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Home My WebLink About02-1044PETITION FOR PROBATE and GR~IANT OF LETTERS Charles Imo' Ewing No. ~(~ O ~ - 1~~ Estate of To: also known as Register of Wills for the Deceased. County of Cumberland in the _ _ 47 Commonwealth of Pennsylvania Social Security No. The petition of the undersigned respectfully represents that: named Your petitioner(s), who is/are 18 years of November tGhe executor 2001 in the last will of the abnonecedent, dated ' and codicil(s) dated (state relevant circumstances, e.g. renunciation, death of executor, etc.) County, Pennsylvania, with Decendent was domiciled at death in Cumberland ~ ` 1 O0 Mb-~LL?n h 1 s last family or principal residence at 44 17 Me s ~' > > `'' oe- y lvan i a Dr~v (list street, number and muncipality) 87 ears of age, died November 10 -> -~2`° Decendent then, y~ 1 Pennsylvania at Messiah Village, Cumber and County, Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: n n n P - Decendent at death owned property with estimated values as follows: $ (If domiciled in Pa) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in None lvania situated as follows: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. v ~ ~ - ~ ~-C/ ~N ~;,~ Charles D Ewind bo 831 Limekiln Road ~~ ^ ~ P 1,nd PA »n~n ~a ~w 7 ~ 00 OATH OF PERSONAL REPRESENTATIVE COMMONWF ACOMB BLAND NSYLVANIA ~ ss COUNTY O The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge 11 wellland trulyladminister the estatepaccording po law. tative(s) of the above decedent petitioner(s) Q ~ ; ~~ ~ ~ ~ Sworn to or affirmed and subscribed before me this ~ end day of a h10V R ter ~ ~~ ~ ~- - Ivy- q Na. 21-02-1044 Estate of CHARLES LEE EWING ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW NOVEMBER 22 2002 , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated NnvAmhA r ~, ~ ~ n CLl described therein be admitted to probate and filed of record as the last will of Char 1 e s L>~~ Ew_inq and Letters of Testamentarv ' are hereby granted to Char 1 e~ D Fwi na Rebister of Will's (~ ~~ ak~ )~~ FEES b Probate, Letters, Etc. ......... ~ 3 4~~ THOMAS B . C.OiiT i7 ~ h 5 ~ R Short Certificates( ) .......... ~ ~ ATI.ORNEY (Sup. Ct. LD. No.) xl~R~ E~tr~a ages ~ 6.00. 2 East Main Street 10.00 ~ 10.00 Shi r~manctnt.Tn AA 1 7(11 j 3 71. O O ADDRESS TOTAL ~ Filed .. , , , 11-22-2002 (717) 731-1461 .......... gave to atty 11-22-2002 PxoNE _ ,~, , 1 _t` 'S ~'.' ', )~ ;L+ "~, ii (_ '.lf t'i' L`ll`2'I3 .. ~i?i:I'cYlli COI1;t: Cj tr[ri,. .111 (:. Ir'1 ,~ ,!:, !' - - i C C ~, .I I I !i.1 ,... .. ~. :_.., ,.-. a. a_. ]~. ~ +.1' t i;s: lal,l~ti; 1U Lilc ~i,l C°` ,. ~ ~~ ~ f, ~ - ,;.. ~= b~~~ IaO~l t~; du~al~ate this ~~~~1 ~y ~~c3t~st~t ~r ~.~ , , , P X6442._18 70.3 Rev. 2/87 ~~~,Li h ~"~ P,c,, ~~ ~~ ,; `~~ „~i~~~ ~)~. :' i ~~ , - i < l~-v j +g^: / -- -~~DV 1-~_2~~Z -- _ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATFf ,...mc yr ~c~cucrv r Ire9. Muse, Latt) SEX SOCIAL SECURITY NUMBER GATE OF DEATH ,Mdnm. Day, rear) ~• Charles L Etain . g :. Maly: 7.198 - 05 - 8647 4• Novrmber 10 AGE (Last Binnda ) UNDER 2002 ' YE y , 1 AR UNDER, DAY DATE Of 81RTH BIRTHPLACE (City aria PLACE OF DEATH ICnmw wry w, -- ;tW myrw;lwins on .rher sn,el Months , Oaya Hours , Minutss IMdnm. Oay, rear) Statew rcrngn Coumry) HOSPITAL OTHER: s $ 7 vrs. Nov . 26 ,14 Nook , Pa Inpatwnt ^ E WOutpauem Ll DOA ^ Rom ~ 1~ Ras,oanca OIMr e ^ ^ ` ' spaciN, lY . z a.. COUNTY OF DEATH C11Y, BORO, TWP OF DEATH FACILfTV NAME III not rnsUNtwn. give meat and numtxa~ WASj~pq~xDENT OF HISPANIC ORIGINI RACE - Amencart Indian, &ack, Wnks. etc. S ^ ' PeclNl tl Y•a• spacrry Cuban. l ,,.Cumberland ~ ~' '•' k. Upper Allen Twp ,, 1 ~~(`,,S /Q (~ ~ / ~ ~C(G'e Maxlpn. Puerto Rican, ac. . 9. ,0. White DECEDENT'S USUAL OCCUPATION KIND OF BUSINESS/INDUSTRY WAS DECEDENT EVER IN OECED NT'S EDUCATION MARIlaL STATUS-Manned Gve k tl d k d I ln ww SURVIVING SPOUSE one Bunngg mog U.S. ARMED FORrry}CA{EyyS? S rt o n. ne51. rode coin wa.t Never Merrwyd, Widowed, III wee. g,ve maxren name, king life; do rrot use re,aee.) Elementary/Secondary College Divorced (S ew ^ - p ry) Ves No Lam' llWller ,,, Etaing Roofing 1o-,21 ('4°'5.1 . 16. ,z. ,3. ,.. Widowed , DEC ' ,. EDENT S MAILING ADDRESS (Street. C4yRown.SWte.l~COdel DECEDENT'S 100 Mt Allen Drive Ac7uAL n,. state Pa Die n~}Qr«.aeceeemayodm TITTTTF~r Al1F-ten _ RESIDENCE eeceeam r•'p ISee mstructroru five in a ,aMr~hanicsburg, Pa 17011 °^°'he,~de) Ipwnahip? HD,MCaeamlivaa ,ro.coen Cllmh 1 anti ,Ta.^ wnn,nanuyfimna°I FATHER'S NAME (FUSt. Middle. Lase _ ciryrporo ' J~nes C Ekain MOTHER S NAME IFnst. MNdk. Maiden Surname) „ . g ,, Rebecca Wilson . INFORMANT'S NAME (7ypaPrmq ' INFORMANT S MAILING ADDRESS ISveel. CiN/TOwn, S4ne, Lp Code) 20 Louise Skelly a 2~. 29 Pine Tree Drive Mrchanicsbur Pa 17055 METHOD OF D P IS OSITION GATE OF DISPOSITION PLACE OF DISPOSITION -Name o1 Cemetery, Crematory LOCATION -CitylTOwn, Stale. Lp CoW ^ IMOnIh Day Year) o Burial ® Cremalan ^ R Oth Pl I , , r er emoval ace ron S,ale Donatnn^ Deter (SpewNl ^ . z 2m. t, a :,p. 2,e. C'ami Hi 1 1 , Pa SIGNATURE NERAL S OR P RSON ACTING AS SUCH LICENSE NUMBER NAME AN ADORES~,S OF FgCWTV k t ' 2:. _ 226. 011654-L 22 903 Hir e S~ ~ Oe ~ _ ll Pa f J T Items 23ac on y when ce ing To the Das, of my knowledge, death occurred at the rime, Bale and place states. LICENSE NUMBER . physician q rot available at ume of death to jSxytame and Lna) DATE SI NED cemN pose of Beam. (MOnm. Day, year) -:-. 