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Home My WebLink About05-24-13 (2) _ ___ _ _ __ _ _ _ _ _ .,��. _-- :.r—�„- � 1505610105 REV-1500 EX(oz-ii)(FI); , ' � OFFICIAL USE ONLY PA Department of Revenue pennsylvania (� OEFAPitttllt Oi 11FVlIIVE y�Un� Bureau of Individual Taxes y Code Year File Number PO BOX 280601 j �r INHERITANCE TAX RETURN " Harrisburg,PA i�iz8-o6oi RESIDENT DECEDENT �i1 ! � �—�' �� L/ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY _ _ _ ._ ........._.__ _ .._ _. . , ' 10/11/2012 12/06/1919 _ _ . ___ _ _ _ _ DecedenYs Last Name Suffix DecedenYs First Name MI _ _ . _ _.. _. . HENSHAW ! THELMA E __ __. .. .. _ _ _ _ _ __ __ _. (If Applicable) Enter Surviving Spouse's Information Below � Spouse's Last Name Suffix Spouse's First Name M� __ _ _ _ Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE __ REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1. Original Return O 2. Suppiemental Return O 3. Remainder Return(Date of Death Priorto 12-13-82) O 4.Limited Estate p 4a. Future Interest Compromise(date of p 5. Federal Estate Tax Return Required death after 12-12-82) C� 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust � 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED,ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION QIlOULD BE DIRE6#�T0: Name Daylime Tel�ro�Number w � � WILLIAM C. DISSINGER (717) 957�4� i ,�; �'? �,�,,-�' � ��+. \`} _�-- Ll) � REGI�TEf2�9F(dV�LLS�ONLY;y r�;I �.w _. _^_ „ -� First Line of Address " 400 SOUTH STATE ROAD Second Line of Address �- � Re City or Post Office Staie ZIP Code DATe FiLED _ _ __ _ __ MARYSVILLE PA '17053 CorrespondenYs e•mail address: 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.Declaration of preparer other than the personal representative is based on all iniormation of which preparer has any knowledge. SIGNA U E OF PERSON R PO FOR FILING RETURN DATE k � ADDRESS 5307 SPRING ROAD, SHERMANSDALE PA 17090 SIGN TU E F PREPARER R AN REPRESENTATIVE � � ATE ADDRESS 400 SOUTH STATE ROAD, MARYSV LLE PA 17053 PLEASE USE ORIGINAL FORM ONLY ' Side 1 2 � 1505610105 1,5�561,0105 �' � �� _ _ _ _ _ ___ . .__ - ..�. - r J 1505610205 REV-1500 EX(FI) DecedenYs Social Security Number DecedenYs rvame: RECAPITULATION 1. Real Estate(Schedule A). .... . ..... ....... .. ..... . ...... ... .... . ..... 1. 0.00 2. Stocks and Bonds(Schedule B) .. ....... .... ..... .. ... .. ..... ... ...... 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) ... .. 3. , 0.00 ' 4. Mortgages and Notes Receivable(Schedule D).. . ... ....... ...... .. .. .. . . 4. 0.00 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). .. . ... 5. 51,818.28 ' 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ... ... . 6. 0.00 7. Inter-Vivos Transfers 8 Miscelianeous Non-Probate Property (Schedule G) O Separate Billing Requested.... . .. . 7. 1,734,352.75 8. Total Gross Assets(total Lines 1 through 7).... ................... . .. ... 8. 1,786,171.03 9. Funeral Expenses and Administrative Costs(Schedule H).. .. ... .. .. . .. . .. .. 9. 25,323.76 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I). ... .. . ........ 10. 3,824.78 11. Total Deductions(total Lines 9 and 10).... ... ... ....... ....... . .. . ..... 11. 29,148.54 12. Net Value of Estate(Line 8 minus Line 11) ........... .. . ...... . ... .... .. 12. 1,757,022.49 ' 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made(Schedule J) . .... . .. ....... ... .. .. . . 13. 0.00 14. Net Value Subject to Tax(Line 12 minus Line 13) .... ....... ... .... . ... .. 14. 1,757,022.49 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 �a)�1.2)X.0- �.00 15. ', �.0� 16. Amount of Line 14 taxable at linea�rate x.0 45 1,757,022.49 16. 79,066.01 17. Amount of Line 14 taxable at sibling rate X.12 0.00 17, Q.QQ 18. Amount of Line 14 taxable at collateral rate X.15 0.00 �g 0.00 19. TAX DUE .. .. . . . . . . .. ....... . ... . ...... ... ... .. .. . .. ..... ...... .. . 19. 79,�66.01 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 � 1505610205 1505610205 J _ _ _ _ __ _ _ . r�� _ • REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME THELMA E. HENSHAW --- -- -- _ __ ___ --— .. ----- ___ ____ _ --_ -- ___ _ — - __ STREETADDRESS 6 WILTSHIRE EAST ROAD __ —_ __ _ ___ - . -- _ _ _ STATE _ _ _ _ ZIP CARLISLE PA 17015 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 79,066.01 2. Credits/Payments - A.Prior Payments __ 36,730.54 ___ _ _ __ B.Discount 1,933.19 Total Credits(A+g� �2� 38,663.73 3. Interest -- (3) 0.00 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. -- Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 40,402.28 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred.......................................................................................... � � b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ � c. retain a reversionary interest .............................................................................................................................. ❑ � d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ � 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. ❑ � 3. Did decedent own an"in trust for"or payabie-upon-death bank account or security at his or her death?.............. � ❑ 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? ........................................................................................................................ � ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposetl on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For tlates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt a transfer to a suroiving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedenYs lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)�. . The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S. §9116(a)(1.3)).A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. . ____ __ _ n��r REV-15o8 EX+(o8-iz) � pennsylvania SCI�IEDULE E DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: THELMA E. HENSHAW 21-12-1168 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Jewelry(appraisal attached) 19,253.00 2. 2000 Cadillac DeVille(third party sale) 6,500.00 3. Misc.-Personal property(appraisal attached) 6,029.23 4. Sun Trust Banks-Acct.#232001431412 3,112.89 5, PNC-Acct.#5004211713 14,987.33 g. Century Link(refund) 12.49 7, Comcast(refund) 42.44 g, Century Link(refund) 10.31 g, Donegal Insurance(refund) 50.00 10. AAA(refund) 11.46 11. Liberty Mutual(refund) 94.00 �2, Liberty Mutual(refund) 82.00 13. Pennsylvania Department of Revenue(tax refund) 384.00 14, Misc.household items sold 983.13 15. Refund from Erie Cemetary 266.00 TOTAL(Also enter on Line 5, Recapitulation) $ 51,818.28 If more space is needed,use additional sheets of paper of the same size. _ . _ . _ .■�r r�EV-isio ex+ �oa-o�� ` pennsylvania SCHEDULE G ��n DEPARTMENT OF FEVENUE INTER—VIVOS TRANSFERS AND INHERITANCE TAX REfURN MISC. NON-PROBATE PROPERTY RESIOENT DECEDENT ESTATE OF FILE NUMBER THELMA E. HENSHAW 21-12-1168 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE,TNEIR RE1A770NSHIP TO DECEDENT AND DATE OF DEATH %OF DECD�S EXCLUSIDN TAXABLE NUMBER THE DATE OF TRANSfER. A7TACH A C07Y OF THE DEED FOR REAI ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1� First National Bank of Mifflintown-Acct.#6620009-Titled"Thelma E. 232,534.35 100 232,534.35 Henshaw, In Trust for Amber Thiemann."Amber Thiemann is the child of Thelma E.Henshaw 2 First National Bank of Mifflintown-Acct.#6620017-Titled"Thelma E. 232,534.36 100 232,534.36 Henshaw, In Trust for James C.Lund."James C.Lund is the child of Thelma E.Henshaw 3 Fidelity Investments-Acct.#X35-820296.TOD to children of Thelma E. 7g,075.56 100 78,075.56 Henshaw. 4 The Bank of Landisburg-Acct.#3731308 POD to James C.Lund,child of 152,224.35 100 152,224.35 5 The Bank of Landisburg-Acct.#3731316 POD to Amber S.Thiemann 152,233.09 100 152,233.09 6 Richard C.Henshaw Testamentary Trust.PNC Bank Trustee.Statement 886,751.04 100 886,751.04 attached.Copy of Will of Richard C.Henshaw attached.Copy of"Inheritance Tax Return of Richard C.Henshaw attached wherein the Estate of Richard C. Henshaw"does not elect to tax pursuant to section 9113.The fund is therefore taxable at the death of the spouse(Thelma E.Henshaw). TOTAL(Also enter on Line 7, Recapitulation) $ 1,734,352.75 If more space is needed,use additional sheets of paper of the same size. ►�,�r r � REV-1.51.1 EXi (10-U9) �� pennsylvania SCHEDULE H _� DEPARTMENT OFREVENUE F U N E RAL EXP E N SES AN D � [NHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER THELMA E. HENSHAW 21-12-1168 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A, FUNERALEXPENSES: 1' Ronan Funerai Home 2,269.30 2. Erie Cemetary 560.00 3. Geiger&Son-engrave headstone 200.00 e. ADMINISTRATIVE COSTS; 1, Personal Representative Commissions: 9,615.28 Name(s)ot Personal Representative(s) AI11b8C Thl@fT1a1111 street address_5307 Sprinq Road city Shermans Dale state PA ZIp 17090 Year(s)Commission Paid; 2013 z, attorneyFees: Dissinger & Dissinger 6,062.27 3• Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) 0.00 Claimant NONE Street Address___ Ciry _ State ZIP Relationship of Claimant to Decedent 4• Probate Fees; R2CJ 1 S t2r of Wi l l s 173.50 5, Accountant Fees: 0.00 6� Tax Return Preparer Fees: 250.00 �� Cumberland Law Journal 75.00 a. Sentinel 138.24 9. Cumberland Co.Register of Wilis(Exempt.Ltrs.) 40.00 �o. First National Bank of Mifflintown(checks) 25.95 ��. Jewei box Qewelry appraisal) 566.04 �2. Jim Lund(reimburse for cleaning fees) 184,05 TOTAL(Also enter on Line 9, Recapitulation) $ If more space is needed,use additional sheets of paper of the same size. _ _ _ _ _ — .�� r • � REV-1511 Ek+ (70-09) � ` pennsylvania SCHEDULE H � DEPARTMENT OF REVENUE FUNERAL EXPENSES AND [NHER[TANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER THELMA E. HENSHAW 21-12-1168 DecedenYs debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERALEXPENSES: 1. e. ADMINISTRATIVE COSTS; 1. Personal Representative Commissions: Name(s)of Personal Representative(s)__ Street Address Ciry _ _ _ _— --____ _—__ — State ZIP Year(s)Commission Paid: Z• Attorney Fees: 3 family Exemption: (lf decedent's address is not the same as claimant's,attach explanation.) Claimant _- ' Street Address __ City _ _ — __ _—_ __-- -- State ZIP Relationship of Claimant to Decedent 4• Probate Fees: 5� Accountant Fees: 6� Tax Return Preparer Fees: �3. Ruth Darr-Condo prep. 385.00 14. Fed Ex 240.00 �5. Postage 17.95 is. Brownawell's(auto parts&repair) 623.67 ��. Amber Thiemann(reimbursement for expenses paid) 405.74 TOTAL(Also enter on Line 9, Recapitulation) $ If more space is needed,use additional sheets of paper of the same size. ___ _ _ _ _ temr a ' � REV-151.1 EX�i� (10-09) � � �{'pennsylvania SCHEDULE H DEPARTMENT OFREVFNUE FU N E RAL EXP E NSES AN D INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RES[DENT DECEDENT ESTATE OF FILE NUMBER THELMA E. HENSHAW 21-12-1168 Decedent's debts must be reparted on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: L B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) ' Street Address City _ __ — __ State ZIP __ Year(s)Commission Paid: z• Attorney Fees: 3� Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) ' Claimant Street Address City _ _ __ ___ ____ _ _ - State ZIP Relationship of Claimant to Decedent 4 Probate Fees: 5 Accountant Fees: ' 6� Tax Return Preparer Fees: �e. James Lund(reimbursement for one jewelry appraisement fee) 20.00 �9. Treiser-Collins(Florida Probate Attomey) 3,471.77 TOTAL(Also enter on Line 9, Recapitulation) $ 25,323.7F> If more space is needed,use additional sheets of paper of the same size. _ ___ _ _ __ r��r _ REV-1512 EX+ (1"L-i2) � pennsylvania SCHEDULE I DEPARTMENTOFREVENUE DEBTS OF DECEDENT� INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER THELMA E. HENSHAW 21-12-1168 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1� UGI 17.40 2. Med Ed 40.23 3. Quantum Imaging 16.40 4. West Shore EMS 178.69 5. West Shore EMS $� 7� 6. Universal Property 851.54 7. Med Ed 56.32 8. UGI 17.40 9. FPL 35.59 10. UGI 15.42 11. UGI 13.14 12. Med Ed 9 2� 13. FPL 10.57 14. Forrest Lakes Condo Assoc. 822.46 15. Liberty Mutual 106.00 16. Liberty Mutual 30.00 17. FPL 40.22 18. Liberty Mutual 34.00 19. Collier Co.Tax(property tax) 1,328.57 20. FPL 30.65 21. FPL 18.67 22. FPL 18.38 23. Liberty Mutual 34.00 24. FPL 19.09 TOTAL(Also enter on Line 10, Recapitulation) $ 3,824.78 [f more space is needed,insert additional sheets of the same size. _ . ___ _ .e�r _ . y REV-1513 EX+ (O1-1D) �� ' pennsylvania SCHEDULE � DEPARTMENT OFREVFNUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: THELMA E. HENSHAW 21-12-1168 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(5)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec,9116(a)(1,2).] 1• James C.Lund Son 50% Beneficiary 5338 Bay Ponte Court,Eureka CA 95503 of all except Testamentary Trust of Richard C. Henshaw 2. Amber S.Thiemann Daughter 50% Beneficiary 5307 Spring Road,ShermansDale PA 17090 of all except Testamentary Trust of Richard C. Henshaw ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN; 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size. . .�,� REV-1513 EXi (01-10) " r �F� pennsylvania SCHEDULE J �� OEPARTMENT OFREVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: THELMA E. HENSHAW 21-12-1168 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1,2).] 3� Kathleen H.Hunter Daughter of deceased 50% Beneficiary 8321 Shaw Road,Ridley Park PA 19078 spouse,Richard C. of Henshaw Testamentary Trust of Richard C. Henshaw 4. Richard C. Henshaw Son of tleceased 50% Beneficiary 9512 West Law Road,North East PA 16428 spouse,Richard C. of Henshaw Testamentary Trust of Richard C. Henshaw ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROU6H 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II— ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON IINE 13 OF REV-1500 COVER SHEET. � If more space is needed,use additionai sheets of paper of the same size. - --- ------ - — --- -----_ ___ _ : _•_q�— Register of Wills Office, Forrtt No. ]5 1/2 File Original unly INVENTORY Erie County, PA, SS. THELA9A E. HENSHAW, EXECUTR/X of fhe ESTATE OF R/CHARD C. HENSHAW deceased, being dufy sworn according to law, deposes and says that this inventory and appraisement sets forth and contains all the personal property and all real estate in Pennsylvania of which the personal representative has knowiedge,and th�t the valuation placed opposite each-item of this inventory represents its fair value thereof as of the date af decedent's dea#h; further that the decedent owned no real estate outside of Pennsylvania excepting that which appears in a memorandum at the end of this inventory, and the value of which is not added to the inventory. Sworn and subsc�ibed this day of January, 2003. Personal Representativ� INVENTORY AND APPRAISEMENT OF ALL PERSONAL PROPERTY AND ALL REAL ESTATE IN PENtdSYLVANIA ,.� Estimated Appraised REAL ESTATE (Location, Deed Book and Page) Value Value None Estimated Appraised PERSONAL�PROPERTY Vaiue Value 133 shares MetLife common stock S 4,499.14 1 share Kahkwa Club stock (SOLD) 100.00 Uncashed Travelers checks , 410.00 1,050 shares Lord Corporation stock, Class B 684,600.00 Fidelity Investments Account #X77-006700 371,494.36 Total Personal Property S 1.061,103.50 , _ _ . .- ._ FA� �_ ��.,�Ex,,�; R E V 15 0 0 OFFICIAL USE ONLY K COMMONWEALTH OF . PENNSYWANIA DEPART EPT�F�REVENUE �N H E R I TA N C E TAX R E T U R N FILE Nl{MBER HARRISBURG,PA 17128-0601 2 5 - 0 2 0 6 8 3 RESIDENT DECEDENT �� - ,� -- - DECEDENTS NAME(LAST,FfRST,AND MIDOLE INtTIAI.) SOCWL SECURITY NUMBER �Z HEN�HAW, RICHARD C. DATE OF OEATH(MM-0D-YEAR) DATE OF BIRTH(MM-DD-YEAR) W TNIS REfURN MUST BE FILED IN DUPLICATE WITH THE V 4/22/02 3/23/18 REGISTER OF WiLLS W (fF APPUCABLE)SURVMN�SPOUSE'S NAME(LAST,FIRST,IWO MIDDIE INITIAL) SOCU1l SECURITY NUMBER � Henshaw, Thelma E. � � t.Originai ReNm � 2.Supplertiental Rehxn � 3.Re�nainder Redxn�d�eaa.w,p�a��-��- �� 4.umited Estate �4a.Fulure Interest Compromise�xe da..a,a�„�z.�2.an � 5.Federal Estate Ta�c Re6um Required �$m � 6.Decedent Died Testate wma�mpy or v� � 7.Decedent A�aaintained a Living Tn�st Wmnc�avr d Tn�l 8.Total Number oF Sa(e Deposit Boxes a � 9.Litiga�on P►ooeeds Received � 10.SPousa�PweAy Ct'e�kt(a�s aaam o�twscn uatat aa�•r-�� t1.ElecGon to ta�c under Sec.9113(A)l�aadi sna o� � a �aE i 1 L.R. Mi 11 e r E s . �� y FIRMNAME(KMv�nea� 717 State St. , Suite 701 � McClure & Miller LLP Erie, PA 16501 p TELEPHONEidUMBER " 814 453=3681 1. ReatF.state(Sq�eduleA) (�) OFFIClAL USE ONLY 2.stocks and Bonds�Scheeu�e s) (2) $I., 0 6 0,6 9 3. 5 0 3.Closely Held Corporation.PaRnership w Soie-ProprieMrshq► I3) 4. hbRgages&Ndes Receivable(SchedWe D) (4) 5. Cash,Bank Deposits 8 MisceUaneous Persp�al propetty (5) 410. 