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02-0527
PETITION ROR PROBATE and GRANT OF LETTERS Decea d. Social Security No. / 96 ~ /`{ - y Register of Wills for the County of G..:,..6arl:.r ~ in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut 3 ~ named in the last will of the above decedent, dated moo...,: ~/__Gir ~ ~w -L, , 19 and wdicil(s) dated (state relevant circumstances, e.g. renunciation, death of executor, etc.) Estate of S~iu..re~J- also known as No. _ ai ~ ` ~ ~ ~ 5a't '7 To: County, Pennsylvania,••~~with ~J I~ FZ_~_ 1 Decendent was domiciled at death in ~,~ h ~ last family or principal residence at (list street, number and muncipali[y) Decendent, then ._~ .Z_ years of age, died ~ ~/ 3~Q "Z.-- , l9 at t ~ t r ,~, -, dt,o S7r~ /L.(Gw ,,, L~~-,~ ~,{j -° Except as fo]low ecedent dtd not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as fallows: (If domiciled in Pa.) All personal property $ 'S~isr O G,y (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: ~~-r d~P art Nsu.. t.~., ~.•, ,.L. ./ , ~ _ . ,. _ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters i-P~{-a, w~o.~r stn [heron. (testamentary; administration c. t.a.; administration d. b.n.c. [.a.) nVv. ~ l~ Sz/ - £'S~ ?£c ~ ,? OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 1 COUNTY OF :./.mfr .-/in -~ ~ ss 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 eepp tative(s) of the above decedent petitioner(s) will well and truly administer the sstatc'~bcordi6faw Sworn to or affirmed and subscribed before me this 3/ at day of 7` ~,~- ~ No, zl-oz-osz~ ~~,~, ~~ y~~~G~~ u~~ ,Deceased Estate of DECREE OF PROBATE AND GRANT OF LETTERS AND NOW MAY 31, X2002 ., in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) date' JANUARY 16 2002 described therein be admitted to probate and filed of record as the last will of A_ MAXINE SHOVER , and Letters TESTAMENTARY are hereby granted to ROBERT J D' ANGELO AND CHRISTOPHER PAUL SHOVER ~ -Y J Register of Wills FEES r ~ '~~( /N +~ r u `ti ~ J ~ i I r3 `~ ~~ Probate, Letters, Etc......... . 5340.00 ( / t Short Certi6cates(12) ......... . 5 36.00 ATTORNEY (Sup. Ct. LD. No.) . XH~ffitI ExTRA.P.G5.4.. . 5 ta_no f%'~ Lc~~Y ~-i'~- // ~/ /~ae~~-r~~~~ ~,~t JCP 5 5.00 ADDRESS / 7/% TOTAL _ 8393.00 _ 7` 7 ~ s y ~ Z ~ MAY 31 2002 Filed ..........t ........... .... ......... PHONE MAILED LETTERS TO ATTORNEY MAY 31, 2002 FV J/A6 ~~s is to ~erti(v e4ar eTC ;nlormation here given is correctly copied from an original certificate of death duly filed with me as local Regisirsr. The oligiral ce)nficate will he forwarded ro the Srrm Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fec for this cerrilicue, $2.00 P_8207117 N o. 21-02-0527 Lord Kegisn~ar ~'°gavzET COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH NAME Of DECEDENT IRrv. MbGe, Laq ~_~-~__~ 4TAlE FILE NVwEI L A. Maxine $Ex SOCIAL SECVq,iY NUMEEN Shover _ female Acf aaa, e:aq.n uNDERlrfw - x' ]. 196 - 14 - UMCERIDb ORE DF&MN BUrtrvPIACF IC.ry ana PI/.CE CI CERN,CnM4 mlvnv- .ev AbN] Dap Nya . Ww,p .MOnm Uav. hv, aM,en lveyn Cwnuvl :I.o-amuMr 77 .,. January 19, NO$°"" E. 1925 Harrisburg, PA I,puM,^ Ewax«„m^ •I^•oGA^ LOIINtt OF DERN CffY,EOgD,TWP DE DERN FACILT'N.LME II, rv~lna"um_giy v,Ly,aM,x.~gvi Cumberland WL50 CFOEM Of • w _ _ New Cumberland 1711 Bridge Street ;!_~ w^x, ... -- 1711 Bridge Street New Cumberland, PA 17070 I SNAMEILvv, MMSt Lavl Charles A. Gerdes w^ rt J. pD~'AnQe to CnmMiln WI R]nM.onglM.^ _^ S O2. ] m. ]'.S S11CN LICE ISSN MRF11 ,,,. FS 012 849 L Inr~m.Mapa. ]N OCCU,,.x M,MUm..en]aMp]«qa,M. b )MI a'TN ~]]~ DATELPN~pN)UNCEDDEAp IMUnu, DayY a ~1~01 I M 1 ,1 (A 1 1 2 ~/ Main Wiyl aMarlM nWaaI OVUq.gu[n , u, sga,u !d COMPLETIONOf C/J15E a AagaM ^ P]MI,Iq MpMMa,gn ^ 'f1a ^ M~ Y ^ ~ ~ u.Wd• ^ CaW MMdlannine0 ^ .. .. ~ oao-].1 I G a _w ,Fe.^rM.eM.MMIN ea..M,x Mn• bwuMT M. MC]xvaM na~.]M,aalmx., RNER 5 R.WE IFV V MWe, Maganyrny«I Estele Irene Rudv 501 Woodcrest Drive, 1~~PIaMC.$PDSRgN ~ Nama M CMMary, Cnr,umry Yorktowne Cremation Svc M AY 14 2002 Daec x. May 13, 2002 ^ RMJ„M~ DIM/ ISkacuyl^ .icsburg, PA 17 IION.CRWT .g1MA FV COM York, PA 17404 LxMI W^ Y]. ^ 1b ^ ............................ ]10. '11gNWNTxMG ANDCERTMY WOINYgILMMIP1r!=ew biN ywmuci,y «am ugcMayvpm<MSe of «alnl L NSE N,1MREfl U/]E SgaE AIM eMI aImY]m.wlpe,Mam«ew,a]I m.u«, M,.,]m IMLe, ]neawm,Meau•W. aoA'lir~ 'YEOICAL E]IAMINEgICORONEq NAMEANDAOOgEgg CF IEg50N WNOCbAPLETEO CAUSE( OnlM pula Ol aaamina110naM!«Inw]LI IIIem D)TygWP1iM - ]tamNnwYfMIW........... 9Mgn, in mY Opimm~, EORIR«CU.ryE]I lRa lima, x]Ia, ME pl]«,]nx CUe IOIM GUN(f)aM /{!/~N'4i-~ 5!~s ()~<< REGISTNAq'S SIGN/RVgE ANONVMREq ~~ I ' Grp /Y A ~l^~13 /~ J, 1~1~1_-~'._~ DRE FILEDIMOnln. pyy YUan r----- -___ __--.-.__ a. enAwCilsASHOVR,a:::^eA'-02 I I 21-02-0527 LAST WILL AND TESTAMENT OF A. MAXINE SHOVER I, A. MAXINE SHOVER, of the Borough of New Cumberland, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I hereby make the following specific bequests of my personal property: A. My diamond solitaire ring and wedding ring to my daugh- ter, EILEEN M. SHULMAN, if she survives me. B. My square diamond ring and solitaire pendant to my daughter, KATHLEEN A. LIPPI, if she survives me. C. My diamond earrings to my daughter, KATHLEEN A. LIPPI, if she survives me. D. My gold jewelry, five bracelets, two diamond-cut chains and coin pendant, cameo pendant and earrings to the following who survive me, EILEEN M. SHULMAN, KATHLEEN A. LIPPI, JANET L" ANGELO, DEB D'ANGELO, GAIL D'ANGELO, JULIE D'ANGELO, and my granddaughters, MICHELLE LIPPI, ELYSIA SHULMAN, MARIE D'ANGELO, BECKY D'ANGELO, and TORI D'ANGELO, to be divided among them as they shall agree. My preference is that distribution of this property be done amicably, keeping in mind what each is fortunate enough to already own. If my Page 1 of 5 younger granddaughters are younger than eighteen at the time of my death, then their parents shall make decisions on their behalf regarding items to be given to them. E. My secretary desk to my son, THOMAS J. D'ANGELO, and his wife, JULIE D'ANGELO, or the survivor of them. F. My bedroom suite to my daughter, KATHLEEN A. LIPPI, if she survives me. ITEM II: I direct that my real estate situate at 1711 Bridge Street, New Cumberland, Cumberland County, Pennsylvania, be sold with the net proceeds therefrom to be distributed in equal shares to the children of my late husband, GILBERT L. SHOVER, who are GILBERT L. SHOVER, JR., JANICE MARIE PELLAM, ANN MARIE EWING, and CHRISTOPHER PAUL SHOVER, or their issue, per stirpes. ITEM III: I devise and bequeath all the rest, residue and remainder of my estate, of every nature and wherever situate ire equal shares to my children, MICHAEL C. D'ANGELO, THOMAS J. D'ANGELO, EILEEN M. SHULMAN, JAMES W. D'ANGELO, KATHLEEN A. LIPPI, and ROBERT J. D'ANGELO, or their issue, per stirpes. ITEM IV: I appoint my Co-Executors and their successors guardian of any property which passes, either under this will or otherwise, to a minor and with respect to which I am authorized to appoint a guard- ian and have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fidu- Page 2 of 5 t ciary in its discretion to distribute a share where possible to the minor or to another for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to time for the minor's support and education (including college education, both graduate and undergraduate) without regard to his or her parent's ability to provide for such support and education, or to make payment for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor. ITEM V: I appoint ROBERT J. D'ANGELO and CHRISTOPHER PAUL SHOVER, Co-Executors of this my last will. Should ROBERT J. D'ANGELO predecease me or be unable to serve as Co-Executor for whatever reason, I appoint JAMES W. D'ANGELO as successor Co-Executor of this my last will. Should CHRISTOPHER PAUL SHOVER predecease me or k~e unable to serve as Co-Executor for whatever reason, I appoint JANICE MARIE PELLAM as successor Co-Executor of this my last will. ITEM VI: No fiduciary acting hereunder shall be required t:o post bond or enter security for the faithful performance of his/her duties in any jurisdiction. IN WITNESS WHEREOF, I, A. MAXINE SHOVER, have hereunto set my hand and seal this ~/- day of ~~~y'(~'~`L~, 2002. //i//r' ~» l //- / -mod; ' A. MA} INE SHOVER Page 3 of 5 SIGNED, SEALED, PUBLISHED and DECLARED by A. MAXINE SHOVER, the Testatrix above named, as and for her Last Will and Testament, and in the presence of us, who at her request, in her presence and in the pres of each other, have subscribed our names as witnesses. Witnesses Address/, '~ / / / ~ E ~~ Witness Address COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND SS: I, A. MAXINE SHOVER, the Testatrix 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 this in:;tru- ment as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. ~ A. MAXINE SHOVER Sworn to or affirmed to land acknowledged before me by A. MAXINE SHOVER, the Testatrix, this V-a- ~ day of _ \(~~;;,~~, 2002. NOTARIAL ~'P.A1. ~~ i~ CAROL L. TROXELI_, wafary r"uhu;; i Notary Public New Cumberland Roro. Cumberland Cc. r My Canmisslon Explras Dec. 27, 2005 Page 9 of 5 COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMB LAND , ~ ~ ~~ We ~ - ~--/ and ~_ the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testatrix sign and execute the instrument as her last will; that Testatrix 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; that to the best of our knowledge, the Testator was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. Witness /~ /Lip ~ ~~~~ Witness // Sworn to or aff/firmed to and acknowled~gJed before me by C~-iu lL-( ~ :S/~llCe~3/~~ and~~(~-~'c°~2~_ ~ , witnesses, this ~~~?