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FAMILY SETTLEMENT AGREEMENT � � � rn
IN THE ESTATE OF GRAY D. WAGNER, DECE�`rS�D � `'' �
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AGREEMENT executed this _�_�� day of ��-�j,i,� 'V , �2014, by a��C,,
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between SALLY A WAGNER, Administratrix of the Estate of GRAY D. WAGNER, �cea�ed�:��
and DENISEA. WAGNER, heir and beneficiary of the Estate of GRAYD. 1�,A'�FNER.�� i--- °�'�'
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WHEREAS, GRAY D. WAGNER, late of West Pennsboro Township, Cumberland
County, Pennsylvania, died on September 10, 2013, having died intestate with no known Last
Will and Testament.
WHEREAS, on September 24, 2013, the Register of Wills in and for the County of
Cumberland, Commonwealth of Pennsylvania, did constitute and appoint SALLYA WAGNER,
as Administratrix of the Estate of GRAYD. WAGNER, in Estate Number 21-]3-1029, and
�WHEREAS, the Administratrix has proceeded with the administration of said Estate
consisting of probate assets in the amount of $7,414.72 less d%sbursements made or debts due
totaling in the am_olznt of$16,732.78, creating an insolvent estate and leaving no distribution to
heirs, as set f'orth on_ the First and Final Account, a true and correct copy of which is attached
hereto and made part hereof as Exhibit"A", and
WHEREAS, Administratrix, from her own funds, assisted in paying the costs of
administering this estate, as the estate was otherwise insolvent;
WHEREAS, the only party in interest in said Estate is the above-named party, and
WHEREAS, said party in interest desires that the Administratrix shall not be required to
file an Account with the Orphan's Court of Cumberland County, Pennsylvania, and that the net
estate of the decedent shall be distributed without the necessity of filing a formal Account to
avoid the expense, delay and publicity of a formal accounting, but should instead be distributed
in accordance with the Administratrix' Proposed Schedule of Distribution, as set forth in the
attached First and Final Account.
NOW THEREFORE, in consideration of the mutual promises, covenants and agreements
recited herein, the above-named heir and beneficiary of the Estate of GRAY D. WAGNER does
hereby mutually agree as follows:
1. Denise A. Wagner agrees and acknowledges that she has fully and carefully
examined the First and Final Account of SALLYA WAGNER, Administratrix for the Estccte
of GRAY D. WAGNER, deceased, and Proposed Schedule of Distribution relating thereto,
and find them to be true and correct, and acceptable to her, and further that she has received
a copy of this Family Settlement and Final Release and of said Account and Proposed
Schedule of Distribution.
2. Denise A. Wagner hereby agrees that in order to avoid the expense, delay and
publicity involved in the filing of a formal Account and Schedule of Distribution, no
accounting to the Court is necessary and she does hereby agree that she does 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
Orphan's Court Division of the Court of Common Pleas of Cumberland County,
Pennsylvania.
3. Denise A. Wagner remises, releases, quitclaims and forever discharges the
Estate of GRAY A WAGNER,� and SALLY A WAGNER, Administratrix, her heirs,
Administratrixs, administrators and assigns, from all manner of acts, suits, claims,
accountings, debts and demands whatsoever which she or her legal representatives or
assigns tnay at any time hereafter have against said Administratrix, estate, or assets thereof,
touching or concerning the Estate of the Decedent.
4. I)enise A. Wagner covenants and agrees that she will contribute her share of
the Estate to satisfy all claims, debts, demands, suits or cause of action which may be
successfully brought against the Estate or the AdministratriX after the execution of this
Family Settlement and Final Release. � �
5. Denise A. Wagner hereby agrees that she will at all times in the future and
wherever necessary, appropriate or convenient, make, execute and deliver to said
Administratrix, and/or to the other party or persons, any and all instruments, documents,
conveyances, deeds, releases or other instruments of any kind necessary or convenient to
carry out the intention of this Family Settlement and Final Release.
6. This Family Settlement and Final Release constitutes the entire understanding
among the parties hereto, and each of them acknowledges that no representations or
statements of any kind, written or oral, have been made to them or any of them prior hereto
by the Administratrix or any other person or party upon her behalf.
7. This Family Settlement and Final Release shall inure to the benefit and shall
bind the parties hereto, and each of them, their heirs, executors, administrators, successors
and assigns.
