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Home My WebLink About01-0358Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Ronald 0 . Ke im also known as Elaine M. Spriggs Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or'B' BELOW:) Deceased No. 21-01-358 Social Security No. 187-09-8753 A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the executnarrledha the last Will of the Decedent, dated 05/09/19916 codicil(s) dated None R~..~N. ~ c . Kam: s, zoo t State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: B. Grant of Letters of Administration (c.t.a.; d.b.n.c.t.a; pendente liter durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: or principal residence at 1700 Market Street Decedent, then 88 years of age, died 02/20/2007at H i 11 ~ij,,,,,m ~,{ e~e. k~%~/ZOf-C~ (list street, number, and unicipality) ( Manor Care Health Services, PA (Location) Decedent 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: X30, Ofi~/ Oa"' /~, - ~ ~~ - ~/y Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form f~N/-~ (1991) (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her last family Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the aoorooriate form to the itnrtarsinneri• Oath of Personal Representative Commonwealth of Pennsylvania 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 knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law,~/~ ~ Sworn to or affirmed and subscribed /~ r V Elaine M. Spriggs before me this 5 th1aY of APRIL 2001 ~,i~~/. For the R No. 21-01-'i 5R Estate of Ronald O _ Kai m Deceased Social Security No: 18 7 - 0 9 - 8 7 ate of Death: AND NOW, APRIL 5, 2001 Attorney: Jeffrey R. Boswell, Esquire in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, _.,. _ IT IS DECREED that Letters ~tamentary f A ministration ~-" ;' _ - (c.t.a.; d.b.n.c.t.a.; pendente life; durante absentia; durante minoritate) are hereby granted to Elaine M. Spriggs ~, in the above estate and that the instrument(s) dated 05/09/1996 - described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ........... $ 60.00 Short Certificate(s) .... . $ 15.00 Renunciation........ $ 5.00 Affidavits ( ) $ Extra Pages ( ) .... $ 24.00 Codicil. $ JCP Fee. $ 5.00 Inventory. $ Other .... $ I.D. No: 25444 02/20/2001 Boswell Tintner Piccola Wicker Address: 315 N. Front Street Y. 0. Box 741 Harrisburg, PA 17100-0741 Telephone: 717/236 - 9377 TOTAL ......... $ 109.00 Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Fonn f3H/-f (1991) RENUNCIATION 21-O1-358 In Re Estate of ~ ~ N ~ L~ ~ - K E ~ M. To the Register of Wills of Cvr~.(~£2L/~N I) deceased. County, Pennsylvania. ~ A ~ ~ , ~-= r M - Co - rXEC v~-v 2 of The undersigned the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters be issued to ~ ~ ~ ~ `~ E N1, Sp R I c; G S WITNESS hand this ~~ day/~of ~p ~' ~ , ~o ~ ~~~:~ ~~ (Signature) j D 3 `~ Co~:~-~ Qy Cc. v4 ~o A 0 C ~P Nr~~ ~q ~-ao~l A ' ((Address) 9 xrv~ /O~ r F-1'~1~ /' n,..~ i.,... '~c~L~ i/ ~..ol,t`n/ ~v.ru O /~ /1 r~~..~-may ~ /~pne~yr~~ Zr / ~~ (Signs/tore) / (Address) -- ~. (Signature) (Address) ~n5r n5 o,n- This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 7177376 //ice d ~,~-'r ~ Local Registrar r !/" F~~ 2 2 2~Q1 No. 21-O1-358 Date Rw. 2187 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH STATE FKE W .....,c ..r ..c~c.rcnr Irnar. mgae. Law/ SE% SOCIAI SECURITY NUMBER DATE OF OEATH,Madt. pay-'•ear) +- Ronald O Keim . ~•Male ~• 187 - 09 - 75 a~'e r ADE (lea &rmoaY) UNDER , YEM UNDER ,DAD' DQE OF BBTTH BIifTHPIACE ICay and PI.ACF OF DEQH ICneclr only rxy -- »a ~nsrucuar on oerer sa»I ' MaaM r Days Hour = MNUIw !MOnIn. Oay A,wl SM»aFUapn CauNry) HOSPITAL: OTHER: 88rre. ~ Mar. 3,1912 Steelton, PA IrtpalaaM ^ ERlOtapsl»M ^ ow ^ „~ ~ Readartce ^ ° ~. ^ r ; ,, N. C.OUNTr OF OERN CRY, BORO. TWP OF DEATH FACR-fTY NAME 01 nq ~nympgn. 9~w sUeal arq numoari NNS DECEDENT OF HISPANIC ORIGIN? RACE • Amnlcan MlAian. Syck, WnRa etc . . CtHOberland No ~] ~.. ^ n Yee. Nncb CuGn, ~a+') damp Hill Mearean.PuargRican,we. Manor Care N H „ . . t0. White DECEOEM' USUAL OCCUPRgN gNOOF BUSINESSIINDUSTRr YwS DECEDENT EVER IN DECEDENT'SEa1CR10N • MARITAL STATUS-Mart»d IGwe Mrrdaaratr da»Durnnpp meal U.S.MMEO FORCES? c Navar~~ SURVIVING SPOUSE a waain YYfoonad M» d t . p - ; o no uw rafrad I E»meMeryl$acardary CoWpa Diwrpd lY wh. piw nurdan narnel Ya a Np ~ ~ ,,..Federal Gov't 1, • a S.I „~ ~~- +~• ,.married Fee L Clouser DECED T' „ . EN S MAILING ADDRESS (Straw, Caylb.n, SMIa. ZO Codel DECEDENT'4 'I_ ACTUAL n..s»»_~A ~ ,Ta.^ ~.~h 1700 Market Street RESIDENCE a.c.a.n IeP. ~n tll,a ~`.,°"" C~.unberland IM m a ,w Hill PA 17011 ,m.cwq 10"'wnO~ nd ~I wran°icacn~wM"r'°Ya Camp Hill , FRHER'S NAME (Frw. Mgoq. Las) cMYraero. A10THER'S NAME IFrw. MidNe. Masten Saname) ,.. J. Earl Keim ,,. Elsie B. Donnell ' INFDiMAANT 4 NAME (TYDarprwl INFORMANT'S MAlJNGADDRESS l5vaw. Cay/Town, S»». Zip Cods) Mrs El ine ri METHOD tic asPO~T1DN DRE OF DISPOSITION PIACE OF asPOSngN • a Cemwery. Cnmway ION - , Slav. Zip Cods Burial ~ Gamation ^ Ramovw from Sla» ^ ~~. aY• ~) a OUw PMq ^ • l+oratwiorl onwlsparyl ^ ~~ruary 23, 2001 ~urchville Cem e :,Qberlin PA 17113 BIGNATU F EN ACTWfi A6 SUCH ICENSE NUMBER NAYS AND ADDRESS OF FACAITV ! _ 112 N. Harrisb St. CorrrO»le p7FOart1)r wltart Grltlyetp IlnyaicrMt avaMaO» el um. a a.ln q Vla Dew~Tde~w»apa, wam occurred allM Ume. da»arttl plats Nalad. ) LICENSE NUMBER ORE SgNEO candy a eeatn. (Marl ay. ww) ~'' rye. Marv 44T, rawly oonplwW D,' OF DEATH DATE PRONOUNCED DEAD IMaan, DaY•lear) WAS CASE REFERRED TO MEDICAL EXAAAINER/CORONEM/ ParsonwM prorgrrgaa WaN. ¢ t1. ~ ~ ~ V .S M ~ ^ Noll 23 -" O (~ ~ . . V M 77. FAIR I: En»r Ilte disMSaa. "vywisa a canpacalgris adaLn uuaW tM dsatn Oo erase IM ngrh of oymp, auto as cardac or re alo anus, a Marl hiluw. I ~ipcMe tgaEtlorta » ~~, Dta LM aey tiro rauw on eaU lino. ~' Appoaimwe PMT B: Otl»r I rasrN! N Bte ttlldN/ytrtp Ursa pavan in PMT I. IrYEOIAT! CAUS[ (Prow t aWl andn ~' 1 Dl1E roIDR AS A CONSEQUENCE GF): Seettarrtraelr sal aarldMiorM D. ~ am ~q~ DIIE IOpR ASACONSEOUENCE Oi): c . I CAY!! IOalear a •MrrY c. + ere a.W W awrw Ol1E TO (OR AS A CONSEQUENCE OFl~ r retMYlp n daaell LABT 0 WIA9 AN AUTOPSY WERF AUTOPSY FWDINGS MANNER OF DEATH DATE OF MUURY TIME OF IWURY IWURYRMRTRK? DESCRIBE HOW IWURY OCCURRED. PERFORMED? NaUTABLE PgIpRro IMmm DaY ,Marl . . COMPLETION Of CAUSE ~y ^ OF OF.rVM Nwurw LJ Hom~ciW AtcidaM ^ Pentarp trtwalrgatgn ^ vLa ^ Na ^ r-~ ,_,/ Yb ^ No L7 rya ^ No 1, Suici6 ^ CarM ra W a»nnmM ^ PLACE of MLURr ~ AI soma mrm want I M. acta alDce OC Q . . . y. L r 10N f4traw. CaWTOwn. SWp Iwad»p, att. ISpacar) 7M. ZM. a, - ClIITwIFJI ICnaca arwy orw ~'- ~. 'ClATWIND PNYlICIM IPnysrcancntayuq cau5etldaaN wfrsnanoMrer onvsa:~an NS pondmca0 seam antic SM.tarQU Tltt OF R To tlN trace of wy trnow»dpe, Matlt oaumd dw M Y,e c ompwte0 nem 231 susses) arW manner a soled ............................... ...................... D 'PRONOWICIND AND CERTIFYING -HYSICIM IPnysCNn OOrn prMprrci ueaar arM Carta LICENSE NUMBER o - DATE Dl ,QaY. lbarl TO BN Gaaet krle n9 wr9 q<ausatldeaml ^ ,q O: C? yI 6 Y MYAOa. MaN eccwnd al U,s Yeta, dau, and plats and due to Ure cauaals) and mann Z % p l '~ . er u a4ted .......................... 7,e. X10. . NAME AND ADDRESS Of PERSON WHO COMPLETED CAUSE OF DEIPH ' MEDICAL E)IAMINlRICORONER (llem 27) Type Or Print ~ r ~,A ~ " " On IM Gal. W nemine,len anNa InveaOpalion, in my opinion, deNh occwnd el LM Lime, dHe 6.`f~ `~ and place and dw to Ilte c mann d l d , , ause(s) an er u s ate K /0 9 ........... ......................... ^ 3ta. ....................................................... .. REGISTRM/S~SS~'e7~~ATURE ANON MBER / ~ ~ u• ~r~~' ~~ ~'O yj P', DATE FILED IMOron. DaY. tMSI ~ ~ Cti%~"Z-¢'f/~~cls~- IL-.~ / // ~ Sl. L+(/.f1iY!/ ~ q -y ) ~v~ ~/C- ~. oS oS of V v l ' x.21-O1-358 LAST WILL OF RONALD O. KEIM JEFFREY R. BOSWELL, ESQUIRE BOSWELL, SNYDER, TINTNER & PICCOLA 315 North Front Street Harrisburg, Pennsylvania 17101 LAST WILL AND TESTAMENT OF RONALD O. KEIM Introductory Clause ............................................ 1 ITEM I Direction to Pay Debts ......................................... 1 ITEM II Direction to Pay All Taxes from Residuary Estate ..................... 1 ITEM III Outright Gift of All Property to Wife, Contingent Gift to Issue ............ 1 ITEM IV Naming the Personal Representative, Personal Representative Succession, Personal Representative's Fees and Other Matters ................ 2 (1) Naming Individuals as Personal Representative .................. 2 (2) Individual Personal Representatives Succession .................. 2 (3) Fee Schedule for Individual Personal Representative .............. 2 ITEM V Definition of Personal Representative .............................. 2 ITEM VI Powers for Personal Representative ................................ 2 ITEM VII Discretion Granted to Personal Representative in Reference to Tax Matters ................................................ 3 ITEM VIII Definition of Children .......................................... 3 ITEM IX Definition of Words Relating to the Internal Revenue Code .............. 4 ITEM X Statement by Testator of Intent Not to Exercise Power of Appointment ..... 4 ITEM XI Simultaneous Death Provision Presuming Beneficiary Predeceases Testator .. 4 Testimonium Clause ........................................... 5 Attestation Clause ............................................. 5 LAST WILL AND TESTAMENT OF RONALD O. KEIM Introductory Clause. I, RONALD O. KEIM, a resident of and domiciled in the Township of Lower Allen, County of Cumberland and Commonwealth of Pennsylvania, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils at any time heretofore made by me. I am married to FAE C. KEIM. I have two living children: ELAINE M. SPRIGGS and LINDA KAY KEIM. ITEM I Direction to Pay Debts. I direct that all my legally enforceable debts, secured and unsecured, be paid as soon as practicable after my death. ITEM II Direction to Pay All Taxes from Residuary Estate. I direct that all estate, inheritance, succession, death or similar taxes (except generation~skipping transfer taxes) assessed with respect to my estate herein disposed of, or any part thereof, or on any bequest or devise contained in this my Last Will (which term wherever used herein shall include any Codicil hereto), or on any insurance upon my life or on any property held jointly by me with another or on any transfer made by me during my lifetime or on any other property or interests in property included in my estate for such tax purposes be paid out of my residuary estate and shall not be charged to or against any recipient, beneficiary, transferee or owner of any such property or interests in property included in my estate for such tax purposes. ITEM III Outrieht Gift of All Property to Wife. Continent Gift to Issue. I give, devise and bequeath all the rest, residue and remainder of my property of every kind and description (including lapsed legacies and devises) wherever situate and whether acquired before or after the execution of this Will, absolutely in fee simple to my wife, FAE C. KEIM, if she shall survive me. If she shall not survive me, then I give, devise and bequeath all of the property to my surviving children in equal shares, provided, Page 1 