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Home My WebLink About01-0260 Estate of Dean E. Pletz also known as PETITION FOR PROBATE and GRANT OF LETTERS at-oI-J.lDO No. To: Register of Wills for the Deceased. County of CUmberland in the Social Security No. 1 88 1 2 4938 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut or in the last will of the above decedent, dated November 29 and codicil(s) dated n/a named ,tt 2000 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with h is last family or principal residence at 27 South West Avenue, Shiremanstown (Lower Allp-n Town~hip) (list street, number and muncipality) Decendent, then 7P. years of age, died ,T;:mll~ry ?Q, ?nnl , I8r at Harrisburg Ho~pital. Harri~bllrg. PA Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: no except ions Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: 7.7 ~nll~h WP~~ lhTPnllp, ~i rpm;::m~~nWTl $ 300,000.00 $ $ $ 1? C) . nno _ 00 WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary (testamentary; administration c.La.; administration d.b.n.c.t.a.) theron. - i u c: o ~- .- '" tIl_ 0'" ~o c: ~o C.;:: cU-: -;no&: '1)'__ :; 0 cu c: bO Vi Mark E. Pletz 27 South West Avenue Shiremanstown, PA 17011 (717) 737-5553 . OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA } ss COUNTY OF CUMBERLAND 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 kuowledge and belief of petit' ner(s) an hat as personal represen- tative(s) of the above decedent petitioner(s) will we truly m. t ate ccording to law. affirmed en ~. ;::s ~ ..... ;;;: ~ ~ ~o. 21-2001-260 Estate of DEAN F.. PLF.'r'7. , Deceased DECREE OF PROBATE A~D GRA~T OF LETTERS AND NOW March 9th, j9y? 001. in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated November 29, 2000 described therein be admitted to probate and filed of record as the last will o'f n,:) <;) n E PI,:) t '7 and Letters Testamentary are hereby granted to Ma r k E . PIe t z FEES Probate, Letters, Etc. ......... Short Certificates(5) . . . . . . . . . . Renunciation ................ x-Pages (3) JCP $ 340.00 $ 15.00 $ $ TOTAL _ $ .t1c:r~I:.?! .2.qQ~. . . . . . . . . . . . . .~~~...~O John S. Davidson A TIORNEY (Sup. Ct. I.D. No.) 1 71 39 9.00 5.00 P.O. BOx 437,J Hershey, PA 17033 ADDRESS (717) 533-5101 Filed PHONE MAILED LETTERS AND ORDER TO A'ITORNE.-Y hi., is to certify that the information here given is correctly copied from an original c~~tific~te of death du!~ filed with me as [()l;(l Registrar. The original certificate will be forwarded to the State Viral Records OHlce tor permanent hlmg, WARNING: It is illegal to duplicate this copy by photostat or photograph. No. ~-_.~;;-,:;%. /.4j~'~~1\i[F pi;;--~ /.\\I~\..t"/ ~. ff4';'-~ ~\\'~~/ .~,'J';'___~ /J~! " \~~ It ~I/ ;....."": \~ ~ ... l1li:1 -: a -- ~ ~ St "f:.',i::~ l*\~~*l \~~\ ......~~\' \':.rA',.. ..../~,\ \~_ A/~j;;-_n _.. (. ~~ ,I'" ~;~:"IJ1ENl \1',,/'&1.- -~!E!!!!.!1!~ ~/.{?~~ . - ~.... ~'''''- Local Registrar r Fee for this certitlcate. $2.00 P 7175897 " c.. 8' (\ ')" ;'11'11 1-[ V ~ Ll;L. Date 21-2001-260 J Rev 2187 COMMONWEALTH OF PENNSYLVANIA · OEPARTMENT OF HEALTH · VITAL RECOROS CERTIFICATE OF DEATH AGE (las! Bwlll<lay) UNDER 1 YEAR Monlha Days UNDER 1 DAY Houo1I Minul.. SEX 2. male STATE FilE NUMBER SOCIAL SECURITY NUMBER NAME Of DECEDENT (f"S!. Middle. Lasll 1. Dean E. Pletz 3. 188 - 12 4938 78 Y.... BIRTHPlACE :CoIy .rod PlACE Of DEATH (CI>edI Ol'Iy OI'e -. ;ee ,nslrucloOns on orner 'l1Cle) State or fcreogn Counuy) HOSPITAL: Penbrook, PA Inpalienl~ ERIOutpa"entO OOAD 7. ... FACilITY NAME (II noll...NutiOO. give stree! and numbet, 5. COUNTY OF OEJa'H ) Dauphin DECEDENT'S USUAL OCCUPifJION (~=:~O:=:::zl,:f . llLAsst. Vice President l1bfinancial-Banking DECEDENT'S MAIliNG ADDRESS (5I.eet. CIlyI1Own. ~. Zop Cooel DECEDENT'S 27 S. We s t Avenue ~~1~~NCE Shiremanstown, PA 17011 ~::':~ 14. MARITAL STATUS. 101_ N._ ManMlCl, W_. DiIIorced (Speedy) widowed SURVIVING SPOUSE ," ...... gt..., maiden name) lit. Ie. Harrisburg .... KINO OF BUSINESSIINDUSTRY 17b. Cou Cumberland Did decedenI .... .. . -.ship? 17d.1iJ ~dec:= ~ 01 MOTHER'S NAME IF.... Moddle. Malden Surname) 1.. Edna Ho 1 t zman INfORMANT'S MAILING ADDRESS (SIt"'. CllyfTown. sw.. Zip cooe) 2Gb. 27 S. West Avenue, Shiremanstown, PA 17011 PlACE OF DISPOSITION -1Wne 01 Cemetery, C.em.1oty LOCATION - CityfTown, Slat.. Zip Code Of Other Plac. 17e.D ., <Iecedenl1Md in 17.. SIal. 1.. fRHER'S NAME (hst. MoOdIe. last) II. Edwa:-d Pletz INFORMANT'S NAME (T ypelP"nll Mark E. Pletz Shiremanstown cityl!A ZOII. METHOO OF DISPOSITION BuNlI;i C._ion 0 R_tromStal.O Donation 0 Other (SpactIy\ . IlL SIGNATURE OF FUNE DATE Of DISPOSITION (Month. Dey, _, o 2K~bruary 1, 2001 NSEE OR PERSON ACTING AS SUCH LICENSE NUMBER ~..$ 0 \ (....- ,.., 22b. 10 ilia bast 01 my knowladga, claatll OC(;urred alt....I'm.. dale and place slated. (SognoMure and Tille) Miller's Cemetery NAME AND ADDRESS Of FACIUTY art ncY.O. Box 431, New lICENSE NUMBER idd1e Paxton Twp., PA 17111 emore FH & CS, Inc. Cumberland, PA 17070-0431 ORE SIGNED (MOnlI\. Dey. 'IleaI1 a. ~. dema 23a-<: only ._ fIhYaIC*\ . nocav..bIa at I ::: C*1IIy ca.- of cIHUl. :::all -- 24.2f1 mull be cornpIated by -= I**'" ""'" ptonouncee dealll. ..~~ tJCJ I 23b. 23c. ~ CASE REFERRED TO MEDICAl EXAMINERlCOAONER? V.eO No~ _DlATE CAUSE (Fonal __ Ol concldoon ~....-.no .. 08aIh)- -i : SaquanciaIIy Iisl concIiIiona ...;jj iI My, ~ 10 immadiaI. =_. E_ UNDERLYING "_ CAUSE (Oosaasa OlllllUfy ._ItIaI~_ ~'-*'o '" Oea\IIllAST 6 r~Mr-- c? ?l.A ~ &?,.-- 26. I Approximete : lIIlanral_n 10'- ., dealh ! ,A_/t.N ,Ih PART II: Other signillcant condiIiona conlribuling 10 claalll. bul noc tMUIIing in Iha uncIel1ying _ g;-. in PART I. - ,k1~ Iody~pkj7 sY^ch DUE 10 (OR AS A CONSEQUENCE OF): DUE 10 (OR AS A CONSEQUENCE OF); DUE 10 (OR AS A CONSEOUENCE Of) . VMS AN AUlOPSY := PERfORMED? .~ d WERE AUlOPSY FINDINGS _IlA81E PRIOR 10 COMPlETION OF CAUSE Of OEJa'H? MANNER OF DEATH DATE OF INJURY (Monlll. Day. '!\!at) TlUE Of INJURY INJURY I(f WORK? DESCRIBE HOW INJURY OCCURRED. Natural ~ o o HomiCide o o o ~CE OF INJURY. At IIome. 'a.m. Slree\. 'aClOfy.olfica bulldino. MC. ISpecdv) 30e. Y.. 0 NoD -- .~ Accident Pendrng In_igation _0 Noli! Yea 0 NoD Swclde M. 3OC. 30d lOCATION (S1r_. ClfyllOwn. State) 'MEDICAL EXAUINER/CORDNER On the b..i. of ..amin.tlon and/or inve:sligalion, in my opinion, dealh occurred allhe 11m., dal., and Plac., and due 10 Ihe cau:se(s) and m.nner a. stated.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31.. o 34. Could noc be determined 2IL 21b. CERTIFIER (Check oniy onel 'ceRTIfYING PHYSICIAN (PhySICoan Ceo"lylng cause ~ <leal/l wn"" anoth", phYSIC ,an has pronounced de.lh ana completed Item 23) To _ baat Of "'y knowlaclge, ctaem occurracl d_ \0 11'1. cauM(sland manner as llaled. . . . . . . . . . . . . . . . . . . . . . . . . . . .. ................. 29. 0"- - .~ ~ it .~ .PFlONOUNCING AND CERTifYING PHYSICIAN (PhysIC"''' txllll ".enouoclng Oealll and cl!f1dyonglO causa 01 <leathl To ilia beat 01 "'y knowladQe, ctaath occurred alllla 11m.. dele. and placa, and due 10 ".. cauM(aland manner.. otaled.. . ~/P<I/ 1/ I LAST WILL AND TESTAMENT OF DEAN E. PLETZ I, Dean E. Pletz, having my legal residence at 27 South West Avenue, Shiremanstown, Cumberland County, Commonwealth of Pennsylvania hereby declare this to be my Last Will and Testament, revoking all other Wills and Codicils heretofore made by me. ITEM ONE: I direct that the expenses of my last illness and funeral be paid from my estate as soon as practicable after my death. ITEM TWO: I give the sum of Five Thousand ($5,000.00) Dollars to Harrisburg Consistory Heritage Builders Endowment Fund. ITEM THREE: Endowment Fund. I give the sum of Five Thousand ($5,000.00) Dollars to Zembo Shrine ITEM FOUR: I give the sum of Five Thousand ($5,000.00) Dollars to the Shriners Hospital for Crippled Children. ITEM FIVE: I give the sum of Five Thousand ($5,000.00) Dollars to the Marlin Looker Permanent Maintenance Memorial Fund ofSteelton-Swatara Lodge No. 775 F&AM. ITEM SIX: I give the sum of Two Thousand ($2,000.00) Dollars to the American Cancer Society-capital Region Unit. ITEM SEVEN: I give the sum of Three Thousand ($3,000.00) Dollars to Miller's Cemetery c/o Hanoverdale Cemetery Association. ITEM EIGHT: I give all the residue of my estate to my son, Mark E. Pletz, if he survives me for a period of thirty (30) days. ITEM NINE: If my son, Mark, does not survive me for a period of thirty (30) days, I give all the residue of my estate in equal shares to such of my nieces and nephews as survive my death. At the time of the execution of this Will my living nieces and nephews are: Linda Faltin, Susan Sokolowski, Kathy Faltin, Gary Miller, Cheryl Gingerich and Sandra Canning. ITEM TEN: All estate, inheritance, succession and other death taxes, imposed or payable by reason of my death, and interest and penalties thereon, with respect to all property comprising my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid out of the principal of my general estate, as if such taxes were administration expenses, without apportionment or right of reimbursement. I authorize my legal representatives to pay all such taxes at such time or times as may be deemed advisable. ITEM ELEVEN: I appoint my son, Mark E. Pletz, Executor of this Will and direct that he be permitted to serve without bond and without any intervention of any court except as required by law. I authorize my Executor to sell, encumber, mortgage, invest, distribute in kind, or retain any items of personal property of my estate in such manner as he shall deem proper, limited only by his own discretion. If for any reason my Executor appointed under this Will should fail to serve in that capacity, I appoint Mellon Bank, or its corporate successor, my Executor with the same powers and privileges set forth above. " IN WITNESS WHEREOF, I have at Hershey, Pennsylvania, this ;. Y ~ day of JJ~ u~ n1. t;. f' , 2000, set my hand and seal to this, my Last Will and Testament consisting of four (4) pages, including the acknowledgment. ~Ej~AL) Dean E, Pletz SIGNED, sealed, published and declared by Dean E. Pletz, the above named Testator, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence and in the presence of each other, have hereunto subscribed our names as witnesses. ~~ttw ~.) I a~j ,J Residence Au. 'aU;fJva, ~ ~"., I iWj Residence ('i.. ~li-'Y~1A..