HomeMy WebLinkAbout03-1029PETITION FOR PROBATE and GRANT OF LETTERS
Estate of HENRY G. NACHMAN
also known as
No.
To:
, Deceased
Social Security No. 195-07-6283
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut OR
in the last will of the above decedent, dated SEPTEMBER 19, 1991
and codicil(s) dated N/A
Register of Wills for the
County of CUMBERLAND
Commonwealth of Pennsylvania
in the
named
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with
h is last family or principal residence at 1520 SLATE HILL ROAD, CAMP HILL, LOWER ALLEN
TOWNSHIP, PA 17011
(list street, number and municipality)
Decedent, then ! ~1 ~'- years of age, died 12/9/03
at 1520 SLATE HILL ROAD, CAMP HILL, PA 17011 ,
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never ajudicated
incompetent: N/A
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 ],~e_npsylvania, ..~ ~F
situated as follows: !_~9)_e~ ~./. ~ /~//I~IY _
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters testamentary
thereon.
GUSTAVE L. WEINSTOCK, JR//
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
1714 MORRISON LANE
FORISTELL MO 63348
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND ; SS
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 and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and R-uly administer the estate~._a~ccording to law.
before me this llth day of
z~ December ^ 2003 .
Donna . 'Otto, ~s~. Deputy
No. 21-2003-1029
Estate of HENRY G. NACHMAN
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
ANDNOW December 15th, 2003
, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated , September 19the 1991
described therein be admitted to probate and filed of record as the last will of
Henry G. Nachman
and Letters Testamentary
are hereby granted to Gustave L. Weinstock Jr,
FEES
Probate, Letters, Etc ......... $ 515.00
Short Certificates ( 3 ) ...... $ 9.00
~xxxxx x.-pages. $ 39.00
JCP Fee (13) $ 10.00
TOTAL_ $
Filed.. December. 15.th, 20.03 ........
Mailed Letters to Attorney on
12/15/2003.
Register ~)f Wills'
Donna M. Otto,lst Deputy
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
his 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 f?ling.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certitqcate, $2.00 ~~ ~ I~~ "' v' I/~'1- "~-~ Loca~ Registrar
No. ~ Date
mos ;4s~v ~/a? COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
21-2003-1029
LAST WInL AND TESTAMENT
OF
HENRY G. NAC~
I, HENRY G. NACH~iAN, of Camp Hill, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament and
revoke any and all Wills and Codicils heretofore made by me.
ITEM I: I direct that all my just debts and funeral
expenses, including my grave marker and all expenses of my last
illness, shall be paid from my estate as soon as practicable
after my decease, as a part of the expense of the administra-
tion of my estate.
If my spouse predeceases me, I hereby give and
ITEN II:
bequeath:
A.
Six Thousand Dollars ($6,000.00) to RUTH and ELAM
BURKHOLDER, who are currently the caretakers of my
residence, provided that they are living and/or employed
by me at the time of my death;
B. One Thousand Dollars ($1,000.00) to the REFORM
TEMPLE OHEV SHOLOM, or its successors;
C. One Thousand Dollars ($1,000.00) to the
POLYCLINIC MEDICAL CENTER, or its successors;
D. One Thousand Dollars ($1,000.00) to the TRI-
COUNTY UNITED WAY, or its successors; and
E. One Thousand Dollars ($1,000.00) to the HOLY
SPIRIT HOSPITAL, or its successors.
ITEM III: If my spouse, FLORENCE B. NACHMAN, survives me,
I give, devise and bequeath to my Trustee, hereinafter named,
to be held IN TRUST, during the life of my said spouse,
FLORENCE B. NACHMAN, a sum equal to the maximum dollar amount,
if any, which can pass free of federal estate tax in my estate
by reason of the unified credit against federal estate tax
allowable to my estate on the date of my death (the "credit
shelter amount"), reduced by the aggregate of (1) all items
includable in my gross estate for federal estate tax purposes
which either are disposed of in previous items of this Will or
pass outside of this Will and which do not qualify for the
federal estate tax marital deduction or the federal estate tax
charitable deduction, and (2) the amount of all charges to
principal of my estate (including expenses and death taxes)
that are not allowed as deductions in computing federal estate
tax. This trust shall be referred to and known as my Credit
Shelter Trust. The aforementioned sum shall be held for the
following uses and purposes:
A. To pay the income to her in convenient
installments, at least quarter annually.
B. The Trustee may apply the net income of this
trust for the benefit of my said spouse should she by
reason of age or illness be incapable of disbursing it.
C. As much of the principal of this trust as the
Trustee, in its sole and absolute discretion may from time
to time think advisable for the support of my spouse to
maintain her in the station of life to which she is
accustomed at my death and after taking into consideration
her other readily available assets and sources of income
or during illness or emergency, may be either paid to her
or else be applied directly for her.
D. Upon the death of my spouse, any remaining
balance, including undistributed income, shall be
distributed in accordance with Item IV-D(2) hereof.
E. I direct that my Executrix and her successors
shall not elect that this Trust be included in my spouse's
estate as a part of the marital deduction. This direction
shall not apply as to sums added by virtue of disclaimer
by my spouse, pursuant to ITEM VII hereof.
ITE~ IV: If my spouse, FLORENCE B. NACHMAN, survives me,
I give, devise and bequeath the rest, residue and remainder of
my estate of every nature and wherever situate to my Trustee,
hereinafter named, to be held in Trust during the life of my
said spouse for the following uses and purposes:
A. To pay the income derived from the principal to
my spouse in convenient installments, at least quarter
annually.
B. To pay to my spouse at any time and from time to
time such sums from or such part of the principal of the
trust, including the whole thereof, as in the sole
discretion of my Trustee is determined to be necessary or
desirable to permit my spouse to maintain her usual
3
standard of living, including payment of the costs of any
illness or accident which may affect her, after taking
into consideration her other readily available sources of
income and assets.
C. My Executrix shall be authorized, in her sole,
exclusive and unrestricted discretion, to determine
whether to elect (under Section 2056(b) (7) of the Internal
Revenue Code of 1954, as amended, or any corresponding
provision of state law) to qualify all or a specific
portion of this Trust for the federal estate tax marital
deduction and any marital deduction available under the
law of the state in which I am domiciled at the time of my
death. I suggest, but do not direct, that in exercising
such discretion, my Executrix attempt to minimize (or
eliminate, if possible) the federal and state estate,
inheritance or other death taxes payable by my estate at
the time of my death. However, my Executrix should also
consider the effect of her election upon the federal and
state estate, inheritance or other death taxes which will
be payable by my spouse's estate at her death. The
decision of my Executrix with respect to the exercise of
the election shall be final and conclusive upon all
persons whose interest in my estate are directly or
indirectly affected by the election.
D. Upon the death of my spouse, Florence B. Nachman,
my Trustee shall pay the Executor of my spouse's estate
4
all income accrued but undistributed at the date of my
spouse's death. My Trustee shall then dispose of the
principal as follows:
1. To pay to the Executor of my spouse's
estate, out of the principal of the trust, am amount equal
to the estate, inheritance, transfer, succession or other
death taxes ("death taxes"), federal, state and other,
payable by reason of the inclusion of the value of the
trust property in her estate. Such payment shall be equal
to the amount by which (1) the total of such death taxes
paid by my spouse's estate exceeds (2) the total of such
death taxes which would have been payable if the value of
the trust property had not been included in her estate.
The determination by my spouse's Executor of the amount
payable hereunder shall be final; I direct my Trustee to
pay such amount promptly upon written request of my
spouse's Executor. The final determination of the amount
due hereunder shall be based upon the values as finally
determined for federal estate tax purposes in my spouse's
estate. After payment of the amount finally determined to
be due hereunder, my Trustee shall be discharged from any
further liability with respect to such payment. My spouse
may waive her estate's right to payment under this
subparagraph by a Will, executed after my death, in which
she specifically refers to the right to payment hereby
given to her estate.
5
2. To pay the principal, if any, remaining on
my spouse's death and after payment of the tax
reimbursement to my spouse's estate as provided for in
Item IV D(1) above as follows:
a) The sum of Thirty Thousand Dollars ($30,000)
to my nephew, LOUIS LOEBNER, or his issue, per
stirpes. I have expressly made this reduced gift not
out of any lack of affection but because I believe he
already has sufficient assets.
b) The remaining balance shall be divided in
four (4) equal shares, one share to each of the
following: BENJAMIN SCHULEIN, JR., LOIS ABRAMS,
NANCY RUBENSTEIN and GUSTAVE L. WE INSTOCK, JR. In
the event any of the aforesaid persons fail to
survive me, the share of such person shall be divided
among his issue, per stirpes.
ITEM V: In the event my spouse, FLORENCE B. NACHMAN,
predeceases me, I give, devise and bequeath the rest, residue
and remainder of my estate of every nature and wheresoever
situate as follows:
a) The sum of Thirty Thousand Dollars ($30,000)
to my nephew, LOUIS LOEBNER, or his issue, per
stirpes. I have expressly made this reduced gift not
out of any lack of affection but because I believe he
already has sufficient assets.
b) The remaining balance shall be divided in
6
four (4) equal shares, one share to each of the
following: BENJAMIN SCHULEIN, JR., LOIS ABRAMS,
NANCY RUBENSTEIN and GUSTAVE L. WEINSTOCK, JR. In
the event any of the aforesaid persons fail to
survive me, the share of such person shall be divided
among his issue, per stirpes.
ITEM VI: Should my wife and I. die simultaneously or under
such circumstances that it cannot be established which of us
died first, my wife shall be deemed to have predeceased me for
all purposes under this Will.
ITEM VII: If my spouse, FLORENCE B. NACHMAN, makes a
qualified disclaimer (as defined in Sec. 2518 of the Internal
Revenue Code, as amended) with respect to all or any portion of
the interest in property given to her under any provision of my
Will, I give such disclaimed property interests to the Trustee
of my Credit Shelter Trust, IN TRUST, for the benefit of my
said spouse during her lifetime with the balance of the
principal and interest passing to my beneficiaries, all in
conformity with the terms of Item IV D(2).
ITEM VIII: My Executrix, Trustee, and their successors
shall have the following powers in addition to those vested in
them by law and by other provisions of my Will, applicable to
all property, whether principal or income, including property
held for minors, exercisable without court approval, and
effective until actual distribution of all property:
A. To borrow money from any person or institution
7
and to mortgage or pledge any or all real or personal
property as they in their sole discretion shall choose,
without regard for the dispositive provisions of this
instrument, except that no property passing to the marital
deduction share shall be so mortgaged or pledged.
B. To reasonably compromise claims asserted by or
against my estate.
C. To join with my spouse in filing a joint income
tax return without requiring her to indemnify my estate
against liability for the tax attributable to her income,
and to consent to any gifts made by my spouse being
treated as having been made one-half by me for the purpose
of federal laws relating to gift tax.
D. To retain any or all of the assets of my estate,
real or personal, without regard to any principle of
diversification or risk.
E. To sell at public sale, to exchange, or to lease
for any period of time, any real or personal property and
to give option for sales, exchanges, or leases, for such
prices and upon such terms or conditions as they deem
proper.
F. To make loans to, to sell to, and to buy property
from my or my spouse's executor or administrator or my
trustee. This shall not be construed as a command to
exercise these powers under any circumstances.
G. Notwithstanding any power granted expressly or
impliedly herein, such shall be void and of no effect as
to the marital gift if such would either reduce or
eliminate said gift beyond the extent elected by my
Executrix. Furthermore, in no event shall there be
included in the Item IV bequest any asset or the proceeds
of any asset which will not qualify for the marital
deduction. Such assets shall be included in the principal
of my Credit Shelter Trust.
H. To combine the assets of any separate trusts
under this Will into one or more administrative or
investment units for convenience of administration and
investment.
I. To merge, following the death of my spouse, any
trust hereunder into any trust created by my spouse, by
Will or otherwise, or to receive by merger assets from any
trust created by my spouse, by Will or otherwise, provided
such trusts have the same beneficiaries and substantially
similar provisions.
J. In the event Gustave L. Weinstock, Jr. is not
serving as Trustee, to actively invest solely in those
investments, securities, or obligations as more
particularly set forth in the Fiduciaries Investment Act
of 1949, Section 3, entitled "Government Obligations";
Section 4 entitled "Obligations of Federal Organizations";
Section 6 entitled "Corporate Bonds" so long as said
corporate bonds are rated by Standard and Poor's as Grade
AA or better; Section 7 entitled "Mortgages"; Section 12
entitled "Interest Bearing Deposit." Additionally, my
Executrix, Trustee and their successors may place funds in
an insured money market account.
K. To make distribution in cash or in kind or partly
in cash and partly in kind, and, except as otherwise
specifically directed, to allocate specific assets to or
among the beneficiaries, including any trusts hereunder,
in such manner or proportion as they may deem advisable;
provided, however, that this clause shall not be construed
to permit them to affect the value of the distribution to
which any such beneficiary may be entitled hereunder.
L. All powers granted to my Executrix and Trustee
under this and other Sections of this Will are exercisable
only in a fiduciary capacity. No such power shall be
construed to enable any person to purchase, exchange or
otherwise deal with or dispose of any estate or trust
asset for less than adequate consideration.
M. Wherever I have granted my Trustee the
discretionary power to make payments from the income or
principal of a trust, no Trustee who is a potential
recipient of such a payment may exercise his discretion in
his own favor.
N. I specifically direct that no payments shall be
made by my Trustee in reimbursement to any governmental
authority which may have incurred expense for the benefit
of any beneficiary hereunder, nor shall my Trustee pay any
10
obligation of a beneficiary hereunder which obligation is
otherwise payable by any governmental entity or pursuant
to any governmental program of reimbursement or payment.
ITRM IX: Anything in this Will to the contrary notwith-
standing, any beneficiary under this Will may, at any time and
from time to time, release, renounce, or disclaim, in whole or
in part, or otherwise limit any power or interest granted to
such beneficiary under this Will, by written instrument, duly
signed, acknowledged before a Notary Public and filed with my
Executrix or with the Trustee of any trust hereunder. Such
instrument need not take effect immediately and may be
contingent upon the occurrence or non-occurrence of any event.
In addition, my Executrix serving hereunder at any time
may in like manner release, renounce or disclaim, in otherwise
limit any power granted to such fiduciary hereunder.
ITEM X: All shares of principal and income hereby given
shall be free from anticipation, assignment, pledge or
obligation of the beneficiaries and any of them, and shall not
be subject to any execution, attachment, levy or sequestration
or other claims of the creditors of said beneficiaries or any
of them.
ITEM XI: All Federal, state and other death taxes payable
because of my death with respect to the property forming my
gross estate for tax purposes, whether or not passing under
this Will, including any interest or penalty imposed in
connection with such tax, shall be considered a part of the
11
expense of the administration of my estate and shall be paid
out of the principal allocable to my Credit Shelter Trust
without apportionment or right of reimbursement. Under no
circumstances shall any such taxes be paid or payable from the
proceeds forming a part or all of the marital trust of Item IV
hereof.
ITEM XII: I appoint my spouse's nephew, GUSTAVE L.
WEINSTOCK, JR., Trustee of the trusts created by this my Last
Will. Should my spouse's nephew, GUSTAVE L. WEINSTOCK, JR.,
fail to qualify or cease to act as Trustee, I appoint JOHN
LAUDEMAN, CPA Trustee of the trusts created by this my Last
Will. Should JOHN LAUDEMAN, CPA fail to qualify or cease to
act as Trustee, I appoint DAUPHIN DEPOSIT BANK AND TRUST
COMPANY, Trustee of the trusts created by this my Last Will.
ITEM XIII: No Executrix or Trustee serving hereunder or
their successors, if any, at any time shall be required to post
bond or enter security in any jurisdiction.
ITEM XIV: I appoint my spouse, FLORENCE B. NACHMAN,
Executrix of this my Last Will and Testament. Should my
spouse, FLORENCE B. NACHMAN, fail to qualify or cease to act as
Executrix, I appoint my spouse's nephew, GUSTAVE L. WEINSTOCK,
JR., Executor of this my Last Will and Testament. Should my
spouse's nephew, GUSTAVE L. WEINSTOCK, JR., fail to qualify or
cease to act as Executor, I appoint JOHN LAUDEMAN, CPA of
Harrisburg, Pennsylvania, Executor of this my Last Will and
Testament. Should JOHN LAUDEMAN, CPA fail to qualify or cease
12
to act as Executor, I appoint DAUPHIN DEPOSIT BANK AND TRUST
COMPANY Executor of this my Last Will and Testament.
ITBM X~: All references herein to the singular or the
masculine shall include the plural or the feminine,
respectively, where appropriate throughout this my Last Will
and Testament.
this
IN WITNESS WHEREOF, I have hereunto set my hand and seal
HENRY G~ NACHMAN
The preceding instrument, consisting of this and twelve
other typewritten pages, was, on the date thereof signed,
published and declared by HENRY G. NACHMAN, the Testator
therein named, as and for his Last Will, in the presence of us,
who, at his request, in his presence, and in the presence of
each other, have subscribed our names as witnesses hereto.
residing at ..~-~%~~ ?C~
~~. ~Y~/ residing at
13
COMMONWEALTH OF PENNSYLVANIA :
SS'.
COUNTY OF DAUPHIN :
WE, HENRY G. NACHMAN, C_c~wo\ ~. ~cx.% ¥c~ and
--'~/l~ ~. ~~~ _ , 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 and that he executed it as his free and
voluntary act for the purposes therein expressed, and that each
of the witnesses, in the presence and hearing of the Testator,
signed the will as witnesses and that to the best of their
knowledge the Testator was at that time eighteen years of age
or older, of sound mind and under no constraint or undue
influence. / .
W~ness ' '
WitnesUs
Subscribed, sworn to and acknowledged before me by HENRY
G. NACHMAN, the Testator, and subscribed and sworn to before me
by ~_~wo~ ~.. ~C%~c~ and )~k'~J 1~5. /~.L/~r-C~ , witnesses,
this , Iq day of ,
NOTARIAL SEAL
Cheryl L. Welsh, Notary Public
H~rrisbu?:l, Dauphin Countv
My Commlssio'n E~;p res Mar, 26~1994~j
~--'N'o~a ry P~bl ic
OF
HENRY G. NACHMAN
LAW OFFICES
1719 N. FRONT STREET
HARRISBURG, PA 17102-2392
REGISTER OF WILLS
COUNTY OF CUMBERLAND, PENNSYLVANIA
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: HENRY G. NACHMAN
Date of Death: 11/23/03
Will No. 21-2003-102~ Admin. No.
To the Register:
I certify that notice of (beneficial interest) ,estate administration required by Rule 5.6(a) of the Orphan's Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on 12/31/03 :
Name Address
GUSTAVE L. WEINSTOCK, JR.
1714 Morrison Lane
Foristell MO 63348
NANCY R. BALDRIDGE 1464 Timber Lake Manor Parkway
Chesterfield MO 63017
LOIS ABRAMS 5420 Connecticut Avenue Northwest
Washington D.C.
