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Home My WebLink About02-0581FOR REGISTER'S OFFICE USE ONLY County Code Year File Number ~~ D a A ~- p` PA DEPARTMENT OF REVENUE Ohl O ESTATE INFORMATION SHEET DECEDENT INFORMATION: Enter data as it will appear on all documents submitted to the department. Name (Last) (First) (Middle) RIS SINGER MARY LOIJISE Decedent's Social Security Number Date of Death Date of Birth 159-09-0530 June 10, 2002 August 21, 1913 TYPE FILING: Enter check (x) mark to indicate the nature of the return to be filed with the department. X Probate Return -Joint Assets Only -Estate Tax Only Litigation Purposes (No Other Assets) LETTERS GRANTED: Enter check (x) mark to indicate the nature; of the proceedings at the Register of Wills Office. (Attach additional sheets if explanation is necessary.) X Testamentary _Administration No Letters -Other ATTORNEY/CORRESPONDENT TNFORMATION Enter all Data concerning the attorney or other individual to receive all tax information and correspondence. Name (Last) (First) (Middle) PICCOLA JEFFREY E. Supreme Court LD. 18018 315 N. Front Street, Post Office Box 741, Harrisburg, PA 17108-0741 (i'17) 236-9377 PERSONAL REPRESENTATIVE INFORMATION: Enter all data concerning the personal representative(s) of the estate authorized by the Register of Wills Executor/Administrator Name (Last) (First) (Middle) Piccola Jeffrey E. SOCIAL SECURITY #159-09-0538 Address 3817 Hillcrest Road, Harrisburg, PA 17109 Prepared By: JEFFREY E. PTCCOT.A, ESQUIRE June 20, 2002 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner above-named swears and affirms that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner and that, as personal representative of the Decedent, Petitioner will well and truly administer the estate according to law. Sworn to and affirmed and subscribed before me this 2`1sl~hday of June, 2002. 9,yc~C', d~~.,~ No. 21-2002-581 Estate of Marv Louise Rissinaer. Deceased Social Security No: 159-09-0530 Date of Death: June 10, 2002 21, t AND NOW, June, 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 ;Administration _ d.b.n.c.t.; pendente liter durante absentia; durante minoritate are hereby granted to Jeffrey E. PICCOIa, In the above estate. FEES Letters ........................... $ 80.00 Short Certificate(s)....f.~). $ 15.00 Renunciation .................. $ Affidavit ( ) ................. $ Extra Pages (5 )............ $ 15.00 Codicil .......................... $ JCP Fee ........................ $ 5.00 Inventory ....................... $ Other ............................ $ TOTAL ................ $ 115.00 Filed June 21st, 2002 ,. Mary C. Lewis Register of Wills _~ ,.. Attorney: JEFFREY E. PICC-OLA c' LD. No: 18018 Post Office Box 741, 315 N. Front Srg= Harrisburg, PA 17108-0741 ~=~ (717) 236-9377 CALL ATPORNEY PICCOLA -~~s ,~~ C°i~~~ 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 Officle for permanent filing. ; H,os t„R.v z~aT FE/-RINT w WANENT ACK wK A WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 ~ -~ ___~~ cal Registrar P 8453857 No. ~ /~G~-- Date COMMONWEALTH Of PENNSYLVANIA • DEPARTMENT Of HEALiH • VITAL RECORDS CERTIFICATE OF DEATH NAME OF DECEDENT 6+y MW01•..Afl ~ SEx SGCIAL SECURITY NUMBER ONE OF OEATM:MCrW. Dos. 'brl ~ 159 - 09 - 0530 Female J 10 2002 ~' Mar Louise Rissin er ,, .. ,. une AGE Ilay 9rnaaq UNDER, vEAR UNDER, DAY DATE OF BgITH BURWIACE:C+Y Ua PLACF OF OENNrfrec. nrW ~%'•-- ,cl_~mvr vU•I .e• yr - M•rWU . Day Moue . M+wlp M"~m DaY KYI 31,1•a FCr•gn s:aunuvl ' OTHER. HOSPITAL ^ ~ "„ ~'° ^ ^ ~ 1 Shippens g, 88 y,, Aug. 21, ERIdAPMwnr DDA , Irwl,w ~ R•rMnu ^ NI COUNTY OF DENN CRY, BORO. TWPOF DEATH fACKR Y NAME IK nd+lyMM. ~,,v mM a MwmOx~ NAB DECEDENT OF HISPANIC ORIGIN? RACE ~ AmMCN Mdnr,. BM4. MT<•. Mc. Cumberland Middlesex Twp. C hurch of God Home ~ „ '~,;,~ A'g'<"'G°"' I~°`"I white t. M. f. 10. OECEDENf'S USUAL OCCIIRCION KwOOF BUSDiESSANDUSTRV NMS DECEDENT EVERw OECEDENT'SEDUCATKw MApTAI STNUS~MaIr~O SURVNBKi SPOUSE IK-+•.a+in+gnnrnN ~ ARMED FORCE37 c N•vr U. S , awd+.or, aon. daag ,,,~ d sNdlnpYl•: d•n"wrWel ~ ~ . Ma^ N•® EMrMNMWS•c"Warf Cq4~ . „~ nurse ,,., hos ital „_ ,,. 'O'~' 12 "'"6" ,.. widow ,,. DECEQENT7MNLwGADORESSISa..,. C•yFTwn, sKr. ZeCodel oecEDENT•s Middlesex ,.,. PA ,7<~w al<.ear•w.ae 801 N. Hanover Street ~.~. . ~"'sro~ENDE "" ~"' ~~ Carlisle, PA 17013 «+~ „~ Cumberland """"°' ,T1.^ ~,~ a ~. fANER'S NAME IF•y. MrOdb. Lal1 MOTHER'S NAME Ifay. sAGdw Ma~O•n Swname) „• Cl de Barner „• Mar Goshert wsQfKwET•s NAME (typrPr<•1 wfoRwwrs MAEwD ADDRESS ISIr•A, c<wTO.n Slr•. zp coop Jeffre Piccolo Es ,,,.P. 0. Box 741 Harrisbur PA 17108 METNODOF OISPOW710N DATE OF OISPOSITMNI PLACE OP OdiP091TgN • NarM dC•mwwy. CrwnMOry LOCJOK7N ~ CA1VT••n. Blal•. ZoC•d, B"""~Q'"""°"^ "'"'°""`°"'s'"'^ oarrwn^ our tsrl.rhl_ ^ June 113 2002 ) "Churchville Cemeter Y Oberlin PA ' ,.. lICiNIB1/FIE OF L E ACTwG AS SUCH ICENBE NUMBER ANO aFAC Hbg.PA 3125 Walnut St. Inc ome ate ric°~"c un - 014404-L , , ., . >:<. C•rrlPNl• tStc arKY vArrl ur,aY•q Malq myMrowMd,•.a O<cln•dMIM MM.dM•MW PIaC•yM•d LICENSE NUMBER GATE SIONEO IM"n, 0•a Mrl p11,YHM ra nq a%aYM•YM,wddWnl• a,d/<Y+• W d•Mn. . •Ytl Tr•1 - Q.C~K.v c'E~x.-~- !{.c.i +l ti, I b 3 S ~ 3 - L ~c .~ Ba•1a i43B aaMIW <•r•PIN•0fY BAE QF DEATH -r•. GATE PR01gUNCED DEAD IMnnIn. D+v.vw1 YAB CASE REFERREDTO MEDICAL ExAWHEWC ~yEy P•r•aA ••1• Pr•rlo.•ICw e.Mw (F,~ i 1 ~1 w ^ R. M 7 ~ / ~ ~O / `. 2• . . • S7.fNRT 1: Enw dl•awFMN,, +Kww"c"np,ca,oM.NCnuwdUw Warn Do n•I MIM pH noMd ,auto a•cMbaca spralpry,n•y, aoona MN 4aur• iAPPru.<MiN PART B: dIW 4y,8CW <GWWr mllraWrgaONIR.0V1 ntlr undrry%gcrR•gY•r,w PART1 nol mlMn +a M E . p •r% •b••n lM a,ry "r Caw an •arA al.. , an,w a,d rN•III KWLOMT! CA1pE 6%,Y L _ I x ar.r•ac"loaa, SrC~ ~ ~ J'E~LL /'~ ~~~C r~aargao•.nl-• a. -~- _ Ol1E IOpR/~ ACQaLEOUENCE OPk /I ' G~4Y~ Gh~T" L t°G? L~ SC ' - /` ' Z ; g l.~ t o2 ~1.~ . 1 h B•var+aN ar aorldn"r o. i r.PBras,,rw•rMdlr. DUE p11ABAC01tlE0UE OFk , /. Elal+lialad MrIN Ol1E W IQR AB A CONSEQUENCE Of): F~Argnd,•EK LABT ' u 7i a 1a116 AN AlROP$Y WERE AUTQ-SYfwOWG$ MMWEROF OEATN ONE OFIWURY TKAE OFINAIRY wAMYNVA7RKi OESCRKIE NOW wJURY OCCUWIED. -FJiFOW,EOf MAKABLE 1111011 TO IMPnn. Day. Marl COMPlET10N OF CAUSE ^ ~ N NMUrM amKO, M• ^ N•^ AmdMll ^ P•r~aq M,Y•Mp4cr ^ M. M•-^ No M• ^ No ^ $rACAM ^ C•uN ll•1Md•,•nnnN ^ PLACE OFIWURY~AI A"M. Nrm, Lr••I. la<10ry. olac• LOGPKTN TS•aat CryFT•+n. SHIN hAlab4 N<. ISD•dvl 2M. if. 70,. 