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Home My WebLink About01-0242 , ------. Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Timothy A. Yeoman also known as No. 21-01-242 , Deceased Social Security No. 121-46 - 3068 KathrYn Yeoman Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) D A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut_ named in the last Will of the Decedent, dated and codicil(s) dated State relevant circumstances. e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: [K] B_ Grant of Letters of Administration (c_t-a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationshi PA Kathr n Yeoman Souse Timoth A. Yeoman, Jr. Son Jolene M. Ben'amin Dau hter Michael Yeoman Son Damian L. Yeoman Grandson (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumber land ton, TN County, Pennsylvania with his/her last family or principal residence at 512 Terrace Dr i ve, New Cumber land (list street, number. and municipality) Decedent, then ~years of age, died 06/16/2000 at Newberry Commons, Etters, PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PAl All personal property (It not domiciled in PAl Personal property in Pennsylvania (If not domiciled in PAl Personal property in County Value of real estate in Pennsylvania $ Litigation $ $ $ situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the ap ropriate form to the undersi ned: Si nature T rinted name and residence Kathryn Yeoman 512 Terrace Drive, New Cumberland, PA 17070 Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems. Inc Form RW-1 (1991) . '"'- Name Relationship Address Laura 1. Yeoman Daughter 512 Terrace Drive New Cumberland, PA 17070 Sarah Webster Daughter Prattsburgh, NY James A. Yeoman Son Oath of Personal Representative Commonwealth of Pennsylvania County of Cumber land The Petitioner(s) above~named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent. Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed %iJ~ ~~ Kathryn eoman before me this 2nd day of MARCH 2001 /2 No. 21-01-242 Estate of Timothy A. Yeoman Deceased Social Security No: 121-46-3068 Date of Death: 06/16/2000 MARCH 5, 2001 , in consideration AND NOW of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters D Testamentary []J Of Administration (c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to Kathryn Yeoman in the above estate and that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters. $ Short Certificate(s). $ Renunciation. $ Aflidavits ( $ Extra Pages ( $ Codicil $ JCP Fee. $ Inventory. $ Other $ TOTAL $ 3.00 270.00 Attorney: John DeLorenzo, Esquire 1.0. No: 72190 Goldberg, Katzman & Shipman, PC 320 Market Street P.O. Box 1268 Harrisburg, PA 17108-1268 Address: 5.00 Telephone: 717/234 -4161 278.00 Prepared by the Pennsylvania Bar Association Copyright (e) 1996 form software only CPSystems.lne. Form RW-1 (1991) H105.90'iM REV. 41% This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vita] Records In accordance with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953. WARNING: It is illegal to duplicate this copy by photostat or photograph, No. ~II~ Charles Hardester State Registrar 092803b JUL 1 4 2000 Date ~/-Ol- ~~~ H105.144 Rev 1/91 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH (Coroner) TYPElPRINT IN PERMANENT BLACK INK SEf 2. fnAI l- STIlTE FilE NUMBER SOCIAL SECURITY NUMBER 3.,2.'''' 4~. 3()~B DATE OF DE!([H (Mooll1. Day. Year) 4. .II/he ,It, :looo twp cilylboro. I Ooft)t'-(u c~-p Mat. ~ 11-[011 t::: ~ ~ r;:) ~ 23a. TIME OF DEATH 2.ft(Yttl- t: S5 M 27. PART tEnt.,. the diseases. injuries or complications which C&;sed tne death. Do not enter tne mode of dying, such as cardiaC or respiratory arrest, shock or heart failure. List only one cause on each line DATE SIGNED (Month, ~ Year) 23pePuty Coroner 23<:. ..J Vne I" 1000 wo.s CASE REFERRED TO MEDICAL EXAMINER/CORONER? y...Kl NoD !26. :~oximate ,Interval between 1 onset and death PART"; Other signif\cant conditions contributing to death, but not resutting in the underlying cause given in PART I DUe TO (OA I>S A CONSEQUENCE OF): DUE TO (OA AS A CONSEOUENCE OF): ""' -+- ~ d. WERE AUTOPSY FINDINGS AVAILABLE PRIOR TO COMPLETION OF CAUSE OF DEATH? MANNER OF DEIITH Natural o IX! o Homtdde DlUe OF INJURY (Month. Day, Year) D Af,.~1- D ~Vl'7e Ib,")..o/JQ 3Gb. (~s) TIME OF INJURY INJURY AT WORK? f Yes~ No D Accident Pending Inv9stigatK>n - 2". 28b. CERTIFIER (Check only one) .CERTIFYINC PHYSICIAN (PhySician Cel\ltylJ'9 cause 01 death when another physiclafl has pronounced death and comp'eled Ilerm 23) TolIM_olmyk~.dHIhOCcU'-_tothecaUM(a)andrnan_..a"tH .................., ..............., SWcide 29. Could not be determined PI! >- Z W o W ~ ~ o w :::Ii <( z .PRONOUNCING AND CERTIFYING PHYSICIAN (Phy"",..n 00111 pronouncIng death and certifYIng to cause 01 death) To 11M _ of my know~, _Ill """""" at the_. elata, anet place, and due to the """'e) and rnan_.. atatH.. 'MEDICAL EXAMINER/CORONER On lINt __ of e..mlnatton and/or Investigation. In my opinion, deeth oecurred et the time, date. and pi""., end due to the cauae(a) and ~nner.....ted...................................................................... _. _.......................... 31a. REGIST 1;4 J ~d 0.. I Jooo \-: - Deceased : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : No. 2001-00242 IN RE: ESTATE OF TIMOTHY A. YEOMAN, CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Will No. Timothy A. Yeoman. deceased June 16. 2000 Admin. No. 2001-00242 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 12. 2001: Rebekah L. Showalter 512 Terrace Drive, New Cumberland, P A 17070 c/o Kathryn Yeoman, 512 Terrace Drive New Cumberland, PA 17070 3720 Cemetery Road, Dundee, NY 14837 201 Maple Avenue, Apartment IE, Marysville, P A 17053 c/o Sheila G. Carter, 128 Hubbard Loop, Jasper, AL 35501 c/o Marinda Yeoman, 7805 Corryton-Luttrell Road Corryton, TN 37721 P.O. Box 349, Newport, P A 17074 Kathyrn Yeoman Laura I. Yeoman, a minor Timothy A. Yeoman, Jr. Jolene May Benjamin Michael Yeoman, a minor Damion Lee Yeoman, a minor Notice has now been given to all persons entitled thereto under Rule 5.6(a) except James A. Yeoman, at this time we are trying to located him: Sarah Webster, at this time we are tying to obtain her address in Prattsburgh. New York she recently moved: Christopher Yeoman. died March 1999 . Telephone ~.' Date . / ]//1/ cJl/ Signature Name Address Capacity: _ Personal Representative ~ Counsel for personal representative In Re: : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF TIMOTHY A. YEOMAN, : ORPHANS' COURT DIVISION Deceased : No. 2001-00242 FINAL RECEIPT, RELEASE AND REFUNDING AGREEMENT THIS FINAL RECEIPT, RELEASE AND REFUNDING AGREEMENT (this "Agreement"), is executed by REBEKAH SHOWALTER (the "Beneficiary"), an adult individual residing at 315 West Main Street, New Bloomfield, Pennsylvania 17068. Recitals WHEREAS, Timothy A. Yeoman (the "Decedent"), of the Borough of New Cumberland, Cumberland County, Pennsylvania, died on June 16,2000, leaving no Last Will and Testament; and WHEREAS, Kathryn Yeoman was appointed by the Register of Wills of Cumberland County, Pennsylvania (the "Register"), under the above-referenced case number, the administratrix (the "Executor"), of the Estate of Timothy A. Yeoman, deceased (the "Estate"), and has functioned in that role to date; and WHEREAS, the Beneficiary has the following interest (the "Beneficiary's Interest") under 20 Pa.C.S. 92103(2), as provided below: 9 2102. Share of surviving spouse. The intestate share ofa decedent's surviving spouse is: (4) If there are surviving issue of the decedent one or more of whom are not issue of the surviving spouse, one-half of the intestate estate. WHEREAS, the Beneficiary survived the Decedent along with seven (7) siblings and a nephew, whereby the Beneficiary's Interest vested; and Page 1 WHEREAS, the Executor has made available to the Beneficiary complete information pertaining to the Estate's assets, receipts, and disbursements; and WHEREAS, to avoid further expense, delay, and publicity, the Beneficiary desires to receive the Beneficiary's Interest without a formal accounting to the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania (the Court having jurisdiction over the matter); and WHEREAS, the Pennsylvania Department of Revenue accepted as filed the Inheritance Tax Return filed by the Estate, which is the only death tax due from the Estate; and WHEREAS, the duties and responsibilities of the Executor incident to the administration of the Estate have been completed; and NOW, THEREFORE, the Beneficiary, for good and valuable consideration, receipt of which is hereby acknowledged, and intending to be legally bound hereby, does hereby agree with the Executor, as follows: Provisions 1. The Beneficiary acknowledges the receipt from the Executor the sum of FIVE THOUSAND THREE HUNDRED SEVENTY-TWO AND 67/1 00 DOLLARS ($5,372.67) in cash (the "Distributed Assets") as a final distribution from the Estate in full satisfaction of the Beneficiary's Interest under the Will and in the Estate. 