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Home My WebLink About03-0896Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of CATHERINE S. YANTZ also known as , Deceased Patricia R. Barchuk Social Security No. 176-10-8377 Petitioner(s), who is/are 18 years of age or older, apply(les) for: (COMPLETE 'A' or 'B' BELOW:) A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut r ix the Decedent, dated 09/27/2002 and codicil(s) dated None named in the last Will of 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: B. Grant of Letters of Administration (c.t.a.; 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 (COMPLP_.IP_ IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her last family or principal residence at 100 Mt. Allen Drive, Upper Allen Township, Mechanicsbur~, (list street, number, and municipality) Decedent, then 92 years of age, died 10/11/2003 at Messiah Village, Mechanicsbur~, Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania (Location) PA 17055 PA 35,275.00 situated as follows: [ "~ SigDatu r~'l ~? "i Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letter~, in the appropriate form to the undersi~lned: Typed or printed name and residence Patricia R. Barchuk 5545 Barbara Drive, Mechanicsbur~, PA 17050 Prepared by the Pennsylvania 8ar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991) Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland before me this 'o~q~lay of ~' ~', ~% ,~,~~._" ~.~-' 'For the Regi~te~ - ~ -sq Th~ 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 and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed .~',..y_~_~/~/~;{,~_~ Patricia R. Barchuk Estate of CATHERINE S. YANTZ Deceased Social Security No: 176-10- 8377 Date of Death: 10/11/2003 AND NOW, (~,._~,LL)~-~'L_ ~.~.~,~ ,,'~0(~ ~.~, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~'~ Testamentary [~] Of Administration (c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to Pat ricia R. Barchuk in the above estate and that the instrument(s) dated 09/27/'2002 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........... $ Short Certificate(s) ..... $ Renunciation ........ $ Affidavits ( ) .... $ Extra Pages ( ) .... $ Attorney: John R. Zonarich, Esquire I.D. No: 19632 Skarlatos & Zonarich LLP Address: 204 State Street Codicil ........... JCP Fee .......... Inventory .......... Harrisburg, PA 17101 Telephone: 717/233-1000 Other ........... $ TOTAL ......... $ / D70~ Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (19~1) 10%81)5 REX,' 9/86 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent fiiing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 No. ~ - - Da[e/ Local Registrar CERTIFICATE OF DEATH 5-19-1911 Vineyard,PA ~,,~,D Cumberland Mechanicsburg Messiah Vi,llage steakhou ~-~~.~c~ w~dow Messiah Village 100 Mt.~len Dr Patricia Barchuk D 6-03 5545 Barbara Dr St. Catherines ter ,D.Heath Funeral Home ,PA 1705~ PA 17260 Mt. Union PA 17061 ~O ~O LAST WILL AND TESTAMENT OF CATHERINE S. YANTZ I, CATHERINE S. YANTZ, a widow, presently of 6407 Cannon Drive, Mechanicsburg, Cumberland County, Pennsylvania 17050, declare this to be my Last Will and revoke any Will previously made by me. ITEM l: I direct that all my just debts and funeral expenses, including the cost of a suitable grave marker and perpetual care for my burial plot, shall be paid from the assets of my estate as soon as practicable after my decease. ITEM Il: I give, devise and bequeath all of my estate, real, personal and mixed wheresoever situated to my daughter, PATRICIA R. BARCHUK of 6407 Cannon Drive, Mechanicsburg, Pennsylvania 17050, per stirpes. If my daughter, PATRICIA R. BARCHUK predeceases me, then I give, devise and bequeath all of my estate to be divided among my three grandchildren, MICHAEL R. BARCHUK, MICHELE R. BARCHUK TIDAY and LISA A. BARCHUK TIDAY, in equal shares, per stirpes. Should any of my above-named grandchildren predecease me, then I give, devise and bequeath his or her share of my estate to his or her Issue, per stirpes. Should any of my above-named grandchildren predecease me leaving no Issue, then I give, devise and bequeath my deceased grandchild's share of my estate to be divided equally between my. remaining grandchildren surviving at my death. ri'EM lll: No interest in income or principal shall be assignable by or available to anyone having a claim against a beneficiary before actual payment to the beneficiary. ATTORNEYS AT LAW LAST WILL AND TESTAMENT OF CATHERINE S. YANTZ Page 3. of 6 ITFM IV: All federal, state, and other death taxes payable on the property forming my gross estate for tax purposes, whether or not it passed under this Will, shall be paid out of the principal of my residuary estate just as if they were my debts, and none of those taxes shall be charged against any beneficiary. ITEM V: I authorize my Executor: (a) to retain and to invest in all forms of real and personal property, regardless of (i) any limitations imposed by law on investments by executors or trustees, (ii) any principle or law concerning delegation of investment responsibility by executors or trustees, or (iii) any principle of law concerning investment diversification; (b) to compromise claims and to abandon any property which, in my Executor's opinion, is of little or no value; to borrow from, and to sell property to others, and to pledge property as security for repayment of any funds borrowed; (c) to sell at public or private sale, to exchange or to lease for any period of time any real or personal property, and to give options for sales or leases; (d) to join in any merger, reorganization, voting-trust plan or other concerted action of security holders, and to delegate discretionary duties with respect thereto; (e) to use administrative or other expenses of my estate as income tax or estate tax deductions and to value my estate for tax purposes by any optional method permitted by the law in force when I die, without requiring adjustments between income and principal for any resulting effect on income or estate taxes; and (f) to distribute in kind and to allocate specific assets among the beneficiaries in such proportions as my Executor may think best, so long as the total market value of any ~XARlArlll3& 7JONAR~ tip LAST WILL AND TESTAMENT OF attorneys At LaW CATHERINE S. YANTZ Page 2 of 6 beneficiary's share is not effected by such allocation. These authorities shall extend to all real and personal property at any time held by my Executor and shall continue in full force until the actual distribution of all such property. All powers, authorities, and discretion granted by this Will shall be in addition to those granted by law and shall be exercisable without leave of court. ITEM VI: I appoint my daughter, PATRICIA R. BARCHUK as Executrix under this Will. I direct that any fiduciary acting hereunder shall not be required to enter bond or other security in any Court or jurisdiction in which said fiduciary may be called upon to act. ITEM VII: I appoint my Executrix as Guardian of the estate over any property that may pass to any minor children with respect to which property I am authorized to appoint a guardian and have not otherwise specifically done so. Such guardian shall have the same management powers as those granted my Executor may pay or apply principal as well as income for the minor's welfare, comfort, support or education, without court approval, and if she, in her sole discretion, determines that it is impractical to administer any fund, she may deposit such fund in one or more savings accounts in the minor's name, payable to him or her at age eighteen (18). The guardian shall have no further responsibility for any funds so paid, applied or deposited. SKAP&g~ & ~I rte ATTORNEYS AT LAW LAST WILL AND TESTAMENT OF CATHERINE S. YANIZ Page 3 of 6 IN WITNESS WHEREOF, I have hereunto set my hand and seal and caused this my Last Will and Testament, consisting of Six (6) typewritten pages, including this attestation clause and the following P~cknowledgment and Affidavit, to be executed, declared and published this c'277~'~ayof "~fTf~,2002, at ~),-- ,Pennsylvania. CATHERINE S. YANTZ' 6~ ~9 ATTORNEYS AT LAW LAST WILL AND TESTAMENT OF CATHERINE S. YANTZ Page 4 of 6 A C KNC~WI,EDC~MF. NT COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF DAUPI-I[N ) SS: I, CATHERINE S. YANTZ, the Te,qtatrix: 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. CATHERINE S. YA'NTZ ~ Swom or affirmed to and acknowledged before me by CATHERINE $. YANTZ, the Testatrix th'~'~ day of ,2002· Public on Expires: ATTORNEYS AT LAW LAST WILL AND TESTAMENT OF CATHERINE S. YANTZ Page 5 of 6 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) an _ ~/' - v ~-.