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HomeMy WebLinkAbout01-0173 Estate of Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS No. 02/- 0/-/73 Helen N. Langjahr also known as , Deceased Social Security No. 164 -18 - 2277 Lee C. Swartz Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) o A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut or the Decedent dated 11/10/1999 and codicil(s) dated None named in the last Will of State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: D B. Grant of Letters of Administration (c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationship Residence I (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumber land County, Pennsylvania with his/her last family or principal residence at 495 Wood Crest Dr i ve, Hampden Twp. (list street, number, and municipality) Decedent. then ~years of age, died 01/29/2001 at Messiah Village Upper Allen Twp., PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania 3 /4 700,000.00 $ $ $ $ 120,000.00 situated as follows: 495 Woodcrest Drive, Mechanicsburg, FA 17055 Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the a propriate form to the undersi ned: Si nature Typed or rinted name and residence Lee C. Swartz, III North Front St. P.O. Box 889, Harrisbur , PA 17108-0889 )6-;ZtJ9--JY Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems. Inc. Form RW-l (1991) 21-01-173 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumber land The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent Petltloner(s) will well and truly administer the estate according to law. Sworn to or affirmed and submibed ~ c&~ ~Swartz a. before me this~ day of vi \:7'<..( b't.<,,-" '~-r-- ,.;:;)C) 0 I . . v:' ,-: Ii., .\ L0'41- I ,"\ '-r)lQu ~I- N-i.i.,....tA F~.C'".u J.-v........ ~L.r. 7J For the Register JLfU 0 No. 21-01-173 Estate of Helen N. Langj ahr Deceased Social Security No: 164 -18 - 2277 Date of Death: 01/29/2001 AND NOW, FEBRUARY 14. 2001 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~ Testamentary D Of Administration (c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia: durante minoritate) are hereby granted to Lee C. Swartz in the above estate and that the instrument(s) dated 11/10/1999 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters. $ 480.00 ~?./ - L1/i ~ h- W ~ ~ . to' t7..e~,{/(fl fWl. .LA ,U-VJ,Jl, . ~ Register of Wills . Short Certificate(s). .(s). $ Renunciation. $ Affidavits ( $ Extra Pages ( 8 ) $ Codicil. $ JCP Fee. $ Inventory. $ Other $ 15.00 Attorney: James G. Morgan, Jr. 24.00 J.D. No: 07193 Tucker Arensberg & Swartz Address: 111 North Front St. P.O. Box 889 Harrisburg, PA 17108-0889 5.00 Telephone: 717/234-4121 TOTAL. $ t::.:2<l gQ MAILED LETTER TO ATTORNEY FEBRUARY 14, 2001 Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems.lnc. Form RW-1 (1991) I <; I , i.:t i!" (hel ( ,f:,ll n.,,> lhll \ \ il! \ ( !l~l'~~')oI.\t I: ',_ ~'.lrIfj( {r~.. '. ;, t ' I ; i I ,I, ) H ; c ';: I, I ; 1 Ll r 1(' ! I iln! \\i [h ,h :h WARNING It:s illegal to duplicate thIs copy by photostat or photo~Jraph> ,',2,1 .,'I'lil,"'"" ."..'1 'J {', r: --.~ 'i', ~\ ,I, 'Jr~i:(;: i~:t~j;;~, J~~~;;,:;,,"~~~;,&J' "(~~~'~.'-rj~4 1 . i"'C:;['-::'~- G () >~ : r\ ) ~ JL~,,,,, ",&/,;1.(.'<2-1", p 7121168 r11 05_ j 43 AS\I 2/87 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH TYPEJPRINT IN PERIoIANENl BLACI< INI< I I ~ :::l Ul <t :rtMA (i. STATE FILE NUMBER SOCIAL SECURITY NUMBER dt.~ -\8 UNDER 1 YEAR _ Days UNoeR 1 DAY H""'" \' Miouleo all, 8IKk.. Whit.. etc - utt II> C Ll,YIt Vc\ 0r<lc-b OECEOENl'S USUAL OCCUPAlION Did --... I' W-1f1. 17b. C~nty ( 1L~ wt{ (}, ~ t..t-,~ IOWnahlp1 174.0 :h~-:'~~ 0' MOTHE't.s NAME ,F,,,t t''P<lIe. MaKlen Surname) 0. \ 11. vn<l~ + >-\ 4 ~'nA t:.. ~ J . A ~ ~ INFORMANl'sMAllINGADDRESS.. (SI.r....,c'~n,SlaI..z"'C~I. ) .I I - ('. .' L. - l . ~ . 2Ob. 5ltCiJc..\f..",)f i)~IU( l::n. CP '\-.\:.\t ~,~I"'~ tllt,C ,a"\C~:.l;..LI..,\: PLACE OF DISPOSITION - N."", 01 C.met.ry. Cr.mok><y LOCATION. CilyfTown, 5.0... rOIl Code O',~I~. 21..,l..;, L \ t I ~C NAME Cllylllom C;i)[c~_ CLc.d:~, 21d.Ln0~" j't,~" D ADDRESS OF FACILITY \) ( , ell '54./DL hlG.;> I-..{ d ~t Q-,~) j,Ju LICENSE NUMBER C.d hY Ill. ( I ~ (,' (.~ ) '1 I Ie. "" .J DAlE SIGNED (MonIIl. Day. ~I , /?(-1N"1/1~ ell,I;././ DVE TO lOA AS 9" SE OUE NCE Of) Li,lJ ,(I", /./' ': . . I I b /~ll;..1AS:~/~N~~~r;=0/11-:' ~-~~~;~;'~0Z-,7---------r- : -------auE TO 100;"5 "'CONSEQUENCE OF)----=-=.:~---- .-----------~.~--l-- 23b. 230. WAS CASE REFERRED TO MEOtCAI. EXAMINEAJCOAONER7 v.. 0 Noli:( ~. I Appro.lmat. PART II: OIller Slgntfk:anI cofl(fiUona cont"bubnq 10 de_lh. buI : int_ _n ""'.......ing .,1'" \lIlClOf1yltlQ cause _., PAFfT I : oflM\ and de."" : J hf/ ii1//,I/{A. t~ //< rlt~?.:t!, I!A v J fit'! / ('-' /._ 218. TIME OF DEATH DATE PRR"OUNCED DEAD IMon'h Day. Yearl 24. PM 25. '/.<1.."