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Home My WebLink About01-0465 (Est<Jte of SADIE ANN THOMAS YEAGER ',also known as SADIE A. YEAGER PETITION FOR GRANT OF LETTERS ~J-~S- No. , Deceased Social Security No. 207070336 IRVIN R. YEAGER Petitioner(s), who is/are 18 years of age or older, apply)ies) for: (COMPLETE "A" OR "B" BELOW:) Gl A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut or Decedent, dated 03/15/1985 and codicil(s) dated NONE named in the Last Will of the 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 incapacitated: o B. Grant of Letters of Administration (c.I.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained the 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 CUMBERLAND County, Pennsylvania, with his/her last family or principal residence at 35 WHITE OAK BLVD., SIVER SPRING TOWNSHIP (list street, number and municipality) Decedent, then 81 years of age, died APRIL 02 2001 at BETHANY VILLAGE , - , (Location) Decedent at death owned property with estimated values as follows: (if domiciled in PA All personal property ......................................... $ 20,000.00 (if not domiciled in PA Personal property in Pennsylvania .................... $ (if not domiciled in PA Personal property in County .............................. $ Value of real estate in Pennsylvania ........................................................................................ $ Total ..................................................................................................................... $ 20,000.00 Real Estate situated as follows: NONE 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 appropriate form to the undersigned: I Signature Typed or printed name and residence I ,~...._ ~ U~ ~ . .. ... ~. - (\ -~. " IRVIN R. YEAGER 35 WHITE OAK BLVD. MECHANICSBURG, PA 17055- -.... I;:, ~ ~:211 '2 Oath of Personal Representative Commonwealth of Pennsylvania County of CUMBERLAND The Petitioner(s) above-named swear(s) and 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, Petitioner(s) will well and truly admin er the estate according to law. before me this Sworn to and affirmed and subscribed 10th day of May 2001 ~ t!~~ ~ Mary ewis ft~ DECREE OF'~tER OF WILLS Estate of SADIE ANN THOMAS YEAGER also known as SADIE A. YEAGER Social Security No: 207070336 Date of Death: 04/02/2001 AND NOW, May 11th 2001 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, Deceased No. 21-2001-465 IT IS DECREED that Letters ~ Testamentary 0 of Administration ((c.I.a.. d.b.n.c.t.; pendente lite; durante absentia; durante minoriate) are hereby granted to IRVIN R. YEAGER in the above estate and that the instrument(s), if any, dated MARCH 15, 1985 described in the Petition be admitted to probate and filed of record as the Last Will of Decedent. FEES Letters .................................... $ 50.. 00 Short Certificates( s) ..."'2)...... Renunciation .......................... Extra Pages (4 ) ............... I.T.R....................................... JCP Fee ................................. Inventory ............ .................... Other .. ...... .................... .......... 6.00 $ $ $ 12 .00 $ $ $ $ $ Signature 5.00 Attorney: DAVID HALLER, ESQ. I.D. No: 18321 Address: 800 CORPORATE CIRCLE, SUITE 104 HARRISBURG P A 17110 Telephone: 717540-5960 DATE FILED: May llth,2001 TOTAL .............................$ 73.00 MAILED LETTERS AND ORDER ro ATI'Y HI05.905 REV.(09/00) This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records In accordance with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. ~II~ cx~s.~; ~~---- /'jr. Robert S. ~erman, Jr., MPH Secretary of Health Charles Hardester State Registrar 1701292 NOV 0 1 2001 Date 21-2001-0465 H1OS.143 Rev. 2187 COR..ltECTED ITEMS: 3 PER:FD DATE:6-6-Qlbas COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH o :0 w.ME OF DECEDENT {Fw$I. MQ:Je, LasI) 1. Sadie Ann Thanas Yeager AGE (last Birthday) UNDER 1 YEAft UNDER 1 OM' 81 Yrt. MonIhs Days HounI! ~ STATE FILE NUMeER SEX SOCIAL SFCURITY NUMBER 2. Female .. 207 07 0336 8&RTHPLACE ICily and PlACE OF oe.qw (Checlc ~one -;eeinatruct.or'ls on other SldeJ - . Staae or Foreq1 Country) HOSPITAL: OTHER: Askarn, PA ,_0 :::::0 ex 7. ... FACIUlY NAME (If no( insIitulion. gMI mite! and number) 037573 TYPElPNNT IN PERMANENT BLACK _ DATE OF DEATH iMctlIh. Oa~. '''W) .April 2, 2001 ~ID S. COUNTY OF DEIlH 01 '" ... cumberland DECeDENT'S USUAL OCCUAVlOH (~~~~=~mcr 11L Hanemaker 110. Hane DECEDENT'S MAIUHG ADORESS (SIr-.~. Stale. Zip COde! 35 White Oak Blvd. Mechanicsburg, PA 17050 Yea er DECEDENTS ACTUAl. RESIDENCE (See~ onolhersiclel ..... ''''. - __.....0 \... 0/ ... ,- '-- : ontIM and ~ L24 Npii.1' PARTI: OltwSiQniftcantcontlliona~to.OM&h,but not NeUIIng in 1M uradIrtytng c.-.g;w. WI PART I. E DUE 10 (OR AS A CONSEQUENCE OF): DUE 10 (OR I<S A CONSEQUENCE Of): <::J WERE AU10PSV FINCNNGS MANNER OF DEATH A\tIUl.A8U: PRIOR 10 COMPLEl1OH OFCAUSE j&- 0 OF DEArI1? - -- - 0 p........- 0 ,..0 ..0 - 0 Couldl'lQtbe~ 0 DATE OF INJURY (........Ooy.- TIME ~ INJURY INJURV JIJ WORK? oeSCRtBE WON INJURY OCC\JRREO. ,.. 0 ..0 - CERnF1ER{~ori'tone\- -CERTIFYING PHYSICIAN (Physioancertifying cause cJ dealh when another physician has prClf'lOlJllC8d deaJh and ccrnpleted Item 2J1 To Ihe-.. of MY knowtedge. ."occurNdtkMtIOhcauM(S)andlNftMr..atated... ..................................... ............. ... .. 3Ota.... PlACE OF INJURY. At home. farm. strHI. lactofY, orne. buiIding..-c:.(5pecify} .... SIGNJlJURe 0,,0. 621 ( ~( 1.11 3Of. E Of CERTIFIER c::< ~;7l<J UCENSE NUMBER DIJE stONED (MOnfI. Day, 'tUr1 Q\ "c. tnDOhS::J'?'ltf 3'" ?,-;1.. -;1..00) r NAME AND AOOReSS OF PERSON W~PlETED ~}use OF DEATH (Item 27) Type 0< pn"\J_y.( N C.......,y""l (fIt:7 w... h...~Jt/ ' m ~J"-'."'''~J ?J'!l'l7o.)-J J D (MonIh. 081/. Yeat) o I- ~ ill fil o .... o w " < Z -PAONOUNCING AND CERTJFYING PHYSICIAN (Physician bOlh pronounclf'l9 dea1h and certifytng 10 cause cJ death) To 11M.... of my knowledge. death oc:curNCf at ttw Ihne. __. Mld ptac4t. and due \0 u.cause(s) ani! mannei''' .-atM_. .. . . . ., . . . . .' . . . . . .. . . .. -MEDICAL EXAMINEA/CORONER on the bMi. of .xantin.non andIorlnvesti9'ltiOn. In my opinion, death occurftd at the II,.,., dat., and place. and due 10 the cause(s) and mennerustated.,.... ,..........,.... ......,.....,..............................,......,.. ..., .......,......... 