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Home My WebLink About02-0576PETITION FOR PROBATE and GRANT OF LETTERS Estate of WDODit'd~/ ~/• FEkTEN~BA'uG/~/ No. ~~~~ ~~ b also known as To: Register of Wills 1'or the Deceased. County of C to M BE~Ct~4ND in the Socia! Security No, X62- ZZ -a/9/ Commonwealth o~F Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/ire 18 years of age or older an the executor named in the last will of the above decedent, dated 1k~rxmber 13 , 199.x_ and codicil(s) dated (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cu-ml~.rlomd County, Pennsylvania, with l last family or p~incipal residence at /75 der enbukw~i Lune Mechaniesb4ra /ylonroe Twasl,%A (list street, number and muncipality) Decendent, then 89 years oft"age, died ~ Tuhe /f , ~. at hg's r~s~a~ent~ ~f /7S /~1YCyI,64K4~ Lame /ylec6~nics~duro /1'lonrc~ Except as follows, decedent did not marry, ~das not divorced and did not ha~4° a child born or adopted after execution of the will offered for probate; was not the victim of a killing artd was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property g; oZ o, ~. 00 (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: N/A' WHEREFORE, petitioner(s) respectfully reqq,uest(s) the probate of the last will and codicil(s) presented herewith and the grant of letters fesTK~-l~ilfary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. v r c ~ I , , ~ ~ ., IN ~4 CF W. ERTE u .g /So FE~2T~jy,Bi~PLlGH L.~Nf ~~;, //lECyif/Y/cs,BuKG, Pry ~7o ss N0. v~ ~~ OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 1 COUNTY OF CuMBERL~fnl~ ~ ~~ 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 t}tat as personal represen- tative(s) of the above decedent petitioner(s) will wel/land truly adminis er the estate according to law. Sworn to or affirmed and subscribed X ll~Q C,J - ~~ before me this 20th day of V/kIUCE w• I=ER'7~NB ~~ ~sb F~e~nl~~•u~N E A ~ MC'CHM~/CSB~tRGt pR /7oss 's r No..'ZI - O 2.- 51 to Estate of wo d D~occ~ w. ~E,eTE7V,B~~IGy ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW J[JNE 20, 2002 ~ , in consideration of the petition on the .reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated 12-13-1993 described therein be admitted to probate and filed of record as the last will of Woodrow w fertenbaugh and Letters testamentary are hereby granted to vance w fertenbaugh FEES Probate, Letters, Etc.......... $ 50.00 Short Certificates( ) .......... $ 9.00 xn extra. pa~ges• • • $ inn ~cp $ 5.00 TOTAL $ 73.00 Filed ..6-~Q-.2Q4~ ...................... m~~ ~-20-2002 to °~ 'ster of Wi ATTORNEY (Sup. Ct. I.D. No/.) (p c.!' o!lSGI' ~~, ~~C~.t'~1/GSOIII~ /~/¢ /7oss ADDRESS 7/J-71a6 -oZo~ PHONE ~.-ti s -. J ' _ G ~~ c_. ;~5 l.rJ 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 ling. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 8391.695 No. HlOS.:.J Rev Y/B7 i YPE~PRINT IN PERMANENT BLACK INK `cv' V / 1 ~/VV~.^i r' IV Local Registrar Date COMMONWEALTH Of PENNSYLVANIA • DEPARTMENT OF HEALTH • YITAL RECORDS CERTIFICATE OF DEATH SLATE FIE NUMBER NAME OF DECEDENT If ea,.MgdO.La) ,. rotes W, r'er•I-en~ ~ $E E. M $OCUIL SECURITY NUMBER ~. -~_ DRE OF OEATN,MCM.Day. Marl .. !~-l/-~~. AOE ILaR Browsrt uNDER,YEM UNDER,DAY DATE OF BIRTH BUTfHIIACE ICnanA PLACE Di DERNICN rY aWrrv--fea.yuucMaa an,Mar v0al MOMM = OM HpA 1 ,Iilllllaa !MOnP. Day'AIYI $MMnFnagnCwrurYl _ HOSPITAL: TIIER: Vn. , ~'p~~/3 Penns Ivania ~ 7. NNr..y IrVMyrM ^ ERgIpMNr. ^ DOA ^ Ilpn. ^ MW.nuLl i5DKN1 ^ r CpINTY OF DEAN CRY, BOr10. TWP Oi DEATH RICEnY NAME IM nol+W~YAgn. 9"~• sYea anA n+roM, NMS~D EDENT OF NISPAIMC OfBGIN7 MCE ~ Am•man YgMn. aYCk, WM•. Mc. Cumberland Monroe twp. 175 Fertenbaugh Lane NnLl~,t•^BY...wacecw.n. Wqw+, P,rrq Rlcan, MC. 1$°°r"'' White M 00. f0. OECEDENT'9IlSYIK OCCUPRION IrWDOF BUSINESSIINDUSTRV VMS DECEDENT EVER UJ DECEDENT'S EOIICRKMI MARRAL STRUS~MangA SVRVR/NVG SPOUSE IGrvaYwd ~~ OunD~ d +grYY9 Y0: I ! U. S.ARMED FORCEST ^ ~ E e°~w: Na.elYmiaA, WrfaaW. °.°~~ ~ In M.9M nuaan rMrnal ~ w. No ro,n k n_. ) d N DECEDENT'S MAILBKi AODNESOISbM.CdyrENw+, SMq. Zp COM1 DECEDENT'S h Lane b 175 F rt "` N.,Aao.AM.Yr.Aq Aq ~'~ 'T`e'a" ~ en aug e „~ ,,,, Pa. 17055 Mechanicsburg ~ ~ Cumberland ""'"' NO Aa aan Br A , ,{. a„ „ . c. • tlwlWiip7 ,TB. 17L^ .wYlBauaI YPW of cAVaorB fRNER'S NAMEIFY9.Madta. UYf' George Fertenbaugh MOTHER'S NAMEIFaa1.Md0a. MMWn54anq) Sara Unknown u. n. INfoRMAf1T•s NAMEnyINy~m Vance Fertenbaugh '"`°RMA"T'S~s~~,~,}Y~'f3~`~PPanicsburg, Pa. 17055 Ta.. sae. METHOD OF DISPOSITION DATE Of DISPO&TKNI RACE OF gSPOSRION-NMa alCalwary, Cremrory LOC1EgN-CAylhn. Slaty. ZO Coe &„~,^XG~„a,„^ "~,„,•"°^~,°•^ IMaan.Day.war, pDIMrPMa Mt Zion Cemete r 17013 Carlisle Pa Dq,„q„^ IsvKaL ^ Jun 15, 2002 . Y , . . a,.. au. ma. :,8. $IGNAT OF FUME R L FOR PERSON BIG AS SUCH LICENSE NUMBER FD-012662-L NAME AND AOORESSOF FACARY Myers Funeral Home, Inc. 37 East Main Street Mechanicsburg, Pa 1705 s. zs<. 2]aa aMy aAMn ant BER Oq eaM d my Y . MMe occurraA L BM ume. Aau anA plan s,alM LICENSE NUM DRE SKiNED MrYW'+M~:rg1.vAY01•Memadewmq n WAwrt ealtl TUN /f ~_ / 1(j~~ 4 a ~MOM.D.y. lbarl a n arua ~l /.. 1~~'OA ~/(/ L a~V ss ~. / ~ 6 3- Mala2a-?e narlGagplMeOOY OF DEATH ORE PRONOUNCED DEAD IMOnm, Day, star) NRS CASE REFERRED 70 MEDKAL E1lAlI1NERICORONER7 wa+`^°vglglaN:••A.wI. ~ w ^ ro~' II 7 ~ Z•. M. ZS. 10. 