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Home My WebLink About04-0670 PETITION FOR PROBATE and GRANT OF LETTERS Estate of Kathleen E. Leib No. 21 - 04 - 0 11 r 7 () also known as N/A, Deceased. To: Social Security No.: 200-09-2984 Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioners who are 18 years of age or older and the Executors named in the last will of the above decedent, dated February 13, 1997, and codicil(s) dated (None.) Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 503 South West Street, Apartment B, Carlisle, PA 17013 (Borough of Carlisle) Decedent, then 94 years of age, died July 6, 2004, at 503 South West Street, Apartment B, Carlisle, PA 17013. 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: no exceptions. Decedent at death owned property with estimated values as follows: (If domiciled in P A) AJlpersonalproperty $ 150.000.00 (If not domiciled in P A) Personal property in Pennsylvania $ (If not domiciled in P A) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: NONE. WHEREFORE, petitioners respectfully request the probate of the last will and codicil(s) presented herewith and the grant ofletters Testamentary thereon. ~l" // L .c .<" / . . " ,- ~ .?{ ,~. u Jr,_ ..6" //: '/(/II'2))'- ;I.' -.{e,"- ( /;f..-~' William L. Leib Edna L. Hawbaker 204 Oak Drive 203 Oak Drive Mount Holly Springs, P A 17065 Mount Holly Springs, PA 17065 (717) 486-5614 (717) 486-7629 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ) ) SS COUNTY OF CUMBERLAND ) The petitioners above-named swear or affirm that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioners and that as personal representatives of the above decedent petitioners will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me /?/ / / ;(/ /"iI -,", ,iiL/I?)' <- this, ~- William L. Leib J day of 11'1 \.f A ) / / -.) ...:'....\....... , it::' 2004 " ---- . .'. ( ( ~-~'--c.:....- /~'/' (.___ L:i. ~lULLl/tLu,,,kU1 I -' i .ld, uD . Edna L. Hawbaker Glenda Farner Strasballgh, Register ~' ~ . ,_, .'\,., .~l ! f.il II ~i! lfi:'"i), , .~ ....~., I ,j r" V CERTIFICATION OF NOTICE UNDER RULE 5.6 (e) Name of Decedent: Kathleen E. Leib Date of Death: July 6, 2004 Will No.: 21-04-0670 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 : July 27,2004 Name Address William L. Leib 204 Oak Drive, Mount Holly Springs, P A 17065 Edna L. Hawbaker, 203 Oak Drive, Mount Holly Springs, P A 17065 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None. Date: -;r/v/O+ _~~_Jz Robert R. Black, Esq. 36 South Hanover Street Carlisle, Pennsylvania 17013 Telephone (717) 243-3727 0 ~ Capacity:_ Personal Representative 0 E: -1L Counsel for Personal Representative N I ...'."'1 gs '"0 c:::c (1) ;.. .0 P .::. j;: .~i) :; :..) u: . 17C NO. 2 1 _ 04 _ I" .' 1. Estate of Kathleen E. Leib, Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW July It.:/h , 2004, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated February 13, 1997, described therein be admitted to probate and filed of record as the last will of Kathleen E. Leib and Letters Testamentary are hereby granted to William L. Leib and Edna L. Hawbaker <) j r l {, .,,,t' a {'v u' Glenda Farner Strasbaugh, Register of Wi 8,., ?~AC ,]/ c~ /.-);(" 'J FEES ffi~ 9 '0~ (, : ' I . i/, , Probate, Letters, Etc. . $ j")'iOO Robert R. Black, Esquire (06267) Short Certificates (b). .... $ \,\;OC 36 South Hanover Street R"Huoei!ltioH j, :-'~'~'\~:;'. . $ ~()n Carlisle, P A 17013 K~ $ \0, CO (717) 243-3727 TOTAL $ ~"q.DO Filed.. .. .. . July {(o , 2004 ,9.1- o1-u" 170 , >i.">N! ~. ~t.u.-&.~ ~ JUL 1 0 2004 ~tf'.~::S dOD--c,c/-a-\ ~^f ;;,h,\)..~ \WJ.\' 'l-{O..o't ('1.,~\'. Hl05.143A""_2187 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH 'RINT lIlllI"EALE Nt,IMBEfI , NENT NAMEOfDECEDENT(Fi"I.M1Cld""Lasl) '" SOCIALSECUArTYNUMSEA D~EOFOEATH(Mo<1t1'>,DaY'''''''rj <INK '- t ,. ,. - - . ~l LOO AGE (l.st B'Mdayl UNOEA1 V!;AR UNOER'OAY BIRTHPL,..O,CEICity.rx! PLACE OF DE,(TH {C"""",,or>yOM _inSlfuCtior>s""_.;oe1 94 Monln. ! ,,~ I-Jovrs J MinUIM SlaleorF",e;gnCounlfy) HOSPITAL Il'Ip.nienlD ER/Ouq>o,..",D g::;",0 " 'cUmbe.k.f.andCo. PA a.. .. COUNTY OF DEATH FACILITY NAME {Il nol inOliiution, g;"""'eel aM numb!<) AACE............,.nlnd..n,Bloocl<.WM..~c Cumbek.fal1d CakV.!~e ",."" ~\ 503 South We.t St. Wh~te ... k. ". DECEOEHT"S USUAL OCCUP!\TIOH KIND OF BUS'NE5$lINOUSTlW V<l\S DECEDENT EVER IN MA.RITAlST.-.ruS.MarrIecl SUAVfVINGSf'OUSE 1~'=i~IIt:':;"~~r;~r~'1 V.S. ARMED FOACES7 N._M._.Widowed. (I!wo!..g;.e~.......) YMO NoCX 0lv0n:ed(Slw;r!y) 1'.. H OU-6ew.{ e 111>. ". " DECEDENT'S~A'l'NGADDAESS(S"_,C""ITI)WO,,Slala,l'oCOdel DECEDENT'S PeYlYl-6ulvanJa 17~.O YM.doo<:-"'liYedln 503 South We.t St. ACTUAl. 17'.Slale ~ ~, RESIDENCE dee_n, CaJrLt-61e, PA 17013 (SeoOlol'uctIOf1' """'na 011 otl1... ""'0) CllmbPJrfn>>d "'wnsP>lp? t7d.a:;,~~":of rtl!Tp; ...Po ... 'Th. (:iIy/boro1 FIirHER'SNAME(F"Sl,MiMhI,laSl\ MOTl-IER'S NAME (F""'. MoOdi<l. MIloidMSurnemel ... ". INFORMANT'S NAME (TypaiPrinl) INFO (SlreeI,CilylTown,Slele,ZipCocleI -- ,~. ,., ~ETHOOOFDISP05ITION P\.ACEOFD'P ITION.Nama.,r "'Y, 'amalo S~",,' ~ CremOlion 0 ~.,r'om 51alaO orOl"""PllI<:e , OU''',(Soec;Jy' 0 "k1t.HoUq S k<.n ~ Cern. .,PAI7065 I I lICENSE NUMBER NAMEANO"OORESSOFFAClllTY , ".. n "" " l'MonIh.o"y.'1'e8I) 23.. n.. ".. TIME OF DE.':rH Wil.SCASE REFERRED TO MEDICAL EJUlMINERlCORONER? ~:30 -, ~ to _0 .,)5<l H. ,.tory.mtS1. on""" 0' hurt la~~.. 'Appro,'m.,. I'.\RTII; OI"""'lgnlf""rJItond1lionoconrrltMJlmg!(ldH'h,boul , :W_I~n noll8SUftlng,nmaomde<lylngeaUMgi-.1n1W'lT1 I jOtloel.nd"".lh , . (>., ,\) Iv"",,, I DUETO(ORASACClNSEOUENCEO'l . , ..- 1: DUETOIO!1ASACClNSEDUENCEOF) , , , ! , DUETO(ORASACONSEOUENCEO'l i WERE"UTOPSYFINOINGS MANNER OF OEAfH DIirEOF INJURV TIMEOFINJURV INJURYAfWORK? DESCRIBE HOW INJURYOCCURREO _'V,BlEPRIORTO IMQ<11h.Day,Vaa'1 COMPLETIQNOFCAUSE Ne'~'.' ~ Hom","'" 0 OFllE.(J'H? _0 ,,0 Acc;oenl 0 P'nd'ngl''''''''hQ''~ 0 ",0 0 o ~CEOFINJURY'Athome.I.~.O:,..,.I.Clory.ofIiea .. ~. _0 $UOO'<j9 Cou'dnot Mdo1......,int><! LOC.':rIONIStr....,CotylTown,$l.la) buikling. ale. (Spocoty) 2Bb. " ,~. CERTIFIER !C"""_only onel SIGNATU 'CERTIFYINGPNYSICI"N(Physoc..nCer1I"""Il,,"u..orOOOth..t>"".""'M<pt\ys;o..nha.o<onouncMd...'h.""comple1Mltom23j 0 Tolh.t>n.ormyk_e<<l..dtI."'oceu"""d""10"'.ca.....(.~.""m.n".r...r.ted 'PRONOUNCING AND CERTIFYING PHYSICIAN IPhysoc..n Ix>II1 pr""""""'''ll <leOlI'1 and Oerl"y,ng 10 cause 01 ~""hl TOtNt>ntD1myk~._'hOC<:~lTed..lh<allm.,d.'a..""plKtI,.nd<l...to,.....e.""f.).""man_.....tH.. 'MEDICAL EXAM1HER/COFlONEFl On the ba.l. of ..amlnaUon and/or Invmlglltlon. In my opinion, da..h OCe~rrM .1 lh.. "..... d.la, .nd pi.ctI, and dlla 10 1tI. eau..(t) and m.nn..r......ad.. ..................... ............ ........................ C.:' rqJ' '" REGISTRAR'SSKlNATUREANDNUMSER ~. ~eu..&.U~ 14.,1';;',I,()1 OAfEFILED(MOntl1,DliY'2 I u. u.\, , } ,,'~ "~ Ii i i ,'j -I' 'II 11- '\ \' \.- /i I J.." - LAST WILL AND TESTAMENT OF KATHLEEN E. LEIB I, KATHLEEN E. LEIB, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this to be my Last Will, hereby revoking all prior wills and codicils. FUNERAL EXPENSES FiRST: I direct the payment of my funeral expenses, including my gravemarker, as soon as may be convenient after my death. PA YMENT OF DEATH TAXES SECOND: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of administration of my estate. DISTRIBUTION OF RESIDUE THIRD: I give the rest of my estate in equal shares to my two children as follows: (A) To my son, William L. Leib, and, ifhe does not survive me, to his wife, Mary Jane Leib, or her heirs; and (B) To my daughter, Edna L. Hawbaker, and, if she does not survive me, to her husband, John F. Hawbaker, or their issue, per stirpes. POWERS OF EXECUTORlRIX FOURTH: I confer upon my executor the right to sell or othelWise convert any real or personal property at public or private sale, at such time or times, in such manner, and for such price or prices, and upon such terms and conditions as my executor shall determine, and to execute and deliver good and sufficient conveyances, assignments and N.e,1 initials transfers thereof, without liability of any purchaser for the application of any consideration; to borrow money and to secure its payment by mortgage of real or personal property, pledge of investments or otherwise, without liability on the part of the lenders to see to the application thereof; to retain any investments at discretion; to invest and reinvest at discretion, without restriction to so-called "legal investments;" to make distribution in cash or in kind; and to do all other acts and things necessary or appropriate in the management, administration and distribution of my estate, APPOINTMENT OF EXECUTORfRIX FIFTH: I appoint William L. Leib and Edna L. Hawbaker, or the survivor, Co- executors of my will. 1 direct that my Co-executors shall not be required to furnish security in any jurisdiction, INTERCHANGEABILITY OF LANGUAGE SIXTH: Words used in the singular may be read to include the plural or the plural may be read as the singular. Similarly, the masculine form may be read to include the feminine and neuter; the feminine may be read to include the masculine and neuter; and the neuter may be read to include the masculine and feminine, HEADINGS SEVENTH: The headings used on the various paragraphs of this will are included for convenience only and shall have no legal significance. I have signed this will this /3fJ1: day Of~ ~ ,1997. ;r rXTD/pA>/ t.. J:L- Kathleen E. Leib, Testatrix --,Wf~ Robert R. Black / ,. J) , ./I-'-~ / -, Witness ACKNOWLEDGMENT and AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND ) We, Kathleen E. Leib, the testatrix in, and Robert R. Black and ,...... " ."' ~.' ~l ..' , the witnesses to the last will, the attached or foregoing instrument, who have signed the instrument, having been duly qualified according to law do depose and say: (a) that I, the testatrix, do hereby acknowledge that I signed and executed the instrument as my last will, that I signed it willingly and as my free and voluntaIY act for the purposes therein expressed; and (b) that we, the witnesses, were present and saw the testatrix sign and execute the instrument as her last will, that she signed it willingly and executed it as her free and voluntaIY act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the will as a witness and that to the best of our knowledge the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence, l( ~~ [, k.t-- Testatrix, Kathleen E. Leib aow~ Witness, Robert R. Black -,,'.- r"O'" 1'>. , ,~~. I, '. , - Witness Notary Public ~ ~ ~~"---~--- 1-'''' n 3~2.1 l~ '~l.~" ,{ Notary Public '- tIt' ""b9rland County r''- ;:"r,,;~,,\, Sept. 4, 1999 I '--,-, ',;~"-::~,:::,~,-:,;~j':.,,:,;iiJl~I;\t.!t'n of Notaries INRE: ESTATE OF VERNON E. : IN THE COURT OF COMMON PLEAS OF DYER, late ofthe Borough : CUMBERLAND COUNTY of Shippensburg, : PENNSYLVANIA Cumberland County, ORPHANS' COURT DIVISION Pennsylvania, deceased : ESTATE NUMBER 2 I -04-0670 CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Vemon E. Dyer on ;; (0 g Date of Death: July 6, 2004 ::l -, 0- ~~ ~! <- Will No. 21-04-0670 ~~ ~ " r.::>. N \0 31 To the Register: N N \0 1 certify that notice of beneficial interest 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 July 28, 2004: Dorothy M. Dyer 302 East Orange Street Shippensburg, P A 17257 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except NONE. July 28, 2004 Signature ~/ a. UJ~ (4J Name: Jerry A. Weigle, Esquire Address: Weigle & Associates, P.C. 126 East King Street Shippensburg, PA 17257 Telephone: (717) 532-7388 Capacity: Personal Representative X Counsel for Personal Representative ).... WEIGLE & ASSOCIATES, P.c. - ATTORNEYS AT LAW - 126 EAST KING STREET _ 5HlPPENSBURG, PA 17257-1397 COMMONWEALTH OF PENNSYLVANIA REV.1162 EX(11-961 DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128.0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004448 DUPLICATE LEIB WILLIAM L 204 OAK DRIVE MOUNT HOLLY SPRINGS, PA 17065 ACN ASSESSMENT AMOUNT CONTROL NUMBER n_n___ fold ---------- -------- 101 I $7,500.00 ESTATE INFORMATION: SSN: 200-09-2984 I FILE NUMBER: 2104-0670 I DECEDENT NAME: LEIB KATHLEEN E I DA TE OF PAYMENT: 09/30/2004 I POSTMARK DATE: 09/30/2004 I COUNTY: CUMBERLAND I DATE OF DEATH: 07/06/2004 I I TOTAL AMOUNT PAID: $7,500.00 REMARKS: WILLIAM L LEIB CHECK#103 INITIALS: SK SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REV-1$Oll EX + (I<<l) REV-1500 0FACtAl USE OM. Y ._m~ PENNSYLVANIA DEPARTIeIT OF REVENUE INHERITANCE TAX RETURN ALE NUllllER DEPT. 280601 HARRISIlURG. PA 17128-0011 RESIDENT DECEDENT 2 1 -0 4 0 6 7 0 "OOiiiY1iiii'" -~ -- iiiiiiR-- OECEDENT'S NAME (lASt, ARST, ANIl MIllIllE INIT1A1) SOClA1. SECURITY IIJMIlER I- LElB KATHLEEN E. 9-2 9 Z 2 0 0-0 8 4 W DATE Of DEATH (IMOO-Yeor) DATEOfBIRtH(IlII-DD-Yeor) TIIS RE1\lRIl_ BE R.ED II IlUPUCATE WITH lIE Q W 0710612004 05129/1910 REGISTER OF WILLS 0 W (1F.II'PlICAIllE) SIJRVMNG SPOUSE'S NAIE (lASt, ARST, All) M100lE INITIAl) SOClA1. SECURITY NUMBER Q N1A - - I!! 00 1. 0rV1naI ReIum o 2. SuppIemenlal Return o 3,R..-Return c-"_"'.'M>Il! lib D4.l.InIlod~ o 4a.FullnlnterestCu.lI}Ifo.lI__d"allr12-12-82) o 5.F_~TaxRetumRequinld X~8 00 6, Dec:odenlIlledT_ _......"'"1 o 7. Dec:odenl_aLiving Trust__"lMII !.. 