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HomeMy WebLinkAbout03-0077 PETITION FOR PROBATE -tl GRANT OF F_xtate o/ Adela Martha Stevens No. --'~'I also known as Adela M. Stevens To: Reg~t~r of Wi'~ for the Deceaxed. County of Cumberland in the Soctal Securtty No. 072-26-6502 Comnlonwealth of Pennsylvania The petition of the undersigned r~pectfully represents that~ Your petitioner(s), who is/axed 8 years of age or older an the executor named in the last will of the above decedent, dated a,,~.~t~ 22 19 78 and codicil(s) dated (stazc relevant circumstanc=, ag. re~tm,-ia~!on, death of exa:umr. Decendent was domiciled at death in Cumberland County, Pennsylvania, with h_er , ~last_£amilY ,or principal residence at i}24 T,i .~l~nrn I~oad, Lo~r Allen Twp. ~.lmuDer±and County, PA (list street, number and m,m~pality) Dependent, rhcn 99 years ofagi:, died January 20r 2003 at Holy Spirit Hospital, E. PennsDoro Twp., Cumber/anct ~ouncy, Fa ' ' Except as follows, decedent did not marry, was not di¥orced and did not have a child born or adopted after execution of the will offered for probate; was not the victinl ora killing and was never adjudicated incompetent: -- Decendent at death owned proper~y with estimated valu~ as follows: (If do,'niciled in Pa.) All personal property $ 70r000.00 (If eot domiciled in Pa.} Personal property in Pennsylvania $ (if not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ ~ 20 ~ 0.00.00 situated as £oltows: ~863 Holly Driver Camp Hill_. PA WHEREFORE, petitionerU) respectfully request(s) the probate of the last will and codicil(s) presented herc~vith and the grant of letters Testamentarv (testamr. m~T; administration c.t.a.; administration d.b.n.c.t.a.} theron. , n-= New Cumberland, PA 17070 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF 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 beiief of petitioner(s) and that as personal represen- tativeis) of the above decedent p:titioner(s) will well ~%nd truly _adnlinister the estate according to law. Sworn to or affirmecl and subscribed,- /~_/-//~/'~/~~~ be£~ore me this ,~'i~ ,day of [////'~am~_.~ Est-re of Ade]~ Martha Stevens, a/k/a Adela M. Stevens _, Dece-Sed DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~ .\l~-a'~q/~'~/ ~'~ ~~ ia consideration of t~ p~tition on the reverse side hereof, ~ati~ctory proof having been presented before me, IT IS DECREED that the instrument(s) dated Au~ 22. ~978 described therein be admitted to probate and filed of record ~ the l~t w~ of gdela ~a Steve~ ~ and k~tters Test~n~ are hereby granted to J~s B~ce Stev~ FEES Probate, Letters, Ere .......... Sa~. Gerald J. Shekletski, #40486 Short Certificates( ) .......... $ q.OO A1'rORNEY ($u~. Ct~ I.D. No.) ~nu,,~ia~i~~ .... ~ 18 .oo 4~4 Bridqe St., ~w ~rl~d, PA 17070 ~0 S lO.Ob ~Da~S TOTAL ~ S~ (717) 774-7435 This is to certify that ~ae .information'b~?e given is correctly copied fi-om an original ccrti6catc of cteati~ duly filed with me as Local Registrar. The original certificate ,rill be f'onvarded to thc State Vital Records Of'floc t'(w permanc!lt f}iin~. WARNING: It is illegal to duplicate this copy by photostat or photograph. t.ocai Registrar No. 1)ate COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH v,. : : March 15, , ~ - ~,.. Camp Hill, PA 17011 I~'~ ,~ Cumberland ~-~ ~.~ m,,. Elbert R. Stephens I,, Eva ..... ~. J. Bruce Stevens ~ - ~ '~'~'m~' ~-~ms~,~mN '~E~mS~a~ {~__p35 Carol Street. New Cumberland, PA 17070 ~. ~ (~ _~ m[~,,.~ Eft Z~ J,,.Torkto~e Cremation Service.= York, PA 17404 ~~E~~E~,E~,~H {~:N~M~E~3 340L :~%~r<'~ Part emore FH& CS, Inc. <~..~.~2~,~- - { . . . Box 431, New Cumberland, PA 17070-0431 17:710 8/11/78 WILL OF ADELA MARTHA STEVENS 1-o5 -nn I, ADELA MARTHA STEVENS, presently a resident of Cumberland County, Pennsylvania, declare this to be my Will, and hereby revoke all prior wills and codicils made by me. 1. I direct that all my debts, funeral expenses, and expenses in connection with the administration of my estate be paid from the residue of my probate estate as soon as practi- cable after my death. 2. I bequeath such items of my tangible personal prop- erty as are specifically itemized on a list, if any, in my hand- writing, signed and dated by me at the end thereof, and attached to this, my Will, to the person(s) named thereupon to receive such items. 3. All the rest of my property, of whatsoever nature and wheresoever situated, including property over which I hold a power of appointment, I bequeath, devise and appoint equally to my children, Barbara Ann Stevens Grimshaw and James Bruce Stevens. If either of my said children is not then living, the share which he or she would otherwise have received shall go per stirpes to his or her then living issue, and if either of my children is not then living and is not then survived by issue of himself or herself, said share shall go to the child of mine who is then living, or if he or she is not then living, shall go per stirpes to his or her issue who are then living. If any beneficiary under the preceding provisions of this Paragraph 3 has not attained twenty-five (25) years of age at the time of my death, his or her share shall be held by my fiduciary(s) hereinafter named in a separate trust for the benefit of such beneficiary, which separate trust shall be subject to the terms and conditions stated in Paragraph 4 below. 4. There shall be paid to each beneficiary of a separate trust created under Paragraph 3 above such portion of the net income or principal of the trust as may from time to time be necessary to enable the beneficiary to maintain a reasonably comfortable standard of living, to meet the costs of his or her collegiate and professional educations, and to meet his or her expenses of an unusual or emergency nature such as those arising from serious illness, physical incapacity or the like. Upon the beneficiary of any such separate trust attaining twenty-five (25) years of age, the remaining sum then held in separate trust for him or her shall be distributed outright to the beneficiary. If any beneficiary of any such separate trust should die before receiving the entire amount held in separate trust for him or her, such amount as he or she has not received shall be distributed per stirpes to his or her then issue, or if he or she then has no issue, shall be distributed per stirpes to my then issue, the share of any one of said issue of myself who is then the beneficiary of a separate trust created under Paragraph 3 being added to and administered as part of such separate trust. 5. I grant to my fiduciary(s) hereunder, and their successor or successors, the following powers, in addition to and not in limitation of such powers as they may hold by law: (a) To invest any funds of my estate in any stocks, bonds, notes or other securities or property, real or personal, notwithstanding that such investments may not be of the character allowed to fiduciaries by statute or general rules of law, it being my intention to give them the broadest investment powers possible. (b) To sell, or otherwise dispose of, any property, real or personal, at any time forming a part of my estate, for cash or upon credit, in such manner and on such terms and conditions as they see fit, and no one dealing with them shall be bound to see to the application of any moneys paid. (c) To manage, operate, repair, improve, mortgage or lease for any term, any real estate at any time held or owned by my estate. (d) To borrow money for the payment of taxes or for other proper purposes in the administration of my estate. (e) To distribute in cash or in kind, upon any division or distribution of my estate. (f) In general, to exercise all powers in the management of my estate which any individual could exercise in the management of similar property owned in his own right, upon such terms and conditions as to them may seem best, and to execute and deliver all instruments and to do all acts which they may deem necessary or proper to carry out the purposes of this, my Will. 6. I direct that all estate, inheritance and succession taxes that may be assessed in consequence of my death, of whatsoever nature and by whatsoever jurisdiction imposed, shall be paid out of the residue of my probate estate to the same effect as if said taxes were expenses of adminis- tration, and all property includible in my taxable estate which is not a part of my probate estate shall be free and clear thereof. Taxes on future interests may be prepaid in the discretion of my fiduciary(s) hereunder. 7. If any beneficiary shall die within sixty (60) days after my death, he shall be deemed to have predeceased me for all purposes hereunder. 8. No interest of any beneficiary of my estate, either in income or principal, shall be subject to anticipation or to pledge, assignment, sale or transfer in any manner, nor shall any beneficiary have power in any manner to charge or encumber his interest, either in income or principal, nor shall the interest of any beneficiary be liable or subject in any manner while in the possession of my fiduciary(s) hereunder for the - 4 - liability of such beneficiary, whether such liability arises from his debts, contracts, torts or other engagements of any type. 9. Any amounts which are payable to a minor under this Will may, at the discretion of my fiduciary(s) hereunder, be paid either to a parent or guardian of the property of such minor, to the person who has custody of such minor, directly to such minor, or may be applied for the use or benefit of such minor. The receipt of such parent, guardian, custodian, or minor, or evidence of the application of such amount, shall be a full and complete discharge of my fiduciary(s) hereunder to the extent of such payment or application. This Paragraph shall be applicable to payments of income as well as principal. 10. The masculine gender shall be deemed to include the feminine gender herein where the context so requires, and the singular shall be deemed to include the plural where the context so requires. 12. I appoint my son, James Bruce Stevens, as Executor and Trustee hereunder, and if ever he is unable or unwilling so to serve, or to continue so serving, my daughter, Barbara Ann Stevens Grimshaw, shall serve in his place, and if ever she is unable or unwilling so to serve, or to continue so serving, National Central Bank shall serve as Executor and Trustee. I appoint my fiduciary(s) hereunder as guardian(s) of all property passing to minors as a result of my death, whether as a result of this Will, any trust created by me, any policies of insurance on my life and in any other situation wherein the power to - 5 - appoint such guardians exists under the laws of Pennsylvania. No individual fiduciary shall be liable for the acts, omissions or defaults of any agent appointed with due care or of any co-fiduciary. No individual fiduciary shall be required to furnish bond or other security for the proper performance of his duties hereunder. IN WITNESS WHEREOF, I, ADELA MARTHA STEVENS, herewith set my hand to this, my last Will, typewritten on seven (7) sheets of paper including the self-proving attestation clause and signatures of witnesses, this~2 ay of ~ , 1978. ADELA MARTHA STEVENS We, ADELA MARTHA STEVENS, w ~ ' ~t/b/~~.~ , and ~ ~.~.