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Home My WebLink About02-0760PE OR PRIN File Number: 21- 02 -1ba Register of Wills of Cumberland County, Pennsylvania PETITION FOR PROBATE AND GRANT OF LETTERS Estate of EDWIN E. STEVENS also known as: Deceased Social Security # 178-16-5424 Petitioner(s): DONALD E. STEVENS and SUSAN J. WAREHIME who islare 18 years of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' as applicable: ® A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the executor(s) named in the last Will of the Decedent, dated O8 / 20 / 1993 and codicil(s) dated (State relevant circumstances, e.g. renunciation, death of executor, etc.) ® Except as follows, Decedent did not marry, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: ^ B. Grant of Letters of Administration (If applicable, enter c.t.a., d.b.n., d.b.n.c.t.a., etc.) Petitioner(s), after a proper search, has/have ascertained that Decedent left no Will and was survived by the fOIIOWIn S OUSe It an an0 Welts: (If Administration c.t.a. or d.b.n.c.t.a. enter date of Will in Section rl and complete uss or neirsf Name Relationship to Decedent .Address THIS SECTION MUST BE COMPLETED: Decedent was domiciled at death in Cumberland County, PA with his/her last family or principal residence at 1765 WALNUT BOTTOP.9 ROAD, NEWVILLE, PA 17241 PENN TOWNSHIP Street address with Post Office and Zip Code Municipality: Township, Borough, City Decedent, then 79 years of age, died 07/22/2002 at NEWVILLE, PA Month, Day, Year of death City and State where death occurred Estimated value of decedent's property at death: - If domiciled in PA All personal property $ - If not domiciled in PA Personal property in Pennsylvania $ - If not domiciled in PA Personal property in County $ - Value of Real Estate in Pennsylvania $ Total Estimated Value Location of Real Estate in Pennsylvania: (Provide full address if possible.) 1765 WALNUT BOTTOD4 ROAD -NEWVILLE, PA 17241 100,000.00 100,000.00 $ 200,000.00 I `~ -~ ~ 13 File Number: 21- ~~" ~~o~ Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and/or the Grant of Letters in the appropriate form to the undersigned: Si natures of Petitioners Address of Petitioner s ,~ ~7/ 44 CONWAY STREET DONALD E. STEVENS CARLISLE, PA 17013 ~ 94 PARSONAGE STREET SUSAN J. WAREHIME NEWVILLE, PA 17241 Commonwealth of Pennsylvania OATH OF PERSONAL REPRESENTATIVE County of Cumberland The Petitioner(s) above-named swear or affirm that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioners} and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this 20th _ day of DONALD E . S EVENS ,~ A l , lST "00~ _ ~~ ,~ ~ SUSAN J. Pl EHIME ~r~ D~ e~juty Register of uVi~ s ~'K-Q ~ xd~.~1, ~=-'k~ 1.~,~.-t.Z Ems.>a ,.~1;~.~. FEES Letters ....................$ 235.00 ~ 10) Short Certificates 30.00 (__) Renunciations.... ( 3) Pages ............ 9.00 Inventory ................... Inheritance Tax............ Subtotal-(RW 500) JCP-(RW 100) ................. 5.00 TOTAL ...................$ 279.00 Attorney's Name: Attorney ID #: Address: Telephone: MARY ELLEN T0117ASC0, ESQ. 19261 P.O. BOX 682 PHOENIXVILLE, PA 19460 610-935-2780 Revised: 06/Oi/2002 No. ~ ~ - O~ - "7 te0 _ Estate of EDWIN E STEVENS ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NUW AUGUST 21 , 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 8-20-1993 described therein be admitted to probate and filed of record as the last will of EDWIN E STEVENS and Letters are hereby granted to DONALD E STEVENS AND SUSAN J WAREH 1 7 '' .:.:.. ! ~ `~ Register of Wills ~,~a~,`~k_''~ ~~i;~ L. FEES J :At"~y~~1t~-~ P bate Letter Etc ~ 235.00 ro s, ......... Short Certificates( ) .......... S 30.00 ~€~°~4~x • xtra '1?a9~s .. $ 9.00 ~-~_ ~ s nn TOTAL $ 279.00 Filed ......... 