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HomeMy WebLinkAbout03-0370PETITION FOR PROBATE and GRANT OF LETTERS also known as To: , Deceased. Social Security No. _ 7d)_l ' Ocli- ~_ 3[~1) ' The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut in the last wil} oi' the above decedent, dated /~/~[-{ ~'...q and codicil(s) dated Register of Wills for the County of Commonwealth of Pennsylvania in the named , ~;e_O/;5 (slate relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in (~ M~[~J~f') . Coumx, Pennsylvania, with h_ D last family or principal residence at ~? ~. ?~c~ ~..~ P.~9..~,/A., PA (list street, number and muncipality) Decendent,~ then ~-55 _ years of.age, died /'{-J l (./ , 1-el ~0~,:5 , Except as f[t'~dws,"de~e~i~nt ~l'i-d~oi ~;~, ~v~s'n(~t di~,c~c-e~ ~n~t did not have a child born or adopted .after execution of the ~l~l~/~ffered for probate; was not the victim ora killing and was never adjudicated incompetent: w'[ ~ Decendent at death o ned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsvlv,0.nia situated as follows: $ WHEREFORE, petitioner(s) respectfully r¢ouest(s) the .vriabate of the last will and codicil(s) presented herewith and the grant of letters "[(~f'~.~'/~X[?..f~--'<-I (heron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) OATH OF PERSONAL REPRESENTATIVE ¢o o w n xu ov ) The petitioner{s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the abeve decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or ~rmed and subscribed ~~(. ~~~ before meAhis .~ day of [~ ~'~ ' - ' ~egister ~ No. Estate Of (Y~o.~ ,~. ~o_6o~, , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW 0~-~- r'~]~ cxTOOa the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated,~' described therein be admitted to probate and filed of record as the last will of and Letters ~ ~o~~e~t~, ,. are hereby granted to /~i_~[ K , in consideration of the petition on FEES Probate, Letters, Etc .......... $ Short Certificates(~) .......... $ IG.oo ~.._~2.a~ {x~ ..... $~1,0o - ,3¢P $i0,0o TOTAL Filed ....~..-~..q.--.O.~ .................... ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 9 0 9 4 9 S 8 APR 1 ? 2003 No. Local Registrar Date ;43 Rev 2/87 COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH '* Mio. hao~l L. ~erTt AGE (Lasl 8,ttr~y) I I./NOE R t YEAFI ~ UN~ER ! D~ DATE ~ ~H ~ ~ "f.: ~ ~ ~ ~- ) J ~uc~ tone ,,~ Vi~ ~sident I,,L P~tne~ship 347 ~h 24~ S~t ~s-- 2 tNFOi~d~ T'S k~l~ ,~Ot~SS (,~4~. ,~dy/To~n ~. ~ ~) ~ ~ ~ncv ~ve~ I - ' ~__.,__~ ~ o~U ~m~,,~ ll~.~y.~) I~ ' ~'~Y ......~ IL~'c~'~''z~ ~ ~ ~ ~,m. ~ ~ ..... [~E S~EO . I~. I~' ~' ~ ~ ~ ~ AC~E~E ~: ~ ~ e~s ~ ~ (~ ~ A C~E~E ~: I~ 0 ~,~ 0 ~ 0 · . . 0~,~.,..,,.~,~. ~ .......................... ~ ~' ~~ -~ ~ 'MEDICAL~AM~E~CORONER (llem27)ty~mp~ ~ ~,~ ~ l~ bllil O~ e~lnltlon a~ invesligati~, in my opinion death ~cu.ed Il I~ I me date and ~0 ~ ~ ~O~ ~ .......................... '~i ...................................................... 0 ~2. ~,~ ,0~ ~ ~' - 03-3-70 LAST WILL AND TESTAMENT OF MICHAEL L. McGOVERN J-o3 KNOW ALL MEN BY THESE PRESENTS, that I, MICHAEL L. McGOVERN, presently residing in the borough of Camp Hill, Cumberland County, Pennsylvania, being in good health and of sound and disposing memory, do hereby make, declare, and publish this as my Last Will and Testament, hereby revoking all former Wills and Codicils heretofore made by me. FIRST: I hereby direct that all the legally enforceable debts and expenses of my last illness and funeral expenses shall be paid by my Executrix, hereinafter named, from my estate as soon after my death as shall be found convenient. SECOND: I direct that any viewing prior to my funeral be conducted with a closed casket. Furthermore, I direct that I not be buried with any jewelry, including my wedding band. THIRD: (a) I give, devise, and bequeath to the children of my marriage to NANCY K. McGOVERN any interest I may have in the estates of J. OWEN and ELIZABETH R. McGOVERN. I direct that this interest, if any, be divided among my children IN EQUAL SHARES. (b) (c) I give, devise, and bequeath the rest, residue, and remainder of my estate, whether real, personal, or mixed, of any nature whatsoever and wherever situated, including any lapsed or void legacy, to my wife, NANCY K. McGOVERN, if she survives me by thirty (30) days. If my wife, NANCY K. McGOVERN, predeceases me or fails to survive me by thirty (30) days, then I give the rest, residue, and remainder of my estate, whether real, personal, or mixed, of any nature whatsoever and wherever situated, including any lapsed or void legacy, to my sister-in-law, MARIANNE K. GREGORY, of Baltimore, Maryland, AS TRUSTEE, who shall collect all assets of my estate, including the proceeds of any insurance policies which may be a part of my estate or otherwise payable to the beneficiaries named hereunder, and shall divide said property into as many equal shares as there are children of my marriage to NANCY K. McGOVERN and shall hold, manage, invest, and reinvest said property and collect the income therefrom for the following uses and purposes: (i) The Trustee shall hold each share, IN TRUST NEVERTHELESS, for the welfare, support, maintenance, education, and benefit of my children as follows: (ii) (A) (B) (c) While any child of