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HomeMy WebLinkAbout01-0136 uJ,,"u.....'uu ....u.J.J. 1\'L.UIo...J'L-I", WI VJjLL--J I.L I -'U_ 'f" t_..... PETITION FOR PRO.BATE and GRANT OF LETTERS Estote of Cleopatra Myers also known as No. To: 21-01-136 Register of Wills fOf the , Deceased. Count)' of C"mhprl.<lnd in the Social Security No. 161-32-2753 Commonwealth of Pennsylvania The petition of Ihe undersigned respectfully rtpresenlS that: Your pttitioner(s), who is/are 18 years of age Or older an the execut or in th~ Ja5t. will of Ihe above decedent. dated April 9 and codicil.(s) dared Nnnp named ~ J9~ (Slare relevrmt cirC1lm'lllnt:e" e.ll. rMuncialil>n, dCllth or C:l\ec:utor, etc.) Decendent was domiejled at death in Cumberland County, Pennsylvania, with h er [ l~l family or~rincipal res.idence al ,i .n L.~ t' '---&tr- - 0 I ~ (H..J l,k} 11 Ih ~1 ' C [] V\? If=I. I t- r:#- 0 f-O ut2f \ L-L.J-.A- (list street, numl)c:r ood mUllc.ipalhy) . Oecendent, then 100 ~ years of age, d.ied January 25, 2001 , ~ at Seidle Memorial Hospital, Mechanicsburg, PA . Except as follows, decedent did not marry, was not divorced and d.id not have a child burn or adopted after execution of the will offered for probate; was not the victim of a killing and was l\~ver adjudicated incompetent: _ Decendent at death owned prop~rty with estimated values as Collows: (If domiciled in Plk.) AJI personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) ~er5;onal property In County Value of real estale in Penn!;ylvania situnted as follows: None $968,400.00 S s S 0.00 WHEREFORE, petitioncr(s) respect full}' requl!~t(s) the probate. of the last will and codicil(s) prcs~n[ed herewith and the grant of letters testamentary (tc~lOmeI1l3">,; 3<1minimution c.La.; administration d.b. n.c.La.) theroll. !i ~!~~ :;j.g ";;i~ "ti"... :;0 OJ c: OIl in Richard E. Myers 109 South 17th Street CRmp Hill, PA t70tl OATH OF PERSONAL REI~RESENTATIVE COMMONWEALTH OF PENNSVLVANIA }' ss COUNTY OF CUMBERLAND The pelitioner(s) above-named swear(s) or affjrm(s) that the statements in the foregoing petition are [rue and cotrect to tlte best of the knowledge and bdief of petitioner(s) and that as personal represeo- tative(s) of the abo\l~ decedent pctitioner(s) will well an.d truly adJuinis r the estate according to law. ~ oV' :s I:l E" ~ :s: Ul(I':;.C'('I-; ry,~.V"/.C'.r, This is to certifY that the information here given is correctly copied fro~ an original certificate of death dul~ filed with me as Local Registrar. The original certificate will be forwarded to the State Vltal Records Office for permanent filmg, WARNING: It is illegal to duplicate this copy by photostat or photograph. No. atAC/~o/~ . Local Registrar ~ Fee for this certificate, $2.00 p 7175530 JAN 2 9 2001 Date 21-01-136 ROY. 2187 COMMONWEALTH OF PENNSYLVANIA' OEPARTMENT OF HEALTH' VITAL RECOROS CERTIFICATE OF DEATH NAME OF DECEDENT iFIl'Sf. Middle, las, .. AllEll'" SEX Z. 100 VIS. UNDER , DJO/ -1M- BIRTHPlACE (C,,","" 3~ QI FCfillCjll Country) Hun tingdon, Pa ::"",0 COUNTY OF DEAl'H 109 South 17th Street ... Canp HIll, Pa 17011 MTHEJl'S NAME IF... _. La,,) DECEDENT'S ACTUAL SIOENCE (SeeflSln.ClIOnI on other SlOe) 17.. Slat. Pa ... ,70.0 ___in lWllTAl SWUS._ --.-. ~-~ Widowed AACE._I__.._..... ISpeQIy) White SUA\II\/INO SPOuSE I" WlIe. g.w INlden ~ '0, 'lIl.Cou Did - liwIina Cumberland .......1 I7d.~ ::"'-=:::01 MOTHER'S NAME (Firl" M.dcIe, MiJKMrl Surname) ...... CaIll> Hill ....,_. __Sl...O Pa ~ff~Pa S~:70It No~ PAIlT U: OdloI........_c:onaiIluIInglO_..... noli ~ in... undIIrlvinQ '*- given in PART I. l: WERE AUlOPSY FINDINGS -......E PAIOlllO COMPI.ETlON OF CAUSE OF DEAl'H1 TIME OF INJURV DESCAlllE HOW INJURV OCCURRED. NOIU101 ~ o o - Pending -lQa- o o o PlACE OF tNJURY. AI home, ta'm.I&I.... tactOl'y. otftce ... bulking, etc. lSpec::llw) _. Yoo 0 ...0 ..,..0 ...0 - - Couki not be dellt1Tllned "MEDICAL EXAMINER/CORONER On the be.. of..aminatlon and/or inv.stlgation. In my opinion. death occUt'fed at the time. date, and place. and due to 1M cau"(I} and manner.. .latad.......... ........ .. .............................................................................. :1.1.. REGISTRAR'S SlQNATURE ~/p<(( I __ HII. __ IC'- only one) -CERTIFYING PHYSICIAN (PhySIClaf' cefblylfl9 cause ~ death *"'*' another phVSIC.." has pronounced dealh ana completed Item 231 To.......o."'fknowtecfge......OCCunactdueto..caUM(.).ndfNInM,........................................ ..................... a. -PRONOUNCINQ AND CMTIFYtNQ PHYSICIAN (Physoan both tlIonounclng death and cenlfyvtg IOCause Of c:lealhl To the beelotmyknowtedQfl. .."'occurred.t........ clate. and plac.. .nd due to IhecaUH(a) .ndm.nn.'...t.led.......................... 33 ~ //2 I N 21-01-136 o. Estate of CLEOPATRA MYERS . Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW FEBRUARY 6 ~ 200~ in consideration of the petilion on the reverse side hereof, satisfaclory proof havin, been pr.cscnted before me, IT IS DECREED Ihat the instrurnent(s) dated APRIL 9th. 1996 desc(ibed therein be admitted to probale and filed of record IJ the last will of CLEOPATRA MYERS TESTAMENTARY RICHARD E MYERS llnd Letter! are hereby granted to Probale, Leners. Etc. "".. . . . . . Shon Cerlific8les( )...."."... }~~~H~i~tion ..............". JCP S $ $ S TOTAL _ S 2-5-01 .............................. - - -.. 515.00 24.00 9.00 5.00 553.00 q//-'l(J~L//~'Jo/n / Atf/.o~/~U/ }tJ~ ~JC:- f GREGORY 1M., KERWIN .-ll2 22 All"ORNEY (Sup. Ct. 1.0. No.) 4245 ROU~E 209, E~IZABETllVI~~E~ rA 17023 A.DDRESS FEES filed '(717) 362-3215 . PHONE , :;;-! r- <. 