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HomeMy WebLinkAbout03-0872PETITION FOR PROBATE and GRANT OF LETTERS also known as To: , Deceased. Social Security No. I c~C - ~&- ~ q$2 The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executoc5 inthelast wilt of the above de. cedent, dated A,oc~ ~, 9,~,~ and codicil(s) dated Ad//J Register of Wills for the County of (~ o~xb ~[cvq c~ Commonwealth of Pennsylvania in the named , ~ ~ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in ~, ~ ~Jr, e,, IL ,~ County, Pennsylvania, with h i s last family or principal residence at (list street, number and muncipality) Decendent, then -/3 years of age, died at h; s ~o,~xe~ ,4~ ~cx~3 , Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: 1'3q Oc~xbncj?. ~e.i~c O\e~h~.. @2r, WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters "tt°$qcone'~4 &%l theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF Q~c,x~ec~c.~,~ f 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 an~ruly adn~inister the estate according to law. Sworn to or affjr~e~and subscribed ~ ~/~q~- befot:l~ me this ,4/~ day of No. Estate 0~~k C ~c~ ~ ~ % . , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~7~xa.~_ ~ ~ ~9_o(~ ~, I~L__~, in consideration of the petition on the reverse side hereof, satisfactow proof having been presented before me, IT IS DEC~ED that the instrument(s) dated ~;~ X~ , ~o ~ to~obate and filed of record as theist_ will of described therein be admitted ~ ~)~ ~ ~~~ ~ . ; ~d Letters ~- ~ ~~ ~ are hereby granted t~~ ~ ~~ ~ ~ ~ ~- ~ ... FEES Probate, Letters, Etc .......... $ oQ.-'lO · ~ Short Certificates( ) .......... $ q . OO ~n .x~X-v4~-..C'~a-~.a $ C~,. oc~ TOTAL ~ $~q~ -°° Filed . .~.o..-..~..'3..-..&..o.o. ~ ................ ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE I05 805 REX/ 9/86 This is to certify that the information here given is correctly copied from an original certificate of' death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent f'~ling. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 9640787 No. Local' t~egistrar - /'~~ Sate ~u0~ ;.3 ~.~ z'a? COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH .......... , u.~.,,~ ,P~.a,u.l E. Wagner, Jr. 1:~x Male ~SOO^LSEClU§~.."U~B~'--'--'----~__ 2989 .o ~ · i , : ~OV 1 U, 1~ ReeGsville I"u~'~t: ---~R ~'~~ Home Im ......... *J ......8 ....... ~s~,~~,.~ J ~:~ I " ,. ~, i, 10,~, /z ~,,=,., I ~arnea I Laura M. ~nook 1 o~ uamDnaae ur ve I~CTU~L ,z. S,,, enn=y~vama ~ Lower Allen Mechamcsburg, Pennsylvama 170~ ....... BLACK INK Paul Em Wagner, Sr. Paul E. Wagner, III Cumberland """' Fy n UalDy ncom~oaa Meg~amcsburg, Pa 17050 I urch Hill Cemete~ ~ Reedsville ~='"' I~,.. , Pa. Oct 23, 2003 FD-O12662-L I~=. y~rersS~Hner[~l'r~o~e. Inc. 37 East Main Street Mechamcsburg, Pa. 17055 CAUSE NAME AND A~)Of=IE'~ OF PER WHO COMPL TED CAU.$E OF DE ^1H ,. /7t, ~'~ SNELBA[ER, ~RENNEMAN SPARE LAST WILL AND TESTAMENT I, PAUL E. WAGNER, JR., of the Township of Lower Allen, County of Cumberland, and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils by me at anytime herei~ofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my Executors, hereinafter named, as soon as conveniently may be done after my decease. SECOND. I order and direct that my body be interred in the family burial plot at Church Hill Cemetery in Reedsville, Pennsylvania. THIRD. I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated, in equal shares unto my two children, namely, PAUL E. WAGNER, III, and SANDRA L. BENNETT, share and share alike, absolutely and in fee simple. If either of my said children should predecease me, I order and direct that the foregoing share of my estate attributable to such deceased child shall be distributed among his or her lawful issue per stirpes by representation and not per capita, subject, however, to the protective trust provisions under Item Four hereinbelow with respect to any beneficiary who has not attained the age of twenty-five (25) years at the time for distribution. FOURTH. If any beneficiary hereinabove has not attained the age of twenty- five (25) years at the time of distribution, I order and direct that the distributive share of such person shall be paid over and delivered unto PNC BANK, N.A., (or its successor by merger, consolidation or other corporate reorganization), as my testamentary Trustee, IN TRUST, NEVERTHELESS, to hold, manage, invest, accumulate income and reinvest until said beneficiary attains the age of twenty-five (25) years, at which time said trust shall be terminated and the net proceeds thereof be paid over to the beneficiary absolutely. LAW OFFICES SN ELBAI(ER, BRENNEMAN ~' SPARE I authorize and empower my said Trustee to invest the assets of said trust in any reasonable manner and not be limited or restricted to so-called "legal" or statutory investments for fiduciaries. I designate any trust hereunder to be a spend-thrift trust. The beneficiary shall have no right to invade, pledge, assign or otherwise dispose of the assets of said trust (including income) nor shall any creditor of a beneficiary have any right to seize, levy or execute upon said assets by reason of any pledge assignment, or other transfer, voluntarily or involuntarily, made by said beneficiary. I further authorize and empower my said Trustee to use, consume, expend and apply from time to time such amounts of principal and income of and from said trust which in the exercise