101. OERTIPIER IUvc. •r,Y an•1 ~ 'CE11TWjWD/MYfIC1AN rPlr yu,n cwtly Wf•dW,n MNn anMMPnv,c am naa aona,rrww+n ana compw•a e.. 2DI SIGNNURE RLE OF CERTIPIER /~ ~/~// ~ `{ ~ y g T7/lif 6M OI m7 arovbYO•.0•,N e<eynaC Ou• Y IM <au,Nf) aM manrMr •• •MW ............................................. W ~.. • R M LICENSE NUMBER DNE D MPM. D•r. Marl ~1) ~~~~2~ i1, ~v ~ a ~ ~ / O DIINOBp AND CERTVVWOINYSICIAN IF1,YSn:.an ppr.;;rv~oWCaq wan aM CMWY•gNCa•!•ol cealM Te K« a..I a.,y Im•.Md,•, d•.n,«wrw aI w dRr., a•u, and P1.c•, ,rw aw m,n• <.ua•1,1 •na m.nM.,, ynW .......................... ^ / ~~ S L= 71 /'. ~ P ~ . 2 S,<. ~~'v ~ NAME AND ADDRESS Of PERBON YYIIO KQEDCAUSE OF DEAT~N ' /_ L/,, ~( ~ loam 271 Tyq a Prm1 T 'MEDICAL EI(AMINER/CORONER OR 1M lN•i• d •aunina,k,n andlw 1nr•aliya,ion• M my apmlon, d•alll occurred al IM Ilm•, daN, and plat'. an0 due Io 1M uuwpl arW ~ L r !/ ~~ ~ J 3o f /~ • ;r ~ REGISTIIAR'S SIGNATURE ANO NUMBER ~ ./' GATE FILEDIMOM OaY. Karl L-~LY..s~e _ `._- 21-2002-581 LAST WII.L AND TESTAMENT OF MARY LOUISE RISSINGER Introductory Clause. I, MARY LOiTISE RISSINGER, a resident of and domiciled in the County of Cumberland and Commonwealth of Pennsylvania, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils at any time heretofore made by me. ITEM 1 Direction to Pay Debts. I direct that all my legally enforceable debts, secured and unsecured, be paid as soon as practicable after my death. ITEM 2 Direction to Pay All Taxes from Residuary Estate. I direct 1;hat all estate, inheritance, succession, death or similar taxes (except generation~skipping transfer taxes) assessed with respect to my estate herein disposed of, or any part thereof, or on any bequest or devise contained in this my Last Will (which term wherever used herein shall include any Codicil hereto), or on any insurance upon my life or on any property held jointly by me with another or on any transfer made by me during my lifetime or on any other property or interests in property included in my estate for such tax purposes be paid out of my residuary estate and shall not be charged to or against any recipient, beneficiary, transferee or owner of any such property or interests in property included in my estate for such tax purposes. ITEM 3 Outright Gift of Residuary. I give, devise and bequeath all the rest, residue and remainder of my property of every kind and description (including :lapsed legacies and devises) wherever situate and whether acquired before or after the execution of this Will, to be divided equally among the following: A. One~sixth (1/6th) to Mary B. Crumlich B. One~sixth (1/ 6th to the Harrisburg Chapter of The Salvation Army, Inc. C. One~sixth (1/6th) to The Bethesda Mission D. One-sixth (1/ 6th) to Goodwill Industries of Central Pennsylvania, Inc. E. One-sixth (1/6th) to the Harrisburg Hospital Nurses' Alumni Association F. One~sixth (1/ 6th) to St. Jude's Hospital ITEM 4 Naming the Personal Representative. Personal Representative Succession, Personal Representative's Fees and Other Matters. The provisions for naming the Personal Representative, Personal Representative succession, Personal Representative's fees and other matters are set forth below: 1 Naming an Individual Personal Representative. I hereby nominate, constitute, and appoint as Personal Representative of this my Last Will and Testament Jeffrey E. Piccola and direct that he shall serve without bond. 2 Fee Schedule for Individual Personal Representative. For its services as Personal Representative, the individual Personal Representative shall receive reasonable compensation for the services rendered and reimbursement for reasonable expenses. ITEM 5 Definition of Personal Representative. Whenever the word 'Personal Representative" or any modifying or substituted pronoun therefor is used in this my Will, such words and respective pronouns shall include both the singular and the plural, the masculine, feminine and neuter gender thereof, and shall apply equally to the Personal Representative named herein and to any successor or substitute Personal Representative acting hereunder, and such successor or substitute Personal Representative shall possess all the rights, powers and duties, authority and responsibility conferred upon the Personal Representative originally named herein. v~ ITEM 6 Powers for Personal Representative. By way of illustration and not of limitation and in addition to any inherent, implied or statutory powers granted to Personal Representatives generally, my Personal Representative is specifically authorized and empowered with respect to any property, real or personal, at any time held under any provision of this my Will: to allot, allocate between principal and income, assign, borrow, buy, care for, collect, compromise claims, contract with respect to, continue any business of mine, convey, convert, deal with, dispose of, enter into, exchange, hold, improve, incorporate any business of mine, invest, lease, manage, mortgage, grant and exercise options with respect to, take possession of, pledge, receive, release, repair, sell, sue for, to make distributions or divisions in cash or in kind or partly in each without regard to the income tax basis of such asset, and in general, to exercise all the powers in the management of my Estate which any individual could exercise i.n the management of similar property owned in his or her own right, upon such terms and conditions as to my Personal Representative may seem best, and to execute and deliver any and all instruments and to do all acts which my Personal Representative may deem proper or necessary to carry out the purposes of this my Will, without being limited in any way by the specific grants of power made, and without the necessity of a court order. ITEM 7 Discretion Granted to Personal Representative in Reference to Tax Matters. My Personal Representative as the fiduciary of my estate shall have the discretion, but shall not be required when allocating receipts of my estate between income and principal, to make adjustments in the rights of any beneficiaries, or among the principal and income accounts to compensate for the consequences of any tax decision or election, or of any investment or administrative decision, that my Personal Representative believes has had the effect, directly or indirectly, of preferring one beneficiary or graup of beneficiaries over others; provided, however, my Personal Representative shall not exercise its discretion in a manner which would cause the loss or reduction of the marital deduction as maybe herein provided. In determining the state or federal estate and income tax liabilities of my estate, my Personal Representative shall have discretion to select the valuation date and to determine whether any or all of the allowable administration expenses in my estate