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Home My WebLink About01-0132 Social Security No. 207 - 07 - 5937 PETITION FOR PROBATE and GRANT OF LETTERS No. .2../- 01- I~ Register of Wills County of Cumberland in the Commonwealth of Pennsylvania Estate of GERALDINE A. ORNER also known as . Deceased. To: The petition of the undersigned respectfully represents that: Your petitioner, who is 18 years of age or older, is the personal representative named in the last will of the above decedent, dated October 22, 1998. Decedent was domiciled at death in SOUTH MIDDLETON TOWNSHIP, Cumberland County, Pennsylvania, with her last family or principal residence at Manor Care Nursing Home, Room 140, Walnut Bottom Road, Carlisle, Cumberland County, Pennsylvania 17013. Decedent, then 83 years of age, died January 17, 2001, at Manor Care Nursing Home, Carlisle, Cumberland County, Pennsylvania. Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent. Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: TOTAL $ $ $ $ $ 350.00 350.00 WHEREFORE, petitioner respectfully requests the probate of the last will presented herewith and the grant of letters testamentary thereon. ~4M 5021 Inverness Drive Mechanicsburg, PA 17050 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND The petitioner above-named swears that the statements in the foregoing petition are true and correct to the best of the knowledge of petitioner and that as personal rep~esentati . of the above decedent petitioner will well and truly administer the estate . to law. Sworn to and sub~ibed before me this ~ day of FEBRUARY, 2001. '-JYY1JwtJ. '~'fJU' (iLl..2j/'~ - . ~ Regist;--~ 1& ~ cJ-()1- 6 Estate of GERALDINE' A. ORNER, Deceased 21-01-132 DECREE OF PROBATE AND GRANT OF LETTERS AND NOW. February---3.... 2001. in consideration of the petition attached hereto. satisfactory proof having been presented before me. IT IS DECREED that the instrument dated October 22. 1998. described therein. be admitted to probate and filed of record as the last will of GERALDINE A. ORNER, Letters Testamentary are hereby granted to AMY L. TALBOT. m:tte, ~~) 'I'M ,;1. a. J1C:n~)'iO#~ Reg. ter of Wills ' FEES Probate, Letters, Etc. $ 18.00 Short Certificates 3 $ 9.00 lileDu:uJaHftEXTRA PGS 3 $ 9.00 JCP $ 5.00 TOTAL $ 41. 00 Filed: FEBRUARY 2, 2001 HAROLD S. IRWIN III (ID NO 29920) 35 East High Street Carlisle, PA 17013 717 -243-6090 CALLED ATTORNEY FEBRUARY 2, 2001 c_--~ I --' , . '".",-> , r \.~, : H10).RO') REV {)/R() This is to certify that the information here given is correctly copied fro~ an original certificate of death dul~ filed with Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filmg. me as WARNING: It is illegal to duplicate this copy by photostat or photograph. No. a ./. ..~f /.f(../ Local Registrar Fee for this certificate, $2.00 p 7174922 JAN 1 8 2001 Date .;43 Rev. 2187 COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH NAME OF DECEDENT {hSl. Middle. La&l1 .. GeJr.ald-ine. A. OJtneJr. SEX STATE FilE NUMBER SOCIAL SECURITY NUMBER DAlE OF OEATH IMcnIh. Ca.,. 'oUt) UNDER. YfAR _ Da.. z. fe.male. 3. 207 07 5937 .. 1-17-2001 AGE (l'" BWI_Yl llHDER.DAY Houra Minut.. BIRTHPLACe l.Coty and PLACE ~ DeATH lCt>eck ()I"Ily 1)(\8 u iN: ,nSlrucloOOS on other ~l Slale 01 FCletgf'l Couorry) HOSPItAL: H oke.-6 , P A 1<'1>0'- 0 ER/Ouq)all... 0 oo.r. 0 ,. ... fACILITY NAME (It not InsfltullOr'. grve slreet and I"IUrTlberl ='YIO 83 v... COUNTY OF OEAJ'H RACE . Amencan lndian, Black, Whit.. etc. (_I ... CumbeJr..ta.nd DECEDENT'S USUAL OCCUP.cr1ON (~-=:~"=':::':l.:'r 11L Home.ma.keJr. 111t. - -- -- - - - - - -- - - - -- DECEDENT'S MAIl.ING ADORESS (SIl.... CCyIbwn. _. Z", lMMl DECEDENT'S 940 Walnut Bottom Road ~~~ CaJll.i.6te., PA 17013 ~~ 10. Wh-i.te. CumbeJr..ta.nd OKI - IIWIn. --'" 11...0 :::=':::0' MOTHER'S NAME (FIISI. Md<SI. MaJden Sufname) It. Ma.Jt Le.e.-6e. HOJt-ic.k INFORMANT'S loIAIUNO ADORESS (SIr.... CoIyIbon. SIoIo. Zip lMMl Z~. 5021 InveJr.ne.-6-6 VJt-ive., Me.c.ha.n-ic.-6buJt ,PA 17050 PLACE OF DISPOSITION. Nomo 01 C_OIY. Cromalofy LOCATION. CiIyI1Own. StaI.. Z.. ~ ..OIhofPlo<:. CJte.ma.Uon SOc.-ie.ty o P A CJt e.ma.tOJt NAME AND ADORESS OF FAClLITY 22<:. 4100 Jone.-6town LICENSE NUMBER MARtTAL SToCrUS._ Newer M...ied, WkIowed, o_tspec;'YI ... V-ivOJtc.e.d .7..0 .....__in SURVIVING SPOuSE I"...... QlYetnall:lennam81 17.. Slate ..... 'lb. Ca.Jt.t-i-6Ie. - c~~~~t~~J c...::.. ~j... - 0> DUE 10 COR AS C E Of)o ~'L-A w...l,...h fV'u\. ~ I : L DUE 10 (OR AS ACONSEOUENCE Of)o WERE AU10PSV FtNDINGS YANNER OF OEATH _lAllLE PRtOR 10 COMPLETfON Off CAUSE ~ 0 OF OE.Q"H? ......... Hom~ Ace..... 0 Pendtng Inv..lIgation 0 No SuickIo 0 Could noI be deltlrmrned 0 DATE OF INJURY (Monlh. Day. 'fear) llUE OF INJURY INJURV oCr WORK1 DESCRIBE HOW INJURV OCCURRED. .... 0 NoD M, 3Oc, z.... ClRTIFIEA ICheCk DRy one) .CERTWYING PHYSICIAN (Physaclan CetllCytng cauM (:J <>>alh when.JnOlhef phVSiC.an has pronounced death ana completed Ilem 231 Tothe........y knowledge, .athoccuned .... etw cauM{,) and manner.. .talted. ...................................,. 2tI. PlACE OF INJURY. AI hamil, farm. sueel. ladoty, omee buikling. Me:. ISpeclM 300. o .PAONOUHCING AND CERTIfVlHQ PHYSICIAN (Phy5lC.an bOth pronouncing "ealh and cer1dytl"lC}lOcause 01 de.lh\ To the blMl of my knowtedQ., death occwrecla' Ihe lime, da'e,,1nd place, and due to the uUH(a) and mann.'.. .,.Ied.. .MEDlCAL EXAMINER/CORONER ~an";:. ~:~::=~~~~t,I~~.'.~o.: ~~~~~t~~~t.~~: in ".'.y. ~~i.n.i~~: ~~:~~ ~~~~~~~ ~~ ~~~ ~I~~,.~~t~: ~~~.~I~~~: ~~~.~~~ ~~ ~~~ ~~~~~~).~~ 0 31.. REGIS~~. SSIGNATUR~U~ U::".~ /'( l";7~ 1.2L II~II' I 3.. 1101) 21-01-132 '.; J !{'\ ",:.:J ..:.." f -~ lr,~. .. 21-01-132 LAST WiLL AND TESTAMENT I, GERALDINE A. ORNER, of the Manor Care Nursing Home, Room #140, Walnut Bottom Road, Carlisle, Cumberland County, Pennsylvania 17013, do hereby make, publish and declare this to be my last will and testament, hereby revoking all wills heretofore made by me. 1. I direct my personal representative to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. I direct that all inheritance taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property, whether or not such property passes under this Will, shall be paid by my personal representative out of my estate. 2. I authorize and empower my personal representative to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My representative is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said representative. 3. I give, devise and bequeath all of my estate of whatever nature and wherever situate as follows: A. To Amy L. Talbot: my Shearson Lehman Portfolio; B. To Kym Rice: my diamond dinner ring, all my clothing and $5,000.00; C. To Wally C. Rice: any automobile I own at death and its contents, my mattress and bedspings, my two televsion sets, my electric blanket (given to me by Wally) and $5,000.00; D. To Jo Rice: all my silver jewelry and $5,000.00; E. To Linda Brymesser: my blue topaz ring and my winter coat; F. To JeffHorick: Grandpa Horick's comforter. 4. The rest, residue and remainder of my estate, both real and personal property, of whatever kind and wheresoever situate to my daughter, Amy L. Talbot, if she survives me. 5. I nominate and appoint my daughter, Amy L. Talbot to be the personal representatives of my estate, to serve without bond. 6. I suggest that my personal representative retain the services of Harold S. Irwin, ill, Carlisle, Pennsylvania in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this .:J02-cl.nay of October, 1998. AAA<k-I;:', ~[) 4' ,,/ Geraldme A. Orner (SEAL) Signed, sealed, published and declared by the above-named person as and for a last will and testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. ~/f/.lo,. qf. /3.pi/yU6 ACKNOWLEDGMENT AND AFFIDAVIT WE, GERALDINE A. ORNER, JOHN J. BARANSKI, JR. and REA THER A. BARBOUR, the testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as a witness and that to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. JO J. B NSKI, JR. ~u/.it~ ~ ~CU< REA THER A. BARB UR COMMONWEALTH OF PENNSYLVANIA :ss: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by GERALDINE A. ORNER, the testatrix herein, and subscribed and sworn to before me by JOHN J. BARANSKI, JR. and REA THER A. BARBOUR, witnesses, this 'Z l.-ru(day of October, 1998. Notarial Seal Harold S. Irwin III. Notary Public Carlisle Bora. Cumberland County My C0.;nmission Expl'es Sept. 23. 2002 . Memoer, t'ennsylvaroi8 Association ot Notanes r I~ CERTIFICATE OF NOTICE UNDER RULE 5.6{!tl Name of Decedent: GERALDINE A. ORNER Date of Death: JANUARY 17, 2001 Will No. 2001-00132 Admin. No. 21-01-0132 To the Register: I certify that notice of beneficial interest or estate administration required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on August 11, 2001. Name JO F RICE Address 511 S WEST ST APT A CARLISLE PA 1703 KYM J WHITE 1491 COUNTY RD #30 SCOTTSBORO AL 35768 WALLACE C RICE 140 AMITY RD BIGLERVILLE PA 17307 LYNDA A BRYMESSER 310 LONGS GAP RD CARLISLE PA 17013 JEFFREY HORICK 1914 DOUGLAS DR CARLISLE PA 17013 AMY L TALBOT 5021 INVERNESS DR MECHANICSBURG PA 17050 Notice has nQw been given to all persons entitle thereto under Rule 5.6(a) except: None August 11 ,;~001 HAROLD S. IRWIN, II, ES IRE 35 East High Street, . 201 Carlisle, PA 17013 717 -243-6090 Attorney for Estate of Geraldine A. Orner ~ SENDER COMPLETE THIS SteeTION COMPLETE THIS SECTION ON DELIVERY . Complete Items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desir'ed. . Print your name and address on the reverse so that we can return the card to you. . Attach this card to the back of the mail piece, or on the front if space permits. 1. Article Addressed to: H~ S.~-nr 35 _~~ \-\ l~ Jt. ~ ;;JD\ ~ ~.V10~3 A. Received by (Please Print Clearly) S: Date of Delivery ~~/~ ~() x D. Is delivery address different from item ? If YES, enter delivery address below: 3. Service Type Q"Certified Mail D Registered D Insured Mail D Agent D Addressee Dyes G1Ifo' D Express Mail D Return Receipt for Merchandise DC.a.D. 4. Restricted Delivery? (Extra Fee) 2. Article Number (Copy from service label) ([XX) OwOO oms l5'14 <::13blr PS Form 3811, July 1999 Domestic Return Receipt " Dyes 102595-99-M-1789 .. '. ~ c:o L/'J m lr -- u.s. Postal Service CERTIFIED MAIL RECEIPT (Domestic Mall Only; No Insurance Coverage ProvIded) .::r lr L/'J r-"I L/'J ru c:J c:J I I Postage $ Certified Fee Postmark Return Receipt Fee Here (Endorsement Required) Restricted Delivery Fee (Endorsement Required) Total Postage & Fees $ c:J c:J -D c:J ~B~rr:~~ ~~_~rint C_e~~/Y) (fo _~~_~~~~~~_~J~a&~____________________ c:J Street, Apt. No.; or Box No. ~ _ _ _ _ __ __ no _ _ _ __ _ __ __ __ _ __ __ _ _ __ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _Q_~ _= _ J_ _3_~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ I"- City, State, ZIP+4 I) I (I I I (I f, ('I III filL S\~f Ri-'verse for Instructions .. -. " .. . . nID/.kme 3(3, 1992/17858 JUN 1 2 2001 ~ Estate No.: 21-01-132 ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA In Re: Estate of Geraldine A Orner Late of South Middleton Township NO. NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT ORPHANS' COURT RULE Personal Representative: Amy L. Talbot Counsel for Personal Representative: Harold S Irwin III Esq Date of Grant of Original Letters: February 2, 2001 Date of Delinquency Notice: May 12, 2001 The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court Orphans' Court Rules, was given by the Register of Wills on May 4,2001, and that the ten (10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e) the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: June 11, 2001 ~. Distribution: Personal Representative Counsel for Personal Representative Estate File 1\ ...JID,}ff1 A hearing is scheduled for w-r at q;~ in Courtroom No.3. filed prior to the hearing date, the hearing will automatically be If the Certification of Notice is . I d. Q(. .Q\ \.e-.6 ~- 1 ~- 01 *' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG. PA 17105-8486 May 18, 2001 HAROLD IRWIN SUITES 201/202 35 E HIGH STREET CARLISLE PA 17013 Re: GERALDINE ORNER CIS #: 450147751 Co/Rec: 21/0087460 Date of Birth: 07/07/1917 SSN: 207-07-5937 Dear Attorney Irwin: Please be advised that the Department of Public Welfare maintains a claim in the amount of 823.780.98 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's itemized statement of claim. A portion of this medical expense, namely 811.971.25, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely 811.809.73, is to be entered as a priority Class 6 claim against the estate. Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. ~f the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a currant appraisal, if available. Sincerely, l~~.~ Carl G. Rinkevich TPL Program Investigator 717-772-6258 717-772-6553 FAX Enclosure Inventory of the real and personal estate of GERALDINE A. ORNER, deceased I 1. PNC BANK - Checking Account No. 51 - 4036 - 5506 1,229 78 2. MANOR CARE - Nursing Home Refund 954 27 3. VARIOUS ITEMS OF PERSONAL PROPERTY 2,500 00 r TOTAL 4,684 05 COMMONWEALTH OF PENNSYLVANIA: :ss: COUNTY OF CUMBERLAND AMY L. TALBOT, being duly sworn according to law, deposes and says that he is the executor of the estate of GERALDINE A. ORNER, late of South Middleton Township, Cumberland County, Pennsylvania, deceased, and that the within inventory made by her, the said executrix of the entire estate of said decedent, consisting of all of the personal property and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the inventory represent its fair value as of the date of decedent's death. -7.. tH: Sworn to and subscribed before me - - (~~ Z ay of August, 2001. AM\ 1__.fALEI -- Executrix Notarial 'aal Harold S. Irwin III, otary Pub!" Carlisle Boro, Cumber nty My Commission Expires Sept. 23. 