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Home My WebLink About02-0586PETITION FOR PROBATE and GRANT OF LETTERS Estate of Charles W. Mengle also known as Deceased. Social Security No. Z °~~ 2 °• 99?S No. a~ -~~ -s~G To: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s~, who isg~l8 years of age or older an the execut or named in the last will of the above decedent, dated Apr i 1 7 , 2000 ~ and codicil(s) dated none ' (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumber 1 a n d County, Pennsylvania, with his last family or principal residence at - L0 8 M i ~ 1 S. r A t, M H o l 'I ~ Sbrinas, Cumber and oun ~, PennG~lvar~= (list street, number and muncipality) Decendent, then 7 5 years of age, died June 19 , 2 0 0 2 ~ fig; at Carlisle Hospital, Carlisle, Cumberland County, Pennsylvania Except as follows, decedent dtd not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: n/ a Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ .SAO • ° (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ S boo . o~ situated as follows: WHEREFORE, petitioner) respectfully request(s) the probate of the last will and codicil(6) presented herewith and the grant of letters t e s t a me n t a r v (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. v v -o ~. av Robert H. Men le ~.0 179 Oakhill Road ~~v Carlisle PA 1701 H0. v <.. ~ O iC C 00 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland ss The petitioner) 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(~Gj and that as personal represen- tative(s'~ of the above decedent petitioner(x) will well and truly administer the estate according to law. 6~ ~ ~.;.,.,~~-- oo' a Sworn to or affirtt;ed and subscribed NO. 21-2002-586 Estate of Charles W. Mengle ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW June 25th ~g~ 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 April 7, 2000 described therein be admitted to probate and filed of record as the last will of Charles W. Mengle and Letters Testamentary are hereby granted to Robert H . Mengle FEES Probate, Letters, Etc. ........ . Short Certificates( 4) ......... . Renunciation ................ x-Pages (2) JCP TOTAL Filed .....~Iune,25th~2002, $ 40.00 $ 12.00 $ 6.OU $~_ 63.00 Register of Wills Mary C. LeW1S Michael A. Scherer, Esquire 61974 ATTORNEY (Sup. Ct. LD. No.) 17 West South Street Carlisle, PA 17013 ADDRESS (717) 249-6873 PHONE Call Attorney ;s r yrvc This is to certih' that the information here given is correctl~r copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 8320027 '~ o. Local Kegis[rar .~1~N 2 0 2002 [)ate itoS., eJ Rev. 2187 COMMONWEALTH Of PENNSYLVANIA • DEPARTMENT Of HEALTH • VITAL RECORDS CERTIFICATE OF DEATH STATE FM1E `!UMBER 2 NAME OF DECED NT IFxn. M~e«e. Lasl ,_ ~- ~ a.~/~eS ~~/; YYl e/tg le SEX SOCIAL SECURITY NUMBER GATE OF DEATH ~MOmd. Day.'roarl ,• Male ,. 203 - 20 - 9935 .. June 19, 2002 AGE (Lan B+maar) UNDER,YEAR UNDER,DAY DATE OF BIRTH BIRTMPVtCE (C.ry a^0 PLACE OF DEANICMc. only One--;ce ~nmttce«nm other vos, MOMM r Days FlOtaa = MNU1es !MOnm. DaY.'karl Stele «F«BQn Cotmttyt June 2 , Sun}jerv j HOSPITAL: OTHER: t I.M•~- ERIdA .ri.M ^ ODA C ^ ^ O'"" . 7 5 s. e. 1 2 ,. n„ P „pdr. Ra,Ea„u tb. - COUNTY OF DERH CrTY. BORO. TWP OF DEATH FACtL(TY NAME (Itnd insMWron. 9'V•meataro numoeri WASD GEDEM OF HISPANIC ORIGIN? RACE-Amancan lnM1m, Bbta, W?1aa. "c. ~ ^ `Spa""' 'y`a "~^~•~~^' Cumberland Carlisle Carlisle Regional Medic 1 "° ~ente ican.PUMORiu"•"°. White ., k. sa. .. ,.. DECEDEM'$USUAL OCCUPRION KIND OF BUSINESSIINDUSTRY WAS DECEDENT EVER IN DECEDENT'S EDVCATK)r1 MARITAL STATUS-MertbC SURVIVING SPOUSE !Give UaW d r«a o«,e ourrg mesa um e r an ~ un U. S. ARM D fORCE57 ~ cbn Nev« Martia6, wleovbe. 1a w.l.. a"+mao.n name! ^ Ebmemary/SatorWary Co6fye 4h'«c••(SP•tM ~ d r«Mbp "e:Mnol usareMetll ~ YM - „Maintenance En in fir. Court House 444--- (0,2) 12 oA«s+. ~~ Widower ,~ - ,:. ,x. oECEDEHT'S MAILING ADDRESS ($Irew.CN/TOVrn. S1La. ZO Co^el 108 Mill Street DECEDENT'S Pennsy vanla rr----77 ACTUAL ,7a. Stns da t7efE[.l Yas.OeceMrs E~.db-~{3•~~I,I~.~.~~C-'~e~ mq. Mra A A Mt. Holly Springs,Penna. ece RESIDENCE ~ "~^° Cumberland ~P7 Fb•a«".Ma... ^ t{. wahb atnW FAMSd ta1'IOOrp- 17l, 176. FATHER'SNAMEtfs9.Mbols„~L~ le Man d MOTHER'S NAMEIFan. MwcM. MSitlen Swnam.l y g e „ ,,. Iva Ro ers INFORMAHT'$NAMEITYP~'PI~'Ml Men 1P y H g MFORMANT'S MAIIINO ADDRESS ($Irrlel. Cify/kwn, Slab, Zq COd 17013 l l i ~ i P l d C . • r za t(oDe lr van a ennsy ar . s e, Roa , ,,,• 179 Oakhil METHOD DF d5PO5rtKN1 DATE OF dSPOSITION PUCE OF dSPOSRKN/ • NarM d Cannery, Crematory LOCATION • Cityrtown, Slab, Zq CoM KW^ Cremelion^ Removal barn SlMa^ B (MWh, pay, ~!") «DIMrPlate t Dmnbn ~ otMrlSl>etayl ^ June 20,2002 Humanity Gifts Regist . Philadelphia y Penna . „e, x,e. x,e. , , , . ' SIGNrTURE FUNERAL SERVIC NSEE OR PERSON ACTING AS SUCH LICENSE NVMB NAME AND ADDRESS OF FACRJTY 4~ ~eg 0 ~~~gyg~ 021 S~~~h ~~ .,,,. a P 9-L „~Ewin Brothers: li ::e 0 a it s <only roan urlilyinq War d my k .Mal" Otc«r al IM IirM,. "Ma area W te0. LICENSE NUMBER a DATE $MaNED .: PMM~n - n« mA.«e n lima of Mam 4 /~ Q (~ Q s 1 ~ T~'~ ~ we area Tab) V (M°'MI'. DaY. Iyr1 D 2 „a, ne. xxe. Xertu 2426 m,W WrxrtgblW try TIME OF DEATH DATE PRONOUNCED DEAD (MOnN, Day. liar( WAS CASE REFERRED 70 ME ALE MINER/CORONER? ~-+ ~~ !A ~ , r ] ~q ( ' , - Dvsdn wI10 Prorlormt ea MatR / ~ / No{, . Ns }~ ` ~ ~ ..- / _/ . 2 V O ~ r /~ Vo r I O ~ . M. xi. xe. 27. MRT 1: Enl« tM af.asee, inryries «umpacatwe whKh auaaa tM Mil". Do rot Amer IM moos al oyhq, fucd as caraa<«raspirabry arrest, slbck «MM IaiWn. I Approaimab PART B: pher sgnilkeM coriMierb mMrbtXM b MMd.ON ~ kKereal Wtrean n« mWlttq ttt Ule wiCaRyirg urM 9A'e^ h PART 1. Lbl oMy Orb ta«Ie on aaU Erb. I anM irr0 Ham MIYEdATE GUSE (Final I «a~.«t«tMbn ~NiEROVE,~I<uL.