21-01-136 LAST WILL AND TESTAMENT OF CLEOPATRA MYERS I, CLEOPATRA MYERS, of the Borough of Camp Hill, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make and publish this, my Last Will and Testament, hereby revoking and making void all former Wills by me at any time heretofore made. FIRST: I direct my hereinafter named Executor to pay all my legally enforceable debts, funeral expenses, administration expenses, and inheritance, estate, succession or excise taxes, which I owe or may become due on account of my death, as soon as may be convenient after my decease. SECOND: I make the following specific bequests: A. I give and bequeath the sum of FIVE THOUSAND ($5,000.00) DOLLARS to my granddaughter, VICKI LYNN MYERS, B. I give and bequeath the sum of FIVE THOUSAND ($5,000.00) DOLLARS to my grandson, JEFFREY SCOTT MYERS, C. I give and bequeath the sum of FIVE THOUSAND ($5,000.00) DOLLARS to my grandson, DOUGLAS EDWIN MORRISON, D. I give and bequeath the sum of FIVE THOUSAND ($5,000.00) DOLLARS to my grandson, STEVEN DON MORRISON, E. I give and bequeath the sum of FIVE THOUSAND ($5,000.00) DOLLARS to my granddaughter, PAMELA ANN MORRISON, GREGORY M. KERWIN TERRENCE J. KERWIN JOSEPH D. KERWIN HOLLY MCCLURE KERWIN ATTORNEYS AT LAW Page 1 of 4 Pages c! w ~~I,M< CLEOPATRA MYERS " F. I give and bequeath the sum of FIVE THOUSAND ($5,000.00) DOLLARS to my grandson, GARY MYRLE HITE, G. I give and bequeath the sum of FIVE THOUSAND ($5,000.00) DOLLARS to my granddaughter, KIM LOUISE HINSON, H. I give and bequeath the sum of FIVE THOUSAND ($5,000.00) DOLLARS to my granddaughter, LINDA KAY KLEEMAN, and I. I give and bequeath the sum of FIVE THOUSAND ($5,000.00) DOLLARS to my granddaughter, TRACY EARLEEN NOLL. In the event any of my aforesaid grandchildren should predecease me, I direct that their share of my estate shall pass to their issue per stirpes. In the event any such decease grandchild should have no issue then living, I direct that such share shall be added to the shares established herein for my other grandchildren. THIRD: I give, devise and bequeath all the rest, residue and remainder of my property, be it real, personal and mixed, whatsoever and wheresoever the same may be situate at the time of my death in equal shares, as follows; A. One-third (1I3rd) of the residue of my estate to my daughter, ALTA M. RYAN, B. One-third (1I3rd) of the residue of my estate to my daughter, CLEOPATRA BECHTEL, and C. One-third (1I3rd) of the residue of my estate to my son, RICHARD E. MYERS. In the event any of my aforementioned children should predecease me I direct that said deceased child's share should pass to their issue per stirpes. GREGORY M. KERWIN TERRENCE J. KERWIN JOSEPH D. KERWIN HOLLY MCCL.URE KERWIN ATTORNEYS AT LAW Page 2 of 4 Pages ~~ ~!V&' CLEOPATRA MYERS . . FOURTH: I nominate, constitute and appoint my son, RICHARD E. MYERS, as Executor of this, my Last Will and Testament, authorizing and empowering him to sell and convey any and all real estate of which I may die seized and possessed. I further direct that my Executor or personal representative shall not be required to post bond to act in said capacity. IN WITNESS WHEREOF, I, CLEOPATRA MYERS, have hereunto set my hand and seal, to this my Last Will and Testament, this 9th, day of ^p:r;H 1996. SIGNED, SEALED, PUBLISHED and DECLARED by the above- named Testatrix, CLEOPATRA MYERS, as and for her Last Will and Testament, in the presence of us, who at her request and in the presence of each other, have hereunto set our names as tn ses: Cf,~rf! r ~~ ..CLEOPATRA MYERS (SEAL) Res' at: +~, ~~.fl.(# ~#./.('/1'",..._ Residing at: ~~,,~ Page 3 of 4 P GREGORY M. KERWIN TERRENCE .J. KERWIN .JOSEPH D. KERWIN Hou.y MCCLURE KERWIN ATTORNEYS AT LAW GREGORY M. KERWIN TERRENCE J. KERWIN JOSEPH D. KERWIN HOLLY MCCLURE KERWIN ATTORNEYS AT LAW " ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF DAUPHIN I, CLEOPATRA MYERS, 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 the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. SWORN TO or affirmed or acknowledged before me by CLEOPATRA MYERS, the Testatrix, this 9th day of April , 1996. '--6 {Lff 1 ~ ( ~ CLEOPATRA MYERS Notarial Seal Beatrice Marie Kerwin, Notary Public Washington Twp", Dauphin County My Commission Expires July 25, 1998 Member. Pennsylvania Association of Notaries .~\1\fu...~ Notary Public AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF DAUPHIN WE, Gregory M. Kerwin and Terrence J. Kerwi.rthe witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her Last Will; that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Will as a witness; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. SWORN TO or affirmed or acknowledged before me by CLEOPATRA MYERS, the Testatrix, this 9th day of April , 1996. Page 4 of 4 Pages ~~n~, Notary ~blic c:\bmk\will\myers.cle Beat . M ~otarial Seal nce ane Kerw" N Washington Twp D~u ~~a6 Public My Commission E~p;res 5u;~ 2gu~8 Member, Pennsylvania AssOCl"alio f N " n 0 otanes f --- CERTIFICATION OF NOTICE IJNTlER RUI,E 5.6(a) Name of Decedent: Cleopatra Myers Date of Death: January 25, 2001 No. 2001-00136 To the Register: I certify that notice of estate administration 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 March 20, 2001. Mr. Richard E. Myers 109 South 17th Street Camp Hill, PA 17011 Mrs. Alta M. Ryan 3219 Roswell Road The Villages, FL 32159 Ms. Vicki L. Myers 109 South 17th Street Camp Hill, PA 17011 Mr. Jeffrey S. Myers 91 Beacon Drive Harrisburg, PA 17112 Mr. Steven D. Morrison Flint Forrest Road Box 7406, RD #1 Coopersburg, PA 18036 Ms. Pamela A. Morrison 2802 Sundown Lane #112 Boulder CO. 80303 Ms. Kim L Hinson 317 East Portland Street Mechanicsburg, PA 17055 Ms. Linda K. Metz 317 East Portland Street Mechanicsburg, PA 17055 Notice has now been given to all persons entitled the eto Date: 03/20/00 Signature: Name: Address: Telephone: Capacity: Mrs. Pat Bechtel 360 Kralltown Road Wellsville, PA 17365 Mr. Douglas E. Morrison 6781 Breakwater Way Sacramento, CA 95831 Mr. Gary M. Hite 201 Meadow Lane Apt. #36 Harrisburg, PA 17104-3512 Ms. Tracy E. Noll 4701 North Clearview Drive Camp Hill, PA 17011 17023 Personal Representative X Counsel for Personal -- Representative D:\DOCUME - 1 \BMK\EST ATES\MYERS-C.56A r iii i ~ x w '" co ::> w II: M (J') ('\J co r- ..q- <( <( d z x < ~ I- W a.. I- - << W -I- 0 zCJ) <w W >0 a: ...Jz >< ..J CJ) zW <C zO - wZ 0 11.< - l- LL. ~ LL. w 0 ::I: Z ~ Z <l: ::J III >- w (fJ >< ZW<l: z:Jl- WZ..J a.W<l: u..>;:) oWe 0:_ Iu..~ <l: ':3oe a. <l: I- ~ - ~t5~~~ z::2;;:) 0 III o~c(~~ ~<l:W~O: ..:a.a:a.o: OW;:)W<l: UOalOI (; (J:) o cO C\l ;:::. --:~ --1" - r-Q _ - '~_T" ,~,.. ..~ I I W <r w :>: 9 ~ 0 C' .-' 0 m '-' . c... I- 0 C- O () z (;. .