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Home My WebLink About03-0349 . ~ REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA PETITION FOR GRANT OF LETTERS Estate of WILLIAM H. LUSH No. -RI- 03 -31f\ also known as N/A Deceased Social Security No.195-38-7994 Petitioner(s) who is/are 18 years of age or older, apply(ies) for: (COMPLETE "AU OR "BU BELOW) o A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the executrix named in the Last Will of the Decedent, dated June 3, 1991 and codicil(s) dated N/A NONE (State relevant circumstances e.g. renunciation, death of executor, etc.) Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: N/A o B. Grant Letters of Administration (d.b.n.c.t.a.; pendente lite; Durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: NAME RELATIONSHIP RESIDENCE (COMPLETE IN ALL CASES) Attach additional sheets if necessary Decedent was domiciled at death in Cumberland County, his/her last family or principal residence at Camp Hill, Camp Hill BorouGh, PA 17011 Pennsylvania, with 2005 Dartmouth Street, Decedent, then 54 years of age, died March 25 WashinGton Hospital Center, WashinGton, D.C. , 20~, at Decedent at death owned property with estimated values as follows: (If domiciled in PAl (If not domiciled in (If not domiciled in Value of Real Estate All Personal Property PAl Personal Property in PAl Personal Property in in Pennsylvania $ PA $ Co.$ $ 20,000.00 150,000.00 situated as follows: 2005 Dartmouth Street, Camp Hill, PA 17011 WHEREFORE, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Signature Typed or printed name and address ~ ty/;f~ Patricia M. Lush 2005 Dartmouth Street Camp Hill, PA 17011 \t- I~lo- I .. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge information and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. p~ fl1X~ Patricia M. Lush Sworn to or affirmed be(fre rEe this;< }..1't ('JI' ~ and subscribed day of , 2003. ~ ""4 OH" 1lL1i ~~t'{~ ~~&t~~cto No. ;z.'-03-~J.jq Estate of William H. Lush Deceased Social Security No. 195-38-7994 Date of Death March 25, 2003 AND NOW, a.p~', J. ~,~ , 2003, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~ Testamentary o of Administration d.n.c.t.a.; pendente lite; durante absentia; durante minoritate are hereby granted to Patricia M. Lush in the above estate and that the instrument(s) dated described in the Petition be admitted to probate and last Will of Decedent. FEES Letters. . . . . . . . . . . . . .. $ ;;35. (jO Short Certificates.. '" $ 30.00 Renunciation. . . . . . . . . .. $ Affidavit ( ).......... $ Extra Pages ( ) .. ..... $ / gr. vO Codicil................ $ JCP Fee ............... $ )0. ()O Inventory.............. $ Automation Fee... ..... $ Other. . . . . . . . . . . . . . . . .. $ TOTAL............ $ cA.~; 00 June 3, 1991 filed of record as the \ '~,.; ~~ J Attorney: I.D. NO.: 32112 Address: 3448 Trindle Road Camp Hill, PA 17011 Telephone: (717) 737-0100 ~cL 4 -c2~ - 0_-3 (!d~C{ 9 Jj 'cJc2- 03 " .. ~ ~ J - 0.3 - c.3 'f 't ~~cL 4--.:L1-03 IDast.ill nun aIeshtm.eut OF WILLIAM H. LUSH c:21 -03 -34'} BE IT REMEMBERED, that I, William H. Lush of Camp Hill, Pen- nsylvania, being of sound mind, memory and understanding, do make publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writing in the nature thereof by me, at anytime heretofore made. ITEM 1: I direct that all my just debts and funeral ex- penses be paid as soon after my demise as may be convenient. ITEM 2: All the rest, residue and remainder of my Estate of whatsoever nature and wheresoever situate, whether it be real, personal or mixed, including any insurance policies therefor, property over which I have a power of appointment, and proceeds from any insurance policies payable to my estate or to said beneficiary, I give, devise and bequeath unto my wife, Patricia M. Lush, absolutely, provided she survives me for a period of thirty (30) days. ITEM 3: Should my wife, Patricia M. Lush, predecease me, / fail to survive me for a period of thirty (30) days, or should we die simultaneously, I then give, devise and bequeath my entire residuary estate to the following set forth beneficiaries (who survive me by a period of thirty (30) days) in the proportions as hereafter indicated: (a) To my son, Corey A. Lush, forty-five (45%) percent of my residuary estate. (b) To my daughter, Jennifer A. Lush, forty-five (45%) per- cent of my residuary estate. W~~H ~~ (c) To my daughter, Alison M. Lush, ten (10%) percent of my residuary estate. Should any of the above named beneficiaries fail to survive me by a period of thirty (30) days, said beneficiary. s share shall lapse and shall then be divided amongst the then remaining residuary beneficiaries in the same proportion as said remaining beneficiaries. respective shares bear to each other. ITEM 4: If and in the event all of the above named beneficiaries fail to survive me by a period of thirty (30) days then I give, devise and bequeath my entire residuary estate unto my grandchildren in equal shares per capita. ITEM 5: In the event any beneficiary mentioned in Item 3 herein has not then reached age 21, his or her share shall be held by my Trustee, hereinafter named, IN SEPARATE TRUST, for the following uses and purposes and subject to the following terms and conditions. 