2002 Member, pennsylvan;aiTcialiOn ot Notaries Date of Death: JANUARY 2001 Day Month Year INSTRUCTIONS 1. An inventory must be filed within three months after appointment of personal representative. 2. A supplemental inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty. 4. See Article IV, Fiduciaries Act of 1949. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE 1b--dt/7--5 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISIDN DEPT. Z8060l HARRISBURG, PA 111Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 10-22-2001 ORNER 01-17-2001 21 01-0132 CUMBERLAND 101 HAROLD S IRWIN STE 201 202 35 E HIGH ST CARLISLE III PA 17013 , )'~* REV-1547 EX iFP 112-QDl GERALDINE A Allount Relli Hed MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ii"EV=i54"j-EX-AFP-li'2=oOY-NClficE--OF-YNHERiTANCE-YAX-APPRAisEMENT-,--ALLOWANCE-oi----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF ORNER GERALDINE A FILE NO. 21 01-0132 ACN 101 DATE 10-22-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets ) CHANGED ll) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 4.684.05 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax 1,532.00 23.780.98 (11) ll2) ll3) ll4) (9) llO) NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 4.684.05 ?1i.31? 98 20,628.93- .00 20,628.93- NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate .00 16. Allount of Line 14 taxable at Lineal/Class A rate .00 17. Allount of Line 14 at Sibling rate .00 18. Allount of Line 14 taxable at Collateral/Class B rate .00 19. Principal Tax Due .00 TAX C DITS: PAYM NT REC IPT D SCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: Estates Df decedents dying Dn Dr befDre Dece.ber 12, 1982 -- if any future interest in the estate is transferred in pDssessiDn Dr enjDy.ent tD Cless B (cDlleteral) beneficiaries Df the decedent after the expiratiDn Df any estate fDr life Dr fDr years, the CD.aDnwealth hereby expressly reserves the right tD appraise and assess transfer Inheritance Taxes at the lawful Class B (cDllateral) rate Dn any such future interest. PURPOSE OF NOTICE: TD fulfill the requireaents Df SectiDn 2140 Df the Inheritance and Estate Tax Act, Act 23 Df 2000. (72 P.S. SectiDn 9140). PAVMENT: Detach the tDP pDrtiDn Df this NDtice and subait with YDUr pay.ent tD the Register Df Wills printed Dn the reverse side. --Make check Dr aDney Drder payable tD: REGISTER OF KILLS I AGENT REFUND (CR): A refund Df a tax credit, which was nDt requested Dn the Tax Return, aay be requested by cD.pleting an "ApplicatiDn fDr Refund Df Pennsylvania Inheritance and Estate Tax" (REV-13l3). ApplicatiDns are available at the Office Df the Register Df Wills, any Df the 23 Revenue District Offices, Dr by calling the special 24-hDur answering service fDr fDres Drdering: 1-800-362-2050; services fDr taxpayers with special hearing and I Dr speaking needs: 1-800-447-3020 (TT Dnly). OBJECTIONS: Any party in interest not satisfied with the appraiseaent, allDwance, or disallowance of deductions, Dr assessaent of tax (inclUding discDunt or interest) as shDwn on this Notice aust object within sixty (60) days of receipt of this Notice by: ADMIN- ISTRATIVE CORRECTIONS: --written prDtest to the PA Department of Revenue, BDard of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the aatter deterained at audit of the account of the personal representative, OR --appeal to the Orphans' CDurt. Factual errors discovered on this assess.ent should be addressed in writing tD: PA Depart.ent of Revenue, Bureau of Individual Taxes, ATTN: Post Assesseent Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions fDr Inheritance Tax Return fDr a Resident Decedent" (REV-150l) for an explanation Df adainistrativelY correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar .Dnths after the decedent's death, a five percent (5%) discount Df the tax paid is allDwed. PENAL TV: The 15% tax a.nesty non-participation penalty is cDeputed on the total Df the tax and interest assessed, and nDt paid before January 18, 1996, the first day after the end of the tax aanesty period. This non-participation penalty is appealable in the sa.e .anner and in the the saae tiae periDd as YDU would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is Charged beginning with first day of delinquency, or nine (9) .onths and one (1) day froe the date of death, to the date of paYBent. Taxes which becaae delinquent before January 1, 1982 bear interest at the rate Df six (6%) percent per annua calculated at a daily rate of .000164. All taxes which beca.e delinquent Dn and after January 1, 1982 will bear interest at a rate which will vary frD. celender year to calendar year with that rate announced by the PA Departaent of Revenue. The applicable interest rates fDr 1982 thrDugh 2001 are: Vear Interest Rate Daily Interest Factor Vear Interest Rate Daily Interest Factor 1982 20% .000548 1992 9% .000247 1983 16% .000438 1993-1994 n .000192 1984 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 n .000192 1986 10% .000274 2000 8% .000219 1987 9% .000247 2001 9% .000247 1988-1991 11% .000301 --Interest is calculated as follDws: INTEREST = BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any NDtice issued after the tax beco.es delinquent will reflect an interest calculatiDn tD fifteen (15) days beYDnd the date of the assess.ent. If pay.ent is aade after the interest cD.putation date shDwn Dn the NDtice, additiDnal interest Bust be calculated. K S-c. STATUS REPORT UNDER RULE 6.12 Name of Decedent: GERALDINE ORNER Date of Death: JANUARY 17, 2001 Will No. 01 21 -.0&- 0132 01 Admin No. 21-96 - 0132 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above- captioned estate: 1. State whether administration of the estate is complete: Yes ~ No__ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No ~ b. The separate Orphans' Court No. (if any) for the personal representative's account is: N/A c. Did the personal representative state an account informally to the parties in interest? Yes ~ No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this port. Harold S. Irwin, III Attorney for Estate January 22, 2002 "'" 0;: 35 East High Street Carlisle, PA 17013 717 -243-6090 ..-- ...- c::: M N z a:; ..., ,'"~ '.-"q"., ',.) l,,~),1 n c; me: cr:. ~ .. .6 c~ Q.>= 0(5 REV-1162 EX(11-96) COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 003342 RECEIVED FROM: IRWIN HAROLD S III 64 SOUTH PITT STREET CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER _____n_ fold ---------- -------- 101 I $3,521.50 ESTATE INFORMATION: SSN: 207-07-5937 I FILE NUMBER: 2101-0132 I DECEDENT NAME: ORNER GERALDINE A I DATE OF PAYMENT: 12/19/2003 I POSTMARK DATE: 00/00/0000 I COUNTY: CUMBERLAND I DATE OF DEATH: 01/17/2001 I I TOT AL AMOUNT PAID: $3,521.50 REMARKS: HAROLD S IRWIN III ESQUIRE CHECK# 8471 INITIALS: SK : ; SEAL -~ RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS , . .. '. ~, Supplemental Inventory of the Real and Personal Estate of GERALDINE A. ORNER, deceased ~/ 1. PNC BANK - Checking Account No. 51 - 4036 - 5506 1,229 78 2. MANOR CARE - Nursing Home Refund 954 27 3. VARIOUS ITEMS OF PERSONAL PROPERTY 2,500 00 4. 1,120 SHARES DANAHER CORPORATION COMMON STOCK 88,883 69 -- TOTAL 93,5657 74 ~~--... 4-" . COMMONWEALTH OF PENNSYLVANIA: :SS: COUNTY OF CUMBERLAND . . AMY L. TALBOT, being duly sworn according to law, deposes and says that she is the executrix of the estate of GERALDINE A. ORNER late of South Middleton Township, Cumberland County, Pennsylvania, deceased, and that the within inventory made by her, the said executrix of the entire estate of said decedent, consisting of all of the personal property and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the inventory represent its fair value as of the date of decedent's death. "~A' A I Sworn to and subscribed before me _rL 04 I <I' day of December 2003. AMY L l' BOT I . Executrix 17 JANUARY 2001 Date of Death: Day Month Year INSTRUCTIONS 1. An inventory must be filed within three months after appointment of personal representative. 2. A supplemental inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty. 4. See Article IV, Fiduciaries Act of 1949. // BUREAU OF IHDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HAR~ PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX HAROLD S IRWIN STE 201 202 35 E HIGH ST CARLISLE III DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-27-2004 ORNER 01-17-2001 21 01-0132 CUMBERLAND 101 Allount Rellitted '* REY-15~7 EX AFP 101-051 GERALDINE A 779. ~, MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REv=is4j-Ex-AFP-coY:03Y-NoTicE--oF-YNHEifiTANcE-TA';rAPPRAisEifENT~--AiDjWANCE-(fR------------ ----- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF ORNER GERALDINE A FILE NO. 21 01-0132 ACN 101 DATE 01-27-2004 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE PA17013 NO. 01 I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets RETURN U) (2) (3) (4) (5) (6) (7) .00 88.883.69 .00 .00 .00 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) UO) 7.227.82 .00 Ul) (2) (13) (14) NOTE: .00 X 51.026.94 X .00 X 10.000.00 X 00 = 045 = 12 = 15 = (9)= NOTE: To insure proper credit to your account. subllit the upper portion of this forll with your tax paYllent. 88.883.69 7.227 82 81.655.87 .00 61. 026.94 .00 2.296.22 .00 1.500.00 3.796.22 11:1:\;1:.11"1 l+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) INTEREST IS CHARGED THROUGH 02-11-2004 TOTAL TAX CREDIT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 3.796.22 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 504.94 TOTAL DUE 4.301.16 . IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF T REV-1162 EX( 11-96) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 003519 RECEIVED FROM: IRWIN HAROLD Sill 64 SOUTH PITT STREET CARLISLE, PA 17013 ACN ASSESSMENT CONTROL NUMBER AMOUNT nn____ fold ---------+ -------- 101 I $779.66 ESTATE INFORMATION: SSN: 207-07-5937 I FILE NUMBER: 2101-0132 I DECEDENT NAME: ORNER GERALDINE A I DA TE OF PAYMENT: 02/02/2004 I POSTMARK DATE: 00/00/0000 I COUNTY: CUMBERLAND I DATE OF DEATH: 01/17/2001 I I TOT AL AMOUNT PAID: $779.66 REMARKS: -~.-, CHECK# 8644 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS v BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT '* REY-1U7 EX AFP (01-05) HAROLD S IRWIN STE 201 202 35 E HIGH ST CARLISLE III DATE ESTATE OF DATE OF DEATH . FILE NUMBER , COUNTY ACN 01-26-2004 ORNER 01-17-2001 21 01-0132 CUMBERLAND 101 GERALDINE A Allount Rellitted PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REY=ii,'irf-ix-AFP-foY:oiY------...--fNHERITANCE-YAif-ST'ATEMENY-'irF'-ACCouiiT--.-..--------------- - ----- ESTATE OF ORNER GERALDINE A FILE NO.21 01-0132 ACN 101 DATE 01-26-2004 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-27-2004 P R I NC I PAL TAX DUE: ........................................................................................................................................................................................................................... 3,796.22 PAYMENTS (TAX CREDITS): INT AT REV PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-19-2003 CD003342 .00 3,521.50 EREST IS CHARGED THROUGH 02-10-2004 TOTAL TAX CREDIT 3,521.50 THE RATES APPLICABLE AS OUTLINED ON THE ERSE SIDE OF THIS FORM.~ BALANCE OF TAX DUE 274.72 INTEREST AND PEN. 482.85 IE IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 757.57 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT '* REY-1607 EX AFP lUl-U51 Reco: _ .". RfJ~~ . " DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-08-2004 ORNER 01-17-2001 21 01-0132 CUMBERLAND 101 GERALDINE A HAROLD S IRWIN STE 201 202 35 E HIGH ST CARLISLE I II "04 MAR 12 P 1 :47 Allount Rellitted C!~'r~'. e61~~;H: MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ R'EV=i6'ifj-'E1CAFP--foY:oiY------...--iNHERiTANCE-fAX-ST'ATEMENf-oF'-AC-Co[iiiT--...---------------- -- --- ESTATE OF ORNER GERALDINE A FILE NO.21 01-0132 ACN 101 DATE 03-08-2004 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-27-2004 PR I NC I PAL T AX DUE: ........................................................................................................................................................................................................................... 