~ day of ~~,p,_ ,?,~~ 2002. J <, J a NOTARIAL SEAL Notary Public CAROL L. TflOXELL, Norary Fi:!`~+_' New Cumberland 9oro. Cumbeci~~:c~ G, . MY Gommisaion Expiry Deo, 27, 2CG7 4 Page 5 of 5 CERTIFICATION OF NOTICE UNDER RULE 5 6(a) Name of Decedent: A. Maxine Shover Date of Death: May 13, 2002 Admin. No. 2002-00527 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on June 11, 2002 and June 19, 2002; Name and Address: Michael C. D'Angelo 725 Elkwood Drive New Cumberland, PA 17070 Thomas J. D'Angelo 324 15~' Street ~ - ~; New Cumberland, PA 17070 Eileen M. Shulman ' r_7 245 Forked Neck Road Shamong, NJ 08088 James W. D'Angelo 726 Gleenarden Drive Lewisberry, PA 17339 Kathleen A. Lippi 114 Hummel Avenue Lemoyne, PA 17043 Robert J. D'Angelo 501 Woodcrest Drive Mechanicsburg, PA 17050 Gilbert L. Shover, Jr. 320 Wayland Street San Francisco, CA 94134 Janice M. Pellam 107 Creekview Drive Carlisle, PA 17013 Ann M. Ewing 84 Hill Drive York Haven, PA 17370 Christopher P. Shover 211 Geary Avenue New Cumberland, PA 17070 Michelle Lippi c/o Kathleen A. Lippi 114 Hummel Avenue Lemoyne, PA 17043 Elysia Shulman c/o Eileen M. Shulman 245 Forked Neck Road Shamong, NJ 08088 Janet D'Angelo 725 Elkwood Drive New Cumberland, PA 17070 Deb D'Angelo 726 Gleenarden Drive Lewisberry, PA 17339 Gail D'Angelo 501 Woodcrest Drive Mechanicsburg, PA 17050 Julie D'Angelo 324 15~' Street New Cumberland, PA 17070 Marie D'Angelo c/o James W. D'Angelo 726 Gleenarden Drive Lewisberry, PA 17339 Becky D'Angelo c/o Robert J. D'Angelo 501 Woodcrest Drive Mechanicsburg, PA 17050 Tori D'Angelo c/o Robert J. D'Angelo 501 Woodcrest Drive Mechanicsburg, PA 17050 Notice has now been given to all persons entitled thereto under Rule 5.6(a). Date: June 19, 2002 William L. Adler, Esquire ADLER & ADLER 125 Locust Street P. 0. Box 11933 Harrisburg, PA 17108 717- 234-3289 Supreme Court ID # 39844 Counsel for Personal Representative .~ ~ WILLIAM L. ADLER CRAIG L ADLER' `ALSO ADMITTED TO PRACTICH IN NJ ADLER &ADLER ATTORNEYS AT LAW 125 LOCUST STREET P.O. BOX 11933 HARRISBURG, PENNSYLVANIA 17108-1933 TELEPHONE (717) 234-3289 FAX (717) 234-1670 OVERNIGHT MAIL ADllRESS: 125 LOCUST' STREET' HARRISBURG, PENNSYLVANIA 17101 .~ <, ,~ J i'_ <; ~~ LEWIS F. ADLER (1934_1984) DAVID S. KOIiN (1934-1985) LOUIS J. ADLER (i9s9_~999) KOHN AND ADLF,R (1934-1960) KOHN, ADLER &ADLER Q96G-1981) August 9, 2002 Cumberland County Court House Register of Wills 1 Courthouse Square Carlisle, PA 17013-3387 FED EX Dear Register of Wills: RE: A. Maxine Shover Estate Enclosed please find a check in the amount of #30,000.00 representing a down payment on inheritance tax for the above estate. Thank you. Very tr%uly y urs, William L. Adler WLA FedEx ~ Ship Manager ~ Labe17919 0421 8104 From: MAYA 6RUKER (717J334-3389 REVENUE BARCOQE AQLER & ADLEA 135 LOCUST STREET E HARRISBURG, PA, 17101 To: REGISTER OF WILLS (000)000-0000 CUMBERLAND COUNTY COURTHOUSE sHIA D,arE: osaucoz 1 COURTHOUSE S4UARE WEIGHT: 1 LBS _i~umi~i~miii! wEp~ . NIp~01N9~NIN~NN ~~~ Shipping Label Page 1 of 1 MON `" AA Deliver by 12AUG02 ' ~ ; Vii.. Schedule Courier Find a Dropoff Location Shipping History Shipment Complete Cancel Shipment Edit Shipment Information 1. Use the "Print" feature from your browser [o send [his page to your laser printer. 2. Fold the printed page along the horizontal line. 3. Place label in air waybill pouch and affix it to your shipment so that the barcode portion of the label can be read and sc Shipment Details To print a copy of the shipment information for your records, please click "Shipment Details". Shipment Details Ship a New Package Ship Inside U.S. Ship Outside U.S. Ship to Same Recipient Use of [his system constitutes your agreement to the service conditions in the current FedEx service Guide, available upon request. FedEx will not be responsible for any claim in excess of $100 per package, whether the result of loss, damage, delay, non-delivery, misdelivery, or misinfortna[ion, unless you declare a higher value, pay an additional charge, document your actual loss and file a timely claim. Limitations found in [he current FedEx Service Guide apply. Your right to recover from FedEx for any loss, including intrinsic value of the package, loss of sales, income interest, profit, attorney's fees, costs, and other forms ofdamage whether direct, incidental, consequential, or special is limited to the greater of$100 or the authorized declared value. Recovery cannot exceed actual documented loss. Maximum for items of extraordinary value is $500, e.g. jewelry, precious metals, negotiable instruments and other items listed in our Service Guide. Written claims must be filed within strict time limits, see current FedEx Service Guide. https://www.fedex.com/cgi-bin/tmity?www42&gifs/04/81 /7919_0421 _8104S.LaOCl.html 8/9/2002 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 ]128-0601 RECEIVED FROM: REV-1162 EX111-961 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 001514 WILLIAM L ADLER ESQUIRE PO BOX 11933 125 LOCUST STREET HARRISBURG, PA 17108-1933 - ---- - gale ACN ASSESSMENT AMOUNT CONTROL NUMBER TOTAL AMOUNT PAID: S 30, 000.00 REMARKS: CHRISTOPHER PAUL SHOVER C/P WILLIAM L ADLER ESQUIRE CHECK#1019 INITIALS: CW SEAL RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS ~/~6~~ February 21, 2003 William E. Adler, Esq. 125 Locust St. Harrisburg, Pa.17101 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPARTMENT 280601 HARRISBURG, PA 17128-0601 Telephone (717) 787-3930 FAX (717) 772-0412 Re: Estate of A.Maxine Shover File Number 2102-0527 Dear Mr Adler: This is in response to your request for an extension of time to file the Inheritance Tax Return for the above estate. In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before August 13,2003. Because Section 2136 (d) of the 1995 Act allows for only one extra period of six (8) months, no additional extension(s) will be granted that would exceed the maximum time permitted. ~ mcerely / A //'' , i~ ~/~i~, j 1 "~effrey Hollenbush, Supervisor Document Processing-Unit Inheritance Tax Division ~ ~ - Off- 5a7 ADLER &ADLER ATTORNEYS AT LA W 125 LOCUST STREET P.O. BOX 11933 HARRISBURG, PENNSYLVANIA 17108-1933 TELEPHONE (717) 234-3289 PAX (717) 234-1670 WILLIAM L. ADLER CRAIG I. ADLER* •A1S0 AD MITTEU TO PRACTICE IN NJ OVERNIGHT MAIL ADDRESS: 125 LOCUST STREET HARRISBURG, PENNSYLVANIA 17101 LEWIS F. ADLER (1934_1984) DAVID S. KOHN (1934-1985) LOtiIS J. ADLER (1959=1999) KOHN AND ADLER (193d-1960) KOHN, ADLER & RULER (1960-1981) April 2, 2003 Cumberland County Court House Register of Wills 1 Courthouse Square Carlisle, PA 17013-3387 Re: Estate of A. Maxine Shover Dear Register of Wills: Enclosed please find the inheritance tax return and inventory to be filed together with filing fees of $31.00 and t:ax due in the amount of $817.27. A copy of the extension is also enclosed. Please clock the copies you do not need and return them to me. Thank you. Very truly y ur ~~~~ William L. Adler WLA cc: Robert J. D'Angelo and Christopher P. Shover `71 Sr RGC HRRRISBU~g P'i+ RP RMOU'J~ ~_ X0.00 vo~s i>°srnma 00653 r 9~" 0000 17013 LAS --~0-~~ P ~/ O W 3 ~^d wnQ i..~l ~ ~ P Z Q c ~ ~ nn ' ~ ffi z J z w w a c 0 a a ~ N ry z w E r x ~ O M 'ii U] ~ ~- E a D o zaar` U S w r- zooa ~axw awEa aEam W [q ,7 H w Hoa ~ w U x U !k .- U 0 ~"' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPARTMENT 280601 HARRISBURG, PA 17128-0601 February 21, 2003 William E. Adler, Esq. 125 Locust St. Harrisburg, Pa.17101 Telephone (717) 787-3930 FAX (717) 772-0412 Re: Estate of A.Maxine Shaver File Number 2102-0527 Dear Mr Adler: This is in response to your request for an extension of time to file the Inheritance Tax Return for the above estate. In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before August 13,2003. Because Section 2136 (d) of the 1995 Act allows for only one extra period of six (5) months, no additional extension(s) will be granted that would exceed the maximum time permitted. Sincerely' - - -, f ~% l ~ . .~~~vy% .~ ~_}~, y,~-`pia ~1 / ter. `~ 1~_,leffrey Hollenbush, Supervisor Document Processing Unit Inheritance Tax Division Register of Wills of Dauphin County, Pennsylvania INVENTORY Estate of A. MAXINE SHOVER No. also known as Date of Death 05/13/02 Deceased Social Security No. ~6-1 4-3295 RW-8 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of [he real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed apposite each item of said Inventory represents its fair value as of the date of [he Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to uns worn fa~yfit~~ authorities. e n to Name of WILLIAM L. ADLER, ESQUIRE Attorney: I.D. No.: Address: 1 2 T O S TR T Dated HARRISBURG PA 17101 Telephone: 71 7-234- Gp ----~----°•~• -~ •=a~ =.