~-~ , the testatrix and the witnesses, re~pe~tfv~l~ W~ose names are signed to the foregoing instrument being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as witness and that to the best of his knowledge the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. TESTATRIX: ADELA MAR~HA STEVENS WITNESS: WITNESS: - 6 - WITNESS: Subscribed, sworn to and acknowledged before me by ADELA MARTHA STEVENS, the testatrix, and 1 .~,_(~]%s~ib~~s~w~or~ to before me,by ~.~ ~~~~7~7c~_~ and ~//~~/ ~~~-~ , witnesses, t~s ~ day of .~~ , 1978. ~'"' ~ry Public KAREN ULRICH, NOTARY P~LIC Herris~urg, PA D~uphin C~ - 7 - LAW OFFICES OF STONE LAFAVER & SHEKLETSKI 414 BRIDGE STREET POST OFFICE BOX E NEW CUMBERLAND, PA. 17070 Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 STONE LAFAVER & SltEKLETSKI ATTORNEYS AT LAW 414 BRIDGE STREET DAVID H. STONE POST OFFICE BOX E OF COUNSEL GERALD J. SHEKLETSKI NEW CUMBEItLAND, PA 17070 CHARLES H. STONE ELIZABETH B. STONE www. stonelaw, net JON F. LAFAVER TELEPHONE (717) 774-7435 FACSIMILE (717) 774-5869 April 15, 2003 Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 RE: Estate of Adela M. Stevens, a/k/a Adela Martha Stevens No. 21-2003-0077 Greetings: Enclosed please find a check for $8,211.03 payable to Register of Wills Agent, for inheritance tax due on the above stated estate. Very truly yours, · G~ald ~letski GJS / kr 1 Enclosure COMMONWEALTH OF PENNSYLVANIA REV-11 62 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 002459 SHEKLETSKI GERALD J ESQ P O BOX E NEW CUMBERLAND, PA 17070 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold 101 $8,211.03 ESTATE INFORMATION: SSN: 072-26-6502 FILE NUMBER: 2103-0077 DECEDENT NAME: STEVENS ADELA MARTHA DATE OF PAYMENT: 04/1 6/2003 POSTMARK DATE: 04/1 5/2003 COUNTY: CUMBERLAND DATE OF DEATH: 01/20/2003 TOTAL AMOUNT PAID: $8,211.03 REMARKS' GERALD J SHEKLETSKI ESQUIRE CHECK//1021 INITIALS: JA SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Adela Martha Stevens a/k/a Adela M. Stevens Date of Death: January 20, 2003 Will No. 2003-00077 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court rules was served on or mailed to the following beneficiaries of the above captioned estate on February 3, 2003. James Bruce Stevens Barbara Grimshaw 824 Lisburn Road 5936 West Via Montoya Drive Camp Hill, Pa 17011 Glendale, AZ 85310 Notice has now been given to all persons entitled thereto under Date: ~ · era d .~/Shekletski, Esquire 414 Bridge Street New Cumberland, PA 17070 ~. ~ 717-774-7435 o ~_~ (~.~ o Capacity: Personal Representative ~ "~':~ X Counsel for Personal ~ . .... u Representative COMMONWEALTH OF PENNSYLVANIA REV-1500 DEPARTMENT OF REVENUE DEPT. 280601 INHERITANCE TAX RETURN F,LENUMBER HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 -- 200.3 __00'77______ COUNTY CODE YEAR NUMBER DECEDEN'¢S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURFrY NUMBER I- Stevens, Adela M 072-26-6502 Z IJ.I DATE OF DEATH (MM-DM-YEAR) DATE OF BIRTH (MM-DM-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE "' 01/20/2003 03/15/1903 REGISTER OF WILLS LLI (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER "' I×1 [%32. Supplemental Return :-- 1. Original Return [~ 3. Remainder Return (date of death pdor to 12-13-82) CO I./~1 6. Decedent Died Testate (Attach copy of Will) ] ] 7. Decedent Maintained a Living Trust (Attach copy of Trust) 8. Total Number of Safe Deposit Boxes D. I ] 9. Litigation Proceeds Received I I 10. Spousal Poverty Credit (date of death ~etween 12-3t-gt and f-t-95) L---J 11. Election to tax under Sec. 91 l$(A)(AttachSch O) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ~ NAME COMPLETE MAILING ADDRESS o Gera'ld J. Shekletsk'i r ~.sq. o 414 Br'idge St. ~ FiRM NAME (If Applicable) LU P.O. Bo× ~ Stone, T,afaver & Shek'letsk± o TELEPHONE NUMBER New Cuz~b~r']and~ P~. 17070 (717) 774-7435 1. Real Estate (Schedule A) (1) 12 9, 9 0 0. 0 0 OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2} 0 · 00 ~,~. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 0. 00 4. Mortgages & Notes Receivable (Schedule D) (4) 0 . 00!:? 5. Cash, Bank Deposits & Miscellaneous Personal Property ~,~ (Schedule E) (5) 91,179.57:::. ' OZ 6. Jointly Owned Property (Schedule F) (6) 0 . 0 0' , ~ i :'~ '~1 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 0. 0(~,~.,, CO :':::~:: Q- 221,079 57 <~ 8. Total Gross Assets (total Lines 1-7) (8) · LLI 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 28,986.4 9 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 0. 00 11. Total Deductions(total Lines 9 & 10) (11) 28,986.49 1 2. Net Value of Estate (Line 8 minus Line 11 ) (12) 192,093 · 08 3. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) (13) 0 . 0 0 4. Net Value Subject to Tax (Line 12 minus Line 13) (14) 192,093.08 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15 Amount of Line 14 taxableat the spousal tax 0. 00 0 00 z rate, or transfers under Sec. 9116 (a)(1.2) x .00 (15) o ~ 192,093.08 8,644 19 <~ 16. Amount of Line 14 taxable at tineal rate x.045 (16) · ~ 0 O0 0 O0 0,. 17. Amount of Line 14 taxable at sibling rate ' x .12 (17) · O 0 18. Amount of Line 14 taxable at collateral rate. 0. 00 x,15 (18) 0· 00 ~- 19. Tax Due (19) 8,644.19 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 2W46451.000 . Decedent's Complete Address: . STREET ADDRESS 824 Lisburn Road cITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 8,644.19 2. Credits/Payments A. Spousal Poverty Credit 0.00 B. Prior Payments 0.00 C. Discount 433.16 Total Credits(A+B+C) (2) 433.16 3. Interest/Penalty if applicable D. Interest 0. O0 E. Penalty 0.00 Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 8,211.03 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 8,211.03 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ....................... [--] [-~ b. retain the right to designate who shall use the property transferred or its income; ........ ~-] c. retain a reversionary interest; or .......................... d. receive the promise for life of either payments, benefits or care? ................. r~ r-~ 2. if death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................ r~ r-~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?r--] [-~ 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, including accompanying schedules and statements, and to the best of my knowledge and belief, it ~ true, correct and complete. Declaration of pr~.[}arer other than the personal representative is based on ail information of which preparer has any knowledge. [x~ew ~an~']PA ~070 . SIGNA~/~'t,~ i/~=~ . , DATE/ ADDRESS 414 "F~r'i~-o_ p,',',',',',',',',',~. 'l::tO~'~. New Cumberland, PA 17070 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.§ 9916 (a) (1.1)(i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. § 9116 (a) (1.1) (ii)] The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. § 9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. § 9116(1.2) [72 P.S. § 9116(a)(1 )]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% (72 P.S. § 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. w4646 1.0oo WILL OF ADELA MARTHA STEVENS I, ADELA MARTHA STEVENS, presently a resident of Cumberland County, Pennsylvania, declare this to be my Will, and hereby revoke all prior wills and codicils made by me. 1. I direct that all my debts, funeral expenses, and expenses in connection with the administration of my estate be paid from the residue of my probate estate as soon as practi- cable after my death. 2. I bequeath such items of my tangible personal prop- erty as are specifically itemized on a list, if any, in my hand- writing, signed and dated by me at the end thereof, and attached to this, my Will, to the person(s) named thereupon to receive such items. 3. All the rest of my property, of whatsoever nature and wheresoever situated, including property over which I hold a power of appointment, I bequeath, devise and appoint equally to my children, Barbara Ann Stevens Grimshaw and James Bruce Stevens. If either of my said children is not then living, the share which he or she would otherwise have received shall go per stirpes to his or her then living issue, and if either of my children is not then living and is not then survived by issue of himself or herself, said share shall go to the child of mine who is then living, or if he or she is not then living, shall go per stirpes to his or her issue who are then living. If any beneficiary under the preceding provisions of this Paragraph 3 has not attained twenty-five (25) years of age at the time of my death, his or her share shall be held by my fiduciary(s) hereinafter named in a separate trust for the benefit of such beneficiary, which separate trust shall be subject to the terms and conditions stated in Paragraph 4 below. 4. There shall be paid to each beneficiary of a separate trust created under Paragraph 3 above such portion of the net income or principal of the trust as may from time to time be necessary to enable the beneficiary to maintain a reasonably comfortable standard of living, to meet the costs of his ou her collegiate and professional educations, and to meet his or her expenses of an unusual or emergency nature such as those arising from serious illness, physical incapacity or the like. Upon the beneficiary of any such separate trust attaining twenty-five (25) years of age, the remaining sum then held in separate trust for him or her shall be distributed outright to the beneficiary. If any beneficiary of any such separate trust should die before receiving the entire amount held in separate trust for him or her, such amount as he or she has not received shall be distributed per stirpes to his or her then issue, or if he or she then has no issue, shall be distributed per stirpes to my then issue, the share of any one of said issue of myself who is then the beneficiary of a separate trust created under Paragraph 3 being added to and administered as part of such separate trust. 5. I grant to my fiduciary(s) hereunder, and their successor or successors, the following powers, in addition to and not in limitation of such powers as they may hold by law: (a) To invest any funds of my estate in any stocks, bonds, notes or other securities or property, real or personal, notwithstanding that such investments may not be of the character allowed to fiduciaries by statute or general rules of law, it being my intention to give them the ~ broadest investment powers possible. (b) To sell, or otherwise dispose of, any property, real or personal, at any time forming a part of my estate, for cash or upon credit, in such manner and on such terms and conditions as they see fit, and no one dealing with them shall be bound to see to the application of any moneys paid. (c) To manage, operate, repair, improve, mortgage or lease for any term, any real estate at any time held or owned by my estate. (d) To borrow money for the payment of taxes or for other proper purposes in the administration of my estate. (e) To distribute in cash or in kind, upon any division or distribution of my estate. (f) In general, to exercise all powers in the management of my estate which any individual could exercise in the management of similar property owned in his own right, upon such terms and conditions as to them may seem best, and to execute and deliver all instruments and to do all acts which they may deem necessary or proper to carry out the purposes of this, my Will. 6. I direct that all estate, inheritance and succession taxes that may be assessed in consequence of my death, of whatsoever nature and by whatsoever jurisdiction imposed, shall be paid out of the residue of my probate estate to the same effect as if said taxes were expenses of adminis- tration, and all property includible in my taxable estate which is not a part of my probate estate shall be free and clear thereof. Taxes on future interests may be prepaid in the discretion of my fiduciary(s) hereunder. 