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Home My WebLink About02-1014PETITION FOR PROBATE and GRANT OF Estate Oj Miriam D. Berkheimer NO. 2i -02. 101 also lrnow-r as To: Register of Wins for the Deaeare~ qty p{ Cumberland in ~~ Social Security Na 21 1 -'~ 6 - 7 5 8 9 CommoawesIt,h of Peaasylvaaia The petition of the uadersigaed respettfuIIy represears that: Your petitioner(s). who is/are 18 years of age or older as the actor o r ~~ in the Iasi wIll of the above deadest, deed , anuarv t t 192L_ and codidl(s) dated July 13. 1994 ~~ ~~ . si, reamdarion, dash of acautor, etc) De+ceadent was domiciled at death is Cumberland County, Peaasyivania, with b er ~ fam37y oY principal tYSideaa at-_ The Woods, 824 Lisburn Road, Caron Hill. PA 17011 ~.it svees, 1>~ba and mundpaGtp) Decendeat, then 104 y~ of age, died ~ November 2 2002 at The Woods, 824 Lisburn~Rd., Camp Hill, PA 17011 Except as follows, decadeat did not marry, was not divorced sad did not have a chrld borer or adopted after execution of the will effer~ Aor probate; was not the victim of a killing and was never adjudicated incompetent: Deceadeat at death owned property with estimated values as follows: (If domia7ed in Pa.) All personal property s 230.000.00 (If not domiaZed is Pa.) Personal property in Pennsylvania = (If not domia7ed in Pa.) Personal property in County S Value of real estate in Pennsylvania NSA = situated as follows: .:: WHEREFORE, petitioner(s) respectfully iequest(sj"the probate' o{'thr Test°sin71'iad"codia7{sj ' --. _ presented hezewith and the grant of letters testamentarv (tatsmmrarr; ~dmiaiscation its.; admiai d.b.n.cti.) thezon. a~ ec ~~ ~L v. ~`o H AllIl~TS~~c~~~f PA, NA P. Box 2961 Harrisburg. PA 17105 OATH OF PERSONAL REPRESENTATIVE COMMONWEALT~i OF PENNSYLVANIA 1 ~ COiJNTY O~ ~. Camber7_and J The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and corr:xt to the best of the knowIcdge and belief of petitioner(s) and that as personal rcpresca- tative(s) of the above decedent petitioners) will wcII sad truly administer the estate accorduig to Iaw. All T ~~~o. of PA, NA Sworn to or aft-u~cd and subsrnbcd B • ~, ~.~~~~-~4/~~,~- _ c., before me this 1 3th ~y of Zvi o,~ NOVEMBER 20 2 ~~ o ~ i inn.,, .. n . ~ i ~ a. _,dr ~ ~ ~ ~ 1 `"1 . _ _ ti No, a~-o~ - id-~! Fgj$te Of Miriam D. Berkheimer ~ . DtCe83~ • DECREE OF PROBATE AND GRAI~IT OF LETTERS AND NOW NOVEMBER 1 4 . 2 0 0 2 _ ~, C ~ - is coas-~das~oa of the ~etitioa oa the reverx side heroof. sstisfactorY proof bsrta~ been ~°d before me, • 1T LS DECREED that the instrumeat(s) dafed 1 / 11 / 91 and Codicil 7 / 3 / 9 4 described therein be admitted to probate and filad of record as the last a~11 of Miriam D. Berkheimer iad ~~ Testamentar aiehereby~~ti0 Allfirst •Trust Co. of PA, NA ~~x1~~3f ~x~~ ~ ~ (~ FEES Ps•ohate, Letters. Etc.......... ~~~c~ L ' v2~p. Oo S 0 Cleckner & ~'earen 449631 111 Locust Street, P.O. Box 11847 Harrisburg PA 17tnR-~R~~ __- ADDRES4 ~yD __ s /D. o0 . ?O?AI-~o8 ~1~ZCJ Filed . ~ ~.: 1.4 r,3 0-0 2 ............:7..2 ... called bank 11-14-2002 (717) 238-1731 _ PHOt~ I ,, ., t.L- ~ _ .~ I , ~ i,,°~ t s~et~ , Lo rL~ l~~ co~t~cl ttr T, aT3 c~li~ i;2;a1 certificl~~_ • ~ ~ _ ` ~ Jt'€i4 ?. iC_.,,~l=~t:U 'O il]t ~~~'.c~ ~ ttl. 1~.-~ ,Ld> { ?1~iCC (': .' -... ~~ ~Pl~ag~1 t~~ t~~~ms~~t~ #I~i~ ~~~p ~~/ h~~OS#a8 ~r ~?~r~~~~zr~r<-.~ t~~. ,t ,;:; ,.: v ,,,~-' ` ~~1 ~~ -, ~ ~ _ yp '~ '~ ~ .. ~ y ,. ~' ;', , r .~' ~ 8643692 =~~-~~~~,~~~~ ~ ~ ~~~ _ NOV 0 5 2002 ,, os.taa RaY. trst COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS T CERTIFICATE OF DEATH T (Coroner) ~vnm~ t/r utlitutrv I IFUSI. Mitldle. Last) - STATE Felt NUMBER '' Miriam .l L. Berkheime SEX SOCIAL SECURITY NUMBER f DATE OF DEA1NlMOnlh. Day. lead AGE (Last &nhday) UNDER7YEAR r UNDEHt DAV DATEOF UIRTH BIR 2. Female 3. .2 // E, ~/ ,7~y `Z .. November 2 2002 Months Days THPLACE Gt and Hours Minutes (Muiidi, Uay. Year) Sialew FweiynlCuwnry) PLACE OF DEATH tClierk oiily„n,~-;en,n5rcu,.roi~., ,,n olhw side) , 104 vr, h%3orE;/sfl.Jev Feb. 20 1898 . HOSPITAL _ OTHER: r N In at 1 ^ s COUNTY O , ~ e. ?. JeN/S/ivJ. URN/N p u em ront ` ERlOutpauent DOA ^ 9 Home ^ 9a Omar . Residences ISV~~IrI^ F DEATH CITV,BOR TWP DEATH FACILITY NAMEiII ~~ulursawuon . yrve seed and nun suer) WAS DECEDENT OF HISPANIC ORIGIN? RACE -American Indian, Rtack, White Cumberland Lower Allen The Woods at Cedar Run "oLC1 va51-711Ya, s atlil c (S~'lyl . p y NDan. eb. ec. Bd. Mexican, Pueno Rican etc ' , . W/ '/~ DECEDENT'S USUAL OCCUPATION KIND OF BUSINESSlINDUSTRV WAS DECEDENT EVER IN 9. t0. (Give kuW of xork done tlui~n DECEDENT'S EDUCATION m t y us U.S. ARMED FORCES? MARITAL STATUS-Merited olworkirg efe; do not use reluedl ISn`~~'IV""'~y_"~~_. !.:~on~~lu'r,l Never Married, Widowed, SURVIVING SPOUSE 1 ~n yum ~ m~ Ki,}/u Yes ^ No Elementary/Secondary College Dworeed (St,ecilyl (II wAe. yrve maulo~~ name) ~n~~ ~ l ® ~J 11a. / cM1~ 116. f2. 13. (P 121 ft-4 of Sr1 W/w~ DECEDENT'S MAILING ADDRESS ISireel. GIy~Town. Slate. Lip Cudcl DECEDENT'S li. d''~~n ty r~ '/ ,~ ~ /S'~L/,Q~ ~~ U~ J, ACTUAL 17a. $lale r~~./JT''~r c UqN/~ LN Vas, tlecedent Iwad in ~LI~C.JL: ~ /9[-~C ~-• RESIDENCE aed 17c• J edam C:Amn ~T /(. (.. ISe6 tl12VUCLOO3 on Ulhei side) p eve in a te. ~6N. S L ti/ jyg;y 77D. COUnt Cu/h/jL'F~- lownsmp9 No. deceaem lived ~Nf~ FATHER'S NAMEjFust. Middle, Lasp _ -- t7tl.^ wnnin awualtimns ol ,9. S. MoR~e i S R~./~ r~ ._, _ MOTHER'S NAMEIt ~rsl Middle-Maiden Jumaniel ----- O ~ INFORMANT'SNAME (Type/Poop /n~ 19. ~ ~' ~~ ~ ~ A V- ~J l /f~J7( ~ INFORMANT'S MAILING ADDRESS (Street. CaylTOwn. Stele. Zip Cadej~ 2a. tHRL Ef3E/,'h'Hr:J/)/tl~_ METHOD OF DISPOSITION 2 b. y ~f1J-L/}Tc~ AFT ! ' ~-Irn/C: i4(~ ~ YO. t~X l2 b' ~u1NCY l~/~/ 1 DATE OF DISPOSITION PLACE OF DISPOSITION - Name of Cemetery, GematorY LOCATION -CnylTOwn, State, Zip Code Burial ® Cremation ^ Removal Irom Stale ^ (Momh. Uay. Year) or Other Place - Do li ^ na on Other (SpecAyl ^ N U'J c M 1?,L ~' 7/ ,ZiJG .~+.. 27a. J- 7 [~/~p~~. ,d ~ ~N~C'a'tK- ~f~{.~JS~JC~r 21b. C/j.~~J /7/7F JSl s~~ iw Lr~/~/ ~ .,1/ L -. - 21c. SIGNATURE Of FUNERAL SERVICE LICENSEE OR PERSON ACTING AS SUCH LICENSE NUMBER 270. !~/} / 7r.! - v ~ NAME AND ADDRESS OF FACILITY .ZUCJ~ - / -•/'~C 22a. -- ~ 226. F S - ~'/ ,~ - ~ ~ i ~p q7 i • iY~ ;E-:f'i s.A t/~6 mPlete Gems -e onry hen c irym9 To the 6es1 of my knowledye, death occurred at the lime, data and place staled. L - C 22t. L f rV//~~ lr/j)7 /y yL [- /%(,~~ , •~f~L i/Ulyl C Y ..: ~ /~'J physician is not available et lime of death to (Siynetwu ei itl Total LICEf --- ~• ceniry cause of death. 23a. nems2W-28 must be wmpletetl by person ho Pronounces dean TIME OF DEATH DATE PRONOUNCED DEAD Momh, Da Vear) AprX. ( y 23b . , November 2, 2002 2a. 11:00 A M WA91 - ~ 27. PART I: Enter the diseases, injuries or co Usl only one cause on each tine. . 2s. mplications which cause0 the death. Do not enter the mode of dying, such as cardiac or res amr pu y arrest, shock ui 26 been lanwn. i Appr i nnerv IMMEDIATE CAUSE (Powl ~ onset di5ea5e w cUnNlion reswtirg in tleam)-. e. Presumed Natural Causes 1 :' DUE TD IOR AS A CONSEQUENCE OF): Seygentialry kal condibona b. ~ Diseases of Aging it any, leading to immediate r s .cause. Emer UNDERLYING DUE TO ((Ni ASA(,ONaEQUENCE OF). 1 1 ^~ CAUSE (Disease w injury c, t ~~ mat initiated events DUE TO (OH AS A CONSEQUENCE OF): i resulting in deam) LAST i ^ tl. i WAS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH ---"'-' i ---'-"`'--'-- PERFORMED? AVAILABLE PRIOR TO DATE OF INJURY TIME OF INJURY :,~ COMPLETION OF CA OF DEATH? USE Natural ~ Homicide ^ (Monm. Uay. Yuar) ~ Yes ^ No ~ Ves ^ No ^ Accident ^ Pending Investigation ^ 3p•, ~--~-- 30b. -~-~~--- tea 2eD Suicide ^ GOUld rat bit determined ^ PLACE OFINJURY. Al Hann. tam building etc (S , ~l s, sireel. te~iixy, ofllw . CERTIFIER (i.t.eck only . one) Y9, . . ; e~ yl 30e. 'CERTIFYING PHYS To Ne Beet of my k ICIAN (PnysiGan ~ riulyuiq ~ .,, iur o nowledge death occurred d t f deanf when anoihnr INiysx;ien has pronouncwl deal) i erid completed l tM iens 23) SIC,NAI URi Day. Veaq Ves ~ No ^ oximate PART II: Other signilicam Gondilions coninbuuny to death, but al belw9en not resulting in the underlying cause given in PART I. and death VJURY AT WORK? Vas j. 1 No ^ ueo cause(a)endmanneraestatsd .................. ._j Jt6sr Coroner - tIt,ENSE B R _. 'PRONOUNCING AND GERTIFYINO PHYSICIAN IPhysx:ai rxrtl Ixonu,na ~g deam and cell lying to cause of clealhl DATE SIGNEDIMOnII .Day, Ye.nl z To tM beat of my krawkdge, deam occurred at lM time, date, and place, end due to the cawe(aJ and manner ea stated...... .... ;. _ I 31 c 31 tl November 4 , 2 00 2 ' NAME ~4ND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH •MEDICAL EXAMINER/CORONER - (?lent Zlj Type or Print Michael L. Norris, Coroner "= On the basis of examination andlor Investigation, in my opinion, death occurred at the lima, date, and place, and due to the cause s end manner as stated ......................... (1 6375 Basehore Road, Suite l~l 3fa. ..................................................................... .... REGISTRAR~fIGNATURE AND NUMBER I J 32. Mechanicsburg, Pa. 17050 ' ~ ~~ DATE FILED (M~1alin, Day, Yearj _ ~ /Yip i~ i i i I ~~~Y ~i11 ~trt~r J C~7~~x~rrt~en~ OF ~ MIRIAM D. BERKHEIMER v ~!