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Home My WebLink About02-0812 Estate of CUMBERLAND Register of Wills of ~:auJlObiKl County I Pennsylvania PETITION FOR GRANT OF LETTERS \ Mark E. Pletz No. ~I-O~ -?I:J. also known as , Deceased Social Security No. 182-40-8007 Petitioner(s). who islare 18 year. of age or older, apply(ies) for; (COMPLETE "A" OR "B" BELOW:) [J A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut_ named in the Last Will of the Decedent, dated and codicil(s) dated State relevant circumstances, e.g., ,enunciation, 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: ~ B. Grant of Letters of Administration (c.t.a., d.b,n.c.t.a.: pendente lite; durante absentia; durante minoritatej 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: no spouse I Name Relationship Residence I Katherine Faltin aunt 1115 Council St. High Point, Annabel Watson aunt 2665 Broad St., York, PA John Faul uncle 219 Swatara St., Stee lton, PA I.... IVIf ........,... IN :1 Attach additional sheets It necessary. NC Decedent was domiciled at death in ~wberl and County, Pennsxlvania, with his/her last family or principal residence at 27 South West Ave, Shl remanstown (Borough) (list street, number and municipality) Decedent, then 50 years of age, died August 19 , 20 02, at Hea lthSouth, Upper A 11 en Townshi p (locationl Decedent at death owned property with estimated values as follows: {If domiciled in PAl All personal property .............................. $ {If not domiciled in PAl Personal property in Pennsylvania. . . . . . . . . . . . . . . . . . . . . . $ (If not domiciled in PAl Personal property in County. . . . . . . . . . . . . . . . . . . . . . . . . . $ Value of real estate in Pennsylvania ............................................... $ Real Estate situatedT::a;Oli~~~:' '27 'South 'West" 'S't: ~. Shlremans"t"owri.................... $ 400.000.00 124.000.00 i:;?L1. nnn nn . Wherefore, Petitioner(s) respectfully request(sl 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: Typed or printed name and residence 2878 Kissel Hill Road Lititz, PA 17543 (717) 330-2643 RW-7 \, _0-, .., Oath of Personal Representative Commonwealth of Pennsylvania County of ~~fMt<l 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 administer the estate according to law. -.. Sworn to and affirmed and subscribed ~C ~~~...e(' before me this 1 Ot h day of Mer 1 e E. Gi ngen ch September 20~ DECREE OF REGISTER Estate of Mark E. Pl etz Deceased No. 21-02-812 also known as Date of Death: August 19, 2002 Social Security No: 182-40-8007 AND NOW, SEPTEMBER 11 I , 20~, in consideriWon of ftie Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters 0 Testamentary ~ of Administration ....... (c.I.a.; d.b.tl.c.t.; pend~..lite; durante absentia; durante minoritale) are hereby granted to Merle E. Gingerich in the above estate and that the instrument(s), if any, dated ~:,-. described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters.......................... . Short Certificate(s).......... Renunciation................. . Affidavit ( I................. Extra Pages ( )............ Codicil.......................... JCP Fee........................ Inventory & Tax Forms... Other.... .............. .......... TOTAL................ $ 375.00 ~ ",..J-I1L ~,I:::. Dzp.';;'P'. In;r tkt $ 30.00 $ 15.00 $ $ $ $ 5.00 $ $ Attorney: John S. Davi dson 1.0. No: 17139 Address: 320 W. Chocolate Ave., P.O. Box 437 Hershey, PA 17033-0437 Telephone: (717) 533-5101 DATE FILED: 9-11-200? $ 42S.00 RW-7a mailed to atty 9-11-2002 Register of Wills of Cumberland County, Pennsylvania RENUNCIATION Estate of Mark E. Pletz, Deceased No.: to) ...{')~ ...? I~ also known as , Deceased AW" if11'v The undersigned, Annabel" Watson, Aunt of the above Decedent, hereby renounces the right to administer the estate and respectfully requests that Letters of Administration be issued to Merle E. Gingerich. Witness my hand this '3 ~ d day of September, 2002. ~ fu.d~ Annabel. Watson 2665 Broad Street York, PA 17404 Sworn to or affirmed and subscribed before me this '3 R.. day of Sep-\-e.mbee.... 2002. AJ "",,,Po- ff iJA-'- ~ Notary Publi ...-.~- .,.- ~- --' ,---~' My Commission Expires: 0:, Notarial Seal Nanna J. BaIr, NotarY Public Oovef lWp., York County My Comm/s8ion ExpIres May 23, 2004 Member, Pennsytvania~oINolalt88 Register of Wills of Cumberland County, Pennsylvania RENUNCIATION Estate of Mark E. Pletz, Deceased No.: :l1"'O.J. "i"IJ./ also known as , Deceased 114{"'V I<f The undersigned, Katherine Fa1'tin, Aunt of the above Decedent, hereby renounces the right to administer the estate and respectfully requests that Letters of Administration be issued to Merle E. Gingerich. Witness my hand this tift day of September, 2002. j(~~ Katherine Fa}f1tinJ<f' 1115 Council Street Highpoint, NC 27262 Sworn to or affirmed and subscribed before me this .~ day of ~ e... MOLLY N.HOWARD .! Notary Public . Guilford County otary P. lie ...~. State of North Carolina t My Commission Expire. 08-17-2008 ~ :"-~; .~ .-- C r".......) --' co My Commission Expires: ~-\'1-~DDlc Register of Wills of Cumberland County, Pennsylvania RENUNCIATION Estate of Mark E. Pletz, Deceased No.: ,J)I-()~.. 'N'/~ also known as , Deceased The undersigned, John Faul, Uncle of the above Decedent, hereby renounces the right to administer the estate and respectfully requests that Letters of Administration be issued to Merle E. Gingerich. Witness my hand this 3 ~j) day of September, 2002. (Jg ;;;f~ Z John Fau I - " 219 Swatara Street Steelton, PA 17] 13 Sworn to or affirmed and subscribed before me this 3 ~.D day of SEPTEP\15/i R ,2002. o \"..J L_' ~'h1~ /.(~ Notary Public 0::. My Commission Expires: NOTARIAL SEAL ROSE MARIE KLEINSAK, Notary Public Steelton. Dauphin County My Commission Expires June 25, 2006 H] 05.805 REV 9/86 This is to certifY that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. 8386898 No. t2J<At/ T-? .~ Local Registrar Fee for this certificate, $2.00 p AUG 2 7 ZOOZ Date 43 As.... 2J87 COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH .. AOE (Lase Bitthday) Mark E. UNDER 1 VEAR _ 0... Pletz UNDER 1 DAY ...... 1 ........ SEX I. male STATE Fll!: ~lIM8EA SOCIAL SECURIT't NUM8ER DATE Of OEATH IMcnlh. 0..." .war, N"ME OF DECEDENT (FIfSl. MlO:M. Latl} I. 182 - 40 - 8007 .. Au ust 19 2002 8lATHPLACE Ie".., ..~ State Of fCf"Jf' CounIfYI 5. COUNTY OF De.CrH 50 v... ~lo 27 South West Avenue ". Shiremanstown, PA 17011 FAfHER.SIlAME'F.......,....lasl) Dean E. Pletz Government DECEDENT'S ACTUAl. RESIOENCE (Seelfl~ 00 0Itl8f $Ide) HealthSouth Wo\S DECEDENT EVER '" U.S. ARMED FORCES? '1M 0 No IXl E~""" 10-'2) _TAL STATUS. Man.... ,......., Warr.. Widowed. ~(S_lIy) to.never married "..0 'IM.__" white SURIIIV1NG SPOuSE I"...... ~ ma.aen nam.t .... 12. 11. Pennsylvania ();d - w.ina Cumberland ..........? 17'.1lZl :;...""=".:::'.. MOTHER'S NAME IF"SI. MtOOte. MaQlnSurNm8l ". Anna Faul IHFOAUANT'S .......,1lG AOORESS {50-.... c.,1Wn. so.u.. Zip ~ . 219 Swatara Street, Steelton, PA 17113 PUCE OF DlSl'OSll'\OIl. Name ofC_. e,_ LOCAllON. e~. Stalo.lipCodo Ol' 01'* PYc. twp. 11a. Stat. In.. Shiremanstown ClIV_. ". 1NF0000000000'S IWoIE (T _P,inQ _. John S. Faul UETHOO OF DISPOSITION O -~ e'........o _oI"""'Sl.'.o Donolion Olhot_ 11.. SIGNATURE OF 2002 21c. Twp., PA 17111 , ne. PA 17070-0431 DATE SIGNED LICENSE NUMBER 2b. FD 012 848 L 10 1M brut 01 my \ii.naMedge. death occ.,ned.. 1M ltfN. lMta al\d ptace ntad '''''I OL. p....r n, 0Ih0t _"",_aNlltlbullnglO_. buI not~in""~ceuMgMMinPAATI. .....s All AU1tlPSY PERFORMED? I :. d. WERE AlIlOPSY FIHOlNGS _LAaE PAIOA 10 COMPlETION OF CAUSE OF DEATH? "ANNER OF DEATH OATE Of INJURY 1Mc:ln1h. Qay. Year} TIME 01 lNJURV INJURY AT WORK? DESCRIBE HOW INJURV OCCURAED. ......... ~ o o Hom)(:1de o o o PlACE OF INJURY - AI home. 'aIm, st,",".-l~. oIka Y. ~. etc:. t$peotvl 300. Yotl 0 NoD AWdo.. Pandtog InYelAag.ltiOn YN 0 No~ v.. 0 NoD - Coutd not be de1armwwd L 2". 2A. CEIlTIFIUI CCh<<:I<....,...., -CERtIFYING I'HYSICIAN (Physoan c~ cause cJ. death wh8r> ijlnothef PhySICIiirl haSPfonounceo <Je.lltI aoo CClfnC)teled Ilem 231 To........ofmyknowJMte.....theccumtCldU41IoIh.cauN(.aandmanne'...t.ted..,....... .......,.....,.......... 29. -PftOMOUNCtHG AND CERTIFYING ~YSICIAN lPhvSC..,n bOIh ."onounclll9 ae..... and ~ert!ty1l'lQ to cause 01' c.1e<1thl To the......o<< my knowMclg_, de,th occ",reclatltte tfme, dale, .net piKe. And due 10 the cauM(') Iftd "'.nnet'.. ......... . . . . . . 'IIEDICAL EXAMINEIIICORONER ~~~~::::~::~~~.i~~~~.~~~ ~~~~~'~~~I.i~~: ~ ~.y. ~~i.n.i~~: ~~~~~ ~~~~~~ ~~ ~~~ ~l~~,.~~t~: ~~~.~~~: ~~.~~~ ~~ ~~~ ~~~~~~).~~~ 0 31.. AEG'SlfW!S SIGNATURE AND NU"~E ...'" i -;h" - .121/...