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HomeMy WebLinkAbout03-0740 PETITION FOR ROBATE and GRANT OF LETTERS also known as To: Register of WiLts for the , Deceased. County of t/!/,mk-~r'],cr~,,] in the Social Security No. / ~ ~ -/~-~J- - ,5~ q Commonwealt-~ ~'l~e--n-ns~lv'ani~ The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut O ~- named in the last will of the above decedent, dated and codicil(s) dated (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in 0--axo~o( Itt. ~,,~ ~County, Pennsylvania_, with h i ~ last family o~ principal residence at ' ' ~ -~ ~ ' (list street, number and muncipality) Decqn~en~, then ~ . ,years of age,~ed ExcePt a~oll$~s, aeceaen~ did ngt marry, was n~t divorced and did not flare a child born or adopted after execution of th~will offered for probate; was not the victim of a killing and was never adjudicated incompetent: ~v 0 Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylva_.ni~ situated as follows: WHEREFORE, petitioner(s) respectfully .reJ;tue_~) the prpbate of the last will and codicil(s) presented herewith and the grant of letters ,'7"~--~7~.~e n'~-c~ c,~ (testamentary; admi~ration c.t.a.; administration d.b.n.c.t.a.) theron. OATH OF PERSONAL REPRESENTATIVE COMMONWEA, L~TH OF PE~NSYI[¥ANIA COUNTY OF {_.fo_./s~. lo~ ( la. ~._/~ The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s)will well a,n~.truly administer the est~:l~ according to law. _ Sworn to or affirmed and subscribed__ before me this ~ ~ day of - k~ ~ .0oo.~'~ Register No. Estate Of DONAI D A YOHN ~ , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW %FPTFMRFR q; ?t3t3R 19 , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated 5-22-2000 described therein be admitted to probate and filed of record as the last will of DONALD A YOHN SR ; and Letters TESTAMENTARY are hereby granted to DONALD A YOHN JR FEES Probate, Letters, Etc .......... $ ~35, Oo Short Certificates(tO) .......... $. 30 · co ~,~,,,~a~a~ ~m~.. ~. .... $. !__~ .an:> TOTAL __ $~.oo Filed ....9.~ 9.-0.3 ........................ mailed to exec on 9-9-03 Register of Wills 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 Ofrice for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 9 5 0 6 9 5 2 AUG :8 0 2.003 No. ~ Date .~ t4~ Rev. 2/87 COMMONWEALTH OF PENNSYLVANIA o DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH STATE FILE NUMBER NAME OF DECEDENT (First. Middle. Last) SEX SOCIAL SECURITY NUMBER I DATF~F DEATH (Month. Day. Year) t. Donald A. Yohn Sr. ~lale 12.88 - 12 - 5467 [,.(i'tt0t,.51 Zoc, ~005' AGE (Last Bi~hday) ~NDER 1 Y~AR UNDER 1 DAY DATE OF BIRTHm BIRTHP~CE (City a~ PLACE OF DEATH (Check only one - see instructions on other s~e) - ~ M~s Days Houm Minutes (~n~. Day. Year) Slate ~ F~eign Count~) HOSPIT~: OTHER: 86 vr,.I I I I I ~/~/1017 mMillerstown, ....... ~ ~.~,,.-D ,o,D ..... -m .... n ~, ~ 5. ~0111 ~ 7. Pa h. Home ~ · ~ (Spe~} ~ . COUN~ OF DEATH I CI~. BORO.~F D~TH ~ FACILI~ NAME (If not institution, give sE~l and numar) IWAS DECEDENT OF HISP~IC ORIGIN? I~CE - A~n Indian. Black. While. eh I I , , ~ .. ' INo~ Yes~lfyes ,p~,~Cuba, l( ~ i~) ,..Cumberland l, Pennsboro I'th 3e, ,r ........... ~ Il0. Whlte DECEDEN]~B USUAL OCCUPATION KIND OF BUSINESS / INDUSTRY ~VAS DECEDENT EVER IN I DECEDENT'S EDUCATION MARITAL STATUS - Married, [ SURVIVING SPOUSE Of ~i~ life; ~ not u~ ~N)I ] U.S ARMED FORCES? I (~e=~ only h~hest gr~e ~mp~} Never Ma~d. W~ed. I (if wi~. give maven name) / -D ,0.,,, ukk , ......, tu. Widower -.. Brakeman I~. Conrail R.R. i~z ~. V ~. DECEDENTS ~ILING ADDRESS (Street. C~y~own. State. Zip C~ I DECEOENT'S . ACTUAL 17a. State ~nn~v~n~ 17c. ~ Yes. decedemiiv~ in ~amp~n ~p. 516 Salmon Road , RESIDENCE - dec~enl -- · -- ~ I (See instructions live in a ~e Mecnan[csDurg, ~a Ionoth~de ,Tb. Cou.ty Cumberland towns~p? 17d.~ No. decedemlived FATHER'S NAME (First. Mille. Last) ~ MOTHER'S NAME (FirsL MiddY. Maiden Surname) ~. Alfre~ F. Yohn I~' Etta Auker INFOR~N~S NAME (TypelP~t) INFOR~NFS ~ILING ADDRESS (Street. City,own. Stale. Zip Code) ~o,. Donald A. Yohn Jr. I~0b. 2150 Chestnut St., Camp Hill, Pa 17011 METHOD OF DISP~ITION DATE OF DISPOSITION ~ P~CE OF DISPOSITION- Name of Cemete~. Cremato~ ]LOCATION - CilyE~n. S~te. Zip C~e ~,. oth.,(sp.~). ~ ~b. Sept 2, 2003 ,~.R°lling Green Mem Par,-'~.Camp Hill, Pa [ OR PERSON ACTING AS SUCH L~CENSE NUMBER N~E ~0 ADDRESS OF FACILI~ ~b. F.D.011897-L ~Sullivan F.H.~51 N. Enola Dr,Enola,Pa LICENSE NUMBER DATE SIGNED To the ~s( of my knowledge, death occurred at the ~ime. da[e and place s~[ed (M~th. Day. YeaQ at lime of death to (Signature and Title) ~di~ cause of dea~. 23a. 23b. 23c. Items 24-26 must ~ comp~t~ by TIME OF D~TH ~ DATE PR~OUNCED D~D (M~. Day. Year) WAS CASEREFERRED TO A MEDIC~ E~MINER/COR~E~ ~monwhopro~un~sdeath. ~' , ,~ '1 J [I,,~ -I ~ ~r,r~ ~ Yes~ ~. ~ wo r U.l~. ~,~u~r ~0' ~,~ _~ j~. No~ List only one cauls on each I~m. , inle~al ~tw~r not resulting in the underlying cause given in P~T I. IMMEDIATE CAUSE (Final disease or condtik~n resulting in death)~ Sequentially list conditions b. Enter UNDERLYING CAUSE (Disease or mju~ thai initiated events resulting on death ) LAST onset and death DUE TO (OR AS A CONSEQUENCE OF): DUE TO (OR AS A CONSEQUENCE OF): WAS AN AUTOPSY J WERE AUTOPSY FINDINGS MANNER OF DEATH DATE OF iNJURY TIME OF INJURY PERFORMED? AVAILABLE PRIOR TO ~ (Mona. Day. Ye,r) j J COMPLETION OF CAUSENatural Homicide [] o~z~r)F DEATH? ACcident E] Pendin{]lJgation Od ~bu011Lid.~ll g .... i~ ~::~ Yes 0 N Yes 0 No 0 Suicide 0 Could not be aetermined ~Ee~F(~JU Y-AIh ...... tr.t. factor, 28a. 128b. 29. 30e' CERTIFIER (Che~ only ~e) 'CERTIFYING PHYSICIAN (Phys~ian ce~ing cause ~ dea{h when another physi~an has pronounced death and completed item 23) ~ To the best of my knowledge, death occurred due to the causes(s) and manner as stated ............................................................... ~ *PRONOUNCING AND CERTIFYING PHYSICIAN (~yinci~, b. ;h ~onouncing death and ce~ilying Io ~use of death) To the best of my knowledge~ death occu~ed at tho time. date. and place, and due lo the causes(s) and manner as stated ...................... 0 '~D~ EX~N~CO~ONE~ On the basis of examlnatl~ and/or Investigation. In my opinion, death occurred at the time. date. and plat=, and due to the causes(s) and INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED. 30c. 30d. LOCATION {Sbeel, City/Town, Stale) 30[ ['T-CENSE NUM~3ER J DATE S~rNE. D (Month. Day. Year) ,to. I". 8/28/03 NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH (gem 27) Type or PHnt Dr. Kenneth Graf ~z532 N. Front St.