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HomeMy WebLinkAbout02-0888 PETITION FOR PROBATE and GRANT OF LETTERS Estate of also known as Evelyn K. Wert No. 21-02 - 8SB To Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania Social Security No. 209-12-8540 The petition of the undersigned respectfully represents that Your petitioner(s), who is/are 18 years of age or older and the executor in the last will of the above decedent, dated June 5, 2001 and codicil(s) dated N/A named (state relevenat circumstances, e.g. renUnCIatIOn, death of executor, etc.) Decedent was domiciled at death in Cumberland her last family or principal resIdence at Carlisle, Pennsylvania County, Pennsy1'lania, with 1903 Douglas Drive, N,,?1 r'rlr/lduJ , (list street, number and municipality) Decedent, then 80 years of age, died September 22, 2002 at Cumberland Crossings, S, Middleton Twp, Cumberland County Except as follows, decedent did nut marry, was not divorced and did not have a chIld born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent No Exceptions Decedent at death owned property with estimated values as follows: (If domiciled in 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: $ unestimated $ $ $ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary (testamentary; admmlstratIOn c.I.a.; admmistration d.b.n.c.l.a.) thereon. of~ 2- ~~ Larry Eo Wert 41 Lebo Road Carlisle PA 17013 OATH 01<' PERSONAL REPRSENTATlVE COMMONWEA TLH OF PENNSYL VANIA COUNTY OF CUMBERLAND N 21-02-888 o. Estate of Evelyn K. Wert , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW 6B'!'OBER 1, 2002 in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated_ June 5, 2001 described therein be admitted to probate and filed of record as the last will of Evelyn K. Wert and Letters Testamentary are hereby granted to Larry E. Wert ~"",-...,,':--'N\ R~gister of Wills FEES Probate, Letters, Etc. $ 270 . 00 Short Certificates(1) $ 1 8 . 00 xR~~~~x ext~$ pages 3.00 jcp $ 5.00 Total $ 296.00 Fi led.....!. Q :~. .1.::?. ~ .9.?............ called atty 10-2-2002 Robert M. Frey ATTORNEY (Sup. Ct. I.D. No.) 5 South Hanover Street Carlisle, Pennsylvania 17013 ADDRESS (717) 243-5838 PHONE 06274 REGISTER OF WILLS OF t:IlMRRRT.ANn COUNTY OATH OF SUBSCRIBING WITNESS 21-02-888 MARY C. WERT AND SHARON J. DEVOS <Xllllrcll: (each) a sUbscribing witness to the wiIl presented herewith,.. (each) being duly qualified according to law, depose(s) and say(s) that they were present and saw EVELYN K.' WERT the testat rix ,sign the same and that we signed as a witness at the reqUest of testat r i X in h er presence and (in the presence of each oth,.er) (in the presence of the other sUbscribing witness(es)), Sworn to or affirmed and subscribed before me this 1 st day of OCTOBER ~XXX Jil ~h 0-. W~ ary 'C... Wert (Name) 5 South Hanover Street, Carlisle PA 17013 ,..... (Address) '- ~~~h9.~i11:) 5 South Hanover Street, Carlisle PA 170~3 (Address) REGISTER OF WILLS OF COUNTY OATH OF NON-SUBSCRIBING WITNESS . ~ (each) a subscriber hereto, (each) being duly qualified accordin~ 1a'depose(s) and say(s) that "., '..... famili the signature of , codicil testat_ of (one of the wiIlherewith and that to the best of know Sworn to or affirmed and subscr' me this Register '- , (Ad ress) (Name) (Address) # 21-02-888 LAST WILL AND TESTAMENT OF EVELYN K. WERT I, EVELYN K. WERT, unmarried woman of North Middleton Township, Cumberland County, Pennsylvania, (mailing address: 1903 Douglas Drive, Carlisle, Pennsylvania 17013) being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all Wills by me at any time heretofore made. I. I declare that I am unmarried and that I have no children. 2. I Give and bequeath 10% of the residue of my estate to the Cavalry Road Church of God, currently located at 910 Cavalry Road, Carlisle, Pennsylvania, 17013. 3. All the rest residue and remainder of my estate real personal and mixed and wheresoever the same may be situate I give devise and bequeath in equal shares to the below named individuals: (a) My nephew, Lester F. Wert, Jr. (b) My niece, Anna Mary Smith (c) My nephew, Craig A. Wert (d) My niece, Joan E. Wert (e) My. brother, Richard L. Wert (f) My nephew, Larry E. Wert (g) My niece, Joann Elaine Nailor (h) My niece, Faye Marlene Garman (i) My niece, Brenda Jane Hartman Should any of the aU0ve named individuuls predecease me or fail to s!Jn:ive me by a period of ninety (90) days, the share that person would otherwise have received shall pass to his or her issue per stirpes, and if there be no issue, such shares shall lapse and be added to the remaining share or shares. 4. Should any person less than 21 years of age be entitled to distribution from my estate, in such event the share that person would otherwise have received shall be paid to my hereinafter named Executor in Trust. I authorize the herein named Trustee to receive and invest the same and to pay the income arising therefrom together with so much of the principal thereof as in the Trustee's opinion is necessary or desirable to be expended for the proper maintenance, support, and education of such person, to or for the benefit of such person, and upon such person attaining 21 years of age to pay to him or her the then remaining principal together with any undistributed income. 5. I Hereby constitute and appoint my nephew, Larry E. Wert, as Executor of this my Last Will and Testament, but should he predecease me or fail to qualify or cease serving as such, then in such event I nominate constitute and appoint my neice, Anna Mary Smith Executor, and I further direct that neither of them shall be required to post any bond to secure the faithful performance of his or her duties in the Conunonwealth of Pennsylvania or in any other jurisdiction. 6. In addition to the powers conferred by law, my herein beforenamed Executors and Guardians of the E""te of a Person less thail 21 years of age, and their ,uccessors are authorized and empowered to: a. To invest any part of the trust corpus in such securities, investments, or other property as may be deemed advisable and proper, irrespective of whether the same are authorized for the investment of trust funds under the laws of any governing jurisdiction. b. With respect to any corporation, the stocks, bonds, or other securities of which may be held, to vote in person or by proxy on any shares of stock; to consent to the merger, consolidation or reorganization of such corporations; to consent to the leasing, mortgaging, or sale of the property of any such corporations; to make any surrender, exchange or substitution of such stocks, bonds, or other securities as an incident to the merger, consolidation or Page 1 of2 l ;3;.)f,; reorganization of such corporations; to pay all assessments, subscriptions and other sums of money which may be deemed wise and expedient for the protection and maintenance of the proportionate interest of the investment in such corporations; to exercise any option or privilege which may be conferred upon the holders of such stocks, bonds, or other securities of such corporations either for the conversion of the same into other securities or for the purchase of additional securities, and to make any and all necessary payments which may be required in connection therewith; and generally to have and exercise as to all such stocks, bonds, and other securities, the powers of an individual owner who is not under trust obligation. c. To hold the trust corpus in one or more consolidated funds in which separate shares shall have undivided interests. d. To sell at public or private sale for cash or upon credit, or partly for cash and partly on credit, and upon such terms and conditions as shall be deemed proper, any part or parts of the trust estate, and no purchaser at any such sale shall be bound to inquire into the expediency or propriety of any such sale or to see to the application of the purchase money arising therefrom. e. To keep on hand and uninvested