- 't , gn tothe attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw CATHERINE S. YANTZ, sign and execute the instrument as her free and voluntary act for the purposes therein expressed; that each of us in the heating and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the Testatrix was at the time twenty-one (21)~or more years of age, of sound mind and under no constraint or undue Residing at Residing at ~-~'vL~OA ~ ~-~ % ~esiding at Sworn or and acknowledged before me by of .,2002. AT LAW witne~, Public ~n Expire[.' LAST WILL AND TESTAMENT OF CATHERINE S. YANTZ Page 6 of 6 CATHERINE S. YANTZ LAST WILL AND TESTAMENT SEPTEMBER 27, 2002 $[Alfl~ATOIi a ZONAPdCH LLP ATTORNEYS AT LAW 204 STATE STREET HARRISBURG, PENNSYLVANIA 17101 (717) 233-I000 CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: CATHERINE S. YANTZ Date of Death: October 11, 2003 Will No. 21-03-0896 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 beneficiary of the above-captioned Estate on November 11, 2003: Name Patricia R. Barchuk Address 5545 Barbara Drive Mechanicsburg, PA 17050 Notice has been given to all persons entitled thereto under Rule 5.6(a). Dated: Nov. 11, 2003 Signature Name: ~rl aR~o ~°~a [~nh'~c~q~,~,~e Address: 204 State Street Harrisburg, PA 17101 Telephone: (717) 233-1000 Capacity: Counsel for Personal Representative JOHN R. ZONARICH* ANNA MARIE SOSSONG KATHY SPEAKER MACNETT JOhn B. ZOnARICH GREGORY S. CHELAP SHELLY J. KUNKEL TODD F. TRUNtZ t DAVID H. JUDY ANGELO SKARLATOS ~1966- 1981) * BOarD CERTIFIED IN CIVIL TRIAL ADVOCACY t ALSO AdMI~FED IN NEW JERSEY & 7DNAII CH ATTORNEYS AT Law 204 STATE STREET HARRISBURg, PENNSYLVANIa 17101 (717) 233- 1OOO TELEFAX (717) 233-6740 WWW.S KA R LATOSZO N A R ICH .COM January 9, 2004 STEELTON OFFICE MECHANICS SAVINGS BUILDrNG, STE. 201 51 SOUTH FRONT STREET STEELTON PENNSYLVANIA 17] ]3 1717) 939 9358 MIDDLETOWN OFFICE 17171 944-5109 WRITER'S EMAIL: sharon@skarlatoszonarich.com Office of Register of Wills ATTENTION: ANN Cumberland County Court House 1 Courthouse Square Carlisle, PA 17013 Estate of Catherine S. Yantz No. 2003-00896 Dear Ann: In accordance with our telephone conversation this past Friday, enclosed please inheritance tax payment for the above-referenced estate. Thank you so much for your assistance. Please tell Cheryl I hope she gets well soon. find the Enclosure Sincerely, Sharon K. Shaffer Estate Administrator A MEMBER Of LAWPACTm - A NATIONAL ASSOCIATION OF INDEPENDENT BUSINESS LAW FIRMS ]ustomer: This service area is provided for your internal use ~nd convenience. Service must be marked on airbill. IFedF. x Service: FedS. PRIORITY OVERNIGHT MON amp: 477898 09JAN04 lOO USA Airbill Express Date /"q-- 0 H FedExTrackingNumber 833049790035 sender's ~,,-L ~"L --1 Name ~_ O~q%~L.~R.~J~~ E,,~f~Jg~_,,Phone '?~.7 ~3::3--1000 Company ~KARLATO~ AND ZONARICH 8330 4979 0035 0215 De/iver By: 12JAN04 AA MDT Number 4a .Express Package Sewice Packages up to1~l lbs. XF OeINery commitmem may be lamr in soma ames. adex Priority Overnight [] FedEx Standard Overnight [] FedEx First Overnight ~' ~ Next business mornlnil Next business aftemoon Eadiest next business morninil de~ivmy to select Ioc~aons [] FedEx2Da¥ [] FedEx Express Saver Second business day Third business day FedEx Envelope ra~not ava~able. Minimum charge: One-pound rate -- 4b Express Fr~ ght Service 7 P~ylll~rlt BJlI~o: EnterFedExAcetNe orCmditCanlNo below, Obtain Recip. '~en Acct No. der [] Recipient [] Third Party [] Credit Card [] Cash/Check A 1A~i~ll be bm.d. Tatal Paekages Tml Weight ~ Tml Chargo~ ] Packages over I..~ I~. Oelivew comm~rnent may be later in some areas. [] FedE,('lDayFreight~ [] FedEx2OayFreight ~ FedEx3DayFreight Next business day Second business day ~ ~ird business day Address 204 STATE ST Oept~oor/Suite/Ronm 5 * ~m ~Pacb""in" * Declared value limit ~500 c~HARRISBURG State PA ZIP 17101 )~'edExEnvelope* [] FedEx Pak* [] Other Includes FedEx Small PaL FedEx yA ~k~TC~ i Large Pek, and FedEx Sturdy Pek Your Internal Billi~l R~omoce AN~ at FedEX Locabon To [] Availeb~eonlyforFedExPdodty [] at FedEx Locafien [] Avaiinbleonh/for Recipient's Overnight and FedEX 2DayNot available for Name Phone to select ZIP codes FedEX Fest Overnight FedEx Priority Overnight [] No ~ Yes [] Yes [] Or, lcd, il, UN,. ~'~'-- U ~ ~ ~.,~ Shippe/s Declara~ ........ ired Address ~.~! ~, ~fl~ f~ , ~,~ ~/.f ~,~ C~y ~'~ (~ ~/~i L~i~ ~ / ~'~ ~ iPt/R°~r/~uito/R°°m COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96 CD 003428 ZONARICH JOHN R 204 STATE STREET HARRISBURG, PA 17101 ........ fold ESTATE INFORMATION: SSN: 176-10-8377 FILE NUMBER: 2103-0896 DECEDENT NAME: YANTZ CATHERINE S DATE OF PAYMENT: 01 / 12/2004 POSTMARK DATE: COUNTY: 01/O9~2OO4 CUMBERLAND DATE OF DEATH: 10/11/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $2,400.00 REMARKS' TOTAL AMOUNT PAID: $2,400.00 SEAL CHECK# 2154 INITIALS' AC RECEIVED BY: GLENDA FARNER STRASBAUGH DEPUTY REGISTER OF WILLS REGISTER OF WILLS Register of Wills of Cumberland County, Pennsylvania Estate of YANTZ, CATHERINE S. also known as INVENTORY , Deceased Patricia R. Barchuk No. 21 - 03 - 0896 Date of Death 10/I 1/2003 Social Security No. 176-10-8377 The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. Attorney: I.D. No.: John R. Zonarich 19632 Address: 204 State Street Harrisburg, PA 17101 Telephone: 717/233-1000 .Personal Property Personal Representative/) /, Signature: Patricia R. Barchuk Signature: Signature: Address: 5545 Barbara DriVe Mechanicsburg, PA 17050 Telephone: 717-763-1177 Dated: 368 Shares First Commonwealth Financial Corp. @ 13.65 per share Omega Bank Certificate of Deposit No. 173-0040250 5,023.20 10,000.00 Omega Bank Certificate of Deposit No. 173-0040250 (accrued interest to DOD, 0.99 Omega Bank Certificate of Deposit No. 173-0040251 10,000.00 Omega Bank Certificate of Deposit No. 173-0040251 (accrued interest to DOD 22.08 Omega Bank Certificate of Deposit No. 173-0040263 Omega Bank Certificate of Deposit No. 173-0040263 (accrued interest to DOD 10,000.00 10.28 (Attach additional sheets if necessary) Total Personal Property and Real Estate $39,720.79 Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of YANTZ, CATHERINE S. also known as continued , Deceased No. 21-03-0896 Date of Death 10/11/2003 Social Security No. 176-10-8377 PA Department of Revenue - 2003 Income Tax Refund Highmark BC/BS - Premium refund Total Personal Property 83.95 161.00 $35,301.50 2 Estate of also known as Real Estate Register of Wills of Cumberland County, Pennsylvania INVENTORY continued YANTZ, CATHERINE S. , Deceased No. 21-03-0896 Date of Death 10/11/2003 Social Security No. 176-10-8377 1/9 interest in property located in Huntingdon County as described on Deed attached hereto as Schedule A (per Huntingdon County tax assessment $6.640 and common level ratio of 5.99) 4,419.29 Total Real Estate $4,419.29 3 REV-1500 COMMONWEALTH OF PENNSYLVANIA [ INHERITANCE TAX RETURN DEPAR3~ENT OF REVENUE ...... ~_.!s~."."_~' ~:~,_,....g2,~o~? .... ~_ .... _RESIDENT DECEDENT FILE NUMBER 2l 03 0896 ....... C_O. UN~_~ C~O D~E_ YE~A_~ NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ........ ?- ~OCiA~ECL~RIT~ NU-I~E~ I YANTZ, CATHERINE S. 176-10-8377 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE I10/]1/2003 I 05/19/1911 APPLICABLE) SURVIVING SPOUSE'S NAME i I--A-~T, FiRS~-~ND~MIDDL~iNiTiAL) - ' I REGISTER OF WILLS ' ~c)c~AL S~EC~ NUMBER [] 1. Original Return - ~ ~i Supplemen~t~l Return ~ ~. R~maind~r I~tur~d~t~ 0r death prior tO '~2-13-82) [] 4. Limited Estate [] 4a. Future Interest Compromise (date of death after 12-12-82) [] 5. Federal Estate Tax Return Required [] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach z of Will) [] 9. Litigation Proceeds Received copy of Trust) [] 10. Spousal Poverty Credit (date of death between __ 8. Total Number of Safe Deposit Boxes [] 11. Election to tax under Sec. 9113(A) (Attach Sch O) IAME Jolm R. ZonarJch Skarlatos&Zonarich LLP ~ELEPHONENUMB~R 717/233-1000 204 State Street Harrisburg, PA 17101 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) .... 