~ Wormleysburq,Pa DATE FILED (Month. Day. Year) LAST WILL AND TESTAMENT (Pour-Over Will) OF DONALD A. YOHN, SR. IDENTITY I, DONALD A. YOHN, SR., residing in the County of Cumberland, Commonwealth of Pennsylvania, being of sound mind and memory, and not acting under duress or undue influence of any person whomsoever, hereby declare this to be my Last Will and Testament, and I do hereby revoke all other former Wills and Codicils to Wills heretofore made by me. My Social Security Number is 188-12-5467. I have the following children: DONALD A. YOHN, JR. born April 26, 1954 and currently residing in Camp Hill, PA and JUDITH ZIMMERMAN born July 25, 1938 and currently residing in New Cumberland, PA and DONNA SCHORR born November 18, 1948 and currently residing in Camp Hill, PA and BETTY LOU WEVODAU bom April 9, 1943 and currently residing in Carlisle, PA. DEBTS, TAXES AND ADMINISTRATION EXPENSES I have provided for the payment of all my debts, expenses of administration of property wherever situated passing under this Will or otherwise, and estate, inheritance, transfer, and succession taxes, other than any tax on a generation-skipping transfer that is not a liability of my Estate (including interest and penalties, if any) that become due by reason of my death, under THE DONALD A. YOHN, SR. REVOCABLE LIVING TRUST executed on even date herewith (the "Revocable Trust"). If the Revocable Trust assets should be insufficient for these purposes, my Executor shall pay any unpaid items from the residue of my Estate passing under this Will, without any apportionment or reimbursement. In the alternative, my Executor may demand in a writing addressed to the Trustee of the Trust an amount necessary to pay all or part of these items, plus claims, pecuniary legacies, and family allowances by court order. PERSONAL AND HOUSEHOLD EFFECTS It is my intent that all my personal and household effects were transferred to the Revocable Trust as a result of the Declaration of Intent signed this date. If there are any questions regarding the ownership or disposition of these assets, it is my desire that such assets pour into the Revocable Trust, signed by me this date in accordance with the provisions of the section titled "Residue of Estate." RESIDUE OF ESTATE I give, devise and bequeath all the rest, residue and remainder of my property of every kind and description (including lapsed legacies and devices), wherever situated and whether acquired before or after the execution of this Will, to the Trustee under that certain Trust executed by me on the same date of the execution of this Will. The Trustee shall add the property bequeathed and devised by this item to the corpus of the above described Trust and shall hold, administer and distribute said property in accordance with the provisions of the said Trust, including any amendments thereto made before my death. POUR-OVER WILLS Page 1 '(T-e~tatc(~ If for any reason the said Trust shall not be in existence at the time of death, or if for any reason a court ofcompetentj urisdiction shall declare the foregoing testamentary disposition to the Trustee under said Trust as it exists at the time of my death to be invalid, then I give all of my Estate including the residue and remainder thereof to that person who would have been the Trustee under the Trust, as Trustee, and to their substitutes and successors under the Trust, described herein above, to be held, managed, invested, reinvested and distributed by the Trustee upon the terms and conditions pertaining to the period beginning with the date of my death as are constituted in the Trust as at present constituted giving effect to amendments, if any, hereafter made and for that purpose I do hereby incorporate such Trust by reference into this my Will. EXECUTOR I hereby nominate and appoint DONALD A. YOHN, JR. to serve without bond as my Executor of this my Last Will and Testament. In the event the first named Executor shall predecease me or is unable or unwilling to act as my Executor for any reasons whatsoever, then and in that event, I hereby nominate and appoint JUDITH ZIMMERMAN to serve without bond as my Independent Executor. Whenever the word "Executor" or any modifying or substituted pronoun therefore is used in this my Will, such words and respective pronouns shall be held and taken to include both the singular and the plural, the masculine, feminine and neuter gender thereof, and shall apply equally to the Executor named herein and to any successor to substitute Executor acting hereunder, and such successor or substitute Executor shall possess all the rights, powers, duties, authority, and responsibility conferred upon the Executor originally named herein. EXECUTOR POWERS By way of Illustration and not of limitation and in addition to any inherent, implied or statutory powers granted to executors generally, my Executor is specifically authorized and empowered with respect to any property, real or personal, at any time held under any provision of this my Will: to allot, allocate between principal and income, assign, borrow, buy, care for, collect, compromise claims, contract with respect to, continue any business of mine, convert, deal with, dispose of, enter into, exchange, hold, improve, incorporate any business of mine, invest, lease, manage, mortgage, grant and exercise options with respect to, take possession of, pledge, receive, release, repair, sell, sue for, make distributions in cash or in kind of partly in each without regard to the income tax basis of such asset and in general, exercise all of the powers in the management of my Estate which any individual could exercise in the management of similar property owned in its own right upon such terms and conditions as to my Executor may seem best, and execute and deliver any and all instruments and do all acts which my Executor may deem proper or necessary to carry out the purpose of this my Will, without being limited in any way by the specific grants or power made, and without the necessity of a court order. My Executor shall have absolute discretion, but shall not be required, to make adjustments in the rights of any Beneficiaries, or among the principal and income accounts to compensate for the consequences of any tax decision or election, or of any investment or administrative decision, that my executor believes has had the effect, directly or indirectly, of preferring one Beneficiary or group of Beneficiaries over others. In determining the Federal Estate and Income Tax liabilities of my Estate, my Executor shall have discretion POUR-OVER WILLS Page 2 (Testator) to select the valuation date and to determine whether any or all of the allowable administration expenses in my Estate shall be used as Federal Estate Tax deductions or as Federal Income Tax deductions. SPECIFIC OMISSIONS I have intentionally omitted any and all persons and entities from this, my Last Will and Testament, except those persons and entities specifically named herein. If any person or entity shall challenge any term or condition of this Will, or of the Living Trust to which I have made reference in the sections "Household and Personal Effects" and "Residue of Estate," then, to that person or entity, I give and bequeath the sum of only one dollar ($1.00) only in lieu and in place of any other benefit, grant, bequest or interest which that person or interest may have in my Estate or the Living Trust and its Estate. SIMULTANEOUSDEATH If any other Beneficiary should not survive me for sixty (60) days, then it shall be conclusively presumed for the purpose of this my Will that said Beneficiary predeceased me. DONALD A. YOI~N; SR. Testator This instrument consists of 5 typewritten pages, including the Attestation Clause, Self-Proving Clause, signature of Witnesses, and acknowledgment of officer. I have signed my name at the bo.,tt,~ of each of the preceding pages. This instrument is being signed by me on this ,~-.