~ ::J ., 0 :2 (0 OJ <( ('ry lTt t/I If; I- m..Ja: o z:2a:W O(/)I-CC <((/)z:2 WO::J ~OZ <( :5 o II: II.. C W > iii o w a: L ..... o <-< ('T) tlJ 0 t, UJ .... >- l- I- <r <r Il. Z .... I)- W ~ 0 ...J 0:: nJ ..J W ..... ~ W> " r- I 03 :)1- C1W Z 0::,0) .... <I 3 If) r"J 0: ~ .... W OJ ..J ::x: <t W w <r w :>: c -' ~ o <( CL I- Z ::J o :2 <( ..J <( I- o I- ex: .w ,U t- o Ul >- >- ..., cc cr f!) 0<1: LiJ w:r: n: > iIi o W a: ~ fl) L0 f' nJ I OJ ('l) i i=' .... III ..0 0: .... ~ z e (J"J ~ to <t 0:: - I- .!J -D ~<r z ('ry 1-0.. :J 0 - ~o .... .... 0 ...... i= 0 dW 0 0 z g ~ <( i ..J 0 0 <I ~ .... !zU ru ru ..J ~~ a: 0 1-' , CI: 0 0 ~m z~ ~o- W IlO :; w'-' U. o:ru w(t ::2; OJ <l:.... OJ I- (l..l J. Z wi ~w >-" 0, z::: L5' w Ill.... 0>- c:~ ~~ ::) 0.... I- ~ru ~I: u.. <l: ~u u.. <( 0 ::2; 0 I- z W W I- Z W W ::2; I- (fJ :J I- CJ) ..J <l: <l: 0 0 <l: WU: Z 0 a. U 0 z ..... ~ cr: W 'x: ~ (/) ~ a: <( :2 W a: ., I , i ] 1 1 1 I I ~1 ::::!l ~1 ~I 0:1 ~1 en1 illi 0:1 I I I 1 1 1 I I I I I I I I I 1 1 I 1 1 Register of Wills of Dauphin County I Pennsylvania I" (/ INVENTORY Estate of CLEOPATRA MYERS No. 9./~ () 1- f :?,l also known as Date of Death January 25 2001 , Deceased Social Security No. 161-32-2753 RICHARD E. MYERS Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. I.D.No.: 21222 qldl {dOOl Name of Attorney: GREGORY M. KERWIN Address: 4245 ROUTE 209 ELlZABETHVILLE, PA 17023 Telephone: 717-362-3215 Dated Description Value 1. Legg Mason Wood Walker, Inc. - see list attached hereto 2. 4460 Shares of the Common Stock of Waypoint Financial Corporation 3. Franklin Universal - PFPC Global 4. Morgan Stanley Dean Witter (U.S. Govt Sec.) 5. T. Rowe Price - Growth Stock Fund 6. Alliance Mortgage Company 7. Legg Mason Wood Walker, Inc., - Cash 8. Certificate of Deposit #7100002302 at Waypoint Bank, Harrisburg, PA 1. 2. 3. 4. 5. 6. 7. 8. 900,033.73 4,500.00 2,000.00 4,400.00 10,063.86 1,551.54 5.63 26,677.35 Total: 949,232.11 (Attach Additional Sheets if necessary) NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. Form RW-7 (Dauphin County - Rev. 9/92) D:\DOCUME-l IBMKIPROBA TEIMYERS-C. [NY I /6-~07- 51 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISE"ENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESS"ENT OF TAX RecoroedOffiCG of Register of wifls GREGORY M KERWIN KERWIN 8 KERWIN 4245 RTE 209 ELIZABETHVILLE '01 NOV 26 All 51 ESQ Clerk-Orr-:"(1'~ Court ~"rfn!~~mdCo.. PA DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-20-2001 MYERS 01-25-2001 21 01-0136 CUMBERLAND 101 *' REV-1S47 EX AFP 112-DDl CLEOPATRA Allount RelliUed 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:is4j-EX-AFP-n2'=ofiY-No'ficE--OF-YNHEifiTANCE-'fAirAPPRAisEMENT-,--ALLOWANCE-oi----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MYERS CLEOPATRA FILE NO. 21 01-0136 ACN 101 DATE 11-20-2001 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. "ortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/"isc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) S. Total Assets CHANGED If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. 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) lS. Allount of Line 14 taxable at Collateral/Class B rate (lS) 19. Principal Tax Due RE I S: AY"EN DATE 04-19-2001 U) (2) (3) (4) (5) (6) (7) .00 922.549.13 .00 .00 26,682.98 22.233.92 .00 (S) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/"isc. Expenses (Schedule H) 10. Debts/"ortgage 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 (9) UO) 78,810.66 25.162.54 Ul) (2) (3) (4) NOTE: .00 X 867,492.83 X .00 X .00 X T DIS OU T (+) INTEREST/PEN PAID (-) 1,951.86 A"OUNT PAID 38,000.00 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 971,466.03 103.973 20 867,492.83 .00 867,492.83 00 = 045 = 12 = 15 = .00 39,037.18 .00 .00 39,037.18 (9)= 39,951. 86 914.68CR .00 914.68CR . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAY"ENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT"' (CR), YOU "AY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS.) /bVdtJ7- 9 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT ~ REY..1U7 EX AFP 1l2-DDl Re~(" ~-, C~"," . .\J i' ",.."-, <_.; Reqist;; DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 12-17-2001 MYERS 01-25-2001 21 01-0136 CUMBERLAND 101 CLEOPATRA .02 JI\N 18 P 3 :1 5 GREGORV M KERWIN ESQ KERWIN S KERWIN ~ . 4245 RTE 209 CIerI', ELIZABETHVILLE C~lfIq'7jO'2'3j Allount RelliUed ..;rt .,~,.." '" ir"M 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 ~ REY=i6Cfj-ix-AFP--n2'=OoY------...--iNHERiTANCE-fAX-STAfEMENf-oF'-Accouiff--.i.--------------------- ESTATE OF MYERS CLEOPATRA FILE NO.21 01-0136 ACN 101 DATE 12-17-2001 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: 11-20-2001 P R I NC I PAL TAX DU E : .......................-...........................................................................................................................-...............-.................................................... 39,037.18 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-19-2001 AA478291 1,951.86 38,000.00 11-30-2001 REFUND .00 914.68- TOTAL TAX CREDIT 39,037.18 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 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"" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) ~ /6 -02CJ 7- 7 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG. PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN *' REV-tta3 EX AFP (01-03) GREGORY M KERWIN KERWIN & KERWIN 4245 RTE 209 ELIZABETHVILLE ESQ DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-24-2003 MYERS 01-25-2001 21 01-0136 CUMBERLAND 201 CLEOPATRA Amount Remitted PA 17D23 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, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES ~ ---------------------------------------------------------------------------------------------------------------- REV-483 EX AFP {Ol-03J .. NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN .. ESTATE OF MYERS CLEOPATRA FILE NO.21 01-0136 ACN 201 DATE 03-24-2003 ESTATE TAX DETERMINATION 1. Credit For State Death Taxes as Verified 26,489.60 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) 37,085.32 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed 37,085.32 .00 5. Pennsylvania Estate Tax Due TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 *IF PAID AFTER THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) GREGORY M KERWIN ESQ KERWIN & KERWIN 4245 RTE 209 ELIZABETHVILLE PA 17023. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN '* BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 REY-7U EX AFP CUi-OZl 03-31-2003 MYERS 01-25-2001 21 01-0136 CUMBERLAND 202 CLEOPATRA 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 FILES ..... Rifv:7iEr-EX--AFP--[oi~-02)-----iii-NCiiicif-OF--DETifRMiiiATiCiN-AiiD-AS;SESS;MENif---------------------------- OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER .. ESTATE OF MYERS CLEOPATRA FILE NO.2l 01-0136 ACN 202 DATE 03-31-2003 ESTATE TAX DETERMINATION 26.489.60 1. Credit For State Death Taxes as Verified 2. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) 37.085.32 3. Inheritance Tax Assessed by Other States or Territories of the United States (Excluding Discount and/or Interest) .00 4. Total Inheritance Tax Assessed 37.085.32 .00 5. Pennsylvania Estate Tax Due 6. Amount of Pennsylvania Estate Tax Previously Assessed Based on Federal Estate Tax Return .00 .00 7. Additional Pennsylvania Estate Tax Due TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 -IF PAID AFTER THIS DATE. SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) - KERWIN & KERWIN ATTORNEYS AT LAW 4245 ROUTE 209 ELlZABETHVILLE, PENNSYLVANIA 17023 GOVERNORS' ROW 27 NORTH FRONT STREET HARRISBURG, PENNSYLVANIA 17101 237 UNION STREET MILLERSBURG, PA 17061 (71 7) 362-3215 (71 7) 362-3215 (71 7) 896-9089 FAX (717) 362-4459 E-mail kkI@epix.net (71 7) 238-4765 FAX (71 7) 238-8455 549 MAIN STREET LYKENS, PA 17048 (71 7) 453-7422 Please Reply To: III ELlZABETHVILLE OFFICE o HARRISBURG OFFICE Apri119,2001 PATRICKE. KERWIN (1913-1987) GREGORY M. KERWIN TERRENCE J. KERWIN JOSEPH D. KERWIN HOLLY McCLURE KERWIN Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013-3387 Re: Estate of Cleopatra Myers Date of Death: 01/25/2001 No.: 2001-00136 Dear Sir or Madam: Please find enclosed herewith a check payable to Register of Wills, Agent, in the amount of $38,000.00 representing a part payment of the Pennsylvania Inheritance Tax with respect to the above-captioned estate. Would you kindly return a receipt to me in the enclosed, stamped, self-addressed envelope? As always, thank you for your help. Very truly yours, (l^~ .. GiE&~~ M. KERWIN GMK:bmk Enclosures ! '(1 r ~ ~~ 10 ; \ , 1'(1 \ -~.' -" l7--'" " :.' '-,-, . . , . ; , \ '- 0. : ; . ::J I :, ~ cv. \ '~"\" ,,- / ,~/ Z - '" ~ N 0 ~ -< ~ Z ~ ;;: ~~ ~ Ul Z Z ..u t2 0.. Zen .u gj::J ->- N - ~~ ..u> f-i=: ::J..u O<:Q ~~ <X:-< "'N ~t2 ,.. - ~trl ~ iZ} ;:J o :I:: E-< ~ ;:J o U~r--- >- ",- 00 E-<-('f) Z<('f) iZ} ~~ ....:l;:JO_ ....:lU 0 r.n 12 ..... ~~- ~OCl'l...,. ~Z;:J"""'" O<O~ ~....:l:I::~ ~~E-<....:l E-<~~~ iZ}~;:J....:l ""'::SO~ Cl;:JU< ~U-U ('./ 1)'1 ft) ;"1 ,. .".. I~J') :r:' "', 1... I.... . oro' i=_: 0:~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: CLEOPATRA MYERS Date of Death: 01/2512001 Estate No.: 2001 - 00136 Pursuant to Rule 6.12 of the Supreme Court Orphans I Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes_X___ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? No _X_ Yes b. The separate Orphans' Court No. ( if any) for the personal representatives' account is : c. Did the personal representative state an account informally to the parties in interest? Yes _X_ No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orpha Court and may be attached to this report. / Date: December 27, 2002 ~~ GREGORY M. KERWIN, ESQUIRE 4245 ROUTE 209 ELIZABETHVILLE, P A 17023-9765 (717) 362-3215 Capacity: Personal Representative X Counsel for personal representative RW-27 E:IBMKIEST A TESlmyers.c1eopatra. form612. wpd # Cumberland County - Register Of wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 . Date: 12/06/2002 RICHARD E MYERS 109 SOUTH 17TH STREET CAMP HILL, PA 17011 RE: Estate of MYERS CLEOPATRA File Number: 2001-00136 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 1/25/2003 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, MARY C. LEWIS REGISTER OF WILLS cc: vi File Counsel Judge /G ~-d. 07 - 9 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT REV-1500EX +(6-00) CAPB HpRL EplO CRAC KOTK ES D E C E D E N T COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) M ers Cleo atra DATE OF DEATH (MM-OD-YEAR) c OFFICIAL USE ONLY FILE NUMBER ,.. ~'/ () I COUNTY CODE YEAR SOCIAL SECURITY NUMBER 161-32-2753 THIS RETURN MUST BE FILED IN DUPLICATE~TH THE /0ft, NUMBER REGISTER OF WILLS SOCIAL SlY NUMBER x o 3 date of death . Remainder Return prior to 12~13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes Ml OLE INITIAL X 1. Original Return 4. Limited Estate X 6. Decedent Died Testate (Attach copy of Will) D 9. LItigation Proceeds Received 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12.82) 7. Decedent Maintained a Living Trust (Attach copy of Trust) o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) o 11. Electlon to tax under Sec. 9113(A} (Attach Sch 0) P NAME COMPLETE MAiliNG ADDRESS C 0 0 Gre or M. Kerwin, Es uire N R D FI RM NAME (If Applicable) 4245 Route 209 R E E Kerwin & Kerwin Elizabethville, PA 17023 S N T TELEPHONE NUMBER C o M P T U A T X A T I o N 36 - 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule!) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Sub.ect to Tax (Line 12 minus Line 13) (1) (2) (3) None 922,549.13 None OFFICIAL USE ONLY R E C A P I T U L A T I o N (4) (5) None 26,682.98 22,233.92 None 78,810.66 25,162.54 (8) 971,466.03 (11) 103.973.20 (12) 867,492.83 (13) (14) 867,492.83 (6) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(aX1.2) 16. Amount of Line 14 taxable at lineal rate 867,492.83 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. X x X X X .0 0 .045 .12 .15 (15) (16) (17) (18) (19) 0.00 39,037.18 0.00 0.00 39,037.18 Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 109 South 17th Street CllY I STATE I ZIP Camo Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 39,037.18 0.00 38,000.00 1,951. 