<1/1/1 :n. ,'.-9~' ;'?,; l ?2--{...'!...ji..-e/if'- rL--- ... CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Mark E. Pletz Date of Death: August 19. 2002 Will No: Adm. No. Estate No: 2002-00812 To the Register: I certify that Notice of Estate Administration required by Rule 5.6 (a) of the Orphans' Court Rules was served or mailed to the following beneficiaries of the above-captioned estate on: September 12. 2002. Name Address Katherine Faltin, 1115 Council Street, High Point, NC 27262 IdaL. Maxwell, P.O. Box 403, Newport, PA 17074 Annabel 1. Watson, 2665 Broad Street, York, PA 17404-1407 John S. Faul, 219 Swatara Street, Steelton, PA 17113 Notice has now been ~iven to all persons entitled thereto under Rule 5.6(a) except: No exceptions. Date: September 20, 2002 (tgr!J~4 Ignature) Name: John S. Davidson Address: 320 West Chocolate Avenue Hershey. Pa 17033 Telephone: (717) 533-5101 ~Yl C'..j Capacity: _ Personal Representative X Counsel for Personal Representative ~~ ~~o/ YOST & DAVIDSON 320 WEST CHOCOLATE AVENUE P. 0. BOX 437 HERSHEY, PENNSYLVANIA 17033-0437 JON A. YOST JOHN S. DAVIDSON TELEPHONE 717-533-5101 FAX 717-534-1293 November 15,2002 Register of Wills CUMBERLAND COUNTY COURTHOUSE One Courthouse Square Carlisle, P A 17013 RE: Estate of Mark E. Pletz File No.: 2002-00812 Dear Ms. Lewis: I enclose a check in the amount of$50,000.00 representing partial payment of the inheritance tax liability for the referenced estate. Please return your receipt for this payment in the self-addressed, stamped envelope which is provided. Thank you. Very truly yours, YOST & DAVIDSON J!tD~:::- JSD/rlb Enclosures cc: Mr. Merle E. Gingerich, Executor 1..(""; ~ ';;I ~ ~ ~ u ~ ~e ~ ~ o '&~ U(J'}~ -: ""'~r- -:f/'}-'-~..... ~ -.-, ."- :;'~~t:l~ -;'Zae~ -1' ~ r- -; t.Ioo' ~ ~ ~t:l~t:l~ ';~CQU~ ::;~~~~ ~ 'Ql...-- ~ u ~~'Uo ~ q <'" \.>l a z";) t;:. o ~ 4. (/)"?C .... ~ e ~~~ ~ ~ ~~~ . ~gl'lo~ %0'7, ~ 06 vc;>:.1J.1 ~ ~ ~ p.o. CS~ ti ~$?';:C. ro ~ ~ ~ - - - -:. -:. ~ - -:. -:. -:. -: -:. -::. - -::. - ~ ~ - ~ - - -: - - -:. ~ ~ - t4 o t4 fI r1 f. .t f. .. " ('" .. COMMONWEALTH OF PENNSYLVANIA OEPARTMENT 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 DAVIDSON JOHN S ESQUIRE PO BOX 437 HERSHERY, PA 17033-0437 -------- fold ESTATE INFORMATION: SSN: 182-40-8007 FILE NUMBER: 2102-0812 DECEDENT NAME: PLETZ MARK E DATE OF PAYMENT: 11/18/2002 POSTMARK DATE: 11/15/2002 COUNTY: CUMBERLAND DATE OF DEATH: 08/19/2002 NO. CD 001855 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $50,000.00 I I I I I I I I TOTAL AMOUNT PAID: $50,000.00 REMARKS: MERLE E GINGERICH C/O JOHN S DAVIDSON ESQUIRE CHECK#140 SEAL INITIALS: CW RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS ~~O/ YOST & DAVIDSON 320 WEST CHOCOLATE AVENUE P. 0. BOX 437 HERSHEY, PENNSYLVANIA 17033-0437 JON A. YOST JOHN S. DAVIDSON TELEPHONE 717-533-5101 FAX 717-534-1293 May 14, 2003 Register of Wills CUMBERLAND COUNTY COURTHOUSE 1 Courthouse Square Carlisle, P A 17013 RE: Estate of Mark E. Pletz No.: 2002-00812 Dear Register: Enclosed is the original inheritance tax return with attachments together with a check in the amount of$24,750.50 in payment of the tax due. I also enclose two copies of the return without attachments. Please return one copy of the inheritance tax return and your receipt for the payment to me in the self-addressed, stamped envelope which is provided. Thank you. Very truly yours, YOST & DAVIDSON (ft~L John S. Davidson JSD/rlb Enclosures cc: Mr. Merle E. Gingerich, Administrator 00 .... ,,"''''l - (0 :3 ~. 0', Q) , ' -~ p)' :J (:t, ::i: ?< 8 ;0 :;:)(tJ ro('? (Q. f:' f..n (..; ,.':::":. ~';:'~ .:.l} '~ -"'r, ~' - V1 a - (' ~: c:\ Q. .." )> N N 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 DAVIDSON JOHN S ESQUIRE 320 WEST CHOCOLATE AVENUE HERSHEY, PA 17033 -------- fold ESTATE INFORMATION: SSN: 182-40-8007 FILE NUMBER: 2102-0812 DECEDENT NAME: PLETZ MARK E DATE OF PAYMENT: 05/15/2003 POSTMARK DATE: 05/1 5/2003 COUNTY: CUMBERLAND DATE OF DEATH: 08/19/2002 NO. CD 002567 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $24,750.50 I I I I I I I I TOTAL AMOUNT PAID: $24,750.50 REMARKS: MERLE E GINGERICH C/O JOHN S DAVIDSON ESQUIRE CHECK#172 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS DONNA M. OTTO DEPUTY REGISTER OF WILLS REV-1500 EX + (6-00) COMMONWEAlTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 . DECE- DENT CHECK APPRO- PRIATE BLOCKS COR- RE- SPON DENT RECA- PITULA- TION TAX COMPU- TATION /7-ff7- 3 C/ OFFICIAL USE ONLY REV-1500 INHERITANCE TAX RETURN F1LENUMBER RESIDENT DECEDENT 21 COUNTY CODE 8J2 2002 VEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Pletz Mark E DATE OF DEATH (MM-DD-YEAR) 08 19 2002 10 14 1951 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, RRST, AND MIDDLE INITIAL) 182-40-8007 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUM8ER ; 1. Original Return 4. Limited EataIe 6. Decedent OledTestate (Atfach copy of Will) 9. litigation ProcaadB Received 3. Remainder Return o (data of death prior to 12-13-82) j 5. Fed...a1 EataIe Tax Return Required u 8. Total Number of Safe Depoa~ Boxes 011. ElectiontotaxunderSec.9113(A) (Attach Sch 0) ~ 2. Supplemental Return 4a Future Int....at Compromis. (date of d.ath .fter 12-12-82) 7. Decedent Maintained a Living Trust Attach a copy of Tru 10. gpou..' Poverty C...:N(date of death between 12-31-91 and 1-1-95) NAME John S. Davidson Es . FIRM NAME (If Appicable) Yost & Davidson TELEPHONE NUMBER (717) 533-5101 COMPLETE MAILING ADDRESS 320 West Chooo1ate Avenue P.O. Box 437 Hershey, PA 17033-0437 1. Real EataIe (Schedule A) 2. Stocks and Bonds (Schedule B) 126,900.00 185,558.0~ .- 0.0;; . o.oi 0::~ 259 ,615. 9i; OFFICIAL USE ONLY (1) (2) 3. Closely Held Corporation, Partnership orSola-Proprietorship (3) 4. MOrlgages & NoIBs Receivable (Schedule D) (4) 5. Caah, Bank DepoB~ & MlscellaneouB PlO'8Onal Property (Schedule E) (5) 6. JoinUy OWned Property (Schedule F) o Separata Billing Requeatad (8) 8 :0 ::0 (t\ mc;. (!:,:,:) () , :J: :> -< i") - U1 0.00' 7. Inter-Vivos Transfers & Miscellaneous Non-Probata Property (Schedule G or L) ;a - "'''1 0.0lt r'j G -, (7) 8. Total Groes _ (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H)(9) 10. Debts of Oecedent, Mortgage Llabilltfes, a. Lien. (Schedule I) (10) 11. Total Deductions (total Lines g & 10) 12. Net Vatue of E..- (Une 8 minus Line 11) 13. Charitable and Gov...nmental Bequeel8lSec 9113 Truals for which an election to tax haa not been mode (Schedule J) 14. NetVslue SUbjecttD Tax (Une12 minus Line 13) SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax (8) 54,613.76 1.579.70 (11) (12) (13) 572,073.99 56,193.46 515,880.53 0.00 (14) 515,880.53 rate, or transfers under Sec. 9118 (a)(1.2) 16. Amount of Line 14 taxable at IIn.al rate 17. Amount of Line 14 taxable atlllbiing rate 18. Amount of Line 14 taxable at collatllral rate 0.00 0.00 0.00 515,880.53 0.00 0.00 0.00 77,382.08 77 , 382 . 08 X.oo X .045 x.12 x.15 (15) (16) (17) (18) (19) o PA15001 NTF 29755 Copyright 2000 Greatiand/Netco LP- Forms Software Only PA REV-1500 EX (6-00) Decedent's Complete Address: Page 2 STREET ADDRESS 27 South West Avenue CITY I STATE I ZIP Shiremanstown PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 77 ,382.08 0.00 50,000.00 2 , 631. 58 Total Credits (A + B + C) (2) 52,631.58 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 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 DUE. A. Enter the interest on the tax due. B. Enter the total of Une 5 + sA. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT :;".'i.i..."";""""'."",,,,;;;,,,,,,,,niii'"I,,Q"JhH"rl&"nnw1~a4im"li;W11fiuaFil"im(jF!nj!1jwlui1:11:DklqllHE!rll..I1!ii'lGWnD~!iFmrmmlijnlillll.I'jhi;~Hi1ii!i4Fj/IlIiFW!1~lJrI;I~."'n'l.l!iqllll!tlUbi iYll..j^Wiiiiii!i)i111JjWiiijiHiiili11jji\jlj:i:li:U;tl?liji1iiiiFiiiiiiiiidiPiriiijiiiUi' ;ll]j]ijlmmmlm~!mmll~immnftg;ml!!gffEfi~i!~nnfr"B~nlffi~ggffUnnk~gk~i!]!iMh;!mU~n~tljj. !bifulr: .j..#~g!l!l!EgtiG!lmtlmPThJ!1iluA,Jll~!j!!!j!lig!!!!! m!:Mn,!, JUjj!l!lffili!i!j ..jm!ill!I!l!l!lisu!! II!~llli!!H!a~!l!l!lffiill;!B!j!E!;!l.limUl!i!ti!K!Hiiiljl!i .. . PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. 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. Under penalties of perjulY, 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 ot preparer other than the personal representative is based on information of which preparer has any knowledge. SIGNATUR F PE ON PONS FOR FII:ING URN DATE ...F- (3) 0.00 (4) (5) (SA) (5B) 24,750.50 0.00 24,750.50 Yes No ~ I B ~ o -<2$ ADDRESS 320 West Cho 01 t Hershey, PA 17033-0437 SIGNATUR OF ?