<11 Zer,2c,-,/ 27. PART I: En11i1t the diseases, IOlufteS 0( compllCatloC\s 'IlIt\ichca\J~ec the deaH\ 00 00\ enle, 'he mode ot dying. such as rchac 01 respiratory arrasl, sheet!; 01 he8t1lalluI. llsl ooty one cause on each kn4t ~ '-, Ii ,,) WERE AUTOPSY FIND'NGS AI.<A.ILABLE PRIOR TO COt.APLETIOH OF CAUSE OF DEATH? MANNER OF DEATH DATE OF 'NJURY ~Montl1, Gay. Veal) TIME OF INJURY INJURY AT WORK? oeSCRIBE HOW INJURY OCCURRED Natu,.l P4 [J [J HomK:id. \1 Pending InveslIg,atlon o [J [J ~CE-OflNjUR~Aiho;;-t;r~~eet.tacIOf)'.~~ 3Oc. budding. .Ie l$POC,lvl JOe. Yes 0 NoD 2... CERTIFIER lCt-eck onlY urlel 'CERllF'Y'NG. PHYSIC'AH IPhySI(;~O Ct.'tl,ly'(H} (JLJ~t! ul ,-~~<utl wher ,Jnal,",e' pll\;'=>'l,;ln I),JS ~IOf1O\Jf)(.eO Iledltl uno c(xn~.ter.W Ilem 2Jl To ihe ~.l o' my ktlOwNdee, death oc:cuUltd Clue lO Ih. '.UU(I).nd maf\n.,.. .t.ted o 1 8 ~ o ~ ~ _u NoD Could nol be det"rmlnttd . PRONOUNCING AND CERTIFYING PHYSICjAH (f't'r::'''':'..in t'lJlll .)IC~lluufI(Al~ (;t!,J.If1 .!I,d L~fllfYlnq lu ':du:;~ OllJl:<llt') To 1M b.t... ot my kt'Owled9., dea,th I)<;Cuf,ad a1 'he Urn., d.'.. .nd p)ue, and due to Ihe '.U38'II.nd mannel 43 a'.ted .MEDICAl EXAMINER/CORONER On Ih. basi. 0' ,...ami"aUon and/or invc$tigalion, in my opmion, deiilllh occurred allhe time, dale, otnd place, and due to the cause(s) and mllnne. .. ~u'ed )1. REGI ~~l~~~~____ ltt(~L/JJj r<bR.')~1fJ..y I, :J...OCJI ~ I - 0 /.- I 7 '3 Will I, HELEN N. lANGJAHR, of Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I. I give all articles of personal or household use, together with all insurance relating thereto, to my daughter, DEBORAH L. HOCKLEY, provided she survives me by thirty (30) days. If my daughter, DEBORAH l. HOCKLEY, does not so survive me, the same shall be added to my residuary estate. ITEM II. I give the residue of my estate, real and personal, A. Fifty (500/0) percent to my daughter, DEBORAH L. HOCKLEY, provided she survives me by thirty (30) days. If my daughter predeceases me, her share shall pass equally, fifty (500/0) percent to be divided among my grandchildren and fifty (500/0) percent to my son-in-law, STEVEN C. HOCKLEY, provided he is not divorced from my daughter, DEBORAH L. HOCKLEY, or proceedings in divorce have not been filed at the time of my death. In such event, the same shall be added to the share to be divided among my grandchildren. B. Ten (100/0) percent to my son in law, STEVEN C. HOCKLEY, providing he is not divorced from my daughter or proceedings in divorce have not been filed at the time of my death and provided he survives me by thirty (30) days. If he does not so survive, his share shall be divided among my grandchildren. Page 1 of 8 pages C. Forty (400/0) percent to my grandchildren, in trust, as set forth hereinafter. The share of any grandchild who predeceases me or dies on or before the thirtieth day following my death shall be distributed to his or her issue per stirpes living on the thirty-first day following my death and in default of any such then-living issue such shares shall be added to the share or shares for my other grandchildren. ITEM III. Should the trust created for my grandchildren come into being by the terms thereof, I name JANICE ATWOOD as both my trustee and the guardian of the estate of any minors surviving me who take under my will. If JANICE ATWOOD fails to qualify or ceases to act as trustee and guardian, I name LEE C. SWARTZ as trustee and guardian. Should he fail to qualify or cease to act, I name JAMES G. MORGAN, JR. as trustee and guardian. ITEM IV. I appoint LEE C. SWARTZ as executor under my will. Should he predecease me or be unable to act, I appoint JAMES G. MORGAN as my executor. ITEM V. Upon my death, the interest and principal, if necessary, of the trust to my grandchildren should be used by my trustee to provide a four-year college education to each of my grandchildren to be so held until the youngest completes his or her education. Said education must be completed by each grandchild within five (5) years following the graduation from high school. When the youngest graduates Page 2 of 8 pages from college, my trust shall be divided into equal shares and be distributed to each grandchild as follows: A. One-third (1/3) of his or her share upon graduating from college. B. One-half (1/2) of his or her share remaining upon attaining the age of twenty-eight (28) years. C. The remaining one-half (1/2) of his or her share upon attaining the age of thirty-three (33) years. D. If any of my grandchildren fail to graduate from college, one- half (1/2) of his or share shall still pass to him or her upon attaining the age of twenty-eight (28) years, with the balance passing to him or her upon attaining the age of thirty-three (33) years. ITEM VI. Should ITEM V come into being by the terms thereof: A. As long as my grandchildren are under twenty-one (21) years of age or still in college: 1. As much of the net income as my trustee, in my trustee's sole discretion, may from time to time think desirable for health or educational needs shall