The URL can be used to link to this page

Home My WebLink About01-0430 PETITION FOR PROBATE and GRANT OF LETTERS Register of Wills for the . Deceased. County of Cumberland in the Social Security No. 175-44-2867 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut or in the last will of the above decedent, dated March 26 and codicil(s) dated None No. To: 21-01-430 Estate of Grace o. Bailey also known as named 1999 ,- Rpnnnriation of Bruce A. Bailey and George Hay (state relevant circumstances, e.g. renunciation, death of executor, etc.) Oecendent was domiciled at death in Cumberland County, Pennsylvania, with h er last family or principal residence at MpRR i ah Village 100 Mt. Allen Dr.... Mechanicsburg, TTpppn Allpn Township (list street, number and muncipality) Decendent, then _97 __ years of age, died April 15, 2001 , ~ at Messiah Villag__ Except as follows, decedent did not marry, was not <;livorced and did not have a child born or adopted after execution of the 'vvill offered for probate; was not the victim of a killing and was never adjudicated incompetent: None Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Valuc of real estate in Pennsylvania situated as follows: $ -:550 000 00 $ , $ $ 0 WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters 'P... ~1"lt f1,)' Administration eta (testamentary; administration c,La.; administration d.b.n.c.t.a.) theron. -", ~ ~-;{ ~1 -::l:; ~:; 7:::' ~= 17019 :oJj f: OATH OF PERSONAL REPRESENTATIVE COl\1MONWEALTH OF PENNSYLVANIA I -'C-O (- t)~ COUNTY OF CUMBERLAND J 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 represen- tati\c(s) of the above decedent petitioner(s) will we~ truZlY admq'!liS r the estate accord-Lng to law. '-~~ ( 13 d./ - -z, :' / / ",/ .:./ ~~ .-.e--z-~ Sv,?r[1 tl) or affir~ed and subscribed (~ -bl~~ ~.. ~~ beton? me thl'l _ 23,Ld____ day of \ _ - ,-,WL ~ l--= APRIL /' ]K}{200 1 '-- _/' "- l::l Z2J.~'Y~;;;/~~.J/f)~ b (' ~ 1/ '9 / ' Register ~ /c.)-~ 7- No. 21-01-430 Estate of GRACE O. BAILEY , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW MAY 1 X1l9200 1 , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated March 26 , 1999 described therein be admitted to probate and filed of record as the last will of Grace O. Bailey and Letters ~~~~ OF ADMINISTRATION CTA are hereby granted to Jon N. Spaulding \ /'-' . /'/)a~. // \., // ~-')' c/f' ! ~ )~, ,'/' / .c-u:y ~tyJ.;./././ ~ lit' L<.. / ,.' /.C'~.<C --r.'-<-F / ' , / t R~ster of Wills FEES Probate, Letters, Etc. ......... Short Certificates( ).......... x-pages Renunciation ................ JCP $ 375 . 00 $ ~ .00 $ 10:88 $ 5.00 TOTAL _ $ 453.00 A~~:r.~ .?~.,. )99.1. .. . . .. .. . .. . . .. . . Jacqueline M. Verney. Esq. #23167 ATTORNEY (Sup. Ct. I.D. No.) 44 S. HAnover St., Carlisle, PA 17013 ADDRESS (717) 243-9190 Filed PHONE CA-<~ C2c.z~IA:;'<'Y Thj~ IS to cerri~' that the information here given IS correctly copied [rom an original certificate of death Julv tiled with me as Local Registrar. The original cerritlcate wi]] be forwarded to the State Vital Records OffIce tor permanenr fiiing. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. /.tfi"';IiI7ii/~~ \\,\II'~~~H OF Pfi--:~ \\.~' / ~ IJtn-:"" ,\~/ 'Z<.I..J.:"- It\~/ 9.~1 \~\ ~ .:! / . _ _t_~, _ \? ~ ~ <::Ii A", -I~~ iU\_ <,-f~1' ./~~ ,,~~"'! *i ';.~'~\' '\. ;~(" /~ l -;.- ',f,~-;-,---<, V:.\; ", ~;/"ENl \)'.,;,~~' ~ j). 7mJJ~ J tlL1~ ~ Local Registrar Fee for this certificate, $2.00 P 7340065 /!rotj / 9: ,:f2M I Date 21-01-430 il05.143 R.... 2/87 COMMONWEALTH OF PENNSYLVANIA e DEPARTMENT OF HEALTH e VITAL RECORDS CERTIFICATE OF DEATH .T 97 STAlE FILE: NUMBER SEX SOCIAl SECURITY NUMBER IT ( NAME Of' DECEDENT If<... ">dale. cas) Grace O. Bailey AGE (La&! llonI>aaVl UNDER 1 VEAR MomI1a Da~ 2. Female 175 - 44 2001 BIRTHPLACE (C.ty ~r..d Slale Of fcre.gt1 CounPy) ="YID . 5. . COUNTY OF DERH .... Cumberland DECEDENT'S USUAl OCCUAQ1ON (Give ~ of .work done dur.ng mosr of ~ life; do... use ,"'ed I . llL Homemaker l1L DECEDENT'S 1AAl1lNG ADDRESS lSU-. Cilylbwn. _. z,pCodel 247 S. York Road Dillsburg, PA 17019 MARITAl STATUS - Mamed Never Married. WICIOw<<I. DMlrced (Spedy) Widowed White SURVIVING SPOuSE IN..... gMI_ nemel 17b. [);d - Min. Cumberland -'1>1 17d.1KI ~~':::ol Mechanicsbur~ MOTHER'S NAME (fOIl. ""<Idle. _ Sutname) 18. Ellen J. Moffat INFORMANT'S MAIUNG ADDRESS lSUoel. ~Ibwn. SIaIe. Zip Code) _.247 S. York Road Di PUCE Of' DISPOSITION. NMMo 0' c.m.terv. CromalOly or 0Iher Ptac8 _. ClIy_. _lromSlaleO =.515 16201 DATE PRONOUNCED DEAD (M001l1. Day. Yea,) 24. M. 25. A ....;L. IS-, ,;)..~Ol 27. PART I: En.... rhe diseases. injuOes Of e;ompic.Mi0n5 which caused I.... o.ath. 00 no. ent... IIl4IITIOde 01 dying. such a5 carOiK 01 re:5piralory anal, ~ or heart lULl,. Lise only one cauM on each 6ine. NoIXI [ : WERE AUtOPSY FINDINGS AIolIUlASl.E PRIOR 10 COMPlETION OF CAUSE OF DERH1 :II. f Apprgximate , InttlfYal befwMn : onMt and dNd'I I l PART..: OIhwaigll;rlClllll_~IO_.buI "'" .-.lIinginlhe ~_g_in IW\T I. (\^"rf( DUE 10 (OR ASA CONSEOUENCE OF): DUE 10 (OR AS A CONSEOUENCE OF)' .......NER OF DEATH DATE Of' IN.JURV (loloolh. Day. Yeatl TIME OF IN.JURY IN.JUR'f AT WORK? DESCRIBE HOW INolURY OCCURRED. v..D NoD NaIutal ~ _.. D Suoc:OIe 0 HcmicOle D Pending 1Iweoliga..... D Could.... be delerm<ned D v.. D NoD .PRONOUNCING AND CERTIFYING PHYSK:lAN (PhYSCIan bcIlh jJfonounclng oealh and cer1lfYWl91O cause of l.1ealtll To 11M best of my knowledge, death oc:c...,recl at ....1Ime. data. and pIKe. and d~ 10 Ihe cauae(a. and mann.,.. ataleG.. . . . . . . . . . . . . . . . . . . . . . . . . 101310 ISllol 28b. QRTWlER lC/1oc1t aniy <>nel .canlfYlNG PHY5ICIAN (PhySDan cerlrfylt\g cause d cealh wilen another pnVSlC.afl has pronOUnced dealh ana complelea Item 23) TO....bMlOllfty knowledge.de.lftoceurndduelGlhecause(s.andmanner ..stated. .... ........................................ 34. 