3,796.22 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-19-2003 CD003342 .00 3,521.50 02-02-2004 CD003519 482.61- 719.66 TOTAL TAX CREDIT 3,818.55 BALANCE OF TAX DUE 22.33CR INTEREST AND PEN. .00 It IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 22.33CR SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l Rtov-1500h (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 /6-0207-6--' REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 21 COUNTY CODE SOCIAL SECURITY NUMBER 207 - 07 - 5938 01 YEAR 0132 NUMBER DECEDENT'S NAME (LAST, FIRST AND MIDDlE INITIAL) ORNER, GERALDINE A. DATE OF BIRTH DATE OF DEATH JULY7,1917 JANUARY17,2001 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (lAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER -1L 1. Original Return 4. Limited Estate _ 2. Supplemental Retum 3. Remainder Return (dates of death prior to 12-13-82) 5. Federal Estate Tax Return Req l 6. Decedent Died Testate (Attach copy of Will) EX. A 9. Litigation Proceeds Received _ 4a. Future Interest Compromise (for dates of death after 12-12-82) _ 7. Decedent Maintained a Living Trust (Attach copy of Trust) _ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 8. Total No. of Safe Deposit Boxes 11. Election to tax (Sec. 9113(A)) (Attach Sch 0) NAME HAROLD S. IRWIN, III TELEPHONE NUMBER 717 -243-6090 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages and Notes Receivable (Schedule D) 5. Cash, Bank Dep & Mise Personal Property (Sched E) 6. Jointly Owned Property (Schedule F) 7. Transfers I Misc. Property(Schedule G) (Schedule L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Sched H) 10. Debts, Mortgage Liabilities & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests (schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 15. Amount of Line 14 taxable at the spousal rate 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax due COMPLETE MAILING ADDRESS 35 EAST HIGH STREET, SUITES 2011202 CARLISLE, PA 17013 (1) OFFICIAL USE ONLY 0.00 (2) 0.00 (3) 0.00 (4) 0.00 (5) 4,684.05 (6) 0.00 (7) 0.00 (8) 4,684.05 (9) 1,532.00 (10) 23,780.98 Decedent's Complete Address: " .. STREET ADDRESS MANOR CARE NURSING HOME WALNUT BOTTOM ROAD CITY I STATE I ZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 18) (1) $ 2. Credits f payments A. Spousal Poverty Credit B. Prior Payments C. Discount $ Total Credits (A+B+C) (2) $ 3. Interest / Penalty if applicable D. Interest E. Penalty TotallnteresUPenalty (D+E) (3) 4. If Line 2 is greater than Line 1 + Line 3. enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (5A) (5) $ B. Enter the total of Line 5+5A. This is the BALANCE DUE. (5B)$ 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 a. retain the use of income of the property transferred; ................................... b. retain the right to designate who shall use the property transferred or its income; ........ C. retain a reversionary interest; or ........................................................................... d. receive the promise for life of either payments, benefits or care? ............................... 2. If death occurred on or before December 123,1982, did decedent within two years preceding death transfer property without receiving adequate consideration? If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................... 3. Did decedent own an "In trust for" or payable upon death bank account or security at his or her death? ...................................................................................................... 4. Did decedent own an individual retirement account, annuity, or other non-probate property? ...... No .-1L -1L -1L -1L N/A -1L -1L IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN Under penalties of pe~ury, I declare that I have examined this retum, including accompanying schedules and statements. and to the best of my knowledge and belief. it is true. correct and complete. Declaration of preparer other than personal representative is based on all infonnation of which preparer has any knowledge. G RETURN A RE ATE 35 EAST HIGH STREET, E, PA 17013 AUGUST -y, ,2001 For dates of death on or after uly 1 1994 and before January 1. 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ction 9116 (a)(1.1)(i)J. For dates of death on or after January 1. 1995, the tax rate imposed on the net value of transfers to or for the use of the survIving spouse is 0% [72 P .5. Section 9116 (a)(1.1 )(ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. Section 9116 (a)(1.2)). The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%. except as noted in 72 P .S. Section 9116 (1.2)[72 P.S. Section 9116 (a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. Section 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. "'j '0(' REV-1502 EX + (12-85) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOENT DECEDENT ESTATE OF GERALDINE A. ORNER SCHEDULE A REAL ESTATE FILE NUMBER 2001 - 0132 (Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value which is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH NONE TOTAL (Also enter on Line 1, Recapitulation) NONE (If more space is needed, insert additional sheets of same size.) ~EV-1503 h + (4-86) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GERALDINE A. ORNER SCHEDULE B STOCKS AND BONDS FILE NUMBER 2001 - 0132 (All property jointly~owned with Right of Survivorship must be disclosed on Schedule F.) ITEM DESCRIPTION NUMBER VALUE AT DATE OF DEATH NONE TOTAL (Also enter on Line 2, Recapitulation) NONE (If more space is needed, insert additional sheets of same size.) ~EV-1504 b + (3-92) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY HELD STOCK PARTNERSHIP AND PROPRIETORSHIP ESTATE OF GERALDINE A. ORNER ITEM NUMBER NONE FILE NUMBER 2001 .0132 DESCRIPTION TOTAL (Also enter on Line 3, Recapitulation) (If more space is needed, inserl additional sheets of same size.) VALUE AT DATE OF DEATH NONE ~EV-1507\oX + (6-86) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES AND NOTES RECEIVABLE ESTATE OF GERALDINE A. ORNER FILE NUMBER 2001 - 0132 (All property jointly-owned with Right of Survivorship must be disclosed on Schedule F.) ITEM DESCRIPTION NUMBER VALUE AT DATE OF DEATH NONE TOTAL (Also enter on Line 4, Recapitulation) NONE (If more space is needed, insert additional sheets of same size.) . . ~EV-1508'EX + (2-87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY ESTATE OF GERALDINE A. ORNER FILE NUMBER 2001 - 0132 (All property jointly--owned with Right of Survivorship must be disclosed on Schedule F.) ITEM DESCRIPTION NUMBER VALUE AT DATE OF DEATH 1. PNC BANK - Checking Account No. 51 - 4036 - 5506 (Value based on attached letter _ ~~~ $ 1,229.78 954.27 2. MANOR CARE - Nursing Home Refund 3. VARIOUS ITEMS OF PERSONAL PROPERTY 2,500.00 TOTAL (Also enter on Line 5, Recapitulation) $ 4,684.05 (If more space is needed, insert additional sheets of same size.) REV-1509 EX + (12-88) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GERALDINE A. ORNER SCHEDULE F .JOINTLY-OWNED PROPERTY FILE NUMBER 2001 - 0132 Joint tenant(s): NAME ADDRESS RELATIONSHIP TO DECEDENT A. B. C. Jointly-owned property. ITEM LETTER DATE DESCRIPTION OF PROPERTY TOTAL DECD'S DOLLAR NO. FOR MADE VALUE 0/0 INT. VALUE OF JOINT JOINT OF ASSET DECEDENT'S TENANT INTEREST NONE TOTAL (Also enter on Line 6, Recapitulation) NONE (If more space is needed, insert additional sheets of same size.) REV-1510 EX + (2-87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GERALDINE A. ORNER SCHEDULE G TRANSFERS FILE NUMBER 2001 - 0132 THIS SCHEDULE MUST BE COMPLETED AND FILED IF THE ANSWER TO ANY OF THE QUESTIONS ON THE REVERSE SIDE OF THE COVER SHEET IS YES. ITEM DESCRIPTION OF PROPERTY EXCLUSION TOTAL DECD.'S DOLLAR NUMBER Include name of the transferee, their relationship to decedent, date of transfer VALUE % OF INT. VALUE OF OF ASSET DECEDENT'S INTEREST NONE TOTAL (Also enter on line 7, Recapitulation) NONE (If more space is needed, insert additional sheets of same size.) REV-1511'EX + (7-88) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES ESTATE OF GERALDINE A. ORNER FILE NUMBER 2001 - 0132 ITEM DESCRIPTION AMOUNT NUMBER A. Funeral Expenses: 1. CREMATION SERVICES OF PENNSYLVANIA 970.00 2. 3. 4. B. Administrative Costs: 1. Personal Representative Commissions: Social Security Number of Personal Representative:: Year Commissions Paid: 2. Attorney Fees: HAROLD S. IRWIN, III 500.00 3. Family Exemption: Claimant Relationship Address of Claimant at decedent's death: Street Address City State Zip Code 4. Probate Fees: REGISTER OF WILLS 41.00 C. Miscellaneous Expenses: 1. REGISTER OF WILLS - File Inventory and Appraisement 15.00 2. HAROLD S. IRWIN, III - Notary Fees 6.00 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. TOTAL (Also enter on Line 9, Recapitulation) $ 1,532.00 (If more space is needed, insert additional sheets of same size.) REV-1512 EX + (1-93) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GERALDINE A. ORNER SCHEDULE I DEBTS OF DECEDENT, MORTGAGES, LIABILITIES AND LIENS FILE NUMBER 2001 - 0132 ITEM NUMBER DESCRIPTION AMOUNT 1. PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE - Medical Lien (See Letter Attached as Exhibit "e") $ 23,780.98 TOTAL (Also enter on Line 10, Recapitulation) $ 23,780.98 (If more space is needed, insert additional sheets of same size.) REV-1513 EX + (2-87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GERALDINE A. ORNER SCHEDULE .J BENEFICIARIES FILE NUMBER 2001 - 0132 ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR NUMBER SHARE OF ESTATE A. Taxable Bequests: 1. AMY L TALBOT 100% RESIDUE 5021 INVERNESS DR MECHANICSBURG PA 17050 2. KYM J RICE VARIOUS ITEMS OF 1491 COUNTY RD #30 PERSONAL PROPERTY SCOTTSBORO AL 35768 3. WALLACE C RICE VARIOUS ITEMS OF 140 AMITY RD PERSONAL PROPERTY BIGLERVILLE PA 17307 4. JO F RICE VARIOUS ITEMS OF 511A S WEST ST PERSONAL PROPERTY CARLISLE PA 17013 5. LINDA A BRYMESSER VARIOUS ITEMS OF 310 LONGS GAP RD PERSONAL PROPERTY CARLISLE PA 17013 6. JEFFREY HORICK ITEM OF PERSONAL 1914 DOUGLAS DR PROPERTY CARLISLE PA 17013 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY AMOUNT OR SHARE OF ESTATE B. Charitable and Governmental Bequests: NONE TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on Line 13. Recapitulation) NONE (If more space is needed, insert additional sheets of same size.) . LAST WILL AND TESTAMENT I, GERALDINE A. ORNER. of the Manor Care Nursing Home, Room #140, Walnut Bottom Road, Carlisle, Cumberland County, Pennsylvania 17013, do hereby make, publish and declare this to be my last will and testament, hereby revoking all wills heretofore made by me. I. I -direct my personal representative to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. I direct that all inheritance taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property, whether or not such property passes under this Will, shall be paid by my personal representative out of my estate. 2. I authorize and empower my personal representative to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, ~s I could do if living. My representative is authorized and empowered to engage In any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said representative. 3. I give, d..vise and bequeRth all of my estate of whatever nature and wherever situate as follows: A. To Amy 1. Talbot: my Shearson Lehman Portfolio; B. To Kym Rice: my diamond dinner ring, all my clothing and $5,000.00; " ,~... , . C, To Wally C. Rice: any automobile I own at death and its contents, my mattress and bedspings, my two televsion sets, my electric blanket (given to me by Wally) and $5,000,00; D. To Jo Rice: all my silver jewelry and $5,000,00; E. To Linda Brymesser: my blue topaz ring and my winter coat; F. To JeffHorick: Grandpa Horick's comforter. 4, The rest, residue and remainder of my estate, both real and personal property, of whatever kind and wheresoever situate to my daughter, Amy L, Talbot, if she survives me, 5, I nominate and appoint my daughter, Amy L. Talbot to be the personal representatives of my estate, to serve without bond, 6, I suggest that my personal representative retain the services of Harold S, Irwin. ill, Carlisle, Pennsylvania in the settlement of my estate, IN WITNESS WHEREOF, I have hereunto set my hand and seal this _;J,,2,cinay of October, 1998, /~A-"L-/~o~[)4" J Geraldine A. Orner (SEAL) , Signed, sealed, published and declared by the above-named person as and for a last will and testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. 41<do,. c# B~dY/~ ACKNOWLEDGMENT AND AFFIDAVIT WE, GERALDINE A. ORNER, JOHN J. BARANSKI, JR. and HEATHER A. BARBOUR, the testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as a witness and that to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. GERALDINE A. 0 /~ /" "" '" JO J. B SKI, JR. ~/itr ~~~ REA THER A. BARB UR COMMONWEALTH OF PENNSYLVANIA :55: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by GERALDINE A. ORNER, the testatrix herein, and subscribed and sworn to before me by JOHN J. BARANSKI, JR. and HEATHERA. BARBOUR, witnesses, thisZL.."1day of October, 1998. Notartal Seal Harold S. Irwin 111. Notary Public Car1lsle Bora, Cumberland CountY 2 My ('~1.nmission ExpIres Sept. 23. 200 Member. r'armsylvar,'a AssocIstion of Notaries FEB-23-2001 16:39 PNCBANK CIF DEPAPTMENT 412 705 0057 P.01/01 '", QPNCBAN< Decedent Reporting Firstside Center 500 First Avenue, 4111 Floor Pittsburgh, PA 15219-3128 SCP February 23, 2001 Harold S. hwin, III Ritner House Suites 201 and 202 35 East High Street Carlisle, PAl 7013 RE: Estate of Geraldine A. Orner, Deceased SSN: 207-07-5937 000: 01117/2001 Dear Mr. Irwin: Please find the date of death balances you have requested listed below. CHECKING ACCOUNT #!l14036SS06 Established 02/2V1984 GERALDINE A ORNER 000 Balance: $1,229.44 + $0.34 accrued interest Our office only provides elate of death balanus for IRA's, CD's, Checking and Savings a<<OUDts. We do NO FiIlancial Transactions or Statement Orders. For Further iIlformation please caD 1-800-4-BANKER or your local PNC Brandl and ask to speak with a Financial Services Representative. Sincerely, ,-::;> ,; Afif'. / c;..