be distributed to my grandchildren, in such amounts or proportions as my trustee may from time to time think appropriate; and Page 3 of 8 pages 2. Any net income not so distributed shall from time to time be accumulated and added to the principal. B. After my grandchildren reach twenty-one (21) years of age, the trust fund is to be kept invested and administered as follows: 1. The net income from trust shall be accumulated until the last of my grandchildren has graduated from college or has attained the age of 28 years; 2. As much of the principal of trust as my trustee may from time to time think desirable-- taking into account funds available from other sources--for the health, support, maintenance or education of my or any of his descendants either shall be paid to that person or shall be applied directly for those purposes; and 3. My trustee shall have the absolute right to determine the necessary expenses for education for my grandchildren, it being my desire that this trust effectuate their ability to have a college education. My trustee, without regard to the rights of any other beneficiaries of the trust and shall have the absolute right to apply any monies on behalf of any of my grandchildren toward their reasonable expenses for education including tuition, books and living, but shall not interfere with any rights they may have to scholarships and/or aid in college. Therefore, my Page 4 of 8 pages ." trustee may restrict payments where it may interfere with their rights to receive scholarships or aid for education from independent sources. This trust is intended to give the trustee full discretion to determine the best interest pursuing advanced education for grandchildren. The trustee is relieved from any further responsibilities, except to see that that is done, in accordance with this trust. ITEM VII. All federal, state and other death taxes--except generation-skipping transfer taxes--payable because of my death on the property forming my gross estate for tax purposes, whether or not it passes under this will, shall be paid out of the principal of my residuary estate just as if they were my debts, and none of those taxes shall be charged against any beneficiary or any outside fund. Any death taxes on future interests shall be paid out of the principal of my residuary estate or the residuary trust whenever my executor or my trustee, in my executor's or my trustee's sole discretion, thinks best. ITEM VIII. If any person is a minor or is, in my trustee's opinion, disabled by illness or other cause and unable to properly manage the funds, my trustee may pay his or her share of the funds to his or her parent or guardian or to any person or organization taking care of the person. Page 5 of 8 pages ITEM IX. No interest in income or principal shall be assignable by, or available to anyone having a claim against a beneficiary, before actual payment to the beneficiary. ITEM X. I authorize my executor, trustee or guardian of my estate: A. To retain and to invest in all forms of real and personal property, regardless of (i) any limitations imposed by law on investments by executors or trustees, (ii) any principle of law concerning delegation of investment responsibility by executors or trustees or (iii) any principle of law concerning investment diversification; B. To compromise claims and to abandon any property which, in my executors or my trustee's opinion, is of little or no value; C. To borrow from anyone, even if the lender is an executor or trustee hereunder, and to pledge property as security for repayment of the funds borrowed; D. To sell at public or private sale, to exchange or to lease for any period of time, any real or personal property, and to give options for sales or leases; Page 6 of 8 pages E. To join in any merger, reorganization, voting-trust plan or other concerted action of security holders, and to delegate discretionary duties with respect thereto; F. To allocate any property received or charge incurred to principal or income or partly to each, without regard to any law defining principal and income; and G. To use administrative or other expenses of my estate as income tax or estate tax deductions or both and to value my estate for tax purposes by any optional method permitted by the law in force when I die, without regard to whether they were paid from principal or income, without requiring adjustments between principal and income for any resulting effect on income or estate taxes. These authorities shall extend to all property at any time held by my executor or my trustee and shall continue in full force until the actual distribution of all such property. All powers, authorities and discretion granted by this will shall be in addition to those granted by law and shall be exercisable without leave of court. will. ITEM XI. Any corporate fiduciary hereunder shall receive compensation in accordance with its standard schedule of fees in effect at the time its services are performed. Page 7 of 8 pages ITEM XII. No executor, trustee or guardian shall be required to post bond. ITEM XIII. The term "executor" and "trustee" or any pronoun used to indicate the executor, trustee, any other fiduciary or any beneficiary shall be deemed to apply to one or more than one person or corporation and to the masculine, feminine or neuter gender, as the case may be. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my last will, this !6'~ay of ~ ~ 999. /(~ RELEN N. LA SIGNED, SEALED, PUBLISHED, and DECLARED by the above TESTATRIX, as and for her last will, in the presence of us, who thereupon at her request, in presence and in the presence of each other, have hereunto subscribed our names as witnesses. ~ ~ J2w~C1 9~ Ll~ t./ Page 8 of 8 pages COMMONWEALTH OF PENNSYLVANIA) ( ss: COUNTY OF DAUPHIN ) / // ~ ;() We, HELEN J. LANGJAHR, ,:A.. G-e_ c> rl~t//t;C ,2 and (J~/t-rI7CL/) .T (~(j12 Ol.-II\J , the executrix and witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn do hereby declare to the undersigned authority that she signed and executed the instrument as her last will and that she had signed willingly and that she executed it as free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as witness and that to the best of our knowledge, the executrix was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. //~~~4 ~.. - Q~.}..\:~~ WFe:s \~~ ,Lt'--- "'} '- ~4 Witness {, SUBSCRIBED, sworn to or affirmed, and acknowledged before me by -f1~amed and by the witnesses whose names appear above on /0 ,1999. ~~Iio_ No ary Public 21566.2 Notarial Seal Pauline Patti Thomas, ~otafY Public Harrisburg, Dauphin County My Commission Expires Mar. 24, 2003 Member, PennsylVania ASSOCiation ot Notanes E --- CERTIFICATION OF NOTICE UNDER RULE 5.6(a) BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY OF PENNSYLVANIA In re: ESTATE OF HELEN N. LANGJAHR, Deceased. DATE OF DEATH: January 29,2001 Will No. 2001-00173 Administration No. To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court rules was served on or mailed to the following beneficiaries of the above-captioned estate on February 14, 2001: Name Deborah L. Hockley Steven C. Hockley Deborah L. Hockley, Parent and natural Guradian of Evan, Sabrina, Amber, Daniel and Matthew Hockley Address 495 Woodcrest Drive, Mechanicsburg, PA 17050 495 Woodcrest Drive, Mechanicsburg, PA 17050 495 Woodcrest Drive, Mechanicsburg, PA 17050 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: Date: 4/C;/OI \ ' m"es G. IV\, , Jr. trucker Aren~ rg & Swartz ~! 11 North Front Street j .0. Box 889 arnsburg, PA 17108-0889 717/234-4121 (~\ \ Signature: Name: Address: Telephone: x Personal Representative Counsel for Personal Representative Capacity: 38570.1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT LEE C SWARTZ 111 NORTH FRONT STREET POBOX 889 HARRISBURG, PA 17108-0889 nnn__ fold ESTATE INFORMATION: SSN: 164-18-2277 FILE NUMBER: 21 - 2001 - 01 73 DECEDENT NAME: LANGJAHR HELEN N DATE OF PAYMENT: 10/11/2001 POSTMARK DATE: 10/10/2001 COUNTY: CUMBERLAND DATE OF DEATH: 01/29/2001 NO. CD 000372 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $3,414.82 I I I I I I I I TOTAL AMOUNT PAID: $3,414.82 REMARKS: LEE C SWARTZ ESQUIRE CHECK# 119 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS j~ o ff o f; iij Iii tr::L 'i"~ ;- ~.,~~~ w :~~i<~ & ~~)f~Y..~':' ;: ~' ~ , Ll.J Q: /'.... T-; lQ (0 ~ l.J.J IE :t: '3 [2 ~.". " I I I I- < ~ o ~ <;( o' ~ ~:.. c~ ,~. . f""'\ ,::::: ,-,' () >( ;!,..... ~Q. ....... $~ Lu ::: (J) () ~LuLu o ~~ r:c C/) ~ .....J ~Lu ~ lli () ~ Q. ~ (j ~....... -Lt... f5Lt... iO ..... I- < lJ.J -..J <~occ OCl)~fjf <;( ffj' < ~ C/JO.==, C/JO< <;( ..: iff I; I I 9 i{ /-. ~ o ~ <:(' -..J i5 E u. '-Q . f1:\ ..<~:. . ~ '\' C/l :>:.'- - ~~ OJ (t (!) o':t !.U ~:E: Q: ijj @ :g" ~ s s! (I) fflJ.J~ ~.:::>~ 0 t$...J 8 ~~~ r!J :]:0:9 ;:: t:i~a ~ wi-~ Q s$iZ-ci ~~O&~ Of.:.:;'O-.J ~O:q~C1J ~;(I#i-'~ 8~:;,&0: OJo:{ C/)- -..J -.J . ~- IJ.. o $- J..::. !2 (!J- f# Cr: ~ -t DATE ESTATE OF DATE OF DEATH P 3 .20 FILE NUMBER . COUNTY ACN I / J I I I I I 11-26-2ulJ.a. ! LANGJAHR 01-29-2001 21 01-0173 CUMBERLAND 101 -..J LJ C/J '\, /h -c2CJ9-/? BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG1 PA 17128-0601 I I I NOTICE '10 APPRAISEMENT~ ALLOWANLL _ OF DEDUCTIONS AND ASSESSMENI REV-1547 EK AFP el2-0Dl HELEN N .01 NOV 30 JAMES G MORGAN JR TUCKER ETAL PO BOX 889 HBG Cien\- PAl 7'ftlNnbe; ; c1> Amount Remitted .), r '}\ MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV: i:s4-j-Ex--AF'P--fi'2-:o0"r-NoYicE--oF-YNHEifiTAN-CE-"-A'x-APPRA-isEirENT~--ALrciwAN-cE-o-R----------- - - - - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF LANGJAHR HELEN N FILE NO. 21 01-0173 ACN 101 DATE 11-26-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) 120~000.00 650.742.09 .00 .00 289.239.88 2.569.93 .00 (8) NOTE: To insure proper credit to your account~ submit the upper portion of this form with your tax payment. 