such moneys as may be deemed proper and for such period as may be found expedient. f. To compromise, settle, or arbitrate any claim or demand in favor of or against the trust estate. g. And authorized in the discharge of fiduciary duties, to employ counsel and to determine and to pay such counsel reasonable compensation which shall be charged against the principal or income of the trust fund, and shall further be entitled to charge against the principal or income such other reasonable expenses and charges as may be necessary and proper to incur for the proper discharge of fiduciary duties and for the proper management and administration of the trust estate. h. In making any division of property into shares for the purpose of any distribution thereof directed by the provisions of the trust, to make such division or distribution, either in cash or in kind, or partly in cash and partly in kind, as shall be deemed most expedient, and in making any division or distribution in kind may allot any specific security or property or any undi vided interest therein to anyone or more of such shares, and to that end may appraise any or all of the property so to be allotted and the judgment as to the propriety of such allotment and as to the relati ve value for puqos<o, of distribution of the securities or property so a!lotted shall be final and conclusive upon all persons interested in the trust or in the division or distribution thereof. i. Authorized to register any shares of stock or other assets of any trust in their own names or in the name of a nominee. j. To retain and invest in shares of stock of my Trustee. k. To retain any investments including mutual funds which I may own at the time of my death and in addition to invest any part of the Trust corpus in such mutual fund or mutual funds as may be deemed advisable or proper, irrespective of whether the same are authorized for the investment of trust funds under the laws of any governing jurisdiction. I. To determine from time to time whether all or some portion of realized capital gains shall be treated as ordinary income for distribution to a beneficiary or treated as principal to be retained as part of the corpus, and such designation need not be consistent from one year to another. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, written on one (2) pages, this 5th day of June, 2001. E~e.t; f.;w~;t :;.1 ;It ,.,,1: (SEAL) Signed, sealed, published and declared by Evelyn K. Wert, the Testatrix above-named, as and for her Last Will and Testament, in our presence, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. StL,Vt'Vl 9 ,0.f!. i19-~) 71 LU'",i Q{di,-r " f Page 2 of2 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1 162 EX{1 1-96} RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT FREY ROBERT E ESQUIRE 5 S HANOVER STREET CARLISLE, PA 17013 --- fold ESTATE INFORMATION: SSN: 209-12-8540 FILE NUMBER: 2102-0888 DECEDENT NAME: WERT EVELYN K DATE OF PAYMENT: 06/05/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 09/22/2002 NO. CD 002649 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $3,778.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: lARRY EWERT C/O REOBERT M FREY ESQUIRE CHECK#154 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS $3,778.00 DONNA M. OTTO DEPUTY REGISTER OF WillS 217 ,/ REV-1500 8$:(G-OO} COMMONWEALTH OF REV -1500 OFFICIAL USE ONLY PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN DEPT. 280601 FILE NUMBER 21-02-0888 HARRISBURG, PA 17128-0001 RESIDENT DECEDENT - COI.lNTY CODE YEAR NUMBER DECEDENrS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ... Evelvn K, Wert . 209-12-8540 ffi DATE OF DEATH (MM-DD-YEAR) IDA TE OF BIRTH (MM-DD- YEAR) THIS RETURN MUST BE FILED IN OUPLlCATE WITH THE Q W 9/22/2002 8/13/1922 REGISTER OF WILLS &l (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Q w [:8:h Original Return 02. SupplemenlalRetum o 3. Ramlindar Retum (dale of death prior 10 12-t3-82) .... ","'" 04 04a D 5. Federal Estale Tax Return Required og:G Limited Estate Future Interest Compromise (date of death after 12-12-82\ wOO [8]6 07 ""~ _ 8. Total Number of Safe Deposit Boxes "a:m Decedent Died Testate (AttaCh copy of Wiff) Decedent Maintained a Living Trust (Attach copy of Trust) " 09 010 011. Election to tax under Sec. 9113(A) (Attach 5ch 0) Litigation Proceeds Received spousajPovertyCrad~(d8leofdealhbelwflen 12-31_91 and 1-1-95) ... THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCEANI}CONFIDENTIAlTAXINFORM/lTIONSHOUI.J)BE DIRECT!'DTOi z NAME COMPLETE MAILING ADDRESS w Q Robert M. Frev 5 South Hanover Street z ~ FIRM NAME (If Applicable) Carlisle, Pennsylvania 17013 '" w Frev and Tilev a: a: TELEPHONE NUMBER 0 717\243-5838 U OFFICIAL USE ONLY ,. Real Estate (Schedule A) (1) 105,000 2. Slacks and Bonds (Schedule B) (2) NONE 9r d ::u ~~ '--' ::u ~" NONE c.':- r:: '.. 3. Crosely Held Corporation, Partnership or Sole-Proprietorship (3) r" ['."\ C- , 4. Mortgages & Notes Receivable (Schedule D) (4) NONE '. 2 5. Cash, Bank Deposits & Miscellaneous Personal Property I (Schedule E) (5) 156,609 Ul 6. Jointly OWned Property (Schedule F) (6) NONE :::=> z o Separate Billing Requested 'D 0 .. W >= 7. Inter-Vivos Transfer & Miscellaneous Non-Probate Property 0\ ..; --' (Schedule G or L) (7) NONE => ... a: 8. TOTAL GROSS ASSETS (total lines 1-7) (8) 261,609 ..; &l 22,515 a: 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I) 10) 12,964 11. TOTAL DEDUCTIONS (total lines 9 & 10) (11) 35,479 12. NET VALUE OF ESTATE (line 8 minus line 11) (12) 226,130 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) (13) 20,233 14. Net Value Subject to Tax (line 12 minus line 13) (14) 205,897 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate ,or transfers under Sec.9116 (aX1.2) X ,0 - (15) Z Q ... 16. Amount of Line 14 taxable at lineal rate X ,0 (16) ..; - ... => Q. 17. Amount of Line 14 taxable at siblin9 rate 20,233 ,12 (17) 2,428 :; x 0 U >< 18. Amount of Une 14 taxable at collateral rale 185,664 x .15 (16) 27,850 ..; ... I 19. Tax Due (19) 30,278 200 1__~lit.I_itTtIm_JiiI[_~m~ t r' C," ,--. 11-,-1-') o > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH .;.; 217 Evelyn K. Wert 209-12-8540 Decedent's ComDlete Address: STREET ADDRESS 1903 Douolas Drive CITY I:TATE IZIP Carlisle PA 17013 Tax Payments and Credits: ,. 2. Tax Due (Page 1 Line 19) Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C, Discount (1) 25,175 1,325 Total Credits (A 'i' B + C) (2) 3. Interest/Penalty jf applicable D. Interest E. Penalty 4. TotallnterestlPenalty ( D + E ) If Une 2 is greater than Line 1 + Line 3. enlerthe difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to r'equast a refund (3) If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE.. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA This is the BALANCE DUE. Make Check (4) (5) (SA) (58) AGENT 30,278 26,500 5. 3,778 3,778 PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS ,. Did decedent make a transfer and: a. relain the use or income of the property transferred; b. retain the right to designate who shall use the property transferred or its income; Yes o o o o o o c. retain a reversionary interest; or 2. d. receive the promise for life of either payments, benefits or care? If death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 3. 4. Did decedent own an Individual Retirement Account, annuity or other non.probate property which contains a beneficiary designation? o [8] IF THE ANSWER TO ANY OF THE A80VE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. No [8] [8] [8] [8] [8] [8] Under penalties af perjury. I declare that \ ha~e examinee this return. including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, and complete, Decl,uation of DreDarer other than the Personal representative is based on all information of which preparer has anY knowledae. SIGNATURE F PERSON RESPONSIBLE FOR FILING RETURN t. L ADDRE DATE b- s.