2. The Beneficiary acknowledges and agrees that the distribution of the Distributed Assets made herewith, is satisfactory and acceptable to the Beneficiary, and that such distribution regarding the Distributed Assets is hereby accepted by the Beneficiary in full satisfaction of the Beneficiary's Interest in the Estate. 3. The Beneficiary releases the Estate, the Executor, and Estate Counsel, namely, Goldberg, Katzman & Shipman, P. C. ("Counsel"), and their respective heirs, successors, assigns, and personal representatives, from all claims and liabilities, which the Beneficiary may have against the Estate arising from this final distribution of the Distributed Assets in full satisfaction of the Beneficiary's Interest in the Estate. 4. The Beneficiary covenants, promises and agrees to and with the Estate and its Executor that the Beneficiary shall indemnify and hold harmless the Estate and the Executor and Counsel from all loss or damage, and from the payment of any and all sums of money to any persons, entities or authorities, for or by reason of this final distribution of the Distributed Assets; and that the Page 2 Beneficiary will refund and repay to the Estate, upon demand by the Executor or Counsel, all or any portion of the Distributed Assets if this final distribution is later determined by the Executor or Counsel to have been improperly or imprudently paid. 5. This Agreement shall be interpreted pursuant to and governed by the laws of the Commonwealth of Pennsylvania, and shall inure to the benefit of and be binding upon the Beneficiary and the Executor, and their respective personal representatives and heirs at law, as the case may be. 6. This Agreement shall be filed with the Register. Execution IN WITNESS WHEREOF, the Beneficiary has executed this Agreement on the I SVday of October, 2001, intending to be legally bound. BENEFICIARY: ~ J. \Cj ,( h{~ l (::i) t, L 61/ )(l t tL", REBEKAH SHOWALTER SWORN TO AND SUBSCRIBED before Ine, a Notary Public, this l~T" of October, 2001. 66560,9 . -, NOTARIAL SEAL J Donald F Howell, District Justice 41.3-04, Newport, Perry Co PA My CommiSSion Expires J'~n 1, 2002 Page 3 . . In Re: : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF TIMOTHY A. YEOMAN, : ORPHANS' COURT DIVISION Deceased : No. 2001-00242 FINAL RECEIPT, RELEASE AND REFUNDING AGREEMENT THIS FINAL RECEIPT, RELEASE AND REFUNDING AGREEMENT (this "Agreement"), is executed by MICHAEL YEOMAN (the "Beneficiary"), an adult individual with a mailing address of Post Office Box 22, Arley, Alabama 35541. Recitals WHEREAS, Timothy A. Yeoman (the "Decedent"), of the Borough of New Cumberland, Cumberland County, Pennsylvania, died on June 16,2000, leaving no Last Will and Testament; and WHEREAS, Kathryn Yeoman was appointed by the Register of Wills of Cumberland County, Pennsylvania (the "Register"), under the above-referenced case number, the administratrix (the "Executor"), of the Estate of Timothy A. Yeoman, deceased (the "Estate"), and has functioned in that role to date; and WHEREAS, the Beneficiary has the following interest (the "Beneficiary's Interest") under 20 Pa.C.S. 9 2103(2), as provided below: 9 2102. Share of surviving spouse. The intestate share of a decedent's surviving spouse is: (4) If there are surviving issue of the decedent one or more of whom are not issue of the surviving spouse, one-half of the intestate estate. WHEREAS, the Beneficiary survived the Decedent along with seven (7) siblings and a nephew, whereby the Beneficiary's Interest vested; and Page 1 . . WHEREAS, the Executor has made available to the Beneficiary complete information pertaining to the Estate's assets, receipts, and disbursements; and WHEREAS, to avoid further expense, delay, and publicity, the Beneficiary desires to receive the Beneficiary's Interest without a formal accounting to the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania (the Court having jurisdiction over the matter); and WHEREAS, the Pennsylvania Department of Revenue accepted as filed the Inheritance Tax Return filed by the Estate, which is the only death tax due from the Estate; and WHEREAS, the duties and responsibilities of the Executor incident to the administration of the Estate have been completed; and NOW, THEREFORE, the Beneficiary, for good and valuable consideration, receipt of which is hereby acknowledged, and intending to be legally bound hereby, does hereby agree with the Executor, as follows: Provisions 1. The Beneficiary acknowledges the receipt from the Executor the sum of FIVE THOUSAND THREE HUNDRED SEVENTY-TWO AND 67/100 DOLLARS ($5,372.67) in cash (the "Distributed Assets") as a final distribution from the Estate in full satisfaction of the Beneficiary's Interest under the Will and in the Estate. 2. The Beneficiary acknowledges and agrees that the distribution of the Distributed Assets made herewith, is satisfactory and acceptable to the Beneficiary, and that such distribution regarding the Distributed Assets is hereby accepted by the Beneficiary in full satisfaction of the Beneficiary's Interest in the Estate. 3. The Beneficiary releases the Estate, the Executor, and Estate Counsel, namely, Goldberg, Katzman & Shipman, P . C. ("Counsel"), and their respective heirs, successors, assigns, and personal representatives, from all claims and liabilities, which the Beneficiary may have against the Estate arising from this final distribution of the Distributed Assets in full satisfaction of the Beneficiary's Interest in the Estate. 4. The Beneficiary covenants, promises and agrees to and with the Estate and its Executor that the Beneficiary shall indemnify and hold harmless the Estate and the Executor and Counsel from all loss or damage, and from the payment of any and all sums of money to any persons, entities or authorities, for or by reason of this final distribution of the Distributed Assets; and that the Page 2 . . Beneficiary will refund and repay to the Estate, upon demand by the Executor or Counsel, all or any portion of the Distributed Assets if this final distribution is later determined by the Executor or Counsel to have been improperly or imprudently paid. 5. This Agreement shall be interpreted pursuant to and governed by the laws of the Commonwealth of Pennsylvania, and shall inure to the benefit of and be binding upon the Beneficiary and the Executor, and their respective personal representatives and heirs at law, as the case may be. 6. This Agreement shall be filed with the Register. Execution IN WITNESS WHEREOF, the Beneficiary has executed this Agreement on the~ of October, 2001, intending to be legally bound. ~'1JtW BENEFICIARY: _rY\ i C ~ II 0 t'1I 0\1(1 MICHAEL 'EDMAN \I SWORN TO AND SUBSCRIBED ~e a Notary Public, this day of October, 2001.. I/flW 4.-< 9!#-- Notary Public 66560.5 ;-", ~A,. ....A.A.. .. . I ... .'''~''''~~IUN bJ'~ Uf..