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Home My WebLink About01-0101 c:: REV-1500 EX + (6-00) OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA REV-1500 ICP ~O5 -I - DEPARTMENT OF REVENUE DEPT. 280601 INHERITANCE TAX RETURN FILE NUMBER HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 2001 0101 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER L3.ke, Janice M. 210-22-8197 DECE- DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE DENT 12/20/00 06/10/1939 WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 3. Remainder Return CHECK ~' Original Return ~' Supplemental Return B (date of death prior to 12-13-82) APPRO- 4. limited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required (dale of death afler 12-12-82) PRIATE 6. Decedent Died Testate 7. Decedent Mamtalned a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach copy of Will) (Attach a copy of Trust) BLOCKS 9. Litigation Proceeds Received 10. Spousal Poverty Credit (dale 01 death between 0 11. Election to tax under Sec. 9113(A) 12-31-91 and 1-1-95) (Attach SchO) fjjj$$mffiji'!I\!V$'tpl$@QM#~l!tilP;A~MpQ!l!lIl$!iQlWll~~eQi'!!lib$~ti\Wit~lNi!i?RMA't@N$!lQliUjj~gjj!Ri!Qtj$QWQ; NAME COMPLETE MAILING ADDRESS COR- David H. Stone, Esquire 414 Bridge Street RE- FIRM NAME (If Applicable) New CUmberland, PA 17070 SPON DENT Stone LaFaver & Shekletski TELEPHONE NUMBER (717) 774-7435 75,370.00 OFFICIAL USE ONLY 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 37,079.56 3. Close\'jI Held Ccrpomt\on, Partnersnip or Sole-Proprietorship (3) None 4. Mortgages & Notes Receivable (Schedule D) (4) None 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 8,265.22 6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested (6) None RECA- PITULA- 7. Inter-Vivos Transfers & Miscellaneous TION Non-Probate Property (Schedule G or L) (7) 1,285.02 8. Total Gross Assets (total Lines 1-7) (8) 121,999.80 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 15,680.89 10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I) (10) 341. 84 11. Total Deductions (total Lines 9 & 10) (11) 16,022.73 12. Net Value of Estate (Une 8 minus Line 11) (12) 105,977.07 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an ejection to tax (13) None has not been made (Schedule J) 14. Net Value Sublectto Tax (line 12 minus Line 13) (14) 105,977.07 SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES 15. Amount of Une 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X.O (15) TAX 16. Amount of Une 14 taxable at lineal rate 105,977.07 X .0 45 (16) 4,768.97 0.00 - COMPU- 17. Amount of Line 14 taxable at sibling rate X .12 (17) 0.00 TATION 18. Amount 01 Une 14 taxable at collateral rate 0.00 X .15 (18) 0.00 19. Tax Due (19) 4,768.97 20. 0 ~jj;'@PK~j#YQM(@jl!lFijl!l!l!le;$'TIw:lA(ijmNQlW@;i;i:l:il~!I!!AYM~i'!t1 . ..........................i..........i~*.ae.$Va!;TQ!\~$Wa'lf\@QQ~!PIll'liPN.f'AG!;gA!'IPR~GH<iPKM!\THi\'<................. o PA15001 NTF 29755 Copyright 2000 Grea\\am:l/Ne-Ico lP - FOlll1s Software Only PA REV-1500 EX (6-00) Page 2 Decedent's Complete Address: STREET ADDRESS 314 Reno Street CITY I STATE -\ ZIP New Cumberland PA 17070 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 4,768.97 4,500.00 236.84 Tolal Credils (A + 8 + C) (2) 4,736.84 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnleresVPenally (D + E) (3) 0.00 OVERPAYMENT. (4) TAX OUE. (5) 32.13 (SA) 0.00 (58) 32.13 4. If Line 2 is greater than Line t + Line 3, enter the difference. This is the Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. Make Check Payable 10: REGISTER OF WILLS, AGENT ~t~'~~'~~!~~9A~~gttg!I~~8G~~+lg~~;~~;~~~I~~;'~;;;\~;;j~+A;~";~~~8~~i'+~;'t82R~? 1. Yes No ~ I 8 ~ Did decedent make a transfer and: a. retain the use or income ofthe property transferred; ............................... b. retain the right to designate who shall use the property transferred or its income: c. retain a reversionary interest; or. d. receive the promise for life of either payments, benefits or care? 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . 3. Did decedent own an "in trust 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 containsabeneficiarydesignation? ........... ........,. ........ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perlury, I declare that I have examined this return1 including accompanying schedules and statements, and to the best of my knowledge and belief, It is true, correct and complete. Declaration OT preparer other Uian the personal representative is based on information of which preparer has any knowledQe. SI~N ~RE OF E~N ~R~ii.!BI<!' FOR FILING RETURN DATE ~__ __ -fDJU/'oLJ 9-;M - (;/ ADDRE S SeeS e t ed SIGNA E OF P ER THAN REPRESENTATIVE o E:J DATE ADDRE 414 Bridge Street, New Cumberland, PA 17070 }....Vl \72P.S. '89116(a}(1.1)(i)J. Fordatas of death on or after January '. 1995, Ihe lax rate Is imposed on the nel value of transfers to or forthe use of the surviving spouse is 0% [72 P,S 99116 (a) (1.1) (ii)]. The statute rl()A~ nflt AXAmDt a transfer to a survivinQ spouse tram tax, and the sta\u~CI)' rc.quimmems 101 disclosure 01 assets and tiling a tax retum are still applicable even if the surviving spouse is the only beneficiary. For dates Of death on or after July 1, 2000: The tax rate imposed on the net value 01 translers trom a deceased child twenty-one years of age or younger at death to orforthe use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 1ii9116{a){1.2)]. The tax fate imposed on the net value of transfers 10 or far the use ot the c\eCedent's lineal beneliciaries is 4.5%, except as noted 'In 72.P.S. 99116(1,2) [72 P.S. %9116(a)(1)]. The lax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. Iii 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 biood or adoption. o PA15002 NTF 29756 Copyright 2000 GreatlandINelco lP - Fonns Softwale Only Estate of: Janice M. Lake 21-2001-0101 The following person(s) are signing the return as representative(s) of the estate: Mary Beers 107 old York Road New CUmberland, PA 17070 REV-is02 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE Of Janice M. Lake SCHEDULE A REAL ESTATE fiLE NUMBER 21-2001-0101 All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which Is Jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NO. DESCRIPTION VALUE AT DATE OF DEATH 1 Property located at 314 Reno Ave., New Cumberland, Cumberland County, PA 75,370.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 75,370.00 7 CPA21 NTF 10904 Copyright Fonns Software Only, 1997 Nelco, Inc. REV-1S03 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Janice M. Lake SCHEDULE B STOCKS & BONDS FILE NUMBER 21-2001-0101 All property Jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NO. DESCRIPTION VALUE AT DATE OF DEATH 1 Waddell & Reed Fin. Servo Acct. #20413126-10,841.978 shs. @ $3 .42 per share 37,079.56 7 CPA31 NTF 10905 Copyright Forms Sollware Only, 1997 Nelco, Inc. TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) . 