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05-07-10 (3)
150561]41114 -~ REV-1500 EX (06-05) OFFICIAL USE ONLY Cou ('ode Year File Number PA Department of Revenue ` Bureau of Individual Taxes INHERITANCE TAX RETURN ~/ it %} ``' Cl (~ PO BOX 280601 --..•..~.~T n~rr`nGNT ~ lJ Harrisbur PA 17128-0601 ENTER DECEDENT INFORMATION BELO Date of Death Social Security Number 195-07-4684 08172009 Decedent's Last Name Suffix Date of Birth 09261914 MI Decedent's First Name DAVID N MI Spouse's First Name DORIS BAIR (If Applicable) Enter Surviving Spouse's Information Below Suffix Spouse's Last Name BAIR Spouse's Social Security Number 197-14-9600 THIS RETURN REGISTER OF WI~L,$ TE WITH THE FILL IN APPROPRIATE OVALS BELOW Q ;I. Remainder Return (date of death l Return i i 0 2 Supplemental Return prior to 12-13-82) na g ® 1. Or l Estate Tax Return Required d F ' 4a. Future Interest Compromise (date of era O e .i. Q 4. Limited Estate death after 12-12-82) Total Number of Safe Deposit Boxes S dent Died Testate O 7. Decedent Maintained a Living Trust . 0 6. Dece (Attach Copy of Trust) Election to tax under Sec. 9113(A) 1 (Attach Copy of Will) Q 9. Litigation Proceeds Received Q 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) Q 1 . (Attach Sch. O) ALL CORRESPONDENCE AND CONFIDE TED DIRECTED T0: NTIAL TD ~NmORM O . CORRESPONDENT -THIS SECTION MUST BE COMPLE Number elephone Name 717-657-0316 0 ANN OPDYKE DEELEY Firm Name (If Applicable) H&R BLOCK PREMIUM First line of address 4811 JONESTOWN ROAD STE 125 Second line of address ?Zf~-- -< "'G~JC State ZIP Code -- City or Post Office pp, 17109 HARRISBURG Correspondent's a-mail address: ANNOPDYKE .DEELEY@TAX . HRBLOCK . COM Under penalties of perllete.IDeclaratiohn of hre areaothe~r than theurersona~re rase tat~ive is based oni all nformationeof wh ch t~eharee hast anY kr true, correct and com --~ SIGN E OF PERSON RESP SIBLE FOR FILING RETURN ~ ADDRESS 513 EUTAW AVENUE NEW CUMBERLAND PA 17070 ..~ SIGNATU A R T N REPRESENTATIVE '~ ~-r ADDRESS 4 811 JONESTOWN ROAD ~ STE PLEASE USE OR GBINAL FORM NLY10 TE .'' r Y ~ -~~r i ~-, (- `:,^ i _ '.:-~ r , t:.z' ;, r_ _~ _. 1 t-..~ '. ;; <'_ Side 1 15056041114 ~ 15056041114 15056042115 REV-1500 EX Decedent's Name: DAVID N BAIR Decedent's Social Security Number :195-07-4684 RECAPITULATION 1. Real estate (Schedule A) ........................................... 1. NONE 2. Stocks and Bonds (Schedule B) ...................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. NOP1E 4. Mortgages & Notes Receivable (Schedule D) ............................ 4. NONE 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 6. Jointly Owned Property (Schedule F) Separate Billing Requested ........ 6. NONE 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) OSeparate Billing Requested ........ 7 NONE 8. Total Gross Assets (total Lines 1-7) .................................. 8. 147094.00 22285.00 169379.00 9. Funeral Expenses & Administrative Costs (Schedule H) ................... 9. 14 7 6 2 . 0 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............... 10. 2 8 2 . 0 0 11. Total Deductions (total Lines 9 & 10) ................................. 11. 15 0 4 4 . 0 0 12. Net Value of Estate (Line 8 minus Line 11) ............................ . 12. 15 4 3 3 5 . 0 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ....................... 1 g, 0 . O 0 14. Net Value Subject to Tax (Line 12 minus Line 13) 14 15 4 3 3 5 0 0 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2)x.o 0 108035.00 15. 0.00 16. Amount of Line 14 taxable at linealratex.o 45 46300.00 is. 2084.00 17. Amount of Line 14 taxable at sibling rate X • 12 17. 0 , 0 Q 18. Amount of Line 14 taxable at collateral rate X , 15 18. 0. O 0 19. TAX DUE .......................................................19. 2 O 8 4. O O 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ Side 2 15056042115 15056242115 REV-1500 EX Page 3 195-07-4684 Decedent's Complete Address: File Number 2009-0081 A DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER DAVID N BAIR 195-07-4684 STREET ADDRESS CITY STATE ZIP NEW CUMBERLAND PA 17070 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 1350.00 C. Discount 67.50 3. InteresUPenalty if applicable D. Interest E. Penalty (1) 2084 00 Total Credits (A + B + C) (2) 1417.50 Total InteresUPenalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (5) 666.50 (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 666.50 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ...................................... . 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? .. ~ ^X 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. 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 three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [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 zero (0) percent [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 four and one-half (4.5) percent, 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 twelve (12) percent [72 P.S. §9116(a)(1.3)). Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 217 REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER DAVID N and DORIS M BAIR 09-21-00818 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. 2. 500 SHARES SOUTHERN COMPANY C~ 31.125 2000 PPL @ 29.02 15,563 3. 500 FIRST ENERGY ~ 43 52 58,040 4. . 1000 EXCELON C~ 49 13 21,760 5. . EXCELON DIVIDEND RECORD DATE 08/14/09 PAYABLE 09/10/2009 49,130 6. SOUTHERN COMPANY DIVIDEND RECORD DATE 08/03/09 PAYABLE 09/05/09 525 7. 25 METLIFEC~34.9 219 8. FIRST ENERGY DIVIDEND RECORD DATE 08/07/2009 PAYABLE 09/01/09 873 9. MET LIFE DIVIDEND RECORD DATE 11/09/09 PAYABLE 12/14/09 275 10. PPL DIVIDEND RECORD DATE 09/10/2009 PAYABLE 10/01/2009 19 690 (If more space is needed, insert additional sheets of the same size) 217 REV-1508 EX+(6-98) SCHEDULE E p ^~ ~+/~ COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, ° M~C^. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER DAVID N and DORIS M BAIR 2009-00818 Include the proceeds of litigation and the date the proceeds were received by the acratp .n more space Is neeaea, Insert addltwnal sheets of the same size) REV-1511 EX + (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COST; ESTATE OF FILE NUMBER DAVID N and DORIS M BAIR 21-09-00818 Debts of decedent must be reported on Schedule I. A B 1 2. 1 FUNERAL EXPENSES: PARTHEMORE FUNERAL HOME 1303 BRIDGE ST NEW CUMBERLAND PA FUNERAL LUNCHEON ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: 2• Attorney Fees State Zip 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant DORIS BAIR Street Address 513 EUTAW AVENUE City NEW CUMBERLAND State PA Zip 17070 Relationship of Claimant to Decedent SPOUSE 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. ESTATE ADVERTISEMENT THE SENTINEL 8. ESTATE ADVERTISEMENT CUMBERLAND LAW JOURNAL TOTAL (Also enter on line 9 R (If more space is needed, insert additional sheets of the same size) 9,247 308 3,500 330 750 364 188 75 762 REV-1512 EX+ (12-03) SCHEDULEI COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, St LIENS ESTATE OF FILE NUMBER DAVID N and DORIS M BAIR 21-09-00818 Report debts incurred by the decedent prior to death which remained unpaid as of the date of dpatn 1~~1~~~~n~ ~~~.o~mti~~.~sa ..,ea:...~ .,.........._,. 2n REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER DAVID N and DORIS M BAIR 21-09-00818 RELATIONSHIP' TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] DORIS M BAIR SPOUSE 70% PHILLIP D BAIR SON 30% 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 AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (If more space is needed, insert additional sheets of the same size) ESTATE OF DAVID N BAIR 21-09-00818 LAST WILL AND TESTAMENT LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.01:) ~N. ._ ~ • - ~~, E., ~=~ t .a_ Certification Number '~ REV 1lpooh I PRINT IN MANENT tCK INK 't'his is to rertifv that the information here given is rorrecdv copied from an original Certificate of Death duly Piled with} me as Local Re-gistrar. The original certificate will be forwarded to the State Vital Records Office nor permanent filing. ~~~,,Z,~~ ~ AUG 2 ~b Z00~_ Local Registrar Date Issued COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (SCC 1113iY110tIODS and eatamnlns nn rnvnranl ~INIt tILt NUMHtH t. Name of Decedent (First, matlee. last, suffix) 2. Sex 3. Social Security Number 4 Dale of Death (Month, day year) , David Noah Bair male 195 - 07 --4684 Au ust 17, 2009 5. Aqe (Last Birthday) Under I ear Under 1 da 6. Dale of Binh Month, tla ear 7. Birth lace Ci and stale or fares n count fie. Place of Death Check onl one Months Days Hoers Minutes Hospital' Other 94 vrs September 26,1914 Harrisbur PA rx~(/ , ^ Inpatient LJ ER f 0utpallent ^ DOA ^ Nurs n Hom ^ Other ~ Specity~ i g e ^ Reeldence f 8 C ounty o b. Death &. City, Boro, Twp. of Death Sd. Facility Name (If not Institution, give street antl number) 9. Was Decedem of Hispanic Origin? ®N to Race A I di Bl ^ . . mencan n o Ves an, ack, White, etc. Cumberland E. Pennsboro Twp. Hol S irit Hos ital nt yea. apeclty Cuban, (SVanly) Y P P Me i P rt R x can, ue o ican, etc/ white ' i r. Decedent s Usual Occu lion Kind of work done dunn most of workin life. Do rat stale retired 12. Was Decedent ever in the 13. Decatlenl's Education (Specify only highest grade completed) 14. Marital Status'. Married Never Marnetl. 15. Surviving Spouse (If wife give maitlen name) , Kintl o1 Work Kintl of Businessflntlusiry U.S. Armed Forces? Elementary I Secondary (0-12) College (1-4 or 5.) Witlowed, Divorced (Specify) Supervisor Com uter ~7 p vee ^Nn 12 Married Doris Mae Simcox ' t6. Decedent s Mailing Address (SVeeL city/ town, state, zip code) Decedent's Dld Decedent Actual Residence na. state - Penns lvania 513 Eutaw Avenue Y ovema 17c D ^ Yes d t Li d . , ece en ve m Twp Townshl ~ New Cumberland, PA 17070 nb.copmy Cumberland ° ntl ~INn.Depademuyedwith'n New Cumberland Actual Llmils of Clry l Boro 16. Fathers Name (FlrsC middle, last, suffix! 19. Mother's Name (First middle maitlen surname) , , George Washington Bair Ellen Mildred. Benner 20a. Informant's Name (Type I Print) 2ph_ Informant's Meiling Atltlress (Street, city I lawn, stale, zip code) Doris Mae Bair 513 Eutaw Avenue, New Cumberland, PA 17070 21 a. Method of Disposition ^ Cremation ^ Donation 21 b. Dale of Dispostion (Month, day, year) 21 c. Place of Disposition (Name of cemetery, crematory or other place) 21 d. Location (City I town, slate, zip cadet ® B l ^ R una emoval ham State r Was Cremation or Oonatlon Authorised ^ other s eri 16yMedlcalExamfneNCoronei? ^ vea^ Np August 20, 2009 Rolling Green Cemetery Lower Allen Twp. PA 17011 22a. Signature uneral rvice Li n for acting as sucnl 22b. Llcense Number 22c. Name and Address of Facility ~ ~ FD 013 340 L Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070 Complete items 23a~c only when certifying 23a. To the best of my knowledge, death occurretl al the time, date and place slatetl. (Signature and title) 230. Llcense Number 23c. Date Signed (Month, tlay, year) physician Is not available al time of death to certiry cause of death Items 24-26 must be completed by person 24. Time of Death /J 25. Dale Pronouncetl Dead (Month, day, year) 26. Was Case Rete~red to Medical Examiner /Coroner far a Reason Oth r th C i n woo pronounces death. `~ M ~ e an remat on or Donabon ^ ~~ . ~~.-~.-L l ~ } (} Yes No CAUSE OF DEATH (See instructions and ex les) i Approximate Interval'. Item D. Pan I: Enter the chain of events -diseases, injuries, or complications -that tlirectly caused the death. DO NOT enter terminal events such as cardiac ar est Part IP. Enter other sianifcant condTons con_trib~ doyth 26. DId Tobacco U;e Contribme ro Death? r , Onset to Death respiratory arrest, or veniricWar Ilbnllation without showing the etiology. List only one cause on each line but not resulting in tlx untlertying cause given in Pan L ^ yes ~ Probably ^ N ^ k IMMEDIATE CAUSE IFnal disease or ~ ° y o Un nown condidon resulting in death) _~ '('.