4~,41.9.29::: 5,023.20 None None ..... 30_,278:30 37,609.74 None 12,923.64 8,678.34 (8) 77,330.53 (11) (12) 21,601.98 55,728.55 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) ................................... (14) 55,728.55 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) x .00 16. Amount of Line 14 taxable at lineal rate 55,728.55 x 17. Amount of Line 14 taxable at sibling rate x .12 18. Amount of Line 14 taxable at collateral rate x .15 19. Tax Due 20. [] (15) (16) (17) (18) (19) 2,507.78 2,507.78 Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 100 Mt. Allen Drive P. O. Box 2015 · Mechanicsburg !zip 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 2,400.00 C. Discount 125.3 9 (1) 2,507.78 Total Credits (A + B + C) (2) 2,5 2 5.3 9 3. Interest/Penalty if applicable D. interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) ] 7.6 | 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. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .............................................................................. b. retain the right to designate who shall use the property transferred or its income; ............................. c. retain a reversionary interest; or ...................................................................................................... d. receive the promise for life of ether oavments benefits or car '~ ............. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate cons derat on9 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 des gnat on'~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury I dec~are that I have examined this return including accompanying schedules and statements, and _preparer other than the P~rsonal representative is based on all info~ation of which preparer has any knowledge, to the best of my knowledge and belief, it is true, correct and complete. Declaration of OF PERSON RESPONSIBLI 3R FIING RETURN ADDRESS Barchuk DATE 5545 Barbara Drive Mechanicsburg, PA 17050 ADDREs~ SI( = OF PREPARER ( REPRESENTATIVE ADORESS DATE 204 State Street Harrisburg, PA 17 ! 01 For .da. tes 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 survlwng 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 net value of transfers to Dr for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. {}9116 1.2) [72 P.S. {}9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. {}9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF YANTZ, CATHERINE S. SCHEDULE A REAL ESTATE FILE NUMBER ITEM NUMBER DESCRIPTION 1/9 interest in property located in Huntingdon COunty a~ desc-~ibe~d 0n-Dee-d ~tt~he-d h~reto a~ S~heclule (per Huntingdon County tax assessment $6.640 and common level ratio of 5.99) TOTAL (Also enter on Line 1, Recapitulation) VALUE AT DATE OF DEATH 4,419.29 4,419.29 21 - 03 - 0896 All real prope .r~y owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which propertY/would be exchanged between a willing buyer and a willing 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. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF YANTZ, CATHERINE S. iFILE NUMBER 21-03-0896 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION I 368 Shares First Commonwealth Financial Corp. ~ 13.65 per share ~VALUE AT DATE Of UNIT VALUE ] DEATH 13.65I 3,023.20 TOTAL (Also enter on line 2, Recapitulation) 5,023.20 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF YANTZ, CATHERINE S. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21 - 03 - 0896 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 DESCRIPTION Omega Bank Certificate of Deposit No. 173-0040250 (per verification attached hereto as Schedule E) Omega Bank Certificate of Deposit No. 173-0040250 (accrued interest to DOD per verification attached hereto as Schedule E) AT DATE OF DEATH 1%oo.oo 0.99 3 4 Omega Bank Certificate of Deposit No. 173-0040251 (per verification attached hereto as Schedule E) Omega Bank Certificate of Deposit No. 173-0040251 (accrued interest to DOD per verification attached hereto as Schedule E) 10,000.00 22.08 Omega Bank Certificate of Deposit No. 173-0040263 (per verification attached hereto as Schedule E) Omega Bank Certificate of Deposit No. 173-0040263 (accrued interest to DOD per verification attached hereto as Schedule E) 10,000.00 10.28 PA Department of Revenue - 2003 Income Tax Refund Highmark BC/BS - Premium refund 83.95 161.00 ., TOTAL (Also enter on Line 5, Recapitulation) 30,278.30 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF YANTZ, CATHERINE S. !FILE NUMBER 21 - 03 - 0896 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT ^ Patricia R. Barchuk 5545 Barbara Drive Daughter Mechanicsburg, PA 17050 JOINTLY OWNED PROPERTY: ~T~A LE'I-rER ~ DATE N 0 ~-I~'~R !FOR JOINTI MADE 1 A 2 A 3 A A 4 .... DESCRIPTION O# ~rbl~E R-TY ........ ,- · TENANT JOINT ]0/30/199] 10/30/1991 04/13/1992 04/13/1992 A 10/26/2001 A 10/26/2001 A A 01/11/1985 01/11/1985 Include name of financial institution and bank account number 3r similar identifying number. Attach deed for jointly-held real ~estate. Omega Bank Certificate of Deposit No. 003-1259170 (per verification attached hereto as Schedule E) Omega Bank Certificate of Deposit No. 003-1259170 (accrued interest to DOD per verification attached hereto as Schedule E) Omega Bank Certificate of Deposit No. 003-1259871 (per verification attached hereto as Schedule E) Omega Bank Certificate of Deposit No. 003-1259871 (accrued interest to DOD per verification attached hereto as Schedule E) First Commonwealth Bank Certificate of Deposit No. 0113 200 0000213 (per verification attached hereto as Schedule F) First Commonwealth Bank Certificate of Deposit No. 0113 200 0000213 (accrued interest to DOD per verification attached hereto as Schedule F) First Commonwealth Bank Certificate of Deposit No. 2445 000 0003402 (per verification attached hereto as Schedule F) First Commonwealth Bank Certificate of Deposit No. 2445 000 0003402 (accrued interest to DOD per verification attached hereto as Schedule F) % OF ' DATE OF DEATH DATE OF DEATH DECD'S VALUE OF VALUE OF ASSET INTEREST DECEDENT'S INTEREST .... 15,0~)~.00 50%1 7,500.00 94.50 10,000.00i 84.821 10,000.00] 50% 50%1 50%I 47.25 5,000.00 42.41 18.30 10,000.00 3.2( Total of Continuation Schedule(s) TOTAL (Also enter on line 6, Recapitulation 50% 50%i 50% 50%1 5,000.00 9.15 5,000.00 1.60 15,009.33 37,609.74 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY continued ESTATE OF YANTZ, CATHERINE S. If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. rFILE NUMBER [ 21- 03- 0896 JOINTLY OWNED PROPERTY ITEM LETTER NUMBER FOR JOINT TENANT 9 l0 ll 12 ~- .... -E)E~CRI~TI-ON OF pROPER:~' - ~- - ' ] DATE Ilncl.ud.e, name of financial institution and bank account number r~aT~ ~= r~=^-,-u % OF ' DATE f31: MADE [or.sl.m,,ar identifying number. Attach deed for jointly-held real ~,~.~.