BENJAMIN SCHULEIN, JR.
20015-2813
4466 West Pine, Apartment 15C
St. Louis
MO 63108
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except:
N/A ?
Name: HOWARD B. KRUG, ESC~UIRE
Address: 1719 NORTH FRONT STREET
HARRISBURG PA 17102
Telephone (2 34) - 4178
Capacity:
X
Personal Representative
Counsel for Personal
Representative
HENRY G. NACHMAN
Continuation of Certification of Notice Under Rule 5.6(a)
Page I
11/23/03
Names and addresses
Name
LOUIS LOEBNER
Address
1127 Bella Vista Drive
St. Louis
MO 63131
HOLY SPIRIT HOSPITAL
Attn: Sue Gookin
PINNACLE HEALTH SYSTEM
Attn: Christopher P. Markley
503 North 21 st Street
Camp Hill
PA 17011
P.O. Box 8700
Harrisbu~
PA 17105-8700
UNITED WAY OF THE CAPITAL REGION
Attn: Joseph M. Capita
2235 Millennium Way
Enola
PA 17025
ELAM BURKHOLDER
RUTH BURKHOLDER
TEMPLE OHEV SHOLOM
Attn: Robert Hoffman
1516 Slate Hill Road
Camp Hill
PA 17O11
2749 Lisburn Road
Camp Hill
PA 17011
2345 N. Front Street
Harrisburg
PA 17110
COMMON. WEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF iNDIVIDUAL TAXES
DEPT, 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
KRUG HOWARD B
1719 NORTH FRONT STREET
HARRISBURG, PA 17102
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
DUPLICATE
NO.
REV-1162 EX(11-96)
CD 003648
........ fold
ESTATE INFORMATION: SSN: 195-07-6283
FILE NUMBER: 2103- 1029
DECEDENT NAME: NACHMAN HENRY G
DATE OF PAYMENT: 03/08/2004
POSTMARK DATE: 00/00/0000
COUNTY: CUM BERLAN D
DATE OF DEATH: 12/09/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $160,000.00
REMARKS:
..... SEAL
CHECK//121
TOTAL AMOUNT PAID:
60,000.00
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
REGISTER OF WILLS
COUNTY OF CUMBERLAND
INVENTORY
Estate of HENRY G. NACHMAN
also known as N/A
, Deceased
Date of Death 11/23/03
Social Security No. 195-07-6283
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory, lANe
verify that the statements made in this inventory are true and correct, lANe understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Name of
Attorney:
I.D. No.:
Howard B. Kruq, Esquire
16826
Address: 1719 North Front Street
Harrisburg PA 17102
Personal Representative:
Gustave L. Weinstock, Jr.
Dated
Telephone: (717) 234-4178
Description
1520 Slate Hill Road, Camp Hill, PA 17011 (home & 10.57 acres)
(Value based on auction sale of May 1, 2004)
16.12 acres local[ed on Slate Hill Road, Camp Hill, PA (8.17 & 7.95 acres)
Value based on auction sale of May 1,2004)
Custodial Account established August 24, 1990 with Dauphin Deposit Bank
& Trust Company, Custodian
A. Money Market Institutional 1-fund (principal) - $171,426
B. Money Market Institutional 1-fund (income) - $11,363
C. $250,000 U.S. Treasury Note due 5/15/06 - $278,477
D. $50,000 GTE North Inc. Note due 1/15/04 - $51,422
E. $20,000 Hampden Twshp. Sewer Authority Bond - $22,243
F. $25,000 Twshp. Upper Allen General Oblig. Bond - $28,683
M&T Bank Savings Account - #15004206016435
(Attach Additional Sheets if necessary)
Total
Value
800,000.00
545,000.00
563,613.00
6,717.00
1,965,373.00
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
RW-4
HENRY G. NACHMAN
Description of Inventory
Personal Property/Antiques
Continuation of Inventory
Page 1
22
03
Description
Value
Funds received from cancellation of Blue Cross policy
Funds received from Rita Powell for personal phone calls made from
Slate Hill Road residence.
Funds received from Verizon telephone service - cancellation fee
Funds received from PP&L (electric) - cancellation fee
Reimbursement for 2003 County Taxes
Reimbursement for 2003 School Taxes
Reimbursement for cancellation of Home Owners Insurance
1103
47,316.00
t16.00
22.00
4.00
27.00
1,497.00
724.OO
337.00
Subtotal $ 50,043.00
Grand Total $ 1,965,373.00
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OFINDIVlDUALTAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 004100
KRUG HOWARD B
1719 NORTH FRONT STREET
HARRISBURG, PA 17102
........ fold
ESTATE INFORMATION: SSN: 195-07-6283
FILE NUMBER: 2103- 1029
DECEDENT NAME: NACHMAN HENRY G
DATE OF PAYMENT: 06/30/2004
POSTMARK DATE: 06/30/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 1 2/09/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $34,599.02
TOTAL AMOUNT PAID:
$34,599.02
REMARKS: H KRUG ESQ
CHECK# 993
SEAL
INITIALS: VZ
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 3 1 0 2 9
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
1 9 5-0 7-6 2 8 3
Nachman, Henry
DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
12/09/2003 08/17/1901 REGISTER OF WILLS
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
[~1. Odginal Retum
'--]4. Limited Estate
~"~ 6. Decedent Died Testate (Attach copy of Will)
-']9. Litigation Proceeds Received
[~]2. Supplemental Return
r--] 4a. Futura Interast Compromise (date of death affe~ 12-12-82)
r-'] 7. Decedent Maintained a Living Trust (A~tach cop)' of Trust)
] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
]3. Remainder Return (dateofdeafl priorto 12-13-82)
]5. Federal Estate Tax Return Required
~ 8. Total Number of Safe Deposit Boxes
[-'-] 11. Election to tax under Sec. 9113(A) (Attach Sch O)
THIS SECTION MuST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIREC~D TO:
NAME
Howard B. Kruq, Esquire
FIRM NAME (If Applicable)
PURCELL, KRUG & HALLER
TELEPHONE NUMBER
(717) 234-4178
COMPLETE MAILING ADDRESS
1719 North Front Street
Harrisburg PA 17102
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 (5)
(Schedule E)
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)
13. Charitable and Govemmental 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)
(8)
113451~00'i00
0.00
620~374.00
24,000.00
271 ~207.00
23~833.00
OFFICIAL USE ONLY
~989,374.00
(11) 295,040.00
(12) 1 ~694~334.00
(13) 4,000.00
(14) 1 ~690~334.00
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.
X 0
X 0
1,684,334.00 X .12
6,000.00 X .15
(15) 0.00
(16) 0.00
(17) 202,120.08
(18) 900.00
(19) 203,020.08
> > BE SURE TO ANSWER ALL QUESTIONS ON R~ERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
ISTREET ADDRESS 1520 Slate Hill Road
c~ Camp Hill
ISTATE PA
zip
17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Pdor Payments
C. Discount
160,000.00
8,421.06
Interest/Penalty if applicable
D. Interest
E. Penalty
(1)
Total Credits ( A + B + C ) (2)
Total Interest/Penalty ( D + E )
203~020.08
(3)
4.If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page I Line 20 to request a refund (4)
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 + SA. This is the BALANCE DUE. (SB)
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 dght to designate who shall use the property transferred or its income; ........................................ [] []
c. retain a reversionary interest; or ...................................................................................................... [] []
d. receive the promise for life of either payments, benefits or care? ............................................................. [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ............................................................................................... [] []
3. Did decedent own an "in trust for" or payable upon death bank account or secudty at his or her death? ................. [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... [] []
168~421.06
0.00
34~599.02
34,599.02
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 declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete,
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE O~ PERSON RESPONSIBLE FOR FILING RETURN
ADDRESS v L W ~n
Gusta e . e' stock, Jr., Executor
1714 Morriso~e, Feds,tell
ADDRESS H~ar~ B. Krug,~............
1 T19 North Fro~'t Street, Harrisburg
DATE
MO 63348
DATE
PA 17102
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
LAST WILL AND TESTAFIENT
OF
~NRY G. NACHF~iN
I, HENRY G. NACHMAN, of Camp Hill, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament and
revoke any and all Wills and Codicils heretofore made by me.
ITEM I: I direct that all my just debts and funeral
expenses, including my grave marker and all expense~ of my last
illness, shall be paid from my estate as soon as practicable
after my decease, as a part of the expense of the administra-
tion of my estate.
If my spouse predeceases me, I hereby give and
.ITEM II:
bequeath:
A.
Six Thousand Dollars ($6,000.00) to RUTH and ELAM
BURKHOLDER, who are currently the caretakers of my
residence, provided that they are living and/or employed
by me at the time of my death;
B. One Thousand Dollars ($1,000.00) to the REFORM
TEMPLE OHEV SHOLOM, or its successors;
C. One Thousand Dollars ($1,000.00) to the
POLYCLINIC MEDICAL CENTER, or its successors;
D. One Thousand Dollars ($1,000.00) to the TRI-
COUNTY UNITED WAY, or its successors; and
E. One Thousand Dollars ($1,000.00) to the HOLY
SPIRIT HOSPITAL, or its successors.
ITEM III: If my spouse, FLORENCE B. NACHMAN, survives me,
I give, devise and bequeath to my Trustee, hereinafter named,
to be held IN TRUST, during the life of my said spouse,
FLORENCE B. NACHMAN, a sum equal to the maximum dollar amount,
if any, which can pass free of federal estate tax in my estate
by reason of the unified credit against federal estate tax
allowable to my estate on the date of my death (the "credit
shelter amount"), reduced by the aggregate of (1) all items
includable in my gross estate for federal estate tax purposes
which either are disposed of in previous items of this Will or
pass outside of this Will and which do not qualify for the
federal estate tax marital deduction or the federal estate tax
charitable deduction, and (2) the amount of all charges to
principal of my estate (including expenses and death taxes)
that are not allowed as deductions in computing federal estate
tax. This trust shall be referred to and known as my Credit
Shelter Trust. The aforementioned sum shall be held for the
following uses and purposes:
A. To pay the income to her in convenient
installments, at least quarter annually.
B. The Trustee may apply the net income of this
trust for the benefit of my said spouse should she by
reason of age or illness be incapable of disbursing it.
C. As much of the principal of this trust as the
Trustee, in its sole and absolute discretion may from time
to time think advisable for the support of my spouse to
maintain her in the station of life to which she is
accustomed at my death and after taking into consideration
her other readily available assets and sources of income
or during illness or emergency, may be either paid to her
or else be applied directly for her.
D. Upon the death of my spouse, any remaining
balance, including undistributed income, shall be
distributed in accordance with Item IV-D(2) hereof.
E. I direct that my Executrix and her successors
shall not elect that this Trust be included in my spouse's
estate as a part of the marital deduction. This direction
shall not apply as to sums added by virtue of disclaimer
by my spouse, pursuant to ITEM VII hereof.
ITEM IV: If my spouse, PLORENCE B. NACHMAN, survives me,
I give, devise and bequeath the rest, residue and remainder of
my estate of every nature and wherever situate to my Trustee,
hereinafter named, to be held in Trust during the life of my
said spouse for the following uses and purposes:
A. To pay the income derived from the principal to
my spouse in convenient installments, at least quarter
annually.
B. To pay to my spouse at any time and from time to
time such sums from or such part of the principal of the
trust, including the whole thereof, as in the sole
discretion of my Trustee is determined to be necessary or
desirable to permit my spouse to maintain her usual
3
standard of living, including payment of the costs of any
illness or accident which may affect her, after taking
into consideration her other readily available sources of
income and assets.
C. My Executrix shall be authorized, in her sole,
exclusive and unrestricted discretion, to determine
whether to elect (under Section 2056(b) (7) of the Internal
Revenue Code of 1954, as amended, or any corresponding
provision of state law) to qualify all or a specific
portion of this Trust for the federal estate tax marital
deduction and any marital deduction available under the
law of the state in which I am domiciled at the time of my
death. I suggest, but do not direct, that in exercising
such discretion, my Executrix attempt to minimize (or
eliminate, if possible) the federal and state estate,
inheritance or other death taxes payable by my estate at
the time of my death. However, my Executrix should also
consider the effect of her election upon the federal and
state estate, inheritance or other death taxes which will
be payable by my spouse's estate at her death. The
decision of my Executrix with respect to the exercise of
the election shall be final and conclusive upon all
persons whose interest in my estate are directly or
indirectly affected by the election.
D. Upon the death of my spouse, Florence B. Nachman,
my Trustee shall pay the Executor of my spouse's estate
4
all income accrued but undistributed at the date of my
spouse's death. My Trustee shall then dispose of the
principal as follows:
1. To pay to the Executor of my spouse's
estate, out of the principal of the trust, am amount equal
to the estate, inheritance, transfer, succession or other
death taxes ("death taxes"), federal, state and other,
payable by reason of the inclusion of the value of the
trust property in her estate. Such payment shall be equal
to the amount by which (1) the total of such death taxes
paid by my spouse's estate exceeds (2) the total of such
death taxes which would have been payable if the value of
the trust property had not been included in her estate.
The determination by my spouse's Executor of the amount
payable hereunder shall be final; I direct my Trustee to
pay such amount promptly upon written request of my
spouse's Executor. The final determination of the amount
due hereunder shall be based upon the values as finally
determined for federal estate tax purposes in my spouse's
estate. After payment of the amount finally determined to
be due hereunder, my Trustee shall be discharged from any
further liability with respect to such payment. My spouse
may waive her estate's right to payment under this
subparagraph by a Will, executed after my death, in which
she specifically refers to the right to payment hereby
given to her estate.
2. To pay the principal, if any, remaining on
my spouse's death and after payment of the tax
reimbursement to my spouse's estate as provided for in
Item IV D(1)above as follows:
a) The sum of Thirty Thousand Dollars ($30,000)
to my nephew, LOUIS LOEBNER, or his issue, per
stirpes. I have expressly made this reduced gift not
out of any lack of affection but because I believe he
already has sufficient assets.
b) The remaining balance shall be divided in
four (4) equal shares, one share to each of the
following: BENJAMIN SCHULEIN, JR., LOIS ABRAMS,
NANCY RUBENSTEIN and GUSTAVE L. WEINSTOCK, JR. In
the event any of the aforesaid persons fail to
survive me, the share of such person shall be divided
among his issue, per stirpes.
ITEM V: In the event my spouse, FLORENCE B. NACHMAN,
predeceases me, I give, devise and bequeath the rest, residue
and remainder of my estate of every nature and wheresoever
situate as follows:
a) The sum of Thirty Thousand Dollars ($30,000)
to my nephew, LOUIS LOEBNER, or his issue, per
stirpes. I have expressly made this reduced gift not
out of any lack of affection but because I believe he
already has sufficient assets.
b) The remaining balance shall be divided in
6
four (4) equal shares, one share to each of the
following: BENJAMIN SC~ULEIN, JR., LOIS ABRAMS,
NANCY RUBENSTEIN and GUSTAVE L. WEINSTOCK, JR. In
the event any of the aforesaid persons fail to
survive me, the share of such person shall be divided
among his issue, per stirpes.
ITEM VI: Should my wife and I. die simultaneously or under
such circumstances that it cannot be established which of us
died first, my wife shall be deemed to have predeceased me for
all purposes under this Will.
ITEM VII: If my spouse, FLORENCE B. NACHMAN, makes a
qualified disclaimer (as defined in Sec. 2518 of the Internal
Revenue Code, as amended) with respect to all or any portion of
the interest in property given to her under any provision of my
Will, I give such disclaimed property interests to the Trustee
of my Credit Shelter Trust, IN TRUST, for the benefit of my
said spouse during her lifetime with the balance of the
principal and interest passing to my beneficiaries, all in
conformity with the terms of Item IV D(2).
ITEM VIII: My Executrix, Trustee, and their successors
shall have the following powers in addition to those vested in
them by law and by other provisions of my Will, applicable to
all property, whether principal or income, including property
held for minors, exercisable without court approval, and
effective until actual distribution of all property:
A. To borrow money from any person or institution
7
and to mortgage or pledge any or all real or personal
property as they in their sole discretion shall choose,
without regard for the dispositive provisions of this
instrument, except that no property passing to the marital
deduction share shall be so mortgaged or pledged.
B. To reasonably compromise claims asserted by or
against my estate.
C. To join with my spouse in filing a joint income
tax return without requiring her to indemnify my estate
against liability for the tax attributable to her income,
and to consent to any gifts made by my spouse being
treated as having been. made one-half by me for the purpose
of federal laws relating to gift tax.
D. To retain any or all of the assets of my estate,
real or personal, without regard to any principle of
diversification or risk.
E. To sell at public sale, to exchange, or to lease
for any period of time, any real or personal property and
to give option for sales, exchanges, or leases, for such
prices and upon such terms or conditions as they deem
proper.
F. To make loans to, to sell to, and to buy property
from my or my spouse's executor or administrator or my
trustee. This shall not be construed as a command to
exercise these powers under any circumstances.
G. Notwithstanding any power granted expressly or
8
impliedly herein, such shall be void and of no effect as
to the marital gift if such would either reduce or
eliminate said gift beyond the extent elected by my
Executrix. Furthermore, in no event shall there be
included in the Item IV bequest any asset or the proceeds
of any asset which will not qualify for the marital
deduction. Such assets shall be included in the principal
of my Credit Shelter Trust.
H. To combine the assets of any separate trusts
under this Will into one or more administrative or
investment units for convenience of administration and
investment.
I. To merge, following the death of my spouse, any
trust hereunder into any trust created by my spouse, by
Will or otherwise, or to receive by merger assets from any
trust created by my spouse, by Will or otherwise, provided
such trusts have the same beneficiaries and substantially
similar provisions.
J. In the event Gustave L. Weinstock, Jr. is not
serving as Trustee, to actively invest solely in those
investments, securities, or obligations as more
particularly set forth in the Fiduciaries Investment Act
of 1949, Section 3, entitled "Government Obligations";
Section 4 entitled "Obligations of Federal Organizations";
Section 6 entitled "Corporate Bonds" so long as said
corporate bonds are rated by Standard and Poor's as Grade
AA or better; Section 7 entitled "Mortgages"; Section 12
9
entitled "Interest Bearing Deposit." Additionally, my
Executrix, Trustee and their successors may place funds in
an insured money market account.
K. To make distribution in cash or in kind or partly
in cash and partly in kind, and, except as otherwise
specifically directed, to allocate specific assets to or
among the beneficiaries, including any trusts hereunder,
in such manner or proportion as they may deem advisable;
provided, however, that this clause shall not be construed
to permit them to affect the value of the distribution to
which any such beneficiary may be entitled hereunder.
L. All powers granted to my Executrix and Trustee
under this and other Sections of this Will are exercisable
only in a fiduciary capacity. No such power shall be
construed to enable any person to purchase, exchange or
otherwise deal with or dispose of any estate or trust
asset for less than adequate consideration.