8-21-2002 .............. . called exec donald stevens on 8-21-2002 mailed cert of grant of letters $nd receipt to atty on 8-21-2002 ATTORNEY (Sup. Ct. LD. No.) .ADDRESS PHONE BATE and GRANT OF TTERS unty of Social Security No. Co onwealth of Pennsylvania Estate of also known as The petition of the undersigned resp tfully represents that: Your petitioner(s), who is/are 18 years o e or older an the in the last wi]} of the above decedent, dated and cow ic~s) dated nt was domiciled at last family or principal circumstances, e.g. renunciation, th m r idence at (list streb~tnumber and muncipality) .. Decendent, th years of age, died. at in the 1 of executor, etc.) \ ~~ County, Pennsylvania, Except as follows, dec nt did not marry, was not dt ced and did not have a child after execution of the will o d for probate; was not the vim of a killing and was n incompetent: ~'~~ Decendent at death owned property wt estimated values as follows - (If domiciled in Pa.) All persona operty $ (If not domiciled in Pa.) Personal proper 'n Pennsylvania ~$. (If not domiciled in Pa.) Personal property in unty $ V o rea e in Pennsylvania $ tuated as follows: ' WHEREFORE, petitioner(s) res pre nted herewith and the grant of theron. V C 'fl .-. PETITION OR Ivo. To: Register of Wills for the Deceased. 19 , i or adopted adjudicated y request(s) the probate of th `~..~ (testamentary; administration c.t.a.; ~ N \ Cl, ~ O C '« cC '.^. ~0. ~w ~ o OATH OF PERS~ ONWEALTH OF PENNSYLV CY OF The petitio s) above-named swear(s) or affirm(s) that the sta nts in the for going petition are true and correct to est of the knowledge and belief of petitioner(s) a personal represen- tative(s) of the above dece 'tioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed v, before me this day of ~~ 19 ° --- - - ~o Register _. _ - --- REPRESENTA ~., } S$ d.b.n.c.t.a.) will and codicil(s) 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 Stare Vital Records Office for permanent filing. WVARNING: It is illegal to duplicate this copy by photostat or photograph. Fee For this certifcate, $2.00 P 8482287 ~~. H 105.. •3 RsM, 7187 NT NT rK ~I ,,,III'IIp~,TH OF pF' Cam` \ti~r~C.~/ s_ ~ ~~ y~ ~ ~ Local Registrar ~i )y' o ~ z * ,; 'i _~~~ ~99rMENTOE~``PII JUL 2 4 2002 ,,,,,,,,,,, Date COMMONWEALTH Of PENNSVLYANIA • DEPARTMENT Of HEALTH • VITAL RECORDS CERTIF{CATE OF DEATH S*AEE FrLE WMflER NAME OF DECEDENT (Fxm. Mroaa.LSS) SEX SOCIAL SECURITY NVMBER DATE OF DEATH rM«M. Dey.''br1 ~ Edwin E. Stevens ,.male ,.178 -16 - 5424 ..July 22, 2002 ACE 0.am BNMay) UNOERtYEM UNDERID/D' GATE OF BIRTH BIRTHPLACE (Cay anE PLACE OF DERNrCnecN «My me--se•mmruclorn an oEbr Yoe) M«MM r Day Noun r NNMASa 'MOnM. Day'INrI $Mb «FCregn COUnlryl HOSPITAL: OTHER: 7 9 yn 5 / 7 / 19 2 3 Penn T wp . yJ IrNalialll ^ ERIOucparnM ^ DOA ^ Nam ^ Ry,a~ IYI ~ ^ s. e. 7. • r t ~, a. ."l COUNTY OF DERN CRY, BORO. TVIP OF DEATH FACKfTY NAME(Il not msnNlwn. grvl sbeel anE ra.nOerr WAS DECEDENT OF NI$PANK:ORIGIN7 RACE ~AmarK'an NEian, BlKa, WINle. an:. Cumberland Penn Tw 7 ~~ »~OKr».w.e^rcAre.^• `sD°~^'' p } t m Rd MaApn PV•rroAN•an ale White • ~ 5 i~~n~~ ~ ~ g ~ 4g , , . ~ „• e i r ~,. K. DECEDEM'S USUAL OCC U PATK~1 KIND OF BUSINESSIINDUS7AV NNS DECEDENT EVER IN DECEDENT'S EDUCATION MARITAL STRUS~Mamna SURVIVING SPOUSE U.S. ARMED FORCES7 c Na.•r~ ~ ~raowA, In.h, pa maven name) a g ~ d K 'a ~ ~ E~^~17 C~~ ol w i retire •~n9lih Co n j ter Construction `*•~ ~^ ~ (+1«D., Widowed Car er _ • n~ p ire. u. n. r1. re. DECEDENT'S MAILIND ADDRESS (SIrM. Cayly^rn. STaIa, ZvCDEe) ~TUAL ~ S s7a 17e ~ h• E.e.E.rM sees in ~ p ' P A Di SIa 1765 Walnut Bottom R . ry j 1 ~. , • , E s1DENDE e.e.E.rM Newville PA 17241 ~ ~"; Cumberland b~Maralaip7 11o~•E•n~ E~ 17D. c«,n na.^ Mrenn arnWenM•ol eeYIDnID. RQNEA'S NAME(FNm. MN1Ele. Lam) John Bo d Stevens Y MOTHER'S NAME (FNm,MEEI•. Malden Sunsma) Mary Jane Pechart ,~ , ~ OfIMANr'S NAME (EypmPrNM) N E ~ Donald b'• Stevens 44 Conway St Carlisle PA 17013 ,~ METHOD OF pSPD$ITgN DATE OF DISPOSITION (MO"I"D° ' I 1 PLACE OF DISPOSRKX/ • Nun. b Camruy, CNmawry LIEIpy . GaY/T~mn Slu•. ZIDcop. `~arl e 7013 BcMMI® cr•m.Iien^ Rernwaln«naM.