21-01-430 LAST WILL AND TESTAMENT OF GRACE O. BAILEY I, Grace O. Bailey, of South Buffalo Township, Armstrong County, Pennsylvania, hereby make, publish and declare this to be my last will and Testament and I do hereby revoke any and all testamentary dispositions which I have heretofore made. FIRST: I hereby direct that all of my just debts, funeral expenses, and expenses of my administration be paid out of my estate as soon as may be practicable after my death. SECOND: I bequeath to my daughter, Ellen Jane Spaulding, my diamond ring. Further, I hereby give and bequeath the rest and residue of my entire estate to my children, Bruce A. Bailey, Elizabeth Ann Hay and Ellen Jane Spaulding, their heirs and assigns forever, per stirpes, so much of : said property as they may each select, and any unselected items may be sold and the proceeds distributed as part of the rest of may estate. THIRD: I appoint Bruce A. Bailey and my son-in-law, George Hay as Co-Executors of this, my Last Will and Testament, and direct that they shall not be required to enter any bond or security in any jurisdiction in which they may act. I also grant them the power to sell any property not specifically devised. IN WITNESS WHEREOF, I, Gr<l;ce O. Bailey, have executed this, my Last Will and Testament, on thisc2G'.~day of /)'7a )(:.l" , 19 '19 . ( " , , j I ~/ .' "'., l ' 'tV/'Zll (~J C/ I l ~. (lel.>'1..- f _ .' '-- Grace o. Bailey, Te'S'tatrix SIGNED, SEALED, PUBLISHED and DECLARED by the above named Testatrix as and for her Last Will and Testament, in the presence of us, who have hereto subscribed our names at her request as witnesses thereto, in the presence of said Testatrix and o~ ch other. I Witne~: I , ! Witness:'- ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF l'u"nj6-t.~{/(tJ?(/ 55. I, Grace O. Bailey, Testatrix, whose name is signed to the foregoing Instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the foregoing Instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Ala r-G t): 6 (Ch", Grace O. Bailey, T estat - Swot,'ll or affirme.d to an~ acknowledged before me, by Gr.~ce O. Bailey, the Testatrix, this ,20~day of n )tliCf- , l'l'-n. J; _ _.. _.' ;: .-,>; (.\c /Z.ll,/(~>:.-- )}). /""2,) /"<"'A...--~ N otalY Public Notarial Seal Diane M. Smith, Notary Public Mechanicsburg 80ro, Cumberland County My Commission Expires June 22, 2000 Page 1 of2 AFFIDAVIT COMMONWEALlH OF PENNSYLVANIA , If COUNTY OF (,( Ll) ) i-t.. i kl ) lef We, ~oN S~ALJQD ~nd SS. /) kt'rr-e I I,), tiA:~/f(J) iII, the witnesses, , whose names are signed to the foregoing Instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the foregoing Instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me byl\[l~' \\~)(:'d-,dd l'lv ~, ,~ fJ t rre! f('. [Ii.))!! J~3J , witnesses, this c;.l.. Y,t, day of l))u .\( l" r and I q(t (I (\ I . I\. /[i..)..l'-"c- Notary Public '\ J' " /}1. ,0.)y~~.rL_ Notarial Seal . Diane M. Smith, Notary Public Mechanicsburg Boro, ~umberlan~2 C~~8~ My Commission Expires June , Page 2 of2 RENUNCIATION 21-01-430 In Re Estate of Grace O. Bailey deceased. To the Register of Wills of Cumberland County, Pennsylvania. The undersigned Co-Executors of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters Testamentary be issued to Jon N. Spaulding WITNESS our hand this 19th day of April ,19 200~ , '1~~/L ~. /57 ~~;;'::7 :2 ~c/ #i/'/V/\fIC C/ If ;)/2 I # rt-rt';5 JvC'i &/1 Jc C r ~ (Address) "7' €A~~~~/ It-( FP/(~?1L. R.r"/A-() LIV€RPoC'{,/ NY /3"~t:J -~ <iV-I (Address) (Signature) (Address) 21-01-430 RENUNCIATION In Re Estate of ~r:=l('p 0 RAiley dec;eased. To the Register of Wills of Cumberland County, Pennsylvania. The undersigned Beneficiaries of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters ~, n "r 1 1 'wf Testamentary be issued to Jon N. Spaulding WITNESS o L{ r2- ....<:". -? - --ft\ /I 0'7 L hanlYlhis ..:)u day of --t.:J f ,- t """0 L_,0 t"J f ,'1'_. I Y fJ~ ; JirMlO~ ature) 247 S. York Rd. Dillsburg, PA 19019 (Address) ~ [~i1.~) ~ 14 Forester Road Liverpool, NY 13090-2441 (Address) (Signature) (Address) CERTIFICATION OF NOTICE UNDER RULE 5.6(a) ,~ Name of Decedent: hr;:)ce o. Bailev Date of Death: April 15, 2001 Will No. 21-01-00430 Admin. No. To the Register: I certify that notice of (beneficial interest) estate adD1ini~tion 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 11, 2001 ~ Address Bruce A. Bailey 240 Hunnicutt Dr., Athens, GA 30606 Elizabeth Ann Hay 14 Forester Rd., Liverpool, NY 13090-2441 Ellpn T;::mp Spmll ding 247 S. York Rd., Dillsburg, PA 17019 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None Date: ~~ -- 1/ -0 I Signature ~-----<- I~l. V~ Name Jacqueline M. Verney, Esquire Admess 44 S. Hanover St. Carlisle, PA 17013 Telephone (711 243-9190 Capacity: _ Personal Representative ~Counsel for personal representative a .. ~'""Io ~... NOTICE OF BENEFICIAL INTEREST IN ESTATE BEFORE THE REGISTER OF WILLS I COUNTY OF r.llmhArl ~nM I PENNSYLVANIA In re Estate of Grace O. Bailey , deceased, No. 00430 of 2001 TO: Elizabeth Ann'Hay 14 Forester Rd. (beneficiary) (address) Livernoolr NY 110g0-2441 Please take notice of the death of deced~nt and the grant.of letters to the personal representative(s) named below. You may ha, a beneficial interest in the estate as follo~s: 1/3 residuary estate (if additional space is needed, use back of page) Name of decedent Grace O. Bailey ~ Last kno"..n address MEssiah Village: 100'Mt. Allen Drive, Mechanicsburg, PA 17055 of decedent Date of death April 15, 2001 Place of deat.h Messiah Village County of grant of original letters Cumberland Decedent died x testat.e intestate. A copy of the will x is is not attached. Name(s), addressees) and telephone number(s) of all personal representatives appointed Name Address TelephoTl (717) 766-1658 Jon N. Spaulding 247 S. York Rd. Dillsburg, PA 17019 Name(s), address(es) and telephone number(s) of all counsel Name Address