37,079.56 REV-150B EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Janice M_ Lake SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21-2001-0101 Include proceeds Of litigation & dale proceeds were received by the estate. All proD. JOlntlv-owned with right of survlvorshlD must be disclosed on Sch. F. ITEM VALUE AT NO. DESCRIPTION DATE OF DEATH 1 Susquehanna Valley FCU-Checking Acct. 990.97 Interest on above item accrued as of decedent's death 2.87 2 Susquehanna Valley FCU-Share Acct. 2,186.50 Interest on aJ::ove i tern accrued as of decedent's death 11.66 3 Susquehanna Valley FCU-Club Acct. 412.19 Interest on aJ::ove item accrued as of decedent's death 2.34 4 Susquehanna Valley FCU-Share Cert. 3,671.74 Interest on above item accrued as of decedent's death 7.95 5 IRS-ref1.1Dd on decedent's final 1040 Federal Incare Tax Retm:n 979.00 for 2000 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 8,265.22 7 CPA81 NTF 10908 Copyright Forms Software Only, 1997 Nelco. loc REV-1510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Janice M. Lake SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21-2001-0101 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-150Q COVER SHEET is yes. DESCRIPTION OF PROPERTY %OF EXCLUSION ITEM INCLUDE NAME OF THE TRANSFEREE, THEIR DATE OF DEATH DECD'S (IF TAXABLE VALUE RELATIONSHIP TO DECD & DATE OF TRANSFER. NO. ATTACH COpy OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST APPLICABLE) 1 Gift taxes on gifts within 3 years 0.00 of death 2 waddell & Reed Financial Servo IRA 1,285.02 100% 1,285.02 Acct. #35077618-140.747 shs. @ $9.13 per share with beneficiaries being Mary Beers, Melinda Macri, and Daniel Lake, III, equally TOTAL (Also enter on line 7, Recapitulation) $ 1,285.02 7 CPAD1 NTF 10910 Copyright Forms Soflware Only, 1997 NalcO,lnc. (If more space is needed, insert additioMI sheets of the same size) REV-1S11EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Janice M. Lake SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-2001-0101 Debts of decedent must be reported on Schedule I. ITEM NO. DESCRIPTION A. FUNERAL EXPENSES: AMOUNT 1 Stone M.lrray Funeral Harre-funeral expenses 5,298.00 B. ADMINISTRATIVE COSTS: 1 , Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EJN No. of Personal Representative(s) Street Address City State 0.00 Zip Year(s) Commission Paid: 2. Attorney Fees Narre: David H. Stone, Esquire 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Daniel E. Lake, III Slreet Address 314 Reno Street City New Cumberland State PA Zip 17070 Relationship of Claimant to Decedent son 6,099.00 3,500.00 4. Probate Fees 280.50 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7 Cumberland Law Journal-advertising grant of letters 75.00 8 The Patriot News Co. -advertising grant of letters 126.39 9 PA Dept. of Revenue-payrrent of decedent's final PA40 Incarre Tax 102.00 10 Reserve for filing Inheritance Tax Return, Inventory, and closing expenses 200.00 TOTAL (Also enter on line 9, Recapitulation) $ (If mora space is needed, insert additional sheets of the same size) 15,680.89 7 CPA11 NTF 10911 Copyright Forms SoHware Only, 1997 Nelco, Inc. REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Janice M. Lake Include unreimbursed medical expenses. ITEM NO. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-2001-0101 DESCRIPTION AMOUNT 1 Susqueharma Valley FC\]-loan 341. 84 7 CPA12 NTF 10912 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 341. 84 CopyriCht Forms Sottwara Only, 1997 NeICQ, Inc REV-1513 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 21-2001-0101 RELATIONSHIP TO DECEDENT AMOUNT OR Do Not List Trustee(s) SHARE OF ESTATE Janice M. Lake 1 Mary Beers 107 Old York Road New CurrUJerland, PA 17070 daughter 35,325.69 2 Melinda M. Macri 115 Rarrblewocd Lane Lewisbeny, PA 17339 3 Daniel E. Lake, III 314 Reno Ave. New CurrUJerland, PA 17070 daughter 35,325.69 son 35,325.69 ENTER DOLLAR AMTS. FOR DISTRIBS. SHOWN ABOVE ON LINES 15 THROUGH 17 AS APPROPRIATE ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS, A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE None B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS None TOTAL OF PART 11-- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00 7 CPA13 NTF 10913 (If more space is needed, insert additional sheets of the same size) Copyright FOllTls Software Only, 1997 Nelco, Inc. ~&.............~......................... - ......_--~_...~....... . . ,"" "'('-k-'"~:;i~~:..",~~~{~,";'~" '"; _:~;. ~.~~""';. CODICIL TO THE LAST WILL AND TESTAMENT OF JANICE M. LAKE I, JANICE M. LAKE, of the Borough of New Cumberland, Cumberland County, and Commonwealth of Pennsylvania, declare this to be the Sole Codicil to my Last Will and Testament dated December 3, 1991. ITEM I: I hereby revoke Item III.d. of my Last Will and Testament. ITEM II: In all other respects I hereby ratify, confirm and republish my 1ast Will and Testament dated December 3, 1991, together with this my sole codicil. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ;"'\,~ day of OD+ 2000. ki.\ I~'") \1,1 . ~,o.\\..\ :./ JANICE M. LAKE ' SIGNED, SEALED, PUBLISHED and DECLARED by JANICE M. LAKE, the Testa- trix above named, as and for a Sole Codicil to her Last Will and Testament, and in the presence of us, who at her request, in her presence and in the presence of each other, have subscribed our names as witnesses. fCUtl '1/ (jS7/~ Witness I Iq<t~ I~fk: tf.;J I-6Mu( .I'fr J7c:JL Address dwJ,w lA.~ Witn~s (O'i 3& SIJ Xn~r /)nrf AdCiress Page 1 of 1 ,."'", ,- -;;;,.. '-'~' LAST WILL AND TESTAMENT OF JANICE M. LAKE I, JANICE M. LAKE, of the Borough of New Cumberland, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I bequeath my gold wedding ring and gold diamond engage- ment ring given to me by my late husband to my daughter, MARY J. BEERS, provided she survives me. ITEM II: I bequeath all of the tools which belonged to my late husband to my son, DANIEL E. LAKE, III, provided he survives me. ITEM III: I bequeath my Waddell and Reed investment account bearing the account number 20413126 in equal shares as follows: a. One share to my daughter, MARY J. BEERS, or to her issue, per stirpes; b. One share to my daughter, MELINDA M. ~1ACnI, or to her issue, per stirpes; c. One share to my son, DANIEL E. LAKE, III, or to his issue, per stirpes; and d. One share to my friend, CLIFFORD SEIDLE, provided he survives me. -1- ITEM IV: In the event my son, DANIEL E. LAKE, III, has not attained the age of thirty-two (32) at the time of my death, I devise and bequeath my house and lot at 314 Reno Avenue, New Cumberland, : Pennsylvania, 17070, together with all household goods and furnishings I II therein, and all policies and insurance on said real and tangible I] personal property to my son, DANIEL E. LAKE, III, until such time as he Iii attains the age of thirty-two (32) so long as he desires to use such premises as his principal residence and pays all costs of maintenance thereof including taxes, assessments, insurance, and ordinary repairs, said property to be insured in a reasonable amount insuring the inter- i I ests of the remaindermen as well as himself. Upon my son, DANIEL E. LAKE, III, attaining the age of thirty-two (32) or at such prior time as he no longer uses said premises as his principal residence, I direct my personal representatives hereinafter named to sell said real estate and the tangible personal property and distribute the net proceeds thereof in equal shares to such of my children, MARY J. BEERS, MELINDA M. MACRI, and DANIEL E. LAKE, III, as are then living. Should any such child of mine not be living at time of distribution, I devise and bequeath the share of child to his or her issue, per stirpes, then living and should any such child of mine die leaving no such issue living at the time of distribution, I devise and I bequeath the time the share of such child to my issue, per stirpes, living at of distribution. -2- ITEM V: I devise and bequeath the residue of my estate of every nature and wherever situate in equal shares to such of children, MARY J. BEERS, MELINDA M. MACRI, and DANIEL E. LAKE, III, as are living at the time of my death. Should any of my above named children predecease me, I devise and bequeath the share of such child to his or her issue, per stirpes, living at the time of my death; and should any such child of mine leave no such issue living at the time of my death, I devise and bequeath the share of such child to my issue, per stirpes, living at the time of my death. ITEM VI: I appoint my Co-Executors and their successors guardian of any property which passes, either under this will or otherwise, to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this ap- pointment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or to another for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to time for the minor's support and education (including college education, both graduate and undergraduate) without regard to his or her parent's ability to provide for such support and education, or to make payment for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor. -3- ITEM VII: I appoint my children, MARY J. BEERS, MELINDA M. MACRI, .