HomeMy WebLinkAbout02-0341CONNONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-15~i5 EX AFP C09-00)
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21
ACN 02110832
DATE 03-18-2002
EST. OF ETHELNYN ! KAUTZ
S.S. NO. Z03-10-92q0
DATE OF DEATH 02-01-2002
COUNTY CUMBERLAND
RITA M KEIM
22q5 LAMBS GAP RD
ENOLA PA 17025-112q
TYPE OF ACCOUNT
[] SAVINGS
[] CHECK/NO
[] TRUST
[] CERTZF.
REMIT PAYMENT AND FORMS TO:
REGISTER OF 14ILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
ALLFIRST FINANCIAL SERVICE has provided the Department with the information 11sted below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint ouner/boneflciary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this fora and return it to the above address. This account is taxable Jn accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Questions may be answered by calling (7171 7R7-RR~7.
COMPLETE PART ! BELON # # # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 0050320831 Date 05-28-197q
Established
Account Balance 1,2q5.ql
Percent Taxable X 50.000
Amount Subject to Tax 622.71
Tax Rate X .15
Potential Tax Due 93.ql
To insure p.~o.~;r~ cradiC~o your ~,~.~nt, two
(Z) copies 04 this not~ must a~co~lpany your
payment to ~ Register o~ ~11S. Hkke check
payable to: ~Ragister ~Nills, Agent".
NOTE: ~ t~ payments are made ~tn three
(~) months ~; ~e deced~t's date of death,
you aay deduct aSZ dJ~unt o~ ~e ~x due,
Any inherit~e tax due will become delinquent
nine (93 ao~s":after ~ data of death.
PART TAXPAYER RESPONSE
A. ~The above information and tax due is correct.
1. You may choose to remit payment to the Register of Rills with two copies of this notice to obtain
CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of
E ONE ~ Hills and an official assessa~ent wlll be issued by the PA Department of Revenue.
BLOCK ~ B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
ONLY to be filed by the decedent's representative.
C. ~The above information is incorrect and/or debts and deductions were paid by
you.
You must complete PART Iii and/or PART
L[NETAX 1.RETURNDa~e Established' COMPUTATZON OF TAX ON JOZNT/TRUST ACCOUNTS
1
2. Account Balance [
3. Percent Taxable $ ~
q. Amount Subject to Tax ~
$. Debts and Deductions ~
6. Amount Taxable 6
7. Tax Rata 7 ~
8. Tax Due ~
PART
DATE PAID
DEBTS AND DEDUCTTONS CLAIMED
PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Co.~autat/on)
Under penalties of parSur¥, Z declare that the facts ! have reported above ara true, correct and
~t' t° th'i~t °f ~'¥ kn°wl'dge and b'l~''f'~r~ -~./~ ~ WORK HOME ((~/'~) )
TAXPAYER STGNA E TELEPHONE NUMBER DATE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 001034
KEIM RITA M
2245 LAMBS GAP RD
ENOLA, PA 17025-1124
f01d
ESTATE INFORMATION: SSN: 203-10-9240
FILE NUMBER: 2102-0341
DECEDENT NAME: KAUTZ ETHELWYN I
DATE OF PAYMENT: 04/03/2002
POSTMARK DATE: 03/27/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 02/01/2002
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $93.41
TOTAL AMOUNT PAID:
$93.41
REMARKS: RITA M KEIM
SEAL
CHECK#7516
INITIALS: JA
RECEIVED BY'
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
Ms. Rita M. Keim
6018 Hummingbird Dr.
Mechanicaburg, PA 17050-2040
Atl~ttlon: T/C 340
Zip Code
PA DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 28O6O1
HARRISBURG PA 17128-0601
h,.llh,,h,,Ih,hlh,hll,,,,Ih,lh,,.,Ihh,II
~Ex55 (9-93) ~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TA
Dear Register of Wills~_/
Enclosed you will find: L~check(s) J~l documents(s) which were received by the Department of Revenue in err
These may be processed bccording to normal procedures.
REMINDER: The POST MARK DATE on envelope attached to any checks enclosed must appear on y~
Official Receipt.
Thank you.
Sincerely,
John Murphy, Chief
Inheritance Tax Division
'02
LOWELL R. GATES
Also Admitted Io Massachusetts Bar
MARK E. HALBRUNER
Also Admitted to New Jersey Bar
CRAIG A. HATCH
CORY J SNOOK
ALBERT N. PETERLIN
Also Admitted to Maryland Bar
STACEY L NACE
ParalegaVOflice Manager
TRACI L. SEPKOVlC
Paralegal
LAW OFFICES OF
GATES HALBRUNER -HATCH P.C.
1013 MUMMA ROAD · SUITE 100 · LEMOYNE, PENNSYLVANIA 17043
(717) 731-9600 · FAX: (717) 731-9627
May 1, 2002
BRANCH OFFICE:
3 WEST MONUMENT SQUARE, SUITE 304
LEWISTOWN, PA 17044
(717) 248-6909
WEB SITE:
www. GatesLawFirm.com
Cumberland County Courthouse
Office of the Register of Wills
One Courthouse Square
Carlisle, PA 17013
Ethelwyn I. Kautz, Deceased
Date of Death: February 1, 2002
Social Security Number: 203-10-9240
Late of: East Pennsboro Township
Dear Sir or Madam:
Enclosed is a check in the amount of $5,500.00 as the inheritance tax prepayment for the
above-referenced decedent. Ms. Kautz died owning no probate assets; therefore, an estate was
not opened. I am enclosing an Estate Information Sheet and original death certificate for your
files. Please send the receipt for the prepayment to our office in the enclosed envelope.
Please contact our office if you need any additional information. Thank you for your
assistance in this matter.
Enclosures
cc: Loft A. Mailey, Trustee
Sincerely,
Traci L. Sepkovic
Paralegal
LAW OFFICES OF
GA~-E~fHALBRUNER &-HATCH, P.C.
1013 MUMMA ROAD, SUITE 100
LEMOYNE, PENNSYLVANIA 17043
Cumberland County Courthouse
Office of the Register of Wills
One Courthouse Square
Carlisle, PA 17013
h,,llh,,lti,,,,,,Ih,lh,,Ih,,Ihhh,,,hlhh,h.
PA DEPARTMENT OF REVENUE '~lil~' County Code Year
ESTATE INFORMATION SHEET ~,~ / ~ ~z~
DECEDENT INFORMATION: Enter dat~ M it will appear on ell documents ~ubmittsd to the department.
i....~..~) (~) (M,ddle)
Kautz Ethelwyn I.
203 I 10 I 924O I Februaf~ 1, 2002 I February 26, 1920
TYPE FILING.' Enter choQk (,,') mark to Indicate the nmure of the return to be filed with the department.
i ! lXlP~oR.~um i-Ij~m A.m o~ I-'l Eotlite Tm( Oflly
· _..._.... ,~.... Enter check (,/) mark to indlcats the natore of the proceedings at the Rngister of Wlll8
LI= I I I:l~= brb"Uql/=U."''"'" Office. (Attach additiofld sheets if explanation ia necessary.)
I-'~Te~my I'-]AdministratJofl I~] No Letters I-'lother (Please Explain)
ATTORNEY/CORRESPONDENT
INFORMATION: tax Information ~md. cor~.~pondence.
Name (Last) (Hrst)
Gates Lowell
Enter idB data conceming the attorney or other individual to receive all
(Middle) ISupmme Court I.D. #
R.
Gates, Halbruner & Hatch, P.C., 1013 Mumma Road, Suite 100
City State Zip Code
ITelephone Number
717-731-9600
Lemoyne PA 17043
PERSONAL REPRESENTATIVE
INFORMATION:
Executor/Administrator
Enter ell data concerning the personal representative(a) of the estate
Name (l. ut) (l=im)
Mailey Loll
authoflzed by the Register of Willa
26 Bryans Mille Way
(Middle) I Social Security Number
City State Zip Code
ITel°phone Number
410-465-1415
Cantonsville MD 21228
CoExecutor/Administrator
Name (last) (First) (Middle)
;treat Addresl
S~ate Zip Code
ISocial Secudty Number
I
ITel°phone Number
Co-ExecutorlAdministrstor
Name (Lad) (Flint) (IdiddJ°)
ISocial SecuTty Number
State Zip Code
ITel°phone Number
Lowell R. Gates, Esquire
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 001146
LOWELL R GATES ESQUIRE
1013 MUMMA ROAD
SUITE 1 O0
LEMOYNE, PA 17043
........ fold
ESTATE INFORMATION: SSN: 203-10-9240
FILE NUMBER: 21 02-0341
DECEDENT NAME: KAUTZ ETHELWYN I
DATE OF PAYMENT: 05/03/2002
POSTMARK DATE: 05/01/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 02/01/2002
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $5,500.00
TOTAL AMOUNT PAID:
$5,500.00
REMARKS: LOWELL R GATES ESQUIRE
SEAL
CHECK//116
INITIALS: AC
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF XNHERITANCE TAX
APPRAXSENENT. ALLOWANCE OR DXSALLOHANCE
OF DEDUCTXON~, AND ASSESSNENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
R I TA M KE I
l
2245 LAMBS GAP RD
ENOLA t~.PA 17025-1124
DATE 05-15-2002
ESTATE OF KAUTZ ETHELWYN
DATE OF DEATH 02-01-2002
FILE NUMBER 21 02-0541
COUNTY CUMBERLAND
SSN/DC 205-10-9240
ACN 02110852
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS *~
~-: [ ~- - ~--~- -~ 5~=5 ~¥ ...................................................................................
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 05-15-2002
ESTATE OF KAUTZ
ETHELWYN
DATE OF DEATH 02-01-2002 COUNTY CUHBERLAND
FILE NO. 21 02-0541 S.S/D.C. NO. 205-10-9240 ACN 02110852
TAX RETURN NAS: CX} ACCEPTED AS FILED C ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICE ACCOUNT NO. 0050520851
TYPE OF ACCOUNT: ( ) SAVINGS (~ CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 05-28-1974
Account Balance 1,245.41
Percent Taxable X 0.500
Amount Subject to Tax 622.71
Debts and Deduct/ohs .00
Taxable Amount 622.71
Tax Rate ~ .15
Tax Due 95.41
TAX CREDTTS:
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
PAYMENT RECEIPT DISCOUNT C+)
DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID
PAYMENT MUST BE MADE BY 11-02-2002~.'
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN ~, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
.00
95.41
.00
95.41
CON~ONNEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
REV-I$~S EX AFP (Dg-Oo)
ZNFORHATZON NOTZCE
AND
TAXPAYER RESPONSE
FZLE NO. 21 02-0341
ACN O21229Z8
DATE 05-09-2002
RITA M KEIM
6018 HUMMINGBIRDtDR
MECHANICSBUR6 ~B~:17055
TYPE OF ACCOUNT
EST. OF ETHELNYN I KAUTZ [] SAVZNGS
S.S. NO. 205-10-9240 [] CHECKTNG
DATE OF DEATH 02-01-2002 [] TRUST
COUNTY CUMBERLAND [] CERTIF.
REMTT PAYMENT AND FORMS TO:
REGISTER OF NILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
MEMBERS 1ST FLU has provided the Department aith the information listed below ahich has been used in
calculating the potantial tax due. Thalr records indlcata that at the death of the above decadent, you Hare a joint omnmr/benmfioiary of
this account. If you feel this information ]s incorrect, please obtain aritten correction from the financial institution, attach a copy
to this for~ and return it to the above address. This account is taxable in accordance Hith the Inheritance Tax Lams of the Co~aon#ealth
of Pennsylvania. Questions may be ansHarad by calling (717) 787-8327.
COMPLETE PART 1 BELON x # # SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 8005-05 Data 11-16-1998
Established
Account Balance 3,168.81
Percent Taxable X 50.000
Amount Subject to Tax 1,58q.41
Tax Rate X .045
Potential Tax Due 71.30
To insure proper credit to your account, tho
(2) copies of this notice must accompany your
payment to the Register of Hills. Hake check
payable to: "Register of Hills, Agent".
NOTE: If tax payments are made Hithin three
($) months of the dacedent's date of death,
you may deduct a 5Z discount of the tax due.
Any inheritance tax due Hill become delinquent
nine (9) months after the date of death.
PART TAXPAYER RESPONSE
I. [] The above information and tax due is correct.
1. You may choose to remit payment to the Register of Hills with ted copies of this notice to obtain
CHECK m discount or avoid interest, or you may check box "A" and return this notice to the Register of
ONE ~ Hills and an official assessment will be issued by the PA Department of Revenue.
BLOCK ~ s. [] The above asset has been or will bm reported and tax paid with the Pennsylvania Inheritance Tax return
ONLY to be filed by the dacedant's representative.
C. [] The above information is incorrect and/or debts and deductions Here paid by you.
You must complete PART [] and/or PART [] belcH.
Tf you indicate a different tax rata, please state your
relationship to decedent:
RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
PART
TAX
LINE
1
3
$
6
7.
8.
Data Established 1
Account Balance ~
Percent Taxable 3 ~
Amount Subject to Tax 4
Debts and Deductions ~. -
Amount Taxable 6
Tax Rata 7 ~
Tax Due 8.
PART
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on Line $ of Tax Computation)
Under penalties of perjury, T declare that the facts Z have reported above ara true, correct and
~o the bast of .~ knowledge end belief. HOME ('~/ '~ ) ~/ q~-- -- ~ ~
UO K C
TAXPAYER SIG~AT~E TELEPHONE NUMBER DATE
Rita M. Keim
6018 Hummingbird Dr.
Mechanicsburg, PA 17050-2040
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT, 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
KEIM RITA M
2245 LAMBS GAP RD
ENOLA, PA 17025-1124
........ fold
ESTATE INFORMATION: SSN: 203-10-9240
FILE NUMBER: 2102-0341
DECEDENT NAME: KAUTZ ETHELWYN I
DATE OF PAYMENT: 08/12/2002
POSTMARK DATE: 08/10/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 02/01/2002
REV-1162 EX(11-96)
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
DUPLICATE
NO.
CD 001511
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
02122928 $71.30
REMARKS:
RITA M KEIM
TOTAL AMOUNT PAID:
$71.30
SEAL
CHECK# 3433
INITIALS: JA
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
.AW OFFICES OF
~RUNER ~.-HATCH~ P.C.
MMA ROAD, SUITE 100
PENNSYLVANIA 17043
D COUNTY COURTHOUSE
THE REGISTER OF WILLS
HOUSE SQUARE
IPA 17013
OFFICES OF
~RUN£R~&- H~
MMA ROAD, SUITE 100
!, PENNSYLVANIA 17043
D COUNTY COURTHOUSE
THE REGISTER OF WILLS
HOUSE SQUARE
'PA 17013
BUREAU OF INDIVIDUAL TAXES
TNHERTTANCE TAX
DEPT. 280601
HARRISBURG, PA 17128-0601
RITA M KEIM
6018 HUMMINGBIRD DR
MECHANICSBURG PA 17055
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTTCE OF TNHERTTANCE TAX
APPRAISEHENT,, ALLOHAHCE OR DISALLOHANCE
OF DEDUCT:IONS; AND ASSESSHENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
DATE 10-07-2002
ESTATE OF KAUTZ ETHELWYN
DATE OF DEATH 02-01-2002
FILE NUMBER 21 02-0541
COUNTY CUMBERLAND
SSN/DC 205-10-9240
ACN 02122928
I Amount Remitted I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~' RETAIN LOWER PORTION FOR YOUR RECORDS '~
REV-1548 EX AFP C01-02)
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 10-07-2002
ESTATE OF KAUTZ
ETHELWYN DATE OF DEATH 02-01-2002 COUNTY CUMBERLAND
FILE NO. 21 02-0541 S.S/D.C. NO. 205-10-9240 ACN 02122928
TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: MEMBERS 1ST FCU ACCOUNT NO. 8005-05
TYPE OF ACCOUNT: C ~ SAVINGS ( ) CHECKING C ) TRUST ( } TIME CERTIFICATE
DATE ESTABLISHED 11-16-1998
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
TAX CREDITS
5,168.81
X 0.500
1,584.41
- .00
1,584.41
X .45
71.50
NOTE:
TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
PAYMENT RECEIPT DISCOUNT C+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
08-10-2002 CDO01511 .00 71.50
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE [S LESS THAN 9[, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
71.50
.00
.00
.00
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 001800
MARK E HALBRUNER ESQUIRE
1013 MUMMA ROAD SUITE' 100
LEMOYNE, PA 17043
........ fold
ESTATE INFORMATION: SSN: 203-10-9240
FILE NUMBER: 2102-0341
DECEDENT NAME: KAUTZ ETHELWYN I
DATE OF PAYMENT: 11/01/2002
POSTMARK DATE: 10/31/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 02/01/2002
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $46.20
TOTAL AMOUNT PAID:
$46.20
REMARKS: MARK E HALBRUNER ESQUIRE
SEAL
CHECK# 2231
INITIALS: AC
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
F~_'(-1500 EX + (6-00)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECE-
DENT
CHECK
APPRO-
PRIATE
BLOCKS
CDR-
RE-
SPON
DENT
RECA-
PITULA-
TION
TAX
COMPU-
TATION
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Kautz, Bthelvyn Z.
DATEOFDEATH(MM-DD-YEAR)02/01/2002 IDATEOFBIRTHlMM-DD-YEAR)2/26/1920
(IFAPPLICABLE) SURVIVINGSPOUSESNAME(LAST, FIRST, AND MIDDLEINmAL)
OFFICIAL USE ONLY
FILE NUMBER
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
203-10-9240
THIS RETURN MUST BE FILED IN DUPLICATE
WITH THE REGISTER OF WILLS
SOCIAL SECURITY NUMBER
1. Original Return
4. limited Estate
6. Decedent Died Testate
(Attach copy of Will)
9. Litigation Proceeds Received
2. Supplemental Return
48. Future InterestComprcmise
~date of death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attacha copy of Trust)
10. Spousal PovertyCredit(date of death between
12-31-91 and 1-1-95)
3. Remainder Return
(date of death pdor to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
'~ 11. Election to tax under Sec. 9113(A)
(Attach Sch O)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE & CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME
Ma.Tk u. Halbru.ue~-, Bfq'u:Lz*e
FIRM NAME (If Applicable)
Gate-,, Halbz'~ne',* & Hat;ch,
TELEPHONE NUMBER
717-731-9600
COMPLETE MAlUNG ADDRESS
1013 MuteR Odd, Su~e 100
Lemoyna, PA 17043
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3, Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
$. Cash, Bank Deposits & Miscellaneous Personal
Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F)
E] Separate Billing Requested (6)
7. Inter-Vivos Transfers & Miscellaneous
Non-Probate Property (Schedule G or L)
0.60:
0.00
0.00
0.00
2,955.00
5,017.81
(7) 142,334.82
OFFICIAL USE ONLY
8. Total Gross Assets (total Lines 1-7) (8)
9. Funeral Expenses & Administralive Costs (Schedule H)(9) 14,193.09
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) ~, 434 · 05
11. Total Deductions (total lines 9 & 10) (11 )
12. Net Value of Estate (line 8 minus Line 11) (12)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax (13)
has not been made (Schedule J)
14. Net Value Subject to Tax (Une 12 minus line 13) (14)
155,325.43
20,626.14
1.29,681.49
0.00
129~681.49
15.
SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES
Amount of Line 14 taxable at the spousal tax
rate. or transfers un der Sec. 9116 (aX1.2) 0 · 0 0 X .00 (15)
16. Amount of Line 14 taxable at lineal rate 12 9,681· 49 x .045 (16)
17. Amount of Line ~4 taxable at sibling rat~ 0.0 0 X .12 (17)
18. Amount of Line 14 taxable at collateral rate 0,00 X .15 (18)
19. Tax Due (19)
20. ~ I CHECK HERE IF YOU ARE REQUESTING A REFUHD OF AN OVERPAYMENT J
0.00
5,835.67
0.00
0.00
5,83S.67
>> BE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND RECHECK MATH<<
0 PA15001 NTF 29755 Copyright2000G[eatland/Nelco LP- Forms Software Only
PA R~E-'V-1500 EX (6-00)
Decedent's Complete Address:
IsiH~-~-~ ADDRESS
Wear:: Bho~'e Ho<:h &Rehab
770 Popl~ (~huz*oh Road
CiTY
Page 2
Tax Paymei~L~ and CreGits:
ISTATE
ZIP
17011
Tax Due (Page I Line 19)
Credits/Payments
A. Spousal Poveriy Credit
B. Prior Payments
C. Discount
Interest/Penalty if applicable
D. Interest
E. Penalty
0.00
5,500.00
289.47
0.00
0.00
(1)
Total Credits (A + B + C) (2)
Total Interest/Penalty (D + E) (3)
5,835.67
5,789.47
0.00
4. If Line 2 is greater than Line I + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ....................................... ~ ~
b. retain the right to designate who shall use the property transferred or its income; .................
c. retain a reversionary interest; or ........................................................
d. receive the promise for life of either payments, benefits or cam? ..............................
2. If death occurred after December 12, 1982, did decedent transier 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? . .. r-~ ~ ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................ M ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury I declare that have exam ned th s return, nc uding accompanying schedules and statements, and to the best of my
knowledge and behef, it is true, correct and complete. Declaration of preparer other than the personal representative is based on information of
which preparer has any knowledge.
46.20
0.00
46.20
SIGNATUR O ERSON SPON IBLE F FILING RETURN
ADDRESS J.U.L~ _--_ ...... -_ ___o., ~u3. c~,~ iO0
Lmm:fy'ne, PA 17043
SIGNATUR~O~F PREPARE~ OT.,~-IER.,3;I-~AN .~~TIVE
AD D R E S S ~}/'/~,c~v'~- '~('~-' ~
Gates, Halbruner & Hatch, P.C , 1013
Mumma Rd., Ste. 100,
DATE
IO
DATE
Lemoyne, PA 17043
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed ~ the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. ! 9118 (a)(1,1) (i)].
For dates of death on or after ,January 1, 1995, the tax rate is imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. S 9116 (a)(1.1)(ii)].
The statute does flotexe mp~ a transfer to a surviving spouse from tax, and the statutory roqsirements 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:
T he tax rate imposed on th · net value of transfers fro m 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 step parent of the ch lid is 0% [72 P.S. §9118(aX1.2)].
The tax rate imposed on the net value of transfers to or for the use of the dscedent's lineal beaeficiaries is 4.5%, except as noted in ?2.P,S. § 9118(1.2) [72 P.S. § 9118(aX1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. § 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an in dividual
who has at least one parent in common with the decedent, whether by blood or adoption.
0 PA15002 NTF 29758 Copyright 2000 Greatland/Nelco LP- Forms Softw~Only
REV-I'508 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Knul:z, Bt:helwy'n Z. ._
Include proceeds of litigation & date proceeds were received by the estate. All prop. jointly-owned with right of survlvorshi 3 must be dlsc!_n_~ed on Sch. F.
ITEM
NO. DESCRIPTION
1. MJ. sool].an~ou. L2o:F.onn3. ~'~ez't:y
(eeo nt:t:nohed nppra:l, anZ)
2 1988 Chev2rolet: atnt:l, on Wngon
V'F~IO1,.TC8117,T,.T2 612 7 S
(vn].ue pa= ]~ADA app=n:l, an].)
TOTAL (Also enter on tine 5, Recapitulation) $
VALUE AT
DATE Of DEATH
1,330.00
1,625.00
2,955.00
0 PA15081 NTF 33305
(If more space is needed, insert additionaJ sheets of the same size)
Copyright 2000 Greatlafld/Nelco LP - Forms Software Only
' REV-'~509 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF FILE NUMBER
K&u[s, u~holwlm Z. ..
If an asset was made joint within one year of the decedent's date of death, It must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Ko4-,,, Ri~a M. Daugh~or
6018 R~,,--,,t ngbizd Ds*ire
bohiniolburg, PA 17055
JOINTLY-OWNED PROPERTY:
DESCRIPTION OF PROPI=RTY
LETTER DATE Include name of financial institution and bank % OF DATE OF DEATH
ITEM FOR MADE
JOINT account number or similar identifying number. DATE OF DEATH DECD'S VALUE OF
NO, TENANT JOINT Attach deed for jointly-held real estate, VALUE OF ASSET INTEREST DECEDENT'S INTERES]
,',ion
Savings ~count
I~ot. B'o. 8005-00
2 & 03/28/1974 JO.l£iz'st: Bank 1,24,5.41 50.00 622.71
Chaoking A~ooun~
A~c~. !o. 0050320831
3 & 11/16/1998 I~mbers 1st. Federal C=o4:Lt U 3,168.81 50.00 1,584.4,0
n:Lon
&~t. ~o. 0005-05
t i 11/15/1~5 ~embers 1st ~eda~al C~adl~ U 5,$95.$7 50.00 2,7~7.70
mion
~he~king ~aount
~ct. !~o. 0005-11
TOTAL (Also enter on line 6, Recapitulation) $ 5,017.01
(If more space is needed, insert additional sheets of the same size)
0 PA15091 NTF 33308 Copyright 2000 Greatland/Nelco LP- Forms Software Only
REV-~I510 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Keats · uthelvl~ Z. ._
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROP~Hi¥ % OF
INCLUDE NAME OF THE TRANSFEREE, THEIR
ITEM RELATIONSHIP TO DECD & DATE OF TRANSFER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
NO. ATrACH COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE)
XnvolCmont SaYingl Aooon~t
Acer. !~O. 181163-05
(trane£erred to Truer on 01/14/
1999)
2 1. On llov---~er 18, 1998, Uthelv 0.00 100.00 0.00 0.00
yn Z. I:autz aatabliahed The Eau
ts Family (Xrrevooable) Trust b
y end between herael£ ae Settle
r end her granddaughter, Lori
· hiley, am Trustee. Pe~ &trio
lo 4.03 o£ the T~uet, upon the
death o£ the Settlor· the
ntng t~uet estate eb~ll be
ributed to Settlor ti grenddaugh
tar, Lori A. Mailey. The £ollo
ring ia a aunnaFF o£ the T~uat
3 One-atoFy, aingle-£ancLl¥ dvelli 113,000.00 100.00 0.00 113,000.00
ng legated at 2245 Lmnba 4bp
ad, Basle, ~--herland C~ounty,
enne¥1venta~ being Ten PLTooX
o. 10-12-2983-008; trena£erred
by Btbelvyn Z. Kautz to The Kau
tz Family T~uat by deed dated
ovm-her 18, 1998, and recorded
eoveaber 24, 1998, in Deed Book
180, page 860. Valuation pe~ a
trashed appraisal.
· Xembera let Federal ~redit Ohio 129.06 100.00 0.00' 120.06
Savinga acoount
Asst. !~o. 181163-00
(trena£erred to Trust on 01/14/
1999)
S Meanbera lot Federal Credit Unio 315.97 100.00 0.00 315.97
a
Chaoking Account
;-cot. IWo. 181163-11
(trana£orred to Truat on 04/13/
1999)
TOTAL (AJs0 enter 0n fine ?, Recapi~ta~on) $ 142,334.82
0 PA15101 NTF 33307
(If more space is needed, insert additional sheets of the same size)
Copyright 2000 Greatland/Nelco LP - Forms Software Only
' REV-i511EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
K-,u~s, B~JaolvFz~ Z. ..
Debts of decedent must be reported on Schedule I.
ITEM
NO,
A.
1.
9
10
11
12
13
DESCRIPTION
FUNERAL EXPENSES:
l~lno~&l Qoods
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN No. of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
Attomey Fees llamot ~a~og, HalbruneE & Ha~uh, 9.~.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Tax Retum Preparer's Fees
xocaA ~.;,~ co~cinuacAon pagll ....
TOTAL (Also enter on line 9, Recapitulation) $
AMOUNT
3,670.00
0.00
5,000.00
0.00
25.00
0.00
0.00
5,000.00
27.25
29.50
28.00
37.34
75.00
aOo.uo
14,192.09
(If more space is needed, insert additional sheets of the same size)
0 PA15111 NTF 33308 Copyright 2000 Greatland/Nelco LP- Forms Software Only
Estate of: Kautz, Ethelwyn I.
Schedule H, Part B -- Administrative Costs
Item
Description
14
RSR Appraisers & Analysts
real estate appraisal
Page 2
Amount
300.00
TOTAL. (Carr~ forward to main schedule) ...... 300.00
' REV-~512 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES,& LIENS
ESTATE OF FILE NUMBER
Kentz, B~elw]m Z. ..
Include unreimbursed medical expenses.
ITEM
NO.
1.
2
5
7
9
lO
11
12
13
14,
15
16
17
18
19
DESCRIPTION
-"-~z~.~_y t~ans~G~t to Holy Sptrlt Hospltel
AT&T
phone aedile
C~ao~ C~Xe
c~le so--ice
xn~o~al R~ue Series
2001 para.aX Ano~ t~ Xi~AIAty
phone ao~A~o
The Steo ~o.
AT&T
phone servtoe
Pinnaole Health HospitaZs
medioal ball
~,-~erland Valley Land Cleaxing
dunpeter rented to olean house
Colleoteoh Systa~-, Zno.
va=izon C~uniaatione, Zno. past due aaoou
nt
AT&T Wireless
cellula= phone sezvioe
Best pennsboro Ambulance Berries
emerganoy medioaX transport
eleotrio eer~ioe
Centuz~r Spouttn~ Co., Zno.
Services oontraoted £or by B~belu3rn Z. Keut
· prior to her death and paid e£ter her den
th.
PPL Utilities
oleotrio servioe
phone eervioe
Eatbx-yn W. Fetrow, Treas%L~er
2002 Real Berate Tms
TOTAL (Also enter on line 10, Recapitulation) $
AMOUNT
27.77
57.36
71.87
450.92
33.80
604.00
28.91
75.00
53.54
297.91
256.70
32.68
11.02
60.00
29.68
4,000.00
23.88
53.07
265.84
6,434.05
(If more space is needed, insert additional sheets of the same size)
Copyright 2000 Greatland/Nelco LP - Forms Software Only
0 PA15121 NTF 3330g
REV-~513 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
£$TATE OF
FILE NUMBER
K&ut:z, ut. helwyn Z.
NUMBER
I
1.
II
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outfight spousaJ distributions, and
transfers under Sec. 9116 (a) (1.2)]
ll~tley'~ Lo~:I. A.
c-,,tonsv:Ll:Le, 2',220
Ko:LIn, R:Lt:& M.
603.8 H,,,,,.,,tngb:L~d D~*:I.'~'e
b~han:l.~bu~g, PA 3.7055
RELATIONSHIP TO DECEDENT
DO Not MSt Trustee(s)
Daughl:e~
AMOUNT OR SHARE
OF ESTATE
124,663.68
5,017.81
ENTER DOLLAR AMTS. FOR DISTRIBS. SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -- ENTER TOTAL NON-TAXABLE DISTRIBS. ON LINE 13 OF REV-1500 COVER SHEET
$ 0.00
(If more space is needed, insert additional sheets of the same size)
0 PA15131 NTF 33293 Copyright 2000 Graatland/Nalco LP- Forms Softwara Only
DEATH CERTIFICATE
LAST WILL AND TESTAMENT
OF
ETHELWYN I. KAUTZ
LAST WILL AND TESTAMENT
O_EF
ETHELWYN I. KAUTZ
I, ETHELWYN I. KAUTZ, now of 2245 Lambs Gap Road, Enola,
Cumberland County, Pennsylvania 17025, do publish and declare this
to be my Last Will and Testament, hereby revoking all other prior
wills and codicils made by me.
FIRST: Family Background and ADpointment of ~Yecutor.
(A) Family and Background Infor~_atio~. I am widowed. I was
married to ROBERT KAUTZ. My children are RITA M. KEIM and ROBERT
R. KAUTZ. Throughout this Will, RITA M. KEIM and ROBERT R. KAUTZ
will be referred to as "my children". The word "issue" will include
my children as well as my other descendants (excluding adopted
issue).
(B) Appointment of Executor. I appoint as my Executrix and
successor Executrix (all hereinafter referred to as Executrix or
Executor(s) under this Will, the following named persons or
corporations to serve without bond and without being required to
account to any Court:
Executrix: My granddaughter, LORI A. MAILEY.
Successor Executrix: My daughter, RITA M. KEIM.
(C) Inter Vivos Trust. The inter vivos trust agreement
referred to in this Will is entitled "THE KAUTZ FAMILY IRREVOCABLE
TRUST", by and between myself as Settlor and my granddaughter, LORI
A. MAILEY, as Trustee, as now in effect or as may hereafter be
amended.
SECOND: Funeral and Last Illness ExDenses; Taxes.
(A) ExDenses of Funeral and Last Illness. I direct my
Executrix to pay my funeral expenses (regardless of amount) and the
expenses of my last illness from my estate.
(B) Taxes. I direct my Executrix to pay any and all estate,
inheritance, succession, legacy, transfer and other death ta~s or
duties, by whatever name called, including any and all inter~ and
penalties thereon, imposed under the laws of any jurisdiction by
reason of my death upon or with respect to any and all [fr6Dertv
LAST WILL AND TESTAMENT
OF
ETHELWYN I. KAUTZ
PAGE 2
included in my gross estate for the purpose of such taxes, whether
such property passes under or outside of this Will. Without any
apportionment otherwise required by law and without being prorated
or apportioned among or charged against the respective devises,
legatees, beneficiaries, transferees, or other recipients of any
such property or charged against any property passing or which may
have passed to any of them, I direct that any taxes so paid shall
be charged against my residuary estate. My Executrix shall not be
entitled to reimbursement for any portion of any such taxes from
any such person. The foregoing provisions of this Article SECOND
shall not apply to such portion or portions of said taxes, interest
and penalties which may be required to be paid, or are actually
paid or reimbursed, by the Trustee of the Trust described in
Paragraph FIRST (C), above.
THIRD: Tangible Personal Property. Except for those items
excluded below and those items enumerated in the Letter of
Instruction, I bequeath all my tangible personal property,
including but not limited to clothing, jewelry, heirlooms,
furniture, household furnishings, personal effects, motor vehicles,
and all other similar articles, which I own, and the insurance
thereon, to my granddaughter, LORI A. MAILEY. Tangible personal
property shall not include: (1) any and all property used by me in
any business, (2) cash on hand or on deposit in banks, (3) stock or
securities, (4) any type of evidence of indebtedness, and (5) any
life, health or accident insurance policies.
If my granddaughter, LORI A. MAILEY, does not survive me, I
leave such tangible personal property to my children, in as nearly
equal shares as is practical, per stirpes. If there is any
disagreement as to distribution, I direct my Executrix to make such
distribution. The decision of my Executrix shall be final and
binding. Any items not selected or any items which my Executrix
considers unsuitable for my children may be distributed or sold in
the sole discretion of my Executrix and, if sold, the net proceeds
therefrom shall be added to the residue of my estate. Any such
article allocated to a minor may, as my Executrix deems advisable,
either be delivered to the minor or to any person to safeguard on
behalf of the minor.
Notwithstanding any other provisions in this Article THIRD, I
may leave a separate, dated and unsigned Letter of Instru ~on,
which I shall place with my Will, containing directions ast 7the
ultimate disposition of certain of the property bequeathed ~der
LAST WILL AND TESTAMENT
O__F
ETHELWYN I. KAUTZ
PAGE 3
this Article THIRD, and such Letter of Instruction shall determine
the distribution of such items.
FOURTH: Residuary Estate. I devise and bequeath all of the
rest, residue and remainder of my estate, real, personal and mixed,
of whatever nature and wherever situated to which I am legally or
equitably entitled, to the then-acting Trustee of the Trust
described in Paragraph FIRST (C) of this Will, to be held,
administered and distributed pursuant to the terms thereof, as the
same may be amended from time to time. By this devise and bequest
of my residuary estate I hereby exercise all Powers of Appointment
I possess at the time of my death except any power of appointment
which I possess under the Trust described in Paragraph FIRST (C) of
this Will.
FIFTH: Powers of Executrix. In addition to the powers and
duties as may have been granted elsewhere in this Will, but subject
to any limitations stated elsewhere in this Will, the Executrix
shall have and exercise exclusive management and control of the
Estate and shall be vested with the following specific powers and
discretion, in addition to the powers as may be generally conferred
from time to time upon the Executrix by law:
(A) In the management, care and disposition of the Estate,
the Executrix shall have the power to do all things and to execute
such instruments, deeds, or other documents as may be deemed
necessary or proper, including the following powers, all of which
may be exercised without order of or report to any Court:
(1) To sell, exchange or otherwise dispose of any
property at any time held or acquired hereunder, at public or
private sale, for cash or on terms, without advertisement,
including the right to lease for any term notwithstanding the
period of the Estate, and to grant options, including any
option for a period beyond the duration of the Estate.
(2) To invest all monies in such stocks, bonds,
securities, mortgages, notes, choses in action, real estate or
improvements thereon, and any other property as the Executrix
may deem best, without regard to any law now or hereafter
enforced limiting investments of fiduciaries.
(3) To retain for investment any property deDosi~
the Executrix hereunder.
LAST WILL AND TESTAMENT
o_g
ETHELW~N I. KAUTZ
PAGE 4
(4) To vote in person or by proxy any corporate stock or
other security and to agree to or take any other action in
regard to any reorganization, merger, consolidation,
liquidation, bankruptcy or other procedure or proceedings
affecting any stock, bond, note or other security.
(5) To use attorneys, real estate brokers, accountants
and other agents, if such employment is deemed necessary or
desirable, and to pay reasonable compensation for their
services.
(6) To compromise, settle or adjust any claim or demand
by or against the Estate and to agree to any rescission or
modification of any contract or agreement affecting the
Estate.
(7) To renew any indebtedness, as well as to borrow
money, and to secure the same by mortgaging, pledging or
conveying any property of the Estate.
(8) To retain and carry on any business in which the
Estate may acquire an interest, to acquire additional interest
in any such business, to agree to the liquidation in kind of
any corporation in which the Estate may have an interest and
to carry on the business thereof, to join with other owners
in adopting any form of management for any business or
property in which the Estate may have an interest, to become
or remain a partner, general or limited, in regard to any such
business or property and to hold the stock or other securities
as an investment, and to employ agents and confer on them
authority to manage and operate the business, property or
corporation, without liability for the acts of such agent or
for any loss, liability or indebtedness of such business if
the management is selected or retained with reasonable care.
(9) To register any stock, bond or other security in the
name of a nominee, without the addition of words indicating
that such security is held in a fiduciary capacity, but
accurate records shall be maintained showing that such
security is a Estate asset and the Executrix shall be
responsible for the acts of such nominee.
(B) Whenever the Executrix is directed
Estate assets in fee simple to a person who is
to distribu~ any
then un~
LAST WILL AND TESTAMENT
ETHELWYN I. KAUTZ
PAGE 5
one (21) years of age, the Executrix shall be authorized to hold
such property in Trust for such person until he/she becomes twenty-
one (21) years of age, and in the meantime shall use such part of
the income and the principal of the Estate as the Executrix may
deem necessary to provide for the proper support and education of
such person. If such person should die before becoming twenty-one
(21) years of age, the property then remaining in trust shall be
distributed to the personal representative of such person's estate.
(C) In making distributions from the Estate to or for the
benefit of any minor or other person under a legal disability, the
Executrix need not require the appointment of a guardian, but shall
be authorized to pay or deliver the same to the custodian of such
person, to pay or deliver the same to such person without the
intervention of a guardian, to pay or deliver the same to a legal
guardian of such person if one has already been appointed, or to
use the same for the benefit of such person.
