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Home My WebLink About04-0583 1 IN RE: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA WILLIAM H. ROOZENBURG, : ORPHAN'S COURT DIVISION An Alleged Incompetent : :NO. PETITION REQUESTING A DETERMINATION OF INCOMPETENCY Petitioner by and through his attorney, John H. Broujos of Broujos & Gilroy, P.C., avers as follows: 1. Petitioner is John B. Klunder, an adult individual residing at 924 SE 21st Terrace, Cape Coral, FL 33990, referred to herein as proposed guardian. 2. William H. Roozenburg is an adult individual currently residing at Todd Home and Rehabilitation Center, 1000 W. South Street, Carlisle, PA 17013, referred to herein as alleged incompetent. 3. William H. Roozenburg is 84 years of age, with a diagnosis of severe dementia. 4. His present condition follows: A. He is restricted to the dementia lockdown unit at the Todd Home, Carlisle. B. He has been removing large sums of money from his bank accounts and making disposition thereof to unknown sources. His nephew is concerned that he is susceptible to losing or dissipating funds essential for his care. C. He wandered around driving his car and had an accident near Dickinson College, with no injuries; so his doctor terminated his driving.. D. The lockdown unit has doors that lock automatically, with patients coded in and out. 5. Because of impairments, he is unable, without the care and assistance of others, to care adequately for his needs of nourishment, personal and medical care, shelter, self-protection and safety. He is also unable to handle his financial assets and is lik~e!i7 to become a victim of predators. No power of attorney exists and utility and other expenses cannot be paid until guardian is appointed. ~: 1.7 !'i~ 6. The proposed guardian of the personta~d df the estate is Petitioner, John B. Klunder, nephew of Mr. Roozenburg. Petitioner has no interest adverse to that of Mr. Roozenburg. He is the closest and most involved in the care of his uncle, with whom he has been closely involved since childhood. His resume is attached hereto as Exhibit A. 7. Proposed guardian is an out of state nonresident, residing at 924 SE 21 st Terrace, Cape Coral, FL 33990. He is the only family member conveniently available, since other family members live as far away as California, are of an advanced age, or are otherwise not available. 8. Mr. Roozenburg's next-of-kin who would be entitled to share in his estate should he die intestate are set forth in Exhibit B. Petitioner has a will with two next of kin beneficiaries, Francis McConney (his sister) and Carl and Alice Benson (his brother-in-law and sister-in-law), who are too elderly and unavailable to act as guardian. 9. The nature and approximated extent of Mr. Roozenburg's estate consists of the following: Savings account. $365 M&T Bank checking account: 3,000 Household effects and car: 3,000 Real property- 1~25,00_0 $131,365 Monthly income from Social Security: 628 Monthly income from military pension: 896 $1,524 10. Dr. William S. Kauffman, of Spring Road Family Practice, 1921 Spring Road, Carlisle, PA ! 7013, will be available for hearing through July. He has been Mr. Roozenburg's physician at the Todd Home, Carlisle. 11. Petitioner requests an expedited hearing, since the house at 141 Strayer Drive is in a deteriorating condition due to the alleged incompetent's conduct in the dementia condition; inability to adequately care for the house; the house is vacant; fire risk is increased; assets must be marshaled and applied to his medical and nursing care expenses; and other related reasons. WHEREFORE, Petitioner prays that a citation be issued directly to William H. Roozenburg, the alleged incompetent, to show why he should not be adjudged an incompetent and a guardian be appointed for his estate and ~son, for his and to i~mpose bond, if required ~ecl,'~ · x,..~ John H. Broujos, Esquiree #626~ 717/243-4574; FAX//717/243-8227 "BR,0~UJOS & GILROY, P.C. 4 North Hanover Street , Date' June 21, 2004 Carlisle, Pennsylvania 17013 I verify that the statements made in this Petition are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S.A. Section 4904 relating to unswom falsification to authorities. Date: ~ B. Klunder RESUME John B. Klunder 924 S.E. 21 st. Terrace Telephone Cape Coral, Fl. 33990 Home: 239-242-0267 Office' 239-768-6000 Age: 61 Married EDUCATION Western Michigan University, Kalamazoo, Michigan B.S Communications Western Michigan University, Kalamazoo, Michigan MA Information Technology Michigan State University, t~ast Lansing, Michigan MA Education Leadership ADULT CAREER SUMMATION 1968-1995 Teacher, coach, building level administrator at middle and high school level. Administrated district-level programs. Administrated State of Michigan programs. 1995-2002 Owned and or~erated commercial cleanine franchise business. 2002-Present Franchise Development Director for franchiser Coverall Cleaning Concepts, and franchiser of commercial cleaning franchises. IN DEPTH CAREER HISTORY 1968-1995 Education Career Union City Public School, Union City, Michigan - Communications, social studies teacher. Football and baseball coach. Belding Public School, Belding, Michigan - Wrote and developed a program for communications ans. Developed and directed a 1 O-watt FM radio station for students and the community. Coached football and baseball. Kentwood Public Schools, Kentwood, Michigan - Director of a library/technology program for a large suburban middle school. Responsible for the supervision of two persons, budgeting, setting goals, and general operation of the center. - District director of State of Michigan program for the economic education of district children K-12. Forest Hills Public Schools, Grand Rapids, Michigan - Director of a library/technology program for two large suburban high schools. Responsible for the supervision of 9 persons, budgeting, goal setting, and general operation of the centers. - Appointed by the State of Michigan to author a pilot program for the instruction of state teachers in the integration of technology into their curriculums. Responsible for chairing the committee, setting agendas, setting goals for the program, and'the implementation of the goals. Our schools became a focal point throughout the state. Teachers came on campus to be trained in the use of technology so they could take the model to their districts and implement it into their curriculums. - Also served as Assistant Principal at both the high school and middle school levels. Responsibilities were for the general curriculum development of the school student discipline, and special education students. ' - District-wide Director of Technology. Responsible for supervision of personnel in 12 schools and their support staff. Responsible for the administrative technology which included telephone and computer systems/networks, three television studios, one radio station, and an interactive distant learning system. Responsible for setting goals, budgets, and the general operations of both instruction and support staff. 1995-2002 Business Career Owned and operated a commercial cleaning franchise (Beacon Commercial Cleaning, Inc.) in Cape Coral, Florida. Responsible for general operation, staff supervision, sales, and customer service. Business operated in three counties in Southwest Florida, cleaning businesses and medical facilities. 2002-Present Employed by franchiser Coverall Cleaning Concepts as a Franchise Development Director. Responsibilities are to train new franchise owners in business practices and operations and the technical side of cleaning and floor care for large commercial businesses. NEXT-OF-KIN OF WILLIAM H. ROOZENBURG Francis McConney (his sister) Carl and Alice Benson (his brother-in-law and 223 Clarence Street 3494 N. Michigan Hwy. 63 sister-in-law) Richmond, CA 94801-4016 Benton Harbor, MI 49022 John B. Klunder (nephew) Diane Frary (niece) 924 SE 21 st Terrace 230 Western Drive Cape Coral, FL 33990 Richmond, CA 94804 Nancy Miniger (niece) Gloria Haan (niece) 2065 108th Street 2980 Fillmore Otsego, MI 49078 Jenson, MI 49428 EXHIBIT B IN RE: William H Roozenburg IN THE COURT OF COMMON PLEAS ORPHANS' COURT DIVISION CUMBERLAND COUNTY, PENNSYLVANIA NO. 21-2004-583' CITATION WE COMMAND, you that laying aside all business and excuses whatsoever, you be and appear in your proper person before the Honorable Judges of the Court of Common Pleas, Orphans' Court Division at a session of the said Court there to be held, for the County of Cumberland to show cause why he should not be ad'ud ed an incom etent and a uardian be a ointed of his erson and of his estate' the time and lace of lhearin are fixed for Court Room NO. 3 4th floor Cumberland Coun Courthouse Carlisle otice pfthe hearing shall be given to William H. Roozenburg, the alleged incompetent, by serving William I1 Roozenbur ersonall with a citation and a co of the fore o~n et~t~on and this Order of Court. and at least 20 days written notice of the petition and hearing shall also be given to the next of kin and othe, arties in interest named in the etition either ersonall or b certified mail. Witness my hand an official seal of office at Carlisle, Pennsylvania, this _2nd day of June, 2004. erk, Orphans' Court'I}~ision~l~t Cumberland County, Carlisle, PA My Commission Expires on the 1 January, t~_0_O3~ IN RE: William H Roozenburg IN THE COURT OF COMMON PLEAS ORPHANS' COURT DIVISION CUMBERLAND COUNTY, PENNSYLVANIA NO. 21-2004-583' CITATION WE COMMAND, you that laying aside all business and excuses whatsoever, you be and appear in your proper person before the Honorable Judges of the Court of Common Pleas, Orphans' Court Division at a session of the said Court there to be held, for the County of Cumberland to show cause why he should not be adjudged an incompetent and a guardian be appointed of his person and of his estate; the time and place of lhearing are fixed for Court Room NO. 3, 4th floor, Cumberland County Courthouse, Carlisle, Pennsylvania, on Monday the 19th day of July, 2004 at 9:30 o'clock a.m. at least days written notice of the hearing shall be given to William H. Roozenburg, the alleged incompetent, by serving William H Roozenburg personally with a citation and a copy of the foregoing petition and this Order of Court; and at least 20 days written notice of the petition and hearing shall also be given to the next of kin and other parties in interest named in the petition, either personally or by certified mail. Witness my hand an official seal of office at Carlisle, Pennsylvania, this 2nd day of June, 2004. lerk, O~phans' Cour~ ~]v-ision ' · Cumberland County, Carlisle, PA~e~ ~ My Commission Expires on the 1 st Monday J anuar y,~_0_.O_~ IN RE: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA WILLIAM H. ROOZENBURG, : ORPHAN'S COURT DIVISION An Alleged Incompetent : Oq- PRELIMINARY DECREE AND NOW, this ~day of~~r~' 2004, upon consideration of the annexed petition, it is ORDERED and DECREED that a citation issue, directed to William H. Roozenburg, to show cause why he should not be adjudged an incompetent and a guardian be appointed of his person and of his estate; the time and place of hearing are fixed for Court Room No..,~ , 4th floor, Cumberland County Courthouse, Carlisle, Pennsylvania, on the /~'tU"dayof ~/-"' ,2004at ~,~d o'clock,~r'.m. At least .~o Udays~written notice of the hearing shall be given to William H. Roozenburg, the alleged incompetent, by serving William H. Roozenburg personally with a citation and a copy of the foregoing petition and this Order of Court; and at least ~' F) days written notice of the petition and hearing shall also be given to the next of kin and other parties in interest named in the petition, either personally or by certified mail. BY THE COURT: cc: Jotm H. Broujos, Esquire IN RE: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA WILLIAM H. ROOZENBURG, : ORPHAN'S COURT DIVISION An Alleged Incompetent : :NO. PETITION REQUESTING A DETERMINATION OF INCOMPETENCY Petitioner by and through his attorney, John H. Broujos of Broujos & Gilroy, P.C., avers as follows: 1. Petitioner is John B. Klunder, an adult individual residing at 924 SE 21 st Terrace, Cape Coral, FL 33990, referred to herein as proposed guardian. 2. William H. Roozenburg is an adult individual currently residing at Todd Home and Rehabilitation Center, 1000 W. South Street, Carlisle, PA 17013, referred to herein as alleged incompetent. 3. William H. Roozenburg is 84 years of age, with a diagnosis of severe dementia. 4. His present condition follows: A. He is restricted to the dementia lockdown unit at the Todd Home, Carlisle. B. He has been removing large sums of money from his bank accounts and making disposition thereof to unknown sources. His nephew is concerned that he is susceptible to losing or dissipating funds essential for his care. C. He wandered around driving his car and had an accident near Dickinson College, with no injuries; so his doctor terminated his driving.. D. The lockdown unit has doors that lock automatically, with patients coded in and out. 5. Because of impairments, he is unable, without the care and assistance of others, to care adequately for his needs of nourishment, personal and medical care, shelter, self-protection and safety. He is also unable to handle his financial assets and is lik¢l.7 to become a victim of predators. No power of attorney exists and utility and other expenses cannot be paid until guardian is appointed. 6. The proposed guardian of the person~af~d 6fthe estate is Petitioner, John B. Klunder, nephew of Mr. Roozenburg. Petitioner has no interest adverse to that of Mr. Roozenburg. He is the closest and most involved in the care of his uncle, with whom he has been closely involved since childhood. His resume is attached hereto as Exhibit A. 7. Proposed guardian is an out of state nonresident, residing at 924 SE 21 st Terrace, Cape Coral, FL 33990. He is the only family member conveniently available, since other family members live as far away as California, are of an advanced age, or are otherwise not available. 8. Mr. Roozenburg's next-of-kin who would be entitled to share in his estate should he die intestate are set forth in Exhibit B. Petitioner has a will with two next of kin beneficiaries, Francis McConney (his sister) and Carl and Alice Benson (his brother-in-law and sister-in-law), who are too elderly and unavailable to act as guardian. 9. The nature and approximated extent of Mr. Roozenburg's estate consists of the following: Savings account: $365 M&T Bank checking account: 3,000 Household effects and car: 3,000 Real property: 125,000 $131,365 Monthly income from Social Security: 628 Monthly income from military pension: 896 $1,524 10. Dr. William S. Kauffman, of Spring Road Family Practice, 1921 Spring Road, Carlisle, PA 17013, will be available for hearing through July. He has been Mr. Roozenburg's physician at the Todd Home, Carlisle. 11. Petitioner requests an expedited hearing, since the house at 141 Strayer Drive is in a deteriorating condition due to the alleged incompetent's conduct in the dementia condition; inability to adequately care for the house; the house is vacant; fire risk is increased; assets must be marshaled and applied to his medical and nursing care expenses; and other related reasons. WHEREFORE, Petitioner prays that a citation be issued directly to William H. Roozenburg, the alleged incompetent, to show why he should not be adjudged an incompetent and a guardian be appointed for his estate and for his fi"&son, and to im~pose bond, if required. ~. John H. Broujos, Esquiree #6268 717/243-4574; FAX# 717/243-8227 BR.O3dJOS & GILROY, P.C. 4 North Hanover Street Date: June 21, 2004 Carlisle, Pennsylvania 17013 I verify that the statements made in this Petition are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S.A. Section 4904 relating to unsworn falsification to authorities. ~]~ B. Klunder RESUME John B. Klunder Telephone 924 S.E. 21st. Terrace Home: 239-242-0267 Cape Coral, Fl. 33990 Office: 239-768-6000 Age: 61 Married EDUCATION Western Michigan University, Kalamazoo, Michigan B.S Communications Western Michigan University, Kalamazoo, Michigan MA Information Technology Michigan State University, East Lansing, Michigan MA Education Leadership ADULT CAREER SUMMATION 1968-1995 Teacher, coach, building level administrator at middle and high school level. Administrated district-level programs. Administrated State of Michigan programs. 1995-2002 Owned and overated commercial cleanine franchise business. 2002-Present Franchise Development Director for franchiser Coverall Cleaning Concepts, and franchiser of commercial cleaning franchises. IN DEPTH CAREER HISTORY 1968-1995 Education Career Union City Public School, Union City, Michigan - Communications, social studies teacher. Football and baseball coach. Belding Public School, Belding, Michigan - Wrote and developed a program for communications arts. Developed and directed a 1 O-watt FM radio station for students and the community. Coached football and baseball. Kentwood Public Schools, Kentwood, Michigan - Director of a library/technology program for a large suburban middle school. Responsible for the supervision of two persons, budgeting, setting goals, and general operation of the center. - District director of State of Michigan program for the economic education of district children K-12. Forest Hills Public Schools, Grand Rapids, Michigan - Director of a library/technology program for two large suburban high schools. Responsible for the supervision of 9 persons, budgeting, goal setting, and general operation of the centers. - Appointed by the State of Michigan to author a pilot program for the instruction of state teachers in the integration of technology into their curriculums. Responsible for chairing the committee, setting agendas, setting goals for the program, and the implementation of the goals. Our schools became a focal point throughout the state. Teachers came on campus to be trained in the use of technology so they could take the model to their districts and implement it into their curriculums. - Also served as Assistant Principal at both the high school and middle school levels. Responsibilities were for the general curriculum development of the school, student discipline, and special education students. - District-wide Director of Technology. Responsible for supervision of personnel in 12 schools and their support staff. Responsible for the administrative technology which included telephone and computer systems/networks, three television studios, one radio station, and an interactive distant learning system. Responsible for setting goals, budgets, and the general operations of both instruction and support staff. 1995-2002 Business Career Owned and operated a commercial cleaning franchise (Beacon Commercial Cleaning, Inc.) in Cape Coral, Florida. Responsible for general operation, staff supervision, sales, and customer service. Business operated in three counties in Southwest Florida, cleaning businesses and medical facilities. 