-s Page 3 In Re: : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF TIMOTHY A. YEOMAN, : ORPHANS' COURT DIVISION Deceased : No. 2001-00242 FINAL RECEIPT, RELEASE AND REFUNDING AGREEMENT THIS FINAL RECEIPT, RELEASE AND REFUNDING AGREEMENT (this "Agreement"), is executed by JAMES A. YEOMAN (the "Beneficiary"), an adult individual residing at 96B Route 1, Highway 145, Eastanellee, Georgia 30538. Recitals WHEREAS, Timothy A. Yeoman (the "Decedent"), of the Borough of New Cumberland, Cumberland County, Pennsylvania, died on June 16, 2000, leaving no Last Will and Testament; and WHEREAS, Kathryn Yeoman was appointed by the Register of Wills of Cumberland County, Pennsylvania (the "Register"), under the above-referenced case number, the administratrix (the "Executor"), of the Estate of Timothy A. Yeoman, deceased (the "Estate"), and has functioned in that role to date; and WHEREAS, the Beneficiary has the following interest (the "Beneficiary's Interest") under 20 Pa.C.S. ~ 2103(2), as provided below: ~ 2102. Share of surviving spouse. The intestate share of a decedent's surviving spouse is: ( 4) If there are surviving issue of the decedent one or more ofwhom are not issue of the surviving spouse, one-half of the intestate estate. WHEREAS, the Beneficiary survived the Decedent along with seven (7) siblings and a nephew, whereby the Beneficiary's Interest vested; and Page 1 WHEREAS, the Executor has made available to the Beneficiary complete information pertaining to the Estate's assets, receipts, and disbursements; and WHEREAS, to avoid further expense, delay, and publicity, the Beneficiary desires to receive the Beneficiary's Interest without a formal accounting to the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania (the Court having jurisdiction over the matter); and WHEREAS, the Pennsylvania Department of Revenue accepted as filed the Inheritance Tax Return filed by the Estate, which is the only death tax due from the Estate~ and WHEREAS, the duties and responsibilities of the Executor incident to the administration of the Estate have been completed; and NOW, THEREFORE, the Beneficiary, for good and valuable consideration, receipt of which is hereby acknowledged, and intending to be legally bound hereby, does hereby agree with the Executor, as follows: Provisions 1. The Beneficiary acknowledges the receipt from the Executor the sum of FIVE THOUSAND THREE HUNDRED SEVENTY-TWO AND 67/100 DOLLARS ($5,372.67) in cash (the "Distributed Assets") as a final distribution from the Estate in full satisfaction of the Beneficiary's Interest under the Will and in the Estate. 2. The Beneficiary acknowledges and agrees that the distribution of the Distributed Assets made herewith, is satisfactory and acceptable to the Beneficiary, and that such distribution regarding the Distributed Assets is hereby accepted by the Beneficiary in full satisfaction of the Beneficiary's Interest in the Estate. 3. The Beneficiary releases the Estate, the Executor, and Estate Counsel, namely, Goldberg, Katzman & Shipman, P. C. ("Counsel"), and their respective heirs, successors, assigns, and personal representatives, from all claims and liabilities, which the Beneficiary may have against the Estate arising from this final distribution of the Distributed Assets in full satisfaction of the Beneficiary's Interest in the Estate. 4. The Beneficiary covenants, promises and agrees to and with the Estate and its Executor that the Beneficiary shall indemnify and hold harmless the Estate and the Executor and Counsel from all loss or damage, and from the payment of any and all sums of money to any persons, entities or authorities, for or by reason of this final distribution of the Distributed Assets; and that the Page 2 Beneficiary will refund and repay to the ~state, upon demand by the Executor or Counsel, all or any portion of the Distributed Assets if this' final distribution is later determined by the Executor or Counsel to have been improperly or imprudently paid. 5. This Agreement shall be interpreted pursuant to and governed by the laws of the Commonwealth of Pennsylvania, and shall inure to the benefit of and be binding upon the Beneficiary and the Executor, and their respective personal representatives and heirs at law, as the case may be. 6. This Agreement shall be filed with the Register. Execution IN WITNESS WHEREOF, the Beneficiary has executed this Agreement on the ~ day of October, 2001, intending to be legally bound. WITNESS: BENEFICIARY: . ~W&~ ( ~:;?~ JAilis A'! YEOMAN SWORN TO AND SUBSCRIBED before me, a Notary Public, this _ day of Octob.. er" 20:1. N'] f)/7 '- Jfl ~)J I <2- ~o.u--- _ . ..-,.~~t,a:ry ~~b~/> 9 - II _ 0 ~ ~;"'~~> . .;~%:~ ~~ ' /.'.' 66560.<G: :' :.::: [1.~\ ~~~L:,i!~ '~'~~"'.'t. .;.:,.,~{'... .. 'r', t, f' 1'l , f~ "''/:/~f/ 7;, ~l :.\ :~, Page 3 ... ; tI In Re: : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF TIMOTHY A. YEOMAN, : ORPHANS' COURT DIVISION Deceased : No. 2001-00242 FINAL RECEIPT, RELEASE AND REFUNDING AGREEMENT THIS FINAL RECEIPT, RELEASE AND REFUNDING AGREEMENT (this "Agreement"), is executed by SARAH WEBSTER (the "Beneficiary"), an adult individual residing at 11655 County Road 122, Prattsburgh, New York 14873. Recitals WHEREAS, Timothy A. Yeoman (the "Decedent"), of the Borough of New Cumberland, Cumberland County, Pennsylvania, died on June 16,2000, leaving no Last Will and Testament; and WHEREAS, Kathryn Yeoman was appointed by the Register of Wills of Cumberland County, Pennsylvania (the "Register"), under the above-referenced case number, the administratrix (the "Executor"), of the Estate of Timothy A. Yeoman, deceased (the "Estate"), and has functioned in that role to date; and WHEREAS, the Beneficiary has the following interest (the "Beneficiary's Interest") under 20 Pa.C.S. 92103(2), as provided below: 9 2102. Share of surviving spouse. The intestate share of a decedent's surviving spouse is: (4) If there are surviving issue of the decedent one or more of whom are not issue of the surviving spouse, one-half of the intestate estate. WHEREAS, the Beneficiary survived the Decedent along with seven (7) siblings and a nephew, whereby the Beneficiary's Interest vested; and Page 1 " ~ WHEREAS, the Executor has made available to the Beneficiary complete information pertaining to the Estate's assets, receipts, and disbursements; and WHEREAS, to avoid further expense, delay, and publicity, the Beneficiary desires to receive the Beneficiary's Interest without a formal accounting to the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania (the Court having jurisdiction over the matter); and WHEREAS, the Pennsylvania Department of Revenue accepted as filed the Inheritance Tax Return filed by the Estate, which is the only death tax due from the Estate; and WHEREAS, the duties and responsibilities of the Executor incident to the administration of the Estate have been completed; and NOW, THEREFORE, the Beneficiary, for good and valuable consideration, receipt of which is hereby acknowledged, and intending to be legally bound hereby, does hereby agree with the Executor, as follows: Provisions 1. The Beneficiary acknowledges the receipt from the Executor the sum of FIVE THOUSAND THREE HUNDRED SEVENTY-TWO AND 67/1 00 DOLLARS ($5,372.67) in cash (the "Distributed Assets") as a final distribution from the Estate in full satisfaction of the Beneficiary's Interest under the Will and in the Estate. 2. The Beneficiary acknowledges and agrees that the distribution of the Distributed Assets made herewith, is satisfactory and acceptable to the Beneficiary, and that such distribution regarding the Distributed Assets is hereby accepted by the Beneficiary in full satisfaction of the Beneficiary's Interest in the Estate. 3. The Beneficiary releases the Estate, the Executor, and Estate Counsel, namely, Goldberg, Katzman & Shipman, P. C. ("Counsel"), and their respective heirs, successors, assigns, and personal representatives, from all claims and liabilities, which the Beneficiary may have against the Estate arising from this final distribution of the Distributed Assets in full satisfaction of the Beneficiary's Interest in the Estate. 