~~ THAN REPRESENTATIVE 20 West Chocolate Avenue P.O. Box 437 PA 17033 0437 DATE /3. .:lUO.! "0 [72 P.S.' 9116 (a)(1.1)(i)]. For dates of death on or after January 1,1995, the tax rate is imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. !i 9116 (a) (1.1}(ii)]. The statute does not GlCAtnot a tran6ferto a$urviving !Spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse isthe only beneficiary. For dates of dBath on or after July 1,2000: The talC rate imposBd on the netvaJue of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% 172 P.S. 89116(a)(1.2)J. The talC rate imposed on the net value of transfer$ to or for the use of the decedent's lineal beneficiariEiS is 4.5%, EilCcspt as noted In 72.P.S.1i 9116(1.2) 172 P.S, Ii 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. Ii 9116(a)(1.3)]. A sibling is defined, undEir SEiction 9102, as an individual who has at IEiast one parent in common with the decedent, whether by blood oradoption. o PA15002 NTF 29756 Copyright 2000 Greatland/Nelco L.P- Forms Software Only REV-1502 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Platz, Mark E SCHEDULE A REAL ESTATE FILE NUMBER 21-2002-0812 All real property owned solely or as 8 tenant In common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which Is )olntly-owned with right of survivorship must be disclosed on Schedule F. ITEM NO. 1. 27 S. value chad) DESCRIPTION W. Avenue, Shiremanstown, PA 17011 - based on sale price (see HUD - 1 atta VALUE AT DATE OF DEATH 126,900.00 o PA15021 NTF33299 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) Copyright 2000 Greatland/NelcQ LP- Forms Software Only 126,900.00 REV-1503 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Pletz, Mark E All property )olntly-owned with right of survivorship must be disclosed on Schedule F. SCHEDULE B STOCKS & BONDS FILE NUMBER 21-2002-0812 ITEM NO. DESCRIPTION 1. 100 sh Intel Corp. 2 100 Ratheon Company New 3 100 sh. Adelphia Business Solutions, Inc. C lass A 4 100 sh. General Electric 5 110 sh Owens Illinois CV PFD $2.375 6 122 sh Verizon Communications 7 150 sh Cisco Bye loc 8 150 sh Oracle Corp. 9 150 sh PPL Corp. 10 175 sh EMC Corp-Mass 11 200 sh Lockheed Martin Corp 12 200 sh. McDonald's Corp 13 224 sh. Worlco Inc. class A - no value 14 225 sh Sun ~cro Systems 15 300 sh. Allied Irish Banks ADR 16 400 sh. Community Banks, Inc. 17 50 sh. Avery Dennison Corp. 18 580 sh Hershey Foods Corp. 19 647.191 sh Smith Barney Premium Total Retur n Fund Cl A 20 766 sh Exelon Corp 21 800 sh. Exxon Mobil Corp. VALUE AT DATE OF DEATH 1,903.50 3,448.00 5.05 3,219.50 2,585.00 4,019.29 2,212.50 1,609.35 5,274.75 1,265.25 12,950.00 4,823.00 0.00 946 . 13 8,167.50 11,925.44 3,219.50 43,430.40 7,604.49 37,457.40 29,492.00 o PA15031 TOTAL (Also enter on line 2, Recapin.Jtation) $ (If more space is needed, insert additional sheets of the same size) Copyright 2000 Graatland/Nelco LP- Forms Softwara Only NTF33300 185,558.05 REV-150B EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Pletz, Mark E 21-2002-0812 Include proceeds of litigation &. date proceeds were received bythll8State. All prop.)olntly-owned with right a1survlvorshlp must be disclosed on Sch. F. ITEM NO. DESCRIPTION 1. All:i.ed Ir:i.sh Banks d:i.v:i.dend payable 09/27/0 2 to owners of record on 08/09/02 2 Cash found in decedent's home 3 C:i. t:i.zens Bank acct .116100713059 4 C:i.t:i.zens Bank acct.1I6100714292 5 C:i. t:i.zens Bank acct .116140699967 6 C:i.t:i.zens Bank acct.1I6140711797 7 C:i.t:i.zens Bank acct.1I6140795850 8 D:i.anon Systems check dated 6/12/02 for refu od of account overpayment 9 Eaton Corp. check dated 5/21/02 uncashed at death 10 Exxon MOb:i.l Corp. d:i.v:i.dend payable 09/10/02 to owners of record on 08/13/02 11 Intel Corp. d:i.v:i.dend payable 09/01/01 to ow ners of record on 08/07/02 12 Members 1st FCU acct.1I20006-00 13 Prudent:i.al F:i.nanc:i.al - cash payment to pol:i. cy holders of record on 12/15/2000 made :i.n connection with demutualization of Prudenti ,al 14 $alomonSm:i.thBarney IRA Condu:i.t acct. 11724-6 8774-14 15 SalomonSm:i.thBarney bank depos:i.t acct.1I724-0 5864-17 16 UBS Pa:i.neWebber RMA account 17 1986 Ford Thunderb:i.rd 18 1994 Mercury Grand Marqu:i.s 19 Coin Collection 20 Dean E. Pletz Estate - balance for d:i.str:i.bu t:i.on to Mark E. Pletz 21 Erie Insurance homeowner's premium refund 22 Exelon Corp. d:i.v:i.dend payable 09/10/02 to 0 wners of record on 08/15/02 23 Household goods, furnishings and miscellane ous personal :i.tems - net proceeds of sale 24 Lockheed Mart:i.n d:i.v:i.dend check dated 06/28/ 02 25 PPL refund account overpayment 26 Susquehanna Surgeons, LTD - refund account overpayment 27 Verizon - refund 28 Household goods, furnishi.ngs and personal e VALUE AT DATE OF DEATH 102.48 952.00 17,973.91 2,638.01 11,239.38 3,666.72 24,260.53 3.50 1,521.00 184.00 2.00 99,207.30 483.48 14,462.66 388.82 1,960.07 200.00 3,275.00 4,617.58 53,635.57 305.00 337.04 8,934.11 22.00 15.42 49.77 1.59 9,177.00 o PA15081 NTF 33305 TOTAL (Also e_ on tine 5, Recapl1ulalion) $ (If more space is needed, insert additional sheets of the same size) Copyright 2000 GreatlandlNllco LP- Form6 Software Only 259,615.94 Estate of: Pletz, Mark E Schedule E -- Cash, Bank Deposits & ~sc. Personal Property Page 2 21-2002-0812 Item No. Description Value at Da te of Death 28 ffects as itemized on Appraisal Report of D ~vid A. Cordier attached hereto - distributed ln kind TOTAL. (Carry forward to main schedule) 0.00 REV-1510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Pletz, Mark E SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21-2002-0812 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY %OF ITEM INCLUDE NAME OF THE TRANSFEREE, THEIR DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE RELATIONSHIP TO DECD & DATE OF TRANSFER. NO. ATTACH COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) 1. Members 1st FCU IRA Savings ace 12,682.59 0 0.00 0.00 t.#20006-10. Individual Retirem ant Account not subject to tax. Decedent was 50 years old at t he time of his death and not en titled to make withdrawals with au t penalty. TOTAL (Also enter on line 7, RecapibJlation) $ 0.00 o PA15101 NTF33307 (If more space is needed, insert additional sheets of the same size) Copyright 2000 Greatland/Nelco LP - Forms Software Only REV-1511EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Pletz, Mark E SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-2002-0812 Debts of decedent must be reported on Schedule I. ITEM NO. DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ,. Parthemore Funeral Home - deposit 300.00 2 Miller's Cemetery 420.00 3 Parthemore Funeral Home 7,998.00 4 CMC - funeral luncheon 280.84 5 Parthemore Funeral Home - balance due 24.00 6 Gingerich Memorials 255.00 8. ADMINISTRATIVE COSTS: ,. Personal Representative's Commissions 15,000.00 Name of Personal Representative(s) Merle E Gingerich Social Security Number(s)/EIN No. of Personal Representative(s) Street Address 2878 Kissel Hill Road City Li ti tz State PA Zip 17543 Year(s) Commission Paid: 2002 and 2003 2. Attorney Fees Name: John S. Davidson, Esq. 15,000.00 3. Family Exemption: (If decedenrs address is not the same as claimant's, attach explanation) 0.00 Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 617.35 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7. Zimmerman Plumbing - plumbing repairs to Shiremanstown 186.00 property 9 Lower Allen Township - sewer service 10/1/02 to 12/31/ 67.50 02 10 Jeffrey Boose - cleaning services for Shiremanstown pr 300.00 operty 11 Jewelry appraisal 89.85 12 Kelli Nachbar - cleaning services 150.00 13 Zimmerman Plumbinmg - furnace repairs at Shiremanstown 1,174.00 property 14 Merle E. Gingerich, Administrator - reimburse mileage 453.60 Total from continuation pages.... 