8. T olaf Number of SaIo Deposit Boxes 1:;;1 . o 9. UIlgation-- o 10.SpousaIPoverlyCnldftc-"__'>31-O'''''''-lI5) o 11._kltaxunderSec.9113(A)_.... i 11lIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDEN11Al. TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPI.ETE MAIl.ING ADDRESS i Robert R. Black FRnuire Landis & Black FIRM NAME (I AppIcoIlIo) Landis & Black 36 South Hanover Street TELEPHONE NUMBER u 717-243-3727 Carlisle ~(" 1M. 17013 J;,. IAI. USE ONLY 1. Real ~ (ScheduIo A) (1) r:" 2._and_<-B) (2) 10g.451.12 c:; <.;,: 3. CIaoeIr Held CorponIlIon, Poo,.....'" or~ (3) ~ U1 4.~&__(ScheduIoD) (4) ~:; 5. Cash, Bank Deposis & _...... Personal Pnlpeo1j' (5) 107.150.48 Z <-E} ;;. 0> 0 6. JoInIy Owned Pnlpeo1j' (SchoWIe F) (6) t= o SeporaIe BBng RequosIBd :5 :;) 7._.VivllsT_&_....._Pnlpeo1j' (7) 12.563.25 I- (SchoWIe G or l) ii: 223.164.85 cC 8. TalIIGnlu _ (tolaILiIes 1.7) (8) 0 16.271.53 W 9.F.......~&_~(Sc:heduIoH) (9) 0:: 10. Debts of Dec:odenl.I9aI8ll8 L-. & LiBns (Sd1eWIe I) (10) 11. TololDod_(tolaILiles981D} (11) 16,271.53 12. Nol VaIuo 01_ (lite 8 minus une 11) (12) 206.893.32- 13. C_and _ Bequests/Sec9113 Truslsforwhi:h an_lDtax has nolbeen (13) made (SdteduleJ) 14. Net_ SUbjoctto Tu (line 12 minus line 13) (14) 206,893.32- SEE IIISI'RUCTlONS ON REVERSE SIDE FOR APPUCABl.E RATES Z 15. Amount 01 une 14 _ at Iho spouoaI tax 0 t= ...., orln",.r... underSec. 9116 (aX1.2) X_(15) ~ 16. Amount 01 Line 14 _ at _.... 206.893.32 x .045 (16) 9.310.2D :;) Q" 17. Amount or une 14 taxable at sibIIrQ raIe X .12 (17) :2 0 18, Amounlolune 14 _ 81_.... X .15 (18) 0 ~ 19. Tax Due 119\ 9.310.20 -..>. , Decedenfs Complete Address: ST1lEEf AIXlRESS 503 South West Street , ADartment B CITY Carlisle I STATE I ZIP 17013 PA Tax Payments and Credits: 9,310.20 1. Tax Due (Page lUne 19) (1) 2. CredtsIPayments A. Spousal Poverty Cred~ B. Prior Paymenls 7.500.00 C, llisrount 394.73 7,894.73 Total Credits (A + B + C ) (2) 3. InterestJPenaIIy ~ applicable D.lnlllresl E.Penally TotaIlnterestIPenalIy ( 0 + E) (3) 4. "Une 2 is greater tIllI1l.ine 1 + Line 3, enter the diIference. This is the OVERPAYMENT. O.Of Check box on Page 1 Line 20 to Jequeet. refund (4) 5. "l.ine 1 + l.ine 3 is greater than Une 2, enter the differllnce, This is the TAX DUE. (5) 1.415.47 A. Enter the interest 00 the tax due. (SA) B. Enter the \olaI of Une 5 + SA. This is the BALANCE DUE. (5B) 1.415.47 Make Check Payable to: REGISTER OF WILLS, AGENT PlEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN.X" IN THE APPROPRIATE BLOCKS 1, Did decedent make a lransfer and; Yes No a. retain the use or income of the property transferred; ........................................................................... 0 00 b, retain the right to designate who shall use the property \Iallsfened or its income; ................................ ........ 0 00 c. retain a IeIIlllSiorIay inlemsl; or ...................................................................................................... 0 00 d. receive the promise for life of either paymenls, benefits or care? ............................................................. 0 00 .~ . 2. "death occuned after December 12, 1982, did decedent lransfer property within one yew of death 00 wiIhoot receiving adequate oonsiderallon?....................................................................................... ........ 0 3. DiddecedentOlOll an.in truslfor" or payable upon death bank acxoontorsecurily aI his or her death? ................. 0 00 4. Did decedent own an Individual Retirement Accoun~ annuity. or other non-probate property which contains a beneIiciary designation? ....................................................................................................... 0 00 IF THE ANSWER TO Atf( OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ~~olpeljwy,I_IhaII__lI1Isllllum,~:t:.:"..t::ojIrQ_lI1d-....ls,lI1db...bestolmy_lI1d_.~IsIrue,COIIllCIlI1d.,.,...... ~ol__.......Il8"'l'1&I...._....Is_"'lIII ol__*"'I_ SIGNA~RSON RE~...'tLINGRETURN ( (~'l' - ( ~: .7--1,,, k_~ DATE _' ~..mj,.. . ADDRESS William L. Leib Edna L. Hawbaker 204 Oak Dr. Ml Hal S . s PA 17065 203 Oak Dr. Ml HoI S . sPA SIGNATURE Of P ~NTAnVE ADDRESS Robert R. Black. Esquire Landis & Black. 36 South Hanover Street PA 17013 For dates of death 00 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. fi9116 (a) (1.I)(i)]. For dates of death 00 or after January 1, 1995, the tax rate imposed on the net value of transfers 10 or for the use of the surviving spouse is 0% (72 P.S. ~9116 (a) (1.1) Oil]. The sIaIule does not exernol a lransfer to a surviving spouse from tax, and the sfaIuIory requirements for disclosure of assets axl filing a tax retum lie sliD applicable even if the surviving spouse is the ooIy beneIiciary, For dales of death 00 or after July 1, 2000: The tax rate imposed 00 the net value of transfers from a del: e and child '-'Iy-one years of age or younger at death to or for the use of a nalurat parenl, an adoptive parent, ora s\flIllllIIllIlt of the child is 0% [72 P.S. fi9116(aX1.2)). _._~. SCHEDULE B caMJNWEALTH PENNSYlVANIA STOCKS & BONDS INHERITANCE TAX RET\JlN i.' ':'~..=~L'~~!.::It=,1 ESTATEOF FD.E NUMBER LEIS KATHLEEN E 21 04 0670 AI JIIOIlIIIY ~ wIIh right "'....1worohIp _ lie dIocIoood on SchoduIo F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 1,972 shares of the common stock of PCN Financial Corp. certificate no. CPT 209972, 103,451.12 CUSIP 693475-10-5 at $52.46 per share. TOTAl. (Also enteron line 2, Recalllf1lIaIio) $ 103,451.12 ~_a.~ . SCHEDULE E CASH, BANK DEPOSITS, & MISC. ClM<<lHWEALTH OF PENNSYlVANIA lNiERITANCE TAX RETUIlN PERSONAL PROPERTY RESIIJENT DECEDENT . ESTATE OF FLE NUMBER LEIB KATHLEEN E 21 04 0670 _tho ~ofliligalionand tho dalatho ~_ _ by tho _. AI """"",,~..tho dghIol............. _be disclosed on SchIduIoF. ITEM VAWEATOATE NUMBER DESCRIPTION OF OEA TH 1. Orrstown Bank, checking account #1 06003209. See atlached letter. 483.13 Principal - $483.13/lnterest - $0.00 2. Onstown Bank, Certificate of Deposit #4000002507. See attached letter. 24,007.97 Principal - $24,000.00 /Interest - $7.97 3. M&T Bank, Certificate of Deposit #31003910972627. See attached letter. 17,516.79 Principal- $16,992.36/lnterest $524.43 4. PNC Bank, checking account #5140398519. See attached letter. 3,960.53 Principal - $3,960.12 /Interest $.41 5. PNC Bank, savings account #5004341972. See attached letter, 17,494.98 Principal - $17,489.52/lnterest $5.46 6. PNC Bank, Certificate of Deposit #31600238599. See attached letter. 1,040.20 Principal- $1,039.75/lnterest $.45 7. PNC Bank, Certificate of Deposit #31700238160. See attached letter. 2,791.12 Principal- $2,786.38/lnterest$4.74 8. PNC Bank, Certificate of Deposit #31900187411. See attached letter. 