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Home My WebLink About02-0936 Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of K. LOUISE MARTIN No. ;;l. / -Dd-. - also known as LOUISE K. MARTIN , Deceased Social Security No. 182-22-8238 Pelitioner(s), who W.e 18 ve.s of age or older. applv(iesJ for: (COMPLETE "A" OR "8" BELOW:) GJ A. Probate and Grant of Letters and aver that Petitioner(sl is/are the execut~ named in the Last the Decedent, dated May 20, 1997 and codicil(s) dated N/A See attached renunciation ill of Statllrel.....tcircumstanees,..g...enunciation,deathofe_ecutor, etc. Except as follows, Decedent did not marry. was not divorced, and did not have a child born or adopted after execution of the documents off ad for probate; was not the victim of a killing and was never adjudicated incompetent: B. Grant of Letters of Administration o Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the fol wing spouse (if any) and heirs: lc,t.a.,d.b.n.c.t.a.; pendl/ntelite; durante absentia; durante minoritateJ Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or pri ipal residence at 442 Walnut Bottom Road, Carlisle Carlisle Bora" PA 17013 c~..str~~num~jj;e.. Decedent, then 96 years of age, dIed r 27 , 2002, at 58 Strawber Dr. Carlisle, PA 1701 lLoclltion) Decedent at death owned property with estimated values as follows: (If domiciled in PAl All personal property (If not domiciled in PAl Personal property in Pennsylvania (If not domiciled in PAl Personal property in County Value of real estate in Pennsylvania Total Real Estate situated as follows: N/A $ 13.000.00 $ $ $ $ 13,000.00 Wherefore, Petitionerls) respectfully requestfs) the probate of the last Will and Codici/(sl presented with this Petition and the grant of letters the appropriate form to the undersigned: Typed or printed name and residence ~ /?-q,,-_.~ Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the fore oing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and th ,as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the tate according to law. Sworn to and affirmed and subscribed before me this 17th day of October , 2002 Donna M.Otto, 1st "~r4'~ /.;.0 -.......; DECREE OF REGISTER r::'; ,Deceased No. 21-2002-936 Estate of K. LOUISE MARTIN. aka also known as LOUISE K. MARTIN Social Security No: 182-22-8238 Date of Death: September 27, 2002 AND NOW, October 17th , 2002, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters I2i Testamentary 0 of Administration are hereby granted to (e.t.a.;d.b.n.c.f.;penderltelite;du'8f1lsab!l<lntia.:dur8l'ltemiflOlitllte Doris June Reed in the above estate and that the instrument(sL if any, dated Ma 20th 199 described in the Petition be admitted to probate and filed of record as the last Will of Decedent FEES Letters.......................... . Short Certificate(s)...J..... Renunciation... .A............ Affidavit ( )................. Extra Pages ( -ID.-......... Codicil......................... . JCP Fee........................ Inventory & Tax Forms... Other............................ TOTAL................ $ 50.00 $ 9.00 $ 5.00 $ $ -0- $ $ 5.00 $ $ B~ 1JJf&Aj,.a~ A Register of Wills Donna M. tt~, Attorney: I.D. No: E. Ralph Godfrey, Esquire 77052 $ 69.00 Address: 2215 Forest Hills Drive, Suite 36 PO Box 6280; Harrisburg, PA 17112 Telephone: (717) 540-3900 DATE FILED: October 17th, 2002 CALL ATTORNEY R~ E. RALPH GODFREY ON 10/17/02 H105_81l5 RFV 9/86 This is to certifY that the information here given is correctly copied from an original certificate of death duly filed wit me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanenr filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. p 8608439 ll:.-~. \='~~. ~ Fee for this certificate, $2.00 Local Registrar 2662 No. Date " '110~ ...:JA... 2/87 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. ....ITAL RECORDS CERTIFICATE OF DEATH 98 UNOERti'EAR - - UNDliA t 0/111' -l~ ... a. Female SWEF'lEMflooIlIER SOCIA.l.SfCUR1Ti'NU~8fR .. 182 22 8238 o...TEOf'DEATH,Moro1\.O"'.-_1 . SepterrtJer 27 2002 " ., N"'MEOf'oeCEO[t.ITI~'t$T.M""""_ '....1 ,. Louise K. Martin '" $lATHPI.o\CE(C.....and P\.,.OQ;OI'OE.-JHIC.,.........,""".._"...,"""""'''''__ Stoo..."Fer..qoC_Y1 HOSPITAl.: Hagerstown MD 1_.., 0 E~_ [j ,. ~ FA,CILIT'tNA"E("","''''''M'''''''~''''''.ncI''''m''." PA AOE(l...~"'Il , Cl')IftlTY OF OERH ;(1 C\M"ber land S. Middleton _. . oeCEOENl'SUSUAlOCC~ (0Jt...,.~.;:~~::~::: llL Sec..-atary 11 Garment Factory oeCEOE~.!IIlWl!HG ...ooRESS{5l'_.C"",~.sw..",Codel OECIEOENT'S """~ """"'" ...- """,J\e<""'l IOt>IOOFElUSIN'E 2002 "" -- ~.. -'IIIip? 17".13 ::::=::'01 Carlisle MOTHEA'S NAAE jF... '"'-. M.OI!i'Suonamel 11. Ma Bell O'lNAWrSIMlUNQIoDDAESSjSIreoIl.~ sa.w.lipCcoel 58 Strawberry Drive, Carlisle PA 17013 Pl.ACEOFOISI'OSIlION.tMmoolc-""l'.C<e","""Y lOCArION.~$IlM..Zil>c.... 0_- Iflmberland Valley Mem. Grdn ".Carlisle PA 17013 HMlENIOAOOAESS~FA,Cll.llY 0 man- era orne Uc. 219 N. Hanover St., Carlisle PA 17013 llCENSEHUWBER ... 11c.D-.__ WNlITA,lST.crUS........... --.-... O__lSpfetyj Widow 442 Walnut Bottom Road 17..$..,. p~ - ,. FJlttER'SNAME (F... MoCICM.lnll ". James W. Farrow _"""""HT'S""'-'E(I'J'PIl'P'''''' June Reed METHOD OF DISPOSITION ..,.. gg er-;on 0 -"'"""' ,~. -- "--"''''''$1"",0 ". I.' ''l:. w.sCASEREFERREl)lO:~OLE;I(,UllNIEI\ICOAONER? MIo~ :lot. M. 2S. 11._~_ E"''''",..s.........''''''....ora>mQOIC.a,__ca_'r..<>>.'h 0CIn<>t."'''' ,,.. """"'<>f<7ylng. lill"""l_......""eacJ>_ orh.atI"'...... ,......".,"""",. 'j-- :........ncl~ : PlI.RTll: ~......i""enI_~'" _~in""'..........._~in !?enll.uf DUEfOJOAAoS"CONStOUENCEM I...-J-~ .s;;.Jt.. A..J l: -AtJ. WERE AUTOPsY FINDlNGS ~E.PRIORfO COWPlE'rll;)HOI'c..,USIE """""' 'nO MAHN'[RO!'flEATH ~ o o D.crE~INJURY 1M~.O.y._f 11MfO!'INJUAY IMJUAi'.-J0\QftI(1 oeSCRIBE't'/t1WIMJURi'OCCURFIfO. --. COUkl""'...."-1....."'ed o o o PUCEO!'IMJURY-"''''''''..''""~;''',,,C1C1O'._. ~. ....*ling.OOC.,Spo<;,..., _. _ D NoD - HcI"'iQcWI ~~ -. Pencli<l9-'l!lMiQn "MIiOlC"L EX"MINlRJCORONER OPllhe b..il"t...min.UOfI Ind/o, in.It..Ug.UOn.in"''f<>p\nil>l>. ".alht>Cum.d .1l.".lImlt. d..It..net plaCIt, and due 10 1M CIU",!"."" """nn....II.'....... n. REGISTR^R.SSIGN"'lIJRE"'N ,~ ~.~eu.M Q,I ,3<1,01 ,. ztoo. 2'''. CDI'1'lFIfJlt,C~"'OtIi\-""'" .CUlTlf'i'INGPHYSIC::"""!.Pt\_~,"~""""'--<J__""~""",,,pI>..-..c_"""",,,,,,,,,,,,*,"","'''''''~omlllttedll_<.J\ fO..._ol....,k~."."'oceu....._"'.....c......(.I.nol"'.n...'...I....... H. .'~NOUNClNC .....0 CflfTl'YING I'MY$IC'AN (Ph..-:_ ""'" P'''''''''nc'''9....''' and Otlf1~~'"'J '" ceuv. 01 GulN T..__<ot"''1k~''.Il'''''<>cc...,....I"",.......,Il'II,'ndpl""...nd..""IO''''c'''''(.I.''''m.n_......,..... LAST WILL AND TESTAMENT OF K. LOUISE MARTIN also known as LOUISE K. MARTIN 21-2002-936 I, K. LOUISE MARTIN, a!kJa LOUISE K. MARTIN, widow, of 225 West Louther Street in the Borough of Carlisle, 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 and making void any and all Wills by me at any time heretofore made. I. I direct my hereinafter named Executors to pay all of my just debts and funeral expenses as soon after my death as may be found convenient to do so. I direct that my funeral services be conducted by Hoffman-Roth Funeral Home, 219 North Hanover Street, Carlisle, Pennsylvania, and that my body be interred beside that of my husband, Lloyd A. Martin, on my burial lot located in Cumberland Valley Memorial Gardens along Ritner Highway near the Borough of Carlisle, Pennsylvania. I further direct that all inheritance, transfer, succession, estate and death taxes which may be payable on account of my death shall be paid from the residue of my estate, including interest and penalties thereon, regardless of whether the assets upon which such taxes are based are included in my probate estate. 