~.l~E~-~="~"~'~r I DECD'S ! vA~'~E~0-'F'-' JOINT lestate. _____'~'~'"_~"*? ' ;INTEREST~ DEC_E.D~;T,s I;:rEREST 01/24/1994 First Commonwealth Bank Certificate of Deposit No. 10,000.00 50%j 5,000.00 01/24/1994 09/07/2001 09/07/2001 2425 0000 920583 (per verification attached hereto as Schedule F) First Commonwealth Bank Certificate of Deposit No. 2425 0000 920583 (accrued interest to DOD per verification attached hereto as Schedule F) First Commonwealth Bank Certificate of Deposit No. 0113 200 0000162 (per verification attached hereto as Schedule F) First Commonwealth Bank Certificate of Deposit No. 0113 200 0000162 (accrued interest to DOD per verification attached hereto as Schedule F) 14.89 20,000.001 3.75 50%J 7.45 50% 50% 10,000.00 1.88 Page 2 of Schedule F COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCI-EI:AJLE H ~EXPENSES& AD~~TIVE COSTS ESTATE OF Y^NTZ, C^THEPdNE S. Debts of decedent must be reported on Schedule I. ITEM ................. NUMBER DESCRIPTION r AMOUNT A. FUNERAL EXPENSES: 1 Robert D. Heath Funeral Home 2 Bilger's Monuments - Headstone inscription 3 Honorarium 4 Funeral luncheon 2 ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Skarlatos & Zonarich LLP Family Exemption: (If decedent's address is not the same as claimanrs, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent Probate Fees Register of Wills State ~ Zip Accountant's Fees Preparation of Final Income Tax Returns Tax Return Preparer's Fees Fiduciary Income Tax Return Other Administrative Costs Recorder of Deeds - Fee to record deed for decedent's I/9 interest in Huntingdon County property Seaboard Surety Company - Fee to replace certificate for First Commonwealth stock Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) 41.00 12,923.64 3,700.00 107.00 100.00 550.00 34.00 109.74 7,681.90 270.00 80.00 250.00 FILE NUMBER '~ Schedule H I COMMONWEALTH OF PEN.SY,VAN~A Funeral Expenses & INHERITANCE TAX RETURN RESIDENT DECEDENT Admin~ Cosls conlinued YANTZ, CATHERINE S. I FILE NUMBER 2] 03 - 0896 Register of Wills - One Short Certificate Register of Wills - Inheritance Tax/Inventory Filing Fee Register of Wills - Release Filing Fee 3.00 28.00 10.00 Page 2 of Schedule H COMMONV~EALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF YANTZ, CATHERINE S. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 - 03 - 0896 Include unreimbursed medical expenses. ITEM NUMBER 1 2 3 DESCRIPTION First Health Services Corporation/PACE - Balance due Messiah Village - Balance due Boscov's - Account balance due TOTAL (Also enter on Line 10, Recapitulation) AMOUNT 36.41 7,932.74 709.19 8,678.34 · REV-1513 EX+ (9-00) = SCHEDULE J COMMONWEALTH Or PENNSYLVAN,A : BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF YANTZ, CATHERINE S. I FILE NUMBER I 21 - 03 - 0896 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY ! DECEDENT ..... o~ No* ~_,,t T,,,-,--~.s).~ OF ESTATE Io TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 PatTicia R. Barchuk Daughter Entire Estate Residue 5545 Barbara Drive Mechanicsburg, PA 17050 II. I Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet NON-TAXABLE DISTRIBUTIONS: I A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE lB. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI TOTAL OF ESTATE OF CATHERINE S. YANTZ FILE NO. 21 - 03 - 0896 INHERITANCE TAX RETURN - SCHEDULE A SOPHIA SZCZ~HBA TO CATH~INk S. YAN~Z, k'T AL Made the seventh Lord one thouund nine hundred and f~f~y-one $2.20 Rev. Sips. eek day of February in the year of om B6tween SOPHIA SZCZ~RBA, widow, Huntingdon, Pennsylvania, party of the first pert and hers- inafter called the ~ ~ . ~ ·' ' ', U on, Pa., MARY S. PANASI Mount Union, Pa., ANNIE S. OLIV ntingdon Pa ..... TI, Tyrone, Pa., STELLA S. BODNAB, - , ., ~O~N A. SZCZERBA, Huntingdon, Pa., JULIA S. TUHIANA, Lakemont Pa., SOPHIA S. LOS, I'Iount Union, Pa., FRANKiE. SZCZERBA, Huntingdon, Pa., and F~ANCBS S. RE~K, Huntingdon~ Pa., parties of the second p4rt and hereinafter called {he ~if~85$~th, th.t i. eo..id.r.tlo, o~ ON~ (81.00) and ......... No/lO0 Dolla~ i. h~d p.id, th. receyt ~ that certain piece, parcel or lot of ~round, with buildings and improvements thereon erected, situate in the Borough of Huntingdon, County of Huntingdon and Commonwealth of Penns~'lvania, bounded and described as follows:. FRONTING fifty (~0) feet on the baste~ly side of Penn Street (formerly Hill Street), and extending back of equ~l width a distance of one Bundred fifty (1~0) feet to a fifteen (1~) house and outbuildings' BEING Lot No. & in Block No. 11 of the ~harton, Miller and Anderson Addition to the Borough of Huntingdon, which '~ddition Plan i9 ~ecorded in the Reco~der's Office of Huntingdc, n County in Deed Book Vol. "C", No. 3, pa~e 13&~. BEING the same p~emises which Ha~ry W. Petrlken by his deed dated May 23, 19~0 and re- corded im the ~eeo~der's Office of Huntingdon County, in Deed Boo~ "I" Vol. 7, page 208, And the said John Sczczerba having departed this life January 22, 1916, the entire title to the said premis.s then vested solely in Sophia Sczczerba, the surviving spouse, who It is expressly agreed, however, by the parties hereto that Sophia Szczerba, the said granter, ~eserves unto herself durJnK the full term of her natural life the ~lfht of possession and occupancy in and to the said real ~state a~d the ~ents and profits arising therefrom and intends to convey unto the grantees herein the full fee title of the said real estate subject only to a life estate h~ei~ reserved by the said grantor. REv-les Ex BK 700PG0189 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE REALTY TRANSFER TAX STATEMENT OF VALUE RECORDER'S USE ONLY ~ate Tax Paid Book Number Po~. Nu~.~ ! ,,S"'~- BUREAU OF INDIVIDUAL TAXES DEPT. 280603 HARRISBURG, PA 171284)603 See Reverse for Instructions Complete each section and file in duplicate with Recorder of Deeds when (1) the full value/consideration is not set forth in the deed, (2) when the deed is without consideration, or bY gift, or (3) a lax exemption is claimed. A Statement of Value is not required if the transfer is ~holl exam t from tax based on: (1) family relationship or (2) public utility easement. If more space is needed, attach additional sheetJs). Y P A CORRESPONDENT - All inquiries may be directed to the following person: Street Address ° -0 B TRANSFER DATA ~.~ 0f ~.~:~..ce Grantor(s)/Lessor(s) ~/~L~-~/~,.~.~ ,~. ~~ff, ~. ~ Grontee(s)/Les~(s) Strut Address ' ]Strut AdGress Ci~ State Zip Code / C P~OPER~ LOCATION Telephone Number: Stole Zip C~e of ~um~ Zip Code 5treat Address D VALUATION DATA 1. Actual Cash Consideration /.~ 4. Courtly Assessed Value E EXEMPTION DATA la. Amount/~ i~)' ~//d°f Extmption Claimed J 1 b. Percentage// // %of Interest Conveyed 2. Check Appropriate Box !Below for Exemption Claimed INa'me o~ [] Transfer to Industrial OevoJopment Agency. iCily, Township, Borough H~n'~, ~ ~d~ ,~ J Sd~ool Dis~id ~ I Tax pa~ei Numar 1 Other Consideration ~ Comm~,e~R~o Factor 3. Total Consideration = /.~ 6. Fair Mark.t Value File NumberI [] Transfer to a trust. (Attach complete copy .of trust agreement identifying all beneficiaries.) [] Transfer between principa/and agent. (Attach complete copy of agency/straw party agreement.} [] Transfers to the Commonwealth, the United States and Instrumentalities by gift, dedication, condemnation or in lieu of condemnation. (If condemnation or in lleu of condemnation, attach copy of resolution.) [] Transfer from mortgagor to a holder of a mortgage in default. Mortgage Book Number , Page Number [] Corrective or confirmatory deed. (Atlach complete copy of the prior deed being corrected or confirmed.) [] Statutory corporate consolidation, merger or division. (A~ach copy of articles.) [] Other (Please explain exemption claimed, if other than listed above.) Under penalties of law, I declare that I hove examined this Statement, including accompanying infonnaticm, and to the be~l of my knowledge and bellef.~/~ is true, correct and complete. FAILURE TO COMPLETE THIS TO RECORD THE DEED. FORM PROPERLY OR ATTACH APPLICABLE DOCUMENTATION MAY RESULT IN THE RECORDER'S REFUSAL ESTATE OF CATHERINE S. YANTZ FILE NO. 21 - 03 - 0896 INHERITANCE TAX RETURN - SCHEDULE E OMEGA BANi( Member FDIC November 18, 2003 Skarlatos & Zonarich Attorneys at Law 204 State Street Harrisburg PA 17101 RE: Catherine Yantz Date of Death: October 11, 2003 Dear Mr. Zonarich: This letter is in regards to the accounts that Catherine Yantz held with our financial institution. Listed below is the information that you requested. 