~me outsiae me Commonwealth of Pennsylvania may, at the election of [he personal representative, include the value of each item, but such ligures should not be extended into the total of [he Invenmry. INVENTORY ESTATE OF A. MARINE SHOVER 1711 Bridge St. New Cumberland, PA 17070 $130,000.00 (See attached settlement sheet) 76 shares Waypoint Bank stock $1,436.40 1000 shares Parallel Petroleum Corporation $0.00 cusip 699158 M&T Investments Massachusetts Invs Trust Class A $12'420.15 M&T Investments MFS Emerging Growth, Class A $6,548.82 M&T Investments MFS Research Intl, Class A $12,479.96 20 shares Metlife stock $507 00 25.35/share . Jewelry See attached insurance schedule $14,825.00 PNC Money market $36,090.58 PSECU, checking account $7,771.72 M&T Bank, CD 031003910927078 $10,011.50 Zurich, Scudder, money market $1,802.18 Pacific Life account $250,473.04 1997 Buick Century Limited 000 $7 00 See attached a ppraisal . , Waypoint Bank, checking 700011978 $11,939.27 Refund 2001 PA income tax $100.00 Patriot News refund $138.50 Prescription reimbursement $119.87 Prescription reimbursement $521.57 IGE Capital Insurance, refund premium $1,868.60 Paid prescriptions reimbursement $195.04 Refund Verizon $1.59 Refund Comcast Cable $175.43 Refund, Johns Hopkins $23.77 Mutual Benefit Insurance Co refund, car insurance $83.00 ";;-1500EX(5-00): COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 \~-l/1-<1 REV-1500 w ,.., :.::~(I) u """ wll.U ",00 U"'-' ll.'" ll. '" INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W C W U W C OECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SHOVER, A. MAXINE DATE OF DEATH (MM-DD-YEAR) 05/13/02 [] 1. Original Return o 4,LimitedEstate [] D. Decedent Died Testate {Altaeh copy of Will) o 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Ma'lntained a living Trust (Attach copy 01 Trust) o 10, Spousal Poverty Credit (date 01 death between 12-31-91 ~nd 1-1-95) OFFJC;AL OtJL E. - DATE OF BIRTHJMM-DD-YEAR) 01/19/25 (IF APPLICABLE) SURVIVING SPOUSES NAME (LIAST, FIRST. AND MIDDLE INITIAL) FILE NUMBER "'.1..-2 '- COUNTY CODE YEAR J2.f.3--~_ NUMBER SOCIAL SECURITY NUMBER 196 14 3295 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (daleoldeam prior to 12-13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (AtlaehSchOJ ,.., z w o z o ll. Ul W '" '" o U COMPLETE MAILING ADDRESS 125 LOCUST STREET P. o. BOX 11933 HARRISBURG, PA 17108 NAME FIRM NAME (lfApplicabl~ ADLER & ADLER TELEPHONE NUMBER 717 234-3289 OFFlcIAI:-USE oNLY- (B) 744,848 99 (11) 24,932.95 (12) 719,916.04 (13) (14) 719,916.04 x.O_ (15) x.o~ (15) 32.396.22 x .12 (1l) x 15 (181 (19) 32.396.22 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3 Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receil/able (Schedule D) (1) (2) (3) (4) {51 130,000.00 33,392.33 343,140.66 z o !ci: ...I ::::l l- ii: <( u w 0:: 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) D. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 24,592.13 340.82 (6) (I) 238,316.00 (9) (10) 12 Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 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) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o !ci: f-' ::::l ll. ::E o u g 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a}(1.2) 16. Amount of Line 14 taxable at lineal rate 719.916.04 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREET ADDRESS 1711 R~IDr.R ~~~RR~ CITNEW CUMBERLAND I STATE PA I ZIP 17070 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 33,396.22 )9,QQO.QQ 1.578.95 Total Credits ( A + B + C ) (2) 3. InteresVPenalty if applicable D. Interest E. Penalty TotallnteresVPenalty ( 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. 817.27 A. Enter the interest on the tax due. (5) (5A) (5B) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 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: 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? . Ves ......0 ......0 ..........0 o ..0 .....0 No IX] IX] IXJ IiJ IX] IXJ o IF THE ANSWER TO ANY OF THE ABOV ............. Iil TIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. )' ,/ ~ DATE 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. 99116 (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. g9116 (a) (1.1) (ii) The statute does not exemot 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 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 paren or a stepparent of the chiid is 0% [72 P.s. 99116(a)(I.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries IS 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(I)]. 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. 99116(a)(1.3)]. A Sibling is defined, under Section 9102, as a individual who has at least one parent in common with the decedent, whether by blood or adoption. SCHEDULE "A" REAL ESTATE Estate of A. Maxine Shover File Number 2002-00527 ITEM NUMBER DESCRIPTION VALUE AT DEATH 1711 Bridge St. $130,000.00 New Cumberland, PA 17070 (See attached settlement sheet) TOTAL REAL $130,000.00 ESTATE .-'-"'1\1, / . OMB NO. 2502.0265 <;i "u;.., // B. TYPE OF LOAN: U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1_DFHA 2.DFmHA 3, [E]CONV. UNINS. '.oVA 5. DCONV. INS. 6. FILE NUMBER: 17. LOAN NUMBER: SETTLEMENT STATEMENT PORTANOVA-MP-2002 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form Is furnished 10 give you a slatement of actual setllemenl costs. Amounts paid 10 and by IlIe sell/emen/ agent are slJOwn. lIems marked 7POCj" were paid au/side Ihe closing; they are shown here for informal/anal purposes end are not included In Ihe fotals. " ", (POR1ANOVA.MP.2002_PFOIPORrANOVA.MP.2002/~ ) D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: Domonlc J. Portanova Province Bank 719 Florence Circle Robert J. D'Angelo and 1205 River Road Mechanlcsburg, PA 17055 . Christopher Paul Shover, Co-Executors of the MaireUa,PA 17547 EslateofA. Maxine Shover G, PROPERTY LOCATION: H. SETILEMENT AGENT: I. SETTLEMENT DATE: 1711 BrldgeStreel Mid-Penn Abstract Co. New Cumberland, PA 17070 Seplember30, 2002 Cumberland County, Pennsylvania PLAFE OF SETTLEMENT 125locustSlreet Harrisburg, Pennsylvania 17101 J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100, GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract Sales Price 130,000,00 401. Contract Sales Price 130,000.00 102. Personal Pro erl 402. Personal Pro e 103. SaUlernent Charges 10 Borrower Une 1400) 5,572.12 403. 104. 404. 105. 405. Ad'us/menls For lIems Paid B Seller In advance Ad'uslments For Items Paid B Seller in advance 106. School Taxes 10 406. School Taxes 10 107, CountvTaxes 10f01/02 10 01l01f03 131.60 407. CounlvTaxes 10f01/02 10 01f01/03 131.60 108. CII Taxes 10 408. CI Taxes 10 109. 409. 110. 410. 111. 411. 112, 412. 120, GROSS AMOUNT DUE FROM BORROWER 135,703_72 420. GROSS AMOUNT DUE TO SELLER 130,131.60 200. AMOUNTS PAlO BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. De osilorearnestmone 5,000.00 501. Excess De osll See Inslructions 202. PrIncipal Amounl of New Loan(s) 123,500.00 502. Settlement Charges to Seller (Line 14001 6,076.62 203. ExlsUn loan s Iakensubecllo 503. Exlslln loan s taken sub ecl 10 204. 504, Payoff of first Mortgage 205, 505. Pa off of second Mort a e 206. 506. 207. 507. De oslldisb.as roceeds 208, 506. 209. 509. Ad'us/men/s For lIems Un aid B Seller Ad'ustmenls For Items Un aid B Seller 210. School Taxes 07/01/02 to 10/01102 364.25 510. SchooJTaxes 07/01102 to 10f01/02 364.25 211. County Taxes 10 511. Count Taxes 10 212. eil Taxes 10 512. Cit Taxes 10 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 128,864.25 520, TOTAL REDUCnON AMOUNT DUE SELLER 8,441.07 300. CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TOIFROM SELLER: 301. Gross Amount Due From Borrower line 120 135703.72 601. Gross Amount Due To Seller (line 4201 130,131.60 302. less Amount Paid By/For Borrower (Line 220) ( 128,864.25) 602. less Reductions Due Seller (Line 520) ( 8,441.0 303, CASH ( X FROM) ( TO) BORROWER 6,839.47 603. CASH ( X TO)( FROM) SELLER 121,690.53 The undersigned hereby ~ edge receipt of a ~mpleted pyof pages 1&2 of HIls slatement & al1y attachments referred to her~D.._~~ .'" ./-..--'-'/ ..... Borrower N o Seller ~, ~~-<....., -~--~_..-_..../ E. 'tOTAL COMMISSION Based dn Price . 0;,;:'0: of Comm;,,;on IIn. 700' "Follow" 701, $ 6,500.00 10 D'Angelo Really Group, 702. $ 10 , 703. CommIssion Paid al Selllement 704 to 800. ITEMS PAYABLE IN CONNECTION WITH LOAN B01.loanOri InallonFee % 10 B02. Loan Discount % 10 803 Flood Certification Fee to 804. Tax Service Fee 10 805. Courier Fee 10 806. UndelWrf[ing Fee to 807. DocumenlPreparalion Fee \0 B08. 80. 810. 611. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Inlerest From 09/30102 to 10lUlI02 @ $ 20.SaGDDD/day ( 902. Mort a e Insurance Premium for 1 months 10 Pro nee Bank 903. Hazard Insurance Premium for 1.0 ars 10 . 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance 3.000 1002. Morlgage Insurance 2.000 1003. School Taxes 3.000 1004. County Taxes 9.000 1005. City Taxes 1006. 1007. 1008. A re ale Ad uslment 1100. TITLE CHARGES 1101. Selllemenlor Closln Fee 1102. Abslractor Tille Search 1103. Tille Cerllncate 1104. Tille Insurance Binder 1105. Deed Pre arallon 1106. Nota Fees 1107. AllorneysFees includes above item numbers' 1108. Tille Insurance to Mid.Penn Abstract Co. includes above item numbersEndorsements 100, 300 & 8.1 1109. Lender's Coverage $ 123,500.00 1110. Owner's Coverage $ 130,000.00 1111. End. 100, 300 & 8.1 10 Mid-Penn Abslract Co. 1112. Closing Proleclion Leller to Fidelity Nalional Title Insurance Company 1113. 1114. 1115. 1116. 1117. Transaction Fee to D'Angelo Really Group, Inc. 1118. Federal Express Charges 10 Adler & Adler 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 28.50; Mortgage $ 50.50; 1202 Cil/Count Tax/Slam s: Deed . Mort a e 1203. Stale Tax/Starn s: Revenue Starn s ; Mort a e 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survey 1302. Pestlns eeUon 1303. 2001-2002 School Taxes 1304. Sewer Sill 1305. 