27. MRT I: EMar Oq Mf.W,wyrxinncanpKCalga•IIi[n 4rKad,M WalO OO nq aru•rlM nqW dO/ap,.ucll ac cardaca r.apnalay anW.slgckaMUl Miw.. IAppotYnM• MRT M: OBw a,yWkW tgWawopivdulrgg4W OUt luq oMy One CarrtOOn aacA Ylq. Y+Mrval0alBan ~ a1a1 an0 OMBe IIOI I•aIR•19n BIe Wgan/aiBCAYM ONenh PARTI. MIYEDUTE CAVBE (Fw1 Q p I ~nu ~rl ' ` j ~ ~ y ,J Q-~ ~ ~7LC r~ n~--• l ho_~o~ct~~ ~~~m ~ ~,, DUE W IOR AS A CONSEOUENLE OF7 , -- SarygnYaOy YY mnOAgM 0 1 .uM Y, a6r g . D11E 10 PDR AS ACONSEOUENCE OfI: E N Y~ CAUSE IOwrar'nWY i ~ aHla.YafaAavaNa --... _-- DUE IOIOR AS ACONSEOUENCE BFI'. I --- - rasiq n oaanl IAST A. __ WAS AM AUTOPSY WEFIE AUTOPSY FINDINGS YANNER a OEATN DATE OF WJURV 71YE OF BWRY BAIURY R VA7RKT OESCPoBE NOW BUURY OCCUrWEO. PEIiORMEDT AVYIABLE PR10r1 TO PAmm. Day, Narl IDN BECAUSE ~ ^ l iF~ I~ Ntl ~ ~N ~ ura YM ^ NO^ AKaYM ^ MnANp YYwalpalgn ^ 1M ^ NpL7- 'h. ^ No SunO• ^ CaWOm,WtlN•rmma0 ^ PEACE Of IWURY.RIwn•. Mn.WN1. lEtlay.aRrA LOLRgNI5bwl.Cn/gwn SW1 DuYbp,aq.ISP•cAVI IOa. Le. H. ]W. J01. CERTIf1Eq ICracY Dray anal SgNRURE AND iRLE OF CERT NiR 'CERTIFYBID PNYfIC1AMIPnyycyn cerWyrq cwary aaM when ~ngna, pnyvcan has panounceA Aeam ano comu~eletl Iran 2J1 2r To,Mewe..yY.q.qaw.a..moawr.aaw.rln.~....le).mrn.nn.....I.Ma ..................................................... ~ (. -- ~ DATE SKINEDIMwiN. Oay. Yaarl LICENSE NUMBER '-RON011NCIND ANDCERTIfY1NG 1NYSICIAN IPn Aeafe ersurreA a, Ow YMa. Aar a,q ncn9 oeadr arMCe,Wyrg locwza of tlee~rl f1 TO,M beat olm YrowMAne y q.ca am ew la,M au+Ha!•ne,mm~.r as aMlee .-[J~ J,c. p~3 ?E~U~O oZ J,A, 6-~/ , , ... y NAME ANO ADDRESS OF PERSON WINO COMPLETED CAUSE OF DERH ' - 'YEDKAI EXAYB/ER/COIIONER O f i (Bem 27) TypB a PnM `/r1, I 1 ~ ~ / I7~t 6tl Phi/~e`P S ~'~ I n,M DOa 001 OuminOtNl„ Onalor m00Uga,wn, in my Opinion, A0M0 occurrOA a1 tee IImO, tlatA, and place, arW Aue,o llle eaua(q and manner as s,a,b ................................................... ^ ........... ...... . . . , `~ ' rd S r ~.! . ............. .. ...... . . ... Jfa. ' u. .~ ~ RE I$ A'SSIGNRU A N ER ` DATEFIL DIMaM.On. Warl ~ ~ I~ ~ ~~t;, L~ 20~ ~ ~T ~.. LAST tiJILL AND TESTAMENT OF WOODROW W. F7~TENBAUGH I, WOODROW W. FERTENBAUGH, of the Township of Monroe, County of Cumberland and State of Pennsylvan:La, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. Z direct the payment of all my just debts and funeral expenses as soon after my decease as the same can be conveniently done. 2. T give and bequeath all farm machinery, including tractors and motor vehicles, if any, which z may own at the time of my decease, to my son, VANCE ~1. FERTENBAUGH. ~• I give and bequeath the sum of Three Thousand 03,000.00) Dollars to my stepson, DONALD LEE GREGG. ~!- • T direct that the inheritance tax on the above bequests be paid out of my residuary estate. -1- ~• I give, devise and bequeath all the resin, residue and remainder of my estate, real, personal and mixed., whatsoever and wheresoever the same may be situate, to my w~.fe, S•RILDRED FERTENBAUGH, absolutely and unconditionally. 6. In the event that my wif e, MILDRED FERTE;NBAUGH, should predecease me, or should she die within thirty (30) days from the date of my death, than in such event, I direct the settlement and distribution of my estate to be made i.n the following manner, to wit: (a) I give and bequeath the sum of Three Thousand (3,000.00) Dollars to my stepson, DONALD LEE GREGG, and direct that the in- hereitance tax on this bequest be paid out of my residuary estate. {b) I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever the same may be situate, to my son, VANCE W. FERTENBAUGH, absolutely, unconditionally and in fee simple. LASTLY, I nominate, constitute and appoi~zt my son, VANCE W. FERTENBAUGH, Executor of this my Last Will and Testament, and direct that he be excused from posting bond o7~ other security for the faithful performance of his duties in any jurisdiction. -2- IN WITNESS j~dHEREOF, T have hereunto set my hand and seal this ~ day of December, A. D., 1993• '~t~ ~.~,{, ~ (SEAL ) Woodrow W. Ferteslbaugh Signed, sealed, published and declared try the above named, WOODROW W. FERTENBAUGH, as and for his Last t~ti'ill and Testament, in the presence of us, who have subscribed our names hereto as witnesses, at the request of said testator, in his presence and in the presence o£ each other. -3- COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND ) I, Z~TOODROW W. FERTENBAUGH the testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and 'Cestament; that I signed it willingly; and that I signed it as my free and volun- tary act and deed, for the purposes therein contained. Sworn and affirmed to and acknowledged before me by WOODROW W. FERTENBAUGH the testat pr this ?.,0~~ day of December ~ A• D• , 1993. ~ ~~~ ____,_ ~~t~t ~ p,~M..3,~!