~k'IZ (=:STuu~ wtTN PELUIL MSI' ES$ ~ 3-y}wj;, RN~LtMOTOIo F~(ZTN~R-~T~S r b a ml~ a AS rg . sa w TO (OR ASAC OU E ~~~=. i ~ Tt eu~I T t S ; 4 ~ . It ~+L;.Lu W TAI L~ v A 3 eu ~ I z I S P ~ - $.aM.Mbey an t«rdAion. d. ' "any, be«nq b imma«ab DUE TO (OR AS A CONSEQUENCE OFI: 1 rause.Em«ubDERLY"W ; AT121AL FLILI C,V,~ GUSE(Oeeese«vptwy c. . Ilbl nieWCevares DUE TO (OR ASACONSEOUENCE t)Fl: _ T ~ ~t-a~oF~(c S~E~ctU uSE ranA«pnOrm,LA6 e. VrMS AN AUTOPSY WERE AUTOPSY FINdNGS MANNER OF DEATH DATE OF INJURY TIME Of INJURY IWURY AT WORK? DESCRIBE HOWIWURY OCCURRED. PERFORMED? AVMUBLE PRIOR lO IManm, Day. 1!«I ION Of CAUSE Hal«n ~ HomieiM ^ DEATH YM ^ ~^ AKgaM ^ Penoirq lmsstgation ^ 'A,e ^ tvo ~~/ vas ^ No l11 ~b• ^ Coub not W Mls^nineG ^ PUCE OF IW URY - AI hums, !stmt Aren, la«ory. o6ka M. ~• LOCATION ($deet. CMRor^. Subl xF.. tee. r. duedrg, "e. ISPecM) xa. xm. CERTIFIERICheta orW arbl onounceo oeam arb com«Mr~a Item I31 h n n«n n n n Ph u d M m . P Y • SIGNATURE AN 1T E IER ~ YI'i (~ w yycan ca yrcq nurse e e a e o vsic~a as « H SICIAN I CERTIFYING Te me Eeet e/ my knerbege, M•m etturtao Due b me caufe(fl an" manner as etatb ..................................................... ((..~ ~ `~ G x10. - DATE SKTNE 1 .Oe LICEN E NUMB E R .'barl S Y •-RONOUNCING AND CERTIFYING PHYSICIAN(iTyscan holt;vonou/Krtg oeam arW CMAyeq bcasedeeamt area hue tolM ceufe(fl area manner as sates .......................... ^ arM Place death occurrae allM tMb date Ytprtee9n - Te Ma asst of m ryy-~ • , A, yam/ (~ .t ~ ]1e '•~ D•-y,~ C17"r -~ xtE "• ~I 1 C" , , , , y NAME AND ADDRESS OF PERSON WMO COMPLETED CAUSE OF DEATH '~ obm 27, Type w Prim w, t. L. i Rm S , K/~.1 F f 111 P11J , wsD 'MEDICAL E7(AMINER/CORONER On tree Dasia of eaaminalton and/or Inees,lgalion, in my opinion, death occurred at the Ilme, date, antl place, and due to Ne cause(s) erW ^ !!~ e ~ Q 2 ( S Psi lV V h~ manner asat.,es .................................................................................................. x,a. xx. C,~L_ySL~ p (1J(3 ER REGIST '$$IGNATUREA NUM B DATE FILE IMOnm. O eail aY. ~/L /•y ,( f~ AIC/~K:~~=~YG `~ xa. ~ ~V/t~,~'`~l 'Q 1 ` l xa. 'l.C~ ~~ AW OJT LAST WILL AND TESTAMENT O F 21-2002-586 CHARLES W. MENGLE I, Charles W. Mengle of Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other wills and codicils heretofore made by me. FIRST I direct the payment of my debts and the expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. I have made my II final arrangements at Ewing Brothers Funeral Home in Carlisle, Pennsylvania, and it is my desire that my body be donated to science. I carry a card in my wallet which contains a telephone number for my family to call to make these arrangements. SECOND I give, devise and bequeath my entire estate of whatever nature and wherever situate to my children, Nancy Enck, Donna Egolf, Charles Mengle, Jr., Keith Mengle and Robert Mengle, in equal shares, per stripes. THIRD I direct that no trustee, executrix, guardian or other fiduciary named, nominated, or appointed by this my Last Will and Testament shall be required to post any bond or give any security of any type for any purpose whatsoever, any law or rule of the court of the Commonwealth of Pennsylvania or any other jurisdiction to the contrary notwithstanding. I direct that the law of the Commonwealth of Pennsylvania shall apply to any interpretation or application of the validity of this instrument. FOURTH Any and all payment or payments of any sum or sums, whether in cash or in kind and whether for principal or income, payable to an heir, or any of them, shall be made upon the sole receipt of the respective individual to whom the payment is made, and free from anticipation, alienation, assignment, attachment, and pledge, and free from control by the creditors of any such beneficiary. FIFTH I appoint my son, Robert H. Mengle, Executor of this my Last Will and Testament. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of three (3) typewritten pages, the first two (2) of which bear my signature in the margin for the purpose of identification, this 7~ day of ~~~ L , 2000. j -~ny('~ (SEAL) Charles W. Mengle Signed, sealed, published and declared by the above named testator, Charles W. Mengle, as and for his Last Will and Testament, in the presence of us, who, at his request, in his sight and presence, and in the sight and presence of each other, have hereunto subscribed our names as witnesses. ~~ ADDRESS Z`JO FAi~vi''C~/ S'ty'. CG~r~~'s~L Pi`F /7ot3 C.~.IrxA ~.~~7'~ '~ f~~;AD D RESS ~ 1'7 N ~ ~ ~ ~ u ~" ~'~ lvl ~ ~-~ ~ [ I V 51~~ S ~~ 1 ?(,~ t~: COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS. We, Charles W. Mengle,MiGYIC>~t~~ ~.~Ci'1>l?~~'(and ~i'Y1C~f1C~~1 L.~ F1~~~ the testator 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 testator signed and executed the instrument of his Last Will and Testament, and that he signed willingly and that he executed as his free and voluntary act for the purposes therein expressed, and ±hat each of the witnesses, in the presence and hearing of the testator, signed the Will as witnesses, and that to the best of their knowledge, the testatrix was at the time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. Sworn to and subscribed before me this 7 ~ day of ~~~ ,2000. Nu::ar. ~1 ..^eai Angela F..!+-,cc:r, t~:niary Public Cartis!e Bern, ~.,~!m~:,c:rland County A/iy l_;ommissio~~ Expires Oct. ?. 2001- .nb2r. Fenns~ivar;ia associating of ~Ut;tarii ~~' God -~J~~'fc~ CERTIFICATION OF NOTICE UNDER RULE 5 6(a) Name of Decedent: Charles W. Mengle Date of Death: June 19, 2002 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 June 26, 2002. Name Robert H. Mengle Donna Jean Egolf Charles W. Mengle, Jr. Keith Edward Mengle Nancy Dawn Enck Address 179 Oakhill Road, Carlisle, PA 17013 2240 Enola Road, Carlisle, PA 17013 108 Mill Street, Mt. Holly Springs, PA 17065 2416 J Herbert Road, Fayetteville, NC 28301 5906 West 124th Street, Overland Park, KS 66209 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: NONE Date: June 26, 2002 ~ ~~~~~ Michael A. Scherer, Esquire O'Brien, Baric & Scherer 17 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 Capacity: Personal Representative x Counsel for Personal Representative 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 SCHERER MICHAEL A ESQUIRE 17 WEST SOUTH STREET CARLISLE, PA 17013 fold ESTATE INFORMATION: ssN: 203-zo-9935 FILE NUMBER: 2102-0586 DECEDENT NAME: MENGLE CHARLES W DATE OF PAYMENT: 1 1 / 1 5/2002 POSTMARK DATE: 00/00/0000 couNTY: CUMBERLAND DATE OF DEATH: 06/ 1 9/2002 REV-1162 EX111-96) NO. CD 001849 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ S 1,000.00 TOTAL AMOUNT PAID: REMARKS: MICHAEL SCHERER ESQUIRE CHECK#10245 SEAL INITIALS: JA RECEIVED BY: MARY C. LEWIS $1, 000.00 REGISTER OF WILLS REGISTER OF WILLS EV-l500EX(MlO\ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 2BOB01 HARRISBURG, PA 17128-0601 11-,1-\0 REV-1500 OFFICIAL USE ONLY D I- Z W o W (,) W o w '"' ~~(I) u I!'"