1400. TOTAL SETTLEMENT CHARGES Enter on LInes 103, Sectlon J and 502, Section K By&Ig"lngp.gelot~'.lalllffianl.l~a.lg""lOris.sckn......edgs'ecsiplol.co,''plaledcopyolpage2011h1.lwOf''I.....latamanl. .f 01' $ L SETTLEMENT CHARGES 130,000.00 all 5.0000 % 6,500.00 Province Bank Province Bank Province Bank Province Bank Province Bank months months monlhs months months months months months $ $ $ $ @ $ $ 24.08oer 80.28 er 120.43 er 43.51 er pee " " ., $ 10 10 to Adler & Claraval 10 10 10 10 Mid Penn Abstract Co. Jod Goldrln 10 10 to Robin Gas ere i to Borou h of New Cumberland Certified to be a true copy. 1 days month month month month mo"~ month monlh month Releases $ Mid Penn )lIJsVact Co. Settlement Agent 6.0000%) PAlO FROM eORROWER'S FUNOSAT SETTLEMENT 15.00 75.00 25.00 100.00 250.00 20.58 60.28 72.24 160.56 361.29 391.59 -180.78 Page~ PAID FROM SELLER'S FUNOSAT SETTLEMENT 6,500,00 75.00 16.00 4.00 1008.75 ) 150.00 35.00 150.00 15.50 79.00 1,300.00 1,445.11 5,572.12 (PORTANOVII-MP.2002IPORTANOVA.M?200214 ) 125.00 1,300.00 72.82 6,076,82 SCHEDULE "B" STOCKS AND BONDS File Number 2002- Estate of A. Maxine Shover 00527 ITEM NUMBER DESCRIPTION VALUE AT DEATH 76 shares Waypoint Bank stock $1,436.40 1000 shares Parallel Petroleum $0.00 Corporation cusip 699158 M&T Investments $12,420.15 Massachusetts Invs Trust Class A M&T Investments $6,548.82 MFS Emerging Growth, Class A M&T Investments $12,479.96 MFS Research IntI, Class A 20 shares Metlife stock $507.00 25.35/share TOTAL STOCKS $33,392.33 AND BONDS SCHEDULE "E" CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Estate of A. Maxine Shover File Number 2002-00527 ITEM NUMBER DESCRIPTION VALUE AT DEATH Jewelry $14,825.00 See attached insurance schedule PNC $36,090.58 Money market PSECU, checking account $7,771.72 M&T Bank, CD $10,011.50 031003910927078 Zurich, Scudder, money market $1,802.18 Pacific Life account $250,473.04 1997 Buick Century Limited $7,000.00 See attached appraisal Waypoint Bank, checking $11,939.27 700011978 Refund 2001 PA income tax $100.00 Patriot News refund $138.50 Prescription reimbursement $119.87 Prescription reimbursement $521.57 GE Capital Insurance, refund $1,868.60 premium Paid prescriptions reimbursement $195.04 Refund Verizon $1.59 Refund Comcast Cable $175.43 Refund, Johns Hopkins $23.77 Mutual Benefit Insurance Co $83.00 refund, car insurance TOTAL CASH, $343,140.66 BANK DEPOSITS, MISC. SCHEDULE "G" TRANSFERS Estate of A. Maxine Shover 00527 File Number 2002- ItJJrn Description of Exclusion Value of Value of N1JmfJer Asset Asset Decedent's Interest Transamerica $67,957.44 $67,957.44 Annuity American General $18,723.35 $18,723.35 Annuity Putnam Hartford $24,269.01 $24,269.01 Annuities Acct: 710063719 Allianz Annuity $8,197.30 $8,197.30 Allianz Annuity $13,546.67 $13,546.67 Allianz Annuity $1,456.07 $1,456.07 Al1ianz Annuity $1,937.10 $1.937.10 Allianz Annuity $58,722.39 $58,722.39 Allianz Annuity $36,988.54 $36,988.54 Allianz Annuity $6,518.13 $6,518.13 Total $238,316.00 $238,316.00 Trans fers SCHEDULE "H" FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES Estate of A. Maxine Shover File Number 2002-00527 ITEM NUMBER DESCRIPTION AMOUNT 1. Funeral Expense $3,491.00 Parthermore Funeral Home 2 . Personal Representative Commission 3. Social Security Number 4 . Year Commission Paid 5 . Attorneys' Fees $10,000.00 6. Family Exemption Claimant, Relationship to Deceased 7. Address of Claimant at Decedent's Death 8 . Probate Fees $393.00 9. Advertising estate $309.55 10. Reserve $175.00 Cost of sale of 1711 Bridge St., $8,441. 07 New Cumberland, PA Brent Gross, lawn care, house $40.00 Verizon, phone $83.73 New Cumberland Borough, sewer, $66.69 trash PP&L, house $255.63 PAWC, utilities, house $71.72 Checks for estate checking $77 . 90 account PA American water Co. House $12.12 Verizon, house $25.32 PP&L, house $51.65 Appraisal, house, Central Penn $225.00 Appraisals, Inc Gene Sawyer, clean house $475.00 Tina Hartley, house cleaning $100.00 Ehrlich, pest service $155.88 PP&L, house $91.89 PA American Water, house $12.15 Postage $37.83 $24,592.13 SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS Estate of A. Maxine Shover File Number 2002-00527 ITEM NUMBER DESCRIPTION AMOUNT Bon Ton credit card $38.10 Bankcard Services, credit card $278.95 Johns Hopkins, medical expense $23.77 Total $340.82 SCHEDULE J BENEFICIARIES Estate of A. Maxine Shover 00527 File No. 2002- ITEM NUMBER NAME AND RELATIONSHIP AMOUNT OR ADDRESS OF TO DECEDENT SHARE OF BENEFICIARY ESTATE A. Taxable Eileen M. daughter Diamond Bequests Shulman solitaire ring 245 Forked $5,250.00 and Neck Rd. wedding ring Shamong, NJ 1/6 residue 08088 Kathleen A. daughter diamond ring Lippi solitaire 114 Hummel pendant Ave. $5,000.00 Lemoyne, PA Diamond 17043 earrings $1,000.00 Bedroom suite 1/6 residue Janet D'Angelo daughter in Misc. Jewelry 725 Elkwood law $325.00 Dr. New Cumberland, PA 17070 Deb D'Angelo daughter in Misc. Jewelry 726 Gleenarden law 325.00 Dr. Lewisberry, PA 17339 Gail D'Angelo daughter in Mise Jewelry 501 Wooderest law 325.00 Dr. Meehaniesburg, PA 17050 Julie D'Angelo daughter in Mise Jewelry 324 15th ST. law 325.00 New Cumberland, PA 17070 Michelle Lippi granddaughter Misc Jewelry 114 Hununel $325.00 Ave. Lemoyne, PA 17043 Elysia Shulman granddaughter Misc. Jewelry 245 Forked $325.00 Neck Rd. Shamong, NJ 08088 Marie D' Angelo granddaughter Misc Jewelry 726 Gelenarden $325.00 Dr. Lewisberry, PA 17339 Becky D'Angelo granddaughter Misc. Jewelry 501 Woodcrest $325.00 Dr. , Mechanicsburg, PA 17050 Tori D'Angelo granddaughter Misc. Jewelry 501 Woodcrest $325.00 Dr. , Mechanicsburg, PA 17050 Thomas J. son desk D'Angelo 1/6 residue 324 15th st. New Cumberland, PA 17070 Gilbert stepson 1/4 proceeds Shover, Jr. 1711 Bridge 320 Wayland St., New St. Cumberland San Francisco, $30,422.63 CA 94134 Janice M. stepdaughter 1/4 proceeds Pellam 1711 Bridge 107 Creekview St. , New Dr. Cumberland Carlisle, PA $30,422.63 17013 Ann M. Ewing stepdaughter 1/4 proceeds 84 Hill Dr. 1711 Bridge York Haven, PA St., New 17370 Cumberland $30,422.63 Christopher P. stepson 1/4 proceeds Shover 1711 Bridge 211 Geary Ave St. , New New Cumberland Cumberland, PA $30,422.63 17070 Michael C. son 1/6 residue D'Angelo 725 E1kwood Dr. New Cumberland, PA 17070 James W. son 1/6 residue D'Angelo 726 G1eenarden Dr. Lewisberry, PA 17339 Robert J. son 1/6 residue D'Angelo 501 Woodcrest Dr. Mechanicsburg, PA 17050 ITEM NUMBER NAME AND ADDRESS OF AMOUNT OR SHARE OF BENEFICIARY ESTATE A. Charitable and Governmental Bequests 0:: UJ C 0:: o 0:: - <( a.. UJ 0:: QUAN. PART NO NAME OF PART SALES COST * AMOUNT POOR RICHARD'S AUTOMOTIVE Automotive/Reconditioning Service General Auto Repairs . Tune-Ups . EngIne Work Air Conditioning . Brakes . Oil Changes . Tire Service Wheel Balancing . Towing Available 669 Gaumer Road, New Cumberland, PA 17070 717.n4-7389 . Automotlve/717.774-4750 . Auto Sales (On Gaumer Rdoff 1-83, lllilwisberryRd. Exit 18) Inrearol FalrvlewFire Hatl Station 1 FAX 717-n4-1485 Nome I'l.~ '..fA-r> ho{"" P. SHeve.r V _L .J~.J Address ,;)/1 (::;.",n ~.. .4.._ _ Npw Cu Phone ./;. 71/) ~'i<J3' QJfJ /7070 77'1 Date t..-IO--o:;'" Speedometer Serio I Reading No. MAKE AND MOOH LICENSE NO. AND STATE I MOTOR NO OPERATION INSTRUCTIONS AMOUNT NUMBER lUBRI- 0 CHANGE 0 :RL~~~, 0 FlUSH 0 WASH 0 POLISH D CATE 0", OIFF. ]1- Is fn .,.,.,1, - '^'- -/-J,~+ -1-), P . {In Iv.." ,..,-f! 1/ u ~) Ir. 1997 /)" l'r k-' r> (>. 'tlA '" ,{ L./h-,,cf-pd - { JI'Y ~ Id G-\ ll.J. 'V.,- /.Yl~ V/ <.<:~ '79_~ ,<,.-I I: '" 1(- lL L .1-', ,S'/" ..~t:' u i!1> 7.,-- ~,( ;1") /"'> ~ ~ /., ;/" .. :/I. J~ I ., ~ N' ,h. ~_ DC}. te. ( -/0- .{)"") ,,- ,",;'0 ,.j.... r'P ~ , ~ '" ~ ..... ; ? PYJ H fI, p. /J: 1. ) b- .4-~ 11:, ~.. .~ J1}A~ -" \...,1 " A C~SSORIES AMOUNT F.S. Total labor TOTAL PARTS / Notarial Seal Total Ports Gals. Gas @ "~"~ ~. ~'T~~~e~o~~o,-ary ..~D"C Gas. Oil. Grease FalrvI9W ' r';": I Q's. Oil @ 'VI Loommlssion expires Jan. ,200 Accessories lbs. Grease (jil IMem er, pennsylvania AssocIation Nola es Tires, Tubes TOlal Gas-Oil.Grease T otol Accessories Outside Work I hereby oulnolilc the above repcw work 10 be done along with the necessary materiol, and hereby gronl yov TOTAL ondor your employees permiSSIon 10 operate Ihe cor, 'ruck or vehicle herein described on streets. highways or elsewhere lor lhe purpo~e of testing Qnd,or inspection. An e><press mechonic's lien is hereby ocknowledged ' obove car, truck or vehicl", 10 secure rhe amount ol.repoirs Iherero. TAX Work Authorized bv Date Promised Delivered 10 Dote Delivered TOTAL AMOUNT OPER JEWELRY 001 14K YG DIAMOND ENGAGEMENT RING W/6 PRONG SOLITAIRE 6.80 X 4.30MM SI1 CLARITY WHITE (I) COLOR BRILLIANT CUT & 1.17CT TW 002 DIAMOND STUD SOLITAIRE EARRINGS 14K GOLD 003 30" DIAMOND CUT GOLD ROPE NECKLACE 004 24" DIA/10ND CUT GOLD CHAIN 005 24" WHITE & YELLOW GOLD CHAIN 006 7" WHITE & HELLOW GOLD BRACELET 007 1/2" GOLD BANGLE BRACELET 008 GOLD COIN & CARRIER PENDANT 009 GOLD HOOPEARRING ENHANCER OR JACKET 010 OVAL CIRCLE ENHANCERS 011 14K YG DIAMOND PENDANT 6-PRONG SOLITAIRE 6.18 X 6.22 X 3.97 MM QUALITY OF PRINCIPAL STONE - FAIR CLARITY SI2 BRILLIANT CUT COLOR WHITE (J) .94CT FINISH FAIR STONE - $4700 CHAIN - $300 012 14K GOLD HOOP WOMENS EARRINGS GRADUATING FROM 15MM TO 4MM WITH SNAP POSTS 013 LADIES DIAMOND GOLD FLEXIBLE BANGLE BRACELET . " MBH061 5,250 1,000 800 500 500 200 400 250 150 75 5,000 200 500 10:24 AM AEGON VAR DEPT FAX NO, 3192978297 p, 04 TRANSAMERICA L1FE COMPANIES ANNUrlY AllMINIS'J'I(}\J'!ON AdJ\lllmtr:llIYi: (l((tL\:: 'HJJ PJt:\"\N()od \Z()~d Nf' Ccd.u R;lpkbl low" 52499.0001 M;lil;llg ^ddr('~s: j',(). kox J IlU (\dJr It\pids, hlwJ ~2.406,J t ~J July 9, 2002 Sstate of A Maxine Shove~ 17 U B,r. i.dgo St New CUlnberland PA 170~0 I . RE: Annuity Number(s) 26200112 bear Est~te of A Maxine Shover: Wo hove receiv~d notification, Joint owners nnd annuitants of deferred annuity is deceased. condolonces for your loss. ^ Maxine Shover and Gilbert L Shover, the above listed non-qualified tax Our office wishes to extend sincero Our recor.ds indicate the following imnuity l11formution: Annuitnnts: Primary Deneficiary(ies): A Maxine Shover Gilbert L Shover A Maxine Shov0r Gilbert L Shover Gilbert L Shover Jr Christopher P Shovor Janice M Kapp Ann MEwing Michael C D'Angelo Thomas J D'AngelO James W D'Angelo Robert J D'Angelo Kathleen A Lippi Eileen M Scholman 06-05-1996 $68,472.45 $18,471. 