- ~",,-i<- ///-1 .. , ACKNOwLEDGMENT N" Li i i t- ./ C:A (J. '-/ , the Testator and I I the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being We, Dean E. Pletz, Jo liIJ / JIJJ(I)f./J and first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and that he had signed willingly (or willingly directed another to sign for him), and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witnesses and that to the best of their knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. r WITNESS ) ."~l . . .1 . ,_ - ,"_' ".. .' " "I / 1<-~s~J-<~7 1/ . Subscribed, sworn to and acknowledged before me by Dean E. Pletz, the Testator, and subscribed and sworn to before me by ~(J"'I..J t. )~..J,~tY! and (V r;. II .;. V ,.S'1i (,t..l , witnesses, this 191/\ day of A lot!~ "'1 &'l/ , 2000. I I w-fJf- 41~"h ~Tii?~;~t~~ pletzd.will6-00 NOTARIAl Al SARAH A. TEMPlIN, NOTARY PUBlIC DERRY 1WP. DAUPHIN courm Mf COMMlSSiii Em Y 19 "" E IN RE: ESTATE OF DEAN E. PLETZ, DECEASED :IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION : NO. 2001-00260 CERTIFICATE OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Dean E. Pletz Date of Death: January 29,2001 Will No. Admin. No. To the Register: I hereby certify that notice of the beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above- captioned estate on March 31, 2001: Notice was given to the beneficiaries identified on the Notice of Beneficial Interest, a true and correct copy of which is attached hereto. Notice has been given to all persons entitled thereto under Rule 5.6(a) except: No exceptions. Date: March 31, 2001 .\1d ;!. ;j(u111.t~ / 1 (Jbhn S. Davidson, Esq. 320 West Chocolate Avenue P.O. Box 437 Hershey, P A 17033 (717) 533-5101 Capacity:___ Personal Representative _ ~ Counsel for Personal Representative .. c....."..). "l:/ '0 OF DEAN E.PLETZ : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT DIVISION IN THE MATTER OF THE ESTATE DECEASED : NO.2001-00260 NOTICE OF BENEFICIAL INTEREST IN ESTATE BEFORE THE REGISTER OF WILLS OF CUMBERLAND COUNTY In Re: Estate of Dean E. Pletz, Deceased TO: Zembo Shrine Endowment Fund, 280 1 North 3rd Street, Harrisburg, P A i 711 0 American Cancer Society-Capital Region Unit, Route 422 and Sipe Avenue, Hershey, P A 17033 Steelton-Swatara Masonic Lodge #775, 350 North Harrisburg Street, Steelton, P A 17113 Shriners Hospital for Crippled Children, 2801 North 3rd Street, Harrisburg, P A 17110 Harrisburg Consistory Heritage Builders Endowment Fund, 2701 North 3rd Street Harrisburg, P A 17110 Miller's Cemetery CIO Rodney Teets, Hanoverdale Churdh of the Brethren, 577 Hershey Road, Hummelstown, PA 17036 Mark E. Pletz, 27 S. West Street, Shiremanstown, PA 17011 Please take notice of the death of the decedent and the grant of letters to the personal representative named below. You may have a beneficial interest in the estate as follows: Under the Will of the decedent, a copy of which is enclosed. Name of the decedent: DEAN E. PLETZ. Last known address of decedent: 27 S. WEST STREET, SHIREMANSTOWN, P A 17011 Date of death: JANUARY 29,2001 Place of death: HARRISBURG HOSPITAL, HARRISBURG, P A County of grant of original letters: CUMBERLAND Decedent died X testate intestate. A copy of the will X IS is not attached. Name, address and telephone number of all personal representatives appointed: Name Address Telephone .. l.,.; ..-1 Mark E. Pletz 27 S. West Street Shiremanstown, P A 17011 (717) 737-5553 Name, address and telephone number of all counsel. Name John S. Davidson Address 3 20 West Chocolate Avenue P.O. Box 437 Hershey, P A 17033-0437 Telephone (717) 533-5101 Additional information may be obtained from the undersigned. Date: ~ (..(A.vL '2.1, 1 {IV I Capacity: _ Personal Representative ..L Counsel for Personal Representative IN THE MATTER OF THE ESTATE OF DEAN E. PLETZ, DECEASED : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYL VANIA : ORPHANS' COURT DIVISION NO.: 2001-00260 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION D.B.N.C.T.A. The Petition of Merle E. Gingerich represents that: 1. Dean E. Pletz died testate on January 29, 2001. 2. Letters Testamentary in the referenced estate were issued to Mark E. Pletz on March 9, 2001. 3. After being appointed and prior to completion of the administration of the Estate of Dean E. Pletz, Mark E. Pletz, Executor aforesaid, died on August 19, 2002. 4. Mark E. Pletz was the son of Dean E. Pletz and was the sole residuary beneficiary under the Last Will and Testament of Dean E. Pletz. 5. The Last Will and Testament of Dean E. Pletz properly admitted to probate as aforesaid provides in ITEM ELEVEN: "I appoint my son, Mark E. Pletz, Executor of this Will.... If for any reason my Executor appointed under this Will should fail to serve in that capacity, I appoint Mellon Bank or its corporate successor, my Executor with the same powers and privileges set forth above." 6. Mellon Bank, N.A. has renounced its right to serve as executor of the Estate of Dean E. Pletz. The original of the written renunciation of Mellon Bank, N.A.is attached hereto as Exhibit "A". 7. On September 11, 2002 Merle E. Gingerich, Petitioner herein, was appointed administrator of the Estate of Mark E. Pletz, who died intestate, by decree of the Register of Wills of Cumberland County entered to No. 2002-00812. 8. All pecuniary bequests under the Will of Dean E. Pletz have been paid. The only beneficiary now interested in the Estate of Dean E. Pletz is the sole residuary beneficiary Mark E. Pletz, whose interests are now represented by the administrator of his estate, Merle E. Gingerich. WHEREFORE, Petitioner, Merle E. Gingerich, respectfully requests the Grant of Letters of Administration, D.B.N.C.T.A. to: Merle E. Gingerich 2878 Kissel Hill Road Lititz, PA 17543. Date: ~1a!~~~ OATH OF PERSONAL REPRESENTATIVE COMMONWEAL TH OF PENNSYLVANIA : ss: COUNTY OF CUMBERLAND The Petitioner, Merle E. Gingerich, swears or affirms that the statements in the foregoing Petition are true and correct to the best of his knowledge and belief and that as personal representative of the above decedent, Petitioner will well and truly administer the estate according to law. '- ~z~ Merle E. Gingerich ~ S\\'om to or affirmed and subsc~ibed before me this JD~ day ofDecelnber, 2002. ~~~~ Register ofWill~~~ ~ U ~ \ Af' ~ Pietz Peti.ti.oo fOJ Gnmt of Letters Register of Wills of Cumberland County, Pennsylvania RENUNCIATION INRE: ESTATE OF DEAN E. PLETZ, DECEASED No. The undersigned, a duly authorized individual on behalf of Mellon Bank, N.A., named as Alternate Executor in Item ELEVEN of the Decedent's Last Will and Testament dated November 29,2000, hereby renounces its right to administer said Estate and respectfully requests that Letters of Administration d.b.n.c.t.a. be issued to whomever this tribunal deems fit and qualified to serve as such. Witness my hand this ?-5 ~_.. day of October, 2002. ATTEST: MELLON BANK, N.A. ~-t:2 Title: t\ ss. '.,.- vCLC-E- r? LU: &.iVJ eAJ I BY: Title: ~- 0-' ~--~ V~(Cb /;/!-?k. q;;~( SWORN TO AND SUBSCRIBED Before me this ::l3/}d. day of (j,t/-(~~) , 2002. '-1lZ'<-("l./v<~?-' Notary Public /)~ ~/~'~ / - My Commission expires: r- Notarial Seal Maureen A. Reynolds. Notary Pubtic Philadelphia. Philadelphia County My Commission Expires Mar. 29. 2004 Member, pennsytvaniaAssOCietiOn otNotartes ", , , ~ 'Lfl~ ~ASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE 8'fATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Dean E. Pletz Date of Death January 29. 2001 Will No.: 2001-00260 Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the above-mentioned 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 informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date b dr; d~tj ~ _~~.4~ ~re John S. Davidson. Esquire Name (Please type or print) 320 West Chocolate Avenue. P.O. Box437. Hershey. PA 17033-0437 Address (MAH:nntJ AM3) (717) 533-5101 Telephone No, Capacity: Personal Representative X Counsel for Personal Representative Rw.n Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 12/06/2002 GINGERICH MERLE E 2878 KISSEL HILL ROAD LITITZ, PA 17543 RE: Estate of PLETZ DEAN E File Number: 2001-00260 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. I, for decedents dying on or after July I, 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: 1/29/2003 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~JJttJ~4Jrl; , MARY C, LEWIS .~?J:J;; REGISTER OF WILLS ~j' cc: v"File Counsel Judge si- c..- 16-c2I5- /<1 REV-1500 EX + (6-00) OFFICIAL USE ONLY COMMONWEALTfi OF PENNSYLVANIA REV-1500 DEPARTMENT OF REVENUE DEPT. 280601 INHERITANCE TAX RETURN FILE NUMBER fiARRISBURG. PA 17128-0601 RESIDENT DECEDENT 21 2001 0260 COUNTY CODE YEAR NUMBER DECEDENTS NAME (LAST. FIRST. AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Pletz, Dean E. 188-12-4938 DECE- DATE OF DEATfi (MM DD-YEAR) I DATE OF BIRTfi (MM-DD-YEAR) TfiIS RETURN MUST BE FILED IN DUPLICATE DENT 01/29/01 01/25/1923 WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST. AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 3. Remainder Return CHECK ~ ' ~'". ".~ ~' Supplemental Return B (date of death prior to 12-13-82) APPRO- 4. Limited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required cgateof death after 12-12-82) PRIATE 6. Decedent Died Testate 7. ecedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach copy of Will) (Attach a copy of Trust) BLOCKS 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death between D 11. Electjon to tax under Sec. 9113(A) 12-31-91 and 1-1-95) (AttachSch 0) itl!f$':l\~ijMQ$iiIlIl!;il!l\WUiill!liAW;@~a~lIl\;QHl!j~I~llifQllMAfjllffl~l!l;Qrli!\mll~jlibrrQ} NAME COMPLETE MAILING ADDRESS COR- JaM s. Davidson 320 West Ch=alate Avenue RE- FIRM NAME (If Applicable) P.O. Box 437 SPON DENT Yost & Davidson Hershey, PA 17033 TELEPfiONE NUMBER (717) 533-5101 124,000.00 OFFICIAL USE ONLY 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 216,249.61 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None 4. Mortgages & Notes Receivable (Schedule D) (4) None' 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 80,637.56 6. Jointly Owned Property (Schedule F) D Separate Billing Requested (6) None RECA- PITULA- 7. Inter-Vivos Transfers & Miscellaneous TION Non-Probate Property (Schedule G or L) (7) 41,443.29 8. Total Gross Assets (total Unes 1-7) (8) . 