7. If any beneficiary shall die within sixty (60) days after my death, he shall be deemed to have predeceased me for all purposes hereunder. 8. No interest of any beneficiary of my estate, either in income or principal, shall be subject to anticipation or to pledge, assignment, sale or transfer in any manner, nor shall any beneficiary have power in any manner to charge or encumber his interest, either in income or principal, nor shall the interest of any beneficiary be liable or subject in any manner while in the possession of my fiduciary(s) hereunder for the liability of such beneficiary, whether such liability arises from his debts, contracts, torts or other engagements of any type. 9. Any amounts which are payable to a minor under this Will may, at the discretion of my fiduciary(s) hereunder, be paid either to a parent or guardian of the property of such minor, to the person who has custody of such minor, directly to such minor, or may be applied for the use or benefit of such minor. The receipt of such parent, guardian, custodian, or minor, or evidence of the application of such amount, shall be a full and complete discharge of my fiduciary(s) hereunder to the extent of such payment or application. This Paragraph shall be applicable to payments of income as well as principal. 10. The masculine gender shall be deemed to include the feminine gender herein where the context so requires, and the singular shall be deemed to include the plural where the context so requires. 12. I appoint my son, James Bruce Stevens, as Executor and Trustee hereunder, and if ever he is unable or unwilling so to serve, or to continue so serving, my daughter, Barbara Ann Stevens Grimshaw, shall serve in his place, and if ever she is unable or unwilling so to serve, or to continue so serving, National Central Bank shall serve as Executor and Trustee. I appoint my fiduciary(s) hereunder as guardian(s) of all property passing to minors as a result of my death, whether as a result of this Will, any trust created by me, any policies of insurance on my life and in any other situation wherein the power to - 5 - appoint such guardians exists under the laws of Pennsylvania. No individual fiduciary shall be liable for the acts, omissions or defaults of any agent appointed with due care or of any co-fiduciary. No individual fiduciary shall be required to furnish bond or other security for the proper performance of his duties hereunder. IN WITNESS WHEREOF, I, ADELA MARTHA STEVENS, herewith set my hand to this, my last Will, typewritten on seven (7) sheets of paper including the self-proving attestation clause and signatures of witnesses, this of &~/~,.~-~ , 1978. ADELA MARTHA STEVENS ~4~ , the estatrix and the w~t--~e~-ses, reo~ut.v~;y, Whose name~-~re signed to the foregoing instrument being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as witness and that to the best of his knowledge the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. TESTATRIX: ADELA MAR~HA STEVENS WITNESS: WITNESS: - 6 - WITNESS: Subscribed, sworn to and acknowledged before me by ADELA MARTHA STEVENS', the testatrix, and (~J~scribe_d and sworn to before me by //~'~&/ ~'~~c/~~ -j witnesses, t~is ~ d a~y o f~..~~~ ~ ~978. "' ~ry Pubiic -'-~ KAREN ULRICH. NOTARY PUBLIC M~ Commk~ ~ ~ug. ,5. 1980 Hanisburg, PA Dauphin Coun~ - 7 - REV-~02~X* ¢-97~ SCHEDULE A · COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Stevens, Adela M 21-2003-0077 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 propedywould be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRiPTiON VALUE ,~T DATE NUMBER OF DEATH 1. All That Certain tract of land, with improvements thereon, 129,900.00 situate in Lower Allen Township, Cumberland County, Pennsylvania ...... known as 1863 Holly Drive, Camp Hill, PA 17011. Being the same premises which Wade C. Vollmer and Lois I. Vollmer, husband and wife, by their deed dated March 30, 1961, and recorded March 30, 1961, in the Office of the Recorder of Deeds of C~mherland County, Pennsylvania, in Deed Book D, Vol. 20, page 708, granted and conveyed unto James E. Stevens and Adela M. Stevens, husband and wife. James E. Stevens dies July 25, 1973, thus vesting title in Adela M. Stevens, his wife and decedent herein, by operation of 'law. The property was sold to Mary Fritsch on April 9, 2003. TOTAL (Also enter on line 1, Recapitulation) $ 129,900.00 2w4695 2.000 (If more space is needed, insert additional sheets of the same size) re\ded\STEVENSadela DEED THIS INDENTURE made the ~/~/~day of~ , in the year 2003, between James Bruce Stevens, Executor of the Last Will and Testament of ADELA M. STEVENS, late of Lower Allen Township, County of Cumber- land and Commonwealth of Pennsylvania, of the first part, hereinafter called the Grantor, -- A~D - MARY FRITSCH, of the second part, hereinafter called the Grantee; WHEREAS, the said Adela M. Stevens became in her lifetime seised, as of fee, of and in to a certain tract of land, together with the improvements thereon erected, situate in Lower Allen Township, County of Cumberland, and Commonwealth of Pennsylvania, and more particularly described hereinafter; and being so thereof seised, died on January 20, 2003, having first made her Last Will and Testament in writing dated August 22, 1978, duly probated and registered in the Office of the Register of Wills of Cumberland County on January 28, 2003, wherein and whereby she appointed as Executor, the said James Bruce Stevens, to whom Letters Testamentary were duly issued by said Regis- ter of Wills on January 28, 2003, wherein and whereby said premises hereinafter described were not specifically devised, all as in and by said Will and the records of said Register of Wills more fully ap- pears; NOW THIS INDENTURE WITNESSETH, that the said Grantor, for and in consideration of the sum of One Hundred Twenty-nine Thousand Nine Hundred and NO/100 ($129,900.00) Dollars, which has been paid to him by the said Grantee at or before the sealing and delivery hereof, receipt whereof is hereby acknowledged, has granted, bargained, sold, aliened, released and confirmed, and by these presents does grant, bargain, sell, alien, release and confirm unto the said Grantee, ALL THAT CERTAIN lot or tract of land situate in Lower Allen Township, Cumberland County, Pennsylvania, bounded and described as follows, to wit: BEGINNING at the point of intersection of the northern line of Holly Drive and the line of adjoinder between lots numbered 23 and 24, Block "B", on the hereinafter mentioned Plan; thence North eleven (11) degrees six (06) minutes West by the said line of adjoinder for a distance of one hundred twenty (120) feet to a point at the southwest- ern corner of Lot No. 3; thence North seventy-eight (78) degrees fifty-four ~(54) minutes East by the southern line of Lot No. 3 for a distance of. seventy-five (75) feet to a point at the northwestern corner of Lot No. 25; thence South eleven (11) degrees six (06) minutes East by the western line of Lot No. 25 for a distance of one hundred twenty {120) feet to a point on the line of the northern edge of Holly Drive; thence South seventy-eight (78) degrees fifty-four (54) minutes West by the northern line of Holly Drive for a distance of seventy-five (75) feet to the point and place of BEGINNING. BEING Lot No. 24, Block "B", on the Plan of Lots of Cedar Village as recorded in the Recorder of Deeds Office in and for Cumberland County, Pennsylvania, on June 9, 1955, in Plan Book 7, Page 26. BEING the same premises which Wade C. Vollmer and Lois I. Vollmer, husband and wife, by their deed dated March 30, 1961, and recorded March 30, 1961, in the Office of the Recorder of Deeds in and for Cumberland County in Deed Book D, Vol. 20, Page 708, granted and conveyed unto James E. Stevens and Adela M. Stevens, husband and wife. The said James E. Stevens died July 25, 1973, thus vesting title in Adela M. Stevens, his wife, by operation of law, Decedent herein. 2 TOGETHER with all and singular the buildings, improvements, ways, streets, alleys, passages, waters, water-courses, rights, liberties, privileges, hereditaments and appurtenances whatsoever, thereunto belonging o~ in any wise appertaining and the reversions and remainders, rents, issues and profits thereof, and all the estate, right, title, interest, property, claim and demand whatsoever of her, the said Adela M. Stevens, at and immediately before the time of her decease, in law, equity, or otherwise howsoever, of, in, to or out of the same. TO HAVE AND TO HOLD the said lot or piece of ground above de- scribed, with the buildings and improvements thereon erected, hereditaments and premises hereby granted or mentioned, and intended so to be, with the appurtenances unto the said Grantees, to and for the only proper use and behoof of the said Grantees, forever. And the said Grantor, for himself and his respective heirs, executors and administrators, does covenant, promise and agree to and with the said Grantees, their heirs and assigns, that he, the said Grantor, has not heretofore done or committed any act, matter or thing whatsoever whereby the premises hereby granted, or any part thereof, is, are, shall or may be impeached, charged, or encumbered in title, charge, estate or otherwise howsoever. IN WITNESS W-HEREOF, the said Grantor has hereunto set his hand and seal the day and year first above written. Wi tness /~t~e ~a ~U~ 1 ~ T ~ ~ s ~~ o ~ fof ADELA M. STEVENS COMMONWEALTH OF PENNSYLVANIA: : SS: COUNTY OF CUMBERLAND : On this, the day of , 2003, before me a Notary Public, the undersigned officer, personally appeared JAMES BRUCE STEVENS, Executor of the Last Will and Testament of ADELA M. STEVENS, known to me. or satisfactorily proven to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereto set my hand and notarial seal. Notary Public -4- I hereby certify that the precise address of the Grantee is Attorney for -5- A. U.S. DEPARTMENT OF HOUSING and URBAN DEVELOPMENT SETTLEMENT STATEMENT OMB No. 2502-0265 TITLEPRO CHARTER SETTLEMENT SERVICES, LLC B. TYPE OF LOAN 4705 East Trindle Road 4. [ ] FHA 2. [ ] FMHA 3.~] CONV. UNINS. Mechanicsburg,PA 17050 4. [ ]VA 5. [ ] CONV. INS. 6. FILE NUMBER: J 7, LOAN NUMBER: Phone: (717) 975-2117 FAX: (717) 730-9665 994727I 7148662 8. MORT. INS. CASE NO.: 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 '(p.o.c.)' were paid outside the closing; they are shown here for informational purposes and are not included in the totals. D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: R NAME AND ADDRESS OF LENDER: Francis M. Socha, Atty. Estate of Coastal Capital Corp. Intermediary for Frank S. Adela M. Stevens Frisch and Mary E. Friscb 220 Ponte Vedra Park Dr. Ponte Vedra Beach, FL G. PROPERTY LOCATION: H. SE'F]'LEMENT AGENT: I. SETTLEMENT DATE: Camp Hill, PA 17011 1863 Holly Drive CHARTER SETTLEMENT SERVICES, LLC 04/09/03 Lower A11 en Township PLACE OF SETTLEMENT: Cumberland County 4705 E. Trindle Road, Mechanicsburg, PA J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: lOO. GROSS AMOUNT DUE FROM BORROWER 40o. GROSS AMOUNT DUE TO SELLER lOl. Contract sales price 129900.00 4ol.Contract sales price 129900.00 lO2. Personal property 4o2. Personal property lo3. Settlement charges to borrower (line 1400) 6 5 93 , 6 5 403. 