mine is under the age of thirty (30) years, my Trustee shall use for his or her benefit so much of the income of his or her trust as my Trustee considers advisable for the support and education of such child, taking into consideration his or her other readily available assets and sources of income. (D) Whenever my Trustee determines that the income of any child of mine from all sources known to the Trustee is not sufficient for his or her reasonable support, maintenance, and education, and that of his or her immediate family, the Trustee may pay to him or her, or use for his or her benefit, so much of the principal of his or her trust as the Trustee determines to be required for those purposes. When any child of mine shall reach the age of twenty-five (25) years, the Trustee shall distribute to that child one-half (1/2) of the balance of his or her trust. When any child of mine shall reach the age of thirty (30) years, the Trustee shall distribute to that child the balance of his or her trust. Upon the death of any child of mine, the Trustee shall distribute his or her trust, as then constituted: (A) (B) (c) To or in trust for the benefit of such person or persons, upon such conditions and estates, with such powers, in such manner and at such time or times, as such child appoints and directs by Will, specifically referring to this power of appointment, and to the extent that he or she does not effectively exercise his or her power of appointment; to his or her then living descendants, per stirpes, or in default of such descendants: to my then living descendants, per stirpes, except that the share of any beneficiary for whose pdmary benefit another trust is to be held under this instrument, shall be added to and commingled with the other trust and held as if it had been an original part of the other trust. FOURTH: I hereby nominate, constitute, and appoint my wife, NANCY K. McGOVERN, as Executrix of this, my Last Will and Testament. In the event that my wife, NANCY K. McGOVERN, shall predecease me or be unable or unwilling to act as Executrix, then I nominate, constitute, and appoint my sons, SEAN M. McGOVERN and CHRISTOPHER O. McGOVERN, as Co-Executors of this my Last Will and Testament. FIFTH: I direct that my Executrix, her successor, or any guardians or trustees named in this document shall not be required to furnish any bond or other security for the faithful performance of his or her duties, notwithstanding any provisions of law to the contrary. SIXTH: My Trustee and Executrix shall have, in addition to the powers and authority conferred upon them by law, the following additional powers and authority: (1) To sell at public or private sale, exchange, lease, mortgage, or pledge any property, real or personal, constituting a portion of this estate or trust, at any time, and upon such terms and conditions as the Trustee and Executor deem wise. (2) To invest any money at any time in such bonds, stocks, notes, real estate, mortgages, life insurance, annuities, or other securities, or such property, real or personal, as the Trustee and Executor deem wise, without being limited by any statute or rule of law regarding investments by the Trustee and Executor. (3) To retain, without incurring any liability, as investments, any property owned by me at the time of my death, as long as they deem it wise, and even though such property is not the kind of property that the Trustee and Executor would purchase as an investment, and even though to retain such property might violate sound diversification principles. (4) To cause any security or other property which may at any time constitute a portion of a trust or of my estate to be issued, held, or registered in their own name, or in the name of a nominee, or in such form that title will pass by delivery. (5) To consent to the reorganization, consolidation, readjustment of the financial structure, or sale of the assets of any corporation or other organization, the securities of which constitute a portion of a trust or my estate, and to take any action with reference to such securities which, in the opinion of the Trustee and Executor, is necessary to obtain the benefit of such reorganization, consolidation, readjustment or sale; to exercise any conversion privilege or subscription right given to them as the owner of any securities constituting a portion of a trust or of my estate; to accept and hold as a portion of a trust or of my estate securities resulting from any reorganization, consolidation, readjustment, sale, conversion, or subscription. (6) To pay all costs, taxes, charges, and expenses in connection with the administration of a trust or of my estate, including such compensation to the Trustee and Executor which shall be in accordance with their established schedule of fees throughout the period of administration of a trust or of my estate. (7) To determine what is "Income" and what is "Principal" hereunder, and their decision thereon shall be final; and to purchase securities at a premium or discount, and to apply or charge said premium or discount against income or principal as the Trustee and Executor may determine. (8) To transfer, sell, exchange, partition, lease, mortgage, pledge, give options upon, or otherwise dispose of any