- O a. - lUt~ I, MIRIAM D. BERKHEIMER of the City of Harrisburg, County of Dauphin and Commonwealth of Pennsylvania, do hereby declare this to be my Last Will and Testament, revoking all other Wills and Codicils heretofore made by me. I ITEM 1: I direct that the expenses of my last illness and ~ funeral be paid from my estate as soon as practicable after my death. i ITEM 2: I give and bequeath to GENEVIEVE PROWELL (Mrs. Prowell) of 2437 Parkway Boulevard, Harrisburg, Pennsylvania my diamond ring with three large stones, my diamond dinner ring with three small stones, my ring with five cubic zirconium stones, my charm bracelet with three gold pieces which I received from George on our 50th anniversary. ITEM 3: I give and bequeath to JANE WARDEN (Mrs. James Warden) of R.D. #l, Beaver Falls, Pennsylvania, my Grandmother Blair's gold watch and chain. ITEM 4: I give and bequeath to PATRICIA MONROE (Mrs. Robert Monroe) of 1401 Diana Lane, Lookout Mountain, Tennessee, my marble top table presently in my living room. ITEM 5: I give and bequeath to NANCY BOERGER of 795 South Main Street, Apartment 2, Wilkes Barre, Pennsylvania, Aunt Clara's silk crazy quilt presently in the cedar chest in my basement. ITEM 6: I give, devise and bequeath all of the rest and residue of my estate, real, personal and mixed, of whatsoever nature and wheresoever situate, to GENEVIEVE PROWELL JANE WARDEN and PATRICIA MONROE, to share and share alike, or to the survivors or survivor. ITEM 7: In the event that any beneficiary under this Will and I shall die under such circumstances that there is no sufficient evidence that we died otherwise than simultaneously, such beneficiary shall be deemed to have predeceased me. Kenneth) ~~„~~; ITEM 8: I direct and appoint the DAUPHIN DEPOSIT BANK AND TRUST COMPANY of Harrisburg, Pennsylvania to be the Executor of this Will and direct that he be permitted to serve without bond and without any intervention of any court except as required by law. I authorize my Executor to sell, encumber, mortgage, invest, distribute in kind, or retain any item of property of my estate in such manner as he shall deem proper, limited only by its own discretion. IN WITNESS WHEREOF, I have at Harrisburg, Pennsylvania this % /~ T da pf~~ y ° ~~t,~`~"~,_ ~~ set my hand and seal to this my Last Will and Testament. rl1 ~' ,3 ~, - ~ " ~'¢ ~ , E z ( SEAL ) R AM D. BERKHEIME Signed, sealed, published and declared by the above-named MIRIAM D. BERKHEIMER as and for her Last Will and Testament, in the who, at her request, in her presence and in the presence of eachsother~fhave hereunto subscribed eur names as witnesses. f i I ~~ _ > ~ ~ ~, `~`~;~~'\ L - Residence _~~~~1 ~ ~.C~S r~ ~~ ,'__ ~ ___~{~ ~~ d - -;.. Res i Bence ?•,/;"-J/~-~ ~. ~~, =~ ~`~-.~ a ,, ~ .s % > .' CODICIL a~-o a- Doty I, Miriam D. Berkheimer, now of Camp Hill, Cumberland County, Pennsylvania, declare this to be the FIRST Codicil to my Will dated January 11, 1991. I hereby amend Item 2 of my Will dated January 11, 1991 to add the following bequest: I in addition give and bequeath to Genevieve Prowell (Mrs. Kenneth) my antique bisque doll and the small rocking chair in which she sits. In witness whereof, I have at Camp Hill, Pennsylvania this ~"~' day of July, 1994 set my hand and seal to this my FIRST Codicil to my Last Will and Testament dated January 11, 1991. ~~. Miriam D. Berkheimer Signed by Miriam D. Berkheimer as and for a Codicil to her Will dated January 11, 1991, in the presence of us who, at her request in her presence and the presence of each other have signed our names as witnesses. Gl~ -sceL ~~S ~t/ti 1~ Residence ~ ~ ~ ~,,,o;? T i,ti1 :, NJl~ C3 J a ~ C IC} ~ % ~t ,r,. ~(-~% ~~` ~'" '`. Residence ~ Y S ~ ~ ~ `~.,n K /~-~. REGISTER OF WILLS OF COUNTY OATH~F SUBSCRIBING ESS codicil (each) a subscribing witness to th will presented herewith, ch) being duly qualified a ording to 1 ose(s) and say(s) that present d saw the testat n the same and that signed as a witness at t request of testat i presence and (i he presence of each oth (in the presence of the other subscribing witness(es)). Sw to or affirmed and subscribe efore me this day f (Name) 19 (Address) Register (Address) REGISTER OF WILLS OF CUMBER ,AND COUNTY OATH OF NON-SUBSCRIBING WITNESS 21-02-"1014 --- ----- (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that THF`Y 7~`FZF. familiar with the signature of MTRTAM rl RFRKAFTMF'R , codicil testat ORS of (one of the subscribing witnesses to) the will presented herewith and codicil THEY that believes the signature on the will is in the handwriting of MIRIIAM D BERKHEIMER to the best of THEIR knowledge and be Sworn to or affirmed and subscribed before me this 1 4th _ ~_ day of ` NOVEMi3Fi2 2002. 1.9 ~~,~,., r Register ~J dA\ lief. -'~~/f ~~ ~~~ (Name) / dress (Name) (Address) CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Miriam D. Berkheimer Date of Death: November 2, 2002 Will No. Admin No. 2002-01014 To the Register: I certify that notice of beneficial interest required by Rule 5.5;a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on December 2, 2002: Name Address Genevieve Prowell, 2437 Parkway Blvd., Harrisburg, PA 17104 Patricia Monroe 1401 Diana Lane Lookout Mountain TN 30750 Jane Warden, R. D. #1, Beaver Falls, PA 15010 Nancy Boerger, 91 Logan Street, Wilkes Barre, PA 18702 Notice has now been given to all persons entitled thereto under Rule 5.6 (a) except Date : 12 / 2 / 0 2 "~...~ ~` ~ ~ "-~ `~ _~,~; Signature Name Ann E. Rhoads, Esquire Address 119 Locust Street Harrisburg, PA 17101 Telephone (717) 238-1731 Capacity:- Personal Representative X Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 002576 ALLFIRST TRUST CO. OF PA, NA P.O. BOX 2961 HARRISBURG, PA 17105 fold ESTATE INFORMATION: SSN: 27 ~-36-7589 FILE NUMBER: 2102-1014 DECEDENT NAME: BERKHEIMER MIRIAM D DATE OF PAYMENT: 05/ 1 9/2003 POSTMARK DATE: 05/16/2003 couNTY: CUMBERLAND DATE OF DEATH: 1 1 /02/2002 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ 53,030.14 TOTAL AMOUNT PAID: REMARKS: ALLFIRST TRUST CO OF PA NA CHECK# 20422512 SEAL INITIALS: CW DONNA M. OTTO RECEIVED BY REV-1162 EX~11-96) 53,030.14 DEPUTY REGISTER OF WILLS REGISTER OF WILLS R~q:ster a# `~dllls ajf cuMB~:RLAN~ i NVENTORY Estate of Miriam D. Berkheimer Personal Representative also known as No. 21-02-1014 Date of Death 11/02/2002 Deceased Social Security No. 211- 36 - 7589 A1lfirst Trust Com an of PA, NA, Perscnal Representatives) of the above Estate. deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate 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 nc real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I /We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 13 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Cleckner & Fearen Name or Attorneys Ann Rhoads I.D. No.: 49631 Addres: P . G . Bow 11847 Harrisburg, PA 17108-1847 Telephone: 717/238 -1_731 Signature: ~~„Q,_, ~'~ A1lfirst Trust Company of PA, NA Signature: Address: 213 Market Street ~ut~$v; t~+~nncvivania ,.__..._ Harrisburg, PA 17101 Telephone: 71 7/255 - 2051 _ _. ..- . ~ ~ :.ate :,._ -- -~; ~a ese t..:iVE. lil C,liCe ."~e 'v B.U _ ~- =,~C ~..i...; ~;.;; ~J,--; iigG'e5 ShvGiG iivi is cX:ci~C.,C InIC til.. I-:ia. ui tf7.. ' V ,_ In c.uCrti. Prepared by the Pennsylvaniz Bar Association Copyright (ci 199fi form software only C?Systems, Inc. ,-. Dated: `s~~5/j~ ° _ •~ ~ .-~ - ~~.. II~TVENTORY Estate of: Date of Death County: Miriam D. Beritheimer 11/02/2002 Cumberland CASH: P_ilfirst Trust Company of PA NA Trustee under Agreement with Miriam D. Berkheimer - Cash Balance as of Date of Death Capital Blue Cross - Medical Insurance Refund Mass Mutual Firancial Group - Life Insurance Proceeds Merchants & Business Mens Mutual Insurance Combanv - Refund on Homeowners' f Insurance PA Department of Revenue - 2002 Personal Income Tax Refund Prudential Insurance Company - Life Insurance Proceeds Received from The Woods at Cedar Run - Reimbursement of Security De~~osit, Rent and Cash Fund j The Patriot News Company - Refund of Subscription 5,750.49 167.05 5,608.98 49.00 58.00 4,731.78 4,236.55 31.x5 -------------- 20,633.34 Estate of: Miriam D. Berkheimer Date of Death: 11%02%2002 County: Cum'r~erland PERSONAL PROPERTY: ------------------ Fs?tique Bisque Doil - 600.00 Appraised Value Charm Bracelet - Appraised 425.00 Value Crazy Quilt - Appraised Value 300.00 Diamond Dinner Ring - 50.00 Appraised Value Diamond Ring w/Three Large 950.00 Stones - Appraised Value Cold Watch & Chain - Appraised 275.00 Value Household Effects - Net 4,276.70 Proceeds from Sale $5,702.30 less Auctioneers Commission $1,425.60 Marble Top Table - Appraised 400.00 Value Rirg w/Cubic Zirconium Stones 1.00 - Appraised Value Small Rocking Chair - 75.OG Appraised Value -------------- STOCKS/LISTED: ---------- ---- 21,387.443 shares ARK Fds tiS Government 214,943.80 Bond Portfolio -------------- TOTAL RECEIPTS OF PRINCIPA.L .............. 7,352.70 214,943.80 ---------------- 242,929.84 allfirst® ~~llfirst "i~rust Fig„~,,, ~ ,~.~ -~t - - „ =s~ ~,~; i~~i May 20, 2003 Register of Wills Office ATTI`d: Cheryl Cumberland County Courthouse One Court House Square Carlisle, PA 17013 Re: Miriam D. Berkheimer, Executor Dear Cheryl: As per our telephone conversation, enclosed please find our Trust Funds Check in the amount of $31.00, representing the filing charges for the Inventory and Inheritance Tax Return for the above Estate. If you have any questions, please give me a call. Thank you for your assistance in this matter. Very truly yours, ~~.~2 / / / U~~ (Mrs.) Sue Mauery Vice President & Trust Officer SM/lt ~. ~- .,~.: = f~~, ~; _.; ~ „~ ~:T Enclosure s; --< N W A allfirst® ~Iliint l~rust _. iiur,:,~,_ ~ncc, Ela:~~ _ ~''_1 .__~+ _ __ -,- ~-; a15<~!~ May 13, 2003 °~ ~- Register of Wills ~. Cwnberland County `='` Onc Courthouse Square ~ Carlisle, PA 17013 ~~ ~o Re: Miriam D. Berkheimer, Executor -' SS #211-36-7589 - a File #21-02-1014 Dear Sirs: Enclosed please find two (2) copies of the Inventory and Inheritance Tax Return for the above Estate. Will you please time-stamp the extra copy of the Inventory and return to me in the envelope provided. I am also enclosing our Trust Funds Check in the amount of $3,030.14, representing the balance of the Inheritance Tax which is due. If you have any questions, please do not hesitate to contact me. My direct-dial telephone number is 255-2051. Very truly yours, ~ ~,L.Q / /l GG.(.~~~ (Mrs.) Sue Mauery Vice President & Trust Officer~~ SM/It F.,nclosure C: Ann E. Rhoads, Esquire ~i NaIDe of Decedent: MIRIAM D . BERKHEIMER Date of Death: 11 / 2 / 2002 Will No. 21-02-1014 Admin No. Pursuant to Rule 6.12 of the Supreme Court Orphans' court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes x No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes No d. Copies of receipts, releases, joinders and approvals of formal accounts may be filed with the Clerk of the Omhans' Court and maybe attached to this report. Date: 10/22/03 M&T TRUST COMPANY Signature VICE PRESIDE T-TRUST OFFICER MA&T TRjU{~ST COMPANY SYain'~ it i~.a$~i i~'p s°. ar ~lrl~t, P.0.. BOX 2961. HARRISBURG. PA 17105 Address (717)255-2051 Tel. No, Capacita: X Personal Representat.~~ e Counsel for p°rs~nal representati~~ e `~-moo o - ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 E% ~FP (O1-R3) ~;`; -,r ~ DATE 07-07-2003 ESTATE OF BERKHEIMER MIRIAM D DATE OF DEATH 11-02-2002 FILE NUMBER 21 02-1014 ~t.