shall be used as state or federal estate tax deductions or as state or federal income tax deductions. ITEM 8 Ap~nointment of Ancillary Representative. If it becomes necessary for a representative of my estate to qualify in any jurisdiction other than the State of my domicile at the time of my death, then to the extent that I may legally do so, I hereby nominate, constitute, and appoint my Personal Representative named in this Will as my representative in such jurisdiction and direct that such Personal Representative shall serve without bond. If for any reason my Personal Representative i.s unable or unwilling to serve as such representative or cannot qualify as such representative, then I hereby appoint my Personal Representative named herein to designate (to the extent that it may legally do so) a person or a corporation to serve as my representative and request that such person or corporation shall serve without bond. Any representative named as provided herein (to the extent that it may legally do so) shall have in such jurisdiction all the powers and duties conferred or imposed on my Personal Representative by the provisions of this Will. ITEM 9 Definition of Words Relating to the Internal Revenue Code. As used herein, the words "gross estate;' "adjusted gross estate;' "taxable estate;' "unified credit;' "state death tax credit;' "maximum marital deduction;' "marital deduction;' "pass;' and any other word or words which from the context in which it or they are used .refer to the Internal Revenue Code shall have the same meaning as such words have for the purposes of applying the Internal Revenue Code to my estate. For purposes of this Will, my "available generation~skipping transfer exemption" means the generation-skipping transfer tax exemption provided in section 2631 of the Internal Revenue Code of 1986, as amended, in effect at the time of my death reduced by the aggregate of (1) the amount, if any, of my exemption allocated to lifetime transfers of mine by me or by operation of law, and (2) the amount, if any, I have specifically allocated to other property of my gross estate for federal estate tax purposes. For purposes of this Will if at the time of my death I have made gifts with an inclusion ratio of greater than zero for which the gift tax return due date has not expired (including extensions) and I have not yet filed a return, it shall be deemed that my generation-skipping transfer exemption has been allocated to these transfers to the extent necessary (and possible) to exempt the transfer(s) from generation-skipping transfer tax. Reference to Sections of the Internal Revenue Code and to the Internal Revenue Code shall refer to the Internal Revenue Code amended to the date of my death. ~~~ ITEM 10 Statement by Testatrix of Intent Not to Exercise Power of Aynointment. I hereby refrain from exercising any power of appointment that I may have at the time of my death. Testimonium Clause. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my seal this ~ day of September, 1995. ~ ~ ~ L) MARY OUISE RISSINGE Attestation Clause. The foregoing Will was this day of September, 1995, signed, sealed, published and declared by the Testatrix as and for her Last Will and Testament in our presence, and we, at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses on the above date;. i ~ of ~~ of 6~ COMMONWEALTH OF PENNSYLVANIA ~Llr~(~1~ SS: COUNTY OF We, Mary Louise Rissinger, and Diane E. Grissinger and Denise L. Foster ,the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, and in the presence of each other, signed the Will as witness and to the best of our knowledge the Testatrix was at that time eighteen years of age or older, of sound mind, and under no constraint or undue influence. MARY OUISE RISSINGER ` ~ ~ ANE E. GRISS:INGER, fitness 1 ISE L. O ER, Witness Subscribed, sworn to, and acknowledged before me by Mary Louise Rissinger, the Testatrix and subscribed and sworn to before me by Diane E. Grissinger and Denise L. Foster ,witnesses, this ~S~I day of September, 1995. <~~~~i ~_ ) Seal) Notary Public for Pennsylva is My Commission Expires: /mil/3 /~' a' NOTARIAL SEAL SARAH E. APPLES`(, Notory Public MY Commission Expires Dec. 13, i 998 Harrisburg, PA Dauphin County ~ ~' IN RE: : IN THE COURT OF COMMON PLEAS ESTATE OF :CUMBERLAND COUNTY, PENNSYLVANIA MARY LOUISE :ORPHANS' COURT DIVISION RISSINGER, :ESTATE #2002-00581 DECEASED :SOCIAL SECURITY #159-09-0530 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Estate No To the Register: Mary Louise Kissinger June 21, 2002 2002-00581 I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the abovf;-captioned estate on August 21, 2002: Mary B. Crumlich 405 Orchard Lane Mechanicsburg, PA 17055 Goodwill Industries of Central Pennsylvania, Inc. 1150 Goodwill Drive PO Box 3155 Hamsburg, PA 17105-3155 ATTN: Gary McElwain Harrisburg Hospital Nurses' Alumni Assoc. 111 S. Front Street Harrisburg, PA 17101 The Salvation Army, Inc. PO Box 2205 Harrisburg, I'A 17105-2205 The Bethesda Mission 1500 N. 2nd Street Harrisburg, F'A 17101 St. Jude's Hospital 4141 N. Henderson Road Plaza Suite 3 Arlington, VA 22203 ATTN: Fran Legon BOSWELL, TINT PICCO & WICKERSHAM c By: Jef y iccola, Esquire Su me Court I.D. #18018 31 orth Front Street P. O. Box 741 Harrisburg, PA 17108-0741 (717) 236-9377 Capacity: Personal Representative X Counsel for Personal Representative REV.l5OtU.(S.ooJ w ~ lI::~!2 1rl~l5 ~"'~ U~m ~ ~ *' ,/ REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 nd 1-1-95 ESPOND i!leE AND C ' ~ DENTI NFO i!I'SHO~ COMPLETE MAILING ADDRESS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 ~ Z W Q W ill Q DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) RISSINGER, MARY LOUISE OFFKIAL USE m~L y /1-7/-S- FILE NUMBER 21 02 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 00581 NUMBER DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 159-09-0530 THtS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Retum (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach SchO) ~DIRe , "TO: 06/10/2002 08/21/1913 315 N, Front SlreetIPO Box 741 Harrisburg, PA 17108-0741 (1) None (2) None (3) None' (4) None (5) 56,285.05 (6) None (7) None (8) (9) 10,194.59 (10) 6,028.26 OFFICIAL USE ONLY 56,285.05 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) ~ 1. Original Return 0 0 4. Limited Estate 0 ~ 6. Decedent Died Testate (Attach copy 0 of Will) 0 .. Litigation Proceeds Received 0 2. Supplemental Return (11) 16,222.85 40,062.20 33,385.15 6,677 .05 ~!ii Ww ~Q QZ u5' THIS SECTION M~ST BE COM AME JEFFREY E. PICCOLA , 'ED.AL~C (12) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (13) SEE INSTR~CTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) 15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) z .045 (16) Q 16.Amount of Line 14 taxable at lineal rate x g ~ 17. Amount of Line 14 taxable at sibling rate x .12 (17) 2 0 U ~ 18. Amount of Line 14 taxable at collateral rate 6,677 .05 x .15 (18) 1,001.56 19. Tax Due (19) 1,001.56 IRM NAME (If applicable) Boswell, TIntner, Piccola & Wickersham ELEPHONE NUMBER 717/236-9377 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship Z Q ~ ~ J;: 11 w '" 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter.Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or ~) 8. Total Gross Assets (total Lines 1.7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 20. 0 CHECK HERE IF YOU ARE REQUESTING A REF~NO OF AN OVERPAYMENT ".II!lE'~~\TO iI\IiISWERlI~L ~~i!!lfJli!Hs 'O~'Iiti!Nli!:i~$i!'i!lilE;II\liiQ I!li!lIlili!CK ";ATfi'~. '" ,;" Copyright 2000 form software only The Lackner Group, Inc. Form REV.1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 801N.HANOVERSTREET CITY CARLISLE I STATE PA I ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 1,001.56 800.00 42.11 Total Credits (A + B + C) (2) 842.11 3. Interest/Penalty if applicable D. Interest E. Penalty (3) 0.00 (4) (5) 159.45 (SA) (5B) 159.45 TotallnterestJPenalty (0 T E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. -- Make Check Payable to: REGISTER OF WILLS, AGENT PLEA5E AN5WER THE FOLLOWING QUE5TIONS 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? ...m........................................................ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................. ...................... ................................................................... 3. Did decedent own an ~in trust for" or payable upon death bank account or security at his or her death? ......... 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ......... ............................ ......................... ........................................................ Yes No ~ I o 181 o 181 o 181 N5WER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Iti of pe ry.' declare that J have examined this retum, including accompanying schedules and statements. and to the best of my knowledge and belief. it is true. correct and complete, Declaration 01 e than th e onal represeruative is based on a" information of which pro TeT has any knowled e. F PER ON ESPONSIBLE FOR FILING RETURN ADDRESS 3817 HILLCREST ROAD HARRISBURG, PA 17109 DATE q- / -oJ, ADDRESS OATE .. RE ER THAN REPRESENTATIVE ADDRESS DATE ~;= 315 N. Front StreetIPO Box 741 Harrisburg, PA 17108-0741 __L.. .;~! r IfL__ _II I~UI~~'IIJ._911.,__ .IF ---" " - -____ 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) (l.l)(i)J. 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 sUlViving spouse \s 0(1/0 172 P.S. ~9116 (a) (1.1) (U)). The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptlve parent, or a stepparent of the child is 0% [72 P .S. ~9116 (a) (1.2)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116 1.2)[72 P.S. ~9116 (a)(1)]. The tax rate imposed on the net value oftransfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116 (a) (1.3)J. A sibling is defined. under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMON'NEAL TH OF PENNSYLVANIA INHERITANCE TAX RETUFlN RESIOENTDeCEDENT ESTATE OF RISSINGER, MARY LOUISE I FILE NUMBER 21 - 02 - 00581 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER 1 DESCRIPTION VALUE AT DATE OF DEATH 40,974.85 W A YPOINT BANK - CHECKING ACCOUNT #200010021 2 ALLFIRST BANK - CERTIFICATE OF DEPOSIT - #87008000240424 11,967.20 3 HETRICK FUNERAL HOME - PREP AID FUNERAL 3,343.00 TOTAL (Also enter on Line 5, Recapitulation) 56,285.05 *' SCHEDULE H FUNERAL. EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENIIlSYl.VANlJI INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RISSINGER, MARY LOUISE I FILE NUMBER 21 - 02 - 00581 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A FUNERAL EXPENSES: 1. HETRICK FUNERAL HOME 3,844.80 B. ADMINISTRATIVE COSTS: 2,800.00 1. Personal Representative's Commissions JEFFREY E. PICCOLA Social Security Number(s) I EIN Number of Personal Representative(s): Street Address 3817 HILLCREST ROAD City HARRISBURG State PA lip 17109 - Year(s) Commission paid 2002 2. Attorney's Fees Boswell, TIntner, Piccola & Wickersham -- JEFFREY E. 2,800.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Slate Zip Relationship of Claimant to Decedent 4. Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS 115.00 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. Other Administrative Costs I CUMBERLAND LAW JOURNAL - ADVERTISE ESTATE 75.00 2 THE SENTINEL - ADVERTISE ESTATE 106.79 3 BOSWELL, TINTNER, PICCOLA & WICKERSHAM - REIMBURSEMENT POSTAGE, 50.00 PHOTOCOPIES, MISC. Total of Continuation Schedule(s) 403.00 TOTAL (Also enter on line 9, Recapitulation) 10,194.59 *' Schedule H FmeraI Expenses & Adninistralive Costs continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RlSSINGER, MARY LOUISE I FILE NUMBER 21 - 02 - 00581 4 W A YPOINT BANK - CHECK CHARGE 3.00 5 BOSWELL, TINTNER, PICCOLA & WICKERSHAM - RESERVE TO CLOSE 400.00 Page 2 of Schedule H *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNS'1'lVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RISSINGER, MARY LOUISE IFILE NUMBER 21 - 02 - 00581 Include unreimbursed medical expenses. ITEM NUMBER 1 DESCRIPTION BOSWELL, TINTNER, PICCOLA & WICKERSHAM - LEGAL FEES PRIOR TO DEATH AMOUNT 219.00 2 CARLISLE HOSPITAL - ER TREATMENT 5/25/02 112.39 3 CHURCH OF GOD HOME - BALANCE DUE TO NURSING HOME 1,766.77 4 MANOR CARE - BALANCE DUE TO NURSING HOME 3,201.63 5 BROCKIE PHARMACY - BALANCE DUE FOR MEDICAL SUPPLlES/MEDICA TIONS 632.89 6 CENTRAL PENN MEDICAL GROUP - MEDICAL BILL 5/25/02 17.93 7 CHURCH OF GOD HOME - BILL FOR MEDICAL DOCTOR 10.30 8 WEST SHORE EMS - MEDICAL TRANSPORTATION 5/25/02 67.35 TOTAL (Also enter on Line 10, Recapitulation) 6,028.26 '* SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RISSINGER, MARY LOUISE I FILE NUMBER 21 - 02 - 00581 RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 MARY B. CRUMLlCH FRIEND 6677.05 405 ORCHARD LANE, MECHANICSBURG, PA 17055 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 THE SALVATION ARMY, INC. 6,677.03 PO BOX 2205, HARRISBURG, PA 17105-2205 2 GOODWILL INDUSTRIES OF CENTRAL PENNSYLVANIA INC 6,677.03 1150 GOODWILL DRIVE, PO BOX 3155, HARRISBURG, PA 17105-3155 3 HARRISBURG HOSPITAL NURSES' ALUMNI ASSOCIATION 6,677.03 III S. FRONT STREET, HARRISBURG, PA 17101 4 THE BETHESDA MISSION 6,677.03 1500 N. 2ND STREET, HARRISBURG, PA 17101 