~'--day of POUR-OVER WILLS Page 3 ~t ~"~estator) ATTESTATION CLAUSE The Testator whose name appears above declared to us, the undersigned, that the foregoing instrument was his Last Will and Testament, and he requested us to act as witnesses to such instrument and to his signature thereon. The Testator thereupon signed such instrument in our presence. At the Testator's request, the undersigned then subscribed our names to the instrument in our own handwriting in the presence of the Testator. The undersigned hereby declare, in the presence of each of us, that we believe the Testator to be of sound and disposing mind and memory. Signed by us on the same day and year as this Last Will and Testament was signed by the Testator. WITNESSES: ~rlnt;~me'of Witness) (PrVml~d'Na-me of Withes) ' ADDRESSES: POUR-OVER WILLS Page 4 (Testator) COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SELF-PROVING CLAUSE ,~a BEFORE ME, tie undersigned authority,g~.n this day pers ~o~ally, lppeared DONALD A. YOHN, SR., c;~'r_.xt_F ~'~---J'/~/T?C and (~*.~doc_ .~Y~ ,.~.J~/7~/~/ , known to me to be the Testator and the witnesses, respectively, whose names are s~ubscribed to the foregoing instrument in their respective capacities, and all of them being by me duly sworn, DONALD A. YOHN, SR., Testator, declared to me and to the witnesses, in my presence, that the instrument is his Will and that he had willingly made and executed it as his free act and deed for the purposes therein expressed; and the Witnesses, each on his or her oath, stated to me in the presence and hearing of the Testator, that the Testator had declared to them that the instrument is his Will and that he executed the same as such and wanted each of them to sign it as a witness; and upon their oaths, each witness stated further that he did the same as a witness in the presence of the Testator, and at his request and that he was at that time eighteen (18) years of age or over and was of sound mind, and that each of the witnesses was then at least fourteen (14) years of age. DONALD A. YOHN, SR] Testator (Printed Name ~ Witness) SUBSCRIBED AND ACKNOWLEDGED before me, by DONALD A. YOHN, pR., Testator, and subscribed and sworn ~ befor~ me by /~d,~-~d__~ ~ ffr~,~'/7/ and (~,.~ ~.,~, / 7/~ , witnesses, this the ~-~'-~ ~-~ day of //~ ,c~dc~. - . No{a,.~iblic~om/j/r6hw~l~h of Penns~vania HUGH $. ~al~J)FIN COMMISSIONER Of Commonwe~h M ~~W [ POUR-OVER WILLS Page 5 (Testator) Name of Decedent: Date of Death: Will No. CERTIFICATION OF NOTICE UNDER RULE 5.6(a) / To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on /O -,fO ~ 0._g : Name Address Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: Signature Name Address Telephone Capacity: ~'/ Personal Representative __.Counsel for personal representative IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWD Whether you will receive any money or property will he deter- mined wholly or partly by the decedent's will. If the decedent died without a will, whether you will receive any money or pr~, .- erty will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, CARLISLE, PA In re Estate of Dot.~x..~.o[, I/~, yc~J~n~ ~_~, ,deceased, Estate No. (Name and Address) TO: Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. The Decedent day of , .~:_ Pennsylvania. The Decedent died testate (~a~r The Decedent died intestate (without a Will). The personal representative of the Decedent is address and telephone number). (na~ County, If the Decedent died testate, the will has been filed with the Office of the Register of Wills of Cumberland County, 1 · ~ourthouse Square, Carlisle, Pa. 17013. Phone No. 717-240-6345 If the Decedent died intestate, a Petition for the Grant of Letters of Administration was filed with the Office of the Register of Wills of Cumberland County, 1 Courthouse Square, Carlisle, Pa. 17013. Phone No. 717-240-6345 A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: tl"~--~-c~?3 Signature: Name (print) .~r~q,z[~ ~, k/~ ~, Address Telephone (q Capacity: ~ Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2806O1 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003231 YOHN DONALD A JR 2150 CHESTNUT ST CAMP HILL, PA 17011 fold ESTATE INFORMATION: SSN: 188-12-5467 FILE NUMBER: 21 03-0740 DECEDENT NAME: YOHN DONALD ASR DATE OF PAYMENT: 11/14/2003 POSTMARK DATE: 11/14/2003 COUNTY: CUMBERLAND DATE OF DEATH: 08/28/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $5,335.00 TOTAL AMOUNT PAID: $5,335.00 REMARKS: DONALDAYOHN JR NO CHECK # SEAL INITIALS: SK RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS REV*1500 EX (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER .2 i -- 0 3 0 0 ? 4 0 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Z DONALD A. YOHN 188-12-5467 UJ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THiS RETURN MUST BE FILED IN DUPLICATE WITH THE UJ 08--28--2003 03--04--1917 REGISTER OF WILLS O ILl (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER C3 uJ Z z x I- b~J 1. Odginal Retum I I 2. Supplemental Retum ~ 3. Remainder Retum (date of death pdor to 12-13-82) ~ 4. Limited Estate [~ 4a. Futura Interest Compromise (date of death after 12-12-82) [~] 5. Federal Estate Tax Return Required r'~6. Decedent Died Testate (Attach copy of Will) r'~ 7. Decedent Maintained a Living Trust (Attach copy of Trust) -- 8. Total Number of Safe Deposit Boxes ~ 9. Litigation Proceeds Received [~ 10. Spousal Poverty Credit (date of death between t2-31-9t and t-t-~5) ~ 11. Election to tax under Sec. 9113(A)(Attac~ SchO) NAME LORRAINE NAGY FIRM NAME (IfApplicable) KERN AND COMPANY, P.C. TELEPHONE NUMBER (717) 763-0888 COMPLETE MAILING ADDRESS 2331 MARKET STREET CAMP HILL, PA 17011 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership orSole-Propdetorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) ---]Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (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 (Sch~ule I) (10) 1 1. 