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Home My WebLink About03-0743Estate of Irene M. Larson Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS ?d3 also known as Margaret Irene Larson , Deceased Social Security No. 191-44-1860 Petitioner(s). who is/are 18 years of age or older, apply(ies) for: (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/are the executor named in the Last Will of the Decedent, dated February 17, 1997 and codicil(s) dated N/A Shirley L. Hu.qhesl the Other Co-Executor named in the Will, has executed a Renunciation of her right to serve as a Co-Executor State relevant circums ances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decedent was a widow B. Grant of Letters of Administration (d.b.n.c.t.a.: pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationship Residence I (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland Bethany Village, 325 Wesley Drive, Lower Allen Township, Mechanicsburg, PA 17055 (list street, number and municil~ality) Decedent, then 96 years of age, died September 4 ,20 03 , at Bethany Village Decedent 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 ........................................................... $ Total ........................................................................... $ Real Estate situated as follows: County, Pennsylvania, with his/her last family or principal residence at (Location) 500,000 None 500,000 Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Carlton E. Hughes 50 South Terrace Wormleysburg, PA 17043-1125 Form RW-1 Page I of 2 (Dauphin County)- Rev. 9/92 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. · Sworn to and affirmed and subscribed ~~,-~t~ L~Carlton E before me this ~*r.~ day of September 20 03 No. Estate of Irene M. Larson, a/k/a Margaret Irene Larson Deceased Social Security No: 191-44-1860 Date of Death: September 4, 2003 AND NOW, September ~[') ,20 03 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ¢3: Testamentary [] of Administration are hereby granted to Carlton E. Hughes, Executor d.b.n.c.t.; per~ente lite; durante absentia; durante minodtate in the above estate and that the instrument(s) dated February 17, 1997 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........................... ~ Short Certificate(s) .......... $ ,..~0. OO Renunciation .................. $ Affidavit ( ) ................. $ Extra Pages (,.~) ............ $ O~. OO Codicil ..........................$ JCP Fee ........................ $ I0, oct, Inventory ....................... $ Other ............................$ TOTAL ................ $~ mo,~.~t. ,~ ~ --q-:r~--o3 -- ' ~%~.~ Register of Wills 0~ Attorney: I.D. No: Keefer Wood Allen & Rahal, LLP Robert R. Church, Esq. 40385 Address: P.O. Box 11963 Harrisburq, PA 17108-1963 Telephone: (717) 255-8059 Form RW-1 Page 2 of 2 (Dauphin County). Rev. 9/92 Register of Wills of Cumberland County, RENUNCIATION Estate of Irene M. Larson also known as Marqaret Irene Larson , Deceased Pennsylvania The undersigned, Shirley L. Huqhest daughter and a named Co-Executor (Relationship) (Capacity) the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters be issued to Carlton E. Huqhest as Executor Witness my hand this Shirley L. Hughes//' ' /' 50 South Terrace, Wormleysbur.q, PA 17043-1125 ,~.l,j dayof September, 2003. (Signature) (Address) (Signature) (Address) (Signature) of Sworn to or affirmed and subscribed before me this ;~-'"/"~ ,d~y of Nota. My Come, ion Expiros: {Signature a~l of No~ or o~er o~1 NOTE: (Address) Renunciations executed outside the Office of Register of Wills are required in some counties to be notarized. 105.805 REV 9/86 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 ~ 9 5 0 7 3 1 6 SEP 0 6 Z003 No. Local Registrar Date Rev 2/87 COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH · Irene M. ta~on '- ~le '- 191 -- 44 -- 1860 "~pt~r 4. 2003 : : 7-23-07 ~~, PA ~'--'~ ~,.~ ~ ~U ~ "~ ~s~ ~. ~rl~d ~ ~1~ . ~th~y ViSage ~ ...... ,~.~ .... I,. ~ite ~CE~'S ~ A~SS (~. C~. Sm~. Z~ C~ ~CE~NT'S 325 ~sley ~c~icsb~g. PA 17055 ~.,~,~ ~O~T'S ~ ~,~,~ ~e. ~ ~o~n INFOR~T'S ~. Shlrlev Huo~s ~. ~u ~. 'z~a~, ~ys~, PA 17043 ,~.~:,__s ~,~ 9-9-03 '~' r,ME~OEmH IDAT~R~CED ~ (~. Day. Y~) '"~'~'"""~ ... ' ................................................................................. 0 LAST WILL AND TESTAMENT OF IRENE M. LARSON a/k/a MARGARET IRENE LARSON I, IRENE M. LARSON, also known as MARGARET IRENE LARSON, of 325 Wesley Drive, Mechanicsburg, Cumberland County, Pennsylvania, do hereby make this my Last Will and Testament, revoking any former Wills and Codicils made by me. FIRST: I direct that the expenses of my last illness and funeral be paid from my estate as soon as convenient after my death. SECOND: I give my tangible personal Property, together with any policies of insurance that I may be carrying on said tangible personal property, to my daughters who survive me, share and share alike, with complete confidence that my daughters who survive me will carry out any written instructions that I may leave with regard to said tangible personal property. THIRD: I give the rest and residue of my estate to my daughters, share and share alike, with the issue of a deceased daughter to take her share, per stirpes. FOURTH: I appoint Carlton E. Hughes and Shirley L. Hughes as my Co-Executors. If either is unable or unwilling to serve, the other shall serve alone. If they are unable or unwilling to serve, I appoint Carlyn H. Chulick as my Executrix. If she is unable or unwilling to serve, I appoint CoreStates Bank, N.A., as my Executor. I direct that my Co-Executors, Executor or Execu- trix serve without bond in any jurisdiction in which called upon to act. FIFTH: If any beneficiary under this Last Will and Testa- ment is under thirty (30) years of age, I direct that his or her interest be held in trust by CoreStates Bank, N.A., hereinafter called Trustee, until such beneficiary reaches thirty (30) years of age. My Trustee shall apply such amounts of income and principal as it, in its sole discretion, deems proper for the support, education and welfare of such beneficiary, and may accumulate any unexpended balance of income to the extent permit- ted by law. Such amounts may be applied directly or may be paid to the beneficiary or to the person with whom such beneficiary resides or who has the care and control of such beneficiary, without the intervention of a guardian. My Trustee shall not be obliged to supervise or inquire into the application of such amounts by such person, and the receipt of such person shall be a complete release of my Trustee. Should the share of a beneficia- ry, in the sole opinion of my Trustee, be or become too small to warrant continuing such fund in trust, or should its administra- tion be or become impractical for any other reason, my Trustee, in its sole discretion, may pay such share, absolutely, to the beneficiary, or may deposit such share in the beneficiary,s name in a savings account in a savings institution of its choosing, payable to the beneficiary at majority, which I define as twenty- one (21) years. SIXTH: I give to any Executor or Executors and to any Trustee or Trustees named in this Will or any Codicil hereto all of the powers now applicable by law to fiduciaries in the -2- Commonwealth of Pennsylvania and in particular, through the Probate, Estates and Fiduciaries Code, as effective and as in effect on the date hereof, during the administration and until the completion of the distribution of my estate, and until the termination of all trusts created hereunder and until the comple- tion of the distribution of the assets of such trusts, including the power to hold and to invest in any corporate fiduciary's stock, notes, certificates of deposit, and common funds, and the power to register securities in the name of a nominee. I specif- ically authorize my Trustee to arrange for transfer of a beneficiary's trust account to a substantially similar trust for the benefit of said beneficiary, such as a Crummey-type trust. NINTH: The word "issue" whenever used in this Last Will and Testament shall include adopted children. IN WITNESS WHEREOF, I have set my hand and seal on this my Last Will and Testament this ~74~'day of ~~ IRENE M. LARSON SIGNED, SEALED, PUBLISHED, and DECLARED by IRENE M. LARSON, as and for her Last Will and Testament, on the day and year last above written, in the presence of us, who, at her request, in her presence, and in the presence of each other, all being present at the same time, have hereunto subscribed our names as witnesses: -3- SELF-PROVING AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF : WE, IRENE M. LARSON, a/k/a MARGARET IRENE LARSON, and and ,A/'~A/qX ,~.' kl/~L.~'~ , the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly (or willingly directed another to sign for her), and that she execut- ed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and to the best of his or her knowledge the Testatrix was at that time eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence. Witness MARY A McCL',,r'it i'q ....... · ,8~atara .Township Dauphin County ,u~¥ uornrn~ss on expires Dec. 18, 2000 Subscribed, sworn to, and acknowledged before me by IRENE M. LARSON, a/k/a MARGARET IRENE LARSON, the Testatrix, and sub- scribed and sworn to before me by-~lclA ~. ~,~e.~ , ~d~c~ 5,'-'~.,~%!~- , and , , wit- nesses, this i ~ ~% day of ~be~L~ , 299~. Nota~ ~ubilc -4- ~ LAST WILL AND TESTAMENT OF IRENE M. LARSON a/k/a MARGARET IRENE LARSON KEEFER, WOOD, ALLEN & RAHAL 210 WALNUT STREET MAILING ADDRESS- P.O. BOX 11963 HARRISBURG. Pa. 17108-1963 Heath L. Allen CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Irene M. Larson, a/k/a Margaret Irene Larson Date of Death: September 4, 2003 Admin. No.: 21-03-0743 To the Register: I certify that notice of estate administration required by Rule 5.6 of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on September 15, 2003: Ilene L. Badke, 12795 Sundance Lane, Corral de Tierra, CA 93908 Ruth L. Sarokon, 124 Bradley Court Drive, Indiana, PA 15701 Ingrid L. Floor, 3846 Snyder Lane, Gig Harbor, WA 98335 Shirley L. Hughes, 50 South Terrace, Wormleysburg, PA 17043 Carlyn H. Chulick, 716 Arlington Road, Camp Hill, PA 17011 Notice has now been given to all persons entitled thereto under Rule 5.6(a). Date: September 15,2003 Robert R. Church, Esq. Keefer Wood Allen & Rahal, LLP P.O. Box 11963 Harrisburg, PA 17108-1963 Capacity: Counsel for Personal Representative IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent' s will. If the decedent died without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND PENNSYLVANIA In re Estate of Irene M. Larson, deceased, TO: Ilene L. Badke 12795 Sundance Lane Corral de Tierra, CA 93908 Please take notice of the death of decedent and the grant of letters to the personal representatives named below. The Decedent, Irene M. Larson, died on the 4~h day of September, 2003, in Lower Allen Township, Cumberland County, Pennsylvania. You are entitled to receive a one-fourth (1/4) share of the estate. The Decedent died testate (with a Will). The personal representative of the Decedent is Carlton E. Hughes, 50 South Terrace, Wormleysburg, PA 17043, (717) 737-7066. The Will has been filed with the Office of the Register of Wills of Cumberland County, 1 Courthouse Square, Carlisle, PA 17013-3387. Phone number (717) 240-6345. A copy of the Will may be obtained by contacting the Register of Wills and paying the charges for duplication. /....~.. '-~ .-- >, Date: September 15, 2003 'l ~ :) ''~ ~ t ~' Robeff R. Church, Esq. Keefer Wood Allen & Rahal, ~P P.O. Box 11963, Haffisburg, PA 17108 Telephone (717) 255-8059 Capacity: Counsel to Personal Representative IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent' s will. If the decedent died without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF Wll J S, COUNTY OF CUMBERLAND PENNSYLVANIA In re Estate of Irene M. Larson, deceased, TO: Ruth L. Sarokon 124 Bradley Court Drive Indiana, PA 15701 Please take notice of the death of decedent and the grant of letters to the personal representatives named below. The Decedent, Irene M. Larson, died on the 4th day of September, 2003, in Lower Allen Township, Cumberland County, Pennsylvania. You are entitled to receive a one-fourth (1/4) share of the estate. The Decedent died testate (with a Will). The personal representative of the Decedent is Carlton E. Hughes, 50 South Terrace, Wormleysburg, PA 17043, (717) 737-7066. The Will has been filed with the Office of the Register of Wills of Cumberland County, 1 Courthouse Square, Carlisle, PA 17013-3387. Phone number (717) 240-6345. A copy of the Will may be obtained by contacting the Register of Wills and paying the charges for duplication. .~) Date: September 15, 2003 , Robert R. Church, Esq. Keefer Wood Allen & Rahal, LLP P.O. Box 11963, Harrisburg, PA 17108 Telephone (717) 255-8059 Capacity: Counsel to Personal Representative IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's will. If the decedent died without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF Wll J S, COUNTY OF CUMBERLAND PENNSYLVANIA In re Estate of Irene M. Larson, deceased, TO: Ingrid L. Floor 3846 Snyder Lane Gig Harbor, WA 98335 Please take notice of the death of decedent and the grant of letters to the personal representatives named below. The Decedent, Irene M. Larson, died on the 4m day of September, 2003, in Lower Allen Township, Cumberland County, Pennsylvania. You are entitled to receive a one-fourth (1/4) share of the estate. The Decedent died testate (with a Will). The personal representative of the Decedent is Carlton E. Hughes, 50 South Terrace, Wormleysburg, PA 17043, (717) 737-7066. The Will has been filed with the Office of the Register of Wills of Cumberland County, 1 Courthouse Square, Carlisle, PA 17013-3387. Phone number (717) 240-6345. A copy of the Will may be obtained by contacting the Register of Wills and paying the charges for duplication. ..