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HomeMy WebLinkAbout04-0938 - PETITION FOR PROBATE and GRANT OF LETTERS :AI- n~- Oq3~ Estate of M<lrie ^. Kichman also known as No. To: Register of Wills for the Deceased. County of Cllmhprl i'lnn in the Social Security No. 1 9 0- S 7 -4041 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 ri x in the last will of the above decedent, dated Februa ry S. 1 9 9 1 and codicil(s) dated N / A /& K\C:Larcf L. t\,cL"nqi, (; ;<'ct,! 5cl'-t .,;;>~, aCLL! ~ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decedent was domiciled a[ death in l'llmhh\,..-l and County, Pennsylvania. with h PT last family or principal residence at R? 1 Wprt- ?u; '10 Poarl Fnnli'l, P^ 17025, ""'at F.mngboro TGI'n8hip llist street, number, Twp. or BarD.) Decedent.then h? yearsofage.died~eptemb'ilr 19, 2004 .>4j( , at H~rr; c::bllr~ ~Oapital . Except as follows. decedent did 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 kiJ!ing and was never adjudicated incompetent: NONI: Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of rea! estate in Pennsylvania situated as follows: 821 Wertz"illo R03.d, Enol3., P.'. S 1, onn 00 S S S95,OOO.QO 17025 WHEREFORE, petitioner(s) respectfully request(s) the prohate of the last will and codicil(s) presented herewith and the grant of letters rpps t ;:lmpn t;:l ry (testamemary; administration ~.t,a.; administration d.b_n.c.t.a.) theron. (/ ]' " :g3 " " ::::;::.: :!.2 i-=: ~.i: tr__ ;; 0 ;;, ::r. ~~~1d~i 1~;'l1z<.'!<yk)J ~ f A )... S CcIHL/H_a J-dc L c tC ( AnnA Livingston n k A Annr'! Hllrrell 821 Wertzvi lle Road F.nnl~. Pl'l. 17n?S OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ s~ COUNTY OF CLlIY1/')E:Rlf\-{\.lv J::; 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- tarive(s) of the above decedent petitioner(s) will well and truly a.drr;inister. the estate az:c ding to law. I _cd ,. r /! Sworn to or affirm1d and subscribed /[, -,,-1<~1 - :7)L '-L,,"'V}:,,('.,~7ff-k _ {J"Z-l--iG.iC/JHCz ~" u_LI . 01" - I ~. before me this '1 IT day of ^nn... Li"ingEton ".~r..3._ )\nna~Hurrell CC~(Bf:::R ~1 ' "- ~~l~;i~~~~L~ill;i;ll1e~~;er ~ ~ r. ": A ,.,~, "". ...., r No. ~H4-UIJ.V , . Estate of Marie A. Kichm"n , Deceased DECREE OF PROBATE AND GRANT OF LETTERS O ~OC~ AND NOW C Tn 13 [f\ I (1 ~, in consideration of the petition on the reverse side hereof, satisfactory proof having been presentgd before me, IT IS DECREED that the instrument(s) dated Februaury 5, 1993 described therein be admitted to probate and filed of record as the last will of M.::::.r-ie:n. "l<:;C'nwan and Letters 'T'''at''-lll'ilfltary are hereby granted to Ann.:=! T,ivinC}c::t-nn, n 1-::l lInna Hllr,\Al' FEES Pb L .2CCCC ro ate, etters, Etc. ......... ~ Sh C'fi (3 $ q C (: ort eft! lcates )..... . . . .n .. "\)~ $ q C C ~~eRl:JRlOlatlon ~'\.:-. r. ,.... .... JlP $ tD .l, C TOTAL _ $n~.CD }J.1ct {I [(./ftVJ u/'{;Lt (IjJ,W_./.'';~ . .,~ Registe: of Wills....." ": \, " (Y-A V (/i 1})JWLr ''';L , " ., 27737 ATTORNEY (Sup. Ct. I.D. No.) 400 South State Road Marvsville. PA 17053 AD DRESS Filed ........... (717) QS7-i474 PHO~'E al-Q1'-OQ3? tZvn-!J? ~ SEF' " .:"'n...... ~ <.) LuU4 H1G~ 143 Reo 2/87 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH' VITAL RECORDS ,{INT lENT '"' , AGE (Lasl BH1/lday) NAME OF DECEDENT IFIr,t MHjjle, Last) Marie A. Kichman CERTIFICATE OF DEATH .. 62 COUr'H{OFOEATH ", SEX SOCIAL SECURlTr NlIMBER 2,Flo'lllale 190 5') 40'.1 BIRTHPLACE Cllyand P'ACE' F[)FATII 11 kOfll On -Sa Jr\ Irudlon Slate or FQregn Countl)'! hOSPITAl 7. harrisburg PA ~;.".ot[] ORJOuljl.,~",D DOAD FA(;:UTY r.AME (irnot Irl't'luU[)n. glYe S1r~el ~nJ nur;',t;ef) STAT" FIL.~ NUMBER o J.- " Dauphin DECEDENT'S USUAL DCCUPATlmJ 8e Harrisburg KlrjDOFBUSI/jESSIINOUSTRY '..,~"'~ el (~','~"~~~::,;;O'14~~".u~r;~~'~';I" Houseduties 11a l1b DECEDENT'S MAiliNG ADDRESS (Slreet ColyiTown Slate, Zop Code) -NASllECEDENTEVERIN US ARMED ~ORCES~ YesD NaGS] " 82) Wertzville Rd. Enola, PA DECEDENT'S ACTUAL RESIDENCE IS"",n.trUCllons anolhelslde) 17aSldle A M~,RITAL STATUS_ Mdrneo ~!~ver MarrlW, Wdow€J DNO,"<<O(Spec.1YI 14, Widowed Hb COLJnI, Cumberland U;d (j~~e(j~rH I,,~ ,,' a lawn.nlp') He []I Yes, O"C~Jenll'"eo on East Pennsbol-o :"'P " FAHtERS NAME IFirst M'ddle, Lasll 18 Harry W. Tolbert INFORMArJT'SNAME (TlpeIPnn'l lOa. Anna M. turrell METHOD OF DISPOSITION DATE O~ DISf-'()SilION OonallOO 0 Burral [l) Cfemat'on Qemooal Irom Slate 0 ("'nnto Oa" Yoa.) 2fa Other (Speclty) 0 21b. Septembe r 23, 04 21e. East SIGNATURE OF FUNERAL seRVICE LICENSEE OR PERSON ACTING AS SUCH LICENSfHU"IeEIl-.7 4- 22a./ 'I ,'-'. JJtt.-z-"t./VJ 22b, U U j L 7 L Compjele'tams23a-conlywhen~ertltyong pnl..c,an '. flOt available at li",e of ~eath to CeltllYC<luseofdealh Hd, 0 ~~r,l~e~~t':J~'I':I:~~,f~ 01 :I~y'o~'ro MOHiER S NAME (FIr.t MIJdle M~I<len Surn'''llel 19. Hdrgaret 1. Smith INFO""1k\'J,T',, MAiliNG ".DDRfSS ISlruet CII/iT""" Stale Z,p Ca(w) 20b, tsi I WertzvlJ Ie Rd. Enola, PA PLACE Of' [)JSPOSlrION. N;J",e 01 C.e"'~lery, CJ~ITlat"ry lOCATION Or 01t,e, Pla~e 17025 C,tylf""''',Slale,ZJpCu.!e Harrisburg Cemetery 21d. Harrisburg, PA riAME Atm ADORE$S OF FAC~LlTt 22e, Richardson F .H. 29S.Enolallr. Enola PA LlCErJSE NUMBER 17025 " Sequefllldllyl,.tCOndiIJOns Jlany,leadlngIQ,mmed,ete cause Enle,UNDERlYING CAUSE IDJSe;J'e or '''ilJry Itlat Jf""at~d evenl, 'e.ultlng 0.-. ~ealll:1 LAST rn.rr""T"S)/T))c_ QIt L U('I",'j !TJ ~I 1/1:;'-{1 DUE TO (OR A5ACONSoQl)oNC~Of) : ApproXlmale "'lIe:'Odloel"'een ;G~SddodJealO PART II; Ollletsrgnrflca"lconM,onsccrrl"r,utH',gtGrlt'dm Out n01 'e.ult"'~ I~ the unaeny,n~ ~au.e gl"~n In f'MRT I r: OUEIOIORA5ACONSEQl)oNCEOFI OUC lOiORA5ACm-lSEOlJoNU 0.) WERE AUTOPSY FINDINGS AVAILABLE PRIOR TO COMPLETION OF CAUS!:: OFOfATH? MAN~jER OF DEATH NuO r,;JllJ.al .0 ACCident 0 ~uIClJe 0 HomlCJlJe DAlEO" IMor.<I"O", TIME OF iNJLJf<Y ItJJUf.!'{ AT 'NORP ufSCRIBE HOVVINJURi 1jr":URRE'u i~'O 1'00' Yes 0 PendinG Irhesl'g~j,ul' o o o ~~:Cl' h,,,,,,,,,~ ", fri'O tJoO CouldnOIbe [!elerrr"ned "" M ", '" ;CA II;)/>< ISI'~el, Crt.,,'),,,,,,, SI~'e', 2Sa 2Bb CERTIFIER{CI,eCkofllyonel .f~~J~fbY~~POr~~~;~~7e~~Sd~:;;,c~~~~lr~%d~~S: l~f t~eea~ha~~:~(:~'~~:1~~A~~;a~~ ":M;~~.'~~~ce\J deatn and compleled 'lerT' ;li " 'i<"'lI(',ldi"; 5t'eel, I~O'''y ot1lce '" '"' .. '.,,( -7'_"'- ....l-~ /,ll//:>ZV.( I 031b L'CEr~SF / ~ .SI,>>('1I::,[)~~~n[r, ~a~ Ye<l'i 31/Y! 31d, 7'/ -.:.-t __{) y~ NAME Aim ADGf,lS" 9:::.I'ERSON 'M,O CU.MPlEfAU CAIJSE 01- [;LATH ilterll~I!,',peo,P"", -'-.:H{,I""/t':'t' //rV()i?.-l:".....,:,,; 'VI:; O 'l'--'"z:.I.!-II'.-n..,r" 17 l,..'h'? 32. ..~(? ____.':_<_ ~.,-nA.--::'~'." . [J.AIEf'ILEDIM(}<;fn, f)dl' h-"J .PRONOUNCING AND CERTIFYING PHYSICIAN 1Pr'V5lc,an ~011' prvnv""clng rlcam and ce<1I/'yJn9 to ca",e.)< "eal~i 10 the besl of my knowledge. dealh occurred at Ihe lime, date,andpt ace,."ddu~tothec.uses(s)a"dll1ano"r;Js5lated ~ .MEDICAL EXAMINER/CORONER On the basis 01 eumlflatiofl andlor iovutigaliofl, 10 my opinion. death occurred al the time. dal~, and place, and due to the c;JlJse'ls) ""d manoerosstated '" SSIGNATU o " " LAST WILL AND TESTAMENT OF MARIE A. KICHMAN I, Marie A. Kichman of 1100 Valley Road, Marysville, Rye 'Iownship, Perry County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last will and Testament, hereby revoking all wills and codicils heretofore made by me. ITEM I. I direct that all my debts and funeral expenses, including my cemetery lot and gravemarker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my death as part of the expense of the administration of my estate. " ITEM II. I devise and bequeath all of my estate of every nature and wherever situate to my husband, Richard L. Kichman if he survives me by thirty (30) days. ITEM III. If my husband, Richard L. Kichman predeceases me on or before the thirtieth (30th) day following my death, I bequeath all my jewelry, rings, watches and old coins to Anna Livingston. ITEM IV. If my husband, Richard L. Kichman predeceases me or dies on or before the thirtieth day following my death, I devise and bequeath all of the rest, residue and remainder of my estate of every nature and wherever situate unto Anna Livingston, IN TRUST, for Richard L. Kichman, III, on following terms and conditions: A. Trustee shall payout at her discretion any amount she considers reasonable for the maintenance of beneficiary after the Trustee takes into consideration all other funds available for the beneficiary maintenance. B. Trustee shall pay health or medical insurance if the beneficiary has no medical coverage. C. When the beneficiary attains the age of twenty (20) years, any money or property still held in trust shall be distr ibuted absolutely and not in trust as follows: seventy-five (75%) percent unto Richard L. Kichman, III and twenty-five (25%) percent unto Anna Livingston. ITEM V. I direct that any and all Inheritance, Estu~e and Transfer taxes imposed upon my estate passing under my Will or otherwise, shall be paid out of the principal of my residual estate. of ITEM VI. this my I appoint Last will my husband, Richard L. Kichman, Executor and Testament. In the event of his ... renunciation, death, resignation or inability to act for any reason whatsoever, I appoint Anna Livingston, Executrix of this my Last Will and Testament. I relieve my Executor or Executrix from the necessity of posting security in connection with his or her duties as such in any jurisdiction in which he or she may be called upon 'I to act. ITEM VII. This will is not the product of any contract or agreement between me and my husband, Richard L. Kichman and my husband shall be free to dispose of any property (whether acquired under this will or otherwise), either during his lifetime or by Will, as he deems proper in his sole discretion. ITEM VIII. In the event my husband, Richard L. Kichman dies under such circumstances that there is not sufficient evidence to determine absolutely whether he survived me, I direct for of this will that he shall be conclusively presumed predeceased me. purposes to have IN WITNESS WHEREOF, I have hereunto set my hand to this my Last will and Testament, which consists of ~ pages, to each of which I have affixed my signature this ~~. day of February, one thousand nine hundred and ninety-three (1993). /.//,:' ) l- I / , Marie A. Kichman /": , COMMONWEALTH OF ;' I I COUNTY OF \.. C' PENNSYLVANIA ss ;:UJ...~ " t.' t~"'; .. \'Ie Marie A. Kichman and I , ,t/ 1.1./ / / / //;;'/; r) //} " _.L....... ," _ -/ , and ;' //j ; I '...' ,! "" 1 the testatrix and the witnesses respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes ! therein expressed, and that each of the witnesses, in the presence I and hearing of the testatrix, signed the will as witness and that to the best of their knowledge the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Testatrix witness - - ~ l ~j~ witness Subscribed and sworn to and acknowledged before me Kichman, Testatrix and ,subscribed and swprn to and b f b . , . I '. ,; '-, -J e ore me Y /! /i/ii) >- /~. (/1,,//, ii, I! / /./ ;' f witnesses this ..-~. , (!, t; by Marie A. acknowledged , and -f i .) ;/1 day of 1-''- , I. , ! ( ,1993. } 1<' I C' . Notary/Public I . I '" " . /' / ',Jj /' I; (-/l,,'- NOT AR!AL SEAL JODI A. CRUIWCH, Notary Publk: Camp Hill Boro, Cur.rberlClnd Co., P~. I My Corr:missiM~~~~es Aug_-___~, .1_??3 ~ , BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REY-liD7 EX AFP IDl-Q5l FOREST N MYERS F N MYERS LAW OFFICES 137 PARK PL WEST SHIPPENSBURG '04 SEP 15 118 :24 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-30-2004 HINKLE 1l-04-2003 21 03-0938 CUMBERLAND 101 MARGARET M Anount Renitted ('.'" . y"::;.:t; PA 1~lMbG 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, subnit the upper portion of this forn with your tax paynent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ R'EV=i6"ifj-i3f-AFP--foY.:oiY------...