86 Total Credits ( A + 8 + C) (2) 39,951. 86 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnterestlPenaity ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line ZO 10 request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the tolal of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT :iiii!!!!!!!!!!!!!i!i!i!immJil::I:::::: iiiiiiiii!iiiiij!i1ii!i!iii::iiii:;;;, :':""';':!ii!:"mmm 'mmm"!iii:iiiiiiiiiiii !i!i!ii!i!!i!i!!i!i!ii!ij mil!!!!!!!!!!!!!!!!!!!!!!!, ;ii!i::':ii:!!i;;!::!:!: :~:~:;~;;:;;;;:;i;:!;I;;!;I;;!;1;;!;I;l;:I;;;:i;;iijilJ!ji1!!lim:m: idJ!:]; i!i!!!!!! I!!!!!!!!!! !!!i!!!!!!!!!!iiji!ll!!II!i!! . PLEASE ANSWER THE 'FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. 0.00 914.68 0.00 0.00 0.00 !!wwm Did decedent make a transfer and: a. retain the use or income of the property transferred; b. retain the right to designate who shall use the property transferred or its income; . c. retain a reversionary interest; or . d. receive the promise for life of either payments, benefits or care? 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? . 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Yes No ~~ o o ~ ~ o rn 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 pre parer has any knowledge. SIGNATUREOF PERSON RESPONSIBLE FOR FILING RETURN RESENTATIVE Richard E. Myers 109 South 17th Street - - -caffi- - -IiiYi; - PA - - Yi6i1- - - - - - - - - - - - - - - - - - - - - - - - -- Kerwin & Kerwin 4245 Route 209 - - Eii.~-';:b;'t-hviYie - - - - - - - I iiYii - - - - - - - - - - - - - - - - - -- DATE "1/:<1/01 DA1E I For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 9116 (a) (1.1) (j)J. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 9116 (a) (1.1) (ii)]. The statute does not exempt a transferto 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 twenty-one 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% (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'%., except as noted in 72 P.S. 9116( 1.2) [72 P.S. 9116(aX1l). The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(aX1.3)J. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (cl 2000 form software only The LaclcnerGroup, Inc. Form REV-1500 EX (Rev. 6-00) .' , REV-1503EX+(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Cleopatra Myers SSfF 161.32.2753 01/25/2001 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 DESCRIPTION UNIT VALUE 500 Shares Taxaco Capital, 6.875% Cum GTD Mth1y Inc Income PFD, Series A 2,412 Shares ACM Government Income Fund, Inc. 310 Shares AT&T Corp 995 Shares AT&T Cap Corp, 8.125%, SR Public Income Nt due 12/15/28 768 Shares Allied Irish Banks PLC 265 Shares American Electric Power Co., Inc. 22 Shares Avaya Inc. 226 Shares Bank of America Corp 400 Shares Bristol Myers Squibb Co. 100 Shares Cigna Investment Securities 742 Shares Cinergy Corp 20 Shares Cons Edison Co of Ney York Inc $5 PFD 52 Shares Consolidated Edison, Inc. 849 Shares Constellation Energy Group, Inc. 69 Shares Corning Inc. 447 Shares DQE 484 Shares Dominion Res Inc VA New 1000 Shares Dreyfus Strategis Muni Inc. 1000 Shares Dreyfus Minicipa1 Income Inc. 252 Shares Emons Transportation Group Inc. 380 Shares Enron Capital Tr i-8.30% Tr Originated Pfd 829 Shares Exe10n Corp. 8074.203 Shares Federated Government Income Securities Fd, C1 F 166 Shares Firstenergy Corp 10949.822 Shares Franklin US Govt Securities Ser.C1assA 600 Shares Franklin Universal Trust - SBI 1200 Shares General Electric Company 162 Shares Harsco Corp 105 Shares Household International Inc, Pfd 5% 1000 Shares JLG Industries Inc. 400 Shares Johnson & Johnson 2028.133 Shares Kemper Income & Capital Preservation Fd Class A 19202 Shares Legg Mason Cas Reserve Trust 325.527 Shares Legg Mason Value Trust 268 Shares Lucent Technologies Inc. 1500 Shares Merrill Lynch Preferred Cap Tr 111-7% Tf originated PFD 12 Shares NCR Corp New 90 Shares WIS New Valley Corp 6 Shares New Valley Corp-New 10 Units UTS-Penn Insured Muni 1nc Tr Ser III Semi 2 3 4 Total of Continuation Schedu1e(s) VALUE AT DATE OF DEATH 12,093.50 19,144.04 7,420.47 25,434.19 18,095.61 11,543.93 341. 00 11,639.00 25,750.00 1,662.50 23,326.25 1,365.00 1,842.72 34,543.26 3,881.25 14,275.83 30,794.50 8,875.00 1,812.00 425.12 9,595.00 51,182.46 70,326.30 4,648.00 74,349.29 4,875.00 55,124.40 4,181.54 3,412.50 11 ,812 . 00 36,700.00 16,650.97 19,202.00 19,352.58 4,824.00 37,312.50 544.50 8.37 18.18 2,416.20 241,748.17 (If more space is needed, insert additional sheets of the same size) CopyrIght (c) 1996 form software only CPSystems, Inc. TOTAL (Also enter on line 2, Recapitulation) Form REV-1503 EX (Rev. 1-97) 922,549.13 Estate of: Cleopatra Myers Soc Sec #: 161-32-2753 Date of Death: 01/25/2001 Item # Continuation of Schedule B (Stocks and Bonds) Description Unit Value Value at Date of Death 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 400 Shares Pepsico Inc. 100 Shares Pittsburgh & West Virginia Railroad - SBI 342 Shares Public Service Enterprise Group Inc. 912 Shares SBC Communications Inc. 282 Shares St Paul Companies Inc. 500 Shares Teco Energy Inc. 255 Shares TXU Corp 40 Shares Tricon Global Restaurants Inc. 450 Shares Tyco International Ltd. 998 Shares UGI Corp Holding Co 984 Shares Verizon Communications 54 Shares WPS Resources Corp 460 Shares Common Stock of Waypoint Financial Corp Franklin Universal - PFPC Global Fund Morgan Stanley Dean witer (U.S. Govt Sec.) T. Rowe Price - Growth Stock Fund Alliance Mortgage Company 17,500.00 618.70 14,470.70 43,206.00 13 ,923.75 14,531. 00 9,849.37 1,342.48 27,984.15 23,514.87 50,368.00 1,923.75 4,500.00 2,000.00 4,400.00 10,063.86 1,551. 