0 0 Z (Schedute Ej � 6.JoinGy Owned Property(Scheduie F) (61 Q ❑Separate Billinq Requested ..,3 � 7. Inier-Ynros Tr�sfers 8 MisceNaneous Nai-Probate PropeAy (7) F" (Schedule G or L) a a 8.Total Gross Assets(total lines 1-J) (e) S 1,0 61,10 3.5 0 � 9. Funeral Expenses 8 Admi�isUative Costs(Schedule H) (9) 3 7,�3 8. 91 to. oen�s ot oeceden�,Mortgage Liabili6es,a uens{scned�,te q (�o) 1, 7 0 9.6 0 11.Total Deductions(total Lines 9 810) (11) 3 9,2 4 8. 51 12. Net Vatue of Estate(Line 8 minus line 11) (�2) $1�0 21�S 5 4 . 9 9 13. Charitable and Govemmental 8equestsl5ec 9113 Ttusts for whidt an elecdon to tax has not been (13) __ 1, 0 21� S 5 4. 9 9 V� made(Schedule J) 14. Net Value Subject to Tax(Line 12 minus L.ine 13) (�q� -0" SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABL,E RI►TES W- �Z t 5.Artrount of line 14 taxable at lhe spousal tax rate.or hansfers urnler Sec.9116(a)(1.2) x .0 _ (15j a -� = ts. a►wunc or t.ine ta taxable at�eal rate x .o _ (1s) _� �' 17.Amount of Line 14 taxable at sibling rate x .12 (1 TJ � V18.Amount of Line 14 taxable at coAateral rate x .15 (18) Q19.Tau Due (t9) -0- ~ 2p. ❑ • • � .:f��-:. � �ap "tp.-�.+Ih'X":Xe'vi+'.� .�:<. __ _ __ _ " " "" ' " " ' _ _ .__ _ ■�� - fi�F,ET AODRESS 411 Shawn��E3 Drive -��--�-- -- TY Erie STATE pA Z1P 16505 r - __--_ -F . ��c Payments and Credit�: Tax Due(Page t Line 19) (11 —�— _ CreditslPayments A.Spousal Poverty Credit — B.Prior Payments _ C.Discount — Total Credits(A+B+C) (2) interestlPenalty if appUcable D.Interest E.Penalty Toql Inter�UPenalty(D+E) (3) If Line 2 is greater than L'+ne 1+L'ine 3,enter lhe difference. This is the OVERPAYMENT. Check box on Page!Line 20 to request a refund (4) I(Une 1+Line 3 is greater than Line 2,enter fhe diQerence.This is the TAX DUE. (5) A.Enter the interest on tl�e tax due. (5A) 8.Enter the total of Line 5+5p.This is ihe BALANCE DUE. (58) —0— Make Check Payable fo: REGISTER OF WILLS,AGENT PtEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a trar�sfer and: Yes No a. retain the use or i�of the property transfeRed:................... ❑ [� ....................................................................... b. �etain the right to designate who shaq use the property transferred or iis income:............................................ ❑ (� c. retain a reversionary interest;or.......................................................................................................................... ❑ � d. receive the promise for life of either payments,benefits or c�e?...................................................................... ❑ � 2. 1t death occurred aftet December 12,1982,cbd decedent transfer property wiihin or�e year of death without receiving adequate consideretion?.............................................................................................................. ❑ � 3. Did decedent own an"in Uust fa'or payable upon death bank�nt or security at his or her death?.............. ❑ [� 4. Did decedent own an Individual Retirement Account,annuity,a other non-probate property which contains a beneficiary designation? .................................................. . ❑ [� ..................................................................... F THE ANSWER TO ANY OF THE ABOVE QUESTIONS iS YES,YOU MUS7 COMPLETE SCHEDULE G ANO FILE IT AS PART OF THE RETURN. :er�naltlss at pe�ury,I declare tl�al I have sxamined tlrs ro�mn.induQm9�Pe^Y�9 schedules and stalema�.and to ria best d mq krwwbdgt and beief.d o trus.cared azW compe�. � ,aratiw+a peparo►ober man a�e personel repesenfaoive is tasea an an inronnadon a w1NCn praparer r�as any krww�eage. 3NATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE 411 Shawnee Dr. , Erie, PA� 16505 DRESS e ma �. Hens aw, Executrix �NATURE OF PREPARER OTHER THAN REPRESENTATNE cC 1 ure & Mi l le r LLP DATE by: ORESS Daniel L.R. Miller, Esq. 717 State St. , Suite 701, Erie, PA 16501 �dates of�ath on or after Juty 1,1994 and before January t,199S,d►e taz rate imposed on the net vak�e of transfers to or for tl�e use d Ihe swviving spouse is 3;6 P.S.§9416(a)(1.1)(i)1• r dates of death on w afte►January 1, 1995,the#ax rate imposed on�e net wdlue of Vansfers bo or for Bse use ot the surviving spouse is 0%[12 P.S.§9116(a)(t.t}(i��. s statute does not exemot a trar�sfer to a survi�rg spouse from Fax,and the stahrtory requirements tor dis�OSUre of assets and f�ing a tax reWm are shll�cable even if 'surviving spouse is the only benefiaary. r dates of death on w after July 1,2000: e fax rate imposed a�the net value of transfers irom a deceased child hvenry-one years of age or yamger at death to a for the use of a nahxal parent,an adopbve parent, a stepparent ot the child is 04G(/2 P.S.§9116(a)(1.2)J. e tau rate imposed on the net value M Uansfers to or for tlie use of the decedenCs lineat beneficiaries is 4.59G,except as noted in 72 P.S.§91t6(1.2)[l2 P.S.§9116(aX1)j. e tax rate imposed on the net value of transfers to or for Ihe use of Ihe decedent's s�gs i� 12X(/2 P.S.§91f6(aj(1.3)j.A s�ing ts defined,ur�de�Sec6on 9102, as an ividual who has at least one pareM in common with the decedent whelhet by blood or adoptlon. _ _ _ .�� , . SCHEDULE "B" STOCKS AND BONDS ESTATE OF FILE NUMBER RICHARD C. HENSHAW 25-02-0683 (All property jointly-owned with Right of Survlvorship must be disclosed on Schedule "�") ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 133 shares MetLife common stock S 4,499.14 2. 1,050 shares Lord Corporation stock, Class B 684,600.00 3. Fidelity Inves#ments Account #X77-006700 371,494.36 4. 1 share Kahkwa Club Stock iSOLD) 100.00 TOTAL (Aiso enter on line 2, Recapitulation) S 1,060,693.50 _ - __ __ _ _ __ _ _ ,�� _ k :� SCHEDULE "E" r CASH, BANK DEPOSITS AND MISCELLANEQUS PERS�NAL PROPERTY� ESTATE OF FILE NUMBER RICHARD C. HENSHAW 25-02-0683 (All property jaMtly-owned with Right of Sunrivorship muat be disciosed on Schedule "F"1 ITEM VALUE AT DAT� NUMBER DESCRIPTION OF DEATH 1. Uncashed Traveler's Checks S 410.00 TOTAL (Also enter on line 5, Recapitulation) $ 410.00 _ ___ _ ____ _ _ _ .,��,, _ w R� SCHEDULE "H" , FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES ESTATE OF FILE NUMBER RICHARD C. HENSHAW ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH A. Funerai Expenses: 1. Naples Daily News - obituary notice 175.12 B. Administrative Costs: 1. Personal Representative Commissions: Thelma E. Henshaw Year Commissions paid - 20Q3 15,915.05 2. Attorney Fees: McClure & Miller LLP 15,916.05 3. Family Exemption - Thlema E. Henshaw, spouse 3,500.00 4. Probate Fees - Register of Wills 38.00 C. Miscellaneous Expenses: 1. Erie County Legal Journal - estate advertising 60.00 � 2. Times Publishing Co. - estate advertising 91.11 3. Register of Wills - filing fees ($10) & add'( probate fee (5460 ) 470.00 4. Thelma E. Henshaw - reimb. executrix estate related expenses 1,374.58 TOTAL (Also enter on line 9, Recapitulation) S 37,538.91 __ on�r � ;. SCHEDULE "I" f DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS ESTATE OF FILE NUMB�R RlCHARD C. HENSHAW 25-02-0683 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MBNA - mastercard bill 5 576.80 2. AT&T - phone bi(I 42.37 3. Penelec - electric bill 23.33 4. Erie Cablevision - bill 37.96 5. Bayhurst Lawn Care 91.16 6. National Fuel Gas - gas bill 35.02 7. Verizon North - phone bill �7,28 8. Erie Water Works - water bill ,�7,�g 9. Etder Beerma� - charge account �4.00 10. Montgomery Eye Care- balance due 74.60 i 1. Kaufmann's - charge account 102.00 12. Forest Hills Condo Assn. - amount due 570.26 13. Erie Sewer & Refuse - bill due 87.63 TOTAL (Aiso enter on line 10, Recapitulation) S t,709.60 _ _ _ ____ __ EA� ; , . SCHEDULE "J" f BENEFICIARIES ESTATE OF FItE NUMBER RICHARD C. HENSHAW 25-02-0683 AMOUNT OR 1TEM NAME AND ADDRESS OF PERSON{S) RELATIONSHIP TO SHARE NUMBER RECEIVING PROPERTY DECEDENT (do not OF ESTATE list trustees} I. Taxeble Distributions: 1. Enter doltar amts for distributions shown above on Lines 15 thru 17, as appropriate, on REV-1500 Cover Sheet ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH II. Non-Taxabte Distributions: A. Spousal Distributions under Section 9113 for which an Election to Tax is not bei�g made 1. PNC Bank, N.A. Trustee under Will of Richard C. Henshaw FBO Thelma E. Henshaw S 1,021.854.99 B. Charitabie and Governmenta! Distributions: 1. TOTAL OF PART ii - Enter total non-taxable distributions � on line 13 of Rev 1500 Cover Sheet 5 .00 _ . _ __ __ _ nr m� T �„' . � F� �� UnitedStatesEstate(andGeneration-Skipping � �R�,.,�� Transfer)TaxRet�n EatateoFaei�er�orrssidentdtheUricedStateslsesseparats�etlorul• oAABNO.t54s-OOtS DepemmarKoltheTraesury Tobefil�dfordiacedent�dy4�ga(OKD�certi1er31.2007.a�lorsJanu�ry1.2003. x,cana�Revenue5erviee Fo►PaperworkReductionAdNotice,seethesep�ra�ein�'uctions. la Decetl�Ys flrst nsme and middle initisl(and maiden name,it�� 10 Decederrc'slsstr�nrt�e 2 D�codent'sSoc�ISecuiryNo. � RICHARD C. HENSHAW � 3a Legalresidence(domicileyattimeofde�h�rnu�ry.state.and 3h Y�r dort�icNe estebNSl�ed 4 DatedbRth SOateddeath ,� z�Pwde.orr«efy�couwy) 6 + s. � ss Namedexecutor(seepage3oftheinstructions) se► execua'saddressfnumberandstreetkichrdngapartmentasuiteno.ornral 10 raute:dry,town.arpostcKce:state:antlz�Pcode) Y � s� ex��«•5��.�cy�,�t��3oru�m�ao��► 3302 Baer Beach Dr. , #B12 022 ; 22 ; 8093 Erie, PA 16505 0 7a NameandbcationofcourtwherewiNwasprobatedorestateadministeredln �le C011rt of Common Plea ��"u"�� . . . . . a 8 If tlecedent died testete.check here ► andattachacertified ofthewiN. 8 IfForm4768isattached.checkhere ► ❑ 10 KScheduleR-1 isattached,checkhere ►❑ 1 Totalgrossestatelessexclusion(fromPa�tS.Recapitulation,page3,iteml2) . . . . . . . � .1�.��.,..L2 2 Totalallowabledeductions(fromPartS,Recepitulation,page3.rtem23) . . . . . _ . . . 2 473 1.5 S� 3 Taxableestate(subuactGne2fromlinel) . . . . . . . . . . . . . . . . . . 3 � 0 � ' 4 Adjustedtaxablegffts(totattaxaWegifts(wfthinthemeaningofsection2503)madebythedecedent afterDecembef31,1976AtherthangiftsthatareincludiWei�ecedenYsgrossestate(section2001(b))) 4 � 5 Addlines3and4 . . . . . . . . . . . . . . . . . . . . . . . . . 5 �� 0 8 Tentativetaxontheamountonline5fromTableAonpage4oftheinsuuctions . . . . . . g 22 80 7 Total gift tax payable with respect to gifts made by the decedent after December 31,1976.InGude gift taxes by the decedenYs spouse for wch spouse's share of spiit gifts(section 2513)oniy if the decedent � wes the dona of these gifts and they are inciudible in the decedenYs goss estate(see insVuctions) � 8 Grossestatetax(subtractfine7fr�nline6) , . . . . . . . 8 229 80 00 9 Maximumunifiedcredit(applicabfecreditamount)againstestatetax 9 • � 10 Adjustmenttounifiedcredit(applicablec►editamount).(Thisadjusunent ,g maynotexceedS6,000.Seepage5oftheinstructions.) , . . . . 10 a. 11 Allowableunifiedcredit(applicablecreditamounU(subtract�inel0iromkne9) , . . . . , , 11 2 2 9� 8� 0 G � 12 Subvactiine1lfromline8(butdonotenterlessthanzero) , , , , , , , , , , , , , �2 —�"` � 13 Creditforstatedeathtaxes(cannotexCeedqnel2). Attachcreditev�(seeinstructions).Figure I thecreditbyusingtheamountonGne3iessS60,000.SeeTableBintheinstructions. N Er�tertheamountherefromTableB ► •............... ..... x .75 . . . ► 13 W 14 Subuactlinel3fromlinel2 . . . . . . . . . . . . . . . . . . . . . 14 a . . . - - 15 Credit for Federal gift taxes on pre-1977 gifts(section 2012)(attach computation). . . . . . . . . . . . . . . . . 15 16 Creditforforeigndeathtaxes(fromSchedule(s)P).(Attach Form(s)706-CE.) . . . . . . . . . . . . . . . . 16 17 Creditfortaxonpriortransters(fromScheduleQ) . . . . . . . » 18 Total(addlines15.16,and17) . . . . . . . . . . . . . . . . . . . . . 18 T9 Netestatetax(subtractiinel8fromlinel4) . . . . . . . . . . . . . . . . . 18 20 Generation-skippingtransfertaxes(fromScheduieR,Part2,linel0) . . . . . . . . . . � 21 Totaitrensfertaxes{addGnesl9and20) . . . . . . . . . . . . . . , 21 22 Priorpayments.Expfaininanattachedstatement . , , . , , 22 23 United5tatesTreasurybondsredeemedinpaymentofestatetax . , 23 24 Total(addlines22and23) . . , , , , , , , , , , , , , , 24 25 Balancedue or�v en subtracttine24fromline2l 25 Underpenaltiesdperjiry.ldectarethatlhaveenarr�edthisretvn.includingaccanpanyi�9•schedulesandstat�.andto • thebestd k itisUUe,correct,andcomplete.OecWrationdprepare.�oU�erthantlieexecutaisbasedaraaftir�ormationdwluch �^Y �andbeiief. prepare rhasanyknouNadge. Signawre(s�ofexecuta(s) T11 lma E. Henshaw, EX Ctlt.r1.X Oate 33�2 Baer Beach Dr. , �B12, Erie, PA 16505 bY� 717 State St. , Suite 701 , Erie Signatureofpreparerotherthanexecutor Address andZlPcode) Date Daniel L.R. Miller, Esq. Cat.Np.20548R _ _ _ _ . _■e� - t � ' . Form7os(Rev.E-o� ' Estateof: Richard C. Henshaw Part3—Elections bythe Executor P/easecheckthe "Yes"or"No°box loreachqusstion.(Seafnsductions nn" an e6.) Ye5 WO 1 Do ouelectaRematevaluation? � X . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Ooyouelectspecialusevaluation? . . . . . . . . . . . . . . . . . . . . 7C tf"Yes," ou mustcompleteandattachScheduleA-1. 2 3 DoyouelecttopaythetaxesininstaBmentsasdescribedinsectionfi166? , . , . . . . , . , , IF"Yes." mustattachtheaddit+onalinfamationdescribedon softheinsuuctions. 3 4 DoyouelectiopostponethepaRofthetaxesat�abletoareversionaryorremainderinterestasdescribed'm x section 61637 , q Part4— General Information �:��raa,u,e,��,�,r�do�, v,,,,�c�r,�r,�e_� (seeinstn,criansa,page to.) Authori ' xhJormadomx�derRe�.sec.607.5041b1(2)61:a�e' ' RS:andtomaicevKitten aaralpreserNationsonbehelfdtheest�eifretunprepererDyana[tontey.accountant.orerxolledage�xfortheexea�tor: Nameofrepresentative(printortypej State Address(number,�,and room or suite no.,city,state,and Z�p tode) Daniel L.R. Miller, Es . PA 717 State St. , Su'ite 701 Erie PA 16501 Idederethetiamthe chisreGxnfortheexecutor.lam suspe�sionp d sbartn¢nt rof mpracticebefaethelntemaiReverweServiceandam�� w qual�edtopract�iceiP n� Signature CAfnumber Date 7ele�onenumber 1 Deathcertificatenumberandissuingauthority(attachacopyofthedeathcertificatetothisretum). 2 Decedent'sbusinessoroccupation.lfre[ired,checkhere ► � andstatedecedent'sformerbusinessoroccupation. Sr. Vice President/Manufacturinq 3 Maritaistatusofthedecedentattimeofdeath: � Married ❑ Widowwwidawer�— Name,SSN,anddateofdeathofdeceasedspouse ►______________________________________________________________ ❑ Single--------------------•--•---•-----°-------------•----._....__....-----...--------------------------------------.._...-------------•-•- ❑ Legailyseparated ❑ Divorced—Date divorcedecreebecamefinal ► 4a Survivingspouse'sname 4b Socialsecu�y number 4c Amo�u received(see page 70 of the instructions) Thelma E. Henshaw 022 ; 22 ; 8093 100$ in trust for life 5 Indrviduals{other than the stxviving spouse),trusts,or other estates who receive beneftts trom the estate(do not include charitable ben�ficiaries shown in Schedule O)(see irtswcGOns).For Privacy Act Notice(applicable to individusl beneficiaries oniy),see the InsuucGons for Form 1040. Namea'vbividuel,wstoreuatereceivingS5.000ormore tderxifjringrxmber Re�ationshiptodecedent MiovRiseeiisuuctia� Kathleen Hunter 163-36-6081 daughter 0� remainderman Richard Henshaw Jr. 179-32-7442 son 0$ remainderman � AUunascertaa�aWebeneficiariesandthosewhoreceivelessthanS5,000 . � Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P►easeehecictlre"ves"'or'yl►o'boxfareech tiva Yes No B Does the gross estate contain any seccion 2044 property(qualified termanable interest property(QTIP)trom a prior gift or estate)(see el0oftheinsuuctions? (continuedonnextpage) Page2 _ ___ _ __. _�q�_ � � ' Fa,,,,��i8_� Richard C. Henshaw , Psrt4—Generallnformation (continued) Pleasechecictbe "Yes°or "No bo�rtarsechqussdon. Yes No 7a HaveFederalgifttaxretumseverbeenfiled? . . . . . . . . . . . . . . . X If°Yes," aseattachc softheretums,ifava�able.andfumishthefdlow� infamiadon: 1b Period(s)covered 7c IntemalReve�ueoffice(s)wherefiled It ouanswer "Yss"to of tior�s8- 16, mustattad�additionalinformatbnasdescr�edinthsinsVuctions. / Sa Wastherea &�surenceonthedecedent 'sRfethatisnotincludedontheretumas rtofthe ossestate? b Didthedecede�townan inwranceonthelifeofanotherthatisnotincludedinthe ossesiate? X 8 Didthedecedentatthetimeofdeathownanypropertyasajointtenantwithrightofsurvivorshipinwhich (s)oneormwe oftheotherjarKtenantswassomeoneotherthanthedecedent 'sspouse,and (b)IessthanthefuNvakieofthepropertyis X includedonttreretumas artoFihe sestate?If "Yes," oumus[com IeteandattachScheduleE 10 Didthedecedent,atthetimeofdeath,ownanyinterestinapartnershipcxunic�ccxporatedbusinessoranystockinaninactiv e orciosel heldc tion? X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Did the decedent make any transfer described in section 2035,2036,2037,or 2038(see the insuuctions for Schedule G be nni on a 12ofthese rateirtSVUCtlon5l?If "Yes," ou mustcom teandetteChScheduleG X '!2 Werethereinexistenceatthetimeofthedecedent 'sdeath: � a Anyuustscreatedbythedecedentduringhisorherlifetime? . . . . . . . . . . . . . . . . . . . b An trustsnotcreatedb thedecedenWnderwhichthedecedent sessedan er.beneficiaiinterest,oruusteesh' ? 