31.. REGIST 34. I II 'I I' I LAST WILL AND TESTAMENT OF SADIE A. YEAGER I, SADIE A. YEAGER, of Allentown, Lehigh County, Pennsylvania, being of full age, sound mind and memory and under no restraint, do make, publish and declare this instrument to be my Last Will and Testament and hereby revoke all Wills and Codicils ever before made by me. ITEM ONE I direct my Executor to pay all of the expenses of my last illness, of my funeral and burial and of the administration of my estate. ITEM 'IWO I direct my Executor to pay all inheritance, transfer, estate and similar taxes (including interest and penalties) assessed or payable by reason of my death on any property or interest in property which is included in my estate for the purpose of computing taxes. My Executor shall not require any beneficiary under this Will to reimburse my estate for taxes paid on property passing under the terms of this Will. ITEM THREE I hereby authorize my Executor to utilize the services of an attorney, accountant and any other professional as may be necessary in the administration of this, my Last Will and Testament. The expenses incurred by the Executor using such professional services shall be an expense to my estate and shall be paid by my estate. I I , I I I II I ! ITEM FOUR My Executor named herein shall be entitled to reasonable compensation commensurate with the services actually performed and to reimbursement for expenses properly incurred. ITEM FIVE I give, devise and bequeath the entire residue of ~ estate, whether real, personal or mixed, of every kind, nature and description whatsoever, and wherever situated, which I may now own or hereafter acquire, or have the right to dispose of at the time of ~ death, by the power of appointment or otherwise, to ~ husband, IRVIN R. YEAGER, absolutely and in fee simple. ITEM SIX Should, however, IRVIN R. YEAGER, predecease me or fail to survive me by thirty (30) days, then the gifts, devises and bequests to IRVIN R. YEAGER shall fail and be of no effect, and in that event, I give, devise and bequeath the entire residue of ~ estate, whether real, personal or mixed, of every kind, nature and description whatsoever, and wherever situated, which I may now own or hereafter acquire, or have the right to dispose of at the time of ~ death, by the power of appointment or otherwise, to ~ children, absolutely and in fee simple, share and share alike. Should any such child predecease me, then his or her share shall pass per stirpes, that is (a) if that child has living issue, the portion of my estate otherwise reserved for that child shall be distributed arocmg said liVing issue by right of representation; or (b) if that child has no living issue, the portion of ~ estate otherwise reserved for that child shall be distributed among those of my children who did survive me and, by right of representation, among the living issue of those of ~ children who did predecease me; or (c) if no child of mine survives me and leaves no living issue, the residue shall go to ~ son-in-law, PHILIP H. KLOTZ. ITEM SEVEN I nominate and appoint IRVIN R. YEAGER as Executor of this, ~ Last Will and Testament, and require that said Executor serve without bond. In the event that the above-named Executor shall, for any reason, fail to qualify, or having qualified, fail to complete the administration of my estate, I nominate and appoint JILL Y. KWTZ instead and give to said Executrix all rights, powers and immunities set forth in this Will, including the requirement that said Executrix serve without bond. ITEM EIGHT If any gift, bequest or legacy made by this, my Last Will and Testament would, but for this Item, be made to any person who, at that time, is less than twenty-one (21) years old, then in that event the gift, bequest or legacy shall be made to PHILIP KLOTZ, in trust, for the benefit of said person. In the event that PHILIP KLOTZ refuses or fails to serve, I hereby grant the same rights, powers and privileges and impose the same duties upon, and make said gift, bequest or legacy to, WILLIAM H. THOMAS instead. 'Ihe purpose of said Trust is to ensure an adequate level of income, support, maintenance and education for said beneficiary. It is my express intention and direction that the income or principal of said Trust shall not supplant or replace the legal obligation for support, maintenance or education which any other person might have with respect to said beneficiary, but rather shall only supplement other, existing sources of income. Tb meet this purpose, I empower the Trustee to distribute, or not to distribute, all or part of the income and to invade all or part of the principal as the Trustee in its sole discretion decides. 'Ihe Trustee shall have the power to manage, invest and reinvest the assets of the Trust estate, to collect the income therefrom and to apply so much or all of the net income and principal thereof as set forth above. Any net income not so applied shall be added to the corpus of the Trust and held, administered and disposed of as a part thereof. 'Ihe corpus of the Trust shall be paid over to such beneficiary when he or she reaches the age first referred to in this Item, or, if such beneficiary shall die before reaching that age, upon his or her death the corpus of the Trust shall be paid over to the residuary beneficiary of this, my Last Will and Testament, or, if none are then surviving, to nw then living heirs at law, by right of representation. ITEM NINE In addition to the powers conferred upon executors and trustees by law, nw Executor and Trustee, if any, or any duly appointed successor shall have authority without adjudication, order or direction of the court: (a) Tb sell, pursuant to option or otherwise, at public or private sale and upon such terms as the Executor shall deem best, any real or personal property belonging to my estate, without regard to the necessity of such sale for the purpose of paying debts, taxes or legacies; (b) To retain any or all of such property not so required without liability for any depreciation thereof; (c) To assign or transfer certificates of stock, bonds or other securities; (d) To adjust, compromise and settle any and all claims in favor of or against my estate; ( e) To conduct and carryon all business now conducted by me and to do all things necessary or proper in the usual course of business until such time as the business can be sold or distributed as a going concern or otherwise, and the Executor shall be exonerated from any loss which may result thereby; and ( f ) To do any and all things necessary or proper to complete the administration of my estate, all as fqlly as I could do if living. ITEM TEN As used herein, the singular form of a word includes both the singular and plural, and reference to words of a certain gender includes reference to all genders. ITEM ELEVEN If I and any beneficiary under this, my Last Will and Testament, should die in a common accident or disaster or under such circumstance that it is difficult or impractical to determine who survived the other, or if any beneficiary, though surviving me, should die within thirty (30) days from and after the date of my death, then such beneficiary shall be deemed to have predeceased me. IN WITNESS WHEREOF, I have hereunto signed my name and acknowledged and published this instrument, consisting of c -- tyPewritten pages, identified by my signature, as my Last Will and Testament, in the presence of the undersigned witnesses, on this /6 day of n, ~ , 1985. .'1 J~tl ~~ SADIE A. YE G We certify that SADIE A. YEAGER, the Testatrix named above, subscribed her name hereto, on this day and in our presence, and to us declared the same to be her Last Will and Testament; that we subscribed our names hereto as witnesss, in the presence and at the request of said Testatrix and in the presence of each other; and that at the time of the execution of said instrument and of our subscribing the same as witnesses, said Testatrix was of sound and disposing mind and signed it as her free and voluntary act. WITNESS our hands at Allentown, Lehigh County, Pennsylvania, this /~ day of m/U'(tJ.... , 1985. j~j~- .TR~ ~itness Resides at ~~;J cf:1jJ<JW 4/ ~ Witness I Resides at 1rf..J.Mk~r PH COMMONWEALTH OF PENNSYLVANIA ACKNOOLEDGMENT COUNTY OF LEHIGH I, SADIE A. YEAGER, testatrix, whose name is signed to the foregoing instrument, having been duly qualif ied according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. :7 ~a-hu tl. ~~ ~;J SADIE A. Y G Sworn or affi~ to and acknowledged before me by SADIE A. YEAGER, the testatrix, this /S day of ~ , 1985. COMIDNWEALTH OF PENNSYLVANIA ~j~~~ Notary PubI1c CAROt SUE KERNS, Notary Public Allentown, Lehigh County, Pa. My Commission Expires May 2, 1988 AFFIDAVIT COUNTY OF LEHIGH We, "SuSf},v r yj, 1J F and Oeho~ ~I ~y , the witnesses whose names are signed to the foregoing instrumerlt, being duly qualified according to law, do depose and say that we were present and saw testatrix sign and execute the instrument as her Last Will and Testament; that she signed it willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the Will as witnesses; and that to the best of our knowledge, the testatrix was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. ~\ i Fj~~ vh ess w~~J~U J' ~~ SWorn or aff irmed to by '~ r: ~~~ this 151 day of ~ me witnesses, suRscribed to before JJ-eJ)(j((j.), VI m ~ , , 1985. / and and E CERTIFICATION OF NOTICE UNDER RULE 5.6(A) Name of Decedent: Sadie A. Yeager Date of Death: APRIL 2, 2001 Will No: 2001 - 00465 To the Register: I certify that notice of beneficial interest required by Rule 5.6 (a) of the OrphanDs Court Rules was served on or mailed to the following beneficiaries of the above captioned estate on 20 August, 2001: Irvin R. Yeager Notice has now been given to all persons entitled thereto under rule 5.6(a) except: NONE. Date:20 August, 2001 ~~ Robert J Knedler and ASSOCIates David HaBer, Esq. Suite 104, 800 Corporate Circle Harrisburg, P A 1 711 0 (717) 540-5960 Counsel for Personal Representative 10-;1,30-3 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ,/ I ~ '4..:,~+(,.,.,) '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT,280601 HARRISBURG, PA 17126-0601 I FILE NUMBER 21 01 00465 NUMBER COUNTY CODE YEAR ------- - ---- sdCTALSECURITY-NUMBER DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL) Yeager, Sadie A. DAIT OF DEATH(MM~DD-YEAR) DATE"OF""SIRTH (MM-DD:YEAR) 207-07-0336 ~ z w c w U w c THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 04/02/2001 01/16/1920 REGISTER OF WILLS SOCIAL SECURITY NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) Yeager, Irvin R. ! II 1. Original Return I [J 4. Limited Estate III 6 o rm!ll1l~. NAME Robert J. Mulderig I o 3. RemairiderRelurn (daTe ofdeaih prior 1012"-13-82) o 2. Supplemental Return o o o o w ~ ",<<n oi:2~ ~~g uftiil . < 4a. Future Interest Compromise (dale of death after 12-12-82) 7 Decedent Maintained a Living Trust (Attach copy of Trust) 10. Spousal Poverty Credit (date of death between 12.31-91 and 1-1-95) ............- ....!. 5 Federal Estate Tax Return Required Decedent Died Testate (Attach copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes D 11.Election to tax under Sec. 9113(A) (Attach Sch 0) . .., ~ z w c z o . rlRM NAME (If applicable) .. Turo Law Offices ~ELE-PHONE-NLJMBER 717/245-9688 28 S. Pitt St. Carlisle, PA 17013 ------- (1) None (2) None' (3) None (4) None (5) 19,303.76 (6) None (7) None (aT 19,303.76 (9) 15,686.70 (10) 891.65 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole~Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) B. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) z o ~ ~ ~ ~ ~ < u w ~ (11) 16,578.35 2,725.41 12. Net Value of Estate (Line 8 minus Line 11) (12) 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) (13) (14) 2,725.41 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, 2,725.41 x ,00 (15) or transfers under Sec. 9116(a)(1.2) z 16.Amount of Line 14 taxable at lineal rate x .045 (16) 0 ~ < ~ ~ 17. Amount of Line 14 taxable at sibling rate ,12 (17) . x ~ 0 u ~ 18. Amount of Line 14 taxable at collateral rate x .15 (18) ~ I 19. Tax Due (19) 0.00 0.00 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 20. 0 Copyright 2000 form software only The Lackner Group. Inc. Form REV.1500 EX (Rev. 6.(0) . Decedent's Complete Address: STREET ADDRESS 35 White Oak Blvd CITY Mechanicshurg STATE- PA ZIP 17050-7930 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (3) 0.00 (4) (5) 0.00 (5A) (58) 0.00 Total Interest/Penalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX CUE. 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;................... ..... .......... 0 181 b. retain the right to designate who shall use the property transferred or its income; ................ .............. 0 181 c. retain a reversionary interest; or..... ....................... .................................... .................. ...................... 0 181 d. receive the promise for life of either payments, benefits or care?....... ....................... .......................... 0 18:1 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration?................. .......................... .. ...................... .................... ................... 0 181 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?..... 0 181 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?................................ ................................................... ................... 0 181 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 I have examined this return, includingaccom6anying schedules and statements, and tothe 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. SIGNATURE OF PERSON RESPc)"NSIBLE FOR-FILING RETURN -- ADDRESS ----- - -------- I, 'n R. Yeage, 35 White Oak Blvd Mechanicshurg, P A 17050-7930 DATE ADDRESS ;2/;66T1 ADDRESS- -DATE . 28 S. Pitt St. Carlisle, PA 17013 ,). ,/0 0...3 For dates of eath on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (iI)). The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P .S. 99116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116 1.2) [72 P.S. ~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. 99116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Yeager, Sadie A. FILE NUMBER 21 - 01 - 00465 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER 1 DESCRIPTION Daily Passport Cash TrusiMoney Market Acct # 616-09436-1-6 Edward Jones 4500 devonshire Road, Suite 101 Harrisburg, P A 17109 - ---- TOTAL (Also enter on Line 5, Recapitulation) VALUE AT DATE OF DEATH 19,303.76 19,303.76 4300 Devonshire Road Ste 101 Harrisburg, PA 17109 (717) 541-5474 www.edwardjones.com Jeffrey L. Hoachlander Investment Representative EdwardJones February 10, 2003 Mr. Irvin R. Yeager 35 White Oak Blvd. Mechanicsburg, PA 17050-7930 Dear Mr Yeager: This lelter is being sent, per your request, to provide information for the following securities that belong to Sadie A. Yeager, now deceased. Quantity 19,303.76 Description Value Per Item Daily Passport Cash Trust Money Market $1.00 Total Value $19,303.76 The values listed are as of April 2, 2001, the day that Mrs. Sadie A. Yeager passed away. The values were obtained from an outside historical pricing service and while we believe that they are reliable, we do not guarantee their accuracy. Please let us know if you need any other information or assistance. Sincerely, C)~ ~ *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Yeager, Sadie A. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS i I 'FILE NUMBER 21 - 01 - 00465 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. --FUNERAL EXPENSES-'--- Malpezzi Funeral Home 2 Srairville United Methodist Church 3 Gay Monument Works B. ADMINISTRATIVE COSTS: Personal Representative's Commissions 1. DESCRIPTION AMOUNT Social Security Number(s) I EIN Number of Personal Representative(s): 2. Street Address City Year(s) Commission paid Attorney's Fees David Haller, Esquire State Zip Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Irvin R. Yeager 35 White Oak Blvd 3. Street Address City Mehanicsburg 4. Relationship of Claimant to Decedent Probate Fees Filing Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs Advetising costs 2 State pa Spouse 17050 Zip Additional Attorney's fees -Robert J. Mulderig, Esquire TOTAL (Also enter on line 9, Recapitulation) 8,890.70 250.00 1,903.00 1,200.00 3,000.00 60.00 183.00 200.00 15,686,70 Ma"/pezzi FUNERAL HOME Michael J. Malpezti Owner S Markel Plaza Way. Mechanic,burg, PA 17055 Phone: 697.4696 April 16, 2001 Irvin R. Yeager 325 Wesley Drive Mechanicsburg, PA 17055 The Funeral Service for Sadie Ann Yeager We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. 1. PROFESSIONAL SERVICES Services of Funeral Director/Staff FUNERAL HOME SERVICE CHARGES SELECTED MERCHANDISE: Solid Cherry Casket Clark 7 Ga. Vault Register, folders, aclrn. Gown THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES. CASH ADVANCES Opening Grave Cemetery Equipment Clergy/Mass Offering Organist Certified Copies of the Death Certificate Flowers TOTAL CASH ADVANCES AND SPECIAL CHARGES SUB-TOTAL INITIAL PAYMENT / DISCOUNT / CREDITS TOTAL AMOUNT DUE C H ~G-K # '-I- C/o {AJ Vl'Lt .~ ...J 6/JG::S /lc(...oCJJl.JT s- '3 -0 I Please $2985.00 $2985,00 $2785.00 $[965.00 $45.00 $[25.00 $7905.00 $300.00 $95.00 $350.00 $75.00 $12.00 $[53.70 $985.70 $8890.70 $8890.70 Ct!Ec-r<- fVo 7 - 10/S/OJ Gay Monument Works, Inc. THIS AGREEMENT, made this 1801 West Front Street, Berwick, PA 18603 Phone (570) 752-6631 Fax (570) 752-6641 5th October day of N~ 0352 2001 by and between Gay Monumem Works, of Berwick, Penna., and Mr. Irvin Y E PA AGE R of 35 White Oak 1705~7930 ~ 717- 790- Phon" ~643 W~TNESSETH: T.hat the s~id.Cay Monument ~ork~ has this daY,sold to the said PARTY and d?es agree to furnish complete and erect, substantiatly accordmg to the followmg d~crlpnon and general dimenSIOns and subject to the K\I'en clauses contained herein and made a part of the same, viz: *corner carving 3/ rectangel panal's 3-0 X O-B X 2-0 Blvd. Mechanicsburg, of Pol. 3 Dk YEAGE R Barre Gray 3-10 X 1-2 monument X O-B Pol. top Barre Gray I R V I N RAY SAD I E ANN mastash nee Thomas ----check Freistak Aug.30,1920 space Jan. 16, 1920-Apr. 2, 2001 The same to be erected in a first class workmanlike manner upon a durable And in l'on.~ideralinn for whil;h the said Party agrees In pay the following: foundation in the Spring 2002/ Cemetery CASH PRICE $1,675.00 CEMENT FOUNDATION Large/$72.00 SPECIAL DRAFTING. ~TALPRICE .~. '1 .............. 1,~~~~O~ement DOWN PA YMEN~. 'on' . acc.t.; $1,666.66 I-This contract becomes fully bindiPJ t,pOl'l bolh parties after bdng signed by BALANCE . . 'New. 'Ba'lanr;e'" 3 f) 3. ~ f) tht-m and is not then subject to countermand. Spr u 2 2-o....ing to the impossibility in everv inseanee of cllttin~ to exact dimcnsioM ~ng +cemen the terms (reneral dimt'nsions) shail be construed 10 mun a variation of no 5-11 ia altl"tcd by the purchawr Ihal a I~uer mailed (0 him at M.. addf1:M mOf'C than thru pen::ent in any measurement. $lat('d hereon. shall br and is hrreby accrpted as sufficirnl Ilotice of anY 3-AlI contracts .re subject to delays occasioned by fire, Ilccidenh, strikes, or derauh in paYlnrnt he....under by him and of Ihe option extl'cis<<l by GAY other causn beYOnd (he conrrol of the company. MONUMENT WORKS, a~ heretn provided. +--Any, nurhle or ~ranite included hel"C~in, whose natural imperfections are G-Thit. agt"tement shrJ.1 il\\\re to the benefit of and be binding upon the heirs, JUbjtet to contttlon by established usage 01 the industry may be trellled in It!al reprelltlltatives. a.nd succ~rs of the parties respec:tively. accordance wllh Rich 1UII.ge. . 7-.lntel'elt at the rate 0( 6 p(,l"ctnt charged on all accounts that an' past dul". The title to and ownenhlp of said monumental w~k shall ~ vute-d in and n,wllin in Eaid GAY MONt:Mf.NT WORKS until ,aid purchut' price hll$ bl-en fully paid; and it is expressly undentood and a!Teed that in the eVl"nt said purc~ price u n.ot rully paid, GA~ MONUMENT WORKS may recovu said monumental works. and may retain as liquidated damages, all sums of money which may have 1~C'n paid on account. 11- 11 further und('l',tood and agn'ed that this contract duly siped conscitutes an order upon said Cemetery Association to JH'rmit GAY MONUMENT WORKS 10 remove the monumen\al work. from lhe cemetery if not lully paid {or. This contract CODu,ins the full agre('ment and no other proyisioD$ or promises all:' tt, bl:' implied Of' to b.. cunsid.'n:d a pan of Ihis contract unit" the ...ame is in wriup&, signed by the parties hereto. Meyer's part of cemetery + plus cement small$156.00 ., Slocum/ Slucum/cem during the month of rea$Dnable time thereafter. or within a 1C: c>. W> tl, ",J.., ~O\)JQc:, 5 October Monument s Witness Our hands and seals this ~A~~"~~ i re of rchaser Please call immediate attention to any error of dates, spelling or location of inscription so as to avoid any extra expense or delay. day of Robert 1. Kreidler & Associates David Haller, Esq. Suite 104 800 Corporate Circle Harrisburg, P A 17110 Statement DATE 05/30/2002 TO: . Yeager. Irving AMOUNT DUE AMOUNT ENC. $700.00 DATE TRANSACTION AMOUNT BALANCE 12/3112000 Balance torward 0.00 05/04/2001 PMT #1 - Retainer -500.00 -500.00 05/04/2001 PMT #2 - Expense Deposit -500.00 -1,000.00 05/30/2002 1NV #295 1,200.00 200.00 05/3012002 1NV #296 500.00 700.00 CURRENT 1-30 DAYS PAST 31-60 DAYS PAST 61-90 DAY::; uVt::R 90 DAYS AMOUNT DUE DUE DUE PAST DUE PAST DUE 700.00 0.00 0.00 0.00 0.00 $700.00 C!-f C:C k_ IJo. 'J-f5 7 c. -- S:/3oJ 02- Robert J. Kreidler & Associates David Haller, Esq. Suite 104 800 Corporate Circle Harrisburg, PA 17110 Invoice DATE 05/30/2002 INVOICE # 295 BILL TO Yeager, Irving P.O. NO. TERMS PROJECT Due on receipt QUANTITY DESCRIPTION RATE AMOUNT 8 Estate Administration - per hour 150.00 1,200.00 Total $1,200.00 Robert 1. Kreidler & Associates Invoice David Haller, Esq. Suite 104 800 Corporate Circle Harrisburg, PA 17110 DATE 05/30/2002 INVOICE # 296 BILL TO Yeager, IIving P.O. NO. TERMS PROJECT Due on receipt QUANTITY DESCRIPTION RATE AMOUNT Expenses to be reimbursed 500.00 500.00 Total $500.00 '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Yeager, Sadie A. Include un reimbursed medical expenses. ITEM NUMBER 1 Bethany Vil1age SkiHed Care Unit DESCRIPTION 2 Alert Pharmacy at Bethany Village 3 Shepherdtown Family Practice , FILE NUMBER I 21 - 01 - 00465 TOTAL (Also enter on Line 10, Recapitulation) AMOUNT 774.74 16.19 100.72 891.65 . BETHANY SKILLED NURSING 325 WESLEY DRIVE MECHANICSBURG PA 17055- ACCOUNTS RECEIVABLE STATEMENT Statement Date: 04/26/2001 SADIE YEAGER c/o IRVIN R YEAGER 35 WHITE OAK BLVD. MECHANICSBURG PA 17055 -.(~ ~ Balance Due: 300.19 Account Number: 207070336 PI ase detach and remit this portion with your payment Balance Forward: 5,725.23 __ ~1iiL"~ 03/23/2001 -03/23/2001 Payment 5.606.45 118.78 03/31/2001-03/31/2001 Co-Ins Nasal Cannual 0.36 119.14 03/31/2001-03/31/2001 Co-Ins Disposable Humidifier 0.60 119.74 04/01/2001 - 04/01/2001 Monthly Fee 180.45 300. 19 TOTAL: 18UI 5.606.45 300.19 PI ase make checks payable to: Bethany Village BETHANY SKILLED NURSING: SADIE YEAGER 207070336 c m '--'-'- IR"II'I R. YEAGER . SADIE A. YEAGER 35 WHITE OAK BLVD MECHANICSBURG, PA 17055 2623 60-1273/313106 s- 17-0/ DATE nAYTOTHE .n ORDER OF S H,~P/-fF'''' i)'; IN",) J:='AWll / Y rR.J+c.TI (F I $ .) J. 9 I ~ F I t= T Y () AI E A I\J {j h.