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02-0575
Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Edith Lavina Burd also known as Edith Anita Boake No.Z'~D~~~~~ Deceased Social Security No. 170 -12 -113 7 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) ~X A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut r i:x the Decedent, dated 07/21/99 and codicil(s) dated None _ None State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: None B. Grant of Letters of Administration (c.t.a.; d.b.n.c.t.a; pendente life; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: or principal residence at 375 Wesley Drive, Mechanicsbur, (list street, number, and municipality) Decedent, then 83 years of age, died 051 G4/02 at Bethany Village Health Care Center, PA (Location} Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in Pennsylvania {If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania situated as follows: None $ 86,000.00 S 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 aaaropriate form to the undersigned: ~ Signatur4 Typed or printed name and residence J Edith Anita Boake ~~~ .L l lrlC~ 471 East Rock Road, Allentown, PA named in the last Will of Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. I ~ _ ~ O ~ ~ Form RW-~ (1991) (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her last family Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed /~ ~_ Edith Anita Boake; i before me this 19tklay of JUNE 2002 ~' ! ~ ~ ,C 4.' ~ c ;%L~ f ~ For th Ragister f'~~~e cC~`O No. _ 2 ~ - o z- 5`7 s Estate of Edith Lavina Burd Deceased Social Security No: 170 -12 -113 7 Date of Death: 05/04/02 -~= AND NOW, ~ JUNE 19 , 2002 , in consideration ~`; of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~X Testamentary ~ Of Administration a (c.t.a.; d.b.n.c.t.a.; pendente liter durante abse7itia; durante minoritate) are hereby granted to Edith Anita Boake --~ in the above estate and that the instrument(s) dated 07/21/99 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters . $ x00.00 Short Certificate(s).. $ 18.00 Renunciation. $ Affidavits ( ) $ Extra Pages ( ) . $ 9.00 Codicil. $ Attorney: Bruce J. Warshawsky I.D. No: 58799 Bernstein &Warshawsky Address: 1820 LinQlestotan Road Harrisbur>;, PA 17110 JCP Fee . $ s _ nn Telephone: 717/232 - 8500 Inventory. $ filed 6-19-2002 mailed to atty 6-19-2002 Other $ TOTAL......... g 232.00 Prepared by the Pennsylvania Bar Association Copyright (c) 7996 form software only CPSystems, Inc. Form RW-1(t9st) Chic 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. Fee for this certificate, $2.00 ~ ~ ocal Registrar P 8237491 No. ~,~A~ ~ hilt?? Date nos w Rey. zreT COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH $TNE FlLE NUMBER T NAME OF OECEDENTIFnsl. Mitldb Loa) SE% SOCIAL SECURITY NUMBEii DATE OF OEATHiMCmh.Oay, barl I- Edith L. Burd ,.Female ,. 170- 12 - 1137 .. May 4, 2002 ADEILasl Bymtlayl VNDERIYEAR UNDERIDAY GATE OF BIRTH v e so"I^ Ua " BIiiTHPUCE~C~ry antl F i PLACE OF DEATH ICne cw nJy nr`a-,ee malruceanmott'er steel MomM r Daya Haun s MMUIea y e rl ~ lelea ?egn t;q~nuvl HOSPITAL' OTHER: 8 3 Y'' 2 8 11 18 C A P t b pMiarll ^ ERJOIApM"' ^ °°" ^ H ,°ae1QXg n ^ °;'; ^ s - - ,. , e e r s u r ~ N ,,, .ardenc. ;$ w, CWNTV OF DEATH CITY, BOFiO.TWP OF DEATH FACK.fTY NAMEIII na mM~NUOn give sweet and numeer~ VM $ D ECEDENT OF HISPANIC ORIGINT RACE-AmarlcanlMlan. Black WMe. Me s / ~ , . ($PegFy) Center NMI. ,., ^ d y4 apecay clc.n 2 / . k4KimI.PrMnoRiun.«e. b, Cumberland k Mechanicsburg ~Betheny Village Healthcare i ' , „-Wh te DECEDENT'S USUAL OCCUPRgN KIND OF BUSINESSIINDUSTRV WAS DECEDENT EVER IN DECEDENT'SEWCATION MAPRAL STATUS-MartiM SURVIVING SPOUSE (Cava kyyawork done OUrrg mml U $ ARMED FORCES? . . ~ atla Can Neyer MardW, YSRdOwW, Itt Me. avs malpen name) d wakksO xN; dp npl uee reTxetl l Ma ^ No ® ENmem ;Sacorba Valley View Ho ,,. RN `Z~ n ('~ ' ow Ml ,,,• . , • a.Wid ed „ DECEDENT'S MAILING ADDREBB (SrrM,Cirylf n. Slaro. Zip COW1 DECEDENT'S AcyuAL n.. sure Pennsylvania Did ne.^rr,ac.a.nlweeln I,•P 375 Wesley Urive PESIDENCE aep.d.rll ISM inpruclms ,~ Mechanicsburg, PA 17055 n~ me,,,dm ~I„PT No.aecadweEysd ~ ,mh ~ and ,Ta „n cppnl dmk ® Mechanicsbur . Y . ra+MrllmK.Id y pttyyeo,p. FRHER'S NAME IFxN. Mitlde. Lasl) MOTHER'S NAME rfxal. Middle. Mmtlen SanameJ +E. W dren Corcelius ,,, Adah Weber INFORMANT S NAME (TypdPlKxl WfORMANT'S IMILIND ADDRESS ISheM. CttyRawn, Saks. tip Codel Plla. ~; ~ h Anita Boake :ob.471 E. - METMOp OF d$POSITgN rr,, ramarpn Id R l N $ ^ GATE OF DISPOSITION IMmin. DaY. Yearl PLAGE OF DISPOSITION-Nama of Cemalery, Crsmalay or DIMr Place LOCATK)t1~CilyRpwn, Slaty, Zp 000e srnova ~ om INa ~~~^ ~~ ($OaCa~ ' -- a ' , y ,,,, 5-6-02 P1e Forsht Crematory P,dAltoona, PA 16601 sgN/RURCOFF RALSERVN:EI N$EE PERSONACTINOA$$l1CN LICENSE NUMBER NAME AND ADDRESS OFFACRITV Altoona ppA 6602 - ,,,,011540-L PPFAaniel fi. M ers Funeral Home,~01 6th Ave Ie A PLC oMy wMn cerrlayxlq plryecw s ner avaxMNS ar nms al Mnrh Io cwhl ttarM.ad.,m To IM Mal a my wnowrorJge. death occur d a1 ma lime. ears and psce Haled LICENSE NUMBER n, R l DACE SgNED D.y.~.d I y . fi 1 h 5.2~ Z aaA.. Ct, LN,.¢fyY~, Ra, 3srJ ~ 14 t_ m 4, ?.oOZ tb Hens 34401swNMCwnpantl oY PMeprl wM Prenarnoea d.alh TIME OF DEAT 3• I : , O ~ , Y, M. . DATE PRONOUNCL~ED DEAD^IM'O^nm. Oay vearl ~ WAS CASE REFERRED TO MEDICAL E%AMINER/CORglEPT 'r s" ^7 m 7 , 1-`~+V Z j1 i i YM Q PS P. __ . PT. MPT 1: EnrarrM dseases. injuries or rnmplKarmns wn~rn causa.f lne deaen fk~rr~I xnler ma n~r.fw i~I Cynq, such ac':ard~ac nr ~nsp~r;uury nr~nsr, sna:k or Mean lelluie iApproaunNe Llas orllYOM Cause on eecn line I PART II: dMra IkW eorldikweaer lo na ~ nrervalMM1esn , Onaal arq MaM IYMEpATE CAUSE IFne1 nd ttlnO in Me undenyinE cesJae Oiyn PART 1. l QMeY d CarrOlyan VV~~~ ~' ~I ~ 'aarl•rq ndealhl-. a ar c. u K. _ D T R ~ Uo.- Nod_-~ti L .-. tio~ ~ - r UE OIO A$ A CO SEQUENCE OFl'. J Saerrnluay Yl carsd0iorn e. M~,l I't`N C.~s,f{ ,AWM (~l1GLi1t I Y asq' IeadMlgMmmMis%e DUE TO pI A$ACC ~~ ~n at~u.-! ~riL`.~ , tlsla0 EMN IINDlRLYNq MSF.OUENf.F OF)' I I CUBE Idwra yeury drat yykalld eswes ~ c - _ _ DUE TO (OR AS A CON$E EN ~ reSAyp m dssml LAST OU CE OF). I a _ _______________________ NakS AN AUTOPSY PERFORMEDT WERE AUTOPSY FINDINGS AWIUBLE PRKN1 TO MANNER OF OEATN GATE OFINJURY TIME OF INJURY INJURY AT WORKT DESCRIBE HOWINJURy OCCURRED. COMPLETpN OF CAUSE (Maim. Uay. Yearl OF DEATHT ^ Nslural l~ Nomcbe f U Va ^ ~ ^ AcCMenl ParMirg lnvealigalion U yM ^ Na~ Ws ^ No ^ _ $UKlde ^ CoWd nosMdero.minad ^ JOb. M. 70e. PLACE OF INJURY-Al npma. roan, weal.rodary,omce LOCATION (ShaeLC~ .$slal Na. 300. 19. auilrlinq, etc. ISpacnvl ]Oe. ]Ot CERCIFIERICnKknMy orsl 'CERTNYMO PNYSIGAN(Physcan ceraysng causeW deem wnerarolner phvsK~an nos ao~ouMSq dealn ono com leled r ZS . SIGN URE AND TITLE OF CERTIFIER c em l ^ tlM MN o1 m1 knowksd0a, death occurred dw se eM causNaj end manner n a,alM ......... ........................................... ~^~ 710. 'PRONOUNCIND AND CERTIFYING PNYSICIANIPn sckan Mm ~ravwrc~n To Ma Leer olmykrsow4d0e, death oecwrlsd el lh~rlma,dale. and place and e~. tlio lh~[a~aelfleMmennerasaseNd. ~ ......................... LICE NV R DATE SKiNED (M ,Day, vearl 71. ~O~~I~bL Z~z _ P,a. NAME AND ADDRESS fIF PERSON WHO COMPLETED CAUSED DEAT 'MEDICAL E%AMINER/CORONER Il O M i 1 (Ile?LZ?) Type a Pslnt ,.