36,379.24 Principal- $36,304.66/lnterest $74.58 9. Slate Fann Insurance Co., refund 120.65 10. Capital Blue Cross, refund 196.08 11. Comcast, refund 36.18 12. Gamet, Inc., return security deposit 548.61 13. Personal property, see appraisal by RE. Snyder, Auctioneer, attached hereto. 495.00 14. 1996 Chevrolet Cavalier sedan, V1N 1G4JC5240T7276191. See appraisal attached 2,080.00 hereto TOTAL (Also enteron line 5, Recapitulation) $ 107150.48 , ,""EX....,. SCHEDULE G INTER-VIVOS TRANSFERS & COMIIONWEAlTH OF PENNSYlVANIA MISC. NON-PROBATE PROPERTY _AlICE TAX REIIJRN RESIIlENT llECElB/T ESTATE OF FILE NUMBER LEIBJ(ATHLEEN E 21 04 0670 This schedule IlIISl be compIeIed and fled W1I1o _to any of questions 1lhmugh 4 on 1I1o.-so side of 1110 REV.1500 COVER SHEET Is yes. DESCRIPTION OF PROPERTY "'OF ITEM lNa.LO:1tEtwE OFlHE ltWIlF9&. lHEIRAElA'IIONlH"TO DECBlEHf NlO lIE b\lE OFllWII'Sl DAlE OF DEATH DECO'S EXCWSION TAXABLE VALlE NUIIlER ATTAiCH ACOPY OFlHE I&D FOR REM. EST.\1E. VALUE OF ASSET INTEREST ............, 1. Glenbrook Life & Annuity Company, Kathleen E. Leib annuity, 6,281,62 100, 6,281.62 account #Allstate Advantage Plus #AC0044035A. See attached statement Beneficiary - William L Leib 2. Glenbrook Life & Annuity Company, Kathleen E. Leib annuity, 6,281.63 100. 6,281.63 account #AC0044035B. See attached statement. Beneficiary - Edna L. Hawbaker TOTAL (Also enler 00 Hne 7, RecaoItulallon\ S 12 '363 '25 """"EX'~* SCHEDULE H OOIIMONWEAI.TH OF PENNSYLVANA FUNERAL EXPENSES & INHERITANCE rAX REIURII ADMINISTRATIVE COSTS RESIlENfIlECEllEllT ESTATE OF FLE NlIIIIlER lEIB KATHLEEN E 21 04 0670 Debls of lIe(-..tInl must be IwpclIlied on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hollinger FUIlElI8I Home, professional services 7,675.00 2. Audrey Shughart, funeral luncheon 200.60 B. ADMINISTRATIVE COSTS: 1. PeIsonaI Rephlsehlallve's CommIsslons Nameol_Repleseo_(8) William L. leiblEdna L. Hawbaker 0.00 SociII Securily Numbel(o) I EIN N_oI PeosonaI Repleseo-<o) -- Cily Stale Zip Y8lII(0) eo.,.._. PaId: None 2. AtDney Fees Landis & Black 7,500.00 3, FamlyExempllon: (11_0 _Is notthesame.._o. _e.cpIaollllloo,) c_ None -- CIty Stale Zip _l8hIpol~IDDecodenI 4. ProbeIe Fees 474,79 5. Aaxlu-. Fees 6. Tax Return """"'..... Fees 7. PPl, invoice 18,97 8. Sprint, invoice 28.68 9. Comcast, invoice 62.55 10. PPl, invoice 6.23 11. PPl, invoice 3.57 12. Sprint, invoice 51.14 13. RElSeIVe for closing and filing Releases 250.00 TOTAL (Also enlIlron Hne9, RscapItuIallon) $ 16271.53 IK____ _____ =. ___..1...1 ~___... _.....It&l___I_L.__~ .c..... ____ .1-.\ ~"'3.x+. SCHEDULE J COIoWONWEALllI OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RElURH RESlIlENf DECEDENt ESTATE OF FILE NUIllER I o::.a 10::0::...0:: ?1 t\4 M7n RElA TlONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S} RECEIVING PROPERTY Do NoIlJ&t TI1I8lee(s) OF ESTATE I. TAXABlE DISTRIBUTIONS (IncIude=~-'and_under See. 9116 (a (1 l 1- William L. leib SSN: 168-24-2725 Son 50% 204 Oak Drive Mount Holly Springs, PA 17065 2. Edna L. Hawbaker SSN: 186-24-8320 Daughter 50% 203 Oak Drive Mount Holly Springs, PA 17065 ENTER OOUARAMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-l500 COYER SHEET n. NON-TAXABlE DISTRIBUTIONS: A, SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE ,. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1- TOTAL OF PART U - ENTER TOTAL NON-TAXABlE DISTRIBUTIONS ON LINE 13 OF REY.l500 COVER SHEET $ (If 1TW'lI'A!ItI\R('R iR nAArIFvi iMAl'f MrfitiMaI ~ rI thA RM'IP. !U7f:!l , , LAST WILL AND TESTAMENT OF KATHLEEN E. urn I, KATHLEEN E. LEIB, of the Borough of Carlisle, Cwnberland County, Pennsylvania, declare this to be my Last Will, hereby revoking all prior wills and codicils. FUNERAL EXPENSES FIRST: I direct the payment of my funeral expenses, including my gravemarker, as soon as may be convenient after my death. PAYMENT OF DUm TAXES SECOND: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of administration of my estate. DISTRIBUTION OF RESIDUE THIRD: I give the rest of my estate in equal shares to my two children as follows: (A) To my son, William L. Leib, and, ifhe does not survive me, to his wife, Mary Jane Leib, or her heirs; and (B) To my daughter, Edna L. Hawbaker, and, if she does not smvive me, to her husband, John F. Hawbaker, or their issue, per stirpes. POWERS OF EXECUTORIRIX FOURm: I confer upon my executor the right to sell or otherwise convert any real or personal property at public or private sale, at such time or times, in such manner, and for such price or prices, and upon such tenus and conditions as my executor shall detennine, and to execute and deliver good and sufficient conveyances, assignments and N. It, /. initials , transfers thereof: without liability of any purchaser for the application of any consideration; to borrow money and to secure its payment by mortgage of real or personal property, pledge of investments or otherwise, without liability on the part of the lenders to see to the application 1hereof; to retain any investments at discretion; to invest and reinvest at discretion, without restriction to so-called "legal investments;" to make distribution in cash or in kind; and to do all other acts and things necessllIY or appropriate in the management, adm;n;stration and distribution ofmy estate. APPOINTMENT OF EXECUTOR/RIX J<U-."H: I appoint William L. Leib and Edna L. Hawbaker, or the survivor, Co- executors of my will. 1 direct that my CO-execUlOrs shall not be required to furnish secwity in any jurisdiction. INTERCHANGEABILITY OF LANGUAGE SIXTH: Words used in the singular may be read to include the plural or the plural may be read as the singular. Similarly, the masculine form may be read to include the fem;n;ne and neuter; the feminine may be read to include the masculine and neuter; and the neuter may be read to include the masculine and feminine. BEADINGS SEVENTH: The headings used on the various paragraphs of this will are included for convenience only and shall have no legal significance. I have signed this will this /:Jfl day of~ ~ ,1997. ~ n-d~g_.J f:. ~t:, :t- Kathleen E. Leib, TeStatriX flM-~ Robert R Black k:" A. !?c,.;{m ,. <>??dr" - Witness . . , ACKNOWLEDGMENT and AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) . SS. COUNTY OF CUMBERLAND ) We, Kathleen E. Leib, the testatrix in, and Robert R Black and /-1 fJ01Q /1. 'KoHm . the witnesses to the last will, the attached or foregoing instrument, who have signed the instrument, having been duly qualified according to law do depose and say: (a) that I. the testatrix. do hereby acknowledge that I signed and executed the instrument as my last will, that I signed it willingly and as my free and voluntmy act for the purposes therein expressed; and (b) that we, the witnesses, were present and saw the testatrix sign and execute the instrument as her last will, that she signed it willingly and executed it as her free and voluntmy act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the will as a witness and that to the best of our knowledge the testatrix was at that time 18 or more years of age, of s01md mind and under no constraint or undue influence. 