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HomeMy WebLinkAbout11-28-14 J REV-1500 EX(02-11)(FI) 1505611185 OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN 21 14 0 517 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 02272014 09061942 Decedent's Last Name Suffix Decedent's First Name M I EARHART TERRY L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI EARHART DONNA B Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW 1. Original Return ❑ 2. Supplemental Return ❑ 3. Remainder Return(Date of Death Prior to 12-13-82) ❑ 4. Limited Estate ❑ 4a. Future Interest Compromise(date of ❑ 5. Federal Estate Tax Return Required death after 12-12-82) ❑ 6. Decedent Died Testate ❑ 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) ❑ 9. Litigation Proceeds Received ❑ 10. Spousal Poverty Credit(Date of Death ❑ 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) o n CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMAMISI SjiOULD BE-1IRECTOITm?1 Name Daytime Te elmber n � C= VANCE E • ANTONACCI 717-58 1�3:MD r7l 1`11 REGISTER TVNiLL§US MLY ;:IJ C1 J C.) til 1l First Line of Address -n 570 LAUSCH LANE -i r c ca Second Line of Address S SUITE 200 City or Post Office State ZIP Code DATE FILED LANCASTER PA 17601 Correspondent's e-mail address: V A N T O N A C C I a@ M W N • C O M Under penalties of perjury, I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE RESPONSIBkE FOR DATE ADDRESS 27 EASTGATI1 JORIVE CAMP HILL, PA 17011 SIGNATURE OF PREP R H AN REPRESENTATIVE DATE ADDRESS PO BOX 1166 HARRISBURG, PA 17108-1166 PLEASE USE ORIGINAL FORM ONLY Side 1 1505611185 OM46473.000 1505611185 J � I 1505611285 REV-1500 EX(FI) RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . • • 1. 0 . 00 2. Stocks and Bonds(Schedule B) . . . . . . . ... . . . . . . . . . . . . . . . . 2. 4-1077 - 00 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C). . . . . 3. 0 • 00 4. Mortgages and Notes Receivable(Schedule D) . . . . . . . . . . . . . . . . . 4. 0 • 00 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) . . . . , 5. . 991908 • 00 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . 6. 0 . 00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested . . . . 7. 0 . 00 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . 8 103-1985 • 00 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . 9, 11-,349 • 00 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) . . . . . , . . . 10. 0 • 00 11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . . . . . . . . 11. 11-1349 • 00 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . 12. 92-1636 • 00 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J). . . . . . . . . . . . . . . . 13. 0 , 00 14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . . . . . . . . . . . . 14 921636 • 00 TAX CALCULATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.00 92 ,636 . 00 15. 0 . 00 16. Amount of Line 14 taxable at lineal rate X.0_4_5 0 . 00 16. 0 . 00 17. Amount of Line 14 taxable at sibling rate X.12 0 . 00 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 0 . 00 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 1505611285 1505611285 OM4648 3.000 REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: 21 14 0517 DECEDENT'S NAME EARHART TERRY L STREET ADDRESS 27 EASTGATE DRIVE CUMBERLAND CITY STATE ZIP CAMP HILL PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 0 . 00 2. Credits/Payments A. Prior Payments 0 . 00 B. Discount 0 . 00 Total Credits(A+B) (2) 0 . 00 3. Interest (3) 0 . 00 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) 0 . 00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0 . 00 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred . . . . . . . . . . . . . . . . . . . . . . . . ❑ b. retain the right to designate who shall use the property transferred or its income . . . . . . . . . . ❑ c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d. receive the promise for life of either payments,benefits or care? . . . . . . . . . . . . . . . . ❑ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ T 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ❑ 4. Did decedent own an individual retirement account, annuity, or other non-probate property,which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ ❑X IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [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 of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent(72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[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 percent [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. OM4671 2.000 REV-1503 EX+(8-12) pennsylvania SCHEDULE B DEPARTMENT OF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER Terry L. Earhart 21 14 0517 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 113 Shares SunLife Financial Inc. 3,900 2 100 Par U.S. Savings Bond, Series EE, Issue date 09/1987 50 Interest accrued to 2/27/2014 127 TOTAL (Also enter on Line 2,Recapitulation) $ 4,077 2w4596 2.000 If more space is needed, insert additional sheets of the same size REV-1508 EX+(08-12) pennsylvania SCHEDULE E DEPARTMENTOF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Terry L. Earhart 21 14 0517 Includethe proceeds of litigation and the date the proceeds were received by the estate. All propertjointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH t. Asbestos Litigation Proceeds 99,908 At the time of his death, the decedent was a plaintiff in asbestos litigation. The amount being reported is the survival action portion of the proceeds received by the decedent's estate in June 2014. Per the attorney handling the asbestos litigation, the survival action is 60% of the proceeds received of $166,513.74. See attached copy of settlement information and allocation information. TOTAL(Also enter on line 5,Recapitulation) $ 99,908 2W48AD 2.000 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(0B-13) SCHEDULE H pennsylvania DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Terry L Earhart 21 14 0517 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Malpezzi Funeral Home 5,716 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. Attorney Fees: McNees Wallace & Nurick LLC (estimated) 5,000 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 339 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. 1 McNees Wallace & Nurick LLC Costs Advanced re: Duplicating $28.80 Toll Calls .30 Fed Ex Charges 31.27 Total from continuation schedules . . . . . . . . . 294 TOTAL(Also enter on Line 9,Recapitulation) $ 11,349 3W46AG 2.000 If more space is needed, use additional sheets of paper of the same size. Estate of: Terry L. Earhart 21 14 0517 Schedule H Part 7 (Page 2) 1 Postage 5.74 66 2 McNees Wallace & Nurick LLC Reserve for closing costs re duplicating, postage, etc. 50 3 Martin Merry & Reid Limited Surety Fee for lost certificate re Sun Life Financial stock 128 4 Cumberland County Register of Wills Filing fee re disclaimers 50 Total (Carry forward to main schedule) 294 REV-1512 EX+(12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Terry L. Earhart 21 14 0517 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 None TOTAL(Also enter on Line 10,Recapitulation) $ 0 2w46AH 2.000 If more space is needed, insert additional sheets of the same size. REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Terry L. Earhart 21 14 0517 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS[include outright spousal distributions and transfers under Sec.9116(a)(11)] 1. Donna B. Earhart 27 Eastgate Drive Camp Hill, PA 17011 100% of residue * *Per the intestate rules, the first $30,000 of the estate residue plus 1/2 of the estate residue is distributable to the spouse. The other 1/2 of the estate residue is distributable to the decedent's three children, however the children, and those who could claim through them, disclaimed their interest in the estate residue. As a result, 100% of the estate residue passes to the spouse. See attached copies of disclaimers filed. Surviving Spouse 92,636 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 0 9W46AI 2000 If more space is needed,use additional sheets of paper of the same size, ESTATE OF TERRY L . EARHART NO . 21 - 1 4 -0517 COPY - SHORT CERTIFICATE EVIDENCING APPT . OF DONNA B . EARHART COMMONWEALTH OF PENNSYLVANIA SHORT CERTIFICATE COUNTY OF CUMBERLAND RRI 1, LISA M. GRA YSON, ESQ. Register for the Probate of Wills and Granting Letters of Administration in and for CUMBERLAND County, do hereby certify that on the 27th day of May, Two Thousand and Fourteen, Letters of ADMINISTRATION in common form were granted by the Register of said County, on the estate of TERRY L EARHART late of HAMPDEN TOWNSHIP (First,Middle,Last) a/k/a TERRY LEE EARHART in said county, deceased, to DONNA B EARHART (First,Middle,Last) and that same has not since been revoked. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office at CARLISLE, PENNSYLVANIA, this 27th day of May Two Thousand and Fourteen. Fi 1 e No. 2014- 00517 PA Fi 1 e No. 21- 14- 0517 Date of Death 212712014 S. S. # VTR is er Of Wi i j. uty NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL ESTATE OF TERRY L . EARHART NO . 21 - 1 4 -0517 SAVINGS BOND VALUATION Inventory Report Active Inventory Print Date: 11/10/2014 Bonds: File P icing Date: 02/2014 Issue Next Interest Final Maturity No. Series Denom Serial Number Date Price Interest Value Rate Yield Date Date Note 1 1 EE 1 $100 09/1987 $50.00 $127.00 $177.00 4.00% 4.92% 03/2014 1 09/2017 Invento Totals: Bonds Price Interest Value 1 $50.001 $127.00 $177.00 • CI-bond was Cashed In • EX-bond was EXchanged for an HH bond • MA-bond is MAtured and not earning interest • NE-bond is Not yet Eligible for payment • NI -bond has Not yet been Issued • P5-bond is a Series I or EE,was issued in or after May 1997 and includes a 3-month-interest Penalty until the bond is 5 years old • ' bond is a Series I or EE,was issued in or after January 1990 and may be tax exempt if used for post-secondary education • Q bond was Cashed In or EXchanged for an HH bond, but is being priced on a date prior to the cashed or exchanged date Untitled 1 Page 1 of 1 ESTATE 01F TERRY L . EARHART NO . 21 - 1 4 -0517 ASBESTOS LITIGATION INFORMATION W E I T Z L U X . , E N B E R G A PR0FESSI0 NAL CORPORATION • -LAW - O F F I CES- 700 BROADWAYNEW YORK-,NY 10003 TEL.212-558-5500 FAX 212-344-5461 W W W.WMzLU3LCOM PERRY WEI TZ ARTHUR M.LUXENBERG ROBERT J.GORDON tt PHAN T ALVARADO CHARLES M.FERGUSON MATTHEW MACINTYRE PETER SAMBERG tt OIC .W BENNO ASHRAFI O SARAH J.FETHERSTON CURT D.MARSHALL t LEONARD SANDOVAL O i Alm admitted In CT DAVID J.BARRY ARI FRIEDMAN o SAMUEL M.MEIROWITZ GENNARO SAVASTANO Abu•d.* d m FL JAMES J.BILSBORROW MARY GRABISH GAFFNEY I JAMES A.MORRIS,JR.••• CINDY YOUNG SAXEY o n Aho ae ea inNJ DANIEL P.BLOUIN ALANI GOLANSKI t KEVIN MULDERIG I JONATHAN M.SEDGH 5 Al ad d M DC •Al-aemMW m OH AMBRE J.9RANDIS DANIELLE M.GOLD tt DANA M.NORTHCRAFT tt KYLE A.SHAMBERG•• t Aha admkW in w and CT EDWARD BRANIFF tt KENDRA Y GOLDHIRSCH TODD OMMEN SHELDON SILVER• -Also admitted in NJ and PA JOHN M.BROAODUS# LAWRENCE GOLDHIRSCH°' FRANK M.ORTIZ tt ROBERT M.SILVERMAN I •Also adminad In w and DC VENUS BURNS o ROBIN L GREENWALD•" JOSIAH W.PARKER o DONALD SOUTAR I Aho admMed In w and ME PATTI BURSHTYN tt CARLOS GUZMAN o MICHAEL E.PEDERSON TYLER R.STOCK o •AJw eamMed e,DC'VA as Aha admMad M CO LISA NATHANSON BUSCH T.SCOTT HAMES O PAUL J.PENNOCK t PETER TAMBINI tt •All.edmmad in TX DAVID A.CHANDLER ERIKA HEYDER STUART S.PERRY• JAMES S.THOMPSON tt O AdmMad.ny h CA THOMAS COMERFORD tt§ DANIEL HORNER LEE W.PREVIANT ea WILLIAM A.WALSH tt V AdmMed.ny in NJ and PA ADAM R.COOPER MARIE L.IANNIELLO t' CAITLIN PRZENICZNY O DANIEL WASSERBERG+ Admlde0 o"y in w TERESA A.CURTIN A& ERIK JACOBS SHAREEF RABAA• LAUREN A.WEITZ kbdW any In MA BENJAMIN DARCHE DAVID M.KAUFMAN tt ADAM C.RAFFO JUSTIN J.WEITZ AdmR 0"in DC,MD.PA and VA Ad.1W my In a TIAL DIHN oo TAE-YOON KIM o SUZANNE M.RATCLIFFE tt NEIDRA S.WILSON•• •••A&rAW only in Colmado,Pamayt—A Taxes ADAM S.DREKSLER GARY R.KLEIN tt ELLEN RELKIN•♦O NICHOLAS WISE ME m Ad n and only In CA and tt. F.ALEXANDER EIDEN♦ DANNY R.KRAFT,JR. JOHN E.RICHMOND tt DENA YOUNG♦ ooAd dd d only In CA,wand PA MICHAEL FANELLI tt JERRY KRISTAL••§ MICHAEL P.ROBERTS BRENT ZADOROZNY o °CeNd W.w Coad JAIME M.FARRELL♦♦ DE881 LANDAU CHRIS ROMANELLI tt ALLAN ZELIKOVIC LEONARD F.FELDMAN I LEAH LEWIS•• DAVID ROSENBAND GLENN ZUCKERMAN June 6,2014 VIA REGULAR MAIL Vance Antonacci, Esq. 570 Lausch Lane Suite 200 Lancaster,PA 17601 RE: THE ESTATE OF TERRY L.EARHART Bear Mr.Antonacci: As you are the estate attorney on file for the above-captioned estate,all future checks will be sent to you to distribute in accordance with the local laws of your State/County. Depending on your local laws,you may be required to obtain an Order of Distribution from the Surrogate's/Probate Court in the county that the decedent resided in. Based on the facts of this case,we propose that sixty percent(60%)be allocated to the decedent's conscious pain and suffering and forty percent(40%)be allocated to wrongful death. If you have any questions regarding this matter,please feel free to contact me at(800)438-9786 ext. 5687. Thank you very much for your attention in this matter. Very Truly Yours, avid M.Kaufman,Esq. 200 lake Drive East,Suite 205•Cherry Hill,NJ 08002•(856) 755-1115 1880 Century Park East Suite 700•Las Angeles, CA 90067•(310)247-0921 2179-/23 W E I T Z L U X E N R E R G A PROFESSIONALCORPORATION • LAW Or F I C ES 700 BROADWAY • NEW YORK,\Y 10003.9.1M PERRYI•N£ITZ TEN.JIJ:S,IS:SM FAX 212344-5I61 ARTRUR 11 LUXENBERO WWW.WEITZLUX.CON ROBERT J.GORDON tt PHAN T. AN ALVARADO ARI FRIEDMANI KEVIN MULOERIG9 JONATHAN M.S£DGH BENNOASNRAFII MARYGRASISHGAFFNEY9 DANA M.NORTNCRAFT tt SINELOON SILVER' IA�a•eOnafhGr DAVID J.BARRY AWA GOLANSKIt TODD OLLMEN ROBERT M.SILVERMANB •w+a vr+nlxrt JAMESJ.BILSBORRON DAM ELLE M.GOLD tt FRAN M.ORTIZN DONALD SOVTARI ukaa.f'P/xx ftrx,.s=•s.fhw DANIEL P.SLOUIN LAWRENCE GOtOHIRSCH•• JOSNH W.PARKER I CARMEN VICTORIA ST.GEORGE t t SMa.c.,wf xa: AMBRE J.BRANS KENDRAY.GOLDHIRSCH MICHAELE PEDERSON MER RSTOCK I •M>Wrefxpl ,EUtNARO BRANIFF tt ROBIN L GRECNNALD•SS PAUL J.PENNOCK PETERTAM81NIft 1Fi>•EnWfhwaM cr JOWL M.BROADDIJS£ CARLOS GUZMAN I STUART S.PERRY' JN,(E$$.THOMPSON tt «At1 wx>?aaa nw ra vA VEAUSBURNS4 ERIKA HEYOER LEEWPREVUNTHo WALLAMAWALSHtT �Aia aCnTofhw.+fa PATTI BURSHTYN tt MARIE L IANNIELLO t• CAITUN PRZENICINY I DANIELWASSERBERGI LSA+•.tvmJ•awafrt LISA NATHANSON BUSCH ERIKJACOBS SHAREEF PASA• IAURFJIAYIEITZ •A4••ssW hMW4VA THOMAS COMERFORD tt S DAVID LL KAUFMAN tt ADAM C.RAFFO JUSTINJ.WEITZ -A, aW. Aco ADAM RCOOPER TAEYOON KIM SUZANNE M.RATCLIFFE tt NEK)RASVALSON- '�Iaameuxnc 7ERESAA CORTIN M GARY R KLEIN tt PIERRE RATZ10 NICHOLAS VASE•° IA.a.,w vry:•u (A:atlrJ•rlthw•tl PA BENJAMIN DARCHE DANNY RKRAFT.JR ELLEN REWN•«££r DE0/AYouNa9 .As.,a.f mYhw TIAT.DIWN-I JERRY KRJSTAL••§ JOAN E.RICHMOND tt BRENNTZADOROZNYI iwf•uv yna.w.vAwvA ADAM$.OREKSLER DEBSI LANDAU MICHAEL P.ROBERTS ALWIIELIKOYiC it Cb "'.ws.•.w Ca F.ALEXANDER EIDEN• LEAN LEWS- CHRIS ROMANELLI tt GLENN ZUCKEWAN I M..+IWx PA MICHAELFANELLJ tt MATTHEVIMACINTYRE OAMO ROSENSAND AA ."JoyhW JAIME M FARRELL a CURT D.MARSHALL T PETER BAMBERG tt LEONARD F.FELOYANl 9 SAMUEL RL MEIROVTrZ OENNAROSAVASTANO CHARLES M.FERGUSON JAMESA MORRIS JR•h1 CINDY YOUNG SAXEY 1 06/03/2014 Vance E Antonacci,Esq. 570 Lausch Lane Suite 200 Lancaster,PA 17601 RE: Terry L Earhart #205765 Dear Sir/Madame: Enclosed,please find a checks)in the amount of$166,513.74,which represents settlement proceeds Weitz&Luxenberg,P.C. has received fiom defendant(s) COMBUSTION ENGINEERING TRUST,VIACOM,INC.,as successor by inerger to CBS CORPORATION,f/k/a WESTINGHOUSE ELEC Plus interest.Please refer to the enclosed balance sheet for the details concerning this settlement payment. Please note that this estate has full letter status,therefore,in as much as your firm is the attorney for the estate of this client,it is your responsibility to ensure that these funds are properly distributed.If all necessary filings have been completed for this estate and you wish to have future checks made payable to the estate representative,please notify us in writing of such request. Should you have any questions,please contact our Estates Attorney,David Kaufman at(212) 558 -5687. Sincerely, WEITZ&LUXENBERG,P.C. Accounting Department 200 LAKE DRIVE EAST,SUITE 205•CHERRY HILL,NJ 08002•TEL 856-755-1115 1880 CE1%TrURY PARK EAST.SUITE 700 •IAS ANGELES.CA 90067 9 TEL 310-247.0921 reference to check #5465531 for $166,513.74 Earhart,Terry L(dec) 205765 33.33 HE] Defendant COMBUSTION ENGINEERING TRUST ............................................. .. .........•-------- -- --- ----•----•- ..................---------.......---•-----------• --------------------------------------------------------- •------------------------ SettlementAmount $24,750.00 .................................--------------------------- . - - ----...--------.---... amount paid by defendant $24,750.00Interest $0.00 ----------------------------•-•-•--•--------................... ......................................................... Payble to Payee Name Check Date Check# Amount Int Amount Interest earned from Escrow account Vance Antonacci,Esq.as Attorney for the Estate of Terry L Earhart 06/03/2014 5465531 $24.09 $0.00 Retainer Fee Weitz&Luxenberg,P.C. $8,244.83 $0.00 W&L Expenses Weitz&Luxenberg,P.C. $15.52 $0.00 Client net Vance Antonacci,Esq.as Attorney for the Estate of Terry L Earhart 06/03/2014 5465531 $16,489.65 $0.00 Sub Total $24,774.09 Total $24,774.09 Defendant VIACOM,INC.,as successor by merger to CBS CORPORATION,f/k/a WESTINGHOUSE ELEC ------------------- -------------------------- -- -- - --------------------------------------------------------- .....- ._.._..._..-----------.............................................-............................. Settlement Amount $225,000.00 amount paid by defendant $225,000.00 Interest $0.00 ................................... - -........... ......................................................... Payble to Payee Name Check Date Check# Amount Int Amount Retainer Fee Weitz&Luxenberg,P.C. $75,000.00 $0.00 Client net Vance Antonacci,Esq.as Attorney for the Estate of Terry L Earhart 06/03/2014 5465531 $160,000.00 $0.00 Sub Total $225,000.00 Total $249,774.09 ` -items in bold-parts of referenced check Page 1 of 2 printed on Tuesday,June 03,2014 04:36 PM ESTATE OF TERRY L . EARHART NO . 21 - 1 4 -0517 COPY - DISCLAIMERS FILED IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION Estate of TERRY L. EARHART Ia C No. 2014-00e1 b -� rn m Late of Hampden Township, ' Deceased n m cn ' rn Cn � o DISCLAIMER OF INTEREST PURSUANT o TO CHAPTER 62 OF THE PENNSYLVANIA PROBATE, ESTATES AND fID"QCIARIIES m CODE, SECTION 9116(c) OF THE PENNSYLVANIA INHERITANCE Ta ACT, ANE). . SECTION 2518 OF THE INTERNAL REVENUE CODE 1. Terry L. Earhart died intestate on February 27, 2014. 2. Terry L. Earhart was survived by his spouse, Donna B. Earhart, and his three (3) children, Hugh Earhart; David Earhart, and Allison Simpson. 3. Pursuant to Sections 2102 and 2103 of the Pennsylvania Probate, Estates and Fiduciaries Code, the Decedent's Estate is distributable as follows: (1) First $30,000 plus one- half of the estate residue to the Decedent's spouse, Donna B. Earhart, and (2) one-half of the remaining estate residue equally between the Decedent's issue, Hugh Earhart, David Earhart, and Allison Simpson. 4. Allison Simpson of 1012 W. Poplar Avenue, York, PA 17404 (hereinafter "Disclaimant") desires to disclaim her right and interest to her 1/3rd share of the one-half of the estate residue passing to the Decedent's issue. 5. Section 6201 of the Pennsylvania Probate, Estates and Fiduciaries Code (20 Pa. C.S. § 6201) provides that any person to whom an interest in property would have devolved may disclaim that person's interest in whole or in part by a written disclaimer that (a) describes the interest disclaimed, (b) declares the disclaimer and extent thereof, and (c) is signed by the disclaiming person. 6. Disclaimant has been advised of the legal and tax consequences of executing this Disclaimer. 7. Disclaimant.therefore does hereby and forever irrevocably disclaim, renounce, and refuse to accept all right, title, and interest that Disclaimant does or may have to a 1/3`d share of one-half of the estate residue passing to the Decedent's issue. 8. It is the intent of Disclaimant that this Disclaimer constitute a qualified disclaimer under law, including Chapter 62 of the Pennsylvania Probate, Estates and Fiduciaries Code, section 9116(c) of the Pennsylvania Inheritance Tax Act (72 P.S. § 9116(c)), and section 2518(b) of the Internal Revenue Code of 1986 (26 U.S.C. § 2518(b)), and that it and all of its provisions be so interpreted. IN WITNESS WHEREOF, intending to be legally bound and intending to comply with all provisions concerning the validity of this Disclaimer, Disclaimant has hereunto set her hand and seal this day of 12014. WITNESS: DISCLAIMANT: Am fll5� Allison Simpson COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF 6 On this, the 9"qday of '5jV , 2014, personally appeared Allison Simpson, known to me to be the person whose name is subscribed to the foregoing Disclaimer and acknowledged that she executed the same for the purposes therein specked and further stated that she desired that such Disclaimer be recorded as such to the extent required by law. IN WITNESS WHEREOF, I have hereunto set my hand and Notarial seal. COMMONWEALTH OF PENE SYLV NIA NOTARULSEAL 44,otary Public MICHELLE SAILER.Ndary ftVC Flamp�n Twp.CumbsAand County My Canmis M E*na May T.2018 2 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION N O Estate of cM C) :0 Cn rn - o TERRY L.�EARHART No. 2014-00517 to a Late of Hampden Township, C> :, Deceased , = - C> M w r rn o �> co `n DISCLAIMER OF INTEREST PURSUANT TO CHAPTER 62 OF THE PENNSYLVANIA PROBATE, ESTATES AND FIDUCIARIES CODE, SECTION 9116(c) OF THE PENNSYLVANIA INHERITANCE TAX ACT, AND SECTION 2518 OF THE INTERNAL REVENUE CODE 1. Terry L. Earhart died intestate on February 27, 2014. 2. Terry L. Earhart was survived by his spouse, Donna B. Earhart, and his three (3) children, Hugh Earhart, David Earhart, and Allison Simpson. 3. Pursuant to Sections 2102 and 2103 of the Pennsylvania Probate, Estates and Fiduciaries Code, the Decedent's Estate is distributable as follows: (1) First $30,000 plus one- half of the estate residue to the Decedent's spouse, Donna B. Earhart, and (2) one-half of the remaining estate residue equally between the Decedent's issue, Hugh Earhart, David Earhart, and Allison Simpson. 4. Allison Simpson disclaimed her right and interest to her 1/3`d share of the one- half of the estate residue passing to the Decedent's issue; therefore her disclaimed share would pass to her issue, namely Jakyra Simpson, Aryana Simpson, and Alaina Simpson. 5. Aryana Simpson (age 16) and Alaina Simpson (age 14) are minors, therefore Allison and Ryandell Simpson, as the natural guardians of their respective estates (hereinafter the "Disclaimants") hereby desire to disclaim on behalf of Aryana and Alaina, any right and interest to the estate residue passing to them as a result of the disclaimer of Allison Simpson. 6. Section 6201 of the Pennsylvania Probate, Estates and Fiduciaries Code (20 Pa. C.S. § 6201) provides that any person to whom an interest in property would have devolved may disclaim that person's interest in whole or in part by a written disclaimer that (a) describes the interest disclaimed, (b) declares the disclaimer and extent thereof, and (c) is signed by the disclaiming person. 7. Disclaimants have been advised of the legal and tax consequences of executing this Disclaimer. 8. Disclaimants, as the natural guardians for the estates of Aryana and Alaina Simpson, therefore do hereby and forever irrevocably disclaim, renounce, and refuse to accept all right, title, and interest that Aryana and Alaina do or may have to the estate residue passing to them as a result of the disclaimer of Allison Simpson. 9. It is the intent of Disclaimants that this Disclaimer constitute a qualified disclaimer under law, including Chapter 62 of the Pennsylvania Probate, Estates and Fiduciaries Code, section 9116(c) of the Pennsylvania Inheritance Tax Act (72 P.S. § 9116(c)), and section 2518(b) of the Internal Revenue Code of 1986 (26 U.S.C. § 2518(b)), and that it and all of its provisions be so interpreted. IN WITNESS WHEREOF, intending to be legally bound and intending to comply with all provisions concerning the validity of this Disclaimer, Disclaimants have hereunto set their hand and seal this day of SAL : , 2014. WITN S DISCLAIMANTS: Allison Simpson, Natural uardian for Aryana Simpson and Alaina Simpson Rya dell Simpso , Natural G ardian for Aryana Simpson and Alaina Simpson 2 COMMONWEALTH OF PENNSYLVANIA SS: 'COUNTY OF � � On this, the a!� day of SJ\ 2014, personally appeared Allison Simpson and Ryandell Simpson, known to me to be the individuals whose name are subscribed to the foregoing Disclaimer and acknowledged that they executed the same for the purposes therein specified and further stated that they desired that such Disclaimer be recorded as such to the extent required by law. IN WITNESS WHEREOF, I have hereunto set my hand and Notarial seal. COMMONWEALTH OF PEN+`: YLVANIA NOTARIAL SEAL MICHELLE BAKER.Notn Pubk Hampden Twp..CwnYerlaWCW* 'otary Public My Comms W Expires Man►7.2018 3 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION Estate of TERRY L. EARHART No. 2014-00517 c rnrn Late of Hampden Township, c} , -� C'> Deceased : n r- ry cs en -n DISCLAIMER OF INTEREST PURSUANT TO CHAPTER 62 OF THE PENNSYLVANIA PROBATE, ESTATES AND FIDUCE{ARTE-S w F m CODE, SECTION 9116(c) OF THE PENNSYLVANIA INHERITANCE TAX ACT;-ARb o SECTION 2518 OF THE INTERNAL REVENUE CODE > W 1. Terry L. Earhart died intestate on February 27, 2014. 2. Terry L. Earhart was survived by his spouse, Donna B. Earhart, and his three (3) children, Hugh Earhart, David Earhart, and Allison Simpson. 3. Pursuant to Sections 2102 and 2103 of the Pennsylvania Probate, Estates and Fiduciaries Code, the Decedent's Estate is distributable as follows: (1) First $30,000 plus one- half of the estate residue to the Decedent's spouse, Donna B. Earhart, and (2) one-half of the remaining estate residue equally between the Decedent's issue, Hugh Earhart, David Earhart, and Allison Simpson. 4. Allison Simpson disclaimed her right and interest to her 1/3`d share of the one- half of the estate residue passing to the Decedent's issue; therefore her disclaimed share would pass to her issue, namely Jakyra Simpson, Aryana Simpson, and Alaina Simpson. 5. Jakyra Simpson, currently residing at 1012 W. Poplar Avenue, York, PA 17404 desires to disclaim her right and interest to the estate residue passing to her as a result of the disclaimer of Allison Simpson. 6. Section 6201 of the Pennsylvania Probate, Estates and Fiduciaries Code (20 Pa. C.S. § 6201) provides that any person to whom an interest in property would have devolved may disclaim that person's interest in whole or in part by a written disclaimer that (a) describes the interest disclaimed, (b) declares the disclaimer and extent thereof, and (c) is signed by the disclaiming person. 7. Disclaimant has been advised of the legal and tax consequences of executing this Disclaimer. 8. Disclaimant therefore does hereby and forever irrevocably disclaim, renounce, and refuse to accept all right, title, and interest that Disclaimant does or may have to the estate residue passing to her as a result of the disclaimer of Allison Simpson. 9. It is the intent of Disclaimant that this Disclaimer constitute a qualified disclaimer under law, including Chapter 62 of the Pennsylvania Probate, Estates and Fiduciaries Code, section 9116(c) of the Pennsylvania Inheritance Tax Act (72 P.S. § 9116(c)), and section 2518(b) of the Internal Revenue Code of 1986 (26 U.S.C. § 2518(b)), and that it and all of its provisions be so interpreted. IN WITNESS WHEREOF, intending to be legally bound and intending to comply with all provisions concerning the validity of this Disclaimer, Disclaimant has hereunto set her hand and seal this day.of , 2014. WIT DISCLAIMANT: Aakyra Siphpson 2 COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF On this, the day of 2014, personally appeared Jakyra Simpson, known to me to be the person whose name is subscribed to the foregoing Disclaimer and acknowledged that she executed the same for the purposes therein specified and further stated that she desired that such Disclaimer be recorded as such to the extent required by law. IN WITNESS WHEREOF, I have hereunto set my hand and Notarial seal. COMMONWFI:LTH QF FEIVASYLVANIA � � NOTARIALSEAL Notary Public MICHELLE BAKER,NOW Public Hampden Twp.,Cumberland COUMY My Cwvft lon Expires May 7.2014 3 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION N_ `L" M Estate of co � o TERRY L. EARHART r -v No. 2014-00517 r- .. M cn Late of Hampden Township, = "' c c� , -4 - Deceased C= w m -Qn Ca DISCLAIMER OF INTEREST PURSUANT TO CHAPTER 62 OF THE PENNSYLVANIA PROBATE, ESTATES AND FIDUCIARIES CODE, SECTION 9116(c) OF THE PENNSYLVANIA INHERITANCE TAX ACT, AND SECTION 2518 OF THE INTERNAL REVENUE CODE 1. Terry L. Earhart died intestate on February 27, 2014. 2. Terry L. Earhart was survived by his spouse, Donna B. Earhart, and his three (3) children, Hugh Earhart, David Earhart, and Allison Simpson. 3. Pursuant to Sections 2102 and 2103 of the Pennsylvania Probate, Estates and Fiduciaries Code, the Decedent's Estate is distributable as follows: (1) First $30,000 plus one- half of the estate residue to the Decedent's spouse, Donna B. Earhart, and (2) one-half of the remaining estate residue equally between the Decedent's issue, Hugh Earhart, David Earhart, and Allison Simpson. 4. Hugh Earhart of 2011 Dickinson Avenue, Camp Hill, PA 17011 (hereinafter "Disclaimant") desires to disclaim his right and interest to his 1/3nd share of the one-half of the estate residue passing to the Decedent's issue. 5. Section 6201 of the Pennsylvania Probate, Estates and Fiduciaries Code (20 Pa. C.S. § 6201) provides that any person to whom an interest in property would have devolved may disclaim that person's interest in whole or in part by a written disclaimer that (a) describes the interest disclaimed, (b) declares the disclaimer and extent thereof, and (c) is signed by the disclaiming person. 6. Disclaimant has been advised of the legal and tax consequences of executing this Disclaimer. 7. Disclaimant therefore does hereby and forever irrevocably disclaim, renounce, and refuse to accept all right, title, and interest that Disclaimant does or may have to a 1/3`d share of one-half of the estate residue passing to the Decedent's issue. 8. It is the intent of Disclaimant that this Disclaimer constitute a qualified disclaimer under law, including Chapter 62 of the Pennsylvania Probate, Estates and Fiduciaries Code, section 9116(c) of the Pennsylvania Inheritance Tax Act (72 P.S. § 9116(c)), and sectiorr 2518(b) of the Internal Revenue Code of 1986 (26 U.S.C. § 2518(b)), and that it and all of its provisions be so interpreted. IN WITNESS WHEREOF, intending to be legally bound and intending to comply with all provisions concerning the validity of this Disclaimer, Disclaimant has hereunto set his hand and seal this 30 day of 3 V N& 2014. WITNESS: DI n, AIMANT: Hu Earhart COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF*NO On this, the3AA day of 2014, personally appeared Hugh Earhart, known to me to be the person whose name is subscribed to the foregoing Disclaimer and acknowledged that he executed the same for the purposes therein specified and further stated that he desired that such Disclaimer be recorded as such to the extent required by law. IN WITNESS WHEREOF, I have hereunto set my hand and Notarial seal. Notary Public 01)MMONWE ALTH OF PENNSYLVANIA Notarial Seal Naomi Losch,Notary Public yCHarrisburg, lsSlW Expires Aug.County 2 MyComm62015 MEMBER,PENNSYLVANIA ASSOCIATION OF NOTARIES IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA o ORPHANS' COURT DIVISION C> J� M 0 w -v Estate of A r- r M M c n C7 TERRY L. EARHART No. 2014-00517 ' c; c) --I Late of Hampden Township, :, c_ c> w r� m Deceased : y; coCn -n DISCLAIMER OF INTEREST PURSUANT TO CHAPTER 62 OF THE PENNSYLVANIA PROBATE, ESTATES AND FIDUCIARIES CODE, SECTION 9116(c) OF THE PENNSYLVANIA INHERITANCE TAX ACT, AND SECTION 2518 OF THE INTERNAL REVENUE CODE 1. Terry L. Earhart died intestate on February 27, 2014. 2. Terry L. Earhart was survived by his spouse, Donna B. Earhart, and his three (3) children, Hugh Earhart, David Earhart,.and Allison Simpson. 3. Pursuant to Sections 2102 and 2103 of the Pennsylvania Probate, Estates and Fiduciaries Code, the Decedent's Estate is distributable as follows: (1) First $30,000 plus one- half of the estate residue to the Decedent's spouse, Donna B. Earhart, and (2) one-half of the remaining estate residue equally between the Decedent's issue, Hugh Earhart, David Earhart, and Allison Simpson. 4. Hugh Earhart disclaimed his right and interest to his 1/3 rd share of the one-half of the estate residue passing to the Decedent's issue; therefore his disclaimed share would pass to his issue, namely Matthew Earhart, Daniel Earhart, and William Earhart. 5. Matthew Earhart, currently residing at 2011 Dickinson Avenue, Camp Hill, PA 17011 (hereinafter the "Disclaimant") desires. to disclaim his right and interest to the estate residue passing to him as a result of the disclaimer of Hugh Earhart. 6. Section 6201 of the Pennsylvania Probate, Estates and Fiduciaries Code (20 Pa. C.S. § 6201) provides that any person to whom an interest in property would have devolved may disclaim that person's interest in whole or in part by a written disclaimer that (a) describes the interest disclaimed, (b) declares the disclaimer and extent thereof, and (c) is signed by the disclaiming person. 7. Disclaimant has been advised of the legal and tax consequences of executing this Disclaimer. 8. Disclaimant therefore does hereby and forever irrevocably disclaim, renounce, and refuse to accept all right, title, and interest that Disclaimant does or may have to the estate residue passing to him as a result of the disclaimer of Hugh Earhart. 9. It is the intent of Disclaimant that this Disclaimer constitute a qualified disclaimer under law, including Chapter 62 of the Pennsylvania Probate, Estates and Fiduciaries Code, section 9116(c) of the Pennsylvania Inheritance Tax Act (72 P.S. § 9116(c)), and section 2518(b) of the Internal Revenue Code of 1986 (26 U.S.C. § 2518(b)), and that it and all of its provisions be so interpreted. IN WITNESS WHEREOF, intending to be legally bound and intending to comply with all provisions concerning the validity of this Disclaimer, Disclaimant has hereunto set his hand and 1 C MMONWEALTH OF PENNSYLVANI seal this ���'h day of (,��L:. 2014• Shannon MNOTARIAL,SEAL Public Lemoyne Bora Cumberland County �ssion Expires Feb.25,2010 R,PENNGYLVANIA ASSOCIATION OF WI Dif NT: Matthew Earhart 2 COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF On this, the A)' day of ! !;! 2014, personally appeared Matthew Earhart, known to me to be the person whose name is subscribed to the foregoing Disclaimer and acknowledged that he executed the same for the purposes therein specified and further stated that he desired that such Disclaimer be recorded as such to the extent required by law. IN WITNESS WHEREOF, I have hereunto set my hand and Notarial seal. Notary Public 3 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION Estate of ^� C= M TERRY L. EARHART No. 2014-005' Late of Hampden Township, � m rn 7M, cn 7a co Deceased : 'W ca r:� W r- rn DISCLAIMER OF INTEREST PURSUANT TO CHAPTER 62 OF THE PENNSYLVANIA PROBATE, ESTATES AND FID'ILJCIARIEI� CODE, SECTION 9116(c) OF THE PENNSYLVANIA INHERITANCE TAX ACT, AND SECTION 2518 OF THE INTERNAL REVENUE CODE 1. Terry L. Earhart died intestate on February 27, 2014. 2. Terry L. Earhart was survived by his spouse, Donna B. Earhart, and his three (3) children, Hugh Earhart, David Earhart, and Allison Simpson. 3. Pursuant to Sections 2102 and 2103 of the Pennsylvania Probate, Estates and Fiduciaries Code, the Decedent's Estate is distributable as follows: (1) First $30,000 plus one- half of the estate residue to the Decedent's spouse, Donna B. Earhart, and (2) one-half of the remaining estate residue equally between the Decedent's issue, Hugh Earhart, David Earhart, and Allison Simpson. 4. Hugh Earhart disclaimed his right.and interest to his 1/3rd share of the one-half of the estate residue passing to the Decedent's issue; therefore his disclaimed share would pass to his issue, namely Matthew Earhart, Daniel Earhart, and William Earhart. 5. Daniel Earhart, currently residing at 2011 Dickinson Avenue, Camp Hill, PA 17011 (hereinafter the "Disclaimant") desires to disclaim his right and interest to the estate residue passing to him as a result of the disclaimer of Hugh Earhart. 6. Section 6201 of the Pennsylvania Probate, Estates and Fiduciaries Code (20 Pa. C.S. § 6201) provides that any person to whom an interest in property would have devolved may disclaim that person's interest in whole or in part by a written disclaimer that (a) describes the interest disclaimed, (b) declares the disclaimer and extent thereof, and (c) is signed by the disclaiming person. 7. Disclaimant has been advised of the legal and tax consequences of executing this Disclaimer. 8. Disclaimant therefore does hereby and forever irrevocably disclaim, renounce, and refuse to accept all right, title, and interest that Disclaimant does or may have to the estate residue passing to him as a result of the disclaimer of Hugh Earhart. 9. It is the intent of Disclaimant that this Disclaimer constitute a qualified disclaimer under law, including Chapter 62 of the Pennsylvania Probate, Estates and Fiduciaries Code, section 9116(c) of the Pennsylvania Inheritance Tax Act (72 P.S. § 9116(c)), and section 2518(b) of the Internal Revenue Code of 1986 (26 U.S.C. § 2518(b)), and that it and all of its provisions be so interpreted. IN WITNESS WHEREOF, intending to be legally bound and intending to comply with all provisions concerning the validity of this Disclaimer, Disclaimant has hereunto set his hand and seal this 2 ym day of su!y 12014. WITNES Aaniel eMAT: 2 COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF On this, the ?Y-4 day of Jc-Iy , 2014, personally appeared Daniel Earhart, known to me to be the person whose name is subscribed to the foregoing Disclaimer and acknowledged that he executed the same for the purposes therein specified and further stated that he desired that such Disclaimer be recorded as such to the extent required by law. IN WITNESS WHEREOF, I have hereunto set my hand and Notarial seal. NN���tt�aa���pp��-��hh COMM01'1WD1L?Ft DliENNSYLVANIA Notarial Seal Robert J.Acor,Notary Public Madison TWP.,Columbia County My Commission& jAres Nov.29,2015 MEMBER;PENNSyLVAN—M =ATION OF NOTARIES :2 3 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYWANIA ORPHANS' COURT DIVISION C M o Estate of A -n cn - ; C'+ c n C7 TERRY L. EARHART o No. 2014-00517 _rt Late of Hampden Township, c — C> M Deceased : y co v' DISCLAIMER OF INTEREST PURSUANT TO CHAPTER 62 OF THE PENNSYLVANIA PROBATE, ESTATES AND FIDUCIARIES CODE, SECTION 9116(c) OF THE PENNSYLVANIA INHERITANCE TAX ACT, AND SECTION 2518 OF THE INTERNAL REVENUE CODE 1. Terry L. Earhart died intestate on February 27, 2014. 2. Terry L. Earhart was survived by his spouse, Donna B. Earhart, and his three (3) children, Hugh Earhart, David Earhart, and Allison Simpson. 3. Pursuant to Sections 2102 and 2103 of the Pennsylvania Probate, Estates and Fiduciaries Code, the Decedent's Estate is distributable as follows: (1) First $30,000 plus one- half of the estate residue to the Decedent's spouse, Donna B. Earhart, and (2) one-half of the remaining estate residue equally between the Decedent's issue, Hugh Earhart, David Earhart, and Allison Simpson. 4. Hugh Earhart disclaimed his right and interest to his 1/3rd share of the one-half of the estate residue passing to the Decedent's issue; therefore his disclaimed share would pass to his issue, namely Matthew Earhart, Daniel Earhart, and William Earhart. 5. William Earhart is a minor, therefore Hugh and Rebecca Earhart, the natural guardian of William's estate, (hereinafter the "Disclaimants") hereby disclaim on behalf of William, any right and interest to the estate residue passing to him as a result of the disclaimer of Hugh Earhart. 6. Section 6201 of the Pennsylvania Probate, Estates and Fiduciaries Code (20 Pa. C.S. § 6201) provides that any person to whom an interest in property would have devolved may disclaim that person's interest in whole or in part by a written disclaimer that (a) describes the interest disclaimed, (b) declares the disclaimer and extent thereof, and (c) is signed by the disclaiming person. 7. Disclaimants have been advised of the legal and tax consequences of executing this Disclaimer. 8. Disclaimants as the natural guardians of the estate of William Earhart therefore do hereby and forever irrevocably disclaim, renounce, and refuse to accept all right, title, and interest that William does or may have to the estate residue passing to him as a result of the disclaimer of Hugh Earhart. 9. It is the intent of Disclaimants that this Disclaimer constitute a qualified disclaimer under law, including Chapter 62 of the Pennsylvania Probate, Estates and Fiduciaries Code, section 9116(c) of the Pennsylvania Inheritance Tax Act (72 P.S. § 9116(c)), and section 2518(b) of the Internal Revenue Code of 1986 (26 U.S.C. § 2518(b)), and that it and all of its provisions be so interpreted. IN WITNESS WHEREOF, intending to be legally bound and intending to comply with all provisions concerning the validity of this Disclaimer, Disclaimants have hereunto set their hand and seal this day of 1J 2014. WITNESS: DISCLAIMANTS: CL S v �, � ►` / Hugh Earhart, Natural Guardian for William Earhart SW wu Rebec a arhart, Natural Guardian for William Earhart 2 COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF� (�kt n On this, the�6� day of --Z-V4A t - 2014, personally appeared Hugh Earhart and Rebecca Earhart, known to me to be the individuals whose names are subscribed to the foregoing Disclaimer and acknowledged that they executed the same for the purposes therein specified and further stated that they desired that such Disclaimer be recorded as such to the extent required by law. IN WITNESS WHEREOF, I have hereunto set my hand and Notarial seal. Notary 'Public COMMONWEALT HOF PENNSYLVANIA Notarlal Seal Naomi Losch,Notary Public City of Harrisburg,Dauphin County My Commission Expires Aug.16,2015 MEMBER PEN I 'vANIA ASSOQATION OF NOTARIES 3 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION Estate of rn r o rn Q TERRY L. EARHART W ;:0 No. 2014-0( 1 ; m Late of Hampden Township, Deceased ' `7' c:R: 7 W F"- rn O DISCLAIMER OF INTEREST PURSUANT cin _n TO CHAPTER 62 OF THE PENNSYLVANIA PROBATE, ESTATES AND FIDUCIARIES CODE, SECTION 9116(c) OF THE PENNSYLVANIA INHERITANCE TAX ACT, AND SECTION 2518 OF THE INTERNAL REVENUE CODE 1. Terry L: Earhart died intestate on February 27, 2014. 2. Terry L. Earhart was survived by his spouse, Donna B. Earhart, and his three (3) children, Hugh Earhart, David Earhart, and Allison Simpson. 3. Pursuant to Sections 2102 and 2103 of the Pennsylvania Probate, Estates and Fiduciaries Code, the Decedent's Estate is distributable as follows: (1) First $30,000 plus one- half of the estate residue to the Decedent's spouse, Donna B. Earhart, and (2) one-half of the remaining estate residue equally between the Decedent's issue, Hugh Earhart, David Earhart, and Allison Simpson. 4. David Earhart of 220 Dunbar Drive, Mechanicsburg, PA 17050 (hereinafter "Disclaimant") desires to disclaim his right and interest to his 1/3rd share of the one-half of the estate residue passing to the Decedent's issue. 5. Section 6201 of the Pennsylvania Probate, Estates and Fiduciaries Code (20 Pa. C.S. § 6201) provides that any person to whom an interest in property would have devolved may disclaim that person's interest in whole or in part by a written disclaimer that (a) describes the interest disclaimed, (b) declares the disclaimer and extent thereof, and (c) is signed by the disclaiming person. 6. Disclaimant has been advised of the legal and tax consequences of executing this Disclaimer. 7. Disclaimant therefore does hereby and forever irrevocably disclaim, renounce, and refuse to accept all right, title, and interest that Disclaimant does or may have to a 1/3`d share of one-half of the estate residue passing to the Decedent's issue. 8. It is the intent of Disclaimant that this Disclaimer constitute a qualified disclaimer under law, including Chapter 62 of the Pennsylvania Probate, Estates and Fiduciaries Code, section 9116(c) of the Pennsylvania Inheritance Tax Act (72 P.S. § 9116(c)), and section 2518(b) of the Internal Revenue Code of 1986 (26 U.S.C. § 2518(b)), and that it and all of its' provisions be so interpreted. IN WITNESS WHEREOF, intending to be legally bound and intending to comply with all provisions concerning the validity of this Disclaimer, Disclaimant has hereunto set his hand and seal this day of 905 , 2014. WIT DISCLAIM N : David Earhart COMMONWEALTH OF PENNSYLVANIA Q SS: COUNTY OFa ��'' On this, theGL4day of ID 2014, personally appeared David Earhart, known to me to be the person whose name is subscribed to the foregoing Disclaimer and acknowledged that he executed the same for the purposes therein specified and.further stated that he desired that such Disclaimer be recorded as such to the extent required by law. IN WITNESS WHEREOF, I have hereunto set my han n otarial s COMM6NfAMLIN AE EgUNSY No �IIc NOTARIAL SEAL CHERYL r,.GARMAN,Notary Public Hampden Twp.,Cumberland County My Commission Expires May 20,2016 2 IN THE COURT OF COMMON PLEAS OF CUMBER-LAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION Estate of :;0 M CCl) Cp TERRY L. EARHART 07 C") No. 2014-00qT3-- r— rn Late of Hampden Township, U1 Deceased DISCLAIMER OF INTEREST PURSUANT U') _n TO CHAPTER 62 OF THE PENNSYLVANIA PROBATE, ESTATES AND FIQjbCIARIE35 CODE, SECTION 9116(c) OF THE PENNSYLVANIA INHERITANCE TAX ACT, AND SECTION 2518 OF THE INTERNAL REVENUE CODE 1. Terry L. Earhart died intestate on February 27, 2014. 2. Terry L. Earhart was survived by his spouse, Donna B. Earhart, and his three (3) children, Hugh Earhart, David Earhart, and Allison Simpson. 3. Pursuant to Sections 2102 and 2103 of the Pennsylvania Probate, Estates and Fiduciaries Code, the Decedent's Estate is distributable as follows: (1) First $30,000 plus one- half of the estate residue to the Decedent's spouse, Donna B. Earh6rt, and (2) one-half of the remaining estate residue equally between the Decedent's issue, Hugh Earhart, David Earhart, and Allison Simpson. 4. David Earhart disclaimed his right and interest to his 1/3rd share of the one-half of the estate residue passing to the Decedent's issue; therefore his disclaimed share would pass to his issue, namely Joshua Earhart, Cole Earhart, Reese Earhart, Bryn Earhart, and Jude Earhart. 5. Cole (age 7), Reese (age 4), Bryn (age 3), and Jude (age 8 months) are minors, therefore David and Ginger Earhart, as the natural guardians of their respective estates, (hereinafter the."Disclaimants") hereby disclaim on behalf of Cole, Reese, Bryn, and Jude, any right and interest to the estate residue passing to them as a result of the disclaimer of David Earhart. 6. Section 6201 of the Pennsylvania Probate, Estates and Fiduciaries Code (20 Pa. C.S. § 6201) provides that any person to whom an interest in property would have devolved may disclaim that person's interest in whole or in part by a written disclaimer that (a) describes the interest disclaimed, (b) declares the disclaimer and extent thereof, and (c) is signed by the disclaiming person. 7. Disclaimants have been advised of the legal and tax consequences of executing this Disclaimer. 8. Disclaimants as the natural guardians of the estates of Cole Earhart, Reese Earhart, Bryn Earhart, and Jude Earhart therefore do hereby and forever irrevocably disclaim, renounce, and refuse to accept all right, title, and interest that Cole, Reese, Bryn, and Jude do or may have to the estate residue passing to them as a result of the disclaimer of David Earhart. 9. It is the intent of Disclaimants that this Disclaimer constitute a qualified disclaimer under law, including Chapter 62 of the Pennsylvania Probate, Estates and Fiduciaries Code, section 9116(c) of the Pennsylvania Inheritance Tax Act (72 P.S. § 9116(c)), and section 2518(b) of the Internal Revenue Code of 1986 (26 U.S.C. § 2518(b)), and that it and all of its provisions be so interpreted. IN WITNESS WHEREOF, intending to be legally bound and intending to comply with all provisions concerning the validity of this Disclaimer, Disclaimants have hereunto set their hand and seal thisc� `day ofe-r�3�, 2014. W ESS: DISCLAIM S: David Earhart, Natural Guardian for Cole Earhart, Reese Earhart, Bryn Earhart, and Jude Earhart Ginger Ear" rt, afural Guardian for Cole Earhart, Ret Earhart, Bryn Earhart, and Jude Earhart 2 COMMONWEALTH OF PENNSYLVANIA (� SS: COUNTY OF OUV,, On this, the` ay of US+ 2014, personally appeared David Earhart and Ginger Earhart, known to me to be the individuals whose names are subscribed to the foregoing Disclaimer and acknowledged that they executed the same for the purposes therein specified and further stated that they desired that such Disclaimer be recorded as such to the extent required by law. IN WITNESS WHEREOF, I have hereunto set my hand and Notarial seal. COMMeA W EM-tH 1134aSNISISYLVANIA NOTARIAL SEAL CHERYL R.GARMAN,Notary Public No a ublic Hampden Twp.,Cumbedand County My Commission Expires May 20,2016_ 3 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANN = ORPHANS' COURT DIVISION C> M eta cr, _D cs Estate of Q p TERRY L. EARHART o No. 2014-00517 -t -n .Late of Hampden Township, w r- M Deceased ' f--► (n C> co DISCLAIMER OF INTEREST PURSUANT TO CHAPTER 62 OF THE PENNSYLVANIA PROBATE, ESTATES AND FIDUCIARIES CODE, SECTION 9116(c) OF THE PENNSYLVANIA INHERITANCE TAX_ ACT, AND SECTION 2518 OF THE INTERNAL. REVENUE CODE 1.1 Terry:L. Earhart diedintestate on February 27, 2014. 2. Terry L. Earhart was survived by his spouse, Donna B.: Earhart,_arid his three (3) children, Hugh,Earhart, David Earhart, and Allison Simpson. 3. Pursuant-to Sections 21,D2 and 2103 of the Pennsylvania Probate; Estates and Fiduciaries Code;.the. Decedent's Estate is distributable as follows- (1) First $30;000 plus one- half of the estate residue to the Decedent's:spouse, Donna B Earhart, and (2)`orie-half of the remaining estate residue equally between the Decedent's issue, Hugh Earhart, David Earhart, and Allison Simpson. 4. David,I arhartdisclaimed,his right and interest to his 1/.3id share of the-one-half of the estate residue passing to the.Decedents issue} therefore. his disclaimed share would pass to his issue,. namely Joshua Earhart, Cole Earhart, Reese Earhart, Bryn Earhart; and Jude Earhart. 5. Joshua. Earhart, currently residing at G b l e pa2T, M 5 s 5;,i2i2/ desires.to disclaim his right and interest to;the.estate residue passing to him.as a;result of the, disclaimer of David Earhart.. 6. Section 6201 of the Pennsylvania Probate; Estates acid Fiduciaries Code (20'Pa. C.S. § 6241) provides that any person to whom an interest in property would have devolved may disclaim that person's interest in whole or in part by a written disclaimer that (a) describes the interest disclaimed, (b) declares the. disclaimer and extent thereof, and (c) is signed by the disclaiming person. 7. Disclaimant has been advised of the legal and tax consequences of executing this Disclaimer. 8. Disclaimant therefore does hereby and forever irrevocably disclaim, renounce, and refuse to accept all right, title, and interest that Disclaimant does or may have to the estate residue passing to him as a result of the disclaimer of David Earhart. 9. It is the intent of'Disclaimant that this Disclaimer constitute a qualified disclaimer under law, including Chapter 62 of the Pennsylvania Probate, Estates and Fiduciaries Code, section 9116(c) of the Pennsylvania Inheritance Tax Act (72 P.S, § 9116(c))., and section 2518(b) of the .Internal Revenue Code of 1986 (26 U.S.C. § 2518(b)), and that it and all of its provisions;be.so interpreted. IN WITNESS WHEREOF, intending to be legally bound and intending to comply with all provisions concerning the validity of this Disclaimer; Disclaimant'has hereunto set his hand and seal this l 5 day of J Ory ; 2014. WITNES DISCLAI NT: Jas arhart Sr 2 STATE OF SS: COUNTY OF On this, the l�Zday of )c-yj. 2014, personally appeared Joshua Earhart, known to me to be the person whose name is subscribed to the foregoing Disclaimer and acknowledged that he executed the same for the purposes therein specified and further stated that he desired that such Disclaimer.be recorded as such to the extent required by law. IN WITNESS WHEREOF, I have hereunto set my hand and Notarial seal. ublic Emily T. alryIonoAFodtfN0tgtUS g f044a 3 lollMcNees Wallace & Nurick LLC 100 Pine Street o PO Box 1166 e Harrisburg,PA 17108-1166 Linda M. Eshelman, Pa.C.P. Tel: 717,232,8000 a Fax: 717,237,5300 Estate Paralegal Direct Dial:717.237,5210 Direct Fax:717.260.1640 leshelman@mwn.com November 25, 2014 Register of Wills VIA CERTIFIED MAIL Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 RE: Estate of Terry L. Earhart Cumberland County File No: 2014-00517 Ladies and Gentlemen: Enclosed for filing in the above-referenced estate are the following documents: • Pennsylvania Inheritance Tax Return (two originals) — No tax is due on the Return. • Inventory (one original) Please date-stamp the copies enclosed and return to us in the stamped envelope provided. fth6k you. Yours truly, :;Q ril rn 0 rn n a M. Estee man, a. P. r— ry rn co ;:Estate Paralegal 71 :> U) _n LIVIE/Ime M Enclosures U' c: Donna B. Earhart www.mwn.com HARRISBURG, PA e LANCASTER, PA • SCRANTON,PA * STATE COLLEGE, PA • COLUMBUS, OH • WASHINGTON, DC �,r . .r„ }ti•�,� U.S.POSTAC ,. ZIP 17101 c Ar " � 0001369981 NOV 26 20 oil McNees 7196 9008 9711 0301 161'7 Wallace & Nurick LLC 100 Pine Street-PO Box 1166•Harrisburg,PA 17108-1166 Flurst Mass Mail REGISTER OF WILLS CUMBERLAND COUNTY COURTHOUSE ONE COURTHOUSE SQUARE CARLISLE PA 17013-3387.