1 Personal Property 4,718.75 TOTAL (Also enter on line 5, Recapitulation) 4,718.75 (If more space is needed, insert additional sheets of the same size) Copyright(c) 1996 form software only CPSystems, lnc. Form REV-J508 EX (Rev 1-97~ REV- 1509 EX + ll-97) SCHEDULE F COMMO.WE^,T, Or ~ENNS~V^~,~ JOINTLY-OWNED PROPER TY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Francis P. Mentzer SS~/ 193-12-9856 05/31/2004 21-04~00542 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Patrecia (Patti) A. Hockenbery 340 Bonnybrook Rd. Daughter Carlisle, PA 17013 ,C. JOINTLY-OWNED PROPERTY: LP- I ~ ER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. DATE OF DEATH DECD'S VALUE OF UMBER TENANT JOINT Attach deed for jointly-held realestate. VALUE OF ASSET INTEREST DECEDENT'S INTERE5 1 Citizens Bank Checking 1,396.86 50.00% 698.43 Account 6100727475 TOTAL (Also enter on line 6, Recapitulation) , $ 698.43 z'~ more space ~s needed insert additional sheets of the same size) Copyright (c) 1996 form software on y CPSystems, Inc. Form REV- 1509 EX (Rev. 1-97) REV-1511 EX *(1-97) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Francis P. Mentzer SS¢~ 193~12-9856 05/31/2004 21-04-00542 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Carlisle Memorial Service 150.00 2 Carlisle BIC Kitchen Fund - Funeral Luncheon 187.50 3 Ewing Brothers Funeral Home, Inc. 5,725.00 4 The Whimsical Poppy - Flowers 196.10 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State~ Zip Year(s) Commission Paid: Z. Attorney's Fees IRWIN & McKNIGHT 6,525.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Re§ister of' Wills 257.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 250.00 7. Other Administrative Costs 1 Charles Milliken 100.00 2 Closing Costs Paid By Seller Settlement Sheet Attached 16,423.87 3 Comcast Cable 1.49 4 Cumberland Law Journal Estate Notice 75.00 5 Electrical Supplies and Labor to Install Service 665.43 6 Hilton's Lock Service 62.17 Total of Continuation Schedule(s) 3,768.25 TOTAL (Also enter on line 9, Recapitulation) $ 34,386.81 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form nEY-1511 EX (Rev. 1-97) Estate of: Francis P. Mentzer Soc Sec #: 193-12-9856 Date of Death: 05/31/2004 Continuation of Schedule H-B7 (Other Administrative Costs) item Description # Amount 7 Lowe's Wallpaper/paint for 826 West North Street 191.46 8 Register of Wills - Filing Fee 25.00 9 Roy Gutshall - Appraisal - Personal Property 50.00 Roy Cottshall - Auctioneer 2,653.00 ll The Sentinel - Estate Notice 115.79 12 WSI Trash Removal 733.00 3,768.25 REV-1512 EX + (1-97) SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN , RESIDENT DECEDENT MORTGAGE LIABILITIES, AND LIENS ESTATE OF FILE NUMBER Francis P. Mentzer SS~ 193-12-9856 05/31/2004 21-04-00542 Includ~ unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Carlisle Regional Medical Center 20.21 2 Dave Sheibley - Trash 155.00 3 JCPenney - Credit Card 907.64 4 MBNA - Credit Card 1,893.09 5 North Middleton Authority - Water/Sewer 48.31 6 Omega Medical Laboratories 35.00 7 PP&L 271.86 8 Septic Hook-Up North Middleton Authority 3,987.20 9 Spring Road Family Medicine 19.07 10 Sprint Telephone 119.10 11 United Church of Christ Homes Nursing 3,580.19 12 York Waste Disposal - Trash Removal 12.59 TOTAL (Also enter on line 10, Recapitulation) 11,049.26 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form R E%/- 1512 EX (Rev 1 97~ REV-1513 EX + (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARlES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Francis P. Mentzer SS# 193-12-9856 05/31/2004 21-04-00542 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBEF NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.Z)] 1 Patti A. Hockenberry Daughter 35% of 340 Bonnybrook Rd. Remainder Carlisle, PA 17013 2 Sharyn L. Kepner Daughter 35% of 652 Poplar Road Remainder New Oxford, PA 17350 3 Jack F. Mentzer Son 30% of 401 Persimmon Lane Remainder E1 izabethtown, PA 17022 , ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SH~.I:! II, NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, Inc. Form RE¥-1513 EX (Rev. 9-00) £ASTWI££ I, FRANCIS p. MENTZER, of North Middleton Township, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me. ONE.: I direct my Executrix to pay all of my debts, funeral and administrative expenses as soon as may be done conveniently after my decease. TWO: I give, devise and bequeath all of my estate of every nature and wherever situate to my children as follows: a. To my daughter, Sharyn L. Kepner. .......................... 