of its sole discretion shall be determined to be reasonable and necessary for the beneficiary's education. The term "education" shall be construed and interpreted to mean college or other post-high school training which is intended to improve the beneficiary's productivity as an adult or enhance the quality of his or her liie. In considering what is reasonable and necessary, my said Trustee shall take into consideration the primary responsibility of the beneficiary's surviving parent to provide such education. It is my will and intention that the foregoing discretionary provision for education shall be supplementary to the parent's primary responsibility. LASTLY. I nominate, constitute and appoint my two children, namely, PAUL E. WAGNER, III, and SANDRA L. BENNETT, to be the Executors of this, my Last Will and Testament, (or either of them in the event that one should fail to qualify or cease so to serve), each and all to serve without bond or other security as a condition of qualification hereunder. IN WITNESS WHEREOF, I, PAUL E. WAGNER, JR., have hereunto set my hand and seal to this my Last Will and Testament, which consists of three (3) typewritten pages to each of which I have affixed my signature this / 7'~ day of -2- , A.D., Two Thousand One (2001). PAUI E. WAGNER, (SEAL) The preceding instrument, consisting of this and two (2) other typewritten )ages, each identified by the signature of the Testator, was on the date thereof signed, sealed, published and declared by PAUL E. WAGNER, JR., the Testator therein named, as and for his I,ast Will and T~stament, in the presence of us, Who, at his request, in his presence and in t~p~sence of each other, have subscribed our names as witnesses hereto. 3NWEALTH OF PENNSYLVANIA) COUNTY OF CUMBERLAND ) SS. We, PAUL E. WAGNER, JR., RICHARD C. SNELBAKER and JANE J. the Testator and the witnesses, respectively, whose names are signed to attached or foregoing instrument, being first duly sworn, do hereby declare to undersigned authority that the Testator signed and executed the instrument as Last Will - t, nu Testame~-lt and ,ia~ he l~ad signed willi~ig;ly, ai~d 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 a and that to the best of his or her knowledge, the Testator was at that time years of age or older, of sound mind and under no constraint or undue influence· Subscribed, sworn to and acknowledged before me by PAUL E. WAGNER, the Testator, and subscribed and sworn to before me by RICHARD C. and JANE j. COONEY, the witnesses, this l-I ~J~ day of~ti¥,'~ , LAW OFFICES SNELBA~ER. BRENNEMAN Notary Public I' Notarial Seal [ · .--~_~..K. S~t~,,rs, Notary Public ~ -3- PAUL E. WAGNER, JR. A PI~.OFF.55IONAL A'I-I"OR. NF..Y5 AT LAW' 44 kY, rE.ST MAIN STR.EET MECHANICSBUR. G, PENNSYLVANIA 17055 P. O. BOX 318 REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Ot I$1NAI Name of Decedent: Paul E. Waaner. Jr. Date of Death: Will No. 2003-00872 Admin. No. 21-03-0872 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-c~aptioned estate on '-'~t~, j Q, .~Od?.~ · Name Address Sandra L. Bennett Paul E. Wagner, Ill 675 Fishing Creek Road New Cumberland 1367 Concord Road Mechanicsbum PA 17070 PA 17050 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: Date: · · Capacity: Signature Marielle F. Hazen, Esq. Name: Law Office of Marielle F. Hazen Address: 2000 Lin(~lestown Road. Suite 303 Harrisbura PA 17110 Telephone(717) - 540433;~ Personal Representative Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003438 WAGNER PUAL E III 1367 CONCORD RD MECHANICSBURG, PA 17050 ........ fold ESTATE INFORMATION: SSN: 180-22-2989 FILE NUMBER: 2103-0872 DECEDENT NAME: WAGNER PAUL E JR DATE OF PAYMENT: 01 / 14/2004 POSTMARK DATE: 01/1 3/2004 COUNTY: CUMBERLAND DATE OF DEATH: 10/18/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $7,000.00 REMARKS: SEAL TOTAL AMOUNT PAID: RECEIVE PAUL WAGNER III IN C/O MARIELLE F HAZEN ESQ CHECK# 1 25 INITIALS: JA RECEIVED BY: $7,000.00 GLENDA FARNER STRASBAUGH DEPUTY REGISTER OF WILLS REGISTER OF WILLS The Law Office of Certified Elder Law Attorney by the National Elder Law Foundation 2000 Linglestown Road Suite 303 Harrisburg, PA 17110 Attorney at Law ~.L: (717) 540-4332 FAX: (717) 540-4313 www. hazenelderlaw, com July 8, 2004 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re~ Estate of Paul E. Wagner, Jr. File No. 21-2003-00872 To: The Register of Wills: Enclosed for filing, please find the original and two copies of the above- referenced Inheritance Tax Return and Inventory, along with two checks, one in the amount of $1670.05 for payment of the tax and one in the amount of $25.00 for payment of fees associated with both filings. Please date-stamp one copy of the Return and Inventory and return it to my office, with the Receipt for Payment, in the enclosed self- addressed envelope. If you have any questions or require any additional information, please do not hesitate to contact me. .'j¢c Enclosures cc: Sandra Bennett Paul Wagner, III Sincerely, Legal Assistant REV-lBO0 EX + (6-00) LU Z ILl 0 Q. LU n,' 0 0 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL Wa,qner~ Paul E.