The URL can be used to link to this page

Home My WebLink About95-0109~I-g5-~10'1 e„oS.,uRan.7/B7 TY.EIIRpT w PewANE-IT Buac wK 3 ~• W w W This is to certify that the certificate hereunto attached is a true and accurate copy of the original death record on file with the Division of Vital Records, and that Frank Yeropoli, whose name is subscribed thereto, was at the time of subscribing the same and now is Director, Division of Vital Records of the Department of Health, for the Commonwealth of Pennsylvania, duly appointed and commissioned as directed by Act 66 of the General. Assembly, approved 29 June 1953, P.L. 304. Date AUG ~ 6 2ppT ? ~_ Fran eropoli, ' ectdY Division of Vital Records P.O. Box 1528 New Castle, PA 16103 COMMONWEALTH OF PENNSYLIMNIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH 002'~~.2 NAMEaF OECEDEI,r If.r Mbr.,Lrp SEx soclAlsECURm NUMBER oREOPOE,v/InAOnn. D•r.w•n ~• ~~ A• ~L.I-t Male >. 180 - 01 - 4728 .. ,Tan 26, 1995 ADE nA+en,a.r) IRI0611 TEAR DRDBI,OM oREDPO,rN aBmin,t~Aar+ar PIACE OPDERNIC7u aM aa7 on.-r.wbcMV•anaMraaN u„r,. D„r ,,,M, I ,B,,,r• IMwn.D4;>r.n iMlotFaroiOauirfl 1 7 0 D b1 ^ 1 ina ra.Br^^ ERIOuplbr^ 88 ~,. 3/6/06 ~ar 1~LS R.rMio^ (~P.1~.y)^ ' ODUNTV aPDERN GI 'p EC ~ p~ f,B0R0. TIM OPDHEN NAMEanollallAior..a«•ana •na nnbrl ~mENraPNrePAIacaRIDwT RACE•Aaarkr brr,Bbat w,+b..IC ~~ ~`"` Cumberland k Camp Hill Leader.Nuraing Home West • White ~~ DECEDENralxtle. Io10aFBU9fMlSBBNOUSIM RRSDECEOENTEVERw DECEDENT'SEDIIGBE7N MAR,PLSDEUa•Maa,IM SISIVIVS1DaPDUSE Nma•alarr nr u.a ARMED FORCEM NMpr~Mrar,Ir,WMar.q OI..Iit Va•nrre.n nYnN a `A°°^°' ~) Bethlehem Steel ,,,.Q9 N.^ k e p W M nj«s.l ,~ , anic ,_ ,~ lo-,a M W1~O o~EOENraMAIUNDAOOREasIS..+.D•sMrAocow ennsy van a "`~°" "` ^"" °in0iA1N 0" ~ 1?4"Robin Court ba REaE,E,+DE .a.er. a ' ' i Mechanicsburg, Pa a ~`.,'°" Cumberland ~~~« •~ b4/ ,~ s ,T-. ,T •wa>w.rrLPr. „ FB,IER'a NAME (Fiat Mi001., tat MOTHEI,'S NAMF Icnt Mi046 Maian Sunrnal 1B. ~ /E. 7 wwRMANrS NAME RYPaP~iiB Pam Gaul SMALWO ADDREaa19Y•.1, CLp~batSM.IIP Caw . 1904 Letchworth Dr. Cam Hill Pa 17011 :. METHOOaPDEIPDargN BWlal® Crraran^ Rallaaa MOw 8MM^ D,vEOFDleroslrlDl, •D.A M.r) w,cEa -Nrracraary<c,rnraly aOBNIPrp LocR,DN•cBwrP.•,srr.mcm• °°""°^^ °"'"1"d~ ^ RJan 30, 1995 ,,, Resurrection Cemeter „,, Harriabur Pa aER~ ~~~ F.D~11897-L „Sullivan F H.,51 N. Enola Dr.,Enola,pa ta.eagr aF•BaIbr WMdwilnb Bre.r d an bb.a.aB•. am ox.n0 r a,.ulnw ear aaa obr.Ma.a. LICENSE NuMSER aaE SEINED ane Tr, drag ~~~~ w,zarwr•rPpwee, w,barballw a..Bt asoEaN ~ tD -RaNOUNCEOceADIllaan.0.,,1Yr1 w~sCASERESEw1EDroMEpCALE%AMINER/CORONEAT 94 5 ,.. ^ N Z( 1 M. . s ~ a. PNRT r. Earba.......bNa..o.mnw~Ir.+~ea~.wm.ewn. DO na.a.r n. nowaarYa rar nro:Malraa.r.Ypaanwtai.a IAppoa:rr wMT r, o+r .grAer.aondYdr mrMaYq bdrR. W Lr ad7ar erMm.altlllM,.. ~..~~ no[wnrYgblM UtlNlpMgorrSlr.NM1Rf1. EMIl04LTE CAIgE 6.r - 1 lNf~a si h~ i t ~. ~.l~, %E~AUvI a~wL wa .. DUEroIDa ASACDNSEOUE OF} D , BaaA lrigbwrrrr. DUEroICR ASACCNSEOUENCE ark I rWr. Err IROERL1wD ' DAIISt IOi..n.at n,.y WYalr Mb DUEro ICR AS A CONSEQUENCE OF} n aar~LAST I a ANAURJPSY WEIEAUID-STFEEIBga LaAPINER (Y OFAM DRE OFIILII/RY TIME OFINJURY wAJRY RNR71,K7 OExPoBE HOW wAN1Y OCCURRED. PERPORMEDT rA. PRIORro DMt wrl Of DENNT ~ Nava ~ Ilomki0a ^ AatiaM. ^ P.Mrq bratlgabn ^ N. ^ N•^ M . N. ^ Na Mr ^ No ^ sash. ^ Caadnara.,unwua ^ PtACE OP wJURY-NIia1N. Nm,, alma. NarK dBr LOCRgNISt.a Cil,Ibwn,SrW Wabq, ac. (Sa.aNl Ir. 2S. iBw ]Of. ~ ! ~~R~°^h'b1i1 SIG ANO TRIFOF ER •CBITWOD n,vwcuN(vnva,.n cwry+v cwraarm.n.naad,..oMmcw nr,xanaxcea a.em.no~amGalw ttam gal . . 7bMMa an„bba.•p..abah reunM AMYIM errNN rdarnna r.bN• ................!.................................... ^ a1 . •PRONOUMCIMD AND CERTMY11q PHYSICIAN IPfryaidan OaRi ganaun[vp tlsab aM / ,•YV•+A••P.r•SI•awnW rS,. SaI.. a.aa, .1la,Ir.. s.a Ow batl ~bcrn.tltlaW.l ~ Ta u,• e.a a a•rNN alas b.m« r aar .......................... N9E. _ ~J _ Mbn.DN.'Mrl 'j ~[q 1 J ~ ! /= 7, G~ / a[ S AND ADO/E$B OP WIIO C OMPLE T ED OP DERV 'MEDICAL EIUWIEA/CORONER On Un brb a •srWadien Pn0/or bvMlS•BOa, In mY •Pinlan. M•N, xcurTw a NI• ISRS. AaN, anU pNee, r,e ew t• tlr er,r(S) SIM / ' - 1 tl,an 2T Typ•aa P,M V ICs/~v I/~ `..~~%4'~ s r ~ 1 1 S /~ - 2 ! 7,•. REGI R'S SK;NRURE AyD NUMB~A L•-~ ~EFl~ ~, ~,.,~I v a.. 02 7 J REV-1547 EX AFP (12-95) COMMONMEALT["[ OF PENNSYLVANIA DEPARTMENT of REVENUE NOTICE OF INHERITANCE TAX ACN 101 BUREAU of I Nfl=VIDUAL taxes APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPT. 280 6 O 1 A 17128-0601 OF DEDUCTIONS AND ASSESSMENT OF TAX HARRISBURG, p DATE 02-12-96 ESTATE yr ~-- w~VRVC N DATE O F fl EATH 01-26-95 COUNTYO~ CUMBERLAND NOTE: TO Z NSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX pAYM E NT TO THE REGISTER OF WILLS. MAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT" REMIT PAYMENT T0: ALAN B RHINEHART DAUPHIN DEP BK 8 TR CO PO BOX 190 CARLISLE PA 17013 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 Aeount Rewitted CUT ALON_G__ THIS LINE -- ---- ---RETAIN-LOWER- PORTION FOR- YOUR RECORDS ---~ --------------_------ REV-1547 E X AFP (12-95) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE O F ELLIS GEORGE A FILE N0. 21 95-0109 ACN 101 DATE 02-12-96 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVAT I ~ N CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R~sl Estat• (Schedul• A) 2. Storks and Bonds (Schedule B) 3. C1 o sly Held Stock/Partnership Interest (Schedule C) 4. Mort 9s9es/Notes Receivable (Schedul• D) 5. Cash/gank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedul• F) 7. Transfers (Schedul• G) g, Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funsr'al Expenses/Aden. Costs/Misc. Expenses (Schedule H) 10. Debt s/Mortgage Liabilities/Liens (Schedul• I) 11. Total Deductions 12. Nit Valw of Tax Return 13. Charitable/Goverru~ental Bequests (Schedul• J) 14. Net Value of Estate Subject to Tax (i) .00 (2)_ 252.137 45 t3) .00 (4) . 