~ ~,`~ --~I~?r L. j~k U ,j Z / y' J C_' Lj4. ( ~1'-~" ~ y` t a ~_ fi `-E' 29- II Female. f Due to (or as a consequence of): ^ Vol pre nant Within ast Saquanlially fsI conditions, II any, b IeaMMng to All cause Fstetl on line a. g p year ^ Pregnant at time of death Due to q ) Enter the UNDERLYING CAUSE for as a mnse uence of ^ Not pregnant, hrn pregnant within 42 tlays (tlisease or ajury that initiated Me ~ i events resulting in death) LAST. of death ~ Due to (or as a consequence ol). ^ Not pregnant, but pregnanl43 tlays to t year d. i before death 30a. Was an Autopsy 306. Were Autopsy Findings 31. Manner of Death 32a. Dale of Injury (Month, day, year) 32b. Describe How Injury Oxurred ^ Unknown it pregnant within the past year Penormed? available Prior to Completior ^ N t l ^ 32c. Place of Injury. Home. Farm, Sheet. Factory, ONice B ildi t S a ura Homicide of Cause of Death? u ng, e c. ( pecify) Ia~~ ^ Yes I~ No ^ Yes ^ No ^ Accident ^ Peiain Invests ton g ~ I 32d. Time of Injury 32e. Inlury at Work? 321. If 7ransponation Injury (Specvty) 32 g. Lotalion of Injury (Street, ci h~ I town. stale) ^ Suicide ^ Cald Not be Detenninetl ^ Ves ^ No ^ Driver/Operator ^ Passenger ^ Pedestna~ M ^ Other ~ Specity 33e. Certifier (check Dory one) • Certiying physician (Physican certiying cause of death when another physician has pronounced death and comoleletl Item 23) To th b t f k l 33b. Signaure and Title of Cenilier ~ ,j ' ___. _, )' (1 ~ _ ~ e as o my now edge, death occurtatl due to the cause(s) and manner as slated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ • P _ "- ~ :' ~ ronouncing and certltying physiclen (Physician both pronouncing deem and cenitying to cause of death) To the best of my knowledge, death oaumed at the time date, and place, and due to the cause(s) and manner as stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 33c. Lk;anse Number j`- ~ ~) 7 - 33d. Date Signed (Month, tlay, yea ) ~ ~ - - • Medleal Examiner/Coroner ~ , „ On the basis of examinatlon and / or Investlgatien, in my opinion, death occurred at the time, date, and place, and due to the cause(s) and manner as atated_ ^ 34. Name antl Atltlress el Person Who Completed Cause of Death (Item 27) Type /Print ~ 4 7 t Li~i ,"i 95. Registrar ignature and D' ric wDYsc/ ~ 36. Date sled ( nth, day, year) , , ,.( l': ') (- ~j J / I Disposition Permit Na. ~~V~Q~ ~J [ J REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS No . 2009- 00818 PA No . 21- 09- 0818 Estate Of : DA VlD NOAH BAIR (First, Middle, Lastl Late Of : NEW CUMBERLAND BOROUGH CUMBERLAND COUNTY Deceased Social Security No: 195-07-4684 WHEREAS, on the 31st day of August 2009 an instrument dated April 20th 2007 was admitted to probate as the last: will of DA VlD NOAH BAIR (First Middle, Lastl late of NEW CUMBERLAND BOROUGH, CUMBERLAND County, who died on the 17th day of August 2009 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wi 11 s in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: DOR/S MAE BAIR who has duly qualified as EXECUTOR(R/Xl and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 31st day of August 2009. ~ ~ ~. ~, i~ egister of Wills eputy f * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIL)DLE, LAST) LAST WILL AND TESTAMENT OF DAVID NOAH BAIR I, DAVID NOAH BAIR, of New Cumberland, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament, and revoke ang~nd ~~> all previous Wills and Codicils I have made. T` r~ ~-~ -~:_ y ........ .. _... i ., "'~ `- ~... ~ i ~- ` -r I IT_ I: I direct that all of my just debts and funeral expenses,=~~ri~luding:.a11 ~ - ~_-- ~ ~ expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my death, as a part of the expense of the administration of my estate. ITEM II: All federal, state, and other death taxes payable because of my death with respect to the property forming my gross estate for tax purposes, whether or not passing under this Will, including any interest or penalty imposed in connection with such tax, shall be considered a part of the expense of the administration of my estate and shall be paid out of the residue of my estate, without apportionment or right of reimbursement. ITEM III: I give, devise, and bequeath seventy-percent (70%) of the rest, residue, and remainder of my estate, wheresoever situate, to my wife, DORIS MAE BAIR, on the condition that she survives me by a period of thirty (30) days. If my wife, DORIS MAE BAIR, does not survive me by a period of thirty (30) days, I then give, devise, and bequeath thirty-five percent (35%) of the rest, residue, and remainder of my estate to my daughter-in-law, ELOISE LYNN KEMMERLING, or her children, per sti es, and thirty-five percent (35%) of the rest, residue, and remainder of my estate to my son-in-law, JOHN KENNETH SMITH, or his children, per stir~es. ITEM IV: I give, devise, and bequeath thirty-percent (30°ro) of the rest, residue, and remainder of my estate, wheresoever situate, to my son., PHILLIP DENNIS BAIR, on the condition that he survives me by a period of thirty (30) days. If my son, PHILLIP DENNIS BAIR, does not survive me by a period of thirty (30) days, I then give, devise, and bequeath fifteen percent (15%~) of the rest, residue, and remainder of my .estate to my daughter-in-law, ELOISE LYNN KEMMERLING, or her children, per sti es, and fifteen percent (15%) of the rest, residue, and remainder of my estate to my son-in-law, JOHN KENNETH SMITH, or his children, per sti es. ITEM V: If any person entitled to share in the distribution of my estate under the terms of this Will becomes an adverse party in any proceeding to contest the probate of this Will, that person shall forfeit his or her entire interest hereunder, 2 and all provisions in favor of that person shall be void and of no effect. The share of the person so forfeited shall be distributed as part of the residue, except that if that person is entitled to share in the residue, that interest shall be distributed proportionately to the other residuary distributees. ITEM VI: I hereby appoint my wife, DORIS MAE BAIR, as Executrix of this my Last Will and Testament. If my wife, DORIS MAE BAIR should predecease me or otherwise fail to qualify as Executrix, I then appoint my daughter-in-law ELOISE LYNN KEMMERLING as Executrix of this my Last Will and Testament. ITEM VII: I direct that no Executrix serving hereunder be required to post bond or enter security in any jurisdiction. 