Telephone (717) 243-9190. , Jacqueline M. Verney, ESq. 44 S. Hanover St., Carlisle, PA 17013 Additional information may be obtained from the undersigned. Date S-/( -() I Signature h~.L-r 1J;. t... v 'y Name Jacqueline M. Verney, Esq. Address 44 S. Hanover St. Carlisle, PA 17013 Telephone (717) 243-9190 Capacity: Personal Representative Counsel for personal representative x NOTICE OF BENEFICIAL INTEREST IN ESTATE BEFORE THE REGISTER OF WILLS, COUNTY OF Cumberland , PENNSYLVANIA In re Estate of Grace O. Bailey , deceased, No. 00430 of 2001 TO: Bruce A. Bailey 240 Hunnicutt Drive (beneficiary) (address) Athens, GA 30606 Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. You may have a beneficial interest in the estate as follows: 1/3 residuary estate (if additional space is needed, use back of page) Name of decedent Grace O. Bailey Last known address Messiah Village 100 Mt. Allen Drive. Mechanicsburg. PA 17055 of decedent Date of death April 15. 2001 Place of death Messiah Village County of grant of original letters Cumberland Decedent died x testate intestate. A copy of the will x is is not attached. Name(s), address(es) and telephone number(s) of all personal representatives appointed Name Address Telephone Jon N. Spaulding 247 S. York Rd. Dillsburg, PA 17019 (717) 766-1658 Name(s), address(es) and telephone number(s) of all counsel Name Address Telephone Jacqueline M. Verney, ESq. 44 S. Hanover St., Carlisle, PA 17013 (717) 243-9190 i Date 5:'-/1-0 , obtained from the undersig~ed. I~ Signature ~7h' jI~_ Name Jacqueline M. Verney, Esq. Additional information may be Addres 5 44 S. Hanover St. Carlisle, PA 17013 Telephone (717) 243-9190 Capacity: Personal Representative x Counsel for personal representative a , ~~ NOTICE OF BENEFICIAL INTEREST IN ESTATE BEFORE THE REGISTER OF WILLS, COUNTY OF r.llmnAr1 ~nrl , PENNSYLVANIA In re Estate of Grace O. Bailey , deceased, No. 00430 of 2001 TO: Ellen Jane SDauldin~ (beneficiary 247 S. York Rd. (address) Dillsburg, PA 17019 Please take notice of the death of deced~nt and ~he grant of letters to the personal representative(s) named below. You may ha a beneficial interest in the estate as follo~s: 1/3 residuary estate (if additional space is needed, use back of page) Name of decedent Grace O. Bailey Last kno~n address MEssiah Villa~~ -100 'Mt. Allen Drive. Mechanicsburg.. PA 1705: of decedent Da't.e of dea t.h April 15, 2001 place of deat.h Messiah Village County of gran~ of original letters Cumberland Decedent died x test.at.e intestate. A copy of the will x is is not attached. Name(s), addressees) and telephone number(s) of all personal representatives appointed Name Address Te 1 ephoT (717) 766-1658 Jon N. Spaulding 247 S. York Rd. Dillsburg, PA 17019 Name(s), address(es) and telephone number(s) of all counsel Name Address Telephone (717) 243-9190. , Jacqueline M. Verney, ESq. 44 S. Hanover St., Carlisle, PA 17013 Additional information may be Date b -Ii -0 , obtained from the undersigned. signature ~ O~ .L.. 7A - ~ Name Jacqueline M. Verney, Esq. Address 44 S. Hanover St. Carlisle, PA 17013 Telephone (717) 243-9190 Capacity: Personal Representative x Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND l J u: ,.... Jon N. Spaulding _...,-~ being duly sworn according to law, deposes and says that he is the Executor of the Estate of Grace O. Bailey late of __________ _ ._t1~~~~~s:s_burg__._____ , Cumberland County, Pa., deceased and that. ~...r-' within ;s an inventory made by Jon N. Spaulding: ., the said ExecuttOr .... of the entire estate of said decedent, consisting of all the personal prop~rty and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. ('/ and subscribed before me, 2-2- * 2.oD J I 247 South Yory- Road ~ Dillsburg, PA 17019 Address Date of Death . EAr KAcTH~ N K. SHAULIS. Notary Public arltsJe ~~o. Cumberland County My CommiSSIon Expires Dec. 22. 2003 15 Day April ?001 Month Year INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additionalasseh. 3. Additional sheets may be attached as to personalty or realty 4. See ArticJe IV. Fiduciaries Act of 1949. 0 . C"'l >- -0 0"' ...;;t CD (/) 0 .... w .,. w a:: .... ,., 0 ~ LU < IU ... I a.. .... u ;;.... ,.,....-l 0 IU t) 0 0 w V) 0 0- Q) >- a:: w 0 lit I J: ,., ,.,....-l t- a.. 0.. ~ c Z .... -J u.. ,., Q) .. N -< 0 d 0 u.. -J a.. :> = w 0 < w >. > a:: ~ < Z .. ~ Z 0 c Q :lI 0 V) Z 0 Q) ~ 0 0 Z LU -< - 'r-! a. "0 ...-i C Q) '" I - i: ::J 0 IU 0"' I ..J:J CJ I IU E " -w Ctl ... ..! 0 IJ I 10 :lI 0 I -' 0 u:: a:a Inventory of the real and personal estate of - Grace O. Bailey l~ .~~derated Hi~h Income Bond Fund B II 7002123498 2. Pionee.r Fund-Class A II 001-6206562490 3. George W. Bailey Trust/Bailey Family Trust 4. Prudential Utility Fund A II 2807881035 Value Fund A II 28207881035 5. PNC Bank acc t II 31200207893 II 5002059615 6; Enterprise Funds II 84927 42461 Fund 233 1/ 84927 42461 Fund 216 7. Fulton Financial /I 16204321 8. Waypoint Bank checking acct 9. MetLife stock 10 shares deceased ~ ,,; .... - . , ':~, ~ t'; " . 70 18 .65 26,~1 25 21,14 86 08 69 88 34 100,07 00 3,77 29 .52 545,748 .:)1 ,. " . ( ti'; ;, ~ ~ . TOTAL COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1162 EX( 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT VERNEY JACQUELINE M 44 S HANOVER STREET CARLISLE, PA 17013 -------- fold ESTATE INFORMATION: SSN: 175-44-2867 FILE NUMBER: 21-2001- 0430 DECEDENT NAME: BAILEY GRACE 0 DA TE OF PAYMENT: 07/06/2001 POSTMARK DATE: 00/00/0000 I COUNTY: CUMBERLAND ~ DATE OF DEATH: 04/15/2001 NO. CD 000019 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $22,724.92 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: JON SPAULDING C/O JACQUELINE M VERNEY ESQ CHECK#109 SEAL INITIALS: VZ RECEIVED BY: REGISTER OF WILLS $22,724.92 MARY C. LEWIS REGISTER OF WILLS !C:.