2002-Present Employed by franchiser Coverall Cleaning Concepts as a Franchise Development Director. Responsibilities are to train new franchise owners in business practices and operations and the technical side of cleaning and floor care for large commercial businesses. NEXT-OF-KIN OF WILLIAM H. ROOZENBURG Francis McConney (his sister) Carl and Alice Benson (his brother-in-law and 223 Clarence Street 3494 N. Michigan Hwy. 63 sister-in-law) Richmond, CA 94801-4016 Benton Harbor, MI 49022 John B. Klunder (nephew) Diane Frary (niece) 924 SE 21st Terrace 230 Western Drive Cape Coral, FL 33990 Richmond, CA 94804 Nancy Miniger (niece) Gloria Haan (niece) 2065 108th Street 2980 Fillmore Otsego, MI 49078 Jenson, MI 49428 EXHIBIT B IN RE: William H. Roozenburg : IN THE COURT OF COMMON PLEAS OF An alleged incapacitated person : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : : NO. 21-2004-0583 IMPORTANT NOTICE CITATION WITIt NOTICE A petition has been filed with the Court to have you declared an Incapacitated Person. If the Court finds you to be an Incapacitated Person, your rights will be affected, including your right to manage money and property and to make decisions. A copy of the petition which has been filed by John B. Klunder is attached. You are hereby ordered to appear at a heating to be held in Court Room No. 3, Cumberland County Courthouse, Carlisle, Pennsylvania, on July 19 ,2004, at 9:30 A.M. to tell the Court why is should not find you to be an incapacitated Person and appoint a Guardian to act on your behalf. To be an incapacitated Person means that you are not able to receive and effectively evaluate information and communicate decisions and that you are unable to manage your money and/or other property, or to make necessary decisions about where you will live, what medical care you will get, or how your money will be spent. At the heating, you have the tight to appear, to be represented by an attorney, and to request a jury trial. If you do not have an attorney, you have the right to request the Court to appoint an attorney to represent you and to have the attorney's fees paid for you if you cannot afford to pay them yourself. You also have the right to request that the Court order that an independent evaluation as to your alleged incapacity. If the Court decides that you are an Incapacitated person, the Court may appoint a Guardian for you, based on the nature of any condition or disability and your capacity to make and communicate decisions. The Guardian will be of your person and/or your money and other property and will have either limited of full powers to act for you. If the court finds you are totally incapacitated, your legal rights will be affected and you will not be able to make a contract or girl of your money to other property. -If the court finds that you are partially incapacitated, your legal rights will also be limited as directed by the Court. If you do not appear at the hearing (either in person or by an attorney representing you) the court will still hold the heating in your absence and may appoint the Guardian requested. Clerk, Orphans Court Division Cumberland County, Carlisle, PA My Commission Expires 1st Monday, January, 2006 BROUJOS & GILROY, P.C. ATTORNEYS, AT LAW' 4 NORTH HANOVER STREET CARLISLE, PENNSYLVANIA 17013 717-243-4574 766-1690 IN RE.' : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA WILLIAM H. ROOZENBURG, : ORPHAN'S COURT DIVISION An Alleged Incompetent .' PRELIMINARY DECREE AND NOW, this ~E~_ day of~ ,2004, upon consideration of the annexed petition, it is ORDERED and DECREED that a citation issue, directed to William H. Roozenburg, to show cause why he should not be adjudged an incompetent and a guardian be appointed of his person and of his estate; the time and place of hearing are fixed for Court Room No..~ , 4th floor, Cumberland County Courthouse, Carlisle, Pennsylvania, on the /~ 'm"day of (~J~/" , 2004 at ~,'3d o'clock,~.m. At least ~ Ofdays~written notice of the hearing shall be given to William H. Roozenburg, the alleged incompetent, by serving William H. Roozenburg personally with a citation and a copy of the foregoing petition and this Order of Court; and at least ,.~ days written notice of the petition and hearing shall also be given to the next of kin and other parties in interest named in the petition, either personally or by certified mail. BY THE COURT: cc: John H. Broujos, Esquire IN RE: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA WILLIAM H. ROOZENBURG, : ORPHAN'S COURT DIVISION An Alleged Incompetent : : NO. DECREE AND NOW, this ~day of ~ , 2004, after review of the petition, and hearing, William H. Roozenburg is adjudged ~' competent and it is ordered and directed that John B. Klunder is appointed~rdian of the pe~on and of the estate of William H. Roozenburg and shall post a bond of $ cc: John H. Broujos, Esquire POWER OF ATTORNEY Know All Men by These Presents: qlrre,ncable) BOND No. R* 2g+& 76~?'~ THR E 5 ~ ,mthoi[zed indl',ldud]-, [ AUTHORIZED INDI~ [I)LTALS - kUTHORIZED IND['~ IDU kLS EEVERLY d DURHAM ~IC~AF d ~ILLE~ PAMELA J VANPELT - n thc £t~ CARLISLE Sta~c AUCTIONEER AN~ ApoRENTIC AUCTION COMPANY AND AUCTICN hOUS~ PRIVATE DETECTIVE ******************************** · ~ ~ E S T F ~ S t R F T ~ --'(' O M P ~N ~ IMPOR'[ANT: This (late must be filled in belbrv it is attached to the bond and it must be the same date tis the bond. IN RE: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA GUARDIANSHIP OF : ORPHAN'S COURT DIVISION V*ILLIAM H. ROOZENBURG : : NO. 21-2004-0583 SURETY BOND KNOW ALL MEN BY THESE PRESENTS. That 1. John B. Klunder of 924 S.E. 21st I'crracc. Capc ('oral. FL 33990. Obligor. and Weslern Surety Company of Sioux Falls. 101 South Phillips Avenue. Sioux Falls. South Dakota. 57117-5077, Surety. are held and bound unlo the Commonx;eahh of Pennsylvania. in the sum of Filiy Thonsand and 00/100 Dollars ($502)00.00), to be paid to the said Commom~ealth. to which payment well and trul3 to be made, wc do bind ourselves, fbr and in the whole, our heirs, executors and administrators, and assigns, and each and every of' them. firmly by thcsc presents. WI1EREAS. said Obligor on the 19th da3 of July. 2004. was appointed Guardian of thc estate and person of William H, koozcnburg. Todd [lomc and Rehabilitation Center. 1000 Vx South Street. Carlisle. PA. i7013, by thc Orphan's Com't of Cumbcrland County, NOW THE CONDITION OF IHIS OBLIGATION 1S. that if said Obligor does well. fhithfMlly, and with fidelity perform his duties, xxhich ma> bc decreed by such Registcr of Wills, or b5 lhe Orphan's Courl of Cumberland Count5. then this obligation to be void. otherwise remain in t~tll ~¥rcc and cft~ct. Scaled ~ith our seals, and dated thc ~ da} ofJuls. Tx~o l'housand Four. Sealed and ddivcr~ / .~ J~n B. Khtnder,~uardian/Obligor~h Pamela ,l. Van PdL Surety Western Surety Company of Sioux Falls. 101 South Phillips Avenue. Sioux }:ails. South Dakota 57117-5077 .-;; IN RE: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA GUARDIANSHIP OF : ORPHAN'S COURT DIVISION VflLLIAM H. ROOZENBI RG : : NO. 21-2004-0583 SURETY BOND KNO'~¥ ALL MEN BY THESE PRESENTS. That I. John B. Klundcr of 924 S.E. 21st I crracc, (ape (oral. k k o> ))0. Obligor. and Xk cstern Sm'et5 Compa% of Sioux Falls, 101 St uth Plnlhps Avenue. Stoux Falls. South Dakota, 57117-5077. St rctv, are held and Iirml5 bound unto the Commonxxealth of Penns3 ~ ania, in the sum of Fifty Thousand and 00/100 I)ollars ($50.000.00), lo be paid lo the said Commonwealth, to which payment ~cll and truly to be made. we do bind ourselxes, lbr and in thc whole, our heirs, executors and administrators, and assiens, and each and ever> of them. firmly by these presents. XYHEREAS, said Obligor on thc 19th day of Jul). 2004, ~as appointed Gnardian of the estate and person of William H. Roozenburg. Todd Home and Rehabilitation Center. 10 ,(~ South Street, Carlisle. PA. 17013. b5 the ()t'phan's Court of Cumberland County. N()~V THE CONDITION OF THIS OBLIGATION IS. that iFsaid Obligor does well. lhithf~ll5. and xxitb fidel~t) perlbrm his duties, x~hich may be decreed b5 such Register of ~'ills. or b) thc Orphan's Com't of Cumberland County. then this obligation to be void. otherx&ise to remain in full lbrcc and ctt~'ct. Scaled with our sca[s, and dated thc ~ day of Jul5. Tx~o Thousand Four. Scaled and dclix ertl, /- , ~ J~n B. Klundcr.~Xmrdian/Obligpr-~ Pamela J. Van P~t.~Surety ' - Western Surety Companx of Sioux Falls. 101 South Phillips Avenue, Sioux Falls. South Dakota 57117-5077 POWER OF ATTORNEY Hrre~ocalde) BOND No. R- 2 ~Z~ ? B ~ ? T Know All Men by These Presents: · · BEVERLY J DURHAM ~ICHA~L ,~ tq, ILLE~ PAMELA J VANPELT -o ~- '9'~ c y L V A An ORIGINAl. boDd tequlIed b} St,llure, Decree ot CotlrI AUCTIONEER AND APPlE%TIC AUCTION COMPANY AND AUCTIPN to the bond and it must bemustthe same date as tbe bond. B IN RE: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA B'ILLIAM H. ROOZENBURG, : ORPHAN'S COURT DIVISION Incompetent : : NO. 21-2004-0583 PETITION FOR PRIVATE SALE OF REAL ESTATE OWNED BY AN INCOMPETENT PERSON Pursuant to 20 PaCS ~3353. John B. Klunder. Petitioner, requests that the court issue an order authorizing Petitioner as thc guardian of the estate of Willianl H. Roozcnburg, an incompetenf, to sell b> private sale certain real property of the estate. Petitioner respectfully represents thai: 1. Petitiouer is John B. Ktundcr. gnardian of thc estate of William II. Roozenburg. with address of 924 SE 21'~ Terrace, (7ape Coral l:l, 33990. Petitioner was appointed guardian alier the Cumberland County Court decreed incompelenc.x on July 19, 2004. Decree is attached hereto as Exhibit A. Petitioner obtained required bond itl the anlount of $50.000.00 on August 3. 2004 ~itll Western Surer> Company of Sioux }:ails, 101 South Phillips Avenue, Sioux Falls. South Dakota 57117-5077 as surct,x, a cop? of Bond is attached hereto as Exhibit B. The guardian requests to bc excused from entering an? additional sccurit,x, since thc court was aware at the commencement of' inconlpctenc? proceedings of circumstances raider which tile inconlpetent was selected and that incompetent had a houle of estimated value itl consort with tile offer itl this petition. 2. As appears in thc petition of June 21,2004 requesting determination of incompcteuc?, an invcntor,x hi'the assels and an appraisenlent ~as included, a cop> being attached hereto and marked }.xhibit C. Tile liens or encumbrances on thc property as of August 10.2004. x~erc county, library, and school taxes in thc anlount of $1,789.27. l'hc description of the real property to bc sold is attached hereto and marked Exhibit D. 3. incompetent, who resides at Todd Honle and Rehabilitation Center, 1000 W. South Street, in tile city n 1' Carlisle. Count,x o ~' C unlberland. Comnlonwealtll of Penn%lxania. is tile owner of thc estate described abnxc. Petitioner o['['ers for private sale tile propert> of thc estate described above. 4. It is to the advantage of tire estate and those interested in the estate to sell the property in order to liquidate asscts of the incompetent to apply it to his maintenance and medical and nursing care expenses. Ifc is not ph.x sicall> or mentally capable of returning to occupy thc premises and the property would bc sub. icct to deterioration and depreciation if not sold. and rcntal el'the premises is not i'casiblc. 5. Petitioner has proposed to sell the premises at prixate sale for a price that is more than is obtainable at public sale. to Gale P,. Co>lc. who resides at 10 Gobin Drive. Carlisle. Proposed purchaser, has entered into an agreement of'sale dated August 18. 2004. lbr a purchase price of S141.000.00. copy of which is attached hereto as Exhibit E. Probable settlement date is scheduled for five da.~s after the approx al b> the court of this petition. 6. Pursuant to OC Rule 3.4(c) of thc Court. Pctitioner xxill submit tx~o affidavits of appraisers. required by PaRCP 12.10. Petitioner requests this conrt to permit filing of the affidavits within live da> s. The affidavits will set forth tbat thc>' arc not personall? inlerested in thc proposed salc and that in their opinion the proposed prix ate sale price is likel> higher than ma.~ be obtained at public salc. 7. This private sale is in tire best interests of thc incompetent. WHEREFORE. your Petitioner pra~x s that this I Ionorable Court issue an order to authorize private sale of thc described properl>, lo cony% all right, title, and interest: and Io excuse entry of additional securitx: and that the court make such further order as m~tv bc propcr&~' ~ the premises. '+ Pgtit~ner Dated: October 14. 2004 · ' ' }~xhibit A I)ecree of Incompetence and Appointment of Guardianship Exhibit B Surety Bond Exhibit C Inventory Exhibit D Deed Exhibit [:~ Sales Agreement ATTORNEY VERIFICATION 1. JOItN I1. BROU,IOS. ESQLIIRE. hereby verily' that I am the attorney of record fbr Petitioner: Johu B. Klundcr; that I am attthorizcd to take Ihis x erification on his behalf pursuant to Pa. R.C.P. 1024(c) because John B. Klunder is outside of the jurisdiction ol'the Court and his verification cannot be obtained withiu the timcfl'amc allo'~xed lbr filiug tiffs pleading; and that based upon n',_y review of the material documents in this case and my reasonable investigation, thc facts contained in the fbregoing petition are true and correct to the best of my knowledge, information, and belief. 1 understaod that t~alse statements made herein are subject to thc penalties of 18 Pa. C.S.A. § 4904 relating to unsx~orn falsification to authorities. Date: John}Il. Brotdos. Esquire ~ IN RE: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA WILLIAM H. ROOZENBURG, : ORPHAN'S COURT DIVISION An Alleged Incompetent : : NO. 21-2004-0583 DECREE AND NOW, this/(~ day o~} ~f , 2004, after review of the petition, and hearing, William H. Roozenburg is adju d an incompetent and it is ordered and directed that John B. Klunder is appointed guardian of the person and of the estate of William H. Roozenburg and shall post a bond in the amount of $ ~ f') (.~C~(]]~) . __. BY THE COURT: cc: John H. Broujos, Esquire A TRUE COPY FROM RECORD iR Testimony wherof, l hereunto set my hand and the seal T' ?f,~i~ Court ,~t C,adisle, PA , Cumbeitand Court L~ Exhibit A IN RE: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA GUARDIANSHIP OF : ORPHAN'S COURT DIVISION WILLIAM H. ROOZENBURG : : NO. 21-2004-0583 SURETY BOND KNOW ALL MEN BY THESE PRESENTS, That I, John B. Klunder of 924 S.E. 21st Terrace, Cape Coral, FL 33990, Obligor, and Wqstern Surety Company ofS oux Falls, 101 South Phillips Avenue, Sioux Falls, South Dakota, 57117-5077, Surety, are held aud firmly bound unto the Commonwealth of Pennsylvania, in the sum of Fifty Thousand and 00/100 Dollars ($50,000.00), to be paid to the said Commonwealth, to which payment well and truly to be made, we do bind ourselves, for and in the whole, our heirs, executors and administrators, and assigns, and each and every of them, firmly by these presents. WHEREAS, said Obligor on the 19th day of July, 2004, was appointed Guardian of the estate and person of William H. Roozenburg, Todd Home and Rehabilitation Center, 1O00 W. South Street, Carlisle, PA, 1701.3, by the Orphan's Coud of Cumberland County, Pennsylvania; NOW THE CONDITION OF THIS OBLIGATION IS, that if said Obligor does well, faithfully, and with fidelity perform his duties, which may be decreed by such Register of Wills, or by the Orphan's Court of Cumberland County, then this obligation to be void, otherwise to remain in full force and effect, with our seals, and dated the .~..~ZZ~day of July, Two Thousand Four. Sealed Sealed and de liver~..... in the~res~f: \ ') ~9h/n B. Klunde[-,~ardian/O lig; ~ -, c,~. ~er~7~ranJ $ uVrae~YP~'mS;arne~Yo f S,oux Falls, .~- 10t South Phillips Avenue, Sioux Falls, o-. South Dakota 57117-5077 %-=-:~ ~ A.,)-RUE COPY FROM RECORD ' 7 ~ l~?estimony wherof, I hereunto ~q. .~et my hand and the seal - ~ ~sai~ Court &t, Cadiste, PA . Clerk~6f the Orphans Co~'~¢,~ Cumberland Coun¥ the closest and most involved in the care of his ancle, with whom he has been closely involved since childhood. His resume is attached hereto as Exhibit A. 7. Proposed guardian is an out of state nonresident, residing at 924 SE 21st Terrace, C.ape Coral, FL 33990. He is the only family member conveniently available, since other family members live as far away as California, are of an advanced age, or are otherwise not available. 8. Mr. Roozenburg's next-of-kin who would be entitled to share in his estate should he die intestate are set forth in Exhibit B. Petitioner has a will with two next of kin beneficiaries, Francis McConney (his sister) and Carl and Alice Benson (his brother-in-law and sister-in-law), who are too elderly and unavailable to act as guardian. 9. The nature and approximated extent of Mr. Roozenburg's estate consists of the following: Savings account: $365 M&T Bank checking account: 3,000 ttousehold effects and car: 3,000 Real property: 125,000 $ 131,365 Monthly income from Social Security: 628 Monthly income from military pension: 896 $ 1,524 10. Dr. William S. Kauffman, of Spring Road Family Practice, 192l Spring Road, Carlisle, PA 17013, will be available for hearing through July. He has been Mr. Roozenburg's physician at the Todd Home, Carlisle. I I. Petitioner requests an expedited hearing~ since the house at 141 Strayer Drive is in a deteriorating condition due to the alleged incompetent's conduct in the dementia condition; inability to adequately care for the house; the house is vacant; fire risk is increased; assets must be marshaled and applied to his medical and nursing care expenses; and other related reasons. WHEREFORE, Petitioner prays that a citation be issued directly to William H. Roozenburg, the alleged incompetent, to show why he should not be adjudged an incompetent and a guardian be appointed for his estate and for' his fl"~son, and to i~pose bond, if required. (, John H. Broujos, Esquire~ #6268 7 l 7/243-4574; FAX# 717/243-8227 B~_0~JJOS & G ILROY, P.C. 4 North Hanover Street Date: June 21, 2004 Carlisle, Pennsylvania 17013 Exhibit C ~pa~sbu:~, ~em-u~lvonia~ hereinafter coll~c~-ively caile~ "~t~r~ ~ cO~r =~ ~ ~e~ ~ ~ ~=, ~, sell, ~, ~, ~ A~, ~ ~. C.S.A. S~ ]301 ~ ~. ~ r~:n~ ~ ~ 1, ~ ~ ~o:d~ On ~- 1, 198~ in ~1~ ~k 310, r~ ~ 16, 19~6 ~ ~c. ~k 323, Pa~ 337, ~ ~ 24, ~57 ~'~ ~ 24, ~87 ~- ~k 332, P~ 87~, ~ ~ ~ 2], 1~ a~ ~'~ ~ ~, 1~B7 ~:. . ~, ~ 272, =~ ~~ ~ ~ J~ 31, 1389, ~d ~ J~ 31, 198~, in ~=. ~k 3~0, ~ ~i, ~ ~ ~i~t~ ~=a~ ~ ~ ~ 1.25% ~ce~, Vol. ~, P~ 45, ~ ~ ~ ~ ~ ~, i~. 6~o(~ 35 ~'~ 207 Exhibit D ~.ox ,~35 r~.~ 208 STANDARD AGREEN[F~N'T FOR I'l[:{~ SALE OF REAL ESTATE Exhibit E IN RE: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA W1LLtAM H. ROOZENBURG, : ORPHAN'S COURT DIVISION Incompetent : : NO. 21-2004-0583 PETITION TO INCREASE VALUE OF BOND Pursuant to 20 PS ~5123. Petitioner, John B. Klunder, Guardian of William H. Roozenbrug, an Incompetent. requests the surety bond entered be increased. 1. John B. Klunder. by Dccrcc ol:3oar Honorable Court on July 19. 2004. was appointed Guardian of William H. Roozenburg. an Incompetent. 2. By Order of this Court. a bond was entered in the amount of $50.000 on Augnst 3. 2004 with Western Safety Compan3 of Sioux Falls. 101 South Phillips Avenue. Sioux Falls. South Dakota 57117-5077 as surct). 3. Meanwhile. after further search for personal propcrty, inability to find key to safe deposit box. and boring into thc sat'c deposit box resulted in an increase in the inventory value by the amonnt of 5286.000. The value of lhe in~enloD is noxx $132.889.00 in cash assets. WtIEREFORE. Petitioner pra3s this I lonorable Court enter an Order increasing the amount of the $50.000.00 surer? bond. Dated October 14. 2004 ATTORNEY VERIFICATION 1, JOHN H. BRO[!JOS, [!SQUIRI~, hereby verif}' that I am thc attorney of record for Petitioner: John B. Klunder: that I am authorized to take this verification on his behalf pursuant to Pa. R.C.P. 1024(c) because ,lohn B. Klunder is outside of the jurisdiction of the Court and his xerification cannot be obtained within thc timeframe allowed fbr filing this pleading; and that based upon my review of the material documents in this case and m> reasonable investigalion, the fiqcts contained in the lbregoing petition are true and correct to the best ofm5 knowledge, intbrmation, and bclieI~ I understand thai l~lse statements made herein are su(~ecl lo thc penalties of 18 Pa. C.S.A. ¢ 4904 relating to unsx~orn lhlsification to attfl~orities. ro~ios, Esquire' ~ BROUJOS & GILROY, P.C. q, ATTORNEYS AT LAW 4 ~o~z~ HANOVE~ ST~E~ CARLISLE, PENNSYLVANIA 17013 0CI 'l 4 2004 717-243-4574 766-1690 IN RE: : IN THE COURT OF COMMON PLEAS OF "~× : CUMBERLAND COUNTY, PENNSYLVANIA WILLIAM H. ROOZENBURG, : ORPHAN'S COURT DIVISION Incompetent : : NO. 21-2004-0583 ORDER ,_ 004, ponP tion oanc aseva u o h $50,000.00 Surety Bond, it is ordered and directed that the bond be increased by $~'~t I~ BY THE COURT: Cc: John H. Broujos, Esquire BROUJOS & GILROY, p.c. ~, ~ ATTORNEYS AT LAW 4 NORTH HANOVER STREET CARLISLE, PENNSYLVANIA 17013 OCT '] g 2004 '~/ 717-243-4574 766-1690 IN RE: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA WILLIAM H. ROOZENBURG, : ORPHAN'S COURT DIVISION Incompetent : : NO. 21-2004-0583 ORDER AND NOW this I~day of ~' , 2004, upon Petition To Increase Value of the~,...