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) 0 5,073 3,754 112 , 536! (8) 5,885 5,076 (11) OFFICIAL USE ONLY 121,363 10,961 110,402 110,402 (12) (13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 __ (15) 16. Amount of Line14 taxable at lineal rate 110,402 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) 20. 4,968 4,968 ~ ~ BE SUR~ TO ~ER ~E QUESTIONS~ON R~E~E~-si~E ~ RECHECK M~TH '<~ 3W4645 1000 Dec,dent's Complete Address: S'[REET ADDRESS 516 SALMON ROAD CITY MECF, ANICSBURG Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 5,335 248 Interest/Penalty if applicable D. Interest E. Penalty STATE ZIP PA 17055 Total Credits (A + B + C) (2) Total Interest/Penalty(D + E) (3) (1) 4,968 5,583 615 4. If Line 2 is greater than Line I + 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. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)_ ~','~'.--'~'~'~"/~- ~ , ~.. ~ ~e to: REGlSTEROFWlLLS, 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; ......... [--~ E~ c. retain a reversionary interest; or ................................ r-"] ~ 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? ............................ r~ ~ 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 penalties of perjury, I declare that I have examined this retum, 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 representatiw is based on all information of which preparer has any knowledge. SIGNATURE.QF~ERSON RESPONSIBLE FOR FI~;;I~ RETURN SIGNA'I~E OF PREPARER OTHER THAN REPRESEN'I'A'I'IVE DA/E DATE KERN AND COMPANY,PC, 2331 MARKET STREETr CAMP HILL~ PA 17011 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.§ 9916 (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 retum 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 decedent's 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. 3w4646 1.000 I~EV-1503 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER YOHN, DONALD A. 21-03-00740 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 28 SHARES OF CONRAIL INCORPORATED COMMON STOCK @ $115/SHARE 66 SHARES OF METLIFE @ $28.08/SHARE TOTAL (Also enter on line 2, Recapitulation) $ VALUE AT DATE OF DEATH 3,220 1,853 5,073 3W4696 1000 (If more space is needed, insert additional sheets of the same size) 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 YOHN, DONALD A 21-03-00740 Include the proceeds of litigation and the date the proceeds were received by the estate. Ail property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1.) 2.) 3.) 4.) WAYPOINT CHECKING ACCOUNT #0100473859-0 MISCELLANEOUS PERSONAL PROPERTY 2003 FEDERAL & PA INCOME TAX REFUND INSURANCE REIMBURSEMENTS TOTAL (Also enter on line 5~ Recapitulation) $ 1,189 1,000 1,236 329 3,754 3W46AD 1.00D (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER YOHN, DONALD A. 21-03-00740 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPE ,RTY ITEM INCLLDE T~'E NAME OF TI~ TRANSFEREE, THEIR RE LATIO NSHIP TO OEC~D~NT AND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NUMBER 7~E DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. HOUSE AT 516 SALMON ROAD 30,000 100 30,000 MECHANICSBURG, PA 17055 HELD IN THE DONALD A. YOHN, SR. REVOCABLE LIVING TRUST AT DOD 2. AMERICAN INVESTMENT LIFE ANNUITY CONTRACT #300518 68,795 100 68,795 HELD IN THE DONALD A. YOHN, SR. REVOCABLE LIVING TRUST AT DOD 3. PNC CHECKING ACCOUNT #514011561T 13,741 100 13,741 HELD IN THE DONALD A. YOHN, SR. REVOCABLE LIVING TRUST AT DOD TOTAL (Also enter on line 7, Recapitulation) $ 112,536 (If more space is needed, insert additional sheets of the same size) 3W46AF 1000 ¢{EV-1511 EY~ + (12-99) COMMONVVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF YOHN, DONALD A. FILE NUMBER 21-03-00740 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION 5. 6. 7. FUNERAl_EXPENSES: SULLIVAN FUNERAL HOME FOR FUNERAL SERVICES, USE FACILITIES AND ENOLA SPORTSMAN ASSOCIATION FOR AFTER FUNERAL LUNCHEON EQUIPMENT, AND VEHICLE ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State __ Zip Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip RelationshipofClaimanttoDecedent ProbateFees COURTHOUSE (SHORT FORMS & Accountant'sFees KERN AND COMPANY, PC ~xReturnP~parer'sF~s SOUDER TAX SERVICE MISCELLANEOUS EXPENSES: PPL UTILITIES CORP CHECKS FROM BANK STAMPS & CERTIFIED LETTER NOTARY RSR APPRAISERS PATRIOT NEWS (DEATH NOTICES) FILING FEE) TOTAL (Also enter on line 9, Recapitulation) $ AMOUNT 3,651 159 287 1,184 75 8 49 12 2 300 158 5,885 3W40^G 1.000 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER ¥O[~'N, DONAT. D A. 21-03-00740 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBEF DESCRIPTION OF DEATH 1. PINNACLE HEALTH HOSPITALS PULMONARY & CRITICAL CARE MEDICAL ASSOCIATES, PC 4,921 155 TOTAL (Also enter on line 10, Recapitulation) $ 5,0 ? 6 3W46AH 2.000 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER ¥OHR, DONA.T.~ A. 21-03-00740 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1 1.) 2.) 3.) 4.) TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] DONALD A. ¥OHN, JR. 2150 CHESTNUT STREET CAMP HILL, PA 17011 JUDITH Z IMMERMAN NEW CUMBERLAND, PA DONNA SCHORR CAMP HILL, PA BETTY LOU WEVODAU CARLISLE, PA SON DAUGHTER DAUGHTER DAUGHTER 25% 25% 25% 25% 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 $ 3W46AI 1.000 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003231 YOHN DONALD A JR 2150 CHESTNUT ST CAMP HILL, PA 17011 ........ foJd ESTATE INFORMATION: SSN: 188-12-5467 FILE NUMBER: 21 03-0740 DECEDENT NAME: YOHN DONALD ASR DATE OF PAYMENT: 11/14/2003 POSTMARK DATE: 11/14/2003 COUNTY: CUMBERLAND DATE OF DEATH: 08/28/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $5,335.00 TOTAL AMOUNT PAID: $5,335.00 REMARKS' DONALDAYOHN JR NO CHECK # SEAL INITIALS: SK RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS TAXPAYER WHEREAS, on the 9th Register of Wills of CUMBERLAND County, Pennsylvania Certificate of Grant of Letters No. 2003-00740 PA No. 21-03-0740 ESTATE OF YOHN DONALD ASR (Lg4~'i', ~'i~'i', mi~) Late of Deceased HAMPDEN TOWNSHIP Social Security No. 188-12-5467 day of September 2003 an instrument dated May 22nd 2000 was admitted to probate as the last will of YOHN DONALD ASR (LgiS'i', ~'l~'i', M±~L~) late of HAMPDEN TOWNSHIP , CUMBERLAND County, who died on the 28th day of August 2003 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, DONNA M. OTTO , 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 YOHN DONALD A JR who has duly qualified as Executor(rix) and has agreed to administer the estate according to law, all of which fully appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my Office the 9th day of September 2003. ~ ~egi~s~r o~ Wills , 0 **NOTE** ALL NA~4ES ABOVE APPEAR (LAST, FIRST, MIDDLE) LAST WILL AND TESTAMENT (Pour-Over Will) OF DONALD A. YOHN, SR. IDENTITY I, DONALD A. YOHN, SR., residing in the County