~-' ~'`~ ~' `.Y> COUNTY CUMBERLAND SUE MAUERY ACN 101 ALLFIRST TRST CO OF PA Amount Remitted 213 MARKET ST HBG PA 17101 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 BERKHEIMER MIRIAM D FILE NO. 21 02-1014 ACN 101 DATE 07-07-2003 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) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) .00 (2) 214,943.80 (3) .00 (4) .00 (5) 17 , 645.28 (6) .00 (7) .00 (8) NOTE: To insure proper credit to your account, submit the upper portion ofi this form with your tax payment. 232,589.08 APPROVED DEDUCTIONS AND EXEMPTIONS: 31,842.39 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 7,212.40 11. Total Deductions (11) 39.054 _ 79 12. Net Value of Tax Return (12) 193,534.29 13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14) 193,534.29 NOTE: If an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15 ) . 0 0 X 0 0 = . 0 0 16. Amount of Line 14 taxable at Lineal/Class A rate (16) . 00 X 045 = . 00 17. Amount of Line 14 at Sibling rate (17) • 00 X 12 = . 00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 193,534.29 X 15 - 29,030.14 19. Principal Tax Due (19)= 29,030.14 TAY CRFi1TTCe DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 01-24-2003 CD002087 1,300.00 24,700.00 05-16-2003 CD002576 .00 3,030.14 TOTAL TAX CREDIT 29,030.14 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE 0 REFUND_ SEE REVERSE SIDF OF TNTS FDRM FOR TNSTRUCTTnuc i COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 J128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 002087 ALLFIRST TRUST CO. OF PA, NA P.O. BOX 2961 HARRISBURG, PA 17105 fold ESTATE INFORMATION: ssrv: 21 ~-36-7589 FILE NUMBER: 2102-1014 DECEDENT NAME: BERKHEIMER MIRIAM D DATE OF PAYMENT: 01 /24/2003 POSTMARK DATE: OO/OO/0000 COUNTY: CUMBERLAND DATE OF DEATH: 1 1 /02/2002 ACN ASSESSMENT CONTROL NUMBER REV-1162 EX111-96) AMOUNT 101 ~ $ 24, 700.00 TOTAL AMOUNT PAID: REMARKS: ALLFIRST TRUST CO OF PA NA CHECK# 20382757 SEAL INITIALS: AC RECEIVED BY: DONNA M. OTTO $ 24, 700.00 DEPUTY REGISTER OF WILLS REGISTER OF WILLS COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DIVISION ESTATE NO. 21-01-1014 FIRST AND FINAL ACCOUNT OF MARJORIE FIDDLER For ANNE E. OLMSTEAD ESTATE LATE. OF CUMBERLAND COUNTY Date of Death: October 27, 2001 Date of Letters: November 5, 2001 Date of Letters Advertised: November 13, 2001 November 20, 2001 _ November 27, 2001 _~ Account Period: October 1, 2004 f Purpose of Account: MARJORIE FIDDLER offers this Account to acquaint interested parties with the transactions that have occurred during the administration of the estate. The Account also indicates the proposed distribution of the estate. It is important that the Account be carefully examined. Requests for additional information or questions or objections can be discussed with: Attorney: Steven J. Fishman 95 Alexander Spring Road, Suite 3 Carlisle, PA 17013 (717) 249-6333 Hamilton C. Davis POBox40 20 East Burd Street, Suite 6 Shippensburg, PA 17257 (717)532-5713 1 SUMMARY OF ACCOUNT Proposed Distribution to Beneficiaries Principal Receipts Gains/ losses on conversion Less Disbursements: Debts of Decedent Funeral Expenses Administration Expenses and Reserve Federal and State Taxes Fees and Commissions Balance before Distributions Distribution to Beneficiaries (Advance Distributions) Principal Balance on Hand Income: Receipts Less Disbursements Balance before Distribution Distribution to Beneficiaries Income Balance on Hand Combined Balance on Hand Recapitulation Page 9 3 4 $231,485.23 Fiduciary Acquisition Value $231,485.23 $274,996.60 $0.00 5 $3,051.79 5 $1,635.00 5&6 $19,291.50 6 $12,323.63 6 6 6 6 7 7 7 7 7 8 8 $25,551.63 $61,853.55 2 $213,143.05 $1,736.00 $211,407.05 $20,078.18 $0.00 $20,078.18 $0.00 $20,078.18 $231,485.23 $231,485.23 FIRST AND FINAL ACCOUNT OF ANNE E. OLMSTEAD THE ACCOUNTANTS CHARGE THEMSELVES WITH THE FOLLOWING: PRINCIPAL F('EIPT Amount Real Propertv: A single family residence known and numbered as 47 "E" Street $95,000.00 Carlisle, PA Cumberland County, Pennsylvania. Personal Property U.S. Savings Bonds $377.56 Washington Mutual Investors Fund -Account No. 58072625 $18,542.90 American Mutual Fund - Account No. 58072625 $15,616.41 Investment Company of America -Account No. 58072625 $18,038.98 Cash Management Fund ofAmerica -Account No. 58072625 $232.34 Washington Mutual Investors Fund -Account No. 58021884 $33,856.82 Washington Mutual Investors Fund -Account No. 58093158 $34,172.59 Checking Account - M&T Bank -Account No. 602663 $7,863.50 Savings Account - M&T Bank -Account No. 15004198249087 $22,136.76 Cash on Hand $6.00 Check from Employer $1,493.85 Sale of Automobile $14,000.00 4 PRINCIPAL DI BLrR EMENTS To/Pur ose° unt• Debts of Deced nt- Cat Care $567.26 State Farm Insurance $237.00 Iran Forge Storage $250.00 Orkin Pest Control $104.36 Pharmerica $578.76 Borough of Carlisle $48.43 Peir One $2.64 Wilson Street Internal Medicine $12 40 Central PA Hema & Med Oncology $12 00 West Shore EMS $32.00 PP&L $128.95 Highmark, Inc. $277.45 Sprint $67.78 2002 County and Township Taxes $384.76 2001 Federal Income Tax $345.00 2001 PA Income Tax $3.00 TOTAL DEBTS OF DECEDENT 53,051.79 Funeral Expen es• Hollinger Funeral Home & Crematory, Inc. $1,635.00 TOTAL FUNERAL EXPENSES $1,635.00 Administration Expenses and Reserve• Probate Fees $340.00 Filing Fee -Inheritance Tax Return $15.00 Music for Memoral Service $100.04 Rowe's Auetion Service $85 00 Food for Memorial Service $200.00 Office Supplies/Postage/Fax Fees $151.57 Photographs $17.70 George's Flowers $30.21 Legal Advertising -Cumberland County Law Journal $75.00 Legal Advertising -The Sentinel $124.26 House Cleaning $96.00 Reimbursement to Executrix $4,197.53 U-Haul Rental $1,572.90 Locksmith $2.65 Removal of Trees - Suncrest Gardens $248.68 Realtor Commission $5,700.00 Transfer Tax $950.00 Home Warranty $385.00 Reserves for contingencies $5,000.00 TOTAL ADMINISTRATION EXPENSES $19,291.50 Federal and State Taxes• 6 Federal Income Tax Witheld on Washington Mutual IRA A and B Balance of Fiduciary Income Tax and Preparation TOTAL TAXES Fees and Commission Steven J. Fishman Marjorie Fiddler TOTAL FEES AND COMNIISSIONS $7,558.83 $4,764.80 512,323.63 $10,000.00 $15,551.63 TOTAL PRINCIPAL DISBURSEMENTS AND RESERVES: Balance before Distributions Distributions to Beneficiaries (advance distributions) Tangiable Personal Property $1,651.00 Tangiable Personal Property $85.00 TOTAL DISTRIBUTIONS Balance of Principal on Hand (before final distributions to residuary beneficiaries) 525,551.63 $61,853.55 $213,143.05 $1,736.00 $211,407.05 6 INCOME RECEIPT AUL -Long Term Care Reimbursement AUL -Long Term Care Reimbursement Quest Refund AAA Refund State Farm Insurance Refunds MBNA Refund Amerihealth Refund Agway Refund Highmark Refund Income Interest Miscellaneous Income & Refund Settlement Tax Reimbursement TOTAL INCOME RECEIVED LESS INCOME DISBURSEMENTS LESS INCOME DISTRIBUTIONS NET INCOME ON HAND $3,366.00 $4,590.00 $49.96 $51.00 $267.27 $7.05 $520.00 $394.13 $53.00 $4,747.49 $5,481.82 $550.46 AMOUNT: $20,078.18 $0.00 $0.00 $20,078.18 7 RECAPITULATION TOTAL PRINCIPAL $274,996.60 LESS PRINCIPAL DISBURSEMEN - $61,853.55 LESS DISTRIBUTIONS TO BENEFICIARIES $1,736.00 PRINCIPAL BALANCE $211,407.05 PLUS INCOME BALANCE COMBINED BALANCE FOR DISTRIBUTION + $20,078.18 $231,485.23 8 STATEMENT OF PROPOSED DISTRIBUTION TO BENEFICIARY Balance for Distribution {As Shown on Above) Composed of CASH $231,485.23 TOTAL $231,485.23 Anne E. Olmstead, by Item 5 of her Last Will and Testament bequeated her residuary estate to the beneficiaries listed below, in the equal shares indicated: Less Balance A an fQ Distributions Distribution Carleton College 1/6 Residue $38,580.87 $25,000.00 $13,580.87 One North College Street Northfield, MN 55057-4075 Allison United Methodist 1/6 Residue $38,580.87 $25,000.00 $13,580.87 Church 99 Mooreland Avenue Carlisle, PA 17013 Bosler Ree Library 1/6 Residue $38,580.87 $25,000.00 $13,580.87 158 West High Street Carlisle, PA 17013 Daniel A. Pensak 1/2 Residue $115,742.62 $60,000.00 $34,948.13 15335 Beach Drive NE Less Inh. Tax -$20,794.49 Lake Forest Park, WA 98155 Net of Tax $94,948.13 Total Present Distribution: $75,690.74 9 STATE OF WASHINGTON ; ss. COUNTY OF . Marjorie Fiddler, executor of the Estate of Anne E. Olmstead, late of the Borough of Carlisle Cumberland County, Pennsylvania, deceased, being duly sworn according to law, does depose and say that the foregoing Account and Statement of Proposed Distribution to Beneficiaries is true and correct, both as to items of charge and discharge, to the best of her lrnowledge, information and belief. MARJO IDDLER Executor Sworn to and Subscribed to before me this ~ day of `! l V V .K/v , 2004. NOTARY PUBLIC STATE OF WASHING T GN THERESA R. CATT My Appointment Expires March > > .2006 Notary Public ~'~(C Sri Q • ~,;~-~- ~ 10 Olmstead Estate Residue Calculation Principal Receipts:_ . _ .. $2.74,996.60: Debts of Decedent ~ $3,051.79 Funeral Expenses _ ~ $1,635.00; ~ ' Administration Ex enses ------------------------------------ ----------p.....-------------....-----------........-------------- ~ 19,291.50? ...-----..........------..........-----........------.....---------.......-------....----------.......- -----------...........------- ------ Taxes '• $12 323 63 ~ _ Fees and Commission $25,551.63; -~ - - - - ...... - - -- --- --------- - -- - ---- --- -----$213,143.05 Total ':, -------------- Advance Distributions ............................................................................. ---------------- ~ - 7 6 0 .................................................................. -- ------------ - --- --- ------ -r ............... ----.....-- --- - ~ $211,407.05; ...................A ..................................................................................................... _ ............._........._...._ .... __........ Income Receipts ... . ~ 1 ~ ..... . . ............................ .. ---.... - ------ --- --------- - - - -- - ............. ..................................... - ---- ---- ---- ------- $231,485.23 Residue ----........------...-------------....--------- Distribution to: : _ __ Less :Balance for Advance Distributions ;Distribution Carleton College 1/6 Residue $38,580.87; $25 000.00: $13 580.87 .One North College- Street Northfield, MN 55057-4075 Allison United Methodist Church 1/6 Residue $38 580.87: $25 000.00; $13,580.87 99 Mooreland Avenue Carlisle, PA 17013 ....................... ..