27e. z36. __ z7c. Items 24-28 must Da completed by TIME OF DEATH DATE PRONOUNCED DEAD IMOnth. Dey, Yearl WAS CASE REFERRED 70 MEDICAL E%AMINEWCORONER7 ~. 7 perwn wlq pronounces death - . // ~~ ; / 2S. 26. - 27. PART 1: Enter the diseases, injuries or complicatana which caused the Beath. Do no enter me muea ul dying, such as card,ac or respuatory arrest, stwtck or nean failure. I Approxlmale PART 11 O h L : t er slgnificam conditona comriDuling to death, but lat only one Wuae On each line. interval between not lasuKln the undo 91n rt m i y g cause 9rven I n PART I. IMMEDIATE CAUSE (Final ~ onset and death JiSea60 p COnd1eM - ; ieaW,ingmdeaml-- a. ~ J t _ 2 ASp,CONSEOUENCE -- \Cyl ~ Sequentialty list conditions b. ~ ~ ~~I J ._ - ' if any, leading to immediate S.A CQk19fOUEN ~ cause. Enter UNDFALYINO ) / • l/ 1 I CAUSE (Unease a xyt,ry c. • mat inauted events ~LTE.7~n (t7R ASACONSEOUEN EOM: I /~ 'Y esWbngn deamlLAST ~ ~/y ~ t -~ ~ ~ ~ ~ ~ _~ l, v 1 ~1>4 d. J-u-C \ ~~ 1 r l ~ .~ ~ ! _ WAS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH DATE OF INJURY TIME OF RY INJURY AT WORK? DESCRIBE MOW INJURY OCCURRED PERFORMED? AWILABLE PRIOR TO . (MOnm. Day, Year) COMPLETION OF CAUSE OF DEATH? Natural ~. Homicide ^ Accidem ^ Pending Investigation ^ Vea ^ No ^ 70s. _ _ 706. __ _ M. 70c. __ Tod. Yes ^ No Yes ^ No ^ Sucide ^ Could riot Da tleterminee ^ PUCE OF INJURY - A~ nu r l mn. arm, sueeL actwy, office LOCATION (SVeer. G~NITOwn. Slate) bwldirg etc. ISpucifvl , .tea. 286. 29. 70s. 701 CERTIFIER ICheck omy one) . 'CERTIFYING PHYSIGAN (Phys~can cerotying cause ul death when anwher Pnvs~C~an has pronounced deem anu completed (fern 23l ^ ~.>_ To me bas, of my knowlWga, Oesm oeeurrad eua to the causa(sl snd manner as •fated ................................ ..................... SIGNATUR NO TITLE 05{=ERTIFIER ~ / ~ _ ~~ ~ 1 ,~ M~-~ ~ ~'J`~+. p j 7, D. Y,- t! -ems _ J ' : 'PRONOUNCING ANOCERTIFYING PHYSICIANtPf ysx:ian bolt;;!„,.wi~c n~3 doaR andcertaymglo BUSe of demnl ' To ma best o/ my knowNdga, death xcwred at Ina tlma, date and place, and due to the cause(s) and manner a• stated....... .... (~ . ........... LICEN NUMBER DATE SIG EQ IMwrm. Day, Year // '•~//``~, r, / \ (,~ 1 7tc ~ V ~) CSI U 4 L-. 7,e L 1 ~ EF _ - _ .._.. _____ . __. _ __ NAME AND ADDRESS OF PEHS(iN WMO COMPLETED CAUS OF DE M _ 'MEDICAL EXAMINER/CORONER (Ilan 17) Typo or Print On the Denis o, e:amtna,lon and/or investigation, in my opinion, death occurred a, the time, date, and place, and due to the cause(s) and manner as stated ................ .................... - .................................... .... .... ....... ..... st r ) ' " ` , ^ .... .. a. REGISTgAR'S SIGNATURE~ND NUMB R • ~ ~ , ~ l .~ Y 1 ~ ,/~~ y ~-- 72' -~~~ 4. ~~~ o ~ ~/ ~`~'i •1 GATE FILED M t n U ~ _ R J -_ ,- '~ y ~+ v r l ~ / / I U n . ay, Yaa~1 E. R.~ ~ _ . / ....~. .~_ -. :7R. i~.._..r am. 73. , , ~ / /~ ~j 7.. ~1LLi ~~ ~//// LAST WILL AND TESTAMENT OF CHARLES L. EWING 021- off- /p~c~ KNOW ALL MEN BY THESE PRESENTS, That I, CHARLES L. EWING, of the Township of Upper Allen, County of Cumberland, and Commonwealth of Pennsylvania, do make, publish, and declare this instrument to be my Last Will and Testament, hereby revoking and making void any and all former Wills by me at any time heretofore made. FIRST: I direct the Executrix hereof to pay all my just debts, funeral expenses and costs of administration as soon as conveniently may be done after my death. I further direct the Executrix hereof to pay all inheritance, estate, transfer and succession taxes which may be levied or assessed upon any property which is included as part of my gross estate for the purpose of any such tax. SECOND: I give, devise and bequeath unto my Wife, NORMA M. EWING, the rest, residue and remainder of my estate, realty and personalty, howsoever designated wheresoever situate provided that she is living on the thirtieth (30th) day after the date of my death. THIRD: In the event that my Wife, NORMA M. EWING, does not survive me or does not survive by the said period of thirty days, then in that event, I give, devise and bequeath all the rest, residue and remainder of my estate in equal share, share and share alike, to my Children, CLARA JEAN SEBASTIAN, GERALDINE LOUISE SKELLY, MARY ELIZABETH HOOVER, and CHARLES D. EWING, pEr StiCpeS. FOURTH: I appoint my said Wife, NORMA M. EWING, to be Executrix of this my Last Will and Testament. I do hereby give to the Executrix hereof full power, discretion and authority at any time or times to sell, at private or public sale, mortgage, lease, pledge, exchange or otherwise deal with or dispose of the property comprising my estate as deemed best, to settle and compound any and all claims in favor of or against my estate as deemed best and, for any of the foregoing purposes, to make, execute and deliver any and all deeds, mortgages, contracts, leases, bills of sale or other instruments necessary or desirable therefor. FIFTH: In the event my said Wife, NORMA M. EWING, fails or refuses for any reason to serve as Executrix of this my Last Will and Testament, then in that event I appoint CHARLES D. EWING as Executor of this my Last Will and Testament. LASTLY: I direct that no fiduciary appointed by this, my Last Will and Testament, shall be required to give bond and that if, notwithstanding this direction, any bond is