1. Trustee may accumulate the income from that share or so much thereof from time to time as it considers advisable; and trustee may expend and apply so much of net income including accumulated income and so much of the principal of that share as Trustee may consider necessary for the support, maintenance, medical and dental expenses and education of such beneficiary, in- cluding college education, both graduate and under- graduate, in accordance with said beneficiaries talents, abilities and needs; and Trustee may pay all expenses which it deems necessary and desirable in con- nection therewith, including, by way of illustration, tuition, room and board, books and supplies, clothing, travel expenses and reasonable sums for personal ex- penses. The amount to be paid for the benefit of said beneficiary shall be determined from time to time based on said beneficiary.s needs with the further direction that said funds shall be liberally disbursed. The said payments may be made directly to said beneficiary if said beneficiary is, in the sole opinion of my Trustee, of an age and ability to handle the funds so paid, or may be made by my Trustee directly to the person having custody and care of said beneficiary, or may be made by my Trustee directly to any institution entitled to such payment by reason of services rendered or to be rendered to said beneficiary. l ~SH~~ 2. The Trustee for the purposes of carrying out my inten- tions stated above and the purposes of the trust shall be entitled to (a) purchase and/or retain any property, real or personal, including common stocks, shares of investment trusts, shares of stock of the corporate trustee and interests in common trust funds: (b) to sell and convey any property real, personal or mixed held in the trust at public or private sale for such price as the trustee determines to be reasonable; (c) to exchange property for other property; (d) to borrow money for the trust and to secure any borrowing by pledge or mortgage; (e) to vote any stock in the trust for any purposes whatsoever in such manner as the trustee deems for the best interests of my said beneficiary and to give proxies with or without full discretionary powers; (f) to deposit under voting trust agreements any shares of stock held by them; and (g) to compromise any claim for or against the trust. The trustee may from time to time amortize premiums paid on the purchase of bonds, notes and other securities by appropriate periodic charges against income, but shall not be required so to do. All purchasers from the trustee shall be exempt from all responsibility with respect to the application of the purchase money and no transfer agency shall be obligated to inquire into the propriety of any transfer made by the trustee. The trustee shall be under no obligation to furnish bond, or, if bond be by law required, surety on such bond. Annual or periodic compensation of the trustee for his services hereunder may be equitably apportioned between principal and income. 3. Any and all payment or payments of any sum or sums, whether in cash or in kind or whether for principal or income, payable to said beneficiary, shall be made upon the sole receipt of the respective individual to whom the payment is made, and free from anticipation, alienation, assignment, attachment, and pledge, and free from control by the creditors of any such beneficiary. All shares of principal and income herein given shall be free from anticipation, assignment, pledge, or obligation of any beneficiary, and shall not be subject to any execution or attachment. 4. When such beneficiary reaches age principal and any accumulated or of his or her share shall be beneficiary, absolutely. 21 the then remaining undistributed income distributed to such 5. In the event such beneficiary dies before reaching age 21 the remaining principal and any accumulated income of his or her share shall become part of my residuary estate and distributed to the beneficiaries thereof as provided for herein, subject nonetheless to the terms and conditions of this trust. 6. Should the principal of any trust herein provided for I ~~ $ LL WILLIAM H. LUSH (// be or become too small in trustee's discretion so as to make establishment or continuance of the trust inad- visable, my trustee or executor my make immediate dis- tribution of the then-remaining principal and any ac- cumulated or undistributed income outright to the per- son or persons and in the proportions they are then en- titled to income. If any such persons is then a minor, distribution may be made to the guardian under Item 7. Upon such termination, the rights of all persons who might otherwise have an interest as succeeding life tenant or in remainder shall cease. ITEM 6: I appoint Dauphin Deposit Bank and Trust Company as Trustee of any trust created by this my Last Will and Testa- mente ITEM 7: I appoint Tracy Lee Ludwig, my wife's sister, as guardian over any property which passes either under this will or otherwise to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or to another for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to time, for the minor's support and education. If and in the event Tracy Lee Ludwig, my wife's sister, fails to survive me or ceases to act as Guardian, I ap- point Dauphin Deposit Bank and Trust Company as Alternate Guar- dian. ITEM 8: If my wife predeceases me, I name Tracy Lee Ludwig, my wife's sister, as guardian of the person of my minor child, Corey A. Lush. ITEM 9: I direct my Executrix to pay all inheritance, es- tate, succession and legacy taxes of whatsoever nature and kind, to which my Estate or the transfer of any property passing ,,; (~~ WILLIAM