13 Didthedecedernever sess,exercise,orrdeasean 1 werofa 'ntmentTlf"Yes," mustcom le[eandatt�hScheduleH �{ 14 asthemaritaldeductroncomputedur�rthetransitkrolruleafulicaw.secUoneconomicecov�yaxc tofT If"Yes,"attach aseparatecompu[ationofthemaritaldeduction,entertheamountonitem20oftheRecapku�ation,andnote onitem20 `com tion attached." 15 Wasthedecedent.immediatelybeforedeath,receivinganannuitydesc�ibedinthe 'General"paragraph oftheinswctions X forSchedulel?If "Yes," mustcom IeteandattachSchedule� . . . . . . . . . . . . . . . . . . 16 Wasthedecedenteverthebeneficiaryofauustforwhichadeductionwasclaanedbytheestateofapre-deceasedspouse undersection2056(b)(7)andwhichisnotre edonthisreturn?If `Yes,"attach a�ex lanation, . X PartS—Recapitulation Item GrpsSestate Altemetevakie Vak�eatdeteoff�eth number 1 ScheduleA—Real Estate . . . . . . . . . . . . . . . . � 2 Schedule B—Stocks and Bonds. . . . . . . . . . . . . . 2 1 0 6 0 6 9 5 0 3 ScheduleC—Mortgages.Notes.andCasA . . . . . . . . . . 3 4 ScheduleD--Insurance ontheDecedent'sl"rfe(attachForm(s)712) , . , 4 5 SchedukE—JofntlyOwnedPropeRy(attachForm(s)712forlifeinsurance) . 5 1 44 29 6 Schedule F—Other Miscelia�ous Property(attach Form(s)712 f�Iiie inwrance) s 7 Schedule G—Transfers During Decedent's Life(att.Fam(s)712 for life insurance► � 8 ScheduleH—Powers ofAppointment . . . . . . . . . . . . 8 s Schedule I—Annuities . 8 . . . . . . . . . . . . . . . . 10 Total rossestate(additemstthr h9). �p , � � 11 ScheduleU—Qualified ConservationEasementExclusion . . . . . . �� 12 Totaigrossestatelessexclusion(subtractftemllfromiteml0).Enterhere andonlinelofPart2 —Tax Com utation. . 12 uem number Oecluctions M�ant 13 Schedule J—Funeral Expenses and Expenses Incurced'm Administering Property 5ubject to Claims . . . �3 14 ScheduleK—Debts oftheDecedent , , , , , , , , , , , , , , , , , , , , 14 75 ScheduleK—Mortgages andLiens . . . . . . . . . . . . . . . . . . . . . 15 16 Totalofitemsl3throughl5 , . . . . . . . . . . . . . . . . . . . . . . 16 17 Allowableamountofdeductio�sfromiteml6(seetheinsUuctionsfwiteml7oftheRecapitulation) . �� 18 ScheduleL—Net�ossesDuringAdministration , , , , , , , , , , , , , , 18 19 ScheduleL—Expenses Incur�edinAdministe�ingPropertyNotSubjecttoClaims . . . . . . , 19 20 ScheduleM—Bequesu,etc.,toSunrivingSpouse , , , , , , , , , , , , , , , , 20 i�. -- 21 Schedule0—Charitable, Pubiic,andSimilarGiftsandBequests . . . . . . . . . . . . 2� 22 ScheduleT—Qualified Fam -Owr�ed8usinessinteres[Deduction 22 23 Totalallowabledeductions(additemsl7throu 22).Enterhereandonline2oftheTaxCom ation 23 . Page3 _ _ _ _ . _ _ __ .,��„ ._ _ _ __ _ _ �a m� __ � ' , LAST WILL AND TESTAMENT OF RICIiARD C. HENSHAW DATED: June 26,2001 � McCLURE & MII,LER Attorneys-at-Law 717 State Street, Suite 701 Erie,Pennsylvania 16501 _ __ _ _ _ re m� � „ . LAST WILL AND TESTAMENT �F RICHA.RD C. HENSHAW I, RICHARD C. HENSHAW, of the City of Erie, County of Erie and Commonwealth of Pennsylvania, declare this to be my Last Will, hereby revoking all prior wi11s and codicils . ARTICLL FIRST All estate and inheritance taxes (including interest and penalties, if any) , together with all administration expenses, payable in any jurisdiction by reason of my death (including those taxes and expenses payable with respect to assets whzch do not pass under this will) shall be paid out of and charged generally against the principal of my residuary estate, without apportionment or right of reimbursement . ARTICLL 38COND I give and bequeath certain items of tangible personai property, including automobiles, boats, furniture and personal effects, unto my wife, THELMA E. HENSHAW, if she survives me, and if she does not survive me, then, in that event, said tangible personal property shall be considered a part of my residuaxy estate and shall be disposed of as hereinafter set forth. _ . _. _ _ _ . _ ,�� __ , ARTICLB TH� In the event that I am survived by my wife, THELMA E. HENSHAW, I give, devise and bequea�h all the rest, residue and remainder of my estate, unto PNC BANK, NATIONAL ASSOCIATZON, Erie, Pennsylvania, as Trustee, to be held as the Residuary Trust under the following terms and conditions: A. My Trustee shall pay aIl the net income from the Residuaxy Trust to my wife, THELMA E. HENSHAW, in quarter-annual or other convenient installments, but at least annually, for and during her lifetime. My Trustee shall be authorized to disburse to her, an amount of principal which, when added to the net income, will provide a total income for her of $50, 000 . 00 per year, but said principal disbursement shall not exceed during any calendar year, 5� of the principal on January lg� of same calendar year, or $5, 040 . 00, whichever is greater. B. Upon the death of my wife, Thelma E. Henshaw, this trust shall terminate and the principal therein, together with all accrued incame thereQn, shall be distributed as follows : 1 . Fifty (50�) per cent thereof unto my daughter, KATHLEEN H. HUNTER, if she is then living, and if she is not then living, then unto her then living issue, per stirpes . 2 __ _ _ _ _ F��r __ r 2 . Fifty (50�) per cent thereof unto my son, RICHAR.D C. HENSHAW, JR. , if he is then living, and if he is not then living, then unto his then living issue, per stirpes . C. If my wife, Thelma Henshaw, predeceases me, I give, devise and bequeath the residue of my estate, real and personal as follows : 1 . Twenty-five (25�) per cent thereof unto my daughter, KATHLEEN H. HUNTER, if she is living, and if she is not living, then unto her issue, per stirpes. 2 . Twenty-five (25�) per cent thereof unto my son, RICHARD C. HENSHAW, JR. , if he is living, and if he is not living, then unto his issue, per stirpes. 3 . Twenty-f ive (2 5�) per cent thereof unto my wi f e's daughter, AMBER SUSAN THIEMANN, if she is living, and if she is not living, then unto her issue, per stirpes. 4 . Twenty-five (25�) per cent thereof unto my wife' s son, JAMES C. LUND, if he is living, and if he is not living, then unto his issue, per stirpes. P�tTICL}3 FouxTx I nomina�e, constitute and appoint my wife, THELMA E. HENSHAW, to be the Executor of this my Last Will . In the event my said wife, Thelma E. Henshaw, shall have predeceased me, fail to 3 . . . ._. _._ ._._ ._. --- ---- - --- -- --� ��.� _. act or refuse �o act for any reason, I nominate and appoint PNC BANK, NATIONAL ASSOCIATION, as Executor in her place, with all the duties, powers and responsibilities as if originally appointed hereunder. No individual fiduciary acting hereunder shall kae required to post bond or enter secur�ty in any jurisdiction. ARTICL� FIFTH In addition to the powers given them by law and by the other provisions of this my Last Will, my personal representatives and the trustee of all trusts created by this will, shall have the following powers, appZicable to all property held by them, effective without court order and un�il actual distribution: A. To retain as an investment for my estate and the Trust, without any duty of diversification, any and all property, real or personal, received hereunder, including any sto�k in PNC Bank Corp. , without liability as a result ot such retention. B. The corporate fiduciary serving hereunder shall have the power to invest the principal and/or income of the Trust Estate in any assets or security including but not limited to stocks, }aonds, debentures, notes or other similar obligations issued, owned, or underwritten by such corparate fiduciary or its affiliate. In additifln, such fiduciary may invest such principal an/or income in 4 _ _ _ _ __ _ _ .q�__ . any bond or other debt secured, supported or otherwise enhanced by a Letter of Credit of such fiduciary or its affiliate. C. To inves� and reinvest the principal of my estate and the Trust in stocks, bonds, mortgages, securities or other property, real or personal, without being limited to the classes of securities or investments in which fiduciaries are by law authorized to invest funds. D. To sell any and all real estate held as an asset of my estate and Trust at such �imes, at public or przvate sale, for such prices and upon such terms as deemed advisable, and to make, execute and deliver any deed or deeds therefor, conveying title thereto in fee simple. absolute, or for any less estate to any purchaser or purchasers, freed and discharged of any and all trusts hereunder. E. To sell, exchange, lease, encumber, option or otherwise, dispose of all or any portion of my estate �nd Trust in such manner and upon such terms and conditions as shall be deemed advisable, and to make, execute and deliver deeds, mortgages, leases, assignments and other documents necessary to effectuate any of the powers granted, which shall specifically include the authority to grant leases which extend beyond tihe term of any trust hereunder and beyond the period authorized by law. 5 _ _ _ _ _ __ . _ �^� r F. To make distribution of my estate and Trust to any person entitled thereto in kind, in cash, or partly in kind and partly in cash, as deemed advisable. To this end allocation of assets in kind shall be in the sole discretion of my fiduciary without regard to the income tax basis of specific property allocated to any benef iciary or Trus� and such allocat ion shall be f inal and binding upon a11 persons whomsoever and shall be a full acquittance and discharge to my fiduciaries and my fiduciaries shall not be liable to any person whomsoever by reason of the exercise of such discretionary power. Assets distributed in kind in satisfaction of any pecuniary distribution under the terms of this Will shall be distributed at their values on the date or dates of distribution. G. To register or carry any investments held hereunder in their own name or in the name of a nominee or nominees; provided, however, that all such investments shall be so designated upon the recards of my fiduciaries that the TrL:st or estate to which said investments belong shall appear clearly at all times. H. To vote by person or proxy any and a11 stock held in my estate and Trust and to participate in any reorganization or merger of companies or corporations whose stock is so held. I . To borrow for the purposes of my estate or Trust from any source, which shall include the authorit�r to borrow from any 6 __ _ _ _ ___ rn m1 separate Trus� created herein, and as gecurity for repayment, to hold or pledge the whole or any part of my estate or Trust Estate J. To employ such servants, agents, attorneys, accountants, investment counsel, and professional advisors, as may be reasonably required or desirable in managing, protecting, and investment the assets of any Trust created hereby and to pay their reasonable compensation. K. In general, to exercise every power and discretion in the management of any Trust created hereby as the Trustees would have if they were the absolute owners thereof, and this general power shall not be limited in any way by the specific powers given herein. ARTICLE 3IXTH The property interests, whether income or principal, passing under this will or passing under any trust created in this will, and the assets of my estate and of any trust created hereunder, sha11 not be subject, while in the hands of my personal representatives or trustee, to voluntary or involuntary anticipation, encumbrance, alienation, or assignment, either in whole or in part, by any beneficiary hereunder, nor shall such interests be subject to any judicial process, execution, levy, or 7 ---- -- _---. __ _ _- _ _ =,r�, _ r attachment for or on behaJ.f of such person' s creditors or claimants . TN WITNESS WHEREOF, I, R=CHARD C. HSN3HA�P, have hereunto set m hand and seal this � y 2(o day of June, 2001. ._�� c. u�� S�} Richard C. Henshaw Signed, sealed, published and declared by the above named Testator, RICHARD C. HENSHAW, as and for his Last Will and Testament, in the presence ot us, who at his request and in his presence, and in the presence of each other, have hereunto subscribed our names as witnesses thereto. - �C}1�� r��L�K.X�.�. s __ ___ _—_ _ _ _ _ __ _ __ _ _ ._ _ ,e� , ACKNOWLEDGMENT TO SELF;PROVE WILL We, the witne$ses and Testator, whose signatures appear below and whose names are signed to the attached or foregoing instrument, being duly aworn, do hereby declare and acknowledge to the undersigned authority: (1) that the said Testator signed and executed said instrument as his Last Will and Testament; (2) that he signed willingly; (3) that he executed it as his f ree and voluntary act for the purposes therein expressed; (4) thaC each af the said witnesses in the presence and hearing of the Testator and of each other signed as witnesses; and (5) that the Testator was at the time he signed said Will, eighteen (18) years of age or older, of sound mind and under no constraint or undue inf luence. ' C l�C�� Testat . Witness 7_i7 _State St. . Erie, PA 16501 Address V 1 �"�Y1�.�, wi� 717 State St. . Erie, PA 16501 Address Sworn to and subscribed before me by the above signed Testator and the above signed witnesses this 2,�;i day o f June, 2 0 O 1. �--x—H.,�.� `�. �G��-C►.�/�C.-- Notary Public TWTI►R�1L.6EAL �i0lC�[A AA.�6CI(,IIOTAl1Y�C Si1E.�COIMiY.��A. i111 COY�OM E�'�B OCf.1l.l�i , _ _ _ _ . _ _ _ _ ___ __ ___ e....-_. . _... _"--._. � F 1� Form706(Rev.B-Q2) f Estateof: Ri r.h�r�i � ,g,��,�h�� SCHEDULEB—Stocks andBonds (ForjoinilyownedpraperiythatmustbediscfosedonScheduleE,seetheinstructionsforScheduleE.J uem oescnptior►incN�rgraceamax�cabondsarx«Merasharssandpar u�cvak,e �� wcdrretevawe vaN,ie ac�e or cleam number valuewhereneetledtorideMitkaUOn.Give9-tligitCUSlPrnxnber. vatustlondate CUSIPnurnber � 133 shs. MetLife commo $ 4 ,499.14 2 1,050 shs Lord Corpora ion Class B 684 ,600. �0 3 Fideli.ty Investments A ct. #X77-006700 371,494. 36 4 Kahkr�a Club stock (SO ) 100. Q0 Totalfromcontinuationschedules(oraddkionalsheets)atiachedtothisschedule . . . $1,060,!693. ,'i0 TOTAL.(AlsoenteronPartS,Reca itulation, a e3,atitem2.) (Ifmorespaceisneeded,attachthecontinuationschedulefromtheendofthispackagearadditionalsheetsofthesamesize.) (TheinstructionstoScheduleBareintheseparateinstn,ctions.) ScheduleB—Page 12 __ _ . . _ _ ___ �,��, _ Farm 706�Rev.B-02) Estateof: Richard C. Henshaw SCHEDULEC—Mortgages, Notes,andCash (ForjointlyownedpropertythatmustbedisclosedonScheduleE,seettreinstructionsforSche�uleE.) number DeSCripGon Altemate Alte*natevakie ValueatdateoFdeath valuationdate � Uncashed Travelers Checks $ 410. 00 Totaffromcontinuationschedules(oradditionalsheets)attachedtothisschedule . . TOTAL.(AlsoenteronPartS,Reca itulation, a e3,atitem3.) $ 410. 00 (If morespaceis needed,attachthecontinuationschedulefromtheend ofthispackageoradditional sheetsofthesamesize.) (Seethe instructionsonthe reverseside.) ScheduleC—Page 13 _ _ �nmr _ • Fotm 706(RQV.BA2) r Estate of: Richard C. Henshaw SCHEDULE D—insut-ance on the Decedent's Life You must iis[ all policies on the liie of the decedern and attach a Form 712 For each f�olicy Item Alternate number ��Oa� valuetion date �temate value Value al date ot death � � Metropolitan Life Ins. Co. , policy #0920194�. on life of Richard C.� Hensh , payable to Kathleen H. Hunter & Richard C. Henshaw, Jr. , children of the decedent, in equal shares (per U. S. Treasury Form 712 attached) $4 ,122 . 33 2 Metropolitan Life Ins. Co. , polity #012-499-910-A on life of Richard C. Henshaw, payable to Kathleen H. Hunte & Richard C. Henshaw, R. , children of the decedant, in equal shares (per U.S. Treasury Form 712 attached0 4 , 491. 7Q 3 Prudential Life Insurance Co. , policy #19 086 097 on life of Richard C. Henshaw, payable to Kathleen H. Hunter & Richard C. Henshaw, Jr. ' children of the decedent, in equal sh res 2 ,000. 00 Total from continuation schedules(or additional sheets) attached to this schedule . . TOTAL.(Also enter on Part 5, Reca itulatlon, a e 3, at i[em 4.). . $1Q, 67:4 . 03 (If more space is needed, attach the continuaqon schedule from the end of this package or additiorral sheets ot the sarr�e si2e.} (See the instruc6ons on the reverse side.) ' Schedute D--Page 15 _ _ _ _--- —--- -- _-- - -_ _ _ r�� F�m 71�2 (Rev.August 1994) Life insurance Statement OMB No.1545-0022 ' Oepartmnnt of the 7reasury internai Ravenue Service � ' ecedent — Insured o Be i ed y e E�cecutor th nite tates state ax Return, orm 06 or orm - q} 1 DecedenYs first name and middle initial 2 Decedent's iast name 3 Decedent's social 04 22 2002 5 Name and address of insurance company METROPOLITAN LIFE INSURANCE COMPANY 700 QUAKER LANE, P.O. BOX 330 WARWICK, RI 02887-0330 6 Type of policy 7 Policy number 30 PL 012-499-910 A 8 Owner's name. If decedent is not owner, 9 Date issued 10 Assignor's name. Attach copy of 11 Date assigned attach copy of application. assignment. 