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Home My WebLink About04-0558TIMOTHY E. FINNERTY, ESQ. EILEEN WAGNER SOLICITOR REGISTER OF WILLS CLERK OF ORPHANS' COURT MARTY MADIGAN CHIEF DEPUTY Register of Wills Cumberland County Carlisle, Pa. 17013 In Re: Estate of Michael H. Winslow Dear Sirs: June 8, 2004 Enclosed you will find the Original Application for Letters of Administration, Death Certificate and Renunciations for the estate of Michael H. Winslow, deceased. We have taken the deposition of Rita A. Winslow as the Administratrix for the above captioned. We have been informed by the attorney of record Marlo Santilli, Jr. that this estate should be filed in your county. If you have any questions in regards to this matter please contact Mr. Santilli at (412) 297-4953 or Scott Bristol,. Assist. Probate Supervisor at (412) 350-5008. Very truly yours, Eileen Wagner Register of Wills 1 ST FLOOR, CITY-COUNTY BUILDING 414 GRANT STREET PITTSBURGH, PENNSYLVANIA 15219-2471 (412) 350-4180 Estate of also known as Deceased PETITION FOR PROBATE AND GRANT OF LETTERS MichaelH. Winslow No. 2[ '" Social Security No. 505-56-2386 Date of Death To: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania 5/30/2004 Petitioner, who is 18 years of age or older, respectfully represents and applies for: CQMPLETE 'A' OR 'B' and if necessary, Part 'C' BELOW and avers that Petitioner is entitled to the aforementioned Letters of Administration (ct.a. or d.b.n.c.t.a.) (~omplete Part "C" also) under the Last Will of the above-named Decedent dated Earl H. Winslow, Maralyn Adkins, Katheryn A.Kiger, Betty Lee Gaskill and Loren D. Winslow, father and siblings of the Decedent, having renounced State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child bom or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: n/a ~] B. Grant of Letters of Administration (d_bn.; pendente lite; durante absent/a; durante m/aoritate) Petitioner after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs as set forth below in part 'C'. [~ C. Decedent's heirs and next of kin Name Relationship Residence Earl H. Winslow Father 313 Bute Road, Uniofi~tqwn, PA 15401 Katheryn M. Winslow Mother Deceased 7/26/1984 (-:' ~ Maralyn Adkins Sister 5011 South 134t~ Str., Omaha, N~__ Katheryn A. Kiger Sister 313 Bute Road, Uniontown, PA ~401 Betty Lee Gaskill Sister Uniontown, PA ':>' Loren D. Winslow Brother 316 Nevada Street, McKeesport, P~ 15133 COMPLETE THE FOLLOWING IN ALL CASES ~ Decedent was domiciled at death in Cumberland residence at 175 Country View Estates, Newville, PA 17241 '~' (list ~'eet, number and municipality) Decedent, then 56 years of age, died May 30~ 2004 ,2004, at Decedent at death owned property with estimated values as follows: County, Pennsylvania, with his last family or principal Holy. Spirit Hospital, Camp Hill, PA (Location) (If domiciled in PA) All personal property $. (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $. situated as follows: None Unknown Wherefore, Petitioner respectfully requests the probate of the last Will presented with this Petition and the grant of letters in the appropriate form to the undersigned: ~ eq '~ Sil~nature Typed or printed name and residence ~.~ (,~ .~0,] UYK~ Rita A. Winslow, 316 Nevada Street, McKeesport, PA 15133 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner above named swears or alTn-ms that the statemems in the foregoing Petition are tree and correct to the best of the knowledge and belief of Petitioner and that, as personal representative of the Decedent, Petitioner will well and ~a-uly administer the estate according to law. Sworn to or atTmned and subscribed~J before me tllJs 5p''~ . . day of Rita A. Winslow No. Estate of Michael H. Winslow Social Security No: 505-56-2386 Date of Death: May 30, 2004 DECREE OF PROBATE AND GRANT OF LETTERS ,deceased _!.~dqD NOW, [,~ , 2004, in consideration of the - .P~tion~n the reverses satisfactory proof having been presented before me, IT IS DECREED that Letters D Testamentary ~ of Administration d.b.n.¢.t.~-; p~ndm~t¢ abs~nfi~ d~mt¢ m~nofitaI¢ om, are hereby granted to Rim A. Winslow in the above estate of Michael H. Winslow and that the instrument dated described in the Petition be admitted to probate and filed of record as the last Will of the Decedent. FEES Probate, Letters ................. Short Certificate(s) .......(tO Renunciation(s) ............(5) Affidavit(s) ................... ( ) Reg. Comp. Fee ................ JCP Fee ............................. RRC Fee ............................ Other ................................. Attomey: Marlo Santilli, Jr. (TYPE OR PPdNT) Address: Cohen & Grigsby, P.C. 11 Stanwix Slxeet, 15t~ Floor Pittsburgh, PA 15222-1319 Other ................................. $ Telephone: (412) 297-4953 TOTAL ...................... $ Supreme Court I.D. No. 38571 Receipt # ........................... $. 642173 1 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DMSION In Re: Estate of MICHAEL II. WINSLOW, Deceased. File No. R.ENUNCIATION OF RIGHT TO SERVE AS ADMINISTRATOR I, EARL H. WINSLOW, father of decedent, MICHAEL H. WINSLOW, hereby renounce my right to serve ~ Personal Representative of the Estate of MICHAEL H. WINSLOW, Deceased. Decedent died intestate on May 30, 2004. I hereby waive and renounce my right to serve as Administrator of this estate and request that the Register of Wills of Cumberland County grant Letters of Adnfinistration to R.ITA A. WINSLOW. Signed and Dated on the- / ~-¢--- day of Jane, 2004. EARL H. WlNSLOW 313 Bute Road Uniontown, PA 15401 Wimps: 829960_1 t~0 'ON bNdq~'B 1~00~z 't 'Nr/r' IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION In Re: Estate of MICHAEL H. WINSLOW, Deceased. File No. RENUNCIATION OF RIGHT TO SERVE AS ADMINISTRATOR I, MARiLYN ADKINS, Sister of decedent, MICHAEL H. W1NSLOW, hereby renounce my right to serve as Personal Representative of the Estate of MICHAEL H. WINSLOW, Deceased. Decedent died intestate on May 30, 2004. I hereby waive and renounce my right to serve as Administrator of this estate and request that the Register of Wills of Cumberland County grant Letters of Administration to RITA A. W1NSLOW. Signed and Dated on the ~ day ofJune, 2004. MARIL~ 1"4 AI)KINS 5011 South 134th St Omaha, NE Wimess: ~7.:~J7/~->7 b~ir~?cJ~- 829960_1 .DOC IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION In Re: Estate of MICHAEL H. WINSLOW, Deceased. File No. .21 - 8 RENUNCIATION OF RIGHT TO SERVE AS ADMINISTRATOR I, KATHENYN A. KIGER, sister of decedent, MICHAEL H. WINSLOW, hereby renounce my right to serve as Personal Representative of the Estate of MICHAEL H. WINSLOW, Deceased. Decedent died intestate on May 30, 2004. I hereby waive and renounce my right to serve as Administrator of this estate and request that the Register of Wills of Cumberland County grant Letters of Administration to RITA A. WlNSLOW. Signed and Dated on the (x4x'~ day of June, 2004. KACd~ERYN A~iGER ' 313 Bute Road Uniontown, PA 15401 Wimess: ~.~_Sj, L~7 &-~,~ 829960_1 .DOC IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA In Re: Estate of MICHAEL H. WINSLOW, Deceased. ORPHANS' COURT DIVISION File No. RENUNCIATION OF RIGHT TO SERVE AS ADMINISTRATOR I, BETTY LEE GASKILL, sister of decedent, MICHAEL H. WINSLOW, hereby renounce my fight to serve as Personal Representative of the Estate of MICHAEL H. WINSLOW, Deceased. Decedent died intestate on May 30, 2004. I hereby waive and renounce my right to serve as Administrator of this estate and request that the Register of Wills of Cumberland County grant Letters of Administration to RITA A. WINSLOW. Signed and Dated on the day of June, 2004. BETTY L~E GksKrLL Uniontown, PA 15401 Witness: 829960_1 .DOC IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA In Re: Estate of MICHAEL H. WINSLOW, Deceased. ORPHANS' COURT DIVISION File No. RENUNCIATION OF RIGHT TO SERVE AS ADMINISTRATOR I, LOREN D. WINSLOW, brother of decedent, MICHAEL H. WINSLOW, hereby renounce my right to serve as Personal Representative of the Estate of MICHAEL H. WINSLOW, Deceased. Decedent died intestate on May 30, 2004. I hereby waive and renounce my fight to serve as Administrator of this estate and request that the Register of Wills of Cumberland County grant Letters of Administration to RITA A. WINSLOW. Signed and Dated on the ~ ~ day of June, 2004. LOREN D. WlNSLOW 316 Nevada Street McKeesport, PA 15133 829960_1 .DOC his is to cerlifv that the information here given is correctly copied from an original certificate of domh d~i,~ Iii ! , ~:i Local Registrar. The original certificate will be forwarded to lhe State Vital Records Office for permane~t !i]t n,~ Fee for this certificate, $2.00 WARNING: It is illegal to duplicate this copy by photostat or photograph. - Local Registrar No. 77. ,~ PEFlUANENT ~ 2 9- 2 7 2 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH (Coroner) ~inslow ,. Hale "~'0 ~-' '"~& ' Michael H 4. Ma~ 30, 2004 / o.~,6/~ / Cumberland ~.East Pennsboro ~. Holy Spirit Hospital ~,~.m. J,,. (~ ~e. pve~ ~) ~E(F~. M~. ~. . I~T~R'S ~E ~s, M~, ~ ~) ~ ~ ~U ~teU I(M~m'~y'~) ~m~ I ~~~' J,4. 12:35 A .. ac. Nm7 30, 2064 .. ~¢ '~ Probable NI 1 · =~~,~ ~ ~)~ ~s~ ..................................................... ~ ~U~ .Coroa~ ~.y~,~m~.~.~..~,~.~.)~.~ ......................... ~ 3s=. ' J~.. June 1~ 2004 'M~MIN~E. (It~2~T~P.. Michael L. Norris, Coroner ~~.~.~:~!~y.~:fT~,.l~,.~..~:~.~:~.~~.