00 (5) 34,392 69 (6) .00 (7) .00 (8) 286,530.14 (y) 26,180.65 (lo) 5 017 05 (11) _ ;1 197 70 (127 255, 332.44 (13) .00 (14) 255, 332.44 NOTE: If an assessment was issued previously, lines rg~lect figures that include the total of A 14, 15 andior 16, 17 and 18 will LL ASSESSMENT OF TAX: returns assessed to date. 15. Aeoun t of Line 14 at Spousal rate (15) .00 X .00 { of Line 14 taxable at Lineal/Class A rate (16) 16. Amoun 250, 332.44 = 06 • 00 17. Amount of Line 14 taxable at Collateral/Class B rate (17) 5,000.00 x• = X .15 15,019.95 18. Prin~ipel Tax Due = 750.00 TAX CREDITS cis) 15, 769.95 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST (-) AMOUNT PAID 04-19-95 AA023065 684.21 10-23-95 AA082249 00 13,000.00 01-17-96 AA082510 00 2,085.74 2,751.00 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX CREDIT BALANCE OF TAX DUE 18,520.95 2,751.000R INTEREST .00 TOTAL DUE 2,751.000R ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF-TOTAL DUE_IS REFLECTED AS A "CREDIT° [[Rl. vnu MAV s~ .,, ,.. 6;ii~~~~~~9~ ~~ FOR DATES OF DEATH AFTER 12/31/91 CHECK HERE REV-1500 EX+(7-94) INHERITANCE TAX RETURN POVERTVCREDITISCLAIMED RESIDENT DECEDENT FILE NunnBER COMDEPARTMENTOFPREVENUEANIA (TO BE FILED IN DUPLICATE 21-95-0109 DEPT. 280801 HARRISBURG, PA 17128-0801 WITH REGISTER OF WILLS COUNTYCODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) DECEDENT'S COMPLETE ADDRESS E Ellis, Geor e A. 14 Robin Court C SOCIAL SECURITYNUMBER DATE OF DEATH GATE OF BIRTH Mechanicsburg , PA 17055 p 180-01-4728 01/26/1995 03/06/1906 N County Cumberland T (IF APPLICABLE)SURVIVING SPOUSE'S NAME (LAST,FIRSTAND MIDDLE INITIAL) e SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS) A B 1. Original Return X 2. Supplemental Return 3. Remainder Return i P L 4. Limited Estate 4a. Future Interest Compromise (for dates of death prior to 12-13-82 R C (for dates of death after 12-12-82) ~ 5. Federal Estate Tax Return Required C P 3 ~ 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 0 e. Total Number of Safe Deposit Boxes (Attach copy of Will) (Attach a copy of Trust) C p ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ~ ~ R N NAME COMPLETEMAILINGADDRESS E E Alan B. Rhinehart Dauphin Deposit Bank and Trust Company S N TELEPHONE NUMBER P.O. BOX 19O - T 717 240-6710 Carlisle PA 17013 1. Keal tstate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) 4. Mortgages and Notes Receivable (Schedule D) (4) R E 5. Cash, Bank Deposits & Miscellaneous Personal Property (Sch. E) (5) A 6. Jointly Owned Property (Schedule F) (s) 46 , 000.00 p 7. Transfers (Schedule G) (Schedule L) 7) I T 8. Total Gross Assets (total Lines 1-7) ~ ~ / (8) 46 , 000.00 U L 9. Funeral Expenses, Administrative Costs, Miscellaneous ~~;~ 150.00 A Expenses (Schedule H) T I 10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) N 11. Total Deductions (total Lines 9 & 10) ifi (11) 150.00 12. Net Value of Estate (Line 8 minus Line 11) ~,`~ (12) 45 , 850.00 13. Charitable and Governmental Bequests (Schedule J) (13) , 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 45 , 850.00 15. Spousal Transfers (for dates of death after 6-30-94) T A X C 0 M P u See Instructions for Applicable Percentage on page 2. (15) 0 . 00 X __ ~ 0.00 (Include values from Schedule K or Schedule M.) 16. Amount of Line 14 taxable at 8% rate (18) 45 , 850.00 X .o - 2 , 751.00 (Include values from Schedule K or Schedule M.) 17. Amount of Line 14 taxable at 15% rate (17) 0.00 X (Include values from Schedule K or Schedule M.) 18. Principal tax due (Add tax from Line 15, 16 and 17.) 19.Credits/Sp Poverty Prior Payments Discount Interest + + - 15 = 0.00 (ia) 2 , 751.00 (1s) 0.00 TA 20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. (20) 0.00 T Q ~ Gheck here If you are requesting a refund of your Auerpayment 0 21. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE. (21) 2 , 7 51.00 N A. Enter the interest on the balance due on Line 21 A. (21 A) 0.00 B. Enter the total of Line 21 and 21A on Line 21 B. This is the BALANCE DUE. (21 B) 2 , 751.00 Make Check Pa able to: Re Ister of Wills, A ent - - BE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND TO RECHECK MATH t ~ Under penalties of perjury, 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. I declare that all real estate has been reported at true market value. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SI TURE OF~ERSO ON51 E FOR FILING RETURN Dauphin Deposit Bank and Trust Company DATE /~ P.O. Box 190 ----------------------------------------------------- /3ss~ (j>cc K.r%~G.-<tTi7uf 0.~.,vCarlisle, PA 17013 / /~ y~ SIGNATURE OFPREPAREROTHERTHANREPRESENTATIVE Dauphin Deposit Bank and Trust Company DATE P.O. Box 190 ----------------------------------------------------- Carlisle, PA 17013 Copyright (c) 1994 form software only CPSystems, Inc. Farm 1500 (Rev.7-94) Act #48 of 1994 provides for the reduction of the tax rates imposed on the net value of transfers to or for the use of the spouse. The rates as prescribed by the statute will be: •39'0 (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96 •2% (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97 •1% (.01) will be applicable for estates of decedents dying on or after 1/1/97 and before 1/1/98 •Spousal transfers occurring on or after 1/1/98 will be exempt from inheritance tax. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A MARK (X) IN THE APPROPRIATE BLOCKS. YES NO 1. Did decedent make a transfer and: a. retain the use or income of the property transferred, . X b. retain the right to designate who shall use the property transferred or its income, X c. retain a reversionary interest; or . X d. receive the promise for life of either payments, benefits or care? . X 2. if death occurred on or before December 12, 1982, did decedent within two years preceding death transfer property without receiving adequate consideration? If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? X 3. Did decedent own an 'in trust for' bank account at his or her death? X IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RET URN. Copyright (c) 1994 form software only CPSystems, Inc. Form f$00 (Rev. 7-94) REV - 1509 EX + (12-88) COMMONWEALTH OF PENNSYLVANIA SCHEDULE F 1NRESIOENTDECE~ENT N JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER George A. Ellis SS# 180-01-4728 01/26/1995 21-95-0109 Joint tenant(s): NAME ADDRESS RELATIONSHIP TO DECEDENT A. Britt St. Pierre 33 Russet Lane Great Granddaughter Levittown, PA 19055 B. C. ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY TOTAL VALUE OF ASSET DECD'S ~, INT. DOLLAR VALUE OF DECEDENT INTEREST 1 A 02/27/90 Real Estate Known as 92,000.00 50.00 46,000.00 One and One-Half Story Cape ~ Cod Dwelling Known as 33 Russett Lane Levittown, ~ Bristol Township, Bucks County, PA Jointly-owned property: " (If more space is needed, insert additional sheets of same size.) Copyright (c) 1994 form software only CPSystems, Inc. TOTAL (Also enter on line 6, Recapitul: 46,000.00 Form 500 Schedule F (Rev. 12-88) REV- 1511 Ex + (7-88) COMMONWEALTH OF PENNSYLVANIA IN RESIDENT DECEDENTRN SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND Please Print or Type FILE NUMBER 21-95-0109 Geor e A. Ellis SS# 180-01-4728 O1 26 1995 ITEM NUMBER DESCRIPTION AMOUNT A. Funeral Expenses: B. AdminlstraUve Costs: 1. Personal Representative Commissions Social Security Number of Personal Representative: Year Commissions paid 2. Attorney Fees 3. 4. C. 1 Family Exemption Claimant Address of Claimant at decedent's death Street Address City Probate Fees State Zip Code Miscellaneous Expenses: Phillip G. Alderfer - Appraisal Fee of Real Estate Located at 33 Russet Lane, Levittown, PA 19055 Relationship 150.00 TOTAL (Also enter on line 9, Recapitulation) $ 150.00 (If more space Is needed, Insert addltlonal sheets of same slze.) Copyright (c) 1994 form software only CPSystems, Inc. Fo 1$fl0 Schedule H (Rev. 7-88) ~ijlt~'r lil~~3 -t.dt deal ~~ dyef ~`~-! , tp9o ~~~e `_ kabfJtf E. HnrLS end R11tHERL~ A. Boris, hla v1 [e (hereinallee called Uet Gtaalot a ), ., ~Hn aRITr at. Plf3tgR AND itroRCt A. LLLta (heeainalke w11a1 die Gtaedee ). ~itnr>tfutl~, Thal in tomideintlan at aINt7Y mull TIWi1sAND csaeeooo.oo) oowaas is hand paid, the rae*t whenaE b ke:eb[ adsv.kdjcd. the nail Gnetgr s do Men Brant and w theaaidGaunec their heirs aadaadfeu, as Solat teaante MftA tM rl~gle~ of serrrivotshlp A1J. tH117 CBRtAiR lot. piece or parcel of land with tin bufldJags and leproreaeots thereon. SI3UAI'B, lTlnc and belreg at Le•Jttora, fa tbt Torgahip of Hriatol. CoagtT of Haeks. Co~oarsaleh of lienasTl•aaJa, abowo and designated as Lot Ma. 1101-R, on Subdirlafoa llap of "Red Cedar $ill°, Lerltlo+rn. Section 2L, [l led io the Offite of the Reeordee• of 4eedp, of .quc~i_.County, Pepnglve+nia, ,oe June 2A. 1959. fn Plan Boole 6. pain 3i, as Iollors. to iii[: . BE7GINNINO at s point ea the SostbrNterlr aide of Rgseeet Lace (SO feet ride) a eorsar of Lot No. 1100-R on ssld Plena said polo[ befn{ tla .three following eourees an6 distances [rp. the interaeetloa oL the NortleeriT aide of Red l:edsr brf•e (58 feet vide); (I) Noreh 6 degrees S MJnuttr AA aecoade Least 89.47 feet co s polgt of currei (2) oa the arc of a efrclt evrrfng to tM ls[t inrfag s redivs of 150 feet the are dlatance o[ 113.70 feet to a point[ and (3D lbtth 37 degrets 20 edqutea OS seconds Yesc 3b7.96 feet to the point end place o[ beefnafngl thence a:tendfae troy acid point of beeJnnlae alone Oat No. 1100-R South 52 dearter 39 .fnutea SS asconds Yert 119.59 feet too point. fn line of Rat No. IOBS-R oa aia Vlant theaee exttndtoa •lemg the aeon North 31 degrees 45 .routes 21 seconds Vent 60.28 feet co a polat, a corner of Lot .Ro. 1102-R oa acid Plant thence esteading elan` eM aaaMr Roreh ST dtarees.39 eeloutea 55 etcohds East 123.13 feet co a pofae on the SovthveaterlT aide of Ruesec~Lane sforesafdl thence excendinc along the eaaK South 37 decrees 20 adqutes ;;OS aecoads East 60.00 feet to tM [lrst eentaoned point cad place v[ bEG11iNiNC. Hl;INO~ I:IIOYN AS 33 Rvantt Vat, Erlatof Tornahip, Hueks ConntT, PennaTlrsnfa. Covacr Parcel Nvel6er 5-39-79. bEINC THE SAitE PREMISES t+V1CN Thelw Dyers, vldor by Dted dated August l7, 1979 and recorded fn Bucks Covatr. PeansTlranle is Deed Hook 2350 peas 1183 graueed and eonreTed uaty Robert E. HoTle cad [i^berlr A. HoTle. bas rife. io fee. UNDER AND SUBJFit.T IU corenants. rights and rtaerratloa as of record. , .• ~•° ... `'_ .. l.,.1 r 8111; ,~ c~i/ ~ " iIl rAl!/"!O~ • ItAt::•:. ... .: ?AIQ 1~-iiA .~ Maid de.nte< •' •lrtebr soe~ritMa ~ tr.d lpae . taw they ` . • .. 8KQ 1 5 Q ~ 16 4 eon ~1 +raredlit fief ti.NO+r+ Y!dll-.+ellwpiL ~ . renew face rwr.:.ra SUMMARY APPRAISAL REPORT - LIMITED APPRAISAL: ---------------------------------------------- This is a Summary Appraisal Report - Limited Appraisal which is intended to comply with the reporting requirements set forth under Standards Rule 2-2(b) of the Uniform Standards of Professional Appraisal Practice of the Appraisal foundation. PURPOSE AND (UNCTION: ' The purpose of this appraisal is to estimate the market value of the subject property as of the effective date of the appraisal. "Market value" is defined by the federal financial institutions" regulatory agencies as follows: Market value means 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 and knowledgeably, 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: (I) buyer and seller are typically motivated; (2) both parties are well informed or well advised and acting ir: what they consider their own best interests; (3) a reasonable time is allowed. for exposure in the open market; (4) payment is made in terms of cash in ll. S. dollars or in terms of financial arrangements comparable thereto; t5) the price represents the normal consideration for the property sold unaffected by special or creative financing or sales e,oncessions granted