~-- - -1 I I I , and DANIEL E. LAKE, III, Co-Executors of this my last will. ITEM VIII: I direct that my Executors and their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, .-, ,'",{ seal this::::> day of JANICE M. LAKE, have /fic~A"fjlv" 1991. hereunto set my hand and ~~.~'~. ,1o.k~, JANICE M. LAKE SIGNED, SEALED, PUBLISHED and DECLARED by JANICE M; LAKE, the Testatrix above named,. as and for her Last Will and Testament, and in the presence of us, who at her request, in her presence and in the have subscribed our names as witnesses. .. ()~> \(c,,\.y1?tt~u, , fl, Address 7'~a:L '7<? r!~ {'~:J witqess ' '-....., /'C- .',' , /...,t....."-~< JI-' '- _L.../.y"Y.::.i.."""'.L-! .....-lA- ~./ Address "L/ , ;:-:t~ -4- COMMONWEALTH OF PENNSYLVANIA: :5S: COUNTY OF CUMBERLAND . . I, JANICE M. LAKE, the Testatrix 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 this instrument as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. %aJ~~ \it, .~(l\u.) JANICE M. LAKE Sworn to or affirmed to and acknowledged before me by JANICE M. 3 Nt day of /1,C/"h."/".L" , 1991. G' '&: / +- ~ 1 ~,4,<,-<,jJ\ CJt( , Notary Public LAKE, the Testatrix, this , NOTARIAL St4L CQ,JSTANCE l. I\/"'~L! i''''T~f:''' r"'"'lIC NEW CU:~aE;;'LMW. PA I 6:,....:~:', ,.~';';. MY Cort~ISSIO~ EXPIRES A?~ll-iJ: 1995 -5- '-~ -----""=--=--="~~.. <- - -. - -~- ,- '- . -., ..... ..,.......;-~, ""'-_.....:;:...,.<. ',' . COMMONWEALTH OF PENNSYLVANIA : :55: COUNTY OF ~ERLAND We, L,.1'h'" ).t-~~ . . and , the witnesses whose names are signed to the instru- ment, being duly qualified according to law, depose and say that we were present and saw Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound mind and under no con- straint or undue influence. D:;^ ~t; ~. W@ ness ~ ~~~d Sworn to or affirmed to and acknowledged before me by /..OCU./-{-d (j ~-'_ _ and K9~U l' ~L4-~~7 this .~ '~I day of /tflL..-.;/~~L<'.J , 1991- (~//y~~; Notary Public , witnesses, , NOTARIAL SEAL CONSTANCE I.. KI,RLl. nOTARY Pl!BLlC NEW CUMBERLMW, FA Clj~~3~:-:t r\.l'W co. MY COMMIS510~ EXPIRES AP.IL 13. 1995 -6- SUSQUEHANNA ~"""-- VALLEY FEDERAL CREDIT UNION February 1, 2001 David H. Stone Stone, LaFaver & Shekletski 414 Bridge street P.O. Box E New Cumberland, PA 17070 Re: Estate of Janice M. Lake SSN 210.22.8197 Dear Mr. Stone: On the date of her death, December 20, 2000, the above referenced decedent had the following accounts this credit union: 1. A share account with a balance of $2186.50 plus accrued interest of $11.66 for a total of $2198.16. There are no joint owners of the account. These shares are pledged as security for the loan listed below. 2. A club account with a balance of $412.19 plus accrued interest of $2.34 for a total of $414.53. There are no joint owners of this account 3. A draft (checking) account with a balance of $990.97 plus accrued interest of $2.87 for a total of $993.84. There are no joint owners on this account. 4. A share certificate with a balance of $3671. 74 plus accrued interest of $7.95 for a total of $3679.69. There are no joint owners on this account. There is also a loan on the decedent's account with a balance of $341.84 as of January 31, 2001. interest will accrue at a rate of $.06/day. We carry a group life insurance policy which pays a benefit based on the date of death share balance and the age of the member when various deposits are made. I estimate the benefit in this case to be approximately $1300. Daniel E. Lake III is the designated beneficiary of the life insurance proceeds. We will need a death certificate to file this claim. We also need a short certificate for our file. If we can be of any further assistance in this matter, please feel free to call. Sincerel)/1) /~. ~---' -- .' / ~.~ -C~ !/ .- Larry L. Stoner President! CEO /~\ :=--, " r-..,- '.....--~ 1213 SLATE HILL ROAD. CAMP HILL, PA 17011-8035 LOCAL: (717) 737-4152 TOLL FREE: (800) 948-1454 FAX: (717) 737-0589 '~~.' ( ~ . r-..,- ~. SEP. 20. 2001 11:48AM CSR FAX2 NO. 370 P.2/2 eWADDEll ~REED Financial Servllces ... Sf"DI1~ L.t=I)..1/U !~ Skt.ft/....f-s/:.i kf<I.n: ();.. ",'J ~10"'1~ 4H o';,r;~F. ~t....; c.'-'....(,,1;("'...,1. PI+ /1<>7" 6300 lamor Aven"e 1'06\ llfIIoa !!ox 29217 s_ Mission, I<S 66201-9217 Date; Cf -1.0 -01 Decedent Name(s): iJlAi/I i '-Co. LA. k. ~ This is written in response Ira your request for a date of death valuation for the above person(s). We have no accounlts on record in the name/social security number of the deceased. :::g We show the follo..lring account(s) in the name of the deceased (The following shares an~r net asset prices are provided as of the date of death. I Z. -lO -(0) AccountlFund Number Shares Price-per-Share Re2istrll.t1on .20+13 IU. { (,3f {D. M[. "11~ it' 3. "Ii J ...(lb.. H Ledc.e 3S071"(~ I ~~o Ito,14i ~ "l.I] 13"- T",..iG. file... /.J.i:e, :r.:R.,4 IkcouoJ- ;"041312.(, Beneficiary of record (ifaplpJicable):- Nc>rJE: hi G"_t 3S-"7 7(, (~ M. P.;eef, tJ.. Ma.<r:) D, l4.1cc. Et,.....dj In order to transfer* (chanlle registration) or redeem these funds, please provide: Letter of instructiolls from the sUlViving owner, executor, beneficiary Certified copy of the death certificate Letters Testamentary/Appointment (current within 60 days) Inheritance Tax Wluver (Consent to Transfer) Stock Certificate fQlr shares CopyofT~tdo~ment Other: ThlUlk you for the opportulnity to be of service. Additional questions may be directed to our clien1;;rvices ~p~esenta~tives at 800-366.5465. .~ *New registration instructions must include the lIocialllecuritv CLffiNT SERVICES DIVISION number and date of birth for new WADDELL & REED SEltVICES COMPANY account cwner(s). PETITION FOR PROBATE and OF LETI'.tJ{S ;2/-0(- 101 Estate of also known as Janice M. Lake No. To: Register of W~ for the r Deceased. County of umber land in the Social Security No. 210-22-8197 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut ors in the fast will of the above decedent, dated December 3 and codicil(s) dated October 26, 2000 narned , 19 91 (state rdevant circumstances, e.g. renunciation. death of executOr. etc.) Decendem was domiciled at death in Cumber land CountY. Pennsylvania. with 11 er last family or principal rJ:Sidel)ce at 314 Reno Ave., New Curnbei'land BOrough, Cumber land County, pennsy 1 vallla . (list street. number aad mUDcipafity) De,j:ndem, then 61 years of age. died December 20, 2000 . ~ at -.11 4 Reno ~e., New Cuinber lana, Cumber land County, PA . ExcepT a3 follows, decedent did not marry, was not divorced and did not have a child born or adopted after executbn of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned propeny with estimated values as follows: (If domiciled in Pa.) All personal propeny (If not domiciled in Pa.) Personal propeny in PennsylVania (If not domiciled in Pa.) Personal propeny in County Value of rea} e'State in Pennsylvania situated as follows: 314 Reno Avenue, New Cumberland Borough, J:QlJP.tv.:, Pennsylvania S 42,000.00 S S s 751000.00 Cumber and WHEREFORE. petitioner(s) respectfully request(S) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentarv (testamentary; administration Cot.a.: administration d.b.n.c.t.a.) theron. - '" 'ii' u c ., :=~ "'- u- =~ ,,=0 ;:E =~ ., .... = O' ;; C CIl Vi 107 Old York Rd., Lot 119 New Cumberland, PA I /U /u 432 Candlewyck Rd. Camp Hlll,"""'PA I /U I I 314 Reno Ave. New Cumberland, PA 1/0/0 OATH OF PERSONAL REPRESENTATIVE COMMON\VEALT.H OF. PENNSYLVANIA } sa COUNTY OF ~~8~AND The perhicmer(s) abcwe-i1amed swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioncr(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. ~ I (p - ~O!:>-. I affirmed aP..d c:l3~ c.., 0;" ::: ~ - ::: ~ ~ '- No. 21-01-101 Estate of Janice M. lake , Deceased'. DECREE OF PROBATE AND GRANT OF LETTERS AND NOW JANUARY 24 , ~ 2001, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated December 3, 1991 and October 26, 2000 described therein be admitted to probate and filed of record as the last will of Janice M. lake and Letters Testamentary are hereby granted to Marv J. Beers, Melinda M. Macri and Daniel E. lake, III FEES Probate, Letters, Etc. ......... $ 235.00 Short Certificates( 5) .. .. .. . . .. $ 15.00 1tU~ ~?C:r.