-.............. -.... .. ..........~...........--.-_-._.......----.-.._....-.-._.-_-j.-.... ......-............-...-...-........ .-...........-......----.....................--.-..-......---.- ~........-.._. _. _..-........-... -... Bosle ee Lib_ _ ~ ---_--. _ _ rary -- -- -- - --- ----- - -- - ---=--1/6 Residue- -. - ._ ----~----- $38,580.87: - --------------- ------ -- Y ' $25 000.00: $13 580.87 -- -----...-- ------------- -- --- 158 West High Street ---------------------- ---------- Carlisle, PA 17013 ... ............................... .. .................................. ... . ... Daniel A. Pensak .......... ~ ................ -............................... i...... 1/2 Residue ? .................................. ~................................................................. }................................... $115,742.62: $60,000.00: 4 48 .1 3 . 15335 Beach Drive NE IT Payment 2 4.4 _ . , Lake Forest Park WA 98155 ~ Net of Tax $94 948.13 $75,690.74 Cash Available: Balance in Savings $84,473.58 Tax Refund $9,205.51 Balance in Checking 2 2 $96,242.37 To Disburse: Specific Fiduciary Reserve $5,000.00 Steve Fishman -Balance $5,000.00 Marjorie Fidler -Balance $10,551.63 [Balance for Distribution to Beneficiaries: $75,690.74] Distribution to Beneficiaries 6 0. 4 Total $96,242.37 COURT OF COMMON PLEAS OF CUMBERLAND COUNTY ORPHANS' COURT DIVISION ESTATE N0.21-01-1014 FIRST AND FINAL ACCOUNT OF MARJORIE FIDDLER For ANNE E. OLMSTEAD ESTATE LATE OF CUMBERLAND COUNTY Date of Death: October 27, 2001 Date of Letters: November 5, 2001 Date of Letters Advertised: November 13, 2001 November 20, 2001 November 27, 2001 Account Period: October 1, 2004 Purpose of Account: MARJORIE FIDDLER offers this Account to acquaint interested parties with the transactions that have occurred during the administration of the estate. The Account also indicates the proposed distribution of the estate. It is important that the Account be carefully examined. Requests for additional information or questions or objections can be discussed with: Attorney: Steven J. Fishman 95 Alexander Spring Road, Suite 3 Carlisle, PA 17013 (717} 249-6333 Hamilton C. Davis P O Box 40 20 East Burd Street, Suite 6 Shippensburg, PA 17257 (717)532-5713 1 SLJ1vIlvIARY OF ACCOUNT Proposed Distribution to Beneficiaries Principal Receipts Gains/ losses on conversion Less Disbursements: Debts of Decedent Funeral Expenses Administration Expenses and Reserve Federal and State Taxes Fees and Commissions Balance before Distributions Distribution to Beneficiaries (Advance Distributions) Principal Balance on Hand Income: Receipts Less Disbursements Balance before Distribution Distribution to Beneficiaries Income Balance on Hand Combined Balance on Hand Recapitulation Page 9 3 4 $231,485.23 Fiduciary Acquisition Value $231,485.23 $274,996.60 $0.00 5 $3,051.79 5 $1,635.00 5&6 $19,291.50 6 $12,323.63 6 6 6 6 7 7 7 7 7 8 8 $25,551.63 $61,853.55 $213,143.05 $1,736.00 $211,407.05 $20,078.18 $0.00 $20,078.18 $0.00 $20,078.18 $231,485.23 $231,485.23 2 FIRST AND FINAL ACCOUNT OF ANNE E. OLMSTEAD THE ACCOUNTANTS CHARGE THEMSELVES WITH THE FOLLOWING: PRINCIPAL RECEIPT Amount Real Property: A single family residence known and numbered as 47 "E" Street $95,000.00 Carlisle, PA Cumberland County, Pennsylvania. Personal Property: U.S. Savings Bonds $377.56 Washington Mutual Investors Fund -Account No. 58072625 $18,542.90 American Mutual Fund -Account No. 58072625 $15,616.41 Investment Company of America -Account No. 58072625 $18,038.98 Cash Management Fund ofAmerica -Account No. 58072625 $232.34 Washington Mutual Investors Fund -Account No. 58021884 $33,856.82 Washington Mutual Investors Fund -Account No. 58093158 $34,172.59 Checking Account - M&T Bank -Account No. 602663 $7,863.50 Savings Account - M&T Bank -Account No. 15004198249087 $22,136.76 Cash on Hand $6.00 Check from Employer $1,493.85 Sale of Automobile $14,000.00 4 Auction Proceeds and other tangiable personal property $3,053.00 Highmark -Last Compensation $1,046.72 Highmark -Survivor Benefits $4,481.55 Gains/ Losses on Conver ions• Gain on WA Mutual Investors Funds $723.28 Gain on American Mutual Fund $653.81 Gain on Investment Company of Amercia $624.77 Gain on Cash Management Fund of Amercia $1.03 Gain on WA Mutual IRA B $1,457.70 Gain on WA Mutual IRA A $1,481.09 Gain on M&T Bank Chcking Account $122.84 Gain on M&T Bank Savings Account $13.10 $5,077.62 TOTAL PRINCIPAL RECEIPTS: $274,996.60 4 PRINCIPAL DI BURSEMENTS To/Pur .~ Debts of Decedent• Amount• Cat Care $567.26 State Farm Insurance $237.00 Iron Forge Storage $250.00 Orkin Pest Control $104.36 Pharmerica $578.76 Borough of Carlisle $48.43 Peir One $2.64 Wilson Street Internal Medicine $12 40 Central PA Hema & Med Oncology $12 00 West Shore EMS $32.00 PP&L $128.95 Highmark, Inc. $277.45 Sprint $67.78 2002 County and Township Taxes $384.76 2001 Federal Income Tax $345.00 2001 PA Income Tax $3.00 TOTAL DEBTS OF DECEDENT $3,051.79 Funeral Ex ense Hollinger Funeral Home & Crematory, Inc. $1,635.00 TOTAL FUNERAL EXPENSES $1,635.00 Administration Expenses and Re erve- Probate Fees $340.00 Filing Fee -Inheritance Tax Return $15.00 Music for Memoral Service $100.00 Rowe's Auction Service $85 OQ Food for Memorial Service $200.00 Office Supplies/Postage/Fax Fees $151.57 Photographs $17.70 George's Flowers $30.21 Legal Advertising -Cumberland County Law Journal $75.00 Legal Advertising -The Sentinel $124.26 House Cleaning $96.00 Reimbursement to Executrix $4,197.53 U-Haul Rental $1,572.90 Locksmith $2.65 Removal of Trees - Suncrest Gardens $248.68 Realtor Commission $5,700.00 Transfer Tax $950.00 Home Warranty $385.00 Reserves for contingencies $5,000.00 TOTAL ADMINISTRATION EXPENSES $19,291.50 Federal and State Taxe • 6 Federal Income Tax Witheld on Washington Mutual IRA A and B Balance of Fiduciary Income Tax and Preparation TOTAL TAXES Fees and Commissions Steven J. Fishman Marjorie Fiddler TOTAL FEES AND COMMISSIONS $7,558.83 $4,764.80 S12,323.63 $10,000.00 $15,551.63 TOTAL PRINCIPAL DISBURSEMENTS AND RESERVES: Balance before Distributions Distributions to Beneficiaries (advance distributions) Tangiable Personal Property $1,651.00 Tangiable Personal Property $85.00 TOTAL DISTRIBUTIONS Balance of Principal on Hand (before final distributions to residuary beneficiaries) $25,551.63 $61,853.55 $213,143.05 $1,736.00 $211,407.05 6 INCOME RECEIPTS AUL -Long Term Care Reimbursement AUL -Long Term Care Reimbursement Quest Refund AAA Refund State Farm Insurance Refunds MBNA Refund Amerihealth Refund Agway Refund Highmark Refund Income Interest Miscellaneous Income & Refund Settlement Tax Reimbursement TOTAL INCOME RECEIVED LESS INCOME DISBURSEMENTS LESS INCOME DISTRIBUTIONS NET INCOME ON HAND $3,366.00 $4,590.00 $49.96 $51.00 $267.27 $7.05 $520.00 $394.13 $53.00 $4,747.49 $5,481.82 $550.46 AMOUNT: $20,078.18 $0.00 $0.00 $20,078.18 7 APITUT ATION TOTAL PRINCIPAL $274,996.60 LESS PRINCIPAL DISBURSEMEN - $61,853.55 LESS DISTRIBUTIONS TO BENEFICIARIES $1,736.00 PRINCIPAL BALANCE $211,407.05 PLUS INCOME BALANCE + $20,078.18 COMBINED BALANCE FOR DISTRIBUTION $231,485.23 8 TATEMENT OF PROPOSED DI TRIB TION TO BENEFI IARY Balance for Distribution (As Shown on Above) Composed of CASH $231,485.23 TOTAL $231,485.23 Anne E. Olmstead, by Item 5 of her Last Will and Testament bequeated her residuary estate to the beneficiaries listed below, in the equal shares indicated: Less Balance A an f~ Carleton Colle e Distribut;onc Distri ution g 1/6 Residue $38,580.87 $25,000.00 $13,580.87 One North College Street Northfield, MN 55057-4075 Allison United Methodist 1/6 Residue $38,580.87 $25 000.00 Church ~ $13,580.87 99 Mooreland Avenue Carlisle, PA 17013 Bosler Ree Library 1/6 Residue $38,580.87 $25,000.00 158 West High Street $13,580.87 Carlisle, PA 17013 Daniel A. Pensak 1/2 Residue $115,742.62 $60 000.00 15335 Beach Drive NE ~ $34,948.13 Less Inh. Tax -$20,794.49 Lake Forest Park, WA 98155 Net of Tax $94,948.13 Total Present Distribution: $75,690.74 9 STATE OF WASHINGTON ss. COUNTY OF Marjorie Fiddler, executor of the Estate of Anne E. Olmstead, late of the Borough of Cazlisle Cumberland County, Pennsylvania, deceased, being duly sworn according to law, does depose and say that the foregoing Account and Statement of Proposed Distribution to Beneficiaries is true and correct, both as to items of charge and dischazge, to the best of her lrnowledge, information and belief. e ~~ MARJO FIDDLER Executor Sworn to and Subscribed to before me this ~ day of ~ NOTARY PUBLIC 2004. STATE OF WASHINGTON THERESA R. CATT My Appointment Expires March t t .2006 ,Notary Public to Olmstead Estate Residue Calculation -----------------------------------------A--------------------...----------------:---------...-------------------------.....---------.....---------}...-----------....----------------~ Principal Receipts: _ _ _ _ $274 996. 60' Debts of Decedent ~ $3 OS 1.79: Funeral Ex enses ------ .. --- - ---- -- --- - -P -- - ~- -- - --- --- - ---... - - - --~-- $1,635.00: A 'stration Expenses $19,291.50: '• '• Taxes ~ $12 323.63: ~ • ees and Commission 25 551.6 $213,143.05 ; Total --- Advance Distributions -------:- -... ---------~------- ---- ----- --------- 17 .. --------------- -------- - - --- ---~v ----------- -----------~ ----------- -- - ----~- - --~------ --_....-- - ...... ' _...__.....__ ...........___...._._ _...._._._...... . -.. - 211,407.05: ...... ~ Income Receipts----------------~-~ - --... 8 18 ......__............................-- ......... ' $231,485.23 `Residue --- ---------------------------------~----....------------.....---....-----~---- Distribution to:-- -- ~- - - - --- - ~ ~ --- - ...- -- - -~ ---~-- - ~ - ----...;....-----------------------~----.....------...---- - -----<- --- --~--- -~--- ---~-~- ~- ------------ -------- ---------.....-----------......-......Y s -------- ----- --------------~--~----- ---------....---------------------....----------...-----.......-..---....----------....------------~ Less ;Balance for ------------------------------- --- A _ -------- -.... .- -~-------~--~-- ----- -~- trib Advance Dis utions :Distribution Carleton College--- ----- ----- - ------ - ----- ------- 1/6 Residue_ _ .._ ___.._ .