^ ^ ^ I ~ 7/2b/2002 rl.and Valle Mem. Y ~~ lsl pa 1 D«Nlian oI1Nr($p.prhe Na me. en3 21D. tta. ' SMJ4QUREOFfVNE LSERVICE K:ENSEEOFI RSONACTINOAS$VCN 1_~ LK:ENSENUMBEA Nr~IEANOfBORE~F~~1~1T~1 Home Znc 15 Big Spring Ave `' `9 y • ,,,, ,,,,FD 13893 L ~I e wv ill • Compne e•ma 73rc only wlNn carlEyxg pry~an. roI avaAaDM •I Inrl• «aam n BN wu a my N , Maln IM Iona, Eats anE place NaIaE. (SgnmtMa ana iine) LICENSE NUMBER ORE SIGNED PA«n+. Day. lberl wlaycw.aaaln. QM/(~ ~f'yjQ - ~ " •3VO~~ Z ~ 7~' ~-~ i . / / 7A. OT zie. ~w v u c rx. M•m•71-78 muu D•comp•IW W TIME OF DERH ORE PRONWNCEO OEAD(Mm m.Da y,Year) WAS CASE REFERRED TO MEDICAL EXAMINEWCORONER7 ^ ' //ry'1 p•raDrl •EID PNVNraIC•a warn. Na^ ~~-~~1~ 21. (/ M. H. 7{. - t7. HART 1: Etwr IM dNaaas, NMMna«conM)ecalMMr wllicn CaM•M IM a•aln. Dona anler IM maaa of Eyirp, eMCn •e caraix «r•spiralory ursm, anoct «Ma^ lailun. t Approaimal• PART M: Olnsr •i0nincant corrOMierr mnDIDIIlIn9 N a•am. Doc Lim pW DM Caln• M ea«r INN. I NMaMI Dalw••n n01 MuXNp N1 tlN WNrhMlq eallaa pMrr "n PAR{ 1. I orr•u anOOe•M IYYEdATECAVeE4FMw I NaMenO n oaelnl --- DUE lD10A ASA CONSEQUENCE OF} SarNnnaly au eonENiDM D. Bark, NaWgmerecNauN DUE 70 KXI ASA CONSEOVENCE Off: I erne. Enlr UMDERLYNp i - Ilr NrawaE eeeraa D11E TOpgASACON$EOUENCE OFI: 1 reawrp r D.elnl LAST a . Var~S AN AIfiOPSY WERE AUTOPSY FINDINGS MANNER OF DERH DATE OF INJURY TIME OFINJURY IWURYR WORK7 DESCRIBE HOW INIURY OCCURRED. PERFDRMED7 AMVIABLE PRK7R i0 (Manor. Day, Ito) COMA Oi CAUSE Nu u L7 N i i ^ w om c M W ^ r/e ^ Ateiaanl ^ Wrreirrq lnysllg•Ibn ^ 70a M. N• ^ ND yYa ^ No SuiciEa ^ D«AE n«De EeNrmmeE ^ PLACE OFINJVRY.AIMm•. larm, mreM,laclory, oBM:a LOCRK7N IStrer. Caylbwn, $taAH Due7eq, me. Ispeeavl ae.. rs. ». Eoe. Sa. CEAEIFIEII ICI+ac•rMYy Dnel IGNRUR OTITLE OF CERTIFIER 'CERTIFYING PHYSICIAN IPnyecnn crrrmyM) cane «Eestn rtwn snomer Dnysc'an naa «Dn«rnteE Seam ano can«erea Ilan 231 r B e N DNI •r my Nnwl•aw. ae•m oeeurraa aw m Ina cau•e(•1 •na manna. a• •eu.a ......................................:.............. SID. ~~ LICEN VMBER DRE S KiNEDIMOnm.Oey. Mead ERTIFYIMOPNYSICIAN(PhysCyn Dpln yOnourcyg 0ealn anEtMrlyrgrouuse of Eealnl • ~ ~Mrm M~I FRM '^ ~1 ~ Q .. ^ Ter N Da•t noa ~ •aqn, e••In xewrea aI tlN Len., ears, ana vlu•, anE aw 1• Ina uuw(•1 aw m•nn•m •I,lea .......................... 31a ~/ D7~~0 714` AME AND ADDRESS OF PERSON YMO COMPLETED CAUSED DEATH 'MEDK:AL EXAMINER/CORONER (Item 211 Type «PnM J _ ~,,/ ~ ,~, ~ On tM Duia Df enminerlon arWlae inveaHgalion, In my opinion, dears xturrea at the .lore, Eare, ana place, arM Eua to me ean•e(q aM /O U s. ~(/ / L H tr ^ manner as ~„w .................................................................................................. 3r.. o:. N•£ u/ t/! /~/~ ~ / ~ 2 `/! REGISTRAR'S SIGNATURE AN U ER DATE FILED (MMM. Day. M4r1 ~• ~~ Ill ~ a, ~ ~ D I ~.. _ cS~~.~ a~ ao~ ~ _' LAST WILL AND TESTAMENT OF EDWIN E. STEVENS 21-02-760 I, EDWIN E. STEVENS, of 1765 Walnut Bottom Road, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking any and all prior Wills and all Codicils made by me at any time heretofore. ITEM 1. I direct that all my legally valid debts, funeral and administration expenses, and inheritance and estate taxes incurred on account of my death shall be paid by my personal representative out of my residuary estate as soon after my death as practicable. ITEM 2. I give, devise and bequeath all the rest, residue and remainder of my estate, whether real, personal or mixed, including automobiles, together with all insurance policies thereon, also specifically including my half (1/2) interest in mountain land in Penn Township, Cumberland County, to my beloved children, DONALD E. STEVENS and SUSAN J. WAREHIME, in equal shares. In the event that either of my children should fail to survive me by thirty (30) days, his or her share shall be distributed to his or her then living children in equal shares. ITEM 3. It is my express desire .that in the event that my Page 1 of 3 E.E.S. Co-Executors wish to sell the property located at 1765 Walnut Bottom Road, Newville, Pennsylvania, they shall first offer it to my neighbor, MELVIN SENIG, at whatever they consider to be the fair market value, and that they should extend an offer in writing to him such that if he does not accept said offer within thirty (30) days thereafter, my Co-Executors may dispose of the property in any manner that they see fit. ITEM 4. I authorize my Co-Executors to exercise the following powers, in addition to those given by law to be exercised in their sole discretion: a. To retain any or all assets of my estate, real, personal or mixed, without regard to any principle of diversification, risk or productivity. b. Tv invest in all forms of property without restriction to investments. c. To sell at public or private sale, to exchange, mortgage or lease for any period of time, and to repair, alter or improve any real or personal property, and to give options for sales, exchanges or leases, for such prices and upon such terms and conditions as they deem proper. d. To compromise any claim or controversy. Page 2 of 3 E.E.S. .'