~.~~~.E.~.~. $~~~ CODICIL JCP $ .Lg: 00 TOTAL _ $ 280.150 Filed . .J~JJAl\X .f~... .~QQL.............. Yru't/' tilt)"'n (1. a. .::w:'.J:u." , Q.p.1t g ~ R<o;'", of wn" David H. stone #39785 ATTORNEY (Sup. Ct. 1.0. No.) 414 Bridge St., New Cumberland, PA 17070 ADDRESS (717) 774-7435 PHONE MAILED LETTERS TO ATTORNEY JANUARY 24, 2001 .... ,. 21-01-101 REGISTER OF WIIJJ.S OF CUMBERLAND COUNTY OATH OF SUBSCRIBING WITNESS codicil (each) a subscribing witness to the will presented herewith, (each) being duly qualified according to law, depose(s) and say(~)"~~t present and saw the testat . sign the sam~~that signed as a witness at the request of testal in n prese~~ and (in the presence of each other) (in the presence of the other sUbscribing witness(es)). " Sworn to or affirmed and subscribed before me this day of 19 "~, (Name) Register (Address) (Address) REGISTER OF WILLS OF ClJMBERLAND COUNTY OATH OF NON-SUBSCRIBING WITNESS Mary J. Beers and Melinda M. Macri (each) a subscriber hereto. (each) being duly qualified according to law, depose(s) and say(s) that they are familiar with the signature of Janice M. Lake COdicil testat rix of ~~) the ~ presented l1erewith and codicil thtlhev believes the signature on the ~ is in the handwriting of Janice M. Lake to the best of their knowledge and belief. Sworn to or affinn~ subscribed before /)1)1/ Of.,,,^,\ 9 ~ me this ~..3 _ day of (Nam2) Mary J. Beers ~~ ~ I 107 Old York Rd., Lot 119 'fiJ:< "tlf;, ;,fo,~V<h r /it1.:;i;j 1i~0'1''''i . i: oJ. {AddreuJ Ned ~ land, PA Regmer 7fL 1/1 - "7r; /?J&1' ./ (Name) Melinda M. Macri 432 Candlewvck Rd., Camp Hill, FA 17011 (Address) 21-01-101 "" 'fy tl at the infotmation here given is correctly copied horn an original certificate of death duly tlled with , 1:~. IS to ceru 1 '.. V' I R i Off! ~ nt fl' 1" l/led Registrar. The original certificate will be forwarded to the State . Ita ecarl s Ice or permane I 11 o' WARNING: It is illegal to duplicate this copy by photostat or photograph, me as ~ee f,)r this certiflcne, $2.00 .4ii~/;~i'; ,,,,,"r~~\ II flU l;;--___ l'''#/ ~A'\ /~ ;;/1 -~\~~ I~..,.. . ~ '.7- ~ ~/ '~.' '. ".~~ ~ \:::), :",J I~~ ~t-'\ _~..d .' ~ ~ *:!".~.~. '". "~" *~ - _.. '-"-~ \~\ ". /~-'" "'-~'-- ..... / &,~/ "'---..}91MENf i\ ~ ""~ """""'/'/UIIIJ/I,jll' I ~L~,~jL-- P 7022212 DEe 2 1 2000 No. Date ;43 Aew 2187 COMMONWEALTH OF PENNSYLVANIA' OEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH $. 1 Yrs COUNTY OF OERH BLRTHPlACf (C,ty ar.d Pl.4CE Of DEATH ICt>ec" MY oroe -- -;ee ,nSlfucloOfl$ l)n Other SIde) Stale 0. Fcreogn CounuYJ HOSPITAL Inpa'_ 0 ERlOutl>a".... 0 OOA 0 7. Lykens, PA Ia. fAClllT'f NAME (II nQllnto1't\JIl()(I, gIVe Slree1 and number, SEX STATE filE NUMBER SOCIAL SECUAIT"t NUMBER NAME OF DECEDENT If',;iM"~~-- --.--.---- ,. Janice M. Lake AGE \la'SS 81l'1r>oay~ uNOER '\ 'tEAR Month. Oars '.Female '.210 -22 20 2000 g''::;.lyIO ,.. "ARIlAL STATUS,_ NeYer MMfied. Widowed. ewon:.d (5_otvl lQ.1idowed RACE. Ameocan IncNn, ENKk, Wh.... ..c. (S"""",,I White SURVIIIING SPOUSE III .we. g~ malOen Nmel . .. Cumberland DECEDENT'S USUAL OCCUPATION 1~":,"~Ii~:OO::-:::'3.:f ,Asst. Mana er I~Texaco Cor DECEDENT'S "AILING AIlORESS (51,.... C....""""....... Z", Code' DECEDENT'S ACTUAL RESIDENCE (See IOstruClIOrIa on Ofhef SIde) Ict:lew Cumberland .} 14 KlNO OF BUSINESS/INDUSTRY WAS DECEDENT EVER 'H us. ARMED ~OACES? Yoo 0 No IKl 11.. Slate PA l7C.O ......__.. ..... 314 Reno Avenue I~ew Cumberland,PA 17070 fRHER'S NAME {fdt. MIOdte. last) 11. H. Edward Collier INFOAMAH'T.S.....ME (T y,,",P'....1 _.Daniel E. Lake, III lAETHOO OF DlSI'OSIT~ O &unol ~ C'.....,"'" 0 R............S..,.O o..n.- au- (5_"" . 21.. l1b. Coo ();d - IHelna Cumberland -' l7d.Kl :;,~.=., New Cumberland MOTHER'S NAME tFIISS. Middle. Malden Sufnamel I.. Mar Ho er INFORIAANT'S UAlUNG AOllRESS (SIr.... ColyllOwn. SlaIo. Z., Code) ..314 Reno Avenue, New Cumberland, PA 17070 PlACE OF DISPOSITION. _.. c.-t1fY. C,.malOfy LOCATION. CiIy{ToMo. Sl.... ZIp ~ .. 0Ut<<_ ...,- .J;iollin Green Mem. Park NAME AHO AOORESS OF FACILITY .one&MurrayFH408 LICENSE NU"BER .~am Hill, PA 17011 3rd St New cumbeEgl8, PA DATE SIGNED (MonIh.OoY. _. ..... 23c. WI\S CASE REFERRED TO "EDlCAL EXAMINERlCORONER. .....0 No.fi(l DATE PRONQUt-tCED DEAD (Mon\h. Day, Yeaf~ ... 0300.. '5. ~ - .;2 0 - 00 ~7. MAT t~ Ent., the daa.ue., injurIeS 01 complicallOnS whtch caused the dealh 00 not .nI8, lhe mode of dying, such as cardtac Of respuacory aHsst, shock or heart fa6lu'. lill ody one cause on each~"" .. rnCi.II.~V\.a.....\- ~~Oyv"\c..... DUE 10 AS A CONSEO E OF): H- I Approxirnafe f inIerwI between : 0rtMI and deIlU'l ! 4mo PART II: Other sigt1tnc.ant condiUonI c:onuibuling 10 death, but noI tMUflinQ in.... ~CI.UH gNren '" PAA1' I. DUE 10 (OR.S A CONSEOUENCE OF), DUE 10 lOR AS ACONSEOUENCE OF): d WEREAU~F~DlNGS -'I.AllI.E PRIOR 10 COMPLETION OF CAUSE ~ OERH' ...."'.. )Zi. o o DATE OF INJURY (Morllh. Day, "at) T'WE OF INJURY INJURY AT WORK? DESCRJ8E HOW INJURY OCCURIlED. MANNER Of DEATH AccOtnI Pending InvestigAlion o o o ~E OF INJURY. At home, tarm, sI,HI, factory,offic. M. buiIdinQ. etC_ tSpec,tv) 200. _ 0 NoD HomiCide No~ Y.. 0 ",,0 SuICide Coukt not be delermlned ... Ub, CEllTaf"lI:.R ICheck oniv onel -CERTIfYING PHVSlCIAN (PtlySIIClan cenltylOg cause 0' dealh oM\eCl .M\OI"ef ph'l'SlC.an hilS pilooO\JJ'\Ced dealtl ana completed l1em 2J) To Ihe beet of my know~, ..th occ~ lStM to the CauM(S. and mann.r.. ....ed. ... ~II ~o/.( I DATE SIGNED (Monch. Day. Yoafl 21c. M~ 0 -5 0<;1:3 S 3111. I 7.. - '2...0 - 00 N.....E AND ADDRESS OF PERSON WHO COMPLE7ED CAUSE OF DEATH (lIemZnTypeOlPrin' ~. ~~.O~+ Ie ..... o ~ Ii' I z.. 'T.... ~ \ e. R.J n. ~ ~ t..l; Il :\' "- no I) DAlE FllEO(MonIh Oa~, 'ftia') .PRONOUNCING AND CERTtFYING PHYSICIAN (PhV$ICaan bolh ;llonOunctng tJedU'l and ceoltyll"lg 10 cause at dealh) To 11M beel of my knowlHQ.. de.th occurred althe lime, del., and pl.c., and dU* 10 lhe CauM(.. i1ncr mann.r.. a.aIM.. 'MEDICAL EXAMINER/CORONER On the a.ia ot ellam'naUon and/or invesUg.lton, in my opinion. de.th occurred at the lime, date, and place, and due to the UUH(S. and manner.. .t.led.. , . . . . , . . . ., ...,............,.. ...,.....,...... _ .. . .. . .. ..........,....,..........,.. .,...... 31.. ... ~~/. ~() 0 t:I ., --t "--. COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND 1. J 55: Mary J. Beers according to law, deposes and says that ~e is the Co-Executor of the Estate of Janice M. Lake late of ---Bo.r.o.~__Qf_B~KCumb.e.rland.-_ , Cumberland County, Pa., deceased and that the 'th" . t d b Mary J. Beers th 'd Co-Executor WI In IS an Inven ory ma e y _, e sal of the entire estate of said decedent, consisting of all the personal prop~rty and real estate, except real estate outside ~he Commonwealth of Pennsylvania. and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. being duly sworn 19 '111CUV1 0 ~ Mary J. C(j- fj6cutor . "'~e+er Beers 107 Old York Road and subscribed before me, New Cumberland, PA 17070 Address Date of Death 20 12 2000 Day Month Year INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of J 949. 'd r:: rcl rl H 0) ~ ::l U ~ " >- 0) III rl I- W Z ... 0 >- ~ l- 'll W -< III .--i ~ a- I- 0) 4-l u 0 0 II) ~ 0 III III I 0 w w jl c 01 >- ~ III III .--i f- J: a- u. ..c:: a- c I- ...J .. 0 Z 0 'lI 0 I u. ...J -< .' ::l a- == .--i I w 0 -< w :2::' ~I >- -< > ~ ('oJ 'I z 0)1 - z 0 c /: c ~ 0 II) Z 0 0 ~ U z I w -< -0-1 I 4IIto a- r:: [ " Itl c IJ 'lI I - -.: I 0 III JJ .." ~ I III E - ...!! 