~n Kay Kn/,~ i~,~!ya.,ry. F•~~:: hSyCor'mi~ E,:~ir~ 31:r-. ~~, t~/ COMMONWEALTH OF PENNSYLVANIA ) S S . ~, peruisYivania Assodaton of P+lOta COUNTY OF CUMBERLAND ) We, the undersigned, J. ROBERT STAUFFI~ and ERIKA L. LEVENHAGEN the witnesses whose names are signed to the attached or foregoing instrument, being daily qualified according to law, depose and say that we were present acid saw the testator WOODROW W. FERTENBAUGH sign and exe- cute the instrument as hiss Last Will and Testament; that the said testat~_, t•ZOODROW W. FERTENBAUGH executed it as hiss free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the testat~_, signed the Will a.s witnesses; and that to the best of our knowledge, the testator- was, at the time, eighteen (18) or more yeairs of age, of sound mind, and under no constraint, duress or undue influence. Sworn and subscribed to before me this ~~ ~` day of ~ December ~ 1993. McAlyn E~dn, Notary °u~lic ^~ AAecharucsb~~ ro, Cumteslanc', Cairn, My Commission F~'res Nov. 5: 'Ii37 CERTIFICATION OF NOTICE UNDER RULE 5.61'x.) Name of Decedent: WOODROW W. FERTENBAUGH Date of Death: June 11, 2002 Will No. Admin. No. :Z1-02-00576 TO THE REGISTER: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on August 6, 2002: Name Address Donald Gregg 5295 E. Trindle Road, Mechanicsburg, PA 17055 Rodney Gregg 146 Fertenbaugh Lane, Mechanicsburg, PA 17055 Stanley Gregg 7249 Wertzville Road, Carlisle, PA 17013 Tambara Swartzell 250 Kenmar Dr., New Cumberland, Pennsylvania 17070 Mr. Vance W. Fertenbaugh 150 Fertenbaugh Lane, Mechanicsburg, PA 17055 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: August 6, 2002 CHARLES E. SHIELDS, III 6 Clouser Road _+ i ~:" Mechanicsburg, PA 17055 Telephone: (717) 766-0209 Counsel for Personal Representative ,-, _... ~, -~, CHARLES E. SHIELDS, III ATTORNEY-AT-LAW 6 CLOUSER ROAD Corner of Trindle anti Clouser Roads MECHAMCSBURG, PA 17055 GEORGE M. HOUCK (1912-1991) March 14, 2003 Ms. Cheryl Winters Office of the Register of Wills Cumberland County Court House 1 Court Square Carlisle, PA 17013 Re: Estate of Woodrow W. Fertenbaugh Dear Cheryl: TELEPHONE (717) 766-0209 FAX (717) 795-7473 Please find enclosed herewith two (2) REV-1500 Forms. The following checks, made payable to the Register of Wills, are also enclosed: Check # 613 - $1174.83 -Inheritance Tax Check # 612 - $15.00 -Filing Fee Check # 611 - $20.00 -Additional Probate Thank you for your assistance with this matter. Very truly yours, Charles E. Shields, CES:dab Encs. v~ n M ~ . • ~ o 0 ~ .. ~~ ~ ~o~ ~ n c'ZO~ . b a :r O r ! r~ ~• D A ^ ~ S'n V1 ~ ~ l~ ` ` ~ ~ ~ VI ^^ T V j ~ ^^ 1~ ~ ~ ~ ~ ~ 1 O F-+ W O .~ m ~ ~ A y 4 ~: _-, ~~ ', ~ ~, ~ ~~ ~ , a ~.` :%~. S !~~~Y ~ ~ ,. ' ' ,. ~g:i N '~ O ~~_°~ ~ ' ~~ ~.~' ;,7 ~~ ''' ,~4 ~ ~ .. . 9 ~ ~ ~ y ~~a, ~---_ 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 SHIELDS CHARLES E III 6 CLOUSER ROAD MECHANICSBURG, PA 17055 fold ESTATE INFORMATION: SSN: 162-22-ois~ FILE NUMBER: 2102-0576 DECEDENT NAME: FERTENBAUGH WOODROW W DATE OF PAYMENT: 03/ 1 7/2003 POSTMARK DATE: 03/15/2003 COUNTY: CUMBERLAND DATE OF DEATH: 06/ 1 1 / 2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 ~ 51,174.83 TOTAL AMOUNT PAID: REMARKS: VANCE W FERTENBAUGH C/O CHARLES E SHIELDS ESQUIRE CHECK# 613 SEAL INITIALS: CW RECEIVED BY: DONNA M. OTTO 51,174.83 DEPUTY REGISTER OF WILLS REV-1162 EX(11-96) N0. CD 002295 REGISTER OF WILLS r oV, STATUS REPORT UNDER RULE. 6.12 Name o f Decedent :~it'o W ~, ~'~'~'16Q.u~~7 Date of Death: G'l/ D a- Will No. Admin. No. ~l 6~-6J`,7co 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 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 Cerk of the Orphans' Court and may be attached to this report. Date : `f • 2 8'' `~--~ ignature "~~ '"~ ~ ' Charles E. Shields, III c:~ F~a ~ ~~ Name (Please type or print) rJk ~ ~ °° , t~...'k 6 Clouser Road, Mechanicsburg, PA 17055 ~- °~ ~ Address ~.. , ~ ~ ~. , , _ (717 ? 766-0209 ~~~ ,,^ o -~: ~ ~R Te 1 . No . ~ ~ Capacity: Personal Representative Counsel for personal representative (MAH:rmf/AM3) REV.'';OOEX (S.OOJ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 2B0601 HARRISBURG, PA 1712B-0601 1- 10- 13 ~E'V-1500 I- :z w c w to) w c w ,., :.::Scn ,,"'''' w"" ",00 ()"'~ ..10 .. " INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) rEi'RTENB4UGI-I / WooD~oW W. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 0"-11-02,. 05-27- (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Nlft 13 ~ 1. Original Return o 4. Limited Estate ~ 6. Decedent Died Testate (Altaell COjJY a/Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise \d~e al deatl1 af\e112-12-.62\ o 7. Decedent Maintained a Living Trust (Atiaell oopyorTrust) o 10. Spousal Poverty Credit (dateo/cleath between1Z.31-91 and 1-1-95) OFFICIAL USE ONLY c: / FILE NUMBER .2-.L-~.d .!!() ~1..~ COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 1"2 -:? =< - 01'; I THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (date of deeth prior 10 12-13-82) o 5. Federa~ Estate Tax Return Required o 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (AtlachSch0) NAME ").;4~ PA E 5HIE:LDS-::or >- z w o z o .. '" w '" 0: o () FIRM NAME (If Applicable) COMPLETE MAILING ADDRESS (;, C Lou (je-~ IV>. f11EC/--lA-NICS13UR6-, fl/l- 17fJSS- TELEPHONE NUMBER 7 f7 - 7("(,, - ozo'1 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) 12) (3) (4) (5) 3. Closely Held Corporation, Partnership or Sole-Proprietorship :z o ~ ...J ::l l- ii: <( to) w a:: 4. Mortgages & Notes Receivable (Schedule 0) 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~Prabate Property (Schedule G or L) 8. Total Gross Assets (tolal lines 1-7) 9. Funeral Expenses & Admlntstrative Costs (Schedule H) 10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Une 11) 13. Charitable and Governmental BequestsJSec 9113 Trusts for which an election to tax has not been made (Schedule J) (6) (I) - fJ- (9) (10) t/> l::i, fLfb,37 11l{.22.