--fNifERiYANC'E--fAX--STA-fEM'E-tif-ifF'-AC-cou'Nf--.-..------------------ --- ESTATE OF HINKLE MARGARET M FILE NO.21 03-0938 ACN 101 DATE 08-30-2004 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-19-2004 PR I NCI PAL T AX DUE: ........................................................................................................................................................................................................................... 7,275.37 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-30-2004 CD003514 157.89 3,000.00 05-21-2004 CD003968 .00 3,911.61 07-28-2004 CD004209 .00 205.87 TOTAL TAX CREDIT 7,275.37 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) ~~ r =r CJ CJ CJ CJ ,...::! ,...::! rn rn CJ to i" ~E;:::=~~*;;::::::'::::::::::::::::::: U.S. Postal ServiceTM CERTIFIED MAILw RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) , ,. , , , ., , , r OFFICIAL USE I Postage $ Certified Fee Return Reclept Fee postmark (Endorsement Required) Here Restricted Delivery Fee (Endorsement Required) Total postage & Fees $ ,...::! rn ,...::! ::r rn l"- I"- LI1 PS Form 3800 June 2002 See Reverse for Instruction. cO CJ ..D lr rn CJ ru ,...::! ,...::! CJ CJ CJ CJ ,...::! CJ ,...::! rn ~ ;~::",m"'{."'''';~':C:f\::C~~::::::::::: CitY.-SiBhi;ZiP+4-------t~J-1~---~ U.S. Postal ServiceTM CERTIFIED MAILTM RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) postage $ Certified Fee Postmark Return Reciept Fee Here (Endorsement Required) Restricted Delivery Fee (Endorsement Required) Total Postage & Fees $ :11 . " : BEFORE THE REGISTER OF WILLS OF : CUMBERLAND COUNTY, PENNSYL VANIA ESTATE OF MARIE A. KICHMAN Deceased : NO. 21-04-0938 NOTICE AND NOW, this 13th day of January, 2005, upon receipt of an instrument purported to be the last will of Marie A. Kichman, dated September 12, 2004, a copy of which is enclosed, and which was filed within three months of the testator's death, the Register of Wills' of the Court of Common Pleas of Cumberland County hereby provides notice to the Petitioner, Anna Livingston, that the Register of Wills may open the probate record, receive proof of the later instrument and amend her probate record unless cause is shown why she should not do so. Such cause is due within ten (10) days from receipt of this notice. William C. Dissinger, Esquire 28 North Thirty-second Street Camp Hill, PA 17011 James D. Cameron, Esquire 1325 North Front Street Harrisburg P A 17102 LJ_ co o C.-- lr) t:91 foS : m w:.. 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J. , ~ --~_._---- - --- -- ~-- ----- --- --- -- ---------- - ---- ----- ---:rq ir.(:,~-- . -'. -...-.-.- ----.--- ------~-.--------- -- --- --.-- ----- -_____u -- - - - --- -~ -- - --- - ~--- ---- V'- LL C) en Lt.! _.~! C_J ;:-:c_~ F:= :::-- '---.? C I.L; (-~::: C) C) Ll..J D.:.: " ~STATE OF MARIE A. KICHMAN DECEASED :BEFORE THE REGISTER :OF WILLS OF CUMBERLAND : COUNTY, PENNSYLVANIA :NO, 21-04-0938 RESPONSE TO RULE TO SHOW CAUSE lL CJ 2(C.r;-" ~;Md now comes Anna Livingston, a.k.a. Anna Hurrell, xao~trix of the Estate of Marie A. Kichman who states as ol1~~;: Cj <' 1. Marie A. Kichman died on September 19, 2004. 2. On October 19, 2004, letters testamentary were granted to Anna Livingston, a.k.a. Anna Hurrell, by the Cumberland County Register of wills and the Last Will and Testament of Marie A. Kichman, dated February 5, 1993, was admitted to probate, 3. On December 17, 2004, a writing proported to be a will of Marie Kichman dated September 12, 2004, was admitted to record. 4. On January 14, 2005, a Notice, in the Nature of a Rule to Show Cause was issued by the Cumberland Register of wills to show cause why the probate record should not be opened and proof of the instrument proported to be dated September 19, 2004, be received and the probate record amended. 5. The writing submitted December 17, 2004, should not be accepted as the Last will and Testament of Marie A. Kichman for the following reasons: a) The writing is instructions to Attorney Joe Kerwin to prepare a new will, not a will. b) The writing is internally inconsistent and it would be impossible to administer the estate and determine disposition of " the estate if the writing were determined to be a will. c) At the time the writing is alleged to have been prepared and executed, Marie A. Kichman, due to illness, was unable to communicate. d) At the time the writing is alleged to have been prepared and executed, Marie A. Kichman, due to illness, lacked testamentary capacity. e) At the time the writing is alleged to have been prepared and executed, Marie A. Kichman, due to illness, was easily influenced and susceptible to suggestion. f) At the time the writing is alleged to have been prepared and executed, Marie A. Kichman, was subject to undue influence. For the foregoing reasons, Anna Livingston, a.k.a. Anna urrell, Executrix of the Estate of Marie A. Kichman, request the robate record not be opened or amended and the writing alleged o have been executed on September 12, 2004 not be accepted as a ill of Marie A. Kichman no admitted to probate. ate: /-:Ji.f - 0 S- ~ fr; J./~ Anna A. Hurrell " VERIFICATION I I, Anna Hurrell, verify that the statements made in the ~OregOing document is true and correct. I understand that false I ftatements herein are made subject to the penalties of 18 Pa.C.S. 4904, relating to unsworn falsification to authorities. ate: 1- ~L{- 0 S- . , ~@ MARIE A, KICHMAN DECEASED :BEFORE THE REGISTER :OF WILLS OF CUMBERLAND : COUNTY, PENNSYLVANIA :NO. 21-04-0938 CERTIFICATE OF SERVICE I, William C, Dissinger, Esquire, do certify that I have on the day indicated served a true and correct copy of the attached "Response to Rule to Show Cause" on James Duryea Cameron, Attorney for Christopher Kichman and Leroy Wade by depositing the same with the United States Mail first class postage prepaid addressed as follows: James Duryea Cameron 1325 North Front Street Harrisburg, PA 17102 ate: ~~~ , Dissinger at Law . REV.1500 EX (6-00) .. REV-1500 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 FILE NUMBER 21 04 INHERITANCE TAX RETURN RESIDENT DECEDENT COUNTY CODE YEAR I- Z W C W U W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Kichman, Marie A. SOCIAL SECURITY NUMBER 190-52 -4041 DATE OF DEATH (MM-DD-YEAR) 09/19/2004 DATE OF BIRTH (MM-DD-YEAR) 03/01/1942 THIS RETURN MUST BE FILED IN REGISTER OF SOCIAL SECURITY NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) NA W I- ~~U) UO::~ wD-U :x: 00 uO::...J D-CD D- o:{ ~ 1. Original Retum o 4. Limited Estate o 6. Decedent Died Testate (Attach copy 01 Will) o 9. Litigation Proceeds Received o 2. Supplemental Retum o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy 01 Trust) o 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-95) o 3. Remainder Return (date of +ath prior to 12-/3-82) o 5. Federal Estate Tax Returnl Required ..Q... 8. Total Number of Safe Deppsit Boxes o 11. Election to tax under se~. 9113(A) (Attach Sch 0) I- Z W C Z o D- U) w 0:: 0:: o U TH IS. SECTI.QN M.l.ISTBI: C.QMPI.I:TI:D. Al.l. C.QRRI:SP.QNOI:N~I:ANO. ~ONFIDI:NTIAI..TAXI N FORMATION:SHOl.lI..[) NAME COMPLETE MAILING ADDRESS William C. Dissinger 400 South State Road FI~M ~AME (II Appl'cablel. . Marysville P A 17053 DIssinger and DIssinger ' TELEPHONE NUMBER (717) 957-3474 1. Real Estate (Schedule A) 2 Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) 109,000.00 0.00 0.00 0.00 502.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) z o < ...J ~ l- n.. < u W 0::: 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o 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) 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) (8) 22,134.65 7,076.69 (11) (12) (13) (6) 0.00 (7) 0.00 (9) (10) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ~ ~ n.. :!E o u >< ~ 0938 _1--___ UMBER DIRECTED TO: I (,,,", <) 1[", ,-=?, ",'1 --'j . :' .'1 " C..J ('J ':""1 :'J (-') ,:1"1 /- ..... -on r....,) ()'1 109,502.00 29,211.34 80,290.66 0.00 80,290.66 15. Amount of Line 14 taxable at the spousal tax 0.00 x.oL 0.00 rate, or transfers under Sec. 9116 (a)(1.2) (15) 16. Amount of Line 14 taxable at lineal rate 80,290.66 x.O~ (16) 3,613.08 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17) 0.00 18. Amount of Line 14 taxable at collateral rate 0.00 x .15 (18) 0.00 19. Tax Due (19) 3.613.08 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ , Decedent's Complete Address: STREET ADDRESS 821 Wertzville Road CITY Enola STATEpA Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 0.00 0.00 0.00 3. InterestlPenalty if applicable D. Interest E. Penalty Total Credits ( A + B + C ) (2) 0.00 0.00 TotallnterestlPenalty ( 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. (5) A. Enter the interest on the tax due. (5A) 3,613.08 0.00 0.00 0.00 3,613.08 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 3,613.08 PLEASE ANSWER TH:aF:L~~::::~~:I:N::::S~:~N:::'~~~: ::E:ROPRIATE BL~~~S No [Kl [Kl [Kl [Kl 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred;.......................................................................................... 0 b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 c. retain a reversionary interest; or.... ................... .... ................................... ................... ................ ......................... 0 d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . ........................ ..................................................... ................................ 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .. ..... .... .......... .... ..... ..................... ..... .... ................. .................. ................... ...... 0 [!] [Kl [Kl IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART 0 THE RETURN. Under penalties of pe~ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of prepar other than the personal representative is based 0 all information of which preparer has any knowledge. SIGNATURE F PIERSON RESPO~ iR FILlN ( ..??'L--KA . ADDRESS 821 Wertzville, Enola, PA 17025 SIGNATURE 0 PR ER OTHER TH V DATE , tf -3/-C{S- ! I 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 spoure is 3% [72 P.S. 39116 (a) (1.1) (i)]. I For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers % [72 P,S'139116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirem( 1)u e.. ~3S _ 0() lturn are sill applicable even if the surviving spouse is the only beneficiary. I 'l=>C\ ;)...00 c>0 I Pf>D ~ S . (N Jral parent, Ian adoptive parent, .2) [72 P.S. ~9116(a)(1)]. ed, under Section 9102, as an 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 a stepparent of the child is 0% [72 P.S. 39116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiari The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is individual who has at least one parent in common with the decedent, whether by blood or adoption. 3, ~'-8\ , .. REV-1502 EX+ (6-9_ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF Marie A Kichman FILE NUMBER 21-04-0938 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller. neither being compelled to buy or sell. both having reasonable knowledge 01 the relevant acts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION 821 Wertzville Road. Enola. PA 17025 (appraisal attached) VALUE A DATE OF DE ATH 109.000.00 TOTAL (Also enter on line 1. Recapitulation) $ (II more space is needed. insert additional sheets 01 the same size) 1 ( 9,000.00 " REV-15G8 EX+ (6-98). COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Marie A. Klchman FILE NUMBER 21-04-0938 Include the proceeds of litigation and the date the proceeds were received by the estate All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALU AT DATE NUMBER DESCRIPTION OF DEATH 1. Checking accl #0513304394 with Commerce Bank 202.00 2. Misc. furniture 300.00 TOTAL (Also enter on line 5, Recapitulation) $ 502.00 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99)W COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Marie A. Kichman FILE NUMBER 21-04-0938 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AM UNT A. FUNERAL EXPENSES: I 1. Pamela's Flowers 150.41 2. Richardson Funeral Home 4,816.00 I B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 6,570.12 Name of Personal Representative(s) Anna Livingston a/k/a Hurrell Social Security Number(s)/EIN Number of Personal Representative(s) - Street Address 821 Wertzville Road City Enola State P A Zip 17025 Year(s) Commission Paid: 2005 2. Attorney Fees 6,570.12 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant Anna Livingston a/k/a Hurrell Street Address 821 Wertzville Road City Enola State PA Zip 17025 Relationship of Claimant to Decedent Daughter 4. Probate Fees 228.