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HomeMy WebLinkAbout04-0717 PETITION FOR PROBATE and GRANT OF LETTERS also known as To: Register of Wills (or ~he Deceased. County of {Z~0h~[~ in the Social Security No. ~'l~. 0 ~ ~ ~ r~ ~ Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executOl~ q named in the last will of the above decedent, dated ?~v~. ~ ~o and (state relevant circnmstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in C2.O ~ ~0 ~ ~.~)x Countv, Pennsylvania, with h~.'(L last familyor, principal residence at ~'~O,~-e--C~R¢]~a ~O~gi~ (~st street, number and muncipality) Decendent,, th~en ~ -'~ years of age, died ~ ~3"'0 [ Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing andwas never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: o WHEREFORE, petitioner(s) respectfully request.(.s) the probate of the last will and codicil(s) presented herewith and the grant of letters ~ e.~ ~ a~ theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) 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 belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affir~/~ and subscribed f- .X' (~ before m~ this __ c-,L ,_ day of I c-~~ ,. , .. f,f,,~,,~s'--f" ¢-;%,"~, ~ ' J ' ~j_ STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: Will No.: ~)xC)C) t~ - O {7) ~ 'l ~ Admin. No.' Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes [~ 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 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes [--] No [-] c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Signature Name ~ ~'~ Address '-' ph :~ ' "~ '[- ~"-':~,~ Tele one No. Capacity: ~ Personal Representative ~] Counsel for personal representative DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~ ~ k k(~)~k.~-V '~/~ , in consideration of the petition on the reverse side h-ereof,(~atisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated "~ - l(t~ ~ ~C~, ~-' described therein be admitted to probate and filed of record as the last will of. and Letters ~ .~"¥'~-,. ',"'~--e v'x-¥o, ~ ~ . ~ ~e hereby granted'rd ~'~ k~x~ ~ ~ ~ ~ Probate, Letters, Etc .......... $~ · ~ Sho~ Certificates( ) .......... $ ~. ~ A~ORNEY (Sup. Ct. I.D. No.) $~ ADDRESS TOTAL $ I ~ ~. ~ ~il~a .~.~.~..v. ~.~ ............ This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. P 10528592 .?ENT %~,,, No. ~ Date H~(~ 143 Rev 2/87 COMMONW~L~ OF PENNSYLVAN~ · DEPAR~ENT OF H~LTH · VITAL REaR CERTIFICATE OF DEATH ~ c Fe~an ~female ~.172 ~1 - 1128 ~.7-28-0~ ,11 -18-1 arrisburg, p~ ~.~, ~ ~,~ ,~umberlanfl. ~ anxcsbur~ Sexdlo Skxlled Care ~, ~"~"~ ' ~. White ,~intenance ,xsor U.~ Posta ~.,D ~ ~,~ ~'~'~ ~idowed ,~arrtsburg, Pa. 17112 (~ William E. Fegan ~.459 Kennedy Dr. Harrisburq, Pa. 17112 ~* ~y 31,2004 Green Mem. Par ~,. Camp Hillt Pa. ,~usselman Funera~ ~ome ~ Q.~-?~c. Pa ELIZABETH C. FEGAN BE IT REMEMBERED, that I, ELIZABETH C. FEGAN, of 508 Harding Street, New Cumberland, Cumberland County, Pennsylvania, being of soun~.~lnd, ql~emo~,~a~nd understanding, do make, publish and declare this as and for my Lasti~ill anWTest~t, : hereby revoking and making null and void any and all Wills and Te~ents-~nd wriffags in the nature thereof by me at any time heretofore made. ITEM 1: I direct that my hereinafter named Co-Executors pay all my just debts, my funeral expenses, and the expenses of the administration of my estate. With this direction, I authorize and empower my Co-Executors to expend for my funeral expenses and interment such amounts as they may consider necessary and proper, without regard to any limit that may be prescribed by a court of law. ITEM 2: I direct my Co-Executors to pay all inheritance, estate, succession, and legacy taxes of whatsoever nature and kind, to which my estate, or the transfer of any property passing hereunder or otherwise passing by reason of my demise, may be subject, and to charge such taxes against my residuary estate, it being my intention that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross estate, under the provisions of any state or federal law now in force or hereafter enacted, shall be prorated among the persons interested in my estate to whom such property is or may be transferred or to whom any benefit accrues. ITEM 3: All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, whether it be real, personal or mixed, including property over which I have a power of appointment, I give, devise and bequeath unto my children, provided they survive me for a period of thirty (30) days, in equal shares, per stirpes. ITEM 4: In the event that any of my children should predecease me leaving issue surviving, I bequeath the share of such deceased child to his or her issue, in equal shares, per stirpes. ITEM 5: In the event any of grandchild who receives an interest under this Will shall be less than thirty (30) years of age at the time of my death, I give the share of such deceased child unto his or her surviving spouse, IN TRUST, NEVERTHELESS, for the following uses and purposes: A. My Trustee shall hold and administer said trust property, collect the income therefrom, and expend or apply the net income as hereinafter directed. During the administration of ~. my estate, the income earned by the property included in this .