12,297.62 TOTAL (Also enter on line 9, Recapitulation) $ 54,613.76 o PA15111 Copyright 2000 Greatland/Nelco LP- Forms Software Only (If more space is needed, insert additional sheets of the same size) NTF33308 Estate of: Pletz, Mark E Schedule H, Part B -- Administrative Costs Item No. Description 14 15 expense Northwest Savings Bank - check printing charge for est ate account Verizon - telephone service PPL - electric utility service to Shiremanstown proper 16 17 ty 18 Erie Insurance group - homeowners insurance premium fo r Shiremanstown property 19 Pa American Water Company - water service to Shiremans town property 20 LB Smith - auto repair and state inspection 21 PA Department of Transportation - duplicate auto title (reimbursed to M. E. Gingerich, Administrator) 22 Pa American Water Co. - water utility service to Shire mans town property 23 Verizon - telephone service 24 PPL - electric utility service to Shiremanstown proper ty 25 Lower Allen Township - sewer and refuse service to Shi remanstown property 26 Verizon - telephone service 27 PPL electric utility service to Shiremanstown property 28 PA American Water Co. - water utility service to Shire mans town property 29 PA Department of Transportation - duplicate auto title (reimburse M. E. Gingerich, Administrator) 30 Sico - heating oil for Shiremanstown property 31 Northwest Savings - check printing charge 32 PA American Water Company - water utility bill 33 PPL - electric utility bill 34 PA American Water Co. - final water utility bill 35 PPL - final electric utility bill 36 Motorists Insurance Co. - auto insurance premium 37 Settlement charges paid at closing on sale of real est ate (see HUD -1 attached hereto) TOTAL. (Carry forward to main schedule) Page 2 21-2002-0812 Amount 10.75 26.83 19.62 379.00 13.12 573.44 22.50 11.67 25.37 26.55 73.35 25.06 19.21 12.23 22.50 209.85 10.75 11.16 15.42 5.49 21.60 74.15 10,688.00 12,297.62 REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE DF Pletz, Mark E Include unreimbursed medical expenses. ITEM NO. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-2002-0812 DESCRIPTION 1. D.J. Maintenanoe - cleaning services 2 Department of the Treasury - decedent. s 200 1 income taxes due 3 Pinnacle Health Hospitals 4 Internists of Central Pennsylvania 5 R.J. Kantor, M.D. 6 PPL - electric service 7 Pennsylvania G I Consultants 8 Pa American Water Co. - water utility servi ce 9 Physicians of Rehabilitation 10 Knight, Boline & D'Amico - physicians servi ces 11 Tru Green Chemlawn - lawn care service 12 Health South - hospital bill 13 Pinnacle Health Hospitals 14 East Pennsboro Ambulance Service 15 Pinnacle Health Medical Services 16 Comcast - tv cable service 17 Verizon - telephone service 18 Charles I. loners, M.D. 19 ENT Faoial Plastic Surgery Group 20 Verizon - telephone service 21 Quantum Inaging - medical expense 22 Sica - heating oil 23 Susquehanna Surgeons, Ltd. 24 Cummings Associates, PC - physicians servie cs 25 Riverside Anesthesia Associates 26 Camcast - tv cable final bill 27 Internists of Central Pennsylvania 28 Physicians of Rehabilitation 29 Susquehanna Surgeons, Ltd. 30 Riverside Anesthesia Associates 31 Health South - decedent's medical care 32 Judy C. Prowell - decedent's per capita tax es 33 Internists of Central Pennsylvania AMOUNT 416.12 9.51 103.44 55.35 8.00 84.61 49.10 37.77 4.00 10.50 45.58 11.66 41.10 29.00 15.00 73.87 52.97 19.00 9.50 25.83 25.30 19.53 49.79 66.45 55.80 4.00 6.15 18.00 49.77 56.00 100.00 11.00 16.00 o PA15121 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) Copyright 2000 GreatlandlNelco LP - Forms Software Only NTF33309 1,579.70 REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER Pletz, Mark E NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS Qnclude outright spousal distributions, and transfers under Soc. 9116 (a) (1.2)] 1. Faltin, Katherine 1115 Council Street High Point, NC 27262 21-2002-0812 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trusteo(s) OF ESTATE aunt 128,970.13 2 ~xwell, Ida L P.O. Box 403 !Newport, PA 17074 aunt 128,970.14 3 ~atson, Annabel J 2665 Broad Street York, PA 17404-1407 aunt 128,970.13 4 Faul, John S 219 Swatara Street Steelton, PA 17113 uncle 128,970.13 ENTER DOLLAR AMTS. FOR DISTRIBS. SHOWN ABOVE ON LINES 15 THROUGH 18 AS APPROPRIATE ON REV 1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS, A SPOUSAL DISTRI8UTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE ,. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS ,. TOTAL OF PART II -- ENTER TOTAL NON-TAXABLE DISTRIBS. ON LINE 13 OF REV-1SOQ COVER SHEET $ (If more space is needed, insert additional sheets of the same size) 0.00 o PA15131 NTF33293 Copyright 2000 Greatland/Nelco LP - Forms Software Only A. U.S. DEPARTMENT OF HOUSING and URBAN DEVELOPMENT OM8No.2502-0266 SETTLEMENT STATEMENT TlTLEPRO SECURED LAND L....rprinl TRANSFERS, INC. B. TYPE OF LOAN 5006 East Trlndle Road 1.1 I FHA 2.[ tFMHA 3.X] CONY. UNINS. Suite 203 4. [ IVA 5. r ] CONY, INS. Mechanlcsburg, PA 17055 6. FILE NUMBER: I 7, LOAN NUMBER: 132387 0132138124 Phone: (717) 591-8500 FAX: (717) 591-8506 8. MORT. INS. CAsE NO,: C. NOTE: This form is furnished to give you a statement 01 actual sel\\emer.\ costs, Amounts paid to and by the seUlemenl agent are shown. lIems marked '(p.c.c.)' were paid outside the closing; they are shown here for informational purposes and are not included in thalotals. D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: Kurt J. Hendley Estate of Mark E. Pletz Members 1st Federal Betsy A. Bellis Credit Union 5275 E. Trindle Rd Mechanicsburg, PA 17055 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: I. SETTLEMENT DATE: Lot 7 Shireman Manor 27 S. West Avenue Secured Land Transfers I Inc. 02/21/03 Lower Allen TOWNSHIP PLACE OF SETTLEMENT: CUMBERLAND County 5050 Linglestown Rd, Harrisburg PA 17112 J. SUMMARY OF 80RROWER'S TRANSACTION: K. SUMMARY OF 9ELLER'S TRANSACTIoN: 100. OR099 AMOUNT DUE FROM sORROWER 400.QIII089 4!ltOUNT DUE TO SELLER 101. Contract salas prica no"' .UU 4lH.Contf8Ct sa\a$ price n69UU.OU 102, Personal properly 402 Personal property 103, Settlement charges to borrower (line 1400) 4b'" . U 1 403. '" ". 105. ." Adjustmen\s lor itams paid by saller in advance Adjustments lor Hems paid by seUer in advance 106.CilylTowntalC " 406,CilyfTowntll~ I' 107, Coun1yla~ " 407,Coun\yla~ " 108. AssGssments " 408.Assessmenls " 109, Bchool U"I d(031O 06( 542.02 409, acnool 02(21(U.IOUb/. 54".u" 110, swr&Ket: ~'13. Jtl/tI ena 3) 1 'u. 5 410,tj:wr&Ket::;;}J,J,I/f.( end 3/:1 3U.55 III 411. 112, m 120, OROSS AMOUNT DUE FROM BORROWER 132092.64 420, OROSS AMOUNT DUE TO SELLER 127472.57 200, AMOUNTS PAID BY OR IN BEHALP OF BORROWER SOD. REDUCTIONS IN AMOUNT DUE TO SELLER 201, Deposit or earnest money 1UUU. sol.Excess depOSit (see instructions) 202. Principal amount 01 new loan(s) 1 .uu s02.Settlement charges 10 seiter (line 1400) 1U&"".UU 203, Existing loan(s) taken subject to s03.E~isting loan(s)laken subject to ". s04.Payofl of First Mortgage Loan NONE 211& 5Os.Payotl of Second Mortgage Loan "" 'co '" 507. '" '" '" '" Adjustments lor ilems unpaid by seller AdjUstments for Items unpaid by seller 210.CltyfTownta~ " slo,CltyfTownttl~ " 211-Counlylax 1/1 1/1)3IoU:l/:il/0~ 0&.34 611.Counly ta~ 01 1/u~"u"/.<1/U. bb.~4 212. A~""menl~ " S12,Assessments 10 '" school " '" SchOol 10 '" ". 215. m '" 'to '" '" "" "" 2)9. 519. 220, TOTAL PAID BYlfOR BORROWER 121621.34 62Q,TOTAL REDUCTION AMOUNT OUE SELLER 10754.34 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER 301. Gross amount due from borrower (line t20) l;<u,,,. b'i f>01GWSS amount due to seUer (line 420) 1"/4/".', 302, Less amount paid bY/lor borrower (line 220) 1"1&"1. 34 602.Less reduction amount due seUer (line 520) 1U'I~4 .:;4 303, CASH (DO FROM) ([ 1 TO) BORROWER 10471.30 603,CASH 100 TO) ([ 1 FROM) SELLER 11671B.23 Buyer or Borrower's Signalure Soller'sSignalure HUD-l Rel/, 5186 l. SETTLEMENT CHARGES 132387 ~ 700. TOTAL SALES/BROKER'S COMMISSION b...d on prlc. $ 126900.00 7.0 ,BORROWER'S SELLER'S Division 01 Commission (uno 700) as lollows: Total: 58,883.00 FUNDS AT FUNDS AT SETTLEMENT SETTLEMENT 70t $ 4416.50 to ERA-NRT, Inc. 702 $ 4466.50 to Re/Max REa1tv Prof. 703 Commission paid al Selllement 8883.00 704. Trans Fee ERA-NRT, Inc. I 100.00 800. ITEQS PAYABLE IN CONNEC'T'ON Wl'TH LO.6." 801, Loan Origination Fee % 802. Loan Discount % 803. Appraisal Fea 10 804. Credil Report 10 805. Lenders Inspection Fee 806. Morlgage Insurance Application Fee to 807. Assumption Fee 808. AOPJl.caFee Members (5325.00 POCI "'. UnderwrFee Members 1st Federal 75.00 810. DoC Preo Members 1st Federal 275.00 811. 900. ITEMS REQUIRED PV LENDER TO BE PAID IN ADVANCE 90t Inlerestlrom 02/21/03 to02l28/03 0$ 20.09Id., 160.74 902. Mortgage Insurance Premium lor mo. to 903. Hazard Insurance Premium lor 1yrs. to 904. yrs, \0 905. 000 RESERVES DEPOSITED WtTH LEMDER FOR 001. Hazard Insurance 3 mo.O$ 27.00 Imo. 81. 00 1002. Mortgage Insurance mo.OS Imo 003. Cily!Town tax mo.O$ Imo. 004 County tax 13 mo.O$ 38.03 Imo. 494.39 005. Assessments mo.OS Imo. 006. Bcncc tax 9 mo.O$ 125.59 Imo 1130.31 1001. mo 0$ Imo. 008. Aqgreqate mo.O$ Imo. -314.12 \00. TITLE CHARGES 1101. Selllement or closing leeto 102. Abstract ortiUe search to 1103. Tille examination to 104. Tille insurance binder to 105 Document preparallon to 106. Notarylees to Cash 10.00 10.00 \ 101 Attorney's lees to Yost & Davl.dson (includes above items No.:) 1105, (POC 51 108, Tille Insurance to Secured Land Transfers ~~43.75 {includes above ilems No 'I end. 100, 300, 900 109. Lender's coverage $ 120,555 1110. Owner's coverage $ 126,900 111. Ma~l Fee Secured Land Transfers 1 112, Tax Cert Secured Land Transfers I 2.00 113. I 1200. GOVERNMENT RECORDING "NO TRANSFER CH"RGES 201, Recording lees: Deed $ 38.50 Mortgage $ 64.50 Misc. $ 103.00 202 Cily/county tax/stamps: Deed $ 1269.0QMortgaga$ 1269.00 203. Slatelax!statnps: Deed$ 1269. QOMortgage$ 1269.00 1204.Ass~ nment Recorder of Deeds 27.00 205. 