H. LUSH ~LL- (/ hereunder or otherwise passing by reason of my demise, may be subject to charge such taxes against my residuary estate, it being my intention that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross estate, under the provisions of any state or federal law now in force or hereafter enacted, shall be prorated among the persons interested in my Estate to whom such property is or may be transferred to whom any benefit accrues. ITEM 10: In addition to the powers conferred by law, I authorize my Executrix in her absolute discretion: (a) To retain in the form received, and to sell either at public or private sale any real or personal property. (b) To manage real estate. (c) To invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principle of diversification. (d) To exercise any option or rights arising from ownership of investments. (e) To compromise claims without court approval, and without the consent of any beneficiary. (f) To join with my spouse in the filing of any federal in- come tax return for any year for which I have not filed such return prior to my death, and to consent to the treatment of any gifts made by him as being made one- half by me for gift tax purposes notwithstanding the fact that such action may result in additional liabilities for my estate. Any income or gift taxes due on such returns and any deficiencies, interest, penalties, or refunds thereon, shall be allocated be ~~~/ WILLIAM H. LUSH tween my estate and my Spouse or my spouse's estate, or all to any of them, in such manner as my Executrix and my said spouse may agree. ITEM 11: I appoint my wife, Patricia M. Lush as Executrix of this my Last Will and Testament. Should my wife, Patricia M. Lush predecease me, fail to qualify, cease to act or renounce probate, I then appoint my wife's sister, Tracy Lee Ludwig as al- ternate Executrix of this my Last Will and Testament. ITEM 12: I direct that my Executrix, guardian or their suc- cessors shall not be required to give bond for the faithful per- formance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~day of _~. , 1991. ( ~ WILLIAM H. ~U(SEAL) L USlY' , . ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF (.. ~ W'Y\ 'o.c. to.~ SS. : We, William H. Lush, Diane G. Radcliff and Deborah L. Don- ley, the Testator and the witnesses respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his last Will and that he had signed willingly (or willingly directed another to sign for him), and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the wit- nesses, in the presence and hearing of the Testator, signed the Will as witness and that to the best of their knowledge the Tes- tator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~~ Sworn to and subscribed to before me this ~t\.. _~ day of ;)~ L , , 19~. /a~~ of: dm/f NOTARY PUBLIC 1/ My Commission Expires: ~---_._..._.._-~._.~.-. Norarial Seal Deoorah L, Donley, Notary F'ubi:c Camp Hill Boro, Cumber!a:1d County My Commission Expires Sept. 23,1991 ~ Member, Pennsylvania Associfition of Notaries ,-~ ~ ~.~~ lrt ~ ~~ t~t ~ = tt ~r----~ ~~t ~t $$ fQZ ;~f ~ ~ S ~ ::r:: U) ::J H . ::r:: ~ ICl; H H H H ::s: ~ ~ :J~"Q::: u ..: 010 ,........:l 0 ~ H ...~ ~ ":..!:l~ ><]....;' . ~'J:::= o ~ r-:I: ~Ooo=.. Z !:: ~ ~ <<""u H ~ -- ~ CERTIFICATE OF NOTICE UNDER RULE 5.6(a) NAME OF DECEDENT: William H. Lush DATE OF DEATH: 3/25/03 WILL NO. : 21-03-0349 ADMIN. NO. : To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on May 9, 2003: NAME ADDRESS patricia M. Lush 2005 Dartmouth Street Camp Hill, PA 17011 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: NAME ADDRESS None Signature: Name: Address: I dcliff, Esquire 34 e Road Ca , PA 17011 Telephone: (717) 737-0100 I.D. No.: 32112 Capacity: Counsel for Personal Representative N <( a. '"G' - . . co c:::t: ~',~) .:1 -=::t ..- i......' o (,;, Q.) a:: ~ p d) .', .a 'C s:: Q) == aU ,03/25/2003 08/28/1948 '(IFAPPLic-ABLEji;i,JRVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) ! LUSH, PATRICIA M, - "I-~-1.-Ori9i;:;;;~t~~n-'-~----------O--2:-s~PP'e~e~~iR~t~r~- -----'- w ~ ~ rn I D 4. Limited Estate 0 4a. Future Interest Compromise (date of death after &l g: i5 I 12,12~2) {ili19 ! 18I 6, Decedent Died Testate (Attach copy 0 7. Decedent Maintained a Living Trust(Attach ~ III of Will) copy of Trust) c( i 0 9. litigation Proceeds Received 0 10. Spousal Poverty Credit(date of death between 0 11,Election to tax under Sec. 9113(A) (Attach Sch 0) .. ..- --rt.. . .... . <. '. .' "c---~---cu----c'--c-c--C"7c.J.:<:'31:~LaO.Q.1'1'!l51_-.--.-___~.--c_"_--.-.---c__~......c"~c_....-.--.-.---.--.-.-_...--C--....--c..-_..-~- r!HIS~~.lIQ~_~lJ~1.!!.E.f.9M~g!cE!l. .Al.b-~()~~~Q-~QE~E,A,.,Q,9()~~Il).E,.,,.~,AI,,.T,A?',""f.QRM,AI'_Q..N~IiRlJ~O BE...Q~E.~E!l.!()~___ NAME : COMPLETE MAILING ADDRESS .. Diane G. Radcliff ,... FIRM NAME (If applicable) I Diane G. Radcliff, Attorney at Law REV .1500 E)C, ~ 1&-00) . I ! COMMONWEALTH OF PENNSYLVANIA I DEPARTMENT OF REVENUE I .. _ .!i~_R,;~;~.~~06,O;,2!l:.0601____1.__ .... 2 W C W o w C .... 2 W C 2 o Q. NU 0100 OF",,;::,.:. '.~r,.: 1. Real Estate (Schedule A) 2, Stocks and Bonds (Schedule B) 2 o f= ::s => .... ii: c( o w IX 3, Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5, Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6, Jointly Owned Property (Schedule F) o Separate Billing Requested 7, Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8, Total Gross Assets (total Lines 1-7) 9, Funeral Expenses & Administrative Costs (Schedule H) 10, Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) REGISTER OF WILLS SOCIAL SECURITY NUMBER I i 209-46-1575 .