4. The Beneficiary covenants, promises and agrees to and with the Estate and its Executor that the Beneficiary shall indemnify and hold harmless the Estate and the Executor and Counsel from all loss or damage, and from the payment of any and all sums of money to any persons, entities or authorities, for or by reason of this final distribution of the Distributed Assets; and that the Page 2 " Beneficiary will refund and repay to the Estate, upon demand by the Executor or Counsel, all or any portion of the Distributed Assets if this final distribution is later determined by the Executor or Counsel to have been improperly or imprudently paid. 5. This Agreement shall be interpreted pursuant to and governed by the laws of the Commonwealth of Pennsylvania, and shall inure to the benefit of and be binding upon the Beneficiary and the Executor, and their respective personal representatives and heirs at law, as the case may be. 6. This Agreement shall be filed with the Register. Execution IN WITNESS WHEREOF, the Beneficiary has executed this Agreement on the _ day of October, 2001, intending to be legally bound. WITNESS: BENEFICIARY: ~JVl ~ L!. ~CL~ SA WEBSTER SWORN TO AND SUBSCRIBED before me, a Notary Public, this q-t!: day of October, 200l. ~~H~ DOROTHY GUERaM Nokry PubI1c #5043439 IT ATE Of NY, CO, or STIU88I A/Y l'V"~MtMK>N exPIRIS .5 -f' r dOC) 3 66560.8 Page 3 In Re: : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF TIMOTHY A. YEOMAN, : ORPHANS' COURT DIVISION Deceased : No. 2001-00242 FINAL RECEIPT, RELEASE AND REFUNDING AGREEMENT THIS FINAL RECEIPT, RELEASE AND REFUNDING AGREEMENT (this "Agreement"), is executed by JOLENE BEJNAMIN (the "Beneficiary"), an adult individual residing at 134 Blaine Drive, Apartment 5, Blaine, Tennessee 37709. Recitals WHEREAS, Timothy A. Yeoman (the "Decedent"), of the Borough of New Cumberland, Cumberland County, Pennsylvania, died on June 16,2000, leaving no Last Will and Testament; and WHEREAS, Kathryn Yeoman was appointed by the Register of Wills of Cumberland County, Pennsylvania (the "Register"), under the above-referenced case number, the administratrix (the "Executor"), of the Estate of Timothy A. Yeoman, deceased (the "Estate"), and has functioned in that role to date; and WHEREAS, the Beneficiary has the following interest (the "Beneficiary's Interest") under 20 Pa.C.S. S 2103(2), as provided below: S 2102. Share of surviving spouse. The intestate share of a decedent's surviving spouse is: ( 4) If there are surviving issue of the decedent one or more of whom are not issue of the surviving spouse, one-half of the intestate estate. WHEREAS, the Beneficiary survived the Decedent along with seven (7) siblings and a nephew, whereby the Beneficiary's Interest vested; and Page 1 WHEREAS, the Executor has made available to the Beneficiary complete information pertaining to the Estate's assets, receipts, and disbursements; and WHEREAS, to avoid further expense, delay, and publicity, the Beneficiary desires to receive the Beneficiary's Interest without a formal accounting to the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania (the Court having jurisdiction over the matter); and WHEREAS, the Pennsylvania Department of Revenue accepted as filed the Inheritance Tax Return filed by the Estate, which is the only death tax due from the Estate; and WHEREAS, the duties and responsibilities of the Executor incident to the administration of the Estate have been completed; and NOW, THEREFORE, the Beneficiary, for good and valuable consideration, receipt of which is hereby acknowledged, and intending to be legally bound hereby, does hereby agree with the Executor, as follows: Provisions 1. The Beneficiary acknowledges the receipt from the Executor the sum of FIVE THOUSAND THREE HUNDRED SEVENTY-TWO AND 67/100 DOLLARS ($5,372.67) in cash (the "Distributed Assets") as a final distribution from the Estate in full satisfaction of the Beneficiary's Interest under the Will and in the Estate. 2. The Beneficiary acknowledges and agrees that the distribution of the Distributed Assets made herewith, is satisfactory and acceptable to the Beneficiary, and that such distribution regarding the Distributed Assets is hereby accepted by the Beneficiary in full satisfaction of the Beneficiary's Interest in the Estate. 3. The Beneficiary releases the Estate, the Executor, and Estate Counsel, namely, Goldberg, Katzman & Shipman, P. C. ("Counsel"), and their respective heirs, successors, assigns, and personal representatives, from all claims and liabilities, which the Beneficiary may have against the Estate arising from this final distribution of the Distributed Assets in full satisfaction of the Beneficiary's Interest in the Estate. 4. The Beneficiary covenants, promises and agrees to and with the Estate and its Executor that the Beneficiary shall indemnify and hold harmless the Estate and the Executor and Counsel from all loss or damage, and from the payment of any and all sums of money to any persons, entities or authorities, for or by reason of this final distribution of the Distributed Assets; and that the Page 2 Beneficiary will refund and repay to the Estate, upon demand by the Executor or Counsel, all or any portion of the Distributed Assets if this final distribution is later determined by the Executor or Counsel to have been improperly or imprudently paid. 5. This Agreement shall be interpreted pursuant to and governed by the laws of the Commonwealth of Pennsylvania, and shall inure to the benefit of and be binding upon the Beneficiary and the Executor, and their respective personal representatives and heirs at law, as the case may be. 6. This Agreement shall be filed with the Register. Execution IN WITNESS WHEREOF, the Beneficiary has executed this Agreement on the 3d day of October, 2001, intending to be legally bound. WITNESS: fi-;~ BENEFICIARY: , 11 .;. . JrAL "{J~1-;N~ ~~~;AMm SWORN TO AND SUBSCRIBED before me, a Notary Public, this ~ day of October, 2001. 66560.7 Page 3 - ,. , , t ,. In Re: : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF TIMOTHY A. YEOMAN, : ORPHANS' COURT DIVISION Deceased : No. 2001-00242 FINAL RECEIPT.. RELEASE AND REFUNDING AGREEMENT THIS FINAL RECEIPT, RELEASE AND REFUNDING AGREEMENT (this "Agreement"), is executed by TIMOTHY A. YEOMAN, JR (the "Beneficiary"), an adult individual residing at 3720 Cemetery Road, Dundee, New York 14837. Recitals WHEREAS, Timothy A. Yeoman (the "Decedent"), of the Borough of New Cumberland, Cumberland County, Pennsylvania, died on June 16,2000, leaving no Last Will and Testament; and WHEREAS, Kathryn Yeoman was appointed by the Register of Wills of Cumberland County, Pennsylvania (the "Register"), under the above-referenced case number, the administratrix (the "Executor"), of the Estate of Timothy A. Yeoman, deceased (the "Estate"), and has functioned in that role to date; and WHEREAS, the Beneficiary has the following interest (the "Beneficiary's Interest") under 20 Pa.C.S. 92103(2), as provided below: S 2102. Share of surviving spouse. The intestate share of a decedent's surviving spouse is: (4) If there are surviving issue of the decedent one or more of whom are not issue of the surviving spouse, one-half of the intestate estate. WHEREAS, the Beneficiary survived the Decedent along with seven (7) siblings and a nephew, whereby the Beneficiary's Interest vested; and Page 1 ... . --- ~ ~ WHEREAS, the Executor has made available to the Beneficiary complete information pertaining to the Estate's assets, receipts, and disbursements; and WHEREAS, to avoid further expense, delay, and publicity, the Beneficiary desires to receive the Beneficiary's Interest without a formal accounting to the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania (the Court having jurisdiction over the matter); and WHEREAS, the Pennsylvania Department of Revenue accepted as filed the Inheritance Tax Return filed by the Estate, which is the only death tax due from the Estate; and WHEREAS, the duties and responsibilities of the Executor incident to the administration of the Estate have been completed; and NOW, THEREFORE, the Beneficiary, for good and valuable consideration, receipt of which is hereby acknowledged, and intending to be legally bound hereby, does hereby agree with the Executor, as follows: Provisions 1. The Beneficiary acknowledges the receipt from the Executor the sum of FIVE THOUSAND THREE HUNDRED SEVENTY-TWO AND 67/100 DOLLARS ($5,372.67) in cash (the "Distributed Assets") as a final distribution from the Estate in full satisfaction of the Beneficiary's Interest under the Will and in the Estate. 2. The Beneficiary acknowledges and agrees that the distribution of the Distributed Assets made herewith, is satisfactory and acceptable to the Beneficiary, and that such distribution regarding the Distributed Assets is hereby accepted by the Beneficiary in full satisfaction of the Beneficiary's Interest in the Estate. 