~ f',' e. To make distribution hereunder in cash, in kind, or partly in cash and partly in kind. ITEM 5. No fiduciary acting hereunder shall be required to post bond or enter security in any jurisdiction. ITEM 6. I nominate, constitute and appoint my children, DONALD E. STEVENS and SUSAN J. WAREHEIM as Co-executors of this, my Last Will and Testament. IN WITNESS WHEREOF, I set my hand and seal to this, my Last ~a ~1 J_~_ /~~~;-~= Will and Testament, this ~ day of r-1993. i ' ,OPAL ) Edwin E. Stevens The preceding instrument, consisting of this and two (2) other typewritten pages, initialed at the bottom of each page for security purposes, was on the date thereof signed, published and declared by EDWIN E. STEVENS, the Testator herein named, as and for his Last Will and Testament in our presence, who, at his request, in his presence and in the presence of each other, have subscribed our names as witnesses whereof. WITNESS WITNESS Page 3 of 3 ,rt. COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND : We, EDWIN E . STEVENS , ~ ~~~~ l/~ ~~/~e~ „?~ and l~-~~,~ ~ ~.-{4`~- the Testator and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the will as witness and that to the best of his knowledge the Testator was at the time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. Edwin E. Stevens WITNESS WITNE S Sworn to and subscribed before me this ~?~ day of ,C~,,, ~ , 1993. ~~~ DISTRICT JUSTICE 09.3.02 P.O. Box 155 Newville, PA 17241 ~~~~ , ,e, ~~ a ~~.~ /~9 ~= CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: EDWIN E . STEVEN Date of Death: __ July 2 2, 2 0 0 2 Wil] No. 21- 0 2- 0 7 6 0 Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of th Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on _ ~~T=?~~ ~ G -2_.-- Name Address Donald E. Stevens 44 Conway St. _ Carlisle, PA 17013 Susan J. Wa_rehime 94 Par onac~ St Newville, PA 17241 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except i~ ----> Date: ~2~ ~ z.. '~~ L (y~~~bi Signature Name 1~'IARY ELLEN TOMASCO , ESQ . Address p. O. Box 6 8 2 Phoenixville PA 19460 Telephone (61Q 935-2780 Capacity: Personal Representative _x_Counsel for personal representative ~~~ ~~~ ATTORNEY The Commons at ikilley Forge East • Suite 62 1188 galley Fcxge Road P O. Box 682 • Phoenixvil~. Pennsylvania 19460 -0682 • 610.935.2780 fax 935.5995 rv_, Dctober 8, 2002 Register of• Wills Cumberland County Courthouse Carlisle, PA 17013 RE : Estate of Edwin E . Stevens File Number: 2002-00760 Dear Sirs Enclosed please find apre-payment on Inheritance Tax due on the above estate in the amount of $30,000.00. Please forward the receipt to my attention. Thank you. Very truly yours, ~; ^ -~ ~~ Mary Ellen Tomasco MET/br Enc . cc: Don Stevens ;..:. ~ ~ ~` ~~ ,•~ e . r ~ n {5~ t "~' ~'~ ~ l r~r~ r ~ ;; ~~~ ~ ~~ = '' nor ~ ~ odr+ ~~~ *~ ~C O O C i :d 0 ... ~~ N :~, ~: ^~ l ~. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT_280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: TOMASCO MARYELLEN PO BOX 682 PHOENIXVILLE, PA 19460 fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: SsN: 178-16-5424 FILE NUMBER: 2102-0760 DECEDENT NAME: STEVENS EDWIN E DATE OF PAYMENT: 10/ 1 1 /2002 POSTMARK DATE: 10/09/2002 COUNTY: CUMBERLAND DATE OF DEATH: 07/22/2002 REV-1162 EX(11-96) NO. CD 001721 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ S 30, 000.00 TOTAL AMOUNT PAID: REMARKS: MARY ELLEN TOMASCO ESQUIRE CHECK# 0180207 SEAL INITIALS: JA RECEIVED BY: MARY C. LEWIS $ 30, 000.00 REGISTER OF WILLS 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 EXf71-96) N0. CD 002311 TOMASCO MARYELLEN ESQUIRE PO BOX 682 PHEONIXVILLE, PA 19460 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold ESTATE