property at any time held by them, at public or private sale or otherwise. (9) To borrow money from any person, firm, or corporation, including any corporation acting as Trustee hereunder, for the purpose of protecting and preserving or improving my estate or trust hereunder; to execute promissory notes or other obligations for amounts so borrowed. (lO) To employ legal counsel, accountants, brokers, investment advisors, custodians, managers, and other agents and employees and to pay them reasonable compensation out of my estate or out of any fund held hereunder to which said compensation is attributable. (11) To do all other acts in their judgment desirable or necessary for the proper and advantageous management, investment, and distribution of a trust or of my estate. SEVENTH: I direct that all transfer and inheritance taxes, state or federal, assessed because of my death, whether the funds, property, or insurance proceeds to which such taxes are attributable pass under this Will or not, shall be paid out of my residuary estate just as if they were my debts and none of those taxes shall be charged against any beneficiary; that my Executrix pay, or provide for payment of all such taxes at such time or times, and in such manner, as my Executrix deems best. EIGHTH: The situs of the trusts created herein for all purposes shall be Cumberland County, Commonwealth of Pennsylvania, and all questions as to the validity of this, my Last Will and Testament, or the administration of the Will shall be governed by the laws of Pennsylvania. NINTH: In the event that my wife, NANCY K. McGOVERN, shall predecease me, I hereby designate and appoint my sons, SEAN M. McGOVERN and CHRISTOPHER O. McGOVERN, guardians of the person or persons of any minor child or children for the duration of the minority of said child or children. Said guardians may retain custody of said child or children in any locality or may, in their sound discretion, in considering the best interests and welfare of said child or children, designate another person or persons in any locality to have custody of said child or children. TENTH: No assignment or order by any beneficiary by way of anticipation of any of the principal or income of the trusts herein created shall be valid; but the income and principal shall be paid directly to the beneficiaries entitled to receive it; and the income and principal shall not be subject to attachment, execution, levy, sequestration, hypothecation, garnishment, or other process while in the hands of the Trustee. 4 ELEVENTH: If my wife and I shall die simultaneously or under circumstances which make it difficult to determine which of us died first, I direct that I shall be determined to have predeceased my wife and I direct further that the provisions of this Will shall be construed upon that assumption irrespective of any provisions of law establishing a contrary presumption or requiring survivorship for a fixed period as a condition of taking property by inheritance. TWELFTH: Should my wife, NANCY K. McGOVERN, my children, and the issue of my children all fail to survive me, then I give the rest, residue, and remainder of my estate, of whatsoever nature and wheresoever situate as follows: a) twenty percent (20%) to my mother-in-law, MRS. JOHN KNOBLOW, of Meadville, Pennsylvania, if she survives me; b) twenty percent (20%) to my sister-in-law, MARIANNE K. GREGORY, of Baltimore, Maryland; c) ten percent (10%) to my sister-in-law, CAROL KNOBLOW, of West Los Angeles, California; d) fifty percent (50%) to my sister, KATHRYN M. DOYLE, of Downingtown, Pennsylvania, or, if she does not survive me, to her heirs-at-law. If my mother-in-law should fail to survive me, I give, devise, and bequeath as follows: a) an additional fifteen percent (1§%) to my' sister-in-law, MARIANNE K. GREGORY; and b) an additional five percent (5%) to my sister-in-law, CAROL KNOBLOW. IN WITNESS WHEREOF, I, MICHAEL L. McGOVERN, the Testator to this, my Last Will and Testament, printed on five sheets of paper which I have identified in the margin of each page by my signature, hereunto freely set my hand and seal this twenty-ninth day of March, 2003. MICHAEL L. McGOVERN The preceding instrument, consisting of this and five other printed pages, each identified in the margin by the signature of the Testator, MICHAEL L. McGOVERN, was on this day and date signed, published, and declared by him, the Testator therein named, as and for his Last Will and Testament, in the presence of us who, at his request, in his presence, and in the presence of each other, have subscribed our names as witnesses. Address.'