~ wou :z:,,9 u..., ~ FILE NUMBER .1..L-02 COUNTf CODE. YE,ll,R INHERITANCE TAX RETURN RESIDENT DECEDENT .Q.~8~ _ NUMBER - DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) MENGLE Charles W. DATE Of DEATH (MM-DO- YEAR) SOCIAL SECURITY NUMBER DATE Of BIRTH (MM-DD.YEAR) 203 - 20 - 9935 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 06-19~2002 06-02-1927 (If APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. fiRST, AND MIDDLE INITIAL) ~ 1, Original Return o 4. limited Estate liOa 6. Decedent Died Testate (Attach copy of Will) o 9. litigation Proceeds Received o 2. Supplemenlal Return o 4a. Future Interest Compromise (dale of death after 12-12-821 o 7. Decedent Maintained a Living Trust (Attach copy of Trust) o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) o 3. Remainder Return (date of death prior to 12.13-82) o 5. Federal Estate Ta.x Retum Required D- 8. Total Number of Safe Deposit Boxes o 11. Election to tax under See, 9113(A} (AttachSchOl Michael A. Scherer, Es ire FIRM NAME (IfAppllca~le) . ' .D'TO:"l .... Z W C Z C .. In W "' "' C U THIS SEC1ION "USlBE COMPLETED, ALL CORRESPONDENl;" NAME TELEPHONE NUMBER (717) 249-6873 17013 (1) (2) (3) (4) (5) OFFICIAL USE ONLY 15.227.7.5 z o ~ ..J ~ !::: Q. <t (,) w [t: 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole.Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Properly (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Bming Requesled 7. Inter.Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administratlve 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) 13. Charitable and Governmenlal Bequests/Sec 91131rusts for which an election to lax has not been made (Schedule J) (11) (12) (13) 3,405.42 14.591. 58 2.769.75 (6) (7) (8) 17.997.00 (9) (10) 3.405.42 14. Net Value Subject to Tax (line 12 minus Line 13) (14) 14,591.58 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o !c( I-" ~ Q. ::i: o (,) ~ 15. Amount of Una 14 taxable at the spousal tax rate, orlransfers under Sec. 9116 (a)(1.2) x.O_ (15) x .0 45 (16) x .12 (17) x.15 (18) (19) 656.62 16. Amount of Line 14 taxable at lineal rale 14,591.58 656.62 17. Amount of Line 14 taxable at sibling rate 18. Amount of line 14 taxable at collateral rate 19. Tax Due CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 20.11Qj > >BE SORE TO ANSWER'ALLQUE$lIOIl.SO~RWEIi~EtlllID CKI'M.TH.~;l;'1;',mf'<t' "'!;'1~~,,;p" Decedent's Complete Address: STREET ADDRESS 108 Mill Street CITY Mt. Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments 1 ,000.00 C. Discount (1) 656.62 Total Credits (A + 8 + C) (2) 1.000.00 3. InteresUPenalty if applicable D. interest E. Penalty TotallnteresVPenalty ( D + E ) (3) 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 (4) 343.38 5. If Une 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) (SA) (58) A. Enter the interest on Ihe tax due. 8. Enter the lotal of line 5 + SA. This is the 8ALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT ", - '-.:. ~.-, -. PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use or income of the property lransferred;..........................................,............................................... 0 b. relain the right 10 designate who sha!! use the property transferred or its income', ............................................ 0 c. retain a reversionary interest or............ .................... ........................................................................................ 0 d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 2. If death occurred after December 12, 1982, did decedenl transfer property within one year of death without receiving adequate consideration? ..........................,.................................. 3. Did decedent own an "in trust fo~ or payable upon death bank account or security at his or her dealh? 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...... ........................................................,............................. No KJ [] [] KJ KJ KJ .....0 KJ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, uu 0 .u.. 0 Under penalties of perjury, l 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 other lhan the personal representative is based on ail informalionolwhich preparerhas any knowledge. DATE .I -:61 -0-6 SIGNATURE OF PERSON RESPONSIBcE FOR FlUNG RETURN ~ /'}t; ~ Robert H. Mengle, Executor ADDRESS 179 Oakhill Road, Carlisle, PA 17013 SIGNATURE OF PABER OT R AN REPRESENTATIVE Michael A. Scherer Es uire ADDRESS 17 West South Street, Carlisle, PA 17013 DATE 2.5.03 ';,1'" '}3tEl~1!L\~;Z~:. . - '~.:'~-:-,~~7.:'2~..:>/:'~' ~/:a::& :,'?;~,~~~J;~J-{~;>.:~:~j:;p~-::~!n~.~.~-3.Z::~j~~'":~ For dates of death on or after July 1, 1994 and before January 1, 1995, the lax rale imposed on the net value of transfers to or for the use of the surviving spouse is 3% i72 P.S. 99116 (a) (1.1) (i)). For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers \0 or for the use of the surviving spouse is 0% i72 P.S. 99116 la) (1.1) (ii) The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed 0\"1 the \"let value of transfers from a deceased child twenty-one years of age or younger at death to or lor the use of a natural parent, an adoptive paren or a stepparent of the child is 0% [72 P.S. 99116(a)(I.2)J. The tax rate imposed on the nel value of Iransfers to or for the use of the decedent's i1neai beneficiaries is 4.5%, except as noted In 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)]. The tax rale Imposed on Ihe net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as a individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 EX+ 112.B5} . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RE51DENT DECEDENT SCHEDULE A REAL ESTATE MENGLE, Charles W. FI LE NUMBER 21-02-0586 ESTATE OF (Property Jointly-owned with Right 01 Survivorship must be disclosed on Schedule Fl All real estate should be reported at lair market value which 11 defined 01 the price at which property would be exchanged between a willing buyer and a willing lener, neither being compelled to buy or leU, both having realonable know1edge of the relevant facts. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. 108 Mill Street, Mount Holly Springs, Cumberland County, Pennsylvania 15,227.25 "' TOTAL (Atso enter on line 11 Recapitulation) (If more space is needed, insert additional sheets of same size.) s 15,227.25 SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY Estate of Mengle, Charles W. File Number 21-02-0586 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right or survivorship must be disclosed on Schedule. Item Number Description Value at Date of Death I. 1985 Pontiac 6000 Sedan 2. PNC checking acocunt #1-4018-8037 3. Proceeds of auction from Frank Potteiger for personal property $325.00 $979.00 $1,465.75 TOTAL (also enter on line 5, Recapitulation) $2,769.75 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Estate of File Number MENGLE, Charles W. 21-02-0586 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Ewing Brothers Funeral Home $770.00 2. 3. B. 1. ADMINISTRATIVE COSTS: - NONE Personal Representative Commissions 2. Attorney Fees $1,500.00 3. Family Exemption - NONE 4. Probate Fees $237.19 5. Accountant's Fees - NONE 6. Tax Return Preparer's Fees 7. Carlisle Hospital $339.36 8. Carlos Leffler, fuel oil $156.92 9. Boyd E. Diller, refuse removal $380.00 10. Mastercard $21.95 TOTAL (Also enter on line 9, Recapitulation) $3,405.42 SCHEDULE J BENEFICIARIES Estate of MENGLE, Charles W. Number File Number 21-02-0586 Name and Address of Person(s) Receiving Property Relationship to Decedent Do Not List Trustee(s) Amount or Share of Estate I. TAXABLE DISTRIBUTIONS (Include outright spousal distributions) 1/5 Residuary 1. Nancy Dawn Enck 5906 West 124th Street Overland Park, KS 66209 Donna Jean Egolf 2240 Enola Road Carlisle, PA 17013 Charles W. Mengle, Jr. 108 Mill Street Mt. Holly Springs, PA 17065 Keith E. Mengle 2416 J. Herbert Road Fayetteville, NC 28301 Robert H. Mengle 179 Oakhill Road Carlisle, PA 17013 1/5 Residuary Daughter 2. Daughter 1/5 Residuary Son 3. 1/5 Residuary Son 4. 1/5 Residuary Son 5. ENTER DOlLAR AMOUNTS FOR DISTRIBUTIONS SHO'M-l ABOVE ON liNES 15 THROUGH 17. As ApPROPRIATE, ON REV 1 SOO COVER SHEET II. NON-TAXABLE DISTRIBUTIONS A. Spousal distributions under Section 9113 for which an election to tax is not being made. 1. B. Charitable and Governmental Distributions 1. TOTAL OF PART 11- Enter Total Non-Taxable Distributions on Line 13 of REV 1500 Cover Sheet A. Settlement Statement FINAL LAWOFACES U.S. Department of Housing and Urban Development IRWIN, McKNIGHT & HUGHES nun u. . ~ST POMFRET PRCFESSJONAL BUILDING ; ~~':" 2. OPmHA 3. DConv.Unins. . 60 lIIEST Pa,AFRET STREET /7. LOAN NUMBER CARLISLE, PENNSYL VANIA 17013-3222 6. FILE NUMBER 8. MORTGAGE INSURANCE CASE NUMBER C.Nole: 'Thllfonn..furNlhMIOO....}'CIU..___l'IlolKfull.......l;OlIta.~paldlo.nfbytlllll.as.m.nt........_ a'-t. ....."*':ed"'(p.o.c.r~IrMu.*-Ing;::r._.IIowrl'*"'otlllfonNtto;~..Ind_not~k'lu.IOCPlI. WARNING:MIt.crlnielok .....,.....___ tI:I'!'MUnMtd.....onw.or otIltrllmlWfonft,PanalIle$upoft D. NAME OF BORROWER: EDDY L. DASHER and PAMELA 1. DASHER .n. , ., "^,, E. NAME OF SELLER: ESATE OF CHARLES W. MENGLE tnOMnT p A 17n^< F. NAME OF LENDER: N/A G. PROPERTY ADDRESS: 10S MILL STREET. Mount Holly Sprinss. P A 17065 H. SETILEMENT AGENT: IRWIN. MCKNIGHT ~ ~GHES. Telephone: 717-249-2353 Fax: 717.249-6354 w.... .. <._.. ("0'''''' p, "^,, .n.... 'n" N' I "'l'S TRAN"Ar .M MM~ 'M ~.no. . .0. ... 39 000.00 n........ 39 000.00 ... .. ,.. ,.. . ... S09.50 ... ... ... ... ... . In. '.m. no'" hv ..11.. . 11/15/02..12131/02 12.38 11/15/02..12/31/02 12.38 ... ....... 11115/02..06/30/03 292.66 .no M ... 11/15/02..06/30/03 292.66 .~ ... ... m ..n ,,,.~ 40 114.54 non nMOo '''n''''. 39 305.04 ?M .un..., ,n" 'M' , n". .n .." '0 ... 1 000.00 .n. ... ...- m 4 998.44 ........~ ~. , ... ,. 19 079.35 PNC BAN'lC ... ... ... ... 1 OOO.DO RBOISTBR OP WILLS ... ~. ... ... .~ ... ...-.. ... ... ... ... ... .. m ... ... ... ... ..n .n... 1 000.00 ..n Tn., ,..,. n, ," 00, 25 077.79 OM Now 'T.o~. .M -... ... .,,"' 40 114.54 n. 39 305.04 ... .~..., 1 000.00 ... ... 25 077.79 '^' 39 114.54 ." . .0 14 227 .25 TitlcExprcss Senlement System Printed 1111.5/2002 II 08;49 REV. HUo..l (3/86) U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number' DASHERE ~"'"I ""'''NT . .,co' .~... , 70<\ .~n. PAID FROM PAID FROM n....... ... ..39 000.00 . 6.000 . 2 340.00 BORRO'h'ER'S SELLER'S ,.. . FUNOSAT FUNDS AT ,., . .... WOLFB& SETTLEMENT SEmEMENT 2 340.00 9BBAJtBR RBALTORS ... 2 340.00 .00 ITO"O .-... ... ..,"' ..- .. ", .n. . ... ... _~'D. .. ... ... ... ... ... ... ." ono ... .... .... .. -. M_ .., .. .., "noM .. ... .. ... ... .00." .. '-' ..., -~ ;;:. .... .... ... .;.. ~ .M. ... .. 8.01 ._ .M' .... n. _. .. n .O~ .... .... 0.00 0.00 ..no' ".. ".. ..., .... .... .... ... ... ... NOTARY PUBLIC 6.00 ..., .", 0 I BRIEN BUle " SCRZRBa 175.00 . .... TO'....,,~... .. ..... . .... .. .... .... ]9 000.00 . .... .", Irwin MeKnirrht " Buahe. 375~OO .. .... ..no ".. D. ~..,.. . _.~. 38.50 .. 38.50 -- -"390.00 390.00 .... ... "'--....390.00 390_00 ".. _.on Tn .", aecorder ot: Deed.a 38.50 .... ,. ~~. ....._, .... "., GILBBRT'S PBST CONTROL 1 369.52 ..., .,... JO"OY CAMPBBLL TAX COLLBCTOR 515. ]7 .... ..... fA SOUTH MIDDLETON TOWNSHIP 154.55 .... tA Irwin Meb! ht " Buahe. 