~ $50,000.00 Surety Bond, it is ordered and directed that the bond be increased by $ ~}t~ 0~ BY THE COURT: Cc: John H. Broujos, Esquire 'I2 BROUJOS & GILROY, p.c. ......... ATTORNEYS AT LAW 15 4 NORTH HANOVER STREET . CARLISLE, PENNS¥ .VANIA 17m3 717-243-4574 766-1690 OOT '~ ,4 ~0,~ ,,~ IN RE: : IN THE COURT OF COMMON PLEAS OF ~ : CUMBERLAND COUNTY, PENNSYLVANIA WILLIAM H. ROOZENBURG, : ORPHAN'S COURT DIVISION Incompetent : : NO. 21-2004-0583 ORDER AND NOW this 1 ~ day of October, 2004, upon Petition For Private Sale Of Real Estate Owned by Incompetent Person, it is ordered and directed that a hearing be held on the 5~).,~ '~ of October, 2004 at __~ .,~ d_) o'clock _~i in Court Room ~ _, on the ~5~' Floor, Courthouse, Carlisle, Pennsylvania, for the purpose of considering authorizing private sale of real property of the incompetent person. Cc: John H. Broujos, Esquire IN RE: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA WILLIAM H. ROOZENBURG, : ORPItAN'S COURT DIVISION Incompetent : : NO. 21-2004-0583 DECREE AND NOW, this [~'~ I~day of (~', 2004, upon Petition For A Private Sale of Real Estate Owned by Incompetent Person, guardian of Estate of William H. Roozenburg, it is ordered and directed as follows: A. Private sale by fee simple deed of premises, described herein as 141 Strayer Drive, South Middletown Township, Cumberland County, Pennsylvania, owned by incompetent person, to Gale R Coy!e, under the agreement of sale dated August 18, 2004, for the consideration of $141,000.00 is authorized: ALL TtfAT CERTAIN Unit in the property known, named and identified in the Declaration referred to below as "Forest Meadow', a Condominium", located on sketch attached hereto as 14I Strayer Drive, South Middleton Township, Cumberland County, Pennsylvania, which has heretofore been submitted to the provisio=~s of the Pennsylvania Uniform Condominium Act, 68 Pa~ C.S.A. Section 330l et seq. by recording in the Office of the Recorder of Deeds of Cumberland County thc Declaration dated November I, 1985 and recorded on November I, 1985 in Miscellaneous Book 310. Page 1090. Amendments thereto dated January 31, 1989, dated September 16, 1986 and recorded September 16, 1986 in Misc. Book 323, Page 337, Amendments dated April 24, 1987 and recorded April 24, 1987 ill Misc. Book 332. Page 878, Amendments dated December 23, 1987 and recorded December 23, 1987 in Misc. Book 344, Page 272, and furlher Amendments thereto dated Jam:ar? 31, 198% and recorded January 31. 1989, in Misc. Book 360, Page 131. being and designated in such Declaration and Amendments as Unit 44 as more fully described in such Declaration and Interest in the Common Elenrents as defined in such Declaration and Amendments of 2.15% percent. "['he purchase price of $141,000 is authorized and approved. C, Additional security as set forth in Order issued pursuant to Petition to Increase Bond shall be posted by guardian of thc estate prior to transfer of deed. Cc: John I-t. Broujos, Esquire IN RE: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNIY, PENNSYLVANIA WILLIAM H. ROOZENBURG, : ORPHAN'S COURT DIVISION Incompetent : : NO. 21-2004-0583 AFFIDAVIT OF VALUE COMMONWEALTH OF PENNSYLVANIA: : SS COUNTV OF CUMBERLAND : - - ioc, tc. OClil~ d[li~ s\~o[n accordin~ to iax~. dc,cs depose and state: 1. Affiant has been engaged in tbe appraisal business, at office located at _~ East High Street, Carlis}¢. Cumberland Count}. Pennsylvania lbr oxcr 3 [ )ears. 2. Alt]ant is acquaintcd with the premises at 141 Strayer Drive. South Middleton Township, Cumberlal~d Count5. Pennsylxania. described in the ibrcgoing petition and with the ~alue of real estate in thc particular localit5. 3. Afl]ant has inspected the premises and is of the opinion t mt ~ is a Iktll and thir price ibr thc pcemises and. under the circumstances, is a price that is more than can be obtained at public sale. 4. ,,Nfl]ant is not an employee of the fiduciary and is not personall5 interested in the proposed sale. Sx~orn and subscribed to .~_, bcib~c me this da> Exhibit H IN RE: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA WILLIAM H. ROOZENB[ RG, : ORPHAN'S COURI DIVISION Incompetent : : NO. 21-2004-0583 AFFIDAVIT OF VALUE COMMON~VEALTH OF PENNSYLVANIA: : SS COUNTY OF CUMBERLAND : P,i!l Bassett, being duly sv~orn according to law. does depose and state: 1. Affiant has been engaged in the appraisal business, at office located at 33 South Pitt Strcet, Carlisle. Cumberland County. Pcnns3 bahia tbr over ' ~ years 2. Affiant is acquainted with the premises at 141 Strayer Dri;e, South Middleton Township. Cumbcrland Count>, })emqsylvania. described in the fbregoing petition and with the xalue of real estate in the particular locality. 3. Affiant has inspected thc prcmiscs and is of the opinion that ~ is a fhll and thir price lbr fine premises and, under the circumstances, is a price that is more than can be obtained at public sale. 4. Affiant is not an emplosee of the fiduciau and is not personally interested in thc proposed Sale. Bilk Bassett Sx~orn and subscribed to "~ ~ da; Notarial Seal bctbre mc this Bridget Ann Corcora~, Notary Public ~(~S Carlisle Boro, Cumberland County of ~:' .2004. My Commission Expires June 10, 2~ , ~)FARY PtfBLIC Exhibit G Exhibit E APPRAISAL REPORT 141 STRAYER DRIVE CARLISLE, PENNSYLVANIA Diversified Appraisal Services Real Estate Appraisers and Consultants SUMMARY OF IMPORTANT FACTS AND CONCLUSIONS LOCATION: 141 Strayer Drive Carlisle, Pennsylvania TAX PARCEL NUMBER: 40-23-0602-064-U441413 IMPROVEMENTS: One and one-half story attached single-family dwelling. PROPERTY RIGHTS: Fee simple interest. OWNERSHIP HISTORY: The subject property is owned by William H. Roozenburg. The property was purchased on August 30, 1991 for a reported consideration of $98,000 and ownership transferred on deed reference 35-H-207. SCOPE OF THE ASSIGNMENT: The scope of the assignment included an analysis of the subject's area, an inspection of the subject property, an estimation of the property's highest and best use, consideration of all three approaches to value, and the application of those relevant to the valuation of the subject. OBJECTIVE: To estimate the market value of the subject property as unencumbered. EFFECTIVE DATE: October 19, 2004. HIGHEST AND BEST USE: Continued use as a single-family residence. COST APPROACH: N.A. SALES APPROACH: $135,000 iNCOME APPROACH: N.A. FiNAL VALUE CONCLUSION: $135,000 2 APPRAISAL CERTIFICATION I hereby certify that upon application for valuation by: WILLIAM H. ROOZENBURG the undersigned personally inspected the following described property: All that certain Unit in the property known, named and identified in the Declaration referred to below as "Forest Meadow, a Condominium", located at 141 Strayer Drive, South Middleton Township, Cumberland County, Pennsylvania, which has heretofore been submitted to the provisions of the Pennsylvania Uniform Condominium Act, 69 Pa. C.S.A. Section 3301 et seq. by recording in the Office of the Recorder of Deeds of Cumberland County the Declaration dated November 1, 1985 and recorded on November 1, 1985 in Miscellaneous Book 310, Page 1090. Amendments thereto dated January 31, 1989, dated September 16, 1986 and recorded September 16, 1986 in Misc. Book 323, Page 337, Amendments dated April 24, 1987 and recorded April 24, 1987 in Misc. Book 332, Page 878, Amendments dated December 23, 1987 and recorded December 23, 1987 in Misc. Book 344, Page 272, and further Amendments thereto dated January 3 I, 1989, and recorded January 31, 1989, in Misc. Book 360, Page 131, being and designated in such Declaration and Amendments as Unit 44 as more fully described in such Declaration and Interest in the Common Elements as defined in such Declaration and Amendments of 2.15 percent. To the best of my knowledge and belief the statements contained in this report are true and correct, and that neither the employment to make this appraisal nor the compensation is contingent upon the value reported, and that in my opinion the Market Value as of October 19, 2004 is: ONE HUNDRED THIRTY-FiVE THOUSAND DOLLARS $135,000 The property was appraised as a whole, subject to the contingent and limiting conditions outlined herein. Certified General Appraiser GA-000014-L 3 PURPOSE OF THE APPRAISAL The purpose of this appraisal is to estimate the Market Value of the subject property as of October 19, 2004. Market Value, as defined by the courts, is the most probable price estimated in terms of money which a property will bring if exposed for sale in the open market, allowing a reasonable time finding a purchaser who buys with knowledge of all the uses to which it is adapted and for which it is capable of being used. Frequently, it is referred to as the price at which a willing seller would sell and a willing buyer would buy, neither being under abnormal pressure. HIGHEST AND BEST USE Highest and Best Use is defined by the Appraisal Terminology and Handbook, published by the Appraisal Institute, as "the most profitable likely use to which a property can be put". The opinion of such use may be based on the highest and most profitable continuous use to which the property is adapted and needed, or likely to be in demand, in the reasonable near future. However, elements affecting value that depend upon events or a combination of occurrences which, while within the realm of possibility, are not fairly shown to be reasonably probable, should be excluded from consideration. Also, if the intended use is dependent on an uncertain act of another person, the intention cannot be considered. Based on the above definition and after seeing the site, neighborhood, and area, it is my opinion that the present use of the subject is its Highest and Best Use. 4 SITE DATA ADDRESS: 141 Strayer Drive TOWNSHIP: South Middleton COUNTY: Cumberland STATE: Pennsylvania LOT SIZE: Not applicable. Condominium unit. SEWERS: Public utility. WATER: Public utility. LANDSCAPING: Typical for the area, with a sodded front lawn with shrubs. DETRIMENTAL INFLUENCES None. Pride of ownership is evident throughout the neighborhood. DESCRIPTION OF IMPROVEMENTS GENERAL DESCRIPTION: One and one-half story detached single-family dwelling containing approximately 1,447 square feet of gross living area above grade with a detached two-car garage. CONDITION: Exterior: Average Interior: Average ROOMS: First Floor: Living room with dining area, kitchen, den, bedroom and full bathroom. Second Floor: Bedroom and full bathroom. Basement: None. Concrete slab. EXTERIOR: Foundation: Concrete slab. Walls: Vinyl siding. Sash: Vinyl-clad thermopanes. Gutters: Aluminum, painted. Roof: Gable, with shingles. 5 INTERIOR, PRINCIPAL ROOMS: Flooring: Carpet Walls: Drywall Ceilings: Drywall Trim: Wood, painted. KITCHEN: Cabinets: Oak, natural finish. Counters: Formica Walls: Drywall, painted. Flooring: Vinyl Sink: Double-bowl, stainless steel. BATHROOMS: Flooring: Vinyl Walls: Drywall, painted. Bathtubs: Built-in, with shower. Lavatories: Vanities Water closets: Two-piece. HEATING: Heat pump. COOLING: Central air conditioning. HOT WATER: Electric, 50-gallon. ELECTRIC: Circuit breaker system, 200-ampere. OTHER: Attached to the rear of the dwelling is a wooden deck. GENERAL CONDITION: All improvements are considered to be in average condition on the interior and on the exterior, with mechanical systems appearing to be adequate and functioning properly. THE APPRAISAL PROCESS Three approaches to value are generally included in an appraisal report. These techniques include the cost approach, sales comparison approach, and income approach to value. The cost approach to value is based on the assumption that the reproduction cost of a building plus land value, tends to set the upper limit to value. A key assumption is that a newly constructed building would have advantages over the existing building, therefore an evaluation focuses upon disadvantages or deficiencies (depreciation) of the existing building compared to a new facility. Due to the age of the subject improvements, the cost approach is considered to be inappropriate and has, therefore, not been included in the development of this appraisal report. The sales comparison approach to value assumes that under normal conditions, a given number of parties acting intelligently and voluntarily, tend to set a pattern from which value can be estimated. Application of this approach relies on a comparison of the subject with a sufficient number of recent transactions of comparable properties in the market, based on a common unit, such as price per square foot of building area. The income approach concerns itself with present worth of the future potential benefits of a property. The initial estimate involves the net income, which a fully informed person is justified in assuming the property will produce during its remaining useful life. This estimated net income is then capitalized into a value estimate, based upon the level of risk as compared with that of a similar type and class. Since homes similar to the subject are not typically utilized as income-producing investment properties, the income approach to value is considered to be inappropriate and has, therefore, not been included in the development of this appraisal report. 7 SALES COMPARISON APPROACH in arriving at this conclusion of the value of the subject property, the appraiser made a survey of properties that have sold in the area of the subject property. Consideration was given and adjustments were made on each comparable sale as to time of sale, size, location, as well as all other factors that might affect value. A resume of some of the sales considered by the appraiser is as follows: SALE NO. 1: Location: 112 Strayer Drive, Carlisle. Date of Sale: April 3, 2002. Sale Price: $138,000 Size: 1,616 square feet. Unit Price: $79.13 per square foot. SALE NO. 2: Location: 139 Strayer Drive, Carlisle. Date of Sale: June 20, 2003. Sale Price: $120,000 Size: 1,039 square feet. Unit Price: $115.50 per square foot. SALE NO. 3: Location: 125 Strayer Drive, Carlisle. Date of Sale: July 20, 2004. Sale Price: $135,000 Size: 1,411 square feet. Unit Price: $95.68 per square foot. The appraiser, in addition to the sales listed, also considered several additional sales in arriving at his final opinion of value. On the Sales Comparison Analysis form that follows this page are dollar adjustments reflecting market reaction to those items of significant variation between the subject and comparable properties. If a significant item in the comparable property is superior to, or more favorable than, the subject property, a minus (-) adjustment is made, thus reducing the indicated value of the subject; ifa significant item in the comparable is inferior to, or less favorable than, the subject property, a plus (+) adjustment is made, thus increasing the indicated value of the subject. After making all of the necessary adjustments, it is the appraiser's considered opinion that the indicated value of the subject property by the Sales Comparison Approach is $135,000. SALES COMPARISON ANALYSIS ITEM SUBJECT COMPARABLE #1 COMPARABLE #2 COMPARABLE #3 141 Strayer Dnvc 112 Strayer Drive 139 Strayer Drive 125 Strayer Drive Address Carlisle Carlisle Carlisle Carlisle Proximity to Subject Same street Nexl doer Same street Sale Price N A $138,000 $120,000 $135.000 Phce/SqFt GLA N.A $7913 $11550 $9568 Dam Source Courthouse & Central Prom MLS Central penn MLS Courthouse records ADJUSTMENTS DESCRIPTION DESCRIPTION $ Adjust DESCRIPTION $ Adjust DESCRIPTION $ Adjust. Sales or Financing Concessions ~ Conventional Conventional Conventional Date of Sale / Time As of 10-19-04 4-3-02 +13,800 6-204)3 +6.000 7-204)4 Location Similar Sinular Similar Site / View Average Similar Similar Similar DesisJ~ and Appeal 1½-story attached 1¼~sto~3' serm-att. -2,000 l-stoD atlachcd 1½-story atlached Construction Vinyl siding Vinyl w/brick accent ~500 Vinyl ~/brick accent -500 Vinyl siding Age 14 years 18 years 14 years 15 years Condition Average Similar Similar Similar Tot Bed Bath Above Grade 5 2 1 Room Count 4,000 +2,000 Gross LNmg Area 1.447 square feel 1,616 square feet -5.100 1,039 square tket +12,200 1,411 square feet Ba s~.mten! &Fiinshed R(x3ms Below (kad¢ None Sirmlar Similar Surdlar Functional Utility Similar Similar S~milar Similar Similar Similar sunilar Similar Similar Porches, Patios Pools, etc. Wood deck - 1,000 Wood deck Wood deck FINAL INDICATED VALUE OF SUBJECT PROPERTY: $135,000 Comparable sale number 3 is the most similar to the subject property and is the most recently sold. Therefore, it has been given the most consideration in arriving at my final opinion of value. 9 CORRELATION Correlation may be defined as "the bringing together of parts in a proper relationship." The parts of this appraisal report are the following approaches to value your appraiser used: Value Indicated by Cost Approach NA. Value Indicated by Sales Comparison Approach $135,000 Value Indicated by Income Approach N.A. These approaches are representative of the market value of the subject property. I have carefully reexamined each step in each method, and I believe the conclusions accurately reflect the attitude of typical purchasers of this type property in this neighborhood. It is my belief that this reexamination has confirmed the original conclusions. The Cost Approach will result in an excellent estimate if all elements are figured accurately, because no prudent person will pay more for a property than the cost to produce a substitute property with equal desirability and utility. Purchasers of the type of dwelling typical of the subject property are more concerned with amenities than with hypothetical replacement of the property. Due to the age of the subject improvements, the Cost Approach is considered to be inappropriate and has not been included in this appraisal report. The Sales Comparison Approach was based on several recent sales of properties similar to that of the subject, all of which are located in the same general area. The adjusted sales prices are most consistent under comparison. This approach is the most reliable because it reflects the reactions of typical buyers and sellers in the market. The Income Approach is most applicable to income producing properties or properties that are primarily utilized for income producing purposes. Purchasers of income producing properties are willing to pay no more for a particular property than the net operating income will support. Since the majority of properties similar to the subject are not utilized for income producing purposes, this approach to value has not been included in this appraisal report. Therefore, as a result of this appraisal and analysis, it is this appraiser's considered judgment and opinion that the Market Value of the subject property, as of October 19, 2004, is: ONE HUNDRED THIRTY-FIVE THOUSAND DOLLARS $135,000 10 UNDERLYING ASSUMPTIONS AND LIMITING CONDITIONS SUBJECT TO THIS APPRAISAL 1. I assume no responsibility for matters legal in nature, nor do I render any opinion as to the title, which is assumed to be marketable. The property is appraised as though under responsible ownership. 2. The legal description used herein is correct. 3. i have made no survey of the property, and the boundaries are taken from records believed to be reliable. 4. I assume that there are no hidden or unapparent conditions of the property, subsoil or structures which would render it more or less valuable. I assume no responsibility for such conditions or for engineering which might be required to discover such factors. 5. The information, estimates, and opinions furnished to me and contained in this report were obtained from sources considered reliable and believed to be true and correct. However, no responsibility for accuracy can be assumed by me. 6. This report is to be used in its entirety and only for the purpose for which it was rendered. 7. Neither all nor any part of the contents of this report (especially any conclusions as to value, the identity of the appraiser or the firm with which he is connected) shall be reproduced, published, or disseminated to the public through advertising media, public relations media, news media, sales media, or any other public means of communication, without the prior written consent and approval of the appraiser. 8. This appraisal was prepared for the exclusive use of the client identified in this appraisal report. The information and opinions contained in this appraisal set forth the appraiser's best judgment in light of the information available at the time of the preparation of this report. Any use of this appraisal by any other person or entity, or any reliance or decisions based on this appraisal are the sole responsibility and at the sole risk of the third party. The appraiser accepts no responsibility for damages suffered by any third party as a result of reliance on or decisions made or actions taken based on this report. 