however, the then living issue of a deceased child of mine shall take per stirpes the share their parent would have taken had he or she survived me. ITEM IV Naming the Personal Representative. Personal Representative Succession Personal Representative's Fees and Other Matters. The provisions for naming the Personal Representative, Personal Representative succession, Personal Representative's fees and other matters are set forth below: (1) Naming Individuals as Personal Representative. I hereby nominate, constitute, and appoint as Personal Representatives of this my Last Will and Testament FAE C. KEIM and ELAINE M. SPRIGGS and direct that they shall serve without bond. (2) Individual Personal Representatives Succession. If any individual Personal Representative should fail to qualify as Personal Representative hereunder, or for any reason should cease to act in such capacity, the remaining individual Personal Representatives shall continue to serve without a successor or substitute. (3) Fee Schedule for Individual Personal Representative. For its services as Personal Representative, the individual Personal Representative shall receive reasonable compensation for the services rendered and reimbursement for reasonable expenses. ITEM V Definition of Personal Representative. Whenever the word "Personal Representative" or any modifying or substituted pronoun therefor is used in this my Will, such words and respective pronouns shall include both the singular and the plural, the masculine, feminine and neuter gender thereof, and shall apply equally to the Personal Representative named herein and to any successor or substitute Personal Representative acting hereunder, and such successor or substitute Personal Representative shall possess all the rights, powers and duties, authority and responsibility conferred upon the Personal Representative originally named herein. ITEM VI Powers for Personal Representative. By way of illustration and not of limitation and in addition to any inherent, implied or statutory powers granted to Personal Representatives generally, my Personal Representative is specifically authorized and empowered with respect to any property, real or personal, at any time held under any provision of this my Will: to allot, allocate between principal and income, assign, borrow, buy, care for, collect, compromise claims, contract with respect to, continue any business of mine, convey, convert, deal with, dispose of, enter into, exchange, hold, Page 2 improve, incorporate any business of mine, invest, lease, manage, mortgage, grant and exercise options with respect to, take possession of, pledge, receive, release, repair, sell, sue for, to make distributions or divisions in cash or in kind or partly in each without regard to the income tax basis of such asset, and in general, to exercise all the powers in the management of my Estate which any individual could exercise in the management of similar property owned in his or her own right, upon such terms and conditions as to my Personal Representative may seem best, and to execute and deliver any and all instruments and to do all acts which my Personal Representative may deem proper or necessary to carry out the purposes of this my Will, without being limited in any way by the specific grants of power made, and without the necessity of a court order. ITEM VII Discretion Granted to Personal Representative in Reference to Tax Matters. My Personal Representative as the fiduciary of my estate shall have the discretion, but shall not be required when allocating receipts of my estate between income and principal, to make adjustments in the rights of any beneficiaries, or among the principal and income accounts to compensate for the consequences of any tax decision or election, or of any investment or administrative decision, that my Personal Representative believes has had the effect, directly or indirectly, of preferring one beneficiary or group of beneficiaries over others; provided, however, my Personal Representative shall not exercise its discretion in a manner which would cause the loss or reduction of the marital deduction as may be herein provided. In determining the state or federal estate and income tax liabilities of my estate, my Personal Representative shall have discretion to select the valuation date and to determine whether any or all of the allowable administration expenses in my estate shall be used as state or federal estate tax deductions or as state or federal income tax deductions and shall have the discretion to file a joint income tax return with my wife. ITEM VIII Definition of Children. For purposes of this Will, "children" means the lawful blood descendants in the first degree of the parent designated; and "issue" and "descendants" mean the lawful blood descendants in any degree of the ancestor designated; provided, however, that if a person has been adopted, that person shall be considered a child of such adopting parent and such adopted child and his or her issue shall be considered as issue of the adopting parent or parents and of anyone who is by blood or adoption an ancestor of the adopting parent or either of the adopting parents. The terms "child;' "children;' "issue;' "descendant" and "descendants" or those terms preceded by the terms "living" or "then living" shall include the lawful blood descendant in the first degree of the parent designated even though such descendant is born after the death of such parent. Page 3 The term "per stirpes" as used herein has the identical meaning as the term "taking by representation" as defined in the Pennsylvania Probate Code. ITEM IX Definition of Words Relating to the Internal Revenue Code. As used herein, the words "gross estate;' "adjusted gross estate;' "taxable estate;' "unified credit;' "state death tax credit," "maximum marital deduction;' "marital deduction;' "pass," and any other word or words which from the context in which it or they are used refer to the Internal Revenue Code shall have the same meaning as such words have for the purposes of applying the Internal Revenue Code to my estate. For purposes of this Will, my "available generation~skipping transfer exemption" means the generation-skipping transfer tax exemption provided in section 2631 of the Internal Revenue Code of 1986, as amended, in effect at the time of my death reduced by the aggregate of (1) the amount, if any, of my exemption allocated to lifetime transfers of mine by me or by operation of law, and (2) the amount, if any, I have specifically allocated to other property of my gross estate for federal estate tax purposes. For purposes of this Will if at the time of my death I have made gifts with an inclusion ratio of greater than zero for which the gift tax return due date has not expired (including extensions) and I have not yet filed a return, it shall be deemed that my generation-skipping transfer exemption has been allocated to these transfers to the extent necessary (and possible) to exempt the transfer(s) from generation-skipping transfer tax. Reference to sections of the Internal Revenue Code and to the Internal Revenue Code shall refer to the Internal Revenue Code amended to the date of my death. ITEM X Statement by Testator of Intent Not to Exercise Power of Appointment. I hereby refrain from exercising any power of appointment that I may have at the time of my death. ITEM XI Simultaneous Death Provision Presuming Beneficiary Predeceases Testator. If any beneficiary and I should die under such circumstances as would make it doubtful whether the beneficiary or I died first, then it shall be conclusively presumed for the purposes of this Will that the beneficiary predeceased me. Page 4 Testimonium Clause. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my seal this ~ day of May, 1996. rf~ /Q (SEAL) RONALD O. KEIM Attestation Clause. The foregoing Will was this 9thday of May, 1996, signed, sealed, published and declared by the Testator as and for his Last Will and Testament in our presence, and we, at his request and in his presence, have hereunto subscribed our names as witnesses on the above date. of ~ _ ~ - ~ Page 5 PROOF OF WILL Commonwealth of Pennsylvania County of Dauphin Self-Proving Affidavit We, RONALD O. KEIM, and Jeffrey R. Boswell and Connie L . Hardy ,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 witness and to the best of our knowledge the Testator was at that time eighteen years of age or older, of sound mind, and under no constraint or undue influence. Subscribed, sworn to, and acknowledged before me by RONALD O. KEIM, the Testator and subscribed and sworn to before me by _Jeffrey R. Boswell and Connie L. Hardy ,witnesses, this 9th day of May, 1996. eal) Notary Public for Pennsylvani My Commission Expires: 12 / 13 / 9 8 ,~._._ - S,QRA's-i E. ~~i~i.~:5j', i~®t~ry '~bEit My Cornrrabssic~r~ ~~~ar~~~+~c. i:3, e99Fi 1-lar~risburg,. P.~4 t~~~-~~i~ ~~~nty Page 6 RONALD O. KEIM .."..101-358 POWER OF ATTORNEY I, FAE C. KEIM, of 824 Lisburn Road, Apartment 304, Camp Hill, County of Cumberland, and Commonwealth of Pennsylvania, do hereby appoint my husband, RONALD O. KEIM, 824 Lisburn Road, Apartment 304, Camp Hill, Pennsylvania 1?011, and my daughter, ELAINE SPRIGGS, of 1039 Country Club Road, Camp Hill, Pennsylvania, to be my true and lawful attorneys-in-fact, to act jointly or individually for me, and as my attorneys-in-fact may transact all of my business for me and in my name and stead manage all my property and affairs as completely as I myself might do if personally present, including but not limited to, exercising the following powers. 1. Ezsctrrioa os Cotes. To enter into, perform, modify, extend, cancel, compromise, enforce, or otherwise act with respect to any contract of any sort whatsoever - including but not limited to, leases and mortgages - and to pay any money or to transfer title and possession to any real or personal property that may be required to be paid or transferred by any contract or in the performance of any obligation entered into or incurred by me or on my behalf. 2. Iavss~rs. To invest in all forms of real and personal property without any restriction whatsoever as to the kind of investment, including but not limited to, United States Treasury Bonds which are redeemable at par in payment of federal estate taxes. 3. Raaisssa-sioa os PaopffitTS. To hold property unregistered or in the name of a nominee. 4. P~esos~. Pstop$aTi. To buy or sell at public or private sale for cash or credit or partly for each, exchange, pledge, lease, give or acquire options for sales or exchanges or leases, or by any other means whatsoever to acquire, dispose of, repair, alter or manage tangible or intangible personal property or any interest therein; and,_without limitation, with respect to any securities, to comply with any securities laws or regulations, to execute indemnity agreements, to purchase insurance and to pay commissions or discounts required by any underwriting. 