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7. Homemasters Realty Group (appraisal) 300.00 TOTAL (Also enter on line 9, Recapitulation) $ 2,134.65 .. (If more space IS needed, Insert additional sheets of the same sIze) II REV-1512 EX+ (12-03) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-04-0938 ESTATE OF Marie A. Kichman 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 NUMBER DESCRIPTION OF EATH I 10. 1. Cardiovascular Surgicallnst. 305.00 2. Quest Diagnostics 96.94 3. Pulmonary & Critical Care Medicine Assoc., P.C. 470.00 4. Siegelbaum, Gunder & Lacey Gastroenterology 418.75 5. Associated Cardiologists 25.00 6. Tristan Assoc. 1,755.00 1,725.00 350.00 7. Quantum Imaging & Therapeutic 8. Harrisburg Gastroenterology, Ltd. 9. Pathology Assoc. of Central PA 290.00 Andrews & Patel Assoc., P.C. 661.00 11. Heritage Cardiology Assoc. 19.00 12. Watkin, Freshman & Nipple Assoc. 961.00 Note: All the above debts are medical bills due an owing - the decedent had no medical insuranc and was deemed ineligible for assistance. TOTAL (Also enter on line 10, Recapitulation) $ 17,076.69 (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 Marie A. Kichman FILE NUMBER 21-04-0938 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF E$"ATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under i Sec. 9116 (a) (1.2)] I 1. Richard L. Kichman, III, deceased son 75%1 2. 1 Anna Livingston a/k/a Hurrell daughter 25%1 i ! I , ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER S~EET II NON-TAXABLE DISTRIBUTIONS: ~. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE , , B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS I ! 0.00 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ I (If more space is needed, insert additional sheets of the same size) \ ...---- ~ ~ ~. ~ r -...: '>-. ,,' , ~ . ~ ;: I '. ,. \ I LAST WILL AND TESTAMENT OF i I I, Marie A. Kichman of 1100 va'lley Road, MarYSVill~, Rye 'Township, Perry County, Pennsylvania, being of sound and di posing mind, memory and understanding, do make, publish and decla e this to be my Las~ will and Testament, hereby revoking all wills and codicils heretofore made by me. MARIE A. KICHMAN ITEM I. I direct that all my debts and funeral expenses, including my cemetery lot and gravemarker and all expenses of my last illness, shall be paid from my residuary estate as s on as practicable after my death as part of the expense of the administration of my estate. \ ITEM II. I devise and bequeath all of my estate of I every I nature and wherever situate to my husband, Richard L. Kichma1 if he I survives me by thirty (30) days. I I I I ITEM III. If my husband, Richard L. Kichman predeceases me on or before the thirtieth (30th) day following my death, I be ueath all ~y jewelry, rings, watches and old coins to Anna Living ton. ITEM IV. If my husband, Richard L. Kichman predeceases me or dies on or before the thirtieth day following my death, I evise and bequeath all of the rest, residue and remainder of my est te of every nature and wherever situate unto Anna Livingston, IN for Richard L. Kichman, III, on following terms and conditi A. Trustee shall payout at her discretion any amou~t she I considers reasonable for the maintenance of benef~ciary after the Trustee takes into consideration all lather I I funds available for the beneficiary maintenance. I I I I I B. Trustee shall pay health or medical insurance if the beneficiary has no medical coverage. h'hen the beneficiary attains the age of tLenty (20) years, any money or property still held in tru~t shall be distributed absolutely and not in trust ab follows: seventy-five (75%) percent unto Richard L. Kjchman, III and twenty-five (25%) percent unto Anna LiVilgston. ITEM V. I direct that any and all Inheritance, ESt~te and I Transfer taxes imposed upon my estate passing under y will or otherwise, shall be paid out of the principal of m residual c. ~ estate. \' of ITEM VI. this my I appoint my husband, Richard L. Kichma~, Last will and Testament. In the eve t Executor of his ,", ~, renunciation, death, resignation or inability to act for any reason whatsoever, I appoint Anna Livingston, Executrix of th's my Last will and Testament. I relieve my Executor or Executri from the necessity of posting security in connection with his or her duties as such in any jurisdiction in which he or she may be c lIed upon to act. -'--- J- " , ~ / ITEM VII ~ This will is not the product of any c or agr~ement between me and my husband, Richard L. Kich my husband shall be free to dispose of any property (whethe acquired under this Will or otherwise), either during h~s life ime or by will, as he deems proper in his sole discretion. ITEM VIII. In the event my husband, Richard L. Ki hman dies under such circumstances that there is not sufficient e idence to determine absolutely whether he survived me, I direct fo of this will th~t he shall be conclusively predeceased me. purposes to ha ve \ I --11 :! I ;1 Last I IN WITNESS WHEREOF, I have hereunto set my hand Ito this my Will and Testament, which consists of ,:) pages, ito each of -rt. ,1 which I have affixed my signature this .s - day of Fe~ruary, one thousand nine hundred and ninety-three (1993). " -:J); -.- .\ :./' /'- Co. -____ -/ ) I .4.-,: ~'\.." ..c.--< .....~. Marie A. Kichman 11 ~..---,--.- .+-_.~_...---. ---'.-- . , COMMONWEALTH OF PENNSYLVANIA (, COUNTY OF l ~ /. '/flit ~.'> / (7/-'/...~:'- .......~, 'J ,-.'~ _~-t......-t..- ss ~, / / j j,~ We Marie A. ,Kichman and ('j /1/1(1,''2-(/ and ',' I / 1/ ! ,), I / / i 1/,/j./lJ ,I'. )';-/,',llj1t'if",:" the testatrix ~and th witnesses i respectively, ~os~ names ~re signed to the attached 0 foregoing instrument, being first duly sworn, do hereby decl re to the undersigned authority that the testatrix signed and e the instrument as her last will and that she had signed wil ingly, and that she executed it as her free and voluntary act for t e purposes therein expressed, and that each of the witnesses, in t~e presence ! and hearing of the testatrix, signed the will as witne1s and that to the best of their knowledge the testatrix was at that time eighteen years of age or older, of sound mind andl under no constraint or undue influence. i I i . 7-:7, -? " ~~'--'! :::; j-( <-<- ~'VL-<'_' I Testatrix I I ,,' /, .' I ( --f- ~' .~<;__ .~~- f I \x, -" ), . - / ',-'. ~. ....!.- j.. J 1..(, I "L_____ .-"\ /' r ( ;:-C.,--<=- \.~ . witness Subscribed and sworn to and acknowledged before me Kichman, Testatrix and,]Subscribed apd s~orn. to and before me by Ifj; Ii ~ l// f( --=r!. / 7/1 ? /( '7 f/ f~t. / j ;'/ (1 J {/ ,~jL,-I,) ( ns/,('-) ---1.::l:: (c UJ i( J./ / . ,,-19 9 3 . _"" - .f ,/' , ./ j I .,: Ii" .1 ,:' ;--Af' (J ,L /-/ / (LU; }1/ {(!./---, Notary/ Publ ic / . - '- ! J Marie A. a:~noWledged , , and 1/., day of NOTARIAL SEAL JODI A. CRUMLICH, Notary Publ1e Camp Hill Boro, Cumberland Co., Pa. ,~ My Commission Expires Aug. 30, 1m, Date: NOVEMBER 11, 2004 Prepared for: WilLIAM DISSINGER. ESQ MARIE A KICHMAN, ESTATE 821 WERTZVlllE ROAD ENOLA. PA 17025 Property Appraised: N/A 821 WERTZVlllE ROAD ENOLA, PA 17025 Work Performed: RESIDENTIAL APPRAISAL REPORT INVOICE DUE UPON RECEIPT Please make checks payable to: HOMEMASTERS REAL TV GROUP P. O. BOX 66 MARYSVlllE, PA 17053 INVOICE File No. 20041009 Case No. Total Amount Due: $ ClickFORMS Appraisal Software 800-622-8727 $ $ $ $ $ $ 300.00 300.00 \ I I! APPRAISAL REPORT OF 821 WERTZVILLE ROAD ENOLA, PA 17025 PREPARED FOR WILLIAM DISSINGER, ESQ MARIE A KICHMAN, ESTATE 821 WERTZVILLE ROAD ENOLA, PA 17025 AS OF NOVEMBER 1, 2004 PREPARED BY HOMEMASTERS REALTY GROUP P. O. BOX 66 MARYSVILLE, PA 17053 ., ..........._. .OW'. . ....._. _. -. .-...-.......... -..- . .-' -- - - File No. 20041009 Case No. \ I Table of Contents Page Title Summary of Salient Features Appraisal Identification URAR Page 1 URAR Page 2 Extra Comps 4-5-6 Photo Subject Photo Com parables 1-2-3 Photo Com parables 4-5-6 Location Map Sketch Untitled Exhibit Letter DEATH CERTIFICATE Subject History Flood Map Limit.Cond. w/Environ. USPAP Certification FIRREA Addendum Page 1 FIRREA Addendum Page 2 Untitled Exhibit Letter Untitled Exhibit Page # 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Clicl<.FORMS Appraisal SofNIare 800-622-8727 II I'-"IWV"'\"-" 1 1'-"1 1 'wV"'\_ I ~l '" I I_"W'~'." \......... ,.... . ,- .-. . -. .--. . SUMMARY OF SALIENT FEATURES File No 20041009 Case No. Subject Address 821 WERTZVILLE ROAD Legal Description DEED BOOK 203; PAGE 335 -City ENOLA State PA Zip Code 17025-1834 Census Tract 0102.01 Map Reference 835 Size (Square Feet) 1,372 Price per Square Foot $ 0.00 Location AVERAGE Age 54 Condition AVERAGE Total Rooms 6 Bedrooms 3 Baths 1.00 Final Estimate of Value $ 109,000 ClickFORMS Appraisal Software 800-622-8727 Page 1 of 0 APPRAISAL AND REPORT IDENTIFICATION File No. 20041009 Case No. Borrower N/A Property Address 821 WERTZVILLE ROAD City ENOLA County CUMBERLAND State PA Zip Code 17025-1834 Lender/Client MARIE A KICHMAN, ESTATE Address 821 WERTZVILLE ROAD. ENOLA. PA 17025 This Appraisal conforms to one of the following definitions: [K] Complete Appraisal The act or process of estimating value. or an estimate of value. performed without invoking the Departure Provision. 0 Limited Appraisal The act or process of estimating value. or an estimation of value. performed under and resulting from invoking the Departure Provision. This Report is one of the following types: 0 Self Contained Report A written report prepared under Standards Rule 2-2(A) of a complete or limited appraisal performed under Standard 1. [K] Summary Report A written report prepared under Standards Rule 2-2(B) of a complete or limited appraisal performed under Standard 1. 0 Restricted Report A written report prepared under Standards Rule 2-2(C) of a complete or limited appraisal performed under Standard 1. Comments on Appraisal and Report Identification Note any departures from Standards Rules 1-2, 1-3, 1-4, plus any USPAP-related issues requiring disclosure: I ----~~~-----,_._- ..-- ChckFORMS Appraisal Software 800-622-8727 Page 2 of 20 SUMMARY APPRAISAL REPORT 04!tIv OescriDtion UNIFORM RESIDENTIAL APPRAISAL REPORT Case No. Prooellv Address 821 WERTZVILLE ROAD Citv ENOLA State PA Zio Code 17025-183<1 Leaal Descriotion DEED BOOK 203: PAGE 335 Countv CUMBERLAND Assesso(s Parcel No. 09-14-0835-053 Tax Year 2004/2005 R.E. Taxes $ 1,700 EST Soecial Assessments $ UNKNO,^ N Borrower N/A CurrenlOwner MARIE A KICHMAN ESTATE Occuoant I IOwner I Tenant IX I Vacant .. Prooertvriahtsaooraised iXlFeeSimole I ILeasehokl Pro--;;;;:tTvnP ilPUD ilCondominiumlHUDNAonlvl HOAS IlJo. N<>inhborhood or Proiect Name EAST PENNSBORO TOWNSHIP Mao Reference 835 Census Tract 0102.01 Sale Price $ MARKET Date of Sale N1A Descriotion and $ amount of loan charoes/concessions to be oaid bv seller NONE Lender/Client MARIE A KICHMAN, ESTATE Address 821 WERTZVILLE ROAD. ENOLA. PA 17025 Anoraiser THOMAS S. HOFFMASTER Address P. O. BOX 66, MARYSVILLE PA 17053 Location == Urban .;, Suburban = Rural Predominant Sil1l!le family hous~ "'-tllnd...