5 ST. JUDE'S HOSPITAL 6,677.03 4141 N. HENDERSON ROAD, PLAZA SUITE 3, ARLINGTON, VA 22203 TOTAL OF PART 11_ ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 33,385.15 21-2002-581 LAST WILL AND TESTAMENT OF MARY WUlSE RISSINGER Introductorv Clause. I, MARY LOUISE RISSINGER, a resident of and domiciled in the County of Cumberland and Commonwealth of Pennsylvania, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils at any time heretofore made by me. ITEM 1 Direction to Pav Debts. I direct that all my legally enforceable debts, secured and unsecured, be paid as soon as practicable after my death. ITEM 2 Direction to Pav All Taxes from Residuarv Estate. I direct that all estate, inheritance, succession, death or similar taxes (except generation~kipping transfer taxes) assessed with respect to my estate herein disposed of, or any part thereof, or on any bequest or devise contained in this my Last Will (which term wherever used herein shall include any Codicil hereto), or on any insurance upon my life or on any property held jointly by me with another or 'on any transfer made Dr me during -my lifetime or on any other property or interests in property included in my estate for such tax purposes be paid out of my residuary estate and shall not be charged to or against any recipient, beneficiary, transferee or owner of any such property or interests in property included in my estate for such tax purposes. ITEM 3 Outril!ht Gift of Residuarv. I give, devise and bequeath all the rest, residue and remainder of my property of every kind and description (including lapsed legacies and devises) wherever situate and whether acquired before or after the execution of .this Will, to be divided equally among the following: A. One-sixth (1I6th) to Mary B. Crumlich B. One-sixth (1I6th to the Harrisburg Chapter of The Salvation Army, Inc. C. One-sixth (1I6th) to The Bethesda Mission D. One-sixth (1I6th) to Goodwill Industries of Central Pennsylvania, Inc. E. One-sixth (1I6th) to the Harrisburg Hospital Nurses' Alumni Association F. One-sixth (1I6th) to St. Jude's Hospital ITEM 4 Naminl! the Personal Reoresentative. Personal Reoresentative Succession. Personal Reoresentative's Fees and Other Matters. The provisions for naming the Personal Representative, Personal Representative succession, Personal Representative's fees and other matters are set forth below: 1 Naming an Individual Personal Reoresentative. I hereby nominate, constitute, and appoint as Personal Representative of this my Last Will and Testament Jeffrey E. Piccola and direct that he shall serve without bond. 2 Fee Schedule for Individual Personal Reoresentative. For its services as Personal Representative, the individual Personal Representative shall receive reasonable compensation for the services rendered and reimbursement for reasonable expenses. ITEM 5 Definition of Personal Reoresentative. Whenever the word ''Personal Representative" or any modifying or substituted pronoun therefor is used in this my Will, such words and respective pronouns shall include both the singular and the plural, the masculine, feminine and neuter gender thereof, and shall apply equally to the Personal Representative named herein and to any successor or substitute Personal Representative acting hereunder, and such successor or substitute Personal Representative shall possess all the rights, powers and duties, authority and responsibility conferred upon the Personal Representative originally named herein. )..- (f ITEM 6 Powers for Personal Reoresentative. By way of illustration and not of limitation and in addition to any inherent, implied or statutory powers granted to Personal Representatives generally, my Personal Representative is specifically authorized and empowered with respect to any property, real or personal, at any time held under any provision of this my Will: to allot, allocate between principal and income, assign, borrow, buy, care for, collect, compromise claims, contract with respect to, continue any business of mine, convey, convert, deal with, dispose of, enter into, exchange, hold, improve, incorporate any business of mine, invest, lease, manage, mortgage, grant and exercise options with respect to, take possession of, pledge, receive, release, repair, sell, sue for, to make distributions or divisions in cash or in kind or partly in each without regard to the income tax basis of such asset, and in general, to exercise all the powers in the management of my Estate which any individual could exercise in the management of similar property owned in his or her own right, upon such terms and conditions as to my Personal Representative may seem best, and to execute and deliver any and all instruments and to do all acts which my Personal Representative may deem proper or necessary to carry out the purposes of this my Will, without being limited in any way by the specific grants of power made, and without the necessity of a court order. ITEM 7 Discretion Granted to Personal Reoresentative in Reference to Tax Matters. My Personal Representative as the fiduciary of my estate shall have the discretion, but shall not be required when allocating receipts of my estate between income and principal, to make adjustments in the rights of any beneficiaries, or among the principal and income acCounts to compensate for the consequences of any tax decision or election, or of any investment or administrative decision, that my Personal Representative believes has had.. the effect, directly or indirectly, of preferring one beneficiary or group of beneficiaries over others; provided, however, my Personal Representative shall not exercise its discretion in a manner which would cause the loss or reduction of the marital deduction as may be herein provided. In determining the state or federal estate and income tax liabilities of my estate, my Personal Representative shall have discretion to select the valuation date and to determine whether any or all of the allowable administration expenses in my estate shall be used as state or federal estate tax deductions or as state or federal income tax deductions. ~-c?f ITEM 8 Apoointment of Ancillary Reoresentative. If it becomes necessary for a representative of my estate to qualify in any jurisdiction other than the State of my domicile at the time of my death, then to the extent that I may legally do so, I hereby nominate, constitute, and appoint my Personal Representative named in this Will as my representative in such jurisdiction and direct that such Personal Representative shall serve without bond. If for any reason my Personal Representative is unable