- 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES :z o !;( I-' ::l a.. :::E o to) X ~ 15. Amount of Une 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) o if OJ", 107, '1-1 o tI x ,0 t2.-.. (15) x ,otiS... (16) x .12 (17) x ,15 (18) (19) 16. Amount of Line 14 taxable allineal rate 17. Amount of line 14 taxable at sibling rate 18. Amount 01 Une 14 taxable al collateral rate 19. in Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT OFFICIAL USE ONLY (8) ,. , 3e 968'.00 , (11) (12) (13) It Of. rQ , !;}., 0 ,,0, 0. Clr;" 107, if! o (14) dc" 107, if ( o ~ j,n'/,t3 o o ~ 1,/7'-/, f3 ""',.-' '>".')11". Decedent's Complete Address: STREET ADDRESS /7S FE RTEf\fB4 t( &f-/ LIINF . CITY fl;!{;CHI'l-I\JIC516 r.uUr I STATE PI/- I ZIP /7oSS Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) - I, 17lf.tJ t) C o Total Credits ( A + 8 + C ) (2) f' 1,174.83 (3) 0 (4) D (5) , I, /7'1J3 (SA) 0 I (58) I. /7 lfJ3 3. InteresUPenalty if applicable D.lnterest E. Penalty o o Total InteresUPenalty (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 Une 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. 8. Enter the total of Une 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT ;li>;,.., 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, 1962, did decedent transfer property within one year of death without receiving adequate consideration? ,......................................................................"...............,..................... 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 4. Did decedent own an Individual Retirement Account, annuity, or other non.probate property which contains a beneficiary designation? ............................................................................................."......................... 0 Yes o o o o No irI o o IRI ~ 00 00 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, 1 declare that I have examined this return, including accompanying schedules and statements. and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer ottler than the personal representative is based on aN information of which preparer has any know:ledg&. f71f /7oS" DATE 3./ '1-C' S DATE ~'i9-u ~ ADDRESS ['E:5 P ;SHfS-~S (g CLovSrg< /fLJ, /J1l?CH/JAlfC'SI310~6, j1A /7/)5''> ,~~~"I.1~"';'m't'?i;-?~:r:::'~7'~,';',:':'7?~:<.::"":::,~::,;~,~~,r'?~;'~-t;~,~;[~1"'..,,~~1:~,.,,>;",~~~m;:>l>~,~,<ll..,_~.~_.._ _~..~"'l1I!'!:,"~,~~~i';~:.~~.~~ 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 survivjng 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 vaiue of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) Iii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty.-one years of age or younger at death to or for the use af 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 sibiings is 12% [72 P.S. ~9116(a)(1.3)J. A Sibling is denned. under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. R""~''':,''''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATEOF FE!? (GJ,//JlttxG-l/, wPof)l(#tV SCHEDULE B STOCKS & BONDS w, FilE NUMBER I ;z/-o~-S71O All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH PIi!.UP(FI>/-r"H mUIVlclPAl /It;:IIII11Jf. FIlAJi>: CUI.ss -1 /1ccbt(J{)T .#J, 3,ylPo~/o751 :.. n eot 1>,v//)E'Vl> ON /TG"/11 NIP. I (SEiE LG77l?7f FlU"'" PJI!UDl91J77/H- F/JlI;1I1JC//fL f' 'f,':?'1/.tfO .; 7. .!'f "#7TA-tlHeb Hare.;!) , TOTAL (Also enteron line 2, Recapitulation) $ if, J/.{'l. (,1 (If more space is needed, insert additional sheets of the same size) Prudential ~ Financial Patricia Cimmino Senior Customer Service Associate Prudential Investments Prudential Mutual Fund Services LLC POBox 8098 Phiiadeiphia, PA 19101 (800) 225-1852 www.prudential.com CHARLES E SHIELDS III ATTORNEY AT LAW 6 CLOUSER RD MECHANICSBURG PA 17055 Shareholder: Woodrow W Fertenbaugh Account Number: 3800210751 August 26, 2002 Dear Mr. Shidds. We have received your request to redeem the Prudential mutual fund account in the name of Woodrow W Fertenbaugh and to provide you with account information. As requested, Mr. Fertenbaugh's account was redeemed on August 19,2002. A check in the amount of $4,3 76.51 has been mailed and should arrive shortly under separate cover. On June 11,2002, the value of the Prudential Municipal Pennsylvania Fund: Class A account number 3800210751 was $4,241.80. The share balance was 412.225 at a price of $10.29 per share. The accrued dividends were earned through this date in the amount of$7.84. The account value is determined by multiplying the total number of shares in the account by the Net Asset Value (price per share of the fund). Please keep in mind that the Net Asset Value of the fund fluctuates on a daily basis and therefore, the account value will also fluctuate daily. If you have any questions, please call the Prudential Mutual Fund Service Center at (800) 225- 1852. The Service Center is open Monday through Friday between 8:00 a.m. and 8:00 p.m. Eastern time. If you are using a telecommunications device for the hearing impaired, you may call (800) 654-7637, Monday through Friday between 8:00 a.m. and 8:00 p.m. Eastern time. Sincerely, (15Q:1JUt;/ft J ~ Patricia Cimmino Senior Customer Service Associate REV1~6E:''''''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF F El<rG"I'I8.4tlGH, 10. FILE NUMBER .:z /-D2 - S7fe, /A)tJob!