~ Jr. DATE OF DEATH {MM-DD-Year) 10/19~2003 'REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT 06/07/1929 OFFICIAL USE ONLY FILE NUMBER 2 1 -0 3 0 8 7 2 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER I 8 0-2 2-2 9 8 9 DATE OF BIRTH (MM-DD-Year) (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER r~l. Odginal Retum E~]4. Limited Estate [~]6. Decedent Died Testate (Altach copyofWill) [~]9. Litigation Proceeds Received NAME Marielle F. Hazen, Esq. FiRM NAME (If Applicable) Law Office of Marielle F. Hazen TELEPHONE NUMBER 717-540-4332 r'--~ 2. Supplemental Retum E~4a. Future Interest Compromise (date of death after 12-12-82) D7. Decedent Maintained a Living Trust (Attach copy of Trust) [] 10. Spousal Pover[7 Credit (date of beath between 12-31-91 and 1-1-95) COMPLETE MAILING ADDRESS 2000 Linglestown Road Suite 303 Harrisburq ~]3. Remainder Return (date of deaffl pdorto 12-13-82) r"-~ 5. Federal Estate Tax Return Required __ 8. Total Number of Safe Deposit Boxes ["-] 11. Election to tax under Sec. 9113(A) (Attach Sch O) PA 17110 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnemhip or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Pemonal 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) 219~198.05 7;679.88 OFFICIAL USE ONLY (8) (11) 226~877.93 4,651.94 21 ~371.28 26,023 22 (12) 200~854.71 (13) (14) 200,854.71 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 ~ (15) 2OO,854.71 X .045 (16) X .12 (17) X .15 (18) (19) 9,038.46 9,038.46 Decedent's Complete Address: STREETADDRESS 134 Cambridge Drive CITY Mechanicsburg ISTATE PA JZ~P 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 7.000.OQ 368.z,.1 Interest/Penalty if applicable D. Interest E. Penalty (1) Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) (3) 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) If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 9~038.46 7~368.41 0.00 1 ~670.05 1 ~670.05 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ........................................ [] [] c. retain a reversionary interest; or ...................................................................................................... [] [] d. receive the premise 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 security at his or her death? ................. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... [] [] IF THE 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, ncluding accompanying schedules and statements, and to the best of my knowledge and Declara§on of.~mparer other than the personal representative is based on all information of which preparer has any knowledge, belief, it is true, correct and complete. ADDRESS 238 Hillside Dr. New Cumberland PA 17070 ADDR'ES~S "~ "' ~(~00 Linglestow~ Road, Suite 303 Harrisburg PA 17110 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 decedenrs 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. REV-1502 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE A REAL ESTATE FILE NUMBER Wagner. Paul E.. ,Ir, 21 03 0872 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 propen'y which is jointly.owned with ri~lht of survivorship must be disc!._-.~e~ on Schedule F. ITEM NUMBER 1. DESCRIPTION Real Estate, 134 Cambridge Drive, Mechanicsburg, Cumberland County, PA Per attached Settlement Statement Real Estate (Camp Property) 395 Upper Stone Mt. Rd., Bellville, Mifflin County, PA Parcel#20.01-0223C, Per assessed value of $24,850 @ common level ratio 1.96 Real Estate (Camp Property) 395 Upper Stone Mt. Rd., Bellville, Mifflin County, PA Parcel#20,01-0223B, Per assessed value of $11,450 @ common level ratio 1.96 Real Estate (Camp Property) 395 Upper Stone Mt. Rd., Bellville, Mifflin County, PA Parcel#20,01-0223, Per assessed value of $10,550 @ common level ratio 1.96 VALUE AT DATE OF DEATH 127,372.05 48,706.00 22,442.00 20,678.00 TOTAL (Also enter on line 1, Recapitulation) i $ 219,198.0,', (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) COMMONWEALTH OFPENNSYLVAN~ INHERITANCETAXRETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Wagner. Paul E.. Jr, FILE NUMBER 03 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. 0872 ITEM NUMBER DESCRIPTION Personal Property Waypoint Bank Checking Acc~0090400995 Waypoint Bank Savings Acct# 10190078 Refunds from Verizon and Keystone Health Plan Refunds from Peoples Prescription Plan and Comcast Cable TOTAL (Also enter on line 5, Recapitulation) VALUE AT DATE OF DEATH 4,704.24 2,366.63 433.44 135.10 40.47 7~679.8~ (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Wagner. Paul E.. Jr. FILE NUMBER 21 03 0872 Debts of decedent must be reported on Schedule 1. DESCRIPTION AMOUNT ITEM NUMBER 1. 2. 3. 4. 8. g. 10. 11. FUNERAL EXPENSES: Myer's Funeral Home Pealers Flowers Headstone Monument Engraving ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Secudty Number(s)/EIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: Attorney Fees Law Office of Marielle F. Hazen Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Zip Street Address City State Relationship of Claimant to Decedent Zip Probate Fees Register of Wills Probate Fee (295.00) Register of Wills Inh. Tax Filing Fee (25.00) Accountant's Fees Tax Return Preparer's Fees Mechanicsburg Post Office - Postage Cumberland County Recorder of Deeds Mifflin County Recorder of Deeds Bank Fee Expenses for Sale of Personal Property: Dollar General Store -Cleaning Supplies Giant Food Store - Cleaning Supplies BJ Wholesale Club - Plastic Bins/Cleaning Supplies Weis Markets - Garbage Bags U-Haul- Cardboard Boxes TOTAL (Also enter on line 9, Recapitulation) $ 407.60 801.31 95.00 191.00 2,500.00 320.00 29.60 39.50 129.00 3.00 6.10 18.40 64.30 18.93 28.20 4~651.9d (Ifmorespaceisneeded, inse~additionalshee~ofthesamesi~) REV-1512 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Wagner. Paul E.. ,Ir. Include unreimbursed medical expenses. FILE NUMBER 21 03 0872 ITEM NUMBER 10. 