M. Wherever I have granted my Trustee the
discretionary power to make payments from the income or
principal of a trust, no Trustee who is a potential
recipient of such a payment may exercise his discretion in
his own favor.
N. I specifically direct that no payments shall be
made by my Trustee in reimbursement to any governmental
authority which may have incurred expense for the benefit
of any beneficiary hereunder, nor shall my Trustee pay any
10
obligation of a beneficiary hereunder which obligation is
otherwise payable by any governmental entity or pursuant
to any governmental program of reimbursement or payment.
ITEM IX: Anything in this Will to the contrary notwith-
standing, any beneficiary under this Will may, at any time and
from time to time, release, renounce, or disclaim, in whole or
in part, or otherwise limit any power or interest granted to
such beneficiary under this Will, by written instrument, duly
signed, acknowledged before a Notary Public and filed with my
Executrix or with the Trustee of any trust hereunder. Such
instrument need not take effect immediately and may be
contingent upon the occurrence or non-occurrence of any event.
In addition, my Executrix serving hereunder at any time
may in like manner release, renounce or disclaim, in otherwise
limit any power granted to such fiduciary hereunder.
ITEM X: All shares of principal and income hereby given
shall be free from anticipation, assignment, pledge or
obligation of the beneficiaries and any of them, and shall not
be subject to any execution, attachment, levy or sequestration
or other claims of the creditors of said beneficiaries or any
of them.
ITEM XI: All Federal, state and other death taxes payable
because of my death with respect to the property forming my
gross estate for tax purposes, whether or not passing under
this Will, including any interest or penalty imposed in
connection with such tax, shall be considered a part of the
11
expense of the administration of my estate and shall be paid
out of the principal allocable to my Credit Shelter Trust
without apportionment or right of reimbursement. Under no
circumstances shall any such taxes be paid or payable from the
proceeds forming a part or all of the marital trust of Item IV
hereof.
I~EN XII: I appoint my spouse's nephew, GUSTAVE L.
WEINSTOCK, JR., Trustee of the trusts created by this my Last
Will. Should my spouse's nephew, GUSTAVE L. WEINSTOCK, JR.,
fail to qualify or cease to act as Trustee, I appoint JOHN
LAUDEMAN, CPA Trustee of the trusts created by this my Last
Will. Should JOHN LAUDEMAN, CPA fail to qualify or cease to
act as Trustee, I appoint DAUPHIN DEPOSIT BANK AND TRUST
COMPANY, Trustee of the trusts created by this my Last Will.
I~EM XIII: No Executrix or Trustee serving hereunder or
their successors, if any, at any time shall be required to post
bond or enter security in any jurisdiction.
I~EM XIV: I appoint my spouse, FLORENCE B. NACHMAN,
Executrix of this my Last Will and Testament. Should my
spouse, FLORENCE B. NACHMAN, fail to qualify or cease to act as
Executrix, I appoint my spouse's nephew, GUSTAVE L. WEINSTOCK,
JR., Executor of this my Last Will and Testament. Should my
spouse's nephew, GUSTAVE L. WEINSTOCK, JR., fail to qualify or
cease to act as Executor, I appoint JOHN LAUDEMAN, CPA of
Harrisburg, Pennsylvania, Executor of this my Last Will and
Testament. Should JOHN LAUDEMAN, CPA fail to qualify or cease
12
to act as Executor, I appoint DAUPHIN DEPOSIT BANK AND TRUST
COMPANY Executor of this my Last Will and Testament.
ITeM XV: All references herein to the singular or the
masculine shall include the plural or the feminine,
respectively, where appropriate throughout this my Last Will
and Testament.
this
IN WITNESS WHEREOF, I have hereunto set my hand and seal
i~~3- day of ~_~.~J- , 1991.
HENRY G/ NACHMAN
The preceding instrument, consisting of this and twelve
other typewritten pages, was, on the date thereof signed,
published and declared by HENRY G. NACHMAN, the Testator
therein named, as and for his Last Will, in the presence of us,
who, at his request, in his presence, and in the presence of
each other, have subscribed our names as witnesses hereto.
residing at
13
COMMONWEALTH OF PENNSYLVANIA :
SS:
COUNTY OF DAUPHIN :
WE, HENRY G. NACHMAN, ~_c~\ ~o ~c~ ~c~ and
~/lI ~. H~~ , 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 and that he executed it as his free and
voluntary act for the purposes therein expressed, and that each
of the witnesses, in the presence and hearing of the Testator,
signed the will as witnesses and that to the best of their
knowledge the Testator was at that time eighteen years of age
or older, of sound mind and under no constraint or undue
influence. ~~
HENRY ~C~AN
Witness
Witne~
Subscribed, sworn to and acknowledged before me by HENRY
G. NACHMAN, the Testator, and subscribed and sworn to before me
by C~ ~-~o~&~c~ and ~ 1~3. ~t~ro~ , witnesses,
NOTARIAL SEAL
Cheil L. Welsh, .N~!.,y Public
Ha, risburg, 'Dauo~i,, uounty
My Commission Expires M~r. 26, lgg4
/ --'~O Ga ry "Pub 1 i c
F~EV-1502 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
Nachman. Henry 21 03 1029
All real property 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 prope~y which is jointly-owned with ri~lht of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
1520 Slate Hill Road, Camp Hill, PA 17011 (home and 10.57 acres)
Value based on auction sale of May 1, 2004.
See attached Auction Sales Agreement dated May 1, 2004
16.12 Acres located on Slate Hill Road, Camp Hill, PA 17011 (8.17 acres & 7.95 acres)
Value based on auction sale of May 1, 2004.
See attached Auction Sales Agreement dated May 1,2004
VALUE AT DATE
OF DEATH
800,000.00
545,000.00
TOTAL (Also enter on line 1, Recapitulation) $ 1,345,000.00
(If more space is needed, insert additional sheets of the same size)
AGREEMENT OF SALE PAE FORTNA A~CTIONEERS , '
(hereinafter
to
. (bemin~er m~e.e~ to as 'Bu~r(sF).
1, The purchase pdce for said property shall.be tl~ su~ of /I.~ ~ 'l ~//l~'~/ ~,-~,-c-r'zl~.r-¢.ll~-~ L~[~.,I/.,~ 7 IUIJLI..AI'~, peyal:lle
(a) ~e sum ~ ~ .~'~~'~ /~ (~ / ~>~ U~ U) DOLORS u~n ~e ~aon ~is ~me~
whi~ said sum aha~ ~ ~ined in ~.~ ~R~ ~1~ ~1
~ed ch~ ~ ~e ~e of s~e~t. /
2. Segment shall be ~ ~in ~ days ~m ~ da~ hem~ id the ~ ~
Count, or at su~ ~r ~le~ as ~e pa~ mmuall~g~n.
3. ~tle to ~ a~resa~ pro~ shall ~ ~y~ b~ ~n~ d~d and Sell.s) hereby ~r~s) ~at ~le shall ~ go~ and ~b~
and su~ es ~ Insu~b~ at ~a~a~ mt~ by a ~ ~s~n~ ~mpeuy li~ ~ do busin~ in Pen~y~ania.
and ~ear ~ all I~ns and en~mbmn~s, but ~b~ to ~n~ e~fing ~st~, ~esw~ons, ~E~, e~e~, ~vesan~, zoning
regulations, o~inan~, stat~, and mgulefions n~ or hema~ pmmu~a~d by any ~n~ pub~
4. tn all in~ncce, time shall ~ ~ ~ essen~ of ~is agm~en~ units e~end~ by m~usl ~n~nt ~ ~e pe~ in ~ting.
5. ~al es~ta ~es, util~i~, ~el oil in ~e tan~ and ~er su~ ~ shall ~ ap~n~ ~n ~e pa~s, pmm~, ss of ~e da~ of
~ffl~est. NI ma~ ~n~r ~s imposed by any g~mmental ~y shall ~ pe~'~ ~ B~s).
6. All plumbing, heefi~, and ~hfi~ ~ums, and sys~ms edpu~enant thoro, and ~ing a pe~ ~e~, es ~ll as all m~ a~ ~er ~ane~
f~ms, ~g~er wi~ s~, shades, venet~n blinds, and ~ings, E any, t~e~er ~ su~ o~er ~nal p~e~ s~l~ I~ herein,
and all t~, shrub~, a~ p~n~ n~ in or on ~e pmm~ herein intesd~ to ~ ~n~ un~ s~lly e~t~ in ~is ag~ am
incl~ in this sa~ and ~mha~ pn~ and shall ~come the pmpe~ ~ Burr(s) at ~e t~e ~ s~l~ ~tho~ ~er docume~o~ Aa
~mceal pmpe~y ~ being ~d in ~ "as is" ~ndEion. ~ ~ll~ng ~ems a~ s~lly in~nd~ in ~e sale:
Possession shall remain with Seller(s) until the time of settlement, at which time possession shall be given to Buyer(s), and, if the premises are
tenanted, then to be sul~ect to said tenancy.
The deed shall be prrepered, acknowledged, and recorded at the expense of the Buyer(s). All title searches, title insurance, and ~sual
conveyancing expenses shall be paid by the Buyer(s} and, if a suwey should be required, the cost thereof shall be paid by the Buyer(s).
Any loss or damage to the propertY/caused by fire, casually, or Ices commonly covered by the extended coverage endorsements of re~utable ,
insurance companies, between the date of this agreement and the date of settlement, shall no~, in any way, void or impair any of the conditions or
obligations hereof. Seller(a) shall maintain existing fire and extended coverage of homeswner"s lype insurenco policies, if any, until the time of final
settlement. Buyer(s) is/are hereby notified that it is his/her/their responsibility to insure his/her/their interest in the said premises at his/her/thek
cost and expense. Seller(s) shall maintain the property and any personal propert~ specifically scheduled herein in its present condition, nOnTml
wear and tear accepted.
10. In the avant Seller(s) ia/ere unable to give a good and marketable title or such as will be insured by a title insurance company licensed todo
business in Pennsylvenis et standarsl rates, as set forth above, Buyer(s) shall have the option of taking such title ss Seller(s) can provide, in which
case the purchase price shall be reduced by the amount which is necessary to eliminate defects in title, ur, of dec~afing this agreement null and
void, in which case Buyer(s) shall be repaid all monms paid on account of the purchase Price, and in such event, there shall be no further liability or
obligation by either of the patties hereunder and this agreement shall become null and void.
11. Should the Buyer(s) violets or fall to fulfill and perform any of the terms or conditions of this agreement, then, Buyer(s) shall be deemed to be in
default under the te~ms of this agreement and all sums paid by the Buyers) on account of the purchase price shall be retained by the Seller(s),
either on account of the purchase price, or as liquidated damages for such breach, as the Seller(s) may elect, and in the latter evenL the Seller(s)
shall be released from all liabilibJ or obligation and this agreement shall become null and void.
12. Seller(s) hereby warrant(s) that he/she/they hove received no notice of violation of any zoning ordinance or ofher gevammerttal low or regulation
with respect to the aforesaid premises and the properly is being used in a manner which does not violate the current zoning law.
13. Assessments for imprcvements commenced prior to the date of this agreement shall be paid bY Seller(s) or s/iowance shall be mede for such
payment by Seller(s) at the time of settlement. Assessments for improvements commenced after the date of this agreement shall be the
responsibility of Buyer(s).
14. Property is being sold 'ss-is~ without any rebresentation or warranties of any kind. Any radon, water, septic, lead paint, hazardous subetenco,
insect infestation, building, structural, electrical, plumbing, heating, or any other inspections of any type required by Buyer(s) or Buyer(s) financial
institution will not void or impair this agreement. This agreement is not contingent on any of the aforementioned items and the results will not void
or impair this agreement.
15. It is understood and agreed that P/ME FORTNA AUCTIONEERS is acting as agent only and shall in no case whatsoever by held liable by either
party for the performance of any term or covenant of this agreement or for damages for nonpedormanco thereof.
16. Buyer(s) acknowledge(s) that he/she/they has/have inspected the premises prior to the time of the auction and before signing this agreement and
erttere this agreement to purchase as a result of said inspection and not aa a result of any advertisement of announcement or rrepresenteticn mede
by the Seller(a) and/or PAE FOE'rNA AUCTIONEERS.
17. This agreement may not be assigned by Buyer(s) without the prior written consent of Seller(s).
18. This agreement contains the whole agreement between Seller(s) and Buyer(s), and there are not other terms, obligations, convenants,
rebresentations, statements, or conditions, oral or otherwise, of any kind whatsoever.
19. This agreement shall be construed in accordance with the laws of the Commonwealth of Pennsylvania; no modirmatidn of this agreement shall be
valid unless the same is In wrtflng and signed by both parties hereto. No waiver of any of the provisions of this agreement shall be valid unless In
writing and signed by the peru/against whom it is sought to be enforced, if there are any growing crops on said premises, they are not included in
this sale and the Seller(s). his/her/their agent or nominee shall be permitted to retum at harvest time to hanreat said crops.
20. This agreement shall be binding un the parties hereto, their heirs, executors, administrators, auc_ce_~_~ore, and assigns.
IN WITNESS WI'IERE~IF, the pj~s~ legally bound, have hereunto sat their hands and seals the day and year first above written.
~':~ ?//';'"' (SEAL) Addmse ~
Addresa / ,~ ! 7/' ~ ; ~ P// , ,(Z_=.L___
Office Phone Area Cede ( ) By: /'" T- -
'-3 G i g ,./.c , a , ' o tO'>'3
I~EV-1508 iX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Nachman. Hen~ 21 03 1029
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 563,614.00
10.
Custodial Account established 8/24/90 w/Dauphin Deposit Bank & Trust Co., Custodian
(See attached Agreement and statement of Manufacturers & Traders Trust Company)
A. Money Market Institutional 1-fund (principal) - $171,395.05 + $30.87 interest
B. Money Market Institutional 1-fund (income) - $11,363
C. $250,000 U.S. Treasury Note (6.875% due 5/15/06) - CUSIP# 912827X80
($277,343.75 + $1,133.24 accrued interest)
D. $50,000 GTE North Inc. Bond (6.00% due 1/15/04) - CUSIP# 362337AD9
($50,221.50 + $1,200 accrued interest)
E. $20,000 Hampden Township PA Sewer Authority Bond (6.150% due 4/1/07)
($22,010.80 + $232.33 accrued interest) - CUSIP # 408797BW7
F. $25,000 Township of Upper Allen General Obligation Bond - CUSIP # 915464AT8
($28,385.00 + $297.50 accrued interest)
Personal Property
Sale by Pae-Fortna Auctioneers, see letter attached.
M&T Bank Savings account
Account No. 15004206016435 ($6,710.47 + $6.63 accrued interest)
See copy of M&T Bank letter attached.
Funds received from cancellation of Blue Cross policy
Funds received from Rita Powell (personal phone calls)
Reimbursement for 2003 County Taxes
Reimbursement for 2003 School Taxes
Funds received from Verizon telephone'company (cancellation of phone service)
Funds received from PP&L (cancellation of electric service)
Funds received from Traveler's Insurance (cancellation of Home Owners Insurance)
47,316.00
6,717.00
116.00
22.00
1,497.00
724.00
4.00
27.00
337.00
TOTAL (Also enter on line 5, Recapitulation) $ 620,374.00
(If more space is needed, insert additional sheets of the same size)
06(14/28~4 11:i4 7!723i2636 N&TBANK PAGE ~2/85
CUSTODIAL AGREEMENT
by and between
Owrte~
HENRY G. NACBMAN
and
DAUPHIN DEPOSIT BANK AND TRUST COMPANY,
Custodian
7/89
06/14/2084 11:14 7172312636 M&TB~NK P~E 83/85
I, Henry G. Nachman , (owner)of Camp Hill, PA
, hereby tzansfer to Dauphin Deposit Balzk and Trust
Company (Custodian), such property as may b'e delivered contemporaneously
herewith, or at such time or times hereafter. With respect thereto, Custodian will:
A. provide safekeeping for such property of my ACcount.
B. Collect the income and, after deducting any charges and necessary expenses,
pay over the net income in such installments and in such manner as owner shall
from time to time direct in writing; and to render an income statement to owner
On a idonthly basis.
C. Collect the proceeds of assets maturing or called for redemption when
known to Custodian.
D. Buy, sell, convert, receive or deliver assets, BUT ONLY UPON OWNER'S
WI~I~ DIRECTIONS AND ALFI'HORIZATION.
E. Maintain appropriate records of property held in the Account and activity
therein; indudiftg all purchases and sales; a. nd fi2rnish a statement of all
transactions involving principal on a monthly basis.
F. Utilize nominee registration for securities.
G. Vote shares or execute and file proxies wkich Custodian considers routine,
without liability.
H. Hold funds in deposit accounts with Custodian, or with other financial
institutions, suck as, but not limited to "Money Market" or "Mutual Fund"
accounts, and provide sweep services on those accounts, for which sweep fees
will be d~argecl.
It is understood and agreed that Custodian shall be under no duty or obligation
t? advise owner regarding retention or sale of any property in the Account, and
that responsibility shall be limited to the terms o~this Agreement.
In the event of owner's death during the continuance of th.is Ae:reement,
custodian shall pay over all assets to owner's Estate. However, t~q,s Agreement
shall not be affected 'by any f~ture disability of the undersigned.
Custodian's compensation for this Custodial Service shall
be as set forth in Exhibit "A" attached hereto.
8~/1~/208~ 11:1~ 7172~128~6 M&TBANK PA6£ 8~/85
This Agreement is effective upon acceptance by Custodian. It may be
terminated bv Custodian or by Owner at any time bY notice in writing.
/ ~~.~ ~- ~ .
The foregoing Custodia..rks. hiP is accepted this ,~6/~'~ day of
,19 ~'.
co~^~..-.
Vice President and Trust Officer
0~/14/2004 1!:14 7!7231263~ H&TBANK PAGE 05/05
CUSTODIAN AGREEMENT
BY AND BET~-EEN
HENRY G. NACHMAN AND
DAUPHIN DEPOSIT BANK AND TRUST COMPANY, NOW
KNOWN AS
MANUFACTURERS AND TRADERS TRUST COMPANY
DATED AUGUST 24, 1990
DATE OF DEATH
12/09/03
PRINCIPAL:
CASH: MTB Money Market Institutional l-Fund
Accrued Interest
$250,000, U. S. Treasury Note 6.875, due 5115106
Accrued Interest
$ 50,000. GTE North Inc 6%, due 1/15/04
Accrued Interest
$ 20,000.