<pw Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointiy-owned with the right of survivorship must be disclosed on Schedule F. DESCRIPTION VALUE AT DATE OF DEATH ITEM NUMBER 1. CITIZE"lVS BJ'/NI< SJfVIAJG.s ffeeolANT #Pt)tJ{)"'f02tJz.8E'f d. CITIZENS 6/1NK CHGCkIII/6- 1I-(!.(!.(!IUIJTd::: (glooSq-l{.{)f(-' (see I7r,,,fou.'ts: h- e;fizen5 q!'ad,et:I h~re~) 3. G E /lhntt ily elt>S~D"t 'lmount (}eh In /vII lief- :Tnven~ry Df ArsDIltJ./fy _ (see fypte/ r;!,f affachedj 4. F. I" .:/0, t,o't.oo ~ I:t., :>78.tQ ~ /,/0/.17 /" /.:? . 00 ,: '1/ %.00 TOTAL (Also enteron line 5, Recapitulation) $ 31, 7/ B. 310 (If more space is needed, insert additional sheets of the same size) Command ;~~l Page 0: o~- C~ ACCQUNi'!' INFO:ro.!l~'1'I()N Account 00006140202384 Ct12 060 Ct13 000 Ct]~ proe TYPE ,,_':0 STNfEMENT SAVINCS ~lSGS: SJ-l. Dt Opened 07/18/94 Dt Last Dr 00/00/00 FERTENBAUGH W Dt Last Cr 07/18/94 Officer 292 Dt Last Mnt 08/26/02 ..---- AATURTTY ------ Period Incr 000 Ann\! Day 18 DIy Accr Unrdm Aoor ~ Accrd Int prin Dist 0 proj Accrd Auto Renew 0 Redep Inc Nxt Mat Dt 00/00/0000 YTD Tnt PF4-Hist PF5-Redisp PF12-Help PF14-S/H Inq ST0051 I; STOP/HOLD ON ACCOUNT WOODROW W FERTENBAUGH 1.75 FERTE!'JB.:"UGP. LN MECHANICSBURG FA 17055-9504 Cust Nbr ':'IN 162-22-0191 Short Name Branch 292 DORMANT HOLD EN~IRE Bh~ANCE PF1-F'.,d TSSTMSEl MAt2. \ l1 J.J 000 Ct..ll O~ AvaiJ. Bal Current Bal closing Bal Coll Bal Holds .. Pledges ,l2.." 14: / c. 15:06::-;~( BALANCES --. o. ()( 20592.7: 20592.7; 20592 ~ 7~ BALANCE O.O( ----- DRS j CRS Last Dr Last. Cr Drs Toy Crs Tdy Q o O.O( 4 ,,- O.O( o.oc INTEREST --- 0.14103' 1.83126; 1. 8: O.O( 42 ~ 8{ LAST 7th S;, 1-> A f ~I NT 06) CJ +" MIL.. ~-Z:TEV I~ H..1)- 1-\ U. BALANG6' .Prs. 01=" t, -/1- 0;;;:' Sp,VllJ(,? It-u.oo jST . 15 ;;O/~o9. GIG. I H J) Acri V lTy BAG 'C. l.s t+f tv Fv L... /fr..i~ H-!4\J1$ A+1 A-G \-t 8"> A ++U1tt2-y OF /2) JOf'oJ r;; 02.. L ;--tyP e 1>--1 d".. ? lEAf€' O-)-L.l... ! Q '06 $[1<.?Al S ) 7)~1r: [oJ. ~~~~ ;;I~."ii I L: 'CI~ 1~'; 1::=; FF' :-.'1 T IZEt'L::; E:t~i.n HE;;:.; Command ===> STI2 '71 '~: -:0.< ,::-.).i S':=:'::"~' TO '::i""":<S7..~7::::;; I:'. D.3 Prod Name ACCOUWl' HI S'1'ORY Account 00006140202884 Ctl2 060 Type 650 S'l'ATEIIlEN'l' SAVINGS WOODROW W FER'l'ENBAOGH AMOilll'T / RATE SEQ BATCH TRAN 1.41 7.00 4.37 7.00 4.37 7.00 4.23 7.00 4.37 7.00 INFORMATION Ct13 DOO Ct14 000 Ctll 01 11/15/02 12:01:13 DATE C 06/30!02 01 D 06/30!02 05 C 07j31/02 01 D 07/31/02 05 c: 08/31/02 01 D 08/31/02 05 C 09!JO!02 01 D 09/30/02 05 C 10/31/02 01 D 10/31/02 05 SVC CHHG/ DESCHIPTION TAXjRA INTEREST EARNED SERVICE CHARGE INTEREST EARNED SERVICE CHARGE INTEREST EARNED SERVICE CHARGE INTEREST EARNED SERVICE CHARGE INTEREST EARNED SERVICE CHARGE PFl..F,]d PF2-Bkwd PF12-Help PAZ-Prompt STPC12S1 ST0047 I: LAST PAGE WB WB WE WB WE 1ST -' ~ ":'- OLC,' ..~.,:";,~!.,~~' i.:'j I:>:.:..,;:,....:..;.. :"!J ".,::; :' r,,;;,:-,_':i:, - ~;:' :-,.'~,:' ~-,.:.'7".f~:'..';'! .:';:::'~', ',' ~.', '-:SL.:...:>: s":'r,:~i,E>I--:- .!,.:..;..,~..:....:'~~.J'jS S:I';C: ,'CI.'~: l.':',;:"':' TR~~~~F:R~~: ~:. ~:T:ZS~!S ;~~.'( .";Y:;"::-~l~ ,;~~...,,' 'i(;i, ~"':< -:;::.,;c':"l:~ \\~':'I :.;~'~::2::"'i:::. :;~E::"'.:\-:-:(,'\ '?:-:: 7 3:'>,~i\::;':-' ':"2 :'0;;:-:- .~.:::C': .'t<':'~::: :::~;::,~:"~:"::: ~':,;.;. -:-~l"'::::F:-;;T . ,-" ,..- \';: ';",1 i.; :ii,t;~: ,:.,~:cc:: <1 8':'.; --l ;;:-Z::-'i,;;: .:0..',..... __._~,'- ;:;rY':;;',':';'f ~;,,,.'J:Nc; L:t~,:':'.'';-_'..:: At.: rJ~ :'S/2',/::::' '!'(';J..:.. :',::?OS!:'S ,=-ST ',)':''-(E:~ '"';::'0:-'lnt~::: T ~Jr:~,~ln7 ~~-;; 1'~7,;'\:' ;:;.n::':"!<:;";;l..',T r'rl W,i,- '^' l 'J ;':~1~A~'J':":"8 IJ'!C:"'...T~N':; ?"2E:;:: _I:.,~I:; CH.n.ECSS T"':::3 ?ERI(Je 7rJ':"'~R:c~']' ClI.!';L\;'J'LL,:: 'ri,~,:; ,'!::FU.:::': ~:,(;;;:'J<= Q.:'.:"'-.,.,":t. 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':-:i;~::~i Qt'c;:l:);'!:O)a8932J ~~, OJ0000020J~3B2;' j ,(-;;;_t;_.,.~; c;~-; 'j''"!::: 1r..3T ,':,.. :.';J:_'~ ~2~,:T ~i\<:;-~~.::.=.,n::' _';~:~', R2C:::'J:'y'EC'!;;'; Cleo'. ':':;::~,t::T:: ru~: ':;::::"::.::'1' :-:~~'rnFWN:-:;:.::; :J, ';-1:;2; ,:;f.:~A;SS7 :':;H0't: O~; ::;PJ.e:r-!1 -:'rc C:",':;'_',:: IS ;,? :'~E I--I':'K;,\Ii:::'d)AR~~ _!l,;;;~E::'1;'" F:;;:'O~ !1;"~ ',:"'_?'": '~U :)R.21S.~: ':''::'::::<~':"2, '~,'\:"L 1-'lGo-v,r.>.E'r:'~.~':'r\I~.' : ,'.::>:~-6837 i /I,t-il', ~iEr.:7I()~,' '.::e:Gr. w:, "/':',', ~,L.::' ,.1l.":~::U':T "'," :,':' .:..>., :;~:SKs~::~r, Nr" ", ~G~';(l~ ~. (:('2':, r.. 3.::::' .: CITIZENS BANK HSo-910-4100 r.:.~dl '<:it1len~' PnOnelltlllK anyttmt: for iCC01.m~ Informacor" current rates anci answers tt YOU! Quest)r::on;. U:;OO? BRZ92 ~QODROW w FERTENB^U~. ,75 ,ERTENBAUGH lN MeCHANI:5euRG PA 170S,-9S0~ C1tllens CHCl(~ Summary .u.;...-a.......-.----~ ,~- .~.~_..".-~.._..~__~__________ ________~_...w~_~_. Account Account Number ----..-.--.-------------..-.-.---._~...__....____..__....__..._.._._____..___.M.~.."...._.