of Cumberland, Commonwealth of Pennsylvania, being of sound mind and memory, and not acting under duress or undue influence of any person whomsoever, hereby declare this to be my Last Will and Testament, and I do hereby revoke all other former Wills and Codicils to Wills heretofore made by me. My Social Security Number is 188-12-5467. I have the following children: DONALD A. YOHN, JR. born April 26, 1954 and currently residing in Camp Hill, PA and JUDITH ZIMMERMAN born July 25, 1938 and currently residing in New Cumberland, PA and DONNA SCHORR born November 18, 1948 and currently residing in Camp Hill, PA and BETTY LOU WEVODAU bom April 9, 1943 and currently residing in Carlisle, PA. DEBTS, TAXES AND ADMINISTRATION EXPENSES I have provided for the payment of all my debts, expenses of administration of property wherever situated passing under this Will or otherwise, and estate, inheritance, transfer, and succession taxes, other than any tax on a generation-skipping transfer that is not a liability of my Estate (including interest and penalties, if any) that become due by reason of my death, under THE DONALD A. YOHN, SR. REVOCABLE LIVING TRUST executed on even date herewith (the "Revocable Trust"). If the Revocable Trust assets should be insufficient for these purposes, my Executor shall pay any unpaid items from the residue of my Estate passing under this Will, without any apportionment or reimbursement. In the alternative, my Executor may demand in a writing addressed to the Trustee of the Trust an amount necessary to pay all or part of these items, plus claims, pecuniary legacies, and family allowances by court order. PERSONAL AND HOUSEHOLD EFFECTS It is my intent that all my personal and household effects were transferred to the Revocable Trust as a result of the Declaration of Intent signed this date. If there are any questions regarding the ownership or disposition of these assets, it is my desire that such assets pour into the Revocable Trust, signed by me this date in accordance with the provisions of the section titled "Residue of Estate." RESIDUE OF ESTATE I give, devise and bequeath all the rest, residue and remainder of my property of every kind and description (including lapsed legacies and devices), wherever situated and whether acquired before or after the execution of this Will, to the Trustee under that certain Trust executed by me on the same date of the execution of this Will. The Trustee shall add the property bequeathed and devised by this item to the corpus of the above described Trust and shall hold, administer and distribute said property in accordance with the provisions of the said Trust, including any amendments thereto made before my death. POUR-OVER WILLS Page 1 If for any reason the said Trust shall not be in existence at the time of death, or if for any reason a court of competent jurisdiction shall declare the foregoing testamentary disposition to the Trustee under said Trust as it exists at the time of my death to be invalid, then I give all of my Estate including the residue and remainder thereof to that person who would have been the Trustee under the Trust, as Trustee, and to their substitutes and successors under the Trust, described herein above, to be held, managed, invested, reinvested and distributed by the Trustee upon the terms and conditions pertaining to the period beginning with the date of my death as are constituted in the Trust as at present constituted giving effect to amendments, if any, hereafter made and for that purpose I do hereby incorporate such Trust by reference into this my Will. EXECUTOR I hereby nominate and appoint DONALD A. YOHN, JR. to serve without bond as my Executor of this my Last Will and Testament. In the event the first named Executor shall predecease me or is unable or unwilling to act as my Executor for any reasons whatsoever, then and in that event, I hereby nominate and appoint JUDITH ZIMMERMAN to serve without bond as my Independent Executor. Whenever the word "Executor" or any modifying or substituted pronoun therefore is used in this my Will, such words and respective pronouns shall be held and taken to include both the singular and the plural, the masculine, feminine and neuter gender thereof, and shall apply equally to the Executor named herein and to any successor to substitute Executor acting hereunder, and such successor or substitute Executor shall possess all the rights, powers, duties, authority, and responsibility conferred upon the Executor originally named herein. EXECUTOR POWERS By way of Illustration and not of limitation and in addition to any inherent, implied or statutory powers granted to executors generally, my Executor is specifically authorized and empowered with respect to any property, real or personal, at any time held under any provision of this my Will: to allot, allocate between principal and income, assign, borrow, buy, care for, collect, compromise claims, contract with respect to, continue any business of mine, convert, deal with, dispose of, enter into, exchange, hold, improve, incorporate any business of mine, invest, lease, manage, mortgage, grant and exercise options with respect to, take possession of, pledge, receive, release, repair, sell, sue for, make distributions in cash or in kind of partly in each without regard to the income tax basis of such asset and in general, exercise all of the powers in the management of my Estate which any individual could exercise in the management of similar property owned in its own right upon such terms and conditions as to my Executor may seem best, and execute and deliver any and all instruments and do all acts which my Executor may deem proper or necessary to carry out the purpose of this my Will, without being limited in any way by the specific grants or power made, and without the necessity of a court order. My Executor shall have absolute discretion, but shall not be required, to make adjustments in the rights of any Beneficiaries, or among the principal and income accounts to compensate for the consequences of any tax decision or election, or of any investment or administrative decision, that my executor believes has had the effect, directly or indirectly, of preferring one Beneficiary or group of Beneficiaries over others. In determining the Federal Estate and Income Tax liabilities of my Estate, my Executor shall have discretion POUR-OVER WILLS Page 2 (Testator) to select the valuation date and to determine whether any or all of the allowable administration expenses in my Estate shall be used as Federal Estate Tax deductions or as Federal Income Tax deductions. SPECB*IC OMISSIONS I have intentionally omitted any and all persons and entities from this, my Last Will and Testament, except those persons and entities specifically named herein. If any person or entity shall challenge any term or condition of this Will, or of the Living Trust to which I have made reference in the sections "Household and Personal Effects" and "Residue of Estate," then, to that person or entity, I give and bequeath the sum of only one dollar ($1.00) only in lieu and in place of any other benefit, grant, bequest or interest which that person or interest may have in my Estate or the Living Trust and its Estate. SIMULTANEOUS DEATH If any other Beneficiary should not survive me for sixty (60) days, then it shall be conclusively presumed for the purpose of this my Will that said Beneficiary predeceased me. DONALD A. YOt-~N[SR. Testator This instrument consists of 5 typewritten pages, including the Attestation Clause, Self-Proving Clause, signature of Witnesses, and acknowledgment of officer. I have signed my name at the botto~ of each of the preceding pages. This instrument is being signed by me on this ,~.