35 %; b. To my daughter, Patti A. Hockenbery 35 %; c. To my son, Jack F. Mentzer ............................... 30 %; If any of my children named above have predeceased me, the share of my deceased child will be divided equally, per stirpes, by the living issue of said child. If one of my children named above has predeceased me without living issue, then the share of said deceased child will be divided equally by my children who survive me. THREE: I appoint my daughter, Patti A, Hockenbery, Executrix of this my Last Will. FOUR: My Executrix may, at her discretion, compromise claims, borrow money, retain property for such length of time as she may deem proper; lease and sell property for such prices, on such terms, at public or private sales, as she may deem proper; and invest estate property and income without restriction to legal investments. FIVE: No Executrix acting hereunder shall be required to post bond or enter security in this or any .jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this /~ )c/c day of February, 1993. FRANCIS P. MENTZER ~ Signed, sealed, published and declared by FRANCIS P. MENTZER, the above named Testator, as and for his Last Will and Testament, in the presence of us, who, at his request and in his presence and in the presence of each other have subscribed our names as witnesses hereto. A CKNOI~FZEDGMENT.,AND AFFIDA FIT WE, FRANCIS P. MENTZER, SHARON L. SCHWALM and KATHLEEN M. KENNEY, witnesses respectively, whose names are signed to the 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 that he had signed willingly, and that he executed it as his tree and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the Will as a witness and that to the best of their knowledge the testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. SHARON L. SCHWALM COMMO~EALTH OF PENNSYLVAN~: :SS: COUN~ OF CUMBE~AND : Subscribed, sworn to and acknowledged before me by FRANCIS p. MENTZER, the testator, and subscribed and sworn to before, me by sItARoN L. SCHWALM and KATHLEEN M. KENNEY, witnesses, this/_~__~day of February, 1993. ettlement Statement u.s. Department of Housing and Urban Development B. 1. ~'HA uMu No. 2502-0265 REV. (3/86) I INAL 2. ~FmHA 3. I-iConv. Unins. 6. FileNumber 7. Loan Number [ HUD-1 4. I-]VA 5. ~Conv. Ins. I ST2004-208RCS l 8. Mortgage Insurance Case Number I I'tiS torm IS turnlsheo to give you a statement o! actua settlement costs. Amounts pal(] to an{3 Dy ne se ement agent are sr~own C. Note: Items marked "(p o c "were paid outside the c os ng they are shown here for information purposes and are not included in the totals. TitleExpress Settlement System WARN NG: It is a crime to knowing y make false stalements to the United States on this or any other similar form Penalties upon conviction can include a fine and imprisonment For details see: Title 18 U. S. Code Section 1OO1 and Section 1010. D. NAME OF BORROWER: Igor Jurinovic and Stipo Jurinovic Printed 10/25/2004 at 08:49 KLL ADDRESS: E NAME OF SELLER: Estate of Francis P. Mentzer ADDRESS: F. NAME OF LENDER: First Horizon Home Loan Corporation ADDRESS: P.O. Box 7481, Springfield, OH 45501 G. PROPERTY ADDRESS: 826 West North Street, Carlisle, PA 17013 North Middleton Township H. SETTLEMENT AGENT: Saidis, Shuff, Flower & Lindsay, Telephone: 717.243.6222 Fax: 717.243.6486 PLACE OF SETTLEMENT: 26 West ~ PA 17013 I. SETTLEMENT DATE: 10/2512004 J. SUMMARY OF ~ROWE~ K. ~ 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 101. Contract sales price 114,000.00 401. Contract sales price [ 11~ 102. Personal Pro e_p_~ 402. Personal Pro e_~ 103. Settlement char~s to borrowe~ 1__~586.69 403. 