__.. Balance Thii: Statement DEPOSll BAlANC, c ~ e c k 1 1'l {; Circ:le (heCl<in~1 with Interest 5 (l v i n 9 s Statement Sallitlg~ 610089-409-6 6140-202884 ""emb~r ~I( 9f(l11~1 l1o<lring l,..iI~lItf ~~i"~""o)~ .::~ f~t ;"'~{"(f."t 11]1~irh.~'.~I, DEe 11 '02 09;25 e.lan... Last St;;tement NO; AVAllAllL, NOT AVAILABLE :ii:1H'Th:'JrClf AccOunl S~~tQ~~t'n: : Of !:ic';innino JUl':l 21 20Ci tr:r::lugt1 jun~' 2S r 2002 :::'ontents SUTTT13fV Check 1 n9 f'agf; Page 2 0,680.69 20,574.00 401 455 S&Sl --_._- --- WOODROW w FERT!NBAUGH :;rele Cn@ckinq wit~ I~tefest 510~~9-409-6 - Total Depo~it 8alance 29.2,1;.69 iotal Relationship Balance 29.254.59 ~ ~ ~ ~ "- FRGE.05 ,~~ '"' .. I..."ITIZENS BAI\"K 1.8~,.9l0.4100 Call ~lt1zen5 Phone8an~ ;nytime for a'coun~ lnfor~aTj~n, curr~nt rates ~nd ~nsweT~ to YQU! questlon~, - --- - =-_oz=...= Cn~ekJng sur'.~iARY Balance C~lCUlqt)Cn ~rtvlous Bal3n(e Cnec~ s Witndraw.ls Oepos1ts & Addl~ions Interes~ Paid 8,.80, ], ,00 _00 .. ,00.;. Current BaldnC:l ~30 ... 8,6BQ,69 " ::00--- - . ':1 t j zen:; i.. I ; ~ i ~ Accu~nt $:4tP~~n~ 2 Dr B6ginnir.~ JU~7 21. 20C~ thlOUgh Junf'~ 2002 --=-_-......::: B.lan,. Average D~ily Batance lnterest (Uf'e~t lnter@st Rate Annual PercentaQc Yield E~rned Numb., of Pay, lnt.re,t E.rned Interest f.~rneCl Interest PaId this Year ~,680,39 .2,,;,. .25'/, 5 .:W 15.79 WOOQROW W FE,TENBAUGH C~rcle Chec~Tng with Interest 610089-409.6 Previous Balance " [ T A I l S _____________.,.________._.w....y__._.__________.._____.___________.....____.__..___.__..__... 5,680,3, T RAN SAC T ION Interest Oat. It"" No. 06/25 Amount Oescriptlon .30 lntere<jt Ddlly Balance Date 06/'15 Sa lance 8,580.69 Date 1~\U'l,b~f ftll~ C l"",~l HO~~_"'I ~'nQ!r )~.. ~Yl:-.t .f;l~ 'to' :"'\'~'l;;nl ,n!e;I1'.J\:~~ DEe 11 '32,);;:25 Balantt: Date a<ll,anc;e 401 455 5651 fatal l~tere~t P;ic + .-..-........--------....-. . ;0 CUrrent Balance: B,&BO.69 co - ~ - .~ "" PRGE.El6 t; CITIZENS BANK 1.880-910-4100 Cdl. Ci:lzen:;' PhOr1e6an,k: anvtlme fo" 3CCOlln: infcrrnatlOI], curren: r~tes ~nr dnSwefS to you: qU~i~lons. U:;OOi BR291 W:OGROW W FERHNIlAUGH lJ5 FERTEN8AUGH IN MECHANICSBU1G PA 17055-950, ~ =~.=--- ....--...-- ---------- --...-------------.-...- ...-----....--.y----------..----.--------...--...---...-.. -_.__...---..........--.-....- (lti.zen'i (jrr.l~~ Sl.IIDlary A"oun~ Account NUr\cer Batal'lce Last Statement D[POS:~ &Al~I<CE C h e ell:: n 11 Cinle Chteklng with lnteffst S a \I 1 n 9 s Statement Savings 610089-40~.6 8,680,69 6140.202884 20,574,00 A'Ill!rage molrthi~1 combi"~d bal<lne:e to wafve 1I'O"tl1ty he i'j 'tour 3\1'erage m,)nthly combined balar,e:e this statement ptrtod is ~i Mtmllet rore ~{qlJ~IHo"fiIIQ l~rt(;t'r ~~ "1:'-..-:. \;~e I,' l'rWO,vnT ,ni"'...:.iw, D~C 11 '02 09:25 ::. i'~ lIen: C. j 1C (:' Accoun~ S~atemer.: 0' o aeQ 1 rm) no Jun~ 26 ZCO:: ttlrougt1 JJLy 24 ZOO; -",,=---..,...-~-- Content:; SlJ'l1l1ar~' PaClf:' Check 1 Mfl ~a9(> " Ba I ,nee This Statement 8,681,41 20,575.41 WOODROW W FERTE~8AUGH Circle Checkina with I~teres~ 610089-409-6 - Total Deposit Balance 19.257.82 10,000.00 Total R,t.tlonshlp B.laneo 29,Z5S.95 - -~.....-----..~-~~._---_.~~ 431 ~SS 5661 29,257.51 ~ * :l. PRG::.e7 ~~ Clf"rTZENS B NY>' ...... .!.l .I.. A~ r.. 1-888-91_ -4100 ~al~ (itizqm' rhOOI!8i1nk inytllllf fo.- accounr lnformatlOH. 'UTT~f1t rates and answers tD your QlIest IOI1~. ChH<\ng '"'it tzen:; (.\rei.:: Ac~oun: Stat~~n7 c OF , 8eginninc Junt 26, Z002 tnrough ~U~j 2~. 2002 ~_.- -~ -_._'~._..__...---.._--_._-----_._.----.._----------- -------------------------~.._- SUM~AF,Y Bala~~e Calculatiop Prevfous 9a(ance C~ec<s Withdrawals Depo,its & Additions ll'ner~:st Paid turr.nt Batance 8.680.00 .00 . all .00 ~ 1.n ... 8,6i,.41 - WOOOROW w F,RT,~B~U[,il Circle Checklng w1th Inteiest Balane. 610089.409-6 Averagl". Oa'ily Balance lnt.r.,t Current lnt~r.st Rat. A"nual Perc~ntage Yield Earned NUMb~f of na~s lnter@>t Earned Interest: tuned Int.r"t Paid thi, Ye,r 8.660.69 .251- .251, 29 1.72 17.51 Previous ~olanc€ _____.__.........__.__..._......_____R_.______.__......__._.........-...w..........---.--...--- ......-.....--..-............. TRANSI.Cl:0N DETAILS Interest O.t. rUm No Amount DescriptIon 01/24 1. n lnttrest Daily BaLanc(', o.t. 07 (Z4 aolonce 8,6&2.41 Date M~I!\be' fOU. C.H~:-i ll;;'llSII}D .!n~p.f s(C .....<t'1. ~I~. I~' '*.'.I\~.II\ IIlIUI :n~t'~n D~C 11 '32 0g:25 Balance Ddt~ Ba ~ ance 4<31 455 5651 &,&80.&9 lot~l lnter~st Paid 1.72 Current 8Zllal"lce 8.682.4) '. 'r. " '" Ii. PRGE.08 ~: CITIZENS BANK 1-888-910-4100 C.ll! ~itlze:nc;' l'honeBank anytime for aCCOU:1t informatIon, current rates and amwers to YOu' question'i., CnecK '"9 SU1'ir~,ARY Balance Ca\~utatlc;, Previous Balance Che,,, With~~awals DepoIl" & Addition, Interes.~ P.id 8,682.41 .oc 8. bi2.41 .00... Current Balante .00 ... .co ~ TRANSACT:ON DETAILS w1lner_wals other WithdraWi:lts Date It.., No, 07(30 4341382,; Amount Description 8.662.41 D.b;~ Mnmo 0. II y Ba lance Date 07(30 BaLance .00 Date /!\E;nb". Hlrt" :!n'l\l.a\ H~\,lIIQQ ~'I\~~' ~.,. """.,,.- \1M r~T '''''FO'Q~t :1I1..r"'..II~n DEe 11 '02 09:26 -- = Balance Avorag. Daily 8alan:, lnterest Luyrent Interest Rate Annual Percentzqe Y\et~ Earned Number of Pay, Interest Earned Interest Earned lnt~rest PaJd this )ear Sa lance Oale 6.201.1:' . 25~. ,01)'1'", ) .00 17.51 Balanc@ 401 450' 5661 Cltll~!"'i~ Cir~ll' Ac~ount Stat~men~ 2 0, I Beglllnjr.