0 I 'lI ~ 0 " ...J U u: CD Inventory of the real and personal estate of Janice M. Lake deceased Inventory Estate of Janice M. Lake From 12/20/00 To 09/20/01 Description Accrued Interest Checking ACCOilllts Susquehanna. Valley Fill-Checking 2.87 Savings ACCOilllts Susquehanna. Valley Fill-Share Acct. 11.66 Susquehanna. Valley Fill-Club Acct. 2.34 Comron Stocks Waddell & Reed Fin. Se:rv . Certificates of Deposit Susquehanna. Valley Fill-Share Cert. 7.95 Residences Property located at 314 Reno Ave. Refunds IRS-refillld on decedent I s final 1040 Value 2,198.16 414.53 1:: Total 99 .84 I II ! i I I I I I I I j ! .00 . ----- --1--- -- $120,7lj4.78 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 21-01-0101 FIRST AND FINAL ACCOUNT AND PROPOSED DISTRIBUTION OF JANICE M. LAKE, DECEASED MARY J. BEERS, MELINDA M. MACRI, AND DANIEL E. LAKE, III, CO-EXECUTORS LATE OF THE BOROUGH OF NEW CUMBERLAND Social Security No.: 210-22-8197 Date of Death: December 20, 2000 Date of Executor's Appointment: January 24, 2001 Date of Advertising Letters Testamentary: Cumberland Law Journal - February 9, 16, & 23, 2001 The Patriot News Co. - February 6, 13, & 20, 2001 Accounting for the Period: December 20, 2000 to December 6, 2001. Purpose of Account: Mary J. Beers, Melinda M. Macri, and Daniel E. Lake, III, Co-Executors, offer this account to acquaint interested parties with the transactions which have occurred during their administration. The account also indicates the proposed distribution of the estate. It is important that the account be carefully examined. Requests for additional information or questions or objections can be discussed with: Melinda M. Macri 115 Ramblewood Lane Lewisberry, PA 17339 David H. Stone, Esquire Stone LaFaver Shekletski 414 Bridge Street New Cumberland, PA 17070 SlJlVIMARY OF ACCOUNT Estate of Janice M. Lake For Period 12/20/00 Through 12/06/01 Page Principal Receipts Net Gain (or Loss) on Sales or Other Dispositions Other Receipts 1-2 less Disburserrents: Administration Expenses (Prin) Fees and commissions (prin) Funeral Expenses (Prin) 3 3 4 $5,875.65 3,500.00 5,298.00 Balance before Distributions Distributions to Beneficiaries 5 Principal Balance on Hand 6 IncaTe Receipts less Disburserrents 7 Balance before Distributions Distributions to Beneficiaries IncaTe Balance on Hand Combined Balance on Hand Fiducicuy Acquisition Value $127,047.51 0.00 0.00 $127,047.51 14,673.65 $112,373.86 112,449.56 $ -75.70 $ 75.70 0.00 $ 75.70 0.00 $ $ 75.70 0.00 RECEIPT'S OF PRINCIPAL Estate of Janice M. Lake As of 12/06/01 Assets Listed in Invento:r:y (Valued as of date of death) Checking AccOlli1ts Susquehanna Valley FCU-Checking Acct. $2 . 87 Accrued Interest Savings AccOlli1ts Susquehanna Valley FCU-Share Acct. $11.66 Accrued Interest Susquehanna Valley FCU-Club Acct. $2.34 Accrued Interest Corrrron Stocks Waddell & Reed Fin. Serv. Acct. #20413126-10,841.978 shs. @ $3.42 per share 10,841.978 Units Certificates of Deposit Susquehanna Valley FCU-Share Cert. $7.95 Accrued Interest Residences Property located at 314 Reno Ave., New Cumberland, Cumberland COlli1ty, PA Refunds IRS-refund on decedent I s final 1040 Federal Income Tax for 2000 TCfTAL INVEN'IDRY $ 2,198.16 414.53 Page 1 Fiducia:r:y Acquisition Value $ 993.84 2,612.69 37,079.56 3,679.69 75,370.00 979.00 $120,714.78 RECEIPTS OF PRINCIPAL Estate of Janice M. Lake As of 12/06/01 Receipts Subsequent to Inventory (Valued when received) M:mey received from Co-Executors to pay expenses incurred during the administration of the estate Susquehanna Valley FOJ-Life Insurance on loan with Susquehanna Valley FOJ TOTAL RECEIPTS SUBSEX;2UENT TO INVENTORY SUMMARY Total Inventory Total Receipts Subsequent To Inventory TOTAL RECEIPTS OF PRINCIPAL $ 5,988.15 344.58 Page 2 $ 6,332.73 ----------- ----------- $120,714.78 6,332.73 $127,047.51 DISBURSEMENTS OF PRINCIPAL Estate of Janice M. Lake For Period 12/20/00 Through 12/06/01 Administration Expenses (Prin) 12/30/00 Susquehanna Valley FCU-nonthly service charge 01/03/01 Check written by decedent but not cleared until after death Check number 2613 01/29/01 Check written for debt of decedent Check number 2615 02/08/01 Check written for debt of decedent Check number 2618 02/13/01 Check written for debt of decedent Check number 2616 02/20/01 Check written for debt of decedent Check number 2617 03/20/01 Register of Wills, Agent-payment of Inheritance Tax w/5% discount 03/20/01 Stone LaFaver & Shekletski-Reimb. on probate fees 04/16/01 PA Dept. of Revenue-payment of decedent I s final PA40 Incorre Tax 09/21/01 Register of Wills, Agent-payment due on Inheritance Tax 09/21/01 Register of Wills-filing Inheritance Tax and Inventory 12/06/01 Stone LaFaver & Shekletski-Reimb. on advertising in 2 newspapers ($201.39) and 2 short cert. ($6.00) 12/06/01 Reserve for filing First and Final Acct., Decree Awarding Real Estate, and closing expenses Fees and Carrnissions (Prin) 12/06/01 Reserve to David H. Stone for Attorney's fee $ 1.00 24.38 74.13 45.00 44.12 40.00 4,500.00 280.50 102.00 32.13 25.00 207.39 500.00 Page 3 $ 5,875.65 3,500.00 DISBURSEMENTS OF PRINCIPAL Estate of Janice M. Lake For Period 12/20/00 Through 12/06/01 Page 4 Funeral Expenses {Prin} 01/02/01 Stone Murray Funeral Horre-funeral expenses $ 5,298.00 IDTAL DISBURSEMENTS OF PRINCIPAL $ 14,673.65 DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES Estate of Janice M. Lake For Period 12/20/00 Through 12/06/01 To: Mary J. Beers Partial Distribution 03/01/01 Waddell & Reed Fin. Servo 3,613.9927 Units $ 12,359.85 To: Mary J. Beers Property located at 314 Reno Ave., New CUrrt:erland, PA 12/06/01 Property located at 314 Reno Ave. Balance before distribution 25,123.33 $75,370.00 Total for Mary J. Beers To: Mel inda M. lVL3.cri Partial Distribution 03/01/01 Waddell & Reed Fin. Servo 3,613.9927 Units Balance before distribution 12,359.85 $24,719.71 To: Melinda M. lVL3.cri Property located at 314 Reno Ave., New CUrrt:erland, PA 12/06/01 Property located at 314 Reno Ave. Balance before distribution 25,123.34 $50,246.67 Total for Melinda M. lVL3.cri To: Daniel E. Lake, III Partial Distribution 03/01/01 Waddell & Reed Fin. Servo 3,613.9926 Units 12,359.86 To: Daniel E. Lake, III Property located at 314 Reno Ave., New CUrrt:erland, PA 12/06/01 Property located at 314 Reno Ave. 25,123.33 Total for Daniel E. Lake, III TOI:AL DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES *See additional explanation of distribution of property. Page 5 $ 37,483.18 37,483.19 37,483.19 $112,449.56 EXPLANATION REGARDING DISTRIBUTION OF REAL ESTATE LOCATED AT 314 RENO AVENUE, NEW CUMBERLAND, PA under Item IV of the Last Will and Testament of Janice M. Lake, the real estate at 314 Reno Avenue, New Cumberland, was to be held for the benefit of Daniel E. Lake, III, until he attained the age of 32 years. Daniel E. Lake, III, attained the age of 32 on November 7, 2001. Accordingly, pursuant to the terms of the will, the real estate is being distributed to Mary J. Beers, Melinda M. Macri, and Daniel E. Lake, III, in kind. less: Incorre balance on hand PRINCIPAL BAI..ANCE ON HAND PRINCIPAL BAI..ANCE ON HAND Estate of Janice M. Lake As of 12/06/01 Page 6 Current Value Carrying Value $ $ 0.00 75.70 0.00 75.70 $ $ -75.70 -75.70 ----------- ----------- ----------- ----------- RECEIPTS OF INC'<:l\1E Estate of Janice M. Lake For Period 12/20/00 Through 12/06/01 Dividends Susquehanna Valley FCU-Checking 12/31/00 Susquehanna Valley FCU-dividend on Checking Account 03/19/01 Susquehanna Valley FCU-dividend on Checking Acct. Susquehanna Valley FCU-Share Acct. 12/31/00 Susquehanna Valley FCU-dividend on Share Account 03/19/01 Susquehanna Valley FCU-dividend on Share Account Susquehanna Valley FCU-Club Acct. 03/19/01 Susquehanna Valley FCU-dividend on Club Acct. Total Dividends Interest Susquehanna Valley FCU-Club Acct. 12/31/00 Susquehanna Valley FCU-dividend on Club Acct. Susquehanna Valley FCU-Share Cert. 12/31/00 Susquehanna Valley FCU-interest on Share Cert. 