462,330.46 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 17,255.50 10. Debts of Decedent, Mortgage liabilities, & liens (Schedule I) (10) 10,759.12 11. Total Deductions (total Unes 9 & 10) (11) 28,014.62 12. Net Value of Estate (Line 8 minus Une 11) (12) 434,315.84 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax (13) 10,000.00 has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 424,315.84 SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES 15. Amount of Line 14 taxable atthe spousal tax rate, or transfers under Sec. 9116(a)(1.2) X .0 (15) TAX 16. Amount of line 14 taxable at lineal rate 409,315.84 X .0 45 (16) 18,419.21 ~ COMPU- 17. Amount of line 14 taxable at sibling rate 0.00 X .12 (17) 0.00 TATION 18. Amount of Line 14 taxable at collateral rate 15,000.00 X .15 (18) 2,250.00 19. Tax Due (19) 20,669.21 20. D t~Kjj~IifWtjjjAijjijRl#lp~lrtiij$A1ij~"pi!m)\ij;Q!&!il!A_ml .. .,.,.....,....."".,.",.,."',','".""""""",,',,"',,', ""'l'li'eEl'WRE'IP'AI'ffiWE1'!'A!$i,OIlE$:)JPNsPN'pAGEilfA/:!! P""!EGAE!:;K:MAUli(ii:",'"",',',",.... .. o PA15001 NTF 29755 Copyright 2000 Greatland/Nelco lP - Forms Software Only Estate of: Dean E. Pletz SUMMARY OF ALLOCATIONS TO BENEFICIARIES Taxable at lineal rate Mark E. Pletz 409,315.84 Taxable at collateral rate Zembo Shrine Endc:wnent Fund Harrisburg CbnsistoryA.A.S.R. Steelton-Swatara Lodge No 775 F&AM 5,000.00 5,000.00 5,000.00 15,000.00 21-2001-0260 PA REV-1500 EX (6-00) Page 2 Decedent's Complete Address: STREET ADDRESS 27 S. West Avenue CITY I STATE I ZIP Shiremanstown PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 20,669.21 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnteresVPenalty (D + E) 4. If Une 2 is greater than Une 1 + Une 3, enter the difference, This is the OVERPAYMENT. Check box on Page 1 Une 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. Make Check Payable to: REG ISlER OF WILLS, AGENT (3) 0.00 (4) (5) 20,669.21 (5A) 0.00 (58) 20,669.21 ~r~x~~~!~!~~~~~;~~tt~!i!~~G~~+i~~~~~~~~i!~;~! "X" l!+~~~!!!~~~iR~~!t~8~~? 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 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. Under penalties of periul)'. I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowled d nef, It i true, correct an mplete. Declaration of preparer other tlian the personal representative is based on information of which a s an owle . SIGNATU PE S paN ETURN DATE /1 b C> I Yes No ~ I B ~ o PARER OTHER THAN REPRESENTATIVE riw-- on on use [72P.S.69116(a)(t.1)(i)). For dates of death on or after January 1, 1995, the tax rate is imposed on the net value of transfers to or forthe use ofthe surviving spouse is 0% {72 P.S. 6 9116 (a)(1.1)(ii)]. The statute rln..", nnt .."..mnta 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 onorafterJuly1, 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% 172 P.S. 891 16{aXl.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 n.p.s. 69116(1.2) 172 P.S. 89116(aXl)J. The tax rate imposed on the net value of transfers to orfor the use of the decedent's siblings is 12% (72 P.S. 69116(aX1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. o PA15002 NTF 29756 Copyright 2000 Greatland/Nelco LP - Forms Software Only REV-1502 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Dean E. Pletz SCHEDULE A REAL ESTATE FILE NUMBER 21-2001-0260 All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which Is Jointly-owned with right of survivorship must be disclosed on Schedule F. ITEMj NO. DESCRIPTION VALUE AT DATE OF DEATH 1 Residential property - 27 S. West Avenue, lDwer Allen Township, Cumberland County. Value per attached appraisal 124,000.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 124,000.00 7 CPA21 NW,0904 Copyright Forms Software Only, 1997 Nelco, Inc. George Clauser Summary Report UNIFORM RESIDENTIAL APPRAISAL REPORT FII.N~ ,.0612R.6 ~jJjy.Mdress 27 S. West Ave. __CltL~hiremanstown Slate PA ~Zip_Codl! 17011 leaal Oescrimlon__ Deed Book 210 Pace 8. Lower Allen Two CC!~ntv Cum~I!l~_ Asse~~'s Parcel No. 48-24--0795-002 _ _.Jax Year 00-01 R.E. Taxes $ 1.225.00 I>p'~,~lal Assess~ $ O.Q<> __ Borrower The Estate of Dean E. Pletz Current Owner The Estate of Dean E. Pletz Occu ant Owner Tenant - Vacant Pro e ri his a sed FeeSlm Ie leasellold Pro'ectT e PUD Condominium UO Aon HOA o. N~lghborhood or Proiect Name Shiremans Manor Ml!IlJ!eference 19 F-6__ Census Tract 324D-112 ~l~.'price $ NA Qate of Sale NA OeSC!_lp![pn and S amoon! of lQ~n charo~cOl1ceM1Qn.t!!!_~_p_a_i!t.!!Y5_elIerJ~~ _~_~..M&lient John Davidson Address 320W. G.h_ocolateAve., H~~~~ PA 17033 __ raiser Geo e C. Clauser SRA Address P. O. Box 777 Cam Hill PA 17001-777 Location Urban Suburban Rural Predominant Ii!' family hou. I!!I PrnenIland use % PRIGE AGE" Bulllup D OVer7S'I. ~ 2S-7S'I. 0 Under2S'I. occupancy $(000) (yrs) One famIly _---.l!L Growth rate 0 Rapid l8l Stable 0 Slow 0 Owner 70 low 1 2-4 family ~_ Propertyvalues 0 Increaslng l8l Stable 0 Dtclinlng 0 Tenant 350 Hi h 100+ Multi-family~_ Demand/supply r.sJ Shortage 0 In balance 0 Over supply C8J Vacant (0-5%1 Predomlnilflt Commercial 5 .M!rketiooJirne Under 3 mos. 3-6 mos. OVer 6 mos. . lli~LQY.eL~_"L _....-12~_-------.l~__ V~__ JO_ Note: a.e. and the racl.' eOlllposltlon o' the nelghbotltood .,. not .ppralA' ,.Iots. NeighborhOod boundaries and characteristics: The subiect neiahborhoodfOnsists of Shirern~n Manor. Lower_ AI!~11 T~,-- CI!'l~__surrourl91!1g__ _~~nl~p'alities in Cumberl~fId County. PA. ___________. _____ _ Factors that atlet! the marketability of the properties in the neighborhood (proxlmlty to employment and amenfties, employment stability, IjIpealto market, etc,): ~ert~'_beina valued is located alongJtl~. west side of S. Wesu.~Jn tl!!t_r~_~Lq~!!.ti'!!.E.r~a_~n_o~l1_a_s_~_~i_r~man Manor. Shopping, schools, and churches are located within 5-10 minutes of the prooerty. Full service shoPJl..IDgjs available~U!l~ Camp: Hi!t~n<<;l__C<lpital~!ly_I!l~II~, aDProxim~~ 10 minutes. . Public school students attend the MechanicsburCl School pistr!f:t Empro~lJ!. ~1!.ters a_~lQC::ateqj!!J:!al!l!;:I:n:!rg, Camp Hill. York and Mechanicsbum. Land use change I J ""'ely [I Li'ely [?<Jlnprocess To:ya~ntla!!<!J.Q... !~siden~?l!.<!t:!~~lol!..n:!enL Market condilions in the subject neighborhood Om:ludlng support for the above conclusions re latedto the trend of property values, demandlsupply, and marketing time --such as data 00 competitive properties for sale In the neighborhood,descriptionofthe prevalen ceof sales and financing com:essions. elc.): Market conditions in the subiect neiClhborhood are considered moderately active with low mortgaQe interest r,!!~~.! beinit.!heJ)ri.!!!?,;f"LcataIY~l_ Salesll1.recent weeks h?lye been moderately active. APProximatelu_.9 houses of various stlles are f~_s!!le within 5 miles..al1.d_~e_i!!_ _com~Q!L~jb the subject. Typical financinCl for residential properties includes 80% to Jt02<J2!!!!L 1-3 ~oints. 6.5-:7.Ji:o,l~ mortg~g!,!jlJ~r~_s.t!at~s for_up' to 30 years. A.y:eraae marketinQ time is between 90 & 18Q d.C'l~_~. __ ____n___ Projectlnformatlonfor PUDs (If applicable) - .Is the developer/bUUder In control of the Home Owners' Association (HOAl? l ] Yes Approximate total number of units in the subject project NA Approximate total number of units for sale in the subjed project Describe common elements and recreational facilities: NA Dimensions 80 x 110 x 8Q x 110 Topography ~vg_ Silearea .20 Acres ______~ Comer lot DVes . [8fN~ Size ~"g Specific zoning classmcalion and description B:LSinale Fa/!ljly Established Residential ___ __ _ Shape Rectangular Zoning compliance [ZJ legal [J legal nonconforming (Grandfaltiered use) D megal fJ No zoning Drainage _Ayg -1flghest & besI use asJOOPf9'led: [X] Presentl,lse mller use (el!PlID!1L_ View Avg UUlftles Publk: Other OIf-.he Improvements Type Public Private landscapingJ\vg_ Electricity [ZI ~______ Street }i!jlcadam ________ c:gJ LJ Driveway Surface Y_Q.nc..r:ete Gas 0 Curb/gutter Concrete 0 0 Apparent easemen~.olgec_qr!l9!!!L_ - Water [8J Sidewalk Concrete 0 0 FEMA Special Flood Hazard Area [) Ves {Xl No Sanilarysewer [XJ Streetlights Incandescent D 0 FEMAZone _y______" Map Dale .g..A9::7!:___ Stoln:u.~r [X] A1lev None II n ~~MAMaDNo. 42101t?f;,t~'!~!!iqtP:~irt.t~d________ Comments (apparent adverse easements, encroachments, special assessments, slide areas, iUegal or legal nonconforming zoning use, etc.): Laflcf!l:~pirlg_ exhil?l~ mature shrubs ?l!ld plantinQs. Subiect is an interior lot on the west side of S. West AYe..._.!b~e are nl!i!P:~E:.e:nLe_asemenJs,___ encroachments s eeial assessments slide areas or iIIe al or Ie al nonconformin uses known. GENERAl. DESCRIPTION EXTERIOR DESCRIPTION FOUNDATION BASEMENT No. of Units 91l~__ Foundation ConcrBlock Slab 9_________ Area Sq. Ft. 1,2).l.._ No.ofSlories ~_~ EKleriorWalls Brick CrawlSpace~__.___ 'I. Finished 3~~____ Type (OeI./AII.) !;!etached _ Roof SUrface f~'ShnQI Basement 1.90% ____ Ceiling ~1k..Tile/Op_en Design (Style) fuln...cJ'l Gutters & Ownspts. Aluminum Sump Pump _~_:t.__ .._ Walls PJlneI/C9-'!~'- ExistinwProposed Existin Window Type DblHun Dampness _No Evid~_~ '"_ Floor ~p:!!!~Qt Age (Yrs.) ~_,_. Storm/Screens Screens ^._ Settlement ~.Q._~,,19~1l~ OutsideEntry~_ Effective rs. 10 Manufactured House No Infestation No Evidence _ROOMS Fo er Livin Dinin ~ilJ:!len Den .FamO Rm. Rec. Rm. _Be_drooms ~ Basement ~____.~ level 1 1 level2~_ .. NA N_A INSULATION Roof Ceiling Wans Roor None UnkooWfl_ Avg _A...g _Ayg___ II N V1 N II II __3.. # BaJhs J~un~_ry _ J?ink!~Q__ -~ Other _~l?rag~_ AreaSq.Ft ____ J,232 J,~}~_ Finished area above ade contains: 6 Rooms' 3 Bedroom s . 1.5 Bath s . 1 232 uare Feel of Gross livi Area INTERIOR MaterlalslCondition HEATING KITCHEN EQUIP. ATTIC AMENITIES CAR STORAGE: Carport Floors _H~/.9:!.tNin Av Type HWBB Refrigerator 0 None [J flJeplate(s)#_~__ W None [J Wans Plst/PanlD Av Fuel ~_ Range{Oven {;3J Stairs D Patio NA . [J Garage # of cars Trim/Finish _Woqcl..__. Av Condition AY Disposal fZ] (}fop Stair fZ] Deck ~--~ LI Allached NA Bath Roar Cpt A"g_ COOLING Dishwasher {8J Scullle 0 Porch NA--~ -- ~ Detached N~ Bath Wainscot_Ceramic Tile Ay Central Central Fan/Hood D Floor [] FellCe -~~_ __=-- 0 Buift.ln NA Doors Wood ___~~fL Other ~._ MIcrowave fZ] Heated lJ Pool~_____ [J Carport !i.:~_! Kitchen Floor Vin I Av ConditIon Av Washe[ er FInished Orivewa 13 ' Wide Additional features (special energy efficient items, etc.): . DweUinc:r appears 10 be of ave!l!Qe maintenance. The!e,is,a'o'{!to1e-'"!Ol,lse .