~ Address: COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) SS: I, MICHAEL L. McGOVERN, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the attached instrument as my Last Will and Testament on the twenty-ninth day of March, 2003; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. MICHAEL L. McGOVERN Sworn or affirmed to and acknowledged before me by MICHAEL L. McGOVERN, the Testator, this twenty-ninth day of March, 2003. COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) SS: We, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw MICHAEL L. McGOVERN sign and execute the instrument as his Last Will and Testament; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed, that each of us in the hearing and sight of MICHAEL L. McGOVERN signed the Last Will and Testament as witnesses; and that, to the best of our knowledge, MICHAEL L. McGOVERN was at the time eighteen (18) or more years of age, of sound mind, and under no constraint or undue influence. Sworn or affirmed to and acknowledged before me by' the above-named witnesses this twenty- ninth day of March, 2003. '03 ~Pr 29 ~9:~9 LAW OFFICES B~T,t,, MLT'R~N & CoN~sq~t,t, 2303 MARKET STREET C~[P HXLI~ P]g~SYLV~,~L~ 17011 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) NAME OF DECEDENT: DATE OF DEATH: WILL NO: TO THE REGISTER: MICHAEL L. McGOVERN APRIL 16, 2003 2003-00370 I certify that notice of Estate Administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneticiafies and intestate heirs of the above- captioned estate on July 29, 2003. NANCY K. McGOVERN, 347 N. 24TH ST., CAMP HILL PA 17011 SEAN M. McGOVERN, 347 N. 24TH ST., CAMP HILL PA 17011 CHRISTOPHER O. McGOVERN, 347 N. 24TH ST., CAMP HILL PA 17011 RYAN P. McGOVERN, 347 N. 24TH ST., CAMP HILL PA 17011 Notice has now been given to all persons entitled thereto under Rule 5.6(a). 29 July 2003 KATHLEEN BUC~ SQl.I 206 WILLOW AVE CAMP HILL PA 17011 (717) 737-3137 Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HAR~i'SBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003450 MURREY KATHLEEN B, ESQ. 206 WILLOW AVE CAMP HILL, PA 17011 ........ fold ESTATE INFORMATION: SSN: 201-40-5340 FILE NUMBER: 21 03-0370 DECEDENT NAME: MCGOVERN MICHAEL L DATE OF PAYMENT: 01 / 16/2004 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 04/16/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $12.96 TOTAL AMOUNT PAID: $12.96 REMARKS: KATHLEEN B. MURREN SEAL CHECK# 3577 INITIALS: SK RECEIVED BY: GLENDA FARNER STRASBAUGH DEPUTY REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES TNHERZTANCE TAX nTVTSTON DEPT. 180601 HARRISBURG, PA 171Z8-0601 CONMONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-1G4? EX AFP (01-0~r) KATHLEEN B MURREN ESQ 206 WILLOW AVE CAMP HILL ._~; DATE 05-08-Z004 R~i:;:/ ~,:, ESTATE OF MCGOVERN ~ ~ DATE OF DEATH 04-16-2005 FILE NUMBER 21 05-0570 '04 -5 P3:42c°UNTY CUMBERLAND ACN 101 Aeoun'l* Reai'l:'l:ed MICHAEL L HAKE CHECK PAYABLE AND RENIT PAYMENT TO; REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-15~7 EX AFP (01-03) NOTICE OF ZNHERZTANCE TAX APPRAZSEMENT~ ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MCGOVERN MICHAEL L FILE NO. 21 05-0570 ACN 101 DATE 05-08-2004 TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~a (Schedule A) (1) 2. S~ocks and Bonds (Schedule D) (2). $. Closely Held S~ock/Par~narshlp /n~aras~ (Schedule C) ($) ~. Hot,gages/No,es Receivable (Schedule D) (~) 5. Cash/Bank Deposi~s/Hisc. Personal Proper~y (Schadule E) (5) 6. Jointly O~nad Proper~y (Schadula F) (6). 7. Transfers (Schedule G) (7). 8. To~al AssaYs APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expensas/Ad.. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Hot,gage LiabilA~ies/Liens (Schedule Z) (10) 11. To~al Daduc~/ons 12. Ne~ Value of Tax Re~urn 15. 1~. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) Ne~ Value of Es~a~a Subjec~ ~o Tax 00 O0 .00 .00 15z081.75 287 99 O0 (8) .00 .O0 (11) (12) (13) (1~) NOTE: Zf an assessment .as issued previously, 11nas lq, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. NOTE: To insure proper credi~ ~o your account, subai~ ~he upper portion of *hAs form ~i~h your ~ax payment. AHOUNT PAID ASSESSMENT OF TAX: 1~. Amoun~ of Line lq a~ Spousal ra~e 16. Aaoun~ of L~ne 1~ ~axabXe a~ LZneal/CXass A ra~e 17. Amoun~ of L1ne lq a~ S1bX1ng ra~e 18. Amoun~ of Line 1~ ~axable a~ Colla~eraX/Class B ra~e 19. Principal Tax Due TAX CREDITS: PAYHENT REC~TpT DTSCOUNT DATE NUHBER INTEREST/PEN PATD (-) 01-16-2004 CD005450 .00 12.96 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADD/TZONAL /NTEREST. (16) 15,081.75 x O0 = .00 (16) 287.99 x 045 = 12.96 (17) . O0 x 12 = . O0 (18) .00 x 15 = .00 (19)= 12.96 .§0 13,369.74 .00 13,S69.74 18 and 19 N111 TOTAL TAX CREDIT BALANCE OF TAX DUE ZNTEREST AND PEN. TOTAL DUE 12.96 .00 .00 .00 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT IS REI~UZRED. ~}L 1F TOTAL DUE 1S REFLECTED AS A 'CREDTT' (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTTONS.) 15,369.7q RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADHIN- ZSTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 11, 1981 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commongealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To ~ulfill the requirements of Section 11~0 of the Inheritance and Estate Tax Act, Act 15 of 2000. (71 P.S. Section 9140). Detach the top portion of this Notice end submit with your payment to the Rag[star of Hills printed on the reverse side. --Hake check or money order payable to: REGISTER OF NILES, AGENT A refund of a tax credit, which was not requested on the Tax Return, say be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS15). Applications ere available at the Office of the Register of gills, any of the 23 Revenue District Offices, or by calling the special Z4-hour answering service for forms ordering: 1-800-S61-Z050; services for taxpayers aith special hearing and / or