-_ n se a a 0 e%emina,lpn and/or inveailSalipn, in my opinion, death occurred al the Ilme, date, and lace, and due,a the csuae • and ~ manner as aided... P 11 ......... .. .. ~ t~P~ A,~ ... a,.. - -- --'--- ~ t}, l P 70~ aP' a4~ L S ~ _ _____ IICOI$TRAR$SI(xeIATVRE ANU NUMBE l1 '--- - ~j ~r ^, - - U-~--I~I DATE FILEDIMonm Day. rear ,~ f' a i- c~a -s~-~s LAST WILL AND TESTAMENT of EDITH LAVINA BURD a resident of 907 Hickory Street, Hollidaysburg, Pennsylvania 16648 I, EDITH LAVINA BURD, declare this to be my Last Will and Testament and hereby R revoke all prior wills and codicils heretofore made by me. FIRST: I direct that all of my just debts and funeral expenses be paid as soon as practicable after my decease. SECOND: I direct that my Executor hereinafter named see that my remains be interred in the Gettysburg National Military Cemetery, Gettysburg, Pennsylvania, in the Plot Section 2, Grave No. 1193 with my late beloved husband, Elvie Robert Burd, U.S.N., retired, buried October 18, 1966. THIRD: Any person who shall die at the same time as I or in a common disaster with me or under such circumstances that it is impossible or difficult to determine which died first shall be deemed to have predeceased me. FOURTH: I give, devise and bequeath unto WALDREN WEBER CORCELIUS, my brother, the sum of Eight Hundred ($800.00) Dollars. In the event that he should predecease me, I give and bequeath his share, the sum of Eight Hundred ($800.00) Dollars to his daughter, my niece, DEANNA LYNN CORCELIUS PALLADINI. FIFTH: I give, devise and bequeath unto D. JEAN BOAKE, my sister, the sum of Eight Hundred ($800.00) Dollars. In the event that she should predecease me, I give and bequeath her share, the sum of Eight Hundred ($800.00) Dollars to her children, my nieces and nephews, FELIX JOHN BOAKE, III, GREGORY WALDREN BOAKE, and EDITH ANITA BOAKE. SIXTH: I give, devise and bequeath the sum of Five Hundred ($500.00) Dollars to r ~ each, namely: D. JEAN BOAKE, my sister; to FELIX JOHN BOAKE, III, my nephew; to GREGORY WALDREN BOAKE, my nephew; to EDITH ANITA BOAKE, my niece; and to DEANNA LYNN CORCELIUS PALLADINI, my niece. SEVENTH: I give and bequeath my gold diamond engagement ring with sets, gold wedding band with diamond sets, and platinum diamond ring to ALDENA M. BISHOP, 223 Bishop Hill Road, Chimacum, Washington, if she survives me. In the event she does not survive me, the three rings as named above are bequeathed to LINDA BISHOP LOPEMAN, 51 Bishop Hill Road, Chimacum, Washington. EIGHTH: I give and bequeath my gold birthstone ring with opal set and filigree work around the stone to my niece, EDITH ANITA BOAKE. }~ NINTH: I give and bequeath my gold ring with jade setting from the Panama Canal Zone to my sister, D. JEAN BOAKE. ~ TENTH: I give and bequeath the remaining personal~ewelryto myfnend, MELISSA LOPEMAN, of Chimacum, Washington, if she survives me. In the event she does not survive me, the remaining personal jewelry is bequeathed to her sister, JAMI DELAINE ' LOPEMAN, of Chimacum, Washington. ELEVENTH: I give and bequeath (a) the antique china cupboard originally from "617" (my parents' home), (b) two 17" x 15" St. Augustine prints in gold frames, and (c) the natural wood bookcase with 3 shelves and the natural wood bookcase with 2 shelves, all to my niece, DEANNA LYNN CORCELIUS PALLADINI. TWELFTH: I give and bequeath (a) the 23" x 38" winter scene oil painting on canvas painted by Elvie R. Burd, (b) the five drawer oak chest of drawers 29" x 48" (from "617"), (c) the original mahogany occasional table with rolled legs„ 21" x 29", and (d) the small child's chair in natural wood tone, all to my sister, D. JEAN BOAKE. THIRTEENTH: I give and bequeath (a) the 21" x 11" picture of the tall ships at Bermuda Anchor, and (b) five 7" x 8" framed pictures of Port Townsend, Washington, including Starrett House, Hastings Building, Clapp Building, Bell Tower and Abandoned Lookout, all to LINDA BISHOP LOPEMAN. FOURTEENTH: I give and bequeath (a) the five piece antique china wash stand with Harvard Stamp, including chamber lid, medium pitcher, wash cloth holder, small ~ ~, pitcher and soap dish with lid (summerflower design), (b) the 7"high ceramic pitcher, hand painted by me and signed on the bottom "ELB 1969",with green leaves and wheat sprays, (c) one cloisonne vase from Japan, given to me by my husband in 1946, and (d) my blue and white Delft platter, all to my niece, EDITH ANITA BOAKE. FIFTEENTH: I give and bequeath two 7" x 9" black and white oil canvas paintings from Paris, France of boats on harbor to ELIZABETH HAWES of 500 Marine Drive, Sequim, Washington. SIXTEENTH: I give and bequeath (a) one charcoal drawing of the moon through • evergreens with snow on ground and one charcoal drawing of the moon shining over a house and shining on the water, both done by Elvie R. Burd, and (b) one framed wall `~ picture entitled "Tall Ships" by Kipp Soldwedel, all to my nephew, GREGORY WALDREN I~' BOAKE . SEVENTEENTH: I give and bequeath (a) one charcoal drawing of a clock tower among tall trees done by Elvie R. Burd, (b) four ceramic wall plates of whaling ships operating in New England waters, and (c) one 21" x 26" canvas oil painting of a winter scene of snow on ridges with water running done by Elvie R. Burd, all to my nephew, FELIX JOHN BOAKE, III. EIGHTEENTH: All the rest, residue and remainder of my estate, being the same real, personal or mixed of whatever nature and kind, I give, devise and bequeath in equal shares to my nieces and nephews as follows: FELIX JOHN BOAKE, III, GREGORY WALDREN BOAKE, EDITH ANITA BOAKE and DEANNA LYNN CORCELIUS PALLADINI. NINETEENTH: I appoint EDITH ANITA BOAKE of 1050 Bolton Court, Bensalem, Pennsylvania as Executrix of this my Last Will and Testament. TWENTI ETH: I expressly direct that my Executrix shall not be required to enter bond or other security in any jurisdiction in which called upon to actin any fiduciary capacity, or if bond be required, there shall be no surety required on said bond. TWENTY-FIRST: I give said Executrix the fullest power and authority in all matters and questions to do all acts which I might or could do if living, including, without limitation, complete power and authority to sell (at public or private sale, for cash or credit, with or without security), mortgage, lease and dispose of and distribute in kind, all property, real -. I~ . ~ and personal, at such times and upon such terms and conditions as it may determine, all without court order. IN WITNESS WHEREOF, I sign, seal, publish and declare this as my Last Will and Testament in the presence of the persons witnessing it at my request this ~~' day of July, 1999. ~u~i ~. Y.vz.~• ~.c.~,E. (sEAL) Edith Lavina Burd The foregoing instrument, consisting of four typewritten pages, this page included, the preceding three pages thereof bearing on the left-hand margin the signature of the Testatrix, was at said date declared by said Testatrix as her Last Will and Testament in our presence, and we, at her request, in her presence, and in the presence of each other, subscribe our names as witnesses, all of us, including the Testatrix, being present together throughout the execution and attestation of the Will. ~~L~„ residing at~/fyon~ _ f A (~~,,,-,,~,l~.c~. C . ~Q.L~r-~u~ residing at :uh REGISTER OF WILLS OF COUNTY 1~~-TH [lESUBSCRIBING WITNESS codicil (each) a subscribing witness to the will epose s that the testat ,sign the same and t request o t in t~ presence other subscribing ess(es)). Sworn to or affirmed and sub 'bed before me this of 19 (each) being duly qualified presence of each to present and 3~c signed as a witness at the ,~ (in the presence of the (Address) (Name) (Address) REGISTER OF WILLS OF C~'1'1 ~ la~ .COUNTY OATH OF NON-SUBSCRIBING WITNESS 21-oz.