--<l,$ 41 lebo Road, Carlisle, Penns lvania 17013 SIGNATURE OF PREPARER OTHER THAN REPRE~!AT1VE ~~-#?'- ~,-.~ OATE (,- 1./. 0"':> ADDRESS 5 South Hanover Street, Carlisle, Pennsylvania 171113 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. Section 9116 (a)(1.1)(i)). For dales of death on or after January 1, 1995. the lax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. Section 9116 (a)(1.1)(ii)J. The statute does not exempt a transfer to a surviving spouse from lax. aM \t'ie stat1J\ory requirements lor 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 lhe 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 adOptlve wern, or a stepparent of the child is 0%[72 P,S. Section 9116(a)(1.2)]. The tax rate imposed on the net vaiue of lransfers to or for the use of the oocetlenrs lineal beneficiaries is 4.5%, except as noted in 72 P.S. Section 9116(1.2) [72 P.S. Section 9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of It'ie decedent's siblings is 12% [72 P.S. Section 9116(a)(1.3)1.A siblin9 is deflfled, under Sec\ior\ 9102. as an individual who has at least one parent in common with the decedent. whether by blood or adoption. AT REV-150,2 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCe TAX RETURN RESIDENT DEceDENT ESTATE OF FILE NUMBER Evelyn K. Wert 21-02-0888 ALL REAL PROPERTY OWNED SOLELY OR AS A TENANT IN COMMON MUST BE REPORTED AT FAIR MARKET VALUE. Fair markel value is defined as the price al which properly would be exchanged between a willing buyer and a willing seller, neither being campellerl to buy or sell, both having reasonable knowledge of the relevant facts. REAL PROPERTY WHICH IS JOINTL Y.OWNED WITH RIGHT OF SURVIVORSHIP MUST BE DISCLOSED ON SCHEDULE F ITEM NUMBER 1. SCHEDULE A REAL ESTATE DESCRIPTION 1903 Douglas Drive, North Middleton Township, Cumberland Township VALUE AT DATE OF DEATH 105,000 ALL THAT CERTAIN tract of land with the improvements thereon situate in North Middleton Township, Cumberland County. Pennsylvania, bounded and described as follows: BEGINNING at a point on the Eostem line of Douglas Drive and at corner of Lot No. 30, Block "B," North 85 degrees East ISO feet to a point at line of Lot No.2, Block "a," on hereinafter mentioned plan of lots, thence by said Lot No.2, Block "B," and Lot No.3, Block "B," North 5 degrees West 150 feet to a point on the Southern line of Lol No. 26, Block "B," thence by same South 85 degrees We,1150 feet to a point on the Eastern line of Douglas Drive, thence by Same South 5 degrees East 150 feet to lhe comer of Lot No. 30, Block "B," on said plan, the Place of BEGINNING. AND BEING Lots No. 29, No. 28, and No. 27 on Plan No.1, Block "B," of Noll manor as recorded in the Office of the Recorder of Deeds in Plan Book 11, Page 51. BEING improved with a residential dwelling and known as 1903 Douglas Drive. BEING the same premises which Thorn.,. j. Davis and Martha L. Davis, his wife, by deed dated AprilIR, 1991 and recorded AprilIB, 1991 in the Office of the Recorder of Deeds in and for Cumberland County at Carlisle, Pennsylvania, in Deed Book "B," Volume 35, Page 390, gr..nted and conveyed 10 Evelyn K. Wert, single woman. TOTAL (Also enter on line 1, RecaoitulatiorlJJ; (If more space Is needed, insert additionai sheels of Ihe same size) 105,000 A. U.S. DEPARTMENT OF HOUSING end URBAN DEVELOPMENT OMBNo.2502.0265 SETTLEMENT STATEMENT llllfPRO SECURED L....prlnl LAND TRANSFERS, INC. B. TYPE OF LOAN 5006 East Trlndle Road ,.ilQFHA 2.( JFMHA 3.1 I CONV. UNINS. Suite 203 .4.!IIiA &. { 'COWl. INS. Mechenlcsburg, PA 17055 6. FILE NUMBER: I 7. LOAN NUMBER: 504635 3004000346 Phone: (717) 591-8500 FAX: (717) 591-8506 8. MORT, INS. CASE NO.: C. NOTE: ThIs form is lumlshed 10 give you a slalement o' actual seUlemeni COils. Amounts paid 10 and by the selllemen( agent ara shown. IIams marked '(p.D.C.)' were paid outside the closing; they are shown here for Inlormallonal purposes and ara nollncluded In the totals. O. NAME AND ADDRESS OF BORROWER E.l'WAE AND AOORESS OF SEllER: F. NAME AND ADDRESS OF lENDER: Dragan Karacic Larry E. Wert, Executor Gateway Funding Diversifi Branka Karacic of the Estate of Evelyn ad Mortgage K. Wert One West First Avenue, Conshohocken, PA G. PROPERTY LOCATION: H. SEffiEMENT AGENT: l. sETTLEMENT OATE: 1903 Douglas Orive Secured Land Transfers, Inc. 05/01/03 North Middleton TOWNSHIP PLACE OF seffiEMENT: CUMBERLAND County 3915 Market Street, Camp Hill, PA 170B J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM. BORROWER <l00.OROS8 AMOUNT DUE 'TO SELLER 101. Contract sales prIce 1 .uu <lOl.Contract sales price 10,000.00 102. Personal properly <lll2.Personal property 103. Settlemenl charges to bon'Ower (line 1400) 1 1 "'. ,... .... 'os. .". Adjuslmenls lor lIems paid by seiter in advance Adluslmenls lor IIams paid by seller In advance 101l.CllyfTownlaK .. 40s.CllylTownlaK .. 101. Counly laK 05/01/ 03to 12/31/0 202.06 <101.Countyt/lK 05/' 1/03'. l2/ JIm -:202.06 !OS.AsslIssments to ~.ASSlIssrMInls to tOll. ......, U5/0~/0.3lo0 ~ 03 171. ~J <lOll. school U>JU1 1006/30/1 171.-93 110. to 410. to 111. Ht. "2. 412. 120. GROSS AMOUNT DUE FROM eORRoWER 1109B4.00 420,08055 AMOUNT DUE TO SELLER 105373.99 200. AMOUNTS PAID BY OR IN 8EHALF OF BORROWER SOD. REDUCTIONS IN AMOUNT DUE TO SELLER 201. Deposit 01 earnest money .UU 50l.Excess deposij (see instructions) 202. Principal amount of new loan(s) 104100.00 S02.SeltJemenl charges to seller (line 1400) 4567: 60- 203. Exlsllng loan(s) taken sublecl. to fon3.Exlsllng Ioan(s) taken sublllc\ \0 204. 504.PByoll 01 First Mortgage Loan NONE 'os 5116.Payolf 01 Second Mortgage Loan 2116. \~Jto\B Cl.OS1ng-Costs .00 Sot!. (SJ to (HJ C os~ng osts ~BB4. 00 201. Reaevel.opment Author1ty 3000.00 ",. ,... ".. 209. 509. Adjustments lor items unpaid by sellar Adlus\menls lor "ems unpaid by seller 210. CllylTown lax to 5to.CllyfTownlD 10 21 LCounty lax 10 511.CounlVtaK to 212. Assenm8flls 10 Sl2,AsHssrnenll 10 213. sc:hool 10 513. Sc:hool 10 214. 514. 215. 51S. 2t6. 516, 211. 517. 218. 5\8. 219. 519. 220. TOTAL PAID BYIFOR_BORROWER 110984.00 &lo.TOTAL REDUCTION AMOUNT DUE SELLER 7451. 60 31>0. CASH AT SETTLE".ENT l'ROMO~ TO ~.ORROWER.,; . 800. CASH AT SETTLEMENT TO OR I='ROM SELLER :HlI. GlOSS amounl due from borrower (line 120) , illl~B". UU 6I:l1.GrosS llITKlunl due to seller (line i420r -..... -.' .105373.99 302. Less amount paId bylfor borrower (line 220) l1'~B4.UU B02.Less reducllon amounl due sellar (Une 520) 451'.\60 303. CASH tOO FROM) ([ 1 "0) BoRROWER 803. CASH (00 TO) ([ ] FROM) SELLER' , .. 97922'.'39 0.00 , " . Buyor or Borrower'. Slgn.8lure Seller's Signature HVo-I Flev.S/aG , U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT OMS No. 2502-0265 l. SETTLEMENT CHARGES 504635 700. TOTAl SALES/BROKER'SCOMMISSION bllll.d on pries $ 105000.00 Division of Commission (line 700) a$ foIlOW$: Total: 3 I 150 .00 701. $ 3150.00 10 ERA NRT, Inc. 702. $ to 703. Commi$sion paid atSetllement 704. Trans Fee 800. ITEMS PAYABLE IH CONNECTION WITH LOAN 801. loan Origination Fee % 602. loan Discount % 803. Appraisal Fee to 804. Credit Report 10 80S. lenders Inspection Fee 806. Mortgage Insurance ApplicaUon Fee 10 801. Assumplion Fee 808. Tax Serv. Gatewa Fund~n 809. UnderwrJ.t Gatewa Fundl.n 810. Flood Cert Fl.rst Amerl.can Flood 811. ComnutFee Gatewa Fundin 900. ITEMS REQUIRED BY l.ENDER TO BE PAID IN ADVANCE 901.lnterestlrom 05 01 03 1005 31 03 @S /day 902. Mortgage InSUrance Premium for mo. 10 Gatewa Fundin 903. Hazard Insurance Premium for lyrs.to STATE FARM (297 .POC) Y1S.tO ERA NRT, Inc. Gatewa Fund~n 325.00 Gatewa Fundin 75.00 81. 00 75.00 17 .50 75.00 1500.00 904. 905. MIP-CashPt 000. RESERVES DEPOSITED WITH LENDER FOR Gatewa Fundl.n 39.00 87.40 /mo. /mo. /mo. Imo. Jmo. Imo. /mo. /mo. 74.25 1001. Hazard Insurance 3 1002. Mortgage Insurance 003. City(Town tex 004. County tax '005. Assessments 1006. School Tax 10 007. 