45 $67,957.44 $66,399.21 Owners: A11n\11ty Policy Date: Full Vulue as of 07-09-2002: Tuxable Portion; Full Value as of 05-13-2002: Full Value as of 11/24/2001: The attached document reflects the options available to the p~ima~y boneficiary(ies) listed ubove. The full vglue as of the date of death is for tax pU~poGes only and i~ not a guaranteed death benefit amount. TI".11\~,1I\1l.Tk,\ AS~\lr~\n(~ CnlllpnllY MfililllCS Ti.1I:,.iI11::I:\:1 J ;(..' l'I:'I:r.'\:<"l .~;,,) ,-\:1:"111; C );'T."n; T;.~n,ill1"r';';;,ll',:1:1 :.,d JI,f'~"ll1rc-;'~II!'l 10:25 AM AEGON VAR DEPT FAX NO, 3192978297 p, 05 The ~ttBched document containft general tax information based on 'rr<1nsamcrio<:\ Life InBUronCe and J\nnuity Company's inteiCp,t'ctiltion and shoUld not be relied upon [OiC your personal tax plannlng. If you have qUDstions concerning tho direct tax consequences when selecting an oplion, you l]ilY WIGCl to cOnsult a tax advisor. J\ny additional questions regarding thi3 annuity can be directed to the Annuity Service Center at 800-538-0041. A Transamcrica [,ife Insurance <Jnc\ AnnuL ty Company representative wi 11 gladl y asej,st you wi th any question you may have regarding this annuity Hnd help you meet your finilClciill goal,cJ. Sincerely, " . Glyndll !larman fMG CI;:jims 800-530-0041 [,nclosure (s I: ~nnuity Claimants Statement Postage Paid Return Envelopa Death Option Paoket Hartford Life August I, 2002 William Adler 125 Locust St PO Box 11933 Harrisburg, PA 17108-1933 . REFERENCE: Hartford Annuity Account # 7I 006371 9 Decedent: A Maxine Shover Dear Mr. Adler: Thank you for your correspondence regarding the above annuity contract. The death benefit payable under this contract is not considered "life insurance" reportable on IRS Form 712, (life insurance statement). Please find the below information in response to your request. Contract Number: Owner: Decedent: Owner's SSN: Date of Death: Date of Death Value: 710063719 Maxine and Gilbert Shover Maxine Shover 196-14-3295 May 13, 2002 $24,269.01 . ; If you have any other questions or concerns, please feel free to contact your investment professional, or one of our annuity Specialists by calling I -800-862-6668, Monday through Thursday from 8 a.m. to 7 p.m., Friday from 8 a.m. to 6 p.m., and on Saturday from 9 a.m. to 2 p.m. Eastern time. We will be happy to assist you. Thank you for the opportunity to help provide for your financial needs. Sincerely, Hartford Life lnsurance Companies 200 Hoprncadow Street Simsbllry, cr 06089 Toll Free 1 8008626668 Investment Prodpct Services MaillQg Address: P.O. Box 5085 Hartford, CT 06102-5085 online.hartfordlife.com C. DeLuca Investment Product Services Contract Management Hartford Life Insurance Company 02 03: 15p Robert R. --, Pugliese 717-737-3115 p.4 ~002 MO, 09,15 FAX 76J 562 6501 LTC/CLAIMS Allianz Lite Inmance Company or No~h Amenea PO Box 59000 Minneapolis, MN 5$459-0060 600/950-40J6 AJlianz @) August 8, 2002 ESTATE OF A MAXINE SHOVER C/O BOB PUGLIESE PO BOX 158 CAMP HILL PA 17001 " . Re, A Maxino Shover, deceased Policy Number: 1625704 Dear Bob, This Jeller is in respon~e 10 your request for the dale of death value on May J J, 2002 for the ~bove policy number. The followin~ information is being provided: Life InstaJlmentswith a March 28, 1995 monthl $199.12 A ri128, 1995 March 28, 2005 $6.969.20 ears I Pre,er:1 Vabo, . i $6,518.13 Should you have' any /Unher questiOnS or concerns, pleaSe contact our office at 1-800-950-4036. Thank you, Sincerely, ~~ Michele Hechanov. Claims Examiner ~ ,. '._..__LA... ,,_ ,~.... ~ ... '- .. . 03:15p Robert A. 717-737-3115 p.5 ~004 i ,I ;i Ii 'I I, I :: Pugliese LTC/CLAIMS MON 09:15 FAX 763 582 6501 Man, We Insurance Company of Not1l1 America PO Bo, 59OS0 Minneapolis. MN 55459-0060 800/950-4036 Al1ianz @D August 8, 2002 ESTA IE Of A MAXINE SHOVER c/o BOB PUGLIESE PO BOX 158 CAMP H1LL FA 17001 " . Re: A Maxine Shover, deceased Policy Number. 1088407 Dear Bob; This lener is in response 10 your request for the date of death value on May 13.2002 fOt the ubove policy number. The following infonnalion is being provided; Senlement Option: Life Installmenlswilh a guaranteed pcriod of ten ycars Effecrive Date: March 28 1995 P~vmenl FreQuency: monthly Payment ArnOWlt: $1,129.95 First Pavment D.le: April28 1995 Last Payment Date; March 28, 2005 Remaining Balance: $39,548.25 I Present Value: I $36,988.54 ____. _ _..____.___--.J Should YOll have' any further questions oj ~ohcer/is, 'picase ;;ontacloUIoiilce:-a, ..- 1-800-950-4036. Thank you. Sincerely, '"7ruM14 ~ Michele Hechanova Claims Examiner 0203:16F Robert R. Pugliese 717-737-3115 F.6 ~ 005 MO~ 09;15 FAX 76J 582 6501 LTC/CLAIMS Allianr lIle Insuran,e Company 01 North America PO Box 59060 Mlnne.po!", MN 554S~0060 800f95()-W36 Allianz @) August 8, 2002 EST A TE OF A MAXINE SHOVER C/O BOB PUGLIESE PO BOX 158 CAMP HILL PA 17001 " . Re: A Maxine Shover, deceased Policy Number: 10884>1 Dear Bob: This len., is in '~sponse to your request fo' the date of death value on May 13,2002 for the above policy number. The following information is being provided: ears I Present Value'. I S58,722,39 5h0l1iG YVl.A hav'c uu)' fU(Utt::J y'Ul,;;)~ivJ.u 01 i,,;vnc.tll'd. JjtCast. COI'ltGUI;'~ 0Ur off\\.e at (-800-950-4036 Thi1Jlk you. Sincerely, ~~ Michele Hechanova Claims Examiner AMERICAN I GENERAL FINANCIAL GROUP American General Life Insurance Company July 25, 2002 ADLER & ADLER CIO WILLIAM L ADLER 125 LOCUST STREET POBOX 11933 HARRISBURG PA 17108-1933 Contract Number: VA40001975 Contract Owner: GILBERT L & A MAXINE SHOVER Dear Mr. Adler: Thank you for your recent correspondence regarding the above referenced American General Life Insurance Company annuity contract. The requested information on the above referenced contract follows: Contract Owner(s) Gilbert L. & A. Maxine Shover Number of Contracts 11VA40001975) Ownershio Joint-ownership Issue Date 03/11/98 Cash Value-5/13/02 $18,723.35 Primary Beneficiaries Eileen Shulman, DauQhter, 10% Gilbert Shover, Son, 10% Janice Kapp, DauQhter, 10% Ann Ewinq, Dauqhter, 10% Christopher Shover, Son, 10% Michael D'An~o, Son, 10% . Tom D'Anqelo, Son, 10% T Jim D'Anqelo, Son, 10% Bob D'Anoelo, Son, 10% Kathv Lippi, Dauohter, 10% If you have questions or need additional assistance, please contact the Annuity Administration Department at 800-200-3883. Distributed By American General Distributors, Inc., member NASD and member American General Financial Group. (SM) American General Di,stributQ[s. Inc., is known in Florida and Illinois as American General Financial Distributors of Florida, Inc., and American General Financial Distributors of Illinois. Inc., respectively. American General Life Insurance Company M errb!r A rmiam Geneml F imrxial Groop Administrative Offices. P.O. Box 1401 . Houston, TX 77251-1401. Fax 713.831-3701 Sincerely, jJJ1!J ~ Scott M. Gonzales Analyst cc: OV0543/000V000725 WilLIAM E CONFAIR . ,r r I I j - , . ,......~ ..tl ..lJ....r...".I"'I'...,""1 1 1 C 03: 15p Robert A. p.3 I4J OOJ Pugliese 717-737-3115 MON 09:15 FAX 76J 562 6501 LTC/CLAIMS AJI.anz Life Insur.nce Company 01 Nor1h America PO 80159060 MinneapolIS, MN 55459.0060 800/950:4036 Allianz @ August 8, 2002 ESTATE OF A MAXINE SHOVeR c/o BOB PUGLIESE PO BOX 15H CAMP HILL, P A 1700 I " . Dc3J' Bob: This letlcr is in reference to YOLlr request for a dale ofdealh value 00 lhe above policies, Please be advised the cash value and annuirizarion valuc on policy #1107934 as of May 13,2002 was S8,197.30 nod $13,546.67, respectively, Please be advised the cash value and annuirization v~l\le on policy #4495987 May 13,2002 was $1,456.07 and $1,937.10, respectively, If you should have any questions. please do nOt hesitate to contact our office at 1-800-950.4036, Thank you. Sir!.cerely, /!Zt~~V Michele Hcchanova Claim Examiner " . . ,,(tt~t{M:,~ . ~~"~ "-I< ,,~. J~1.1 , \ :. ' ;,..'j'fl . '~~r , "., '.' . A' -:l? ,~'.~ ,tttt11:'t \/Q/-'''~~ :/"'':)_'!l"t .~, 'T,.-i"" ". f~ '~~..~: ;1,;. +... ~.-).,~ .t..~ Register of wills of CUMBERLAND County, pennsylvania Certificate of Grant of Letters ...... r . ~ 'I..) ~ "- , . ~'. "\ " ' . " . ~ ~.t- 11''" , , No. 2002-00527 PA No. 21-02-0527 ESTATE OF SHOVER A MAXINE (LA~l, tlK~l, M1UUL~) ,...,.,." Late of NEW CUMBERLAND BOROUGH LUM~~KLAl~U CUUNIX, Deceased WHEREAS, on the 31st dated January 16th 2002 was admitted to probate as the last will of SHOVER A MAXINE (LA~l, tlK~l, M1UUL~) Social Security No. 196-14-3295 day of May 2002 an instrument late of NEW CUMBERLAND BOROUGH CUMBERLAND County, who died on the 13th day of May 2002 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, MARY C. LEWIS , Register of wills in and for the County of CUMBERLAND in the Commonwealth of pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to D'ANGELO ROBERT J and SHOVER CHRISTOPHER PAUL who have duly qualified as Executor (rix) and have agreed to administer the estate according to law, all of which fully appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, of my Office the 31st day I have hereunto set my hand and affixed the seal of May 2002. '-11')/J1ft? ~~ .N~ - ~ a..