04 20 1939 12 Value of the policy at the 13 Amount of premium(see instrnctions) 14 Name of beneficiaries KATHLEEN H HUNTER t1f116 Of eS51g�fT16f1t. RICHARD C HENSHAW JR $ 23.90 i 5 Face amount of policy , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , $ 1,000.00 16 Indemnity benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0.00 17Additionalinsurance , , , , , , , , , , , , , , , , , , , , , , . . . . . . $ 0.00 180therbenefits , „ , , , , , , , , , , _ , , , , . . _ . . _ a 0.00 . . . . . . . . . . . . . . . . 19 Principal of any indebtedness to the company deductible in determining net praceeds , , , , , , , , _ , , , $ 0.00 20 Interest on ind�tedness (item 19) accrued to date of death, , , , , , , , , , , , , , , , , , , , , , , 0.00 21 Amount oi accumulated dividends , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , $ 3,448.79 22 Amount of post-mortem dividends , , , , , , , , , , , , , , , , , , , , , . . . , $ 42.91 23Amountofreturnedpr�mium , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , $ fl.00 24 Amount of proceeds if payable in one sum , , , , , , , , . , . . . . 4 491.70 25 Value of proceeds as of date of death (if not payable in one sum), , , , , , , , , , , , , , , , , , , � � 26 Policy provisions conceming deferred payments or installments. � � N ote: If th o r th n lu e a m -s tt um lem nt i ri se e s autho z f r ed o ri ' asuvvm u P s o se lease tt 9 P . P a ach a co of th e pY `>:«:`;:>��:;�` %R n I' sura ce o�c . n y :::�` :,��;::><� :;�<:: ;�:�: ........ <::::�:.�: . ..................•.............................................................................................................. - - vK� .......»....................................................................... ^1. ';}:(:'�•i::ii: •:.� 27 l4f Tl.... ...... ........................................................................._................................................................................................... ........................................ ountof installments........................................................_......_.............._.................................._......................................................... $;: 28 Date of bi►th, sex, and name of any person the duration of whose life ma measure the number of y ments. PaY ��;�;>:�;:`::? ��Y;::: ...�...............�.....�...............�.............r.........................�..............�...................�...............................................�.............................�...................�... ,:O::i "}" y'� ................ . •......a.....�.............................. ....�.............................. ................... .r...... ........... 4�4>% . .......«.... . ...... :{{}.�. v4'i ti:\�:: ....� .......................�.. .. ........�.. v::n�:::::::::..::. . . •.. ..... ....... � 'i::t: �::}� :j;:;f 29 Am - �:.;:;�:;� ount a lied b the insur n p a ce com an as a sin le remi P Y um re resentin the h P Y urc i I 9 P ase of n t I m P s a ent benefits. 9 P ................:........................:.:... ......................::::. .........................................................................................................................................................................................................................� $ SO Basis (mortaiity table and rate of interest) used by insurer in valuing installment benefits. ......................................................................................................................................................._..._...._............»............................................................................................ 31 Was the insured the annuitant or beneficiary of any annuity contract issued by the company? , , , , , , , , , , , � Yes (] No 32 Names of companies with which decedent carried other policies and amount of such policies if this information is disclosed by your records. ............................................................................................................................................................................................................................................................................. ............................................................................................................................................................................................................................................................................. ......................................................................................._..................................................................................................._......._...................................................................... The undetcigned officer of the above-named insurance company hereby catifie5 that this statemant sets foRh true and correct informatfon. Sqnature W+�'�'�' �� Title►CLAIM APPROVER DateMCatilfcatbn► OB 26 2Q02 Instructions Paperwork Reduction Act Notice.—We ask for the information on this form to catry instructions of the tax return with which this form is filed.0�NOT send the tax form fo out the Intemal Revenue laws of the United States. You are required to gi� us the either of these oifices.Instead,return it to the executor or representative who requested it. infarmation.We need it to ensure that you are complying with these laws and to allow us to figure and collect the ripht amount of tax. Ststemeat of Insurer.— This statement must be made,on behalf of the insurance The time needed to complete and file this form will vary depending on individual company that issued the poliay, by an officer of the company havinq access to the circumstances.The estimated averape time is: records of the company. for purposa of this statement a facsimile siqnature may be Form Recordksepinq Prepariny th�torm used in lieu of a manual signature and if used,shaU be binding as a manual signature. 712 18 hrs.,25 min. 18 min. S�parate SYatsmenh. — File a separate�orm 712 tor each poliq. If you have comments concerning the accuracy of tfiese time estimates or suggestions Line 13. -�Report on line 13 the annual premium,not the cumulative premium to date for making this form more simpte,we would be happy to hear from you.You can write of death. If death acurred after the end of the premium period, report the last annual to both the IRS and the Office of Management and Budqet at tha addresses listed in the premium. Cat.No.10170Y Form T12 (Rav.9-94) _ _ __ _ __ ___ .__._. ._--. _-, _... ..._. ._ _. . .F�� .._.. Form � 1� OMB No.1545-0022 (Rev.August 1994) Life Insurance Statement ' Department of the Treasury Internal Revenue Service ecedent — Insured o e e by e ecutor �th Un e tates state ax eturn, orm 7 or orm 7 - A) 1 DecedenYs first name and middle initial 2 DecedenYs last name 3 DecedenYs social security number 4 Date of death RICHARD C HENSHAW (if known) 04 22 2002 5 Name and address of insurance company METROPOLITAN LIFE INSURANCE COMPANY 700 QUAKER LANE, P.O. BOX 330 WARWICK, RI 02887-0330 fi Type ot policy 7 Policy num6er 30 PL 013-455-883 A 8 Owner's name. if decedent is not owner, 9 Date issued 10 Assignor's name. Attach copy of 11 Date assigned attach copy of apptication. assignment. 09 20 1941 12 Value of the policy at the 13 Amount of premium(see instructions) 14 Name of beneficiaries KATHLEEN H HUNTER CIfIIB DI 2S51QI1RIeI1[. RICHARD C HENSHAW JR y 47.56 15 Face amount of policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2,000.00 16 Indemnity benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0.00 17Additionalinsurance , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , $ 0.00 18 Other benefits , � , � , • , . , , . . . . . . . . . . . . . . . . . . . . . . $ 0.00 19 Principal of any indebtedness to the company deductible in determining net proceeds , , , , . , , . . . . . $ 0.00 20 Interest on indebtedness(item 19) accrued to date of death, , , , , , , , , , , , , , , , , , , , , , , 0.00 21 Amount of accumulated dividends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � 1,996.42 22 Amount of post-mortem dividends , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , $ 125.91 23 Amount of returned premium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ �•Q� 24 Amount of proceeds if payable in one sum , , , . . . . . . . . . . . . . . . . . . . . . . . . . 4 122.33 25 Valus of proceeds as of date of death (if not payable in one sum), , , , , , , , , , , , , , , , , , , , , $ t . >:<:;':;::i:: r in t Ilmen s nso sa �:::.:.:� in f rred a me t li r isi ns concem de e 26 P c ov o 0 Yp 9 PY :::::::::::t tt tt haco o he le a ac r' f r rvivin ouse ase i tho ize o a su s I m nt au d - m tt e e s . Y I m su se P • If th r than u P N . e ote o 9 p ;<:�<; p >:::>�>::<>; >:;.;;;�:<= n lic . ....{ insura ce o y P . ................................... <:;i>' .. ................................................................................................ . '.;�:: . .. .............................................. .. . � ........................ ...... . ;.;.. - :i] ...... ..� .....................................r....r.......�.�.............�..........................�..r....'...-........................�................�....�....�....�.... :W:............................................ .�� H��..��..�� ..• 27 Amount of installments.......................................................................................................... ;:::>:�:�3 nt . r f ame s n mb o m the u s >;:>::t t n n the duration of whose I'rfe ma easure 28 �ate of birth sex and name o a rso Y P Y . , Y De ;��>. ::»:;�: :� . ........................................................................._.........._.......---.......................................... >s ............................................................................. . .`;E:`;.:;;';i i�4 .^'�` ........................ .... .............................................. ........ .................... . .... ......... ......... .... .............. ...... +.:}:r . . ......... ...... ............ ...... ..... ... .... ........ ...... .. ...... 't't::.;:5:' �t . . . ...'............... %::i:::i:;::iit':i:[:;i::::�:fx::i:::i:i:::�t:::i::, 29 Amount applied by the insurance company as a single premium representinp the pu�chase of installment benef s °�"-' �-`°'��`��`-�''°��'��" :.::::::.::::.::::::::::........:............ ..............................................................................................................................................................................................._......................... $ 30 Basis (mortality table and rate of interest) used by insurer in valuing installment benefits. ...................................................................................................................._......................................................................................................................................................... 31 Was the insured the annuitant or beneficiary of any annuity contract issued by the company? . . , , , . . . . . . ❑ Yes �] No 32 Names of companies with which decedent carried other policies and amount of such policies if this+niormation is disclosed by your records. ...................................._.................................................................................................................................................................................................................................._... ........................................................................................................................................._.................................................................................................................................. .............................................................................................................................................................................................................................................................................. The undersiqned oificer of the abwre-named irnurance company hereby certifiea that this rtatart�t sets forth true and correct Information. Sqnature W� �� ►CLAIM APPROVER ��e�� OB 2G 2002 Instructions Paperwork Raductlon Act Notice.—We ask for the infwmation on this form to carry instructions of the tax return with which this iwm is filed.DO NOT send the tax form to out the Internal Revenue laws of the United States. You are required to give us the either of these offices.Instead,return it to the�cecutor or representative who requested�t. information.We need it to ensure that you are compyinp with these laws and to allow S�ement of In:urer.— This statement must be made,on behalf of the insurance us to figure and collect the�ight amount of tax. comparry that issued the policy, by an officer of the comparry having access to the The time needed to complete and file this form will vary dependiny on individual records of the comparry. For purposes of this statement a facsimile siqnature may be circumstances.The estimatad average time is: used in lieu of a manual sipnature and if used,shall be bindinq as a menual siqnature. Ferm Reeordkeepiny Preparinq theform 712 18 hrs.,25 min. 18 min. Sepante Statements. — Fi1e a separate Fwm 712 for each policy. If you have comments concerning the accuracy of these tima estimates or sugyestions Un�13. —Heport on line 13 the annual premium,not the cumu�ative premium to date for making this form more simple,we would be happy to hear from you.You can write of death. If death occurred afte�the end of the premium period, report the last annual to both the IRS and the Office of Management and Budget at the addresses Iisted in the premium. Cat_No.1017DV Form 712 (Rev.8-941 _ _ .��, „` , • Fam706(Rev.B-02) Estateof: Richard C. Henshaw SCHEDULEE--JoinUy OwnedProperty (lfyoue/ectsection2032Avaluatlon,YoumustcompleteScheduleEar►dScheduleA-1.) PART1.—QualifiedJointlnterests—InterestsHeidbythe Decedentand HisorHerSpouseastheOnlyJointTenarrts (SeCtion 2U40(b)(2)) Item pt Altemate Altertwtevalue Vah�estdateofdeath rnimber FarsecuritieS.g�NeCUSIPr�m�ber. valuationdate roperty si�uate 411 Shawnee Drive City of Erie, Erie County, PA (SOLD) Net proceeds $173,456.46 2 Suntrust Checking #0232001431412 4 , 809.17 3 First Nat' 1 Bank �of PA Checking #655 11376 5,482. 06 4 Lord Federal Credit Union -#15013 7 ,504. 40 5 Lord Federal Credit Union #1952016 6 ,138. 29 6 IRS income tax refund 494 .20 7 Mi:sc. Household Gds & Personalty 5, 000. 00 Totatfromcontinuationschedules(oradditionalsheets)attachedtothisschedule . . . . 1 a Totals 1 a ♦ • 5 8 �b Amountsincludedin rossestate(one-halfofline �a) . 1b 101 4 2. 29 PAR72.—AllOtherJointlnterests 2a Statechenameandaddressofeachsurvivingco-tenant.ifttierearemwethanthreesurvivingco-tenants,Nsttheadditional catenants onanattachedsheet. Name Address(rMxnberand5treetcity.SRate.and2lPcode) A. B. C. Item En[er Destription Percentage I� fntkitlibkvslueat �� ette►tor fmcludingattematevakiebondateifany)For includide atternatevalue dateddeath co-cenane secunues, CUSIP�xxnber. Totalfromcontinuationschedules(oradditionaisheets)attachedtothis schedule 2b Totalother" intinterests 2b . . . . . . . . . . . . . . . . . . . . 3 Totalincludiblejointinterests (add{ines7band2b).AlsoenteronPanS,Recapftulation. page3,atitem5 . . . . . . . . 3 (Ifmorespaceisneeded,attachthecontinuationschedulefromtheendofthispackageoradditionalsheetsofthesamesize.) (Seetheinstructionsonthereverses+de.) ScheduleE —Page 17 . _ ��ar Form706(Rev.B-02� Estateof: Richard C. Henshaw SCHEDULEM—Bequests, etc.,toSurvi�ingSpouse EtectionToDeductQualifiedTerminablelnterestPropertyUnderSection2d56(b)(�• Ifauust(orotherproperty)meetsthe requirementsofquai�ied terminablein[erestpropertyunde�section2056(b)(7),and a.Thetrus[orotherpropertyis listedon Schedule M,and b.Thevalueofthetrust(orotherproperty)isentered inwholeorin partasa ded�tiononScheduleM, then unlesstheexecutor specificallyidentifiesthetrust(all orafractional portionor percentage)orotherpropertyto be excludedfromtheelection,the executorshall bedeemed to have madeanelectiontohavesuchtrust(orother property) treated asqualifiedterminableinterestpropertyundersection2056(b)(7). Iflessthantheentirevalueofthe Vust{orotherproperty)thattheexecu[orhas included inthegrossestatsisenteredas a deductiononScheduleM,theexecutorshaiibeconsideredtohavemadeanelectiononlyastoafractionoftheVUSt(orother property).Thenumeratorofthisfractionisequaltotheamountofthetrust(orotherproperty)deductedonScheduleM.The denominatorisequaltothetotaf valueofthetrust(orotherproperty). ElectionToDeductQualified DomesticTrustPropertyUnderSection2056A. Ifatrustmeetstherequireme�tsofaqualifred domestictru5tundersection2056A{a)andthisreturnisfilednolaterthanl yearafterthetimeprescribedbylaw(including extensions)forfilingthereturn,and a.TheenUrevalueofa Vustortrustproperty is tistedon ScheduleM,and b.Theentirevalueoftheirustortrustproperty is entered asadeductionon ScheduleM, thenunlesstheexecutor specificallyidentifiesthetrustto beexcludedfromtheelection,theexecuto�shall be deemed to have madeanelectiontohavetheentiretrustVeatedas ualifieddomestictrust ro Yes No 7 Didanypropertypasstothesurvivingspouseasaresultofaqualifieddisclaimer? . . . . . . . � � li"Yes,"attachacopyofthewrittendiscJaimerrer�uiredbysection2578(b). 