3 IN WITNESS WHEREOF, I have hereunto set my hand anal seal this :'~'L' day of s~j ~,z, l~- 2007. ,~ ~~~ ~2t ~~~~~s~AL) DAVID NOAH BAIR The preceding instrument, consisting of this and tlvee other typewritten pages, was, on the date thereof signed, published, and declared by, the named Testator, DAVID NOAH BAIR, as his Last Will, in the presence of us, who at his request, in his presence and in the presence of each other., have subscribed our names as witnesses hereto. i ~ ~~ residing at i~ ~ `~~ .5 / ~..~ f~~ j ~,~ E7~ ~ r ~r~-v ~ , Aa~Ns ~ u2C~ ~~~ Li~~!~G~1,•~- residmg at /~YN~~~4~~~ hUtis ~j,4- ~~cS'S 4 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss WE, DAVID NOAH BAIR, ~ ~, ~ ~-~~~~~ ;~~~ ~i -~~ i ~! 7~ ,and the Testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament, and that he signed it willingly and that he executed it as his free and voluntary act for the purpose therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witnesses and that to the best of their knowledge the Testator was at that time eighteen years of a.ge or older, of sound mind, and under no constraint or undue influence. /~Ct2raZ ~~~~ DAVID NOAH BAIR ~~ ~~ ~- Witne s ~ (~ c~ vt. Witness Subscribed, sworn to, and acknowledged before me by DAVID NOAH BAIR, the Testator, and subscribed and sworn to before me by ~. ,h ~~ e F ~'~> /~ ~ r d } and ` ~ . ~ t ,~~,.? ~ ~ :~, witnesses, this :~ ~ day of i9y,~, ~, 2007. r-~ ~''` . / G j Pub~l~ic My Commission Expires: utiP~~~a;:.~:,~:~~t~,r; ~t ;:LNPiSYLVANIA NOTARIAL SEAL CARMELO ..I. CLAUp10, i~lotary Public Lemoyne B©ro; Cumberland County MY Commis~ian 4xpires ~e~. 27, 2010 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 REV-1162 EX(11-96) N0. CD 01 1962 BAIR DORIS MAE 513 EUTAW AVENUE NEW CUMBERLAND, PA 17011 fold ACN ASSESSMENT AMOUNT CONTROL NUMBER ESTATE INFORMATION: SsN: 195-o7-4s84 FILE NUMBER: 2109-0818 DECEDENT NAME: BAIR DAVID NOAH DATE OF PAYMENT: 11/OC/2009 POSTMARK DATE: 1 1 /06/2009 COUNTY: CUMBERLAND DATE OF DEATH: 08/17/2009 REMARKS: RECEIPT TO ATTY SEAL CHECK# 9999 101 ~ $1,350.00 TOTAL AMOUNT PAID: 51,350.00 INITIALS: CJ RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER ESTATE OF DAVID N BAIR 21-09-00818 SCHEDULE B THE CHECK BELOW REPRESENTS A DIVIDEND PAYMENT Exelc~n. your To inquire about your account, contact BNY Mellon Shareowner Services Toll Free Number 800-626-8729 Outside the U.S. (Collect) 201-680-6578 Hearing Impaired 800-231-5469 accoun Simply enroll in our self-service program by using the option below. Login to Investor ServiceDirect~ ar www.bnymellon.com/shareowner/isd Have one of your checks handy. You will need to refer to the bank information printed across the bottom of your check. EXELON CORPORATION DIVIDEND INVESTOR ID CUSIP ACCOUNT KEY ISSUElCLASS OF STOCK RECORD DATE PAYABLE DATE 806459763986 114 001 30161 N10 BAIR---DAVIN0000 COMMON OS/14/2009 09/10/2009 RATE PER SHARE CERTIFICATED SHARES BOOK-ENTRY SHARES GROSS AMOUNT TAX WITHHELD CURRENT DIVIDEND $0.5250000 500 500.0000 $525.00 $0.00 $525.D0 DIVIDEND PAID YEAR TO DA TE TAX WITHHELD YEAR TO DATE TAX IDENTIFICATION NUMBER $1,575.00 $0.00 ON FILE please detach and retain this form for our records. Y PLEASE DETACH BELOW CHECK NUMBER: 76391855 - • ~• r . .• • ~ / ~ - PAYABLE DATE CHECK NUMBER 60-160 Exelc~n. 09/10/2009 76391855 433 P.O. BOX 3525 S. HACKENSACK, NJ o7sos-sz2s PAYABLE AT THE BANK OF NEW YORK MELLON IN U.S. DOLLARS 114001 30161 N10 BAIR--DAVIN0000 ' 5004490 01 AT 0.357 "AUTO T3 2 5248 17070-1851 138 1 DOM00000150 '111'~'IIIIIIIII~IIII If IIIIIIIIIII~IIII~IIIII'111'IIIIIII~IIII PAY TO THE ORDER OF: DAVID N B A I R PAY""*""`*"""'**"*$525.00 513 EUTAW AVE NEW CUMBERLAND PA 17070-1851 ~ 1 ~i AUTHORIZED SIGNATURE 11'7639 X85511' ~:0~.330 L60 ~~: 19 L1110 28411' Dividend Check so1dTHERN ~ COMPANY The Southern Comppany Check Number ra-tva 30 Ivan Allen Jr. 61vd. NW 611 Atlanta, Georgia 30308 ~ ~ '] ~ Q /I OQ2237812 J Q y~ To The Order Of Date Dollars Cents _ 09/05,/Q9 PAY$ ~*~*~~*~***218.75* DAVID N BAIR 513 EUTAW AVE NEW CUMBERLAND PA 17070-1851 ~~,~~~ Bank of America CustomerConnection Bank of Amerie'a.-N.A. authori2edSrna?uro Atlanta, Dekaib County, Georgia VOID IF NOT CASHED. WITHIN 136 DAYS °li'000 2 2 3 78 4 21t` i~:061~~27881: OL0 LL6 3L3811' i I ne aouinern company ,.: 08/03/09 09/05/09 .43750000 SDO.OD00 I 218.75 .00 Account Number 0000552090 ENROLL IN SOUTHERN INVESTMENT PLAN (SIP) and REINVEST DIVIDENDS ON ALL SHARES 1 acknowledge that the Prospectus describing the Plan has been made available to me, either in electronic form at www.southerncompany.com or in paper form, and hereby request that / be enrolled in the Plan. !agree to abide by all the terms ono' conditions of the Plan and understand that all requests must be processed in accordance with the Prospectus. Signature(s) of All Registered Owners Date ^ Change of address -Please print or type'. ]AVID N BAIR 513 EUTAW AVE JEW CUMBERLAND PA 17070-1851 Name No. and Street, Apt, Suite, or P.O.BOx City, State, and Zip Code Daytime Phone No. signature(s) All Registered Owners Date 1-800-554-7626 www.southerncompany.com STOCKHOLDER SERVICES, P.O. BOX 54250, ATLANTA, GA 30308-0250 Internet Account Access at Web Address above - Internet Security Code is equal to the last four digits of the Account's Tax ID. ~lectrol~ic Deposit of Dividel~d Authorization Mail To: STOCKHOLDER SERVICES, P.O. BOX 54250. ATLANTA. GA 30308-0250 Concerned about slo~N delivery or lost checks? Ailow us to deposit your dividend directly into your bank account. ]AVID N BAIR Financial institution 513 EUTAW AVE JEW CUMBERLAND PA 17070-1851 Routing Number (9 Digits) Bank Account Number Name(s) on Bank Account Daytime Phone Number Please atfach a copy of a VOIDED check or savings account deposit slip. I (we) hereby authorize Southern Company Services, Inc., to make automatic electronic deposits of dividends to the bank account specified. (All bank account owners must sign.) Signature(s) Date S®IOTFlEItI~i ~:®~~~~~ OOOD55209D Account type: ^ Checking ^ Savings . ~ .:~ ~ ~ N .O Z ' ~ ~ ~ O O ~ rn O N ~ ~' ~ LLI ~ W ~ O i `` ;. 