300 ADDITIONAL SETTLEMENT CHARGES 30\. Survey to 302. Pest Inspection to Bl.echler & T~llerv 50.00 303,Home Warr AH5 Warranty 399.00 1304 Trans Fee Re/Max Realtv Prof. 125.00 ~305. h400. TOTAL SETTLEMENT CHARGES (enter on lines ;03 and 502. Sections J and K) 4620.07 10688.00 U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT OMB No. 2502-0265 Page 2 P.,tie. .g,.... tI"t no It8bility i. '88UITlt'd by SlIlIllIm....t Aount tor Ih.. 8ccuracy <>t inlormalion lumlsh8d by oU...... n shown on Ih8 HUD.l S"Ulumn..' Sl_'llm..n!. S.Ulem"nl Ag..nl hllr"by ".press/V ,,,S8lVeSlh..,lgI>llad8po&ll&llY lUI'IoulIl..collacltld'<>T <m,bIlnemT11\l in lInlnl".ulbe..,ing8 ccounlill.fede..flyineu'&dinslHu'ion.lld'oCf..d~8nyinle..slllO"..nedtoilsown8ccoun'U8ddl1iDnef comp..nB8,jonroths"rvlce8Inlhlsha....."1I0" HUD CERTIFICATION OF BUYERS AND SELLERS carelully reviewed the HUO.t SettlelTlElnt Sl.alemenl aM \(I 100 b&lll 01 my \l.nowledge and beliet, ills a true and accurate slatemenl 01 all receipts and disbursements my.",,",b m Iht.,,,,,..,,,oo. It""h"'"""YIh"'h''''',"lYod'''PY,~~'''"m~;1'U~~~' aA... Buye,',Addt&ss&Phone SaUe,'sSlgn.lUflf S..Ilef's N.......Add....& Phon..: h~V..p.8p....dlsa'ru"end8""u,.,B.CCo"..IOllhis""n..G,iDn.1 h.v..c.......d Q' 'Hill CIlUSOl lrn.,,,,,dal..t...rtisbu,..&rlln.,,cordencll wuhlhlssl.lemenl ").(J/( (J 7 S..ll ."tAgenl Dele w/\ NlN~~~ ~:: 'tr~"d~j.,ns:~e,'~ 'rtU ~~':'S:~t\::;:'10~sOlo 'he Unhri Sleles On Ihll Or any ..."il.. 10,," Penellies upon <;on,"cllon call IncllJde e IIn.. Ind Imp,18ollmllnl F", dolln. See HUD.l Rev, 5/86 Estate Valuation Date of Death: 08119/2002 Estate of: Mark E. Pletz Valuation Date: 08/19/2002 Report Type: Date of Death Processing Date: 01/28/2003 Number of Securities: 22 File ID: YOSTPLE'I" Shares Security Mean and/or Div and Int Security or Par Description High/ Ask Low/Bid Adjustments Accruals Value 1\ 100 RAYTHEOO co 1755111507) COM NEW NYSE 08/19/2002 34.80000 34.16000 H/L 34.480000 3,448.00 21 100 INTEL CORP (4581401001 COM NASDAQ 08/19/2002 19.63000 18.44000 H/L 19.035000 1,903.50 Div: 0.02 Ex: OB/05/2002 Rac: 08/07/2002 Pay: 09/01/2002 2.00 31 100 GENERAL ELOC CO (369604103, GEl COM NYSE 08/19/2002 32.89000 31.50000 H/L 32.195000 3,219.50 4) 122 VERIZON COlolMUNICATIONS (92343V1041 COM NYSE 08119/2002 33.99000 31.90000 H/L 32.945000 4,019.29 51 150 ORACLE CORP 168389Xl05, ORCLI COM NASDAQ 08/19/2002 11.14000 10.31800 H/L 10.729000 1,609.35 61 150 CISCO SYS INC (17275Rl02, CSCOI COM NASDAQ 08/19/2002 15.00000 14.50000 H/L 14.750000 2,212.50 71 150 PPL CORP (693S1TI06) COM NYSE 08119/2002 35.56000 34.77000 H/L 35.165000 5,274.75 81 175 EM C CORP MASS 1268648102, EMCI COM NYSE 08119/2002 7.35000 7.11000 H/L 7.230000 1,265.25 91 200 LOCKHEED MARTIN CORP 15398301091 COM NYSE 08/19/2002 65.90000 63.60000 H/L 64.750000 12,950.00 101 200 MCDONALDS CORP 15801351011 COM NYSE 08/19/2002 24.69000 23.54000 H/L 24.115000 4,823.00 111 224 WORLCO INC (9814141051 CL A NASDAQ OS/24/1991 0.50000 0.25000 A/B 0.375000 N/A Last price available on 05124/1991 Page 1 This report was produced by the Mail-In Service of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at fBIB) 313-6300. Date of Death: Valuation Date: Processing Date: 08/19/2002 08/19/2002 01/2812003 Low/Bid 4.11000 HIL 27.01000 HIL 14) Div: 0.3416 Ex: 08/07/2002 Rec: 08/09/2002 Pay: 09/27/2002 50 AVERY DENNISON CORP (053611109) COM NYSE 08/19/2002 Estate of: Mark E. Pletz Report Type: Date of Death NUmber of Securities: 22 File ID: YOSTPLET Mean and/or Di v and Int Security Adjustments Accruals Value Shares or Par security Description High/ Ask 63.38000 HIL 74.52000 H/L 48.27000 HIL 171 Div: 0.44 Ex: 08/13/2002 Rec: 08/15/2002 Pay: 09/10/2002 800 EXXON MOBIL CORP (30231GI02i XQM) COM NYSE 08/19/2002 4.205000 9'6.13 36.45000 HIL 18) Div: 0.23 Ex: 08/09/2002 Rec: 08/13/2002 Pay: 09/10/2002 10 AEROQUIP-VICKERS INC (530000108) COM NYSE 04/09/1999 27.225000 8,167.50 121 225 SUN MICROSYSTEMS INC (866810104) COM NASDAQ 08/19/2002 '.30000 57.87500 HIL 57.87500 HIL 0.04600 A/B 26.23000 HIL 11.75000 Bid 102.48 6'.390000 3,219.50 131 300 ALLIED IRISH BKS P L C (019228402) SPON PJlR QRn NYSE 08/19/2002 27.44000 7'.880000 43,430.40 65.40000 151 580 HERSHEY FOODS CORP (427866108) COM NYSE 08/19/2002 75.24000 48.900000 37,457.40 161 766 EXELON CORP 130161N101) COM NYSE 08/19/2002 49.53000 337.04 36.865000 29,492.00 37.28000 58.00000 Last price available on 04/09/1999 191 40 AEROQUIP-VICKERS INC (007869100) COM NYSE 04/09/1999 58.00000 184.00 57.937500 N/A 20) Last price available on 04/09/1999 100 ADELPHIA BUSINESS SOLUTIONS (44914K306) CL A NQB 08/19/2002 0.05500 57.937500 N/A 21) 449 COHHUNITY BKS INC HILLERSBURG (203628102) COM NASDAQ 08/19/2002 26.89000 0.050500 5.05 22) 647.191 SHITH BARNEY INCOMH FUNDS 183181A104) PREM 'I'OT RET A NASDAQ 08/19/2002 26.560000 11,925.44 11. 750000 7,604.49 Page 2 This report was produced by the Mail-In Service of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300. Date of Death: Valuation Date: Processing Date: 08/19/2002 08/19/2002 01/28/2003 Estate of: Mark E. Pletz Report Type: Date of Death NUmber of Securities: 22 File ID: YOSTPLET Total Value: Total Accrual: Total: $183,598.57 $182,973.05 $625.52 Page 3 This report was produced by the Mail-In Service of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300. .: CITIZENS BANK 525 William Penn Place Suite 153-2510 Pittsburl!:h, PA 15219 October 2, 2002 JOHN S. DAVIDSON 320 WEST CHOCOLATE AVENUE PO BOX 437 HERSHEY, PA 17033-0437 Estate of MARK E PLETZ Date of Death: Aug 19,2002 SSN: 182-40-8007 Dear SirlMadam: In accordance with your request, the attached information sheet has been provided in the above decedent's name as of his /her date of death. For n. or LC accounts, contact our Loao Department at 1-800-537-5591. For all other inquiries, please ca11412.867.3881. Sincerely, Jid~)1M~ Kathleen Nave Operations Services C CITIZENS BANK Account Number Account Title Wednesday, October 2,2002 6100713059 Mark E. Pletz Date Opened: 01/31/1964 Account Type: DDA Principal Sal as of DOD $17,973.42 Int from Last Account Sal Posting to DOD as of DOD $0.49 $17,973.91 YTD Int to DOD $30.09 6100714292 Mark E. Pletz Date Opened: 8120/1971 Account Type: OOA PrIncIpal Sal as of DOD $2,638.01 Int from Last Account Sal Posting to DOD as of DOD $0.00 $2,638.01 YTD Int to DOD $0.00 6140699967 Mark E. Pletz Date Opened: 8/18/1995 Account Type: TO Principal Sal as of DOD $11,238.47 Int from Last Account Sal Posting to DOD as of 000 $0.91 $11,239.38 YTD Int to 000 $131.71 6140711797 Mark E. Pletz Date Opened: 3/31/1997 Account Type: TO PrincIpal Sal as of DOD $3,661.77 Int from Last Account Sal Posting to 000 as of 000 $4.95 $3,666.72 YTD Int to DOD $51.90 6140795650 Mark E. Pletz Date Opened: 6/07/2001 PrIncipal Sal as of DOD $24,222.52 Account Type: TO Int from Last Account Sal Posting to DOD as of DOD $38.01 $24,260.53 YTD Int to DOD $628.51 MemberslST FEDERAL CREDIT UNION INSURANCE DEPARTMENT 5000 Louise Drive P. O. Box 40 Mechanicsburg, PA 17055 1-800-283-2328 or (717) 697-1161 October 18, 2002 John S. Davidson Yost & Davidson 320 W. Chocolate Avenue PO Box 437 Hershey, PA 17033-0437 RE: Estate of Mark E. Pletz SSIN 182-40-8007 Dear Mr. Davidson, Enclosed is the information requested in your letter of September 12, 2002 regarding the accounts held with Members 1 sl by Mark Pletz. A safe deposit box was not maintained with Members ls'. We will require a death certificate to process the IRA savings account. In addition, as it appears that the named beneficiary may have predeceased Mr. Pletz, we will require a copy of her death certificate as well. Please do not hesitate to contact me at 795-5131 should you have any questions or require Q":i2 M~ Denise A. Anders Insurance Products Supervisor Enclosure MemberslST FEDERAL CREDIT UNION INSURANCE DEPARTMENT 5000 Louise Drive P. O. Box 40 Mechanicsburg, PA 17055 1-800-283-2328 or (717) 697-1161 REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Opened Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 20006 -00 12/09/1977 $99,123.29 $84.01 $99,207.30 None IRA SAVINGS ACCOUNT: Account Number/Suffix Date Account Opened Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Beneficiary 20006 -10 04/13/1983 $12,669.59 $13.00 $12,682.59 Anna Pletz ~BERS 1ST ~r~eA. n e s Insurance Products Supervisor CREDIT UNION October 18, 2002 Estate of: MARK E. PLETZ Date of Death: 0811912002 Social Security Number: 182-40-8007 . ~ III S'T' L.. { -r-, rZ "",V""U'SR:'k' "" '<~;:::;,i~.,;'~' !..