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HomeMy WebLinkAbout04-0627 Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Margaret Dyson also known as Margaret Jane Dyson , Deceased late of the Borough of Camp Hill, Cumberland County, PA Petitioner(s), who is/are 18 years of age or older apply(ies) for: Social Security No. 193-36-3011 COMPLETE "A" OR "B" BELOW:) [] A. Probate and Grant of Letters and avers that Petitioner(s) is the executrix named in the Last Will of the Decedent, dated March 16, 1998 and codicil(s) dated N/A. State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: [] B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendente lite; durante absentia; durante rninodtate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence I I (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 1952 Chestnut Street, Camp Hill, Cumberland County, PA 17011 (list street, number and municipality) Decedent, then 60 . years of age, died June 17, 2004, at Holy Spirit Hospital, East Pennsboro Township, Cumberland County, PA 17011 (,oc~t~on) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property ................................................................................ $ 850,000.00 (If not domiciled in PA) Personal property in Pennsylvania ............................................ $ (If not domiciled in PA) Personal property in County ...................................................... $. Value of real estate in Pennsylvania ...... ~..~ ......................................................................................... $ 150,000.00 Total ........................................ ~.,.: .................................................... $ 1,000,000.00 Real Estate situated as follows: 1952 Chestnut Street, Camp Hill, PA Wherefore, Petitioner(s) respectfully.,~e~que~s~t(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the:a~3prol~t~:f~r~..~'e)~he/undersigned: · .. S' re/~' z~ --~' /~Z.--- . ,/;.~.~.~ ~. ~ ~ ~ Typed or pnnted name and residence I C/~- Jane M. Dyson 1952 Chestnut Street, Camp Hill, PA 17011 Form RW-1 Page 1 of 2 (Dauphin County - Rev. 9/92) Commonwealth of Pennsylvania County of Cumberland Oath of Personal Representative The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate~ ac,~ _~l,~_~_,aT.~.// Sworn to and affirmed and subscribed ~,~- before me this ..,,', /"ti" day of Estate of Margaret Dyson, Deceased also known as Margaret Jane Dyson Social Security No.: 193-36-3011 iF REGISTER Date of Death June 17, 2004 AND NOW, _-~..X.\k.A L~ ,2004, in consideration of the Petition on the reverse side h(~i~on, satisfactory proof having been presented before me, IT IS DECREED that Letters [~ Testamentary [] of Administration are hereby granted to Jane M. Dyson (c.t.a; d.b.n.c.t.; pendente lite; durante absentia; durante minodtate) in the above estate and that the instrument(s), if any, dated Will dated March 16, 1998 described in the Petition be admitted to probate and filed of record as the last Will of Decede.~t. ~' ~ ~ ,/j '" . Letters .................................. $ Short Certificate(s) ...... Renunciation ........................ $ Affidavit ( ) ......................... $ Extra Pages ('7) .................. $ ~.(, Codicil .................................. JCP Fee ............................... Inventory & Tax Forms ........ Other .................................... TOTAL .................... $ $ Attorney: James A. Dish, Esquire I:D. No.: 10169 3401 North Front Street ~nAddress: Harrisburg, PA 17110-0950 '-Telephone: 717-232-5000 DATE FILED: ~ ~ Lc -- Form RW-1 Page 2 of 2 (Dauphin County - Rev. 9/92) 400994vl 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 filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Local Registrar Date t/29-285 Margaret AGE (Last B~lhOay) UNDER 1 YEAR Month~ Days 60 v,,. Cumberland DECED~m'$ USUAL OCCUPATION 1952 Chestnut St. Camp Hill PA 17011 Edgar Dyson INFORMANT'S NAME (TYP~P'~) Jane Dyson I COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH (Coroner) SEX SOCIAL SECURITY NUMBER I' ' IDATE OF DEATH (M(~th Day Year) J Dyson Ia. Female 1,393-36-3011 "'- 14. June 17, 2004 UNDER 1 DAY J DATE OF BIRTH BIRTHPLACE (C~ty and I PLACE OF DEATH Chcck only one -- see ~WuCl~ns on c~he s~e) CITY BOR F DEATH FAC L T~ NAME If not ~n ' , ~ ( stiluhon, ~ve street and numbs-) WAS~EC.,~r~E NT OF HISPANIC ORIGIN? RACE - American Indian, B~ck, White. East Pennsboro Select Specialty Hospital =,=l~.~,,~,~;~.,~/c~,,. ~ite KIND OF BUSINESS/INDUSTRY WAS DECEDENT EVER IN_EV_E_R_ _INI DECEDENT'S EDUCATION SURVIVING SPOUSE U.S. ARMED ~OH(3~7~..1 (S ...... h~h ....... ompl~ed I Never Marlil~ Widowed, - r~l ~ I Elemen~rv/Secon~ary Coaeg$ / Divo~:ed(Specay} · .8U NO~ I 12 (o-t2) 4 t.4,s+) ~.ever married .a. s,a,. Pennsylvania D~ ,?~.[] Y.,,~.t~.~ ,~b.~,,~ Cumberland tow,~nip? ,~,. '~'~'~,i~,o, Camp Hill MOTHER'S NAME (F,rst, M~ddla, Mmden Surname) IlNFORMANT'S MAILING ADDRESS (Sheet, City/Town. Slate. Z;) Code) J~952 Chestnut St.~Camp Hill~PA 17011 io%~.L, sposi,,o... .... ,c .... ..c .... . i~,~.-c~.o...siel..z, co.. i=,?oCon-O-Lite Crematory ,~,,.haefferstown, PA17088 List only one cause on each line. IMMEDIATE CAU$E (Fmal ~ e6~iting in death} ~ a I - '~ 24'~ m.. ~,~(+d ~y ;'=~ ~ DE.H ; IDlE PR~OUNCED ~AO (Monlh, Day, Sepsis Urinar7 Tract Infection Quadriplegia DUE TO (OR AS A CONSEQUENCE OF): ,.~.~)L~Sr Motor Vehicle Crash d ~MPLET~N OF CAUSE , Y. 0 0 A ;x pera~or lost cent;el, OF ~ATH? Natural ~ Hom~ ~ P' Yes ' Jul 5 1965 ' 8 00 A ' ~ ~ venzc~e left roadway, [~ic' ¢ ...............~ ]_~¢E~IN~URy-AI~me, I~m, sh~L f~.~e L~ATION SIr~t Cliyff~n.~ e ~,~ ~ ~ ~al~oad 3 PA Rt.3 Jaflisle. PA lo ~ mi ol m~ ~w~. ~,m ~,m4 ~ to ~ ~,) ,~ m,.,,r ~,mt,d ..................................................... ~ ,,./~ _ Coroner ,.~.,o,~o.....m~,,~el~.~.,~,.,.~,.~...m,~...~.l~.~,..~,~ .......................... ~-*. [,,,. June 18~ 2004 'MEDICAL~AMINE~COR~ER ;Item27)Ty~mP,int Michael L. Norris, Coroner manner~n~m~d~r~M~t~nmy~n~n~de~th~t~h~t~d~te~ndp~c~ddu~t~c~u~(~)~~t~" ........... ' ' ~ ,z 6375 Basehore Road, Suite #i .............................. Mechanicsburg, Pa. 17050 /[ LICENSE NUMBER DATE SIGNED :Me. Ih, Day, Year) OF esf arnenf MARGARET DYSON I, MARGARET DYSON, of Camp Hill, Cumberland County, Pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils by me at any time made. ITEM I: I direct that all inheritance and estate taxes becoming due by reason of my death, whether such taxes may be payable by my estate or by any recipient of any property, shall be paid by the Executor out of the property passing under ITEM IV of this Will, as an expense and cost of administration of my estate. The Executor shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. ITEM II: I direct the Executor to pay the expenses of my last illness and funeral expenses from the property passing under this Will as an expense and cost of administration of my estate. ITEM III: I give and bequeath to my parents, Edgar L. Dyson and Jane M. Dyson, absolutely and iq;fee simple, all of my household furniture and furnishings, books, pictures, je~velry, silverware, automobiles, Page 1 wearing apparel and all other articles of household or personal use or adornment and all policies of insurance thereon. ITEM IV: I give, devise and bequeath all the rest, residue and remainder of my estate, not disposed of in the preceding portions of this Will, to the then acting Trustee(s), as Trustee(s), IN TRUST NEVERTHELESS, to be held, administered and distributed in accordance with the terms of the MARGARET DYSON REVOCABLE DECLARATION OF TRUST executed by me as Trustee and Grantor on the __ day of March, 1998. I hereby confirm and ratify said Revocable Declaration of Trust in every respect. ITEM V: In the settlement of my estate, the Executor shall possess, among others, the following powers: (a) To retain any investments I may have at my death, including specifically those consisting of stock of any bank even if I have named such bank as the Executor herein, as long as the Executor may deem it advisable to my estate so to do. (b) To vary investments, when deemed desirable by the Executor, and to invest in such bonds, stocks, notes, real estate mortgages or other securities or in such other property, real or personal, as the Executor shall deem wise, without being restricted to so-called "legal investments", and without being limited by any statute or rule of law regarding investments by fiduciaries. Page 2 (c) In order to effect a division of the principal of my estate or for any other purpose, including any final distribution, the Executor is authorized to make said divisions or distributions of the personalty and realty partly or wholly in kind, and to allocate specific assets among beneficiaries hereunder so long as the total market value of any share is not affected by such division, distribution or allocation in kind. Should it appear desirable to