~ trust shall be considered income of this trust and subject to ~ distribution as hereinafter provided for other income of this ~ trust, v~ B. My Trustee shall pay and/or use for the benefit of said minor ~.~.~'~ children or their lineal descendants so much of the net income as deemed necessary for their support, maintenance, and education, and any income not so used shall be accumulated and added to the corpus of this trust. C. My Trustee shall have the power in his discretion to encroach upon the corpus of the trust estate in such amounts and at such times as he may deem necessaxy in order to provide for the support, maintenance, care, and education of said minor children. D. All of the net income may be paid to or for the benefit of the children at least semi-annually. E. When the oldest said minor child attains the age of twenty-two (22) years, the principal of the trust shall be divided into as many shares as are hereinbefore mentioned living children. Upon attaining that age, that child shall have the right to withdraw principal from this trust in the following manner: (1) TWenty-Five Per Cent (25%) of the then value of the principal upon the child's attaining the age of twenty-two (22) years, at his or her request; (2) Fifty Per Cent (50%) of the balance of the remaining principal upon the child's attaining the age of twenty-five (25) years; and 3 (3) The entire balance of his or her share upon said child's attaining the age of thirty (30) years. Such rights of withdrawal shall be cumulative, and may be exercised in whole or in part, from time to time, after that right accrues. ITEM 6: I nominate, constitute and appoint my son, WILLIAM E. FEGAN and my daughter LINDA J. GLUCK or the survivor of them, as Co-Executors of this my Last Will and Testament. ITEM 7: I direct that my hereinbefore named Co-Executors shall not be required to give bond for the faithful performance of their duties in this or any jurisdiction. IN ~W~NESS WHEREOF, I have hereunto set my hand and seal this /~(~- day of ( ~Z/Y(.ff , 1995. The preceding instrument, consisting of this and four (4) other typewritten pages, was on the day and date thereof signed, sealed, published, and declared by the Testatrix herein named, as and for her Last Will and Testament, in the presence of us, who, at her ~.tqCe~;~ ~ rt~ence a~nd inlhe presence °f ~f.~h other, have subscribe,.d our names as COMMONWEALTH OF PENNSYLVANIA : COUNTY OF YORK : -~,~ 6~/~~ and We, ELIZABETH C. FEGAN, t~ ~' o~fl-JJ[~ff"" ,the Testatrix and the witnesses, respectively, whose names are signed ftfi the attached or 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 Testament, and that she signed willingly, 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 witnesses, and that to the best of their knowledge, the Testatrix was at the time eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence. SWORN TO AND SUBSCRIBED BEVORE ME THIS D^Y NOT ,A~Y PU~LI~// Notarial Seal Janet $. Gore, Notary Dilisburg Boro, York County My Corem ss on Exp res Oct. 25, 1998 Member, Per~r~ylva~a AssociaOon of Iqota~es COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11 96) PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004425 FEGANWlLLIAM E 459 KENNEDY DR HARRISBURG, PA 17112 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 $2,773.00 ESTATE INFQRMATION: SSN: 172-01-1128 FILE NUMBER: 2104-0717 DECEDENT NAME: FEGAN ELIZABETH C ~ATE OF PAYMENT: 09/24/2004 POSTMARK DATE: 09/23/2004 COUNTY: CUMBERLAND DATE OF DEATH: 07/28/2004 TOTAL AMOUNT PAID: $2,773.00 REMARKS: CHECK# 105 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS Date of Death: '0"~1~ ~-~{~, .~x~(~l.~ Will No. ~00 ~ -- 0 ~ { ~ Admin. No. To ~¢ Register: I ce~ ~at notice of (~nefi~ ~t) ~ ~uired by Rule 5.6(a) of~e ~h~s' Cou~ Rules was se~ on or m~led to the following benefici~es of me above-captioned estate on ~ ~; ~00~· Nme Ad&es~ Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Address.. L.