-,' .\,r:;;;"\, -CP'" 1:;;1;;. QTV. DESCRIPTION 2 3 . M&eGE s _.... 6 ,1" a 9 10 II IZ 13 14 IS 16 -- :iIl. . fC (f)'L - (,.2-7-6i'fr PRICE AMOUNT , , , , , ,~ , '" " ," , "' TOTAL THANK yoa IER Estate of Mark E. Pletz 27 S. West Avenue Shiremanstown, Pennsylvania Final Report and Settlement February 21, 2003 Estate of Mark E. Pletz Income: Live Auetiou: Autiqaes (1102103) Gross CommisBlon (35%) Net Dne Consignor Household (1107103) Gross Commission (35%) Net Due Consignor Internet Sales: Gross Commission (30%) Net Due Consignor Other: Private Sale (MIseeUaneous items, mattress, two ftIe abiDets) Income to Estate EIDeIl8eS: Appraisal Services: (Six hours @ $75.00 per hour) Pack and Broom Clean Property: Total Expenses Settlement: Income: Expenses: $9,634.11 $ 700.00 Net Paid Estate: Paid in Fan Check # 1597 $1,912.00 $ 669.25 $1,242.75 $3,365.40 $1.177.89 $2,187.51 S8,(i48.36 $2.594.51 $6,053.85 $ 150.00 $9,634.11 5450.00 $250.00 $700.00 ~,934.1~ " Appraisal Report Estate of Mark Pletz 27 S West Avenue Shiremantown, Pennsylvania Prepared for: Mr. Merle Gingrich, Executor 2878 Kissel Hill Road Lititz, Pennsylvania \7543 (717) 330-2643 File #Pletz Prepared by: David J. Cordier Erica S Wineske Cordier Antiques & Fine Art 220] Market Street Camp Hill, Pennsylvania \7011 Phone: (7] 7) 731-] 740 Fax (717) 73] -9830 Member: Certified Appraisers Guild of America /1~ " Table of Contents Title Page Table of Contents Summary Analysis Conditions of Appraisal Certification Purpose of Report Method of Valuation Definition of Value Basis of Appraisal Description Appraiser Qualifications Value Listings I 2 3 4 5 5 6 6 6 6 6 7 Appendix A Page: 2 of 15 .. Summary On December 18, 2002, at the request of Mr. Merle Gingrich, I personally inspected the assets of Estate of Mark Pletz, 27 S. West Avenue, Shiremantown, Pennsylvania. Value Fair Market Value The Fair Market Value for the property in total is: $9,177.00 This is not the appraisal report. The appraisal report must be read in its entirety. Page: 30flS '. Analysis Condition All items viewed in this appraisal report were in good condition unless otherwise noted. Analysis Unless otherwise noted, diamonds were tested by the appraisers, but not graded. The jewelry in items #14 and #31 were appraised by a Certified Gemologist We consulted with Mr. David Henderson of Henderson & Co. Jewelers, Inc of Mechanics burg, Permsylvania. Mr. Henderson is a Gemologist of the Gemological Institute of American (Number 3561240). Page: 4ofl5 Conditions of Appraisal The value stated in this Appraisal Report is based on the best judgment of the appraisers given the facts and condition available at the date of the valuation. The use of this report is limited to the purpose of determining the value of personal property for estate tax purposes. Any additional research or testimony required by the client or the court will be billed at the current rates. Disclosure of the contents of the report is governed by the Standards and Practices of the Certified Appraisers Guild of America. Certification of Report Neither David J. Cordier, Erica Shea Wineske, Cordier Antiques & Fine Art nor any of its employees have any present or future interest in the subject property. No prohibitive fee was assesses for this report. David J. Cordier and Erica Shea Wineske of Cordier Antiques & Fine Art have successfully completed the personal property appraisal certification program with the Certified Appraisers Guild of America and are members in good standing. This report was prepared in accordance with the Uniform Standards of Professional Appraisal Practice and with the Standards and Practices of the Certified Appraisers Gui ld of America which has reviewed the authority of this report. David 1. Cordier and Erica S. Wineske have personally examined the subject property. The statements of fact contained in this report are true and correct to the best knowledge and belief of the appraisers. ~ \ ~~ca'. ineske,C.A.G.A. Cordier Antiques & Fine Art avi . Cordier, CAG.A. Cordier Antiques & Fine Art Page: 5 of 11 Purpose of the Report The purpose of this report is to determine the value for Estate Tax purposes for Mr. Merle Gingrich, Lititz, Pennsylvania. Method of Valuation The method of valuation used for this appraisal is the Fair Market Value. Definition of Value Fair Market Value Under the United States Treasury regulation 1.I70-lc Fair Market value is defined as: The price at which the property would change hands between a willing buyer and a willing seller, neither being under compulsion to buy or compulsion to sell and both having reasonable knowledge. Basis of Appraisal Valuation Date The date of valuation for determining the value estimation is December 18, 2002. Date Appraisal Conducted This appraisal was conducted on December 18, 2002. Limitations ofProDerty There were no limitations on use or disposition of this property. Description An itemized list with descriptions is in Appendix A. Page: 6 of 15 CORDIER ANTIQUES & FINE ART Cordier Antiques & Fine Art was established in 1984. The company specializes in appraisal of antiques, fine art and personal property, estate liquidations and the purchase and sale of fine antiques and art. Cordier Antiques & Fine Art maintains membership in the Certified Appraisers Guild of America, The Antiques and Collectibles Dealers Association, Inc., The Dauphin County Historical Society, The Cumberland County Historical Society, The Friends of Pennsylvania State Museum, The Antique Dealers Association of Pennsylvania, The Capital Region Antiques Dealers Association and the National Association of Clock and Watch Collectors. Cordier Antiques & Fine Art has conducted appraisal clinics for such organizations as The Harrisburg Area Community College's Older American Days, The Questers, Rohrer Bus Antiquing Road Show Tour, Millersburg Historical Society, Friends of Fort Hunter, West Shore Country Club and The Friends of the Pennsylvania State Museum. Cordier Antiques & Fine Art is an underwriter of The Antiques Road Show on WITF, public television. DAVID J. CORDIER. C.A.G.A. CERTIFIED APPRAISER David J. Cordier is co-owner of Cordier Antiques & Fine Art located in Camp Hill, PA. Mr. Cordier has been an antiques and jewelry dealer since 1980 and an appraiser since 1990. David Cordier has successfully completed the personal property appraiser certification program with the Certified Appraisers Guild of America. Mr. Cordier is a graduate ofWinterthur Museum's Winter Institute, a graduate level program in American Decorative Arts. David Cordier has attended classes in appraisal studies in the fine and decorative arts at George Washington University, Washington, D.C. and the appraisal studies program at New York University, New York. Mr. Cordier has studied the arts and decorative arts in Pennsylvania at Penn State University and holds a Master's degree in Business Administration from Penn State Capital Campus. Mr. Cordier write a bi-weekly feature column, "Eye on Antiques", for Harrisburg's daily paper, The Patriot News, which focuses on antiques and related events in central Pennsylvania. ERICA S. WINESKE. C.A.G.A. CERTllflED APPRAISER Erica Wineske joined Cordier Antiques and Fine Art in February of 2002. Ms. Wineske holds a Bachelor's degree in Arts Management from Lebanon Valley College where she studied art history and business management. Ms. Wineske has successfully completed the personal property certification program with the Certified Appraisers Guild of America and is currently taking classes in Appraisal Studies at New York University. Erica Wineske is a graduate oflbe Harrisburg Area Community College Auctioneer's Program and is a licensed Pennsylvania Auctioneer. Ms. Wineske has worked as a tour guide and exhibit worker at the Suzanne H. Arnold Gallery at Lebanon Valley College and has worked at Fortna's Auction Company and Gallery in Annville, PA and Boltz and Snider Auction Company in Lancaster, PA. Page: 7 of15 Appendix A Fair Market Value 4"'1 ~~ Sandy Canning 1. $5.00 Recipe Box. Lithographed tin with Pennsylvania Dutch kitchen themed decoration. Rust on base. Late 20th century. 2. 3. 4. 5. 6. 