8. This Family Settlement and Final Release shall be governed by the laws of the
Commonwealth of Pennsylvania.
IN WITNESS WHEREOF, the parties hereto have hereunto set their respective hands
and seals the day and year first above written.
W SETH:
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Date ALLYA AGNER,
Administratri.x
i� -i 3 �i y ��Z�z.�. �- ������z���-
Date DENISE A. WAGNER
Individually as heir ancl beneficiary
In the Court of Common Pleas of Cumberland County, Pennsylvania
Orphans' Court Division
File No. 21-13-1029
Estate of Gray D.Wagner, Deceased
Late of Township of West Pennsboro
First and Final Account
Sally A. Wagner, Administratrix
Date of Death: 09/10/2013
Date of Incapacity, if any: None
Date of Administratrix's Appointment: 09124/2013
Date of First Complete Advertisement:
Accounting for the period: 09/10/2013 to 10/15/2014
Purpose of Account: Sally A.Wagner,Administratrix, offers this Account to acquaint interested
parties with the transactions that have occurred during the Administration.
It is important that the Account be carefully examined. Requests for additional information or questions
or objections can be discussed with:
Bradley L. Griffie
Griffie &Associates, P.C.
200 North Hanover Street
Carlisle, PA 17013
717-243-5551
Supreme Court I.D. No. 34349
SUMMARY OF ACCOUNT
Estate of Gray D. Wagner, Deceased
For the neriod of Sentember 10. 2013 thro��h October 15, 2014
PAGES
PRINCIPAL
Receipts: This Account A 7,012.22
Net Gain (or Loss) on Sales
or Other Dispositions 0.00
7,012.22
Less Disbursements: C
Debts of Decedent 4,688.12
Funeral Expenses 2,357.86
Administration Expenses 1,186.80
Federal, State 8� Local Taxes 0.00
Commissions 0.00
Fees 5,000.00
Family Exemption 3,500.00 16,732.78
Balance Before Distributions -9,720.56
Transfer to (from) Principal TP 0.00
Distributions to Beneficiaries 0.00
Principal Balance on Hand PBOH -9,720.56
For Information:
Investments Made
Changes in Holdings F
INCOME
Receipts This Account 0.00
Net Gain (or Loss) on Sales 0.00
or Other Dispositions 0.00
Less Disbursements 0.00
Balance Before Distributions 0.00
Transfer to (from) Income TI 0.00
Distributions to Beneficiaries 0.00
Income Balance on Hand 0.00
For Information:
Investments Made
Changes in Holdings
COMBINED BALANCE ON HAND CBOH -9,720.56
Signature
Verification
SCHEDULE A
RECEIPTS OF PRINCIPAL
Assets Listed in Inventory Fiduciary
(Valued as of Date of Death) Acquisition
Value
Cash
Capital One refund of overpayment 4.29
Discover Refund 2•37
Hay Check(Brenize) 414.00
Hay Check(McKeehan) 1,554.00
Hay Check(Newswanger) 2,000.00
Health Insurance direct payment to decedent 49.95
Health Insurance Direct Payment to decedent 39.41
Health Insurance direct payment to decedent 49.95
Health Insurance direct payment to decedent 49.95
Health Insurance direct payment to decedent 49.95
Orrstown Bank- 60.15
Checking Account No.XXXXX2734
Orrstown Bank- 213.61
Checking Account No.XXXXX3373
Orrstown Bank- 1,600.64
Checking Account No.XXXXX3944
PFB Members Service Corp. (Insurance refund) 411.45
Refund of retainer from Griffie&Associates 250.00
Reimbursement from American Express 42.50
USDA Disbursement 220.00
Total Cash 7,012.22
Total Receipts �,0�2.22
Total Receipts of Principal �,0�2.22
A-1
SCHEDULE C
DISBURSEMENTS OF PRINCIPAL
Debts of Decedent
Andrews & Patel Associates. PC (Medical)
10/16/2013 258.26
258.26
Camp Hill Emergency Physicians
09/10/2013 2,469.00
2,469.00
Capital Cardiovascular Associates (Medical)
10/18/2013 14.66
14.66
CenturyLink(final bill)
10110/2013 137.29
137.29
CTI Networks
09/12/2013 81.00
81.00
Direct TV
09/12/2013 122.24
122.24
Holy Sairit Hosnital
09/10/2013 44.22
(Computer Credit, Inc.)