~ ,~ 6375 Basehore Road, Suite ~,~ ~. . ~echanicsburt, Pa. 17050 IN THE COURT OF 'COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Michael H. Winslow, Deceased Date of Death: May 30, 2004 ORPHANS' COURT DIVISION No. 21-04-0558 .CERTIFICATION OF NOTICE UNDER RULE 5.6(a/ To the Register: I certify that notices of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules were served on or mailed to the following beneficiaries of the above-captioned estate on June 21, 2004: (attach additional sheets, if necessary) Name Mr. Earl H. Winslow Mrs. Maralyn Adkins Ms. Katheryn Ann Kiger Mrs. Betty Lee Gaskill Mr. Loren D. Winslow _Address 313 Bute Road Uniontown, PA 15401 5011 South 134th Street Omaha, NE 68137-1616 313 Bute Road Uniontown, PA 15401 C/O 313 Bute Road Uniontown, PA 15401 316 Nevada Street McKeesport, PA 15132 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: Date: June 21, 2004 None. Mario Santilli, Jr., Es~tuire Cohen & Grigsby, P.C. 15th Floor, 11 Stanwix Street Carlisle, PA 15222-1319 (412) 297-4900 Capacity: Personal Representative ___X Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENTOFREVENUE BUREAU OFJNDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-O601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV 1162 EX(11-96) NO. CD 004338 SANTILLI MARLO, ESQ. 11 STANWIX STREET 15TH FLOOR PITTSBURGH, PA 15222-1319 ....... fold ESTATE INFORMATION: SSN: 505-56-2386 FILE NUMBER: 2104-0558 DECEDENT NAME: WlNSLOW MICHAEL H DATE OF PAYMENT: 09/02/2004 POSTMARK DATE: 08/30/2004 COUNTY: CUMBERLAND DATE OF DEATH: 05/30/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 t~1,484.37 REMARKS: TOTAL AMOUNT PAID: RECEIVED OF EARL H WlNSLOW 313 BUTE RD UNIONTOWN PA 15401 $1,484.37 SEAL CHECK# 102 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS STEVEN M TOMS - MN .JASON R. FOSTER - MN REGISTER OF WILLS BALOGH BECKER, LTD. AI-FORNEYS AT LAW SEND ALL WRITI'EN REPLIES TO: 41 S00LSON MEMORIAL HIGHWAy, SUITE 200 MINNEAPOLIS, MINNESOTA 55422-4811 TELEPHONE 763-852-8440 FAX763-852-8499 TOLL-FREE 877-768-4494 CUMBERLAND COUNTy COURTHOUSE 1 COURTHOUSE SQUARE, #102 CARLISLE, PA 17013 ARIZONA OFFICE: 64 E. BROADWAY ROAD SUITE 175 TEMPE, AZ 85282 DIANA THEOS - AZ, CO SANDRA TANG -AZ, CA OF COUNSEL: LITOW LAW OFFICES, P,C. (IowA) LUSTIG, GLASER & WILSON, P.C. (MASSACHUSETTS) 11123/04 Re: In the Estate of MICHAEL H WINSLOW Probate Case No. 21-04-558 Social Security No: 505562386 Last known residence: 175 COUNTRy VIEW EST NEWVILLE, PA 17241 Our Client: CITIBANK USA, N.A. (SEARS ROEBUCK & CO) Account Number: 5121071849637818 Amount of Debt: $ 3492.74 Dear Sir or Madam: Enclosed please find a Creditor's claim to be filed in the record with the above-referenced Estate. Please return a file stamped copy of the claim in the enclosed self~addressed, stamped envelope. Thank you for your assistance. If you have any questions or if this is a duplicate claim, please call our firm toll free at 1- 877-768-4494 Cordially, Balogh Becker, Ltd. Attorneys at Law Enclosures A check for $5.00 for the filing fee. cc: Attorney for Estate Personal Representative This letter is an attempt to collect a debt and any information obtained will be used for that purpose. This letter is from a debt collector. COMMONWEALTH OF PENNSYLVANZA Zn Re: The Estate of: NO TICE OF CLAII~ COURT OF COMMON PLEAs OF CUUaERL~ND COUNTY ORPHANs, COURT DZVZSZON MICHAEL H WINSLOW Deceased Court File No: 21-04-558 TO: THE CLERK OF THE ORPHANS' COURT DZV?SZON: Notice of claim by creditor, Pursuant to Sect/on 3532(b)(2) of the Probate, Estates, and Fiduciaries Code, 20 PA.C.S.A. §3532(b)(;~). :1) Claimant's name: CITIBANK USA, N.A. (SEARS ROEBUCK & CO) c/o BALOGH BECKER LTD, 4150 OLSON MEMORfAL 2) Claimant's address: HWY,200 MINNEAPOLIS, MN 55422 877-768-4494 3) Creditor listed below is ~he $~4~2.~. Owner and holder of a claim in the amoun~ of 4) The facts upon which this claim is based: This claim is based on an account for credit evidenced by the attached Affidavit of Account Stated. 5) Decedent's address: 175 COUNTRY VIEW EST NEVILLE, PA 17241 6) Date of Death: 05/30/04 7) That the claim arose prior to the death of the decedent on or about 8) That the claim is secured by_ On behalf of the claimant, [ do Solemnly declare and a~i m rider the enalties of pedu~ that they Information and repr~sentatio mad h ein are t and Corre~ Isea A. Whitfey/Angefa M. H~hersia Lee, A~omey-in Fact Wri~en notice of claim was g yen to Persona Representative and/or his/her coun Name 316 NEVADA ST Address MCKEESPORT, PA 15133 City/State/Zip . . [e notice ~led J~s A. BALOGH - MN gARY W. BECK~R - DC, FL, IL, MN, WI* *CREDITOR'S RIGHTS SPECIALIST AMERICAN J~OARD OF CERTIFICATION CHELSF~ A. WHITLEY - MN, WI ANGELA M. HORN - MN MICHAEL D. JOHNSON -MN MARy ELLEN WEEM~N -- KS, MN, MO TH ERSlA O. LEE - MN CHAD J. BOLINSKE - MN STEV~N M. Jo~ - MN MICHAEL L. McCAIN -MN JOHN E. OLCHEFSKE - MN JASON R. FOSTER - MN MEAGAN M. PRO,ST - MN MICHAEL J. DOUGHERTY -- MN MICHAEL J). BOUNSKE - MN, OR BALOGH BECKER, LTD. ATTORNEYS AT LAW SEND ALL WRITTEN REPLIES TO: 4150 OLSON MEMORIAL HIGHWAY, SUITE 200 MINNEAPOLIS, MINNESOTA 55422-4811 TELEPHONE 763-852-8440 FAX 763-852-8499 TOLL-FREE 8??-?65-4494 REGISTER OF WILLS CUMBERLAND COUNTY COURTHOUSE 1 COURTHOUSE SQUARE, #102 CARLISLE, PA 17013 ARIZONA OFFICE: 64 E. BROADWAY ROAD SUITE 175 TEMPE, AZ 85282 DIANA THEOS - AZ, CO SANDRA TANG - AZ, CA OF COUNSEL: LITOW LAW OFFICES, P.C. (IOWA) LUSTIG, GLASER & WILSON, ?.C. (MASSACHUSETTS) 11123104 Re: In the Estate of MICHAEL H WINSLOW Probate Case No. 21-04-558 Social Security No: 505562386 Last known residence: 175 COUNTRY VIEW EST NEWVILLE, PA 17241 Our Client: CITIBANK USA, N.A. (SEARS ROEBUCK & CO) Account Number: 5121071849637818 Amount of Debt: $ 3492.74 Dear Sir or Madam: Enclosed please find a Creditor's claim to be filed in the record with the above-referenced Estate. Please return a file stamped copy of the claim in the enclosed self-addressed, stamped envelope. Thank you for your assistance. If you have any questions or if this is a duplicate claim, please call our finn toll free at 1- 877-768-4494 Cordially, Balogh Becker, Ltd. Attorneys at Law Enclosures A check for $5.00 for the filing fee. cc: Attorney for Estate Personal Representative This letter is an attempt to collect a debt and any information obtained will be used for that purpose. This letter is from a debt collector. COMMONWEALTH OF PENNSYLVANTA NO TICE OF CLAIM COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DIVISION Tn Re: The Estate of: MICHAEL H WINSLOW Deceased Court File No: 21-04-558 TO: THE CLERK OF THE ORPHANS' COURT DIVISION: Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries Code, 20 PA.C.S.A. §3532(b)(2). CITIBANK USA, N.A. (SEARS ROEBUCK & CO) 1) Claimant's name: C/O BALOGH BECKER LTD, 4150 OLSON MEMORIAL 2) Claimant's address: HWY #200 MINNEAPOLIS, MN 55422 877-768-4494 3) Creditor listed below is the owner and holder of a claim in the amount of $ 3492.74 4) 5) The facts upon which this claim is based: This claim is based on an account for credit evidenced by the attached Affidavit of Account Stated. Decedent's address: 175 0OUNTRY VIEW EST NEWVILLE, PA17241 6) Date of Death: 05/30/04 7) That the claim arose prior to the death of the decedent on or about 8) That the claim is secured by On behalf of the claimant, i do solemnly declare and aff~Fm~nder the j~enalties of perjury that they Information and representation~ mad~ hCein are t~ and correct to the best of my knowledge, information and)~lief. ,~ / ~ / ~ Dated: [ ('--~ ~" 0 41 /~/~/~1,/../ ,//~.:, ,~_ ., , _.~ Chelsea A. Whifley/Angela M. H o r n//~a~yi~i%~ ~Neenj~n/(~had Bolinske/Thersia Lee, Attorney-in-Fact Written notice of claim was given to PersonaFRepresentative and/or his/her counsel as stated below: RITA WINSLOW Name 316 NEVADA ST Address MCKEESPORT, PA 15133 City/State/ZiD , , 12 13/o'/ Date notice ~na~led IN RE ESTATE OF: MICHAEL H WINSLOW AFFIDAVIT OF ACCOUNT The undersigned, being first duly sworn deposes and states the follows: 1. Your Affiant is authorized by the Claimant as its Attorney-In-Fact to make this Affidavit. Your Affiant has reviewed the account records of the Claimant with respect to the decedent. Your Affiant is familiar with these records and accounts and reviews them as a regular part of his/her duties. 3. The Decedent purchased merchandise in the amount of $ 3492.74 evidenced by account number 5121071849637818 Further your affiant sayeth not The unpaid balance does not include any post-death late payment charges, accrued interest, collection costs or attorney's fees. Michael D. Johnson __ Mary Ellen Weeman Thersia O. Lee __ Chad J. Bolinske / 4150 Olson Memorial Highway, Suite 200 Minneapolis, MN 55422-4811 Subscribed and sworn before me This c~ dayof ?2al<J, ,2004. NOTARY PUBLIC - MINNESOTA · HENNEPIN COUNTY ) Commission Expires Jan 3t, 2006 .... '__,__ r COMMONWEALTH OF PENNSYLVANI'A NO TICE OF CLAIM COURT OF COMMON PLEAS OF CUMBERLAND .COUNTY ORPHANS' COURT DZVZSZON Zn Re: The Estate of: Court File No: 21-04-558 MICHAEL H WINSLOW Deceased TO: THE CLERK OF THE ORPHANS' COURT DZVZSZON: Notice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries Code, 20 PA.C.S.A. §3532(b)(2). CITIBANK USA, N.A. (SEARS ROEBUCK & CO) ~.) Claimant's name: CIO BALOGH BECKER LTD, 4150 OLSON MEMORIAL 2) Claimant's address: HWY #200 MINNEAPOLIS, MN 55422 877-768-4494 3) Creditor listed below is the owner and holder of a claim in the amount of $. 3492.74 4) 5) 6) 7) 8) The facts upon which this claim is based: This claim is based on an account for credit evidenced by the attached Affidavit of Account Stated. Decedent's address: 175 COUNTRY VIEW EST NEWV~LLE, PA17241 ~ Date of Death: 05/30/04 :.(~ That the claim arose prior to the death of the decedent on or abo~~ff That the claim is secured by ::~'-~ On behalf of the claimant, I do solemnly declare~nd af~'~under the penalties of perjury that they Information and representa~s ma~e/~e~'ein are tr~and correct to the best of my knowledge, information ar)(:J/~.