~!! (oraddltil:lm~1 coou~ ___n__________ CondUion of the improvements, depreciation (physical, functional, and external), repairs needed, quality of construction, remodelingladOrtlons, etc.: $ubj!'!:9t .is_ a _ranch style dwelli!!9j!L@,,,~JaQe condition with a one car carport. Physical: ~p_reciation due to ag~_~I!~n(;9.!!.qit!Q!l. F_lll!glo_n<lL.tl.Q~~_~_~e:rnat_ No adverse locational fe_atures noted. Adverse environmental conditions (such as, but not ~mited to, hazardous wastes, toxic substances, elc.) present In the ilTlllrovements, on the site, or in the immediate vicinity of the SUbject property.: Non~_Known - appraiser _is not qualified to de1~ sueh s_ub!'l~illr]~~--, j!Jhe hO_l,I!;e J:s soJd, !~rmite_and radon certifications are su ested. Houses built before 1978 ma contain lead base aint. Freddie Mac Form 70 6193 PAGE 1 OF 2 Fannie Mae Form 1004 6193 Form UA2 - "TOTAL 2000 for Windows" appraisal software by a la mode, inc. -1-800-AlAMODE " ESTIMATED SITE VALUE eSTIMATED REPRODUCTION COST-NEW-OF IMPROVEMENTS: Dwelllng-----.-------J_'-~~.Sq.Ft. @$~:: $__~8-,-~Q 1~Sq.R.@$~:: 18.480 Summary Report UNIFORM RESIDENTIAL APPRAISAL REPORT '"'No. 1-0612R-S ..= $ __25 000 Convnents on Cost Approach (such as, source of cost estimate, sHe value, square loot calculation and lor HUD, VA and FmHA, the estimated remaining economicIKeoftheproperty):______ Source of Costs Marshall Valuation Service a~ local ~ntract~.._~._______ Garage/Carport :z~Sq.FI.@$~:: Total Estimated Cost New = $ Less Physical Functional External Depreciation 24.0061 -L OepreclatedValue of Improvements "As.Is"ValueofSltelmprovemenls INOfCATEDVALUE BY COST APPROACH ITEM SUBJECT 27 S. West Ave. Address Shiremanstown ProxlmltYtoSubect ~a!.e.s_rlli:~_~__ _ $~_ P~rossLivinaAIea Data and/or Ye.rjfl~~_onSOlJrce VAlUEAOJUSTMENTS Sales or financing Concessions Dale of Sal me location Suburban leaseh ee S' Fee 81m Ie .mtL__. ~lL~res ~_ View _ Av fJ.tS.i!lDJ!.ntlPJlJljlL._ Ran9!l_ au of Construction Av . 36 Condlti.90. Av AboveGJade T~iBdrms: Baths Room Count 6 ' 3 ' 1.5 ~oss Uvin Area 1.232 . Ft Basement & Fmlslled Full Part Finished B.QQ!)l_ta~W__G(a!lL_ gBl~ink/ComfSto FunctionalUlil' Av H~a,t1rJw!:~]lng m_ _. 9tfYY/GA En~rgy_EfficienlllemL- I_nsulation (ia@ge&alJ!!,!rt Ca ort Porcll, Pallo, Oeck, Enclosed Porch IDL~~"------ 1E~ .Fencl!....PooL~__. NA NA -~~?~@ 120.030 =$ =$ =$ COMPARABLE NO, 1 21 S. West Ave. Shiremanstown 0.04 miles ~. "'L 101.38"' CPMl, Courthouse, Realtor NA DESCRIPTION ---.--~-:-S- Conventional None Known ---r----" 10113/00 DOM 9 , Suburban m.,..___~ Fee Sim Ie .20 Acres E ual Ranch Av 37 E ual _ ._.....___ Tolal:Bdrms: Baths: 6 : 3 1.5.J 1232 S.R.: Full Unfinished S.!lllil.9!':___ A gtJWLgp._~_~ Insulation 1Car,C..IDPJ>il____: NA 1FP NA NA + S 123 000 $ L___~!:l-'-.-8-.!.tf] $ 108.2011-1 '" CPMl, Courthouse, Realtor CPMl, Courthouse, Realtor NA N&_ DESCRIPTION + SMust D_ES_9l!IIT\O~__ i__:'"J~)l_~dju~--,- Conventional Conventional None Known None Knowr) 9/14/00DOM 28 11127/00 DOM26 Suburban Suburban. Fee SimeI~_ Fee fil~~ _~~~_____ .19 Acres .24 ~~r!!,~_.. ' EQ!:!?J . EgulIL__ Ranch , Ranch A~.9~_ .~~____~ AV9_~_--':'_ ---__~- 39 ' .~..:!i: ~__---,-_ E ual E ual -----'-__~_~ Tolal : Bdrms: Baths : T9.l!!.~BdD!!,s,~_B!\lh.~_: ~__:l~"';~ ~-.:.?_ t~_: ~232~!l:lt.~_._ ~__lL~~2_Sq._L_ Full Part Finished : Full Part Finished : FR/BRlOFC/Stor : -2--,--ooQ FRIBRi'\IVRKlSlo.r. ~ Avg_m~~~ _~~__~ Avg_~__ - - -,-- .9JiW~CA __~______~_ 9MW/CA j~~!:I!~!i9n _ __ .___~ Insulation NA _-----.:__ +1.50jL OIl~.C~r_~It. Enclosed Porch NA 1 FP ..___"~ JJ:P___~ ~,1\~_____. NA NA ~~__ _~~JLmat~&~aining economic life of the dwelli~jsJL ...J'ears. 24 006 96.024 8.000 129,024 COMPARABLE NO.2 305 W. Maple Ave. Shiremanstown 0.21 miles __ _C{)t.1P~LEN9.~ 300 W. Courtland Ave. _~___~ Shlremans:!~~ 0.24 miles 124900 st +2 000 +1,500 133 300 __-2,OQl)_ -1,500: +1.500 2,000 131300 sUBJECT COMPARABlE NO. 1 ~P~!,RA8l!-'~O. 2 1- COMPARABlE NO.3 ,,;"'!!.nor of ,,,,,isaL Not Applicable Not Applicable Not Applicable __ :ot :PPhcable Analysis of aflY curren1 agreement of sale, optlofl,orllstlng ofsub/ectpropertyaooarn lIysls of any pJior sales 01 sllbjectandcomparableswilhinofle yeai' of Ihe date ofappra Isal: l!t_e_~.!l.bject oror2ertv is an owner occupied dwellin!1 with a one car caroort. _~Q.Pr..~!@J~_~i!hi!Lo!!.eJear. INDICATED VALUE BY SALES COMPARISON APPROACH INDICATEDVAlUEBYINCOMEAPPROACH if A Ik:able Estimaled MaI'ket Rent o. x GrossRenlMu '1Ier NA This appraisal is made "as is" 0 sllbject to the repairs, alterations, Inspections or coflditions Msted below slIbjecllo completion per plafls & speciflcatiofls. CondRioos of Appraisal: _!fJ?r9.p.~rty: i~ sold. subiect to satisfactory termite and radon certin~tions with appraised vlll!J_!!'_J~i!l~~l!.Qn _cll!~_rJ~R results. $ .________1.24,OQQ. Final Reconciliation: Insufficient ma*~~ data was available to proces!Jhe Inco~proach. .J..MJ;Q!?!~..QI:~achJ~Q.ns}dered arllLu~_~_<l.~<l g-a~9< fOrJ~J'il_appraisal and tvplcallv sets the UPper limit of value, Jhe S~_I~_s Comparison Aopro~c!!l~__fte_emed most~llable_{li!l~gjyeflgr.e_atest ~19ht. Dennis L. Stover m~sistant. participated in the pr~ralion of this report. _~..__^_________~__ _ _ The purpose 01 this appraisal is to estimate the market value of the real property thai is the subject of this report, based on the above conditions and the certnlcalion, contingent and ~millng condiliOfls, and market value definition that are stated In the atlaclled Freddie Mac F0fTTl439/FNMA form 1004B (Revised 6-93 ). I (WE) ESnMA TE THE MARKET VALUE, AS DEfINED, OF THE REAL PROPERTY THA TIS THE SUBJECT OF THIS REPORT. AS OF 1-29-01 (WHICH IS THE DATE OFINSPECnON AND THE EFFECnvE DATE OFTHtS REPORT)TO BE ~__ 124~OOO __ - APPRAISER: D J. ~ SUPfRVIS AISER{ONYltIFI}i9~I:. . A _ Stg!!!.h!rL_ ~. ~ ~ ~rei.:~ _ ~ Did [J Did Not ~me Dennis l Stover. AsSistant to the APpraiser Name Geo~~ us~er, SRA Inspect Property Date RmgrtSigned___6-26-o1 DaleReDO!t~igl]ed 6-26-01 _ __~____~_ St~ C~italiOfl -# Slale ~l! CertifK:alion # G~f1'!l"@! ~.Qpralser GA: 000_2_:P:L Or S1ate license # Slate OrSlale license # Freddie Mac Form 70 6193 PAGE 2 OF 2 Form UA2 - "TOTAL 2000 for Windows" appraisal software by a la mode, inc. - 1-800-AlAMODE _SI~IV~__ Slate Fannie Mae Form 1004 6-93 REV-1503 EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTAlE OF Dean E. Pletz SCHEDULE B STOCKS & BONDS FILE NUMBER 21-2001-0260 All property Jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NO. DESCRIPTION VALUE AT DATE OF DEATH 1 United States Series E and Series EE Savings Bonds - see attached schedule 21,832.20 2 2142,717 shares Delaware Growth Opportunities Fund A @ $22.48 3 394.839 shares ctmmunity Bnaks, Inc @ $20.495 48,168.28 8,092.23 4 570.2238 sh. Hershey Foods Corporation @ $59.16 33,734.44 5 200 sh. McDonald's Corp. @ $28.855 5,771. 00 6 224 sh. Worlco, Inc. @ $0.375 84.00 7 766 sh. Exelon Corp. @ $62.06 47,537.96 8 150 sh. PP&L CDrp. @ $42.81 9 400 sh. Exxon Mobil Corp. @ $80.445 10 300 sh. Allied Irish Banks PIC @ $23.35 6,421.50 32,178.00 7,005.00 11 100 sh. Adelphia Business Solutions @ $9.125 912.50 12 100 sh. General Electric Co. @ $45.125 4,512.50 7 CPA31 NTF 10905 Copyright Forms Software Only, 1997 Nelco, Inc. TOTAL (Afso enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 216,249.61 Dab of Death: Valuation Date: proce..ing Date: 01/29/2001 01/29/2001 04/03/2001 ahara. or Par Security Description Estate Valuation Bstate of: Dean &. Pletz Report Type: Dat. of Death Number of Securiti.s: 10 File ID: tOS1'PLE'l Mean and/or Div and Int Security Adjustment. Accrua18 Value High/Ask Low/Bid 1) 394.839 CCHHUNITY BKS IHe ~~ (203628102) ASK 01/29/2001 20.62000 20.37000 B/L 100 ADILPBIA BUaINlaa aOLUTIONa (44914<306) CLA IIASIl-'Q 01/29/2001 9.68750 2) 570.2238 HBRSBlt FOODS CORP (427866108) mal 01/29/2001 3) 200 ~a CORP (580135101) mSl 01/29/2001 4) 224 WORLCO INC (981414105) IIASIl-'Q OS/24/1991 Last price available on OS/24/1991 5) 766 EXlLON CORP (717537104) mSl 01/29/2001 6) 150 PPL CORP (709051106) mSl 01/29/2001 7) 400 IXXON M)IlIL CORP (302290101) mSl 01/29/2001 8) 300 ALLIED IRISH BKS P L C (019228402) SPOH ADR ORD mal 01/29/2001 9) 10) 100 GENIRAL lLEe CO (369604103) mal 01/29/2001 'lotal Value: Total Accrual: Total: $146,165.13 20.495000 59.75000 58.57000 niL 59.160000 29.71000 28.00000 niL 28.855000 0.50000 0.25000 AlB 0.375000 62.97000 61.15000 niL 62.060000 43.57000 42.05000 niL 42.810000 81. 20000 79.69000 niL 80.445000 23.60000 23.10000 niL 8,092.23 33,734.44 5,771.00 R/A 47,537.96 6,421.50 32,178.00 7,005.00 912.50 4,512.50 23.350000 8.56250 niL 9.125000 46.25000 44.00000 B/L $146,165.13 $0.00 This report was produced with BstateVal, a product of Estate Valuations' Pricing systems, Inc. It you have questions, ple.s. contact gyp systems at (818) 313-6300. (Revision 6.3.3) 45.125000 Page 1 '/14.11. '1<11. L! 'n1.'lo ~ c'l.- <1'1 q. , .' 1/'2. .. mIl ISSUE DATE' . WHit" ""fl ""51 ll" or " d'': - ~ 'Jl~;: U.1'61~ MR. DEAN E. PLETZ '1\,8-12-4938 ."';mmon~'"oill 27 S. 11, AVE. ,. ,. (\~'RaI8lflk'. 1jl. SHIREKANSTO\lN, PA 17011, : ' ..~..'" , " ~~. ANIlA r. PLETZ . ~;,i' MA1I:'t'5"197.601 :![', / -:.' ,:~:-f ':,_ '_.' JJ' -:,"'1] ," .. -', __'_"__":6<__' .--.- HARIllSOOIIG. PA. :;, . ~~;::~$ihES E (~J -~:b="::-~-~~:Qi~"c z 015 znsT' _ j' I ~m.~----'". \II v, ...., . ",,:;t;. ~;. ""~~~:f;;;~~1 1lIml~"lI.l"-J1J)~00'_mR@l!l. ~siiiijOijm~ij(ti;i.;i~ft!l ~ \. I' '., " / '1:(' "I , ~~!=;;::~5u.~mI! ....~i'ilG8ICENTHIrlI^ll"1lI.:-- - ~~"&O"''''''''LM'''''''''TYHI''.__~~ ~._ .... '_ :.:,'- ~~~,9J)Jl(r)D'lC1t\I'Hib '-s~5iD'lT'E'-~>, '. .',-_ . ~..~ ..."!(HI5T1'(-"IISTDJlYOr'l I r, i-,!~ . AP~...:Jlt6 ' JR. DEAN E. PLETzt~e-12-49Ja ',~ n. c' . 27"S... 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AVE. ~.\ f,:~~"'8lIIJlD/ANSTOWN. PA W~ -.-.. , '-=.;.~RNAr. PLETZ /' /t .,~4q~' Ii " ;:,'L -. I -Itl" C~'''' ':\'1 oM' .'"""'- ..i,,__....":; .::" ~ __.._._....-...: ',-.."...,.....i_,_~_ :; ....A. :)l . _~~!'.::,::-' '_' tA:-="..:;::..oo;:.:=:;o..r.:: "-...-:.........::::,-..:.::.:: eeRier 1 '::.~~RIES.E;"\~';-=="<'f ~.G2 021353149 E .!' ~i~4::,:."'~~.,~~~;~,,,;~.;""';.~~~i~+.;;ii~~ l/3Vl( 35jJ '13'1(1. 