01/31/01 Susquehanna Valley FaJ-interest on Cert. of Deposi t 02/28/01 Susquehanna Valley FCU-interest on Cert. of Deposit 03/19/01 Susquehanna Valley FCU-interest on Share Cert. Total Interest TOTAL RECEIPTS OF INC'<:l\1E $ 0.65 2.72 3.37 $ 2.62 12.62 15.24 $ 2.39 2.39 $ 0.49 6.73 19.04 17.28 11.16 54.21 Page 7 $ 21.00 54.70 $ 75.70 COMMONWEALTH OF PENNSYLVANIA: SS: COUNTY OF CUMBERLAND Mary J. Beers, Melinda M. Marci, and Daniel E. Lake, III, Co-Executors under the Last Will and Testament of Janice M. Lake, deceased, hereby declare under oath (penalties of perjury) that they have fully and faithfully discharged the duties of their office; that the foregoing First and Final Account is true and correct and fully disclose all significant transactions occurring during the accounting period; that all known claims against the estate have been paid in full; that, to their knowledge, there are no claims now outstanding against the estate; and that all taxes presently due from the estate have been paid. ~t~ '~7JjL 777 7J71U<< ~:JJ;{];' Daniel E. Lake, III Sworn tc and subscribed before me this .lj.f'. day O.f ~ ---;-2002. d.L/la. }yl~ Notary Public . NOTARIAL SEAL TINA M. BURKEY, Notary Public New Cumberland Boro. Cumberland Co. My Commission Expires April 15, 2005 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND 1. J 51: Mary J. Beers according to law, deposes and says that ~e is the Co-Executor of the Estate of Janice M. Lake late of .-BoJ:O.u<1h-hof_.NEJoL.Cum.b.er.laruL- . Cumberland County, Pa., deceased and that the . h" . t d b Mary J. Beers th 'd Co-Executor Wit In IS an Inven ory ma e y -- - ., e sal of the entire estate of said decedent, consisting of all the personal propc!rty and real estate, except real estate outside the Commonwealth of Pennsylvania. and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. being duly sworn 19 Mar71.~~t~ Beers 107 Old York Road and subscribed before me, New Cumberland, PA 17070 Addr.ss Date of Death 20 12 2000 Day Month Y.ar INSTRUCTIONS J. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. "d s:: m r-l l-l 0)/ ~ :;j U ~ -ci >- 0) Gl .-l .- W Z .. 0 >- c:: .- 'II W -< 0) 4-l Q) .-l a::: a.. .- u 0 0 Vl ..!< 0 Q) Gl I 0 w w m Q ~ >- c:: III Gl .-l l- I a.. H .c: a.. c .- ...J LL 'II ... 0 Z -< 0 a.. , 0 I LL ...J . :;jl :: I W -< W .-l > 0 c:: :E:, il >. [< N ,i z - Z 0 0)1 c Q ::s 0 Vl Z u 0 c:: -< 'n U - Z I w s:: I I a.. I ~ I la I C I-J 'II I I - -.: I 0 Q) , ~ ~ I I Q) E -0 - Gl 0 ! !! 'II ::s 0 ...J U u: CD Inventory of the real and personal estate of Janice M. Lake deceased - Irwento:ry Estate of Janice M. Lake From 12/20/00 To 09/20/01 Description Accrued Interest Value Checking Accounts Susquehanna Valley FCU-Checking 2.87 Savings Accounts Susquehanna Valley FCU-Share Acct. 11.66 II 2,198.16 I 414.53 I ---------- Ii I I I Susquehanna Valley FCU-Club Acct. 2.34 Camon Stocks Waddell & Reed Fin. Se:rv . Certificates of Deposit Susquehanna Valley FCU-Share Cert. 7.95 Residences Property located at 314 Reno Ave. Refunds IRS-refund on decedent I s final 1040 Total 99 .84 2,61. . b9 , I I I I .56 .69 00 __ __ - __I~ - _u .- $120,7lj4."I8 STONE. LAFAVER & SHEKLETSKI -4- 'L-' CODICIL TO THE LAST WILL AND TESTAMENT OF JANICE M. LAKE I, JANICE M. LAKE, of the Borough of New Cumberland, Cumberland County, and Commonwealth of Pennsylvania, declare this to be the Sole Codicil to my Last Will and Testament dated December 3, 1991. ITEM I: I hereby revoke Item III.d. of my Last Will and Testament. ITEM II: In all other respects I hereby ratify, confirm and republish my Last Will and Testament dated December 3, 1991, together with this my sole codicil. IN WITNESS WHEREOF, I have hereunto set my hand and seal this .~ ..LL-. (., ~, n I day of 00+ , 2000. :, \ \. ~\ll ~~_ \\) . \,\Q.\~\ ;J JANI CE M. LAKE " SIGNED, SEALED, PUBLISHED and DECLARED by JANICE M. LAKE, the Testa- trix above named, as and for a Sole Codicil to her Last Will and Testament, and in the presence of us, who at her request, in her presence and in the presence of each other, have subscribed our names as witnesses. Yaw 7' OSii Wl.tness /Ct<t~ I~~ k: rtd 1-6 hlctK , /fr I 7c 3L , Address . ~W It),(JAM- Wl.tn s Page 1 of 1 ~A ,:.,...;~~... '~~;ff;~'; ~%;';)l^;~~~~:J~~" II II LAST WILL AND TESTAMENT OF JANICE M. LAKE I, JANICE M. LAKE, of the Borough of New Cumberland, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I bequeath my gold wedding ring and gold diamond engage- ment ring given to me by my late husband to my daughter, MARY J. BEERS, provided she survives me. ITEM II: I bequeath all of the tools which belonged to my late husband to my son, DANIEL E. LAKE, III, provided he survives me. ITEM III: I bequeath my Waddell and Reed investment account bearing the account number 20413126 in equal shares as follows: a. One share to my daughter, MARY J. BEERS, or to her issue, per stirpes; b. One share to my daughter, ~mLINDA M. ~mCRI, or to her issue, per stirpes; c. One share to my son, DANIEL E. LAKE, III, or to his issue, per stirpes; and d. One share to my friend, CLIFFORD SEIDLE, provided he survives me. -1- ITEM IV: In the event my son, DANIEL E. LAKE, III, has not attained the age of thirty-two (32) at the time of my death, I devise and bequeath my house and lot at 314 Reno Avenue, New Cumberland, Pennsylvania, 17070, together with all household goods and furnishings therein, and all policies and insurance on said real and tangible personal property to my son, DANIEL E. LAKE, III, until such time as he attains the age of thirty-two (32) so long as he desires to use such premises as his principal residence and pays all costs of maintenance thereof including taxes, assessments, insurance, and ordinary repairs, said property to be insuIed in a reasonable amount insuring the inter- ests of the remaindermen as well as himself. Upon my son, DANIEL E. LAKE, III, attaining the age of thirty-two (32) or at such prior time as he no longer uses said premises as his principal residence, I direct my personal representatives hereinafter named to sell said real estate and the tangible personal property and distribute the net proceeds thereof in equal shares to such of my children, MARY J. BEERS, MELINDA M. MACRI, and DANIEL E. LAKE, III, as are then living. Should any such child of mine not be living at time of distribution, I devise and bequeath the share of child to his or her issue, per stirpes, then living and should any such child of mine die leaving no such issue living at the time of distribution, I devise and bequeath the share of such child to my issue, per stirpes, living at the time of distribution. -2- ITEM V: I devise and bequeath the residue of my estate of every nature and wherever situate in equal shares to such of children, MARY J. BEERS, MELINDA M. MACRI, and DANIEL E. LAKE, III, as are living at the time of my death. Should any of my above named children predecease me, I devise and bequeath the share of such child to his or her issue, per stirpes, living at the time of my death; and should any such child of mine leave no such issue living at the time of my death, I devise and bequeath the share of such child to my issue, per stirpes, living at the time of my death. ITEM VI: I appoint my Co-Executors and their successors guardian of any property which passes, either under this will or otherwise, to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this ap- pointment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or to another for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to time for the minor's support and education (including college education, both graduate and undergraduate) without regard to his or her parent's ability to provide for such support and education, or to make payment for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor. -3- ITEM VII: I appoint my children, MARY J. BEERS, MELINDA M. MACRI, and DANIEL E. LAKE, III, Co-Executors of this my last will. ITEM VIII: I direct that my Executors and their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, JAN*CE M. LAKE, have hereunto set my hand and seal this 3 ,...d day of J.lukYA~~j~.Y1/I, 1991. -%~~'~ ,1,a\t~ JANICE M. LAKE SIGNED, SEALED, PUBLISHED and DECLARED by JANICE M. LAKE, the Testatrix above named, as and for her Last Will and Testament, and in the presence of us, who at her request, in her presence and in the have subscribed our names as witnesses. I/~u j (\.