15.50 n., .... uno TnT>, n. .. .~. ..'''MO. 809.50 " 998.44 HUD CERTIl'lCA.'t\ON OF auvt.R. AND SELLER I h~W1 carltfully rnlew..,:l U-HUO.1 SfttIotrnent StaC_nl ancIlD Ih. battofmy knowla6lla Ind ben.t 1111 a InM and KCU"'W .tat......nl of aN 1'K.lplland dllb,,"_~ mad. on myacc:ountor b ,............. ."'_~."..., ....._.... . ""of....,.., ....._.. ........... \\ r~~ ;PA.A YQNY\Jl9..9 0",,-...1 EDOYLOASHER 'ANELAJ.O~ER - ESATEOFCHARLES W. MENGLE Br.~:::!,~ ~e WARNING: rrISA.CR1U! TOKNOW\NGLY ~ FAl.SE STAftMENTST01l-lE UNITEO STATES ON THIS Oft AN'( SIMILAR fOR'" peNAL TIES UPON CONVICTION CM INCLUDE A. FINE AND IMPRISONMENT. FOR DU....LS SEE TlTU! 18: U.$.CODE $ECTlO}t tOOl AND~c:no'M 1010. ,;:;:'=~~t::::.:=:=.=-o::,tIhIlIr'lIIIadlCl >riority 50 Plus Account Statement NC Balik For tho poriod 06/06/2002 to 07/05/2002 CHARLES W MENGLE, SR 108 MILL ST MOUNT HOLLY SPRINGS PA 17065-1715 ~ 0. PNCBAN< Primary account number: 51-4018.8087 Page 1 of 2 Number of enclosures: 5 11' For 24-hour clIstomer service or current rates: Call 1-888-PNC-BANK Moving? Please contact us at '-888-PNC-BANK ~ Write to: Customer Service PO Box 609 Pittsburgh PA 15230.9738 IQ Visit liS at www.pncbank.com .Ga, I TOO terminal: '-800-531-1648 For hC'Joflng in'lpaired c1iC'nt~ only he PNC Bank Check Card. A More Convenient Way to Make Purchases. Uti call lIse YOllr PNC fiank Check Card for more thanjusl ATM access. Use it to make purchases everywhere VISA is accepted, \'er 22 millioll localions worlc.lwide. IL works just like 'i:\ check, only faster and easier. AIH.1 right now, using your card mar par ill lUre wars Lhalljusl convenience! Visit www.pncb;Jnk.collllO read about other excilillg fealUres. And slart paying with your PNC _llIk CIH'ck Card lod"y_ 'riority 50 Pills IJterest Checking Account SlImmary ;count number: 51.4018.8087 Account Link ~ nlllnber: 0203209935 alance Summary Beginning balance l)i0.Di Deposits and Checks and other Ending other additions deductions balance 194.10 800.G3 373.r,O Average montl\ly Chilrges balance and fees 769.38 .00 Bank card/POS Account Information Teller transactions assistance calls transactions f) 0 0 PNC Bank MAC Other MAC ATM OtherATM ATM transactions transactions transactions 0 0 0 Number of d<lYs Average collected Interest Earned in in\er~s\ period balance lor APYE this period 30 769..38 .16 ransactioll SUnln1ary Checks paid! withdrawals 5 Total ATM transactions (} .terest Summary Annual Percentage Yield E"rned (APYEl 0.2:1% Charles W Mengle, Sr Please see the Activity Detail section for additional information. As of 07/05, a total of $1.34 in interest was earned this year. ctivity Detail eposits and Other Additions !e Amount Description /01 HH .00 Direct Deposit. Civil Serv LIS Tre.....sul")' ~1,12 F 15Gi90i \V CSF .Ii) rntl~rest P"pncllt '/05 There were 2 Deposits and Other Additions lolaling $194.16. FOAM953A Reviewing Your Statement --------- o PNCBAN< PI~:lse lYYfCW lhi5 ~t;}t('melll GJrefully and reconcile it with your record.~. Call the lckphollc numocr 011 the upper right side of the first page of lhi~ sl:lIt'llIellt if: you h::we ::\1\Y (1\lt.~:i\iolH r(,.~r;lrdillg your account(s); your 11:1111(' or ;)<1<11'(,$,;; i~ incoll'Ccl; YOll I\:I\'(';} bminess 7IfCounl :1J1c1 YOllr t;:JX idcnlificllioll IIlllubef is missing or incorrect; p.lll !.:lYt' ;111" (Itll'~liom I'cg:lnling illlere'.it paid to rill inl('n.'st-bl'Jrin.g :1ccounl. Balancing Your Account Update Your Account Register Compare: Checl( Off: The aCli\'itr detail section of rOll I' slatclllC'ullo your accoUIH register. All ilel1l~ in your :1CCounl register ,h:1! also appe;lf 011 your st.ll('IllCIll. Remember 10 begin Wilh the ending d:llC' of )'our I:Jsl slatemelll. (An ;lsterisk [*l will appear in the Checl\ sectlou if there t:s 3 g:lp ill the listing of consecutive check Illllubl'rs.) An}' dcpo,\il~ or tlddilions including- inll:'fest paYlnent5 tl1Hl A TM or e)('(lronic deposits li~ted Oil the statC'lllelll Ih:11 nre !lot ;1lretldy el1lcled. Am' arcmmt d{,lh.u::tions including fees tllld ATi\I or electronic deductions (h:lI tll"C' not already cntcn:.d, Add to Your Account Register Balance: Subtract From Your Account Register Balance: Update Your Statement Information Step 1: Add togelhl'1 <It'posit,') ::llId Of Ill' I' ;Jddilions lis\edinYI}\!r ;](cntllll. IT,1,,;slcr but not on your st;Hl'JIlC'IIt. Date of Deposit Amount Step 2: Add together chl'ck~ ,lIld olher deductions listed ill YOllr account rt~gi..,t('r but not on your sttl1.elllelH. Check Number or Deduction Description Amount Total A Step 3: EllIeI' thl' C'lIding b:-.bllce recorded Oil )'OUI' sl;lleIIIl'llt .$ Add dl'J)(Jsil.s ;:lIJd oLher additiom litH rcronled Total A + $ Sublot:ll= S .)1I1J1r,1('I checks :llld oth('r d\'dllctions notl'ccorckd ToI:ll B . .$ Thl' resull should l'qual your ZlCt-ounl rl'gl~ter b(llallCl.~ $--- Total a Verification of Direct Deposits Tn \'('1 if\' wllc'lher;) direcI deposit or other n;)llsfcr to your account has OCt1.11Ted, call U"i at the 2-l.hm\r customer senict' tdephollC' number listed on the lIppe-r rig"\ side of tl1(, first p:lge of this Sl;JtcllIcnL Electronic Funds Transfers III ca~l' of crron or qunliolll ahout your ck'('fTonic tramfcn or if you l\i:~d more infNmati(11l abollt a tramfer, call m at the 24-hollr nl~lomer sc~'k(' ldephollc IHlInber lilted on the "pper ri,:,:'ht ~idc of the finl p,l:;e llf thh H,lll'lllenf. Or. if you prefer, ple,He "Tite us at: Cllitolller Se",in', P,O, Box 609, Pimburgh, FA 15230.0009, If there is tl prtlhl.'m. YOll mmt Wlll.1CI th IW Jall'T 111;1\1 GO (l:ir~ ;Ifler the eliding date' of the first ~t;ltem(,l1t ('II which the error or pr(lbl('fi) ~ppc3n::d. You will need to provide the follQ\\-illg inlorm,lliou: \"'ut' \1.lme ,llld MnHrn\ lllullh('rls); .