104. 404. 105. 405. Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance 106. City/Town tax to 406. City/Town tax to 107. County tax 04/09/03to 12/31/03 288.89 407. Coun~ tax 04/09/03to 12/31/03 288.89 108. Assessments to 408. Assessments to ,09. SCHOOL 04/09/03to 06/30/03 231.87 4o9. SCHOOZ, 04/09/03to 06/30/03 231.87 110. Sew/Ref 4/9-6/3~ 66.42 410. Sew/Ref 4/9-6/3t@ 66.42 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 137080 . 83 420. GROSS AMOUNT DUETO SELLER 13048~ . 18 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. Deposit or earnest money 3 0 0 0 . 0 0 5ol.Excess deposit (see instructions) 202. Principal amount of new loan(s) 9 7 4 0 0 , 0 0 502.Settlement charges to seller (line 1400) 1 1 6 9 5 . 9 4 203. Existing loan(s) taken subject to 503.Existing loan(s) taken subject to 204. so4. Payoff of First Mortgage Loan 205. sos. Payoff of Second Mortgage Loan 206. 506. 207. 507. 208. 508. 209. 509. Adjustments for items unpaid by seller Adjustments for items unpaid by seller 210. City/Town tax to 510. City/Town tax to 211. County tax to 511.County tax to 212. Assessments to 512. Assessments to 213. SCHOOL to 513. SCa{CO'r. to 214. 514. 215. 515. 216. S16. _~17, 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 1 0 0 4 0 0 . 0 0 520. TOTAL REDUCTION AMOUNT DUE SELLER 1 1 6 9 5. 9 4 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SE'I-rLEMENT TO OR FROM SELLER 301. Gross amount due from borrower (line 120) 1 3 7 0 8 0 . 8 3 6Ol .Gross amount due to seller (line 420) 1 3 0 4 8 7 . 1 8 302. Less amount paid by/for borrower (line 220) "1 0 0 4 0 0 , 0 0 6o2. Less reduction amount due seller (line 520) 1 1 6 9 5.9 4 3o3. CASH([~M) ([ ]TO)BORROWER 36680 . 83 §o3.CASH([.,~.TO) ([ ]FROM)SELLER 118791 24 /~y'er or B~r r~natdTe ~ ' ' .7,,/-' Seller's~g nature U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT OMB No. 2502-0265 SETTLEMENT STATEMENT Page 2 L. SETTLEMENT CHARGES 9 9 ~: 7 2 7 PAID FROM PAID FRO~--'~ 70'0. TOTAL ;; ~.ES/BROKER'S COMMISSION based on price $ 12 9 9 0 0 . 0 0 '7 . 0 BORROWER'S SELLER'S FUNDS AT FUNDS AT Division of Commission (line 700) as follows: Toga].: ~ 93 . 0 0 SETI'LEMENT SETTLEMENT 701.$ 9093.00 to ERA-NRT, Inc. 702. $ to 703. Commission paid at Settlement 9093.00 704. Trans fee ERA-NRTr Inc. 100 00 100 00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN ' ' 801. Loan Origination Fee 1. 000 % Advanced Residential 974.00 8o2.~-xJ~i&~k YSP to AdvanCed from Coastal $974.00 poc 803. AppraisaI Fee to .~CO ($275.00) poc 804. Credit Report to ARMCO ($18.00) poc 805. Lenders Inspection Fee 806.~-~~-aTA~6~R',~x~ courierAdvanced Res ident ial 3 0 0 0 807.~~ corm-~itment Advanced Residential 4 80 00 808. Underwriti Coastal Capital 420 00 809. Processing Advanced Residential 250 00 8t0. Tax servic Coastal Capital 85 00 8It. Flood cert Advanced Residential 15 00 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest from 04/09/03 to04/30/03 ~$ /day 352.22 902. Mortgage Insurance Premium for mo. to 903. Hazard Insurance Premium for lyrs. to Personal Lines Ins. 3 84 · 0 0 904. yrs. to 905. I000. RESERVES DEPOS, T+.u WITH LENDER FOR 1001. Hazard Insurance .3 mo.@$ 32. 00 'mo. 96. 00 1002. Mortgage Insurance mo. @ $ 'mo. r003. City/Town tax mo. @ $ 'mo. !004. Countytax 4 mo.@$ 33.01 'mo. 132. 1005. Assessments mo. @ $ 'mo. 1006. School 11 mo. @$ 86.25 'mo. 948.75 1007. mo. @ $ 'mo. 1008. Agg Adj. mo.@$ 'mo. -293 . 11 100. TITLE CHARGES 101. Settlement or closing feeto 102. Abstract or title search to 103. Title examination to 104. Title insurance binder to 105. Document preparation to Stone¢ Lafaver (poc) 106. Notary fees to Notary Public 14.00 6.00 107. Attorney's fees to 108. Title Insurance to Charter Settlement Servic 1008.75 10. Owner's .coverage $ 12 9¢ 900 lt. Endts. Charter Settlement Servic 150.00 12. CSL Old Republic 35.00 13. Courier Charter Settlement Servic 10.00 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording fees: Deeds 38.50 Mortgages 64:.50 Misc.$ 103 .00 1202. City/countytax/stamps: DeedS 1299.00MortgageS 1299.00 1203. State tax/stamps: DeedS 1299 . 0 0 Mortgage $ 1299,00 1204. Pest All American Pest 689.00 1205. electric Scott Foor 50.00 1300. ADDITIONAL SETFLEMENT CHARGES 1301. Survey to 1302. Pest Inspection to 1303. Sew/Ref (AMS) Lower Allen Twp. 66.01 ~3o4. Tax cert. Bonnie Miller 4.00 ~305. 03 Cty/Twp Bonnie Miller 388.93 1400. TOTAL SETTLEMENT CHARGES (enter on lines 103 and 502, Sections J and K) Parties agree that no liability is assumed by Settlement Agent for the accuracy of information furnished by others as shown on the HUD-1Setllement Statement. Settlement Agent hereby expressly reserves the right to deposit any amounts collected for disbursement in an interest bearing account in a Federally insured institution and to credit any interest so earned to its own account as additional compensation for its services in this transaction. HUD CERTIFICATION OF BUYERS AND SELLERS c.l.ly-reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements cunt by m,e in thi/~ansactig~. I further certify that I have received a copy of t,~he HUD-1 Settlement_.State_ment~ f/y er or Borrower's Signature ~4-",~,~ ~ ~ ~/ S eller's/~n~ture ~'~uyer's Address & Phone' ~ Seller'S'New Address & Phone' The HUiQ-;I Settlement Statement which I have prepar, ed is a true and~ ~'~ ~ ~'~'~~'/~"' '~"' ...... te account of this t ...... tion. I h ....... ~, ~rOr ' ~/'~-I ~cau e the funds to be disb 7~,~ .... di ...... d ..... ith this stat .... Settlement Agent Dete WARNING: It is a crime lo knowingly make lalse statements to the United States on this or any similar form. Penalties upon conviction can include a fine and imprisonment. For details see REV-I~8 ~ + (1-97) SCHEDULE E COMMONVV~L~ OF PENNS~VANIA CASH, BANK DEPOSITS, & MISC. iNHE~TANCE TAX ~TURN ms~ ~m~ PERSONAL PROPERTY ESTATE OF FILE NUMBER Stevens, Adela M 21-2003-0077 include the )roceeds of litigation and the d~e the proceeds ~m received by the estate. MI prope~ jointly~wned with the rig~ of suwivomhip must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. D.A. Davidson investment account 72813526. Date of Death of 72,963.26 January 20, 2003, was a holiday when the market was closed. Value as of January 17, 2003, of $73,046.20 + value as of January 21, 2003 = $145,926.52/2 = $72,963.26. 2 Allfirst checking account number 00818-7962-8. 9,649.34 3 One 14K white gold solitaire ring with one, approximately 1.00 2,697.00 carat, old European cut diamond set low in a four prong, platinum, scalloped illusion head. 4 One 18K white gold solitaire engagement ring with one, 1,681.00 approximately .95 carat, old European cut diamond set in a 14K white gold, six prong head. 5 1985 Ford LTD Sedan. Title n,,mber 37202767604ST. VIN ~mher 345.00 1FABP393XFA148703. Blue Book Value = $345.00. 6 Refund checks from Woodlands nursing home and cable TV. 3,316.69 7 Cable TV and telephone refund checks. 27.28 8 Miscellaneous personal property. 500.00 TOTAL (Also enter on line 5, Recapitulation) $ 91,1 7 9.57 2W46AD 2.000 (If more space is needed, insert additional sheets of the same size) D.A. Davidson & Co. member $1PC February 7, 2003 Gerald J. Shekletski Stone LaFaver & Shekletski PO Box E New Cumberland PA 17070 Re: Adela M. Stevens - Account 72813526 Dear Mr. Shekletski: Enclosed you will find Portfolio Reports created on 1/22/03 and 1/23/03. The date of death, 1/20/03 was a holiday and the market was closed. The 1/22/03 will show the values as of the close Friday, 1/17/03 and the 1/23/03 will show the values as of the close on Tuesday, 1/22/03. You will note that they are identical. Please feel free to contact our office if you are in need of further information. Sincerely, Myra Lundstrom, Sales Assistant to ALAN T WORDEN CC: Barbara Grimshaw James B Stevens Redmond Office 7530 164th Ave. N.E. o Suite A215 · Redmond Town Center o P.O. Box 748 o Redmond, WA 98073-0748 o (425) 881-6665 · 1~800-956-6665 . FAX (425) 881-7018 California o Colorado o Idaho o Montano o Oregon · Utah o Woshington · Wyoming www.dadavidson.com ADELA M STEVENS Financial Consultant CIO J BRUCE STEVENS AL WORDEN 535 CAROL STREET (425) 881-6665 NEW CUMBERLAND, PA 17070 .-,,., son Po~folio Repo~ Account: 72813526 As of: 1/22/03 Purchase Current Pct of Gain or Loss Annual Quantity Description Price Cost Price Value Total Amount Pct Div/Int Income Yield % Cash & Cash Equivalent Cash and Cash Equivalent $5,889.01 $5,889.01 8.1% Total For: Cash & Cash Equivalent $5,889.01 $5,889.01 8.1% UIT - Taxable 200 BANKAMERICA CAPITAL IV 7% TOPRS $25.00 $5,000.00 $25.45 $5,090.00 7.0% $90.00 1.8% 1.75 $350.00 6.9% 100 CFB CAPITAL CUM CAP SEC 8.20% $25~00 $2,500.00 $25.11 $2,511.00 3.4% $11.00 0.4% 2.05 $205.00 8.2% PFD 12/15/07 300 ENCANA CORPORATION 9.50% PFD $25.00 $7,500.00 $27.30 $8,190.00 11.2% $690.00 9.2% 2.38 $712.50 8.7% SER 9/30/48 200 GLACIER CAPITAL TRUST I 9.40% CUM $25.01 $5,003.45 $27.75 $5,550.00 7.6% $546.55 10.9% 2.35 $470.00 8.5% TR PRD SEC 2-1-31 200 PGS TRUST I 9.625% TRUST PFD $25.00 $5,000.00 $2.10 $420.00 0.6% -$4.560.00 -91.6% 0 $0.00 0.0% SECS 400 TECO CAP TRUST I 8.50% TRUST $25.00 $10,003.45 $26.35 $10,540.00 14.5% $536.55 5.4% 2.13 $850.00 8.1% PREFERRED SECS 1/31/41 SERIES 500 U S BANCORP CAPITAL III 7.75% TR $25.00 $12,503.45 $26.90 $13,450.00 18.5% $946.55 7.6% 1.94 $969.00 7.2% PFD SECS 5/01/31 SER 200 ZIONS CAPITAL TRUST B 8.00% CAP $25.02 $5,004.85 $26.61 $5,322.00 7.3% $317.15 6.3% 2 $400.00 7.5% SECS 9/01/32 SERIES Total For: UIT-Taxable $52,515.20 $51,073.00 70.1% -$1,442.20 -2.7% $3,956.50 7.7% Mutual Funds 578 AMERICAN STRATEGIC INCOME $15.00 $8,670.00 $12.11 $6,999.58 9.6% -$1,670.42 -19.3% 1.05 $606.90 8.7% PORTFOLIO INC III 610.454 VAN KAMPEN US GOVT INCOME CL A $17.34 $10,588.43 $14.61 $8,918.73 12.2% -$1,669.70 -15.8% 0.72 $439.53 4.9% Total For: Mutual Funds $19,258.43 $15,918.31 21.8% -$3,340.12 -17.3% $1,046.43 6.6% Total for Account $77,662.64 $72,880.32 100.0% -$4,782.32 -6.2% $5,002.93 6.9% Security prices are obtained from sources believed to be reliable. They do not, however, represent bids to buy or sell. Cost information presented should be verified by comparison with personal records, purchase confirmations and / or documents provided to you directly by security issuers ADELA M STEVENS Financial Consultant CIO J BRUCE STEVENS AL WORDEN 535 CAROL STREET (425) 881-6665 NEW CUMBERLAND, PA17070 D.A. Davidson& PageOffice:20ARep:03241 o, 1 Portfolio Report Account: 72813526 As of: 1121103 Purchase Current Pct of Gain or Loss Annual Quantity Description Price Cost Price Value Total Amount Pct Div/Int Income Yield % Cash & Cash Equivalent Cash and Cash Equivalent $5,889.01 $5,889.01 8.1% Total For: Cash & Cash Equivalent $5,889.01 $5,889.01 8.1% UIT - Taxable 200 BANKAMERICA CAPITAL IV 7% TOPRS $25.00 $5,000.00 $25.37 $5,074.00 6.9% $74.00 1.5% 1.75 $350.00 6.9% 100 CFB CAPITAL CUM CAP SEC 8.20% $25.00 $2,500.00 $25.10 $2,510.00 3.4% $10.00 0.4% 2.05 $205.00 8.2% PFD 12/15/07 300 ENCANA CORPORATION 9.50% PFD $25.00 $7,500.00 $27.20 $8,160.00 11.2% $660.00 8.8% 2.38 $712.50 8.7% SER 9/30/48 200 GLACIER CAPITAL TRUST I 9.40% CUM $25.01 $5,003.45 $27.85 $5,571.00 7.6% $567.55 11.3% 2.35 $470.00 8.4% TR PRD SEC 2-1-31 200 PGS TRUST I 9.625% TRUST PFD $25.00 $5,000.00 $2.29 $458.00 0.6% -$4,542.00 -90.8% 0 $0.00 0.0% SECS 400 TECO CAP TRUST I 8.50% TRUST $25.00 $10,003.45 $26.50 $10,600.00 14.5% $596.55 6.0% 2.13 $850.00 8.0% PREFERRED SECS 1/31/41 SERIES 500 U S BANCORP CAPITAL III 7.75% TR $25.00 $12,503.45 $27.15 $13,575.00 18.6% $1,071.55 8.6% 1.94 $969.00 7.1% PFD SECS 5/01/31 SER 200 ZIONS CAPITAL TRUST B 8.00% CAP $25.02 $5,004.85 $26.57 $5,314.00 7.3% $309.15 6.2% 2 $400.00 7.5% SECS 9/01/32 SERIES Total For: UIT - Taxable $52,515.20 $51,262.00 70.2% -$1,253.20 -2.4% $3,956.50 7.7% Mutual Funds 578 AMERICAN STRATEGIC INCOME $15.00 $8,670.00 $12.07 $6,976.46 9.6% -$1,693.54 -19.5% 1.05 $606.90 8.7% PORTFOLIO INC III 610.454 VAN KAMPEN US GOVT INCOME CL A $17.34 $10,588.43 $14.61 $8,918.73 12.2% -$1,669.70 -15.8% 0.72 $439.53 4.9% Total For: Mutual Funds $19,258.43 $15,895.19 21.8% -$3,363.24 -17.5% $1,046.43 6.6% Total for Account $77,662.64 $73,046.20 100.0% -$4,616.44 -5.9% $5,002.93 6.8%' Security prices are obtained from soumes believed to be reliable. They do not, however, represent bids to buy or sell. Cost information presented should be verified by comparison with ~ersonal records, purchase confirmations and / or documents provided to you directly by security issuers allfirst '" ADF:LA M STEVENS 1863 HOLLY DR CAMP HILL PA 1701%7421 Pnge I of 4 Relationship With Interest J.,,.