~~ Erica A. BiShop 1-800-762-1775 A membcr of The PNC Ananda. Services Group PNC Bilnk NA Piusbu'gh Pennsylvania 15265 TOTAL P.01 - - .",. *' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8486 May 18, 2001 HAROLD IRWIN SUITES 201/202 35 E HIGH STREET CARLISLE PA 17013 Re: GERALDINE ORNER CIS #: 450147751 Co/Rec: 21/0087460 Date of Birth: 07/07/1917 SSN: 207-07-5937 Dear Attorney Irwin: Please be advised that the Department of Public Welfare maintains a claim in the amount of S23.780.98 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf c,f the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's itemized statement of claim. A portion of this medical expense, namely $11.971.25, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $11.809.73, is to be entered as a priority Class 6 claim against the estate. Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. ~f the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a currant appraisal, if available. Sincerely, CaJ.~. ~ Carl G. Rinkevich TPL Program Investigator 717-772-6258 717-772-6553 FAX Enclosure REV-1500 EX (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 J {p-d07-5 REV.1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY (I V/ FILE NUMBER 21 01 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 207 - 07 - 5938 0132 NUMBER DECEDENT'S NAME (LAST, FIRST AND MIDDLE INITIAL) ORNER, GERALDINE A. DATE OF BIRTH DATE OF DEATH JULY7,1917 JANUARY17,2001 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 4. Limited Estate .lL 2. Supplemental Return 3. Remainder Return (dates of death prior to 12-13-82) _ 5. Federal Estate Tax Return Req _ 1. Original Return r----o:-oecedeill DiedTeSlate (Attach copy of Will) EX. A 9. Litigation Proceeds Received _ 4a. Future Interest Compromise (for dates of death after 12-12-82) _ 7:-Decedent-Mi:lilltC:lill...J d L;v;IIQ Trust--. (Attach copy of Trust) _ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95 &-'retefNo, <*Safe Deposit Boxes NAME HAROLD S. IRWIN, III TELEPHONE NUMBER 717.243.6090 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closeiy Held Stock/Partnership Interest (Schedule C) 4. Mortgages and Notes Receivable (Schedule D) 5. Cash, Bank Dep & Mise Personal Property (Sched E) 6. Jointly Owned Property (Schedule F) 7. Transfers I Misc. Property(Schedule G) (Schedule L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schad H) 10. Debts, Mortgage Liabilities & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests (schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 15. Amount of Line 14 taxable at the spousal rate 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax due COMPLETE MAILING ADDRESS 35 EAST HIGH STREET, SUITES 201/202 CARLISLE, PA 17013 (1) 0.00 (2) 88,883.69 (3) 0.00 (4) 0.00 (5) 4,684.05 (6) 0.00 (7) 0.00 (9) 8,197.82 (10) 23,780.98 OFFICIAL USE ONLY (8) 93,567.74 $51,588.94 $10,000.00 $ (11) 31,978.80 (12) 61,588.94 (13) 0.00 (14) 61,588.94 x. - (15) 0.00 x .45 (16) 2,321.50 x .12 (17) 1,200.00 x .15 = (18) 0.00 (19) 3,521.50 Decedent's Complete Address: STREET ADDRESS MANOR CARE NURSING HOME WALNUT BOTTOM ROAD CITY CARLISLE I STATE PA I ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 18) (1) 2. Credits J payments A. Spousal Poverty Credrt B. Prior Payments C. Discount 3. Interest J Penally if applicable D. Interest E. Penalty Total Credrts (A+B+C) (2) TolaIlnterestlPenalty (D+E) (3) 4. If Line2is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the lax due. (SA) B. Enter the total of Line 5+5A. This is the BALANCE DUE. (5B) Make Check Payable to:. REGISTER OF WiLLS, AGENT ."."".".,.","""""""""""""""""""", """""" '!'{Nj:F"':';:{:FiN"}i~E~~€i~~~t!;€~:~~g;::~8ec8wi~\iiiaG'[~fIg~~"}i!i:':"""i'i':'\N":':,e:'{""" BY PLACING AN "X" IN THE APPROPRIATE BLOCKS :.-.;.:.".,.:.:.,.:.:."<.: ;,:,;;:::;::::::,:,:}}:::::;=:=:}::'::}:{: };:;::::?/:; 1. Did decedent make a transfer and: Yes a. retain the use of income of the property transferred; ................................... b. retain the right to designate who shall use the property transferred or its income; ........ c. retain a reversionary interest; or ........................................................................... d. receive the promise for life of either payments, benefits or care? ............................... 2. If death occurred on or before December 123, 1982, did decedent within two years preceding death transfer property without receiving adequate consideration? If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................... 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ...................................................................................................... 4. Did decedent own an individual retirement account, annuity, or other non..probate property? ...... No ---L -L -L -L NJA -L -L IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN Undor penalties of pe~ury, I declare that J 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 personal representative is based on all information of which preparer has any knowledge. RETURN SBURG, PA 17050 NAl REPRESENTATIVE DATE ,(;/ DECEMBER 16 ,2003 ~~ ~ l. 35 EAST HIGH STREET, CARL: LE, P 17013 DECEMBER ,2003 For dates of death on or after July 1, 1994 a before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. Section 9116 (a)(l.l)(i)). For dates of death on or after January 1, 1995, the tax rate Jmposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. Section 9116 (a)(1.1 )(ji)J. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% {72 P.S. Section 9116 (a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. Section 9116 (1.2)[72 PS. Section 9116 (a)(l)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P .S. Section 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. REV-1502 EX + (12-85) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GERALDINE A. ORNER SCHEDULE A REAL ESTATE FILE NUMBER 2001 - 0132 (Property jointly-owned with Right of SUlVlvorshlp must be disclosed on Schedule F) All real estate should be reported at fair market value which Is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both havlnn reasonable knowledae of the relevant facts. ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH NONE TOTAl (Also enter 00 Line 1, Recapitulation) NONE (If more space is needed, insert additional sheets of same size.) REV-1503 EX + (4-86) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GERALDINE A. ORNER SCHEDULE B STOCKS AND BONDS FILE NUMBER 2001 .0132 IAlfiiiODe tv .olntlv-owned with Rlaht of Survlvorshla must be disclosed on Schedule FT ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1. 1,120 SHARES DANAHER CORPORATION COMMON STOCK (Value based on sale price). $ 88,883.69 TOTAl (Also enter on Line 2. Recapitulation) $ 88,883.69 (If more space is needed, inserl additional sheets of same size.} REV-1504 EX + (3-92) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GERALDINE A. ORNER SCHEDULE C CLOSELY HELD STOCK PARTNERSHIP AND PROPRIETORSHIP FILE NUMBER 2001 - 0132 ITEM NUMBER DESCRIPTION NONE TOTAL (Also enter on Line 3. Recapitulation) (If more space is needed, insert additional sheets of same size.) VALUE AT DATE OF DEATH NONE REV-1507 EX + (6-86) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES AND NOTES RECEIVABLE ESTATE OF GERALDINE A. ORNER FILE NUMBER 2001 - 0132 (All DroDertv lolntlv-owned with Rlaht of SurvlvorshlD must be disclosed on Schedule F. ITEM DESCRIPTION NUMBER VALUE AT DATE OF DEATH NONE TOTAL (Also enter on Line 4, Recapitulation) NONE (If more space is needed, insert additional sheets of same size.) REV-1508 EX + (2-87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY ESTATE OF GERALDINE A. ORNER FILE NUMBER 2001 . 0132 IAII orooertv 0 Intlv-Dwned with Rloht of Survlvorshlo must be disclosed on Schedule F.\ ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1. PNC BANK - Checking Account No. 51 - 4036 - 5506 (Value based on attached letter- Exhibit B) $ 1,229.78 2. MANOR CARE - Nursing Home Refund 954.27 3. VARIOUS ITEMS OF PERSONAL PROPERTY 2,500.00 TOTAL (Also enter on Line 5, Recapitulation) $ 4,684.05 (If more space is needed, insert additional sheets of same size.) REV-1509 EX + (12-88) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GERALDINE A. ORNER SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER 2001 - 0132 Joint tenant(sl: NAME ADDRESS RELATIONSHIP TO DECEDENT A. B. C. Jointly-owned nronert . ITEM LETTER DATE DESCRIPTION OF PROPERTY TOTAL DECD'S DOLLAR NO. FOR MADE VALUE % INT. VALUE OF JOINT JOINT OF ASSET DECEDENT'S TENANT INTEREST NONE TOTAL (Also enter on Line 6, Recapitulation) NONE (If more space is needed, insert additional sheets of same size.) REV-1510 EX + (2-87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GERALDINE A. ORNER SCHEDULE G TRANSFERS FILE NUMBER 2001 - 0132 THIS SCHEDULE MUST BE COMPLETED AND FILED IF THE ANSWER TO ANY OF THE QUESTIONS ON THE REVERSE SIDE OF THE COVER SHEET IS YES. ITEM DESCRIPTION OF PROPERTY EXCLUSION TOTAL DECD.'S DOLLAR NUMBER fncluds name of the transferee, their relationship to cleC9dant, dBte of transfer VALUE % OF INT. VALUE OF OF ASSET DECEDENT'S INTEREST NONE TOTAl (Also enter on Une 7, Recapitulation) NONE (If more space is needed, insert additional sheets of same size.) REV-1511 EX + (7-88) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES ESTATE OF GERALDINE A. ORNER FILE NUMBER 2001 .0132 ITEM NUMBER A. 1. 2. 3. 4. B. 4. C. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. DESCRIPTION Funeral Expenses: CREMATION SERVICES OF PENNSYLVANIA 1. Administrative Costs: Personal Representative Commissions: Social Security Number of Personal Representative:: Year Commissions Paid: 2. HAROLD S. IRWIN, III Attomey Fees: 3. Family Exemption: Claimant Address of Claimant at decedent's death: Street Address City Probate Fees: REGISTER OF WILLS State Zip Code Relationship Miscellaneous Expenses: REGISTER OF WILLS - File Inventory and Appraisement and Short Certificates HAROLD S. IRWIN, III - Notary Fees SUNTRUST - Fees and Expenses Associated with Replacement of Lost Stock Certificates and Sale of Stock TOTAL (Also enter on Line 9. Recapitulation) $ (If more space is needed. insert additional sheets of same size.) AMOUNT 970.00 6,000.00 131.00 56.00 10.00 1,030.82 8,197.82 REV-1512 EX + (1-93) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GERALDINE A. ORNER SCHEDULE I DEBTS OF DECEDENT, MORTGAGES, LIABILITIES AND LIENS FILE NUMBER 2001 - 0132 ITEM NUMBER DESCRIPTION AMOUNT 1. PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE - Medical Lien (See Letter Attached as Exhibit "e") $ 23,780.98 TOTAL (Also enteron Line 10. Recapitulation) $ 23,780.98 (If more space is needed, inserl additional sheets of same size.) REV-1513 EX + (2-87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GERALDINE A. ORNER SCHEDULE J BENEFICIARIES FILE NUMBER 2001 - 0132 ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR NUMBER SHARE OF ESTATE A. Taxable Bequests: 1. AMY L TALBOT DAUGHTER 100% RESIDUE 5021 INVERNESS DR MECHANICSBURG PA 17050 2. KYM J RICE NEICE $5,000.00 AND VARIOUS 1491 COUNTY RD #30 ITEMS OF PERSONAL SCOTTSBORO AL 35768 PROPERTY 3. WALLACE C RICE NEPHEW $5,000.00 AND VARIOUS 140 AMITY RD ITEMS OF PERSONAL BIGLERVILLE PA 17307 PROPERTY 4. JO F RICE DAUGHTER $5,000.00 AND VARIOUS 511AS WEST ST ITEMS OF PERSONAL CARLISLE PA 17013 PROPERTY 5. LINDA A BRYMESSER NEICE VARIOUS ITEMS OF 310 LONGS GAP RD PERSONAL PROPERTY CARLISLE PA 17013 6. JEFFREY HORICK NEPHEW ITEM OF PERSONAL 1914 DOUGLAS DR PROPERTY CARLISLE PA 17013 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY AMOUNT OR SHARE OF ESTATE B. Charitable and Governmental Bequests: NONE TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on Line 13, Recapitulation) NONE (If more space is needed, insert additional sheets of same size.) ., LAST WILL AND TESTAMENT 21-01-132 I, GERALDINE A. ORNER, of the Manor Care Nursing Home, Room #140, Walnut Bottom Road, Carlisle, Cumberland County, Pennsylvania 17013, do hereby make, publish and declare this to be my last will and testament, hereby revoking all wills heretofore made by me. I. I direct my personal representative to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. I direct that all inheritance taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property, whether or not such property passes under this Will, shall be paid by my personal representative out of my estate. 2. I authorize and empower my personal representative to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My representative is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said representative. 3. I give, devise and bequeath all of my estate of whatever nature and wherever situate as follows: A. To Amy L. Talbot: my Shearson Lehman Portfolio; B. To Kym Rice: my diamond dinner ring, all my clothing and $5,000.00; , C. To Wally C. Rice: any automobile I own at death and its contents, my mattress and bedspings, my two televsion sets, my electric blanket (given to me by Wally) and $5,000.00; D. To 10 Rice: all my silver jewelry and $5,000.00; E. To Linda Brymesser: my blue topaz ring and my winter coat; F. To IeffHorick: Grandpa Horick's comforter. 