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03-0920
PETITION FOR PROBATE and GRANT OF LETTERS Estate of ANNA E. NEIBERT No. also known as To: Deceased. Social Security No. 183-10-328~ Register of Wills for the County of Cumberland Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut ors in the last will of the above decedent, dated August 31 and codicil(s) dated N/A in the named ,1990 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 4905 East Trindle Road, Hampden Township (list street, number and muncipality) Decendent, then 86 years of age, died October 17 , ~ 2003 , at Harrisburg Hospital, Harrisburq, Dauphin County, PA Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will of.fe, red for probate; was not the victim of a killing and was never adjudicated incompetent: no excep~:zons Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: 39 West Coover Street, Mechanicsburg, $ 115,000.00 $ $ $ 92,000.00 PA WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. Lois E. Witmer Doris L. Murphy 630 E. Siddonsburg Road 109 Orchard Street Mechanicsburgr PA 17055 M~~h,,r~_ CA 17~[q Daryl E Neibert 610 Southview Drive Mechanicsburg, PA 17055 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 represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed ~ before me this ~'~ day of / Lois E. Witmer ~' ~/-~.November ~ ~ 2003 ~ ~-)~'~, ~'~/~0/x ~ Estate of ANNA E. NEIBERT , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW~~/ff/--._J/_~v ~ 2003, 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 Auqust 31, 1990 described therein be admitted to probate and filed of record as the last will of ANNA E o NEIBERT and Letters Testamentary are herebygrantedto Lois E. Witmer, Doris L. Murphy and Daryl E. Neibert FEES Probate, Letters, Etc .......... ~5~ Short Certificates( ) .......... $ /~. ,~o iation ................ $ $ /t~Do O~ ~k~- _-- .~_--TOTAL $~om~. Oo Filed .~.,~..Cd-.%~'"...~',A~]O~ .............. Register of W~~~ Marlin R. McCaleb, Esq. (06353) ~ ~TT~R~EY~Suo. CLI.D. No.) 219 ~ast ~axn Street Mechanicsburg, PA 17055 ADDRESS (717) 691-7770 PHONE his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Re, gistrar. 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 for this certificate, $2.00 P 9640812 No. Local Registrar Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH Harrisbur · . ~ ~~ (~j ' ' · g J~. Harrisburg HospRal ~ ..... ~'~ ' L White Dauphin HomemaKer ,,~ Own Home ~ ~x [ ~~ m. . ,,. Widowed ,,. 4905 East Trindle Road ' - · Mechanicsburg, Pennsylvania 1705~ ,~.c~_ Cumberland ....... - I Ralph ~m[.'s ~ ~,. ~ ..~=~ ~ ~ ~. =- Jennie Sell Hadan .s~o~ Bollinger Doris L. Murphy J~z's~(~'~.z~ I~. 109 Orchard Street Mechanicsburq Pa 17055 ~u ~(~ ~ ~. Oct 21, 2003 ~,~ Mechanicsburg Cemete~ =~. Mechanicsbur~ Pa. 17055 I',,~ .......... FD-012662-L I ~. M~ers F~neral Home Inc. 37 East Main Street Mechanic~burq, Pa 17055 ~Y' ~} October 17, 2003 ~,~4;~.~'~ ........................ ~ ................ ~ ................... ~ ......... ..................................... ......................................................................... u LAST WILL AND TESTAHENT OF ~ E. NEIBEItT I, ANNA E. NEIBEI~T, of the Borough of Mechanicsburg, County of Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can be conveniently done. me I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever nature and where- soever the same may be situate, to my three (3) children, to wit, LOIS g. WITMER, BOP, IS L. MURPHY, and DARYL g. NEIBERT, share and share alike. For the purpose of facilitating the settlement and distribution of my estate, I authorize and empower my Executors, hereinafter named, to sell any and all real estate which I may own at the time of my de- cease at either public or private sale or sales. LASTLY, I nominate, constitute and appoint my three (3) -1- children, the aforesaid LOIS E. WITMER, BOP, IS L. MURPHX, and DAR~L E. NEIBE~T, Co-Executors of this, my Last Will and Testament, and in the event that any of my said children reside in a State other than the State of Pennsylvania at the time of my decease, I direct that they be permitted to serve in such capacity without the necessity of filing bond or other security normally required of foreign fiduciaries. IN WITNESS W~EREOF, I have hereunto set my hand and seal this day of /~z~ , m. D. 1990. / Anna E. Neibert (SEAL) Signed, sealed, published and declared by the above-named ANNA E. NEIBERT, as and for her Last Will and Testament, in the presence of us, who, at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. -2- COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) SS. I, A~ E. NEIBF~RT , the testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and volun- tary act and deed, for the purposes therein contained· day of Sworn and affirmed to and acknowledged before me by ~'~NA E. NEI~ERT , the testatrix , this _~zz~z ~z~-~ , A. D. 1990. / COMMONWEALTH OF PENNSYLVANIA ) : COUNTY OF CUMBERLAND ) We, the undersigned, J. ROBERT ST~IFFER and 14AP. ILYN KAY ]~N , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the testatrix , ~N-NA E. NEIBERT , sign and exe- cute the instrument as k~K/her Last Will and Testament; that the said testatrix , AI~NA E. NEIBERT , executed it as k~K/her free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the testatrix , signed the Will as witnesses; and that to the best of our knowledge, the testatrix was, at the time, eighteen (18) or more years of age, of sound mind, and under no constraint, duress or undue influence. 1990. I NOTARIAL SEAL MARY S, ROBINSON, NOTARY PUILIC MECHANICSBU,G IORO. CUMBERLAND CO. ~, .~2_~,~/ . ~ ~ss~on Explres Sept· 21. 1,91 I.A.CIT W-iLL AND TESTANENT OF ANNA E. NEIBERT j. ROBERT STAUFFER ATTORNEY AT LA~r Mm~s:s'r SQu~ Bux.unmc MECHANICSBLIRG, PA. 17055 LAW OFFICES MARLIN R. McCALEB CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Anna E. Neibert Date of Death: October 17, 2003 Will No. 21-03-0920 To the Register: I certify that notice of beneficial interest and estate administration required by Rule 5.6(a) of the Orphans' Court Rules was personally served on the following beneficiaries of the above-captioned estate on November 17, 2003. Name Address Lois E. Witmer 630 E. Siddonsburg Road Mechanicsburg, PA 17055 Doris L. Murphy 109 Orchard Street Mechanicsburg, PA 17055 Daryl E. Neibert 610 Southview Drive Mechanicsburg, PA 17055 Notice has now been given to all persons entitled thereto under Rule 5.6(a) . Date: November 17, 2003 Marlin R. McCaleb Attorney I.D. No. 06353 -- 219 East Main Street ' P.O. Box 230 Mechanicsburg, PA 17055 (717) 691-7770 ~--~ FAX: (717) 691-7772 Counsel for Personal Representatives COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128 0601 RECEIVED FROM: MCCALEB MARLIN R 219 E MAIN STREET MECHANICSBURG, PA 17055 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EXI11-96) CD 003418 ........ ford ACN ASSESSMENT CONTROL NUMBER AMOUNT ESTATE INFORMATION: SSN: 183-10-3285 FILE NUMBER: 2103-0920 DECEDENT NAME: NEIBERT ANNA E DATE OF PAYMENT: 01/07/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 10/17/2003 REMARKS: TOTAL AMOUNT PAID: 101 I $ 11,000.00 I $11,000.00 SEAL CHECK#1004 INITIALS: AC RECEIVED BY: GLENDA FARNER STRASBAUGH DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD OO3418 MCCALEB MARLIN R 219 E MAIN STREET MECHANICSBURG, PA 17055 ........ fold ESTATE INFORMATION: SSN: 183-10-3285 FILE NUMBER: 2103-0920 DECEDENT NAME: NEIBERT ANNA E DATE OF PAYMENT: 01/07/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 1 O/17/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $11,000.00 TOTAL AMOUNT PAID: $11,000.00 REMARKS: SEAL CHECK//1004 INITIALS: AC RECEIVED BY' GLENDA FARNER STRASBAUGH DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF iNDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD OO4145 WlTMER LOIS E 630 EAST SIDDONSBURG ROAD MECHANICSBURG, PA 17055 ........ fold ESTATE INFORMATION: SSN: 183-10-3285 FILE NUMBER: 2103-0920 DECEDENT NAME: NEIBERT ANNA E DATE OF PAYMENT: 07/09/2004 POSTMARK DATE: 07/09/2004 COUNTY: CUMBERLAND DATE OF DEATH: 10/17/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $1,623.37 REMARKS: LOISWITMER CHECK//1011 SEAL TOTAL AMOUNT PAID: 81,623.37 INITIALS: SK RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REV-1500 EX + (6-00/ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. Z80601 CA PB RL H~IO E~AC C K~TK YES cg R E C A P I T U L A T I O N C O M ×I T I O REV-1500 NHERITANCE TAX RETURN RESIDENT DECEDENT HARRISBURG, P.~ 171Z8-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL/ Neibert Anna E. DATE OF DEATH (MM-OD-YEAR) I DATE OF BIRTH (MM-DO-YEAR) 10/17/2003 I 02/10/1917 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) OFFICIAL USE ONLY FILE NUMBER 21-03-0920 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 183-10-3285 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS sOCiAL SECURITY NUMBER 1. original Return 4. Limited Estate 5. Decedent Died Testate (Attach copy of Will) ~ 9. Litigation Proceeds Received ~247! Supplemental Return · Future Interest Compromise (date of death after 12-12-8Z) Decedent Maintained a Living Trust (Attach copy of Trust) [~10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) H (date of death 3. Remainder Return prior to 12-13-8Z) 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes i~1 11. Election to tax under Sec. 9113(A) (Attach Scl O) NAME Marlin R. McCaleb Esq. FiRM NAME (If Applicable) Law Offices-Marlin R. McCaleb TELEPHONE NUMBER 717./691-7700 COMPLETE MAILING ADDRESS 219 East Main P. O. Box 230 Mechanicsburg, Street PA 17055 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or (3) Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. 14. 108,00Q;00 None None None 126,906.85 None 73,008.71 13,403.53 1,127.14 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) OFFICIAL US[: ONLY (8) 307,915.56 (11) 14,530.67 (12) 293,384.89 (13~ (14) 293,384.89 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 293,384.89 X .0 0 X .0 45 X .12 X .15 (1,5) O. O0 (15) 13,202.32 (17) 0.00 (15) O. O0 (19) 13,202.32 Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) 'De(~edent'~ Complete Address: STREET ADDRESS 39 West Coover Street CITY Mechanicsbur~ Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty ISTATE ?^ 0.00 11,000.00 578.95 Total Credits ( A + B + C ) I z~.7055 Total Interest/Penalty ( D + E ) (3) (1) 13,202.32 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 re~luest a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB) 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; ......................... E~ [] 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? .............................................. ['--] ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................ ~] E~] IF THE ANSWER TO AN'( OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 11,578.95 0.00 0.00 1,623.37 0.00 1,623.37 Under penalties of perju~, 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. SIGNATUR~.~F PERSON RESPONSIBLE FOR FILING RETURN Lois E. Witmer DATE ......... ' .............. ............................ ~ Mechanicsbur~, PA 17055 SIGNATU~OFPREPAREROT .N~RTHAN REPRE~.~NTATIVE Law Offices-Marlin R McCaleb DATE /J J .7 /~..~ /// 219 East Main Street · ................... 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 P.S. 9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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(aX1.3)]. 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) ?000 form software only The Lackner Group, Inc. Form REV- 1,500 EX (Rev. 6-00) ADDITIONAL Personal Representatives Estate of Anna E. Neibert SS# 183-10-3285 10/17/2003 **************************************************** Under penalties of perjury, the undersigned declare that they have examined this return, including accompanying schedules and statements, and to the best of their knowledge and belief, it is true, correct and complete. Signature Name Address Line 1 Address Line 2 City, State, Zip Date Doris L. Murphy 109 Orchard Street Mechanicsburg, PA 17055 Signature Name Address Line 1 Address Line 2 City, State, Zip Date Daryl E. Neibert 610 Southview Drive PA 17055 LAST WILL AND TESTAMENT OF ANNA E. NEIBERT I, ANNA E. NEIBERT, of the Borough of Mechanicsburg, County of Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can be conveniently done. I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever nature and where- soever the same may be situate,, to my three (3) children, to wit, LOIS E. WITMER, DORIS L. MURPHY, and DAR~L E. NEIBERT, share and share alike. For the purpose of faciIitating the settlement and distribution of my estate,· I authorize and empower my Executors, hereinafter named, to sell any and all real ~state which I may own at the~time of my de- cease at either public or private sale or sales. LASTLY, I nominate, constitute and appoint my three (3) -1- children, the aforesaid LOIS E'. WITMER, DORIS L. MURPHY, and DARYL E. NEIBERT, Co-Executors of this, my Last Will and Testament, and in the event that any of my said children reside ina State other than the State of Pennsylvania at the time of my decease, I direct that they be permitted to serve in such capacity without the necessity of filing bond or other security normally required of foreign fiduciaries. IN WITNESS ~OF, I have hereunto set my hand and seal this day of d~'. , A. D. 1990. / Anna E. Neibert (SEAL) Signed, sealed, published and declared by the above-named ANNA E. NEIBERT, as and for her Last Will and Testament, in the presence of us, who, at her request and in her presence,, and in the presence of each other, have hereunto subscribed our names as witnesses. COMMONWEALTH OF PENNSYLVANIA ) : COUNTY OF CUMBERLAND ) SS. I, ANNA E. NEIBERT , the testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and volun- tary act and deed, for the purposes therein contained. day of Sworn and affirmed to and acknowledged before me by ~INA E. NEIBERT , the testatrix , this .