104. 4O4. 105. 405. A~tments for items ~in advance _~l_~stments for items~ seller in advance 107. Count_y_taxes 10125104to12131104 53.16 407. Count~axes 10125104to12131104 53.16 108. SchooITaxes 10125104to06130105 741.65 408. SchooITaxes 10125104to06130105 741.65 109. 409. 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 116,381.50 420. GROSS AMOUNT DUE TO SELLER 114_~_794.81 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201.._____~Deposit or earnest money ~ 501. Excess D~see instructions_)_ 202. Principal amount of new loans 114_L000.00 502. Settlementchar~ ~. 203. Existi~ to 503. Existin~'ect to 204. 504. Pa_p_~y_p_ff~f First Mort a~ Loan 205. 505. 206. 506. 207. 507. 208. , 508, Escrow for sewer hookup_ _~3 687.20 209, Saidis Sh-L~Fl°wer & Lindsa Ad~stments for items~ seller ~_5_509. r 213, Adjustments for items una~ seller 214. 513. 215. 514. 216. 515. 217, 516. 218. 517. 219, 518. L 519. 220. TOTAL PAID BY/FOR BORROWER 115.000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER i ~ 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER 301. Gross amount due from borrower~ 11~381.50 601. Gross amount due to seller ~ 114~ 302. Less amounts~/for borrower ~ 115,000.00 602. Less reduction amount~____~20~111.07 303. CASH FROM BORROWER 1~381.50 603. CASH TO SELLER 94~683.74 SUBSTITUTE FORM 1099 SELLER STATEMENT: The information contained herein is important tax information and is beir~g furnished to the Internal Revenue Service If ou ar return, a negligence penalty or other sanction will be imposed on you if this item is required to be reported and the IRS determines tibet it his not been re or~;d The Contract ' I Y e required to file a line 401 above constitutes t~'e Gross Proceeds of th~s transaction. P Sa es Price described on SELLER INSTRUCTIONS: If h s real es ate was your principal residence file Form 2119 Sale or comp ete the applicable parts of Form 4797, Form 6252 and/or Schedule (~ (Form 1040) ' Exchange of Principal Residence, for any gain, with your Income tax return, for other transactions, You are required by law to provide the settlement agent Fed. Tax ID No: ) with your correct taxpayer dentificetion number. If you do not provide your correct taxpayer identification number, you may be subject to civil or criminal pena ties imposed by law tinder penalties of p~qury, certify that the number shown on this statement is my correct taxpayer identification number TIN: / SELLER(S) SIGNATURE(S): / SELLER(S) NEW MAILING ADDRESS: bkS. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: ST2004-208 FINAL PAGE 2 SETTLEMENT STATEMENT REV. HUD-I~ ~ Settlement S_~Y.~D_ Printed 10/25/2004 at 8:49 KLL L. SETTLEMENT CHARGES PAID FROM PAID FROM 700. TOTAL SALES/BROKER'S COMMISSION based on price $111~000.00 ~ 6.000 = 6,660.00 BORROWER'S Division of commission (line 700) as follows: SELLER'S $ 6,660.00 to Ebener & Associates FUNDSAT FUNDS AT $ to SETTLEMENT SETTLEMENT 703. Commission .paid at Settlement 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan_~..~q. ination Fee % 802. Loan Discount % _- Fee to Charles E. Garner ~275.00 B~ -1.00 804. Credi~rt to Total Credit Service 805. Lender's ~n__q~pection Fee LR 14.8,~ 806. Mort~ication Fee 807. Flood Determination to Federal FLODO LR 24.00 808. Courier Fee to First Horizon ~' 15.00 809. Underwriting__Fee to First Horizon LR 22~ 810. Tax Service Fee to Total Mt_g Solution LR 90.~ 811. Processinq. Fee to First Horizon 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 275.1 902. Mort ag~gg~nsurance Premium for to 138.1 903. Hazard Insurance Premium for 12_ear to Nationwide Insurance ~ 458.00 B 904. 9O5. 1000. RESERVES DEPOSITED WITH LENDER FOR 1001. Hazard Insurance 3 mo.___~.9~ 38.17/mo LI 114.1 1002. Mort ag_~g~nsurance mo. ~ /mo ~ Tax mo. ~ /mo 1004. Count Pro_y_._~9_p_~ Tax 9 mo...~,_~_ 23.78/mo LR 214. 1005. School Taxes 5 mo. ~_$ 90.60/mo LR stment to First Horizon 453.00 1100, TITLE CHARGES -323.97 1101. Settlement or closinq_fee 1102. Abstract or title search 1103. Title examination 104. Title insurance binder 1105. Doc Pr~ to Saidis S_~_~.