% Bui~ up _ Over 75% ~ 2S-75% _ Under 25% ~upancy ~()(J()~ ~I One family 50 Growth rate ..,.. Rapid 25. Stable _ Slow 2S. Owner ~ Low ~ 2-4 family 5 Property values 2S. Increasing .,.,. Stable _ Declining _ Tenant 350 Hioh 100+ Multi-family 5 Demand/supply _ Shortage 4 In balance = Over supply 2S. Vacant (0-5%) .7a Predominant I',;Y Commercial 5 Marketinotime Under 3 mos. X 3-6 mos. Over 6 mos. Vacant'over5%\ 110 I 35 VACANT lOr Note: race and the raclal composition of the neighborhood are not appraisal factors. . Neighborhood boundaries and characteristics: THE SUBJECT PROPERTY IS LOCATED IN AN AREA WITH VARIOUS LAND USES PRESENT AN . IS SITUATED IN EAST PENNSBORO TOWNSHIP ON THE NORTH SIDE OF ROUTE 944, EAST OF CAROL LANE . Factors that affect the marketability of the properties in the neighborhood (proximity to employment and amenities. employment stability. appeal to market. etc.): CENTRAL PENNSYLVANIA IS A STABLE AREA WITH DIVERSIFIED EMPLOYMENT OPPORTUNITIES INCLUDING THE STATE GOVERNMEN . .. INDUSTRY AND AGRICULTURAL POSSIBILlTES. THE AREA IS WITHIN A REASONABLECOMMUTE TO EMPLOYMENT OPPORTUNITIES AN SHOPPING FACILITIES. PUBLIC PARKS AND SCHOOLS ARE AVERAGE FOR THE NEIGHBORHOOD AND ARE WITHIN ACCEPTABU DISTANCES. BELOW AVERAGE TO ABOVE AVERAGE PROPERTY MAINTENANCE PROGRAMS WERE OBSERVED. I FileNo. 20041009 Land use change , D Not likely D Ukelyl 00 In process I' To: RESI:EIITW.. 25% WOODED & AGRICUL rURAL Market conditions in the subject neighborhood (including support for the above conclusions related to the trend of property values. demand/supply. and marketing time - such as data on competitive properties for sale in the neighborhood. description of the prevalence of sales and finandng concesslons. etc.): VARIOUS PROPERTIES ARE CURRENTLY ON THE MARKET FOR SALE IN THIS MARKET AREA. THERE ARE NO ADVERSE MARKET CONDITIONS OR CONCESSIONS IN THIS MARKET AREA THAT WOULD ADVERSELY AFFECT THE MARKETABILITY OF THE SUBJEC PROPERTY. CONVENTIONAL LOANS COMMONLY HAVE ONE TO THREE POINTS. WITH NO POINTS AS WELL AS MORE THAN THRE POINTS ALSO AVAILABLE WITH VARYING INTEREST RATES. NO PERSONAL PROPERTY ITEMS WERE INCLUDED IN THE FINAL ESTIMATE OF VALUE. . Project Information for PUDs (If applicable - Is the developerlbuikler in control of the Horne Owne(s Association (HOAl? U Yes ~ No Approximate lOtal number of units in the subject project Nt A Approximate total number of units for sale in the subject project Describe common elements and recreational facilities: NOT APPLICABLE Dimenslons 70 X 189.58 X 70 X 190.45 Topography LEVEL Site area .31 ACRES Corner Lot DYes [K]No Size TYPICAL FOR THIS AREA Specific zoning dassification and description R-l RESIDENTIAL Shape RECTANGULAR I Zoning compiance: 00 LegalUR Legal nonconforming (Grandfathered use) U Illegal 0 No Zoning Drainage APPEARS ADEQUATE Hiohest & best use as imoroved: . rXl Present use n Other use lexolain\ VIeW AVERAGE FOR AREA Utilities P~lic Other Off-site Improvements Type Pu~ Private Landscaping AVERAGE FOR AREA Electricity X 100 AMPS Street ASPHAL T ~ 8 Driveway Surface MACADAM Gas Curblguller NONE i= Apparent easements UTILITY Water X Sidewalk NONE ~ R FEMA Special Flood Hazard Area UVes [KJ No Sanitary sewer X Streetlights YES e2S. FEMA Zone C Map Date 04/15f1977 Storm sewer Allev NONE FEMA Mao No. 420359 0003B Comments (apparent adverse easements. encroachments. special assessments, slide areas. illegal or legal nonconforming zoning use. etc.): NO ADVERSE SITE CONDITIONS WERE OBSERVED. GENERAL DESCRIPTION EXTERIOR DESCRIPTION No. of Units ONE Foundation CONC. BLOCK No. of Stories ONE Exterior Walls BRICKlALU~ Type (Det./AlL) DETACHED Roof Surfaces ASP/GAB Design (Style) RANCH Gutters & Dwnspts. ALUMINUM ExistinglProposed EXISTING Window Type WI AWNING Age (Yrs.) 54 Slom1IScreens THERMOSlYE~ Effective A nP IV rs. \ 12 Manufactured House NO ~ ROOMS Fover Uvino Dinino Kitchen Den Basement Levell . Level 2 FOUNDATION Slab NONE Crawl Space 28% Basement 72% Sump Pump NO. DRAIN Dampness MINIMAL Settlement UNAPPARENT Infestation UNAPPARENT Famih;Rm. Rec. Rm. Bedrooms 1 BASEMENT INSULATlON_' Area Sq. Ft. 988 Roof _.,.,. % Rnished 50 Cemng _ X Ceiling DRYWAlL Walls _! Walls DRYWAlL Floor _ ~ Floor CARPET None _ ~ Outside Entry YES-DOOR Unknown_ '-- THERMOPANES # Baths Laundrv Other Area So. Ft. AREA 988 1.00 1,372 ! AREA 3 . Fl1ished area above orade contains: 6 Rooms; 3 Bedroom1s" 1.00 Bathlsl; 1,372 uare Feel of Gross Livinn Are INTERIOR Materials/Condition HEATING KITCHEN EQU~ ATTIC AMENITIES CAR STORAGE Floors CARPET.VNUAVE HTWTR. 8 ~ [K] Type Refrigerator ~ None Fireplace(s) # -i- None Walls DRYWALUAVE. Fuel OIL Range/Oven Stairs Patio Garage # of cars . TrimlFinish SOFTWOOD/AVE Condition AVE ~ I- Disposal i= Drop Stair Deck i== Attached Bath Floor VINYUAVE COOliNG Dishwasher ~ Scuttle ~ Porch ~ Detached Bath Wainscot FIBERGLASS/AVE. Central NO FanlHood Floor Fence CHAIN LINK Buitt-In Coors HOLLOW CORElAV Other Microwave ~ R ~ - Healed Pooi Carport 330 SF KlCABINETS PINEl B/AVE Condition NtA WasherlDrver Finished STOOP 20 SF Fx" Drivewav ADEQ Additional fealures (special energy efficient ~ems. etc.): 1 VANITY; 1 MEDICINE CABINET; 2 CEILING FANS; TEXTURED CEILINGS; UV LIGHT; Condition of tie improvements, depreciation (physical, functional, and external). repairs needed, quality of construction. remodeling/additions. etc.: NO FUNCTIONAL Of; EXTERNAL OBSOLESCENCE WAS OBSERVED. SOME OF THE WALL AND FLOOR COVERINGS SHOW WEAR. NO REPAIRS ARE MADE A CONDITION OF THIS APPRAISAL REPORT. NO PERSONAL PROPERTY IS INCLUDED IN THIS APPRAISAL REPORT .: I Adverse enWonmentaJ conditions (such as, but not Iim~ed to. hazardous wastes. toxic substances, etc.) present in the improvements. on the site, or in the inmediate vicinity of the subject property.: THE APPRAISER IS NOT AN EXPERT IN THE IDENTIFICATION OF HAZARDOUS SUBSTANCES OR DETRIMENTAL ENVlORONMENT AL CONDITIONS. THE APPRAISER DOES NOT WARRANT OR GUARANTEE THE ABSENCE OF SUCH CONDITIONS Fredde Uac Form 70 &-93 Click FORMS Appraisal Software 800-622-8727 Fannie Mae Form 1004 (&-93) Page 3 of 20 ESTIMATED SITE VALUE = $ 28.000 Comments on Cost Approach (such as. source of cost estimate. site ~alue. ! ESTIMATED REPRODUCTION COST-NEW-OF IMPROVEMENTS: square foot calculation and for HUD, VA and FmHA. the estimated remaininll Dwelling 1.372 Sq.Ft.@$ 65.19 =$ 89.441 economic life of the property): NO FUNCTIONAL OR EXTERNAL : Bsmt. 988 Sq. Ft.@$ 10.00 = 9.880 OBSOLESCENCE OBSERVED. THE COST DATA WAS . APPLS. EXTRAS = OBTAINED FROM THE MARSHALL AND SWIFT RESIDENTI L GaragelCarport ~ Sq. Ft. @$ 8.00= 2.640 COST HANDBOOK, WHICH ESTIMATES REPLACEMENT cm T. Total Estimated Cost New = $ 101.961 NOT REPRODUCTION COST. THE CLIENT SHOULD OBTAII Less Physical 23 ] Functional [Extemaol THE SERVICES OF A CONTRACTOR IF REPRODUCTION · Depreciation 23.451 _ O.~ = $ 23.451 COST DATA IS NECESSARY. CURRENT COST AND LOCAL DeprecIated Value of Improvements = $ 78.51C MULTIPLIERS ARE APPLIED TO SAID COST DATA 'As is' Value of Sit&-lmprovements = $ 3,50C INDICATED VALUE BY COST APPROACH = $ 110.01C Est. Remainino Econ. Life: 40 vrs ITEM I SUBJECT COMPARABLE NO.1 COMPARABLE NO.2 COMPARABLE NO.3 821 WERTZVILLE ROAD 13 SALT RoAD 34 LOUIS LANE 330 SALT ROAD i Address ENOLA. PA 17025 ENOLA. PA 17025 ENOLA, PA 17025 ENOLA, PA 17025 ! Proximitv to Subiect~}~!,~;>~~,,:i:l8.' 0.43 MILES 1.09 MILES 0.82 MILES Sales Price $ MARKET '1e.Ji'~ioi\~#~ 122,900~,,;):;'-f:Mi~i~,1t-'~.1S 108.000 'f)E;-'.&<i,;;l';~$):il<1ilS 119,900 PricelGrossUv.Area $ 0.00 IZl $ 113.80 0liJi,t,t\'f',(~~' $ 86.40 0[;*.'XXii'J.''#)Jt; S 98.28 J2f Data and/or INSPECTION MULTIPLE LISTING SERVICE MULTIPLE LISTING SERVICE MULTIPLE LISTING SERVIC Verification Source COURTHOUSE COURTHOUSE RECORDS COURTHOUSE RECORDS COURTHOUSE RECORD VALUE ADJUSTMENTS BiltRIPTION DESCRIPTION +i-I$Adiustment DESCRIPTION +{-I$Adiustment DESCRIPTION +{.I$Adiustme t Sales or Financing CONVENTIONAL VA -2,54€ CONVENTIONAL i Concessions DOM-13 DOM-5 DOM-12! Date of Salemme ~f1'>,,:~'iiii~o:~'7.,,"f, 3-26-2004 7-30-2004 12-29-2003 +2,997 Location AVERAGE AVERAGE AVERAGE AVERAGE i Leasehold! Fee Simple FEE SIMPLE FEE SIMPLE FEE SIMPLE FEE SIMPLE Si1e .31 ACRES/AVE .41 ACRES/AVE -50( .20 ACRES/AVE .68 ACRES/AVE VIeW SEE ABOVE' SEE ABOVE" SEE ABOVE" SEE ABOVE" De~ign and APreal RANCH/AVE RANCH/AVE RANCH/AVE RANCH/AVE OualitvofConstruclion AlAVERAGE GOOD -3.50C AVERAGE +3.50( GOOD Aoe 54 52 EST 51 EST -BOC 47 EST Condition AVERAGE AlAVERAGE -3,50C AlAVERAGE -3,50( AlAVERAGE Above Grade Total I Bdrmsl Baths Total I Bdrmsl Baths Total I Bdrmsl Baths Total I Bdrmsl Baths Room Count 6 I 3 I 1.00 6 I 2 I 2.00 -2.00( 6 I 3 I 1.00 ( 6 I 3 I 1.00 Gross Uvino Area 1.372 So. Ft. 1.080 So. Ft. +5,11C 1.250 So. Ft. +2.13! 1.220 So. Ft. Basement&FlIlished 988SFBSMNT 1080SFBSMN -23( SLAB +6,47( 1,220 SF BSMN · Rooms Below Grade REC RM REC RM N/A +1.50( REC RM, PR . FunctionalUtirrrv AVERAGE AVERAGE AVERAGE AVERAGE HeatinolCoolino HTWTR.lNO OIL FHAlYES -2,50C GAS FHAlYES -2,50< ELECT BB/ NO Energy Efficient Items THERMOPANES THERMOPANES THERMOPANES THERMOPANES . Garaoe/Camnrt 1 CARPORT 1+ CAR ATTACHED -2.00C NONE +1,00C l+CARATTACHED Porch, Patio. Deck, STOOP C/STOOP -2,50( PORCH, SHED -1.00C STOOP, DECK Flfel)iace{s). etc. 2 DECKS. PORCH PORCH Fence, Pool. etc. FENCE NONE +50C FENCE NONE Fireplace NONE FIREPLACE -2,50C NONE FLUE NetAgj,[tolall _ J+ IXI- $ -13,620 IXI+ I ,- $ 4,459 I 1+ IXI- S Adjusted Sales Price ' et=-11 % I t-ler-4 % J ~et=-9% I of Comparable ross=20% Is 109,280 IGross=23% IS 112.459 IGross=19% $ 109.227 Comments on Sales Comparison (including the subject property's compatibility to the neighborhood, etc): PRICE PER GROSS LNlNG AREA FIGURES V AR DUE TO SQUARE FOOTAGE DIFFERENTIALS. HAD TO EXCEED GROSS ADJUSTMENT GUIDELINES FOR COMPARABLE #4 ALTHOUGH LIMITED, MARKET DATA OF CLOSED SALES WAS SUFFICIENT TO ARRIVE AT THE ESTIMATED MARKET VALUE. ALL OF THE ADJUSTMENTS WERE NECESSARY AND APPROPRATE TO ESTIMATE MARKET VALUE. .. ,.............., ''''' . ......... -.... .-...-.....-. -..- ..- .-. Valuation Section UNIFORM RESIDENTIAL APPRAISAL REPORT Case No 'I -1.8 0 -3,5 0 -1,4 0 -3,510 o +2.6 0 -5 0 -1.0( 0 -2,0 0 -2.0C 0 +5(0 -1,OCO -10.673 ITEM SUBJECT COMPARABLE NO.1 COMPARABLE NO.2 COMPARABLE NO.3 Date. Price and Data HAS NOT NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE Source, for prior sales TRANSFERED within year of aooraisal LAST 3 YEARS Analysis of any current agreement of sale. option, or listing of the subject property and analysis of any prior sales of subject and comparables withil one year of the date of appraisa . THE SUBJECT HAS NOT TRANSFERRED IN LAST 3 YEARS. COMPARABLE PROPERTIES HAVE NOT TRANSFERRED TWELVE MONTHS PRIOR TO THE APPRAISAL DATE. INDICATED VAlUE BY SAlES COMPARISON APPROACH $ 109.000 INDICATED VAWE BY INCOME APPROACH m APPlicablel Estimated Mar1\et Rent $ N/A /Mo. x Gross Rent Multiclier N1A =$ NlA This appraisal is made lKJ'as is' U subject to the repairs. alterations. inspections or conditions listed below U subject to completion per plans and specifications. I Conditions of Appraisal: THE SUBJECT PROPERTY WAS APPRAISED "AS IS," WITH NO CONDITIONAL ITEMS. NO REPAIRS ARE MADE A I CONDITION OF THIS APPRAISAL REPORT. NO PERSONAL PROPERTY ITEMS WERE INCLUDED IN THE FINAL ESTIMATE OF VALUE. Filla! Reconciliation: THE SALES COMPARISON APPROACH. THE INCOME APPROACH AND THE COST APPROACH WERE AL CONSIDERED TO EVALUATE THE SUBJECT PROPERTY. . The purpose of this appraisal is to estimate the market value of ~ r~ property that is~#Ubjlt t 10 this report, based on the abo~e conditions and the certification, contiflgent and limiting coodii!~' and market value definition that al staW,'fc attached Freddie . Form 439/Fannie Mae Form l004B (Revised JUNE 1993 ). I (WE) ESTJ THE MARKET VALUE, A:~D N'YJ L PROPERTY IS THE SUBJECT OFTHIS REPORT, AS OF NOVEMBER 1. 