~, ll, 200,~,hruFabruaryll, 2003 Adela M ~ev~ns Acct NO 00818-7962-8 0 allflrst.~ ~ 24~our Custo~ ~1~ 1-800-533-~30 Activity Summary Number of images enclosed 4 Balance on 01/10 $% ~9.6? Annual percentage yield earned n. 2r.,t Deposits and additions ~. so. Avg. dally ledger balance $5, '752_, o.~ Checks -% 341. Avg. daily col lected balance $5, '7~'z, J'~ Balance on 02/11 $30~, ~ Interest earned this statement :; ~. 26 Inlerest paid this statement $.~. 26 Interest paid this year s 3, no Days covered by this statement 32 Deposits and additions Da~e Do$crit~tion Amount 01/21 DEPOSIT $].~ 9. 02/11 INTEREST PAID 1.26 $.150.9? Cheeks ' Denotes missing sequence number Number Date Amounf Number t.~,91o 5634 01/24 sS0.69 5636 01/28 .'.~39.q, 80 5635 01/22 61,25 5637 01/30 8,8oo, oo $9,341. 000'121 000~9831755665005~ Belendn9 your checkbook Be sum you have recorded e~ry account tran~'~fiOfl--whether It was by ArM, retS, irrtemet b~t~kfng, merchant pu~hase.., at,lc~'na~d tr~le, phOne syslem, electro¢~ic transfer o~ ~ .re-at,thori~d p~,en~.ns weft as alt fees and k11erest payroll', ir~ your checkbook r~ister. Cnmpam ynur rJ'~'xhaak re the list of l~ansactJons on ),n~.,r .'a,~'emant. nncJ put a ch~,~ mark in your moist.er beside e~h one, 5nt~r ,ql{ tran~ctiuns that remain unchecked in the apoml0r{r~e. ¢c:~umn below. ....................... _~.d.?t? ................ withdrawals ~ Write your current ~ Cinder 'Withdrawals," stal~men~ hel~llqce on the I~ any checks, paymenL% Pa~?e 2 of 4 line directly beto~ ............................ transfe~ or other ~ Lieder "Addiflom~" list withdrawals ~hat you have all de. po~tG, trans{er~ end ............................. not checked off it? your of/~er adcllt~n5 to your .......................... reglste~ Tote! the wfthdrawal.~ and enter account That you ho~ tlof rh~s amount on li~e 3. checked off In your registe~ ..................... Total the addition~ and ~cld ~i) Subtract the total ~i~ amnunt.to yol/r c~rr~nt "WithrJr~wal$" {rorrt 3'tared. at bala~ce~ £ntcr ............................................... 'Add~r~niq$" and enter ~hl.~ c~n line 2 _ ..................... bflat figure on llr~. 4 below. This amount ........................................... should metc. h your $ +$ -$ ~.$ IErron or q~,estlen.~ nbeut your electronic t~s.~l~s ~l~hone us at 1 .~-533.4630 or wr~e to ~ at AIIfi~t Error R~lufion. Mail Code 101-825, P.O. Box 17033, geeing, MD 21297.~52~ ~ ~oon ,~R ~t~ can, E you thtnk ~ur ~tae~nl ~ ~eipt Is wrong or tf ~u ~ mom Info~tlon ab~: a tran~er lsted on ~ ~ate~nt or r~cei~L We When ~u na~l or wrfl~, ~lo~e p~ldo: your name and ec~unt n~ber, a d~ion ~ the s~ec[~ e~r, and dollar amot.mt of the ~tm~:~ erst, W~ will }nv~tignte your complaint end cormd any error ~ly. If ~ take mom than 10 ~iness da~ to do this, we wil~ o~it ~r a~cou~t f~ (h~ .~u~ ~ think is ~ error, so that ~u will have the u~e ~ the mon~ durln~ the time It takes us to c~Neta otrr in~tiB~inn, Qu~tloe~ ab~ your st~e~.t Ca~ us. AIIfl~ Bank of Allflrst Financial Center N.A.. at 410-2~-4300 or 1-800-53~- 4630 ~DD 1-80~.g~5.8~59) ~ernlng que~tion~ ¢)r RURp~f~ e~r~ ~ y~r ~a/ement. or to repof[ a Io~/stol~ A~it.n" Che~ Card or to ~qu*et n reminder o[ you~ exi~t~ p~onal id~uf;~tlon n~ (HN), or for o~ ~i~t~ng to ~ur a<~c~m'~t. Y~ may al~ write to u~ et the eddm~e~ ~wn be~ow. O~ndlng on t~ type of ~1~, cntltn~ m~ nm Dr~ ym~r rights. When y~ call ~ ~lte. ~ease p~de: your na~ and accent number, a descr~fion of the ~u~e~ed erro~ and the doffer ~mmmt of flqe s~Oecterl Ermm of questions abo~ ~ut ~n-ele~mnlc ~an~e~s call us et th~ number abo~. ~u must mpo~ er~m on non-ele~mnt¢ tran~ctien~ within 14 da~. All items am cradled subJe~ to final ~ mq.e~ an ATM~sa Check Ca~ or ~ Ple~ v~t yo~sr nee~ b~nch I~tton. ~as~ o~ffwe~e ~ allfi~.com Au~msted ~ep~e sewke For balanc~ and tm~fon I~mmion or I~ ~rl~ n dl~ d~R ~r el~ct~E trnn~actlon, o~' to transfer fund~ baleen relat~ ~ec~lng, ~n~ market, ~avlngc a~ line, af ~mdff ,~lJ~t~ ~all a10-244-4300 or 1-eO~-533-4~.30 I~rnet Banking For account balnn~s, tran~ct.ion information. ~o veri~ a dtm~ dep~l or ~lectto~l~ ~ange ~ add.ss Cut off fl~e lop o[ p~ge 1 ~ ~r ~tatem~nt, c~ out th~ inc~ i~a~on, and ~tte the inf~ton and the da~e on ~lch It bec~ eff~l~, end sign it. Y~ may drop fh~ ~lip DE m ~ branch, indu~ it ~Eh your ne~l A~ deposal, or m~? if ~): Cu~omnt In[o~ati~ Se~ic~, Mail Code ~01-120, EO. ~o~ 1596, aalt+m~e MO 21203. ~i~n Inqt~lrlfls For ATM~isa Ch~k Ca~ or ATM/Me~ant Pu~ha~e i~quitle~ Or In[~mct inqu~5, wr~e to: Debit Ca~ 5etv~c~ - Erst R~lJtion. Mail Code 101~5, RO, BOX 170~, Baltimore. MD 21297-0529. For ACH tr*flt.3ct~n% ~it~ ACH~DI ~Mces, Mai~ Code 501-181. RO. g~ 170]9, g.lltl~m, M0 21297-1039, Uallfirst End of Day Ledger Balance Account balances are updated in the section below on days when transactions posted to this accounL 0~110 ~;9, 4~9. R7 01124 .~., ~,,~_, an 01/30 01121 9, 6~.'3~ 0~128 01/22 P, ~,09 The annual percentage yield earned reflects the amount of interest earned on the account during the statement pedod and the average daily balance in the account for that period. The interest rate paid will fluctuate according to money market conditions. About your Relationship Checking with Interest account. When you maintain an average dally ledger balance of $1,0t'~your checking account; or $2~5~4)ur checking, money market and savings accounts; or $7,5¢~)ali related accounts you will not be assessed the $10 monthly maintenance fee. Balancing your checkbook. Look on the back of your first statement page for a fast and easy way to balance your checkbook. What your icons mean Customer Service 0 Important reminder I~ Other banks' ATM ~ Credit to your aCCOLInt I~ Charge to your account transaction I~00 21 000~g8317500650050 i iMO TZ j E W E L E R S Trust Your Special Moments To Mountz. Febmary 21, 2003 Gerald I. Sheldetski 414 Bridge Street New Cumberland, PA 17070 Dear Gerald Shekletski, At your request I examined the jewelry you submitted for valuation and have provided an opinion of the Fair Market Value for the estate ofAdela M. Stevens This report is valid only in its entirety and the final figure excludes any app}icable taxes. You may wish to take this into consideration when using the report. The value conclusions are subject to limiting conditions that are set forth in the body of the report. To the best of my knowledge and experience, I estimate the. jewelry has a total Fair Market Value of $4,378.00. Photographs are included with the original report for your reference. I suggest that you keep your copy of this report in a safe place. This report was prepared in accordance with the Uniform Standards of Professional Appraisal Practice COSPAP). If I can be of any further assistance, please call. Sincerely, Lmda L. Cunnmgham G.G. w' Certified Gemologist Appraiser, AGS Enclosures ~.~ 3780 Trindle Road - Ca~eIJi~lf ~'A 17011 · (717) 763-1199 ¢ ~...~. www. mountzjewelers.com ROLEX Table of Contents · Letter of Transmittal · Table of Contents · Purpose · Intended Use · Definition of Fair Market Value · Approach to Value · Market · Limiting Conditions · Subscriptions Retained for Value Consulting · Metal Markets Certification · List of Laboratory Instruments · Item Descriptions · Photograph(s) · Biographical Information This report is valid only in its entirety and for its stated purpose and intended use and was prepared in accordance with the Uniform Standards of Professional Appraisal Practice (USPAP). -Statements and Limiting Conditions Purpose The purpose of this report is to describe and document the quality of the jewelry listed and to estimate it's Fair Market Value. Intended Use The intended use of this report is for providing an estate appraisal listing the Fair Market Value for use in thc resolution of thc Adela M. Stevens. Valuation Date: Definition of Fair Market Value The fair market value is the price at which the property would change hands between a willing buyer and willing seller, neither being under any compulsion to buy or sell and both having reasonable knowledge of relevant facts. The fair market value ora particular item of property.., is not to be determined by a forced sale price. Nor is the fair market value of an item of property to be determined by the sale price of the item in a market other than that in which such item is most commonly sold to the public, taking into account location of the item wherever appropriate. Taken from Treasury Regulation 20.2031-1 Co) Approach to Value There are three traditional approaches to value that are as follows: Income approach: Applies to income producing properties and is used only if an income situation or rental property can be identified. Market Data approach: Compares the qualities of the subject item to an article with similar or identical qualities, and researches and records current verifiable sales of such merchandise. Cost approach: Establishes the total value of an item by considering the value of its component parts (precious metal content, gemstone weights and qualities, labor, and any other fees) together with the appropriate retail markup according to the norms of the jewelers in the locale, supply and demand, and the current state of the marketplace. Page 2 of 8 Fair Market Value is estimated using the market data approach. Neither the income approach nor the cost approach apply in establishing Fair Market Value. However, the cost approach to value was used to check on the reasonableness or market values found. Market To value an item a market (and market level) must be recognized. The most appropriate market for jewelry can vary depending upon the article's age, condition, quality, intrinsic content, aesthetic appeal, provenance, current fashion trends, artistic interpretation, period of manufacture among others. The type of retail outlet