~j Flower & Lindsa_y_ 1106. Notary Fees to Said~Flower & Lindsay__ - 14.0~' 75.00 1107. Attorney's fees to Irwin & McKniq_~ POC lincludes above items No: 1108. Title Insurance to ACCPLInC. ) {includes above items No: 411.69 517.1 1109. Lender's Poli_g_y_ 114_.~000.00 . ) 1110. Owner's Policy__ 114,000.00 - 928.75 - 1 11. End 100 End 300 End 900 to ACCP~ Inc. 150.00 1 12. Down Load Fee to Saidis Shj_~_~.ff_LFlower & Lindsa_y_ 1113. Closin_gServiceLetter to ACCP, Inc. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES _-- 35.0~' 1201. Recordi~ 38.50 ~ 64.50 ~e $ 1203. State Tax/stam. p~._ Deed_~$1 140.00 ~ 1204. Lien Sa~ to North Middleton Authority_ 14.00 1205. Home/Termite Cert to South Central PA Home Inspect ~ 300.00 Buy -- 1300. ADDITIONAL SETTLEMENT CHARGES__ 1301. 2004_Ct.._~.~L~ Tax to Robin Sollenberg._er - 1302. 2004-05 School Tax to Robin Sollenberg_er 320.27 1303. Courier Fee to Saidis Shj.~_~j_Flower & Lindsay_ to AT&T Wireless 20.00 to AT&T Wireless _ 2~ 1306, Final Water to North Middleton Authority__ 621.0( 1307. Lateral~ to North Middleton Authority_ --------- 51.25 1308. Permit~ to North Middleton Authori_.i~ 2,050.00 2~ 1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section K ~ 16,423.87 HUD CERTIFICATION OF BUYER AND SELLER ~-- -- I have carefully reviewed he HUD~I Settlement Statement and to the best of my know edge and be ef it is a true and accurate alt receipls and disbursements made on my account or by me in h s transaction I further certify that I have received a COpy of the HUD-1 Settlement Sta ement statement of igorJl~nn6wc.~.. . .~ -~., ~ · , . - -- WARNING: IT IS ^ CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION I have caused..~or~ja~l~caDs-e~funds to be disbursed in acCOrdance with this statemenl CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18: The HUD-1 Settlement Statement which I have prepared is a true and accurate acCOunt of this transaction U.S CODE SECTION 1OO1 AND SECTION 1010 CITIZENS BANK Account Number 6100727475 Account Title FRANCIS P MENTZER or PATRECIA A HOCKENBERY Date Opened 6/6/1966 Account Type Checking Principal Balance as of DOD $1,396.86 Interest from Last Posting to DOD $ .00 Account Balance as of DOD $1,396.86 YTD Interest to DOD $ .00 Ewing Brothers Funeral Home, Inc. 630 South Hanover Street Carlisle, PA 17013- (717)243-2421 June 3, 2004 Patrecia A. Hockenbery 340 Bonnybrook Rd. Carlisle, PA 17013 The Funeral Service for Francis P. Mentzer We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. I. PROFESSIONAL SERVICES Services of Funeral Director/Staff ................... $3475.00 I;UNERAL HOME SERVICE CHARGES ............ $3475.00 SELECTED MERCHANDISE: 20G Baron NonGask. Casket .................... $820.00 #5 Regular Sealed Vault ...................... $995.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED $5290.00 Cash Advances Opening Grave. ........................ $550.00 Certified Copies of the Death Certificate $50.00 Honor Squad ......................... $75.00 ttanover Sun Obituary $60.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES ........ $735.00 Total Total Cost .......................... $6025.00 SUB-TOTAL $6025.00 INITIAL PAYMENT / DISCOUNT / CREDITS 100.00 TOTAL AMOUNT DUE $5925.00 /"~ a,'~.e ~c-c e ,,~' ¢~'/ The unpaid ba~an~e ~v¢r 45 days is subjected t~ a ~.~ % service charge per m~nth - ~2.~ % per annum -- ~CO ;":' -(o/q]Ott / 725- Member of National Funeral Directors Association FINAL SETTLEMENT Date % Address Date of Sale ~- ~{' '~ ~ Sale Location Auctioneer Clerk Cashier Other PROCEEDS OF SALE: Cash ............................................... $ Checks .............................................. Other .......................................................................................... Miscellaneous (see attached list) ............................................ TOTAL PROCEEDS OF SALE ...................... $ LESS SELLER'S SALE EXPENSE: Auctioneer's Fee ................. ~~ ............................ $ Other Seller's Expenses Advanced by Auctioneer: Miscellaneous (see attached list) .............................................. DEDUCT TOTAL SELLER'S SALE EXPENSE ~ $ .~/. "5 .~ -'], O TOTAL NET PROCEEDS TO SELLER ............................... $ l, ~(2,'~. O I, (or we), the seller of goods, merchandise, and/or property sold at public auction on above date and location, acknowledge and accept this settlement of proceeds of sale. I (or we) agree to accept all responsibility for providing merchantable title to all goods, merchandise, and/or property sold, and for delivery of title to the purchaser. (Date) (Seller's Signature) Auctioneer or Cashier's Signature (Seller's Signature) Form No. FS Reorder from: MISSOURI AUCTION SCHOOL Phone 1-800-835-1955 FINAL SETTLEMENT '~,, ~, Address Date of Sale Sale Location Auctioneer Clerk Cashier Other PROCEEDS OF SALE: Cash ............................................... Ch~c~ ............................................ Other ............ Miscellaneous (see attached list) ............................................ · o~^~ ~.oc~os o~s^,~ ...................... $ to2~'.,,,~ LESS SELLER'S SALE EXPENSE: Auctioneer's Fee .... ._~___._~__~_;_ .................................................... $ ~/. O~ ~ Other Seller's Expenses Advanced by Auctioneer: Miscellaneous (see attached list) .............................................. DEDUCT TOTAL SELLER'S SALE EXPENSE ............................... $ ,_.-?'~ ~. ~ · o~^,.~ ~.oc~os ~o s~,~, ............................... ~ -:7,,Y~ I, (or we), the seller of goods, merchandise, and/or property sold at public auction on above date and location, acknowledge and accept this settlement of proceeds of sale. I (or we) agree to accept all responsibility for providing merchantable title to all goods, merchandise, and/or property sold, and for delivery of title to the purchaser. {Date) (Seller's Signature) Auctioneer or Cashier's Signature (Seller's Signature) Form Ne. FS Reorder from: MISSOURI AUCTION SCHOOL Phone 1-800-835-1955 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE REV-1162 EX(11-96) BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004610 MCKNIGHT MARCUS A III 60 W POMFRET STREET CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold 101 $687.69 ESTATE INFORMATION: SSN: 193-]2-9856 FILE NUMBER: 2104-0542 DECEDENT NAME: MENTZER FRANCIS P DATE OF PAYMENT: 1 1/09/2004 POSTMARK DATE: I 1/09/2004 COUNTY: CUMBERLAND DATE OF DEATH: 05/31/2004 TOTAL AMOUNT PAID: $687.69 REbIARKS: IRWIN CHECK# 021635 INITIALS: CCP SEAL RECEIVED BY' GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA : : SS COUNTY OF CUMBERLAND : Patrecia A. Hockenberr¥ , being duly sworn according to law, deposes and says that she is tl~e Executrix of the Estate of Francis P. Mentzer , late of Carlisle Borough Cumberland County, Pennsylvania, deceased and that the within is an inventory made by Patrecia A. Hockenbery the said Executrix of the entire estate of said decedent, consisting of all the personal property and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. Sworn and subscribed before me, } ~ ,~ } , . , - mat~ia A. Hocke~bery, ~ix this _ day of November } ~~~~ } ' 340 Bonnybrook Road ~ ' } Carlisle. PA 17013 } Address } No~i~ Seal Month Year INSTRUCTIONS I An inventory must be filed within three months after appointment of personal representative-: 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty. 4. See Article IV, Fiduciaries Act of 1949. Inventory of the real an personal estate of FRANCIS P. MENTZER , deceased 1. 826 West North Street, Carlisle Borough, Pennsylvania $114,000 00 4,718 75 2. Personal Property .................. 3. Citizens Bank - Checking Account 6100727475 ..... 698 43 TOTAL ................. $119,417 18 COMMONWEALTH OF PENNSYLVANIA REV-11 62 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF iNDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004826 MCKNIGHT MARCUS A III 60 W POMFRET STREET CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold 101 $36.2O ESTATE INFORMATION: SSN: 193-12-9856 FILE NUMBER: 21 04-0542 DECEDENT NAME: MENTZER FRANCIS P DATE OF PAYMENT: 01/11/2005 POSTMARK DATE: 01/11/2005 COUNTY: CUMBERLAND DATE OF DEATH: 05/31/2004 TOTAL AMOUNT PAID: $36.20 REMARKS: IRWIN ET AL CHECK# 021736 INITIALS: VZ SEAL RECEIVED BY' GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL ~~\'lD[D O~HCE OF NOTICE OF INHERITANCE TAX INHERITANCE TAX DIVISION or""" 1..'f"":;1 \ Il\PPRAISEMENT, ALLOWANCE OR OISALLOWANCE PO BOX Z806Dl r:c".