Hampden Township PA Sewer 6.150%, due
04/O 1/07
Accrued interest
$ 25,000
Upper Allen Township PA 6.3%, due 12/9/2003
Accrued interest
$171,395.05
30.87
277,343.75
1,133.24
50,221.50
1,200.00
22,010.80
232.33
28,385.00
297.50
INCOME:
CASH: MTB Money Market Institutional t-Fund
LESS: Manufacturers & Traders Trust Company
Termination Fee
11,363.12
c2.5oo.00)
Hstate Valuation
Pate of Death:
Valuation Pate:
Processing Bate:
12/09/2003
12/09/2003
01/1~/200~
Shares
or Par
Security
Description
tligh/A~k Low/Bid
!) 171395.05
MTB GROUP FDS (55176T429)
~4KT INSTL i
NASDAQ
No pricing information
2) !1363.L2
3) 250000
NTB GROUP FDS {553769'429)
bH4KT INS?L !
NASDAQ
No pricing informatio.
UNITED STATES TREASURY NT (912827X80)
OTC
DTD: 05/15/!996 Mat: 05/15/2006 6.875%
12/09/2003
Iht: 11/15/2003 to 12/09/2003
4)
50000 GTE NORTH INC (362337AD9)
OTC
DTD: 01/15/1994 Mat: 01/15/2004 6%
12/09/2003
Iht: 07/15/2003 to.12/09/2003
110.96875 110.90625 A/B
100.44300 Bid
Estate of: llenry Nachman
Report ']hype: Date o£ Death
Number of Securities: 6
File ID: nachman
Mean and/or Div and Iht
Adjustments Accruals
110.937500
100.443000
Security
Value
N/A
N/A
1,133.24
277,343.75
1,200.0.0
50,221.50
This ~epor t
was produced with EstateVal, a product o£ Estate Valuations & Pricing Systems,
contact EVP Systems at (818) 313-6300. (Revision
Inc. If you hove questions, please
Date of Death: 12/09/2003
Valuation Date: 12/09/2003
Processing Uate: 01/14/2004
Shares Security
or Par Description
High/Ask
Low/Bid
Estate of: Henry Nachman
Report TyDe: Date of Death
Number of Securities: 6
File ID: naclunan
}lean and/or Div and Iht
Adjustments Acczuals
Security
Value
o_
C3
~3
U)
5)
6)
20000 HM4PDBN q~P PA SWR AUTII REV
FT Intr.
DTD: 03/~5/1978 blat: 04/01/2007 6.15%
12/09/2003
Iht: 10/01/2003 to 12/09/2003
25000 UPPER ALLEN TNP PA
FT Intr.
DTD: 03/15/1978 Mat: 04/01/2013 6.3%
12/09/2003
Iht: 10/01/2003 to 12/09/2003
GTD SWR It {408797BW7]
110.10900
O.O. BDS {915464AT8)
113.54000
109.99900 A/B
113.54000 A/B
110.054000
113.540000
232.33
297.50
22,010.80
28,385.00
Total Value:
Total Accrual:
Total: $380,824.12
$2,863.07
$377,961.05
Page 2
This report was produced with RstateVal, a product of Estate Valuations & Pricino Systems, Inc.
contact EVD Systems at (818) 313-6300. {Revision 6.3.3)
If you have questions, please
PAE
AUCTIONEERS
26 e. Main St. · annviile, Penn$¥1¥ania 17005
HENRY NACHMAN ESTATE
PERSONAL PROPERTY AUCTION
SETTLEMENT STATEMENT
TOTAL PROCEEDS
AUCTION COMMISSION 10%
(Advertising costs were paid from Real Estate Proceeds)
NET
$47,316.00
4,731.60
$42,584.40
Kerry Pae, CAI
(717) 236-3752
(Harrisburg)
FAX: (717) 867-5265
www. paefortna-aucfioneers.com
Michael Fortna, CAi
(717) 867-4451
(Annville)
499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12
Purcell, Krug & Hailer
Attorneys At Law
1719 North Front Street
Harrisburg, PA 17102-2392
Phone (888) 502-4349
F ax (302) 934-2955
February 3, 2004
Re: Estate o£Henrv G Nachman
Social Security: 195-07-6283
Date of Death: December 9,2003
Dear Sir or Madam:
Per your inquiry dated January 8, 2004, please be advised that at the time of death, the above-named decedent had on
deposit with th/s bank the following:
Type of Account
Account Number
Ownership 6Vames o99
Opening Date
Balance on Date of Death
Accrued Interest
Total
Savings Account
15004206016435
Henry G Nachmcrn
Florence B Nachman
Gus I~einstock, POA
02/28/86
$6,710.47
$ 6.63
$6,717.10
For further account information, closures and/or reimbursement of funds please call the Camp Hill Office at #717-255-2279.
Please be advised, there was no safe deposit box found for the above decedent.
Records Management
Capital BlueCross
Capital Advantage Insurance Company*
independent licensees of the Blue Cross and Blue Shield AssOC~t~on
CHECK NUMBER:
30001543
GROUP/SUBGROUPID:
00900001-
01/22_J04
HENRY NACHMAN
C/O THE ESTATE Of HENRY NACHMAN
ATTN: HOWARD KRUG
1719 NORTH FRONT ST
HARRISBURG, PA 17102-2392
Explanation Of Refund
Refund Reason: Subscriber Deceased-H Nachman- 195076283
Total Refund Amount:
$115.72
NF-49 (8/2002)
Capital Advantag® Insurance Company
independent licensees of the Blue Cross and aue Shield Associaaon :~i.!ii~::... ~::i:? ;:':.:ii '~:~i:.ii ...... ~: ;::~i:~:;: ~ii~! i~ ;; 01/22/04
PAY TO THE ORDER OF: '%~:~?':'~;!!!!:'::'i~'i~ID AFTER 180 DAYS
HENRY NACHNAN
C/O THE ESTATE OF HENRY NACHNAN
ATTN: HOWARD KRUG
1719 NORTH FRONT ST
HARRZSBURG, PA 17102-2392
Mellon Bank, N.A., Philadelphia, PA
Payable Through Mellon Bank (DE) N.A. Wilmington, DE
CHECK
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT
SETTLEMENT STATEMENT
C. NOTE:
OMB NO. 250;2-0265 ~
I B. TYPE OF LOAN:
1.[--1FHA 2.DFmHA 3. DCONV. UNINS. 4. I--IVA 5. [-ICONV. INS.
6. FILE NUMBER: I 7. LOAN NUMBER:
1344.1421 I
8. MORTGAGE INS CASE NUMBER:
This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked "[POC]" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
1.0 3/98 (GULAPURCH.O4.PFD/1344.1421/16)
D. NAME AND ADDRESS OF BORROWER:
William P. Gula and
Michele R. Gula
34 Emlyn Lane
Mechanicsburg, PA 17055
G. PROPERTY LOCATION:
1520 Slate Hill Road, Tract 2~being 8.17acres
as set forth in Deed Book C-26, Page 627 &
Tract '% as shown on the Final Subdivision of
a 106.85 acre tract as recorded in Plan Book
41, Page 68, Lower Allen Township, Cumberland
CountyI Pennsylvania
E. NAME AND ADDRESS OF SELLER:
Gustave L. Weinstock, Jr.
Executor of the Last Will & Testament of
Henry G. Nachman
c/o Howard Krug, Esquire
1719 North Front Street
Harrisburg, PA 17102
23-2283826
H. SETTLEMENT AGENT:
South Central Agency, Inc.
f. NAME AND ADDRESS OF LENDER:
PLACE OF SETTLEMENT
3401 North Front Street
Harrisburg, PA 17110-0950
None
I. SETTLEMENT DATE:
May 19, 2004
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER:
101. Contract Sales Price
102. Personal Property
103. Settlement Charges to Borrower (Line 1400I
104.
105.
Adiustments For Items Paid Bv Seller in
545,000.00
13,968.00
400. GROSS AMOUNT DUE TO SELLER;
401. Contract Sales Pdce
402. Personal Property
403.
545,000.00
405.
to 406.
to 01/01/05 334.20 407.
to 07101/04 146.92 408.
409.
410.
411.
412.
559,449.12 420.
106. City/town taxes
107. Countytax 2parcels
108. Schooltax 2parcels
109.
Adiustments For Items Paid Bv Seller in advance
City/town taxes to
Countytax2parcels 05/19/04 to 01/01/05
Schooltax 2parcels 05119/04 to 07/01/04
334.2(
146.92
05/19/04
05/19/04
110.
111.
112.
120. GROSS AMOUNT DUE FROM BORROWER GROSS AMOUNT DUE TO SELLER 545,481.12
REDUCTIONS IN AMOUNT DUE TO SELLER:
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500.
201. Deposit or earnest money 55,000.00 501.
202. Principal Amount of New Loan(s) 502.
203. Existing loan(s) taken subject to 503.
204. 504.
205. 505.
506.
507.
508.
509.
510.
511.
512.
513.
514.
515.
516.
517.
518.
519.
206.
207.
208.
Excess Deposit (See Instructions)
Settlement Charges to Seller (Line 1400)
Existing loan(s) taken subject to
Payoff of first Mortgage
Payoff of second Mortqage
(Deposit dish. as proceeds)
Adjustments For Items Unpaid By Seller
City/town taxes to
Countytax 2parcels to
21,847.00
Schooltax 2parcels to
!209.
Adjustments For Items Unpaid By Seller
210. City/town taxes to
211. Countytax 2parcels to
212. Schooltax 2parcels to
213.
214.
215.
216.
217.
218.
219.
220. TOTAL PAID BY/FOR BORROWER 55,000.00 1 520. TOTAL REDUCTION AMOUNT DUE SELLER 21,847.00
300. CASH AT S~¥¥LEME~T FROM/TO BORROWER: ~ 600. CASH AT SETTLEMENT TO/FROM S~=I I ~=R:
301. Gross Amount Due F~ bm Borrower (Line 120) I 559,449.12 I 601. Gross Amount Due To Seller (Line 420) 545,481.12
302. Less Amount Paid Bi For B~orrower (Line 220) ~ I( 55,000.00)1 602. Less Reductions Due Seller (Line 520) 21 847.00'~
303. cAsH(x FROM) ' . // I 5o4,449.121 603. CASH(XFROM)SELlER 5231634.12
The undersigned here~/~ ck.~wl~/d~~a~o/~¢eted copy of pages 1&2 of this statement& any attachments referred to herein.
Borrower [ /! ~_~'~. (~//,~ Seller Gustave L. Weio~tock, Jr., Executor of the Last Will and
V~ [m ~ G~u~, ,, /.~ ~ //..,_~ Testament o,~,j~ry G. Nachma~
HUD-1 (3-86) RESPA, HB4305.2
Page 2
L. SETTLEMENT CHARGES
545.000.00 ~.. 3.0000 % 16.350.00
700. TOTAL COMMISSION Based on Price
Division of Commission (line 700) as Follows:
701. $16,350.00 to Pae Fortna Auctioneers
PAID FROM
BORROWER'S
FUNDS AT
SE'FrLEMENT
PAID FROM
SELLER'S
FUNDS AT
SETTLEMENT
702. $ to
703. Commission Paid at Settlement 16,350.00
704. to
I~00. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Origination Fee % to
802. Loan Discount % to
803. Appraisal Fee to
804. Credit Report to
805. Lender's Inspection Fee to
806. Mortgage Ins. App. Fee to
807. Assumption Fee to
808. Document Preparation Fee
809.
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From to @ $
902. Mortgage Insurance Premium for
903. Hazard Insurance Premium for
904.
905.
months to
1.0 years to
/day ( days
%)
1000. RESI~RVE~ PlEPO~ITEP WITH LENDER
1001. Hazard Insurance
1002. Mortgage Insurance
1003. City/town taxes
1004. Countytax 2parcels
1005. Schooltax 2parcels
months (~ $ per month
months (~ $ per month
months (~ $ per month
months (~ $ per month
months @ $ per month
1006. months (~ $ per month
1007. months @ $ per month
1008. months ~ $ per month
111~1~. TITLE CHARGE{~
1101. Settlement or Closing Fee
1102. Abstract or Title Search
to
to
1103. Title Examination to
1104. Title Insurance Binder
to
1105. Document Preparation to
1106. Notary Fees to
1107. Attorney's Fees to Mette, Evans & Woodside (POC)
(includes above item numbers:
1108. Title Insurance to 3,027.50
(includes above item numbers.1102, 1103,
1109. Lender's Coverage
1110. Owner's Coverage
South Central Agency, Inc.
1104 & 1108
$ 545,000.00
1111. Endorsements 100/300/8.1
1112. Closing Service Letter South Central Agency, Inc.
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees: Deed $ 40.50; Mortgage $
Releases $
1202. City/County Tax/Stamps: Deed
1203. State Tax/Stamps: Deed
1204.
5,450.00;Mortgage
5,450.00;Mortgage
1205.
40.50I
5,450.00
5,450.00
1300, APDITIONAL SETTLEMENT CHARGES
1301. Survey to
1302. Pest Inspection to
1303. Advertisin(j Costs
to Pae Fortna Auctioneers
1304.
1305.
1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K)
By signing page 1 of this statement, the signatories acknowledge receipt of a completed copy of page 2 of this two page statement.
Certified ,o be a true copy South Central Age;~ ,~l~c.
Settlement Agent
13,968.00
5,497.00
21,847.00
( 1344.1421 / 1344.1421 / 15 )
ACKNOWLEDGMENT OF RECEIPT OF SETTLEMENT STATEMENT
Borrower:
Seller:
Lender:
Settlement Agent:
Place of Settlement:
Settlement Date:
Property Location:
William P. Gula and Michele R. Gula
Gustave L. Weinstock, Jr., Executor of the Last Will and
None
South Central Agency, Inc.
717-232-5000
3401 North Front Street
Harrisburg, PA 17110-0950
May 19, 2004
1520 Slate Hill Road, Tract 2~being 8.17acres
as set forth in Deed Book C-26, Page 627 &
Tract "A as shown on the Final Subdivision of
a 106.85 acre tract as recorded in Plan Book
41, Page 68, Lower Allen Township, Cumberland
County, Pennsylvania
I have c~efully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and
accurat~ statement ~f all receipts~ an(~disbursements made on my account or by me in this transaction. I further certify
that I I'~, ve r,ece~/e~a ,copy of )~ H,I~O-1 Settlement Statement.
// ~~ ~ ,~ Gustave L. Weinstock, Jr., Executor of the Last Will and
~~~. ~ ~ ~ ~ ~~ Testament of ~n~ G. Nachman
WARNING: It is a crime to knowingly make false statements to the United States on this or any similar form. Penalties upon conviction can
include a fine and imprisonmenL For details see: Title 18 U.S. Code Section 1001 and Section 1010.
(GULAPURCH.04.PFD/1344.1421/17)
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT
SETTLEMENT STATEMENT
C. NOTE:
OMI~ NO. 2502-0265 ~
I B. TYPE OF LOAN:
1.DFHA 2.E~FmHA 3. r~-']CONV. UNINS. 4. I-]va 5. ~']CONV. INS.
6. FILE NUMBER: I 7. LOAN NUMBER:
1344,1419 I
8. MORTGAGE INS CASE NUMBER:
This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked "[POC]" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
1.0 3/98 (STENCEFARMPURCH.O4.PFDI1344.1419/27)
D. NAME AND ADDRESS OF BORROWER:
Edward G. Stence and
Stephanie L. Stence
1016 Tumbridge Lane
Mechanicsburg, PA 17050
G. PROPERTY LOCATION:
1520 Slate Hill Road being Tract No.1~
10.57 acres in Deed Book C-26, Page 627
Lower Allen Township, Cumberland
County, Pennsylvania
E. NAME AND ADDRESS OF SELLER:
Gustave L. Weinstock, Jr. Executor of the
Last Will & Testament of Henry G. Nachman
c/o Howard Krug, Esquire
1719 North Front Street
Harrisburg, PA 17102-2392
H. SETTLEMENT AGENT:
South Central Agency, Inc.
23-2283826
PLACE OF SETTLEMENT
3401 North Front Street
Harrisburg, PA 17110-0950
F. NAME AND ADDRESS OF LENDER:
Communi~ Banks
390 East Penn Drive
Enola, PA 17025
I. SETTLEMENT DATE:
May12,2004
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
400. GROSS AMOUNT DUE TO SI=I I ER:
100. GROSS AMOUNT DUE FROM BORROWER:
101. Contract Sales Pdce
102. Personal Property
103. Settlement Charges to Borrower (Line 1400)
104. COMMUNITY BANKS PAYOFFI3-46005400
105.
106.
Adiustments For Items Paid Bv Seller in advance
Trash 04/01-06/30 to
107. County taxes 05112/04 to 01101/05
108. School taxes 05/12104 to 07/01/04
109.
110.
800,000.00
27,472.10
63,867.84
1,163.11
401. Contract Sales Price
402. Personal Property
403.
404.
405.
Adjustments For Items Paid Bv Seller in advance
406. Trash 04101-06/30 to
407. County taxes 05/12/04 to 01/01/05
800,000.00
1,163.11
576.78 408. School taxes 05/12/04 to 07101/04 576.78
409.
410.
111. 411.
i12. 412.
120. GROSS AMOUNTDUE FROM BORROWER 893,079.83 420. GROSS AMOUNTDUE TO SELLER 801,739.89
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
501. Excess Deposit (See Instructions)
Settlement Charcjes to Seller (Line 1400)
Existing loan(s) taken subject to
Payoff of first Mortgage/d
Payoff of second Mortgage
(Deposit disb. as proceeds)
201. Deposit or earnest money 80,000.00
202. Principal Amount of New Loan(s) 800,000.00 502.
203. Existing loan(s) taken subject to 503.
204. 504.
205. 505.
206. 506.
207. 507.
208. 508.
209. 509.
Adjustments For Items Unpaid By Seller
210. Trash 04/01-06/30 04/01/04 to 05/12/04 22.23 510.
Adjustments For Items Unpaid By Seller
Trash04/01-06/30 04101/04 to 05/12104
29,502.00
22.23
211. County taxes to
212. Schooltaxes to
511. County taxes to
512. School taxes to
213. 513.
214. 514.
215. 515.
216.
516.
217. 517.
:218. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER
300. CASH AT SETTLEMENT FROM/TO BORROWER:
301. Gross Amount Due From Borrower (Line 120)
880,022.23
893,079.83
880,022.231
13,057.60
302. Less Amount Paid By/For Borrower (Line 220)
303. CASH ( X FROM) ( TO) BORROWER
The
520. TOTAL REDUCTION AMOUNT DUE SELLER
600. CASH AT SETTLEMENT TO/FROM SELLER:
601. Gross Amount Due To Seller (Line 420)
602. Less Reductions Due Seller (Line 520)
603. CASH ( X TO) ( FROM) SELLER
29,524.23
801,739.89
29,524.231
772,215.66
undersigned hereby ack~nowle~:e~"of'~a~ompleted copy of pages 1 &2 of this statement & any attachments refer[ed to herein.