-O-i.-Remalnder Returl1(ciate Ofde,,"thpiiorto12~i3.a2) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 3448 Trindle Road Camp Hiil, P A 17001 (1 ) (2) (3) (4) (5) (6) (7) 143,000.00 None None None 40,724.00 None 61,973.56 11, Total Deductions (total Lines 9 & 10) 12, Net Value of Estate (Line 8 minus Line 11) (8) 245,697.56 (9) (10) (11 ) (12) 245,697.56 13, Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 0.00 15,Amount of Line 14 taxable at the spousal tax rate, Dr transfers under Sec, 9116(a)(1,2) 2 o f= ~ => Q. ::;; o o >< ~ 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 (13) (14) 245,697.56 19, Tax Due 245,697.56 x .00 (15) x .045 (16) x .12 (17) x .15 (18) (19) 0.00 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT, Copyright 2000 form software only The Lackner Group, Inc. --------~--------- --~-~~-~----_.,.- ----.- >> SE SURE TO ANSWER ALL QUESTIONS ON REVE!!SE SIDE ~NO RE.cHECK MATH << __,~_._____.._.__ Form REV.1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 2005 DARTMOUTH STREET CITY CAMP HILL - --------------------- - - ------- - ___on, ---1---- -- ------ .-- j STATE PA ! ZIP 17011 Tax Payments and Credits: 1, Tax Due (Page 1 Line 19) 2, Credits/Payments A. Spousal Poverty Credit 8, Prior Payments C. Discount (1 ) 0,00 3, Interest/Penalty if applicable D. Interest E, Penalty Total Credits (A + 8 + C) (2) 0,00 Total Interest/Penalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference, This is theOVERPAYMENT. Check box on Page 1 Line 20 to request a refund S, If Line 1 + Line 3 is greater than Line 2, enter the difference, This is theTAX DUE. A. Enter the interest on the tax due, 8, Enter the total of Line S + SA. This is the BALANCE DUE (3) (4) (S) (SA) (S8) 0.00 0.00 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT 3, Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 4. Did decedent own an Individual Retirement Account, annuity, or other non'probate property which contains a benefiCiary designation? .".",.",...,'...." ',..".,....".""",., ,......."., ",'..." "" ".... ",."".. '....,." ..,." .".""."" 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 ~ ~: ~::::~ :h~e~;~;i:~~~s:~~e~=s~~~ ,~~,~I.I, ,~.~~, ~~~, :.~~~~~,~.~~,~.~.~~~~~.~, ,~,~.i,~~, ~~~~~~~:::::::::::::::::::',:',:::::::::::: B ~ d, receive the promise for life of either payments, benefits or care?.............................,_............................ 0 ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year Df death without receiving adequate consideratiDn? .,..".." ,,"" ...,.." ",' ,..,'......".."",..."...", '., ...." ".,.. ...,.. ..""" "...,.".." ".."....,'., 0 ~ o ~ ~ 0 ~-~._--------~--_.._-------_._------_._._----- .._-----~---- ---- -------------_._--------_.-~.._-----------------------------~------- IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FilE IT AS PART OF THE RETURN. Under penalties of pe~ury, J declare that I have examined this return, induding accompanying schedules and statements. and to the best of my knowledge and be/ief, it is true, correct and complete. Declaration 0 p.rel'arElrClther~hanthe persClnalrepresentati~e_is bas~d onaU infonnationof whichpreparer ha~ any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS ~~H ~~ ~~-~~,~- ---.,-f"fL_"__~~____.~ __ __~___~_~__ .__ SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN \ ~~REPRESENTATI--\.. m---ADDRESS~ 'ff 3448 Trindle Road Camp Hill, P A 17001 DATE 2005 DARTMOUTH STREET CAMP HILL, PA 17011 ...] //.f / 0 ~ ADDRESS DATE --'~---"'-- _n._ --~--~------~-----~-~--.---~-.~---- - ~--'---~.-DATE---.'~--- .:l./Io{ / 0 4 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, 99116 (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, 99116 (a) (1,1) (Ii)]. The statute does not exemDt 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, 99116 (a) (1,2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4,S%, except as noted in 72 P,S. 99116 1,2) [72 P.S, 99116 (a) (1 )1, The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116 (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, SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA i INHERITANCE TAX RETURN i __________~SIDE~ DECEDENT ._______~__________ ~-----~------------------______.._.l________________________ ______ _ ___ *' ESTATE OF LUSH, WILLIAM H ~---~----------_._---------------~ -----------~.._------_.,._.~------_._-------- All real property owned solely or as a tenant in common must be reported at fair market valueFair market value is defined as the price at which property would be exchanged between a willing buyer and a wilflng seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts, Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. i FILE NUMBER 21 .. 03 .. 0349 ITEM NUMBER 1 DESCRIPTION VALUE AT DATE OF DEATH 143,000.00 2005 Dartmouth Street Camp Hill, PA 17011 --- -_._--_.._----------_._---------------_.__._-~---_.~--~------- TOTAL (Also enter on Line 1, Recapitulation) 143,000.00 ~- "" -_.__.._~_.._-- SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT - -- -- --'. ---"--,,---- ESTATE OF LUSH, WILLIAM H I FILE NUMBER 21 - 03 - 0349 -~--. ---.---------."---- - - ---.------ -- .---- .. - -- - .,'.--------- -- Include the proceeds of litigation and the date the proceeds were received by the estate All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER 1 DESCRIPTION VALUE AT DATE OF DEATH -._- ----_._...._~-- -".. -.