-dd7-. C; COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 08-20-2001 BAILEY 04-15-2001 21 01-0430 CUMBERLAND 101 JACQUELINE M VERNEY ESQ 44 S HANOVER ST CARLISLE PA 17013 l~ 'U~ REV-1S47 EX AFP el2-00l GRACE o Amount Rellitted CHANGED (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 541,675.63 3,775.16 .00 (8) MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-V: is'4-j-E"X--AFP-ci"2:ooj--NO,.-icE--OF--ftiHEifiTAifCE-YAX-A-PPRAisEifENT~--Ai.l-ciwAifcE-o-R----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BAILEY GRACE 0 FILE NO. 21 01-0430 ACN 101 DATE 08-20-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. ~ointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule ~) 14. Net Value of Estate Subject to Tax (9) (10) 11,703.80 NOTE: To insure proper credit to your account, subllit the upper portion of this form with your tax payment. 545,450.79 13.873 88 531,576.91 .00 531,576.91 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ~ returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: .00 X 00 = .00 531,576.91 X 045 = 23,920.96 .00 X 12 = .00 .00 X 15 = .00 (19)= 23,920.96 2.170.08 (11) (12) (13) (14) PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-06-2001 CDOOOO19 1,196.05 22,724.92 TOTAL TAX CREDIT 23,920.97 BALANCE OF TAX DUE .0ICR INTEREST AND PEN. .00 TOTAL DUE .0ICR . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) ., ~ ~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: Grace o. Baily Date of Death: 4/15/01 Will No. 21-01-00430 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 x No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No x b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the persdnal representative state an account informally to the parties in interest? Yes X No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Da te : (1- z- -(; ( ~ .' ,a; ~ -'--' -yo ;:~ - f h, V 'l^-~_ '" , ig~~ure c) Jacqueline M. Verney, Esquire Name (Please type or print) 44 S. Hanover St Carlisle, PA 17013 Address (717 ) 243-9190 Te 1. No. Capacity: Personal Representative (MAH:rmf/AM3) X Counsel for personal representative ESTATE OF GRACE O. BAILEY, Deceased FILE NO. 21-01-00430 FAMILY AGREEMENT This Agreement entered into this 30'-0- day of (!Jc f ,2001, by and between the undersigned Beneficiaries and Executor appointed in the Estate of Grace O. Bailey, Deceased. BACKGROUND 1. Grace O. Bailey died April 15, 2001, a resident of Messiah Village, Mechanicsburg, Cumberland County, leaving a Will dated March 26, 1999. 2. Decedent's will was admitted to probate by the Register of Wills of Cumberland County on April 23, 2001 and letters Testamentary were issued to Jon N. Spaulding. 3. In her Will, Decedent bequeathed all the rest, residue and remainder of her estate to her children, Bruce A. Bailey, Elizabeth Ann Hay and Ellen Jane Spaulding. 4. The Executor advertised the grant of letters testamentary, prepared and filed an Inventory and Appraisement of Decedent's property and prepared and filed a Pennsylvania Inheritance Tax return and will prepare or cause to be prepared state and federal income tax returns and has or will pay the appropriate taxes thereon. 5. The Executor has liquidated all of the assets of the estate. , 6. The Executor has paid all the debts and expenses of the estate known to him and he has no knowledge of any unpaid claims, absolute or contingent, which may be asserted against the . estate nor does he have any reason to believe there are any such claims, except for the state and federal income taxes for 2001. 7. A statement reflecting all estate receipts, disbursements and distributions is annexed hereto as Exhibit "A". 8. It is the desire of the Beneficiaries and Executor that the Estate of Grace O. Bailey, deceased, be distributed without the formality of a Court accounting, and the said Jon N. Spaulding, Executor is willing to make such distribution upon receipt of this executed agreement. 9. In consideration of the foregoing and intending to be legally bound hereby, Bruce A. Bailey, Elizabeth Ann Hay and Ellen Jane Spaulding, agree as follows: a. Do hereby waive an audit of an account of the administration of the Estate of Grace O. Bailey, deceased, by the Orphan's Court Division of the Court of Common Pleas of Cumberland County. b. Do hereby declare that they have examined the attached account of the Estate of Grace O. Bailey, deceased; that they find it to be true and correct in all particulars; that they accept and approve it with the same force and effect as if it had been prepared and duly filed with, audited, adjudicated and confirmed absolutely by the Orphan's Court Division of the Court of Common Pleas of Cumberland County. c. Do hereby acknowledge that Jon N. Spaulding, Executor has distributed all assets of the . Estate of Grace O. Bailey, deceased, except that which has been reserved for the payment of 200 1 income taxes and preparation thereof, final legal fees and administration expenses. Any amount not needed from the reserve will be distributed to the beneficiaries upon final payment of expenses. d. Do hereby absolutely and irrevocably remise, release, quitclaim and forever discharge Jon N. Spaulding, Executor, his heirs, executors, administrators and assigns, of and from any and all action, reckonings, liabilities, claims and demands relating in any way to their administration of the Estate of Grace O. Bailey, deceased. e. Do hereby declare it to be their intention that this instrument shall be legally binding upon them and upon their heirs, executors, administrators and assigns. f. Do hereby agree to indemnify and hold harmless Jon N. Spaulding and his heirs, personal representatives, successors and assigns, from and against any claims, liabilities, loss or expense (including costs and counsel fees) arising from any cause whatsoever, which the Executor may incur as a result of the administration of the estate and its distribution in accordance with this agreement including but not limited to any liability for any federal estate taxes, Pennsylvania Inheritance tax or any other death taxes, and any federal or Pennsylvania income taxes, and Pennsylvania personal property taxes, together with any interest and costs incidental thereto, relating in any way to the estate and also including, but not limited to, any assets received or payments or distributions made by reason of any negligence or mistake of law or fact. IN WITNESS WHEREOF, the undersigned have set their hands and seals, intending to be legally bound. WITNESS: U->>:l""-- ~- ,{},'J-tl v-(( /~~ ..... 