partition any real estate, the Executor is authorized to make, join in and consummate partitions of lands, voluntarily or involuntarily, including giving of mutual deeds, recognizances or other obligations, with as wide powers as an individual owner in fee simple. (d) To sell either at public or private sale and upon such terms and conditions as the Executor may deem advantageous to the estate, any or all real or personal estate or interest therein owned by the estate severally or in conjunction with other persons or acquired after my death by the Executor, and to consummate said sale or sales by sufficient deeds or other instruments to the purchaser or purchasers, conveying a fee simple title, free and clear of all trust and without obligation or liability of the purchaser or purchasers to see to the application of the purchase money or to make inquiry into the validity of said sale or sales; also, to make, execute, acknowledge and deliver any and all deeds, assignments, options or other writings which may be necessary or desirable in carrying out any of the powers conferred upon the Executor in this paragraph or elsewhere in my Will. (e) To mortgage real estate, and to make leases of real estate. Page 3 (f) To borrow money from any party, including the Executor, to pay indebtedness of mine or of my estate, expenses of administration or inheritance, legacy, estate and other taxes, and to assign and pledge assets of my estate therefor. (g) To pay all costs, taxes, expenses and charges in connection with the administration of my estate. (h) To make distributions of income and of principal to the proper beneficiaries thereof, during the administration of my estate, with or without court order, in such manner and in such amounts as my Executor deems prudent and appropriate. (i) To vote any shares of stock which form a part of the estate, and otherwise to exercise all the powers incident to the ownership of such stock. (j) In the discretion of the Executor, to unite with other owners of similar property in carrying out any plans for the reorganization of any corporation or company whose securities form a part of the estate. (k) To disclaim any interest in property which would devolve to me or my estate by whatever means, including but not limited to the following means: as beneficiary under a will, as an appointee under the exercise of a power of appointment, as a person entitled to take by intestacy, as a donee Page 4 of an inter vivos transfer, and as a donee under a third-party beneficiary contract (1) To do all other acts in the Executor's judgment deemed necessary or desirable for the proper and advantageous management, investment and distribution of the estate. ITEM VI: Any person who shall have died at the same time as I shall have, or in a common disaster with me, or under such circumstances that the order of our deaths cannot be established by proof, or within thirty (30) days of my death, shall be deemed to have predeceased me. ITEM VII: I hereby nominate, constitute and appoint my parents, EDGAR L. DYSON and JANE M. DYSON, or the survivor of them, to be the Executors, herein collectively referred to as "Executor." In the event of the death or inability or refusal of both to serve, I nominate, constitute and appoint JESSE E. FOSSELMAN to be the Executor. The Executor is specifically relieved from the duty or obligation of filing any bond or other security. IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will and Testament, consisting of this and the preceding four (4) pages, at the end of each page of which I have also set my initials for greater security and better identification this I C~4~ day of /~f A ~0 ~¥ , 1998. (SEAL) We, the undersigned, hereby certify that the foregoing Will was signed, sealed, published and declared by the above-named Testatrix as and for her Last Will and Testament, in the presence of us, who, at her request and in her presence and in the presence of each other, have hereunto set our hands and seals the day and year first above written, and we certify that at the time of the execution thereof, the said Testatrix was of sound and disposing mind and memory. (SEAL) ~k~ (SEAL) / Residing at ~ P ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~a q ?]~: q ) ) SS: ) I, MARGARET DYSON, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. , ' ~ ' \ , %~,~: /?~v~'~ /? ~ ~r~7~_(~EAL) MA~GARt~ DYSON TM -- --~T Sworn to and subscribed before me this //~ ~ h day of Notary My Commission Expires: (SEAL) AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) SS: cottonY OF ~/°~/~ '~"/' ffw/5/~/// , the Witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix, MARGARET DYSON, sign and execute the instrument as her Last Will and Testament; that Testatrix signed willingly and that she executed said Will as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as Witnesses; and that to the best of our knowledge the Testatrix was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. "-......_.,~.~ Witness , Witness Witness Sworn to and subscribed before me this /go t~ &day o.f Aqa t~ k , 19~. ~ Notary Public My Commission Expires: (SEAL) 67853 1 CERTIFICATION OF NOTICE UNDER RULE 5.6(A) Name of Decedent: MARGARET J. DYSON, a/k/a MARGARET JANE DYSON Date of Death: June 17, 2004 Will No. 2004-00627 Admin. No. 21-04-0627 To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on Julv~q, 2004: Name Address Jane M. Dyson 1952 Chestnut Street, C~m.n l-lill~ PA 17011 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None Date: July9-~l, 2004 Jame'Z-A:,~Jlsh, Esquire Name 3401 North Front Street Harrisburg, PA 17110 Address Capacity: (717) 232-5000 Telephone Personal Representative X Counsel for Personal Representative 403492vl METTE, EVANS & WOODSIDE September 16, 2004 VIA CERTIFIED MAIL RETURN RECEIPT REOUESTED Glenda Famer Strasbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Estate of Margaret J. Dyson File No. 21-2004-0627 Dear Ms. Strasbaugh: Enclosed is a check in the amount of $49,000.00 payable to "Register of Wills, Agent" representing a prepayment of Pennsylvania Inheritance Tax in the above-referenced estate proceeding. Please send a receipt for this payment. Thank you for your assistance. Very truly yours, Lisa J. Kn6d~ Paralegal to James A. Ulsh LJK: Enclosure cc: Jane M. Dyson, Executrix 406866vl COMMONWEALTH OF PENNSYLVANIA DEPARTMENTOFREVENUE BUREAU OFINDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128 0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV 1162 EX(11-96) NO. CD 0044O0 ULSH JAMES A 3401 N.FRONT ST. P.O. BOX 5950 HARRISBURG, PA 17110-0950 fold ESTATE INFORMATION: SSN: 193-36-3011 FILE NUMBER: 2104- 0627 DECEDENT NAME: DYSON MARGARET DATE OF PAYMENT: 09/17/2004 POSTMARK DATE: 09/1 6/2004 COUNTY: CUMBERLAND )ATE OF DEATH: 06/17/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $49,000.00 TOTAL AMOUNT PAID: $49,000.00 REMARKS: SEAL CHECK# 00006069 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS 7002 3150 0006 7726 8651 h,,llh,,llh,,,,,Ih,ll,h,hl Glenda Famer Stmsbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 I I II METTE. EVANS & WOODSIDE A PROFESSIONAL CORPORATION ATTORNEYS AT LAW 3401 NORTH FRONT STREET P.O. BOX 5950 HARRISBURG, FA 1711.0-0950 DIRECT DIAL (717) 231-5256 3AMES A. ULSH IRS NO. 23-1985005 E-MAIL ADDRESS jaulsb@mette.com TELEPHONE (1717) 232-15000 FAX (717) 236-1816 http://www.mette.com March 17, 2005 VIA CERTIFIED MAIL RETURN RECEIPT REQUESTED C,' Glenda Farner Strasbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 C:) -'j,J r".,,-. r::-;::1 (j, Re: Estate of Margaret J. Dyson, aIkIa Margaret Jane Dyson File No. 21-04-0627 Dear Ms. Strasbaugh: Enclosed for filing are the following: I. The original and two (2) copies of an Inventory; 2. The original and one (I) copy of Rev-I 500, Pennsylvania Inheritance Tax Return, plus a cover page of the return; 3. An estate check payable to "Register of Wills, Agent" in the amount of$748.28 representing payment of the balance ofInheritance Tax owed; 4. A firm check payable to your office in the amount of $30.00 in payment of your filing fees; and 5. A self-addressed, postage prepaid envelope for return mail. Please file the Inheritance Tax Return. Please return a date-stamped copy of the Inventory and the cover page ofthe Inheritance Tax Return, along with a receipt for the payment ofInheritance Tax, in the envelope which has been provided. March 17,2005 Page 2 Please do not hesitate to call with any questions. Thank you for your assistance. Very truly yours, ~U)'tV~ \(""0 ~ Lisa J. KnW Paralegal to James A. Dish UK: Enclosures 419629vl \", c,:) -',. REV-1500 EX (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 Due ~ I--Rlb (IWb OFFICIAL USE ONLY 2"lo '5 . C\.