5. Rr~r. Paopsass. To buy or sell at public or private sale for cash or credit or partly for each, exchange, mortgage, encumber, lease for any period of time, give or acquire options for sales, purchases, exchanges or leases, dedicate, or by any other means whatsoever to acquire or dispose of real property or any interest therein; to partition and subdivide real property; to manage real property; to repair, alter, erect, or tear down any structure or part thereof; and to file such plans, applications, or other documents in connection therewith and to do such other acts as may be requested by any government or other authority having or purporting to have jurisdiction. 6. Bosiagss/Pao~ssioe. To continue and operate any business owned and/or operated by me and to do any and all things deemed needful or appropriate by my attorneys-in-fact, including the power to incorporate, to add additional capital, to enter into buy-sell agreements, to close-out, liquidate or sell the business, to make an orderly disposition of a professional practice, all at such time and upon such terms as my attorneys-in-fact shall deem best. 7. SscmtiTiss. To vote in person or by proxy at any meeting, to join in any merger, reorganization, voting-trust plan or other concerted action of security holders, to make payments in connection therewith, and in general to exercise all rights of a security holder. 8. INSUSAxCB. To procure, alter, extend or cancel insurance against any and all risks affecting property and persons, and against liability, damage or claim of any sort; and to exercise any non-forfeiture provisions of life insurance policies. To deal with and collect proceeds from health and/or long-term care insurance. 9 • Ra~rir. arc. , Proms. To deal with retirement plans, including but not limited to individual retirement accounts, roll- overs, voluntary contributions, changing the ownership or -2- beneficiary designations on such accounts, plans and/or annuities and waiving non-employee spousal rights. 10. Es'ris. To collect amounts due me and qualify me for various government entitlements, such as Medicaid, Social Security, or supplemental Social Security, including the power to renounce or disclaim an inheritance and/or insurance proceeds. 11. LoASS. To borrow money in such amounts for such periods and upon such terms as my attorneys shall deem proper and to secure any loan by the mortgage or pledge of any property, and I specifically authorize my attorneys to borrow money and to pledge property as collateral for the purpose of purchasing United States Treasury Bonds which are redeemable at par in payment of federal estate taxes. 12. Bic AccovliTS. To sign checks, drafts and other instruments or otherwise make withdrawals from any checking, savings, transaction or other deposit account in my name, and to endorse checks payable to me and receive the proceeds thereof in cash or otherwise; to open and close checking, savings, transaction or other deposit accounts in my name; to purchase and redeem savings certificates, certificates of deposit or similar instru- ments in my name; to execute and deliver receipts for any funds withdrawn or certificates redeemed; and to do all acts regarding any checking account, savings account, savings certificate, certificate of deposit or similar instrument which I now have or may hereafter acquire, the same as I could do if personally present. Any financial institution may continue to rely on this power of attorney until it receives written notice from me that this power of attorney is revoked or actual notice of my death and shall be indemnified and held harmless by me and my estate, personal representatives and heirs against any liability or loss, including lawyers' fees, costs of suit and claims of third parties, which it might incur by relying on this power after termination or revocation but before it receives such notice, or at any time because of wrongful acts, omissions or representations of my attorneys with respect to transactions covered by this power of attorney. My attorneys shall be subject to whatever bank rules and regulations to which I would be subject. -3- ~.~~ 13. SAFE DEPOSIT BOEES. To have access to any control over the contents of any safe deposit box rented to me, to rent safe deposit boxes in my name, to close out and execute and deliver receipts for safe deposit boxes in my name, and to do all acts regarding any safe deposit box which I now have or may hereafter acquire, the same as I could do if personally present; provided that my attorneys shall not deposit or keep in any such safe deposit box any property in which my attorneys have a personal interest. Any financial institution may continue to rely on this power of attorney until it receives written notice from me that this power of attorney is revoked or actual notice of my death and shall be indemnified and held harmless by me and my estate, personal representatives and heirs against any liability or loss, including lawyers' fees, costs of suit and claims of third parties, which it might incur by relying on this power after termination or revocation but before it receives such notice, or at any time because of wrongful acts, omissions or representations of my attorneys with respect to transactions covered by this power of attorney. 14. RECEIPTS AND APPjLOVAL OF ACCOUNTS. To receive a payment of any kind, including a bequest, devise, gift or other transfer of real or personal property to me in ray own right or as a fiduciary for another, and to give full receipt and acquittance therefor, or a refunding bond therefor, to approve accounts of any business, estate, trust, partnership or other transaction whatsoever in which I may have any interest of any nature whatsoever, and to enter into any compromise and release in regard thereto. 15. CoNPAO~I88 AND AstsITEtATION of CLAIIts. To collect, forgive, compromise or arbitrate any debt or claim in which I may be in any manner interested, and for that purpose to enter into agreements to compromise or arbitrate, and either through counsel or otherwise to carry on such compromise or arbitration and perform or enforce any award entered in arbitration. 16. INSTITUTION AND DEFESSE of CLAWS. To institute, prosecute, defend, appeal, compromise, or otherwise dispose of, and to appear for me in, any proceedings at law or in equity or otherwise before any tribunal for the enforcement or for the defense of any claim, either along or in conjunction with other persons, relating to me or to any property of mine or any other person, and to retain, discharge and substitute counsel and -4- ..-,::: ~.. •. ,,..1.,.~ _:~~..,......~~... authorize appearance of such counsel to be entered for me in any such action or proceeding. 17. TAESS. To prepare, execute and file in my name and on my behalf any return, report, protest, application for correction of assessed valuation of real or other property, appeal, brief, claim for refund, or petition, including petition to the United States Tax Court, in connection with any tax imposed or purported to be imposed by any government, authority or agency, or claimed, levied or assessed by any government, authority or agency and to pay any such tax and to obtain any extension of time for any of the foregoing; to execute waivers of restrictions on the assessment and collection of deficiency in any tax; to execute closing agreements and all other documents, instruments and papers relating to any tax liability of mine of any sort; to institute and carry on either through counsel or otherwise any proceeding in connection with contesting any such tax or to recover any tax paid, or to resist any claim for additional tax or any proposed assessment or levy thereof, and to enter into any agreements or stipulations for compromise or other adjustment or disposition of any tax. 18. ErscTioxs ~ Discr.~~es. To make statutory elections and disclaimers, including the power to disclaim or refuse to accept an inheritance or life insurance proceeds, and to execute, deliver and file for record disclaimers of any part or all of any property, power or interest passing to or for me under any will, deed of trust or otherwise. 19. E1~LOna~r of OTSSZts. To employ accountants, attorneys-at-law, investment counsel, advisors, custodians, agents, servants, and others, to delegate to them, to remove them, to appoint others in their places, and to pay them such remuneration as my attorneys shall deem proper. To waive attorney-client and other similar privileges to facilitate consultations between an attorneys-in-fact and the principal's attorney and other advisers of the principal. 20. Ez$cirriox of Docuro~rs. To execute, deliver, file for record, cancel, modify, endorse, acquire or dispose of any instrument, including but not limited to, stock and bond powers, vehicle registrations, financing statements and related filing -5- documents, reports of any sort to any government, authority or agency, as required or permitted by law, deeds with or without covenants or warranties, and any other document appropriate for carrying out any of the foregoing powers. 21. R8t~0uxcs FlnvclAS? POSITIONS . To renounce f iduciary positions to which I have been appointed or am serving. 22. Rsvoc~-srs TBIISTS. To deliver any property of mine to and deposit any such property with the trustee or trustees of any revocable deed of trust for my benefit executed by me and to revoke in whole or in part any such trust. 23. GIFrs. To make gifts in any amount to my children and my grandchildren, including my attorneys, so long as the gifts are made to equalize gifts made to others of her/his class, outright or in trust, so long as my attorneys believe that the gifts are consistent with my past gifts and are as I would have continued to do. To complete charitable pledges, and to continue an existing pattern of annual charitable gifts, and to make further charitable gifts in amounts as I have done in the past. 24. GBNS~r.. To do all things which my attorneys shall deem proper in order to carry out any of the foregoing enumerated powers, which shall be construed in the broadest possible manner. The descriptive headings of this general power of attorney are inserted for convenience only and shall not be deemed to affect the meaning or construction of any of the provisions hereof or to limit in any way the construction thereof in the broadest possible manner. 25. RsL=utcs ai Oasts. This power of attorney shall continue in force and may be accepted and relied upon by anyone to whom it is presented in spite of (i) my purported revocation of it, (ii) the issuance of a court decree declaring my incompetency or (iii) my death, until written notice of such event is received by such person. 26. StrssTITUTION. My attorneys shall have full power of substitution and revocation, and such substitution or revocation may relate to, or be limited to, any one or more or all of the -6- foregoing acts or powers, or be limited as to time or in such other respect as my attorneys shall deem proper. 27, ~IFicnTiox. I hereby ratify and confirm all that my attorneys or the substitute or substitutes therefor shall lawfully do or cause to be done by virtue hereof. 28. EFFBCr of Mz DISASILITT. It is specifically understood that I am conferring this power upon my attorneys-in-fact, effective immediately, in contemplation that I may become physically unable, or legally incompetent to handle my affairs, and that this power is to continue in force and effect, even though I should become physically unable or legally incompetent to handle my affairs by reason of any condition of physical or mental disability. 