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HomeMy WebLinkAbout07-18-11 (5)Johnson, Duffis, Stewart 8 Weidner, P.C. By: Jerry R. Duffle Attorney I.D. No. 9601 301 Market Street P. O. Box 109 Lemoyne, Pennsylvania 17043-0109 (717) 761-4540 jrd(a~jdsw.com Attorneys for Petitioner IN RE: ESTATE OF SHIRLEY BENNETT LOTZ A/K/A SHIRLEY ANNE BENNETT LOTZ, Deceased N ~ ~ ~~ ~~~ r cr .~ c-~ ~+~~ _ U7 r[ t U ~~ ~~ e .-,. -n rr -:~„ _. _ T~ ~ ~ ~ ~~ ~~ ~. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION N0.2010-1196 TO THE HONORABLE JUDGES OF THE ORPHANS' COURT DIVISION: Petitioner, Richard S. Simpson, II, Executor of the Estate of Shirley Bennett Lotz, deceased, files this Petition for Court approval of (I) Executor's resignation and request to be discharged, (ii) withdrawal of Executor's counsel and (iii) filing of First and Partial Account, and respectfully represents that: 1. Shirley Bennett Lotz (Decedent) died on November 20, 2010, residing at 340 Messiah Circle, Mechanicsburg, Upper Allen Township, Cumberland County, Pennsylvania, leaving a Last Will and Testament, dated May 26, 2010, a copy of which is attached, marked Exhibit A, and made part hereof. 2. The Last Will and Testament of Shirley Bennett Lotz was admitted to probate by the Register of Wills of Cumberland County on December 6, 2010 and, in accordance with the provisions of Paragraph X of Decedent's Last Will and Testament, Richard S. Simpson, II qualified and was appointed Executor. A copy of the Letters Testamentary is attached, marked Exhibit B, and made part hereof. 3. Executor engaged Johnson, Duffie, Stewart & Weidner, P.C. ("Firm") to represent the Executor. 4. The Estate's Employer Identification Number (27-6952762) was obtained and the Grant of Letters Testamentary was advertised in the Patriot-News Co., Inc. and the Cumberland Law Journal and the first complete advertisement was completed on December 31, 2010 and proofs of publication were obtained. 5. The Inventory setting forth the assets of Decedent's Estate as of Decedent's date of death is attached hereto, marked Exhibit C, and made part hereof. 6. Decedent is survived by her daughter, Dyane V. Smith, an adult individual residing at 24 Ridgewood Drive, Redding, Connecticut 06896. 7. Decedent's household goods, personal effects and automobile have been appraised and, in accordance with Paragraph III, Decedent's Last Will and Testament, said items of tangible personal property have been distributed to Decedent's daughter, Dyane V. Smith. 8. In accordance with Paragraph IV, Paragraph V and Paragraph VI, Decedent's Last Will and Testament, the three (3) pecuniary bequests, each in the amount of One Thousand ($1,000.00) Dollars, have been paid to each of the named legatees by check, dated May 3, 2011, and a Release has been obtained from each legatee. 9. Pursuant to Paragraph VII, Decedent's Last Will and Testament, the residuary beneficiaries are (i) Grant Foundation, (ii) Presbytery of Carlisle, Presbyterian Church (U.S.A.) and (iii) Dyane V. Smith. The residuary charitable bequests to Grant Foundation and Presbytery of Carlisle, Presbyterian Church (U.S.A.) have been paid by 2 checks, dated May 23, 2011, and Releases have been obtained. To date, no distribution of the remaining portion of the residuary estate has been made to Dyane V. Smith. 10. All of Decedent's debts have been paid and all administration expenses have been paid except the Executor's commission, attorney's fees and costs advanced by Firm but not reimbursed. 11. A prepayment on account of Pennsylvania inheritance tax in the amount of Thirteen Thousand ($13,000.00) Dollars was paid to the Cumberland County Register of Wills on February 18, 2011. 12. The Pennsylvania Inheritance Tax Return, dated May 5, 2011, was filed with the Cumberland County Register of Wills on May 6, 2011. A copy of the Pennsylvania Inheritance Tax Retum is attached, marked Exhibit D, and made part hereof. 13. The undistributed residuary assets remaining as of the date of this Petition (prior to payment of the Executor's commission, attomey's fee and costs) consist of the following: Asset Current Value Estate checkin account - M&T Bank Account No. 9853851732 $ 33,575.31 Non-Qualified Accounts - (Annuity Accounts and REIT Account) Estate of Shirle Bennett Lotz Fixed Retirement Annuity - VP Account No. 000 0930 0211 5662 3 004 $ 15,726.94 Fixed Retirement Annuity - VP Account No. 000 0930 0240 7024 3 004 $ 39,438.69 Fixed Retirement Annuity - VP Account No. 000 0930 0340 3326 4 004 $ 28 124.92 Fixed Retirement Annuity 1-YR Account No. 000 0930 0411 5967 2 004 $ 48,009.41 Inland American Real Estate Account No. 00064103922021 z $ 6,080.323 Total Value of Annui Accounts and REIT Account: $146,079.61 Qualified Accounts (Individual IRA Plans -Beneficiary: Estate of Shine Bennett Lotr as of Ma 31, 2011 Ameriprise Brokerage Account No. 0000 0000 2677 7656 5 021 Total Value of Individual IRA Plans: $145,170.90 Totaf Value of Remainin Assets: $310,954.88 ~rootnotes are on the top or the next page.) 3 Footnote 1. Estate Checking Account balance will be reduced by payment of Executor's commission, attorney's fees, costs to be reimbursed to Firm and Probate Bond premium upon Court approval. Footnote 2. Inland American Real Estate (REIT) is in the process of being liquidated and current value to be paid to Estate by September 26, 2011; if liquidation occurs prior to effective date of Court's Order, current value will be deposited in Estate Checking Account upon receipt. Footnote 3. Date of death value of Inland American Real Estate (REIT) and not the amount to be paid upon liquidation (currently unknown). 14. With respect to the above-described Individual IRA Plans, the beneficiary of each plan is the Estate of Shirley Bennett Lotr. In order to minimize potential federal income tax consequences, it Executor intended to do atrustee-to-trustee transfer of the Individual IRA Plans for the benefit of Decedent's daughter, Dyane V. Smith. 15. The above-described annuity accounts have not been liquidated or transferred to the Estate because three (3) annuity accounts currently earns approximately 4% per annum and the remaining annuity account earns approximately 3.5% per annum. 16. Paragraph X, Decedent's Last Will and Testament, provides, in part, that if the Executor (Richard S. Simpson, II) "fail to qualify or ceases to act as Executor...", Decedent appointed "Mid Penn Bank, of Camp Hill, Pennsylvania, Executor... ". Mid Penn Bank, pursuant to Renunciation, dated June 6, 2011, elected to renounce its right to serve as the Alternate Executor. A copy of the Renunciation is attached hereto, marked Exhibit E, and made part hereof. 17. During Decedent's lifetime, Decedent was hospitalized at Holy Spirit Hospital on a couple of occasions. During one of those occasions, there was an incident, on or about August 1, 2009, which may have resulted in an injury to Decedent. Decedent engaged the firm of Navitsky, Olson & Wisneski, LLP to represent the Decedent in connection with that matter. 18. The malpractice claim was not resolved prior to the Decedent's death and Decedent's daughter, Dyane V. Smith, understandably, desires to pursue that matter by litigation which said litigation has not been instituted. 4 19. Firm has, since 1959, represented Holy Spirit Hospital and, currently, Firm is Corporate Counsel for Holy Spirit Health System, as well as all of its subsidiary corporations, including Holy Spirit Hospital. 20. Notwithstanding that Firm is Corporate Counsel for Holy Spirit Health System and its subsidiaries, including Holy Spirit Hospital, all insured claims, including professional malpractice claims, are handled by Dickie, McCamey & Chilcote, P.C. 21. Decedent's daughter, Dyane V. Smith, understandably, now desires that Firm resign as the attomeys for the Estate of Shirley Bennett Lotz and Firm, because of the possible litigation, as described above, desires to resign as attorneys for the Estate of Shirley Bennett Lotz. 22. Decedent's daughter, Dyane V. Smith, has or intends to file a Petition for Letters of Administration d.b.n.c.t.a., to qualify as the Administratrix d.b.n.c.t.a. to complete the administration of her mother's Estate and to engage Richard W. Stevenson, Esquire, as the attorney for the Estate. 23. Contemporaneously with the filing of this Petition, Firm filed a Praecipe with the Cumberland County Register of Wills resigning as the attomeys for the Estate of Shirley Bennett Lotz and Richard W. Stevenson, Esquire, filed a Praecipe with the Register of Wills of Cumberland County to enter his appearance as attorney for the Estate of Shirley Bennett Lotz. Copy of Firm Praecipe and Mr. Stevenson's Praecipe are attached as Exhibit F and Exhibit G, respectively, and made part hereof. 24. Executor has prepared a First and Partial Account, dated as of June 17, 2011, pertaining to the administration of the Estate of Shirley Bennett Lotz. A copy of the First and Partial Account, together with a Schedule of Distribution and Petition for Adjudication/Statement of Proposed Distribution Pursuant to PA. O.C. Rule 6.9, is attached, marked Exhibit H, and made part hereof. 25. Decedent's daughter, Dyane V. Smith, has, pursuant to the Consent attached hereto, marked Exhibit I, and made part hereof, consents to the following: 5 (a) The resignation of the Executor. (b) The resignation of the Estate's attorney. (c) Payment of (i) Executor's commission in the amount of Nine Thousand ($9,000.00) Dollars, (ii) payment of Firm's fee in the amount of Nine Thousand ($9,000.00) Dollars in accordance with Firm's statement, attached hereto, marked Exhibit J, and made part hereof, (iii) reimbursement to Firm for costs advanced in the amount of Eight Hundred Ninety-Three Dollars and Twenty- Five Cents ($893.25) as shown on the Firm's statement (Exhibit J), (iv) that the Executor's commission, Firm's attorney's fees and costs, be paid out of the Estate checking account prior to the effective date of the Court's Order in this matter. (d) To the filing of the First and Partial Account (substantially in the form set forth in Exhibit H) and the Petition for Adjudication prior to the effective date of the Court's Order and submission of the First and Partial Account to the Court for confirmation after receipt of the Department of Revenue's Appraisement, filing of the Appraisement with the Cumberland County Register of Wills and approval of the First and Partial Account, waiving any required advertisements, personal notice or other formalities in connection with the confirmation process and waiving all objections to the First and Partial Account. (e) Discharge of the Executor (Richard S. Simpson, II) upon confirmation of the First and Partial Account. 26. That within five (5) business days after Dyane V. Smith is appointed by the Cumberland County Register of Wills as Administratrix d.b.n.c.t.a. of Decedent's Estate, that Executor shall deliver or cause to be delivered to Richard W. Stevenson, Esquire, in his capacity as counsel for the Estate, a copy of the following documents: (a) Petition to Probate and Grant of Letters Testamentary. (b) Proofs of Publication. 6 (c) Notices to of Estate Administration Pursuant to PA. O.C. Rule 5.6 and Certification of Notice Under PA. O.C. Rule 5.6(a). (d) Safety deposit box inventory (ring) (e) Inventory. (f) Prepayment of Pennsylvania inheritance taxes. (g) Pennsylvania Inheritance Tax Retum. (h) Department of Revenue Appraisement (when received). (i) Checks to pecuniary legatees and residuary charitable legatees and releases from each said legatee. (j) Appraisals of personal property and jewelry (ring). (k) M&T Bank Estate checking account statements (Account No. 9853851732). (I) First and Partial Account and Petition for Adjudication/Statement of Proposed Distribution Pursuant to PA. O.C. Rule 6.9. 27. That the Executor shall transfer all remaining funds (after payment of the Executor's commission, Firm's fee, reimbursement of expenses and bond premium) in the M&T Bank Estate checking account to a new Estate checking account to be opened by Dyane V. Smith, in her capacity as Administratrix d.b.n.c.t.a. 28. That Dyane V. Smith, in her capacity as Administratrix d.b.n.c.t.a., upon receipt of the Appraisement, if any additional Pennsylvania inheritance tax, to include interest, is due and payable that Dyane V. Smith pay such additional Pennsylvania inheritance tax and, if applicable, any interest, and file any required supplement to the 7 Pennsylvania inheritance tax return based on (i) any additional Pennsylvania inheritance due or (ii) the litigation (if applicable), or both. 29. That Court's Order be effective upon the qualification and appointment of Dyane V. Smith as Administratrix d.b.n.c.t.a. WHEREFORE, Petitioner respectfully requests that the Court enter an Order, effective upon the qualification and appointment of Dyane V. Smith as Administratrix d.b.n.c.t.a. of the Estate of Shirley Bennett Lotr, deceased, specifying the following: 1. That the resignation of Richard S. Simpson, II as the Executor of the Estate of Shirley Bennett Lotr, deceased, is approved. 