~, bn lL\dll , jl., Address --/~ ..;J ~ 1 /,~ . dL '7C, .. .)~<'~O- W~tq,~ss fl '-../7 ~ ''-~ /--;:. /' ~ / b' , /...f--.i:-c~,. ,--.A!A"~Y~_'L/"~_~L_<~r--t,A....1J , I ct.__ Address ' -4- . . .~- -~ "" . ~ ._.. - ~...... - "'_ 0- __.. ,,~...-....... _._ COMMONWEALTH OF PENNSYLVANIA: :SS: COUNTY OF CUMBERLAND I, JANICE M. LAKE, the Testatrix 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 this instrument as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. ~CN~~ \it, .~ah) 11 JANICE M. LAKE Sworn to or affirmed to and acknowledged before me by JANICE M. LAKE, the Testatrix, this 3 ~ day of /\.{)~~'2_''V1,lL~-' ' , 1991. G' '~ / '-f/ 1 ~1/.~' /\., 0~Li:.(- Notary Public , I NOTARIAL St~L CO,ISTA,!CE l. KARL! ;"~"Rv .'" NEW CUi1EERlhND Pi' .:i';'!~~~'l ,r:~d~IC MY COr*iISsror~ EXpr;~1:S "AP;tl.l....A1,:) "1?' , ;), :<95 -5- - ~ __-------.::....___ ~": ____ __ ~ _ _' __"'A' . . .... \ COMMONWEALTH OF PENNSYLVANIA : :SS: COUNTY OF 0RLAND We, _ t.l.'("I ~~" . . and , the witnesses whose names are signed to the instru- ment, being duly qualified according to law, depose and say that we were present and saw Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound mind and under no con- straint or undue influence. ~,,~ 4tb wi ess ~~.~~ W ness Sworn to or affirmed to and acknowledged before me by ADCLV<-d (j ~^: and KPU:t X~~ this <3 ~'lcl day of /J:..!Lc,;/...JU2~J , 1991- (~/LY~0-i; Notary Public , witnesses, " NOTARIAL SEf;L COIJSTAtlCE L. Ktd~LI. 1;DrARY l'l!BLIC NEW CUMRERu\!m. P;I. C'j~iB~:tl r.:H> co. MY C0111'1IS5IO:l EXPI~ES APRIL 13. 1995 -6- - -~- - - - -- ~ ------~-- -- -+- - --- THE THE PATRIOT NEWS SUNDAY PATRIOT NEWS Proof of Publication Under Act No. 587, Approved May 16,1929 Commonwealth of Pennsylvania, County of Dauphin} ss Michael Morrow being duly sworn according to law, deposes and says: That he is the Asst. 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 812 to 818 Market Street, in the City of Harrisburg, County of Dauphin, State of Pennsylvania, owner and publisher of The Patriot-News and The Sunday Patriot-News newspapers of general circulation, printed and published at 812 to 818 Market Street, 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/ Metro editions which appeared on the 6th, 13th and 20th day(s) of February 2001. That neither he 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 he 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 f the said Company and subsequently duly recorded in the office for the Recording of Deeds in and for said County f auphi in Miscellaneous Book "M", Volume 14, Page 317. Estate Notices Notarial Seal Terry l. Russell, Notary PUbIiC~ Harrisburg, Dauphin County My Commission Expires June 6, 2 PUBLICATION COPY EXl!CUrOR'S NOTICE Letters Testamentary on the Estate of JanIce M. Lake. late Of the Boroul!h of New CU,mberland, County of Cumberland and Commonwealth of PennsYlvania, deceased, hove been granted to the undersigned. All persons Indebted to Ihe,sold Estate ore requested to make Immediate l>Oyment and those having cl~lms wIll present them without ~Iay to: Mary J. ...... 107.otd York RaacI, Let "9 N_ Cllmllerlancl, PA 17070 Mell_ M. Macri 02 Condlewyclc RaacI Camp Hili. PA 17011 DanIel E. Lab, III 314 Reno Avenue N_ Cumllerlancl. PA 17070 David H. StoM, Esquire STONE LaFAVER & SHEKLI!T5KI P.O. lox I! N_ Cumberland, PA 17070 TARY PUBLIC Member, Pennsylvania Association at Notaries. . " . My commiSSiOn expires June 6, 2002 STONE, LAFAVER & SHEKLETSKI ATTN: DAVID H. STONE 414 BRIDGE STREET NEW CUMBERLAND, PA. 17070 Statement of Advertising Costs To THE PATRIOT-NEWS CO., Dr. For publishing the notice or publication attached hereto on the above stated dates $ Probating same Notary Fee(s) $ Total $ 124.89 1.50 126.39 Publisher's Receipt for Advertising Cost The Patriot News Co., publisher of The Patriot-News and The Sunday Patriot-News, newspapers of general circulation, hereby acknowledge receipt of the aforesaid notice and publication costs and certifies that the same have been duly paid. By.................................................................... PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 STATE OF PENNSYLVANIA : ss. COUNTY OF CUMBERLAND : Roger M. Morgenthal, 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 officia11ega1 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: FEBRUARY 9, 16,23,2001 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. Lake, Janice M., dec'd. Late of the Borough of New Cum- berland. Executors: Mary J. Beers, 107 Old York Road. Lot 119, New Cumberland. PA 17070, Melinda M. Macri, 432 Candlewyck Road. Camp Hill, PA 17011 and Daniel E. Lake. Ill. 314 Reno Avenue. New Cumberland, PA 17070. Attorneys: David H. Stone. Es- quire. Stone LaFaver & Sheklet- ski. P.O. Box E, New Cumber- land, PA 17070. /~ Roger M Morgentha1, Editor SWORN TO AND SUBSCRIBED before me this 23 day of FEBRUARY. 2001 N AL LOIS E. SNYDER, Notary Public Corfitle Boro, ClHYlb.rlond County, PA My Com minion Expirn Morch 5, 2001 est\mis\lakef&fnotice IN RE: ESTATE OF JANICE M. LAKE, LATE OF THE BOROUGH OF NEw: CUMBERLAND, CUMBERLAND COUNTY, PENNSYLVANIA DECEASED IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-01-0101 NOTICE OF FILING ACCOUNT AND STATEMENT OF PROPOSED DISTRIBUTION NOTICE IS HEREBY GIVEN THAT Mary J. Beers, Melinda M. Macri, and Daniel E. Lake, III, Co-Executors of the Last Will and Testa- ment of Janice M. Lake, Deceased, has this date filed the First and Final Account and Statement of Proposed Distribution in the above captioned Estate in the Office of the Register of Wills in and for Cumberland County, Pennsylvania, where the same are filed as public records and may be inspected. Enclosed herewith is a copy of the Inventory, First and Final Account and Statement of Proposed distribution as filed. YOU are further notified that any exceptions or objections to said account or statement must be filed in writing at the Office of the Register of Wills aforesaid prior to the confirmation of said account scheduled as set forth below. UNLESS written exceptions or objections are filed prior thereto, said account and statement will be presented to the above captioned Court in Court Room No. 1 of the Cumberland County Courthouse, Carlisle, Pennsylvania, at 9:30 A.M., prevailing time on March 5, 2002, at which time said account will be confirmed and distribution ordered in accordance with the Statement of Proposed Distribution. G;~~ DATE OF NOTICE: ~ - 3>0 ~L NOTICES TO: 1. Mary J. Beers, 107 Old York Rd., New Cumberland, PA 17070 2. Melinda M. Macri, 115 Ramblewood Lane, Lewisberry, PA 17339 3. Daniel E. Lake, III, 314 Reno Ave., New Cumberland, PA 17070 STATUS REPORT UNDER RULE 6.12 C// 1/ Name of Decedent: Janice M. Lake Date of Death: December 20, 2000 Will No. 21-01-0101 To the Register: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes ~ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: (a) Did the personal representative file a final account with the Court? Yes X No (b) The separate Orphans' Court No. the personal representative's account is: (if any) for N/A (c) Did the personal representative state an account informally to the parties in interest? Yes No (d) Copies of receipts, releases, joinders approvals of formal or informal accounts may be with the Clerk of the Orphans' Court and may b to this report. V-<;-O'L and filed attached Date: 'Ji..l~} , '<) Davia H, 414 Bridge Street New Cumberland, PA 17070 717-774-7435 Z~l: ~, Ul (!,j1jCa1{kcity: Personal Representative X Counsel for Personal Representative CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Janice M. Lake Date of Death: December 20, 2000 Will No. 2001-00101 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court rules was served on or mailed to the following beneficiaries of the above captioned estate on January 26, 2001. Mary Jo Beers 107 Old York Road, Lot 119 New Cumberland, PA 17070 Melinda M. Macri 432 Candlewyck Road Camp Hill, PA 17011 Daniel E. Lake, III 314 Reno Avenue New Cumberland, PA 17070 Notice has now been given to all persons entitled thereto under Rule 5.6(a) Date: /". ! "' .:-i '. i" \ I ,"" J ....j . V -.,:- , ',' '" Da~:Lb. ~' St~ne, Esquire 414 Bridge Street New Cumberland, PA 17070 717-774-7435 Capacity: Personal Representative x Counsel for Personal Representative ..,. est\mis\LAKErealestate\3-02 IN RE: ESTATE OF JANICE M. LAKE, LATE OF THE BOROUGH OF NEW CUMBERLAND, CUMBERLAND COUNTY: PENNSYLVANIA, DECEASE IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-01-0101 DECREE AWARDING REAL ESTATE AND NOW, this ~ day of ~ o'clock ~.M., prevailing time, it appearing that the First and Final Account and Statement of Proposed Distribution of Mary J. Beers, , 2002, at ~'(J~ Melinda M. Macri, and Daniel E. Lake, III, Co-Executors of the Last Will and Testament of Janice M. Lake, Deceased, have been duly filed and advertised according to law and Rules of Court, and said First and Final Account and Statement of Proposed Distribution have been con- firmed and approved by the above Court in and for Cumberland County, Pennsylvania, on March 5, 2002; and it further appearing that the said Co-Executors have in their Statement of Proposed Distribution proposed to distribute certain Real Estate in kind to Mary J. Beers, Melinda M. Macri, and Daniel E. Lake, III, in accordance with the provisions of the Last Will and Testament of Janice M. Lake, Deceased, and the Court aforesaid having decreed distribution in accordance with said State- ment of Proposed Distribution. IT IS ORDERED, ADJUDGED AND DECREED that all right, title and interest of the said Janice M. Lake, Deceased, in and to -1- ALL THAT CERTAIN piece or parcel of land situate in the Borough of New Cumberland, Cumberland County, Pennsylvania, bounded and described in accordance with a survey and plan thereof, dated May 7, 1968, prepared by Roy M. H. Benjamin, Professional Engineer, as follows: BEGINNING at a point on the southwestern line of Reno Street, said point being twenty-five (25) feet Northwest of the corner of River Avenue and Reno Street; thence through the center of a partition wall separating the premises 314 and 312 Reno Street, South thirty-nine (39) degrees forty-five (45) minutes West one hundred forty (140) feet to a point on the northeastern line of Cherry Avenue; thence along the line of Cherry Avenue, North fifty (50) degrees fifteen (15) minutes West twenty-four (24) feet to a point; thence North thirty-nine (39) degrees forty-five (45) minutes East one hundred forty (140) feet to a point on the southwestern line of Reno Street; thence along the southwestern line of Reno Street, South fifty (50) degrees fifteen (15) minutes East twenty-four (24) feet to a point, the place of BEGINNING. HAVING THEREON ERECTED a three story frame dwelling known as No. 314 Reno Street. BEING the same premises which David E. Dunkle and Mary K. Dunkle, husband and wife, by their deed dated July 3, 1968, and recorded July 3, 1968, in the Office of the Recorder of Deeds in and for Cumberland County, Pennsylvania, in Deed Book V-22, Page 460, granted and con- veyed unto Daniel Eugene Lake and Janice M. Lake, husband and wife. The said Daniel Eugene Lake died July 19, 1989, thus vesting title in Janice M. Lake, his wife, by operation of law, Decedent herein, is hereby awarded unto Mary J. Beers, Melinda M. Macri, and Daniel E. Lake, III, in fee simple. IT IS FURTHER ORDERED AND DIRECTED that a certified copy of the Decree be recorded in the Office of the Recorder of Deeds in and for Cumberland County, Pennsylvania, among the deeds recorded ln said Office, said Decree to be indexed in the Grantor Index against the Estate of Janice M. Lake, Deceased, and in the Grantee Index to Mary J. Beers, Melinda M. Macri, and Daniel E. Lake, III, pursuant to the -2- Probate, Estates and Fiduciaries Code, Act of 1972, P.L. 164, Section 3536 (20 PA. C.S.A. 3536). J. VjLLH1~J 'T~) L l: :) \f 6l CI~t,1 ZOo -3- /b -c2LJ~ / COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN DAVID H STONE ESQ STONE ETAL 414 BRIDGE ST NEW CUMBERLAND PA 17070 11-05-2001 LAKE 12-20-2000 21 01-0101 CUMBERLAND 101 Allount Rellitted '* REV-1547 EX IFP 112-001 JANICE M MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=is4-j-Ex-AFP--fi'2-:ooY-NoTIcE--oF-iNHEififAtfCE-TAX-A-PPRA-isEiiENT~--A[rowAirCE-(fR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF LAKE JANICE M FILE NO. 21 01-0101 ACN 101 DATE 11-05-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Hortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets ( ) CHANGED (1) (2) (3) (4) (5) (6) (7) 75,370.00 37,079.56 .00 .00 8,265.22 .00 1.285.02 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H) 10. Debts/Hortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax NOTE: I~ an assessment was issued previously, lines re~lect ~igures that include the total o~ ALL ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: PAYHENT DATE 03-19-2001 RECEIPT NUHBER AA478179 DISCOUNT (+) INTEREST/PEN PAID (-) 236.84 INTEREST IS CHARGED THROUGH 11-20-2001 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM (9) (10) 15,680.89 341. 84 (11) (12) (13) (14) NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 121,999.80 16.02? 73 105.977.07 .00 105,977.07 14, 15 and/or 16, 17, 18 and 19 will returns assessed to date. .00 X 00 = 105,977.07 X 045= .00xI2= .00 X 15 = (19)= AHOUNT PAID 4.500.00 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE · IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .00 4,768.97 .00 .00 4,768.97 4,736.84 32.13 .48 32.61 ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) //6- QL'J6-:" / BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REV-1U7 EX AFP (12-001 Recoroed of Register of \^i1t1s DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-19-2001 LAKE 12-20-2000 21 01-0101 CUMBERLAND 101 JANICE M DAVID H STONE STONE ETAL 414 BRIDGE ST NEW CUMBERLAND "01 NOV 26 All:48 ESQ Clerk-(:. . . Court .ml~t"I~ld Co., PA Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ rfEv=i6"ifj-E3f-AFP--fi'2:ooY------...--zNifERITANcE-fAx-STAfEMENf-oF'-Aifcomff--.-i.---------------- ----- ESTATE OF LAKE JANICE M FILE NO.21 01-0101 ACN 101 DATE 11-19-2001 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-05-2001 P R I NC I PAL TAX DUE: ........................................................................................................................................................................................................................... 4,768.97 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 03-19-2001 AA478179 236.84 4,500.00 09-21-2001 CDOO0292 .00 32.13 TOTAL TAX CREDIT 4,768.97 BALANCE OF TAX DUE .00 INTEREST AND PEN. .01 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .01 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J c:' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.2B0601 HARRISBURG, PA 1712B-0601 RECEIVED FROM: STONE DAVID HEAN 414 BRIDGE STREET NEW CUMBERLAND, PA 17070 n______ fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: SSN: 210-22-8197 FILE NUMBER: 21 - 2001 - 0101 DECEDENT NAME: LAKE JANICE M DATE OF PAYMENT: 09/21/2001 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 12/20/2000 REMARKS: DAVID H STONE ESQUIRE CHECK# 1061 SEAL ACN ASSESSMENT CONTROL NUMBER 101 TOTAL AMOUNT PAID: INITIALS: VZ RECEIVED BY: REGISTER OF WILLS REV-1162 EX(11-96) NO. CD 000292 MARY C. 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