2a Inwhatcountrywasthesurvivingspouseborn? USA b Whatisthesurvivingspouse' sdateofbirth? �_2/6/19 /% c IsthesurvivingspouseaU.S.citizen? . . . . . . . . . . . . . . . . . . . . . . . 2c X d if the surviving spouse is a naturalized citizen,when did the surviving spouse acquire citize�ship? e If the surviving spouse is not a U.S. citizen, of whai counuy is the surviving spouse a citizen? 3 Election Out of QTIP Treatment of Annuities—Do you elect under section 2056(b)�7�(C)(iiy not to ueat as qualified � terminabte interest property any joint and survivor annuitles that are included in the gross estate and would otherwise � be treated as qualified terminable interest property under section 2056(b)(7j(C)7(see insVuctions) . . g X Icem peknpcionotpropertyinteresupassingtowrviWngspouse Amount number � 1/2 jointly owned assets per Schedule E $101 ,442.29 2 Residue Trust -- Article Third -- Pursuant to Article Third, the Executrix elects to qualify this fractional part of the Article Third Trust as a marital deduction pursuant to section 2056 (b) (7) of the IRC 3'�1,Z1:7.. 53 Totalfromcontinuation schedules(or additional sheets)attachedtothis schedule 4 Total amountofpropertyinterestslistedonScheduleM . . . . . . . . . . . . . . . 4 ' 2 5a Federalesta[etaxespayableoutofpropertyinterestslistedon5cheduleM , , 5a 0 b OtherdeathtaxespayableoutofpropertyinterestslistedonScheduleM , _ , 5b c Federal and state GST taxes payable out of property interests listed on � ScheduleM . . . . . . . . . . . . . . . . . . . . . . . . 5c d Additems5a,b,andc . . . . . . . . . . . . . . . . . . . . . . . . . . gd 6 NetamountofpropertyinterestslistedonScheduleM(subtract5dfrom4).AlsoenteronPartS, 473�1$9, $2 Reca itulation, a e 3,at item 20 6 (Ifmorespaceisneeded,attach[hecontinuationschedulefromtheendofthispackageoradditionalsheetsofthesamesize.) (Seetheinstructionson[he reverseside.) Schecp�leM—Page 27 _ _ . . _ _ s�m� ; ESTATE TA7C BECUAITIEB V11LV114ION 8AO& NO. 1 ACCOVNT: 9986840-741-66-58 Name ot Estate: AICHARD C. HENSW�P UMI� DATE OT DL'ATH: Thursday, oatober 11 2012 ITSM CUBIP NO. 8W►RSS/ DEBCRIETION PRIC& HI�H/A6K L09P/SID 1�ifN 9SCURITY ACCg{T� CpD�4SNTg __'PA7t VIiLVE D11TZ PAICE 8RIC6 PR2CH VALSIE DIVIINT __'- --'___'-' -'_____--'__ '-__----_-'___--__"-__'----'- ---° -�------_' ---------- ---°---__ _'_'--'---___ -'_---'____' MUT tUNA 1) 02968A408 816.7080 Af�itlGt7 HEACON lUNDS 10/11 16.0000 16.00000 18,061.2b � INTE HQT INBTL 2) 04S14N204 652.1740 ]1RTI8AN PTRNS B'DS INC 10/11 23.6400 23.54000 12,988.18 MUT gt1Nll ZNTL 1'D INV � 3) 092B1R602 1,725.6890 SL7►CIRiOCK CI►p AppAgC �'D INC 10/11 24,6600 29.66000 92,696.77 � g�� HLi�CRROCH CL 9) 092S1N504 2,809.3600 SL1►CitROCK LQVITY DIVID l'D SO/il 20.1900 20.19000 66�461.77 � p�� INBTL CL 6) 2562D6103 399.9910 DODOE 6 COX H'D9 10/11 92.6B00 32.66000 13,044.11 � p�p INTL HTK H'D 6) 256210105 10,713.1050 DODOE b COX INCC4�� l'D 10/11 19.6800 13.88000 148,697.90 � pq�p CODa 7) 277911491 8,761.0760 EATOH VANCE MUT 1'D8 TA 10/11 9,1000 8.10000 62,426.78 � 7�,� !'AT AT CL I B) 98192Y401 872.6800 OOLDD4IN SI�CH9 TR 10/11 25.6300 25.53000 17�173.62 �T LR;r� 6RW OPPT INBTL 9) 911511801 1,120.8940 }[�RHOR !D 10/11 11,6400 11.64000 13,047.21 � p��q INTL OR1P INSTL 10) 4642B7234 209 I9}W'L&B TA 10/li 91.6200 91.3800 41.50000 8,673.60 PACI6TC EX I43CI 6t46R0 l9CT 11) 47109C291 789.8090 JAN08 INVT FD SO/11 22,0400 22,04000 17�400.78 � g�t7p PARN L1C VL I SHS 12) SS2983694 2,192.9720 L49'S 8&R TR I 10/11 25.6900 25.69000 56,537.46 � p� VALVB FD CL S 19) 699390700 12,780.0610 PIMCO TDS PAC INVT Mfit4T 8LR 10/11 11.5800 11.58000 147,998,11 � p�y TOTAL RBTAN PT 14) 69951J793 SS,B68.7370 PNC �'DS 10/11 11.0300 11.03000 130,601.87 �y ppNp TTL RTN ADV f'D C 16) 779919109 835.6160 ROWL T YRIC6 RE11L S8T71Tti f'D 10/il 20.8100 20.81000 17,389.21 p�p� r� COdf 18) 880208400 9,925.6500 T�LETON INCOtR TR 10/li 19.8700 19.37000 b2,485.94 � �p C�.H HD 11DV90R 17) 89165H827 3�359.3540 TOVCH8TON6 !'DH OROVP TR 10/11 12.6200 12.62000 92,331.95 � gv};�p BANDC71P8dS�OR Y 18) 999527641 25,863.9600 SL71ClCitOCK LIQ B'D8 TEMPFUND ADM BH9 kHi 25,863.96 4.39 MANVAI, PA2NCIP7IL CA9H 19) 999527641 259.9900 SLACIatOCK AIQ FDS TSI9dBt1ND ADM 8H3 NHi 234.99 0.00 DANUAL INC� CABH Oran Totals __'____"_'___'_ '_-'_�____�_ 868,958.26 4.99 Total Briaaipal plua Aacrued interest and dividends �868,9gy,59 This raport was prepared uainq APPA7�i8L Ver. 7.6.0 aoltware, an EVAINATION SE[tVSC66, INC. produot. Phoae 201 784 8500. Visit our wab sites at S7o7W.ApPRAZgg.NJ,C0�4 and W9iW.GpIT11LCHANpa80NLIN&.COM. Please compar� tha data on thio doawnsnt carePUlly with your souraa doat�ent to verily its aaauraay. _ —_ _ ►e� . ► SSTATB TAX BRCfJAiTZES VALV]1TION PAOE N0. 1 ACCOVNT: 3986840-001-Sb-5S Name o! Satate: RICHAttD C. HLNSNA�P DATE O! DdJ1TH: T6araday, OctObeT 11 2012 ITID� CUBIB NO. 8N71RE8/ DSSCRIFTION BRICS HIOH/A8K 7A➢P/DID t�AN 9SCUAITY 11CCLUJSD C04ID�SAP3 g�y�ypy D71TZ PRICB pRICS PAICS VA7 VR DN/INT °-- °------' '--°'-""..'-" °------'--'---"------"°---'.. '-'-- '--^°---' --°----'- ----'----- -°-°-----° --^°°-'-'- ---------' 1) 999327641 16,900.9300 8L7\CICROCK LIQ !D8 TL�P1'[1tiD 1�D� 8H8 11}f1 16,900.93 19.09 Ml�ti[tAL EASNCIP7IL CA88 2) 999527641 868.4400 SL1►CI(ROCH LIQ FDS Tl�P1'Vt�ID 11Dffi 8H9 �Hl 868.44 0.06 MANIT�.I� INCO2� C718R '..'___��'__'__� '�.._____'..__ Orand Totais 17,�69.87 19.08 Total ¢riacigal piva 1►ccrued inta=eat aad dividenda 17,788.46 This report was preparad usinq APet�7►,IBS Ver. 7.6.0 soPtr►are, an EW►LtfATiON BSRVSCZB, INC. produat. eLoae 201 784 8500. ViaiE our web sites at �1fP.J�PPAAIBiNJ.COli and�WI�►.C]►PITAT�CItJ�tioa80NLINE.C�l. eieaa� compar� the aata on this documeat aaretully witII your souroa doaum�nt to verily it• aaauraoy. _ -- _ ►1I�1 ,. � , ., r i ,4 LAST WILL ANA TESTAMENT OF RICHARD C.HENSHAW DATED: June 26, 2001 . McCLURE&MILLER � Attorneys-at-Law � 717 State Street, Snite 701 Erie,Pennsylvania 16501 _ _ FA m1 • j ' ( 1 LAST WILL AND TESTAMENT OF RICHARD C HENS W I, RICHARD C. HFsNSHAW, of �he City of Erie, County of Erie and Commonwealth of Pennsyl.vania, declare this to be my Last Will, hereby revoking aIl prior wills and codicils. ARTICLL FIRST All esta�e and inheritance taxes (inc7.uding interest and penalties, if any) , toge�her with al]. adminis�ration expenses, payable in any jurisdiction by reason of my dea�h (including those taxes and expenses payable with respect to assets which do not pass under �his will} shall be paid out of and charged generaZly against the principal of my residuary es�ate, without apportionment or right of reimbursement . ARTTCLE sECOr1n I give and bequeath certain items of tangible personal property, including au�omobi.les, boa�s, furniture and personal effects, unto my wife, THELMA E. HENSHAW, if she survives me, and if she does nat survive me, then, in tha� even�, said tangible personal property shall. be considered a part of my residuary estate and ahall be disposed of as hereina�ter set forth. __ r�m� f ( ARTICLE THIRD In the event that I am survi.ved by my wife, THELMA E. HENSHAW, I give, devise and bequea�h al.l the rest, residue and remainder of my estate, unto PNC BANK, NATIONAL ASSOCIATION, Erie, Pennsylvania, as Trustee� to be held as the Residuary Trust under the following terms and conditians: A. My Trustee shall pay all �he net income from the Residuary Trust to my wi�e, THELMA E. HENSHAW, in quarter-annual or other convenient installments, but at least annuaily, for and during her lifetime. My Trustee aha3.1 be authorized to disburse Co her, an amount of principal whi,ch, when added �o the net income, will pravide a tatal income for her of $50, QOO . QO per year, but said principal. disbursemen� shal.l not exceed during any calendar year, 5$ of the principal on January lst af same calendar year, or $5, 000 . 00, whichever is greater. B. Upon the dea�h of my wife, Thelma E. Henshaw, �his trus� shall terminate and the principal therein, �ogether with aIl accrued income thereon, sha11 be distributed as �o3.lows : 1 . Fifty (50�) per cent thereof unto my daughter, KATHLEEN H. HUNTER, if she is then la.ving, and if she is not then l.iving, then unto her then living issue, per stirpes. 2 __ _ _ �� , � . { ( 2 . Fi£ty (50�) per cent thereot unto my son, RICHARD C. HENSHAW, JR. , if he is �hen living, and if he is not then living, then unto his then living issue, per stirpes. C. I£ my wife, Thelma Henshaw, predeceases me, I give, devise and bequeath the residue af my estate, real and personal as follows: 1 . Twenty-five (25�) per cent thereof unto my daughter, ICATHLEEN H. HUNTER, i f she i s 1 iving, and i f she i.s not 1 iving, then unta her issue, per st,irpes. 2 . Twenty�five (25�) per cenC thereof unto my son, RICHARD C. HENSHAW, JR. , if he is livxng, and if he is not Iiving, then unto his issue, per stirpes. 3 . Twenty-five (25�� per cent thereof unto my wife' s daughter, AMBER SUSAN THTEMANN, if she is living, and if she is not living, then unto her issue, per stirpes. 4 , Twen�y-five (25�) per cent thereot unto my wife' s son, JAMES C. LUND, if he is living, and i.f he is no� living, then unto his issue, per stirpes. ARTICLE FOIIRTH I nominate, �onstitute and appoint my wife, THELMA E. HENSHAW, to be the Executor of �his my Last Will . In the even� my said wife, Thelma E. Henshaw, shall have predeceased me, tail to 3 _ _ i�l� �' { � act or refuse �o acC for any reason, I nominate and appoint PNC BANK, NATIONAL ASSOCIATION, as Executdr in her place, with al.l the duties, powers and responsibilities as if originally appointed hereunder. No individual fiduciary acting hereunder shall. be required to post bond or enter security in any jurisdiction. .ARTICLE FIFTH in addition to the powers given them by 1aw and by the other provisions of this my Last Will, my personal representatives and the trustee af ali trusts created by this wi11, sha11 have the following powers, applicable to all property held by them, effective wiChout court order and until actual distribution: A. To re�ain as an investment for my esta�e and the Trus�, wi�hout any duty of diversification, any and a1.1 property, real or personal, recezved hereunder, including any stock in PNC Bank Corp. , without liability as a result of such re�ention. B. The corporate fiduciary serving hereunder sha11 have the power to invest the principal and/or income of the Trust Estate in any assets or securi�y including but not 2imited to stocks, bonds, debentures, notes or other similar obligations issued, owned, or underwritten by such corporate fiduciary or its affiliate. In adda.tion, such fiduciary may invest such principal an/�r income in 4 __ _ _ !A� . '� . ( f any bond or other debt secured, supported or otherwise enhanced by a Letter of Credit of such fa.duciary or its atfiliate. C. To i.nvest and reinvest the principal of my estate and the Trust in stocks, bonds, mortgages, securities or other property, real. or persanal, withou� being limited to the classes of securi.ties or investments in which fiduca.aries are by law authorized to invest tunds. D. To se13. any and all real estate held as an asset of my estate and Trust at such times, at public or private sa�e, for such prices and upon such terms as deemed advisable, and to make, execute and deliver any deed or deeds therefor, conveying �itle thereto in fee simple absolute, or for any less estate to any purchaser or purchasers, freed and discharged of any and all trus�s hereunder. E. To sell, exchange, lease, encumber, option or otherwise, dispose of all or any portion of my estate and Trust in such manner and upon such terms and conditions as ahall be deemed advisable, and to make, execute and de].iver deeds, mortgages, leaseg, assignments and ather documents necessary to effectuate any o� �he powers granted, which sha13. specifically include the authority to grant leases which extend beyond the term of any trus� hereunder and beyond the period authorized by law. 5 __ e A m� r " . ( ( F. To make distribu�ion of my esta�e and Trust to any persan � entitled thereto in kind, in cash, or partly in kind and partly in cash, as deemed advisable. To thie end allocation of assets in kind shall be in the so3e disca:etion of my fiduCiary without regard ta the income tax basis of �pecific property allocated to any beneficiary or Trust and such allocation shaJ.l be final and binding upon aIl persons whomsoever and shall be a full acqui�tance and discharge to my fiduciaries and my fiduciaries shall not be liable to any person whomsoever by reason of the exercise ot such discretionary power. Assets distributed in kind in sa�isfaction oF any pecuniary distribution under Che terms of this Wi7.1 shall be distributed at their values on the date or dates of distribution. G. To register ar carry any investments held hereunder in their own name or in Che name of a nominee or nominees; provided, however, that all such investments sha11 be so designated upon the records of my fiduciaries tha� the Trust or estate to which saa.d investments belong sha3.1 appear clearly aC all times. H. To vote by person or proxy any and all stock held in my estate and Trust and to partic�.pate in any reorganization or mergar of companies or corporations whose s�ack is so held. � I . To borrow �or �he purposes of my es�ate or Trus� from any source, which shall include the autharity to borrow from any 6 _ ��m� ' : { � separate Truat created herein, and as security for repayment, to hold or pledge the whole or any part of my estate or Trust Esta�e J. To employ auch servan�s, agents, attorneys, accoun�ants, investment counsel, and professional advisars, as may be reasonably required or desirable in managing, protecting, and inves�men� the assets of any Trust created hereby and to pay their reasonable compensation. K. In general, to exercise every power and discretion in the managemen� of any Trust created hereby as �he Trustees would have if they were the absolu�e ownexs thereo�, and this general power shall not be limited in any way by the specific powers given herein. ARTICLE 9IXTH The property interes�s, whether incame or principal, passing under this will or passing under any trust creaCed in this will, and the assets o£ my estate and of any �rust created hereunder, shall not be subject, while in �he hands of my personal representatives or trustee, to voluntary or involuntary anticipation, encumbrance, alienation, or assignment, either in whole or in part, by any bene�ica.ary hereunder, nor shall. such interests be subject to any judicial process, execu�ion, levy, or 7 �� . _ _ . . . r {. at�achment for or an behalf af such person� a creditors or claimants. IN WITNESS WHEREOF, T, RICHARD C. HENBI�iAW, have hereunto set � my hand and seal this 2 b�day of June, 2001 . ��.u�� (SEAL) Richard C. Henshaw Signed, sealed, published and declared by the above named Testator, RICHARD C. HENSHAW, as and for his Laat Will and Testament, in the presence of us, who at his request and in his presence, and in the presence of each o�her, have hereunto subscribed our names as wiGnesses �hereto. , . _��}�v } 8 __ _ __ _ ___ _ �A� _ ' : r {. a�CKNOWLEDGMENT TO S LF—PR VE WILL We, the witnesses and Testator, whose signatures appear below and whose names are signed to the attached or Eoregoing instrument, being duly sworn, do hereby declare and acknowledge to the undersigned authority: (1} that the said Testator signed and execu�ed said instrument as his Last Will and Testament; (2) that he signed wi.11ingly; {3) tha� he executed iC as his free and voluntary acC for the purposes therein expressed; t4) that each of the said witnesses in the presence and hearing of the Testator and of each other a�.gned as witnesses; and (5) that the Testator was at the time he si.gned said Will, eighteen {18? years of age or older, of sound mind and under no cons�raint or undue influence. ` C. � Testat � Witness 717 State St . . Erie, PA 16501 Address �^�� Wit esa �17 State St. , Eri.e PA 16501 Address "� Sworn to and subscribed before me by the above signed Testa�or and the above aigned witnesses this �i day of June, 2001 . _ �• ��2:� Notary Public � ------- id�TAFNAL 6EAL 1�?0!!'e!A M.Bl1SECK�NOTARY P1lR��. � �,EfllE COIMETY�PBIrA. �lY C�1lMiS810N F�OCf.18,4�8 r�� , . . ��~' . ( r REGISTER OF WILLS CERTIFICATE QF GRANT QF LETTERS ERtE County, Pennsylvania No. 2502- 00683 Es ta te Of: R/CHARD C HENSHA W lfssr,M/ddle,t.au La te Of: ERIE CITY OF ER/�COUNTY Deceased Socia3 Security No: WHEREAS, on Che 14th day of May 2002 an instrumen� dated June 26Ch 2001 svas admitt�d to probate as the Ias� wi1.I of RICHARD C HENSHA W (fbsL Mlddls,1ssU �a�e of ERIE, CITY OF, ERIE County, who died on the 22nd day of Apr.i.1 2002 and, WHEREAS, a txue capy of �he will as probated .is annexed hereto. ' THEREF�RE, .I, PA TR/CK L. FETZNER , Register of Wi.Z.is in and for ERIE County, in the Commonwealth of Pennsylvania, hereby cert�.fy �hat I have th.zs day gran�ed Letters TESTAMENTARYto: THELMA E HENSHA W who has duly qua.Iified as EXECUTORrR/X� and has agreed to adminis�er �he estate according to law, all of which fu11 y appears of recard in my office a t ER/E COUNTY COURT HOUSE, ER/E, PENNSYL VANIA, IN TESTIMONY WHEREOF, I have hereunto set m}• hand and affixed the seal of my office on �he 14th day of May 2002. �.