4. The rest, residue and remainder of my estate, both real and personal property, of whatever kind and wheresoever situate to my daughter, Amy L. Talbot, if she survives me. 5. I nominate and appoint my daughter, Amy L. Talbot to be the personal representatives of my estate, to serve without bond. 6. I suggest that my personal representative retain the services of Harold S. Irwin, III, Carlisle, Pennsylvania in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this d ,k.c.i.ay of October, 1998. /~A--'h~/~o~[)A' oJ Geraldine A. Orner (SEAL) '. Signed, sealed, published and declared by the above-named person as and for a last will and testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses, ~(//~,. cd g,p//)//~ ACKNOWLEDGMENT AND AFFIDAVIT WE, GERALDINE A. ORNER, JOHN J. BARANSKI, JR. and HEATHER A. BARBOUR, the testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as a witness and that to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. JO J. B SKI, JR. ~V/k~ ~&OtV< HEATHER A. BARB DR COMMONWEALTH OF PENNSYLVANIA :ss: COUNTYOFCU~ERLAND Subscribed, sworn to and acknowiedged before me by GERALDINE A. ORNER, the testatrix herein, and subscribed and sworn to before me by JOHN J. BARANSKI, JR. and HEATHER A. BARBOUR, witnesses, thisZ"' rv(day of October, 1998. Notarial Seal Harold S. trwin tII. Notary Publk: Car1ls1e Boro. Cumberland county My C'1.t1mis$k)n Expl'9S Sept 23. 2002 Member, r>ennsylVaP1a ASSOCu,dlon 01 Notaries LAW OFFICES OF HAROLD S. IRWIN, III ATTORNEY-AT-LAW HAROLD S. IRWIN, III JOHN J. BARANSKI, JR. HITNER HOUSE, SUITES 201 and 202 35 EAST HIGH STREET CARLISLE, PENNSYLVANIA 17013 www.irwinlawoffice.com e-mail: irwinlaW@epix.net 717-243-6090 PHONE 717-243-9200 FACSIMILE HEATHER A. BARBOUR RHONDA S. MECHTL Y PARALEGALS February 16, 2001 PNC BANK NOBLE BLVD CARLISLE PA 17013 RE: Estate of Geraldine A. Orner SSN: 207 - 07 - 5937 Checking Account No. 51 - 4036 - 5506 Dear Sir or Madam: Please be advised that Geraldine A. Orner died on January 17, 2001. I represent Amy L, Talbot, who has been named executrix of the estate. I have enclosed for your records, a copy of the death certificate and the short certificate naming Ms. Talbot the executrix. Please provide rne with a letter documenting the balance in the 3bove aCCOl.iilt and any other account she may have had with your bank as of January 17, 2001, as well as the names of the joint owners, the date their names were added to the accounts as owners and whether it is specifically designated that the joint owners had the right of survivorship. Also, at this time it will be necessary for us to close out this account in order to pa~' estate administration costs and expenses. Please issue a check payable to the estate and forward it to me as attorney tor :i1e estate as soon as lJos:sibit". Thank you for your cooperation in this matter. Interest Checking Account Statement I':\C Bank 0,PNCBAN< Primary account number: 51-4036-5506 Page 1 of 2 For the period 12/20/2000 to 01/22/2001 Number of enclosures: 2 GERALDINE A ORNER CIO AMY L TALBOT 5021 INVERNESS DR MECHANICSBURG PA 17055-8314 11' For 24*l1our customer service or current rates: Call1-888-PNC-BANK 12!5] Write to: Customer Service PO Box 609 Pittsburgh PA 15230-9738 8 Visit liS at www.pncbank.com Ii TDD terminal: '-800-531-1548 For he~r.ing impaired clients only this year. make a resolution to save money on auto insurance. C~lll PNC Insurance at 1-877-PNC*4flOO today for a free, no-obligation quote. Licensed insur<\uc.e ad\isors \'1iB comp<lre quotes fl>r YOllr in:;ur<111C(' needs from a 11mnber of leading companies. This means )'ou'll receive the rate and the co\-crage that's right [('I" you. AIId while you're on the phone, relnemher to ask ahom other great deals on homeowner's, fenter's or term life il Sllrann'. Call 1-877-PNC-4000 ape:[ mention campaign code P21. Interest Checking Account Summary AI count number: 51-4036-5506 Accollnt Link@ number: 0207075937 Geraldine A Orner Please see the Activity Detail section for additional information. Balance Summary Beginning balance ~9~. 75 Deposits and other additions 1,9GO.35 Checks and other deductions 9!0,l-l Ending balance 1,312.96 Average monthly balance 892.9~ Charges and fees 9,00 T,'ansaction Summary Checks. paid' withdrawals BallK card/POS Account Inform(:ltion transactions assistance calls Teller transactions 2 o o Total ATM PNC Bank MAC .'.;Tlvl Ir;~lIs.;;c:lOl\S Other MAC ATM a..rlsaCilon" OtherATM ,rartsac;t"Jj\S ~,'<l1l5ar;tlVIS o o o o As of 01/22, a total of $.40 in interest was earned this year. Interest Summary OAB% 34 Average collected balance for APYE 892.92 Interest Earned this period Annual Percentage Yield Earned (APYE) Number of days in interest period .10 Activity Detail D"posits and Other Additions Dat' Amount Description \2 29 21l-}.q;1 Direct Deposit - Annuitant PA Treasury Dept 207075937 01 03 755.00 Direct Deposit ~ Soc See l'S Treasl1l~' :W3 ~070759:~ 7 A OJ 18 1,000.00 Deposit Reference :\0. 023320760 (I] 22 .'10 lnten'st P"yment There were 4 Deposits and Other Additions totaling $1.960.35, Account number: 51-41136-55116 - continued 0.PNCBAN< For the period 12120/2000 to 01'2212001 GERALDINE A ORNER Primary account number: 51-4036-5506 Page 2 of 2 Interest Checking Account Statement ft For 24-hour clIstomer sE!lVice: Call: '-B88-PNC-BANK Checks Check number 2~1:16 2937 Amount 907.88 Date paid 01/18 Reference number 0220851"j Amount 21.26 Date paid OL'12 Reference number 0250125J5 Checl< number Date 01/05 Amol.lnt Description 2.0{) Dired P;lrment -Jm Dues Benefits P;1ckage 010386800000 There were 2 checks listed totaling $929.14. There was 1 Online or Electronic Banking Deduction totaling $2.00. ... Gap in check sequence Online and Electronic Banking Deductions Date 01/22 Amount 9.00 Description Selvice Chilrge There was 1 Other Deduction totaling $9.00. Other Deductions Daily Balance Detail Date Balance 12 '20 2~12.75 12'19 497.70 Date 01/03 01/0':l Balance 1,2':l2.70 1,250.70 Date 01/12 01/18 Balance 1,229.44 1,321.56 Date 01/22 Balance 1,312.96 Log on to www.pncbank.com to see what's new with Account Link by Web ~'ow you can get information on your PNC Bank Brokerage accounts, loans and CD's! As always, YOll'JI receive the other great features of Account Link. by \\'e_b; up-to-the-nlinute balances on checking. savings, and money market accounts. You can also n'yiew the last three months of .--\ T:\I and check card transactions. Account Link by 'Veb is a,'ailabIe to all PNC Bank customers- - an you need is a custollH:"r number and your AT:\I PIN. Discover the simplicity of Account Link by 'Veb, REV.1SOO~(6-llI'1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 I b - r::J-(J 7- ~~ REV-1500 OFF!CIAL USE ONLY I- Z W C W o W C w ...., lol:~(/l (.)O:lol: wo.u J:00 (.)0:...1 0.111 0. <I: ------.----.---..-.....' FILE NUMBER INHERITANCE TAX RETURN RESIDENT DECEDENT L~--D.--L Jl(L-LL~ COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) GUERARD, ROGER H. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) January 16, 2001 November 1, 1908 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 136 -01 2645 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER !J 1. Original Return o 4. Limited Estate ~ 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Anach copy of Trust) o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) o 3. Remainder Return (date of death prior to 12-13-82) [j 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) t- Z W Q Z o 0. (/l W 0: 0: o (.) NAME Duffie, Esq. Jerry R. FIRM NAME (ff Applicable) Johnson Duffie TELEPHONE NUMBER (717) stewart & Weidner 761-4540 (1) (2) (3) (4) (5) 96,900.00 609,280.44 OFFICIAL USE ONLY z o !;( -I ~ I- 0: < o w 0:: 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) (6) o Separate Billing Requested 188,800.77 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 894,981.21 (8) 67,775.41 5,130.94 (11) (12) (13) 72,906.35 822,074.86 -0- (9) (10) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 822,074.86 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o rei I- ~ a.. :2 o o ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x.O_ (15) -0- x.O_ (16) -O- x .12 (17) 25,895.35 x .15 (18) 90,942.03 (19) 116,837.38 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 215,794.65 606,280.21 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT >> B~~URETq ~SWER.ALLQUEStlONS ON REVERSE SIDE AND RECHECK MAtH < < . REV-15131'X.(1-97) .. . ." . . , COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF GUERARD, ROGER H. FILE NUMBER 21-01-00133 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE NUMBER 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. Raymonde G. McCoach 20 Rustic View Rd., Greenwich, cr 06830 sister 26.25% residue 2. Patricia M. Knight 20 Rustic View Road Greenwich, cr 06830 William Knight 1616 Sunnydale Ave., Simi Valley, CA 93065 Niece Bronze plate: tie pin: figurines 20% residue 3. Grandnephew Bronze Book Ends 20% residue 4. Roger Knight 7 Oldfield Rd., Rowayton, cr 06853 Sophia McCoach 27 Birch street, Bloomfield, NJ 07003 Grandnephew Bronze Book Ends 20% residue 5. Sister-in-law 13.75% residue 6. Margaret P. Chapnan 107 October Dr., Apt. 3 Camp Hill, PA 17011 7. Mary Catherine Shuping - Deceased Friend Ruggieri/Snow Paintings Deceased Deceased 8 . Vivian Hanlon - Deceased Deceased Deceased ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART n. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) Pamela Reitenbach Form GA2 - 'TOTAL 2000 for Windows' appraisal software by a la mode, inc. -1-800-ALAMODE (0[2>1 REV-'502fX . (j-97) '* SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly.owned with right of survivorshlD must be disclosed on Schedule F. ITEM NUMBER 1. GUERARD, ROGER H. FILE NUMBER 21-01-00133 ESTATE OF DESCRIPTION VALUE AT DATE OF DEATH Real Estate - No. 5 Brentwood Road, East Pennsboro Township, Cumberland County, pennsylvania. (Deed Book Y, Volume 20, Page 501) Appraised Value (Copy of Appraisal attached) $ 96,900.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 96,900.00 SUMMARY OF SALIENT FEATURES Subject Address 5 Brenlwood Road Legal Description Deed Book Y20, Page 501 - City Camp Hill ~ County Cumberland Stale PA .. ZIp Code 17043 Census Tract 3240-0102 Map Reference Plan Book 7, Page 16,1014 : Sale Price $ NA Dale of Sale NA Borrower I Client NA Lender Jerry Duffie, Esquire Size (Square Feel) 1,160 Price per Square Foot $ Location Average - Age 45 Years - Condition Average . . Total Rooms 5 - Bedrooms 3 Baths 1 Appraiser Karen Darney. PA State Certified General Appraiser . Date of Appraised Value January 16,2001; Dale of Death of Roger H. Guerard Anal Estimate of Value $ 96,900 Form SSD - .TOT AL 2000 for Windows. appraisal software by a la mode, inc. - 1-800-ALAMODE Pro e 0 scrl tlo UNIFORM RESIDENTIAL APPRAISAL REPORT FileNo. 01-553 _PrQg~rty Mdl]~s !L!;!~nl!!.~_t! RoaiL._.. nn_~_g.~P.I:l.m State PA Zip Cgde 17043 Leg~ Oes~riP1ig~~~d ~C?O~ Y20, Pag~ !jOl _ .____.u._..... Cll.YJ)!yGulTltll!r\anQ Assessor'.s p~.~1..N.ll., Q!l:1!!-1.!j1l0~1.0.!!. .__ R.E. Taxes $ 1,400.27 Special As~s!llllents $ 0.00 Borrower NA Occu ant Owner Tenant Vacant Pro e ri hts a raised PUO i, Condominium HUD A onl HOA S NA Mo. NeiglJtlQthJ!9.d.Q!f'!gj~ NarT\e .L.2!!g_Mead~ . . M.apJle.l.e~Jlce PIa.nEl~ 7, Pg 16, lot 4 Census Tract 3240-0102 . .Sale Price $ NAllate 01. Sale ~A n_ u. ~plion and S amount olloan charueslconcej~n.sJD!!e Pl\id bHell.l!f NA Lender/Client Jerry Du.ma.,_Esg~lra. .... 'u..._ Address 301..MarketStree.t,l,.l!mQll~e~Pf'. 17043 A raiser Karen Dame, Cert. General A raiser Address 2159 Market Street, Cam Hill, PA 17011 Location Urban ' Suburban . Rural Predomlnsnt i Single faml y ouslllQ Presentland use % PRICE AGE- . Buitt up Dver 75% X 25-75% Under 25% .. occupancy $(000) (yrs) One family 96 Growth rate Rapid X Stable Slow ~ Owner . ..3Q... _ Low ~~ 2-4 family Property values Increasing:X Stable Declining Tenant 200+.. ..!jigh }5+ . Multi.lamily Demand/supply Shortage X In balance Over supply jg Vacanl (0-5%) _!'re~.~m!n.a~ Commercial '~arkeijngijme ~ llnder.3I!!Qs.X3-6mOL Over 6 mos. '-, Vac.(over5%L__.~Q~HQ .~O+/- Note: Race and the racial composition of the neighborhood are not appraisal factors. Neighbortlood boundaries and characteristics: JJl8.~!!!?l~.!.!!IlliJ~rhood Is Indic~ the enclo,!!\!'~jg.~tlOrhood map which Is included within the addenda. Pamela Refienbach Land use change X Not likely Likely In process 1 3 To: _ Factors that affect lhe marketability of the properties in the neighbortlood (proximity to employment and amenities, employment stability, appeal 10 marke~ etc.): . Subject has acc_es~.lo an.n"~e.ss,,,ry ~~.J?()r1il}!l..!aclliti,,!? includk!9.~ools~.I1ubl~~.tra.nsI19!!!!ti"n,~hO.l!pJn9 .;000 churches. Employment stability is good .- due to the state capital at H~frlsburg. Ttle.. ~~~_~4~PlY.J)~P.9~.i!:1_.M.~<<;h~_nl~.~l}IJJ.. ~_e_ ~Y_,~_l!P-P!Y..P_~~t in.N~:W Cl,l~m_~rland. Pennl!Ylvania Blue Shield. and .the expandi~g ~llt shor" .a[,,~_ "'",,['!!l".J1!Qll~!.!!Y. ~i[l~n;O.!lC!!.I!.Ill!I@m.~ ~'!. QQ~I!.'Y!'.!!~g[lli1!QYmenlli ~jl} .!!.1S-3D minute~.I11mute. MLS statistics . demonstralegood de.rTlan.~ f(lr .thl!. a[,,;<~ The ~!1~mQ!l~'!I1~~.i!'s cQ[!.v.enieplI9E!1!i(l'!.to.m."Jor lQ"c;lw.ays. (See Ac;I.deOO.a1 ".. .._---" ---.- -------.-..--.------..----------.- Markel conditions in the subject neighborhood Oncluding support lor the above conclusions related to the trend ot property values, demand/supply, and marketing ijme .. such as data on competitive properties for sale in the neighborhood, descripijon of the prevalence of sales and financing concessions, etc.): The search of county I"x .reC()~s .a.ndl!!l!.IyI_L.!! seJ:V)!e'l_sh~.p.!i_"'!'?.'!tabll!.. Ihl!.IyI.L,S_s!lJ"i~!l i.~.di~I"slha! the. typical property sells in 3-6 months. Mortgage funds are readily ""ai,,!bJ!l fC9n.!a variety 9f!ourC!!L~Il.~()~vl!'l~9n"lloa.n~ .bein.96~.to6.117!?o/., 95"1! .rTlor!9.!!.!l!!, ~p to 3 points. Sellers are not required to offer sales or financing concessions, however, .s.eller assisl"nc.e ]! .QC!:.