29 , GovB~iac LA1t. This power of attorney shall be governed by and interpreted in accordance with Pennsylvania law (except for use in the State of Florida, where the laws of that State will govern). IN WITNESS WHEREOF, I have hereunto set my hand and seal this 1~ day of _~ /~,~ , 1995. .~. ''-~ ~_~ ~~ ( SEAL ) .: ,~ FAE C. KEIM Witnesses: ~o~ -~- ,~-~ ,.. COMMONWEALTH OF PENNSYLVANIA: SS: COUNTY OF DAUPHIN: On this 16th day of January , 1995, before me the undersigned officer, personally appeared Fae C. Reim, known to me [or satisfactorily proven] to be the person whose name is subscribed to the foregoing instrument, and acknowledged that she executed it for the purposes therein contained. Witness my hand and official seal the day and year aforesaid. .~.~ Notary Public My Commission Expires: 12/13/98 R07~il~lAL S~n.i ~~:.1; E_. ~?'L~3Y, Netar ~ Public ~75 i"•^ ~:~':iil~r.~~~:li' i cx^;~ es ~:~c. 13, 1998 '~?~; iSla~;f~ P,4 F13G':SU~ ie:'s ~UL'fl~~i -$- BEFORE THE REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA IN RE: : IN THE COURT OF COMMON PLEAS ESTATE OF :CUMBERLAND COUNTY, PENNSYLVANIA RONALD O. KEIM ORPHANS' COURT DIVISION ESTATE NO. 2001-00358 SOCIAL SECURITY #187-09-8753 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Ronald O. Keim Date of Death: February 20, 2001 Will No.: Adm. No.: 2001-00358 To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on May 4, 2001. Fae C. Keim c/o Elaine M. Spriggs 1039 Country Club Road Camp Hill, PA 17011 BOSWELL, TINTNER, PICCOLA & WICKERSHAM By: ~ - J R. Boswell, Esquire Supreme Court I.D. #25444 315 North Front Street P. O. Box 741 Harrisburg, PA 17108-0741 .` (717) 236-9377 Capacity: Personal Representative _X Counsel for personal representative _~ Dated: May 4, 2001 V ,' IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECENE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE. Whether you will receive any money or property will be determined wholly or partly by the decedent's will. If the decedent died without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA IN RE: : IN THE COURT OF COMMON PLEAS ESTATE OF :CUMBERLAND COUNTY, PENNSYLVANIA RONALD O. KEIM ORPHANS' COURT DNISION ESTATE NO. 2001-00358 SOCIAL SECURITY #187-09-8753 NOTICE OF BENEFICIAL INTEREST IN ESTATE PURSUANT TO RULE 5.6 TO: Fae C. Keim c/o Elaine M. Spriggs = 1039 Country Club Road Camp Hill, PA 17011 Please take notice of the death of decedent and the grant of letters to: the personal representative(s) named below. The Decedent, Ronald O. Keim, died on the 20`'' day of February, 2001, at Cumberland County, Pennsylvania The Decedent died testate. The personal representative of the Decedent is Elaine M. Spriggs, Executrix, 1039 Country Club Road, Camp Hill, PA 17011, telephone no. (717) 737-0936. The will has been filed with the Office of the Register of Wills of Cumberland County, Cumberland County Courthouse, 1 Courthouse Square, Carlisle, Pennsylvania 17013-3387. a A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. BOSWELL, TINTNER, PICCOLA & WICKERSHAM By: ~_ Jeffr .Boswell, Esquire Supreme Court I.D. #25444 315 North Front Street P. O. Box 741 Harrisburg, PA 17108-0741 (717) 236-9377 Capacity: Personal Representative _X Counsel for personal representative Dated: May 4, 2001 ,e,.,,oo~.lsaai REV-1500 OFFICNUL9EOieLv -7 ' INHERITANCE TAX RETURN FlLE NUMBER LVANIA COMMONWEALTH OF PENNSI DEPAflTMENT OF aEVENUE 200001 DEPT RESIDENT DECEDENT zl 2001 oo3s8 . NAaalaeURG. PA 1Tt26a60t COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER KEIM,RONALD O. 187-09-8753 w DATE OF DEATH (MM-DD-NEAR) DATE OF BIRTH (MM-DD-NEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE D w 02/20/2001 03/03/1912 REGISTER OF WILLS ~ (IF APPLICABLE)SURVIVING SPOUSE'S NAME(IAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Keirn, Fae C. 192-34-6022 ® 1. Original Retum ^ 2. Supplemental Return 3, Remainder Remm (sate of tleath prior to Iz-13-82) w a y ^ 4. Limited Eslale ^ qa. Future Interest Compromise (dale of death otter ^ 5. Federal Estate Tax Return Required m ax 1z-12-ez> i m ® e. Decedent Died Testate (AtWCh copy ^ 7. Decedent Maintained a Living Trust (Anach ` 8. Total Number of Safe Deposit Boxes u of Will) capyot Trost) a ^ 9. Litigation Proceeds Received ^ 10. Spousal P (dale or seam between ^ 11. Election to tax under Sec. 9113(A) (ARach Sch G) 12 31 91 an 1-1-95 THIS SECTION MUSTBE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TA%•1NFORFAATIDN'SHQULD BEbIRECTEb YDd AME COMPLETE MAILING ADDRESS JEFFREY R. BOSWELL 315 N. Front Street o IRM NAME drapplicable) u s Boswell Tintnex Piccolo Wickersham P. O. Box 741 ELEPHONE NUMBER HaII-l511llLg, PA 17108-0741 717!236-9377 1. Real Estate (Schedule A) (1) _0_ o=Fiar;L use oNLr 2. Stocks and Bonds (Schedule B) (2) None ' ~i. r'.' N •7- ~f - ' i 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None ' m 4. Mortgages & Notes Receivable (Schedule D) (4) None ~ fti 5. Cash. Bank Deposits & Miscellaneous Personal Property (5) 20,214.88 "J (Schedule E) 6. Jointly Owned Properly (Schedule F) (6) 12,340.85- _ ''' ~ ^ Separate Billing Requested `v T Infur_Vivnc Transfers R Miscellaneous Non-Probate PrODeftY (7) 122,579.99 ~ ~`~' V ~ (Schedule G or L) "" a 8. Totai Gross Assets (total Lines 1-7) (8) 155,135.72 U rc 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 27,715.98 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 1,538.42 11. Total Deductions (total Lines 9 & 10) (11) 29,254.40 12. Net Value of Estate (Line 8 minus Line 11) (12) 125,881.32 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (74) 125, 881.32 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable al the spousal tax rate, 125, 8 81.32 x .00 (15) 0.00 or transfers under Sec. 9116(a)(1.2) 16.Amount of Line 14 taxable at lineal rate x .045 (16) a r f 17.Amount of Line 14 taxable at sibling rote x .12 (17) 0 U ~ 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 0.00 » $E SURE TO,AN'SWER L' guESY ONS ON REVERSE SIDE'RND RE HEOK NM SF)'St ~~. Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 1700 Market Street CITY Camp Hill sTnTE PA ziP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 0.00 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A+B+C) (2) 0.00 3. InteresUPenalty if applicable D. Interest E. Penalty Total InteresUPenalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 1 Llne 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. 15A) B. Enter the total of Line 5 + 5A. This Is the BALANCE DUE. (5B) ~. ~ Make Check Payable to: REGISTER OF W/LLS, AGENT ~tlillill~II~IIIIIfICM~I!'~IINI~~II~ I~I~i ~i~l~l!~INlflllu1111k~11~. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the properly transferred :.................................................................................. b. retain the right to designate who shall use the property transferred or its income;~ ................................... c. retain a reversionary interest: or .................................................................................................................. I(1Sd~~ll 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 wnsideration? ....................................................................................................................... 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 properly which ® ^ contains a benefciary desi9nation? ...................................................................................................................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Untler rhatl RESPONSIBLE FOR FILING RETURN anc ro me ovr is [nie, cortect entl complete. DeclardtiM of Country Club Road I Hill, FA 17011 DATE OZ- 72 - o'L 315 N. Front Street P. O. Box 741 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of [he surviving spouse is 3 f [72 P.S. §9516 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only benefciary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptlve parent, or a stepparent of the child is 0 % [72 P.S. §9116 (a) (1.2)]. The tax rate imposed on the net value of Vansfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedenYS siblings is 12% [72 P.S. §9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. COMMONWEALTH OF RENNSYLVANU INHERRANCE TAX RETNRN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF KEIM, RONALD O. FILE NUMBER 21 - 2001 - 00358 All real property owned sole)y 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 wilting seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointlyowned with right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH NONE TOTAL (Also enter on Line 1, Recapitulation) SCHEDULE E i CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF GENNSVLVANN PERSONAL PROPERTY INHERITANCE TA% RETURN RESIDENT DECEDENT ESTATE OF KEIM, RONALD O. FILE NUMBER 21 - 2001 - 00358 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 PNC Bank 10,445.35 Certificate of Deposit No. 31000189000 Principal and accrued interest 2 Department of Revenue 16.00 Tax Refund 3 HCRManorCare 1,413.76 Refund 4 Mid Atlantic Insurance Group 115.00 car insurance refund 5 Internal Revenue Service 600,00 Tax Relief Refund 6 Blue Cross/Blue Shield 3.52 Refund 7 Equitable Life Assurance 4.96 refund 8 Blue Cross/Blue Shield 33.69 refund 9 Blue Cross/Blue Shield 34.60 refund 10 1995 Ford Taurus Sedan 5,000.00 11 Internal Revenue Service -refund 2,528.00 12 PNC Bank -service charge refund 20.00 TOTAL (Also enter on Line 5, Recapitulation) I 20,214.88 SCHEDULE F COMMONWEALTH OF PENNSYLVANIA dOINTLYAWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER KEIM, RONALD O. 21 - 2001 - 00358 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME 1700 Mazke[ Street W Tie ADDRESS RELATIONSHIP TO DECEDENT A Fae C. Keim B Elaine M. Spriggs JOINTLY OWNED PROPERTY: Camas Aill PA 17011 1039 Country Club Road Camp Hill, PA 17011 Daughter ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY Include name of financial institution and bank account number or similar identifying number. Attach deed forjointly-held real estate. DATE OF DEATH VALUE OF ASSET "/° OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST B 10/26/1997 Certificate of Deposit No. 247412066196706 20,210.38 33.3% 6,730.06 First Union National Bank Owned jointly by A & B Principal and accrued interest A 11/12/1994 PNC Bank 11,221.57 50% 5,610.79 Checking Account No. 5080540148 i Principal and accrued interest TOTAL (Also enter on line 6, Recapitulation) 12,340.85 SCHEDULE G INTER-VIVOS TRANSFERS & COMMONWEALTH OF PENNSYLVANIA INHERITANCETAX RETURN MISC. NON-PROBATE PROPERTY ESTATE OF KEIM, RONALD O. FILE NUMBER 21 - 2001 - 00358 TFic ~~tisar~fe r.rrr~~ na rnr„olnrnd and filed if the answer to anv of questions 1 through 4 on page 2 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY Include the name of the tmns(arse,their relationship to tlecetlent and the date o(hansfer Attachacopy of the deed for real estate. ~ DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IFAPPLICABLE) TAXABLE VALUE 1 MetLife Investors 122,579.99 10000% 122,579.99 Preferred Choice Plus Annunity Contract No. A 2063626 -Ronald O. Keim 1 TOTAL (Also enter on line 7, Recapitulation) 122,579.99 SCHEDULE H ~F~UN^ER~A'~L'pE~X'r'P~~E~NSES& COMMON