1.'1 '...;' ..1/l.. Lt,{ ~{ ~iw-~k STATE OF ~/ >-xf COUNTY OF C LCY'Y l.l ~ On this --L1- day of ~~ 1 , 2001, before me, a Notary Public, personally appeared Bruce A. Bailey, own to me (or satIsfactonly proven) to be the person whose name is subscribed to the within instrument, and executed the same for the purposes contained therein. SS IN WITNESS WHEREOF, I hereunto set my hand and official seal. L Ikh Notary Pub~ STATE OF "'--~~')D~-~ COUNTY OF D\)c.)f\\:)~C~~~ SS On this ~~ day of \'f::~' , 2001, before me, a Notary Public, personally appeared Elizabeth Ann Hay known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and executed the same for the purposes contained therein. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ~. ~ ~~ APRILJAMES Notary ubhc Notary Public, State of New York Quolified in OnondogWunjy My Commission Expires .c.E:::.~()~ b \ ~)fS)'-f(.fl,J COMMONWEALTH OF PENNSYLVANIA : SS COUNTY OF CUMBERLAND On this ~ day of (j{\j-()kJe r ,2001, before me, a Notary Public, personally appeared Ellen Jane Spaulding, known to me, (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and executed the same for the purposes contained therein. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ::hcuiJt&---~W Notary Public Notarial Seal Lori Ann Leitch, Notary Public Upper Allen Twp., Cumber1and County My Commission Expires Mar. 1,2004 Member, Pennsylvania Association of Notaries COMMONWEALTH OF PENNSYLVANIA : SS COUNTY OF CUMBERLAND On this 30th day of 0cJ.o~ y , 2001, before me, a Notary Public, personally appeared Jon N. Spaulding, known to me, (or satisfactorily proven) to be the person whose name is subscribed tot he within instrument, and executed the same for the purposes contained therein. IN WITNESS WHEREOF, I hereunto set my hand and official seal. S::go J ~ l.~Cu Notary Public Notarial Seal Lori Ann Leitch, Notary Public Upper Allen Twp., Cumberland County My Commission Expires Mar. 1,2004 1 1 ~ Member, Pennsylvania Association o! Nntarler EXHIBIT" A" ASSETS: (under control of executor) 1. Enterprise Equity-Income Fund: 2. Enterprise High-Yield Bond Fund: 3. Federated High-Yield Bond Fund: 4. Pioneer Fund: 5. Prudential Utility Fund: 6. Prudential Value Fund: 7. MetLife-sale of stock: TOTAL: $ 8,843.02 7,730.56 7,665.41 11,013.19 25,215.13 21,678.79 297.52 96,379.46 14,256.13 3,775.16 1,630.32 58.52 1.921.13 $200,464.34 8. PNC Bank CD: 9. PNC Bank Money Market Acct: 10. Waypoint Bank checking acct: 11. Prudential Life Insurance Policy: 12. AFLAC Insurance -refund: 13. Misc. income from investments: ASSETS: (under control of others, distributed or to be distributed as noted) 1. National City Bank: (already distributed) $240,000.00. Remainder to be distributed directly to beneficiaries by National City Bank. 2. Fulton Financial: (to be distributed directly to beneficiaries) $100,072.00 DEBTS AND DEDUCTIONS: TOTAL: $ 4,732.76 250.00 187.62 71.02 2,100.00 .54 55.1 0 14.44 16.25 453.00 22,724.92 1,648.65 143.37 $ 32,397.67 1. Bauer Funeral Home: 2. Presbyterian Women: 3. Flowers: 4. Printing booklets: 5. Messiah Village: 6. Verizon telephone: 7. PharMerica: 8. CP02-wheelchair: 9. Fulton Bank checkbook charge: 10. Probate fees/filing fees-Register of Wills: 11. State Inheritance taxes: 12. Attorney's fees to date: 13. Executor's admin expenses: RESERVE FOR FUTURE EXPENSES: 1. Federal/state income taxes, tax prep fees, attorney's Fees, admin expenses $ 5,602.27 TOTAL A V AILABLE FOR DISTRIBUTION: ($200,464.34 - 32,397.67 - 5,602.27 = $162,464.40) $162,464.40 PROPOSED DISTRIBUTION: Bruce A. Bailey: Elizabeth Ann Hay Ellen Jane Spaulding $ 54,154.80 $ 54,154.80 $ 54,154.80 -. REV-1500EX(6-00) cV COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 OFFICIAL USE ONLY w .., ~::$cn o Q'" w"O ",00 0"''''' ..Ill .. " 1lJ; ~__2 '2 rl=_~_._ FILE NUMBER INHERITANCE TAX RETURN RESIDENT DECEDENT ...2..-L-JLl CQUNTYCQDE YEAR ..Q...Q.../L...1...Q NUMBER I- Z W C w (,) w c DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Baile Grace O. DATE OF DEATH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER SOCIAL SECURITY NUMBER 175- 44 - 2867 DATE OF BIRTH (MM-DD-YEAR) 04 15 01 08/19/03 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) N A ~ 1. Original Relurn D 4. Limited Estate ~ 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (dale of death after 12-12.82) ~ 7. Decedent Maintained a Living Trust (Attach cOj)yofTrusl) o 10. Spousal Poverty Credit (date of death between 12-31.91 and 1-1-95) D 3. Remainder Return (date of death prior 10 12-13-82) o 5. Federal Estate Tax Return Required o 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sell 0) I- Z W o z o .. '" w '" '" o o NAME Jacqueline M. Verney, Esquire FIRM NAME (If Applicable) COMPLETE MAILING ADDRESS Jacqueline M. Verney, Esquire 44 S. Hanover St. Carlisle, PA 17013 TELEPHONE NUMBER (717) 243-9190 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) o o OFFICIAL USE ONLY 3. Closely Held Corporation, Partnership or Sole-Proprietorship n o z o !cC ...I ~ l- ii: <( (,) w a:: 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or l) 8. Total Gross Assets (total Lines 1-7) (8) 545,450.79 1::\/..1 ~h7r::; h~ (6) 3,775.16 (7) o 9. Funeral Expenses & Administrative Costs (Schedule H) (9) (10) 11,703.80 2.170.08 