2. All of the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath in equal shares to my four children, their heirs and assigns, provided each of them shall survive me by a period of ninety (90) days, they being Doris June Reed, James Lloyd Martin, Judith Louise Gross and Jacquelyn Farrow Gusler, but should any of them so survive me then the share such deceased child of mine would have received shall pass to such of his or her issue as shall survive me by a period of ninety (90) days, per stirpes, and if there be no such issue the same shall lapse and be added to the share or shares of my other children. 3. I hereby nominate, constitute and appoint my four children, Doris June Reed, James Lloyd Martin, Judith Louise Gross and Jacquelyn Farrow Gusler, or any of them, as co-Executors of this my Last Will and Testament, and I further direct that none of them shall be required to post any bond to secure the faithful performance of his or her duties in the Commonwealth of Pennsylvania or in any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament written on one (I) page, this 20th day of May, 1997. I< ;R,...." '; ~ 1l./T( r:>.rz /1 ;;, K. Louise Martin $u. ~Q J( 177 n,;j;;;., Louise K. Martin (SEAL) (SEAL) Signed, sealed, published, and declared by K. LOUISE MARTIN, aJk/a LOUISE K. MARTIN, the Testatrix above named, as and for her Last Will and Testament, in our presence, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ~-h.... ~'l Y,ct:... ;1"'1 REGISTER OF WILLS OF OA TI! OF SUBS;CRIB , I / / C,JI'V'~..rtc........J. r', ing to nd saw e testat request of testa other subscribin signe as a '<:it ss at the i f each other) (in the p'rese ce of the Sworn to or a me this (Name) (Addres '" !.- Regis er (Name) ,-- (Address) 21-2002-936 ~i p REGISTER OF WILLS OF C v..v.-'->tA",---' COUNTY OATH OF NON-SUBSCRIBING WITNESS W~) 'Eo Kc.\f"- c;,.".~ Gc,-d \)o~u Tv"-l. \Lad (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that We ilrp familiar with the signature of \L 0 ( U ...H' 'i, 'fY'.o.-~ n"'- codicil ~ presented herewith and codicil believe!llthe signature on the~is in the handwriting of testat, \ 'JL of (one of the subscribing witnesses to) the that V-'L $. ~u 'i. '/V'V>v \>H0 to the best of O,jr knowledge and belief. or;) /) Sworn to or affirmed and subscribed before r I(o~ ( 9e-cL-~ me this 17th day of ( (Name) October ~ ~r';t:.Q U7<'Z- 2-Z-f<;' hm:-~" Ihtlr /:K-,v<.] <;:" Ie. >le' //e.;.....} fJPYn/HA. In __/. Vy/t~/ n~ddreSS) /? . Donna M. Otto, 1st Deputy Reg' e;,4M..1P1/ (y, 0 _/~ ff.pt?r~ ~ ' nJ!!!lme) n . r tl ~?R ~:;,~;f-~h$ (u "0 17/[1 RENUNCIATION 21-2002-936 In Re Estate of K. Louise Martin a.k.a. Louise K. Martin deceased To the Register of Wills of Cumberland County, Pennsylvania. The undersigned ,Tames 1. Martin ,Tuni th 1. r.rn"". "nn .T"l'qll"lyn F. Gu the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letter be issued to n,..",...., C! Tll1')e Reed WITNESS hand this 1((7 f'.-- day of ~ , )J;o~. I pfirFfi/e~atff/A~ c<, ';;! (Address) 3. ;;f: (Signature) I, c29-J JaUJ1fal1 {)ri/R.. Po r-)/')e, yJq. (Address) ;;. ~.t:.,7 fd,el'Y~derf1. Jf ~n yo 11-;,.11 f'ct (Signature) it /(1. 3 d, if! Vt1rk<;JlI'r~ .Dy, (1ull~ 'pl/;. . ((Address) (J CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent Date of Death Will No. K. Louise Martin a.k.a Louise K. Martin September 27. 2002 2002-00936 Admin. No.: 21-02-0936 To the Register: I hereby 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 October 22, 2002. Name Address JacQuelvn F. Gusler 241 Taunton Drive. Carlisle. P A 17013 James L. Martin 257 Belvedere Street Carlisle. PA 17013 Judith L. Gross 641 Yorkshire Drive. Carlisle. PA 17013 D. June Reed 58 StrawberrvDrive. Carlisle. PA 17013 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None Date: 10/28/02 Signaturq . Address 2215 Forest Hills Dr. Suite 36 P.O. Box 6280 Harrisburg. P A 17112 Telephone (717) 540-3900 L I: ,:' ;r;, Capacity: Personal Representative X Counsel for Personal Representative 10.28.02 - Certificate of No lice Under Rule 5.6(a) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIOUAl TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTAT OFFICIAL RECEIPT GODFREY E RALPH ESQUIRE 2215 FOREST HILLS DRIVE SUITE 36 HARRISBURG, PA 17112 _nn_n fold ESTATE INFORMATION: SSN: 182-22-8238 FILE NUMBER: 2102-0936 DECEDENT NAME: MARTIN K LOUISE DATE OF PAYMENT: 12/27/2002 POSTMARK DATE: 00/00/0000 COUNTY; CUMBERLAND DATE OF DEATH: 09/27/2002 TOTAL AMOUNT P REMARKS: DORIS JUNE REED C/O E RALPH GODFREY ESQUIRE CHECK# 01 05 SEAL INITIALS: HA RECEIVED BY: REGISTER OF WILLS REV-1162 EX(11. E TAX NO. CD 00199 ACN SSESSMENT AMOUNT CONTROL NUMBER . un 101 I $300.00 I I I I I I I I AID: $300.00 DONNA M. OTTO DEPUTY REGISTER OF WILLS A ~ - INVENTORY Estate of K. Louise Martin No. 21 Date of Death 9/2712002 02 0936 also known as Louise K. Martin , Deceased Social Security No. 162226238 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory indude all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. IlWe verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative: 1.0. No.: 77052 Name of Attorney: E. Ralph Godfrey. Esauire Address: 2215 Forest HUIs Drive Dated 0612512003 Harrisbura PA 17112 Telephone: 717-540-3900 Description Value Stocks & Bonds 511.926 Shares; AAL Mutual Fund 5.266 Closely-Held Corporation, Partnership or Sole-Proprietorship ~- ;....I~~ d :lJ ,:;,: ~ I". :t1 '.1> -< - W c~ . s. c- O c-, '- c: 0 Z N 0-. :;.::: \D ~ a w 0 None. Mortgages & Notes Receivable None. Total (Attach Additional Sheets if necessary) 6.056 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 Continuation of Inventory K. Louise Martin 21 02 0936 Pane 1 Description of Inventory Description Value Casn. Bank Deposits. & Misc. Personal Property M&T Bank; checkin9 accounl1342452 (see attacned letter) 2,620.23 Misc. kitchen items (lived in nursing home) 5.00 Mise items of household linens, towels, sheets, blankets, and other related items 20.00 Mise items of personal cIotl1ing 50.00 Reclining chair 25.00 T.v. 20.00 Lamps (2) 10.00 Table Stand 10.00 Dresser 25.00 Radio 5.00 Real Estate None. 0.00 Subtotal $ Grand Total $ 2.790.23 8,056.67 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 ''l/':S-SREV_1500 INHERITANCE TAX RETURN RESIDENT DECEDENT RL\I-1S00E)("'{Il-OO} I- Z W Cl W () W Cl '" !