speaking needs: 1-800-447-5010 (TT only). Any party in interest net satisfied with the appraisement, allowance, or disalloaance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object aithin sixty (60) days of receipt of this Notice by: --aritten protest te the PA Department of Revenue, Board of Appeals, Dept. 281011, Harrisburg, PA 171Z8-1011, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 180601, Harrisburg, PA 17118-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid aithin three (5) calendar months after the decedent's death, a five percent (5Z) discount of the tax paid is allowed. The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes ahich became delinquent before January 1, 1981 bear interest at the rate of six (61) percent per annum calculated at a daily rate of .OOO16q. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate ahich will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 19aZ through ZOO3 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20Z .000548 1987 9Z .0002q7 1999 71 .000192 1985 161 .000458 1988-1991 111 .000301 ZOO0 8Z .000119 1984 llZ .000301 1991 9Z .000247 2001 91 .O00Zq7 1985 152 .000356 1993-1994 72 .OOOleZ ZOO2 62 .000164 1986 lOX .000174 1995-1998 9Z .000247 2003 51 .000137 --Interest is calculated ZNTEREST= BALANCE OF as falloas: TAX UNPAID X NUtiBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Hot[ce issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date sheen on the Notice, additional interest must be calculated. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND being duly _'?~'~/~ according to law, deposes and says that'~he, late of ~[~_~ ~.~ , Cumberland County, Pa., deceased and that the within is an inventory made by ~C.~ ~, ~-~~ , the said of the entire estate of said decedent, consisting of all +he personal property and real estate, except real estate oufslde the Commonwealth of Pennsylvania, end that +he figures opposite each item of the Inventory represent Ws fair value es of ~he date of decedenf's de~fh. C...~rn ~ and subscribed before me, ~ C~mp ;-;~ ~a~o, Cu.nd~_m~l County ~ Month Year INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. , Inventory of the real and personal estate of deceased STATUS REPORT UNDER RULE 6.12 Name of Decedent: A/~'C~[~ L...]~c CQOV~-~ Date of Death: ! Will No.' 200'~--00~0 Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: State whether administration of the estate is complete: If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: ao bo Did the personal representative file a final account with the Court? Yes _ No ]~ The separate Orphans' Court No. (if any) for the personal representative's account is: ~ c. Did the personal representative state an account informally to the parties in interest? Yes [-] No ~ Date: Co Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Signature Name Address Telephone No. Capacity: [--I Personal Representative J~Counsel for personal representative EV 1500 EX (6~0) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 0 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) McGovern, Michael L. DATE OF DEATH (MM-DD-YEAR) 04/16/2003 DATE OF BIRTH (MM-DD-YEAR) O1/05/1950 FILE NUMBER 21 _ O3 O0370 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 201-40-5340 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER McGovern, Nancy K. 170-42-2122 [-~[ 1. Odginal Return [] 2. Supplemental Return [] 4. Limited Estate [] 4a. Future Interest Compromise (dale of death after 12-12-82) [] 6. Decedent Died Testate (A~ach copy of W~) [] 7. Decedent Maintained a Living Trust (Attach copy of Trust) [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-95) NAME Kathleen B. Murren, Esq. FIRM NAME (Ii'Applicable) TELEPHONE NUMBER (717) 737-3137 [~]3. Remainder Retum (date of death prior to 12-13-82) ]5. Federal Estate Tax Return Required 0~8. Total Number of Safe Deposit Boxes [] 11. Election to tax under Sec. 9113(A)(^~ch Sch O) COMPLETE MAILING ADDRESS 206 Willow Ave. Camp Hill PA 17011 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Padnership or Sole-Proprietorship (3) 4. Uodgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) r'--[ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 13,081.75 287.99 (8) (11) (12) (13) (14) 13,369.74 0.00 13,369.74 13,369.74 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers underSec. 9116 (a)(1.2) 13,081.75 x .0 0~ (16) 16. Amount of Line 14 taxable at lineal rate 287.99 x .0 45 (16) 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 0.00 12.96 12.96 Decedent's Complete Address: STREET ADDRESS 347 N. 24th Street CiTYcamp Hill STAT E PA Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. if Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. I ziP17011 A. Enter the interest on the tax due. 12.96 0.00 0.00 12.96 (5) (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 12.96 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ............................................ [] [] c. retain a reversionary interest; or .......................................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ...................................................................... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [] [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penal6es of perjurT, I declare that I have examined Ibis return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG~N,~ES. POI~BLE_ FOR F~_ING RETURN ADDRESS DATE 01/16/04 347 N. 24th Street, Camp Hill PA 17011 DATE ADDRESS 206 Willow Ave., Camp Hill PA 17011 01/16/04 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. {}9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedenrs lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER /~L'(~la~[ L. ~ ~"~'~ 21-03-0370 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. iTEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH J, One - fifth (1/5th) interest in dBIG Partnership 8,157.75 1996 Jeep Cherokee Sport (VIN 1J4FJ68S2TL130777) Misc. personal property (clothing, jewelry) 4,425.00 500.00 TOTAL (Also enter on line 5, Recapitulation) $ 13,081.75 (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98~, .~, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Michael L. McGovern 21-03-0370 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A, JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINI MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER, ATTACH DEED FOR JOINTLY-HELD REAL ESTATE, VALUE OF ASSET INTEREST DECEDENT'S INTEREST TOTAL (Also enter on line 6, Recapitulation) $ 2 7. fl q (If more space is needed, insert additional sheets of the same size) REV-'~513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Michael .. McGovern 21-03-0370 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE !1 TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Nancy K. McGovern 347 N. 24th St. Camp Hill PA 17011 Christopher McGovern 347 N. 24th St. Camp Hill PA 17011 Ryan McGovern 347 N. 24th St. Camp Hill PA 17011 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A, SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insed additional sheets of the same size) 13081.75 25.52 262.46 LAST WILL AND TESTAMENT OF MICHAEL L. McGOVERN KNOW ALL MEN BY THESE PRESENTS, that I, MICHAEL L. McGOVERN, presently residing in the borough of Camp Hill, Cumberland County, Pennsylvania, being in good health and of sound and disposing memory, do hereby make, declare, and publish this as my Last Will and Testament, hereby revoking all fO.rmer Wills and Codicils heretofore made by me. FIRST: I hereby direct that all the legally enforceable debts and expenses of my last illness and funeral expenses shall be paid by my Executrix, hereinafter named, from my estate as soon after my death as shall be found convenient. SECOND: I direct that any viewing prior to my funeral be conducted with a closed casket. Furthermore, I direct that I not be buried with any jewelry, including my wedding band. THIRD: (a) I give, 'devise, and bequeath to the children of my marriage to NANCY K. McGOVERN any interest I may have in the estates of J. OWEN and ELIZABETH R, McGOVERN. I direct that this interest, if any, be divided among my children IN EQUAL SHARES. (b) (c) I give, devise, and bequeath the rest, residue, and remainder of my estate, whether real, personal, or mixed,, of any nature whatsoever and wherever situated, including any lapsed or void legacy, to my wife, NANCY K. McGOVERN, if she survives me by thirty (30) days. If my wife, NANCY K. McGOVERN, predeceases me or fails to survive me by thirty (30) days, then I give the rest, residue, and remainder of my estate, whether real, personal, or mixed, of any nature whatsoever and wherever situated, including any lapsed or void legacy, to my sister-in-law, MARIANNE K. GREGORY, of Baltimore, Maryland, AS TRUSTEE, who shall collect all assets of my estate, including the proceeds of any insurance policies which may be a part of my estate or otherwise payable to the beneficiaries named hereunder, and shall divide said property into as many equal shares as there are children of my marriage to NANCY K. McGOVERN and shall hold, manage, invest, and reinvest said property and collect the income therefrom for the following uses and purposes: (i) The Trustee shall hold each share, IN TRUST NEVERTHELESS, for the welfare, support, maintenance, education, and benefit of my children as follows: (ii) (A) (B) (c) (D) While any child of mine is under the age of thirty (30) years', my Trustee shall use for his or her benefit so much of the income of his or her trust as my Trustee considers advisable for the support and education of such child, taking into consideration his or her other readily available assets and sources of income, Whenever my Trustee determines that the income of any child of mine from all sources known to the Trustee is not sufficient for his or her reasonable support, maintenance, and education, and that of his or her immediate family, the Trustee may pay to him or her, or use for his or her benefit, so much of the principal of his or her trust as the Trustee determines to be required for those purposes. When any child of mine shall reach the age of twenty-five (25) years, the Trustee shall distribute to that child one-half (1/2) of the balance of his or her trust. When any child of mine shall reach the age of thirty (30) years, the Trustee shall distribute to that child the balance of his or her trust. Upon the death of any child of mine, the Trustee shall distribute his or her trust, as then constituted: (A) (B) (c) To or in trust for the benefit of such person or persons, upon such conditions and estates, with such powers, in such manner and at such time or times, as such child appoints and directs by Will, specifically referring to this power of appointment, and to the extent that he or she does not effectively exercise his or her power of appointment; to his or her then living descendants, per stirpes, or in default of such descendants: to my then living descendants, per stirpes, except that the share of any beneficiary for whose primary benefit another trust is to be held under this instrument, shall be added to and commingled with the other trust and held as if it had been an original part of the other trust. 