or unwilling to serve as such representative or cannot qualify as such representative, then I hereby appoint my Personal Representative named herein to designate (to the extent that it may legally do so) a person or a corporation to serve as my representative and request that such person or corporation shall serve without bond. Any representative named as provided herein (to the extent that it may legally do so) shall have in such jurisdiction all the powers and duties conferred or imposed on my Personal Representative by the provisions of this Will. ' ITEM 9 Definition of Words Relating to the Internal Revenue Code. As used herein, the words "gross estate," "adjusted gross estate," "taxable estate," "unified credit," "state death tax credit," "maximum marital deduction," "marital deduction," "pass," and any other word or words which from the context in which it or they are used refer to the Internal Revenue Code shall have the same meaning as such words have for the purposes of applying the Internal Revenue Code to my estate. For purposes of this Will, my "available generation~kipping transfer exemption" means the generation-skipping transfer tax exemption provided in section 2631 of the Internal Revenue Code of 1986, as amended, in effect at the time of my death reduced by the aggregate of (1) the amount, if any, of my exemption allocated to lifetime transfers of mine by me or by operation of law, and (2) the amount, if any, I have specifically allocated to other property of my gross estate for federal estate tax purposes. For purposes of this Will if at the time of my death I have made gifts with an inclusion ratio of greater than zero for which the gift tax return due date has not expired (including extensions) and I have not yet fIled a return, it shall be deemed that my generation~kipping transfer exemption has been allocated to these transfers to the extent necessary (and possible) to exempt the transfer(s) from generation-skipping transfer tax. Reference to Sections of the Internal Revenue Code and to the Internal Revenue Code shall refer to the Internal Revenue Code amended to the date of my death. 1- (jf ITEM 10 Statement bv Testatrix of Intent Not to Exercise Power of Aooointment. I hereby refrain from exercising any power of appointment that I may have at the time of my death. Testimonium Clause. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my seal this ~$YJ day of September, 1995. . M~~~L) MARY OUlSE RISSINGE Attestation Clause. The foregoing Will was this _ day of September, 1995, signed, sealed, published and declared by the Testatrix as and for her Last Will and Testament in our presence, and we, at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses on the above date. Jj::j1:;;r of Jlt:Uf/1M~, /JA (() ny; Jll/ I2G of 6~ COMMONWEALTH OF PENNSYLVANIA DAlAPl-\lN OF . CUI,IB~nL.um SS: COUNTY We, Mary Louise Rissinger, and Diane E. Grissinger and Denise L. Foster , the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first du1y sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, and in the presence of each other, signed the Will as witness and to the best of our knowledge the Testatrix was at that time eighteen years of age or older, of sound mind, and under no constraint or undue influence. , M~ d~':'_~....ti.' ~_ MARycE.OUISE RISSINGER ~ Subscribed, sworn to, and acknowledged before me by Mary Louise Rissinger, the Testatrix and subscribed and sworn to before me by Diane E. Grissinqer and Denise L. Foster , witnesses, this 02~#; day of September, 1995. ~ f. ~.A~eal) Notary Public for Pennsylv ia My Commission Expires: 1d-/13 h f> NOTARIAL SEAL SARAH E. APPLEBY, Notary Public My Commission Elq)lreS Dee. 13, 1998 liarrisburg, PA Dauphin County &31' ~IWay~ql~lt LOOK FOR US. WE'LL GET YOU THERE. 07/12/2002 BOSWELL TINTNER PICCOLA & WICKERSHAM 315 N FRONT ST HARRISBURG PA 17108 The information which you requested on the account(s) of MARY LOUISE RISSINGER (Social Security Number 159-09-0530) is/are as follows: Account Number Class of Account Date Opened Principal Balance Accrued Interest 200010021 CHECKING 03/1 7/84 40972. I 6 2.69 40974.85 Balance at Date of Death Account Ownership SOLE Name of Joint Owner, if any Dale Ownership Was Established Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established Additional Information Requested PLEASE COMPLETE W-9 l!;e1YUnMl KA~~O~ SENIOR SE~~ES REP. P.O. Box 1711. HARRISBURG. PeNNSYLVANIA 17105-1711 Toll Free I-B66-WAYPOINT (1-866-929-7646) . IN YORK AREA 717/815-4500 . www.waypointbank.com Il allflrst Boswell, Tintner, Piccola & Wickersham Attorneys At Law 315 North Front Street PO Box 741 Harrisburg, PA 17108-0741 Re: Estate of Mary Louise Rissinf.!er Social Security: ]59-09-0530 Date of Death: June] O. 2002 Dear Sir or Madam: Allfirst Finaddal Center N .A. P. 0. Box 900 Millsboro, DE 19966 Phone (302) 934-2909 Fax (302) 934-2955 July 10,2002 Per your inquiry dated July 5, 2002, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Exempt Checking Account Number 0010071709 Ownership (Names oj) Mary Louise Rissinger, Owner Jeffrey E. Piccoia. POA Opening Date 10/28/90 Balance on Date of Death $0.00 2. Type of Account Certificate of Deposit Account Number 87008000240424 Ownership (Names oj) Mary Louise Rissinger, Owner Jeffrey E. Piccola. POA Opening Date 10/04/85 Maturity Date 10/04/02 Balance on Date of Death $11,759.40 Interest Rate 2.58% Accrued Interest $ 207.80 Total $11,967.20 . . This letter does not include any accounts in which the deceased may have been listed as Power of Attorney, Custodian of Uniform Transfers. Representative Payee, or Trostee under a Written Agreement. For further account information, closures and/or reimbursement of fUnds refer to be/ow branch: PENBROOK OFFICE 2551 WALNUT STREET HARRISBURG, PA 17103 717-255-2266 Z,? Sue Kimble Assistant I Cis Services, (302) 934-2909 .0<11(;' :'~ Register of Wills of Cumberland County, Pennsylvania Estate of RISSINGER, MARY LOUISE INVENTORY No. 21 - 02 - 00581 also known as ,Deceased Date of Death 6/10/2002 Social Securifi~ No. 159-09-0530 JEFFREY E. PICCOLA 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. INVe unders nd that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to uns falsifi 'on to authorities. Personal Repress Attorney: REY E. PICCOLA Signature: I.D. No.: 18018 Signature: Signature: Address: 315 N. Front Street/PO Box 741 Harrisburg, PA 17108-0741 Telephone: (717) 236-9377 Address: 3817 HILLCR)='sST ROAD HARRISBURGy PA 17109 Telephone: Dated: ~ ~Cl~ Personal Property WAYPOINT BANK -CHECKING ACCOUNT #200010021 ALLFIRST BANK -CERTIFICATE OF DEPOSIT - #87008000240424 