2004 . (WHICHJ"j DATEOFIHSPECTIONANO E .T 'H.....ATEOFTHIS~TOBE$ 109,000 , -"I? ~t:d)-.. '(J//fr, ';0 .;.I'~Y APPRAISER (ONLY IF REQUIRED): I ~M ~/rr' t ""I') . . - Signature ODid DDidNcI Name THOMAS S. HOFFMASTER ,...../ Name Inspect Property Date Report Signed NOVEMBER 11. 2Q"04 Date Reoort Signed StateCertitication# RL-001987-L State PA State Certifica1ion # State Of State License # State Of State License # Slate Freddie Mac Form 706-93 ChckFORMS Appraisal Software 800-622-8727 Fannie Mae Form 1004 (6-93) Page 4 of 20 Borrower N/ A Property Address City Lender/Client EXTRA COM PARABLES 4-5-6 File No. 20041009 Case No. 821 WERTZVILLE ROAD ENOLA County CUMBERLAND MARIE A KICHMAN, ESTATE Address Slate PA ZipCode 17025-1834 821 WERTZVILLE ROAD, ENOLA, PA 17025 These recent sales of properties are most similar and proximate to subject and have been considered in the market analysis. The description includes a dollar adjustment, ren ecting market reaction to those items of significant variation between the subject and comparable properties. If a significant item in the comparable property is superior to, or more fa orable thuabW:~e s~~~.prope~~~ a minus (-) adjustment is made, thus reducing the indicated value of subject; if a significant item in the comparable is inferior to. or less favorable th n, the su' t pro . a plus +) adiustment IS made, thus increasinq the indicated value of the subject. ITEM -t SUBJECT COMPARABLE NO. 4 COMPARABLE NO. 5 COMPARABLE NO. 6 821 WERTZVILLE ROAD 914 WERTZVILLE ROAD Address ENOLA, PA 17025 ENOLA PA 17025 Proximitv to Subi<lct _~11~~~~~?~fil~ 0.29 MILES Sales Price $ MARKET 109,900 {~~tf~44%:~~}t~~$ Price/Gross Uv. Area $ 0.00 0$ 61.29 ~ $ .0 $ 0 Data and/or INSPECTION MULTIPLE LISTING SERVICE Verification Source COURTHOUSE COURTHOUSE RECORDS VALUE ADJUSTMENTS _ OESCRlf'l1()< I-+{-)$Adiustment DESCRIPTION I-+{ -)$ Adiustment DESCRIPTION -+{-)$Adiu! tment Sales or Financing CONVENTIONAL I Concessions DOM-5 Date of Salemme 12-23-2003 +2,74 Location AVERAGE AVERAGE Leasehold/ Fee Simole FEE SIMPLE FEE SIMPLE Site .31 ACRES/AVE .96 ACRES/AVE -1,95C VIeW SEE ABOVE" SEE ABOVE" Desion and Aooeal RANCH/AVE RANCH/AVE Qualilv of Construction NAVERAGE AVERAGE +3,50( Ane 54 43 EST -2,20< Condition AVERAGE B/AVERAGE +3,50( Above Grade Total 1 Bdrmd Baths T otall Bdrms Baths T otatl Bdrms Baths T otall Bdrms Baths . Room Count 6 1 3 I 1.00 71 3 I 1.00 I I 1 1 Gross Uvioo Area 1,372 So. Ft. 1,793 8o.Ft. -7,36~ So. Ft. So.Ft. Basement & Finished 988 SF BSMNT 1176 SF BSMN -47( I Rooms Below Grade REC RM UNFINISHED +1,50C . Functional Utilitv AVERAGE AVERAGE I Heatioo/Coolioo HTWTR./NO GAS FHAlYES -2,50C Enerov Efficienlltems THERMOPANES THERMOPANE~ Ga"'""'Camort 1 CARPORT 2 CAR DETACHED -3,50C Porch. Patio, Deck, STOOP DECK, PORCH -2,00C Fireolacelsl. etc. Fence Pool etc. FENCE NONE +50( Fireolace NONE FIREPLACE -250( Net Ad;. (totall ~, ~.. 1 1+ IXI- $ -10,741 rxl+ r l- $ 0 XI+ I I- . $ 0 Adjusted Sales Price lNet= -10% I ~et= 0% I ~o/;--i~ of Comoarable IGross= 31% 1$ 99 159 IGross= 0% 1$ 0 ross= 0% $ 0 Comments on Comparables: ! , ITEM SUBJECT COMPARABLE NO. 4 COMPARABLE NO. 5 COMPARABLE NO. 6 Date. Price and Data HAS NOT NOT APPLICABLE Source, for prior sales TRANSFERED within vear of """"'isat. LAST 3 YEARS .~. . ClickFORMS Appraisal Software 800-622-8727 P 5 of 0 age ItIVIYln.,J I IVI I I~II~'''''''' ~I \II 1>...."...'-'..01 ,..... . _I ...... . .-.. .-. . -......-. SUBJECT PHOTO ADDENDUM File No. 20041009 Case No. II Borrower N/A Prooertv Address City ENOLA Lender/Client 821 WERTZVILLE ROAD County MARIE A KICHMAN, ESTATE CUMBERLAND Address Stale P A Zip Code 821 WERTZVILLE ROAD, ENOLA. PA 17025 17025-1834 FRONT OF SUBJECT PROPERTY 821 WERTZVILLE ROAD ENOLA. PA 17025 REAR OF SUBJECT PROPERTY STREET SCENE Page 6 of 20 I nVIVll"\v nvr r IYI/"\..:J I cru nVIVILIVIr\o,,) I L-l '\\..1 I 'L-r'\~ I I COM PARABLES 1-2-3 Borrower N/A Property Address 821 WERTZVILLE ROAD City ENOLA County Lender/Client MARIE A KICHMAN, ESTATE CUMBERLAND Address State P A Zip Code 821 WERTZVILLE ROAD, ENOLA, PA 17025 17025-1834 File No, 20041009 Case No. COMPARABLE SALE # 13 SALT ROAD ENOLA, PA 17025 COMPARABLE SALE # 2 34 LOUIS LANE ENOLA, PA 17025 COMPARABLE SALE # 3 330 SALT ROAD ENOLA, PA 17025 Page 7 of 20 I nVIVII"'\.;:) nvrrlYI1"'\01 c.r\/nVI'..IClltlf""l"'> I L-l'\."'" I "\.L-ru...I I '-II '.......VI COMPARABLES 4.5-6 Borrower N/A Property Address 821 WERTZVILLE ROAD City ENOLA County Lender/Client MARIE A KICHMAN, ESTATE File No. 20041009 Case No. CUMBERLAND State PA Zip Code 17025-1834 Address 821 WERTZVILLE ROAD, ENOLA, PA 17025 ClickFORMS Appraisal Software 800-822-8727 COMPARABLE SALE # 4 914 WERTZVILLE ROAD ENOLA, PA 17025 COMPARABLE SALE # 5 COMPARABLE SALE # 6 Page 8 of 20 I nVIWlf"'\o,,) I IVI I IWlf"'\,.,) I L..I '" I......IW'~"'II\..... I 6-1 ,..... , '~I-\'" I , LOCATION MAP ADDENDUM File No. 20041009 Case No. Borrower Nt A Property Address 821 WERTZVILLE ROAD City ENOLA County Lender/Client MARIE A KICHMAN, ESTATE CUMBERLAND State PA Zip Code 17025-1834 Address 821 WERTZVllLE ROAD, ENOLA, PA 17025 _-I~ Z C .~ '~ ------.(. \ '~ I I I. ',~ "- ---./1 I l~_ i-I J..-----...'t.-\ I --L-, \ 6tcJo~idg~ '.---- J I ././ ,// ::>..( \ '>/ ./......... // ;{ ~/ ~--/.. ~ .../( >-"~......~/.-.. -"~~... ---- ~",./(~?:?\... -~ ~~~" ----- - ~ ...-"- . 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"'-~ . \.\, \ \p. - <3'1."":' 'I II \ 11:l, ~..a& ~- i , ",~...-~~~ I I 'S;S;' \.., """ ,.-- ......-----.....-.j >%"'" \" ',,- ....... ! /J' ...~.... '\ "> ___...! . ':1',..':::/'\ ", .... I' ~' \ /-' . II _II , r;J, \ / ;:-17',1 I /f!~ Ji I ""r::' I I }.;'< " I' ,~.~ If-I ~ G) \-._ 1 (/) \..-i 0'" i 'la2; -il '(I) " ,"" "'G.:: I, I 0.." ' (I) '::" I O'~';.' I ~ :;:/ \\V~I I 1000 tt 'I al2OO3 G 01 C~r..~~"'\ _lJ l-'" ,I I 0 I, P"'o., \., ":_J~. \ \, ) ',5.', ... 4 '~ \ .-- \CJ../'~""II \, .-.~~~.\~-\"", " .~ \, 0......... ',.,.".." (.~~> "\ ... iP~ "', \ ..<..,......" ~~\, \\, ...\ \, '..... \ \ Click FORMS Appraisal Software 800-622-8727 Page 9 of 20 IIIVI'I'"'''' I IVI I 1'111""'" II-I \11 1_1"~I1l.'\"'" 1 ~I ,.... I ,~, '_1 . _. ,_...... SKETCH ADDENDUM File No. 20041009 Case No. Borrower N/A Property Address 821 WERTZVILLE ROAD City ENOLA County Lender/Client MARIE A KICHMAN, ESTATE CUMBERLAND State PA Zip Code 17025-1834 Address 821 WERTZVILlE ROAD, ENOLA, PA 17025 I 24' i j - - 1 i , I i 1 STORY O/CRAWL i I ! 16' I I 22' CARPORT I 1 STORY OVER BASEMENT 26' 15 38' 4' I STOOP 5' BUILDING SKETCH ! 1372 SQ FT I FAMILY ROOM BEDROOM KITCHEN BEDROOM BATH i . I I DINNING ] LIVING ROOM BEDROOM FLCX)R PLAN : ClickFORMS Appraisal Software 800-622-8727 Page 10 of 20 Lt:.\.;I/""\L. UI~\..,r""\1 r I IVI 'II UI-I-LJ rile .'tU. "'...........,. I Case No. Borrower N/ A Property Address 821 WERTZVILLE ROAD City ENOLA County CUMBERLAND State PA Zip Code 17025-1834 Lender/Client MARIE A KICHMAN, ESTATE Address 821 WERTZVILLE ROAD, ENOLA, PA 17025 ,. ._QiV -~'i~--_e.. ,... ~': ':'" . ~:::~ ',~::R f;';~"'-O:':"':"' ."'-; "~;:"-c.:'\~ r,-Ov ~..v_. .., .,.- J.", :~U~-3Eri~.J.:~~: CO~;':1Y-~.\ .99 JUL 6 PI'l 2 is T_PM:.IIOI Ofi-I'I--O'i35-0!53 ~ .....,.j(,DI8d "."..,...1 THIS DEED . ,.~" MADE THE ~ DAY OF JUNE IN THE YEAR OF OUR LORD ONE THOUSAND IIIIIE HUllDIIED AND ... J 'f-lllllE If"" 1IE1WEEN: DONALD a. OWEN, HEREJNAFTER AEFERftED TO AS TlfE "GRAMl"C)fr AND MARIE A. KICM_'" IERElNAFTER R~ED TO AS THE -GRANTEE'" wnM!StJDH. THAT IHCONSIOERATIONOF MNETYTHOUSAND DOLLARS ($90.000.00) .. HAND PAJO. THE RECEIPT OF WHICH 1SH:AE8Y ACKNOvtU:DGED. TIE GRANTOO ~ HEReBY CONVEY TO SAID GAANrEE. HER HBRS AHD ASSIGNS. ALL THAT CERTAINl'RACT OR PIECE of ground situate In East Pen.lSboro Township. Cumbectand Co\rty, Pennsyfvania, IXu1ded and desdfbed as foIJows: BEGINNING at a point on the nor1tt side 01 the $fa1B Highway Route No. 944 known as WertzWIe RoacS as shOwn on 'Ihe herein2IftBr' I'IMIf1Ib led pIIn " rI Jots, said point being 70 feet ~ in an ~ ~ectiun from Calef l.8n8 (40 feet wide) said point also bel~ the dMsion line between l..DtS Nos. 22 and 23 on the pean of Penn I ~~; thence North 5 degl'88S 1B'mnrt&s west alOng said dIVIding line 190.45 feet to lot No. 24 on said plan; Ihence north 85 degr8eS 25 mlrUes east alOng Lot No. 24 on said ptan" a distanCe c:A 70 feet 10 lot No. 21 on said plan; thefa southS degrees 18 mlroles east along said lot No. 21, a d"1Stance of 189.58 feet so the nonh side d 1he aforeSaid WertzVille Road; thence south 84 degf'ees 42 minutes west along said WeItzvftfe road, a distance d 70 feet 10 lDt No. 23. the pCaca or ttle beginning. BEING Lot 122. on the plan of Penn lle~ lb recorded in the Office of the ~ of Deeds in CUI'nbertand County in Plan Book 6. Page 28. BEING THE SAllE PREMISES which the grantor herein received by deed daEd the 18th day d May. 1997. from Ellen P. Wood and WIiam K. Wood . her huSband. as will more fuIy appear in the Recotdef of 0eecIs OffIce in and for C\Jmbeftaild County. as recorded in Book 158. Page 976 on the 3rd day cI June. 1997. 8QiJi ~Oa t~~E 33$ ClickFORMS Appraisal Software 800-622-8727 Page 11 of 20 Ut:f\ In VCr\ IlrlvM I C . rm:: l'4U. LUU-r I VV.;J ~ Case No. Borrower N/A Property Address 821 WERTZVILLE ROAD Ci ENOLA Lender/Client MARIE A KICHMAN, ESTATE Coun CUMBERLAND State PA Zi Code 17025-1834 Address 821 WERTZVILLE ROAD, ENOLA, PA 17 25 Thi~ i: -~)-I:~l1il\ 111;)1 ,~ inl'"nn:Jri..,n her:: ~i\"en h c:wre-:c1y \.""!,,i~.! (r":l~ ;:11 Qri$in~l! ,("fi.iti:.:.l!~ ,,( do!;Wt uuly til~ \\Jclt il-"' l,";al'R.:~iwar: Th.: oriPnal ':~1"tiii.::1I': wili b.: furw:ud.:d m th..: $r:.lc( \"j.a! [tC~~'N.' Ofci...~ (.x- penn:1r..:nt til;~t. WARNING; It Is meg.' to duplicate this copy by pnotostat M photograph. - Fee (ot this ceniticl\rc. S::!.OO ~I'l~ to=! ~risu'3r SEP ~ 3 ZCC4 ,.... 'i n5~" 309 .a.,....,. v.L ..J ~o. 01f.,e .-- CO. Cl.....EIlLTMGF~"AMA. ~TO#II&ALTIl . VITAL Ur:clftDS CERTIFICATE OF DeATH ="'0 - --..---- --- - or --...~ ..... ....... .. --... ......-- -..- ..........~ ,. F =i:..~ _fI'_ ~..r'~ ~..O-..~~.....~ - .~_ 0 - -0 -21 ..0....0 - ~............... ... -.- ~~-=:m:::I:--..-=~~~~_~.~~._.____...o _ rTrttI_...~~~.:...~~~.:=-.-:..-==.:c.:.. _.~~==-........ ~- -fTI =-:-~~~..~.....--.--...............-._--........~-- 0 _.. ____.___~---_-...--e-.....-"--___,... .. .~.... r <' "'~-:<':'.1-.