--::; '315 'GO 6<)'DLR)\-#- JS1 REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT \ FILE NUMBER 21 04 0627 ----- COUNTY CODE YEAR NUMBER ~ z w o w (J w o DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Dyson Margaret DATE OF DEATH (MM.DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 6/17/2004 12/21/1943 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (lAST, fiRST. AND MIDDLE INITIAL) REGISTER OF WILLS SOCIAL SECURITY NUMBER J SOCIAL SECURITY NUMBER 193-36-3011 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE w >- :J::::!tn u"'" w..u J:~O (Ja..a:l .. '" 00, 04 00. 09 7. Decedent Maintained a living Trust (Attach copy 01 Trust) _ 8, Total Number of Safe Deposit Boxes 1 0, Spousal Poverty Credit (d,te of de'th Iletween 12-31.91 arid 1-1-9~) 0 11. Election to lax under Sec. 9113(A) (Allllch Sch Ol o 2. Supplemental Retum o 4a, Future Interest Compromise (date of death after 12-12-82) o o o 3, Remainder Return (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required Original Retum limited Estate Decedent Died Testate (Attach copy of Will) Litigation Proceeds Received ... z w " z o .. '" w " " 8 THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS James A, U1sh, Esquire 3401 N, Front Street, PO Box 5950 FIRM NAME (If Applicable) METTE, EVANS & WOODSIDE TELEPHONE NUMBER 717-232-5000 Harrisburg, PA 17110-0950 1. Real Estate (Schedule A) 174,846.00 773,285.23 0,00 0.00 126,583.09 118,882.71 ~, ~.' -.J (1) :q~USE~(Y ^,.'Tl 2. Stocks and Bonds (Schedule B) (2) C) ......" 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E} (5) Z 6 Jointly Owned Property (Schedule F) (.) 0 D Separate Billing Requested f= ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) ::::l (Schedule G orL) ~ ii: 8. Total Gross Assets (tolallines 1-7) <( (J W 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 0:: 10. Debts of Decedent, Mortgage liabilities, & liens (Sdledule I) (10) 11. Total Deductions (total lines 9 & 10) ,1 f',,) 0.00 (8) 30,529,15 240,57 1,193,597.03 (11) 30,769.72 1,162,827,31 0,00 12. Net Value of Estate (line 8 minus line 11) 13 Charitable and Governmental Bequests/See 9113 Trusts for which an election to lax has not been made (Schedule J) (12) (13) 14 Net Value Subject to Tax (line 12 minus line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of line 14 taxable atlhe spousal tax 0,00 Z rate, or transfers under Sec. 9116 (a)(1.2) 0 ;:: 1.. Amount of line 14 taxable at lineal rate 1,162,827.31 '" .. :> 0.00 .. 17. Amount of line 14 taxable at sibling rate :E 0 0,00 U 18. Amount of line 14 taxable at collateral rate )( >! 19 T ax Due 1,162,827.31 (14) x .0 ~(15) x .0 45 (1.) x.12 (17) x .15 (18) (19) 0.00 52,327,23 0,00 0.00 52,327.23 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < -V3W46451000 o d . C I t Add ece ents omDle e ress: STREET ADDRESS 1952 Chestnut Street Cumberland CI1Y I STAlE I ZIP Camp Hill PA 17011- Tax Payments and Credits: 1. Tax Due (Page 1 line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 52,327.23 0.00 49,000.00 2,578.95 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A. + B + C) (2) 51,578.95 0.00 0.00 Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 748.28 A. Enter the interest on the tax due. (SA.) 0.00 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. Make Check Payable to: REGISTER OF (5B) 748.28 AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;. . . . . . . . . . . . . . . D b. retain the right to designate who shall use the property transferred or its income; . D c. retain a reversionary interest; or . , . , . . , . , , , . . . . , . . . , . . , . D d. receive the promise for tife of either payments, benefits or care? , , . , . . . . . D 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? , . , , . . . , . . . . . . . . . . . . . . . . . . ., D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? , . , . . , . , . , . . . , , . . . . . . , . . . . . . . . .. 0 []g 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 penaltias of perjury, ! declare that I have examined this return, including accompanying SChedules and statements, and to the best of my knowladge and beliaf, it is true, correct and complete Declaration of pre parer other than the personal representative is based on all information of which preparerhas any knowledge, SIGNATURE OF PERSON RESPW"~.!IJNG~RN ~.J.-- L-/~~ Jane M. Dyson ~ ~ ADDRESS Yes No i:J<I i:J<I i:J<I i:J<I O! QlI DA:J iJ?:'\ II.., ::LOOS 1952 Chestnut Street SIGNATURE OF PREPARER OTHER THAN REPR James A. UIsh, Esqu' ADDRESS 3401 N. Front Street, Camp Hill, PA 17011 'J- OOr;:; 5950 Harrisburg, PA 17110-0950 ','0,::\':Jrr:~':':' .~2~T':-"t::-~'::A~; 'i'."/,:a?;Jf;;, "-:;;,,~:j~~!@R'~'.:;;;r{::;;" For dales of death on or after July 1, 1994 and before nuary 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. ~ 9916 (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) (li)1 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 ofthe child is 0% [72 P.S. ~ 9116(a)(1.2)1. 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 l]. 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. 3W46461000 REV-1502EX+ (6.9B) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER Marqaret J. Dvson 21 04 0627 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 'Atlich property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or self, both having reasonable knowledge of the relevant facts. Real property which Is jointly-owned with right of survivorship must be dIsclosed on Schedule F. ITEM DESCRIPTION NUMBER l 1952 Chestnut Street, Borough of Camp HiLL, Cumberland County, PA; Tax Parcel Number 01-22-0536-007A-UA-1952 VALUE AT DATE OF DEATH 174,846.00 Real estate situate in the Borough of Camp Hill, Cumberland County, PA, known as 1952 Chestnut Street. Value has been computed by taking the tax assessed value of $166,520 as determined by the Cumber1and County Tax Assessment Office and multiplying it by the applicable Common Level Ratio (CLR) factor as determined by the Pennsyl.vania Department of Revenue. $166,520 x 1.05 = $174,B46 3W46951 000 TOTAL (Also enter on line 1. Recapitulation) (If more space is needed, insert additional sheets of the same size) $ 174,846.00 REV-1503 EX" (60gB) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER Marqaret J. Dvson 21 04 0627 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER ,. 230 Shares Apache Corp. common stock CUSIP: 037411105 DESCRIPllON VALUE AT DATE OF OEA lH 10,034.90 2 200 Shares Arch Coal, Inc. common stock CUSIP: 039380100 6,626.00 3 15,000 Par Bucks Cnty PA Water & Sewer Auth municipal bond CUSIP: 118673FX5 16,098.45 CPN 6.375%; DUE 12/01/08 4 200 Shares Consul Energy, Inc. common stock CUSIP: 20854P109 6,744.00 5 200 Shares Dominion Res, Inc. VA New couunon stock CUSIP: 25746U109 12,672.00 6 100 Shares EOG Resources, Inc. common stock CUSIP: 26875P101 5,827.00 7 35,000 Par Erie PA Swr Auth municipal bond CUSIP: 295533HR7 35,861.00 CPN 5.125%; DUE 06/01/21 8 75,000 Par FNMA, Pool #006895 CUSIP: 31360HUU3 2,567.23 Total from continuation pages 676,854.65 3W46961 000 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 773,285.23 Schedule B (Page 2) Estate of: Margaret J. Dyson Item No. Description Value at Date of Death CPN 8.5; DUE 02/01/09 DTD 07/01/86 Factor: 0.3266731 9 302.939 Shares FPA Capital Fund, Inc. 11,929.74 10 806.368 Shares FPA Paramount Fund, Inc. CUSIP: 302546106 10,168.30 11 1,143 Shares Fulton Financial Corp. common stock CUSIP: 360271100 22,699.98 12 300 Shares General Electric Co. common stock CUSIP: 369604103 9,708.00 13 80,000 Par GNMA, Pool #001654 CUSIP: 36202BZT5 6,929.54 CPN 6.5%; DUE 04/20/24 DTD 04/01/94 Factor: 0.08970583 14 50,000 Par GNMA, Pool #002443 CUSIP: 36202CWC3 4,318.29 CPN 7.0T; DUE 06/20/27 DTD 06/01/97 Factor: 0.08549270 15 25,000 Par GNMA, Pool #003100 CUSIP: 362028NR9 22.44 CPN 9.0%; DUE 11/15/04 DTD 01/01/75 Factor: 0.00107212 16 27,377 Par GNMA, Pool #004790 CUSIP: 362030KB3 14 .48 Total (Carry forward to main schedule) 65,790.77 Schedule B (Page 3) Estate of: Margaret J. Dyson Item No. Description Value at Date of Death CPN 9.0%; DUE 12/15/04 DTD 02/01/75 Factor: .00078638 17 35,000 Par GNMA, Pool #006011 CUSIP: 362031VC7 168.31 8.0%; DUE 07/15/05 DTD 07/01/75 Factor: 0.00514984 18 25,000 Par GNMA, Pool #007012 CUSIP: 362032YH1 61.32 CPN 6.0%; DUE 06/15/05 DTD 09/01/75 Factor: 0.00351413 19 25,000 Par GNMA, Pool #007150 CUSIP: 3620325K6 37.46 CPN 6.25%; DUE 01/15/05 DTD 10/01/75 Factor: .00209521 20 50,000 Par GNMA, Pool #007731 CUSIP: 362033SU7 257.01 CPN 8.5%; DUE 03/15/06 DTD 03/01/76 Factor: 0.00521993 21 25,000 Par GNMA, Pool #009110 CUSIP: 362035DP9 82.37 CPN 8.5%; DUE 01/15/06 DTD 04/01/76 Factor: 0.00341556 22 50,000 Par GNMA, Pool #010862 CUSIP: 362037B77 300.49 Total (Carry forward to main schedule) 906.98 Schedule B (Page 4) Estate of: Margaret J. Dyson Item No. Description Value at Date of Death CPN 8.25%; DUE 06/15/06 DTD 06/01/76 Factor: 0.00594214 23 25,000 Par GNMA, Pool #010910 CUSIP: 362037DP5 118.49 CPN 8.0%; DUE 09/15/05 DTD 11/01/76 Factor: 0.00545893 24 30,000 Par GNMA, Pool #012363 CUSIP: 362038WY3 212 . 