7. S. 9. $50.00 Three Mixing Bowls. (1) 4-1/2" high x S" diameter. Cream glaze overall with banded pattern in relief. Base marked "Roseville, Ohio. Microwave, Dishwasher, Oven proof 2 Qt. RP USA". (1) 3-1/2" x 5-3/4" diameter. Cream ground with blue decoration, Base marked "Pyrex by Coming". Contemporary. (1) 3-1/4" high x 5" diameter. Cream ground with pink and blue bands, Banded design in relief Base marked "USA E-I-5". $5.00 Salt and Pepper Shakers. 4" high. Etched glass base with silver plated tops. Anchor Hocking. Contemporary. Late 20th century. $7.00 Snack Serving Set, "Korea, International Stainless Lyon IS-S". Various serving pieces. Boxed. Contemporary. tf$70.00 Faberge Egg Display, 5-1/2" high display case with gilt metal base and clear glass dome. Seven Faberge eggs each measuring 1-1/4" high. Base of display case marked "Sapphire Garden, Crafted in China, House ofFaherge, Hand Painted Limited Edition, No CPIII80 c.TFM". The Franklin Mint. Late 20th century. $75.00 Hummel Figurine, "Flying High ChristbaumengeJ". Marked "First Edition Goebel W. Germany". 4" wide. In original box and packaging. c.I98S. $60.00 Faberge Russian Bouquet, 6-3/4" high. Brass urn shaped vase with purple, red, green and white wire stemmed flowers. Base marked "The Imperial Russian Bouquet, Carl Faberge, FM 78". Crafted by the Franklin Mint. c.l97S. W $15.00 Ladie's Watch. 5/S" x 1/2" rectangular face, Dial marked "Hamilton". Back of case stamped "I4K Gold Filled" and engraved "Ann from Dean 12/25/42". Slender rope band with gold filled clasp. c.1942. $5.00 Ladie's Fashion Ring. 14 karat gold electro plate band with emerald cut lab-created blue stone with three round clear synthetic stones on either side. Band marked with original paper tag. Contemporary. Page: S of 15 . 10. $300 Costume Bracelet, 7" length. Silver-toned metal setting with rows of round black and clear rhinestones. Unmarked. Vintage. 11. $2.00 Ladie'sCostume Bracelet, 7-I/2"length, Three strands of polished plastic beads with filigree silver-toned metal clasp. Vintage. 12. $2.00 Ladie's Bracelet, 6-1/2" length, Silvertoned metal link bracelet with three clear glass beads. Unmarked, Vintage. 13. $1.00 Pin, 3-1/2" x 1-1/4". Three gold-toned metal bars flanked by two oval black and gold polished stones. Arts and crafts style. c.1960-l970. 14. $1.300,00 Ladie'sDiamond Fashion Ring, 18 karat white gold setting. Twenty-three round diamonds are prong set into ring, the center of the ring has five diamonds of graduated sizes. Center Diamonds: Five round faceted natural diamonds as follows: (1).40 carat, (2) .16 carat, (2) .08 carat-Clarity: VS, Color: H-I. Side Diamonds: Eighteen single cut round diamonds, .015 carat each (.27 carat total weight). Clarity: SI I to VS 2, Color H-I. $1.600.00 Tota] : Sandy Canning ^" ( Cheryl Gingerich 15. $8.00 Hanging Salt and Pepper Shakers. Stand: 4-1/2" high, Silver plated, Grape motif. Shakers: 3" high, Glass in the form of grapes with silver plated tops. Contemporary. 16. $12.00 Soup Pot, Base: 4-1/4" high x 10-114" diameter. White enamel ground with blue countryside scene decoration. Matching Baking Dish, 1-1/2" high x 14" x 8-112". Contemporary. 17. J~ ($10.00 Two SmallBaking Dishes, 8" x 4" oval, "Pfaltzgraff, 8 oz Au Gratin, 8". Tan with brown decoration. Other miscellaneous baking dishes. ] 8. $35.00 Cake Plate, ] 0" diameter. Pink depression glass with central floral design and scroll pattern overall. Pattern not identified. c.1930's. ]9. $40.00 Square Bow] with Underp]ate. Plate: 9-1/4" square. Bowl: 3" high x 7-3/4" square. Clear glass with block pattern on base and diamond pattern on sides with ribbed rim. Mid 20th century. 20. $145.00 G]asses, Clear Fostoria glass with etched floral pattern. (6) 5- ]/2" high cordials, (8) 6" high Sherbets, (8) 8" high goblets. 21. $120.00 Plates, Set of(9). 7-3/8" diameter. Clear Fostoria glass, Etched Navarre pattern. Page: 9 of 15 . 22. $85.00 Cake Plate, 11" diameter. Matching bon-bon: 3"high. Fostoria Baroque pattern decorated with etched Navarre pattern. 23. $4000 Dip Set, Fostoria clear glass with etched Navarre pattern. 3" high x 5-1/4" diameter with glass spoon. 24. $25.00 Milk Pitcher, 4-1/2" high. White porcelain body in the form ofa moose head. Paint decorated. Base marked "Austria". 25. $150.00 Hummel Figurine, "Happiness". 5" high. Base marked "8662 Western Germany". c.1960-1972. 26. $250.00 Hummel Figurine, "For Father". 6" high. Base marked "8776 Germany". c.1960-1972. 27. $1000 Figurine, 5-1/4" high. Man playing string bass, Ceramic body with painted decoration. Base marked "4450, 1952". c.1952. 28. $15.00 Print on Board, "Rue Saint Rustique". Image: 9" x 6-3/4", Overall: 12" x 10'" Titled in pencil in lower right. Framed. 29. $40.00 Relish Dish, 2-1/4" high x 6" x 4" oval. Scalloped edge design with multi-point star pattern at base. Heisey, Marked with "H" in diamond. 30. $15.00 Ladie's Watch. 1/2" square dial marked "Bulova", (Serial #1223365). J 2 karat gold-filled band is marked"] 2 KT GF". Stretch band accented with leaf design and two pink mother of pearl natural cut stones. 31. $2.800.00 Engagement Ring, .9] carat diamond center stone. Stone is loose from setting, ]4 karat white gold, six prong setting. Clarity: SI 1, Color: I. $3.800.00 Total: Cheryl Gingerich ..,..c ..,t ~ Gary and Layne Miller 32. $]7500 Music Cabinet, 38" high at back x 19-112" wide x ]2" deep. Shaped back splat with applied carving, Single drawer opens to reveal five shelves. Slender cabriole front legs. American. Oak, Refinished. c.] 900-] 920. 33. $20.00 Plant Stand, 20-112" high, 14-114" x 12-112" shaped top. Turned pedestal base with three splayed legs. Top decorated with gold and black geometric pattern at edge. c.1940's. 34. $3000 Tea Infuser, 3-114" high. White porcelain ground with pink floral groupings. Infuser rests in fitted bowl. Base marked in blue "Kaiser W Germany". German. Early 20th century Page: 10 of15 . 35. $10.00 George Foreman Grill. Small size. In original box. c.1995. 36. $5.00 Baby Shoe, Leather with cut out design. 37. $475.00 Drysink, 36-1/2" high x 44-1/2" wide x 20" deep. Two drawers over two decorative paneled doors. Replaced white porcelain drawer and door pulls. Dove tailed construction. Poplar, refinished. 19th century. 38. $125.00 Set Golf Clubs, 23 clubs in gold vinyl bag. Various clubs, condition and age. Contemporary. 39. $30.00 Putter, Proselect Acculite, Titanium. Contemporary. 40. $20.00 Chess board and pieces, Wood board with green felt backing. Contemporary. 41. $10.00 Sewing items. Boxes of supplies with various contents. Contemporary. 42. $10.00 Craft items. Boxes of supplies with various contents. Contemporary. 43. $40.00 Ladie's Wedding Set. Yellow gold band with white gold accents. Matching engagement ring setting (missing stone). Both marked "14K-18K". Interior band of engagement ring engraved with couple's names. c. 1940's. 44. $100.00 Turquoise Jewelry Set. Each piece set in sterling silver with oval cut and polished turquoise stones and engraved sun ray design in setting. (I) Cuff bracelet with one stone, (I) Cuff bracelet with three stones, (I) Ring with one stone, (I) Pendant with one stone and matching 15" sterling silver chain. 20th century. 45. $25.00 Turquoise Stick Pins, Two. (I) Large turquoise stone, Set in sterling silver with floral design accenting setting. (1) Small turquoise stone with etched line design accenting setting. 20th century. 46. $10.00 Pair of Turquoise Earrings. Each earring with single oval gold-veined, polished turquoise stone, Set in sterling silver with rope design around perimeter. Clip-on closure. 20th century. 47. $ I 0.00 Necklace, 15" length. Sterling silver cylindrical bead chain accented with polished turquoise stones and heishe beads. 20th century. 48. $10.00 Necklace, 15" length. Sterling silver with three groupings of three round sterling silver beads. 20th century. $ I.1 05.00 Total: Gary and Layne Miller Page: II of 15 "'....--- f 1t~1 .1 \/t'-If . Ida Maxwell 49. $35.00 Bon Bon Dish, 6-3/4" diameter, 1-112" high. Basket weave pattern with open lattice design at rim. Green depression glass. Pattern not identified. c.1930's. 50. ~1.. .~-11'1, r ~(/ ~ $45.00 Silverware Service. "Oneida Deluxe Stainless". (12) Dinner Knives, (12) Soup Spoons, (24) Place Spoons, (6) Tea Spoons, (12) Dinner Forks, (12) Salad Forks, (2) Serving Spoons. Contemporary. 51. $375.00 Dinner Service, "Noritake, Savannah, Japan, 2031 ". Savannah pattern by Noritake. Service for twelve, including: Dinner plates, Cups and saucers, Bread plates, Salad plates, Fruit nappies, (2) Oval platters, Gravy with underplate, (3) Oval serving bowls, Creamer and Sugar. Contemporary. 52. $15.00 Paperweight, 2-1/4" high. Egg shaped, clear glass with multi-colored swirl inclusions. Late 20th century. 