~~ ., . ClickFORMS Appraisal Software 800-622-8727 Page 12 of 20 I'" . ,. '. ..:" ~. ( ~:..: .:.. ~~~.; . . I nV''W'M,.,) I 'VI I IVIr'\\o.J I ~I \.11 .......IIlIU....IIlIII"""'\V . ~I "'..... I ",~r\,-. t SUBJECT HISTORY ADDENDUM File No. 20041009 Case No. : Borrower N/A Property Address 821 WERTZVILLE ROAD City ENOLA County lender/Client MARIE A KICHMAN, ESTATE CUMBERLAND State PA Zip Code 17025-1834 In developing a real estate appraisal, an appraiser must consider, analyze and disclose: (a) Any current agreement of sale, option or listing of the property being appraised. (b) Any prior sale of the subject property being appraised that occurred within the following time periods: (I) one (1) year for 1-4 family residential property, and (II) three years for all other property types. The appraiser has attempted to obtain specific information on the subject property with the following findings: o The subject property has had no change of ownership during the past one (1) year. [K] The subject property has had no change of ownership during the past three (3) years. o The subject property is currently under contract. Details of the pending purchase are summarized below. o The subject property is currently offered for sale, listing price is $ o The subject property has been sold during the past one (1) year period. Details of the previous sale are disclosed below. o The subject property is proposed construction and is not currently being offered. o A previous sale history of the property could not be obtained by the appraiser in the normal course of business. Grantor/Owner of Record: GranteelPurchaser: Contract Price/Sale Price: Date of Contract/Sale: Comments: Click FORMS Appraisal Software 800-622-8727 Page 13 of 20 : I nUI'iln..J I tVel-IV-ln.,,) I ~1"'11 lVIVU...IWIf"'\V I.....' '''''' . "'-riP... I I ....... .._.....,1 FLOOD MAP ADDENDUM File No 20041009 Case No. Borrower N/ A Property Address 821 WERTZVILLE ROAD City ENOLA County Lender/Client MARIE A KICHMAN, ESTATE CUMBERLAND Slale PA Zip Code 17025-1834 Address 821 WERTZVILLE ROAD, ENOLA. PA 17025 :,~ I ,) ~~0'i\~ l-~l.tr Flood Zones A.relill illU nd3lld b)' soo-year ibod ing A.relill 0 alii De oflhe 100 and SOO year !bod pan . A.relill in u nd3lld by 100-year ibod ing . A.rear in u nd<tea tr; 100-year !bod ing w tn yebCly nararcl . Fbo<lw3)' arear . Fbo<lw3)'arelill \11th yebcly nazard Arelill ofu IIdeb30r mined but poll ibl& ft:>ocl hzard A.relill not raapped 0 n any pu blir hed FIRM SFHA (Flood Zone): out Within 250 ft. of multiple flood zone? Within 250 feet Community: 420359 Community Name: EAST PENNSBORO TOWNSHIP OF Zone: [ Panel: 420359 00038 Panel Date: 04/15/1977 FIPS Code: 42041 Census Tract: 0102.01 This Flood Reoort is for the sole benint of the Customer that ordered and paid I for the Reoort and is based on the orooertv information orovided bv the customer. That customer's use of this reDort is subiect to the terms aoreed bv that customer when accessino this Droduct. No third DartY is authorized to use or relv on this reoort for any Duroose. NEITHER FIRST AMERICAN FLOOD DATA SERVICES NOR THE SEllER OF THIS REPORT MAKES ANY REPRESENTATIONS OR WARRANTIES TO ANY PARTY CONCERNING THE CONTENT ACCURACY OR COMPlETENESS OF THIS REPORT INCWDING ANY WARRANTY OR MERCHANTABIUTY OR FITNESS FOR A PARTICUlAR PURPOSE. Neither TFHC nor the seller of this Reoort shall have any liability to any third party for any use or misuse of this Report. Clicl<FORMS Appraisal Software 800-622-8727 Page 14 of 20 . Case No. DEFINITION OF MARKET VALUE: The most probable price which a property should bring in a competitive and open market under all conditions requisite to a fair sale, the buyer and seller, each acting prudently, knowledgeable and assuming the price is not affected by undue stimulus. Implicit in this definition is the consummation of a sale as of a specified date and the passing of title from seller to buyer under conditions whereby: (1) buyer and seller are typically motivated; (2) both parties are well informed or well advised, and each acting in what he considers his own best interest; (3) a reasonable time is allowed for exposure in the open market; (4) payment is made in terms of cash in U.S. dollars or in terms of financial arrangements comparable thereto; and (5) the price represents the normal consideration for the property sold unaffected by special or creative financing or sales concessions' granted by anyone associated with the sale. / . 'Adjustments to the comparables must be made for special or creative financing or sales concessions. No adjustments are necessary for those costs which are normally paid by sellers as a result of tradition or law in a market area; these costs are readily identifiable since the seller pays these costs in virtually all sales transactions. Special or creative financing adjustments can be made to the comparable property by comparisons to financing terms offered by a third party institutional lender that is not already involved in the property or transaction. Any adjustment should not be calculated on a mechanical dollar for dollar cost of the financing or concession but the dollar amount of any adjustment should approximate the market's reaction to the financing or concessions based on the appraiser's judgment. CERTIFICATION AND STATEMENT OF LIMITING CONDITIONS CERTIFICATION: The Appraiser certifies and agrees that: 1. The Appraiser has no present or contemplated future interest in the property appraised; and neither the employment to make the appraisal. nor the compensation for it. is contingent upon the appraised value of the property. 2. The Appraiser has no personal interest in or bias with respect to the subject matter of the appraisal report or the partici- pants to the sale. The 'Estimate of Market Value' in the appraisal report is not based in whole or in part upon the race, color. or national origin of the prospective owners or occupants of the property appraised. or upon the race, color or national origin of the present owners or occupants of the properties in the vicinity of the property appraiSed. 3.The Appraiser has personally inspected the property. both inside and out. and has made an exterior inspection of all comparable sales listed in the report. To the best of the Appraiser's knowledge and belief, all statements and information in this report are true and correct, and the Appraiser has not knowingly withheld any significant information. 4.AII contingent and limiting conditions are contained herein (imposed by the terms of the assignment or by the under- signed affecting the analyses. opinions. and conclusions contained in the report). 5. This appraisal report has been made in conformity with and is subject to the requirements of the Code of Professional Ethics and Standards of Professional Conduct of the appraisal organizations with which the Appraiser is affiliated. a.AII conclusions and opinions concerning the real estate that are set forth in the appraisal report were prepared by the Appraiser whose signature appears on the appraisal report. unless indicated as 'Review Appraiser'. No change of any item in the appraisal report shall be made by anyone other than the Appraiser. and the Appraiser shall have no responsibility for any such unau1horized change. CONTINGENT AND LIMITING CONDITIONS: The certification of the Appraiser appearing in the appraisal report is subject to the following conditions and to such other specifiC and limiting conditions as are set forth by the Appraiser in the report. 1. The Appraiser assumes no responsibility for matters of a legal nature affecting the property appraised or the title there- to. nor does the Appraiser render any opinion as to the title. which is assumed to be good and marketable. The property is appraised as though under responsible ownership. 2.Any sketch in the report may show approximate dimensions and is included to assist the reader in visualizing the prop- erty. The Appraiser has made no survey of the property. 3. The Appraiser is not required to give testimony or appear in court because of having made the appraisal with reference to the property in question. unless arrangements have been previously made therefor. 4.Any distribution of the valuation in the report between land and improvements applies only under the existing program of utilization. The separate valuation for land and building must not be used in conjunction with any other appraisal and are invalid if so used. 5.The Appraiser assumes that there are no hidden or unapparent conditions of the property. subsoil. or structures, which would render it more or less valuable. The Appraiser assumes no responsibility for such conditions, or for engineering which might be required to discover such factors. 6.1nformation. estimates. and opinions furnished to the Appraiser, and contained in the report, were obtained from sources considered reliable and believed to be true and correct. However, no responsibility for accuracy of such items furnished the Appraiser can be assumed by the Appraiser. 7. Disclosure of the contents of the appraisal report is governed by the Bylaws and Regulations of the professional appraisal organizations with which the Appraiser is affiliated. 8.Neither all. nor any part of the content of the report, or copy thereof (including conclusions as to the property value. the identity of the Appraiser. professional designations, reference to any professional appraisal organizations, or the firm with which the Appraiser is connected). shall be used for any purposes by anyone but the client specified in the report. the borrower if appraisal fee paid by same, the mortgagee or its successors and assigns, mortgage insurers, consultants, professional appraisal organizations. any state or federally approved financial institution. any department. agency, or instrumentality of the United States or any state or the D!strict of Columbia, without the previous written consent of the Appraiser: nor shall it be conveyed by anyone to the public through advertising, public relations. news, sales, or other media, without the written consent and approval of the Appraiser. 9.0n all appraisals. subject to satisfactory completion. repairs. or alterations. the appraisal report and value conclusion are contingent upon completion of the improvements in a workmanlike manner. ENVIRONMENTAL DISCLAIMER: The value estimated is based on the assumption that the property is not negatively affected by the existence of hazardous substances or detrimental environmental conditions unless otherwise stated in this report. The appraiser is not an expert in the identification of hazardous substances or detrimental environment conditions. The appraiser's routine inspection of and inquiries about the subject property did not develop any information that indicated any,Hp rent significant h rdeus sub- stances or detrimental environmental conditions whi ould affect the property nega' ely otherwise stat this report. It is possible that tests and inspections made by a hazardous substance a expert would re the existence of hazardous substances or detrimental enviro I conditions on or around t would n a ect its value. ...&\..) App . Date: NOVEMBER 11. 2004 Freddie Mac Form 439 7/86 Click FORMS Appraisal Software 800-622-8727 Fannie Mae Form 10048 7/86 Page 15 of 20 I nVIYll"'\v nVrrlYll"'\v I 1...1'/1 IVIYlI...IVII"'\-..) 1 1..."."'" I'~L I I V''\VVI . File No 20041009 Case No. " APPRAISER'S CERTIFICATION: The Appraiser certifies and agrees that: 1. I have researched the subject market area and have selected a minimum of three recent sales of properties most similar and proximate to the subject property for consideration in the sales comparison analysis and have made a dollar adjustment when appropriate to reflect the market reaction to those items of significant variation. If a significant item in a comparable property is superior to, or more favorable than, the subject property, I have made a negative adjustment to reduce the adjusted sales price of the comparable and, if a significant item in a comparable property is inferior to, or less favorable than the subject property, I have made a positive adjustment to increase the adjusted sales price of the comparable. 2. I have laken into consideration the factors that have an impact on value in my development of the estimate of market value in the appraisal report. I have not knowingly withheld any significant information from the appraisal report and I believe, to the best of my knowledge, that all statements and information in the appraisal report are true and correct. 3. I stated in the appraisal report only my own personal, unbiased, professional analyses, opinions, and conclusions, which are subject only to the contingent and limiting conditions specified in this form. I certify that, to the best of my knowledge and belief: The statements of fact contained in this report are true and correct. The reported analyses, opinions, and conclusions are limited only by the reported assumptions and limiting conditions, and are my personal, impartial, and unbiased professional analyses, opinions and conclusions. 