49 CPN 8.5%; DUE 08/15/06 DTD 10/01/76 Factor: 0.00708929 25 35,000 Par GNMA, Pool #013701 CUSIP: 362041GJ8 349.95 CPN 8.0%; DUE 12/15/06 DTD 01/01/77 Factor: 0.00985655 26 50,000 Par GNMA, Pool #013753 CUSIP: 362041H65 835.84 CPN 8.0%; DUE 11/15/06 DTD 11/01/76 Factor: 0.01643301 27 25,000 Par GNMA, Pool #014175 CUSIP: 362041XC4 334.88 CPN 8.0%; DUE 01/15/07 DTD 01/01/77 Factor: 0.01295744 28 35,000 Par GNMA, Pool #016056 CUSIP: 362043ZV6 924.33 Total (Carry forward to main schedule) 2,775.98 Schedule B (Page 5) Estate of: Margaret J. Dyson Item No. Description Value at Date of Death CPN 7.5%; DUE 04/15/07 DTD 05/01/77 Factor: 0.02566422 29 25,000 Par GNMA, Pool #016739 CUSIP: 362044S42 300.80 CPN 7.0; DUE 05/15/07 DTD 08/01/77 Factor: 0.01591188 30 40,000 Par GNMA, Pool #019437 CUSIP: 362047S29 520.33 CPN 8.0%; DUE 08/15/07 DTD 08/01/77 Factor: 0.01472092 31 25,000 Par GNMA, Pool #021234 CUSIP: 362049SX7 120.81 CPN 8.0%; DUE 01/15/08 DTD 02/01/78 Factor: 0.00459976 32 25,000 Par GNMA, Pool #023141 CUSIP: 362051WA8 266.63 CPN 9.0%; DUE 09/15/Q8 DTD 09/01/78 Factor: 0.01000056 33 35,000 Par GNMA, Pool #026309 CUSIP: 362055GS8 615.16 CPN 8.5%; DUE 08/15/08 DTD 10/01/78 Factor: 0.01664384 34 25,000 Par GNMA, Pool #026628 CUSIP: 362055SR7 138.02 Total (Carry forward to main schedule) 1,961.75 Schedule B (Page 6) Estate of: Margaret J. Dyson Item No. Description Value at Date of Death CPN 9.0%; DUE 01/15/09 DTD 02/01/79 Factor: 0.00514080 35 57,331 Par GNMA, Pool #031206 CUSIP: 362060U78 2,173.65 CPN 9.5: DUE 06/15/09 DTD 07/01/79 Factor: 0.3487412 36 30,000 Par GNMA, Pool #045252 CUSIP: 362076H53 461. 88 CPN 12.5%; DUE 12/15/10 DTD 12/01/80 Factor: 0.01367118 37 35,000 Par GNMA, Pool #223236 CUSIP: 36218H4V3 1,109.34 CPN 9.0%; DUE 03/15/18 DTD 03/01/88 Factor: 0.02843479 38 45,000 Par GNMA, Pool #225772 CUSIP: 36218LW92 339.34 CPN 9.5%; DUE 10/15/~7 DTD 10/01/87 Factor: 0.00672948 39 25,000 Par GNMA, Pool #331557 CUSIP: 36224LJA6 308.13 CPN 7.5%; pUE 02/15/23 DTD 02/01/93 Factor: 0.01167895 40 25,500 Par GNMA, Pool #359365 CUSIP: 36203UFE7 5,196.94 Total (Carry forward to main schedule) 9,589.28 Schedule B (Page 7) Estate of: Margaret J. Dyson Item No. Description Value at Date of Death CPN 6.5%; DUE 06/15/23 DTD 06/01/93 Factor: 0.19551750 41 50,000 Par GNMA, Pool #359938 CUSIP: 36203UZB1 5,219.97 CPN 7.5%; DUE 11/15/23 DTD 12/01/93 Factor: 0.10651767 42 25,000 Par GNMA, Pool #416553 CUSIP: 36206NWN1 1,212.08 CPN 7.25%; DUE 01/15/26 DTD 01/01/96 Factor: 0.04536385 43 25,000 Par GNMA, Pool #458553 CUSIP: 36208RMA9 2,601.96 CPN 7.5%; DUE 07/15/29 DTD 07/01/99 Factor: 0.09711967 44 35,000 Par GNMA, Pool #484551 CUSIP: 36209X1145 4,557.55 CPN 7.5%; DUE 09/15/~8 DTD 10/01/98 Factor: 0.12141380 45 25,000 Par GNMA, REMIC Ser #03-85GA CUSIP: 38374C2R1 8,792.66 CPN 5.5%; DUE 02/20/33 DTD 10/01/03 Factor: 0.45209463 46 50,000 Par GNMA, REMIC Ser #03-95BA CUSIP: 38374EAA5 31,586.62 Total (Carry forward to main schedule) 53,970.84 Schedule B (Page 8) Estate of: Margaret J. Dyson Item No. Description Value at Date of Death CPN 5.5%; DUE 08/20/32 DTD 11/01/03 Factor: 0.71252907 47 50,000 Par GNMA, REMIC Ser #04-14LA CUSIP: 38374FKZ6 30,278.50 CPN 5.5%; DUE 01/17/34 DTD 02/01/04 Factor: 0.72337717 48 300 Shares Johnson & Johnson common stock CUSIP: 478160104 16,665.00 49 100 Shares Merck & Co. common stock CUSIP: 589331107 4,832.00 50 400 Shares ~crosoft Corp. common stock CUSIP: 594918104 11,107.60 51 25,000 Par Moon Twp. PA Auth Wtr & Swr municipal bond CUSIP: 615513FX1 26,240.25 CPN 5.4%; DUE 12/01/14 52 200 Shares Natural Resources Partners LP Limited Partnership CUSIP: 63900P103 7,530.00 53 10,000 Par North Wales PA Water Auth municipal bond CUSIP: 663226JN9 9,535.80 CPN 4.0%; DUE 05/01/16 54 0.841 Shares Nuveen Sector Port Unit Trust CUSIP: 67068G201 5.97 Total (Carry forward to main schedule) 106,195.12 Schedule B (Page 9) Estate of: Margaret J. Dyson Item No. Description Value at Date of Death 55 25,000 Par PA St Ref 2nd municipal bond CUSIP: 709141D85 21,970.25 CPN 3.9%; DUE 07/01/19 56 200 Shares Peabody Energy Corp. common stock CUSIP: 704549104 10,290.00 57 512 Shares Pepco Holdings, Inc. common stock CUSIP: 713291102 9,487.36 58 500 Shares Plum Creek Timber Co. I Inc. common stock CUSIP: 729251108 16,015.00 59 200 Shares Public Svc Enterprise Group, Inc. common stock CUSIP: 744573106 8,092.00 60 100 Shares Royal Dutch Petroleum Co. common stock CUSIP: 780257804 5,213.00 61 1,000 Shares Source Capital, Inc. common stock CUSIP: 836144105 64,000.00 62 200 Shares Tyson Foods, Inc. Cl A common stock CUSIP: 902494103 4,080.00 63 30,000 Par U.S. Treasury Bond 5.25% CUSIP: 912810FFO 29,146.86 CPN 5.25%; DUE 11/15/28 DTD 11/15/98; FC 05/15/99 Total (Carry forward to main schedule) 168,294.47 Schedule B (Page 10) Estate of: Margaret J. Dyson Item No. Description Value at Date of Death 64 20,000 Par U.S. Treasury Bond 6.0% CUSIP: 912810EW4 21,375.00 CPN 6.0%: DUE 02/15/26 DTD 02/15/96; FC 08/15/96 65 150,000 Par U.S. Treasury Inflation Index Note CUSIP: 912828AF7 168,762.36 CPN 3.0%: DUE 07/15/12 DTD 07/15/02: FC 01/15/03 Factor: 1.04141000 66 25,000 Par U.S. Treasury Note CUSIP: 912827Z62 26,953.13 CPN 6.5%; DUE 10/15/06 DTD 10/15/98; FC 04/15/97 67 50,000 Par U.S. Treasury Note, Inflation Index CUSIP: 912828BDl 50,278.97 CPN 1.875%: DUE 07/15/13 DTD 07/15/03: FC 01/15/04 Factor: 1.01950000 Total (Carry forward to main schedule) 267,369.46 REV-1508 EX.. (6-96l COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Margaret J. Dyson FILE NUMBER 21 04 0627 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the rinht of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 1995 Dodge van, equipped with wheelchair lift; VIN 1B4GH44R1SX509416 17,000.00 VIN #lB4GH44R1SX509416 2 Community Banks Checking Account #4601897509 8,261.53 Interest accrued to 6/17/2004 0.72 3 Community Banks Checking Account #1502861105 2.38 4 Hospital bed 3,000.00 5 Janney Montgomery Scott Money Market Account #2958-3865 92,318.46 6 Motorized wheelchair 6,000.00 3W46AD 1_000 TOTAL (Also enter on line 5 Recaoitulationl $ (If more space is needed, insert additional sheets of the same size) 126,583.09 REV-1509 EX + (e-gal COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Maraaret J. Dvson SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER 21 04 0627 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT{S) NAME A. Dyson, Jane M B. c. ADDRESS 1952 Chestnut Street, Camp Hill, FA 17011 RELATIONSHIP TO DECEDENT Mother JOINTLY-OWNED PROPERTY: <Em' OA'!E DESCRIPTION OF PROPERTY %Of DATE OF DEATH I'!EM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION Af<I) BANK ACCOUNT DAlE OF DEATH DECD'S VALUE OF ~BERORSIMllAR IDENTIFYING NUMBER, ATTACH DEED FOR NUMBER TENANT JOINT JOINTLY./-ELDREALESTATE VALUE OF ASSET INTEREST DECEDENT'S INlEREST 1. A. 1 A 12/30/1899 Janney Montgomery Scott Account #HB23-2818-6185; owned as joint tenants with the right of survivorship with Jane M. Dyson. See attached correspondence. from Janney Montgomery Scott for itemization of assets held in this account as of decedent's date of death. 237,765.42 50.000 118,882.71 - TOTAL {Also enter on line 6 Recaoitulationl $ 118,882.71 3W46AE 1000 (It more space is needed. insert additional sheets of the same size) REV-1511 EX + {12-99} COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Marqaret J. Dvson SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. FILE NUMBER 21 04 0627 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Musselman's Funeral Home 3,994.54 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s} I EIN Number of Personal Representative(s) - - Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 20,000.00 3. Family Exemption' (If decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant Jane M. Dyson Street Address 1952 Chestnut Street City Camp Hill Slale PA Zip 17011 Relationship of Claimant to Decedent MOTHER 4. Probate Fees 641.00 5. Accountant's Fees 100.00 - 6. Tax Return Preparer's Fees 7 1 Cumberland Law Journal Advertise estate no ti ce 75.00 Total from continuation pages 2,21B.61 TOTAL (Also enter on line g, Recapitulation) $ 30,529.15 3W46AG1,OOO (If more space is needed, insert additional sheets of the same size) Estate of: Margaret J. Dyson Item No. 2 3 Description Janet ~ller, Tax Collector Borough of Camp Hill School real estate taxes The Sentinel Advertise estate notice Schedule H part 2 (Page 2) Amount 2,082.30 136.31 Total (Carry forward to main schedule) 2,218.61 REV-1512EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Marqaret J. Dvson SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 04 21 0627 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Conner-Rich Associates Medical bill 50.48 2 Mid Penn Urology Medical bill 6.61 3 Neiman Marcus Credit card 183.48 3W46AH2,OOO TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 240.57 REV.1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Maraaret J. Dvson FILE NUMBER 21 04 0627 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE 1 Jane M. Dyson 1952 Chestnut Camp Hill, PA Street 17011 100% Residue: 1,162,827.31 Mother 1,162,827.31 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV.1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS, A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 3W46AI1,OOO TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (If more space IS needed, Insert additional sheets of the same size) $ 0.00 ESTATE OF MARGARET J. DYSON FILE NO. 21-04-0627 Attachment to Schedule J, Part I, Beneficiaries Pursuant to Item IV of the decedent's Last Will and Testament dated March 16, 1998, the residue of decedent's estate was to pour over into her revocable trust under agreement dated the same day. Said trust was not funded during the decedent's lifetime. According to the terms of the trust agreement, upon decedent's death, the trust was to terminate and be paid to decedent's mother, Jane M. Dyson. (Decedent's father, Edgar L. Dyson predeceased decedent.) Based on the foregoing, the residue of decedent's estate will be paid directly to decedent's mother, Jane M. Dyson. The trust will not be funded. 