( ",_Ul u"'''' ",o.u ",00 U"'"' 0.", 0. < DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL) K. Louise Martin a.k.a. Louise K. Martin DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) OffiCIAL USE QNl Y E 09/27/2002 09/15/1904 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST. AND MIDDLE INITIAL) 001. Original Return o 4. Limited Estate lXl 6. Decedent Died Testate (A\laCheopyofWW) D 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date 01 death after t2.t2-82) D 7. Decedent Maintained a Living Trust (Attach copy ofTrusij D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) -- FILE NUMBER 2 1 -0 2 0 9 3 6 CQU'NiyCOiiE ---:rEAR- - - NUIiBEFI- - SOCIAL SECURITY NUMBER 182-22-8238 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Retum (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes o 11. Election to lax under Sec. 9113(A)(AIt<h"hOI THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS E. Ral h Godfre Es uire 2215 Forest Hills Drive FIRM NAME (If Applicable) Godfre & Courtne P.C. Sutte 36 TELEPHONE NUMBER 717-540-3900 Harrisbu PA 17112 OFPIl<l. USEONLY 'T. ,..,. z o i= < ..J :J l- e:: < () W 0:: z o i= < I- :J a. :;; o () >< < I- I- Z '" C Z o 0. Ul '" '" '" o u 1. Real Estate (Schedule A) (1) (2) (3) (4) (5) ~ :; ~: G' 5.266.44 '-- ~ o VJ N 0"> 2.790.23 ~<::j b~, 'oJ 5.226.44 13.283.11 1.945.07 500.00 (11) (12) (13) 2.445.07 10.838.04 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule 0) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Scl1edule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Admin~tralive Costs (Scl1edule H) 10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (totai Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (6) (7) (8) (14) 10.838.04 (9) (10) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate. ortransfe" under Sec. 9116 (a)(1.2) X _(15) 10.838.04 X 0.045 (16) X .12 (17) X .15 (18) (19) 487.71 487.71 20 D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due Decedent's ComDlete Address: STREET ADDRESS 442 Walnut Bottom Road Thomwald NursinCl Home CITY I STATE I ZlP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 487.71 300 00 1500 Total Credits (A + 8 + C) (2) 315.00 3. InleresUPenalty if applicabie D.lnlerest E. Penally TotallnteresUPenalty (0 + E) (3) 4 If Line 2 is greater than Line 1 + Line 3, enter Ihe difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enler the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) 8. Enter the total of Line 5 + SA. This is the 8ALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 172.71 172.71 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; ........................................................................... 0 1RI b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 1RI c. retain a reversionary interest; or ........................................................."."......"................................ D 00 d. receive the promise for life of either payments, beneffts or care? ............................................................. 0 1RI 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration?........... .................. ......... ....................... ........ ......... ................ 0 1RI 3. Did decedent own an 'in trust fo~ or payable upon death bank account or securily at his or her death? ................. 0 1RI 4. Did decedent own an Individual Retirement Account, annuity, or other non-probale property which contains a beneficiary designalion? ....................................................................................................... 1RI 0 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 pe~ury, I declare thai I have examined this relum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PE N RES ONSIBLE FOR FILING RET N DATE ADDRESS 58 Stra Carlisi SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE PA 17013 DATE ADDRESS 2215 Forest Hills Drive, Suite 36 HarrisburQ PA 17112 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. 99116 (a) (1.1) (i)l. 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 ofthe surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)l. The stalute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum 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-<>ne years of age or younger at death fa or for the use of a natural parent, an adoptive parent, or a slepparent of the child is 0% [72 P.S. 99116(a)(1.2)1. The tax rate imposed on the net value of transfers to or for Ihe use of the decedent's lineal beneficiaries is 4.5%, except as noled in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)1. The tax rate imposed on the nel value of transfers to or forthe use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)1. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. '''.'~'''''IWI. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN R I ESTATE OF FILE NUMBER K Louise Martin a.k a. Louise K Martin 21 02 0936 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorshin must be disclosed on Schedule F. SCHEDULE A REAL ESTATE ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH None. 0.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) ""'~"".I"'''* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RE IDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF K Louise Martin a k a Louise K Martin All property jointly-owned with right of survivorship must be disclosed on Schedule F. FILE NUMBER 21 02 0936 ITEM NUMBER 1. DESCRIPTION 511.926 Shares; AAL Mutual Fund: account 6600002777: $10.2875 on September 27,2002 - see attached statement VALUE AT DATE OF DEATH 5,266.44 2. TOTAL (Also enter on line 2, Recapitulation) $ (If mDre space is needed, insert additional sheets of the same size) 5266.44 \P Thrivent Financial for Lutherans~ 4321 N. Ballard Road, Appleton, WI 54919.0001 Phone: 800-THRIVENT (800-847-4836) E-mail: mail@thrivent.com.WINW.thrivent.com The union of AAL and LB Securities offered through Thrivent Investment Management Inc., 625 Fourth Ave. 5., Minneapolis, MN 55415-1665, a wholly owned subsidiary of Thrivent Financial for Lutherans. Member NASD. Member SIPC. March I, 2003 E. Ralph Godfrey 2215 Forest Hill Drive Suite 36 P.O. Box 6280 Harrisburg, PA 17112-0280 RE: Louise K. Martin The AAL Bond Fund Account number: 6600002777 Dear Investor: We received your request for the date of death value of the above referenced AAL Mutual Fund account. This total value, as of September 27,2002, includes all accrued dividends through the date of death. Account number 6600002777 Value $5266.44 If you need additional information regarding this account, please contact your local financial associate, Deborah Schmitt at (717) 776-2380, or our Investment Interaction Center at ( 800 ) 847-4836. Sincerely, ~~ Debbie Wells Correspondence Services Cordinator cc Deborah Schmitt 165-3475 REV.'''''''_,''" *' COMMONWEALTH OF PENNSYLVANIA INHERJTANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP or SOLE.PROPRIETORSHIP ESTATE OF K Louise Martin a.k a. Louise K Martin FILE NUMBER 21 02 0936 Schedule C-1 or C-2 (Including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole.proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH None. 0.00 TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV.1505EX+j1.97) '* SCHEDULE C.1 CLOSEL Y.HELD CORPORATE STOCK INFORMATION REPORT COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF K. Louise Martin a.k.a. Louise K. Martin FILE NUMBER 21 02 0936 1. Name of Corporation Address City 2. Federal Employer 1.0. Number 3. Type of Business State Zip Code State of Incorporation Oate of Incorporation Total Number of Shareholders Business Reporting Year Product/Service 4. TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE STOCK Voting / Non-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK Common $ Preferred $ Provide all rights and restrictions pertaining to each class of stock. 