INFORMATION: ssrv: ins-~s-5424 FILE NUMBER: 2102-0760 DECEDENT NAME: STEVENS EDWIN E DATE OF PAYMENT: 03/ 1 9/2003 POSTMARK DATE: 00/00/0000 couNTY: CUMBERLAND DATE OF DEATH: 07/22/2002 101 ~ $176.30 TOTAL AMOUNT PAID: REMARKS: MARY ELLEN TOMASCO ESQUIRE SEAL CHECK#125 INITIALS: JA RECEIVED BY: DONNA M. OTTO $176.30 DEPUTY REGISTER OF WILLS REGISTER OF WILLS ~, l ~- ~3 ~ /3 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-154] ER ~FP (01-33) DATE 05-05-2003 ESTATE OF STEVENS EDWIN E DATE OF DEATH 07-22-2002 FILE NUMBER 21 02-0760 COUNTY CUMBERLAND MARY ELLEN TOMASCO ESQ ACN 101 PO BOX 682 PHOENIXVILLE PA 19460 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS 1 ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF STEVENS EDWIN E FILE NO. 21 02-0760 ACN 101 DATE 05-05-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 199,000.00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) 407,761.80 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4l .00 of this form with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 1 28,525.11 tax payment. 6. Jointly Owned Property (Schedule F) [6) .00 7. Transfers (Schedule G) (7) .00 8. Totai Assets (81 735,286.91 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 29,148.87 10. Debts/Mortgage Liabilities/Liens (Schedule Il ( 10) 466.90 11. Total Deductions (11) _ 29.615.77 12. Net Value of Tax Return (121 705,671.14 13. Charitable/Governmental Bequests; Non-elected 9113 Trust s (Schedule J) (13) .0 0 14. Net Value of Estate Subject to Tax (141 705,671.14 NOTE: If an assessment was issued previously, lines 14, 15 andior lb, 17, 18 and 19 will reflect figures that include the total of ALL ret urns 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) 705, 671.14 X 045 . 31, 755.20 17. Amount of Line 14 at Sibling rate (17) .00 X 1 2 - .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 - .00 19. Principal Tax Due (191. 31,755.20 TOY f_QFi1TTC• DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 10-09-2002 CD001721 1,578.95 30,000.00 03-19-2003 CD002311 .00 176.30 TOTAL TAX CREDIT 31,755.25 BALANCE OF TAX DUE .05CR INTEREST AND PEN. .00 TOTAL DUE .05CR * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TDTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) Estate of EDWIN E. STEVENS ,Deceased File Number: INVENTORY AND APPRAISEMENT PAGE 1 OF 2 21-02-0760 Of all the goods, chattels and credits of EDWIN E. STEVENS 1765 WALNUT BOTTOP4 ROAD - NE1(VVILLE, CUll~IBERLAND COUNTY, PA. Date of Death: JULY 22 , 2002 late of Date acquired by Decedent Description of Items Included in Inventory and Appraisement (Attach additional pages as necessary) REAL ESTATE known as Walnut Bottom Road Penn Townshi sin le famil ranch st le horse on .988 acre, assessed value 162,530, tax par- cel #31-11-0298-O16B , fair market value per at- tached sales agreement 174,000.00 12 ACRES VACANT LAND Peach Orchard Road, Penn Townshi assessed value 64,.760, tax ar- cel #31-13-0112-022 , decedent owned jointly with sister, Elverta S. Kapp, as tenants in common er attached deed dated December 18, 1964, and in Deed Book 21 Pa a 361 fair market value er attached appraisal. 20 , 200 , actual value . based on best o er or lan to ate, , decedent's one-half interest 25,000.00 25,000.00 AnAP~S COUNTY NATIONAL BANK STOCK 4532 shares @ 22.25 per share • Date of death value per John Chriton, CFO of ACNB 100,837.00 rR&T BANK 4030 shares @76.16 er share Date of death Hi h-77.50 -Low-74.82 306,924.80 FARP9ERS NATIONAL BANK OF NF.LVVII.LE Checkin Account #13-124-5 Date of death balance 14,115.04 DONALD E. STEVENS I, SUSAN J. WAREHIP9E Personal Representative of Estate of EDWIN E. SEVENS ,Deceased Verify that the statements made in this inventory and appraisement are true and correct. I understand that false statements herein are made subject to the penalties of 18 PA C.S. Section 4904, relating to unsworn fal ' cation to autho 'ties. ~ ~ ~ ~~~ Signature of Personal Representative Signature Personal Representative . DONALD E. STEVENS SUSAN J. WAREHIr7E PAGE 2 OF 2 Estate of EDWIN E. STEVENS ,Deceased File Number:. 