Borrower ~..~.,~;.-~+~"~.~~stence /'"~'- Seller Estate of Hen~l~achma~~_~~~___~/-'7
~__...,~ ~..~.~ .,~___..__:~ By:'"
Steph"a~ie Stence
HUD-1 (3-86) RESPA, HB4305.2
Pa~e 2
L. SE~LEMENT CHARGES
700. TOTAL COMMISSION Based on Price $ ~)00.000.00 ~ 3.0000 % 24.000.00 PAID FROM PAID FROM
Division of Commission (line 700) as Follows: BORROWER'S SELLER'S
701. $ 24,000.00 to Pae Fortna Auctioneers FUNDS AT FUNDS AT
702. $ to SETTLEMENT SETTLEMENT
703. Commission Paid at Settlement 24,000.00
704. Advertisin,~ Costs to Pae Fortna Auctioneers 5~497.00
I~{)1;), ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Origination Fee % to
802. Loan Discount 0.9000 % to Community Banks 7,200.00
803. Appraisal Fee to Scott Archibald POC $775.00b
804. Credit Report to Trans Union POC $2.60L
805. Life of Loan Flood Certif. to Credit Plus Solutions Group POC $1.75L
806. Mortgage Ins. App. Fee to
807. Assumption Fee to
808. Document Preparation Fee to Community Banks POC $150.00L
809. Flood Determination Fee to Credit Plus Solutions Group POC $24.00L
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. interest From 05/12/04 to 06/01104 @ $ /day ( 20 days %)
902. Mortgage insurance Premium for months to
903. Hazard Insurance Premium for 1.0 years to Nde Insurance Group POC $972.00b
904.
905.
11~0~. RESERVES DEPOSITED WITH LENDER
1001. Hazard Insurance months (~ $ per month
1002. Mortgage Insurance months (~ $ per month
1003. Trash04101-06/30 months (~ $ per month
1004. County taxes months {~ $ per month
1005. School taxes months (~ $ per month
1006. months (~ $ per month
1007. months @ $ per month
1008. months ~ $ per month
1100. TITLE~ ~HARGES
1101. Settlement or Closing Fee to
1102. Abstract or Title Search to Credit Plus Solutions Group POC $61.00L
1103. Title Examination to
1104. Title Insurance Binder to
1105. Document Preparation to
1106. Notary Fees to
1107. Attorney's Fees to Mette, Evans & Woodside (POC)
(includes above item numbers:
1108. Title Insurance to South Central A,qency, Inc. 3,983.75
(includes above item numbers.1102, 1103, 1104 & 1108 )
1109. Lender's Coverage $ 800,000.00
1110. Owner's Coverage $ 800,000.00
1111. Endorsements 100/300/8.1 to South Central Agency, Inc. 150.00
1112. Closing Service Letter to First American Title Insurance Company 35.00
1113.
1;~1~, GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees: Deed $ 38.50; Mortgage $ ; Releases $ 38.50
1202. City/County Tax/Stamps: Deed 8,000.00; Mortgage 8,000.00
1203. State Tax/Stamps: Deed 8,000.00; Mortgage 8,000.001
1204. Recording Fees mortg/satisfact to Cumberland County Recorder of Deeds POC $123.00L
1205.
1;~1;){), ADIDITIONAL SETTLEMENT CHARGES
1301. Survey to
1302. Pest Inspection to
1303. Trash-04/01-06/30 to Lower Allen Township Trash Department 49.35
1304. Overnight Fee to Mette, Evans & Woodside 15.50
1305. Tax Certification Fee to Bonnie K. Miller, Treasurer Acct 13-26-0251-022 5.00
1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K) 27,472.10 29,502.00
By signing page 1 of this statement, the signatories acknowledge receipt of a completed copy of page 2 of this two page statement.
Certified to be a true copy South Cent~~n~~'~''f~'
Settlement Agent
( 1344.1419 / 1344,1419/27 )
ACKNOWLEDGMENT OF RECEIPT OF SETTLEMENT STATEMENT
Borrower:
Seller:
Lender:
Settlement Agent:
Place of Settlement:
Settlement Date:
Property Location:
Edward Stence and Stephanie Stence
Henry G. Nachman and Florence B. Nachman husband and wife
Community Banks
South Central Agency, Inc.
717-232-5000
3401 North Front Street
Harrisburg, PA 17110-0950
May 12, 2004
1520 Slate Hill Road being Tract No.1~
10.57 acres in Deed Book C-26, Page 627
Lower Allen Township, Cumberland
County, Pennsylvania
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and
accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify
that I have received a copy of the HUD-1 Settlement Statement.
Stephanie Stence
Estate of Henry G. Nachman
WARNING: It is a crime to knowingly make false statements to the United States on this or any similar form. Penalties upon conviction can
include a fine and imprisonment. For details see: Title '18 U.S. Code Section 1001 and Section 1010.
(STENCEFARMPURCH.04.PFD/1344.1419/27)
DATE
06/02/04
CREDIT BALANCE REFUND
TELEPHONE NUMBER
717 761-7099
TOTAL REFUND
$3.77
PA
PPL Electric UtlhtmSp[h ~ ~.~.,C°rD',:~¢~~~~ "' "/" N~. 00t 0749316
, [~,~ .... ~.~,
HARRISBURG PA 17102~ ....
DC, LL,'AF ~ C;!!! i
Totai E, eoosit
2-7 z.9
m: 5 L, O00 ~= 2r-,
P. O. BOX 3008
FALL RIVER, HA 02722-3008
3772
3772
HENRY NACHMAN
Z HAROLD KRUG
1719 N FRONT STREET
HARRISBURG PA 17102
DATE: 06/07/04
CHECK NUMBER: 883A 36905778
AMOUNT: $232.00~mm
OFFICE: 818 AGENT: 0HR689
ACCOUNT: 031466962
REFUND DUE TO CHANGE OR OVERPAYMENT
031466962
NAMED INSURED HENRY NACHMAN
AND ADDRESS % HAROLD KRUG
1719 N FRONT STREET
HARRISBURG PA 17102
~m IF YOU HAVE ANY QUESTIONS, PLEASE CALL (717) 657-3227
LOGAN INS AGCY
P. O. BOX $008
FALL RIVER, NA 02722-3008
Detach Check.
= 62-20
311
om .KDELAwA 883A 36905778
NEW CASTLE DELAWARE 19720
DA~E': '"OFFICE: AGENT: ACCOUNT: 031466962 PAY ~;232 00~*
06/0,7/04 818 OHR689 '
TNO HUNDRED THIRTY T~/O & OO/1OO DOLLARS
PAY
TO THE
ORDER OF
HENRY NACHMAN
% HAROLD KRUG
1719 N FRONT STREET
HARRISBURG PA 17102
AUTHORIZED SIGNATURE
PLEASE CASH WITHIN 60 DAYS
P. O. BOX 3008
FALL RIVER~ MA 02722-$008
37/3
3773
HENRY NACHMAN C/O HAROLD KRUG
1719 N FRONT ST
HARRISBURG PA 17102
DATE: 06/07/0q
CHECK NUMBER: 883A 36905787
AMOUNT: $25.00mn~
OFFICE: 818 AGENT: 0HR689
ACCOUNT: 233006205
REFUND DUE TO CANCELLATION
233006205
NAMED INSURED HENRY NACHMAN C/O HAROLD KRUG
AND ADDRESS 1719 N FRONT ST
HARRISBURG PA 17102
nm IF YOU HAVE ANY QUESTIONS, PLEASE CALL (717) 657-3227
LOGAN INS AGCY
r--Detach Check
P. O, BOX 3008
FALL RIVER~ HA 02722-$008
CITIBANK DELAWARE
NEW CASTLE DELAWARE 19720
883A
62-20
311.
36905787
DATE:' 0FFI. CE: AGENT:
06/0?/04 818 OHR689
ACCOUNT: 233006205
PAY ~25. O0~n~
TWENTY FZVE & 00/100 DOLLARS ******************************************************************
PAY
TO THE
ORDER OF
HENRY NACHMAN C/O HAROLD KRUG
1719 N FRONT ST
HARRISBURG PA 17102
AUTHORIZED SIGNATURE
PLEASE CASH WITHIN 60 DAYS
P. O. BOX $008
FALL RIVER~ MA 02722-$008
3774
3774
HENRY NACHMAN C/O HAROLD KRUG
171g N FRONT ST
HARRISBURG PA 17102
DATE: 06/07/04
CHECK NUMBER: 883A 36905796
AMOUNT: ~80.O0*~x
OFFICE: 818 AGENT: OHR68g
ACCOUNT: 233009675
REFUND DUE TO CANCELLATION
233009675
NAMED INSURED HENRY NACHMAN C/O HAROLD KRUG
AND ADDRESS 171g N FRONT ST
HARRISBURG PA 17102
xx IF YOU HAVE ANY QUESTIONS, PLEASE CALL (717) 657-3227
LOGAN INS AGCY
~,--- De.t ach Check
P. O. BOX $008
FALL RIVER~ HA 02722-3008
DATE:: IOFF'ICE:" AGENT:
06/0?/04 818 0HR689
CITIBANK DELAWARE
NEW CASTLE DELAWARE 19720
ACCOUNT: 233009675
883A
Detach Check_
62-20
311
36905796
PAY 880.00xxx
EZGHTY & 00/100 DOLLARS ***********************************************************************
PAY
TO THE
ORDER OF
HENRY NACHMAN C/0 HAROLD KRUG
1719 N FRONT ST
HARRISBURG PA 17102
AUTHORIZED SIGNATURE
PLEASE CASH WITHIN 60 DAYS
REV-1510 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Nachmanl Henry 21 03 1029
This schedule must be completed and flied if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER AC[ACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (~r ~PUCAB~ VALUE
1. Gustave L. Weinstock, Jr. - Nephew to Decedent 9,000.00 100. 3,000.00 6,000.0(:
Miscellaneous personal property ($1,345) and cash ($7,655)
gifted on 12/1/03.
2. Lois Abrams - Niece to Decedent 9,000.00 100. 3,000.00 6,000.0(:
Miscellaneous personal property ($8,895) and cash ($105)
gifted 11/10/03.
3. Benjamin Schulein, Jr. - Nephew to Decedent 9,000.00 100. 3,000.00 6,000.0(:
Cash ($9,000) gift on 12/1/2003.
4. Nancy Baldridge - Niece to Decedent 9,000.00 100. 3,000.00 6,000.0(:
Cash ($9,000) gift on 11/14/1/2003
TOTAL (Also enter on line 7 Recapitulation) $ 241000.00
(If mom space is needed, insert additional sheets of the same size)
,~NNSYLVANIA
RETURN
.,ECEDENT
SCHEDULE H
FUNEP-~L EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21 03
1029
Debts of decedent must be reported on Schedule I.
DESCRIPTION AMOUNT
8.
9.
10.
13.
15.
16.
FUNERAL EXPENSES:
Neill Funeral Home
Stephenson's Flowers
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Pemonal Representative (s)
Social Secudt'/Number(s)/EIN Number of Personal Representative(s)
S~'eetAddress 1714 Morrison Lane
cit~ Foristell
Year(s) Commission Paid: 2004-50%; 2005-50%
AttomeyFees Purcell, Krug & Hailer
Family Exemption: (If decedent's address is not the same as claimanfs, attach explanation)
Claimant 4~
Street Address
Gustave L. Weinstock, Jr., Executor
State ,vltJ Zip o~4~
City State Zip
Relationship of Claimant to Decedent
Probate Fees Cumberland County Register of Wills
Cumberland County, Pennsylvania
Accountant's Fees
Tax Return PrepareFs Fees Beard Miller Co., John Laudeman, CPA
Cumberland County Register of Wills (Short Certificates)
Cumberland County Register of Wills (Certified Copy of Will)
Cumberland Law Journal (Advertising Notice)
Sentinel (Advertising Notice)
Robert Jones Appraisers (appraisal real estate)
Pae-Fortna Auctioneers (appraisal personal property)
M&T Investment Group (termination fee)
Gustave L. Weinstock, Jr. (Three round trips for travel, lodging, food, etc...)
(St. Louis to Harrisburg, PA)
Andrea Reed (maintain home, coordinate w/Exec. & counsel re: maintenance,
cleaning, condition & auction at premises)
Michael Reed (lawn care; removal of trees) ,m
TOTAL (Also enter on Pine 9, Recapitulation) $
7,681.00
108.00
99,541.00
69,757.00
564.00
495.00
21.00
2.00
75.00
129.00
850.00
800.00
2,500.00
4,987.00
11,608.00
4,710.00
271~207.00
(If more space is needed, insert additional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Nachman, Henry 21 03 1029
Decedent's Name Page 1 File Number
Schedule H - Funeral Expenses & Administrative Costs - B7.
ITEM
NUMBER DESCRIPTION AMOUNT
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
Tom Reed (lawn maintenance)
World Painting (painting of home)
J.S. Norford (plumbing work)
Keller Bros. (tractor repair for sale)
Tom Evanoff (roof repair)
Highland Gardens (mulch)
Fehl Awning Company (Install Awning)
Pae Fortna Auctioneers (Fees for sale of real estate and land)
Pae Fortna Auctioneers (Advertising Costs for Sale of Real Estate)
Pae Fortna Auctioneers (Sale of personal property)
Bonnie K. Miller (Tax Certification Fee)
Additional Probate Fees - Cumberland County
150.00
9,800.00
192.00
273.00
275.00
143.00
115.00
40,350.00
10,994.00
4,732.00
5.00
350.00
SUBTOTAL SCHEDULE H-B7 67,379.00
REV-1512 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
Nachman, Henry
FILE NUMBER
21 03
1029
Include unreimbursed medical expenses.
ITEM
NUMBER
10.
11.
12.
13.
14.
15.
DESCRIPTION
PP&L - Electric Bill
AT&T - Telephone bill
Keystone Oil - Heating fuel for property
Lower Allen Township - Refuse
Verizon - telephone
Griswold Special Care- Nursing Facility
Alvana Brown - Private Duty Nurse
Andrea Reed - Caregiver- Nurse
Rita Powell - Private Duty Nurse
Ahold Financial - Giant (outstanding grocery bills)
Weis Pharmacy (outstanding bill for prescriptions)
Elam Burkholder- Caretaker
Bonnie K. Miller, Tax collector (real estate taxes)
Bonnie K. Miller, Tax Collector (per capita tax)
PA Department of Revenue
(Income taxes for 2003)
VALUE AT DATE
OF DEATH
1,662.00
218.00
2,732.00
220.00
174.00
131.00
117.00
384.00
107.00
296.00
203.00
900.00
2,358.00
10.00
193.00
TOTAL (Also enter on line 10, Recapitulation) $ 23,833.00
(If more space is needed, insert additional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Nachman, Henry 21 03 1029
Decedent's Name Page 2 File Number
Schedule I - Debts of Decedent, Mortgage Liabilities, & Liens
ITEM
NUMBER DESCRIPTION AMOUNT
16. US Treasury - 2003 Taxes 128.00
17.
Purcell, Krug & Hailer (unpaid fees)
14,000. O0
SUBTOTAL SCHEDULE I 14,128.00
GRAND TOTAL SCHEDULE I $ 23,833.00
REV-1513 EX + (g-nm
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Nachmarh Henry
NUMBER
1.
2.
3.
4.
5.
6.
7.
[]~.
NAME AND ADDRESS OF 15ERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, andtmnsfers under
Sec. 9116 (a)(1.2)]
Gustave L. Weinstock, Jr.
1714 Morrison Lane, Foristell, MO 63348
Nancy R. Baldridge
1464 Timber Lake Manor Pkw., Chesterfield, MO 63017
Lois Abrams
5420 Connecticut Ave. Northwest, Washington D.C. 20015
Apartment 719
Benjamin Schulein, Jr.
4466 W. Pine Blvd., Apt. 15C, St. Louis, MO 63108
Louis Loebner
1127 Bella Vista Drive, Saint Louis, MO 63131
Elam Burkholder
1516 Slate Hill Road, Camp Hill, PA 17011
Ruth Burkholder
2749 Lisburn Road, Camp Hill, PA 17011
FILE NUMBER
21 03
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Nephew
Niece
Niece
Nephew
Nephew
Friend
Friend
1029
AMOUNT OR SHARE
OF ESTATE
1/4 residuary estate
1/4 residuary estate
1/4 residuary estate
1/4 residuary estate
$30,000
$3,000
$3,000
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
Holy Spirit Hospital
503 N. 21st Street, Camp Hill, PA 17011
United Way of the Capital Region
2235 Millenium Way, Enola, PA 17025
Pinnacle Health System
P.O. Box 8700, Harrisburg, PA 17105-8700
1,000.00
1,000.00
1,000.00
TOTAL OF PART I! - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 4,000.00
(If more space is needed, insert additional sheets of the same size)
Nachman, Henry
Decedent's Name
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
21
Page 3
03 1029
File Number
Schedule J - Beneficiaries - 2B
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
Temple Ohev Sholom
2345 N. Front Street, Harrisburg, PA 17110
SUBTOTAL SCHEDULE J-2B 1,000
1,000.00
Purcell, Krug & Hailer
HERSHEY
717 533 3836
.JOSEPHNSSLEt¢ 9 0 982!
JOHN W PURCELL
~ DELI~rg~D
?eqiseer of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17213-3387
Re:
Estate of Henry G. Nachman
File Numbez: 21-93-1'329
Dale ~ Death: IZ/~,2~
Dear $ir/'Hadam:
Mn ...... d please =_n.a t
in she amcunt .cf $50,533'.,i, 3 for cie above Estate.
Thank you.
Ho~4a sS. Krug
HSK/ase
Ensiesures
Gus Weinstock,
Ex .... t~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENTOFREVENUE
BUREAU OF~ND[VIDUAL TAXES
DEPT280601
HARRISBURG, PA 17128 0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV 1162 EX(11 96)
NO. CD 004290
KRUG HOWARD B
1719 NORTH FRONT STREET
HARRISBURG, PA 17102
ESTATE INFORMATION: SSN: 195-07 6283
FILE NUMBER: 2103 1029
DECEDENT NAME: NACHMAN HENRY G
DATE OF PAYMENT: 08/19/2004
POSTMARK DATE: 08/1912004
COUNTY: CUMBERLAND
DATE OF DEATH: 12/09/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $50,530.03
TOTAL AMOUNT PAID:
$50,530.03
REMARKS: H KRUG
SEAL
CHECK# 996
INITIALS: VZ
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WLLLS
BUREAU OF INDIVTDUAL TAXES
INHERITANCE TAX DIVISION
DEP"r. 780601
HARRISBURG, PA 17128-0601
CONMONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLO#ANCE OR DZSALLONANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REV-1E;~7 EX &FP C01-05)
HONARD B KRUG ESQ
PURCELL ETAL
1719 N FRONT ST
Hag
PA 17102
DATE 08-16-200q
ESTATE OF NACHMAN HENRY
DATE OF DEATH 12-09-Z005
FILE NUMBER Zl 05-1029
COUNTY CUMBERLAND
ACN 101
Amount Remitted
MAKE CHECK PAYABLE AND REMZT PAYMENT TO:
REGISTER OF HILLS
CUMBERLAND CO COURT HOUSE
G
r,.-- ::::,,~,~: CARLISLE, PA 17015
REV-1547?EX~ AFP ~D1-03} ,NOTICE OF ZNHERZTANCE TAX ~-~P~-~-~-'/~-~-~-~- .................