required by any law, statute or rule of court, no surety shall be required thereon. IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will and Testament, consisting of three (3) typewritten pages on the margin of which (except this page) I have affixed my initials this 6th day of November, A.D. 2001. r i arles L. E ng ~ Signed, sealed, published and declared by CHARLES L. EWING, the above- named Testator, as and for his Last Will and Testament, in the presence of us and each of us, who at his request, and in his presence, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. s ~~ F ~ /~ eth Myers ~/~-~" v Amy Knauer - 2 - County of Cumberland Commonwealth of Pennsylvania ss. ACKNOWLEDGMENT AND AFFIDAVIT We, CHARLES L. EWING, the testator, and the undersigned witnesses to the Will, the attached or foregoing instrument, having been qualified according to law do depose and say: (a)that I, the testator, do hereby acknowledge that I signed the instrument as my Will, that I signed it willingly and as my free and voluntary act for the purposes therein expressed; and (b)that we, the witnesses, were present and saw the testator sign the instrument as his last Will, that he signed it willingly and as his free and voluntary act for purposes therein expressed; that each of us in the hearing and sight of the testator signed the Will as a witness and that to the best of our knowledge the testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn to or affirmed before me by, testator, and Beth Myers and Amy Knauer, witnesses, this 6th day of November, 2001. 1 Z arles L. Ewing -l , ,. ,~ ~. ,~ ~ C~.,~~ ~~~~ By: David W. Knauer Attorney I.D. #21582 ~~' -~. ~.._ _. ~.~~~ eth Myers Amy Knauer - 3 - REGISTER OF WILLS OF OATH OF SC: codi (each) a subscribing w' ness to th ill presented law, depose(s) and ay(s) t ~ the sign the same and that request of testat in h other subscribing witness(es)). Sworn to or affirmed and subscri d before me this d~ 19 COUNTY ING WITNESS (each) being duly qualified according to present and saw si ned as a witness at the and (in the pres a of each othe (in the presence of the (Name) (Address) Register (Name) (Address) REGISTER OF WILLS OF ~~~.fl-.~n~- COUNTY OATH OF NON-SUBSCRIBING WITNESS 01-- oa- ~oyu V, (each) a subscriber hereto, (each) being duly qualified according to law, epose(s) and say(s) that 1~ familiar with the signature of „ Q~~ ~, ~ codici testat~_ of (one of the subscribing witnesses to) the ill presented herewith and codicil that ~ ~~~A . _ believes the signature on the will is in the handwriting of to the best of ~1L,r____ knowledge belief. Sworn to o!r~a^ffirmed and sut7scribed before me this ~~ day of ~~l ~~ t,~Q ` ~ppR~eg~istt~e U d~_ _1 _ ~J q~ !Name) ,~~'~ ~ ess ~ ~ ~' " Z cam,' ~ ~. (Name) ~>G/ ~ '~ -~ c.c~... i (Address) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE REV-1162 EX(11-96) BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 002137 EWING CHARLES D 831 LIMEKILN ROAD NEW CUMBERLAND, PA 17070 ACN ASSESSMENT AMOUNT CONTROL NUMBER fold ESTATE INFORMATION: ssN: ~ sa-o5-ss47 FILE NUMBER: 2102-1044 DECEDENT NAME: EWING CHARLES L DATE OF PAYMENT: 02/06/2003 POSTMARK DATE: 00/00/0000 couNTY: CUMBERLAND DATE OF DEATH: 1 1 / 10/2002 TOTAL AMOUNT PAID: REMARKS: CHARLES D EWING NOTE: NO CHECK NUMBER SEAL INITIALS: JA RECEIVED BY: DONNA M. OTTO 521,719.45 DEPUTY REGISTER OF WILLS REGISTER OF WILLS STATUS REPORT UNDER RULE 6.12 Name of Decedent: Cy-nI' ~~ L ~''~ ~ n.~ Date of Death: ll'Ov~~ ti /O. ,200 2- Will No.: 2 1- ~ 2 -. l0 S/y _ 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 [JX No L] 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No [] b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes I] No c. Copies of receipts, releases, joinders and approval of formal or informal accounts maybe filed with the Clerk of the. Orphans' Court and maybe attached to this report. Date: /d~o? ~ ~ ~~ ~~- S~ig 1nature ~'h~r~Jat ~• ~s ~•~ Name Address l ~ ~ V ~~~n )~3i- ~y6~ Telephone No. Capacity: [1 Personal Representative Counsel for personal representative IN THE MATTER OF THE ESTATE IN THE COURT OF COMMON PLEAS OF CHARLES L. EWING, OF CUMBERLAND COUNTY, PENNSYLVANIA DECEASED ORPHANS" COURT DIVISION NO. 21-02-1044 ESTATE SETTLEMENT AGREEMENT THIS AGREEMENT, made this ~ 7 day of ~ 2003. WITNESSETH: THE CIRCUMSTANCES leading up to the execution of this Agreement are as follows: 1. CHARLES L. EWING (the "Decedent"), died testate on November 10, 2002, and CHARLES D. EWING duly qualified with the Register of Wills of Cumberland County, Pennsylvania, as the Executor (the "Executor") of the Decedent's probate estate (the "Estate") 2. The Third paragraph of the Decedent's Last Will and Testament (the "Will") provides for the distribution of the Decedent's estate equally to CLARA JEAN SEBASTIAN, GERALDINE LOUISE SKELLY, MARY ELIZABETH CRUM and CHARLES D. EWING. 3. Charles D. Ewing is the Decedent's surviving son, and Clara Jean Sebastian, Geraldine Louise Skelly and Mary Elizabeth Crum are the Decedent's surviving daughters (collectively, the "Beneficiaries"). The Beneficiaries desire the Executor to settle the Estate informally in order to avoid the expense and delay involved with the formal adjudication of a First and Final Account by the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania (the "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 confirm their acceptance of the Informal Account (the "Account"), attached hereto as Exhibit "A" and incorporated herein by this reference, and the Schedule of Proposed Distribution (the "Schedule"), attached hereto as Exhibit "B" and incorporated herein by this reference. The Beneficiaries desire that the distributions, as set forth on Exhibit "B," be in full satisfaction of their rights in the Estate. 