(D) In the disbursement of the Estate and any division into
separate trusts or shares, the Executrix shall be authorized to
make the distribution and division in money or in kind, or both,
regardless of the basis for income tax purposes of any property
distributed or divided in kind, and the distribution and division
made and the values established by the Executrix shall be binding
and conclusive on all persons taking hereunder. The Executrix may
in making such distribution or division allot undivided interests
in the same property to several trusts or shares.
(E) The Executrix shall be authorized to lend or borrow,
including the right to lend to or borrow from any trusts which I
may have established during life or by will at an adequate rate of
interest and with adequate security, and upon such terms and
conditions as the Executrix shall deem fair and equitable.
(F) The Executrix shall be authorized to sell or purchase at
the fair market value as determined by the Executrix, any property
to or from any trust created by me during life or by Will, even
though the same person or corporation may be actingas Executrix of
my estate or as Trustee of any of my other trusts.
(G) The Executrix shall have discretion to determine whether
items should be charged or credited to income or prlnclp~_ or
allocated between income and principal as the Executrix m~Y~eem
equitable and fair under all the circumstances, includi~g~h~er_~
LAST WILL AND TESTA~W. NT
O_EF
ETHELWYN I. KAUTZ
PAGE 6
to amortize or fail to amortize any part or all of any premium or
discount, to treat any part or all of the profit resulting from the
maturity or sale of any asset, whether purchased at a premium or at
a discount, as income or principal or apportion the same between
income and principal, to apportion the sales price of any asset
between income and principal, to treat any dividend or other
distribution of any investment as income or principal, or apportion
the same between income and principal, to charge any expense
against income or principal or apportion the same, and to provide
or fail to provide a reasonable reserve against depreciation or
obsolescence on any assets subject to depreciation or obsolescence,
all as the Executrix may reasonably deem equitable and just under
all the circumstances. If the Executrix does not exercise the
above discretionary power, the cash or accrual allocation shall be
in accordance with Chapter 81 of Title 20 of the Pennsylvania
Consolidated Statutes, or the corresponding provisions of
subsequent state law.
(H) If at any time the total fair market value of the assets
of any trust established or to be established hereunder is so small
that the corporate Trustee's annual fee for administering the trust
would be the minimum annual fee set forth in the Trustee's
regularly published fee schedule then, in effect, the Trustee in
its discretion shall be authorized to terminate such trust or to
decide not to establish such trust, and in such event the property
then held in or to be distributed to such trust shall be
distributed to the persons who are then or would be entitled to the
income of such trust. If the amount of income to be received by
such persons is to be determined in the discretion of the Trustee,
then the Trustee shall distribute the property among such of the
persons to whom the Trustee is authorized to distribute income, and
in such proportions, as the Trustee in its discretion shall
determine.
(I) Except as otherwise provided in this Will, when the
authority and power under this Will is vested in two (2) or more
Executrixes or Trustees, the authority and powers are to be held
jointly by the Executrixes or Trustees, respectively. A majority
of the Executrixes or Trustees may exercise any authority or power
granted under this Will or granted by law, and may act under this
Will. Any attempt by one such Executrix or Trustee to act under
this Will on other than ministerial acts shall be void. The action
of one such Executrix or Trustee under this Will may be valuated
by a subsequent ratification of the act by a ma jo 'r~the
LAST WiLL AND TESTaMeNT
0!
ETHELWYN I. KAUTZ
PAGE 7
Executrixes or Trustees.
SIXTH: Riqhts and Liabilities of ~Yecutrix ~-d Trustee.
(A) No bond or other security shall be required of any
Executrix.
(B) This instrument always shall be construed in favor of the
validity of any act or omission by any Executrix, and any Executrix
shall not be liable for any act or omission except in the case of
gross negligence, bad faith or fraud. Specifically, in assessing
the propriety of any investment, the overall performance of the
entire Estate shall be taken into account.
(C) Each Executrix shall be entitled to receive reasonable
compensation for services actually rendered to my estate, in an
amount the Executrix normally and customarily charges for
performing similar services during the time which she performs the
services.
SEVENTH: Tax Elections.
(A) In determining the estate, inheritance and income tax
liability relating to my Estate, the Executrix's decision as to all
available tax elections shall be conclusive on all concerned. In
accordance with IRC Section 2632(a) and without regard to whether
a Federal estate tax return is actually filed, my Executrix shall
allocate so much of the Federal Generation Skipping Transfer (GST)
exemption amount as will fully exempt any generation skipping
transfer which may occur under this Will.
(B) The Executrix may, in its discretion, determine the date
as of which my gross estate shall be valued for the purpose of
determining the applicable tax payable by reason of my death.
(C) The Executrix may, in her discretion, decide whether all
or any part of certain deductions shall be taken as income tax
deductions (even though theymay equal or exceed the taxable income
of my estate and whether or not claimed or of benefit on my
estate's income tax return) or as estate tax deductions when a
choice is available; and in the event that all or any part of such
deductions are taken as income tax deductions, no adjust~t of
income and principal accounts in my estate shall be ma~e;~ ~
result of such decisions.
LAST WILL AND TESTAmeNT
0!
ETHELW~N I. KAUTZ
PA~E 8
EIGHTH: Spendthrift Provision. No beneficiary shall have the
power to anticipate, encumber or transfer his or her interest in
the estate in any manner other than by the valid exercise of a
power of appointment. No part of the estate shall be liable for or
charged with any debts, contracts, liabilities or torts of a
beneficiary or subject to seizure or other process by any creditor
of a beneficiary.
NINTH: Definitions and ~eneral Provisions.
(A) Survival. Any beneficiary who dies within sixty (60)
days after my death shall be considered not to have survived me.
(B) Captions. The captions set forth in this Will at the
beginning of the various articles hereof are for convenience of
reference only and shall not be deemed to define or limit the
provisions hereof or to affect in any way their construction and
application.
(C) Children. As used in this Will, the words "child" and
"children" shall include persons who are legally adopted and the
issue of said persons, whether born in or out of wedlock, so long
as any person born out of wedlock is acknowledged in a written
instrument executed by the one of their natural parents who is a
descendant of mine to be the child of said descendant. The word
"issue" shall include descendants of all generations including
adopted persons. A posthumous child shall be considered as living
at the death of his parent. The birth to me or the adoption by me
of a child or children subsequent to the execution of this Will
shall not operate to revoke this Will.
(D) Code. Unless otherwise stated, all references in my Will
to section and chapter numbers are to those of the Internal Revenue
Code of 1986, as amended, or the corresponding provisions of any
subsequent federal tax laws applicable to my estate.
(E) Other terms. The use of any gender includes the other
genders, and the use of either the singular or the plural includes
the other.
(F) Powers of Appointment are ~-~-ercised. By this Will I
timeeXerciSeof myanYdeathand all Powers of Appointment which I possess/air]the
except any power of appointment which I/po~sess
under the Trust described in Paragraph FIRST (C), abo
LAST WILL AND TESTAMENT
O__F
ETHELWYN I. KAUTZ
PAGE 9
IN WITNESS WHEREOF, I, ETHELWYN I. KAUTZ, the Testatrix, have
to this my Last Will and Testament, typewritten on ten (10) pages,
including the Acknowledgment and Affidavit, set my hand and seal
this 18th day of November, 1998.
Signed., sealed, published and declared by the above-named
Testatrix, as and for her Last Will and Testament, in the presence
of us, who have hereunto subscribed our names at her request, as
witnesses hereto, in the presence of the said Testatrix, and in the
presence of each other. Each of us further declares that he or she
believ~.~ the Testatrix to be of sound mind and memory. The
prece~ng instrument consists of this and nine (9) other
consecutively numbered typewritten
~ckn( ~l~gement and Affidavit. pages including the
(pr] nt name)
(print name)
ACKNOWLEDGMENT AND AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA :
:
COUNTY OF CUMBERLAND :
SS:
The Testatrix and the witnesses whose names are signed and
subscribed to the attached or foregoing instrument, being first
duly sworn and qualified according to law, do hereby acknowledge,
depose and say to the undersigned authority, that the Testatrix
signed and executed the instrument as her Last Will in the presence
of the witnesses; that she signed it willingly or willingly
directed another to sign it for her; that she executed it as her
free and voluntary act for the purposes therein expressed; that
each of the witnesses were present and saw the Testatrix sign and
execute the instrument as her Last Will; that each subscribing
witness in the hearing and sight of the Testatrix signed the will
as witnesses; 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.
Sworn to or affirmed, subscribed to, and acknowledged, before
me by the above-named Testatrix and witnesses, this 18th day of
~ot]ary Pub]~fc U /
My Co~ission E~ires:
Notarial Seal
Linda Lee Gates, Notary Public
Shiremanstown Boro, Cumberland County
Commission Expires Oct. 9, 1999
. i,;aoer, Pennsylvania Association of Notaries
THE KAUTZ FAMILY TRUST
dated November 18, 1998
THE
KAUTZ FAMILY
TRUST
THIS TRUST AGREEMENT is executed in triplicate on this 18th
day of November, 1998, by and between ETHELWYN I. KAUTZ, now of
2245 Lambs Gap Road, Enola, Cumberland County, Pennsylvania 17025
(hereinafter called "Settlor") and LORI A. MAILEY, now of 3 K
Roberts Path, Sparks, Maryland, 21152 (hereinafter called
"Trustee").
ARTICLE I. TRUST ESTATE
1.01. Initial Principal. Settlor, desiring to establish
an irrevocable trust, does hereby irrevocably transfer, assign and
deliver to the Trustee and its successors, and assigns the assets
listed on Schedule A, attached hereto and made a part hereof. As
further evidence of such assignment, the Settlor has executed or
will execute or cause to be executed such other instruments as may
be required for the purposes of completing the assignment or
transfer of title to such property to the Trustee. The Trustee
accepts such transfer and assignment to itself as Trustee, and
undertakes to hold, manage, invest and reinvest the assets of this
Trust, and to distribute the income and principal of the Trust in
accordance with the provisions of this Agreement.
1.02. Additional Principal. The Settlor and any other
person or persons, with the consent of the Trustee, shall have the
right at any time to make additions to the corpus of this Trust or
any share thereof hereby established. Ail such additions shall be
held, governed, and distributed by the Trustee in accordance with
the terms and conditions of this Agreement. The Trustee, in its
sole discretion, may require, as a prerequisite to accepting
property, that the transferring party provide evidence satisfactory
to the Trustee that (i) the property is not contaminated by any
hazardous or toxic materials or substances; and (ii) the property
is not being used and has never been used for any activities
directly or indirectly involving the generation, use, treatment,
storage, disposal, release or discharge of any hazardous or toxic
materials or substances.
1.03 Disclaimer. The Trustee shall have the right to
disclaim, in whole or in part, prior to its acceptance by the
Trustee, any interests in property for any reason, including but
not limited to a concern that such property could cause potential
liability under any federal, state, or local environmental law.
1
ARTICLE II. IRREVOCABILITY OF TRUST
2.01. Irrevocability. Settlor has been advised of the
consequences of an irrevocable trust and hereby declares that this
Trust shall be irrevocable and shall not be altered, amended,
revoked, or terminated by Settlor or any other person or persons.
ARTICLE III. LIFE INSURANCE POLICIES
3.01. General Provisions. If any insurance policies are
transferred into this Trust, the Trustee shall be vested with all
right, title, and interest in and to the transferred policies of
insurance, and is authorized and empowered to exercise and enjoy,
for the purposes of the Trust herein created and as absolute owner
of such policies of insurance, all the options, benefits, rights
and privileges under such policies, including the right to borrow
upon and to pledge them for a loan or loans. The Trustee takes all
rights, title, and interest in and to the above stated insurance
policies subject to any prior split-dollar life insurance agreement
and assignments, which may be in effect at the time of transfer.
The insurance companies which have issued policies are hereby
authorized and directed to recognize the Trustee as absolute owner
of such policies of insurance and as fully entitled to all options,
rights, privileges, and interests under such policies, and any
receipts, releases, and other instruments executed by the Trustee
in connection with such policies shall be binding upon all persons
interested in this Trust. The Settlor hereby relinquishes all
rights, title, interest and powers in such policies of insurance
which Settlor may own and which rights, title, interest and powers
are not assignable, and will, at the request of the Trustee,
execute all other instruments reasonably required to effectuate
this relinquishment.
3.02. Payment of Premiums. The Trustee shall be under no
obligation to pay the premiums which may become due and payable
under the provisions of any policy of insurance which may be
transferred or assigned to this Trust, or to make certain that such
premiums are paid by the transferor of such policy, or to notify
any persons of the nonpayment of such premiums, and the Trustee
shall be under no responsibility or liability of any kind in case
such premiums are not paid, except the Trustee shall apply any
dividends received on such policies to the payment of premiums
thereon. Upon notice at any time during the continuance of this
Trust that the premiums due upon such policies are in default, or
that premiums which will become due will not be paid, either by the
transferor or by any other person, the Trustee, within its sole
discretion, may apply any cash values attributable to such policy
to the purchase of paid-up insurance or of extended insurance, or
may borrow upon such policy for the payment of premiums due
thereon, or may accept the cash values of such policy upon the
policy's forfeiture. In the event that the Trustee receives the
cash value of such policy upon its forfeiture for nonpayment of
premiums, the amount received shall be added to the corpus of this
Trust, and shall be administered according to the terms of this
Agreement. If the insured under such policies of insurance,
becomes totally and permanently disabled within the meaning of any
policies and because thereof the payment of premiums, or any of
them, shall during the pendency of such disability, be waived, the
Trustee, upon receipt of such knowledge, shall promptly notify the
insurance company which has issued such policies, and shall take
any and all steps necessary to make such waiver of premium
provision effective.
3.03. Duties of Trustee With Regard to Life Insurance
Policies. The Trustee shall be under no obligation or duty
whatever except with respect to the safekeeping of such policies of
insurance and the duty to receive such sums as may be paid to them,
in accordance with the requirements of this Trust, by the companies
issuing such policies, and to hold, manage and disburse such
proceeds subject to the terms of this Agreement. Upon the death of
the insured, the Trustee shall make reasonable efforts to carryout
the provisions of this Agreement, including the maintenance or
defense of any suit, provided, however, the Trustee shall be under
no duty to maintain or enter into any litigation unless its
expenses, including counsel fees and costs, have been advanced or
guaranteed in an amount and in a manner reasonably satisfactory to
the Trustee. The Trustee may repay any advances made by it or
reimburse itself for any such fees and costs from any corpus or
income of this Trust.
ARTICLE IV. TRUST DISTRIBUTIONS
4.01. Trust PrinciDal. The entire corpus of this Trust,
including the assets initially transferred to this Trust,
subsequent additions to this Trust, and the proceeds of any sale,
exchange or investment of such Trust assets, shall be used for the
purposes herein contained.
4.02. Income Distribution. During the Settlor's lifetime,
the Trustee shall distribute all of the net income of the trust to,
or for the benefit of, ETHELWYN I. KAUTZ. The Trustee shall make
no distributions of principal to ETHELWYN I. KAUTZ.
4.03. Principal Distributions. Upon the death of the
Settlor, the Trust shall terminate. Upon termination, the
remaining trust estate shall be distributed to Settlor's
granddaughter, LORI A. MAILEY, per stirpes. If the Settlor's
granddaughter, LORI A. MAILEY, predeceases the termination of this
Trust, then her share shall be distributed equally to her issue,
per stirpes. If the Settlor's granddaughter, LORI A. MAILEY,
predeceases the termination of this Trust without leaving issue,
then her share shall be distributed to Settlor's granddaughter,
LISA M. HOCH, or in the event that LISA M. HOCH does not survive,
then to Settlor's great-granddaughter, MELISSA M. HOCH.
3
4.04. General Power of Appointment. Settlor's
granddaughter, LORI A. MAILEY, is hereby granted the general power
to appoint some or all of the principal of this Trust to herself,
her estate, her creditors, the creditors of her estate, in such'
proportions and upon such terms (in trust, outright gifts, or in
any other manner) as she deems advisable. This power shall not be
exercisable under her Will. If Settlor's granddaughter fails,
either in whole or in part, to exercise this general power of
appointment herein granted, the unappointed principal shall
continue in trust and shall be administered according to the terms
of this Trust. Upon the death, resignation, removal or incapacity
of Settlor's granddaughter, then Settlor shall have the authority
to designate any person, other than herself, her creditors, or her
estate, or her agents, successors or assigns, with the authority to
exercise this General Power of Appointment.
4.05. Broad Special Power of Appointment. ETHELWYN I.
KAUTZ is hereby granted the special power to appoint, at any time
and from time to time, the principal of this Trust, in whole or in
part, and in any manner and in such proportions as she deems
advisable to whomever she desires. This power shall be exercisable
by her Will, specifically referring to this special power of
appointment in this paragraph 4.05 of this Trust. This special
power of appointment does not grant to ETHELWYN I. KAUTZ the power
to appoint the principal of this trust to herself, her estate, her
creditors, or the creditors of her estate. If ETHELWYN I. KAUTZ
fails, either in whole or in part, to exercise this special power
of appointment herein granted, the unappointed principal shall
continue in trust and shall be administered according to the terms
of this trust.
ARTICLE V. POWERS OF TRUSTEE
5.01. General Powers. In addition to such other powers
and duties as may have been granted elsewhere in this Trust, but
subject to any limitations contained elsewhere in this Trust, the
Trustee shall have the following powers and duties:
A. In the management, care and disposition of this Trust, the
Trustee shall have the power to do all things and to execute such
deeds, instruments, and other documents as may be deemed necessary
and proper, including the following powers, all of which may be
exercised without order of or report to any court:
(1) To sell, exchange, or otherwise dispose of any
property, real, personal or mixed, wheresoever located,
at any time held or acquired hereunder, at public or
private sale, for cash or on terms as may be determined
by the Trustee, without advertisement, including the
right to lease for any term notwithstanding the period of
the Trust, and to grant options, including an option for
a period beyond the duration of the Trust.
(2) To invest all monies in such stocks, bonds,
securities, investment companies or trust shares,
mortgages, notes, choses in action, real estate,
improvements thereon, and other property as the Trustee
may deem best, without regard to any law now or hereafter
in force limiting investments of fiduciaries.
(3) To retain for investment any property deposited
with the Trustee hereunder.
(4) To vote in person or by proxy any corporate
stock or other security and to agree to or take any other
action in regard to any reorganization, merger,
consolidation, liquidation, bankruptcy or other procedure
or proceedings affecting any stock, bond, note or other
security held by this Trust.
(5) To use lawyers, real estate brokers,
accountants and any other agents, if such employment is
deemed necessary or desirable, and to pay reasonable
compensation for their services.
(6) To compromise, settle or adjust any claim or
demand by or against the Trust and to agree to any
rescission or modification of any contact or agreement
affecting the Trust.
(7) To renew any indebtedness, as well as to borrow
money, and to secure the same by mortgaging, pledging or
conveying any property of the Trust, including the power
to borrow from the Trustee (in the Trustee's individual
capacity) at a reasonable rate of interest.
(8) To retain any business interest transferred to
the trustee, as shareholder, security holder, creditor,
partner or otherwise, for any period of time whatsoever,
even though the interest may constitute all or a large
portion of the trust principal; to comply with the
provisions of any agreement restricting transfer of the
interest; to participate in the conduct of the related
business or rely upon others to do so, and to take or
delegate to others discretionary power to take any action
with respect to its management and affairs which an
individual could take as outright owner of the business
or the business interest, including the voting of stock
(by separate trust or otherwise regardless of whether
that separate trust will extend for a term within or
beyond the term of the trust) and the determination of
all questions of policy; to execute and amend partnership
agreements; to participate in any incorporation,
reorganization, merger, consolidation, sale of assets,
recapitalization, liquidation or dissolution of the
business, or any change in its nature, or in any buy-
sell, stock restriction, or stock redemption agreements;
to invest in additional stock or securities of, or make
secured, unsecured, or subordinated loans to, the
business with trust funds; to take all appropriate
actions to prevent identify, or respond to actual or
threatened violations of any environmental law or
regulation thereunder; to elect or employ with
compensation, as directors, officers, employees, or
agents of the business, any persons, including a trustee
of any trust held under this instrument, or any director,
officer, employee, or agent of a corporate trustee of
any trust held under this instrument, without adversely
affecting the compensation to which that trustee would
otherwise be entitled; to rely upon reports of certified
public accountants as to the operations and financial
condition of the business, without independent
investigation; to deal with and act for the business in
any capacity (including in the case of a corporate
trustee any banking or trust capacity and the loaning of
money out of the trustee's own funds) and to be
compensated therefor; and to sell or liquidate the
business or any interest in the business.