4 o Certificate of Deposit # 003-1259170 Balance as of date of death $15,000.00 Accrued interest as of date of death $94.50 Accrued interest year to date of death $447.91 Date account opened October 30, 1991 The account is joint with Patricia Barchuk Certificate of Deposit # 003-1259871 Balance as of date of death $10,000.00 Accrued interest as of date of death $84.82 Accrued interest year to date of death $342.11 Date account opened April 13, 1992 The account is joint with Patricia Barchuk Certificate of Deposit # 173-0040250 Balance as of date of death $10,000.00 Accrued interest as of date of death $.99 Accrued interest year to date of death $42.18 Date account opened May 7, 2003 The account is just in the decedent's name Certificate of Deposit # 173-0040251 Balance as of date of death $10,000.00 Accrued interest as of date of death $22.08 Accrued interest year to date of death $53.33 Date account opened May 7, 2003 The account is just in the decedent's name PO Box 298 State College, PA 16804-0298 Customer Information Center, Toll Free: 1-877-861-7800 Certificate of Deposit # 173-0040263 Balance as of date of death $10,000.00 Accrued interest as of date of death $10.28 Accrued interest year to date of death $45.32 Date account opened June 14, 2003 The account is just in the decedent's name If we can be of any further assistance to you please call or write. Sincerely, ~ Linda Confer Deposit Service Representative (800) 494-1810 Ext # 7574 ESTATE OF CATHERINE S. YANTZ FILE NO. 21 - 03 - 0896 INHERITANCE TAX RETURN - SCHEDULE F OMEGA BANK Member FDIC November 18, 2003 Skarlatos & Zonarich Attorneys at Law 204 State Street Harrisburg PA 17101 RE: Catherine Yantz Date of Death: October 11, 2003 Dear Mr. Zonarich: This letter is in regards to the accounts that Catherine Yantz held with our financial institution. Listed below is the information that you requested. Certificate of Deposit # 00371259170 Balance as of date of death $15,000.00 Accrued interest as of date of death $94.50 Accrued interest year to date of death $447.91 Date account opened October 30, 1991 The account is joint with Patricia Barchuk 2 o Certificate of Deposit # 003-1259871 Balance as of date of death $10,000.00 Accrued interest as of date of death $84.82 Accrued interest year to date of death $342.11 Date account opened April 13, 1992 The account is joint with Patricia Barchuk Certificate of Deposit # 173-0040250 Balance as of date of death $10,000.00 Accrued interest as of date of death $.99 Accrued interest year to date of death $42.18 Date account opened May 7, 2003 The account is just in the decedent's name 4 o Certificate of Deposit # 173-0040251 Balance as of date of death $10,000.00 Accrued interest as of date of death $22.08 Accrued interest year to date of death $53.33 Date account opened May 7, 2003 The account is just in the decedent's name PO Box 298 State College, PA 16804-0298 Customer Information Center, Toll Free: 1-877-861-7800 Certificate of Deposit # 173-0040263 Balance as of date of death $10,000.00 Accrued interest as of date of death $10.28 Accrued interest year to date of death $45.32 Date account opened June 14, 2003 The account is just in the decedent's name If we can be of any further assistance to you please call or write. Sincerely, ~ hinda Confer Deposit Service Representative (800) 494-1810 Ext # 7574 FILE No.414 12×15 '03 10:52 ID:BRIcKING SERVICE SUPPORT FAX:?24 463 5706 PRGE 2/ 2 ommonwealth Invc~meflls DECEDENT: C,, DATE OF DEATH: Following is the information you requested on thc above: CER..___~TIFICATE OF DEPOS_.IT.IT Title: q~'t~ ~. ~ Open Date:~.: 0 I' DateMade Joint: Ot~.~ Balance Date of Death: Ac, crud Interest: _.2~ / t~. ~ O .CERTIFICATE OF DEPOSIT Open Date:_J.x~l- Date Made $oin~:~~~,~.~ Balance Date of'Death: Aecruodhatemst: '~. -,~. .s. are PEPOSZT BOX Box No.:__ Title: Location: CERTIFICATE OF DE. POSIT Acct. No.:~ Title: C~.'~e,~teoq;-- ~. ~_T_~ Ac~t~e~: ~ t~. R~ SER~cA~ OF DEPOSIT ~Da~: ~-~-0/ lfyou have any questions, please call me aI._~_~q_:~qot/./I ,._% 7 Sincerely, ESTATE OF CATHERINE S. YANTZ FILE NO. 21 - 03 - 0896 INHERITANCE TAX RETURN LAST WILL AND TESTAMENT LAST WILL AND TESTAMENT OF CATHERINE S. YANTZ I, CATHERINE S. YANTZ, a widow, presently of 6407 Cannon Drive, Mechanicsburg, Cumberland County, Pennsylvania 17050, declare this to be my Last Will and revoke any Will previously made by me. ITFM l: I direct that all my just debts and funeral expenses, including the cost of a suitable grave marker and perpetual care for my burial plot, shall be paid from the assets of my estate as soon as practicable after my decease. lTEM Il: I give, devise and bequeath all of my estate, real, personal and mixed wheresoever situated to my daughter, PATRICIA R. BARCHUK of 6407 Cannon Drive, Mechanicsburg, Pennsylvania 17050, per stirpes. If my daughter, PATRICIA R. BARCItUK predeceases me, then I give, devise and bequeath all of my estate to be divided among my three grandchildren, MICHAEL R. BARCHUK, MICHELE R. BARCHUK TIDAY and LISA A. BARCHUK TIDAY, in equal shares, per stirpes. Should any of my above-named grandchildren predecease me, then I give, devise and bequeath his or her share of _my estate to his or her Issue, per stirpes. Should any of my above-named grandchildren predecease me leaving no Issue, then I give, devise and bequeath my deceased grandchild's share of my estate to be divided equally between my. remaining grandchildren surviving at my death. ITFM III: No interest in income or principal shall be assignable by or available to anyone having a claim against a beneficiary before actual payment to the beneficiary. ATTORNEYS AT LAW LAST WILL AND TESTAMENT OF CATHERINE S. YANTZ Page q of 6 ITF~.M IV: All federal, state, and other death taxes payable on the property forming my gross estate for tax purposes, whether or not it passed under this Will, shall be paid out of the principal of my residuary estate just as if they were my debts, and none of those taxes shall be charged against any beneficiary. ITEM V: I authorize my Executor: (a) to retain and to invest in all forms of real and personal property, regardless of (i) any limitations imposed by law on investments by executors or trustees, (ii) any principle or law concerning delegation of investment responsibility by executors or trustees, or (iii) any principle of law concerning investment diversification; (b) to compromise claims and to abandon any property which, in my Executor's opinion, is of little or no value; to borrow from, and to sell property to others, and to pledge property as security for repayment of any funds borrowed; (c) to sell at public or private sale, to exchange or to lease for any period of time any real or personal property, and to give options for sales or leases; (d) to join in any merger, reorganization, voting-trust plan or other concerted action of security holders, and to delegate discretionary duties with respect thereto; (e) to use administrative or other expenses of my estate as income tax or estate tax deductions and to value my estate for tax purposes by any optional method permitted by the law in force when I die, without requiring adjustments between income and principal for any resulting effect on income or estate taxes; and (f) to distribute in kind and to allocate specific assets among the .beneficiaries in such proportions as my Executor may think best, so long as the total market value of any ATTORNEYS AT LAW LAST WILL AND TESTAMENT OF CATHERINE S. YANTZ Page 2 of 6 beneficiary's share is not effected by such allocation. These authorities shall extend to all real and personal property at any time held by my Executor and shall continue in full force until the actual distribution of all such property. All powers, authorities, and discretion granted by this Will shall be in addition to those granted by law and shall be exercisable without leave of court. ITFM VI: I appoint my daughter, PATRICIA R. BARCI-1UK as Executrix under this Will. I direct that any fiduciary acting hereunder shall not be required to enter bond or other security in any Court or jurisdiction in which said fiduciary may be called upon to act. 1TFM VII: I appoint my Executrix as Guardian of the estate over any property that may pass to any minor children with respect to which property I am authorized to appoint a guardian and have not otherwise specifically done so. Such guardian shall have the same management powers as those granted my Executor may pay or apply principal as well as income for the minor's welfare, comfort, support or education, without court approval, and if she, in her sole discretion, determines that it is impractical to administer any fund, she may deposit such fund in one or more savings accounts in the minor's name, payable to him or her at age eighteen (18). The guardian shall have no further responsibility for any funds so paid, applied or deposited. - ATTORNEYS AT LAW LAST WILL AND TESTAMENT OF CA THER1NE S. YANTZ Page 3 of 6 IN WITNESS WHEREOF, I have hereunto set my hand and seal and caused this my Last Will and Testament, consisting of Six (6) typewritten pages, including this attestation clause and the and Affidavit, to be executed, declared and published this followin~p/~cknowledgment C'~77~of-~f4~,2002, at ~~~ ,Pennsylvania. CATIt RINE S. -XNTZ' ATTORNEYS AT LAW LAST WILL AND TESTAMENT OF CATHERINE S. YANTZ Page 4 of 6 ACKNOWI,EDGMENT COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF DAUPH~ ) SS: I, CATHERINE S. YANTZ, the Testatrix: 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. CATHERINE S. YANT~ ~ Sworn or affirmed to and acknowledged before me by CATHERINE S. YANTZ, the Testatrix th'~7 davy of .