1. w ~.~.;_ DOS . ^_ 1'P1 .-~ ru ui a O r~ ~o ti O 0 a .a O to ['~ rLl f7J S a fY1 ~wrnr E ~ w~T--o a~ F- Z r c ~? 2 W>T~~ ~ ~=ZON ~ a~ ZHZo~a D OrJm ~oY~~ N n a~~~~ O mm°~ 0 L a N N H m Z O O w z i ~U ~ N ~ N tl U ~ O 4 ~ O C ~ v .~ ~~ ~+ d 2 L U ro m 0 O O W H -p ~ ~ O i O ~ > h ~ :':': i i Y 'CI' s U r Q W o 7 ~ <. ~ >a~o U c"1 C > Z 0 ~ ~ ~ ° ° m ~ tf1 C ~ ~ O N O In ~ lA C ~ N L CL a N p N .' ~ . _ 7 C Q 0 Z ~ ~ U .~ ~ Y U m ~ O ~ ~ ~ U ~ ~ ~ Z ~ U Q ~ a °o, ~o uo roo a~ ~~ c° ar`'r'• ~ O o ~ O ~ Of m ~p N a>~ c0 Z~ ~ ~ ~ ° ~ ~ C M ~ :O ° ° O d D v Q ~ ~ ~ Z Z c O ~ O p O ° O a ~ °' p~ mro$ ~~O m~° ~ ~ p p~ ~ p N ~ `~ D ctl E O p a~i ~ ~ a~ ;~. ~ o ~ <~ U C ~ cn C 'm pC ~ o[ r Q m o[ a o~ U ~ d a .j 0 L r Y L 7 1J r L 7 ~_ O v ! IIpWpIIIG m t N d N S L m a~ 0 ~~~ DAVID N BAIR Account Markfet `Jalue Stock Price as of Total M~uket 11 09/2009 '/alu 3 $35.100 $1i77.'i0 The aggregate amount paid to all Trust Beneficiaries in thi ~ dis'ribl~tion is $173,468,239.77• For inquiries about your acroLlnt, you may visit www.bnymellon.com/shareowner/isd, or call 1-800-6~~9~593. Trust BeneReiary Irlformatio n You may purchase or sell shares of MetLife, Inr,. comrnon stock through the MetLife Policyholder Trust (the `Trust"), free of any commissions or other fees, under the Metl'da Purc~lase and Sale Program, as amended. A copy of the brochure descrbing the program i;> available on the Internet at yyyvvr.metlife.com by selecting Investx (Relations and then the Shareholder Services Inforration page, or by calling the number listed above. You are permitted to transfer your Trust Interests only in the circumstances described it the trochure. You may also instruct that all (but not less than all) of your shares of MetLife, Inc. common stock held by the Trust be withdrawn from the Trust. Information regarding your ...irhArnwal rights may be found ir: the Purchase and Sale Brochure or by ~ I ~~3i ~ "~ ~iiii ~ M ~ ~ ~ f;tillY'I~1~ ~ t ~ ~a a -_ Cr1VBStOr ID 50621728 0445 5009 Divi dend Summary _ _ _ _ - Record Date Total Trust Interests Dividend per Tru:;K Interest Cur ant Distrit ut:on 11/09/2009 25.0000 $0.74 __ $tE 5f.- Payable Date Tax Withheld Net Distribution Prior Year Distribution 12/14/2009 $0.00 $18.50 __ $1F 51:i_ An annual shareholders' meeting to elect members of the Board of Directors of MetLife, Inc. and for the transaction of other b~ssinecs is expected to be held on April 27, 2010. The deadline fc submitting shareholder proposals for consideration a:t this meeting is December 1, 2009. A copy of MetLife, Int.'s annual report: and proxy statr meant wJl be available free of charge on or before March 31, 2010, alorg evith ether MetLife, Inc. and Trust filings under federal securities laws, di) on the Internet at www.metlife.com by selecting About MetLife. Corporate Governance, under Related Links, (ii) by writing to MetLife, Inc.. c/o BNY Mellon shareowner Services, PO Box 358447. Pittsburgh, P.1 15252-8447 or (iii) by calling the number listed above. These and other SEC filings by MetLife and the Trust are also available on the Internet at ww w.;ec.gov Ri 11Ta' a~S4-- Please Note: Important 2009 Tax Information FORM 1099-DIV. DIVIDENDS/DISTRI BUT'~ONS MetLife U.S. TAX INFORMATION FOR 2009 UMB N0.1545-0110 COPY B Ft)F C_- RECIPIENT - RECIPIEN f'S TOTAL ORDINARY IDENTIFICATION NUMBER _ DIVIDENDS QUALIFIED DIVIDENDS FECIERAL INCOME TAX ~AfITHHELD BOX to BOX t6 80% 4 195-07-46E34 _] [_ $18.50 ~ $1$.50 ~C__. 50.00.,- - 'AYER'S NAME PAYER'S FEDERAL IDENTIFICATION NUMBEF=' BNY MELLON SHARE:OWNER SERVICES AS Ei1-8516987 CUSTODIAN OF THE METLIFE POLICYHOLDER TRUST _ - SECURITY DESCRIPTION TRUST INTERESTS _] 'ANT TO WHOM PAID DAVID N BAIR 513 EUTAW AVE NEW CUMBERLAND PA 17070-1851 FOR This Is Important tax Information ~rnd Is being furnlahed to the Internal Revenue Service. M you are required to the a return, a negligence penalty or other sanction may be Imposed on you if this Income Ire taxable and the IRS determines that It has not been reported. Box 1A -Shows total ordinary dividends that are taxable. Include this amount on line 9a of Form 1040 or 1040A. Also, repoA it on Schedule B (Form 1040) or Schedule 1 (Form 1040A), if required. The amount shown may be dividends a corporation paid directly to you as a parti- cipant (or beneficiary of a participant) in an employee stock ownership plan (ESOP). Report it as a dividend on your Fonn 1040/1040A, gut treat it cts a plan distribution, not as investment income for any other purpose. Box 1 B -Shows the portion of the amount in box 1 A that may be eligible for the 15 % or zero capital gains rates. See the Form 1040/1fW0A instructions for how to determine this amount. Report the eligible amount on line 9b, Fonn 1040 or 1040A. REPORTED 13Y -fHE BANK OF NEW YORK MELLON 480 WASHWGTON BOULEVARD JERSEY CITY, NJ 07310 4RDING THE ABOVE Box 4 -Shows backup withholding. For example, a payer must backup ~witl~ hold cn certain pay- ments at a 28 % rate 'rf you did not give your taxlpayer idenTrfication nurnb:~r to the payer. See form W-9, Request for Taxpayer Identification (Number and Cert'rficalion for information on backup withholding. Include this amount on your income tax return as '.at withheld. Nominees. li this form includes amounts belonging to another person, y~ru are considered a nominee recipient. You must file Form 1099-DIV wRh the IRS for each o' the other owners to show their share of the income, and you muss furnish a Form 1099-DI\i to each. A husband or wife is not required to file a nominee return to show amounts owned by thr~ other. See the 2009 General Instructions for Forms 1099, 1098, 3921, 3922, 5498, and W-2G .