WEALTH OF PENNSYLVANIA /"11.JIY1)N~IIw11YGC~ INHERITANCE TA% RETNRN RESIDENT DECEDENT ESTATE OF KEIM, RONALD O. FILE NUMBER 21 - 2001 - 00358 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: 1 James F. Stone Funeral Home 8,214.00 2 James R. Gingrich Memorials 1,568.00 3 Churchville -cemetery cost 525.00 4 Churchville -open grave 600.00 B. ADMINISTRATIVE COSTS: 7,500.00 1. Personal Representative's Commissions Elaine C. Spriggs Social Security Number(s) / EIN Number of Personal Representative(s): 20 reet Address 1039 Country Club Road City Camp Hill State PA Zip 17011 Year(s) Commission paid 2002 y. AnomeYs Fees Boswell Tintner Piccolo Wickersham 7,500.00 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Fae C. Keim Street Address 1700 Market Street City Camp Hill State PA Zip 17011 Relationship of Claimant to Decedent Spouse a. Probate Fees Cumberland County Register of Wills 109.00 5. Accountant's Fees 6. Tax Return Preparers Fees Included in Attorney's Fees 7. Other Administrative Costs 1 Waypoint deluxe checks 3.00 2 The Sentinel -legal advertising 100.31 3 Ctunberland Law Journal -legal advertising 75.00 Total of Continuation Schedule(s) 1,521.67 TOTAL (Also enter on line 9, Recapitulation) 27,715.98 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Schedule H Funeral F_xpenses 8 Administrative Costs continued ESTATE OF KEIM, RONALD O. FILE NUMBER 21 - 2001 - 00358 4 ~ Boswell, Tintner, Piccola & Wickersham -disbursements 11.71 5 Boswell, Tintner, Piccola & Wickersham -closing fees and filing fees 1,000.00 6 Waypoint Bank -charge back fee 5.00 7 Waypoint Bank -charge back fee 4.96 8 Reserve for Income Tax 500.00 Page 2 of Schedule H COMMONWEALTH OF PENNSTLVNNIA INHERRANCE TAX RETNRN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER KEIM, RONALD O. 21 - 2001 - 00358 Include unreimbursed medical expenses. ITEM NUMBER 1 ARC ManorCare 2 NeighborCare -medication 3 Camp Hill Fire Company 4 Equitable Life DESCRIPTION ~ AMOUNT 1,421.00 43.17 68.29 5.96 TOTAL (Also enter on Line 10, Recapitulation) I 1,538.42 c LAST WILL OF RONALD O. KEIM JEFFREY R. BOSWELL, ESQUIRE BOSWELL, SNYDER, TINTNER & PICCOLA 315 North Front Street Harrisburg, Pennsylvania 17101 LAST WILL AND TESTAMENT OF RONALD O. KEIM Introductory Clause ............................................ 1 ITEM I Direction to Pay Debts ......................................... 1 ITEM II Direction to Pay All Taxes from Residuary Estate ..................... 1 ITEM III Outright Gift of All Property to Wife, Contingent Gift to Issue ............ 1 ITEM IV Naming the Personal Representative, Personal Representative Succession, Personal Representative's Fees and Other Matters ................ 2 (1) Naming Individuals as Personal Representative .................. 2 (2) Individual Personal Representatives Succession .................. 2 (3) Fee Schedule for Individual Personal Representative .............. 2 ITEM V Definition of Personal Representative .............................. 2 ITEM VI Powers for Personal Representative ................................ 2 ITEM VII Discretion Granted to Personal Representative in Reference to Tax Matters ................................................ 3 ITEM VIII Definition of Children .......................................... 3 ITEM IX Definition of Words Relating to the Internal Revenue Code .............. 4 ITEM X Statement by Testator of Intent Not to Exercise Power of Appointment ..... 4 ITEM XI Simultaneous Death Provision Presuming Beneficiary Predeceases Testator .. 4 Testimonium Clause ........................................... 5 Attestation Clause ............................................. 5 LAST WILL AND TESTAMENT OF RONALD O. KEIM Introductory Clause. I, RONALD O. KEIM, a resident of and domiciled in the Township of Lower Allen, County of Cumberland and Commonwealth of Pennsylvania, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils at any time heretofore made by me. I am married to FAE C. KEIM. I have two living children: ELAINE M. SPRIGGS and LINDA KAY KEIM. ITEM I Direction to Pav Debts. I direct that all my legally enforceable debts, secured and unsecured, be paid as soon as practicable after my death. ITEM II Direction to Pav All Taxes from Residuary Estate. I direct that all estate, inheritance, succession, death or similar taxes (except generation-skipping transfer taxes) assessed with respect to my estate herein disposed of, or any part thereof, or on any bequest or devise contained in this my Last Will (which term wherever used herein shall include any Codicil hereto), or on any insurance upon my life or on any property held jointly by me with another or on any transfer made by me during my lifetime or on any other property or interests in property included in my estate for such tax purposes be paid out of my residuary estate and shall not be charged to or against any recipient, beneficiary, transferee or owner of any such property or interests in property included in my estate for such tax purposes. ITEM III Outrieht Gift of All Property to Wife. Contineent Gift to Issue. I give, devise and bequeath all the rest, residue and remainder of my property of every kind and description (including lapsed legacies and devises) wherever situate and whether acquired before or after the execution of this Will, absolutely in fee simple to my wife, FAE C. KEIM, if she shall survive me. If she shall not survive me, then I give, devise and bequeath all of the property to my surviving children in equal shares, provided, Page 1 however, the then living issue of a deceased child of mine shall take per stirpes the share their parent would have taken had he or she survived me. ITEM IV Namina the Personal Representative Personal Representative Succession Personal Representative's Fees and Other Matters. The provisions for naming the Personal Representative, Personal Representative succession, Personal Representative's fees and other matters are set forth below: (1) Namine Individuals as Personal Representative. I hereby nominate, constitute, and appoint as Personal Representatives of this my Last Will and Testament FAE C. KEIM and ELAINE M. SPRIGGS and direct that they shall serve without bond. (2) Individual Personal Representatives Succession. If any individual Personal Representative should fail to qualify as Personal Representative hereunder, or for any reason should cease to act in such capacity, the remaining individual Personal Representatives shall continue to serve without a successor or substitute. (3) Fee Schedule for Individual Personal Representative. For its services as Personal Representative, the individual Personal Representative shall receive reasonable compensation for the services rendered and reimbursement for reasonable expenses. ITEM V Definition of Personal Representative. Whenever the word 'Personal Representative" or any modifying or substituted pronoun therefor is used in this my Will, such words and respective pronouns shall include both the singular and the plural, the masculine, feminine and neuter gender thereof, and shall apply equally to the Personal Representative named herein and to any successor or substitute Personal Representative acting hereunder, and such successor or substitute Personal Representative shall possess all the rights, powers and duties, authority and responsibility conferred upon the Personal Representative originally named herein. ITEM VI Powers for Personal Representative. By way of illustration and not of limitation and in addition to any inherent, implied or statutory powers granted to Personal Representatives generally, my Personal Representative is specifically authorized and empowered with respect to any property, real or personal, at any time held under any provision of this my Will: to allot, allocate between principal and income, assign, borrow, buy, care for, collect, compromise claims, contract with respect to, continue any business of mine, convey, convert, deal with, dispose of, enter into, exchange, hold, Page 2 improve, incorporate any business of mine, invest, lease, manage, mortgage, grant and exercise options with respect to, take possession of, pledge, receive, release, repair, sell, sue for, to make distributions or divisions in cash or in kind or partly in each without regard to the income tax basis of such asset, and in general, to exercise all the powers in the management of my Estate which any individual could exercise in the management of similar property owned in his or her own right, upon such terms and conditions as to my Personal Representative may seem best, and to execute and deliver any and all instruments and to do all acts which my Personal Representative may deem proper or necessary to carry out the purposes of this my Will, without being limited in any way by the specific grants of power made, and without the necessity of a court order. ITEM VII Discretion Granted to Personal Representative in Reference to Tax Matters. My Personal Representative as the fiduciary of my estate shall have the discretion, but shall not be required when allocating receipts of my estate between income and principal, to make adjustments in the rights of any beneficiaries, or among the principal and income accounts to compensate for the consequences of any tax decision or election, or of any investment or administrative decision, that my Personal Representative believes has had the effect, directly or indirectly, of preferring one beneficiary or group of beneficiaries over others; provided, however, my Personal Representative shall not exercise its discretion in a manner which would cause the loss or reduction of the marital deduction as may be herein provided. In determining the state or federal estate and income tax liabilities of my estate, my Personal Representative shall have discretion to select the valuation date and to determine whether any or all of the allowable administration expenses in my estate shall be used as state or federal estate tax deductions or as state or federal income tax deductions and shall have the discretion to file a joint income tax return with my wife. ITEM VIII Definition of Children. For purposes of this Will, "children" means the lawful blood descendants in the first degree of the parent designated; and "issue" and "descendants" mean the lawful blood descendants in any degree of the ancestor designated; provided, however, that if a person has been adopted, that person shall be considered a child of such adopting parent and such adopted child and his or her issue shall be considered as issue of the adopting parent or parents and of anyone who is by blood or adoption an ancestor of the adopting parent or either of the adopting parents. The terms "child;' "children;' "issue;' "descendant" and "descendants" or those terms preceded by the terms "living" or "then living" shall include the lawful blood descendant in the first degree of the parent designated even though such descendant is born after the death of such parent. Page 3 The term "per stirpes" as used herein has the identical meaning as the term "taking by representation" as defined in the Pennsylvania Probate Code. ITEM IX Definition of Words Relative to the Internal Revenue Code. As used herein, the words "gross estate;' "adjusted gross