~ ~ (-~/' i~' Date: September 15, 2003 / -~ I 4~c"4~5/~· Robert R. Church, Esq. Keefer Wood Allen & Rahal, LLP P.O. Box 11963, Harrisburg, PA 17108 Telephone (717) 255-8059 Capacity: Counsel to Personal Representative IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's will. If the decedent died without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WlIJS, COUNTY OF CUMBERLAND PENNSYLVANIA In re Estate of Irene M. Larson, deceased, TO: Shirley L. Hughes 50 South Terrace Wormleysburg, PA 17043 Please take notice of the death of decedent and the grant of letters to the personal representatives named below. The Decedent, Irene M. Larson, died on the 4th day of September, 2003, in Lower Allen Township, Cumberland County, Pennsylvania. You are entitled to receive a one-fourth (1/4) share of the estate. The Decedent died testate (with a Will). The personal representative of the Decedent is Carlton E. Hughes, 50 South Terrace, Wormleysburg, PA 17043, (717) 737-7066. The Will has been filed with the Office of the Register of Wills of Cumberland County, 1 Courthouse Square, Carlisle, PA 17013-3387. Phone number (717) 240-6345. A copy of the Will may be obtained by contacting the Register of Wills and paying the charges for duplication. .'/~) f~ ~/~7' / Date: September 15, 2003 [ ''~. -~"'<(."×-- '~,?~'~"~'~'/~"-~" Robert R. Church, Esq. Keefer Wood Allen & Rahal, 1.1JP P.O. Box 11963, Harrisburg, PA 17108 Telephone (717) 255-8059 Capacity: Counsel to Personal Representative IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent' s will. If the decedent died without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WHJS, COUNTY OF CUMBERLAND PENNSYLVANIA In re Estate of Irene M. Larson, deceased, TO: Carlyn H. Chulick 716 Arlington Road Camp Hill, PA 17011 Please take notice of the death of decedent and the grant of letters to the personal representatives named below. The Decedent, Irene M. Larson, died on the 4m day of September, 2003, in Lower Allen Township, Cumberland County, Pennsylvania. In the event of disclaimer by Shirley L. Hughes, you are entitled to receive a one-quarter (1/4) share of the estate. The Decedent died testate (with a Will). The personal representative of the Decedent is Carlton E. Hughes, 50 South Terrace, Wormleysburg, PA 17043, (717) 737-7066. The Will has been filed with the Office of the Register of Wills of Cumberland County, 1 Courthouse Square, Carlisle, PA 17013-3387. Phone number (717) 240-6345. A copy of the Will may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: September 15, 2003 Robert R. Church, Esq. Keefer Wood Allen & Rahal, LLP P.O. Box 11963, Harrisburg, PA 17108 Telephone (717) 255-8059 Capacity: Counsel to Personal Representative IN THE MATTER OF THE ESTATE OF IRENE M. LARSON, DECEASED IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION INSTRUMENT OF DISCLAIMER THIS INSTRUMENT, made this . HUGHES (the "Disclaimant"), ~,,',5""~d%y of September, 2003, by SHIRLEY L. follows: WITNESSETH' THE CIRCUMSTANCES leading up to the execution of this Instrument are as Irene M. Larson, also known as Margaret Irene Larson (the "Decedent"), a widow, late of Lower Allen Township, Cumberland County, Pennsylvania, died testate on September 4, 2003. The Decedent was survived by her four daughters, one of whom is Shirley L. Hughes (the "Disclaimant"). The Disclaimant is married and has one child, Carlyn H. Chulick, who is an adult. 2. The Register of Wills of Cumberland County, Pennsylvania has appointed Carlton E. Hughes as Executor of the Decedent's probate estate (the "Estate"). The Disclaimant executed a Renunciation of her right to serve as a Co-Executor of the Estate. 3. The Decedent's Last Will and Testament, dated February 17, 1997 (the "Will") provides, in pertinent part, as follows, concerning the disposition of the Estate: "THIRD: I give the rest and residue of my estate to my daughters, share and share alike, with the issue of a deceased daughter to take her share, per stirpes." 4. The Disclaimant now desires to renounce and disclaim, absolutely and forever, any and all of her right, title and interest in and to the Estate, thereby vesting ownership of the same in her daughter, Carlyn H. Chulick. The Executor is willing to accept this Disclaimer, for the purposes expressed herein. NOW THEREFORE, the Disclaimant, intending to be legally bound, does for herself, her heirs, personal representatives, successors and assigns, hereby exercise the rights granted to her in Chapter 62 of the Pennsylvania Probate, Estates and Fiduciaries Code, 20 Pa. C.S.A. § 6201-6207, and hereby disclaims, releases and renounces, absolutely and forever, any and all of her right, title and interest in and to the Estate. The Disclaimant intends that this Instrument of Disclaimer shall constitute a "qualified disclaimer" by the Disclaimant under Section 2518 of the Internal Revenue Code of 1986, as amended. IN WITNESS WHEREOF, the Disclaimant, intending that this Instrument shall be delivered to the ExecutOr and filed of record in the Office of the Register of Wills of Cumberland County, Pennsylvania, has hereunder set her hand and seal to this Instrument of Disclaimer on the date first above written. WITNESS: · SHIRLEY~. HUGHES, Di~claimant COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF CUMBERLAND : On this, the ~day of _v ,2003, before me, the undersigned officer, personally appeared SHIRLEY L. HUGHES, known to me, (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged purposes therei~ IN WITNESS W lat she executed the same as her voluntary act and deed for the contained. -IEREOF, I hereunder set my hand and official seal. NOTAP. iAL SF!~,L MARY A. k~,;C..N ',~, Swatara Township, D~ph~ ~ ~mmission Expires Dec. ACCEPTANCE BY EXECUTOR THE UNDERSIGNED, Carlton E. Hughes, Executor of the Estate of Irene M. Larson, deceased, hereby accepts the Instrument of Disclaimer of Shirley L. Hughes, for the purposes expressed therein. IN WITNESS WHEREOF, the undersigned has set his hand hereto on this r~-'~4day of ~)'~e,,~',~e~- , 2003. CARLTON E. HUGHES, Ex~-'~tor IN THE MATTER OF THE ESTATE OF IRENE M. LARSON, DECEASED IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION No. 2003-00743 RECEIPT, RELEASE AND REFUNDING AGREEMENT CONCERNING PARTIAL DISTRIBUTION i~*.,~ '*~ THIS AGREEMENT, made this 3rd day of October, 2003, !--i WITNESSETH' ~ THE CIRCUMSTANCES leading up to the execution of this Agreement are ~ follows: 1. Irene M. Larson, also known as Margaret Irene Larson (the "Decedent"), a widow, late of Lower Allen Township, Cumberland County, Pennsylvania, died testate on September 4, 2003. The Decedent was survived by her four daughters (hereinafter named), one of whom, Shirley L. Hughes, was nominated as a Co-Executor of the Decedent's probate estate (the "Estate"). 2. Shirley L. Hughes executed a Renunciation of her right to serve as a Co- Executor of the Estate. The Register of Wills of Cumberland County, Pennsylvania, has appointed Carlton E. Hughes as Executor of the Estate (the "Executor"). 3. The Decedent's Last Will and Testament, dated February 17, 1997 (the "Will") provides, in pertinent part, as follows, concerning the disposition of the Estate: "THIRD: I give the rest and residue of my estate to my daughters, share and share alike, with the issue of a deceased daughter to take her share, per stirpes." 4. By Instrument of Disclaimer, dated September 25, 2003, Shirley L. Hughes disclaimed and renounced, absolutely and forever, any and all of her right, title and interest in and to the Estate, thereby vesting ownership of the same in her daughter, Carlyn H. Chulick. The Decedent's non-disclaiming daughters, namely Ilene L. Badke, Ruth L. Sarokon and Ingrid L. Floor, together with the aforesaid Carlyn H. Chulick (all of whom are hereinafter collectively referred to as the "Beneficiaries") desire to join in this Agreement for the purposes hereinafter set forth. 5. The Executor is in a position to make a cash distribution to the Beneficiaries, in partial satisfaction of their rights in the Estate under the Will, and the Beneficiaries desire the Executor to do so. 6. In consideration of the indemnifications hereinafter provided, the Executor is willing to make an interim cash distribution to each of the Beneficiaries. Such partial distribution is being made pending the final settlement of the Decedent's Pennsylvania inheritance tax liability and pending either the approval of the Executor's First and Final Account by the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania (the "Court"), or a duly executed agreement of the Beneficiaries to waive a formal accounting by the Court and settle the Estate by informal agreement. NOW THEREFORE, in consideration of the foregoing and intending to be legally bound, jointly and severally, the Beneficiaries, for themselves, their heirs, assigns and successors hereby agree as follows: A. The Beneficiaries each acknowledge receipt of the sum of One Hundred Thousand Dollars ($100,000)in partial satisfaction of their respective rights in the Estate. B. To the extent of the aforesaid partial distribution, the Beneficiaries hereby absolutely and irrevocably remise, release, quitclaim and forever discharge the Executor, his successors and assigns, of and from any and all actions, payments, accounts, reckonings, -2- liabilities, claims and demands relating in any way to the Will or the Estate. The Beneficiaries agree to refund, on demand, all or any part of their respective partial distributions, which have been determined by the Executor, or by the Court, or by any other court of competent jurisdiction, to have been improperly made. Do To the extent of the aforesaid partial distribution, the Beneficiaries hereby agree to indemnify and hold harmless the Executor, including his successors and assigns, from and against any and all claims, loss, liability or damage (whether or not related to the negligence of the Executor) which the Executor may suffer, or to which he may be subjected by reason of his administration of the Estate, including the partial distributions described above. Eo The Beneficiaries consent to the Court exercising personal jurisdiction over them in any suit or action arising out of the enforcement of this Agreement. IN WITNESS WHEREOF, the Beneficiaries have set their hands and seals to the Consents attached hereto, with the same to be effective as of the date first above written. -3- IN THE MATTER OF THE ESTATE OF IRENE M. LARSON, DECEASED IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION No. 2003-00743 CONSENT TO RECEIPT, RELEASE, REFUNDING AND INDEMNITY AGREEMENT CONCERNING PARTIAL DISTRIBUTION THE UNDERSIGNED, Ilene L. Badke, a residuary legatee of the Estate of Irene M. Larson, deceased, hereby consents to the Receipt, Release, Refunding and Indemnity Agreement Concerning Partial Distribution, a copy of which has been provided to her. The undersigned also acknowledges receipt of the interim cash distribution in the amount of One Hundred Thousand Dollars ($100,000), in partial satisfaction of her rights under the Will, as more particularly described in the aforesaid Agreement. SS. STATE OF CALIFORNIA COUNTY OF MONTEREY On this, the //0 day of (~(~0~/2,_, 2003, before me, the undersigned officer, personally appearedJ~'c~==L=F~Jtr~, known to me (or satisfactorily proven) be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same as her free and voluntary act for the purposes expressed therein. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. ¢ ~ MARBELLA OLIVEIRA~, 0 .~!~_x~ COMM. # 1326854 ~j~,~"~"~NOTARY PUBLIC-CALIFORNIA S~-¢~ ~ON~,~Y COUNTY Notar~ Public -4- RECORDING REQUESTED BY: AND WHEN RECORDED MAIL TO: Space above this line for Recorder's use ILENE L. BADKE, Principal to BRENDA B. LANDON, Agent: DURABLE POWER OF ATTORNEY AND NOMINATION OF CONSERVATOR TO PERSON EXECUTING THIS DOCUMENT: THIS IS AN IMPORTANT LEGAL DOCUMENT. IT CREATES A DURABLE POWER OF ATTORNEY. BEFORE EXECUTING THIS DOCUMENT, YOU SHOULD KNOW THESE IMPORTANT FACTS. 1. THIS DOCUMENT MAY PROVIDE THE PERSON YOU DESIGNATE AS YOUR ATTORNEY-IN-FACT WITH BROAD POWERS TO MANAGE, DISPOSE OF, SELL, CONVEY, AND ENCUMBER YOUR REAL AND PERSONAL PROPERTY, AND TO USE YOUR PROPERTY AS SECURITY IF YOUR AGENT BORROWS MONEY ON YOUR BEHALF. 2. THIS DOCUMENT DOES NOT AUTHORIZE ANYONE TO MAKE MEDICAL AND OTHER HEALTH DECISIONS FOR YOU. 3. THESE POWERS WILL EXIST FOR AN INDEFINITE PERIOD OF TIME UNLESS YOU LIMIT THEIR DURATION IN THIS DOCUMENT. THESE POWERS WILL CONTINUE TO EXIST NOTWITHSTANDING YOUR SUBSEQUENT DISABILITY OR INCAPACITY. 4. YOU HAVE THE RIGHT TO REVOKE OR TERMINATE THIS DURABLE POWER OF ATTORNEY AT ANY TIME. 5. YOUR AGENT HAS NO DUTY TO ACT UNLESS YOU AND YOUR AGENT AGREE OTHERWISE IN WRITING. Durable Power of Attorney I ILENE L. BADKE, Principal TO WHOM IT MAY CONCERN: ILENE L. BADKE (the principal), presently a resident of Monterey County, California, hereby appoints BRENDA B. LANDON (the agent) presently a resident of Monterey County, California, as the principal's true and lawful attorney-in-fact for the principal and in the principal's name, place and stead: 1. Real Property Management. The agent is authorized to manage, control, lease, sublease, and otherwise act concerning any real property which the principal may own, collect and receive rents or income there&om; pay taxes, charges, and assessments on the same; repair, maintain, protect, preserve, alter, and improve the same; and do all things necessary or expedient to be done in the agent's judgment in connection with the property. 2. Real Property Transfer/Encumbrance. The agent is authorized to purchase real property on the principal's behalf; to mortgage, pledge, or otherwise encumber such newly acquired property; to commit the resources of the principal with respect to purchase of such property; to do all acts and execute all documents necessary for the purchase of such property; and to otherwise generally deal in all respects and have all powers described in this power of attorney with respect to such property. 3. Partnerships. The agent is authorized to manage and control all partnership interests owned by the principal and to make all decisions the principal could make as a general partner, limited partner, or both, and to execute all documents required of the principal as such partner, all to the extent that the agent's designation for such purposes is allowed by law and is not in contravention of any partnership or other agreement. 