11, 12. 13. 14. 15. DESCRIPTION Comcast cable bill Verizon cell phone bill PA American Water 134 Cambridge water bill AT&T Wireless business cell phone bill PP&L Electric bill Patriot News newspaper bill J.C. Penny Penelec ele~ric bill ~rcamp property Shipley Energy fuel oil Central PA Hematology medical bill Bonny Miller - Tax Collector - 134 Cambridge Dr., Mechanicsburg, PA property tax 2003 Bonny Miller- Tax Collector - 134 Cambridge Dr., Mechanicsburg, PA property tax 2003 Shipley Energy furnace repair Herbert Eichorn - Tax Collector 2003 property tax for camp property Erie Insurance homeowners Insurance bill TOTAL (Also enter on line 10, Recapitulation) $ VALUE AT DATE OF DEATH 44.87 229.22 101.17 26.65 132.44 14.10 179.99 31.70 131.79 43.61 1,182.32 475.86 153.95 1,032.90 143.00 21~371.2R (If more space is needed, insert additional sheets of the same size) Wagner, Paul E., Jr. Decedent's Name Continuation of REV-1500 Inheritance Tax Return Resident Decedent 21 Page 1 03 0872 File Number Schedule I - Debts of Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION 16. AT&T household phone bill 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. Circuit City computer monitor for logging sale items Staples Filing and Office Supplies Headstone for wife unpaid balance before date of death Sears credit card#0363590188423 MBNA credit card#4264293147155562 L.L. Bean credit card#5490999017618264 Bon Ton credit card#050290428 Texaco-Citi Card credit card#1346422460 Waypoint Bank ~ersonal loan #1851003621 _ower Allen Township sewer bill SUBTOTAL SCHEDULE I GRAND TOTAL SCHEDULE I AMOUNT 23.05 317.99 15.74 95,00 1,813.75 5,024.00 6,062.97 1,375.00 525.00 2,129.20 66.01 17,447.71 $ 21,371.2~ REV-1513 EX + (9.nn~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Wa_oner. ~aul E.. Jr, NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS [include outdght spousal distributions, and transfers under Sec. 9116 (a)(1.2)] 1. Paul E. Wagner, III 1367 Concord Rd. Mechanicsburg, PA 17050 2. Sandra L. Bennett 238 Hillside Dr. New Cumberland, PA 17070 II. FILE NUMBER 21 03 O872 AMOUNT OR SHARE OF ESTATE RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Son Daughter 1/2 Residue 1/2 Residue (If more space is needed, insert additional sheets of the same size) TOTAL OF PART U - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 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 PAUL E. WAGNER, JR. SNELBAKER., BR. ENNEMAN 8 SPAR. E A PI~.C) FE~S ION.~d_ LAW OFFICEe ~NELBAKER, BR£NN£MAN LAST WILL AND TESTAMENT I, PAUL E. WAGNER, JR., of the Township of Lower Allen, County of Cumberland, and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils by llle at anytime herei,ofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my Executors, hereinafter named, as soon as conveniently may be done after my decease. SECOND. I order and direct that my body be interred in the family burial plot at Church Hill Cemetery in Reedsville, Pennsylvania. THIRD. I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated, in equal shares unto my two children, namely, PAUL E. WAGNER, III, and SANDRA L. BENNETT, share and share alike, absolutely and in fee simple. If either of my said children should predecease me, I order and direct that the foregoing share of my estate attributable to such deceased child shall be distributed among his or her lawful issue per stirpes by representation and not per capita, subject, however, to the protective trust provisions under Item Four hereinbelow with respect to any beneficiary who has not attained the age of twenty-five (25) years at the time for distribution. FOURTH. If any beneficiary hereinabove has not attained the age of twenty- five (25) years at the time of distribution, I order and direct that the distributive share of such person shall be paid over and delivered unto PNC BANK, N.A., (or its successor by merger, consolidation or other corporate reorganization), as my testamentary Trustee, IN TRUST, NEVERTHELESS, to hold, manage, invest, accumulate income and reinvest until said beneficiary attains the age of twenty-five (25) years, at which time said trust shall be terminated and the net proceeds thereof be paid over to the beneficiary absolutely. LAW OFFlC~S SNELBAKER, BRENNEMAN · ~ SPARE I authorize and empower my said Trustee to invest the assets of said trust in reasonable manner and not be limited or restricted to so-called "legal" or statutory investments for fiduciaries. I designate any trust hereunder to be a spend-thrift trust. The beneficiary shall have no right to invade, pledge, assign or otherwise dispose of the assets of said trust (including income) nor shall any creditor of a beneficiary have any right to seize, levy or execute upon said assets by reason of any pledge assignment, or other transfer, voluntarily or involuntarily, made by said beneficiary. I further authorize and empower my said Trustee to use, consume, expend and apply from time to time such amounts of principal and income of and from said trust which in the exercise of its sole discretion shall be determined to be reasonable and necessary for the beneficiary's education. The term "education" shall be construed and interpreted to mean college or other