~ ~(/'/I ~} ~4~ 2002. I/ ' n Expires: ATTORNEYS AT LAW LAST WILL AND TESTAMENT OF CATHERINE S. YANTZ Page 5 of 6 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) : SS: the witnesses, ;~o-se name~~gned ,o the --' - ~. v ~ attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw CATHERINE S. YANTZ, sign and execute the instrument as her free and voluntary act for the purposes therein expressed; that each of us in the heating and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the Testatrix was at the time twenty-one (21))or more years of age, of sound mind and under no constraint or undue Residing at Residing at ~'~rT...~_~0~q tX_ ~ % ~esiding at Sworn or to and acknowledged before me by of ,2002. 5 AT LAW witnes~ 'Public ' don Expiret: LAST WILL AND TESTAMENT OF CA THERINE S. YANTZ Page 6 of 6 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURg, PA 17126-0601 CONNONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLOWANCE OR DZSALLOHANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-1547 EX AFP JOHN R ZONARTCH SKARLATOS & ZONARICH 204 STATE ST H B G.,=: .~. DATE 08-16-2004 ESTATE OF YANTZ CATHERINE S DATE OF DEATH 10-11-2003 FILE NUNDER 21 03-0896 COUNTY CUNBERLAND ACN 101 Aeoun~ ReaA~ted I .;.::PA.:~ 17101 HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 L]~ i1~ RETAIN LO#ER PORTION FOR YOUR RECORDS CUT ~ ~ ~[~ALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE O~ YANTZ"-' ;jd CATHERINE S FILE NO. 21 03-0896 ACN 101 DATE 08-16-2004 TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Estete (Schedule A) (1) 2. Stocks end Bonds (Schedule B) 3. Closely Held Stock/Par~:nershAp Interest (Schedule C) ($) ~. Nortgages/Notes ReceAvable (Schedule D) (~) $. Cash/Bank DeposAts/NAsc. Personal Property (Schedule E) (S) 6. JoAntly Owned Property (Schedule F) (6} 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEHPTIONS: 9. Funeral Expenses/Ada. Costs/HAsc. Expenses (Schedule H} (9) 10. Debts/Nortgege LAabilities/Liens (Schedule Z) (10) 11. 12. 1:5. NOTE: 4~419.29 5~023.20 .00 .00 30~278.30 $7~609.74 .00 (8) 12,923.64 NOTE: To Ansure proper credAt to your account, subaAt the upper portAon of thAs fora wAth your tax payment. 8,678.34 Total Deduct ions (11) Net Value of Tax Re4:urn (12) CharAtable/Governaental Bequests; Non-elected 911:5 Trusts (Schedule J) (15) Net Value of Estate Subject to Tax (1~+) ;f an assessment was lssued previously, 11nes 1~, 15 and/er 16, reflect flgures that lnclude the total of ALL returns assessed to date. 77,330.53 21.601.98 55,728.55 ASSESSHENT OF TAX: 16. Aeount of LAne 1~, at Spousal rate 16. Amount of LAne 1~ taxable at Lineal/Class A rate 17. Aeount of LAne 1~, at SAblAng rate 18. Aeount of LAne lfi taxable at Collateral/Class B rate 19. PrAncipel Tax Due TAX CREDITS: PAYNENT RECEIPT DISCOUNT (+) DATE NUNBER INTEREST/PEN PAID (-) 01-09-2004 CD003428 125.39 08-09-2004 REFUND . O0 .00 55,728.55 17, 18 and 19 will (1~} .00 x O0 = .00 (16) 55,728.55 x 045= 2,507.78 (17) . O0 x 12 = . O0 (18) .00 x 15 = .00 (19)= 2,507.78 ANOUNT PAID 2,400.00 17.61- IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX CREDIT I 2,507.78 BALANCE OF TAX DUEl .00 INTEREST AND PEN. .00 TOTAL DUE . O0 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REi~UZRED. ~ ZF TOTAL DUE IS REFLECTED AS A 'CREDIT' (CR), YOU NAY BE DUE ~-~ A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.) RESERVATION: Estates of decedents dying on or before December 1Z; 19BE -- if any futura interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonaaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the Iaaful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYHENT: REFUND (CR): OBJECTIONS: ADHIN- ISTRAT/VE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section Zl~O of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (72 P.S. Section 91~0). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGISTER OF NILES, AGENT A refund of a tax credit, which was not requested on the Tax Return; amy be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISiS). Applications are available at the Office of the Register of Hills, any of the 25 Revenue District Offices; or by calling the special Z~-hour answering service for forms ordering: 1-BOO-~6Z-ZOSO; services for taxpayers with special hearing and / or speaking needs: l-BOO-fi~7-5OZO (TT only). Any party in interest not satisfied with the appraisement, allowance; or disallowance of deductions; or assessment of tax (lncIuding discount or interest) as shown an this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals; Dept. 281OIl; Harrisburg; PA 17128-lOZ1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue; Bureau of Individual Taxes; ATTN: Post Assessment Review Unit; Dept. IS0601, Harrisburg; PA 171Z8-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death; a five percent (SI) discount of the tax paid is allowed. The 15X tax amnesty non-participation penalty is computed on the total of tho tax and interest assessed; and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has bean assessed as indicated on this notice. Interest is chorded beginning with first day of delinquency; or nine (9) months and one (1) day from the date of death; to the date of payment. Taxes which became delinquent before January 1; 198Z bear interest at the rata of six (6Z) percent per annum calculated at a dally rate of .000164. Al1 taxes which became delinquent on and after January l, 19BI will bear interest et a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOO4 are: Interest Daily Interest Daily Interest emily Year Rate Factor Year Rate Factor Year Rate Factor ~'~ 20Z .0005fi8 ~'~-1991 llZ .000~01 ~ 9Z .OOOZfi? 1983 162 .OOOq58 1992 9Z .000Z¢7 200Z 62 .000164 19B~ llZ .000~01 1995-199~ 7Z .OOOlgZ ZOO5 5Z .000157 1985 152 .000556 1995-1998 9Z .OOOZfi7 ZO0~ 4Z .000110 1986 lOX .00027~ 1999 72 .00019Z 1987 lOX .000274 ZOOO 7Z .O0019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINilUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. ESTATE OF CATHERINE S. YANTZ, Deceased IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE NO. 21 - 2003~96 :: RECEIPT~ RELEASE AND INDEMNIFICATION AGRE~hlENT For Full Distribution This~ Receipt, Release a0d Indemp, ification Agreement (hereinafter referred to as '*~'greement") is given this 16~ day of ~5.)01]efflD'~ r, 2004, by PATmCIA R. BARCHUK o _B545 Barl ara Drive, Mechanicsburg, Pennsylvania 17050, (hereinafter referred to as "Beneficiary"). WITNESSETH: WHEREAS, Catherine S. Yantz, (hereinafter referred to as "Decedent"), late of Upper Allen Township, Cumberland County, Pennsylvania, died testate on October 11, 2003, having first made a Last Will and Testament, duly executed on September 27, 2002, which is recorded in the Office of the Register of Wills of Cumberland County, Pennsylvania; WHEREAS, Letters Testamentary on the Estate of the said Decedent were duly issued on October 30, 2003, by the Register of Wills of Cumberland County, Pennsylvania, unto Patricia R. Barchuk, who by the Decedent's aforesaid Last Will and Testament was appointed as Executrix of the Estate (hereinafter referred to as "Executrix"); WHEREAS, the Executrix has paid all the debts, taxes and expenses of the Estate known to them as detailed in the Pennsylvania Inheritance Tax Return and