21-02-0760 INVENTORY AND APPRAISEMENT Of all the goods, chapels and credits of EDWIN E. STEVENS 1765 WALNUT BOTTOP4 ROAD - NE`(VVILLE, CUt\9BERLAND COUNTY, PA. Date of Death: JULY 22 , 2002 late of Date acquired by Decedent Description of Items Included in Inventory and Appraisement ~ (Attach additional pages as necessary) FARP9ERS NATIONAL BANK OF NEWVILLE ~9P7DA #1594478 Date of death balance including accrued interest of $50.16 44,876.27 FARP~ER5 NATIONAL ]SANK OF NECVVILLE Certificate of Deposit #3990991 Date of death balance including accrued interest of $17.80 50,017.80 1985 FORD CROI'1N VICTORIA VIN #2FABP43F2FX200003 139 833 miles Sold to nei hbor for $1,•200.00 1,2 1995 FORD F-150 EDnIE BAUER PACKAGE Pick-u VIN #1FTEF14HOSNB47998 • 68 , 591 miles Kell Blue Book 10,460.00 CONTENTS OF DECEDENT"S HOUSE See attached a raisal 7 , 856.00 TOTAL 735,286.91 DONALD E. STEVENS I, SUSAN J. WAREHIP4E Personal Representative of Estate of EDWIN E. SEVENS ~ Deceased Verify that the statements made in this inventory and appraisement are true and correct. I understand that false statements herein are made subject to the penalties of I8 PA C.S. Section 4904, relating to unsworn falsification to authorities. Signature of Personal•Representative DONALD E. STEVENS Signature of Personal Representative • SU5AN J. WAREHIPZE t °7-_5~' '~ ~. 13 i REV+500118-00) COMMONWEALTH OF REV -15 0 0 OFFICIAL USE ONLY ' PENNSYLVANIA DEPART REVENUE EP ~OF INHERITANCE TAX RETURN _ FILE NUMBER ____ D ~ ~ ~ l HARRISBURG, PA 17128-0601 RESIDENT DECEDENT N~ e ~ - - ~~ nc -oDE ~ ~ DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Z STEVENS EDWIN E. 178- 16 -6424 W DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE W v JULY 22, 2002 P9AY 07, 1923 REGISTER OF WILLS G (IF APPLICABLE} SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER F ~ 1.Original Retum ~ 2. Supplemental Return ~ 3. Remainder Retum lda+eaae~n+prlaw+2-+aszt ~ a ~ ~ 4. Limited Estate ~ 4a. Future Interest Compromise teals of death any +2-u-azl ~ 5. Federal Estate Tax Retum Required W ~ a m ~ 6. Decedent Died Testate (attach cagy er wag ~ 7. Decedent Maintained a Living Trust (Attach wr of Trust) 0 8. Total Number of Safe Deposit Boxes a 9, Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date or aeatn hetvreen i2-a+-s+ aoa +-+•esl ~ 11. Election to tax under Sec. 9113(A) (Attach Sch of F- z W NAME COMPLETE MAILING ADDRESS o A'IARY ELLEN TOP9ASC0, ESAUIRE p,0. F30X 6 82 H FIRMNAME(1taPq~caelel PHOENIXVIL LE, PA 19460 °C TELEPHONE NUMBER ~ 610-935-2780 1. Real Estate (Schedule A) (1} 199 , 000.00 OFFICIAL USE ONLY 2. stocks and Bonds (Schedule B) (2) 407 , 761.80 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3} 4. Mortgages 8 Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (5) 128 , 525.11 Z (Schedule E) 6. Jointly Owned Property (Schedule F) (6) Separate Billing Requested ~ 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (7) a Q V W Ixrteaute ~ or t.l 8. Total Gross Assets (total Lines 1-7) 11. Total Deductions (total Lines 9 8 10) 12. Net Value of Estate (Line 8 minus Line 11} 13. Charitable and Governmental Bequests/Sec 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) (8) 735,286.91 9. Funeral Expenses 8 AdminisUative Costs (Schedule H} (9} 2 9 , 148.8 7 10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I} (10) 466.90 (11) 29, 615.77 (1z) 705,671.14 (13) (14} 705,671.14 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Q 15. Amount of line 14 taxable at the spousal tax ~ rate, or transfers under Sec. 9116 (a)(1.2) x .0 -_ (15) Fa- 16. Amount of Line 14 taxable at lineal rate 705 , 671.14 x .0 __ (16) 31, 7 55.20 d 17. Amount of Line 14 taxable at sibling rate x .12 (17) V 18. Amount of Line 14 taxable at collateral rate x .15 (16) 19. Tax Due (19) 31, 755.20 F- 20. ^ ~ • a • • ` °,~ ~' "` ,`'~, '~'> > ~ E'70 ANSNfERALL t1tJES'11dN9'ON REVERSE~SIDE AND RECHECK MATH ~ <' ~. ': r^= '-r.