~I!:i!!9, No NA NA Prolecllnformatlon for PUDs (n applicable) - -Is the developer/bUilder In control of the Home Owners' Association (HOA)? Yes Approximate total number of unns in the subject project~.~ no. Approximate total number ot units for sale in the subject project Describe common elements and recreaijonal facilities: NA Dimensions Pleasl!. Sl!e_legaldes.crij:lti()l) ~!I)!!,.~. ....Qc;I.e.~." C?f I~i! f!lport. . Topography Slight decline to rear Sne area !IAOO square feet or.19 "cre..;.'p!,r ~"e.c;I Comer Lot . Yes ~ No Size Typicalfor Area Specific zoning classnication and descripijon ill~ Residen.t!ll! SingleJ=....l!!!Iy.... ....m_~__ .... _ ... .o. ._ Shape Rec;langular Zoning compliance X Legal Legal nonconforming (Grandfathered use) .~, lIIegal- No zoning Drainage AI1I1'!<!TS Adequate Hig~~I&.~st~lie.M.iI1!PlOlej!: .x l'r~n1Y~L.-=.!!.Ih~[y~tie..xmID!!L . View Typical Street Utilities Public Other on-slte Improvements Type Public Private Landscaping Typj!=S! l()r Area. Electricity X Street Macadam X Driveway Surface Macadam/gravel Gas X .. Curb/gutter .G9ncne~ . . :81 ' Apparent easements Standard Utility Water X Sidewalk Concrete :XJ FEMA Special Flood Hazard Area Yes X No Sanitary sewer X Street IighlS ~e.cl.;i~ :8J' FEMA Zone C Map Date 4-15-1977 Stann sew~r :x. _Alley Non~ . . _ _JEM..A~_N.9. 420359 B Comments (apparent adverse easements, encroachments, special assessments, slide areas, illegal or legal nonconfonning zoning use, etc.): for electric. 1~lel!.hQn!l,~\'. . Tt1~rl!. ll!.e...n.o k'!Q\l'.lll!Q.,!~(1;e ll~~~n.t~._ encroacj1ments oJ condllJ9..'1! noted... . Standard easements GENERAL DESCRIPTION No. of Units One No. of Stories One Type (OetJAtt.) ~t:..c;!1!ld_ Design (Style) ~a_nch Exisijng/Proposed Exj.s.ti~g Age (Vrs.) 45 Ya."rs Effective A e rs. 15 +/- Years ROOMS FoY.\lr 1i'i!ml. . Basemenl Le.vell x - Level 2 EXTERIOR OESCRIPTlON ,FOUNOATION . Foundation ~~1!!~~__.. ; Slab f'o.!l',. Exterior Walls \Ii~Y!!!.l!!~.___..oJCrawl Space ~_ Hoof Surface Shil}glB!A"g...1 Basement E!1!L.._._ Gutters & Dwnspts. ~uminumlAvg ._.-iSump Pump Yl!~.~ floor D.rai!, .. Window Type vr)f'!'!~ DH/!!win.9. J Dampness !i'1fle Not~_._._.. Storm/Screens ThermolYes : Settlement None Noted Manufactured House ..N;;----.--llnfestaoon None-Noted 0111iOg !<n<<l:!.~o u .~___~Rm,_ Rec.Rm.p~!!oJ!lsl ! BASEMENT . Area Sq. Ft. 1,160 . 'I. Finished 0 J Ceiling Unfinished Walls C()n... Block ~ Roor Concrete . Outside Entry No INSULATION Roof Ceiling Walls Floor None Unknown X # Bath.s .!'o!!!!'_ .. __i. - ~ -"--"T- I. Finished area above rade contains: 5 Rooms' 3 Bedroom s . INTERIOR MaterialS/Condilion : HEATING I KITCHEN EOUIP. i ATTIC - Aoors CrpVWOlxl!A"g. ~ Type FHA ,Refrigerator : None Walls Dryw.a.ll/l',yg . Fuel Gall i Range/Oven k8J Stairs Trim/Finish WoodlAvera.9~..J;ond~n. Ayg ~ Disposai Orop Stair Bath Floor C'!rpell.A,vg .. .._.:COOLING Dishwasher Scutue Bath Wainscot g!'J:lIrTlic lile/Average Central y.!~. . J FaJVHood ~' Roor Doors W()O<!Ilwer!'.g!!._ ., Other_! Microwave : Heated :Condition Av 'Washer er I Finished Additional features (special energy efficient items, etc.): .)he s~iecl has a.!'!!~'l9.!!!!JocaledJ!!. to the living_,!,!?m. ~ L~undlY x Other Area Sq. R. 1,160 1,160 ~Io!lP 1,160 S uare Feet of Gross Uvin CAR STORAGE: None X Garage Attached X Detached Bui~.1n Carport Drivewa Area # of cars 1 Car 1 Car Condition of the improvements, depreciation (physical. functional. ~d ext~m~)',-rep8ir;- ~;;d~d,-qu-aifty 01oo~;tructlon, r~~Odeli~~additionsl etc.: See Addendum Mverse environmental conditions (such as, but not limtted to, hazardous wasles, toxic substances, etc.) present in the Improvements, on the site, or in the immediate vicini\)' 01 the subject property.: Thera are. n9 ~no_w..!l.oJ.!!I1I1!'.!l!cnt ed,!!!r.s~ "jlviC9.(!R1ental conditlo[l.!!tJ'!t wou.ld negatively imp"cl on the sal.e of the ro ert . See Addendum Freddie Mac Form 70 6/93 PAGE 1 OF 2 Fannie Mae Form 1004 6193 UNIFORM RESIDENTIAL APPRAISAL REPORT FileNo. 01-553 Comments 011 Cost Approach (such as, source of cost estimate, sUe value, square foot calculation and for HUD, VA and FmHA, 1he estimated remaining eCOl1omic IRe of the property): The Cost Approach generally will result in an excellent estimate to value If the buildlnn is new or reasonabl~ and the imnrovemenls reflect the hiahest and best use of the land. However when Items of nhvslcal deterioration and obsolescence must be estimated an area of iudllement is Involved which is sublect 10 error. The Cosl Annroach was nol utilized due to the age of the subiecl____ _._ property. ________ ..__..___._~_._~ 333 Glenn Road 11 Hunter Lane Camn Hill PA Camo Hill, PA Within 1/4 Mile ;Block -------------- 109900 's 67.21 rP 105000K~ 95.60$rjj."'" 1109~~ MLS; Agenl; Exllnspection MLS; Agent; Exl . Inspection Court House Records Court House Records DESCRIPTION : +1-\$ Adlust. DESCRIPTION 1MML~_ n + - .S 11500liillt-S Adjusted Sales Price of Comnarable 9B 400 94,000 97 900 Comments on Sales Comparison Oncluding tile subJect property's compatillility to the neighborhood, etc.): All sales selected are located within Easl Pennsboro Township. Adiusbnents were made to reflect substantial differences between the comparable propertles and the subject. The adjusbnents thai were made reflect the Ivnical actions of buyers and sellers in the rnarketnlace. All sales were considered eQually. (See Addenda) Val"~nn~IOn~ ESTIMATED SITE VALUE ESTIMATED REPRODUCTION COST-NEW-OF IMPROVEMENTS: Dwelling 1,160 Sq. Ft @$ = $__ 1.160 Sq. Ft. @$ = ..= $ : Garage/Carport _ Sq. Ft @$ T olal Estimated Cost New _ Less Physical Depreciation Depreciated Value of Improvements 'As-is' Value of SUe Improvements INDICATED VALUE BY COST APPROACH ......... ITEM I SUBJECT 5 Brentwood Road Address Camo Hill Proximilv to Subiect Sales Price Price/Gross Livino Area Data and/or VeriflcatiOl1 Source VALUE ADJUSTMENTS Sales or Rnancing Concessions Date of Salp./Time Location Avera"" Leasehold/Fee Simnle Fee Simnle SUe .19 AcreIAvg View Twlca! Slreel Dasinn and A~ Ranch OualUv of Construction A1um/BricklAvll Aae 45 Years COI1ditlon Averaoe Above Grade Total: Bdrms: Baths Room Count 5 3 1 Gross Livino Area 1 160 Sn. Ft Basement & Finished 1,160 - Rooms Below Grade 0 Functional UtilUv Averaoe . Heatinn/Coolinn ~~_ - Enerov Efficient Rams Averaoe Garaae/Ca[pOrt Carnort Porch, Patio, Deck, Patio/Sloop RreDlace(s), etc. None Fence Pool etc. Functional ,,= $ Extemal L Inspection C. H. Records DESCRIPTION =$ =$ " =$ . =S I COMPARABLE NO.1 ~24 Brentwood Road Camo Hill PA Same Street NA -etl ~ 92.43 rP MLS; Agent; Ex!. Inspection Court House Records DESCRIPTION COMPARABlE NO.2 + 1-1$ Adlust. -10.000 Conventional Nonel 66 DOM 5-17-2000 Average Fee Slmnle .32 Acre/Comer Tvolcal Streel Ranch : A1umIBricklEoual 35 +/- Years Suoerior T olal : Bdrms: Baths : 6 3: 1.5 : 1 ,204 Sa. Ft : Conventional Nonel17 DOM 1-18-2000 Averalle Fee Simple .23 Acre/Eoual Tvolcal Street Ranch BrlckNlnvUAvll 43 +/- Years SU08rior Total . Bdrms: Batl1s : 5 3: 1.5 : 1169 Sn.Ft; -1,500 o Equal Unfinished Averalle FHNCA Averaoe Carnort Patio None Equal Unflnlshed Averane FHN/None AveraDe Carpcrt Porch/Patio None ----.-- COMPARABLE NO. 3 + (-)$ Adjust. Conventional Costs/18 DOM -1,000 10-20-2000 _.___ __ AveragL-_.__ .___.___ .__ Fee SimJ11e _ _.____ ._._.. -1 500 .20 Acre//EQual _~n___ ___ .lYPlcal Street _________ Ranch A1umlEqual .______~_~ 45 +/- Years -10,000 l;uperior T olal Bdrms Baths -1,500 ~L~_ o 1 160 Sn. Ft Equal Rec RmlWel Bar ~~ +2000 FHNCA Averaoe k'11ort__ Patio None __ :1Q,000 ~ -- 11,000 .+ 13,000 ~- _.-"------~ =~~~ :~'"=- ~"~:~' ~::~' -1~::""3- .. Analysis of any current agreement of sale, option, or listing of subject property and analysis 01 any prior sales of subject and comparables wRhln one year of the date of appraisal: Other prior sales of comparable properties occurred more than one year ago. The subject property is currenUy lisled for sale at a ~riC8 of $1 06,000, which appears high. (Please see commenls within the Sales Comparison Approach of this report). - ~~- INDICATED VALUE BY SALES COMPARISON APPROACH $ ~-~-~ INDICATED VALUE BY INCOIlE APPROACH fit Annlicablel HEstimatetl M~ R~nt H "t ".. 1L\0.~ Gro~s R~nt Multioller d NA This appraisal is made ~ 'as is':J subject to tile repairs, aRarations, Inspections or conditions listed below LJ subject to completiOl1 pel plans & spacUlcations. Conditions of Appraisal; _ No warranly of the appraised is given or impled. No liability is assumed for the structural or mechanical elements. of the property. --.- ---- Rnal ReconciliatiOl1: Due to the lack of quantity and Quality of rental data, the Income Approach was considered inappropriate and not utilized. Greatest W8~ was Diven 10 the Sales Comnarison Annroach il reflects the Ivnical actions of buyer & sellers in the market nlace. The Cost ~proach was considered bu1 nol utilized due to the age of the subiecl property. . Dale of Dealh of Roger H. Guerard. - The purpose of this appraisal Is to estimate the maJ1<et value of the real property that Is the subJect of this report. based on the above conditions and the certification, contingent and limiting conditions. and market value definition that are stated in the attached Freddie Mac Form 4391FNMA form ll104B (Revised ~ 1993 _I. _ I (WE) ESTI~ATE THE M ET VALUE, AS DEFINED, OF THE REAL PROPERTYTHATlS THE SUBJECT OFTHIS REPORT, AS OF ___ .. January 16, 2001. -- (WHICH IS THE DA 0 NSPECTlON AN~D1N THE EFF ~ECTlVE DATE OF THIS REPORT) TO BE $ 96,900 A~PRAlSER: jJrJ J } i I /) VI /I I II _ SUPERVISORY APPRAISER (ONLY IF REQUIRED): Sionature ~,-I '..K/ l.t_A./V' -Slanature ___ = Did :J Old Not Name Karen Damey, Cert. General Apolaiser /'1 Name _._.______ Inspect Property Date Renart Sinned Seotember 26 2001 ( I Date Reoort Skmed ---~------- State Certification # GA-001260-L State PA State Certification # _______ ._u__~~_ ------ Or State License # State Or State License # Stale Fannie Mae Form 1004 6-93 ~eM~ PAGE20F2 ""'^'" . ~VA2 - 'TOTAL 2000 for Windows' appraisal software by a la mode, inc. -1-800-ALAMODE Pamela M. eitenbac~ Asst. to Certified General Appraiser File No. 01-553 September 26, 2001 L. G. Connor Real Estate Appraisers, LTD 2159 Market Street Camp Hill, PA 17011 Johnson, Duffie, Stewart & Weidner ATTN: Jerry R. Duffie, Esquire 301 Market Street P. O. Box 109 Lemoyne, PA 17043-0109 RE: Estate of Roger H Guerard 5 Brentwood Road East Pennsboro Township, Cumberland County Camp Hill, P A 17043 Dear Mr. Duffie: Pursuant to your request, we have prepared a COMPLETE APPRAISAL, SUMMARY REPORT of the property captioned in the "Summary of Salient Features" which follows. The accompanying report is based on a site inspection of improvements, investigation of the subject neighborhood area ofinfluence, and review ofsales, cost, and income data for similar properties. This appraisal has been made with particular attention paid to applicable value influencing economic conditions and has been processed in accordance with nationally recognized appraisal guidelines. The opinion of value conclusion stated herein is of the date of death of Roger H. Guerard on January 16, 2001; as stated in the body of the appraisal, and contingent upon the certification and limiting conditions attached. The purpose of this report is to determine an opinion of the estimated market value of the subject property for estate settlement purposes. The date of inspection was on September 24, 2001. Please do not hesitate to contact me or any of my staff if we can be of additional service to you. Respectfully, Form DCVR - 'TOT At 2000 for Windows' appraisal sollware by a la mOlle, Inc. - '-800-ALAMODE Supplemental Addendum File No. 01-553 Borrower/Clienl NA Properly Addre~s 5 I!