2. That upon the confirmation of the First and Partial Account that the Executor, Richard S. Simpson, II, shall be discharged from any liability as Executor of the Estate of Shirley Bennett Lotr, deceased. 3. That the withdrawal of Johnson, Duffle, Stewart & Weidner, P.C., as attorneys for Richard S. Simpson, II, Executor of the Estate of Shirley Bennett Lotr, deceased, is approved. 4. The Executor's commission, Firm's fees and costs as set forth in this Petition are approved and prior to the qualification and appointment of Dyane V. Smith as Administratrix d.b.n.c.t.a. of the Estate of Shirley Bennett Lotr, deceased, Richard S. Simpson, II, Executor, is authorized to pay the Executor's commission, attorney's fees and costs as set forth in this Petition. 5. That prior to the qualification and appointment of Dyane V. Smith as Administratrix d.b.n.c.t.a. of the Estate of Shirley Bennett Lotr, deceased, Executor is authorized to file a First and Partial Account (substantially in the form set forth in Exhibit H) and Petition for Adjudication/Statement of Proposed Distribution Pursuant to PA. O.C. Rule 6.9, and following the filing of the First and Partial Account, file with the Cumberland County 8 Register of Wills the Appraisement received from the Pennsylvania Department of Revenue and following receipt of said Appraisement and payment of additional Pennsylvania inheritance tax, if any, by Dyane V. Smith, in her capacity as Administratrix d.b.n.c.t.a., the First and Partial Account and Petition for Adjudication shall be submitted to the Court for confirmation. 6. That following the qualification and appointment of Dyane V. Smith as Administratrix d.b.n.c.t.a. of the Estate of Shirley Bennett Lotz, deceased, the Executor (Richard S. Simpson, II) shall transfer all then remaining funds in the M&T Bank Estate checking account to an Estate checking account created by Dyane V. Smith as Administratrix d.b.n.c:t.a. and said funds shall not be distributed directly to Dyane V. Smith, individually. 7. That within ten (10) days after Dyane V. Smith is appointed Administratrix d.b.n.c.t.a., that Executor (Richard S. Simpson, II) deliver or cause to be delivered to Richard W. Stevenson, Esquire, copies of the documents described in Paragraph 26 of the Petition. Respectfully submitted, JOHNSON, DUFFIE, STEWART & WEIDNER, P.C. By: Jer uffie Attorney I.D. No. 9601 301 Market Street P.O. Box 109 Lemoyne, PA 17043-0109 Telephone (717) 761-4540 Attorneys for Petitioner, J~ ~/ Richard S. Simpson, ll, Executor Dated: :443827v3 9 VERIFICATION I, Jerry R. Duffle, attorney for Petitioner, verify that the statements made in this Petition are true and correct to the best of my personal knowledge, or information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. §4904 relating to unsworn falsification to authorities; I verify that all the statements made in the foregoing are true and correct and that false statements may subject me to the penalties of 18 Pa. C.S. §4804. rry ie ~.ac~t ~iYY a~r~b ~e~ta~rrrer~t - OF SHIRLEY BENNETT LOTZ I, SHIRLEY BENNETT LOTZ, of Upper Allen Township, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. I I direct that all my legal debts and funeral expenses including my gravemarker and all expenses of my last illness, shall be paid from my residuary estate as soon as.pradicable after my ', decease as a part of the expense of the administration of my estate. Ih I direct my Executor to pay all inheritance, transfer, estate, income and similar taxes (including interest and penalties) assessed or payable by reason of my death on any property or interest in property which is .included. in my estate for the purpose .of computing taxes. My F~cecutor shall not require any beneficiary to reimburse my estate for taxes paid on property passing under the terms of this Wilf or otherwise. III. . I bequeath my. automobile, household goods, jewelry, including, but not limited to, my.. yellow gold diamond-ring and my platinum diamond ring, and other tangible personal property of a like nature (not incuding cash or securities), together with any insurance thereon, to my daughter, DYANE VALERIE SMITH. Shauld my daughter,. DYANE VALERIE SMITH, predecease me, then I direct that my Executor shall liquidate said items of personalty and the net proceeds therefrom shall be added to•my~residr~ary estate: ~- • ~ . , IV. I bequeath the sum of One Thousand ($1,000.00) Dollars to my friend, MARY LOUISE SHETTER; provided she shall survive me. V. • I bequeath the sum of One Thousand ($1,000.00) Dollars to my friend, LISA STARNER, provided she shall survive me. - • VL . I bequeath the sum of One Thousand ($1,000.00) Dollars to my friend, SUSAN FULGINI'1f1, provided she shall survive me. _- VII. devise and bequeath the residue of my estate of every nature and wherever situate as follows: .. A. The lesser of five (5%) percent of my residuary estate or the sum of Ten Thousand ($10,000.00) Dollars to GRANT FOUNDATION, P.O. Box 81048, Pittsburgh, Pennsylvania 15217, for the benefit of Hospital Albert Schweitzer Haiti. I further direct that this residuary bequest shall be paid by GRANT.. FOUNDATION to the goveming body of Hospital Albert Schweitzer Haiti and to be used as part of the general operating fund. B. The lesser of five (5%) percent of my residuary estate or the sum of Ten Thousand ($10,000.00) Dollars to PRESBYTERY OF CARLISLE, .PRESBYTERIAN CHURCH,(IJ.S.A.) to be given to the Presbyterian Church of which I am an active member .. ,. _ at the time of my death. Further, I direct that the bequest be given to the Presbyterian Church of which ~ I am an active member at the time of my death to be invested and ..reinvested by the Church's goveming body in a separate fund and the principal and income in said fund to be used, by the Senior Pastor in service at said Church in said Pastor's discretion-to assist womeri and families in financial difficulty because of domestic abuse or abandonment. , _ . _ .r C. The balance thereof to my daughter, DYANE VALERIE SMITH. Should my daughter, DYANE VALERIE SMITH, predecease . me, I devise and bequeath a residuary to my grandson, TAYLOR. LELAND SMITH, subject to the provisions of Paragraph VIII. 2 vln. Should any of my issue, including my grandson, TAYLOR LELAND SMITH, entitled to a share of my estate not attain the age of twenty-five (25) at the time of distribution to.him or her, I- devise and bequeath the share of each such issue to MID PENN BANK, Camp Hill, Pennsylvania, IN SEPARATE TRUST, to hold, manage, invest and reinvest the shares so received, and the accumulation of income thereon, and to use and apply the income and principal .or so much thereof as, in Trustee's sole and absolute discretion, may be necessary or appropriate for such .issue's support and education (including trade school and college education, both graduate and undergraduate) after taking into consideration his or her parent's ability to provide' for such support or education, or tit. make payments for these purposes, without further responsibility, to such issue or to such issue's parent or to any person taking care of such issue. Any principal or income not so applied shall be distributed to such issue absolutely when he or she attains the age of twenty-five .(25). If he or she dies before attaining the age of twenty-five (25) the Separate Trust shall terminate and such share shall be distributed to his or her personal representative. IX. The interest of the beneficiaries hereunder shall not be subject to antiapation or to voluntary or involuntary alienation. X. - I nominate, constitute and appoint, RICHARD S. SIMPSON II, Executor, of this, my last Wilt.. Should.RICHARD S. SIMPSON III fail to qualify or cease to act as Executor, I appoint M1D PENN BANK, of Camp Hill, Pennsylvania; Executor, of this, my last Will. Xl. I direct that my Executor, and his successor, shall not be required to post bond in any jurisdiction for the faithful performance of his or her duties. XII. My corporate fiduciary shall be entitled to compensation based on its regular schedule of fees for such services in.effect from time to time during the period over which the services are performed. 3 ~h IN-WITNESS WHEREOF, 1 have hereunto set my hand and seal this ~ day of 2010. . ~._irm D,e. a-l-'h-~o~'i (SEAL) SHIRLEY NNETT LOTZ Signed, sealed, published and declared by the above-named Testator, as and for his Last Will and Testament, in,the presence. of us, who, at .her request, in his presence and in the presence of each other have hereunto subscribed our names as witnesses, AC COMMONWEALTH OF PENNSYLVANIA . ss: COUNTY OF CUMBERLAND , I, SHIRLEY BENNETT LOTZ, Testatooc, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~n...leu ' ~csssi~- L. o'{'s. SHIRLEY BENNETT LOTZ Swom or affirmed to and acknowledged before me, liy SHIRLEY BENNETT LOTZ, the Testatrix, this ~71~' day of ~IlI.U , 2010. No ry Public COMMONWEFILTH OF PENNSYLVAHIA I~TOTARTAT. SEAL . Qai17. Mahoney; NotaiyPublic Lemoyne Borough, CS~mbal8nd Googly 4 commission F 19, 2(114 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA . ss. ' COUNTY OF CUMBERLAND We, . ~t_°r-'N 2. 17k~ft ~ and - r `Q~'~CLfe~ ~~ ~'+~' ,the witnesses whose names are signed to the foregoing instrument, being duly qual'~fed according to law, do depose and say that we were present and saw the Testatrix sign and execute the foregoing instrument as her Last Will and Testaments that she signed willingly and.that she executed it as her free and voluntary act' for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge,. the Testatrix was that time at least 18 years of age, of sound mind and under nb constraint or undue influence, Sworn or affirmed to and srubnscribed to before me by ~r'(~ ~, ~~ ~ and mG.a^6,21,~~ ~ . ~ k`~" ,witnesses, this o~ 97~ day of _ rn~-~~ 2010.. No ary Publi :399609 OOI~ONRVEALIH OFPffi~1NSYLVANtA NOTARIAL SEAL C18ii 7. Mahmey, Notp[yPobliC Lemoyne Ba~ougb, O~mbaieod ~!' . 19,4014 5 REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA GRANT OF LETTERS No. 2010- 01196 PA No. 21- 10- 1196 Estate Of: SHIRLEYBENNETTLOTZ (First, Middle, last! _-- _ a/k/a : SH/RLEY ANNE BENNETT-LOTZ Late Of : UPPER ALLEN TOWNSHIP CUMBERLAND COUNTY Deceased Social Security No: 202-20-6116 WHEREAS, on the 7th day of December 2010 an instrument dated May 26th 2010 was admitted to probate as the last will of SH/RLEY BENNETT LOTZ (First, Midd/e, Lasy a/k/a SHIRLEYANNEBENNETT-LOTZ late of UPPER ALLENTOWNSH/P,CUMBERLANDCounty, who died on the 21st day of November 2010 and WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: RICHARD S S/MPSON // who has duly qualified as EXECUTOR(R/XI and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 7th day of December 2010. /~ ~J1 n g p neg/s~e7r o~Wi s -"C" C~c1 loll lX~~[ h,y '°'l ~) lf~ /~ rl[~in uty **NOTE** ALL NAME5 ABOVE APPEAR (FIRST, MIDDLE, LAST) INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA couNTY of Cumberland County } ss File Number 21-10-01196 ,~, Richard S Simpson II n Personal Representative(s) of the Estate of Shirley Bennett LOTZ ~ ~ --~ `,~'~'-,' r~ ~~-~, I deceased, depose(s) end say(s) that the items appearing In the following inventory include ell of the perso~s~ts wherever. ~_i c: -i sttuate and ell of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuatiori~I~c~d,opposite each;. t-~ item of said irneMory represents its fair value as of the date of the decedent's death, and that Decedent ota0e>Si~tfrreal 33tate .,` ,: -~'-r, outside of the Commonwealth of Pennsylvania except that which pears infp m orandum et the end of~l~ventor~- - = c~ I verily that the statements made in this Inven- ~ C.!'ety , tory are true end correct. I understand that false state- Richard S Simpson II O r manta herein are made subject to the penalties of i 18 Pa.C.S. § 4904 relating to unswom fals'tficetion to l authorities. AttorTray - (Name) JERRY R. DUFFIE (supreme Court-,o. No.) 09601 (Flan) JOHNSON DUFFIE STEWART ~ WEIDNER (Address) _301 MARKET ST. LEMOYNE, PA 17043-0109 (Telephone) (717) 761-4540 DATE OF DEATH LAST RESIDENCE Messiah Village DECEDENT'S 80C. SEC. ND. 11!2112010 Mechanicsbum, PA 17050 202-20-6116 FIGURES MUST BE TOTALED Personal Proq Cash ............................................................................................... Personal Property ........................................................................ Stocks/Liated ................................................................................ StockslClosety Held ..................................................................... Bonds .............................................................~..u„•.,........................ Partnerships and Sole Proprietorships ..................................... Mortgagee and Notes Receivable ............................................... All Other Property ........................................................................ Total Personal Property ........................................ Total Real Property ................................................ Total Personal and Real Properly 291,877.54 8,895.00 37,615.22 332,387.78 332,387.76 NOTE: The Memorandum oT r~l estate oulalda the Commonwealth or Penruryhrenia may, at the election of the personal representatNe In~Jude the value of each item, but such Silures should nol be extended Into the total of the Imrentory. (See 20 Pe. C.S. § 3501(h)) Form RW-09 72ev. iGiJ-2006 INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA } SS couNTY of Cumberland County Flle Number 21-10-01196 DATE OF DEATH LAST RESIDENCE McSSiah VIIIege DECEDENT'S SOC. SEC. ND. 11/21/2010 Mechanicsburp,PA 17050 202-20-6116 2010 Federel Individual Income Tax Return 950.00 Allstate Insurence Refund -Refund on Rentere Insurence 52.00 Beneficiary: Residue of Estate Allstate Insurence Refund -Refund on Automobile Insurance 57.00 Beneflclary: Residue of Estate Amerlprlse Annuity Account No. 93002115662 3004 15,415.73 Ameriprise Annuity Account No. 93002407024 3 004 -Beneflclary: Estate of Shirley 38,753.33 Bennett Lotz Ameriprise Annuity Account No. 93003403326 4 004 -Beneflclary: Estate of Shirley 27,568.38 Bennett Lotz Ameriprise Annuity Account No. 83004115967 2 004 -Beneficiary: Estate of Shirley 47,059.41 Bennett Lotz Freedom Blue Premium Refund 132.60 Hartford Annuity 382.20 Holy Spirit Hospital -Refund on Account 75.00 Home Shopping Network (HSN) Refund on Account 5780-9785-3235-0856 -Beneficiary: 163.74 Residue of Estate Kay LLC dlb/a Home instead Senior Care -Refund -Beneflclary: Residue of Estate 1,167.52 Pinnacle Health System Refund -Beneficiary: Residue of Estaba 50.00 Reimbursement from The Law Offices of Pretz and Wallace - Error In bliling 75.00 (Attach additional sheets if necessary) Total Personal Property and Real Estate 332,387.76 INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA CouNTY of Cumberland County ~ SS File Number 21-10-01196 DATE OF DEATH LAST RESIDENCE Messiah Village DECEDENTS SOC. SEC. NO. 11/21/2010 Mechanicsbu PA 17050 202-20-6116 ReimbureamerrtlRefund of Retainer Check from Law Offices of Pretz and Wallace LLC - Beneflciary: Residue of Estate Social Security -Payment of benefits Sovereign Bank Checking Account No. 1051070267 Ameripriae Annuity Accounts - -Beneficiary: Estate Ameriprise Annuity Account No. 00066763806 B 021 (IRA) -Cash Account - Beneftciary: Estate Ameriprise Annuity Account No. 00066763806 8 021 (IRA) - Trena Short Term Bond - C Trans America Funds Beneftciary -Estate Ameriprise Annuity Account No. 93107812869 5 004 (IRA) -IRA Annuity Account Beneflciary: Estate Total Cash Personal Property 1995 Dldsmobile Clere SL Sedan 4D -Kelly Blue Book valuation fs attached Lady's 18K Yellow Gold Diamond Engagement Ring - Appretsed by Joseph James Jewelers -Appraisal Is attached to thia Retum Beneficiary: Dyans V. Smith ----- Personal Property appraised by Chucl~Bricker--Appreisal.by_Chuck Bricker,___. Auctioneer AU084-L Beneficiary: Dyane V. Smith Total Personal Property 2,990.00 1,096.00 13,853.08 30,890.27 10,208.89 100,843.39 291,877.54 2,675.00 5,250.00 . -- -- ..........- 970.00 8,895.00 -2- INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY COUNTY, PENNSYLVANIA couNTY of Cumberland County } File Number 21-10-01186 DATE OF DEATN LAST RESIDENCE Messiah Village DECEDENr3 SOC, SEC. NO. 11/21/2010 Mechanicsbu PA .17060 202-20-6116 StockslListed 1,040.1920 shares Amertprise Mutual Fund Account No. 010137 91526 7 002 - Transfer on Death 7,832.65 Account to Estate of Shirley Bennett Lotr 961.8990 shares Infl Prtct Services Seca B - Ameriprt6e Mutual Fund Account No. 01013480119 9 6,867.89 002 -Transfer on Death Account to Estate of Shirley Bennett Lotr 1,597.2310 shares Columbia Inflation Protected Securities Fund B -Transfer on Death Account to 18,914.88 Estate of Shirley Bennett Lotr Total StOCkslLlsted 31,615.22 COMMONWEALTH OF PENNSYLVANIA } SS -3- J 1505610143 REV-1500 ~"°'~'°' ~~ OFFICIAL USE ONLY PA Department of Revenue penttsylvania c«~y cods Yaer N NumUer Bureau of Individual Taxes "+•~~~ PO BOX.28o8D1 INHERITANCE TAX RETURN 21 10 01196 Hamsburg, PA 17128-0801 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW SoGai Security Number Date of Death Date of Birth 202 20 6116 11 21 2010 06 13 1927 Decedent's Last Name Suffix Decedent's First Name MI LOTZ SHIRLEY ~ O ~~ B (If Applicable) Enter Surviving Spouse's Information Below ~/~V) Spouse's Last Name Suffix Spouse's Flret Name Spouse's Social Securty Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Q 1. Original Retum ~ 2. Supplemental Rewm ~ 3. Pdaom~nd2 1 ~ (date of death 4. Limded Estate ~ 4e. ~~ m ~ ~ ,~~) ~ 6. Federal Estate Tax Retum Required ® a, i coPY dT~ry ~ ~ 7. ~ ~° )s LMne Trust 1 8. Total Number of Safe Deposit Boxes B. LldBetlon Proceeds Received ~ 10. ~P~9~~f ~~ ~ 11. Election to tax under See. 8113(A) (Attach Sch. 0) CORRESPONDENT • THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORN SHOUL~$E DIRECTFJ~~O: ~. Nams Daytlme Tsl _~ Numbe_r- ~I -n JERRY R Di7FFIE (717) ~~L 454'0 ~~~? - ~.:, ., RE(31STER ~Mil~ US~ONLY-'` ~ _ 7~O rM ~. -ii First Ilne of address ~ ~ ~ ~ ; rn 301 MARKET ST v~ ~. ~ a ~, -z-t Second Iine of address !'- PO BOX 109 DATE FILED City or Poat Office State ZIP Code LEMOYNE PA 170430109 Correspondent's e-mail address: Under Idea of perju I declare dot 1 have examined this Tatum, Indud{no In schedules and statements, and 1o dIO bust of kmaAedpe end bedef, h Is W erW cart~p Deduatlon W preparor dher than the personal rep~~tly~ Is based on all Mformadon of whkh preparer fret airy Ivtowled8e. SIO OF/PER N RE ONSIBLE FOR FILING RETURN pq'~ `~/ ~ a. Lricc cum Richard S Simpson II ,'~~ ?; ~ c~( ~ ~ JERRY R DUFFIE DATE ~1 Market Street, Lemoyne, PA Side 1 1505610143 1505610143 J 1505610243 REV-1500 EX Deadx~re Namx LOTZ, Shirley Bennett RECAPITULATION 1. Reel Estate (Schedule A) ....................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4. 5. Cash, Bank Deposits d Miscellaneous Personal Property (Schedule E) ............... 5. 6. Jolntty Owned Properly (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivoa Transfers 8 Miscellaneous robate Properly arate Billin uested Se Re 7 g ............ p q (Schedule G) . 8. Total Gross Aaaeta (total Lines 1-7) ..................................................................... 8. 9. Funeral Expenses & Administretive Costs (Schedule H) ....................................... 9. 10. Debts of Decedent, Mortgage Liabilttiea, & Llena (Schedule I) .............................. 10. 11. Total Deductions (total Lines 9 ~ 10) ................................................................... 11. 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 13. Charitable and Govemmentel eequeats/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... 14. TAX COMPUTATION • SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rete, or transfers under Sec 9116 Decedents Social Security Number 202 20 6116 (a)(1.2) X .00 15. 18. Amount of Line 14 taxable 313 7 0 9 . 7 4 i 6. at lineal rete X .045 ~ 17. Amount of Une 14 taxable 0 0 0 17 at sibling rate X .12 . . 18. Amount of Line 14 taxable 3 000.00 18. ---- -at-collateral-reto-~15----------~--....---._.._....._ -,_ _ .__ ___ _.- 19. Tax Due .................................................................... .............................................. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 300,780.54 70,230.27 371,010.81 27,706.40 6, 594•. 67 34,301.07 336,709.74 20,000.00 ' 316,709.74 0.00 14,116.94 0.00 450.00 14,566.94 Side 2 1505610243 1505610243 J REV-1500 l7t Page 3 Decedent's Complete Address: File Number 21-10-01196 DECEDENTS NAME LOT2; Shirley Bennett STREET ADDRESS Messiah Village 340 Messiah Circle CITE STATE 21P Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Dua (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 13,000.00 B. Discount 684.21 (1) 14,566.94 Total Credits (A + B) (2) 13,684.21 3. Interest 4. If Line 2 is greater than Line 1 + Llne 3, enter the difference. This Is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund (3) (4) 5. If Lina 1 + Line 3 is greater than Line 2, enter the dfference. This is the TAX DUE. (5) 882.73 Make Check Pa able to REGISTER OF WILLS AGENT. ~~t :a~ i .x ~?~~e'`~.~"~tL'~~'~+ •, .. .... v. ..'~'~x~~'~~'ijwR.'LYa s~„ik~',"2,.dg~~, e'`y"~4-'&},yxT4 e °,'Sr b w 3r ~.• _ ..,. _ ... , x: .. _ .. ~; t7 xd"1i n MwT.I&t4'..-szG+`'. n...st~'ckt,:xi x ~..~` n.7,^;+^+r„r~_a PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a trensfar and: Yas No a. retain the use or income of the property trensferred :.................................................................:............. b. retain the right to designate who shall use the property transferred or its income :.................................. c. retain a reversionary interest; or ............................................................................................................... d. receive the promise for life of either payments, benefits or care7 ............................................................ x - ----~---2:-Ifdeath-occurred-alterDecember-12; 1982; did dacedent~trensfeFproperty-withio-oneyearoideafh.wkhout--__.___ _. receiving adequate consideretion7 .................................................................................................................... ^ 3. Did decedent own an 'in trust fif' or payable upon death bank account or security at his or her death?....... © ^ 4. Dkl decadent own en Individual Retirement Arxount, annuity, or other non-probate property which contains a beneflGary deaignation9 .................................................................................................................. © ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ..Aru~~itd45S+a'`-~7-r-',:,~,{"'.Gti. .* ,. ..:. s?L,. ~ .~ .. ','8 . liu 'tX.-'.'.Y~<.~ ,e ~~'v*i. Y' .. ,.:. .iv. .i t'~`.z.i.^. `2i' 'x a~.u:s~~ `~''.r'.. see.. :'.xe,'- 1 a~:F ~`~v: . For dates of death on or after July 1, 1994 and before Jen. 1, 1995, the tax rate Imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent (72 P.S, §9118 (a) (1.1) (I)j. For dates of death on or after January 1, 1995, the tax rata Imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requiroments for disclosure of assets end filing a tax return ere still applicable even if the surviving spouse la the onty beneficiary. For dates of death on or after July 1, 2000: . The tax refs imposed on the net value of trenafers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, en adoptive parent, or a stepparent of the chill is 0 percent [72 P.S. §911 B (a) (1.2)]. . The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneflciarfes is 4.5 percent, except as noted in 72 P.S. §9118 1.2) [72 P.S. §9118 (a) (1)). . The tax rate Impdsed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §§9116 (a) (1.3) . A sibling is defined under Section 9102, es an IndNidual who has at least one parent in common with the decedent, wfiether by bloo~ or adoption I:ev-~soa oc+ Is-ee) coseeodneA~Tw of FawRmvANN reERRANCE TAX REnXW REBIDFNT ~ECEOErrr SCHEDULE E CASH, BANK DEPOSITS, 8t MISC. PERSONAL PROPERTY ESTATE OF (FILE NUMBER LOTZ, Shirley Bennett 21-10-01196 Inchrde the q~~ed~~ d a~Ibn end u,e dx. the proosede wse reoeHdby tM eelete. Ap property Jolrrdyownsdwkhche dept orsurvlvorahlp mwt W dlsoloeedon soharhAa F. ITEM NUMBER DESCRIPTION VALUE AT DATE pF DEATH AmeHprise Annuity Accounts - -Beneflclary: Estate 1 Amerlprise Annuity Account No. 00066783806 8 021 (IRA) -Cash Account -Beneflclary: 30,990.27 Estate 2 Ameriprise Annuity Account No. 00068763806 8 021 (IRA) -Trans Short Term Bond - C Trans 10,208.89 America Funds Beneficiary -Estate 3 Ameriprise Annuity Account No. 93107812969 5 004 (IRA) -IRA Annuity Account 100,643.38 Beneflclary: Estate 4 Social Security -Payment of benefits 1,096.00 5 Sovereign Bank Checking Account No. 1051070267 13,853.08 6 1985 Oldsmobile Gera SL Sedan 4D -Kelly Blue Book valuation is attached 2,675.00 7 Lady's 18K Yellow (Sold Diamond Engagement Ring -Appraised by Joseph James Jewelers 5,250.00 -Appraisal is attached to this Retum Beneficiary: Dyane V. Smith B Personal Property appraised by Chuck Bricker -Appraisal by Chuck Bricker, Auctioneer 870.00 AU094L Beneflclary: Dyana V. Smith _-__- _-9--. --2070-Federal"rridiV(dOatlTiEesm~Ta7cReYurrr------------ _.------------------------.._...