4. Securities. The agent is authorized to purchase, sell, invest, reinvest and generally deal with all stocks, bonds, debentures, warrants, partnership interests, rights, and securities owned by the principal. 5. Collections. The agent is authorized to collect and deposit for the benefit of the principal all debts, interest dividends or 'other assets that may be due or belong to the principal, and to execute and deliver receipts and other discharges therefor; to demand, arbitrate, and pursue litigation on the principal's behalf concerning all rights and benefits to which the principal may be entitled; and to compromise, settle, and discharge all such matters as the agent considers appropriate under the Circumstances. 6. Payment of Obligations. The agent is authorized to pay any sums of money which may at any time be or become owing from the principal, to sell, and to adjust and compromise any claims which may be made against the principal as the agent considers appropriate under the circumstances. Durable Power of Attorney 2 ILENE L. BADKE, Principal 7. General Power of Sale, Etc. The agent is authorized to grant, sell, transfer, convey, mortgage, deed in trust, pledge and otherwise deal in all property, real and personal, which the principal may own; including but not limited to any real property described on any exhibit attached to this instrument including property acquired after execution of this instrument; to attach exhibits to this instrument which provide legal descriptions of any such property; and to execute such instruments as the agent deems proper in conjunction with all matters covered in this paragraph 7. 8. Tax Returns. The agent is authorized to prepare and file all income and other federal and state tax returns which the principal is required to file; to sign the principal's name; hire preparers and advisors and pay for their services; and to do whatever is necessary to protect the principal's assets from assessments for income and other taxes for the years 2001 to 2050. The agent is specifically authorized to receive confidential information; to receive checks in payment of any refund of taxes, penalties, or interest; to execute waivers (including offers of waivers) of restrictions on assessment or collection of tax deficiencies and waivers of notice of disallowance of claims for credit or refund; to execute consents extending the statutory period for assessment or collection of taxes; to execute closing agreements under Internal Revenue Code section 7121, or any successor statute; and to delegate authority or substitute another repres, entative with respect to all above matters. 9. Deposit Accounts. The agent is authorized to deposit in and draw on any checking, savings, agency, or other accounts which the principal may have in any banks, savings and loan associations, and any accounts with securities brokers or other commercial institutions, and to establish and terminate all such accounts. 10. Investments. The agent is authorized to invest and reinvest the principal's funds in every kind of property, real, personal, or mixed, and every kind of investment, specifically including, but not limited to, corporate obligations of every kind; preferred or common stocks; shares of investment trusts, investment companies, and mutual funds; mortgage participations; that, under the circumstances then prevailing (specifically including but not limited to the general economic conditions and the principal's anticipated needs) persons of skill, prudence, and diligence acting in a similar capacity and familiar with those matters would use in the conduct of an enterprise of a similar character and with similar aims, to attain the principal's goals; and to consider individual investments as part of an overall plan. 11. Safe Deposit Boxes. The agent is authorized to have access to all safe deposit boxes in the principal's name or to which the principal is an authorized signatory; to contract with financial institutions for the maintenance and continuation of safe deposit boxes in the principal's name; to add to and remove the contents of all such safe deposit boxes; and to terminate contracts for all such safe deposit boxes. Durable Power of Attorney 3 ILENE L. BADKE, Principal 12. Enforcement of Agency Powers. The agent is authorized to bring suit against any bank, savings and loan association, or other person or entity that fails or refuses to honor this power of attorney. 13. Trust Transfers. The agent is authorized to make additions and transfer assets to any and all living revocable trusts of which the principal is or becomes a settlor. 14. Credit Cards. The agent is authorized to use any credit cards in the principal's name to make purchases and to sign charge slips on behalf of the principal as may be required to use such credit cards; and to close the principal's charge accounts and terminate the principal's credit cards under circumstances where the agent considers such acts to be in the principal's best interest. 15. Principal's Personal Care. The agent is authorized to do all things and enter into all transactions necessary to provide for the principal's personal care and to maintain the principal's customary standard of living; to provide suitable living quarters for the principal; and to hire and compensate household, nursing and other employees as the agent considers advisable for the principal's well being. The above shall specifically include but not be limited to the authority to pay the ongoing costs of maintenance of the principal's present and future residence, such as interest, taxes, repairs; to procure and pay for clothing, transportation, medicine, medical care, food and other needs; and to make arrangements, enter into contracts and commit the principal's resources on the principal's behalf with respect to provision of residential care for the principal in a hospital, convalescent hospital, skilled nursing home, convalescent home, hospice or other similar organization. 16. Mail. The agent is authorized to receive, open, read, direct and respond to the principal's mail; and to represent the principal in any matters pertaining to the U.S. Postal Service. 17. Retirement Accounts. The agent is authorized to establish and contribute to IRA accounts and other retirement accounts and employee benefits plans on the principal's behalf; to select or change payment options and make elections under any IRA or other retirement accounts or employee benefit plan in which the principal is a participant; and to make "rollovers" of plan benefits into other retirement plans or IRA accounts. 18. Gifting for Education/Medical Care. The agent is authorized to make direct payments to the provider for tuition and medical care for the principal's issue under Internal Revenue Code section 2503(e) or any successor statute, which excludes such payments from gift tax liability, and for such purposes to remove the principal's assets from any grantor revocable trust of which the principal is a grantor. Durable Power of Attorney 4 ILENE L. BADKE, Principal 19. Annual Gifts to Principal's Issue. To make gifts on the principal's behalf to a class composed of the principal's children, any of their issue, or both to the full extent of the federal annual gift tax exclusion in effect from time to time, including the $10,000 per donee annual exclusion under Internal Revenue Code section 2503(b) or any successor statute, and for such purposes to remove the principal's assets from any grantor revocable trust of which the principal is a grantor. 20. Insurance and Other Benefits. The agent is authorized to apply for and make any elections required for payment of governmental, insurance, retirement, or other benefits to which the principal may be entitled, to take possession of all such benefits, and to distribute such benefits to or for the principal's benefit. 21. General Authori .ty. Generally, the agent is authorized to do, execute, and perform any other act, deed, matter, or thing, that in the opinion of the agent ought to be done, executed, or performed in conjunction with this power of attorney, of every kind and nature, as fully and effectively as the principal could do if personally present. The enumeration of specific items, acts, rights, or powers in this instrument does not limit or restrict, and is not to be construed or interpreted as limiting or restricting, the general powers granted to the agent except where powers are expressly restricted. 22. Information Release Authorization. Any third party from whom the agent may request information, records, or other documents regarding the principal's personal affairs may release and deliver all such information, records, or documents to the agent. The principal hereby waives any privilege that may apply to release of such information, records, or other documents. 23. Third Par _ty Reliance. The agent's signature under the authority granted in this power of attorney, may be accepted by any third party or organization with the same force and effect as if the principal were personally present and acting on the principal's own behalf. No person or organization who relies on the agent's authority under this instrument Shall incur any liability to the principal, the principal's estate, heirs, successors, or assigns, because of reliance on this instrument. 24. Present and Future Assets. This power of attorney shall apply to all presently owned and future acquired assets of the principal, and shall include the power to acquire anY assets as described herein on the principal's behalf. 25. Binding Authority. The principal's estate, heirs, successors, and assigns shall be bound by the agent's acts under this power of attorney. 26. Durabili .ty. This power of attorney shall not be affected by the principal's subsequent disability or incapacity. Durable Power of Attorney 5 ILENE L. BADKE, Principal 27. Ratification. The principal hereby ratifies and confirms all that the agent shall do, or cause to be done, by virtue of this power of attorney. 28. Conservator Nomination. If a conservatorship of the principal's person or estate or both is deemed necessary, the principal hereby nominates BRENDA B. LANDON as conservator of the principal's person and estate. If BRENDA B. LANDON is for any reason unwilling or unable so to serve, the principal hereby nominates DEEANNE B. IPSARO as such conservator. On the appointment of a conservator of the principal's estate, this power of attorney shall terminate and the agent shall deliver the assets of the principal under the agent's control as directed by the conservator of the principal's estate. 29. Successor Agent. If for any reason the agent under this durable power of attorney is unwilling or unable to serve, DEEANNE B. IPSARO, whose current address is 7138 VIA COLINA, SAN JOSE, CA 95139, shall serve as successor agent. In such case, one of the following documents shall be attached to this durable power of attorney: a resignation or declination to serve signed by the original agent; a written and signed opinion from a licensed physician that the original agent is physically or mentally incapable of serving; a certified court order as to the incapacity or inability of the original agent to serve; or a certified death certificate of the original agent. Third parties who deal with the successor agent shall be entitled to rely on the original power of attorney instrument with any such document attached. If for any reason DEEANNE B. IPSARO is unwilling or unable to serve, ROBERT T. BADKE, JR., whose current address is 23107 ESPADA, SALINAS, CA 93908, shall serve as successor agent. 30. Photocopies. The agent is authorized to make photocopies of this instrument and any attached documents as frequently and in such quantity as the agent deems appropriate. Each photocopy shall have the same force and effect as the original. The principal declares that she understands the importance of this durable power of attorney, recognizes that she is granting the agent broad power to hold, administer and control the principal's assets, and recognizes that this durable power of attorney will become effective immediately on execution and will continue indefinitely until specifically revoked or terminated by death, even if the principal later becomes incapacitated. IN WITNESS WHEREOF, the principal has signed this durable power of attorney on ILENE L. BAD'KE, PrinCipal ~ Durable Power of Attorney 6 ILENE L. BADKE, Principal STATE OF CALIFORNIA ) ) COUNTY OF MONTEREY ) SS. On Ot.--J-oJ~o_,~ '7, 'ZCXD~ , before me, ERIC I-IOLK, a Notary Public in and for the State of California, personally appeared ILENE L. BADKE, ~ Pao.~m-~mm(or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed, to the within instrument and acknowledged that she executed the same in her authorized capacity(les), and that by her signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. Witness my hand and official seal. ERIC HOLK, Notary Public ERIC HOLK COMM. # 1296397 "~NOTARY PUBLIC-CALIFORNIA MONTEREY COUNTY ~~COMM. EXP. MARCH 8, 2005 Durable Power of Attorney 7 ILENE L. BADKE, Principal IN THE MATTER OF THE ESTATE OF IRENE M. LARSON, DECEASED IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION No. 2003-00743 CONSENT TO RECEIPT, RELEASE, REFUNDING AND INDEMNITY AGREEMENT CONCERNING PARTIAL DISTRIBUTION THE UNDERSIGNED, INGRID L. FLOOR, a residuary legatee of the Estate of Irene M. Le. rson, deceased, hereby consents to the Receipt, Release, Refunding and Indemnity Agreement Concerning Partial Distribution, a copy of which has been provided to her. The undersigned also acknowledges receipt of the interim cash distribution in the amount of One Hundred Thousand Dollars ($100,000), in partial satisfaction of her rights under the Will, as more particularly described in the aforesaid Agreement. INGRI-D~. FL~OR - STATE OF WASHINGTON COUNTY OF ' ,_.~.,',.-__~ SS. On this, the ~-~'~-\ day of C....~..Q-.~. ,2003, before me, the undersigned officer, personally appeared INGRID L. FLOOR, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same as her free and voluntary act for the purposes expressed therein. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. Notary Public -5- IN THE MATTER OF THE ESTATE OF IRENE M. LARSON, DECEASED IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION · No. 2003-00743 CONSENT TO RECEIPT, RELEASE, REFUNDING AND INDEMNITY AGREEMENT CONCERNING PARTIAL DISTRIBUTION THE UNDERSIGNED, RUTH L. SAROKON, a residuary legatee of the Estate of Irene M. Larson, deceased, hereby consents to the Receipt, Release, Refunding and Indemnity Agreement Concerning Partial Distribution, a copy of which has been provided to her. The undersigned also acknowledges receipt of the interim cash distribution in the amount of One Hundred Thousand Dollars ($100,000), in partial satisfaction of her rights under the Will, as more particularly described in the aforesaid Agreement. COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~ RUTH L. SAROKON ss. , 07- S8 - 97q? On this, the '7¢/, day of O~ , 2003, before me, the undersigned officer, personally appeared RUTH L. SAROKON, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same as her free and voluntary act for the purposes expressed therein· IN WITNESS WHEREOF, I have hereunto set my hand and official seal. Notary Public ANO~H W ~WPU~ INDIANA, INDIANA COMW~ION EXPII~ JUN£ -7- IN THE MATTER OF THE ESTATE OF IRENE M. LARSON, DECEASED IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION No. 2003-00743 CONSENT TO RECEIPT, RELEASE, REFUNDING AND INDEMNITY AGREEMENT CONCERNING PARTIAL DISTRIBUTION THE UNDERSIGNED, CARLYN H. CHULICK, a residuary legatee of the Estate of Irene M. Larson, deceased, hereby consents to the Receipt, Release, Refunding and Indemnity Agreement Concerning Partial Distribution, a copy of which has been provided to her. The undersigned also acknowledges receipt of the interim cash distribution in the amount of One Hundred Thousand Dollars ($100,000), in partial satisfaction of her rights under the Will, as more particularly described in the aforesaid Agreement. ~//-~('~ )7 ~j,,,,-~ ~,/.~"~,...., ~.,( ~' CAR-'L-YI~ Iq ~HUL~ICK ~ ..... "~-~/ COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS. On this, the /___-~:;;/~ day of ,2003, before me, the undersigned officer, personally appeared CARLYN H. CHULICK, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same as her free and voluntary act for the purposes expressed therein. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. Notary lic, -6- HEATH L. ALLEN N. DAVID RAHAL CHARLES W. RUBENDALL '1'1' ROBERT L. WELDON EUGENE E. PEPINSKY, UR. .JOHN H. ENOS 'ITt GARY E. FRENCH DONNA S. WELDON BRADFORD DORRANCE .JEFFREY S. STOKES ROBERT R. CHURCH STEPHEN L. GROSE R. SCOTT SHEARER WAYNE M. PECHT ELYSE E. ROGERS CRAIG A. LONGYEAR DONALD M. LEWIS'FIT BRIDGET M. WHITLEY ,JOHN A. FEICHTEL ANN McGEE CARBON ELIZABETH J. GOLDSTEIN BARBARA A. GALL STEPHANIE KLEINFELTER KEEFER WOOD ALLEN & RAHAL, 210 WALNUT STREET P. O. BOX 11963 HARRISBURG, PA I7108-1963 PHONE {717) 255-8000 EIN No. 23-0716135 www. keeferwood.com December 2, 2003 CERTIFIED MAIL - RETURN RECEIPT REQUESTED Donna Otto, Register of Wills Cumberland County Court House 1 Courthouse Square Carlisle, PA 17013-3387 LLP ESTABLISHED IN 1878 OF COUNSEL: SAMUEL C. HARRY WEST SHORE OFFICE: 415 F'ALLOWFIELD ROAD CAMP HILL, PA 17011 (7171612-5800 WRITER'S CONTACT INFORMATION: '255-8032 Re: Estate of Irene M. Larson, deceased Cumberland County Estate No. 2003-00743 Date of Death: 09/04/2003 Dear Mrs. Otto: /C~/_ /~/~/_ /,~0~o/C? Enclosed is the Executor's check in the amount of $19,950.00, which represents an estimated payment of Pennsylvania inheritance tax for the above-referenced estate. Thank you for your assistance in this matter. Very truly yours, Maria Smith Legal Assistant Enclosure cc: Carlton E. Hughes, Executor KEEFER WOOD ALLEN & RAHAL, LLP 210 WALNUT STREET P. O. BOX 11963 HARRISBURG, PA 17108-1963 ?099 3400 0016 3672 9457 CERTIFIED MAIL - RETURN RECEIPT R1 Donna Otto, Register of Wills Cumberland County Court House 1 Courthouse Square Carlisle, PA 17013-3387 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 003303 KEEFER WOOD RAHAL & ALLEN 210 WALNUT STREET HARRISBURG, PA 17108 fold ESTATE INFORMATION: SSN: 191-44-1860 FILE NUMBER: 2103- 0743 DECEDENT NAME: LARSON IRENE M DATE OF PAYMENT: 12/03/2003 POSTMARK DATE: 12/02/2003 COUNTY: CUMBERLAND DATE OF DEATH: 09/04/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $19,950.00 REMARKS: TOTAL AMOUNT PAID: CARLTON E HUGHES C/O KEEFER WOOD RAHAL & ALLEN CHECK//1015 INITIALS: AC SEAL RECEIVED BY.' 819,950.00 DONNA M. OTTO 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 004043 CHURCH ROBERT R P.O BOX 11963 210 WALNUT ST HARRISBURG, PA 17108-1963 ........ fold ESTATE INFORMATION: SSN: 191-44-1860 FILE NUMBER: 2103-0743 DECEDENT NAME: LARSON IRENE M DATE OF PAYMENT: 06/14/2004 POSTMARK DATE: 06/1 4/2004 COUNTY: CUMBERLAND DATE OF DEATH: 09/04/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $6,001.20 REMARKS: TOTAL AMOUNT PAID: $6,001.20 SEAL CHECK# 102O INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REV-1500 EX (6-00) I-- Z U.I LU z W n,, Z X I- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Larson, Irene M. DATE OF DEATH (MM-DO-YEAR) DATE OF BIRTH (MM-DO-YEAR 09/04/2003 7/23/1907 (IF APPLICABLE)SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) OFFICIAL USE ONLY FILE NUMBER 21 COUNTY CODE -- 03 0743 YEAR NUMBER SOCIAL SECURITY NUMBER 191-44-1860 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ~ 1. Original Return [~1 2. Supplemental Return r---I 3. Remainder Return (date of death pdor to 12-13-82) r"--1 4. Limited Estate [~1 4a. Future Interest Comprom,se (date of death after 12-12-82) [~1 5. Federal Estate Tax Return Required ~ 6. Decedent Died Testate (Attach copy of Will) [~l 7. Decedent Maintained a Living Trust (Attach copy of Trust) 0 8. Total Number of Safe Deposit Boxes ~ 9. Litigation Proceeds Received r--] 10. Spousal Poverty Credit (date of death bet .... 12-31-91 ar~ ~-1-95) ~ 1 1. Election to tax under Sec. 9113(A)(Attach Sch O) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME Robert R. Church, Esq FIRM NAME (If Applicable) Keefer Wood Allen & Rahal, LLP TELEPHONE NUMBER 717-255-8059 COMPLETE MAILINGADDRESS P.O. BOX 11963 Harrisburg, PA 17108-1963 0o00 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 444 r 511.5.~'; ~' 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 0.0~0;-'' 4. Mortgages & Notes Receivable (Schedule D) (4) 0 . 00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 198,042.11 6. Jointly Owned Property (Schedule F) (6) 0 . 00 ~'] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 6,78 8.35 (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (8) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 41,7 41.15 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 7 8 5. 7 7 11. Total Deductions (total Lines 9 & 10) (11 ) 12. Net Value of Estate (Line 8 minus Line 11) (12) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) (13) OFFiC[N. USE ONLY 649,341.99 42,526.92 606,815.07 6,788.35 600,026.72 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax 0.00 rate, or transfers under Sec. 9116 (a)(1.2) x .00 (15) 16. Amount of Line 14 taxable at lineal rate 600,026.72 x .045 (16) 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17) 18. Amount of Line 14 taxable at collateral rate 0 . 00 x .15 (18) 19. Tax Due (19) 0.00 27,001.20 0.00 0.00 27,001.20 > · BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 2W46451.000 Decedent's Complete Address: S~EET ADDRESS IBeth~ny Village 325 Wesley Drive CITY Mechanicsburq STATE ziP 17055 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 0.00 19,950.00 lf050.00 0.00 0.00 (1) Total Credits (A + B + C) (2) Total Interest/Penalty (D + E) (3) 27,001.20 21,000.00 0.00 6,001.20 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (5B) 6,001.20 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~ I---] b. retain the right to designate who shall use the property transferred or its income; ......... r~ I'~ c. retain a reversionary interest; or ................................ ~ ~ d. receive the promise for life of either payments, benefits or care? ................. r'~ r-~ 2. if death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................ r'--1 ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? I---1 ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................ I'~ [~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that 1 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. ADDRESS [~. O. BOX 119~ '] Harrisburg, PA 17108-1963 DATE SIGNATURE OFPREPARER~(~ [ N R P SENTATIV ADDRESS210 Walnu~);t Street P.O. Box 11963 Harrisburg, PA 17108-1963 DATE 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. § 9916 (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(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 2w4646 1.000 REV-1503 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Larson, Irene M. 21-03-0743 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 3134 shares Alliancebernstain Grw & Incm Cl.A 9,684.06 NASDAQ 3 4 5 6 7 10 11 12 13 14 15 1000 shares Corts Tr Bellsouth Cap Fdg Deb 7.12% NYSE 1000 shares Corts Tr II Chrysler Debs 7.875% Acct. #9816301 NYSE 852 shares Delaware Decatur Equiity, Income Fd Inc. NASDAQ 600 shares Duquesne Lt Hldgs Inc., common NYSE 1,594.447 shares Federated Fd for U.S.Govt Secs A $30,000 General Motors Accept. Corp. 7% Accrued income $460.83 $14,000 General Motors Accept. Corp. 7.1% Accrued income $466.62 $10,000 General Motors Accept. Corp. 7.25% Accrued income $279.93 2000 General Mtrs Accep Corp (GMA) Pines 7.30% NYSE Accrued income $912.50 245 shares Kramont Rlty Tr Pfd Ser D 9.5% 1225.55 shares PIMCO Strategic Gbl Gov Fd Inc. NYSE Accrued income $90.69 1600 shares PPL Corp., common, NYSE 500 shares Repsol Intl. Capital LTD NYSE 2000 shares Salomon Bros High Income Fd II, common NYSE 25,800.00 25,890.00 13,512.72 9,153.00 12,420.74 28,657.23 14,326.62 9,829.93 50,392.50 6,296.50 14,546.05 65,560.00 12,637.50 23,580.00 Total from continuation pages .... 122,224.68 TOTAL (Also enter on line 2, Recapitulation) $ 444,511.53 2w4696 3.000 (If more space is needed, insert additional sheets of the same size) Page 2 Estate of: Larson, Irene M. 21-03-0743 Schedule B -- Stocks & Bonds Item Description Value at Date of Death 16 750 shares UGI Corp. New, common NYSE Accrued income $213.75 23,332.50 17 30 shares Units Penn Insd Mun Bd #5Q 18 2400 shares Van Kampen Govt Secs Fd Cl A NASDAQ 5,580.90 24,768.00 19 800 shares Van Kampen U S Govt Fd C1 A NASDAQ 11,288.00 20 1334 shares Wachovia Corp 2nd New, common NYSE Accrued income $466.90 57,255.28 TOTAL. (Carry forward to main schedule) ...... 122,224.68 REV-1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA · INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Larson, Irene M. 21-03-0743 Include the ~roceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 2 3 4 8 9 10 11 PNC Bank Savings Acct. No.5080034958 PNC Bank Checking Acct. No.5070095044 Smith Barney Acct. No.724-22882-10 Federated Funds Dividend check deposited in Smith Barney account on 9/17/03 $25,000 Bank Hapoalim B M New York BRH 5/1/09 OTC Accrued interest as od decedent's death $452.71 $100,000 Bank One C/D 4.4% due 6/8/05 $102,712.00 Plus Accrued Interest to DOD $298.00 Unidentified deposit made to PNC Checking Account after date of death Verizon - phone bill refund Mobile X-ray Imaging- Refund PA Dept of Revenue, 2003 Form 40-PA Refund Receivable Rolling Green Cemetery - 2 Vacant Lots 59,730.66 6,322.53 841.60 39.86 26,950.61 103,010.00 422.16 6.54 20.15 98.00 600.00 198,042.11 TOTAL (Also enter on line 5, Recapitulation) $ 2W46AD 2.000 (if more space is needed, insert additional sheets of the same size) REV-1510 EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOSTRANSFERS & MISC. NON-PROBATEPROPERTY ESTATE OF FILE NUMBER Larson~ Irene M. 21-03-0743 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCPJP~ON OF PROPER~ % OF ITEM INCLUDE ME NAME OF ME TRANSFEREE, ~EIR RE~TIONSHIP TO DATE OF DEATH DECD'S EXCLUSION DECEDE~ ~D ME DA~ OF TRANSFER. A~ACH A COPY OF THE TAXABLE VALUE NUMB EF ~ED F~ REAL ESTATE. VALUE OF ASSET IN.REST (IF ~PLIC~LE) 1. United Methodist Stewardship 6,788.35 100.00 0.00 6,788.35 Foundation of Central Pennsylvania - charitable gift annuity policy, upon the death of the Decedent/Annuitant the remainder interest vested in the tax-exempt issuer, i.e. The United Methodist Stewardship Foundation of Central Pennsylvania TOTAh(Alsoenteronline7, Recapitulation) $ 6,788.35 (if more space is needed, insert additional sheets of same size.) 2W46AF 2,000 REV-1511 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Larson, Irene M. 21-03-0743 Debts of decedent must be reported on Schedule I. ITEM NUMBER 5. 6. 7. 8 DESCRIPTION FUNERAL EXPENSES: West Shore Country Club - funeral luncheon Myers-Hamer Funeral Home Rolling Green Cemetery - grave opening (reimbursement to Carlton Hughes) Tavern on The Hill restaurant -. family dinner on the day of funeral (reimbursement to Carlton Hughes) ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Ca"rlton ~... H%1.ghes Social Security Number(s) / EIN Number of Personal Representative(s) Street Address 50 South Terra.ce City Cam[3 Hill State PA Zip 17043-1125 Year(s) Commission Paid: 2004 Attorney Fees Neme: Keefer Wood Allen & Rahal, LLP Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address Ci~ State Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Name: Bruce Brown, CPA - Tax Prep Tax Return Preparer's Fees Carlton Hughes- reimbursement for probate expenses Keefer Wood Allen & Rahal, LLP- Attorney's Disbursements through 4/30/04 Reserves for Estimated Closing Expenses TOTAL (Also enter on line 9, Recapitulation) $ AMOUNT 1,007.20 8,704.00 87O.00 420.86 10,000.00 19,000.00 0.00 0.00 500.00 0.00 429.00 310.09 500.00 41,741.15 2W46AG 2.000 (If more space is needed, insert additional sheets of same size) REV-1512 EX+ (1-97) COMi~IONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Larson, Irene M. 21-03-0743 Include unreimbursed medical expenses. ITEM NUMBEF DESCRIPTION AMOUNT Trangle Traveling Stores - debt of the decedent Bethany Village - final bill AT&T - decedent's long distance telephone charges Alert Pharmacy Bethany Village Mobile X-Ray Imaging Payment of account balance TOTAL (Also enter on line 10, Recapitulation) $ 46.00 682.80 12.20 20.62 4.00 20.15 785.77 2W46AH 2.000 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Larson Irene M. 21-03-0743 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 2 3 TAXABLEDISTRIBUTIONS[includeoutrightspousaldistributions, andtransfers underSec. 