--..... 1,565.00 1997 Seadoo GTX Jet Ski 2 1986 Yamaha Motorcycle 290,00 3 2000 F-250 Ford Truck 18,750.00 4 1985 Terry Travel Trailer 2,810.00 5 1979 Puch Moped 300,00 6 2001 Cargo Trailer 500.00 7 1998 C.E. Smith Trailer 750.00 8 1996 Nuway Trailer - Title Number 50115736704 LU 300.00 9 1996 Nuway Trailer - Title Number 50115736702 LU 300.00 10 1986 Southwind Motorhome 8,990.00 11 Farmers Bank of Maryland Savings Account Number 1683-1039 917.00 12 NBA Credit Union Account Number 0195387994 5,252.00 TOTAL (Also enter on Line 5, Recapitulation) 40,724.00 ..~ ~ COMMONWEALTH OF PENNSYLVANIA ---- -- ----~----------_._------_._----,----. _.~_._--------_._--_.- ESTATE OF LUSH, WILLIAM H FILE NUMBER 21 - 03 - 0349 ITEM NUMBER This schedule must be completed and filed if the answer to any ofquesti(),ns 1 through 4 on page~ is yes. DESCRIPTION OF PROPERTY 'DATE OF DEATH: % OF i i Include the name of the transferee, their relationship to decedent and the date of transfer. i i DE CD'S ! EXCLUSION ' TAXABLE VALU E Attach a copy of the deed for real estate VALUE OF ASSET, .. (IF APPLICABLE) , . ! I INTEREST i : -- --,-- ------ u --------...---.. -_____ - .... _u_.___,__...._ 1..-_ ---_...____________,______ .______+___ .-----__..L.. 3,701.001 I , , Morgan Stanley IRA Account 3,701.00 2 ESOP - Flippo Construction 15,097.061 , I 43,175.50 15,097.06 3 401-K - Flippo Construction 43,175.50 -_______J____.._______ ___..._____ _______________ __,_...__ I i I I I ' i .----,-l--.--__.___.._.____..______---L.._________~________ I 1---_- TOTAL (Also enter on line 7, Recapitulation) 61,973.56 mast mill nub ID.e51ttm.ent OF WILLIAM H. LUSH ;2. 1- 03 - 3J-fg BE IT REMEMBERED, that I, William H. Lush of Camp Hill, Pen- nsylvania, being of sound mind, memory and understanding, do make publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writing in the nature thereof by me, at anytime heretofore made. I TEM I: I direct that all my just debts and funeral ex- penses be paid as soon after my demise as may be convenient. ITEM 2: All the rest, residue and remainder of my Estate of whatsoever nature and wheresoever situate, whether it be real, personal or mixed, including any insurance. policies therefor, property over which I have a power of appointment, and proceeds from any insurance policies payable to my estate or to said beneficiary, I give, devise and bequeath unto my wife, Patricia M. Lush, absolu~ely, provided she survives me for a period of thirty (30) days. ITEM 3: Should my wife, Patricia M. Lush, predecease me, / fail to survive me for a period of thirty (30) days, or should we die simultaneously, I then give, devise and bequeath my entire residuary .estate to the following set forth beneficiaries (who survive me by a period of thirty (30) days) in the proportions as hereafter indicated: (a) To my son, Corey A. Lush, forty-five (45%) percent of my residuary estate. (b) To my daughter, Jennifer A. Lush, forty-five (45%) per- cent of my residuary estate. ~~~t- ~~ WILLIAM H. LUSH ~~ (c) To my daughter, Alison M. Lush, ten (10%) percent of my residuary estate. Should any of the above named beneficiaries fail to survive me by a period of thirty (30) days, said beneficiary's share shall lapse and shall then be divided amongst the then remaining residuary beneficiaries in the same proportion as said remaining beneficiaries' respective shares bear to each other. ITEM 4: If and in the event all of the above named beneficiaries fail to survive me by a period of thirty (30) days then I give, devise and bequeath my entire residuary estate unto my grandchildren in equal shares per capita. ITEM 5: In the event any beneficiary mentioned in Item 3 herein has not then reached age 21, his or her share shall be held by my Trustee, hereinafter n~ed, IN SEPARATE TRUST, for the following uses and purposes and subject to the following terms and conditions. 1. Trustee may accumulate the income from that share or so much thereof from time to time as it considers advisable; and trustee may expend and apply so much of net income including accumulated income and so much of the principal of that share as Trustee may consider necessary for the support, maintenance, medical and dental expenses and education of such beneficiary, in- cluding college education, both graduate and under- graduate, in accordance with said beneficiaries talents, abilities and needs; and Trustee may pay all expenses which it deems necessary and desirable in con- nection therewith, including, by way of illustration, tuition, room and board, books and supplies, clothing, travel expenses and reasonable sums for personal ex- penses. The amount to be paid for the benefit of said beneficiary shall be determined from time to time based on said beneficiary's needs with the further direction that said funds shall be liberally disbursed. The said payments may be made directly to said beneficiary if said beneficiary is, in the sole opinion of my Trustee, of an age and ability to handle the funds so paid, or may be made by my Trustee directly to the person having custody and care of said benefiCiary, or may be made by my Trustee directly to any institution entitled to such payment by reason of services rendered or to be rendered to said beneficiary. WITNESS, ~ ~ o.J ~ ~ I ~ ~ ~ \l WILLIAM H. LUSH C/ 2. The Trustee for the purposes of carrying out my inten- tions stated above and the purposes of the trust shall be entitled