~ DAVID N BAIR 513 EUTAW AVE NEW CUMBERLAND PA 17070 PPL Corporation Two North Ninth -Street Allentown, PA 18101-1179 Dividend Check Account Number: 3097115036 Dividend Record Date: 09!10/2009 Payment Date: OCTOBER 1,2009 Check Number: 02900614 Amount: $690.00 Print Number: 71928000893 d Di id Number of Dividend en v Class of Stock Shares Rate Amount PPL CORP COMMON 2,000.000 .3450 690.00 You can have your dividends deposited directly into your bank account. To request a Direct Deposit Authorization form, or if you have any questions regarding your account, visit the Investor Center at www.pplweb.com or call toll free: 1-800-345-3085 To access your account online, please visit www.shareowneronline.com Please detach and retain this statement for your records. of COMMONWEALTH OF PENNSYLVANIA _ STATE EMPLOYEES' RETIREMENT SYSTEM S MONTOURSVILLE REGIONAL COUNSELING CENTER 93 PIERCE LANE MONTOURSVILLE, PA 17754 TELEPHONE: (570) 368-5680 FAX: (570) 368-5667 TOLLFREE: 1-800-633-5461 www.seis.state.pa.us September 22, 2009 Estate of David N. Bair 513 Euthw Ave. (few Cumberland, PA 17070 Dear ~1trs. Bair. We have recently been notfied of the death of David N. Bair. We would like to extend our condolences to you and the family. Based on the member's option selected at retirement, all payments are to cease with the membe-'s death. As the State Employees' Retirement System pays after the fact and mails the annuity checks on the next to the last working day of each month, it will be necessary for you to reimburse this. System for the days the member did not live in the month of their death. If the August check has been cashed or deposited, the reimbursement due our system is X117.91, which represents the overpayment for the period August 18, through 30, 2009. If you are in possession of the check, it can be deposited by having the bank stamp °For Deposit Only" on the back; however, you must send reimbursement for the overpayment to our office. Reimbursement should be made payable to the State Employees' Retirement System and mailed with the enclosed copy of this letter to the above address. We will also require a certified copy of the death certificate. If you cannot permanently spare an original certificate, please submit one with a large note attached asking that we return it. We will make and certify a copy for our records and return the original to you within five working days. Upon receipt of the reimbursement for the overpayment and the death certficate, this account will be paid in full and closed. There are no death benefits payable from this System. Thank you for your cooperation in this matter. MEMBER'S NAME: SOCIAL SECURITY NUMBER: DATE OF DEATH: DATE OF OUTSTANDING CHECK: MONTHLY CHECK AMOUNT: THIS INVOICE ~: Sincerely, Eva M. Bower Administrative Assistant David N. Bair 195-07-4684 August 17, 2009 August 31, 2009 x272.10 21542 rn o ~ ° ~ N ;~ , - r m ~ ~ ~ N Y ~ °~ ¢ ~ r °= N r W ~ o W a I` ca * v ` '~ N .k it N T ~ ~ ~ Y ~,C , `,g '~ ~ w F-; ~ , w , O 0 • ~' ~ ~, 3 ~ ~ ^ LL ~ V ;a > v co .) } O \~ ~ # ~., ,~ e~seoa 0 . P-~ N ~, ~~' t0 Z ¢ Q N 3 ~ -_ ,~. N p. ~ ~ ,~ o° a 0 x = T j w ° ° } a r- O ~ m w o ~ > ~' O ~- ~ ~ a a a o '- a O a O ~ '_' ~' ~ w O ¢ a - ~ V ~~ 0 -~ m c 3 Z '~ ~ ~ F Q F- ~ J c 0 O Z a y ~ m~ m ~ o Q m=Z O °so Zf-~ = o LL ¢ a > W Q ~ ¢ O p~U > ~ M > = '~ ! I O =O~ti H DMZ ~ o I IIIII IIIIIIIII IIIII 7 2 0 IIIIIIIIII Iilllllll 0 0 0 0 lllllll IIIIIIIIIIIIIII Illlllli 0 2 7 2 1 0 lilll !Z z z w O w ~_ l m O , ui ~' N n.i ~~ ru X11 • O a • a IY7 O ~' lf1 N ~ L~ • a ~ 1'Y'I S .-~ ^ COMMONWEALTH OF PENNSYLVANIA STATE EMPLOYEES' RETIREMENT SYSTEM MONTOURSVILLE REGIONAL COUNSELING CENTER 93 PIERCE LANE MONTOURSVILLE, PA 17754 TELEPHONE: (570) 368-5680 FAX: (570) 368-5667 TOLLFREE: 1-800-633-5461 www.sers.state.paus September 22, 2009 Estate of David Bair 513 Eutaw Ave. New Cumberland, PA 17070 ""~,, RE: David N. Bali (Beneficiary Annuitant) Unavailable (Original Member) SS# 195-07-4684 SS# 172-01-8875 Dear Mr. Bair. We have been informed of the death of David N. Bair, one of our beneficiary annuitants. We wish to extend our condolences to you. All payments from this System were to cease with the beneficiary annuitant's death. If the August check has been cashed or deposited, it will be necessary for you to reimburse our system $163.82, which represents the overpayment for the period August 18, through 30, 2009. If you are in possession of the check, it can be deposited by having the bank stamp "For Deposit Only° on the back; however, you must send reimbursement for the overpayment to our office. Reimbursement should be made payable to the State Employees' Retirement System and mailed with the enclosed copy of this letter to the above address. We will also require a cert~ed copy of the death certificate. If you cannot permanently spare an original cert~cate, please submit one with a large note attached asking that we return it. We will make and certify a copy for our records and return the original to you within five working days. Upon receipt of the reimbursement for the overpayment and the death certificate, this account will be paid in full and closed. There are no death benefits payable from this System. If you have any questions or concerns regarciing this, please do not hesitate to contact this office. Sincerely, Eva M. Bower Administrative Assistant /emb Enclosures C~~ (~ ~, Ji r <D N W N ~ ,A Z W `~ U 1_ N N r I r N ~rJ W LL N Q N ~ ~ m 0 a ~ -~ c.F "O „F- rn 0 0 N MW ~o 0 .C ~~ `~' F m o . 3 J'r"-"-; G ti O rl L ~' O a ^ 00 M ac Q ~_ O ZL9£00 a Z Q Z d O W U _ o o' ~ a } a o r ~ w > 0 ~~ Q ~ - °' O ~ G w m ~ z Wg ~ _ W >~ - Q W Z 0- ¢ y ~ ec Q c m¢ Z = o Q~ U ~ Q p > W Q ~ w0 w CaW~ Z~ W S ~ ti Qg~ az ~ ° G ~n Z ~a> ao 111111 (IIII (IIII VI " 7 1 0 II VIII VIII 0 0 VIII VII 0 0 IIII VIII VI II VIII III I IIII I II II 0 3 7 8 0 5" 1 ffl LJl ^ ~ O RJ Lfl rv ti O O a a O .a cD ru ru ..T .