1~062~551.90 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 50~547.58 447.02 (11) (12) (13) (14) 50.994 60 1~011~557.30 .00 1~011~557.30 NOTE: If an assessment was issued previously, lines 14, 15 and/or 1&, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: (15) .00 X 00 = .00 (16) 1~011~557.30 X 045 = 45~520.08 (17) .00 X 12 = .00 (18) .00 X 15 = .00 (19)= 45~520.08 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-26-2001 AA496517 2~105.26 40~000.00 10-10-2001 CDOO0372 .00 3~414.82 TOTAL TAX CREDIT 45~520.08 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ~ IF PAID AFTER DATE INDICATED~ SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1~ NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)~ YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) Register of Wills of CUMBERLAND County, Pennsylvania INVENTORY Estate of Helen N. Langj ahr No. also known as Date of Death 01/29/2001 , Deceased Social Security No. 164-18-2277 Lee C. Swartz, Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I !We verify that the statements made in this Inventory are true and correct. l!We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. 06897 Personal Representative Signature ~ (t~/ Signature: \..J Name of Attorney: James G. Morgan, Jr. I.D. No.. Address: III North Front St. Address: III North Front St. Harrisburg, PA 17108-0889 Harrisburg, PA 17108-0889 Telephone: 717/234-4121 Telephone: 717/234 - 4121 Dated: Description Value (See continuation page(s) attached) (Attach additional sheets if necessary) Total: 1,059,981.97 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form #RW-7 (1992) Estate of: Date of Death: County: INVENTORY Helen N. Langjahr 01/29/2001 Cumberland CASH: A1lfirst Bank - Relationship Checking Account No. 0038325195 1,610.64 Accrued interest through date of death AT&T - Service Refund 20.69 Atlantic Mortgage - Refund of Escrow to Martgagor 9.58 Blue Cross/Shield - Policy Refund 316.90 Commerce Bank - checking account #0513261479 3,044.15 Accrued interest through date of death 12,414.00 Merrill Lynch CMA Money Fund - cash account 12,414.00 ML Banking Advantage - Money account 429.00 Pennsylvania Department of Revenue - 2000 Income Tax Refund 198.00 Pittsburgh National Corporation Savings Account - PNC Advisors - cash account #16-35-035-0660717 291.32 -1- Accrued interest through date of death 2,693.12 shares T. Rowe Price - Equity Income Fund account {/207005403-9 shares The Vanguard Group - PA Tax Exempt Money Market u.s. Treasury - Income tax refund u.s. Treasury - Social Security benefit Verizon - Commission/Refund STOCKS/LISTED: 150.00 shares AT&T Corp - traded on the NYSE, common 10.00 shares Avaya Inc. 1.00 share Friendly Ice Cream Corporation - traded NYSE, common stock 600.00 shares General Electric Co - traded on the NYSE, common 128.00 shares Lucent Technologies, Inc. - traded on NYSE, common 110.00 shares Marine Transport Corporation - traded on the NYSE, common 2,662.00 shares Ogden Corp - traded on the NYSE, common -2- 218.02 66,600.88 201,783.74 1,427.00 838.00 37.96 3,571.50 170.00 2.99 26,628.00 2,301.44 763.13 44,854.70 289,239.88 1,105.00 shares aMI Corp - traded on the NYSE, common 210.00 shares PepsiCo Inc - traded on the NYSE, common 9,687.66 shares The Vanguard Group - Equity Income Fund 28,931.57 shares The Vanguard Group - Inter-Term Treasury Inv. 220.00 shares Verizon Communications - traded on NYSE, common REAL ESTATE/PA: 495 Woodcrest Drive, Mechanicsburg, PA 17050 - 6/8 of the value 6,409.00 9,166.50 231,535.07 313,618.16 11,721.60 120,000.00 TOTAL RECEIPTS OF PRINCIPAL......... ...... -3- 650,742.09 120,000.00 1,059,981.97 .-- " .~ , I ~OK STATUS REPORT UNDER RULE 6.12 Name of Decedent: Helen N. Langjahr Date of Death: January 29, 2001 Will No. 2001-00173 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes No X 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 6/30/2003 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes No d. Copies of receipts, reJeases, joinders and approvals of formal or informal acc\nts ay be filed with the Cerk of the Orphans' Court and may att hed to this report. 'f\) " Date: 12/30/3002 Sign ,ur \ Jam G. \.. 0 ,J r . Tuc er Arensb rg & Swartz Nam (Please type or print) III North Front StreeL Harrisburg, FA 17101 Address (7 1 7 ) 2 34 - 4 12 1 Te 1. No. Capacity: Personal Representative x Counsel for personal representative (MAH:rmf/AM3) * Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (71 7) 240 - 6345 . Date: 12/06/2002 LEE C SWARTZ 111 NORTH FRONT STREET POBOX 889 HARRISBURG, PA 17108-0889 RE: Estate of LANGJAHR HELEN N File Number: 2001-00173 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1/ for decedents dying on or after July 1/ 1992/ the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 1/29/2003 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, MARY C. LEWIS REGISTER OF WILLS cc: ;/ File Counsel Judge Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: Helen N. Langjahr Date of Death: January 29, 2001 Estate No.: 2001-00173 Pursuant to Rule 6J2 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. Stat~ther administration of the estate is complete: Yes?