-\d(;'~'Tiplh)n o(thl' ('11'01' e,l' the tramfer you ale' <Jll(,itionillg, Pkl~e' e:-.:plain as dearly as rOll ('an wh)' )'0\1 need more in(ormathlH or why you belkve an enol' W70S nude; TIl,~ doll.lI' :imu\lIll (If th\' Hl~pected <:1'1'01'. We I\HI illw,ligat~ your compl.linl,1Ild \\'ill Cl1rrecl any error promptly. If the investigalion 1:.1kes longer lh:m 10 hminess d:JY" we will credit your ~cc{)\mt ("I' ,he ;lInl>tmt rOll think i" in f"tror. w Ih.1t YOll will h;'\n~ ll~e ofl,he f\\nd, dnring the time itl.lkf"s m to complete our in\'estig;ltioll, Member FDIC ~ Equal Housing Lender FORM953R ..~..~~~ :.,' _~:.,- :,;:;,"'R,__l '~, ". ' , , ;ONSIGNliR'S NAME ~ 110 A ~.......... ~ e./)l, ,DDRESS I.., '1 CJStc. H,LL I1..Il C ;:JfiL,C, 1~--'<(JJlt..-..",c 'HONE ~ ~~- y s"'c,'1 nod t~ L/.....e..L'i-j'~ '~flJ ~ ~~7--_ \. ' , u.L-Q. ~ ~<Z; '5 -s:~ \ t., -- . - - -, ..-,. . lrY\+, Uf,' f\.,--!; ,HEET # OF____TOTALSHEETS "; -. ",,~;<r'"~'i\'J::..: ~1:\;{~~+!~0k'.'1 'LE'MENT .o,~\.:,,; ,.;:-';,<, ,,~-~~/_:'~';: ,;'i:;'. :EXPEN~~ ,TO_"TAL: CONSIGNOR SALES' _" r -$' :Jc2, S S 35' % COMMISSION - - I (consignor) hereby commission you 10 sell the items listed above & on the attached sheets to the highest bidder by public auction. I certify that I am the owner of the above listed items and have good title and the right to selllhem. I certify thai the items listed are free lrom all incumbrances. I a~ree to accept all responsibility lor providing good title and for delivery ollllle to the purchaser. II is agreed thai the consignee is nol responsible lor the loss of any item due to fire, theft, damage, elc. I understand that a % commission will be deducted from the gross sales 01 my items. "No Bid" items will be disposed 01 at the discretion of the Auctioneer/Auction House. Payment wilt be made to the consignor within _ days from date of sale. . -f- ~ ~ .$ $~S $ $ '''''$ TOTAL EXPENSES $ J<6q ~S Jg~S~S Date Consignor Signature CHECK NO, NET pAYABLE TO CONSIGNOR Date Auctioneer/Auction Staff Signature CONSIGNOR'S SETTLEMENT COPY -. c \,) ~~'. " -""T I I I -+--. I I I J.. i ....:....1 ~--_._. --- ') , .- - ._....---:-:-::-"."~-=-=-:-:-......:-_----~.::::..-~.....:..._".:.=...:.:..:.:..:..:::...:':'-,-~- ';"':'; ----,---1 " Yahoo! Used Car Prices Page 1 of2 _ SeU.,-1Uue Book TIre Trusted ResoumI . ibtM:om Go back to "YJi;fICOlA~.~_ .. Yahoo! Autos Home> Used Car Prices> Blue Book Trade-In Values> 1985 > Pontiac> 6000 Sedan 40 > Report Kelley Blue Book Trade-In Report. Pennsylvania. November 7, 2002 1985 Pontiac 6000 Sedan 40 Trade-In Value (Fair) $325 Trade-in value represents what you might expect to receive from a dealer for this consumer owned vehicle. Keep in mind that the dealer must then absorb the cost of making the vehicle ready for sale, advertising, sales commissions, arranging financing and insurance and standing behind the vehicle for any mechanical or safety problems. Engine: V6 173 Trans; Automatic Drive: Front Wheel Drive Mileage: 95,000 Equipment Air Conditioning Power Steering AM/FM Stereo Consumer Rated Condition: Fair "Fair" condition means that the vehicle probably has some mechanical or cosmetic defects, but is still in safe running condition. The paint, body and/or interior need work to be performed by a professional in order to be sold. The tires need to be replaced. There may be some repairabie rust damage. The value of cars in this category may vary widely. A clean title history is assumed. Even after significant reconditioning this vehicle may not qualify for the Blue Book Suggested Retail value. ..t.. ": Sell this Car or Buy this Car on Yahoo! Autos Classifieds , . [Reprice This Vehicle] [Select Another Vehicle] [Yahoo! Autos] Yahoo! Used Car Prices Page 2 of 2 Copyright@2002 by Kelley Blue Book Co.. All Rights Reserved. No'Dec 2002 Edition. The information in this report was printed from the Kelley Blue Book Web site (www.kbb.com)and Is intended for the personal use of the customer only and may not be sold or transmitted to another party. We assume no responsibility for errors or omissions.(v.02110) Kelley Blue Book Resources . Home Page - See what else Kelley Blue Book has to offer. . Motorcycle Values - Blue Book values for motorcycles, ATVs, personal watercraft, and snowmobiles. . Top 50 Cars - See the most popular cars at kbb.com. . Buy the Book - You can order the printed version of the book online. . The History of Kelley Blue Book - Read more about the company that has been providing automotive values since 1926. Copyright@2002 Yahoollnc. All rights reserved. Pri\l8C'I Polic\I. Terms of Service- ~ Copyright@2002 by Kellev Blue Book ALL RIGHTS RESERVED. This information may not be reproduced or communicated in whole or in part by any printed electronic means without explicit written permission from the publisher. All information and prices published herein are gathered from sources which are thought to be reliable, but the reader should not assume that the information is official or final. The publisher does not assume responsibility for errors, and all pricing data are subject to change without notice. - o' n ..., ... ..., o ... IP r a> - ., ~~ or :: '~ a> 1 T \ \ \ \, " ~~i '0~~ !it:s:~ ~~c ~!i ~t, ~ 9.J ~ oJJ <'\ t V) ~ '" - Jl ~,\,.... 13> " \\\ ! .... s ~. I.. ..r; ,. . .':-1 o ~~^ ~~ ~~ ~ ' --- u 0<} ~ x PATIENT ACCOUNT STATEMENT CA. . 246 Parker Street . r@1~SlE P.O. Box 4100 "",c" c,,(;l; Carlisle. PA 17013 WID ~MASTERCARO CARD NUMBER IF PAYING BY MASTERCARD, DISCOVER, VISA OR AMERICAN EXPRESS, FILL OUT BELOW. CHECK CARD USING FOR PA,'fMENT "...0 VISA ~ 07102/02 9224967 AMERICAN EXPRESS SIGNA.1UAE RETURN SERVICE REQUESTED ACCOUNT NO. STATEMENT DArE - 06/17/2002 $339.36 652297\0',132) '."1,1.",11".,1,,, ,1.1....11I." 1...11.1.1.1'11I1,,1.1,1,,1 MR CHARLES W SR MENGLE 108 MILL ST MT HOLLY SPRIN,PA 17065 _ MAKE CHECKS PAYABLE TO: 1",11I".11I,..".11"11.11."',1,.'1.,,,,,1111...11...1..1.1 CARLISLE REGIONAL MEDICAL CENTER 246 PARKER ST. P.O. BOX 4100 CARLISLE, PA 17013 04676138 PS86 f- o Please checK jf above address is incorrect and indicale change on reverse side. TO INSURE PROPER CREDIT, DETACH AND RETURN THIS PORTION IN THE ENCLOSED ENVELOPE PATIENT NAME MENGLE, CHARLES W DATE PATIENT ACCOUNT NO. 9224967 DESCRIPTION DATE OF SERVICE 05112/2002 