3S'1)~ .;'.:;:SERlES E if.t'3'. . - - ~~~~lr""~""I'II\A1'tlft~~'1 '1.".; "'71.V I C 3 'I' vi '/JJ41( 3<(6 (I( 4'1/.41( ~Y6W , "(l-<;1' ~5014 :J - tj 1 \~, :' ';L(f \.) ~ " . ~~~<<mw~ ..~ T"~ O..'.......L ....T"..'H ......o~ WILL ..... . ~~llJImD1~ll","'1l18J ~, .r,~' .- _~_'t,' , .....IIR. DEAN E. PLETZ 'i; t .. -12-493B 278. W. AVE. --.~;--~ . SIl~REUA~STOWN, PA '{? ;-;-oR~-";:"- ;' -~ -. - - .. ._~ ...~ ," ',' ,., '" Em ~~~~~~~m4U'~~ -~- \~/:I .' ..1 . ~~~Qr~Dfimlii).'1iS} _~H~~~~~~t><" 1ic;'Qo ,.-~<',\'t-t''''''' '~ " 0 '.,n. .. _~. i. . \;~,;"oNT - ..~,.', ' ,J!' .c..'IIR.\~EAll E. PLETZ /~ 11ge-12-4938 ' .1":/. ." ..'~..': -.r..._.,.'.":.~t.EII.. :Ns~~iN, PA '~.:'~~<i._l . (Osf".~..."'.........'~.;.;...!... .' .. "IllS. ANRA r. PLETz,11rl'. '1IAIiiI1Si-:, '0' , .,' " II I, . . ro.....~lIR\t~'" f" 1', ., '.. ," ,'...... ~-., { ~'_i-,.,_;__':'":'~1~~\~::~~~, __.___.. " j<_..............,_~..._ ~"'" r :1,1 ./1s~iESE @=';::'-3, .. ~.u~"c 2 0298404C7f1,i _~~~~~~l'li~~:-^"'I t_~-:~-!-ft_~l~ ~,:,~.~~~~#~ii~r~ .,....,."~,.,.,.." /._ _, ' ;?:i '.........".c.,:,,,..,'.' ..<". (. ,::'-':~:r:'::;'R'<'::;:f:Yl: :NIJV,}$\ . .' " 'lMt~:.It~.,,!,.,:,.,c. \~ ~ ':.:J .,;. ~, mI ISSUE DATE .~ 'II~I(;I' I~TI"!'fl~ST 0.. D' JI ::',~':~ ;;,:'0< ":"'H'" ~~ii'.'.'1 SIIIREMMI5TOWN. PA i'70i~ :J' aYl'"":l'-"" ~. OR ' /. , H" 2 8 197, ' IIRS. ANNA:. PLETZ' '., -,,-..- :' II . ., 'I -'~M., " .. ,. - , _....;._- ...-...... -_.__._.: .. _......__._ ..; .;1: --- ~!l/ FOIlGIi . ~ _..____...... . ___.._....._._ ::-~;~SERIESE, cgJ====--~r~-C2035316413E _' mJ~-" -.-Mn"'......' ;.....,..:...~i:,,=~~~;;~1El '/(fI~ ~'.;.r. ." ,- ':::;'1--' ~J.~ ' ~'{. '~ra~.",:l,,'," 'C'~;'~,. E. PLETZ .. ... 8 18,8, -12-4938 , , ! .... ."1'. AVE., 'I 1.8BIWAIIS'l'OrN, fA 17Qtl M:A' ~"7;'O<lll"';~i','1 , OR, . '~J' , .,\.;i,.,.~flT" J,: ,,~ , . , i,us. AII.a r PLETZ ' .,.. / "'I i " .. . IIIil ' ", I i "'" ""., '~ " ' lll8{'M. ~'I II ;'=:i~~~ERIESE @~:;;;:~=.:.~C 2 044 5~;;G~ 11 l(~k~*~~~~~:~-. ~ ~--~ ~';'-"~,;-- I-~:~-;-~-~ I'~: ".IK'~~~i~;i'~r~~J L( fI(. -: &. ". y : t ;)5, Vi,C 4 'I .,/ :' !, ~/ 'mmlWmD~gM1I"Dll\ AT .....It O,,,.,NAL .......U"", "~""O~ ....LL ....... ~~..lmD>mmM'flS\ ~G,.,'; ~ ISSUE DATE WHIUI IS TilE rtRST O~T_Or .j,' ("';]lR~"1)EAII'E~ PLETZ . 1~e_12_4938J ":'a\1 i ~~i~~:N~~~:~' PA 1701;i ~,Uf(I!.:t9'7,i II . "r'''aaS.ANIlA r. PLETZ ii' ,.' =PI\" ,11 f, _'''''' _ --.----.!&r.,..-......-. eeftlIr "~ '1SiRIES'E;~C:~:-""=:-J~~"G2 043 492 790 rl Bl1G~E~!~~~~,I-,--~.WY w-:-~-~~---,--;.,;.;~ ~-I.~ ~-~~m~;~;;~tiu ,,', _~ t I ' , """-',' "IH/V . ',' ',/ ,":/~ ifll 17, (j 3.32 ;l b . Il) 1 .} \ ?n, J~ J' (.11" rn). J75 <11 ;V? '1'1 . ~-7'iiV1;f ~ V\1-. ~~ - ... C'"': l I , - ", ~~l!'l"'i"'t~iW 11!mlW~~~~~!~4ffl~~-"-(~ _TD"""""nBIiJlDti>1l~nlSl ossut.OATE' ~~~':"~ " ~ WW'O"5fll".jF,u,o",or y,., . ifrJ> '~'/',~ ,:'/":~r<>:.' :'~ "'::;ll~~~ ~VE~LET& iJ'}.rW-12-ms ~.... ~:IlltlANSTO'N. FA 1m/~ '4uli1~:-ihl'; > 1UlSO, ANlIA F. FLETZ )~-,:.,". '''''. '." ,'H""i~;:"! . '; i' f../ .,..S; ~\~t~ (i)........--...........".......-..-..-......:;::"'M. .... '\...~~1:""';;::;:.~'''.-.'..''''"~. ' . ::'-':~:sEdlE;SE -:::":-:-'-1~~-c2 047719732 [ _ . .;.;~;ft.;.",..~~iI:t~r~l1 . - \1\1. I .: 'mIImU~~Q~- AT 'M" o..,......~ MU"".n ..l....o~ ...~L ".T @m~"UIlll')~1lMlSl ~'-7~ Jr.' ~,.., . ;,,__,~t1....: '.'.........IIR~,...'D.,EAN E. PLETZfj4,',~~,....'. -12-4939 -;0,.,,278. ... AVE.r" '.- ,'., "",SIII,lU:IIArISTOIN,PA i,~9 ' :..'-;;.i _ OR . "''''iII''\'' S~p_"~,,, ,")IIas.; ANNA 1. PLETZ .' P, ' ." ,,- -;" ;' f' 1 " " . '. . --.---:a-...----.-. __ill -"1 ,~~\s~nIEsE @~=.:~j.?~"'C2047=~ , ~~~.;,~- .~..",.~~.,ft~'",.;~,~,~.-;;"'1!~~~TI 'mIImUlllJWIJ)~Q~IGlaQ,) n Till OI..OO.....~ MAT".'TY ..UI.... ....,LL ~"'T @1m~'f!@Tl~ .>-.~ ~-U.'Pr.1:ft}~-12-49'S' ~ ",.J- 'iW+ AU. ;;.c.', ,,\<.~\ ,', ~ >',". _~' PA l'l'in ' : ,_"ow_: ~ - .,.,., net6 "'f, ;c (~' I '," :1< "-,,-~- { , "--..." -- ' f - " ",,' , , - --.. ~'........ , . " . ......~ :'i_~~" _sE.~=i.r;~J: c 2 oso'~~ ';. ED~~~y-: ~ ~ " l'^"~ I:: t ~ :.11-'... ~ I~~ ;.~~ll5~~~~~~ IIR. DEAN E. PLETZ 180-12-4938 ' . ~~" 27 S. I. AVE. ,I '............01....-...... . SHIR&UlISTOWN. PA l7011 ,. 3197t ~ ~L_,' '.'MU., ANNA F. PLETZ ~~\: :-~'irSinr~~E .,~~':sr~.~~=c 2 052 9~37s~'. .0 ~_"._~'II"_"t^~~;- I t>I:"I^"_I'~":..~ii~:~~~'Si:~~n 'it; ," ':i:) lu..llEAIIE. PLETZ 189-12-4938 I ~. ::;~:;S~~N. PA 'l1011 o'~e-".t91ii . .. .....,...... ,~ PUTZ _ ~jj " ,..! 51'.. ~IIJ:iIIlIr _J1t/lHy--'':-''_ ,_', ==..::-~...:.~.......--.- :.~:'~rEsE: ~=T~:Wlv:;~J~C 2 057 4 7G o~n E ~~Ii'~--.'I".... .t~", ''''J:l ,~,.. ii;..~~~=*~[~ .,.C' 11) If'?' Ii? 'it MR. DEAN E. PLETZ 188-12-1938 f J:~~tai"! 27 S. .. AVE, '. l "SHIREllAllSTOWN, PA non I .-.--....' OR \ JIltt.~~: MRS. ANNA P. PLETZ; . \~ :--~:':9EntEsE~~~.~.1'~c 2 057 68-/ 1"141: ,0 ~~;.....t~".,_.t~;i~l!-;;;"~~~- -~--~.'" ,'-;. JAN 1918" -,.........-..; =:::-: --:-~;~~;~.': "RS ANftA F PLETZ 1711&083& ' 21 SOUTH IlEST AVENUE TJ(USUREIl \, '. SHIAE"ANSTOIIIl PA 11091 cOMl(aNllnrTlf OF, OR PE'~Il&~II"HI.' ,j.. DE"" E PLETZ 18812.938 HARIHS8URG. -,loA . ~"~. ...."- "~": ~~~~~~~:!:'~ L2112S0~~:~-~5--i97f1./ ~'~~&lWES:E- -=- .V~/f..2::~~L 2112 501 746 [m ~~~'~=~~'IiiM~'~W ~ U tft~'I_1 J;;'o, ft~ i ;"-(~~~,~;~ .7 v3" J.'tf .SIO ",',\ 'd , ';r, ), r I" ;~,>. I. tl )." 1 r -" ;:, 1,i\,'/ ~(/~: l)~.' ,~ ISSUE DAT-& .c-", WllICK IS '~i '11lST l)~.,.Q""- ;;"0 -. .1' '''. .._,' "r'.",.,.~....; jJ~',:"""<' -..,. .... .....:...IIIl.'.JlEAfr. .E.PL..... 18 << ' .., . c' ns. .. AYE. ..... 8-12- 938 -'~~:;i >.S.lI~A"nOlN. '4 .1'1011 ,. . " -oa : ,.---....... ,',.,:' .....us:.IIlQ r. PLEtZ"~MAK.ZUl'lll' '.' "',:-.:. ,: ,: . iJ!PI'~'m.q~": I . - .....bFF:) __.___.~_.__._ OllCllATIOIlS .'" ~~..:_~~v1;~J:C.2 OG12?7 670E jjJ!Il'LW.J:l!W l:.t:-t 1ft ~ l. PI :.. 'i': )(~4 ,,;.,.~.~,^-"; 317N ;,<12"11 ~IO 7;- ).09;6 > (/. v-,? . i ~, 6 'I /' ","" y ~1..:6:r .ANNA F. PLETZ 177-16-0836 27 SOUTH W. AVENUE SHIREMANSTOWN, PA. 17011 OR DEAN E. PLETZ 16.3 .....n.l .1' . /C N B \ ~u~iS::ii' ) l~\',' ~ '. .. --.----t-...--.- YA"~I'-_~M1E-__-_: -. E -...--...-....... -..-.............-.... '. . SEl11l'iS . -:.:==----~ " W,/f,.i;~.{ C 2 064 137 004 E . .. . . _... . . -.....-.._~ ~~~...,iil.i.u..r"....." ':oIM("'..I...:". '_~~~~~~ .--',' -~)(-):l 1)7-<-/. l'WC.'A' .A'.C...rwN.,..l;..........."E ~<....~~~,.,.",j~~ .};,:- w6f ~1. G1 ,,</. ,. ;. J<;.4- mIl ISSUE DATE vrn'CII1S11K:f1I16TPAYPf .:~:~f~" /~.,-'~-T!.f'fT?.-';,:,. PA l70lt __.__._..~_..__.._ Iot,M ~..".=;:: W:~:4C20(hm'm~' . r ,. ~"'*-..., :~;' )u/ ~(j ~Jt.-!.,~ IIOV. 1918"',. -,'MoNT-..l---:-."'"",,~":~:. O~I~:';:' --..........,.. I :,c," , I._O~...:'-\' ANNA ~. PLETZ,. Qf C,l. .JI"f' ~. ...,.d;...., . . "=""==--"'A:z...:-_="".,.,,,, .~ ". :"";~$f]RIEsE -::::::':=--~.wl{k~.{c 2 077 8G1979E ~it~.~~iii! Ii 5' ~i'.;;.,::::~;...;~''':'''-_ ~B;~f~ ~R. PEA~ E. PLETZ 2'1.5. W. An. -5UIREIMil3TO~'i:', Pi\ 01\ IlllS. 1l3~-lZ-t,?33 17011. - I I -., .~_=<., ~ mm~~~~mmi AT T"~ "..,,""AL MATU"'T'r ........,,~ ""LL ....Y ~~I"ll..m!!)~IM~ kr.,'j:o "',: ~ .,.-_....:f...!' 1111. DEAll E. PL&TZ IH Ma-12-49)8 27;8. ...AVE. ..-/'; '/~'~~j - )? ';}I r ( ~/ ('. / j, - ( _'I'W~V:"'''''''I ~,i;;;: . -" ._' (Cu" . - ~ -- -_.- .~--~-- ItoIt..r......tl" :... ~ 1~..<- -/.,- "" ,,'..' I;;',':'" ~ . ..'!, :fl:~:, ;":1 ,~ ~-; i ..-'::.'..i_ ' "'....,. ----:-"'O...'....'I ,,'( ')71 _,'I "(' J7- J. J /- J!J:f.;'Z. J..'f/,3'"V ImII ISSUE.DATE WM!tIl_IS_~t?,!TPA.or<l ~;o;,"_:J_'-!~:';""',_: ~PR. .. :.:.197:11;.\ ~f'.-:'~~J;:.! w...... . .."j, , .::.',. ':'--.:...'..-:;.,'-}"- " ANt/A r. rLETZ APItfl1t7&r., , ., .. " '. ....:;'''-' ~;"~"I_~" d, . . . . 'ill :", r:..... ......-.. ..-.--.-.... ..- .....---.- ..IfL..~~ .'.' ._<.:._.~y-~,;,:~~c ::.::.":::::...~'7'.::"_'= .. .~~':'~.:.....=.".:.:.: -n ~ ,o<'SE8IES E ~.~.., lvH~:::!.tC 2 083..~~,,~.~.9.~,~.fi-~:1 ~~~:~;""'V'A'" .....::A..t~'~a=~~~ .1;;i:~-jJ _ i";f'L!R. DEAN E. PLETZ ~'jj27S. W. AVE. . .C"S:ltRE~,~~ISTO:'lil. P~ "POll ~:-'1 :,: OR .IIRS. '1:J:-12-1?33 3/2 ,. 1. ,J.j7 )Z l/i", mIl ISSUE DATE .,...!!'..Il,!l;Il,IS'UIJ.J;llt$ro_.o, " ''''''''''fP_l!,' .. ' .. . , ....... ". """ - ,'" - ' ) IliUIDI E. PLETZ ;188-12-4938 '"''f.):''';:t,,~t "'W' an: .' = I ~mR, '4~~l1o,1i ~\ . .. j , . ," I I ta;"Bh r. pqn:, ~. . , rr-$J , i I ( .,,' , I . " . ., -..'J ..'" . ~~-__.___.. u_ " .~____" - __._........._... " , _....._.__...... . rL .. "'" .:; :'~:_~~~EfiIE&'E :~~--=-;~~;~C 2093151371E ~~~ ~5\~" . ~';;j\~;~:;:~--_."............."~ ,:.""'I'i~;. i" '~-ft,~,. t :...~l:I~~~\~~.13 ~ 57 {'j(( '<IIi\il: : " :~- .-~ t" r '.~ j' ?(J~V ____ _ ~ril-"';;""'"""-""","jf.,,,p""',,, ~t\'.1lIB~~M!l~~@~JlRnmA - ~i;Il"i';;~~i9.;00iji~g ~:;> ,.c. ~:~>_ _~ - ~-: i) -,.lIl1.-.DEAII E. PLETZ .' r.l1l2-1~-1933 . c' 27 S. II. AVE. ;' I \('1 SIIInEUAlISTQWlI, PA' J<\7,oh OR ~ ;/f " 30 \41. J, ,/.'11 IIn. DEAN E. PLETZ l02-12-1938 .,.,!.:;'.,:,~'r9 27 s. W. AVE. :' .....W SIlIREU.'W3TQilN, PA '17011 ' '.___~"T" ' '. on :.~ER_.tJS7,~ 1Ii$. ANNA F. PLEtz.. "'/. '" . iwmISBlJRI{P~, >~E~;ESE . ~-:=~":7..:::r.~~~-=J:C 2 095 o;;:;~t~ .~=li~~,:,;-;-'; ~ ,~~~~:;.; :~~~r;~~ i~:.~:;*=1in ;,:' . {. (I?' '.d) III , .,? /.9" ,I,,)' \ 0C1'. 11)19 KR.DEAN E. PLETZ ..' ,188.12-4938 'ii:~M."" ""Iil,:~r' 11 S. .. "VE. IiIiiiii _ . " 8HllIUANS'tOJII, PA170n :.._.;....,.,.... '~:.~.uI.A r. PLETZ, . Od;Ji'l:JJl9 .: ',' lIAr"rsll@!!l.J>A;;: , ~~'~~~n~i~sE.' ~~;~~_:;;::73c 2 09t;;;~r:l; ~~~~",;~,.;~"'._:,,,~,::;;:,.~;~:i;*~~ , 3a~ .71' A jy.r~ '.' ';-i) j'l (J )?V/o ) ~ y.l" ;15'1 " ) ~ )1' ~ 3'/ ro , _ . I" ",_,_,u , - - _~ltc~ E "'-::'.SERJES ~~.~~~;.;.~:::.~ .......,......-... ~ ~ ~ ~~rft:-~." :~~~~i~~ d''; DEC. 1979 .,Ui;~-'-'-""'-- /1lItlanII.... OE~.~~J979 fI. .- . ';"~"",,,,,p' .~, " : " ,,""~---'~, ,~, -' . --.----ctt; ..... ._~ .-". ","Oil" _ -..._____...... _":'"-t"~'::':'-'"::- . \AIII_ ",'<-'.:Ql;1. 'RIVO'. .... ---'---.. --.='''-':': .' ---'~~~-f'j . . .~~- ,'.> , -:..--. .:" , r r- -, ~'OC-C,c""",,---,-,~,:/, .' ..' ,fAJ)f2;;;::::!!.(C 2 098 8SIl ,),,1\ L _ '. ~~...~.-- ....".~: ~ ',;,,~~.'..D.'~"""""""~ ___.," __' . l^,,"'f ltot: ft ~t ]'., __'~;~~~ ._~ MR. DEAN E. PLETZ 27 S. W. An. snIRE~AtISTOIiN, FA ,17011 . OR IIRS. ANNA 7. PLETZ). . , .,. " ".-:- ". .' lO~-1~-4?33 ",' 1m iSSUEOATE" ."'CHI5TIft.":~Tu'YOr "'~IIR. DEAN E. PLETZ S:~;lgO-12-1?38 JAIf. "'Y98Q~; ,,=-,,_ 2,7..8. I. AVE. I ,-":> '''0''<1'..,"; " "'~oIl1,., - ~";SHI~ANSTOJrj, PA 'X7Qt~~;~A.';'--. .J-i,OR . ~,,'~. M..,.,....,_. ~i~.r ANNA. r. PLETZ ". ..:..,~. , ' ..