�� t eg ste�o � s tk�kNllTCi'*tY 7�T r rsnwwr+.-. .r..-...... _ __—_ , _ _._____ . _ r�m� ��,F1��'�ll"� November 29, 2012 WILLIAM C DISSINGER C/O DISSINGER AND DISSINGER ATTORNEYS AT LAW 28 N 32ND ST CAMP HILL, PA 17011 Dear William C Dissinger: We are responding to your request for information regarding Thelma E Henshaw's Fidelity Investments account(s). All information in the enclosed valuation report(s)is(are) based on assets in the Fidelity account(s) as of the date indicated on the report(s). Valuation information is provided through a third party valuation service provider. Fidelity does not warranty the accuracy of this information for any particular purpose, nor dces Fidelity provide legal or tax advice. Consult with an attorney or tax professional regarding any specific legal or tax situation. We hope this information is helpful. If you have any questions about account holdings or need instructions on how to transfer the ownership of the accounts,please visit us at Fidelity.com and search under"Change Account Registration"or call us at 800-544-0003. Fidelity Inheritor Services Representatives are available Monday through Friday from 8:00 a.m. to 6:30 p.m. Eastern time. Sincerely, Carla Goins Carla Goins Fidelity Investments Account Re-Registration Services Representative Our file: W723156-23NOV 12 LGLTR2/DDODCNFM 5312981.0 Brokerage Services provided by Fidelity Brokerage Services LLC Member NYSE,SP[C Clearing,custody and setHement services by National Financial Services LLC Member NYSE,SPIC P.O.Box 770001,Cincinnati,OH 45277-0034 _ rn� $ (.� ,S,"' ["1 N rl .-I N � O a--� � O O O �i E"� (� •' C� !-1 . . . U] N U7 N �..' O O O (A �.' ri �l � '-i H i/T �'i � l(S 'r-i rl U] '�'. � W J-J l0 `� r-1 � Tf O -r-I 61 �' (� 'r-1 J-� W -�i N N cd � 5 � � o � � N �CS •�--1 J-1 U N ,7 U -{ � �CCau� •• �l � 6� � H Q � ,i." •• W H l0 O O lD 'J E-i � � O � L(l O O �.[l � •• N � ?-I f-i Lf'1 O O tSl � 4--I O E-� N'ri C� � O N � C*� � O O O � � � , � N i N -.i � � 1-� in O 'Z � N [� [� w o !-� � � U �� H � U1 �'. � (� M W " Ul i� . [� J-� � O U O O O H O O � �.,' Lf] O O .,� U '� � N o o � � U � � c� o O � _,� rC af +� �n o o � � � � � � � � � � rn � � � � ` � o � ,� cn 0 N a � O � � � x •� U `� U • � O o O _,� � � O O O � ,y 0 0 0 o a � `� '� �--I O N O �y � � -�-1 � �i �Q rl ri [� � � �1 � � M � � � O A �l � �'-i i � � U � O N W N � � i!] p � N � � � LC1 O O .--I (� O '� L� N 'J O l� Ul 00 � E-� N C"" !� � .� �`� C31 N �o p .-i .-i p .-� U � � p� U � P�-i � r� FC x `� � � � r-I U1 M O � O W �-' 0 �-' w m � � o r+ o � � �, � co "� � � � � o w o N � +� � � � � � o � � � � �� , � a w o � °; rx .-� a ,-� c� � o ,x �, � � � � x � � o o u� o r;� m � W O H V]N 4-I N U W N �J L4 -rl a1 r-i �-i .--I N � J-1 � .�'. �-1 ON U] ON � E-� U] NO r-I J-J W �-I � `�i � � �-I �-i � H N \ (� � 1-J J.-1 � � o�c � x a� ,--i � w a�i ,�-� � `� � aUi ai >c o ai o u� 'J � � r� '' � � w � � U] � W U Zi � U H � /-C C*-� H � �(,' l-� O ,`�-i ,�-� ,�-� '_" `-i 3 u � 0 0 0 0 °o °o N N N N • O O � � � � � � �\� M O O • U � �--I c-i Ol U] S-1 �[1 p p � �� r-1 �--I N N � 00 O O C� `� � \ \ \ 0 � O O O .-i ((f a � .-I � c-i ,L; }.� � O • � U] O O � �+ o � � � ' � N M � � • � t� �, o 0 0 . 3 � � Q N `-� `--� N� � � rtf C� w � � � � � � � � �1 -r{ M �7 f� � � � <y i.�n � �6 ?-i O p � .,� �+ o � � � U E-� �, w -� m v (v-7 (� �.�, � � � o � cn zs c� N H � � � � � �-i O � N �' O rd .,� n-� � a � ° N H Nov, 30, 2012 2:28PM PNC Bank No, 2331 '. 1/1 ��:� ��.�� November 30, 2012 William C Dissiz�gei Esq. I7issinger&Dissinger 28 North 32ad St Camp Hill,pA 17011 RE: Thelzna E Henshaw S�N: DOD: 10-11-2012 Dear Mi.Dissinger: In response to yoYU-requcst for Datc of Death(DOD)balances£or r,�e customer noted abo�ve,our records sho�v the following: Checking Account Account# 500421 T 713 Established: 06-02-2003 THELMA E HENSHAW DOD balance: $ 14,987.30 +0.03 accrued interest Ynterest paid O 1-O 1-2012 thru 10-11-2012 $0.42 YTD please note that this office provides date o�death balances for deposit accounts(TTiAs,CDs,Checking and Sa'�ings). We do not process any financial trausactiobs or pro�'ide statements. �£you need assistance with any of these iums,please call 1-888-PNC�BAN1�(I-888-762-2265)or stop by your local pNC 13ank branch office. Sincerely, National�`inancial Services Center PNC Bank,N.A. Member FDIC 7'his message is intended for the use of the individual or entiry to which it is addressed and may contain inrormation��iat is privileged, con�deritial and exempt from disclosure under applicable law. 1'jthe reader of this message is nor�he inzended recipient or the employee or agent responsible for delivering this message to the intended recipient,you are hereby notif ed that any dissemination, distribution or copyi�g of this communications is s�trictly prohibited. 1'f you have received this communication fn error, please notify me immediately by reply or by telephone at 800-762-1775 and immediately destroy thrs fc�ed docur,ient. page 1 of 1 _ _ . rq m� � � � � U � � � y ,� � + � l � � ti � � o y � m ,o � � 4 � d � � � i o "0 �o r-1 U � M � � M n y M a �� O r � ,� U � � � �i .,, .� � � '� O '� '� vj O z N � � � o � � � � .g Q �,r r, o .� o � � � � � $ A o � � � Q �-+ .fi � � � °�� `� zA ° � ��o � 1LL V�Q � \ �Z��O¢,. � , ��Zx� � '� `~ �D��m¢p � � � 3 a � �az � � � v � O � �` Y o on o a�i e � �: �` �m� g � � � x v � � ��/�W� W � � � w � � �� = 2 a � ro \ � H � a� � .� � � o �, o U � �GQ _ _ FAX TO BOOKKEEPING ATTENTION LINDA WILES DEATH NOTICE NAME: Thelma E Henshaw ADDRESS: 6 Wiltshire East Street, Carlisle, PA 17015 SOCIAL SECURITY#: DATE OF DEATH: October 11, 2012 BRANCH CONTACT: Connie L Welcomer COPY TO RAY EGOLF FOR IRA NOTIFICATION _ �I��r OjMlfflintown PO BOX 96 MIFFLINTOWN PA 17059 RESPONSE TO ACCOUNT INQUIRY TO: DISSINGER&DISSINGER, ATTORNEYS AT LAW DECEDENT: THELMA E HENSHAW DATE OF DEATH: 10/11/2012 SOCIAL SECURITY#: We held account s in which this decedent had an interest at the time of his/her death as follows: ACCOUNT OWNER(S): THELMA E HENSHAW, IN TRUST FOR AMBER THIEMANN Type of Account : INDIVIDUAL CHECKING Account#: 6620009 Principal Balance at D.O.D: $ 232,484.67 Interest Rate: 0.6000% Original Opening Date: 11/03/2009 Interest to DOD: $ 49.68 ACCOUNT OWNER(S): THELMA E HENSHAW, IN TRUST FOR JAMES C LUND Type of Account: INDIVIDUAL CHECKING Account#: 6620017 Principal Balance at D.O.D: $ 232,484.68 Interest Rate: 0.6000% Original Opening Date: 11/03/2009 Interest to D.O.D: $ 49.68 ACCOUNT OWNER(S): Type of Account: Account#: Principal Balance at D.O.D: $ Interest Rate: % Original Opening Date: Interest to D.O.D: $ Penalty is waived on withdrawal of decedent's fund before maturity: Yes� No Safe Deposit Box: Yes No First Community Financial Corp. stock o her securities: Yes No Trust Dept. Accounts: Yes No ��S�.hA�1.��rJ/G�a.�f�on�� a�.e��J //— ��—/�-- Authorized Signature/Title Date . _ ��.� � � DIS�INGER ' DISSINGER �1 tto��nc�vs at LrzT�,� , � �. ` ; �y�, November 16, 2012 ' � �-_� First Natiorial Bank of Mifflintown P.O. Box 96 Mifflintown, PA 17059 RE: Estate of Thelma E. Henshaw, Deceased Date of Death: October 11, 2012 Dear Sir or Madame : ' We represent the estate of Thelma E. Henshaw, who died on October 11, 2012, with interest (s) in the following account (s) at your bank: Number 6620017 and 6620009 . For tax purposes, we would appreciate you providing us with - a statement stating, for each account or certificate: 1 . The reqi.stered owner or owners (exact title of the account) and type of account; 2 . The dat:e on which the account was established; 3 . If there was a change of ownership or registration of the account= within three (3) years prior to the date of death: (a) Date of such change; (b? Title of account prior to change. - 4 . Applicable interest rate; 5 . The dat=e of death balance (principal plus accrued interest, if any} . EnclosE�d is a death certificate, a short certificate and an • 28 North ThirtySecond Street •Camp Hill,Pennsylvania 17011 •717.975.2840�voice•717.975.3924�fax . �00 South State Road •Marysville,Pennsylvania •17053 i 17.957,3474�voice• 717.951,2316�fax Authorization for Release of Information and Documents signed by the Executrix. If you have any questions, please feel free to contact me. Ver ruly s, , � ��C�� - William� Dissinge Attorney at Law WCD: ck �,ncl : 1 . CC: Amber S. Thiemann File: 4-12-225 .. .. . ..�,,,.t, ....:�.9 � . 4 �. .. . . � � N � ��. . . LL�j � � f ��6 z,i��.�:o� � � �.�, € ,� ad � �, _.._ , � __ �r�r SunTrust Banks Mail Code GA-ATL-5134 Post Office Box 4418 Atlanta,GA 30302-4418 �� SUl1{�tUST' Verification of Deposit/Loans DISSINGER AND DISSINGER Applicant 28 NORTH THIRTY-SECOND STREET ESTATE OF THELMA E CAMP HILL PA 17011 HENSHAW Date of Death balance on the deceased as of October 11, 2012. Checking account 232001431412 contained $3,112.89 Ti�le�' �s: ''1'�rIl11N E Hen�t�aw Account opened 02/04/1980. Accrued interest$0.02 No other accounts or safe boxes located. Signature of De�s�sitory Official Title Date �� `-"�'� 0 erations I��a.narter 11!2$/2012 An ela Cainion Please direct inquires: SlJ1�hUST Cr Credit Verification Department GA-ATLANTA-5134/Post Office Box 4418 Atlanta,GA 30302-4418 Request Number Contact Number: 1-800-786-8787 This letter is confidential and written without prejudice as a matter of business courtesy withe understanding that its source and contents will not be divulged and[hat no responsibility is to attach to this Bank or any of iu o�cers or agents for informa[ion herein. Ibt.ons information solety as to transactions or experience between thaiesignated customer and this Bank. ��,.� . � � � �� _ _ _ . . _ �AtT _ � �� ___-._. � _ _._ . -� l �Da. l7 - --- - --- -- ---------- --------_------ sold Larry's-- ebay I------ Lenox vase $ 9.95 amber -- - ----- - - --- - - ----- --- -- - Lenox vase $ 6.00 'amber --- ----- - --- -- _ - ----- -_ Lenox vase $ 2.49 amber ---___------ -- --- --_ --. ---- -- --__ _ __-- ._ - Lenox vase $ 7.00 ' amber -------- ----------- ---- ------ ----- -__. --- - —--. Lenox vase $ 17.99 am�er -- -- -- - ---- - --------- -- - -:_ Assorted tea cups $ 45.00 am�er ---- _--- ---- --___ _----- ---------- _ --- __- - -- -__ --- __ _ ---- - - _ ..__-- Fairfax china $ 300.00 �amber _ -- -- --- -- ----- ---- --- --- --- -- ._ glass vase $ 19.95 arr��er ----- -- ---- - - -- __ - --- -- _ ._ Corning ware x ' -- ---- -_-- ----- --____ silverpl tray x - - -- -- ------ --- -- -- sliver chip n dip broken x - --- ---- ---- - --__----------- --------------� -- Silverpl revere x - --- --- -- --- _ _- -- ----- - --- _ ,_ Rogers flatware e � -- ---- - --- -- ------ - a erwei ht - P P 9 $ 18.95 - - _ am�er - . ----- -- - -------- - -------- - - -__ - -- �_ paperweight $ 13.99 ,amber --- -_-------------- - ----- - - --- ------ - _-._. enamel wall art $ 45.00 amb�r - ---__ ----- - --- --- ---- --- ------ __- ._. oil lamp __ _ $ 15.99 amb�r -- -- __- -- oil lamp _-- --- -__ - __ _ _- ----- --- $ --- _-_10.00 _�--- --_ amber -- - �.;_. oil lamp_ _ _-_- _ $ 11.88 'amb�r _ --- _-- -__-- -- __ - -__ - --- - -- ------ _ -- __ _ --- --- -- --.,- - Wmston mug , $ 18.50 am��r - -- -- - --- --- -- --- --- -_ - _-_ -- .,_ Lenox dish $ _ 8.49 amber -- - -- - --- -- - --- ----- glass dolphin -- - - __ ----- - - $_ 30.00 � amb�r ------ _-- - _ �_ --- - ss flask $ 5.00 amber --- - - - -- --------- --------- rt- :__ wooden_figures_Hannah canada $ 36.00 amber --- -- --- ----__ -- --- clothing �/a -�- --- -- - ---- - - ------_.__-- ------ ---_ ___---- --- - photos _ _ - _ n/a -- --- -- - - --- -- -- - - -- --- - -,_ _ books 2 $ 10.00 amber - - - - -- ------- - - - _ _ - - - --- --__ _ _ ---- -,_ costume jewelry _ ___ $ 250.00 amher _ _ _------------� -- - - :_ _ boat picture X - - --- ---- ----- - - - - -------- --_- --- _ -- --- -.- - May's_picture __- - ---- -- $ 6.00 � am�ier --- - -� - -- -- --- ---_ clowns e ---- --- ---- -- --_ - ----- � -- --- -- -- tennis racket - - -- --- - - - $ _- 9.99-� - -- _- ----�amb�er glass bowl $- - _- 3.00_j-----_- ambier - -- -- - - ___ -- ------ - pierrot clown e ---- -- ------— -- _ -------F --- � ___ misc knick knacks ___ X -- ---�- - - ______- -- _-- ___ -- --- silv. Plate cream_& sugar X -� - - -- -__- - _. ---- -- silv. Plate christmas 1992 bell X _ _ _ _ _ __ ___ _ _ . � '►�. pottery pict frame x - - -- ----- --- _ Mikasa casserole chip lid x -- --- — --_ _ ___ _ __ __ cloth purses 2 Not VB $ 8.00 amber - .__- -- - ----- ---- __ --- -- � coffee mugs 2__ _ x '� --- --- -- --- ----- - �---- __ Electric curlers x ' - --- - -�--- --- ---- - -- Herend Hun a lates 10 2 $ 52.00 '' _ amber 9 rY P �� ---- -' -------- ---- - ..-. - -- Compaq CPU& printer $ 75.00 amber ----- ----------- - -- - - -- - -- -- -- --- -- --- -._ -- wooden figure J. Caran $ 20.00 amber - - -- - - - ._ -- mahogany nut dishes 2 $ 5.00 amber -- __ ---- ---_-- - ----_-- --- - ---_ wooden Jewelry box $ 10.00 amber ---- -- ----- --- __ 9 music CDs $ 9.00 amber -------- - --- -- --___--- - --- ___ -- —._ A. Santini nude statue copy $ 3.00 amber - - --__ - -- ---- ---------------_____ --__ cloth purses 2 $ 10.00 amber - - ------ - -____- --- - ___- - ---- 2 snap jewelry boxes $ 5.00 amber ---- ---- ------ -- - —.;_ 2 Teddy bears & stuffed mouse $ 4.00 _ _ amber --_ --- - - --- ___- -- -- -- --- -- ---- _- ._. - $ {�_1,102.17 _ _ _ ___ __ . _ _ __ __ FA�7 _ t' �.+ . � _ II.P'[.f/V items est value sold to Larry�s �� - -- --- ------ - - __---- - ---- • Pots/pans $ 5.00 �hariie �/�3.�9 . -- — --- __-- - -__----- --- - ---- microwave $ 20.00 charlie _ �� -� -- - - --- ---- -- - -- -- _ ___ , toaster oven X + . i D�{,9,d G;,��, - - -- ---- ---- -- mixer �x �__ ---- --- -_ --- - --- -- - _� - ___ __ .,. coffee pot--- -- X 'J . 9��, D�;, - -- --- -_ - -- -- ,, GF grill ---------_ __ _- " - �--- -, -- --- -- ---- - --- , --._-. wooden shelf ;x I - blender -- -- ------ - - - __ -X------_ _ --- -- - ---- ----- ------- __--- canister set X - -_-- --------- —____._.. dishes & glasses x -- ------ ------ -- -- corning ware x --- ----- ----- ------- mini food processor x ' - --- - ----- - - -------� _ __-- _ cake plate � 700.00 x - --- - -- -- - - Piano __ ---- ----- �Stacey - - —-- ---- --- tv/vcr/dvd $ 20.00 ' Charlie -- --- --- --_-- --- --- -- -- - - _ 2 cherry end tables x - ---- - ---- - --- _ -- --------- - -_ Lazy boy sofa 84" ' x --- __- -- -- ---- --___- -__ - --- --_ 2 wing chairs x - _-- -- - -- -- - --- -- - - - ___ tub chair �x --- - -- -_ - ---- - -- -- - oil painting ___ $ 75.00 lamber ------- --------�- _____ 3 framed prints ;x __-- -------- -- -- � -------_ __ __ cherry curio cabinet $ 75.00 amber _ -- ---- -- - - - --- -- -- cherry grandmother clock $ 300.00 amber ---- ---- ---- - --- --- - --___ white china lamps 2 $ 40.00 amber -- -- _____ -- - - -- - - -- � _ brass lamp _ $ 20.00 ! amber - --- -- -- - -- --- -- - - cherry butler tray table__ $ 100.00 amber -- - - -- - - - -- --- -- cherry stand ;x -------- -- - _-_ -- X --- ----_ - brass mirror stand -- -----___- ------ - -+----- - ---- --- ----- - - - - -- antique sconces ' $ 40.00 amber -------------- --- --------- ------- ------_ cassette radio X -- ------- - - - ---- - - - -- - _ _ __ 1_ _ ___ misc baskets --- - -�X---- - ----�' - -- -__ ------ --- --- --- _ Cherry dining table 2 leaves x - - - --- - - -__-__- ----- __. 