419486vl La~t Win and T e~tament OF MARGARET DYSON I, MARGARET DYSON, of Camp Hill, Cumberland County, Pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils by me at any time made. ITEM I: I direct that all inheritance and estate taxes becoming due by reason of my death, whether such taxes may be payable by my estate or by any recipient of any property, shall be paid by the Executor out of the property passing under ITEM IV of this Will, as an expense and cost of administration of my estate. The Executor shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. ITEM II: I direct the Executor to pay the expenses of my last illness and funeral expenses from the property passing under this Will as an expense and cost of administration of my estate. ITEM III: I give and bequeath to my parents, Edgar L. Dyson and Jane M. Dyson, absolutely and in fee simple, all of my household furniture and fumishings, books, pictures, jewelry, silverware, automobiles, Page 1 wearing apparel and all other articles of household or personal use or adornment and all policies of insurance thereon. ITEM IV: I give, devise and bequeath all the rest, residue and remainder of my estate, not disposed of in the preceding portions of this Will, to the then acting Trustee(s), as Trustee(s), IN TRUST NEVERTHELESS, to be held, administered and distributed in accordance with the terms of the MARGARET DYSON REVOCABLE DECLARATION OF TRUST executed by me as Trustee and Grantor on the day of March, 1998. I hereby confirm and ratifY said Revocable Declaration of Trust in every respect. ITEM V: In the settlement of my estate, the Executor shall possess, among others, the following powers: (a) To retain any investments I may have at my death, including specifically those consisting of stock of any bank even if I have named such bank as the Executor herein, as long as the Executor may deem it advisable to my estate so to do. (b) To vary investments, when deemed desirable by the Executor, and to invest in such bonds, stocks, notes, real estate mortgages or other securities or in such other property, real or personal, as the Executor shall deem wise, without being restricted to so-called "legal investments", and without being limited by any statute or rule oflaw regarding investments by fiduciaries. Page 2 (c) In order to effect a division of the principal of my estate or for any other purpose, including any final distribution, the Executor is authorized to make said divisions or distributions of the personalty and realty partly or wholly in kind, and to allocate specific assets among beneficiaries hereunder so long as the total market value of any share is not affected by such division, distribution or allocation in kind. Should it appear desirable to partition any real estate, the Executor is authorized to make, join in and consummate partitions of lands, voluntarily or involuntarily, including giving of mutual deeds, recognizances or other obligations, with as wide powers as an individual owner in fee simple. (d) To sell either at public or private sale and upon such terms and conditions as the Executor may deem advantageous to the estate, any or all real or personal estate or interest therein owned by the estate severally or in conjunction with other persons or acquired after my death by the Executor, and to consummate said sale or sales by sufficient deeds or other instruments to the purchaser or purchasers, conveying a fee simple title, free and clear of all trust and without obligation or liability of the purchaser or purchasers to see to the application of the purchase money or to make inquiry into the validity of said sale or sales; also, to make, execute, acknowledge and deliver any and all deeds, assignments, options or other writings which may be necessary or desirable in carrying out any of the powers conferred upon the Executor in this paragraph or elsewhere in my Will. (e) To mortgage real estate, and to make leases of real estate. Page 3 (f) To borrow money from any party, including the Executor, to pay indebtedness of mine or of my estate, expenses of administration or inheritance, legacy, estate and other taxes, and to assign and pledge assets of my estate therefor. (g) To pay all costs, taxes, expenses and charges in connection with the administration of my estate. (h) To make distributions of income and of principal to the proper beneficiaries thereof, during the administration of my estate, with or without court order, in such manner and in such amounts as my Executor deems prudent and appropriate. (i) To vote any shares of stock which form a part of the estate, and otherwise to exercise all the powers incident to the ownership of such stock. (j) In the discretion of the Executor, to unite with other owners of similar property in carrying out any plans for the reorganization of any corporation or company whose securities form a part of the estate. (k) To disclaim any interest in property which would devolve to me or my estate by whatever means, including but not limited to the following means: as beneficiary under a will, as an appointee under the exercise of a power of appointment, as a person entitled to take by intestacy, as a donee Page 4 of an inter vivos transfer, and as a donee under a third-party beneficiary contract (1) To do all other acts in the Executor's judgment deemed necessary or desirable for the proper and advantageous management, investment and distribution of the estate. ITEM VI: Any person who shall have died at the same time as I shall have, or in a common disaster with me, or under such circumstances that the order of our deaths cannot be established by proof, or within thirty (30) days of my death, shall be deemed to have predeceased me. ITEM VII: I hereby nominate, constitute and appoint my parents, EDGAR L. DYSON and JANE M. DYSON, or the survivor ofthem, to be the Executors, herein collectively referred to as "Executor." In the event of the death or inability or refusal of both to serve, I nominate, constitute and appoint JESSE E. FOSSELMAN to be the Executor. The Executor is specifically relieved from the duty or obligation of filing any bond or other security. IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will and Testament, consisting of this and the preceding four (4) pages, at the end of each page of which I have also set my initials for greater security and better identification this I b-tL,. day of n\ A I~(' If ,1998. t-rL' .- . I r{d~~T DYS~~C)/6 /1 (SEAL) We, the undersigned, hereby certify that the foregoing Will was signed, sealed, published and declared by the above-named Testatrix as and for her Last Will and Testament, in the presence of us, who, at her request and in her presence and in the presence of each other, have hereunto set our hands and seals the day and year first above written, and we certify that at the time of the execution thereof, the said Testatrix was of sound and disposing mind and me~ry~ (~ //' \ (SEAL) 1~~t7')' ( L ~1 \-!tu.{ J 1 1''-<)0 Ujvt)C~ (SEAL) i (SEAL) :'\' IJ /\ Residing at lJ V UA...t., d,L'(J-{ "f\~c~,-- R, ( 'J 0 f'i .. i!jJ'}4Lt./ "'Ii)' ResIdmg at rf,"; , p'-/w<L___1. fU c c{ (J (U.AA'l f!A if .r14 /7 ( ( ( . 7' Residing at ; /7 d It ;+'- ) /'/' , // 1~;;/;;{A-&f(JuL& {// /C5~-3 . I ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTYOF Villi pt", ) ) SS: ) I, MARGARET DYSON, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~~~~ (~~~~"'/ ~j1J'i-hl <SEAL) Sworn to and subscribed before me this If.. -r h. day of /Yio r... l., ,19Rr. ),o7~d' ~. kP~ Notary Public My Commission Expires: (SEAL) Nolarial seako,alY publiC !vi KenlNo!ln~aupnin coun6b1 !vIalga...~a,;na iINP., ~s sepl. 28. 