44.22
C-1
SCHEDULE C
DISBURSEMENTS OF PRINCIPAL
Continued
Milton S. Hershe�Medical Center
09/10/2013 1,345.25
1,345.25
Quantum Imaging 8�Therapeutic Associates (Medical)
10/18/2013 112.81
11/27/2013 6.40
119.21
Southampton Township (Trash)
10/10/2013 48.90
48.90
West Shore Pathology Associates
09/10/2013 48.09
48.09
Total Debts of Decedent 4,688.12
Funeral Ex ep nses
�aer Funeral Home. Inc.
09/10/2013 2,357.86
2,357.86
Total Funeral Exaenses 2,357.86
Administration Ex ea nses
Cost of Aporaisal
01/20/2014 500.00
C-2
SCHEDULE C
DISBURSEMENTS OF PRINCIPAL
Continued
500.00
Probate Fees
09/10/2013 443.50
443.50
The Cumberland Law Journal (Advertisinal
10/25/2013 75.00
75.00
The Sentinel (Advertisina)
10/25/2013 168.30
168.30
Total Miscellaneous Administrative Exnenses 1,186.80
Fees
Griffie 8 Associates. P.C.
09/10/2013 5,000.00
5,000.00
Total Fees 5,000.00
Family Exemption
Denise A.Wagner
09/10/2013 3,500.00
3,500.00
Total Familv Exemntion 3,500.00
C-3
SCHEDULE C
DISBURSEMENTS OF PRINCIPAL
Continued
TOTAL DISBURSEMENTS OF PRINCIPAL 16,732.78
C-4
PRINCIPAL BALANCE ON HAND
Current Value Fiduciary
10/15/2014 Acquisition
# Units Description or as Noted Value
ach
Orrstown Bank -16,732.78 -16,732.78
Total Cash -16,732.78 -16,732.78
QSS _ S
Capital One refund of overpayment 4•29
Discover Refund 2•3�
Hay Check(Brenize) 414.00
Hay Check(McKeehan) 1,554.00
Hay Check(Newswanger) 2,000.00
Health Insurance direct payment to decedent 239.21
Orrstown Bank 1,874.40
PFB Members Service Corp. (Insurance refund) 411.45
Refund of retainer from Griffie&Associates 250.00
Reimbursement from American Express 42.50
USDA Disbursement 220.00
Total Assets 7,012.22
-16,732.78 -9,720.56
PBOH-1
PROPOSED DISTRIBUTIONS TO BENEFICIARIES
Current Value Fiduciary
10/15/2014 Acquisition
or as noted Value
TO:
Denise A.Wagner 0.00 0.00
0.00
0.00
Total 0.00 0.00
PD-1
In the Court of Common Pleas of Cumberland County, Pennsylvania
Orphans' Court Division
File No. 21-13-1029
Estate of Gray D. Wagner, Deceased
Signature
(;e�1.: , ' - , `G, , �
Sally A.W ' ner, Administra rix
- 9 -
In the Court of Common Pleas of Cumberland County, Pennsylvania
Orphans' Court Division
File No. 21-13-1029
Estate of Gray D. Wagner, Deceased
Verification
Sally A. Wagner,Administratrix under the Last Will and Testament of Gray D.Wagner, Deceased,
hereby declares under oath that he/she has fully and faithfully discharged the duties of his/her
office; that the foregoing Account is true and correct and fully discloses all significant transactions
occurring during the accounting period; that all known claims against the Estate have been paid in
full; that,to his/her knowledge, there are no claims now outstanding against the Estate; that all
taxes presently due from the Estate have been paid; and that the grant of Letters Testamentary and
the first complete advertisement thereof occurred more than four months before the foregoing
Account.
This statement is made subject to penalties of 18 Pa. C.S.A. Section 4904 relating to unsworn
falsification to authorities.
,
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Dated: /h! c't'��,f' /,�� ,�_ ��,�,� � C�l������ �, �� � Z
Sally A.W�gner, Administratrix
- 10 -
I hereby certify that written notice of the filing of this Account, and of the date, time and place when the
same will be presented to the Court for confirmation and of the last day to file written objections to said
Account, has been given to every unpaid claimant and to every other person known to the accountant to
have or claim an interest in the estate as creditor, beneficiary, heir, or next of kin.
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dl . r' ie, Esquire