that most commonly carries the items being appraised is considered to be the most appropriate market. However, the auction market was also considered as another appropriate market in establishing Fair market Value for this type ofjeweh-y. Limiting Conditions The jewelry described within has been analyzed and graded in accordance with prescribed grading standards using "state of the art" methods and precision laboratory equipment. Jewelry constructed solely of, or in combination with, precious metals (i.e. platinum, palladium, yellow or white gold and/or silver) is tested, analyzed and described for its type and content of such metal. Unless otherwise stated, all gemstone weights, grades and measurements are approximate and stones have not been removed fi.om their mountings. Diamonds are graded with the prescribed grading nomenclature of the Gemological Institute of America (GIA) and the use of pre-graded permanent master diamond color comparison stones. Colored stones are color graded according to the GIA color grading system. Unless otherwise stated, all colored stones listed on this appraisal report have Probably been subjected to various treatments to improve their appearance. Treatments are considered usual and customary practices when properly disclosed and when done without intent to defraud the consumer. The treatments are mostly stable and do not require special care. When a treatment is detected and considered unusual it will be so noted by this appraiser. Some treatments are reversible and re-treatable. It may be beyond the scope of an appraisal to determine exact treatment methods or the amount of treatment present. Some treatments require sophisticated equipment not found in a standard gemological laboratory. Prevailing market values are based on these universally practiced and accepted processes by the gems and jewelry trade. Sources are assumed to be reliable and the appraiser does not assume responsibility for their information. The appraiser assumes the ownership of the subject property is true as stated by the client. The fees paid for this appraisal do not include the services of the appraiser for any other matter. In particular, fees paid to date do not include any of the appraiser's time or services in connection with any statement, testimony or other matters before an insurance company, its agents, employees or any court or other body in connection with the property herein described. If the appraiser is required to testify or to make any statements to a third party concerning the described properly and/or appraisal, the applicant shall pay the appraiser for all of such time and services so rendered. This document is limited to its stated intended use and is invalid if all items listed in the Table of Contents are not present. Unless expressly stated, the items appraised are in good condition. Any serious deficiencies and repairs are noted. Ordinary wear and tear is not noted. The information in this report is confidential. Page 3 of 8 This appraisal process does not discover liens, encumbrances, or fractional interests but, if known, they are noted. The limited owner of this appraisal is the party for whom the work was performed. Possession of this report does not provide title to the items appraised. Possession of this report, any portion of this report, or any copy thereof, does not include the right of publication without the appraiser's written consent. Use of the information contained in the appraisal is invalid if all items listed in the Table of Contents are not present. Each item described in this report has been photographed and file copies of the photograph(s) as well as a copy of the report are maintained in the appraiser's files for at least five years after the report date. Third parties may rely on the information in this report for the defined purpose and intended use only. Third parties requiting further information than what is in the report must obtain the written permission of the owner of the appraisal before the appraiser will discus the report. No changes may be made to this report by anyone other than the appraiser. The appraiser cannot be responsible for unauthorized alterations. The professional relationship between the appraiser and the client ends with the delivery of this report. Subscriptions Retained for Value Consulting Drucker, Richard - The Guide. Northbrook, IL Rapaport, Martin - Rapaport Diamond Report, New York, NY Metal Market 02/21/2003 Gold $377.00 Silver $4.70 Platinum $593.00 List of Laboratory Instruments Binocular microscope Leveridge gauge Electronic scale Thermal conductivity diamond tester Touchstone and acids Ultraviolet light unit Spectrascope Proportionscope Polariscope Dichroscope Refractometer Chelsea color filter Heavy liquids Diamond light and graded master comparison diamonds Page 4 of 8 Certification · I hereby certify that, to the best of my knowledge and belief.' · The statements of fact contained in this report are tree and correct. · The reported analyses, opinions, and conclusions are limited only by the reported assumptions and limiting conditions, and are my unbiased professional analysis, opinions, and conclusions. · I have no present or prospective interest in the property that is the subject of this report and I have no personal interest or bias with respect to the parties involved. · My compensation is not contingent upon the development or reporting of a predetermined value or direction in value that favors the cause of my client, the amount of the value estimate, the attainment of a stipulated result, or the occurrence of a subsequent event. · I have made a personal inspection of the property that is the subject of tiffs report. · No one provided significant professional assistance to the person signing this report. · My analyses, opinions, and conclusions were developed, and this report has been prepared, in conformity with the Uniform Standards of Professional Appraisal Practice. Linda L. Cunningham G.G. Certified Gemologist Appraiser, AGS ~' 02/21/2003 Page 5 of 8 Prepared For: Gerald J. Shekletski Date: 02/21/2003 414 Bridge Street New Cumberland, PA 17070 Item 1 Ring One 14K white gold solitaire ring with one, approximately 1.00 carat, old European cut diamond set low in a four prong, platinum, scalloped illusion head. The top of the ring has six overlapping "leaves" and measures 14.3 mm wide. The shank is slightly domed and tapers from 3.0 to 1.6 mm. The ting has no markings, is finger size 8 1/4, and weighs 3.6 grams. Diamond Grading Report Shape and Cut: Old European Measurements: 6.29 x 6.24 x 3.99 mm (approximate) Weight: 1.00 Cts. (estimated) Depth: 63.70% Table: 50.1% Girdle: Extremely thin - thin Culet: Large Finish Polish: Good Symmetry: Good Clarity: SI-1 Color: J Total Approximate Estate Value Excluding Tax $2,697.00 Item 2 Ring One 18K white gold solitaire engagement ting with one, approximately .95 carat, old European cut diamond set in a 14K white gold, six prong head. The shank is half round, pinched at the top and tapers fxom 2.35 to 1.25 mm. The ting has no trademark or stampings, is f'mger size 8 1/4, and weighs 2.5 grams. Diamond Grading Report Shape and Cut: Old European Measurements: 6.39 x 6.09 x 3.84 mm (approximate) Weight: 0.95 Cts. (estimated) Depth: 61.50% Table: 45.8% Girdle: Very thin - medium, frosted Culet: Medium Finish Polish: Good Symmetry: Poor Clarity: I-1 Color: H Fluorescence: Moderate blue (lw) Total Approximate Estate Value Excluding Tax $1,681.00 Page 6 of 8 Total Approximate Estate Value for All Items - Excluding Tax: $4,378.00 Four thousand three hundred seventy-eight dollars and no cents Signature of Appraiser: . ~ , ~:~--- .... ~.-~/ ~ ' Linda L. Cun/ffingham G.G. Certified Gemologist Appraiser, AGS Page 7 of 8 Biographical Background and Qualifications Appraiser's Name Linda L. Cunningham G.G. Education: Bachelor of Arts, the University of Missouri, 1981. Graduate Gemologist, Gemological Institute of America, 1992. Registered Jeweler, American Gem Society, 1998. Certified Gemologist, American Gem Society, 1999. Certified Gemologist Appraiser, American Gem Society, 2001. Pearl Grading, Gemological Institute of America, 2001. Business: In the jewelry trade since 1995. Member Gemological Institute of America Alumni Association, Washington, DC Chapter. Member American Gem Society. Page 8 of 8 ' REV-1511 EX+ (1-97) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & · INHERITANCE TAX RETURN AD MI N ISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Stevens, Adela M 21-2003-0077 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Parthemore Funeral Home and Cremation Services, Inc. 3,497.80 1303 Bridge St. New Cumberland, PA 17070 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 0.00 Name of Personal Representative(s) Social Security Number(s) / LIN Number of Personal Representative(s) Street Address City State __ Zip Year(s) Commission Paid: 2. AttorneyFeesName: Gerald J. Shekletski, Esq. 10,750.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 0.00 Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 272.00 Letters Testamentary 5. Accountant's Fees 0,0 0 6. Tax Return Preparer's Fees 0,00 7. The Patriot News - legal advertising. 111.67 8 The C,:mherland County Law Journal - legal 75.00 advertising. 9 Woodlawn Memorial Garden. 625.00 10 Mountz Jewelers - Ring appraisals. 130.00 11 Moffitt Heart and Vascular Group. 72.66 Total from continuation pages .... 13,452.36 TOTAL (Also enter on line 9. Recapitulation) $ 28,986.49 2W46AG 2000 (if more space is needed, insert additional sheets of same size) Page 2 Estate of: Stevens, Adela M 21-2003-0077 Schedule H, Part B -- Administrative Costs Item No. Description Amount 12 Alert Pharmacy Services, Inc. 300.70 13 Woodlands Center for Nursing. 48.00 14 Sue Tobias-hair care at Woodlands nursing home. 12.00 15 PA Department of Revenue - 2002 state income tax. 34.27 16 UGI - gas service 175.11 17 PAWC - water bill. 21.26 18 PlumBing Repair. 25.00 19 West Shoe Anesthesia. 19.38 20 PPL - electric service. 23.11 21 Riverside Gingerbreadman Restaurant-funeral luncheon. 744.46 22 Proof of mailing fee. 1.80 23 UGI - gas service. 181.57 24 Travelers Indemnity and Affiliates - Homeowners 44.00 Insurance. 25 Mitch Pastula - pl~mhing repairs. 209.55 26 PAWC - water service. 12.23 27 William Danforth-electrical repair.. 100.00 28 Settlement expenses on sale of 1863 Holly Drive, Camp 11,108.76 Hill, PA 17011. $11,695.94 (line 502 of settlement sheet) less $587.18 (prorations for real estate taxes on lines 407, 409 and 410 of settlement sheet) = $11,108.76. 29 Miscellaneous home repair expense. 65.00 TOTAL. (Carry forward to main schedule) ...... 13,126.20 Page 3 Estate of: Stevens, Adela M 21-2003-0077 Schedule H, Part B -- Administrative Costs Item No. Description Amount 30 PPL - electric service. 16.16 31 Filing fees for PA Inheritance Tax Return and 25.00 Peraonal Inventory form. 32 Additonal probate fee. 35.00 33 Reserve for closing expenses. 250.00 TOTAL. (Carry forward to main schedule) ...... 326.16 REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Stevens, Adela M 21-2003-0077 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Stevens, James B. Son 96,046.54 535 Carol St. New Cumberland, PA 17070 2 Stevens Grimshaw, Barbara A Daughter 96,046.54 5936 West Via Montoya Dr. Glendale, AZ 85310 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 2W46A11000 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH O~ PENNSYLVANIA ss,' COUNTY OF CUM~E.