- ; -•--..._..958:00-_ 10 Allstate Insurance Refund -Refund on Renters Insurance 52.00 Beneficiary: Residue of Estate 11 Allstate Insurance Refund -Refund on Automobile Insurance 51.00 Beneficiary: Residue of Estate Total of Continuation Schedule See attached page TOTAL (Also enter on Line 6, Recapitulation) 300,780.54 (If moro span is needed, addltlonai pages of the same size) Copyright (c) 2002 forth software only The Lackner Group, Inc. Forth PA-1500 Schedule E (Rev. 6-gB) Rev-1609 p(a Is•~1 SCHEDULE E CASH, BANK DEPOSITS, 8 MISC. PERSONAL PROPERTY cornnwNV~un~ op petasnvrviu 9MERrtANOETAX RETURN continued RE91UENr DECEDENT ESTATE OF (FILE NUMBER LOTZ, ShiHey Bennett 21-10-01196 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 72 Freedom Blue Premium Refund 132.60 13 Holy Spirit Hospital -Refund on Account 75.00 14 Homa Shopping Network (HSN) Refund on Account 5780-97953235-0956 -Beneficiary: 163.74 Residue of Estate 15 Kay LLC d/b/a Home Instead Senior Care ~ Refund - Beneftciary: Residue of Estate 1,167.62 16 Pinnacle Health System Refund -Beneficiary: Residue of Estate 50.00 17 Relmbureement from Tha Law Offices of Pratr and Wallace - Error in billing 75.00 18 ReimbureementlRefund of Retainer Check from Law Offices of Pratr and Wallace LLC - 2,990.00 Beneficiary: Residue of Estate 19 Ameriprise Annuity Account No. 83002115662 3004 15,415.73 20 Ameriprise Annuity Account No. 93002407024 3 004 - Benefciary: Estate of Shirley Bennett 38,753.33 Lotr 21 Ameriprise Annuity Account No. 93003403326 4 004 -Beneficiary: Estate of Shirley Bennett 27,588.38 Lotr 22 Ameriprise Annuity Account No. 93004115957 2 004 -Beneficiary: Estate of Shirley Bennett 47,059.41 Lotz 23 Hartford Annuity 382.20 TOTAL (Also enter on Line 5, Recapitulation) I 300,780.54 Copyright (c) 2002 form software only The Lackner Group, Inc. Form pA-1500 Schedule E (Rev. 6-98) R.V.teto ok. (e-aq ~xn+oRpeNr~nvuaH a1NHiITAl1CE TN(HENRN REapEln' D@C®!NT SCHEDULE G INTER-VIVOS TRANSFERS 8 MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER LOTZ, Shirley Bennett 21-10-01196 Thb schedule mutt a canplstW sntl flbtl r e,e eruwsrlo rn of quoNiorn 1 thrau0h 4 on the revaae aide of the REV-1600 COVER SHEET la yw. ITEM NUMBER E ~q~~ p~ ~ggD~ESCRIPT~I{ORN OF PRNOP~EpRTY 7HE DATE OF TRANSFERaATr~AC~ A CIOPY OF THE6DEE ~FORERFAL EsT~. DATE pF p~TM VALUE OF ASSET % of oeco~a INTEREST Excl.usloN (Ip gpp~ICgg~ TAXABLE VALUE 1 1,597.231 shares of Columbia Inflation Protected 18,914.88 18,914.68 Securities Fund B - Transfer on Death Account to Estate of Shirley Bennett Lotz Ameriprtse ONE Financial Account No, 00064103922 7 021 2 CNL Lifestyle Properties -Ticker: CNLIDI -Real Este 5,240.00 5,240.00 Share 3 Corporate Property Associates -Ticker: WP15DI - 5,350.00 5,350.00 Real Estate Share 4 Inland American -Ticker: INAMDI ^ Real Estate Share 6,080.32 6,080.32 5 Ameriprise Certificate of Deposit Account 8,207.12 6,207.12 00604724475 4 001 - Transfer on Deatfi Account to Estate of Shirley Bennett Lotz 6 Amerlprise Certificate of Deposit Account 8,646.22 6,648.22 00804836762 0 001 - Trensfer on Death Account to Estate of Shirley Bennett Lotz 7 1,040.192 shares of Ameriprise Mutual Fund Account 7,832.65 7,832.65 No. 01013191525 7 D02 -Transfer on Death Account to Estate of 5hlrley Bennett Lotz 8 Ameriprise Mutual Fund Account No. 01133915297 4 5,091.39 6,097.39 002 - Transfer on Death Account to Estate of Shirley Bennett Lotz Total of Continuation Schedule attached page TOTAL (Also enter on Line 7, Recapitulation) I 70,230.27 (If more apace Is needed, addPoonal payee of the name size) Copyright (c) 2002 form software ony The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-85) Rrv-16t0 EXt (6-98) couua~~tr1 oR rexN9vLVnNN IN!Q9TANCE TAX RETURN REelOENT DEC~(T SCHEDULE G INTER-VIVOS TRANSFERS 8r MISC. NON-PROBATE PROPERTY continued ESTATE OF FILE NUMBER LOTZ, Shirley Bennett 21-10-01198 ITEM NUMBER DESCRIPTION OF PROPERTY m~LOnoTE oFRn°FNSF~Ea.Sn~r~H~~~~Pi o~EOTOORERCEALEO~sT~AtE. DATE OF DEATH VALUE OF ASSET % OF DEC~'B INrERESr EXCLUSION OF APFUCnaLE) TAXABLE VALUE 9 961.889 shares of Infl Prtct Services Secs B' 6,887.89 6,887.88 Amerlprise Mutual Fund Account No. 01013480119 9 002 -Transfer on Death Account to Estate of Shirley Bennett Lotz TOTAL (Also enter on Une 7, Recapitulation) I 70,230.27 CopyrlgM (c) 2002 form software only The Lackner Group, Ina Form PA-1500 Schedule G (Rev. B-g6) KEV-1161 IXa 110-0!) SCHEDULE H corn~ep~~e~Ana FUNERAL EXPENSES & :t ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER LOTZ, Shirley Bennett 21-10-01196 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT A. ~ UNERAL EXPENSES: B. ADMINISTRATIVE COSTS: 1. Personal RepresentaWe's Commissions Name of Personal Representative(s) Richard Simpson Street Address 426 South Third Street city Lemoyne state PA zio 17043 Year(s) Commission oaid 2011 z. Attomev's Fees JOHNSON, DUFFIE, 3TEWART 8~ WEIDNER 3, Famiy Exemption: (If decedents address is not the same as claimant's, attach explanation) Claimant Street Address -__-_,_ _._ CRY-- State _ _ _ _Zlo__ Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees B. Tax Retum Preparer'a Fees 7. Other Adminlstrative Costs See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 9,000.00 9,000.00 194.50 225.00 9,266.90 z~,TOS.ao Copyright (c) 2009 form software only The Lackner Group, Inc. Fonn PA-1600 Schedule H (Rev. 10-08) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER LOTZ, Shirley Bennett 21-10-01196 ITEM NUMBER DESCRIPTION AMOUNT 7 Other Administrative Costs Chuck Bricker, Auctioneer -Appraisal of Decedent's personal property 120.00 2 Cumberland County Register of Wills Office -Additional Short Certificates for Ameriprise 24.00 Accounts 3 Cumberland County Register of Wills Office -Filing Fees for Inheritance Tax Retum and 30.00 Inventory 4 Cumberland County Register of Wills Office -Additional Probate Fees 225.00 5 Dyane Smith -Reimbursement for expenses associated with gathering Decedent's personal 751.65 property and Uhaul storage 8 Joseph James Jewelers -Appraisal of Decedent's Diamond Ring 150.00 7 Messiah Village -Resident Account No. 90913 -Final Balance Due 4,569.20 8 Nancy and Jim Rickard -Moving Expenses of Decedent's personal property to Storage Unit 520.00 9 Nefil Funeral Homes Inc. -Remaining Balance 1,048.28 10 Reserves: Filing of Formal Account with Advertising and other Miscellaneous 650.00 Administrative Expenses 17 Sovereign Bank Checking Account No. 1051070287 -Bank Service Fees 12.00 12 Sovereign Bank Checking Account No. 1051070287 -Bank Service Fees 12.00 13 Sovereign Bank Checking Account No. 1051070287 -Bank Service Feea 12.00 14 The Patriot News Co. - Notice of Estate Administration 189.75 Copyfight (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-96) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER LOTZ, Shirlay Bennett 21-70-01796 ITEM NUMBER DESCRIPTION AMOUNT 15 Verizon 18 Vital Records -Additional Death Certificates 17 Wiedeman & Douty, P.C. -Accountants performing Audit of Power of Attorney Records H-B7 48.02 90.00 840.00 9,288.80 Copyright (c) 2002 firm software only The Lackner Group, Ina Forrn PA-1600 Schedule H (Rev, 6-98) co~wronueA~Tn of reRrmrwnnu INHERfTANCE TAX RETURN RCalUB1T UECEOENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8r LIENS ESTATE OF FILE NUMBER LOTZ. Shirlev Bennett 21-10-01196 RupoR dulrts Ilwumid bytaa dseudunl pAor b duel thatromulnM unpMd utd» dub of dsdh, Ineludl~q unnimburuudmediaul uXPunaua ITEM NUMBER DESCRIPTION 1 Alert Pharmacy 2 Allstate Insurance ~ Final Payment on Account 3 Bon Ton Credit Card Account No. 2116-0410-1033-1511 - Tumed over to HSBC for Payment 4 Dr. Cohen -Final payment 5 Messiah Village -Home Care Asalstant Fees (Flnal) 6 Messiah Village -Payment for November-Check Clearing after Date of Death 7 Messiah Village Home Health Care -Payment for November -Check Clearing after Date of Death 8 PA Department of Transportation -Duplicate title for Automobile 9 Ssars Credit Card Account No. 5121-0718.7237-9139 10 Social Security - Retum of benefits 11 Uhaul -Mechanicsburg -Payment for Decedent's Storage Unit of Personal Property 12 West Shore EMS -Final Invoice VALUE AT DATE OF DEATH 113.18 51.00 55.61 19.80 68.00 4,166.00 339.25 22.50 442.85 1,096.00 121.85 99.68 TOTAL (Also enter on Line 10, Recapitulation) 8,584.87 (If moro spaee is rroeded, eddirwnal papas of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1600 Schedule I (Rev. 12-08) REV-1617 EX* (11-0E) corar~~~F~ei~alw SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER LoTZ snipe Bennett 27-10-01 196 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE MOUNT OF ESTATE NUMBER PERSON(S) RECENING PROPERTY DECEDENT (Words) ($SS) I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9118 a 1.2 1 Susan Fulginitl Friend $1,000 Specific 703 Robert Street Bequest Mechanicsburg, PA 17055 2 Mary Louise Shatter Frend $1,000 Specific 938 Boller Avenue Bequest Lemoyne, PA 17043 3 Dyane V Smith Daughter Tangible PO Box 723 Personal Danbury, CT 06810 Property; 90°~ of Residue 4 Lisa Starner Friend $1,000 Specific 732 Ridge Drive Bequest Diilsburg, PA 17019 Total Enter dollar amounts for distribudons shown above on lines 15 throw h 18 on Rev 150 0 cover sheet as a ro riate. II NON-TAXABLE DISTRIBUTIONS: . q. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 Grant Foundation Hopital Albert Schweitzer Haiti io,ooo.oo - ------2--- -- ~bytery of~rlisTe ~"Pr'es~jf~rian`Churc~(U:S:A:)--- _ ..- - ----._. -- -----io ooo:oo- TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTION3 ON LINE 13 OF REV-150D COVER SHE 20 000.00 Copyright (c) 2009 form software onty The Lackner Group, Inc, Fonn PA-15110 Schedule J (Rev. 11-0B) REV-1613 FXe (N-0!I ~! ~ I ~oM~~~~a SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER LOTZ Shirle Bennett 21-10-01 196 N A M RELATIONSHIP TO DECEDENT SHARE OF ESTATE MOUNT OF ESTATE NUMBER (Sl RECEIVING PROPERTY PERS O N (Words) ($$$) I • TAXABLE DISTRIBUTIONS [include outright spousal end nsfars distribu0ons , under Sec. 9116 a 1.2 1 Susan Fulginiti Friend $1,000 Specific 703 Robert Street Bequest Mechanicsburg, PA 17055 2 Mary Louise Shatter Friend $1,000 Specific 936 BoslerAvenue Bequest Lemoyne, PA 17043 3 Dyane V Smith Daughter Tangible PO Box T23 Personal Danbury, CT 06810 Property; 10°k of Residue 4 Lisa Starner Friend $1,000 Specific 132 Ridge Drive Bequest Dillsburg, PA 17018 Total Enter dollar amounts for distributiore shown above on Tines 15 throu h 18 on Rev 15 00 cover shee as a ro riete. II NON-TAXABLE DISTRIBUTIONS: 3 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN E SE T ON 1 . I A. SPOUSAL DISTRIBUTIONS UND R C 9 1 8. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 ---.. -. ------- Grant Foundation Hopital Albert Schweitzer Haitl - 10,000.00 2 - ---- Presbytery of Carlisle ~ Pres er an urc~i (U:~/C:f-- ---- ~~" "~ -_...---f o;ooo.oo - TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEEfI 20,D00.00 Copyright (c) 2009 form satlware onty The Lackner Group, Inc. form PA-1500 Schedule ~ (Rev. 11-OB) RENUNCIATION REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA Estate of SHIRLEY BENNETT LOTZ a/k/a SHIRLEY ANNE BENNETT LOTZ Deceased (No. 2010-1196) I,1jgr?~~'1-'J . I~/~lp ~ as ~ l~ ~3~R'NT for M1D PENN BANK named Alternate Executor pursuant to Paragraph X, Last Will and Testament of Shirley Bennett Lotz, dated May 26, 2010, hereby renouttce the right to a~rr,;n+cter the Estate of Shirley Bennett Lotz, Deceased. WITNESS my hand this ~~ day of ~ v~13 , 2011. Nfid Penn Bank: By: Name: `17M~ ldl-- S, Wic/{-7l(7 "zG Title: V i C~* P2bz3l~ 349 Union Street Millersburg, PA 17061 Executed in Register's O, f,~Sce Executed out ojRegister's D,,~rce COMMONWEALTH OF PENNSYLVANIA: COUNTY OF DAUPHIN: SWORN to and snbsm'bed before me Before the undersignod personally appeared the this _ day of , 2011. party execudag this Rennnciatioa and certified that heJsho axecubed the Renunciatiem for tiu DaPuh' ~ ~~' of Wills l~, iJnPstetedlwithin oa this ih day of otary Public My Commission Expires: aonlMONwen~rrt of ra~snvarra rbarw sir 7area M. laonardr Notary f'ubpC PAiddla PaMtan'IWp., Gaup~~ County MY ~!