5. Was the decedent employed by the Corporation? 0 Yes o No If yes, Position Annual Salary $ Time Devoted to Business 6. Was the Corporation indebted to the decedent? 0 Yes o No If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? 0 Yes 0 No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 8. Did the decedent sell or transfer stock of this company within one year prior to death or within two years if the date of death was prior to 12-31-827 DYes 0 No If yes, 0 Transfer 0 Sale Number of Shares Transferee or Purchaser Attach a separate sheet for additional transfers and/or sales. 9. Was there a written shareholde~s agreement in effect al the time of the decedent's death? If yes, provide a copy of the agreement. Consideration $ Date DYes o No 10. Was the decedenl's siock sold? DYes 0 No If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedent's death? 0 Yes 0 No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporalions or partnerships? 0 Yes 0 No If yes, report the necessary information on a separate sheet, including a Schedule C-l or C-2 for each interest. THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. "V''''''''.I'~I. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN I NTD NT SCHEDULE C.2 PARTNERSHIP INFORMATION REPORT ESTATE OF K. Louise Martin a.k.a. Louise K Martin FILE NUMBER 21 02 0936 1. Name of Partnership Address Date Business Commenced Business Reporting Vear 2. 3. 4. City Federal Employer I.D. Number Type of Business Decedent was a 0 General State Zip Code ProducUService o Limited partner. If decedent was a limited partner, provide initial investment $ 5. PERCENT OF PERCENT OF BALANCE OF PARTNER NAME INCOME OWNERSHIP CAPITAL ACCOUNT A. B. C. D. 6. Value of the decedent's interest $ 7. Was the Partnership indebted to the decedent? If yes, provide amount of indebtedness $ o Ves o No 8. Was there life insurance payable to the partnership upon the death of the decedent? 0 Ves If yes, Cash Surrender Value $ Net proceeds payable Owner of the policy o No $ 9. Did the decedent seli or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82? o Ves 0 No If yes, 0 Transfer 0 Sale Percentage transferred/sold Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 10. Was there a written partnership agreement in effect at the time of the decedent's death? If yes, provide a copy 6f the agreement. o Ves o No 10. Was the decedent's partnership interest sold? If yes, provide a copy of the agreement of sale, etc. 11. Was the partnership dissolved or liquidated afterthe decedent's death? 0 Ves 0 No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. o Ves o No 12. Was Ihe decedent relaled to any of the partners? o Ves o No If yes, explain 13. Did the partnership have an interesl in other corporations or partnerships? 0 Ves 0 No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax retums (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership Interest. REV.1507E)(+(1.97) '* SCHEDULE D MORTGAGES & NOTES RECEIVABLE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF K. Louise Martin a.k.a. Louise K Martin All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. FILE NUMBER 21 02 0936 DESCRIPTION VALUE AT DATE OF DEATH None. D.OO TOTAL (Also enteron line 4, Recapit"iation) $ (If more space is needed, insert additional sheets of the same size) ''''''''''''''''''. COMMONWEALTH OF PENNSYLVANIA INHERJTANCE TAX RETURN RES/DENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER K. Louise Martin a.k a. Louise K Martin 21 02 0936 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M&T Bank; checking acccunl 1342452 (see attached letter) 2,620.23 2. Misc. kitchen items (lived in nursing home) 5.00 3. Mise items of household linens, towels, sheets, blankets, and other related items 20.00 4. Mise items of personal clothing 50.00 5. Reclining chait-- 25.00 6. T.V. 20.00 7. Lamps (2) 10.00 8. Table Stand 10.00 9. Dresser 25.00 10. Radio 5.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 2 790.23 MAR-03-03 MON 08:48 AM FAX NO, p, 02 ~ M&rBank Mnnll!.11;lwme: on(1 r!iKlr:I~1 Iru~,1 C:::Un1p.1rlY, 1100 Wehrl!} Dr,y(~, P,O, Box 'f07, Bullalo, NY 142'10-0767 Febl1l:lI'y 28, 2003 tn:, Esfntc Se:lrrh The .';'1:110 uf, n"le pf n,-nll1 (1).0,f),) LOl7lSli:KMARTIN 912712002 '10 WhOllllt May ('on('cm: IdC'ntificd below is t'h~~ ;;Jcc:ollnt Lnfuclll:ltion rcquC'stc-d, I. 1\<1&'1' B.mlc aCC::Ollnts il1 wl1i.::h the <.kc:cdcnt's nanle appears: ('IlK J 347452 LOlIISE K MARTIN 4345 D,O.D. Accnlcd Int''Test Dolanccs (Incluues ACCl. Inl.) $2620.23 $.00 Meonnt Typ(' A';l:<llit)t N\lnltx'1' Account Tille Opening Branch 1. 1.,0:\1\.0;, MOI'IL~"e.l;~. Of olher obHg:\tiol11i litled in the uecedcntls n.1mc ACCOUllt NUll1her Amount Owc~l Account Descriplion N{) Safe lkp\,sit Bl)xlit1cd in lhL l>credcut's 11amc cJCiijled nt OtlT office. If YOll '':lve nny que,';""s :1b(ll1llhc info","tion proviueu, plc.se conlact our Recorrl~ Department.t (716) 635-4010 or 1-800.724- H10 ""Iside of Iho Huffo!o, NY Clllling .reo. Thank you. Sincl,:rcly, M&'J' HANK CORPORATION IJY, "P J' S- .. _~I~a&:~C~.{e!-~'\,~... . _~<<....--L,Q:";>.~L Autholin:d Riglil1tllfL' -c> -.... DATE: __u ~:::~. 0.::.~. P.2_. ----.. . ..'--~-~- ,ev"509EX"""* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTL Y.OWNED PROPERTY ESTATE OF K. Louise Martin a k a Louise K Martin If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. FILE NUMBER 21 02 0936 SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIQNSHIPTO DECEDENT A. B c JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF OATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed forjoinUy-held reaJestate. VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. TOTAL (Also enter on line 6, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) ''''.,''''''.".,,'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY ESTATE OF K. Louise Martin a.k.a. Louise K. Martin FILE NUMBER 21 02 0936 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY %OF ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHll'TODECEOENTANOruEOATEOf TAANSFER DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE NUMBER ATTACH A COPV OFTHE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IFAPPLlCA8LE) 1. AAL Anuily; Account 6600002777 . see attached slalement 5,226.44 100. 5,226.44 - TOTAL (Also enler on line 7, Recapitulation) $ 5 226.44 (if more space is needed, insert additional sheets of the same size) i\,"{f Thr;ve~t Investment Management'. 222 W. College Ave., Appleton, WI 54919-0007 Phone: (800) 553-6319. E-maH: mail@ljjE~m.~M'1jtl'OTATION Member NASD. Member SIPC. FOR AAL MUTUAL FUNDS A 5ub<,idi,uy of Thrivent Fin.m..:iClI for luHwr,lI1\ Deceased: Louise K Martin Date of Death: September 27.2002 Account Type: Individual Account Number: 6600002777 Registration: Louise K Martin Value as of date of death: $5,226.44 Beneficiary: .