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total lines 9 & 10) (11) 13.873.88 (12) 'ill 'i7h ql - (13) 0 (14) 531,576.91 12. Net Value of Estate (line 8 minus Line 11) 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (ScheduleJ) 14. Net Value Subject 10 Tax (line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o !cc I-' ~ a. ::E o (,) ~ 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x.O_ (15) 0 x .0ltL (16) 23,920.96 x .12 (17) 0 x .15 (18) n (19) 23.920.96 16. Amount of line 14 taxable at lineal rate 531.576.91 17. Amount of line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: , STREET ADDRESS Messiah Village 100 Mt. Allen Drive CITY Mechanicsburg I STATE PA 1 ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 23,920.96 1,196.04 Total Credits (A + 6 + C ) (2) 1,196.04 3. InteresUPenalty if applicable D.lnterest E. Penalty TotallnteresUPenalty ( D + E ) (3) 4. If Line 2 is 9reater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) o 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) o 22,724.92 A. Enter the interest on the tax due. (5A) o 6. Enter the total of Line 5 + 5A. This is the 6ALANCE DUE. (56) Make Check Payable to: REGISTER OF WILLS, AGENT _n" 1IIIiEllllllll!l I!l"llllll i: III" .~Il!IIl_-- iIIIllllI _ 11l1lil1li11;1".1111_..._.._ 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 property transferred;.. ................ ....................... D [Xl b. retain the right to designate who shall use the property transferred or its income;... . D [1{] c. retain a reversionary interest; or... ...... ............. .................. ... 0 ~ d. receive the promise for life of either payments, benefits or care? ......... D [19 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .. . ............... ...................... .............. D ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?. ... D ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . .. ............... ........... D Qg IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FilE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, induding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE Jac ueline M. Verne , Esquire ADDRESS 44 South Hanover St, Carlisle, PA 17013 ~tllll!I\llll!wrilill\lIIIll1Illi!lll_I!_Jllll_\lli~_I*l!lllill!lllilll IliITlIUIJI1_IIJL_..IlL RilL. J II IIIIlmill.B\lm~!lllllllf For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 PS 99116 (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. 99116 (al (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116(a)(I.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1 I]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(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, REV-1508 EX + (1.971 '*' SCHEDULE E CASH, BANK DEPOSITS. & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bailey, Grace O. FILE NUMBER 21-01-00430 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. 2. 3. 4. DESCRIPTION Federated High Income Bond Fund B # 7002123498 P.O. Box 8604 Boston, MA 02266-8604 VALUE AT DATE OF DEATH 7,901. 70 Pioneer Fund-Class A #001-6206562490 P.O. Box 9014 Boston, MA 02205-9014 10,579.18 George W. Bailey Trust/Bailey Family Trust National City Bank, Trustee P.O. Box 94715 Cleveland, OH 44101 248,008.65 Prudential Utility Fund A Value Fund A P.O. Box 7387 Philadelphia, PA 19101-7387 II 2807881035 II 28207881035 26,216.25 21,148.86 5. PNC Bank Acct # 31200207893 95,389.08 500 First St. Acct II 5002059615 14,237.69 Pittsburgh, PA 15219-3128 6. Enterprise Funds Acct II 84927 42461 Fund 233 7,866.88 P.O. Box 219731 Kansas City, MO 64121 Acct II 84927 42461 Fund 216 10,255.34 7. Fulton Financial Acct II 16204321 100,072.00 599 N. 12th St. Lemoyne, PA 17043 TOTAL (Also enter on line 5, Recapitulation) $541,675.63 (if more space is needed, insert additional sheets of the same size) MAY-23-01 WED 10:27 AM FAX NO. 412 288 1982 P. 02 LOOKUP: AS-OF DAILY VALUATION FUNe AB Fln{D 0000630 QUAL 7002123498 SFFX 04152001 ______ (0000630-01002123498/2) ----------------------------------------------- 'W-y ..T'l~ G1lA~' C]'1!l'l'%Lln'" J't" WRt7S' 247 S YORK RD DIl,r,snUnG PA 17019-9515 FUND NAME.. ... ... ..... FHIBFB DEAl,ER(BRANCH.. 0047114/003 REi' NO................. 1348049 REP NAME. . STEVEN M AAGOFSKY PRICE DATE....... ........ .......... 04/12/2001 LAs'r TWcNSACTION... . . . . . . . . . . . . . . . . O./la/2:C01' NET ASSET VALUE.................... 8.3600 TOTAL SliRS.....,.,. ...,... 945.1800 AS-Dr' VALUE"...... .. . .. . 'T, i01.. 70 t George W. Bailey died 2/22/99 DEALER/REP COPY . E PIONEER PIONEER FUND-CLASS A ACCOUNT STATEMENT DATE, 04/13/99 DEALER #: 3742-3911 BRANCH, PITTSBURGH ALLEGHENY INVESTMENTS LTD. 3000 MCKNIGHT EAST DRIVE PITTSBURGH, PA 15237 BAILEY GRACED GRACE 0 BAILEY 247 SO. YORK RD DILLSBURG, PA 17019 ...... ...... ............_,....,.",..... .......'.......'......-.... ................--....,.,-.. ... .........--.--.-............ ....................... ......... ............................................................................. . ...-.,--.....-.