~Z~-~~ , A. D. 1990. / COMMONWEALTH OF PENNSYLVANIA ) : COUNTY OF CUMBERLAND ) M ~~~Ny NOTARIAL SEAL S. ROBINSDN. NOTARY ~UBLIC IC~G BORO. CUmBErLAND CO. jMy Co~'lssion Expires Sept. 21, }991 We, the undersigned, J. ROBERT STAUFFER and I~LI~N KAY F~N , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the testatrix , AI~ E. NEIBERT , sign and exe- cute the instrument as k~/her Last Will and Testament; that the said testatrix , ~ E. ~T , executed it as kix/her free and voluntary act for the purposes t'herein expressed; that each of us, in the hearing and sight of the testatrix , signed the Will as witnesses; and that to the best of our knowledge, the testatrix was, at the time, eighteen (18) or more years of age, of sound mind, and under no constraint, duress or undue influence. Sworn and s~bscribed to before ~L ~'I < ] me this ~/S~ day of ~ ~ ~ ~ ~ , ~=z~ , 1990. / NOTARIAL SEAL MARY S. RDBINSON, NOTARY ~UILIC MECHANICSBURG IORO, CUMBERLAND CO. My Commission Expires Sept, 21, t~91 REV-150? EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Anna E. Neibert SS# 183-10-3285 SCHEDULE A REAL ESTATE 10/17/2003 FILE NUMBER 21-03-0920 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 DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1 House and lot, known and numbered as 39 West Coover Street, Mechanicsbur~, PA, acquired by Decedent and spouse, Harold R. Neibert, by deed dated 02/08/1985, Deed Book "C", Volume 31, Page 646 · Y'-2~- ~7 ). recorded in Cumberland County (Harold R. Neibert died 108,000.00 TOTAL (Also enter on line 1, Recapitulation) $ 108,000. O0 (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. 1-97) Mark E. Hilbert & Associates 04-008M 1S File No. 04-008MIS APPRAISAL OF Sum rn ery Appraisal LOCATED AT: 39 West Coover Street Mechanicsburg, PA 17055 FOR: Marlin R. McCaleb Esq. 219 East Main Street Mechanicsburg, PA. 17055 BORROWER: Anna E. Neibert (Estate) AS OF: October 17, 2003 BY: Mark E. Hilbert MARK E. HILBERT & ASSOCIATES 04-008M1S Property Desc~iptio, . UNIFORM RESIDENTIAL APPRAISAL REPORT File No. 04-008M1S · Property Address ~ West Coover Street City Mechanicsburg State PA ZipCode 17055 Location [] Urban Built up [] Over 75% Growth rate [] Rapid [] Slew Property valuesU Increasing [] Declining Demand/supply [] Shortage [] Inbalance [] Oversuppiy Under 3 mos. ~-] 3-6 mos. [] Over 6 mos. Attached County Cumberland Assessor's Parcel No. Tax Year R.E. Taxes $ Special Assessments $ Borrower Anna E. Neibert Current Owner Estate Occupant: I~] Owner [~J Tenant [~} Vacant PUD ~] Condominium (HUDNA only) HOA$ /Mo. or Project Name Borough of Mechanicsburg Map Reference Census Tract 114 Price $ Estate Date of Sale Description and $ amount of loan charges/concessions to be pa'~ by-~.~m Lender/Client Marlin R. McCaleb Esq. Address 219 East Main Street, Mechanicsburg, PA. 17055 Mark E. Hilbert Address 219 East Main Street, Mechanicsburg [] Suburban [] Rural Predominant [] 25-75% [] Under 25% occupancy Stable ~ Owner Stable Tenant [] vac~t(o~%) ]Vacant (ov~ 5%) Note: Race and the racial composition of the neighborhood are not appraisal factors. Neighborhood boundaries and characteristics: Subject Property is located along West Coover Street in the Borough of Mechanicsburg, Cumberland County, Pennsylvania. Single family housing I Present land usei% I Land use change $P(?o01C)E A(~)E One family ~0/o J [] Not likely [] Likely 60 Low 612-4fam"y ~ [] Inprocess I_j5o ..,h O/olTo: ~ Predominant ~1 Commercial :~°/° I 140 I 80 Landl2%1 Factors that affect the marketability of the properties in the neighborhood (proximity to employment and amenities, employment stability, appeal to market, etc.): ood access to employment and services. Churches ,Schools and Recreational areas are within a reasonable distance. Market conditions in the subject neighborhood (including support for the above conclusions related to the trend of property values, demand/supply, and marketing time - - such as data on competitive properties for sale in the neighborhood, description of the prevalence of sales and financing concessions, etc.): With the improving markets the seller are not required to offer sales or financing concessions. Financing is reedly available from a of sorces. Project Information for PUDs (If applicable) - - Is the developer/builder in control of the Home Owners' Association (HOA)? L] YES Approximate total number of units in the subject project Approximate total number of units for sale in the subject project Describe common elements and recreational facilities: Dimensions 58 x 140 x 58 x 140 Corner Lot [] Yes [] No Topography Sitearea 8120 Sq. Ft. +/- Size Specific zoning classification and description Residential Shape Zoning compliance [] Legal [] Legal nonconforming (Grandfathered use) [],legal [] Nozoning Drainage hast & best use as improved: [] Present use [] Other use (explain) View Public Private Landscaping ~ypical Electridty [] 125 Am p S~'eet Macadam [] Driveway Surface None Gas [] Curb/gutter Concrete [] Water [] Sidewalk Concrete [] [~ Sanitary sewer [] Street lights Yes [] Storm sewer ~ Alley Macadam ~J Comments (apparent adverse easements, encroachments, special assessments, slide areas, illegal or legal nonconforming zoning, use,~ etc ) act however to reservations,easements, conditions and right of way of record. [] NO Basically Level 0.20 Acres Rectangular Appears adequate Residential Apparent easements None apparent . FNMA Special Flood HaZard Area [] Yes [] No FNMA Zone "C" Map Date 03-03-92 FEMA Map No. 420362-0005-D None Apparent GENERAL DESCRIPTION No. of Units One No. of Stories Two Type (Dat./Att.) Detached Design (Style) 2 Story Existing/Proposed Existing Age (Yrs.) 120 +/- 12-14 ROOMS Basement Level 1 Level 2 Finished area above ~rade contains: IN i I:HiOR Materials/Condition Floors Carpet / Avg Walls Plaster / Average Trim/Finish Wood / Avg Bath Floor Vinyl / Avg Bath Wainscot Ceramic Tile / Avg Doors Wood / Avg EXTERIOR DESCRIPTION Foundation Stone Exterior Walls Aluminum Roof Surface Com position Gutters & Dwnspts. Aluminium Window Type Dbl. Hung Storm/Screens YES YES Manufactured House No Dinin~ Kitchen 1 1 6 Rooms; HEATING Type Steam Fuel Oil ConditionAvg. COOLING Central None Other None Condi~onAvg. Additional features (special energy efficient items, etc.): FOUNDATION Slab NONE Oawl Space Part Basement Part Sump Pump Floor Drain Dampness None noted Settlement None noted Infestation None noted 3 Bedroom/s); KITCHEN EQUIP. | ATTIC Refrigerator []~ None Range/Oven []/ Stairs Disposal i IDrop Stair Dishwasher Scuttle Fan/Hood Floor Microwave Heated Finished BASEMENT Area Sq. Ft. 416 % Finished Unfinished Ceiling Joist Walls Stone Floor Concrete Outside Enlry Bedrooms J # Baths P/Rm. 3 I 1.5 Bath(s); AMENITIES [] Fireplace(s)# [] Patio [] Deck [] Porch Rear [~ Fence Pool INSULATION Roof ~ Ceiling ___ Walls Floor [~j None Unknown [] 1 ~656 Square Feet of Gross Livin~ Area CAR STORAGE: 3 3 3 None [] Garage # of cars Attached Detached 1 Built-In Carport ~/asher/Dryer ~] Balcony (--] Driveway None 17X19 Detached Garage ,Storage building is in Poor condition nO valve given. Condition of the improvements, depreciation (physical, functional, and external), repairs needed, quality of construction remodeling/additions, etc.: of functional or external obsolescence. No evidence Adverse environmental conditions (such as, but not limited to, hazardous wastes, toxic substances, etc.) present in the improvements, on the site, or in the immediate vicinity of the subject property: There are no visible or apparent adverse enviornmental conditioins that Would negatively impact the value of the subject i Freddie Mac Form ?0 6-93 PAGE 1 OF 2 Fannie Mae Form 1004 6-93 Valuatibn ~ecti6n UNIFORM RESIDENTIAL APPRAISAL REPORT 04-008 M 1S FileNo. 04-008M1S ESTIMATED SITE VALUE ........................... : $ 22,000 ESTIMATED REPRODUCTION COST-NEW OF IMPROVEMENTS: Dwelling 1,656 Sq. Ft. @$. 48.15 = $ 79,736 Bsmt. 416 Sq. Ft. @$. 8.75 = 3,640 Porch, Balcony = 3,500 Garage/~ 323 Sq. Ft. @$. 14.10 = 4,554 Total Estimated Cost New ................ = $ 91,430 Less 50 Physical I FunctionalI External Est. Remaining Econ. Life: Depredation $9,143I I = $ 9,143 Depreciated Value of Improvements ................... = $ 82,287 "As-is" Value of Site Improvements ................... = $ 2,500 INDICATED VALUE BY COST APPROACH ........... = $ 106,800 ITEM I SUBJECT 39 West Coover Street COMPARABLE NO. 1 Comments on Cost Approach (such as, source of cost estimate, site value, square foot calculation and for HUD, VA and FmHA, the estimated remaining economic life of the property): In the reproduction cost of improvements, Marshall & Swift Residential Cost Handbook and local contractors are referenced. Address Mechanics_burg,p~... Sales Pdca 108 000 Price/Gross Liv. Area 65.22 Data and/or Verification Sources Inspection VALUE ADJUSTMENTS Sales or Financing Concessions Date of Sale/Time Location Site View Condition Above Grade Room Count Basement & Rnished Rooms Below Grade Functional Utility ~ Effident Items Porch, Patio, Deck, s, Pool, etc. Estimated remain n,q economic life is 30-35 years. COMPARABLE NO. 3 COMPARABLE NO. 2 113 South Washington Street 1218 orth Arch Street 39 West Green Stret DESCRIPTION Mecl~anicsburg,PA I 0.35 Miles +/- ' J ? ~ 65.73 ~] ~ C-P'M-L I Agent I Suburban Fee Simple 0.20 Acres Mechanicsburg,PA I Mechanicsburg,PA 0.25 Miles +/-' 10.40 Miles $ 105 000 $ 105 000 $ 70.19 ~] $ 84.81 Agent Agent DESCRIPTION DOM 3 Conventional 08-27-03 Suburban + (-) $ A~ DESCRIPTION DOM 65 Conventional 08-28-03 Suburban Fee Simple , 0.12 Acres ' Fee Simple 0.10 Acres Residential Residential Residential 2 Story / Avg Aluminum 2 Story / Avg Brick / Alumin 100 +/- Ave, rage, , Total I Bdrms ', Baths , 7: 3~ 1.00', 1,496 Sq. Ft. I Part ', Unfinished : Average ,, B.B. Elec / None Average I Car Garage Porch / Deck None None None 120 Yrs.+/- +2,000 +2,400 -1,500 +1,500 Ave, rage, TotalI Bdrms ~ Baths 6~ 3, 1.50 1,656 Sq. Ft. Part Unfinished Average Oil Steam/None Average 1 Car Garage Porch None 2 Story / Avg , Frame , 95 +/- ' Ave, rage, Total '1 Bdrms ', Baths 4,, 2', 1.00 1,238 Sq. Ft. Full Unfinished Average H. Water/None Average 2 Car Garage Porch None Balcony , Fence +2,00( +6,300 -1,000 -2,500 -1,000 Balcony None DESCRIPTION DOM 16 ConVentional 0-26~03 Subqrban Fee Simple 0.16 Acres Residential 2 StOry / Av.q AsbeStos 90 +/ Abo, ve Av, erage 61 3', 1.0~ 1,704 Sq. Ft. Full Unfiniished Average H. Water/2 Wall Average 1 Car Garage Sun Room None. None + (-) $ Aalu~,.nt -3,500 +2,000i -1,000 -1,000 -3,000 +1,500 None : $ 107 000 $ ~o9,4o~ ~~5~ lO8,~oo Comments on Sales Comparison (including the subject property's compatibility to the neighborhood, etc. ):. Date, Price and Data J None I None None COMPARABLE. NO. 2 None COMPARAR~ E NO. 3 Source for p~r sales I N/A I N/A I N/A N/A ]Owners Deed ]C.P.M.L,/Court House ]C.P.M.L,/Court House C.P.M.L,/Court House Analysis of any current agreement of sale, option, or listing of the subject property and analysis of any prior sales of subject and cornpa'ables within one year of Ihs date of appraisal: The sales comparison approach carries the most weight in determing market value as it is based on historical infermation and is not as INDICATED VALUE BY SALES COMPARISON APPROACH ..................................................... $ 108,000 INDICATEDVALUEBYINCOMEAPPROACH(IfAppr~able) Estimated Market Rent $ N/A /Mo. xGrossRentMuttiplier N/A =$ 0 This appraisal is mede [] "as is" [] subject to the repais, alterations, inspec'tJons or conditions listed below [] subject to completion per plans and spedficaUons. CondrdonsofAppraisal: The appraiser assumes a maretable title and that equipment associated with the improvement is in working order Final Reconciliation: The market approach reindorced by the cost approach is a good indicator of fair market value. The fact that the seller is of the closing costs has no effect on this appraisal. DATE OF DEATH OCTOBER 17~ 2003. The purpose of this appraisal is to estimate the market value of the real property that is the subject of this report, based on the above conditions and the cerfir~flon, contingent and limiUng conditions, and market value definition that am stated in the attached Freddie Mac Form 43g/Fannie Mae Form 1004B (Revised 6/93 ). I (WE) ESTIMATE THE MARKET VALUE, AS DEFINED, OF THE REAL PROPERTY THAT iS THE SUBJECT OF THIS REPORT, AS OF ' D.O.D.