- . - -- -$38,580.87':._ .---.___ $25 000.00 $13 580.87 One North Colle e Street ~~ ~-~ Northfield, MN 55057-4075 Allison United Methodist Church ~ 1/6 Residue $38 580 87' $25 000.00 $13 580.87 Mooreland Avenue Carlisle, PA 17013 ....................... i--- -------"--....-..-...-----.......-...... .--..- Bosle ee Lib ......................................racy ..-....-.-.- -,.- -- ..--. _ _ __1/6 Residue - ---- - .._. --- - - - -- ~--- $38,580.87: --- ---------- -------- ----~-~---- - $25 000.00 ~ $13 580.87 --~--~----- ------ ~ ~ 158 West High Street r -------~--~-~-~ ----- ---- ----------~ - -...: - ...- -- - -- - -~ ~ - Carlisle, PA 17013 Daniel A. Pensak _1/2 Residue $115,742.62; $60,000.00: 4 948.13 5 Beach Drive NE .. -... . IT Payment 4.4 Lake Forest Park, WA 98155 ~ Net of Tax 94 948.13; $ ' ~~ - --- - $75,690.74 COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-02-1014 ESTATE OF MIRIAM D. BERKHEIMER, DECEASED FIRST AND FINAL ACCOUNT OF Manufacturers and Traders Trust Company, Successor to Dauphin Deposit Bank and Trust Company, Executor ________________ Date of Death: November 2, 2002 Date of Executor's Appointment: November 14, 2002 Date of First Advertisement of Letters: November 29, 2002 Accounting for the Period: November 2, 2002 to July 21, 2003 Purpose of Account: Manufacturers and Traders Trust Company, Successor to Dauphin Deposit Bank and Trust Company, Executor, offers this account to acquaint interested parties with the transactions that have occurred during this administration. It is i<<po-rtant that the account be carefully examined. Requests for additional information or questions or objections can be discussed with: Sue Mauery Manufacturers and Traders Trust Company 213 Market Street Harrisburg, PA 17101 (717) 255-2051 OR Ann Rhoads, Esquire Attorney Identification No. 49631 Cleckner & Fearen PO Box 1184', Harrisburg, PA 17108 (717) 23$-1731 SUMMARY OF ACCOUNT Estate of Miriam D. Berkheimer, Deceased For Period of 11/02/2002 through 07/21/2003 Page Proposed Distributions 15 to Beneficiaries PRINCIPAL Receipts: Per Inventory Filed 3-4 Subsequent Principal 4 Receipts Net Gain (or Loss) on Sales 5 or Other Disposition Less Disbursements: Debts of Decedent 6 Funeral Expenses 6 Administration Expenses 6 Federal and State Taxes 7 Fees and Commissions 7 Balance before Distributions Distributions to Beneficiaries g Principal Balance on Hand g For Information: Investments Made Changes in investment Holdings 10-11 INCOME Receipts: This Account 12 Net Gain (or Loss) on Sales or Other Disposition Less Disbursements 13 Balance Before Distribution Distributions to Beneficiaries Income Balance on Hand 14 Investments Made Changes in Investment Holdings COMBINED BALANCE ON HAND Fiduciary Current Acquisition Value Value ------- ----------- 173,642.43 173,642.43 242,929.84 7.99 (1,283.24) --------------- 241,654.59 7,202.60 7,067.20 871.79 27,730.14 23,934.40 66,806.13 174,848.46 3,076.00 171,772.46 2,035.93 0.00 2,035.93 165.96 --------------- 1,869.97 0.00 1,869.97 173,642.43 RECEIPTS OF PRINCIPAL As per Inventory Filed: CASH: Allfirst Trust Company of PA, N.A., Trustee under Agreement with Miriam D. Berkheimer - Cash balance as of date of death Capital Blue Cross - Medical insurance refund Mass Mutual Financial Group - Life Insurance proceeds Merchant & Business Mens Mutual Insurance Company - Refund on homeowners insurance PA Department of Revenue - 2002 Personal income tax refund Prudential Life Insurance Company - Life insurance proceeds The Patriot News Company - Refund of subscription The Woods at Cedar Run - Reimbursement of security deposit, rent and cash fund 5,750.49 167.05 5,608.98 49.00 58.00 4,731.78 31.45 4,236.59 PERSONAL PROPERTY: Antique Bisque Doll - 600.00 Appraised value Charm Bracelet - Appraised value 425.00 Crazy Quilt - Appraised value 300.00 Diamond Dinner Ring - Appraised Value 50.00 Fiduciary Acquisition Value 20,633.34 3 Diamond Ring w/Three Large 950.00 Stones - Appraised value Gold Watch & Chain - Appraised 275.00 value Household Effects - Net 4,276.70 Proceeds from Sale $5,702.30 less auctioneer's commission of $1,425.60 Marble Top Table - 400.00 Appraised Value Ring w/Cubic Zirconium Stones 1.00 - Appraised value Small Rocking Chair - 75.00 Appraised value -------------- STOCKS/LISTED: 21,387.443 shares Ark Funds US Government 214,943.80 Bond Portfolio SUBSEQUENT PRINCIPAL RECEIPTS: ------------------------ 06/13/03 Pinnacle Health System - Refund for uncashed check found in home dated 7/99 7.99 TOTAL RECEIPTS OF PRINCIP.~L .............. 7,352.70 214,943.80 7.99 -------------- 242,937.83 GAINS AND LOSSES ON SALES OR OTHER DISPOSITIONS - PRINCIPAL Gain Loss 12/02/02 21,387.443 shares Ark Funds US Government Bond Portfolio Net Proceeds 213,660,56 Fid. Acq. Value 214,943.80 01/30/03 Household Effects - Net Proceeds from Sale $5,702.30 less auctioneers commission of $1, 425.60 Net Proceeds 4,276.70 Fid. Acq. Value 4,275.70 0.00 1,283.24 TOTAL GAINS AND LOSSES/PRINCIPAL........... 0.00 1,283.24 LESS LOSS.......... ................... NET GAIN OR LOSS ................ 1,283.24 (1,283.24) DISBURSEMENTS OF PRINCIPAL DEBTS OF DECEDENT 11/26/02 ------------ Alert Pharmacy Service, Inc. 50.47 11/26/02 Sue Tobias - for perm 50.00 11/26/02 The Woods at Cedar Run - Rent 11/1-11/30/02 2'627'24 12/13/02 Verizon - Utility expense 4.86 12/18/02 The Woods at Cedar Run - Rent 12/1-12/31/02 2,810.00 12/26/02 The Woods at Cedar Run - Rent 1/1-1/8/03- $610.20, plus 1,660.03 Repairs to apartment, $1,049.83 -- TOTAL DEBTS OF DECEDENT........... ---------- FUNERAL EXPENSES 11/21/02 ----------- W. Orville Kimmel - Funeral expense 7,067.20 -- TOTAL FUNERAL EXPENSES .................. ------------ . ADMINISTRATION EXPENSES 11/12/02 --------------- Cumberland County Register of Wills - Probate Costs 308'50 11;12/02 Cumberland Law Journal - Cost of Advertising and Proof 75.00 of Publication 12/20/02 The Patriot-News - Cost of Advertising and Proof of 246.04 Publication 12/23/02 Hobbie Auctioneers - Appraisal 100.00 01/08/03 C. G. Buser - Jewelry appraisal 100.00 03/28j03 Sue Mauery - Reimburse cost to mail Quilt 11.25 05/20/03 Cumberland Count Re y gister of Wills - Costs to file Inventory 31.00 and Inheritance Tax Return TOTAL ADMINISTRATION EXPENSES....... ...... .......... 7,202.60 7,067.20 871.79 6 FEDERAL AND STATE TAXES ---------------- 01/23/03 Cumberland County Register of Wills - PA Inheritance Tax 24,700.00 $26,000 less 5$ discount of $1,300.00 05/14/03 Cumberland County Register of Wills, Agent - Balance of pA 3,030.14 Inheritance Tax -------------- TOTAL FEDERAL AND STATE TAXES ....................... 27,730.14 FEES AND COMMISSIONS -------------------- RESERVE: Cleckner & Fearen - Attorney 11,717.20 Fee Manufacturers and Traders Trust Company - Executor's 11,717.20 Fee Filing Fees 500.00 -------------- TOTAL FEES AND COMMISSIONS...... .................... 23,934.40 TOTAL DISBURSEMENTS OF PRINCIPAL .................... 66,806.13 7 CHANGES IN INVESTMENT HOLDINGS - PRINCIPAL Antique Bisque Doll ------------------- 11/02/02 inventoried 01/08/03 distributed Ark Funds US Government Bond Portfolio ---------------------------- 11/02/02 21,387.443 shares inventoried 12/02/02 (21,387.443)shares sold -------------- 0 Charm Bracelet -------------- 11/02/02 01/08/03 Crazy Quilt 11/02/02 05/07/03 Diamond Dinner Ring ------------------- 11/02/02 Oi/i0/03 inventoried distributed inventoried distributed inventoried distributed Diamond Ring w/Three Large Stones --------------------------------- 11/02,/02 inventoried 01/08/03 distributed Gold Watch & Chain ------------------ 11/02/02 Ol,/Og/03 inventoried distributed Cost 600.00 (600.00) -------------- 0.00 214,943.80 (214, 943 .80) -------------- 0.00 425.00 (425.00) -------------- 0.00 300.00 (300.00) -------------- 0.00 50.00 (50.00) -------------- 0.00 950.00 (950.00) -------------- 0.00 275.00 (275.00) -------------- 0.00 10 Household Effects 11/02/02 inventoried 01/30/03 sold 4,276.70 (4,276.70) -------------- 0.00 Marble Top Table 11/02/02 inventoried 01/08/03 distributed 400.00 (400.00) -------------- 0.00 Ring w/Cubic Zirconium Stones ----------------------------- 11/02/02 inventoried 02/06/03 distributed Small Rocking Chair ------------------- 11/02/02 01/08/03 inventoried distributed 1.00 (1.00) -------------- 0.00 75.00 (75.00) -------------- 0.00 11 RECEIPTS OF INCOME INTEREST Ark Money Market Portfolio 12/02/02 12/18/02 01/02/03 2.24 transferred from trust account 2.24 01/03/03 02/03/03 transferred from trust account 214.08 0.17 03/03/03 198.40 04/01/03 158.13 05/01/03 172.19 06/02/03 162.67 07/01/03 168.70 148.20 -------------- Ark Funds US Government Bond Portfolio 1,227.02 --------------------------------- 12/02/02 12/18/02 241.29 transferred from trust account 488.59 -------------- Mass Mutual Financial Group 729.88 --------------------------- 12/13/02 interest on all policy proceeds 26.56 Prudential Life Insurance 04/18/03 interest on policy 52.47 -------------- TOTAL INTEREST INCOME ............. 2,035.93 TOTAL RECEIPTS OF INCOME .................. 2,035.93 12 DISBURSEMENTS OF INCOME 12/18/02 Allfirst Trust Company of PA, N.A. - Trustee's fee on Revocable Trust 83.74 Of Miriam Berkheimer, 11/05/02 - 12/15/02 07/21/03 Manufacturers and Traders Trust Com an 82.22 P y - Commission on Income ---------- TOTAL DISBURSEMENTS OF INCOME .................. 165.96 1J INCOME BALANCE ON HAND # Units Description Current Value or as Noted Fiduciary Acquisition Value Ark Money Market Portfolio 1,869.97 1,869.97 1,869.97 1,869.97 1~ PROPOSED DISTRIBUTIONS TO BENEFICIARIES # Units Janet Patricia Monroe Cash - 1/3 share of residue As per Item 6 of the Will --------------- Principal Income Genevieve Prowell Cash - 1/3 share of residue As per Item 6 of the Will --------------- Principal Income Jane Warden Cash - 1/3 share of residue As per Item 6 of the Will --------------- Principal Income Current Value or as Noted 57,257.49 623.32 -------------- 57,880.81 57,257.48 623.33 -------------- 57,880.81 57,257.49 623.32 -------------- 57,880.81 -------------- 57.257.49 623.32 -------------- 57,880.81 57.257.48 623.33 -------------- 57,880.81 57.257.49 623.32 -------------- 57,880.81 -------------- 173,642.43 173,642.43 Fiduciary Acquisition Value IS AFFIDAVIT Manufacturers and Traders Trust Company, Executor under the Last Will and Testament of MIRIAM D. BERKHEIMER, deceased, hereby declares under oath that it has fully and faithfully discharged the duties of its 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 its knowledge, there are no claims now outstanding against the Estate; that all taxes presently due from the Estate have been paid; and that more than four months have elapsed since the first complete advertisement of the granting of letters in this estate. rianuLacturers and Traders Trust Company, Exec~u o Subscribed and sworn to before me this ~ 1 day o f ~'".""" 