Tax Assessment Notice, and she has no knowledge of any unpaid claim which may be asserted against the Estate, nor does she have any reason to believe that there are any such claims; WHEREAS, the Beneficiary, pursuant to the Decedent's Last Will and Testament is beneficially interested in the above referenced estate; and WI-~REAS, it is the desire of the Beneficiary that distribution be made without the formalin of an accounting, and the Executrix is willing to make such distribution upon the receipt of a proper release and indemnification, which it is the purpose of this Agreement to provide. NOW, THEREFORE, intending to be legally bound hereby, the Beneficiary represents, warrants, covenants and agrees as follows: 1. Waiver of Accounting. The Beneficiary hereby waives the necessity for an accounting and directs the Executrix to dispense with a formal audit of the same. 2. Receipt. The Beneficiary requests the Executrix to make distribution of the following property (adjusted for subsequent income and expenses) and effective upon delivery to the undersigned of the property shown as distributable, acknowledges receipt of such property: Page 1 of 3 Cash -$2,501.97 The Beneficiary does further acknowledge that the aforesaid distribution, in addition to any partial distribution made prior to the date of this Agreement, represents the Beneficiary's entire interest in the above-referenced estate, as detailed in the Informal Accounting attached hereto as Exhibit A. 3. Release. Upon having received the above described property distribution, the Beneficiary does by these presents remise, release, quit-claim and forever discharge from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, (a) the Executrix for or by reason of the Executrix's administration of the above-referenced Estate, or any other act, matter, cause or thing whatsoever; and (b) Skarlatos & Zonarich LLP, its employees, successors and assigns, for or by reason of their representation of the Executrix, or any other act, matter, cause or thing whatsoever. 4. Indemnification. In exchange for the Executrix's willingness to make the distribution hereunder without first securing the benefit of a formal court audit, the Beneficiary agrees to indemnify Executrix and Skarlatos & Zonarich LLP, its employees, successors and assigns, and hold them harmless, to the extent of any funds or assets received by the Beneficiary hereunder, from and against the Bcneficiary's then pro rata share of any and all liabilities, losses, damages, costs, verdicts, judgments, awards and expenses (including attorney's fees and other costs or expenses of defense) to which (i) the Executrix may be subjected by reason of the Executrix's administration of the above referenced Estate, as well as the settlement thereof by means of an informal distribution; and (ii) Skarlatos & Zonarich LLP, its employees, successors and assigns may be subjected by reason of their representation of the Executrix. The Beneficiary further agrees to: a. Refund or return, promptly upon the Executrix written demand, any funds or assets distributed by the Executrix to the Beneficiary, if the distribution thereof is determined at any time to have been an erroneous or negligent distribution to the Beneficiary, whether such error or negligence was or was claimed to have been premised upon a mistake of law or of fact. b. Modify and displace any otherwise applicable period limiting the time within which the Executrix's action to collect an erroneous or negligent distribution must be commenced, so as to provide that the Executrix need not commence an action to collect an erroneous or negligent distribution to the Beneficiary until two (2) years atter such time as the Executrix shall have obtained actual knowledge of such error or negligence. 5. Miscellaneous a. The provisions of this Agreement shall be deemed severable in the event that one or more thereof shall be deemed invalid or unenforceable, with the effect that the remaining provisions shall persist as if such invalid or unenforceable provision had never been a part hereof. In addition, the construction, effect, validity and performance of this Agreement shall be governed in all respects by the laws of the Commonwealth of Pennsylvania, without regard to its conflict of laws provision. b. This Agreement shall bind the Beneficiary, the Beneficiary's heirs, representatives, successors, and assigns together with any person with respect to whom the Beneficiary is a natural or appointed guardian. Page 2 of 3 c. The Beneficiary hereby acknowledges that this Agreement may be filed at any time, at the discretion of the Executrix with any court of competent jurisdiction, and the Beneficiary consents to any such filing. IN WITNESS WHEREOF, the Beneficiary has executed and sealed this Agreement on the date first above inscribed. PATRICIA R. BARCHUK Social Security Number: 160-34-1599 STATE OF PENNSYLVANIA COUNV O SS: On this, the {:M-- day of J~k)OI/g, tYl b Eg-- ,2004, before me, the undersigned authority, personally appeared PATRICIA R. BARCHUK, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Release and acknowledged that the Beneficiary executed the same for the purpose therein contained. Wimess my hand and official seal the day and date aforesaid. NOTARY PI~LIC- My Commission Expires: l NOTARIAL SEAL I .~¥ L. S_H~FF~R. N~ ~ ~ala~esex fY,9., Cumberland Cour~ My Commissio~ Expires June 10, 2~06 Page 3 of 3 SKARLATOS AND ZONARICH LLP ATTORNEYS AT LAW 204 STATE STREET HARRISBURG PENNSYLVANIA 17t01 (717)233-1000 FAX (717)233-6740 Accounting Of: Estate of Catherine S. Yantz As Of: 1012/04 Description Deposi~ First Commonwealth Fin. Corp. - Interest/Dividends PA Dept. of Revenue - Refund Highmark - Reund Omega Bank - Interest First Health Services Corp. First Commonwealth Fin. Corp, - Close CD Omega Bank - Close CD's Messial Village Boscov's - Barchuk Acct. Commerce Bank - Interest Register of Wills - Inheritance Tax Pmt. Robert D. Health Funeral Home - Funeral Recorder of Deeds - Recording Fee Seaboard Surety Co. - Certificate Replacement Register of Wills - Short Certificate Bilger's Monuments Patricia Barchuk - Partial Distribution Register of Wills - Filing Fee PA Dept. of Revenue - Inheritance Tax Refund Skarlatos & Zonarich LLP - Fee Skarlatos & Zonarich LLP - Costs Register of Wills - Release Filing Fee (Reserve) Preparation of Fiduciary Income Tax Return (Reserve) 346.09 83.95 161.00 157.98 20,006.25 45,046.2O 293.59 17.61 Balance of Estate for Distribution Disbursements 36.41 7,932.74 709.19 2,400.00 7,681.90 34.00 109.74 3.00 270.00 40,000.00 28.00 3,700.00 145.72 10.00 550.00 2,501.97 2501.97 Final Distribution Patdcia Barchuk Exhibit A Report Date: 10/27/2004 ESTATE OF CATHERINE S. YANTZ, Deceased IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE NO. 21-03-0896 RECEIPT~ RELEASE AND INDEMNIFICATION AGREEMENT For Partial Distribution This Receipt, Release/~nd Indemnification Agreement (hereinafter referred to as "Aereement'"} is given this t,2 t/ day of ~ , 2004, by PATRIC,,L~ R. BARC,,,HUK, of 5~545 Barb~ra Drive, Mechanicsburg, Penns~lvania, 17050 (hereinafter referred to as Beneficiary ). WITNESSETH: WHEREAS, Catherine S. Yantz (hereinafter referred to as "Decedent"), late of Upper Allen Township, Cumberland County, Pennsylvania, died testate on October 11, 2003, having first made a Last Will and Testament, duly executed on September 27, 2002, which is recorded in the Office of the Register of Wills of Cumberland County, Pennsylvania; WHEREAS, Letters Testamentary on the Estate of the said Decedent were duly issued on October 30, 2003, by the Register of Wills of Cumberland County, Pennsylvania, unto Patricia R. Barchuk, who by the Decedent's aforesaid Last Will and Testament was appointed as Executor of the Estate (hereinafter referred to as "Executor"); WHEREAS, the Executor has been advised that the Statute of Limitations for presentment of claims against the estate have not expired, and that any claims presented subsequent to this distribution are the responsibility of the Executor/distributee; WHEREAS, the Beneficiary, pursuant to the Decedent's Last Will and Testament is beneficially interested in the above-referenced estate; and WHEREAS, it is the desire of the Beneficiary that distribution be made without the formality of an accounting, and the Executor is willing to make such distribution upon the receipt of a proper release and indemnification, which it is the purpose of this Agreement to provide. NOW, THEREFORE, intending to be legally bound hereby, the Beneficiary represents, warrants, covenants and agrees as follows: 1. Waiver of Accounting. The Beneficiary hereby waives the necessity for an accounting and directs the Executor to dispense with a formal audit of the same. 2. Receipt. The Beneficiary requests the Executor to make distribution of the following property (adjusted for subsequent income and expenses) and effective upon delivery to the undersigned of the property shown as distributable, acknowledges receipt of such property: Cash - $40,000.00 Page 1 of 3 The Beneficiary does further acknowledge that the aforesaid distribution represents the Beneficiary's partial interest in the above-referenced estate. 