D~SALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE 0~: NACHM~ ::::iii! HENRY G FILE NO. 21 05-1029 ACN 101 DATE 08-16-200q
T~ RETURN NAS: ( ) ACCEPTED AS FILED
RESERVATZ~N~CONCERNZNG~F~TURE INTEREST - SEE REVERSE
APPRAZSED~4~LUE C~ RETUR~BASED ON: ORIGINAL RETURN
1. Re~ Estate ;Schedu~ (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
q. Mortgages/Notes Receivable (Schedule D) (q)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (ScheduZa G) (7)
8. Total Assets
APPROVED DEDUCTZONS AND EXEMPTZONS:
9. Funeral Expanses/Adm. Costs~Misc. Expenses (SchaduZe H)
10. Debts/Mortgage Liabilities/Liens (Schedule Z) (10)
Total Deduct/OhS
Nat Value of Tax Return
11.
12.
13.
lq.
NOTE:
(X) CHANGED SEE ATTACHED NOTTCE
1~3q51000.00
.00
.00
.00
620~7q.00
.00
NOTE: To Lnsura proper
credit to your account,
submit ~ha upper portion
of this form wi~h your
tax payment.
ZqzO00.O0
(a) 1,989,$7q.00
271,Z07.00
ZS,855.00
(11) 29~.040.00
(12) 1,69q,~q. O0
Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) q,O00.00
Nat Value of Estate Sub~ect to Tax (lq) 1,690,55q.00
Zf an assessaent was lssued previously, 11nes 1~, 15 and/or 16, 17, 18 and
reflect flgures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of L/ne lq at Spousal rata
16. Amount of L/ne lq taxable at L/naal/Class A rate
17. Amount of Line lq at Sibling rata
18. Amount of L/ne lq taxable at Collateral/Class B rata
19. Principal Tax Due
TAX CREDITS:
PAYMENT RECEIYl DISCOUNT
DATE NUMBER /NTEREST/PEN PAID (-)
05-08-200q CD00~6~8 8,~21.05
06-$0-200q CDO0~IO0 .00
PAYMENT MUST ~E MADE ~Y 09-09-Z00q~.
(1~) .00 x O0 = .00
(16) .00 X 0(~5 = .00
(17) .00 x 1Z = .00
(18) 1,690,$$q.00 x 15 = 253,550.10
AMOUNT PAID
160,000.00
$q,599.02
ZF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL TAX CREDIT
BALANCE OF TAX DUEI
ZNTEREST AND PEN.
TOTAL DUE
(19)= 253,550.10
.00
50,530.03
( IF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUZRED.
IF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
ZO$,0ZO.07
50,530.03
RESERVATION:
PURPOSE OF
NOTICE:
PAYNENT:
REFUND (CR):
OBJECTIONS:
ADH/N-
ZSTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December 12, 1982 -- if any future 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 Comaonmeaith hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the laafu! Class B (collateral) rate on any such futura interest.
To fulfill the requirements of Section Zl~O of the Inheritance and Estate Tax Act, Act Z3 of 2000. (72 P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Nills printed an 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, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" CREV-131$). Applications are available at the Office
of the Register of Nills, any of the 23 Revenue District Offices, or by calling the special Z~-hour
ansmering service for fores ordering: 1-800-361-ZOS0~ services for taxpayers aith special hearing and / or
speaking needs: 1-800-~q7-3010 ITT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on 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. 281021, Harrisburg, PA 17118-1011j 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 eriting to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601j Harrisburg, PA 17128-0601
Phone (717) 787-6S05. Sea 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 dacedent's death, a five percent (51) discount of
the tax paid is allowed.
The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the and 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 been assessed as indicated on this net/ce.
Interest is charged 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 l, 1981 bear interest at the rate of
six (61) percent per annum calculated at a daily rate of .00016q. Al! taxes which became delinquent on and after
January 1, 198Z will bear interest at a rate which will vary from caZendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1981 through ZOOq are:
Interest Daily Interest Daily
Year Rate Factor Year Rate Factor
1981 ZOZ .goose,8 ~t~)'~'8 - 1991 111 .000301
1983 161 . OOOq38 1992 97. . O00Zq7
198q 117. · 000301 1993-199~ 77. .000192
1985 137. .000356 1995-1998 91 .O00Zq7
1986 101 .00027~ 1999 71 .000192
1987 101 . O00ZTq Z000 77. .000191
--Interest is calculated as follows:
INTEREST = BALANCE OF TAX UNPAID X NU)~BBR OF DAYS DELINQUENT
Interest Daily
Year Rate Factor
~ 9Z .0gozq7
ZOOZ 61 .00016~
2003 SZ .000137
ZOOq qZ .000110
X DAILY TNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (153 days
beyond the date of the assessment. If payment is Bade after the interest computation date shown on the
Notice, additional interest suet be calculated.
:~EV-1470 EX (6-88)
INHERITANCE TAX
EXPLANATION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 28O601
HARRISBURGi PA 17128-0601
DECEDEN'FS NAME FILE NUMBER
HENRY NACHMAN 2103-1029
REVIEVVED BY ACN
John Kealy 101
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
J Changed tax rate from 12% to 15%, nieces and nephews are collateral heirs.
ROW Page 1
BUREAU OF ZNDZVTDUAL TAXES
TNHERTTANCE TAX DZVTSZOH
DEPT. ZSD601
HARRTSBURG, PA 171Z8-0601
COHHON~IEALTH OF PENNSYLVANZA
DEPARTMENT OF REVENUE
ZNHERZTAHCE TAX
STATEMENT OF ACCOUNT
REV-i&g7 EX &FP
HONARD B KRUG ESQ
PURCELL ETAL
1719 N FRONT ST
HBG PA 17102
DATE 09-27-2004
ESTATE OF NACHHAN
DATE OF DEATH 1Z-09-ZO05
FZLE NUHBER 21 0:3-1029
COUNTY CUHB E R L AND
ACN 101
I Amoun~ Remi'l:'l:ed
HENRY G
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
RESTSTER OF t,/TLLS
CUMBERLAND CO COURT HOUSE
CARLTSLE, PA 1701:5
NOTE: To insure proper credit: ~:o your account, submit: ~:he upper portion of '~his fore wi~:h your ~cax payment:.
CUT ALONG TH'rS LZNE I~ RETA'rN LOI,/ER PORT'rON FOR YOUR RECORDS
ESTATE OF NACHMAN HENRY G FZLE NO. 21 0:3-1029 ACN 101 DATE 09-27-2004
THZS STATEMENT ZS PROVZDED TO ADVZSE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAMED ESTATE. SHOI./N BELO#
ZS A SUMMARY OF THE PRZNCZPAL TAX DUE., APPLZCATZON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, ZF APPLZCABLE,
A PROJECTED ZNTEREST FZGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTHENT: 08-16-2004
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYHENTS (TAX CREDITS):
25:3,550.10
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
0:3-08-2004
06-:30-2004
08-19-2004
CD00:3648
CDO04100
CDOO4ZgO
8,421.05
.00
.00
ZF PA/D AFTER THZS DATE, SEE REVERSE
S/DE FOR CALCULATZON OF ADDZTIONAL /NTEREST.
( IF TOTAL DUE ZS LESS THAN $1,
NO PAYHENT 1S REQUZRED.
ZF TOTAL DUE 1S REFLECTED AS A 'CRED/T- (CR),
:34,59~9 .:02
50,5:30.0:3
TOTAL TAX CREDZT 25:3,550.10
BALANCE OF TAX DUE .00
ZNTEREST AND PEN. .00
TOTAL DUE .00
YOU HAY BE DUE A REFUND. SEE REVERSE S'rDE OF THTS FORM FOR TNSTRUCT/ONS. )
.n=^-~r!\ Arrl^r r-
BUREAU OF INDIVIDUA~a'~iI:lI),J, Ui->,ij: ,)C
INHERITANCE TAX DIVISION ;"-, ,.. . " ., i r
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF DETERMINATION AND
ASSESSMENT OF PENNSYLVANIA
ESTATE TAX BASED ON FEDERAL
ESTATE TAX RETURN
'*
REV-483 EX AFP (06-05)
2035 Sr.? - 2
P:j 10.' "8
I Ill':. U
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
HENRY
G
HOWARD B(kRUG ESQ
PURCEll ETAL
1719 N FRONT ST
HBG
PA 17102
09-05-2005
NACHMAN
12-09-2003
21 03-1029
CUMBERLAND
201
APPEAL DATE: 11-04-2005
(See reverse side under Objections)
Amount RE!lIIitted I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, sub.it the upper portion of this form with your tax paynent.
CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR FILES +-
REY=48i-Ex-AFP-coi=osj----..-NOTICE-OF-DETERMINATION-AND-ASSESSHENy-----------------------
OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN ..
ESTATE OF NACHMAN
HENRY
G FILE NO.21 03-1029
ESTATE TAX DETERMINATION
ACN 201
DATE 09-05-2005
1. Credit For State Death Taxes as Verified
37.788.00
2. Pennsylvania Inheritance Tax Assessed
(Excluding Discount and/or Interest)
245.129.05
3. Inheritance Tax Assessed by Other States
or Territories of the United States
(Excluding Discount and/or Interest)
.00
4. Total Inheritance Tax Assessed
5. Pennsylvania Estate Tax Due
245.129.05
.00
TAX CREDITS:
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 THIS DATE, SEE REVERSE SIDE IIF TOTAL DUE IS LESS THAN $1, NO PAY"ENT IS REQUIRED RK
FOR CALCULATION OF ADDITIIlHAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YDU ~Y BE
DUE A REFUND. SEE REVERSE SIDE OF THIS FO~ FOR INSTRUCTIONS.)
HOWARD B KRUG ESQ
PURCELL ETAL
1719 N FRONT ST
HBG
ClEP< C =
Ce'.F". i." "
.;->',-:-:,-:
Ci I' "
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
rl~F\opn'L-D~tOE. ,nJF DETERMINATION AND
'.. J ." )iS$I($SMENT OF PENNSYLVANIA
ESTAtE."TAX BASED ON FEDERAL
CLOSING LETTER
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
*'
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX ZS06Dl
HARRISBURG PA 17128-0601
RE,~n, EX '-FP (,,-11!;)
Z005 SEP 13 PH I: If 4
09-13-2005
NACHMAN
12-09-2003
21 03-1029
CUMBERLAND
202
APPEAL DATE: 11-12-2005
(See reverse side under Objections)
AIIDun't Relli't'ted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
HENRY
G
PA 17102
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, su~it the upper portion of this for. with your tax pay..nt.
CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR FILES ~
RE-V:;36--EX-jiFP--iDi~ii2i-----.ii-NoiffcE--OF-iiETifRMi~Tioji-AiiD-ASisESSiMENir----------------------------
OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER ..
ESTATE OF NACHMAN
HENRY
G FILE NO.2l 03-1029
ACN 202
DATE 09-13-2005
ESTATE TAX DETERMINATION
1. Credit For State Death Taxes as Verified
37,788.00
2. Pennsylvania Inheritance Tax Assessed
<Excluding Discount and/or Interest)
245,129.05
3. Inheritance Tax Assessed by Other States
or Territories of the United States
<Excluding Discount and/or Interest)
.00
5. Pennsylvania Estate Tax Due
245.129.05
.00
4. Total Inheritance Tax Assessed
6. Amount of Pennsylvania Estate Tax Previously Assessed
Based on Federal Estate Tax Return
.00
7. Additional Pennsylvania Estate Tax Due
.00
TAX CREDITS:
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 THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRJ, YOU HAY BE
DUE A REFUND. SEE RJ;VFR~F Il:.TnC ftl! or........ ",__u --- --
J~/'
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 11/01/2005
KRUG HOWARD B
1719 NORTH FRONT STREET
HARRISBURG, PA 17102
RE: Estate of NACHMAN HENRY G
File Number: 2003-01029
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by: 12/09/2005
Thank You.
Your prompt attention to this matter will be appreciated.
Sincerely,
~- . S:' U~t' ~
~ " ,.',11;:"'.,,__: ;./,_/
....,_J,"'.,~,;.=_,{../ .,.cd;:,... ;'.t
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
1/-,
I ,
, ,
c
C'
I
LA W OFFICES
HOWARDB. KRUG
LEON P. HALLER
JOHN W. PURCELL JR.
JILL M. WINEKA
BRIAN 1. TYLER
NICHOLE M. STALEY O'GORMAN
LISA A R YNARD
(!/J~ ~ r3 ~
1719 NORTH FRONT STREET
HARRISBURG, PENNSYLVANIA 17102-2392
TELEPHONE (717) 234-4178
FAX (717) 234-0409
JOSEPH NISSLEY (1910-1982)
HERSHEY
(717) 533-3836
JOHN W PURCELL
OF COUNSEL
November 3, 2005
Glenda Farner Strasbaugh
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
Re: Estate of Henry G. Nachman
File No. 2003-01029
Dear Ms. Strasbaugh:
Enclosed please find one original and one copy of the Status
Report Under Rule 6.12 for filing in your office. Please time-
stamp the copy and return to my office in the enclosed, self-
addressed, stamped envelope.
Thank you.
..-----
/"'....
'.Sincerel)VYo
\/'
/< ?2 ~ -~
~ow )'cY 13 ~~
/
f
c
HBK/ase
Enclosure
cC:~l;us Weinstock (w/enc.)
t..~.;
'.---'
STATUS REPORT UNDER RULE 6.12
Name of Decedent: HENRY G. NACHMAN
Date of Death: 12/9/2003
Will No. 2003-01029
Admin. No.
Pursuant to Rule 6. 12 of the Supreme Court Orphans I
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
I . State whether administration of the estate is complete:
Yes No X
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete: December 31, 2005
3 . If the answer to No. I is Yes, state the following:
a.
account with the Court?
Did the personal representative file a final
Yes No
b. The separate Orphans I Court No. (if any) for
the personal representative I s account is:
c . Did the personal representative state an
account informally to the parties in interest ? Yes No
d . Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with ~e /7
Clerk of the Orphans' Court and may be attached to thi rep rt. .'
, ./ /
I ,
JJ/('U
Date: 11/3/2005 _ '/ Iff f/:..
tu
CI')
PA 17102
{717) 2344178
Tel. No .
Capacity :
Personal Representative
X
Counsel for personal
representative
STATUS REPORT UNDER RULE 6.12
Name of Decedent: HENRY G. NACHMAN
Date of Death: 12/9/2003
Will No. 2003-01029
Admin. No.
Pursuant to Rule 6. 12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1 . State whether administration of the estate IS complete:
Yes X No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3 . If the answer to No. 1 is Yes, state the following:
a.
account with the Court?
Did the personal representative file a final
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
Date: 1/4/2006
S.gn
t/
Howard B. Krua. Esauire
Name (Please type or print)
1719 North Front Street
Harrisbur<;! PA 17102
Address
(717 ) 2344178
Tel. No .
Capacity :
Personal Representative
X
Counsel for personal
representative
l' ;J :<.' 11
'l-,." (1
\11:-
LAW OFFICES
HOWARDB. KRUG
LEON P. HALLER
JOHN W. PuRCELL JR.
JILL M. WINEKA
BRIAN 1. TYLER
NICHOLE M. STALEY O'GoRMAN
USA A. RYNARD
P7>~~fJ~
1719 NORTH FRONT STREET
HARRISBURG, PENNSYLVANIA 17102-2392
TELEPHONE (717) 234-4178
FAX(717)234-0409
HERSHEY
(717) 533-3836
JOSEPH NISSLEY (1910-1982)
JOHN W. PURCEll
OF COUNSEL
January 4, 2006
Cumberland County Courthouse
Register of Wills
One Courthouse Square
Carlisle, PA 17013
Re: Estate of Henry G. Nachman
No. 2003-01029
Dear Sir/Madam:
Enclosed please find one (1) original and two (2) copies of
the Family Settlement Agreement and Status Report Under Rule 6.12
for filing with your office. Also enclosed is a check in the
amount of $20.00 to cover the filing fee for the Family
Settlement Agreement. Please time-stamp the additional copies
and return same to me in the enclosed, self addressed, stamped
envelope.
Thank you.
HBK/ase
Enclosures
10 :8 lId g- ~.'lIr o"r'z
.i fJ JUU
'cl lit'
JIG J:''"';..'.~_i:,'~: (~:~:!'--'~.'!i~~{-""~'
~-'_l_.J..JIJ, J ., !il : f-~i~."j
..... ~.J""'...'_"'-",,,,,,,,,,,;,U
i<
IN RE:
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF HENRY NACHMAN
DECEASED
No. 21-03-1029
FAMILY SETTLEMENT AGREEMENT WAIVING
FILING OF ACCOUNT
This instrument, (hereinafter "Agreement"), executed this ~day of
1.M~ A. ,2005, by and between GUSTAVE L. WEINSTOCK, JR., Individually and as
Executor of the Will of Henry Nachman, (the "Deceased"), BENJAMIN SCHULEIN, JR.,
LOIS ABRAMS, and NANCY BALDRIDGE (hereinafter "Beneficiaries").
WITNESSETH:
WHEREAS, Henry Nachman died on December 9, 2003, having first made and
published his last Will and Testament dated September 19, 1991, in which he named
Gustave L. Weinstock, Jr. as Executor. A copy of said Will was previously distributed to the
Executor and Beneficiaries.; and
WHEREAS, on December 15, 2003 said Will was duly probated by the Register of
Wills of Cumberland County, Pennsylvania, and Letters Testamentary granted thereon to
Gustave L. Weinstock, Jr. as Executor (hereinafter "Executor"); and
WHEREAS, the Executor has proceeded with the administration of said estate, and
has prepared for filing a First and Final Account and Sch~dule of Di$tribu~&n. A true and
correct copy thereof is attached hereto, made a part hereof:' artd maffied Exhibit "A"; an'd
1""""'1'::1 C ','"'c)""'l
,U ~v t~t ..]- I'i'orl ..i'JU
S-l 'I:;, UJL:
J(j -:J"IJ-L1(': 'O~IIJ'-'<,"j
........J v...J...v .J.-...,.__ _",,_'>oJ
Q/
WHEREAS, the parties desire that the Executor shall not be required to file said
Account and Schedule of Distribution with the Orphans' Court of Cumberland County, and
that the net estate of the decedent shall be distributed without the necessity of filing a formal
account.