¥E'~ K%iM~,/ ~OXL Teleph°ne ~1~ ~5~- qOgg Capacity: Personal Representative ~.Counsel for personal representative September 23, 2004 REGISTER OF WILLS ESTATE OF ELIZABETH C FEGAN FILE # 2004-00717 William E Fegan 459 kennedy Dr Harrisburg Pa 17112-3164 Phone # H (717) 652-9082 W (717) 257-4893 (M-F 7:30 - 4:00) co..o.w,,,,oF REV-1500  "~*,2[o~'~~ INHERITANCE TAX RETURN ~m~o~ RESIDENT DECEDENT 11/1~ 07~ REG~R OF ~LLS WI~M E FEG~ 459 ~NNEDY OR F~ ~E ~) ~RISBURG, PA 17112-31~ (71 ~ 652-~ 3. ~H~ ~,~~p (3) 0.~ (~O~L) ~2, NM V*~ ~ ~ (u~ 8 m~ ~ ~) 19. T~ (19) 2,919.00 Decedent's Complete Address: 459 KENNEDY DR Clh'HARRISBURG I SrAmPA I Ze17112 Tax Payments and Credits: 1. Ta~ Due (Page 1 Lm 19) (1) 2,919.00 2, Credits/Payments 0.00 A. Six~sal PoveAy C~it B. Prior ~y~mels 0.00 Totel C~lits (A+ B + C) (2) ~.~, 3. Inte~nalty if app~cabte O. Iman~ 0.00 E. Pmmlt-/ 0.00 Total IntemsUPe~alty ( D + E ) (3) 0.00 4. IfL]ne2isguetm'thanLiuel +Liue3, enterltmdilfamnce. This is the OVERPAYIIENT. Check box mt Page I Line 2~ to request a refund (4) 0 5. ff Lira I + Line 3 is greater Utah Line 2, enter the diltesm'tce. This is the TAX DUF_ (5) ~'~'~ ~ A. Enter f~he interest ue the tex due. (SA) 0,00 B. Entre lhe te~al of L~e 5 + SA. This is the I~J. ANCE i~JE. (58) 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 kaester and: Yes No a. retain Ihe use or irte~me of the pmf)erty tmnstennd; .......................................................................................... [] [] b. retain ~e ~ht to desi~ate wbo s~dl use the property traesfmTed or its mc~rne; ............................................ [] [] c. mteio a revelsimmly ink~ or .......................................................................................................................... [] [] d. recewe the pmm~ue ~ li~ of ei'~er paymuets, bemats e~ cam? ...................................................................... [] [] 2. If death occun~l alter Decembor 12, 1982, did decedent tnmsfm' properly withk~ orm year of dueth ~out rece~ adequate ~-~dea, o,? .............................................................................................................. [] [] 3, Did decede~ arm an 'in ~msst tel' or payal~e upon death bank account or sesulity at his or ~r ~? .............. [] [] 4. Did desnde~t own an Individual Ref~mment Accouet, annuity, or olher ue~bate pmpedy wflich corem a be,er~ de~r~m? ........................................................................................................................ [] [] IF THE ANSWER TO ANY OF THE ABOVE QUES110NS IS YES. YOU MUST C01IPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ~ ',~,~ ! '~ 09/21/04 NX~ESS 459 KENNEDY DR, HARRISBURG, PA 17112 SlGNA'It~E OF PREPARER OTHER ~ REPRESENTATIVE N~ORESS F2 P.S. ~s (a) (1.1) (i)]. For dams M daeth m or aft~ Jesua~ 1, 1995, Ihe tax v~e imposed m Ihe net v~ue o~ ~aode~ te ~r ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ E~ ~116 (a) (1.1) ~ Tbo stelum ~es n~ a~!~ a trainer tea suwiving sCueue from tex, and the statutec/mquimme~s for disdemm of ~ ~ a~ a ~ ~m ~ ~ ~Ne ~ ~ Ihe sundog slxx~se ~s Ihe o~y I~uef~ary. er a stepl~a~ ~ the child is 0~ ['/2 P.S, ~9116(aX12)]. 1he tax rate b~:l m the n~ value of Iranstem te or for tl~e use d ~e desedeot's llnuel ~ is 4.5%, ~ es ~ ~ ~ RS. ~11~12) ~ RS. ~11~a~1)]. The lax rate impoesd ue ~e net vdue ot' l~anste~s to er fer the ues ~ the desedeot's aTJ~ is 12% |72 ES. ~9116(aX1.3)]. A sibrmg is defined, under Sesl~ 9102, es an REV-1503 EX+ ~ SCHEDULE B c,~.,.o,~L~ o~,.~.,~,,,,.~. STOCKS & BONDS ESTATE OF FILE NUMBER ELIZABETH C FEGAN 2004-00717 All propaK'/jointly.owned with right of survivorship must bs disclosed on tlchedule P, I11~M VALUE Al- BAT~ NUMBER DESCRIP 110N OF DEATH 1. JOHN HANCOCK PREFERRED INCOME FUNO I11 46,244.00 2 COHEN & STEERS REIT PREFER!RED INCOME FUNO 22,118.00 3 JANES ASPEN GLOBAL TECH 1,285.00 4 CAPITAL APPRECIATION PORTFOLIO ~LAC 1,585.00 5 MFS EMERGING GROWTH PORTFOLIO TLAC 1,750.00 6 EQUITY INCOME PORTFOLIO TLAC 3,530.00 TOTAl. (Nso ~ter on line 2, Rec~pibda~i<m) $ 76,512.00 (if more space is needed, insert additional sheets of the same size) .aVelers Life & Annuity' Amemberofcitigroup ~J ~O~'I'R~ATION ~TAT~T Annuity Tnvestor Services Current Date: 08/22/2003 PO Box 990012 HARTFORD CT 06199-0012 Agent Name: OFF[CE ACCOUNT ELIZABETH C FEGAN 459 KENNEDY DR HARRISBURG PA 17112-3164 Non-Qualified Account Number: 9358237 Unit Units This Date Transaction Description Amount Price Transaction 05/22/03 Adm/nistrative Charge $4.73- $0.313154 15.1044- 08/22/03 Administrative Charge $5.84- $1.410263 4.1411- 08/22/03 Administrative Charge $6.44- $1.058736 6.0827- ACCOUNT SUF~U%RY Janus Aspen Global Tech 1,285.44 Capltal A~preciation Port 1,585.41 MFS Emerging Growth Port 1,749.81 Equity Income