-~-~--day of POUR-OVER WILLS Page 3 ~stator) ATTESTATION CLAUSE The Testator whose name appears above declared to us, the undersigned, that the instrument was his Last Will and Testament, and he requested us to act as witnesses to such to his signature thereon. The Testator thereupon signed such instrument in our presence. At the T, request, the undersigned then subscribed our names to the instrument in our own handwriting in the of the Testator. The undersigned hereby declare, in the presence of each of us, that we believe to be of sound and disposing mind and memory. Signed by us on the same day and year as this Last Will and Testament was s~ WITNESSES: (Pnnted,,~fime of Witness) (PrYrrt~d Name of' Witn~s's) ADDRESSES: / 7075- POUR-OVER WILLS Page 4 (Testator) COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SELF-PROVING CLAUSE ,BEFORE ME, the undersigned authority,&n this day personally, appeared DONALD A. c~'~.x~l' ~' ~lr'~/7'X/ and ~"'~,-~eoc_ ~, ~ ? ~// , known to me Testator and the witnesses, respectively, whose names are s~ubscribed to the foregoing respective capacities, and all of them being by me duly sworn, DONALD A. YOHN, SR., Testator,! to me and to the witnesses, in my presence, that the instrument is his Will and that executed it as his free act and deed for the purposes therein expressed; and the Witnesses, oath, stated to me in the presence and hearing of the Testator, that the Testator had instrument is his Will and that he executed the same as such and wanted each of them to sign and upon their oaths, each witness stated further that he did the same as a witness in the presence of the' Testator, and at his request and that he was at that time eighteen (18) years of age or over and was of sound mind, and that each of the witnesses was then at least fourteen (14) years of age. DONALD A. YOHN, SR[ Testator (Printed Name ~ Witnes~ (P~inted Na~ne of Witness) ' SUBSCRIBED AND ACKNOW-L~ EDGED before mc.by DONALD A. YOHN, ~R., Testator, and subscribed and sworn ~ befor~ me by /r..(~d~/~-z~.~ ~ ~~ and ~. ~~/~ , witnesses, this the ~ ~ day of o ~ ~b Ii ~~nw~h o~ ~ a~van i a HUGH S, GOLDFIN COMMISSIONER OF DEEDS Comm°nwea~ c~ Pennsytvanla commb~, ~xp~e~s~t. ~6, am POUR-OVER WILLS Page 5 (Testator) Form Approved OMB No. 2502-0265 U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT Abstract Land Associates, Inc. 3912 Market Street Camp Hill, PA 17011 (717) 763-1450 FINAL B. TYPE OF LOAN 1. [] FHA 2. [] FMHA 3. []CONV. UNINS. 4. [] VA 5. [] CONV, INS. 6. ESCROW FILE NUMBER: 7. LOAN NUMBER: 00015153-001 NJT 8. MORTGAGE INSURANCE CASE NUMBER: C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(P. O. C:)" were paid outside the closing; they are shown here for in£ormat/onal purposes and are not included in the totals, D, NAME OF BORROWER: Donald A. Yohn Jr. ADDRESS OF BORROWER: 2150 Chestnut Street Camp Hill, PA 17011 E. NAME OF SELLER: ADDRESS OF SELLER: The Donald A. Yohn Sr. Revocable Living Trust 516 Salmon Road Mechanicsburg, PA 17055 F. NAME OF LENDER: ADDRESS OF LENDER: G. PROPERTY LOCATION: 516 Salmon Road Mechanicsburg, PA 17055 Cumberland County 10-19-1598-097 Lot(s) 1, of The Salmon Hole Plot, Plan Book 2, Page 61 H. SETTLEMENT AGENT: PLACE OF SETTLEMENT: Abstract Land Associates, Inc. 3912 Market Street, Camp Hill, PA 17011 I. sETrLEMENT DATE: 4/6/2004 PRORATION DATE: DISBURSEMENT DATE: 4/6/2004 J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 101. Contract Sales Price 30,000.00 401. Contract Sales Price 30,000.0C 102. Personal Property 402. Personal Property 103. Settlement charges to Borrower (line 1400) 483.50 403. 104. 404. 105. 405. ADJUSTMENTS FOR ITEMS PAiD BY SELLER IN ADVANCE: ADJUSTMENTS FOR ITEMS PAiD BY SELLER IN ADVANCE: 106. City/Town Taxes 406. City/Town Taxes 107. County Taxes 04/06/04 to 12/31/04 120.82 407. County Taxes 04/06/04 to 12/31/04 120.8; 108. Assessments 408. Assessments 109. School Tax 04/06/04 to 06/30104 143.35 409. School Tax 04/06/04 to 06/30/04 143.3[ 110. Sewer/Trash 04/06/04 to 06/30/04 107.33 410. Sewer/Trash 04/06/04 to 06/30/04 1 111. 411. 112. 412. 113. 413. 114. 414. .:MENT CHARGES ~~~~T ................................................................. ~ BASED ON PRICES 30,000.00 @ %= DIVISION OF COMMISSION (LINE 700) AS FOLLOWS: 701. $ 1o 702. $ to ESCROW FILE NUMBER: PAID FROM BORROWER'S FUNDS AT SETTLEMENT 00015153-001 NJT PAID FROM SELLER'S FUNDS AT SE'T-FLEMENT 703. Commission paid at settlement 704. 801. Loan Origination Fee 802. Loan Discount Fee 803. Appraisal Fee 804. Credit Report 805. Lenders Inspection Fee 806. Mortgage Insurance Application Fee 807. Assumption Fee 808. 809. 810. 811. 901. Interest From to @ $/day % (days) 902. Mortgage Insurance Premium for Month(s) to 903. Hazard Insurance Premium for Years(s) to 904. 905. 1001. Hazard Insurance months @ $ ~er month 1002. Mortgage Insurance monlhs @ $ ~er month 1003, City Property Taxes mmlhs @$ }er month 1004. County Property Taxes months @ $ 13.68 ]er month 1005. Annual Assessments months (~ $ ~er month 1006. mo'~ths (~ $ ~er month 1007. months @ $ )er month 1008. months @ $ )er month 1101. Settlement or closing fee 1102. Abstract or title search 1103. Title examination Title insurance binder 1104. 1105. Document preparation 1106. Notary fees 1107. Attorney's Fees to Abstract Land Associates, Inc. to Settlement Officer (includes above items numbers: 1108. Title Insurance to Abstract Land Associates, Inc. (includes above items numbers: 10.00 420.00 15.00 1109. Lenders coverage $ 1110. Owner's coverage $ 30,000.00 1111. Overnight Del very Fee to Abstract Land Associates, Inc. /b. UU 10.00 : '.il . : 'llliR · 'ii.. .' !!93 QUIT CLAIM DEED Dated this ---~'~'~ ~ day of .,/~/ ,2000. The Grantor(s): Donald A. Yohn a/k/a Donald A. Yohn, Sr. whose address is 516 Salmon Road, Mechanicsburg, Cumberland County, Pennsylvania 17055 quit-claim(s) to THE DONALD A. YOHN, SR. REVOCABLE LIVING TRUST whose address is 516 Salmon Road, Mechanicsburg, Cumberland County, Pennsylvania 17055 Consideration: TEN DOLLARS ($10. 