5. The Beneficiaries wish to release the Executor and to indemnify him against any and all claims that may be asserted against the Estate or the Executor after the date hereof. (, The Executor is willing to settle the Estate informally consideration of the indemnifications hereinafter provided by In the Beneficiaries. and intending NOW THEREFORE, in consideration of the foregoing 11 bound, jointly and severally, the Beneficiaries, for to be lega y ns: themselves, their successors and assig Re resent and warrant that they have read and understand 1. P A reement and confirm that the facts set forth above are true this g ect to the best of their knowledge, information and and corr , belief. 2, Declare that they have sufficient information to make an ~~ dCCOUnting with the p~m ..~a t,1~1~1 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. 4. Release, remise, quitclaim and forever discharge the Executor, his heirs, personal representatives, successors and assigns, from and against all claims that they, as legatees of the Estate and in connection with the Estate, had, now have or may in the future have in connection with the Estate. 5. Agree to refund, on demand, all or any part of any aforesaid distribution, which has been determined by the Executor, or by the Court, or by any court of competent jurisdiction, to have been improperly made. 6. Agree to indemnify and hold harmless the Executor, his 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 Executor) that may hereafter be asserted against the Estate or against the Executor. 7. Agree to execute such other or additional documents as may be necessary to effectuate the agreements set forth herein. g. Acknowledge that this Agreement shall be governed by and construed in 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 read and agreed to the terms and conditions set forth in this Estate Settlement Agreement and intending to be legally bound hereby placed their hands and seals. !I - WITNESS C,~,.u c~. tt WITNESS _~ CLARA SEAN STIAN rj GERALDINE LOUISE SKE LY Cw~~ ~rl. WITNESS WI ESS COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ~~ ~ MF Y EL ABETH CRUM ~, CHARLES D. SWING SS On this, the ~ day of 2003, before me, the undersigned officer, person 1 ap ared CLARA JEAN SEBASTIAN, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same in the capacities and for the purposes therein contained. IN WITNESS WHEREOF, I hereunder set my hand and official seal. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS On this, the / 7 day of l..' 2003, before me, the undersigned officer, personally a pear GERALDINE LOUISE SKELLY, known to me (or satisfactorily p ven) o be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same in the capacities and for the purposes therein contained. IN WITNESS WHEREOF, I hereunder set my hand and official seal. ~T+ ~ L E 6tNSTVhti!~i~. IYy P~b~ T~~~ N a y Public COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS On this, the /~ day of ~ 2003, before me, the undersigned officer, personally ear MARY ELIZABETH CRUM, known to me (or satisfactorily proven) to e the person whose name is subscribed to the within instrument, and acknowledged that she executed the same in the capacities and for the purposes therein contained. IN WITNESS WHEREOF, I hereunder set my hand and official seal. ~1~" '? ~ ~ ~ r' ~`~ N t ry Public COMMONWEALTH OF PENNSYLVANIA . . SS COUNTY OF CUMBERLAND On this, the ~_ day of ~~, 2003, before me, the undersigned officer, personally p eare CHARLES D. EWING, known to me (or satisfactorily proven) o be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same in the capacities and for the purposes therein contained. IN WITNESS WHEREOF, I hereunder set my hand and official seal. r~ ,.~,.--- ~-~...,~.:.,~ _ _~ t y P u b t i c ~ WO`~i=~~~, .,.~ ~~ INFORMAL ACCOUNT ESTATE OF CHARLES L. EWING ITEM VALUE AT DEATH ASSETS: Stocks & Bonds Cash, Bank deposits & financial accounts Total DEBITS: Funeral & Administration Expenses PA Inheritance Tax Total Net Value of Estate at time of Death $ 275,946.43 $ 242,366.35 $ 518,312.78 $ 10,255.55 $ 21,719.45 $ 31,975.00 $ 486,337.78 The value of the stocks, bonds, cash and bank deposits has fluctuated during the administration of the estate and a final value will be determined at the time of actual distribution. A PROPOSED DISTRIBUTION OF ASSETS OF ESTATE OF CHARLES L. EWING BENEFICIARY SHARE Clara Jean Sebastian 250 Geraldine Louise Skelly 250 Mary Elizabeth Crum 250 Charles D. Ewing 250 Total 1000 B l CERTIFICATE OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Will No. 21-02-1044 TO THE REGISTER: Charles L. Ewing November 10, 2002 I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was serviced on or mailed to the following beneficiary of the above-captioned estate on February 25, 2003. Name CLARA JEAN SEBASTIAN Address 5232 STRATHMERE DRIVE MECHANICSBURG, PA 17050 GERALDINE LOUISE SKELLY 29 PINE TREE DRIVE MECHANICSBURG, PA 17055 MARY ELIZABETH CRUM 2109 CEDAR RUN DRIVE #206 CAMP HILL, PA 17011 CHARLES D. EWING 831 LIMEKILN ROAD NEW CUMBERLAND, PA 17070 Notice has now been given to all persons entitled thereto under Rule 5. F /a1 J ~ ~ . Date: ,-~,~.ryta~y .ZS 2A~3 ~.,; Thomas D. Gould, Esquire I.D. # 36508 Attorney For Charles L. Ewing 2 East Main Street Shiremanstown, PA 17011 (717) 731-1461 ~~7-ion - ~ COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 171zs-o6o1 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 ER AFP (D1-OS) ~~,-..