Portfolio 3,529.55 ACCOUNT BALANCE AS OF 08/22/2003 $ 8,150.21 If you have any questions or Service needs, call your smith Barney financial consultant directly or call our customer service center at 1-800-842-8573 Monday through Friday 8:00 a.m. to 6:00 p.m. Eastern Time. If you prefer to write, our address is: Travelers Life & A~nuity, Annuity Investor Set%rices, PO Box 990013, Hartford CT 06199-0013. Travelers Distribution LLC., ~s principal underwriter, confirms the above transaction(s) in your account in accordance with your instructions for the fund(s) in which the transaction(s) were made and in accordance with the prospectus. The contract(s) is issued by either The Travelers Insurance Company or The Travelers Life and Annuity Company. 923516 Page t of I UBS FINANCIAL SERVICES INC. 1735 MARKET STREET 35TH FLOOR Confirmation PHILADELPHIA, PA 19105=6933 DOllOOg7150OOOOOO~300006183JHS349000002S PASE I OF 1 Account Number JH 65q90 Universal ID: n8719q9000N Your Financial Advisor HOPP, JEFFREY 215-972-6800/ *Important. Please retain for your records.* ELIZABETH C FESAN C/0 VALERIE A FEGAN ~ q59 KENNEDY HARRISBURG PA 17112-S16q ~ I,,,111,,,I,,,11,,,11,,I,1,,11,,,,11,11,,,I,,I,1,1,1,1,,11,,,I We confirm the following transaction(s): Payment datel Trade activity Trade date Date processed Settlement date SOLD 08/09/2004 08/09/2004 08/12/2004 It is important that you retain this trade confirmation for your tax and financial records. When remittances/securities are due, they must be received by us at the address above on or before the payment/settlement date. Payments not received by the settlement date may be subject to a late settlement fee. Please indicate your account number on your check or correspondence. Make checks payable to UBS Financial Services Inc. Please see the back of this confirmation for additional terms and definitions applicable to this transaction. UBS Financial Services Inc. is an indirect subsidiary of UBS AG and an affiliate of UBS Securities LLC. UBS FINANCIAL SERVICES INC. ~1~ 1735 MARKET STREET · · Confirmation ~ 35TH FLOOR PHILADELPHIA, PA 19103~6953 DO110097)5 00000001300006103 JH63490 O 00025 PAGE 1 OF 1 Account Number JH 63~,90 Universal ID: 08719~9000N Your Financial Advisor HOPP, JEFFREY · Important. Please retain for your records,* zls-97z-6800/ ELIZABETH C FEGAN C/O VALERIE A FEGAN ~ ~59 KENNEDY ~ HARRIS'RURG PA 17112-316q A h,,llh..h.,Ih,,Ih,hh.lh.,Ihlh,,h.hhhhh,lh,,I We confirm the following transaction(s): Payment date/ Trade activity Trade date Date processed Settlement date SOLD 08/09/2004 08/g9/200~ 08/12/2004 2,000 JOHN HANCOCK PREFERRED 25.495000 e~6,990.00 e759.68 ~6.55 ~NCOHE FUND III UNSOLICITED Average P~lced T~ade SYHSOL HPS CUSIP NO. 41021PlO$ Locat/on of Execution: 01Capac/t¥= lent It is important that you retain this trade confirmation for your tax and financial records. When remittances/securities are due, they must be received by US at the address above on or before the payment/settlement date. Payments not received by the settlement date may be subject to a late settlement fee. Please indicate your account number on your check or correspondence. Make checks payable to USS Financial Services Inc. Please see the back of this confirmation for additional terms and definitions applicable to this transaction. uas Financial Services Inc. is an indirect subsidiary of UBS AG and an ah'iliate of UBS Securities LLC. ,~-,~ca F~* (~0~) ,j~ SCHEDULE U C(~a4MOelWE~d.TH ~ PIE~INSYLVANtA CASHI BANK DEPOSITS, & MISC. ESTATE OF FILE NUMBER ELIZABETH C FEGAN 2004-00717 Include the proceeds of litigation and the date the proceeds mm received by the estate. All property jothtly-owned with dg~t of Sundvomhlp must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH I WAYPO~NT ~U~JK- CHEC~NG ~%LANCE 1,266.00 TOTAL (Also enter on line 5, Recapitulation) $ 1,266.00 (If mom space is needed, insert additional sheets of the same size) Account Agreement Date: 8/23/2004 ...... Internal Use WAYPOINT BANK - 021 == -- - 235 N SECOND ST THE ESTATE OF ELIZABETH C FEGAN HARRISBURG, PA 17101 WILLIAM E FEGAN LINDA JEAN GLUCK 459 KENNEDY DR HARRRISBURG, PA 17112 MPORTANT ACCOUNT OPENING INFORMATION: Federal law requires ~.j=,_.::=._._.::;: .... us to obtain sufficient information to verify your identity. You may be asked several questions and to provide one or more forms of The specified ownership will remain the same for all accounts. identification to fulfill this requirement. In some instances we may use outside sources to confirm the information. The information you provide [] Individual [] Corporation - For Profit is protected by our privacy policy and federal law. [] Joint with Survivorship [] Corporation - Nonprofit Enter Non-Individual Owner Information on page 2. There is addltional (not as tenants in common) [] Partnership Owner/Signer Information space on page 2. [] Joint with No Survivorship [] Sole Proprietorship (as tenants in common) [] Limited Liability Company N.me WILLIAM E FEGAN [] Trust-Separate Agreement Dated: Relationship ~o EIXTING [] Accoun! {Owner *d~.e. 459 KENNEDY DR (Check appropriate ownership above.) HARRRISBURG, PA 17112 [] Revocable Trust Mailing Address 459 KENNEDY DR [] ifdifferentl HARRRISBURG, PA 17112 ~*rne Phone (717) 652-9082 i ............ '~' ....... ' .... (Check appropriate beneficiary designation above.) Vor~ ~0.~ (717) 257-4893 E-Mail 8i.h De,. 12/06/2004 SS.IT,. 181383773 Driver'sLi°e[3seN°' PADL 14904504 EXP 12/06/2004 (Description, Detalia] [] If checked, this is a temporary account agreement. ErnPl°Yer'sName Number of signatures required for withdrawal: 1 & Address Addrees 3812 PALMETTO CT as. or on behalf of, the account Owner{s) agree to the terms of, and ~.,i,=^dd,, 13812 PALMETTO CT [] Terms and Conditions [] Truth in Savings [] Privacy if di~.,..~ ELLICOTT CITY, MD 21043 [] Electronic Fund Transfers [] Funds Availability .o.~ ~o.e I (410) 465-4270 [] Common Features [] Birth Date 6/12/1946 WILLIAM E FEGAN ss.mN 168363212 [ ] s~.,a, ~..~. Da~.. LINDA JEAN GLUCK ,CDeh.': rli pDtion, Details) IX ] [] Authorized Signer (If checked and account is individual and consumer purpose, the last of the above signers is an Authorized Signer.) U.me Ne.. THE ESTATE OF ELIZABETH C FEGAN Relationship to FIN 746536747 and/or Signer, etc,) P~none (717) 652-9082 E-Mail 459 KENNEDY DR Si,hO~te HARRRISBURG, PA 17112 SSN/TIN Mailing AUd .... 459 KENNEDY DR Ddver'sLicenseNe. (~fdifferentl HARRRISBURG, PA 17112 Fi~eneiallr~s! FOCUS FIFTY 100853225 , 1,265.82 "'--' [] Cash [] Check( Addless [] Cash [] Check [] Home Phone [] Cash [] Check ~r~h Date [] ATM [] Debit/Check Cards (No. Requested: SSN/TIN [] [] Oliver's License Ne, [] [] ?f not a "U.S. Person," certify foreign status separately.) TIN: 746536747 [] Taxpayer I.D. Number (TIN) - The number shown above is my correct taxpayer identification number. {~ Backup Withholding - ~ am not subject to backup withholding either because I have not been notified that I am subject to backup withholding as a result of a failure to report all interest or dividends, or the Internal Revenue Service has notified me that I am no longer subject to backup withholding. [] Exempt Recipients - I am an exempt recipient under the Internal Revenue Secvice Regulations. cel~dfy under penalties of perjury the statements checked in this section and that J am a U.S, person (including e U,S. resident alien). X (Date) ©2003 Bankers Systems, Inc., St Cloud, MN Form MPMP-LAZ-PA 5/12/2003 __ /page 2 of 2] SCHEIDUlII H COMMONWEALTH OF PENNSYLVANIA IF~NEE~ ~ & INHERITANCE TAX RETURN A[~i~E COSTS ESTATE OF FILE NUMBER ELIZABETH C FEGAN 2004-00717 NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~' UUSSELIMAN FUNERAL HOME (ALL EXPENSES) 6,090.00 B. AD~INIS'IRATIVE COSTS: c~ s~e R~ao,s.~p of C~a~mant to 4. Probate Fees 118.00 TOTAL (Also enter on line 9, Recapitulation) $ 6.208.00 (If mom space is needed, insert ad~lional sheets of the same size) ,,~ SC#EDUI~E ;I CO..O.WE^LT, OF.E..S~LVA,~^ DEBTS OF ;~;EDIE~, ~,,~,~,c~ ~,~u,, ~GAGE L~BiI;~I~. & MIENS ESTATE OF FILE NUMBER ELI~BETH C FEGAN 20~-00717 1. SEI~LE S~LILED INURSIN~N~E H~LTH 780.00 2 SEI~E S~LLEO NURSIN~PIN~E H~LT~ 5,7~.~ 3 SEI~E S~LLED NURSI~RNN~E H~LTH 16.~ 4 DR JOHN GIL~D~ 135.~ TOTAL (Also en~on lifm 10, Re~,~ulalion) $ 6,697.00 (if more space is needed, insert additional sheets of the same size) RRAUD PEGAN ,ELIZABETH 233504 IF 193 I 07/0~0~10!~0~ ! ~ I HTT~RMOSER G~RY S~RY OF CHARGES R&C NF-INT 27~YS~ 195.00 5265.00 5265.00 LAB0~TORY 89 176.00 176 . 00 MED/SURG S~PLIES 287.46 287.46 SPECIAL ~R ~IT 213.96 213.96 SUB-qOTAL OF C~G~ 5942.42 5942.42 BA~CE FORWARD 5766.42- 5766.42 GUA~ RELATIONSHIP: S SE~ F G~AR NO: 23350~ DIA( NOSIS: V66.5 331.0 Pinnacle Health Hospitals P.O. BOX 2353 :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::i:::.: i:::. ?::15 HARRISBURG, PA 17105 ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: i::.:: ~!:: ::~ :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: Fur Aeeount l uformatlon, Please Call Ol Transaction D~e Descri~ion Amount PREVIOUS BALANCE 6,186.21 07/26/06 W/0 DIRECT INP/OP 701 MEDICARE 17.00- 07/28/06 PMT-CREDIT CARD 6,380.Z1- 08/17/06 PMT MEDI B VERITUS 701 MEDICARE 262.72- 08/18/06 MEDICARE OISCOUNT 701 MEDICARE 1,527.96- Estimated Insurance Due: .00 Total Patient Credits: Account Balance: 16.34 CUSTOMER SERVICE HOURS MON-WED-FRI 7:00AM TO 4:00PM TUES-THUR 7:00AM TO 6:00PM CALL 717-230-3717 LOCAL OR 1-800-~03-6064 OUT OF AREA .................................................................... _~ ?