2 SUSque missien EtP\f . \ Notaries !vI~ Corn . ~ssocial\OO 0 ?,nns~\van" l.I,mb"" AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA h. ) SS: COUNTY OF VdLc'P 'Vl ) ) We JAlIH '0 i~ lli 6 L" 5liMI 111, /-//J/A/f U , , l/JL /ul, js J.Jq // , the Witnesses whose names are signed to ,the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix, MARGARET DYSON, sign and execute the instrument as her Last Will and Testament; that Testatrix signed willingly and that she executed said Will as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as Witnesses; and that to the best of our knowledge the Testatrix was at that time eighteen (18) or more years of age, of sound mind and and under no constraint or undue influence. l\ ,>-~ "'-'-^--.I.~ '- i ----~~ , Witness L ell I / '//()-1 j~,zl( Witness I " i "{ /' !~. I 1~-;7 I -"/, ~'-"/__J \__ J/i4~$ -d_::~~>~ Witness Sworn to and subscribed before me this / Ie t ~day of /f/(H~ h , 199cr: ~'A.j~. ~ Notary Public My Commission Expires: NOlarla\ sea~O\8lY public M KenworthY, h' county Margare~anna ,wp" DausPep\~ 28, 2001 SusQuel' . E~p\fes . My commisslen . f on 01 Notaries \ip.ff1hef, penns'1\\Ian\8 ASSOCI'3 \ (SEAL) 678531 . Page.! ofl Detailed Results for Parcel 01-22-0536-007A-UA-1952 in the 2000 Tax Assessment Database DjstrictN 0 1 Parcel_ID 01-22-0536-007 A-UA-1952 MapSuffix HouseNo 1952 Direction Street CHESTNUT STREET Ownerl DYSON, MARGARET J Owner2 PropType R PropDesc Liv Area 2264 CurLandVal 0 CurlmpVal 166520 CurTotVal 166520 CurPrefVal Acreage 0 CIGrnStat TaxEx 1 SaleAmt 140000 SaleMo 5 SaleDa 21 SaleCe 19 SaleYr 92 DeedBkPage 0035R-00449 YearBlt 1988 HF_File_Date HF _Approval_Status http://taxdb.ccpa.net/details.asp?id=01-22-0536-007 A-UA -1952&dbselect=0 6/23/2004 JUN-~8-200~ 10:17 JANNEY MONTGOMERY SCOTT 1".02 61161200.4 09:49:53 ;.M Account Workbook Positions Page: 1 29583865 . DYSON MARGARET JANE 295e-3865 10 0 HB23 CSI 4C MARGARET JANe DYSON 1952 CHESTNUT STREET MMF Bal CAMP HILL PA 17011 Total Mar1<.tVal Total Acet Val 88.583.08 Fund. Available 773.261.83 865.581.21 88.583.08 Q.antitY Nome S mbol CUSIP' MktPriCe Value Tvoe Lac Man ~. ...._".... "230 - 77328S.2ll 1 iiPACHE CORP N'A '. 037411-10-6 43,6300 J~34.90 1 SEG y.~ 2 200 AR H COALlNC ACI 03938G-1 -0 .'33T:ioo 326.00 1 -SEG-- Yes 3 200 qQN~EN5R<eY INC . CNX 20854P-l0.9 33.7200 6744.00 1 SEG Yes 'X ,'Y' , .... '200 . DOMINION RES INC VA NEW D 25746U-10-9 63.3600 12 672.00 1 SEG Yes 5 100 EOG RESOURCES INC EOG 26875P-l0.1 582700 5 827.00 1 SEG Yes 6 302.93900 FPA CAPITAL FUND INC FPPTX 302539-10.1 39.3800 11929.74 1 SKF Yes 7 .__ 1.~g FUL]Qt:!.FJN.ANCIALcoBp .f'A ....Fl.!bT._ ___..m<lll:'!'Q:o.. .. __ 19.8l?g~ __~,~~!l.l!!! L._._ .~L Yes -'8 300 GENL EL.EC CO GE 389604.10.3 32.3600 ..!!~8.oo 1 SEG .Y!l.S_._ 9 300 JOHN & JOHNSON JNJ 4781 lG-4 -55.5500 16 65.00 1 . SEG-' Yes 10 100 MERCK & CO INC MRK 589331-10.7 48.3200 4 832.00 1 SlOG' -;;, 'n - -- Yes ''ff .'...."'. '-400 MiCRoSoFT CORP 'MSFT 594918-10-4 27.7690 f-.l1.107.60 1 SEG Yes 12 200 PEABODY 10 GY CORP BTU 704549-10.4 -. 51,4500 10.290.00 1 -SEG 'Yes'" 13 512 PEf'CO HLOClS INC POM 713291-10.2 18.MOO 9.487.38 1 SlOG Yes 14 500 PLUM CREEK TIMBER CO INC pCL 729251-10-8 32.0300 16.015.00 1 SEG Yes "'.,. 15 200 PUB SVC ENTERPRise' .-.--- 'PEG' . '74457~10:jj 40.4600 8.0\i2:00 T' SEc;" Yes 16 100 ROYAL DUTCH L.EUM RO 78 5.60.4 52.1300 5213.00 1 EG Yes 17 1.000 SOURCE CAPITAL INC SOR 836144-10-5 64.0000 64.000.()() 1 SEG .... Yes 18 200 i TYSON FOODS INCCL')\' . ..... tSN .. 90249~10-3 20.4000 4 080.00 '1 $G yes-.---- 19 200 NATURAL RES PARTNERS LP NRP 63900P-1G-3 37.6500 7.530.00 1 SEG Yes 20 15.000 ~~I~t;~~0~10~ ...~. .....,." ....-.. 118673.FX-5 107.3230' ._.__ 16.9~~::.4.~. ...1....___ !l~- No -- 21 35:000 ..... 295i;>>-HR:i' . "1'02~"60ri1i' 3~,~61..oo 1 EG r~"!! 22 75.000 -~ '~-'.-.' "--31360H-UU:!j' --')Oil.0150' , 2.587.23 1 ."-~' SEG -- FNMA ooee96 .5 020109 -- No --- 23 25 000 NMA 016739 7.0051507 3 2044-54-2 104.8610' 300.80 1 S No 24 25 000 GNMA 021234 8.0011508 -.- 362049.SX.7 1072520' .n. 120.81 1 ..i;;1;9_ -~~. - -~ _.___ ..3QJl.OO. GNMA 012363 8.5081506 362038-WV:3' -.. 105~536ii" .-. 21:2':49' i " SlOG No GNMA'oii715ifs:25'Oi 1505"-' - ,.-......-.--..... -. 362032-5k:.e 103.2410' 37:48 1 . . SEG No 26 25 000 -p _.......~M9.o_ GNMA 013701 8.0 121506 362041.GJ.8 105.1890' 349.95 1 SEG No 28 25 000 GNMA 009110 8.5 011505 362035-01"-9 105.5380' -- 82,37 1 SEG No 29 45 000 GNMA 225772 9.5101517 .. 36218L-W9-2 i 12.39715- 339.34 1 SlOG -.. No ... 30 35.000 GNMA 018058 7.5041507 - . 362043-ZV-6 105.8190' 924.33 1__ ~EG No 31 35.000 GNMA0211309' 8:50811;08'-' 362056.GS-8 107,7150' .Jlj5'1~ +-.. - SEG No 32 35 000 GNMA 223236 .0 31518 -. 3821 -4V-3 If~~ .." 1.109.34 -J---.... -SEG -- Ne 33 57331 GNMA 031206 9.5 061509 362060.1.17-8 110.2320' 2.173.65 1 'SEG'" NO__ 34 25 000 GNMA 014175 8.0011507 3620.41.XC-4 106.3710' 334.88 1 SEG No 35 -- _~5.,OOO NMA 006011 8.0 071505 362031.VC.7 103.0860' 168.31 1 SEG No ---36 25 000 GNMA003100 9.011150.4 .,..-.. 362028-NR-9 101.5170' 22.44 1 SEG No 37 30 000 GNMA045252 12.5121s'10..~ ." .. ~07S:-H5-3 113.51340'/1 461.88 1 SEG No 38 .25.000 GN 012 8:0'"681501;- 362032- V".l 103.0860' 61.32 1 6EG... .~~ - . 39 n.... 25.000 GtftiiA026628 9.0011509 362055-SR-7 1092510. 138.02" ,..... .. SEG No 40 50 000 GNMA 007731--8:5 'O:mS06 ....--.. -. 382033-SU-7 105.5360' 257.01 1 SEG NO'. ... 41 25 000 GNMA 010910 8.0091505 362 31-oP-5 103,0860' . .. "li~~~ r-- SlOG No 42 27 377 GNMA 004790 9.0 121504 362030-K8-3 101.5170' 14.48 1" ....- 'SEG ~o 43 .25..5..00 GNMA 359365 6.5061523 36203U-FE.7 104.4720' .... . 5:196.94 1 S5(j'" No --'4.1' ... 25,000 GNMA331557 7.5021523 36224L-JA-6 107.9830' 308.1 1 S~'- No' 45. 25.000 i!l:5~3 7.~51JWl.t- -...- .- 36206N.WN-l 107.0380' 1.212. 1 SE(; -N -....... '!......_- 48 50.000 ...,-- " _. 36203U.Z8-1 107.9830' 5.219.97 1 SEG No.. 47 50 000 GNMA010852 .25051506 . ---. 362037-87-7 105.3000' 300.49 1 SlOG No ----..-. 362ii2B:n:5 6929. 1 .."-... 48 80 000 GNMA 001664 8.5 042024 104.0210' SEG ! NO I--~~- ..,.... .~~M!OO NMA 002443 7.0062027 38202C:WC:3 105.7040' 4.31829 1 SlOG ' NO -- -- ..- --'3i!2047.S2.9 --'106.3710' 520.33 1 SEG No ~ 40.000 GNMA 019437 8.0 081507 51 -.-- '50 coif "ij'NMA 013753 8.0111506 382041-Ha-5' 105.1890' ..,- 835.84 1 SEG No 52 GNMA 023141 9.0091508 36 51-WA-8 1"06.4000'" 266.83 1 ... SEG No 53 25.000 GNMA4e6563' 7.5071529 36208R.MA.9 1012990' '---2;&)1,98 1 =~~g .. No 54 35 000 GNMA_551 7,5 0916~8 -, ," ....--. 36209X.H4.5 107.3720' 4557. 1 . ~ "No 55 25 000 GNMA 03-lI5GA 5, 3 ..~.......- 38374C-2R.l 99.8142' _...,ll.m.611 1 E No GNMA 03-95BA 5.5 082032.." .._. ... - SE No 68 50000 38374E-AA-5 97.7959" 31.686.52 1 ..-... .."' sf ~ NMA lJ4.14LA 5.5011734 ---- ,.-.- 38374F-KZ-8 96.7780' -30 278.56 1 SEG No ~.., .'-- -. .-_58 PA W&S 5.4120114 ... :'. .__.!l1~13-FX-1 104.9610' 26.24l!.~ ..1..._.... 'SEG ... No JUN-1.8-2004" 10: 18 JANNEY MONTGOMERY SCOTT P.03 6/1812004 09:49:53 AM Account Workbook Positions Pag.:2 29583865 . DYSON MARGARET JANE ,,9~ Name . "Silmbol . cusfP...... -'Mki"Pri.. . .. r;m. Lee M n .'SS 1 000 HW .0 OS-0118 ss .IN-9 80' 9.535.80 1 SEG Yes 80 25 000 PA ST REF 3.9070119 709141.[)8..5 .- 87.8810' .. 2.1.970.25 1 SEa Yes 61 .. .....~.!tll!lJl. ~sJ.139f'lP .' 6.0021526 91281 (l-EW-4 106:875'0 21.375)jo f' ....~G-. N<> 62 25 000 UST NOT!: 6.5101506 TN06F"- .' . 912827-Z6-2 107.8125 26.95 .13 1 S G No 53 30 000 NO 6.25111628 US28B 91281(l-FF-0 97.1562 29 146.86 1 SEG No 64 150 000 UST NT INFL T 3.0071512 912828-AF-7 J9.!-7.soJl.. 168.762.36 1 ..... sea No ...... 65 50 000 UST ~L Tl.~75 07.!5.1~. .......... 912828-B[)'1 98.3750 '50 278.97 1 SEC;" -NO' 66 0.84100 V UEL 5'fR 8100 RE SA " '.~""-.~""-' 670 1 7.1024 5.97 1 SEG No 67 806.36800 FPA PARAMOUNT FO 'Ne FPRAX 302546-1Q..6 12.6100 1oJ!i.a.:M!...M........ ._.."n.... ..y...... ... TOT~ P.03 Communit~Banks RE: Margaret J. Dyson DATE OF DEATH: June 17, 2004 Dear Sir: Enclosed please find a copy of the information requested on the above mentioned individual's accounts. The information furnished is on the date of death, unless otherwise noted. If you have any questions regarding the given information, please feel free to contact me. Sincerely, DAwn &.unCl.S) Community Banks Bookkeeping Department P.O. Box 350 . Millersburg. PA 17061 . Phone 1-800-331-8362 Communit'lBanks ACCOUNT NUMBER(S) \~261o I IOS L.\ t..o01 ~cn ~CA TYPE OF ACCOUNT C h e..dr.\..l""'A Che..~9 DATE OPENED 06- I Lt. COlD 01-2>\ -02 PRINCIPAL BALANCE 2. . '2,8 8.2.(01. <53 ACCRUED INTEREST TILL 1'2- DATE OF DEATH BALANCE AT DATE OF 3'6 6.2.