~nlwood R()~ CUy Camp HJII., . Lender Jer Duffie, Es uire Qounty,. C_u!!l,~~r1an<!.. . Sl~~ .,~~ Zip Code H043 NEIGHBORHOOD COMMENTS. Cont'd: Subject is located one block east of Erford Road which is one of this areas major roadways providing access to Route 11/15. Commercial influences are located along Erford Road; which would have no effect on the subject's marketability. . IMPROVEMENTS. Cont'd: The subject's kitchen and bath are dated, which will decrease market appeal. Carpets are wom and need replaced. Entire exterior of home needs painted. The property is in average condition. Based on maintenance, condition and comparison neighborhoods, the estimated effective age is below the actual age. Physical depreciation due to age and deferred maintenance. No economic or functional obsolescence noted. ADVERSE ENVIRONMENTAL CONDITIONS. Cont'd: The property is of an age where lead based paint may be present. The market does not penalize the property, but the client should be advised of it's possible existence. It is assumed that it is not present. If the client has a concern then a qualified expert in the area should be contacted. SALES COMPARISON APPROACH, Cont'd All sales selected have newer kitchen's, bath's, carpet's and have been repainted. The weighted average was also considered to indicated the value of the SUbject. Estimated indicated value is determined by using the Gross Adjustment of sale price for each comparable (comp) as a measure of the relative quality of the compo A lower adjustment indicates a better comp, and visa versa. The ratio of gross dollar adjustment to sale price for each of the comps is used to calculate the weight each comp should have in a weighted average calculation. As with any method, this technique is not perfect. However, it does a good job of giving more weight to the most similar comps, while at the same time minimizing values near the extremes of the indicated value range. The indicated weighted average is $96,900; which supports the conclusion of value. All sales were considered equally. Some adjustments exceeded recommended guidelines but were considered necessary to reflect an accurate value. It is our opinion that the subject has a market value range from $94,000 to $98.400. FINAL RECONCILIATION. Cont'd: The market value conclusion stated herein is as of the date of death of Mr. Roger H. Guerard on January 16, 2001; as stated in the body of the appraisal, and contingent upon the certification and limiting conditions attached. The date of inspection was September 24, 2001. SPECIAL LIMITING CONDITIONS: This appraisal is not a home inspection and the appraiser is not acting as a home inspector when preparing the report. When performing the inspection of this property, the appraiser visually observed areas that were readily accessible. The appraiser is not required to disturb or move anything that obstructs access or visibility. The inspection is not technically exhaustive. The inspection does not offer warranties or guaranties of any kind. If the property is sold, this appraisal is subject to satisfactory inspection reports including, but not limited to: wood infestation, water testIs), radon, building inspections, etc. SUPPLEMENTAL CERTIFICATIONS: This appraisal was prepared by Karen Darney and Pamela M. Reitenbach for the exclusive use of Mr. Jerry Duffie, Esquire represent the estate of Mr. Roger H. Guerard. Mr. Jerry Duffie, of the law offices of Johnson, Duffie., Stewart & Weidner is considered to be our client for this appraisal. The purpose of this appraisal is to provide an opinion of the estimated market value of the subject property for estate settlement purposes. The information and opinions contained in this appraisal set forth the appraiser's best judgement in light of the information available at the time of the preparation of this report. Any use of this appraisal by any other person or entity, or any reliance or decisions based on this appraisal are the sole responsibility and at the sole risk of the third party. Ms. Darney and Ms. Reitenbach accept no responsibility for damages suffered by any third party, as a result of reliance on or decisions made or actions taken based on this report. In our opinion the reasonable exposure time linked to the value opinion is 90 to 180 days. We further certify that, to the best of our knowledge and belief: - This appraisal is a COMPLETE APPRAISAL-SUMMARY APPRAISAL REPORT. - The statements of fact in this report are true and correct. - The reported analyses, opinions, and conclusions are limited only by the reported assumptions and limiting Form TAnD - 'TOTAL 2000 for Windows' appraisal software by a la mode, inc. -1-BOO-ALAMODE Supplemental Addendum File No. 01-553 Borrow!r/Client NA ProoerlY Address 5 Brentwood Road CitY Camp Hill Lender Jerrv Duffie. ESQuire State PA _._---_...~ ZiD Code 17043 County Cumbertand conditions, and are our personal, impartial, and unbiased professional analyses, opinions and conclusions. _ We have no present or prospective interest in the property that is the subject of this report, and no personal interest with respect to the parties involved. _ We have no bias with respect to the property that is the subject of this report or to the parties involved with this assignment. _ Our engagement in this assignment was not contingent upon developing or reporting predetermined results. _ Our compensation for completing this assignment is not contingent upon the development or reporting of a predetermined value or direction in value that favors the cause of the client, the amount of the value opinion, the attainment of a stipulated result, or the occurrence of a subsequent event directly related to the intended use of this appraisal. _ Our analyses, opinions and conclusions were developed, and this report has been prepared in conformity with the Uniform Standards of Professional Practice. _ No one provided significant professional assistance to the persons signing this report. _ This appraisal has been made in conformity with the requirements of the Code of Professional Ethics and Standards of Professional Appraisal Practice of the Appraisal Institute. _ The use of this report is subject to the requirements of the Appraisal Institute relating to review by its duly authorized representatives. , _ Karen Damey and Pamela M. Reitenbach personally inspected the interior and the exterior of the subject property. Pamela M. Reitenbach prepared this report. Karen Damey reviewed the report and concurred with the conclu 'ons contained in this report. ren Damey ~ ~-Ci~i?:rj.~ [~ .A.~ ela M. RellenDac Assistant to the PA State Certified General Appraiser Form T ADD - 'TOTAL 2000 for Windows' appraisal software by a la mode, inc. -1.BOO.ALAMODE Building Sketch Borrower Client NA _._____ Pro Address 5 Brentwood Road City Camp HiU _.___m Lender Je Duff..., Es uire County Cumberland State PA .~Code ... IT9.1L * Interior Not To Scale 12.0' 0 0 Kit. ....... 9.0' 28.0' Qj Ul 0 G Bedrm Bedrm Dining ~ Area co C") 0 Carport co N Living Bedrm Room 9.0' Sketch IV WindoWs'" Comments: Area GLA1 GAR AREA CALCULATIONS SUMMARY Name of Area Size Totals First Floor 1160.00 1160.00 Carport 234.00 234.00 LIVING AREA BREAKDOWN Breakdown Sublotals ~...____"__~_________ .0 First Ploor 12.0 x 36.0 432.00 26.0 x 28.0 728.00 TOTAL LIVABLE (rounded) 1160 2 Areas Total (rounded) 1160 Form SKT.BLDSKI- 'TOTAL 2000 for Windows' appraisal software by a la mode, Inc. -1-800-AlAMODE REV-l103 ex. (1-97) '*' SCHEDULE B STOCKS & BONDS ESTATE OF COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21-01-00133 GUERARD, ROGER H. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. 2. 3. 4. DESCRIPTION Merrill Lynch - Investment Account No. 872-30771 Date of death value 5. Delaware Investments - Account No. 6000220567 Date of death value PNC Brokerage Corp. - Account No. 39308731 Date of death value First Union Securities - Account No. LN07-3754-3980 Date of death value American Express - AXP High Yield Tax-Exempt Fund Account No. 0011-5144 0026 3 00.2 Date of death value VALUE AT DATE OF DEATH 269,483.00 11,982.13 20,918.31 285,061.56 21,835.44 . /If: ........,..,.,... ,.."'''''''^ ;,.. ",,^l'V'I,.,,~ ;..."",."r+ "'~~;";^I'\.."I ","'^"f,.. M ."'^ "'''l.......,.. ,..:...,..\ TOTAL (Also enteron line 2, Recapitulation) $ 609,280.44 REV.1S1l8 eX. (1.1l7) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GUERARD. R)GER H. FILE NUMBER 21-01-00133 Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jointly.owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. ll. 12. 13. 14. 15. 16. Household Goods - sold at auction Automobile - 2000 Mercury Sable - date of death value 14kt Yellow Gold Gargoyle Mask tie tac with one natural pearl - appraised value Specific Bequests: Bronze Book Ends - appraised value Bronze Plate - appraised value Nick Ruggieri Print - appraised value Porcelain Figurines - appraised value Glass & Porcelain figurines - appraised value Ruggieri Print (City) - appraised value Figurines (Rockwell) - appraised value Print (Snow-Covered Bridge) - appraised value PNC Bank - Checking Account No. 51-4019-9405 PNC Bank - Money Market Account No. 50-0203-6296 PNC Bank - Certificate of Deposit No. 31100181821 American Express - IDS Life Fixed Retirement Annuity - Account No. 0930 0161 9449 8 004 Beneficiary: Estate American Express - IDS Life Immediate Annuity in Payout - Acct. No. 0930 0241 8995 1 004 Beneficiary: Estate patriot-News Co. - subscription refund Blue Cross/Blue Shield - premium refund AllState - automobile insurance refund Benefit Consultants, Inc. - premium refund PA Department of Revenue - 2000 Income Tax refund PA Department of Revenue - 1999 Income Tax refund Internal Revenue Service - tax rebate 1,343.00 13,925.00 50.00 50.00 40.00 100.00 60.00 300.00 60.00 50.00 100.00 760.00 18,799.80 63,149.07 52,927.59 32,185.17 4,309.56 17.60 248.20 95.80 6.00 134.00 549.98 300.00 188.800.77 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) " ~EV-1511 EX+ (12-99) . . .. *- y... . .'\ ~ SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER 21-01-00133 ITEM NUMBER A. GUERARD, ROGER H. Debts of decedent must be reported on Schedule 1. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Neill Funeral Home - pealer's - flowers 3,164.00 217.25 2. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 2. Name of Personal Representative(s) Patricia M. Knight 152-26-4353 Social Security Number(s)/EIN Number of Personal Representative(s) 20 Rustic View Road 30,235.00 Street Address City Greenwich State~Zip 06830 Year(s) Commission Paid: 2001/2002 Attorney Fees Johnson, Duffie, stewart & Weidner 25,700.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 7. 8. 9. 10. 11. 12. Claimant Street Address City State _ Zip Relationship of Claimant to Decedent 4. Probate Fees - Register of wills - Cumberland County Register of Wills - Short Certificates Accountant's Fees 542.00 21. 00 5. 6. Tax Return Preparer's Fees The Patriot-News Co. - advertising letters Cumberland Law Journal - advertise letters Register of wills - file Inv. & Inh. Tax Return Barb Coble - copy of deed AllState - homeowner's insurance AllState - automobile insurance 93.81 75.00 25.00 4.00 226.00 509.70 Total from additional sheet 6,962.65 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 67,775.41 <I' . SCHEDULE - H CONTINUED ESTATE OF: GUERARD, ROGER H. 21-01-00133 13. AT&T -line charge 14. Allfirst Bank - Estate check charge 15. Jane E. Biddle, Treasurer - county real estate taxes 16. Gerst M. Buyer, Painting/Repairs - painting, supplies and repairs prior to listing real estate for sale 17. East Pennsboro Township - sewer/trash 18. A-1 Carpet Cleaning - cleaning prior to listing for sale 19. Robert/Mary Haring - charges for removal of junk from premises 20. Gilbert Vargas - lawn mowing 5/19-8/15 21. East Pennsboro School District - School real estate taxes 22. PA Water Co. - service -12/19 - 8/17/01 23. PP&L - service - 12/29 - 7/30/01 24. UGI- service - 12/21 - 7/24/01 25. Verizon - service - Jan/Aug. 26. Reserve for filing Account/Distribution and close-out costs Sub-total 5.93 7.00 286.89 2,620.00 103.95 217.25 300.00 127.20 1,113.38 94.19 174.26 1 ,241.30 171.30 500.00 $ 6.962.65 ..", '"', COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT REV.,m EX' ('.97) ESTATE OF SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS GUERARD, ROGER H. FILE NUMBER 21-01-00133 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. ll. 12. Bethany Village - barber charges Internists of Central pa - decedent's account balance not covered by insurance West Shore Emergency Medical Services - decedent's account not covered by insurance The GM Card - Account No. 5437 00002 8854 7302 balance due H & R Block - preparation of decedent's 2000 Federal and State income tax returns united States Treasury - 2000 Income Tax due on Form 1040 PA Water Co. - service - 11/20-12/19 PP&L - service - 11/29-12/29 UGI - service - 11/20 - 12/21 Verizon - December charges East pennsboro Township - sewer/trash Holy Spirit Hospital (16099178) decedent's account balance not covered by insurance 14.00 69.44 72.15 2,673.94 306.00 832.00 15.18 30.95 220.05 24.70 96.53 776.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 5,130.94 Decedent's Complete Address: STREET ADDRESS 5 Brentwood Road CITY Camp Hill I STATE PA I ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 116,837.38 107,750.00 5.671.05 Total Credits (A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty (3) (4) (5) (5A) Total Interest/Penalty ( 0 + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 113,421.05 3,416.33 -0- 3,416.33 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS No [Xl [Xl [Xl [Xl fX] 00 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred;.......................................................................................... 0 b. retain the right to designate who shall use the property transferred or its income; ...............,............................ 0 c. retain a reversionary interest; or.......................................................................................................................... 0 d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 00 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. patricia M. Knight, Executrix . . . u sq. Market st., P. O. Box 109, Lemoyne, PA 17043-0109 DATE DATE /0 g ()/ For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to orfor the use ofthe surviving spouse is 3% [72 P.S. 99116 (a) (1.1) (i)l. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(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. *' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105.8486 May 18, 2001 HAROLD IRWIN SUITES 201/202 35 E HIGH STREET CARLISLE PA 17013 Re: GERALDINE ORNER CIS #: 450147751 Co/Rec: 21/0087460 Date of Birth: 07/07/1917 SSN: 207-07-5937 Dear Attorney Irwin: Please be advised that the Department of Public Welfare maintains a claim in the amount of $23.780.98 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95. effective June 30. 