- 5~ (each) alsubscriber hereto, (each) being duly qualified according to law, depose(s) and says that 1/ y~ 1 S familiar with the signature of ~ ~~ ~~j'~ a~/~ , codicil testat '~I ~ of (one of the subscribing witnesses to) the will presented herewith and codicil that ~ ~ believes the signature on the will is in the handwriting of Cod 1'~ La~~~~ u B ~ ~ to the best of ~ S ltnowledge and belief. Sworn to or affirmed and subscribed before me this ~ 8~ day of JUNE 2002 19 ~._._~ ~~/' l ~i~.~ ~ Register ~- ~l~~ ~D~tr~ ~yak2 ~ 5 ~ /Nmnel . S~l-~e P ~~03 (Address) REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS (each) a subscribing witness to the will ~ e ose(s) and say(s) that the tes , sig a same and that request of test in h= other subscribing wit s(es)). Sworn to or affirmed and sub presence and (in the before day of r-. Register signed as a fitness at the each other) (in the pre nce of the (Address) (Address) `© REGIS~'LR OF WILLS OF M ~~~'~ _ COUNTY OATH OF NON-SUBSCRIBING WITNESS 21-0.-515 D~ ~ ealn $paK2- (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that familiar with the signature of Ea(i~1ti7 Lg//~.,ct Bv,~ , codicil testat r ~ ~ of (one of the subscribing witnesses to) the wil presented herewith and ~:odicil that S ~ 2 believes the signature on the will is in the handwriting of .1• ~a4 . ~~ to the best of ~e ~ knowledge and belief. ~ ~tt~/ ~~~ Sworn to or affirmed and subscribed before V " ~ ~ :~P~G'CL~1. ~`~~ ~ ~~e- 19! TH me this ( day of /{~ame) JUBE 2002 19 ~~~ ~y,~V%?.c~' ~/', ~r'C~r"CS~ai/itli !~ ~ (Address) P~ ~ 7 OS S Y S Register (Name) herewith, (each) being duay qualified according to present and saw (Address) CERTIFICATION OF NOTICE UNDER RULE 5.6(al -35 tr; i ~! Name of Decedent: EDITH LAVINA BURD Date of Death: Mav 4, 2002 Will No To the Register: Admin.No. 2002 - OOS75 I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above- captioned estate on July. 2002 Name Address Edith A. Boake 471 E. Rock Road Allentown. PA 18103 Waldren Weber Corcelius Old Rt 220 Blair Christian Home Duncanville PA 17025 D Jean Boake 922 Allenview Drive Mechanicsburg, PA 17055 Felix John Boake: III 373 West Gate Drive State College, PA 16803 Gregory Waldren Boake P.O. Box 578 Williamsbay. WI 53191 Deanna Lynn Corcelius Palladini 201 E. 2°d Ave. Apt 3 Altoona. PA 16602 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None Date: July,, 2002 ~ // ~~ Bruce J. Warshawsk 1820 Linglestown Road Harrisburg, PA 17110 (71?) 232-8500 Capacity: Personal Representative X Counsel for Personal Representative :~J THE LAW OFFICE OF I~lEIf~T~7['IEI~T ~ ~A]E~SIE-][f~~SK~' MILTON BERNSTEIN, ESQUIRE E-mail: milt b@prodigy.net BRUCE 1. WARSHAWSKY, ESQUIRE E-mail: bruce_w@prodigy.net DIANE K. McKAY, PARALEGAULAW CLERK E-mail: dianemckay@prodigy.net ROUTING REQUEST 1820 Linglestown Road Harrisburg, Pennsylvania 17110 Phone (717 232-8500 Fax 1717 232-8035 www.lawbw.co m - ~- Date: August 2, 2002 ~~' To: Office of Register of Wills ` ~7~ Re: Estate of Edith LaVina Burd ~ ,/)a No.: 2002-00575 ~, ~V ~~ Enclosed is: Inheritance Tax Payment ; ~ IZ, eao ` ^ Please time-date stamp and return one copy. ` ^ Please file the Original. Please return the receipt of payment in the self addressed stamped envelope. Please direct all correspondence regarding this matter to the address and telephone number above indicated. Very truly yours, taL~~ Diane McKay, Paralt Enclosures (3) Legal advisor io p-vfic~siorrala acrd tbt br~rirtws co»urskrri0y; arraG to individauilt for utater acrd, fsrrasuial pla:nring COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EXI11-96) NO. CD 001505 WARSHAWSKY BRUCE J ESQ 1820 LINGLESTOWN ROAD HARRISBURG, PA 17110 ACN ASSESSMENT CONTROL NUMBER rota ESTATE INFORMATION: ssrv: i ~o-i 2-i i s~ FILE NUMBER: 2102-0575 DECEDENT NAME: BURD EDITH LAVINA DATE OF PAYMENT: 08/09/2002 POSTMARK DATE: 08/08/2002 couNTY: CUMBERLAND DATE OF DEATH: 05/04/2002 AMOUNT 101 ~ S 1 1, 400.00 TOTAL AMOUNT PAID: REMARKS: EDE BOAKE C/O BRUCE WARSHAWSKY ESQUIRE SEAL CHECK# 96 INITIALS: SK RECEIVED BY: MARY C. LEWIS S 1 1, 400.00 REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-961 NO. CD 001504 WARSHAWSKY BRUCE J ESQ 1820 LINGLESTOWN ROAD HARRISBURG, PA 17110 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold ESTATE INFORMATION: SSN: ~ 70-~ 2-~ ~ 37 FILE NUMBER: 2102-0575 DECEDENT NAME: BURD EDITH LAVINA DATE OF PAYMENT: 08/09/2002 POSTMARK DATE: 08/08/2002 couNTY: CUMBERLAND DATE OF DEATH: 05/04/2002 101 ~ 5600.00 TOTAL AMOUNT PAID: REMARKS: TERESA SETLAK C/O BRUCE WARSHAWSKY ESQUIRE SEAL CHECK# 3041 INITIALS: SK RECEIVED BY: MARY C. LEWIS 5600.00 REGISTER OF WILLS REGISTER OF WILLS February 14, 2003 Office of Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Edith LaVina Burg, deceased # 2002-0575 To Whom It May Concern: SINCE 1888 3211 North Front Street P.O. Box 5300 Harrisburg, PA 17110-0300 717-238-8187 Fax:717-234-9478 Other Offices Colonial Park Mechanicsburg 717-652-7020 717-691-5577 Millersburg Shippensburg 717-692-5810 717-530-7515 With respect to above referenced estate, enclosed for filing are an original and one copy of the inheritance tax return along with 5 copies of same for time and date stamped return. Also enclosed is a check for the inventory filing fee of $25.00 made payable to the Register of Wills and a check made payable to the Department of Revenue in the amount of $7.55, which represents the tax due. Please kindly return 5 copies of the filed return in the self addressed stamped envelope enclosed herein. Thank you for your prompt attention to this matter Very truly yo ~_ Diane McKa} Enclosures (9 Document #: 261798.! James F. Carl Edward E. Knauss, N* Jered L. Hock Steven P. Miner Clark DeVere Francis J. Lafferty, IV David H. Martineau Andrew W. Norfleet Melissa L. Van Eck Andrew C. Spears Young-Suh Koo "Board Certified in civil trial law and advocacy by the National Board of Trial Advocacy COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: N0. CD 002189 WARSHAWSKY BRUCE J ESQUIRE 321 1 N FRONT STREET P 0 BOX 5300 HARRISBURG, PA 1 71 1 0-0300 fold ESTATE INFORMATION: ssN: i 7o-i 2-~ ~ 37 FILE NUMBER: 2102-0575 DECEDENT NAME: BURD EDITH LAVINA DATE OF PAYMENT: 02/ 1 9/2003 POSTMARK DATE: 02/14/2003 COUNTY: CUMBERLAND DATE OF DEATH: 05/04/2002 TOTAL AMOUNT PAID: 57.55 REV-1162 EX111-96) PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 57.55 REMARKS: EDITH A BOAKE C/O BRUCE J WARSHAWSKY ESQ CHECK#117 SEAL INITIALS: CW RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Burd, Edith LaVina also known as Edith A. Boake Signature: ~~l ,'~ ,~-. ~_ Signature: ,./,~ , ~,~L-.._. Deceased Social Security No. 170-12-1137 Edith A. Boake The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. Personal Representative Attorney: Bruce J. Warshawsky Signature: ~ t"f-L / ~, , I.D. No.: 58799 Address: 1820 Linglestown Road Harrisburg, PA 17110 Telephone: 717/232-8500 No. 21 - 2002 - 0575 Address: 471 E. Rock Road Allentown, PA 18103 ys~33 Telephone: 610-797-3 6 Dated: o21.y~ap A ~ Personal Proaerty Checking Account No. 4243229 Omega Bank Certificate of Deposit No. 173-0005795 -Omega Bank Jewelry (see attached list for itemization) IRS tax refund year 2001 Funeral death benefit refund from Myers Funeral home PSERS retirement account Tax refund Date of Death 5/4/2002 81,325.93 6,818.29 3,960.00 493.00 100.00 48.72 36.43 Tb'~1'Personal Property $92,782.37 (Attach additional sheets if necessary) Total Personal Property and Real Estate $92,782.37 ~~_~o ~ ~~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRI58URG, PA 17128-0681 BRUCE J WARSHAWSKY BERNSTEIN & WARSHAWSKY 1820 LINGLESTOWN RD COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX HBG PA 1711b'. REY-1547 E% AFP (Y1-m) 03-31-2003 BURD EDITH L 05-04-2002 21 02-0575 CUMBERLAND 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 DATE ESTATE OF DATE OF DEATH FILE NUMBER ~OUNTY ACN CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BURD EDITH L FILE N0. 