3. The Beneficiary releases the Estate, the Executor, and Estate Counsel, namely, Goldberg, Katzman & Shipman, P. C. ("Counsel"), and their respective heirs, successors, assigns, and personal representatives, from all claims and liabilities, which the Beneficiary may have against the Estate arising from this final distribution of the Distributed Assets in full satisfaction of the Beneficiary's Interest in the Estate. 4. The Beneficiary covenants, promises and agrees to and with the Estate and its Executor that the Beneficiary shall indemnify and hold harmless the Estate and the Executor and Counsel from all loss or damage, and from the payment of any and all sums of money to any persons, entities or authorities, for or by reason of this final distribution of the Distributed Assets~ and that the Page 2 -; , . Beneficiary will refund and repay to the Estate, upon demand by the Executor or Counsel, all or any portion of the Distributed Assets if this final distribution is later determined by the Executor or Counsel to have been improperly or imprudently paid. 5. This Agreement shall be interpreted pursuant to and governed by the laws of the Commonwealth of Pennsylvania, and shall inure to the benefit of and be binding upon the Beneficiary and the Executor, and their respective personal representatives and heirs at law, as the case may be. Execution 6. This Agreement shall be :filed with the Register. IN WITNESS WHEREOF, the Beneficiary has executed this Agreement on the -M... day of October, 2001, intending to be legally bound. WITNESS: BENEFICIARY: ~4'~, cf 1~~}~/l~c.'/~Au7 ff~ TIM! Y jfYEOMAN, SWORN TO AND SUBSCRIBED before me, a Notary Public, this M day of October, 2001. ~J!,~ Notary Public HElEN D. 8AXT!R ..... ....., Public, State of New .... No. 01 BA493080G 66560.3 ~~:~r~;h~t~~~"7)~ Page 3 In Re: : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYL VANIA ESTATE OF TIMOTHY A. YEOMAN, : ORPHANS' COURT DIVISION Deceased : No. 2001-00242 FINAL RECEIPT, RELEASE AND REFUNDING AGREEMENT THIS FINAL RECEIPT, RELEASE AND REFUNDING AGREEMENT (this "Agreement"), is executed by KA THRYN YEOMAN (the "Beneficiary"), an adult individual residing at 512 Terrace Drive, New Cumberland, Pennsylvania 17070. Recitals WHEREAS, Timothy A. Yeoman (the "Decedent"), of the Borough of New Cumberland, Cumberland County, Pennsylvania, died on June 16, 2000, leaving no Last Will and Testament; and WHEREAS, Kathryn Yeoman was appointed by the Register of Wills of Cumberland County, Pennsylvania (the "Register"), under the above-referenced case number, the administratrix (the "Executor"), of the Estate of Timothy A. Yeoman, deceased (the "Estate"), and has functioned in that role to date~ and WHEREAS, the Beneficiary has the following interest (the "Beneficiary's Interest") under 20 Pa.C.S. ~ 2103(2), as provided below: ~ 2102. Share of surviving spouse. The intestate share of a decedent's surviving spouse is: ( 4) If there are surviving issue of the decedent one or more of whom are not issue of the surviving spouse, one-half of the intestate estate. WHEREAS, the Beneficiary survived the Decedent, whereby the Beneficiary's Interest vested; and Page 1 WHEREAS, the Beneficiary, due to her dual capacities of Executor and Beneficiary, has in her possession complete information pertaining to the Estate's assets, receipts, and disbursements, and all other aspects of her administration of the Estate; and WHEREAS, to avoid further expense, delay, and publicity, the Beneficiary desires to receive the Beneficiary's Interest without a formal accounting to the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania (the Court having jurisdiction over the matter); and WHEREAS, the Pennsylvania Department of Revenue accepted as filed the Inheritance Tax Return filed by the Estate, which is the only death tax due from the Estate; and WHEREAS, the duties and responsibilities of the Executor incident to the administration of the Estate have been completed; and NOW, THEREFORE, the Beneficiary, for good and valuable consideration, receipt of which is hereby acknowledged, and intending to be legally bound hereby, does hereby agree with the Executor, as follows: Provisions 1. The Beneficiary acknowledges the receipt from the Executor the sum of FORTY- TWO THOUSAND NINE HUNDRED EIGHTY-ONE AND 37/100 DOLLARS ($42,987.37) in cash (the "Distributed Assets") as a final distribution from the Estate in full satisfaction of the Beneficiary's Interest under the Will and in the Estate. 2. The Beneficiary acknowledges and agrees that the distribution of the Distributed Assets made herewith, is satisfactory and acceptable to the Beneficiary, and that such distribution regarding the Distributed Assets is hereby accepted by the Beneficiary in full satisfaction of the Beneficiary's Interest in the Estate. 3. The Beneficiary releases the Estate, the Executor, and Estate Counsel, namely, Goldberg, Katzman & Shipman, P. C. ("Counsel"), and their respective heirs, successors, assigns, and personal representatives, from all claims and liabilities, which the Beneficiary may have against the Estate arising from this final distribution of the Distributed Assets in full satisfaction of the Beneficiary's Interest in the Estate. 4. The Beneficiary covenants, promises and agrees to and with the Estate and its Executor that the Beneficiary shall indemnify and hold harmless the Estate and the Executor and Counsel from all loss or damage, and from the payment of any and all sums of money to any persons, Page 2 entities or authorities, for or by reason of this final distribution of the Distributed Assets; and that the Beneficiary will refund and repay to the Estate, upon demand by the Executor or Counsel, all or any portion of the Distributed Assets if this final distribution is later determined by the Executor or Counsel to have been improperly or imprudently paid. 5. This Agreement shall be interpreted pursuant to and governed by the laws of the Commonwealth of Pennsylvania, and shall inure to the benefit of and be binding upon the Beneficiary and the Executor, and their respective personal representatives and heirs at law, as the case may be. 6. This Agreement shall be filed with the Register. Execution IN WITNESS WHEREOF, the Beneficiary has executed this Agreement on the /8 day of October, 2001, intending to be legally bound. WITNESS: BENEFICIARY: ~~~ KA HRYNi 'EDMAN SWORN TO AND SUBSCRIBED befC)fe me, a Notary Public, this ~ day of October, 01. C~Q, Notary Public District Cedar en Malt 1108 Cartlsle Aoed Camp Hili, PA 17011 66560.1 Page 3 In Re: : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYL VANIA ESTATE OF TIMOTHY A. YEOMAN, : ORPHANS' COURT DIVISION Deceased : No. 2001-00242 FINAL RECEIPT, RELEASE AND REFUNDING AGREEMENT THIS FINAL RECEIPT, RELEASE AND REFUNDING AGREEMENT (this "Agreement"), is executed by KATHRYN YEOMAN (the "Trustee"), residing at 512 Terrace Drive, New Cumberland, Pennsylvania 17070, an adult individual and step-grandmother of DAMION LEE YEOMAN, a minor, (the "Beneficiary") residing at c/o Marinda Yeoman, 7805 Corryton-Lutrell Road, Corryton, Tennessee 37721. Recitals WHEREAS, Timothy A. Yeoman (the "Decedent"), of the Borough of New Cumberland, Cumberland County, Pennsylvania, died on June 16, 2000, leaving no Last Will and Testament; and WHEREAS, Kathryn Yeoman was appointed by the Register of Wills of Cumberland County, Pennsylvania (the "Register"), under the above-referenced case number, the administratrix (the "Executor"), of the Estate of Timothy A. Yeoman, deceased (the "Estate"), and has functioned in that role to date; and WHEREAS, the Beneficiary has the following interest (the "Beneficiary's Interest") under 20 Pa.C.S. S 2103(2), as provided below: S 2102. Share of surviving spouse. The intestate share of a decedent's surviving spouse is: ( 4) If there are surviving issue of the decedent one or more of whom are not issue of the surviving spouse, one-half of the intestate estate. Page 1 WHEREAS, the Beneficiary survived the Decedent along with seven (7) siblings of Beneficiary's father, whereby the Beneficiary's Interest vested; and WHEREAS, the Executor has made available to the Trustee for the Beneficiary complete information regarding the Estate's assets, receipts, and disbursements; and WHEREAS, to avoid further expense, delay, and publicity, the Trustee for the Beneficiary desires to receive the Beneficiary's Interest without a formal accounting to the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania (the Court having jurisdiction over the matter); and WHEREAS, the Pennsylvania Department of Revenue accepted as filed the Inheritance Tax Return filed by the Estate, which is the only death tax due from the Estate; and WHEREAS, the duties and responsibilities of the Executor incident to the administration of the Estate have been completed; and NOW, THEREFORE, the Trustee for the Beneficiary, for good and valuable consideration, receipt of which is hereby acknowledged, and intending to be legally bound hereby, does hereby agree with the Executor, as follows: Provisions 1. The Trustee for the Beneficiary acknowledges the receipt from the Executor the sum ofFIVE THOUSAND THREE HUNDRED SEVENTY- TWO AND 67/100 DOLLARS ($5,372.67) in cash (the "Distributed Assets") as a final distribution from the Estate in full satisfaction of the Beneficiary's Interest under the Will and in the Estate. 