(9) To register any stock, bond or other security
in the name of a nominee, without the addition of words
indicating that such security is held in a fiduciary
capacity, but accurate records shall be maintained
showing that the stock, bond or other security is a trust
asset and the Trustee shall be responsible for the acts
of the nominee.
(10) To set aside as a separate trust, to be held
and administered upon the same terms as those governing
the remaining trust property, any interests in property,
for any reason, including but not limited to a concern
that such property could cause potential liability under
any federal, state, or local environmental law.
B. Whenever the Trustee is directed to distribute any trust
principal in fee simple to a person who is then under twenty-one
(21) years of age, the Trustee shall be authorized to hold such
property in trust for such person until he becomes twenty-one (21)
years of age, and in the meantime shall use such part of the income
and the principal of the trust as the Trustee may deem necessary to
provide for the proper support and education of such person in the
standard of living to which he has become accustomed. If such
person should die before becoming twenty-one (21) years of age, the
property then remaining in trust shall be distributed to the
personal representative of such person's estate.
6
C. In making distributions from the Trust to or for the
benefit of any minor or other person under a legal disability, the
Trustee need not require the appointment of a ~uardian, but shall
be authorized to pay or deliver the distribution to the custodian
of such person, to pay or deliver the distribution to such person
without the intervention of a guardian, to pay or deliver the
distribution to the legal guardian of such person if a guardian has
already been appointed, or to use the distribution for the benefit
of such person.
D. In the distribution of the Trust and any division into
separate trusts and shares, the Trustee shall be authorized to make
the distribution and division in money or in kind or in both,
regardless of the basis for income tax purposes of any property
distributed or divided in kind, and the distribution and division
made and the values established by the Trustee shall be binding and
conclusive on all persons taking hereunder. The Trustee may in
making such distribution or division allot undivided interests in
the same property to several trusts or shares.
E. If at any time after Settlor's death the total fair market
value of the assets of any trust established or to be established
hereunder is so small that the corporate Trustee's annual fee for
administering the trust would be equal to or less that the minimum
annual fee set forth in the Trustee's regularly published fee
schedule, then the Trustee in its discretion shall be authorized to
terminate such trust or to decide not to establish such trust, and
in such event the property then held in or to be distributed to
such trust shall be distributed to the persons who are then or
would be entitled to the income of such trust. If the amount of
income to be received by such persons is to be determined in the
discretion of the Trustee, then the Trustee shall distribute the
property among such of the persons to whom the Trustee is
authorized to distribute income, and in such proportions, as the
Trustee in its discretion shall determine.
F. The Trustee shall be authorized to lend or borrow,
including the right to lend to or borrow from the Settlor's
estate, at an adequate rate of ±nterest and with adequate security
and upon such terms and conditions as the Trustee shall deem fair
and equitable.
G. The Trustee shall be authorized to sell or purchase, at
the fair market value as determined by the Trustee, any property to
or from Settlor's estate, the estate of Settlor's spouse, or any
trust created by Settlor or Settlor's spouse during life or by
will, even though the same person or corporation may be acting as
executor of Settlor's estate or the estate of Settlor's spouse or
as trustee of any other such trusts and as the Trustee of this
Trust.
H. The Trustee shall have discretion to determine whether
items should be charged or credited to income or principal or
allocated between income and principal as the Trustee may deem
equitable and fair under all the circumstances, including the power
to amortize or fail to amortize any part or all of any premium or
discount, to treat any part or all of the profit resulting from the
maturity or sale of any asset, whether purchased at a premium or at
a discount, as income or principal or apportion the same between
income and principal, to apportion the sales price of any asset
between income and principal, to treat any dividend or other
distribution on any investment as income or principal or to.
apportion the same between income or principal, to charge any
expense against income or principal or apportion the same, and to
provide or fail to provide a reasonable reserve against
depreciation or obsolescence on any asset subject to depreciation
or obsolescence, all as the Trustee may reasonably deem equitable
and just under all of the circumstances.
I. The Trustee is hereby authorized and empowered to purchase
such insurance policies as it deems appropriate.
5.02. Voting by Trustee. When the authority and power
under this Trust is vested in two (2) or more Trustees or Co-
Trustees, the authority and powers are to be jointly by the
Trustees or Co-Trustees. A majority of the Trustees or Co-Trustees
may exercise any authority or power granted under this Trust
Agreement or granted by law, and may act on behalf of the Trust.
Any attempt by one such Trustee to act for the Trust on other than
ministerial acts shall be void. The action of one such Trustee on
behalf of the Trust may be (but need not be) validated by a
subsequent ratification of the act by a majority of the Trustees or
Co-Trustees.
5.03 Trustees Power to Deal with ~nvironmental Hazards.
The Trustee shall have the power to use and expend the trust income
and principal to (i) conduct environmental assessments, audits, and
site monitoring to determine compliance with any environmental law
or regulation thereunder; (ii) take all appropriate remedial action
to contain, clean up or remove any environmental hazard including
a spill, release, discharge or contamination, either on its own
accord or in response to an actual or threatened violation of any
environmental law or regulation thereunder; (iii) institute legal
proceedings concerning environmental hazards or contest or settle
legal proceedings brought by any local, state, or federal agency
concerned with environmental compliance, or by a private litigant;
(iv) comply with any local, state or federal agency order or court
order directing an assessment, abatement or cleanup of any
environmental hazards; and (v) employ agents, consultants and legal
counsel to assist or perform the above undertakings or actions.
Any expenses incurred by the trustee under this paragraph may be
charged against income or principal as the trustee shall determine.
ARTICLE VI. SPENDTHRIFT PROVISION
6.01. General Provision. No beneficiary shall have the
power to anticipate, encumber or transfer his interest in the Trust
Estate in any manner other than by the valid exercise of a Power of
Appointment. No part of the Trust Estate shall be liable for or
charged with any debts, contracts, liabilities or torts of a
beneficiary or subject to seizure or other process by any creditor
of a beneficiary.
ARTICLE VII. CONSTRUCTION OF TRUST
7.01. Choice of Law. This Trust shall be administered and
interpreted in accordance with the laws of the Commonwealth of
Pennsylvania.
7.02. Code. Unless otherwise stated, all references in
this Trust to section and chapter numbers are to those of the
Internal Revenue Code of 1986, as amended, or corresponding
provisions of any subsequent federal tax laws applicable to this
Trust.
7.03. Other Terms. Unless the context otherwise requires,
the use of one or more genders in the text includes all other
genders, and the use of either the singular or the plural in the
text includes both the singular and the plural.
7.04. Captions. The captions set forth in this Agreement
at the beginning of the various divisions hereof are for
convenience of reference only and shall not be deemed to define or
limit the provisions hereof or to affect in any way their
construction and application.
7.05. Situs of Trust. The Trust shall have its legal
situs in Cumberland County, Pennsylvania.
ARTICLE VIII.
COMPENSATION OF TRUSTEE AND
APPOINTMENT OF SUCCESSOR TRUSTEE
8.01. Compensation. The Trustee shall receive as its
compensation for the services performed hereunder that sum of
money, based on an hourly charge or percentage rate, which the
Trustee normally and customarily charges for performing similar
services during the time which it performs these services.
8.02. Removal of Trustee. Settlor may remove the Trustee,
at any time or times, with or without cause, upon thirty (30) days
written notice given to the current Trustee. Upon the death of the
Settlor, a majority of the current beneficiaries may remove the
Trustee, at any time or times, with or without cause, upon thirty
(30) days written notice given to the Trustee. Upon the removal of
the Trustee, a successor Trustee shall be appointed in accordance
with the terms set forth in Paragraph 8.03.
8.03. Appointment of Successor Truste~. The Trustee may
resign at any time upon thirty (30) days written notice given to
the Settlor if Settlor is living, or in the event of Settlor's
death, upon thirty (30) days written notice given to the current
beneficiary or beneficiaries (including a beneficiary's natural or
legal guardian or legal representative), hereunder. Upon the
death, resignation, removal or incapacity of the Trustee, a
successor trustee may be appointed by the Settlor during Settlor's
lifetime, or, after Settlor's death, by a majority of the current
income beneficiaries. The first successor Trustee shall be RITA M.
KEIM. Any other successor trustee shall be a financially sound and
competent corporate trustee. Any successor trustee thus appointed,
or, if the Trustee shall merge with or be consolidated with another
corporate fiduciary, then such corporate fiduciary, shall succeed
to all the duties and to all the powers, including discretionary
powers, herein granted to the Trustee.
8.04. Exoneration of Trustee. No Trustee shall be liable
for any loss or depreciation in value sustained by the Trust as a
result of the Trustee retaining any property upon which there is
later discovered to by hazardous materials or substances requiring
remedial action pursuant to any federal, state, or local
environmental law, unless the Trustee contributed to the loss or
depreciation in value through willful default, willful misconduct,
or gross negligence.
8.05. Indemnification of Trustee Upon Distribution.
Notwithstanding any contrary provision in this Trust Agreement, the
Trustee may withhold a distribution to a beneficiary until
receiving from the beneficiary an indemnification an agreement in
which the beneficiary agrees to indemnify the Trustee against any
claims filed against the Trustee as an "owner" or "operator" under
the Comprehensive Environmental Response, Compensation and
Liability Act of 1980, as from time to time amended, or any
regulation thereunder.
ARTICLE IX. PERPETUITIES CLAUSE
9.01. General Provision. Notwithstanding anything to the
contrary in this Trust, each disposition I have made here, legal or
equitable, to the extent it can be referred in its postponement of
becoming a vested interest to a duration measured by some life or
lives in being at the time of my death is definitely to vest in
interest, although not necessarily in possession, not later that
twenty-one (21) years after such lives (and any period of gestation
involved); or, to the extent it cannot be referred in any such
postponement to such lives, is to so vest not later than twenty-one
(21) years from the time of my death.
10
ARTICLE X.
ACQUISITION OF UNITED STATES TREASURY BONDS
ELIGIBLE FOR TAX PAYMENT; PAYMENT OF TAXES, FUNERAL
EXPENSES, AND EXPENSES OF ADMINISTRATION
10.01. Acquisition of Bonds. The Trustee may, at any time,
without the prior approval or direction of the Settlor and whether
or not the Settlor is able to manage Settlor's own affairs, acquire
United States Treasury Bonds selling at a discount, which bonds are
redeemable at their par value plus accrued interest thereon for the
purposes of applying the proceeds to the payment of the United
States estate tax on the Settlor's estate; and the Trustee may
borrow from any lender, including itself, with or without security,
to so acquire these bonds.
10.02. Payment of United States Estate Tax by Bond
RedemDtion. The Settlor directs that any United States Treasury
Bonds which may be redeemed at their par value plus accrued
interest thereon for the purpose of applying the proceeds to the
payment of the United States estate tax imposed on the Settlor's
estate, and which are held by the Trustee, shall, to the extent of
the amount determined to be required for payment of the estate tax,
be distributed to the legal representative of the Settlor's estate
to be used by the legal representative ahead of any other assets
and to the fullest extent possible to pay the estate tax.
10.03. Payment of Death Taxes and Other Estate Settlement
Costs. After the Trustee has complied with paragraph 10.02, above,
and ascertained from the legal representative that all such bonds
have been redeemed in payment of the United States estate tax, the
Trustee shall also ascertain from the legal representative whether
the legal representative has sufficient assets to pay the remaining
legacy, succession, inheritance, transfer, estate and other death
taxes or duties (except the additional estate tax imposed by
Section 2032(c), or corresponding provisions of the Internal
Revenue Code of 1986 applicable to the Settlor's estate and
imposing the tax) levied or assessed against the Settlor's estate
(including all interest and penalties thereon), all of which taxes,
interest and penalties are hereafter referred to as the death
taxes, interest and penalties. If the legal representative advises
the Trustee that insufficient funds exist to pay all the death
taxes, interest and penalties, the Trustee shall then pay to the
legal representative from the trust property, an amount equal to
all the death taxes, interest and penalties in excess of the funds
available to the legal representative for this purposes, which
payments are to be made without apportionment. In making the
payments, the Trustee shall use only those assets or their proceeds
which are includable in the Settlor's gross estate for purposes of
the United States estate tax and shall not impair the marital
portion without first exhausting the entire non-marital portion.
11
If the Executor of the Settlor's estate, in such Executor's
sole discretion, shall determine that appropriate assets of
Settlor's estate are not available in sufficient amount to pay (1)
the Settlor's funeral expenses, and (2) expenses of administering
the Settlor's estate, the Trustee shall, upon the request of the
Executor of the Settlor's estate, contribute from the principal of
the trust estate the amount of such deficiency; and in connection
with any such action the Trustee shall rely upon the written
statement of the Executor of the Settlor's estate as to the
validity and correctness of the amounts of any such expenses, and
shall furnish funds to such Executor so as to enable such Executor
to discharge the same, or to discharge any part of all thereof
itself by making payment directly to the person entitled or
claiming to be entitled to receive payment thereof. No
consideration need be required by the Trustee from the Executor of
Settlor's estate for any disbursement made by the Trustee pursuant
hereto, nor shall there be any obligation upon such Executor to
repay to the Trustee any of the funds disbursed by it hereunder,
and all amounts disbursed by the Trustee pursuant to the authority
hereby conferred upon it shall be disbursed without any right in or
duty upon the Trustee to seek or obtain contribution or
reimbursement from any person or property on account of such
payment. The Trustee shall not be responsible for the application
of any funds delivered by it to the Executor of the Settlor's
estate pursuant to the authority herein granted, nor shall the
Trustee be subject to liability to any beneficiary hereunder on
account of any payment made by it pursuant to the provisions
hereof.
IN WITNESS WHEREOF, the Settlor and Trustee have hereunto set
their~nds and seals as of the day and year first above written.
(SEAL)
12
COMMONWEALTH OF PENNSYLVANIA :
COUNTY OF CUMBERLAND :
SS:
On this, the 18th day of November, 1998, before me, a Notary
Public, the undersigned officer, personally appeared ETHELWYN I.
KAUTZ, known to me (or satisfactorily proven) to be the person
whose name is subscribed to the within Trust Agreement, and
acknowledged that she executed the same for the purposes therein
contained.
IN WITNESS WHEREOF, I have set my hand and official Seal.
~ot/ary Public 7 ./
My Co(~-u,ission Expires:
Notarial Seal
Llnda Lee Gates, Notary Public
Shiremanstown Boro, Cumberland County
My Commission Expires Oct. 9,'19~
r,",~mber, Pennsylvania Association of Notaries
foregoing Trust Agreement was delivered, and is hereby
at Lemoyne, Pennsylvania, on November 18, 1998.
X~-_ (SEAL)
13
SCHEDULE "A"
SCHEDULE
REFERRED TO IN THE ANNEXED
TRUST AGREEMENT
DATED: NOVEMBER 18, 1998
FROM ETHELWYN I. KAUTZ,
SETTLOR
TO LORI A. MAILEY,
TRUSTEE
ProPerty Description:
14
PA REV-1500
SCHEDULE E
CASH, BANK DEPOSITS &
MISCELLANEOUS PERSONAL
PROPERTY
APPRAISAL
Personal Property of ~'~2-A/'~/- Z~'),'A/~.~ v 7-2- z=:.s~ .2 -2_ z/~-Z .~,~ES',~ 4- ?/z d z::.,u e z4 /04,
Appraised by Chuck E. Bricker AU094-L Date c~'-'/~ - ~..~.
ITEM VALUE ITEM VALUE
~~ /o,~
DEPARTMENT OF TRANSPORTATION
CERTIFICATE OF TITLE FOR A VEHICL~~0~979
issued itt accordance with Section 1105 of the Vehicle Code, Title 75, Peonsylvania Cottsolidated Statutes
031007 882180011001462-001
ETHELNYN I KALTZ
2245 LAMBS GAF RD
ENOLA PA 1702..c
" o%64a%Ol ' .... "
CODELEGEND
A = ANTIQUE VEHICLE
C = CLASSIC VEHICLE
F = OUT OF STATE VEHICLE
H = AGRICULTURAL VEHICLE
L = LOGGING VEHICLE~
'P~ FORMERL¥"A~ POLICE, VEHICLE
R = RECONSTRUCTED VEHICLE
X FORMERLY A TAXI"~'~' ~
0
SECOND LIEN FAVOR OF:
LIEN RELEASED
FL~I-;N'rATI V E
DATE
I certify that reasonable diligence has been used itt examining the statements
presented in the application for Certificate of Title to the vehicle described hereon,
and that the proof of ownership of said vehicle presented with said appllcatioa
warrants the issuance of this certificate uaming the applicant tls lanful owner of
said vehicle. Wherefore. I certify that as of the date inscribed hereon, the official
records of the Pennsylvania Department of Transportation reflect that said
applicant is the lawful owner oJ'said vehicle.
LIEN Hal,DER
BY
· N. ADA Appraisal Gu/des - Get a Value - Older Used Cars - Domestic Page 1 of 2
NADJ~~.S~-- Your Destination for Free Vehicle Information .H~.me I e.uy.a...Ou..Pe. I .F^O. I _C.~.0.B.C.t..U_S. Powere
Free Price Quote J Find a Car I Find a Dealer I Buy a Vehicle I Sell a Vehicle I Free Finance Quote I Free Insurance
~/arra[Lty_ I _C4msumer_I/ps I I~ew Car_Ee~ e~s I _(33~mkX_our_C~li_t I
The Rece~nized Authority Si~
Older Used Car Consumer Pricing 1983 to 1991
CHE.VRO.LET
1988
CAVALIER-FWD
Body Style: Station Wagon 4 Door
Model Number: JC8
Weight: 2,413
Low Retail: $975
Average Retail: $1,625
High Retail: $2,050
Free.
Free
Click below on the first letter of the Manufacturer's Name.
[-A I B ICI_DI_E IEILI U IOI P]
[ Domestic Cars I Import Ca_~m. J Trucks, Vans & SUVs ]
You have received I of the ! 0 free daily values for Older Used Cars - Domestic
Low Retail Value -- A Iow retail vehicle may have extensively visible wear and tear. Th,
body may have dents and other blemishes. The buyer can expect to invest in
and/or mechanical work. It is likely that the seats and carpets will have visible
vehicle should be able to pass local inspection standards and be in safe running
Low retail vehicles usually are not found on dealer lots.
Average Retail Value -- An average retail vehicle should be clean and without glarin
defects. Tires and glass should be in good condition. The paint should match and have
good finish. The interior should have wear in relation to lhe age of the vehicle. Carpet
seat upholstery should be clean, and all power options should work. The mileage should be
within the acceptable range for the model year. An Average Retail vehicle on a dealer lot
may include a limited warranty or guarantee, and possibly a current safety and/or emission
inspection (where applicable).
High Retail Value -- A high retail vehicle should be in flawless condition. All power
http://www2.nadaguides.com/ValueReport.asp?UserlD=053F02041E0&DID=37313&Typ... 2/26/2002
PA REV-1500
SCHEDULE F
JOINTLY OWNED PROPERTY
Membersl
FEDERAL CREDIT UNION
INSURANCE DEPARTMENT
5000 Louise Drive
P. O. Box 40
Mechanicsburg, PA 17055
1-800-283-2328 or (717) 697-1161
ACCOUNTNAME:
..REGULAR SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Interest Earned from 1/1/02 to Date of Death
Name of Joint Owner
Date Joint Ownership Created
!NVESTMENT SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Interest Earned from 1/1/02 to Date of Death
Name of Joint Owner
Date Joint Ownership Created
CHECKING ACCOUNT.