HETRICK FUNERAL HOME -PREPAID FUNERAL Total Personal Property 40,974.85 11,967.20 3,343.00 $56,285.05 (Attach additional sheets if necessary) Total Personal Property and Real Estate $56,285.05 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PICCOLA JEFFREY E ESQUIRE 315 N FRONT STREET PO BOX 741 fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX111-961 NO. CD 001580 ACN ASSESSMENT AMOUNT CONTROL NUMBER ESTATE INFORMATION: SSN: ~ 5s-o9-0530 FILE NUMBER: 2102-0581 DECEDENT NAME: RISSINGER MARY LOUISE DATE OF PAYMENT: 08/29/2002 POSTMARK DATE: 00/00/0000 couNTY: CUMBERLAND DATE OF DEATH: 06/ 10/2002 101 ~ 5800.00 TOTAL AMOUNT PAID: REMARKS: JEFFREY E PICCOLA ESQUIRE CHECK#103 SEAL INITIALS: VZ RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS 5800.00 REGISTER OF WILLS 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 EX(11-96) NO. CD 001624 PICCOLA JEFFREY E 315 N FRONT STREET PO BOX 741 HARRISBURG, PA 17108-0741 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold ESTATE INFORMATION: ssN: ~ 5s-os-o53o FILE NUMBER: 2102-0581 DECEDENT NAME: RISSINGER MARY LOUISE DATE OF PAYMENT: 09/17/2002 POSTMARK DATE: 00/00/0000 couNTY: CUMBERLAND DATE OF DEATH: 06/ 10/2002 REMARKS: JEFFREY E PICCOLA SEAL CHECK#105 101 ~ S 159.45 TOTAL AMOUNT PAID: INITIALS: SK RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS S 159.45 REGISTER OF WILLS ~ ~~- ~ r -~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-D601 JEFFREY E PICCOLA BOSWELL ETAL PO BOX 741 HBG COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1547 EX AFF (O1-OP7 DATE 10-28-2002 ESTATE OF RISSINGER MARY L `~;,!r' i'- -~~. '.. ~" SATE OF DEATH 06-10-20D2 FILE NUMBER 21 02-0581 COUNTY CUMBERLAND '' ` ACN 101 Amount Reaftted PA 17108 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND C:0 COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-02] NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF RISSINGER MARY L FILE N0. 21 02-0581 ACN 101 DATE 10-28-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ( )CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) .00 (2) .00 (3) .00 (4) .00 (5) 56,285.05 (6) .00 (7) .00 (8) NOTE: To insure proper credit to your account, subait the upper portion of this fora with your tax payment. 56,285.05 APPROVED DEDUCTIONS AND EXEMPTIONS: 10 ,194.59 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) . (9) 10. Debts/Mortgage Liabilities/Liens [Schedule I) (10) 6,028.26 11. Total Deductions (11) 16.222.85 12. Net Vslue of Tax Return (12) 40,0!2.20 13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedule .J) (13) 33,385.15 14. Net Value of Estate Subject to Tax (14) 6,677.05 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 returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) • 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 (17) .00 X 12 .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 6,677.05 X 15 1,001.56 19. Principal Tax Due (19)= 1,001.56 TAY CQFTITTC~ DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 08-29-2002 CD001580 42.11 800.00 09-17-2002 CD001624 .00 159.45 TOTAL TAX CREDIT 1,001.56 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * 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.) 7 -- 1 1 1 ` 7 IN RE: : IN THE COURT OF COMMON PLEAS ESTATE OF :CUMBERLAND COUNTY, PN:NNSYLVANIA MARY LOUISE :ORPHANS' COURT DIVISION RISSINGER, :ESTATE #2002-581 DECEASED :SOCIAL SECURITY #159-09-0530 ESTATE SETTLEMENT AGREEMENT ESTATE OF MARY LOUISE RISSINGER THIS AGREEMENT executed this day of _, 002, by and between Mary B. Crumlich, The Salvation Army, Inc., Goodwill Industries of Central Pennsylvania, Inc., Harrisburg Hospital Nurses' Alumni Association, The Bethesda Mission and St. Jude's Hospital, beneficiaries of the Estate of Mary Louise Kissinger, and Jeffrey E. Piccola, Executor of the Estate of Mary Louise Kissinger. WITNESSETH: WHEREAS, Mary Louise Kissinger died on June 10, 2002, having first made and published her last Will and Testament dated September 25, 1999, wherein she named Jeffrey E. Piccola as Executor. Letters Testamentary were issued by the Cumberland County Register of Wills on June 21, 2002; and WHEREAS, the Executor represented by Boswell, Tintner, Piccola & Wickersham, has proceeded with the administration of said estate, and has paid all proper bills and debts for the estate and has prepared an Inventory and a Pennsylvania Inheritance Tax Return, which documents have been filed with the Register of Wills of Cumberland County on September 17, 2002; and T ~ ~ ~ ~ t '- ~ WHEREAS, the Executor and the heirs have examined the income and expense statements for the estate pertinent to the estate assets, income earned anct expense paid during the course of the administration; and WHEREAS, the Executor has prepared an Informal First and Final Account, and that the net estate of the decedent shall be distributed pursuant to an agreement among the heirs as follows: Mary B. Crumlich The Salvation Army, Inc. Goodwill Industries of Central Pennsylvania, Inc. Harrisburg Hospital Nurses' Alumni Association The Bethesda Mission - cash $6,455.75 - cash $6,455.75 - cash $6,455.75 - cash $6,455.75 - cash $6,455.75 St. Jude's Hospital - cash $6,455.75 NOW, THEREFORE, the parties hereto intending to be legally bound hereby, mutually agree, as follows: 1. Pennsylvania Inheritance Tax. The parties hereto, and each of them, agree and acknowledge that they have fully and carefully examined the Pennsylvania Inheritance Tax Return and the Schedule J Beneficiary form relating thereto, and finds them to be true and correct, and acceptable to the parties hereto and each of them, and further that they have received a copy of these documents. 2. Release and Discharge. The parties hereto do hereby release, remise and forever discharge the Estate of Mary Louise Rissinger, the Executor and the attorney for the Estate, of ~ '~ s L ~ '~ ~ • and from all manner of acts, suits, claims, accounts, accountings, debts, dues and demands whatsoever which they or their legal representatives or assigns may at ar~y time hereafter have, against the Executor, the said Estate or the assets thereof, from, for, touching or concerning any of the assets and property of the said Estate and/or any claim or interest thereto or therein, and the administration, management, collection, sale or distribution of any of the; said assets and for or on account of any money, interest, income, assets or proceeds out of the same, from the time of the death of the said decedent to and including the date of this Agreement acid release. 