~ ^ ESTATE OF DAVID N BAIR 21-09-00818 SCHEDULE H Parthemore Funeral Home & Cremation Services, Inc. P.O. Box 431 1303 Bridge Street New Cumberland, PA 17070-0431 (717) 774-7721 Mrs. Doris M. Bair 513 Eutaw Avenue New Cumberland, PA 17070 Statement DATE 9/ 18/2009 AMOUNT DUE AMOUNT ENC. $0.00 DATE TRANSACTION AMOUNT BALANCE 07/31/2009 Balance forward 08/19/2009 1NV # 1874. Due 09/18/2009 0.00 09/16/2009 . PMT#I.estate 9,247.32 9,247.32 09/16/2009 PMT #7391 I5. County of Cumberland VA Benefit -9,247.32 0.00 09/18/2009 CHK - ~Y1C.~CJ~CI -100.00 _100.00 100.00 0.00 ~;~~~',, ~~~~~ ., CURRENT 1-30 DAYS PAST DUE 31-60 DAYS PAST DUE 61-90 DAYS PAST DUE OVER 90 DAYS PAST DUE AMOUNT DUE 0.00 0.00 0.00 0.00 0.00 $0.00 Please don't hesitate to call our office if we may be of assistance. Thank you. Funeral Luncheon o Date: o~ / D q Food Expenses: ~ ~~ 3`~ Paper Expenses (# served) ~_X $.50 = _.~ d ~ U ~ Coffee Expenses (per pot) Total Expenses= 30~• 3 Check payable to Trinity United Methodist Church -memo section with name of funeral. 7 wi - cfswri - a t ~ ~ro}~,Q -~ X $1.00 = -H" ~' , _ ~ ~~~ Qua lity,5electiooti, Savings, Every Gray. Visit us on the Internet www.GlantFoodStores.com My coal is to ensure your satisfaction every time you shop with us, If there is anythins more I can do to improve your experience Please call or write. Keith Kohl, Store Manaser Giant Food Store X253 130 Old York Road New Cumberland, PA 17070 Store Telephone: (717) 774-4936 Pharmacy Telephone: (717) 909-4320 08/19/09 8:56PM ~~ - T Quality,5electit~~i, :iavings, Every bay. Visit us on i•he Internet www,GiantFoodStores,com My coal is to ensure your satisfaction every time you shop with us, If there !s anythlns more I can do to lmProve your experience Please call or write. Keith Kohl, Store Manaser Giant Food Store >>t253 • 130 Olcl York Road New Cumberland, PA 17070 Store Telephone; (717) 774-4936 THANK YOU 480011592 81 Pharmacy Telephone: (717) 909°4320 3 @ 2.39 OP;/20~/ 09 10:09AM MTOLV PCKLS 16Z 7 li F KRAFT LTE MAYD 3 69 F 3 @ 9.99 . THANK YOU 48001159281 UTZ CHIPS 1602 19 97 F 2 @ .99 PRRTY 7RRY 69.99 F LETTUCE 29 1J 1 98 F FARTY "kAY 69.99 F 2 @ 2.39 FULL SHEET CAKE. 37.99 F TURKEY HILL TEA 9 78 F FRUIT TRRY LG 35.99 F 2 @ 2.25 RELISH TRAY,SM 16.99 F SIJISS LEMONADE 4 50 B TRX PRID .00 TAX PAID 2-t _ ***aTOTAL 230.95 ****TOTAL 37.36 RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Receipt Date: 8/31/2009 Cumberland County - Register Of Wills Receipt Time: 13:17:35 One Courthouse Square Receipt No.: 1058060 Carlisle, PA 17613 BAIR DAVID NOAH Estate File No.: 2009- 00818 Paid By Remarks: TIMOTHY A HOLMES CJ ------------------------ Receipt Distrib ution ----- -------- -------- --- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 260.00 CUMBERLAND COUNTY GENERAL FUN WILL 15.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 40.00 CUMBERLAND COUNTY GENERAL FUN JCP FEE 10.00 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5.00 ---------------- CUMBERLAND COUNTY GENERAL FUN Check# 968 $330.00 , Total Received......... $330.00 FROM: BILL TO Invoice H&R BLOCK PREMIUM 4811 JONESTOWN RD, SUITE 125 HARRISBURG, PA 17109 ESTATE OF DAVID N BAIR 513 EUTAW AVENUE NEW CUMBERLAND, PA 17070 Statement of Charges FOR THE PREPARATION OF REV-1500 AND RECEIPT RELEASE AND REIMBURSEMENT OF THE ABOVE NAMED ESTATE 5/6/2010 Sub= total 0.00 750.00 TOTAL 750.00 M Q °~` d~ H o ~ ~ N i ~a M ~ .. 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BAIR, late of the Borough of New Cumberland, Cumberland County, Pennsylvania, deceased, have been granted to the undersigned. All persons knowing themselves to be indebted to said Estate will make payment immediately, and those having claims will present them for settlement. Doris M. Bair, Executrix - 513 Eutaw Avenue New Cumberland, PA 17070 Tim Holmes, Esquire 122 South 16th Street Camp Hill, PA 17011 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 publica ' e true. //~//////~//~//~.~/ 6% s! !I~ Swo to ands bsc ibed before me this 1 ~ ~~~ Notary Public My commission expires: COMMON EAL,TH OF PENNSYr..Lrr>NiA ~ NOTARIAL SEAL 1 ~?AIVIBI ANN HECKENUORN, Nolany i'Ittir•,: Camp HiN Boro., Cumberland Courlt~ R °~~;~ ~^omr~ls~;-,, ~x~-~.iret .Januar}s 27 "t~ ; l THE SENTINEL - LEGAL Ad# 374100 First taken by wolfc 08/31/2009 L :52 Printed on 08/31/2009 at 13:54 by wolfc Last changed by wolfc 08/31/2009 L :54 (717) 343-3256 Acct# 70408 Given by TIMOTHY HOLMES PO# Est. David Bair TIMOTHY HOLMES Start 09/01/2009 Stop 09/1.5/2009 ~S 16TH ST Transient Bill Expi.r. Class 10 PUBLIC NOTICES CAMP HILL, PA 17011 Index: EXECUTRIX NOTICE LETTERS TESTAMENT Subscr? N Cols 2 Lines 17 Inches 1.60 Words 73 Box? N Mail Info: Type Mail Sched Copies Sunday Comment Affid N L 1 Estate of David N. Bair Pb# Code Rate Base-Charge Addl-Charge Total-Cost Ins Start Stop SMTWTFS 01PRF 7.00 3 LGL 180.54 7.00 187.54 3 09/01/2009 09/15/2009 0010000 TOTAL AD COST 187.54 ***** TENT.~TIVE ***** TENTATIVE ***** TENTATIVE ***** TENTATIVE ***** TENTATIVE ***** EXECUTRIX NOTICE Letters Testamentary on the Estate of DAVID N. BAIR, late of the Borough of New Cumberland, Cumberland County, Pennsylvania, deceased, have been granted to the undersigned. All persons knowing themselves to be indebted to said Estate will make payment immediately, and those having claims will present them for settlement. Doris M. Bair, Executrix 513 Eutaw Avenue New Cumberland, PA 17070 Tim Holmes, Esquire • 122 South 16th Street Camp Hill, PA 17011 • CUMBERLAND LAW JOURNAL CUMBERLAND COUNTY BAR ASSOCIATION 32 SOUTH BEDFORD STREET, CARLISLE, PA ~70~3 (7~7) 249-366 - PA toll free (800) 990-908 -Fax (7~7)~ z49-2663 LETTERS OF ADMINISTRATION OR TESTAMENTARY Letters Testamentary o r Letters of Administration (circle one) - ~~----~ On the Estate of David N. Bair late oi~ New Cumberland Boroueh of Cumberland County, Pennsylvania, borough/township deceased, have been granted to the undersigned. All persons knowing themselves to be indebted to said Estate will make payment immediately, and those having claims will present them for settlement to: Name : Doris M. Bair Executor' r Administrator (circle one) Address: 5~3 Eutaw Avenue, New Cumberland, PA X7070 • OR Attorney: Tim Holmes, Esquire Address: ~z2 S. 6th Street, Camp Hill, PA ~7oi~ FEE: Fee is Payable in Advance Cost 575.00 for three (3) consecutive Friday publications Check payable to: Cumberland Law Journal Following receipt of the completed notice and payment the notice will publish three consecutive times in the Cumberland Law Journal. Proof of publication will'ne forwarded to the attorney or representative at the address listed. A copy of the notice should also be sent to one of the following newspapers of general circulation in Cumberland County. The Sentinel 457 E. North Street P. O. Box 130 Carlisle, PA 17013 (717) 240 7130 Patriot News Metro West Edition P. O. Box 2265 Harrisburg, PA 17105-2265 (717) 255 8121 or (800) 692 7207 THE FOREGOING ADVERTISEMENT IS OFFERED AS A DRAFTING GUIDE ONLY; THE PERSON PLACING THE ADVERTISEMENT IS SOLELY RESPONSIBLE FOR THE CONTENT CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717) 249-3166 Fax: (717) 249-2663 September 25, 2009 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: Tim Holmes, Esquire RE: David N. Bair 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: September 11 September 18, and September 25, 2009 Advertising Cost Proof of Publication Second Proof Request Payment received Total Amount Due $ 75.00 $ 0.00 $ 0.00 $ 75.00 $ 0.00 Becky H. Morgenthal, Executive Director PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.:~784 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. 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, vlz: September 11, September 18 & September 25 2009 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 ilrterested 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. Bair, David N., deed. Late of New Cumberland Bor- ough. Executrix: Doris M. Bair, 513 Eutaw Avenue, New Cumberland, PA 17070. Attorney: Tim Holmes, Esquire, 122 S. 16th Street, Camp Hill, PA 17011. _ ~ ~.-- sa M rle Coyne, ditor SWORN TO AND SUBSCRIBED before me this 25 day of September, 2009, Notary ,; " /~ NgTAR!AL SEAL DEBORF,N A COLLINS Notary Public CARLISLE BORO, CUh~IBERL~ND CUl1NTY My Commission Ex~lres Apr 2~, 2010 RETAIN THIS PORTION FOR YOUR RECORDS THE SENTINEL - LEGAL P.O. BOX 130, CARLISLE, PA 17013 AD NUMBER CLASS 374100 10 PUBLIC NOTICES • ADnDESCRI,PTION EXECUTRIX NOTICE LETTERS TESTAMENT 1\IC CC 3 THE SENTINEL - LEGAL TOTAL AD CHARGE 3 PROOF OF PUBLICATION PREVIOUSLY PAID DAYS RUN PURCHASE ORDER Est. David Bair TIMOTHY HOLMES SALESPERSON BILLING DATE wolfc 09/1!5/09 START DATE 09/01/09 'IONS RATE NET AMOUNT 3 LGL 180.54 34 * 2 09/15/09 GROSS AMOUN 180.54 OlPRF 7.00 -187.54 PAY THIS AMOUNT I .00 1 MESSAGE: Thank you for advertising with The Sentinel. .oo* Deadlines for in-column legal advertisements: Monday is Thursday at 5 p.m; Tuesday is Friday at 5 p.m.; Wednesday is Monday at 5 p.m; Thursday is Tuesday at 5 p.m; Friday is Wednesday at 5 p.m Saturday is Wednesday at 12 Noon; Sunday is Wednesday at 5 p.m. If you have any questions regarding your Legal bill please call .Classified Manager at 717-240-7176 Fax your legals to 717-243-3754 attention Classified :Manager You can also EMAIL your legal to Classified ads: 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 Est . David Bair P n RnX 13n CARI ISI F PA '17(]'13 AD NUMBER CLASS START DATE STOP DATE O 374100 PUBLIC NOTICES 09/01/09 09/15/09 AD DESCRIPTION BILLING DATE TELEPHONE NUMBER EXECUTRIX NOTICE LETTERS TESTAMENT 09/15/09 717-343-3256 TIMOTHY HOLMES 122 S 16TH ST CAMP HILL, PA 17011 I~~~III~~~III~~~~~~II~~~IIII~~~I GROSS AMOUNT OF .00 DUE AFTER 10/1 5/09 TOTAL AMOUNT DUE .00 ENTER AMOUNT ENCLOSED 20200000003741000000000000000000000000000000002 ESTATE OF DAVID N BAIR 21-09-00818 SCHEDULE CB Us`'eue;e- _-_--_--_._n_ .i_p PN ~ _- __ _ _ d a C u T f le ______ C~[rR Pk, N.A. 040 -- -- - .._! °_' ° ~ q i ~ s. ---__ C4 PAY TO THE w ORDER OF _.~~ NO. a c .~e e- ~ DATE / ~7~~~--C-~ € ~ ~"~ l~ y[° ~~ ~, ~ `~` ~ ~.~.-~ 60-1273/313 a ~,, ~ ^ ~ ~ ESTATE OF ~~ " "``~-~a7.,.% ~ cal L.~-y-yt.-' FOR j/~ _ .' . _._~ _~--~ °ti.~ __. _ . _ __. ----- _ _ ~:0 3 j _.. "'"" ADMINISTRgTOR -- _._ -- -_ -- __ ._ '~ 2~38~; _ .__ NAL ----- 5004 a ~OB L7 ~711~ ._.. ..._... _. ._ .._ _. _.... .._M'/ TRp~~E NTATIVE I PNCBAIIK PNC Bank, N.A. 040 ('.entrai PA PAY TO THE1~ ` ORDER OF `~°•''~ -_I ~ e n h a ._ d p u.__..-_.S--b_~ rTR / ~. d e t a i l s NO. i /' 60-12 313 ~ DATEf "'~-c~sNl-U'GH` -`J .~8~ ! ~ ~~' 3 ~ r - DOLLARS 8 ~..Mr=.. -'STATE OF ~' --_.~....__ , ADMINISTRATOR FOR /~/.~,ril~ ~_~ / (.- ` '~..~~2 <<.-e .. _ _..~ ~~ ^* ~ Execurow ~- -~ ~ - - - -~ - ror PERSONAL ' ' REPRESENTATIVE i '---------'---.._ __._~._._____----- ...-`- --- M,' TRUSTEE ~:O 3 i 3 i 2 7 3Bi: 50046908 2 2~~' ~---- Tim Halmes 122 S. 16~' Street Camp Hill, PA 17011 September 26, 2009 State Employees Retirement System Montoursville Office Hamsburg, PA 17101 To Eva M. Bower, Administrative Assistant: My name is Tim Holmes. I am an attorney licensed to practice in Pennsylvania, and I am assisting Doris M. Bair with the administration of her late husband's estate. Her husband's name was David Noah Bair. Mrs. Bair and I both received two letters from you concerning David Bair's retirement payments ceasing upon his death. (Copies of those letters are enclosed with this letter.) In the one letter, you write that if Mr. Bair's August check was cashed or deposited, the reimbursement due to your system is $117.91. In the other letter, you write that if Mr. Bair's beneficiary annuitant check for August was cashed or deposited the reimbursement due to your system is $163.82. Both checks were deposited into Mr. Bair's estate account; therefore, Mrs. Bair is remitting to you a check for $117.91 and a check for $163.82. In both letters, you also write that you require a certified copy of Mr. Bair's death certificate; therefore, Mrs. Bair is providing to you a Certificate of Death from the Cumberland County Registrar's Office for David N. Bair. If you require any additional information from me, please do not hesitate to write to me at the address above or telephone me (717) 343-3256. Timothy. Holmes, Esquire Cc: Doris M. Bair P. Dennis Bair