estate;' "taxable estate;' "unified credit;' "state death tax credit;' "maximum marital deduction;' "marital deduction," "pass," and any other word or words which from the content in which it or they are used refer to the Internal Revenue Code shall have the same meaning as such words have for the purposes of applying the Internal Revenue Code to my estate. For purposes of this Will, my "available generation-skipping transfer exemption" means the generationskipping transfer tax exemption provided in section 2631 of the Internal Revenue Code of 1986, as amended, in effect at the time of my death reduced by the aggregate of (1) the amount, if any, of my exemption allocated to lifetime transfers of mine by me or by operation of law, and (2) the amount, if any, I have specifically allocated to other property of my gross estate for federal estate tax purposes. For purposes of this Will if at the time of my death I have made gifts with an inclusion ratio of greater than zero for which the gift tax return due date has not expired (including extensions) and I have not yet filed a return, it shall be deemed that my generationskipping transfer exemption has been allocated to these transfers to the extent necessary (and possible) to exempt the transfer(s) from generation-skipping transfer tax. Reference to sections of the Internal Revenue Code and to the Internal Revenue Code shall refer to the Internal Revenue Code amended to the date of my death. ITEM X Statement by Testator of Intent Not to Exercise Power of Aoaointment. I hereby refrain from exercising any power of appointment that I may have at the time of my death. ITEM XI Simultaneous Death Provision Presuming Beneficiary Predeceases Testator. If any beneficiary and I should die under such circumstances as would make it doubtful whether the beneficiary or I died first, then it shall be conclusively presumed for the purposes of this Will that the beneficiary predeceased me. Page 4 Testimonium Clause. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my seal this ~ day of May, 1996. ~~, ~, ~'~(SEAL) RONALD O. KEIM Attestation Clause. The foregoing Will was this 9thday of May, 1996, signed, sealed, published and declared by the Testator as and for his Last Will and Testament in our presence, and we, at his request and in his presence, have hereunto subscribed our names as witnesses on the above date. -~-r i "/ Y-Ctc/J . ^Y .' ~ '. .yam .~ J Page 5 PROOF OF WILL Commonwealth of Pennsylvania County of Dauphin Self-Proving Affidavit We, RONALD O. KEIM, and Jeffrey R. Boswell and Connie L. Hardy ,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 witness and to the best of our knowledge the Testator was at that time eighteen years of age or older, of sound mind, and under no constraint or undue influence. Subscribed, sworn to, and acknowledged before me by RONALD O. KEIM, the Testator and subscribed and sworn to before me by Jeffrey R. Boswell and Connie L. Hardy ,witnesses, this 9th day of May, 1996. Notary Public for Pennsylvania My Commission Expires: 12/13/98 --- -~ s r ~.: n Page 6 ~, i7 RO LNA D O. KEIM ~w ~0 ~01 ~"1 ~' ~S PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 STATE OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. Roger M. Morgenthal, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, viz: APRIL 20, 27, MAY 4, 2001 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. ~~~yy1i~--, Roger M. Morgenthal, Editor Heim. Ronald O.. decd. Late of the Borough of Camp Hill. Executrix: Elaine M. Spriggs. Attorneys: Jeffrey R. Boswell, Esquire. Boswell. Tmtner. Plccola & Wickersham. 315 N. Front Street P.O. Box 741. Harrisburg, PA 17108-0741. SWORN TO AND SUBSCRIBED before me this 4 day of MAY. 2001_ LQlS E. SNYDER, ~ Publb Cartlde 8oro, Cumberland Cowl ply Commrs~^n ire^:s Marttr 5, 5 PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland. ~„~ ~ sr Sherry Clifford, Classified Ad Manager of THE SENTINEL, of the County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a newspaper of general circulation in the Borough of Carlisle, County and State aforesaid, was established December 13th, 1881, since which date THE SENTINEL has been regularly issued in said County, and that the printed notice or publication attached hereto is exactly the same as was printed and published in the regular editions and issues of THE SENTINEL on the following dates, viz Copy of Notice of Publication ~ ESTATE NOTICE 7 etters Testamentary on I the Estate of RONALD i O. KEIM, late of Borough of Camp Hill, County of Cumberland County, PA, tleceased, have been granted to the undersigned. All persons having claims or demands against the estate are requested to make known the claim or demand, antlall persons indebted to the estate are requested to make payment, without delay, to the Executrix or to her attorneys named below: Elaine M. Spd99s. Executrix Attorney: Jeffrey R. Boswell, Esquire Boswell, Tintner, Piccolo 8 Wickershern -'-'" 315 N. Front Sireat, P.O. Box 741 Harrisburg, PA 17108-0741 April 14, 21, and, 28, 2001 Affiant further deposes that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statement as to time, place and character of publication are true. r April 30, 2001 Sworn to and subscribed before me this day of April , 2001. 30th ~~e~a O ' ~(!/(/{G!/~ Notary Public My commission expires: NOTARIAL SEn1. SHIRLEYO. DURNIN, I`,!_+:cl~ :'..;:"~ Carlisle Bora., CumberlaoJ Cuw.ry Commission Expires Au . 9, 2003 OLi30i0:- ~57rD 11:09 F.aS 1~1~-3~i~.10? )IETLIFE ItiPESTORS M eifLife Inv~~tors° November 28, 2001 ELAINE SPRIGGS 1039 COUNTRY CLUB RD CAMP HILL, PA 17011 RE: Policy NumberA2063626 Company: MetLife Investors USA Insurance Company Dear MS. SPRIGGS~ Thank you for your recent inquiry. The date of death value is listed below. Ana` o y o~ chg Ot` Date of Death Value: $122,579.99 G 4 If you require any further information, please feel free to writes or call our toll-free customer service number at: 1 (800) 2844536. Sincerely, Kirk Fuller Annuity Policy Service Department Enclosure(s): Return Address Envelope (pp) ~~ ~~S 6 Carer For Forms P.O. BOJ[ 14593 Des Moines, IA 503063593 C~ooz MRY-22-2001 0E~40 ~~~ PNCERNfC CIF DEPRRTMENT ~ PN CBAIV< Decedent Reporting Firstside Center P7-PFSC-4-F 500 First Avenue Pittsburgh, PA 15214-3128 May 21, 2001 Jeffrey R. Boswell 315 North Front Street P.O. Box 741 Harrisburg, PA 17108-0741 r RE: Estate of Ronald O. Keim, Deceased SSN: 187-09-8753 DOD: 2/20/2001 Dear Mr. Boswell: Please find the date of death balances you have requested listed below. CERTIFICATE OF DEPOSIT #31000189000 RONALD O KEIM DOD Balance: $10,391.28 + $54.07 accrued interest @ 6.55% CHECKING ACCOUNT #5080540148 RONALD O KEIM FAE C KEIM DOD Balance; $11,215.33 + $6.24 accrued interest Page 1 of 2 412 705 0057 P.01i02 /Lz~o! sly ti P..,~ ~Ca9a coo-.../-, /SCP Established 06/22/2400 Established 11/21/1994 A member °C The PNC finandat Services Group PNC fienk N,A, Pittsburgh Ptnnyylwnia 75265 MRY-22-2001 08 40 PNCERNK CIF DEPRRTMENT 412 705 0057 P.02i02 t! a PNCBANC Our office only provides date of death balances for IRA's, CD's, Checking and Savings accounts. We do 1~0 Financial Transactions or Statement Orders. For Further information please call t-800-4-BANKER or your local PNiC Branch and ask to speak with a Financial Services Representative. Sinclerle~ly~, ~~~~ Rachelle Sciullo 1-800-762-1775 Page 2 of 2 A memhcr of The PNC Finandsl Services Group PNC Bank NA. Pirtsburgh Pennsylvania 15265 TOTRL P.02 FEN" First Union National Bank Attn: Account Verifications P O Box 40028 Roanoke VA 24022-7313 May 3, 2001 BOSWELL, TINTNER, PICCOLA & WICKERSHAM COUNSELORS AT LAW PO BOX 741 HARRISBURG, PA 17108-0741 SUBJECT: Verification /Confirmation of Account and Balance Information provided for: RONALD O KEIM (SSN# 187-09-8753) Date of Death: February 20, 2001 Deposit Account Information .~ ~-: 'vim-`r`~i- i,s-0 ~ ^~ t'V Account Account Dare of Death Average Dale Maturity Interest Accred YTD Date Type Number Balance Balance* Opened Date Ra[e Interest Interest Paid Closed CERTIFICATE OF DEPOSIT 247412066196706 $20,000.00 10/26/1997 10/26/2001 $59.35 $210.38 LEGAL TITLE: RONALD O. & FAE C. KEIM ELAINE M. SPRIGGS * Due to system limitations, we can only provide a twelve month average balance on depository accounts. ` Date of death balance does not include accrued interest. ` If date of death occurrs on a weekend or a holiday, date of death balance does not include any transactions that were made during that time period. Signature of Depository Representative Melanie Moorman Depository Representative abs; a[ Date zoos Servicenter Associate Title ~, ~~~ ~ ~, ~~ ~ ~. Reference ID: 159713 (540)563-7323 Phone Number J ~,~Y ~ g ~ 001032 ~~..~~~ ~ Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of KEIM, RONALD O. also known as No. 21 - 2001 - 00358 Date of Death 2/20/2001 Deceased Social Security No. 187-09-8753 Elaine C. Spriggs The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/V1le understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. Attorney: JEFFREY R. BOSWELL I.D. No. Personal Represe tie , _ Signature: Elaine C. Spriggs 254 4 Signature: Signature: Address: 315 N. Front Street Address: 1039 Country Club Road P. O. Box 741 Camp Hill, PA 17011 Harrisburg. PA 17108-0741 Telephone: (717) 236-9377 Telephone: Dated: Personal Propert PNC Bank 10,445.35 Certificate of Deposit No. 31000189000 Principal and accrued interest ^ r'°; '~ r;, Cj _~ N ~ Department of Revenue u ,~, ~ 16.00 Tax Refund m cis HCR ManorCare ~ 1,413.76 Refund _~ Mid Atlantic Insurance Group ~~~ ~ - _ 115.00 car insurance refund ~ ~,,~ , Internal Revenue Service 600.00 Tax Relief Refund Blue CrossBlue Shield 3.52 Refund (Attach additional sheets if necessary) Total Personal Property and Real Estate $20,214.88 ' Register of Wills of Cumberland County, Pennsylvania INVENTORY continued Estate of KEIM, RONALD O. No. 21 - 2001 - 00358 also known as Date of Death 2/20/2001 Deceased Social Security No. 187-09-8753 Equitable Life Assurance 4.96 refund Blue CrossBlue Shield 33.69 refund Blue CrossBlue Shield 34.60 refund 1995 Ford Taurus Sedan 5,000.00 Internal Revenue Service -refund 2,528.00 PNC Bank -service charge refund 20.00 Total Personal Property $20,214.88 2 Register of Wills of Cumberland County, Pennsylvania Estate of KEIM, RONALD O. INVENTORY continued also known as Deceased No. 21 - 2001 - 00358 Date of Death 2/20/2001 Social Security No. 187-09-8753 Real Estate NONE Total Real Estate 3 267 East Market Street • York, Pennsylvania 17403 Wolfson & Associates (717) 846-1252 A PROFESSIONAL CORPORATION (800) 321-8467 Attorneys at Law Fax (717) 848-1146 March 13, 2002 CUMBERLAND COUNTY GOVERNMENT CENTER CLERK OF ORPHANS' COURT DIVISION 1 COURTHOUSE SQUARE . CARLISLE, PA 17013 RE: Estate Claim -HCR Manor Care vs. Estate of Ronald Keim Dear Sir/Madam: Enclosed please find a claim against the estate of the above referenced deceased person which is being filed on behalf of my client, HCR Manor Care. Also enclosed is our check no. 2238 in the amount of $5.00 to cover the cost of the filing. Please be advised a copy of the claim has been sent to the attorney for the estate. If you have any questions, please call my office and speak with Lauren in the collection department. Thank