3. Release. Upon having received the above described property distribution, the Beneficiary does by these presents remise, release, quit-claim and forever discharge from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, (a) the Executor for or by reason of the Executor's administration of the above-referenced Estate, or any other act, matter, cause or thing whatsoever; and (b) Skarlatos & Zonarich LLP, its employees, successors and assigns, for or by reason of their representation of the Executor, or any other act, matter, cause or thing whatsoever. 4. Indemnification. In exchange for the Executor's willingness to make the distribution hereunder without first securing the benefit of a formal court audit, the Beneficiary agrees to indemnify Executor and Skarlatos & Zonarich LLP, its employees, successors and assigns, and hold them harmless, to the extent of any funds or assets received by the Beneficiary hereunder, from and against the Beneficiary's then pro rata share of any and all liabilities, losses, damages, costs, verdicts, judgments, awards and expenses (including attorney's fees and other costs or expenses of defense) to which (i) the Executor may be subjected by reason of the Executor's administration of the above referenced Estate, as well as the settlement thereof by means of an informal distribution; and (ii) Skarlatos & Zonarich LLP, its employees, successors and assigns may be subjected by mason of their representation of the Executor. The Beneficiary further agrees to: a. Refund or return, promptly upon the Executor's written demand, any funds or assets distributed by the Executor to the Beneficiary, if the distribution thereof is determined at any time to have been an erroneous or negligent distribution to the Beneficiary, whether such error or negligence was or was claimed to have been promised upon a mistake of law or of fact. b. Modify and displace any otherwise applicable period limiting the time within which the Executor's action to collect an erroneous or negligent distribution must be commenced, so as to provide that the Executor need not commence an action to collect an erroneous or negligent distribution to the Beneficiary until two (2) years after such time as the Executor shall have obtained actual knowledge of such error or negligence. 5. Miscellaneous a. The provisions of this Agreement shall be deemed severable in the event that one or more thereof shall be deemed invalid or unenforceable, with the effect that the remaining provisions shall persist as if such invalid or unenforceable provision had never been a part hereof. In addition, the construction, effect, validity and performance of this Agreement shall be governed in all respects by the laws of the State of New Jersey, without regard to its conflict of laws provision. b. This Agreement shall bind the Beneficiary, the Beneflciary's heirs, representatives, successors, and assigns together with any person with respect to whom the Beneficiary is a natural or appointed guardian. c. The Beneficiary hereby acknowledges that this Agreement may be filed at any time, at the discretion of the Executor with any court of competent jurisdiction, and the Beneficiary consents to any such filing. Page 2 of 3 IN WITNESS WHEREOF, the Beneficiary has executed and sealed this Agreement on the date first above inscribed. PATRICIA R. BARCHUK Social Security Number: 160-34-1599 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND On this, the _~.]~7~ day of ~ authority, personally appeared PATRICIA R.~3 person whose name is subscribed to the within~ same for the purpose therein contained. SS: ~ ,2004, before me, the undersigned .CHUK, known to me (or satisfactorily proven) to be the tease and acknowledged that the Beneficiary executed the Witness my hand and official seal the day and date aforesaid. ~O~A~RY PUBLIC ' ~ -- ~' ~/-- My Commission Expires: ' Notadal Seal · Sharon K. Shaffer, Notary Public Harrisburg Dauphin County My Commission Expires Sept. 6, 2004 i~ln~g Peflnsyivania A s ~.,~;~fion of Notaries Page 3 of 3 BUREAU OF INDIVIDUAL TAXES 'rNHERITANCE TAX DTVTSZON DEPT. Z80601 HARRTSBUR{~, PA 171Z8-0601 COHHONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT RE¥-1507 EX AFP JOHN R ZONARICH SKARLATOS & ZONARICH 204 STATE ST HBO PA 17101 DATE 08-25-2004 ESTATE OF YANTZ DATE OF DEATH 10-11-2003 FILE NUHDER 21 05-0896 COUNTY CUHBERLAND ACN 101 Amoun'l: Rem/*~ed CATHERINE S HAKE CHECK PAYADLE AND REHZT PAYHENT TO: ,..., ,.. __ REGISTER OF ~I~'LS CUHBERLAND C~' COURT HOUSE~' CARLISLE, PA:,' 17015~ NOTE: To 1nsuPe pPopeP cPedi~ ~o youP ~ccoun~ submi~ ~he uppeP poP,ion o~ ~hls ~o~m CUT ALONG THZS LZNE ~ RETA/N LOHER PORTION FOR YOUR RECORDS :::: ,'.~ ESTATE OF YANTZ CATHERINE S F'rLE NO. 21 05-0896 ACN 1~01 -'JDATE 08-25-2004 TH'rS STATEMENT IS PROVI*DED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACH TN THE NAMED ESTATE. SHOt/N BELOtI TS A SUMMARY OF THE pR'rNC/PAL TAX DUE, APpLTCAT/ON OF ALL PAYMENTS, THE CURRENT BALANCE., AND, TF APPL'rCABLE, A PROJECTED 'rNTEREST FI'OURE. DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 08-09-2004 PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS)= 2,507.78 PAYHENT RECEIPT DISCOUNT C+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID ¢-) 125.39 01-09-2004 08-09-2004 CD005428 REFUND .O0 2,400.00 17.61- ZF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CRED/T" TOTAL TAX CREDIT 2,507.78 · ALANCE OF TAX DUE .00 ZNTEREST AND PEN. .00 TOTAL DUE .00 YOU NAY BE DUE A REFUND. SEE REVERSE STDE OF THTS FORH FOR TNSTRUCTTONS. ) STATUS REPORT UNDER RULE 6.12 Name of Decedent: CATHERINE S. YANTZ Date of Death: OCTOBER 11, 2003 Will No.: 0896-2003 Admin. No.: Pursuant to Rule 6. 12 of the Supreme Court Orphans' Court Rules, I report that 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 . representative be complete: If the answer is No, state when the personal reasonably believes that the administration will 3. following: If the answer to No. 1 is Yes, state the 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 account informally to the parties in interest? Yes X state an No Date: May 3, 2005 d. Copies of receipts, releases, joinders and formal or informal accounts may be filed with the Orphans' C;;~/~be attach~is report. i /, \. / R. Zonaric (Please type or print) approvals of Clerk of the :'1 Skarlatos & Zonarich LLP 17 S. Second Street, 6th Floor Harrisburg, PA 17101 Address (717)233-1000 Tel. No. Capacity: Counsel for Personal Representative J COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,PENNYSLVANIA ORPHANS' COURT DIVISION Docket No: 21-2003-0897 IN RE: FIRST AND FINAL ACCOUNT OF MANUFACTURERS AND TRADERS TRUST COMPANY AND DUDLEY M. BAKER, III, CO-TRUSTEES OF THE MARSHA BAKER CHARITABLE REMAINDER UNITRUST DATED 06/23/2000 AND PETITION FOR ADJUDICATION/STATEMENT OF PROPOSED DISTRIBUTION ORDER OF COURT AND NOW, this 18TH day of JUNE, 2013, the herein account is confirmed absolutely and distribution is decreed in accordance with the proposed schedule of distribution herewith. BY THE COURT, V C7 u m c m n M = 3> mm rZrn co ;;Ua <n c o z Cy C o � � n ° n O G N O r- m D 67