by anyone associated with the sale. In preparing this appraisal, the appraiser has been requested to perform an interior and exterior inspection of the subject property. Per prior agreement with the client, the appraiser did not value the site and did not use either the cost or income approaches to value, although these approaches would generally be considered meaningful in appraising a property of this type. The appraisal process therefore involved departure from Standards Rule I-4(a) and (b)i, ii, iv and vi. Data were collected from a variety of sources including, but not limited to, public land records, a multiple listing service, tax records, brokers, buyers, sellers and in-office files. The form summarizes the process and conclusion of value fur thF sales comparison approach and a final value conclusion. Additional supporting data can be found in our appraisal file. PROPERTY RIGHTS APPRAISED: fee Simple STATEMENT OF LIMITING CONDITIONS AND APPRAISER'S CERTIFICATION: This is a Summary Appraisal Report - limited Appraisal which is intended to comply with .the reporting requirements set forth under ~.R. 7_-2(h) of the Uniform Standards of Professional Appraisal Practice. s such, ~t might not include full discussion of the data, reasoning and analyses chat were used in the appraisal process to develop the appraiser's opinion of value. Supporting documentation concerning the data, reasoning and analyses is retained in the appraiser's file. The information contained in this report is specific to the needs of the client and for the intended use stated in this report. The appraiser is not responsible for unauthorized use of this report. CONTINGENT AND LIMITING CONDITIONS: I. The appraiser will not be responsible for matters of a legal nature that affect either the property being appraised or the title to it. The appraiser assumes that the title is good and marketable and, therefore, will not render any opinions about the title. The property is appraised on the basis of it being under responsible ownership. 2. The appraiser has provided a sketch in the appraisal report to show approximate dimensions of the improvements and the sketch is included only to assist the reader of the report in visualizing the property and understanding the appraiser's determination of its size. 3. The appraiser has examined the available flood maps that are provided by the Federal Emergency Management Agency (or other data source) and has noted in the appraisal report whether the subject site is located in an identified Special Flood Hazard Area. Because the appraiser is not a surveyor, he or she makes no guarantees, express or implied, regarding this determination. 4. The appraiser will not give testimony or appear in court because he or she made an appraisal of the property in question. unless specific arrangements to do so have been made beforehand. 5. The appraiser has noted in the appraisal report anv adverse conditions (such as needed repairs, depreciation, the presence of hazardous wastes, toxic substances, etc.) observed during the inspection of the subject property or that he or she became aware of during the normal research involved in performing the appraisal. Unless otherwise stated in the appraisal report, the appraiser has no knowledge of any hidden or unapparent conditions of the property or adverse environmental conditions isincluding the presence of hazardous wastes, toxic substances, etc.? than: would make the property more or less valuable, and has assumed that there are no such conditions and makes no guarantees or warranties, express or implied, regarding the condition of the property. The appraiser will not be responsible for any such conditions that do exist or for any engineering or testing that might be required to discover whether such conditions exist. Because the appraiser ic_ not, an expert in the field of environmental hazards, the appraisal report must no 4: be considered as an environmental assessment of the property. 6. The appraiser obtained the information, estimates and opinions that were expressed in the appraisal report from sources that he or she considers to be reliable and believes them to be true and correct. The appraiser does not assume responsibility for the accuracy of such items that were furnised by other parties. 7. The appraiser will not disclose the contents of khe appraisal report except as provided for in the Uniform Standards of Professional Appraisal Practice. 8. The appraiser must provide his or her prior written consent before the lender/client specified in the appraisal report can distribute the appraisal report (including conclusions about the property value, the appraiser's identity and professional designations, and references to any professional appraisal organizations or the firm with which the appraier is associated) to anyone other than the borrower; the mortgagee or its successors and assigns; the mortgage insurer: consultants; professional appraisal organizations; any state or federally approved financial institution; or any department, agency or instrumentality of the !Inited States or any state or the District of Columbia; except that the lender/client may distribute the property description section of the report only to data collection or reporting service(s) without having to obtain the appraiser's prior written consent. The appraiser's written consent and approval must also be obtained before the appraisal can be conveyed by anyone to the public through advertising, public relations, news, sales or other media. 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 proi>erties 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 taken 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 and professional analysis, opinions and conclusions, which are subject nO~y tO the contingent and limiting conditions specified in this eddandum. 