\. No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. I is Yes, state the following: a. Did the perso~resentative file a final account with the Court? Yes 0 No~ b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the per~epresentative state an account informally to the parties in interest? Ye~ No 0 c. Copies of receipts, releases, joinders a~oval of formal or informal accounts may be filed 1 the Clerk of tn ans' Court and may be attached to this report. ~ ~I/</:':;'_ ~ ~,J Jr. Date: Name Tucker Arensberg, P.C. P.O. Box 889 Address . Harrlsburg, PA 17108-0889 (717) 234-4121 Telephone No. Capacity: ,J:J Personal Representative 17' Counsel for personal representative Q J' REV-1500 EX + (6-00) CAPB HpRL EplO CRAC KOTK ES C P o 0 R N R 0 E E S N T C o M P T U A T X A T I o N REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER ..;) / t') / COUNTY CODE YEAR SOCIAL SECURITY NUMBER /;l3 NUMBER o E C E o E N T COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Lan 'ahr Helen N. DATE OF DEATH (MM-DD-YEAR) DATEOF BIRTH (MM-DD-YEAR) 164-18-2277 THIS RETURN MUST BE FilED IN DUPLICATE WITH THE 01/29/2001 01/24/1920 IF APPLICABLE SURVIVING SPOUSE'S NAME LAST, FIRST, AND MIDDLE INITIAL) REGISTER OF WILLS SOCIAL SECURITY NUMBER X 1. Original Return 4. Limited Estate X 6. Decedent Died Testate 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust 1 (Attach copy of Will) D 9. Litigation Proceeds Received 3. (date of death . Remainder Return prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes (Attach copy of Trust) D 10. Spousal Poverty Credit D 11. Election to tax under Sec. 9113(A) (date of death between 12-31-91 and 1-1-95) (Attach Sch 0) . . THIS SE.CTIo'NiMI;IST~Bl!~q"'P,L1:!IIlD< l\Jl~ :CClJ'iRl!$1'PNnENG''''JI'i~NFIDEN'tlALjTjl\xiIN!'ORMATIClIISHOULO BE tltl'lECTED Ire! -. - NAME COMPLETE MAILING ADDRESS James G. Mar an, Jr. FIRM NAME (If Applicable) Tucker Arensber & Swartz TELEPHONE NUMBER 111 North Front St. P.O. Box 889 Harrisburg, PA 17108-0889 R E C A P I T U L A T I o N 17 234-4121 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule DJ 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate BiUing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (1) (2) (3) 120,000.00 650,742.09 Rone (4) (5) None 289,239.88 (6) 2,569.93 None 50,547.58 447.02 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) 16. Amount of Line 14 taxable at lineal rate 1,011,557.30 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20, x X X X .0 0 .0 45 .12 .15 Copyright (c) 2000 form software only The Lackner Group, Inc. OFFICIAL USE ONLY (8) 1,062,551.90 (11) 50.994.60 (12) 1,01l,557.30 (13) (14) 1,01l,557.30 (15) (16) (17) (18) (19) 0.00 45,520.08 0.00 0.00 45,520.08 Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 495 Wood Crest Drive CITY I STATE I ZIP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 45,520.08 0.00 40,000.00 2,105.26 Total Credits ( A + B + C ) (2) 3. Interest/Penalty jf applicable O. Interest E. Penalty 42,105.26 Totallnterest/Penalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0.00 3,414.82 0.00 3,414.82 PLEASE ANSWER THE FOLLOwi~~ QUESTIONS BY PLACING AN 1. "X" :::://H:;-..,....,.""'"..'.....'.','"..;;'../UU IN THE APPROPRIATE BLOCKS Did decedent make a transfer and: 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 care? 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Yes No ~~ o o o IX] IX] IZJ Under penalties of perjury, I declare that I have examined this return. including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representatIve is based on all information of which preparer has any knowledge. For dates of deat on or a 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is % [72 P. For dates of death on 0 ter J nuary 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 9116 (a) (1.1) (ii)J. e statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. ONSIBLE FOR FILING RETURN Lee C. Swartz 111 North Front St. .. Harr{si);.'-r.; .PA...1 lic'8 ~ 0Il89..... Tucker Arensberg & Swartz 111 North Front St. -~ ~ - -- - - -~- - ~ -- - - ~ -- ~ - -- - ~ -- ~ - -- - ---- Harrisbur PA 17108.0889 DATE For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%. except as noted in 72 P.S. 9116(1,2) [72 P.S. 9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(a)( 1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (cl 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) REV- 1502 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Helen N. Langjahr SS# 164-18-2277 01/29/2001 All real property owned solely or as a tenaht in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with riQht of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE DESCRIPTION NUMBER OF DEATH 1 495 Woodcrest Drive, Mechanicsburg, PA 17050 - 6/8 of the value 120,000.00 SCHEDULE A REAL ESTATE TOTAL (Also enter on line 1, Recapitulation) $ 120,000.