6 cherry chairs X ---- -_ ------ --__ -- -- ----- - framed mirror $ 50.00 amber -- ---_ - - - ------ --- _ _-- - ----�- - needle point sconces $ 5.00 amber - _ - -- ---- _. chimney candle sconce � $ 10.00 �amber _-- -- ------- -_- --------- ------- -- artificial plants $ 25.00 amber -----_ __- - -- - ------ _ __ -__--_ Cherry china cabinet $ 300.00 amber _-- ----- __-- - - - --- ----- cherry tea cart X----- ---____ _ _--- -- --_ _ -- __ -- --- --y --- - --- brass chandelier $ 25.00 �, amber - - --- --- _- -- - - - -- - - --- - cherry octagon table __ �_$ 150.00 r amber - -- -- - ----- --- __ Sauderbookcase X __ . _ _ __ _ __ �A'i �' . Hoover vacuum cleaner Ix - ---- -- --- --�-- ------ -- -- Cherry stand & mirror $ 150.00 amber --- ---- --------- ------fi--_ - Magazine stand lamp x __; ____ _ _ ----- --- ca�tus oil painting $ 25.00 amber ---- --- _--- -- ----- ---------- -------- - --- --- Bose radio/cd $ 185.00 amber - - - -- ---__ ._ --__-_ -_ 3 piece bedroom set & mirror x -- - --- ---__-- --- --- — - Double matt & box spring x ---- ------- — - -- -_-- ------- --- -------- - -- computer desk x ---- - _ _- ----- --- --- ---- ----- __ 13" tv $ 10.00 amber -- ---_--- -------- - --- wooden desk x --- - ----- - -------- --- ._ brass lamp x ------ - ------- __ __ -- glass lamps 2 x Gateway laptop $ 150.00 amber — — -- ----------- --__- HP printer 7350 _ _____ $ 5.00 amber - - -- �------------ -- HP printer !x -- ----- ----- ----- - ____ Keyboard & mouse �x ----___---- -- ---- -----� ------— —___ Lift chair jx - ---___ ____ _------ ---__- bed board x ---_----- -- chair in bedroom x - --- - ----- - ----- - wicker hamper ix - - -- -- --- ----- ---- -- --- - - -{ -- ----- ---- -- bathroom bench �x --- -- - -- — -- - - - bathroom stand ix ---- - � - — --- hairdryers 3 x --- - -------- --- ------ - --__ __ luggage X ------------ - - ---- -__ ___ . ___ _---_._ ------ --------______ decorator pillows x - - --- -- - -- --------------- _ ----___----- -- -- --_ ____ clothing $ 100.00 amber ------- ----___ _------ -- -- -- purses 3 Vera Bradley $ 30.00 amber ------------——- - ---- ----- ------- ------__--- purses 1 bella taylor $ 8.00 amber purses 1 Laurel Burch $ 9.00 amber purses 1 Eitiene Aignier $ 5.00 amber - ------------ ------ --- ----- iron & ironing board x -- - -- ._ _ ------ _-------------- - - ----- -- __ Step Stool $ 3.00 �amber -------------------------- --- -- ----- -----�-_-----— brooms/mops x ------------- - -______ _- ---- --___ throw rugs-4----„__ ---- I x -- - -- Karastan oriental rug $ 60.00 � amber -- - -- - - —--__ --_- ---- Digital photo frame $ 5.00 amber ___ _----- ----__-- ----- ----- - ___ electronic bp cuff $ 5.00 amber -- - Pp� 9 p P --- --�-- Christmas wra in a er $ 2.00 ', iamber --p - --------- ---------� ----_--- ----- Books s ecial $ 15.00 amber ------------� ------___--- ---- Misc paperbacks 20 j x -------- ---------- - ------- ---- ---------- ---- ---- books hardcover i x '� -- -------------- -- - ---- -- ---f __. misc knick knacks x - ------__---- --- ----------- ---- ---- ____ Wall mirror $ 5.00 amber . __ . _ _ ___ r�,� table linens X ------------ — - - ---- ---___ towels, sheets,blankets $ 60.00 Charlie -- - -- - -- -- ----- -- __. --- -- pillows 8 X - - _---- -- - --- -_ _ _ folding porch chair $ 5.00 amber -- -- _-------- --- - ---+ -- --- -- --- 3 framed prints $ 30.00 ' I - - -------- --- --- ---- - --- � _— _ needle point picture & misc X ' --- --_---- -- -- ------ _ _ - Christmas tree $ 2.00 amber -- -- ---- --�------_ .----- - -- - variety box _ ' x_ __ -- --- framed photo $ 5.00_�_ _ _____ amber _ ------- -- - --. -- --- - framed oils (Hilliers) 8 $ _ 50.00 __ ___�amber _ blue tote bag $ ___ 4.00 _____ __ amber_ _ — - - - - --- - - - sneakers 2 $ 5.00 i amber -- _.--- --- -- - -------� __ ----- -- -- wooden shoes $ 8.00 amber footstool X --.-- --- - - - - -- --- ---- - bread plates 2 X -------- --- -- - ---- - ----- 2 telephones $ 15.00 amber ------ -- - - -__ _-------- — _ 12 musi� Cds $ 12.00 amber ----------- --- - --- - 4 chairs with padded seats x - --__ -- --------�- blanket rack _ '� mattress & spring _ ;x -- - --- -- - --- ---- ----- --- --- ---- �--- - headboard/frame �x I - --- - -- --- - - ---� - _ maple table/3 chairs __ 'x - -_ _ _— - -- - - - - Misc porch furniture X --- - --- - ---- ------- - - -- glass vase --roses $ 3.00 'amber _ .- -- --------- --_--- - - - bundt pan $ 2.00 amber --- ---- - --- -__--- - ------ --- -- --_. plastic flower tray $ 1.00 amber ------_ -- --- —--- ---- --- - _ 3 grabbers $ 3.00 amber ---- --- -- ---- ---- ------- --------- ------ - kitchen magnets $ 1.00 _____ amber _ --- ----- -- - - - 47 pieces silver pl flatware ebay ____ ----- -- --- -- -- - 2 sm oval oil paintings $ 3.00 amber ------ -- --- -- -------- _-- --- -- - _ misc extens cords etc $ 30.00 amber - - -- glass decanter $ 2.00 amber --- --- -_---- - --- ------ - -- - - -- 2 shot glasses $ 0.50 amber -- -_ - --- ----- ---- _�—_ __ martini glass $ 1.00 �amber -- - --- -._�_- -- 4 placemats and table runner $ 3.00 -amber ---------___-- -- ---- - ---- �-- -- silver deer papervveight $ 2.00 ;amber 17 picture frames sm-Irg $ 17.00 �amber __----- ---_-- ---- - - --- -- -------- --- 3 snap jewel boxes $ 3.00 amber ---__---- - - - --- ----- - -__ ____- -- -- 2 egg cups $ 1.00 amber ------ _ __ - ----- ------- ------------ --. __ silveplate mirror, comb, brush $ 20.50 amber _------- -- --- --- --_- - ----_ _.. anchor bookends $ 4.00 amber - -- --- - lenox swan $ 16.99 amber Misc china trinket dishes etc $ 60.00 '� amber ___ _ __ .__ .. I'A 7 6 glass tumblers $ 12.00 amber -- -- -------- --_--_ captain and mate figures $ 30.00 amber - - ----- --- -----__ ________ ,... � --- - — --�f----- �-_ _-- $ 3,143.99 ' . _ _. _ _ �11�1t ! . . ., � � � Umbrella boy $ 105.00 amber_ Umbrella girl $ 122.00 amber -- -- -- _ a stitch in time � $ 48.00 amber Apple tree girl 8� bo $ 93.00 amber Happy traveler $ 15.00 amber_ "boy on fence" chip $ 5.00 amber Sensitive hunter � $ 24.00 amber For mother $ 22.00 amber — --__----- __------ Carnival fasnacht $ 28.00 amber – ----- – -- - --_�- ---__ _-- -- -- - Top of the hill $ 42.00 amber Belle $ 30.00 amber Cherie $ 25.00 amber Fair lady $ 27.00 amber_ Balloon Man_ ___� $ _99.00 Jim Balloon Lady � $ 49.00 amber T----- -- --- ��_... - _ ;;___734.00 __ ___ �"li 7 .� . Antique teapot __ _ _ $ 30.00 amber antique sugar ___ ___ __ $ 15.00 amber _ antique creamer _ $ 5.00 amber Ansley china 8 serve __ _ $ 600.00 amber Copenhagen 1973 _ _ _ _ $ 0.99 amber_ B�G 1968 $ 5.00 amber B&G 1967 $ 5.00 amber B&G 1970 $ 15.00 amber ----- --- - -- ---- ------- Royal Copen 1969 _ _ _ _ _ $ 2.95 amber_ Royal Copen 1972-__--- _- $ _ 4.99 amber Royal Copen 1983 _ $ 6.50 amber _ Royal Copen 1972 chipped ___ $ 1.00 amber _ Bradf. Russian $ 4.00 amber - _ _- - - -- Signed bird vase $ 25.00 amber Elizabeth coronation $ 4.75 amber ---- --- Depression bowl $ 4.00 amber -- -------__---�------ ----. Waterford candlestix $ 40.00 amber --- -- -- - Waterford ships decant $ 99.00 �amber - -- -- . --- --- --- -.___- Blue cut glass vase ___ $ ___ 13.00 amber_ Lenox candy dish __ _ $ 9.99 amber ___ Bradford plate 5005H $ 15.00 amber Bradford plate roses $ 19.95 amber _------ -_ - - pink plate $ 2.00 amber __- -- --- ---- tea cup/saucer __ _ $ 5.00 amber Silverpl goblets "H" _ _ $ 10.00 �amber Crystal goblets not Waterf _$ 20.00 ;amber ---------- -- -- - Ginger jar $ 3.00 �amber Audobon bird pl $ 14.95 amber Bradford plate chipped $ 1.00 amber - - -- Buddha statue $ 57.00 amber _ ---- - -- china flowers $ ,10v1�Q-_amber , ----- --___-- - -t-- -- 1,049.07 ' ��-"''�". ,� _ -___- --- I � �::�T�,� E'�'ALL ATIOlti' ( ,' - !i � �,� � ,-;�-_,:.:._ �_-�=�-:- `".�* �;-;� have this day cazefully examined the following listed and described articles, at _:^.c .� �--..�� ,I III! � i i ' 'ti.��,iE: Estate of Thelma Henshaw � , j � ;i.�._ �_. '_��ember 1,2012 �� I ' � In making this evaluation, we do not agree to purchase these items. i ' � ;. It is understood that the'items described in this report belong to the above, and that the manner of acquisition raiser does not reseazch ownershi . � can be formally stated by the above named. T'he app p �t'e do not guarantee values. Values could differ depending upon the appraiser_ The weights, }t��asurements, ,T • tin allows.` ormal wear ' ��arriy grades, and color grades of any or all diamonds were all determmed as moun g 1+� , �nd tear on items is not noted. � I � �'his evaluation report consists of 2 pages. . � These records are confidential. We will not permit access to them without your authorization. I !: It has been a pleasure serving you. We look forward to helping you with any of your future jewelry needs. ! ' �� li Appraiser: � � 'i I ,' '�I � i Scott Snavely, Gra `te Gemologist(GIA) � ; � � I � _ --- -- _ __ _ __ - ��« _ ,, � ... , �� v�� One ladies two-tone 14k yellow gold diamond solitaire engagement ring. The ring contains a Round Brilliant Cut diamond in a six prong white gold crown (the crown needs prong repair). The diamond has an approximate average diameter of 6.25 mm (as measured with the Leveridge ga.uge). It weighs appmx.0.90 cts(as determined using a weight estimation formuia). The diamond grades VSt-2 clarity and J-K-L color(as mounting allows). The yellow gold shank measures 2mm at the top and tapers to 1.2 mm at the bottom. Fstate Value 53.400.00 CJne ladies two-tone 14k four stone diamond anniversary style band. The band centains faur full cut diamonds each set in �white gold prongs.(The prongs are wom). They each measure approximately 4.0 mm each(as measured with the Leveridge g�ge). They have an approx.total diamond weight of 0.92 cts(as determined using a weight estimarion formula). Two grade SI l-z ciatity and the other iwo VS2-SI t clarity and H-I-J color(as mounting allows).The yellow gold shank measures 3 mm at the top and t�ers to I mm at the bottom. E,siate Value$�.900.q0 ,/ �j � wS a ESTATE EVALUATION We herewith certify that we have this day carefully examined the following listed and descr�bed articies, a: the request of: NAME: Thelma Henshaw Date: January 9, 2013 Gold Market:51,658.00%z Silver Market:�3036/oz In making this evaluation, we do not agree to purchase these items. Items 1-89 are priced at fair marke� value (which is an estimate based on what a knowledgeable, willing, and unpressured buyer may pay to � knowledgeable, willing, and u.npressured seller. Fair Market Value is usually subjective due to many variables; one including precious metal markets. Opinions on value are always based upon subjective interpretation of available information at the time of assessment. It is understood that the items described in this report belong to the above, and that the manner of acquisition can be formally stated by the above named. The appraiser does not research ownership. We do not guarantee values. Values could differ depending upon the appraiser. The weights, measurements; clarity grades, and color grades of any or all diamonds were all determined as mounting allows. Normal weaz and tear on items may or may not be noted. This evaluation report consists of 15 pages. Pictures included are used as reference only; may not represent the true colors or actual size. These records are confidential. We will not permit access to them without your authorization. It has been a pleasure serving you. We look forwazd to helping you with any of your future jewelry needs. Appraiser: Scott Snavely, ate Gemologist(GIA) 1 . I'A 7 , . •� • � � �_ , . ,, �._< �F ��'ATE �VALUATION l. 14K yellow sea shell bracelet.22.8g $1,080.00 2. 14K yellow men's wedding band(5.7g)with five small diamonds 0.17tdw li clarity. �30U.00 .�_ ��i:��-t t�8��s��tvkmc#s) S�1(i_QQ 4. 14K yeqow oval garnet earrings(9x7mm). $48.00 5. 14K yellow imitation oval emerald(IOx8mm)and CZ(2.4mm)earrings. �120.00 6. 18"6mm pearl strand necklace with 14k yeilow clasp. $325.00 7. 14k yellow 19x12mm Mab�pearl enhancer with five 1.2mm diamonds. $277•50 8. Gold Plated bracelet with double row of CZs.(Gold plating wearing off.) $24.00 9. 14K yellow pendant with 7.Smm CZ. $75•�� 10. 14k yeilow double link charm bracelet with twelve charms(not all charms are karat $2,2�ro.00 gold)and weighs approx SOg. 11. 14k yellow rope love knot earrings 3.2g. �192.00 12. 1985 1/10 Ounce gold paada coin with 14K yellow rope coin frame pendant $347.00 � _ __ _ �`II 7 . . •, • f " ,� �� IIi��MIM��N1oR�C.: $I�'�1.dI�Q � � ..,.°f�� ' �' $ ,�� l�t. G"��wa�,:h a�w�h�+e Face arEd�id piated bcaeelc�band_ $75.00 1�. 14K}�ellow shell pendant 0.8g with gold plated sterling silver chain. $74.00 16. 14K yellow dolphin pendant 4.Sg with diamonds. $210.00 i�_ a�1��i � ` �. "s�'�_�,a 18. Sterling silver gold plated rope chain(stamped"925 Italy"). $27.0p 19. 14K yellow 16x12mm green scarab pendant;3.4g(weighed with stone). $135.00 20. 14K yellow sand dollar earrings;7.4g $594.00 21. Gold plate sterling silver 20mm x 8mm hoop earring with Grecian design. $72.C►0 22. Gotd plate sterling silver 20mm 600p earrings with diamond cut design. $45.00 23. lOK yellow oval IOx8 mm Swiss blue topaz earrings. $327,00 24. 14K yellow modified bar cut garnet earrings. $239.00 25. 14K yellow 13.Smm round flower earrings with mixed pear shaped gemstones. $150.�0 26. 14K yellow boy charm engraved"Charles"and"6-10-79";1.4g. $144.00 3 _ ___ rn n� f ; � ; �'.� ��€' ��.' �� 3�9FiCI�, ��'�_�� ?E_ t 8K yeilow�and sterIing silver filigree 7:c5mm oval blue topaz earrings. $120.00 29. Steriing silver gemstone ring with marcosite and foilback. $30.00 30. 18"8mm fresh water pearl strand with gold plated magnetic clasp. $23_00 31. l 7"8mm fresh water pearl strand with base metal magnetic clasp. $23.00 32. 14"fresh water 3mm double pearl strand with 3 single 6-9mm pearls with sterling $24A0 silver extender chain. 33. 14k yellow 16"S-link chain stamped"Italy"(1.7 g)with 6.Smm fresh water pearl and $150.00 diamond pendant. � 34. 16" "Tin cup"style 14k yellow snake chain with eleven Smm fresh water pearls.Clasp $160.Q0 attached but broken. 35. 7" 18k yellow"hugs and kisses"bracelet with eleven 8 mm fresh water pearls. $540.00 Stamped"RJP';11.1 g weighed with pearls. 36. 7.5"6mm imitation pearl strand with gold plated lobster style clasp. $10A0 37. 14k yellow ]0.5 mm Mab�pearl earrings. $600.00 38. 14k yellow cluster(eaf shaped earrings each containing four pearls. $'72,0(} 39. 6mm imitation pearl stud earrings. $8.00 40. 14k yellow 7mm ii-esh water pearl earrings;peazl missing in one. $59.00 _ _ _ _ _ _ _ �'�7 _ r ��. ��i 31�i1l�3"C�+�Si1Y�� -� 4?. Une i4k yetiow�ope circle earring weig6ing 13g. �75.t10 43. 18"sterling silver gold plated single link chain with gold plated starfish chann. $18.00 44. 14k yellow street car charm with 18" t4k yellow rope chain. $300.00 -t�. 1-�K�-ellow� 18"S-Link chain stamped°Ital�"with sterlins silver palm tree charnt 5138_00 46. Sterling silver gold plated heart pendant containing three heart shaped 4x4mm g8rnets $81.00 on an 18"sterling silver gold plated single link chain. 47. 14k yellow 16"gold cobra link chain 2 g. $150.00 48. 14k gold"Live,Love, Laugh"charm on 14"broken rape chain.(charm 0.3 g chain $I 50.00 0.4g). 49. 12k gold filled round brooch with prong set oval amethyst. $90.00 50. 3 gold tie tacks. $270.Q0 a) 14k yellow concave oval with 1 approx 2mm diamond. 1.3g b) 1/10 lOk gold filled tie tac w/three simulated rounds. c) l Ok yellow tie tac with two single cut diamonds approx. 1 mm each. 51. 14k yellow 6x4mm ovaI blue topaz stud earrings. $41.00 52. 14k yellow 8x5mm pear shaped blue topaz stud earting with leaf. $99.00 53. 'h pair gotd plated hoops. $2.00 5 - - _ _ I'A i� . � �� _ � ��.�� i�. Goid piated oval abalone sheli earri�gs_ �I2.0(� 56. Sterling silver gold plated cubic zirconia stud earrings. $2�•� 57. Sterling Silver haops with five sky blue topaz baguettes. $35.00 �8. �a"bese m�tat rope c6ain_ S�6_i?C� 59. 18"base metal herringbone chain. $12.00 60. Sterling Silver gold plated 18"box chain with broken clasp. $12.00 61. 14k yellow 18"fine box chain 0.8g with unitation diamond and imitation oval amethyst $105.00 pendant. 62. Base metal bracelet with round foil backs. $12.00 63. Sterling silver"David Anderson Normway"butterfly brooch. $I 50.00 64. Flower brooch stamped"ARTONE","BONE CHINA",and"made in England"with �9.00 base metal pin and catch. 65. Muti-colored oval cab plastic earrings. $6.00 66_ Large base metal love knot earrings with 14k yellow backs. $12.00 67. Sterling silver"Norway"rose enamel brooch measuring 41 mm. $120.00 _ �'n�� r F.:�r�.�:�� , ... . . .7�r�� t. �; '�,..:. J �. 7E�i�3i1�'�'G�.�� '�.7l!#Eii��' �.� '�Q. Stertmg silver leaf bracelet with black ovai mother of pearl. $94.00 ?1. Sterling Silver leaf bracelet with oval turquoise. $99.00 �?. S€eri�Sii�er a�netl�y�t b�c t�az and f�sf�w-�'peari eazt�s. S`'�.�)t? 73. Sterling Silver"Hand&Hammer"tennis player brooch. $��•Q� 74. 20"multicolored tourmaline bead necklace with silver clasp and abalone shell triplet $26.00 earrings. 75. Two-tone base metal triple hoop hearings. $2.50 76_ 24"gold twisted s-link plated chain. $4.00 77. Base metal gold plated ovat hoops earrings with heart and box design. $3.00 78. Gold piated charm holder with gold plated silhouette charms ea.engraved with name $8.00 and date. 79. Two pair of gold plated studs with white simulated stones. (One pair princess cut other $3.00/ea Round). 80. One pair of base metal two-tone studs with simulated colorless stone. $7.00 _ . _ . I=II 1 r �� '��ie�iec�:: � 5�.� �w�� v. . ve �.� , r.. � � �: ��r��paa��s- �"'-flQ �. Yei�hase tnetal scarab style brooch. $8.00 8�. Sierling Silver and gold plated engraved locket. $40.00 8�_ I.a�Qe b�e me�al necB�i�ce��tt��-„'�P�ar st�u��t�on ma��- S8_t�il 86. 1/20 12k gold filled hollow 8mm engraved bangle. �i��fl� 87. Sterling silver 13mm hollow engraved bangle,stamped"A&Z""ST'ER". $120.00 88. Sterling silver cuff bracelet with five turquoise cabochons. $150.00 89. 15"speckled glass bead necklace and matching earrings. $8.00 � � � � 5 � -�_ I , _ . . . _ __ __ _ _ . — � � i � ;: . � �. . R�,'�`�'�,. �'�'�,', �� b�� i � ,�� .a'' I��.