1008. A reAd 1100. TITLE tHARGli$ 1101. Settlement or closing feelo 1102. Abstract or tiUe search to 1103. Tilleellamination to '104. Tille insurance binder to 105. Document preparation 10 1106. Notary lees to 1107. Allorney'sfees 10 (includes above items No.:) 1108. Tille Insurance 10 (includes above items No. lender's coverage $ Owner's coverage.$ 24.75 3 mo.OS mo.O$ mo.OS mo.O$ me.@.$ mo.OS me.O$ mo.O$ 25.19 75.57 874.00 -387.09 Robert M. Cash Fre (POC-S 20.00 1109. '110. 1111. f1l2. 1113. 1200. 1201. 1202. 1203. 1204. 1205. 1300. 1301. 1302. 1303. 1304. 1305. prnc lPa t Gatewa Fund1n 1400. TOTAL SETTL.EMENT CHARGES (enter on Imes lOJ and 502, Secliol\S J and Kl End. 100 104,100 105,000 Secured 300 900 Land Transfers 35.00 Tax Cert Secured Land Transfers ICPL Fee Fl.rst Amerl.can T1tle Ins. GOVERNMENT RECORDING AND TRANSFER CHARGES Recording fees: Deed S 3 8 . 50 Mortgage.$ 46 . SO City/county tax/stamps; Deed $ 1050 . 00 Mortgage $ Slale tax{slamps: Deed.$ 1050 . 00 Mortgage.$ Rec 2nd Recorder of Deeds Misc.S 85.00 1050.00 1050.00 38.50 ADDITIONAL SETTLEMENT CHARGES Survey to Pesllnspection to F1nWtr Swr House Master(POC BJ Carl1s1e Surburban Auth. 89.60 699.53 5610.01 4567.60 PB.lles .<Ju.a Ihal no lIabllily II a....m-.:l by Samamant AUenllor Iha Iccurao:y ollnlo"".lIon lu.nishad by olh..a as ahown "" Iha HUO.I Salll.manl Slatamanl. S.tll....enl Agent ha.aby ..p...soty res..rves Iha r~h' 10 depOsll any amoun's eollecled lor disbu.umen. In an in....... b..arlng accoun' In a Fed.rally Insu'ed InslM..Uon and 10 c..dil any Inlere~ so ..arned'o ils Own eccounl.s .dditlona' compensallonlorllsMrvlc:eslnllli."ensaetiDn HUD CERTIFICATION (IF BUYERS AND SELl.ERS I have eBIEilfully reviewed the HUD-l Selllement Statement and to th, basi of my knowledge and baliel,lI is a lrue and st:t:urate statement of all receipts and dtsbursements made on my account by me In this lrallsat:lion~ r:UfUter cerll(y thai' have reclllved a copy a/!he HUD- ~ Rmenl Statement. i.~ ~ ,,-.' ~ c L....,- . ~M ft:aA.c:tctc... Buyer or Dorro'Y.". Signlltu'" euye<'. Add.ass & Phona: Seller'SS/g<12l"'.. Sell..... N_Addr... S Phone: The UO. S I1lemenl Slat"",a 1 hieh' .. preO~d is I.ue and st:cu,a'" aecounl 01 1101. "ansaclion.' ,..a caUSed or will cause lhe lund.lo be diMIU'Hd in acco.danc. with 11015 sl.temanl. , .. . ~{-r8 Salll manlAgenl 01110 WARM~;I~~ 1: t:.~ d~~:z:~~ f:~ ~~~';;::'::n .nl D'O Iha Unilad S'al" On lhls or any simil8,'o,m. Pilnallkls uftDn con~I"'llon clln Includa a lina and Imprisonm~nL Fllr del..1Is se. HUD.I Relt 5186 . AT . REV~15MEX +(1-97)(\) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Evelyn K. Wert FilE NUMBER 21-02-0888 Include the proceeds of litigation and IhB' dale the proCHds Wllf1l received by the estate_ ALL PROPERTY JOINTLY-OWNED WITH THE RIGHT OF SURVIVORSHIP MUST BE DISCLOSED ON SCHEDULE F. ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. DESCRIPTION VALUE AT DATE OF DEATH Automobile, 1990 Oldsmobile Sedan M& T Bank, Checking Account #732702 M&T Bank, Savings Account #15004200024559 Accrued Interest to September 22,2002 Cash from Home United Farm Guaranteed Investment Accrued Interest Refund, The Sentinel Refund, Hoffman Roth Funeral Home Refund, AARP Premium Proceeds from Auction of Household Contents Foot Locker, Pension Fund Refund, State Fanm Mutual Automobile Insurance Company 1,600 6,753 133.245 138 107 7,500 167 114 166 127 6.255 203 234 TOTAL IAlso enter on line 5, Recapitulation' $ (If more space IS needed, Insert addltlonai sheets of the same size) 156,609 .-,.~..... ........,_.".,""-~.~'...:-'--. ._~--- '.'_ ,_......r-,..._,,'~,.., _~.."-_"_...e '" TAMMY L. WALBORN 247 S SPRING GARDEN ST. PMBNO. 173 CARLISLE, PA 17013 08-98 60-83/0313 4911 129 .9t,,,, Oct. ,<1 iXo8 1<.. (De.(t I $ IJl..;CD 00 .M 6/) // In (-) <o>_/-,,-/kl;>,) 0. ~..._. w :~~,_Z:;~. The Money Fund Alternative AlIfirst Bank Hattisburg, PA 17101 ~m~ L. ~f6"1-f1 '" 'la2a2~'lOIl' O~2'l sro ., , Ci'; ;l~-":"".. NAME AlfI~l(.uJlltlJv ACCO~. '10% 065'3.sS OA" ~.~ .;lotiO! DEPOSITS MAY NOT BE AVAI BLE FOR IMMEDIATE WITHDRAWAL. CURRENCY COIN c H , C K S o 60-15031313 TOTAl FfIOMOlliEIISIDE CHECKING DEPOSIT TICKET PLEASE ITEMIZE ADDITIONAL CHECKS ON REVERSE SIDE ~~ ORRSTOWN BANK I:OHHS03I;1: CHECKS AND OTHER ITEMS ARE RECEIVED FOR DEPOSIT SUBJECT TO THE TERMS !\NO COHOlTlONS OF THIS INSTITUTION'S COLLECTION AGREEMENT IO:=-~ TIlE BAN]{ OF NE\V YOHI( NI!:W .,o",,'s ~'''ST eAN" ~ ..QU,q:II!:O '''$'' ~~ ."I1"'."PE'" ......M'..TOtl P.O. Box 19561 Newark, NJ 07195-0561 ACCT#: PLAN#: PAY DATE: CHECK#: 211912 GSI0Sl 12/01/20112 26459269 EVEL YN K WERT 1903 DOUGLAS DRIVE CARLISLE, PA 17013 Please lIse the reverse side of statement for changes. Acel#: 211912 Plan #: GSIUSl BENEFIT PAYMENTS CURREtlT AMOUNT YTD AMOUNT DESCRIPTION RETI RENE 2112.511 2,430.00 Check#: 2&4592&9 Pay Date: 12101/2002 DEDUCTIONS DESCRIPTION CURRENT AMOUNT 'fTO AMOUNT lU I'AL G'WSS: 2lJZ.50 2,4311.1111 o AL Ut:UUCIIONS: u.uo Il.UU TOTAL NET, 20Z.50 2,430.00 EMPLOYEE CONTRIBUTIONS: Please Detoe 1 Stalernellt From Check Il.UO THE BANKOF . NEW YORK Attr NAME' FOOT LOCICER :INC. PENsHm TRUST GS10s1 20912' . ,-, nO 26459269 26459269 PlAN-It, . ACCT#-: DATE. IZllll/21l02 AMOUNT: x!x~xx~y202.50 TWO HUNDRED TWO DOLLARS K- SO/lOll T6THE ORDER EVELYN K WERT 19113DDllGL.AS DRIVE CARL:ISLE, PA 0,11013 T1i,.lJ.ink u[""wY"rk 1 W~I1;';1 SY. "y tll~~6 .'\5 Tru~lee or "~<:'l\l .~~ AUlllorlz,=,JSign.,wrl Voldatter 180tMys II' 2".. 5 'i 2" 'ill' ':0210000 HI': 11'000000521511' ~ r:g M&fBank Manufacturers and Traders Trust Company, 1100 Wehrle Drive, P,O. Box 767. BuHalo, NY 14240-0767 October 22, 2002 RE: Estate Search The Estate of: Date of Death (D.O.D.) EVELYN K WERT 9/22/2002 To Whom It May Concern: Identified below is the account information requested. 1. M&T Bank accounts in which the decedent's name appears: Account Type Account Number Account Title Opening Branch D.O.D. Balances (Includes ACCL Int.) $6752.68 $133,382.35 CHK SAY 732702 15004200024559 EVELYN K WERT EVELYN K WERT 4319 4319 2. Loans, Mortgages, or other obligations titled in the decedent's name Account Number Amount Owed Account Description NO Safe Deposit Box titled in the Decedent's name existed at our office. Accrued Interest $.00 $137.77 If you have any questions about the information provided, please contact our Records Department at (716) 635-4010 or 1-800-724- 2440 outside of the Buffalo, NY calling area. Thank you. Sincerely, M&T BANK CORPORATION BY: Aut~~~~~ DATE: I 0 ~ 2 2... - 0--;"'-- -' 0'" 12/20/02 ~F YOU HAVE ANY QUESTIONS CONCERNING THIS REFUND, PLEASE CALL US TOLL FREE AT 1-800-523-5800. ESTATE OF E.WERT 1903 DOUGLAS DR CARLISLE PA 17013 PAYEE: ESTATE OF EVELYN K WERT REG 088 INSURED ACCOUNT NUM 0186835451 CHECK AMOUNT ***********127.00 CHECK DESCRIPTION CHEcr. NO. 19905492 MRP Health Care Options. ~ REFUND OF MONTHLY PAYMENTS PAID BEYOND THE CANCELLATION DATE. Form T'258-7 Prlnled In U.S.A. FtEA5E DEI ACH CHECK BELOW AND CASH PROMPTLY us ~ ._ 1:1I....~..'..,,1I~::I:IM":I:..::U.:I,l:1::1:_.I..n.~.,'""...-::I1:I:"'Pu:I.ln."['III~I"'W'1.::l:I""":1;1I!II:i.I.'.I'.I[tt:i..I.'j:l:U:i."".'.";Mr.ul' 0'" 12/20/02 19905492 MRP Health Care Op1ions" ~ No 7281903 CHECK NO. THIS CHECK IS VOID IF GREEN COLOR BACKGROUND IS ABSENT PAY ***********127 DOLLARS 00 CENTS 0186835451 950 PAY TO THE ESTATE OF EVELYN K WERT ORDER OF 1903 DOUGLAS DR CARLISLE PA 17013 ",'1'1051,'12" ,:m, , , .327'1': 07 502 5'18" ~**********127.00 WACHOVIA BA.NK, N.A. Augusta, GA. ~ L Kcv,'-C - >UW ,n . -.-- ._-..~.. -.., ,-..---..--._. ..-- :i:"'\DL .,'Lt';':':,::":':i::;':",?:"':~,:;,-::,: "....,:, ,:',::::'-,:,:, ,UNITED FA~MFAMllVL.IFE ... 