-v DOLLARS IIi illiii.':. PNCBANJI\ ~~~~:,9366 ~oo is t~\i:5 iL'"t5 PNC Baok, N.A. 040 ~ Central PA Plan F~~O~~~~~;:I~~n5~"O~7"7a511.d --2U:I '~~a~,"" !/-/. 8 ( 46.'11 /00.'72- ",,,",,"0 Date Dr. Patient Name Proc. Code Description DIagnosIs Chrgs./Credlts Item Balance PREJIOUS b~~hNCE---\ '.:t. :~::. ~~i.l / Qi ::.:' j/ iZJ ; 'L"i:: ~::;ii\ U .. C:' f"') '; ~ ._"..; ,. .-- Nut"sing HOlle; Subsequen 401. Plal\ Peymerlt:000 (:)dj ;;!-.iedic-,3'i",-:., :^){'iteof'" -*.:''')1. E\:L d 10:'0 E,5.02, ',. 'n'" ~~~~~/tZl~? l'C! ~ '21. '0'0 Q)3/"iZ~"7/'G e, ':'1' / ;~: 13 ./ ~~! :. Plan PaYinent~0000 ~~~nd El1:::'i-) L: cI'.o:'l::uct ~j. Oil: ( 1 j Sheplml0:'r-"Jst 0 Jl'i F.:'.~m i 1 '/ 21l;.Q) F=-i lit:, F:oC,1t] j{!Pc::liEtTi i ~:;bu -'~l, pri 17~)5 I fax Id:23 2333075 o;;;.hp Ihone:717 7Ef:..--i7'35 Payment is due within two weeks of receipt. PLEAse RETAIN THIS PORTION OF STATEMENT FOR YOUR RECORDS PAY THIS AMOUNT ~ 51. E! 1 Insulance Balance Patient Balance :51.. 81 ::i1 . E\ 1 0.0C'l 61- 90 0.00 ill. 00 91-120 0.0el 0.00 PATIENT t BALANCE AMOUNT DUE Account Analysis Total 130.00 Current 0.00 30 -DO 65.00 120+ ...:J. IILl lZi.00 Account Balance 1 (31 ~ i31 c. @: C. fjecCk No ;J.. 71'2- - /0/1)01 Date Dr Patient Nam(' Proc. Code Descnpllon DiagnosIs Chrgs.lCredlts I Item Balance 09/05/0 99312 NUl'sing Home; Subsequen 401. 1 Plan Payment:0428218 Adj:Medicare Writeof $48.19 ded/$.72 coins Payment-Thank You apply to ded 55.00 2.90 13. 19 48.91 03/18/0 001 Sadie A Y 05/10/0 05/10/0 0.00 Shepher"sto n Family 2140 Fi her Road Mechani~sbu~g,PA 1705.5 ax Id:23 2933075 oshp 'hon e: 717.- 755.--1795 PLEASE RETAIN THIS PORTION OF STATEMENT FOR YOUR RECORDS PAY THIS AMOUNT-7 48.91 Insurance Balance Patient Balance E-~~ft IllIZi ~I-n. ':"j 1 Current 0.00 ~-8. 91. 30" 60 0.1Z\16 Q). it~ 0 61 -90 IZI.!l\Q\ 0.00 91-120 0. Ill>ZI 0..00 PATIENT t BALANCE AMOUNT DUE Account Analysis Total 120+ &5.. iZ10 0. ~)iZl Account Balance 1 J -::~;" ') j c.~ ----------- --- _"'-'-'---_''',---.,--,-----,-". 1"-- . I IR.VIN R. YEAGER SADIE A. YEAGER 35 WHITE OAK BLVD MECHANICSBUAG, PA 17055 PAYTClTHE ORDER OF ouf... C/V./...../ hJIJR PNCJBANK . ' PNC Bank, N.A. 040 @ Prennum Central PA Plan I;JU. ;VoS. -r1(,,2..CJICf TI/R.U J"/<,2-q2.<!- FOR "2.q ::["/(,,1-'170 ':0:11.:1 ~ 27:181: 5 ~I,O ~ 71, 78 511' DATES J:I-(PP._... ?,-)-::O 0 ! ?:'-I-OO ~.. .... .. .... ....... i · ! )..-:L~CJ q 1}-/~(;>Q 5'-)-CJ'1TH4..U !J--2/,-9ct !l-2.b-99 J!-1-99 To TF) L 1 - -::;::~_-:-:=_;':::::_7_" ----- ,,"- 2601 !..1.. 60-1273/313106 I .... J q .. 0 I DATE ~ I $ Lf71J. ~::,- ~-S- / d-O DOLLARS ~ AA/D' l/. 7'f.t;"f;;' 300.19 -,-..- 77'f.7<f l/Vvo IcE Mo. M 0 UA)T jf ~::~~ [ '6";1...,/8 B ';L./B r; 9. s'1 34-.5" 1 I. '83 35.19 # 4-7 if, !;!J j J J(" 2.. q )Cj T r to. '1, q 2.9 rJ~2er:)...r T ) .0.?-Cr ;L 4- J } ':2.. 92 '1..... ~/b .:L 96 q 'Tlb2970 Jlb2.123 rQ "-~! Bethany Village 9M-1-W-asltifih>loh A, OMC T,.rone;-PA-J 6686 :::5, INC. 7) -..L-'S" l,UC:SLG::'-I f).vl.JE 111~(_J-hJ1rJ i(,..~ 8-.; i'~ (, PA 17os:::'- , 203-05-6682-B STATEMENT DATE (1999) CCOUNT NO. TAX ID: 03/14/01 521730117 fOC 2 -, INVOICE # J162919 ...J SADIE YEAGER BETHANY VILLAGE 9511 W"'3HII~GTON-AlJ.E .3.2.5 WE&LE"'f /)<c'IV<c TYftONE rA lsse6 lV15::/+f.hJIC{)eUQ..f:,. Pit l7D.(-~ $ 82./8 ' . AMOUNT ENCLOSED PRIVATE PAY PLEASE DETACH AND RET1JRN WITH REMmANCE ,TE DESCRIPTION CHARGE CREDIT '01 /OC SYRINGE 60CC CATH TIP BOLUS 3400621B tl/oe (PATIENT SHARE) GTY; 31 34. 72 JEt../ I TV 80Z CAN 16,1-'''l<1t1l=NI :::;l-lAKJ::.) UIY;1:J6 103 1 5 '+7. 46 . - . -.... -. .- -. .. --. -_. . . -. .- . . PAYMENT DUE UPON RECEIPT OF THIS STATEMENT TEMENT DATE PREVIOUS BALANCE FINANCE CHARGE TOTAL CHARGE TOTAL CREDITS NEW BALANCE 3/14/01 8'-/ 18 O. 00 ~. c ~ Bethany Village 9511 Washington Avenue Tyrone, PA 16686 S, INC. \CCOUNT NO. 203-05-6682-B (1999)STATEMENT DATE TAX ID: 03/14/01 521730117 LOC: 2 r ..., INVOICE # J162920 PRIVATE PAY SADIE YEAGER BETHANY VILLAGE 9511 WASHINGTON TYRONE AVE PA 16686 ...J PLEASE DETACH AND RETURN WITH REMmANCE $ 7/:,. eq AMOUNT ENCLOSED HE OESCR-IPTION CHARGE CREDll 101l0e SYRINGE 60CC CATH TIP BOLUS 3400621B ( PATIENT SHARE) GTY= 29 32. 48 101l0e JEVITY 80Z CAN 16. 4# 10315 (PATIENT SHARE) GTY=146 44. 41 , PAYMENT DUE UPON RECEIPT OF THIS STATEMENT !l"TEMENT DATE PREVIOUS BALANCE FINANCE CHARGE TOTAL CHARGE TOTAL CREDITS NEW BALANCE ,/ )3/14/01 76. 89 / O. 00 c (< Bethany Village 9511 Washington Avenue Tyrone, PA 16686 S, INC. ACCOUNT NO. 203-05-6682-B ( 1999 )STATEMENT DATE TAX ID: 03/14/01 521730117 LOC: r; -- r -, INVOICE # J162921 PRIVATE PAY SADIE YEAGER BETHANY VILLAGE 9511 WASHINGTON AVE TYRONE PA 16686 ..J PlEASE DETACH AND RETURN WITH REMITTANCE $ '6J-./B AMOU'NT ENCLOSED OATE DESCRIPTION CHARGE CR 03/01/0C SYRINGE 60CC CATH TIP BOLUS 3400621B (PATIENT SHARE) GTY= 31 34. 72 03/01/0C JEVITY 80Z CAN 16.4# 10315 (PATIENT SHARE) GTY=156 47.46 PAYMENT DUE UPON RECEIPT OF THIS STATEMENT STATEMENT,DATE PREVIOUS BALANCE FINANCE C.HAAGE TOTAL CHARGE TOTAL CREDITS NEW BALANCE ./ / 03/14/01 82. 18 O. 00 (. ( Bethany Village 95]] Washington Avenue Tyrone, PA 16686 ES, INC. CCOUNT NO. 203-05-6682-8 (1999)STATEMENT DATE TAX ID: 03/14/01 521730117 LOC: 2 r -, INVOICE ~ J162924 PRIVATE PAY SADIE YEAGER BETHANY VILLAGE 9511 WASHINGTON TYRONE AVE PA 16686 ...J PLEASE DETACH AND RETURN WITH REMmANCE $ e::L.!(? AMOUNT ENCLOSED .TE oeseR IPTlON CHARGE CREDIT ').61/9<, SYRINGE 60CC CATH TIP BOLUS 340062113 Yo 119<, (PATIENT SHARE) GTY= 31 34. 72 JEVITY SOZ CAN 16. 4# 10315 (PATIENT SHARE) GTY=156 47. 46 PAYMENT DUE UPON RECEIPT OF THIS STATEMENT TEME:NT DATE PREVIOUS BALANCE FINANCE CHARGE TOTAL CHARGE TOTAL CREDITS NEW BALANCE 3/14/01 82.18 ./ O. 00 -,'):' c (c1 Bethany Village 9511 Washington Avenue Tyrone, PA 16686 ES, INC. \CCOUNT NO. 203-05-6682-0 ( 1999 )ST A TEMENT DATE TAX ID: 03/14/01 521730117 LOC: 2 r -, INVOICE ~ 0162922 PRIVATE PAY SADIE YEAGER BETHANY VILLAGE 9511 WASHINGTON AVE TYRONE PA 16686 .J PLEASE DETACH AND RETURN WITH REMITTANCE $ 79.~9 AMOUNT ENCLOSED ATE DESCRIPTION CHARGE CREDIT 101/0C SYRINGE 60CC CATH TIP BOLUS 3400621B ( PATIENT SHARE) QTY= 30 33. 60 /01/0C JEVITY 80Z CAN 16. 4# 10315 (PATIENT SHARE) QTY=151 45. 99 PAYMENT DUE UPON RECEIPT OF THIS STATEMENT b,TEMENT DATE PREVIOUS BALANCE FINANCE CHARGE TOTAL CHAFl.GE TOTAL CREDITS NEW BALANCE 7 / )3/14/01 79. 59 O. 00 c. 0; Bethany Village 9 511 Washington Avenue Tyrone, P A 16686 oS, INC. ,CCOUNT NO. 203-05-6682-B STATEMENT DATE 03/14/01 LOC: ~, ~ r -, INVOICE # J162969 MECHANICSBURG PA 17055 SADIE YEAGER BETHANY VILLAGE 9511 WASHINGTON TYRONE AVE PA 16686 IRVIN YEAGER 35 WHITE OAK DRIVE ..J PLEASE DETACH AND RETURN WITH REMITTANCE $ 34-. ",-j AMOUNT ENCLOSED HE DESCRIPTION CHARGE CREDIT ADJUSTMENTS TO YOUR ACCOUNT 474. 5 01/90; SYRINGE 60CC CATH TIP BOLUS 3400621B (PATIENT SHARE) QTY~ 17 19. 04 '01/90; JEVITY SOZ CAN 16.4# 10315 (PATIENT SHARE) QTY~137 ,.., 44 ~. '22/9S SYRINGE 60CC CATH TIP BOLUS , 3400621B (PATIENT SHARE) QTY~ 4 4. 48 '22/9c; JEVITY SOZ CAN 16.4# 10315 (PATIENT SHARE) QTY~ 33 1. 83 '26/9, SYRINGE 60CC CATH TIP BOLUS 3400621B (PATIENT SHARE) GTY~ 5 6. 72 PAYMENT DUE UPON RECEIPT OF THIS STATEMENT \TEMENT DATE PREVIOUS BALANCE FINANCE CHARGE TOTAL CHARGE TOTAL CREDITS NEW BALANCE l3/14/01 474. 55 0.00 34. 51 474. 55 $34 51 S=. E l/~:,'_! .)! c. C't Bethany Village 9511 Washington Avenue Tyrone, PA 16686 :5, INC. ACCOUNT NO. 203-05-6682-B STATEMENT DATE 03/14/01 LOC: 2 r -, INVOICE # J162970 IRVIN YEAGER 35 WHITE OAK DRIVE MECHANICSBURG PA 17055 SADIE YEAGER BETHANY VILLAGE 9511 WASHINGTON TYRONE AVE PA 16686 ..J PLEASE DETACH AND RETURN WITH REMITTANCE $ /.