-October, 17 2003 (WHICH IS THE DATE OF INSPE/C~710_O.O_.~NNNN AN~;;I?-IE E..,FF~CTIVE DATE OF THiS REPORT) TO BE $ 108,000 . APPRAISER: ~//..//[/~/~/_~/~/ SUPERVISORY APPRAISER (ONLY IF REQUIRED): Signature f////'//~// ~///~ Signature []Did []Did Not Name Mark ~//,/~/l~e~Y'/' ~-'~'~"~ - ~ [ Name Date Report Signed February 23, 2004 State Certification # RL-000388-L Date Report Signed State PA State Certification # Or State License # RB029755A State PA Or State License # Freddie Mac Form 70 ~-93 PAGE 2 OF 2 Produced using P~m'eld Dtglbll $~ sol~, 800.234.8727 www. pohvoldforms.com Mark E. Hilbert and Assoc. Inspect Property State State Fanr~e Mae Fa~n 1004 6-93 Borrower: Anna'E. Neibert (Estate) ADDENDUM File No.: 04-008MIS Property Address: 39 West Coover Street City: Mechanicsburg State:' PA Case No.: 04-008MIS Zip: 17055 Lender: Marlin R. McCaleb Esq. Comments on Sales Comparison The subject is over 30 years old, but has been modernized as necessary and is marketable in its present condition. The effective age is significantly less than 30 years. The property's heating, plumbing and electrical systems appear to be functioning properly to the best of the appraiser's knowledge and expertise. It is noted that the price per sq. fi. of gross living area for comparable sale No(s) 2 varies by more that $10.00 per sq. ft. compared to the subject. The comparables chosen are the best available. The vacant land in the area is changing to single family and does not have a negative effect on the value. I am unable to verify the insulation "R" factor. The presence of UREA-FORMALDEHYDE FOAM INSULATION could not be determined. IfUFFI is present, the appraised market value may be adversely affected or voided. Any information about insulation stated on the appraisal was provided by · inspection, owner or agent and is assumed to be accurate. The appraiser in not aware of the existence of RadOn Gas and/or Radon Daughters and dOes not have the necessary equipment to test for presence of same. Ifa future test shows unacceptable levels of Radon present, the appraised market value may be adversely effected or voided. Please be advised that in the market data analysis grid, bathrooms are adjusted for on the first line and gross living area/room count are adjusted together as a single adjustment on the second line. All comparable sales are settled to the best of the appraiser's knowledge. Verification of Settlement is with County and/or Realtor. Addendum Page I of 1 SUBJECT PROPERTY PHOTO ADDENDUM ' Borrowe~: Anr~a E. Neibert File No.: 04-008MIS Property Address: :~'9 West'Coover Street Case No.-' 04-008MIS City: Mechanicsburg State: PA Zip: 17055 Lender: Marlin R. McCaleb Esq. FRONT VIEW OF SUBJECT PROPERTY Appraised Date:October 17, 2003 Appraised Value: $ REAR VIEW OF SUBJECT PROPERTY STREET SCENE ~r~na E. Neibert File No.: 04-008MIS Property,~ddress! ;~9 West Coover Street Case No.: 04-008M15 ~nicsburg State: PA ~17055 Lender: Marlin R. McCaleb E_.~..~. · COMPARABLE PROPERTY PHOTO ADDENDUM BorroWer: 'Anna~ E. Neibert (Estate) Proper{y Address: 39' West Coover Street City: Mechanicsburg State: PA Lender: Marlin R. McCaleb Esq. File No.: 04-008MIS Case No.: 04-008MIS Zip: 17055 COMPARABLE SALE #1 113 South Washington Street Mechanicsburg, PA Sale Date: 08-27~03 Sale Price: $105,000 COMPARABLE SALE #2 218 orth Arch Street Mechanicsburg,PA Sale Date: 08-28-03 Sale Price: $105,000 COMPARABLE SALE ~3 39 West Green Stret Mechanicsburg, PA Sale ·Date: 0-26-03 Sale Price: $112,000 Borro~vedC~ient FileP Property Address City County State Zip Code Lender BUILDING SKETCH 'WARRAN'WI~ DEED TI~ Plm~:~l:~om C~. ' Wllll~m~po~, Pa. I'/'/01 MADE the dl/~/7 day o[ Feb ruary in the ye~ nineteen hundred and eighty-five (1985). BETWEEN HAROLD R. NEIBERT and'ANNA E, NEIBERT, his wife, of the Borough of MeChanicsburg, County of Cumberland and State of Pennsylvania, 'parties of the 'first part, grantors, A N 'D HAROLD. R. .NEIBERT and, ANNA E, NEIBERT, his wife, of the Borough of Mechmxzcsburg; County of"Cumberland and.State of pennsylvania, parties of the'second part, grantees, ' ' WITNESSETH, That in conaideration o[ the aura of One ~*** ($1.00) ...*** in hand paid, the receipt whereo[ is hereby acknowledged, the ~aid grantor s do and convey to the mid grantees, their, heirs and as signs, ' Dollars, hereby grant ALL THAT CERTAIN Lot of Ground situate on'the 'South~ side of West Coover Street, in the Borough of Mechanicsburg, Cumberland COunty, State of'Pennsylvania, bounded and'.described as follows, to wit: BEGINNING on the building line of said Coover Str.eet andlat, corner of lot formerly'of'Robert Armstrongl now'of Ralph'Paulus, J=.i thence along the building line of' said'Coover Str.eet Eastward' fifty.aeight (5.8).feet t° a point at corner of lac formerly of S. C. Oswald'now of Carl'M; Pittenturfi thence'along the line ~f said lot of Carl M. Pittenturf Southward one hundred'forty'(140).~.eet, more or less, to the line of a twenty-feet wide Alleyl thence.along the line'of said'Alley Westward fifty-eight (58).feet to'tine of'lot of Ralph Paulus, Jr. aforesaidi thence along the line of said lot of Ralph Paulus, Jr. Northward one hundred'forty (140) feet, more or less, to the building line of said Coo~er Street, theiPlace of BEGINNING.' : HAVING thereon er.ecte, d a two'and one-half story frame, dwelling house numbered 39'West Coo~er Street, also frame garage. ' BEING the same premises which Bertha K. Wister, Widow, by her deed dated October'lS,'1943, and recorded in the Cumberland. Caunty Recorder's Office in'Deed Book "S"; Volume 12, Page 402,1granted~ and conveyed unto Harold R. Neibert. This is a nontaxable transfer' ,_~_e~n husband'and wife and is made ~or the purpose of. ~estzng title in husband and wife as tenants by the~entireties, title to which was heretofore vested in the name of husband 'only. 646 AND the said grantor will Generally hereby conveyed. WARRANT AND FOREVER DEFEND the property IN WITNESS WHEREOF, said grantor s have day and year first above-written. hereunto set their hand~ and se~s , the Harold' R. Neibert ,. ............................................................................................. C~) .£.v ~ '~-2 .,.~. 'l .... ~-~ ';'~--. c , t t e ~'b.'~-cA- (,,~3. ~nna E. NezlSert .............................................................................................. ............................................................................................... .............................................................................................. I hereby certify, that the vrecise residence of the gLant~e '~//7// /' ,,'"h~rein is as fo]lows: ~t~, . ~. '. Commonwealth oE Pennsylvania [ SS: Co,~y o~ ..~.9~.5~ ...................... : ........ I " On this, the~:f~ day of February 1985, before me, a ~ot:ary the undersigned· officer, personally appeared HAROLD R. his wife, known to me [or satisfactorily p~oven] to be the person s NEIBERT ~and ANNA 'E. NEIBERT, whose names sresubscribed to the .within instrument, and. acknowledged that contained. IN WITNESS WHEREOF, Commonwealth of Penrisylvania C%nt~ of they executed the same for the,. purpose th*rein. ., .. · '.' " I have herem~to set my..l~d~and offic~ql ~'~!~ ~..' ....... '~~....;,::~:.,,..~.;~;. ~., H' ~-- ........................................................................... i..,',...~ ...... M~ C0~l~ll-$SI0fl EEPlRES ~Y 14, SS: .~ember. P~nnsylva~ia ~s0ciatio, of ~0taries On this, the day oE 19 , before me the undersigned officer, personally appeared known to me (or satisfactorily proven) to be the pers9n instrument, and acknowledged that contained. whose name subscribed to the within executed the same Eof the purpose therein IN WITNESS WHEREOF, I have hereunto set my hand and : seal. My Commission F_,a~pires ~00 3i ~,'~c[ 647 ' m.a:toql oso&ncI oql :xoj otues, o,4~ .po3nooxo u!tD!~a oql o.l poqvosqns otueu osoqm om o;tojoq ' 6I :SS' po:teocIdu ,(IleUOSIOcI 'aaoDjo pauS:s:t~pun aq:l jo Xsp aql 's:q;. uO jo ~unoO 'jo roms so','!clx~ uo~s!mmoD ilAI .leOS pue pueq am ~os u!o~oq~ osodxncI o,4a aoj ames otD. po~naoxo u!qum oql o3 poq!:tasqns omeu osoqat Om o~ojoq ' 6I :SS MULTI-PURPOSE SUPPLEMENTAL ADDENDUM FOR FEDERALLY RELATED TRANSACTIONS (FIRREA) 04-O08MlS 04-008M 1 S Borrower/Client Anna E. Neibert (Estate) Property Address 39 West Coover Street City Mechanicsburg Lender Marlin R. McCaleb Esq. County Cumberland State PA Zip Code 17055 This Multi-Purpose Supplemental Addendum for Federally Related Transactions was des gned to provide the appraiser with a con- venient way to comply with the current appraisal standards and requirements of the Federal Deposit Insurance Corporation (FDIC), the Office of the Comptroller of Currency (OCC), The Office of Thrift Supervision (OTS), the ResolUtion Trust Corporation (RTC) and the Federal Reserve. This Multi-Purpose Supplemental Addendum Is for use with any appraisal, iOnly those statements which have been checked by the appraiser apply to the property being appraised. The purpose of the appraisal is to estimate the market value of the subject property as defined herein. Tl~e function of the appraisal is to assist the above-named Lender in evaluating the subject property for lending purposes. This is a federally related transaction. ~-~ The appraisal is based on the information gathered by the appraiser from public records, other identi ied sources, inspection of the subject property and neighborhood, and selection of comparable sales within the subject market area. ]'he original source of the corn- parables is shown in the Data Source section of the market grid along with the source of confrmation if available. The original source is presented first. The sources and data are considered reliable. When conflicting information was pro~/ided, the source deemed most reliable has been used. Data believed to be unreliable was not included in the report nor used as a basis for the value conclusion. ~-~ The Reproduction Cost is based on Marshall & Swift residential Cost Hand book and Local Cont~ractors. supplemented by the appraiser's knowledge of the local market, ' ~ Physical depreciation is based on the estimated effective age of the subject property. Functional and/or external depreciation, if present, is specifically addressed in the appraisal report or other addenda. In estimating the site valUe, the appraiser has relied on personal knowledge of the local market. This knowledge is based on prior and/or current analysis of site Sales and/or abstraction of site values from sales of improved properties, ~ The subject property is located in an area of primarily owner-occupied single family residences and thei Income Approach is not consi- dered to be meaningful. For this reason, the Income Approach was not used. [~ The Estimated Market Rent and Gross Rent Multiplier utilized in the Income Approach are based on the appraiser's knowledge of the subject market area. The rental knowledge is based on prior and/or current rental rate surveys of residentia properties. The Gross Rent Multiplier is based on prior and/or current analysis of prices and market rates for residential properties. [~ For income producing properties, actual rents, vacancies and expenses have been reported and analyze~l. They have been used to pro- ject future rents, vacancies and expenses. According to Deed : the subject property; has not been offered for sale in the past months or 3 years. is currently offered for sale for $ was offered for sale within the past __ months or ~ years. Offering information was considered in the final reconciliation of value. Offering information was not considered in the final reconciliation of value. Offering information was not available. The reasons for unavailability and the steps taken by the appraiser are explained later in this addendum. According to Deed ; the subject property; r~has transferred the past monthsor years. not in 3 ~===~ has transferred in the past _ months or years. L__J All prior sales which have occurred in the past months or years are listed below and reconciled to the appraised value, either in the body of the report or in the addenda. Date Sales Price Document # Seller Buyer ~E~ Subject property is not located in a FEMA Special Flood Hazard Area. Subject property is located in a FEMA Special Flood Hazard Area. Zone FEMA Map/Panel# Map Date Name of Community/ "C" 420362-0005-D 03-03-92 Borough of Mechahicsburg ~-] The community does not participate in the National Flood Insurance Program. X I The community does participate in the National Flood Insurance Program. I J It is covered by a regular program. I I It is covered by an emergency pro,ram. FW.70M Decemb~ 1992 Forms & Worms Inc., 315 Whitney Ave. New Haven, CT 06511 All Rights Reserved This from reproduced ~ ~ an the ACl Development RapldForrns ~ystem (~00) 234~727 " ' 04-008MIS · 04-008MIS ~-~The subject property is currently not under contract. ~---~The