~ .o.tl"/~' e'glS er 0 l * *NOTE* * ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE) f I -?\wills\SHOVERmaxine\1-02 . . - , 21-02-0527 LAST WILL AND TESTAMENT OF A. MAXINE SHOVER I, A. MAXINE SHOVER, of the Borough of New Cumberland, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I hereby make the following specific bequests of my personal property: ~ A. My diamond solitaire ring and wedding ring to my daugh- ter, EILEEN M. SHULMAN, if she survives me. B. My square diamond ring and solitaire pendant to my daughter, KATHLEEN A. LIPPI, if she survives me. C. My diamond earrings to my daughter, KATHLEEN A. LIPPI, if she survives me. D. My gold jewelry, five bracelets, two diamond-cut chains and coin pendant, cameo pendant and earrings to the following who survive me, EILEEN M. SHULMAN, KATHLEEN A. LIPPI, JANET D'ANGELO, DE~ D'ANGELO, GAIL D'ANGELO, JULIE D'ANGELO, and my granddaughters, MICHELLE LIPPI, ELYSIA SHULMAN, MARIE D'ANGELO, BECKY D'ANGELO, and TORI D'ANGELO, to be divided among them as they shall agree. My preference is that distribution of this property be done amicably, keeping in mind what each is fortunate enough to already own. If my Page 1 of 5 -(. ~~. . /. / younger granddaughters are younger than eighteen at the time of my death, then their parents shall make decisions on their behalf regarding items to be given to them. E. My secretary desk to my son, THOMAS J. D'ANGELO, and his wife, JULIE D'ANGELO, or the survivor of them. F. My bedroom suite to my daughter, KATHLEEN A. LIPPI, if she survives me. ITEM II: I direct that my real estate situate at 1711 Bridge Street! New Cumberland, Cumberland County, Pennsylvania, be sold with the net proceeds therefrom to be distributed in equal shares to the children of my late husband, GILBERT L. SHOVER, who are GILBERT L. SHOVER, JR., JANICE MARIE PELLAM, ANN MARIE EWING, and CHRISTOPHER PAUL SHOVER, or their issue, per stirpes. ITEM III: I devise and bequeath all the rest, residue and remainder of my estate, of every nature and wherever situate in equal shares to my children, MICHAEL C. D'ANGELO, THOMAS J. D'ANGELO, EILEEN M. SHULMAN, JAMES W. D'ANGELO, KATHLEEN A. LIPPI, and ROBERT J. t D'ANGELO, or their issue, per stirpes. ITEM IV: I appoint my Co-Executors and their successors guardian of any property which passes, either under this will or otherwise,_to a minor and with respect to which I am authorized to appoint a guard- ian and have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fidu- Page 2 of 5 - /[ , ciary in its discretion to distribute a share where possible to the minor or to another for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to time for the minor's support and education (including college education, both graduate and undergraduate) without regard to his or her parent's ability to provide for such support and education, or to make payment for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor. . ITEM V: I appoint ROBERT J. D'ANGELO and CHRISTOPHER PAUL SHOVER, Co-Executors of this my last will. Should ROBERT J. D'ANGELO predecease me or be unable to serve as Co-Executor for whatever reason, I appoint JAMES W. D'ANGELO as successor Co-Executor of this my last will. Should CHRISTOPHER PAUL SHOVER predecease me or be unable to serve as Co-Executor for whatever reason, I appoint JANICE MARIE PELLAM as successor Co-Executor of this my last will. ITEM VI: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his/her dutiest in any jurisdiction. hand and seal this /6 , IN WITNESS WHEREOF, I, A. MAXINE SHOVER, have hereunto set my day of >>-IY j/,,{rv ,2002. ~ !!1:~E'{SH":4 Page 3 of 5 .'~// 711. - /~ " SIGNED, SEALED, PUBLISHED and DECLARED by A, MAXINE SHOVER, the Testatrix above named, as and for her Last Will and Testament, and in the presence of us, who at her request, in her presence and in the ~;;2::;;;~ve WitnessU ~/~~~ ,~~A Wltness f' COMMONWEALTH OF PENNSYLVANIA: subscribed our names as witnesses, ~'I44/ J):' ~<&.- ~;f;-0 K J Address (10~I-~/?J~~,A Address SS: COUNT! OF CUMBERLAND I, A. MAXINE SHOVER, the Testatrix 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 this instru- ment as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. ., 'i;;/' i.... ~ . ./ /1/Q", ,,,/, '~ I A. MAXINE SHOVER \ Sworn to or affirmed to and acknowledged before SHOVER, the Testatrix, this \~~ me by A. MAXINE NOTARIAL "EN. CAROL l. TROXEll, Notary Public New Cumberland Boro. Cumberland Co. My Commission Expirss Dec. 27, 2005 day of .:1\\ \ ~.\\t'\ C~,,,\'--\ '-\~h Notary Public , 2002. Page 4 of 5 / , COMMONWEALTH OF PENNSYLVANIA : SS: COO", ~A"O , We, /d~- /7 and /t1;;//L~/s;ld<- the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and that she executed it ay 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; that to the best of our knowledge, the Testator was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. <~/aZ~ /~~~~ ~~ Witness t/ Sworn to or affirmed to and acknowle~ged before me by {/tZ!/~ 7 Jledulf/<"r \. and ~~ ~~~ wi tnesses, this \\~\-.-. day of '\~ ' ",I>\- . , , 2002. ~ \~ ,~\ ~., " , NOTARIAL SEAL CAROL L. TROXELL, Notary PUb!!? New Cumberland BolO. Cumberla1!IJ Ce,. . My Commission Explrea D80. 27, 200.1 . Notary 5--- Page 5 of 5 STATUS REPORT UNDER RULE 6.12 Name of Decedent: 4 ,AJla.~,~ 4~o~--d~ Date of Death: Will No.: Z-o O 'Z- - O O5 ~7 Pursuant to Rule 6. t2 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 [-"t Admin. No.: U / --O Z - ~-~ Z.-7 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: Did the personal representative file a final account with the Court? Yes No [] b. The separate Orphans' Court No. (if any) for the personal representative's account is: ~ c. Did the personal representative state an account informally to the parties in interest? Yes ~ No [-'1 Co Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court Signature Name Ad.ess Telephone No. and may be attached to this report. Capacity: Personal Representative [~Counsel for personal representative FAMILY SETTLEMENT AGREEMENT FILING OF ACCOUNT l- - AGREEMENT executed this ~ day of /~,~-- 2004, by and between Robert J. D'Angelo and Christopher P. Shover, Executors of the Will of A. Maxine Shover, Deceased, and Eileen Shulman, Kathleen Lippi, Thomas D'Angelo, Gilbert Shover, Jr., Janice Pellam, Ann Ewing, Christopher Shover, Michael D'Angelo, James D'Angelo, and Robert D'Angelo, individually. WITNESSETH: WHEREAS, A. Maxine Shover died on May 13, 2002, having first made and published her Last Will and Testament dated January 16, 2002, in which she named Robert J. D'Angelo and Christopher P. Shover as Executors. A true and correct copy of said Will is attached hereto, made part hereof and marked Exhibit "A" · and WHEREAS, on May 31, 2002 said Will was duly probated by the Register of Wills of Cumberland County, Pennsylvania, and Letters Testamentary granted thereon to Robert J. D'Angelo and Christopher P. Shover, as Executors; and WHEREAS, the Executors have proceeded with the administration of said estate and have prepared their First and Final Account copy thereof is attached hereto, Exhibit "B"; and and Schedule of Distribution. A true and correct -1- made part hereo~ ~nd ~rke~ WHEREAS, the parties hereto desire that the Executors shall not be required to file said Account with the Orphan's Court of Cumberland County, and that the net estate of the decedent shall be distributed without the necessity of filing a formal account. NOW, THEREFORE, the parties hereto intending to be legally bound hereby, mutually agree as follows: 1. The parties hereto, and each of them, agree and acknowledge that they have fully and carefully examined the First and Final Account of Robert J. D'Angelo and Christopher P. Shover, Executors of the Will of A. Maxine Shover, Deceased, and Schedule of Distribution relating thereto, and find them to be true and correct, and acceptable to the parties hereto and each of them, and further that each of them has received a copy of this Agreement and of the said Account and Schedule of Distribution. 2. The parties hereto do hereby release, remise and forever discharge the Estate of A. Maxine Shover and Robert J. D'Angelo and Christopher P. Shover, Executors of and from all manner of acts, suits, claims, accounts, accountings, debts, dues and demands whatsoever which they or any of them of their legal representatives or assigns may at any time hereafter have, against the Executors, the said Estate or the assets thereof, -2- from, for, touching or concerning any of the assets and property of the said Estate and/or any claim or interest thereto or therein, and the administration, management, collection, sale or any money, interest, income, assets or proceeds out of the same, from the time of the death of the said decedent to and including the date of this Agreement and Release. 