3. Distribution. The beneficiaries under the Last Will & Testament agree to distribution as follows: (a) Taxes. The Pennsylvania Inheritance Tax return was filed on September 17, 2002; (b) Creditors' claims. All claims of the creditors, as known to the Executor has been paid. (c) Residuary distribution. Distribution to the residuary beneficiaries will be made of the balance of the estate, after payment of all debts, taxes, and bequests. 4. Personal PropertX. There was no personal property available for distribution. 5. Final agreements. This instrument is a full and final Fair~ily Settlement Agreement by and between the parties hereto, both fiduciary and individual, all of the same having been arrived at, concluded, and executed after a full and complete; disclosure of the estate assets, the obligations, and the rights of the parties and of all the parties to, and each of them, agree to abide by these terms. •. 6. Requirement to execute documents. All of the parties to, and each of them, agree that they will at all times in the future and whenever necessary, appropriate or convenient, make, execute and deliver to the said Executor and to the other party or persons, any and all instruments, documents, conveyances, deeds, releases or other instruments of any kind necessary or convenient to carry out the intention of this Agreement and/or to perrriit, assist and enable the Executor to fulfill his duties with reference to the said estate and all of the assets and obligations. 7. Entire agreement. This Agreement constitutes the entire understanding among these parties to, and each of them acknowledges that no representations or statements of any kind, written or oral, have been made to them or any of them previously by the Executor or by any other person or party upon their behalf. 8. Heirs. This Agreement shall enure to the benefit of and shall be binding upon, these parties to, and each of them, their heirs, executors, administrators, successors and assigns. 9. Counterparts. This Agreement maybe signed in counterparts, which means each party may execute a separate copy. IN WITNESS WHEREOF, these parties to have hereunto set their respective hands and seals the day and year first above written. In the presence of: E. PICCOLA, EXECUTOR ~. r IN WITNESS WHEREOF, these parties to have hereunto set their respective hands and seals the day and year first above written. M Y B. UMLICH i + , ~ ~ `• ~ IN WITNESS WHEREOF, these parties to have hereunto set their respective hands and seals the day and year first above written. THESALV. B Allen, Asst. Secretary ~~ f ~ ~ ~ ~ ~• ~ IN WITNESS WHEREOF, these parties to have hereunto set their respective hands and seals the day and year first above written. HARRISBURG HOSPITAL NURSES' ALUMNI ASSOCLATION ~r~~al~wt.~111V~ BY: IN WITNESS WHEREOF, these parties to have hereunto set their respective hands and seals the day and year first above written. GOODWILL INDUSTRIES OF CENTRAL PENNSYLVANIA, INC. BY:~~~ ~r~ . ~ t ~ ~- w---- . _DEC-02-2002 ICON 05;02 PM ALSAC LEGAL • i~ r k ~. f FAX N0. 9015'182831 P, 02 IN WITNESS V4 NIFREOF, these partizs to have hereunto set their respective hands and seals the day and year fig st above written. St. Jude Chiidreu's gesearch Hospital BY: Bradley D. Iiagee, neral~Counsel COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DIVISION COMMONWEALTH OF PENNSYLVANIA ESTATE OF MARY LOUISE RISSINGER LATE OF MIDDLESEX TOWNHIP CUMBERLAND COUNTY, PENNSYLVANII~ FIRST AND FINAL ACCOUNT OF JEFFREY E. PICCOLA, EXECUTOR Date of Death: June 10, 2002 Letters Granted: June 21, 2002 Advertisements: Cumberland Law Journal -July 12, 19 & 26, 2002 The Sentinel -July 9, 16 & 23, 2002 Account Stated to: 11/7/2002 Estate No. 02-0581 Jeffrey E. Piccola, Esquire Boswell, Tintner, Piccola & Wickersham Post Office Box 741 Harrisburg, Pennsylvania 17108 717-236-9377 Attorney for Estate of Mary Louise Kissinger PRINCIPAL DISBURSEMENTS Schedule H (as filed) Schedule I (as filed) To which is added: 9/27/2002 - Brockie Home Medical Supply 9/17/02 -Cumberland County Register of Wills Inheritance Tax Payment 9/17/2002 -Cumberland County Register of Wills Filing fee for inheritance tax return Cumberland County Register of Wills Filing fee for Estate Settlement Agreement Boswell, Tintner, Piccola & Wickersham Photocopies, Postage, Travel expense Reserve for closing and filing of 2002 Income Tax Returns TOTAL DISBURSEMENTS 10,194.59 6,028.26 405.27 959.45 25.00 25.00 75.00 200.00 $17,912.57 r • ~ 1 • ~ ~ PROPOSED SCHEDULE OF DISTRIBUTION TO BENEFICIARIES ACCOUNT STATED TO NOVEMBER 7.20f12 Distribution of cash totaling $38,734.50 as follows: Mary B. Crumlich - cash $6,455.75 The Salvation Army, Inc. - cash $6,455.75 Goodwill Industries of Central Pennsylvania, Inc. - cash $6,455.75 Harrisburg Hospital Nurses' Alumni Association - cash $6,455.75 The Bethesda Mission - cash $6,455.75 St. Jude's Hospital - cash $6,455.75 COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN ss Jeffrey E. Piccola, Executor of the Estate of Mary Louise Kissinger, deceased, being duly sworn according to law, deposes and says that the foregoing account is true and correct to the best of his knowledge, information and belief, and that no persons claiming to be interested in said Estate as creditors, legatee, next of kin or otherwise, have given notice of their claim to the deponent, in writing or to BOSWELL, TINTNER, PICCOLA & WICKERSHAM, their attorneys, in writing. Sworn to and subscribed before his pZ day of - 0~~./ . Q~-w~ _('Jf~~~ otary Public My commission expires: 3, J l ~C,LZ -_ ~`~a;_ Oenise L. ~est:;r Nc'arv Fubl:c Harrisburg, ~,4, Dzu~h~,n ~~c~r,ty 'yComrnissioncx.~;r~s-~t~~.vt,,,~05 ~~ IN RE: : IN THE COURT OF COMMOhI PLEAS ESTATE OF :CUMBERLAND COUNTY, PENNSYLVANIA MARY LOUISE :ORPHANS' COURT DIVISION RISSINGER, :ESTATE #2002-00581 DECEASED :SOCIAL SECURITY #159-09-(1530 STATUS REPORT UNDER RULE 6.12 Name of Decedent: MARY LOUISE RISSINGER Social Security No. 159-09-0530 Date of Death: JUNE 10.2002 Will No. Register File No. 2002-581 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 (;state: 1. State whether administration of the estate is complete: YE:s x No _ 2. If the answer to #1 is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to #1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes X No d. Copies of receipts, releases, joinders and approvals of formal or information accounts may be filed with the Clerk of the Orph s' urt and maybe attached to this report. Date: December 3, 2002 Signature: Name: Jeffrey E. Pi c la, Esquire Address: 315 rth Front Stre;et, Harrisburg, PA, 17101 Telephone: (717) 236-9377 Capacity: x Personal Representative X Counsel