-.., -~......",' . " :,;.J~, .1~NM.1980) - I. 1 . ,., ~",=.==-J.~:"'_._-_.- ~o:. ~. ~g]~~~:-':~~::~~:~~~~~;~11~~iit~11 ;1)71 ~~!tI.l!ml~a~ (E~. aI.. - -- AT ~H~ ..,.'OINAL ..~~"..'n ..~..."" WILL ,... '._ -_. -' .- ,_~, W",~~~,~,;;:.:~ 0'.:.:.......' 1~~r-493B n8~"i~' ilL,: F:~vo:?l::~!}I. .. . ,. . iWlRlseu~G .,/ .... >",,' . .f~S'?""'i..:~;:;G 2100=~'1 r~~-....- .;.:,.,~..:.~ ,::~7~!~~~=~.i.i.~[~ ~f..,'- ;(':,11.- (/..7,61.- ~~~qm~aM~!JWl11 ~i;r~ ~I;..o"T-..l-:: =:4-(;.&lf"i~:~:: illS _,F'LETZ 1111608)6 ,." "'.:'^<". Z7 ,SOU," lIES, 'AVENUE TR'EASOREIl.\<' SHIRENANSTOWN Pol. '17091 COIlIlb_.........~ oa PEitN~Y.L YA/lltlt DiM E 'lEU 1881Z~9)8 HAkRJSBURG.' ;I., PUR ACUNO 171~I"'08)6 NA1i..it !l.,dT8, __.___.~.'"__._ L2115~9)82BE' J .'''s~nIEsE ~- '~.Vw:;';;~~L 2115 493 828 E . ~~1~~m:zl'A-"'> -. i ~'..,. .... ";;it., i I" !~~R.~Jt;~4~n "-. /()( 11, 111.~ ? APk 1978 -'~~I-::::-t'iA~-- .S ANNA F PUU 111160836 /' ..... " .SOUI" WEST 'AVENUE TREASURER '., SfIIR.EflMSTOIIN PA lT091 COIINo.....t'tII '" Olt Pl!.~Yl.JtMtI.. .. OEM E "'''Z 1881Z.U8 "ARltl SIIUlI&. ,loA '~~~', 5_~~_~~~~~6,.~~ L2lZ75~;~.~.-:9~' - .-~:sEfllEsE - Vb7.iig.....~-Il-l..L 2127 ...,.,.' If . - . . .0-- .," _ .-." . - . . ..............-.. ~~~..."j""(WIl\".,~,..i'(i!\'.i.",..~.~1m JUN 1918 .-s. _ F PLEU 177160836 .,n:,,~;::,,::~,,:",,- 2'SOUY" IlESTAVENUE llIEASURER'., ~'OWH Pol 11091 (;OII!lll~..'n, 'pf ... PE~IA OEAII E kEU 1881.2.938 HAMil SBUItG. /PA PWl "'" IIOE1....U6 ';UN_.lO-'(lIl8 :="="-='"'~. .":'"_~'='=:'"":''':: L2127S5638SE =---:'--- .. .1f:S::::;';:.L 2127 S5Gl85E --- c;~~~~~""'l'lIY1WI-A~~" '\11 ~lfto'~'--;' :...:....~.......~~~;ID I ~;7(,1.. (11 (L.. 1~7,71! il', ~~ 611' ~"~~~A1IIB!~ ~gfl\~!J1m~ (711'&. /(~r.'Or1 ,~!. Y't' i-.I ... la. DEAN E. PLETZ &7 S. I. AVE. ~91~MSTO'K. PA ~' JaS. ANIA 7. PLEtZ lse-12-493S 11011 I:AII., 1980 -~.- NNHH;4980\ , ' , ;..olll..........""': ~~~. --'--'1!J"--"'-- _:~=-' '.' 'i\:::\:."-.. - .\_.......-.,. K2 393 260 EE . ~Jre~!f!~!\!~L~M1Im1~ ~~~~!JlmN.'fl8I "I'&' '.~. ,>>UN E.PLETZ 27" I. ",E. Sn;REKANSTOIH. P. ~.'AN.. ~. PLtTZ ~ ,SERIES EE I ',;~<:~1}i '~'l'l! Nf<< !:~~:.::.-S~~_; '~~:,:~i'?# 'm~lii' tl :'l-l~'< "J',' ~S: ;~; t';::: ""i' .', . '<~:~ . '-. :1:, .-,~; , ._~. ~'~; ...1 ~i.J. ; );';: .~;,:~~'~.,~~< "A'-'" ", ;~::S.~...:l','" f." ,',' ':-:~::/l./ ;t~, .:{. '~J .~V'J:" ';'.., ;,' laS-12-4938 ,J .~ non --'_'_'1IJ_m _::::".. '" '\\:~L - .\_......-.,. . BAlI. 1980 -'~1ii,- -- ~""- WII~ 1An~~~ . ....T'......,....... I paullG. w: OKAAllQ~f>"~F, K2 393 261 EE t,,_, i' '.'''' .\.1" " , / 6 I r~ / Jf vi REV-150B EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF IBan E. Pletz SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21-2001-0260 Include proceeds of litigation & date proceeds were received by the estate. All DroD. lolntlv-owned with rtaht of survlvorshlD must be disclosed on Sch. F. ITEM VALUE AT NO. DESCRIPTION DATE OF DEATH 1 Mellon Bank account #160-070-0387 9,043.52 2 Mellon Bank ac=unt #0355071241 18,537.62 3 Mellon Bank ac=unt #112-712-5423 3,245.83 4 Mellon Bank CD#16-A61054-C 12,171. 09 5 Mellon Bank CD#01334590 25,264.50 6 1994 Mercury Grand Marquis autom::bile 4,875.00 7 Household goods and furnishings 7,500.00 TOTAL (Also enter on line 5, Recaoitulalion\ $ (If more space is needed, insert additional sheets of the same size) 80,637.56 7 CPA81 NTF 10908 Copyright Forms Software Only, 1997 Neice, Inc:. ~ Mellon Bank PERSONAL BANKING STATEMENT DIRECT INQUIRIES TO I MELLON BANK NA 0 COMMONWEALTH REGION HARRISBURG MAIN 10 S 2ND ST HARRISBURG PA 17101-2001 717-780-3173 1",111",111"""11".11,11,,,1,1,,1,,1.1,,1,,1,11.,,1,,1.11 DEAN E PLETZ 27 S WEST AVE SHIREMANSTOWN PA 17011-6544 00419 0111 112-712-5423 PAGE 1 OF 5 STATEMENT FROM 01/11/01 THRU 02/09/01 INTUIT INC. IS OFFERING QUICKENIRI TURBOTAXIRI FOR THE WEBISM) FOR FEDERAL AND STATE TAX RETURNS, WITH THE CONVENIENCE OF FILING ONLINE WITH THE APPROPRIATE AGENCY. VISIT WWW.MELLON.COM/TAXCENTER AND LET TURBOTAX ASK THE QUESTIONS AND DO THE MATH. '"_1 RELATIONSHIP SUMMARY DEPOSIT ACCOUNTS CHECKING HITH INTEREST CHECKING HITH INTEREST PREHIUII SAYINGS CERTIFICATEISI OF DEPOSIT TOTAL BALANCE 3,354.57 9,OBO.51 IB,537.62 37.~35.59 6B,~D8.29 LOAN ACCOUNTS OUTSTANDING CHECKING WITH INTEREST ACCOUNT 112-712-5423 ~~.Q.Y~:I1;~ .. MM OPEHING BALANCE AS OF 01/11/01 TOTAL DEPOSITS AND OTHER ADDITIONS INCLUDING INTEREST CREDITED THIS PERIOD TOTAL CHECKS AND OTHER HITHDRAHALS INCLUDING FEES AND CHARGES THIS PERIOD CLOSING BALANCE AS OF 02/09/01 3 ,~51. 72 +517.33 -61~.48 3,354.57 AVERAGE ACCOI.tIT BALANCE AVERAGE COLLECTED BALANCE FOR ANNUAL PERCENTAGE YIELD EARHED YOUR ANNUAL PERCENTAGE YIELD EARHED FOR THIS STATEMENT PERIOD IS 0.~6X 3,363.3'" 3,363.3~ DEPOSITS CHECKS DATE AND 'OTHER AND OTHER DAILY POSTED DESCRIPTION ADDITIONS HITHDRAHALS BALANCE 01/11/01 OPENING BALANCE 3,~51. 72 01/12/01 CHECK . ~68 . 21.59 3,430.13 01/16/01 MIse AUTOMATED DEBIT BANKERS LIFE 13607707~oINS PREM 980101~36010115 137.78 3,292.35 01/22/01 CHECK . ~69 . 23.00 3.269.35 8 Mellon Bank PERSONAL BANKING STATEMENT - . DEAN E PLETZ 00419 112-712-5423 PAGE 2 OF 5 CHECKING WITH INTEREST ACCOUNT 112-712-5423 (continued) . DATE POSTED DESCRYPnDN DEPOSITS CHECKS AND OTHER AND OTHER ADDITIONS HITHDRAHALS Z3.SZ 71.14 34.33 444.'Z 43.50 Z'.03 Z4.0D 1'.1' 6.60 157.94 94.00 1.Z7 .00. DAILY BAlANCE 0l/Z6/01 IlISC AUllIIlATED DEBIT BELL ATLANTIC 'ZZD397860PAYllENTS 717737555341594 . 01/31/01 IlISC AUllIIlATED CRED PA TREASURY DEPT 1Z360D3133ANNUITANT 1BBIZ4.38 IlISC AUllIIlATED DEBIT PP 1BO.S9590 ELEC BILL '34!.078009ltS . DZ/01/01 ,,: IlISC AUllIIlATED. CRED CllIItOIllEAL TH HAT 1ZH013BD3PENS PIlTS 1881Z493B IlISC AUllIIlATED DEBIT LOHER ALLEN ZZ360OSZ53LAT REFUSE 10_600 . IlISC AUllIIlATED DEBIT SUBURBAN CABLE Z316S.1411ACH SUBCAB OS3153101 11 . IlISC AUllIIlATED DEBIT LllIIER ALLEN ZBZl7BZ54LATA SENER 1084080300 . OVOS/01 IlISC AUllIIlATED DEBIT PAIlC 1008096660 PAYllENT 0655866 IlISC AUllIIlATED DEBIT AD&08OD-ZSZ-Z148 ,SZB6.100ZINS. PREH 634043906 CHECK . 947Z OV06/01 CHECK. 9471 DVO'/Ol INTEREST CREDIT SERVICE CHAIIGI;: . DZ/O'/Ol CLDSINIl BALANCE 3.Z4S.a3 3.Z8Z.64 3.631.03 3.447.30 3.353.30 3.3S4.&7 3.354.S7 . YOUR t1llNTIIL Y SERVICE CHARGE FOR THE SMART ACCOUNT. BANUNIl PLAN HAS BEEN HAlVED BECAUSE YOU NET THE DEPOSIT RELATIONSHIP BALANCE REllUIRENENT . - ""a ZI.S' DOOOOZ600Z6401. 9471* 94.00 000OOZao044706. * AN ASTERISK INDICATES A BREAK IN THE LISTINIl OF CONSECUTIVE CHECK IUBERS. PLEASE USE THE ACCOUNT RECONCILENENT FORM LOCATED ON THE LAST PAGE OF THIS STATEMENT TO BALANCE YOUR ACCOUNT. CLEAR OUT THAT HOLIDAY BILL PAYING CLUTTER. SIGN UP FOR ONLINE BILL PAYING AND START PAYING YOUR BILLS EASILY ONLINE. YOU CAN PAY VIRTUALLY ANYONE. SET UP FUTURE-DATED PAYMENTS AND RECURRING PAYMENTS WITH NO CHECK WRITING OR STAMP BUYING. SIGN UP AT WWW.MYMELLON.COM ~ Mellon Bank PERSONAL BANKING STATEMENT . DEAN E PLETZ 00419 112-712-5423 PAGE 3 OF 5 CHECKING WITH INTEREST ACCOUNT 160-070-0387 ~)"""'.)j......,. ... _', ,_, .'. "... .." .. "".' ","",+}",.1'-""".'_,,:.i{;;,.c.__,.,i , .., .. .. ".,'.. .." ',,"j' ".^:,_A..,~",_1"";J"I,-,"""_,,, q:Y;:j:i" . i'i'Pi.A'" <iWY Y';;Pi ";;w~jr:?-;'i;~t;''':;- .., "'1 \:'"i,:' OPENING BALANCE AS OF 01/11/01 TOTAL DEPOSITS AND OTHER ADDITIONS INCLUDING INTEREST CREDITED THIS PERIOD TOTAL CHECKS AND OTHER HITHDRAHALS INCLUDING FEES AND CHARGES THIS PERIOD CLOSING BALANCE AS OF D2/09/01 8,721.45 +1,251.06 -892.00 9,080.51 AVERAGE ACCOUNT BALANCE AVERAGE COLLECTED BALANCE FOR ANNUAL PERCENTAGE YIELD EARNED YOUR ANNUAL PERCENTAGE YIELD EARNED FOR THIS STATEIlENT PERIOD IS 2.86;( 9,076.95 9,057.94 DEPOSITS CHECKS DATE AND OTHER AND OTHER POSTED DESCRIPTION ADDITIONS HITHDRAHALS 01/11/01 OPENING BALANCE 01/ZS/01 DEPOSIT REF 100D002200507597 322.07 01/31/01 DEPOSIT REF 1000D02300184053 16.00 02/02/01 HISC AUTOHATED CRED us TREASURY 303 3031D36030SOC SEC 188124938A SSA 892.00 02/08/01 IIISC AUTOHATED DEBIT ACH RECLAIH 3031036030REVERSAL 188124938A SSA 892.00 02/09/01 INTEREST CREDIT 20.99 SERVICE CHARGE .00. 02/09/01 CLOSING BALANCE DAILY BALANCE 8,721.45 9,043.52 9,059.52 9,951.52 9,059.52 9.080.51 9,080.51 12.00 I . YOUR HONTHLY SERVICE CHARGE ISHOHN TO THE RIGHT) HAS BEEN HAlVED THIS HONTH BECAUSE YOU HET THE AVERAGE DAILY BALANCE REQUIREHENT IN YOUR CHECKING ACCOUNT. PLEASE USE THE ACCOUNT RECONCILEHENT FORH LOCATED ON THE LAST PAGE OF THIS STATEIlENT TO BALANCE YOUR ACCOUNT. CLEAR OUT THAT HOLIDAY BILL PAYING CLUTTER. SIGN UP FOR ONLINE BILL PAYING AND START PAYING YOUR BILLS EASILY ONLINE. YOU CAN PAY VIRTUALLY ANYONE, SET UP FUTURE-DATED PAYMENTS AND RECURRING PAYMENTS WITH NO CHECK WRITING OR STAMP BUYING. SIGN UP AT WWW.MYMELLON.COM 8 Mellon Bank PERSONAL BANKING STATEMENT ""- DEAN E PL ETZ 00419 112-712-5423 PAGE 4 OF 5 PREMIUM SAVINGS ACCOUNT 00355-071241 OPENItG BALANCE AS DF 02/0&1'01 ClOSINl; BAlANCE AS OF 02/0'/01 AYEIlASE ACClUfT BAlANCE FOR THE I1lINTH OF .I_V 18.537.62 la.537.62 18..'1.1. CERTIFICATE(S) OF DEPOSIT CERTIFICATE IUBER 01134590 li-AilO~-C TYPE ~ ~ FACE VAlUE 25.000.00 11.250.00 CURRENT VALUE 25.2".50 12.171.0' INTEREST RATE 6.2'X 5.ar/. ISSUE DATE 11/21/2000 10/08/1'" 1IA1UIlITY DATE 06"21"2001 12/08/2001 IF YOU HAVE QUESTIONS ABOUT THE INFORMATION CONTAINED IN THIS STATEMENT. PLEASE CALL THE MELLONDIRECT 24 CENTER FOR CUSTOMER SERVICE. THE NUMBER TO CALL IS 1 aDo 222-9034. REV-1510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Lean E. Pletz SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21-2001-0260 This schedule must be completed and filed jf the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY %OF EXCLUSION ITEM INCLUDE NAME OF THE TRANSFEREE, THEIR DATE OF DEATH DECO'S (IF TAXABLE VALUE RELATIONSHIP TO DECO & DATE OF TRANSFER. NO. ATTACH COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST APPLICABLE) 1 Salaron Smith Barney IRA Rollover 44,443.29 100% 3,000.00 41,443.29 Account - see attached valuation report TOTAL (Also enter on line 7, Recacitulation) $ 41,443.29 7 CPA., NTF 10910 <If more space is needed, insert additional sheets of the same size) Copyright Forms Software Only, 1997 Nelco, Inc. SALOMONSMITHBARNEY 717-7BO-17oo . 