4. I have no present or prospective interest in the property that is the subject of this report, and I have no present or prospective personal interest or bias with respect to the participants in the transaction. 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 of the present owners or occupants of the properties in the vicinity of 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. I was not required to report a predetermined value or direction in value that favors the cause of the client or related part;r~, the amount of the value estimate, the attainment of a specific result, or the occurence of a subsequent event in order to ,°eceive my compensation and/or employa~ent for performing the appraisal. I did not base the appraisal report on a requested minimum valuation, a specific valuation or the need to approve a specific mortgage loan. 7. I performed this appraisal in conformity with the Uniform Standards of Professional Appraisal Practice that were adopted and promulgated by the Appraisal Standards Board of The Appraisal Foundation and that were in place as of the effective date of this appraisal. I acknowledge that an estimate of a reasonable time for exposure in the open market is a condition in the definition of market value and the estimate I developed is consistent with the marketing time noted in the neighborhood section of this reoort, unless I have otherwise stated in the reconciliation section. 8. I have personally inspected the interior and exterior areas of the subject property. 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 c:~nditions on the marketability of the subject property. 9. I personally prepared all conclusions and opinions about the real estate that were set forth in the appraisal report. If I relied on significant professional assistance from any 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. SUPPLEMENTARY CERTIFICATIONS: I certify that the use of this report '.s subject to the requirements of the Appraisal Institute relating to review by its duly authorized representatives. In addition, I certify that, to the best of my knowledge and belief, the reported analysis, opinions and conclusions were developed, and this report was prepared in conformity with the requirements of the Code of Professional Ethics and the Standards of Professional Appraisal Practice of the Appraisal Institute. As of the date of this appraisal. Philip G. Alderfer, SRA has completed the requirements of the continuing education program of the Appraisal Institute. Philip G. Ald rfer, SRA Certified General Real Es~ate Appraiser GA-000158-L, Expiration Date: June 30. 1995 (tr ~~~~ REV - tsoo Ex . (~-9~) INHERITANCE T RETURN. coM Nw A H OF P SYLVANIA RESIDENT DECEDENT H~A~aRIS~~~cTA ti~ osot ~C BE FILED IN DUPLICATE WITH REGISTEI DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Ellis Geor a A, SOCIAL SECURITY NUMBER DATE OF DEATH DATE OF BIRTH 180-01-4728 O1/26~95 03/06/1906 FOR DATES OF DEATH AFTER 1TJ31/91 CHECX HERE IF A SPOUSAL POVERTY CRED T IS C~ AIMED FILE NUMBER 21-95-0109 COUNTY CODE YEAR NUMI D E C E D E N T ECEDENT'S COMPLETE ADDRESS 14 Robin Court Mechanicsburg, PA 17055 county Cumberland APPLICABLE)SURVIVINGSPOU SNAME(LAST,FIRSTANOMIODLEINITIAL) SOCIAL SECURITY NUMBER CAB X 1. Original Return 4 Limit d E C O K . e state K P S QX 6. Decedent Died Testate (Attach copy of WII) C p ALL CORRESPONDENCE AND O O R N S N - T R E C A P I T u L A T I O N T A X C 0 M P U T A T 1 O N 2. Supplemental Return - ^ 4a. Futuro Interest Compromise (for dates of death after 12-12-82) 7. Decedent Maintained a Livinq Trust (Attach a copy of Trust} TAX SHOULD BE DIRECTED 1 AMOUNT RECEIVED (SEE INSTRUCTIONS) 0.00 U 3. Remainder Retum (for dates of death prior to 12-13-82) S. Federal Estate Tax Retum Required 0 8. Total Number of Safe Deposit Boxes COMPLETE MAILING ADDRESS Alan B. Rhinehart Dauphin Deposit Bank and Trust Company TELEPHONE NUMBER P.O. BOX 19O (717) 240-6710 Carlisle PA 17013 1. Real Estate (Schedule A) Z S 1 None . tocks and Bonds (Schedule B) (2) 252 ,137.45 3. Closely Held Stock/Partnership Interest (Schedule C) None 4. Mortgages and Notes Receivable (Schedule D) (4) --~"None 5. Cash, Bank Deposits & Miscellaneous Personal Property (Sch. E) (5~ ~' 34, 392.69 6. Jointly Owned Property (Schedule F) None 7. Transfers (Schedule G) (Schedule L) (7) None 8. Total Gross Assets (total Lines 1-7) -° 9. Funeral Expenses, Administrative Costs, Miscellaneous ( 26 ,180.65 Expenses (Schedule H) 10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) 5 , 017.05 11. Total Deductions (total Lines 9 8 10) - -'- 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmerttal Bequests (Schedule J) 14. Net Value Subjset to Tax (Line 12 minus Lins 13) 15. Spousal Transfers (for dates of death after 6-30-94) (8) 286 , 530.14 (1t) 31,197.70 (12) 255 , 332.44 (13) None (14) 255 , 332.44 See Instructions for Applleable Percentage on page 2. (15) 0.00 X = (Include values from Schedule K or Schedule M.) 0.00 16. Amount of Line 14 taxable at 6% rate (16) 250 , 332.44 X .06 = 15 , 019.95 (Include values from Schedule K or Schedule M.) 17. Amount of Line 14 taxable at 15% rate (17) 5 , 000.00 - (Include values from Schedule K or Schedule M.) X'"' 750.00 18. Principal tax due (Add tax from Line 15, 16 and 17.) rM 19. Credits/Sp Poverty Prior Payments Discount Interost _ ~•00+ 13,000.00 + 684.21 0.00 20. If Line 19 is greater than Line 18, enter the diffaronce on Line 20. This is the OVERPAYMENT. a ^ Cheek: Efets if sq you:ars:r usa~fn :$:n~a~ol:. r ovr4 Z7. If line 18 is greater than Line 19, enter the differonce on Line 21. This is the TAX DUE. A. Enter the interest on the balance due on Line 21A. B. Enter the total of Line 21 and 21A on Lins 218. This is the BALANCE DUE Make Cheek Payable to: Reyfstsr of Wilb, Aaent - - BE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND TO RECHECK MATH ~ ~ Ise of periurv. I declare rr,ae i ti~w -..