to (a) purchase and/or retain any property, real or personal, including common stocks, shares of investment trusts, shares of stock of the corporate trustee and interests in common trust funds: (b) to sell and convey any property real, personal or mixed held in the trust at public or private sale for such price as the trustee determines to be reasonable; (c) to exchange property for other property; (d) to borrow money for the trust and to secure any borrowing by pledge or mortgage; (e) to vote any stock in the trust for any purposes whatsoever in such manner as the trustee deems for the best interests of my said beneficiary and to give proxies with or without full discretionary powers; (f) to deposit under voting trust agreements any shares of stock held by them; and (g) to compromise any claim for or against the trust. The trustee may from time to time amortize premiums paid on the purchase of bonds, notes and other securities by appropriate periodic charges against income, but shall not be required so to do. All purchasers from the trustee shall be exempt from all responsibility with respect to the application of the purchase money and no transfer agency shall be obligated to inquire into the propriety of any transfer made by the trustee. The trustee shall be under no obligation to furnish bond, or, if bond be by law required, surety on such bond. Annual or periodic compensation of the trustee for his services hereunder may be equitably apportioned between principal and income. 3. Any and all payment or payments of any sum or sums, whether in cash or in kind or whether for principal or income, payable to said beneficiary, shall be made upon the sole receipt of the respective individual to whom the payment is made, and free from anticipation, alienation, assignment, attachment, and pledge, and free from control by the creditors of any such beneficiary. All shares of principal and income herein given shall be free from anticipation, assignment, pledge, or obligation of any beneficiary, and shall not be subject to any execution or attachment. 4. When such beneficiary reaches age principal and any accumulated or of his or her share shall be beneficiary, absolutely. 21 the then remaining undistributed income distributed to such 5. In the event such beneficiary dies before reaching age 21 the remaining principal and any accumulated income of his or her share shall become part of my residuary estate and distributed to the beneficiaries thereof as provided for herein, subject nonetheless to the terms and conditions of this trust. 6. Should the principal of any trust herein provided for WITNESS, ~ . . LL ~ ~ L {-I WIL1rf{~ -%'c- be or become too small in trustee's discretion so as to make establishment or continuance of the trust inad- visable, my trustee or executor my make immediate dis- tribution of the then-remaining principal and any ac- cumulated or undistributed income outright to the per- son or persons and in the proportions they are then en- titled to income. If any such persons is then a minor, distribution may be made to the guardian under Item 7. Upon such termination, the rights of all persons who might otherwise have an interest as succeeding life tenant or in remainder shall cease. ITEr1 6: I appoint Dauphin Deposit Bank and Trust Company as Trustee of any trust created by this my Last Will and Testa- ment. ITEH 7: I appoint Tracy Lee Ludwig, my wife's sister, as guardian over any property which passes either under this will or otherwise to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or to another for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to time, for the minor's support and education. If and in the event Tracy Lee Ludwig, my wife's sister, fails to survive me or ceases to act as Guardian, I ap- point Dauphin Deposit Bank and Trust Company as Alternate Guar- dian. ITEM 8: If my wife predeceases me, I name Tracy Lee Ludwig, my wife's sister, as guardian of the person of my minor child, Corey A. Lush. ITEfvl 9: I direct my Executrix to pay all inheritance, es- tate, succession and legacy taxes of whatsoever nature and kind, to which my Estate or the transfer of any property passing ~~0 ~{r ~~ WILLIAM H. LUSH ~M-.' C/ hereunder or otherwise passing by reason of my demise, may be being my intention that none of the aforesaid taxes, either subject to charge such taxes against my residuary estate, it federal or state, on any property required to be included in my gross estate, under the provisions of any state or federal law now in force or hereafter enacted, shall be prorated among the be transferred to whom any benefit accrues. persons interested in my Estate to whom such property is or may ITEM 10: In addition to the powers conferred by law, I authorize my Executrix in her absolute discretion: (a) To retain in the form received, and to sell either at public or private sale any real or personal property. (b) To manage real estate. (c) To invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principle of diversification. (d) To exercise any option or rights arising from ownership of investments. (e) To compromise claims without court approval, and without the consent of any benefiCiary. (f) To join with my spouse in the filing of any federal in- come tax return for any year for which I have not filed such return prior to my death, and to consent to the treatment of any gifts made by him as being made one- half by me for gift tax purposes notwithstanding the