11 CERTIFICATE OF APPRAISAL Your appraiser hereby certifies that: 1. The statements of fact contained in this report are true and correct. 2. The reported analyses, opinions, and conclusions are limited only by the reported assumptions and limiting conditions, and are my personal, impartial and unbiased professional analyses, opinions, and conclusions. 3. l have no present of prospective interest in the property that is the subject of this report, and no personal interest with respect to the parties involved. 4. I have no bias with respect to the property that is the subject of this report or to the parties involved with this assignment. 5. My engagement in this assignment was not contingent upon developing or reporting predetermined results. 6. My compensation for completing this assignment is not contingent upon the development or reporting of a predetermined value or direction in value that favors the cause of the client, the amount of the value opinion, the attainment of a stipulated result, or the occurrence of a subsequent event directly related to the intended use of this appraisal. 7. To the best of my knowledge and belief, the statements of fact contained in this appraisal report, upon which the analyses, opinions, and conclusions expressed herein are based, are true and correct. 8. This appraisal report sets forth all of the limiting conditions (imposed by the terms of my assignment or by the undersigned) affecting the analyses, opinions, and conclusions contained in this report. 9. This appraisal report has been made in conformity with the Uniform Standards of Professional Appraisal Practice adopted by the Appraisal Standards Board of the Appraisal Foundation, and is subject to the requirements of the Code of Professional Ethics and Standards of Professional Conduct of the National Association of Realtors Appraisal Section. 12 10. No one other than the undersigned prepared the analyses, conclusions, and opinions concerning real estate that are set forth in this appraisal report. Larry E. Foote Certified General Appraiser GA-000014-L 13 PRIVACY NOTICE Pursuant to the Gramm-Leach-Billey Act of 1999, effective July 1,2001, appraisers, along with all providers of personal financial services are now required by federal law to inform their clients of the policies of the firm with regard to the privacy of client nonpublic personal information. As professionals, we understand that your privacy is very important to you and are pleased to provide you with this information. In the course of performing appraisals, we may collect what is known as "nonpublic personal information" about you. This information is used to facilitate the services that we provide to you and may include the information provided to us by you directly or received by us from others with your authorization. We do not disclose any nonpublic personal information obtained in the course of our engagement with our clients to nonaffiliated third parties, except as necessary or as required by law. By way of example, a necessary disclosure would be to our independent contractors, and in certain situations, to unrelated third party consultants who need to know that information to assist us in providing appraisal services to you. All of our independent contractors and any third party consultants we engage are informed that any information they see as part of an appraisal assignment is to be maintained in strict confidence within the firm. A disclosure required by law would be a disclosure by us that is ordered by a court of competent jurisdiction with regard to a legal action to which you are a party. We will retain records relating to professional services that we have provided to you for a reasonable time so that we are better able to assist you with your needs. In order to protect your nonpublic personal information from unauthorized access by third parties, we maintain physical, electronic and procedural safeguards that comply with our professional standards to insure the security and integrity of your information. 14 LARRY E. FOOTE REAL ESTATE APPRAISER EXPERIENCE: 1979~Present: Chief Appraiser, Diversified Appraisal Services, Carlisle, Pa. Principal Broker, LaRue Development Company, Carlisle, Pa. 1976-1979: Associate Broker, Colonial Realty, Carlisle, Pa. 1972-1976: Realtor Associate, Jack Gaughen Realtor, Carlisle, Pa. Appraisal experience included undeveloped land, farms, buikftng lots, single-family dwellings, mobile home parks, medical centers, nursing homes, motels, apartment buildings and complexes, office buildings, service stations, veterinary clinics, rehabilitation centers, retail buildings, daycare centers, warehouses, and manufacturing facilities. EDUCATION: Bachelor of Business Administration, Pennsylvania State University, 1976. Associate Bachelor of Business Administration, Hamsburg Area Community, College, 1974. Diploma, Carlisle Senior High School, 1965. Certificate, Pennsylvania Realtors Institute, GRI I, GRI II, GRI Ili. Certificate, Realtors National Marketing Institute, C1 101, CI 102, CI 103, CI 104, CI 105. Standards of Professional Practice, American Institute of Real Estate Appraisers. Real Estate Appraisal Principles, American Institute of Real Estate Appraisers. Residential Valuation, American Institute of Real Estate Appraisers. Appraisal Procedures, Appraisal Institute. Principles o£ Income Property Appraising, Appraisal Institute. Case Studies in Real Estate Valuation, Appraisal Institute. Report Writing and Valuation Analysis, Appraisal Institute. PROFESSIONAL LICENSES: General Appraiser #GA-000014-L, Commonwealth of Pennsylvania. Real Estate Broker #RB-029729-A, Cormnonwealth of Pennsylvania. PROFESSIONAL DESIGNATIONS: GRI:Graduate of the Pennsylvania Realtors Institute, awarded by the Pennsyl- vania Association of Realtors. CRS: Certified Residential Specialist, awarded by the Realtors National Market- ing Institute of the National Association of Realtors. CCIM: Certified Commercial Investment Member, awarded by the Realtors National Marketing Institute of the National Association of Realtors. PROFESSIONAL ORGANIZATION AFFILIATIONS: National Association of Realtors Appraisal Section. Carlisle Association of Realtors. Pennsylvania Association of Realtors. National Association of Realtors. Realtors National Marketing Institute. 15 PAST CLIENTS: Borough of Carlisle 3anerican Home Bank Keystone Financial Mortgage Trans Union Cornerstone Federal Credit Union M&T Mortgage Corporation Pennsylvania State Bank Cody Financial Mortgage Services Commerce Bank Waypoint Bank Cumberland-Perry Association for Retarded Citizens Northwest Savings Bank Carlisle Suburban Authority Blue Ball National Bank Members Ist Federal Credit Union Adams County National Bank Pennsylvania National Bank Countrywide Home Loans Evans Financial Corporation Aarrow Mortgage Greenawalt & Company, CPA Various law finns and individuals Smith's Transfer Corporation Carlisle Department of Parks and Recreation Executive Relocation Services Carlisle Area School District Messiah Homes, Incorporated ERA Eastern Regional Services Pennsylvania Turnpike Commission Chase Home Mortgage Corporation Defense Activities Federal Credit Union Pennsylvama State Employees Credit Union PNC Mortgage Corporation F&M Trust Company National City Mortgage Corporation Washington Mutual Home Loans, Inc. Prudential Relocation Services Lender's Choice Market Intelligence, Incorporated United Telephone Employees Federal Credit Union Cumberland County Commissioners Allstate Enterprises Mortgage Corporation Dickinson College PPG Industries, Incorporated Gettysburg College Redevelopment Authority of Cumberland County Record Data Appraisal Services, Incorporated First United Federal Savings Association Fulton Bank United States Marshall Service GMAC Mortgage Corporation Orrstown Bank Letterkeuny Federal Credit Union BancPlus Mortgage Corporation Coldwell Banker Relocation Services, Incorporated Central Pennsylvania Savings Bank Mellon Bank Provident Home Mortgage Corporation Drovers Bank 16 PHOTOGRAPH OF THE SUBJECT IMPROVEMENTS 17 COMPARABLE SALE NO. 1 COMPARABLE SALE NO. 2 COMPARABLE SALE NO. 3 18 Marjorie A. Wevodau First Deputy One Courthouse Square Carlisle, Pa. 17013 Glenda Fainer Strasbaugh Register of Wills & Clerk of the Orphans' Court Kirk S. Sohonage, Esquire Solicitor (717) 240-6345 FAX (717) 240-7797 OFFICES OF 3Regi~ter of WiII~ anti (!Clerk of tbe (!&rpban~' (!Court ([ount1' of ([umberIanb December 1, 2005 John B. Klunder 924 SE 21 st Street Cape Coral FL 33990 IN RE: Estate of William H. Roozenburg, an incapacitated person File No. 21-04-583 Dear Sir/Madam: It has come to my attention that you have not filed the guardian reports required by 20 Pa.C.S.A. ~5521(c) in the above captioned guardianship. Enclosed you will find the suggested formes). Please mail those reports, along with a check for the filing fee which is $15 for each report filed, payable to the Clerk of Orphans' Court, to the following address within (30) days: Clerk of Orphans' Court One Courthouse Square Carlisle, P A 17013 If you have any questions, please contact your attorney. Respectfully, .tJ . V ,LL- ~ /J ~.~~. it'?;&>.1'A..eA.j' ~ . . , /1 Glenda Farner Strasbaugh . . Clerk of the Orphans' Court CC: John H. Broujos, Esquire Clerk of Orphans' Court of Cumberland County WILt-l'A/V\ H€NJZy' IN RE: ~C1? i#' .NJ3 CJ JZG- An Incapacitated Person Docket No. 2./ ~ (!)tf - .5""8'3 ANNUAL REPORT OF GUARDIAN OF THE ESTATE I, .:::J@!-IN 13. /L.l..v~~ ~ere appointed plenary guardian") of the estate of '~IY\ tfJ!N {l. 't' ~<J/ZG;. by Decree of the Honorable JUdge,!/tt:;;:::;CJJ? Dated r - )9- ($)";/ . This is my annual report for the period from /- / -(!;)~ to J 2 - ~ J -(!)..!J- , ("The Report Period"). - I. SUMMARY B. Total amount of income earned during the report period? $~~O,s/~ ~ ./ ~r" $J~5~ ~ A. Value of principal assets at the beginning of the Report Period? Total amount of all expenditures made for ~and maintenance of the C. incapacitated person during the Report Period? 2. From income IIr ___ $ ~~3L/3 ~ ~ $ --e; -- D. Total amount spent for all other purposes during the Report Period? $ 16',/3'-1~ '" E. Total amounts remaining at the end of the Report Period? 1. Principal $ --e::r 2. Income $ ~ .c Total Income and Principal $ 2 1? S-J 2 =-- ..., , . I I \ ~ (, I ,> II. ADDITIONAL INFORMATION A. Principal: 1. Total amount remaining at the end of the Report Period? ~ $ Z.9~SJ2.. ~ ./ 2. How is principal currently invested? M(S)NIZY NtA/~ A ft"roU ~ J. Have there been any expenditures from principal during the Report Period? 0 Yes 1NO If you answered YES, was there Court approval for all expenditures from principal? 0 Yes 0 No 4. Did you receive any principal assets dunng the repol t period which were not included on the inventory or a prior report filed for the estate? 0 Y es ~o If you answered YES, did you receive Court approval prior to receiving additional principal? 0 Yes 0 No 5. State the sources and amounts of the additional principal you received: filA- $+ $ B. Income: 1. State sources and amounts of income received during the Report Period (i.e., social security, pension, rents, etc.): e2- $~3Z $J~~.399~ $ tjZZ~ Total Income received during Report Period $ If S 9''/ ;.> 2. How is income currently invested? (Please specify, restricted bank accounts, ~ient care account, etc.) ~LIAL .s~CUi2JJr liS MiL/TAllY /~NSJ'oJ\..l . TN-r&~Jlk.$T I N V J?;~J /'NQ..l 1:5 \ C! ::J - ~Lfj -N I CA ;(ff_ v --- -- (V\(i;JI\J~ MAJtJ?J~J .kOJNJ 3. Specify what payments were made for the care and maintenance of the incapacitated person (i.e., clothing, nursing home, medicine, support, etc.). 11'-'~/1\lG. H~~ MerJ/C-/NJ~ J I7~NJLV I ../ · 5~{Lt/J~SJ QL..o:;rHfNG--} AM~uL.A~ ~/c.l/'Cb / / 4. Specify what other payments were made during the Report Period. ~J7.m/D Fu~?LY ~~b?&,~~5 I ./ I verify that the foregoing information is correct to the best of my knowledge, information and belief; and that this verification is subject to the penalties of 18 Pa. C.S.A. 94904 relative to unsworn falsification to authorities. ) Z -..3) -(Os-' Date * FILING FEE $15 MUST ACCOMPANY TillS FILING. , Docket No. 2-/ - lSJt..( -. 'f:$ ,3 ANNUAL REPORT OF GUARDIAN OF THE PERSON I, ;::J;;m &. ;<L.u~~'L ~ereapPointed plenary guardian(s) of the person of - M\ H, J~~ y Decree of the Honorable Judge /-ir'9P'::~JL , dated 7... /1'- t9L( . This is my annual report for the period from _ 1- I - (l) > to / Z. -? 1- (fj,..!) - ,("The Report Period"). 1. Present age of the incapacitated person: g~ Yrs. 2. Current address of the incapacitated person ~ARAJ-:J ~OJ? MeM~Jz.1AI IdJ~ w _ 5~ur/-:J- ~-:r; (' -AJ?i-ii??~/ ?A l-kJflJt& /7(9/3 , 3. The incapacitated person's residence is: D own home/apartment 'I nursing home D boarding home/personal care home !"';. ~ .I ...~. D guardian's home/apartment D hospital or medical facility 4. ~IA I D other: N fA- , , The incapacitated person has been in the present residence since ~L 'f" 26X!Jl{. If the incapacitated person has moved within the past year, state change and reason(s) for (describe) D relative's home (Name and relationship) change: N/A- 5. Name and address of the incapacitated person's primary care giver: ..sAIZA~ %Ol/ MeM@~fJa/'ll~ 6. The major medical or mental problems of the incapacitated person are as follows: A?J-JASIA - L4~iL/Jr ~ vf/I~-fI (' OMNIUN/~6 JJrflJENTiA - PFFh::J2J4JTOAJ t9F 1>1€K1A!-0PACi-r-( 7. Specify what, if any, social, medical, psychological and support services the incapacitated person IS recelvmg: -bj () IL>J.N ~ fd-(!M.E CAJ7P. r 8. It is our opinion as guardian of the person that the guardianship should: (check one) ~continue, 0 be modified, 0 be terminated. (Briefly explain your response) - .UNCJ...Je l?JLL I S UNA!~ 10 TA~ CAJ~ ClJr= Jdi!Y,5..€ll::;:' I N 5A~ iZfV C9ur5JO FE- 4- N uf?-C./ 1'1 Gz. /-Jq;}ff&, / During the past year, I have visited the incapacitated person I times with the a,rerage "f"risit lasting 9. ~ (5~ A CCtOM{/AN y/j 1\1 Ga. 1_lt/rr~7- (State number of hours 1m in utes, etc.) The report of a social service organization employed by the guardian to oversee and coordinate the care of the incapacitated person for the period covered by this report may be attached to supplement this report. I verify that the foregoing information is correct to the best of my knowledge, information and belief; and that this verification is subject to the penalties of 18 Pa. C.S.A. 94904 relative to unsworn falsification to authorities. / ! -~~J - c(b-- Date * FILING FEE $15 MUST ACCOMPANY THIS FILING. John B. Klunder 924 SE 21 st. Terrace Cape Coral. Florida 33990 January 2, 2006 Glenda Farmer Strasbaugh Clerk of Orphans' Court Carlisle, PA 17013 Dear Ms Farmer Strasbaugh: Enclosed please find my two reports on the status of my Uncle Bill Roozenburg finances, per your request. I am 63 years old and the nephew of William Roozenburg. His wife has been deceased for over 6 years and they had no children He has two sisters who are alive, however they are 92 and 87 respectively and both are not in good enough health to travel, since one lives in Florida and the other California. There are two nieces, both living in Michigan and both of them asked me to look after Uncle Bill. Uncle Bill is my mother's brother. I was like a son to him and the family asked me if I would serve as his guardian when he could not live alone at home safely. I am his court appointed guardian for both health and for finances. Uncle Bill has two handicaps that prevent him from not living alone. One is aphasia which is when you can form ideas but can not make the mechanics of speech work. Hence he can not talk in a complete sentence and an orderly pattern, making his speech unintelligible. His second hindrance is that he has dementia. His brain can not put together the thinking process that leads to decisions of everyday living. He is now living at the Sarah Todd Memorial Home, in Carlisle. As you can see by the letter address, I live in Southwest Florida, some 1,300 miles south of where Uncle Bill lives. During 2004, when we were getting him settled at Sarah Todd and liquidating his property to pay his bills, I was in Carlisle on a regular basis every six weeks. As you can note from the report my last visit was in February, 2005. The reason for this is that I have had physical problems of my own...1 have an eye disease and have gone blind in one eye. During most of 2005, I had several operations and laser treatments on the eye. This has precluded me from visiting Uncle Bill. However, the operations are over and I have adjusted to using only "one headlight", so I am now ready to travel. I plan on visiting Uncle Bill in the short future and resume regular visits. 1-.,.3 ,-. ~. (~;-, I C,"t '''''''.) My wife and I are also planning on moving to South Carolina, which will be much closer to him. His finances are enclosed. For the past year plus I have been working out of a money market account, which has checkbook-type access. All of his military pension, his social security check, and any interest garnered from this account and any other areas are put into the account. So, all of his assets were put into that account and I pay his bills out of that account. That is why I put both principal and interest together on the report. I hope that this letter and the enclosed report will suffice for the court. I can be reached by telephone at my home at 239-242-0267, or my cellular telephone at 239-994-2214. --- Guardian for William Roozenburg JBK/jk PETITION FOR PROBATE and GRANT OF LETTERS U20t'~l'>~ ,1/- ()t.f- 6f3 To: Register of Wills for the Deceased. . County of in the Social Security No. """> (.,. (" l'-z. ~ >~ Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: J r..,"/~ __ .. L ~ ~G1"" Your petitioner{g'), whodShre 18 years of age or older an the executol4 ~'i V4;::;::f4.v~ na d in the last will of the above decedent, dated ~ ~ I q~"Z.- , 19_ and codicil(s) dated U't~1 1~ .~ I vv-s.- ~ /I ~~~ ~ L, ,-~,,~~c5.~~r Estate of \,..ll \..-l_'~ )~M also known as (state relevant circumstances, e.g. renunciation, death of executor, etc.) Qecendent was domiciled at death in 0> A ~"'.... ~~._ County, penn~va~ h \? last family or principal residence at < ~(:s-.~ ,,~.J) "" 'CSt)O~.r "5o~~ ~ P-4~(c:,Ll..1;. 1rD1'" (list street, number and muncipality) Decendent, then ~ ~ years of age, died ~ {.p at Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: 06'7 , 19. Decendent at death owned property with estimated values as follows: , (If domiciled in Pa.) , All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: '"'2..~c::> c.~O' - ~ $ $ $ $ , .. WHEREFORE, petitioner(s) respectfully request() the probate 0 the last will and codicil(s) presented herewith and the grant of letters (testamentary; administration c.La. admJ!listration d.b.n.c.!:!:) ~ '" '-' '" u c: '" -o~ .- '" '" '-' "'... 0::'" c: -00 co::: tU "';:: 3~ "'..... ;:;0 tii c: t>O Vi t!Jt~~~~~/2 (--~) - :0 C) =:.J --' ::T_: C': ~'" OATH OF PERSONAL REPRESENTATIVE!~i;::- COMMONWEA H OF PENNS LV ANIA I ss COUNTY OF J ~~'" -, I ~) ---. '_i .... The petitioner(s) above-named swear(s) or affirm( t true and correct to the best of the knowledge and b ief tative(s) of the above decedent petitioner(s) will wel a Sworn _ to or amrlt ~ subscribed { x: blforj; me this ~~_/ _ day of ~~~'~OMv~a~~~ f2tr <ts ~ Reg' ler en QQ' :::s s:::. ..... l:: ~ ~ No. rlI-Dlf - ()5f 3 Estate of YVll-/....-l ~ \{.~"-< ~>z..~~~(.:.~eceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW \'\"0 '~ \1) ~~, in consideration of the petition on the reverse side hereof, satisf ry proof haVing been pr~ before me, IT IS DECREED that the instrument(s) dated ()~~ \ '\ 1 \ C\(y~ described t rein be admitted to probate and filed of record as the last will of~~ ~ CO ~ ~,"I\-v-\ \tJ' and Letters are hereby granted to FEES Probate, Letters, Etc. ......... $ atcf), Cb .... Short Certificates(~) . . . . . . . . .. $ d<t. cD Renunciation ................ $ ,~ ,() b \0\\\ $ )S.rb v ~_S John H. Brou;os, Esq. #06268 AITORNEY (Sup. Ct. J.D. No.) 4 N.Hanover St, Carlisle,PA 17013 ADDRESS 717-243-4574 Filed ............ '6~"" '\' ~', 00" jCP fa. 00 (\ . W s- / ot? ~ .--::---;; 3~~. PHONE H105.805 REV 1105 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 '3.>-~.~~~ Local Registrar p 13310675 FEB 1 2 2007 Date No. :,1 --:,'; ~ -:1 H105-143 REV 11J2OO6 TYPE I PRINT IN PERMANENT BlACt< INK COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH (See Instructions and axamples on reverse) STATE ALE NUMBER ~f .. _ 01 OeaIllIMonth. day. yoar) 2/6/2007 3...."__ 366 - 12 - 7256 Bo. PIacll 01 Deolh (Check onel Ho6pll8; Olhe< o Inpatient 0 ER 1 Oulpolienl 0 llOA IKl Ntning Home 0 ~ Oou... Spoc;fy: 9.WuOec:8denlol_0rigIn? I2lINo Oves 10._'__'_-''''' IN"". speclfyClJbon, ISpoc/Ill arah A. Todd Marorial Hane Me"""". Puoflo-''''.) White 12. Wu Oec:8denIever in'" 13 Decedeol'$ EducetIon (Spedfy only hipeI grP compIeled) u.S~FD~ _'_ry((}.12) 1 CoIIoge(1-4or5+1 =-'~ 17aState PA :.~ 17e.D Yes.OIcedentlMdil T_? 17bCou1ly Onnberland 17d.KJ ~~.\"""- Carlisle 6. _ 01_ Month, dey, yoar) 7. Bir\tlJI8C8{ andlllll.leor 86 v", 60. Cou1ly at 0eaIll 5/30/1920 Allegan, MI ...FeclilyNameO'noI_.gIve.....endnumbel) d Twp. 11.-.UsuoI Kildol_ 1000 W. South St. Carlisle PA 17013 16. """",.Name~_.IUI._) John W. Roozenbur 200. -. Name cr,../PIIr/) John B. Klunder Cify/Bao 19. Mother's NIne (A11t, rQddIe, maiden lUTI8m8) Anna - Tries 2Ob._.-.gAddnleeISlr8el,dfy/-......zipexxlel Nortlinan Dr. Columbia SC 21. PleceolOllpo&itioo (NameolCllllllOSry._..-pIacol 29210 21d.I.<IcI1klnICIyI__zipexxlel Annville, PA "II I" orllonollon? ~ !II ~ t'- " -q ~ IJ' 010 '1 01(.10 Approxinale interval: Part II: Enter other !IimIicanI mndIions mnIrtIuIna to dMIh 28. Did Tobacco lI8e ConbtbulI to 0eIttI? 0nseI 10 Dee" """"'_.......-.lellyi>9"""glvon..ertl. 0 VIe OPrnbellly [;I.lio Ou- ~ ~ =~=I~ ~_I"'I. =UtlEYv::b=a. =-~':...~ . (oN("E..'iTI\J~ ~i f-A\L.u.v-~ Duelo(oraslconseq.l8fK:8of): b. Sft. VE..~.e... A1v~ yp, Due to (or as a consequence 01): f 110 ST A ~ C A-Nc..E. jIL Due 10 (or IS a consequence 01): 29." FtmBIlr. o Nol__puIyeBl O_Iflimeol_ o ..._bulpnlQllOnt_42clry1 01_ o ..._buI_43clry1Io1yeBl -.- o u_w__"'"",yeer 32<:.ti::=~jSlr8el,_. ~ IAcation 01 Injury (Slr8el, c1y/_ -I 'j) I'I"lJ wlSO:-.s: 'i tUuL; b V\.t~,.n-I A- t ."\1 '" ........ d. 3Ob. __ FnInge ._ Prior"c....-. 01 Causa 01 Deettl? OVle ONo llel'} 3Oa.WuanAukJpsy - 31, Manner (i DeMh g..., 0- O_OPan<ln9lnwstigetion 0"- OCculclNolbellolamW>ld M. 32d. TIme 01 Injury o VIe [31'16 I l!i l!; ! 330. Cao1IlI<< 1_ only ""I . CerIltylngpbyllcllnl__OlUIlIoI""..wnenenolher........ ""pronounced ",,".nd com""'od 11em23) 10 the bMloI my ~ deIIh ClCCUI'M due to the CIUI8(.).nd......, II stalMl. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- . ~:=.~=:::~8nd~~=tolO~=IfIIMer..stItecL_________________ 0 . ::: =- ~ and I or 1nvBttgItIon, In my opinion, dMIf1 0CCUJTed Ill: the time, dIt&. 8nd place, and due to the cauR(s) and manner...stIted- 0 33d. De1e Signed (Mon". day. ,..., '2-o{(,,{~1 34. Name and AdcmI of PenKlIl Who CompIet8d CaLlIe of DeaIh (Item 27l. Type I Pfilt Wll...'-11'l'W\. t. kA-\..t pAft I\>V ,U.-W 1<\ 1.-( S'~~/~ ~M::I j4. l..ULt t'i'\- ,.. ~ Iqll lall In I _""'No 0 \IfSt~< LAST WILL AND TESTAMENT OF WILLIAM HENRY ROOZENBURG I, WILLIAM HENRY ROOZENBURG, Social Security Number 366-12-2256, of the state of Pennsylvania, declare that this is my LAST WILL AND TESTAMENT and I revoke all other wills and codicils previously made by me. FIRST: I appoint my Wife, HARRIETTE MAE ROOZENBURG, as my Personal Representative concerning this Will. If she is unable or fails to serve, I then appoint my sister, FRANCES R. McCONNEY, Kalamazoo, Michigan and my brother in law, CARL L. BENSON, Benton Harbor, Michigan to serve as my Personal Representative. a. I request that my Personal Representative be permitted to serve without bond or surety thereon and without the intervention of any court, except as required by law. I direct that my Personal Representative act in unsupervised administration so as to administer my estate with a minimum of court supervision. If it becomes necessary to have ancillary administration of my estate in any jurisdiction where my Personal Representative is unable or does not desire to qualify as ancillary legal representative, I appoint as such ancillary legal representative such individual or corporation as my Personal Representative shall designate, in writ in g._ -:;() b. I direct my Personal Representative to pay thEi;~xp~ses of my last illness, the expenses of a funeral appropriate to:J#y st:atfon~ in life and custom of living (including a suitable monument:;9+ maX'ker for my grave), and written charitable pledges which I have mad~. ~.~ grant my Personal Representative the power to extend or reneior'any=deb:t: for such time as my Personal Representative shall deem app~opriat~-. --l c. All estate, inheritance, succession and other death~<taxes with respect to all property passing under this my Will shall be paid from and borne by the principal of my residuary estate, without regard to reimbursement, as if such taxes were administration expenses. My Personal Representative may pay such taxes at any time deemed advisable, whether or not then due and payable. d. My Personal Representative is requested to settle my estate as soon after my death as may be practicable, and to payor deliver every legacy or bequest to my beneficiaries without waiting time that may be believed to be customary in probate matters. / I I ! Ji/ ". ''l, / / 17 J I.? any PAGE 1 OF 5 PAGES , 1J1, j) ZIJQ ~ e. I have served in the Armed Forces of the United States. Therefore, I direct my Personal Representative to consult with a Legal Assistance Attorney at the nearest military installation and with the Department of Veterans Affairs and the Social Security Administration to ascertain if there are any benefits to which my family members are entitled by virtue of my military service. f. I may leave a letter of intent with the executed copy of this Will for the purpose of giving guidance to my Personal Representative concerning the distribution or sale of certain items of my property. I request, but do not require, that my Personal Representative honor my wishes therein expressed. SECOND: I give, devise and bequeath, absolutely and forever, all of my estate and property of which I may be seized or possessed, or to which I may be entitled, at the time of my death, wherever situated or of whatever nature, be it real, personal, or mixed, to my Wife, HARRIETTE MAE ROOZENBURG, as her sole and absolute property if she shall survive me. THIRD: In the event that my Wife, HARRIETTE MAE ROOZENBURG shall not survive me, I give, devise and bequeath, absolutely and forever, all of my estate and property of which I may be seized or possessed, or to which I may be entitled, at the time of my death, wherever situated or of whatever nature, be it real, personal, or mixed, as follows: 50% to my brother in law, CARL L. BENSON, Benton Harbor, Michigan or if he fails to survive me, to his wife, ALICE BENSON; 25% to my sister, FRANCES R. McCONNEY, Kalamazoo, Michigan; and 25% to my sister, MARY R. KLUNDER, Grand Rapids, Michigan. If either of my sisters fails to survive me, then the surviving sister shall take the share of my deceased sister. I empower my Personal Representative to sell any or all of such property, if such property is not distributed in kind hereunder, and to distribute the proceeds among the persons named in this paragraph, or the survivor, in substantially equal shares. Any determination of my Personal Representative as to what should pass or be sold under this paragraph and to whom it should pass or be delivered or at what price it should be sold shall be conclusive. PAGE 2 OF 5 PAGES JJJJB c!ll ~ FOURTH: If there is a complete failure of takers under the preceding paragraphs, the property undisposed of shall be distributed as follows: a. A one half share shall be distributed to my heirs determined at the time of my death, pursuant to the Statutes of Descent and Distribution in effect, in the state of my domicile, at the time of my death. b. A one half share shall be distributed to the heirs of my spouse, the identity of such heirs to be determined at the time of my death, pursuant to the Statutes of Descent and Distribution in effect, in the state of my domicile, at the time of my death. FIFTH: Except as otherwise provided in this Will, I have intentionally failed to provide for any other relatives or other persons, whether claiming to be an heir of mine or not. Insofar as I have failed to provide in this Will for any of my issue now living or later born or adopted, such failure is intentional and not occasioned by accident or mistake. SIXTH: Any beneficiary who fails to survive until one hundred twenty (120) hours after my death shall be deemed to have predeceased me, and the gift to that beneficiary shall be disposed of accordingly. SEVENTH: Definitions: a. The term "children" as used in this Will includes adopted and afterborn persons. The term "children" as used in this will shall also include step-children, the natural born or adopted children of a person's spouse. A relationship by or through legal adoption shall be treated the same as a relationship by or through blood for purpose of succession to property under this Will. b. The term "descendants" as used in this Will means the immediate and remote lawful, lineal descendants by blood or adoption of the person referred to who are in being at the time they must be ascertained in order to give effect to the reference to them. c. The term "issue" as used in this Will means all persons who are descended from the person referred to either by legitimate birth to or legal adoption by that person, or any of that descendant's legitimately born or legally adopted descendants. d. The term "Personal Representative" as used in this Will means Executor, Executrix, Independent Executor, or any other title of like import which is used to describe such a fiduciary. PAGE 3 OF 5 PAGES ,jJW cJl ~ e. The term "per stirpes" as used in this Will means that whenever a distribution is to be made to the descendants of any person, the property to be distributed shall be divided into as many shares as there are (1) living children of the person, and (2) deceased children, who left descendants who are then living, of the person. Each living child (if any) shall take one share and the share of each deceased child shall be divided among his then living descendants in the same manner. EIGHTH: In addition to any powers granted by the laws of the state in which this Will is probated, I hereby authorize and empower the fiduciaries named in this Will, to the extent of the discretion herein granted, to sell, exchange, convey, transfer, assign, mortgage, pledge, lease or rent the whole or any part of my real or personal estate, to invest, reinvest, or retain investments of my estate, to perform all acts and to execute all documents which my fiduciaries may deem necessary or proper in regard to my property. If any of my fiduciaries elect to receive compensation for services, such compensation will be that allowed by law. NINTH: If any part of this Will shall be invalid, illegal, or inoperative for any reason, it is my intention that the remaining parts, so far as possible and reasonable, shall be effective and fully operative. My Personal Representative may seek and obtain court instructions for the purpose of carrying out as nearly as may be possible the intention of this Will as shown by the terms hereof, including any terms held invalid, illegal, or inoperative. IN WITNESS WHEREOF, I have at Carlisle Barracks, Pennsylvania, this ~day of September, 1992 set my hand and seal to this my LAST WILL AND TESTAMENT, consisting of 5 typewritten pages, each page bearing my handwritten signature. (SEAL) PAGE 4 OF 5 PAGES JJ11I2 ~ ~ The foregoing instrument was, at Carlisle Barracks, Pennsylvania, this /;731 day of September, 1992, signed, sealed, published and declared by WILLIAM HENRY ROOZENBURG, the testator, to be his LAST WILL AND TESTAMENT in the presence of all of us at one time, and at the same time we, at his request and in his presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses, and we do so verily believe that the said testator is of sound and disposing mind and memory at the date hereof. cfi%/f14~ ~~ ~ SSAN I '} '}- .J.. if - 'l b~ ~ SSAN ~ --0 _ _ s:::j -=-~ . _ :J!;.3 6': 1ft OF Rl/:2, ik" Lt/,J OF //~J(JJm-2lfNl'.et: ~;:t;1I/ 1#. /?'I/~ kwlSTOwJ, 14. J70'lf ')jjRtAnJ7/(l'btJvy PAGE 5 OF 5 PAGES ~. !:})j) ~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ACKNOWLEDGMENT I, WILLIAM HENRY ROOZENBURG, testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I sign~~~t willingly; and that I signed it as my free and voluntary act for th~pur~oses t~efein pressed. ~~fi> ,Y . A ?V/. /7 tv ( SEAL) WILLI HEN RO AFFIDAVIT We, t:zs !)J Of'/lJi1. ,u~( R... ' ~Elmac..;) 2)/3vt../Naet CJ1l , and Ell;:) y'.C;~LrZ- , the witnesses, sign our names to this instrument, be~ng duly qualified according to law, do depose and say that we were present and saw the testator sign and execute the instrument as his Last Will; that the testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testator signed the will as a witness; and that to the best of our knowledge the testator was at that time 18 or more years of age, of sound mind and u~der no constraint orundu~ influe~ _ ~/!! (j)~ f/:l::::/l1:JwtJl ~ c,ut Subscribed, sworn to and acknowledged before me by WILLIAM HENRY ROOZENBURG, the testator, and subscribed and sworn to before me by ...t;f:/I!!J;_GP'j{' ,):~4.j)exJ/..J"'C;1& l/7l. , and ",. -. ,the witnesses, this 17 day of September, 1992. ~ti/~ NOT Y PUBLIC My ;~,'" commiss.on~~. ~;(.' t.Ay eonlllis8ion ~():t 18,1 : ' ! Member. PennsyMlnia AssodaIiondNolaJfee i This statement is to be considered only upon the deaths of Harriette and William Roozenburg within a one month period of each other. As stated on Page 2, paragraph f of my Last Will and Testament I request my nephew, John Klunder, Grand Rapids, Michigan and Larry Minegar, Otsego, Michigan share in all of my tools located in my garage. ThePersonal Representative must set a time limit for the above persons to choose their items so the remaining part of the estate can be settled as soon as possible. (~ '-') dateJ:fl~j Iff,;/- Signed I, Harriette Roozenburg, honor my husband's request to have my share of the tools be included in the above distribution. Da te -f1.J3.,jff ~ Signed JI~7~ddh~ RENUNCIATION IN RE: ESTATE OF WILLIAM HENRY ROOZENBURG TO: REGISTER OF WILLS The undersigned Alice Benson, is a beneficiary under the will of Decedent by way of Carl L. Benson, deceased, and ordinarily would be in line for appointed as executrix. She resides in Michigan and has a home in Florida. 'Vif~ Harriet Mae Roozenburg and both named executors Frances R. McConney and Carl L. Benson are deceased. Alice Benson renounces the right to administer the estate and respectfully requests that Letters Testamentary d. b. n. c. t. a. be issued and appointment made to John B. Klunder, 115 Northman Drive, Columbia,-S. c., 19210,803 561 9018. All beneficiaries and named executors are deceased except beneficiary Alice Benson. WITNESS my hand and seal this 2J oih day of March, 2007. ..,:.. {])1A..e.. ~ LS Alice Benson 10749 Everglades Kite Estero, FLORIDA 33929 33C1z.~ a2.Y STATE OF FLORIDA COUNTY OF Lee... ss Sworn and affirmed to and acknowledged before me this ~day of March, 2007. ~~ ~""V"lI~ ,.fV .~ ,.. "A. ~ "OFt\.1S (407) 398-0153 VICKY T. CRUZ MYCOMMISS!ON /I 00469555 EXPIRES, Sept 7, 2009 Florida Notary Service. com C:' ,IF-~ G-l J-1 ,4 2-- ~\\ ~ 'f2-;:;:-'[ u ~ Bond No. 98 LX 4351 5 BOND OF EXECUTOR, ADMINISTRATOR OR GUARDIAN ITATI 'AIM A 'N'UU.NC\ COUNTY OF CUMBERLAND STATE FARM FIRE AND CASUALTY COMPANY BLOOMINGTON, ILLINOIS } ss COURT OF COMMON PLEAS COMMONWEALTH OF PENNSYLVANIA ~"':. -~ ...~ ~ Estate IN THE MATTER OF THE 0 Guardianship OF WILLIAM HENRY ROOZENBURG \ .......0 --:~1 ~ Deceased o Incompetent o Minor Bond of ~ Executor o Administrat . ". .' . --+- o Guardian ' o KNOW ALL PERSONS BY THESE PRESENTS: That we, JOHN B. KLUNDER ' as Principal, and State Farm Fire and Casualty Company, a corporation of Illinois, as surety, are held firmly bound unto the Commonwealth of Pennsylvania, in the penal sum of FOUR HUNDRED THOUSAND AND NO CENTS Dollars ($ 400, 000.00 ), for the payment of which we jointly and severally bind ourselves, our heirs, executors, administrators, successors, and assigns. THE CONDITION OF THE ABOVE OBLIGATION IS SUCH, that if the above bound principal shall faithfully discharge the duties of his, her, their trust as EXECUTOR ' of the estate of (EXECUTOR, ADMINISTRATOR, GUARDIAN, ETC.) WILLIAM HENRY ROOZENBURG according to law, then the above obligation is to be void, else to remain in full force. S Dated, signed and sealed with our seals this 24TH ~" By: Approved this day of Attest: COMMONlNEALTH OF PEmJSYL'JP.~JI/\ ~~ ~ $0'.,),,",* e~\,.,j-' I swear that I will faithfully discharge the duties of my trust as Subscribed and sworn to before me, the ~ ~ ~MQ,<K- ~ of the person and estate of WILLIAM HENRY ROOZENBURG Printed in U.S.A. 12067S ILLINOIS ACKNOWLEDGMENT OF SURETY } ss County of MCLEAN I, HEIDI J" STEVENS , in and for said county in the state aforesaid, do hereby certify that PERRY TRACY , Attorney-in-Fact of STATE FARM FIRE AND CASUALTY COMPANY of Bloomington, Illinois, a corporation duly organized and existing under the laws of the State of Illinois, personally known to me to be the same person whose name is subscribed to the foregoing instrument as Attorney-in-Fact of STATE FARM FIRE AND CASUALTY COMPANY, appeared before me this day in person and acknowledged that he signed and delivered the said instrument as his and State Farm Fire and Casualty Company's free and voluntary act for the uses and purposes therein set forth. My Commission Expires Given under my hand and official seal this 24TH ,2007 . MARCH 12 OFFICIAL SEAL HEIDI J STEVENS y PU8L1C. STAlE OF ILLINOI , ~~~\5SlON EXPIRES MAR 12, LEDGMENT OF PRINCIPAL S~"T'C 4 Sou--o.~ CIArRO \.-1] C<i)....ot~'\.[Al 'fi I or pn;Itl~YL'IANIA ss County of Ux~ I, ~~ !(. ~fc'r in and for said County, do hereby certify that J o-~ B. lL-l-U N t> ~ ~otary Public D County Clerk personally known to me to be the same person(s) whose name J S subscribed to the foregoing instrument as Principal, appeared before me this day in person and acknowledged that \..vD' signed, sealed and delivered said instrument as '0+\ I free and voluntary act, for the uses and purposes therein set forth. ~ day of ~A(j ,:lrJ;l1 My Commission Expires Given unde(my .hand and seal this \)e{:12~~ \~. Z' e:: ::J 0 () C/) III 'c c>- L5 III > Zz --I >. <(e( a.. III Z e:: wo.. e:: O:::E 0 Q) U:O ::2: a.. ::2: - :EO 0 0 0::>- .t: <(I- () :I::: III u....J u.. Q) we( 0 ~ 1-;:) l- e:: <(en 0 IX: 0 1-<( z :J ~ enO 0 () 0 () .." ,au\{Q. 4~kk..-L~ I:&. Notary Public D County Clerk D Dr&DDD CI) - ~ ~ '" 0 CI) ." ::I >- 13 "E -, III ~ "'C D Q) Cl III a.. "'C "E Q) III 0 III 0 Q) Q) 0 IX: ~ Q) ca - III W .5 "'C Q) "'C "'C III ... Q) 0 > :c 0 e - ~ "'C 0. ~ "'C 0 e::- 0. c: _0 <( u: III Z - u.. 0 0 - 0 ro 0 W .t: Z X Q) 0 W a:l a:l Z e:: IX:IX:Z 0 00<( IX: .' 