WHEREAS, the specific beneficiary named in Item IV(D}(2)(a} of the Last Will,
LOUIS LOEBNER has executed a General Release acknowledging receipt of the amount
bequeathed to him, a copy of which is attached hereto and collectively marked as Exhibit "B";
and,
WHEREAS, the specific beneficiaries named in Item II(A} of the Last Will, ELAM
BURKHOLDER and RUTH BURKHOLDER have executed General Releases,
acknowledging receipt of the amount bequeathed to them, copies of which are attached
hereto and collectively marked as Exhibit "C"; and,
WHEREAS, representatives for the specific charities named in Item II(B, C, 0, & E}
of the Last Will, TEMPLE OHEV SHOLOM, POLYCLINIC MEDICAL CENTER, UNITED
WAY, HOLY SPIRIT HOSPITAL, have executed General Releases acknowledging receipt of
the amount bequeathed to them, copies of which are attached hereto and collectively marked
as Exhibit "0"; and,
NOW THEREFORE, the parties hereto, intending to be legally bound hereby
mutually agree as follows:
1. The parties hereto, and each of them, agree and acknowledge that they have
received and fully and carefully examined the First and Final Account of Executor and a
2
related Schedule of Distribution, and that they find all of such documents to be true and
correct, and acceptable to the parties hereto and each of them.
2. The parties hereto do hereby release, remise and forever discharge the Estate
of Henry Nachman, Gustave L. Weinstock, Jr., Executor, Howard B. Krug, Esquire, and the
law firm of Purcell, Krug & Haller, jointly and severally, as well as their heirs, partners,
employees, agents, successors, and assigns, of and from all manner of acts, suits, claims,
accounts, accountings, debts, dues and demands whatsoever which they or any of them or
their legal representatives, heirs, successors, or assigns may at any time hereafter have,
from, touching upon, or concerning any aspect of the Estate, including but not limited to: the
assets, rights, filings and taxes paid by the Estate; any claim or interest in or to said Estate;
the administration of the Estate; preservation, retention, repair, improvement, management,
collection, sale or distribution of any Estate assets; or on account of the receipt of any asset
or debt payment, interest or income received by, assets sold, or proceeds paid out of the
Estate from the date of death of Deceased to and including the date of this Agreement and
Release.
3. The Beneficiaries further agree to indemnify, defend and hold harmless from all
losses, costs, taxes, and expenses, including counsel fees incurred to defend against any
claim, the Executor, Howard B. Krug, Esquire and the law firm of Purcell, Krug & Haller,
jointly and severally, including their heirs, partners, employers, agents, successors and
assigns, from any claim, action, liability, or demand asserted by any person, firm,
3
corporation, governmental or other entity with respect to or concerning, directly or indirectly,
the Estate.
4. In the event any liability arises against the Estate after the signing of this
Agreement, the Beneficiaries shall be solely responsible for satisfying same, including but not
limited to any and all income, gift, estate and inheritance taxes, liabilities, claims, demands,
suits and causes of action which may be successfully prosecuted or assessed against the
Estate after the signing, sealing and delivery of this Agreement.
5. This instrument is a full and final Family Settlement Agreement by and among
the parties hereto, both fiduciary and individual, all of the same having been arrived at,
concluded and executed after a full and complete disclosure of the assets of the Estate and
each of the parties agrees to abide by the terms of this Family Settlement Agreement.
6. The parties hereto understand that there may be additional interest accrued in
the Wachovia Bank account and the M& T Bank account. Upon the closing of these
accounts, the interest shall be equally among the Beneficiaries, in accordance with the Last
Will.
7. The parties hereto, and each of them, agree that they will at all times in the
future and whenever necessary, appropriate or convenient, make, execute and deliver to the
Executor, or to any other person authorized by the Executor, any and all instruments,
documents, conveyances, deeds, release or other instruments of any kind necessary or
4
convenient to carry out the intention of this Agreement or to permit, assist and enable the
Executor to fulfill his duties with reference to the Estate and all of the assets thereof.
8. This Agreement constitutes the entire understanding among the parties hereto,
and each of them acknowledge that no representations or statements of any kind, written or
oral, have been made to them or any of them prior to the date of this Family Settlement
Agreement by the Executor or by any other person upon his behalf.
9. This Agreement shall enure to the benefit of and shall be binding upon the
parties hereto, and each of them, their heirs, executors, administrators, successors and
assigns.
10. A modification or waiver of the provisions of this Agreement shall be effective
only if made with the same formality as this Agreement. The failure of any party to insist
upon strict performance of the provisions of this Agreement shall not be construed as a
waiver of any subsequent default of the same or similar nature.
11. The Beneficiaries have been advised and understand that they have the right
to have this Agreement, Accounting and Schedule reviewed by an attorney of their choice,
and they have either done so prior to the signing or waived the right to so do.
12. This Agreement shall be construed, interpreted and covered by the laws of the
Commonwealth of Pennsylvania, and where such law is inconsistent, the terms of this
instrument shall govern.
5
13. The Beneficiaries agree that the original signature page and notarization on
their respective agreements may be removed and attached by the Executor to a single
identical Agreement to be filed with the Court, avoiding the filing of four (4) individual copies
of the Agreement
IN WITNESS WHEREOF, the parties hereto have hereunto set their respective
hands and seals the day and year indicated on the respective notarizations.
WITNESS:
GUS1~!&~eWlllof
Henry Nachman, Deceased
~~~~I{
Gustave L. Weinstock, Jr., Individually
Date: '20~ O~
STATE OF .9A'\~Vf,\M ltt , :
~'l ~'A l~' : ss
COUNTY OF ~ :
On this, the ~ day of ~ 2005, before me, a Notary Public, the undersigned
officer, personally appeared Gustave L Weinstock, Jr., Individually and as Executor of the Estate of
Henry G. Nachman, Deceased, known to me (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument, and acknowledged that he is the Accountant of the within Account, that
the Account as stated is true and correct, and that he executed the same for the purposes therein
contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
Nota
co~ Notarial Seal .
~ S Shaffer. Notary~
,.\lu Of Ha~bU''9. Dauphin 12. 2008
""'} .' expires Jan.
My Com .' Of NotarieS
ylvania AssOCIation
Member. penns
The undersigned hereby agrees to the Family Settlement Agreement Waiving Filing of Final
Account, the Accounting provided and the Balance Remaining for Distribution and Proposed
Schedule for Distribution, all of which have been attached to the Family Settlement Agreement.
By my signature, I hereby agree to waive the filing of the First and Final Account and Distribution
as provided in the Family Settlement Agreement, and agree to all of the terms of the Family
Settlement Agreement.
WITNESS:
~g--
. , Jr.
Date:
Jd- c9b~ c&
STATEOFfY\~~~~ Jv-?
COUNTY OF("-~ . tu ,?:~
: ss
On this, the~day of {)D{)om..-.ny, 2005, before me, a Notary Public, the
undersigned officer, personally appeared, Benjamin Schulein, Jr., known to me (or satisfactorily
proven to be the person whose name is subscribed to the within instrument, and acknowledged
that he executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
nliiL~~
Notary Public
My Commission Expires: I ~ ;;;y5~U7
NICOLE R. MCBEE
Notary Public - Notary Seal
STATE OF MISSOURI
ST. !-quIs CITY County
My CommIssion Expires JAN 25, 2009
7
The undersigned hereby agrees to the Family Settlement Agreement Waiving Filing of Final
Account, the Accounting provided and the Balance Remaining for Distribution and Proposed
Schedule for Distribution, all of which have been attached to the Family Settlement Agreement.
By my signature, I hereby agree to waive the filing of the First and Final Account and Distribution
as provided in the Family Settlement Agreement, and agree to all of the terms of the Family
Settlement Agreement.
WITNESS: ~
(//& -.
~~~ /J~ ,--~
~I l:1l..A:_.v'\J
Lois Abrams
Date: cJ) a~/9100b
STATE OF District. of 00\umbi2
: ss
COUNTY OF
On this, the 01 / day of Me. ,2005, before me, a Notary Public, the
undersigned officer, personally appeared, Lois Abrams, known to me (or satisfactorily proven to
be the person whose name is subscribed to the within instrument, and acknowledged that she
executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
~)I/ ()dtvu6
No ary Public
My Commission Expires: . .
ROSIE w. RICHARDS
Notary Public D\str1,ct ct! ff~~
My eomm\sslon Exp reS"9f ,..-
8
The undersigned hereby agrees to the Family Settlement Agreement Waiving Filing of Final
Account, the Accounting provided and the Balance Remaining for Distribution and Proposed
Schedule for Distribution, all of which have been attached to the Family Settlement Agreement.
By my signature, I hereby agree to waive the filing of the First and Final Account and Distribution
as provided in the Family Settlement Agreement, and agree to all of the terms of the Family
Settlement Agreement.
WITNESS:
~~
/Il~~~L
Nancy Bal dge
Date:~ 20, ;;u;o6"
STATE OF htLuo~
COUNTY OF J,t. ~
..."
: ss
On this, the .)0 day of ~ 2005, before me, a Notary Public, the
undersigned officer, personally appeared, Nancy Baldridge, known to me (or satisfactorily proven
to be the person whose name is subscribed to the within instrument, and acknowledged that she
executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
. ~~~tu
1HA GENBVVN~ Me. .~ . . -
Nota:ryPlibHc.JN'e~Setl. Not Public
STATEOPMISSOuRl My Commission Expires:
l '",-, . C SL Louis county,. . .
~ " . My CornmissionExpi:res;~.~ 2008
9
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 2003-01029
ESTATE OF HENRY G. NACHMAN
Late of Lower Allen Township
FIRST AND PARTIAL ACCOUNT OF
GUSTAVE WEINSTOCK, EXECUTOR
Date of Death: December 9,2003
Letters Granted: December 15, 2003
First Complete Advertisement of Grant of Letters: January 17, 2004
Account Stated to: December 9, 2005
Summary and Index
Paae No.
Principal Realty
Principal Personalty
1
2-3
T atal Principal
Less Disbursements
4-6
Balance Before Distributions
Distributions to Beneficiaries
7
Principal Balance Remaining
Income Personalty Receipts
8-9
Balance Remaining for Distribution
LESS RESERVES
1/2 Executor Fees
1/2 Attorney's Fees
Future Estate expenses
Accounting fees, 2005 federal and state taxes,
fling fees, miscellaneous fees
Balance Remaining for Distribution
j
j
EA'BIT
$1,295,849.78
$601,843.58
$1,897,693.36
($658,875.85)
$1,238,817.51
($40,000.00)
$1,198,817.51
$51,903.45
$1,250,720.96
($49,770.50)
($34,878.50)
($17,500.00)
$1,148,571.96
COMPOSIT.IONOF NET BALANCES
Wachovia Bank Estate checking acct.
(bearer bond money to be added here)
M& T Bank Estate checking account
$913,817.77
$36,871.99
$300,020.92
PKH Escrow Account
$10.28
Balance remaining for distribution
$1,250,720.96
LESS RESERVES TO BE PAID
1/2 Executor Fees
1/2 Attorney's Fees
Future Estate expenses
(Accounting fees, 2005 federal & state taxes, filing fees,
miscellaneous expenses)
($49,770.50)
($34,878.50)
($17,500.00)
$1,148,571.96
PRINCIPAL REAL TY INVENTORIED
1520 Slate Hill Road, Camp Hill, PA (home & 10.57 acres)
(Value based on auction sale of 5/1/04)
$800,000.00
$1,739.89 Tax Proration
$801,739.89
($29,524.23) Settlement Costs
$772,215.66
16.12 acres located on Slate Hill Road, Camp Hill, PA
(8.17 & 7.95 acres - Value based on auction sale of 5/1/04)
$545,000.00
$481.12 Tax Proration
$545,481.12
($21,847.00) Settlement Costs
$523,634.12 $523,634.12
Total Principal Realty Inventoried
$1,295,849.78
1
PRINCIPAL PERSONALTY
DESCRIPTION
AMOUNT
Custodial Account established August 24, 1990 w/Dauphin Deposit
Bank & Trust Company, Custodian
A. Money Market Institutional 1-fund (principal) - $171,426
B. Money Market Institutional1-fund (income) - $11,363
C. $250,000 U.S. Treasury Note due 5/15/06-
D. $50,000 GTE North Inc. Note due 1/15/04
E. $20,000 Hampden Twshp. Sewer Authority Bond - $22,243
F. $25,000 Twshp. Upper Allen General Oblig. Bond - $28,683
$171,425.92
$11,363.12
$278,476.99
$51,421.50
$22,243.13
$28,682.50
Personal Property - auction
($47,316 less auctioneer fees $4,731.60)
M&T Bank Savings Account - #15004206016435
Funds received from cancellation of Blue Cross policy
Funds received from Rita Powell for personal phone calls made
from Slate Hill Road residence
Funds received from Verizon telephone service - cancellation fee
Funds received from PP&L (electric) - cancellation fee
Reimbursement for cancellation of Home Owners Insurance
Total Principal Personalty Inventoried
$42,584.40
$6,717.10
$115.72
$22.28
$3.77
$27.24
$337.00
$613,420.67
Adiustments to PrinciDal Personalty
M&T Bank Savings Account #15004206016435
(6,717 less miscellaneous fee - transfer amount 6,705.90)
($11.10)
M&T Custodial Account (money market)
Adjustment for deposits made from Date of Death to Date of Transfer
$1,140.70
GTE North Inc. Note ($51,500)
(Adjustment made for Inventoried Value to Sale value)
$78.50
$250,000 Treasury Note
(Inventoried $278,476.99 less redemption value $253,994.14)
($24,482.85)
$20,000 Hampden Township Sewer Authority Bond
(Inventoried $22,243.13 less redemption value $22,126.87)
($116.26)
$25,000 Twshp. Upper Allen General Oblig. Bond
(Iventoried $28,682.50 less redemption value $29,106.37)
$423.87
Total Principal Personalty after adjustments
$590,453.53
2
DESCRIPTION
PRINCIPAl.. PERSONAL TV
AMOUNT
Subseauent Personalty (not inventoried)
3/3/2004 Andrea Reed (receipt for personal property)
3/3/2004 Lynn Berkley (receipt for personal property)
3/3/2004 Ben Schulein (receipt for personal property)
3/3/2004 Gus Weinstock (receipt for personal property)
3/3/2004 Lois Abrams (receipt for personal property)
6/16/2004 PP&L Refund
10/18/2004 IRS Refund check
11/1/2004 Keystone Oil Refund
$1,740.00
$850.00
$900.00
$6,255.00
$289.00
$121.08
$444.71
$790.26
TOTAL PRINCIPAL PERSONAL TV
$601,843.58
3
DATE
12/01/03
01/01/04
01/08/04
01/22/04
01/22/04
01/22/04
01/22/04
01/22/04
01/22/04
01/22/04
01/22/04
01/22/04
01/22/04
01/29/04
01/29/04
01/29/04
01/29/04
01/29/04
02/05/04
02/05/04
02/05/04
02/05/04
02/05/04
02/05/04
02/05/04
02/14/04
02/17/04
02/17/04
02/17/04
02/17/04
02/23/04
02/24/04
02/28/04
02/29/04
03/08/04
03/09/04
03/09/04
03/09/04
03/11/04
03/18/04
03/18/04
03/29/04
03/30/04
03/30/04
03/30/04
03/30/04
DISBURSEMENTS
DESCRIPTION
Rita Powell (final nursing care payment
M&T Bank debit (termination fee for custodial acct.)
Ahold financial (grocery/household expense
PP&L
PP&L
Lower Allen refuse bill
Lower Allen refuse bill
Verizon
Keystone Oil
Keystone Oil
Weis Pharmacy (prescriptions)
AT&T
Alvana Brown (final nursing payment)
Cumberland Law Journal (advertising)
The Sentinel (advertising)
Robert Jones Appraisers (appraisal fee for home)
Robert Jones Appraisers (additional appraisal fee)
Robert Jones Appraisers (additional appraisal fee)
Stephenson's Flowers (funeral)
Purcell, Krug & Haller (reimburse expenses)
Pae Fortna Auctioneer
Andrea Reed (final nursing payment)
Griswold Special Care
Neill Funeral Home
Gustave Weinstock, Executor (reimburse travel expenses)
Elam Burkholder (3 months care taker payments)
Verizon
AT&T
Keystone Oil
Keystone Oil
PP&L
Andrea Reed (cleaning, etc.)