- ,_,{ DATE 05-19-2003 ~_t _ ESTATE OF EWING CHARLES L DATE OF DEATH 11-10-2002 FILE NUMBER 21 02-1044 ~d3 h1AY 23 fit ;Z~j COUNTY CUMBERLAND CHARLES D EWING ACN 101 K J SPANGLER Amount Remitted 660 OLD YORK RD L ~ _' ETTERS PA 17~~b~60 _ _ _, MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF EWING CHARLES L FILE N0. 21 02-1044 ACN 101 DATE 05-19-2003 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) 275,946.43 (3) .00 (4) .00 (5) 242 , 366.35 (6) .00 (7) .00 (B) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 518,312.78 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10,255.55 (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00 11. Total Deductions (11) 1 0. r, 12. Net Value of Tax Return (12) 508, 057.23 13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14) 508, 057.23 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) .00 X 00 _ .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 508,057.23 X 045. 22,862.58 17. Amount of Line 14 at Sibling rate (17) .0 0 X 12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) •00 X 15 - .00 19. Principal Tax Due (19)= 22,862.58 TOY r'_DCf1TTC. DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 02-06-2003 CD002137 1,143.13 21,719.45 TOTAL TAX CREDIT 22,862.58 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 A REFUND. SEE REVERSE ST11F nF TNTC snow, cno TucTOnrrrnu~ . \. / 7-/Dd.- q ......-- REV-1500 EX (6-00) REV-1500 OFFICIAL USE ""'lY COMMONWEALTH OF . PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER DEPl 280601 RESIDENT DECEDENT <<>2 L - LL..2.. _f..t::L'L"L HARRISBURG, PA 17128-0601 COUNTY CODE YEA' MJMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INfllllL) SOClllL SECURITY NUMBER I- Z CHARLES L. EWING 198-05-8647 w DATE OF DEATH (MM-DD- YEAR) DATE OF BIRTH (MM-DD- YEAR) TliIS REllJRN MUST BE FILED IN DUPLICATEWlTli TliE C W 11/10/02 11/26/14 REGISTER OF WILLS (,) w (IF APPLK:ABLE) SURVIVING SPCUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCV\L SECURITY NUMBER C NOT APPLICABLE NOT APPLICABLE w 1ZI 1 Onginal Return 0 2. Supplemental Return 0 3. Remainder Return (date of death prior to 12-13-S2) t-, ",5", 0 4. LImited Eetete 0 4a. Future Interest Compromise (date of death after 12.12-S2) 0 5. Federal Estate Tax Return Required ,,"'" wo.g 0 6. Decedent Ded Testate (Attach copy of WI) 0 7. Decedent Maintained a Living Trust (Altacheopy ofTrusl) ~ 6. TctaJ Number of Safe Deposit Boxes J:~....l "0.10 ~ 0 9. Litigation Proceeds Received 010. Spousal Poverty Credit (date of deatll between 12.31.91 and 1-1-95) 011 Eleclion to tax under Sec. 9113{A) (Alt"h&h 0) .... THIS"SEctioN.'MUST'Ill;/;QMPLETED..ALL,CQRRESPONDEN/;I1ANIlCONFIlll;I\rML.TI\XINFORMAtIONSHOULIl.EiE.OIRECrEIl.TO: z NAME CCMPUETE MAILING ADDRESS w 0 CHARLES D. EWING 831 LIMEKILN RD NEW CUMBERLAND PA 17 z 0 FIRM NAME (If ~") 0. '" K J SP GLER CPA PC w " 660 OLD YORK RD ETTERS PA 17319 " TEUEPHONE NUMBER 0 " (717 ) 938-5340 1 Roo Estele (Schedule A) (1) OFFICIAL USE ONLY 2. stocks end Bonds (Schedule B) (2) 275,946.43 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Rece..ble (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 242,366.35 Z (Schedule E) 0 6. Jcjnly CNined Property (Schedule F) (6) !;;: o Seperate ~lIing Requested ...I 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) ~ I- (Schedule G or L) ii: 8. Total Gross Assets (total LInes 1 - 7) (8) 518,312.78 < (,) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10,255.55 W 0:: 10. Debts of Deceden( Mortgage Liabilities, & LIens (Schedule I) (10) 11. Total Deductions (total LInes 9 & 10) (11) 10,255.55 12. NelV.I" 01 Estate (LIne 8 minus LIne 11) (12) 508,057.23 13. Charitable and Governmental BequestsJSec 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) 508,057.23 SEE INSTRucnONS FOR APPUCABLE RATES Z 15. Amount of Line 14 taxable at the spousal tax 0 ~ rate, or transfers under Sec. 9116 (a){1.2) X.O_ (15) . I-' 16. Amount of line 14 taxable at lineal rate 508,057.23 x.o 45 (16) 22,862.58 ~ Il.. 17. Amount of Line 14 taxable at sibling rate X .12 (17) :::!!; 0 18. Amount ofUne 14 taxable at collateral rate X .15 (16) (,) ~ 19. Tax Due (19) 22,862.58 20. 0 I CHECK HERE IF YOtJARl;REQl1l;sTINGAREFUND()fANOVERPAYMl;NTI 07t:? STFPA42021F.1 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Decedent's Complete Address: STREET ADDRESS 8 3 1 LIMEKILN ROAD CITY NEW CUMBERLAND I STATE PA I ZIP 17070 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Cred~s/Payments A. Spousal Poverty Cred~ B. Prior Payments C. Discount (1) 22,862.58 1,143.13 3. Interest/Penalty il applicable D. Interest E. Penalty Total Cred~s (A + B + C) (2) 1,143.13 Total Interest/Penalty (D + E) (3) 4. II Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. II 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) 0.00 21,719.45 ~ B. Enter the total 01 Line 5 + SA. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 21,719.45 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 03 YORK ROAD ETTERS PA 17319 For dates 01 desth on or after July I, 1994 and before January 1, 1995, the tax rate imposed on the net value 01 transfers to or for the use 01 the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)]. For dates 01 death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use at the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure 01 assets and filing a tax retum are still applicable even il the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use 01 a natural parent, an adoptive parent, ora stepparent olthe child Is 0% [72 P.S. ~9116(a)(1.2)]. The tax rate Imposed on the net value 01 transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)]. The tax rate imposed on the net value of transfers to or tor the use at the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)]. A ,"bling is defined, under Section 9102, as an individual who has at ieast one parent in common with the decedent, whether by blood or adoption. STFPA42021F,2 REV-1502 EX+ (1.97) (I) COMMON'v\€ALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDEtfI SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER ESTATE OF CHARLES L. EWING All real property owned soIaly or as I tenant in ~ must be reported at fair rnarll.1t value. Fair marka 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 fads. Real property which is jointly-ownecl with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH TOTAL (Also enteron line 1, Recap"ulation) $ (If more space is needed, insert additional sheets of the same size) STFPA42021F.3 REV.1503 EX+ (1-97) (I) COMMO~LTH OF PENNSYLVANIA INHERITANCE TAX. RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF ESTATE OF CHARLES L. EWING FILE NUMBER All property jointly_ned w~h the right 01 survivol1hip must be disclosed on Schedu'e F. ITEM NUMBER DESCRIPTION 1. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 BANK OF AMERICA 7% CAP GENERAL MOTORS SMART NOTES SAVANNAH ELC & POWER COLUMBIA GAS SYSTEM NOTES AIM INVT SECS FDS PLM EQUIPMENBT GROWTH DUKE ENERGY GROWTH PEPCO HOLDINGS COLONIAL 8.32% GROWTH DOMINION CNG 7.8% CAP ENERGY EAST CAP 8.25% SAVANNAH ELEC CAP 6.85% US TREASURY NOTES US TREASURY NOTES FEDL HOME LOAN MORTGAGE AMERICAN NATL BANK & TRUST EATON VANCE INSURED JOHN HANCOCK PFD INC MORGAN STANLEY INSD MORGAN STANLEY QUALITY DISCOVER BANK CD PROVIDIAN NATL BANK CD SOUTHERN FINANCIAL BK PENNSYLVANIA ST GO RFDG DAUPHIN CNTY PA GENRL GNMA FUND - CLASS AARP VALUE AT DATE OF DEATH 10,144.00 9,364.80 10,039.90 8,853.90 1,872.99 2,050.00 10,245.00 5,195.70 10,280.00 5,068.00 10,088.00 9,924.00 10,568.80 10,565.60 10,137.90 25,784.50 13,900.00 24,410.00 3,254.50 2,816.00 15,524.10 20,000.00 10,488.10 25,539.50 5,001.20 4,829.94 STFPA42021F.4 TOTAL (Also enter on line 2, Recapttulation) $ (If more space IS needed, Insert additional sheets of the same size) 275,946.43 REV-1504 EX "" (1-97) <I) COMMOI'MEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP or SOLE-PROPRIETORSHIP ESTATE OF ESTATE OF CHARLES L. EWING FILE NUMBER Schedule c-1 or c-2 (ImMing all supporting information) must be attached for each dosey-h~d oorporationlpartnership interest of the decedent otr.r than a ode-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. TOTAL (Aiso enter on line 3, Recapitulation) $ (If more space is needed, insert addItIOnal sheets of the same size) STFPA42021F.5 REV.1505 EX + (1-97) (I) COMMotMEALTH oF PENNSYLVANIA INHERITANCE 1M RETURN RESIDENT DECEDENT SCHEDULE C.1 CLOSELY.HELD CORPORATE STOCK INFORMATION REPORT ESTATE OF ESTATE OF CHARLES L. EWING FILE NUMBER State State of Incorporation Date of Incorporation Total Number of Shareholders Business Reporting Year 1. Name of Corporation Address City 2. Federal Employer I.D. Number 3. Type of Business Zip Code ProducUService 4. TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OFTHE STOCK Voting I Non-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENTS STOCK Common $ Preferred $ Provide ali rights and restriclions pertaining to each class of stock. 5. Was the decedent employed by the Corporation? 0 Yes 0 No DYes Annual Salal'{ $ DNa lime Devoted to Business If yes, Position 6. Was the Corporation indebted to the decedent? If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? DYes DNa 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 wRhin two years if the date of death was prior to 12-31-82? DYes DNa If yes, OTransfer OSale Number of Shares TmnsrereeorPumha~ Attach a separate sheet for additional transfers and/or sales. Consideration $ Date 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? DYes DNa If yes, provide a copy of the agreement of eate, etc. 11. Was the corporation dissoi'led or liquidated after the decedent's death? 0 Yes D No If yes, provide a breakdown of distributions received by the estate, inciuding dates and amounts received. DYes DNa 12. Did the corporation have an Interest in other corporations or partnerships? DYes DNa If yes, report the necessary information on a separate sheat, including a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax retums (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 reat estate appraieats have been secured, attach copies. D. List of principal stockholders at the dale of death, number of shares heid 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. STFPA42021F.6 REV.1506 EX+ (1-97) (I) COMM~LTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDEIlT DECECENT SCHEDULE C.2 PARTNERSHIP INFORMATION REPORT ESTATE OF ESTATE OF CHARLES L. EWING FILE NUMBER 1. Name of Partnership Address Date Business Commenced Business Reporting Year city State Zip Code 2. Federal Employer !.D. Number 3. Type of Business Product/Service 4. Decedent was a 0 General 0 Um~ed 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? 