~ July 25. 20P2 througll August 23. 2002 -""""= WOODROW W FERTENBAUGH Circte Checklng with Interest 6100M.409.6 PrevioU~ 8a:an'~ a,681." Tot., Wlthdr.wai, 8.682.41 (urri!'nr BalZloct' .oc o ~ - o? '- PRGE.18 ,; CITIZENS BANK 1..88S-910..4100 (,-,L CttlZens' Phone&an~, <1nytime fo: ac.count Intormatio1'l, LUlren~ rate~ and answel~ to your qucs~ion~. lliO,9 BRZgz 1 WOODROW W FERT<NBAUGe 17, FERTFN8AUGH LN MECKAN1CSBURG PA 170\,.9,~ - Citilens Circle Summary Cl':l2.e1' CHell:- Ac'ou~: Stdtemer.t J. ij~glnnin4 JULY~: ZOOi through Augu,: 2;: 2001 ---- Contents :>ummary Cnec. ing fog' 1 Pago 2 ~ --~- Account Account Numb~r -.----...----.----------..----------...--------....---------...-----------....---------.....--. ----....----- -------...------ B3l:tnGe Lut Statement --.._---------~_._------._.__.~------_..__._------._....----------.-.-.-.-----...---. ---------- Balance This Statement DEPQo!T BALANCE Checking (hol. Chec.lng with lnt"e,! 61008~.409-. Savin~s Statement )avl"9) 61.0-2028&4 "'ember ftlrc O'C1..~1 i10Ul{~1l t"no'lT $H ;''''''1;'' ji~~ ~\,. ''''Mr::..., mi~;~I"~:"', DEe 11 '02 ,'9:25 8,682,41 ze,575,", 20,579,78 WooOROW W FERTENaAUGH Cir<l~ Ch~<Kin9 ~ith Int~r'SI 610089-~09-6 .00 lotil Veposlt Bal2nce ZO,579.78 Total Rl!lat ionship Balance 20,579.78 -, "- ~ v '" "- 'I::>\': Ten RL F'8GE. CIS ** e' GE Life and Annuity Assurance Company ~ ~) POBox 6700 ~ Lynchburg, VA 24504-6700 PLEASE DIRECT INQUIRIES TO: 1-800-253-0856 12900044005 1 1...111...111"111.1..1.1.1.1...1.1.11","1111111.1.1.1...1.11 THE ESTATE OF WOODROW W FERTENBAUGH c/O CHARLES E SHIELDS III 175 FERTENBAUGH LANE MECHANICSBURG PA 17055-9504 Description Policy Number Payment Information Amount Comment POLICY 0110243083 REFUND OF UNEARNED PREMIUM OF $1,101.17 I Check Number 2900044005 Check Date 08/29/02 Check. Total $1,101.17 c~nl)~ 01" "-00 Please detach before negotiating check . GE Life and Annuity Assurance Company POBox 6700 Lynchburg, VA 24504-6700 CHECK NO. 2900044005 51-44 119 DATE OF CHECK 08/29/02 ONE THOUSAND ONE HUNDRED ONE AND 17/100 DOLLARS PAY TO THE OROER OF CHECK AMOUNT THE ESTATE OF WOODROW W FERTENBAUGH C/O CHARLES E SHIELDS III 175 FERTENBAUGH LANE MECHANICSBURG PA 17055-9504 $1,101.17 Fleel Sank CONNECTICUT N.A. HARTFORD, CONNECTlCu1 ~ _~'r~?- Au1horized Signature ,,'2'WOOI.1.00S'" I:O~~'WOI.I.SI: W7b7'" Personalty Estate of Vance Fertenbaugh Old couch Old rocker, upholstered Old recliner, upholstered Old floor lamp Old coal stove-unused for years, junk value Small square table Small oval shaped stand Old 12" black and white TV- no working Miscellaneous dishes & kitchen utensils and hand-held appliances Old living room suite, (fuzzy) Old square table Old heater - not operating 2 folding tables Old small table Another old couch Another old rocking chair, all wood Old wooden chair Old corner table Old dining room table and 4 chairs 2 more small tables Old white metal kitchen cabinet (bent up) Small cupboard Miscellaneous hand tools Old butchering tools TOTAL $2.00 $7.50 $8.00 $1.00 $0.00 $1.00 $1.00 $0.00 $25.00 $65.00 $5.00 $0.00 $100 $100 $2.00 $500 $5.00 $5.00 $60.00 $2.00 $3.00 $3.50 $15.00 $20000 $418.00 REV-15ll EX+ i12-99'-s>",~/~ ~.v;. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF .:2-/-0.:<-57" FE~TENt3I4-UGH / wooD/CPW W. FILE NUMBER Debts of decedent must be reported on Schedule l. ITEM NUMBER A DESCRIPTION FUNERAL EXPENSES: myerS Pi<nerCiI HOWle of Mee~ll.ll;c$b"'~ ~. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 2. 3. 4. Name of Personal Representative(s) V,4I1C~ w. FEt<r€/IISAaCI-/ Social Security Number(s)/E1N Number of Personal Representative(sl Street Address City State _ Zip Year(s) Commission Paid: CL4 l-~ ,.., S' 'e./cls -.r ('f:: :r"d.J., 2 1","1 op:":."s os fu Attorney Fees "r ~ 1:::'". n...w. J acle"W'kon <<Me! ae(ven<> r!j-h1:S a.1t-en..p/1,,/ tv "'" c:,ss".rfed "-'fi~st ~,fa.Je) Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant (lI~1V J;" Street Address Cily State _ Zip Relationship of Claimant to Decedent Probate Fees W O"-;(j';",,1 ,,,Site l>~ ""h.r+ c.",.t;,i;'""reS 5. Accountant's Fees 6. 7. It. If). II. 9. TaxReturnPreparer'sFees Jema- 6"'A.c.k~;f'- Iff/? ;j/~t:-!<, /~'I{),/#I/I//!/1I/{)/P/fI!Jetc_ IIdverlising ," C......k.-I..nd LILuJ Jo,-<-,,,o.f Irdverfis;j ", HllrriSb"'J P",f,..:.t- Nt>-J5 Cerf;jJ~'" ",,,;/;,;/ ~ Dsti we::J re: w;I/, e:t<. {lediCd I1Iq;/'~1 of; ])dOl'es ~ ",: w;//, ",1:. ('ed/6ut /I1I1;/.'-' ~ iGa',,~ €>r<Si r-e: w.-If, ",t<,. AMOUNT #9_'-3S.r..O W/l-IVeD t d./ S38'. {)8' A1tJJVE 'l'7:ff.DO .J CJO. In' ~ 7S',tJO , 7 ,. "3 i'l. 'Iz. JZr. 'IZ , '/, '12 TOTAL (Also enter on line 9, Recapitulation) $ /2./ ;-'1? 37 (If more space is needed, insert additional sheets of the same size) 5C-I/ED. N, &"tCl. I3Sf. of .' FEt<7E:l'liJ/tltG-H Wtit1f)/2pN /(J. / I':'. eltartts.f;r relurned" ehdS" q'ufudetl ;;"HI I:'sM 13. ~ J~rt eerk{eaks If. lIt1dr"Ii~/1"/ I+/Jlu.fe Fee IS. &.sf,( ,I;/'1 :J:nha;/4J1C-( f66 lb. e5h'm. jJkk~fJ/a 4M' .<t;:/~;;c/la/ j>>$'.hj!'.5 klHYlt 7P..?fL .:L/-02- 576 'f! 32, tn) fZ 9.<>0 ';:'0,00 ;I Is-, tJo ~, 710 t - % /.:{, 6'f'~.3'7 . RE\I-1S12 EX"'r.1-9i ESTATE OF .. ~'~ :.