1995. Enclosed is the Department's itemized statement of claim. A portion of this medical expense, namely $11.971.25, was incurred during the last six months of the decedentJs life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code. 20 Pa. C.S.A. 3392(3). The balance of the claim. namely Sll.809.73. is to be entered as a priority Class 6 claim against the estate. Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a currant appraisal, if available. Sincerely, la+t~. ~ Carl G. Rinkevich TPL Program Investigator 717-772-6258 717-772-6553 FAX Enclosure DEPT. 2:80 HARRISBUF ,OZVZDUAL TAXES ,~X DIVISION PA ~[7118-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF ZNHERZTANCE TAX APPRAISEMENT, ALLOWANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX HAROLD S IRWIN III STE 201ZOZ $5 E HIGH ST CARLISLE PA 17015 DATE 01-27-2004 ESTATE OF ORNER DATE OF DEATH 01-17-Z001 FILE NUMBER 21 01-0152 'COUNTY CUMBERLAND ACN 101 I Amount Remitted GERALDINE A HAKE CHECK PAYABLE AND REMZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTZON FOR YOUR RECORDS ~ DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF ORNER GERALDINE A FILE NO. 21 01-0152 ACN 101 DATE 01-27-2004 TAX RETURN HAS: ( ) ACCEPTED AS FILED (X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: 1 $ 6 7 APPROVED DEDUCTIONS AND EXEHPTZONS: 9 Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10 Debts/Mortgage Liabilities/Liens (Schedule Z) 11 Tote1 Deductions 12 Net Value of Tax Return SUPPLEHENTAL RETURN Real Estate (ScheduLe A) (1) Stocks end Bonds (ScheduLe B) (2) Closely Held Stock/Partnership Interest (Schedule C) ($) Mortgages/Notes Receivable (Schedule D) iq) Cash/Bank Deposits/Misc. Personal Proper~y (Schedule E) Jointly Owned Property (Schedule F) (6) Transfers (Schedule G) (7) Tote1 Assets NO. 01 00 88/885.69 O0 00 00 00 00 (8) 7,227.82 (9) (lo) .00 (11) (12) 15 CheritebXe/governmen~el Bequests; Non-elected 9115 Trusts (Schedule J) (15) Xq Net Value of Estate Subject to Tax (Iq) NOTE: Z~ an assess, ant was issued previously, 1/nes 14, 15 and/or 16, 17, reflect figures that include the total of ALL returns assessed to date. ASSESSHENT OF TAX: IS. Amoun~ of Line 1~ a~ Spousal ra~e (IS) . O0 X O0 = 16. Amoun~ of L/nm 1~ ~axabXm m~ L~neal/CXmss A ra~e (16) 5~, 026.9~ x Oq5 = 17. Amount of Line lq a~ Sibling ra~e (17) . O0 X ~ = 18. Amount of Line lq ~axable a~ Collateral/Class B ra~. (18) ~0,000.00 X ~5 = ~al Tax Due (19)= 19. Princi TAX CREDITS PAYIIENT DATE RECEIPI NUMBER NOTE: To insure proper credi~ ~o your account, submit ~he upper portion of ~his form wi~h your tax payment, 88,885.69 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL /NTEREST. REVERSE SIDE OF THIS FORM DISCOUNT INTEREST/PEN PAID (-) INTEREST IS CHARGED THROUGH 01-11-2004 AT THE RATES APPLICABLE AS OUTLINED ON THE AMOUNT PAID TOTAL TAX CREDIT I BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 5,796.22 504.94 4,501.16 ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT 1S REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) .00 1,500.00 5,796.ZZ 2,296.22 .00 61,026.94 and 19 will .00 7.227.82 81,655.87 ~EV-1470 EX (6-88) ~.~ INHERITANCE TAX ~~ EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG~ PA 17128-0601 DECEDENT'S NAME FILE NUMBER Orner, Geraldine A. 2101-0132 REVIEWED BY ACH Daniel Heck 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES Applied excess deductions from prior return(s). B Accepted additional assets. H Accepted additional expenses. Funeral expenses removed as they were claimed on original return. J 2,4 Changed tax rate from 12 percent to 15 percent since a niece is a collateral beneficiary. ROW Page 1 ~~:""'rr\ r(T\f" BUREAU OF IIGJIVlDUAL;.' r ':"Jr:U l,,;T;\J: INfERITANCE TAX DIVISION PD lOX 2150601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT '* AEV-16Q7 EX AFP (D3-05) 10 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 04-11-2005 ORNER 01-17-2001 21 01-0132 CUMBERLAND 101 _t _ltt... GERALDINE A I HAROLD S IRWIN STE 201 202 35 E HIGH ST CARLISLE III PA 17013 I; MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To lnsu~ proper credit to your account, ~it the upp.r portion of this for. with your t.x ~t. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ................................................................................................................ REV-1607 EX AFP (03-05) ~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF ORNER GERALDINE A FILE NO.21 01-0132 AtN 101 DATE 04-11-2005 THIS STATEHENT IS PROVIDED TD ADVISE OF THE CURRENT STATUS OF THE STATED ACN IH THE MAHED ESTATE. S_ BELIlII IS A SUltHARY DF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAvtlEHTS, THE ClIllRt:HT BALANCE, AND, IF APPlLICABLE, A PROJECTED IHTEREST FICURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 01-20-2004 PRINCIPAL TAX DUE, 3,796.22 PAYMENTS (TAX CREDITS), PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-19-2003 CD003342 .00 3,521.50 02-02-2004 CD003519 482.61- 779.66 03-28-2005 REFUND .00 22.33- I , , . i TOTAL TAX CREDIT ~,796.22 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 . . ~ SIDE FOR CALCUlATIOH OF ADDITIONAL IHTEREST. IF TDTAL DUE IS LESS TIWl $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT"' ICU, YDU /lAY BE DUE A IEFUIBl. SEE REVERSE SIDE DF THIS FOIH FOI INSTIlUCTIOHS. ) C) C"" U,J ~2 -. t~-:- C_"; C')' LJ-l_c ~" (~'" " , -', ~ t.Li i._ 0::- STATUS REPORT UNDER RULE 6.12 Name of Decedent: GERALDINE A ORNER Date of Death: 1/17/2001 Will No. 21 - 01 - 0132 Admin. No. 2101 - 0132 Pursuant to Rule 6. 12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: I . State whether administration of the estate IS complete: Yes X No 2 . If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3 . If the answer to No. I is Yes, state the following: a. account with the Court? Did the personal representative file a final Yes No X b . The separate Orphans' Court No. (if any) for the personal representative's account is: N/A c . Did the personal representative state an account informally to the parties in interest? Yes X No d . Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to thi re rt. Date: 10/17/2005 HAROLD S. IRWIN III Name (Please type or prin 64 SOUTH PITT STREET CARLISLE PA 17013 Address en C> ( 717 ) - 2436090 Tel.No. s Capacity : Personal Representative X Counsel for personal representative r-- '- c..) co lor:> c::::_~ c:; c-J c:; vt RELEASE I, AMY L. TALBOT, hereby acknowledge that I have this day had and received from AMY L. TALBOT, executrix, and HAROLD S.IRWIN, III, the legal counsel for the ESTATE OF GERALDINE A. ORNER, deceased, the final sum of Five Thousand and no/100 ($5,000.00) Dollars in full satisfaction and payment of my share in the estate. AND THEREFORE, I, the said AMY L. TALBOT by these presents remise, release, quit claim, and forever discharge the said executrix and attorney, their heirs, executors and administrators, of and from the said share and of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by reason thereof, or any other act, matter, cause or thing whatever, from the beginning of the world to the day of the date of these presents. And I hereby consent and agree that the Orphans' Court of Cumberland County may discharge the said executor and legal counsel as to this share upon application, without further notice to me. IN WITNESS WHEREOF, I have hereunto set my hand and seal the ~ day of ,sc.l'l",",ber, 2005. Q(:;{Uf?>~ Chll t",ltJ ~ldp J(I\ J. [)n n . //) --z:(~ Wl-rn.t:.SS: ~L..../ (AMfuALBOT COMMONWEALTH OF PENNSYLVANIA (SEAL) :SS: COUNTY OF CUMBERLAND On this, the I tf( day of s~~, 2005, before me, the undersigned officer, personally appeared AMY L. TALBOT, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed same for the purposes therein contained. In witness whereof, I hereunto set my hand and official seal. (SEAL) o ~^NI^ NOTARIAL SEAL Mary /WI C. G<I\:l<IMO. Hoter( PubIC SMr Spllng Twp. cunbelklnd Coun1Y !lAY CO'\"~ Expires Dec. 13. 2008 RELEASE I, AMY L. TALBOT, hereby acknowledge that I have this day had and received from AMY L. TALBOT, executrix, and HAROLD S. IRWIN, III, the legal counsel for the ESTATE OF GERALDINE A. ORNER, deceased, the total sum of Thirty-five Thousand and no/100 ($35,OOO.00) Dollars in partial satisfaction and payment of my share in the estate. AND THEREFORE, I, the said AMY L. TALBOT by these presents remise, release, quit claim, and forever discharge the said executrix and attomey, their heirs, executors and administrators, of and from the said partial share and of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by reason thereof, or any other act, matter, cause or thing whatever, from the beginning of the world to the day of the date of these presents. And I hereby consent and agree that the Orphans' Court of Cumberland County may discharge the said executor and legal counsel as to this partial share upon application, without further notice to me. IN WITNESS WHEREOF, I have hereunto set my hand and seal the day of December, 2003. Cy~L~~ ~~~(SEAL) AMY . TAL T COMMONWEALTH OF PENNSYLVANIA :SS: COUNTY OF CUMBERLAND On this, the day of December, 2003, before me, the undersigned officer, personally appeared AMY L. TALBOT, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed same for the purposes therein contained. In witness whereof, I hereunto set my hand and official seal. (SEAL) Notary Public RELEASE I, WALLACE C. RICE, hereby acknowledge that I have this day had and received from AMY L. TALBOT, executrix, and HAROLD S. IRWIN, III, the legal counsel for the ESTATE OF GERALDINE A. ORNER, deceased, the total sum of Five Thousand and no/100 ($5,000.00) Dollars in full satisfaction and payment of my share in the estate. AND THEREFORE, I, the said WALLACE C. RICE, by these presents remise, release, quit claim, and forever discharge the said executrix and attorney, their heirs, executors and administrators, of and from the said share and of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by . - -- . reason thereof, or any other act, matter, cause or thing whatever, from the beginning of the world to the day of the date of these presents. And I hereby consent and agree that the Orphans' Court of Cumberland County may discharge the said executor and legal counsel as to this share upon application, without further notice to me. IN WITNESS WHEREOF, I have hereunto set my hand and seal the day of December, 2003. w.&~~7([~ COMMONWEALTH OF PENNSYLVANIA :SS: COUNTY OF CUMBERLAND On this, the day of December, 2003, before me, the undersigned officer, personally appeared WALLACE C. RICE, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed same for the purposes therein contained. In witness whereof, I hereunto set my hand and official seal. (SEAL) Notary Public RELEASE I, KYM J. RICE, hereby acknowledge that I have this day had and received from AMY L. TALBOT, executrix, and HAROLD S. IRWIN, III, the legal counsel for the ESTATE OF GERALDINE A. ORNER, deceased, the total sum of Five Thousand and no/100 ($5,000.00) Dollars in full satisfaction and payment of my share in the estate. AND THEREFORE, I, the said KYM J. RICE, by these presents remise, release, quit claim, and forever discharge the said executrix and attorney, their heirs, executors and administrators, of and from the said share and of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by reason thereof, or any other act, matter, cause or thing whatever, from the beginning of the world to the day of the date of these presents. And I hereby consent and agree that the Orphans' Court of Cumberland County may discharge the said executor and legal counsel as to this share upon application, without further notice to me. IN WITNESS WHEREOF, I have hereunto set my hand and seal the JJI1-- day of December, 2003. V/MV'_ n,~ (SEAL) KY'TJ.l~E COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND :SS: I~J-5K'- 19,;(/ On this, the 1/ day of December, 2003, before me, the undersigned officer, personally appeared KYM J. RICE, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed same for the purposes therein contained. In witness whereof, I hereunto set my hand and official seal. MY COMMISSION EXl':?ES sa>m,lBER 21. 2005 /117 If! / ar CG r-/u;J ~ l2-so-o~ RELEASE I, JO F. RICE, hereby acknowledge that I have this day had and received from AMY L. TALBOT, executrix, and HAROLD S. IRWIN, III, the legal counsel for the ESTATE OF GERALDINE A. ORNER, deceased, the total sum of Five Thousand and no/100 ($5,000.00) Dollars in full satisfaction and payment of my share in the estate. AND THEREFORE, I, the said JO F. RICE, by these presents remise, release, quit claim, and forever discharge the said executrix and attorney, their heirs, executors and administrators, of and from the said share and of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by reason thereof, or any other act, matter, cause or thing whatever, from the beginning of the world to the day of the date of these presents. And I hereby consent and agree that the Orphans' Court of Cumberland County may discharge the said executor and legal counsel as to this share upon application, without further notice to me. IN WITNESS WHEREOF, I have hereunto set my hand and seal the day of December, 2003. (SEAL) :SS: ( cf 9-3:). - {J-.O I COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND On this, the day of December, 2003, before me, the undersigned officer, personally appeared JO F. RICE, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed same for the purposes therein contained. In witness whereof, I hereunto set my hand and official seal. (SEAL) Notary Public