3. This instrument is a full and final Family Settlement Agreement by and among the parties hereto, both fiduciary and individual, all of the same having been arrived at, concluded and executed after a full and complete disclosure of the assets of the said estate and the rights of the parties therein and thereto and all of the parties hereto, and each of abide by the terms hereof. them agrees to 4. they will at all The parties hereto, and each of them, agree that times in the future and whenever necessary, appropriate or convenient, make, execute and deliver to the said Executors, and/or to the other party or persons, any and all instruments, documents, conveyances, deeds, releases or other instruments of any kind necessary or convenient to carry out the intention of this Agreement and/or to permit, assist and enable the Executors to fulfill their duties with reference to the said estate and all of the assets thereof. 5. This Agreement constitutes the entire understanding among the parties hereto, and each of them -3- acknowledges that no representations or statement of any kind, written or oral, have been made to them or any of them prior hereto by the Executors or by any other person or party upon their behalf. 6. This Agreement shall enure to the benefit of and shall be binding upon, the parties hereto, and each of them, their heirs, executors, administrators, successors and assigns. 7. Under the Will, the house proceeds were to be split four ways. This would have given Gilbert, Janice, Ann and Chris $30,422.64 each versus the $28,750.00 that was distributed. 8. Chris received the car in kind over and above the distribution required under the Will. 9. The remainder under the Will was to be distributed to Michael, Thomas, Eileen, James, Kathleen and Robert. This proposed distribution divides the remainder among all ten siblings and stepsiblings which is not in accordance with the Will. 10. This settlement agreement reflects all parties' agreement with the distribution as proposed, although it is not in strict compliance with the terms of the Will. 11. Exhibit "C" reflects all distributions made to the beneficiaries. Some accounts had beneficiary designations, so that those proceeds were not distributed through the estate, yet they are reflected here to reflect everything passing to beneficiaries as a result of the death of A. Maxine Shover. -4- set their written. IN WITNESS WHEREOF, the parties hereto have hereunto respective hands and seals the day and year first above Robert D'Angelo, Individually and as Executor Christopher Shover, Individually and as Executor Eileen Shulman Kathleen Lippi Thomas D'Angelo Gilbert Shover, Jr. Janice Pellam Ann Ewing James D'Angelo Michae~gelo -5- IN WITNESS WHEREOF, the parties hereto have hereunto set their respective hands and seals the day and year first above written. Robert D'Angelo, Individually and as Executor Christopher Shover, Individually and as Executor Eileen Shulman Kathleen Lippi Thomas D'Angelo Gilbert Shover, Jr. Janice Pellam Ann Ewi-ng ~ James D'Angelo Michael D'Angelo -5- set their written. IN WITNESS WHEREOF, the parties hereto have hereunto respective hands and seals the day and year first above Robert D'Angelo, Individually and as Executor Christopher Shover, Individually and as Executor Eileen Shulman Kathleen Lippi Thomas D'Angelo Gilbert Shover, Jr. 6/ Janic~ Pellam Ann Ewing James D'Angelo Michael D'Angelo IN WITNESS WHEREOF, the parties hereto have hereunto set their respective hands and seals the day and year first above written. Robert D'Angelo, Individually and as Executor Christopher Shover, Individually and as Executor Eileen Shulman Kathleen Lippi Thom~ s, D' Angel~o. ~ Gilbert Shover, Jr. Janice Pellam Ann Ewing James D'Angelo Michael D'Angelo -5- IN WITNESS WHEREOF, the parties hereto have hereunto set their respective hands and seals the day and year first above written. Robert D'Angelo, Individually and as Executor Christopher Shover, Individually and as Executor ~ een Shu±man Kathleen Lippi Thomas D'Angelo Gilbert Shover, Jr. Janice Pellam Ann Ewing James D'Angelo Michael D'Angelo -5- set their written. IN WITNESS WHEREOF, the parties hereto have hereunto respective hands and seals the day and year first above Robert D'Angelo, Individually and as Executor Christ~he~ ~hover, Individually and as Executor Eileen Shulman Kathleen Lippi Thomas D'Angelo Gilbert Shover, Jr. Janice Pellam Ann Ewing James D'Angelo Michael D'Angelo -5- IN WITNESS WHEREOF, the parties hereto have hereunto set their written. respective hands and seals the day and year first above Christopher Shover, Individually and as Executor Eileen Shulman Kathleen Lippi Thomas D'Angelo Gilbert Shover, Jr. Janice Pellam Ann Ewing James D'Angelo Michael D'Angelo -5- set their written. IN WITNESS WHEREOF, the parties hereto have hereunto respective hands and seals the day and year first above Robert D'Angelo, Individually and as Executor Christopher Shover, Individually and as Executor Eileen Shulman Kathleen Lippi Thomas D'Angelo Gilbert Shover, Jr. Janice Pellam Ann Ewing James D' Ang~'i0' ...... ---------___b Michael D'Angelo -5- IN WITNESS WHEREOF, the parties hereto have hereunto set their respective hands and seals the day and year first above written. Robert D'Angelo, Individually and as Executor Christopher Shover, Individually and as Executor Eileen Shulman Thomas D'Angelo Gilbert Shover, Jr. Janice Pellam Ann Ewing James D'Angelo Michael D'Angelo -5- set their written. IN WITNESS WHEREOF, the parties hereto have hereunto respective hands and seals the day and year first above Robert D'Angelo, Individually and as Executor Christopher Shover, Individually and as Executor Eileen Shulman Gilbert Shover, Jr. Janice Pellam Ann Ewing James D'Angelo Michael D'Angelo -5- LAST WILL AND TESTAMENT OF A. MAXINE SHOVER I, A. MAXINE SHOVER, of the Borough of New Cumberland, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I hereby make the following specific bequests of my personal property: A. My diamond solitaire ring and wedding ring to my daugh- ter, EILEEN M. SHULMAN, if she survives me. ~B. My square diamond ring and solitaire pendant to my daughter, KATHLEEN A. LIPPI, if she survives me. C. My diamond earrings to my daughter, KATHLEEN A. LIPPI, i~ she survives me. D. My gold jewelry, five bracelets, two diamond-cut chains and coin pendant, cameo pendant and earrings to the following who survive me, EILEEN M. SHULMAN, KATHLEEN A. LIPPI, JANET D'ANGELO, DE~ D'ANGELO, GAIL D'ANGELO, JULIE D'ANGELO, and my granddaughters, MICHELLE LIPPI, ELYSIA SHULMAN, MARIE D'ANGELO, BECKY D'ANGELO, and TORI D'ANGELO, them as they shall agree. My preference is this property be done amicably, If my to be divided among that distribution of keeping in mind what each is fortunate enough to already own. Page 1 of 5 younger granddaughters are younger than eighteen at the time of my death, then their parents shall make decisions on their behalf regarding items to be given to them. E. My secretary desk to my son, THOMAS J. D'ANGELO, and his wife, JULIE D'ANGEL©, or the survivor of them. F. My bedroom suite to my daughter, KATHLEEN A. LIPPI, if she survives me. ITEM II: I direct that my real estate situate at 1711 Bridge Street? New Cumberland, Cumberland County, Pennsylvania, be sold with the net proceeds therefrom to be distributed in equal shares to the children of my late husband, GILBERT L. SHOVER, who are GILBERT L. SHOVER, JR., JANICE MARIE PELLAM, ANN MARIE EWING, and CHRISTOPHER PAUL SHOVER, or their issue, per stirpes. ITEM III: I devise and bequeath all the rest, residue and remainder of my estate, of every nature and wherever situate in equal shares to my children, MICHAEL C. D'ANGELO, THOMAS J. D'ANGELO, EILEEN M. SHULMAN, JAMES W. D'ANGELO, KATHLEEN A. LIPPI, and ROBERT J. D'ANGELO, or their issue, per stirpes. ITEM IV: I appoint my Co-Executors and their successors guardian of any property which passes, either under this will or otherwise,_to a minor and with respect to which I am authorized to appoint a guard- ian and have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fidu- Page 2 of 5 ciary in its minor or to another for the minor's benefit. the power to use principal as well as income discretion to distribute a share where possible to the Such guardian shall have from time to time for the minor's support and education graduate and undergraduate) without ability to provide for such support for these purposes, without further (including college education, regard to his and education, responsibility, both or her parent's or to make payment to the minor or to the minor's parent or to any person taking care of the minor. ITEM V: I appoint ROBERT J. D'ANGELO and CHRISTOPHER PAUL SHOVER, Co-Executors of this my last will. Should ROBERT J. D'ANGELO predecease ~me or be unable to serve as Co-Executor for whatever reason, I appoint JAMES W. D'ANGELO as successor Co-Executor of this my last will. Should CHRISTOPHER PAUL SHOVER predecease me or be unable to serve MARIE PELLAM as bond as Co-Executor for whatever reason, I appoint JANICE successor Co-Executor of this my last will. ITEM VI: No fiduciary acting hereunder shall be required to post or enter security for the faithful performance of his/her duties~ in any jurisdiction. IN WITNESS WHEREOF, hand and seal this /~ A. MAXINE SHOVER, have hereunto set my Page 3 of 5 SIGNED, SEALED, PUBLISHED and DECI~%P. ED by A. MAXINE SHOVER, the Testatrix above named, as and for her Last Will and Testament, and in the presence of us, who at her request, in her presence and in the pres~e~ of each_ other, have subscribed our names as witnesses. Witness Address Witness COMMONWEALTH COUNTY OF PENNSYLVANIA: OF CUMBERLAND : Address SS: I, A. MAXINE SHOVER, the Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law do hereby acknowledge ment as my last will; that I as my free and voluntary act that I signed and executed this instru- signed it willingly and that I signed it for the purposes therein contained. A. MAXINE SHOVER Sworn to or affirmed to and acknowledged before me by A. MAXINE SHOVER, the Testatrix, this day of_~[\¥<~k%~ , 2002. Notary Public \ NOTARIAL CAROL L. TROXELL N0mu New Cumberland Boro, Cumberlal~d C?.. My Comml&sion Expirss Dec. 27, 2005 Page 4 of 5 COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF CUMB~LAND : the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and that she executed it a~ 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; that to the best of our knowledge, the Testator was at that time eighteen or more years of age, of sound mind and under nc constraint or undue influence. Sworn to or affirmed to and witnesses, '{his~~ day of NOTARIAL SEAL AROL t 'I'ROXELL, flo[ary Cumberland Bom. Comml~ion E~pire~ /Witness Witness acknowledged before me by andy /j , Notary Public Page 5 of 5 ~00000000 ~1~°°°~~ 00000000000 0 0 0 0 0 0 0 0 0 0 0 mmmmmmmmmmm Z ..q© ~,~~oooo_.