21 02-0575 ACN 101 --------------------- OR DATE 03-31-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this fore with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)_ 9 2,782.37 tax payment. 6. Jointly Owned Property [Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 8. Total Assets (B1 92,782.37 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 11,,36 4.19 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 887.8 5 11. Total Deductions (111 1 7 .2~7 _ 04 12. Net Value of Tax Return (121 80,530.33 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (141 80,530.33 NOTE: if an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will reflect figures that include the total of ALL retu rns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (151 •00 X 00 _ .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) .00 X 045 . .00 17. Amount of Line 14 at Sibling rate (171 2,400.00 X 12 - 288.00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 78,130.33 X 15 - 11,719.55 19. Principal Tax Due (191 = 12, 007.55 TAY PDCTTTL+. DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 08-09-2002 CD001504 .00 600 00 08-09-2002 CD001505 .00 . 11 400 00 02-14-2003 CD002189 .00 , . 7.55 TOTAL TAX CREDIT 12,007.55 BALANCE OF TAX DUE .00 INTEREST AND PEN. .O1 TOTAL DUE .O1 * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A ''CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) 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 ,-~ J tL d~ STATUS REPORT UNDER RULE 6.12', Name of Decedent: ~ ~ ~ +1^- C.AV~,a~ ~t^cc~ Date of Death: /f~~ ~ o~~o ,~ Will No.: Admin. No.: b0 - b ~ S ~JS Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes ,~ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is yes, state the following: A. Did the personal representative file a final account: with the court? Yes No 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 ~ No D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of theirl lhans' Court and may be attached to this report. _ _ _ Date: (~ '~Io~ - o~ Q~ - . -'1 Q ~~ o (MAH:rmdAM3) ,., 4 Signature ;~ ~P1LiCE J i~u~R5~1r1tiJ5~y - `;- Name (Please type or printint ~ ~;;~ Mrc-r~yFx ~l~ckEk~sa.,~., I~r1.4us5 f E Deb, T'C . .~:.~ ,~ s= ,321! x1.'r1Za~.; STn:~er ~,a~e2~sb.~e4 ~,a I7~IC, ~`~ =" ,~; L.: Address ~- ~_7~7) ~38-8)~~`~- Telephone No. Capacity: Personal Representative X Counsel for Personal Representative R.W.-27 77-7()- /2- i ': REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT HARRtSBURG,PA 17126-OlK1l _u _. ____ _~ --rDe.CEDENrS NAME (LAST, FIRST, AND MIDDLE INITIAL) Burd, Edith LaVina !ttV.,_U+IIHICII ~ li~!:l ....g :S:~.J u..m ~ *' c~NVIIEAl.1'H OF PENNSYLVANIA oePARTMENT OF REVENUE DEPT. 280601 ~ z .. o .. ld o ~A;~~~~~~~;:DO.YE:)~-=_-J7;~;~~;; 1(~:oo.YEARl (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDL-E INITIAL} 1. Original Return 4. limited Estate 2. Supplemental ~etum ./ ")FFIC!,~L USE mjl '/ FILE NUMBER 21 2002 0575 COUNT'( CODE YEAR NUMBER SOCIAL SECURITY NUMBER 170-12-1137 THIS RETURN MUST BE FILED IN DUPUCATE Wlnt THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 6. Decedent Died Testate (Attach copy "WIIIl 9. Litigation Proceeds Received 4a. Future Interest Compromise (dale of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach aypy Gf Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1.1.95 o 3. Remainder Return (dale of death prior to 12-13-82) o 5. Federal Estate Tax Retum Required 1 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113{A) (Attach Sch 0) ..~ ~~ OZ u2 ME Bruce J. Warshawsky IRM NAME (If applicable) Bernstein & Warshawsky ELEPHONE NUMBER ='r.' 7~7~::~~~::(SchedUle A)- 2. Stocks and Bonds (Schedule B) I 3. Closely Held Corporation, Partnership or SOle.Proprietorship 4. Mortgage. & 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) 8. Total Gross Assets (total Unes 1-7) 9. Funeral Expenses & Administra<<ve Costs (Schedule H) , 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been t' made (Schedule J) 14. Net Value Subject to Tax (Une 12 minus Une 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES " 15.Amount of Line 14 taxable at the spousal tax rate. or transfers under Sec. 9116(a)(1.2) Z g ~ ::! 10. Debts of Decedent, Mortgage Uabilities, & Uens (Schedule I) 11. Total Deductions (total Unes 9 & 10) 12. Net Value of Estate (Une 8 minus Une 11) Z o ~ S .. '" 8 S 16. Amount of Line 14 taxable at lineal rate 17.Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 1820 Linglestown Road Harrisburg, PA 171\0 (1) Norre OFFiCi.-'<,L USE 01Jl.Y (2) None (3) None (4) None (5) 92,782.37 (6) None (7) None (8) 92,782.37 (9) 11,364.19 (10) 887.85 (11) (12) (13) (14) 12,252.04 80,530.33 80,530.33 19. Tax Due x .00 (15) x .045 (16) 2,400.00 x .12 (17) 288.00 78,130.33 x .15 (18) 11,719.55 (19) 12,007.55 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. 8-00) Ollcedent's Complete Address: STREET ADDRESS 375 Wesley Drive CITY Mechanicsburg ISTATE PA TZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 12,OQ7.55 11,400.00 600.00 Total Credits (A + 8 + C) (2) 12,000.00 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnteresllPenalty (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. 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (3) 0.00 (4) (5) 7.55 (SA) (58) 7.55 Make Check Payable to: REGISTER OF WILLS, AGENT 1. Did decedent make a transfer and: a. retain the use or income oftha 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? .,..','.,........,.........,..,..,...............,...". ...,.",.. ......................... .................... .... .... PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS '~ I 3. Did decedent own an Min 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? .............................."...,.,............................,'.".,.....................,."...,................ o o o ~ ~ ~ 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 relum, including accomP8nying schedulas and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparei' other than the personal. representative is based on an infonnatlon of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS Edith A. Boak. cc::l'f1--~' (J~ SIGNATUREOFPERSON RESPONSIBLE FOR TURN DATE 471 E. Rock Road Allentown, PA 18103 OJ) '-/),;z 0 OJ , , DATE A/;/Jo03 ! DATE ADDRESS ADDRESS 1820 Linglestown Road Harrisburg, PA 171\0 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to 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 exemDt 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. ~9116 (a) (1.2)). The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116 1.2) [72 P.S. ~9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P,S. ~9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ." " - " . . ~1-002-5L5 . LAST WILL AND TESTAMENT of EDITH LAVINA SURD a resident of 907 Hickory Street, Hollidaysburg, Pennsylvania 16648 I, EDITH LAVINA BURD, declare this to be my Last Will and Testament and hereby revoke all prior wills and codicils heretofore made by me. FIRST: I direct that all of my just debts and funeral expenses be paid as soon as practicable after my decease. SECOND: I direct that my Executor hereinafter named see that my remains be interred in the Gettysburg National Military Cemetery, Gettysburg, Pennsylvania, in the Plot Section 2, Grave No. 1193 with my late beloved husband, Elvie Robert Burd, U.S.N., retired, buried October 18,1966. THIRD: Any person who shall die at the same time as I or in a common disaster ~ with me or under such circumstances that it is impossible or difficult to determine which , , died first shall be de~l11~d to have predeceased me.._, . ___ .'~__,__~_._ 'c:'J?':'." _, .. ", . _ .. .,.." _~. "'.0..__.....;;,.........:,. "L-;';::~~N ._.,...;:..'::;_;;~_,~'~::.'F_._'._"'".,._,,.. ,.....,..__."._.. ...,~~.,__~.' ','. .... .. .. ",'C- _"" .. ., .. ",," c-c',~.;..'I!!'.:._;::-,_. .'_~.." - ',.'-,' __' ,",.. "-"'C'''"'.'', ,-,',;"T:;:-: ;".;.....;..:r~-'::~.y_-:;.I..:---_.. ..".~",..,---. :.-. I\J.,.;'''''''..''~'"~.Fb'ORTWlgiVe;.de\iise-and.bequeaWunloWAWRENWES"EFt"CORCECTlTS;rrlY. ,-" . " brother, the sum of Eight Hundred ($800.00) Dollars. In the event that he should predecease me, I give and bequeath his share, the sum of Eight Hundred ($800.00) Dollars to his daughter, my niece, DEANNA LYNN CORCELlUS PALLADINI. FIFTH: I give, devise and bequeath unto D. JEAN BOAKE, my sister, the sum of Eight Hundred ($800.00) Dollars. In the event that she should predecease me, I give and bequeath her share, the sum of Eight Hundred ($800.00) Dollars to her children, my nieces and nephews, FELIX JOHN BOAKE, III, GREGORY WALDREN BOAKE, and EDITH ANITA BOAKE. , , I 1 ~ SIXTH: I give, devise and bequeath the sum of Five Hundred ($500.00) Dollars to 1 ~ .\ 'S: ~ 1 \\i <X'1 . ,..... ' ) ...., . \ . .~ " . ;- ....; t_ ~ ' . -:-.::.eaeh:"'flamely~~I?AN'BO;6;KE,my sister; to FELIX JOHN BOAKE, III, my nephew; to GREGORY WALDREN BOAKE, my nephew; to EDITH ANITA BOAKE, my niece; and to DEANNA LYNN CORCELlUS PALLADINI, my niece. SEVENTH: I give and bequeath my gold diamond engagement ring with sets, gold wedding band with diamond sets, and platinum diamond ring to ALDENA M. BISHOP, 223 Bishop Hill Road, Chimacum, Washington, if she survives me. In the event she does not survive me, the three rings as named above are bequeathed to LINDA BISHOP LOPEMAN, 51 Bishop Hill Road, Chimacum, Washington. EIGHTH: I give and bequeath my gold birthstone ring with opal set and filigree work around the stone to my niece, EDITH ANITA BOAKE. NINTH: I give and bequeath my gold ring with jade setting from the Panama Canal Zone to my sister, D. JEAN BOAKE. TENTH: I give and bequeath the remaining personal jewelry to my friend, MELISSA LOPEMAN, of Chimacum, Washington, if she survives me. In the event she does not survive me, the remaining personal jewelry is bequeathed to her sister, JAMI DELAINE LOPEMAN, of Chimacum, Washington. ELEVENTH: I give and bequeath (a) the antique china cupboard originally from "617" (my parents' home), (b) two 17" x 15" St. Augustine prints in gold frames, and (c) the natural wood bookcase with 3 shelves and the natural wood bookcase with 2 shelves, all to my niece, DEANNA LYNN CORCELlUS PALLADINI. "'-<;i,~",",,,,,,,,,,,,,",,,,=,..:,,]}~sbEll:i~, .Lgi\(e.and'bequeathc(a),the::'2~"'3~wintet'$c-ejtfif'dil.tJaihtilitrtjff canvas painted by Elvie R. Burd, (b) the five drawer oak chest of drawers 29" x 48" (from "617"), (c) the original mahogany occasional table with rolled legs, 21" x 29", and (d) the small child's chair in natural wood tone, all to my sister, D. JEAN BOAKE. THIRTEENTH: I give and bequeath (a) the 21" x 11" picture of the tall ships at_ Bermuda Anchor, and (b) five 7" x 8" framed pictures of Port Townsend, Washington, including Starrett House, Hastings Building, Clapp Building, Bell Tower and Abandoned Lookout, all to LINDA BISHOP LOPEMAN. FOURTEENTH: I give and bequeath (a) the five piece antique china wash stand with Harvard Stamp, including chamber lid, medium pitcher, wash cloth holder, small '. " ..Pit~M~srfWitfti~i~r'iiiTier fl();;:;~r ;fusigi]>. (6) Hie?" high ceramic pitcher, hand painted by me and signed on the bottom "ELB 1969", with green leaves and wheat sprays, (c) one cloisonne vase from Japan, given to me by my husband in 1946, and (d) my blue and white Delft platter, all to my niece, EDITH ANITA BOAKE. FIFTEENTH: I give and bequeath two 7" x 9" black and white oil canvas paintings from Paris, France of boats on harbor to ELIZABETH HAWES of 500 Marine Drive, Sequim, Washington. SIXTEENTH: I give and bequeath (a) one charcoal drawing of the moon through evergreens with snow on ground and one charcoal drawing of the moon shining over a house and shining on the water, both done by Elvie R. Burd, and (b) one framed wall picture entitled "Tall Ships" by Kipp Soldwedel, all to my nephew, GREGORY WALDREN BOAKE. SEVENTEENTH: I give and bequeath (a) one charcoal drawing of a clock tower among tall trees done by Elvie R. Burd, (b) four ceramic wall plates of whaling ships operating in New England waters, and (c) one 21" x 26" canvas oil painting of a winter scene of snow on ridges with water running done by Elvie R. Burd, all to my nephew, FELIX JOHN BOAKE, III. EIGHTEENTH: All the rest, residue and remainder of my estate, being the same real, personal or mixed of whatever nature and kind, I give, devise and bequeath in equal shares to my nieces and nephews as follows: FELIX JOHN BOAKE, III, GREGORY WALDREN BOAKE, EDITH ANITA BOAKE and DEANNA LYNN CORCElIUSPALLADINI. ' ,t~-":'-"'""';':;"'-"_~"""~:;i~.{.~-:;x.~):~':?::"",';':"7C'~,:Cc.;'> -- -, """~ _'," : ,,'.','; - ,:.;__'-,;.",~;;:~"<_.;,..,.:"..;~.~_<.~~~"..,,, NINETEENTH: I appoint EDITH ANITA BOAKE of 1050 Bolton Court, Bensalem, Pennsylvania as Executrix of this my Last Will and T estamenl. TWENTIETH: I expressly direct that my Executrix shall not be required to enter bond or other security in any jurisdiction in which called upon to act in any fiduciary capacity, or if bond be required, there shall be no surety required on said bond. TWENTY-FIRST: I give said Executrix the fullest power and authority in all matters and questions to do all acts which I might or could do if living, including, without limitation, complete power and authority to sell (at public or private sale, for cash or credit, with or without security), mortgage, lease and dispose of and distribute in kind, all property, real J ./ ~ ~ .