54 241,748.17 REV-1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERJTANCETAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Cleopatra Myers SS# 161-32-2753 01/25/2001 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Legg Mason Wood Walker, Inc. - cash 5.63 2 Certificate of Deposit #7100002302 at Waypoint Bank Harrisburg, PA 17105-1711 26,677.35 TOTAL (Also enter on line 5, Recap,ulation) S 26,682.98 (If more space is needed, insert additional sheets of the same size) Copyrlght(c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) AEV-1509EX t{1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Cleopatra Myers SCHEDULE F JOINTL V-OWNED PROPERTY FILE NUMBER SS11 161-32-2753 01/25/2001 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. A. SURVIVING JOINT TENANT'S) NAME Richard E. Myers ADDRESS 109 South 17th Street Camp Hill, PA 17011 RELATIONSHIP TO DECEDENT Son 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 DATE OF DEATH DECD'S VALUE OF account number or similar Identifying number. NUMBER TENANT JOINT Attach deed for Jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1 A 02/13/81 Checking Account #222007476 6,221.14 50.00% 3,110.57 at Waypoint Bank, P.0.1711 Harrisburg, PA 17105-1711 2 A 10/19/96 Certificate of Deposit 34,727.71 50.00% 17,363.86 111055298505 at Waypoint Bank 3 A 12/16/96 Certificate of Deposit 3,518.97 50.00% 1,759.49 ~1055300306 at Waypoint Bank TOTAL (Also enter on line 6, Recapitulation) S 22,233.92 (If more space is needed insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1S09 EX (Rev. 1~97) REV-1511 EX + (1~97) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Cleopatra Myers SSf! 161-32-2753 01/25/2001 FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES, 1 Myers-Harner Funeral Home, funeral 5,433.00 2 Rolling Green cemetery, opening and closing grave 760.00 3 Luncheon after funeral service 355.67 4 Clothes for decedent for funeral 62.75 B. ADMINISTRATIVE COSTS, 1. Personal Representative's Commissions 35,477.00 Name of Personal Representative(s) Richard E. Myers Social Security Number(s) I EIN Number of Personal Representative(s) Street Address 109 South 17th Street City Camp Hill State PA Zip 17011 - Year(s) Commission Paid: 2. Attorney's Fees Kerwin & Kerwin 35,477.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip - Relationship of Claimant to Decedent 4. Probate Fees Register of Wills 553.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs Patriot News, Estate advertisement 99.24 Cumberland Law Journal, Estate advertisement 75.00 Register of Wills, Short Certificates 18.00 Reserved for closing costs 500.00 TOTAL (Also enter on line 9, Recapitulation) $ 78,810.66 (If more space is needed, insert additional sheets of the same size) CopyrIght (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) . REV-1512EX+(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCETJilX. RETURN RESIDENT DECEDENT ESTATE OF Cleopatra Myers SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS FILE NUMBER SStf 161-32-2753 01/25/2001 Include unreimbursed medical expenses. ITEM NUMBER 1 DESCRIPTION Pinnacle Health Hospital, account payable for services rendered AMOUNT 20,981. 37 2 Social Security administration, repayment of January check 882.00 3 Gloria Myers, services rendered 100.00 4 Printing of Estate checks 3.00 5 Pinnacle Health Home Infus., account payable for services 943.17 6 Assistant Nurse Care 150.00 7 Preparation of Income Tax 77 .00 8 United States Treasury, 2000 income tax 1,628.00 9 Pennsylvania Department of Revenue, 2000 income tax 398.00 TOTAL (Also enter on line 10, Recapitulation) $ 25,162.54 (If more space is needed, insert additional sheets of the same size) Copyright (el 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) . REV-1513EX+(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCETAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES SSII 161-32-2753 01/25/2001 Cleopatra Myers NUMBER I. 1 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) 2 NAME AND ADDRESS OF PERSONtS) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions): Vicki L. Myers 109 South 17th Street Camp Hill, PA 17011 Jeffrey Scott Myers 91 Beacon Drive Harrisburg, PA 17112 Douglas Edwin Morrison 6781 Breakwater Way Sacramento, CA 95831 Steven Don Morrison Flint Forest Road, Box 7406, RD #1 Coopersburg, PA 18036 Pamela A. Morrison 2802 Sundown Lane, #112 Boulder, CO 80303 Gary Myr1e Hite 201 Meadow Lane, Apt. #36 Harrisburg, PA 17104-3512 Grandson FILE NUMBER AMOUNT OR SHARE OF ESTATE Five Thousand Dollars Five Thousand Dollars Five Thousand Dollars Five Thousand Dollars Five Thousand Dollars Five Thousand Dollars ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS, A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE Granddaughter Grandson 3 Grandson TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET S (If more space is needed, insert additional sheets of the same size) Copyright {c} 1996 form software only CPSystems, Inc. 4 Grandson 5 Granddaughter 6 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 0.00 Form REV-1513 EX (Rev. 1-97) Estate of: Cleopatra Myers Soc Sec #: 161-32-2753 Date of Death: 01/25/2001 Item # Continuation of Schedule J, Part I (Taxable Bequests) Name and Address of Beneficiary Relationship Amount or Share of Estate 7 Granddaughter Five Thousand Dollars Kim Louise Hinson 317 East Portland Mechanicsburg, PA Street 17055 8 Linda Kay (Kleeman) Metz 317 East Portland Street Mechanicsburg, PA 17055 Granddaughter Five Thousand Dollars 9 Granddaughter Five Thousand Tracy Erleen Noll 4701 North Clearview Drive Camp Hill, PA 17011 10 Daughter Alta M. Ryan 3219 Roswell Road The Villages, FL 32159 One-third of the residue of the estate 11 Cleopatra Bechtel 360 Kralltown Road Wellsville, PA 17365 Daughter One-third of the residue of the estate 12 Richard E. Myers 109 South 17th Street Camp Hill, PA 17011 Son One-third of the residue of the estate '!-._--"- OllEOOIIY M. KEFlWIJol TEIIIll:NCI: J. KEIlWlJol JO.'