2. The Trustee for the Beneficiary acknowledges and agrees to hold these sums IN TRUST at a financial institution and account of her choice; however, the title of the account shall be Trust of Laura 1. Yeoman for the health, education and welfare of a child under the Uniform Transfers to Minor Act. 3. The Trustee for the Beneficiary acknowledges and agrees that the Executor will not file an Account or Petition for Distribution or secure a Decree of Distribution from any court having jurisdiction in the matter of the Estate, and the Trustee waives any right thereto. 4. The Trustee for the Beneficiary acknowledges and agrees that the distribution of the Distributed Assets made herewith, is satisfactory and acceptable to the Trustee for the Beneficiary, Page 2 and that such distribution regarding the Distributed Assets is hereby accepted by the Trustee for the Beneficiary in full satisfaction of the Beneficiary's Interest in the Estate. 5. The Trustee for the Beneficiary releases the Estate, the Executor, and Estate Counsel, namely, Goldberg, Katzman & Shipman, P.C. ("Counsel"), and their respective heirs, successors, assigns, and personal representatives, from all claims and liabilities, which the Trustee or Beneficiary may have against the Estate arising from this final distribution of the Distributed Assets in full satisfaction of the Beneficiary's Interest in the Estate. 6. The Trustee for the Beneficiary covenants, promises and agrees to and with the Estate and its Executor that the Trustee for the Beneficiary shall indemnify and hold harmless the Estate and the Executor and Counsel from all loss or damage, and from the payment of any and all sums of money to any persons, entities or authorities, for or by reason of this final distribution of the Distributed Assets; and that the Trustee for the Beneficiary will refund and repay to the Estate, upon demand by the Executor or Counsel, all or any portion of the Distributed Assets if this final distribution is later determined by the Executor or Counsel to have been improperly or imprudently paid. 7. This Agreement shall be interpreted pursuant to and governed by the laws of the Commonwealth of Pennsylvania, and shall inure to the benefit of and be binding upon the Trustee, Beneficiary and Executor, and their respective personal representatives and heirs at law, as the case may be. 8. This Agreement shall be filed with the Register. Page 3 Execution IN WITNESS WHEREOF, the Beneficiary has executed this Agreement on the M day of October, 2001, intending to be legally bound. WITNESS: BENEFICIARY: 1f~' ~~~Vh THR YEO ,TRUSTEE FOR DAMION LEE YEOMAN, A MINOR SWORN TO AND SUBSCRIBED before me, a Notary Public, this I e day of October, 2001. ~Q.~ Notary Public 66560.4 District Court Cedar Cliff Ma , 1106 Carll818 Road Camp Hili, PA 17011 Page 4 In Re: : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYL VANIA ESTATE OF TIMOTHY A. YEOMAN, : ORPHANS' COURT DIVISION Deceased : No. 2001-00242 FINAL RECEIPT, RELEASE AND REFUNDING AGREEMENT THIS FINAL RECEIPT, RELEASE AND REFUNDING AGREEMENT (this "Agreement"), is executed by KATHRYN YEOMAN (the "Trustee"), an adult individual and surviving parent of LAURA L YEOMAN, a minor, (the "Beneficiary") all residing at 512 Terrace Drive, New Cumberland, Pennsylvania 17070. Recitals WHEREAS, Timothy A. Yeoman (the "Decedent"), of the Borough of New Cumberland, Cumberland County, Pennsylvania, died on June 16, 2000, leaving no Last Will and Testament; and WHEREAS, Kathryn Yeoman was appointed by the Register of Wills of Cumberland County, Pennsylvania (the "Register"), under the above-referenced case number, the administratrix (the "Executor"), of the Estate of Timothy A. Yeoman, deceased (the "Estate"), and has functioned in that role to date; and WHEREAS, the Beneficiary has the following interest (the "Beneficiary's Interest") under 20 Pa.C.S. ~ 2103(2), as provided below: S 2102. Share of surviving spouse. The intestate share of a decedent's surviving spouse is: ( 4) If there are surviving issue of the decedent one or more of whom are not issue of the surviving spouse, one-half of the intestate estate. Page 1 WHEREAS, the Beneficiary survived the Decedent along with seven (7) siblings and a nephew, whereby the Beneficiary's Interest vested; and WHEREAS, the Executor has made available to the Trustee for the Beneficiary complete information regarding the Estate's assets, receipts, and disbursements; and WHEREAS, to avoid further expense, delay, and publicity, the Trustee for the Beneficiary desires to receive the Beneficiary's Interest without a formal accounting to the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania (the Court having jurisdiction over the matter); and WHEREAS, the Pennsylvania Department of Revenue accepted as filed the Inheritance Tax Return filed by the Estate, which is the only death tax due from the Estate; and WHEREAS, the duties and responsibilities of the Executor incident to the administration of the Estate have been completed; and NOW, THEREFORE, the Trustee for the Beneficiary, for good and valuable consideration, receipt of which is hereby acknowledged, and intending to be legally bound hereby, does hereby agree with the Executor, as follows: Provisions 1. The Trustee for the Beneficiary acknowledges the receipt from the Executor the sum ofFIVE THOUSAND THREE HUNDRED SEVENTY-TWO AND 67/1 00 DOLLARS ($5,372.67) in cash (the "Distributed Assets") as a final distribution from the Estate in full satisfaction of the Beneficiary's Interest under the Will and in the Estate. 2. The Trustee for the Beneficiary acknowledges and agrees to hold these sums IN TRUST at a financial institution and account of her choice; however, the title of the account shall be Trust of Laura I. Yeoman for the health, education and welfare of a child under the Uniform Transfers to Minor Act. 3. The Trustee for the Beneficiary acknowledges and agrees that the Executor will not file an Account or Petition for Distribution or secure a Decree of Distribution from any court having jurisdiction in the matter of the Estate, and the Trustee waives any right thereto. 4. The Trustee for the Beneficiary acknowledges and agrees that the distribution of the Distributed Assets made herewith, is satisfactory and acceptable to the Trustee for the Beneficiary, Page 2 and that such distribution regarding the Distributed Assets is hereby accepted by the Trustee for the Beneficiary in full satisfaction of the Beneficiary's Interest in the Estate. 5. The Trustee for the Beneficiary releases the Estate, the Executor, and Estate Counsel, namely, Goldberg, Katzman & Shipman, P.C. ("Counsel"), and their respective heirs, successors, assigns, and personal representatives, from all claims and liabilities, which the Trustee or Beneficiary may have against the Estate arising from this final distribution of the Distributed Assets in full satisfaction of the Beneficiary's Interest in the Estate. 