~ ~ " .' '. '. and personal, at 50th times and upon such terms andc~;';-d~ic:>~s as it may determine, all without court order. IN WITNESS WHEREOF, I sign, seal, publish and declare this as my Last Will and sr Testament in the presence of the persons witnessing it at my request this ? (- day of July, 1999. ~~ ~V~ E~ Edith Lavina Surd (SEAL) Thef6reg6iflg instrument, consisting offourtypewritten pages; this page induded, the preceding three pages thereof bearing on the left-hand margin the signature of the Testatrix, was at said date declared by said Testatrix as her Last Will and Testament in our presence, and we, at her request, in her presence, and in the presence of each other, subscribe our names as witnesses, all of us, including the Testatrix, being present together throughout the execution and attestation of the Will. {JIU<.J(JM "7~ residing at iI/mom P/I I (It {1f? j JJ..X;L. c Yna Wt..l.- residing at 0~~tr, 1ft. *' I l SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY I ,."--- I FILE NUMBER 21 - 2002 - 0575 Cor.woNWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF d Ed'th V. Bur, I La ma Include the proceeds of litigation and the date the proceeds were received by the estate, All property jolntly-owned with the right of survivorshIp must be disclosed on schedule F. -~-- - -~ VALUE AT DATE OF DEATH 81,325.93 ITEM NUMBER I DESCRIPTION Checking Account No. 4243229 Omega Bank 2 Certificate of Deposit No. 173-0005795 - Omega Bank 6,818.29 3 Jewelry (see attached list for itemization) 3,960.00 4 IRS tax refund year 200 I 493.00 5 Funeral death benefit refund from Myers Funeral home 100.00 6 PSERS retirement account 48.72 7 Tax refund 36.43 ---- TOTAL (Also enter on Line 5, Recapitulation) 92,782.37 @ 02~d~'"~:;':~"B.nk July 10, 2002 BERNSTEIN & WARSHAWSKY LAW OFFICES 1820 LINGLESTOWN ROAD HARRISBURG PA 17110 Dear Sirs: This letter is in regards to the accounts that Edith L. Burd held at Our financial Institution. Listed below is the information that you requested. Checking Account: # 4243229 Balance as of 000: $ 81,301.59 Accrued Interest: $ 24.34 Date Opened: 7/18/90 Account Title: Edith L. Burd Certificate of Deposit: # 173-0005795 Balance as of 000: $ 6,818.29 Accrued Interest: $ 5.37 Date Opened: 10/21/99 Account Title: Edith L. Burd Safe Deposit Box: # 48-311 Date Opened: 10/12/00 Account Title: Edith L. Burd If I can be of further assistance to you, please do not hesitate to call or write. Sincerely, i!~~z~ Deposit ,Service Representative (800) 494-1810 ext. 2061 PO Box 298 State COllege, PA 16804-0298 Customer Information Center, TOil Free: 1-877-861-7800 ~.tI~"1<:flt..,r:t.,('.,'r:tt.~ M..l11e B@ Distinctively Different Fine Jewelry The items herein were appraised pursuant to the request of Bruce Warshawsky, Esquire, of the Law Offices of Bernstein & Warhshawsky of the Estate of Edith Burd. It is my opinion that the listed items have an estate value as follows: Mollie Date: 1. (1) Green Jade Ring in 14 K yellow gold: $300.00 2. (2) 14K white gold 1.5 mm. Bands: $70.00 each 3. (1) Costume brooch w/amber colored stones by Robert: $20.00 4. (1) Silver plated bracelet by Monet: $25.00 S. (1) Ladies Timex quartz watch silver w/white face $25.00 6. (6) Gold colored bangle bracelets: $5.00 7. (1) Gold plated bracelet by Monet: $20.00 8. (1) Gold plated chain necklace: $10.00 9. (1) Green Jade and gold plated pendant w/o chain: $75.00 10. (1) Gold plated square locket w/gold plated chain: $25.00 11. (I) 14K yellow gold and diamond band: $250.00 12. (I) 14K yellow gold ring illusion head w/diamonds approx. .15 ct.:$3S0.00 13. (1) 14K white gold ringw/approx. .5 ct.: $2,000.00 14. (I) 14K white gold ringw/star sapphire & small diamond: $400.00 15. (I) Faux pearl double strand necklace (unstrung): $20.00 16. (1) Gold ring w/filigree & light blue stone: $50.00 17. (I) 10K yellow gold opal ring: $20.00 18. (1) Cocktail ring-white metal unmarked: $75.00 19. (2 sets) Faux pearl screw back earrings: $25.00 each 20. (1 matching set) Costume necklace and screw back earrings by Monet: $75.00 /// / I I ( \ \ -,- // \ ......" ;/ ,_1 I I I I \ \ \ \ , , '" , " , , , \ \ I I / / / // , , , " " \ \ \ I J . /// / .- 2017 Linglestown Road. Beaufort Plaza. Harrisburg, Pennsylvania 17110 .717-540-9040 . FAX: 717-541-8028 v 485 EX. (1-92) COMMONWEALTH OF PENNSYLVANIA DEPT OF !!J'lIENUE INHERITANCE TAX DIV ""--.POST OFFICE BOX 8327 HARRISBURG, PA 17105.8327 SAFE DEPOSIT BOX INVENTORY Please Print or Type I COUNTY CODE J!;,\~,\r MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS, 2 FILE NUMBER 3 SOCIAL SECURITY OR DEATH CERTIFICATE NUMBER ~DD~ - OOSIS 110-Jci- II ~7 5 DATE OF DEATH ~-\f-;~PO~ L, I DECEDENT'S NAME (Last, First. Middle) ~\>. ( ~ l2.\. ; +" I ADDRESS OF DECEDENT (Str"t) 3S.s ~-\-1e ~;,z (\N(\"""\C.5.\:t...<r I NAME AND ADDR~SS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPO (N"",) i:LA,-\-'r\ ~;-P.. (bo,,- ~ (City) PA (Stat,) (Zip Code) '70S~ BOX (Stroot Add",,) l{, \ E ~o~ CZoa,d Wity) " \ \ ~ -\1>.../\ p.... (Stat,) (Zip Code) Ig ID 2. NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING a. (N"",) CLcli~ f'I"'TA E, (Street Address) 1\ Qp",'4., oc-K (l"oo. c! (Relationship) (\e'I(e. ~i(\ b, (N"",) '" (Relationship) (Street Address) (City) (Stat,) (Zip Code) c. (Name) (Relationmip) (Street Address) (City) (Stat,) (Zip Cod,) NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED (Name of Financial Witution) 0 t/ Ui'K'\"- 0"-1\" N j\ (Street Address) p \-Sl.> E. If'q<;, \.)t.\ He NAME OF PERSON MAKING LAST ENTRY CL .\4+1 \... Burel \ud, (CW) r' tWD" '\ (Stat,) (Zip Cod,) 'A It,.,l,O II DATE AND TIME OF LAST ENTRY 11-'S-oD "\:':>:'0..,.., 14 TITLE UNDER WHICH BOX IS REGISTERED tt6i~ L. e,\lf'd D,I~rOO 13 NUMBER OF BOX ~<!\\ B.Md t)n--<.. () (Stato) (Zip Cod,) r^ 1<6\0:;' NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY t't--u." \ t), ('<x:> \ 0 o y" a. (Name) (J.;~ L, (Str'" Ad<k,;) ._ :.?~S W".s.-\ \( (CA;) . 'lV'(~rAII.\(S.'o-"'r b, (N"",) ~di% ~i~ (So" ~ ~oc-~ l\ci . (State) (Zip Code) \~\Db poA WAS A WILL IN THE BOX? c..uS.io~ SCr..\<I' s.-~SO(' [W' No If yes, a. Date ofwilI: b. Name and addrellS of personal representative, ffnamed in the will (Nam,) (Street Address) (City) (Stat,) (Zip Code) c. Name and address of at tomey, ffmy (N"",) (Street Address) (City) (State) (Zip Code) SDINVRPT (10/200 I) // Page d- of ~ SAFE DEPOSIT BOX INVENTORY TRUCTIONS /(1) Cash: Report total only. .' (2) Stocks: List in detail every common or preferred certificate, warrent or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. (3) Obligations of U. S. Government: Number of items, date of issue, face value, names in which registered and type of ownership. Le., jointly held, payable on death, etc. (4) Bonds: Designate by'llame, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other contents. tem# s; \ \rY ~~ . \~ (Y! e. <>- . . . IV"<( . .\.c. . .., . . bn>ot:.h " . \'-4c IC \Cl"<l,. 0.0 ~I ~"'rti 1\ j ddHIW jJ."'Yili HiM.iff iJfniiiril&'iiiAffiii ~g<Wt lty:(jjiil l~ CORREcr AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. Signature t), ~...Q ~. \,\\ebold fffis(}ff fifHMfi(] (;(jf'l (if SAFE DEPOSIT BOX INVENTORY, Signature t.::." J ~/-fz- Print Name and check appropriate box ~ f=t "..... Print Name w.r Print Title (JAS.-WC'Hr SUJ,l.( Sv-pervi~or NOTF.