------ Death Claim Quotation Annuity Certificate 3793491 Deceased: LOUISE K MARTIN Death Date: Sep 27, 2002 COST BASIS TAXABLE GAIN TOTAL AMOUNT PAYABLE $4,778.86 $~.43 $4,788.2~ Beneficiary: June Reed, James Martin, Judith Gross, Jackie Gusler, children in equal shares Special messages for this certificate only: 1. IMPORTANT TAX REQUIREMENTS: Each beneficiary will be subject to federal income tax withholding for their share of the taxable gain. Each beneficiary needs to complete a form W4P (Withholdin~ Certificate for Pension or Annuity Payments). If NO withhold1ng is desired, the box in line number one of the W4P should be checked. If the beneficiarY DOES want withholding, the percentage of withholding should be inserted on line number two of the W4P (the minimum is 10%). ,0""""",:",. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER K Louise Martin a k a Louise K Martin 21 02 0936 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTiON AMOUNT A. FUNERAL EXPENSES: 1. Burial Hole 800.00 2. Funeral meal. Bethany Guild 284.00 3. Church Service program. Patty Schutter 25.00 B. ADMINISTRATIVE COSTS: 1. Personal. Representative's Commissions Name of Personal Representative (s) Social Security' Number{s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 69.00 5. Accountant's Fees 95.00 6. Tax Return Prepare~s Fees 7. Cumberland County. Estate Notice 75.00 8. Sentinel- Estate Notice 97.07 9. Repayment to June Reed for burial 500.00 TOTAL (Also enter on iine 9, Recapitulation) $ 1945.07 (If more space is needed, insert additional sheets of the same size) '~.'''2E''I'.'''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF K. Louise Martin a.k.a. Louise K. Martin FILE NUMBER 21 02 0936 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1, September rent to Thomwald Nursing home 500,00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 500,00 REV.,513EX.I'W COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF K. SCHEDULE J BENEFICIARIES FILE NUMBER NUMBER I. in AMOUNT OR SHARE OF ESTATE RELATIONSHIP TO DECEDENT Do Not List Trustee(s) NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS ~nclude outright spousal distributions, and transfers under Sec. 9116 (al (1.2)] 1. Jacquelyn F. Gusler 241 Taunton Drive Canisle, PA 17013 James L. Martin 257 Belvedere Street Carlisle, PA 17013 Judith L. Gross 641 Yorkshire Drive Canisle, PA 17013 D. June Reed 58 Strawberry Drive Can~le, PA 17013 Daughter 1/4 1/4 1/4 1/4 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II, NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 2. Son 3 Daughter 4. Daughter 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space Is needed, Insert additional sheets of the same size) '''''''".,..,,'. COMMONWEALTH OF PENNSYLVANIA INHERJTANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN Check Box 4 on Rev.1500 Cover Sheet FILE NUMBER K Louise Martin a k a Louise K Martin 21 02 0936 This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5-1-89. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. D Will D Intervivos Deed of Trust D Other LIFE ESTATE INTEREST CALCULATION NAME(S) OF NEAREST AGE AT TERM OF YEARS LIFE ESTATE IS LIFE TENANT(S) DATE OF BIRTH DATE OF DEATH PAYABLE D Lile Dr DTerm 01 Years _ DLile Dr DTerm 01 Years _ DLileorDTermDIYears _ DLile or DTerm of Years _ 1. Value of fund from which life estate is payable 2. Actuarial factor per appropriate table Interest table rate - D 3 1/2% D 6% D 10% D Variable Rate 3. Value of life estate (Line 1 multiplied by Line 2) ANNUITY INTEREST CALCULATION $ % $ NAME(S) OF NEAREST AGE AT TERM OF YEARS ANNUIT ANTIS) DATE OF BIRTH DATE OF DEATH ANNUITY IS PAYABLE DLileor DTermofYears _ D Lile Dr DTerm olYears _ DLileorDTermDIYears _ DLile or DTerm 01 Years _ 1. Value of fund from which annuity is payable $ 2. Check appropriate block below and enter corresponding (number) Frequency of payout - D Weekly (52) D Bi-weekly (26) D Monthly (12) D Quarterly (4) D Semi-annually (2) D Annually (1) D Other ( ) 3. Amount of payout per period $ 4. Aggregate annual payment, Line 2 multiplied by Line 3 5. Annuity Factor (see instructions) Interest table rate D 31/2% D 6% D 10% DVariable Rate % 6. Adjustment Factor (see instructions) 7. Value of annuity - If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is : Line 4 x Line 5 x Line 6 $ If using variable rate and period payout is at beginning of period, calculation is : (Line 4 x Line 5 x Line 6) + Line 3 $ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13, 15, 16 and 17. (If more space is needed, insert additional sheets of the same size) REV.1644 EX + (3-84) '* INHERITANCE TAX SCHEDULE'L' COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT OR INVASION INHERITANCE TAX RETURN RESIDENT DECEDENT OF TRUST PRINCIPAL FILE NUMBER 21 02 0936 I. Estate of I( I n"i~" M<utin " ~" I n"i~" K. Martin (Last Name) (First Name) (Middle Initial) This schedule is appropriate only for estates of decedents dying on or before December 12, 1982. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisi of Sedion 714 of the Inheritance and Estate Tax Ad of 1961 or to report the invasion of trust orincipal. II. Remainder Prepoyment: A. Election to prepay filed with the Register of Wills on (attach copy of election) (Dote) B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income or Annuitont(s) of election or annuity is payable C. Assets: Complete Schedule L- 1 1. Reo I Estate $ 2. Stocks and Bonds $ 3. Closely Held Stock/Partnership $ 4. Mortgages and Notes $ 5. Cosh/Misc. Personal Property $ 6. Total from Schedule L-l $ D. Credits: Complete Schedule L-2 1. Unpaid liabilities $ 2. Unpaid Bequests $ 3. Value of Unincludoble Assets $ 4. Total from Schedule L-2 $ E. Total value of trust assets (Line C-6 minus Line 0-4) $ F. R"mainder factor (see Table I or Table II in Instruction Booklet) G. Taxable Remainder value (Line E x Line F) $ (Also enter on line 7, Recapitulation) III. Invasion of Corpus: A. Invasion of corpus (Month, Day, Year) B. Name(s) of Life T enont(s) Date of Birth Age on date Term of years income or Annuitant(s) corpus consumed or annuity is payable C. Corpus consumed $ D. Remainder factor (see Table I or Table II in Instruction booklet) $ E. Taxable value of corpus consumed (Line C x Line 0) $ (Also enter on Line 7, Recapitulation) ons REV-16.4S EX + (3-S.4) INHERITANCE TAX SCHEDULE L-l COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ElECTION INHERITANCE TAX RETURN RESIDENT DECEDENT -ASSETS- FILE NUMBER 21020936 I. Estate of K. I ""is" Martin ~.~.