Account Number/Suffix
Date Account Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Interest Earned from 1/1/02 to Date of Death
Name of Joint Owner
Date Joint Ownership Created
Ethelwyn I. Kautz
8005 -00 181163 -00
08/19/1965 01/14/1999
$25,82 $129.06
$.oo $.oo
$25.82 $129.06
$.00 $.19
Rita M. Keim None
11/16/1998
8005 --05 181163 -05
11/16/1998 01/14/1999'
$3,168.81 $28,889.79
$.oo $.oo
$3,168.81 $28,889.79
$4.81 $50.95
Rita M. Keim None
11/16/1998
8005 -11 181163 -11
02/26/1982 04/13/1999
$5,595.57 $315.97
$.oo $.oo
$5,595.57 $315.97
$4.72 $.00
Rita M. Keim None
11/16/1998
ME~'~ERS 1sT FEI;~A~DIT UNION
Insurance Products Supervisor
April 2, 2002
Estate of: ETHELWYN I. KAUTZ
Date of Death: February 1, 2002
Social Security Number: 203-10-9240
allfirst
March 28, 2002
Gates, Halbruner & Hatch, P.C.
Att: Traci L. Sepkovic
1013 Mumma Road, Suite 100
Lemoyne, PA 17043
Allfirst Financial Center N.A.
P.O. Box 900
Millsboro. DE 19966
Dear Ms. Sepkovic:
Estate of Ethelwyn I. Kautz
Date of Death: February 1, 2002
Social Security Number: 203-10-9240
In response to your request, please be advised that at the time of death, the above-
named decedent had on deposit with this bank the following accounts.
Account 7'iipe ........................... Golden Age Checking Account
Account Number. ...................... 0050320831
Ownership (Names of) ............... Ethelwyn I. Kautz or Rita M. Keim or Robert Kautz
Opening Date ........................... 03/28/74
Balance on Date of Deattt .......... $1,245.41
Accrued Interest. ...................... 0.00
Total ...................................... $1,245.41
o
Account 7~pe ........................... Safe Deposit Box
Account Number. ...................... 00001000553100001140
Ownership (Names of) ...............Ethelwyn I. Kautz Closed 2/8/02
This reSl~Omse does not apply to any assets held with Al~fl~st Bro&erage, where Al~Itrst Bank is servin~ as a
t~tee, nor to any credit cards owned by Bank of America bearing Al~first l~mks's name
· Page 2
March 28, 2002
If you have any further questions on these accounts, please contact the branch of
record: 423 North Enola Road, Enola, PA 17025, telephone 717-255-2261.
Sincerely,
Mary Anne Macielag
Associate I/CIS
{302) 934-2240
PA REV-1500
SCHEDULE G
INTER-VIVOS TRANSFERS and
MISCELLANEOUS NON-PROBATE
PROPERTY
Membersl
FEDERAL CREDIT UNION
INSURANCE DEPARTMENT
5000 Louise Drive
P. O. Box 40
Mechanicsburg, PA 17055
1-800-283-2328 or (717) 697-1161
ACCOUNTNAME:
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Interest Earned from 1/1/02 to Date of Death
Name of Joint Owner
Date Joint Ownership Created
INVESTMENT SAVINGS ACCOUNT'
Account Number/Suffix
Date Account Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Interest Earned from 1/1/02 to Date of Death
Name of Joint Owner
Date Joint Ownership Created
CHECKING ACCOUNT.
Account Number/Suffix
Date Account Opened
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Interest Earned from 1/1/02 to Date of Death
Name of Joint Owner
Date Joint Ownership Created
d Ethelwyn I. Kautz
8005 -00 181163 -00
08/19/1965 01/14/1999
$25,82 $129.06
$.oo $.oo
$25.82 $129.06
$.oo $.19
Rita M. Keim None
11/16/1998
8005 -05 181163 -05
11/16/1998 01/14/1999
$3,168.81 $28,889.79
$.oo $.oo
$3,168.81 $28,889.79
$4.81 $50.95
Rita M. Keim None
11/16/1998
8005 -11 181163 -11
02/26/1982 04/13/1999
$5,595.57 $315.97
$.oo $.oo
$5,595.57 $315.97
$4.72 $.00
Rita M. Keim None
11/16/1998
Oenise A. Anoers
Insurance Products Supervisor
April 2, 2002
Estate of: ETHELWYN I. KAUTZ
Date of Death: February 1, 2002
Social Security Number: 203-10-9240
TAX PARCEL NO.
10-12-2983-008
DEED
THIS DEED is made the 18th day of November, in the year nin~e~i
hundred and ninety-eight (1998). mo
BETWEEN ETHELWYN I. KAUTZ, a widow, now of 2245 Lambs Gap Road~-
Enola, Cumberland County, Pennsylvania, 17025, party of the ~s~
part, GRANTOR. ~ ~-
AND ~ -~.....
LORI A. MAILEY, Trustee of THE KAUTZ FAMILY TRUST, dated Nove~er[
18, 1998, party of the second part, GRANTEE.
WITNESSETH, that said party of the first part, for and in
consideration of the sum of One ($1.00) Dollar, lawful money of the
United States of America, well and truly paid by the said party of
the second part to the said party of the first part, at or before
the sealing and delivery of these presents, the receipt whereof is
hereby acknowledged, has hereby granted, bargained, sold, aliened,
enfeoffed, released, conveyed and confirmed, and by these presents
does grant, bargain, sell, alien, enfeoff, release, convey and
confirm unto the said party of the second part, her heirs,
successors and assigns,
ALL THAT CERTAIN house and tract of land situate in the Township of
Hampden, County of Cumberland and State of Pennsylvania, bounded
and described as follows, to wit:
BEGINNING at a point on the Lamb's Gap Road at the corner of lands
now or formerly of Wilson E. Forney; thence along said lands of'
Wilson E. Forney in a westwardly direction seven hundred twenty-
three and five-tenths (723.5) feet to a point at the corner of
lands now or formerly of Mike Cekovic; thence along said land of
Mike Cekovic in a northwardly direction two hundred forty (240)
feet to a point at the corner of other lands now or formerly of
Paris D. Wilfong and Flora I. Wilfong; thence along said lands of
Paris D. Wilfong and Flora I. Wilfong in an eastwardly direction
seven hundred fifty-six (756) feet to a point in the aforementioned
Lamb's Gap Road; thence along the said road in a southwardly
direction two hundred thirty-five (235) feet to a point on said
road, the place of BEGINNING.
CONTAINING four (4) acres of land more or less and having erected
thereon a ranch-type dwelling house.
BEING the same premises which Paris D. Wilfong and Flora I.
Wilfong, his wife, by their deed dated December 2, 1952, and
recorded in the Recorder of Deeds Office of Cumberland County, in
Deed Book E, Volume 15, Page 169, granted and conveyed unto Robert
Kautz and Ethelwyn I. Kautz, husband and wife. Robert Kautz died
October 20, 1998, survived by his wife, Ethelwyn I. Kautz, thereby
vesting full and complete title under operation of law in Ethelwyn
I. Kautz, GRANTOR herein.
THIS is a transfer for nominal consideration to a trustee of an
living trust.
TOGETHER with all and singular the buildings and improvements,
ways, streets, alleys, driveways, passages, waters, watercourses,
rights, liberties, privileges, hereditaments and appurtenances,
whatsoever unto the hereby granted premises belonging, or in any
wise appertaining, and the reversions and remainders, rents,
issues, and profits thereof; and all the estate, right, title,
interest, property, claim, and demand whatsoever of the said
Grantor, as well at law as in equity, of, in, and to the same.
TO HAVE AND TO HOLD, the said lot or piece of ground above-
described, with all and singular the buildings and improvements
thereon erected, hereditaments and premises hereby granted, or
mentioned and intended so to be, with the appurtenances, unto the
said Grantee, her heirs and assigns, to and for the only proper use
and behoof of the said Grantee, her heirs and assigns forever.
AND the said Grantor, for herself, her heirs, executors and
administrators, does covenant, promise and agree, to and with the
said Grantee, her heirs and assigns, by these presents, that she,
the said Grantor, and her heirs, all and singular the hereditaments
and premises hereby granted or mentioned and intended so to be,
with the appurtenances, unto the said Grantee, her heirs and
assigns, against her, the said Grantor and her heirs, and against
all and every person and persons whomsoever lawfully claiming or to
claim the same or any part thereof, by, from or under him, her,
them or any of them, shall and will, subject as aforesaid,
SPECIALLY WARRANT AND FOREVER DEFEND.
IN WITNESS WHEREOF, the said party of the first part has hereunto
set he~:~hand and seal, the day and year first above-written.
COMMONWEALTH OF PENNSYLVANIA :
:
COUNTY OF CUMBERLAND :
SS:
On this, the 18th day of November, 1998, before me, a Notary
Public for the Co~k~Lonwealth of Pennsylvania, the undersigned
officer, personally appeared ETHELWYN I. KAUTZ, known to me (or
satisfactorily proven) to be the person whose name is subscribed to
the within instrument, and acknowledged that she executed the same
for the purpose therein contained.
seal.
IN WITNESS WHEREOF, I have
hereunto set my hand and notarial
N6thry Publ%c /~
My Commission Expires:
Notadal Seal I
Linda Lee Gates, Notary Public
Shiremanstown Bom, Cumberland County
COMMONWEALTH OF PENNSYLVANIA : ~ Uy Commission Expires Oct 9,1999
: SS: L
COUNTY OF CUMBE~ Member, Pennsylvan a As~9~mtion:.. . .. or. No~s.%.:..,
for said County, in Deed Book No ~a~e ~,~3 .:~,,~.~%~.,:~,:~,:.t.~,-~--..--.
WITNESS my hand and official seal this ~) I day of
Recorder of Dee~s
CERTIFICATE OF RESIDENCE
~ here~y certify that the present residence of
The Ka~tz Famlly Trust ~.~:J.,'~
3K Roberts Path
Sparks, ~ 21152
RETURN DEED TO:
The Kautz Family Trust
Lori A. Mailey, Trus%ee
3K Roberts Path
Sparks, MI) 21152
Actor
fey for Grantee
CLEMENT A. LEO
2ca1-1 Ip
]
AI~PRAISAL OF
A SINGLE FAMILY RESIDENCE
L O C A T I O N : 2245 Lambs Gap Road
Enola
PA
17025
CLIENT
: Gates 8, Associales
1013 Mumma Road, Lemoyne, PA 17043
AS OF DATE :Februao/1,2002
APPRAISER :ClementA. Leo, CREA
CLEMENT A. LEO
Gates & Associates
1013 Mumma Road, Lemoyne, PA 17043
In accordance with your request, I have personally
inspected aud appraised tile property located at:
2245 Lambs Gap Road
Enola PA 17025
The pu ~rp?sc of thc appraisa was to estimate the market
value ol tile property, as improved, n unencumbered Ice
simple title of ownership.
The subject property consists of:
Rooms
3 J~cdroolllS
1.0 Bath(s)
The Ranch style residence contains
Gross l.iving Area.
it is my opinion that tile estimated market value of the
property ils of February 1, 2002 is $ 113,000
The above inlbrmation has been automatically extracted
l?om thc appraisal and inscrlcd in this cover page.
1,168 square t~et of
Respectfully submitted,
Clement A. Leo, CREA
Property Description UNIFORM RESIDENTIAL APPRAISAL ,.EPORT
File No. 2cal-11p
Rroperty Address 2245 Lambs Gap Road City Enola Slate PA Zip Code 17025
Legal Description Deed Book 15E, Page 169 County Cumberland
_ Assessor's Parcel No 10-12-2983 Tax Year01 RE Taxes $ 0.00Special Assessments
Borrower Est ut Ethel Wynnkautz
, .--- Current Owner Es of EhelWynnkautz Occupant: [XlOwner I jTena~t
t Property rights appra,sed j X iFee Simple~-JLeasehold prelect Tv e ' PU 1-1Condominium (HUDNA only) HOASN/A
I ~hborhood or Project N;me 'P ~ I D _
Map Reference 10-12-2983 Census Tract 0113
S~ Pri~ $ N/A Date of Sale NIA D~on ~ $ amouul of loan charges/concessions Io be paid by sel~er N/A
L~er/Client Gales & Associates A~ess 1013 Mumma Road, Lemoyne, PA 17~3
Clement A Leo
A~ss RSR, 308 Eas~ Penn Drive, Enola, PA 17025
Nlup ~ lover75% I~l ' I I Ioccupancy I $ib00~ (y,~ IOnefam'ly 80J X'Nolhkel
~'"~te I--IR~>'u I~1stau~ I- Is~°~. IlXlow"~ I 100 Low New 12-4famil~ 1.~J
Pf~eRy value ~lncreasing
~supply ~Sho.age ~t~b.,e ~ea,n,ngl~Tenant I 500H,gh 901Uu,,,.,a;y
~".~,~v~,..,~I~vace.,(o.?l ~eUom,..~, Ico~al 51
~eting timer ~Under3mos. iA 13~m~. IIo~.11 Ivac~.,(o~,5,~)l 170 40I
Note: Race and the racial composition ef the neighbo~d are not appraisal factors.
~hborhood boundaries and characterisacs: Subj~t is I~ ~Rh ut Roule 944 We~ville Road on Lambs Gap Road.
F~s that aff~I the markelability of the pro~s in the neigh~d (proximi~ In employment and amenities, emplo~enl stability, appeal to
~ neighborhh~ is comprised of propel/es re~fing similar Jn ~lity, maintenance, design and appeal. Availabili~ for this neighborh~ of mos~
s~es combined with average access Io em~ymenl, shopping ~ schools gives a similar appeal Io Ihe market on olher nearby neighborh~ds.
Market condilions in the subiecl neighborhood (including support fa ii~e alive conclusions related Io Ihe Irend of properly values, demand/supply, and marketing time
-- such as data on competitive properties for sale in the neighborhood, description of the prevalence of sales and financing concessions, etc.):
Oveall market conditions are considered stable, morlgage interest rates are available at 6.5% Io 7.5% for 30 years. Marketing time and demand/supFly a:e -
fa' similar areas in this market. New construction aclivily is moderale. No adverse marketability neighborhood factors were evident.
Project Information for PUDs (If applicable) - - Is the devek)per/builder in control of the Home Owner's Association (HOA)? i _jYes ~',:
' Approximate total number of units ~n the subject project N/A Approximate total number of units for sale in the subject project N A
I facilities: N/A
Dimensions
Topography Level
S,tearea 4Acres CornerLotl ryes jxlNolSize Average for area
Speclhc zomng classd~cation and descriptionR-C Residential CountPj __ JShape Rectangular
Zoning compliance j X I Legal [jLegal nonconlorming (G,aedfalhaed use) ~-~lllegal I J No zoning JDrainage Good
H~lhest 8, best use as impraved: p X~ Present use j Other use (e~alain) JView Average
[~!ililies P~ublic Other JOri-site Improvements Type Public Pdvale]Landscaping Average
I:,ecmc]ty J_~ JStree, Macadam ~.~ ~__~JDr,vewaysurface Macadam
Gas J_~ JCurb/gutter
Water j__j Private JSidewalk L I I I IApparent easemenls None noted
San"fY sewer I j Private JStree, I,ghts ~ j~/FEMA Spec,al Flood Hazard Area
Slormsewer I ! IAIley t I ] IIFEMAZ°ne C Map Date 2/15 78
I r I I IFEMA Map No. 420360A
Cou~aems (apparent adverse easemenls, encroachments, special assess.~i~, slide areas, illegal or legal nonconforming zoning use, etc)i No adverse easements.
encroachmenls or special assessments noted at time of inspection.
GENERAL DESCRIPTION IEXTERIOR DESCRIPTION FOUNDATION BASEMENT !INSULATION
No. o~ Units One ~Foundation Conc Block Slab No Area Sq. Ft. 1.168 Roof
No. of Stories One ~Extarior Walls Per Stone/Alu~ Crawl Space No % Finished None Ceihng
Type (Dm./Att.) Delached JRoof Surface Asp Shingle Basement Full Ceiling Joisls Walls
Design (Style) Ranch IGulters & Dwnspls. Alum Sump Pump No
:r Existing/Proposed Existing Walls Conc Block Floor
i Age (Yrs.) 54 Years None
J Window Type DH Dampness None noted Floor Conc ; -
I Storm/Screens Yes Seltlement None noted Dulside EnI~/ Yes Unknown '
E#ecl~veA,~e (Yrs.) 20 Years IManulactured House NO infestation None noted --
ROOMSI F°yer I Living I Dining JKitchenJ J J J
Bas~ntl I I I Oen =am,y.m. Rec. Rm. Sedr! .s # Bat~s Leundr~ J ,her J Area Sq Pt
Levet l J I 1 I 1 I ~ . 1 0
~: INTERIOR MatedalstCoedilion HEATING KITCHEN EQUIP. ATTIC AMENITIES
~ Floors Vinyl/CrptJAve Type HA CAR STORAGE:
rfrigera~orJi~'_il ~lone [~ Fireplace(s)# 0~ None
Walls Plasler/Ave Fuel Oil rage/Oven ~ ~tairs ~ Patio Garage 1 # of cars
Trim/Finish Wood/Ave Condlllon Good sposal ~ )rop Slalr ~ Deck Attached X
Bath Floor Vinyl/Ave COOLING shwasher J I ~cuttle I_X_J Porch Detached
Bath Wainscot Fiberglass/Ave Central Yes n/Hood I-I :loor I--[ Fence Broil-In
Doors Wood/Ave Other crowa~e ~ teated ~ Pool 3arport
Condilion Good sher/D~er :inished ! I )riveway Macadam
Add~tioaal features (special energy efficient items, etc ,: Sla.m wiodow units
Condition of the improvements, depreciation (physical. functional and external), repairs needed quality of construction remodeling/additions, etc
There aa no physical or functional obsolescence. The subject is in average condition on the outside as well as the inside. New asphalt shingle roof is m the
process of being installed.
Adverse environmental conditions (such as. but not lira ted to, hazardous wastes, toxic substances, etc.) present in lhe improvements, on the slle
or in th~ immediate vicinity of lbo sub]ecl property Apl)raiser is I~ all oxpell in llut idl,'ulilic;llion ul il;Jzardou5 s Ills ~ ICc'; nl dl'llinll:UJ;ll I:llVlrOnHlJ:llt,ll
Valuation Section
ESTIMATED SITE VALUE ................. = $
ESTIMATED REPRODUCTION COST-NEW-OF IMPROVEMENTS:
Dwelhng 1.168 Sq Fl @ 67.14 = $ 78,420
Bsmt 1,168 Sq. Ft. @ 12.26 = 14,320
Household Enc Pm' = 5,000
Garage/Carpod 360 Sq Ft. @ 21.84 = 7,862
Total Estimated Cost New ....... = $ 105,602
Physical Functional External
Less
Depreciation 10,5601 0~ 0 = $
Depreciated Value of Improvements ............. = $
"As-is" Value of Site Improvements ................. = $
INDICATED VALUE BY COST APPROACH ......... = $
ITEM I SUBJECT COMPARABLE NO. 1
Address 2245 Lambs Gap Road
$ N/A
$ 0.00
Inspection
DESCRIPTION
Enola
Proximity to Sul:~ect
Sales Price
Price/Gross Liv. Area
Data and/or
Venfication Source
VALUE ADJUSTMENTS
Sales or Financing
Concessions
Date of Sale/Time
Location .~uburban
Leasehold/Fee Simple :ee Simple
Site t AC
View ~,verage
Design and Appeal {anch/Good
Quahly el Consuactm~ Stucco/Alum/Goed
Age 54 Years
Condition Average
Above Grade Total Bdrms Baths
Roonl Count 6 3 1.0
Gross Living Ama 1,168Sq. Ft.