~ f~tres Ap1M !, 2014 Member, Vent~syNanla Aaodatbn of Hotariei IN RE: ESTATE OF SHIRLEY BENNETT LOTZ A/K/A SHIRLEY ANNE BENNETT LOTZ LATE OF UPPER ALLEN TOWNSHIP CUMBERLAND COUNTY, PENNSYLVANIA DECEASED IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA. ORPHAN' S COURT DIVISION NO. 2010-1196 To: The Register of Wills of Cumberland County PRAECIPE TO WITHDRAW APPEARANCE Please withdraw my appearance as counsel for Richard S. Simpson, II, Executor of the Estate of Shirley Bennett Lotz a/k/a Shirley Anne Bennett Lotz. Respectfully submitted, JOHNSON DUFFIE STEWART & WEIDER Date: June~> 2011 By: ~~ erry R Attorney I.D. No. 19601 301 Market Street Lemoyne, PA 17043 :443096 IN RE: ESTATE OF SHIRLEY BENNETT LOTZ A/K/A SHIRLEY ANNE BENNETT LOTZ LATE OF UPPER ALLEN TOWNSHIP CUMBERLAND COUNTY, PENNSYLVANIA DECEASED . IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHAN'S COURT DIVISION NO. 2010-1196 To: The Register of Wills of Cumberland County PRAECIPE TO ENTER APPEARANCE Please enter the appearance of Richard W. Stevenson, Esquire, on behalf of Dyane V. Smith, Administrator d.b.n.c.t.a. (to be appointed) of the Estate of Shirley Bennett Lotz, deceased, effective as of (i) the approval of the Court of the resignation of Richard S. Simpson, II, Executor, Estate of Shirley Bennett Lott, deceased and (ii) the approval of the Court of the resignation of Jerry R. Duffie, Esquire, attorney for Richard S. Simpson, II, Executor, Estate of Shirley Bennett Lotz. Respectfully submitted: McN apace & Nurick L Date: June,, 2011 By; ~U Richard W. Stevenson Attorney I.D. No. 7120 100 Pine Street P.O. Box 1166 Harrisburg, PA 17108-1166 :443802 In the Court of Common Pleas of Cumberland County County, Pennsylvania Orphans' Court Division File No. 21-10-01196 Estate of Shirley Bennett LOTZ, Deceased Late of Township of Upper Allen First and Partial Account Date of Death: Richard S Simpson II, Executor 11/21/2010 Date of Executor's Appointment: 12/07/2010 Date of First Complete Advertisement: 12/3112010 Accounting for the period: 11/21!2010 to OW17/2011 Purpose of Account: Richard S Simpson II, Executor, offers this Account to acquaint interested parties with the transactions that have occurred during the Administration. It is important that the Account be carefully examined. Requests for addittonai information or questions or objections can be discussed with: JERRY R. DUFFIE JOHNSON, DUFFIE, STEWART & WEIDNER 301 MARKET 3T. PO BOX 109 LEMOYNE, PA 17043-0109 (717) 761540 Supreme Court l.D. No. 09601 SUMMARY OF ACCOUNT Estate of Shirley Bennett LOTZ, Deceased Fer the neried of Novemher 21,,2010 through Innr 17~ 2017 PAGES PRINCIPAL Receipts: This Account 371,162.11 Net Gain (or Loss) on Sales or Other Dispositions 74.58 371,236.69 Less Disbursements: Debts of Decedent 6,594.67 Funeral Expenses 0.00 Administration Expanses 9,286.40 Federal, State ~ Local Taxes 13,882.73 Commissions 9,000.00 Fees 9,225.00 Family Exemption 0.00 47,988.80 Balance Before Distributions 323,247.89 Transfer to (from) Principal 0.00 Distributions to Beneficiaries 31,s9s.o0 Principal Balance on Hand 291,352.89 For Information: Investments Made Changes In Holdings INCOME Receipts This Account 5,881 86 Net Galn (or Loss) on Sales 0.00 or Other Dispositions 5,881.86 Less Disbursements 0.00 Balance Before Distributions 5,881.86 Transfer to (from) Income O.UO Distributions to Beneticlarles o.00 Income Balance on Hand 5,881.86 For Information: Investments Made Changes in Holdings COMBINED BALANCE ON HAND 287,234 75 Signature Verification SCHEDULE A RECEIPTS OF PRINCIPAL Assets Listed in Inventory (Valued as of Date of Death) C Ameriprise Annuity Account No. 00066763806 8 027 30,890.27 PIRA) Ameriprise Annuity AccountNo. 00066763806 8 021 10,208.89 (IRA) • Trans Short Term Bond - C Trans America Funds Beneficiary: Estate Ameriprise Annuity Account No. 93002115662 3 004 15,415.73 Ameriptse Annuity Account No. 93002407024 3 004 - 38,753.33 Beneficiary: Estate Ameriprise Annuity Account No. 93003403326 4 004 - 27,568.38 Beneficiary: Estate Ametprise Annuity Account No. 93004115967 2 004 - 47,059.41 Beneficiary: Estate Ameripriae Annuity Account No. 93107672969 5 004 1D0,843.39 (IRA) -IRA Annuity Account Beneficiary: Estate Amerlptse Annuity Accounts Sovereign Bank Checking Account No. 1051070287 13,853.08 Hartford Annuity 382.20 Social Security - Payment of benefits 1,D96.00 lCay LLC d/bla Home Instead Senior Care -Refund 1,167.52 Pinnacle Health System Refund 50.00 Allstate Insurance Refund -Refund on Renters 52.00 Insurance Reimbureemeni/Refund of Retainer Check from Law 2,980.00 Offices of Pratz and Wallace LLC Home Shopping Network (HSN) Refund on Account 783.74 5780-97953235-0956 Allstate Insurance Refund -Refund on Automobile 51.D0 Insurance Freedom Blue Premium Refund 132.60 Holy Spirit Hospital -Refund on Account 75.00 2010 Federal Individual Income Tax Return 958.00 Reimbursement from The Law Offices of Pratz and 75.00 Wallace - Enor In billing Fiduciary Acquisition Value SCHEDULE A RECEIPTS OF PRINCIPAL Continued Fiduciary Acquisition Value Amsriprise Annuity Account No. 95002407024 3 004 - Beneflciary: Estate Total Cash Personal Prey r~tv 1995 Oldsmobile Gera 5L Sedan 4D -Kelly Blue Book valuation is attached Lady's 18K Yellow Gold Diamond Engagement Ring - Appraised by Joseph James Jewelers Penonaf Property appraised by Chuek Bricker - Apprafsal by Chuck Bricker, Auctioneer AU094-L Total Personal Property 4teckelListed 1.040.1820 shares Ameriprise Mutual Fund Account No. 01013181525 7 002 - Trenafer on Death Account to Estate 1,597.2310 shares Columbia Inflation Protected Securities Fund B -Transfer on Death Account to Estate 961.8890 shares Infl Prtct Services Secs B - Ameriprise Mutual Fund Account No. 01013480119 9 002 - Transfer on Death Account to Estate Total Stocks /Listed All Oth P t er rener y Ameriprise Certificate of Deposit Account 00804836762 0 001 - Trensfer on Death Aceount to Estate 524.0000 CNL Lifestyle Propertles -Ticker: CNLIDI -Real Estate Share 500.0000 Corporete Property Associates -Ticker. WP15D1- Real Estate Share 757.2000 Inland American -Ticker. INAMDI -Real Estate Share Amerprise Aceount No. 00064103922 021 5,091.3900 Ameriprise Mutual Fund Account No. 01133815297 4 002 -Transfer on Death Account to Estate 29.23 291,814.77 2,675.00 5,250.00 s7o.oo 8,895.00 7,832.65 16,914.68 6,867.89 31,615.22 8,646.22 5,240,00 5,350.00 6,080.32 5,081.38 SCHEDULE A RECEIPTS OF PRINCIPAL Continued Fiduciary Acquisition Value Ameriprise Certificate of Deposit Account 8,207.12 00804724475 4 001 - Transfer on Death Account to Estate Total All Other Property 38,615.05 Total Receipts 371,oa0.oa rbs ~en_ t Prin~inal Racai~ 12H6/2010 10.0750 shares Amerlprlse Mutual Fund Account No. 77,78 01013191525 7 002 -Transfer on Death Account to Estate 12116!2010 4.3130 shares Columbia Inflation Protected Securities Fund 44,29 B • Trensfer on Death Account to F~tate Total Subsequent Principal Receipts 122.07 Total Adjustments and Subsequent Receipts 122.07 Total Receipts of Principal 371,162.71 SCHEDULE B GAINS AND LOSSES ON SALES OR OTHER DISPOSITIONS -PRINCIPAL Spin 44$s 12127/2010 1,601.5440 Columbia Irrtlation Protected Securities Fund B - Transfer on Deatfi Account to Estate Net Proceeds 16,608.01 Fiduciary Acquisition Value -16,958.87 12127!2010 961.6890 Infl Prtct Services Seca B ~ Ameriprise Mutual Fund Account No. 01013480118 9002 - Transfer an Death Account to Estate Net Proceeds 7,281.50 Fiduciary Acquisition Value 3,g67,8g 12/3112010 1,050.2670 Ameriprise Mutual Fund Account No. 01013191525 7 002 - Transfer on Death Account to Estate Net Proceeds 8,181.58 Fiduciary Acquisition Value -7,910.43 0411512011 500.000D Corporate Property Associates -Ticker: WP15DI - Real Estate Share Net Proceeds 4,836.00 Fiduciary Acquisitlon Value 3.350.00 05/20/2011 524.0000 CNL Lifestyle PropeNies -Ticker: CNLIDI -Real Fatale Share Net Proceeds 5,494.78 Fiduciary Acquisition Value -5,240.00 TOTAL GAINS AND LOSSES/PRINCIPAL LESS LOSS NET GAIN OR LOSS 350.96 413.61 271.15 -S74.OD 254.78 939.54 $64.96 74.58 SCHEDULE C DISBURSEMENTS OF PRINCIPAL Alert Pharmacy 01/18/2011 113.18 113.18 Allstate Ins~rence - 04/09/2011 Final Payment on Acr_m~nf 51.00 51.00 Bon Ton Credit Card 01!19/2011 Account No. 2176-0410-1033-1511 Turned over to HSBC for Payment 55.61 55.61 Dr. Cohen D4/08/2011 Final payment 18.80 19.80 Messiah Village 11125!2010 Payment for November -Check Clearing after Date of 4,165.00 Death 01/24/2011 Home Care Assistant Fees (Final) 68.00 M i h Vill 4,233.00 ess a age Hom 11!26/2010 e Health Care Payment for November ~ Check Clearing after Date of 339.25 Death PA D 339.25 epartment of Tr 02101/2011 ans orta ion Duplicate title for Automobile 22.50 SCHEDULE C DISBURSEMENTS OF PRINCIPAL Continued 22.50 Sears Credit Gard Ac 01/18/2011 count No. 5121-0719-7237-9139 442.85 442.85 Socfal Security • 01/25/2011 Return of benefits 1,D96.00 Uh 1,096.00 aul -Mechanicsbu 12113!2010 rg Payment for Decedents Storage Unit of Personal 121.85 Property • W 121.85 est Shore EMS 03/02!2011 Final Invoice 98.63 99.63 Total Debts of Decedent Administration Ex enses 8,594.67 chuck Bricker. Aucti 01!2412011 oneer Appra(sal of Decedents personal property 120.00 C b l d 120.00 um er an County 1 1 /2 112 01 0 Register of Wills Office Filing Fee 10.00 72/06/2010 Probate Fees 184,50 12/20/2010 Additional Short Certiflcates for Ameriprise Accounts 24.00 05/0412011 Filing Fees for Inheritance Tax Return and Inventory 30.00 SCHEDULE C DISBURSEMENTS OF PRINCIPAL Confinued 05/08/2011 Additional Probate Fees 225,00 08/15/2011 Filing Fees for Formal Account (Estimate) g5p,~ S i h 633.50 jZyane m t 01!07/2011 Reimbursement for expenses associated witfr 751.65 gathering Decedents personal property and Uhaul storage Josa h J J 751.65 n ames ewe 0 7 10 7/201 7 lers Appraisal of Decedents Diamond Ring 150.00 M ssiah Vill 150.D0 e age 01!19!2011 Resident Account No. 90913 -Final Balance Due 4,569.20 Nanc a d Jl Ri 4,569.20 y n m cka 01/25!2011 rd Moving Expenses of Decedents personal property to 520.00 Storage Unit Nelli F l H 520.00 unera omes 01/21/2011 Inc Remaining Balance 1,O~,Y8 Soverei n Bank 1,043.28 g 12/20/2010 Bank Service Fees for Date of Death Letter on 20.00 Aeeaunts 20.00 SCHEDULE C DISBURSEMENTS OF PRINCIPAL Continued Sovere gn Bank Che 01/07/2011 cking Account No. 7051070237 Bank Service Fees 12.00 02108/2011 Bank Service Feea 12.00 03108/2011 Bank Service Fees 12.00 36.00 The Cumberland I aw 12!17/2010 Journal Notice of Estate Administration 75.00 Th 75.00 e Patriot News Co 03/01/2011 . Notice of Estate Administration 189.75 189.75 Verizon 01/18/2011 48.02 i l R 48.02 ta ecords V 1 212712 01 0 Additional Death Certificates 90.00 90.00 11Yiedeman ~ Dpi. 0 3/0 312 0 1 1 P.C. Accountants pertonning Audit of Agent Records 840.00 840.00 Total Miscellaneous Administrative F.xoenses Federa ,State. and Local Taxes 9.286.40 ~yister of Wills. Agent 0 212 012 01 1 05!08/2011 Richard 3lmpson 08/05/2011 Johnson Duffie 06/OS12011 ~edeman & Douty. P.C. oa1112D11 SCHEDULE C DISBURSEMENTS OF PRINCIPAL Continued Inheritance Tax Prepayment Total Taxes Commissions Executor Commission Total Commissions Fggg Attorneys Fees Preparation of 2010 Personal Income Tax Returns Total Fees TOTAL DISBURSEMENTS OF PRINCIPAL 13,000.00 882.73 13,882.73 13.882.73 8,OD0.00 9,000.00 9.000.00 8,000.00 9.000.00 225.00 99A M 47.968.80 SCHEDULE D DISTRIBUTIONS OF PRINCIPAL 05/25/2011 05125/2011 05/25/2011 Qyane V Smith 7 1121 /2 01 0 11 /21 /2010 01/01/2011 Lisa Starner Mary Louise Shatter Susan Fulglnitl 1,000.00 1,000.00 1,000.00 Lady's 18K Yellow Gold Diamond Engagement Ring - 5,250.00 Appraised by Joseph James Jewelers Personal Property appraised by Chuck Bricker 970.00 1995 Oldsmobile Cisre SL Sedan 4D 2,675.00 Grant Foundation Honkol Albert Schweitzer Haiti 05/25/2011 Grant Foundation 10,000.00 3,000.00 8,895.00 10,000.00 Presbvterv of Carlisle ~ Pnashvterian Gh!rrrh (rl~.a;. 0 512 5/2 0 1 1 Prosbytery of Carlisle, Presbyterian Church, USA 10,000.00 10,000.00 TOTAL DISTRIBUTIONS TO BENEFICIARIES 31.896.00 PRINCIPAL BALANCE ON HAND # Units Description hash Ameriprise Trust #2677 7656 5 021 Annuity 830024070243004 Annuty 930034033264004 Annuity 9 30041 1 59672004 Annuity No. 930021158623004 M T Bank Estate Account Total Cash Assets 757.2000 Inland American Current Value Fiduciary 08/17/2011 Acquisition or as Noted Value 142,042.55 142,042.55 38,782.56 38,782.56 27,568.38 27,568.38 47,059.41 47,059.41 15,415.73 15,415.73 14,403.94 14,403.94 285,272.57 285,272.57 6,080.32 Total Assets 8,080.32 285,272.57 291,362.89 SCHEDULE E PRINCIPAL INVESTMENTS MADE # u"Its 12/16/2010 10.0750 Ameriprise Mutual Fund Account No. 01013181525 7 002 12/16l2D10 4.3130 Columbia Inflatlon Protected Securities Fund B Total SCHEDULE F CHANGES IN PRINCIPAL HOLDINGS i# Units ~ 1995 Oldsmobile Gera SL Sedan 4D 11!21!2010 Inventoried 2~B7S,0D 01/01!2011 Distributed -2,675.00 . 0.00 Amednrisa Mu 11/21/2010 tual Fund Accou 1,040.1920 nt No. D1013191525 7 002 Inventoried 7~832,gg 1?J1612010 10.0750 dividend reinvestment 77,78 12/31/2010 -1,050.2670 Sold -7,910.43 0.0000 0.00 CNL Lifestyle 11/21/2010 Pro en rties 524.0000 Inventoried 5,240.00 05!20/2011 -524.0000 Sold 5,240.00 0.0000 0.00 Columbia Infla 17121/2010 tion Protected S 1,597.2310 ecurities Fund B Inventoried 16,914.68 12/16/2010 4.3130 dividend reinvestment 44,49 12127!2010 -1,601.5440 Sold -16,958.87 0.0000 0.00 Gon~orete Pro 11/21/2010 Re~y~gso is 50D.0000 Inventoried 5.350.00 04M5/2011 -500.0000 Soid 5,350.00 o.oooo o.oD __ Infl Prt~t Servi 11121/2010 ces Secs B ^• Am 961.8890 erinrise IiAu1uA1 Fnnd Ocenunf Nn 0904 RARr1AAq Inventoried O 1109 6,867.89 121Z712D70 -961.8890 Sold -6,867.89 O.D000 D.OD SCHEDULEF CHANGES IN PRINCIPAL HOLDINGS Continu®d # Units Sit I In and meriean 11121!2010 757.2000 Inventoried 6,080.32 757.2000 6.080.32 ~,y's 18K Yellow Gold Diamond Enaaaement Rina 11/21/2010 Inventoried 5,250.00 11!21!2010 Distributed -5,250.00 0.00 Personal Projlgrty aooralaed by Chuck Bricker 11!21/2010 Inventoried 970.D0 11!21/2010 Distributed -970.D0 O.DO 6,080.32 T'Otai 6,080.32 SCHEDULE G RECEIPTS OF INCOME Dividend Comorete Prosy Associates 04/26M011 Ticker. WP15DI - Raal Estate Share 03123/2011 Ticker. INAMDI -Real Estate Share 0 411 512 01 1 Ticker: INAMDf ~ Real Estate Share 05115/2011 Ticker. INAMDI -Real Estaba Share TOTAL DMDEND INCOME 1 112 9/2 01 0 1 1 /3 012 01 0 05/26/2011 11/27/2010 05/2612011 11/29/2010 05/26/2011 32.04 32.04 32.04 96.12 187.07 13.28 1.65 286.30 311.21 32.89 623.24 656.13 23.71 532.83 556.54 SCHEDULE G RECEIPTS OF INCOME Continued emeriprise Annuity Accaunt No. 93.,^0.115967 20 11/27!2010 0. 