~lief//[ ./~ ~ .~ /[ Dated: / "~ --/-- ~/~ ~/ ~//~/~/~/~//~ ( v Ch~sea A.I Whitley/Angela M. Hor~a~/Ellen Weeman/Chad Bolinske/Thersia Lee, Attorney-in-Fact Written notice of claim was given to Personal Representative and/or his/her counsel as stated below: RITA WINSLOW Name 316 NEVADA ST Address MOKEESPORT, PA 15133 City/State/,Zip ~ , ~ / I[./o~/ Date notice rr/aile~ IN RE ESTATE OF: MICHAEL H WINSLOW AFFIDAVIT OF ACCOUNT The undersigned, being first duly sworn deposes and states the follows: 1. Your Affiant is authorized by the Claimant as its Attomey-In-Fact to make this Affidavit. Your Affiant has reviewed the account records of the Claimant with respect to the decedent. Your Affiant is familiar with these records and accounts and reviews them as a regular part of his/her duties. 3. The Decedent purchased merchandise in the amount of $ 3492.74 evidenced by account number 5121071849637818 Further your affiant sayeth not The unpaid balance does not include any post-death late payment charges, accrued interest, collection costs or attorney's fees. One/l~/its attorneys: Chelsea A. Whitley __ Angela M. Horn__ Michael D. Johnson __ Mary Ellen Weeman __ Thersia O. Lee __ Chad J. Bolinske/' E 4150 Olson Memorial Highway, Suite 200 Minneapolis, MN 55422-4811 Subscribed and sworn before me This ~ dayof ~-t~. ., 2004. NOTARY PUBLIC - MINNESOTA HENNEPIN COUNTY' My Commission Expires Jan. 31.2008~ Register of Wills of CUMBERLAND County, Pennsylvania INVENTORY Estate of Michael H. Winslow No. 12-04-0558 also known as Date of Death 05/30/2004 ,Deceased SociaJ Security No. 505-56-2386 Rita A. Winslow, 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. I/We verify that the statements ma.de in this Inventory are true and correct. If We understand that talse statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities, 38571 Signature: l...\-L..,.,f Name of Attorney: Mario Santilli, Jr. 1.0. No.: Signature: Address: Cohen, 11 Stanwix St. 15th Floor Address: Cohen, 15th Fl 11 Stanwix Street Pittsburgh, PA 15222-1319 Pittsburgh, PA 15222-1319 Telephone: 412/297 -4853 Telephone: 1+12/297 -4864 Dated: j'o\v.\,'-'-(\,j~ ~';)"aU)S Description Value (See continuation page(s) attached) 1"") ) 1;1 r',,) (Atta.ch additional sheets if necessary) Total: 7,496.14 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. Prepared by the Perlrlsylvania Bar Association Copyright (0)1996 form sottwafe ol'\~Y CPSystems, Inc. Form #AW-7 (1992) INVENTORY Estate of: Date of Death: County: Michael H. Winslow 05/30/2004 Cumberland CASH: M&T Bank 100 South Spring Garden S tree t Carlisle, PA 17013- Checking Account No. 1127993 Non-interest bearing account Bank balance as of 5/28/04: $1,874.19 Less: Outstanding checks: 255.00 Bank fees: 4.50 1,614.69 M&T Bank 100 South Spring Garden S tree t Carlisle, FA 17013 - Account No. 15004201110414 Non-interest bearing account 135.25 Merit Life Insurance Company Policy No. 13493288 1,621.50 United States Treasury Anticipated 2004 income tax refund 1,190.00 Verizon Wireless - Refund 9.6L, 4,571.08 -1- PERSONAL PROPERTY: 1973 Glastron I boat - Hull Id. No. GIA07397M73H 1971 Tee Nee Boat Trailer - VIN 371160002B4 400.00 1994 Ford Sedan VINlFARP14J4RW288696 200.00 1994 Dodge Ram 1500 Pick Up VIN 387HF16Y3RM5423l9 2.000.00 2,600.00 STOCKS/LISTED: 36.855 shares Alger Funds - Large Cap Growth Class B - NASDAQ 325.06 325.06 TOTAL RECEIPTS OF PRINCIPAL. . . . . . . . . . . . . . . 7,496.14 -2- DIJ,,- we). G10 'Pd I){ .0'--:) ~?p N ?\vb 0l~CJ0 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY REV-1500 EX+(6-QO) CAPB HpRL EplO CRAC KOTK ES C P o 0 R N R D E E S N T C o M P T U A T X A T I o N FILE NUMBER 12-04-0558 D E C E D E N T COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0801 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INIT;AL) Winslow Michael H. DATE OF DEATH (MM~DO-YEAR) DO-YEAR) 505-56-2386 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMB E R REGISTER OF WILLS SOCIAL SECU RIlY NUMB E R 05 30 2004 06 20 1947 (IF APPLICABLE) SURVIVING SPOUSE'S NAM E (LAST, FIRST, AND MID OLE INITIAL) X 1. Original Return 2. Supplemental Return 4. Limited Estate 4a. Future Interest Compromise (date of death after 12-12-82) 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 3. Remainder Return hdrf~i t~f 1d2_a{~_82) 5. Federal Estate Tax Return Required 8. Total Numberof Safe Deposit Boxes o (AttachcopyofWill) (Attach copy of Trust) o 9. Litigation Proceeds Received D 10. Spousal Poverty Credit o 11. Election to tax under Sec. 9113(A) (date of death between 12-31-91 and 1-1-95) (Attach Sch 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE & CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAiliNG ADDRESS Mario Santilli, Jr. FIRM NAME (If Applicable) Cohen, 11 Stanwix St. 15th Floor Pittsburgh, PA 15222-1319 Cohen & Gri sb , P.C. TELEPHONE NUMBER R E C A P I T U L A T I o N 412 297-4853 1. Real Estate (Schedule A) (1) None 2. Stocks and Bonds (Schedule B) (2) 325 . 06 3. Closely Held Corporation, Partnership or (3) None Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (4) None 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 5,549.58 (Schedule E) 6. Jointly Owned Property (Schedule F) (6) - 0- D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) - 0- (Schedule G or L) 8. Total Gross Assets (total Li nes 1-7) (8) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 9,270.44 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 6,548.30 11. Total Deductions (total Lines 9 & 10) (11) 12. Net Value of Estate (Line 8 minus Line 11) (12) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (9,944.10) OFFICIAL USE ONLY .~ f'" 5 ,874:::64 15.818.74 (9,944.10) 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. X CHeCK Helle.IF YOU AilE l'leOUE$TlI!lQ A REFUNO > > BE SURE TO ANSWER ALL QUESTIONS ON REV x .0 0 (15) (9,944.10) x .0 45 (16) x .12 (17) X .15 (18) (19) 0.00 0.00 0.00 0.00 0.00 < < Copyright(c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address' STREET ADDRESS 175 Countrv View Estates CITY I STATE I ZIP Newville PA 17241 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 1,484.37 Total Credits (A + B + C) (2) 1,484.37 3. Interest/Penalty if applicable D. Interest E. Penalty Totallnterest/Penalty ( 0 + E ) 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 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. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check to: REGISTER OF (3) 0.00 (4) (5) (SA) (5B) AGENT 1,484. 37 0.00 0.00 0.00 1. Did decedent make a transfer and: a. retain the use or income of the property transferred; b. retain the right to designate who shall use the property transferred or its income: . c. retain a reversionary interest; or . d. receive the promise for life of either payments, benefits or care? 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES. YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Yes No ~~ o o IT] IT] o rn Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of pre parer other than the personal representative is based on all information of which preparer has any knowledge. 1 , ~ RE ROTH ER THAN REPRESENTATIVE Rita A. Winslow _ _ _~()l1~_rl' _ }-_5_ ~11_ _"=~ _ )-}, _? .t_"',"",_i_~ _ S .t_,:"".t_ _ _ _ _ _ _ _ _ __ Pittsbur h, PA 15222-1319 Cohen & Grigsby, P.C. _ _ _~()l1~_rl' _ )-}, _? .t_"''"'''j._~ _? .t__ _ ~:O_t:ll_ .F_~()()!'_ _ _ _ _ _ _ _ - -- Pittsbur h PA 15222-1319 DATE SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN J \~';). \0"; 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. 9116 (a) (1.1) (l)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2) (72 P.S. 9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(a)(1.3)], A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright(c) 2000form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) REV-1503 EX+(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Michael H. Winslow SS# 505-56-2386 05/30/2004 12-04-0558 All property Jointly-owned with right of survlvor~hlp must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 36.855 shares Alger Funds - Large Cap Growth Class B - 8.82 325.06 NASDAQ TOTAL (Also enter on line 2, Recapitulation) 325.06 (If more space is needed, insert additional sheets of the same size) Copyright (c}1996 form soHware only CPSystems, Inc. Form REV-1503 EX (Rev. 1-97) REV-15GB EX+(1-97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Michael H. Winslow FILE NUMBER 12-04-0558 Include the proceeds of litigation and the date the proceeds were received by the estate, All property jointly-owned with the right of survivorship must be disclosed on Schedule F. SS# 505-56-2386 05/30/2004 ITEM NUMBER 1 DESCRIPTION VALUE AT DATE OF DEATH 1,614.69 M&T Bank 100 South Spring Garden Street Carlisle, PA 17013 - Checking Non-interest bearing account Bank balance as of 5/28/04: Less: Outstanding checks: Bank fees: Account No. 11.27993 $1,874.19 255.00 4.50 2 M&T Bank 100 South Spring Garden Street Carlisle, PA 17013 - Account No. 15004201110414 Non-interest bearing account 1.35.25 3 United States Treasury - Anticipated 2004 income tax refund 1,190.00 4 Verizon Wireless - Refund 9.64 5 1973 Glastron I boat - Hull 1971 Tee Nee Boat Trailer Value is the sale price. Id. No. GIA07397M73H VIN 37116000284 400.00 6 1994 Ford Sedan - VIN1FARP14J4RW288696. Value based on sale price. 200.00 7 1994 Dodge Ram 1500 Pick Up - VIN 387HF16Y3RM542319. Value is -the sale price. 