53. $65.00 Hatpin Holder, 3-3/4" high. White porcelain with purple and green flowers and gilt accents. Nippon style. Minor wear to gilt decoration. c.1890-1910. 54. $95.00 Hatpins, (8) pieces. Various designs with beads and rhinestones, Gold filled filigree. Late 19th to early 20th century. 55. $35.00 Chair, 33" high at back. Wing back arm chair, upholstered in green damask quilted floral upholstery. c.I960's-1970's. 56. $120.00 Wash Set, including: pitcher, bowl and covered chamber pot. White ground with charcoal floral transferware pattern, design in relief c.1890-1910. 57. $50.00 Card table and four padded folding chairs. Contemporary. Late 20th century . $835.00 Total: Ida Maxwell Jean Faul 58. $45.00 Chair, 32-112" high at back, 16" x 16-1/2" caned seat. Shaped crest with five turned spindles, Turned legs and turned supports. Walnut, refinished. Victorian. c.1890- I 900. 59. $40.00 Lamp, 13" high. Clear pressed glass base and shade with metal harp. Geometric and etched floral design overall. c.1920-1940. 60. $15.00 Print, 4" x 5-1I2"image, 9" x 12" overall. Hand colored print of street scene. Titled and signed in pencil, possibly "Rothinburg", signature Page: 120fl5 . indecipherable. Framed in 1/2" wide wood frame. 20th century. 61. $15.00 Carousel, 10-1/2" high. "Waco Melody in Motion, Hand painted porcelain, Bisque finish". Musical. Original box. c.1990's. 62. $200.00 Diamond Earrings and Necklace Set. 14 karat white gold setting. Necklace: .33 carat round diamond stone in four prong white gold setting, 15" white gold chain. Earrings: .13 carat round diamonds in each earring in a four prong white gold setting. Diamonds were tested and not graded. 63. $125.00 Ladie's Ring. 14 Karat yellow gold setting (marked 14K BH on interior of band). Center oval-cut pale ruby colored stone with twelve .025 carat round diamonds around perimeter (approximately .30 carat total diamond weight). Gemstones were not graded. 64. $30.00 Ladie's Class Ring. 10 karat gold ring with school crest and" 1939" engraved on band. Band marked "10K". Gold not tested. c. ]939. 65. $] 10.00 Pair of Earrings. Each with two marquise ruby-colored stones accented with three approximately .02 carat round diamonds each (approximately .]2 total diamond weight). Set in 14 karat yellow gold setting. Each marked "14K". Diamonds were tested and not graded. 66. $]0.00 Ladie's Fashion Ring. Gold colored metal band and setting with .33 carat round synthetic clear gemstone in four prong setting. Band not marked. Stone tested. Contemporary. 67. $10.00 Pair of Earrings and Ring, Ladie's Fashion Set. Gold toned metal setting and marquise cut synthetic clear gemstones. Contemporary. 68. $15.00 Ladie's Jewelry Set. Three tone braided herringbone design in white, yellow and rose-toned metal. Includes 22" length necklace, 6-1/2" bracelet, and earrings. Contemporary. Unmarked. 69. $10.00 Ladie's Necklace and Earrings Set. Silver toned metal chain and setting. Necklace with clear crystal heart pendant in round silver hoop setting with etched heart design in center. Clasp of necklace marked "Hallmark Cards". Earrings are clear crystal in heart shape. Contemporary. 70. $]5.00 Costume Jewelry Brooch and Earrings. Strawberry shaped pieces crafted of silver-toned metal setting and accented with red and green rhinestones. Earrings have clip-on closure. Brooch marked "Pell". Vintage. 71. $5.00 Ladie's Slide Chains, Two. Each measures 28" when fully extended, Crafted of gold plated herringbone link and two slide mechanisms per Page: 13 of] 5 . chain. Contemporary. $645.00 Total: Jean Faul Annabel Watson 72. $45.00 Figurine, "Daschund". 9-1/2" high x 12" wide. Ceramic body, painted. Base marked "H6774". Mid 20th century. 73. $30.00 Floor Lamp, 56" high. Brass pole base with milk glass shade, Handpainted with leaf decoration. Contemporary reproduction. 74. $55.00 Pair of Side Chairs, 32-1/2" high at back. Wood frame with carving at crest, Caned sides. Upholstered in orange upholstery on padded backrest, seat and arm rests. c.1960's-1970's. 75. $45.00 Pair of Chairs, 32" high, 15" x 15-114" plank seat. Stained wood frame with hand painted floral decoration at crest, backsplat and seat. Contemporary reproduction of Pennsylvania Dutch design. 76. $10.00 Motorcycle Model, "1942 Indian 442". 1/IOthscaledie-cast. c.1990's. 77. $90.00 Reverse Glass Painting, "Rockville Bridge". 11-1/2" x 29-112" image, Framed in 1-1/2" oak frame. c.I920's-1940's. 78. $25.00 Storage Cabinet, 34" high at back. One drawer over two doors. Hand crafted, Plywood with Formica accents. Contemporary. $300.00 Total: Annabel Watson Katherine Faltin 79. $375.00 Marble Top Table, 27" high, 17" x 24" oval white marble top. Pedestal base with four splayed legs. Minor chips and stains on marble top. Walnut base. American. Victorian. c. I 870-1890. 80. $185.00 Lamp, 20" high. Pierced metal base with white milk glass pedestal and shade. Hand painted pansy decoration at front. Electric. c.1900-1920's. $560.00 Total: Katherine Faltin Kathy Faltin 81. $40.00 Horse and cowboy. 9" high horse. Plastic. Saddle unattached. White cowboy figure. c.I960's. 82. $40.00 Horse and cowboy. 8-1/2" high horse. Includes cowboy hat and gun. c.1960's. 83. $60.00 Lone Ranger and Silver figures. 8" high horse with saddle, Lone Ranger Page: 140fJ5 )"r f 'J.I.~ . figure with cowboy hat and two guns. c.1960's 84. $60.00 T onto and Scout figures. Indian and horse, horse 8" high. Includes feathers, saddle, knife. c.1960's 85. $12.00 Indian and Horse Figure. 3-1/2" high indian on black horse with bow and arrow, bow broken. 86. $20.00 Picnic basket. Bent wood with two handles. Minor damage. Early 20th century. $232.00 Total: Kathy Faltin Jim Canning 87. $75.00 Set of Taylor-Made Golf Clubs in bag. 14 clubs, various age and condition. Contemporary. Merle Gingerich 88. $25.00 Golf Club, Great Big Bertha, Titanium club by Calaway. Contemporary. $9177 00 Total Page: 15 of 15 CJ~K PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION. ST A TUS REPORT UNDER RULE 6.12 Name of Decedent: Mark E. Pletz Date of Death August 19.2002 Will No.: Admin. No.: 2002-00812 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the above-mentioned estate: 1. State whether administration ofthe estate is complete: Yes x No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is yes, state the following: A. Did the personal representative file a final account with the court? Yes No X 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 X No D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: (1J/~)/1 ift;!rft1# /b.--.- ',....- John S. Davidson. Esquire Name (Please type or print) 320 West Chocolate Avenue, P.O. Box437. Hershey.PA 17033-0437 Address (MAH:nnt/ AM3) (717) 533-5101 Telephone No. Capacity: Personal Representative X Counsel for Personal Representative R.W. -27 , //}-;;?-?-3 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX -, DATE ESTATE OF DA TE OF DEATH FILE NUMBER A 7 :5 9 COUNTY ACN 06-30-2003 PLETZ 08-19-2002 21 02-0812 CUMBERLAND 101 AlIOUI\t Rellitted JOHN S DAVIDSON YOST S DAVIDSON PO BOX 437 HERSHEY ESQ '03 JUN 30 '* REV-1547 EX AFP 101-031 MARK E G.~;t;, PA 17(()3mbellh'\O 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:is4'~rEx-AFi)-(Ol':o3T-NoTicE-oF-YtiHEififAiicE-TAx-APPRA-isEMENi'~--AiLOWANCE-OR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF PLETZ MARK E FILE NO. 21 02-0812 ACN 101 DATE 06-30-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED I~ an assessment was issued previously, lines 14, lS and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ~ returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. A_ount of Line 14 at Sibling rate (17) 18. A_ount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due D T . 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 Receiveble (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets ll) (2) (3) (4) (5) (6) (7) 126.900.00 185.558.05 .00 .00 259.615.94 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/AdD. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governnental Bequests; Non-elected 9113 Trusts 14. Net Value of Estate Subject to Tax (9) 1l0) 54,613.76 1.579.70 Ill) 1l2) (13) 1l4) (Schedule oJ) NOTE: .00 X .00 X .00 X 515,880.53 X + INTEREST/PEN PAID (-) 2,631.58 .00 AMOUNT PAID 50,000.00 24.750.50 DATE 11-15-2002 05-15-2003 NUMBER CDOo1855 CD002567 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax paYlIBnt. 572,073.99 56.193.46 515,880.53 .00 515,880.53 00 = 045 = 12 = 15 = .00 .00 .00 77,382.08 77,382.08 (19)= 77,382.08 .00 .00 .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERS!" STnJO n~ TU...... "..ft" --- -.------~-