225 s: E~SlSiniel' P.O, Box 1250 Indianapolis, IN 46202 (317) 692-7861 PAY Seven thousand; six hundred sixty-siX and 67/100 dollars Fifth Third Bank 71-859 ----m- 001546 TO THE ORDER OF DATE 12/10/2002 AMOUNT $**"**7,666.67 Estate. of Evelyn K Wert 1903 Douglas Dr Carlisle, PA t?013-1020 .3~':7'fi~ M' lI'OO~5L,bll' I:07L,Cj085CjL,I:07b5~~~~57~1I' UNITED FARM FAMILY LIFE 001546 INVOICE OATE AMOUNT CREDlTS TOTAL 12/10/2002 12/1 0/2002 lnv #1014: Withdrawal From United Farm Guaranteed Investm lav #1014: Accrued Interest From Date of Last Payment 7,500.00 166.67 Check number 1546 Dale 12/l012002 TOTAL PAID THIS CHECK $7,666.67 Hoffman-Roth Funeral Home, Inc. 219 North Hanover Street Carlisle, PA 17013 (717)243-4511 October 11, 2002 Anna Mary Smith 482 Petersburg Road Carlisle, PA 17013- The Funeral Service for Evelyn K. Wert 13845-178 We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. OUR SERVICE: Traditional Funeral Service Package . . . . . . FUNERAL HOME SERVICE CHARGES SELECTED MERCHANDISE: Coleman Casket . . . . . . . . . . . . . . . . . . . . . . THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THATYOUHAVESELECTED . . . . . . . . . . . . . Cash Advances Newspaper Obituary Notice-Patriot News, Certified Copies of Death Certificates. Flowers. . Hairdresser. . . . . . . . . Organist. . . . . . . . . . TOTAL CASH ADVANCES AND SPECIAL CHARGES. Total Total Cost . . . . . . . . . . . . . . . . . . . . . . . . . . History 10/09/2002 AIlianz Life Insurance Company. 10111/2002 Estate Evelyn K. Wert CK#20904 TOTAL AMOUNT DUE. . . This statement Is net and payable In full within 30 days of receipt. $3490.00 $3490.00 $1405.00 $4895.00 $122.40 $20.00 $132.50 $30.00 $50.00 $354.90 $5249.90 $-5415.97 $166.07 $0.00 Please return this portion with your Remittance ---------------------------------------.__________________a_Maw_a. $ Amount Enclosed Service 10 # 13845-178 Evelyn K. Wert j~ ~ :tJ0 ),-S'f)!:J J :=~[~~4~~"~f::~~fM/ CAJhP_/~, PA I LOCATION OF SALE ~ ~ ~ AUCTIONEER X~ irl.. Jjr~ "::"^,;,;::'1';\'\j;I~"?;~R"/i~1',1,,~:!'jt~1\:~'f:f(0:,";;"',' ~" ..' ',' ." ...., ','",' ..', "" """ Ci~ELLER'Sexl>ENSES ) ,<; ~ u' ~t] PROFESSIONAL FEES ';; AUCTIONEER i1* ;i~ fje ;1:;, ~~~ .t\~ .~ :~1\\ :i<<~ :~,z( ~/ CLERK 10% $ CASHIER OTHER EXPENSES .; a,dM/riA~~_ YJ<9fd;a)-~) :'\,;; ',) /'i 02/Y1h1J FINAL SETTLEMENT DATE OF SALE ~ :l6, J()O~ PHONE ZIP J '1 () / .3 PHONE 7/7'/J..Lfj-lo/? c . RECEIPTS ) $ (;;J.5,tpg $ q~~,DO $ 5.;;,7;),.75 , CASH CHECKS $ OTHER RECEIPTS $ J. Jf9.1f7 to.!, r/J-t-~~ ~co.- : ~J<;;;hi;;: ZJ- $ (tt115) tJa-h ((L dO,OO QlJf1>.J. $ $ $ $ '+/3. 'f0 G<Z.90 $ $ $ $ $ $ $ 0. .;).5175 . $ i,357.~5 , $ 4; gQ7, 5D $ $ $ $ $ TOTAL RECEIPTS LESS TOTAL EXPENSES (TOTAL EXPENSES NET PROCEEDS PAYABLE TO SELLER d,357.;is) r (or we). the seller, accept this settlement and acknowledge receipt of the above specified net proceeds Irom the auction 01 my goods and property sold on the above date. I accept all responsibility for providing merchantable title to all goods, and property sold, and far delivery of title to the purchoser. ~LM. fl1.f..~ ~ ~ I L.r:~ y-2-(O-O> Auctioneer or Cashier's Signature {Seller', Signature) 7'- ~6';20"J Date Dale (Seller's Signature) 217 REV-1511 EX + (12-99) ESTATE OF COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Evelyn K. Wert 21-Q2.{)888 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ,. B. ADMINISTRATIVE COSTS: ,. Personal Representative's Commissions Name of Personal Representative (s) Larry E. Wert Social Security Number(s) I EJN Number of Personal Representative(s) Street Address 41 Lebo Drive City Carlisle State PA Zip 17013 Year{s) Commission Paid: 2003 10.878 2. Attomey Fees 10,878 3. Famlly Exemption: (If decedent's address is not the same as claimant's. attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Det:edent 4. Probate Fees 296 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Cumberland Law Journal, Advertising 75 B. The Sentinel, Advertising 84 9. Checks cleared after date of death 158 10. Filing Fee for Pennsylvania Inheritance Tax Return 15 11. Fee to File Final Account 128 12. Short Certificate (1) 3 TOTAL 'Also enter on line 9, Recaoituiation $ 22,515 Debts of decedent must be reported on Schedule I. (If more space is needed, Insert additional sheets of the same size) REV-1512 EX+ (6-98) AT COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN R I T ESTATE OF Evelyn K. Wert SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-02-0888 Include unrelmbursed medical expenses. ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. DESCRIPTION VALUE AT DATE OF DEATH Alert Pharmacy, Prescriptions Carlisle Suburban Authority, Utilities Central Penn Medical Group, Medical Cumberland Crossing Retirement Community, Nursing Home Diversified Appraisal Service, Appraisal of Real Estate ERA. Real Estate Commission Real Estate Closing Costs Recorder of Deeds, State taxlstamps:Deed Secured Land Transfers, Tax Certificate Real Estate, Gateway Funding Miscellaneous, Notary Fees Robin K. Sollenberger, Tax Collector, County and School Taxes PP&L, Electricity Peerless Insurance Company, Homeowners Benjamin S. Souder, Mowing and Snow Removal Sprint, Telephone Kevin M. Wickard, Auctioneer Expenses and Commission York Waste Disposal Larry E. Wert, Reimburse "For Sale Signs" Bank Charge, Return item Dragan Karacic, Painting of Real Estate 207 320 18 1,528 250 3,250 2,884 1,050 2 156 20 -78 155 292 210 201 1,357 460 25 7 650 TOTAL (Also enter on line 10, Recaeitulation) $ (If more space is needed, Insert addItional sheets of the same size) 12,964 217 REV-1513 EX + (S-OO) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER Evelvn K. Wert 21-02-0888 RElATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSONIS\ RECEIVING PROPERTY Do Not List Trustee/sl OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions. and transfers under Sec. 9116 (al (1.2)J 1. Richard l. Wert 8 Middleton Avenue Carlisle, Pennsylvania 17013 Brother 10% of residue of estate 2. Lester S. Wert, Jr. 53 Bloserville Road Carlisle, Pennsylvania 17013 Nephew 10% of residue of estate 3. Craig A. Wert 1254 Holly Pike Carlisle, Pennsylvania 17013 Nephew 10% of residue of estate 4. Larry E. Wert 41 Lebo Road Carlisle, Pennsylvania 17013 Nephew 10% of residue of estate 5. Anna Mary Smith 482 Petersburg Road Carlisle, Pennsylvania 17013 Niece 10% of residue of estate 6. Joan E. Wert 105 South Orange Street Carlisie, Pennsylvania 17013 Niece 10% of residue of estate CONTINUED ON ATTACHED SHEET 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. Calvary Road Church of God 910 Calvary Road Carlisle, Pennsylvania 17013 10% of residue of estate TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed. insert additional sheets of the same size) SCHEDULE "J" CONTINUED Joann Elaine Nailor 1175 Boiling Springs Road Mechanicsburg, Pennsylvania 17055 Niece 10% of residue of estate Faye Marlene Gannan 590 McClure's Gap Road Carlisle, Pennsylvania 17013 Niece 10% of residue of estate Brenda Jane Hartman 406 Harrisburg Pike Dillsburg, Pennsylvania 17013 Niece 10% of residue of estate LAST WILL AND TESTAMENT OF EVELYN K. WERT !, EVELYN K. WERT, unmarried woman of North Middleton Township, Cumberland County, Pennsylvania, (mailing address: 1903 Douglas Drive, Carlisle, Pennsylvania 170(3) being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last WiJI and Testament, hereby revoking and making void any and all Wills by me at any time heretofore made. I. I declare that! am unmarried and that! have no chiidren. 2. 1 Give and bequeath 10% of the residue of my estate to the Cavalry Road Church of God, currently located at 910 Cavalry Road, Carlisle, Pennsylvania, 17013. 3. All the rest residue and remainder of my estate real personal and miKed and wheresoever the same may be situate I give devise and bequeath in equal shares to the below named individuals: Ca) My nephew, Lester F. Wert, Jr. Cb) My niece, Anna Mary Smith (c) My nephew, Craig A. Wert (d) My niece, Joan E. Welt Ce) My. brother, Richard L. Wert CI) My nephew, Larry E. Wert (g) My niece, Joann Elaine Nailor (h) My niece, Faye Marlene Garman (i) My niece, Brenda Jane Hartman Should any of the above named individuals predecease me or fail to survive me by a period of ninety (90) days. the share that person would otherwise have received shall pass to his or her issue per stirpes. and if there be no issue. such shares shall lapse and be added to the remaining share or shares. 