---.......... . ACliPQiwmNqM~Ii!1i 001 6206 62490 FOR ASSISTANCE CALL 1-800-225-6292 DATE TRANSACTION 04/12/99 TRANSFER IN 6202704256 175442867 REP, 1348049 HAGOFSKY STEVEN M 0218 2588 RECORD OF YOUR TRANSACT IONS SHARES TOTAL SHARES OWNED 233.719 233.719 233.719 DOLLAR AMOUNT PRICE lOJ ~O"'f. s-o 'i/I~/OI IO,S"7<!j. J,g- Prepared by Steven M. HagDfsky, acct rep FACTFONE IS A FAST AND EASY WAY TO ACCESS YOUR PIONEER ACCOUNT. YOU CAN CHECK FUNO PRICES. REVIEW RECENT ACCOUNT ACTIVITY ANO CHECK YOUR CURRENT BALANCE. CALL FACTFONE AT 1-800-225-4321. SUMMARY OF YOUR ACCOUNT YEAR-TO-DATE DIVIDENDS & S.T. GAINS LONG TERM CAPITAL GAINS INVESTMENTS HR IN CERTIFICATE FORM SHARES ON DEPOSIT TOTAL SHARES OWNEO .00 .00 DIVIDEND OPTION CAPITAL GAIN OPTION 0.00 ACCOUNT FEATURES: TELEPHONE EXCHANGE .000 233.719 233.719 CASH REINVEST TELEPHONE REDEMPTION CONTINUE INVESTING IN PIONEER FUND-CLASS A FOR ADDITIONAL INVESTMENTS PLEASE USE THIS SLIP TO ENSURE FASTER PROCESSING. PLEASE MAKE YOUR CHECK PAYABLE TO YOUR FUND WITH YOUR ACCOUNT NUMBER ON THE CHECK AND SEND TO: D Account/Address Change or Correction? Please check this box and complete the reverse side. GRACE 0 BAILEY PIONEERING SERVICES CORP. P.O. BOX 9014 BOSTON, MA 02205-9014 AMOUNT ENCLOSED $ MINIMUM $ 50 PH)~VO \0/11196 00lb2065b2490rl II PRIVATE INVESTMENT ADVISORS RESOURCE CENTER May 24, 2001 Ms. Jacqueline M. Verney 44 South Hanover Street Carlisle, PA 17013 Re: Account Name: Account Number: BAILEY, GEORGE W TRUA IR Pl-3232-00-7 Dear Ms. Verney: Thank you for the information that you sent us regarding the estate of Mrs. Bailey. I have also received a copy of her death certificate and the short certificate appointing Mr. Jon Spaulding executor of the estate. I have enclosed a date of death valuation for the assets in the above-referenced trust. I have also forwarded your request to our Special Services unit. They will be able to provide you with the information you requested for all other accounts. This information will sent directly to you from Special Services. ... ~ ~.., ..., r . I d r 1 . ~ 1 ~ , . III aUOltlU!l, 1 nave H':':f~arue - a copy vi tJ.l€ tl'itst agreE:;-l1€at::o o~r iegal G€partrr:.enr who will review the appropriate provisions and advise me regarding the final disposition of the trust and will indicate if any Pennsylvania inheritance tax issues are outstanding. Once our legal department has provided me this information, I will contact the remainder beneficiaries and ask them to provide me with their instructions for their distributions. Please feel free to contact me at 1-800-628-8151 should you have any questions or need any additional information. National City Bank, Resource Center I Post Office Box 94715, Loc. 01-3030, Cleveland, Ohio 44101-0756 Fiduciary Services: TEL 800.628.8151 FAX 216.222.2300 Brokerage Services: TEL 888.462.8289 h\X 216.222.3105 Brokerage services provided through NarCity Investments, Joe. NatCity Investments, loc. is the full-service brokerage subsidiary of National City Corporation and is a member of NASD and SIre. Sincerely, C1f)'J~~ Jtv Cind;~an~ poa I ~ Assistant Vice President cc: Jon N. Spaulding Enclosure Estate Va~uation 04/15/2001 04/15/2001 05/10/2001 Estate of: GEORGE W BAILEY TRUA IR Account: Pl-3232-007 Report Type: Date of Death Number of Securities: 14 Fi~e ID: BAILEYG Date of Death: Valuation Date: Processing Date: 1) 2) 3) Shares or Par Securi ty Description High/Ask Low/Bid Mean &/or Div & Int Security Adj'ments Accruals Value 855.615 ARMADA FDS (04208N689) MID CAP GRW I NASDAQ 04/12/2001 7.48000 Bid 7.480000 6,400.00 571.242 ARMADA FDS (042086579) SML CAP GRW I NASDAQ 04/12/2001 10.32000 Bid 10.320000 5,895.22 506.146 ARMADA FDS (042086629) INTL EQTY CL I NASDAQ 04/12/2001 10.89000 Bid 10.890000 5,511.93 4) 2307.849 ARMADA FDS (042086660) GNMA FD CL I NASDAQ 04/12/2001 10.22000 10.220000 0.0257509 E 04/15 R 04/15 P 05/01/01 5) 6) 23,586.22 59.43 4605.249 ARMADA FDS (042086686) BOND CL I SHS NASDAQ 04/12/2001 9.72000 9.720000 0.026138 E 04/15 R 04/15 P 05/01/01 44,763.02 120.37 480.769 ARMADA FDS (042086843) SML CAP VAL I NASDAQ 04/12/2001 17.96000 Bid 17.960000 8,634.61 :;, Page 1 This report was Pricing Systems, produced with EstateVal, a product of Estate Valuations & Inc. If you have questions, please contact EVP Systems at (818) 313-6300. (Revision 6.3.2) Date of Death: Valuation Date: Processing Date: 04/15/2001 04/15/2001 05/10/2001 Shares or Par Estate of: GEORGE W BAILEY TRUA IR Account: Pl-3232-007 Report Type: Date of Death Number of Securities: 14 File ID: BAILEYG Security, Description High/Ask Low/Bid Mean &/or Div & Int Security Adj'ments Accruals Value 7) 588.235 ARMADA FDS (042086868) L CAP VAL CL I NASDAQ 04/12/2001 8) 669.467 ARMADA FDS (042086884) EQUITY GRW I NASDAQ 04/12/2001 16.53000 Bid 16.530000 9,723.52 22.87000 Bid 22.870000 15,310.71 9) SQUIBB CO (110122108) 200 BRISTOL MYERS NYSE 04/12/2001 04/16/2001 58.40000 58.90000 56.40000 H/L 57.18000 H/L 57.720000 11,544.00 0.275 E 04/04 R 04/06 P 05/01/01 55.00 10) CORP (58551A108) 1200 MELLON FINL NYSE 04/12/2001 04/16/2001 39.45000 39.65000 11) 800 VERIZON COMMUNICATIONS NYSE 04/12/2001 52.15000 04/16/2001 52.95000 38.29000 38.15000 H/L H/L 38.885000 46,662.00 (92343V104) 49.80000 H/L 50.85000 H/L 51.437500 41,150.00 0.385 E 04/06 R 04/10 P 05/01/01 308.00 0.00 12) ARMADA MONEY MAR1(ET FUND (EVP0001) ACCRUAL ON 28,862.89 58.69 13) 28,827.42 PRINCIPAL AFM + PRINCIPAL CASH (EVP0002) INCOME AFM + INCOME CASH 35.47 14) ACCRUED FEE CHARGEABLE TO PRINCIPAL (EVP0003) ACCRUED FEE CHARGEABLE TO INCOME -100.60 0.00 Page 2 ." This report was Pri.cing Systems, produced with EstateVal, a product of Estate Valuations & Inc. If you have questi.ons, please contact EVP Systems at (818) 313-6300. (Revision 6.3.2) '. . Date of Death: Vaiuation Date: Pr9cessinq Date: 04/15/2001 04/15/2001 05/10/2001 Estate of: GEORGE W BAILEY TRUA IR Account: Pl-3232-007 Report Type: Date of Death Number of Securities: 14 File ID: BAILEYG Total Value: Tota~ Accrual: Total: $248,545.01 $248,008.65 $536.36 .y Page 3 This report was Pri.cing Systems, produced with EstateVal, a product of Estate Valuations & Inc. If you have questions, please contact EVP Systems at (818) 313-6300. (Revision 6.3.2) ~ Prudential - Prudential Mutual Fund Services llC P.O. Box 8098, Philadelphia, PA 19101 May 9,2001 Law Offices of Jacqueline Verney 44 South Hanover Street Carlisle, P A 17013 Re: Estate of Grace O. Bailey Dear Ms. Verney, My name is Gina Gagliardi and I am writing in response to your request for the account value of Grace O. Bailey's Prudential mutual fund accounts. April 15, 2001 was not an active trade date for the fund. As of April 12, 2001, the value of the Prudential