2,000.00 TOTAL (Also enter on line 5, Recapitulation) $ 5,549,58 (If more space is needed, insert additional sheets of the same size) Copyright(c} 1996 form sottware only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) REV-1509 EX+(1-97} COMMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Michael H. Winslow SCHEDULE F JOINTLY-OWNED PROPERTY SS# 505-56-2386 05/30/2004 FILE NUMBER 12-04-0558 If an asset was made Joint within one year of the decedent's date of death, It must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Shawn M. Winslow Nephew B. C. 175 Country View Estates Newville, PA 17241 JOINTLY-OWNED PROPERTY: LETTER ITEM FOR JOINT NUMBER TENANT 1 A DATE MADE JOINT 09/01/02 DESCRIPTION OF PROPERTY Include name of financial institution and bank account number or similar identifying number. Attach deed for jointly-held real estate. 2002 Skyline Birchfield Model 770-CT 14 x 76 Mobile Home. Owned as joint tenants with right of survivorship with Shawn M. Winslow, Decedent's nephew. Per the valuation letter attached, the entire residence had a value of $24,600 as of the date of Decedent's death. Correspondingly, the Decedent's individual one-half interest would be worth $12,300. However, there was an outstanding mortgage on the property in the amount of $29,922.68 and the Decedent's one-half share ($14,963.34) exceeds the value of his interest in the underlying property. As the mortgage was greater than the appraisal, no value is being assigned to the residence. DATE OF DEATH VALUE OF ASSET 0.00 % OF DATE OF DEATH DECO'S VALUE OF INTEREST DECEDENT'S INTEREST 50.00% 0.00 $ 0.00 TOTAL (Also enter on tine 6, Recapitulation) (If more space IS needed insert additional sheets of the same size) Copyright(c} 1996 form soltware only CPSystems, Inc. Form REV-1509 EX (Rev. 1-97) REV-1510 EX + (1-97) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESfO€:NT DECEDENT ESTATE OF Michael H. Winslow SS# 505-56-2386 05/30/2004 This schedule must be completed and fjJed jf the answer to any of questions 1 through 4 on page 2 is yes. ITEM NUMBER 1 DESCRIPTION OF PROPERTY RELAIf18~~~I~ t~ ~~~~B f~lt!JDT~~~1flllJF ~~K~\FE R. ATTACH ACOPYOFTHE DEED FOR REAL ESTATE. AIM Funds IRA Rollover - Account No. 3808470821. Account value as of Decedent's date of death was $6,672.34. Decedent was 56 years of age at death and was not disabled. Therefore, he could not withdraw funds from this account without penalty. Therefore, this asset is identified for informational purposes only with a tax value of $0.00. EXCLUSION (IF APPLICABLE) %OF DECO'S INTEREST DATE OF DEATH VALUE OF ASSET 0.00 TOTAL (Also enter on line 7, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) Copyright(c) 1996 form software only CPSystems, Inc. FILE NUMBER 12-04-0558 TAXABLE VALUE 0.00 0.00 Form REV-1510 EX (Rev. 1-97) REV-1S11 EX+(1-97) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 12-04-0558 ESTATE OF Michael H. Winslow SS# 505-56-2386 05/30/2004 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip 2. Attorney's Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent B. AMOUNT DESCRIPTION 1 FUNERAL EXPENSES: Kezmarsky Funeral Horne funeral expense for Union town funeral 3,000.00 2 Kezmarsky Funeral Home additional funeral expenses 320.00 3 Kraft Funeral Home - funeral expense for Carlisle funeral 5,051.50 4 Pechin Market - funeral luncheon 187.00 Total of Continuation Schedule(s) 264.52 Year(s) Commission Paid: 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs Cohen & Grigsby, P.C. - Miscellaneous expenses 11.95 2 Cumberland County Register of Wills Document filing fees 50.00 3 Cumberland County Register of Wills Probate expenses 91. 00 4 Cumberland Law Journal - Legal advertising 75.00 5 The Sentinal - legal advertising 129.47 6 M&T Bank - Account service fee 5.00 Total of Continuation Schedule(s) 85.00 TOTAL (Also enter on line 9, Recapitulation) $ 9, 270.44 (If more space is needed, insert additional sheets of the same size) Copyright (el 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) Estate of: Michael H. Winslow Sac See #: 505-56-2386 Date of Death: 05/30/2004 Continuation of Schedule H-A (Funeral Expenses) Item # Description Amount 5 K-Mart - funeral luncheon 80.00 6 White Swan Florist - funeral expense 84.52 7 Reverand Goldsberry - minister honorarium 50.00 8 Georgia and Roger Bricker - stipend for set-up/clean-up for funeral luncheon 50.00 264.52 Estate of; Hichael H. Winslow Sac Sec #; 505-56-2386 Date of Death; 05/30/2004 Continuation of Schedule H-B7 (Other Administrative Costs) Item # Description Amount 7 Register of Wills - Short Certificates 16.00 8 Rita A. Winslow - Reimbursement for fees paid to McKeesport Messenger Service for duplicate truck and boat trailer titles. 69.00 85.00 REV-1512 EX+(1-97) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Michael H. Winslow FILE NUMBER 12-04-0558 SS# 505-56-2386 05/30/2004 Include unrelmbursed medical expenses. ITEM NUMBER 1 DESCRIPTION National City Bank - Decedent's share of the mortgage secured by the 2002 Skyline Birchfield Model 770-CT Mobile Home owned as joint tenants with right of survivorship by the Decedent and his nephew, Shawn M. Winslow. The entire mobile home had been appraised at $24,600, however, there had been a $29,922.68 outstanding mortgage on the residence. The National City Bank mortgage was in the names of Michael H. Winslow and Shawn M. Winslow. The amount of the debt attributed to the Decedent is one-half of the difference between the outstanding mortgage and the appraised value or one-half of $5,322.68. AMOUNT 2,661.34 2 Royer's Gulf Service - paid Dodge truck repairs contracted for prior to Decedent's death 499.84 3 Discover Financial Services, Inc. - Account No. 6011298636822573 1,792.00 4 Holy Spirit Hospital Account No. 23315104 35.00 5 Holy Spirit Hospital Account No. 23300858 3.18 6 Verizon - Account No. 1276422 27.68 7 West Shore EMS Carlisle Ambulance service provided 5/27/2004 941.88 8 West Shore EMS - Carlisle - Ambulance service provided 5/29/2004 587.38 TOTAL (Also enter on hne 10, Recapitulation) $ 6,548.30 (If more space is needed. insert additional sheets of the same size) Copyright (c) 1996 'arm sottware only CPSystems. Inc. Form REV-1512 EX (Rev. 1-97) REV-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INH ERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Michael H. Winslow 05/30/2004 SS# 505-56-2386 NUMBER 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [Include Dutnghtspousal distributions, and transtersunder Sec. 9116(a)(1.2)] RELATIONSHIP TO DECEDENT Do Not List Trustee(s) 1 Earl H. Winslow 313 Bute Road Uniontown, PA 15401 Father FILE NUMBER 12-04-0558 AMOUNT OR SHARE OF ESTATE ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET 11. NON TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) Copyright(c) 2000 form software only The Lackner Group, Inc. 0,00 Form REV-1513 EX (Rev. 9-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96} :ECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SANTILLI MARIO, ESQ. 11 STANWIX STREET 15TH FLOOR PITTSBURGH, PA 15222-1319 __~~_n_ fold ESTATE INFORMATION: SSN: 505-56-2386 FILE NUMBER: 2104-0558 DECEDENT NAME: WINSLOW MICHAEL H DATE OF PAYMENT: 09/02/2004 POSTMARK DATE: 08/30/2004 COUNTY: CUMBERLAND DATE OF DEATH: 05/30/2004 NO. CD 004338 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,484.37 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: RECEIVED OF EARL H WINSLOW 313 BUTE RD UNIONTOWN PA 15401 CHECK#102 SEAL INITIALS: JA RECEIVED BY: TAXPAYER $1,484.37 GLENDA FARNER STRASBAUGH REGISTER OF WILLS AUG-25-2004 07:53 AM MEALS. 249 1547 P.02 Meals Mobile Home Sales 1300 Ritner Highway Carlisle, PA 17013 Phone: (717) 249-5446 Fax: (717) 249-1547 August 24, 2004 RE: Estate of Michael Winslow To Whom It May Concern: 2002 Skyline Birchfield Model77O-CT 14x76 Mobile Home. Serial Number 49- 11-051o-P. The appraised value of this home is $24.600.00. If you have any questions or need any further information, please do not hesitate to contact me at 717-249-5446. Sincerely, ~~~ Owen E. Meals OM/jh Estate valuation Date of Death: Valuation Date: Processing Date: 0513012004 05130/2004 06/21/2004 Shares or Par Security Description High/Ask 11 150.27 AIM EQUITY FDS INC {001413855i ABCBX) BLUE CHIP B Mutual Fund (as quoted by NASDAQ) OS/28/2004 21 80.203 AIM EQUITY FDS INC {00l413772i CSTBX} CONSTELLTION 8 Mutual Fund (as quoted by NASDAQ) OS/28/2004 31 117.093 AIM INTL FDS INC (008882508; AIEBX) INTL GRW CL B Mutual Fund (as quoted by NASDAQ) OS/28/2004 41 109.873 AIM FDS GROUP (008879751; AGWBX) SELECT EQTY B Mutual Fund (as quoted by NASDAQ) OS/28/2004 Total Value Total Accrual Total $6,672.34 Page 1 Low/Bid 10.61000 Mkt 20.15000 Mkt 15.95000 Mkt 14 .51000 Mkt Estate of: Michael E. Winslow Account: AIM Funds IRA Report Type: Date of Death Number of Securities: 4 File 10: 9997.0591-Mike Mean and/or Div and Int security Adjustments Accruals Value 10.610000 1,594.36 20.150000 1,616.09 15.950000 1,867.63 14.510000 1,594.26 $6,672.34 $0.00 This report was produced with EstateVal, a product of Estate valuations & pricing Systems, Inc. If you have questions, please contact EVP Systems at {BIB) 313-6300 or www.evpsYS.com. (Revision 7.0.3) Estate Valuation Date of Death: Valuation Date: Processing Date: 05130/2004 05130/2004 01/14/2005 Account: Estate of: Michael H. Winslow Alger Account No. 500208293-00 Report Type: Date of Death Number of Securities: 1 File 1D: 9997.0519 Shares or Par Security Description Hi9h/Ask Low/Bid Mean and/or Div and Int Security Adjustments Accruals Value 11 36.855 ALGER FDS (015565609; AFGPX) LRG CAP GRW B Mutual Fund (as quoted by NASDAQ) 05/28/2004 8.82000 Mkt 8.820000 325.06 Total Value Total Accrual Total $325.06 $325.06 $0.00 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 1.0.4) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAL ~_ ~ c _ cc, " n,__, ,-APPRAISENENT, ALLOWANCE OR DISALLOWANCE IHfERITAHCE TAX DIVISION , J ~ r -_, ~j fll/t UfOF DEDUCTIONS AND ASSESSltENT OF TAX PO BOX 280601 HARRISBURG PA 17128-0601 r:: 2UOf:<;May I;:. UU rtH V DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 05-09-2005 WINSLOW 05-30-2004 21 04-0558 CUMBERLAND 101 rl 2: 4/ CLERK F ~RQH""'" C l,.!RT MARIO SAN ,JfJ.:~:~,~li~ ;":: C/O COHEN "GRIGSlIY' Ii, Pll, 11 STANWIX ST 15TH F PGH PA 5222-1319 Anount R..itted * REV-lS47 EX AFP (03-05) MICHAEL H MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS ~ 1UV-"J.'g'~"Yf.'xlwm~'.'tM .!II!".!NIl!It'l"t'~M!I!'