9116(a)(1.2)] Badke, Ilene L. 12795 Sundance Lane Corral de Tierra,, CA 93908 Sarokon, Ruth L. 124 Bradley Court Drive Indiana,, PA 15701 Floor, Ingrid L. 3846 Snyder Lane Gig Harbor,, WA 98335 Chulick, Carlyn H. 716 Arlington Road Camp Hill, PA 17011 Daughter Daughter Daughter Granddaughter 150,006.68 150,006.68 150,006.68 150,006.68 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE ANDGOVERNMENTALDISTRIBUTIONS United Methodist Stewardship Foundation of Central Pennsylvania- Remainder Beneficiary of Charitable Gift Annuity Policy 6,788.35 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 6,788.35 2W46AI 1.000 (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF IRENE M. LARSON a/k/a MARGARET IRENE LARSON I, IRENE M. LARSON, also known as MARGARET IRENE LARSON, of 325 Wesley Drive, Mechanicsburg, Cumberland County, Pennsylvania, do hereby make this my Last Will and Testament, revoking any former Wills and Codicils made by me. FIRST: I direct that the expenses of my last illness and funeral be paid from my estate as soon as convenient after my death. SECOND: I give my tangible personal property, together with any policies of insurance that I may be carrying on said tangible personal property, to my daughters who survive me, share and share alike, with complete confidence that my daughters who survive me will carry out any written instructions that I may leave with regard to said tangible personal property. THIRD: I give the rest and residue of my estate to my daughters, share and share alike, with the issue of a deceased daughter to take her share, per stirpes. FOURTH: I appoint Carlton E. Hughes and Shirley L. Hughes as my Co-Executors. If either is unable or unwilling to serve, the other shall serve alone. If they are unable or unwilling to serve, I appoint Carlyn H. Chulick as my Executrix. If she is unable or unwilling to serve, I appoint CoreStates Bank, N.A., as my Executor. I direct that my Co-Executors, Executor or Execu- trix serve without bond in any jurisdiction in which called upon to act. FIFTH: If any beneficiary under this Last Will and Testa- ment is under thirty (30) years of age, I direct that his or her interest be held in trust by CoreStates Bank, N.A., hereinafter called Trustee, until such beneficiary reaches thirty (30) years of age. My Trustee shall apply such amounts of income and principal as it, in its sole discretion, deems proper for the support, education and welfare of such beneficiary, and may accumulate any unexpended balance of income to the extent permit- ted by law. Such amounts may be applied directly or may be paid to the beneficiary or to the person with whom such beneficiary resides or who has the care and control of such beneficiary, without the intervention of a guardian. My Trustee shall not be obliged to supervise or inquire into the application of such amounts by such person, and the receipt of such person shall be a complete release of my Trustee. Should the share of a beneficia- ry, in the sole opinion of my Trustee, be or become too small to warrant continuing such fund in trust, or should its administra- tion be or become impractical for any other reason, my Trustee, in its sole discretion, may pay such share, absolutely, to the beneficiary, or may deposit such share in the beneficiary's name in a savings account in a savings institution of its choosing, payable to the beneficiary at majority, which I define as twenty- one (21) years. SIXTH: I give to any Executor or Executors and to any Trustee or Trustees named in this Will or any Codicil hereto all of the powers now applicable by law to fiduciaries in the -2- Commonwealth of Pennsylvania and in particular, through the Probate, Estates and Fiduciaries Code, as effective and as in effect on the date hereof, during the administration and until the completion of the distribution of my estate, and until the termination of all trusts created hereunder and until the comple- tion of the distribution of the assets of such trusts, including the power to hold and to invest in any corporate fiduciary's stock, notes, certificates of deposit, and common funds, and the power to register securities in the name of a nominee. I specif- ically authorize my Trustee to arrange for transfer of a beneficiary,s trust account to a substantially similar trust for the benefit of said beneficiary, such as a Crummey-type trust. NINTH: The word "issue" whenever used in this Last Will and Testament shall include adopted children. IN WITNESS WHEREOF, I have set my hand and seal on this my Last Will and Testament this }74~day of ~~ IRENE M. LARSON SIGNED, SEALED, PUBLISHED, and DECLARED by IRENE M. LARSON, as and for her Last Will and Testament, on the day and year last above written, in the presence of us, who, at her request, in her presence, and in the presence of each other, all being present at the same time, have hereunto subscribed our names as witnesses: -3- · SELF-PROVING AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF : WE, IRENE M. LARSON, a/k/a MARGARET IRENE LARSON, and A , , respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly (or willingly directed another to sign for her), and that she execut- ed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and to the best of his or her knowledge the Testatrix was at that time eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence. a/kI~M~RGARET fR~NE- LA~S~ ' Witness Subscribed, sworn to, and acknowledged before me by IRENE M. LARSON, a/k/a MARGARET IRENE LARSON, the Testatrix, and sub- scribed and sworn to before me bY-~lCl~. ~. ~1%~ , ~C~ S.'~ie~ , and , wit- nesses, this i~t'% day of F'e.. b r. ~.~ , ~997. Nott,~ubilc -- -4- ~/ IN THE MATTER OF THE ESTATE OF IRENE M. LARSON, DECEASED IN THE COURT OF COMMON'PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION INSTRUMENT OF DISCLAIMER THIS INSTRUMENT, made this ~ 0'-~d~ay of September, 2003, by SHIRLEY L. HUGHES (the "Disclaimant"), WITNESSETH. THE CIRCUMSTANCES leading up to the execution of this Instrument are as follows: 1. Irene M. Larson, also known as Margaret Irene Larson (the "Decedent"), a widow, late of Lower Allen Township, Cumberland County, Pennsylvania, died testate on September 4, 2003. The Decedent was survived by her four daughters, one of whom is Shirley L. Hughes (the "Disclaimant"). The Disclaimant is married and has one child, Carlyn H. Chulick, who is an adult. 2. The Register of Wills of Cumberland County, Pennsylvania has appointed Carlton E. Hughes as Executor of the Decedent's probate estate (the "Estate"). The Disclaimant executed a Renunciation of her right to serve as a Co-Executor of the Estate. 3. The Decedent's Last Will and Testament, dated February 17, 1997 (the "Will") provides, in pertinent part, as follows, concerning the disposition of the Estate: "THIRD: I give the rest and residue of my estate to my daughters, share and share alike, with the issue of a deceased daughter to take her share, per stirpes." 4. The Disclaimant now desires to renounce and disclaim, absolutely and forever, any and all of her right, title and interest in and to the Estate, thereby vesting ownership of the same in her daughter, Carlyn H. Chulick. The Executor is willing to accept this Disclaimer, for the purposes expressed herein. NOW THEREFORE, the Disclaimant, intending to be legally bound, does for herself, her heirs, personal representatives, successors and assigns, hereby exercise the rights granted to her in Chapter 62 of the Pennsylvania Probate, Estates and Fiduciaries Code, 20 Pa. C.S.A. § 6201-6207, and hereby disclaims, releases and renounces, absolutely and forever, any and all of her right, title and interest in and to the Estate. The Disclaimant intends that this Instrument of Disclaimer shall constitute a "qualified disclaimer" by the Disclaimant under Section 2518 of the Internal Revenue Code of 1986, as amended. IN WITNESS WHEREOF, the Disclaimant, intending that this Instrument shall be delivered to the Executor and filed of record in the Office of the Register of Wills of Cumberland County, Pennsylvania, has hereunder set her hand and seal to this Instrument of Disclaimer on the date first above written. WITNESS: SHIRLEY~. HUG H ES, DiS~claimant COMMONWEALTH OF PENNSYLVANIA · · SS. COUNTY OF CUMBERLAND · this, the ~ day of _~"~ On / 2003, before me, the undersigned [,My ~rn, ,rn, issi:~ =x;,.*~:. ~.-~¢. officer, personally appeared SHIRLEY L. HUGHES, known to me, (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same as her voluntary act and deed for the purposes therein contained. IN WITNESS WHEREOF, I hereunder set my hand and official seal. ACCEPTANCE BY EXECUTOR THE UNDERSIGNED, Carlton E. Hughes, Executor of the Estate of Irene M. Larson, deceased, hereby accepts the Instrument of Disclaimer of Shirley L. Hughes, for the purposes expressed therein. IN WITNESS WHEREOF, the undersigned has set his hand hereto on this CARLTON E. HUGHES, Ex~tor ~12 ?68 3458 41~ 968 3458 P.01 PNCBA K May 26, 2004 Sharon Garcia 210 Walnut Street P.O. Box 11963 Harrisburg, PA 17108-1963 Estate of Irene M. Larson, deceased SSN: 191-~-1860 DOD: 9/4/2003 Dear Ms. Garcia: Please find that I am faxing over a corrected date of death balance letter. On my previous letter to Maria Smith I cn'oneously mistyped the balance figure for the Checking Account. l just spoke with Mr. Carlton Hughes regarding it and advised him that I would be faxing this to your attention. I cannot apologize enough for the error and any inconvenience it has caused. Please accept my sincerest apology. In response to your request for Date of Death balances for the customer noted above, our records show the following: Checking Account Account #5070095044 IRENE M LARSON DOD balance: $6,322.16 + $.37 accrued interest Established 06/08/1979 Savings Account Account #5080034958 IRENE M LARSON DOD balance: $59,724.13 + $6.53 accrued interest Established 10/15/1996 Page 1 of 2 MAY-25-2004 412 ?68 3458 21:52 PNCBANK 412 768 5~58 P. 02 Please note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not process any fmancial transactions or provide statements, If you need assistance with any of these items, please call 1-888-PNC-BANK (!-888-762-2265) or stop by your local PNC Bank branch or'ce. Sincerely, Rachelle Wells 1-800-762-1775 P7-PFSC-O4-F $00 first Ave. Pittsburgh PA 15219 Page 2 of 2 Member FDIC TOTAL P.02 09/18~2003 # 7179012326 13:55 7179012° - STEWART AMOS ~- .-~ ':WAGE 81 UJ Tlge United STEWARDSHIP FOUNDATION 303 Mulberry Drive · Suite 30~} ° NIechanic',*burg. Pcnn~ylvania }7050-31'11 (71 ,'D 766-7343 ° (,SRO0) 7-720113 ' F.x: (717)766-t6-~3 ° Email: sfcpa@nctr'ax.nct September 17, 2003 Carlton E Hughes PO Box 2035 2700 Paxton Street Harrisburg PA 17111 Dear Mr. Hughes: Thank you for sending the death certificate for Irene M. Larson to me so quickly. As you requested, I'm writing to inform you that the value of her gift annuity as of the date of her death, September 4th, was $6,788.35. Our policy is to pay earnings through the end of the month of death, so the residue of the matured charitable gift annuity paid to Bethany Village will be slightly higher than that amount. There was no unrecovered investment on this gift annuity; but because Mrs. Larson did receive one payment during the 2003 calendar year, I will send the final 1099-R to you before the end of January 2004. Please contact me if you have any questions regarding the above or if i can be of further assistance. Sincerely. Sandy Brandt Trust Accountant '?n t.'estm en ! Ma nc~.gerne rz t a nd Stewa rd.~b il) Sm-c, ices" Rolling Green Cemetery December 3, 2003 Mr. Carlton Hughes 50 South Terrace WOrmleysburg, PA 17043 Dear Mr. Hughes, !t was a pleasure speaking with you on the telephone today. ! am writing to confirm our conversaUon. Gust M. and Irene M. Larsen purchased four spaces at Rolling Green Cemetery for the sum of $1,200.00. The Larsens are interred in two of those spaces and two spaces remain. Many families who have extra spaces sell them through a newspaper classified advertisement. Host of the families who successfully sell their spaces get between $200 and $500 per space. Many families don't even get "a nibble" for their ad. ! believe the original price the Larsens paid of $300 per space to be a reasonable and fair value for the private sale of these two remaining spaces. In order to change the ownership of the two spaces, we will need signed and notarized Quitclaim forms, the original deed to the spaces and a $95.00 transfer fee. Enclosed are four Quitclaim forms for the children of Gust M. and Irene M. Larsen to sign. Their signatures will have to be notarized. There is a place at the bottom of the form for the new owner to sign in agreement to receive ownership. This signature does not have to be notarized. ! hope this clarifies the process. Please call Tim Shomper or me if you have any questions or need any assistance. ~./rely, Bridget~loyd ] Eric. 1811 Carlisle Road · Camp IIi]l, PA 17011 · 717-761-4055 · Fax 717-761-4826 www.digt~itymemori~tl.com · MYERS-HARNER FUNERAL HOME, INC. 1903 MARKET STREET P.O. BOX 291 ~,%~,~r HIL. L, ,r~ENN~'~L%'ANIA lTOII LOCALLY OWNED AND OPERATED ROBERT H. HARNER SUPERVISOR TELEPHONE 717-737-9961 September 23, 2003 Mrs. Shirley Hughes 50 South Terrace Wormleysbur9 PA 17043 Services for Irene M. Larson September 9, 2003 Charges for Services Selected Professional Services Use of Facilities Automotive Equipment $ 3,775.00 $ 3,775.00 Charges for Merchandise Selected Casket Vault $ 3,510.00 980.00 $ 4,490.00 Cash Advanced Newspaper Notice/Local Clergy Certified Copies Flowers Hair Dresser Total due within thJ_rty days, please: 60.00 100.00 24.00 215.00 40.00 $ 439.00 $ 8,704.00 THIS AG~EMENT PRO.DES FOR ENDOWMENT CA~ :CE~TERY INTE~ENT ~GHTS, MERCHANDISE AND SERVICES PURCHASE/SECU~TY'AG~EM~NT The undersigned, referred to as "Purchaser", hereby agrees to purchase the Interment Rights, Merchandise and Services described herein, subject to acceptance and approval of the above named cemetery, hereinafter referred to as "Seller". Name of Deceased /'~ ~' e rx ~¢ Description of Interment Rights: Issue Certificate of Interment Rights Address ~ Street Cl~, Stat~ Zip INTERMENT RIGHTS, MERCHANDISE AND SERVICES Interment Rights (including Endowment Care of $ ) ................................................................... $ Interment Fees ............................................................................................................................................................. Memorialization -- Type Size Design ........................... Memorial Base -- T~pe Size 70, Color ........................... --(~ Memorial Endowment Care of Memorial Installation/Inspection Fee Outer Burial Container r'-- Material ............................ / Model Supplier Cremation Charge ...................................... . Urn -- Type Size ........................... Flower Vase ~ Type Nameplate .......................................................................................................................................... Lettering ....................................... Other · - Other ?o.o0 oo :> Sales Tax ................................................... ' ........................... TOTAL CASH PRICE ............................................................................................................................ LESS: Down Payment Cash .......... ~ .................................. ~ ...................................... $ ~(,.),~) (,,3 Other Credit Total Down Payment UNPAID BALANCE OF CASH PRICE REMARKs: TELEPHONE: ('~17) 7~1-~530 761-4531 761-4532 · FAX 761-7234 INVOICE # West Shore Country Club 100 BRENTWATER ROAD · CAMP HILL, PA 17011-2099 16406 Carlton Hughes, Jr. 50 S. Terrace Wormleysburg, PA 17043 INVOICE DATE ACCOUNT NO, FUNCTION DATE FUNCTION 09/12/2003 H2305/Hughes 09/09/2003 Reception FOOD HORS D'OEUVRES/BREAKS BEVERAGES WINE/CHAMPAGNE FLOWE RS/E NTERTAI N M ENT CHECK ROOM/RENTALS MISC. SERVICE CHARGE TAX NO, OF PERSONS $ 10.00 $200.00 (Hearth Room) $ 25.00 (Carver) $ 50.00 (Bartender) $156.00 $ 46.20 TOTAL DUE PLEASE RETURN YELLOW COPY WITH YOUR REMI'I-TANCE. 25 $1,257.20 -$ 250.00 $1,007.20 '¢3ETHJ~NY SKILLED NURSING 32~ WESLEY DRIVE MECHANICSBURG PA 17055- AC JNTS RECEIVABLE STATEMENT Statement Date: 091{J412003 IRENE LARSON cio SHIRLEY HUGHES 50 SOUTH TERRACE WORMLEYSBURG PA 17043 Balance Due: 682.80 =lease detach and remit this portion with your payment Account Number: 407 Balance Forward: 6,485.76 ~ ;.~'~ Date · ~ iil l .;'~.i.~*~ _ Description..'. i,~ . .J Days/Units Charge ! .. ?a_~_ment/Cmdit ;~ ~; , aala 08/05/2003 - 08/05/2003 08/12/2003 - 08/12/2003 08/13/2003 - 08/13/2003 08/19/2003 - 08/19/2003 08/26/2003 - 08/26/2003 08/31/2003 - 08/31/2003 09/01/2003 - 09/03/2003 Beauty/Barber Shop Charge Beauty/Barber Shop Ch. arge Payment Check #182 Beauty/Barber Shop Charge Beauty/Barber Shop Charge Oral Nutritional Supplements Monthly Fee 1.00 14.00 1.00 14.00 1.00 14.00 1.00 14.00 10.00 17.80 3.00 609.00 6,485.76 6,499.76 6,513.76 28.00 42.00 56.00 73.80 682.80 TOTAL: 682.80 6,485.76 682.80 ~lease make checks payable to: Bethany Village ~ETHAN¥ 5, KILLEO NUE..~ING: IRENE LARSON 407 Estate of also known as Register of Wills of Cumberland Irene M. Larson County, Pennsylvania INVENTORY No. 2003-00743 Date of Death September 4, 2003 , Deceased Social Security No. 191-44-1860 Carlton E. Hughes Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory INVe 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. Personal Representative: ~ Name of ~'~,~.~ I~ ('~,..~,e.~4~ Attorney: Robert R. Church, Esq. I.D. No.: 40385 Address: 210 Walnut Street, Harrisbur,q, PA 17101 Dated: ~- ~'~~ ~ Telephone: (717) 255-8059 Description Value SEE A'I-I'ACHED. ~ ~ - c'7~ Total: $642,553.64 (Attach Additional Sheets if nec~ssa~I NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RECEIPTS OF PRINCIPAL Estate of Irene M. Larson As of 06/03/2004 Page 1 Assets Listed in Inventory (Valued as of date of death) Fiduciary Acquisition Value Checking Accounts PNC Bank Chking Acct. No.5070095044 $0.37 Accrued Interest Money Market Accounts PNC Bank Svgs Acct. No.5080034958 $6.53 Accrued Interest Smith Barney Acct. No.724-22882-10 Smith Barney Estate Acct. Refund PA Dept of Rev-PA-40 2003 Refund Closely Held Corporations Repsol Intl. Capital LTD 500 Units Common Stocks Alliancebernstain Grw & Incm Cl.A 3,134 Units Delaware Group Decatur Fd Inc. 852 Units Duquesne Lt Hldgs Inc. 600 Units PPL Corp. 1,600 Units Pimco Strategic Global Govt Fund 1,225.5533 Units $90.69 Accrued Dividend Salomon Bros High Income Fd II 2,000 Units UGI Corp. New 750 Units $213.75 Accrued Dividend Van Kampen Govt Secs Fd C1 A 2,400 Units Van Kampen U S Govt Fd C1 A 800 Units Wachovia Corp 2nd New 1,334 Units $466.90 Accrued Dividend $ 59,730.66 841.60 39.86 $ 9,684.06 13,512.72 9,153.00 65,560.00 14,546.05 23,580.00 23,332.50 24,768.00 11,288.00 57,255.28 $ 6,322.53 60,612.12 98.00 12,637.50 252,679.61 RECEIPTS OF PRINCIPAL Estate of Irene M. Larson As of 06/03/2004 Page 2 Assets Listed in Inventory (Valued as of date of death) Fiduciary Acquisition Value Mutual Funds Federated Fd for U.S.Govt Secs A 1,594.447 Units Preferred Stocks Corts Tr Bellsouth Cap Fdg Deb7.12% 1,000 Units Corts Tr II Chrysler Debs 7.875% 1,000 Units General Mtrs Accep Corp 7.30% 2,000 Units $912.50 Accrued Dividend Kramont Rlty Tr Pfd Ser D 9.5% 245 Units Bond Funds Units Penn Insd Mun Bd %5Q 30 Units Corporate Bonds General Motors Accept. Corp. 7% 30,000 Units $460.83 Accrued Interest General Motors Accep5. Corp. 7.1% 14,000 Units $466.62 Accrued Interest General Motors Accept. Corp. 7.25% 10,000 Units $279.93 Accrued Interest Certificates of Deposit Bank HAPOALIM B.M.-NY C/D 5.3% $452.71 Accrued Inserest Capital One Bank C/D 4.4% 6/8/05 $298.00 Accrued Interest Miscellaneous Property Rolling Green Cemetery-2 Lots Refunds Mobile X-ray Imaging Verizon - phone bill refund $ 25,800.00 25,890.00 50,392.50 6,296.50 $ 28,657.23 14,326.62 9,829.93 $ 26,950.61 103,010.00 $ 20.15 6.54 $ 12,420.74 108,379.00 5,580.90 52,813.78 129, 960.61 600.00 RECEIPTS OF PRINCIPAL Estate of Irene M. Larson As of 06/03/2004 Page 3 Assets Listed in Inventory (Valued as of date of death) Fiduciary Acquisition Value TOTAL INVENTORY $ 26.69 $642,131.48 RECEIPTS OF PRINCIPAL Estate of Irene M. Larson As of 06/03/2004 Page 4 Receipts Subsequent to Inventory (Valued when received) PNC ckg-Deposi5 made after DOD TOTAL RECEIPTS SUBSEQUENT TO INVENTORY 422.16 $ 422.16 SUMMARY Total Inventory Total Receipts Subsequent To Inventory $642,131.48 422.16 TOTAL RECEIPTS OF PRINCIPAL $642,553.64 COMMONWEALTH OF PENNSYLVANIA DEPARTMENTOFREVENUE BUREAU OFINDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128 0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) NO. CD 004228 CHURCH ROBERT R P.O BOX 11963 210 WALNUT ST HARRISBURG, PA 17108-1963 ESTATE INFORMATION: SSN: 191-44-1860 FILE NUMBER: 2103-0743 DECEDENT NAME: LARSON IRENE M DATE OF PAYMENT: 08/03/2004 POSTMARK DATE: 08/03/2004 COUNTY: CUMBERLAND DATE OF DEATH: 09/04/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 86.60 REMARKS: TOTAL AMOUNT PAID: 86.60 SEAL CHECK//74506 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS HEATH L. ALLEN N. DAVID RAHAL CHARLES 'd~ RUSENDALL~ August 2, 2004 Register of Wills Cumberland County Courthouse Carlisle, PA 17013 Re: Irene M Larson Estate #57,025 Gentlemen; KEeFER WOOD ALLEN & RAHAL, LlP 210 WALNUT STREET R O. BOX 11963 HARRISBURG, Pa 17108-I963 PHONE (717) 255-8000 ESTABLISHED IN 1878 OF COUNSEL: SAMUEL C. HARRY WEST SHORE OFFICE: 415 FALLOWFIELD ROAD CAMP HILL, PA 17011 (717) 255-8032 Fax: (717) 255-8003 E-Mail: sgarcia~kee ferwood.com "13 Enclosed please find our check in the amount of $6.60 representing the payment of interest and penalty due on the Pennsylvania Inheritance Tax Return filed for the above-mentioned estate, File # 21-03-0743. Kindly return the receipt for this payment in the self-addressed, stamped envelope enclosed. Thank you for your assistance with this matter. Please contact me at 717-255- 8032 if you have any questions. Very truly yours; KEEFER WOOD ALLEN & RAHAL, LLP Sharon M. Garcia Legal Assistant for Trusts & Estates Enclosures Cc: Carlton E. Hughes, Executor KEEFER WOOD ALLEN & RAHAI, LLP 210 WALNUT STREET P, O. BOX I 1963 HARRISBUR~-'~A 17108-1963 h.llh,,llh,.,,Ih,lh h,hl Register of Wills Cumberland County Courthouse Carlisle, PA 17013 170 i .~-i-.~S~2 0 ~ h-iIh,,llh..,tl.lh,,Ih.lhhh.,hthh,hh.,thl 9UREAU OF ~NDZV~DUAL TAXES ROBERT R cHURCH ESQ KEEFER ETAL PO 50X 11963 HBS PA 17108 oN#EALTH OF PENNSYLVANI~ COH~EPARTHENT OF REVENUE IRENE M RESISTER OF WILLS CuHgERLAND CO coURT HOUSE cARLISLE, PA 17013 ~TAIN Lo~RR PORT~O~ ~nR YOUR RECORDS '~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: Irene M. Larson Date of Death: September 4, 2003 Estate No. 0743-2003 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: State whether administration of the estate is complete: Yes x No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete:. 3. If the answer to No. 1 is Yes, state the following: Did the personal representative file a final account with the court? Yes __No x_. The separate Orphans' Court No. (if any) for the personal representative's account is: Co Date: September Did the personal representative state an account informally to the parties in interest? Yes x No ~C: Copies of receipts, releases, joinders and ap _p~als of~orma~...informal accounts may be filed with the Clerk of the O~ans' Court a.~8~ay be attached to this report. ,2004 Robert R. Church, Esq. Name (Please type or print) Keefer, Wood, Allen & Rahal LLP 210 Walnut St., P.O. Box 11963 Harrisburq, PA 17108-1963 Address (717)255-8059 Tel. No. Capacity: __ Personal Representative X Counsel for Personal Representative IN THE MATTER OF THE ESTATE OF IRENE M LARSON DECEASED IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-03-0743 ESTATE SETTLEMENT AGREEMENT THIS AGREEMENT, made this"~'0'~H[- day of .,") _ _z_~ WlTNESSETH: ,2004, THE CIRCUMSTANCES leading up to the execution of this Agreement are as follows: 1. Irene M. Larson, also known as Margaret Irene Larson (the "Decedent"), a widow, died testate on September 4, 2003, and Carlton E. Hughes duly qualified with the Register of Wills of Cumberland County (the "Register"), Pennsylvania, as Executor (the "Executor") of her Probate Estate (the "Estate"). 2. Article THIRD of the Decedent's Last Will and T~t~men he" , providos as follows, to wit: ~ ": IHIRD: I ~ive the rest and residue o[ my estate t0~my dau~hters~ .ham and sharo aliko, with tho issuo of a docoasod 0au~htor to. ko h0r ~hare, per stirpes." :J ~:. ~ :~ 3. By an Instrument of Disclaimer, dated September 25, 2003, and filed of record with the Register on October 1,2003, Shirley L. Hughes, daughter of the decedent (the "Disclaimant"), renounced and disclaimed all of her right, title and interest in and to the Estate, thereby vesting ownership of the same in her daughter, Carlyn H. Chulick. 4. The Executor has prepared an Account (the "Account"), copies of which are attached hereto as Schedule "A" and incorporated herein by this reference. After the payment of expenses of administration and inheritance taxes there is a remaining balance of One hundred seventy five thousand, three hundred thirty three dollars and sixty eight cents ($175,333.68) available for distribution to the Decedent's children, namely, Ilene L Badke, Ruth L Sarokon, Ingrid L. Floor, and to the Decedent's Granddaughter, Cadyn H. Chulick (all of such persons as hereinafter referred to collectively as the "Beneficiaries") 5. The Beneficiaries desire to forever settle and compromise any and all claims and rights which they may possess, now or hereafter, in the Estate and to confirm their acceptance of the proposed final distribution set forth on the Schedule of Distribution (the "Schedule"), which is attached hereto as Schedule "B" and incorporated herein by this reference. The Beneficiaries desire that the distributions and payments set forth on the Schedule be in full satisfaction of their entitlements in the Estate, whether under the Will or otherwise. 6. The Beneficiaries wish to release the Executor and to indemnify him against any and all claims that may be asserted against the Estate or the Executor after the date hereof. 7. The Executor is willing to settle the Estate informally in consideration of the indemnifications hereinafter provided by the Beneficiaries. NOW, THEREFORE, in consideration of the foregoing and intending to be legally bound, jointly and severally, the Beneficiaries, for themselves, their heirs, personal representatives, successors, and assigns: 1. Represent and warrant that they have read and understand this Agreement and confirm that the facts set forth above are true and correct, to the best of their knowledge, information and belief. 2. Acknowledge receipt of a copy of the Account and the Schedule of Distribution. 3. Declare that they have had the opportunity to review the Account and Schedule based upon an examination (or on their decision not to make such an examination), they are satisfied that they have sufficient information to make an informed waiver of their right to a formal accounting with the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania (the "Court"), and do hereby waive the filing and auditing of the same. 4. Accept the Account and Schedule, examined or not, as if the same had been duly filed with and audited, adjudicated and confirmed absolutely by the Court. 5. Acknowledge that the share or amount listed on the Schedule is made in full satisfaction of their entitlements in the Estate, whether under the Will or otherwise. 6. Release, remise, quitclaim and forever discharge the Executor, his heirs, personal representatives, successors and assigns, from and against all claims that they as residuary legatees and heirs had, now have or may in the future have in connection with the Estate. 