2 0 0 3. ~. ~ ~` Notary Public Notarial Seat Deanna L. Wells, Notary PubNc Han~isburg, Dauphin County MY Commission Expires Dec, 6, 2004 Member. Pennsylvania Association of Notaries 15 J 1- /607 REV-1500 EX + (6-00) CAPB HpRL EplO CRAC KOTK ES C P o 0 R N R 0 E E S N T REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER o E C E o E N T COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Berkheimer Miriam D. DATE OF DEATH (MM-DO- YEAR) COUNTY CODE YEAR SOCIAL SECURITY NUMBER 211-36-7589 THIS RETURN MUST BE ALEC IN DUPlICATEWlTH THE DATE OF BIRTH (MM-DD-YEAR) OFFIC!AL USE ONLY 21-02-1014 NUMBER REGISTER OF WILLS SOCIAL SECURITY NUMBER X 1.0rlglnaJReturn 4. limited Estate X 6. Decedent Died Testate (Attach copy of Will) D 9. litIgation Proceeds Received 2. 40. X 7. Supplemental Return Future Interest CompromIse (date of death after 12-12-82) Decedent Maintained a LIving Trust 0 (Attach copy of Trust) Spousal Poverty Credit D 3 date of death . Remainder Return prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch 0) 213 Market Street Harrisburg, PA 17101 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) 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 20. 0.00 0.00 0.00 193,534.29 x X X X .0 0 .0 L;5""- .12 .15 010. 5 1. Real Estate (Schedule A) (1) None 2. Stocks and Bonds (Schedule B) (2) 214,943.80 3. Closely Held Corporation, Partnership or (3) ~€ 8 Sole-Proprietorship ::$::; 4. Mortgages & Notes Receivable (Schedule D) (4) llroj1e :;; R 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 17, 64!i'.. 28 =< E (Schedule E) C ~ A 6. Jointly Owned Property (Schedule F) (6) ijQne \0 P I 0 Separate Bilting Requested -0 T 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None ~ U L (Schedule G or L) ',,) ~ A )0' (S) 0 T S. Total Gross Assets (total Lines 1-7) I 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 31,842.39 0 N 10. Debts of Decedent, Mortgage Liabilities, & liens (Schedule I) (10) 7,212.40 11. Total Deductions (total Lines 9 & 10) (11) 12. Net Value of Estate (Line 8 minus line 11) (12) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) C o M P T U A T X A T J o N ~\I_~~~.llilM~I!!t!r NAME Sue Mauer FIRM NAME(lf Applicable) A11first Trust Com an of PA, NA TELEPHONE NUMBER II COMPLETE MAILING ADDRESS (15) (16) (17) (lS) (19) OFFICIAL USE ONLY :0 ro () Q c 232,589.08 39.054.79 193,534.29 193,534.29 0.00 0.00 0.00 29,030.14 29,030.14 Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 824 Lisburn Road CITY I STATE -I ZIP Camu Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A.. Spousa.l POl/erty Credit B. Prior Payments C. Discount (I) 29,030.14 0.00 24,700.00 1,300.00 Total Credits ( A + 8 + C) (2) 26,000.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E) (3) 4. If Line 2 is greater than Une 1 + line 3, enter the difference. This is the OVERPAYMENT. Cheek box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than line 2, enter 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 BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0.00 3,030.14 0.00 3,030.14 i:!i:mi,~i~[~~nn:i!:H1!:[!W(~!WW!!, .:;;:!.~i~ . [:\i!!i:i\!!lWlmmi1i~ W!!j!.lllWW!!~liHI!!!!!!!"W!!!!W!!::!:~! _ i~:W\!l[!W.i!~!!!:;!;;:~;,.:!~:r:~!~n~!~ii; " .< ,'i .'. ':~:~!:llmmmmmmm\\!\\\\llm!l \ml\! . .... . PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" 1. Did decedent make a transfer and: a. retain the use or income of the property transferred; b. retain the right to designate who shall use the property transferred or its income; . c. retain a reversionary interest; or. . . d. receive the promise for life of either payments, benefits or care? 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 fo( ar payable upon death bank account or security at his or her death? 4. Did decedent awn 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. .mmm ", (l(Wi~HHli(m!i .;::::;~!i;\~~i ,\iii;W, (:;mnl~\HTW-l\ lWlUH\EU(\l\W,lU. iiliTHEAPPROPRiATEBLOCKS..... . Yes No ~~ o o o [B [B [B Under penalties of perjury, I declare that I have examined this return, Inc:ludlng 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 representatrve Is based on all Information of which preparer hasaNf knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Allfirst Trust Company of PA I NA DATE xI~ //7~<'e.~ --~gr~~~~~~:?-}r~-i7ioT---------W-------__h ~/+yd.j' SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE Allfirst Trust Company of PA, NA DATE 213 Street 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)). 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.$. 9116 (a) (1.1) (iiH The statute does not exempt a transfer to a sUfl/il/lng spouse iTom 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 an 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 pafent, an adoptive parent. or a stepparent 01 the child is Q% (72 P.S. 9116 (a) (1.2)). The tax rate imposed on the net value of transfers to or for the use ()f the decedent's lineal beneficiaries is 4.5%. except as neted in 72 F.S. 9115(1.2) [72 P.S. 9116(a)(1)). The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(a)(1.3)]. 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. copyright (c) 2000 form software only The Lackner Group, lnc., Form REV-1500 EX (Rev. 6-00) AEV-'S03 EX + ('~97) COMMONWEALTH OF PENNSYLVANIA It-tHERIT ANCE TAX RETURN RESIDENT DECEDENT SCHEDULE a STOCKS & aONDS ESTATE OF FILE NUMBER Miriam D. Berkheimer 331ft 211-36-7589 11/02/2002 21-02-1014 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION UNIT VALUE VALUE AT DATE NUMBER OF DEATH 1 21,387.443 shares ARK Fds US Government Bond Portfolio 214,943.80 I TOTAL (Also enter on line 2, Recapitulation) 214,943.80 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1S03 EX (Rev. 1-97) REV- '508 EX + (1-97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Miriam D. Berkheimer FILE NUMBER 21-02-1014 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. SS!I 211-36-7589 11/02/2002 ITEM NUMBER 1 10 11 12 Allfirst Trust Company Miriam D. Berkheimer DESCRIPTION of PA NA Trustee under Agreement with Cash Balance as of Date of Death VALUE AT DATE OF DEATH 5,750.49 2 Capital Blue Cross - Medical Insurance Refund 167.05 3 Merchants & Business Mens Mutual Insurance Company - Refund on Homeowners' Insurance 49.00 4 PA Department of Revenue 2002 Personal Income Tax Refund 58.00 5 Received from The Woods at Cedar Run - Reimbursement of Security Deposit, Rent and Cash Fund 4,236.59 6 The Patriot News Company - Refund of Subscription 31.45 7 Antique Bisque Doll - Appraised Value 600.00 8 Charm Bracelet - Appraised Value 425.00 9 Crazy Quilt - Appraised Value 300.00 Diamond Dinner Ring - Appraised Value 50.00 Diamond Ring w/Three Large Stones - Appraised Value 950.00 Gold Watch & Chain - Appraised Value 275.00 13 Household Effects - Net Proceeds from Sale $5,702.30 less Auctioneers Commission $1,425.60 4,276.70 14 Marble Top Table - Appraised Value 400.00 15 Ring w/Cubic Zirconium Stones - Appraised Value 1.00 16 Small Rocking Chair - Appraised Value 75.00 TOTAL (Also enter on line 5, Recapitulation) $ 17 1 64-5 .28 (If more space IS needed, insert additional sheets of the same size) Copyright (cl 1996 form software only CPSystems, Inc. Form REV-1S08 EX (Rev. 1-97) REV-1510 EX +(1-97) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCETAX RETURN RESIDENT DECEDENT ESTATE OF Miriam D. Berkheimer SSfj 211-36-7589 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. 11/02/2002 ITEM NUMBER 1 DESCRIPTION OF PROPERTY RELAt~8~M~I~ t~ 'b~~~5~~TT~~DT~~~lfA1~E6F t~~NRSFER. ATTACH ACOPYOFTHE DEED FOR REAL ESTATE. Allfirst Trust Company of Pennsylvania, N.A. Trustee under Agreement dated 5/25/93 with Miriam Berkheimer, Settlor. Upon death of Settlor, Trust terminated and Assets were distributed to the Personal Representative of the Estate. See Schedule B & E DATE OF DEATH VALUE OF ASSET %OF DECO'S INTEREST EXCLUSION (IF APPLICABLE) TOTAL (Also enter on line 7, Recapitulation) $ (If more space IS needed, Insert additional sheets of the same sIze) Copyright (c) 1996 farm software only CPSystems, Inc. FILE NUMBER 21-02-1014 TAXABLE VALUE 0.00 Form REV-1510 EX (Rev. 1-97) REV- iS1 1 EX + (1~97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Miriam D. Berkheimer SSlF 211-36-7589 11/02/2002 FILE NUMBER 21-02-1014 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. B. 1. DESCRIPTION AMOUNT 1 FUNERAL EXPENSES' W. Orville Kimmel Funeral Home, Inc. - Funeral Expense 7,067.20 ADMINISTRATIVE COSTS, Personal Representative's Commissions Name of Personal Representative(s) Allfirst Trust Company of PA, NA Social Security Number(s) J EIN Number of Personal Representative(s) 52 - 2206238 Street Address 213 Market Street City Harrisburg State PA Zip 17101 11,717.20 Year(s) Commission Paid: 2. 3. Attorney's Fees Cleckner & Fearen Family Exemption', (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 11,717.20 City Relationship of Claimant to Decedent State Zip 4. Probate Fees Register of Wills 308.50 5. Accountant's Fees 6. Tax Return Pre parer's Fees 7. 1 Other Administrative Costs C.G. Buser - Appraisal of Jewelry 100.00 2 Cumberland Law Journal - Cost of Advertising and Proof of Publication 75.00 3 Hobbie Auctioneers - Appraisal Fee 100.00 4 Sue Mauery - Reimbursement to Mail Quilt to Nancy Boerger 11. 