00) and other good and valuable consideration in hand paid Property (including any improvements): ALL THAT CERTAIN lot or piece of land with the improvements thereon erected, situate in Hampden Township, Cumberland County, Pennsylvania, and more particularly bounded and described as follows to wit: BEGINNING at an iron pin in the center of the Public Road leading to Orrs' Bridge, at line of land now or late ofM.C. Deitz Estate; thence South 81 degrees 30 minutes West, 140 feet to a point on said Deitz line which is 30 feet from a stake on the bank of the Conodoguinet Creek; thence Northwardly and parallel with said Creek 62.5 feet to a pin at line of Lot No. 2 on the hereinafter mentioned Plan of Lots; thence North 74 degrees 45 minutes East, 142 feet to a point in the center of said public road; thence Southwardly along the center of said public road, 76.3 feet more or less to the place of beginning. BEING Lot No. 1 Oil the Plan of Lots laid out by the Elnandar Realty Company, known as "The Sah-non Hole Plot" which said Plan is recorded in the Recorder's Office of Cumberland County, Pennsylvania, in Plan Book 2, page 61. UNDER AND SUBJECT to and together with the rights, privileges, agreements, rights-of- way, easements, conditions, exceptions, restrictions and reservations as exist by virtue of prior recorded instruments, deeds or conveyances. :, ND WHEREAS, Eva C. YoJm departed this life on the day of ",'.".., 221.. ,,,': 879 Page I of 3 AND WHEREAS, Eva C. Yohn owned said property as joint tenant with the right of survivorship with Donald A. Yohn a/k/a Donald A. Yohn, Sr., Grantor, his/her interest, now destroyed, is vested in fee in said Grantor. For chain of title see Deed recorded in the aforesaid County in Deed Book Volume 15W Page 107 Being the same as Tax Parcel Number /d-/~--"/'5'~Tda'- d,~,~' For the consideration Grantor quit claims to Grantee all of Grantor's right, title, and interest in and to the property, to have and to hold it to Grantee, Grantee's heirs, executors, administrators, successors, or assigns shall have, claim, or demand any right or title to the property or any part of it. When the context requires, singular nouns and pronouns include the plural. Signed by: DONALD A. YO~I~ a/k/a DONALD A.VSfOHN, SR. 22i 880 Page 2 of 3 STATE OF PENNSYLVANIA} COUNTY OF CUMBERLAND} ss. On this, the -- day of , in the year ~'q~d/06_9, before me, ./-7,-.~d-/7"~ ~---_x, /-o~'/,<~" ,a Notary Public in and for said state, personally appeared Donald A. Yohn a/k/a Donald A. Yohn, Sr., known to me to be the person who executed the within quitclaim deed and acknowledged to me that he/she executed the same for the purposes therein stated. I hereby certify the address of the within grantee is 516 Salmon Road, Mechanicsburg, County of Cumberland, State of Pennsylvania 17055. Atteste~/o by:., /.~/~ Attestor (please print) Page 3 of 3 DEED Dated: DONALD A. YOHN, SR. Grantor, TO Record& Return to: BRETT B. WEINSTEIN Attorney at Law 707 West DeKalb Pike Suite 2 King of Prussia, PA. 19406 THE DONALD A. YOHN, SR. REVOCABLE LIVING TRUST Grantee. State of Pennsylvania (;oua1¥ of CumberlandJ i'i ~:::~r c_:~d i;'~ th~ office for the recording ot Deads :5~ h':g,~d fof~umb~rlnnd County,~ wJl~i..::s m,/h~n~nd se~l of office of Mr. Donald A. Yohn, Sr. 516 Salmon Road Mechanicsburg, PA 17055 Donald A. Yohn, Jr. 2150 Chestnut Street Camp Hill, PA 17011 Dear Donald A. Yohn, Jr.: I have executed a Revocable Living Trust Agreement and have named you to succeed me in the capacity of Successor Trustee. Your duties as such will be to distribute the Trust property to my Beneficiaries as designated in the Trust Agreement. Please indicate your acceptance of this appointment by signing where indicated at the bottom of this letter and returning the letter to me. Sincerely, ,/~, DONALD A. YOHN, Trustor/Trustee I accept appointment as Successor Trustee of THE DONALD A. YOHN, SR. REVOCABLE LIVING TRUST. DO ×Lq5 A. JR. O'/o 5/2) Date / Trustee, please return this acceptance letter to the Trustor at the letterhead address. This signed letter will be kept by Mr. Yohn with his lrztst documents. Mr. Donald A. Yohn, Sr. 516 Salmon Road Mechanicsburg, PA 17055 Judith Zimmerman 5 Crescent Court New Cumberland, PA 17070 Dear Judith Zimmerman: I have executed a Revocable Living Trust Agreement and have named you to succeed me in the capacity of Successor Trustee. Your duties as such will be to distribute the Trust property to my Beneficiaries as designated in the Trust Agreement. Please indicate your acceptance of this appointment by signing where indicated at the bottom of this letter and returning the letter to me. Sincerely, ----DONALD A. YOI0~, SR. Trustor/Trustee I accept appointment as Successor Trustee of THE DONALD A. YOHN, SR. REVOCABLE LIVING TRUST. J U-~I/T H ZIMMERN~AN Date~~ ~q, Trustee, please return this acceptance letter to the D'ustor at the letterhead address. This signed letter will be kept by Mr. Yohn with his trust docwnents. BUREAU OF ZNDZVZDUAL TAXES INHERITANCE TAX DTVTSZON PO BOX 280601 HARRISBURG, PA 17128-0601 CONNONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX LORRAINE NAGY KERN & CO 1551 MARKET ST CAMP HILL PA REV-ZS~7 EX ~FP (09-0¢i) DATE 1Z-06-ZOOq ESTATE OF YOHN SR DONALD A DATE OF DEATH 08-18-Z005 FILE NUNBER 21 05-07q0 ?~:;i~OUNTY CUMBERLAND ACN ~0! Amoun~ Remi~ad I HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF WILLS CUNBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTZON FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF YOHN SR DONALD A FILE NO. 21 03-07~0 ACN 101 DATE 12-06-200~ TAX RETURN gAS: (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 B) (2) $. Closely Held S~ock/Par~nership Zn*ares~ (Schadula C) ($) q. Mor~gagms/No*ms Receivable (Schedule D) (q) S. Cash/Bank Doposi~s/Misc. Personal Propar~y (Schedule E) (E) 6. Jointly Owned Propar*y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Asse~s APPROVED DEDUCTIONS AND EXENPTZONS: 9. Funeral Expensas/Adm. Costs/Misc. Expenses (Schedule H) (9} 10. Debts/Mortgage Liabilities/Liens (Schedule Z) (10) 11. To~al Deductions 12. Net Value of Tax Re*urn 5~073.00 .00 3;75R.00 .00 .00 NOTE: To insura proper cradi~ *o your account, submi~ ~ha upper portion .00 of *his form wi~h your ~ax payment. 