6. The Trustee for the Beneficiary covenants, promises and agrees to and with the Estate and its Executor that the Trustee for the Beneficiary shall indemnify and hold harmless the Estate and the Executor and Counsel from all loss or damage, and from the payment of any and all sums of money to any persons, entities or authorities, for or by reason of this final distribution of the Distributed Assets; and that the Trustee for the Beneficiary will refund and repay to the Estate, upon demand by the Executor or Counsel, all or any portion of the Distributed Assets if this final distribution is later determined by the Executor or Counsel to have been improperly or imprudently paid. 7. This Agreement shall be interpreted pursuant to and governed by the laws of the Commonwealth of Pennsylvania, and shall inure to the benefit of and be binding upon the Trustee, Beneficiary and Executor, and their respective personal representatives and heirs at law, as the case may be. 8. This Agreement shall be filed with the Register. Page 3 Execution IN WITNESS WHEREOF, the Beneficiary has executed this Agreement on the /8 day of October, 2001, intending to be legally bound. WITNESS: 'l LQJLur)i~~v BENEFICIARY: f:m1iJ7i0~iiE FOR LAURA L YEOMAN, A MINOR SWORN TO AND SUBSCRIBED before me, a Notary Public, this -LE- day of October, 20 . Notary Public Dlsti1ct Court 1..01 Cedar Cliff Mall 1106 Carlisle Road Camp Hili, PA 17011 66560_2 Page 4 Register of Wills of Cumberland County, Pennsylvania Estate of Timothy A. Yeoman also known as INVENTORY No. 21-2001-0242 Date of Death June 16. 2000 I Deceased Social Security No. 121-46-3068 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 ofthe 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. INJe verify that the statements made in this Inventory are true and correct. l!Vlle understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. 1.0. No.: 72190 Personal Representative: ~~'rG Kathryn Y man, dministrator Name of Attorney: John DeLorenzo, Esq. Address: Goldberq, Katzman & Shipman, P.C., 320 Market Street, Dated ~\/)O\ P.O. Box 1268, Harrisburq, PA 17108-1268 Telephone: 717-234-4161 Description Value 1. Settlement of civil action docketed to Cumberland County Court of Common Pleas at civil action number 01-2674, amount allocated to survival action $140,000.00 (Attach Additional Sheets if necessary) Total: $140,000.00 NOTE: The Memorandum of real estate outside the Comrnorr.r.ealth of Pennsylvania may,attheelection of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. ~ l:;: ---- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPARTMENT 280601 HARRISBURG, PA 17128-0601 Telephone 5/22/2001 717-783-0972 John DeLorenzo, Esquire Goldberg etal PO Box 1268 Harrisburg, Pa Re: Estate of Timothy A. Yeoman File Number: 2101-0242 Court Number: None Listed Dear Mr. DeLorenzo: The Department of Revenue has received the Petition for Approval of Settlement Claim to be filed on behalf of the above-referenced Estate in regard to a wrongful death and survival action. It has been forwarded to this Bureau for the Commonwealth's approval of the allocation of the proceeds paid to settle the actions. Pursuant to the Petition, the 47 year old decedent died as a result of a work-related accident. Decedent is survived by the decedent's spouse and eight children, of which two are minors.. Please be advised that, based upon these facts and for inheritance tax purposes only, this Department has no objection to the proposed allocation of the gross proceeds of this action, $ 560,000.00 to the wrongful death claim and $ 140,000.00 to the survival claim. Proceeds of a survival action are an asset included in the decedent's estate and are subject to the imposition of Pennsylvania inheritance tax. 42 Pa.C.S.A. ~8302; 72 P.S. ~~9106, 9107. Costs and fees must be deducted in the same percentages as the proceeds are allocated. In re Estate of Merryman, 669 A.2d 1059 (Pa. Cmwlth. 1995). I trust that this letter is a sufficient representation of the Department's position on this matter. As the Department has no objections to the Petition, an attorney from the Department of Revenue will not be attending any hearing regarding it. Please contact me if you or the Court has any questions or requires anything additional from this Bureau. Finally, the approval of this allocation is limited to this estate and does not reflect the position that the Department may take in any other proposed distribution of proceeds of a wrongful death / survival action. ~'nc~elY_' . ~""l' " ! ;/"":'x ~ -~~ lbert Inheritance Tax Division Bureau of Individual Taxes cc: Cumberland County Clerk of Courts ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT JAMES DELORENZO ESQUIRE 320 MARKET STREET PO BOX 1268 HARRISBURG, PA 1 7108-1 268 n___n_ fold ESTATE INFORMATION: SSN: 1 21 -46-3068 FILE NUMBER: 21 - 2001 - 0242 DECEDENT NAME: YEOMAN TIMOTHY A DA TE OF PAYMENT: 08/07/2001 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 06/16/2000 NO. CD 000124 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,951.40 I I I I I I I I TOTAL AMOUNT PAID: $ 1 ,95 1 .40 REMARKS: JAMES DELORENZO ESQUIRE CHECK# 14743 SEAL INITIALS: VZ RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS /6-c:2/~-/o COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX JOHN DELORENZO ESQ GOLDBERG ETAL PO BOX 1268 HBG PA 17108 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 09-17-2001 YEOMAN 06-16-2000 21 01-0242 CUMBERLAND 101 REV-lS47 EX AFP elZ-DDl TIMOTHY A Amount Remitted 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=is'4'-Ex-AFp-cl"2-:offr-No;--icE--oF-'rNHERiTANCE-YA)C-AppRAiSEHENy-,--Ail-oWANCE-oi----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF YEOMAN TIMOTHY A FILE NO. 21 01-0242 ACN 101 DATE 09-17-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED NOTE: 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. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: 32,523.34 X 00 = .00 32,523.33 X 06 = 1,951.40 .00 X 00 = .00 .00 X 15 = .00 (9)= 1,951.40 RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets U) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 140,000.00 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) UO) 46,693.65 28.259.68 (1) (2) (3) (4) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 140,000.00 74.953 33 65,046.67 .00 65,046.67 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 08-07-2001 CDOOO124 .00 1,951.40 08-07-2001 WRITEOFF .00 69.40 TOTAL TAX CREDIT 1,951.40 BALANCE OF TAX DUE .00 INTEREST AND PEN. .01 TOTAL DUE .01 * IF PAID AFTER DATE INDICATED, SEE REVERSE 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 DI" A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS,' STATUS REPORT UNDER RULE 6.12 Name of Decedent: TIMOTHY A. YEOMAN Date of Death: June 16. 2000 Will No. Admin. 2001-00242 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 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? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes X No d. Copies of receipts, releases, joinders and approvals of formal or information accounts may be filed with the Clerk of the Orphans' Court and may be attache to t s e S' /' Date: ; I C I ,;)( l?- John DeLorenzo. Esquire Goldberg. Katzman & Shipman. p.e. 320 Market Street. P.O. Box 1268 Harrisburg. P A 17108-1268 (717) 234-4161 Capacity: Personal Representative X Counsel for personal representative r"'>0 " , , c:. OFFICIAL USE ONLY REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT , , I[p- 2 I 4 - ) U FILE NUMBER REV-1500 EX + (6~OO) CAPB HpRL EplO CRAC KOTK ES C P o 0 R N R 0 E E S N T C o M P T U A T X A T I o N o E C E o E N T COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OEPT, 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Yeoman Timoth A. DATE OF DEATH (MM-DD-YEAR) COUNTY CODE YEAR SOCIAL SECURITY NUMBER 121-46-3068 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE DATE OF BIRTH (MM-DO-YEAR) 21-01-0242 NUMBER REGISTER OF WILLS SOCIA SEe RITY UM ER 03 26 1953 NAM LAS, FIRS ,AND MIODL INlT AL 3 date of death . RemaInder Return prior to 12-13-82) 5. Federal Estate T<l.x Return RequIred 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch 0) . :',Ttfi$lSEOT1QNiMusnll!i,eOl1!1!I1 NAME John DeLorenzo, Es uire FIRM NAME (\f Applicable) Go1dber , Katzman & Shi man, P.C. TELEPHONE NUMBER COMPLETE MAILING ADDRESS 320 Market Street P.O. Box 1268 Harrisburg, PA 17108-1268 R E C A P I T U L A T I o N 23 -4 1 Real Estate (Schedule A) Stocks and Bonds (Schedule B) 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 I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) Yeoman, Kath X 1. Original Return 4. LImited Estate 6. Decedent Died Testate (Attach copy of Will) [!] 