contract and/or escrow instructions were not available for review. The unavailability of the contract is explained later in the addenda section. [--'~The contract and/or escrow instructions were reviewed. The following summarizes the contract: Contract Date Amendment Date Contract Price Seller [~The contract indicated that personal property was not Included in the sale. ~-]The contract indicated that personal property was Included. It consisted of Estimated contributory value iS $ r'---]Personal property was not included in the final value estimate. r~']Personal property was Included in the final value estimate. The contract indicated no financing concessions or other incentives. The contract indicated the following concessions or incentives: ~jIf concessions or incentives exist, the comparables were checked for similar concessions and appropriite adjustments were made, if applicable, so that the final value conclusion is in compliance with the Market Value defined herein. Six months is considered a reasonable marketing period for the subject property based on service data. The Appraiser certifies and agrees that: (1) Their analyses, opinions and conclusions were developed, and this report was prepared, in conformity;with the Uniform Standards of Professional Appraisal Practice ("USPAP"), and in accordance with the regulations developed by lhe Lender's Federal Regulatory Agency as required by FIRREA, except that the Departure Provisions of the USPAP do not apply.. (2) Their compensation is not contingent upon the reporting of predetermined value or direction in vatueithat favors the cause of the client, the amount of the value estimate, the attainment of a stipulated result, or the occurrence of a subsequent event. (3) This appraisal assignment was not based on the requested minimum valuation, a specific valuation, or the approval of a loan. The value estimated is based on the assumption that the property is not negatively affected by the existence of hazardous substances or detrimental environmental conditions unless otherwise stated in this report. The appraiser is not an ~xpert in the identification of hazardous substances or detrimental environmental conditions. The appraiser's routine inspection of an~d inquiries about the subject property did not develop any information that indicated any apparent significant hazardous substances pr detrimental environmental conditions which would affect the property negatively unless otherwise stated in this report. It is possible tl~at tests and inspections made by a qualified hazardous substance and environmental expert would reveal the existence of hazardoi~s substances or detrimental environmental conditions on or around the property that would negatively affect its value, Appraiser's Name State PA Phone # ( 717 ) 76614988 I J License I I Residential Certification I X J Certification # RL-OOO388-L [~The co-signing appraiser has personally Inspected the subject property, both inside and out, and has m~de an exterior inspection of all comparable sales listed in the report. The report was prepared by the appraiser under direct supervision of the co-signing appraiser. The co-signing appraiser accepts responsibility for the contents of the report including the value conclusions and the limiting condi- tions, and confirms that the certifications apply fully to the co-signing appraiser [~]The co-signing appraiser has not personally inspected the interior of the subject property and: [---]has not inspected the exterior of the subject property and all comparable sales listed in the report. has inspected the exterior of the subject property and all comparable sales listed in the report. The report was prepared by the appraiser under direct supervision of the co-signing appraiser. The Co-signing appraiser accepts responsibility for the contents of the report, including the value conclusions and the limiting conditions, and confirms that the certifications apply fully to the co-signing appraiser with the exception of the certification regarding physical inspections. The above describes a level of Inspection performed by the co-signing appraiser. E~The co-signing appraiser's level of inspection, involvement in the appraisal process and certification are covered elsewhere in the addenda section of this appraisal. Appraiser's Signature Appraiser's Name (print) State ~ [---]License Certified Residential [----~Tr ain ee ~ Review SS# Certification # FW-70M Forms & Worms Inc., 315 Whitney Ave. New Haven, CT 065t t All Rights Reserved December 1992 This form r~r~'uced wflh pa'mission m ~ ACl Development RapldForm, system (800) 234-B727 Borrower ,Anr~a, E! Neibert {' Estate) File No. 04-008M1S Property Address 39 West Coover Street City Mechanicsburg County Cumberland Lender Marlin R. McCaleb Esq. APPRAISAL AND REPORT IDENTIFICATION State PA Zip Code 17055 This appraisal conforms to one of the following definitions: [] Complete Appraisal (The act or process of estimating value, or an opinion of value, performed without invoking the Departure Rule.) [] Limited Appraisal (The act or process of estimating value, or an opinion of value, performed under and resulting from linvoking the Departure Rule.) This report is one of the following types: [] Self Contained (A written report prepared under Standards Rule 2-2(a) of a Complete or Limited Appraisal performed under STANDARD 1.) [] Summary (A written report prepared under Standards Rule 2-2(b) of a Complete or Limited Appraisal performed under STANDARD 1.) [] Restricted (A written report prepared under Standards Rule 2-2(c) of a Complete or Limited Appraisal performed under STANDARD 1 for client use only.) Comments on Standards Rule 2-3 certify that, to the best of my knowledge and belief: · The statements of fact contained in this report are true and correct. · The reported analyses, opinions, and conclusions are limited only by the reported assumptions and limiting conditions, and are my personal, impartial, and unbiased professional analyses, opinions and conclusions. · I have no present or prospective interest in the property that is the subject of this report, and no personal interest with respect to the parties involved. · I have no bias with respect to the property that is the subject of this report or the parties involved with this assignment. · My engagement in this assignment was not contingent upon developing or reporting predetermined results. · My compensation for completing this assignment is not contingent upon the development or reporting of a predetermined value or direction in value that favors the cause of the client, the amount of the value opinion, the attainment of a stipulated result, or the occurrence of a subsequent event directly related to the intended use of this appraisal. · My analyses, opinions and conclusions were developed and this report has been prepared, in conformity with the Uniform Standards of Professional Appraisal Practice. · I [] have [] have not made a personal inspection of the property that is the subject of this report. Comments on Appraisal and Report Identification Note any departures from Standards Rules 1-2, 1-3, 1-4, plus any USPAP-related issues requiring disclosure: APPRAISER: ~ .~ ~ Signature: .~.~J~'~ Name: Mafl~/~.."l~l~llo~r( "~ ~ Date Signed: February 23, 2004 State Certification #: RL-000388-L or State License #: RB029755A State: PA Expiration Date of Certification or License: June 30, 2005 SUPERVISORY APPRAISER (only if required): Signature: Name: Date Signed: State Certification #: or State License #: State: Expiration Date of Certification or License: [] Did [] Did Not inspect Property USPAP Identifica~on (Rev 9/99) 1 of 1 Produced using Polaroid ~ Solu~ons ~)~vare, 800.234.8727 'eww.p~laroldf~-ms.ca~ 04-008MIS File No. 04-O08M1S DEFINITION OF MARKET VALUE: The most probable price which a property should bring in a competitive and open market under all conditions requisite to a fair sale, the buyer and seller, each acting prudently, knowledgeably and assuming the price is not affected by undue stimulus. Implicit in this definition is the consummation of a sale as of a specified date and the passing of title from seller to buyer under conditions whereby: (1) buyer and seller are typically motivated; (2) both parties are well informed or well advised, and each acting in what he considers his own best interest; (3) a reasonable time is allowed for exposure in the open market; (4) payment is made in terms of cash in U.S. dollars or in terms of financial arrangements comparable thereto; and (57 the price represents the normal consideration for the property sold unaffected by special or creative financing or sales concessions* granted by anyone associated with the sale. *Adjustments to the comparables must be made for special or creative financing or sales concessions. No adjustments are necessary for those costs which are normally paid by sellers as a result of tradition or law in a market area; these cost~ are readily identifiable since the seller pays these costs in virtually all sales transactions. Special or creative financing adjustments can be made to the comparable property by comparisons to financing terms offered by a third party institutional lender that is not already involved in Ithe property or transaction. Any adjustment should not be calculated on a mechanical dollar for dollar cost of the financing or concession but the dollar amount of any adjustment should approximate the market's reaction to the financing or concessions based on the Appraiser's judgment. STATEMENT OF LIMITING CONDITIONS AND APPRAISER'S CERTIFICATION CONTINGENT AND LIMITING CONDITIONS: The appraiser's certification that appears in the appraisal report is subject to the following conditions: 1. The appraiser will not be responsible for matters of a legal nature that affect either the property being appraised or the title to it. The appraiser assumes that the title is good and marketable and, therefore, will not render any opinions about the title. The property is appraised on the basis of it being under responsible ownership. 2. The appraiser has provided a sketch in the appraisal report to show approximate dimensions of the improvements and the sketch is included only to assist the reader of the report in visualizing the property and understanding the appraiser's determination of its size. 3. The appraiser has examined the available flood maps that are provided by the Federal Emergency Management Agency (or other data sources) and has noted in the appraisal report whether the subject site is located in an identified Special Flood Hazard Area. Because the appraiser is not a surveyor, he or she makes no guarantees, express or implied, regarding this determination. 4. The appraiser will not give testimony or appear in court because he or she made an appraisal of the property in question, unless specific arrangements to do so have been made beforehand. 5. The appraiser has estimated the value of the land in the cost approach at its highest and best use and the improvements at their contributory value. These separate valuations of the land and improvements must not be used in conjunction with any other appraisal and are invalid if they are so used. 6. The appraiser has noted in the appraisal report any adverse conditions (such as, needed repairs, depreciation, the presence of hazardous wastes, toxic substances, etc. ) observed during the inspection of the subject property or that he or she bec~ame aware of during the normal research involved in performing the appraisal. Unless otherwise stated in the appraisal report, the appraiser has no knowledge of any hidden or unapparent conditions of the property or adverse environmental conditions (including the preserlce of hazardous wastes, toxic substances, etc. ) that would make the property more or less valuable, and has assumed that there are nO such conditions and makes no guarantees or warranties, express or implied, regarding the condition of the property. The appraiser willlnot be responsible for any such conditions that do exist or for any engineering or testing that might be required to discover whether such conditions exist. Because the appraiser is not an expert in the field of environmental hazards, the appraisal report must not be considered as an environmental assessment of the property. 7. The appraiser obtained the information, estimates, and opinions that were expressed in the appraisal report from sources that he or she considers to be reliable and believes them to be true and correct. The appraiser does not assume responsibility for the accuracy of such items that were furnished by other parties. 8. The appraiser will not disclose the contents of the appraisal report except as provided for in the Uniform Standards of Professional Appraisal Practice. 