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1502 EX (Rev. 1-97) REV-1503 EX + (1-97) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SSI/ 164-18-2277 01/29/2001 Helen N. Langjahr ITEM NUMBER 1 All property jointly-owned with right of survivorship must be disclosed on Schedule F. DESCRIPTION 150 shares AT&T Corp, CUSIP 1/001957109 - traded on the NYSE, common 2 10 shares Avaya Inc., CUSIP 1/053499109 3 1 share Friendly Ice Cream Corporation, CUSIP 1/358497105 - traded NYSE, common stock 4 600 shares General Electric Co, CUSIP 1/369604103 - traded on the NYSE, common 5 128 shares Lucent Technologies, Inc., CUSIP 1/549463107 - traded on NYSE, common 6 110 shares Marine Transport Corporation, CUSIP 1/567912100 - traded on the NYSE, common 7 2,662 shares Ogden Corp - traded on the NYSE, common 8 1,105 shares OMI Corp, CUSIP I/Y6476W104 - traded on the NYSE, common 9 210 shares PepsiCo Inc - traded on the NYSE, common 10 9,687.66 shares The Vanguard Group - Equity Income Fund 11 28,931.565 shares The Vanguard Group - Inter-Term Treasury Inv. 12 220 shares Verizon Communications, CUSIP 1/92343V104 - traded on NYSE, common UNIT VALUE 23.81 17.00 2.99 44.38 17.98 6.9375 16.85 5.80 43.65 23.90 10.84 53.28 TOTAL (Also enter on line 2, Recapitulation) (If more space is needed, insert additional sheets of the same size) copyright (c) 1996 form software only CPSystems, Inc. FILE NUMBER VALUE AT DATE OF DEATH 3,571.50 170.00 2.99 26,628.00 2,301.44 763.13 44,854.70 6,409.00 9,166.50 231,535.07 313,618.16 11,721. 60 650,742.09 Form REV-1503 EX (Rev. 1-97) REV-150B EX + (1-97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEA.L TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Helen N. Langjahr FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. SSII 164-18-2277 01/29/2001 ITEM NUMBER 1 U.S. Treasury DESCRIPTION Social Security benefit VALUE AT DATE OF DEATH 838.00 10 2 A11first Bank Relationship Checking Account No. 0038325195 1,610.64 Accrued interest on item 2 to date of death 0.00 3 AT&T - Service Refund 20.69 4 Atlantic Mortgage Refund of Escrow to Martgagor 9.58 5 Blue Cross/Shield Policy Refund 316.90 6 Commerce Bank - checking account 110513261479 3,044.15 Accrued interest on item 6 to date of death 0.00 7 12,414 Merrill Lynch CMA Money Fund - cash account 12,414.00 8 429 ML Banking Advantage Money account 429.00 9 Pennsylvania Department of Revenue - 2000 Income Tax Refund 198.00 Pittsburgh National Corporation Savings Account - PNC Advisors cash account 1116-35-035-0660717 291. 32 Accrued interest on item 10 to date of death 218.02 11 2,693.121 shares T. Rowe Price - Equity Income Fund account fl207005403 - 9 66,600.88 12 201,783.74 shares The Vanguard Group - PA Tax Exempt Money Market 201,783.74 13 u.s. Treasury - Income tax refund 1,427.00 14 Verizon - Commission/Refund 37.96 TOTAL (Also enter on line 5, Recapitulation) $ 289,239.88 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) REV-1509 EX + (1 -97) SCHEDULE F JOINTL V-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Helen N. Langjahr SSIf 164-18-2277 01/29/2001 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. RELATIONSHIP TO DECEDENT FILE NUMBER A. SURVIVING JOINT TENANT(S) NAME Deborah L. Hockley ADDRESS 495 \/oodcrest Dr. Daughter Mechanicsburg, PA 17050- B. c. JOINTLY-OWNED PROPERTY' LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank DATE OF DEATH DECD'S VALUE OF account number 01 similar identifying number. NUMBER TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1 A M&T Bank - checking account 5,139.85 50.00Y, 2,569.93 1/2676000074 TOTAL (Also enter on line 6, Recapitulation) $ 2,569.93 (If more space is needed insert additional sheets 01 the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1509 EX (Rev. 1-97) REV-1511 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Helen N. Langjahr Debts of decedent must be reported on Schedule I. ITEM NUMBER A. B. FILE NUMBER 8811 164-18-2277 01/29/2001 DESCRIPTION AMOUNT FUNERAL EXPENSES, 1. ADMINISTRATIVE COSTS, Personal Representative's Commissions Name of Personal Representative(s) Lee c. Swartz Social Security Number(s) / EIN Number of Personal Representative(s) Street Address 111 North Front St. City Harrisbur~ State PA Zip 17108-0889 23,500.00 Year(s) Commission Paid: 2. 3. Attorney's Fees Family Exemption; Claimant Street Address City Relationship of Claimant to Decedent 23,500.00 Tucker Arensberg & Swartz (If decedent's address ;s not the same as claimant's, attach explanation) Zip State 4. Probate Fees Register of Wills 524.