0 Yes 0 No If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the dealh of the decedent? 0 Yes 0 No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 9. Did the decedent sel or transfer an interest in this partnership w~hin one year prior to dealh or within two years if the date of dealh was prior to 12-31-82? DYes 0 No If yes, OTransfer o 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 dealh? If yes, provide a copy of the agreement. 11. Was the decedent's partnership interest soid? DYes 0 No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? 0 Yes 0 No If yes, provide a breal<down of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? DYes ONo If yes, explain DYes DNa 14. Did the partnership heve an interest in other corporations or partnerships? DYes ONo If yes, report the necessary information on a separate sihee\, including a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (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 lair 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. STFPA42021F.7 REV-1507 EX + (1-97) (I) COMMot-MEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF ESTATE OF CHARLES L. EWING FILE NUMBER All property jointly-owned with the right of sUlVivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. VALUE AT DATE OF DEATH STFPA42021F.8 TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed, ,nsert additional sheets of the same sIZe) REV-1508 EX+ (1-97) (I) COMMO/IMEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF ESTATE OF CHARLES L. EWING FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of sulVivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. EVERGREEN MONEY MARKET FUND 1,683.00 2 EVERGREEN MUNICIPAL MONEY MARKET FUND 222.53 3 CASH 379.38 4 EVERGREEN MONEY MARKET FUND 47,296.66 5 EVERGREEN MUNICIPAL MONEY MARKET FUND 300.92 6 PNC INTEREST CHECKING 19,555.61 7 PNC PERFORMANCE MONEY MARKET 29,133.50 8 PNC CERTIFICATES OF DEPOSIT 27,280.44 9 MORGAN STANLEY LIQUID ASSET FUND 10,327.75 10 SIBLINGS ACCOUNT 40,000.00 11 CHILD EVANGELISM 10,101.27 12 CASH ON HAND 2,499.20 13 OPTIMAX 3 ANNUITY JACKSON NATL LIFE 18,642.00 14 BANKERS LIFE AND CASUALTY COMPANY 14,352.18 15 ING FINANCIAL LIFELINE - RELIASTAR 20,507.91 16 PRUDENTIAL LIFE 84.00 STF PA42021F.9 TOTAL (Also enter on line 5, Recap"ulalion) $ (If more space is needed, insert additional sheets of the same size) 242,366.35 REV-15D9 EX + (1-97) (I) COMMQMo\€AlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT r.€CEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF ESTATE OF CHARLES L. EWING FILE NUMBER If an asset was n.de joint within one year "'the decedent's date of dath, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEI):NT A. B. c. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FORJOlNT MADE lrrlt.de name 01 f1narrialinslituion;nl bark aCCOUJl runber orsimilar idrifyilll runber. DATE OF DEATH DECD'S VAlUE OF NUMBER TENANT J~NT AtIact1deedfOfjoi~realestate. VAlUE OF ASSET INTEREST DECl:DENT'S INTEREST 1. A. TOTAL (Also enter on line 6, Recapitulation) $ .. (If more space IS needed, Insert additIOnal sheets of the same sIZe) STFPA42D21F,10 REV-1510 EX+ (1-97) (I) COMMO/MEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER.VlVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF ESTATE OF CHARLES L. EWING FILE NUMBER This schedule must be completed and filed ilthe answer to any 01 questions 1 through 4 on the r....erse side of the REV-1500 COVER SHEET is yes. OESCRIPTION OF PROPERTY %OF I ITEM INCLUDE TIlE NAME OF THE TRANSFEREE, TIlEIR RELATIONSHIP TO DECEDENT AND THE DATE OATEOFOEATH DECO'S EXCLUSION TAXABLE VALUE NUMBER OF TRANSFER. ATTAQi A COP'f OF "THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) 1. TOTAL (Also enter on line 7, RecapRulation) $ (If more space is needed, insert addRiona sI1eets of the same size) STF P A42021 F 11 REV.1511 EX + (1-97) (I) COMMON'AEAlTH OF PENNSYlVANIA lNHERITAfICE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF ESTATE OF CHARLES L. EWING FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. FUNERAL EXPENSES 313.52 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative{s) Social Security Number(s) f EIN Number of Personal Representative{s) street Address Oty State Zip Year(s) Commission Paid: 2. Attorney Fees 1,371.00 3. Family Exemption: (If decedent's address is not the same as daimant's, attach explanation) Claimant street Address Oty Slate Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accoontanfs Fees 6. Tax Retum Preparer's Fees 850.00 7. MEDICAL 881. 03 2 NURSING HOME BILLS 6,840.00 TOTAL (Also enter on line 9, Recapoulalion) $ 10 255.55 (If more space is needed, insert addoional sheets of the same Size) STF PA42021 F.12 REV.1512 EX i" (1.97) (I) COMMOfINvEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF ESTATE OF CHARLES L. EWING FILE NUMBER Include unreimbursed medical expenses. ITEM NUMBER 1. DESCRIPTION AMOUNT TOTAL (Also enter on line 10, Recapitulation) $ (If more space IS needed, Insert additional sheets of the same sIZe) STF P A42021 F. 13 REV-1513 EX oj. (9-00) COMMOfIM€ALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECECA;NT SCHEDULE J BENEFICIARIES ESTATE OF ESTATE OF CHARLES L. EWING FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTiONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. 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 ELECTIONTO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRiBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, Insert additional sheets of the same size) STF PA42021 F.14 REV-1514 EX + (1-97) (I) COMMO~LTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN (Check Box 4 on Rev-1S00 Cover Sheet) ESTATE OF FILE NUMBER ESTATE OF CHARLES L. EWING 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 singie 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. DWill Dlntervivos Deed ofTrust DOther LIFEESTATEINTeRESTcALCULATION NAME(S) OF NEAREST AGE AT TERM OF YEARS LIFE ESTATE IS LIFE TENANT(S) DATE OF BIRTH DATE OF DEATH PAYABLE OUleor OTenn olYears o Ufe or OTennofYears o Ufe or OTenn olYears OUfeor OTenn olYears 1. Value of fund from which life estate is payable 2. Actuarial factor per appropriate table Interesttable rate - 03 1/2% 06% 0 10% 3. Value of life estate (Line 1 multiplied by Line 2) ANNI.l\'1'Y.INTERESTiCALCULATiON $ o Variable Rate % $ NAME(S) OF NEAREST AGE AT TERM OF YEARS ANNUITANT(S) DATE OF BIRTH DATE OF DEATH ANNUITY IS PAYABLE OUfeor OTenn olYears o ute or OTennofYears OUfeor OTennolYears OUfeorOTennofYears 1. Value of fund from which annuity is payable $ 2. Check appropriate block below and enter corresponding (number) Frequency of payout - OWeekty (52) 0 Bi-weekly (26) 0 Monthly (12) o Quarterly (4) 0 Semi-annually (2) o Annually (1) o 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 03 1/2% 06% 010% 0 Variable Rate % 6. Adjustment Factor (see instructions) 7. Value of annuity -If using 31/2%, 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 taxrate on Lines 13, 15,18and17. (II more space is needed, insert add"ional sheets of the same size) STF PA42021 F 15 REV_1647 EX -+ (9-00) COMMOt'M~AlJH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE M FUTURE INTEREST COMPROMISE (Check Box 4a on Rev-15OC) Cover Sheet) ESTATE OF FILE NUMBER ESTATE OF CHARLES L. EWING This schedule is appropriate only for estates 01 decedents dying alter December 12, 1982. This schedule is to be used for all future interests v.I1ere the rate of tax v.!lich v.ill be applicable v.!len the future interest vests in possession and enjoyment cannot be established v.ith certainty. Indicate below the type of instrument v.!lich created the future interest and attach a copy to the tax return. o Will 0 Trust 0 Other 1. Beneficiaries NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. 2. 3. 4. 6. IL For decedents dying on or after July 1, 1994, if a sur.;ving spouse exercised or intends to exercise a right of v.ithdrawal v.ithin 9 months of the decedent's death, check the appropriate block and attach a copy of the document in v.!lich the sur.;ving spouse exercises such v.ithdrawal right. 0 Unlimited right of withdrawal 0 Limited right of withdrawal IlL Explanation 01 Compromise Offer: IY. Summary of Compromise Oller: 1. Amount of Future Interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..."" ................... $ 2. Value of Line 1 exempt from tax as amount passing to chartties, 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 otlotal shown on Line 16 of Cover Sheet) 5. Value of Line 1 Taxable at sibling rate (12%) (also 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) ................................ $ STFPA42021F16 (If more space is needed, insert addttional sheets of the same size) REV-1649 EX+ (1-97) (Il COMMOI'MEAlTH oF PENNSYLVANIA INHERITANCE 1M RETURN RESIDENT r:tCEDENT SCHEDULE 0 ELECTION UNDER SEC. 9113(A) (SPOUSAL DISTRIBUTIONS) ESTATE OF FILE NUMBER ESTATE OF CHARLES L. EWING Do not complelethis schedule unless the estate is making the election to tax assets under Section 9113 (A) of thelnher~ance & Estate Tax Act. lIthe election applies to more than one trust or similar anangement, a separate form must be filed for each trust. This election applies to the Trust (marital, residual A, B, By-pass, Unified Credit, etc.). If a trust or similar anangement meets the requirements of Section 9113 (A), and: a. The trust or similar anangement is listed on Schedule 0, and b. The value of the trust or similar anangement is entered in whole or in part as an asset on Schedule 0, then the transferor's pOlOOnaI representative may speci~cally 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 vaue of the trust or similar property is included as a taxable transfer on Schedule 0, the pOlOOnal representative shell be considered to haVe made the election only as \0 a fraction of the trust or similar anangement. The numerator of this fraction is equal to the amount of the trust or similar anangernent included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar anangement. PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113 (A) trust or similar arrangement. OESCRIPTION VALUE Part A Total $ PART B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is being made. DESCRIPTION VALUE Part B Total $ (If more space is needed, insert additional sheets of the same size) STF PA42021 F.17