(,;>2.2!5 DEATH 2.. MATURITY DATE - ACCOUNT OWNERSHIP ~^;,,~ S i .....'j \ eo NAMES OF JOINT OWNER- SHIP,IF ANY E. L. Dyoon DATE JOINT OWNER- SHIP WAS ESTABLISHED ADDITIONAL INFORMATION INTEREST RATE o.CC>% O.?..Ok SIGNATURE l:::u.wn c~ DATE 01-2.1- O-l. P.O. Box 350 . Millersburg, PA 17061 ' Phone 1-800-331-8362 "~n~om'elry"'"llliia,:':'.':m":' Scott LLC :{-:::'~~J,?f': -1);i;t;:J;'Y~t;i;*li->X~,t;if'tt~~a~';i~;,~-;i'k'_~;t~~~1:~t~;~;~~~~t~4;ll~tt~'ii~ September 14, 2004 Mette Evans & Woodside Attn: Lisa Knode PO Box 5950 Harrisburg, PAl 711 0-0950 RE: Account# 2818-6185 Dyson Jt-Ten Dear Lis:'l.. 20 Elford Road Suite 315 Lemoyae, PA 17043-1109 (717) 73t-4400 fax, (717) 73]-4411 The following is the information you requested on the date of death values for the joint account of Jane and Margaret Dyson. Q!!!y Security Cusio# 100 FPL Group Inc 302571-10-4 280.717 FPA Captial FundInc 302539-10-1 40,000 GNMA 317787 8.0041522 36223T-6Y-2 25,000 GNMA 384142 7.5051524 36204Y-WB-5 28,000 GNMA 000410 8.0102022 36202A-N3-7 25,000 GNMA 416553 7.25011526 36206N-WN-1 35,000 GNMA 002054 7.0082025 36202C-H7-1 26,000 GNMA 000545 7.5 122022 36202A-TA-5 25,000 GNMA 001843 7.5062022 36202C-BL-6 25,000 GNMA 404275 8.0081524 36205Y-CL-4 60,000 GNMA 198790 8.0041517 36217N-XT-4 25,500 GNMA 469699 7.0 111528 36209E-X4-9 25,000 GNMA518496 8.0101529 3621IN-7H-5 50,000 GNMA 312575 8.0101521 36223N-FQ-2 70,000 GNMA322798 8.0051522 36224A-RT-0 100,000 GNMA 04-21GA 5.0102032 38374F-V7-6 20,000 PA Turpike Rev 5.00120120 709223-NJ-6 15,000 US TreasNote 3.375041532 91281O-FQ-6 30,000 US Treas Note 4.00 111512 912828-AP-5 Money Market Balance Total Account Value as of June 17,2004 Price $ 63.75 $ 39.38 $100.00 $100.00 $100.00 $100.00 $101.00 $100.00 $100.00 $100 00 $100.00 $101.00 $100.00 $100.00 $104.00 $ 96.00 $103.00 $120.5625 $96.3437 Interest $ 8.04 $ 2.52 $ 3.63 $ 3.65 $ 7.85 $ 4.42 $ 4.63 $ 4.44 $ 5.73 $ 7.41 . $ 3.38 $ 1.43 $ 9.51 $217.78 $ 44.44 Total Value $ 6,375.00 $]] ,054.64 $ 2,269.43 $ 757.75 $ 1.024.02 $ 1,136.03 $ 2,554.94 $ 1,329.24 $ 1,392.18 $ 1,252.80 $ 1,617.85 $ 2,412.85 $ 954.25 $ 402.97 $ 2,792.54 $94,298.66 $20,644.44 $18,084.38 $28,903.11 ~38.508.34 $237,765.42 If I can be of further assistance to you in the handling of this matter, please feel free to contact me at 731-4400. Sincerely, ~d~ Daphne L. Williams Sales Assistant to Alan S. Meminger . . Members, NYSE . NASD . slPe Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Margaret J. Dyson No. 21-04-0627 also known as Margaret Jane Dyson Date of Death June 17, 2004 late of the Borough of Camp Hill, Cumberland County, Pennsylvania , Deceased Social Security No. 193-36-3011 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 of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. Ime verify that the statements made in this Inventory are true and correct. IlWe understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. 1.0. No.: Personal Representative: James A. Ulsh, Esquire Jane M. Dyson 10169 ~ . 2:'i?'"2--7/ 3401 N. Front St., PO Box 5950, Harrisburg, PA 17110 ( '(~::U:~03\~Z \.Qoo.s;- (717) 232-5000 Name of Attorney: Address Telephone: DESCRIPTION !.VALUE REAL PROPERTY: .:! 1952 Chestnut Street, Borough of Camp Hill, Cumberland County, PA; Tax Parcel Number 01-22-0536-007A-UA-1952 ." c>) 174,84600 , .,..,..,. PERSONAL PROPERTY: , II (~~j -..; See attached TOTAL 1,074,714.32 (Attach Additional Sheets If Necessary) 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. 419265v1 FClI1T1 PJN-7 (Dauphjn County)-Rev. 9192 ESTATE OF Marqaret J. Dvson FILE NUMBER 21 04 0627 "' ITEM NUMBER 1.230 Shares Apache Corp. common stock CUSIP: 037411105 2 200 Shares Arch Coal, Inc. common stock CUSIP: 039380100 3 15,000 Par Bucks Cnty PA Water & Sewer Auth municipal bond CUSIP: 118673FX5 CPN 6.375%; DUE 12/01/08 4 200 Shares Consul Energy, Inc. common stock CUSIP: 20854P109 5 200 Shares Dominion Res, Inc. VA New common stock CUSIP: 25746U109 6 100 Shares EOG Resources, Inc. common stock CUSIP: 26875p101 7 35,000 Par Erie PA Swr Auth municipal bond CUSIP: 295533HR7 CPN 5.125%; DUE 06/01/21 8 75,000 Par FNMA, Pool #006895 CUSIP: 31360HUU3 DESCRIPTION VALUE AT DATE OF DEATH 10,034.90 6,626.00 16,098.45 6,744.00 12,672.00 5,827.00 35,861. 00 2,567.23 Estate of: Margaret J. Dyson Item No . Description Value at Date of Death CPN 8.5; DUE 02/01/09 DTD 07/01/86 Factor: 0.3266731 9 302.939 Shares FPA Capital Fund, Inc. 11,929.74 10 806.368 Shares FPA Paramount Fund, Inc. CUSIP: 302546106 10,168.30 11 1,143 Shares Fulton Financial Corp. common stock CUSIP: 360271100 22,699.98 12 300 Shares General Electric Co. common stock CUSIP: 369604103 9,708.00 13 80,000 Par GNMA, Pool #001654 CUSIP: 36202BZT5 6,929.54 CPN 6.5%; DUE 04/20/24 DTD 04/01/94 Factor: 0.08970583 14 50,000 Par GNMA, Pool #002443 CUSIP: 36202CWC3 4,318.29 CPN 7.0T; DUE 06/20/27 DTD 06/01/97 Factor: o . 08549270 15 25,000 Par GNMA, Pool #003100 CUSIP: 362028NR9 22.44 CPN 9.0%; DUE 11/15/04 DTD 01/01/75 Factor: 0.00107212 16 27,377 Par GNMA, Pool #004790 CUSIP: 362030KB3 14.48 Estate of: Margaret J. Dyson Item No. Description Value at Date of Death CPN 9.0%; DUE 12/15/04 DTD 02/01/75 Factor: .00078638 17 35,000 Par GNMA, Pool #006011 CUSIP: 362031VC7 168.31 8.0%; DUE 07/15/05 DTD 07/01/75 Factor: 0.00514984 18 25,000 Par GNMA, Pool #007012 CUSIP: 362032YH1 61.32 CPN 8.0%; DUE 08/15/05 DTD 09/01/75 Factor: 0.00351413 19 25,000 Par GNMA, Pool #007150 CUSIP: 3620325K6 37.48 CPN 8.25%; DUE 01/15/05 DTD 10/01/75 Factor: .00209521 20 50,000 Par GNMA, Pool #007731 CUSIP: 362033SU7 257.01 CPN 8.5%; DUE 03/15/06 DTD 03/01/76 Factor: 0.00521993 21 25,000 Par GNMA, Pool #009110 CUSIP: 362035DP9 82.37 CPN 8.5%; DUE 01/15/06 DTD 04/01/76 Factor: 0.00341556 22 50,000 Par GNMA, Pool #010862 CUSIP: 362037B77 300.49 Estate of: Margaret J. Dyson Item No. Description Value at Date of Dea th CPN 8.25%; DUE 06/15/06 DTD 06/01/76 Factor: 0.00594214 23 25,000 Par GNMA, Pool #010910 CUSIP: 362037DP5 118.49 CPN 8.0%; DUE 09/15/05 DTD 11/01/76 Factor: 0.00545893 24 30,000 Par GNMA, Pool #012363 CUSIP: 362038WY3 212.49 CPN 8.5%; DUE 08/15/06 DTD 10/01/76 Factor: 0.00708929 25 35,000 Par GNMA, Pool #013701 CUSIP: 362041GJ8 349.95 CPN 8.0%; DUE 12/15/06 DTD 01/01/77 Factor: 0.00985655 26 50,000 Par GNMA, Pool #013753 CUSIP: 362041H65 835.84 CPN 8.0%; DUE 11/15/06 DTD 11/01/76 Factor: 0.01643301 27 25,000 Par GNMA, Pool #014175 CUSIP: 362041XC4 334.88 CPN 8.0%; DUE 01/15/07 DTD 01/01/77 Factor: 0.01295744 28 35,000 Par GNMA, Pool #016056 CUSIP: 362043ZV6 924.33 Estate of: Margaret J. Dyson Item No. Description Value at Date of Death CPN 7.5%; DUE 04/15/07 DTD 05/01/77 Factor: 0.02566422 29 25,000 Par GNMA, Pool *016739 CUSIP: 362044S42 300.S0 CPN 7.0; DUE 05/15/07 DTD 08/01/77 Factor: 0.01591188 30 40,000 Par GNMA, Pool *019437 CUSIP: 362047S29 520.33 CPN 8.0%; DUE 08/15/07 DTD 08/01/77 Factor: 0.01472092 31 25,000 Par GNMA, Pool *021234 CUSIP: 362049SX7 120.81 CPN 8.0%; DUE 01/15/08 DTD 02/01/78 Factor: 0.00459976 32 25,000 Par GNMA, Pool *023141 CUSIP: 362051WAS 266. 63 CPN 9.0%; DUE 09/15/08 DTD 09/01/78 Factor: 0.01000056 33 35,000 Par GNMA, Pool *026309 CUSIP: 362055GS8 615.16 CPN 8.5%; DUE OS/15/08 DTD 10/01/78 Factor: 0.01664384 34 25,000 Par GNMA, Pool *026628 CUSIP: 362055SR7 138.02 Estate of: Margaret J. Dyson Item No. Description Value at Date of Death CPN 9.0%; DUE 01/15/09 DTD 02/01/79 Factor: 0.00514080 35 57,331 Par GNMA, Pool #031206 CUSIP: 362060U78 2,173.65 CPN 9.5: DUE 06/15/09 DTD 07/01/79 Factor: 0.3487412 36 30,000 Par GNMA, Pool #045252 CUSIP: 362076H53 461. 88 CPN 12.5%; DUE 12/15/10 DTD 12/01/80 Factor: 0.01367118 37 35,000 Par GNMA, Pool #223236 CUSIP: 36218H4V3 1,109.34 CPN 9.0%; DUE 03/15/18 DTD 03/01/88 Factor: 0.02843479 38 45,000 Par GNMA, Pool #225772 CUSIP: 36218LW92 339.34 CPN 9.5%; DUE 10/15/17 DTD 10/01/87 Factor: 0.00672948 39 25,000 Par GNMA, Pool #331557 CUSIP: 36224LJA6 308.13 CPN 7.5%; DUE 02/15/23 DTD 02/01/93 Factor: 0.01167895 40 25,500 Par GNMA, Pool #359365 CUSIP: 36203UFE7 5,196.94 Estate of: Margaret J. Dyson Item No. Description Value at Date of Death CPN 6.5%; DUE 06/15/23 DTD 06/01/93 Factor: 0.19551750 41 50,000 Par GNMA, Pool #359938 CUSIP: 36203UZB1 5,219.97 CPN 7.5%; DUE 11/15/23 DTD 12/01/93 Factor: 0.10651767 42 25,000 Par GNMA, Pool #416553 CUSIP: 36206NWN1 1,212.08 CPN 7.25%; DUE 01/15/26 DTD 01/01/96 Factor: 0.04536385 43 25,000 Par GNMA, Pool #458553 CUSIP: 36208RMA9 2,601.96 CPN 7.5%; DUE 07/15/29 DTD 07/01/99 Factor: 0.09711967 44 35,000 Par GNMA, Pool #484551 CUSIP: 36209XH45 4,557.55 CPN 7.5%; DUE 09/15/28 DTD 10/01/98 Factor: 0.12141380 45 25,000 Par GNMA, REMIC Ser #03-85GA CUSIP: 38374C2R1 8,792.66 CPN 5.5%; DUE 02/20/33 DTD 10/01/03 Factor: 0.45209463 46 50,000 Par GNMA, REMIC Ser #03-95BA CUSIP: 38374EAA5 31,586.62 - Estate of: Margaret J. Dyson Item No. Description Value at Date of Death CPN 5.5%, DUE 08/20/32 DTD 11/01/03 Faotor: 0.71252907 47 50,000 Par GNMA, REMIC Ser #04-14LA CUSIP: 38374FKZ6 30,278.50 CPN 5.5%; DUE 01/17/34 DTD 02/01/04 Faotor: 0.72337717 48 300 Shares Johnson & Johnson common stock CUSIP: 478160104 16,665.00 49 100 Shares Merck & Co. oommon stock CUSIP: 589331107 4,832.00 50 400 Shares ~crosoft Corp. common stock CUSIP: 594918104 11,107.60 51 25,000 Par Moon Twp. PA Auth Wtr & Swr muni.cipal bond CUSIP: 