1.8III..IIIIUI..IIIIIIIIIIIIIIII TYPE OF SERVICE TOTAL CHARGES EMERGENCY-ROOM $1304.49 PAYMENT/ADJUSTMENTS 05/31/02 05/31/02 06/12/02 MEDICARE PAYMENT MEDICARE CONTRACTUAL ADJUSTMENT BLUE CROSS PAYMENT 231.69- 653.11- 80.33- PAYMENTS AND CHARGES RECEIVED AfTER THE STATEMENT DATE W1LL BE REFlECTED ON THE NEXT STATEMENT. ACCOUNT BALANCE DUE $339.36 IMPORTANT MESSAGE The amount shown on this statement is outstanding at this time. Your prompt payment will be greatly appreciated. FOR BILLING QUESTIONS, PLEASE CALL: (717) 218-8852 -- ~ 07/02/02 o~-,~~6 FAMILY SETTLEMENT AND FINAL RELEASE IN THE ESTATE OF CHARLES W. MENGLE KNOW ALL MEN BY THESE PRESENTS, that: WHEREAS, Charles W. Mengle, late of Cumberland County, Pennsylvania, died testate on June 19, 2002, having first made his last Will and Testament which was duly executed on April 7, 2000; and, WHEREAS, the said last Will and Testament of named Robert H. Mengle as Executor of his last Will and Testament; and, WHEREAS, Letters Testamentary on the estate of the said decedent were duly issued by the Register of Wlls of Cumberland County, Pennsylvania to Robert H. Mengle on June 25, 2002; and, WHEREAS, the Executor has gathered the assets of the estate of the said decedent and the assets consist of real estate, a bank account, motor vehicle and personal property, to a total value of $ 15,227.25, as set forth in "Exhibit A," which is a copy of the Pennsylvania Inheritance Tax Return in this estate; and, WHEREAS, the debts and deductions of principal, including the payment of Pennsylvania Inheritance Tax in the said estate, have been made leaving a balance for distribution of $ 13,500.00; and, WHEREAS, the balance for distribution has been reduced to cash and is available for distribution in accordance with the terms of the last will and testament of the said decedent. NOW, THEREFORE, KNOW YE, that we, being all of the beneficiaries of Charles W. Mengle, do hereby each of us, acknowledge that we have this day agreed to receive from the aforesaid personal representative, in full satisfaction and payment of all sum or sums of money, legacies, bequests, and devises as are given, devised and bequeathed to each of us respectively by our father, Charles W. Mengle, the sum of $2,700.00, due to us under his said Last Will and Testament, which amounts we will receive when each heir has executed this document. AND, each of us does hereby stipulate that in order to avoid the expense and time involved in the filing of a formal account and schedule of distribution, we each agree that no account is necessary and we do hereby agree that we do consent to distribution being made without the filing of an account and schedule of distribution, the same to be with the same force and effect as if they had been filed and confirmed by the Orphans' Court Division of the Court of Common Pleas of Cumberland County; AND each of us does hereby ratify and confirm the sale of 108 Mill Street, Mt. Holly Springs, Pennsylvania by the Robert H. Mengle to Eddy L. Dasher and Pamela J. Dasher. THEREFORE, we and each of us, do hereby remise, release, quitclaim and forever discharge the said personal representative, heirs, executors, and administrators and assigns of and from the said estate and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever for or by reason thereof, or for any other use, matter, cause or thing whatsoever, touching upon the estate of the said decedent, and each of us do further hereby covenant and agree that should any liability come due to the estate of the said decedent after the signing of this agreement, we and each of us do hereby covenant and agree with each other and the aforesaid personal representative, that we will contribute pro-rata, our share of the estate to satisfy any and all claims, demands, suits, or causes of action which may be successfully prosecuted against the said estate or the aforesaid personal representative after the signing, sealing and delivery of this family settlement agreement and final release. IN WITNESS WHEREOF, we have hereunto set our hands and seals the day and year below written opposite our respective names. Na y D. Enck STATE OF KANSAS SS COUNTY OF ,j/~f v~-~~i.n% On this, the /~~ day of ~£~i' ~-~~~~ , 2003, before me, a Notary Public, the undersigned officer, personally appeared Nancy D. Enck (known to me or satisfactory proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ~' o^=______ ~,'1iRlSTOPHER L. t3QIC~ NOTFIRY PUBLIC STATE OF KAN5AS ~Y App4 Exp. ~=i~~' _ „~ ~- ~~1,~„~J ~'? ~ (SEAL) Robert H. ngle STATE OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND ~I ~_ C ~~_(SEAL) Donna J. golf On this, the ~ ~";.~day of , 2003, before me, a Notary Public, the undersigned officer, personally appeared Robert H. Mengle (known to me or satisfactory proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. STATE OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND On this, the ~ ~~ day of , 2003, before me, a Notary Public, the undersigned officer, personally appeared Donna J. Egolf (known to me or satisfactory proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ;.r -~ ~~• ~ `'" (SEAL) Charles W. eng , Jr. STATE OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND On this, the ,~~Si day of ~~ br~~ <.~ ~~ , 2003, before me, a Notary Public, the undersigned officer, personally appeared Charles W. Mengle, Jr. (known to me or satisfactory proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. r seal Amanda L. Fisher, Notary Public Car~sle Bono. Cumberland County My Commission E~ires Apr. 17, 2006 Member. Penns Aaa~iation Qt N~ies -~ ~ SEAL) ~`~ ( Keith E. Meng STATE OF NORTH CAROLINA SS. COUNTY OF C~uM~zr Ja~c~ On this, the ~ 1 day of ~G~-~u ~~ -' ~ , 2003, before me, a Notary Public, the undersigned officer, personally appeared Keith E. Mengle (known to me or satisfactory proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. .~ ~. ~~~ra ~ ~ ~ r~. ~_f~ C7J~ yy~~ C~~~~-~ ~u~~~' '~~v-~kro Ex 16~a~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 OFFICIAL USE ONLY INHERITANCE TAX RETURN FILE NUMBER RESIDENT DECEDENT ? 