.mr.l'lll'AlTftMMf~.'lrCt!l\l'~M!I!'.Ilyt'.............. ... DIS LLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WINSLOW MICHAEL H FILE NO. 21 04-0558 ACN 101 DATE 05-09-2005 I~ an assessment as issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures t at include the total of abb returns assessed to date. ASSESSMENT OF TAX: 15. _t of Lin. 14 .t S 115) 16. ~t of Lin- 14 t. 1_.t Lin..l/Class A rat. (16) 17. AIIount of Li"" 14 .t S ling ~.t. 117) 18. Anount of Line 14 tax 1. at Collateral/Cles5 Brat. (18) 19. Principal Tax Due C I ) CHANGED RESERVATION CONCERNING FU RE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN ASED ON: ORIGINAL RETURN 1. R..l Est.t. (Schedul. A 2. Stocks end Bond. I 1. B) 3. Closely Hald Stock/Part arship Interest (Schedule C) 4. KortgagesINotas Receive 1. (Schedule D) S. Cash/Benk Deposits/Hisc Personal Property (Schedule E) 6. Jointly Owned Prope~ty Schodul. F) 7. Transf.rs (Schedule $) 8. Total Assets 11) (2) (3) (4) IS) (6) (7) .00 325.06 .00 .00 5.549.58 .00 .00 (8) APPROVED DEDUCTIONS AND E EMPTIONS: 9. FUl"Mlral ExP8I\ses/Act.. sts/Misc. Expenses (Schedule Hl 10. Dobts/"o~tgeg. Lisbilit ../Li.,. ISch8dul. I) 11. Total Deductions 12. Net V.lue of Tax R.t rn 13. Charitable/Gov.rnm.n _I Bequests; Non-elected 9113 Trusts 14. Net Value of Est.t. ject to Tax (9) (10) 9,270.44 6.548.30 Ill) 112) 113) 114) ISch.dul. J) NOTE: .00 X .00 X .00 X .00 X INTEREST/PEN PAID (-) .00 . AIlOUIIT PAID 1,484.37 DATE 08-30-2004 ~ TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE NOTE: To insure proper cr~it to your accountl subnit the _~ por'Uon of this for. with your tax paYltlmt. 5,874.64 lli.81A 74 9,944.10- .00 9,944.10- 00 = 045 = 12 = 15 = .00 .00 .00 .00 .00 119)= 1,484.37 1,484.37CR .00 1, 484. 37CR . IF PAID AFTER DATE INDICAT , SEE REVERSE FOR CALCULATION OF ADDITI L INTEREST. I IF TOTAL DUE IS LESS THAN $1, NO PAY"ENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YDU "AY BE DUE A REFUND. SEE REVERSE SIDE OF T"IS FOR" FOR INSTRUCTIONS.) . IN THE COURT OF COMMON PLEAS OF ALLEGHENY COUNTY, PENNSYLVANIA INRE: ORPHANS' COURT DIVISION ESTATE OF MICHAEL H. WINSLOW, No. 12-04-00558 DECEASED FIRST AND FINAL ACCOUNT AND STATEMENT OF PROPOSED DISTRIBUTION Filed on Behalf of: Rita A. Winslow, Administratrix Counsel of Record for this Party: Mario Santilli, Jr., Esquire PA J.D. No. 38571 Cohen & Grigsby, P.C. Firm No. 621 II Stanwix Street 15th Floor Pittsburgh, PA 15222 (412) 297-4900 r.:? . . 933072_. .DOC COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 12-04-00558 ESTATE OF MICHAEL H. WINSLOW, DECEASED ACCOUNT OF RITA A. WINSLOW, ADMINISTRATRIX ------------------------------------------------- ---------------------------------------------------- Date of Death: May 30, 2004 Date of Administrator's Appointment: June 15, 2004 Date of First Advertisement of Letters: July 30, 2004 Accounting for the Period: May 30, 2004 to May 31,2005 ------------------------------------------------ ---------------------------------------------------- Purpose of Account: Rita A. Winslow offers this account to acquaint interested parties with the transactions that have occurred during this administration. Annexed to the Account is the Accountant's Statement of Proposed Distribution. It is important that the account be carefully examined. Requests for additional information or questions or objections can be discussed with: Mario Santilli, Jr., Esquire Attorney Identification No. Cohen & Grigsby, P.C. 11 Stanwix Street, 15th Floor Pittsburgh, P A 15222-1319 412-297-4900 GROSS ESTATE: (Principal Receipts + Income Receipts) $7.970.70 SUMMA~ OF ACCOUNT Estate of Michael H. Winslow, Deceased For Period of 05/30/2004 through 05/31/2005 Page Current Value Proposed Distributions to Beneficiaries 0.00 PRINCIPAL Receipts: Per Inventory Filed 1-2 Subseq Prn Receipts Net Gain (or Loss) on Sales or Other Disposition 3 Less Disbursements: Debts of Decedent 4 Funeral Expenses 5 Administration Expenses 6 Federal and State Taxes Fees and Commissions Family Exemption 3,886.96 8,823.02 579.42 0.00 0.00 0.00 Balance before Distributions Distributions to Beneficiaries Principal Balance on Hand 7 For Information: Investments Made Changes in Investment Holdings 8 INCOME Receipts: This Account Net Gain (or Loss) on Sales or Other Disposition Less Disbursements Balance Before Distribution Distributions to Beneficiaries Income Balance on Hand Investments Made Changes in Investment Holdings COMBINED BALANCE ON HAND Fiduciary Acquisition Value 0.00 7,970.70 8,823.02 (9.95) 16,783.77 13,289.40 3,494.37 0.00 3,494.37 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,494.37 SCHEDULE A RECEIPTS OF PRINCIPAL CASH: 02/23/05 AAA - membership refund 05/30/04 Landis, Inc. - Final payroll check 05/30/04 M&T Bank 100 South Spring Carden Street Carlisle, PA 17013 - Checking Account No. 1127993 Non-interest bearing account 05/30/04 M&T Bank 100 South Spring Garden Street Carlisle, PA 17013 - Account No. 15004201110414 Non-interest bearing account 05/30/04 Merit Life Insurance Company Policy No. 13493288 02/28/05 United States Treasury - 2004 income tax refund 10/20/04 Verizon Wireless - Refund PERSONAL PROPERTY: 05/30/04 1973 Glastron I boat - Hull Id. No. GIA07397M73H 1971 Tee Nee Boat Trailer - VIN 37116000284 -1- 20.92 453.64 1,614.69 135.25 1,621. 50 1,190.00 9.64 400.00 Fiduciary Acquisition Value 5,045.64 05/30/04 05/30/04 05/30/04 06/30/04 1994 Ford Escort Sedan - VIN1FARP14J4RW288696. Administratrix has been unsuccessful in her attempts to sell this vehicle. 1994 Dodge Ram 1500 Pick Up - VIN 387HF16Y3RM542319 STOCKS/LISTED: 36.855 shares Alger Funds - Large Cap Growth Class B - NASDAQ SUBSEQUENT PRINCIPAL RECEIPTS: Earl H. Winslow - Non-interest loan to estate to enable proper funeral and burial 200.00 2,000.00 325.06 8,823.02 TOTAL RECEIPTS OF PRINCIPAL.... ........ ... -2- 2,600.00 325.06 8,823.02 16,793.72 07/09/04 02/05/05 02/26/05 SCHEDULE B GAINS AND LOSSES ON SALES OR OTHER DISPOSITIONS - PRINCIPAL Gain 36.855 shares Alger Funds - Large Cap Growth Class B - Sale Net Proceeds Fid. Acq. Value 315.11 325.06 1994 Dodge Ram 1500 Pick Up - VIN 387HF16Y3RM5423l9 Net Proceeds Fid. Acq. Value 2,000.00 2,000.00 0.00 1973 Glastron I boat - Hull Id. No. GIA07397M73H 1971 Tee Nee Boat Trailer - VIN 37116000284 Net Proceeds Fid. Acq. Value 400.00 400.00 0.00 TOTAL GAINS AND LOSSES/PRINCIPAL.. ..... .... 0.00 LESS LOSS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.95 NET GAIN OR LOSS. . . . . . . . . . . . . . . . . . . . . . . . . . . (9.95) -3- Loss 9.95 9.95 05/30/04 05/30/04 05/30/04 05/30/04 05/30/04 05/30/04 06/01/04 SCHEDULE C DISBURSEMENTS OF PRINCIPAL SCHEDULE C-l DEBTS OF DECEDENT Discover Financial Services, Inc. - Account No. 6011298636822573 - unpaid - Discharge of debt requested Holy Spirit Hospital - Account No. 23300858 - unpaid - Discharge of debt requested Holy Spirit Hospital - Account No. 23315104 - unpaid - Discharge of debt requested Verizon - Account No. 1276422 - unpaid - Discharge of debt requested West Shore EMS - Carlisle - Ambulance service provided 5/27/2004 - unpaid - Discharge of debt requested West Shore EMS - Carlisle - Ambulance service provided 5/29/2004 - unpaid - Discharge of debt requested Royer's Gulf Service - Dodge truck repairs contracted for prior to Decedent's death - paid by family to secure release of truck - truck was subsequently sold and proceeds deposited to estate checking account. 1 , 792 . 00 3.18 35.00 27 .68 941.88 587.38 499.84 TOTAL DEBTS OF DECEDENT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . -4- 3,886.96 05/30/04 05/30/04 05/31/04 06/01/04 06/01/04 06/01/04 06/01/04 06/01/04 05/31/05 SCHEDULE C-2 FUNERAL EXPENSES Kezmarsky Funeral Home - additional funeral expenses 320.00 Kezmarsky Funeral Home - funeral expense for Uniontown funeral 3,000.00 Kraft Funeral Home - funeral expense for Carlisle funeral 5,051. 50 White Swan Florist - funeral expense 84.52 K-Mart - funeral luncheon 80.00 Georgia and Roger Bricker stipend for set-up/clean-up for funeral luncheon 50.00 Pechin Market - funeral luncheon 187.00 Reverand Goldsberry minister honorarium 50.00 All funeral expenses were paid via the loan made to the Estate reflected in the Account by Decedent's Father, Earl Winslow. The funds and Estate assets remaining at the close of the administration will be used to reimburse Mr. Winslow in part. 0.00 TOTAL FUNERAL EXPENSES.......... ..... .., ............ -5- 8,823.02 06/25/04 07/20/04 07/20/04 11/17/04 01/11/05 01/13/05 02/07/05 02/22/05 OS/26/05 SCHEDULE C-3 ADMINISTRATION EXPENSES M&T Bank - Account service fee 5.00 Cumberland County Register of Wills - Probate expenses 91.00 Cumberland Law Journal legal advertising 75.00 Cohen & Grigsby, P.C. Miscellaneous expenses 11.95 Rita A. Winslow - Reimbursement for fees paid to McKeesport Messenger Service for duplicate truck and boat trailer titles. 69.00 The Sentinal - legal advertising 129.47 Register of Wills - Short Certificates 16.00 Cumberland County Register of Wills - Document filing fees 52.00 Register of Wills - Account filing fee and advertising 130.00 TOTAL ADMINISTRATION EXPENSES.............. ... ... ... TOTAL DISBURSEMENTS OF PRINCIPAL..... ... ............ -6- 579.42 13,289.40 PRINCIPAL BALANCE ON HAND # Units Description Estate Checking Acct. Unpaid bill account 1994 Ford Escort Sedan .7. Current Value or as Noted 4,181.33 (886.96) 3 ,294.37 Fiduciary Acquisition Value 4,181.33 (886.96) 200.00 3,494.37 SCHEDULE F CHANGES IN INVESTMENT HOLDINGS - PRINCIPAL Cost 1973 Glastron I boat - Hull Id. No. GIA07397M73H 1971 Tee Nee Boat Trailer - VIN 37116000284 05/30/04 02/26/05 inventoried sold 400.00 (400.00) 0.00 1994 Ford Escort Sedan 05/30/04 inventoried 200.00 200.00 1994 Dodge Ram 1500 Pick Up 05/30/04 02/05/05 inventoried sold 2,000.00 (2,000.00) 0.00 Alger Funds - Large Cap Growth Class B 05/30/04 07/09/04 36.855 shares inventoried (36.855)shares sold 325.06 (325.06) o 0.00 -8- IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE ESTATE OF MICHAEL H. WINSLOW, Deceased. No. 12-04-0558 INTESTACY STATEMENT OF PROPOSED DISTRIBUTION To the Honorable, the Judges of said Court: Rita A. Winslow, Administrator of the Estate of Michael H. Winslow, Deceased, through her counsel, Mario Santilli, Jr., of Cohen & Grigsby, P.c., respectfully represents that: I. Michael H. Winslow (the "Decedent"), died on the 30th day of May, 2004, intestate, domiciled in Pennsylvania and residing at 175 Country View Estates, Newville, P A 17241. Letters of Administration on his estate were granted on the June 15, 2004. Complete advertisement of letters was made in the Cumberland Law Journal and The Sentinel, the first publication having been made on the 30th day of June, 2004 and on the 19th day of January, 2005, respectively, more than four months before the filing of the account. Proofs of publication marked Exhibit "A" and "A-l" are attached. An inventory, a certified copy of which is hereto attached and marked Exhibit "B", was filed on the 24th day of February, 2005. 2. The family exemption was not claimed as there were no eligible family members. 3. Accountant has given written notice of the filing of the account to every unpaid creditor who has given written notice of his claim to the accountant or her attorney of record. The following is a list of all creditors, together with the amounts of their claims and the extent to which Petitioner proposes making payment of such claims (see Notices attached and marked Exhibit "C"): 1. Name Estate Information Services, Inc. on behalf Of Discover Financial Services, Inc. 5330 East Main Street, Suite 200 Davis Professional Buildings Columbus,OH 43213 Amount of Claim $1,792.00 Proposed Payment None 2. 3. 4. 5. 6. Name West Shore EMS-Carlisle 205 Grandview Avenue, Suite 211 Camp Hill, P A 17011 West Shore EMS-Carlisle 205 Grandview Avenue, Suite 211 Camp Hi\1, P A 17011 HSBC on behalf of Holy Spirit Hospital 118 Lukens Drive New Castle, DE 19720 Verizon Wireless Executive Relations PO Box 553 Warrendale, PA 15086 Holy Spirit Hospital 503 N. 21st Street Camp Hill, P A 170 II Amount of Claim $941.88 Proposed Payment None $587.38 None $35.00 None $27.68 None $3.18 None 4. (a) A copy of the account does not need to be filed with the Department of Revenue of the State of Pennsylvania in accordance with Section 6, Rule 7 of the Orphans' Court Rules of the Supreme Court of Pennsylvania. (b) Decedent was not maintained in an institution. (c) There is no charitable interest involved. 5. A copy of the account does not need to be filed with the United States Veterans Administration in accordance with Section 6, Rule 8 of the Orphans' Court Rules of the Supreme Court of Pennsylvania. 6. All parties, other than the creditors, known to the accountant to have an interest in the estate as heirs or next of kin, have had written notice of the filing of the account. territory; 7. (a) The beneficiary is sui juris. (b) There are no parties who are enemy aliens or residents of enemy occupied ( c) The beneficiary is not in the military service ofthe United States; (d) The Accountant is not acting in a dual fiduciary capacity. 8. (a) The estate is subject to the payment of a transfer inheritance tax to the Commonwealth of Pennsylvania and the tax has been paid and the Inheritance Tax return has been appraised by the Department of Revenue. -2- (b) The estate is not subject to the payment of a federal estate tax. ( c) The estate is not subject to the payment of a Pennsylvania estate tax. 9. (a) Decedent was not married at the time of his death. (b) There was not a marriage settlement. (c) Decedent had no children. 10. At the time of his death the decedent was not known to be a fiduciary of an estate. 11. The name of all persons having interests as legatees, next of kin, devisees, or heirs, including adopted children with names of parents of all children if necessary to show relationship, are as follows: Earl H. Winslow 313 Bute Road Uniontown, PA 15401 Father Sui juris 12. The balance for distribution is cash. 13. There are matters requiring adjudication: (a) Approve payment of the balance of the Estate's assets to Earl Winslow in partial satisfaction of loan and to pay funeral bills, a Category 3 Claim per 20 Pa.C.S. 93392. (b) Discharge of the following debts of the Decedent as the Estate's assets are insufficient to satisfy priority claims: Estate Information Services, Inc., on behalf of Discover Financial Services, Inc. $1,792.00 West Shore EMS - Carlisle $941.88 West Shore EMS - Carlisle $587.38 HSBC on behalf of Holy Spirit Hospital $35.00 Verizon Wireless $27.68 Holy Spirit Hospital $3.18 -3- 14. The accountant is the Petitioner. WHEREFORE, your petitioner prays that distribution be awarded by the Court to the parties entitled thereto as hereinabove set forth. COHEN & GRIGSBY, P.C. By ~~ Counsel for Petitioner -4- CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, P A 17013 AUGUST 13, 2004 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Cohen & Grigsby, P.C. RE: Michael H. Winslow, ESTATE Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. --------------------------------------------------------------------- --------------------------------------------------------------------- Advertisement inserted on following dates: JULY 30, AUGUST 6, 13,2004 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment Received $ 75.00 Total Amount Due $ 0.00 --------- --------- Payment received JULY 26. 2004 by Beckv H. Morgenthal/Executive Director ~ EXHIBIT i ?1 I PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L,1784 STATE OF PENNSYLVANIA : ss. COUNTY OF CUMBERLAND : Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, V1Z: JULY 30, AUGUST 6, 13, 2004 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. Winslow, Michael H., dec'd. Late of Newville. Administratrix: Rita A. Winslow, c/o Cohen & Crigsby, p,e., 15th Floor, 11 Stanwix Street, Pitts- burgh. PA 15222-1319. Attorneys: MaJia Santilli. Jr.. Es- quire, Cohen & Grigsby, P.C., 15th Floor, 11 StanWix Street, Pittsburgh. PA 15222-1319. TO AND SUBSCRIBED before me this 13 day of AUGUST 2004 S AL SEAL LOIS E. SNYDER, Notary Public Carlisle Bora, Cumbef1and County My Commission Expires March 5, 2005 REMITTANCE ADDRESS 1 BILL TO THE SENTINEL - LEGAL COHEN & GRIGSBY P.O. BOX 130, CARLISLE, PA 17013 AD NUMBER I CLASS SALESPERSON BILliNG DATE LINES 269663 10 PUBLIC NOTICES 28 02/02/05 36 * 2 AD DESCRIPTION START DATE STOP DATE ADMINISTRATRIX NOTICE LETTERS OF A 01/19/05 02/02/05 PUBL leA nON INSERTIONS RATF NET AMOUNT GROSS AMOUN r 3 THE SENTINEL - LEGAL 3 LGL FLAT CHARGE FC 123.12 TOTAL AD CHARGE 123.12 3 PROOF OF PUBLICATION 01PRF 6.35 PREVIOUSLY PAID -129.47 DAYS RUN PURCHASE ORDER PAY THIS AMOUNT .00 .00* Michael Winslow RETAIN THIS PORTION FOR YOUR RECORD? "* AFTER 03/04/05 MESSAGE" Thank you for advertising with The Sentinel. Deadlines for in-column legal advertisements: Monday is Friday at 11 a.m.; Tuesday is Friday at 4 p.m.; Wednesday is Monday at 12 Noon; Thursday is Tuesday at 12 Noon; Friday is Wednesday at 12 Noon; Sunday is Thursday at 12 Noon. If you have any questions regarding your Legal bill please call Tammy Shoemaker 243-2611, ext 203. Fax your legals to 243-3754, attention Tammy Shoemaker You can also EMAIL your1egaltoClassifiedads:classified@cumberlink.com Please send a cover letter including your name and address as an attachment DETACH AND RETURN THIS PORTION WITH YOUR PAYMENT THE SENTINEL - LEGAL POBOX 130 CARLISLE PA 17013 Michael Winslow AD NUMBER ClASSO START DA TE STOP DATE 269663 PUBLIC NOTICES 01/19/05 02/02/05 AD DESCRIPTION BILLING DATE TELEPHONE NUMBER ADMINISTRATRIX NOTICE LETTERS OF A 02/02/05 412-297-4900 --- GROSS AMOUNT OF .00 DUE AFTER 03/04/05 COHEN & GRIGSBY 11 STANWIX ST. 15TH FLOOR PITTSBURGH, PA 15222 - TOTAL AMOUNT~ .00 ENTER AMOUNT ENCLOSED ~ EXHIBIT g -1lL J * J5222R-> 20200000002696630000000000000000000000000000007 PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland Tammv Shoemaker, Classified Sales Manager , of The Sentinel, of the County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a newspaper of general circulation in the Borough of Carlisle, County and State aforesaid, was established December 13th, 1881, since which date THE SENTINEL has been regularly issued in said County, and that the printed notice or publication attached hereto is exactly the same as was printed and published in the regular editions and issues of THE SENTINEL on the following daters 'anuarv 19 26 and Februarv 02 2005 _~________)____,___~_.,._.__L______._.__.__._.__._.._____.......__..-----.,1"_____..