~I.AND .S~s Bruce being duly sworn ac¢ord;ng to law, Heposes and says that he is Executor of the Esfafe of Adela Martha Stevens a/k/a Adela M. Stevens Lower Allen To--ship , late of ................. Cum~er,and County, Pa., deceased and fhaf the within is an inventory made by _~~~_ _~ the said Executor of +he enf;re es+ate of ~aid decedent, consisting of all +he personal property and real estate, except real estate outside the Commonweaffh of Pennsylvania, and that the figures opposife each item cf fha Inventory represent it's fair value as of %he date of decedenf's death. and ~ubscribed before me, James Bruce Stevens 535 Carol St., New Cumberland, PA 17070 Addre~* 20 January 2003 Dale of Dea{h Day Month Year INSTRUCTIONS I. .An inventor7 must be filed within three months after appolnfmenf of personal representative. 2. A ~uppiemen,+ inventory must be fired wifMn fh;Hy days of discovery of addffional assets. 2. Addlfionnl ~hee+s may be ~ff~ched ~s +o personnlfy or re~lfy 4. See Article Inventory of the real and personal estate of Adela Martha Stevens a/k/a Adela M. Stevens deceased PERSONAL PROPERTY 1. D.A. Davidson investment account 72813526. $ 72,963.26 2. Allfirst checking account #00818-7962-8. $ 9,649.34 3. One 14 K white gold solitaire ring. $ 2,697.00 4. One 18K white gold solitaire engagement ring. $ 1,681.00 5. 1985 Ford LTD Sedan. Title number $ 345.00 37202767604ST. VIN 1FABP393XFA148703. 6. Refund checks from Woodlands nursing home $ 27.28 and cable TV. 7. Miscellaneous personal property. $ 500.00 TOTAL PERSONAL PROPERTY $ 91,179.57 REAL PROPERTY 1. 1863 Holly, Drive, Camp Hill, PA 17011 $ 129,900.00 TOTAL REAL PROPERTY $ 129,900.00 TOTAL REAL AND PERSONAL PROPERTY $ 221,079.57 ~/¢-//~- CONHONNEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTNENT OF REVENUE ~,.,~,~.J~ INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURg, PA 17Z28-060! NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLO#ANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-154?EXAFP(BI-05) ?'~"'; ..... ,,. DATE 07-07-Z005 ESTATE OF STEVENS ADELA H DATE OF DEATH 01-ZO-ZO0$ FILE NUHBER 21 0~-0077 COUNTY CUHBERCAND GERALD J SHEKCETSK! ESQ ACN tot STONE ETAE Amount Remitted I PO 80X E I NEN CUHBERLAND PA Z?O?O HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF CUH~ER£AND CO COURT HOUSE CARLISLE, PA CUT ALONG TNZS LZNE ~" RETAXN LONER PORTZON FOR YOUR RECORDS REV-ZS~7 EX AFP (OZ-03) NOTZCE OF XNHERXTANCE TAX APPRAXSENENT, ALLONANCE OR ~XSALLONANCE OF DE~UCTXONS AN~ ASSESSNENT OF TAX ESTATE OF STEVENS ADELA NFZLE NO. Zt 05-0077 ACN tOZ DATE 07-07-Z005 TAX RETURN NAS: ( X~ ACCEPTED AS FZLED ( ) CHANGED RESERVATZON CONCERNZNG FUTURE XNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASE~ ON: ORiGiNAL RETURN Z. R~aZ Es~a~a (Schedule A~ (Z) ~9~900 O0 NOTE: To insure p~ope~ 2. S~ocks and Bonds (Sch.du~e B} (~) O0 cred~ ~o your account, ~. CZose~ HeZd $~ock/Pa~ne~shJp Zn~e~es~ (Schedule C) ($~ O0 subm~ ~he uppe~ po~Jon ~. Hor~gages/No~es Receivable (Schedule D) (~) O0 of ~h/s fore wi~h your 5. Cash/Bank Deposi~s/Hisc. Personal Proper~y (Schedule E) (5) 911179 57 ~ax payment. 6. Jointly O~ned Prop~r~y (Schedul. F) (6) O0 7. Transfers (Schedule G) (7) 8. To'al Ass.~s (8) ZZ1,079.57 APPROVED DEDUCTIONS AND EXEHPTZONS: Z8,986.~9 9. Funeral Expenses/Ad.. Cos~s/Hisc. Expenses (Schedule H} 10. Deb~s/Hor~gage Liabili~ies/Liens {Schedule 1} (10) .00 11. To,al Deduc~/ons (11) 12. N~ Value of Tax Re~urn (12) 192,09~.08 13. Charitable/governmental Bequests; Non-elected 9115 Trusts (Schedule J) (13) .00 1~. N~ Valu~ o~ (s~l~m Subj~e~ ~o Tax (1~) 192,09~.08 NOTE:X~ an assessment was ~ssued previously, l~ngs 1~, lJ and/o~ 16, 17, 18 and ~eflect f~Du~es that ~n:lude the total of ACC ~etu~ns assessed to date. ASSESSHfNT OF TAX: 16. Amoun~ of L~nm 1~ a~ Spousal r~ (lA) .00 X O0 : .00 1~. Amoun~ of L~nm 1~ ~Bxibl~ a~ L~n~il/Class A ra~8 (1~) 192,09~.08 x 0~5: 8,~.19 17. Amoun~ of L/n~ 1¢ a~ Slblino ra~e (17) .00 X ~ = .00 18. Amoun~ of L/ne 1~ taxable a~ Collateral/Class B ra~e (18) .00 X 15 = .00 19. Principal Tax Due (19)= 8,6~.19 TAX CREDITS: PAYHENT R~CEZPT DISCOUNT AHOUNT PAID DATE ~HBER INTEREST/PEN PAID (-) 0~-15-200S CD002~59 ~2.16 8,211.03 PAYHENT HUST BE HADE BY 10-20-2005~. TOTAL TAX CREDIT I 8,6~$.19 BALANCE OF TAX DUEl 1.00 INTEREST AND PEN. . O0 TOTAL DUE 1. O0 ZF PAID AFTER DATE INDICATED, SEE REVERSE ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) RESERVATION: Estates of decedents dying on or before December II, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collataral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commoneaalth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class D (collateral) rate on any such future interest. PURPOSE OF NOTICE: To ~ulfill the requirements of Section Il40 of the Inheritance and Estate Tax Act, Act ZS of ZOO0. (TI P.S. Section 91q0). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT REFUND (CR): A refund of a tax credit, which wes not requested on the Tax Return, may ba requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-iSIS). Applications ere available at the Office of the Register of Hills, any of the 23 Revenue District Offices, or by calling the special Z4-hour answering service for fores ordering: 1-800-S6Z-Z050~ services for taxpayers with special hearing and / or speaking needs: 1-800-447-SOZ0 (TT OBJECTXONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Z1, Harrisburg, PA 171ZB-lOZ1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CDRRECTIONS: Factual errors discovered on this assessment should be addressed in eriting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. ZB0601, Harrisburg, PA 171Z&-0601 Phone (7173 7B7-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for e Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (5) caZendar months after the dacadent's death, a five percent (SI) discount of the tax paid is PENALTY: The ISg tax amnesty non-participation panaZty is computed on the total of the tax and interest assessed, end not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same tiao period as you would appeal the tax and interest that has been assessed as indicated an this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (93 months and one (1) day from the date of death, to the date of payment. Taxes which became daIinquant before January 1, 19BI bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .000164. All taxes ehich became delinquent on and after January 1, 19BZ wit1 bear interest at e rate which wilt vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2005 ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor X98Z ZOZ .O00S4B 1987 9Z .000247 1999 ?Z .OOOl9Z 1983 16Z .O004~B 1988-1991 llZ .000301 2000 aZ .000219 1984 IZZ .000S01 199Z 9Z .000Z47 ZOOZ 9Z .000Z47 1985 152 .000S56 199S-1994 72 .Ooolgz ZOOZ 6Z .O0016q 1986 lOX .000274 1995-1998 92 .000247 ZOOS 5Z .O00IS7 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT 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 shown on the Notice, additional interest must be calculated. CONNONNEALTH OF PENNSYLVANZA BUREAU OF ZNDZVZDUAL TAXES DEPARTNENT OF REVENUE ZNHERZTANCE TAX DEPT. Z80601 HARRZSBURG, PA 171Z8-0601 NOTZCE OF ZNHERZTANCE TAX APPRA/SEHENT, ALLONANCE OR DZSALLO#ANCE .,~q./~ ~c~q? OF DEDUCTZONS AND ASSESSHENT OF TAX ~i- ' ~:' ESTATE OF STEVENS ADELA H DATE OF DEATH 01-20-2005 FZLE NUNBER 21 05-0077 '03 JUL 16 ~.~5~ CUNBERLAND 6ERACD J SHEKLETSK~ ESQ ACN 101 STONE ETAL PO 80X E k'~;~lu. Amoun~ NEN CUH~ERLAND PA 17070 HAKE CHECK PAYABLE AND REH~T PAYNENT TO: REGISTER OF N~LLS CURBERLAND CO COURT HOUSE CARLISLE, PA 1701~ CUT ALONG THXS LXNf ~ R~TAXN LONER PORT~ON FOR YOUR R~CORDS RiV-15~? EX AFP (01-03) NOTZCE OF ZNHiRZTANCE TAX A~PRAZSEHENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND A$sEs~'-i~-~ OF TAX __,,l'= OF STEVENS ADELA H FZLE NO. 21 03-0077 ACN 101 DATE 07-07-2003 TAX RETURN HAS: (X) ACCEPTED AS FZLED ( ) CHANGED RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORZGINAL RETURN 1. Reel Estate (Schedule A) (1) 1ZglgO0.O0 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 cred/t ~o your account, $. Closely Held Stock/Partnership Tnterest (Schedule C) ($) .00 subm/t the upper 4. Hortgeges/Notes Receivable (Schedule D) (4) .00 of this fora w/th your 5. Cash/Bank Deposits/Hisc. Personal Proper~y (Schedule E) (5} 91;179.57 tax payment. 6. Jointly Owned Proper~y (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 8. Tote1 Assets (8) 221,079.57 APPROVED DEDUCTZONS AND EXENPTZONS: 28,986.~9 9. Funeral Expenses/Adm. Costs/H/sc. Expanses (Schedule H) (9) 10. Debts/Nortgege Liabilities/Liens (Schedule T) (10) .00 11. Total Deduc~/ons (11) 12. Net Value of Tax Return (12) 19Z,093.08 15. Cher/teble/Governeentel Bequests; Non-elected 9115 Trusts (Schedule J) (15) .00 14. Net Value of Estate Subject to Tax (14) 19Z,093.08 NOTE: Zf an assessment ~as issued previously, lines l&, 1S and/or 16, 17, ~8 and ]g reflect f/gures that include the total of ALL returns assessed to date. ASSESSNENT OF TAX: 15. Amount of L/ne 14 et Spouse1 rate (15) .00 X O0 = .00 16. Amount of L/ne 14 ~axeble et Lineal/Class A rate (16) 192,095.08 X 0~5 = 8,6~q.19 17. Amount of Line 14 et Stbl/ng rate (17) .00 X 12 = .00 18. Amount of L/ne 14 taxable et Collateral/Class B rata (18) .00 X 15 = .00 19. Pr/nc/pal Tax Due (19)= 8,6~.19 TAX p~eFr~TS: *EC[ZPT O~$COU.T ,+, A.OUNT PATD DATE NUHBER TNTEREST/PEN PATD (-) 0~-15-Z005 CD002~59 ~$Z.16 8,211.03 HUST BE NADE BY 10-20-2005~. TOTAL TAX CREDTT J 8,6~3.19 PAYNENT BALANCE OF TAX DUEI 1.00 TNTEREST AND PEN. .00 TOTAL DUE 1. O0 TF PAZD AFTER DATE /ND/CATED) SEE REVERSE ( [F TOTAL DUE KS LESS THAN $1, NO PAYHENT KS REI~UTRED. FOR CALCULATTON OF ADDTTTONAL TNTEREST. TF TOTAL DUE KS REFLECTED AS A 'CREDTT' (CR)) YOU HAY BE DUE A REFUND. SEE REVERSE STDE OF THTS FORN FOR TNSTRUCTTONS.) CONNONNEALTH OF PENNSYLVANIA BURE&U OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX ~PT. 180601 HARRISBURG, PA 17118-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE ~c~ OF DEDUCTIONS AND ASSESS.ENT OF TAX ~ ~/~,/. REV-I$,7 EX AFP (01-OS) ~i-' '~ ESTATE OF STEVENS ADELA M DATE OF DEATH 01-20-2005 FILE NUMBER 21 05-0077 '03 JUL 16 ~'~ CUMBERLAND GERALD ~ SHEKLETSK! ESQ ACN 101 STONE ETAL PO 80X E k*~;~'I:' I Amoun~ Rem1*~ed NEN CUMBERLAND PA 17070 ~t~l~ !-~ HAKE CHECK PAYABLE AND REMZT PAYMENT TO: REGZSTER OF NZLLS CUMBERLAND CO COURT HOUSE CARLZSLE, PA 17015 CUT ALONG THZS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS REV-1547 EX AFP (01-03) NOTICE OF ~NHERZTANCE TAX APPRAISEMENT, ALLONANCE OR DZSALLONANCE OF DEDUCTZONS AND ASSESSMENT OF TAX ;~,'~'1'= OF STEVENS ADELA M FZLE NO. 21 05-0077 ACN 101 DATE 07-07-2003 TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATXON CONCERNZNG FUTURE XNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Es~e~e (Schedule A) (1) 129/900.00 NOTE: To insure proper 2. S~ocks end Bonds (Schedule B) (2) .00 cred~ ~o your account, $. Closely Held Stock/Partnership In~eres~ (Schedule C) ($) .00 subei~ ~he upper por~ior ~. Hor~gages/No~es Receivable (Schedule D) (q) .00 of ~his fore with your 5. Cash/Bank Deposits/Misc. Personal Proper~y (Schedule E) (5) 91;179.57 ~ax payment. 6. Jointly Owned Proper~y (Schedule F) (6) .00 7. Transfers (Schedule G) (7) . O0 8. To~l Ass.~s (8) 221,079.57 APPROVED DEDUCTIONS AND EXEMPTIONS: 28,986.~9 9. Funerel Expenses/Adc. Costs~Misc. Expenses (Schedule H) (9) 10. Deb~s/Nortgege Liabilities/Liens (Schedule I) (10) .00 11. To~el Deductions (11) 12. Ne~ Vmlue of Tax Re~urn (12) 192,095.08 15. Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (13) .00 lq. Ne~ Vmlu~ of Es~e~eSub~ec~ ~o Tax (lq) 192,095.08 NOTE:~f an assessment ~as issued previously, Ztnes l&, 15 and/er 16, 17, 18 and reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 16. Aeoun~ of Line 1~ e~ Spouse1 re~e (15) .00 X O0 = .00 16. Amoun~ of L/ne 1~ ~exeble e~ Lineal/Class A re~e (16) 192,095.08 X 0~5 = 8,6~.19 17. Aeoun~ of Line 1~ e~ Sibling re~e (17) .00 x 12 = .00 18. Amoun~ of L/ne 1~ ~axable a~ Collateral/Class B ra~e (18) .00 X 15 = .00 19. Principal Tax Due (19)= TAX CREDZTS: PAYflENT RECEIPT DISCOUNT AMOUNT PAID DATE NUMBER ~NTEREST/PEN PAID (-) 0~-15-2005 CDOO2q59 ~$2.16 8,211.0~ PAYMENT MUST ]~E MADE ~Y 10-20-2005~. TOTAL TAX CREDIT I 8,6q$.19 BALANCE OF TAX DUEl 1. O0 iNTEREST AND PEN. .00 TOTAL DUE 1. O0 ~ IF PAID AFTER DATE ZNDZCATED~ SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1~ NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDZT]:ONAL ]:NTEREST. IF TOTAL DUE IS REFLECTED AS A "CRED/T" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE STDE OF THTS FORM FOR INSTRUCTIONS.) COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 002808 SHEKLETSKI GERALD J ESQ P O BOX E NEW CUMBERLAND, PA 17070 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold .......... 101 $1.00 ESTATE INFORMATION: SSN: 072-26-6502 FILE NUMBER: 2103-0077 DECEDENT NAME: STEVENS ADELA MARTHA DATE OF PAYMENT: 07/16/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 01/20/2003 TOTAL AMOUNT PAID: $1.00 REMARKS: JAMES BRUCE STEVENS C/O GERALD J SHEKLETSKI ESQ CHECK//1033 INITIALS: SK SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS '~-/'~-//~'-~ CONNONgEALTH OF PENNSYLVANZA BUREAU OF ZNDZVZDUAL TAXES DEPARTHENT OF REVENUE ZNHERZTANCE TAX DZVISZON DEPT. Z80601 ZNHERZTANCE TAX HARRISBURG, PA 171Z8-060! STATEHENT OF ACCOUNT RE¥-1607 EX AFP (D1-05) ' ' DATE 07-Z8-ZO05 ~* ESTATE OF STEVENS ADELA H DATE OF DEATH 01-20-200:5 FZLE NUHBER 21 0:5-0077 '0~ /\!~ ~ ~ !~ :~0 COUNTY CUHBERLAND GERALD J SHEKLETSK! ESQ ACN 101 STONE ETAL PO ~OX E L .... [ Amount Re.itted NEg CUHBERLAND I HAKE CHECK PAYABLE AND REH]T PAYHENT TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 1701:5 NOTE: To insure proper credit to your account, submit ~he upper port~on of this for. with your tax payment. CUT ALONG THZS LZNE ~'* RETAZN LOHER PORTZON FOR YOUR RECORDS REV-1607 EX AFP ~01-03} ~# ZNHERZTANCE TAX STATEHENT OF ACCOUNT ESTATE OF STEVENS ADELA H FZLE NO. 21 0:5-0077 ACN 101 DATE 07-Z8-200:5 TH'rS STATENENT TS PROV/DED TO ADVTSE OF THE CURRENT STATUS OF THE STATED ACN TN THE NANED ESTATE. SHO#N BELON TS A SUNNARY OF THE PR/NC/PAL TAX DUE,, APPLTCATTON OF ALL PAYNENTS*, THE CURRENT BALANCE., AND., TF APPLTCABLE., A PROJECTED TNTEREST FTGURE. DATE OF LAST ASSESSNENT OR RECORD ADJUSTHENT= 07-07-200:5 PR/NCIPAL TAX DUE: 8,6RR.19 PAYHENTS (TAX CREDITS): PAYHENT RECEZPT DISCOUNT (+) DATE NUN~ER INTEREST/PEN PAZD ¢-) ANOUNT PAZD 0R-15-200:5 CDOOZ~59 R:52.16 8,211.0:5 07-16-200:5 CD002808 .00 1.00 TOTAL TAX CREDZT 8,6R~.19 BALANCE OF TAX DUE .00 ZNTEREST AND PEN. .00 ZF PAZD AFTER THZS DATE., SEE REVERSE TOTAL DUE . O0 SZDE FOR CALCULATZON OF ADDZTTONAL ZNTEREST. ZF TOTAL DUE ZS LESS THAN $1., NO PAYHENT ZS RE{~UZRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDZT' {CR),, YOU NAY BE DUE A REFUND. SEE REVERSE S/DE OF TH/S FORN FOR ZNSTRUCT'rONS. PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF #ILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: CONHON#EALTH OF PENNSYLVANIA. REFUND (CR): 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-IS13). Applications are available at the Office of the Register of Nills, any of the Z3 Revenue District Offices or from the Department's Zq-hour answering service for fores ordering: 1-800-36Z-2050; services for taxpayers with special hearing and / or speaking needs: 1-BOO-q~7-3OZO (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revanuej Bureau of Individual Taxes, ATTN: Past Assessment Review Unit, Dept. lB0601, Harrisburg, PA 17liB-g601, phone (7173 787-6505. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is allowed. PENALTY: The 15X tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning aith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January l, 198Z bear interest at the rote of six (67,) percent par annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 198Z will bear interest et a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 19BI through ZOO3 ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor xgBz 207. . O00SqB 1967 97. . OOO 2q7 1999 77. . O0019Z 1983 167. .000438 1988-1991 117. .000301 ZOOO 87. .O00Zl9 1984 117. .000301 199Z 97. .0002q7 ZOO1 97. .O00Zq7 1985 137. .000356 1993-1994 77. .000192 200Z 67. .00016q 1986 lOX .OOOZ7~ 1995-1998 9Z .O00Z~7 ZOO3 57. .000137 --Interest is calculated as follows: TNTEREST = BALANCE OF TAX UNPA/D X NUHBER OF DAYS DEL/NQUENT X DATL¥ I'NTEREST 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 tho interest computation date sheen on the Notice, additional interest must ba calculated. Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 12/01/2004 SHEKLETSKI GERALD J ESQ P O BOX E NEW CUMBERLAND, PA 17070 RE: Estate of STEVENS ADELA MARTHA File Number: 2003-00077 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 1/20/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely.., ,~ GLENDA FARNER STP~ASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge STATUS REPORT UNDER RULE 6.12 Name of Decedent: Adela Hartha Stevens a/k/a Adela H. Stevens Date of Death: January 20, 2003 Will No. 2003-00077 To the Register: Pursuant to Rule 6.12 ef the Supreme Court Orphans' Court Rules, I report the following with respect te completion ef the administration ef 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: N/A (c} Did the personal representative state an account informally te the parties in interest? Yes X Ne (d} Copies of receipts, releases, joinders and approvals ef formal er informal accounts may be filed with the Clerk of the Orphans' Court and may be attached te report. 414 Bridge Street New Cumberland, PA 17070 717-774-7435 Capacity: Personal Representative ~. × Counsel for Personal ~-) ~T_ ~u~-'~ Representative est\rel\lform.rel IN RE: ESTATE OF ADELA MARTHA : IN THE COURT OF COMMON PLEAS OF STEVENS, A/K/A ADELA : CUMBERLAND COUNTY, PENNSYLVANIA M. STEVENS LATE OF LOWER ALLEN : TOWNSHIP ,CUMBERLAND : ORPHANS' COURT DIVISION COUNTY, PENNSYLVANIA : NO. 2003-00077 RECEIPT, RELEASE AND WAIVER OF ACCOUNTING KNOW A ILL MEN BY THESE PPdZSENTS, that I, BARBARA GRIMSHAW, being one of the beneficiaries under the will of ADELA MARTHA STEVENS, A/K/A ADELA M. STEVENS, do hereby acknowledge that I have received all sums of money and property due me by virtue of the death of ADELA MARTHA STEVENS, A/K/A ADELA M. STEVENS, in full satisfaction and settlement of all of my rights and claims under her estate. I further declare, intending to be legally bound, that I hereby waive my right to require the filing of a First and Final Account and Proposed Schedule of Distribution in any Court of Common Pleas having jurisdiction over the same, and I acknowledge that I have had an opportunity to examine copies ef the books and records of the said estate, and I agree to the final distribution of the estate without further formalities, and with the same force and effect as if a First and Final Account and Proposed Distribution had been filed in a Court ef Common Pleas ef Pennsylvania having jurisdiction over the same and duly audited and confirmed. AND THEREFORE, I, BARBARA GRIHSHAW, do by these presents, remise, release, quitclaim and forever discharge the Executor, his heirs, successors and assigns, from the acts ef the Executor as aforesaid, and of and from all actions, suits, payments, accounts, reckonings, claims, and demands whatsoever, for or by reason thereof, or any ether act, matter, cause or thing whatsoever, and I de hereby consent te the discharge of the said Executor. IN WITNESS WHEREOF, I have hereunto set my hand and seal the day of ./_~~, ' , 2004. Witness BARBARA GRIMSHAW COUNTY OF : On this, the day of , 2004, before me a Notary Public, the undersigned officer, personally appeared BARBARA GRIMSHAW, known te me (er satisfactorily proven) te be the person whose name is subscribed te the within instrument and acknowl- edged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and seal the day and year first above written. COMMONWEAUH OF PENN~LVANIA / No{~r~/Pub-1 i c - ;.7©'tARIAL SEAL _ .. J GERALD ,}. SHE!(LETSKI, Notary Fumic I New Cumberland Boro. Cumberland Co. J My Commi~ion Expires Noy. 9, 2006] est~relllform.rel IN RE: ESTATE OF ADELA MARTHA : IN THE COURT OF COMMON PLEAS OF STEVENS, A/K/A ADELA : CUMBERLAND. COUNTY, PENNSYLVANIA H. STEVENS : LATE OF LOWER ALLEN : TOWNSHIP ,CUMBERLAND : ORPHANS' COURT DIVISION COUNTY, PENNSYLVANIA : NO. 2003-00077 RECEIPT, RELEASE AND WAIVER OF ACCOUNTING KNOW ALL MEN BY THESE PRESENTS, that I, JAMES BRUCE STEVENS, being one of the beneficiaries under the will of ADELA MARTHA STEVENS, A/K/A ADELA M. STEVENS, do hereby acknowledge that I have received all sums of money and property due me by virtue of the death of ADELA MARTHA STEVENS, A/K/A ADELA M. STEVENS, in full satisfaction and settlement of all of my rights and claims under her estate. I further declare, intending to be legally bound, that I hereby waive my right to require the filing of a First and Final Account and Proposed Schedule of ~istribution in any Court of Common Pleas having jurisdiction over the same, and I acknowledge that I have had an opportunity te examine copies ef the books and records ef the said estate, and I agree to the final distribution of the estate without further formalities, and with the same force and effect as if a First and Final Account and Proposed Distribution had been filed in a Court of Common Pleas of Pennsylvania having jurisdiction over the same and duly audited and confirmed. AND THEREFORE, I, JAHES BRUCE STEVENS, de by these p'resents, remise, release, quitclaim and forever discharge the Executor, his heirs, successors and assigns, from the acts of the Executor as afore- said, and ef and from all actions, suits, payments, accounts, reckon- ings, claims, and demands whatsoever, for or by reason thereof, or any other act, matter, cause or thing whatsoever, and I do hereby consent to the discharge of the said Executor. J~-~INdayWITNESSof~r_~r~~ve,hereunt°2004. set my~hand and seal the Witness JAMES BRUCE STEVENS -' COMMONWEALTH OF PENNSYLVANIA: : SS: COUNTY OF CUMBERLAND : On this, the /~'~/~ day of ~ , 2004, before me a Notary Public, the undersigned officer, personally appeared JAHES BRUCE STEVENS, known to me (or satisfactorily proven) te be the person whose name is subscribed to the within instrument and acknowl- edged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereunto se~ my hand and seal the day and year first above written. ~~.~~~~ t~O'!'~RIAL SEAL ~ N~ry Public ~!' ~AL~ J. SHE~L~SKI, No~ry Public j ~ow G,mi)e~tan~ Boro. Cumberland Co. My g~,mmissir~n Expires Nov. 9, 2006