5,885. O0 5a076.00 (11) (~2) 110,~02.00 13. NOTE: ASSESSNENT OF TAX: 16. Amoun* of Line lq a~ Spousal rate 16. Aeount of Line lq ~axabla a~ Lineal~Class A ra~a 17. Amoun~ of Line Zq a~ Sibling ra~e 18. Aaoun~ of L/nm lq ~axable at Collateral/Class B rata 19. Principal Tax Due TAX CREDITS: PAYMENT I RECEIPT BATE NUMBER 11-1q-2003 CD003231 DISCOUNT (+) INTEREST/PEN PAID (-) (1;) .00 x O0 = .00 (16} 110,q02.00 X Oq5 = q,968.00 (17) . O0 x 12 = . O0 (~8) .00 x 15 = .00 (19)= q,968. O0 AMOUNT PAID ZF PAID AFTER DATE INDZCATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. Chari~able/Governman~:al Bequests; Non-elected 9115 Trusts (Schadula J) (15) . O0 Na~: Value of Es~:a~:a SubSec~: to Tax (lq) 110,q02.00 Zf an assesseent ~as lssued previously, 11nas 1~, 15 and/or 16, 17, 18 and 19 will reflect figures that lnclucle the total of ALL returns assessed to date. Zq8.q0 5,335. O0 BALANCE OF TAX DUE 615.qOCR INTEREST AND PEN. .00 TOTAL DUE 615.qOCR ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REQUIRED. ~/~/~ ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR ZNSTRUCTZONS.) 112z536.00 (8) 121,363.00 RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CR]: OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 1Z, 1981 -- if any future interest in the estate is transferred in possession ar enjoyment to Class 8 (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the CoemonNealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the laNful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S. Section 9140). Detach the top portion of this Notice and submit Nith your payment to the Register of Nills printed on the reverse side. --Make check or money order payable to: REGISTER OF NZLLS, AGENT A refund of a tax credit, Nhich Nas not requested on the Tax Return, amy be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications ara available online at mmN.revenue.state.pa.us, any Register of Nills or Revenue District Office, or free the Department's Z4-hour ensuering service for forms orders: 1-800-362-2050~ services for taxpayers Nith special hearing and/or speaking needs: 1-800-447-3020 (TT only). Any party in interest not satisfied Nith the appraisaent, a11oNance or disalloaance of deductions or assessment of tax (including discount or interest) as shone on this Notice may object Nithin 60 days of the date of receipt of this notice by filing one of the folloNing: A) Protest to the PA Department of Revenue, Board of Appeals. You amy abject by filing a protest online at wNN.boardofappeals.state.pa.us on or before the expiration oF the sixty-day appeal period. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals Nebsite. You may also send a written protest to PA Department of Revenue, Board of Appeals P.O. Box 281021, Harrisburg, PA 17116-1011. Petitions may not ba foxed. B) Election to have the matter determined at the audit of the account of the personal representative. C) 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 RevieN Unit, P.D. Box 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-ISa1) for an explanation of administratively correctable errors. If any tax due is paid Nithin three (3) calendar months after the decedent's death, a five percent (51) discount of the tax paid is aZloNad. The 15Z tax amnesty non-participation penalty is computed an the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same tiaa period as you Nould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning Nith first day of delinquency, or nine (9] months and Dna (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest et the rate of six (61) percent per annum calculated at a daily rate of .000164. Al! taxes which became delinquent on and after January l, 1981 Nill bear interest at a rate Nhich Nill vary from calendar year to calendar year Nith that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through Z004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ 20X .000548 ~J'8-6-1991 XXZ .000301 ~ 9X .000247 1983 162 .000438 1992 92 .000247 ZOOZ 62 .000164 1984 IIX ,000301 1993-1994 72 .000191 2003 52 .000137 1985 131 .000356 1995-1998 9X .000147 2004 4~ .000110 1986 101 .000274 1999 7~ .000191 1987 10~ .000274 ZOO0 7X .000191 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPA/D X NUItBER OF DAYS DELTNI~UENT X DATLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent Nill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU Of INOIVIIlUAlrAxES INHERITANCE TAX DIVISION PO BOX Z8D60l HARRISBURG PA 17128-D601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT '* REV-1U1 EX AFP (12-D~) ,^,c.' ~ . ,-,....., :-~ J DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-24-2005 YOHN SR 08-28-2003 21 03-0740 CUMBERLAND 101 Allount R_i tted DONALD A LORRAI'NE NAGY KERN &CO 2331 MARKET ST CAMP HIL L PA l70ll 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 form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ~~:i&&,r.!5rir'~..rGl~.6!'........;;;:rA~!~e!r",A5r.4tl"f!~.~.Ae1:6D~...j(...................... ESTATE OF YOHN SR DONALD A FILE NO.21 03-0740 ACN 101 DATE 01-24-2005 THIS STATEHENT IS PROVIOEIl TO AIlVISE Of THE CURRENT STATUS Of THE STATEO ACN IN THE NAHEIl ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX IlUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, ANI!, IF APPLICABLE, A PROJECTEIl INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 11-29-2004 PRINCIPAL TAX DUE,. ".,.,~,~,.,.,."u'.'.'.'.'.'.'N".""~I.'.'~'.'.'.'.'"''''""'''.'.'.'. 4,968.00 PAYMENTS (TAX CREDITS): PAYMENT \ RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) " ll-14-2003 , CD003231 248.40 5,335.00 " 01-03-2005 . REFUND .00 615.40- TOTAL TAX CREDIT 4,968.00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PALO AFTER THIS OATE, SEE REVERSE TOTAL DUE .00 SLOE FOR CALCULATION OF AIlIlITIONAL INTEREST. ( IF TOTAL OUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)~ YOU HAY BE OUE A REFUNO. SEE REVERSE SIDE OF THIS FORH fOR INSTRUCTIONS. ) ~ Register of Wills of Cumberland County Name of Decedent: STATUS REPORT UNDER RULE 6.12 . 0("lV1n./ J ^ I Yo h" S ~ . 8-;18-03 Date of Death: Estate No.: c200 3 oo7i.fO 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 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. Ifthe answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes 00 No 0 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 00 No 0 c. Copies of receipts, releases, joinders and approval of formal or infonnal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. J)-PJ iC~~ Signature Date: ?3-IO-D5 cry ,b 0 VI o...L-l. Name A . Y DhtJ d:r. I Lf-:-"J C~, c.-:::J C'-" I.. e> do /5 () e-h p~fJV~f Sf, (!afo/J i-JdJ~ ft I '1tJ II Address (']Iq) ~37-/.;J.5i) Telephone No. U.I C) . c: L,_ C", C) CD -, ~~:_- , . '-' Capacity: JZl Personal Representative o Counsel for personal representative ,;1 Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240 - 6345 Da t e : 7/27/2005 YOHN DONALD A JR 2150 CHESTNUT ST CAMP HILL, PA 17011 RE: Estate of YOHN DONALD A SR File Number: 2003-00740 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 8/28/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, A~ftldL~~W) ~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge cJvR