you. Sincerely, WOLFSON & ASSOCIATES, P.C. ~~ Amy F. Wolfson AFW/bs Enclosure COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF Ronald Keim, Decedent NO. 21-01-358 Notice of claim by HCR Manor Care To the Clerk of the Orphans' Court: ENTER the claim of HCR Manor Care Camp Hill in the amount of $81,603.68 (Eighty One Thousand Six Hundred-Three and 68/100 Dollars), against the above entitled estate. The Decedent, whose last known address was 824 Lisburn Rd #6-11, Camp Hill, Cumberland County, Pennsylvania 17011, and who died: February 20, 2001. Amy F. W~lfson, Esq. Attorney or Claimant, HCR Manor Care 267 E. Market Street York, Pennsylvania 17403 (717) 846-1252 I.D. No. 87062 COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF Ronald Keim, Decedent NO. 21-01-358 Notice of claim by HCR Manor Care To the Clerk of the Orphans' Court: ENTER the claim of HCR Manor Care Camp Hill in the amount of $81,603.68 (Eighty One Thousand Six Hundred-Three and 68/100 Dollars), against the above entitled estate. The Decedent, whose last known address was 824 Lisburn Rd #6-11, Camp Hill, Cumberland County, Pennsylvania 17011, and who died: February 20, 2001. Amy F. W~lfson, Esq. Attorney or Claimant, HCR Manor Care 267 E. Market Street York, Pennsylvania 17403 (717) 846-1252 I.D. No. 87062 BOSWELL, TINTNER, PICCOLA & WICKERSHAM COUNSELORS AT LAW 315 NORnI FRONT STREET P.O. Box 741 HARRISBURG, PA 17108-0741 LEONARD TINTNER JEFFREY E. PICCOLA 1717) 236-9377 RICHARD B. WICKERSHAM FAX 17171 236-9316 JEFFREY R. BOSWELL btpw®att.net BRIGID O. ALFORD G. EDWARD SCHWEIKERT, IV WILLIAM D. BOSWELL 11943 -19991 August 9, 2002 Register of Wills Cumberland County Courthouse c One Courthouse Square "`= Carlisle, PA 17013 -_ Re: Ronald O. Keim Estate . - File No.: 21 01-0358 Cumberland County ': Assessment Date: 04-08-2002 .` .~ ACN: 101 Dear Sir or Madam: Pursuant to the enclosed notice, I have enclosed our trust check in the amount of $158.03 for final payment of tax and interest. The tax is paid pursuant to the Notice of Inheritance Tax Appraisement dated April 15, 2002. Kindly contact me if you need any additional information. I thank you for your consideration. Sincerely, Jeffrey R. Boswell JRB:cIh Enclosures .~~ cc: Mrs. Elaine M. Spriggs, Executrix (w/copy of enc.) ' COMMONWEALTH OF PENNSYLVANIA BuREau of INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 INHERITANCE TAX HARRISBURG, PA 17128-0601 DUNNING NOTICE ATTN: POST ASSESSMENT REVIEW UNIT REY-15GP ~FP (R7-99) PHONE (717) 787-6505 TDD# 1-800-447-3020 (SERVICE FOR TAXPAYERS WITH SPECIAL HEARING AND SPEAKING NEEDS). ,~.~l, ,•,i .~~ ~ •, ;;~ NOTICE DATE 07-05-2002 ESTATE OF JEFFREY R BOSWELL _ KEIM RONALD 0 BOSWELL ETAL ,;t, FILE NO/SSN 21 01-0358 PO BOX 741 COUNTY CUMBERLAND HBG PA 17108 DATE OF ASSESSMENT 04-08-2002 ACN 101 OUR RECORDS INDICATE A DELINQUENT INHERITANCE TAX LIABILITY FOR THE ABOVE ESTATE. OUTLINED BELOW IS A SUMMARY OF OUR RECORDS. ADDITIONAL INTEREST IS CALCULATED AND INCLUDED IN THE BALANCE TO FIFTEEN (15) DAYS FROM THE DATE OF THIS NOTICE. TAX INTEREST CREDIT BALANCE 151.43 6.60 ADDITIONAL INTEREST- ADD .00 158.03 .02 PER DAY FROM 07-23-2002 TO AVOID ADDITIONAL COSTS AND INTEREST, THE ABOVE AMOUNT DUE MUST BE PAID WITHIN 15 DAYS FROM THE DATE OF THIS NOTICE. PLEASE DETACH AND RETURN THE LOWER PORTION WITH YOUR PAYMENT TO THE REGISTER OF WILLS OF THE COUNTY INDICATED. MAKE CHECK OR MONEY ORDER PAYABLE TO 'REGISTER OF WILLS, AGENT'. IF THE ABOVE BALANCE DUE HAS BEEN PAID RECENTLY, PLEASE DISREGARD THIS NOTICE. PLEASE RETURN THIS PORTION WITH YOUR PAYMENT TO THE REGISTER OF WILLS LISTED BELOW ESTATE OF KEIM RONALD 0 FILE NO/SSN 21 01-0358 COUNTY CUMBERLAND DATE OF ASSESSMENT 04-08-2002 ACN 101 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ~ i4..~ ~ "'( ~ ~ r -' i_ ..d. m ~r r. ~ -`Arts ~,+'~ i~Y'~, ~ - . . _. ~'1 ., i~..1'm" ~ ice. ~-,~- ~`lj ~?", ~~ •i r.~1~ O Frl O ,1''~~~'~ ~ ~ o, ~~ 1 r• • c~~ 11} _ 1 a i , r-a ~ W ~ O E / _ ~ ~° - O~~ ~ ,,....~~ W ~ HWO = _ _ WW ~ ~Z~ W W cYUOU c~ ,; ~~ ~ ~ ~ Ul o~G a V ~ iE w ~ '1 `~ l.. ~ Cl (. i l.~~l, I. . O P, ~ ~ C7 a u z ~ :'` O PQ c+t cv a' ~a r~ .~. ~+ r- .,... COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BOSWELL JEFFREY R 315 N FRONT ST PO BOX 741 HARRISBURG, PA 17108-0741 fold ESTATE INFORMATION: sSN: 187-OS-x753 FILE NUMBER: 2101-0358 DECEDENT NAME: KEIM RONALD 0 DATE OF PAYMENT: 08/12/2002 POSTMARK DATE: 08/09/2002 COUNTY: CUMBERLAND DATE OF DEATH: 02/20/2001 REV-1162 EXI11-96) N0. CD 001506 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ $158.03 TOTAL AMOUNT PAID: REMARKS: JEFFREY R BOSWELL ESQUIRE CHECK# 3429 SEAL INITIALS: CW RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS S 158.03 REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION • DEPT. 280601 HARRISBURG, PA 17128-0601 JEFFREY R BOSWELL BOSWELL ETAL PO BOX 741 HBG PA 17108 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 E% ~FP (01-027 ~'`° `' DATE:; 04-15-2002 f_e, ',:- ESTATE OF KEIM RONALD 0 DATE OF DEATH 02-20-2001 FILE NUMBER 21 01-0358 .OZ fll'~ T ~ ~~NT~ CUMBERLAND ACN 101 (f,w_; Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS t ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF KEIM RONALD 0 FILE NO. 21 01-0358 ACN 101 DATE 04-15-2002 TAX RETURN WAS: [ ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this form with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 20,21 4.88 tax payment. 6. Jointly Owned Property [Schedule F) (6) 12,340.85 7. Transfers (Schedule G) (7) 122,579.99 8. Total Assets (g) 155,135.72 APPROVED DEDUCTIONS AND EXEMPTIONS: 27,715.98 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 1,5 38.42 11. Total Deductions (11) 29.254.40 12. Net Value of Tax Return (12) 125,881.32 13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedule J) (13) .00 14 Net Value of Estate Subject to Tax (14) 125,881.32 . NOTE: If an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 122,516.29 X 00 = .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 3,365.03 X 045. 151.43 17. Amount of Line 14 at Sibling rate (17) .00 X 12 .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 .00 19. Principal Tax Due [19)= 151.43 TAV /+~Qt1TTC. DATE, ~ .NUMBER ~ INTEREST/PEN PAID (-) I AMOUNT PAID INTEREST IS CHARGED THROUGH 04-30-2002 TOTAL TAX CREDIT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 151.43 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 4.51 TOTAL DUE 155.94 ^ IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT° [CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) REV-7470 EX (8-68) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 INHERITANCE TAX EXPLANATION OF CHANGES DECEDENTS NAME FILE NUMBER Keim, Ronald O. 2101-0358 Daniel Heck 101 ITEM EXPLANATION OF CHANGES SCHEDULE NO. F 1 b Jointly held assets are taxable to the survivors. No deductions can be claimed against joint property, as it was not the responsibility of the survivors to pay the debts. Row Page 1 /6-~~~-7 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280b01 HARRISBURG, PA 17128-0601 JEFFREY R BOSWE`LL BOSWELL ETAL PO BOX 741 HBG COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT REY-1607 EX AFP (R1-OY) DATE 08-26-2002 ESTATE OF KEIM RONALD 0 DATE OF DEATH 02-20-2001 FILE NUMBER 21 01-0358 COUNTY CUMBERLAND ~~ ACN 101 Amount Remitted PA 17108 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: 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 (01-021 ~*~ INHERITANCE TAX STATEMENT OF ACCOUNT ~*~ ESTATE OF KEIM RONALD 0 FILE N0. 21 01-0358 ACN 101 DATE 08-26-2002 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF AlL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 04-15-2002 PRINCIPAL TAX DUE: 151.43 PAYMENTS (TAX CREDITS): PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) AMOUNT PAID 08-12-2002 CD001506 6.60- 158.03 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. ^ IF PAID AFTER THIS DATE, SEE REVERSE l TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN S1, 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. ) 151.43 .00 .50 .50 • ,~ J C~~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: Ronald O. Keim Date of Death: February 20, 2001 Will No. Admin. No. 2001-00358 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes No~_ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete : ~~p~•an+~ 302003 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 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did r.he personal representative state an account informally to the parties in interest? Yes No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Date : Iz o3 ti_ S' Lure Jeffrey R. Boswell, Esquire Name (Please type or print) 315 N. Front Street Harrisburg, PA 17101 Address i 717) 236-9377 Tel. No. Capacity: Personal Representative X Counsel for personal representative (MAH:rmf/AM3) Cumberland County - Register Of Wills __ Hanover and High Street Carlisle, PA 17013 Phone:(717) 240-6345 Date: 1/06/2003 ELAINE M SPRIGGS 1039 COUNTRY CLUB ROAD CAMP HILL, PA 17011 RE: Estate of KEIM RONALD O File Number: 2001-00358 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 2/20/2003 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, DONNA M. OTTO DEPUTY REGISTER OF WILLS cc: File Counsel Judge Name of Decedent: Date of Death: Will No.: STATUS REPORT UNDER RULE 6.12 Robert B. Weber May 3, 2001 2001-00538 Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes ^ No c. Copies of receipts, releases, joinders and approval of formal or informal accounts maybe filed w' e Clerk o e O ans' Court and may be attached to this r rt ~ Date: ~ - Q 3 /~, ~~ Steven J. Schiffman, Esq. Name 2080 Linglestown Rd., Suite 201 Harrisburg, PA 17110 Address (717) 540-9170 Telephone No. 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: June , 2 0 0 3 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 ^ 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 ^ No ^ Capacity: ^ Personal Representative Q Counsel for personal representative Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 4/09/2003 CAREY CHERYL L 615 WILLIAMS GROVE ROAD MECHANICSBURG, PA 17055 RE: Estate of WEBER ROBERT B File Number: 2001-00538 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 5/03/2003 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, DONNA M. OTTO DEPUTY REGISTER OF WILLS cc : /File Counsel Judge G~K STATUS REPORT UNDER RULE 6.12 Name of Decedent: Ronald O. Keim Social Security No. 187-09-8753 Date of Death: Februar~20, 2001 Will No. Register File No. 2001-00358 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No 2. If the answer to #1 is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to #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 (Estate Settlement Agreement filed with this report) d. Copies of receipts, releases, joinders and approvals of formal or information accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: September ZS~, 2003 Signature: Name: Jef .Boswell Es uire Address: 315 North Front Street, Harrisburg, PA, 17101 Telephone: X717) 236-9377 Capacity: Personal Representative X Counsel ESTATE SETTLEMENT AGREEMENT THIS AGREEMENT is made the ~_ day of September, 2003, between ELAINE M. SPRIGGS, Executrix of the Estate of Ronald O. Keim, Deceased (herein referred to as Executrix), of 1039 Country Club Road, Camp Hill, Pennsylvania 17011, and ELAINE M. SPRIGGS, Executrix of the Estate of Fae C. Keim, as the said Fae C. Keim was the residuary legatee and beneficiary of the estate (herein referred to as the Beneficiary). In accordance with their desire that the administration of the Estate of Ronald O. Keim be completed, and in consideration of the mutual covenants expressed, the stated Executrix and Beneficiary, and intending to be legally bound agree, as follows: 1. Ronald O. Keim died on February 20, 2001. 