_~_, _~_'~:_h_ _a "_~_ _r _'t~ _" ~ ?_ ~_~ _u ~_ £~ _m~ ............................................................... Pinnacle Health Hospitals P.O. BOX 2353 HARRISBURG, PA 17105 For Accmmt lnfi)rmation~ Please Call (717)2~0-D717 ....... Transaction Date Descriptioo Amou~ PREVIOUS BALANCE 596.11 05/26/06 8ED HOLD-PRIVATE 195.00 05/27/04 8ED HOLD-PRIVATE 195,00 05/28/04 8ED HOLD-PRIVATE 195.00 05/29/0~ ~ED H~!.D-PRIVATE 195.00 06/10/06 MEDICARE DISCOUNT 650 MEDICARE 98.11- 08/12/06 PMT-MEDICARE A 650 MEDICARE 581.86- 08/18/04 MEDICARE DISCOUNT 650 MEDICARE 8S.86 kst'matcd Insurance Doe: o00 Total Patient Credits: Accoont Balance: 780.00 CUSTOMER SERVICE HOURS MON-WED-FRI 7:00AM TO 4:00PM TUES-THUR 7:00AM TO 0:00PM CALL 717-230-37~7 LOCAL OR 1-800-60341004 OUT OF AREA ...................... Pimple de,ach and return with your [~a~mmnt , For Hompltal Uae Only Account Numbe~ ~ ADM DT: 053004 233504401I ~QiO0 :. Patient Name: ]Duo ay: PINNACI~IC IIEALTll IIOSIqTALS DSH DT: 053104 FEGAN ,£LIZABETHI 09103104 P.O. BOX 22153 IIARRISBUBG, PA 17105 HOSPSVC: SSN [] ~ [] pm~mml [] ~ [] ~ ADDRESS SERVICE REQUESTED DX CD: Mal<e Check Payable To PINNACLE HEALTH HOSPITALS I.,llh.,I,,,ll,,,Ih,hh,lh,,,Ihlh,,h,hhl,hl,,Ih,,I 00000575 1 AT 0.292 01 I,,,111,,,I,,,1111,,,,I,1,,,I,1,,11,,I,1,,,11,,I,1,,,11,,I,1,1 253506601 PINNACLE HEALTH HOSPITALS ELIZABETH C FEOAN P.O. BOX 2353 659 KENNEDY ]'JR HARRISBURO, PA 17105-2555 HARR'rSBUR6 PA I711Z-5164 ] Please check this box If your address or Insurance Information has changed and record the changes on the hack of this statement Dr. John I. Gilson 11 W. Winding Hill Road Mechanicsburg, PA 17055 717-766-4479 TO: E11 zabeth Fegan c/o Mr. Bill Fegm~ 459 Kennedy Drive Harrisburg, PA 17112 DATE DESCRIPTION TOTAL CREDITS 7~ Initial Consaltationfor fractured tooth #9 mesial/ .... incisal fracture. Removed sharp edses~ smoothed and sealed tooth fracture, 135 O0 7-~r~/Oh Post-Dp check N/C 135 O0 SCHEDULE J ESTATE OF FILE NUMBER ELIZABETH C FEGAN 2004-00717 Sec. ells (a) ('L2)I WILLIAU E FEGAN SON 0.34 459 KENNEDY DR HARRI$8URG, PA 11112 2 LINOA J GLUCK DAUGHTER 0.33 3812 PALMETTO CT BUUCOTT cI~rY, MO 21043 3 NANCY J GERESHEIM DAUGHTER 0.33 830 CHANCBULOR CT NAPERVILLE, IL 60540 B, CHARITABLE ANO GOVERNMENTAL OIS TRIBU TIONS TOTAL O~ PART II - ENTER TOTAL NON*I'AXABLE OIS'IRIBUTIONS ON LINE 13 OF REV-1500 COVI~ SHEET 0.00 (if more space is needed, insert additional sheets of the same size) ELIZABETH C. FEGAN BE IT REMEMBERED, that I, ELIZABETII C. FEGAN, of 508 Harding Street, New Cumberland, Cumberland County, Pennsylvania, being of sound mind, memory and nnderstanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any aad all Wills and Testaments and writings in the nature thereof by me at any time heretofore made. ITEM 1: I direct that my hereinafte~ ~amed Co-Executors pay all my just debts, my funeral expenses, and the expenses of the administration of my estate. With this directioa, I aatborize and empower my Co-Exeeulors to expend for my funeral expenses and interment such amounts as they may consider necessary and proper, without regard to any limit that may be prescribed by a court of law. ITEM 2: I direct my Co-Executors to pay all inheritauce, estate, succession, and legacy taxes of whatsoever nature and kiad, to which my estate, or the transfer of any property passing hereunder or otherwise passing by reason of my demise, may be subject, and to charge such taxes agaiust my resklumy estate, it being my intention that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross estate, under tbe provisions of any state or federal law now iu force or hereafter enacted, shall be prorated among the persons interested iu my estate to whom such property is or may be transferred or to whom any benefit accrues. ITEM 3: All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, ~vhether it be real, personal or mixed, iacluding property over which I have a power of appointment, I give, devise and bequeath unto my children, provided they smwive me for a period of thirty (30) days, in equal shares, per stirpes. ITEM 4: Ill the event that any of my children should predecease me leaving issue sutwiving, I bequeath the share of such deceased child to his or her issue, in equal shares, per stirpes. ITEM 5: In tile event any of grandchild who receives all interest under this Will shall be less than thirty (30) years of age at the time of my death, I give the share of such deceased child