~. I "";o~ K. M~"in (Last Name) (First Name) (Middle Initial) II. Item No. Oescriotion Value A. Real Estate (please describe) Total value of real estate $ iinclude an Section II, Line C-l an Schedule L) B. Stacks and Bands (please list) - Total value of stacks and bands $ iinclude on Sedion II, Line C-2 on Schedule Ll C. Closely Held Stock/Partnership (attach Schedule C-l and/or C-2) (please list) Total value of Closely Held/Partnership $ (include an Section II, Line C-3 on Schedule Ll D. Mortgages and Notes (please list) Total value of Mortgages and Notes $ iinclude on Sedion II, Line C-4 on Schedule L) E. Cash and Miscellaneous Personal Property (please list) Total value of Cash/Misc. Pers. Property $ iinclude on Section II Line C-5 on Schedule L\ III. TOTAL fAlso enter on Section II, Line C-6 on Schedule Ll $ (If more space is needed, attach additional 81/2 x 11 sheets.) REV.1646 EX + (3.84) INHERITANCE TAX *' SCHEDULE L-2 COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION INHERITANCE TAX RETURN -CREDITS- FILE NUMBER 21020936 RESIDENT DECEDENT I. Estate af K LnlJi~" M"rtin ~ I< ~. In, 'i~o I<' (last Name) (First Name) (Middle Initial) II. Item Na. Description Amaunt A. Unpaid Liabilities Claimed against Original Estate, and payable from assets reported on Schedule L-1 (please list) - Total unpaid liabilities S I;nclude on Section II, Line 0-1 on Schedule L) B. Unpaid Bequests payable from assets reported on Schedule L-1 (please list) Total unpaid bequests S {include on Section II, Line 0-2 on Schedule L1 C. Value of assets reported on Schedule l-l (other than unpaid bequests listed under "B" above) that are not included for tax purposes or that do not form a part of the trust. Computation as follows: Total unincludable assets $ (include on Section II, Line 0-3 on Schedule L) III. TOTAL (Also enter on Section II, Line 0-4 on Schedule L) $ (If more space is needed, attach additional 8112 x 11 sheets.) REV"647EX.. SCHEDULE M FUTURE INTEREST COMPROMISE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Check Box 4a on Rev.1500 Cover Sheet FILE NUMBER ESTATE OF K Louise Martin a k a Louise K Martin 21 02 0936 This Schedule Is appropriate only for estates of decedents dying after December 12,1982. This schedule is to be used for aii future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate beiow the type of instrument which created the future interest and attach a copy to the tax return. o Will 0 Trust 0 Other I. Beneficiaries NAME OF BENEFICiARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. 2. 3. 4. 5. II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. o Unlimited right of withdrawal o Limited right of withdrawal III. Explanation of Compromise Offer: IV. Summary of Compromise Offer: 1. Amount of Future Interest .... .... ..........................................$ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) --....$ 3. Value of Line 1 passing to spouse at appropriate tax rate Check One 06%, 03%, 00% ................$ (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check One 06%, 04.5% ......................$ (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 taxable at sibling rate (12%) (aiso include as part of total shown on Line 17 of Cover Sheet) ......$ 6. Value of Line 1 taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) ......$ 7. Total value of Future Interest (sum of Lines 2thru 6 must equal Line 1) .....................$ (If more space is needed, insert additional sheets of the same size) R'V.'04..'XI1.92) '* SCHEDULE N SPOUSAL POVERTY CREDIT COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX DIVISION (AVAILABLE FOR DATES OF DEATH 1/1/92 to 12131194) ESTATE OF I FILE NUMBER K. Louise Martin a.k.a. Louise K Martin 21 02 0936 This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet. PART I - CALCULATION OF GROSS ESTATE ................................................ 1- 13283.11 ................................................ 2. ................................................ 3. ................................................ 4. ................................................ 5. 6a. 6b. 6c. 6d. ................................................ 6. 7. 13283.11 .,.............................................. B. ................................................ 9. 13,283.11 .;~ 'ih~ '~;;;dii.' ii~~i' ~-;~ii~~~' k; p;;; ii. PART II - CALCULATION OF JOINT EXEMPTION INCOME - (Attach copies of Federal Individual Income Tax Returns far decedent and spouse.) Income: 1- TAX YEAR: 19 2. TAX YEAR: 19 3. TAX YEAR: 19 a. Spouse. . . . . . . . . . . . . . . . . . . . . . . . la. 2a. 3a. b. Decedent ....... .. ........... 1 b. 2b. 3b. Co Joint. ............ .. ........... k 2c. 3c. d. Tax Exempt Income ........ ld. 2d. 3d. e. Other Income not listed above ......<...... 10. 20. 30. f. Total............................. 11. 21. 31. 1. Taxable Assets totol from line 8 (cover sheet) ............................ 2. Insurance Proceeds on Life of Decedent ................................... 3. Retirement Benefits .......... 4. Joint Assets with Spouse ......................................................... 5. PA Lottery Winnings. 60. Other Nontaxable Assets: list (Attach schedule if necessary) .. 6. SUBTOTAL (lines 60, b, c, d) .................................................. 7. Total Gross Assets (Add lines 1 thru 6) ..................................... 8. Total Actual liabilities ............................................................. 9. Net Value of Estate (Subtract line B from line 7) ........................ If line 9 is greater than $200,000 - STOP. The estate is not ellEPhle to cia 4. Average Joint Exemption Income Calculation 4a. Add Joint Exemption Income from above: (1 D + (2D + (3D = (+ 3) 4b. Average Joint Exemption Income ................................................:........................................... = Ifline 4(b) is grealerlhan $40-000. STOP. The eslale is naleligible 10 claim Ihe credil. I/nat canlinue 10 Part III. PART III - CALCULATION OF SPOUSAL POVERTY CREDIT FOR RESIDENT AND NONRESIDENT ESTATES 1. Insert amount of taxable transfers to spouse or $100,000, whichever is less ....."......................... 1. 2. 3. Multiply by credit percentage (see instructions) .......................................................................... This is the amount of the Resident Spousal Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet. ................................................... For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate . ......................................................................................................... 4. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet. 2. 3. 4. 5. 5. ow""".-,,.,,'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 0 ELECTION UNDER SEC. 9113(A) SPOUSAL DISTRIBUTIONS ESTATE OF FILE NUMBER K. Louise Martin ak a Louise K Martin 21 02 0936 Do nol complele Ihis schedule unless Ihe eslale is making the election to tax assels under Section 9113(A) of the Inheritance & Estale Tax Ad If the election applies to more than one trust or similar arrangement, a separate form must be med for each trust. This election applies to the Trust (marital, residual A, B, Bv-pass, Unified Credit. etc) If a trust or similar arrangement meets the requirements of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule 0, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arranqement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar arranqement. PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's survivin souse under a Section 9113 A trust or similar arran emen!. DESCRIPTION VALUE Part A Total $ PART B: Enter the descri tion and value of all interests included in Part A for which the Section 9113 A election to tax is bein made. DESCRIPTION VALUE Part B Total (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 11128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTAT OFFICIAL RECEIPT GODFREY E RALPH ESQUIRE 2215 FOREST HILLS DRIVE SUITE 36 HARRISBURG, PA 17112 _n_____ fold ESTATE INFORMATION: SSN: 182-22-8238 FILE NUMBER: 2102-0936 DECEDENT NAME: MARTIN K lOUISE DATE OF PAYMENT: 06/26/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 09/27/2002 TOTAL AMOUNT REMARKS: DORIS JUNE REED C/O E. RALPH GODFREY, ESQ. CHECK#102 SEAL INITIALS: DO RECEIVED BY: . REGISTER OF WILLS REV-1162 EX(11- I ETAX NO. CD 00273 ACN SSESSMENT AMOUNT CONTROL NUMBER ~n_ 101 I $172.71 I I I I I I I I PAID: $172.71 DONNA M. OTTO DEPUTY REGISTER OF WillS Ii. A //)- 96--$" \,. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION IlEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 'm [.so 19 :10 E RALPH GODFREY ESQ GODFREY & COURTNEY 2215 FOREST HLLS DR ~ HBG PA ej;vU2 08-11-2003 MARTIN 09-27-2002 21 02-0936 CUMBERLAND 101 A.aunt R...itt.d '( ,..,.....1 ,;'.6~_ ~,'~... '.:.t,,::',:,,;' '-~;.~- -., _..:,-~' ....".... , K L MAKE CHECK PAYABLE AND REMIT PAYMENT 0: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ iiE'v=is'4-j-EiCAFP-rliFo3"r-iiiii'"icE--OF-INHERiTANcn'"iin:"pitAiSE"EN;"~--ALLOWANcnIR---------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HARTIN K L FILE NO. 21 02-0936 ACN 101 DATE 08-1 2003 TAX RETURN WAS: I X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Estete ISchedule A) 2. Stocks 8nd Bonds (Schedule 8) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. MortgageslNoies R.celvable (Schedule DJ S. CashlBank hPosi:ts/"isc. rers0n81 Property (Schedule E) 6. Jointly Owned Property ISchedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expen_slA... Costsll1isc. Expenses (Schedule H) 10. Debtsll10rtgage Llabilitles/LiBns (Schedule Il 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/GoYer~ent.l Bequests; Non-elected 9113 Trusts 14. Net Value of Estate Subject to Tax NOTE: TA NUI1BER CD 01999 CD002735 INTEREST/PEN PAID 1-) 15.79 .00 DATE 12-27-2002 06-26-2003 I ) CHANGED (9) 110) III 121 (3) 1'1) (5) (6) (7) I Schedule .J) .00 5.266.44 .00 .00 2.790.23 .00 5.226.44 (8) 1,945.07 500.00 Ill) (12) 113) 11'1) .00 10,838.04 .00 .00 X 00 = X 045 = X 12 = X 15 = I~ an assess_ent was issued previously, lines 14, 15 and/or 16, 17, 18 and re~leC't ~igures 'tha't include 'the 'ta'tal o~ ALL returns assessed 'to da1:e. ASSESSMENT OF TAX: IS. ~t of Line l~ at Spousal rate (IS) 16. A~unt of LIne 14 taxable at Lineal/Class A rat. (16) 17. Amount of LIne 14 at Sibling rat. (17) 18. A.ount of Line 14 taxable at Collateral/Class Brat. (18) 19. Principal Tax Due AMOUNT PAID 300.00 172.71 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE NOTE: To ins credit to you subIoit t.... of this for.. tax peynent. proper account I r portion th your 13,28 .11 10,83 04 00 10,83 04 19 will (19)= 00 48 71 00 00 48 71 488. . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. I IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU HAY A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRU~Tr STATUS REPORT UNDER RULE 6.12 c"'- Name of Decedent: K Louise MArtin a k a Date of Death: 9/27/200? Will No. ?1-ll?0936 Admin. No. 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: I . 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. I is Yes, state the following: a. account with the Court? Did the personal representative file a final 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 Clerk of the Orphans' Court and may be attached to this r rt . Date: 11270004 Si Name (Please type or print) 2215 Forest Hills Drive, Suite 36 Address Capacity : Personal Representative X Counsel for personal representative IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYL VANIA INRE: ORPHANS' COURT DIVISION ESTATE OF K. LOUISE MARTIN AlKJA LOUISE K. MARTIN, NO. 21-02-0936 DECEASED ESTATE SETTLEMENT AGREEMENT () -:J ...---.- THIS AGREEMENT, made this ~ day Of~"Vo-02004. WITNESSETH: THE CIRCUMSTANCES leading up to the execution of this Agreement are as follows: L K. Louise Martin aJk/a Louise K. Martin ("Decedent"), died testate on September 27, D. June Reed duly qualified with the Register of Wills of Cumberland County, Pennsylvania, Executrix ("Executrix") of the Decedent's probate estate ("Estate"). 02, and s the 2. Article THIRD of the Decedent's Last Will and Testament ("Will") provides for the distribution of the Decedent's rest, residue and remainder of her estate equally to Doris June Reed, James Lloyd Martin, Judith Louise Gross, and Jacquelyn Farrow Gusler. 3. Doris June Reed, James Lloyd Martin, Judith Louise Gross, and Jacquelyn Farrow Gusler are the Decedent's surviving issue ("Beneficiaries"). The Beneficiaries desire the Executrix to settle the Estate informally in order to avoid the expense and delay involved with the formal adjudication of the First and Final Account by the Orphans' Court Division of the Court of Common Pleas of Franklin County, Pennsylvania ("Court"). 4. The Beneficiaries desire to forever settle and compromise any and all claims and rights which they may possess, now or hereafter, in the Estate and to conlirm their acceptance of the Informal Account ("AccounC), attached hereto as Exhibit "A" and incorporated herein by this reference, and the Schedule of Proposed Distribution ("Schedule"), attached hereto as Exhibit "B" and incorporated herein by this reference. The Beneficiaries desire that the distributions as set forth on the Exhibit "B" be in full satisfaction of their rights in the Estate. 5. The Beneficiaries wish to release the Executrix and to indemni fy her against any and all claims that may be asserted against the Estate or the Executrix after the date hereof 6. The Executrix is willing to settle the Estate informally in the consideration of the indemnifications hereinafter provided by the Beneficiaries and agreed to in the Consent to Estate Settlement Agreement and Receipt for Distribution incorporated herein by reference and attached as Exhibit "C". NOW THEREFORE, in consideration of the foregoing and intending to be legally bound, jointly and severally, the Beneficiaries, for themselves, their successors, and assigns: I. Represent and warrant that they have read and understand this Agreement and confirm that the facts set forth above are true and correct, to the best of their knowledge, information and belief. 2. Declare that they have sufficient information to make an informed waiver of their right to a formal accounting with the Court, and do hereby waive the filing and auditing of the same. 3. Acknowledge that the distributive share or amount set forth on the Schedule shall be in full satisfaction of their respective entitlements under the Will. 2. Release, remise, quitclaim and forever discharge the Executrix, her heirs, personal representatives, successors and assigns, from and against all claims that they, as legatees of the Estate, or indirectly as beneficiaries of the Trust, and in connection with the Estate, had, now have or may in the future have in connection with the Estate. 3. Agree to refund, on demand, all or any part of any foresaid distribution, which has been determined by the Executrix, or by the Court, or by any court of competent jurisdiction, to have been improperly made. 6. Agree to indemnify and hold harmless the Executrix, her heirs, personal representatives, successors and assigns, from and against any and all claims, loss, liability or damage (whether or not related to the negligence of the Executrix) that may hereafter be asserted against the Estate or against the Executrix. 