9. litigation Proceeds Received 2. 4a. 7. Supplemental Return Future Interest Compromise (date of death after 12-12~82) Decedent Malntairwd a Living Trust (Attach copy of Trust) Spousal Poverty Credit (date of death between 12.~31-91 and 1-1-95) o OFFICIAL USE ONLY (8) 140,000.00 (11) 74,953.33 (12) 65,046.67 (13) (14) 65,046.67 (15) (16) (17) (18) (19) 0.00 1,951.40 0.00 0.00 1,951.40 010. o (1) (2) (3) None None None (4) (5) None 140,000.00 (6) None None 46,693.65 28,259.68 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 32,523.34 32,523.33 X X X X .0 0 ,0 6 ,12 .15 Copyright (c) 2000 {orm software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 512 Terrace Drive CITY I STATE I 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) 1,951.40 Total Credits ( A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 TotallnterestlPenalty ( D + E) (3) 4. If Line 2 \s grealer than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. 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 total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT <,:;,,<>,::';':,::::;,;;":i:i:i::;;:::::f:;:::':::i:':<,:"::,::::;;,::':",:'::":,::';;,;:',:,;:;:",;:;",,,:;:',;,;::q:i:;iOiUJ;';iii;;iiii,;;ii%i;,;,:,;;;;;;,;;;:;::;:.:;::::';;::';;;;;;;:::::::,;::: ;;;;;;;::::;:!:I;!IIII,,:::::i::::i::i:i::;;:::;;:::!!!!!!!iii!i::;!!!:!:;;;:::!;:!::;:!:!;!::!;!;;!;;;;~!;I:!:::::::::::;::;:;,::::::.. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 0.00 1,951.40 0.00 1,951.40 Yes No ~; 1. 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 tor 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. o o o [B [B [B Under penalties of perjury. I declare that I have examined this return, Including accompanying schedules and statements, and to the best of my knowledge and belief, It is true, correct and complete. Declaration of preparer other than the personal representative Is based on all Information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FlUNG RETURN Kathryn Yeoman 512 Terrace Drive ----------------------------------------------------- New Cumberland, PA 17070 Goldberg, Katzman & Shipman, P.C. 320 Market Street, PO Box 1268 - - -Harr-isb~': - - - W... - - -17io-8: ii68 - - - - - - - - - - - - - - - - -- DATE (Sh /0 I DATE For s 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) (i)]. 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 transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child 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 PS. 9116(aX1)j. 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 Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) REV-1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Timothy A. Yeoman SS# 121-46-3068 06/16/2000 21-01-0242 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 NUMBER 1 DESCRIPTION Settlement of civil action docketed to Cumberland County Court of Common Pleas at civil action number 01-2674, amount allocated tc survival action (copies of Court Order dated July 17, 2001, Petition for Court Approval and Allocation of Wrongful Death anc Survival Action Settlements, and letter dated May 22, 2001 from the Department of Revenue attached to death tax return only) NOTE: GOLDBERG, KATZMAN & SHIPMAN, P.C. RECEIVED PAYMENT OF SETTLEMENT FROM INSURANCE COMPANY ON 8/7/01 VALUE AT DATE OF DEATH 140,000.00 TOTAL (Also enter on line 5, Recapitulation) $ 140,000.00 (If more space IS needed, insert additional sheets of the same sjze) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) REV-1511 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Timothy A. Yeoman Debts of decedent must be reported on Schedule I. ITEM NUMBER A. B. SSfl 121-46 - 3068 06/16/2000 FILE NUMBER 21-01-0242 DESCRIPTION AMOUNT 1 FUNERAL EXPENSES, Neill Funeral Home 4,535.00 funeral services ADMINISTRATIVE COSTS, 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. 3. Attorney's Fees Goldberg, Katzman & Shipman, P. C. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Kathryn Yeoman Street Address 512 Terrace Drive City New Cumber land State PA Zip 17070 Relat'lonship of Claimant to Decedent Spouse 3,000.00 3,500.00 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs Goldberg, Katzman & Shipman, P.C. - attorney fees, percentage allocated to survival action 35,000.00 2 Goldberg, Katzman & Shipman, P.C. - reimbursement for out-of- pocket expenses, percentage allocated to survival action 413.65 3 Goldberg, Katzman & Shipman, P.C. - reserved for closing costs of estate administration 100.00 4 Register of Wills, Cumberland County - filing fee for Return & Inventory 25.00 Total of Continuation Schedu1e(s) 120.00 TOTAL (Also enter on line 9, Recapitulation) $ 46,693.65 (It more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems.lnc. Form REV-1511 EX (Rev_ 1~97) Estate of: Timothy A. Yeoman Soe See #: 121-46-3068 Date of Death: 06/16/2000 Continuation of Schedule H-B7 (Other Administrative Costs) Item # Description Amount 5 Register of Wills, Cumberland County - filing fee reserved for Final Releases 120.00 120.00 REV-1512 EX + {1-97} COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Timothy A. Yeoman SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS SSII 121-46-3068 06/16/2000 FILE NUMBER 21-01-0242 Include unreimbursed medical expenses. ITEM NUMBER 1 DESCRIPTION Schuyler County, New York, Department of Social Services - back child support AMOUNT 689.96 2 Perry County Domestic Relations - administrative fee for New Yor~ ordered child support 5.00 3 Charles Ewing - jointly owned mortgage for jointly owned residence (1/2 of value) - valued per letter dated 3/26/01 (attached to death tax return only) 22,172.50 4 Cincinnait Insurance Company - estate's share of worker's compensation claim repayment 5,392.22 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, 'Insert additional sheets of the same size) 28,259.68 REV-1513 EX + (9~00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Timothy A. Yeoman SSfI 121-46-3068 06/16/2000 FILE NUMBER 21-01-0242 R~LATIONSHIP TO OEC~DEN I AMOUNT OR ~HAKE Do Not List Trustee(s) OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS [indude outright spousal dIstrIbutions, a.nd transfers under Sec. 9116(a)(H.)1 1 Kathryn Yeoman 512 Terrace Drive New Cumberland, PA 17070 Spouse 32,523.34 2 Laura I. Yeoman, a minor c/o Kathryn Yeoman 512 Terrace Drive New Cumberland, PA 17070 Daughter 4,065.42 3 Damian Lee Yeoman, a minor c/o Kathryn Yeoman 512 Terrace Drive New Cumberland, PA 17070 Grandson 4,065.42 4 Timothy A. Yeoman, Jr. 3720 Cemetery Road Dundee, NY 14837 Son 4,065.42 ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHfET II. NON- TAXABLE DISTRIBUTIONS, A. SPOUSAL DISTRIBUTiONS UNDfR SEC. 9113 FOR WHICH AN ELECTION TO TAX is NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON- TAXABLE DiSTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group. Inc. 0.00 Form REV-1513 EX (Rev. 9-00) Estate of: Timothy A. Yeoman Soc Sec #: 121-46-3068 Date of Death: 06/16/2000 Item II Continuation of Schedule J, Part I (Taxable Bequests) Name and Address of Beneficiary Relationship Amount or Share of Estate 5 Jo1ene May Benjamin Apartment 5 134 Blain Drive Blaine, TN 37709 Daughter 4,065.42 6 Son 4,065.42 Michael Yeoman c/o Shelia Carter P.O. Box 22 Arley, AL 35541 7 Rebekah L. Showalter 315 West Main Street New Bloomfield, PA 17068 Daughter 4,065.41 8 Sarah Webster P.O. Box 656 Prattsburgh, NY 14873 4,065.41 Daughter 9 4,065.41 James A. Yeoman 96B Route 1, Highway 145 Eastanel1ee, GA 30538 Son Index to Exhibits Pennsylvania Inheritance Tax Return Estate of Timothy A. Yeoman, deceased Exhibit A: Grant of Letters of Administration Exhibit B: Copy of Court Order dated 7/17/01 Exhibit C: Copy of Petition for Court Approval and Allocation of Wrongful Death and Survival Action Exhibit D: Copy of Department of Revenue letter dated 5/22/01 approving allocation Exhibit E: Copy of check for proceeds from Cincinnati Insurance Company (received 8/7/01) Exhibit F: Copy ofletter dated March 26, 200 I regarding joint mortgage G6GSK 1