post-high school training which is intended to improve the beneficiary's productivity as an adult or enhance the quality of his or her life. In considering what is reasonable and necessary, ,ny said Trustee shall take into consideration the primaw responsibility of the beneficiary's surviving parent to provide such education. It is my will and intention that the foregoing discretionary provision for education shall be supplementary to the parent's primary responsibility. .LASTLY. I nominate, constitute and appoint my two children, namely, PAUL E. WAGNER, III, and SANDRA L. BENNETT, to be the Executors of this, my Last Will and Testament, (or either of them in the event that one should fail to qualify or cease so to serve), each and all to serve without bond or other security as a condition of qualification hereunder. IN WITNESS WHEREOF, I, PAUL E. WAGNER, JR., have hereunto set my hand and seal to this my Last Will and Testament, which consists of three (3) typewritten pages to each of which I have affixed my signature this / ~ day of -2- A.D., Two Thousand One (2001). PAUL E. WAGNER, J~. (SEAL) The preceding instrument, consisting of this and two (2) other typewritten ,ages, each identified by the signature of the Testator, was on the date thereof signed, sealed, published and declared by PAUL E. WAGNER, JR., the Testator therein named, as and for his Last Will and T~stament, in the presence of us, who, at his request, in his presence th, e~"~sence and in of each other, have subscribed as witnesses hereto. OF PENNSYLVANIA) OF CUMBERLAND ) SS. We, PAUL E. WAGNER, JR., RICHARD C. SNELBAKER and JANE J. COONEY, the Testator and the witnesses, respectively, whose names are signed to attached or foregoing instrument, being first duly sworn, do hereby declare to undersigned authority that the Testator signed and executed the instrument as Last Will and Testament and that he had signed willingly, and that he ex~cuted it as his free and voluntaw act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as a and that to the best of his or her knowledge, the Testator was at that time years of age or older, of sound mind and under no constraint or undue influence. ~ W(~ness ~ Subscribed, sworn to and acknowledged before me by PAUL E. WAGNER, the Testator, and subscribed and sworn to before me by RICHARD C. and JANE J. C©ONEY, the witnesses, this ]-} ~-I~ day of~2~c, ~ , ~ ~PARE Notary Public Notarial Seal Sa~dra K. Showem, Notary Public B~ro. O~nb~rland C,c~nty J~n Expires Nov. 22, 2003 -3- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003438 WAGNER PUAL E III 1367 CONCORD RD MECHANICSBURG, PA 17050 ........ fold ESTATE INFORMATION: SSN: 180-22-2989 FILE NUMBER: 2103-0872 DECEDENT NAME: WAGNER PAUL E JR DATE OF PAYMENT: 01/14/2004 POSTMARK DATE: 01/1 3/2004 COUNTY: CUMBERLAND DATE OF DEATH: 1 0/1 8/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 1 01 $7,000.00 TOTAL AMOUNT PAID: $7,000.00 REMARKS: RECEIVE PAUL WAGNERIII IN CIO MARIELLE F HAZEN ESQ SEAL CHECK# 1 25 INITIALS: JA RECEIVED BY.' GLENDA FARNER STRASBAUGH DEPUTY REGISTER OF WILLS TAXPAYER OMB NO. 2502-0265 ~ 'ir A. B. TYPE OF LOAN: U,S, DEPARTMENT OF NOUSING& URBAN DEVELOPMENT 1.I-]FHA 2.~--]FmHA 3.~--]CONV. UNINS. 4.~--]VA 5. [X1CONV. INS. 6, FILE NUMBER: I 7, LOAN NUMBER; SETTLEMENT STATEMENT 04248I 0134298322 ' 8. MORTGAGE INS CASE NUMBER: C. NOTE: 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. l.O 3~8 (04248/04248/21) D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: Gregory V. MikolaJczak and Sandra L. Bennett Members First Federal Credit Rose A. Mikolajczak Union 5000 Louise Drive Mechanicsburg, PA 17055 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 25-1878915 I. SE'FrLEMENT DATE: 134 Cambridge Drive Keystone Land Transfer, Ltd. Mechanlcsburg, PA 17055 June 16, 2004 Cumberland County, Pennsylvania PLACE OF SE'FTLEMENT 3421 Market Street Camp Hill, PA 17011 J. ,~UMMARY OP BORRLtWER'~ I ~b~N,.'.'SA(.; I FJN K. ~UMMARY UP 5ELLP_.R'~5 1PU~N~SAL;[ION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract Sales Pdce 137,900.00 401. Contract Sales Pdce 137,900.00 102. Personal Property 402. Personal Property 103. Settlement Charges to Borrower (Line 1400) 5,591.58 403. 104. 404. 105. 405. Adjustments For Items Paid By Seller in advance Adjustments For Items Paid By Seller tn advance 106. City/Town Taxes to 406. City/Town Taxes to 107. County Taxes 06/16/04 to 01101105 254.43 407. County Taxes 06/16/04 to 01101105 254.43 108. School Tax 06/16/04 to 07/01/04 47.55 408. School Tax 06/16/04 to 07/01/04 47.55 109. Sewer 06/16/04 to 07/01/04 8.13 409. Sewer 06/16/04 to 07/01104 8.13 110. Trash 06/16/04 to 07/01/04 3.96 41u. I rash Ub/lb~U4 to U/IUIIU4 J.~O 120. GROSS AMOUNT DUE FROM BORROWER 143,805,65 420. GROSS AMOUNT DUE TO SELLER 138,214.07 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deposit or eamest money 2,000.00 501. Excess Deposit (See Instructions) 202. Principal Amount of New Loan(s) 131 ,g00.00 502. Settlement Charges to Seller (Line 1400) 10,242.02 203. Existing loan(s) taken subjeCt to 503. Existing loan(s) taken subject to 204. 504. Payoff of first Mortgage 205. ~u~. P'ayon ot secono Mortgage 206. 506. 207. 507. (Deposit disb. as proceeds) 208. , 508. 