fact that such action may result in additional liabilities for my estate. Any income or gift taxes due on such returns and any deficiencies, interest, penalties, or refunds thereon, shall be allocated be WITNESS, ~Q ~--~~~ ~~~ WILLIAM H. LUSH tween my estate and my spouse or my spouse's estate, or all to any of them, in such manner as my Executrix and my said spouse may agree. ITEM 11: I appoint my wife, Patricia M. Lush as Executrix of this my Last Will and Testament. Should my wife, Patricia M. Lush predecease me, fail to qualify, cease to act or renounce probate, I then appoint my wife's sister, Tracy Lee Ludwig as al- ternate Executrix of this my Last Will and Testament. ITEM 12: I direct that my Executrix, guardian or their suc- cessors shall not be required to give bond for the faithful per- formance of their duties in any jurisdiction. IN WITNESS WHEREOF I I have hereunto set my hand and seal this ~~ day of _~.\. , 1991. WITNESS: ~ ~~~/H:;( ~ ~L?(SEAL) WILLIAM H. LUS~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF '- C:J r"Y'\ ~ I ~ ~ ACKNOWLEDGMENT SS.: We, William H. Lush, Diane G. Radcliff and Deborah L. Don- ley, the Testator and the witnesses respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his last Will and that he had signed willingly (or willingly directed another to sign for him), and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the wit- nesses, in the presence and hearing of the Testator, signed the Will as witness and that to the best of their knowledge the Tes- tator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~~ Sworn to and subscribed to before me this ~l\. ~ day of :') l.j .~ , 19.:li... /a~t1A d, /Lm// NOTARY PUBLIC . # My Commission Expires: . tto(a~i~-~~-'.'--~---f Deborah L. Donlel', Nolary l'u~!:c J Camp Hm Bore, Cumb$rla~d Ccun~ My Commission Expires Sept 23, 1991 l.. Member, Peonsyl\'2n;~ Associfltion 01 I-Io,,,j,$ Personal Watercraft New Car Pricing Build a Car Incentives Quality Ratings Ownership Cost My Car's Value Used Car Retail Free Price Quote Buy a Used Car Sell Your Car Motorcycles Financing Insurance lemon Check Car Reviews Car Previews Decision Guides Advice Free Newsletter About kbb Home Page 1 of 1 Kelley Blue Book l'tiE TRUSTED RESOURCE ~."--"~".,,"~,,.,"--~--" kbb.(om Blue Book MIRIET WireR. Enter email address I,.J Si, Blue Book Personal Watercraft Trade-In Report January 27, 2004 1997 Sea-Doo GTS 3-Pass 2-Cylinder 2-Stroke 718cc SS!IL~Qu[ PeL~nC3IWC3J~[c:rC3ft Motorcyc~ Store GeUIlSUrCl~El ;\notl1er _REllLQa Sf::!.I.I-YQYI-PE:!r'.sJlJ@IJl'tcllen::raft OJ] ~E3a-y f\lIOJOf$ Trade-In Value (Good Condition) $1565 The trade-in value represents what you might expect to receive from a dealer for this consumer-owned unit. Keep in mind that the dealer must then absorb the cost of making the unit ready for sale, advertising, sales commissions, arranging financing and insurance and standing behind the unit for any mechanical or safety problems, Trade-in values are based on clean units in good condition. Copyright@2004 by Kelley Blue Book Co" All Rights Reserved, Jan-Apr 2004 Edition, The information in this report is intended for the persDnal use of the custDmer only and may not be sold or transmitted to another party. We assume no responsibility for errors or omissions, http://www.kbb.com/kblki.dll/ke.kb.mr?kbb.PA;345275;PA041&17011;pw;t&30&1997;S...1/27 12004 . Motorcycle New Car Pricing Build a Car Incentives Quality Ratings Ownership Cost My Car's Value Used Car Retail Free Price Quote Buy a Used Car Sell Your ear Motorcycles Financing Insurance Lemon Check Car Reviews Car Previews Decision Guides Advice Free Newsletter Aboutkbb Home Page 1 of 1 Kelley Blue Book HIE TRUSTED RESOURCE -~"~-^~_."~."~~~-~ kbb.(om Blue Book MARIET WITCI_ Enter email address b! 51, Blue Book Motorcycle Trade-In Report January 27, 2004 1986 Yamaha CV80S Riva 1-Cylinder 2-Stroke 80cc ayY-,~_.MotQ[cY-Gle ~elL'LQl!r MgtQLc:YQe MQtor~~IEL~PBsfrQm"p,9j)% Motorcygle_ Store MotQ[c:ycle.1 nsura n ce Anoth~rB~RQrt ~J:~lLYQ l.JLY~[TljLh_aQn~l;taYJIIIQtQn; Trade-In Value (Good Condition) $290 The trade-in value represents what you might expect to receive from a dealer for this consumer-owned unit. Keep in mind that the dealer must then absorb the cost of making the unit ready for sale, advertising, sales commissions, arranging financing and insurance and standing behind the unit for any mechanical or safety problems. Trade-in values are based on clean units in good condition, with all original standard equipment. Mileage/condition and ~_qQjtio.naLegYlP[Tl~nt may have a substantial impact on the value shown above. Copyright@2004 by Kelley Blue Book Co., All Rights Reserved. Jan,Apr 2004 Edition. The informatiDn in this report is intended for the personal use of the custDmer only and may not be sold or transmitted to another party. We assume no responsibility for errors or omissions. http://www.kbb.comlkbIkLdll/ke.kb.mr?kbb.PA;051358;PA041&17011;rc;t&29&1986;Ya...1/27 /2004 . NADA Appraisal Guides - Get a Value - Motor Homes NADAguides .rrn Free Vehicle Pncmg & Intofmaton Page 1 of2 The Recognized Authority Since 1933 HOrTl~ I S_u_bscri!:le toTrad~ Guides I Site Map I F,ll Roadside Service I Buy an RV i SeH an RV I Finance Quote I Insurance Ouot<1 I Warranty Quote! CheG1, Your ( DONATE..YOU.RRV I CHOOSE A Cf1 MORE THAN ~ CHA:RITIES Of[\f'T;:;: rom-;V:'F L:dJ\:ft::i\::.,lr1~~~ 7J l!