4. I have no present or prospective interest in the property that is the subject of this report, and no personal interest with respect to the parties involved. I did not base, either partially or completely, my analysis and/or the estimate of market value in the appraisal report on the race, color, religion, sex, handicap, familial status, or national origin of either the prospective owners or occupants of the subject property or the present owners or occupants of the properties in the vicinity if the subject property. 5. I have no present or contemplated future interest in the subject property, and neither my current or future employment nor my compensation for performing this appraisal is contingent on the appraised value of the property. 6. My engagement in this assignment was not contingent upon developing or reporting predetermined results. My compensation for completing this assignment is not contingent upon the development or reporting of a predetermined value or direction in value that favors the cause of the client, the amount of the value opinion, the attainment of a stipulated result, or the occurrence of a subsequent event directly related to the intended use of this appraisal. 7. My analyses, opinions, and conclusions were developed, and this report has been prepared, in conformity with the Uniform Standards of Professional Appraisal Practice in place as of the effective date of this appraisal, with the exception of the departure provision of those Standards, which does not apply. I acknowledge that an estimate of a reasonable time for exposure in the open market is a condition in the definition of the market value and the estimate I developed is consistent wittl the marketing time noted in the neighborhood section of this report, unless I have otherwise stated in the reconciliation section. 8. I have made a personal inspection of the property that is the subject of this report. I further certify that I have noted any apparent or known adverse conditions in the subject improvements, on the subject site, or on any site within the immediate vicinity of the subject property of which I am aware and have made adjustments for these adverse conditions in my analysis of the property value to the extent that I had market evidence to support them. I have also commented about the effect of the adverse conditions on the marketability of the subject property. 9. No one provided significant professional assistance to the person signing this report. If I relied on significant professional assistance from any individual or individuals in the performance of the appraisal or the preparation of the appraisal report, I have named such individual(s) and disclosed the specific tasks performed by them in the reconciliation section of this appraisal report. I certify that any individual so named is qualified to perform the tasks. I have not authorized anyone to make a change to any item in the report; therefore, if an unauthorized change is made to the appraisal report, I will take no responsibility for it. SUPERVISORY APPRAISER'S CERTIFICATION: If a superviSOry appraiser signed the appraiser report, he or she certifies and agrees that: I directly supervise the appraiser who prepared the appraisal report, have reviewed the appraisal report, agree wittl the statements and conclusions of the appraiser, agree to be bound by the appraiser's certifications numbered 4 through 7 above, and am taking full responsibility for the appraisal and the appraisal report. ADDRESS OF PROPERTY APPRAISED: ::~U7,)- Name: THOMAS S. HOFFMASTER Date Signed: NOVEMBER 11, 2004 State Certification #: RL-001987-L or State License #: State: PENNSYLVANIA Expiration Date of Certification or License: JUNE 30, 2005 SUPE RY APPRAISER (o"lv lfneqllired) ...&\..) Signature: Name: Date Signed: State Certification #: or State License #: State: Expiration Date of Certification or License: D Did D Did Not Inspect Property r:SPAP 3 3/ 99 Compilmrl ClickFORMS Appraisal Software 800-622-6727 Page 16 of 20 t I IV'...II""\"-' 1 IVI 1 1...11""\"-,, I L-I " 1 1......I1IU...l1Ilr'.... I L-I....... 1"_ \.... 1 File No. 20041009 Case No. . CERTIFICATION ,. . Borrower N/A Property Address 821 WERTZVILLE ROAD City ENOLA County CUMBERLAND Lender/Client MARIE A KICHMAN, ESTATE Address State PA Zip Code 17025-1834 821 WERTZVILLE ROAD. ENOLA, PA 17025 F.I.R.R.E.A. ADDENDUM I. PURPOSE OF THE APPRAISAL The purpose of this report is to estimate the market value of the subject property, as defined I1l!rein. The estimate of market value is to be used solely by the client as a basis for lending decisions or portfolio management. II. SCOPE OF THE APPRAISAL The following steps were followed in arriving at the final estimate of value included in the appraisal report of the subject property: 1. An investigation was made to determine market trends, influences and other significant factors pertinent to the subject property. 2. A physical inspection of the property was performed. Although due dilligence was exercised while at the subject property. the appraiser is NOT an expert in such matters as pest control, structural engineering, hazardous waste, or construction etc. and no warranty is given or implied as to these or other elements outside of analysis of market data. Inspections by various professionals within these fields may be recommended with the final estimate of market value subject to their findings. 3. A more detailed review of the collected data was then performed with the most relevant factors extracted and considered. Sales were examined and confirmed closed from material provided by one or more service(s) that obtain information from public records. Market factors were weighted and their influence on the SUbject property was determined. A highest and best use analysis was done on the subject property. 4. The appraisal report was then completed in accordance with standards dictated by THE APPRAISAL FOUNDATION in the UNIFORM STANDARDS OF PROFESSIONAL APPRAISAL PRACTICES (USPAP). The report included sufficient data and information needed to lead a reader to a similar conclusion of market value. 5. The appraisal report was then delivered to the client, which constiuted the completion of the assignment. III. THIS REPORT COMPLIES WITH THE UNIFORM STANDARDS OF PROFESSIONAL APPRAISAL PRACTICES (USPAP) As adopted by the Appraisal Standards Board ot The Appraisal Foundation as of August 9, 1990. N. COMPETENCY OF THE APPRAISER Unless otherwise noted in writing, the appraiser has done similar assignments and has the knowledge and experience to complete this assignment competently. V. SALES HISTORY The marketing history of the subject was researched for at least one year. Unless otherwise noted in the appraisal report, the subject property has not been listed, sold or transferred in the past twelve months. VI. RENTS AND VACANCIES Unless otherwise noted in the appraisal report, the subject property is currently owner occupied. VII. TREND ANALYSIS real estate prices have been changing due to current economic conditions and local trends. It is reasonable to assume that this same trend would apply to the subject. Still the average marketing time typically varies between 90-180 days for residences within the county provided the property is competively priced and property marketed. VIII. DEDUCTIONS AND DISCOUNTS In keeping with the USPAP. any financing concessions that influence the selling price of a comparable sale were addressed and accounted for to result in a market value of the subject property that is free of discounts, deductions or other seller concessions. IX. PROHIBITED INFLUENCES The appraisal assignment was not conditioned upon the appraisal producing a specific valuation or approval of a loan. Employment of the appraiser was not conditioned upon the appraisal production a specific value. Neither employment nor compensation are based upon approval of any related loan application. X. SELF CONTAINMENT This appraisal report is intended to be a self contained document containing all information necessary to enable a reader to understand the appraiser's opinion. Any third party studies referred to. such as pest control, structural, soils or hazardous materials have been verified by the appraiser as to their existence. to the extent the assumptions and conclusions are used. If not included with the report, they are maintained with our file and available upon request by the client. XI. PERSONAL PROPERTY Any personal property involved in the transaction have been excluded from the valuation of the real property. Should a transaction which includes personal property of sufficient value to affect the market value of the real property be evident, a separated assessment of the personal property fixtures or intangible items will be included with the report as a separate valuation. XII. THREE APPROACHES TO VALUE The appraiser has made a reasonable effort to apply the three recongnized approaches to value. Most single family residences are purchased for owner occupancy and. as such. the INCOME APPROACH does not generally reflect the highest and best use of the property and is not generally relevant indicator of market value. The use of the INCOME APPROACH to value will only be used: ClickFORMS Appraisal Software 800-622-8727 Page 17 of 2 , , : : . I ! i , CERTIFICATION Case No. . " . Borrower Nt A Property Address 821 WERTZVILLE ROAD City ENOLA County Lender/Client MARIE A KICHMAN, ESTATE CUMBERLAND State PA Zip Code 17025-1834 Address 821 WERTZVILLE ROAD, ENOLA, PA 17025 1. At the request of the client for non-owner occupied units. 2. When sufficient market evidence exists in a neighborhood to indicate that rental properties or investor purchases are typical, measurable and their analysis adds to the relevancy and reliability of the appraisal process. I CERTIFY TO THE BEST OF MY KNOWLEDGE AND BELIEF: The statements of fact contained in this report are true and correct. The reported analyses, opinions, and condusions are limited only by the reported assumptions and limiting conditions, and are my personal unbiased professional analysis, opinions and conclusions. Unless otherwise noted in this report, I have no present or prospective interest in the property that is the subject of this report, and I have no personal interest or bias with respect to the parties involved. ClickFORMS Appraisal Software 800-622-8727 Page 18 of 20 . ..' . '~; : ~;~,;'j{!;~:ir~t~..: (') C)..:,. ..~ . ~...,.-,,;-.",.., .;-: { ,.,~ ~ I ~:\~~,::::~~:i}~~. I at' :2.... .,.,.,."'..;h'/P....;f.. t........:...~ ..' 5' I',' <>.-';;:.,~,..~,., ~ ":./ :__..,/ f~r~:;~.t ~' ,." ".....,...h !i \. ',' .~t~'::,.::i;~~~p ~ pO s:: ..,':~.;}..d...,t~~''h ..0Q.,; ~v 'I." ,rp-';"';' '. ~. 0;;, \ %:.;;:; /-'<; '" '" - ~ .... ' . ,'''c' .r:? .#>.'" > - .>' -- -, ~'. Q . .... -.9>" . ,,'''.; /,,':' ";.--_~,,,,~~'d> Q"'.'. .~".' ".,..... .'; ~., .. ~.~ ..8 M.'".....~,.<' ;"'" , '." _ $;~"'" -v>!'tI .~' '"7 ,. .~, ," ,~,' .'.'. ",,", <::f _"..., l , "',." ~,' ':,,~~ ~. .,... ..,r _c '.c:' /' . . ...... .,~ ,.,..'", .<y;' .'..:to;.- ~:'w ,.;. . ," , . "". . ' -<....~ :<";;:;;', ,. ..^' ,., _'.' oot ....... ....:~ 'r;. . '"I":'" ,-., ,.:" ", ~,e ~~?~.~..:J~ ".:.: ' ., ,:~:' ...,... .."-' < --~;,/!-' " . -... ....:"" ~ ......"..,......''-. . ~__ .;'Ir.'. . ,',' <' ......' . Q!.'\~ ~-""" . ....::0 0 ~... -. ~ "- .,,,' : ':, ,-".:, ; "". ..' ,$ ~ "i{,<l. . .. .-' ...,.-' ,'-'- ..~ - ....... '.'. '" ,_,' '. .' _' ": .:>:<'''.... l:S . ;;1' .. , .....,. .' . ",,,,' ."'" ~-f'!t:' ...~:,T'. ,/( - -'. ,.~~._._-,..../.. -- ~"~...,_.,-,.~,,.., .~ ~. ';~ ...._ . ..."')001':..... ~~' ,;;-.1-'"'." ." .' c:;I' _' ,,' < .IJ)C' ., ...,._w~.,.,;;~;ii~~5F>~~;~ . ;p.. e.. "1f'..~ -'" . , '-1:>' ,,, .... .,-_..~; . ~. "".J '.' ...~.,:~c:'~~~~~~~~ ...~,'~:,~?<::i;~~. CD,. f.IJ. ,- "',' " Q .(, .. .,~< '~;L'~!:'; ~ .... ..- "d'>'~"'" ."! "i': '':::'~:;:''~;: ..._....:.-::~:' .' ~.-~..