�Ili 3i �� I ' ��, � � I i �:�� i� �� ,. i , — }.i�t' � " � � � � 120 �� '�� . $'�ST f� s,�� r � t�� d,� �'� � 6 �"A 4� g Y` � �4��f�' �� _ �:_. .�.r, ,:., ,.. 3 .,„-.. . . „_. , .-�; � l� ��,,)G7G), �C;. .� 3Z S. t t � �,. ::._ <� � �� e� � ''�� f�� "' ' ia �� i , ��: -� ��7�� r � � �. ,- :. �� -� Zll' �� : g �� _��,��' �F�`��`�'�,��s f �'il�^�...; �; E�� , , a, ,�;,,,� � ,� � `�§� �� - c ,..�3 . .��; � . 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I . .. . . . ... _ i iI . ._. .. . . ..... .. . . . .. . � ra, . �-.. . 1 Fi)i � �. � i_ ._----._ ...._.._ ._}. ... _..._ .. .. . :. . .. . . , i � �H S 9 TOTA�.. �-, -a,- ,� _ � Fw-, ,- ; _ F� a 1:�'. rv � � -, �� ` .i 'i-a.ix"_ ... ..mw`d�.. . . r 6 r 9 �A . : +�n •4 !:� � _ _ . _ r�� r' � ' � , �� lI o�� . d% q B C D E �I i I� I $ 1,080.00 I $ 1,08Q.00 1 14K old sea shell bracelet with recei t _ �_ �------- -- 9 ----------p----- ---- ---;----- ' ' ' I 2 14K old!5 sm diamond me�s wedding band with receipt $ 300.00 $ 300.00 J ---- ------ -._. 9 - --------- - - ------- , I 3 14K gold/gamet cluster ring with receipt IK-A $ 210.00 $ 210.00 {------ ---- -- ~- --- -- --- ------ ------------ � ---- 4 14K gold!oval gamet earrings with receipt _ ___ __ _____�� _ $ `�.00 '' $ 48.(]0 � ------ ---_. - -- -- � 5 14k gold/imitation emerald and cz earrings with receipt �J � $ 120.00 I $ 1�0.00 -- - - , ---- - , -�----- ------ -- I 6 18"6mm pearl strand necklace with gold clasp with receipt LK-A _ $ 325.00 �i $ 325.00 -- ---------_ _ --- ------ - -----+--- --�_ 7 14K gold/mabe pearU5 sm diamond enhancer with receipt _ _ J $ 277 50 ; $ 277.50 --- - --- ---- I�--___ � -.,_. 8 gold plated and CZ bracelet with receipt � I $ 24.00 �' � $ 2+4.'0 - ---- -- ----- - --�--- t------ ---- ------- � i - --------- - ------I,� - $ - 75 00 '� $ 75.00 9 14K goldlcz pendant � �._ _-- 10 14K gold double chain charm bracelet with 12 charms I J $ 2,200 00 , $ 2,2010.00 -- -- -- �------ �--._. i 11 14K gold rope love knot earrings _--- _- -------_-- _-_- 6-A---_Y$ _ 192 00 i $_ 192_00�_----_- � 7.00 Ili 12 1985 1l10 ounce gold panda coin with 14K rope holder �B-A___ ' � ��•� I� $ � -- -----------�- i -------- ._. il I 13 antique gold bangle bracelet I K-A $ 119.00 $ 119.00 - ___- _ .. _-- - -_,- ---- 4 --- 9 p --- - ------ -�B-A $ 75.00 ' $ 75.00 _ 14 Citizen uartz watch with white face and old lated weave band I__ __ _ ___ _ __ -------- I , , - - --- ---- -- -- - -- ---�A--- '�-�------�---- ! --_ - 15 14K gold shell pendant 8�chain $ 74.00 $ 74.00 , 16 14K old/diamond Dol hin ndant I K-A I�� $ 210.00 ( $ 210.00 9 --- --p-�-- - --- -----I---------�--- __ ; � � i 17 14K 16"gold rope chain J ' $ 379.00_�_ _ I $ 379.00 _ -------_-- --- -- -- _ ,_. ; ' ', 'i 18 Italy 925 18"gold rope chain - -- - -'K-A-�_$__- 27-00 ; $ 27.00 I --- - � ! ------ ---__ 19 14K gold scarab pendant B-A � $ 135.00 ', $ 135.00 ---- --- --- -_____- _-- --------- ----. --- �---- ! i 20 14K gold sand dollar earrings _�J $ 594.00 $ 594.00 i 21 925 gold plated sterling silver grecian desgn 8mm wide with 2cm hoop earrings �J $ 72.00 ' $ 72.00 -- ____ . �---- --_-- ---- �--- -� � I 22 925 gold plated sterling siNer diamond pattem with 2an hoop eartings J � $ 45.00 ' $ �5.00 __ __ _ �If'� vA• 'b 4 q B C D E , � 23 14K goldlfopaz earrings ';J i $ 327.00 , � $ 327.E)0 - -- - — � -- ---rt_--- -- --- 24 14K gold/rectangular gamet earrings _ IB-A $__239.00�$ _ 239.00 __ ----- --------- --1----- , � 25 14K gold 1.5cm gemstone flower earrings J $ 150.00 $ 15p i)0 I - -- ---- -- ----------- --- -�------- ---__ 26 14K gold engraved Charles boy charm B-A I $ 144.00 $ 144.00 - -----i—--- _._-- ----_ 27 14K gold/blue motheddaughter cameo pendant&18"box chain _ i B-A _ _ � $ 74.00 t $ 74.00 � i --— t -7—__ 28 18k/925 siNer filigree/topaz oval earrings � _ � $ 120.00 - - - - - --- ---�A _ $ 120.00 __--- --- 29 silveN emstone nn _ _ __ _�J __ $ 30.00 '� $ 30.1)0 9 9 - _- ------ i------ -- 30 18"8mm pearl strand with gold_plated magnetic Gasp .1 ' $ 23•00 � $ 2�•1�� -- -- ---- --�---- -- —.�_. �I I 31 1T'8mm pearl strand necklace with magnetic clasp J $ 23.00 I $ 2�.1)0 ----------- -_ ----- ----- --- -------I------- 1 _--- —�-- � i 32 14"fresh water double 3mm pearls strand with 3 single 6-9mm pearls/siNer chain 8�Gasp IJ �� $ 24.00 ! $ ��•�� , _--- - -- --- ----rt------ -----—F---._ I--- I 33 14K gold/6mm pearl with diamond pendant and 16"italy flat gold chain _I�-A_ �$ 150.00� $ 150.00 ----- __ - --.._ _-- I- I ------- 34 16"14K gold fine rope with 11 8mm pearls... clasp attached but is broken �,J $ 160.00 I $ 1�i0.f)0 ---- -- -�--- (---- --------- --__. g pearls"hu s and kisses' bracelet _ _ _ __ _ _ B-A __ $_ 540•00 35 7"14K old/11 8mm -_g-- $ `�0.� -_._. ------ ---- � -�- � _--- 36 7.5" 6mm imitation pearl strand bracelet II J (� $ 10_00� $ 'M(�.��0 -- ----------------- +-- - --- -- ----- , , 37 14K gold/1.5 cm Mabe pearl earrings �K_A___ � $ 600.00 �I $ 600.00 ----- ---- -__.- ---- i , — - E � �'� 38 14K gold 4 pearl Guster leaf shaped earrings __ ;B A_ �� $ _ 72•00 _$ 72•00 ---- - ---._.. i ' 39 6mm imitation pearl stud earrings iJ I $ 8•00 ' $ k3.{�0 ------ ---- ------ i -- - _.- __. � �----_.. i � 40 14K pearUgold earrings... pea�l missing on one IB-A I $ 59.00 i $ 59.00 - - - - ------i---�------ --- �- 41 14K gold sm sand dollar stud earrings J II_� 35.00 $ ��i.00 42 one 14K gold rope circle earring � I� $ 75.00 $ 75.!JO --- - ---- - - --._ i -�-------- --- � i 43 18"gold plated sterling silver chain with gold plated stafish chaRn _ ___ _ _J ,I $ 18.00: _ $ 18.t�0 - - - � —__ . 44 14K gold street car charm with 18"14K gold chain �J � $ 300.00 $ 3�b.I�O . - ..__ . —.__..__.. . . -_—.___ ,1_. _ _ rn� ,. , � - q B C D E i i 45 14K sterling silver palm tree chartn withl8"gold Italy chain �J $ 138.00 $ 138.00 ----------- --_-- ---- -- --. -�--- i �, � � 46 18"gold plated sterling silverchain with 925 heart/r�ed gemstone pendant �J _ i $ 81.00 ____�$ 81_QO _ �- � � � i 47 16"14K gold flat chain 'J $ 150.00 i $ 1�Jd_UO --------- ---- -- � -- -- --- -t t-- � I 48 14K gold LIVE,LOVE,LAUGH charm on 14"14K chain... chain is broken _ _ J _ $ 150.00 � $ 15Q.C/Q - ---�- +------ - - 49 14K gold filled/amethist round brooch J $ 90.00 I $ 9d.U0 -- ---- --___ _ -- ----- - �--- ------- �------- _ - --,_ 50 3 gold tie tadcs with 1,2 and 3 sm diamonds __�J $ 270.00 I $ 27Q.U0 ----- _ ----- � 51 14K gold/blue gemstone stud earrings _ _ _ _ _ __ _�J_ $ 41_00 i $ 4'�.00 ---- - -_ - - i-- --__.. 52 14K gold leaflblue teardrop gemstone stud earrings 'J $ 99.00 ! $ 9�.00 -------- --- - --- ----�------ -�--- � - - ---.._. 53 1 gold plated hoop earring iJ $ 2•00 i $ �•�)0 54 gold plated fratemity key _ �J $ 12.00 ' $ 12.00 _- --- - - -�--- ------�_------ � i ! - - - -+---- ------ + $ 12.O0 55 gold plated oval abalone shell earrings _ J $ 12.00 I _ _ _ _ � I 56 sterling silver gold plated/cz earrings J $ 24.00 II $ 2�.O0 ---- -- - - -------- ------ --- -- i -- ----_ 57 sterlings silveN5 blue topaz eamngs IIJ $ 35.00 $ 3�.00 ----------- -____ __....------ -- --- ---�----- ..--..-- ----. __ �__------ -__ 58 30"rope necklace - ----.�J-- --- $-----6.00 ! $ �r.O0 - -- ---- - � ___ ; T 59 18" 4mm flat necklace ---- --------!K-A $ 12.00 � $ 12.00 --- -------- - -- --�-- -- � --__ 60 18"italy sterling silver gotd plated box chain with broken clasp J � $ 12.00 I $ 1�.f)0 --- - ---- -- �- 1-------- --�---- 61 18"14K gold chain with 7 fiinestone/imitation amethyst oval pendant K-A I $ 105.00 $ 105.00 - - --- -- ---�------ --- ---- I � � 62 base metal bracelet jJ $ 12.00 � $ 1�.G10 ----- -------- -------�--- ----- --- ----- j 63 David Anderson norvvay sterling butterfly brooch !J ' $ 150.00 '. $ 150.C10 64 Artone bone china brooch IJ $ 9.00 ' $ Q.ClO - --- ------ -- r-- -----... + __--- �_ 65 oval mutti colored stone earrin s _ _ �J_ _ _ $ 6.00 �'i ___ $ �.00 9 ----- _--- -- ------ +--- ----- i� '', 66 gold large love knot earrings with 14K badcs �J � $ 12.00 � $ 1�.00 -- _ - �_.__ . ____. _ __ _ � � .- . . A B C D E 67 4 cm norvway sterling rose enamel brooch iJ $ 120.00 �; $ 120.(JO --- - - --- - ------i--- - - i 68 SilverJturquoise ring J $ _41.00 �i $ 41_C10 - --}------ --j_--- 69 metaUimdation turquoise 4cm disc pendant __ ______ J__� $_ 6_00� _ � $ $ 6.00 - - -- - -- ---�--._. 70 silver leaf!biack mother of pearl stone bracelet J I $ 90.00 I $ 90.00 71 silver leaf/turquoise bracelet J $ 99.00 $ 99.�0 72 925 chine silver gemstone/pearl earrings J $ 23.00 �23.O0 -- - --- - - ----- ------ -- I� 73 sterling silver hand hammered tennis player brooch _ _ _ _ _ J _ � $___ 24A0 _ _ _� $ 2�4.�0 � ; 74 20"multicolored stone necklace with sitver clasp and matching earrings J �$ 26.00 ; $ 26.t)0 - ----- ------ - ------- ---- ----- _--------fi--._ _ i --- -- --- - I - �$ 2.� �------f-$ �.:)� P P _..-9-----___---- --- - -- -- ---}- ------ - -- __. 75 tn le hoo metal earrin s �� i j I ! � 76 24"gold plated chain I J ! $ 4.00 � I $ ��.��0 -------------- - ------ -- --- --- ---+--._ -- -�---�---_-----�--- i I �I j I 77 oval heart and box filigree earrings �J - , $ -- 3.00� ---- --- --�, $ 3.O0 ---------- ----------- - ----- - ------------ - i __ I _ _ 78 gotd plated charm holder with 3 charms ;�J $__ 8.00� li $ �3.O0 . � -------- - � �- - I P Q 9 P � 9 _p 9 P 9 J $ 6.00 � $ 6.00 --- - -�----a ------- _ 79 1 r.S uare old lated/rhinestone eamn s and 1 r.Round old lated/rhinestone earrin s � --�- , --. �, � ' � 80 1 pr. round rhinestone earrings �J ' $ 7.00 � $ 7.9�0 ----------- -------- --- --- - - -�-- --- ' i I 81 1 pr.Gold.plated 6 rhinestone flower pattem earrings _ K-A � $ 5.00 ' $ 5.00 i -- I -�----�---- '-;- � I � 82 1 pr.Gold plated/1cm imRation pearl stud earrings (J � $ 2.00 � $ 2.fl�0 - --- - -- -------------f- -----�--------- � -------1----- � I 83 3 scarab brooch J ; $ 8.00 ! $ 8.�0 ------------ - _ ----- - - - �- - ---- a __. � , I ' 84 sterling siNer engraved lodcet J � $ 40.00 '' $ 40.00 -- ------- __---------- -------------- --- ------ ----�-- 85 Mexico 5cm imitation turquoise teardrop/copper metal nedclace J $ 8.00 $ �3.1)0 86 8mm antique 1/20 12k gold bangle bracelet K-A $ 15.00 $ 15.00 ---- -__--------- - - --_---- ------ - --- ,_. � i � 87 13mm sterling silver bangle bracelet J $ 120.00 � $ 12U.i)0 -- - -------- - -- --- �_---- '� ! , 88 5 oval turquoise stone/sterling silver bracelet I J $ 150.00 �i $ 1�(3.l)0 _ _ ____. ��'i , .� ,, , A B C D E 89 15"spedcled glass beaded necklace and matching earrings __ _ �J _ $ _ 8.00+ $ _ $_O0 --- � � 9 9 9 -- -------+� $ 3,900.00 � $ 3,900.00 -- -- --- -- 9 diamond solitaire en a ement nn _ � It_____ I II 91 four diamond ladies wedding band �-A $ 1,900.00 I $ 1,900.00 --------- --- ------ - --------- - ---t-_---- -_ I 92 14K gold wheat necklace J � $ 1,100.00 I I $ 1,10Q1.U0 ----- --- ---- ----- - – –— –t-------— – 93 I $19,253.00 $,A,649.00 $ 9,6q�4.Q0 ---- --- _ __ -- --- �---�—_;._ -------- �-----_- — , � ` , 94 � r� � Amber � Jim ---- — - ----- —i---- �__---— f � � � ; 95 � ( � --- -------_------ ° � - ------ - - ------- ---- ' .. � �, i _� 96 � ------- ---------�-- --___----r-----{---- �__._ 97 � ------- ----- --- ------ -----. ____-___--__ -- — --- _-----�---- i i gg � ----- ----_ -___------- -— -- --------------- I ( i ! 99 — -- ---—------------ - --,I�---_ I---- i _ ---- i -----_----------- - � -- -- 100 � - , }--�----_ 101 I � ---. ----- ___. __ __-_------- -- �----- --__ ;___------- ---_. 102 _ _ _ � . � 1@124f2012. 14:29 7175822� TRF � PAGE 02/13 � � T �=LL .OF TI�EI+M7� $• �NSF�� p I, THFsLMA �• �ENS�AW. of the County of Erie and Commonweal�h of Pennsylvania, declare ,.,.this �o be my Last W�I1, hereby revoking a11 prior wi�l.s and codiciJ.s. �RT�CLS FIR.$T � A7.1 e�tate and inheri�ance Caxe� (i.nclud3ng �ntexest and pena3ties, if any) , together with a17. adm�nistration expenHes, payable in any juri9diction by �eason of my dea�h (including those taxes and expent�e� payable with reapect to asse�.g which do not pass under this Wi3I) sha11 be paid out of and chazged generally agaiz�s� the principal of my residuary e�tate, without apportianment . � waive any' right of reimbursement tor, recovery o�, or contributian towa�d the p�yment of thoae tiaxes and administzation exper��es, except my executor aha11, to the max.imum extent permitted by 1aw, seek reimbursement �or, recavery of, vr contribu�ion toward the payment of Federal or state estate ta� a�t�ributable to property in which z have a qualifying income a.ntereat for li�e, over which I have a power of appointment, or wh3ch i� included in rr�Y 9rQ�s e$ta�e by reagon of Section 2036 (c) of the Interna� Revenue Code of �.986, n� from tiime to time amended ("Code") , and which tax ie not . otherwise paid or payable. _ _ _ _ . _ _ FA 7 10124/2012 14: 29 7175822� TRF � PAGE 03/7.::i , �. ARTICL� SSCOND A. I giv� all the tangib�e personal property that I own at my death, �nc�uding any household �urniture and furnishings, automobiles, books, pictures� jewelry, art.�objects, hobby equxpment and collectians, wearing appare7., and other articles of household pr pe]G'sonal uae or orilattlent, to my husband, RICHARD C. HEI�SHAW, if he is living on the tha,rtieth day after the date of my death ar, if my huaband i.a not Ghen living, then unto ou�h oF my rhildrere who are liv�ng at �he ti�►e of nty death, namely, AI�BER SLIBAN THIffi�{ANN . and Jp,MES C. LUND, as they shall agree. ARTICI��II� I give, deva��e and bequ�ath a11 the reat� res�due and remainder o� my estate, real and pergonal, unto my huaband, RICFiARD C. HII3SHAW, i.f he is living and if he �s nat living, then as foll.ows: A. Fifty (50�) per cent �hereof unto my daughter, AMBER SUSAN THIEMANN, if she is liv�.z�g, and if she is not living, then unto her iasue, per stixpe�, and if she leavea no isaue surviving, then unto my iseue, per stirpes. B. Fifty (50�) per Cent thereof unto my eon, JAMES C. LUND, if he is living, snd if he is r�ot living, then unto his �.saue, per e�irpes, and if he leaves no iseue �urviving, then unto my issue� per sti�C'pes. 2 . _ _ _ _ _ �I`lu"f 1Nl24/2012 14:29 7175822� TRF � PAGE 04/I.;; . .�r' . d� , ARTICLL FOIIRTH � Zn addition to the powez�e given �hem by �aw and by the other provisiona of this my Last Will, my personal repre�entative sha11 have the �ollowing power�, appJ,a,cable ta all property held by them� efifective without court order and uz�t�.l actual distri.bution: A. To ee�.1 at public or private sale, to exchange ox to lease €or any period of time, any xeal or p�rsonal pxoperty, and to give options for sa�les, leases or exchanges for such price$ and � upon such �erms and conditions that Chey deem proper, without liability on the purchaser� to aee to the applicatio� of th� purchase tnoneys. H. To campro�li�e controversies. C. To distribute �n cash or kind or part7.y in each. ARTIGLE P'�FTH I nominate and appo�.nt my husband, RICHARD C. HENSHAW, to be the Executor of this my Last Will and Testar�ent . zn the ever�t my husban�d, either at the time of my death or thereafter, shall be unable or unwi�ling �o act for any reason, � nominate and appoint my daughter, AMSER SUSAN THIFsMA1+Y1�T, �e Executrix o� thi� my Last Wzl�. and Testament. No personal representat�v�e acting hereundex shall b� r�quired to post bond o� enter Becurity in any �uriadiction. 3 -- --- - ��r _- --- _ _ --T-- - 1@/24l2612 14:29 71758222= TRF PAGE 05�1:' .� -- --. ___—�. � - -- -.�` - , � �,•. �f IN i�i�TNBSS T�THBREOF, I, THBI�MA F. H�iSHAW, have he�e�n�o f� ' �. set my hand and seal on th�.s the (� � day of �'uly� 200Z. � � (�LJ Thea.me� S. �ienshaa� `. Signed, sealed� publish�d and declared by the above named Te9tatrix, THELMA E. HENSHAW, as and �or hez Last wi],1., in the presence of us, Who, at her request, in h�r px�s�nce and in �h� presence of each oth�r, have here�znto subacrib�d our names as Witnes�es. F . t� � 4 _ — _ __ - --r - _ - - _ 1�"1 � 1�1I24/2012 14:29 7175822� TRF PAGE 06l1'; � ✓` , � ACTCNOWLEDGM_�TO SBLF�PROVE WILL We, the witnesses and Testat�ix, whose �ignatures appear be�ow � and whose name�s are signed to the a�tached or �oregoi,ng� in��xument, be�ng du�.y �worn, do hereby declare and acknowledge to �he undexsigned authority: (1) that the said Testatrix signed and � e�c,ecuted sai.d instrument as k�er Las�� Will and Te��ament; (2? tbat she signed willingly; (3) that she executed .iC as her fxee and voluntax'y acC for the purposes �here�n expreesedt (4) Chat eetCh of ,�; ;a� ,.....�, the said witne�ses in the presence and hearing o� the Testatrix and of eaoh other signed as wi�nesses; and (5) that the Testatrix wag at tih� time she signed said Will, eighteen E18) years of age oz° alder, of sour�d mind and undex no constraint ox undue it�fluence. � � � /V � TesCa x � � i ti3ea�s 717 State Stree� �xi PA 1�F5d]. Addre�s � Witness 717 St� Street E ie PA z659:� �,ddx'ess Sworn to and subec�ibed before me by the above aigned Testatr�x and the above signed witn�sses thi� .�� day of Ju1y , 2401 . . Gxi��-' /''� , Notary Qublic � ` NoT/U11f�1.�RA1. d6�11Rr.lINiQ,ibYMr!�� 91E C01�1'�,!�� MIl t�1�i�OC?.1l.�1/