unto his or her smwiviag spouse, 1N TRUST, NEVERTHELESS, for the following uses and purposes: A. My 'Fruslee shall hold and adminisler said trust property, collect tile income therefrom, and expend or apply tile net income as hereinafter directed. During tile administration of my estate, the income earned by tile property included in this trust shall be considered income of this trust and subject to distribution as hereinafter provided for other income of this t]'u st. B. My Trustee shall pay and/or use for the benefit of sakt minor children or their lineal descendants so much of tile net iacome as deemed necessary for thei]' support, maintenance, a~ld 2 education, and any income not so used shall be accumulated and added to tile corpus of this trust. C. My Trustee shall have tile power itt his discretion to encroach upon tile corpns of lhe trusl estate in such amonnts and at such times as he may deem necessary ia order to provide for the support, mainlenance, care, and education of said minor children. D. All of the net income may be paid Io or for tile benefit of the children at least semi-annually. E. When the oldest said minor child attains the age of twenty-two (22) years, lhe principal of the tt'ust shall be divided inlo as many shares as are hereinbefore mentioned living children. Upon attaining that age, that child shall have the right to withdraw principal h'om this Irust in the following manner: (1) Twenly-Five Pet' Cent (25%) of the then value of lite principal upon lite child's attaining the age of twenty-two (22) years, al his or her request; (2) Fifty Per Cent (50%) of lhe balance of tile remaining principal upon the child's attaining the age of twenty-five (25) years; attd (3) The entire balance of his or her share upon said child's attaining the age of thirty (30) years. Sach rights of ~vithdrawal shall be cumalative, and may be exercised in whole or in part, from time to time, after that right accrues. ITEM 6: I nominate, constita~e and appoint my son, WILLIAM E. FEGAN and my daughter LINDA J. GLUCK or the smwivor of them, as Co-Executors of lifts my Last Will and Testament. ITEM 7: I direct that my hereinbefore named Co-Executors shall not be required to give bond for the faithful performance of theh' duties in this or any jurisdiction. IN WITNESS WlIEREOF, I have hereunto set my hand and seal this /~- day of ( ~ , 1995. The preceding instrmnent, consisting of this and four (4) other ~pewritten pages, was on the day and date thereof signed, sealed, published, and declared by the Testatrk herein named, as and for her Last Will and Testament, in the presence of us, who, at her request in her presence a Ir in the resence of each other, have subscribed our names withies h~t~ . as COMMONWEALTH OF PENNSYLVANIA COUNTY OF YORK /' / ..-~' :'~ ~' A~:~ , he Testatrix and the witnesses, respectively, whose names are signed t61he altached or foregoing instrument, being first dnly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament, and that she signed willingly, and that she executed it as her fi'ee and volunta~T act for the parposes therein expressed, and that each of the witnesses, Jn the presence and heariag of the Testatrix signed the Will as witnesses, and that to the best of their knowledge, the Testatrix was at the time eighteen (18) years of age or older, of sound mind, and under no constraint or undue.influence. ELIZAB~TII C. FEGAN // SWORN TO ~D SUBSCRIBED BEFORE ME THIS /~ DAY NOTARY ~ ~otaria~ Seal Janet S. Gore, Nota~ Pub Dil~sbur~ Boro York Coun y My Commission Expires O~. 25, 1998 of U.S. POSTAGE 17 06 h.llh,,llh.,,,Ih,lhl.,hl I,,,111,,,111 ...... II.,ll,,,ll,,,lhh h,,,1,h,,!ll COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES /NHERZTANCE TAX DIVISION NOTICE OF INHERITANCE TAX PO BOX ZS0601 APPRAISEMENT, ALLO#ANCE OR DISALLOWANCE HARRISBURG, PA 17118-060! OF DEDUCT/ONS AND ASSESSMENT OF TAX DATE 11-22-200q ESTATE OF FEGAN ELIZABETH C DATE OF DEATH 07~-100q. FILE NUMBER 21 ~04-071~ COUNTY CUMBERLAND WILLIAM E FEGAN ACN 101 q59 KENNEDY DR Amount H~G PA 17112 MAKE CHECK PAYABLE AND REHZT PAYMENT TO: REGZSTER OF W~LLS CUMBERLAND CO COURT "ROUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~- RETAIN LOWER PORTION FOR YOUR RECORDS REV-15~7 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAZSEMENT; ALLOWANCE OR DISALLOWANCE OF DEDUCTZONS AND ASSESSMENT OF TAX ESTATE OF FEGAN ELIZABETH C FILE NO. 21 0q-0717 ACN 101 DATE ll-ZZ-ZOOq TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) O0 NOTE: To ~nsure proper 2. Stocks and Bonds (Schedule B) (2) 76z512.00 credit to your account, $. Closely Held Stock/Partnership Znteres~ (Schedule C) ($) O0 submit the upper portion q. Mortgages/Notes Receivable (Schedule D) (q) O0 of ~his fore w/th your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (E) 11266.00 tax payment. 