~7J0 rner 1 I to 2003 SOUTHWIND FLEETWOOD ENTERPRISES 1986 FOR STORM MODELS 2001 AND NEWER, SEE LISTING UNDER STORM, Model: Length: Coach Design: Floor Plan: Self-Contained: Low Retail: Average Retail: M-A 32' Motor Home Center Kitchen YES $8,990 $10,830 Mileage Factor (Gasoline engine only): Plus 17.00% 40,001.45,000: Low: $1,528 Avg: $1,841 Totals Total Low Retail: Total Average Retail: @Pdnt 8epq},:t Research A New Car 1$ Ge.t A:",~th.e,. P"~e $10,518 $12,671 Find a new C~J, Picl<LJP Truck or SJJV to tow behind your motorhome? Before you buy Qh~eGIs_YQ_ur Creqit and get a Free Einanc_e Qu.ote Obtain a E[e.~Uo.SJ![am:e 9upte for your Recreation Vehicle Get anE)(t~ndec:1 VYarrclrlty to help protect your investment Sign up now for RV EmergencYRoadsi_de Service, Click below on the first letter of the Manufacturer's Name. [AIB/CID/EIF/GIHIIIJIKILIMINIOIPIRISITIUIYIWIXIYIZ] [Truck Campers I Motor Homes I TravelTrailers& Fifth Wheels I Park Models / Camping Trailers You have received 1 of the 10 free daily values for Motor Homes Low Retail Value - A low retail unit may have extensive wear and tear. Body parts may have dents and blemishes. The buyer can expect to invest in cosmetic and/or mechanical http://www.nadaguides.cOmNaluesNalueReport.asp?UserID=550807F35A626&DID=38...1/27/2004 . NADA Appraisal Guides - Get a Value - Travel/Fifth Wheel Trailers NAD~guides .rrn free Vehicle Pnc:ng & The Recognized Authority Since 1933 H()rlle I Subscribe to Trade Guides I Site Map I F,tl Roadside ServICE' I I 1986 to 2003 TERRY FLEETWOOD ENTERPRISES 1986 TERRY SERIES Model: LengthlWidth: Axles: Weight: Self-Contained: Low Retail: Average Retail: M-25N 25' x 8' 2 5,040 YES $2,810 $3,390 ~ Print ~t!1R'Prt tijr;Resean::h A New Car ~ Ci!,t'8t'J!tlj!J~et:f,~! Find a new Car, PickLJP Truck or SUV to tow behind your motorhome? Before you buy Check your Credit and get a Eree FinanGe Quote Obtain a Free InsLJrance Quote for your Recreation Vehicle Get an Extended vvarranty to help protect your investment Sign up now for RV Emergency Roadside Service, Click below on the first letter of the Manufacturer's Name. [41 A I B 1 C I 0 I ElF I G I /-i III J I K I L I M I N I 0 1 p 1 R I SIT I U I V I VV I Y] [ Truck Campers I Motor Homes I Travel Trailers & Fifth Wheels ! P~rkMpdels I CC:1lT1ping TrC:1iler~ ] You have received 2 of the 10 free daily valup.s for Travel/Fifth Wheel Trailers Low Retail Value - A low retail unit may have extensive wear and tear, Body parts may have dents and blemishes, The buyer can expect to invest in cosmetic and/or mechanical work. This vehicle should be in safe running order, Low retail vehicles usually are not found on dealer lots. Low retail should not be considered a trade-in value. Average Retail Value - An average retail vehicle should be clean and without glaring defects, Tires and glass should be in good condition, The paint should match and have a good finish. The interior should have wear in relation to the age of the vehicle, Carpet and seat upholstery should be clean, and all power options should work. The mileage should be within the acceptable range for the model year, An Average Retail vehicle on a dealer lot may include a limited warranty or guarantee, and Page I of2 800-521-2 rvoa.cor http://www.nadaguides.com/ValuesNalueReport.asp?UserID=550807F35A626&DID=38...1 /27/2004 ~BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ~> t' .-." DATE .ESTATE OF DATE OF DEATH FILE NUMBER @lJ~Y ACN 03-22-2004 LUSH 03-25-2003 21 03-0349 CUMBERLAND 101 DIANE G RADCLIFF ATTY 3448 TRINDLE RD CAMP HILL PA 17001 '04 MAR 19 '* REV-1541 EX AFP <01-03) WILLIAM H Amount Remitted , L~'.;l CUlT\b> MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF LUSH WILLIAM H FILE NO. 21 03-0349 ACN 101 DATE 03-22-2004 T AX RETURN WAS: (X) ACCEPTED AS F I LED ) CHANGED If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of !hh 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 (18) 19. Principal Tax Due TAX CREDITS: RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN I. Real Estate (Schedule A) 2. 3. 4. 5. 6. 7. 8. 143,000.00 .00 .00 .00 40,724.00 .00 61,973.56 (8) Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) (6) (7) Closely Held Stock/Partnership Interest (Schedule C) Mortgages/Notes Receivable (Schedule D) Cash/Bank Deposits/Misc. Personal Property (Schedule E) Jointly Owned Property (Schedule F) Transfers (Schedule G) Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) II. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax .00 .00 (11) (12) (13) (14) NOTE: (15) (16) 245,697.56 X . DO X .00 X .00 X (17) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 245,697.56 .00 245,697.56 .00 245,697.56 00 045 = 12 15 .00 .00 .00 .00 .00 (19)= PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ~ * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, 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.) STATUS REPORT UNDER RULE 6.12 NAME OF DECEDENT: WILLIAM H. LUSH DATE OF DEATH: 03/25/2003 WILL NO.: 21-03-0349 ADMIN. NO. Pursuant to Rule 6..12 ofthe Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No 2. If the Answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the Answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the court? Yes No X 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 X No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. n ~~ Date: June 17. 2004 3448 Trindle Road. Camp Hill. P A 17011 Address (717) 737-0100 Telephone number l (~"N' ~D. Capacity: _ Personal Representative ---X- Counsel for personal representative