~ Attach arlditional R1/2" Check appropriate box: [l{ Executor(trix) 0 Administrator(trix) Estate Representative Joint owner of safe deposit box X 11" ~hppth' if np,.p.c,:c~rv nr lIep f'lnnli....tpc nf ""i" n..lT.. nf'f'n....... COMMONWEALTH OF PENNSYLVANIA STATE EMPLOYEES' RETIREMENT SYSTEM 30 NORTH THIROSTREET - P.O. BOX 1147 HARRISBURG, PENNSYLVANIA 17108-1147 TOLLFREE: 1-800-633.5461 www.sers.state.pa.us October 10, 2002 EDITH A BOAKE EXECUTRIX EDITH BURD ESTATE 1820 LINGLESTOWN RD HARRISBURG PA 17110 Member SSN: 170-12-1137 Beneficiary SSN: 170-12-1137 Dear Beneficiary: A check in amount of $48.72 will be mailed to you within two (2) weeks from the date of this letter. The amount of $0.00 was withheld for Federal Withholding Taxes. If you have elected to rollover then the taxable portion of $0.00 has been transferred to your qualified plans. This payment represents your designated share of 100.00% in the Final settlement of the Account of EDITH L BURD with this retirement system. If the individual listed above was a member of the Retirement system before January 1, 1982, their contributions prior to that date were taxed as part of their gross income at that time. Therefore, no taxes are being withheld on that portion of their contributions. The difference between the amount of your payment and your share of the deceased member's non-taxable contributions, if any, is taxable for federal income tax purposes. This payment has been reported to the Internal Revenue Service. If a 1099R form is not enclosed with this letter, you will receive one prior to January 31 of next year, with the necessary tax information regarding this payment. Under current law there are no Pennsylvania state or local taxes on any benefits paid from this system. This letter and the 1 099R form that you receive should be kept in a safe place, as you will need the information when filing your Federal Income Tax Return. This is the only notice you will receive. There is a $5.00 charge for each request of duplicate information. Sincerely, ~<<q" m. >'h ~ Linda M. Miller, Director Benefit Determination Division BEN31FSL 11111111111111111111111111111111111111111I1111I111I1111111111I11111111 *' SCI-EDll..E H FlN:RAL.EXPeSES& AD\IINSTRAllVE COSTS COM\1ONWEAL TH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT - --'--- ESTATE OF --...--.....--..------...-------.---.--.,..-- I FILE NUMBER u_ 21-2002-057~ Burd, Edith LaVina Debts of decedent must be reported on Schedule I. ITEM i NUMBER I -"'---'--...--- A. ' FUNERAL EXPENSES: I Myers Funeral Home DESCRIPTION AMOUNT 2,310.40 2 Lena's Cafe - Funeral reception 62.56 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Edith A. Bonke Social Security Number(s) I EIN Number of Personal Representative(s): 211-40-2507 Street Address 471 E. Rock Road City Allentown Year(s) Commission paid 2002 3,600.00 State P A Zip 18103 2. Attorney's Fees Bernstein & Warshawsky 3,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip 4. Probate Fees Register of Wills 257.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Legal Advertisement 162.35 2 Bank Fee - checks 35.00 Total of Continuation Schedule(s) 1,436.88 11,364.19 -.-- .--..- --.-.-..---.--.......----- -.. .-- ------- TOTAL (Also enter on line 9, Recapitulation) *' I L COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF B d Ed'th L V' ur,l ama 3 TMollie~.Jew~~-appraisal , 4 Law Office Postage Schedule H Funeral Expenses & Adrinislralive CosIs continued --~- --.._-..._--- ----....- I FILE NUMBER . 21 - 2002 - 0575 5 Insured Shipping Fees of Specific Bequests 6 Pursuant to 72 P.S. 9 I 44(a) Inheritance Transfer Tax on Will Items Fifth, Sixth & Ninth 7 Pursuant to 72 P.S. 9144(a) Inheritance Transfer Tax on Will Items Fourth 8 Pursuant to 72 P.S. 9144(a) Inheritance Transfer Tax on Will Item Sixth 9 Pursuant to 72 P.S. 9144(a) Inheritance Transfer Tax on Will Item Seventh 10 Pursuant to 72 P.S. 9144(a) Inheritance Transfer Tax on Will Item Eighth II Pursuant to 72 P.S. 9 I 44(a) Inheritance Transfer Tax on Will Item Tenth I , I I I 1_ _Iu_ Page 2 of Schedule H 100.00 26.37 173.51 192.00 96.00 300.00 390.00 3.00 156.00 DANIF..L R. MYERS FiJNEHAL HOME 501 6th Avenue Alman!!, Pennsylvania 16602 (814) 942-7747 DECEASED r-,l; ,\ C I f3.. r.l DATE OF DEATH f'^t a.~ J.j, ,:./ "(':;7 PLACE OF DEATH H't.k"-'I':"~L,,,,<... DATE OF STATEMENT (\....10,. _ _ 06"2 , No, PA A. CHARGE FOR SERVICES SELECTED 1. Professional Services: Basic Services of Funeral Director & Staff. . . . . . Embalming. . . . . . . . . . . . . . . . . . . . . . . . . . . Other preparation of body.. .. ............ 2. Facilities, Equipment & Staff: Use of Facilities & Staff for Viewing I Visitation. . . Use of facilities & Staff for Funeral Ceremony. . . Use of Facilities & Staff for Memorial Service. . . Use of Equipment & Staff for Graveside Service. . Use of Equipment & Staff for Church Service. . . . fr/)o -eo 3. Transportation: Transfer of Remains 10 Funeral Home. Hearse. Limousine. . . . . Sedan. . . . . . . . .. .. .. . . . Service I Utility Vehicle. . . . . 4. Other Services / Facilities / Equipment: TOTAL OF SERVICES SELECTED, , , "" ,$ B. CHARGE FOR MERCHANDISE SELECTED Casket (or other receptacle) . . . Name/No. Material Color Outer Burial Container. Name/No. Material Acknowledgement Cards. . . .., ............................. Register Book. . . . . . . .. . . . . . . . . . . . . . . ... .................. MemoryFo(ders/PrayerCards. ............................ C~\hing , .. , , , , , " , , , , ' , , , , , , " " , , , , , , , " , , " " , , , , , ,&:-If/:uJ LIt:.Ji." ",' , ' " "'" , , " """" , """, Cremation Urn . . . ,E/t?'i"7'~.: j , i)~;ct,' k{,~~';;, !/:-"/'} / :-0, on , ,'-' " , ~. : ./.](1,1"0 .;;:~../) ('<<::1 ""'" "',"""'" ~I'~ r~ / :", ..' ". ,,/$ <:3r;~ .0 -; 'f' _.. TOTAL OF MERCHANDISE SELECTED, C. SPECIAL CHARGES o Forwarding remains to: o Receiving remains from: Immediate Burial. 'Direct -Cremation. . .. ... """,,'," . ". 'f/', Other....................... ........... TOTAL OF SPECIAL CHARGES" , " , '" " '" $ ~ " " 'U',jj,. ,l / J ''\''0 'ot ,./.~ . '.': I ;:~ ;S.() , TOTAL FUNERAL HOME CHARGES, , , (This total does not include Cash Advances) "",., $ 17...;;-J:' ,p STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED Charges are only for those items that you selected or that are required. If we are required by law or by a cemetery or crematory to use any items, we wifl explain the reasons in writing below. If you selected a funeral that may require embalming, such as a funeral with viewing, you may have to pay for embalming. You do not have to pay for embalming you did not approve if you selected arrangements such as a direct cremation or immediate burial. If we charged for embalming, we will explain why below. CASH ADVANCES Certified Copies of Death Certificate 11 ,~~ @$ 1 each _$ I/A' .'t"J Clerqy ~,-f'"o. ~b Musician / I 'I 9ll /4.$.-'/,-\ Paid Newspaper Notice tJ/;;-L, ;/",,.;,/:,,,,'1 Cemete"!y EJ- Other 7-;;"'n"'!,,'~ru I., //~'.~ .~, /f,.,,.!.,.../;,.{ /3.3 I.~ T.f//.J"""'f''''' '1""./,,,,: 1-. ht'IIS,....L~J'r /":"n.r.'D P TOTAL CASH ADVANCES $ of 'Fd"! ,'/n We charge you for our services in obtaining: (specify cash advance items). SUMMARY '" '<' Total Funeral Home Charges. . . . . . . .. . . $ I-'T..fO Local Sales Tax (if applicable) . . . . . . . . . . . . . . . . . $ State Sales Tax (if applicable) . . . . .. . . . . . .. . . $ TotaICashAdvances........ ...............$ .!j~?;.() "ib GRAND TOTAL $ d..'; I tI, "It) Less Credits and Payments $ $ Total Credits. .. .. . . . . . . . .. . . . . . .. .. .~. --- BALANCE DUE ~j $ ,)::1 (J ,40' I Billing To "---.. "" .