209. Repair Credit from Seller 600.00 ' 500. Repair Credit from Seller 600.00 Adjustments For Items Unpaid By Seller Adjustments For Items Unpatd By ~eller 210. City/Town Taxes to 510. City/Town Taxes to 211. County Taxes to 511. County Taxes to 212. School Tax to 512. School Tax to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 133,600.00 520. TOTAL REDUCTION AMOUNT DUE SELLER l 10,842.02 300. (,.;A~H A[ ,~,1=.1 iLEMENT FI'~UM/TU BURROWER: 6OO. (;ASH AT SImTTLbMENT TO/FROM SELLEI~: 301. Gross Amount Due From Borrower (Line 120) 143,805.65 601. Gross Amount Due To Seller (Line 420) 138,214.07 302. Less Amount Paid By/For Borrower (Line 220) 133,500.00J 602. Less Reductions Due Seller (Line 520) 10,842.021 303. CASH( X FROM)( TO)BORROWER 10,205.65 603. CASH( X TO)( FROM)SELLER 127,372.05 The undersigned hereby acknowledge receipt of a completed copy of pages 1&2 of this statement & any attachments referred to herein. Borrower (~{~,/~.1[~- Seller , .'~.~.¢~./. ~/~~T'""'~- Gr~jg~y~ff. Mi~olaj~,~ajk . Sah'dra L. Bennett - Rose A. MIkolajczalC V ~ ' L', SE I I ~.EMENT CHARGES 700. TOTAL COMMISSION Based on Price $ 13Z,900.00 @ 6.0000 % 8,274.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 802. Loan Dis~ount % to uu~, Appra~sm tee to u~. ~mmt ~e~n to ~. Lenders Ap~aon r~ to Members First ~eoerm ~remt umon UUU. Mo~ga~ Ins. ~p. Fee to Uuu. to Memners I-irst I-ederal L;realt union ~o MemDers i-irst i-eaeral ~;redl[ union U14. Ulti, U1U. U19, 5~U. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANGE 901. Interest From 06/16/04 to 07101/04 b~JZ. Mortgage insurance Premlu.~io~ monms to 903. Hazard Insurance Premium for 1.0 years to $ 22.288000/day ( 15 days 905. 1000. RFR;RVES DEPOSITED WITH LENDER 1001. Hazard Insurance 3.000 months @ $ 30.00 per month 1002. Mortgage Insurance months ~ $ per month 1003. City/Town Taxes months ~ $ per month 1004. County Taxes 5.000 months @ $ 39.00 per month 1005. School Tax 12.000 months r.~ $ 96.69 per month quuu. monms (g~ ~, per monm 1007. months (g~ $ per month 1008. Aggregate Adjustment months @ $ per month 1100. TITLE CHARGES %) POC $360.00b PAID FROM BORROWER'S FUNDS AT SETTLEMENT 32T.SU ~Z~.UL 75.00 ZIO.UU 334.32 90.00 195.00I 1,160.2§ -119.27 Page 2 PAiD FROM SELLER'S FUNDS AT SETTLEMENT 1101. Settlement or Closing Fee 1102. Abstract or Title Search 1103. Title Examination to 1104. Title Insurance Binder to 1105. Document preparation to Key~iui,= Land Transter, Ltd. 1106. Notary Fees to CA~SH 1107. Attorney's Fees to (incluDes 8DOVe irem numbers: 1108. Title Insurance to Keystone Land Transler, Ltd. (mcludes above item numbers: 11U~. Lenders ~;overage :t, 1,51,UUU.UU 111~. 111~. lll[. 111U. t200, GOVERNMENT RECORDING AND TRANSFER CHARGES ; 1201. Recording Fees: Deed $ 38.50; Modgage $ 64.50; Releases $ ' 1zuz. ~Jl[ylL;OUnty I ax/ulamps:uee(] 1 ,;:l/u.uu; Mortgage 1203. State Tax/Stamps: Revenue Stamps 1,379.00; Mortgage to Cumbedand County Recorder of Deeds 12.00 1,048.75 14.00 103.00I 1,~I~.U~ 27,00 100.00 12.00 1,379.00 Survey to to Biechler & llllery to American Home Shield to Bonnie Miller Certified to be a true copy. Settlement Agent ( 0424[t / 04248 / 2 ! ) Cumberland County Register of Wills INVENTORY Estate of Paul E. Wa,qner~ Jr. also known as , Deceased No. 21 2003 00872 Date of Death 10/18/2003 Social Security No. 180-22-2989 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. I/We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative: Nameof Afforney: Marielle F. Hazen, Esq. Sandra Bennett 83006 I.D. No.: Address: 2000 Linqlestown Road~ Suite 303 Harrisburq PA 17110 Dated 7-6-04 Telephone: 717-540-4332 Description Real Estate- 134 Cambridge Dr., Mechanicsburg, PA Real Estate - 395 Upper Stone Mt., Rd, Bellville, PA Parcel#20.01-2223, B & C Cash & Personal Property (Attach Additional Sheets if necessary) To~l Value C. 127,372.05 91.826.00 7,679.88 226,877.93 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 net be extended into the total of the Inventory. RW-4 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 004153 BENNETT SANDRA L 238 HILLSIDE DR NEW CUMBERLAND, PA 17O7O ........ fold ESTATE INFORMATION: SSN: 180-22-2989 FILE NUMBER: 2103-0872 DECEDENT NAME: WAGNER PAUL E JR DATE OF PAYMENT: 07/1 2/2004 POSTMARK DATE: 07/1 2/2004 COUNTY: CUMBERLAND DATE OF DEATH: 1 O/18/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $1,670.05 REMARKS: TOTAL AMOUNT PAID: $1,670.05 SEAL CHECK#1356 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS The Law Office of Attorney at Law 2000 lAnglestown Road Suite 303 Harrisburg, PA 17110 Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 STATUS REPORT UNDER RULE 6.17 Name of Decedent- Paul E. Wagner, Jr. Date of Death · 10/19/2003 Will No. 21-03-0872 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- 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: account with the Court ? Did the personal representative file a final Yes No b. The separate Orphans' Court No. ( if any ) for the personal representative's account is' c. Did the personal representative state an account informally to the parties in interest ? Yes × No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date · S [gnatur-e -~'" '"----'--'~ Marielle F. Hazen, Esquire Name (Please type or print ) 2000 Linglestown Rd., Suite 303 Harrisburq PA Address 17110 ( 717 ) -540-433 Tel. No. Capacity' Personal Representative X Counsel for personal representative FAMILY SETTLEMENT AGREEMENT AND FINAL RELEASE IN THE ESTATE OF PAUL E. WAGNER, JR., DECEASED KNOW ALL MEN BY THESE PRESENTS, that WHEREAS Paul E. Wagner, Jr., late of Mechanicsburg, Cumberland County, Pennsylvania, deceased, died testate on October 19, 2003, having first made his Last Will and Testament, which was duly executed April 17, 2001 and is duly recorded in Cumberland County Courthouse, Register of Wills, File No. 21-03-0872; WHEREAS, the said Paul E. Wagner, Jr., by the aforesaid Last Will and Testament, named Sandra Bennett and Paul E. Wagner, III as Co-Personal Representatives of his Last Will and Testament; WHEREAS, Letters Testamentary on the estate of said decedent were duly issued by the Register of Wills of Cumberland County, and Letters were granted to Sandra Bennett and Paul E. Wagner, III, hereinafter called Personal Representatives; WHEREAS, the Personal Representatives have gathered the assets of the estate of the Decedent, and the assets consist of personal property to a total value of $226,877.93 as set forth in Exhibit A, which is a statement of account of the Personal Representatives, and which is attached hereto and made a part hereof and marked Exhibit A; WHEREAS, the balance for distribution as shown in the statement marked Exhibit A has been distributed as herein indicated in accordance with the terms of the Last Will and Testament of the Decedent; NOW, THEREFORE, KNOW YE, that we, Sandra Bennett and Paul E. Wagner, III, being the beneficiaries and heirs of the Decedent, and being those persons entitled to inherit under the Last Will and Testament, do hereby acknowledge that we have this day had and received from the aforesaid Personal Representatives, in full satisfaction and payment, all sum or sums of money, legacies, bequests and devices as are given, devised and bequeathed to us, which amounts we have received this day, and which amounts are set opposite our names in the table and schedule of distribution in said statement attached hereto and marked Exhibit A; AND, we do hereby stipulate that in order to avoid the expense and time involved in the filing of a formal account and schedule of distribution, we agree that no account is necessary, and we do hereby agree that we do consent to distribution being made without the filing of an account and schedule of distribution, the same to be with the same force and effect as if it had been filed and confirmed by the Orphans' Court Division of the Court of Common Pleas, Cumberland County. THEREFORE, we and each of us do hereby remise, release, quit claim and forever discharge the Personal Representatives, their heirs, executors, administrators & assigns and MARIELLE F. HAZEN, ESQUIRE, of and from the said estate and from all actions, suits, payment, accounts, reckoning, claims and demands whatsoever for or by reason thereof, or for any other use, matter, cause or thing whatsoever touching upon the estate of the decedent; and each of us do further hereby covenant and agree that should any liability come due to the estate of the decedent after the signing of this agreement, each of us do hereby covenant and agree with each other and the aforesaid Personal Representatives that we will contribute pro rata our share of the estate to satisfy any and all claims, demands, suits or causes of action which may be successfully prosecuted against the estate or the aforesaid Personal Representatives after the signing, sealing and delivery of this Family Settlement Agreement and Final Release. 2 IN WITNESS WHEREOF, we have hereunto set our hands and seals this -3-~l7 ,2004. day of W~ss Wimess Paul E. Wagner, III COMMONWEALTH OF PENNSYLVANIA ) ) SS: ) County of ~. X(~ . On ~ ~ ',~ d~ o~ /%~ , ~00~, ~e~o~ m~,~ $o~ Public, ~e ~dersi~ed officer, peso ly e~ed S~dm Be~e~, ~o~ to me or smisfactofily proven to be ~e pe~on whose nme is subscfi~d to ~e ~ ~s~ent, ~d ac~owledged thru she execmed ~e s~e for ~e p~o~s therein contained. ~ W~SS ~~OF, I here~to set my ~d ~d offici~ se~. ~elle E H~n, Not~ ~blic Ci~ of H~sburg, DaupMn County ~O~ Public ~ ~'~ ~' My Co~$sion ~pims Sept. ~, 2~ COMMONWEALTH OF PENNSYLVANIA ) County of On this the Public, the undersigned __ day of ) SS: ) , 2004, before me, a Notary officer, personally appeared Sandra Bennett, known to me or satisfactorily proven to be the person whose name is subscribed to the within instmmem, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Notary Public 3 IN WITNESS WHEREOF, we have hereunto set our hands and seals this ~ day of , 0o4. Wimess San~nllett ~ Paul wagner4ff COMMONWEALTH OF PENNSYLVANIA County of ! On of ) ) SS: ) , 2004, before me, a Notary Public, the undersigned officer, personally appeared Sandra Bennett, 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 hereunto set my hand and official seal. Maxielle E H~en, Notary Public ~ I~ City of Harrisburg, Dauphin County My Commission Expires Sept. 23, 2006 O COMMONWEALTH OF PENNSYLVANIA County of On this the Public, the undersigned ) ) SS: ) __ day of , 2004, before me, a Notary officer, personally appeared Sandm Bennett, 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 hereunto set my hand and official seal. Notary Public 3 STATEMENT OF ACCOUNT OF THE ESTATE OF PAUL E. WAGNER, JR. Assets (date of death values) Real Estate Cash, Bank Deposits, & Misc. Property Total $219,198.05 $ 7,679.88 $226,877.93 Expenses Funeral Expenses & Administrative Costs Debts of Decedent, Liabilities & Liens Inheritance Tax Total $ 4,651.94 $ 21,371.28 $ 8,67O.O5 $ 34,215.77 Net Distributable Estate $192,184.66 Name Sandra Bennett Paul E. Wagner, III DISTRIBUTION TO BENEFICIARIES OF REAL PROPERTY Amount $ 96,092.33* $ 96,092.33* *Actual distribution may be increased or decreased based on interest accrued, market value of assets, and/or presentation of an obligation and/or payment of additional charges. EXHIBIT "A" BUREAU OF TNDZVIDUAL TAXES TNHERITANCE TAX D/VIS/ON DEPT. 280601 HARRTSBURG, PA 17128-0601 CONNONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOHANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-I~? EX AFP COZ-03) HARZELLE F HAZEN ESQ H F HAZEN LAN OFFZCE ZOO0 LZNGLESTNN RD 30 HBG PA 17110 DATE 09-06-200q ESTATE OF NAGNER JR PAUL DATE OF DEATH iIZr,].8-ZO0$ FILE NUHBER Z~- 087~ C,~dd.~R LA~ '~; COUNTY ACN 10Z ~ : HAKE CHECK PAYAblE AND ~ZT P~YHENT TO: REGISTER OF ~Z~LS CUH~ERLAND CO' COURTHOUSE CARLISLE, PA 1701~ CUT ALONG THIS LINE ~ RETAIN LONER PORTZON FOR YOUR RECORDS ~ DZSALLONANCE OF DEDUCTZONS AND ASSESSHENT OF TAX ESTATE OF NAGNER JR PAUL E FILE NO. 21 05-0872 ACN 101 DATE 09-06-200q TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRA/SED VALUE OF RETURN BASED ON: ORIG/NAL RETURN 1. Real Estate (Schedule A) (1) 2. S~ocks and Bonds (Schedule B) (2) $. CloseZy Held Stock/Partnership Interest (Schedule C) ($) q. Mortgages/Notes Receivable (Schedule D} (q) E. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al Assets APPROVED DEDUCTIONS AND EXENPTZONS: 9. Funeral Expenses/Ada. Costs/Nisc. Expenses (Schedule H) (9) 10. Debts/Hortgage Liab111~ies/Liens (Schedule 1) (10) 11. Total Deductions 12. Net Value of Tax Re~urn 219~198.05 .00 .00 .00 7~679.88 .00 .00 (8) q,651.9q NOTE: To insure proper credit to your accoun*, submit the upper portion of thAs fore with your tax payment. 15. NOTE: Z16,877 21~$71.28 (].:].) 2& .023.22 (12) 200,85q.71 Charitabla/governmen*al Bequests; Non-elected 9115 Trusts (Schedule J) (15) Ne~c Value of Estate Subject to Tax Zf an assessment ~as issued previously, lines 1~, 15 and/or 16, 17, reflect flgures that include the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Amount of Line lq at Spousal rate 16. Aeount of Line lq taxable at Lineal/Class A rate 17. Amount of Line lq at Sibling rate 18. Aeount of Line lq taxable at Collateral/Class B ra~a 19. Principal Tax Due TAX CREDITS: PAYMENT RECEIPT DISCOUNT t+) DATE NUMBER INTEREST/PEN PAID (-) 01-13-200q CD00$q$8 $68.q2 07-12-200q CD00q155 .00 .00 Z00,85q.71 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATZOH OF ADDITIONAL INTEREST. 18 and 19 will (15), .00 X O0 = .00 (16). 200,85d.71 X Off5 = 9,058.q6 (17), .00 x 12 = .00 (:].8), .00 x 15 = .00 (lC)= 9,058.q6 AMOUNT PAID 7,000.00 1,670.05 TOTAL TAX CREDZT I 9,058.q7 BALANCE OF TAX DUE .01CR INTEREST AND PEN. . O0 TOTAL DUE .01CR ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REgUIRED. IF TOTAL DUE TS REFLECTED AS A "CRED/T" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTTONS.)V~___., RESERVATION: PURPOSE OF NOTICE: PAYHENT: REFUND (CA): OBJECTIONS: ADH/N- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on er before December 1Z, 1962 -- 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 Coeeonaaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the laaful Class B (collateral) rate on any such future interest. To ~ulfi11 the requirements of Section 116`0 of the Inheritance and Estate Tax Act, Act 13 of ZOO0. (71 P.S. Section 916`0). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Hake check or money order payable to: REGISTER OF N/LES, 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" (REV-1313). Applications are availabZe at the Office of the Register of NilZs, any of the 23 Revenue District Offices, or by calling the special ZB`-hour ansaaring service for forms ordering: 1-BO0-36Z-ZOSO~ services for taxpayers with special hearing and / or speaking needs: 1-800-~6`7-3010 (TT only). Any party in interest not satisfied with the appraisement, allowance, er disallowance of deductions, er assessment of tax (including discount or interest) as shown on this Notice must object eithin sixty (60) days of receipt of this Notice by: --written pretest to the PA Department of Revenue, Beard of Appeals, Dept. 161011, Harrisburg, PA 17118-1011, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 180601, Harrisburg, PA 17116-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) fur an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (51) discount of the tax paid is allowed. The 15X tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and nat paid before January 16, 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 notice. Interest is charged beginning eith first day of delinquency, or nine (9) months and one (13 day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of six (61) percent per annum calculated et a daily rate of .000166`. All taxes which became delinquent on and after January 1, 1981 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1981 through Z006` are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor :~ ZOX .00056`8 1988-1991 11Z .000301 Z001 91 .O00Zq7 1983 162 .0006`38 1992 97. .00026`7 200Z 62 .000166` 1966` 112 .000:501 1993-1996` 77. .000192 2003 57. .000137 1965 132 .000356 1995-1996 97. .00016`7 ZOO6` 6`7. .000110 1986 102 .000276` 1999 77. .000192 1967 102 .000276` 2000 71 .000191 --Interest is calculated as folloes: INTEREST = BALANCE OF TAX UNPAID X NUtIBER OF DAYS DELINI~UENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date sheen on the Notice, additional interest must be calculated.