1-1---1 0 " ~~~IX:Z~ 1-1- 0<( C/)C/)J:I--IX: ZZI-:JOW __~()IX:C/) ::2:::2: W:3~ 00 X <(<( W"() Power of Attorney STATE FARM FIRE AND CASUALTY COMPANY KNOW ALL PERSONS BY THESE PRESENTS: That STATE FARM FIRE AND CASUAL TV COMPANY, an Illinois corporation, with its principal office in Bloomington, Illinois, does hereby constitute and appoint: Kristina Backus, Eugina Brant, Christine Cameron, Ceola Campbell, Pamela Chancellor, Christine M. Chenoweth, Julie Fehrman, Mark Fink, Julie Freed, Matthew J. Gibbons, John Gibson, John R. Horton, Cynthia Johnson, Susan K. Johnson, Amanda Kaufman, Julia Klinzing, Connie S. Knox, G.F. Krawcyk, Amber Kull, Christine Macdonnell, Lori McDowell, Melissa L. Morris, Donna K. O'Crowly, Amy C. Ogan, James Platt, Vicki Redman, Leann Rees, Linda Rieck, Suzanne M. Robertson, Rebecca F. Robison, Lucinda K. Samford, Alice Schuler, Mary Sieg, Trudy Spence, Mary A. Spotts, Heidi Stevens, Cindy R. Swick, Sara L. Tackett, Perry Tracy, Susan M. Wagoner, Diana L. Watt, Karen Weber, of Bloomington, Illinois its true and lawful Attorney(s)-in-Fact, to make, execute, seal and deliver for, and on its behalf as surety, any and all bonds, undertakings or other writings obligatory in the nature of a bond as follows: Any such obligation in any amount This appointment is made under and by the authority of a resolution which was passed by the Executive Committee of the Board of Directors of State Farm Fire and Casualty Company on the 24th day of July, 1974, as is duly authorized by the Board of Directors in Article II, Section 6 of the By-Laws of the Company, which resolution is: Resolved, that the Executive Vice-President or a Vice-President of the Company is hereby authorized to appoint and empower any representative of the Company or other person or persons as Attorney-in-Fact to execute on behalf of the Company any bonds, undertakings, policies, contracts of indemnity or other writings obligatory in the nature of a bond, which the Company might execute through its duly elected officers, and affix the seal of the Company thereto. Any said execution of such documents by an Attorney-in-Fact shall be as binding upon the Company as if they had been duly executed and acknowledged by the regularly elected officers of the Company. Any Attorney-in-Fact, so appointed, may be removed for good cause and the authority so granted may be revoked as specified in the Power of Attorney. Resolved, that the signature of the Executive Vice-President or any Vice-President and the seal of the Company may be affixed by facsimile on any power of attorney granted, and the signature of the Secretary, Vice-President or Assistant Secretary, and the seal of the Company may be affixed by facsimile to any certificate of any such power and any such power or certificate bearing such facsimile signature and seal shall be valid and binding on the Company. Any such power so executed and sealed and certificate so executed and sealed shall, with respect to any bond or undertaking to which it is attached, continue to be valid and binding on the Company. IN WITNESS THEREOF, STATE FARM FIRE AND CASUALTY COMPANY has caused this instrument to be signed by its Vice- President, and its Corporate Seal to be affixed this 14th day of September, 2004. This APPOINTMENT SHALL CEASE AND TERMINATE AUTOMATICALLY AS OF DECEMBER 31,2007, UNLESS SOONER REVOKED AS PROVIDED. STATE OF ILLINOIS COUNTY OF McLEAN On this 14th day of September 2004, before me personally came William K. King to me known, who being duly sworn, epose and say that he is Vice-President of STATE FARM FIRE AND CASUALTY COMPANY, the corporation described in and which executed the above instrument; that he knows the seal of said corporation; that the seal affixed to said instrument is such Corporate Seal; and that he executed said instrument on behalf of the corporation by authority of his office under the By-Laws of said corporation. STATE FARM FIRE AND CASUALTY COMPANY By: "OfFICIAL SEAL- TnJdy A. Sptnce NcIWJ PubIc. stili Of 1\llnoiI COmrI'IiI;IIon ~ 07J29101 ~{f.,;,~ My commission expires July 29, 2008 CERTIFICATE I, the undersigned Vice-President of STATE FARM FIRE AND CASUALTY COMPANY, do hereby certify that the original Power of Attorney of which the foregoing is a true and correct copy, is in full force and effect and has not been revoked and the resolutions as set forth are now in force. It Signed and sealed at Bloomington, Illinois. Dated this ~Lltt\ day of '\ ~ ,LC1)1 ~~.~ If you have a question concerning the validlt FB6-9043A.37 (01/07) ower of Attorney, call (309) 766-2090. Printed in U.S.A. BEFORE THE REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYL VANIA ESTATE OF WILLIAM HENRY ROOZENBURG, DECEASED NO 21-2004-0583 DECREE OF THE REGISTER OF WILLS AND NOW, thisrly of February, 2007, upon consideration of the Petition for Grant of Letters of John B. Klunder, dated February 2/~007, for the estate of William Henry Roozenburg, IT IS HEREBY DECREED that the Petitioner shall post surety bond in the amount of $400,000. IT IS ALSO DECREED that Page 1 through Page 5 as well as the Acknowledgement and Affidavit of the instrument offered for probate as The Last Will and Testament of William Henry . Roozenburg are admitted to probate. The page immediately following the Acknowledgement and Affidavit is not admitted to probate. IT IS FURTHER DECREED that upon filing the Bond of Personal Representative and the Renounciation of Alice Benson, Letters of Administration c.t.a. shall be granted to John Henry Klunder. John Henry Klunder shall have all the rights and duties of a fiduciary under the laws of Pennsylvania and shall proceed with the administration ofthis estate according to law. Glenda Farner Strasbaugh, Registe 0 Wills John H. Broujos, Esquire Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717)240-6345 Date: 07/31/2007 C) ~O ...'C :-D -'u '-,-C) '~~~ 1-- :~:= ~8 ,i_; >-( BROUJOS JOHN 4 NORTH HANOVER STREET CARLISLE, PA 17013 c-) (-} -~C::)'~ -)..--- ::6 --j RE: Estate of ROOZENBURG WILLIAM HENRY File Number: 2004-00583 Dear Sir/Madam: This notice is to serve as a reminder that the Certificate of Notice under Rule 5.6(a) is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his councel, within ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing is due by: 08/19/2007 Please feel free to contact this office with any questions you may have. If you have already filed your certificate, please disregard this notice. SincerelYI ~-<4t. ~AJ~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) '" c:-..::> = -... J> c::: G") I :t- 2: co (".) 0'0 -:) q Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717)240-6345 Date: 07/31/2007 o ?~ TCJ ,~ t:;:; -- c "T1 t._/);:'~ ~ C:'::J = ......... :::0.. c:: en I KLUNDER JOHN B 115 NORTHMAN DRIVE COLUMBUS, SC 29210 ") -) c:-:) -~) ----i :t> ::t: ~ w en RE: Estate of ROOZENBURG WILLIAM HENRY File Number: 2004-00583 Dear Sir/Madam: This notice is to serve as a reminder that the Certificate of Notice under Rule 5.6(a) is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his councel, within ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing lS due by: 08/19/2007 Please feel free to contact this office with any questions you may have. If you have already filed your certificate, please disregard this notice. Sincerely, ~h l~-~) tA;~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel ~ CERTIFICATION OF NOTICE 'UNDER Pa. O.C. Rule 5.6(2) (~ REGISTER OF \\'LLLS ~ N\J~ (1/ A (\.I 0 cOtJNTY, PEN'NSYL VAl\lA NameofDeceden,: UL~LLJAN\. HEN.le-VI ~0-C1--J[lu(ZL.f2J' DaleofDeath:J-J~ t:; I 7JC'cof- File Nu;nber: 2.otZ:YL/ -ctJ (rJ.,S-2 ~ Dcte Leuers Granlt:d: ~A 'c..c:f...t ~ ? rCl(f) 7 To the Register: I certify that Notice of Estate Administration reguired by Pa. O.c. Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on -tJ.. b ( u H- !;. 7L:?ctJ 7' . Name: Address: hJCJ7.. .J'4-"I7taN ~~.~~ ~2JH /vt- t?~ ' ?~ 1\1 JZJ:l<p/~1 M ~y~22- .-/ (Jjmore space is needed, attach separate sheet.) Notice has now been given to all persons entitled thereto under Pa. a.c. Rule 5.6(a) excef.t; o Counsei Dale 5? - L/- 0/ ...0 ..s .,~) ~ ....::.: 0: C" O~::c. U <. -;-;; g N @~:> !-{ L-u N a& z __ Name of Person Fllmg mls Forrr. ~1:;~ N CO tcEi+M"A N l/1~~ . Ce:eJ L(~M--1?1y s:~~ Z9d.?/ 0 IX:: <Z1LJ3 - 5-q/- /e;/y T ele!JhDn~ ~:::::-'gt!?.3 ::: 7/9 - '7.3~ Z r\ ./-, i LiJ . 1--- ,y ~~,( c-:- ..,.:.... CJ .<,- <' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT KLUNDER JOHN B 115 NORTHMAN DRIVE COLUMBUS,SC 29210 -------- fold ESTATE INFORMATION: SSN: 366-12-2256 FILE NUMBER: 2104-0583 DECEDENT NAME: ROOZENBURG WILLIAM HENRY DA TE OF PAYMENT: 01/18/2008 POSTMARK DATE: 01/18/2008 COUNTY: CUMBERLAND DATE OF DEATH: 02/06/2007 NO. CD 009189 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $36,516.60 I I I I I I I I TOTAL AMOUNT PAID: $36,516.60 REMARKS: JOHN B KLUNDER CHECK#1016 SEAL INITIALS: OM RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS COM~ ONWI:AlTH OF PENNSYLVANIA DEPA TMENT OF REVENUE SURE U OF INDIVIDUAL TAXES DEPT. 280601 HARR SBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVE~ FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT 2104-0583 ROOZENBURG WILLIAM HENR'r 05/09/2008 05/09/2008 CUMBERLAND 02/06/2007 KL JNDER JOHN B 11 5 NORTHMAN DRIVE CC LUMBUS, SC 29210 ------ fold ESTAIr-E INFORMATION: SSN: FILE r UMBER: DECE DENlT NAME: DATE OF PAYMENT: POS1MARK DATE: COU TY:: DATE OF DEATH: RErv ARKS: RECEIPT TO ATTORNEY CHECK# 1019 S AL 366-12-2256 NO. CD 009696 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,258.20 I I I I I I I I TOTAL AMOUNT PAID: INITIALS: AJW RECEIVED BY: REGISTER OF WILLS $1,258.20 GLENDA FARNER STRASBAUGH REGISTER OF WILLS W I- ~ S(I) uO:::~ W o.u :1:00 uO:::..J &:111 <( COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY c I- Z W CI W () W CI DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Roozenbur , William H. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) FILE NUMBER 21 -0 4 0 0 5 83 ""CoUNTvCOiiE ---vEAA- - - NiiiER- - SOCIAL SECURITY NUMBER 3 6 6 - 1 2 - 2 2 5 6 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Return (date of death prior to 12-13-82) D 5 Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes D 11 Election to tax under Sec. 9113(A) (Attach Sch 0) .. Tt-IISSECTIONMu-st.SECONlPI..ETED. AI..l.. CORREsPONDENCE AND CClNFIDENTI AI.. TAXINFORNlA'TIONSt-lOULDBEDIRECTEDT(); NAME COMPLETE MAILING ADDRESS ohn H. 8rou'os 4 North Hanover Street FIRM NAME (If Appicabe) z o I- ~ :::> a.. ~ o () X ~ X _(15) X _(16) X .12 (17) 251,832.00 x .15 (18) 37,774.80 (19) 37,774.80 02/06/2007 05/30/1920 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Deceased [R] 1 Original Return D 4. Limited Estate [R] 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received D 2 Supplemental Return D 4a. Future Interest Compromise (date of death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach copy ofTrust) D 10 Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) I- Z W C Z o 0. VI W 0::: 0::: o U Carlisle, PA 17013 TELEPHONE NUMBER 17-243-4574 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) 3. Closely Held Corporation, Partnership or Sole-Proprietorship z o l- e:( ...J :::> I- a.. e:( () w ct:: 4. Mortgages & Notes Receivable (Schedule D) 5 Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) [J Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. T,otal Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) (10) (6) (7) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11 Total Deductions (total Lines 9 & 10) 12. N,etValue of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. N,et Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Talx Due 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ::i>:>. 'BE SORE TO ANsWERAl..1.. blJEStloNsbN RE\fERSE SIDE .ANDRECHECK MATH ... .<< OFFICIAL USE ONLY 42,078.14 t-_.) C:;::) c;::, '.::0 (8) 244,889.5,' 9 -, _D . -D =CO . -::~93 -:\.JjX :.:::CJ --j ::5 -:0-1 );i 27,234.00 9,137.00 :~. ~~ ;:-:1~67.67 C/) c) ~ t") -m- ;:;; -< I \.0 :x '-:'! -l:"" N (11) (12) (13) 36,371.00 250,596.67 (14) 250,596.67 Dee dent's Complete Address: STRE ADDRESS Sarah Todd Memorial Home West South Street CITY STATE PA ZIP 17013 Tax ayments and Credits: 1 T x Due (Page 1 Line 19) 2. C editsfPayments A Spousal Poverty Credit 8 Prior Payments C Discount (1) 37,774.80 36.516.60 Total Credits (A + 8 + C) (2) 36,516.60 3. I eres1JPenalty if applicable D Interest E Penalty TotallnteresllPenalty (D + E) (3) 4. If ine;~ is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If ine 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 1,258.20 1 ,258.20 PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;...................................... ................................... 0 [gJ b. retain the right to designate who shall use the property transferred or its income~...................................... 0 [gJ c. retain a reversionary interest;.or............................................. ............ ......................................... 0 [gJ d. receive the promise for life of either payments, benefits or care?.......................................................... 0 [gJ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.............................................. ............................................ 0 [gJ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?............... 0 [gJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?................................................. ..... .............. .............. ....... ......... 0 [gJ UESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. accompanying schedues and statements, and to the best of my knowedge and beief, it is true, correct and compete. based II information of which preparer has any knowedge. URN DATE '- 2~ -~y SC 29210 DATE K C)~ ADD RES PA 17013 For dat 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. 9911<6 (a) (1.1) (i)]. For date 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. 99116 (a) (1.1) (ii)]. The stat te 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 surv ing spouse is the only beneficiary. For date of death on or after July 1, 2000: The tax ate 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 ste parent of the child is 0% [72 P.S. 99116(a)(1.2)]. The tax ate imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)]. The tax ate imposed on the net value of transfers to or for the use of the decedenfs siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an individu I who has at least one parent in common with the decedent, whether by blood or adoption. REV-1 03 EX + (6-98) '*' SCHEDULE B STOCKS & BONDS OMMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTA E OF Roo enburg. William H. FILE NUMBER 21 04 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUM ER 1. DESCRIPTION United States Savings Bonds -- 3 Series EE X4578560EE ($10,000) X4578561 EE ($10,000) X4578562EE ($10,000) AT&T Stock ~- 309 shares Account No. C2006553225 2. 3. AT&T Dividend 4. Guardian Bond Refund 5. Tax Refunds 00583 TOTAL (Also enter on line 2, Recapitulation) $ (If more space IS needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 26,676.00 12,714.62 290.22 272.21 2,125.09 42,078.14 REV- 5 08 EX + (6-98) . SCHEDULE E OMMONWEAL TH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTA EOI" FILE NUMBER Roo enburQ. William H. 21 04 00583 Include the proceeds of litigation and the date the proceeds were received by the estate All property jointly-owned with right of survivorship must be disclosed on Schedule F. IT M VALUE AT DATE NU~ BER DESCRIPTION OF DEATH 1. Raymond James 189,368.00 2. SunTrust Account NO.1 000027913994 51,687.80 P. O. Box 622227 Orlando, FL 32862-2227 3 Prudential Financial insurance proceeds Policy #098876828 3,833.73 TOTAL (Also enter on line 5, Recapitulation) $ 244 889.53 (If more space IS needed, insert additional sheets of the same size) REV-11511 EX + (12-99) *' OMMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTA E OF Roo enburg. William H. IT M NU" BER A. 1 ~ . B. 2. 3. 4. 5. 6. 7. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Debts of decedent must be reported on Schedule I. 21 04 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) John B. Klunder Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 115 Northman Drive City Columbia FUNERAL EXPENSES: Prepaid Year(s) Commission Paid: DESCRIPTION State SC Zip 29210 Attorney Fees John H. Broujos, 4 North Hanover Street, Carlisle, PA 17013 Family Exemption (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip Probate Fees Register of Wills for Cumberland County Probate, Letters, Short Certificates (6), Renunciation, Will, Bond, JCP, Automation Accountant's Fees T ax Return Preparer's Fees (If more space is needed, insert additional sheets of the same size) TOTAL (Also enter on line 9, Recapitulation) $ 00583 AMOUNT 0.00 13,900.00 13,000.00 334.00 27 234.00 REV- 5 12 EX + (6-98) . SCHEDULE. OMMONWEAL TH OF PENNSYLVANIA DEBTS OF DECEDENT, IINHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESH EOF FILE NUMBER Roo ent>ura. William H. 21 04 00583 Include unreimbursed medical expenses. TEM VALUE AT DATE N MBER DESCRIPTION OF DEATH 1. BB& T -- Bank draw for checks 70.00 2. 2005 Taxes to IRS 1,589.00 3. 2006 Taxes to IRS 2,116.00 4. Sarah Todd Memorial Home -- Final Payment Owed 1,486.00 5. Pharmerica .- Final Medicine Payment Owed 37.00 6. Administrative fees 1,140.00 7. 2004 Taxes to IRS 235.00 8. Executor Bond Payment 1,040.00 9. Taxes 206.00 10. 2007 Taxes to IRS 1,218.00 TOTAL (Also enter on line 10, Recapitulation) $ 9,137.00 (If more space is needed, insert additional sheets of the same size) C MMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES 1. H. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)J Alice Benson 3494 North M-63 Benton Harbor, MI 49022 FILE NUMBER 21 04 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Sister-in-law 00583 AMOUNT OR SHARE OF ESTATE 100% 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 1. 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - 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) LAST WILL AND TESTAMENT OF WILLIAM HENRY ROOZENBURG I, WILLIAM HENRY ROOZENBURG, Social Security Number 366-12-2256, of the state of Pennsylvania, declare that this is my LAST WILL AND TgSTAMENT and I revoke all other wills and codicils previously made by mE~ . FIRST: I appoint my Wife, HARRIETTE MAE ROOZENBURG, as my PE!rsonal Representative concerning this Will. If she is unable or fails to serve, I then appoint my sister, FRANCES R. McCONNEY, Kalamazoo, Michigan and my brother in law, CARL L. BENSON, Benton Ha.rbor, Michigan to serve as my Personal Representative. a. I request that my Personal Representative be permitted to serve without bond or surety thereon and without the intervention of any court, except as required by law. I direct that my Personal Representative act in unsupervised administration so as to administer my estate with a minimum of court supervision. If it becomes necessary to have ancillary administration of my estate in any jurisdiction where my Personal Representative is unable or does not desire to qualify as ancillary legal representative, I appoint as such ancillary legal representative such individual or corporation as my Personal Representative shall designate, in writing. b. I direct my Personal Representative to pay the expenses of my last illness, the expenses of a funeral appropriate to my station in life and custom of living (including a suitable monument or marker for my grave), and written charitable pledges which I have made. I gr.ant my Personal Representative the power to extend or renew any debt for such time as my Personal Representative shall deem appropriate. c. All estate, inheritance, succession and other death taxes wi"th respect to all property passing under this my Will shall be paid from and borne by the principal of my residuary estate, without regard to reimbursement, as if such taxes were administration expenses. My Personal Representative may pay such taxes at any time deemed advisable, whether or not then due and payable. d. My Personal Representative is requested to settle my es1:ate as soon after my death as may be practicable, and to payor eliver every legacy or bequest to my beneficiaries without waiting any time that may be believed to be customary in probate matters. <' ;;"'/0" '. or .r."' .-.-<.....- // '/ .' .-'".'" PAGE 1 OF 5 PAGES ,./~l,J.f~ _: ' I , ,,-,I, (' ~..'