2. The administration of the Estate of Ronald O. Keim has now been completed, with Letters Testamentary having been duly granted to the stated Executrix by the Register of Wills of Cumberland County on Apri15, 2001. Jeffrey R. Boswell, Esquire has served as legal counsel. 3. In April, 2001, counsel prepared and arranged for the publication of the required legal advertisements, which proofs of publication are attached as Exhibit "A" and "B." 4. The Executrix established an estate checking account at Waypoint Bank and paid all proper debts as listed in the Inheritance Tax Return. 5. The beneficiary acknowledges receipt of Rule 5.6 notice regarding notice of her beneficial interest in the estate. Counsel prepared a Certification of Notice Under Rule 5.6(a) and filed same with the Register of Wills of Cumberland County on May 4, 2001. 6. After review by the Executrix, Counsel filed the Inventory and the Pennsylvania Inheritance Tax Return on February 27, 2002. 7. As filed, the Pennsylvania Inheritance Tax Return showed no inheritance tax due, as decedent's surviving spouse was the sole residuary legatee and the sole beneficiary according to the Last Will and Testament. 8. On April 12, 2002, counsel for the estate received a Notice of Inheritance Tax Appraisement, Allowance or Disallowance of Deductions and Assessment of Tax indicating the tax return was changed slightly with inheritance tax due in the amount of $155.94, because the decedent owned a bank account jointly with his wife and daughter. 9. On August 9, 2002, pursuant to the Notice of Inheritance Tax Appraisement, counsel for the estate, paid to the Register of Wills, Agent, the inheritance tax due in the amount of $158.03, which documents are attached as Exhibits "C" and "D." 10. According to Item III of his Last Will, Ronald O. Keim gave the entire residuary estate, after payment of debts and taxes, to his wife, Fae C. Keim, who survived him. As such, she is the sole residuary legatee. 11. The decedent had no household personal property, as he was a resident of a nursing facility, HCR ManorCare. 12. The Executrix sold decedent's 1995 Ford Taurus Sedan, depositing the $5,000.00 proceeds in the estate checking account. 13. The parties acknowledge and agree that the estate checking account at Waypoint Bank, account number 0100170422, was closed with the final statement for the period ending June 28, 2002, showing a zero balance. 14. The parties acknowledge and agree that distributions were made to decedent's spouse, Fae C. Keim, payable to her guardian in the amounts of $5,000.00 (January 31, 2002), $3,011.24 (February 26, 2002), and $13.81 (June 11, 2002). 15. The Executrix filed federal and state income tax returns for the period ending December 31, 2001. The parties acknowledge and agree that a tax refund was received from the U.S. Treasury in the amount of $5,767.00, which was paid to the surviving spouse, in addition to the distribution of amounts previously stated. 16. The parties acknowledge and agree that the Executrix completed all details pertinent to non-probate property, including retirement annuity, MetLife annuity, and life insurance. 17. The parties acknowledge and agree that all taxes and administrative expenses have been paid, as set forth in the Pennsylvania Inheritance Tax Return. 18. The parties agree that Jeffrey R. Boswell, Esquire, as counsel, will file this Estate Settlement Agreement with the Register of Wills, to be made part of the official record and that counsel has explained the effect of the "at risk" distribution made pursuant to this agreement. 19. The parties acknowledge and agree that counsel will file with the Register of Wills a Rule 6.12 Report, noting that the estate administration is complete. 20. The parties hereby forever fully release, compromise, settle, and discharge any and all claims, demands, actions, or causes of action, legal or equitable, absolute or contingent, vested or hereafter to accrue, which one may have against the other party hereto or against the Estate of Ronald O. Keim, Deceased, or the agents of the estate, including accountants and attorneys, by reason of any matter, cause or things growing out of or relating to any property or assets of said estate., or growing out of or relating to any act of the Executrix in her administration of the said estate, even if attributable to negligence, and agree that any period of limitation of actions for the collection of any erroneous distribution or distributions shall commence only at such time as the Executrix shall have obtained actual knowledge of said erroneous distribution or distributions, which period shall end two (2) years after actual discovery. 21. The beneficiary acknowledges that if it is determined that there is presented any tax liability, including interest and penalties, or any proper debt, Elaine M. Spriggs, Executrix of the Estate of Fae C. Keim, will provide information sufficient to show any claimant that the Estate of Fae C. Keim is insolvent, thereby having no money to pay any claim. 22. The parties acknowledge and agree that the Estate of Fae C. Keim had insufficient assets to pay all creditors and did receive direction from the Department of Public Welfare to pay Class 3 (priority) creditors a proportional amount of each claim. 23. The parties acknowledge and agree that this Estate Settlement Agreement shall constitute an acknowledgment and release with regard to all distributions paid to Fae C. Keim, through her Guardian, Elaine M. Spriggs. 24. The parties agree to execute such additional documents and releases as the Executrix may submit to them in order to complete any administration details to confirm her discharge from any further liability to the parties in connection with the said estate. IN WITNESS WHEREOF, the parties have hereunto set their hands and seals the day and year first above-written. '~ M ,, , DATE: C( ~-~~~C~ ~ ~~ C ~I j~..~• ~C. ~ .~L~Z~ ame M. Spriggs, Execu ix of Es ate of Ronald O. Keim ~~ r DATE: ~-~~ ~ - ~.Z~.-(,~i~ Elaine M. Spriggs, Execu ix a Esta e of Fae C. Keim, Residuary Legatee, and Beneficiary COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN . ss. On this, the day of September, 2003 before me, the undersigned, personally appeared Elaine M. Spriggs, who acknowledged herself to be the Executrix, a Beneficiary, and Residuary Legatee of the Estate of Fae C. Keim, Deceased, executed the foregoing instrument for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. CorxMe L. Hardy, NAY Pic ~~ ~02oov COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN ss. On this, the day of September, 2003 before me, the undersigned, personally appeared Elaine M. Spriggs, who acknowledged herself to be the Executrix of the Estate of Ronald O. Keim, Deceased, executed the foregoing instrument for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. NOTARY P LIC Wotarial Seed Connie L. Hardy, Notary Pubic My~Oommisston 1 . PerxreyMrria npociatlon of Ncbirlee ~9lol G.`v..~ ~ ~S PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 STATE OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. Roger M. Morgenthal, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, viz: APRIL 20, 27, MAY 4, 2001 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. ~~ R g r M. Morgenthal, Editor g~~, Ronala o.. aec'a. SWORN TO AND SUBSCRIBED before me this Late of the Borough of Camp Hill. 4 day of MAY. 2001 Executrix: Elaine M. Spriggs• Attorneys: Jeffrey R. Boswell, Esquire. Boswell. Tintner. piccola & Wickersham. 315 N. Front Street. P.O. Box 741, Harrisburg. PA 17108-0741. ~~~~ S~ LCD ~. SNYDER+ No~rY Ptr1z11C Cafisle Sao, ~ 5 _~ Corrsm•a^I"~ ~~s March 5, EXHIBIT PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland. ~ s/~~ o ~ ~ £r Sherry Clifford, Classified Ad Manager of THE SENTINEL, of the County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a newspaper of general circulation in the Borough of Carlisle, County and State aforesaid, was established December 13th, 1881, since which date THE SENTINEL has been regularly issued in said County, and that the printed notice or publication attached hereto is exactly the same as was printed and published in the regular editions and issues of THE SENTINEL on the following dates, viz Copy of Notice of Publication i ESTATE NOTICE p etters Testamentary on ~ the Estate of RONALD I O. KEIM, late of Borough of Camp Hill, County of ~ Cumberland County, PA, deceased, have been granted to the undersigned. All persons having claims or demands against the estate are requested to make known the claim or demand, and-alt persons indebted to the estate are requested to make payment, without delay, to the Executrix or to her attorneys named below: Elaine M. Spriggs, Executrix Attorney: Jeffrey R. Boswell, Esquire Boswell, Tintner, Picco_la & Wickersham " ~" 315 N. Front Street, P.O. Box 741 Harrisburg, PA 1 71 0 8-0741 April 14, 21, and, 28, 2001 Affiant further deposes that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statement as to time, place and character of publication are true. r April 30, 2001 30th Sworn to and subscribed before me this day of April , 2001. Notary Public My commission expires: NOTARIAL SE!!!_ ~ SHIRLEY 0. DURNIR;, P-'~~: ,: ~ ~'.~. ' Cariisie 8oro., Cumberlsnu Cuul~cy Commission Expires Au . 9, 2003 COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 INHERITANCE TAX HARRISlURG, PA 17128-0601 DUNNING NOTICE ATTN: POST ASSESSMENT REVIEW UNIT REV-ISLP AFP (07-99) JEFFREY R BOSWELL BOSWELL ETAL PO BOX 741 HBG PA 17108 PHONE (717) 787-6505 TDD# 1-800-447-3020 (SERVICE FOR TAXPAYERS WITH SPECIAL HEARING AND SPEAKING NEEDS). NOTICE DATE 07-05-2002 KEIM FILE N0. COUNTY DATE OF ACN OUR RECORDS INDICATE A DELINQUENT INHERITANCE TAX LIABILITY FOR THE ABOVE ESTATE. OUTLINED BELOW IS A SUMMARY OF OUR RECORDS. ADDITIONAL INTEREST IS CALCULATED AND INCLUDED IN THE BALANCE TO FIFTEEN (15) DAYS FROM THE DATE OF THIS NOTICE. TAX INTEREST 151.43 6.60 ADDITIONAL INTEREST- ADD CREDIT .00 ESTATE OF RONALD 0 ASSN 21 01-0358 CUMBERLAND ASSESSMENT 04-08-2002 101 BALANCE 158.03 .02 PER DAY FROM 07-23-2002 TO AVOID ADDITIONAL COSTS AND INTEREST, THE ABOVE AMOUNT DUE MUST BE PAID WITHIN 15 DAYS FROM THE DATE OF THIS NOTICE. PLEASE DETACH AND RETURN THE LOWER PORTION WITH YOUR PAYMENT TO THE REGISTER OF WILLS OF THE COUNTY INDICATED. MAKE CHECK OR MONEY ORDER PAYABLE TO 'REGISTER OF WILLS, AGENT'. IF THE ABOVE BALANCE DUE HAS BEEN PAID RECENTLY, PLEASE DISREGARD THIS NOTICE. PLEASE RETURN THIS PORTION WITH YOUR PAYMENT TO THE REGISTER OF WILLS LISTED BELOW ESTATE OF KEIM RONALD 0 FILE NO/SSN 21 01-0358 COUNTY CUMBERLAND DATE OF ASSESSMENT 04-08-2002 ACN 101 EXHIBIT REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 _ ~ ~f ~~ i ' :, T r '' ~_.:~, .. _. . 9-..~ .,,,