&3 AMOUNT ENCLOSED ,- ) JATE DESCRIPTION CHARGE CRED /26/9< JEVITY 80Z CAN 16.4# 10315 (PATIENT SHARE) QTY= 31 1. 83 , PAYMENT DUE UPON RECEIPT OF THIS STATEMENT -ATEMENT DATE PREVIOUS BALANCE FINANCE CHARGE TOTAL CHARGE TOTAL CREDITS NEW BALANCE 03/14/01 34. 51 0.00 03 ) O. 00 $36. 34/" , '! ;- J .:....--:.:: I /, S:.' ~ ?, G c Bethany Village 9511 Washington Avenue Tyrone, PA 16686 oS, INC. ACCOUNT NO. 203-05-6682-B ( 1999 1ST A TEMENT DATE TAX ID: 03/14/01 521730117 LOC: 2 r -, INVOICE # 0162923 PRIVATE PAY SADIE YEAGER BETHANY VILLAGE 9511 WASHINGTON TYRONE AVE PA 16686 .J PLEASE DETACH AND RETURN WITH REMmANCE $ 35': /9 AMOUNT ENCLOSED lATE OeseR IPTlON CHARGE CREor /01 /9' SYRINGE 60CC CATH TIP BOLUS 3400621B (PATIENT SHARE) GTY= 30 33. 60 '/01/9' 0EVITY 80Z CAN 16. 4# 10315 (PATIENT SHARE) GTY=151 1. 59 - PAYMENT DUE UPON RECEIPT OF THIS STATEMENT -ATEMENT DATE PREVIOUS BALANCE FINANCE CHARGE TOTAL CHARGE TOTAL CREDITS NEW BALANCE 03/14/01 35.19 ,/ O. 00 ~ -~-:;~.~=:-:::,==-::-,,::::;-----'-~-'--::.,.~:=;.~~-~,,- IRV.IN R, YEAGER SADIE A. YEAGER 35 WHITE OAK BLVD 170..'::.-0 -7Q30 MECHANtCSBURG, PA 1-1-M5 2612 60-1273/313106 4--2-8-0/ DATE PAYTOTHE ORDER OF III err, PHfJaMA( Y AT t3ETHA,,'-J l/;rJA/;"F.I $ /&.19 , ---.1.3..- J a-v DOLLARS lIi m!i~~'~. , rJ PNCBANK PNC Bank, N.A. 040 ~ Centr.d PA _ ~~_~Uu - NP 5 ~ 1,0 ~ 71, 78 511' 2b ~ 2 ,,'cliJOo6o ~b ~g.,. Premium Plan FOR nlERT RHY.AT BETHANY VIL. 125 WESLEY DRIVE HECHNICSBlJRG. PA 17055 B/27/01l i 1,Pymt-- I. 63.09-i ., ACTIVI fY FOR YE!AGER J SADIE i i +YEIAGS -I - B/28/01 2004583', 301110RPHII~E SULF 2011'01! i ! 15.00' "3/28/01 ' 6181399 I 6 ! ACE P H E t4 65011 G SUP 01 . i i 5 .49 ~4116/01 6180584 I 120ITHERA-PLUS LIQUID 01 * j i,' 4.30- , i ' I ! I I J i I I I I I i ! J ',.\ I \ I I I 15.00 I lEGEND NON-LEGENO r""~"""'''''''.''''.1 r.:""'"7':....,"."'''1 -''''''''.'''.:','''~- ~ Fr~,.i.\,g,;t~~",,"., ('.L09 + ~0."9 +1 .0" 1= 8~.58 - 67.,~! = .00 .00 .00 63.0 15.0' 5.4' <1.31 - ~ .^ r , , @ , REV-1513 h+ (9-tlOJ '* SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT _L____ ESTATE OF Yeager, Sadie A. FILE NUMBER 21 - 01 - 00465 I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) Irvin R. Yeager RELATIONSHIP TO DECEDENT _~_.N_9t L1s_tTruste~{~1 AMOUNT OR SHARE OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Spouse 100 percent II. I Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover she~t I NON-TAXABLE DISTRIBUTIONS, A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT : BEING MADE lB. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHE~T " LAST WILL AND TESTAMENT OF SADIE A. YEAGER I, SADIE A. YEAGER, of Allentown, Lehigh County, Pennsylvania, being of II full age, sound mind and memory and under no restraint, do make, publish and I, declare this instrument to be my Last \-Hll and Testament and hereby revoke all wills and Codicils ever before made by me. ITEM ONE I direct my Executor to pay all of the expenses of my last illness, of my funeral and burial and of the administration of my estate. ITEM ~ I direct my Executor to pay all inheritance, transfer, estate and similar taxes (including interest and penalties) assessed or payable by reason of my death on any property or interest in property which is included : in my estate for the purpose of computing taxes. My Executor shall not require any beneficiary under this Will to reimburse my estate for taxes paid on property passing under the terms of this Will. ITEM THREE I hereby authorize my Executor to utilize the services of an attorney, accountant and any other professional as maybe necessary in the administration of this, my Last Will and Testament. The expenses incurred by the Executor using such professional services shall be an expense to my estate and shall be paid by my estate. I I " ITEM FOUR My Executor named herein shall be entitled to reasonable compensation " I' 'I commensurate with the services actually performed and to reimbursement for expenses properly incurred. " .,. ITEM FIVE I give, devise and bequeath the entire residue of my estate, whether real, personal or mixed, of every kind, nature and description whatsoever, , I! and wherever situated, which I may now own or hereafter acquire, or have the right to dispose of at the time of my death, by the power of appointment or otherwise, to my husband, IRVIN R. YEAGER, absolutely and in fee simple. I. ,. " , ., ITEM SIX Should, however, IRVIN R. YEAGER, predecease me or fail to survive me by thirty (30) days, then the gifts, devises and bequests to IRVIN R. YEAGER shall fail and be of no effect, and in that event, I give, devise and bequeath the entire residue of my estate, whether real, personal or mixed, of every kind, nature and description whatsoever, and wherever situated, which I may now own or hereafter acquire, or have the right to dispose of at :1 the time of my death, by the power of appointment or otherwise, to my children, absolutely and in fee simple, share and share alike. Should any such child predecease me, then his or her share shall pass !J per stirpes, that is (a) if that child has living issue, the portion of my estate otherwise reserved for that child shall be distributed am:mg said living issue by right of representation; or (b) if that child has no living issue, the portion of my estate otherwise reserved for that child shall be distributed among those of my children who did survive me and, by right of representation, among the living issue of those of my children who did predecease me; or (c) if no child of mine survives me and leaves no living issue, the residue shall go to my son-in-law, PHILIP H. KLOTZ. ITEM SEVEN il I nominate and appoint IRVIN R. YEAGER as Executor of this, my Last !' will and Testament, and require that said Executor serve without bond. In the event that the above-named Executor shall, for any reason, fail to qualify, or having qualified, fail to complete the administration of my estate, I nominate and appoint JILL Y. KLOTZ instead and give to said Executrix all rights, powers and immunities set forth in this Will, including the requirement that said Executrix serve without bond. .. , I: ITEM EIGHT I, " ,1 :1 If any gift, bequest or legacy made by this, my Last Will and Testament would, but for this Item, be made to any person who, at that time, is less than twenty-one (21) years old, then in that event the gift, bequest or legacy shall be made to PHILIP KLOTZ, in trust, for the benefit of said person. In the event that PHILIP KLOTZ refuses or fails to serve, I hereby grant the same rights, powers and privileges and impose the same duties upon, and make said gift, bequest or legacy to, WILLIAM H. THOMAS instead. '!he purpose of said Trust is to ensure an adequate level of income, support, maintenance and education for said beneficiary. It is my express intention and direction that the income or principal of said Trust shall not supplant or replace the legal Obligation for support, maintenance or education which any other person might have with respect to said beneficiary, but rather shall only supplement other, existing sources of income. Tb meet this purpose, I empower the Trustee to distribute, or not to distribute, all or part of the income and to invade all or part of the principal as the Trustee in its sole discretion decides. II assets of the Trust estate, to collect the income therefrom and to apply so '!he Trustee shall have the power to manage, invest and reinvest the much or all of the net income and principal thereof as set forth above. Any net income not so applied shall be added to the corpus of the TrLlst and held, administered and disposed of as a part thereof. The corpus of the Trust shall be paid over to such beneficiary when he or she reaches the age first referred to in this Item, or, if such beneficiary shall die before reaching that age, upon his or her death the corpus of the Trust shall be paid over to the residuary beneficiary of this, my Last Will and Testament, or, if none are then surviving, to n!