Basement & Finished Full
Rooms Below Grade Un[in
Functional Utility Average
Heating/Cooling 3il HA/CA
Energy Efficient Item ~verage
' Garage/Carport I/Car Alt
Porch, Patio, De~, :'ncl Porch
Fireplace(s), etc. ~lone
Fence, Pool, etc Fence
6408 Cannon Drive
Mechanicsburg
2 Miles
CPML Settled, STEB
20,000
10,566
95,042
5,000
120,042
115,50~
File No. 2cal*llp
Comments on Cost Approach (such as, source o1 cost es: ~-
site value, square foot calculation and for HUD VA uno F ....
lite estimated remaining econonl~c life of the property)
~ee attached sketch.
;cst figures from Marshall & Swift Residential Cost Handbe~k a~,: ,:
~ources. Est. Remaining economic life--50 to 60 years.
COMPARABLE NO. 2 I COMPARABLE NO 3
4 Riven/iew Drive 1 208 Erford Road
Enola ~ Camp Hill
3 Miles J 3 Miles
CPML Settled, STEB | CPML Settled, STEB
DESCRIPTION
60 DOM
FHA
8/16/01
Suburban
Fee Simple
.80 AC
Average
Ranch/Goed
AiumlBricklGood
40 Years
Average
t,24/Sq Fl
Full/Fr
Bt/Bath
Average
Oil BB/HW
A~erage
1 Car Att
Patio
None
None
DESCRIPTION +(-)$l DESCRIPTION
232 DOM
FHA
4/27/01
Suburban
Fee Simple
· 26 AC
Average
Ranch/Good
Brick/Good
41 Years
Average
2.~
1,150Sq. Ft.
Full
Unfin
Average
Oil BB/HW
Average
1 Car Crpt
Patio
None
In Gr Pool
12 DOM
Conv.
8/28/01
Suburban
Fee Simple
;.21 AC
Average
Ranch/Good
Brick
47 Years
Bath;0
1,306Sq Ft.
Full
Unfin
Average
Gas HW/CA
Average
1 Car Crpt
Patio
Fireplace
None
-I ..:;
Adjusted Sales phc 1.6 % Net 2 % Net 1% Net
of Comparable 8.0 % Grs 117,300J 9 % Grs 112~300J 7 % Grs 109 .c::
Comments on Sak~,s Comparison (including the subject property's compatibility to the neighborhood, etc.): All market data is similar in style and
construction to lhe subject property. Comparable sales are the most recent, similar, nearest sales available. All comparables have been closed and settled on tr
above dates.
ITEM SUBJECT COMPARABLE NO. 1 COMPARABLE NO. 2 COMPARABLE NO 3
:)ate, Price, and Data
3ource, for prior sales q/A N/A NIA N/A
~ithin year ct appraisal
~, option, or listing of the subject property and analysis of any prior sales of subject and comparables
wilhin one year of Ihe date of appraisal: No currant agreement of sale, option, or listing. No sale of comparables wilhin 1 year.
INDICATED VALUE BY SALES COMPARISON APPROACH
............................................... $ 113,0~0
/Mo. x Gross Refit Mullil~ier NIA = ~ N/A
This appraisal is made ' ' ~ .... I _1 bjec pi lion per pans and spec ficat~on$
nspecllons o~ ~.~uo~s listed below su I to corn e I
Conditions of Appraisal: See attached Special Conditions Addendum and Statement of Limitin9 Conditions. All equipment with improvements ware in working
condition, unless herein stated. '
Final Reconciliation: The Comparison Approach, reinforced b the Cost Approach, provides a 9cod indication of Market Value. Good range of vague $109,900 to
$117,300. Chose value of $113,000.
The purpose ct this aPprasal is to estimate the market va~e ct the real prope~ that is the sul~ct of this reporl, based on the above coalitions and the cetl~fication, contingent
and ltmHin9 conditions, aed markel value delinil~n that are stated in the allached Freddie Mac Form 439/Fannie Mae Form 1004B (Revised 6193 )
I (WE) ESTIMATE THE MARKET VALUE, AS DEFINED, OF THE REAL PROPERTY THAT IS THE SUBJECT OF THIS REPORT, AB OF Febfua~/1, 2002
WHICH IS THE CATE OF INSPECTION AND THE
APPRAISER: /' { i,, ~./~ <./~ .~ EFFECTIVE DATE OF THIS REPORT) 3'0 I~E $ 113,000
sig~ture ~ -'~ ILOL,/ I_XjDid i-]DidNot
Name Clement A. Le~, CREA ' Name William G. Rothman~ ~, -inspect Properly
Date Report Signed February 8, 2002 Date Report Signed February 8, 2002
State Certificahon # RL-001765-L Slate PA State Certitication # GLA 001455-1 State PA
AR 03080,t-I ~;~te PA Or State License # RM 0527/2.A Sial,; PA
SUBJECT PHOTOGRAPH ADDEN~,JM
f.......... 2cai-11~
I~,rr~)',~C~ / ( 'hClH ESi of Ethel Wynnkaulz
~'~,,I,¢~1) .-".dd,c~,~ 2245 Lamb. Gap Road
I'll~' Enola ( ',,, m~,. Cumberland
IcJhl,..iGales & Associates Nliuc PA Zip ~',,dc 17025
,',;'r R I!I!T S(-'ENli
SKETCH ,MAP AND PHOTOGRAPH ADDENDUM
~ & Asso~-Jates
I _Bor row~er / C._]llen__~t
Proper1¥Ad~ress ~ [,drabs Gap R,~dd
~;Ity Eno] ~
~ender ~nty Cumberland
$lato
ZIp Code
I 7025
LAYOUT SKETCH
38
20'
] 6 ' ENCL POR
, DR I ~ BR
LR I ] 0.'
"
BRj . 28'
PoRFH I
!.
,
L. ~PARABLES PHOTOGRAPH ADf.,,_,~IDUM
.............
Ilurm....,cr / ('h~:.l Esl ol Ethel Wynnkaulz
I'u,p~:~b' A&h,:~ 2245 Lambs Gap Road
(~1~, Enola (.'mmty Cumberland :',; u~lc PA Zip ('ode 17025
I cmlur Gales & Associates
6408 Cannon Drive
Mechanicsburg
I)alc ol'Salc: 8/16'01
:'hdc I'rlcc : 115 500
Nq. Ft. 1,247
$ / .";q I:~ : 92 62
(~()~ll',~l~,.~lll.l.; 5..~1.1~ # 2
4 Riverview Drive
Enola
I)i.col'Salc : 4127/01
Sale I'ricc :110,500
Sq FI :1,150
$/Nq FL :96
208 Edord Road
Camp Hill
I)alc of Sale : 8/28/01
Sale Price :108,600
Sq. Ft. :1,306
$ / Sq. FI. :83
~,~-~' J oWaynesville ,? -
New B~.al..o,._~
VictOria Furnace
o oWhIte Spnr~
Ellendale Forge
vBemer Island
oSIone Glen
oSingersville
Heckto~.~3j
Hollow
vMillers Gap -
Ridge _.
~ ~ 1.4'j
· ~l-ambs Gap
Hogestown
Bill a~'
oGood Hope Mill
/
New Kingstown
o New Kingston
Naval
Trfndle:
nicsburg
Lane
Williams GrOve
BrandlsvJlle
oMt AJl~n ~ '
~,.
ale Usburn
·Grantham Nauvoo
-. oSiddonsburg
eMt Pleasant
irvtew Park
oEmey
Statement of Limiting Conditions
I:ilc #: 2cal-llp
DEFINITION OF MARKET VALUE: Thc most probable price which a property should bring in u ctmlpctilivc and {)pen markc:
und~ all conditions rcquisilc lo u I~ir sale, thc buyer and ~11~, each acting prudcmly, knowledgeably and assuming Iht price is n~
al'lb~cd by nodo ~limulus. hnplicil in Ihis dclinilion is the co~ummion ufa ~lc ~ ol'a spccilicd dulc and lilt passing ol'liLIc
lYom ~llcr Io huycr under condiliuns whereby: ( I ) buy~ and ~ller are lypicully molivalcd; (2) bulb parties are well inlbrmed or
well Wised, and each acting in svhal hc considcm his own b~ imcrcsl; (3) a re,unable lime is allowed Ibr exposure in Ibc open
m~cl; (4) puymcnL is made in lerms ofc~h in [J.S. dollars ~ in lcrms of Iinancial a~angemcnls comparable Ihcrclo; and (5) Ll~c
price rcprcscuLs ~hc nurmal considcralion Ibr thc property sold unallbclcd by special or crc~livc linau~ing or sales couccssions*
gran~ by anyone associated with Ibe sale.
* Adjuslmcms to the comparables must be made for special or ercalive financing or sales concessions. No ad. juslmcnts are
necessary lbr those costs which are normally paid by sellers as a result ol'trudilion or law in thc market area; thes~ costs are
readily idenliliublc since the seller pays these costs in virtually all sales Imnsactions. Special or cruutivc linancing udjuslmems
tun be made to thc compuruble propcny by comparisons Io linancing terms ol'lbred by a third puny inslitutionul lender that is
not alrcudy involved in Ibc property or Iransuction. Any 'ad. jusmlenl should not be calculated on a mechanical dollar cost of
thc linancing or concession bul Ibc dollar amount ofany adiusUnent should approximate thc market's reaction to tile linancing
or coaccssi~ms based ILnl thc appraiser's.judgement '
STATEMENT OF LIMITING CONDITIONS AND APPRAISER'S CERTIFICATION
CONTINCENT AND LIMITING CONDITIONS: The appraiser's cenificalion Ihat appears in the appraisal report is subject to
Iht Ibllowiug couditions: .
I. The appraiser will not be responsible Ibr mattcra of legal nalure that affi:ct either the property being appraised or thc title [o iL
Thc appraiser assumes Ihat thc lille is good and marketable and, Ihcrclbre, will nol render any opinions aboul Iht lhlc. Thc
property is appraised on the basis of it being under responsible ownership.
2. Thc appraiser has provided a sketch in Ibe appraisal report to show approximate dimensions ot'tbe improvements and the
sketch is included only tO assist Iht reader ol'thc report in visualizing Iht property and understanding the appraiser's dclcrmination
of its size.
3. Tbe appraiser has examined Ihe available flood maps that are provided by Ibe Federal Emergency Management Agency (or other
data sources) and has noted in thc appraisal report whether the sahieCt site is located in an idenlified Special Flood I lazard Area.
Because thc appraiser is not a surveyor, be or she makes no guarantee, express or implied, regarding lhe determination.
4. The appraiser will nol give testimony ur appear in court because he or she made an appraisal of thc property in question, unless
sp¢cilic arrangculcnls lo do so have I~cn made hcl~rchand.
5. The appraiser has eslimated the value of the land in thc cosl approach at ils highest and best usc and Iht improvements at Ihcir
contribulory value. These saparule valuations ol'lhe land and improvements musl not be used in coniunctio I wilh any olhcr
appraisal and arc invalid i l'lhcy arc so used. '
6. Thc appraiser has nolcd in thc appraisal report uny adverse co~dilions (such as, needed repairs, depreciation, the presence o£
hazardous wastes, Ioxic substances, crc.) observed during lhe inspection oftbe suhiect property or thut he or she became aware
ufduring Iht normal research involved in pcrlbrming Iht appraisal. Unless olherwisc slaled in thc appruisa report, the appraiser
has no [:nowlcdge ol'any hidden or unupparcnt condiliuns ol'thc property or adverse environmental conditions (including tile
prcs~:nsc ul'hitzardous waste, toxic substances, gtc.) tilul would make the property more or less valuable, and haas assumed that
there un: no such conditions and makes no guarantcas or warranties, express or implied, regarding thc condition ol'lbe property.
Thc appraiser will not be responsible Ibr any such conditions th~ do exist or lbr any engineering or tcsling Ihal might hc
rcquircd Io discover whether such conditions exist. Ilccause thc appraiser is nol an cxpcn in thc field of cnviranmcntu hazards,
thc appraisal report must not be considered as an environmental assessment of lbe property.
7. The appraiser obtained the information, estimates, and opinions that were expressed in the appraisal report from sources that he
or she considers to be reliable and believes them to be true and correct. The appraiser does not assume responsibilily for the
accuracy of such items that were Ihrnishcd by other panics.
8. The appraiser will not disclose the contents oftbe appraisal report except as provided for in the Uniform Standards of
Prolbssional Appraisal Practice.
9. Thc appraiser has based his or her appraisal report and valualioe conclusion for an appraisal that is subject to satisfactory
completion, repairs, or uhcrations on the assumption thai complcti~a of thc improvcmcms will bc pcrlbrmcd in a workmanlike
Inanncr.
10. The appraiser must provide his or her prior written con.seat before the lender/client specified in the appraisal report can
dislrihut¢ Ibc appraisal report (including conclusions ubout the properly value, the appraiser's identity and profi:ssional
dcsignutions, and rcl~renccs to any prolbssional appraisal organizations or Iht lirm with which thc appraiser is associalcd) to
anyone ~aber Ihun thc borrower; Ibc mortgagee or ils succas.,alrs and assigns; Ibc montage insurer; consultants; prolbssional
appraisal urganizalions; uny slal¢ or federally approved linancial institution; or any dopanment agency, or instrumentality oftbe
Untied States or any state or thc District of Columbia; except that the Icnder/cliem may distribute the property descriplion section
o1' the rclx~rl only to data collection or reporting service(s) wilhoul having to obtain the appraiser's prior written consent. The
uppraiscr's written consent and approval musl also he ohtainc~l bclb~: thc appraisal can be conveyed by anyone to Iht public
tbrough udvenising, public rclutious, news, sales, or other media.
APPRAISER CERTIFICATIOee
File #: 2cal-llp
APPRAISER'S CERTIFICATION: Thc Appraiser cenilics and agrees that
I. I have researched thc subiccl market area and have sclecled a minimum oflhrac recent sales of properties most similar and
proxiu]utc lo Iht ~u~j~ct prop~ lbr consideration in thc sales compari~n analysis ~d havc made u dollar u~just~ncnt tvhcn
appropriate to rellect Iht mark~ reaclion to those ilems ol'signJlicanl variation. II'a si~ilicanl ilcm in a comparable property
is superior to, or more I~vorabE Ihan, the subject property, I have m~c a negative adjustmcnl lo reduce Iht adjusted sales price
of the comparable and, ifa statical item in a comparable prope~y is inlbrior to, or I~ I~vorablc th~, thc subject property
I have made a positive u~jusxm~ lo incre~c Iht adjusted sales price ol*~c compa~blc. ' '
2. I have lakcn inlo considcmtim thc I~clors thai have an im~cl on value in my dcvclo~cnl of thc cstimalc ol'markcl value in
the uppraisal report. I have nm [nowingly wilhold uny ~i~nilicunl inlbrmaion I~om thc apprai~l report mid I hclicvc, to thc
best el'my km~wlcdge, thai all ~lcmcnl~ and inlbrmulion in thc upprai~l rcpo~ arc trac ~d correct.
3. I staled in thc apprui~l rc~ only my ~rsonal, unbiased, ~d prolb~ional analysi~ opinions, ~d conclusions, which arc
subjcc~ on y m thc condogcm ~ limidug ~pccilicd in thi~ Ibrm.
4. I have no present or prospe~c intcrasl in thc pro~ny thai is the subj.[ of Ibis re~n, and I have no prcsenl or
prospective personal imcrcst or~ with rcspec[ 1o thc panicipams in thc Iran~clion. I did nol base, cilhcr purlially or
complclcly, my ~ulysis mid/or ~ mlimalc of murkcl value in thc apprai~l rc~n on thc mcc, color, religion, sex, handicap,
l~nfiliul slalus, or nulional origin el'either thc prospective ownc~ or ~cu~ of thc subject property or el'thc prcscm owucrs
or occupunls of thc propcrlic~ ia thc vicinib' of thc ~ubjccl pro~ny.
S. I have no present or conlcm~led lblura imcresl in thc subi~ prepay, ~d neither my cu~nl or future cmploymcnl nor my
compcnsalion tbr pcrlbrm tnb th~ appraisal i5 coulingcnl on thc upprai~d value of thc property.
6. I w~ not required to report a ~dcle~incd value ur direction in value thai I~vom Ihe cause of thc clicm or uny mlutcd
par[y, Ibc amounl el'thc value c~ialc, thc allaimncnl ol'u specific rasull, or thc occurancc ol'a suhscqucm cvcnl in order to
rc~civc my cumpensation and/or ~ploymc II br pcrlbmiing thc apprai~l. I did nol b~ thc uppraisal report on a requested
nmmnum vuluation, ~ spccilic v~uufion, ur Iht nccd lo approve a specilic mortgage Io~.
7. I perlbrmcd this appraisal in ~tb~ily wi~h ~hc Unilbrm Standards of Pml~ssional Appraisal Practice thai were adopled and
promulgated hy thc Appraisal S~urds llomd el I'hc Apprai~l Foundalion and thai were in place as el'Ibc cll~clivc dale of this
appraisal, with thc cxucpfion o1'~ departure provision el'those 51andards, which does nol apply. I acknowledge that an estimate
ol'u reasonable lime Ibr exposure M thc open marke[ is a condition in the dclinilion ofm~kc[ value and the cslimatc I developed
is consislent with Ibc markcling l~c nolcd in thc ueighborhuod ~clion of this report, unless I have otherwise slated in thc
reconcilialion 5corian.
8. I have personally inspected the interior and cxlcrior ~e~ of the subj~t pmpe~ and the exterior of all properties listed ~
~omparablcs in thc appraisal rcp~ I Ibnhcr centre, thai I have holed any apparent or known advcmc ~ndilions in thc subject
m~provcmcnls, on thc su~jccl sil~ ~ on ~y silo within thc immedialc vicinily of thc surimi pro~ny el'which I am aware and
have mude udiuslmcn s Ibr Ihcsc ~vc~ conditions in my analysis of thc pro~y value lo thc cxlcnl Ihal I had markcl evidence
lo ~upport them. I huvc also com~mcd uhoul thc cllbcl of thc advc~ condilions on Iht m~kclability of thc ~u~iec~ propc~y.
9. I personally prepared all concl~ns and opinions about Ihe mai eslale the wm set fmh in Ihe appmi~l report. If I
relied on signilicam prolbssional ~islacc I~om any individual or individu~(s) in thc ~rlb~ce of thc apprui~l ~ ~ha
prepumlion ol'~he upprul~l r¢po~ I have numcd such individual(s) und diploid thc s~lllc ~ks perlbrmed hy th~ in thc
rcconciliulion ~clioa el'this uppr~l rc~n. I ccniiy lhul any individual ~ named is qualified Io ~rlbm] thc tasks. I have
nol uuthorizcd unyonc h) make chic lo any item in thc report; thcralbrc, il'an unauthorized change is made lo thc appruisul
rcporl, I will luke no responsibility I~ iL
SUPERVISORY APPRAISER'S CERTIFICATION: Ifa supervlnory appraiser signed tho appraisal report, ho or she
cenilies and agrees that: I directly supervise the appraiser who prepared thc appraisal report, have reviewed the appraisal report,
agree with thc statements and conclusions of thc appraiser, agree to be bound by the appraiser's certilications numbered 4 through
7 ubovc, and um taking full responsibility for thc appraisal and thc appraisal report.
ADDRESS OF PROPERTY APPRAISED:
2245 Lambs Gap Road
Enola
APPRAISER: ~..../""
Date Signed: February& _2002-
Stale Certilication #: RL.001765.L ........ Slate: PA
or Stale License #: AB-030804-L Stutc: PA
Expiration I)alc ol'Ccrlilication o~-~l.i~-"n.~:
PA
17025
SUPERVISORy A~PR,~SEI~ (only il required):
Signature: ~_._~ [~
Name: _W:e~ _~.-_ G.~.: .~__4n '. ~-
Date Signed: F ..ebfl~__' 8,L2002 ............
state Certification RI: GLA 001455.1 State: PA
or Slate I.iccnsa #: RM 052272-A ...... State: PA
Expiration Date of Ccnilication'~*'l.i~.c~sc: ....