25 5 The Patriot News Company - Cost of Advertising and Proof of Publication 246.04 Total of Continuation Schedule(s) 500.00 TOTAL (Also enter on line 9, Recapitulation) $ 31,842.39 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc, Form REV-1511 EX (Rev. 1-97) Estate of: Miriam D. Berkheimer Sac See #: 211-36-7589 Date of Death: 11/02/2002 Continuation of Schedule H-B7 (Other Administrative Costs) Item # Description Amount 6 Reserve for Filing Fees 500.00 500.00 REV*1512 ~X + (1-91'1 , COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Miriam D. Berkheimer SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS SSlft 211-36-7589 11/02/2002 FILE NUMBER 21-02-1014 Include unreimbursed medical expenses. ITEM NUMBER 1 DESCRIPTION Alert Pharmacy Services, Inc. - Medical Expense AMOUNT 50.47 2 Quantum Imaging and Therapeutic Association - Medical Expense 9.80 3 The Woods at Cedar Run - Convalescent Home Expense 11/1 - 11/30/02 2,627.24 4 The Woods at Cedar Run - Convalescent Home Expense from 12/1 - 12/31/02 2,810.00 5 The Woods at Cedar Run - Rent 1/1-1/8/03 $610.20 plus repairs to apartment $1,049.83 1,660.03 6 Sue Tobias - Hair Care 50.00 7 Verizon - Telephone Expense 4.86 TOTAL (Also enter on line 10, Recapitulation) $ 7,212.40 (If more space is needed, insert additional sheets of the same size) Copyrlghl(c) 1995form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1~971 R~V-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE T/JX. RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [Include outright spousal dIstributions, and transfers under Sec. 9116(a)(1.2.)] RELA ,IONSHIP TO DECEDENT Do Not List Trustss(s) FILE NUMBER 21-02-1014 AMOUNT OR SHARE OF ESTATE ESTATE OF Miriam D. Berkheimer SSil 211-36-7589 11/02/2002 1 Janet P. Monroe 117 Meadow Pond Run Lookout Mountain, GA 30750-4611 Friend 1/3 share of Residue Gold Watch & Chain 2 Jane Warden R.D. #1 124 Georgetown Rd. Beaver Falls, PA 15010 Friend 1/3 share of Residue Marble Top Table ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS, A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON- TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (U more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, Inc. 0.00 Form REV-1513 EX {Rev. 9-00} Estate of: Miriam D. Berkheimer Soc Sec #: 211-36-7589 Date of Death: 11/02/2002 Continuation of Schedule J, Part I (Taxable Bequests) Item II Name and Address of Beneficiary Relationship Amount or Share of Estate 3 Genevieve Prowell 2437 Parkway Blvd. Harrisburg, PA 17104 Friend 1/3 share of Residue Antique Bisque Doll, Small Rocking Chair, Diamond Ring w/Three Large Stones, Diamond Ring w/Three Small Stones, Ring w/Gubic Zirconium Stones and Charm Bracelet w/Gold Pieces 4 Nancy Boerger 91 Logan Street Wilkes Barre, PA 18702 Friend Crazy Quilt C G BUSER & SON 875 Market Street, Second Floor Lemoyne, PA 17043 (717) 972-1230 Diamond Mounting A Specialty Prompt Attention To Mail Orders December 5, 2002 Estate of Marian Berkheimer Lady's 14K white gold ring containing three brilliant cut diamonds. The center diamond weighs approximately 48 pts and is of SI2 clarity and L color. The two side diamonds weigh approximately 21 pts each, and are ofI-H color. One side diamond is ofSIl clarity, the other is ofVSI clarity. The ring weighs approximately 2 dwt 8 gr. Total fair market value approximately $950. Lady's gold-filled charm bracelet containing three 2 Y2 $ gold coins dating 1915,1910 andl925. Total fair market value approximately $425. Lady's American Waltham pocket watch in 14K yellow gold closed case with attached yellow costume chain. Movement number 5262444 model 1890 circa 1891. Given to Mrs. Blair 1893 as engraved. Total fair market value approximately $275. Lady's 18K white gold ring (center stone missing) containing six single cut diamonds. The diamonds weigh approximately 1 pt each, two are chipped, three are ofSI clarity and one is ofVS clarity. All the diamonds are ofJ-1 color. The ring weighs approximately I dwt 17 gr. Total fair market value approximately $50. Lady's white antique style ring containing 5 imitation white stones. No fair market value. dAj,,~ Charles G Buser III G.G., LS.A. Fair Market Value: The price in the market place in which the item would change hands between willing buyet and willing seller, neithet undet any compulsion to buy or sell and each having reasonable knowledge of the relevant facts (i.e.: the price in the marketplace in which the item is most commonly sold to the public). Also taken into consideration was a reasonable and realistic time frame for willing buyers and willing sellers to reach an "arms-length" agreement ~thin the market. Manufacturing Je-..velers & Diamond Setters .. '"' ::;'31 {~ HOBBIE AUCTIONEERS William W. Hobbie AU 2591 L Reply to: 901 N. 2nd Street Harrisburg, PA 17102 (717) 233-0115 8 N. Market Street Duncannon, PA 17020 (717) 834-5655 12/17/2 Ms. Susan Mauery Allfirst Bank and Trust Co. P.O. Box 2961 Harrisburg, P A 17105 Dear Ms. Mauery: As per your request, on December 13, 2002, I did inspect items in the estate of Ms. Miriam Berkheimer as designated by Sharon Bradnick and located in Apartment # 241, The Woods, 846 Lisburn Road, Camp Hill, PA 17011. Having been an antique dealer for over twenty years and an auctioneer for over fourteen years, it is my opinion that the value for estate evaluation purposes of the aforementioned items is as follows: Eastlake Victorian white marble top table, turned legs, incised carving, rectangular top. ..................................................................................... .$400.00 Crazy quilt with display ("exibition") stitching and silk, velvet, and period miscellaneous material patches in excellent condition.. ........................... $300.00 Porcelain dol1, 27" tall, bisque head impressed "S,H" flanking a star, Gennan, composition hands and legs, articulated glass eyes ..................................$600.00 Child's spindle rocker, replaced caning, turned fInials .......................................$75.00 Hoping this appraisal is helpful to you, I ask thalY:' u phone if you have any questions. , ,,// . ' ,) j '; ~ j, // j'" Smcerely, ~</ eel k/. ,~ ~ William W. Hobbie Hobbie Auctioneers 11 ;J--, v . ___ <it f \-w\o :: .ILV \'1.1' \ ~J I'"" I .........I\.,,"\,/', ,_ .1)1. v . j '"._{/L l~/.""""'- ---=...-.. HAAR'S AUCTION DILLSBURG, PA 432-3815 . 432-3011 AUCTION EVERY TUESDAY a. FRIDAY EVE. - 6:30 PM ITEM ,t ; TAA TAXABLE Name '/ () ,,;;. l,', ,"}I ; TOTAl SALE Street or R.F.D. 1:,1' ',' .'" , f (, ' "} COMM . "__"_.~,..w..".,,,,.~..,..,' L/ ;I i,' l(l NET DOLLARS CENTS ) " //>7 i {;i" ":, 1;"", it/' ~" ~. ! ( !" , ,i:'", " l"\ I' J" ') .<l t:') ,,-- f-1 ,j," /'9 6<' ","/ ') I , /, ,'.- (, \ {/ {Z IV' E; (L elf I'~;~i " l t S"/j () 6 /' .;:ltl1- I) L,..> (, ~~ 1/ ',,/ .) ./7(.1,t::.: ,L""'/) :.; Ii. /fo.} I) ) .."" I,r/"... " " f 4.i ~~) r (,;J.?' ' J.;;.:I ,1-.;2" " Y I ,:4N~fl. , It>- {leE' (' M.'1rfl /~?A-~I ( 1;:'..-1 ,. t{/.' ' " '> '''J ........ (~_,~~ i:~';' I") /..;;'" l/~f"-l;J.l=) I ~, y"~' l.) (~[)h(2t~ /[' ~, of:):;? t--;~ I) t:::... " ,I' '~::ii,2'V' ,.._.--"-"-.".~-~ ' (l ;~;:.'''' L:' It,.,! 'i~) City #;7. sheet TAX State ZIP % CHARGE /, I ',~" /' 'J ~',,) . /;.1./::> t'. ,"c' ,," , '..,,~ "..q ... . ....... ........... ........."........ ~.... '-J'" ......'" >.,.J '-' ... ~ THIS AGREEMENT made and entered into this) () day of , 1981, by and between MIRIAl'4 D. BERKHEIMER, hereinafter called the "Settlor", and DAUPHIN DEPOSIT BANK AND TRUST COMPANY, hereinafter called the "Trustee". WITNESSETH: WHEREAS, The Settlor is the owner of.certain asse-ts more fully described in Schedule "A", attached hereto and made a part hereof; and WHEREAS, The Settlor is desirous of placing certain assets in the Trust created by this instrument. NOW, THEREFORE, for and in consideration of their mutual covenants and promises, the parties agree as follows: ARTICLE 1. The Settlor here by transfers and conveys to the Trustee the assets listed on Schedule "A" attached hereto and made part hereof, and the Trustee, in considerati.on thereof, agrees to hold and administer said assets and any additions thereto, IN TRUST NEVERTHELESS, for the following uses and purposes: 1. To have, hold, manage, invest and reinvest the same, to collect the income and to pay over the net income in monthly installments, after payment of all proper charges and expenses, to Settlor dur ing Settlor's lifetime. The Trustee is authorized and directed to pay and use such portion or all of the principal of the Trust < ~~~::.:~~~:~~~i~~~!&~~~~~~II~ifJ~I~~i~~~~~I~lIl[. assets as it, in its sole discretion, from time to time, shall deem necessary to provide for the proper main- tenance, support, medical, hospital, nursing or nursing home care of the Settlor. 2. The Trustee at all times shall have the power to pay either from the principal or income of the Trust assets any outstanding bills or obligations owing by the Settlor. 3. The Trustee shall pay such portion or all of the principal of the Trust assets to the Settlor as the Settlor may, from time to time, request. 4. Upon the death of the Settlor during the existence of this Trust, the Trustee shall pay over all the remaining assets of the Trust, whether corpus or incom e, to the Executor or Administrator of the Settlor's Estate to be distributed as part of the as sets of that Estate. ARTICLE II. The Settlor reserves the right at any time to alter, modify, amend or revoke any or all of the provisions of this Trust Agreement. - 2 - ARTICLE III. The Trustee shaH render annual statements of the receipts and disbursements of income and principal of the Trust to the Settlor. ARTICLE IV. During the continuance of the foregoing Trust, the Trustee shall possess, among others, the following powers, exercisable in all events, for the best interest of the Settlor: 1. To retain any property or investments which the Settlor has.herein transferred and conveyed in trust, or will hereafter transfer and convey in trust, as long as the Trustee may deem it advisable so to do. Z. To vary investments, when deemed desirable by the Trustee, and to invest in such bonds, stocks, notes, real estate, mortgages or other securities or in such other property, real or personal, as it shall deem wise, without being restricted to so-called "legal investments", and without being limited by any statute or rule of law regarding investments by fiduciaries. 3. To sell either at public or private sale and upon such term s and conditions as the Trustee may deem advan- tageous, any or all real or personal estate including Settlor's - 3 - ; ~:;-'~,: :?;>:~~'.