~" r'(~D1 ~~i--.o: ~f~- " COMMOi'JWEALTH OF PENNSYLVAN;(\ INHEQITANCE TAX RETUR~; P.ESIDENT DECEDENT F EtlLrElVEA-tl6~ SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER W~Ob/ZPN w. 0l1-02-S7b ITEM NUMBER 1. Include unreimbl.lrsed medical expenses. I -:p;n"""I.. tie.. \1-1, DESCRIPTION AMOUNT 1J<f.2Z TOTAL (Also enter on line 10, Recapitulation) $ I if. z.~ (If more space is needed, insert additional sheets of the same size) '~.;n".."'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF F c;Ii?7E/l6'-4C/6f1 , Wt/o.Df?at) NUMBER I. SCHEDULE J BENEFICIARIES N. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distrtbutions) 1 Vtl/VCE tv. FERT/:7118,1/tU..f./ I 50 F~Y<f@l/L3'fU6H [I//IIG M€CHA-NIe,Si3LO~C., Ill- 170$5 1Pz - "II items Were a clumo/ or crt ven riW"1 well \:J..for<. one year pri or 1<> cl.o. c/. r? rob - ~5;due .;;.. Dorv1t/..,l) (P3 / LF6 GR.EGG- -fredeco.o.:,...d. 1P to d. - g;trs la.psed. FILE NUMBER RELATIONSHIP TO DECEDENT Do Not List Trustee(s) SON S7.:P-SON lul~E' ..:z /- 02- 576 AMOUNT OR SHARE OF ESTATE IOO~ Y"c: S; du e _ 0 - - V - ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, 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 3 /111 L ",IUD F'E~-rEN'BA-U6J./ - pre.dl!ce.tu.<..e/. TP tn - g', H !..pse.d 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) LAST ':JILL AlID TESTAl'lENT OF WOODRO,'l \-J. F3RTENBAUGH d )-O~- 51 i.,,;. 1., WOODRO\l H. FERTENBAUGH, of the Township of Monroe, COQnty of Cumberland and State of Pennsylvania, being of sound and disposing m~nd, memory and understanding, do make, publish and declare this my Last \HIl and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can be conveniently done. 2. I give and bequeath all farm machinery, including tractors and motor vehicles, if any, which I may own at the time of my decease~ to mJ son, VANCE W. FERTE~rnAUGH. 3. 1. give and bequeath the sum of Three Thousand (S3,000.00) Dollars to my stepson, DONALD LEE GREGG. 4. I direct that the inheritance tax on the above bequests be paid out of my residuary estate. -1- . . . ~____,_"_.m________~.__'_'___'~""""'~__'___~____'_"__'___'_~-_.. -..... -,'--- -- _._-~,_._-~.._.~-~-----------_._-_._-_.. 5. I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever the same may be situate, to my wife, ~rrLDRED FERT5l'IDAUGE, absolutely and unconditionally. 6. In the event that my wife, MILDRED FERTElfBAUGH, should predecease me, or should she die within thirty (30) days from the date of my death, tben in such event, I direct the settlement and distribution of my estate to be made in the following manner, to 101it: (a) I give and bequeath the sum of Three Thousand ($3,000.00) Dollars to my stepson, DONALD LEE GREGG, and direct that the in- hereitance tax on this bequest be paid out of my residuary estate. (b) I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever the same may be situate, to my son, VANCE \'r. FERTEl'IDAUGH, absolutely, unconditionally and in fee simple. LASTLY, I nominate, constitute and appoint my son, VANCE ,V. FERTElffiAUGH, Executor of this my Last Hill and Testament, and direct that he be excused from posting bond or other security for the faitlu'ul performance of his duties i~ any juriDdiction. -c:..- . ....___~_">~~._..-,.-,...._.~~_~__._~._~,....~_n~_......-__.~-"._.~'''_ , . IN ,HT:N:ESS i-!HEREOF, I have hereWlto set my ha..'1d and seal this Ji day of December, A. D., 1993. ''\'It/~/~~l,,1.z:LWv~ '\\f/{ ~J~'~<3~'-L 1-~L ( SEAL) Woodrow W. Fertenbaugh Signed, sealed, published and declared by the above named, \'iOODROW IV. FERTE:NBAUGH, as and for his Last Ifill and Testament, in the presence of us, who have subscribed our names hereto as witnesses, at the request of said testator, in his presence and in the presence of each other. ~f7i/~ '-/" ./~' /~" ,// / / -3- . . . ~ 1~ I. , ::J , , ,. .." -" COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND ) 1, ,,fOODROI'J \'<1. FERTENBAUGH , the testatOr whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and volun- tary act and deed, for the purposes therein contained. Sworn and affirmed to and acknowledged VlOODRO"Ill VI. FERTENBAUGH ,the testilt or day of December , A. D. , 1993. before me by . ,this ,1,]11- /l -;1 fl/Oj_I...--Ji-h-.. v' '--.J /\ " I ~":J ~" .. j. C1-~ COMMONWEALTH OF PENNSYLVANIA ) Nata",) &.;I .. Mai1'1vn l(ay Bi-cr., N-"Rry Pi.1~~ U~~.I;-I,.n"Iectc C-\~l,?rt".1~.~::Ur'ty ~;=,~...':>l.l.'~. '. ."' 'IC"-'7 My c-.\rr;m;~!'l bDfEIS N~)\i. ;>, . ':;'.J 'Member. ~"'~A.6CO"<<'~01\~ SS. COUNTY OF CUMBERLAND We, the undersigned, J. ROBERT STAUFFER and ERIKA L. LEVENHAGEN , the witnesses "hose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the testator VlOODRmv VI. FERTENBAUGH , sign and exe- cute the instrument as his~ Last Will and Testament; that the said testato.,. VlOODROW VI. FERTElffiAUGH , executed it as his~ free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of ~he testat~, signed the Will as witnesses; and that to the best of our knowledge, the testator was, at the time, eighteen (18) or more years of age, of sound mind) and under no constraint, duress or undue influence. Sworn and subscribed to before me. this .I -.l /.L.... day of December 1993. 1/1 ,I.. if ."W""""- , ., / NotaIillfS€a1 ~ Kay Eakin, Notary PUb!!c ~.Bcro.qllm,?al'la~I::r.t.J11iY i MvCornml8lllOl1 Eltpires ,lav b. .'~ .~ll.~~l1ufl~ :-"-/' , - 1.0,.;.., I/i./~'.