4. Should any person less than 21 years of age be entitled to distribution from my estate. in such event the share that person would otherwise have received shall be paid to my hereinafter named Executor in Trust. I authorize the herein named Trustee to receive and invest the same and to pay the income arising therefrom together with so much of the principal thereof as in the Trustee's opinion is necessary or desirable to be expended for the proper maintenance, support, and education of such person. to or for the benefit of such person, and upon such person attaining 21 years of age to pay to him or her the then remaining principal together with any undistributed income. S. I Hereby constitute and appoint my nephew, Larry E. Wert, as Executor of this my Last Will and Testament, but should he predecease me or fail to qualify or cease serving as such, then in such event I nominate constitute and appoint my neice, Anna Mary Smith Executor, and I further direct that neither of them shall be required to post any bond to secure the faithful performance of his Of her duties in the Commonwealth of Pennsylvania or in any other jurisdiction. 6. In addition to the powers conferred by law, my herein beforenamed Executors and Guardians of the Estate of a Person less than 21 years of age, and their successors are authorized and empowered to: a, To invest any part of the trust corpus in such securities, investments. or other property as may be deemed advisable and proper, irrespective of whether the same are authorized for the investment of trust funds under the laws of any governing jurisdiction. b. With respect to any corporation, the stocks, bonds, or other securities of which may be held, to vote in person or by proxy on any shares of stock~ to consent to the merger, consolidation or reorganization of such corporations; to consent to the leasing, mortgaging, or sale of the property of any such corporations; to make any surrender, ex.change or substitution of such stocks, bonds. or other securities as an incident to the merger. consolidation or Page 1 of2 l >> .)~<' reorganiza!ion of such corporations; to pay all assessments, subscriptions and other sums of money whIch may be deemed wise and expedient for the protection and maintenance of the proportionate interest of the investment in such corporations; to exercise any option or privilege whIch may be conferred upon the holders of such stocks, bonds, or other securities of such corporations either for the conversion of the same into other securities or for the purchase of additional securities, and to make any and all necessary payments which may be required in connection therewith; and generally to have and exercise as to all such stocks, bonds, and other securities, the powers of an individual owner who is not under trust obligation. c. To hold the trust corpus in one or more consolidated funds in which separate shares shall have undivided interests. d. To sell at public or private sale for cash or upon credit, or partly for cash and partly on credit, and upon such terms and conditions as shall be deemed proper, any part or parts of the trust estate, and no purchaser at any such sale shall be bound to inquire into the expediency or propriety of any such sale or to see to the application of the purchase money arising therefrom. e. To keep on hand and uninvested such moneys as may be deemed proper and for such period as may be found expedient. f. To compromise, settle, or arbitrate any claim or demand in favor of or against the trust estate. g. And authorized in the discharge of fiduciary duties, to employ counsel and to determine and to pay such counsel reasonable compensation which shall be charged against the principal or income of the trust fund, and shall further be entitled to charge against the principal or income such other reasonable expenses and charges as may be necessary and proper to incur for the proper discharge of fiduciary duties and for the proper management and administration of the trust estate. h. In making any division of property into shares for the purpose of any distribution thereof directed by the provisions of the trust, to make such division or distribution, either in cash or in kind, or partly in cash and partly in kind, as shall be deemed most expedient. and in making any division or distribution in kind may allot any specific security or property or any undivided interest therein to anyone or more of such shares, and to that end may appraise any or all of the property so to be allotted and the judgment as to the propriety of such allotment and as to the relative value for purposes, of distribution of the securities or property so allotted shall be final and conclusive upon all persons interested in the trust or in the division or distribution thereof. i. Authorized to register any shares of stock or other assets of any trust in their own names or in the name of a nominee. j. To retain and invest in shares of stock of my Trustee. k. To retain any investments including mutual funds which I may own at the time of my death and in addition to invest any part of the Trust corpus in such mutual fund or mutual funds as may be deemed advisable or proper. irrespective of whether the same are authorized for the investment of trust funds under the laws of any governing jurisdiction. 1. To determine from time to time whether all or some portion of realized capital gains shall be treated as ordinary income for distribution to a beneficiary or treated as principal to be retained as part of the corpus, and such designation need not be consistent from one year to another. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, written on one (2) pages, this 5th day of June, 2001. t I' . 'Y 'It ~-- SEAL) .~/>....( . .....:{y7 /. - - ' -1'_.''/'- ( Evelyn K. ert Signed, sealed, published and declared by Evelyn K. Wert, the Testatrix above-named, as and for her Last Will and Testament, in our presence, who, in her presence, at her request, and In the presence of each other, have hereunto subscribed our names as attesting witnesses. f~yVl 9&!.r1IQ 11~rQ;LJ.h-Y Page 2 0/2 /'7-9/-/.:3 \, BUREAU OF INDIVIDUAL TAXES INHPRITANCE TAX DIVISION DFpT. 280601 '1ARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 07-21-2003 WERT 09-22-2002 21 02-0888 CUMBERLAND 101 ROBERT M FREY FREY & TI LEY 5 S HANOVER ST CARLISLE 'OJ 0U'_ 21 PA ',1\7013 Allount Rellitted * REV-1547EXAFPIDI-D!l EVEL YN K MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-";=is4-j-Ex-Af'p-foFii3Y-No'TYcniF-YNHERYTiiifci-YAX-XPPRA-isEHENT-:--ALDiwiiNci-cfli----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WERT EVELYN K FILE NO. 21 02-0888 ACN 101 DATE 07-21-2003 TAX RETURN WAS: ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds {Schedule BJ 3. Closely Held stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable {Schedule DJ 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule f) 7. Transfers (Schedule G) 8. Total Assets ll) (2) (3) (4) (5) (6) (7) 105.000.00 .00 .00 .00 156,609.00 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ad... Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax NOTE: If an assessment was issued previously, lines reflect figures that include the total of ALL ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due T : DATE 12-23-2002 06-05-2003 NUMBER CD001986 CD002649 INTEREST/PEN PAID (-) .00 .00 INTEREST IS CHARGED THROUGH 08-05-2003 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. (9) 1l0) 22,515.00 NOTE: To insure proper credit to your account~ submit the upper portion of this form with your tax payment. 261,609.00 3o;.47Q nn 226,130.00 22,613.00 203,517.00 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. .00 .00 2,442.20 27,474.80 29,917.00 28,953.00 964.00 5.81 969.81 [ IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" [CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) 12.964.00 (11) (12) (13) (14) .00 X 00 = .00 X 045 = 20,351. 