[ ~]l)id [~.~ I)id N~,,I Inspect property
?~E~. 2 o1'2
I:mmie M!Lc I"orm~l ¢_~!_1:1_ t ~'~-qt _j
PA REV-1500
SCHEDULE H
FUNERAL EXPENSES and
ADMINISTRATIVE COSTS
29 South Enola Drive
Richardson [ aneral Home,
' · (717) 732 - 0587
Michael G, Murray
STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED Supervisor
Charges are only for those items that you selected or that are required. If we are required by law or by a cemetery or crematory to use any items, we will explain in writing below.
If you selecled a funeral that may require embalming, such as a funeral with viewing, you may have to pay for embalming. You do nol have to pay for embalming you did nol
approve if you selected arrangements such as a direct c~emation or immediate burial. If we charged for embalming, we will explain why below.
For the Service of: Ethelwyn I. Kautz Date of Death: Pre-arrangement
Charge to: Laurie Ann Mailey 26 Bryans Mill Way Catonsville Maryland 21228
(Name) (Address) (City) (State)
A. CHARGE FOR SERVICES SELECTED:
1. PROFESSIONAL SERVICES
Services of Funeral Director/Staff ................ $ _0
Embalming ................................. $ 0
Other preparation of body
Ccemetology/Dressi~g/C asketing
$ 0.00 OTHER
SUB-TOTA~-'0~:'PR~I~ES~i0N~L ~ER~CE$' .' ,' .' .'.'.' .' .' .' .'. ........ ~ A1 $
2. FACILITIES AND SERVICES
Use of facdities and services for C.
Evening Viewing (6:00 - 8:00) ............. $ 0.0___~0
Use of facilities and services
Funeral ceremony ....................... $ 0.00
Use of facilities and services for
Uemodal Service ....................... $ 0,00
Use of equipment and services
For graveside service ..................... $ Q00
Use of equipment and services
For Church or Off Premise Service ...........
Other Use of Facilities
Viewinq Pdor to Service (6:00 - 7:00) ...... $ 0.00
SUB-TOTAL OF FACILITIES/EQUIPMENT ......................... A2 $ 0.00
3. AUTOMOTIVE EQUIPMENT D.
Vehicle to transfer remains to Funeral Home.
Local,
................................. $ O.O__QO
Hearse (Casket Coach)
Local ................................... $ 0.00
Limousine
Local.
................................. $ o.o._Q
Family Car
Local ................................... $ 0.0__..~0
Flower car or floral disposition
Local .............................. $ 0.0__~0
Lead car/Clergy car
Local.
................................. $ o,o._Qo
Car for pallbearers
Local .................................... $ 0.00
Out of town transpodation ................... $ 0.0~0
SUB-TOTAL OF AUTOMOTIVE EQUIPMENT ...................... A3 $ 0.00
TOTAL OF PROFESSIONAL SERVICES,
FACILITIES AND AUTOMOTIVE
EQUIPMENT... A $ 000
OtherClothing
Cremation Urn ..................... $
(Description)
0,00
0.0_~0
O.O__Q
TOTAL MERCHANDISE SELECTED ........
SPECIAL CHARGES
Fo~Narding of remains to
$ o.o_.Do
$ 0.oo
.... B $ Q00
(Funeral Home)
Receiving of remains from
(Funeral Home)
immediate Budal ................... $
Direct Cremation .................... $
Full Service Cremation $
SUB-TOTAL OF SPECIAL CHARGES .......
$ o.o__Q
O,O__QO
O.O__QO
O.O._Q
3555.00
· C $ 3555O0
CASH ADVANCED
Opening Grave ..................... $ 0.0__p_0
Cemetery Equipment ................. $ 0.00
Lot and Deed ....................... $ 0.00
Newspaper Notices- Local ............ $ 0.00
Newspaper Notices - Out ol Town ...... $ 0.00
Telephone & Telegrams .............. $ 0.0~0
Airfare ........................... $ 0.00
Clergy/Mass Offering ................ $ 50,00
Pallbearers ........................ $ 00._.p_0
Certified Copies of the Death
Certificate ......................... $ 20.00
Police Escort ....................... $ 0,00
Flowers ........................... $ 0.0.__~0
Vault Service Charge ................ $ 0.00
Organist ......................... $ ~
Soloist ........................... $ 0,00
Honor Guard ...................... $ 0~_
Beautician $ 45,00
$ o,o___Do
SUB- TOTAL OF ADVANCES ................ D $ 115.00
We charge you for our se~ices in obtaining:
(Special cash advances that are marked-up)
CHARGE FOR MERCHANDISE SELECTED:
Casket ..................................... $ 0.00
(Description)
Other Receptacle ............................ $ 0.00
Outer Burial Conta her ......... $ 0.00
(Description)
Acknowledgement Cards ....................... $ 0.00
Register Book(s) ............................. $ 0.00
Memory Folders ............................. $ 0,00
Prayer Cards ................................ $ 0,0~0
Temporary Grave Marker ...................... $ 0,0.__~0
Burial Clothing .............................. $ 0.00
SUMMARY OF CHARGES:
A. Professional Services, Facilities and
Services, and Automotive Equipment ..... $ 0,00
B. Merchandise ...................... $ 0.00
C Special Charges ................... $ 3555.00
D, Cash Advances ................... $ 115.00
TOTAL OF ALL SELECTIONS ................ $ 3570.00
PAID AT TIME OF OR PRIOR TO
ARRANGEMENTS ......................... $ - 0,00
BALANCE DUE ............................ $ 3670.00
REASON FOR EMBALMING
Family Requested Public Viewing or Buda 24 Hours after death
If any law, cemetery or crematory requmements have required the purchase of any (
listed above the law or requirements is explained below.
Outer Budal Container
I agree that I have examined the items of goods and services selected above and found them to be con'ect and according to the arrangements I have requested. I acknowledge
receipt of a copy of this Statement of Funeral Goods and Services Selected. I represent that I have sufficient funds available for payment of the cash price for the goods and
e2ices selected. I also agree to make payment of $ 3670,00 within 35 days. I agree to be jointly and severally liable with anyone else who signs below, A late charge of
· per month amounting to 12% . per year will be applied Io the unpaid balance beginning 35~days from the date of this agreement. I will also pay to the Funeral
Director all reasonable costs paid by the Funeral Director to collect amounts I owe under this agreement. Those costs may include attorneys' fees, court costs and other costs.
Any additional services or merchandise ordered or requested after the dates of this agreement will be considered part of this agreement and the cost thereof will be reflected on
the final bill or statement.
(Seal)
Saturda¥~ January 26 2002
0CT-11-2002 FRI 06:55 AH PENN NATIONAL IN~
FAX NO. 4107858982
P. 05
allfirst
Acct No 0050320831
,,.. '//,%/,, <._ .
C~ecic IT,riD!
28.C0
12200~;
STATEMENT
DATE
TERMS
DC5812
RSR appraisers
&
anab~sts
February 8, 2002
Gates & Associates
1013 Mumma Road
Lemoyne, Pa 17043
APPRAISAL:
APPRAISAL FEE:
2245 Lambs Gap Road
Enola, Pa 17025
Est of Ethelwynn Kautz
Our Tax ID#23-2468209
Our File #2CAL-11P
$300.00
Please make check payable to:
Include File #2CAL-11P
RSR Appraisers & Analysts
308 E. Penn Drive
Enola, Pa 17025
THANK YOU!
308 East Penn Drive · Enola, PA 17025 · Phone (717) 763-1212 · Fax ('717) 763-1656
PA REV-1500
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES
and LIENS
"MECHANICSBURG, PA 17055
.(717) 761-5343
TAX # 23-6050136
BILL TO:
ETHELWYN KAUTZ
2245 LAMBS GAP RD
ENOLA, PA 17025
DATE: 04/26/2002
PATIENT: ETHELWYN KAUTZ
ACCOUNT #: 203109240A CONTROL #: 0200001
PATIENT PICKED UP: RESIDENCE 17025
PATIENT TAKEN TO: HOLY SPIRIT
PATIENT HAS SYNCOPE, CHEST PAIN AND VERTIGO - REQUIRES OXYGE
N
DATE OF SERVICE: 01/02/2002
DESCRIPTION
2002 BLS BASE RATE
BLS MILEAGE
OXYGEN AND SUPPLIES
UNIT COST QTX.
A0429 250.00 1.0
A0380 5.00 7.0
A0422 25.00 1.0
250.00
35.00
25.00
Comments: THIS IS YOUR FIRST NOTICE.
B~tLANCE IS DUE WITHIN 30 DAYS
PLEASE WRITE THE INVOICE NUMBER ON YOUR CHECK
THANK YOU
THANK XOU.
SUBTOTAL
AMOUNT
PAID
TOTAL
310.00
282.23
ETHELWYN I. KAUTZ
RITA M. KEIM
2245 LAMBS GAP RD.
ENOLA, PA 17025
03-74
2786
80-'83/~ 13
5531
~ OIU)F~ OF . ·
Harrisburg, PA 17101
gO '~ 20,B, :i I,,' 2 ?B, r-, ,"000 5 ? ~, F-,,,°
ETHELWYN I. KAUTZ
RITA M. KEIM
2245 LAMBS GAP RD.
ENOLA, PA 17O25
03-74
2784
5531
ORDER OF _
allfirst
Harrisburg, PA 17101
Fo. ~_~4.z d s'z, V~ ~.2o /
~:O ~
SO =. BOP, :t, 00000
ETHELWYN I. KAU'I-Z 03-74 2791
RITA M. KEIM
ENOI.A, PA 17025 D~a~ ~-- fi0-83/0313
5531
ETHELWYN I. KAUTZ 03-74 2789
RITA M. KEIM
2245 LAMBS GAP RD. ~ / /
60"8310313
ENOLA, PA 17025 D,~I'E~ 553!
~ o.o= o~~. s. ~ $ 5/o-a,
ETHELWYN I. KAUTZ
RITA M. KEIM
2245 LAMBS GAP RD.
ENOLA, PA 17025
ORDER OF__._~/__~ ~
0~74
2794
Uallfirst Allfizst Bank
Harrisburg, PA 17101 ~ ~
~o.~ o - ~ f , oo ..-7, ,/q~. ,..
27q4 ,"OOOO002q6P, o'
ETHELWYN I. KAUTZ 03-74
ENOI.A, PA 17025
2790
~bur8, PA 17101
ro~~
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ETHELWYN I. KAUTZ . [ ~
AT&T
Wireless
Questions?
· www.attwireless.com
· 1-800-888-7600
· 611 from your wireless phone
· TTY use~ - 1-866-4-AWS-1-FY
Date of Invoice: 04/03/02
S~Y OF NONTHLY CHARGES FOR ACCOUNT 2002133981)
11.02 .00 .~ .~ 11.~ .~
billing cycle ~an on 03/02 and e~ on ~/01. :~ ~?~:,~Due:,.~:::~.,
11.02
Current Monthly Charges
Monthly Service Charges
Home Airtime Charges
Home Long Distance Charges
Text Messaging Charges
Roaming Charges
Other Charges and Credits
Taxes, Surcharges & Regulatory Fees
Total Current Monthly Charges
TOTAL ANOUNTDUE
.00
.00
.00
.00
.00
.00
.00
.00
11.02
You can now pay your invoice online ii vew.attwireless.cam
AT&T WIRELESS APPRECIATES YOUR BUSINESS
Note: mm~
We Print on
Front and Back.
GEN-OldmOl g2-~1
Consumer Service Department:
31229 Cedar Valley Dr.
We~tlake Village, CA 91362
M- F 6 am to 4 pm PST
(818) 879-2948
26 BRYANS Mll~I~ WAY
BALTIMORE, MD 21228-5456
See Comumer Ri~ Information
on Reverse Side
Clie~ Name:
Ammmt Da~:
Client Ref. No:
Placement l~:
Social Security No:
Client Phone:
7177321356061
0048088217
(800)652-5094
Our client, Verizon Communications, Inc., has been unable to resolve this
outstanding balance due on your account. Since you have failed to resolve this issue
with Verizon Communications, Inc., they have now assigned your account to us for
collection.
If you have questions or need assistance regarding payment, please call
(800)652-5094.
Send your check or money order payable to Ver/zon Communications, Inc. for the
full amount due or see reverse side. It is in your best interest to resolve this matter
to avoid any further collection efforts. To ensure accurate recording of your payment
you must send your payment using the bottom tear-off portion of this letter with the
enclosed envelope. When your obligation has been resolved, we will clear this record
from our collection file.
CUMBERLAND VALLEY LAND
6820 NERTZVILLE ROAD
ENOLA, PA 17025
CLEARING
Voice: 717-766-6403
Fax: 717-766-8690
Sold To:
LORI MAILEY
26 BRYANS MILL WAY
CATONSVILLE, MD 21228
Ship To
Duplicate
Invoice
Invoice Number:.
430-
Invoice Date:
FeB 28, 2002
Page:
I I
Customer ID I Customer PO I' Payment Terms
MAILEY, LORI I I Net 30 Days
Sales Rep I I
Shipping Method
Ship Date
Due Date
Airborne 3/30/02
Quantity Item Description Unit Price I Extension
1.94
1. O0
~K 284715 02/18/02
PULL CHARGE
~AID $315.00 CK 2075 2/4/02
kEFUND WITH THIS INVOICE $58.30
55.001 106.70
150.001 150.00
Check No:
2/28/02
Subtotal
Sales Tax
Total Invoice Amount
Payment Received
TOTAL
256.70
256.70
256.70.
0.00
Pinnacle Health Hospitals
P.O. BOX 2353
HARRISBURG, PA 17105
(717)230-3414
SHIRLEY
count Information, Please Call (717)230-3414
ansaction Date
Statement of Account
Description
03/12/02
Amount
2/20/01
2/20/01
2/20/01
2/20/01
2/20/01
2/20/01
2/20/01
~/20/01
2/20/01
2/20/01
Z/20/01
2/20/01
2/20/01
Z/Z0/01
1/21/02
1/21/02
[/25/02
[/25/02
2/05/02
PREVIOUS BALANCE
1EMER MED VISIT III P/F99285
1 EMER MED VISIT III ~
1 VISIT LEVEL 3 E 99283
I CBC & AUTO DIFFERENTIA85025
I CBC & AUTO DIFFERENTIA85025
I SEDIMENTATION RATE 85651
1 URINE DIPSTICK ONLY 81oo5
1 CBC & MANUAL DIFF 85025
1 BASIC METABOLIC PANEL 80068
1 KNEE COMP MIN 6 VIENS 73566RT
I CHEST PA & LAT 710ZO
1 CT BRAIN W/O CNTRST 70650
I EKO 95005
I VENOUS DOPPLER LIM 11195971
PMT MEDI B XACT 701 MEDICARE
MEDICARE DISCOUNT 701 MEDICARE
PMT MEDI B VERITUS 701 MEDICARE
MEDICARE DISCOUNT 701 MEDICARE
PMT-PVT INS
.00
129.00
.00
286.00
51.00-
51.o0
50.00
21.00
66.00
65.00
159.00
165.00
855.00
150.00
332.00
49.79-
66.76-
298.80-
1,686.29-
12.65-
;stimated Insurance Due: .00
Total Patient Credits:
Account Bnlnm-,-: 297.91
ACCOUNT IS SERIOUSLY DELINQUENT!
5E CALL OR PAY IMMEDIATELY.
OMER SERVICE HOURS
NED-FRI 7:00AM TO 4:00PM
-THUR 7:00AM TO 6:00PM
717-230-3717 LOCAL OR 1-800-603-6064 OUT OF AREA
Please detach and return with your payment
,.., QOT-11-2002 FRI 08:55 aH PENN NATIONAL INS FaX NO. 4107858982 P. 03
ETHELWyN I. KAUTZ oa-?4 2799
RITA M. KEIM
ENOLA, PA 17025 , .
ETHELWYN I. KAUTZ
RITA M. KEIM
2245 LAMBS GAP RD.
EMCJ[4~, PA 1'71)25
'"""'"": 7;L,
IIl(lll,,ll Iq' . .......
03-74
2797
tlo,.l131r~313
bk'tl
, .:.:-u,".~;~ /.f.-':~ ,:;t.'.".) ,t :, t.~.L'-~ .t.i ~, 'r~ .
· allfirst ,t,r.,.,,
t'(drr~hl,r~l[, I>A ] 710 !
,:o3~ooa~'.,:~ so~aoa~,,' 2,"~?. ,,'ooooou?s.~,,,'
./
,... .00T-11-2002 FR[ 06:55 AH PENN NATIONAL INS FAX NO, 4107858982 P. 04
ETHELWYN I. KAUTZ, o3-74 2800
ENOLA~ PA
50½aDB~,'" ~800 ,,'OOOOO05~O?,"
ETHELWYN I. KAUTZ
RITA M. KEIM*
2245 T.AM[.I,$ GAP RD.
ENOIA, PA 17025
(tllltl.;li i I1,' .................
,,./
OCT- 11-2002 FR I
06:55 aH PENN NaTIONaL INS FaX NO. 4107858982
Scm,los.'., Spouting
GLitter I .lehno! ®
Replncnment Windows
Slorm Windows & Doors
Flooring & Rubber Roofing
Siding
£liz;d~ell~town 367-6693
.... Proposal
2147 $OUTFI MARKET STREET, ELIZADETHTOWN, PA 17022
Lancaster 653~2000 Camp Hill 975-9944 Carlisle 243-9192
TOLL FREE 1-800-292-9676 FAX: [717) 367-6211
P. 02
Patio Covers & Enclosures
Mobile Home Roofove,'s
Relracl~bte Fabric Awnings
Screen Roo~ms
Carports
Hershcy 533-4186
./
j~
) ~ h , mater, I n labor corn otc ¢,~tccord~tn~ewtlhabove.~p~c.]hcatior',$ forthosumot (AIIg:~count~App,od)
........................ ................ ~ .; ==~.,' o~ .... "t~'~ ~... ~.. ~'. J l
Accepta nco of Pro posal -. Th~..o~o p~.o~, spocir,c:tio,,s
tO do ~1'1o wulk ~t:; ~t)oc[licd Payl-en[ will be m3de as outlined abuve.
Siqnature
S~gn;.~tL~re
II
Net: 10 days 1.5% after 30 days
RE: Supply and Install Siding and Trim
as per contract:
Deposit
Sub Total
Tax
$4,785.00
($785.00)~
$o.oo /
Total Due
$4,000.001
Invoice Notes:
Price includes all discounts.
II I AXi'.'.~ Al I1: ~N E ~.:,t;I g)w. I'OI (WAI q'~ It I1~ L}II l 1'O YO~
MOH[GAC~[
I(ATI ir{YN w, FETI-iOW, TREASLJRErl
5000 (':rlEE-KVIEW ROAD
MI,.'CI ANIU,?.,IJLII'[G t'A 17050-2099
MAP I',10:10-12-2983.008
2245 LAM[iS GAP I{OAD
AC[lES 4.000 DFt~D 001 t{:¥ 00,360
Wflh [{ uik.llnrj~
IAI.
:~x KAU'rZ F'AMII.Y TI"tU$1' TR
, .,,.,.c,, tOIII M^II.E¥
,?fi 131'IYAN& MII.I.. WAY
(;;A ['(')NSVII.LE MD 212211
el TIC[: "(.:LOSE r) MONDAYS"'
I'U[_-'B t HI F~AM-.51-'M,MAY.JUN DAM
Al'fi) SL!P r 15 - DI'-:(; .~AM- 1 PM
PHONE- (','17)
C2.r";o!.N.q. q,!9_- o_ooO, s_4__ ......