Purcell, Krug & Haller (past due fees)
Gustave Weinstock, Executor (reimburse travel expenses)
Register of Wills - Inhertiance Tax payment
Bonnie K. Miller, Treasurer (taxes)
Bonnie K. Miller, Treasurer (taxes)
Verizon
World Painting
PP&L
PP&L
M&T Bank Miscellaneous debit (bank fees)
Keystone Oil
Michael Reed
Tom Reed
Andrea Reed
$107.25
$1,500.00
$296.34
$245.38
$318.82
$49.35
$49.35
$90.78
$327.67
$428.18
$202.74
$72.82
$117.00
$75.00
$129.47
$500.00
$175.00
$175.00
$107.99
$435.78
$800.00
$383.50
$131.25
$7,681.22
$1,641.16
$900.00
$19.94
$11.88
$351.10
$480.43
$237.87
$2,247.00
$14,000.00
$1,404.44
$160,000.00
$2,358.07
$9.80
$19.97
$4,900.00
$116.22
$149.56
$90.00
$334.69
$680.00
$100.00
$1,630.00
4
DATE
03/30/04
03/30/04
03/31/04
04/02/04
04/02/04
04/09/04
04/09/04
04/13/04
04/13/04
04/13/04
04/13/04
04/13/04
04/22/04
04/22/04
04/30/04
04/30/04
04/30/04
04/30/04
04/30/04
04/30/04
05/04/04
05/08/04
05/08/04
05/08/04
05/08/04
05/08/04
05/14/04
05/14/04
05/14/04
05/18/04
05/19/04
05/19/04
05/31/04
05/31/04
06/14/04
06/30/04
06/30/04
06/30/04
06/30/04
08/16/04
08/30/04
01/19/05
02/15/05
02/15/05
03/07/05
DISBURSEMENTS
DESCRI.PTION
J.S. Norford (plumber)
Keystone Oil
World Painting
PA Department of Revenue (taxes)
US Treasury (taxes)
AT&T
Beard Miller Company (accounting fees)
Keystone Oil
Keystone Oil
Verizon
Lower Allen Township - refuse
Lower Allen Township - refuse
PP&L
PP&L
Michael Reed
Andrea Reed
Andrea Reed (reimburse Reed for mulch)
Andrea Reed
Kelly Brothers (maintenance and repair to Kubota tractor)
Tom Evanoff (roof repairs)
Gustave L. Weinstock (reimburse for travel expenses)
Tom Reed
Andrea Reed
Michael Reed
Andrea Reed
Verizon
PP&L
PP&L
Fehl Awning
Andrea Reed
Michael Reed
Andrea Reed
PP&L
PP&L
AT&T
Internal Revenue Service - Form 706 payment
PA Department of Revenue {additional Inheritance Tax Return pn
Purcell, Krug & Haller (% attorney's fees)
Gustave L. Weinstock, Jr. (% executor's fees)
Register of Wills (additional Rev 1500 payment)
Wachovia Bank Service Fee
Register of Wills (payment of additional probate fees)
Internal Revenue Service (2004 Form 1040)
PA Department of Revenue (2004 PA 41)
Beard Miller Company (Prep of taxes)
5
AMOUNT
$191.50
$455.57
$4,900.00
$193.00
$128.00
$71.22
$495.00
$354.77
$455.57
$20.63
$49.35
$49.35
$130.91
$141.58
$2,280.00
$300.00
$142.84
$2,660.00
$272.96
$275.00
$2,514.55
$50.00
$3,460.00
$1,480.00
$150.00
$22.33
$121.08
$27.24
$115.49
$750.00
$270.00
$410.70
$34.55
$139.14
$62.06
$247,062.00
$34,599.02
$35,059.00
$49,770.50
$50,530.03
$20.00
$350.00
$8,262.00
$539.00
$2,080.00
DATE
03/15/05
05/05/05
07/28/05
08/08/05
09/13/05
09/30/05
10/13/05
11/23/05
DISBURSEMENTS
DESCRIPTION
Wachovia Bank (additional estate checks)
United States Treasury (Form 1041 - 11/30/2004)
Treasury Direct Fees
Beard Miller Company
Return of the bearer bond
Cumberland County Orphans Court - Short Certificates
Federal Reserve Bank of Chicago service fee
Cumberland County Orphans Court - Short Certificates
$29.79
$523.08
$28.02
$95.00
$615.00
$8.00
$45.00
$4.00
TOTAL DISBURSEMENTS
$658,875.85
6
PRINCIPAl... DISTRIBUTIONS TO BENEFICIARIES
617/2004 TO: Louis Loebner $30,000.00
4/12/2004 TO: Elam Burkholder $3,000.00
4/20/2004 TO: Ruth Burkholder $3,000.00
1/20/2004 Polyclinic Med Center n/k1a Pinnacle Health $1,000.00
1/20/2004 United Way of the Capital Region $1,000.00
2/3/2004 Holy Spirit Hospital $1,000.00
2/10/2004 Temple Ohev Sholom $1,000.00
TOTAL DISTRIBUTIONS TO BENEFICIARIES
$40,000.00
7
INCOME RECEIPTS
DATE DESCRIPTION AMOUNT
M& T Bank Estate checking account
02/02/04 Interest $12.07
03/02/04 Interest $48.57
04/02/04 Interest $39.33
05/02/04 Interest $20.94
06/02/04 Interest $12.05
07/02/04 Interest $8.23
08/02/04 Interest $6.04
09/02/04 Interest $6.48
10/02/04 Interest $6.18
11/02/04 Interest $2.92
12/02/04 Interest $2.22
1/2/2005 Interest $2.58
2/2/2005 Interest $2.58
3/2/2005 Interest $2.33
4/1/2005 Interest $2.50
5/2/2005 Interest $2.58
6/2/2005 Interest $3.00
7/1/2005 Interest $3.10
8/2/2005 Interest $3.42
9/1/2005 Interest $3.31
10/2/2005 Interest $3.20
11/2/2005 Interest $18.33
12/2/2005 Interest $24.66
Wachovia Bank checking account
617/2004 Interest $300.62
6/30/2004 Interest $1,178.42
7/30/2004 Interest $828.38
8/30/2004 Interest $814.57
9/30/2004 Interest $755.92
10/30/2004 Interest $762.32
11/30/2004 Interest $891.79
12/31/2004 Interest $875.71
1/31/2005 Interest $950.23
2/28/2005 Interest $865.60
3/31/2005 Interest $1,052.58
4/29/2005 Interest $996.89
5/31/2005 Interest $1,168.20
6/30/2005 Interest $1,198.06
7/31/2005 Interest $1,165.58
8/31/2005 Interest $1,328.70
9/30/2005 Interest $1,212.39
10/31/2005 Interest $1,256.28
11/30/2005 Interest $1,230.46
8
8/16/2004
11/10/2004
5/16/2005
10/13/2005
INCOME RECEIPTS
Treasury Note Interest
Interest
Interest
Interest
Interest
$8,594.15
$8,593.75
$8,593.75
$7,052.48
TOTAL INCOME
$51,903.45
9
IN RE:
ESTATE OF HENRY NACHMAN
DECEASED
: IN THE COURT OF COMMON PLEAS
: CUMBERlAND COUNTY, PENNSYLVANIA
: NO. 21..()3-1029
CASH BALANCE REMAINING FOR DISTRIBUTION
AND PROPOSED SCHEDULE OF DISTRIBUTION
The Executor herein respectfully suggests distribution of the balance remaining
as follows:
Cash balance remaining for distribution before reserves:
Wachovia Bank Estate Checking Acct.
M&T Bank Estate Checking Acct.
PKH Escrow Accl
$950,689.76
300,020.92
10.28
1,250,726.96
-49,nO.50
-34,878.50
-17.500.00
Less Future Reserves
% Executor Fees
% Attomey Fees
Reserve for future Estate expenses & future distribution
(Accounting fees, 2005 federal & state tax, filing fees,
miscellaneous expenses)
Cash balance remaining for partial disbibution
$1,148,571.96
$287,142.99
TO: Gustave L. Weinstock, Jr., pursuant to Item V of last Will
One-Fourth Share
TO: Benjamin Schulein, Jr., pursuant to Item Vof last Will
One-Fourth Share
$287,142.99
TO: Lois Abrams, pursuant to Item V of Last Will
One-Fourth Share
$287,142.99
TO: Nancy Rubenstein, pursuant to Item V of Last Will
One-Fourth Share
$287,142.99
TOTAL DISTRIBUTION
$1,148,571.96
Date: 1(P~ t95
~/-~~~ ~
Gustave L. Weinstock, Jr., Exe or
GENERAL RELEASE
KNOW ALL MEN BY THESE PRESENTS, THAT the undersigned Releasor
does hereby acknowledge that he has received of and from THE ESTATE OF
HENRY G. NACHMAN, the sum of THIRTY THOUSAND ($30,000) DOLLARS and
other valuable consideration in satisfaction of all sum or sums of
money owed, payable and belonging to him by any means whatsoever
arising out of the bequest contained in Item IV (D) (2) (a) of Henry G.
Nachman's Last Will and Testament dated September 19, 1991.
AND, THEREFORE, the undersigned does by these presents, remise,
release, quitclaim and forever discharge The Estate of Henry G.
Nachman, Gustave L. Weinstock, Executor of the Estate, Howard B. Krug,
Esquire and the law firm of Purcell, Krug and Haller, Attorneys for
the Estate, as well as the estate's heirs, successors and assigns of
and from all actions, suits, payments, accounts, reckonings, claims
and demands whatsoever for or by reason thereof from the beginning of
the world to the day of these presents.
the
IN WITNESS WHEREOF, Releasor has hereunto set his hand and seal
.:.~~. day of /l1rff y
,
, 2004.
WITNESS:
~C~
~(J ~..fl
. /-\ ; /J _
. j V- (:-.~.J~
LOUIS LOEBNER
'-I qro . 3C> .~-cPr 19
Social Security Number
STATE OF MISSOURI
COUNTY OF .sr~ !-bUt S
On this, the d.Su... day of MAY , 2004, before me, the
undersigned officer, personally appeared LOUIS LOEBNER, known to me,
(or satisfactorily proven) to be the person whose name is subscribed
to the within instrument and acknowledged that he executed same for
the purposes therein contained.
ss
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
TERRI OEHLER
Notal}' Public - Notary Seal
State of Missouri
City of St. Louis
My Commission Expires 09127/2005
expires:
I
EXHIBIT
6
GENERAL RELEASE
KNOW ALL MEN BY THESE PRESENTS, THAT the undersigned Releasor
does hereby acknowledge that he has received of and from THE ESTATE OF
HENRY G. NACHMAN, the sum of THREE THOUSAND ($3,000) DOLLARS and other
valuable consideration in satisfaction of all sum or sums of money
owed, payable and belonging to him by any means whatsoever arising out
of the bequest contained in Item II(A) of Henry G. Nachman's Last Will
and Testament dated September 19, 1991.
AND, THEREFORE, the undersigned does by these presents, remise,
release, quitclaim and forever discharge The Estate of Henry G.
Nachman, Gustave L. Weinstock, Executor of the Estate, Howard B. Krug,
Esquire and the law firm of Purcell, Krug and Haller, Attorneys for
the Estate, as well as the estate's heirs, successors and assigns of
and from all actions, suits, payments, accounts, reckonings, claims
and demands whatsoever for or by reason thereof from the beginning of
the world to the day of these presents.
IN~)TNESS WHEREpF, Releasor has hereunto
the 1:2. -fA, day of ---A' f)r- I I , 2004.
I"~ //' I
!1TN~~7~/ I"
. j /.tjf/Z,--z_ /y
~;._, >~ I
/<' /
//' ,/
r,,/
set his hand and seal
&e~ t~~
ELAM BURKHOLDER ~
dD, - yo - YFDV
Social Security Number/
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF 't)a...LLf>Lu ~
On this, the J~~ day of
ss
. ,fi~
, 2004, before me, the
undersigned officer, personally appeared ELAM BURKHOLDER, known to me,
(or satisfactorily proven) to be the person whose name is subscribed
to the within instrument and acknowledged that he executed same for
the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my h~nd and official
seal.
COMMONWEALTH OF PENNSYLVANIA
NoIariaI Seal
Angela S. Shaffer. NoIarY PublIc
City Of Harrisburg, DauphIn Ccu1ly
My CommissiOn Expires Jan. 12, 2008
Member pp'lnsylvania Association Of Notaries
I
EXHIBIT
c-
GENERAL RELEASE
KNOW ALL MEN BY THESE PRESENTS, THAT the undersigned Releasor
does hereby acknowledge that she has received of and from THE ESTATE
OF HENRY G. NACHMAN, the sum of THREE THOUSAND ($3,000) DOLLARS and
other valuable consideration in satisfaction of all sum or sums of
money owed, payable and belonging to him by any means whatsoever
arising out of the bequest contained in Item II(A) of Henry G.
Nachman's Last Will and Testament dated September 19, 1991.
AND, THEREFORE, the undersigned does by these presents, remise,
release, quitclaim and forever discharge The Estate of Henry G.
Nachman, Gustave L. Weinstock, Executor of the Estate, Howard B. Krug,
Esquire and the law firm of Purcell, Krug and Haller, Attorneys for
the Estate, as well as the estate's heirs, successors and assigns of
and from all actions, suits, payments, accounts, reckonings, claims
and demands whatsoever for or by reason thereof from the beginning of
the world to the day of these presents.
IN WITNESS WHEREOF, Releasor has hereunto set his hand and seal
the ~()fb. day of ~ ' 2004.
~ -l:-::A. ,.. PA..tk.t-
R TH BURKHOLDER
~- "';}o:J.- 38'-~'l"1()
Social Security Number
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF -t)O Mf{CUA
On this, the ~D-tltday of J3.pl?.J) , 2004, before me, the
undersigned officer, personally appeared RUTH BURKHOLDER, known to me,
(or satisfactorily proven) to be the person whose name is subscribed
ss
to the within instrument and acknowledged that she executed same for
the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
EAL TH OF PENNSYLVANIA
Seal
, Angela S. Shalfer, Notary PubIc
e s City Of Hanisbutg, Dauphin Ccu1ly
My Commission Expires Jan. 12, 2008
Member. Pennsylvania Association Of Notaries
p",
15 3~Y {,).,7
GENERAL RELEASE
KNOW ALL MEN BY THESE PRESENTS, THAT the undersigned Releasor
does hereby acknowledge that it has received of and from THE ESTATE OF
HENRY G. NACHMAN, the sum of ONE THOUSAND ($1,000) DOLLARS and other
valuable consideration in satisfaction of all sum or sums of money
owed, payable and belonging to him by any means whatsoever arising out
of the bequest contained in Item II(B) of Henry G. Nachman's Last Will
and Testament dated September 19, 1991.
AND, THEREFORE, the undersigned does by these presents, remise,
release, quitclaim and forever discharge The Estate of Henry G.
Nachman, Gustave L. Weinstock, Executor of the Estate, Howard B. Krug,
Esquire and the law firm of Purcell, Krug and Haller, Attorneys for
the Estate, as well as the estate's heirs, successors and assigns of
and from all actions, suits, payments, accounts, reckonings, claims
and demands whatsoever for or by reason thereof from the beginning of
the world to the day of these presents.
IN WITNESS WHEREOF, Releasor has hereunto set its hand and seal
the /ON; day of ~d-- , 2004.
WITNESS:
TEMPLE OHEV
l .}.
,...J ~..
~
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF 8~
On this, the 1/ #; day of the
undersigned officer, personally appeared known
to me, (or satisfactorily proven) to be person whose name is
subscribed to the within instrument and acknowledged that ~
executed same for the purposes therein contained.
ss
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
EXHIBIT
I-D-
. -....--.----- ----_.,-j ~
I Notarial Seal I'
Mose,~~ry, E. M~rtin, ~o~ry Pu.biic, 1'1. e. 7'7' <<-
Hal j ,s'Jurq, \..Jauphin 'Jounty ,
My Comm~2-s'on E:,pires May 13, ~0041 Not ry PUblV
l:J~':;--:'-'" -- ',~;'~~~;:;::m](;G:)t';:0''?J My commission
P. ;J tLf; .. 0
expires: .;,( 'j.--
I J. 01 "0 ~
, ,
. .
GENERAL RELEASE
KNOW ALL MEN BY THESE PRESENTS, THAT the undersigned Releasor
does hereby acknowledge that it has received of and from THE ESTATE OF
HENRY G. NACHMAN, the sum of ONE THOUSAND ($1,000) DOLLARS and other
valuable consideration in satisfaction of all sum or sums of money
owed, payable and belonging to him by any means whatsoever arising out
of the bequest contained in Item II(C) of Henry G. Nachman's Last Will
and Testament dated September 19, 1991.
AND, THEREFORE, the undersigned does by these presents, remise,
release, quitclaim and forever discharge The Estate of Henry G.
Nachman, Gustave L. Weinstock, Executor of the Estate, Howard B. Krug,
Esquire and the law firm qf Purcell, Krug and Haller, Attorneys for
the Estate, as well as the estate's heirs, successors and assigns of
and from all actions, suits, payments, accounts, reckonings, claims
and demands whatsoever for or by reason thereof from the beginning of
the world to the day of these presents.
IN WITNESS WHEREOF, Releasor has hereunto set its hand and seal
the zotl., day of J., ""Y' , 2004.
WITNESS:
POLYCLINIC MEDICAL CENTER
n/k/a PINNACLE HEALTH SYSTEM
~f%~
Repres tati ve )'VI? 1 S; r.
~Q)(Vo: _
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF -:DAlli>+t I "I_
On this, the :l.D*day of ::HiutJj(JJrJf ' 2004, before me, the
undersigned officer, personally appeared ~.hrl~+nrflpr (J MI1r1~/{)t, known
to me, (or satisfactorily proven) to be the person whose name is
subscribed to the within instrument and acknowledged that hL-
executed same for the purposes therein contained.
ss
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
lJi&-~. -P~
Notary P lic
My co :3:-S S i QR QXpi...e9'
_y..~
I\IIr -~j ... 9.~ .
'. -
GENERAL RELEASE
KNOW ALL MEN BY THESE PRESENTS, THAT the undersigned Releasor
does hereby acknowledge that it has received of and from THE ESTATE OF
HENRY G. NACHMAN, the sum of ONE THOUSAND ($1,000) DOLLARS and other
valuable consideration in satisfaction of all sum or sums of money
owed, payable and belonging to him by any means whatsoever arising out
of the bequest contained in Item 11(0) of Henry G. Nachman's Last Will
and Testament dated September 19, 1991.
AND, THEREFORE, the undersigned does by these presents, remise,
release, quitclaim and forever discharge The Estate of Henry G.
Nachman, Gustave L. Weinstock, Executor of the Estate, Howard B. Krug,
Esquire and the law firm of Purcell, Krug and Haller, Attorneys for
the Estate, as well as the estate's heirs, .successors and assigns of
and from all actions, suits, payments, accounts, reckonings, claims
and demands whatsoever for or by reason thereof from the beginning of
the world to the day of these presents.
IN WITNESS WHEREOF, Releasor has hereunto set its hand and seal
the '2...a~day of ~(\"^,u.. o1L..~ ' 2004.
WITNESS: UNITED WAY OF THE CAPITAL REGION
./-.~
~~~~
~--, "
.' >/ / /
;' /Pt<CC/L/Ll ((/i:..jtL.-~
~,~i)resentati ve
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF C'.AI. ~ ~e./(":'\~
On this, the '2-o~ay of ~n^,,>A""~ ,2004, before me, the
undersigned officer, personally appeared ,,^t'L"'\ 'fl ~ ~\J....,~ ~ known
to me, (~r satisfactorily proven) to be the person whose name is
ss
subscribed to the within instrument and acknowledged that
executed same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
N~itd tAn~
My lSSlon explres:
NOOlriIl $eft
Joa 1l CanafJeee. NOWJ NIle
Lower .u.... Twp.. ~..amI:lorieU ~
...., CrIlIIIIIiaaoll E:qliHs Mil:. 1. 10rJIJ
.,~ ~""".'..~... J". I _._ .11.. ...
., .
. .
GENERAL RELEASE
KNOW ALL MEN BY THESE PRESENTS, THAT the undersigned Releasor
does hereby acknowledge that it has received of and from THE ESTATE OF
HENRY G. NACHMAN, the sum of ONE THOUSAND ($1,000) DOLLARS and other
valuable consideration in satisfaction of all sum or sums of money
owed, payable and belonging to him by any means whatsoever arising out
of the bequest contained in Item II(E) of Henry G. Nachman's Last Will
and Testament dated September 19, 1991.
AND, THEREFORE, the undersigned does by these presents, remise,
release, quitclaim and forever discharge The Estate of Henry G.
Nachman, Gustave L. Weinstock, Executor of the Estate, Howard B. Krug,
Esquire and the law firm of Purcell, Krug and Haller, Attorneys for
the Estate, as well as the estate's heirs, successors and assigns of
and from all actions, suits, payments, accounts, reckonings, claims
and demands whatsoever for or by reason thereof from the beginning of
the world to the day of these presents.
IN WITNESS WHEREOF, Releasor has hereunto set its hand and seal
the ~~ ~~ day of _}-p 'bf\\.IV-\~ ' 2004.
WITNESS:
HOLY SPIRIT HOSPITAL
-I)~ o. )lldbv
Re~~~el\(J D~Yntt-
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Q.-...rr. ~~~\~U A
On this, the ~h~ day of ~@ 'bt..u ~':J ,2004, before me, the
undersigned officer, personally appeared ~u~~Ne l ~onTl,~) , known
to me, (or satisfactorily proven) to be the person whose name is
subscribed to the wi thin instrument and acknowledged that ShE'
: . ss
executed same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official
seal.
N~~~.LM~~
My commission expires: NOTARIAL SEAL
Mary L. Landvater, Notary Public
Camp Hill BOlO., Cumberland County
My commission expires June 11,2007