45.53 11/2812D10 40.47 05/2612011 864.E 950.D0 Amerirzse Certificate of Deposit Account 0080.7 02/08/2011 2~~5 q OD1 26.70 26.70 Amerlprise CertiHfcate of Deposk Account 008^.8 11/28/2010 36762 0 007 7.57 06!01/2011 45.54 53.11 Ameriprise IRe grokerapa Accaunt No 0006676 11/25/2010 2808 8 D21 0.83 12/27/2010 0.67 1.50 Ameriprise Mutual Fund Account No D101348011 01/07/2011 0 9 002 8 62 9.62 Ameriprise Mutual Fund Account No 0113391529 01/31/2011 7 4 002 0.02 0.02 Amerlprise Tn!st Gomp~y c!o Richard 5imp~on, D5/26/2011 Exec~rtar for Estate 3.128.36 3,128.36 SCHEDULE G RECEIPTS OF INCOME Continued Sovens n Bank Checking Account No. 1051070287 12109!2010 12/09/2010 12/09/2010 03/07/2011 TOTAL BANK INTEREST TOTAL RECEIPT5 OF INCOME O.S8 0.67 0.10 0.05 1.60 5,694.79 5.881.86 INCOME BALANCE ON HAND # Units Description Gash Ameriprise Trust #2877 7656 5 021 Annuity 930024070243004 Annuity 830034033264004 Annuity 930041159672004 Annuity No. 930021156623004 M T Bank Estate Account Total Cash Current Value Fiduciary 06/17/2011 Acquisition or as Noted Value 3,129.86 3,129.66 656.13 656.13 555.54 556.54 950.00 950.00 311.21 311.21 278.12 278.12 5,881.86 5,881.86 5,681.86 5.881.86 COMBINED BALANCE ON HAND # Units Description Casts Amerlpriss Trust #2677 7656 5 021 Annuity 830024070243004 Annuity 930034033264004 Annuity 930041159672004 Annuity No. 930021156623004 M T Bank Estate Account 757.2000 Inland American Current Value Fiduciary 06/17!2071 Acquisition or as Noted Value 145,172.41 145,172.41 39,438.69 39,438.69 28,724.92 28,124.92 48,009.41 48,Ob9.41 15,726.94 15,726.94 14,682.06 14,682.08 Total Cash 291,154.43 291,154.43 6,080.32 Total Assets 6,080.32 291,154.43 297,234.75 In the Court of Common Pleas of Cumberland County County, Pennsylvania Orphans' Court Division File No. 21-10-01196 Estate of Shirley Bennett LOTZ, Deceased Signature Richard S Simpson II, Executor In the Court of Common Pleas of Cumberland County County, Pennsylvania Orphans' Court Division File No. 21-10-01196 Estate of Shirley Bennett LOTZ, Deceased Verification Richard S Simpson II, Executor under the Last wll and Testament of Shirley Bennett LOTZ, Deceased, hereby declares under oath that he/she has fully and faithfully discharged the duties of his/her office; that the foregoing Account is true and correct and fully discloses all significant transactions occurring during the accounting period; that all known claims against the Estate have been paid in full; that, to his/her knowledge, there are no claims now outstanding against the Estate; that all taxes presently due from the Estate have been paid; and that the grant of Letters Testamentary and the first complete advertisement thereof occurred more than four months before the foregoing Account This statement is made subject to penalties of 16 Pa. C.S.A. Section 4904 relating to unswom falsification to authorities. Dated: Richard S Simpson II, Executor ESTATE OF SHIRLEY BENNETT LOTZ a/k/a SHIRLEY ANNE BENNETT LOTZ, DECEASED. Court of Common Pleas of Cumberland County, Pennsylvania Orphan's Court Division ESTATE OF SHIRLEY BENNETT LOTZ a/k/a , SHIRLEY ANNE BENNETT LOTZ, DECEASED. No. 21-2010-1196 PETITION FOR ADJUDICATION/ STATEMENT OF PROPOSED DISTRIBUTION PURSUANT to PA. O.C. Rule 6.9 This form maybe used in all cases involving the Audlt of the Account of a Decedent's Estate. If space is insulTcient, riders maybe attached. Attach the spouse's election, if any,• the papers requited under items 8-19 inclusive; and any instroment pertinent to the adjudication. INCLUDE ATTACHMENTS AT THE BACK OF THIS FORM JERRY R. DUFFIE Attorney Identification Number. 09601 Johnson, Duffle, Stewart & Weidner P.O. Box 109 Lemoyne, PA 17043-0109 (717) 761-4540 Estate of SHIRLEY BENNETT LOTZ a/k/a SHIRLEY ANNE BENNETT LOTZ. Deceased 1. Name and address of Petitioner: RICHARD S. SIMPSON II 426 South Third Street Lemoyne, PA 17043 Identify any executors or administrators who have notjoined in the Petition for Adjudication and Statement of Proposed Distribution and state reason: Is this the first accounting by this fiduciary? ..........................................®Yes ^ No If not, identify prior accountings, the accounting periods covered and the date of adjudication of the prior accounting. 2. Decedent died on November 21.2010 Letters Testamentary or ^ Letters of Administration were granted to Petitioner on December 7, 2010. Exhibit "A" Date of Will (-f applicable): Mav 26, 2010 Date(s) of Codicil(s) (rf applicable):. Was a bond required? ^ Yes 12l No If yes, state amount: Are proofs of advertising of the grant of letters attached?..... ~ Yes ^ No Exhibit "B' and "C" Dates of advertising of grant of letters: Cumberland Law Journal: December 31 2010 and January 7, and January 14.2011 • The Patriot News• December 24 and December 31.2010 and January 7, 2011 3. Was decedent survived by a spouse? .................... ^ Yes EINo If yes, name the surviving spouse: 4. Has the surviving spouse filed to take an elective share? ^ Yes ^ No 5. In the case of an intestacy, state the names of the decedents surviving children or surviving issue of deceased children (rf none, so state): 2 Estate of SHIRLEY BENNETT LOTZ a/k/a SHIRLEY ANNE BENNETT LOTZ. Deceased 6. Did decedent marry after execution of III or Codicil(s)?....... ^ Yes ®No Were any children born to decedent after execution of Will or Codicil(s) ........^ Yes f?1 No If yes, give names and dates of birth: Name Date of Birth 7. If required by the Medical Assistance Estate Recovery Act, 62 P.S. § 1412, was a request for a statement of claim sent to the Department of Public Welfare? .................... 0 Yes ^ No Exhibit "D" 8. Written notice of the Audit as required by Pa. O.C. Rules 6.3, 6.7 and 6.8 has been or will be given to all parties in interest listed in item 9 below, all unpaid creditors and all claimants listed in item 10 below. In addition; notice of any questions requiring Adjudications as discussed in item 14 below has been or will be given to all persons affected thereby. A. If Notice has been given, attach a copy of the Notices as well as a list of the names and addresses of the parties receiving such Notice. B. If Notice is yet to be given, a copy of the Notice as well as a list of the names and addresses of the parties receiving such Notice. Exhibit "E" C. If any person entitled to Notice is not sui juris (e.g., minors or incapacitated persons) Notice of the Audit has been or will be given to the appropriate representative on such party's behalf as required by Pa. O.C. Rule 5.2. D. If any charitable interest in involved, Notice of the Audit has been or will also be given to the Attorney General as required under Pa. O.C. Rule 5.5. In addition, the Attorney General's clearance certificate (or proof of service of Notice and a copy of such Notice) must be submitted herewith or at the Audit. 9. List all parties (charitable and non charitable) of whom Petitioner has notice or knowledge, having or claiming any interest in the estate as beneficiaries under the Will or Codicil(s) or as intestate heirs if there is a complete or partial intestacy: 3 Estate of SHI RLEY BENNETT LOTZ a/1c/a SHIRLEY ANNE BENNETT LOTZ Deceased A. State each party's relationship to the decedent and the nature of each party's interest(s): NAMES RELATIONSHIP TO DECEDENT INTEREST Dyane V. Smith [Daughter 90% of Reafdue of Estate PO Box 723 Bethel, CT 06801 B. Identify each party who is not sui jurrs (e.g., minors or incapacitate persons). For each such party, give date of birth, name of each Guardian and how each Guardian was appointed. If no Guardian has been appointed, identify the next of the kin of such party, giving the name, address and relationship of each. C. State why a Petition for GuardianrTrustee Ad Litem has or has not been filed for this Audit (see Pa. O.C. Rule 12.4). D. If distribution is to be made to the personal representative of a deceased party, state date of death, date and place of grant of Letters and type of Letters granted. 10. Other than the claim for the family exemption, list names of all known claimants and the amount of their claims and state whether each claim is admitted. Name and Addresses of Each Claimant Amount of Ga/m Claim Admitted? ill Gaim Be Paid in Full? ^ Yes ^ Yes ^ No ^No If the estate is insolvent, attach a schedule setting forth the order of preference under 20 Pa.C.S. § 3392 and the proposed p8yments. 11. Was family exemption claimed? ................................. ^ Yes ®No Was family exemption allowed? ................................. ^ Yes 0 No Family exemption claimant's name and relationship: Relefionshlp: 12. The amount of Pennsylvania Transfer Inheritance Tax and additional Pennsylvania Estate Tax paid, the date(s) of payment(s), and the interest(s) upon which paid, are as follows: 4 Estate of SHIRLEY BENNETT LOTZ a/Ida SHIRLEY ANNE BENNETT LOTZ. Deceased Data February 17. 2011 Payment S 13.000.00 Inferest S 867.73 13. On the date of death, was the decedent a fiduciary (personal representative, trustee, guardian, agent under power of attorney) or surety on the bond of a fiduciary?........ ^Yes ~ No If yes, provide the name of the estate, indicate whether an account has been filed and confirmed absolutely and all awards performed, or, in the alternative, how the decedent's estate will be discharged for the decedent's fiduciary administration of the estate. 14. A. Describe in detail any questions requiring adjudication and state the position of the Petitioner(s) as to each question: See attachment B. Has notice of the question requiring adjudication been given to the parties identified in Paragraph 9 above? .............................. ®Yes ^ No 15. If Petitioner has knowledge that a share has been assigned, renounced, disclaimed or attached, provide a copy of the assignment, renunciation, disclaimer or attachment, together with any relevant supporting documentation. 16. Had the decedent been adjudicated an incapacitated person? ^Yes 0 No If yes, attach a copy of the Order if available: otherwise state the Court, term, number, date, and name of Hearing Judge. 17. A. List or attach a separate list of additional receipts and disbursements since the closing date of the Account. B. Has notice of the additional receipts and disbursements been given to the parties identified in Paragraph 9 above? ..................... ^ Yes ^ No 18. If a reserve is requested, state amount and purpose. Amount: Purpose: Exaenses incurrod in oreoaration of Axountina and potential Geims aaalnst the Estate If a reserve is requested for counsel fees, has notice of the amount of fees to be paid from the reserve been given to the parties in interest? ..............................................^ Yes ^ No ff so, attach a copy of the notice. 5 Estate of SHIRLEY BENNElT LOTZ a/k/a SHIRLEY ANNE BENNETT LOTZ Deceased 19. Is the Court being asked to direct the filing of a Schedule of Distribution ...........................................^ Yes ®No As to real estate only? ........................................................^ Yes H No Wherefore, your Petitioner asks that distribution be awarded to the parties entitled and suggests that the distributive shares of income and principal (residuary shares being stated in proportions, not amounts) are as follows: A. Income: Proposed Dis6lbutee(s) Amounf/Proporfion Duane V. Smith Remeinlno 80% of Residue of Estate B. Principal: Proposed Distributee(s) AmounVProportion Duane V. Smitlr Remaining 90% of Residue of Estate Submitted by: Richard S. Simpson, II, Petitioner 6 Estate of SHI RLEY BENNETT LOTZ a/k/a SHIRLEY ANNE BENNETT LOTZ. Deceased Verification of Petitioner (Verification must be signed by at least one petitioner) The undersigned hereby verifies that the facts set forth in the foregoing Petition for Adjudication/Statement Proposed Distribution which are within the personal acknowledge of the Petitioner are true, and as to facts based on the information of others, the Petitioner, after diligent inquiry, believes them to be true; and that ant false statements herein are made subject to the penalties of 18 Pa.C.S. § 4904 (relating to unswom falsecation to authorities). Richard S. Simpson, tl, Petitioner Certification of Counsel The undersigned counsel hereby cert~es that the foregoing Petition for Adjudication/Statement of Proposed Distribution is a true and accurate reproduction of the form Petition authorized by the Supreme Court, and that no changes to the form have been made beyond the responses herein. Counsel for Petitioner 7 EXHIBIT I CONSENT OF DYANE V. SMITH THE UNDERSIGNED, Dyane V. Smith, an adult individual, being the daughter of Shirley Bennett Lotz, deceased, and a residuary heir under the Last WII and Testament of Shirley Bennett Lotz, dated May 26, 2010, and in accordance with the Petition to Approve (1) Resignation and Discharge of the Executor, (2) Withdrawal of Executor's Counsel and (3) Filing of the First and Partial Account, does hereby agree and consent to and confine the following: 1. Consent to the request of Richard S. Simpson, II, Executor, Estate of Shirley Bennett Lotz, to resign as Executor of the Estate and upon the confirmation of the First and Partial Account, to discharge the Executor of any responsibility as personal representative of the Estate. 