800-237-1700 A memberof c,tlgroup'" April 9, 2001 John S. Davidson Yost & Davidson 320 W. Chocolate Avenue P.O. Box 437 Hershey, PA 17033 Dear Mr. Davidson: For securities that Mark is holding the certificates; we will need an original death certificate, an original short certificate, a notarized affidavit of domicile, and a stock power signed by Mark for each security. These documents are required by the transfer agents for the securities. The following are needed by Smith Barney to establish an Estate account for deposit of those securities. Death Certificate Short Certificate/Letters of Testamentary Client Agreement signed by the Executor (enclosed) Tax ID Number for the Estate Instructions from Executor to transfer the assets We will need additional information from Mark to set up the account (he can come in or give me a call) For Mr. Pletz's IRA; Death Certificate Short Certificate/Letters of Testamentary IRA Application signed by Mark (enclosed) IRA Client Agreement signed by Mark (enclosed) IRA Distribution Form signed by beneficiary (enclosed) We will need additional information from Mark to set up the account (he can come in or give me a call) On the following page is a valuation of Mr. Pletz's IRA account 724-65313-18 for his date of death January 29, 2001. SALOMON SMITH BARNEY INC. 11 North 3rd Street. 2nd Floor. Harrisburg, PA 17101-1702 FAX 717-233-2090 Security Quantity Per share Total Value Money Funds 559.46 Colonial PPTYS Trust SBI 200 26.75 5,350.00 GPU Inc. 100 31.96 3,196.00 Prentiss PPTYS Trust 175 24.82 4,343.50 Verizon Communications 122 53.28 6,500.16 Owens Illinois CV PFD $2.375 110 14.50 1,595.00 SB Investment Grade Bond Fund A 512.842 11.85 6,077.18 SB Premium Total Retum Fund A 586.555 16.68 9,783.74 SB Diversified Strategic Income Fund A 998.334 7.05 7,038.25 44,443.29 If you need any additional infonnation, please give me a call. M ~ ~~ \\"s tt\.\~ o~ ~ (.tS ~ v-~\tf. ;.,...,,\~ sou'" :\ GUP' 5 '\v.t \~\~o \V.O~ ,p ~~,,\.t\t~ts . o,'\,..\~\.,~\.\., 0'" CO ,\0 * V; rJj'i-"C< \'\'3 ,,~ Sincerely, Robert Wilson Vice PresidenUlnvestments REV-1511EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Dean E. Pletz SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-2001-0260 Debts of decedent must be reDOrted on Schedule I. ITEM NO. A. FUNERAL EXPENSES: DESCRIPTION AMOUNT 1 partherrore Funeral Home 8,858.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN No. of Personal Representative(s) Street Address City State 0.00 Zip Year(s) Commission Paid: 2. 3. Attorney Fees Name: JOM S. Davidson Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 7,500.00 0.00 City Relationship of Claimant to Decedent State Zip 4. Probate Fees 369.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7 Mellon Bank - check printing charges 63.50 8 George C. Clauser Appraisals - real estate appraisal 275.00 9 Seidel and Associates - inccrne tax return preparation 100.00 10 Register of Wills - short certificates 90.00 7 CPA11 NTF 10911 Copyright Forms Software Only, 1997 Nelco, Inc. TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 17,255.50 REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Dean E. Pletz Include unreimbursed medical eXDenses. ITEM NO. DESCRIPTION SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS FILE NUMBER 21-2001-0260 AMOUNT 1 Erie Insurance Exchange - insurance premium due 525.00 2 Verizon - decedent's telephone bill 78.24 3 Cancast - decedent's tv cable bill 29.03 4 Pennsylvania American Water G::npany - decedent's water bill 5 pinnacle Health - decedent's medical bill 27.55 79.66 6 Patriot News - decedent's subscription bill due 33.25 7 PP&L - decedent's electric bill 51. 95 8 pinnacle Health - decedent's medical bill 398.91 9 pennsylvania Department of Revenue - decedent's estimated 2000 PA 40 income tax liability 513 . 00 10 US Treasury Department - decedent's estimated 2000 form 1040 tax liability 3,088.00 11 PP&L - decedent's final electric bill 23.56 12 Hematology and Medical Oncology Associates - decedent's physicians bill 120.00 13 CitiBank - decedent's credit card bill 86.18 14 Cytometry Associates - decedent's medical bill 15 Mary Ann Prior, Tax Collector - County and 'I'a>mship real estate taxes 100.61 422.99 16 Mary Ann Prior, Tax Collector - decedent's personal taxes 9.80 17 AT&T - decedent's final long distance telephone bill 4.87 18 Edgepark Surgical, Inc. - decedent's medical bill 37.60 19 Lower Allen Township - decedent's sewer and refuse bill 67.50 20 E. E. Latsha, Inc. - decedent's heating oil bill 88.23 Total fran continuation Dacre (s) 4, 973 .19 7 CPA12 NTF 10912 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 10,759.12 Copyright Forms Software Only, 1997 Nelco, Inc. Estate of: Dean E. Pletz SCHEIJJLE I -- Debts of Decedent, M::lrtgage Liabilities and Liens Item No. Description 21 The Franklin Mint - decedent's account debt 22 Ccmronwealth of Pennsylvania Department of Transportation - auto registration fee and decedent's returned check fee 23 Department of the Treasury - deoedent' s 2000 income tax liability 24 pennsylvania Department of Revenue - decedent's 2000 state income tax liability 'IOI'AL. (Carry forward to main schedule) . . . . . . Page 2 21-2001-0260 Arrount 43.19 66.00 4,485.00 379.00 4,973.19 REV-1513 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER Dean E. Pletz No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS Qnclude outright spousal distribulions) RELATIONSHIP TO DECEDENT Do Not List Trustee(s) 1 Mark E. Pletz 27 S. West Street ShireITl3I1Stown, PA 17011 son 2 Zeml:o Shrine Endo.vment Fund 2801 North 'Ihird Street Harrisburg, PA 17110 3 Harrisburg Consistory A.A.S.R. 2701 North third Street P.O. Box 2423 Harrisburg, PA 17110 4 Steelton-Swatara Lcx:ige No 775 F&AM 350 North Harrisburg Street Steelton, PA 17113 21-2001-0260 AMOUNT OR SHARE OF ESTATE 409,315.84 5,000.00 5,000.00 5,000.00 ENTER DOLLAR AMTS. FOR DlsmlBS. SHOWN ABOVE ON LINES 15 THROUGH 17 AS APPROPRIATE ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE None B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS See Schedule attached Total from continuation page (s) TOTAL OF PART II -- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 7 CPA13 NTF 10913 (If more space is needed, insert additional sheets of the same size) Copyright Forms Software Only, 1997 Nelco, Inc. 10,000.00 10,000.00 Estate of: Dean E. Pletz S01EOOLE J, Part 2 -- Charitable and Governrrental Distributions Item No. Des=iption 1 Arrerican Cancer Society, Pennsylvania Division Route 422 and Sipe Avenue P.O. BOx 897 Hershey, PA 17033 2 Shriners Hospital for Children P.O. Box 31356 Tampa, FL 33631-3356 3 Millers Cemetary Ass=., Hanoverdale Church 577 Hershey Road Hummelstown, PA 17036 TarAL. (Carry forward to main schedule) . . . . . . Page 2 21-2001-0260 Arrount 2,000.00 5,000.00 3,000.00 10,000.00 ~ I-' Register of Wills of CUMBERLAND County, Pennsylv.""~.", Certificate of Grant of Letters No. 2001-00260 PA No. 21-01-0260 ESTATE OF PLETZ DEAN E \UA~~, ~~Ko~, M~UUu~J Late of LOWER ALLEN TOWNSHIP ~UM~~KLANU CUUNTr, , WHEREAS, on the 9th lated November 29th 2000 Deceased Social Security No. l88-l2~4938 day of March 2001 an instn....~ ,as admitted to probate as the last will of PLETZ DEAN E (LA~T, rlH~T, M1UUL~) .ate of LOWER ALLEN TOWNSHIP 29th day of January 2001 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, MARY C. LEWIS , Register of Wills in and fo~ :he County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify :hat I have this day granted Letters TESTAMENTARY :0 MARK E PLETZ , CUMBERLAND County, who died on th~ Iho has duly qualified as Executor(rix) lnd has agreed to administer the estate according to law, all of which fully lppears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, :ARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal )f my Office the 9th day of March 2001. **NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE) .' . v , :-- , 21-2001-260 LAST WILL AND TESTAMENT OF DEAN E. PLETZ I, Dean E. Pletz, having my legal residence at 27 South West Avenue, Shiremanstown, Cumberland County, Commonwealth of Pennsylvania hereby declare this to be my Last Will and ,.- ,"",'-"....,,".,.......~>':\'i.i... Testament, revokiDg all other Wills and Codicils heretofore made by me. ITEM ONE: I direct that the expenses of my last illness and funeral be paid from my estate as soon as practicable after my death. ITEM TWO: I give the sum of Five Thousand ($5,000.00) Dollars to Harrisburg Consistory Heritage Builders Endowment Fund. ITEM THREE: I give the sum of Five Thousand ($5,000.00) Dollars to Zemba Shrine Endowment Fund. ITEM FOUR: I give the sum of Five Thousand ($5,000.00) Dollars to the Shriners Hospital for Crippled Children. ITEM FIVE: I give the sum of Five Thousand ($5,000.00) Dollars to the Marlin Looker Permanent Maintenance Memorial Fund of Steelton-Swatara Lodge No. 775 F&AM. ITEM SIX: I give the sum of Two Thousand ($2,000.00) Dollars to the American Cancer Society-capital Region Unit. .' \...i ',_i ITEM SEVEN: I give the swn of Three Thousand ($3,000.00) Dollars to Miller's Cemetery clo Hanoverdale Cemetery Association. ITEM EIGHT: I give all the residue of my estate to my son, Mark E. Pletz, if he survives me for a period of thirty (30) days. ""~'~~:': "',' ITEM NINE: Ifmy son, Mark, does not survive me for a period of thirty (30) days, I give all the residue of my estate in equal shares to such of my nieces and nephews as survive my death. At the time of the execution of this Will my living nieces and nephews are: Linda Fallin, Susan Sokolowski, Kathy Faltin, Gary Miller, Cheryl Gingerich and Sandra Canning. ITEM TEN: All estate, inheritance, succession and other death taxes, imposed or payable by reason of my death, and interest and penalties thereon, with respect to all property comprising my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid out of the principal of my general estate, as if such taxes were administration expenses, without apportionment or right of reimbursement. I authorize my legal representatives to pay all such taxes at such time or times as may be deemed advisable. ITEM ELEVEN: I appoint my son, Mark E. Pletz, Executor of this Will and direct that he be permitted to serve without bond and without any intervention of any court except as required by law. I authorize my Executor to sell, encwnber, mortgage, invest, distribute in kind, or retain any items of personal property of my estate in such manner as he shall deem proper, limited only by his own discretion. If for any reason my Executor appointed under this Will should fail to serve in that capacity, I appoint Mellon Bank, or its corporate successor, my Executor with the same powers and privileges set forth above. . v "t-'" IN WITNESS WHEREOF, I have at Hershey, Pennsylvania, this ;. ~ ~ day of !J(!;tJt.../It/" , 2000, set my hand and seal to this, my Last Will and Testament consisting of four (4) pages, including the acknowledgment. i.Lt:Z~L) Dean E. Pletz SI!;;JWP.