. II{ G ,Ilk-- ~/>:..).. (~:'-j , S '/ e. I have served in the Armed Forces of the United States. ThE~refore, I direct my Personal Representative to consult with a Legal ssistance Attorney at the nearest military installation and with the Department of Veterans Affairs and the Social Security Administration to ascertain if there are any benefits to which my family members are nt:i tIed by virtue of my military service. f. I may leave a letter of intent with the executed copy of his Will for the purpose of giving guidance to my Personal epresentative concerning the distribution or sale of certain items of y property. I request, but do not require, that my Personal epresentative honor my wishes therein expressed. SECOND: I give, devise and bequeath, absolutely and forever, all f my estate and property of which I may be seized or possessed, or to hi.ch I may be entitled, at the time of my death, wherever situated or f whatever nature, be it real, personal, or mixed, to my Wife, lRIETTE MAE ROOZENBURG, as her sole and absolute property if she hall survive me. THIRD: In the event that my Wife, HARRIETTE MAE ROOZENBURG shall survive me, I give, devise and bequeath, absolutely and forever, 11 of my estate and property of which I may be seized or possessed, or o which I may be entitled, at the time of my death, wherever situated r of whatever nature, be it real, personal, or mixed, as follows: 50% o my brother in law, CARL L. BENSON, Benton Harbor, Michigan or if he ails to survive me, to his wife, ALICE BENSON; 25% to my sister, RANCES R. McCONNEY, Kalamazoo, Michigan; and 25% to my sister, MARY R. LUNDER, Grand Rapids, Michigan. If either of my sisters fails to urvive me, then the surviving sister shall take the share of my eceased sister. I empower my Personal Representative to sell any or 11 of such property, if such property is not distributed in kind ereunder, and to distribute the proceeds among the persons named in his paragraph, or the survivor, in substantially equal shares. Any etermination of my Personal Representative as to what should pass or e sold under this paragraph and to whom it should pass or be delivered r at what price it should be sold shall be conclusive. /.'(J?' ///~./ .~ /~>/ /< //~,/'. '>/ PAGE 2 OF 5 PAGES p ,--, -;" !JfJ: / I /l! C v Idk/ --?- . - ""/ J -- . ~- \ D. ':1- -" // FOURTH: If there is a complete failure of takers under the prE~ceding paragraphs, the property undisposed of shall be distributed as follows: a. A one half share shall be distributed to my heirs determined t the time of my death, pursuant to the Statutes of Descent and istribution in effect, in the state of my domicile, at the time of my eath. b. A one half share shall be distributed to the heirs of my spouse, the identity of such heirs to be determined at the time of my eath, pursuant to the Statutes of Descent and Distribution in effect, in the state of my domicile, at the time of my death. FIFTH: Except as otherwise provided in this Will, I have in1:entionally failed to provide for any other relatives or other ersons, whether claiming to be an heir of mine or not. Insofar as I aye failed to provide in this Will for any of my issue now living or la1:er born or adopted, such failure is intentional and not occasioned y accident or mistake. SIXTH: Any beneficiary who fails to survive until one hundred wEmty (120) hours after my death shall be deemed to have predeceased and the gift to that beneficiary shall be disposed of accordingly. SEVENTH: Definitions: a. The term "children" as used in this Will includes adopted nd afterborn persons. The term "children" as used in this will shall Iso include step-children, the natural born or adopted children of a erson's spouse. A relationship by or through legal adoption shall be reated the same as a relationship by or through blood for purpose of succession to property under this Will. b. The term "descendants" as used in this Will means the imrrediate and remote lawful, lineal descendants by blood or adoption of thE~ person referred to who are in being at the time they must be ascertained in order to give effect to the reference to them. c. The term "issue" as used in this Will means all persons ho are descended from the person referred to either by legitimate iJ:th to or legal adoption by that person, or any of that descendant's legitimately born or legally adopted descendants. d. The term "Personal Representative" as used in this Will eans Executor, Executrix, Independent Executor, or any other title of like import which is used to describe such a fiduciary. ,// . -~ /.~;' >Z" / -'. .' r /, ." '- I J ~ ;i' - >~/, ~;:'./ ~ /~;;;;/), PAGE 3 OF 5 PAGES -P ~ (-', . 11//) .. [/ -/ ;1" ('- \ (;%rJ/ --r?':J C ?/f' - , '\ e. The term "per stirpes" as used in this Will means that hE~never a distribution is to be made to the descendants of any person, hE~ property to be distributed shall be divided into as many shares as here are (1) living children of the person, and (2) deceased children, ho left descendants who are then living, of the person. Each living hild (if any) shall take one share and the share of each deceased hild shall be divided among his then living descendants in the same anner. EIGHTH: In addition to any powers granted by the laws of the state in which this Will is probated, I hereby authorize and empower he fiduciaries named in this Will, to the extent of the discretion erein granted, to sell, exchange, convey, transfer, assign, mortgage, ledge, lease or rent the whole or any part of my real or personal es1:ate, to invest, reinvest, or retain investments of my estate, to perform all acts and to execute all documents which my fiduciaries may eE~m necessary or proper in regard to my property. If any of my fiduciaries elect to receive compensation for services, such compensation will be that allowed by law. NINTH: If any part of this Will shall be invalid, illegal, or inoperative for any reason, it is my intention that the remaining parts, so far as possible and reasonable, shall be effective and fully operative. My Personal Representative may seek and obtain court instructions for the purpose of carrying out as nearly as may be possible the intention of this Will as shown by the terms hereof, including any terms held invalid, illegal, or inoperative. IN WITNESS WHEREOF, I have at Carlisle Barracks, Pennsylvania, this f --, day of September, 1992 set my hand and seal to this my LAST WILL ANJ~TESTAMENT, consisting of 5 typewritten pages, each page bearing my handwritten signature. "'. _/~ />~" ) / u-.:/ . :t>~/:,:<:-:/;;' 'WILLIAM HENRY ROOZE~~URG (SEAL) /~<<:~~:~/ .:,~ .... " i .",./.....J "'/ _///>) /"// PAGE 4 OF 5 PAGES rf'/ 711 V"-, ,/ r.J, , /.. "-/; 5c~". J(j ( oj~G/ ./ ". -f/\ t-~'1 / .~A \ L-.... //.j The foregoing instrument was, at Carlisle Barracks, Pennsylvania, / ~.' '{ .:< his day of September, 1992, signed, sealed, published and eclared by WILLIAM HENRY ROOZENBURG, the testator, to be his LAST WILL D TESTAMENT in the presence of all of us at one time, and at the same ime we, at his request and in his presence and in the presence of each ther, have hereunto subscribed our names as attesting witnesses, and e do so verily believe that the said testator is of sound and isposing mind and memory at the date hereof. --// /(;"\:. , ~ ~:~ ;;?/llu!!:17ti~.-v SAN ) 1} // .J. '-f ~ /} &~ t f F~~l)3 (jt~J- If5 .. -~l/7-':;~'v ./#. I?€'i/$/ / SSAN ~.; ~ h ~IYl~~~I'O::: 7'l::/J:) ~'~ C SSAN it,t. ./[ -:')-:;;; :::;5-/ / . ~"'\'A 2!~. ~. OF /..- J(J - )} -, ;j i (" t. )11:.1 ha)1 / (Jh j' v' 9 J " ." 17 /:)/}- OF /< [)_:3::')c.~ / ...,..j JEZi.iS7t i~J I iJJ. /70 ftl '. :/ ,/ PAGE 5 OF 5 PAGES f/.." "" j ": . ." iJJ k /. -2'.) / (\ (/ hi. hi (~-C;~l_r COI1MONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ACKNOWLEDGMENT I, WILLIAM HENRY ROOZENBURG, testator, whose name is signed to the at1:ached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Willi that I signed it willinglYi and that I signed it as my frE~e and voluntary act for the purposes therein expressed. <:>,>' .,. ,..'..., > "j/'::';; ., " WILLIAM HENRY ROOZENBURG (SEAL) AFFIDAVIT We, ?-;;s JJ! {J7/1)J.111){;t f\~ ' EIJJiL':12...;J 12~^,/-J/\!C,BZ ,:)7Z , and --- ~~(/ J-J' . c::; 7i) L 1'2 , the witnesses, sign our names to this instrument, be1ng duly qualified according to law, do depose and say hat we were present and saw the testator sign and execute the instrument as his Last Willi that the testator signed willingly and xecuted it as his free and voluntary act for the purposes therein xpressedi that each subscribing witness in the hearing and sight of he testator signed the will as a witnessi and that to the best of our nowledge the testator was at that time 18 or more years of age, of SO;:d;r~5::::: no ~:n4::~i21cf: ~/:: inflU&~71.~LF'V c,&~ 11:ness j W1tness vhtness..j / / v ~ Subscribed, sworn to and acknowledged before me by WILLIAM HENRY OOZENBURG, the testator, and subscribed and sworn to before me by ,;.Z'<5 /Jj l)I'/1./l-zIUr.,f.J2 , /!:)./J;J.:72- //J)e-:;;vJ...u...iOtJ2. L-Tf2, , and ::., (2/ ,r/ /j;' th . t th. ...,:>7/t:.(i,<.i({/>:.r r-I:j; , e W1 nesses, 1S 1992.V ~.4'~ NO~ PUBLIC ) '7 ; day of September, My , '---iJ;:;';;'Seai--j commiss~on V~tt~t.Iot:wYPlbIo ..... ~ I Cai'.iS:e-aY.o. curr.wr~ Jd ~ 'L; ',' 'f . My Co.'11l11ission expms Q:t. 18, 1 ' . '. ! I " .1 : \I.l,o.!':'bs.... P"''1/"lSyt.r.;r:'a Assodaf.nn of No!?..r.ez COMMONWEALTH OF RE Y -1500 urriciuustoN~r PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPT. 280601 HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 2 1- 0 4 0 0 5 x 3 - COUNfY CODE YEAR NUMBER~ DECFDENT'SNAME (LAST, FIRST, AND MEDDLE INITIAL) SOCIAL SECURITY NUMBER W Roozer.bur ,William H. 3 6 6- 1 2- 2 2 5 6 ~ DATE: OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS U 02/06/2007 05/30/1920 LL1 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Deceased - - ~ Q 1. Original Return ~ 2. Supplemental Return ~ 3 Remainder Return (date of death prior to 12-13-82) Q ~ a Y ~ 4. Limited Estate ~ 4a. Future Interest Compromise (date of death otter 1z-12-az} ~ 5. Federal Estate Tax Return Required U ~ a m 0 6. Decedent Died Testate (Attach copy of Will} ~ 7. Decedent Maintained a Living Trust (Attacn copy of Trust} _ 8. Total Number of Safe Deposit Boxes a a ~ 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death between 12-31-s1 and 1-1-ss) ~ 11. Election to tax under Sec. 9113(Aj (Attach sen o) THIS SECTION MUST BE;COMPLETEp. ALL CORRESPQNQENCEiAND CONFIpFNT{AL TAX {NFQRMATIQN SIiOULD BE pIREGTI"p T0: F w NAME COMPLETE MAILING ADDRESS °z John H. Brou'os 4 North Hanover St reet a FIRM NAME (ItAppicable) Carlisle PA 17013 , p TELEPHONE NUMBER 717-243-4574 OFFICI SE ONLY 1. Real Estate (Schedule A) (1) ;~ ~ -,-, 2. Stocks and Bonds (Schedule B) (2) 42,078.14 ~ ~ ~ ~ ~ = --- 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) t t~> i'"+ t -t 4. Mortgages & Notes Receivable (Schedule D} (4) r~:~ ~ ~ ~ - 'r-. ,~-~ 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 244,889.53 '' '' ~ ~' ~ (Schedule E) ~ !'V _ ; Z _. ~_ 6. Jointly Owned Property (Schedule F) (6) ~ ~ ~-;-• f" Q ~ Separate Billing Requested ~ 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Prooerty (71 t` (Schedule G or L) a Q 8. Total Gross Assets (total Lines 1-7) U ~ 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) (g) 286,967.67 (g) 27,234.00 (10) 9,137.00 (11) 36,371.00 250,596.67 12. Net Value of Estate (Line 8 minus Line 11) (12) 13. Cfiarltable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) (14) 250,596.67 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Z H Q H a 0 X Fa- 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (x)(1.2) 16 Amount of Line 14 taxable at lineal rate 17 Amount of Line 14 taxable at sibling rate X (15) X (16) X .12 (17) 18. Amount of Line 14 taxable at collateral rate 251 ,832.00 X .15 19. Tax Due (18) 37,774.80 (19) 37,774.80 > > BE SUREi:TO iRNSWER ALL QUES.TIO.NS QN REVERSE-SIQE AND RECHECK MATH < < r - decedent's Complete Address: STREET ADDRESS Sarah Todd Memorial Home 1000 West South Street CITY STATE PA zlR 17013 Carlisle Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 37.774.80 C. Discount Total Credits { A + B + C ) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + 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. (1) 37,774.80 (2) 37, 774.80 (3) {4) 0.00 {5) 0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 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;.... ........................... ....... ^ 0 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 "intrust 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 WER ANY OF THE ABOVE ESTI S IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under pen tie of pe decFare t ve examined this , inclu ' mpanying schedules and statements, and to the best of my knowledge and beief, i t is true, correct and complete. Declaratio of repa r er tha a Hal repre tative ' ased nformation of which preparer has any knowledge. SIGNA RS P SI OR F G N ~'(i ~~ ~~~~ ,v--f r _ - DATE ~ s° l it OF ADDRESS 4 Hover T1VE 29210 DATE PA 17013 For dates of death on or after July 1, 1994 and before January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the netvalue of transfers to or for the use of the decedent's lineal beneficiaries is 4.5°l0, 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°I° [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. rc~v- r oua tx + to-aa) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Roozenburg. William H. 21 04 00583 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. United States Savings Bonds -- 3 Series EE 26,676.00 X4578560EE ($10,000) X4578561 EE ($10,000) X4578562EE ($10,000) 2. AT&T Stock -- 309 shares Account No. 02006553225 12,714.62 3. IAT&T pividend 4. (Guardian Bond Refund 5. (Tax Refunds TOTAL (Also enter on line 2, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) 290.22 272.21 2,125.09 14 REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & M~SIi. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Roozenbura William H 21 04 00583 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Raymond James & Associates, Inc. 189,368.00 Member New York Stock ExchangelSlPC 2. SunTrust Account No. 1000027913994 51,687.80 P. O. Box 622227 Orlando, FL 32862-2227 3 Prudential Financial insurance proceeds Policy #098876828 3,833.73 TOTAL (Also enter on line 5, Recapitulation) ~ $ 244 (If more space is needed, insert additional sheets of the same size) ccv-~o~~ e,x+~~~-aa) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Roozenbura. William H. 21 04 00583 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Prepaid 0.00 2. B 1 2 3 city Columbia State SC Z;p 29210 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representafive (s} John B. Klunder Social Security Number(s)tEIN Number of Personal Representative(s) Street Address 115 Northman Drive Year(s) Commission Paid: Attorney Fees John H. Broujos, 4 North Hanover Street, Carlisle, PA 17013 Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip _ Relationship of Claimant to Decedent 4. Probate Fees Register of Wills for Cumberland County Probate, Letters, Short Certificates (6), Renunciation, Will, Bond, JCP, Automation 5 Accountant's Fees 6. ~ Tax Return Preparer's Fees 7 TOTAL (Also enter on line 9, Recapitulation) I $ 13,900.00 13,000.00 334.00 234.00 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (6-98) SCHEDULE 1 DEBTS OF DECEDENT COMMONWEALTH OF PENNSYLVANIA , INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ~ ESTATE OF FILE NUMBER Roozenburq. William H. 21 04 00583 Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. BB&T -- Bank draw for checks 70.00 2. 2005 Taxes to IRS 1,589.00 3. 2006 Taxes to IRS 2,116.00 4. Sarah Todd Memorial Home -- Final Payment Owed 1,486.00 5. Pharmerica -- Final Medicine Payment Owed 37.00 6. Administrative fees 1,140.00 7. 2004 Taxes to IRS 235.00 8. Executor Bond Payment 1,040.00 9. Taxes 206.00 10. 2007 Taxes to IRS 1,218.00 TOTAL (Also enter on line 10, Recapitulation) I $ 9,137.00 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Alice Benson 3494 North M-63 Benton Harbor, MI 49022 II. FILE NUMBER RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Sister-in-law 100% AMOUNT OR SHARE OF ESTATE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. I` TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 GOVER SHEET I $ (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF WILLIAM HENRY ROOZENBURG I, WILLIAM HENRY ROOZENBURG, Social Security Number 366-12-2256, of the state of Pennsylvania, declare that this is my LAST WILL AND TESTAMENT and I revoke all other wills and codicils previously made by me. FIRST: I appoint my Wife, HARRIETTE MAE ROOZENBURG, as my Personal Representative concerning this Will. If she is unable or fails to serve, I then appoint my sister, FRANCES R. McCONNEY, Kalamazoo, Michigan and my brother in law, CARL L. BENSON, Benton Harbor, Michigan to serve as my Personal Representative. a. I request that my Personal Representative be permitted to serve without bond or surety thereon and without the intervention of any court, except as required by law. I direct that my Personal Representative act in unsupervised administration so as to administer my estate with a minimum of court supervision. If it becomes necessary to have ancillary administration of my estate in any jurisdiction where my Personal Representative is unable or does not desire to qualify as ancillary legal representative, I appoint as such ancillary legal representative such individual or corporation as my Personal Representative shall designate, in writing. b. I direct my Personal Representative to pay the expenses of my last illness, the expenses of a funeral appropriate to my station in life and custom of living (including a suitable monument or marker for my grave), and written charitable pledges which I have made. I grant my Personal Representative the power to extend or renew any debt for such time as my Personal Representative shall deem appropriate. c. All estate, inheritance, succession and other death taxes with respect to all property passing under this my Will shall be paid from and borne by the principal of my residuary estate, without regard to reimbursement, as if such taxes were administration expenses. My Personal Representative may pay such taxes at any time deemed advisable, whether or not then due and payable. d. My Personal Representative is requested to settle my estate as soon after my death as may be practicable, and to pay or deliver every legacy or bequest to my beneficiaries without waiting any time that may be believed to be customary in probate matters. _ PAGE 1 ~' c / ~ t ~; I ~~/ I i'' ~ f ~ ! ;,;~ OF 5 PAGES ~, ~ r.. : ,* 4: ~ ~ ~ . f; e. I have served in the Armed Forces of the United States. Therefore, I direct my Personal Representative to consult with a Legal Assistance Attorney at the nearest military installation and with the Department of Veterans Affairs and the Social Security Administration to ascertain if there are any benefits to which my family members are entitled by virtue of my military service. f. I may leave a letter of intent with the executed copy of this Will for the purpose of giving guidance to my Personal Representative concerning the distribution or sale of certain items of my property. I request, but do not require, that my Personal Representative honor my wishes therein expressed. SECOND: I give, devise and bequeath, absolutely and forever, all of my estate and property of which I may be seized or possessed, or to which I may be entitled, at the time of my death, wherever situated or of whatever nature, be it real, personal, or mixed, to my Wife, HARRIETTE MAE ROOZENBURG, as her sole and absolute property if she shall survive me. THIRD: In the event that my Wife, HARRIETTE MAE ROOZENBURG shall not survive me, I give, devise and bequeath, absolutely and forever, all of my estate and property of which I may be seized or possessed, or to which I may be entitled, at the time of my death, wherever situated or of whatever nature, be it real, personal, or mixed, as follows: 50~ to my brother in law, CARL L. BENSON, Benton Harbor, Michigan or if he fails to survive me, to his wife, ALICE BENSON; 25~ to my sister, FRANCES R. McCONNEY, Kalamazoo, Michigan; and 25~ to my sister, MARY R. KLUNDER, Grand Rapids, Michigan. If either of my sisters fails to survive me, then the surviving sister shall take the share of my deceased sister. I empower my Personal Representative to sell any or all of such property, if such property is not distributed in kind hereunder, and to distribute the proceeds among the persons named in this paragraph, or the survivor, in substantially equal shares. Any determination of my Personal Representative as to what should pass or be sold under this paragraph and to whom it should pass or be delivered or at what price it should be sold shall be conclusive. - PAGE 2 // , ,~ (_~.. . ~, ,%s' r-, ', ~ OF 5 PAGES ,_ ~ , Cl~; FOURTH: If there is a complete failure of takers under the preceding paragraphs, the property undisposed of shall be distributed as follows: a. A one half share shall be distributed to my heirs determined at the time of my death, pursuant to the Statutes of Descent and Distribution in effect, in the state of my domicile, at the time of my death. b. A one half share shall be distributed to the heirs of my spouse, the identity of such heirs to be determined at the time of my death, pursuant to the Statutes of Descent and Distribution in effect, in the state of my domicile, at the time of my death. FIFTH: Except as otherwise provided in this Will, I have intentionally failed to provide for any other relatives or other persons, whether claiming to be an heir of mine or not. Insofar as I have failed to provide in this Will for any of my issue now living or later born or adopted, such failure is intentional and not occasioned by accident or mistake. SIXTH: Any beneficiary who fails to survive until one hundred twenty (120) hours after my death shall be deemed to have predeceased me, and the gift to that beneficiary shall be disposed of accordingly. SEVENTH: Definitions: a. The term "children" as used in this Will includes adopted and afterborn persons. The term "children" as used in this will shall also include step-children, the natural born or adopted children of a person's spouse. A relationship by or through legal adoption shall be treated the same as a relationship by or through blood for purpose of succession to property under this Will. b. The term "descendants" as used in this Will means the immediate and remote lawful, lineal descendants by blood or adoption of the person referred to who are in being at the time they must be ascertained in order to give effect to the reference to them. c. The term "issue" as used in this Will means all persons who are descended from the person referred to either by legitimate birth to or legal adoption by that person, or any of that descendant's legitimately born or legally adopted descendants. d. The term "Personal Representative" as used in this Will means Executor, Executrix, Independent Executor, or any other title of like import which is used to describe such a fiduciary. `'' PAGE 3 ..