7. Agree to refund on demand, all or any part of the aforesaid distribution, which has been determined by the Executor, or by the Court, or by any court or competent jurisdiction to have been improperly made. 8. Agree to indemnify and hold harmless the Executor, his heirs, personal representatives, successors and assigns, from and against any and all claims, loss, liability or damage (whether or not related to the negligence of the Executor) that may hereafter be asserted against the Estate or against the Executor. 9. Consent to the Court exercising personal jurisdiction over them in any suit or action arising out of the enforcement of this Agreement. IN WITNESS WHEREOF, the Beneficiaries have placed their hands and seals on the attached Consents to Estate Settlement Agreement. CONSENT TO ESTATE SETTLEMENT AGREEMENT I, RUTH L. SAROKAN, hereby consent to and join in the Estate Settlement Agreement relating to the Estate of Irene M. Larson, a copy of which Estate Settlement Agreement, including Exhibits A and B attached thereto, has been provided to me. Ruth L. Sarol~n COMMONWEALTH OF PENNSYLVANIA COUNTY OF INDIANA : SS On this, the //¢~ day of ~ ,2004, before me, the undersigned officer, personally appeared RUTH L. SAROK~N, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunder set my hand and official seal. Notary Public NOTA A ' I ANINIE~ H KOCHMAN, NOTARf PUBLIC INDIANA, INDIANA C0UIOY Mf COMMI~ON EXPIRI~ JUNE CONSENT TO ESTATE SETTLEMENT AGREEMENT I, Brenda B. Landon, authorized agent for my Mother Ilene L. Badke, pursuant to her Durable Power of Attorney dated October 7, 2003, a copy of which has been provided previously to Cadton E. Hughes, Executor, do on behalf of the said Ilene L. Badke, hereby consent to and join in the Estate Settlement Agreement relating to the Estate of Irene M. Larson, a copy of which Estate Settlement Agreement, including Exhibits A and B attached thereto has been provided to me. Ilene L. Badke STATE OF CALIFORNIA COUNTY OF :SS On this, the ~'~7't- day of 2004, before me, the Undersigned officer, personally appeared BRENDA B. LANDON, Authorized Agent of ILENE L. BADKE, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same in the fiduciary capacity indicated for the purposes therein contained. IN WITNESS WHEREOF, I hereunder set my hand and official seal. SEE ATTACHED NOTARY CERTIFICATE Notary Public ;ALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California On ~.~--~. ~"~,'~r~")t'-[~ beforeme, personally appeared _'~'~""-~]~,_/'JXC-,.' _~- ~sr~- - ~ ' [] personally known to me ~ved to me on the basis of satisfactopJ evidence to be the person~ whose name~)is/~f'e subscribed to the within instrument and F~******~r~/i"L~*i~'**"***[ acknowledged to me that h~/she/t~ey executed the same in ~s/her/tb~ir authorized COMM. #1414716 S capacity(ie,,~), and that by h~/her/th~r I ~ MONTEREYCOUNTY 1 signature~) on the instrument the person~), or * ~ycem,,.Exp ~a¥~,~0~7 , the entity upon behalf of which the person~')' acted, executed the instrument. WITNF~S my hand and official sea~. OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this fO/Tn to another document. Description of Attached Document Title or Type of Document: ~--.,~--~'t'/.-~- ~, ~,.,~l .~ .~'v'~_~.-,.-'~"- Document Date: /~/,~,..~ · Signer(s) Other Than Named Above: Number °f Pages: Z<:~/~ ~< .~ ~'__-_-.~._-..,;;.~,(;~;~) C:---:.~.-"d by Ri?n,,.. Signer's Name: ~_ [] Individual [] Corporate Officer -- Title(s): [] Partner -- [] Limited [] General [] Attorney-in-Fact [] Trustee [] Guardian or Conservator [] Other: Signer Is Representing:. Top of thumb here CONSENT TO ESTATE SETTLEMENT AGREEMENT I, INGRID L. FLOOR, hereby consent to and join in the Estate Settlement Agreement relating to the Estate of IRENE M. LARSON, a copy of which Estate Settlement Agreement, including Exhibits A and B attached thereto, has been provided to me. STATE OF WASHINGTON COUNTY OF Ingrid L. F~or - ~ - :SS undersigned officer, personally appeared INGRID L. FLOOR, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunder set my hand and official seal. CONSENT TO ESTATE SETTLEMENT AGREEMENT I, CARLYN H. CHULICK, hereby consent to and join in the Estate Settlement Agreement relating to the Estate of Irene M. Laarson, a copy of which Estate Settlement Agreement, including Exhibits A and B attached thereto, has been provided to me. ~A-'I~LYN H. ICHULICt~ COMMONWEALTH OF PENNSYLVANIA COUNTY OFCUMBERLAND On this, the /~/A day of /'~'7Z- :SS : ,2004, before me, the undersigned officer, personally appeared CARLYN H. CHULICK, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunder set my hand and official seal. SUMMARY OF ACCOUNT Estate of Irene M. Larson For Period 09/04/2003 Through 08/05/2004 Principal Receipts Net Gain (or Loss) on Sales or Other Dispositions Other Receipts Less Disbursements: Administration Expenses (Prin) Funeral Expenses (Prin) Other Expenses (Prin) Balance before Distributions Distributions to Beneficiaries Principal Balance on Hand For Information: Changes in Investment Holdings Income Receipts Less Disbursements Balance before Distributions Distributions to Beneficiaries Income Balance on Hand Page 1-4 5-9 10 10 10-11 12 13 14-18 19-21 $26,365.29 11,002.06 761.15 Fiduciary Acquisition Value $642,529.02 -1,251.66 0.00 $641,277.36 38,128.50 $603,148.86 400,000.00 $203,148.86 $ 1,537.03 0.00 $ 1,537.03 0.00 $ 1,537.03 Combined Balance on Hand $204,685.89 RECEIPTS OF PRINCIPAL Estate of Irene M. Larson As of 08/05/2004 Page 1 Assets Listed in Inventory (Valued as of date of death) Checking Accounts PNC Bank Chking Acct. No.5070095044 $0.37 Accrued Interest Money Market Accounts PNC Bank Svgs Acct. No.5080034958 $6.53 Accrued Interest Smith Barney Acct. No.724-22882-10 Smith Barney Estate Acct. Refund PA Dept of Rev-PA-40 2003 Refund Closely Held Corporations Repsol Intl. Capital LTD 500 Units Common Stocks Alliancebernstain Grw & Incm Cl.A 3,134 Units Delaware Group Decatur Fd Inc. 852 Units Duquesne Lt Hldgs Inc. 600 Units PPL Corp. 1,600 Units Pimco Strategic Global Govt Fund 1,225.5533 Units $90.69 Accrued Dividend Salomon Bros High Income Fd II 2,000 Units UGI Corp. New 750 Units $213.75 Accrued Dividend Van Kampen Govt Secs Fd C1 A 2,400 Units Van Kampen U S Govt Fd C1 A 800 Units Wachovia Corp 2nd New 1,334 Units $466.90 Accrued Dividend $ 59,730.66 841.60 39.86 $ 9,684.06 13,512.72 9,153.00 65,560.00 14,546.05 23,580.00 23,332.50 24,768.00 11,288.00 57,255.28 Fiduciary Acquisition Value $ 6,322.53 60,612.12 98.00 12,637.50 252,679.61 RECEIPTS OF PRINCIPAL Estate of Irene M. Larson As of 08/05/2004 Page 2 Assets Listed in Invensory (Valued as of date of death) Mutual Funds Federated Fd for U.S.Govt Secs A 1,594.447 Units Preferred Stocks Corts Tr Bellsouth Cap Fdg Deb7.12% 1,000 Units Corts Tr II Chrysler Debs 7.875% 1,000 Units General Mtrs Accep Corp 7.30% 2,000 Units $912.50 Accrued Dividend Kramont Rlty Tr Pfd Ser D 9.5% 245 Units Bond Funds Units Penn Insd Mun Bd #5Q 30 Units Corporate Bonds General Motors Accept. Corp. 7% 30,000 Units $460.83 Accrued Interest General Motors Accept. Corp. 7.1% 14,000 Units $466.62 Accrued Interest General Motors Accept. Corp. 7.25% 10,000 Units $279.93 Accrued Interest Certificates of Deposi5 Bank HAPOALIM B.M.-NY C/D 5.3% $452.7! Accrued Inzerest Capital One Bank C/D 4.4% 6/8/05 $298.00 Accrued Inserest Miscellaneous Property Rolling Green Cemetery-2 Lots Refunds Mobile X-ray Imagin~ Verizon - phone bill refund $ 25,800.00 25,890.00 50,392.50 6,296.50 $ 28,657.23 14,326.62 9,829.93 $ 26,950.61 103,010.00 $ 20.15 6.54 Fiduciary Acquisition Value $ 12,420.74 108,379.00 5,580.90 52,813.78 129,960.61 600.00 RECEIPTS OF PRINCIPAL Estate of Irene M. Larson As of 08/05/2004 Page 3 Assets Listed in Inventory (Valued as of date of death) Accrued Liabilities Alert Pharmacy Bethany Village TOTAL INVENTORY $ -20.62 -4.00 Fiduciary Acquisition Value $ 26.69 -24.62 $642,106.86 RECEIPTS OF PRINCIPAL Estate of Irene M. Larson As of 08/05/2004 Page 4 Receipts Subsequent to Inventory (Valued when received) PNC ckg-Deposit made after DOD TOTAL RECEIPTS SUBSEQUENT TO INVENTORY SUMMARY Total Inventory Total Receipts Subsequent To Inventory TOTAL RECEIPTS OF PRINCIPAL $ 422.16 $ 422.16 $642,106.86 422.16 $642,529.02 GAINS AND LOSSES ON SALES OR OTHER DISPOSITIONS Estate of Irene M. Larson For Period 09/04/2003 Through 08/05/2004 09/23/2003 Sale of Repsoi Intl Cap Ltd 7.45% Ser A PFD- USD 500 Units Net Proceeds Fiduciary Acquisition Value Net Loss $ 12,374.41 12,637.50 09/23/2003 Sale of Bank of Hapoalim B.M.N.Y. C/D Net Proceeds Fiduciary Acquisition Value Net Loss $ 25,574.00 26,497.90 09/24/2003 Sale of asset: 1594.447 shs Federated Fd for US Gov't Secs A 1,594.447 Units Net Proceeds Fiduciary Acquisition Value Net Gain $ 12,580.19 12,420.74 09/24/2003 of Pimco Strat. Glob. Fd. Liquidation of fractional shares by broker 0.5533 Units Net Proceeds $ 6.22 Fiduciary Acquisition Value 6.50 Net Loss 09/26/2003 Sale of Alliancebernsrain Grw & Incm Cl. A 3,134 Units Net Proceeds $ 9,715.40 Fiduciary Acquisition Value 9,684.06 Net Gain 09/26/2003 Sale Tr II Chrysler Debs 7.875% 1,000 Units Gain 159.45 31.34 Page 5 Loss $ 263.09 923.90 0.28 GAINS AND LOSSES ON SALES OR OTHER DISPOSITIONS Estate of Irene M. Larson For Period 09/04/2003 Through 08/05/2004 Net Proceeds Fiduciary Acquisition Value Net Gain 26,154.76 25,890.00 09/26/2003 Sale of General Mtrs Accep Corp 7.30% 2,000 Units Net Proceeds Fiduciary Acquisition Value Net Gain $ 49,629.87 49,480.00 09/26/2003 Sale of PPL Corp. 1,600 Units Net Proceeds Fiduciary Acquisition Value Net Gain $ 65,567.47 65,560.00 09/26/2003 Sale of Van Kampen U S Govt Fd C1 A 800 Units Net Proceeds Fiduciary Acquisition Value Net Gain $ 11,360.00 11,288.00 09/26/2003 Sale of Van Kampen Govt Secs Fd C1 A 2,400 Units Net Proceeds Fiduciary Acquisition Value Net Gain $ 25,008.00 24,768.00 09/26/2003 Sale of asset: #5Q 30 Units 30 units Penn Insd Mun Bd Fd Net Proceeds Fiduciary Acquisition Value Gain 264.76 149.87 7.47 72.00 240.00 Page 6 Loss $ 5,283.30 5,174.10 Net Gain 109.20 GAINS AND LOSSES ON SALES OR OTHER DISPOSITIONS Estate of Irene M. Larson For Period 09/04/2003 Through 08/05/2004 09/26/2003 Sale of Corts Tr Bellsouth Cap Fdg Deb 7.12% !,000 Units Net Proceeds Fiduciary Acquisition Value Net Loss 25,593.79 25,800.00 09/26/2003 Sale of Duquesne Lt. Hldgs Inc. 600 Units Net Proceeds Fiduciary Acquisition Value Net Loss $ 9,016.24 9,153.00 09/26/2003 Sale of Kramont Rlty Tr Pfd Ser D 9.5% 245 Units Net Proceeds Fiduciary Acquisition Value Net Loss $ 6,269.52 6,296.50 09/26/2003 Salomon Bros High Income Fd II 2,000 Units Net Proceeds Fiduciary Acquisition Value Net Loss $ 23,028.92 23,580.00 09/26/2003 Sale of UG! Corp. New 750 Units Fiduciary Acquisition Value Net Loss $ 22,120.60 23,118.75 09/26/2003 Sale of Wachovia Corp. 2nd New 1,334 Units Net Proceeds Fiduciary Acquisition Value $ 55,334.76 56,788.38 Gain Page 7 Loss $ 206.21 136.76 26.98 551.08 998.15 Net Loss 1,453.62 GAINS AND LOSSES ON SALES OR OTHER DISPOSITIONS Estate of Irene M. Larson For Period 09/04/2003 Through 08/05/2004 09/26/2003 Sale of 1225 units Pimco Strst. Glob. Govb. Fd. 1,225 Units Net Proceeds Fiduciary Acquisition Value $ 14,286.98 14,448.86 Net Loss Gain S Page 8 Loss 161.88 10/14/2003 Sale of asset: 852 shs Delaware Decatur Equity Income Fund 852 Units Net Proceeds Fiduciary Acquisition Value Net Gain $ 13,555.32 13,512.72 42.60 11/17/2003 Redemption of asset: General Motors Acceptance Corp Smartnotes 7.1% due 9/15/12 14,000 Units Net Proceeds Fiduciary Acquisition Value Net Gain $ 14,000.00 13,860.00 140.00 11/17/2003 Redemption of asset: General Motors Accceptance Corp Smartnotes 7% due 6/16 30,000 Units Net Proceeds Fiduciary Acquisition Value Net Gain $ 30,000.00 28,196.40 1,803.60 11/17/2003 Redemption of asset: General Motors Acceptance Corp. Smartnotes 7.25% due 10/16 10,000 Units Net Proceeds Fiduciary Acquisition Value $ 10,000.00 9,550.00 Net Gain 450.00 GAINS AND LOSSES ON SALES OR OTHER DISPOSITIONS Estate of Irene M. Larson For Period 09/04/2003 Through 08/05/2004 Gain Total Gains and Losses $3,470.29 Less Gain Net Loss Page 9 Loss $4,721.95 3,470.29 $ 1,251.66 DISBURSEMENTS OF PRINCIPAL Estate of Irene M. Larson For Period 09/04/2003 Through 08/05/2004 Page 10 Administration Expenses (Prin) 09/29/2003 Carlton Hughes- reimbursement for probate expenses 12/02/2003 Register of Wills Agent Payment on account PA Inh Tax Check number 1015 05/17/2004 Keefer Wood Allen & Rahal, LLP - payment of Attorney's Dirsbursements through 4/30/04 Check number 1017 06/04/2004 Brown Shultz Sheridan Fritz - Tax Prep Check number 1019 06/08/2004 Register of Wills, Agent- Balance of PA Inheritance Tax Due Check number 1020 Funeral Expenses {Prin) 09/29/2003 West Shore Country Club - funeral luncheon Check number 1004 09/29/200~ Myers-Harner Funeral Home Check number 1005 09/29/2003 Rolling Green Cemetery - grave opening (reimbursemen% to Carlton Hughes) Check number 1006 09/29/2003 Tavern on The Hill restaurant - family dinner on the day of funeral (reimbursement to Carlton Hughes) Check number 1007 Other Expenses (Prin) 09/29/2003 Trangle Traveling Stores - debt of the decedent Check number i001 09/29/2003 Bethany Village - final bill Check number i002 $ 429.00 19,500.00 310.09 125.00 6,001.20 $ 1,007.20 8,704.00 870.00 420.86 $ 46.00 682.80 $ 26,365.29 11,002.06 DISBURSEMENTS OF PRINCIPAL Estate of Irene M. Larson For Period 09/04/2003 Through 08/05/2004 Page 11 09/29/2003 AT&T - decedent's long distance telephone charges Check number 1003 12/31/2003 Mobile X-Ray Imaging payment of account balance Check number !016 TOTAL DISBURSEMENTS OF PRINCIPAL $ 12.20 20.15 $ 761.15 $ 38,128.50 DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES Estate of Irene M. Larson For Period 09/04/2003 Through 08/05/2004 Page 12 To: Ilene L. Badke Interim distribution 10/20/2003 Smith Barney Estate Acct. Check number 1011 $100,000.00 To: Ruth L. Sarokon Interim distribution 10/20/2003 Smith Barney Estate Acct. Check number 1012 100,000.00 To: Ingrid L. Floor Interim distribution 10/20/2003 Smith Barney Estate Acct. Check number 1013 100,000.00 To: Carlyn H. Chulick Interim distribution 10/20/2003 Smith Barney Estate Acct. Check number 1014 100,000.00 TOTAL DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES $400,000.00 PRINCIPAL BALANCE ON HAND Estate of Irene M. Larson As of 08/05/2004 Page 13 Money Market Accounts Smith Barney Estate Acct. Less: Income balance on hand PRINCIPAL BALANCE ON HAND Current Value $204,685.89 $204,685.89 1,537.03 $203,148.86 Carrying Value $204,685.89 $204,685.89 1,537.03 $203,148.86 INFORMATION SCHEDULES Estate of Irene M. Larson For Period 09/04/2003 Through 08/05/2004 Page 14 Changes in Investment Holdings Alliancebernstain Grw & Incm C1.A 09/26/2003 Sale of Alliancebernstain Grw & Incm Cl. A 3,134 Units Certs Tr Bellsouth Cap Fdg Deb7.12% 09/26/2003 Sale of CorEs Tr Bellsouth Cap Fdg Deb 7.12% 1,000 Units Certs Tr II Chrysler Debs 7.875% 09/26/2003 Sale Tr II Chrysler Debs 7.875% 1,000 Units Delaware Group Decatur Fd Inc. 10/14/2003 Sale of asset: 852 shs Delaware Decatur Equity Income Fund 852 Units Duquesne Lt Hldgs Inc. 09/26 2003 Sale of Duquesne Lt. Hldgs Inc. 600 Units Federaned Fd for U.S.Govt Sees A 09/24/2003 Sale of asset: 1594.447 shs Federated Fd for US Gov'~ Secs A 1,594.447 Units General Mtrs Accep Corp 7.30% 09/09/2003 Collection of accrued interest $ 9,684.06 -9,684.06 $ 25,800.00 -25,800.00 $ 25,890.00 -25,890.00 $ 13,512.72 -13,512.72 $ 9,153.00 -9,153.00 $ 12,420.74 -12,420.74 $ 50,392.50 -912.50 0.00 0.00 0.00 0.00 0.00 0.00 INFORMATION SCHEDULES Estate of Irene M. Larson For Period 09/04/2003 Through 08/05/2004 09/26/2003 Sale of General Mtrs Accep Corp 7.30% 2,000 Units $-49,480.00 Kramont Rlty Tr Pfd Ser D 9.5% 09/26/2003 Sale of Kramont Rlty Tr Pfd Set D 9.5% 245 Units $ 6,296.50 -6,296.50 PPL Corp. 09/26/2003 Sale of PPL Corp. 1,600 Units $ 65,560.00 -65,560.00 Pimco Strategic Global Govt Fund 09/11/2003 Collection of accrued dividend 09/24/2003 of Pimco Strat. Glob. Fd. Liquidation of fractional shares by broker 0.5533 Units 09/26/2003 Sale of 1225 units Pimco Strst. Glob. Govt. Fd. 1,225 Units $ 14,546.05 -90.69 -6.50 -14,448.86 Repsol Intl. Capital LTD 09/23/2003 Sale of Repsol Intl Cap Ltd 7.45% Ser A PFD- USD 500 Units $ 12,637.50 -12,637.50 Salomon Bros High Income Fd II 09/26/2003 Salomon Bros High Income Fd II 2,000 Units $ 23,580.00 -23,580.00 Page 15 0.00 0.00 0.00 0.00 0.00 0.00 INFORMATION SCHEDULES Estate of Irene M. Larson For Period 09/04/2003 Through 08/05/2004 UGI Corp. New 09/26/2003 Sale of UGI Corp. New 750 Units 10/01/2003 Collection of accrued dividend $ 23,332.50 -23,118.75 -213.75 Van Kampen Govt Secs Fd C1 A 09/26/2003 Sale of Van Kampen Govt Secs Fd C1 A 2,400 Units $ 24,768.00 -24,768.00 Van Kampen U S Govt Fd C1 A 09/26/2003 Sale of Van Kampen U S Govt Fd C1 A 800 Units $ 11,288.00 -11,288.00 Wachovia Corp 2nd New 09/15/2003 Collection cf accrued Dividend 09/26/2003 Sale of Wachovia Corp. 2nd New 1,334 Units $ 57,255.28 -466.90 -56,788.38 General Motors Accept. 2orp. 7% 11/17/2003 Collection cf accrued Interest 11/17/2003 Redemption sf asset: General Motsrs Accceptance Corp Smartnotes 7% due 6/16 30,000 Units $ 28,657.23 -460.83 -28,196.40 General Motors Accept. /3rp. 7.1% 09/15/2003 Collection cf accrued Interest 11/17/2003 Redemption cf asset: General Motors Acceptance Corp Smartnotes 7.1% due 9/15/12 14,000 Units $ 14,326.62 -466.62 -13,860.00 Page 16 $ 0.00 0.00 0.00 0.00 0.00 0.00 INFORMATION SCHEDULES Estate of Irene M. Larson For Period 09/04/2003 Through 08/05/2004 Page 17 General Motors Accept. Corp. 7.25% 10/15/2003 Collection of accrued Interest 11/17/2003 Redemption of asset: General Motors Acceptance Corp. 7.25% due 10/16 10,000 Units Smartnotes Units Penn Insd Mun Bd ~5Q 09/25/2003 Penn Ins Mun Bd #5Q Return of Principal 09/26/2003 Sale of asset: %5Q 30 Units 30 units Penn Insd Mun Bd Fd Bank HAPOALIM B.M.-NY C/D 5.3% 09/23/2003 Sale of Bank of Hapoalim B.M.N.Y. C/D 09/23/2003 Collection of accrued interest Capital One Bank C/D 4.4% 6/8/05 09/24/2003 Collection of Cap One C/D @ DOD $101,250.00 plus accd iht $277.25 09/24/2003 Collection of Cap One C/D @ DOD $101,250.00 plus accd iht $277.25 Mobile X-ray Imaging 03/05/2004 Refund of amount not due by decedent from Mobile X-ray Imaging $ 9,829.93 -279.93 -9,550.00 $ 5,580.90 -406.80 -5,174.10 $ 26,950.61 -26,497.90 -452.71 $ 103,010.00 -102,712.00 -298.00 $ 20.15 -20.15 0.00 0.00 0.00 0.00 0.00 INFORMATION SCHEDULES Estate of Irene M. Larson For Period 09/04/2003 Through 08/05/2004 Page 18 ~ng Green Cemetery-2 Lots L4/2004 Carlton Hughes - Purchase of 2 vacant cemetery lots at $300 per lot zon - phone bill refund 29/2003 Collection of refund from Verizon 5 Pharmacy 99/2003 Alert Pharmacy any Village 27/2003 Bethany Village $ 600.00 -600.00 $ 6.54 -6.54 $ 20.62 -20.62 4.00 -4.00 0.00 0.00 0.00 0.00 RECEIPTS OF INCOME Estate of Irene M. Larson For Period 09/04/2003 Through 08/05/2004 Dividends Alliancebernstain Grw & Incm C1.A 09/26/2003 Dividend Delaware Group Decatur Fd Inc. 09/25/2003 Dividend Duquesne Lt Hldgs Inc. 10/01/2003 Dividend Federated Fd for U.S.Govt Secs A 09/29/2003 Dividend PPL Corp. 10/01/2003 Dividend Repsol Intl. Capital LTD 09/30/2003 Dividend Salomon Bros High Income Fd II 09/26/2003 Dividend Smith Barney Estate Acct. 05/14/2004 Dividend 05/14/2004 Dividend 06/11/2004 Dividend 07/30/2004 Dividend $ 31.34 Van Kampen Govt Secs Fd C1 A 10/01/2003 Dividend 10/01/2003 Dividend 25.56 150.00 60.59 616.00 232.80 230.00 80.11 99.52 79.80 97.41 356.84 $ 45.70 25.70 71.40 Page 19 RECEIPTS OF INCOME Estate of Irene M. Larson For Period 09/04/2003 Through 08/05/2004 Page 20 Van Kampen U S Govt Fd C1 A 10/01/2003 Dividend 10/01/2003 Dividend Total Dividends Interest Bank HAPOALIM B.M.-NY C/D 5.3% 09/23/2003 Collection of accrued interest Capital One Bank C/D 4.4% 6/8/05 09/24/2003 Collection of Cap One C/D @ DOD $101,250.00 plus accd iht $277.25 General Motors Accept. Corp. 7% 11/17/2003 Collection of accrued Interest General Motors Accept. Corp. 7.1% 09/15/2003 Collection of accrued Interest 11/17/2003 Interest General Motors Accept. Corp. 7.25% 10/15/2003 Collection of accrued Interest 11/17/2003 Interest PNC Bank Svgs Acct. NO.5080034958 10/03/2003 Interest received at closing of PNC Savings Account Smith Barney Acct. No.724-22882-10 09/12/2003 Interest (Citibank Bank Deposit Program) $ 25.60 14.40 40.00 $ 66.40 -1,482.75 414.17 30.38 165.67 196.05 $ 82.57 60.42 142.99 $ 18.28 0.40 1,814.53 RECEIPTS OF INCOME Estate of Irene M. Larson For Period 09/04/2003 Through 08/05/2004 09/17/2003 Interest (Citibank Bank Deposit Program) 10/10/2003 Interest (Citbank Bank Deposit Program) 11/14/2003 Interest (Citibank Bank Deposit Program) 11/18/2003 Interest (Citibank Bank Deposit Program) $ 0.07 0.32 1.08 0.06 1.93 Smith Barney Estate Acct. 10/30/2003 Interest Citibank Bank Deposit Program 03/10/2004 Misc Interest earned on Citibank Sweep funds from 9/1/03-2/29/04 03/12/2004 Interest on sweep Units Penn Insd Mun Bd %5Q 09/25/2003 Interest Total Interest TOTAL RECEIPTS OF INCOME $ 103.43 103.00 81.30 287.73 $ 77.70 Page 21 $ -277.50 $ 1,537.03 "Schedule B" Schedule of Distribution Estate of IRENE M. LARSON Combined Principal and Income Balance per Account Less Principal Reserves: Keefer Wood Allen & Rahal- Legal Fees $19,000.00 Carlton E. Hughes - Executor's Fee 10,000.00 Closing Administrative Expenses 300.00 Total Principal Reserves Proposed Distributions as follows: Ilene L. Badke $43,847.47 Ruth L. Sarokan 43,847.47 Ingrid L. Floor 43,847.47 Carlyn H. Chulick 43,847.48 Proposed Total Distribution Balance remaining $204,685.89 ($ 29,300.0O) $(175,388.89) $ 0.00 BUREAU OF INDIVIDUAL TAXES TNHERTTANCE TAX DTVTSTON DEPT. Z8060! HARR/SBURG, PA 17128-0601 COHHONHEALTH OF PENNSYLVANIA DEPARTNENT OF.REVENUE NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLO#ANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-I~4? EX AFP ROBERT R CHURCH ESQ KEEFER ETAL PO BOX 11965 HBG JUL 30 11:30 CUT ALONG THIS LINE ~ DATE 08-02-ZOOq ESTATE OF LARSON DATE OF DEATH 09-Oq-ZO0$ FILE NUHBER 21 05-07~$ COUNTY CUNBERLAND ACN 101 Aeount Rea/ttad IRENE HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF HILLS CUNBERLAND CO COURT HOUSE CARLISLE, PA 17015 RETAIN LONER PORTION FOR YOUR RECORDS REV-X547 EX AFP ¢01-03) NOTXCE OF XNHERZTANCE TAX APPRAXSENENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF LARSON IRENE N FILE NO. 21 05-07R$ ACH 101 DATE 08-02-200~ TAX RETURN NAS: (X) ACCEPTED AS F/LED ( ) CHANGED RESERVATTON CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~itl (Schedule A) 2. S~ocks and Bonds (Schedule B) $. Closely Held Stock/Partnership Interest (Schedule C) ($) q. Nortgagas/Notas Receivable (Schedule D) 5. Cash/Bank Dsposits/Hisc. Personal Property (Schedule E) (5) 6. Jo/ntly Owned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expenses/Ada. Costs/N1sc. Expanses (Schedule H) (9) 10. Debts/Nortgage L/ab/lltles/L/ans (Schedule Z) (10) 11. Total Deduct/ons 12. Nat Value of Tax Ra~urn .00 ~q~z511.55 .00 .00 198z0~2.11 .00 NOTE: To insure proper crad/t to your account, subm/t the upper port/on of th/s fore w/th your tax payment. 6~788.35 (8) 6~9,3~1.99 ql,7ql.15 785.77 (ll) ~2.526.92 (12) 606,815.07 13. lq. NOTE: Char/table/Govorneantal Bequests; Non-elected 9115 Trusts (Schedule J) (15) Net Value of EstIta Subject to Tax If an assessment ~as issued previously, lines 1~, 15 and/or 16, 17, reflect flgures that include the total of ALL returns assessed to date. 6,788.35 600,026.72 ASSESSNENT OF TAX: 15. Amount of L/ne lq at Spousal rats 16. Amount of L/ne lq taxable at L/heal/Class A rata 17. Aeount of L/ns lq at S/bl/ng rata 18. Aeount of L/ne lq taxable at Collateral/Class B rata 19. Pr/nol ~al Tax Due TAX CREDZTS PAYNENT RECETpT DTSCOUNT DATE NUHBER INTEREST/PEN PAID (- 12-02-2003 CD003303 1,050. O0 06-1~-200~ CD00~0~3 . O0 18 and 19 ~ill (is) .00 x O0 = .00 (16) 600,026.72 x OR5= 27,001.20 (17) . O0 x 12 = . O0 (18) .00 x 15 = .00 (la)= 27,001.20 AHOUNT PAID BALANCE OF UNPAID INTEREST/PENALTY AS OF 06-15-200q 19,950.00 6,001.20 TOTAL TAX CREDIT BALANCE OF TAX DUEI INTEREST AND PEN. TOTAL DUE ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 27,001.20 .00 6.60 6.60 ( IF TOTAL DUE IS LESS THAN $1, NO PAYNENT IS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 198Z -- if any futura interest in the estate is transferred in possession or enjoyment to Class B [collateral) beneficiaries of the decadent after the expiration of any estate for life or for years, the Cowaonwaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B [collateral) rata on any such futura interest. To fulfill the requirements of Section 2160 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 916`0). Detach the top portion of this Notice and submit with your payment to the Ragistar of Hills printed on the reverse side. --Make check ar money order payable to: REgXSTER OF NZLLSj AGENT A refund of a tax credit, which was not requested on the Tax Return, way be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1513). Applications ara available at the Office of the Register of Nills, any of the 23 Revenue District Offices, ar by calling the special 26`-hour answering service for forms ordering: 1-800-$6Z-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-6`6`7-30Z0 (TT only]. Any party in interest not satisfied with the appraisement, allowanca~ or disallowance 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 the PA Department of Revenue, Board of Appeals, Dept. Z810Z1, 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 [n writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax duo is paid within three (3) calendar months after the decedent's death, a five percent (SZ) discount of the tax paid is allowed. The 15Z 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 and of the tax amnesty period. This non-participation penalty is appealable in the same wanner and in the the same time per[od as you would appeal tho 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 data of payment. Taxes which became delinquent before January l, 198Z bear interest at the rate of slx (6X) percent par annum calculated at a dally rate of .000166`. All taxes which became datinquant on and after January 1, 198Z wi1! bear interest at a rate which will vary from calendar year ta calendar year with that rate announced by the PA Department of Revenue. The applicable [ntarest rates for 198Z through ZOO6` ara: Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year ~ 20Z .00056`8 '~'~'8-1991 117. .O0030Z ~ 1983 167. .0006,38 1992 9Z .00026`7 200Z 1986` llZ .000301 1993-1996, 7Z . OOOlfZ 200:5 1985 137. .000356 1995-1998 9Z .00026`7 ZOO6` 1986 IOZ .000276` 1999 7Z .000192 1987 107. .OOOZ7q ZOOO 7Z .O0019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NURBER OF DAYS DRLTNQUENT X DAILY INTEREST FACTOR Interest Daily Rate Factor 9X .O00Zq7 6Z .000166` 5Z .000137 6`Z .000110 --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 Not[ce, additional interest must be calculated. BUREAU OF ZND/V'rDUAL TAXES INHERITANCE TAX DIVISION DEPT. ZB060i HARRISBURG, PA 17128-0601 COHHONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-1607 EX AFP (01-05) ROBERT R CHURCH ESQ KEEFER ETAL PO BOX 11965 HBG PA 17108 DATE 09-13-ZOOq ESTATE OF LARSON DATE OF DEATH 09-0q-2005 FZLE NUHBER Z1 03-07~$ COUNTY CUHBERLAND ACN 101 Amount Remitted IRENE H HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF NILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credit to your account, subeit the upper portion of this fora with your tax payeent. CUT ALONG TH'rS LINE ~ RETA'rN LONER PORT'rON FOR YOUR RECORDS *-~ ESTATE OF LARSON IRENE H FILE NO. 21 05-07~3 ACN 101 DATE 09-13-Z00~ THIS STATENENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NANED ESTATE. SHO#N BELO# ZSA SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS`, THE CURRENT BALANCE,, AND,, ZF APPLICABLE`, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 08-OZ-ZO0~ PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): 27,001.20 PAYHENT DATE 12-02-2003 06-1q-200R 08-03-Z00~ RECEIPT NUMBER CD003303 CDOOqOq3 CDOOfiZ28 DISCOUNT (+) INTEREST/PEN PAID (-) 1,050.00 .00 6.60- ZF PAID AFTER THIS DATE`, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" AMOUNT PAID 6,00~:;: ZO 6.60 TOTAL TAX CREDIT 27,001.20 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR TNSTRUCTZONS. )