~. •:. . ueceaen><'s Vompie><e Haaress: STREETADORESS ED~yIN E. STEVENS 1765 WALNUT BOTTOM ROAD CITY NEWVILLE STATE PA ZIP 17241 Tax Payments and Credits: 1. Tax Due {Page 1 Line 19) 2. CreditsfPayments A. Spousal Poverty Credit B. Prior Payments 3 0, 0 0 0.0 0 C. Discount 1, 5 7 8.9 0 Total Credits (A + B + C ) (1) 31,755.20 3. InteresUPenalty if applicable D. Interest E. Penalty Total InteresUPenalty (D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (2) 31,578.90 (3) -0- (4) -0- (5) 176.30 (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 176.30 Make Check Payable fo: 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 No a. retain the use or income of the property transferred :.................................................................................... ...... ^ b. retain the right to designate who shall use the property transferred or its income : ...................................... ...... ^ c. retain a reversionary interest; or .................................................................................................................... ...... ^ ^ d. receive the promise for life of either payments, benefits or care? ................................................................ ...... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................... ....... ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ....... ....... ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................................................................................................. ....... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer ottrer tfran the personal representative is based on all information of which preparer has any knowledge. SIGN RE OF PE 0 R SPONSIBLE FOR FILING RETUR~ ~ ~ / ,/j /~,, ?DA7 i1/~~~~ /l 0 }~P/l/~ ~7 rt / i ,1 lp e . i 1/ ~ I P~(l ,~ t~ Y l ~ Yt A i~ /~ 7 / ~ / C 44 CONWAY STREET - CARLISLE, PA 17013 OF PREPARFgR QTHER THAN REPRESENTATIVE DATE ., ADDR ss 1` ARY ELLEN TOMASCO, E5AUIRE P.O. BOX 682 - PHOENIXVILLE, PA 19460 ,w_ . .. For dates of death on or after July 1,1994 and before January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% (72 P.S. §9116 (a) (1.1) (i)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 surviving spouse is 0% (72 P.S. §9116 {a) (1.1) (ii)j. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% (72 P.S. §9116(a)(1.2)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. §9116(1.2) [72 P.S. §9116(a)(1)j. The tax rate imposed on the net value of Uansfers to or for the use of the decedent's siblings is 12°~ (72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. rEV~~,o:or• nm , C~+fMONVVEAt.TH OF PENNSYLVANw INHEPoTMICE TAX RETURN SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER EDVIIN E. STEVENS 21-02-0760 All real property ovmed soley or as a bnant In common must be nported at taU market value. Fak madcet value B defrred as the price at which pmpaAy would be excharryed between a wiffinq buyer and a wilUnp seAer, rreiCrer be6rq oompeUed W buy or seU, both ~ reasorrabb knowbdye d the relevant fads. tteai property vfiich is jointy~owned vrith right of ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. REAL ESTATE known as Walnut Bottom Road, Penn Town- ship, single family ranch style home on .988 acre, assessed value 162,530, tax parcel #31-11-0298-016B, fair market value per attached sales agreement 174 , 000.00 2. 12 ACRES VACANT LAND, Peach Orchard Road, Penn Town- ship, assessed value 64,760, tax parcel #31-13-0112-022, de- decent owned jointly with sister, Elverta S. Kapp, as tenants in common per attached deed dated December 18, 1964, and recorded in Deed Book 21 Page 361, fair market value per at- tached appraisal 20 , 200 , actual value based on best offer for land to date, 50,000.00, decedent's and-half interest 25,000.00. 25,000.00 TOTAL (Also enter on fine 1, Recapitulation) ~ f 199 , 000.00 /11 mnro QY~gf A is -1AR+tR/1 insert a/tditional sheets of the same size) IEKt~GOFA~S~I CAMMONVVEALTH QF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS ~ BONDS EDWIN E. STEVENS 21-02-0760 AU property jointly-0wned with rlpht of surrivorshlp must bs discbsed on ScheduN F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~• ADAD9S COUNTY NATIONAL BANK STOCK 4532 shares @ 22.25 per share Date of death value per John Chriton, CFO of ACNB 100,837.00 2. 119r1sT BANK 4030 shares @ 76.16 per share Date of death High-77.50 -Low-74.82 306,924.80 TOTAL (Also enter on line 2, Recapitulation} I S 407 , 7 61.8 0 na ..,,,,~ ,..,.,..n ie nnn.l..a i..