-_. correct and complete. I declare that all real estate has been •- • a.w • •• ••~~~~ ~~~~~ senedules and statsmenta, and to the reported at trw nwket value. Declaration of ~ know ge and be . it s trw, which prsparer has arty knowledge. preparer other than the personal roprosernatlve is based on all Ir~formatlan of SI TURE OF,QERS PONSI E FOR FILING RETURN ~~ DATE P.O. Box 190 / ~~ Carlisle PA 17013 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ---- DATE Dauphin-De~osit_Bank and Trust Company ---- ------------- P.O. Box 190 -'---- Copyright (e) 1994 form software ony CPSystsms, Inc. Carl i s 1 e , PA 1707.3 Form (Rev, 7-9~) (18) 15 , 769.95 (19)_ 13 , 684.21 (~) 0.00 (21) 2 , 085.74 ( 21A) 0.00 (218) 2,085.74 /_ ` Act #48 of 1994 provides for the reduction of the tax rates imposed on the net value of transfers to or for the use o! the spouse. The rates as prescribed by the statute will be: •3% (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96 •2% (.02) will be applicable for estates of decedents dying on or aRer 1/1/96 and before 1/1/97 • 1% (.01) will be applicable for estates of decedents dying on or after 1/1/97 and before 1/1/98 •Spousai transfers occurring on or after 1/1/98 will be exempt from inheritance tax. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A MARK (X) IN THE APPROPRIATE BLOCKS. YES NO 1. Did decedent make a transfer and: a. retain the use or income of the property transferred, . ... .. .. R b. retain the right to designate who shall use the property transferred or its income, .. .. .. $ c. retain a reversionary interest; or . .. g d. receive the promise for life of either payments, benefits or care?. g 2. If death occurred on or before December 12, 1982, did decedent within two years preceding death transfer property without receiving adequate consideration? If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .. ...... .. .. .. .. ... .. g 3. Did decadent own an 'in trust for' bank account at his or her death? ... .. .. .. g IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Copyright (e) 1994 form softwaro only CPSystems, I ne. Form 1500 (Rw. 7-94) ~C REV - 1502 EX + 02_85) COM INEALTM pp~Syi MANIA SCHEDULE A '~~~f~~bl~~V'~EDT NL~7t#"N REAL. ESTATE ESTATE OF George A. Ellis SS~~ 180-01-4728 01/26/1995 FILE NUMBER (pro 21 95 0109 party jointly-owned with Right ~ Survivorship must be disclosed on Schedule F} All real estate should bs reported at fair market value which is defined as the prke at which property would bs exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell. both Navin reasonable knowled • of the rolevsnt facts. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH TOTAL (Also enter on line 1, Reca itulation) S 0.00 (If more space is needed, insert additional sheets of same sae.) Copyright (e)1994 form softwaro oMy CPSystsms, Ina. Form 1500 schedule A (Rev, fz-85) C _ REV - 1503 EX + (4-86) COMMNt))~yEAi,7pp,~Ngy~~,,gp„p SCHEDULE B ___ _ __ _ _ 1 ~~~~F"l~I~b~~''l T Fe~n~JrpN STOCKS AND BOI George A. Ellis SS~~ 180-01-4728 01/26/1995 ,n ro arty of owrtid with Ri ht of Survivorship must be diselos~d on Schedule ITEM NUMBER DESCRIPTION 1 $20,000 Dauphin Deposit Bank and Trust Co. Certificate of Deposit 3.97: due 8/29/95 Accrued Interest 2 $89,479.61 Dauphin Deposit Bank and Trust Co. Certificate of Deposit 3.559: due 3/27/95 Accrued Interest 3 $44,164.95 Harris Savings Assn. Certificate of Deposit 4.44y due 8/6/95 Accrued Interest 4 $18,406.57 Harris Savings Assn. Certificate of Deposit 4.44Y. due 8/29/95 Accrued Interest 5 $22,452.98 Harris Savings Assn. Certificate of Deposit 4.449: due 8/13/95 Accrued Interest 6 $55,321.63 Meridian Bank Certificate of Deposit 3.60Y due 3/25/95 Accrued Interest TOTAL (Also enter on line 2, yr more space Is neeOea, insert additional sheets O} same size.) Copyright (e) 1994 form softwaro only CPSystems, int. FILE NUMBER 21-95-0109 VALUE AT DATE OF DEATH 20,000. 322.68 89,479.61 1,061.74 44,164.95 134.31 18,406.57 55.98 22,452.98 68.28 55,321.63 668.72 s Z5Z 137.45 1500 SehedWs B (Rev. 4-86) TOTAL (Also enter on line 3 Recapitulation) ~S 0 00 (If more space ~s needed, insert additional sheets of same size.) Copyright (e) 1994 form softwaro ony CPSystsms, Inc. Form 1500 Schedule C (Rw. 3-92) REV - 7507 EX • (1-88) COMINR Nq~~y~yANIA SCHEDULE D MORTGAGES. AND NOTES George A. Ellis ITEM NUMBER SS~~ 180-01-4728 with the Right of Survivors) 01/26/1995 must b~ dbclossd on SeMdule F.) DESCRIPTION 21-95-0109 VALUE AT DATE OF DEATH TOTAL (Also enter on line 4, Reca itulation) i 0.00 (If more space is needed, insert additbnal sheets of same size.) Copyright (e)1994 form softwaro oMy CpSyatsma, Ins, Form 1500 Seh~dule D (Re. 7-88) REV - 1508 EX + (2-87) COM INHEREAIT}{ _Op~gyLyANIA SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS George A. Ellis SS~~ 180-01-4728 01/26/1995 ~. tt or I ype FILE NUMBER 21-95-0109 lnn ro omtry-owned with Rl ht of Survivorshi t b di p mus s selos~d on Sehsdub F) ITEM NUMBER DESCRIPTION VALUE AT DATE 1 Allstate Insuranc C OFDEATH e o. - Refund of Unused Premium 162.40 2 Proceeds on Sale of 1994 14 250 00 Chrysler LeBaron Landau , . 3 Blue Cross/Blue Shield - Benefits 29.76 4 Carlisle Imaging Associates - Refund 9.42 5 Country Meadows of West Shore Home - Refund 2,058.94 6 Commonwealth of Pennsylvania - 1994 Form PA-40 Refund 150.00 7 Dauphin Deposit Bank and Trust Co. Market Square Cash 7,400.00 Manager No. 1 8 Dauphin Deposit Bank and Trust Co. Checking Account 1,404.17 ~~0010264949 Accrued Interest 3.96 9 George A. Ellis - Cash 51.29 10 Cash Found in Apartment 36.77 11 Household Effects - Appraised Value and Sale 550.00 Proceeds 12 Harris Savings Assn. Certificate of Deposit 81.94 ~~02096237753 - Interest Check Found in Home 13 Metropolitan Life Insurance Co. - Benefits 2,050.00 (see continuation schedule attached) Total of Continuation Schedule(s) 4.04 TOTAL (Also errter on line 5, Reca itulation) 34 , 3 92.6 9 (Attach additional 8 1/2" x 11" sheets if more space is needed.) Copyright (c) 1994 form software ony CPSystems. Ine. Form 1500 SchsdWe E (Rw. 2-871 - _ _ - . p Estate of: George A. Ellis SS~~ 180-01-4728 01/26/1995 CONTINUATION SCHIDULE Continuation of Schedule E ITEM DESCRIPTION VALUE AT DATE ~~ OF DEATH 14 Property Management Inc. - Security Deposit Refund 42.76 15 Property Management Inc. - 287 91 Refund on Prepaid Rent 16 Prudential Insurance Company 4 409.07 of America - Benefits , 17 U.S. Railroad Retirement 983 30 Board - Benefit for Burial . Expense 18 U.S. Treasury - 1994 Form 431 00 1040 Refund . 