- .... ---... ': ." ,.', v....."," ,v'""'v'" ----- 82 ~ \f\/ERiZ'/\LLE ROAD MAR\E A K\C\-\N\At't Esi A iE coun ler ~IA AddresS ::~OLA erlClient ~;'" .J";>/:.' .. .-.~ ;>.. g ~ ...,' g 0' ~ ~. ~ g. ':S 'd S'l S' E'i~ ~~~ ;;.(.rn=- ~~lP f::~~ ~~~ ~ ~ :=i ::e S ~O ~ '"" '"" ~ 'fA -.. ~ 11 (:) o ~ CD ~ r- n 'Z~ ~ - %-S ~~ ;- ;' ""'. ;:t. ~ n ~ lot ~ ~ (') g. ;:s d . ~ o """ ~ :> fl) CS) '" case NU. ..~ ',\ ..\ ..l\ , , :' -1'-' , ~,;::..~;...:-.........~ -.-- C"c\<fOR"S ApProlsal softWare ~:l2-8727 of :2 -- L- Ul ......, II..h.)UI"\r\I....V.... I 1ft;; I"V. ,",VVI . LI........ Case No. . 4 . Borrower N/ A Property Address 821 WERTZVILLE ROAD Ci ENOLA Coun Lender/Client MARIE A KICHMAN, ESTATE CUMBERLAND State PA Zi Code 1t025-1834 Address 821 WERTZVILLE ROAD, ENOLA, PA 17 25 INTERSTATE INSURANCE GROUP Issued by: CHICAGO INSURANCE COMPANY Executive Offices: 55 E. Monroe Street Chicago, Illinois 60603 DECLARATIONS -------------------------- PURCHASING GROUP POUCY NUMBER 88R-2880005 I CERTIFICATE NUMBER 88R- 2017150 I REAl ESTATE AGENTS ERRORS AND OMISSIONS UABIUTY INSURANCE POUCY ------------------------- 1. Named Insured and Mailing Addrus: Ray J Marsico Assoc Inc t/a Homemasters Realty Group PO Box 66 Marysville P A 17053 · · · · NonCE · · · · THIS IS A CLAIMS-MADE POUCY. PlEASE READ CAREFUUY. - 2~ - POlicy PERioD~ - - ;ROM: - - 06/oi72003 - - TO~ - -06101/2004 - - - - - - - - - - - At 12:01 AM. standard nl114l at location of Named Insured. ---------------------------------------------- 3. UMfTS OF UAB.IUTY: EACH CLAIM $ AGGREGATE $ 500,000 500,000 4. CLAIM EXPENSES b. A separate limit of liability applies to claim expense 5. STATUS OF INSURED: COYporation ----------------------------------------------~- 6. DEDUCTIBLE EACH CLAIM $ 1,000 a. The deductible amount specified above applies only to damages ----~------------------------------------------i- 7. PRJORACTS DATE 06/01/1997 If a date is indicated, this insurance will not apply to any regular act, error, omission or personal injury ~ oc:cumtd before such date. ! - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - _!- S. ANNUAL PREMIUM $ 1,054.00 : - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -:- 9. ENDORSEMENTS This policy is made and accepted subject to the printed conditions in this policy together with the provision~, stipulations and agreements contained in the following form(s) or endorsement(s}. POJ-20l6 (12/99)(Ed 4/02) PON-2oo3 (OllOl) PON-2035 (8198)(Ed 6/99) POE-2118 Rev. (J0/99) -----------------------------------------------~ 10. MANAGING AGENT . Herbert H. Landy Insurance Agency, Inc. 75 Second Avenue, Suite 410 Needham. Mass 02494-2876 ~ Authorized Representative POP-2131 (11199) ClickFORMS Appraisal Software 800-622-8727 Page 20 of 20 DISSINGER~ ~ DISSINGER Camp Hill Offices: 717.975.2840jvoice . 717.975.3924jfax Marysville Offices: 717.957.3474jvoice . 717.957.2316jfax September 2, 2005 :c) ~ ., 1 , ") ,.j Cumberland County Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 /" .... Re: Estate of Marie A. Kichman No. 21-04-938 Dear Madame: ("~) , i -'i~ 1 _lJ :) rn Enclosed please find three (3) executed copies of an Inheritance Tax Return in the Marie A. Kichman Estate as well as an estate check in the amount of $15.00. Please file two (2) originals of record, clock-in the last copy and return it to ~e in the enclosed self-addressed stamped envelope. I I I If you have any questions, please feel free to contact m+ at my office. William C. Dissinger Attorney at Law WCD:las encl: 3 cc: Anna M. Hurrell File 1-04-227 v- Attorneys at Law 28 North Thirty-Second Street · Camp Hill, PA 17011 400 South State Road · Marysville, PA 17053 '" CERTIFICATION OF NOTICE UNDER RULE 5.6 Name of Decedent: Marie A. Kichman Date of Death: September 19, 2004 Will No. 2004-00938 To the Register: I certify that notice to beneficiaries and heirs require~ Rule 5.6 of the Orphan's Court Rules, in the form prescribe4 Rule 5.7, was served on or mailed to ~he jollowing beneficiarie~ the above-captioned estate on 1 ~~ LP~ by by of Anna Livingston n/k/a Anna Hurrell 821 Wertzville Road Enola, PA 17025 Richard Kichman, III c/o Anna Hurrell 821 Wertzville Road Enola, PA 17025 Notice has now been given to all persons entitled thei'eto under Rules 5.6 and 5.7, except NONE. Date: i #(J6 . 'll~~ Wl lam C. Dlsslnger 400 South State Road Marysville, PA 17053 (717) 957-3474 Attorney for Personal Representa~ive r- ~~; - C".', L ~~:_; L_ eo I c___ L'., G/) ,- ~A ( ) l~-'" c-,~: ....l <:::J "'"" ( ;. 11-07-2005 KI CHMAN 09-19-2004 21 04-0938 CUMBERLAND 101 APPEAL DATE: 01-06-2006 ( See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 9~I_~~9~~_I~~~_~~~~----__~___~~!~!~_~9~~~_~9~!!9~_E9~_Y9Y~_~~~9~~~__~____________________ REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX MARIE A FILE NO. 21 04-0938 ACN 101 BUREAU OF INDIVIDUAl TAXES INHERITANCE TAX DIVISION . PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX WILLIAM C DISSINGER DISSINGER & DISSINGER 400 S STATE RD MARYSVILLE DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN PA 17053 ESTATE OF KICHMAN REV-1547 EX AFP (06-05) MARIE A TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED DATE 11-07-2005 RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets U) (2) (3) (4) (5) (6) (7) 109,000.00 .00 .00 .00 502.00 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) UO) 22,134.65 7.076.69 (11) (2) (3) (4) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 109,502.00 29.2]1 34 80,290.66 .00 80,290.66 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: .00 X 00 = .00 80,290.66 X 045 = 3,613.08 .00 X 12 = .00 .00 X 15 = .00 (9)= 3,613.08 n~~~., , (+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) INTEREST IS CHARGED THROUGH 11-22-2005 TOTAL TAX CREDIT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 3,613.08 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 77 .22 TOTAL DUE 3,690.30 · IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. ,i?~ IF TOTAL DUE IS REFLECTED AS A ..CREDIT" (CR), YOU MAY BE DU1I\I\ A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) BEFORE THE REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF MARIE KICHMAN, DECEASED NO 21-04-0938 DECREE OF THE REGISTER OF WILLS AND NOW, this 6th day of February, 2006, Letters Testamentary in the Estate of the above- named decedent having been granted on October 19, 2004 to Anna Livingston, and the instrument titled New Will for Marie Kichman to Joe Kerwin, dated September 12, 2004, having been offered for probate on December 17, 2004, in consideration of Response to the Notice of the Register of Wills by William C. Dissinger, Esquire, satisfactory proof having not been presented before me, IT IS DECREED that the instrument dated September 12, 2004, described therein shall not be admitted to probate and filed of record as the Last Will of Marie Kichman, and that Anna Livingston shall be permitted to conclude administration of decedent's Estate without amendment of the Letters Testamentary previously granted. Glenda Farner Strasbaugh, Regist 0 Wills William Dissinger, Esquire 400 South State Road Marysville P A 17053 James D. Cameron, Esquire 1325 North Front Street Harrisburg, P A 17102 I c., r- 1--', --J \ '" \~... \,-' In Re: Estate of Marie Kichman, Deceased ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 21-04-938 CERTIFICATE OF SERVICE OF ORDER ORDER DATED: 02/06/06 JUDGE'S INITIALS: GFS TIME STAMP DATE: 02/06/06 INRE: Decree of the Register SERVICE TO: William Dissinger, Esquire James D. Cameron, Esquire METHOD OF MAILING: r2l USPS DRRR D Hand delivered D Other: ENENVELOPE(S) BY: D Petitioner D Judge r2l Clerk of Orphans' Court DATE OF MAILING: 02/06/06 ~~.~"" .."-~._------ - - "-',, --..--.------.---.------------,.--.-----.--..-.."-----_""_,.__________,.,_...".,,_.___.__ ".u___ __~_"_'"'.._____'_'_______""".__..____"_____."_"'''_____._._,.,._".~__.______,_"_ SERVICE TO: METHOD OF MAILING: D USPS DRRR D Hand delivered D Other: _ ENVELOPE(S) BY:D Petitioner D Judge D Clerk of Orphans' Court DATE OF MAILING: Margie A. Wevodau First Deputy Clerk of Orphans' Court Clerk of the Orphans' Court COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT, 280601 HARRISBURG, PA 17128-0601 REV-1162 EX( 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 00651 7 DISSINGER WILLIAM C 400 S STATE ROAD MARYSVILLE, PA 17053 ACN ASSESSMENT CONTROL NUMBER AMOUNT _____n_ fold 101 $3,775.35 ESTATE INFORMATION: SSN: 190-52-4041 FILE NUMBER: 2104-0938 DECEDENT NAME: KICHMAN MARIE A DATE OF PAYMENT: 04/04/2006 POSTMARK DATE: 04/04/2006 COUNTY: CUMBERLAND DATE OF DEATH: 09/19/2004 TOTAL AMOUNT PAID: $3,775.35 REMARKS: DISSINGER ET AL CHECK# 005617 SEAL INITIALS: VZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS IUREAU OF INDIVIDUAL TAXES :NHERITANCE TAX DIVISION '0 BOX 280601 IARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REV-1607 EX AFP (03-05) WILLIAM C DISSINGER DISSINGER & DISSINGER 400 S STATE RD MARYSVILLE PA 17053 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 04-24-2006 KICHMAN 09-19-2004 21 04-0938 CUMBERLAND 101 MARIE A 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 form with your tax payment. CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +- --------------------------------------------------------------------------- REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT KKK ESTATE OF KICHMAN MARIE A FILE NO.21 04-0938 ACN 101 DATE 04-24-2006 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW 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: 11-07-2005 PRINCIPAL TAX DUE: 3,613.08 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE /NUMBER INTEREST/PEN PAID (-) 04-04-2006 J CD006517 161.73- 3,775.35 : ) TOTAL TAX CREDIT 3,613.62 BALANCE OF TAX DUE .54CR INTEREST AND PEN. .00 TOTAL DUE .54CR IE IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRJ, vnll OlAV De nile A 1l~~IlNn ~~~ RFVFRSI:: SIDI:: OF THIS FORM FOR INSTRucTTnN~- ) Q Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/27/2006 ltUd< il ~.v4-M(}1SWN ANNA ~ 821 WERTZVILLE ROAD ENOLA, PA 17025 RE: Estate of KICHMAN MARIE A File Number: 2004-00938 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COUR.T 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: 9/19/2006 please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, h . c.~,~' -A-- / /J J:.J//4zdl((, '~~72~/!4''?rfAj J.1/d:tl..d..tf7~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/27/2006 DISSINGER WILLIAM C 400 S STATE ROAD MARYSVILLE, PA 17053 RE: Estate of KICHMAN MARIE A File Number: 2004-00938 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. 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 lS due by: 9/19/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, tJ, (~# ,. Lt-./ /J ):..ut(/!~ Uf2Y-~j~:~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) ell ~ Register of Wills of Cumberland County STATUS REPORT UNDER Rl:JLE 6.12 Name of Decedent: 1)1 'wi to' n - K f (' h JIr '\ OJ V\ Estate No.: C(-Iq--Ct( ;J{'(' 1.1__ eC (7 :3 ~/ Date of Death: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following v,ith respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes 0 No 121 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 1 Cv J - (~{;., 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account ",ith the Court? Yes 0 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 0 No 0 c. Copies of receipts, releases, joinders and approval of formal or L.1.formal accounts may be filed Viith the Clerk of the Orphans' Court and may be attached to this report. ;/ /, l? /(~\ L..t'L.{-t:{:tt/J (/ /\ L,i.d.../ (." l("______ Signature 7 - t::l L \ Ii \ (A H.! (', '\)'\ (~'~)/'~di 1-" I Date: I ;'3)/~"'& Name ;1 (. fv' ?"'j-.'''-' \) C" 4' ~ i) :."':>:7' '-! I Address (;r ~vl r) (of I II r) Jf. -'II'}' r;7~ J6l{(') Telephone No. c' , ...,. ..... 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