- fJca)';: ",.r,:f~l/ /. " / \L -{u.u ( i ;7 ! II I. ". I,/.i',~ lV. /I!.-ift,-, J DISCLOSURES Rea.sq(1 for embr/ing '--//;(" f /'(' .I1..('<'1.oo/,,,(:.. , , If any law, cemetery. or crematory requirements have required the purchase of any it#ns listed, the law or requirement is explained below. ,/7 /, AI.. . ,L_' I '/C"'l"q /, .n ACKNOWLEDGEMENT AND AGREEMENT I hereby acknowledge that I have the legal right to arrange the final services for the deceased, and I authorize this funeral establishment to perform services, furnish goods, and incur outside charges specified on this Statement. I acknowledge that I have received the Gen~ral Price List and the Casket Price List and the Outer,,.Buriar Container Price List. Terms of Payment: '<' Full payment is due no later than If any payment is not paid when due, an unanticipated LATE CHARGE of % per month (ANNUAL PERCENTAGE RATE %) on the unpaid balance will be due. I agree to pay the Balance Due listed on this Statement, plus any Late Charge. In the event I default in payment to this funeral establishment, , agree to pay reasonable attorney's fees and court. co:Sts in addition to any Late Charge applicable. r understand anC!(.agree that I am assuming personal liabjlity for.\the charges setdorth in this Statement and that, this is_in additjo-n,~. .the .liab)lit-y..imp-Gsed.-by.taw "uj:!)'O'n-.the.-estate, of; the deceased.,. By my signature bel.O.,.~' I her.e.bY agre. "....'.0 all of the above and aCk~,~~le,~ge receipt of a C~7fJ of ~~~S,,~!~.t~~~,f;lt.. . 1*/"'71 :x:.~ f:J f ,:,1_ . ....:-tklf- l i;j/tj/t'A 'Jf f2",,"- Signed ~ ~ ' Dated Social Security Number (-, .,- '{' x Signed ," . Dated ACCEP,itANCE This funerilOestablishment agrees 10 provide all services, merc~jndis~_and ca;h ,~dvan6:"Andicated on ~~lS Statement. By /'\ ,."'nO 7../, 1/(',,/ T ..., J ;. .c- "n' ',-':'-.:;,' n.. r',-',,'. _ "[-C';' C;T ;1:"--,',- '\;::' :,'.' '1;" ";.". ",;::- ,!,~ ',:;: ?,'1 ~ ~ t ~ a: w Q a: o " z ii: Do 3: CIl i ... 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Ul 10._._ Ctll <'O.c.c ClICl..CI)CI) , ! ru..-.- >- , ~, 0- , o ~ ~ -x~ ~~- ~,....~ o '" ,....'" ~- ..c_~ =""~ "''''0 ,.... <C a. ""o"'~ ~~o: 0:. -0..- .- :! ;! :! Q. o -"~ om ~c .c ~ U.c u Q:1t ~'" ... 00 0<<_ NNO_ N<a:::r-- ..-' ~ a.Z ... '" "" UCI:IO<-.::t l-:::E:I-a..Ln WO:::<n I <cW ....- <nu..-..J(!) 'V lU OO:::LD X 1-2::::::) 1 Oo:::_CO........ COO-J<n_ u. _" -l:::::)MO:: ~i1i8~ ::lE:a::lC'\.!::J:: - '" '" C> U w !i' '" '" '" ~ ~ ~ ~ '" ..c ~ '" '- => o ~ '" 0> I ~~ 1~ ~ ~ - ~ ~ Ju.- ;.+: ~ ;.- $ .0- '/'\ 'I .q. ~ '- ;S' ~C)\/\ on .~ ;; ~ ~~18 J~~I~~ ~glfd:.i.1 " fl.IU Q> 8 ~~l~~ ~~lld~I"ill~~I~~ Ul~ c:> tsa..~ 11::5 lijlli ...,1'1. ....ll : !Iii lHII! III 1" III 1'1 j" W 'il in: " ,I "1 !i. .,' 1:1 !" .", filii !.. lid !in II! ; . ~ .~ " , o I ~ o N \l: ii" ~ w J~ ~ a; IE ~ o o "'- @l (j ;<: ~ '" ~ << ~ CUMBERLAND LAW JOURNAL 2 LIBERTY AVENUE CARLISLE, P A 17013 JULY 26, 2002 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Bruce Warshawsky, ESQUIRE Edith Lavina Burd, ESTATE RE: Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. --------------------------------------------- ------------------------------------------------- Advertisement inserted on following dates: JULY 12, 19,26,2002 Advertising Cost $ 75.00 $ 0.00 $ 0.00 $ 0.00 ------------- $ 75.00 Proof of Publication Second Proof Request Payment received Total Amount Due Payment received by ESTATE OF .. Hurd, EdIth LaVma SCHEDULE I DEBTS OF DECEDENT, MORTGAGE COM'.lONWOALTHOF PENNmVANIA LIABILITIES, & LIENS INHERITANCE TAX RETURN RESIDENT~ECEDENT _~"'._____.____...________ ____~ _________ _____________ --- -- -----------IFILENUMBE~ _____ __ _' ~1-2002-0575 *' Include unreimbursed medical expenses. ITEM NUMBER I Bethany Village DESCRIPTION AMOUNT 118.24 2 Verizon 9.86 3 Silver Spring Ambulance 733.75 4 Heritage Medical Group 26.00 TOTAL (Also enter on Line 10, Recapitulation) 887.85 - .~, .~ eQ\(f,l-\.J~ (V)f,~W' ilver Spring Ambulance & Rescue Assoc illing Office TIN: 23-7389823 PATIENTNAME:BURD, EDITH L .0. Box 726 DATEOFSERVICE:04/05/02 12:54 pm ew Cumberland, PA 17070-0726 Dx: 428.0 INVOICE DATE: 08/19/02 INVOICE NUMBER: 5897 Address Service Requested FROM:BETHANY VILLAGE RETIREMENT CTR TO:PHYSICIAN OFFICE AMOUNT ENCLOSED: $ 7)),1~. CHARGE TO: 0 VISA 0 MC 0 DISCOVER EDITH L BURD 325 WESLEY DRIVE MECHANICSBURG, PA 17055 CARD NUMBER EXPIRATiON DATE ~ECK HERE FOR ADDRESS CORRECTION Local: oj BACKOFTHIS FORM Toll Free: 1 Fi;\:K: 717 214-6018 877 214-6018 7:\.7 n4-602Q CARDHOLDER NAME (PLEASE PRINT) SIGNATURE ESTATE OF, EDITHL BURD 60;,~4218 EDITH.A.!:l()AKE."XEC~TRIX 101984755 1 620 L1I11GLEsTqWN fiQ" DATE 1- g ~ :JM:J, Ht,R. 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I 0' oi I ~r -' I I fr ~ , I i~ .. ~ ~ , - !)~~I 8T A TEMENT S /Vh)i')A- ,A.\;.....~ <-1<'-' ,{,v..> ~ BETHr::\I.iY I) TI.J.,nm:: POBOX (:,P~", Cnl'IP HILL. pn 1 '7(ilOj,""v.)f,P:'.'; PHO~~ NO., (717) 909-7118 F.En~ I~Dn" 232933075 EDITH BUI~D C/O,:n:::t)~l t,ncWE: 'X:'i,:' m.LE:i'I\}:rE:~1 llPI','E I~EC~.!q~!ICSBlJR(3 riA 1.7055 ACCOUNT NO. ::lCIc'. STATEMENT DATE TACH AND RETURN TOP PORTION WITH YOUR PAYMEi>n:rI'I~:;, ~,,::?~I C(,~I:(i::,., , ~~J9/1e/(.J;:':.~ MAKE CHECKS PAYABLE TO: HERITAGE MEDICAL GROUP PLEASE QQ...MQ! MAIL CASH PAYMENTS AMOUNT ENCLOSED $ c5l &, tz!!-- ~~e ~ ~tTl\-\..~ 'be<<...s..i ~~~~\elr.)~~~ ...>"I(t'{ \i!.'"lO b",,\ \<<$'illwn ~,..o \\I/'/t.i\~ ('"..\....,\10 -\. -. '. -. -..- . '-. ~18 100 313 Q&s.J6c<t- "U<>2.- :t< ~. , .- ./"..:.........:.:......:. J\,lpIe" 1oJ"" ,', ':,' . "-~.l9.~,.:3(,g.~\.."-b~~~~_'-.~:~:::L , I:OH30~~221: UH qaI.-755bll" O~OO . - BETHANY SKILLED NURSING 325 WESLEY DRIVE MECHANICSBURG PA 17055- ACCOUNTS RECEIVABLE STATEMENT Statement Date: 07/22/2002 Balance Due: 118.24 EDITH BURD c/o EDE BOAKE 1050 BOLTON CT. BENSALEM PA 19020 Account Number: 275 -~~. ?9- FINAL INVOICE BETHANY SKILLED NURSING: EDITH BURD 275 REV'.1513 EX+ (9.00) *' SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Burd, Edith LaVina I FILE NUMBER 21 - 2002 - 0575 RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) I Waldren Corcelius Brother 800.00 c/o Deanna Coreelius 201 E. 2nd A venue, Apt 3 Altoona P A 16602 2 D. Jean Boake Sister 1,600.00 922 Allenview Drive Mechanicsburg, P A 17055 3 Felix Boake Nephew 18,617.58 373 Westgate Drive State College, P A 16803 4 Gregory Boake Nephew 18,617.58 P.O. Box 578 Williams Bay WI 53191 See Continuation Schedulels) attached Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DiSTRIBUTIONS - TOTAL OF PART 11- ENTER TOTAL NON.TAXABLE DISTRIBUTIONS ON liNE 13 OF REV-1500 COVER SHEET . ',' w :;;,. ( . SCHEDULE J BENEFICIARIES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX. RETURN RESIDENT DECEDENT ESTATE OF Burd, Edith LaVina ..----.-T-. - i NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I . --TAXABLE DIS~RIBUTIONS Vnclude outright spousal dIstributions. and transfers under . I'~ Sec. 9116(0)(1.2)J 5 ' Edith A. Boake 471 E. Rock Road Allentown OA 18103 6 Deanna Corcelius 20 I E. 2nd A venue, Apt 3 Altoona P A 16602 7 Aldena Bishop 223 Bishop Hill Road Chimacum, W A 98325 8 Melissa Lopeman 685 N. Catron Street Monmouth, OR 97361 _____L__ Page 2 of Schedule J I 1 I FILE NUMBER I 21 - 2002 - 0575 RELATIONSHIP TO DECEDENT Do Not U.t TRlatH(s' Niece Niece Friend Friend AMOUNT OR SHARE OF E'STATE 18,637.58 18,617.58 2,600.00 1,040.00