'couk~f
R=tc:~ .O02lJ~Ou
~:)UN'f'Y R/~ 9~.00
.00i)~300~
TAXPAYEH COPY
2002 S,lale ,m~.. ,nt of Real Estate Taxes
.UUOzu300
..... '__Z.__0~, .__
,0002O0O0
o
......... Z (- --
231.5G
2('
11.65
22.63
Bill No: 435:
TAX AMOUNT DUE -','~. ,s265'e4 I $271,27
.,.
~.~. o_~. .......... ?_~.
$298.40
'i/:)1/:;
Return Dill with P~ymcnt. For a Receipt. Enclose Se:/Add~e,~od Str. nlped Envelope.
BUREAU OF TNDZVZDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG.. PA 17128-0601
COHHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
I'NHERZTANCE TAX
STATEHENT OF ACCOUNT
RE¥-I6D7 EX AFP (01-0~}
RITA H KEIH
2245 LAHBS GAP RD
ENOLA PA 170Z5-1124
DATE 11-25-2002
ESTATE OF KAUTZ
DATE OF DEATH 02-01-2002
FILE NUHBER 21 02-0541
COUNTY CUHBERLAND
ACN 0Zl10852
Aeoun~ Reei'l:'l:ed
ETHELWYN
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NOTE: To insure proper credi~ ~:o your account:, subei~: ~:he upper portion of ~:his fore wi~ch your ~:ax payeen~:.
CUT ALONG THIS LINE ~ RETA'rN LOWER PORTION FOR YOUR RECORDS
REV-1607 EX AFP (01-02) ~N~ INHERITANCE TAX STATEHENT OF ACCOUNT
ESTATE OF KAUTZ ETHELWYN FILE NO. 21 02-0541 ACN 0Zl10832 DATE 11-25-2002
THIS STATEHENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAMED ESTATE. SHO#N BELO#
ZSA SUNHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 05-13-2002
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYHENTS (TAX CREDITS):
93.41
PAYHENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUHBER INTEREST/PEN PAID (-)
03-ZT-ZOOZ CD001054 4.67 93.41
IF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( ZF TOTAL DUE IS LESS THAN $1,
NO PAYMENT ZS REQUIRED.
IF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR),
TOTAL TAX CRED'rT
98.08
BALANCE OF TAX DUE 4.67CR
INTEREST AND PEN. .00
TOTAL DUE 4.67CR
YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
,,BUREAU OF INDIVIDUAL TAXES
TNHERTTANCE TAX DTVTSTON
DEPT. 280601
HARRTSBURg,, PA 171:'8-0601
RITA M KEIM
ZZq5 LAMBS GAP RD
ENOLA
PA 17025-112~
COMMONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
RECORD ADJUSTMENT
JOINTLY HELD OR TRUST ASSETS
DATE 12-02-2002
ESTATE OF KAUTZ
DATE OF DEATH 02-01-2002
FILE NUMBER 210Z-OSql
COUNTY CUMBERLAND
SSN/DC 205-10-92q0
ACN 02110852
Amoun~ Rem/~ed
REV-X~:O4 EX AFP (12-00)
ETHELNYN
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF MILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE
~ RETAIN LONER PORTION FOR YOUR RECORDS
REV-1604 EX AFP (12-00)
~ INHERITANCE TAX RECORD ADdUSTMENT JOINTLY HELD OR TRUST ASSETS
DATE 12-02-2002
ESTATE OF KAUTZ ETHELNYN DATE OF DEATH 02-01-2002 COUNTY CUMBERLAND
FILE NO. 21 02-05ql S.S/D.C. NO. 205-10-92q0 ACN 02110832
ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICE ACCOUNT NO.
0050320831
TYPE OF ACCOUNT: ( ) SAVINGS (X) CHECKING C ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 03-28-1974
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions -
Taxable Amount
Tax Rate X
Tax Oue
TAX CRED'rTS:
.00 NOTE:
0.500
.00
.00
.00
.15
.00
TO INSURE PROPER CREDIT TO YOUR
ACCOUNT, SUBMIT THE UPPER PORTION
OF THIS NOTICE NZTH YOUR TAX
PAYMENT TO THE REGISTER OF MILLS
AT THE ADDRESS SHONN ADOVE.
MAKE CHECK OR MONEY ORDER PAYABLE
TO: 'REGISTER OF MILLS, AGENT.""
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
03-27-2002 CD001034 .00 93.41
TOTAL TAX CREDIT I 93.41
BALANCE OF TAX DUEl 93.41CR
INTEREST AND PEN. .00
TOTAL DUE 93.41CR
TF pATD AFTER THIS DATE., SEE REVERSE FOR CALCULAT'rON OF ADDTTI'ONAL 'rNTEREST.
ZF TOTAL DUE TS LESS THAN $1., NO PAYMENT TS REI~UZRED. IF TOTAL DUE TS REFLECTED AS A 'CREDTT' (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SI'DE OF THIS FORM FOR INSTRUCTIONS.)
BUREAU OF ZND'rV'rDUAL TAXES
TNHERTTANCE TAX DTVTSZON
DEPT. 280601
HARRISBURG, PA 17126-060!
RITA H KEIH
6018 HUMMINGBIRD DR
HECHANICSBURG
COHHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
INHERITANCE TAX
RECORD ADJUSTHENT
JOINTLY HELD OR TRUST ASSETS
PA 17055-0000
DATE 12-02-2002
ESTATE OF KAUTZ
DATE OF DEATH 02-01-2002
FILE NUHBER 21 02-03~1
COUNTY CUHBERLAND
SSN/DC 203 - 10 - 9 Z ~ 0
ACN 02122928
Amount: Remi~ed
REV-160~i EX AFP (1:)-00)
ETHELWYN
I
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THTS LTNE ~ RETATN LOWER PORT'rON FOR YOUR RECORDS ~
REV-1604 EX AFP (12-00)
~ 'rNHERZTANCE TAX RECORD ADJUSTHENT ,JO~'NTLY HELD OR TRUST ASSETS
DATE 12-02-2002
ESTATE OF KAUTZ ETHELWYN DATE OF DEATH 02-01-2002 COUNTY CUHBERLAND
FILE NO. 21 02-03~1 S.S/D.C. NO. 203-10-92~0 ACN OZIZZDZ8
ADJUSTMENT BASED ON: ADHINISTRATIVE CORRECTION
JOINT OR TRUST ASSET ZNFORHATZON
FINANCTAL TNSTITUTTON: HEHBERS 1ST FCU ACCOUNT NO.
8005-05
TYPE OF ACCOUNT: (X) SAVINGS ( ) CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 11-16-1998
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions -
Taxable Amount
Tax Rate X
Tax Due
TAX CREDI'TS:
.00
0.500
.00
.00
.00
.c~5
.00
NOTE=
TO /NSURE PROPER CREDIT TO YOUR
ACCOUNT, SUBHZT THE UPPER PORTION
OF THIS NOTICE WITH YOUR TAX
PAYHENT TO THE REGISTER OF WILLS
AT THE ADDRESS SHOWN ABOVE.
HAKE CHECK OR HONEY ORDER PAYABLE
TO: "REGISTER OF WILLS, AGENT."
PAYHENT RECEIPT DISCOUNT (+)
DATE NUHBER INTEREST/PEN PAID (-) AHOUNT PAID
08-10-2002 CD001511 .00 71.30
TOTAL TAX CRED*rT I 71.30
BALANCE OF TAX DUEl 71.30CR
INTEREST AND PEN. .00
TOTAL DUE 71.3OCR
TF pATD AFTER THTS DATE~ SEE REVERSE FOR CALCULATION OF ADDTTTONAL TNTEREST.
TF TOTAL DUE IS LESS THAN $1,, NO PAYMENT IS REI~UTRED. 'rF TOTAL DUE 'rs REFLECTED AS A "CRED'rT" (CR},,
YOU HAY BE DUE A REFUND. SEE REVERSE S'rDE OF TH'rS FORH FOR 'rNSTRUCT'rONS. }
~EV~1470 EX ~-88)
INHERITANCE TAX
EXPLANATION
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE OF CHANGES
BUREAU OF INDIVIDUAL TAXES
DEPT. 28O6O1
HARRISBURG~ PA 17128-0601
DECEDENT'S NAME FILE NUMBER
ETHELWYN KAUTZ 2102-0341
REVIEWED BY ACN
Phyllis Hoch 02110832,02122928
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
ADJUSTED ABOVE ACN'S TO ZERO. REPORTED ON PROBATE RETURN. REFUND DUE.
ROW Paqe 1
BUREAU OF ZNDZVIDUAL TAXES
ZHHERTTANCE TAX DTVZS/ON
DEPT. 280601
HARRISBURG, PA 17128-0601
MARK E HALBRUNER ESQ
101~ MUMMA RD
STE 100
LEMOYNE PA 170q$
COMMONWEALTH OF PENNSYLVANZA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLO#ANCE OR DZSALLO#ANCE
OF DEDUCTZONS AND ASSESSMENT OF TAX
DATE 12-02-2002
ESTATE OF KAUTZ
DATE OF DEATH 02-01-2002
FILE NUMBER 21 02-05ql
COUNTY CUMBERLAND
ACN 101
RE¥-lS47 EX AFP (01-02)
ETHELWYN
Amount Remitted I
MAKE CHECK PAYABLE AND REMZT PAYMENT TO:
REGTSTER OF WTLLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~ RETAZN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-02) NOTZCE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DZSALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF KAUTZ ETHELWYN FILE NO. 21 02-0541 ACN 101 DATE 12-OZ-ZOOZ
TAX RETURN NAS: (X) ACCEPTED AS FTLED ( } CHANGED
RESERVATION CONCERNZNG FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORI$INAL RETURN
I Real Estate (Schedule A)
2 Stocks and Bends (Schedule B)
$ Closely Held Stock/Partnership Interest (Schedule C)
Mortgages/Notes Receivable (Schedule D)
$ Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6 Jointly Owned Property (Schedule F)
7 Transfers (Schedule G)
8 Total Assets
APPROVED DEDUCTZONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule 1)
11. Total Deductions
Net VaIue of Tax Return
(1) .00
(2) .00
($) .00
(~) .00
(5) 2z955.00
(6) 5/017.81
(7) lq2;$$4.82
(B)
NOTE: To insure proper
credit ~o your account,
submit the upper portion
of this form with your
tax payment.
150,$07.65
(9) lq,192.09
(10) 6,qSq.05
(].1) 20.62&. ]4
(12) 129,681.49
15.
lq.
NOTE:
Charitable/govarneental Bequests; Non-elected 9115 Trusts (Schedule J) (15)
Nat Value of Estate Subject to Tax (lq)
:Zf an assessment was lssued previously, lines 1~, 15 and/or 16, 17,
reflect figures that lnclude the total of ALL returns assessed to date.
.00
129,681.49
18 and 19 Hill
(].5) .00 x O0 = .00
(].6) 129,681.q9 x 045= 5,855.67
(].7) .00 x 12 = .00
(lB) .00 x 15 = .00
(].9)= 5,855.67
AMOUNT PAZD
ASSESSMENT OF TAX:
15. Amount of Line lq at Spousal rate
16. Amount of Line lq taxable at Lineal/Class A rata
17. Amount of Line lq at Sibling rate
18. Amount of Line lq taxable at Collateral/Class B rate
19. Princ] )al Tax Due
TAX CREDZTS
PAYMENT RECEXrl D~SCOUNT
DATE NUMBER INTEREST/PEN PA'rD (-
05-01-2002 CD001146 289.
11-01-2002 CD001800 .
5,500.00
46.20
TOTAL TAX CREDIT
BALANCE OF TAX DUEI
INTEREST AND PEN.
TOTAL DUE
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
5,855.67
.00
.00
.00
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT *rs RE{)UIRED.
IF TOTAL DUE *rS REFLECTED AS A "CRED*rT" (CA), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF TH'rS FORH FOR INSTRUCTIONS.)
BUREAU OF INDIVIDUAL TAXES
TNHERTTANCE TAX DTVTSTON
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
MARK E HALBRUNER ESQ
1013 MUMMA RD
STE 100
LEMOYNE PA 17043*
COMNONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEHENT OF ACCOUNT
DATE 1Z-O3-Z002
ESTATE OF KAUTZ
DATE OF DEATH OZ-01-Z002
FILE NUMBER 21 02-0341
COUNTY CUHBERLAND
ACN 101
RE¥-16n? EX AFP ¢01-02}
ETHELNYN
Amoun~ Remi:t:ted
MAKE CHECK PAYABLE AND REMTT PAYNENT TO:
REGISTER OF MILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credi:t :to your accoun:t, submi:t :the uppar por:tion of :this form wi:th your
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~
REV-1607 EX AFP (01-02) ~ INHERITANCE TAX STATEMENT OF ACCOUNT ~
ESTATE OF KAUTZ ETHELNYN FILE NO. 21 02-0341 ACN 101 DATE 12-03-2002
THIS STATEHENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACM ZN THE NAHED ESTATE. SHO#N BELO#
ZSA SUHNARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 1Z-OZ-200Z
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYMENTS (TAX CREDITS):
5,835.67
PAYMENT RECEIPT DISCOUNT ¢+)
DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID
289.47
05-01-2002
11-01-2002
CD001146
CDOO1800
.00
5,500.00
46.20
ZF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
{ ZF TOTAL DUE ZS LESS THAN $1,
NO PAYHENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" {CR),
TOTAL TAX CREDIT
5,835.67
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
BUREAU OF INDIVIDUAL TAXES
TNHER/TANCE TAX D/VTS/ON
DEPT. 280601
HARRTSBURG, PA 17128-0601
COHHONWEALTH OF PENNSYLVAN:iA
DEPARTHENT OF REVENUE
ZNHERTTANCE TAX
STATEHENT OF ACCOUNT
REV-i~O? EX AFP (01-02)
MARK E HALBRUNER ESO
1015 MUMMA RD
STE 100
LEMOYNE PA
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
· /i COUNTY
ACN
12-09-2002
KAUTZ
02-01-2002
21 02-05ql
CUMBERLAND
101
Aeount Reeitted
ETHELWYN
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NOTE: To insure proper credi~ to your account, submit the upper portion of this fore with your tax payment.
CUT ALONG THIS L'rNE ~ RETAIN LOWER PORTION FOR YOUR RECORDS
REV-1607 EX AFP (01-02) aax INHERITANCE TAX STATEMENT OF ACCOUNT
ESTATE OF KAUTZ ETHELWYN F'rLE NO. 21 OZ-OSql ACN 101 DATE 12-09-2002
THIS STATEMENT TS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAMED ESTATE. SHOWN BELO#
TS A SUMMARY OF THE PRZNC/PAL TAX DUE, APPLICATION OF ALL PAYMENTS,, THE CURRENT BALANCE, AND,, ZF APPLICABLE,
A PROJECTED TNTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-02-2002
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYMENTS CTAX CREDITS):
5,855.67
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER ZNTEREST/PEN PAID (-) AMOUNT PAID
289.q7
05-01-2002
10-$1-2002
CDOOllq6
CDO01800
.0O
5,500.00
q6.20
IF PAID AFTER THIS DATE, SEE REVERSE
S/DE FOR CALCULATION OF ADDITIONAL INTEREST.
( ZF TOTAL DUE ZS LESS THAN $1,
NO PAYMENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR),
TOTAL TAX CREDIT 5,835.67
BALANCE OF TAX DUE! .00
INTEREST AND PEN. .00
TOTAL DUE .00
YOU MAY BE DUE A REFUND. SEE REVERSE STDE OF THTS FORM FOR ZNSTRUCTTONS. )
BUREAU OF INDIVIDUAL TAXES
TNHERZTANCE TAX DTVTSZON
DEPT. 280601
HARRISBURG, PA 17128-0601
CONHONWEALTH OF PENNSYLVANIA
DEPARTNENT OF REVENUE
INHERITANCE TAX
STATEHENT OF ACCOUNT
REV-Z69? EX AFP
RITA H KEIH
6018 HUNNINGBIRD DR
HECHANICSBURG PA '.17055
DATE 12-16-2002
ESTATE OF KAUTZ
DATE OF DEATH OZ-01-ZOOZ
FILE NUHBER 21 02-0541
COUNTY CUHBERLAND
ACN 02122928
Amount: Rem ~/c'l:ed
ETHELWYN
HAKE CHECK PAYABLE AND RENXT PAYNENT TO=
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NOTE: To insure proper credi~ ~o your account, submit: ~he upper portion of ~his form wi~h your 1:ax payment.
CUT ALONG TH'rS LTNE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1607 EX AFP (01-02) -## ZNHERXTANCE TAX STATENENT OF ACCOUNT ..~
ESTATE OF KAUTZ ETHELWYN FZLE NO. 21 02-0541 ACN 02122928 DATE 12-16-2002
THZS STATEHENT TS PROV/DED TO ADV]:SE OF THE CURRENT STATUS OF THE STATED ACN TN THE NANED ESTATE. SHO#N BELON
IS A SUHNARY OF THE PRXNCTpAL TAX DUE, APPL]:CATZON OF ALL PAYNENTS, THE CURRENT BALANCE, AND, ZF APPL'rCABLE,
A PROJECTED ZNTEREST FI';URE.
DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 11-27-2002
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYHENTS (TAX CREDITS):
.00
PAYHENT RECEIPT DISCOUNT (+)
DATE NUNBER INTEREST/PEN PAID (-) AHOUNT PAID
08-10-2002
12-05-2002
CD001511
REFUND
.00
.00
71.50
71.50-
XF PAXD AFTER TH/S DATE, SEE REVERSE
S~DE FOR CALCULAT[ON OF ADDZT[ONAL XNTEREST.
( ZF TOTAL DUE 1S LESS THAN $1,
NO PAYNENT 1S REQUIRED.
XF TOTAL DUE XS REFLECTED AS A 'CRED/T' (CR),
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
.00
.00
.00
TOTAL DUE .00
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR /NSTRUCTTONS.
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX BIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMHONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
ZNHERZTANCE TAX
STATEHENT OF ACCOUNT
RITA M KEIM
22~5 LAMBS GAP RD
ENOLA PA 17025-112~
DATE 12-16-2002
ESTATE OF KAUTZ
DATE OF DEATH 02-01-2002
FZLE NUMBER 21 02-05~1
COUNTY CUMBERLAND
ACN 02110832
Amoun~ Remi~ed
RE¥-I~O? EX AFP (01-02)
ETHELNYN
HAKE CHECK PAYABLE AND REMZT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
NOTE: To insure proper credit: ~o your account, submit: ~he upper por~:ion of ~:his for. wi~:h your ~:ax payment.
CUT ALONG THIS L'rNE ~'* RETAIN LONER PORTION FOR YOUR RECORDS ~
REV-1607 EX AFP (01-0:~) ~N INHERITANCE TAX STATEHENT OF ACCOUNT N~
ESTATE OF KAUTZ
ETHELNYN FILE NO. ZZ OZ-OSR1 ACN 02110852 DATE ZZ-16-Z00Z
TNZS STATEMENT ZS PROVZDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAMED ESTATE. SHONN BELON
ZSA SUHHARY OF THE PRZNCZPAL TAX DUE, APPLZCATZON OF ALL PAYHENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE,
A PROJECTED ZNTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-27-2002
PRINCIPAL TAX DUE:
PAYMENTS
(TAX CREDITS):
PAYMENT
DATE
05-27-2002
12-05-2002
.00
RECEIPT
NUMBER
CD00103~
REFUND
DISCOUNT (+)
INTEREST/PEN PAID (-)
.00
.00
AMOUNT PAID
ZF PAID AFTER TNZS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDZTZONAL INTEREST.
( ZF TOTAL DUE ZS LESS THAN $1,
NO PAYHENT ZS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDZT"
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
.00
.00
.00
TOTAL DUE .00
YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR ZNSTRUCTZONS. )