615513FX1 26,240.25 CPN 5.4%; DUE 12/01/14 52 200 Shares Natural Resources Partners LP Limited Partnership CUSIP: 63900P103 7,530.00 53 10,000 Par North Wales PA Water Auth municipal bond CUSIP: 663226JN9 9,535.80 CPN 4.0%; DUE 05/01/16 54 0.841 Shares Nuveen Sector Port Unit Trust CUSIP: 67068G201 5.97 Estate of: Margaret J. Dyson Item No. Description Value at Date of Death 55 25,000 Par PA St Ref 2nd municipal bond CUSIP: 709141D85 21,970.25 CPN 3.9%; DUE 07/01/19 56 200 Shares Peabody Energy Corp. common stock CUSIP: 704549104 10,290.00 57 512 Shares Pep co Holdings, Inc. common stock CUSIP: 713291102 9,487.36 58 500 Shares Plum Creek Timber Co., Inc. common stock CUSIP: 729251108 16,015.00 59 200 Shares Public Svc Enterprise Group, Inc. common stock CUSIP: 744573106 8,092.00 60 100 Shares Royal Dutch Petroleum Co. common stock CUSIP: 780257804 5,213.00 61 1,000 Shares Source Capital, Inc. common stock CUSIP: 836144105 64,000.00 62 200 Shares Tyson Foods, Inc. Cl A common stock CUSIP: 902494103 4,080.00 63 30,000 Par U.S. Treasury Bond 5.25% CUSIP: 912810FFO 29,146.86 CPN 5.25%; DUE 11/15/28 DTD 11/15/98; FC 05/15/99 -. Estate of: Margaret J. Dyson Item No. Description Value at Date of Death 64 20.000 Par u.s. Treasury Bond 6.0% ccrSIP: 912810EW4 21,375.00 CPN 6.0%; DUE 02/15/26 DTD 02/15/96; FC 08/15/96 65 150,000 Par U.S. Treasury Inflation Index Note CUSIP: 912828AF7 168,762.36 CPN 3.0%; DUE 07/15/12 DTD 07/15/02; FC 01/15/03 Factor: 1.04141000 66 25.000 Par u.s. Treasury Note CUSIP: 912827Z62 26,953.13 CPN 6.5%; DUE 10/15/06 DTD 10/15/98; FC 04/15/97 67 50.000 Par U.S. Treasury Note, Inflation Index CUSIP: 912828BD1 50,278.97 CPN 1.875%; DUE 07/15/13 DTD 07/15/03; FC 01/15/04 Factor: 1.01950000 68. 1995 Dodge van, equipped with wheelchair lift; VIN 1B4GH44R1SX509416 17,000.00 VIN #lB4GH44R1SX509416 69. Community Banks Checking Account #4601897509 8,261.53 Interest accrued to 6/1"'1/2004 0.72 70. Community Banks Checking Account #1502861105 2.38 7l. Hospi tal bed 3,000.00 72. Janney Montgomery Scott Money Market Account #2958-3865 92,318.46 73. Motorized wheelchair 6,000.00 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU Of INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1162 EX( 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT UlSH JAMES A 3401 N.FRONT ST. P.O. BOX 5950 HARRISBURG, PA 17110-0950 ___u.__ lold ESTATE INFORMATION: SSN: 193-36-3011 FILE NUMBER: 2104-0627 DECEDENT NAME: DYSON MARGARET DATE OF PAYMENT: 03/18/2005 POSTMARK DATE: 03/17/2005 COUNTY: CUMBERLAND DATE OF DEATH: 06/17/2004 NO. CD 005095 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $748.28 I I I I I I I I TOTAL AMOUNT PAID: $748.28 REMARKS: CHECK# 735 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WillS Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: 259 3/18/2005 MARGARET T. DYSON 21-2004-0627 JAMES A ULSH, ESQUIRE 3401 N. FRONT ST p,o. BOX 5950 HARRISBURG, PA 171100950 JA 350.00 Total $350.00 Qty 1 Fee Description Additional Probate Fee Total: $350.00 Checks should be made payable to the Register of Wills. Terms: Net 30. Please return one copy of this invoice with your payment. Thank you. Glenda Farner Strasbaugh Register of WHls and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, ESQ Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: 259 3/18/2005 MARGARET 1. DYSON 21-2004-0627 JAMES A. ULSH, ESQUIRE 3401 N. FRONT ST P.O. BOX 5950 HARRISBURG, PA 171100950 JA Qty 1 Fee Description Additional Probate Fee Total 350.00 $350.00 Total: $350,00 Olecks should be made payable to the Register of Wills. Terms: Net 30. Please rerum one copy of this invoice with your payment. Thank you. Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S, Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland G ReC\uest One Courthouse Square seco~................ \ Carlisle, PA 17013 .... 'P!otn'Pt~ (717) 240-6345 1'\ease 'Qa~ FAX (717)240-7797 INVOICE Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: JAMES A. ULSH, ESQUIRE 3401 N. FRONT ST P.O. BOX 5950 HARRISBURG, P A 171100950 259 3/18/2005 MARGARET T. DYSON 21- 2004-0627 JA Qty 1 Fee Description Additional Probate Fee Total 350.00 $350.00 Total: $350.00 1>d ~ 3/13 ,.r"', (-,", Checks should be made payable to the Register of Wills. Terms: Net 30. Please return one copy of this invoice with your payment. Thank you. </ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT, ALLOWANCE DR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX BUREAU OF IHDIVIDllaTIlxES' . INHERITANCE TAX DH'ISJlJH. PO BOX 280601 HARRISBURG PA 17128-0601 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN Y 27 PI,IZ: 35 C1 ~DV I'D I-ti;;\ 'oj; ORPHAN'S CC)URT JAMES ICWSWESQ(, " METTE ETAL PO BOX 5950 HBG PA 17110 05-30-2005 DYSON 06-17-200'1 21 0'1-0627 CUMBERLAND 101 Amount Re.i Heel I. .. REV-1547 EX AFP (03-05) MARGARET J MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ 1l~~-M~"Yf.~.m~1.1M'M:'I!t.W.!MftIlrt'AMM.'I'Xl!'."Wll"MMMl':.'lrC[WAM!!'.lIT(.............. ... DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF DYSON MARGARET J FILE NO. 21 0'1-0627 ACN 101 DATE 05-30-2005 I~ an assessment was issued previously. lines 14. 15 and'or 16. 17. 18 and 19 will re~lect ~igures that include the tatal o~ ~ returns assessed to date. ASSESSMENT OF TAX: 15. A.mmt of Line 14 at Spousal rat. (15) 16. Anount of Line 14 taxable at lineal/Class A rat. (16) 17. A.aunt of Lins 14 at Sibling rat. (17) 18. A.aunt of Line 14 taxable at Collateral/Class Brat. (18) 19. Principal Tax Due I : TAX RETURN WAS: I X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Estate ISchedule A) 2. stocks and Bonds (Schedule BJ 3. Closely Held Stock/Partnership Interest (Schedule Cl 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule Fl 7. Tnmsfers (~. S) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral ExPenses/A~. Costs/Misc. Expenses (Schedule Hl 10. Debts/Nortgage Liebilities/Liens ISchedule I) 11. Totel Deductions 12. Net Value of Tax Return 13. Charitable/Governmental B8questSj Non-elected 9113 Trusts 14. Net Value of Estate Subject to Tax NOTE: + DATE 09-16-2004 03-17-2005 IMIBER CD004'100 CD005095 INTEREST/PEN PAID 1-) 2,578.95 .00 ~ . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. I ) CHANGED III (2) (3) (4) IS) (6) 171 17'1,846.00 773.285.23 .00 .00 126.583.09 U8 ,882.71 .00 (8) 00 = 0'15 = 12 = 15 = 119)= NOTE: To insure proper credi t to your account I ~it the upper portion of this forn with your tax P8YIIfInt. 1,193,597.03 30.71iQ 7? 1,162,827.31 .00 1,162,827.31 .00 52,327.23 .00 .00 52,327.23 52,327.23 .00 .00 .00 I IF TOTAL DUE IS LESS THAN n. NO PA YHENT IS RElIUIRED. IF TOTAL DUE IS REFLECTED AS A wCREDIT" ICR). YDU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORK FOR INSTRUCTIDNS.) (9) 110) 30,529.15 2'10 57 1111 (12) (13) (14) ISchedule J) .00 X 1,162,827.31 X .00 X .00 X AHOl/NT PAID 49,000.00 7'i8.28 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE METTE. EVANS & WOODSIDE A PROFESSIONAL CORPORATION ATTORNEYS AT LAW 3401 NORTH FRONT STREET P.O. BOX :59:50 HARRISBURG, PA 1'7110-09:50 DIRECT DIAL (717) 231-5256 JAMES A. ULSH IRS NO. 23-198~OO~ E-MAIL ADDRESS jaulsh@mette.com TELEPHOl'.'"E (71 7) 232-~OOO FAX (717) 236-1816 HTTP://WWW.METTE.COM January 11, 2006 Glenda Farner Strasbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 Re: Estate of Margaret Dyson, a/k/a Margaret Jane Dyson File No. 2004-00627 Dear Ms. Strasbaugh: Enclosed for filing is the original and one (1) copy of a Status Report Under Rule 6.12. Please file the original and return a date-stamped copy to my attention in the enclosed envelope. Please note that administration of this estate is complete. Thank you for your assistance. Very truly yours, (~~\; -- ~ \~J^ c) "--(. \ Lisa J. Kn~ Paralegal to James A. Ulsh " (\ \ i Ii \--.. 'V\ocX-Q/ LJK: Enclosures cc: Jane M. Dyson, Executrix (wI enc.) C~, 440811 vI Wyomissing Office 11105 Berkshire Boulevard, Suite 320 I Wyomissing, PA 19610 I Telephone (610) 374-11351 Facsimile (610) 371-9510 PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF THE ESTATE IS NOT COMPLETED, FILE A 6.12 FORM YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: MARGARET DYSON. a/k/a MARGARET JANE DYSON Date of Death: June 17. 2004 Will No. 2004-00627 Admin. No. 21-04-0627 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 [8J No D 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes D No [8J account is: b. The separate Orphans' Court No. (if any) for the personal representative's c. Did the personal representative state an account informally to the parties in interest? Yes [8J No D d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. O\\\\\G(j Date: ~ 0-' ~ James Ulsh. Attornev LD. #10169 Name (Please type or print) 3401 North Front Street. P.O. Box 5950 Address Harrisburg. PA 17110-0950 (717) 232-5000 Telephone 440809vl Capacity: D Personal Representative [8J Counsel for Personal Representative \l~~