7. Agree to execute such other or additional documents as may be necessary to effectuate the agreements set forth herein. 8. Acknowledge that this Agreement shall be governed by and construed in the accordance with the laws of the Commonwealth of Pennsylvania. 9. Consent to the Court exercising personal jurisdiction over them in any suit or action arising out of the enforcement of this Agreement. IN WITNESS WHEREOF, the Beneficiaries have placed their hands and seals on the attached Consents to Estate Settlement Agreement. Respectfully Submitted, GODFREY & COURTNEY, P.C. By: E. Ralph God rey, Esquire Attorney lD# 77052 P.O. Box 6280 Harrisburg, PA 17112 Dated: /2-'7 101 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA INRE: ORPHANS' COURT DIVISION ESTATE OF K. LOUISE MARTIN A/KIA LOUISE K. MARTIN, NO. 21 -02-0936 DECEASED INFORMAL ACCOUNT OF D. JUNE REED, EXECUTRIX OF THE ESTATE OF KI LOUISE MARTIN AfKIA LOUISE K. MARTIN, LATE OF CUMBERLAND COUNTY, PENNSYL VANIA ------------------------------------------------ Date of Death: Letters Testamentary Granted: Letters Advertised: The Sentinel - September 27, 2003 October 17, 2002 October 22,29 and November 5, 2002 November 1, 8, and 15,2002 December 17, 2003 Cumberland Law Journal- Account Stated to -----------------~------------------------------- SUMMARY PRINCIPAL Receipts Disbursements Balance before Distribution Advancements to beneficiaries Principal balance remaining: $ $ $ $ 13,359.92 1,609.09 11,750.83 0.00 $ 11,750.83 EXHIBIT "A'" ASSETS COMPRISING ESTATE M&T Checking Account $ 2,627.06 BALANCE FOR DISTRIBUTION: $ 2,627.06 RECEIPTS OR PRINCIPAL Sale of Furniture $ 235.00 Sprint Telephone refund $ 7.07 Blue Cross refund $ 2.17 Dr. Abrams refund $ 5.18 Blue Cross refund $ 112.45 Blue Cross Refund $ 9.61 AAL Annuity $ 5,133.27 Refund from Thornwald $ 301.25 PSERS - Pension $ 82.22 AAL Money Market $ 4,827.68 Interest $ 16.96 TOTAL PRINCIPAL RECEIPTS $ 10,732.86 DISBURSEMENT OF PRINCIPAL Cumberland Law Journal $ 75.00 The Sentinel $ 97.07 Yellow Breeches EMS $ 112.89 Carlisle Imaging $ 7.35 PSERS- refund $ 91.36 Godfrey & Courtney, P.C. $ 29.48 Dr. Evans $ 9.61 Repayment to June Reed for Bethany Guild lunch ($284.00), Register of wills probate fee, ($69.00) Hoffman Roth - death certif,cates and burial ($354.16) $ 707.16 EXHllllT "A" Clark American Checks Register of Will, Inheritance Tax TOTAL PRINCIPAL DISBURSEMENTS $ $ $ PRINCIPAL ADVANCEMENTS TO BENEFICIARIES 6.46 472.71 1,609.09 NONE. TOT AL PRINCIPAL ADVANCEMENTS TO BENEFICIARIES $ 0.00 EXHIBIT 'A' IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA INRE: ORPHANS' COURT DIVISION ESTATE OF K. LOUISE MARTIN AfKJA LOUISE K. MARTIN, NO. 21-02-0936 DECEASED STATEMENT OF PROPOSED DISTRIBUTION I. The following distributions were or will be made before the filing of the First and Fin Account of the Executrix, D. June Reed: Pursuant to Article II of the Last Will and Testament of Decedent, the rest, residue and remainder of Decedent's Estate in the amount of$ 11,750.83 will be equally distributed as follows: A) D. June Reed = $2,937.70 B) James L. Martin =$2,937.71 C) Judith L. Martin = $2,937.71 D) Jacquelyn Farrow Gusler = $2,937.71 EXHIBIT "8" CONSENT TO ESTATE SETTLEMENT AGREEMENT AND RECEIPT FOR DISTRIBUTION I, James 1. Martin, hereby acknowledge receipt of the property of the Decedent, and in my individual and fiduciary capacities I hereby consent to and join in the Estate Settlement Agreement relating to the Estate of K. Louise Martin a/k!a Louise K. Martin, deceased, a copy of which Estate Settlement Agreement, including exhibits, has been provided to me. OA9~d'" 7- l11o~ V Commonwealth of Pennsylvania County of SS. On this, the ;l-'i"" day of De..~.....b..t- ,2003, before me, the undersigned officer, personally appeared James 1. Martin, known to me ( or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he/she executed thc same in the capacities and for the purposes therein contained. IN WITNESS WHEREOF, I hereunder set my hand and official seal. NOTARIAL SEAL DONNA L. GODFREY. NOTARY pup CITY OF CARLISlE, CUMBERLAND eoulTY MY COMMISSION EXPIRES DEC. 02. 2001 ~~.e~ otary Pubhc CONSENT TO ESTATE SETTLEMENT AGREEMENT AND RECEIPT FOR DISTRIBUTION I, Jacquelyn F. Gusler, hereby acknowledge receipt of the property ofthe Decedent, and in my individual and fiduciary capacities I hereby consent to and join in the Estate Settlement Agreement relating to the Estate of K. Louise Martin a!k/a Louise K. Martin, deceased, a copy of which Estate Settlement Agreement, including exhibits, has been provided to me. 90/ r/~AJfcA- Commonwealth of Pennsylvania County of C~CVV1 J SS. /9' 9' ~ 3 0 ~ ~7 0 / On this, the 3 / day of ~, 2003, before me, the undersigned officer, personally appeared Jacquelyn F. Gusler, known to me ( or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he/she executed the same in the capacities and for the purposes therein contained. IN WITNESS WHEREOF, I hereunder set mjand and Oflicial. se~ . / /1 /~ . .~. . / Y ublic -~ - ROS NOTARIAL SEAL IE M. BURTON. Notary PubHc Borough of CaI1I8fe, Curnbedaud QltalIy My Commission Elcplree May e. 2JXJ1 CONSENT TO ESTATE SETTLEMENT AGREEMENT AND RECEIPT FOR DISTRIBUTION I, Judith 1. Gross, hereby acknowledge receipt of the property of the Decedent, and in my individual and fiduciary capacities I hereby consent to and join in the Estate Settlement Agreement relating to the Estate ofK. Louise Martin alk!a Louise K. Martin, deceased, a copy of which Estate Settlement Agreement, including exhibits, has been provided to me. ~?~U L~ {/ Commonwealth of Pennsylvania County of C-wYlbu\o.nd. SS. / t 'r"~ o:L?- DO 77 On this, the .2.3 day of Dee.-. ,2003, before me, the undersigned officer, personally appeared Judith 1. Gross, known to me ( or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he/she executed the same in the capacities and for the purposes therein contained. IN WITNESS WHEREOF, I hereunder set my hand and official seal. ~1Y) ~ Notary Public NOTARIAL SEAL ANNETTE M. STAUB. Notary Public Borough of Carlisle. Cumberland County My Commiltlon E iras March 8, 2004 CONSENT TO ESTATE SETTLEMENT AGREEMENT AND RECEIPT FOR DISTRIBUTION I, D. June Reed, hereby acknowledge receipt of the property of the Decedent, and in my individual and fiduciary capacities I hereby consent to and join in the Estate Settlement Agreement relating to the Estate ofK. Louise Martin alk/a Louise K. Martin, deceased, a copy of which Estate Settlement Agreement, including exhibits, has been provided to me. ~U~__ /ti~~ Commonwealth of Pennsylvania Countyof ~~ SS. On this, the I~ day of ~ ,2003, before me, the undersigned officer, personally appeared D. June Reed, known to me ( or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he/she executed the same in the capacities and for the purposes therein contained. IN WITNESS WHEREOF, I hereunder set my hand and official seal . 5~~~~ Public NOTARIAl 8eAl JUDITH D. KAUFFMAN, Notary Public Borough of CaItisIe, Cumberland County My Commission ElCjllreo M8roh 10, 2007