6. Jointly Owned Property (Schedule F) (6) O0 7. Transfers (Schedule G) (7) O0 8. Tote1 Assets (8) 77,778.00 APPROVED DEDUCTZONS AND EXEMPT;ONS: 6,208.00 9. Funeral Expenses/Adm. Costs/H/sc. Expenses (Schedule H) (9) 10. Deb~s/Mortgage Liabilities/Liens (Schedule Z) (10) 6E697.00 11. Total Deductions (11) 12. Net Value of Tax Return (12) 6q,875.00 15. Charitable/Governeentel Bequests; Non-elected 9115 Trusts (Schedule J} (15) .00 lq. Net Value of Estate Sub~ect to Tax (lq) 6q,875.00 NOTE: Zf an assesseent was issued previously, lines lq, 15 and/or 16, 17, 18 and 19 ~ill reflect flgures that lnclude the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of L/ne lq et Spouse1 rate (15) .00 X O0 = .00 16. Amount of L/ne lq taxable et Lineal~Class A rate (16) 6q,875.00 X Oq5 = 2,919.00 17. Amount of L/ne lq et Sibling rate (17) .00 X 12 = .00 18. Amount of L/ne lq taxable et Collateral/Class B rate (18) .00 X 15 = .00 19. Principal Tax Due (19)= 2,919.00 TAX CREDZTS: PAYMENT RECEIPT DISCOUNT AMOUNT PA~D DATE NUMBER INTEREST/PEN PAID (-) 09-Z$-Z00q CD00qqZ5 lq5.95 2,77~.00 TOTAL TAX CREDZT 2,918.95 BALANCE OF TAX DUE] .05 INTEREST AND PEN. .00 TOTAL DUE .05 ZF PAID AFTER DATE INDICATED, SEE REVERSE ( TF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REI)UZRED. FOR CALCULATTON OF ADDZTZONAL TNTEREST. ZF TOTAL DUE TS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ~._ RESERVATION: Estates of decadents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to CZass B (cotleteral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class S (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z~ of ZOO0. (7Z P.S. Section 91~0). PAYHENT: Detach the top portion of this Notice and submit with your payment to the Register of #ills printed on the reverse side. --Make check or money order payable to: REGISTER OF #ILLS, AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may ba requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-i~IB). Applications ara availabIa online at www.revenue.state.oa.us~ any Register of Hills or Revenue District Office, or from the Department's Z~-hour answering service for forms orders: 1-800-562-Z050~ services for taxpayers with special hearing and/or speaking needs: 1-800-q~7-~OZO (TT only). OBJECTIONS: Any party in interest not satisfied with the appraismant, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within 60 days of the date of receipt of this notice by filing one of the following: A) Protest to the PA Department of Revenue, Board of Appeals. You may object by filing a protest online at www.boardofappaals.stata.pa.us on ar before the expiration of tho sixty-day appeal period. In order for an electronic protest to ba valid, you must receive a confirmation number and processed date from the Board of Appeals websita. You may also send a written protest to PA Department of Revenue, Board of Appeals P.O. Box ZBiOZ1, Harrisburg, PA 17118-1011. Petitions may not ba foxed. B)Election to have the matter determined at the audit of the account of the personal representative. ADH[N- C) Appeal to the Orphans' Court. ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should ba addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, P.O. Box 180601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. Sam page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three ($) calendar months after the dacedent's death, a five percent (5Z) discount of the tax paid is allowed. PENALTY: The 1BI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same tiaa period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (l) day from the date of doeth, to the date of payment. Taxes which became delinquent before January l, 1981 bear interest at the rate of six (61) percent per annum calculated at a daily rate of .00016~. A11 taxes which became delinquent on and after January 1, 19AZ will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. Tho applicable interest rates for 1982 through ZO0~ ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rata Factor Year Rate Factor 1981 ZOZ .0005q8 ~)'~'8-1991 I1Z .O0050X ~ 9Z .0001~7 1985 161 .O00~3B 1992 9Z .0002~7 ZOOZ 62 .00016~ 198~ llZ .000301 1995-1994 72 .00019Z 2003 52 .000157 1985 13Z .000556 1995-1998 91 .0001~7 ZOOq ~Z .000110 1986 102 .O00Z7q 1999 7Z .000192 1987 lOZ .O00Z7k ZOO0 7Z .00019Z --Interest is calculated as follows: ZNTERBST= BALANCE OF TAX UNPA/D X NUNBER OF DAYS DEL/NQUENT X DAZEY 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 ba catcutatad.