~~ oooooooooooooooo ~!~ oooo0 ~ooooooooooooo 0 Z 000~000 0 0 DISTRIBUTIONS TO DATE FROM ALL ACCOUNTS OF MAXINE SHOVER Eileen Kathleen Thomas Gilber~ Janice Ann Ewing Chris Michael James Robert Shulman Lippi D"Angelo Shover, Jr. Pellam Shover D'Angelo D'Angelo D'Angelo 1711 Bridge $28,750.00 $28,750.00 $28,750.00 $28,750.00 St. (Dis~ibution fi.om Estate) M&T Investments (went into account) ?acific Life $42,173.13 $42,173.13 $42,173.13 $42,173.13 $42,173.13 $42,173.13 Transamefic $6,951.70 $6,951.70 $6,951.70 $6,951.70 $6,951.70 $6,951.70 $6,951.70 $6,951.70 $6,951.70 $6,951.70 Annuity American $1,855.97 $1,855.97 $1.855.97 $1,855.97 $1,855.97 $1,855.97 $1,855.97 $1,855.97 $1,855.97 $1,855.97 General Annuity Annuity (went into account) Allianz $9,604.50 $9,604.50 $9,604.50 $9,604.50 Annuity 407 Allianz $6,770.00 $6,770.00 $6,770.00 $6,770.00 Annuity 704 AIlianz $15,312.25 $15,312.25 $15,312.25 $15,312.25 Annuity 431 Allianz $2,283.66 $2,283.66 $2,283.66 $2,283.66 $2,283.66 $2,283.66 Annuity 934 Gil~ $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 $60.00 (Dislfibution from Estate) TOTALS $53,324.46 $53,324.46 $53,324.46 $69,304.42 $69,304.42 $69,304.42 $69,304.42 $53,324.46 $53,324.46 $53,324.46 Proposed $8,200.00 $8.200.00 $8,200.00 $8,200.00 $8,200.00 $8,200.00 $8,200.00 $8,200.00 $8,200.00 $8,200,00 Distributions fmm Remainder in Estate Account IN KIND Eileen Kathleen Thomas Gilbert Janice Ann Ewing Chris Michael James Robert DISTRIBUT Shulman Lippi D"Angelo Shover, Jr. Pellam Shover D'Angelo D'Angelo D'Angelo IONS Buick $7,000.00 Ring $5,250.00 Pendant $5,000.00 Earrings $1,000.00 Bedroom $100.00 Suit Desk $300.00 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE REV-7762 EXI11-96) BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA t]125~060t RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 002385 ADLER &ADLER 125 LOCUST STREET PO BOX 11933 HARRISBURG, PA 17108 ACN ASSESSMENT AMOUNT CONTROL _-_-__ ,o„ NUMBER ESTATE INFORMATION: FILE NUMBER: DECEDENT NAME: DATE OF PAYMENT: POSTMARK DATE: COUNTY: DATE OF DEATH: SSN: 196-14-3295 2102-0527 SHOVER A MAXINE 04/03/2003 04/02/2003 CUMBERLAND 05/13/2002 TOTAL AMOUNT PAID: REMARKS: CHRISTOPHER P SHOVER C/O ADLER &ADLER CHECK#1040 INITIALS: DO SEAL RECEIVED BY: 5817.27 DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS \,>~6~9 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 1]12 B-0601 WILLIAM L ADLER ESq ADLER 8 ADLER PO BO COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX PEV -I54> IX ,Fp (pl -O Al Rcccrc=~r ; _ '03 MAY 16 A1O =46 X 11933 DATE 05-12-2003 ESTATE OF SHOVER A M DATE OF DEATH 05-13-2002 FILE NUMBER 21 02-0527 COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE B- RETAIN LOWER PORTION FOR YOUR RECORDS --'-------'-------------'- ---- ------- ~ ------------ REV-1547 EX AFP CO1-031 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR --------------------- D ISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SHOVER A M FI LE NO. 21 02-0527 ACN 101 DATE 05-12-2003 TAX RETURN WqS: C X) ACCEPTED AS FILED C ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) I1) 130.000.00 2. Stocks and Bonds (Schedule B) NOTE: To insure Proper C2) 33.392.33 3. Clpsely Held Stpck/Pa rt nersh3p Interest (Sched l credit to your account, u e C) (3) .00 4. Mortgages/Notes Receivable (Schedule D) submit the upper porYlon (4) .00 5. Cash/Bank Deposits/Misc. Personal Property (Sched l of this form with your u e E) (5) 343.140 66 6. Jointly Owned Property (Schetlule F7 tax payment. c6)~~p0 7. Transfers (Schetlule G) (7) 238.316.00 e. Total Assets ce) 744,848.99 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expanses/Atlm. Costs/Misc. Expenses (Schedule H) (g) 24,592.13 10. Debts/Mortgage Liabilities/Liens (Schetlule I) cl o) 340.82 11. Total Detluctions 12. Net Value of Taz Return I11) 74.917 gr, 13. Cheri table/Governmental Bequests; Nan-elect d 9 719.916. e 113 Trusts (Schedule J) (13) 14. Net Value of Estate Subject t 00 o Tax (14) 719,916.04 NOTE: If an assessment was issued previously, lines 14 15 , and/or 16, 17 reflect fi8ures that include the total of ALL , 18 and 19 will returns assessed to ASSESSMENT OF TAX: date. 15. Amount of Line 14 at Sppusal rate (15) .00 00 X 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 719,916 04 045 _ .00 . X 17. Amount of Line 14 at Sibling rate _ 32,396.22 (177 .00 X 12 18. Amount of Line 14 taxable at Collateral/Class B _ .00 rake (18) .00 X 15 19. Principal Tax Due _ .00 - TAX CREDITS: (19) = 32,396.22 PAYMENT RECEIPT DISCOUNT (+) DATE 08-12-2002 NUMBER INTEREST/PEN PAID (-) AMGUNT PAID 04-02-2003 CD001514 CD002385 1,578.95 30,000.00 .00 817.27 BALANCE OF UNPAID INTEREST/PENALTY AS OF 04-03-2003 TOTAL TAX CR EDIT 32,396.22 BALANCE OF TAX DUE .00 INTEREST AND PEN. 5.37 TOTAL DUE 5 37 * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN 81, NO PgYMENT FOR CALCULATION OF ADDITIONAL INTEREST. IF IS REpUIRED. TOTAL DUE IS REFLECTED AS A ''CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES REV-1162 EX111-96) DEPT. y80601 HARRIS6URG, PA 1 J128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 002667 ADLER WILLIAM L ESQUIRE PO BOX 11933 HARRISBURG, PA 17108 ACN ASSESSMENT AMOUNT CONTROL ------ ,old NUMBER ESTATE INFORMATION: FILE NUMBER: DECEDENT NAME: DATE OF PAYMENT: POSTMARK DATE: COUNTY: DATE OF DEATH: SSN: 196-14-3295 2102-0527 SHOVER A MAXINE 06/11/2003 06/ 10/2003 CUMBERLAND 05/13/2002 TOTAL AMOUNT PAID: REMARKS: WILLIAM L ADLER ESQUIRE ADLER &ADLER CHECK#1047 INITIALS: JA SEAL RECEIVED BY: 55.37 DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE Tp% DIVISION DEPT. 280601 HpRRISBHRG, Pp 1]128-0601 WILLIAM L ADLER ESQ ADLER 8 ADLER (.?. f , COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT PO BOX 11933 1, HBG PA ~~~Pl~d&` DATE ESTATE OF DATE OF DEA FILE NUMBER COUNTY ACN REY-liw EX RFP tXl-n) 06-30-2003 SHOVER p M ~H 05-13-2002 21 02-0527 CUMBERLAND 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this fore with your tax payment. CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) ^i* INHERITANCE TAX STATEMENT OF ACCOUNT *** ESTATE OF SHOVER A M FILE NO. 21 02-0527 ACN 101 THIS STATEMENT IS PROVIDED TD ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATETESHONN BEL N003 IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: OS-12-2003 PRINCIPAL TAX DUE:.......... PAYMENTS (TAX CREDITS): DATE ~" NUMBER u15000NT (+) INTEREST/PEN PAID (-) AMOUNT PAID 08-12-2002 CD001514 1 578 95 04-02-2003 CD002385 , . 30,000.00 06-10-2003 CD002667 .00 817.27 5.37- 5.37 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. w IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN 51, NO PAYMENT IS REQUIRED. IF TOTAL OUE IS REFLECTED AS A ••CREDIT^ (CR), YDU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 32,396.22 32,396.22 .00 .00 .00 x 1 O 1 1 F 1 W x Q a a w F N w ~ O v W 2 M N f~ O ~ ~ 0 O N Z H M 0 0 l[1 Q H G K .-i N N O J E n Z N O o K R' a J O 1~ N W M N W ° Q J U '+ N .w > .-i o m ~, M W ti O O ~ x .a c J 3 0 ~ If1 2 1I1 .+ ~ O e m U Q O W o N o N U .+ < ~ Q OLL Ca a l7 ~ Y W 2 Q maw ~. z Q J LL Q y a W J J C YW XJ ° W W !L N W My+ ~~ LL O m L! N m J i YZ rrnti O W O x 1' YI d' U U d .~. w '. i'F-' H F ~ Z ~~ ]C LL rc v m fr; Q N Q H O U -, Q Z i c° ~aa .. ow oc v Q x O~ _ _ o z J Q 4' I J x O Q N -+ a l Q F 2 1 WOC Mr ~ OL1 3Q zr' _l7 WI o W o z~ _` ~~ o f x0 z~w-' N ,... Ji O Q° N ZI tt LL 1 ~ R ° QI a H~ w o ~~ .a ~ r j .-I / 1 N d ~ Q Q ! W a ~ K w W x J ~ < O W M W ~ Q J M rZr o v J Q .-i "'1 .d q y T x OE H ~ ~ N Q X = u O F4 K O ~ ~ J W m ~ ~ Q 6 J J (.~ it F a w O O m Z ° ie°a~ 3 Q d 2 O J Q la-Ny Q ~WF1' F 2_ 2 aK C1 O2 () STATUS REPORT UNDER RULE 6 1 ~ Name of Decedent ~-~ /l/~G k Date of Death: J // 3/O z WillNo.: Zou Z - po~7 Admin.No.: Z~-oZ-G'FZ ~ Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes ~( No ^ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes _ No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal re resentative state an account informally to the parties in interest? Yes ~ No ^ c Date: ~,~r N N u-i N c .:~ Copies of receipts, releases, joinders and approval of formal or informal accounts maybe filed with the Clerk of the Orphans' Court and maybe attached to this report. Signature / J~/- l~, ~, ~ L . ~~/~ Name i z 5 C~ ~~:~~ S7~ Address 7/7_z ~ `r-~~~y Telephone No Capacity: ^ Personzl Represen±ative ©"Counsel for personal representaiive