1 -°-? 0 5 8 6 CCUNTYCOCE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) H Z MENGLE Charles W. W DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 0 W 06-19=2002 06-02-1927 U W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 203 - 20 - 9935 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUIv18ER w ®1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (aa;e or ceacti pnc~ to u-19-82) a ~, Y z x ~ 4. Limited Estate ~ 4a. Future Interest Compromise (da;e of Ceam aner 12-u-ezl ~ 5. Federal Estate Tax Relurn Required ~ a m ~ 6. Decedent Died Testate ;Anacn copy or wnq ~ 7. Decedent Maintained a Living Trust (Attach copy or trust) ~ 8. Total Number of Safe Deposit Boxes a ~ 9. Litigation Proceeds Received ~ 1 O. SpoUSal POVefty Credit (date of deaN between 12J1-91 and 1.1.95) ~ 11. Election to tax under Sec. 9113(A) (Attach scn o; ~ THIS SECTION MUST BE COMPLETED. ALLCORRESPONDENCE'AND'CONFIDENTiq ~'~ = ,dRMATiONS - 0 Lb BE' li~~ D70 w NAME COMPLETE MAILING ADDRESS o Michael A. Scherer, Esquire O'Brien, Boric & Scherer a FIRM NAME (~tAppiicabe; w 17 West South Street ~ TELEPHONE NUMBER Carlisle, Pennsylvania 17013 ~ (717) 249-6873 1. Real Estate (Schedule A) l1) 15 227 25 ~ .!OFFICIAL USE ONLY 2. Stocks and Bonds (Schedule B) (2) _ ~ I 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) l4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 2, 769.75 Z (Schedule E) I ~ 6. Jointly Owned Property (Schedule F) (6) ~ Q ~ Separate Billing Requested f J ~ 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (7) - -- - - F-- (Schedule G or L) n. Q 8. Total Gross Assets (total Lines 1-7) (a) 17 997 00 W 9. Funeral Expenses 8 Administrative Costs (Schedule H) (s) 3 , 405.42 _ ~ 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 8 t0) (11) 3 , 405.42 12. Net Value of Estate (Line 8 minus line 11) (12) 141591 58 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 14, 591 .58 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Z 15. Amount of Line 14 taxable at the spousal tax ~ rate, or transfers under Sec. 9116 (a)(1.2) x .0 _ (15) 16. Amount of Line 14 taxable at lineal rate 14, 591.58 x .0 45 (16) 656.62 ~" 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) U X 1s. 7ax Due (19) 656.62 __ _--~...~~ ... ~..~~-..a... w.. w....~e~n~c.~e~C. \IF1 lYGf!CPIfI~ATL1 it°a'-. _;~+_:;t~~L~~"_.t~~~ti~,f_~=_._ L, /f ~~~ 1 STATUS REPORT UNDER RULE 6.12 Name of Decedent: Charles W. iKengle Date of Death: June 19, 2002 Will No. Admin. No. 21-02-0586 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 x No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes x No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be aL-tached to this report. Date : ~~ a~ Q3 Y Signat re Michael A. Scherer, Esquire Name (Please type or print) O'Brien, Baric & Scherer 17 West South Street Address Carlisle, PA 17013 ,717 249-6873 Tel. No. Capacity: Personal Representative x Counsel for personal representative (MAH:rmf/AM3) / j - `ri ~C COMMONWEALTH OF PENNSYLVANIA '~ BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP coi-o3~ DATE 03-24-2003 ESTATE OF MENGLE CHARLES W DATE OF DEATH 06-19-2002 FILE NUMBER 21 02-0586 COUNTY CUMBERLAND MICHAEL A SCHERER ESQ ~ ACN 101 OBRIEN ETAL Amount Remitted 17 W SOUTH ST CARLISLE PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP CO1-03~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MENGLE CHARLES W FILE N0. 21 02-0586 ACN 101 DATE 03-24-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) C1) 15,227.25 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) C2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) C3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) C4) .00 of this form with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) 2,7b9.75 tax payment. 6. Jointly Owned Property (Schedule F) C6) .00 7. Transfers (Schedule G) (7) .DO 8. Total Assets C8) 17,997.00 APPROVED DEDUCTIONS AND EXEMPTIONS: 3,405.42 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .0 0 11. Total Deductions (11) 3.40F:.42 12 Net Value of Tax Return C12) 14,591.58 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13) •00 14. Net Value of Estate Subject to Tax C14) 14,591.58 NOTE: If an assessment was issued previously, lines 14, 15 and/or 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 C15) • 00 X 00 = . 00 16. Amount of Line 14 taxable at Lineal/Class A rate C16) 14,591.58 X 045 = 656.62 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) •00 X 15 - .00 19. Principal Tax Due TAY !`DCTTTC. C19)= 656.62 PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID 11-15-2002 CD001849 .00 1,000.DO TOTAL TAX CREDIT 1,000.00 BALANCE OF TAX DUE 343.38CR INTEREST AND PEN. .00 TOTAL DUE 343.38CR * 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" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ~~- ~~- ~~ COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 INHERITANCE TAX HARRISBURG, PA 17128-0601 STATEMENT OF ACCOUNT REV-16 D7 E% RFP X01-037 -~:jz, 4_ DATE 04-28-2003 err '`;~ ESTATE OF MENGLE CHARLES W DATE OF DEATH 06-19-2002 FILE NUMBER 21 OZ-0586 'Q3 ~~~Y '(s ?~1~ _44COUNTY CUMBERLAND MICHAEL A SCHERER ESQ ACN 101 OBRIEN ETAL Amount Remitted 17 W SOUTH ST (,;~~,-, CARLISLE PA 170~~~I1L, , ~`F _ .: , ~~ MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS 1 ---------------------------------------------------------------------------------------------------------------- REV-1607 EX AFP (01-03) ~(** INHERITANCE TAX STATEMENT OF ACCOUNT ~** ESTATE OF MENGLE CHARLES W FILE N0. 21 02-0586 ACN 101 DATE 04-28-2003 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 03-17-2003 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): 656.62 PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID 11-15-2002 CD00 .00 1,000.00 04-07-2003 REFUND .00 343.38- TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. * IF PAID AFTER THIS DATE, SEE REVERSE I TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 656.62 .00 .00 .00