9. The appraiser has based his or her appraisal report and valuation conclusion for an appraisal that is subject to satisfactory completion, repairs, or alterations on the assumption that completion of the improvements will be performed in a workmanlike maaner 10. The appraiser must provide his or her prior written consent before the lender/client specified in the appraisal report can distribute the appraisal report (including conclusions about the property value, the appraiser's identity and professional ~lesignations, and references to any professional appraisal organizations or the firm with which the appraiser is associated ) to anyone other than the borrower; the mortgagee or its successors and assigns; the mortgage insurer; consultants; professional appraisal organizations; any state or federally approved financial institution; or any department, agency, or instrumentality of the United States or any siate or the District of Columbia; except that the lender/client may distribute the property description section of the report only to data collection or reporting service(s) without having to obtain the appraiser's prior written consent. The appraiser's written consent and approval must also be obtained before the appraisal can be conveyed by anyone to the public through advertising, public relations, news, sales, o.r other media. Freddie Mac Form 439 6-93 Page 1 of 2 Fannie Mae Form 1004B 6-93 04-O08MlS File No. 04-008MIS APPRAISERS CERTIFICATION: The Appraiser certifies and agrees that: 1. I have researched the subject market area and have selected a minimum of three recent sales of properties most similar and proximate to the subject property for consideration in the sales comparison analysis and have made a dollar adjustment when appropriate to reflect the market reaction to those items of significant variation. If a significant item in a comparable property is superior to, or more favorable than, the subject property, I have made a negative adjustment to reduce the adjusted sales price of the comparable and, if a significant item in a comparable property is inferior to, or less favorable than the subject property, I have made a positive adjustment to increase the adjusted sales price of the comparable. 2. I have taken into consideration the factors that have an impact on value in my development of the estimate of market value in the appraisal report. I have not knowingly withheld any significant information from the appraisal report anid I believe, to the best of my knowledge, that all statements and information in the appraisal report are true and correct. 3. I stated in the appraisal report only my own personal, unbiased, and professional analysis, opinions, and iconclusions, which are subject only to the contingent and limiting conditions specified in this form. 4. I have no present or prospective interest in the property that is the subject to this report, and I have no Present or prospective personal interest or bias with respect to the participants in the transaction. I did not base, either partially or completely, my analysis and/or the estimate of market value in the appraisal report on the race, color, religion, sex, handicap, familial statusi or national origin of either the prospective owners or occupants of the subject property or of the present owners or occupants of the pl'operties in the vicinity of the subject property. 5. I have no present or contemplated future interest in the subject property, and neither my current ior future employment nor my compensation for performing this appraisal is contingent on the appraised value of the property. 6. I was not required to report a predetermined value or direction in value that favors the cause of the client or any related party, the amount of the value estimate, the attainment of a specific result, or the occurrence of a subsequent event in order to receive my compensation and/or employment for performing the appraisal. I did not base the appraisal report on a requested minimum valuation, a specific valuation, or the need to approve a specific mortgage loan. 7. I performed this appraisal in conformity with the Uniform Standards of Professional Appraisal Practice that were adopted and promulgated by the Appraisal Standards Board of The Appraisal Foundation and that were in place as of the effective date of this appraisal, with the exception of the departure provision of those Standards, which does not apply. I acknowledge tllat an estimate of a reasonable time for exposure in the open market is a condition in the definition of market value and the estimate I developed is consistent with the marketing time noted in the neighborhood section of this report, unless I have otherwise stated in the reconciliation section. 8. I have personally inspected the interior and exterior areas of the subject property and the exterior of all properties listed as comparables in the appraisal report. I further certify that I have noted any apparent or known adverse conditions in th~ subject improvements, on the subject site, or on any site within the immediate vicinity of the subject property of which I am aware and ha~'e made adjustments for these adverse conditions in my analysis of the property value to the extent that I had market evidence to suppori them. I have also commented about the effect of the adverse conditions on the marketability of the subject property. 9. I personally prepared all conclusions and opinions about the real estate that were set forth in the appraisal report. If I relied on significant professional assistance from any individual or individuals in the performance of the appraisal or ~he preparation of the appraisal report, I have named such individual(s) and disclosed the specific tasks performed by them in the reconciliation section of this appraisal report. I certify that any individual so named is qualified to perform the tasks. I have not authorized anyone to make a change to any item in the report; therefore, if an unauthorized change is made to the appraisal report, I will take no responsibility for it. SUPERVISORY APPRAISER'S CERTIFICATION: If a supervisory appraiser signed the appraisal report, he or she certifies and agrees that: I directly supervise the appraiser who prepared the appraisal report, have reviewed the appraisal report, agree with the statements and conclusions of the appraiser, agree to be bound by the appraiser's certifications numbered 4 l~hrough 7 above, and am taking full responsibility for the appraisal and the appraisal report. ADDRESS OF PROPERTY APPRAISED: 39 West Coover Street, Mechanicsburg, PA 17055 APPRAISER: Signature: ~'~/jj~ Name: M ~k~'E~. J,~i~b~'~ Date Signed: February 23, 2004 State Certification #: RL-000388-L or State License #: RB029755A State: PA Expiration Date of Certification or License: June 30, 2005 SUPERVISORY APPRAISER (0nly if required) Signature: Name: Date Signed: State Certification #: or State License #: State: Expiration Date of Certification or License: [] Did [] Did Not Inspect Property! MARK E. HILBERT & ASSOCIATES Freddie Mac Form 439 6-93 Page 2 of 2 Fannie Mae Form 1004B 6-93 PRODUCER USI Colbum Insurance S~rvic¢ One International Plaza Suite 400 Pkiladelphia, PA 19113 Mark E. Hilbert & Associates 14 North Walnut St Mechanivsburg, PA 17055 This Certificate is issued as a matter of information only and confers no rights upon the certificate holder. This Certificate does not amend, extend or alter the coverage afforded by the policy below. COMrAN¥ A~FOP~D~r~G COVERAGE CNA This is to certify that the policy ofiusuranc¢ listed below has been issued to the insured ~amed above for tho policy period indicated, notwith~anding an)- requirement, tem~ or condition of any contract or other do~umvnt with respect to which this cer~ifloa~e may bc issued or may peri, in, the insurance afforded by thc peltry described h~ein is ~ubject to all ~he tern{s, exch~ions ~ud conditions of such _p..oliey, Limits shown may haw been reduced by paid claims. TYPE OF II~$URAWCg REAL ESTATE ERRORS & oMIssIONS 1'3312428-6-03__ ___ May 1, 2003 .... May 1, 2004 $$00,000 Per Claim / $500,000 :Per Aggregate May 1, 1994 J CERTIFICATE HOLDER Should the above described policy be clmc~led before thc ~xpimfion date · ~eo~ the Issuing Co~y ~{1 cndcavor to m~l l 0 da~ ~t~ no~i~e ~o thc C~ficato Hold~ n~d to ~e le~ but I'~lure t0 mail such notice shall impose no obligation ~ li~flity of~y Mhd upon the company, its agents Or A~i130, 2003 O. UALIFIOATIONS OF APPRAISER Mark E. Hilbert, CRIVIA, ICA, l:lwker Appmi~er Education: Reel ~n~e Theory ~nd Real EaLata Hath Real ~aEn~e AdvnnoedAppraieal ~tmndard§ of Professional Prnottoa - Part A M~rk~ lxtrao~t~ Profe.slonel ~ember~hlp~ and, D~.lguatione: Senior H~er - Inke~m~i~l'O~i~a~ Candtdn~e~pratsnl In~EiEu~ ~arrimhr~ Board o~ ~enl~orm Pe~aylv~ia Board o~ Pe~.ylvania Aa~ooin~ion Expetlgnee: Haroh 1~7! to April 1~76 Stuard ~erriok Real Estate ]:no. April I~76 to Oo~obar l~B1 R~/MAX~eml~/Ammoolatem " Ootober i~B1 to F~br~az~ 1~' Februazy I~BB Real Estate Lleenee: Eqareh 1971 Assoelate Broker: April 197G App~aislng.Mnoe 197~. Appraisal Experlenoe: ~rena/ers/=alooabt~ne, aing].a family, oondo. Uompleted Aeslg.me.t~ for: and Ab~ornmy.. REV-1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Anna E. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY Neibert SS# 183-10-3285 10/17/2003 FILENUMBER 21-03-0920 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 NUMBER 2 4 5 6 7 8 9 DESCRIPTION Certificate of Deposit #1853257556, Waypoint Bank - Principal balance as of D.O.D.: $47,280.34; Interest accrued to D.O.D.: $30.88. Certificate of Deposit #1856257613, Waypoint Bank - Principal balance as of D.O.D.: $22,819.85; Interest accrued to D.O.D.: $10.40. Checking Acct. #50006683, Waypoint Bank. - Principal balance as of D.O.D.: $55,846.88; Highmark Blue Shield, Highmark Blue Shield Interest accrued to D.O.D.: $3.41. medical reimbursement. refund of Blue Shield premium. Household goods, contents, furniture and furnishings. PA Department of Revenue, - 2003 personal income tax refund. The Patriot-News, refund of newspaper subscription. UGI, refund. TOTAL (Also enter on line 5, Recapitulation) VALUE AT DATE OF DEATH 47,311.22 22,830.25 55,850.29 96.97 86.35 620.00 75.00 25.20 11.57 $ 126,906.85 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. !Form REV-1508 EX (Rev. 1-97) waup .n LOOK FOR US, WE'LL GET YOU THERE. 11/21/2003 MARLIN R MCCALEB 219 E MAIN ST PO BOX 230 MECHANICSBURG PA 17055 The information which you requested on the account(s) of ANNA E NEIBERT (Social Security Number 183-10-3285) is/are as follows: Account Number 1853257556 1856257613 50006683 Class of Account CERTIFICATE CERTIFICATE CHECKING Date Opened 010595 011995 012600 Principal Balance 47280.34 22819.85 55846.88 Accrued Interest 30.88 10.40 3.41 Balance at Date of 47311.22 22830.25 55850.29 Death Account Ownership SOLE Name of Joint Owner, if any Date Ownership 010595 Was Established SOLE SOLE 011995 012600 Account Number Class of Account Date Opened Principal Balance Accmed Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established Additional Information Requested Shncerelv-- , ERIN WATTS SENIOR SERVICES REP. RO. Box 171 I, HARRISBURG, PENNSYLVANIA 171OE;-1711 Toll Free 1-866-WAYPOINT (I-866-9;~9-7646) · IN YORK AREA 717/815-4500 · www. Wagpointbank. com APPRAISAL Personal Property of ,//~/1,//(,/,,~ /~/~'/~ ~-7'* ~$ ~-~ ~ Appraised by Chuck E. Bricker AU094-L Date / ITEM VALUE ITEM VALUE i i REV-1510 EX+ (1-97) SCHEDULE G INTER-VIVOS TRI~JqSFERS & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN MISC. NON-PROBATE PROPER'D~ RESIDENT DECEDENT ESTATE OF Anna E. Neibert SS# 183-10-3285 10/17/2003 FILE NUMBER 21-03-0920 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. DESCRIPTION OF PROPERTY % OF ITEM INCLUDETHE NAMEOFTHETRANSFERE~THEIR DATE OF DEATH i DECD'S EXCLUSION TAXABLE VALUE RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. NUMBER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET i INTEREST (IF APPLICAB~) 1 American Intl Group Inc 54,143.85 100% ' 54,143.85 Policy No. BX202908, Single Premium Deferred Annuity, payable on death in equal shares to Decedent's children: Lois E. Witmer, Doris L. Murphy and Daryl E. Neibert. 