{ then living heirs at law, by right of representation. ITEM NINE :: In addition to the powers conferred upon executors and trustees by law, I d I, " : my Executor and Trustee, if any, or any duly appointed successor shall have ,I authority without adjudication, order or direction of the court: (a) To sell, pursuant to option or otherwise, at public or private sale and upon such terms as the Executor shall deem best, any real or ,I " ii " ,I " i! I: personal property belonging to my estate, without regard to the necessity of such sale for the purpose of paying debts, taxes or legacies; (b) To retain any or all of such property not so required without liability for any depreciation thereof; (c) To assign or transfer certificates of stock, bonds or other securities; II I (d) To adjust, compromise and settle any and all claims in favor of or against my estate; (e) To conduct and carryon all business now conducted by me and to do all things necessary or proper in the usual course of business until such time as the business can be sold or distributed as a going concern or otherwise, and the Executor shall be exonerated from any loss which may result thereby; and (f) To do any and all things necessary or proper to complete the administration of my estate, all as fully as I could do if living. II ITEH 'rEN As used herein, the singular form of a word includes both the singular and plural, and reference to words of a certain gender includes reference to all genders. ITEM ELEVEN If I and any beneficiary under this, my Last Will and Testament, should die in a common accident or disaster or under such circumstance that it is difficult or impractical to determine who survived the other, or if any beneficiary, though surviving me, should die within thirty (30) days from II and after the date of my death, then such beneficiary shall be deemed to have predeceased me. IN WITNESS WHEREOF, I have hereunto signed my name and acknowledged and i! published this instrument, consisting of c - typewritten pages, identified j! by my signature, as my Last Will and Testament, in the presence of the undersigned witnesses, on this It; day of n. ,vr.<../c , 1985. ,r, vJJuj d 7-Ld.~,H/ SADIE A. YE GEIy' , We certify that SADIE A. YEAGER, the Testatrix named above, subscribed her name hereto, on this day and in our presence, and to us declared the same to be her Last Will and Testament; that we subscribed our names hereto as witnesss, in the presence and at the request of said Testatrix and in the presence of each other; and that at the time of the execution of said instrument and of our sUbscribing the same as witnesses, said Testatrix was of sound and disposing mind and signed it as her free and voluntary act. WITNESS our hands at Allentown, Lehigh County, Pennsylvania, this /) day of m/J.ro /... , 1985. 17 J..",l',,~ .I.L_ Witness 1~E:2~--" Resides at 11" 1 C J:.. L.. -1!<<- ":O..A ! , /) ;BjJf J<l1,Q J j l ~VW~I Witness J ,.7 Resides at tJvtlunJ:Oy~, A~ CDMM)NWEALTH OF PENNSYLVANIA ACKNOOLEDGMENT COUNTY OF LEHIGH I, SADIE A. YEAGER, testatrix, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. II .,d~ tl ~~.vJ SADIE A. Y G Ii Sworn or affir~ to and acknowledged before me by SADIE A. YEAGER, the testatrix, this /S day of /)"1 flU0 , 1985. " COMMJNWEALTH OF PENNSYLVANIA /' !(' NO~~tfc J.t &1-/}W~) CAROL SUE KERNS, Notory P"bllr. Allentown, Lehigh County, Pa. My Commission E.xpires Mi.JY 2, 1986 AFFIDAVIT COUNTY OF LEHIGH We, ~'~1<-) r fr-/;,LIF and OebolM ~J-t=h>", , the witnesses whose names are signed to the'foregoing instrurnerlt, being duly II' qualified according to law, do depose and say that we were present and saw I, testatrix sign and execute the instrument as her Last Will and Testament; that she signed it willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the Will as witnesses; and that to the best of our knowledge, the testatrix was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. ~\ 1 ess i Pi 1 ~~ sQ ~1 o V,illll /J. Wltness I, '1:~ v v Sworn or affirmed to by '~ r. t'~~ this f..<' day of LC.( , and and su scribed ~ , 1985. , me witnesses, /"~ . }~~, ',t"itry uh!~ ! &!"."h ,:-"U.;,y, pc, /6 -c2c5CJ -3 "v BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER . COUNTY ACN ROBERT J MULDERIG TURD LAW OFFICES 28 S PITT ST CARLISLE PA 17013- 03-31-2003 YEAGER 04-02-2001 21 01-0465 CUMBERLAND 101 *' REY-1541 EX AFP (01-0$) SADIE A Anount Rellitted ) CHANGED (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 19.303.76 .00 .00 (8) 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=is47-EX-AFP-COY:03Y-NO'ficE-OF-YtiHEifiTANCE-TAX-APPRjrisEHENT~--ALDjWANCE-OR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF YEAGER SADIE A FILE NO. 21 01-0465 ACN 101 DATE 03-31-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets 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/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax I~ an assessment was issued previously, lines 14, lS and/or 1&, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate 16. Allount of Line 14 taxable at Lineal/Class A rate 17. Allount of Line 14 at Sibling rate 18. Allount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due NOTE: 15.686.70 891. 65 (11) (2) (3) (14) (9) UO) US) 2,725.41 X 00 = (16) .00 X 045 = (7) .00 X 12 = (8) .00 X 15 = (9)= NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 19,303.76 16.578 35 2,725.41 .00 2,725.41 .00 .00 .00 .00 .00 TAX CREDITS: . ~..._... ..---., l-FJ AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 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 PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "'CREDIT"' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) 0; oK STATUS REPORT UNDER RULE 6.12 Name of Decedent: SADIE A. YEAGER Will no: 00465 of 2001 Admin: IRVING YEAGER Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes No_XX__ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: _90 DAYS 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: NONE c. Did the personal representative state an account informally to the parties-in-interest? Yes _ No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphan's Court and may be attached to this report. Dated: 17 April 2003 C-!JMw-V ikj!tL- David Haller PA Atty No. 18321 Kreidler and Assocs Suite 104, 800 Corporate Cr Harrisburg, PA 17110 Counsel for Per___preserttative Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240 - 6345 Date: 3/10/2003 IRVIN R YEAGER 35 WHITE OAK BLVD MECHANICSBURG, PA 17055-7930 RE: Estate of YEAGER SADIE A File Number: 2001-00465 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: 4/02/2003 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, DONNA M. OTTO DEPUTY REGISTER OF WILLS cc: .J File Counsel Judge J IN RE: ESTATE OF SADIE A. YEAGER : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHAN'S COURT DIVISION : NO. 01-00465 PRAECIPE FOR