~~.Il~?I~~~.~d decl,ared by Dean E. Pletz, the above named Testator, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence and in the presence of each other, have hereunto subscribed our names as witnesses. ~~~ 11 "'7 - ~J Residence Jt....'ab /fNa, ~ ~' '_,I Residence ~ /./ri < . v .,.... ACKNowLEDGMENT We, Dean E. Pletz, Jo (itJ /. J"'Jr/Jr.-J and N t2 ,I Lf S:AL'I' the Testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and that he had signed willingly (or willingly directed another to sign for him), and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witnesses and that to the best of their knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ., ~f~ ~Ai- r WITNESS n~~ Subscribed, sworn to and acknowledged before me by Dean E. Pletz, the Testator, and subscribed and sworn to before me by ~t1f(aJ f. )",J.~.".r and -1J/IU1:"1/ Sit 4. y' . witnesses, this J'91A day of ffiLlt>mbe.....- ,2000. { f ~J,a .--?~~L - NOTARYP L1C pletzd.wilI6-00 I.:=~.~ I BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX OIVISION PO BOX 2801i0l HARRIS8URG PA 17128-01i0l COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ~C(,(V'\nCI\ n~l="lrI!ntERITANCE TAX '~':::'~~,J.':~ ::$.'t:~"fE'MENT OF ACCOUNT ;.-\t, '11" I'" '." ; ! "'!I' I I, I j \...A' \...' I ; ,-I: ~ ~ I Tl...,..,) '* REV-l1i07 EX AFP (03-05) MARK E PLETZ 27 S WEST AVE SHIREMANSTOWN CLERK OF ORPHAN'S COURT CUM2F:J[/'.'''ID CO, PA DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 06-18-2007 PLETZ 01-29-2001 21 01- 0260 CUMBERLAND 01119925 DEAN E 2001 JUN 29 PH I: 22 Amount Remitted PA 17011 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 RECORDS +- REV-1607 EX AFP (03-05) --------------------------------------------------------------------------- *** INHERITANCE TAX STATEMENT OF ACCOUNT *** 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. ESTATE OF PLETZ DEAN E FILE NO.21 01-0260 ACN 01119925 DATE 06-18-2007 DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 03-18-2002 PRINCIPAL TAX DUE: 13.01 PAYMENTS (TAX CREDITS): INT AT REV PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) EREST IS CHARGED THROUGH 07-03-2007 TOTAL TAX CREDIT .00 THE RATES APPLICABLE AS OUTLINED ON THE ERSE SIDE OF THIS FORM.* BALANCE OF TAX DUE 13.01 INTEREST AND PEN. 4.24 1I IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 17.25 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. { IF TOTAL DUE IS LESS THAN .1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" {CRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J ~ \ 16 -c2/6-1y BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE . NOTICE OF INHERITANCE TAX APPRAISEKENTL ALLOWANCE OR DISALLOWANCE OF DEDUCTION~, AND ASSESSKENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-1548 EX AFP <01-02) i ~;. ,i '02 i\PFc-1 ~(\ =~ DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 03-25-2002 PLETZ 01-29-2001 21 01-0260 CUMBERLAND 188-12-4938 01119925 DEAN E MARK E PLETZ 27 S WEST AVE SHIREMANSTOWN P~~l;ltO~l 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-1548 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 03-25-2002 ESTATE OF PLETZ DEAN E DATE OF DEATH 01-29-2001 COUNTY CUMBERLAND FILE NO. 21 01-0260 S.S/D.C. NO. 188-12-4938 TAX RETURN WAS: (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 01119925 FINANCIAL INSTITUTION: MELLON BANK ACCOUNT NO. 162-106-1215 TYPE OF ACCOUNT: DATE ESTABLISHED ( ) SAVINGS (X> CHECKING ( ) TRUST ( ) TIME CERTIFICATE 08-20-1971 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due x 578.06 0.500 289.03 .00 289.03 .45 13.01 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." X TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) INTEREST IS CHARGED THROUGH 04-02-2002 TOTAL TAX CREDIT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 13.01 REVERSE SIDE OF THIS FORM INTEREST AND PEN. .40 TOTAL DUE 13.41 IF PAID AFTER THIS DATE, 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 DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) /6 .;2 A6--/-;/ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT * BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 REV-l'07 EX AFP (12-00) Race c Res;~ ()T DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 12-24-2001 PLETZ 01-29-2001 21 01-0260 CUMBERLAND 101 DEAN E JOHN S DAVIDSON YOST & DAVIDSON PO BOX 437 HERSHEY .02 JAN -4 P12 :04 Allount Rellitted ."" c..;; B r t\ PlUJt?lNi3d, .. -. "1 pj\ MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLEI PA 17013 NOTE: To insure proper credit to your account 1 subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV = i6"ifj-EX--AFP--fi"2-:offf------...--iNifERiYANC"E--TAX--STAfEM"E-N"T-ifF-AC-Couirf--.-..---------------- - - --- ESTATE OF PLETZ DEAN E FILE NO.21 01-0260 ACN 101 DATE 12-24-2001 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 DUEl APPLICATION OF ALL PAYMENTSI THE CURRENT BALANCE 1 ANDI IF APPLICABLE 1 A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-10-2001 P R I NC I PAL TAX DUE: ...................................................................................m..........................................................m......mmm.mm..mm.......m.m............................ 201669.21 PAYMENTS (TAX CREDITS): BAL PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-07-2001 CDOO0496 30.00- 201699.21 ANCE OF UNPAID INTEREST/PENALTY AS OF 11-08-2001 TOTAL TAX CREDIT 201669.21 BALANCE OF TAX DUE .00 INTEREST AND PEN. 15.95 . IF PAID AFTER THIS DATEI SEE REVERSE TOTAL DUE 15.95 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $11 NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)1 YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) ~ / b- c:2/~-- /y 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 RecorCh~C Recir;.':s DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 12-17-2001 PLETZ 01-29-2001 21 01-0260 CUMBERLAND 101 .01 Ole 27 A10:l1 JOHN S DAVIDSON YOST & DAVIDSON PO BOX 437 HERSHEY ClerK .cAurm:s tfj.f' .,.~ " ,.'- "-_ .A t i '. PA *' REV-1S47 EX AFP 112-00) DEAN E Amount Remitted ) CHANGED (1) (2) (3) (4) (5) (6) (7) 124,000.00 216,249.61 .00 .00 80,637.56 .00 41,443.29 (8) 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 ~ RE-V =is'4j-Ex-AFP--fi"2-:oo1--NoT-icE--oF-.rNHEififAifci-YAX-A-PPRA-isEi.rENT~--ALi-owAifci-iri----------- - - - - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF PLETZ DEAN E FILE NO. 21 01-0260 ACN 101 DATE 12-17-2001 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. 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 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 I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ Abh 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 (16J 17. Amount of Line 14 at Sibling rate (17J 18. Amount of Line 14 taxable at Collateral/Class B rate (18J 19. Principal Tax Due TAX CREDITS: NOTE: 17,255.50 10.759.12 (11J (12J (13) (14) (9) (10) .00 X 00 = 409,315.84 X 045 = .00 X 12 = 15,000.00 X 15 = (19J= NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 462,330.46 28.014 62 434,315.84 10,000.00 424,315.84 .00 18,419.21 .00 2,250.00 20,669.21 PAYMENT RECEIPT DISCOUNT (+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) INTEREST IS CHARGED THROUGH 01-01-2002 TOTAL TAX CREDIT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 20,669.21 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 325.02 TOTAL DUE 20,994.23 . 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" (CRJ, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.J "v /b-r:::2~ /y BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT * REV-1U7 EX AFP (12-00) JOHN S DAVIDSON YOST & DAVIDSON PO BOX 437 HERSHEY '01 OIC 27 A10 :07 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 12-17-2001 PLETZ 01-29-2001 21 01-0260 CUMBERLAND 101 DEAN E Recc((j~~'~ at Re'~j1 ~~c,t.:-~-j Allount Rellitted C~erK' . "JT ('ltf\1 tJ~;Q ~ i3" F,li, 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 ~ RE-V =i6cfi-Ex--AFP--fi2":ofjr------...--iNirERIi'-ANc'E--TAx--sTAfEM'E-tiT-ifF'-Ac-couii"f--.-..--------------- - -- - -- ESTATE OF PLETZ DEAN E FILE NO.21 01-0260 ACN 101 DATE 12-17-2001 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 12-17-2001 P R I NC I PAL TAX DUE: ........................................................................................................................................................................................................................... 20,669.21 PAYMENTS (TAX CREDITS): BAL PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-07-2001 CDOO0496 30.00- 20,699.21 ANCE OF UNPAID INTEREST/PENALTY AS OF 11-08-2001 TOTAL TAX CREDIT 20,669.21 BALANCE OF TAX DUE .00 INTEREST AND PEN. 15.95 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 15.95 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) 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 DAVIDSON JOHN S 320 WEST CHOCOLATE AVE HERSHEY, PA 17033 _nn_n fold ESTATE INFORMATION: SSN: 188-12-4938 FILE NUMBER: 2 1 - 2001 - 0260 DECEDENT NAME: PLETZ DEAN E DATE OF PAYMENT: 12/26/2001 POSTMARK DATE: 12/21/2001 COUNTY: CUMBERLAND DATE OF DEATH: 01/29/2001 NO. CD 000696 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1 5.95 I I I I I I I I TOTAL AMOUNT PAID: $15.95 REMARKS: JOHN S DAVIDSON ESQ CHECK# 21571 SEAL INITIALS: AC RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS 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 DAVIDSON JOHN S 320 WEST CHOCOLATE AVE HERSHEY, PA 17033 -------- fold ESTATE INFORMATION: SSN: 188-12-4938 FILE NUMBER: 21-2001- 0260 DECEDENT NAME: PLETZ DEAN E DATE OF PAYMENT: 11/07/2001 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 01/29/2001 NO. CD 000496 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $20,699.21 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: MARK E PLETZ CHECK# 1031 SEAL INITIALS: SK RECEIVED BY: $20,699.21 MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS