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05-15-15 (2)
r i 1505610140 REV-1500 EX (02-11)(FI) PA Department of Revenue OFF CtaL USE ONLY Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number PO BOX 280601 2 1 1 4 1 0 0 6 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 0 9 3 0 2 0 1 4 1 2 0 2 1 9 2 4 Decedent's Last Name Suffix Decedent's First Name MI WI L L I SS WARREN D (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI WI L L I SS ELI Z A B E T H A Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 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) QX 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) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number R M A R K THOMAS , E S Q U I R E 7 1 7 7 9 6 2 1 0 0 C= REGULYER OFWILLSUSE ONLY rT' r� -0 First Line of Address , c- C/) 1 0 1 S MARKET S T R E ET . 7M cn ; � _ C") Second Line of Addressr7 j C'7 7 Ca -OVE T C� City or Post Office State ZIP Code PATE FILE r= M E C H A NI CSBURG PA 1705563-'28 I� via Correspondent's e-mail address: rmarkthomas@gmail.Com 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 OF PERSON RESPONSIBLE FOR FILING RETURN D E ADDRE / 1121 BALDWIN STR T MECHANICSBURG PA 17055 SIGNATU OR ES TATIVE AT� ADDRESS �il� 101 S MARKET STREET MECHANICSBURG PA 170556328 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 J 1505610240 REV-1500'EX(FI) Decedent's Social Security Number Decedent's Name: WARREN D. WILLISS RECAPITULATION 1. Real Estate(Schedule A) . . . . .. .. .. .... . ....... .. .. .. ..... . . . .. .. .. . 1. 2. Stocks and Bonds(Schedule B) . .. . . .. .... .. . . .. .. .. .. .. ..... . ... ... . 2. 1 7 8 1 7 0 , 1 6 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) .. .. . 3. 4. Mortgages and Notes Receivable(Schedule D) .. .. .. .. .... ... . . . . . . . . . . . 4. 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). .. .. .. 5. 7 7 1 2 • 4 7 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested .. .. ... 6. 2 2 0 8 6 9 • 1 2 7. Inter-Vivos Transfers&Miscellaneous N Probate Property 5 2 2 3 3 • 8 3 (Schedule G) Separate Billing Requested . .. .... 7. 8. Total Gross Assets(total Lines 1 through 7) 8. 4 5 8 9 8 5 , 5 8 9. Funeral Expenses and Administrative Costs(Schedule H) .. .. .. .. .. .. .... .. 9. 3 2 0 3 1 7 4 10. Debts of Decedent,Mortgage Liabilities,and Liens Schedule I 10. 3 7 3 9,. 9 9 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . .. . . .. .. . . .. .. . 11. 3 5 7 7 1 . 7 3 12. Net Value of Estate(Line 8 minus Line 11) . .. .. . . .. . . .. .. .... .. ..... .. 12. 4 2 3 2 1 3 . 8 5 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) . .. .... .. .. .... . . .. . . 13. 14. Net Value Subject to Tax(Line 12 minus Line 13) . .. . . ... .. . . . . . . . . .. . . 14. 4 2 3 2 1 3 . 8 5 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.0 _ 3 7 3 1 8 1 . 8 9 15. 0 . 0 . 0 16. Amount of Line 14 taxable at lineal rate X.0_ 0 - 0 0 16, 0 . 0 0 17. Amount of Line 14 taxable at sibling rate X.12 0 . 0 0 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate x.15 5 0 0 3 1 . 9 6 18. 7 5 0 4 . 7 9 19. TAX DUE .. ... .. .. . . .. . . . . . . . . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .... . 19. 7 5 0 4 . 7 9 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 1505610240 1505610240 REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: 21 14 1006 DECEDENTS NAME WARREN D. WILLISS STREET ADDRESS CITY STATE ZIP Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 7,504.79 2. Credits/Payments A.Prior Payments 7,000.00 B.Discount 368.41 3. Interest Total Credits(A+B) (2) 7,368.41 4. If Line 2 is greater than Line 1+Line 3,enter the difference.This is the OVERPAYMENT. (3) Fill in oval 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) 136.38 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 ...................................................................... ❑ X❑ b. retain the right to designate who shall use the property transferred or its income ............................... ❑ ❑X c. retain a reversionary interest ..................................................................................................... ❑ 0 d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ X❑ 2. If death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ❑ X❑ 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ X❑ 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation?.................................................................................... © El.............. 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 i; 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. REV-1503 Ex+(8-12) pennsylvania SCHEDULE B DEPARTMENT OF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT I ESTATE OF FILE NUMBER WARREN D. WILLISS 21 14 1006 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. SERIES EE SAVINGS BONDS -6-$50-VALUED AT$115.32 EACH 691.92 L142285058EE,L51185956EE, L151185957EE, L151397492EE,L151399179EE, L151399178EE, 2. RAYMOND JAMES FUNDS 164,375.18 ACCOUNT 12506002 3. PRUDENTIAL FINANCIAL, INC- 149 SHARES-COMMON STOCK 13,103.06 JANET WILLISS- TOTAL(Also enter on Line 2,Recapitulation) $ 178,170.16 If more space is needed,insert additional sheets of the same size REV-1508 EX+(08-12) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: WARREN D. WILLISS 21 14 1006 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH I COINS 1,513.45 2 REFUND-ADDUS HEALTH CARE 36.00 3 HIGHMARK-PREMIUM REFUND 219.00 4 3 VIOLINS AND 3 BOWS-appraisal Chimney Violins- Boiling Springs, PA 4,500.00 5 HOUSEHOLD PERSONAL PROPERTY- Rowe's Auction 1,258.50 6. AIG PREMIUM REFUND 97.50, 13.02 110.52 7 BANJO-HARMONY 75.00 TOTAL(Also enter on Line 5,Recapitulation) $ 7,712.47 If more space is needed,use additional sheets of paper of the same size. REV-1509 EX+(01-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: WARREN D. WILLISS 21 14 1006 If an asset was made jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. ELIZABETH A. WILLISS 1121 BALDWIN STREET SPOUSE MECHANICSBURG, PA 17055 B. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. 3/24/10 PNC BANK, N.A. 6,133.57 50. 3,066.79 CHECKING ACCOUNT#5140069336 .08 ACCRUED INTEREST 2. A 3/15/12 DEED- 1121 BALDWIN STREET 156,000.00 50. 78,000.00 MECHANICSBURG, PA 17055 tax assessment 3 A 3/24/10 PNC INVESTMENTS 31,355.99 50. 15,678.00 INCLUDING ACCRUED INTEREST 4. A 3/2010 RAYMOND JAMES 238,023.66 50. 119,011.83 ACCOUNT 79236458 5. A 2011 2011 CHEVROLET IMPALA 10,225.00 50. 5,112.50 TOTAL(Also enter on Line 6,Recapitulation) $ 220 869.12 If more space is needed,use additional sheets of paper of the same size. REV-1510 EX+(08-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER WARREN D. WILLISS 21 14 1006 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DEWS EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST OFAMICA" VALUE 1. Lincoln Financial Group-Annuity account 95-9801007 52,233.83 100.00 52,233.83 ELIZABETH WILLISS, SPOUSE- BENEFICIARY TOTAL (Also enter on Line 7,Recapitulation) $ 52 233.83 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(08-13) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER WARREN D. WILLISS 21 14 1006 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 MALPEZZI FUNERAL HOME 12,446.30 2. OLIVE GARDEN- FUNERAL LUNCHEON 819.33 3. RAST HARRISBURG CEMETARY-VAULT, PROFESSIONAL SERVICE 1,795.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Yeaqs)Commission Paid: 2. Attorney Fees: R. MARK THOMAS, ESQUIRE 15,582.00 3, Family Exemption:(If decedent's address is not the same as claimants,attach explanation.) Claimant Street Address City state ZIP Relationship of Claimant to Decedent 4. Probate Fees: 370.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. SHORT CERTIFICATE 10.00 8 POSTAGE 10/28-11/24/14 10.28 9. PATRIOT NEW-PUBLISH-LEGAL 277.46 10. CUMBERLAND LAW- LEGAL 75.00 11. VIOLIN APPRAISAL-CHIMNEY VIOLIN 95.40 12. APPRAISAL-CHUCK BRICKER 75.00 13. ROWE'S AUCTIONEER FEES @ 35% 440.47 14. ROWE'S HAULING FEES 35.00 TOTAL(Also enter on Line 9,Recapitulation) $ 32,031.74 If more spaoe is needed,use additional sheets of paper of the same size. REV-1512 EX+(12-12) pennsylvania SCHEDULE DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES&LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER WARREN D. WILLISS 21 14 1006 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. HOLY SPIRIT HOSPITAL 9/20-22/2014 869.40 2. VISITING ANGELS 2,625.00 3. WEST SHORE EMS-BLS 156.47 4. PA GASTRO 54.69 5 CAMP HILL EMERGENCY PHYSICIANS 34.43 TOTAL(Also enter on Line 10,Recapitulation) $ 3,739.99 If more space is needed,insert additional sheets of the same size. REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: 7.000.00 Discount: 368.41 Interest Table Year Days Delinquent Balance Due Interest this time period this year this period Before 1981 1982 1983 1984 1985 1986 1987 1988 through 1991 1992 1993 through 1994 1995 through 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 throu h 2014 TOTALS Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17, 1996: Penalty: COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT N0. CD 020060 i THOMAS R MARK jam. 101 S MARKET STREET j_ MECHANICSBURG, PA 17055-3851 ( ( iL ACN ASSESSMEN CONTROL NUMBER ---------- -------- 101 $71000.00 ESTATE INFORMATION: SSN: FILE NUMBER: 2114-1006 DECEDENT NAME: WILLISS WARREN D DATE OF PAYMENT: 12/23/2014 POSTMARK DATE: 12/22/2014 COUNTY: CUMBERLAND DATE OF DEATH: 09/30/2014 TOTAL AMOUNT PAID: $7,000.00 REMARKS: RECEIPT TO ATTY CHECK# 20053 INITIALS: WZ SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS REGISTER OF WILLS C.D LAST WILL AND TESTAMENT C BE IT REMEMBERED THAT l) 1, WARREN D. WILLISS, a resident of Cumberland County, Pennsylvania,:.6eing of soun-& and disposing mind,memory and understanding do make, publish and declare this to be mvL--.ASr WILL and TESTAMENT, hereby revoking any and all Wills and Codicils previously made by me. I declare that I am married to ELIZABETH A. WILLISS, and I have no issue, but I have two (2) step-daughters, namely SHELLEY SEIBERT and JILL BAUER II I direct that all my just debts and funeral expenses shall be paid from my residuary estate as soon as practicable ager my decease. III I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. TV I give, devise and bequeath all my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment as follows: A. One-third (1/3) to my friend, ROY W. FULLER, formerly married to my niece, HOLLY D. SHEETS, per stirpes; and B. Two-third (2/3)to my wife, namely ELIZABETH A. WILLISS,per stirpes. V In the event that my wife, ELIZABETH A. WILLISS, should predecease me or fail to survive me for a period of thirty(30) days, then her share shall lapse and be divided into two equal shares with one (1) share passing to my step-daughter, SHELLEY SEIBERT, per capita, and one (1) share passing to my step-daughter, JILL BAUER, per stirpes. VI I nominate, constitute and appoint my wife, ELIZABETH A. WILLISS, and R. MARK THOMAS, ESQUIRE, as Co-Executors of this LAST WILL, to serve without bond. If my wife, ELIZABETH A. WILLISS is unable or unwilling to act in that capacity, then I nominate,constitute and appoint ROY W. FULLER, to act in her stead. In the event that R. MARK THOMAS, ESQUIRE, is unable or unwilling to act in that capacity, then I nominate, constitute, and appoint JAMES BOGAR, ESQUIRE, as Co-Executor. IN WITNESS WHEREOF, I, WARREN D. WILLISS, have set my hand to this LAST WILL this 7`h dayof September, 2010. WARREN D. WILLISS Signed,sealed,published and declared by the above-named WARREN D. WILLISS, as and for his Last Will and Testament, in the presence of us, who, at his request and in his presence, and in the presence of each other, have hereunto subscribed our names as witnesses. /, it ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUMBERLAND I, WARREN D. WILLISS, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my LAST WILL; that I signed it as my free and voluntary act for the purposes therein expressed. WARREN D. WILLISS Sworn or affirmed to and acknowledged before me by WARREN D. WILLISS,Testator, this 7th day of September, 2010. E OTARIAL SEAL tary Public TTE L MCGOWEN Notary Public G BORO,CUMBERLAND CNTY sion Expires Jul 7,2014 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUMBERLAND We, R. Mark Thomas and ;� ��.T�' ,the witnesses whose names are signed to the attached r foregoing instrument being duly qualified according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his LAST WILL; that WARREN D. WILLISS signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses;and that to the best of our knowledge, the Testator was at the time 18 years of age or more, of sound mind and under no constraint or undue influence. Sworn or affirmed to and acknowledged before me by R. Mark Thomas and tJ`T 7-' this 7 1 dayof September„ 2010. r� ary Public NOLENNotary Public MECHANERLAND CNTYMy ul 7,2014 Providing Quality Healthcare Since 1979 Dear Valued Addus Client: Thank you for using Addus HealthCare for your homecare needs. In reviewing your account, we find that there is a credit balance either due to an overpayment made by you or a deposit on the account that has not been refunded to you. Attached is a check to settle your account. Again, we thank you for choosing Addus HealthCare. If you have any questions, please contact our Reimbursement Department at 877-244-5411. Sincerely, Ad us Heal are Addus Healthcare,Inc PAID TO: (RO6739) The Estate of WARREN WILLISS 2300 Warrenville Rd 1121 BALDWIN ST MECHANICSBURG,PA 17055 Downers Grove,IL 60515 Check Date: 11/14/2014 Check Amt: $36.00 Check Number: 1034973 Payment ID: 94466 Office Period Ending Check Date Amount 2080 Addus-Carlisle 10/2312014 1013112014 $36.00 000036 0001 0001 000 527130-002-0 v IIGH"K.a Freedom Blue PPO P.O.Box 535049 Pittsburgh PA 15253-5049 THE ESTATE OF WARREN D WILLISS CO 1121 BALDWIN ST o MECHANICSBURG, PA 17055 Premium Refund 10/14/2014 Check Number '0000937076 Check Date 10/14/2014 Product Name Gross payment amount $219.00 Net payment amount $219.00 Highmark Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association REORDER 9018•U.S.PATENT NO.5538290.5575508,5641163,5765353.5934364,03W00 CHECK DATE CHECK AMOUNT CHECK NUMBER_ POLICY# CLIENT 02/03/2015 $13.02 1000005263 5500795901 LIT This check represents excess premium for a policy that has been cancelled to•the reported death of the insured.-if a claim has been submitted,you-will be receiving correspondence Linder-separate cover. lf+you have any additional questions,please contact.our office at 1-800-235-6943:. . fI I rEORDEF 901.0.U.S.PATENT 140.5538290,5575508.5647763,5785353.598,354,603000,-, CHECK DATE CHECK AMOUNT . CHECK NUMBER POLICY# CLIENT . 12/17/2014 $97.50 1000002374 5500795900 LIT 'rhis check represents excess.prernium for a-policy that has been cancelled to the treported death ofhe insured. If a claim.has beer,submitted,.you.will-be receiving correspondence under separate cover.,if you.: have any additional questions;please;contact our office at 1-800-235-6943: 02 k r rn o\ § jo 0 m) 2 . z o z o ( C) ° \ e 2i � a 220 ]§ p = p ; 61RL / § /0-4 < m \� U � \ \ k � � :7, ® ° rt k /Id / } / \ fo e� arm k � 2 � t4 � 0.4 � � w > � ?93 m 0 / \ cn § ƒ ) � \ } \\ / a � fA , \ 7� o i » o a 0 z moo » g . 7 ? qim . \ } / f I / : o $ a f § , - o 0 0 0 rl-fflo IM Cbivarb C Cainpberl OW11Pr 014t TD4imn evs rtolin 1� v �LPIPpl,011P -ee15011 JD. �bteffp 614 Brew Moab' .. igniting ftrings, 717-258-3203 31WI)ier Pennoglunititt 17007 ift. 1&. .i. ifax: 717-258-3201 tl)Pci)i lnnep5@Partl)liiih.11et tuilltn.ti)PA)iIII 11P-.p5biAti115bap.COiti January 13, 2015 R. Mark Thomas, Esquire lot South Market Street Mechanicsburg, PA 17055 The violin labeled "Nicolaus Amatus fesit in Cremona 16 ", with a repair label of"Jos. F. Ricker &Son, Columbus, O 1962", in our opinion, was not made by Nicolo Amati and has a value of$1,000.00. The top is of one piece fine grained spruce. The back is of two piece quarter cut maple with the flame perpendicular to the center joint, with ribs and scroll to match. The varnish is red/brown in color on a golden base. Mensure: L: 354 mm UB: 166 mm CB: 112 mm LB: 204 mm The unlabeled violin with the Stradivari arching and Guarneri f holes, in our opinion, was probably made here in the USA., and has a value of $2000.00. The top is of two piece fine grained spruce. The back is of two piece quarter cut maple with the flame perpendicular to the center joint, with ribs and scroll to match. The varnish is red/brown in color on a golden base. Mensure: L: 359 mm UB: 165 mm CB: 113 mm LB: 205 mm The unlabeled violin with the top replaced, in our opinion, has a value of $300.00. The top is of two piece medium grained spruce with no purfling. The back is of one piece quilted maple with the flame perpendicular to the center joint, with ribs and scroll to match. The varnish is red/brown in color on a golden base. Mensure: L: 363 mm UB: 170 mm CB: 110 mm LB: 206 mm R. Mark Thomas, Esquire January 13, 2015 The ebony/nickel mounted violin bow stamped "* G A Pfretzschner *" with a pernambuco octagonal stick, in our opinion, has a value of$500.00. The ebony/silver mounted violin bow with a pernambuco octagonal stick, in our opinion, has a value of$400.00. The ebony/nickel mounted viola bow with a Brazilwood octagonal stick,in our opinion, has a value of$300.00 We have visually examined the above listed and described items in the condition in which they were delivered for examination. .We have estimated the items at current retail value excluding any taxes. These opinions are for the benefit of the person addressed in the heading and the owners but may not be relied upon by others. We do not agree to purchase or replace the above listed and described items. The maximum liability, for any damage caused by a reliance on this opinion, is limited to the price paid for this opinion. Any claim, demand, or lawsuit based upon or arising from this appraisal shall be barred unless the owner commences a claim demand, or lawsuit with one (1) year from the date the appraisal is delivered to the owner. Three copies of this document are hereby delivered to you and this document becomes valid when a signed and dated copy is returned to us. Of the other two, one is for your records and the other is for the owners of these violins and bows. We trust this is the information you needed. If we can be of further assistance, please let us know. Best Regards, THE CHIMNEYS VIOLIN SHOP d vv�- `? Nelson P. Steffy, Ma iolin Maker I have read and understand the terms of this agreement and agree to be legally bound by them. Signed (Sealed) Date 2 ROWE'S AUCTION SERVICE (RH-79L 2505 Ritner Highway • Carlisle,PA 17015 Bill Rope (AU 1538L) 249-1978 215-1044 574-1008 Dave Rowe (AU 2295L) Auction Is Actio all "Row " For Satisfaction SI$.LERS NAME r L u -e DATE pC ADDRESS fw PHONE OTHER 74!�!Y5 AUCTIONEER % 357- AACTION DATE/LOCATION CLERK % / JD—ESCRIPT ON OFERCHANDIS //, o leo Z 7 I Commission the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise to be sold as is & grouped as necessary to obtain bids. I certify that I am the owner or authorized represen- tative of the merchandise,goods and or property and have good title and the right to sell and that they are free from all ' brances. I agr to accept all responsibility for providing merchantable title and for delivery of title to rchase I t hold harmless the Auctioneers against any claims of the nature referred to in this a ent. � moi, c�. ��✓z.�.�.� AUCTION SIGNATURE T ELLERS SIGNATURE Total Sales (Clerking Tickets Attached) $ Z sv Less Sale Expense: �)% Commission Auctioneer $ L(4� %Commission Clerks $ OTHER: TOTAL SALE EXPENSE DEDUCTED $ SELLERS NET $ 3 tat 03-17-2015 13:21 :30 Rowe' s Auction Service 2505 Ritner Highway Carlisle, PA 17015 717-574-1008 lindenhaIl@aol. cnm ittlement Elizabeth Willis-7.i 76E-6634 Page : 1 Gler: 2 1121 Baldwin St Mechanicsburg PA 17055 Item Description Price Qty Total '------------------------------------------------------------------------------ - BL - leather jacket lot 1 ' 4. 00 - BL - reel-to-reel lot/wire 1 12. 50 lot - BL - DeWalt set lot 1 10. 00 - BL - wrenches/Craftsman lot 1 35. 00 - BL - tool lot 1 6. 00 - BL - phone lot/hardware lot 1 1. 00 - BL - tool lot (CH) 1 17. 50 - BL - tool lot (CH) 2. 00 5 10. 00 - BL - tool lot (CH) planes 1 35. 00 - BL - tool lot (CH) 1 35. 00 - BL - tool lot (CH) 1 25. 00 - BL - tool lot (CH) 1 20. 00 - BL - tool lot/tool lot 1 5. 00 - BL - tool lot (CH) toolbox 1 40. 00 - BL - tool lot (CH) 1 30. 00 - BL - tool lot (CH) 3' 00 3 9. 00 - 2 BL - tool lot 1 4. 00 - BL - tool lot (CH) 1 20. 00 - BL - air tank lot ^1 8' 00 - BL - 2 wooden clamps 1 3. 00 � - BL - little stepladder 1 2. 00 - BL - 2 metal bar clamps lot 1 12. 50 - BL - tool ! at (CH) 6. 00 2 12. 00 - 2 BL - tool lot 1 8. 00 - 3 BL - tool lot 1 10. 00 - BL - WorkMate lot 1 5. 00 - BL - tools/hardware 1 35. 00 lot (CA) toolbox - BL - tools/hardwaer lot (CH) 1 25. 00 - BL - tools/hardware lot (CH) 1 6. 00 - BL - tools/hardware lot (CH) 2. 00 4 8' 00 - BL - tools/hardware 1 25. 00 lot (CH) fishing - 8L - tools/hardware lot (CH) 1 25. 00 - BL - tools/hardware lot (CH) 1 20. 00 - BL - tools/hardware lot (CH) 1 6. 00 - BL - tools/hardware 1 5. 00, lat &H) bits - 2 BL - tooldhardware lot 1 2. 00 " - BL - tools/hardware lot (CH) 1 17. 50 - ate : 03-17-2015 13:21 :30 - � Rowe' s Auction Service 2505 Ritner Highway Carlisle, PA 17015 717-574-1008 lindenhall@aol. com ` Rttlement Elizabeth Williss 766-6634 Page , 2 �ller: 2 1121 Baldwin St Mechanicsburg PA 17055 Item Description Price Qty Total -------------------------------------------------- -------------------------------- - BL - tools/hardware lot (CH) 1 12. 50 - BL - tools/hardware lotVCH> 1 6. 00 - BL - tools/hardware lot (CH) ' 1 6. 00 ' - 2 BL - tools/hardware lot 1 4. 00 - BL - creeper lot 1 7. 50 - BL - heaters (CH) 1 25. 00 - BL - heater lot 1 25. 00 - BL - hardware lot (CH) 1 17. 50 - BL - hardware lot (CH) 1 8. 00 - BL - hardware lot 1 5. 00 (CH) sprayer - BL - hardware lot (rest ) 1 8. 00 - BL - saw lot 1 4. 00 - BL - metal wind item lot 1 15. 00 - Compressor-Sears 1 40. 00 - Wall clock ` 1 65' 00 - Spy glass 1 55. 00 - 1951 US Airforce maps t 30. 00 - Gauges (CH) 1 60. 00 - Gauges (CH) 30. 00 4 120. 00 - Temperature gauge 1 14. 00 - Headsets 1 20, 00 - Sterilizer 1 20. 00 - BL - gauge lot 1 45. 00 - Metal file cabinet 1 6. 00 - 2-dr. metal file w/red 1 4. 00 handles - Antique potty chair 1 30. 00 - Metal quilt rack 1 2. 00 - Heat-n-pure heater 1 40. 00 - Plank chair 1 2. 00 - Antique potty chair & stool 1 7. 00 - 2-dr metal file 1 1. 00 Items : 68 Amount : 1, 258. 50 Commission at 35' 000� ^^p ^-7 - BL - tools/hardware lot (CH) 1 17. 50 . ' ate : 03-17-2015 13:21 :30 Rowel Auction Service 2505 Ritner Highway Carlisle, PA 17015 717-574-1008 lindenhalWaol. com ettlement Elizabeth Williss 766-6634 Page : 2 ' eller: 2 1121 Baldwin St Mechanicsburg PA 17055 Item Description Price Qty Total -------------------_--------------------------------------------------------------- - BL - tools/hardware lot (CH) 1 12. 50 - BL - tools/hardware lot (CH) 1 6. 00 - BL - tools/hardware lot (CH) ' 1 6. 00 - 2 BL - tools/hardware lot 1 4. 00 - BL - creeper lot 1 7, 50 - BL - heaters (CH) 1 25. 00 - BL - heater lot 1 25. 00 - BL - hardware lot (CH) 1 17. 50 - BL - hardware lot (CH) 1 8. 00 - BL - hardware lot 1 5. 00 (CH) sprayer - BL - hardware lot (rest ) 1 8. 00 - BL - saw lot 1 4. 00 - BL metal wind item lot 1 15. 00 - Compressor-Sears 1 40. 00 - Wall clock1 65. 00 - Spy glass 1 55. 00 - 1951 US Airforce maps 1 30. 00 - Gauges (CH) 0 1 60. 0 � - Gauges (CH) 30. 00 4 120. 00 - Temperature gauge 1 14. 00 - Headsets 1 20. 00 - Sterilizer 1 20. 00 - BL - gauge lot 1 45. 00 - Metal file cabinet 1 6. 00 - 2-dr. metal file w/red 1 4. 00 handles - Antique potty chair � 1 3�. 00 - Metal quilt rack 1 2. 00 - Heat-n-pure heater 1 40. 00 - Plank chair 1 2. 00 - Antique potty chair stool 1 7. 00 - 2-dr metal file 1 1. N0 Items : 68 Amount : 1 , 258. 50 Commission at 35. 000% 440. 47 — Antique potty chair & stool | 7' 00 2—dr metal file 1 1. 0Q Items : E8 Amount : ' 258 50 - , . Commission at 35. 000� 440. 47 Less adjustments ; -440' 47 ___________ Net due to seller : 818. 03 Thank you for your business ! � ` ` ^ Nov. 25. 2014 8: 34AM PNC Bank No. 1034 P. 2 QPNC 1NVESTIVIEIVTS Mem$*r FINRA and SIPC November 24,2014 Chuck Little Charles.little ftpg.com RE: 097-0631251 Warren Williss -JWROS Dear Chuck: The value of the above-referenced account on September 301h,2014 is as follows: Symbol! :' ODD: AcctUe Amount desert tion, Cusl %'. Price` -Moo Value 'Interes 839.923 Federated Pa Muni Income Class A PAMFX $10.95 $ 9,197.16 0.340 Federated Prime Cash Obligations CL SS QPRXQ $ 1.00 $ 0.34 3.620.669 Federated Strategic Value Dividend CL A SVAAX $ 6.12 $ 22,158.49 $ 31 355.99 - Grand Total Market Value+Accrued Interest $ 31,355.99 Note:DOD price is based off the closing price or the high/low Average on the day the client has passed away,if this is a non- business day the price will be taken from the previous business day's closing price. If you have any questions, please contact our Estate Resolution Desk at 800-622-7086. Sincerely, Omar Omar PNC Investments,LLC. Estate Resolution Desk J The summaries, prices,quotes and/or statistics contained herein have been obtained from sources believed to be reliable but are not necessarily complete and cannot be guaranteed.They are provided for Informational purposes only. Past performance does not guarantee future results. PNC Investments LLC Member of The PNC Financial Services Group 2 East Main Street Mechanicsburg Pennsylvania 17055 www.pne.com 'SU7'LwseWlic Important lnvestorinformattan:Sacurities and brokerage services are provided by PNC Investments LLC,member FINRA and SIPC. •\a@vdeCuuauce Annuities and other insurance products are offered by PNC Insurance Services LLC,a deemed insurance agency. Nov. 5. 2014 11 :03AM PNC Bank No. 6956 P. 1/1 d November 5, 2014 R Mark Thomas Attorney At Law 101 S Market St Mechanicsburg PA 17055 RE: Warren D Williss SSN: DOD: 09-30-2014 Dear Mr. Thomas: In response to your request for Date of Death(DOD)balances for the customer noted above,our records show the following: Checking Account Account#5140069336 Established: 03-24-2010 WARREN D WILLISS ELIZABETH A WILLISS DOD balance: $ 6,133.49 +0.08 accrued interest Interest paid 01-01-2014 thru 09-30-2014 $ 1.51 YTD Please note that this office provides date of death balances for deposit accounts(MAs,CDs,Checking and Savings). We do not process any financial transactions or provide statements. If you need assistance with any of these items,please call 1-888-PNC-BANK(1-888-762-2265)or stop by*your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank.,N.A. Member FDIC This message is intended for the use of the individual or entity to which it is addressed and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communications is strictly prohibited. If you have received this communication in error,please notify me immediately by reply or by telephone at 800-762-1775 and immediately destroy this faxed document. Page 1 of 1 Instrument#: "201421246 Book: Recorded Date: SEP 19, 2014 Page: 10:44:11 AM Total Pages: 5 Instrument Type: DEED Parcel Numbers: 17230561177 County: CUMBERLAND Municipality: MECHANICSBURG BOROUGH - 2ND WARD Recording Status: VERIFIED Nkes: 1121 BALDWIN ST LOT 35 PL BK 15 PG 10 GRANTOR GRANTEE WILLISS,WARREN D - •WILLISS,ELIZABETH A WILLISS,ELIZABETH A Year Property taxes Change Tax assessment Change Mole .Less 2014 $2.762t-3.33% 3`'« $156,000 -- 2013 $2,674 =1.6°/v : 1,t "it: $156,000 -- 2011 $2,55724.9"$156,000 24.E}`: Kelley Blue Book Page 1 of 2 l,�yRl Kelley Blue Book The Trusted Resource` 11 1 WAI ttiEvrao LET A&erOSernwt Why ads? 2011 Chevrolet Impala Trade In to a Dealer Pricing Report Trace-in Vatue $1.0,225 Style:LS Sedan 4D Miteage:30,000 r Vehicle Highlights r Fuel Economy: Max Seating:6 Trade-in Values valid for your area through 4/16/2015 City 19/Hwy 29/Comb 23 MPG Very Good Condition Doors:4 Engine:V6,Flex Fuel,3.5 Liter Drivetrain:FWD Transmission:Automatic,4-Spd w/Overdrive EPA Class:Large Cars Body Style:Sedan Country of Origin:United States Country of Assembly:Canada Your Configured Options Our pre-selected options,based on typical equipment for this car. Options that you added while configuring this car. Engine Comfort and Convenience Seats V6,Flex Fuel,3.5 Liter Keyless Entry Power Seat Transmission Air Conditioning Lighting Automatic,4-Spd w/Overdrive Power Windows Daytime Running Lights Drivetrain Power Door Locks Wheels and Tires FWD Cruise Control Alloy Wheels Braking and Traction Steering Traction Control Power Steering Stability Control Tilt Wheel ABS(4-Wheel) Entertainment and Instrumentation AM/FM Stereo MP3(Single Disc) XM Satellite Safety and Security Dual Air Bags Side Air Bags F&R Head Curtain Air Bags Glossary of Terms Kelley Blue Book@ Trade-in value-This is the amount you can expect to receive whenTip' you trade in your car to a dealer.This value is determined based on the style,condition,mileage and options indicated. 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Jy N L► L1 N VF to t^ N N 4A.to It^ A^ cn Ls V. Vs 'z OWo W O Ot -tH.+ N FHaNJ r0~0 hW10 NJ-� 00 p A Q1 O W Qi w to i M .A w in N Vt A N W 0) (n V w d W O 0W1 C5 45A. GNJ W V O �qq (t�v w V -4 ON0 dM� . vpp W 4 W N e GT1 Ln to O 1A+ QCOi Q W A O tin W Go T Ct M kO W Lntb A C O O n � O ' T tD j d A M N � i bZVE19LLIL 6T:01 b10Z/81/11 L0100 39dd 1- N O L O N a-� U N m M LL. czd Y _C d L U U Q N 3 m > O .N O a a m r U Q) N L a N d L s O O c� io � 3 v � o J c a 0 Q � � + o 4 = N d1 0 0 to- + O c + O N a \ u Q •U O G D + U t . 00 Ict V' ai � * O O O O l0 N N N N N - O O -, Q� M M M -1 ` a v Y O ECN v H \ d 3 Q o a H J .0 i a 3 + o a v a) v IR ca a m v ao a W c c o v y a 0 0 0 a v o o m m 2 v v a U > > Q in a c a W W d V w mo i nLincoln Financial Groupe PO BOX 7880 FORT WAYNE, IN 46801-7880 November 5, 2014 Nancy.brown@raymondjames.com Contract#959801007 Warren D. Williss; deceased To Whom It May Concern, Per your request,please see the information below. The date of death value as of 9.30.2014 was $52,233.83. If you have any questions please contact claims customer service at 800-454-6265 ext. *8200. Sincerely, DD Amy Lavender Annuity Claims Examiner 11 Registered Representative of,and securities offered through,Lincoln National Life Insurance Company and Lincoln Financial Advisors Corp.,broker-dealers. Lincoln Retirement is the marketing name for the annuities operation of The Lincoln National Life Insurance Company. Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Q Q Q Q Q Q in M M M M M M Ln LA Ln Ln Ln Ln 1-f r 1 rl V-4 -4 r-1 i p � rl ri rl T4 r4 .., O d� � fiF � i -. 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': -tc�»>.�a:•;,•..;,1.-ovY+s:�,'c. s r," .;'.�%'-:^i•� r +. ����.L.tJ fl �:G% f � ,`..=;q�>r•*y":-'e=-J- � : 1�4F ��'r�`7k�t `'�:ii��iia�$:T�17R I.�.�,Ip 'l5�'}� '��I'�I�:u�t'�i�.0 �'^`r"..� r�.� F! ' `ltis•.Nill��,,�q_,.�'_�(''���t���cl:�,'- `/�_r,�f'��r•.ti� l\� AT THE NATU RITV HEREOF WILL PAY l�/ �,/�,�-1,,` hp�f-�� <.a. _ .,C'.,,?_'-�. '...�,:�.!'-.,e.m•-. .-d�.2-..-+ WRICH IS THE FIRST OAY OG i ,? �3>�2-20.--3262 Ls. A"',P �NUVIM1T�2.�__--rYE;�I- MECHANICSBURG, PA : 7055 1,5 DDEi IIS IQ 4GENT'S fMMe'� ^ JANET A tV - ' ��� �IOATII.IG STAMP V}�'r. FARS J' ET MARIE WILLISS AUL o 'PAel'-"_ _ SERILS G "rs �,II�EP V,Pf,aU„q tiE�,iv O"oaotw w0[P. r Sn..l�drA.7 ry nCl ry P. kk L - / ��' • ';� "•_ �� � .� � _--_T y"� `-,cro'.'rPN9' �1\`tom'+.- .,• -V. ' ��'��� �;1tf ee a ce el :�e►y �i�•: _ � o _ 'e -tee e r �.�� .�aF, - - '^.v�<,v Cs- ^3•i�:lSvfii'f.FY.:a[.6L. .tl:{.tl::YiG'TSCA'ti:Jlc:tE:::.^[-S;:bG'.AM3r 4:JIIM8fY.N-tr7600'.OM1Yr6U0Ubl'e7MM'rPJtr]65E�Ko-�W6+CJfii +OkTb�(Y75N.f'4 N5R ;�.4,�^��J[ � tG'*�-�. AT THE MATURITY HEREOF WILL PAY _- v UWED © "� ISSUE DATE ` � -�,.e[, WHICH IS THE FIRST DAY OF 302-20-3262 l T�,R WARR(EiN DAVID WILLISS AMP 0'7660 N�0V19_83 --- - 1.120 BF"�.LDWIN STREET MECHANICSBURG PA 17055 4L40 i\ r ooB� 6ow AGENTS ggG- y„ - WTII�U STAMP OR MRS JANET MARIE WILLISS HBG. �t�e RO.OSEV.'• / G phDil4U[O.mp[n.Vt .E,r,'ep,P♦ /, J A•.,I 1 suue,ro rae rtn _.: irooa L _1 i ') 1 i �9' E f SEE . 07. �. .__. � a _'TJn:a•^.::: :aeacxxwr d'b"b*bT.,.,z-ri,�.,_-. s:��?s:;>:'a-_.z;xx+z:,yn•.:.�..,r'a�=. s;��^>~IGra tz=;:.,^<Yc„a � G-.,�� AT THE,MATURITY HEREOF WILL PAY ISSUEOATE WHICH IS THEFI RST DAY OF 302-20--32.62 TiiMR WARREN DAVID WILLISS AMP 09660- ia��_19s13_ ______-- 1120 WhLiJ�'lt�l C&REE /MONTHI_,--- IYEARI MECHANICSBURIG PA I.7065 4 150 DDO - OATINGST P 0R MRS JANET MARIE WILLISS, HSGs>'-PA-.'- 001. PA_a'_00,Z" / _ S r ..,onw�'i,[c'•v,e[..,rt.o, o.�ononv eo,o.cT.ns,.vcnoco. , .1 k. SERIEs EE p ��•z:+:r:.�esaiLnSYCthM n^wca�.ty�.�::a'6•a:: �vas^JzrJ<::n� - -':5.::zusls'S"..C•[ecn�>2•;�:+J•:M:w�;;TM.�-'L�..:srs:l�s�::;^3v.,,zo: ^.x;:.uk.:�'�+ !'.s�.:5;+'+::cai:Yc.:>r=v�'.�,:ss,,• r`�_ k;= •,:.��''��+%', .�3ti.Yr•1✓..w;t �, r�����42'�D l9 N.-9)�.� !le�lt- _ D i 6? ,{ r `� •.J atif;-f�fsr^r•=-�[;�_,�;. ;\ W'A'` ..( • - �- =-� .,`ice=4r.... .g...._..,<;�•:/x'. •;ti�'_:'"� iii• '�4.c; �.'`S. i't'��'�r...... .�'� r,�, ':V' ,rF.`s t�*`-��"=�`� �_�: �;. � :: •'ey'+t�` ,C.:r.In� �r�k�41i 5,tt•I.a�•✓.�a7' 1. 1a.�.�id� �r✓ ATMQ�y� .:Ca..vayst• ,.< s•�..�..:`� .. AT THE MATURITY HEREOF WILL PAY [ •���J'1 ._.�_., IN �.., ., S'.•` .c.�.,�• S,r,m_ !'/!-::C!!IS THE FIRST DAY O: aGc-20 -34262. MR WARREN -DAVILD WILLISS AMP 0136b0l _� t: II20 ,v% STR�c . _ MECH,&.% G4,�y� SBURC PA 17055 ✓D O �p i r iJ G nGE[.Yr's . OR MRS . t;haET MARIE kJI LLk.55 i ls(_1 'N o 5 wn�o�n�tm wo.wr *['tovo wcr.wt.ur.n[o. y �* .trE, [oovtx[ox4txEnEoi, i ~', � 5 � ^ -� � S.e.e�dra.T •,bl �x.�rureawq���;c.•wmetisln:3mssuxm:>'~.�ss .c.:r:z:.;s•:.:rs:n'sx:;'«E',_>s:r:�„Y.:�:?�.:a•�rssre,M, i5'``�1� �`„. .�\°:�� 4 _`° '.s•�,�+- Q6Y 0�M:•0 1 -_.. - � _- D - i D! n. 4. Y'�' rn�.a.m +ei:T.}?�-`!�'-` yLsf ._ _ .�' - .. �. �_' _�. sb .��ak.'•. ci .��,f��.•�;>��[,',,.`-��� 'x-44�J �� )`A•.�b:>.a�J:4'4:F,Y.4TG+d=3_.Z{:�>j:.c .i4.v':i\:;'.(<+`��::.1:.^.•.•�,b•�p Y'4 '] ti^-f,'?�:r.'.•.�.�]w....•..fir..^nT,...�..-._ ..wCwy �J �� 1r " .,„.•y E�• ,w.n,`Rt...�_ !�g Sµ}. P �. �.+•�� � r/LRIM,� �. •.,,_O -,w r y 4` VW' -•���'���•�_ -AT THE MATURITY HEREOF WILL PAV L�ti•`������_ ! SUE DATE WHICH IS THE FIRST DAY OF .ry . 02-20--3262 MR. WARREN DAVID WILLISS AMP € 9660 01.- (YEG.41-- __ 11X1 BALDWIN STREE=T r 4150 ME%�if�NICSBURG RA 17055 - s 0!L.1ZTQ�TA An OR MRS JANET MARIE WILLISS Hb(;- ' 'A 5 w00:3EV.£v. .ro'nK�,[e�.m.wE o:E[nnErU[eewH wtwvExDEo. L 151185 S 6 EE sue+[cT ro rxE rE . oo.x awc:xeneoE. wg Vol 1 Iki Eeu"•"•'"^"^'"-""'^ •^ti:SLSSSR.9RCSLNfSY^'ERC:s`s>�C¢eY.SiuR't#YCL`•t'»ti_Ktt¢rSSa"tiYa2'.s1'C+tx;.EY'.ffc.+:::a'.u:.cY.�^Y.CS .C:S'�'C:�:::x:Y:[.:•"^"•:�G::c:2:.Y �.,� '.( �< .f — 0/ D i/N :•0 1 — _ !i _ '_ 0 e�— �D �0/ ��,'.. �Zea •i�t%f'i ae�$•� I�" =r --J. J 1 tib, AT THE MATURITY HEREOF WILL PAY ISSUE DATE D!-o���\C,,,�,s.P WHICH IS THE FIRST DAY OF 302--20-3262 ;: '° • T°MR WARREN DAVID WILLISS AMP 09,660 CjLT__l9a3--------1120 BALDWIN. STREET - +•f?;'ice��.. 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V (7 Ln C7 (� 00 2 0 Z !- ti o v 2 n Cai LL w o°o � Prudential Computershare + Computershare Trust Company,N.A. PO Box 43033 Providence,RI 02940-3033 Within USA,US territories 8 Canada 800 305 9404 Outside USA,US territories 8 Canada 732 512 3782 020672 www.computershare.com/investor 111sill l l'11'I'1111111'I I I"I I'11111�111'1111'111'1111111'I'I I Prudential Financial,Inc.is organized under the laws of the State of NJ. R MARK THOMAS &ELIZABETH A WILLISS EX EST WARREN D WILLISS 101 S MARKET STREET Holder Account Number MECHANICSBURG PA 17055 C0033501030 Company ID PRU SSN/TIN Certified Yes Prudenthl Financial; Inc.- Direct Registration (DRS) Advice Transaction(s) Date Transaction DescriptionClass I Shares/Un is I Total CUSIP I Description 09 Apr 2015 Transfer 149.000000 744320102 Common Stock Account Information: Date: 09 Apr 2015(Excludes transactions pending settlement) Direct Total Price Class Registration Shares/ Per Share Value($) CUSIP Description Balance Units ($) 149.000000 149.000000 81.130000 12,088.37 744320102 Common Stock IMPORTANT INFORMATION RETAIN FOR YOUR RECORDS. This advice is your record of the share transaction affecting your account on the books of the Company as part of the Direct Registration System. It is neither a negotiable instrument nor a security,and delivery of this advice does not of itself confer any rights on the recipient. It should be kept with your important documents as a record of your ownership of these shares. No action on your part is required,unless you wish to deposit your existing certificates,sell or request a certificate, or transfer your book-entry shares. Please note that certificate requests made as part of a transfer request may automatically be changed to book issuance. If you wish to obtain a certificate please access your account via the Investor Centre web site or contact a customer service agent. Fees may apply to certificate issuances.We encourage you to leave your registrations In book form to facilitate a secure and easily accessed account holding. The IRS requires that we report the cost basis of certain shares acquired after January 1,2011. If your shares were covered by the legislation and you have sold or transferred the shares and requested a specific cost basis calculation method,we have processed as requested.If you did not specify a cost basis calculation method,we have defaulted to eke first in,first out(FIFO)method. Please visit our website or consult your tax advisor if you need additional information about cost basis. Upon request,the Company will furnish to any shareholder,without charge,a full statement of the designations,rights(including rights under any Companys Rights Agreement,if any),preferences and limitations of the shares of each class and series authorized to be issued, and the authority of the Board of Directors to divide the shares into series and to determine and change rights,preferences and limitations of any class or series.Assets are not deposits of Computershare and are not insured by the Federal Deposit Insurance Corporation,the Securities Investor Protection Corporation,or any other federal or state agency. If you do not keep In contact with us or do not have any activity In your account for the time perlods specified by state law,your property could become subject to state unclaimed property laws and transferred to the appropriate state. 4 0 U D R P R U + 001 CS0003.d.mix.051935 5348#nO672N22985 00115AB D10 PRU lRev.10/141 Please see important PRIVACY NOTICE on reverse side of statement Prudential Computershare + Computershare Trust Company,N.A. PO Box 43033 Providence,RI 02940-3033 Within USA,US territories b Canada 800 305 9404 Outside USA,US territories&Canada 732 512 3782 012488 www.computershare.comTnvestor Prudential Financial,Inc,is organized under the laws of the State of NJ. JANET PAULES WILLISS C/O R MARK THOMAS 101 S MARKET ST Holder Account Number MECHANICSBURG PA 17055 C0004377036 Company ID PRU SSN/TIN Certified Yes Prudential Financial, Inc. - Direct Registration (DRS)Advice Transaction(s) Date I Transaction DescriptionTotal Class I ShareslUnits I CUSIP I Description 09 Apr 2015 Transfer -149.000000 744320102 Common Stock Account Information: Date: 09 Apr 2015(Excludes transactions pending settlement) Direct I Total Shares/Units I CUSIP I Class Registration Balance Description 0.000000 0.000000 744320102 Common Stock IMPORTANT INFORMATION RETAIN FOR YOUR RECORDS. This advice is your record of the share transaction affecting your account on the books of the Company as part of the Direct Registration System. It is nether a negotiable instrument nor a security,and delivery of this advice does not of itself confer any rights on the recipient. It should be kept with your important documents as a record of your ownership of these shares. No action on your part is required,unless you wish to deposit your existing certificates,sell or request a certificate, or transfer your book-entry shares. Please note that certificate requests made as part of a transfer request may automatically be changed to book issuance. If you wish to obtain a certificate please access your account via the Investor Centre web site or contact a customer service agent. Fees may apply to certificate issuances.We encourage you to leave your registrations In book form to facilitate a secure and easily accessed account holding. The IRS requires that we report the cost basis of certain shares acquired after January 1,2011. If your shares were covered by the legislation and you have sold or transferred the shares and requested a specific cost basis calculation method,we have processed as requested. If you did not specify a cost basis calculation method,we have defaulted to the fust in,first out(FIFO)method. Please visit our website or consult your tax advisor 9 you need additional information about cost basis. Upon request,the Company will furnish to any shareholder,without charge,a full statement of the designations,rights(including rights under any Company's Rights Agreement,if any),preferences and limitations of the shares of each class and series authorized to be issued, and the authority of the Board of Directors to divide the shares into series and to determine and change rights,preferences and limitations of any class or series.Assets are not deposits of Computershare and are not insured by the Federal Deposit Insurance Corporation,Are Securities Investor Protection Corporation,or any other federal or state agency. If you do not keep In contact with us or do not have any activity In your account for the time periods specified by state law,your property could become subject to state unclaimed property laws and transferred to the appropriate state. 4 0 U D R P R U + 001 CS0003.d.m ix.051935_534RI012488/012489/i 001-15AB 010 PRU(Rev.101141 Please see imoortant PRIVACY NOTICE on reverse side of statement Azdential Financial,Inc. (PRU) Historical Prices & Data-NASDAQ.com Page 4 of 7 r 6te Open High Low --Close;Last Volume £ V21/2014 81.75 83.62 ---8f:§9---83-62 ' 2,641,950 V20/2014 80.71 81.07 79.92 81 2,164,622 717/2014 79.74 81.54 79.63 81.06 3,385,753 U' 716/2014 76.16 79.4643 76.015 78.82 3,792,392 715/2014 78.89 78.98 75.89 77.86 4,904,251 00O 0.10 11412014 80.45 81.3 80.01 80.25 2,864,251 913/2014 82.54 82.9 80.1 80.21 2,928,949 149• x 1110/2014 83.28 83.68 81.93 82.15 2,776,417 67-94 - T09/2014 85.61 85.65 82.92 83.38 4,218,185 '13003-06 108/2014 85 85.86 83.74 85.75 2,247,933 0 107/2014 86.29 86.59 84.7 84.74 2,291,763 106/2014 87.44 87.49 86.24 86.76 1,762,229 1103/2014 87.02 87.67 86.505 87.04 2,407,618 102/2014 85.68 86.46 85.01 86.14 2,014,080 1N1/2014 87.66 87.89 85.63 85.69 3,286,264 09,10/2014 89.15 89.58 87.94 87.94 2,411,001 0929/2014 88.88 89.515 88.45 89.1 1,550,489 0926/2014 90 90.49 89.19 90.05 1,948,258 0925/2014 91.31 91.52 89.5 89.64 2,202,310 0924/2014 91.15 91.7 90.77 91.48 2,306,314 0913/2014 91.78 92.38 90.8 90.95 2,110,476 O9R2/2014 92.53 92.88 91.71 91.88 2,046,100 O9A912014 93.43 94.3 92.7 93.16 3,659,261 0908/2014 91.08 93.49 91.01 92.95 3,277,254 09/17/2014 91.18 91.65 90.37 90.82 2,309,751 09/16/2014 89.97 91.49 89.97 90.93 1,866,716 09/15/2014 90.62 90.81 89.97 90.36 2.042,834 09/12/2014 89.58 91.03 89.395 90.94 2,820,957 09/11/2014 88.64 89.6 88.63 89.44 1,433,114 09/'0/2014 88.6 89.51 88.35 89.37 1,854,582 09/03/2014 88.92 88.92 88.072 88.25 1,862,842 09/OB/2014 88.94 89.65 88.5 89.14 1,507,363 09/05/2014 89.05 89.59 88.39 89.24 2,033,466 09/04/2014 89.92 90.28 89.07 89.29 1,701,662 09/03/2014 90.41 90.49 89.38 89.66 1,853,249 09/0212014 90.02 90.46 89.1001 89.78 2,438,678 08/29/2014 89.55 90.04 89.4 89.7 1,580,657 08/28/2014 89.8 89.88 88.765 89.06 2,134,028 08/27/2014 90.23 90.7 90.07 90.47 1,877,439 08/26/2014 89.63 90.36 89.63 90.07 2,338,296 08/25/2014 89.14 90.27 89.14 89.75 1,419,206 08/22/2014 89.32 89.72 88.57 88.65 1,456,978 08/21/2014 89.37 90.4 88.82 90.12 2,967,262 http://www.nasdaq.com/symbol/pru/historical 4/15/2015 rage 1 of 2 Ul�i. Prudential Computershare I'llow Computershare Trust Company,N.A. PO Box 43033 Providence,RI 02940-3033 Within USA,US territories&Canada 800 305 9404 Outside USA,US territories&Canada 732 512 3782 www.computershare.comriinvestor 002661 _= Irrlulllrlrllllllrinrllllllllrllrinllrlrlrlllrllllllrlll�ll R MARK THOMAS &ELIZABETH A WILLISS EX EST WARREN D WILLISS 101 S MARKET STREET MECHANICSBURG PA 17055 Holder Account Number C0033501030 FID Ticker Symbol PRU CUSIP 744320102 Prudential Financial, Inc. - Sales Advice Trade Date: 22 Apr 2015 14:02(Time) Settlement Date: 27 Apr 2015 Cost Basis Method: FIFO Shares/Units Price per Gross Amount Trading BankingMire Backup Other Net Amount Sold Share/Unit(USD)I of Sale(USD)I Fees(USD)I Fees(USD)�itholding(USD) Fees(USD)I of Sale(USD) 149.000000 81.099100 12,083.77 22.92 0.00 0.00 15.00 12,045.85 Covered Transaction Total: 0.000000 Noncovered Transaction Total: 149.000000 Covered Shares/Units Covered Cost Covered Short Term Covered Long Term Overall Covered Sold Basis(USD)I Gain/Loss(USD)I Gain/Loss(USD) Gain/Loss(USD) 0.000000 N/A N/A N/A N/A PLEASE SEE REVERSE SIDE FOR IMPORTANT DISCLOSURES AND DEFINITIONS 1 L T R P R U + 001 CD70003 us.ltr.c.4dy..%aIJ 1_5763/002661/002661 A WARNING:MULTIPLE SAFETY FEATURES.THE FACE OF THIS CHECK HAS A BLUE BACKGROUND AND FLUORESCENT INK(HOLD UNDER BLACKLIGHT TO VIEWt.REFER TO SECURITY ENDORSEMENT BACKER FOR TRUE WATERMARK AND ADDITIONAL FEATURES, Prudential Harris Central N.A. 70.1558 Roselle,Illinois 719 PLEASE DEPOSIT THIS CHECK PROMPTLY. PRU Pay to R MARK THOMAS Check Number:0000934596 &ELIZABETH A WILLISS EX EST WARREN D WILLISS 1013 MARKET STREET MECHANICSBURG PA 17055 27 Apr 2015 $`12,045.85"" The sum of $**"TWELVE THOUSAND AND FORTY-FIVE DOLLARS AND EIGHTY-FIVE CENTS US Computershare I FUNDS ONLY"" Authorized Paying A nt Computershare Inc. 250 Royall St,Canton,MA 02021 a Security Features Details on Back. Authorized Signature(s) 11'00009 34 S9611' 1:0 7 L9 L S S8011: 04ea1 2 2 S-180 Sell LII' .M alpe.Z.zz Funeral Moyne 8 Market Plaza Way - (717)697-4696 Mechanicsburg,PA 17055 www.MalpezziFuneralHome.com Jeremy J.Shartzer,FD Michael J.Malpezzi,Owner,FD Kyle C.Knipe,FD October 7,2014 Elizabeth Williss 1121 Baldwin Street Mechanicsburg,PA 17055 This is the final statement for the funeral services of Warren D. Williss We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way. PROFESSIONAL SERVICES: Services of Funeral Director/Staff $5,475.00 FUNERAL HOME SERVICE CHARGES $5,475.00 SELECTED MERCHANDISE: Stainless Steel Casket $3,950.00 Sentinel Vault $1,450.00 Flag Register Book $250.00 THE COST OF OUR SERVICES,EQUIPMENT,AND MERCHANDISE THAT YOU HAVE SELECTED $11,125.00 CASH ADVANCES: At the time funeral arrangements were made, we advanced certain payments to others as an accomodation. The following is an accounting of those charges. Certified Death Certificates $60.00 Newspaper Notices-Patriot $411.30 Clergy/Mass Offering $250.00 Organist $200.00 Flowers $300.00 Betty Noss $100.00 TOTAL CASH ADVANCES AND SPECIAL CHARGES $1,321.30 CONTRACT PRICE $12,446.30 TOTAL AMOUNT DUE BY November 1,2014 $12,446.30 Ck L If you have any questions or concerns regarding this bill, please call our office at(717)697-4696. D � A r 1 13 2260 Herr St. Harrisburg,PA 17103 Phone 717-233-6789 Fax February 2,2015 14-INT-047 Elizabeth A Williss 1121 Baldwin Street Mechanicsburg,PA 17055 We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES,MERCHANDISE,AND CEMETERY PROPERTY THAT YOU SELECTED WHEN MAKING THE ARRANGEMENTS. Vault Category Vault Fee $ 45.00 Subtotal of Vault Category $ 45.00 Professional Service Fees Traditional PSF:After 3pm, Saturday $ 1,750.00 Subtotal of Professional Service Fees $ 1,750.00 TOTAL CHARGES $ 1,795.00 PAYMENTS& ADJUSTMENTS ($ 1,795.00) October 2,2014 PNC Bank ($ 1,795.00) BALANCE DUE: $ 0.00 OLIVE GARDEN 1471 6520 Carlisle Pike Mechanicsburg, PA 17055-5251 Check # :29325 Table 50 : 53-52-50-51 Ryan L 19:09 10/06/2014 Gst 37 Transaction #:470226269 ----------------------------------------.. ID # 6259 72263 7164 * We value your opinion. Please * tell us about your dining * experience by completing an * online survey within 7 days of * your visit. You could win a * $1,000 Grand Prize or 1 of 100 * $50 prizes. Winners are drawn * monthly!! * * * To complete the survey and enter * the contest, go to * www.OliveGardenSurvey.com and * enter the ID on this receipt. * NO PURCHASE NECESSARY. Void where * * prohibited. See Official Rules at * * www.OliveGardenSurvey.com. * Valoramos su opinibn. Complete la * encuesta sobre su experiencia * gastronbmica en * www.OliveGardenSurvey.com. a ************X*X****XX*X**Xx**-**X (OFFER EXPIRES Oct 13, 2014) ------------------------------------------- Card Number Auth Code xxxxxxxxxxxx 4815 816090 Visa Check Arno�_.�r7 t E�89 _ 33 Tip Not Included ---------------------------------------- Suggested tip amounts 15% - $97.59 are provided for your 18% - $117.11 convenience. 20% - $130.12 ----------------------------------------- 01 Roundup 4 BGCA T i p - - - - - _...vv Total - - - X Cardmember agrees to pay total in accordance with agreement governing use of such card. Guest Copy RECEIPT FOR PAYMENT ------------------- ------------------- LISA M. GRAYSON, ESQ. Receipt Date : 3/03/2015 Cumberland County - Register Of Wills Receipt Time : 09 : 35 : 12 One Courthouse Square Receipt No. : 1080646 Carlisle, PA 1713 WILLISS WARREN D Estate File No. : 2014-01006 Paid By Remarks : R MARK THOMAS DB1 ------------------------ Receipt Distribution ---- ------------ ------- - Fee/Tax Description Payment Amount Payee Name SHORT CERTIFICATE 10 . 00 CUMBERLAND COUNTY GENERAL FUN ---------------- Cash $10 . 00 Total Received. . . . . . . . . $10 . 00 RECEIPT FOR PAYMENT ------------------- ------------------- LISA M. GRAYSON, ESQ. Receipt Date: 10/23/2014 Cumberland County - Register Of Wills Receipt Time : 15 : 08 :37 One Courthouse Square Receipt No. : 1079514 Carlisle, PA 1713 WILLISS WARREN D Estate File No. : 2014-01006 Paid By Remarks : R MARK THOMAS DMB ------------------------ Receipt Distribution ------------------------ Fee%Tax Description Payment Amount Payee Name PETITION LTRS TEST 260 . 00 CUMBERLAND COUNTY GENERAL FUN WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 25 . 00 CUMBERLAND COUNTY GENERAL FUN INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 35 . 50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 4733 $370 . 50 Total Received. . . . . . . . . $370 . 50 STATEMENT i ExA ca P'ci T4T7Y, s, /"l AR K-eT .-,7-, lel EC(,4-A/(C s 43y P.9 s) U.5.5- TERMS MATE Gt/ R6 N, P. e 7S, oA 73, ■ops. 3409 MADE IN U.S.A. NMI Igg 4.. 5, j? A'l 4 41, .. K'S il;tl tSYIA..":'.'� e RO 'M 'sam qUIreo),' .��I(E6dor§drfiehvKea J7 1.14 'V6 FI im 4� 'o �.(l=naorsem-e*nt'R,5�ulred)Ll, : - .......... :4� ,R6stfliiiedbeliVi&r�Ebb, "3�;'e. �� "q SM ostage!91F T Sent-To��, f A, P, YA ru, 5�91 M',�'Stree A L'jo ---------- �&'PbSoi'N67 'Z'!gg, pt' N ON; Nd 7 �Olwil"`OAR 5 L—y'—... _Q�rll 7 �l % Z 'iM i)$3 'IN -A ugy Pl-.."M Zi klb� `0 0"R IV, X, VIP A `,-'�X-A SK.-$P-30 L4N A -.iCHANGE'i�s'$0 0 C.'OL.'. ('A M�_4 N) Mt t 14 a�. INHAR-C 1-4 �'NNIM, So AI Y� -4turW,.MUS 67�pccompanle a I --sales fuuuipUo:. Wand, q Hi P. R 1'7' A 2 AWR' Ji M'1'01'�i "ki Postal CERTIFIED RECEIPT (Domestic tU For cfe—livery information visit our website at www.usps.com& � ANIC58� -0 Postage $ L 9cA < .y �Y4s7 Certified Fee '1 7 O O� Retum Receipt Fee Postmark O Here'.": ' C7 (Endorsement Required) pU O •f. Re str cted Delivery Fee �. (Endorsement Required) O Total Postage&Fees $ fU Sen , -- • y-- w---- -- ---- ------------- 3 Street,Apt N / -- or PO Box No�! /�' /'lQC e(,�`/1/ / ----------------- •--------------------------.----- City e State�,Z1P+ A / �y PS Form :00 A.ugiist,2006 See Reverse/ The Patriot-News Co. • 2020 Technology Pkwy Suite 300 the Patr10t*W(xfW5 Mechanicsburg, PA 17050 Now you know Inquiries - 717-255-8213 R. MARK THOMAS 101 SOUTH MARKET STREET MECHANICSBURG PA 17055 STATEMENT ALL CHARGES ARE NET ACCT# NAME AD ORDER# DATE EDITION ADDTL.INFO. TYPE OF CHARGE AMOUNT 35242 R.MARK THOMAS 0002322613 12/23/14 XXX WILLISS BASIC AD CHARGE $90.82 35242 R.MARK THOMAS 0002322613 12/30/14 XXX WILLISS BASIC AD CHARGE $90.82 35242 R.MARK THOMAS 0002322613 01/06/15 XXX WILLISS BASIC AD CHARGE $90.82 AFFIDAVIT CHARGE $5.00 TOTAL: $277.46 This is not an invoice. Please do not remit payment from this Statement. An invoice will be generated at the end of the month. --Thank you. NOTE: This Statement replaces the Order Confirmation which we previously sent with Proofs of Publication The Patriot-News Co. 2020 Technology Pkwye atrl*ot'° CWS Suite 300 Mechanicsburg, PA 17050 Now you know Inquiries - 717-255-8213 R. MARK THOMAS 101 SOUTH MARKET STREET MECHANICSBURG PA 17055 THE PATRIOT NEWS THE SUNDAY PATRIOT NEWS Proof of Publication Under Act No. 587, Approved May 16, 1929 Commonwealth of Pennsylvania, County of Dauphin} ss Marianne Miller, being duly sworn according to law, deposes and says: That she is the Assistant Controller of The Patriot News Co., a corporation organized and existing under the laws of the Commonwealth of Pennsylvania, with its principal office and place of business at 2020 Technology Pkwy, Suite 300, in the Township of Hampden, County of Cumberland, State of Pennsylvania, owner and publisher of The Patriot-News and The Sunday . Patriot-News newspapers of general circulation, printed and published at 1900 Patriot Drive, in the City, County and State aforesaid; that The Patriot-News and The Sunday Patriot-News were established March 4th, 1854, and September 18th, 1949, respectively, and all have been continuously published ever since; That the printed notice or publication which is securely attached hereto is exactly as printed and published in their regular daily and/or Sunday/Community Weekly editions which appeared on the date(s) indicated below. That neither she nor said Company is interested in the subject matter of said printed notice or advertising, and that all of the allegations of this statement as to the time, place and character of publication are true; and That she has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed and adopted severally by the stockholders and board of directors of the said Company and subsequently duly recorded in the office for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book"M", Volume 14,.Page 317. PUBLICATION COPY This ad# 0002322613 ran on the dates shown below: i ESTATE NOTICE December 23, 2014 Letters Testamentary on the Estate of December 3O, 2014 WARREN D.WILLISS,loteof Mechanicsburg Borough,Cumberland January 06, 2015 County,Pennsylvania,deceased,have been granted to the undersigned,all persons knowing themselves to be Indebted to said estate will make — payment immediately and those having ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' clalms will present them for settlement to: R.Mark Thomas,Co-Executor 101 South Market Street Sworn to rid,-subscr--ibed before me this 15 day of January, 2015 A.D. Mechanicsburg,PA 17055 f Elizabeth A.Williss,Co-Executor / i 1121 Baldwin Street Mechanicsburg,PA 17055 .� 11 t✓ l SIJ vvv "� R.Mark Thomas R� No, ry Public l i Attorney at Law 101 South Market Street Mechanicsburg,PA 17055 COMMONWEALTH OF PENNSYLVA A NOTARIAL SEAL Sheryl Marie Leggore,Notary Public Hampden.Twp„Cufnberland County My Commission Expires July 16,2018 111EMB'ER,PENNSYLVANIA ASSOCIATION OF NOTARIES D cOG CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717)249-3166 Fax:(717)249-2663 January 2, 2015 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: R. Mark Thomas, Esquire RE: Warren D. Williss Estate Legal advertisements'must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: December 19, December 26, 2014 and January 2, 2015 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 75.00 ------------- Total Amount Due $ 0.00 Becky H. Morgenthal, Executive Director PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 COMMONWEALTH OF PENNSYLVANIA : ss. COUNTY OF CUMBERLAND Lisa Marie Coyne,Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952,been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, viz: December 19, December 26, 2014, and January 2, 2015 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. ./,Liga Marie Coyne, liditor SWORN TO AND SUBSCRIBED before me this 2 day of January, 2015 WWiss,Warren D.,deed. C Late of Mechanicsburg Borough. Co-Executors: R. Mark Thomas, �N�otary" 101 South Market Street,Mechan- icsburg, PA 17055 and Elizabeth A. Williss, 1121 Baldwin Street, Mechanicsburg,PA 17055. Attorney: R. Mark Thomas, Es- COMMONWEALTH OF PENNSYLVANIA quire,Attorney at Law, 101 South NOTARIAL SEAL Market Street,Mechanicsburg,PA 17055. DEBORAH A COLLINS Notary Public CARLISLE BORO.'CUMBERLAND CNTY My Commission Expires Apr 28,2018 505T i N N VOI l0/f m .N -Coo Q .?. 0N � O �. m m n2 0oo C �p 3O« W .Z7 p C0 0 z 00 y0Y a cr m UDZ � mm c `° 5 � cn ,r7Cn 0 Z-- — ° 0 CD D ° 0oo elo C* co -' Ul co 2 N > M o w .p. as cwr+ � .r.r■ w X if w tv -� = t� -• v' w m � �: v c � � � ;� -I conies o m. err -► '! 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PAGE Oct 01 2014 3644 Page l of 3 Warren Williss 1121 Baldwin St Mechanicsburg,Pa 17055 Terms: DUE UPON RECEIPT Client Date Start-End Time Description/Care Giver Unit QTY Rate / Per Amount Williss,Warren 09/16/2014 7:OOAM 3:0GPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Williams,Regina 09/16/2014 3:OOPM 11:OOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Gay,Brenda 09/16/2014 11:00PM 7:OOAM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Lynch,Letecia 09/17/2014 7:OOAM 3:OOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Williams,Regina 09/17/2014 3:OOPM 11:OOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Williams,Regina 09/17/2014 11:OOPM 7:OOAM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Lynch,Letecia 09/18/2014 7:OOAM 3:OOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Williams,Regina 09/18/2014 3:OOPM I LOOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Gay,Brenda 09/18/2014 I LOOPM 7:OOAM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Lynch,Letecia 09/19/2014 7:OOAM 3:OOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Williams,Regina 09/19/2014 3:OOPM 11:OOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Stevenson,Lynette 09/19/2014 11:00PM 7:OOAM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Stevenson,Lynette 09/20/2014 7:OOAM 3:OOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Akra,Vicki 09/20/2014 3:OOPM. 11:OOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Stevenson,Lynette 09/20/2014 l 1:OOPM 7:OOAM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Stevenson,Lynette 09/21/2014 7:OOAM 3:OOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Akra,Vicki 09/21/2014 3:OOPM 11:OOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Williams,Regina 09/21/2014 11:00PM 12:OOAM HomeMaker HOURS 1.00 7.50 /Hour 7.50 Williams,Regina 09/22/2014 12:OOAM 7:OOAM HomeMaker HOURS 7.00 7.50 /Hour 52.50 Williams,Regina 09/22/2014 7:OOAM 3:OOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Williams,Regina , Invoice (��sctuAngels_, Visiting Angels Phone:(717)652-8899 1Y18G 45515iAVGC SE 'P-=S 4607 Locust Lane Fax:(717)909-3185 Harrisburg,PA 17109 Invoice To DATE. INVOICE NO: PAGE Warren Williss Oct 012014 3644 Page 2 of 3 1121 Baldwin St Mechanicsburg,Pa 17055 Terms: DUE UPON RECEIPT Client Date Start-End Time Description/Care Giver Unit QTY Rate / Per Amount Wil liss,Warren 09/22/2014 3:OOPM 11:OOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Gay,Brenda 09/22/2014 11:00PM 7:OOAM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Williams,Regina 09/23/2014 7:OOAM 3:OOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Williams,Regina 09/23/2014 3:OOPM 11:OOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Gay,Brenda 09/23/2014 11:00PM 7:OOAM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Williams,Regina. 09/24/2014 7:OOAM 3:OOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Williams,Regina 09/24/2014 3:OOPM I I:OOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Stevenson,Lynette 09/24/2014 11:00PM 7:OOAM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Williams,Regina 09/25/2014 7:OOAM 3:OOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Williams,Regina 09/25/2014 3:OOPM 11:OOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Williams,Regina 09/25/2014 11:00PM 7:OOAM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Lynch,Letecia 09/26/2014 7:OOAM 3:OOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Williams,Regina 09/26/2014 3:OOPM 11:OOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Stevenson,Lynette 09/26/2014 11:00PM 7:OOAM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Lynch,Letecia 09/27/2014 7:OOAM 3:OOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Williams,Regina 09/27/2014 3:OOPM 11:OOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Stevenson,Lynette 09/27/2014 1 LOOPM 7:OOAM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Lynch,Letecia 09/28/2014 7:OOAM 3:OOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Stevenson,Lynette 09/28/2014 3:OOPM 11:OOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Stevenson,Lynette 09/28/2014 11:00PM 12:OOAM HomeMaker HOURS 1.00 7.50 /Hour 7.50 Lynch,Letecia Invoice 7rrrrrca:Cli0 to in 7fcvrrccurr / Visiting Angels Phone:(717)652-8899 V4G6ArigglSm l4lGG 4551'iSA1:4E SEFYF�?S 4607 Locust Lane Fax:(717)909-3185 Harrisburg,PA 17109 Invoice To DATE INVOICE NO.. PAGE Oct 012014 3644 Page 3 of 3 Warren Williss 1121 Baldwin St Mechanicsburg,Pa 17055 Terms: DUE UPON RECEIPT Client Date Start-End Time Description/Care Giver Unit QTY Rate / Per Amount Williss,Warren 09/29/2014 12:OOAM 7:00AM HomeMaker HOURS 7.00 7.50 /Hour 52.50 Lynch,Letecia 09/29/2014 7:OOAM 3:OOPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Gay,Brenda 09/29/2014 3:OOPM I I MPM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Gay,Brenda 09/29/2014 1 I:OOPM 7:OOAM HomeMaker HOURS 8.00 7.50 /Hour 60.00 Lynch,Letecia 09/30/2014 7:OOAM l:00PM HomeMaker HOURS 6.00 7.50 /Hour 45.00 Williams,Regina 09/30/2014 3:OOPM 1 LOOPM HomeMaker HOURS 8.00 7.50 !Hour 60.00 Gay,Brenda Client Total,Hours&Dollars 350.00 2,625.00 r `C TOTAL.: 350.00(Hours) $2,625.00 DUE UPON RECEIPT ............................ ........ .... . WEST SHORE EMS - BLS 205 GRANDVIEW AVE SUITE 211 vlsa °°`COCK "6st�ca.d CAMP HILL PA 17011-1708 WEST SHORE EMS Phone #: (800) 367-0512 Federal Tax ID: 23-2463002 ON REVERSE SIDE OHOLY SPIRIT HEALTH SYSTEM WARREN WILLISS NOVITAS SOLUTIONS, INC. DED PATIENT NAME: INSURANCE: HIGHMARK-FREEDOM BLU NONE CALL NUMBER: 25323853W09/22/2014 DATE OF CALL: HOLY SPIRIT HOSPITAL FROM: 1121 BALDWIN ST TO: WARREN WILLISS I ACCOUNT SUMMARY 1121 BALDWIN ST 156.47 MECHANICSBURG, PA 17055 TOTAL CHARGES: 0.00 PAYMENTS/ADJUSTMENTS: 156.47 PLEASE PAY THIS AMOUNT: DETACH ALONG PERFORATION AND RETURN STUB WITH PAYMENT DESCRIPTION OF CHARGE QUANTITY UNIT PRICE AMOUNT Stretcher One Way Trans Member T2005 1.0 128.33 128.33 Stretcher Van Mileage T2049 5.9 4.77 28.14 4l� Total Charges L15a666.47 DESCRIPTION OF PAYMENT RECEIPT PAYMENT DATE AMOUNT Denied by Insurance-HOSPICE OF CENTRAL f 10/16/2014 0.00 Total Credits 0.00 1 PLEASE PAY THIS AMOUNT-INVOICE DUE UPON RECEIPT $156.47 RETURNED CHECK EEE-$31.00 W PAYING BY VISA OR MASTMARD,FILLOUTBELOW Consultants w ❑MASYERCARO Pennsylvania Gastroenterology .DATE V"M 899 POPLAR CHURCH ROAD CAM CAMP HILL PA 17011-2206yE�cIIR Ty CaOE FOROIM ggtU,UAE o�oc cpao RETURN SERVICE REQUESTED STATEMENT DE PAY THIS AMOUNT ACCOUNT NO. AT WARREN D WILLISS $54 69 134756 Billing Phone: 717-763-0430 ext 319 12/20/2014 Billing Fax: 717-763-9854 Silting Email: brendar@pagiconsultants.Com CW;9Gc5 aND CREOl7S t1A E AFTER STA:c aVT SHOW AMOUNT a iconsultants.com DATE-ILL.IPPEAR ON NEXT STATE:>IEI: PAID HERE Web Address: www.p 9 nrlwrMAKE CHECKS PAYABLE/REMIT T0:® Pennsylvania Gastroenterology Consultants WARREN D WILLISS 899 POPLAR CHURCH RD 81121 BALDWIN ST CAMP HILL PA 17011-2206 mi MECHANICSBURG PA 17055-3935 I,,,IIII�IIII,,,II.I„I,111111,I,IIIIfill 10111fI,I„0111,11,1 I,,.III,,,III, +III,IIII,I,II,IIIIII,I,11,,1,1„11{II„1,1 EPLEASE DETACH AND RETURN TOP PORTION WITH ] Please check box if above address is incorrect or insurance � YOUR PAYMENT IN ENCLOSED ENVELOPE Information has changed,and indicate change(s)on reverse side. Please Note:If a'1'appears in this column,we have filed with your primary carrier. If a'2'appears, we have also filed with your secondary carrier. Our records show your insurance as follows: 1: Novitas Solutions Inc 2: Pro- Amount Your Date vider Reference Descri tion of Services Char ed Pa ments Insurance Balance 03/19/14 CBF 5:::1C:D9] .999221 INITIAL HOSPITAL CARE 230.00 0.00 1 04/16/14 Highmark Freedom Blue Adj 131.72 04/16/14 Highmark Freedom Blue Pay 98.28 03/20/14 CBF 578.999232 SUBSEQUENT HOSPITAL CARE 170.00 0.00 1 04/16/14 Highmark Freedom Blue Adj 100.45 04/16/14 Highmark Freedom Blue Pay 69.55 03/21/14 CBF 57$.9 99232 SUBSEQUENT HOSPITAL CARE 170.00 0.00 1 04/16/14 Highmark Freedom Blue Pay 69.55 04/16/14 Highmark Freedom Blue Adj 100.45 03/22/14 KKK 578.9 99232 SUBSEQUENT HOSPITAL CARE 170.00 0.00 1 34/16/14 Highmark Freedom Blue Pay 69.55 )4/16/14 Highmark Freedom Blue Adj 100.45 )3/23/14 KKK 578.9 99232 SUBSEQUENT HOSPITAL CARE 170.00 0.00 1 )4/16/14 Highmark Freedom Blue Pay 69.55 14/16/14 Highmark Freedom Blue Adj 100.45 3/24/14 KKK 578.9 99232 SUBSEQUENT HOSPITAL CARE 170.00 0.00 1 4/16/14 Highmark Freedom Blue Pay 69.55 4/16/14 Highmark Freedom Blue Adj 100.45 9/20/14 MSC 578.0 99221 INITIAL HOSPITAL CARE 230.00 20.06 1 1/24/14 HGS Admin Payment 78.62 1/24/14 HGS Admin Adj 131.32 )/08/14 Highmark Freedom Blue Pay 0.00 SERVICES NOT COVERED PT IS ENROLLED 14 HOSPICE )/21/14 MSC 578.0 99233 SUBSEQUENT HOSPITAL CARE 245.00 20.44 1 /24/14 HGS Admin Adj 144.44 /24/14 HGS Admin Payment 80.12 Account Current Over 30 Over 60 Over 90 Over 120 Due From DUE FROM PATIENT Balance Balance Patient '54.69 $54.69 $0.00 $0.00 $0.00 $0.00 $54.69 $54.69 siders: C`) 0-1- � stopher B Furlong MD,Karen K Kormis MD an S Charan MD, f Q J Checks Payable To: Isylvania Gastroenterology Consultants STATEMENT IfI�II�III�IIII��I���III��IIIIIIfI�I1�IIIIII�II SEE REVERSE SIDE FOR IMPORTANT BILLING INFORMATtnIlr STATEMENT OF ACCOUNT (2) CAMP HILL EMERGENCY PHYSICIANS Statement Date: March 01,2015 PO BOX 13693 ACCOUNT NUMBER: HYP48880033 PHILADELPHIA, PA 19101-3693 Patient Name:WARREN D WILLISS Tax ID#: 20-4667340 Account Balance: $34.43 Amount Pending Insurance: $0.00 IIrrIIIII11IrrrIIrl,Ir.lrl��"111111111rlllllll�rll�lrlrlr.11rlll Amount Due From Patient(Current): $0.00 082516-0000048880033-06 Amount Due From #BWNJFDB Patient(Past Due): $34.43 #OOOOOOHYP9130513# Pay This Amount: $34.43 WARREN D WILLISS 1121 BALDWIN ST YOUR ACCOUNT IS PAST DUE! PLEASE MECHANICSBURG PA 17055-3935 REMIT PAYMENT PROMPTLY. THANK YOU. Please refer to coupon below for payment instructions. Pay your bill securely online anytime at www.MyMedicalPayments.com Date # Description Charge Paid By Paid By Paid By Amount Due From PATIENT First Ins. Other Ins. Patient Adjusted Insurance BALANCE 09/19/14 1 99285-GV EMERGENCY EVAL&MGMT(LVL 5) $1,323.00 DX:787.01 DR.CHETLEN/HOLY SPIRIT HOSPITAL 10/30/14 BLUE SHIELD CLAIM DENIED-COVERED BY ANOTHER -$0.00 PAYER 11/28/14 MEDICARE CLAIM DENIED-COVERED BY HOSPICE -$0.00 01/21/15 MEDICARE CONTRACTUAL ALLOWANCE $-1,150.84 01/21/15 MEDICARE SEQUESTRATION-REDUCTION IN FEDERA $-2.75 SPENDING 01/21/15 MEDICARE PAYMENT $-134.98 $34.43 Important Messages: TOTALS: $1.323.00 -$134.98t $0.00 $0.00 -$1,153.59 $0.00 $34.43 This statement is for the direct treatment and/or supervision of care you recently received from an Emergency Physician at Holy Spirit Hospital.The fees for this private physician are billed separately from any hospital charges or other professional fees for which you may also be responsible. Therefore,should you receive a bill from the hospital or other physicians for charges in connection with this visit,it will not include the items listed on this statement "Payment Plans"Accepted Questions about this statement?/Llame de Lunes a Viernes? Call 1-800-355-2470 Monday through Friday 9:30AM -4:OOPM. Your automated system access code is 0801-48880033, or you can send email to billing_questions@emcare.com. 95213-R1-7874 +4 Please detach and return bottom portion with your remittance. ++ ------ - -- --- --- ------- ---- -- - --- -- --- --- - --- WARREN D WILLISS STATEMENT OF ACCOUNT 1121 BALDWIN ST Statement Date: March 01,2015 MECHANICSBURG PA 17055-3935 ACCOUNT NUMBER: HYP48880033 YOU MAY PAY THIS BILL WITH YOUR CREDIT CARD I Patient Name:WARREN D WILLISS PLEASE SEE REVERSE SIDE. Payment Due By: P E Make Check/Money Order payable to: Amount Du $34.43 Amount Enclosed- /Go Green-pay online at CAMP HILL EMERGENCY PHYSICIANS <www.MyMedicalPayments.com 'rhe insurance information in our file appears below.Please make any corrections PO BOX 13693 and/or additions on the reverse side of this form and return it to us.Thank you. PHILADELPHIA, PA 19101-3693 I 'I� I of 'I 'I �I I 11111 II I ' 11 � I I MED NOVITAS MEDICARE SOLUTIONS 111 1 11111 111111 11 11 11 1 1 1 1 1 1 1 11 r r I t 1 302203262A SMPAO F] If your address has changed, check this box. and complete the reverse side of this form 0825160000048880033000034430000000000005