70 X 12 = 183,165.30 X 15 = (19)= AMOUNT PAID 25,175.00 3,778.00 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE REV-1470EYrl,i-BBl , '*' INHERITANCE TAX . , EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME FILE NUMBER WERT, EVELYN 2102-0888 REVIEWED BY ACN LARRY SZOLLOSY 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES J Corrected the inheritance tax return per the will. ROW Page 1 //)-9/-/3 "'- BUREAU OF INDIVIDUAL TAXES INHERITANCE TAK DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RECORD ADJUSTMENT DATE ESTATE OF DATE OF DEATH FILE NUMBER '.COUNTY ACN ROBERT M FREY FREY & TILEY 5 S HANOVER ST CARLISLE 1" PA 1701~ 07-31-2003 WERT 09-22-2002 21 02-0888 CUMBERLAND 101 Amount Rellitted .. REY-159~ EK ~FI' C01-0$) EVEl YN K MAKE CHECK PAYABLE AND REMIT PAYMENT TO: RESISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this for.. with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-Y=iS9:3-iX--AFi>-foi-:03'------.-.-iN-HERi-fANC-E-TAlC-RE-CORU--ADJ-USTH-ENT-Ji.----------------------------- ESTATE OF WERT EVEl YN K FILE NO. 21 02-0888 ACN 101 1. Real Estate (Schedule AJ 2. Stocks and Bonds (Schedule B) 3. Closely Held stock/Partnership Interest (Schedule C) 4. Hortgages/Notes Receivable (Schedule DJ 5. Cash/Bank Deposits/Misc. Personal Property (Schedule EJ 6. Jointly Owned Property (Schedule f) 7. Transfers (Schedule G) 8. Total Assets DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Administrative Costs/ Miscellaneous Expenses (Schedule H) Debts/Mortgage Liabilities/Liens (Schedule I) Total Deductions Net Value of Tax Return Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) Net Value of Estate Subiect to Tax ADJUSTHENT BASED ON: VALUE OF ESTATE: ADMINISTRATIVE CORRECTION 10. ll. 12. 13. 14. TAX: 15. Allount of 16. Allount of 17. Amount of 18. Allount of 19. Principal TAX CREDITS: Line Line Line Line 14 at Spousal rate 14 taxable at Lineal/Class A rate 14 at Sibling rate 14 taxable at Collateral/Class B rate Tax Due III (21 (31 (41 (51 [61 (71 105,000.00 .00 .00 .00 156,609.00 .00 .00 (8) DATE 07-31-2003 (91 llDI 22,515.00 12,964.00 (lll ll2) ll3) ll4) 261,609.00 35,479.00 226,130.00 22,613.00 203,517. 00 .00 .00 2.442.20 27.474.80 29,917.00 rAm"", "J AHDUNT PAID DATE NUHBER INTEREST/PEN PAID (-) 12-22-2002 CDOO1986 1,325.00 25,175.00 06-05-2003 CD002649 .00 3,778.00 TOTAL TAX CREDIT 30,278.00 BALANCE OF TAX DUE 361. OOCR INTEREST AND PEN. .00 TOTAL DUE 361.00CR . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. llS) ll6) ll71 llB) .ooxoo = .00X045= 20.351.70X 12 = 183.165.30X 15 = ll9) IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FDRH FOR INSTRUCTIONS. I REV-1470 EX (6-88) '*' INHERITANCE TAX EXPLANATION OF CHANGES COMMONWEAL THDF PENN~YLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME EVELYN K WERT FILE NUMBER REVIEWED BY Dianne McClain ACN 2102-0888 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES The Notice of Inheritance Tax Appraisement, Allowance or Disallowance of Deductions and Assessment of Tax has been adjusted to reflect the early payment discount. ROW Paqe 1 '. FIRST AND FINAL ACCOUNT OF LARRY E. WERT, EXECUTOR OF THE LAST WILL AND TESTAMENT OF EVELYN K. WERT, LATE OF SOUTH MIDDLETON TOWNSHIP, CUMBERLAND COUNTY, PENNSYLVANIA, DECEASED. DATE OF DEATH: September 22, 2002 LETTERS TESTAMENTARY ADVERTISED: The Sentinel:Oct7th, 14th,& 21st,2002 CLJ: Oct11th, 18th, & 25th, 2002 21-02-0888 ESTATE FILE NO.: PRINCIPAL RECEIVED ACCOUNTANT IS CHARGED WITH THE AMOUNTS OF PRINCIPAL AND INTEREST RECEIVED AND CLAIMS CREDIT FOR THE DISBURSEMENTS MADE AS STATED BELOW: 2002 Sept 22 Sept 22 Sept. 22 Sept 22 Sept. 22 Oct. 21 Oct. 28 Nov. 15 Nov. 18 Dec. 10 2003 Jan. 8 Real Estate, 1903 Douglas Drive, N. Middleton Township, Cumberland County, Pennsylvania M&T Bank, Checking Account #732702 M& T Bank, Savings Acct #15004200024559 Interest accrued to September 22, 2002 1990 Automobile,Oldmobile Sedan Cash from Home Refund, The Sentinel Refund, State Farm Mutual Auto Ins. Company Foot Locker, Pension Fund Refund, Hoffman Roth Funeral Home United Farm Guaranteed Investment Accrued interest to September 22, 2002 Refund, AARP Premium Page 1 $105,000.00 $6,752.68 $133,244.58 $137.77 $1,600.00 $107.08 $113.69 $233.58 $202.50 $166.07 $7,500.00 $166.67 $127.00 April 29 Proceeds from Auction of Household Goods $ 6.254.75 TOTAL PRINCIPAL RECEIVED $261,606.37 INCOME RECEIVED 2002 Sept. 22 Interest, M & T Savings Acct #15004200024559 $135.35 Oct. 27 Interest, Estate Checking Acct. $21.21 Nov. 24 Interest, Estate Checking Acct $43.87 Dec. 25 Interest, Estate Checking Acct $41.50 2003 Jan. 26 Interest, Estate Checking Acct $37.51 Feb. 25 Interest, Estate Checking Acct $35.15 March 25 Interest, Estate Checking Acct $32.74 April 27 Interest, Estate Checking Acct $38.04 May 26 Interest, Estate Checking Acct $47.13 June 26 Interest, Estate Checking Acct $54.82 July 23 Interest, Estate Checking Acct $ 41.10 TOTAL INCOME RECEIVED $528.42 OTHER INCOME RECEIVED March 31 Capital Life Insurance Company (No Beneficiaries on the Life Policy) $1.000.00 TOTAL OTHER INCOME RECEIVED Page 2 $1,000.00 DISBURSEMENTS 2002 Sept. 22 Checks cleared after date of death $157.90 Oct. 1 Register of Wills, Probate Will $296.00 Oct. 3 Cumberland Law Journal, Advertising $75.00 Oct. 10 Benjamin S. Souder, Mowing $31.80 Oct. 10 PP&L, Electricity $23.25 Oct. 10 Sprint, Telephone $26.80 Oct. 17 Diversified Appraisal Service, Real Estate Appraisal $250.00 Oct. 17 Alert Pharmacy Services, Medical $198.00 Nov. 15 Alert Pharmacy Services, Medical $8.62 Nov. 15 Sprint, Telephone $27.01 Nov. 15 PP&L, Electricity $13.31 Nov. 15 Benjamin S. Souder, Mowing $31.80 Nov. 15 Register of Wills, (1) Short Certificate $3.00 Nov. 15 The Sentinel, Advertising $84.11 Nov. 15 Cumberland Crossings Retirement Community $2,586.52 Nov. 15 Carlisle Suburban Authority, Water $76.80 Nov. 15 Peerless Insurance Co., Homeowner's $57.65 Dec. 3 Sprint, Telephone $29.23 Dec. 3 PP&L, Electricity $17.18 Dec. 18 Peerless Insurance Co., Homeowners $38.15 Page 3 Dec. 18 York Waste Disposal, Trash Removal $29.91 Dec. 23 Register of Wills $25,175.00 Estimated Pennsylvania Tax Return Dec. 23 Refund, Cumberland Crossing Retirement -$1,058.21 Community Dec. 23 Bank Fee $7.00 Dec. 30 Larry E. Wert, Reimburse for "For Sale Signs" $25.27 Dec. 30 Sprint, Telephone $28.43 Dec. 30 PP&L, Electricity $25.30 2003 Jan. 8 Peerless Insurance Co., Homeowner's $43.15 Jan. 8 Benjamin S. Souder, Snow Removal $25.00 Jan. 8 Carlisle Suburban Authority, Water $76.80 Jan. 14 Benjamin S. Souder, Snow Removal $20.00 Jan. 28 Peerless Insurance Co., Homeowner's $38.15 Jan. 28 Sprint, Telephone $28.43 Feb. 12 PP&L, Electricity $12.28 Feb. 21 Benjamin S. Souder, Snow Removal $20.00 Feb. 21 Peerless Insurance Co., Homeowner's $38.15 Feb. 25 Sprint, Telephone $28.43 Feb. 25 Benjamin S. Souder, Snow Removal $50.00 March 10 Carlisle Suburban Authority, Water $76.80 March 10 PP&L, Electricity $25.96 Page 4 March 17 Peerless Insurance Co., Homeowner's $38.15 March 17 Robin K. Sollenberger, TIC $296.22 March 18 York Waste Disposal, Trash Removal $29.91 April 2 PP&L, Electricity $24.55 April 9 Sprint, Telephone $28.57 May 1 Kevin M. Wickard, Auctioneer Commission $1,357.25 May 1 Peerless Insurance Co., Homeowner's $38.15 May 1 Benjamin S. Souder, Mowing $31.80 May 1 Sprint, Telephone $28.57 May 1 Dragan Karacic, Repairs $650.00 May 1 Carlisle Suburban Authority, Water $89.60 May 1 Refund, Credit County & School Taxes, -$373.99 Sale of Real Estate May 1 Recorder of Deeds, State Tax/Stamps $1,050.00 May 1 Secured Land Transfers, Tax Certification $2.00 May 1 Notary Fee $20.00 May 1 Closing Costs, Sale of Real Estate $2,884.00 May 1 Gateway Funding, Tax Service $81.00 May 1 Gateway Funding, Underwriting $75.00 May 1 ERA, Commission, Sale of Real Estate $3,150.00 May 1 ERA, Transfer Fee, Sale of Real Estate $100.00 May 5 PP&L, Electricity $22.66 May 19 PP&L, Electricity, Final Bill $6.41 Page 5 May 19 Central Penn Medical Group, Medical $17.93 May 22 Refund, PP&L, Electricity -$16.25 June 3 Refund, Sprint, Telephone -$23.97 June 3 York Waste Disposal, Trash Disposal $400.00 June 4 Refund, PP&L, Electricity -$6.41 June 4 Register of Wills, Agent $3,778.00 Balance of Pennsylvania Inheritance Tax June 4 Register of Wills, Filing Fee $15.00 Pennsylvania Inheritance Tax Return June 25 Refund, Peerless Insurance Co., Homeowner's -$73.55 July 24 Register of Wills, File Final Account $119.00 Aug. 26 Larry E. Wert Executor's Fee $10,878.00 Aug. 26 Robert M. Frey, Prepare & File 2003 Taxes $50.00 Aug. 26 Robert M. Frey, Executor's Fee $10.878.00 TOTAL DISBURSEMENTS $64,393.58 RECAPITULA TlON TOTAL PRINCIPAL $261,606.37 $ 1. 