7-( at;:U"..,/ f., ~ Testatrix. Kathleen E. Leib ~~ Witness, Robert R Black ,J1;ctlo. . ,4, 7?<d?ff( Witness Notary Public r-- Notarlal Seal --. ... du:!!n K, GU~, ~ PubIc {i' nil; . lJofll berIarid . ~. e . I um ~ My C~ffifiUD- ExplIes Sept. 4, 1 Mlnn'ilf\ nof . ~ , ORRSTOWN BANK TO: Law Offices Landis & Black 36 South Hanover Street Carlisle, PA 17013 FROM: ORRSTOWN BANK P.O. BOX 250 SHIPPENSBURG PA 17257-0250 RE: ESTATE OF Kathleen E Leib DECEASED DATE OF DEATH: July 6,2004 IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD, ON THE ABOVE DATE, THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK: (1) CHECKING ACCOUNTS DATE OF DEATH ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPLE & ACCRUED INTEREST 106003209 Kathleen E Leib 11/03103 483.13 0.00 SAVINGS ACCOUNT DATE OF DEATH v/ ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPLE & ACCRUED INTEREST (3) CERTIFICATES OF DEPOSIT DATE OF DEATH 1/ ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPLE & ACCRUED INTEREST 4000002507 Kathleen E Leib 11/03103 24,000.00 7.97 8/26/04 By Timothea Customer Service Operator '=! M&rBank 499 Mitchell Road. MiII'boro, DE 19966 Mail Code 501-120 Phone (302) 934-2909 F ax (302) 934-2955 August 30. 2004 Landis & Black Attorneys At Law 36 South Hanover Street Carlisle, P A 17013 Re: Estate of Kathleen E Leib Social Security: 200-09-2984 Date of Death: Julv 6. 2004 Dear Sir or Madam: p.,.. your inquiIy dated August 23, 2004, please be advised that at the time of death, the abovc>-named decedent bad on deposit with this bank the following: J. Type of Account Certificate 'If Deposit Account Number 3JOO39J0972627 Ownership (Names oj) Kathleen E Leib Opening Dale O8IJOIOO Balance on Date 'If Death $/6,992.36 Accrued /1IIerest $ 524.43 Tota/ -$/7,5/6.79--------.-..--- For further accouat inform.tiOD, closures and/or reimbursement of fUDds please all the High Street Carlisle Office at #717-240-4536- We were unable to locate any safe deposit box for the above-mentioned decedent. t . OCT-28-2W4 19:20 FNCBAH< 412 768 3458 P.01 >" ~ PNCBAN< October 29, 2004 Robert R. BIact, Esquire 36 South Hanova- Slmit Carlisle, P A 17013 RE: Estate of ~ E. Leib, deceesed SSN: 200-09-2984 OOD: 7/612004 DearMr. BIacIc In ~ to your ~ for Dale of Death holt- for1he custnn- noted abcMo" our JllCO[lJs show 1he fOlJ.owiDa: Cenifieatel ofDepoBlt A<:count #31600238599 EsIabIiabed 09123/2002 KA'I'HLHllN B LElB DOD beIance: $1,039.75 + U5 llCCl1ICd interest Account #31700238160 Established 03/13/2000 KATHLEEN BLBIB DOo 11a1ance: 5.2,786.38 + S4.74llCCl11Cd iDIBrest v Acoount#31900187411 llstablislll:d 0512212000 KA'I'HLEBN E LElB DOD baIaDee: 536,304.66 + S74.58 accrued i-. Cheeldoa Aeanmt Accoant #S 140393519 Establislll:d 09IOUl98 I KA'I'HLEBN E LEIB DOD balance: $3,960.12 + $041 accrued interest Snfap heo.at Acoount #5004341972 I!stab1I8bed 09/2212003 KATHLEENE LEIB OOD beIance: $17,489.52 + $5.46 accrued in1eIe8t PIIF 1 of2 JCT-28-2004 19:21 f'HCBI'N< 412 76S 3458 P.lil2 The ~et'~ear ftI.11mOlnM ~r A<<omIt (lNV "1499008), fur fiuther iDfumwion you may call the.Brollllmige Depufmem all-800- 762-6111. PI...., note that tlIia oftk:e oIlly providea cIate of death baLmces for deposit accounts (lRAs. CDs, ~m,g IIId Savmg, lICCOUIItI). We do IIOt pncen U1 flB.-eiIl .......oooed6.....,...we 9ftt ... Jf)'OllIllled U&istauce with any of these items, . please ClIIII-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. SlllCel91y, ~u.W-1,.- RacheIIe Wells 1-800.762-1775 P7.PFSC-04-P SOOllI'llAve. PilM_aLPA 15119 P8F2of2 Mombor FDIC TOTAl.. P.02 . . An Appraisal for Kathleen E. Leib, Estate Apt. 503 B Elwood Garden Apartments S. West St Carlisle, Pa 17013 ~ Amount Sofa $30.00 Desk $75.00 Living Room Chairs $15.00 Dining Room table and Chairs $40.00 End Tables $10.00 Micro Wave and Stand $30.00 Storage Cabinets $20.00 Electric fan $5.00 4 pc Bedroom Suite $100.00 Lane Cedar Chest $100.00 Misc. Chairs $20.00 Kitchen items $30.00 Misc. Lights $20.00 TOTAL $495.00 Richard E. Snyder, Jr Auctioneer Lic. # AU-1nO-L Rcfb,.d<B ~C).. 332 Zion Road Mt Holly Springs, Pa 17065 : Kelley Blue Book Used Car Values Page 1 of2 :,. :J~JIIt,s ( Auto<M ~- -. _... -- ----~~~--_...~ .---.-.-------..---.---.-----------------.-- Get vehicle information straight from the source ~ Search dealer inventory for this vehicle ~ Qmbu'1powet,o:om Q:)0I<:J6l._ 'PORTIAC @)....CIC (1It)~ YOUfI:ar.Your choice. - II Blue Book Private Party Report ~ - ~, -....."' i Pennsylvania. July 9,2004 , :"'_.-' CHEV , ! 1996 Chevrolet Cavalier Sedan 4D i'f.i<:, ~~,~J$.t:1k-r,~ ~r Report Engine: 4-CyI. 2.2 Uter Shop by Trans: Automatic Drive: Front Wheel Drive body sty' Mileage: 21,112 Search d Equipment inventol') Air Conditioning Dual Front Air Bags Power Steering ABS (4-Wheel) Current AM/FM Stereo offers > Consumer Rated Condition: Good Request "Good" condition means that the vehicle is free of any major a quote I defects. The paint, body and interior have only minor (if any) blemishes, and there are no major mechanical problems. In states where rust Is a problem, this should be very minimal, and a deduction should be made to correct it. The tires match and have substantial tread wear left. A dean title history is assumed. A "good" vehide will need some reconditioning to be sold at retail; however major reconditioning should be deducted from the value. Most recent model cars owned by consumers fali into this category. /IIBuvH Search Local Listinas for This Car I~ Private Party Value YeW'13'. Yaw chaio $2,080 Private Party value represents what you might expect to pay for a ~.~ used car when purchasing from a private party. It may also r. . _,_ ....",. represent the value you might expect to receive when selling your own used car to another private party. -----~-.---_._------~----~___ - _____.._uu__,__._____ .________...____________....__..__.__ _._. __ .___.....__ Copyright @ 2004 by Kelley Blue Book Co., All RJohts Res""'ed. JuH\ug 2004 Edition, The specific Infonnation required to determine the value to... this particula... vehide was supplied by the person generating this report. Vehicle valuations a...e opinions and may vary from vehide to vehicle. Actual valuations win vary based upon market conditions, specifications, vehide condition or other particular drcumstances pertinent to this particular vehide or the transaction or the. parties to the b'ansaction. This report Is .,.....'- " . .~PAIfl'MENT OF 'rRANSPom-4.'rION Ca::RTIF.c;A>TEOF TITLE FOR A VEHICLE -,":-_-~.....""';~~-,,'-'--_._._- ----- 'b~bOOO~~OO~2?'~OO~ ~G~Jc:52lfDT7271ali'~ , 'bl. CIfEVROL.ET I 50l.D81f211701oLE: VEJ:ICLE~~ "-YeAR IMKEOFVEl<<U '11TlENUNBER. ~ I 0 "1 '. I." I loOIO.",1. I 0002"1 0 800'tTVPE DUf".", . c. ..SEAT-CAP', PfIIORTm.ESDaE ODOU.PRDCO.IWE OOON.MI.ES OOOM.SD0'U8 lO'O,,,b I :LOFO.~J"b ,.,... . I. I I. 0IaERll."J1TLED ~OF_' _ - 'UNLADEN WI!IBHT GVWR GCWR 11TI.E~ lllICME1ER ....... O-_.AClUJLUlEAGE It..:MiEAGE EDEDs 'OE:UECHIlHCo\L I _~~ 1 ,...,_~ 3- NOfntE -""1EA 1J'oWIEANi - --; .-EXBIPTFRCIU~~ \ ~ , . lIl1.E~ A-NfTIQIJEV9ICUii: ~.-: KATHLEEN E LEIS c-cussoc...... '" . _ . - ',:- -- -_. . - . F-ourOFCOlafIRY -?: ~a. ~w. WILLOW ST l G-~""'RlR""'" APT'~D ~,:~\/QIQ.E,_::: CARLISLE PA ],1013 ::~...... SooS1'AEETROD T-REOl:.l\EAED~ Y-'IEtCI.2CD11T,1lJNSflEIS$t.IED\lW W"R.OODVEHICLE. ' X"~A'" SECOND~fiIIlIOFIOF: --- -- . ....:cnd IInhaIdllr ........a;-................ d lie IIlIt 1In.....__ J ~ .......,......farWMI .... TIll 10 .. ..... aI ..... ~ ..wf\''-' FlRSJ'UENRIEl.EASEO ~farm"'_ '" " DIUti "'1,;'~-~_' ~,,~7'~',,"~::,;~~ _'~'~."P""".",,':;~CT<' ~".::,,,.;:=::=~~...:;:-,,,,c"'""~"'~'-"~ .,... ".. ~'~lU'fE~_",c KATHLEEN E LEIB ],2b,"'lfILl.Olf ST APT 0 CARLISLE PA 17013 . I \ . I l~_:*aI"'dII1itOl__:~_""'_"~,';lM-"---" <.. B~AOLEY- L - aI~__......IIIIIIftlid""'Ih8...-...JorCDlllll:*lJ""'''''''.'''''''''_ , of............ . , . . ",'- . WtIen......._......~..........JlU'.......dl8cl-oMd --'1:IIclcb.. no tecIt 111---'" "".be __. .....tnc.--, NO. Mr \'EIR A C t:.':::.~"~lI:wtdllatlol__.Mt_ Be ""'t1Oll11lnalfclneJldlot__..-.ddlcle8Md_ 11011II............... OFf'ER8Ofi QlUf LEN F HOllEN 0 DIllE: CftEaC BOX , ...... ~.-. ". SDEET CRY .... ,., LEN FNOLEN 0 ...., OEa<llOll =-....~=--...... _...;':-=:"~IIo'::__"""" 8ECXNUJEfHllDER ...... """'" -- CRY ,., . , .~ . GIenbrook ute and Annuity Company Telephone: 1-800-75&&!75 PO Box 94042 Fax: 1-847-402-5313 Allstate. Palatine Il 60094-4042 July 16, 2004 KATHLEEN E lEIB .' ....;[;:.y~r~~!~~~..~;:;,..'.... 126 W WillOW ST APT.D CARLISLE PA 17013.3862 CHARLES E LITTLE PNC INSURANCE SERVICES, INC 2 EAST MAIN STREET MECHANICSBURG PA 17055-3851 (717)691-4003 A1IstBtee Advantage Plus Annuity Statement It GA0682702 '::-_.',':/" .;:;:+i":AcnVrrvTtlI$.Pr;:f'U()D:;'" . . :".:}-.<",~"" '---, "'-'.,:':;:,,," '--',' Beginning Account Balance 04116104 . . . . . . . . . . . . . . . _ . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . .. $ 12,460.91 Interest Earned 04116104 thru 07/16104 ...................;............................... $ 92.17 Ending Account Balance 07/16104 _ . . _ _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $ 12,5531l8 . 'ct ;,; ;';;'f,.';;A~Ym:~-#q~;Q~~~MQF/01'~~:Jit"'t;;j;~'j;,;;l,.;11';:- ,T ,c.. Cummt Fund Rate Value 3.00% $ 12,553.08 New effective annual rates for each fund will be determined when the current guarantee expires. It yeu h:::vc :lnr quest:x.s concerr.:ng your annt::ti p:ease ccntact yoor iepresenidtive at yOUI fi.ranGiui illSiiiuiiurl. Glenbrook ute and Annuity Company issues fixed and SEe-registered insurance products. SEe-registered insurance products are underwritten by ALFS, Inc. Both Glenbrook ute and ALFS are wholly owned subsidiaries of Allstate ute Insurance Company. ~ 1 B14NDYRQ.N01 A._____._.____ OtENBROOK LIFE July 26, 2004 A Member of AlIst4te Financial Group Ult RE: Allstate" Advantage Plus # ACOO44035A As you requested, your annuity has been surrendered. The check amount of $6,281.62 represents the net proceeds of your annuity as of 07/26/04. Surrender Information: Gross Annuity Value as of 07/26/04 $6,281.62 $6,281.62 Gross Withdrawal Amount $6,281.62 $6.281.62 Check Amount $6,281.62 Remaining Annuity Value as of 07126104 $0.00 As required, the taxable amount of this distribution will be reported to the Internal Revenue Service on Form 1099R. A copy of this form will be mailed to you by January 31 of the next year. Please retain this information for your financial and tax records. If you have any questions. please contact your representative or call Glenbrook Life at Hl00-755-5275. If we can be of any service in the future, we would again welcome the opportunity to assist you in reaching your long-term financial goals. Glenbrook Ufe and Annuity Company issues fixed and SEC-registered insurance products. SEC-registered insurance products are underwritten by ALFS, Inc. Both Glenbrook Ufe and ALFS are wholly owned subsidiaries of Allstate Life Insurance Company. 839402 GLG62 C88NHJNH.N01 81957.2 (#LIENBROOK LIFE July 26, 2004 A Member qf Allstate FinancUd Group RE: Allstate" Advantage Plus f/()..uAfrfy # AC0044035B As you requested, your annuity has been surrendered. The check amount of $6,281.63 represents the net proceeds of your annuity as of 07/26104. Surrender Information: Gross Annuity Value as of 07/26/04 $6,281.63 $6,281.63 Gross Withdrawal Amount $6.281.63 $6.281.63 Check Amount $6,281.63 Remaining Annuity Value as of 07/26/04 $0.00 As required, the taxable amount of this distribution will be reported to the Intemal Revenue Service on Form 1099R. A copy of this form will be mailed to you by January 31 of the next year. Please retain this information for your financial and tax records. If you have any questions, please contact your representative or call Glenbrook life at 1-800-755-5275. If we can be of any service in the future, we would again welcome the opportunity to assist you in reaching your long-term financial goals. Glenbrook Life and Annuity Company issues fixed and SEC-registered insurance products. SEC-registered insurance products are underwritten by ALFS, Inc. Both Glenbrook Life and ALFS are wholly owned subsidiaries of Allstate Life Insurance Company. 839401 81957.2 GLG62 C88NHJNK.N01 COMMONWEALTH OF PENNSYLVANIA '* DEPARTMENT OF REVENUE BUREAU OF ~~~4 (fA/iflE OF NOTICE OF INHERlrANCE TAX INHERITANCE T~:~ ",i$I~ ,':~ APPRAISEMENT, ALLOWANCE DR DISALLOWANCE PO sox 280601 D,..-l ":r"" ,";' I OF DEDUCTIONS AND ASSESSMENT OF TAX HARRISBURG PA'I"i-Zs:'""tl6bl' R[V-1Sfi7 EltJFP Cl2.04l ZDD" 1,,\1 \ L} Hi 3: 15 DATE 01-17-2005 ",u...,'I;'l ESTATE OF LEIB KATHLEEN E DATE OF DEATH 07-06-2004 CLEF,\( OF FILE NUMBER 21 04-0670 ~RnfJ"~I''' C";IiR! COUNTY CUMBERLAND 1\ ,I,.", d ",,,,,', R~ItT;RllCAC1C E!i~ ACN 101 ulWllis & BLACK I Allount Relllitt.d I 36 S HANOVER ST CARLISLE PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE .... RETAIN LOWER PORTION FOR YOUR RECORDS ~ REv:r,!l,"'!it',m.'-m-:6'~r-NliT-{c!-'liF-'l:'Ni1!RYfANcE-i"Ax-APIlRA-{~!ii€Nt~--ALt'liWANCE'OR'--'-----'-'-'-'- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF LEIB KATHLEEN E FILE NO. 21 04-0670 ACN 101 DATE 01-17-2005 TAX RETURN WAS: I X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 11) ,00 NOTE: To insure proper 2. Stocks and Bonds (Schedule BJ (2) 103,451,12 credit to your account, 3. Closely Held stock/Partnership Interest (Schedule C) (3) .00 subllit the upper portion 4. Mortgages/Hotes Receivable (Schedule OJ (4) .00 of this forti with your S. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5) 107, 150,48 tax paYMent. 6. Jointly Owned Property (Schedule F) (6) ,00 7. Transfers (Sehedule G) 17l 12.563.25 8. Total Assets (8) 223,164.85 APPROVED DEDUCTIONS AND EXEMPTIONS: 16,271.53 9. funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule Xl 110) .00 11- Total Deductions (11) 16.27] ~3 12. Net Value of Tax Return 1121 206,893.32 13. Charitable/Govern.ental Bequests; Non-elected 9113 Trusts (Schedule J) 1131 ,00 14. Net Value of Estate Subject to Tax 114) 206,893.32 NOTE: If an assessment was 1ssued prev1ously. l1nes 14. 15 and/or 16. 17, 18 and 19 w1ll reflect f1gures that 1nclude the total of abb returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) ,00 X 00 = .00 16. AMount of Line 14 taxable at Lineal/Class A rate (16) 206,893.32 X 045 = 9,310,20 17. A.ount of Line 14 at Sibling rat. 117l .00 X 12 = .00 18. A.ount of Line 14 taxable at Collateral/Class Brat. 118) ,00 X 15 = .00 19. Principal Tax Due 119)= 9,310.20 T : + AMOUNT PAID DATE HUMBER INTEREST/PEN PAID (-) 09-30-2004 CD004448 394.74 7,500.00 PAYMENT MUST BE MADE BY 04-06-2005~, TOTAL TAX CREDIT 7,894,74 BALANCE OF TAX DUE 1,415.46 INTEREST AND PEN. ,00 TOTAL DUE 1,415.46 . IF PAID AFTER DATE INDICATED, SEE REVERSE I IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED, FOR CALCULATION OF ADOITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR IHSTRUCrIDHS.) ~'<;(- COMV,C,,\'\IEALTH OF P!:NNSYLVANIA REV 1162 EX(11-96i DEPARH.i1E\:T 010 REVENUE 3UR[AU OF 'NDI\/IDUA'~ TAXES DEPT. 288601 HA~RISBURG. ~A 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004891 HAWBAKER EDNA L 203 OAK DRIVE MOUNT HOLLY SPRINGS, PA 17065 ACN ASSESSMENT AMOUNT CONTROL NUMBER ----.--- told 101 I $1,415.46 ESTATE INFORMATION: SSN, 200~O9~2984 I FILE NUMBER, 2104-0670 I DECEDENT NAME: LEIB KATHLEEN E I DATE OF PAYMENT: 01/27/2005 I POSTMARK DATE: 01/27/2005 I COUNTY: CUMBERLAND I DATE OF DEATH: 07/06/2004 I I TOTAL AMOUNT PAID: $1,415.46 REMARKS: E HAWBAKER CHECK# 105 INITIALS: VZ SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS In the Court of Common Pleas of Cumberland County, Pennsylvania INRE: ORPHANS' COURT DIVISION Estate of Vernon E. Over NO. 21-04-0670 Status ReDort Under Rule 6.12 Name of Decedent: Vernon E. Dyer Date of Death: 7/6/2004 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete. 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest: Yes X No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphans' Court and may be attached to this report. Date: ~,iI ~/tl:;- ~ ~ ~ . .. _ I ( \"'^___ ,oJ q~ Signature Name: Address: Shippensburg, PA 17257 Telephone: 717-532-7388 uf Capacity: Personal Representative X Counsel for Personal Representative BUREAU OF INDIVIDUAI..-/tAXESd- INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REV-U07 EX AFP <12-04) DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-14-2005 LEIB 07-06-2004 21 04-0670 CUMBERLAND 101 AlIOunt R_i tted KATHLEEN E ROBERT If BLACK ESQ LANDIS Ii BLACK 36 S HANOVER ST CARLISLE PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subnit the upper portion of this forn with your tax pay.ent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ... IlV:i'~f).,.!rA~,rtBr-.6J'......j(ii''"fARIM!m~r'''lY.!''lYI!Amf.tJ'1!'.lt1!'6'OFrr....................... ... ESTATE OF LEIB KATHLEEN E FILE NO. 21 04-0670 ACN 101 DATE 03-14-2005 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-17-2005 PRINCIPAL TAX DUE:. ..--.__u...~_...... 9,310.20 PAYMENTS (TAX CREDITS): ~ PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-30-2004 CD004448 394.74 7,500.00 01-27-2005 CD004891 .00 1,415.46 TOTAL TAX CREDIT 9,310.20 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 IE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), ".... WAV RIO DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) STATUS REPORT UNDER RULE 6.12 Name of Decedent: Kathleen E. Leib Date of Death: Will No. July 6, 2004 21-04-670 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 XX No 2. If the answer is NO, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a fmal account with the Court? Yes No XX 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 XX 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. aJi2 }tb~pC, Robert R. Black, Esq~ 36 South Hanover Street Carlisle, Pennsylvania 17013 (717) 243-3727 Dattt::~ Lf({ Lf( OS Capacity: _ Personal Representative X Counsel for Personal Representative vi ESTATE OF VERNON E. DYER File No. 21-04-0670 FAMILY SETTLEMENT AGREEMENT THIS AGREEMENT made this ~ ~ day of yY) ~ ,2005, BETWEEN: DOROTHY M. DYER, being the legatee under the Last Will and Testament of Vernon E. Dyer, late of the Borough of Shippensburg, Cumberland County, Pennsylvania, AND JUDITH ANN DYER, Executrix of the Estate of Vernon E. Dyer, deceased. WHEREAS, Vernon E. Dyer died July 6, 2004, testate; and WHEREAS, Letters Testamentary were granted to Judith Ann Dyer on July 16, 2004, by the Register of Wills of Cumberland County, Pennsylvania; and WHEREAS, all assets of the late Vernon E. Dyer have been liquidated or distributed and all his debts paid in full, and further the period of four months having been terminated since the first advertisement of the issuance of Letters to the said Executrix, the said party hereto desires to waive the duty of the Executrix to file a First and Final Account with Proposed Schedule of Distribution for purposes of confirmation by the Court of Common Pleas of Cumberland County, Orphan's Court Division, AND FURTHER desires that a Family Settlement Agreement be executed, which Family Settlement Agreement will be duly recorded among the deed records in and for Cumberland County. gJ WEIGLE & ASSOCIATES. RC. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397 NOW, THEREFORE, WITNESSETH, that the party hereto, in consideration of the premises above stated, and of the Accounting and Proposed Schedule of Distribution attached hereto and made a part hereof, and the receipt of her distributive share as therein shown, does mutually bind herself to the said Distribution and Accounting as set forth and further mutually releases Judith Ann Dyer, Executrix, from all claims and demands whatsoever arising out of settlement of the Estate of Vemon E. Dyer. The party hereto does further agree that should any liability corne due to the estate of the said decedent after the signing of this agreement, she does hereby covenant and agree with the aforesaid personal representative that she will contribute pro rata her share of the estate to satisfy any and all claims, demands, suits, or causes of action which may be successfully prosecuted against the said estate or the aforesaid personal representative after the slgmng, sealing and delivery of this family settlement agreement and final release. IN WITNESS WHEREOF, the party has hereunto set her hand and seal the day and year first above written. WITNESS: ~rJA1~/~ t7tJr]12 .