2 American Express Financial 18,864.86 100% 18,864.86 Advisors, Inc., Annuity Acct. #01154690940 6 002, payable on death in equal shares to Decedent's children: Lois E. Witmer, Doris L. Murphy and Daryl E. Neibert. ! TOTAL (Also enter on line 7, Recapitulation) $ 73,008.71 (If more space is needed, insert additional sheets of the same s~ze) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1510 EX (Rev. 1-97) Fax Transmission American International Group Annuity 205 E. 10th Amarillo, TX 79101-3546 (800) 424-4990 To- Deb Company: Fax Number: 1-717-795-8479 Voice Phone: From: Leann Fritz Fax Number: 1-806-342-1703 Voice Phone: 1-800-424-4990 CC: , , , Fax Notes' This is to confirm that 10-17-03 value on policy BX202908 for Anna E Neibert was $54,143.85. Thank you for your inquiry, Leann Fritz Date and time of transmission: Monday, March 15, 2004 11:22:44 AM Number of pages including this cover sheet: 01 · A Stock Company Home Office: 205 East 10th Avenue A N N U I TY ~,~uo, Texas 79101-3546 Telephone: 800.424.4990 · SINGLE PREMIUM.DEFERRED ANNUITY POLICY Ame~can General Annuity Insurance Company (referred to in this annuity policy as we") has issued this nolicv in considerataon of your apphcation and single premium payment Interest .... earned ;n your single premiu~ payment will accumulate until annuitization. At that time, on the Annuity Date, raceme payments will be made according to the raceme plan selected Wxthdrawals are subject to a decreasing early w~thdrawal charge for five years after the Policy Date. The with- is e ual to the pe oe ge s own b low of the amount of prelim with awn. See Withdrawals, beginning on. page 5, for additional information. . . ' President Read your policy carefully. This annuity policy is a legal contract between you and American General Annuity Insurance Company. RIGHT TO CANCEL: If, after reading the policy you are not satisfied for any reason, you may return the policy to us or any agent authorized by us within 10 days after receiving it We will refUnd any preminm~ prod w~thm 10 days of our receipt of notification and the policy will then be void. Monthly ~ncome at normal retirement (a~o ~$), paid for lifo with ~0 year period certain w be a representative single premium of $~0,000:00. This is based on tho ~uaranteed cash Yaluos, assumin~ no v~thdrawals and that the §uaranteed ntorest rate of $ 0% is paid · . . A78-gS-PA Page 1 GENERAL ANNUITY American General Annuity Insurance Company A Stock Company Home Office: 205 East [0~h Avenue Amarillo, Texas 79101-3546 Telephone: 800.424.4990 SINGLE PREMIUM DEFERRED ANNUITY APPLICATION 3wner All Policyholder :orrespondence viii be sent to his address./ Name: Last First Middle Marital Status Address: Street City State Zip Code Date of Bi~ ' Ag~q~ ~ ~ Da~ime Telephone: Ioint Owner Optional. 4on-Qualified ~nnuities Only. /lust be Spouse ~f Owner.) t, nnuitant If different · om Owner.) )urchase )ayment I Sex J Social Security Number Prima~ Beneficial: . Re at onship: Contingent Beneficial: "i, -' L RelatiOnShip: aoinz owners aD not have dghts or suwivorsn p under this policy. Please list joint owner as p~ima~ benefi~i~, if applica%le. Name: Last ' First Middle Date of Birth t Age Sex Social Security Number [ Daytime Telephone: ( ) Primary Be..neficiary: Relationship: Contingent Beneficiary: Relationship: Joint owners do not have riqhts of survivorship under this policy. Please list other owner as primary beneficiary, if,applicable. Name: Last First Middle Address: Street City State ' Zip Code Primary Beneficiary: Relationship: Contingent Beneficiary: I Relati°nsh!p: Policy Number BX 20 2.9 0 8 Policy Date Single Premium Payment $ ~. ~; .~"7,01 Annuity Date The Company will provide written notice of the Initial Interest Rate with delivery of your policy, is this Annuity intended to replace or be exchanged for existing life insurance or annuities? Yes Y~ No Check one:' Non-Qualified Plan *Tax Qualified Plan * If Tax Qualified Plan or IRA, this section must completed. Check one: __ Traditional IRA** __ SEP __ Roth IRA* __401 Corp Plan __Other **If IRA, please complete: Transfer $. Reliever $. Contribution $. Tax Year $. Tax Year I understand this annuity is not federally insured. On behalf of myself and any person who may claim.any interest under this policy, I represent that all statements set forth are full, complete and true as written and correctly recorded to the best of my knowledge. Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or a statement of claim containing any materially false information or conceals for the purpose of misleading, information concernin~g any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects such person to civil and criminal penalties. CHECKS MUST BE 'MADE PAYABLE TO AMERICAN GENERAL ANNUITY. City )wrier gency Name nd Number on Joint Owner (If applicable) Licensed Agent Signature - v Printed Name ~ ~J Agent # of Licensed Agent ~D~gJ, ~, ~.~ ~ Monthly income at normal retirement (age 65), paid for life with 10 year period certain, will be $143.73 based on a representativesingle premium of $10,000;00. This is based on the guaranteed cash values, assuming no wiihdrawals and that the guaranteed interest rate of 3.0% is paid. DR AGENT: To the best of your knowledge, is this insurance being purchased to replace or change any existing insurance or annuity? yes, give company, amount, year issued and reason. . YES BDA (B)-96-A-PA WHITE- Policyholder Copy YELLOW-Home Office Copy PINK-Agency Copy GOLD-A.~ent Copy' :) . 11/10/2003 05:14 PM To: Laura ] Sandoe/Field/WH/AEFA@AMEX cc: Subject: Client Anna Neibert id# 1537 9284 i 001 IDS LIFE INSURANCE COMPANY AMERICAN EXPRESS FUNDS AMERICAN EXPRESS CERTIFICATE COMPANY AMERICAN EXPRESS BROKERAGE 70i00 AXP Financial Center Minneapolis, MN 55474 November 10, 2003 LAURA JEANNE SAN-DOE FL 1 1105 SHRIVERS CORNER RD GETTYSBURG, PA 17325-8369 Dear LAURA JEANNE SANDOE: Thank you for your recent inquiry regarding ANNA E NEIBERT's accounts. These are the values of the accounts as of 10/17/2003. At the end of this letter, you will fred a list of beneficiaries shown in our initial review of the deceased's accounts. Please provide our office with any contact information you may have, including but not limited to complete names, addresses, telephone numbers and relationships to the deceased for any beneficiary or claimant identified on the deceased's accounts IMPORTANT REMINDER(S): - In accordan.ce with various regulatory agencies, American Express Financial Advisors will continue to mail monthly/quarterly statements for the deceased to the deceased's address of record. The only individual(s) granted authorization to change the address of the deceased and thus, redirect the mailing address of the statements, is the Executor(s) of the Estate of the deceased. - The revised Death Claim Statement Form now includes a default lump sum option for annuities and life insurance in wkich t~e beneficiary will receive a checkbook, w/th immediate access to their funds through Membership Banking, rather than a check. Account Information Mutual Funds Account Number 01154690940 6 002 Ownership Individual - ToD Mutual Funds Account Number Total Value # of shares Asset Value Per Share 01154690940 6 002 $18864.86 4275.052 4.400 The date of death values provided are for estate tax purposes and are not values to be paid. Accounts may be subject to market fluctuation as govemed by each product. Please note that the values indicated for any Life Insurance product(s) reflect the gross death benefit at date of death, not the cash value. Account Disposition Account disposition is based on how an account is owned (the ownership type). The following irdormation will help you understand the process that will be used to settle the accounts. Disposition for Individual - TOD ownership Upon the death of the owner, all accounts registered as individual-transfer on death pass to the named beneficiaries. Although the assets do not become part of the estate for distribution, we understand they should be included for inheritance and/or estate tax purposes. Required Documents In order to take appropriate steps to settle the accounts we will need these documents: Certified Death Certificate The death certificate must be an original document that bears certification from the health department or local registrar and includes the cause of death. Estate Settlement Form (3248F) To process a settlement on a Mutual Fund, Certificate or Brokerage account, we need a completed Estate Settlement Form 3248F fxom each claimant. A separate form should also be included for each ownership type; Sections 1, 2, 4 and 10 must be completed. For instructions on completing this form, please see page 6. Incomplete information would cause delay. An Obituary or Statement listing all children of the decedent Because the beneficiary designation is living lawful children or children per stirpes, we require either an obituary or a statement signed by either the advisor or an adult child, listing all children of the decedent (both l!ving and deceased). Ifa child is deceased, we require a certified copy of his or her death certificate. In addition to this, other requirements may be needed. In order to be compliant with fair claims practices of many states and to limit the potential for the deceased's accounts to become abandoned property, we will also be immediately corresponding with the beneficiaries listed for any Life and Annuity accounts held by the deceased client. Similarly we will be corresponding with the beneficiaries or claimants of all accounts held by the decedent within a minimum of six months of the date of this letter. Please contact us if you wish to see a copy of these correspondences. If you wish to complete settlement this tax year, all requirements must be received by December 15, 2003. We will put forth our best efforts to handle all requests received after this date before year-end, llowever, we cannot guarantee that processing will be completed for the 2003 tax year. If there are IRA assets involved with this claim and the Required Minimum Distribution for 2003 has not yet been fulfilled, p~ease contact our office for instructions. . Additional information about death settlements can be found on Advisor Connect at www.intema~.aexp.c~m/c~nne~t/acd~c~ib.nsf/webpages/Death+Sett~ements?~pend~cument. We appreciate the opportunity to be of service to you. Please contact us if you have any questions. In an effort to improve our process, we invite you to share your feedback with us by sending a Lotus Note to: Settlements Feedback. Sincerely, Kelly Pramanu Death Settlements Processing Team 70310 AXP Financial Center Minneapolis, MN 55474 888-723-8476, option 1, 3, 19339 Attachment: Beneficiary Information Beneficiary Information We have the following beneficiaries on record for the deceased's accounts. Account Number: 01154690940 6 002 Designation: PRIMARY BENEFICIARY LIVING, LAWFUL CHILDREN IN EQUAL SHARES 100.00% ~F A CHILD IS DECEASED, HIS OR HER SHARE TO BE PAID TO HIS OR HER LIVING, LAWFUL CHILDREN IN EQUAL SHARES REV- 1511 EX + {1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Anna E. Neibert SS~/ 183-10-3285 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS 10/17/2003 FILENUMBER 21-03-0920 Debts of decedent must be reported on Schedule I. ITEM NUMBER Bo DESCRIPTION FUNERAL EXPENSES: Myers Funeral Home, Myers Funeral Home, - funeral expense. - inscription on gravemarker. ADMINISTRATIVE COSTS: 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: Attorney's Fees Law Offices-Marlin R. McCaleb Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees Register of Wills Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Chuck E. Bricker, Auctioneer, appraisal of Cumberland Law Journal, advertising Letters Marlin R. McCaleb, Esq.). Mark E. Hilbert, appraisal of real estate. PNC Bank, service charge. PP&L, - electric service to home. PP&L, - electric service to home. Total of Continuation Schedule(s) Zip household contents. (reimbursed to TOTAL {Also enter on line 9, Recapitulation) AMOUNT 7,573.50 95.00 4,500.00 298.00 50.00 75.00 300.00 15.00 45.71 8.79 442.53 13,403.53 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) Estate of: Anna E. Neibert Soc Sec #: 183-10-3285 Date of Death: 10/17/2003 Item Description Continuation of Schedule H-B7 (Other Administrative Costs) Amount 7 8 9 10 Register of Wills, filing Inventory and Appraisement. Reserve for filing Account, Releases, etc. The Patriot-News advertising Letters Testamentary. UGI, - gas service to home. 28.00 250.00 153.25 11.28 442.53 REV- 151Z EX + (1-97) SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Anna E. Neibert SS~/ 183-10-3285 10/17/2003 21-03-0920 Include unreimbursed medical exl~enses. ITEM NUMBER DESCRIPTION AMOUNT AT&T, account payable, telephone. Comcast Cablevision, - account payable, cable TV. Country Meadows West Shore, - account payable, room, services. PP&L, - account payable, electric service. UGI Utilities, Inc., account payable, gas service. Verizon, account payable, telephone service. Verizon, account payable, telephone. board andl TOTAL (Also enter on line 10, Recapitulatipn) 5.06 23.00 975.00 17.38 23.26 67.79 15.65 $ 1,127.14 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) REV- 1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA iNHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Anna E. Neibert SS# 183-10-3285 NUMBER 2 3 SCHEDULE J BENEFICIARIES 10/17/2003 I1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec, 9116(a)(1.Z)] Lois E. Witmer 630 E. Siddonsburg Rd. Mechanicsburg, PA 17055 Doris L. Murphy 109 Orchard Street Mechanicsburg, PA 17055 Daryl E. Neibert 610 Southview Drive Mechanicsburg, PA 17055 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter Daughter S on FILE NUMBER 21-03-0920 AMOUNT OR SHARE OF ESTATE One-Third (1/3) One-Third (1/3) One-Third (1/3) 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) Z000 form software only The Lackner Group, Inc. I Form REV-1513 EX (Rev. 9-00) B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, QN REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: / A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE Register of Wills of CUMBERLAND INVENTORY County, Pennsylvania Estate of Anna E. Neibert also known as No. 21-03-0~20 , Deceased Date of Death , 10/17/2003 Social Security Noi 183 - 10- 3285 Lois E. Witmer and Doris L. Murphy, 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 Decedeni, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, amd tl~at Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the bnd of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false Statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: Marlin R. McCaleb Esq. I.D. No.: 06353 Address: 219 East Main Street Telephone: Mechanicsburs, PA 17055 717/691-7700 Personal Representative Signature: ~_ ~ ~~~_. Lois E. Witmer~ Signature: Doris L. Murphy Address: 630 E. Siddonsbu~ Road Mechanicsbur~, P~ 17055 Telephone: 717/766~2171 Description (See continuation page(s) attached) (Attach additional sheets if necessary) Value Total: 234,906.85 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the per[sonal representative,. -- include the value of each item, but such figures shou!d not be extended into the total of the Inventory. Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, {nc. Form #RW-7 (1992) Estate of: Date of Death: County: Anna E. Neibert 10/17/2003 Cumberland INVENTORY CASH: Certificate of Deposit #1853257556, Waypoint Bank - Principal balance as of D.O.D.: $47,280.34; Interest accrued to D.O.D.: $30.88. Certificate of Deposit #1856257613, Waypoint Bank - Principal balance as of D.O.D.: $22,819.85; Interest accrued to D.O.D.: $10.40. Checking Acct. #50006683, Waypoint Bank. Principal balance as of D.O.D.: $55,846.88; Interest accrued to D.O.D.: $3.41. PERSONAL PROPERTY: Highmark Blue Shield, medical reimbursement. Highmark Blue Shield - refund of Blue Shield premium. Household goods, contents, furniture and furnishings. PA Department of Revenue, 2003 personal income tax refund. 47,311.22 22,830.25 55,850.29 96.97 86.35 620.00 75.00 125,991.76 -1- The Patriot-News, refund of newspaper subscription. UGI, refund. 25.20 11.57 REAL ESTATE/PA: House and lot, - known and numbered as 39 West Coover Street, Mechanicsburg, PA, acquired by Decedent and spouse, Harold R. Neibert, by deed dated 02/08/1985, recorded in Cumberland County Deed Book "C", Volume 31, Page 646 (Harold R. Neibert died 108,000.00 TOTAL RECEIPTS OF PRINCIPAL ............... 915.09 108,000.00 234,906.85 -2- FAMILY SETTLEMENT AGREEMENT, RECEIPT AND RELEASE :, WHEREAS, ANNA E. NEIBERT, late of Hampden Township, Cumberland County, Pennsylvania, died on October 17 2003 having first made her Last Will and Testament in writing dated August 31, 1990, which since her decease was duly probated before the Register of Wills of said Cumberland County and Letters Testamentary issued to LOIS E. WITHER, DORIS L. MURPHY and DARYL E. Testament of WHEREAS, NEIBERT, are said decedent and NEIBERT, said decedent; and LOIS E. WITHER, DORIS L. lineal descendants, heirs and the only persons the Executors named in the Last Will and MURPHY and DARYL E. and next of kin of the interested in her Estate; NOW KNOW ALL MEN BY THESE PRESENTS, the we, LOIS E. WITMER, DORIS L. MURPHY and DARYL E. NEIBERT, being the beneficiaries sharing in the distribution of the Estate of said decedent, do hereby declare and say that we have examined the Account and Schedule of Distribution of LOIS E. WITHER, DORIS L. MURPHY and DARYL E. NEIBERT, Executors as aforesaid, for the period ending September 23, 2004, and find the same to be accurate and according to law, and we, LOIS E. WITHER, DORIS L. MURPHY and DARYL E. NEIBERT, distributees as aforesaid, do hereby acknowledge that we, this day have, had and received of and from LOIS E. WITHER, DORIS L. MURPHY and DARYL E. NEIBERT, the Executors of the Estate of ANNA E. NEIBERT, the cash or property set opposite our names in the above stated Schedule of Distribution, in full satisfaction, payment and discharge ef all claims we, er any of us, have er may have against each ether er against the Estate of ANNA E. NEIBERT, Deceased, and all interest accrued thereon. NOW, THEREFORE, we the same LOIS E. WITHER, DORIS L. HURPHY and DARYL E. NEIBERT, distributees as aforesaid, do by these presents, remise, release, quit-claim and forever discharge each ether and the said LOIS E. WITHER, DORIS L. HURPHY and DARYL E. NEIBERT, Executors, their heirs, executors and administrators, ef and from our distributive shares of the Estate as set forth in the Schedule ef Proposed Distribution aforesaid, and of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for er by reason thereof, er under the said decedent's Will, or by contract, or under the intestate law of the Commonwealth ef Pennsylvania, or by reason ef any other act, matter, cause or thing whatsoever, from the beginning of the world te the daF and date of these presents, except for any obligations arising under this FamilF Settlement Agreement, Receipt and Release or under the Schedule of Distribution. AND desiring to avoid the delay and expense ef the settlement ef said Estate by filing the foregoing Account of said administration in the Office ef the Register of Wills ef -2 said County and by having the balance in the hands of the Executor, as shown by said Account, distributed by the Court of Common Pleas of Cumberland County - Orphans' Court Division, we do hereby agree that the within Family Settlement Agreement, Receipt and Release concerning the matter of settlement may be recorded with the same effect upon us as if the same had been reported upon by said Court, and a decree of distribution made on such report by the said Court of Common Pleas - Orphans' Court Division. AND in consideration of the aforesaid settlement being made without the aid of such Court of Common Pleas Orphans' Court Division, that we, LOIS E. WITMER, DORIS L. MURPHY and DARYL E. NEIBERT, distributees as aforesaid, do hereby agree that if any debts or demands other than those included in the aforesaid Account of the said LOIS E. WITMER, DORIS L. MURPHY and DARYL L. NEIBERT, the Executors of the Estate of ANNA E. NEIBERT, Deceased, shall be hereafter recovered against the Estate of said decedent and be legally payable out of the same, that we will return to the said Executors such amount thereof as may be necessary to pay such debts or demands. The signature page or pages may be executed by the parties hereto in several counterparts (one by each signatory hereto), each of which is an original and all of which taken together shall be deemed and considered as part of the original document -3- herein. IN WITNESS WHEREOF, seals this 28th day of September, 2004. Lois E. Witmer Dary~' 'E. ~e~'bert~ we have hereunto set our hands and __ (SEAL) (SEAL) __ (SEAL) STATE OF PENNSYLVANIA) COUNTY OF CUMBERLAND) SS On this, the 28th day of September, 2004, before me, a Notary Public in and for said State and County, the undersigned officer, personally appeared LOIS E. WITMER, DORIS L. MURPHY, and DARYL E. NEIBERT, known to me (or satisfactorily proven) to be the persons whose names are subscribed to the within mnstrument and acknowledged that they executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. SEAL) Notary Public My commission expires: adin R McCaleb, Notary Public Mechanicsburg Bona, Cumberland County My Commission Expires Dec. 14 2006 IN RE: ESTATE OF ANNA E. NEIBERT, DECEASED LATE OF HAMPDEN TOWNSHIP, CUMBERLAND COUNTY, PENNSYLVANIA : IN THE COURT OF COHHON PLEAS OF : CUHBERLAND COUNTY, PENNSYLVANIA : : ORPHANS COURT DIVISION : ESTATE NO. 21-03 0920 Testament 2. Register November 6, E Neibert, said Nill. ~ETITION FOR DECREE AWARDING REAL ESTATE T©~THE HONORABLE, THE JUDGES OF SAID COURT: ~ The Petition of Lois E. Witmer, Doris L. Murphy and Daryl Ei_~Neibert, Executors under the Last will and Testament of Anna E Neibert, deceased, by and through their attorney, Harlin R. HcCaleb, Esquire, respectfully represents as follows: 1. The decedent herein was Anna E. Neibert, who died on October 17, 2003, a resident of Hampden Township, Cumberland County, Pennsylvania, having first made her Last Will and dated August 31, 1990· Letters Testamentary herein were issued by the of wills of Cumberland County, Pennsylvania on Doris L. Murphy and Daryl 2003, to Lois E. Witmer, the Petitioners herein, pursuant to Item LASTLY of 3. The assets of the decedent's estate include certain real estate known and numbered as 39 West Coover Street, Borough of Mechanicsburg, Cumberland County, Pennsylvania· 4. Your Petitioners have prepared and filed a Pennsylvania Inheritance Tax return and have paid the ?ennsylvania Inheritance Tax in full as evidenced by the Notice dated September 6, 2004, attached hereto and made a part hereof, marked Exhibit "A." This Estate is not of sufficient size as to incur any liability for federal estate tax. 5. Ail debts and obligations of the decedent have been paid in full and there are no unpaid creditors of the Estate. 6. Your Petitioners have stated their First and Final Account and Statement of Proposed Distribution, in which they propose to distribute the residue of real estate described in Paragraph 3, Doris L. Murphy and Daryl E. Neibert, said Estate, including the above, to Lois E. Witmer, decedent's children and next of kin and the residuary beneficiaries described in Item 2 of said Will. Your Petitioners propose to distribute the said real estate in kind to the said residuary beneficiaries. 7. Lois E. Witmer, Doris L. Murphy and Daryl E. Neibert, residuary beneficiaries as aforesaid, have accepted said Account and Proposed Distribution by way of a Family Settlement Agreement executed by them on September 28, 2004, and thereafter filed with the said Register of wills. 8. There are no persons interested in this Estate who have not joined in the aforesaid Family Settlement Agreement. 9. Your Petitioners desire to avoid the time and expense of a formal accounting that is unnecessary because of the foregoing facts and circumstances. WHEREFORE, your Petitioners respectfully request your Honorable Court to issue a Decree Awarding Real Estate transferring decedent's real estate in kind to Lois E. Witmer, Doris L. Murphy and Daryl E. Neibert, residuary beneficiaries, without the filing of a First and Final Account and confirmation of same. Date: September 28, 2004 Marlin R. McCaleb, Esquire Attorney for Petitioners COMMONWEALTH OF PENNSYLVANIA) COUNTY OF CUMBERLAND) LOIS E. WITMER, DORIS L. SS. MURPHY and DARYL E. NEIBERT, being duly sworn according to law, depose and say: that they are the Petitioners in the foregoing Petition for Decree Awarding Real Estate; and that the facts set forth therein are true and correct to the best of their knowledge, information and belief. Lois E. Witmer Do~is L. Murphy DataVUE. Nefbert Sworn to and subscribed before me this ~'~ day of · 2004. / -'"-'~ Not~fial Seal Martin R. M~:;Oaleb, Notap/Public Mechanicsburg Boro, Cumberland Counb/ My Commission Expires Dec 14.200~ -3 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX MARLIN R MCCALEB ESQ M R HCCALEB LAW OFCS PO BOX 230 MECNANICSBURG PA 17055 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 09-06-200q NEIBERT ANNA 10-17-2003 21 03-0920 CUMBERLAND 101 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: RESISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~.~ RETAIN LOWER PORTION FOR YOUR RECORDS ~'~ REV-1547 EX AFP ¢01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF NEIBERT ANNA E FILE NO. 21 03-0920 ACH 101 DATE 09-06-200q TAX RETURN WAS: [ X ) ACCEPTED AS FILED { ) CHANGED RESERVATION CONCERNINS FUTURE INTEREST ' SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 5. Closely Held Stock/Partnership Interest (Schedule C) q. Mortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/M/sc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. TransFers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm, Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage L/abil/ties/Lfens (Schedule I) 11. Total Deduct/ohs 12. Net Value oF Tax Return il) 108~000.00 (2) .00 cs) . O0 (q) .00 (5) 126 ~906.85 (6) . O0 {7) 73~008.71 (8) NOTE: To insure proper credft to your account, submit the upper port/on oF th/s form w~th your tax payment. 15. lq. NOTE~ 307,915.56 13,q03.53 [lO) 1. 127. lq [11) IG .5~0.67 (121 293,38fi.89 .00 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. AMOUNT PAID ll,O00.O0 1,623.37 ASSESSMENT OF TAX: 1~, Amount of Line lq at Spousal rate 16. Aaount oF Line lq taxable at Lineal/Class A rate 17. Amount oF L/ne lq at Sibling rate 18. Amount of Line lq taxable at Collateral/Class B rate 19. Pr/ncipal Tax Due TAX CREDITS: DATE NUMBER INTEREST/PEN PAID (-) 01-07-200q CDQO3q18 578.95 07-09-200fi CDOU41~5 .00 TOTAL TAX CREDIT I BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE 13,202.32 .00 .00 .00 TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE REFUND. SEE REVERSE STDE OF THTS FORM FOR INSTRUCTIONS.) .00 x O0 .00 (lb) 293,38q.89 x OqS: 13,202.32 (17). .OO X 12 .00 (18). .00 x 15 .00 (19)= 13,Z02.32 re~lect ~igures that Lnclude the totaZ 0~ ALL returns assesseB to Bate. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (15) Net Value oF Estate Subject to Tax (lq) 293,38q.89 ~f an assessment Nas issued previous{y, [~nes [4, 15 and/er 16, 17, 18 and [9 ~i1! RESERVATION: Estates of decedents dying on or before December 1Z) 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years) the Commoneealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawfu! Class 8 (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section Zl~O of the Inheritance and Estate Tax Act) Act Z3 of ZOO0. (7Z P.S. Section 91~0). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax credit~ which was not requested on the Tax Return, amy be requested by cowpletin9 an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications ars available at the Office of the Register of Hills, any of the Z3 Revenue District Offices, or by calling the special Z~-hour answering service for fores ordering: 1-800-36Z-ZOSO~ services for taxpayers with special hearing and / ar speaking needs: 1-800-qq7-30ZO (TT only). Any party in interest not satisfied aith the appraisement) allowance) or disalloaance of deductions) or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to ~he PA Depart~ent of Revenue, Board of Appeals, Dept. Z81021, Harrisburg) PA 171ZS-10Z1, OR --election to have the matter determined at audit of the account of the personal representative) OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue) Bureau of Individual Taxes) ATTN: Post Assessment Review Unit) Dept. 280601) Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is allowed. The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed) and not paid before January 18, 1996) the first day after the end of the tax amnesty period. Th~s non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning aith first day of delinquency) or nine (9) months and one (1) day from the date of death) to the date of payment. Taxes which became delinquent before January 1) 1982 bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .00016fi. All taxes which became delinquent on and after January 1) 198Z mill bear interest at a rate which will vary free calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOq are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 ZOZ .O005qB ~)'~'8-1991 11Z .000301 ~ 9Z .O00gq? 1983 162 .000~38 1992 92 .O00Z~7 ZOOZ 6Z .00016~ 198~ 112 ,000301 1993-199q 72 .O0019Z 2003 52 .000137 1985 132 .000~56 1995-1998 9Z .O00Z~7 ZOOq ~Z .000110 1986 102 .00027q 1999 72 .O0019Z 1987 lOX .O0027~ 2000 72 .O0019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date sheen on the Notice, additional interest must be calculated. BUREAU OF ZND/VZDUAL TAXES INHERTTAHCE TAX DTVTSTON DEPT. Z80601 HARRISBURG, PA 17128-0601 COHMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-IS47 EX AFP (01-05) MARLIN R MCCALEB ESQ M R MCCALEB LAN OFCS PO BOX Z30 MECHANICSBURG PA 17055 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 09-06-2004 NEIBERT ANNA 10-17-2005 21 03-0920 CUH~-'~R_~LAND ~ I lmo~ 'Remi{{ed MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO*' COURT ~OUSE CARLISLE, PA-: 17013 .. <'~: : CUT ALONG THIS LINE ~'~ RETAIN LOWER PORTION FOR YOUR RECORDS REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF NEIBERT ANNA E FILE NO. 21 03-0920 ACN 101 DATE 09'06-2004 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) $. Closely Held Stock/Partnership Interest (Schedule C) ($) ~. Hortgagas/No~as Raca/vabla (Schedule D) (q) 5. Cash/Bank Daposits/N/sc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) ~ (7) 8. Tote1 Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9 Funeral Expansas/Adm. Costs~Misc. Expanses (Schedule H) (9) 10 Dab,s/Mortgage L/ab/1/t/as/Liens (Schedule Z) 11 Total Daduct/ons 12 Net Value of Tax Return 108z000.00 O0 O0 O0 126~906.85 O0 731008.71 (8) 13,403.53 NOTE: To insure proper credit to your account, submit the upper port/on of this form w/~h your tax payment. 13 NOTE: 307,915.56 (lo) la127.14 (11) 14.5~0.67 (ia) 293,384.89 Charitable/governeenta! Bequests; Non-elected 9115 Trusts (Schedule J) (15) Nat Value of Estate Subject to Tax If an assessment ~as issued previously, lines 14, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of L/ne lq et Spousal re~a 16. Amount of L/ne lq taxable et Lineal/Class A rate 17. Amount of L/ne 1~ at Sibling rate 18. Amount of L/ne 1~ taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS PAYHENT RECEZPT DZ$COUNT DATE NUNBER INTEREST/PEN PAID 01-07-2004 CD005418 578.95 07-09-2004 CD004145 .00 .00 293,384.89 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 18 and 19 will (is) .00 x O0 = .00 (16). Z93,384.89 x 045 = 13,ZOZ.3Z (17). .00 x 12 = . O0 (lB) .oo x 15 = .oo (19)= 13,202.32 AMOUNT PAID 11,000.00 1,623.37 TOTAL TAX CREDIT I 13,202.32 BALANCE OF TAX DUEI .00 INTEREST AND PEN. .00 TOTAL DUE .00 ( IF TOTAL DUE 1S LESS THAN $1, NO PAYNENT 1S REg)UZRED. IF TOTAL DUE 1S REFLECTED AS A 'CREDIT" (CR), YOU NAY BE DUE;,-~ A REFUND. SEE REVERSE SZDE OF THIS FORN FOR ZNSTRUCTIONS. Register of Wi Us of Cumberland County STATUS REPORT lJNDER RULE 6.12 Name of Decedent: Anna E. Neibert Date of Death: October 17, 2003 Estate No.: 21-03-0920 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 [X No 0 2. lfthe 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: a. Did the personal representative file a final account with the Court? Yes 0 No iii. 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 0 c. Copies of receipts, releases, joinders and approval of fonnal or informal accounts may be filed with the Cler!>: of the Orphans' Court and may be attached to this report // _ . n /)~ A /i7 09/26/05 ~~ Date: Signature Marlin R. McCaleb Name 219 East Main Street Mechanicsburg, PA 17055 Address 717/691-7770 Telephone No. 8S:j :\l 8:sd:: Capacity: 0 Personal Representative ug Counsel for personal representative \...-~ RESERVATION: PURPOSE OF ROT[CE: PAYNENT: REFUND (CR): OBJECTIONS: ADH/N- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 196Z -- if any futura interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, ~ha Comaonmealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act Z3 of lOgO. (7Z P.S. Sect[on 9140). Detach the top portion of this Notice and submit aith your payment to the Register of Hills printed an the reverse side. --Hake check or money order payable tot REGISTER OF HILLS, AGENT A refund of a tax credit, which ems not requested on the Tax Return, may ba requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office of tho Register of Hills, any of the Z3 Revenue District Offices, or by calling the special Z0`-hour answering service for forms ordering: 1-800-36Z-ZOSO; services for taxpayers aith special hearing and / or speaking needs: 1-800-0`0`7-3020 (TT only). Any party in interest not satisfied eith the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount er interest) as shown on this Notice must object aithin sixty (60) days of receipt of this Rotica by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. Z81021, Harrisburg, PA iT1ZB-IOZ1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in mriting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Raviem Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax duo is paid within three (3) calendar months after the decedant's death, a five percent (BI) discount of the tax paid is alloeed. The 1SI tax amnesty non-participation penalty is computed an the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. Th~s non-participation penalty is appealable in the sase manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January l, 198Z bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000160`. All taxes which became delinquent on and after January 1, 198Z will bear interest at a rate which mill vary fram calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2000` are: Interest Daily Interest Daily Year Rate Factor Year Rate Factor ~ lOX .OOOSq8 ~)"~'~ - 1991 IiX .OOO$Ol 1983 16Z ,0000`38 199Z 97. . oo 020`7 1950` IIX .000301 1993-1990` 7Z .000192 1985 13Z .000556 1995-1998 97. .00020`7 1986 IOZ .00027o, 1999 7Z . O0019Z 1987 IOZ .OOOZ70` lOgO 7Z .O0019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID Interest Daily Year Rate Factor ~'~ 9Z .000Z0`7 ZOOZ 6Z .000164 2003 5Z .000137 ZOO0` 0`Z .O00llO X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must bo calculated. Tax Parcel No.: 16-24-0787-075 IN THE COURT OF COHHON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA IN RE: ESTATE OF ANNA E. NEIBERT, DECEASED LATE OF HAMPDEN TOWNSHIP, CUHBERL/kND ORPHANS COURT DIVISION COUNTY, PENNSYJ~VANIA ESTATE NO. 21-03-0920 AND NOW, this ~ ~\ day of 2004, it appearing that Lois E. Witmer, Doris L. Hurphy and Daryl E. Neibert, Executors of the Estate and under the Last Will and Testament ef Anna E. Neibert, Deceased, have stated their First and Final Account of their administration ef said Estate and Proposed Distribution thereof to Lois E. Witmer, Doris L. Hurphy and Daryl E. Neibert, being all ef the decedent's children and all of her residuary beneficiaries under her said Will; and it further appearing that the said Lois E. Witmer, Doris L. Hurphy and Daryl E. Neibert, decedent's children and residuary beneficiaries as aforesaid, have accepted said First and Final Account and Proposed Distribution as evidenced by their Family Settlement Agreement, executed by them en September 28, 2004, and filed with the Register ef Wills of Cumberland County, Pennsylvania; and it further appearing that all specific bequests as set forth in Item 2 ef decedent's Will have been properly distributed to, and receipt 2hereof has been acknowledged by, the specific legatees named therein; and it further appearing that all taxes and creditors of the Estate have been paid in full; and it further appearing that the said Lois E. Witmer, Doris L. Hurphy and Daryl E. Neibert are the only persons interested in the Estate of the Decedent herein; and it further appearing that the said Executors propose to distribute certain real estate in kind to the said residuary beneficiaries and desire to avoid the time and expense of a formal accounting; and it further appearing that there are no other persons interested in the Estate, so that a formal accounting is not required and is not necessary for the protection of persons interested in the Estate, IT IS ORDERED, ADJUDGED AND DECREED that all the right, title and interest of the said Anna E. Neibert, Deceased, in and to: ALL THAT CERTAIN lot of ground situate on the South side of West Coover Street, in the Borough of Mechanicsburg, Cumberland County, State of Pennsylvania, bounded and described as follows, to wit: BEGINNING on the building line of said Coover Street and at corner of lot formerly of Robert Armstrong; now of Ralph Paulus, Jr.; thence along the building line of said Coover Street Eastward fifty-eight (58) feet to a point at corner of lot formerly of S. C. Oswald now of Carl M. Pittenturf; thence along the line of said lot of Carl M. Pittenturf Southward one hundred forty (140) feet, more or less, to the line of a twenty-feet wide Alley; thence along the line of said Alley Westward fifty-eight (58) feet to line of lot of Ralph Paulus, Jr. aforesaid; thence along the line of said lot of Ralph Paulus, Jr. Northward one hundred forty (140) feet, more or less, to the buildzng line of said Coover Street, the Place of BEGINNING; HAVING thereon erected a two and one-half story frame dwelling house numbered 39 West Coover Street, also frame garage; BEING the same premises which Harold R. Neibert and Anna E. Neibert, his wife, by choir deed dated February 8, 1985, and recorded in the Office of the Recorder of Deeds, Cumberland County, Pennsylvania in Deed Book "C", Volume -2 31, Page 646, granted and conveyed unto Harold R. Neibert and Anna E. Neibert, his wife, as tenants by the entireties. The said Harold R. Neibert died on April 28, 1987, survived by his wife, the said Anna E. Neibert, the decedent herein, in whom =itle to the same vested absolutely and in fee simple as the surviving tenant by the entireties; is hereby awarded unto Lois E. Witmer, Doris L. Murphy and Daryl E. Neibert, as tenants in common, pursuant to Item 2 of said Last Will and Testament. IT IS FURTHER ORDERED AND DIRECTED that a certified copy of this Decree be recorded in the Office of the Recorder of Deeds in and for Cumberland County, Pennsylvania, among the deeds recorded in said Office, said Decree to be indexed in the Grantor Index against ANNA E. NEIBERT and in the Grantee Index to LOIS E. WITMER, DORIS L. MURPHY and DARYL E. NEIBERT, pursuant to Section 3536 of the Probate, Estates and Fiduciaries Code (20 Pa. C.S.A. 3536) . BY THE COURT, Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (71 7) 240 - 6345 Date: 9/15/2005 MCCALEB MARLIN R 219 E MAIN STREET MECHANICSBURG, PA 17055 RE: Estate of NEIBERT ANNA E File Number: 2003-00920 Dear Sir/Madam: It has corne 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.1, for decedents dying an 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: 10/17/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, '~~hMJ,A::,,t..,,.j ., . ~~ --' GLENDA FAP~ER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge l... \:,.