2 FOURTH: I hereby nominate, constitute, and appoint my wife, NANCY K, McGOVERN, as Executrix of this, my Last Will and Testament. In the event that my wife, NANCY K. McGOVERN, shall predecease me or be unable or unwilling to act as Executrix, then I nominate, constitute, and appoint my sons, SEAN M. McGOVERN and CHRISTOPHER O. McGOVERN, as Co-Executors of this my Last Will and Testament. FIFTH: I direct that my Executrix, her successor, or any guardians or trUstees named in this document shall not be required to furnish any bond or other security for the faithful performance of his or her duties, notwithstanding any provisions of law to the contrary. SIXTH: My Trustee and Executrix shall have, in addition to the powers and authority conferred upon them by law, the following additional powers and authority: (1) To sell at public or private sale, exchange, lease, mortgage, or pledge any property, real or personal, constituting a portion of this estate or trust, at any time, and upon such terms and conditions as the Trustee and Executor deem wise. (2) To invest any money at any time in such bonds, stocks, notes, real estate, mortgages, life insurance, annuities, or other securities, or such property, real or personal, as the TruStee and Executor deem wise, without being limited by any statute or rule of law regarding investments by the Trustee and Executor. (3) To retain, without incurring any liability, as investments, any property owned by me at the time of my death, as long as they deem it wise, and even though such property is not the kind of property that the Trustee and Executor would purchase as an investment, and even though to retain such property might violate sound diversification principles. (4) (5) To cause any security or other property which may at any time constitute a portion of a trust or of my estate to be issued, held, or registered in their own name, or in the name of a nominee, or in such form that title will pass by delivery. To consent to the reorganization, consolidation, readjustment of the financial structure, or sale of the assets .of any corporation or other organization, the securities of which constitute a portion of a trust or my estate, and to take any action with reference to such securities which, in the opinion of the Trustee and Executor, is necessary to obtain the benefit of such reorganization, consolidation, readjustment or sale; to exercise any conversion privilege or subscription right given to them as the owner of any securities constituting a portion of a trust or of my estate; to accept and hold as a portion of a trust or of my estate securities resulting from any reorganization, consolidation, readjustment, sale, conversion, or subscription. (6) To pay all costs, taxes, charges, and expenses in connection with the administration of a trust or of my estate, including such compensation to the Trustee and Executor which shall be in accordance with their established schedule of fees throughout the period of administration of a trust or of my estate. (7) To determine what is "Income" and what is "Principal" hereunder, and their decision thereon shall be final; and to purchase securities at a premium or discount, and to apply or charge said premium or discount against income or principal as the Trustee and Executor may determine. (8) To transfer, sell, exchange, partition, lease, mortgage, pledge, give options upon, or otherwise dispose of any property at any time held by them, at public or private sale or otherwise. (9) To borrow money from any person, firm, or corporation, including any corporation acting as Trustee hereunder, for the purpose of protecting and preserving or improving my estate or trust hereunder; to execute promissory notes or other obligations for amounts so borrowed. (lO) To employ legal counsel, accountants, brokers, investment advisors, custodians, managers, and other agents and employees and to pay them reasonable compensation out of my estate or out of any fund held hereunder to which said compensation is attributable. (11) To do all other acts in their judgment desirable or necessary for the proper and advantageous management, investment, and distribution of a trust or of my estate. SEVENTH: I direct that all transfer and inheritance taxes, state or federal, assessed because of my death, whether the funds, property, or insurance proceeds to which such taxes are attributable pass under this Will or not, shall be paid out of my residuary estate just as if they were my debts and none of those taxes