6,154.04 COMIMIq~v~F~~~q~~$nyANIA SCHEDULE F ~€sIb'~'N r~" JOINTLY-OWNED PROPERTY ESTATE OF George A. Ellis SS~~ 180-01-4728 01/26/1995 FILE NUMBER 21 95 0109 Joint tsnaM(s): NAME ADDRESS eerwrrnu~u d ~ ~^ ^~^~~nIP TO DECEDENNT -° ' B. C. Jointly-owned property: ITEM LETTER DATE NUMBER OINT MADE DESCRIPTION OF PROPERTY TOTAL VALUE DECD'S DOLLAR VALUE OF TENANT JOINT OF ASSET °ti INT. DECEDENT INTEREST TOTAL (Also enter on line 6, Reca itulation) 0,.00 (If more space is needed, insert additional sheets of same size.) Copyright (e) 1994 form softwaro only CPSystems, Inc. Form 1500 sohwul. F (aw. tz-ee> REY - 1510 t7C + (2-87) VANIA I SCHEDULE G COM~N~ i~I~L,7Op~gy~ ~~SFERS :OF ~DE-~1 T NOTR~I George A. Ellis SS~~ 180-O1-4728 01/26/1995 21-95-0109 THIS SCHEDULE MUST BE COMPLETED AND FILED IF THE ANSWER TO ANY OF THE DUESTIONS ON PAGE 2 IS YES. ITEM DESCRIPTION OF PROPERTY TOTAL VALUE DECD'S DOLLAR VALUE OF NUMBER lneludenamsoftMtransferse,thNr IXCLUSION relatlonahl todKSdsrK date oftrarafer. OF ASSET % INT. DECEDENT INTEREST TOTAL (Also enter on line 7 Recapitulation) ~ 0 00 (If more space :s needed, Insert additional sheets of same size.) Copyright (c)1994 form aoftwars only CPSyst~ms, lne. Porn 1500 Sehedul. G (Rev. 2-a7) REV - 1511 D(. (7.88) COMINO ESI~EN~Dp~~pENN~LVANIA SCHEDULE H FUNERAL EXPENSES, ADMINISTRATNE COSTS AND ESTATE OF - - - - -- ~~ease rent or • FILE NUMBER Geor a A. Ellis SS~~ 180-O1-4728 O1 26 1995 21-95-0109 ITEM NUMBER DESCRIPTION AMOUNT A• Funeral Expenssa: 1 John C. Sullivan Funeral Home - Funeral Expense 4,578.00 9. Administrative Costs: 1• Personal Representative Commissions Dauphin Deposit Bank and Trust Co . Social Security Number of Personal Rspressr><ative: Year Comrrtissions paid 2 Attorney Fees Edmund G. Myers , Esquire Johnson, Duffie, Stewart & Weidner 3. Family Exemption Claimant Relationship Address of Claimant at decedent's death Street Address Ctty Stets Zip Code 4. Probate Fees 11,595.90 9,000.00 0.00 267.00 C• Miscellaneous Expenses: 1 Allstate Insurance Co. - Insurance Premium 2 Cumberland Law Journal - Cost of Advertising and Proof of Publication 3 Commonwealth of Pennsylvania - Charge to Re-Register 1994 Chrysler 4 Dauphin Oil Co. - Gas for Chrysler 5 Federal Express Priority Mail - Postage Expense (see continuation schedule attached) Total of Continuation Schedule(s) TvTAL (Also enter on line 9, Reea itulation) fit mon space is needed, insert additlonal sheets of same size.) Copyright (e) 199 form softwaro only CPSystems, Inc. 137.06 40.00 39.00 10.00 11.50 x_502.19 26,180.65 Form 1900 SeheduM H (Rev. 7-ee) Estate of: George A. Ellis SS~~ 180-01-4728 01/26/1995 CONTINUATION SCHEDULE Continuation of Schedule H-C ITEM DESCRIPTION ~~ AMOUNT 6 M.F. Rockey Moving Co. - Balance Due 7 Patriot News Company - Cost of Advertising and Proof of Publication 8 Sollenberger's Messenger Service - Charge to Re-Register 1994 Chrysler 9 Thompson's Reconditioning .Cleaning - Clean 1994 Chrysler LeBaron 10 Vital Statistics - Death Certificate on Sharon Bockin 191.79 176.20 30.50 100.70 3.00 502.19 REV - 1512 EX a (1-93) SCHEDULEI COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN RESIDENT DECEDENT MORTGAGE LIABILITIES AND ., FILE NUMBER George A. Ellis SS~~ 180-O1-4728 01/26/1995 21-95-0109 ITEM NUMBER DESCRIPTION AMOUNT 1 Allstate Policy ~~00$15694706122 - Insurance 65.55 Pr em i~,lttt 2 Bell Atlantic - Telephone Expense 22.87 3 Barbara A. Baer - Clean Apartment 96.00 4 Chuck Bricker, Auctioneer - Appraisal of Household 30.00 Effects f 5 Carlisle Imaging Assoc. - Medical Expense 9.42 6 Cowley Associates - Physician Service Expense 69.10 7 Dauphin Oil Co. - Inspection on 1994 Chrysler LeBaron 16.95 8 Good Hope Family Physicians - Physician Service Expense 23.45 9 Harrisburg Oncology Associates - Medical Expense 39.41 10 Holy Spirit Hospital - Hospital Care Expense 17.55 11 Johnson, Duffie, Stewart & Weidner - Professional 1,005.00 Services Rendered 12 Leader Nursing Center, Inc. - Convalescent Home Expense 2,213.73 13 MedLab - Medical Expense 40.50 (see continuation schedule attached) Total of .Continuation Schedule(s) TOTAL (.Alen snts..... rs ~n n____:, (If more space is needed, insert addiponal sheets of same size.} Copyright (c) 1994 form software only CPSystems, Inc. 1,3 7.52 _ 017.05 Form 15 seneduls ((Rw.1-93j Estate of: George A. Ellis SS~~ 180-01-4728 01/26/1995 CONTINUATION SCHEDULE Continuation of Schedule I ITEM DESCRIPTION ~~ AMOUNT 14 M.F. Rockey Moving Co. Inc. - Move Household Contents into Storage 15 Pennsylvania Power & Light Co. - Utility Expense 16 Shermansdale Family Practice - Physician Service Expense 17 Tri-County Ambulance Service - Charge to move from Carlisle to Camp Hill 993.04 174.28 21.20 179.00 1,367.52 ' REV - 1513 EX + (2-87) COMIN~~~Ep~1{pFpENNgy~yAN,A SCHEDULE J ___ _ __ _ _ +aa ~F`L+TEACXERpEETN[JTRN BENEFICIARIES Geor a A. Ellis SS~~ 180-01-4728 O1 26 1995 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY A. Taxable Bequests: 1 Ardella Kohr 220 N. Enola Drive Enola, PA 17025 2 Veronica St. Pierre (minor) 33 Russet Lane Levittown, PA 19055 3 Britt (Bocklin) St. Pierre 33 Russet Lane Levittown, PA 19055 4 Samantha Ammar 1214 Federal Street Philadelphia, PA 19146 5 Veronica St. Pierre (minor) 33 Russet Lane Levittown, PA 19055 FILE NUMBER 21-95-0109 RELATIONSHIP AMOUNT OR SHARE OF ESTATE Friend $5,000 Spe est Great-grea~ $100,000 in randdaught Trust Great ~ 101: of Residue Great ~ 50/a of Residue Great-grea 401: of Residue randdaughte in Trust ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY B. Charitable and Governmental Bequests: AMOUNT OR SHARE OF ESTATE TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) I= 0 00 (H more space is needed, insert addlbonal sheets of same size.