______ COPY OF NOTICE OF PUBLICATION ADMINISTRATRIX ~ Letters of Administration on the Estate of MICHAEL H. WINSLOW, late at the Borough of Newville, Cumberland County, Pennsylvania, deceased, have been granted to the undersigned. . . All persons knowing themselves to be mdebted to said Estate will make payment immediately, and thOse having claims will present them for settlement to: Rita A. Winslow. Administratrix c/o Cohen & GrigsbY, P.C. Attorneys 15th Floor, 11 StanwixStreet Pittsburgh, PA 17222-1319 aria: Mario Santilli, Jr., Esquire Cohen & Grigsby, P.C., Attorneys 15th Floor, 11 Stanwix Street Pittsburgh, PA 15222-1319 Affiant further deposes that he/ she is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statement as to time, place and character of p1lication are tru A d) (I, I_J ~--=-JOvmI1U -lAY' <J:1)01"- Sworn to and subscribed before me this (t~!l(! day of F~~h.tlJ"J:YLfQQ." (litLi$1Aa) 'fl. ~~ Notary Pu ic My commission expires: 9/I/tJf ~"":i':,: (L',:/J\:.'\ Register of Wills of CUMBERlAND County, Pennsylvania INVENTORY Estate of Michael H. Winslow No. 12-04-0558 also known as Date of Death 05/30/2004 , Deceased Social Security No. 505-56-2386 Rita A. Winslow, 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 opposjte~ 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. I /We verify that the statements made in this Inventory are true and correct. l/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. 38571 Personal ~epresentative J' . Signaru~ hLQ .lt~~J Ri a A. winslow Signature: Name of Attorney: Mario Santilli, Jr. 1.0. No.: Address: Cohen, 11 Stanwix St, 15th Floor Address: Cohen, 15th F1 11 Stanwix Street Pittsburgh, PA 15222-1319 Pittsburgh, PA 15222-1319 Telephone: 412/297 -4853 Telephone: 412/297 -4864 Dated: _1 Q ~"'LWlJ\J..~ ,., d, ~ lOco, Description Value 'r i~ is c,.?:'~';jf,_?d 1C\~~ 2. r~~~~~.;~l (See continuation page(s) attached) (Attach additional sheets if necessary) Total: 7,496.14 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal rep include the value of each item, but such figures should not be extended into the total of the Inventory. ~ ! I {\\ EXHIBIT Prepare a by the Pennsylvania Bar Associatiol1 Copyright(c) 1996 iorm software only CPSystems, Il1c. Estate of: Date of Death: County: INVENTORY Michael H. Winslow 05/30/2004 Cumberland CASH: M&T Bank 100 South Spring Garden Street Carlisle, PA 17013- Checking Account No. 1127993 Non-interest bearing account Bank balance as of 5/28/04: $1,874.19 Less: Outstanding checks: 255.00 Bank fees: 4.50 1,614.69 M&T Bank 100 South Spring Garden Street Carlisle, PA 17013- Account No. 15004201110414 Non-interest bearing account 135.25 Merit Life Insurance Company Policy No. 13493288 1,621.50 United States Treasury Anticipated 2004 income tax refund 1,190.00 Verizon Wireless - Refund 9.64 4,571.08 -1- PERSONAL PROPERTY: 1973 Glastron I boat - Hull Id. No. GIA07397M73H 1971 Tee Nee Boat Trailer - VIN 37116000284 400.00 1994 Ford Sedan VINIFARPl4J4RW288696 200.00 1994 Dodge Ram 1500 Pick Up - VIN 387HFl6Y3RM542319 2,000.00 2,600.00 STOCKS/LISTED: 36.855 shares Alger Funds - Large Cap Growth Class B - NASDAQ 325.06 325.06 TOTAL RECEIPTS OF PRINCIPAL. . . . . . . . . . . . . . . 7,496.14 - 2- 972006_1:DOC IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION In Re: Estate of Michael H. Winslow No. 12-04-00558 NOTICE OF FILING ACCOUNT AND CALL FOR AUDIT TO: Estate Information Services, Inc., on behalf of Discover Financial Services, Inc. 5330 East Main Street, Suite 200 Davis Professional Buildings Columbus,OH 43213 PLEASE TAKE NOTICE that the First and Final Account of this matter was filed in the Office of the Register of Wills of Cumberland County, Pennsylvania, - One Courthouse Square, Carlisle, PA 17013-3387 - on the 31" day of May, 2005, and will be called for audit and confirmation by the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania, One Courthouse Square, Carlisle, Pennsylvania on August 23, 2005 at 9 o'clock A. M. At that time, we are asking the Court to: (a) Approve payment of the balance of the Estate's assets to Earl Winslow in partial satisfaction ofloan and to pay funeral bills, a Category 3 Claim per 20 Pa.C.S. 93392. (b) Discharge of the following debts of the Decedent as the Estate's assets are insufficient to satisfy priority claims: Estate Information Services, Inc., on behalf of Discover Financial Services, Inc. $1,792.00 West Shore EMS - Carlisle $941.88 West Shore EMS - Carlisle $587.38 HSBC on behalf of Holy Spirit Hospital $35.00 Diversified Consultants, Inc., on behalf of Verizon $27.68 Holy Spirit Hospital $3.18 ~ EXHIBIT i (' I ~ 972006 _I. DOC For your reference, a copy of the Statement of Proposed Distribution and the First and Final Account are attached hereto. This notice is given to you in accordance with the rules of Court and not with any suggestion that your presence is required at the audit unless there are matters which you wish to bring to the attention ofthe Court. Mario Santilli, Jr., Esquire Cohen & Grigsby, P.C. (412) 297-4900 972006.I;DOC IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DNISION In Re: Estate of Michael H. Winslow No. 12-04-00558 NOTICE OF FILING ACCOUNT AND CALL FOR AUDIT TO: West Shore EMS - Carlisle 205 Grandview Avenue, Suite 211 Camp Hill, P A 170 II PLEASE TAKE NOTICE that the First and Final Account of this matter was filed in the Office of the Register of Wills of Cumberland County, Pennsylvania, - One Courthouse Square, Carlisle, PA 17013-3387 - on the 31st day of May, 2005, and will be called for audit and confirmation by the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania, One Courthouse Square, Carlisle, Pennsylvania on August 23, 2005 at 9 o'clock A. M. At that time, we are asking the Court to: (a) Approve payment of the balance of the Estate's assets to Earl Winslow in partial satisfaction of loan and to pay funeral bills, a Category 3 Claim per 20 Pa.C.S. S3392. (b) Discharge of the following debts of the Decedent as the Estate's assets are insufficient to satisfY priority claims: Estate Information Services, Inc., on behalf of Discover Financial Services, Inc. $1,792.00 West Shore EMS - Carlisle $941.88 West Shore EMS - Carlisle $587.38 HSBC on behalf of Holy Spirit Hospital $35.00 Diversified Consultants, Inc., on behalf of Verizon $27.68 Holy Spirit Hospital $3.18 For your reference, a copy of the Statement of Proposed Distribution and the First and Final Account are attached hereto. 972006 J DOC This notice is given to you in accordance with the rules of Court and not with any suggestion that your presence is required at the audit unless there are matters which you wish to bring to the attention of the Court. Mario Santilli, Ir , Esquire Cohen & Grigsby, P.e. (412) 297-4900 972006_I.DOC IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DNISION In Re: Estate of Michael H. Winslow No. 12-04-00558 NOTICE OF FILING ACCOUNT AND CALL FOR AUDIT TO: HSBC on behalf of Holy Spirit Hospital 118 Lukens Drive New Castle, DE 19720 PLEASE TAKE NOTICE that the First and Final Account of this matter was filed in the Office of the Register of Wills of Cumberland County, Pennsylvania, - One Courthouse Square, Carlisle, PA 17013-3387 - on the 31st day of May, 2005, and will be called for audit and confirmation by the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania, One Courthouse Square, Carlisle, Pennsylvania on August 23, 2005 at 9 o'clock A. M. At the time, we are asking the Court to: (a) Approve payment of the balance of the Estate's assets to Earl Winslow in partial satisfaction ofloan and to pay funeral bills, a Category 3 Claim per 20 Pa.C.S. {l3392. (b) Discharge of the following debts of the Decedent as the Estate's assets are insufficient to satisfy priority claims: Estate Information Services, Inc., on behalf of Discover Financial Services, Inc. $1,792.00 West Shore EMS - Carlisle $941.88 West Shore EMS - Carlisle $587.38 HSBC on behalf of Holy Spirit Hospital $35.00 Diversified Consultants, Inc., on behalf of Verizon $27.68 Holy Spirit Hospital $3.18 972006JDOC For your reference, a copy of the Statement of Proposed Distribution and the First and Final Account are attached hereto. This notice is given to you in accordance with the rules of Court and not with any suggestion that your presence is required at the audit unless there are matters which you wish to bring to the attention of the Court. Mario Santilli, Jr., squire Cohen & Grigsby, P.C. (412) 297-4900 972006_] .DOC IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DNISION In Re: Estate of Michael H. Winslow No. 12-04-00558 NOTICE OF FILING ACCOUNT AND CALL FOR AUDIT TO: Verizon Wireless Executive Relations PO Box 553 Warrendale, PA 15086 PLEASE TAKE NOTICE that the First and Final Account of this matter was filed in the Office of the Register of Wills of Cumberland County, Pennsylvania, - One Courthouse Square, Carlisle, PA 17013-3387 - on the 31st day of May, 2005, and will be called for audit and confirmation by the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania, One Courthouse Square, Carlisle, Pennsylvania on August 23, 2005 at 9 o'clock A. M. At that time, we are asking the Court to: (a) Approve payment of the balance of the Estate's assets to Earl Winslow in partial satisfaction ofloan and to pay funeral bills, a Category 3 Claim per 20 Pa.C.S. 93392. (b) Discharge of the following debts of the Decedent as the Estate's assets are insufficient to satisfY priority claims: Estate lnformation Services, lnc., on behalf of Discover Financial Services, lnc. $1,792.00 West Shore EMS - Carlisle $941.88 West Shore EMS - Carlisle $587.38 HSBC on behalf of Holy Spirit Hospital $35.00 Diversified Consultants, lnc., on behalf of Verizon $27.68 Holy Spirit Hospital $3.18 972006_1:DOC For your reference, a copy of the Statement of Proposed Distribution and the First and Final Account are attached hereto. This notice is given to you in accordance with the rules of Court and not with any suggestion that your presence is required at the audit unless there are matters which you wish to bring to the attention of the Court. ~,~ Cohen & Grigsby, P.C. (412) 297-4900 ~ 972006 1. DOC -. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYL VANIA ORPHANS' COURT DIVISION In Re: Estate of Michael H. Winslow No. 12-04-00558 NOTICE OF FILING ACCOUNT AND CALL FOR AUDIT TO: Holy Spirit Hospital 503 N. 215t Street Camp Hill, PA 17011 PLEASE TAKE NOTICE that the First and Final Account of this matter was filed in the Office of the Register of Wills of Cumberland County, Pennsylvania, - One Courthouse Square, Carlisle, PA 17013-3387 - on the 31st day of May, 2005, and will be called for audit and confirmation by the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania, One Courthouse Square, Carlisle, Pennsylvania on August 23, 2005 at 9 o'clock A. M. At that time, we are asking the Court to: (a) Approve payment of the balance of the Estate's assets to Earl Winslow in partial satisfaction of loan and to pay funeral bills, a Category 3 Claim per 20 Pa.C.s. g3392. (b) Discharge of the following debts of the Decedent as the Estate's assets are insufficient to satisfY priority claims: Estate Information Services, Inc., on behalf of Discover Financial Services, Inc. $1,792.00 West Shore EMS - Carlisle $941.88 West Shore EMS - Carlisle $587.38 HSBC on behalf of Holy Spirit Hospital $35.00 Diversified Consultants, Inc., on behalf of Verizon $27.68 Holy Spirit Hospital $3.18 972006_!DOC For your reference, a copy of the Statement of Proposed Distribution and the First and Final Account are attached hereto. This notice is given to you in accordance with the rules of Court and not with any suggestion that your presence is required at the audit unless there are matters which you wish to bring to the attention of the Court. ~,~2,~ Cohen & Grigsby, P.C. (412) 297-4900 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) ) SS: COUNTY OF ALLEGHENY ) Before me, the undersigned authority, personally appeared Rita A. Winslow, Administrator of the Estate of Michael H. Winslow, who, being first duly sworn according to law, deposes and says that (i) she caused this Statement of Proposed Distribution and Account to be prepared; (ii) she has review the Statement of Proposed Distribution and Account; and (iii) the averments of fact contained in the foregoing Statement of Proposed Distribution and Account are true and correct to the best of her knowledge, information and belief. C/*,"~~d ~ Sworn to and subscribed before me this 31st day of May, 2005. - c/ ~<..~_-~'"::. )."1.--"'-,,--- Notary Public Notarial Seal Bonnie S_ Price, Notary Public City OJ Pitlsburgh, Allegheny County ~v COmmission ExpIres Feb. 22, 2006__ ,lennsy\v;1f';;' A.ssociation Of No'-' %8131_1,DOC BUREAU Of INDIVIDUAL TAXES INHERITANCE TAX DIVlSl1lM PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REY-16D7 EX AFP (03-05) MARIO SANTILLI C/O COHEN 8 GRIGSBY 11 STANWIX ST 15TH FL PGH PA 15222-1319 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 06-13-2005 WINSLOW 05-30-2004 21 04-0558 CUMBERLAND 101 A.aunt R...1 Hood MICHAEL H MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax paynent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ...............................................................................................................1 REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF WINSLOW MICHAEL H FILE NO.21 04-0558 ACN 101 DATE 06-13-2005 THIS STATENENT IS PRDVIDED TO ADVISE Of THE CURRENT STATUS Df THE STATED AtN IN THE MANED ESTATE. SHOWN BELOW IS A SUHHARY Of THE PRINCIPAL TAX DUE, APPLICATION Of ALL PAYHENTS, THE CURRENT BALANCE, AND, If APPLICABLE, A PROJECTED INTEREST fIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 05-02-2005 PRINCIPAL TAX DUE: .00 PAYMENTS (TAX CREDITS): ~ PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 08-30-2004 CD004338 .00 1,484.37 05-25-2005 REFUND .00 1,484.37- TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 If PAID AfTER THIS DATE, SEE REVERSE TOTAL DUE .00 . SIDE fOR CALCULATION Of ADDITIONAL INTEREST. I If TOTAL DUE IS LESS THAN $I, NO PAYHENT IS REQUIRED. If TOTAL DUE IS REfLECTED AS A "CREDIT" ICRl, YOU HAY BE DUE A REfllHD. SEE REVERSE SIDE OF THIS fOIN fOR INSTRUCTIONS. 1 ALL-STATE LEGAL. A DIVISION OF ALL-STA"lr lNTERNATlONAl.. 11 FORM NO.: 07152-BF. 07153-BL . 07156-GY. 07156-WH n ~ 0 .-; ::0 t'!'j "d ~ :J; - -' trJ ~ fIJ ~ ~ ~ .... Z :,:l ~ -. :,:l .... ~ 00 >-r: ::: > .., rD "d ..., > >t: ... ~ iJ: if; .-; Qo~ Ci 0 ~ > 0 U "' .-; ...., '.,-: 'JI :.: '-' ~ 00 Z .,... to; t'1 e-J ;:c aa t'!'j 00 is '/, iJ: '/, '/ ..., ~ ~ '/ ::;: M ... ~ I ~ ~ lJ :J; ~ ..,. ~ ... c::r ~ 0 ~ j " ~ :i. .= ~ - 0 :,:l :D <-: U1 ;,- H ,r. rD - t'!'j Z g re. ;,- 0 Q - 00 ~ CD / ;:c ;;; '"" ;= ..., ~ '-l ...., :"l '-l > t': > if1 ~ t'!'j I'C ,f.. ~ ~ ~ ::;: td t'!'j ~ Z > (;1 = Ie :-< fIJ ..., ~ Ie -? ... ~ I? == 0 ~ fIJ ..., 0 ~ - Ci - ~ ~D ~ 0 ~ n z z ..., ~< f.~ UHltiUI ::!'5.^ctOo~:f- ~ " ~. Qi g <; ~ ... :r (if $" ,.... ~;~~!rl; 0 en i~8'i ~!1. ~ g>~, a ~i!\it\lli ~~J s !j1} ,.... a - ,.... - - .../ ,.... - ~11'!lJ.h .... {itll1 1 i II i!1i,~ I.Hi1t1IU llSl. ft~~ ~fOil ~~ i IISA t'. a Q t =.= r~lt!fi~ Jf1iU I: i '2. ~ ~ i ~ i ihl~\n -' 3 <; dl ~ 1 = ~Df-o~~ = . ;:)dl_~.C: ~ (0 ...o:=::J. ~ i1I 0 ;:);:) - ~ . . \, IN THE COURT OF COMMON PLEAS OF CUMERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ~ c::J ,:I~ IN THE MATTER OF THE ESTATE OF MICHAEL H. WINSLOW, DECEASED ) ) --C) --"~I c/o') 1.:8 NO. 12-04-00558 N -n RECEIPT. RELEASE AND REFUNDING AGREEMENT ;::) I, EARL H. WINSLOW, being beneficially interested in the above-titled estate, h~y acknowledge to have received THREE THOUSAND FOUR HUNDRED NINETY-FOUR AND 37/100 ($3,494.37) from Rita A. Winslow, Administratrix of the Estate of Michael H. Winslow, deceased, which distribution represents my entire interest in the probate assets in the above Estate after the payment of debts, fees, expenses, and all death and income taxes. I, EARL H. WINSLOW, on behalf of myself and my heirs, personal representatives, and assigns, hereby waive the issuance of any notice whatsoever that may be required to be given to me by either the Pennsylvania Probate, Estates, and Fiduciaries Code or the Rules of the Orphans' Court of Cumberland County, Pennsylvania, and release the Administratrix from proceeding with any further steps in the administration of the above Estate. I acknowledge that I have previously received statements and other information regarding the Administratrix' administration of the above Estate, and have had the opportunity to request such further information as I wished regarding the administration of the Estate, and do hereby approve the administration of the above Estate by the Administratrix, and on behalf of myself and my heirs, personal representatives, and assigns, and in consideration of the distribution of my interest in the above Estate, I agree to release, indemnify, and hold harmless the Administratrix and all Attorneys and law firms involved in the above Estate from and against any and all losses, claims, demands, surcharges, and causes of action, either at law or in equity, including legal fees that may be incurred in defending same, and which may arise either from the administration of the above Estate by the Administratrix or from the distributions to me from the above Estate. -:r :.0 11"\ C-) '3 ?'f', \.':J ~ .~, C) ~ -",--1 -" .~O l-n I do hereby agree, in consideration of the distribution I have received from the above Estate as hereinabove provided, and intending to be bound hereby and to bind my heirs, personal representatives, and assigns, to refund to the above Estate, on demand, all or any part of such distributions, or the value thereof, which may be determined to have been made improperly through mistake, negligence, or otherwise. I agree to extend any applicable period limiting the time within which the Estate must file an action to collect an erroneous, improper, or negligent distribution, so as to provide that the Administratrix need not commence such an action until two (2) years after the Administratrix shall have obtained actual knowledge that a distribution was a result of error. impropriety, or negligence. I further acknowledge that this Receipt, Release, and Refunding Agreement may be filed at any time, at the discretion of the Administratrix, with the Court of Common Pleas of Cumberland County, Pennsylvania, Orphans' Court Division, and I agree that no action relating to this distribution can be filed in any court other than the said Court. Dated this ?'V'-- day of ~ \eM',,'''-- , 2005. WITNESS: ~d.~~ &vJ1/ ~ EARL H. WINSLOW (SEAL) IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA INRE: ESTATE OF MICHAEL H. WINSLOW, DECEASED ) ) ) ORPHANS' COURT DIVISION No. 12-04-00558 STATUS REPORT UNDER RULE 6.12 Name of Decedent: Michael H. Winslow Date of Death: May 30, 2004 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes x No b. The separate Orphans' Court No. (if any) for the personal representative's account is: N/A c. Did the personal representative state an account informally to the parties in interest: Yes x No Date: d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and may be attached to this report. f\ C'k September 9, 20051 \I~~ ~1},~-.){J ,0, r-- c Mario Santilli, Jr., Esquire Cohen & Grigsby, P.c. 11 Stanwix Street 15th Floor Pittsburgh, PA 15222 (412) 297-4900 u; &? ~ (, , c:' c. L.:.J t C' , D: _ C)(' ~7~; }:.J a:: <".I Personal Representative Capacity: Lr----" c__ x Counsel for Personal C::::''i- C"-J %