~:~~,:~,q~ . '~~~j~%J~it~~I~~fli'i{~t(f1~~l~lft~~r . present residence at 3110 North Third Street, Harrisburg, Pennsylvania or interest therein owned by the Trust severally or in conjunction with other persons, and to consummate said sale or sales by sufficient deeds or other instruments to the purchaser or purchasers, conveying a fee simple title, free and clear of all trust and without obligation or liability of tl}e purchaser or purchasers to see to the application of the purchase money or to make inquiry into the validity of said sale or sales; also, to make, execute, acknowledge and deliver any and all deeds, assignments, options or other writing", which may be neces!3ary or desirable, in carrying out any of the powers conferred upon the Trustee in this paragraph or elsewhere in this instrument. 4. In the discretion of the Trustee, to unite with other owners of siInilar property in carrying out any plans for the reorganization of any corporation or company whose securities form a part of the Trust assets. 5. To place and carry any asset of the Trust In the name of a nominee. 6. To assign to and hold in the Trust an undivided portion of any asset. - 4 - 7. To make any division o~ the principal of the Trust assets or any distribution of the assets partly or wholly in kind. If such division or distribution is made in kind, said assets are required to be divided or distributed at their respective values on the date or dates of their division or distribution. 8. To pay all costs, taxes, expenses, compensation and charges in connection with the administration and term- ination of the Trust. 9. To do all other acts in its judgment deemed necessary or desirable for the proper and advantageous management, investment and distribution of the Trust assets. 10. To mortgage real estate, and to make leases of real estate, extending beyond the term of the Trust hereunder. 11. To borrow money and to assign and pledge assets of the Trust therefor. 12. Whenever and as often as the Settlor, to whom pay- ments of income and principal are herein directed to be made, shall be unable to act, or shall lack ability, or, in the sole judgment of the Trustee, shall otherwise be unable to apply such payments to the Settlor's own best interest and advantage, - 5 - i~~~~~r;;~~i?')~;~~~;'~~\!1~~1~:t~!iKt~~~~1r the Trustee may make all or any portion of such payments in any.one or more of the following ways: (a) Directly to such Settlor. (b) To the Legal Guardian or Conservator of the Settlor. (c) To a relative of such Settlor to be expended by such relative for the benefit of the Settlor. (d) By the Trustee expending the same for the benefit of the Settlor. ARTICLE V. It is the intention of the parties to be legally bound by this instrument. ARTICLE VI. This Trust shall be governed by the laws of Penn- sylvania, and its situs shall be Dauphin County, Pennsylvania. ARTICLE VII. No part of the income or principal of the property held under the Trust created hereunder shall be subject to attachment, levy or seizure by any creditor, spouse, assignee, or trustee or receiver in bankruptcy of the Settlor prior to their actual receipt thereof. The Trustee shall pay over the net income and the principal to the parties herein designated, as their interest may appear, without regard to any attempted anticipation (except as specifically provided in this instrument), pledging or assignment , - c - by the Settlor under the Trust created hereund~r, and without regard to any claim thereto or attempted levy, attachment, seizure or other process against the Settlor. IN WITNESS WHEREOF, MIRIAM D. BERKHEIMER, Settlor, has hereunto affixed the Settlor's hand and seal and DAUPHIN DEPOSIT BANK AND TRUST COMPANY, Trustee, has caused this Agreement of Trust to be signed by its (Vice) President, attested by its (Assistant) Secretary and affixed hereunto its corporate seal under the authority of its Board of Directors and all on the day and year first above written. WITNESS: SETTLOR ~h~~7J~ . .,- ),/) " "f) " . . I' / J../ /1 A A ,h"" r\' I ~ ::'./l/k/h. (<{ A."1."" L/l ~ (SEAL) ATTEST: TRUSTEE DAUPHIN DEPOSIT BANK &: TRUST COMPANY I rL RJ/::tL (Vice) President By: Ii ( ",I, {(_ . " t ',/ '/ if - 7 - ~~~;;~~i~f~~11l~t~;~[t~~f~~ij~~~~~~1ir SCHEDULE "A" 1. Cash $ 4/ {;-uV . cro 2. Deed to 3110 North Third Street, Harrisburg, Pennsylvania 3. Insurance policy on life of Mrs. Berkheimer, face amount $1000, No. 1484221 with Massachusetts Mutual Life Insurance Company 4. Life insurance policy No. M2485S33 with The Prudential Insurance Company of America, face amount $500 on life of Mrs. Berkheimer 5. 2 Shar e s The Corporate Incom e Fund 6. Passbook for account No. 08-1-01205 with Dauphin Deposit Bank and Trust Company 7. Certificate of Deposit No. 001857 with Dauphin Deposit Bank and Trust Company, face amount $3,000 8. Certificate of Deposit No. 1-15-01604 with State Capital Savings and Loan Association, face amount $61,000 9. Certificate of Deposit No. 2-13-814359 with The Harris Savings Association, face value $20,000 10. Certificate of Deposit No. 01-16-019426 with The Harris Savings Association, face amount $5067.84 11. Pennsylvania Power & Light Company Stock Certificates: 50 shares; 20 shares; 30 shares; 20 shares; 25 shares; 2 shares; 50 shares; 23 shares -- totaling 220 shares 'COMMONWEALTH OF PENNSYLVANIA) SS. : COUNTY OF DAUPHIN On this the 30th day of November , 1981, before me, a Notary Public in and for the said County above, the undersigned officer, perSdnallyappeared Thomas W. Walker , who acknowledged himself to be the Vice President of The Dauphin Deposit Bank and Trust Company, a corporation, and that he as such, being authorized to do so, executed the foregoing instrument for the purpose therein contained by signing the name of the corporation by himself as Vi,ce President. IN WITNESS WHEREOF, I hereunto set my hand and official seal. -.'~(~ Y.: ,;; jvi-~ /',1 i !./ Notary Public - ' E!iz2&et~ J, B.nko. lIoh", D"boe M~' (em ',<' . ~ : '" . '_ .m._.lO;: [;qNi'S I.;;,;! is, 1934 ~;arrJ:;b"rg, Pil. D" aU;;.l'il Co;,:l1ty COMMONWEALTH OF PENNSYLVANIA) SS: COUNTY OF DAUPHIN "t/1 On this the..J(.) day of 77.D LHJ)J;-UU I 1981, before me, a Notary Public, in and for the said County above, the undersigned officer, personally appeared MIRIAM D. BERKHEIMER, known to me (or satisfactorily I proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ('ClhlVn { :S/u-r.'{J Not~ry Public CAROLYN E. SHOOP, Notary Public Harrisburg, Dauphin (0./ Pa. My Commission Expires Dec. 3, 1984 'I" !' Ie . , , (_, <'.'ll I ' )' . , .' , ,I' I' /.1" ~~-,~~,-""""~"",,,._--- . . - 31Ict!lt 3[lIill ctub mt~tctlntttl OF MIRIAM O. BERKHEIMER I, MIRIAM D. BERKHEIMER of the City of Harrisburg, County of Dauphin and Commonwealth of Pennsylvania, do hereby declare this to be my Last Will and Testament, revok i ng a 11 other Wi 11 s and Cadi ci 1 s heretofore made by me. lTEM 1: I direct that the expenses of my last illness and funeral be paid from my estate as soon as practicable after my death. lTEM 2: I give and bequeath to GENEVIEVE PROWELL (Mrs. Kenneth) Prowell) of 2437 Parkway Boulevard, Harrisburg. Pennsylvania my diamond ring with three large stones, my diamond dinner.r1n9..withthree small stones; my ring with five cubic zirconium stones, my charm bracelet with three gold pieces which I received from George on our 50th anniversary. ITEM 3: I give and bequeath to JANE WARDEN (Mrs. James Warden) of R.D. #1, Beaver Falls. Pennsylvania. my Grandmother Blair's gold watch and chain. ITEM 4: give and bequeath to PATRICIA MONROE (Mrs. Robert Monroe) of 1401 Diana Lane, Lookout Mountain, Tennessee, my marble top table presently in my living room. ITEM 5: give and bequeath to NANCY BOERGER of 795 South Main Street. Apartment 2, Wilkes Barre. Pennsylvania. Aunt Clara's silk crazy quilt presently in the cedar chest in my basement. ITEM 6: I give, devise and bequeath all of the rest and residue of my esta.te, real. personal and mixed, of whatsoever nature and wheresoever situate, to GENEVIEVE PROWELL, JANE WARDEN and PATRICIA MONROE, to share and share alike. or to the survivors or survivor. ITEM 7: In the event that any beneficiary under this Will and I shall die under such circumstances that there is no sufficient evidence that we died otherwise than simultaneously, such beneficiary shall be deemed to have predeceased me. )~71 'b 13 //;,1'7/ . . ITEMJ.Lc I direct and appoint the DAUPHIN DEPOSIT BANK AND TRUST COMPANY of Harrisburg, Pennsylvania to be the Executor of this Will and direct that he be permitted to serve without bond and without any intervention of any court except as required by law. I authorize my Executor to sell, encumber, mortgage, invest, distribute .in kind, or retain any item of property of my estate in such manner as he shall deem proper, limited only by its own discretion. Ii IN WiTNESS WHEREOF, I have at Harrisburg, Pennsylvania this ,II day ,9Q/ of lc'J-vvJ.-<"] ,..:J.g9& set my hand and seal to this my Last Will and Testament. {/ I)l '0 (j 2V7/I ">'? (SEAL) - V('/j'4:11~) , fQu-,j,d'hR'~ R AM D. BERKHEiME Signed, sealed, published and deClared.by the above-named MIRIAM D, BERKHEIMER as and for her Last Will and Testament,in the presence ,of.us, who, at her request, in her presence and in the presence of each other, have hereunto subscri bed our names as witnesses. (~.)~\ ,roM, " \~(' /~( Residence ;J\\\ ,Q,stW(\' ~0"'-\. ~. ~ "y~ ( ,\;;, v tf-, \~y I K,. ~\\\_Cla::J\ Residence ]y'J- viet t/I,n/? f/ 710.' ~~R'(Q/L~--J/ he ~ 1M 0 -----, CODICIL I, Miriam D. Berkheimer, now of Camp Hill, Cumberland County, Pennsylvania, declare this to be the FIRST Codicil to my will dated January 11, 1991. I hereby amend Item 2 of my will dated January 11, 1991 to add the following bequest: I in addition give and bequeath to Genevieve Prowell (Mrs. Kenneth) my antique bisque doll and the small rocking chair in which she sits. In witness whereof, I have at Camp Hill, Pennsylvania this &j1K day of July, 1994 set my hand and seal to this my FIRST Codicil to my Last will and Testament dated January 11, 1991. "}rf1-(.,/,.........ev-'--t--t..-" i:..) '~."'LK ~4.-"\..- Miriam D. Berkheimer Signed by Miriam D. Berkheimer , as and for a Codicil to her will dated January 11, 1991, in the presence of us who, at her request in her presence and the presence of each other have signed our names as witnesses. /}:::::~{!~ Residence e;)v l.tS.bi.t/1l/ PJ (;tun"c? I/~ tI P '1 /70i( '3 'fr OLD 'f(2~ !2c/ n eu", b 12tZ./IUJj) Id - /707<-> d /~/ ~ Residence