528.42 TOTAL INCOME RECEIVED TOTAL RECEIPTS $263,134.79 $ 64.393.58 LESS TOTAL DISBURSEMENTS BALANCE FOR DISTRIBUTIONS $198.741.21 Page 6 PROPOSED SCHEDULE OF DISTRIBUTION BALANCE FOR DISTRIBUTION TO: Cavalry Road Church of God 910 Cavalry Road Carlisle PA 17013 10% of residue of estate: TO: Richard L. Wert 8 Middleton Avenue Carlisle PA 17013 10% of residue of estate: TO: Lester S. Wert, Jr. 53 Bloserville Road Carlisle PA 17013 10% of residue of estate: ,. TO: Craig A. Wert 1254 Holly Pike Carlisle PA 17013 10% of residue of estate: TO: Larry E. Wert 41 Lebo Road Carlisle PA 17013 10% of residue of estate Page 7 $198.741.21 $19.874.13 $19.874.12 $19.874.12 $19.874.12 $19.874.12 TO: TO: TO: TO: TO: Anna Mary Smith 482 Petersburg Road Carlisle PA 17013 10% of residue of estate: $19.874.12 Joan E. Wert 105 South Orange Street Carlisle PA 17013 10% of residue of estate: $19.874.12 Joann Elaine Nailor 1175 Boiling Springs Road Mechanicsburg PA 17055 10% of residue of estate: $19.874.12 Faye Marlene Garman 590 McClure's Gap Road Carlisle PA 17013 10% of residue of estate: $19.874.12 Brenda Jane Hartman 406 Harrisburg Pike Dillsburg PA 17019 10% of residue of estate: $19.874.12 TOTAL DISTRIBUTION $198.741.21 Page 8 "t COMMONWEALTHOFPENN8YLVANIA ) ):88.: COUNTY OF CUMBERLAND ) Before me, the undersigned officer, personally appeared Larry E. Wert, Executor of the Last Will and Testament of Evelyn K. Wert, deceased, who, being duly sworn according to law, deposes and says that the foregoing First and Final Account is true and correct to the best of his knowledge, information and belief. t:-tf r: ~ LARRYE. WE T NOTARIAL SEAl TRISHA A.lIESS, NOTARY PUBLIC BOROUGH OF CARLISlE, CUMBERLAND CO., PA MY C~lssrON EXPIRES MAY 20,2006 Page 9 -, ft~j JI~~ i 15'I~il I l its't , ;i'I.J!i J r indih~ I ~ filii I'~j..( !tlf~Jlf; \;r !15JI~i1fi~! ~ .0 ~6ji~aif L~Ei~~Ij< ... .. ~ Ci-c Q: ~ 0 ..... _ ...:i .. ........c: ...~ ..c"""Ortl......Q.l ~.....""""Q.l==rI.l =... ~... ~ ::I:ll ......OJ;:i~oOc.J =...s...:iE-<U" ::1=",... "Cl~ 8=~..== . c.J <.JL" OJ..s "'=.! <~"Cl~"1:= - r~' = w:a ~ ~ Ol-Ol~"Cl..c.:; = 4'_ .....- 8 ~ ~ t:= ~~ = ~ "Cl~~;:;..c:U= = ...... > .........,..,0) Olr-l ~r-l::l =_ ... , = ~~fJJ ri: ~Y.:' _~ .~~-) ~:. <> ~ ',;!, ,,~, .' ~ ;;.. '''",.l :F~... lI,"f lpjJ:..__~ ,".'~ - ...l ~ah .' htt.~ .~ ~ ~.. '~' -, '> .t . .~;: "" ., - 5 ._' ,0;' ,. -;.2'- .-.' ~'Z >1' l ~ '~l:;'l~_ , , . i' .') '-:... "J \ -; P ~ "<., ,.. ~ . \ ~ :;; '[:::.<: (I '~l ,\ ~ ,- :;.. I ~~: ;.. --:.. , > = = .~ ... ::I ..c .~ .. ... '" S ... = .. 'E "Cl .. ..c: '" '" "Cl ~ = c.. = .. ~ '" f5 ~ o _;: 0 _ . CkQ) :;"'- - lJ) C ~ c: lil8 ~ c: c. III III ~-a CD ilis'- . ., q;!~.~",.!!!,gi r :; j>~ ~o J '0 ~ S ~ :5 ~ ~ " ~ -eB~.,. rt ~iIJlg!t ~ i~ ~r~ l! , itiB15~ . lii '5 it'~ :i 8~ l~jil l;~~ i~~)~ !fl~l~t\;~ co ~ '" Q) co Q) U) >-5:':::~M LU:5Ulo.,. ....J~Qi~N ~~~<R _>-ca..;:: vv w ctI ._ >-ZI~CD LUa::O..c~c ~ ~ 0 a:l-gro.c LL~cnUg- L() ~ ~ IN RE: ESTATE OF EVELYN K. WERT LATE OF SOUTH MIDDLETON TWP IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA, ORPHANS COURT ESTATE NO. 21-2002-0888 ORDER OF COURT ~ AND NOW, -z.ct day of August, 2003, the within account is confIrmed and distribution directed in accordance with the schedule. ..., - v' CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: EVELYN K. WERT Date of Death: September 22, 2002 Will No. To the Register: Admin.No. 21-02-0888 I certify that notice of (beneficial Interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on: December 3, 2002 Name Cavalry Road Church of God Lester S. Wert, Jr. Anna Mary Smith Craig A. Wert Joan E. Wert Richard L. Wert Larry E. Wert Joann Elaine Nailor Faye Marlene Garman Brenda Jane Hartman Address 910 Cavalry Road, Carlisle PA 17013 53 Bloserville Road, Carlisle PA 17013 482 Petersburg Road, Carlisle PA 17013 1254 Holly Pike, Carlisle PA 17013 113 W. South Street, Carlisle PA 17013 8 Middleton Avenue, Carlisle PA 17013 41 Lebo Road, Carlisle PA 17013 1175 Boiling Springs Rd,Mechanicsburg PA 17055 590 McClure's Gap Rd, Carlisle PA 17013 406 Harrisburg Pike, Carlisle PA 17013 Notice has now been given to all persons entitled thereto under Rule 5.6)a) except NO EXCEPTIONS Date: December 3, 2002 ~- A" ~'7 Signature Name: Address: Robert M. Frey 5 South Hanover Street Carlisle. Pennsylvania 17013 Capacity:_Personal Representative -.llCounsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT FREY ROBERT M ESQUIRE 5 SOUTH HANOVER STREET CARLISLE, PA 17013 _u_____ fald ESTATE INFORMATION: SSN: 209~ 12~8540 FILE NUMBER: 2102-0888 DECEDENT NAME: WERT EVELYN K DATE OF PAYMENT: 12/23/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 09/22/2002 NO. CD 001986 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $25,175.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: FREY AND TILEY C/O ROBERT M FREY ESQUIRE CHECK# 3989 SEAL INITIALS: CW RECEIVED BY: REGISTER OF WILLS $25,175.00 DONNA M. OTTO DEPUTY REGISTER OF WILLS /'}-'1/-/3 '\- BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REV-U07 EX AFP 101-OS) ROBERT M FREY FREY & TI LEY 5 S HANOVER ST CARLISLE DATE ESTATE OF DATE OF DEATH FILE NUMBER 'COUNTY ACN 09-02-2003 WERT 09-22-2002 21 02-0888 CUMBERLAND 101 EVEl YN K Allaunt Rellitt.d PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account} submit the upper portion of this for.. with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=16rWix-AFP-foFiiiY------..iE--INifiRITANcE--i'Ax--sTA-jEHENi'-cfF"-AC-COUN-j--iE..--------------------- ESTATE OF WERT EVElYN K FILE NO. 21 02-0888 ACN 101 DATE 09-02-2003 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACH IN THE NAHED ESTATE. SHOWN BELOW IS A SUHNARY OF THE PRIHCIPAL TAX DUE, APPLICATIOH OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-30-2003 PRINCIPAL TAX DUE:_ 29,917.00 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-22-2002 CDOO1986 1,325.00 25,175.00 06-05-2003 CD002649 .00 3,778.00 08-15-2003 REFUND .00 361. 00- TOTAL TAX CREDIT 29,917.00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. J - Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 8/03/2004 FREY ROBERT M 5 S HANOVER STREET CARLISLE, PA 17013 RE: Estate of WERT EVELYN K File Number: 2002-00888 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: 9/22/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~L~~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge STATUS REPORT UNDER RULE 6.12 Name of Decedent: WERT, EVELYN D. Date of Death: September 22, 2002 Will No. Admin. No. 21-02-0888 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes (X) No ( ) 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: Date: 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 (X) No (). (b) The separate Orphans' Court no. (if any) for the personal representative's account is: (c) Did the personal representative state an account informally to the parties in interest? Yes ( ) No ( ) (d) Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. August 9, 2004 Signature Robert M. Frey Name (Please type or print) ~ity: ( ) Personal ( X ) Counsel 5 South Hanover Street Carlisle, Pa 17013 Address (717) 243-5838 Telephone No. Representative for personal representative