~~ ' 7-- o{ </ DO~~y ~ ID;~r -~/~ L/ (SEAL) WEIGLE & ASSOCIATES. Pc. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397 COMMONWEAL TH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND On this the I y\U... day of f1lCVtvh ,2005, before me, a Notary Public in and for said County and State, the undersigned officer, personally appeared DOROTHY M. DYER, 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 otlicial seal. t P atu~ ~ (0TYt2 Notary Public (SEAL) NOTARW, SEAl. MJRIaA l TOME ~=~CXlMY My CommIuIon ExPlfel,q, 7. 2001 .~~""'o:~.'" :,1\ i Ii :,/ ," I, /~'J.~,',;:S~'j/ J/ ; -..{(.; ;:-' / , ' .~l i .~.:....... Vi r ,.",.::,.,,' .,.' WEIGLE & ASSOCIATES, RC. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 EXECUTRIX'S ACCOUNT FIRST AND FINAL ACCOUNT OF JUDITH ANN DYER, EXECUTRIX FOR ESTATE OF VERNON E. DYER, DECEASED Date of Death: Date of Executrix's Appointment: Dates of Advertisement of Letters: News Chronicle Cumberland Law Journal Accounting for the Period: July 6, 2004 July 16, 2004 August 3, 10, 17,2005 August 6, 13,20,2005 July 16, 2004, to February 12,2005 Purpose of Account: Judith Ann Dyer, Executrix, offers this account to acquaint interested parties with the transactions that have occurred during her administration. The account also indicates the proposed distribution of the estate. It is important that the account be carefully examined. Requests for additional information or questions or objections can be discussed with: Jerry A. Weigle, Esquire Weigle & Associates, P.C. 126 East King Street Shippensburg, P A 17257 717-532-7388 WEIGLE & ASSOCIATES. P.c. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397 SI)MMARY OF ACCOUNT Estate of Vernon E. Dyer, Deceased For the period of Julv 6. 2004 throuQh February 12. 2005 PRINCIPAL Receipts: This Account Net Gain (or Loss) on Sales or Other Dispositions Less Disbursements: Debts of Decedent Funeral Expenses Administration Expenses Federal and State Taxes Commissions Fees Family Exemption Balance Before Distributions Transfer to (from) Principal Distributions to Beneficiaries Principal Balance on Hand For Information: Investments Made Changes in Investment Holdings INCOME Receipts: This Account Net Gain (or Loss) on Sales or Other Dispositions Less Disbursements Balance Before Distributions Transfer to (from) Income Distributions to Beneficiaries Income Balance on Hand For Information: Investments Made Changes in Investment Holdings COMBINED BALANCE ON HAND PaQe 1 2 2 2 2 3 4 5 Current Value 26,548.00 7,606.40 841.97 0.00 0.00 2,537.50 1,993.57 Fiduciary Acquisition Value 205,200.48 0.00 205,200.48 39,527.44 165,673.04 165,673.04 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 07/06/2004 07/06/2004 08/20/2004 07/26/2004 07/16/2004 07/09/2004 08/09/2004 SCHEDULE A RECEIPTS OF PRINCIPAL Cash M & T Bank Checking Account #9836374679- non-interest bearing Stock I Listed 1.928.0000 shares IBM Stock Bond U. S. Savings Bonds - 9 $50 bonds, proceeds of liquidation Subseauent PrinciDal ReceiDts Dorothy M. Dyer contribution - for payment of funeral expenses Judith Ann Dyer contribution - for payment of Letters Testamentary Menna Haven Penn Hall, Inc. - refund Penn Treaty Network American Insurance Company - refund of premium 28.835.59 165.673.04 2.292.74 7.606.40 271.00 256.00 265.71 Total Receipts of Principal 1 Fiduciary Acquisition Value 28.835.59 165.673.04 2.292.74 8.399.11 205.200.48 SCHEDULE C DISBURSEMENTS OF PRINCIPAL Debts of Decedent 07/10/2004 M & T Bank Checking Account #9836374679- 26.548.00 checks clearing after date of death Total Debts of Decedent 26.548.00 Funeral Expenses 07/10/2004 Spring Hill Cemetery - grave opening 600.00 07/26/2004 Fogelsanger-Bricker Funeral Home 7.006.40 Total Funeral Expenses 7.606.40 Miscellaneous Administration Expenses 07/16/2004 Register of Wills, Cumberland County - Letters 271.00 Testamentary and Short Certificates 07/28/2004 Cumberland Law Journal - advertising Letters 75.00 Testamentary 09/01/2004 Postmaster - certified mailing of IBM stock 15.22 09/09/2004 News Chronicle - advertising Letters 101.00 Testamentary 11/16/2004 Register of Wills, Cumberland County - filing PA 15.00 Inheritance Tax Return 02/12/2005 Register of Wills, Cumberland County - filing 75.00 Family Settlement Agreement 02/12/2005 Weigle & Associates, P.C. - reimbursement for 18.75 postage, xerox copies, and long distance telephone calls 02112/2005 Judith Ann Dyer - reimbursement for 271.00 contribution to estate for payment of administrative expenses Total Miscellaneous Administrative Expenses 841.97 Fees 11/16/2004 Weigle & Associates, P.C. 2.537.50 2 SCHEDULE C DISBURSEMENTS OF PRINCIPAL Continued Total Fees Familv Exemption 02/12/2005 Dorothy M. Dyer, spouse - 302 East Orange Street, Shippensburg, PA 17257, part payment of Family Exemption Total Familv Exemption TOTAL DISBURSEMENTS OF PRINCIPAL 3 1.993.57 2.537.50 1.993.57 39.527.44 Dorothv D. Over 09/15/2004 SCHEDULE D DISTRIBUTIONS OF PRINCIPAL 1.928.0000 IBM Stock 165.673.04 TOTAL DISTRIBUTIONS TO BENEFICIARIES 4 165.673.04 165.673.04 IBM Stock 07/06/2004 09/15/2004 SCHEDULE F CHANGE IN INVESTMENT HOLDINGS - PRINCIPAL # Units 1.928.0000 Inventoried -1.928.0000 Distributed 0.0000 Total 5 Cost 165.673.04 -165.673.04 0.00 0.00 JUDITH ANN DYER, Executrix of the Estate of Vernon E. Dyer, deceased, hereby declares under oath (penalties of perjury) that she has fully and faithfully discharged the duties of her office; that the foregoing First and Final Account is true and correct and fully discloses all significant transactions occurring during the accounting period; that all known claims against the estate have been paid in full; that, to her knowledge, there are no claims now outstanding against the estate; and that all taxes presently due from the estate have been paid. \-/ (~~~~ JuMth Ann Dyer, Executrix Subscribed and sworn to by JUDITH ANN DYERj ?e~ me this <? day of /vla , 2005. EDWARD FRANKlIN AUENDORF CommIssion # 1416339 Notary PUblic - California ~ San Francisco County - MYComm. Expires May 25. '2JJJ7 ~ ~LL ~h WEIGLE & ASSOCIATES. Pc. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397