shall be charged against any beneficiary; that my Executrix pay, or provide for payment of all such taxes at such time or times, and in such manner, as my Executrix deems best. EIGHTH: The situs of the trusts created herein for alt purposes shall be Cumberland County, Commonwealth of Pennsylvania, and all questions as to the validity of this, my Last Will and Testament, or the administration of the Will shall be governed by the laws of Pennsylvania. NINTH: In the event that my wife, NANCY K. McGOVERN, shall predecease me, hereby designate and appoint my sons, SEAN M. McGOVERN and CHRISTOPHER O. McGOVERN, guardians of the person or persons of any minor child or children for the duration of the minority of said child or children. Said guardians may retain custody of said child or children in any locality or may, in their sound discretion, in considering the best interests and welfare of said child or children, designate another person or persons in any locality to have custody of said child or children. TENTH: No assignment or order by any beneficiary by way of anticipation of any of the principal or income of the trusts herein created shall be valid; but the income and principal shall be paid directly to the beneficiaries entitled to receive it; and the income and principal shall not be subject to attachment, execution, levy, sequestration, hypothecation, garnishment, or other process while in the hands of the Trustee. 4 ELEVENTH: If my wife and I shall die simultaneously or under circumstances which make it difficult to determine which of us died first, I direct that I shall be determined to have predeceased my wife and I direct further that the provisions of this Will shall be construed upon that assumption irrespective of any provisions of law establishing a contrary presumption or requiring survivorship for a fixed period as a condition of taking property by inheritance. TWELFTH: Should my wife, NANCY K. McGOVERN, my children, and the issue of my children all fail to survive me, then I give the rest, residue, and remainder of my estate, of whatsoever nature and wheresoever situate as follows: a) twenty percent (20%) to my mother-in-law, MRS. JOHN KNOBLOW, of Meadville, Pennsylvania, if she survives me; b) twenty percent (20%) to my sister-in-law, MARIANNE K. GREGORY, of Baltimore, Maryland; c) ten pement (10%) to my sister-in-law, CAROL KNOBLOW, of West Los Angeles, California; d) fifty percent (50%) to my sister, KATHRYN M. DOYLE, of Downingtown, Pennsylvania, or, if she does not survive me, to her heirs-at-law. If my mother-in-law should fail to survive me, I give, devise, and bequeath as follows: a) an additional fifteen percent (15%) to my sister-in-law, MARIANNE K. GREGORY; and b) an additional five percent (5%) to my sister-in-law, CAROL KNOBLOW. IN WITNESS WHEREOF, I, MICHAEL L. McGOVERN, the Testator to this, my Last Will and Testament, printed on five sheets of paper which I have identified in the margin of each page by my signature, hereunto freely set my hand and seal this twenty-ninth day of March, 2003. MICHAEL L. McGOVERN The preceding instrument, consisting of this and five other printed pages, each identified in the margin by the signature of the Testator, MICHAEL L. McGOVERN, was on this day and date signed, published, and declared by him, the Testator therein named, as and for his Last Will and Testament, in the presence of us who, at his request, in his presence, and in the presence of each other, have subscribed our names as witnesses. Address: Address:. COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) SS: I, MICHAEL L. McGOVERN, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the attached instrument as my Last Will and Testament on the twenty-ninth day of March, 2003; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. MICHAEL L. McGOVERN Sworn or affirmed to and acknowledged before me by MICHAEL L. McGOVERN, the Testator, this twenty-ninth day of March, 2003. 7 COMMONWEALTH OF PENNSYLVANIA ) ) COUNTY OF CUMBERLAND ) SS: We, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw MICHAEL L. McGOVERN sign and execute the instrument as his Last Will and Testament; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed, that each of us in the hearing and sight of MICHAEL L. McGOVERN signed the Last Will and Testament as witnesses; and that, to the best of our knowledge, MICHAEL L. McGOVERN was at the time eighteen (18) or more years of age, of sound mind, and under no constraint or undue influence. Sworn or affirmed to and acknowledged before me by the above-named witnesses this twenty- ninth day of March, 2003. OTA Y PUBL2 ~ 8 STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: Will No. 2/- Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: State whether administration of the estate is complete: Yes / No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal reprDsentative file a final account with the Court? Yes No ~/ . b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative stat9 an account informally to the parties in interest? Yesw' No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Date: Sigfiabure Name (Please type or print) Address Tel. No. Capacity: /Personal Representative (MAH:rmf/AM3) __Counsel for personal representative