} Copyright (e) 1994 form software only CPSystems, Inc. Form 1500 Schedule J (Rev. 2-8~ `" 004380-00001/October 4, 1993° `~M/GMM/39803 1~t~t 3~i11 ~xrt.~ C~e~ttt~ertt OF GEORGE A. ELLIS I, GEORGE A. ELLIS, of Mechanicsburg, Cumberland Co~.lnty, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all Wills or Codicils at any time heretofore made by me. ARTICLE I I direct the payment of all my legal debts, and the expenses of my last illness and funeral from my Estate as soon after my death as conveniently may be dons. I direct that all taxes that may be assessed in consequence of my death, of whatever nature and whatever jurisdiction imposed, shall be paid from my Residuary Estate as part of the expense of the administration of my Estate. ARTICLE II I give and bequeath the sum of Five Thousand ($5,000.00) Dollars unto my friend, ARDELLA KOit3R, Enola, Pennsylvania, provided she survives me. ARTICLE III I give and bequeath the sum of One Hundred Thousand (5100,000.00) Dollars unto DAUPHIN DEPOSIT BANK ANA TRUST COMPANY, in Trust, however, to hold, manage, invest and reinvest the same and the accumulation of income thereon and to use and apply the income and principal, or such much thereof as, in Trustee's discretion, may he necessary or appropriate for the support and education 004280.00001/October 4, 19931^~M/GMM/29802 of my great-great granddaughter, VERONICA ST. PIERRE, such education to include college education, both graduate and undergraduate and vocation training beyond high school, without regard to her ability to provide for such support or education, or to make payment for these purposes without further responsibility, to such beneficiary or to any person taking care of such beneficiary. When VERONICA ST. PIERRE shall reach the age of twenty-one (21) years, Trustee shall distribute to her a one-third (1/3) of the then-remaining principal and any income accumulated thereon, and the balance of principal and any income accumulated thereon when she shall have reached the age of twenty-four (24) years: In the event the beneficiary, VERONICA ST. PIERRE, dies before receiving her final distribution hereunder, this Trust shall terminate, and the balance of principal and income shall be paid over to her personal representative. I direct that the interest of VERONICA ST. PIERRE under this Trust shall not be subject to anticipation or to voluntary or involuntary alienation. If at any time during the continuance of any Trust created hereunder, the Trustee in its' sole and absolute discretion determines that the size of any individual Trust account has become so small as to be impractical to continue to hold in Trust and uneconomical to continue to administer as a Trust, then in such circumstances, the Trustee may without further authorization distribute the balance of the principal and income in such Trust account to the heneticiary then-entitled to the income therefrom, and upon such distribution the Trustee shall he released from further c~bligatiun with respect to that account and shall ~, not be subject to any claim from any person who may have had a future interest in such Trust account had it been continued in Trust. ARTICLE IV I give, devise and bequeath all the rest, residue, and remainder of my Estate, of whatsoever nature and wheresoever situate as follows: A• Ten (10%) percent thereof unto my great granddaughter, BRITT (BOCKLIN) ST. PIERRE, Levittown, Pennsylvania; 004280.00001/October 4, 19931"'"'M/GMM/29802 S j 13. Fifty (50%) percent thereof unto my great granddaughter, SAMANTHA AMMAR, Levittown, Pennsylvania; and C. Forty (400) percent thereof unto my great-great granddaughter, VERONICA ST. PIERRE, provided that should she not have reached the age of twenty-one (21) years at the time of my death, I give, devise and bequeath her share unto my Trustee named in Article III hereof for the uses and purposes set forth therein. ARTICLE V I name, constitute and appoint DAUPHIN DEPOSIT BANK AND TRUST COMPANY, Harrisburg, Pennsylvania, Executor of this my Last Will and Testament. IN WITNESS WHEREOF, i have hereunto set my hand and seal, this b'~day of October, 1993. ~v~ C ~ i ~ a " ~~f ` ~' ~'j ~ (SEAL) "George A!Ellis r Signed, sealed, published and declared by the above-named Testator, as and for his Last Will and Testament, in the presence of us, who at his request, in his presence and in the presence of each other, have hereunto subscribed our names as witnesses. /v ..~~ i '• 004280-00001/October 4, 19936^^•M/GMM/:9803 ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA ; COUNTY OF CUMBERLAND :SS W e, George A. Ellis, ~!,~ (~~l+a'ej !=+ ~ ~v! {~~pi 3 and ~ `;~ ~-~h ~r ~ ~ i~ ~ `~ jt~~ cJ~', , the Testator and the witnesses, respectively, whose names are si ned to the attachedJor fore oin g g g instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and that he had signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witness and that to the best of his/her knowledge the Testator was at that time eighteen years of age ~r older, of sound mind and under no constraint or undue influence. George.r~,~. Ellis ~` f~ Witness i i~ ,~~ ice"`=. Wit ess Subscribed, sworn to and acknowledged before me by George A. Ellis, Testator, and subscribed and sworn to before me by ~~ +-!+„~+, ~ ~4 ~`,.-.,.~ w . ~~, f and ~~ ~ 7 i-+ . p . •~~`." ;. lei ~,t+~?- ,~~, ,witnesses, this ~:~ day of October, 1993. .j Gha M. MWa1y, Nomty RL7ic Carrutis8.~«orai Expces t)ea[)ea ~ 1 M2rr~, ren~yrNar~ASSOda~n of f~o~.ories i ~ ~;. ~ ~ i i ~' ~ II / Notary Public +' I ,/ ..