~H O. KlllWIJol Hou..y MCCLUIIE II:IFIWIN ATI'OIlNIY."TLltw 21-01-136 LAST WILL AND TESTAMENT OF CT.1?OfA.TRA MYERS I, CLEOPATRA MYERS, of the Borough of Camp Hill, Cumberlahd County, Pennsylvania, being of sound mind, memory and understanding, do make and publish this, my Last Will and Testament, hereby revoking and making void all former Wills by me at any time heretofore made. llRSI: I direct my hereinafter named Executor to pay all my legally enforceable debts, funeral expenses, administration expenses, and inheritance, estate, succession or excise taxes, which I owe or may become due on account of my death, as soon as may be convenient after my decease. SECOND: I make the following specific bequests: A. I give and bequeath the sum of FIVE THOUSAND ($5,000,00) DOLLARS to my granddaughter, VICKI LYNN MYERS, ~ B. I give and bequeath the sum of FIVE THOUSAND ($5,000,00) DOLLARS to my grandson, JEFFREY SCOTT MYERS, ./ C. I give and bequeath the sum of FIVE THOUSAND ($5,000.00) DOLLARS to my grandson, DOUGLAS EDWIN MORRISON, v' D. I give and bequeath the sum of FIVE THOUSAND ($5,000.00) DOLLARS to my grandson, STEVEN DON MORRISON,'/ E. I give and bequeath the sum of FIVE THOUSAND ($5,000.00) DOLLARS to my granddaughter, PAMELA ANN MORRISON I Page I of 4 Pages i (J,-yJ ~~eM CLEOPATRA MYERS '~-- I' . 01111:0011'1' M. ICERWIN TIEIIII.lNCf: J. KERWIN JQ&II;,.H O. KrllWIH HOu.y MCCI,.UIU; Kt:llWIN ATTOIINEYlIAT LAW F. I give and bequeath the sum of FIVE THOUSAND ($5,000.00) DOLLARS to my grandson, GARY MYRLE HITE, ./ G. I give and bequeath the sum of FIVE THOUSAND ($5,000.00) DOLLARS to my granddaughter, KIM LOUISE HINSON,./ H. I give and b<:queath the sum of FIVE THOUSAND ($5,000.00) DOLLARS to my granddaughter, LINDA KAY KLEEMAN, and8 I. I give and bequeath the sum of FIVE THOUSAND ($5,000.00) DOLLARS to my granddaughter, TRACY EARLEEN NOLL." In the event any of my aforesaid grandchildren should predecease me, I direct th81 their share of my estate shall pass to their issue per stirpes. In the event any such decease grandchild should have no issue then living, I direct that such share shall be added to the shares established herein for my other grandchildren. IllIlU!: I give, de....ise and bequeath all the rest, residue and remainder of my property, be it real, personal and mixed, whatsoever and wheresoever the same may be situate at the time of my death in equal shares, as follows; A. One-third (1/3rd) of the residue of my estate to my daughter, ALTA M. RYAN, I B. One-third (1I3rd) of the residue of my estate to my daughter, CLEOPATRA BECHTEL, and ( C. One-third (11300) of the residue of my estate to my son, RICHARD E. MYERS.' In the event any of my aforementioned children should predecease me I direct that said deceased child's share should pass to their issue per stirpes. Page 2 of 4 Pages ~ ~ ~lvY CLEOPATRA MYERS GllltOOllY M. I(tllWIN TItRIIQ(Ct 4. KtI'lW\N JOaUH P. KtllWrN HOU.Y MC:Cl..URt KIRWIN ...nOllNcY....T LAW FOURTH: nominate, constitute and appoint my son, RICHARD E. MYERS, as Executor of this, my Last Will and Testament, authorizing and empowering him to sell and convey any and all real estate of which I may die seized and possessed. I further direct that my Executor or personal representative shall not be required to post bond to act in said capacity. IN WITNESS WHEREOF, I, CLEOPATRA MYERS, have hereunto set my hand and seal, to this my Last Will and Testament, this ~ day of Apr~l. 1996. SIGNED, -SEALED, PUBUSHED and DECLARED by the above- named Testatrix, CLEOPATRA MYERS, as and for her Last Will and Testament, in the presence of us, who at her request and in the presence of each other, have . hereunto set our names as ~'f1<. t--. Res' at: ~Lj1, ~.HA'&I?.fl~; 'JI.?,/./....,.- Residing at: tflrfl rM#' 'CLEOPATRA MYERS (SEAL) ">>l"/A/C<'~A. M Page 3 of4 P COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT,280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT '* No.AA 478291 REV-II62EXI"961 RECEIVED FROM: ,- ACN ASSESSMENT CONTROL NUMBER AMOUNT KERWIN & KERWIN ATTYS 101 $38,000.00 4245 ROUTE 209 ELIZABETHVILLE, PA 17023 OlO HERE FOLD HERE --- ESTATE INFORMATION:l FILE NUMBER 21-2001-0136 SSN 161-32-2753 NAME OF DECEDENT (LAST) (FIRST) (MI) MYERS CLEOPATRA DATE OF PAYMENT 4/20/2001 POSTMARK DATE 4/19/2001 COUNTY CUMBERLAND DAlE OF DEATH 1/25/2001 RI ~ r'1Y~,HS TOTAL AMOUNT PAID $38,000.00 C/O KERWIN & KERWIN CHECK II 106 SEAL RECEIVED BY MARY C. LE REGISTER REMARKS TAXPAYER G.. David Bias Legg Mason Wood Walker, Inc. 21812001 3:34 PM Cleopatra Mvers Date Of Death Values - 01/25/01 HoldinQs: Approx. Value 1.) 500.000 Shs. Texaco Capital, 6.875% Cum GTD Mthly Inc $ 12,093.50 Income PFD, Series A 2) 2,412.000 Shs. ACM Government Income Fund, Inc. $ 19,144.04 3.) 310.000 Shs. AT&T Corp $ 7,42047 4) 995.000 Shs. AT&T Cap Corp, 8.125%, SR Public Income Nt $ 25,434.19 Due 12/15/28 5.) 768.000 Shs. Allied Irish Banks PLC $ 18,095.61 6) 265.000 Shs. American Electric Power Co. Inc. $ 11,543.93 7) 22.000 Shs. Avaya Inc. $ 341.00 8.) 226.000 Shs. Bank Of America Corp. $ 11,639.00 9) 400.000 Shs. Bristol Myers Squibb Co. $ 25,750.00 10.) 100.000 Shs. Cigna Investment Securities $ 1,662.50 11.) 742.000 Shs. Cinergy Corp. $ 23,326.25 12.) 20.000 Shs. Cons Edison Co Of New York Inc $5 PFD $ 1,365.00 13.) 52.000 Shs. Consolidated Edison Inc. $ 1,842.72 14.) 849.000 Shs. Constellation Energy Group Inc. $ 34,543.26 15.) 69.000 Shs. Corning Inc. $ 3,881.25 16.) 447.000 Shs. DOE $ 14,275.83 17.) 484.000 Shs. Dominion Res Inc VA New $ 30,79450 18.) 1,000.000 Shs. Dreyfus Strategic Muni Inc. $ 8,87500 19.) 1,000.000 Shs. Dreyfus Minicipallncome Inc $ 1,812.00 Page 1 .G. David Bias 2/8/2001 3:38 PM Legg Mason Wood Walker, Inc. 20.) 252.000 Shs. Emons Transporation Group Inc $ 425.12 21.) 380.000 Shs. Enron Capiital Tr 1-8.30% Tr Originated Pfd Secs $ 9,595.00 22.) 829.000 Shs. Exelon Corp. $ 51,182.46 23.) 8,074.203 Shs. Federated Government Income Securities Fd, CI F $ 70,326.30 24.) 166.000 Shs. Firstenergy Corp $ 4,648.00 25.) 10,949.822 Shs. Franklin US Govt Securities Ser, Class A $ 74,349.29 26.) 600.000 Shs. Franklin Universal Trust - SBI $ 4,875.00 27.) 1,200.000 Shs. General Electric Co. $ 55,124.40 28.) 162.000 Shs. Harsco Corp $ 4,181.54 29.) 105.000 Shs. Household Internationallnc, Pfd 5% $ 3,412.50 30.) 1,000.000 Shs. JLG Industries Inc. $ 11,812.00 31.) 400.000 Shs. Johnson & Johnson $ 36,700.00 32.) 2,028.133 Shs. Kemper Income & Capital Preservation Fd, Class A $ 16,650.97 . f.;:rf.', ":i,i "00 WAS ~ 33.) 19,202.000 Shs. Legg Mason Cash Reserve Trust rrHMAkHoJ' ON ;J./...'" 1"<> fAy $ 19,202.00 .BILlS ~ 34.) 325.527 Shs. Legg Mason Value Trust $ 19,352.58 35.) 268.000 Shs. Lucent Technologies Inc. $ 4,824.00 36.) 