~ Sc ~{[~ ,,/i 'i;~;- OF 5 PAGE ~~ ~~~" ~ e. The term "per stirpes" as used in this Will means that whenever a distribution is to be made to the descendants of any person, the property to be distributed shall be divided into as many shares as there are (1) living children of the person, and (2) deceased children, who left descendants who are then living, of the person. Each living child (if any) shall take one share and the share of each deceased child shall be divided among his then living descendants in the same manner. EIGHTH: In addition to any powers granted by the laws of the state in which this Will is probated, I hereby authorize and empower the fiduciaries named in this Will, to the extent of the discretion herein granted, to sell, exchange, convey, transfer, assign, mortgage, pledge, lease or rent the whole or any part of my real or personal estate, to invest, reinvest, or retain investments of my estate, to perform all acts and to execute all documents which my fiduciaries may deem necessary or proper in regard to my property. If any of my fiduciaries elect to receive compensation for services, such compensation will be that allowed by law. NINTH: If any part of this Will shall be invalid, illegal, or inoperative for any reason, it is my intention that the remaining parts, so far as possible and reasonable, shall be effective and fully operative. My Personal Representative may seek and obtain court instructions for the purpose of carrying out as nearly as may be possible the intention of this Will as shown by the terms hereof, including any terms held invalid, illegal, or inoperative. IN WITNESS WHEREOF, I have at Carlisle Barracks, Pennsylvania, this °r day of September, 1992 set my hand and seal to this my LAST WILL AND TESTAMENT, consisting of 5 typewritten pages, each page bearing my handwritten signature. ,;~ ,- ~: ~ . ~ ~ z ` i - l , ;~/ ( SEAL ) WILLIAM HENRY ROOZEN$URG ,t, PAGE 4 , ~ ~ ~'~} ~-' j~' __,/,~, ~ -, ;/ . ,~ ~~''~ fail%'~ OF 5 PAGES %~1 /,.,F ~ ~.~ r'.._ The foregoing instrument was, at Carlisle Barracks, Pennsylvania, this -~ day of September, 1992, signed, sealed, published and declared by WILLIAM HENRY ROOZENBURG, the testator, to be his LAST WILL AND TESTAMENT in the presence of all of us at one time, and at the same time we, at his request and in his presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses, and we do so verily believe that the said testator is of sound and disposing mind and memory at the date hereof. /~ ,, ~~ ;, ssAN~ ; ~l - ~ ~- - '~~=~ 1 > 7 f ~i " t ~,_ .i' " , cif s' ~, . ;; ~ % ~~~~ _" ssAN ~c.~, ~~~, r? ~ ~~-- OF ~ ~~~ ~~;_~ ~~"~ --'' .' r` L~ ~ . ~ ,~~1 OF ~ j~ PAGE 5 t ~ !% ' OF 5 PAGES ~,~/1 ~' 1 ;. t c' ~!~ _~' r' %~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ACKNOWLEDGMENT I, WILLIAM HENRY ROOZENBURG, testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ._ - r i-'~ ~ SEAL ) :% `WILLIAM HENRY'ROOZENBURG AFFIDAVIT we, 4~ ~ s 1!~ I ,'~~~~' ,'Jr:= ~° ~~ , ~L.~r~i4 /.~~ l%-ivf-%.vCr~~ x;'71 and ~' ~ 4 f ~~ , the witnesses, sign our names to this instrument, being duly qualified according to law, do depose and say that we were present and saw the testator sign and execute the instrument as his Last Will; that the testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testator signed the will as a witness; and that to the best of our knowledge the testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influenc fitness Witness ~' / Witness~~I Subscribed, sworn to and acknowledged before me by WILLIAM HENRY ROOZENBURG, the testator, and subscribed and sworn to before me by }~ -~ i , !:. ~~~r.L, ~~,~., ~.f c.: , and ~: _=_ '; ~ :!-~ r , the witnesses, this ~~ day of September, _`__~ 19 9 2 : ~ ______. _,_._._. P~;~sr~ ~~ Sal ..__,_., NOT Y PUBLIC My Commiss~ion~~ ~G-' ' My Ca~rmvss+on Expires Oa.18,1 i -- Family Settlement Agreement File No. 21-04-00583 THIS is an agreement entered into this 28th day of August, 2008, by and between John B. Klunder, Executor under the Estate of William Henry Roozenburg, of Sarah A. Todd Memorial Home, of Carlisle, PA 17013, and Alice Benson, 3494 North M-63, Benton Harbor, MI 49022, Beneficiary, whose names are set forth as signatories at ~~ nd of ~is Agreement. ~ T ~' ~' ~~ r ~?- r G7 ~_~ N WHEREAS: -_-- ~~~„ ~' ~ 'L J A, William Henry Roozenburg, of Sarah A. Todd Memorial Home, of ~ai~, PAS YJ'.~ 17013, died on February 6, 2007. ~' N B. On May 10, 2007, Letters Testamentary for Executor were granted to John B. w Klunder at File No. 21-04-00583 in the Register of Wills Office for Cumberland County, Pennsylvania. C. Executor has administered the estate up until the present time and has paid all debts of the estate, including Inheritance Tax owed. ~- ll. William Henry Roozenburg died testate, thereby vesting all rights and interest in his estate to Alice Benson. E. The estate has received assets as set forth in Exhibit A attached hereto and made a part hereof; has paid debts and expenses as set forth in Exhibit B attached hereto and made a part hereof; and has directed distributions as set forth in Exhibit C attached hereto and made a part hereof. F. There remains for distribution the sum as set forth on the last page and "payment to beneficiary to be in the amount of $6,741.11." G. Executor and Beneficiary desire to forego a formal accounting and schedule of distribution and desire to conclude the estate by virtue of the filing of this document. NOW, THEREFORE, Executor and Beneficiary, intending to be legally bound state as follows: 1. The Executor and Beneficiary agree that the Executor of the Estate of William Henry Roozenburg need not file a formal accounting or schedule of distribution. 2. Executor states that all costs of the estate are paid. 3. Beneficiary agrees that the final distribution of all estate assets remaining after payment of debts and expenses shall be made to the Beneficiary, with the exception of $1,000.00 to be held in escrow by Executor of the Estate for a period of approximately 4 months or longer if necessary, when final approval by the Bureau of :Inheritance Tax is received, for final tax returns and other unforeseen expenses and any required adjustment of inheritance tax, with the balance to be distributed to Beneficiary with an accounting which shall not be filed with the Register of Wills, as is customary for informal accounting upon written authorization of counsel to the Beneficiary. 4. The parties acknowledge that any distribution made by Executor pursuant to this Agreement is an "at risk" distribution pursuant to 20 P.S. 3532. Beneficiary hereby releases Executor with respect to acts or omissions in the administration and distribution of the estate and hereby agrees to return such funds as were distributed under the administration of the estate as may be required for the payment of any proper claims not discharged prior to this distribution. 5. The parties designate this statement as a "satisfaction of award" and hereby authorize and direct the Clerk of Orphans' Court to make satisfied of record any award which may subsequently be made by the Court with respect to the distribution made to the distributees in this Agreement. 6. The parties agree that this Family Settlement Statement shall be filed with the Clerk of Orphans' Court in final settlement of the estate of William Henry Roozenburg, subject to the provisions hereof. IN WITNESS WHEREOF, Executor and Beneficiary, intending to be legally bound, hereby set their hands and seals the day and year fret ahnve written. WITNESS: Alice Benson, Beneficiary EXHIBIT A -ASSETS VALUE AT DATE ITEM OF DEATH NUMBER DESCRIPTION 1 United States Savings Bonds --- 3 Series EE $ 26,676.00 . X4578560EE($10,000) X4578561($10,000) X4578562EE($10,000) 2. AT8~T Stock -- 309 shares Account No. 02006553225 12,714.62 3. AT8LT Dividend 290.22 4, Guardian Bond Refund 272'21 5. IRS Tax Refund 2,'125.09 6. Raymond James Investment 189,368.12 7. Sun Trust Account No. 1000027913994 51,687.80 P. O. Box 622227 Orlando, FL 32862-2227 8 Prudential Financial Insurance proceeds . Policy #098876828 3,833.73 9. Economic Stimulus from US Government 600.00 TOTAL ASSETS $287,567.67 EXHIBIT B -DEBTS AND DEDUCTIONS ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES --Prepaid B, ADMINISTRATIVE COSTS 1. Personal Representative -John B. Klunder -Advance 7,100.00 2. Attorney Fees -John H. Broujos -Advance 8,000.00 C. MISCELLANEOUS DEBTS 07 70 1. 668zT -Bank draw for checks . 589.00 1 2. 2005 Taxes to IRS , 116.00 2 3. 4 2006 Taxes to IRS Sarah Todd Memorial Home -Final Payment Owed , 1,486.00 . 5 Phamterica -Final Medicine Payment Owed 37.00 . 7 2004 Taxes to IRS 235.00 . 8 Executor Bond Payment 1,040.00 . 9 IRS Taxes 206.29 . 10 2007 Taxes to IRS 1,218.00 . 11. Family Settlement Agreement -Filing fees 20.00 12. Inheritance Tax Retum -Filing fees 10.00 TOTAL 23,127.36 D. INHERITANCE TAX PAID 37.824.80 TOTAL DEBTS AND DEDUCTIONS $60,952.16 JOHN'S EXPENSES TO BE REIMBURSED S. 7.07 State Farm Insurance/Balance on Probate Bond $48.00 7.17.07 Death Certificates $54. DO 7.17.07 Register of ~lls/Short Certificates $24.00 9.11.07 Register of Wills/Short Certif cafes $24.00 10.19.07 Certified Mail $ 5.38 7.1.08 UPS to Klunder $ 6.60 7.2.08 UPS from Klunder $ 6 60 7.9.08 Register of ~lls/Inheritance lax Return (addt'I) . $ 5.00 $173.58 TOTAL PAYMENTS TO BE MADE BEFORE BENEFICIARY $5,000.00 Balance Due Attorney 6,800.00 Balance Due Personal Representative 173.58 Attorney's expenses to be reimbursed 2 000.00 Contingency (Reserve for Potential Bond charge, etc.) $~ 3 9758 TOTAL PAYMENT TO BENEFICIARY 741. 20,714.69 TOTAL DISBURSEMENTS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX ~''e, BUR,tiAU OF INDIVIDUAL TAXES ApPRAISEMENT,:ALLOWANCE OR DISALLOWANCE INHERITANCE TAX DIVISION OF DEDUCTLON:S AND ASSESSMENT OF TAX PO BOX 280601 HARRISBURG PA 17128-0601 ~ REY-1547 EX AFP (06-05) DATE 08-11-2008 ~~Uv ~~~~ ~ ~ ~~~~ ~~ ~S ESTATE OF ROOZENBURG WILLIAM H DATE OF DEATH 02-06-2007 (;~~-~;~( t,~ FILE NUMBER 21 04-0583 OH~'t-;'fii~!~~ (~~1~(~i COUNTY CUMBERLAND JOHN H BROUJOS ~,,I,j~1~r~' r ACN 101 ` `"~" ~A APPEAL DATE: 10-10-2008 4 N HANOVER ST CARLISLE PA 17013 (See reverse side under Objections) Amount Remittedr MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE -1 RETAIN LOWER PORTION FOR YOUR RECORDS ~ ______________ ----------------------------------------------------------------------------- REV-1547 EX AFP C03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF ROOZENBURG WILLIAM H FILE N0. 21 04-0583 ACN 101 DATE 08-11-2008 TAX RETURN WAS: C ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) .00 2. Stocks and Bonds (Schedule B) (2) 42, 078.14 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 4. Mortgages/Notes Receivable (Schedule D) (4) .00 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) 24 4,889.53 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 8. Total Assets C8) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 286,967.67 APPROVED DEDUCTIONS AND EXEMPTIONS: 27,234.00 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 9,137.00 11. Total Deductions (11) 36.371.00 250,596.67 12. Net Value of Tax Return (12) .00 13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedule J) (13) 250,596.67 14. Net Value of Estate Subject to Tax (14) NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due rev nerrrrn. C15) .00 X 00 = .00 c16) .00 X 045. .00 cln .00 X 12 .00 cle) 250,596.67 X 15 = 37,589.40 (ly)= 37,589.40 ~~`PAYM NT~ DATE RECEIPT NUMBER SCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID 01-18-2008 CD009189 .00 36,516.60 05-09-2008 CD009696 185.40- 1,258.20 BALANCE OF UNPAID INTEREST/PENALTY AS OF * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 05-10-2008 TOTAL TAX CREDIT 37,589.40 BALANCE OF TAX DUE .00 INTEREST AND PEN. 420.34 TOTAL DUE 420.34 C IF TOTAL DUE IS LESS THAN 61, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) REV-7470 EX (8.88) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 William H. Roozenburg Destiny S.R.Brown INHERITANCE TAX EXPLANATION OF CHANGES 2104-0583 101 ITEM SCHEDULE Np, EXPLANATION OF CHANGES The value of the estate has been adjusted as the result of the correction of an error in arithmetic. Row Page 1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL Taxes ', INHERITANCE TAX INHERITANCE TAX Drv1s1oN STATEMENT OF ACCOUNT PO BOX 280601 HARRISBURG PA 17128-0601 REV-1607 EX AFP C03-05) ,,~- ~ y~,,,_ ~~ - ~• " DATE 10-14-2008 ~~~ ~ ~ ESTATE OF ROOZENBURG WILLIAM H DATE OF DEATH 02-06-2007 .. FILE NUMBER 21 04-0583 ~, - - ',_., COUNTY CUMBERLAND JOHN H BROUJOS ACN 101 4 N HANOVER ST Amount Remitted CARLISLE PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: 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 payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS E- --------------------------------------------------------------------------- REV-1607 EX AFP C03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT *** ESTATE OF ROOZENBURG WILLIAM H FILE N0. 21 04-0583 ACN 101 DATE 10-14-2008 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-04-2008 PRINCIPAL TAX DUE: PAYMENTS CTAX CREDITS): PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 01-18-2008 CD009189 .00 36,516.60 05-09-2008 CD009696 /1 185.40- 1,258.20 09-11-2008 CD010258 / 420.34- 420.34 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. * IF PAID AFTER THIS DATE, SEE REVERSE I TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REpUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 37,589.40 37,589.40 .00 .00 .00 Pa. ®.C. Rule 6.1/2 STATU /S REP®RT REGISTER OF WILLS OF ~ Y)~ /'~t1_!1T COUNTY, PENNSYLVANIA Name of Decedent: r Date of Death: ~o~-/~~-~.~CiL~'~ File Number: ~/ ~~~~- ~~~~ Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the administration of the above-captioned estate: _.. 1. State whether administration of the estate is complete:.................... Yes ~ No 2. If the answeris 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 ~ No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? ............................... Yes ~No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts maybe filed with the Clerk of the Orphans' Court and may be attached to this report. _ ~ c` L. Signature of Pers n Filin,; this Form Capacity: ; ~r'ersonal Representative ,Counsel ~~ _ :.~ .. ~ ~?~! h f -~, ~rG~ tJ r~c~~ = L''.- ~ Name of Person Fi[inS this Form 4;y ~ < _ "~ ~ h'~i~.~~ ~ t7L?'r, ~ ~c~r vl~ rem ~ ,,~ i _ l ~_ -~ , Add/re~ss~ y~ ~ /'~ 1. ~~~? ~/7 % . ~ -•; ~ ..~ = ~ ~~ Telephone corm RYI'-l0 rev. /0.!3.06 t: ~~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 2 8-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 010258 KLUNDER JOHN B 115 NORTHMAN DRIVE COLUMBUS, SC 29210 fold ESTATE INFORMATION: SSN: 36s-12-2256 FILE NUMBER: 2104-0583 DECEDENT NAME: ROOZENBURG WILLIAM HENR DATE OF PAYMENT: 09/ 1 1 /2008 POSTMARK DATE: 09/1 1 /2008 COUNTY: CUMBERLAND DATE OF DEATH: 02/06/2007 REMARKS: RECEIPT TO ATTY CHECK#1027 SEAL ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 5420.34 TOTAL AMOUNT PAID: INITIALS: CJ REV-1162 EX(11-96) 5420.34 GLENDA EARNER STRASBAUGH RECEIVED BY: REGISTER OF WILLS REGISTER OF WILLS JOHN H. BROUJOS Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 JOHN H. BROUJOS ATTORNEY AT LAW 4 NORTH HANOVER STREET CARLISLE, PENNSYLVANIA 17013 September 11, 2008 717-243-4574 FAX: 717-243-8227 e-mail: troop73@PA.Net Re: Estate of William Henry Roozenburg DOD: 02-06-2007 File No. 21-04-00583 Dear Sir: Enclosed is a check in the amount of $420.34 for payment of interest and penalty due. Also enclosed is the Notice of Inheritance Tax Appraisement from Departm ent of Revenue Bureau of Individual Taxes, Inheritance Tax Division dated August 11 , 2008. Call if~u have any questions or need any additional information. Sin rely ydu~ s;' _ 4 ~ _ ` \.. y John . Broujos ~ ^ ~.a ~ _Z :}ice ~ ~ wkh ,' ~ ~ r'' ~ j _ y ~ .` c: John B. Klunder ' c- ; ~ 7 ~~ C~ ~ i "v c,:~ N '' tL9 COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX BUREAU ~^ INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE INHERITANCE TAX DIVISION OF DEDUCTIONS AND ASSESSMENT OF TAX PO BOX 280601 HARRISBURG PA 17126-0601 REV-1547 EX AFP C06-05) DATE 08-11-2008 ESTATE OF ROOZENBURG WILLIAM H DATE OF DEATH 02-06-2007 FILE NUMBER 21 04-0583 COUNTY CUMBERLAND JOHN H BROUJOS ACN 101 4 N HANOVER ST APPEAL DATE: 10-10-2008 CAR L I S L E PA 17 013 (See reverse side under Objections Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ -------------- ----------------------------------------------------------------------------- REV-1547 EX AFP C03-05~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF ROOZENBURG WILLIAM H FILE N0. 21 04-0583 ACN 101 DATE 08-11-2008 TAX RETURN WAS: C ) ACCEPTED AS FILED C X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper credit to your account, 2. Stocks and Bonds (Schedule B) (2) 42, 078.14 3. Closely Held Stock/Partnership Interest (Schedule C) (3) 00 submit the upper portion of this form with your 4. Mortgages/Notes Receivable (Schedule D) (4) .00 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 244,88 9.5 3 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 s. Total Assets (e) 286,967.67 APPROVED DEDUCTIONS AND EXEMPTIONS: 27,234.00 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 9.137.00 11. Total Deductions C11) 36,371.00 12. Net Value of Tax Return C12) 250,596.67 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13) .00 14. Net Value of Estate Subject to Tax (14) 250,596.67 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) •00 X 00 = .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) •00 X 04 5 = .00 17. Amount of Line 14 at Sibling rate (17) .00 X 12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 250,596.67 X 15 _ 37,589.40 19. Principal Tax Due (19)= 37,589.40 TAY f`D CTTTC. PAYM NT DATE RECEIPT NUMBER DISCDUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID 01-18-2008 (0009189 .00 36,516.60 05-09-2008 (0009696 185.40- 1,258.20 BALANCE OF UNPAID INTEREST/PENALTY AS OF 05-10-2008 TOTAL TAX CREDIT 37,589.40 BALANCE OF TAX DUE .00 .INTEREST AND PEN. 420.34 TOTAL DUE 420.34 ^ IF PAID AFTER DATE INDICATED, SEE REVERSE C IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) REV-1170 EX (8-08) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 NAME BY William H. Roozenburg Destiny S.R.Brown INHERITANCE TAX EXPLANATION OF CHANGES LE NUMBER 2104-0583 101 ITEM SCHEDULE Np, EXPLANATION OF CHANGES The value of the estate has been adjusted as the result of the correction of an error in arithmetic. ORIGINAL Page 1