~;':1 :.:, .,,).,._'.... OF DEDUCTIONS AND ASSESSMENT OF TAX HARRISBURG PA 171Z8-D601 ' 2005 JAN \ 0 ~.l1 9: 49 CLEfiK OF ORP\-IPNS CQURI , MARCUS A M~~!fJ,\ E:s!l \:f) Fi' IRWIN & MCKNIGHT 60 W POMFRET ST CARLISLE PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-10-2005 MENTZER 05-31-2004 21 04-0542 CUMBERLAND 101 *' REV-1547 EX AFP (l2.-0~) FRANCIS P Allount Rellitted 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 ~ RW:isi,"j-iif-AW-riiFo3Y-riiiij-ici"-OF-i'NiiiR"ifAN"CE"YAX"jipiiRAisiM"€riiT~--Ar.rOWAN-CE-oii"""-------""----- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MENTZER FRANCIS P FILE NO. 21 04-0542 ACN 101 DATE 01-10-2005 TAX RETURN WAS: (X) ACCEPTEO AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held stock/Partnership Interest {Schedule CJ 4. Mortgages/Notes Receivable (Schedule DJ S. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets lI) (2) (3) (4) (5) (6) (7) 114.000.00 .00 .00 .00 4.718.75 698.43 .00 (B) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Hisc. Expenses (Schedule H) 10. Debts/Hortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax R.turn 13. Charitable/Governmantal Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ~ returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rat. (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due (9) lID) NOTE: 34,386.81 11.049.26 lII) lI2) (13) lI4) .00 X 73,981.11 X .00 X .00 X NOTE: To insure proper credit to your account~ submit the upper portion of this form with your tax payment. 119,417.18 41; 4~6 07 73,981.11 .00 73,981. 11 00 = 045 = 12 = 15 = .00 3,329.15 .00 .00 3,329.15 lI9)= TAX CREDIT". rKm=n. .. I+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 08-27-2004 CD004316 130.26 2,475.00 11-09-2004 CD004610 .00 687.69 PAYMENT MUST BE MADE BY 02-28-2005*. TOTAL TAX CREDIT 3,292.95 BALANCE OF TAX DUE 36.20 INTEREST AND PEN. .00 TOTAL DUE 36.20 1 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS TMAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT C'? ('? .' . MARC~~ A MCKJ+1sHT ESQ IRWIJL & MCI(NjSHT 60 W2POMF~Et'ST CARL.~SLE PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN '* REY-ln7 EX IFP 112-04> 02-22-2005 MENTZER 05-31-2004 21 04-0542 CUMBERLAND 101 Allount Rellitted FRANCIS P MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ..... RETAIN LOWER PORTION FOR YOUR RECORDS ~ IlV:r&fl.,.lrA"r.C'8r:lf!'.........;..fAJlWfmer..,ly.~nYlAm.b'J!'.~e'l"60W....................... ... ESTATE OF MENTZER FRANCIS P FILE NO. 21 04-0542 ACN 101 DATE 02-22-2005 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE. APPLICATION OF ALL PAYHENTS. THE CURRENT BALANCE. AND. IF APPLICABLE. A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-10-2005 PRINCIPAL TAX DUE:. PAYMENTS (TAX CREDITS): 3.329.15 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 08-27-2004 CD004316 130.26 2.475.00 11-09-2004 CD004610 .00 687.69 01-11-2005 CD004826 .00 36.20 TOTAL TAX CREDIT 3.329.15 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 IF PAID AFTER THIS DATE. SEE REVERSE TOTAL DUE .00 . ~ SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1. NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) STATUS REPORT UNDER RULE 6.12 Name of Decedent: FRANCIS P. MENTZER Date of Death: MAY 31. 2004 No. 21-04-00542 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: ~ Yes _ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 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 X 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? X Yes No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cle k of Orpha' ourt and may be attached to this report. Date: 12/0812005 ("'...) I' ( . ~'~.~1 Capacity: Personal Representative Counsel for Personal Representative X Vb