1,500.000 Shs. Merrill Lynch Preferred Cap Tr 111-7% Tr Originated PFD $ 37,312.50 37.) 12.000 Shs. NCR Corp New $ 544.50 38.) 90.000 Shs. WTS New Valley Corp $ 8.37 39.) 6.000 Shs. New Valley Corp-New $ 18.18 40.) 10.000 Uts. UTS-Penn Insured Muni Inc Tr Ser 111 Semi $ 2,416.20 41.) 400.000 Shs. Pepsico Inc. $ 17,500.00 42.) 100.000 Shs. Pittsburgh & West Virginia Railroad-SBI $ 618.70 43.) 342.000 Shs. Public Service Enterprise Group Inc $ 14,470.70 44.) 912.000 Shs. SBC Communications Inc $ 43,206.00 , . Page 2 G. David Bias 2/8/2001 3:38 PM Legg Mason Wood Walker, Inc. 45.) 282.000 Shs. St Paul Companies Inc $ 13,923.75 46.) 500.000 Shs. Teco Energy Inc $ 14,531.00 47.) 255.000 Shs. TXU Corp $ 9,849.37 48.) 40.000 Shs. Tricon Global Restaurants Inc $ 1.342.48 49.) 450.000 Shs. Tyco International LId $ 27.984.15 50.) 998.000 Shs. UGI Corp Holding Co $ 23,514.87 51.) 984.000 Shs. Verizon Communications $ 50,368.00 52.) 54.000 Shs. WPS Resources Corp $ 1,923.75 53.) Cash $ 5.63 .. The foregoing information was prepared from sources believed to be reliable but is not guaranteed as to accuracy. It should be carefully reviewed and compared with your Legg Mason monthly statements. Any questions should be referred to your Investment Executive or the Branch Manager. . . Page 3 T. Rowe Price Services, Inc. April 16, 2001 P,O, Box 89000 Baltimore, Maryland 21289-0250 , 0090 Red Run Boulevard Owings Mills, Maryland 21117 www.lroweprice.com Gregory M Kerwin Kerwin & Kerwin 4245 Route 209 Elizabethville PA 17023 Subject: Account Information Growth Stock Fund account 201012768-3 Dear Mr. Kerwin: Thank you for your request for balance information on the T. Rowe Price Fund account shown above. This account is registered to the late Cleopatra Myers. Our records show the folJowing: Date: Number of shares: Price per share: Total value: January 25, 2001 369.995 $27.94 $10,337.66 If you require additional information or have any questions, please do not hesitate to call a customer service representative at 1-800-225-5132. Sincerely, \~~ Terry MacKay Senior Account Services Representative Correspondence Number: 00456359 1:R~;;lli~e 11. KERWIN & KERWIN ATTORNEYS AT LAW 4245 ROUTE 209 ELlZABETHVILLE, PENNSYLVANIA 17023 GOVERNORS' ROW 27 NORTH FRONT STREET HARRISBURG, PENNSYLVANIA 17101 (717)362-3215 (7l?) 896-9089 FAX (717) 362-4459 E-mail kkl@epix.net (717) 238-4765 FAX (717) 238.8455 P!emf Reply To: . ELlZABETHVILLE OFFICE D HARRISBURG OFFICE March 22,2001 Alliance Mortgage Company Investor Reporting Department P.O. Box 2159 Jacksonville, FL 32232-0003 Re: Cleopatra Myers Date of Death: January 25, 2001 Social Security No.: 161-32-2753 GNMA Pool No.: 022928 Certificate No.: 03927729SF Dear Sir or Madam: 237 UNION STREET MILLERSBURG, PA 17061 (717)362-3215 549 MAIN STREET LYKENS, PA 17048 (7171453.7421 PATRICKE, KERWIN (1913-1987) GREGORY M. KERWIN TERRENCE J. KERWIN JOSEPH D. KERWIN HOllY McCLURE KERWIN I represent Richard E. Myers, Executor of the estate of Cleopatra Myers. For purposes of preparing the Pennsylvania Inheritance Tax Return for the Estate, would you kindly provide me with the balance of the above-captioned account as of the date of death of Mrs. Myers? Thank you for your help. Very truly yours, GMK:brnk CC: Richard E. Myers ~ C-.e-. 'ji; \ ,<; S \ . "54- ~~.bt5~~~~ ~"'Alliance u iiCr MORTGAGE COMPANY INVESTOR REPORTING DEPARTMENT POST OFFICE BOX Z 159 JACKSONVILLE, FLORIDA 32232-0003 . ~"'-J.n <.l""v~;~.~... p_ - :'l7;(-.'~ \'" _,,~,",__r._ . ft'>'V'ilt ~,.. ('<,,~.. ..~rT.....,.... /1, 1(, ,,-- - ,'":; -- . (" , ..' , t" ~ ...':J~,~ III I I'll ',) ~,~"~ f1 '~::ii~ :1) , "I' \ l ) I'" I' f' "",,--1:\._/ /~d\j,!)11 .Y'_~ v )...",0' I TO THE FOLLOWING SECURITY HOLDER' CLEOPATRA MYERS CAMP HILL, PA 17011.5508 HUD-11714 GOVERNMENT NATIONAL MORTGAGE ASSOCIATION MORTGAGE BACKED SECURITIES PROGRAM ISSUER'S MONTHLY REMITTANCE ADVICE FOR TAX.ID 161-32-2753 REPORTING MONTH 12/00 DATE 01/08/2001 CHECK NUMBER' 170280 109 S 171H 51 THIS REMITTANCE ADVICE COVERS THE ABOVE SECURITY HOLDER'S PROPORTIONAL SHARE OF THE DISTRIBUTION IN THE INDICATED POOL OF MORTGAGES FOR THE AaOVE REPORTING MONTH. THE CHECK IS ATTACHED. GNMA CERT PRO RATA INTEREST POOL# NUMBER SHARE % RATE I 022928 0392772951" 1.49782 El.aoooo 14.32 10.44 1. 35 0.00 0,00 26.11 1,551.54 A B C o E F G ,. , 01/08/2001 TOTAL AMOUNT OF CHECK NUMBER 170280 161-32-2753 ............$26.11 I HEREBY CERTIFY THAT THE INFORMATION A CASH DISTRIBUTION FOR SCHEDULED PRINCIPAL AMORTIZATION CONTAINED HEREIN IS TRUE TO THE BEST B CASH DISTRIBUTION FOR INTEREST OF MY KNOWLEDGE AND BELIEF C. CASH DISTRIBUTION OF ADDITIONAL PRINCIPAL COLLECTIONS o ADJUSTMENTS (+ OR.) E LESS FEDERAL INCOME TAX WITHHELD (IF ANY) F TOTAL CASH DISTRIBUTION DUE HOLDER G OUTSTANDING BALANCE OF THIS CERTIFICATE AFTER CREDIT I VI Way~ql~lt LOOK FOR US. WE'LL GET YOU THERE. MARCH 26, 2001 KERWIN & KERWIN 4245 ROUTE 209 ELlZABETHVILLE P A 17023 The information which you requested on the CLEOPATRA MYERS DECEASED (Social Security Number 161-32-2753) is as follows. Account Number(s) 2222007476 1055298505 1055300306 Class of Account CHECKING CERTIFICATE CERTIflCA TE Date Opened 021381 101996 121696 Principal Balance 6216.29 33945.59 3504.64 Accrued Interest 4.85 782.12 14.33 Balance at Date of Death 6221.14 34727.71 3518.97 Account Ownership JTO JTO JTO Name of Joint Owner, if any RICHARD MYERS RICHARD MYERS RICHARD MYERS Dale Ownership Was Established 021381 10 1996 121696 Additional Information Requested PLEASE COMPLETE W-9 P.O. Box 1711. HARRISBURG. PENNSYLVANIA 17105-1711 Toll FrEe I-B66-WAYPOINT (1-866-929-7646) . www.waypointbank.com . ' ~IWay~qi!lt LOOK FOR US, WE'LL GET YOU THERE. Account Number(s) 7100002302 Class of Account CERTIFICATE Date Opened 090500 Principal Balance 26016,56 Accrued Interest 660,79 Balance at Date of Death 26677.35 Account Ownership SOLE Name of Joint Owner, if any Date Ownership Was Established 090500 Additional Information Requested PLEASE COMPLETE W-9 Sincerely, f1t<Ptt I '2kvnIV Kath{ L. Y&~g j Senior Services Rep. P.O, Box 1711, HARRISBURG, PENNSYLVANIA 17105-1711 Toll Free I-B66-WAYPOINT (I-B66-929-7646) , wwwwaypointbank,com