2. In connection with the confirmation of the First and Partial Account, (1) waive any required notice to her as the sole party in interest and as residuary legatee, (2) waive the right to object to the First and Partial Account (to include the Schedule of Distribution), (3) consent to the Court's approving the First and Partial Account (including the Schedule of Distribution) and waive any and all other formalities pertaining to the confirmation of the First and Partial Account. 3. Consent to the withdrawal of Johnson, Duffie, Stewart & Weidner, P.C., as attorneys for the Executor/Estate. 4. Approval of and consent to the payment by the Executor of the Executor's commission ($9,000.00), payment of the Estate attorney's fees ($9,000.00) and reimbursement of costs advanced by Firm ($893.25). The foregoing is conditioned upon the appointment of the undersigned as Administratrix d.b.n.c.t.a. of the Estate of Shirley Bennett Lotz, deceased, or the appointment of a third party (acceptable to the undersigned) as the Administratrix d.b.n.c.t.a. EXHIBIT I EXHIBIT I Executed this day of July, 2011. Dyane V. mdh COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF I~ On this the ~ 5~' day of July, 2011, before me, the undersigned officer, personally appeared DYANE V. SMITH known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have set my hand and official seal. oo~oNweKni of Pe~-nv~ran r seal Karon D. RetrMy, Notary Publk Qly d 9. ~~ Gxarly My CArrMMsslon Feb. 13, 2014 EXHIBIT I 2 301 MARKET STREET P.O. BOX 109 LEMOYNE, PA 17043-0109 717.761.4540 EIN: 25-1802360 June 24, 2011 Estate of Shirley Bennett Lotz c/o Richard J. Simpson, III 426 S. Third Street, Suite 104 Lemoyne, PA 17043 RE: Estate Administration FOR PROFESSIONAL SERVICES RENDERED Statement No. 78222 015637-00001 JRD Billed through 06/23/11 11/24/10 DLW Review of decedent' s Will; Draft petition for probate; draft estate 1.30 hrs information sheet 11/26/10 JRD Telephone conferences with Dyane Smith re request for copy of 1.60 hrs Last Will and Testament; Office conference with Ms. Smith re delivery of copy of Will, incomplete portion of Petition to Probate, access to storage unit and related matters; Telephone conferences with Mr. Simpson re arrangements to access Mrs. Lotz's existing storage area; Telephone conference with Charles Bricker re request for expedited personal property appraisal 12/01/10 DLW Begin accounting 0.20 hrs 12/03/10 DLW Discussion with GI-11v1 regarding administration 0.10 hrs 12/06/10 DLW Telephone conference with Richard Simpson; Revise probate 2.10 hrs documents; Calculate probate fees; Conference with JRD re same 12/07/10 DLW Telephone conference with Mr. Simpson re scheduling of probate 0.60 hrs and related matters; Telephone call with Register of Wills Office 12/08/10 DLW Telephone conference with Mr. Simpson; Conference with Mr. 0.40 hrs Simpson 12/09/10 DLW Organize estate files; Acquire E]N; Begin estate accounting; 3.60 hrs Complete Estate account Application; Telephone conference with Mr. Simpson; Correspondence to Register of Wills with payment of additional filing fees 12/10/10 DLW Telephone conference with M&T Bank re Estate checking account 0.10 hrs 12/13/10 DLW Telephone conference with Mr. Simpson; Conference with Mr. 1.20 hrs Simpson; Update account with debts received; Draft correspondence to Prudential re: Insurance 12/14/10 DLW Telephone conference with Mr. Simpson 0..20 hrs ***PLEASEMA%E CHEC%PAYABLE TO "JOHNSONDUFFIE" AND INCLUDE STATEMENT NUMBER ON YOURCHEC~ THAN%YOU*** Statement No. 78222 015637- 00001 Page 2 12/15/10 DLW Draft Notices to Beneficiaries, Certificate of Notice, DPW Letter, 2.00 hrs Correspondence to Register of Wills Office, Notice of Estate Administration, Correspondence to Patriot News and Cumberland Law Journal; Draft Representation letter; Telephone conference with Mr. Simpson; Review of email received; Respond to email; Telephone conference with Department of Revenue re: safe deposit box inventory; Draft correspondence to Depaztment of Revenue; Begin estate administration checklist 12/16/10 JRD Conference with Mr. Simpson, Susan Fulginiti, Ameriprise and 1.30 hrs DLW re review of decedent's accounts (Ameriprise), beneficiary designations for various accounts, review of existing accounts and decision as to which accounts are to be liquidated, initially (based on current yield/risk), request for audit of Agent's activities pursuant to Power of Attorney 12/16/10 DLW Conference with Mr. Simpson, Ms. Fulginiti and JRD; Revise 1.80 hrs Notice to Beneficiaries; Revise Certificate of Notice 12/17/10 DLW Forwazd documents to beneficiaries; Forward copies of documents 1.60 hrs to Mr. Simpson; Review of email received from Mr. Simpson; Draft correspondence to Ms. Fulginiti; Research re filing of Inventory; Research re Charitable beneficiaries; Review of notices from meeting; Draft points for correspondence from JRD 12/20/10 DLW Review of emails; Review of debts to be paid; Discussion with 0.90 hrs JRD; Email to Mr. Simpson; Correspondence to Sovereign Bank; Telephone conference with Mrs. Fulginiti; Telephone conference with Mr. Simpson; Correspondence to Mrs. Fulginiti enclosing death certificate 12/22/10 DLW Telephone conference with Mr. Simpson; Prepaze Death Certificate 2.20 hrs Application; Discussion with JRD; Conference with Mr. Simpson; Reconcile account; Draft correspondence to Mr. Simpson; Telephone call with Neill Funeral Home 12/23/10 DLW Review of Decedent' s Will; Email to JRD 0.10 hrs 01/03/11 DLW Update estate accounting with Date of Death Letter received from 0.30 hrs Sovereign Bank 01/04/11 DLW Telephone conference with Mr. Simpson 0.20 hrs 01/07/11 JRD Telephone conference with Ms. Smith re inventory of safe deposit 2.60 hrs box and related matters; Conference with Mr. Simpson and DLW re reimbursement of Ms. Smith's expenses and related matters; Telephone conference with Joseph James, Jeweler re expedited appraisal/ring; Telephone conference with Department of Revenue re authorization letter to inventory safe deposit box; Telephone conference with Thomas Lacey, PNC Branch Manager re same; Telephone conference with Ms. Smith re reimbursement of expenses and procedure to have ring appraised and delivered to Ms. Smith 01/07/11 DLW Discussion with JRD; Telephone call with PNC Bank; Conference 1.70 hrs with Mr. Simpson and JRD; Prepare documents for Mr. Simpson to meet with Betsy Gregory ***PLEASEMAgE CHECgPAYABLE TO "JOSNSONDUFFIE" AND INCLUDE STATEMENT NUMBER ON YOUR CHECK THAN% YOU*** Statement No. 78222 015637 - 00001 01/12/11 DLW Review of documents received from Mr. Simpson; Draft correspondence to Mr. & Mrs. Rickard; Pay decedent' s debts; Forwazd to creditors; Conference with Mr. Simpson 01/17/11 DLW Telephone conference with Mr. Simpson; File Review; Correspondence to Ms. Smith 01/19/11 DLW File review; Draft correspondence to Highmark; Email to JRD; Update estate accounting; Reconcile Ameriprise Accounts 01/21/11 DLW Telephone conference with Mr. Simpson; Email to JRD 01/25/11 DLW Telephone call to Vital Records; Telephone conference with Mr. Simpson; Discussion with JRD; Email to Ms. Smith 01/27/11 DLW Telephone call with Mr. Simpson; Telephone call to Mrs. Smith 01/28/11 DLW Telephone call with Mr. Simpson; Email to JRD 01/31/11 JRD Reviewed E-Mail Memorandum from Ms. Smith re several issues; Reseazch re advance distribution to residuary heir/distributable net income and related issues; Conference with EGM re same; Telephone conference with Mr. Simpson re duplicate vehicle title, DNI issues and related matters 01/31/11 DLW File review; Review of Emails received; Email to JRD; Email to Mr. Simpson; Telephone call to Mr. Simpson; Telephone call to Neill Funeral Home; Discussion with JRD 02/01/11 JRD Research re distributable net income and tax consequences of advance distribution to residuary legatee; Telephone conference with Richard Stevenson, Esquire re same 02/01/11 DLW Discussion with JRD; File review re: appraisal of personal property; Email to JRD re: automobile/title 02/04/11 DLW Telephone conference with Susan Moore, Esquire, Pennsylvania Disciplinary boazd; Email to Mr. Simpson; Discussion re: title issues; Telephone call with AAA; Prepare documents for Mr. Simpson; Telephone call with Mr. Simpson 02/07/11 JRD Telephone conference with Ms. Moore re confirmation pertaining to receipt of Mr. Pratz' letter and reimbursement of portion of retainer; Telephone conference with Ronald Butler, Esquire re scheduling conference to review advance distribution request and related issues; Telephone conference with Mr. Simpson re same 02/07/11 DLW Telephone call with Mr. Simpson; Email to Mr. Simpson re: automobile insurance; Review of email from Mr. Simpson; Conference with Mr. Simpson; Draft correspondence to Ms. Smith retitle of automobile; Correspondence to Hartford enclosing Death Certificate 02/08/11 DLW Discussion with JRD; Revise correspondence to Ms. Smith; Prepare file for meeting 02/09/11 JRD Conference with Mr. Butler and Mr. Simpson re Ms. Smith's request for an advance distribution, income tax implications, possibility of using a "stretch" IRA, engaging tax counsel and related matters; Conference with Mr. Simpson re same Page 3 2.10 hrs 0.50 hrs 2.00 hrs 0.20 hrs 0.70 hrs 0.20 hrs 0.50 hrs 1.10 hrs 1.80 hrs 0.80 hrs 0.20 hrs 0.60 hrs 0.70 hrs 1.00 hrs 0.50 hrs 1.60 hrs ***PLEASEMASE CHECBPAYABLE TO "JOHNSONDUFFIE" AND INCLUDE STATEMENT NUMBER ON YOUR CHECK THANSYOU*** Statement No. 78222 015637- 00001 Page 4 02/09/11 DLW Review of correspondence received from Dauphin County; Review 0.20 hrs file; Telephone call with Dauphin County 02/11/11 JRD Reviewed E-Mail Memorandum from Ms. Smith re required 0.30 hrs minimum distributions by Mrs. Lotz during her lifetime with respect to current IRA accounts; E-Mail Memorandum to Ms. Fulginiti re same 02/14/11 DLW Telephone conference with Mr. Simpson; Email to Mr. Simpson 0.20 hrs and Mr. Butler 02/15/11 DLW Draft Inheritance Tax Return; Update accounting; Draft Statutory 2.60 hrs Inventory; Calculate attorneys fees; Review of email; Email to Mr. Simpson; Telephone conference with Mary Louise Sheffer 02/16/11 JRD Reviewed E-Mail Memorandums from Ms. Smith re original IRA 0.80 hrs beneficiary forms; E-Mail Memorandum to Ms. Fulginiti re same; Reviewed initial draft of Pennsylvania Inheritance Tax Return and Inventory; Telephone conference with Mr. Simpson re prepayment of Pennsylvania Inheritance Tax and related matters; Conference with DLW re prepayment of Pennsylvania Inheritance Tax 02/16/11 DLW Discussion with JRD; Revise correspondence; Revise inheritance 0.70 hrs tax return; Email to Mr. Simpson 02/17/11 DLW Telephone call to Mr. Simpson; Prepare package for Ms. Smith; 1.00 hrs Draft correspondence to Register of Wills Office re: prepayment; Telephone call with Register of Wills re: Inventory; Emails to file 02/21/11 DLW Review of documents received from Ms. Smith 0.10 hrs 02/22/11 JRD Office conference with Mr. Stevenson re utilizing one or both of 1.40 hrs the existing IR.A accounts for purposes of a requested partial advance distribufion, taxation of the existing IRA accounts and related matters 02/22/11 DLW Reconcile account with statement received; Email to Mr. Simpson; 1.00 hrs Review of certified documents 02/24/11 DLW Review of file; Email to Ms. Smith 0.80 hrs 02/25/11 JRD Reviewed a-mail from Ms. Smith re Jeffrey Pratz's retainer and 0.40 hrs statements; Telephone conference with Mr. Simpson re same 02/25/11 DLW Review of email received 0.10 hrs 02/28/11 DLW Review of file re: insurance information; 0.50 hrs 03/02/11 JRD Letter to Mr. Butler re transmittal of the Change of Beneficiary 0.20 hrs Form for decedent's IRA accounts 03/04/11 DLW Revise documents for JRD 0.30 hrs 03/07/11 DLW Draft correspondence to Mr. Simpson with check to be deposited 0.20 hrs 03/08/11 DLW Reconcile estate accounting; Reconcile Amerprise Account; Email 3.30 hrs to Ms. Fulginiti; Email to Mr. Simpson; Discussion with JRD; Email to Mr. Simpson and Ms. Fulginiti re: meeting; Update accounting 03/09/11 DLW Schedule meeting; Telephone call with Mr. Simpson; Email with 0.10 hrs Ms. Fulginiti ***PLEASEMASECHEC%PAYABLETO "JOHNSONDUFFIE" AND INCLUDE STATEMENT NUMBERONYOURCHEC$ THAN%YOU*** Statement No. 78222 015637- 00001 Page 5 03/10/11 JRD Conference with Mr. Simpson, Ms. Fulginiti and DLW re trustee to 0.70 hrs trustee transfer of ]RA accounts for the benefit of Dyane V. Smith, federal income tax consequences with respect to non-qualified annuities, advance distribution to Ms. Smith and related matters; Telephone conference with Mr. Butler (voice mail) 03/10/11 DLW Review of draft inheritance tax return; Revise; Calculate 5.20 hrs distributions to beneficiaries; Discussion with JRD; Draft calculations for meeting; Prepaze for meeting 03/14/11 DLW Review of check received; Update estate account; Correspondence 0.30 hrs to Mr. Simpson 03/15/11 DLW Telephone call from Mr. Simpson. Review of file; Email to Mr. 0.10 hrs Simpson 03/17/11 DLW Review of fax from Ameriprise; Reconcile accounts 0.50 hrs 03/18/11 DLW Reconcile accounts 0.60 hrs 03/21/11 DLW Reconcile Amerprise Accounts 2.00 hrs 03/24/11 JRD Telephone conference with Mr. Butler re partial advance 0.30 hrs distribution and process for expediting settlement of the estate (and distribution of all residuary funds) 03/30/11 DLW Review of file; Prepare Release; Discussion with JRD 1.00 hrs 03/30/11 DLW Review of file; Discussion with JRD 1.00 hrs 03/31/11 DLW Email to TLK re seazch at Prothonotary' s Office; Telephone call 3.70 hrs with Mr. Simpson; Reconcile accounts; Telephone call with Ms. Fulginiti; Re-calculate distributions; Prepaze fiduciary income tax return 04/01/11 JRD Reviewed/revised Receipt and Release for pecuniary bequest and 1.10 hrs Receipt and Release Agreement for charitable residuary bequests (Grant Foundation); Conference with DLW re preparation of Pennsylvania inheritance tax return and calculation of residual charitable bequests; Telephone conference with Mr. Stevenson re procedure to expedite advance distribution and final informal accounting pertaining to the estate 04/01/11 DLW Draft Releases for specific beneficiaries; Discussion with JRD; 1.10 hrs 04/04/11 DLW Revise Releases 0.20 hrs 04/06/11 JRD Telephone conference with Mr. Butler re advanced partial 1.80 hrs distribution, disposition of IRA accounts and calculation of charitable residuazy bequest; Conference with DLW re same; Reviewed initial draft of the Pennsylvania Inheritance Tax Return; Prepared draft of letter to Mr. Butler re advance distribution, Pennsylvania Inheritance Tax Return, informal accounting and related matters 04/06/11 DLW Revise inheritance tax return; Memo to JRD; Revise Release; Draft 1.60 hrs correspondence to specific beneficiaries; Discussion with JRD; Meeting with Ms. Fulginiti; Email to Ms. Fulginiti 04/08/11 JRD Conference with Mr. Stevenson re calculation of residuary 0.50 hrs charitable bequests and related matters ***PLEASEMASECHEC%PAYABLETO "JOHNSONDUFFIE" AND INCLUDE STATEMENT NUMBER ON YOURCHECb THAN%YOU*** Statement No. 78222 015637- 00001 Page 6 04/11/11 JRD Conference with DLW re revised Pennsylvania inheritance tax 0.60 hrs return and draft of the First and Final Account; Reviewed revised Pennsylvania inheritance tax return and First and Final Account 04/11/11 DLW Prepaze documents for JRD; Revise inheritance tax return; Draft 5.30 hrs accounting; Revise; Prepare calculations; Draft correspondence to specific beneficiaries re: releases 04/12/11 DLW Finalize documents for mailing; Copy documents for file 0.50 hrs 04/13/11 DLW Telephone conference with Ms. Sheffer 0.10 hrs 04/14/11 DLW Conference with Ms. Sheffer; Notarize documents 0.10 hrs 04/16/11 JRD Letter to Mr. Butler re partial advance distribution, Pennsylvania 0.80 hrs Inheritance Tax Return and proposed informal First and Final Account 04/19/11 DLW Review of estate checking account with statement received; 0.20 hrs Reconcile account 04/21/11 DLW Telephone call with JRD; Telephone call with Mr. Simpson; Email 0.30 hrs to GHM 04/22/11 JRD Reviewed proposed Receipt (Partial), Release and Refunding 0.60 hrs Agreement and the proposed Waiver of First and Partial Account, Receipt, Release and Indemnification Agreement; Revised same 04/25/11 JRD Revised Waiver of First and Partial Account, Receipt, Release and 0.80 hrs Indemnification Agreement, Receipt (Partial), Release and Refunding Agreement; Conference with DLW re same; Telephone conference with Mr. Simpson re rescheduling appointment; Telephone conference with Mr. Butler re same 04/25/11 DLW Discussion with JRD; Email documents to Mr. Simpson; Email 0.50 hrs documents to Mr. Butler 04/26/11 DLW Review of documents; Revise; Discussion with JRD; Email to 1.00 hrs parties; File review re: specific bequests; Telephone call to Lisa Starner; Telephone call with Mr. Simpson 04/29/11 DLW Discussion with JRD; Telephone call to Mr. Butler's Office; 0.20 hrs telephone call to Mr. Simpson 05/02/11 JRD Conference with Mr. Simpson re review of tax returns and 1.20 hrs proposed First and Final Account; Conference with Mr. Simpson and Mr. Butler re Inheritance Tax Return, partial distribution of residuary funds, proposed settlement methodology and related matters 05/02/11 DLW Prepare for meeting with Mr. Simpson and Mr. Butler 2.00 hrs 05/03/11 DLW Prepare Inheritance Tax Return for filing 1.00 hrs OS/OS/11 DLW Review of documents received; Discussion with JRD; Revise 4.60 hrs Return; telephone conference with Mr. Simpson; telephone conference with Register of Wills Office; Revise Inventory; prepaze listing of exhibits; Prepaze return for filing; Prepaze exhibits; Telephone conference with Lisa Starner; Draft Settlement Agreement; Revise Release 05/09/11 DLW Prepare Releases for charitable beneficiaries; Draft correspondence 3.00 hrs to charitable beneficiaries; ***PLEASE MASS CHEC%PAYABLE TO "JOHNSONDUFFIE" AND INCLUDE STATEMENT NUMBER ON YDUR CHECb THAN%YOU*** Statement No. 78222 015637- 00001 Page 7 OS/10/11 DLW Forward copies of filed documents to Mr. Simpson 05/16/11 DLW Draft correspondence to specific beneficiaries enclosing checks for distribution 05/17/11 DLW Correspondence to Ms. Fulginiti re distribution check 05/18/11 DLW Reconcile account with statement received; Email to Mr. Simpson; Review of Release received; Telephone call with Charitable Beneficiary 05/20/11 DLW Conference with JRD re status 05/21/11 JRD Revised proposed Settlement Agreement/Estate of Shirley Bennett Lotz, Deceased 05/23/11 DLW Review of Release received; Draft correspondence to Charitable Beneficiaries with distributions; Update estate accounting 05/24/11 JRD Telephone conference with Mr. Butler re Settlement Agreement, resignation of Executor, resignation of Mid Penn Bank (alternate Executor), letters of Administrator d.b.n.c.t.a. and related matters; Telephone conference with Ms. Fulginiti re liquidation of four (4) annuities and remaining certificate, documentation for change of IRA beneficiary and related matters; Telephone conference with Alice Camerini, Trust Officer, Mid Penn Bank re request for renunciation of Mid Penn Bank as alternate Executor and related matters; Reseazch re procedure for resignation of Executor, alternate, bond requirement for Ms. Smith as Administrator d.b.n.c.t.a. and related matters; Telephone conference with Glenda Famer Strasbaugh, Cumberland County Register of Wills re same 05/24/11 DLW Draft Petition to Withdraw; Telephone call with Register of Wills Office; Copy documents from file; Discussion with JRD; Reseazch re: documents needed 05/25/11 JRD Telephone conference with Mr. Butler re preparation for Petition for Letters of Administration d.b.n.c.t.a. and Administrator's bond and related matters 05/27/11 JRD Telephone conference with Mr. Butler re request that Mr. Simpson resign as Executor, that JDSW resign as the attorney for the Executor and related matters; Letter to Ms. Camerini, Trust Officer, Mid Penn Bank re request that Mid Penn Bank renounce as Alternate Executor, Estate of Shirley Bennett Lotz; Telephone conference with Ms. Fulginiti re asset statements and liquidation of AFI Flex Savings Certificate and related matters; Prepazed draft of Petition of Richard S. Simpson, II, Executor for Court approval to resign, withdrawal of JDSW and confirmation of First and Partial Account 05/27/11 DLW File review; Email to JRD; Discussion with JRD; Email to Ms. Fulginiti; Reconcile account; Review 05/28/11 JRD Prepared draft of the Petition to Approve Resignation and Discharge of the Executor, withdrawal of JDSW and First and Partial Account; Prepazed Consent/Waiver of Dyane V. Smith; Prepared Proposed Order of Court 0.30 hrs 1.00 hrs 0.10 hrs 0.50 hrs 0.30 hrs 2.80 hrs 1.00 hrs 2.60 hrs 1.30 hrs 0.30 hrs 2.60 hrs 2.00 hrs 4.50 hrs ***PLEASE MA%E CHEC%PAYABLE TO "JOHNSONDUFFIE" AND INCLUDESTATEMENTNUMBERONYOURCHECb THAN%YOU*** Statement No. 78222 015637- 00001 Page 8 05/31/11 DLW Reconcile estate account; Email to M&T Bank re: balance of 0.80 hrs account today; Review of file re: short certificates; Discussion with JRD 06/01/11 JRD Reviewed and revised Petition to Approve Resignation and 1.80 hrs Discharge of the Executor; Finalized letter to Alice Camerini, Trust Officer, Mid Penn Bank re renunciation; Prepaeed Praecipe to resign as attorney for Estate; Prepared Renunciation for Mid Penn Bank; Prepaeed draft of the proposed Order of Court 06/02/11 JRD Revised Petition to Approve Resignation and Dischazge of 2.40 hrs Executor; Conference with Mr. Simpson and DLW re review of letter to Mid Penn Bank pertaining to renunciation as Alternate Executor, review of Petition and related matters; Telephone conference with Mr. Stevenson (voice mail) confirming that the four (4) annuities being held by Ameriprise Financial have not been liquidated 06/02/11 DLW File review re: value of estate account; Telephone call with Mr. 1.30 hrs Simpson 06/08/11 DLW Review of filing dates for formal account; Email to JRD 0.20 hrs 06/09/11 DLW Review of costs to be paid 0.30 hrs 06/12/11 JRD Finalized proposed Petition to Approve (1) Resignation and 2.50 hrs Dischazge of the Executor, (2) Withdrawal of Executor's Counsel and (3) Filing of First and Partial Account; Revised draft of Order of Court; Prepared proposed Consent of Dyane V. Smith; E-Mail Memorandum to Mr. Butlez and Mr. Stevenson re transmittal of proposed Petition, Order of Court and Consent 06/13/11 JRD Reviewed/revised Petition and Release and Indemnification 0.60 hrs Agreement; Conference with DLW re same 06/13/11 DLW Review of correspondence received from Charitable Beneficiary 0.10 hrs 06/14/11 JRD Reviewed Petition to Approve (1) Resignation and Dischazge of 1.80 hrs Executor, (2) Withdrawal of Executor's Counsel and (3) Filing of First and Partial Account, Release and Indemnification Agreement and related documents; Telephone conference with Mr. Stevenson re same; Telephone conference with Mr. Butler re same; Conference with DLW re preparation of the revisions to the First and Paztial Account and related matters 06/14/11 DLW Revised First and Partial Account; Discussion with JRD; Email to 3.20 hrs Mr. Simpson 06/15/11 DLW Reconcile accounts; Revise draft Accounting; Conference with 2.80 hrs JRD; Conference with Mr. Simpson; Draft Petition for Adjudication; Revise invoice; Revise Account 06/16/11 DLW Reconcile estate account with statement received; Email to Mr. 0.20 hrs Simpson; Telephone call with Mr. Simpson 06/17/11 DLW Reconcile accounts with fax received from Ameriprise 0.50 hrs 06/20/11 DLW Review of correspondence received from M&T Bank; Telephone 0.40 hrs call with Mid Penn Bank re request for Estate EIN ***PLEASE MA%E CHECgPAYABLE TO "JOHNSONDUFFIE" AND INCLUDE STATEMENT NUMBER ON YOUR CHECK THAN% YOU*** Statement No. 78222 015637- 00001 Page 9 DANA WIESEMAN 94.40 hrs 75.00 /hr $7,080.00 JERRY R DUFFIE 43.10 hrs 250.00 /hr $10,775.00 Total Services $17,855.00 DISBURSEMENTS 06/03/10 Register of Wills; Filing Fee; Satisfaction and Release 10.00 12/06/10 Register of Wills; Probate Fee 179.50 12/09/10 Register of Wills; Filing Fee -additional probate 15.00 12/17/10 Cumberland Law Journal; Legal Advertisement; Notice of 75.00 Estate Administration 12/20/10 Sovereign Bank; Miscellaneous; Date of Death Balances on 20.00 Accounts 12/20/10 Register of Wills; Additional Short Certificates 24.00 03/01/11 THE PATRIOT=NEWS CO.; Legal Advertisement 189.75 05/04/11 Register of Wills; Filing Fee Inheritance Tax Return 30.00 06/23/11 Register of Wills; Filing Fee Petition and First and Partial 350.00 Agreement Total Disbursements $893.25 BILLING SiJNIlvIARY Total Services $17,855.00 Total Disbursements $893.25 Fee Adjustment $8,855.00 Total Services and Disbursements $9,893.25 Total Amount Due $9,893.25 ***PLEASEMASE CHECSPAYABLE TO "JOHNSONDUFFIE" AND INCLUDE STATEMENT NUMBER ON YOUR CHECK THANE YOU*** CERTIFICATE OF SERVICE I hereby certify that a copy of the foregoing Petition. has been duly served pon Dyane V. Smith and Richard W. Stevenson, Esquire, by hand delivery on Julyl~~, 2011. JOHNSON, DUFFIE, STEWART & WEIDNER, P.C. By c-.---- erry ie