~oA o.~lrlilinnal Shoots of iho came ciool ~v-~so~ oc. I~~n COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER EDWIN E. STEVENS 21-02-0760 Indude the proceeds of litigation and the date the proceeds were received by the estate. AU property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALVE AT DATE NUMBER DESCRIPTION OF DEATH t• FARMERS NATIONAL BANK OF NEWVILLE Checking Account #13-124-5 Date of death balance 14,115.04 2. FARirRERS NATIONAL BANK OF NEWVILLE P.7MDA #1594478 Date of death balance including accrued interest of $50.16 44,876.27 3. FARP~IERS NATIONAL BANK OF NEWVILLE Certificate of Deposit #3990991 Date of death balance including accrued interest of $17.80 50,017.80 4. 1985 FORD CROWN VICTORIA VIN #2FABP43F2FX200003 139 , 833 miles Sold to neighbor for $1,200.00 1,200.00 5. 1995 FORD F-150 EDDIE BAUER PACKAGE Pick-up VIN #1FTEF14HOSNB47998 68,591 rules Kelly Blue Book 10,460.00 6. CONTENTS OF DECEDENT'S HOUSE See attached appraisal 7 , 856.00 TOTAL {Also enter on line 5, Recapitulation) 13 12 8 , 5 2 5.11 rlf mnrP cnA('P iC nPP(fP(t incPrf grt(titinnal R11P.QtS of the SATP CI7Pi aev psi iex. pan COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE H FUNERAL EXPENSES 8 ADMINISTRATIVE COSTS FILE NUMBER EDWIN E. STEVENS 21-02-0760 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t. PRE-PAID 8. ADMINISTRATIVE COSTS: 1. Personal RepresentatNe'sGommissions Name of Personal Representative (s) NONE Social Security Number(s) ! EIN Number of Personal Representative(s) SUeet Address City State Zip Year(s) Commission Paid: 2, AttomeyFees P4ARY ELLEN TOP4ASC0, ES4~UIRE 3. Family Exemption: (II decedent's address is not the same as claimant's, atlach explanation) Claimant N / A Street Address City State Zip Relationship of Claimant to Decedent 22,058.00 4• Probate Fees REGISTER OF WILLS -Probate fee 279.00 5, Accountant's Fees g. Tax Retum Preparer's Fees 7, PP&L -Upkeep expense 1,083.94 8. SPRINT _ Upkeep expense 294.31 9. ADAPZS COUNTY BANK - Check order 13.00 10. KEP'IPER INSURANCE -Homeowner's Insurance 947.86 11. P9AT3EL STITT - School taxes 2,272.90 12. W5I HARRISBURG -Trash removal 103.86 13. DIVERSIFIED APPRAISAL SERVICES -Land appraisal 250.00 14. GLENN RAUDABAUGH -Lawn care 106.00 15. RECORDER OF DEEDS - 1% Transfer Tax 1,740.00 TOTAL (Also enter on line 9, Recapitulation)_ ~ s 2 9 ,14 8.8 7 pit ... _.,. ___,.,. ~~ ....~., . a ,.. ~.,.. ,.aal~t„~ol .•1. ~.,~~ .~! ~~.,... ~..... ~, nl • REV-tSttEX•(t-s~) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER EDWIN E. STEVENS 21-02-0760 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. PP&L -Electric bill 176.58 2. THE NECVS -Bill of decedent 20.30 3. GLENN RAUDABAUGH -Lawn mowing 200.00 4. SPRINT -Phone bill 70.02 TOTAL (Also enter on line 10, Recapitulation) I S 466.90 (If more space is needed, insert additional sheets of the same size) gEV.tSU Df ~ U•9A SCHEDULE) COMMONWEALTH OFPENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER EDWIN E. STEVENS 21-02-0760 RELATIONSHIP TO DECEDENT AMOUNT OR SNARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not L(st Trustee{s) OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. DONALD E, STEVENS SON ONE-HALF 44 CONWAY STREET RESIDUE CARLISLE, PA 17013 2. SUSAN J. WAREHIPIE DAUGHTER ONE-HALF 94 PARSONAGE STREET RESIDUE NEWVILLE, PA 17241 II. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET 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 II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET I S ~f ~K~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: Ft~WTN F ~TRVFNS Date of Death: 7/22/02 Will No. 21-02--0760 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the fallowing 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 X b. The separate Orphans' Court: No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest?' Yes X No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Date : ~ Q ~ ~ I C~~~"C Signat re Mary Ellen Tomasco, Esq. Name (Please type or print) P. O. Box 682, Phoenixville, PA Address 1 (610 ) 935-2780 Tel. No. Capacity: Personal Representative X Counsel for personal representative (MAH:rmf/AM3)