ENTRY OF APPEARANCE TO THE PROTHONOTARY OF SAID COURT: Please enter the appearance of Robert J. Mulderig, Esquire, on behalf of the Estate of Sadie A. Yeager. Respectfully Submitted, TURO LAW OFFICES 4~1/()j Date obert ulderig, Esqui Turo Law Offices 28 South Pitt Street Carlisle, PA 17013 (717) 245-9688 J' IN RE: ESTATE OF SADIE A. YEAGER : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHAN'S COURT DIVISION : NO. 01-00465 FAMILY SETTLEMENT AND FINAL RELEASE ESTATE OF SADIE A. YEAGER KNOW ALL MEN BY THESE PRESENTS, that Sadie A. Yeager, late of Silver Spring Township, Cumberland County, Pennsylvania, deceased, died testate on April 2, 2001, having first made her Last Will and Testament, which was duly executed on March 15, 1985 and probated in the Office of the Register of Wills of Cumberland County, on May 11, 2001. WHEREAS, the said Sadie A. Yeager, by the aforesaid Last Will and Testament, named Irvin R. Yeager as Executor of said Last Will and Testament; WHEREAS, Letters Testamentary on the Estate of the said decedent were duly issued by the Register of Wills of Cumberland County, Pennsylvania, to the said Executor, hereinafter called personal representative; WHEREAS, the personal representative has gathered the assets of the Estate of the said decedent and the assets consist of personal and real property with the total value of $19,303.76 as set forth in Exhibit "A", which is a copy of the Pennsylvania Inheritance Tax Return filed and approved by said personal representative, and which is attached hereto and made a part hereof, and marked Exhibit "A"; WHEREAS, the debts and deductions, including the payment of inheritance tax in the said Estate, which have now been paid, leave a balance for distribution of $2,725.41, also as set forth in the statement of said personal representative, which is attached hereto and marked Exhibit "B"; WHEREAS, the balance for distribution as shown in the said statement marked Exhibit "8" has been reduced to cash and has been distributed as herein indicated in accordance with the terms of the Last Will and Testament of the said Decedent , NOW, THEREFORE, Irvin R. Yeager being sole heir under the Last Will and Testament of the said decedent, and being that person entitled to inherit under said Last Will and Testament, does hereby acknowledge that I have this day had and received from the aforesaid personal representative, in full satisfaction and payment of all sums of money, legacies, bequests, and devises as are given, devised and bequeathed to me respectively by the said Last Will and Testament, the amounts due me under said Last Will and Testament, which amounts I have received this day or prior to this day; and, I do hereby stipulate that in order to avoid the expense and time involved in the filing of a formal account and schedule of distribution, I agree that no account is necessary and I do hereby agree that I do consent to distribution being made without the filing of an account and schedule of distribution, the same to be with the same force and effect as if they had been filed and confirmed by the Orphan's Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania. THEREFORE, I do hereby remise, release, quitclaim and forever discharge the said personal representative, Irvin R. Yeager, his heirs, executors, administrators and assigned, of and from the said estate and from all actions, suits, payments, accounts, reckonings, claims, and demands whatsoever for or by reason thereof, or for any other use, matter, cause or thing whatsoever, touching upon the Estate of the said decedent, and I do further hereby covenant and agree that should any liability come due to the estate of the said decedent after the signing of this Agreement, I do hereby covenant and agree with each other and the aforesaid personal representative, that I will contribute pro-rata my share of the Estate to satisfy any and all claims, demands, suits or causes of action which may be successfully prosecuted against the said Estate or the aforesaid personal representative after the signing, sealing and delivery of this Family Settlement Agreement and Final Release. IN WITNESS WHEREOF, I have hereunto set my hand and seal the day and year noted below. /,/j/ /'o:l7 / ~J "ate / ~~::e'";s t1 Htik~wT~ \' / " Q ,::::,::Yl.>"\ .J'L.'1'1 .,{..:\:~.o.....,\. -f /t J .J J BUREAU OF INDIVIDUAL TAXES IHHERtTAHCE TAX DIVISION DEPT. ZIl0601 HARRISBURG, ~~ 111Z8-~Ol COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ROBERT J MULDERIG TURO LAW OFFICES 28 S PITT ST CARLISLE PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-31-2003 YEAGER 04-02-2001 21 01-0465 CUMBERLAND 101 *' REY-15~7 EX AFP (01-051 SADIE A Allount Rellitted 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 ~ REY=is4"-Eif-AFP-("oY:oiY-NoTICE--or:-iNHEifiTANCE-TAX-XP"PRXisEiiENY-;-ALrOWANCE-o'R----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF YEAGER SADIE A FILE NO. 21 01-0465 ACN 101 DATE 03-31-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED I~ an assess.ent was issued previously, lines 14, 15 and/or 16, 17. 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: IS. AIlount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due 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) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets U) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 19,303.76 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/A~. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Govern.antal Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 15,686.70 891. 65 (11) (12) (3) (4) NOTE: 2,725.41 X .00 X .00 X .00 X NOTE: To insure proper credit to your account, sub.it the upper portion of this forll with your tax pay_nt. 19,303.76 16.r:;7R 35 2,725.41 .00 2,725.41 00 = 045 = 12 = 15 = .00 .00 .00 .00 .00 (9)= TAX CREDITS: KC\.CAI"I (+J AttOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 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), YDU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) Cumberland County - Register of Wills One Courthouse Square, Room 102 Carlisle, P A 17013 Phone: (717) 240-6345 Date: 3/0312005 David Haller, Esquire 1 East Penn Avenue Cleona, P A 17042 RE: Estate of Yeager, Sadie A File Number: 21-01-0465 Dear sirIMadam: 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 AMMENDMENTS 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 is due by: 04/0212005 Your prompt attention to this matter will be appreciated. Thank you. Sincerely, ~~~ t...... GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Judge ~ . Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: SADie A. Ye-AGER /1Prc.IL 2) '2.Dol 2./-01-04-b5' Date of Death: Estate 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 B No 0 2. lfthe answer is No, state when the personal representative reasonably believes that the administration will.be complete: 3. lfthe answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes 0 No 0 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 N No 0 Date: c. Copies of receipts, releases, joinders and approval offormal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report ~ ,1 - /0 - 0 !; ~d ,.."",'1 W" 6 I -" ~Lh J SIgnature / R\/ IN R. YEF;G6P. Name 3.=,- tt! H ( T e () (1 k B J- \/ f) . M&r:HFtNIC,c, S(If(r-;\ PA J7tJS-o-7'13b Address \) \j . ~ , " ! (OJ \....; ( 7 I 7) 7 c1j tJ - q b 4-3 Telephone No. Capacity: ~Personal Representative o Counsel for personal representative t......, ("J . vcJ