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs A Perfect Affair, Inc. Funeral expense 322.24 129.16 75.00 248.04 150.00 275.00 1,824.14 $ 50,547.58 2 Citibank - payoff credit card 3 Cumberland Law Journal - Legal Advertisement 4 Harris T.V. & Appliance - Home Appliance repairs 5 Janice Atwood - 2000 Tax Preparation Fees 6 L.G. Connor Real Estate Appraisers, Ltd. Appraisal fee Total of Continuation 8chedu1e(s) TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) Copyright (e) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) REV- 1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Helen N. Langjahr SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS FilE NUMBER SSII 164-18-2277 01/29/2001 Include unreimbursed medical expenses. ITEM NUMBER 1 DESCRIPTION Kathryn W. Fetrow, Treasurer - 2001 Real Estate Tax; Map No. 10-17-1033-084;495 Woodcrest Drive AMOUNT 447.02 TOTAL (Also enter on line 10, Recapitulation) $ 447.02 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form softwilreonly CPSystems, Inc. Form REV-1512 EX (Rev. 1_97) REV-1513 EX + (9-00) SCHEDULE J BENEFICIARIES COMMONWEAL.TH OF PENNSYLVANIA INHERITANCETP;X RETURN RESIDENT DECEDENT ESTATE OF Helen N. Lang;ahr SS# 164-18-2277 01/29/2001 NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] Amber Kirsten Hockley 495 Woodcrest Drive Mechanicsburg, PA 17050-6854 1 2 Daniel Eric Hockley 495 Woodcrest Drive Mechanicsburg, PA 17050-6854 3 Deborah L. Hockley 495 Woodcrest Drive Mechanicsburg, PA 17050-6854 4 Evan Christopher Hockley 495 Woodcrest Drive Mechanicsburg, PA 17050-6854 5 Matthew Charles Hockley 495 Woodcrest Drive RELATIONSHIP TO DECEDENT Do Not List Trustee{s} Granddaughter Grandson Daughter Grandson Grandson FILE NUMBER AMOUNT OR SHARE OF ESTATE 8% residue of estate 8% residue of estate 50'10 of res idue 8% residue of estate 8% residue of estate ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON- TAXABLE DISTRIBUTIONS, A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 0.00 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (It more space is needed, insert additional sheets of the same size) CopyrIght (c) 2000 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00) Estate of: Helen N. Langjahr Sac Sec #: 164-18-2277 Date of Death: 01/29/2001 Continuation of Schedule H-Bl (Personal Representative's Commissions) Item 11 Description Amount 1 Tucker Arensberg & Swartz - Executor Fee 23,500.00 23,500.00 Estate of: Helen N. Langjahr Soc See #: 164-18-2277 Date of Death: 01/29/2001 Continuation of Schedule H-B2 (Attorney's Fees) Item II Description Amount 1 Tucker Arensberg & Swartz - Attorney fees 23,500.00 23,500.00 Estate of: Helen N. Langjahr Soe See iI: 164-18-2277 Date of Death: 01/29/2001 Continuation of Schedule H-B4 (Probate Fees) Item II Description Amount 1 Register of Wills - Probate fees 524.00 524.00 Estate of: Helen N. Langjahr Sac Sec #: 164-18-2277 Date of Death: 01/29/2001 Item # Continuation of Schedule H-B7 (Other Administrative Costs) Description Amount 7 M&T Bank - check fees 14.74 8 PP&L Electric Utilities Corporation - Electric 300.22 9 Register of Wills Two short certificates 6.00 10 Register of Wills Five short certificates 15.00 11 State Farm Insurance Company - Homeowners Insurance Policy No. 38-30-3084-0 370.00 12 The Sentinel - Legal - Proof of Publication 90.59 13 Tucker Arensberg & Swartz - administrative expenses (reserve) 1,000.00 14 Verizon - Telephone 27.59 1,824.14 Estate of: Helen N. Langjahr Sac Sec #: 164-18-2277 Date of Death: 01/29/2001 Item # Continuation of Schedule J, Part I (Taxable Bequests) Name and Address of Beneficiary Relationship Amount or Share of Estate Mechanicsburg, PA 17050-6854 6 Sabrina Angelique Hockley 495 Woodcrest Drive Mechanicsburg, PA 17050-6854 Granddaughter 7 Steven C. Hockley 495 Woodcrest Drive Mechanicsburg, PA 17050-6854 Son- in-Law 8% res idue of estate 10% residue of estate ~ Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: Helen N. Langjahr Date of Death: January 29, 2001 Estate No.: 2001-00173 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: I. Stat~ther administration of the estate is complete: YesA No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. I is Yes, state the following: a. Did the perso~resentative file a final account with the Court? Yes 0 No~ b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the pe~. nal r resentative state an account informally to the parties in interest? Ye/\ No 0 c. Copies of receipts, releases, joinders accounts may be filed the Clerk of ill attached to this report. Date: ;<./</0, . oval offormal or informal ans' Court and may be 0~) C.:.,",~ Name Tucker Arensberg, P.C. P.O. Box 889 Address . Harrlsburg, PA 17108-0889 (7l7) 234-4121 Telephone No. Capacity: ..,J:} Personal Representative ~ Counsel for personal representative J Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 2/01/2005 MORGAN JAMES G JR 111 N FRONT ST POBOX 889 HARRISBURG, PA 17108-0889 RE: Estate of LANGJAHR HELEN N File Number: 2001-00173 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 1/29/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge vA