Utility Fund: Class A account number 2807881035 was $26,216.25. The share balance was 2092.279 at a price of$12.53 per share. The value ofthe Prudential Value Fund: Class A account number 28207881035 was $21,148.86. The share balance was 1,204.377 at a price of$17.56 per share. Should you have any further questions regarding this account, please feel free to contact our Customer service Department at 1-800-225-1852 between the hours of8:00 am and 8:00 pm eatsern time Monday through Friday. :to ~\RY-10-2001 15: 41 PtKBRNK elF DEPi=PTMENT 412705 0057 P.01/02 Q PNCBAN< Deeedent Reporting Firsbidc Center P7-PFSC-04-F 500 First Avenue Pittsb~,PJ\ 15219-3128 ISCP May 10,2001 JaGqueline M Verney Attorney and Counselor at Law 44 S Hanover St Carlisle. PA 17013 RE: Estate of Grace 0 Bailey, Deceased SSN: 175-44-2867 OOD: 04-15-2001 Dear Ms Verney: Please find the date of death balances you have requested listed below. CERTIFICATE OF DEPOSIT #/31100207893 Established 03-15-2001 DOD Balance: $95,3 89.08 + $0.00 aCCNed interest SJ\ VlNGS ACCOUNT 115002059615 Established 10-04-1999 DOD Balm\;\): $14,231.46 + 56.23 aCCNed interest Page I of2 A member caf The PNC Financi81 Sc:rvien Groop t'NC ~nk NA (l'ittsbul'9h Pc-nn::;ylv<tnia 16.26& MRY-10-2001 15:42 PNCBRNK CIF DEPRRTMENT 412 705 0057 P.02/02 a PNCBAN< Our oft'iee oaJy provides date of death balances for IRA's, CD's, Checkin& 1D4 Savings ac:COUJla. We do m Finandal Tra.ac:tlon. or Statement Orden. For Further information please c:aJI1.lIOO-4-BANKER or your local PNC Branch ad uk to .peak with a FfJuulclal Servic:es Representative. Sincerdy, ~ /. JJ4/ Erica L. Schlegel 1-800-762-1775 Pl\&e2of2 A merllber of" The PNt rlnanclal Servlca; (Jroup PtJC Bar1k N.A. PittsblJrgh Penn:;ylvlilni:J 15265 TOTRL P.02 .06/26/01 Tt~ 11:37 F~t 724 774 1954 HERBRVCK ~ADDELL TADDEO ~001 ~ THE MDNY GROUP MOllY Life Ill8lIl8IICe Ca.ll, 798 Turnpike Street BoavO[ PA 16009 www.Rlony.com 7247742175 m 7741954 Fax bdonnHll@rnony.com Ra~ert D. IIoIlIIIII,. CFS Financial Prol.~lonal Member, Top Club Milian Dollar Round Table, au.lh'/Ino Momb!r June 26, 200 1 Atty. Jackie Verney 44 South Hannover Street {,ut;i:11~ FA. !7:nJ RJ::: 111549214:<461 (~~'f"~ -W ~lkiiay, \~a.~ O. Btt~j.;,y' IT v,,'RQS FOJ!lJwil1g l<\'a1.i:.6 Va.lOlaS oiJle at-ave I;Med account uof AprilI 15,2001, Grace Bailey's "f.~!f' "f tj~nth. EnteI'!)rise EQuitY Income Fund L!l.I.UI~:'iu~ :tQl: Yic..~d D:;:,tf! To'tw $1O)S5.34 L:!.~.Ci.,~~ S:~lJ~J.,7;?,j,2 T!J~~ sb.~es W~ rl!lgi~~ lwdlill" the EBtlUe of Grace O. 8ailey. A Jl."wil) d:lf;~:: {];Jf "",,' '.' -+ r 1\1" P' "- f<"'-~ 0 B i1 ',y'" . ',- . ""'J, ,,:..,.,> w r.:-"DL~g ~'~/'," ,,0 .";.m J" ,...~.!.l^"llJ'1.g.. D.'1'f~\~' 0 "..J1~e ..a ey, ..."fl ~Ot.liJ1 ...unc-lVw'G ilii~bl;[g, P A 17019. I'" YO'I have any fun:iler questions please .:urlla.;, .1", al ill" sJ)~v" r.\lt:lbef. Si:'JCltt'i1ly, I Q -7 ~ ./ ..# IiI ,/ ( >. 'I/i:;A/wr 'v"'t-A",l/{;,I __.l R"bmD. Do1ll1I'lHy CFS Ill/j! ~'~~l!lT9reci HE1:p~SernatM. DewriilC:S ~lol. (''ff,:~'''.d b~ \U."~';' ,j'WwLi .,jClii Cu, ~""'"';'';''' ~\";';i,::',;i ~~/;eD, e~l:>c ~74(.0 O(UdOttay, "!~'N \'~!;. \r/1 ~~~. ww 7;;0 ij~~::. ~.~=~~": :..: :il....,-..;~.j; C..mrliltl'f end ft,lHJN'( ".::~ ..~;;:: ;';:',;~;;',:,.~~~:~; ",;':;': .: ..~::;:! ~f Th.. Mnr..JY "':I-W~. . 06-26-2001 09:54AM -ROM FULTON BRNK TO 2433518 R.m FULTON BANK 599 N iil'HoSTREET LEMOYNE, PA 17043 PHONE NUMBER (717)-255-7674 FAX NUMBER (717)-731-8963 . . FROM:_. .._..III~ '(.. ____..._:,";..'l: _.J.,ti.,~'\",l~~..., v~ TO: TIUS DOCUMENT OF _'_' PAGES (INCLlJDINO "fi-llS PAOE) IS Tf\ANSMITmD FROM FUl-TON BANK. LEMOYNE PA. PLEASE CALI. (717) 255,7674 IF YOU DO NOT RECEIVETlIE NUMBlJR or PAGES INDJCATED ABOVI' OR IF THERE ARE OTHER PROBLEMS WITH TIll., TRANSMISSIO/'. OR DELIVERY OF 'flUS DOCUMENT CQNflLlEN11AUTY NO'nCE: TlHS FACSJMILE CONT..t:SS C0NF!DP"'Tb.L )\ji'(;:'.....ATION .#H.I':'~'~ li/1J.'\ Y ALSO nE LEGi\L.:.:'1 ~'R1VALEGED At-.Tr. \V';.ii(;l~ 1.:5 INTEN,DE1) Ct~;_,y .;Ol~ THE lj,;',: 01' Ti.-iE ADKBSSEfI ~S) 1.:-",1[" .\EOvE. IF YOU ,\:\1: NOT T,'l1! INTENDED RECIPIENT. YOl) ,,[:J) ilElllil:> V NI)'mmD T'IA,' AN~ DISSEMINATION OR COI'ING OF THE FACSIMILE, C)'. Tl'W !~,KJ."(j 01' ANY ACTION IN REUANClJ ON ITS COMMENTS MAYBE S".H:.~V: !'R0HIBlTtlD. IF YOU HAVl! RECElVlJD THIS "M:S\MlI.." _~i !:H.Hon, l'LBASE NOTlry i.'o IMMEDIATELY BY TELl'PH'0~1:' Nil> RE11.iRN THB P.'Tlj{f F/.tSi,vliI.E )'0 r.l5 .>1' THE ;::::;~=,:,:='[RI1':l\';:3~~",&_ a;L~ \ r' . \., \I ,.. ( . .~~ \ L ) (I -_V'4'\.1f~~=..jLlu t> ~ ;t~ - 0 _'_OU'__"__"_ . I ~ .,_...L~.._~ \' :ttl ."","--;.-.-,L ~ . 1/ ,- ,~ /' ~ ~.. "'\' , " ~ I! ,....... ,~ ~_.~~: Qr.:L,' rf I (1. CA_n..."L .L.J 't J J.._,.. ,. I' ~. 1- \ I It ,.-, I ,-.. l- .". . '-1 ,. (,"" ..... ......,.- '" U ',J /< ,1 . _ ~ '..oJ 1....-~, "r '" ~ . .... .... ' - "'"' -.-t..., .... .~...,'--_ . --\..0::;.,..1.. +~t._- ,t'>' I , \.... '''rn~- ~_\.\ ..u_......_ C. . L/ 4 J. l '._, 1Y ~:t~"" h.~ K ..... -'-I.' . '. ~ ....,.....-~.. \ _.... ...... lA. A;..-'.. ~I , .......ac. \ .. 't F.hI.X Nt.:MBI:.l-t Or r~CI.liIFl'l'l': f'JTP;, ':;,'211 REV-l509 EX+ (12-88) .. SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bailey, Grace O. FILE NUMBER 21-01-00430 Joint tenant(.): NAME A. Ellen J. Spaulding ADDRESS 247 S. York Road Dillsburg, PA 17019 RELATIONSHIP TO DECEDENT Daughter B. C. Jointly-owned property: LETTER DATE ITEM FOR TOTAL VALUE DECO'S DOLLAR VALUE OF NUMBER JOINT MADE DESCRIPTION OF PROPERTY OF ASSET % INT. DECEDENT'S INTEREST TENANT JOINT 1. A 3/4/99 Waypoint Bank P .0. Box 1711 Harrisburg, PA 17105-1711 checking acct # 500061019 7,550.32 50% 3,775.16 TOTAL (Also enter on line 6, Recapitulation) 53,775.16 (If more space is needed insert additional sheets of same size) 96-25-91 15:31 WAYPOINT BANK ID=7179S97481 P92/S2 ""Way~i!1J LOOK FOR Us. we'LL GET YOU THERE. JACQUELlNE'lEPl';fY 44 SOUTH HANOVER ;.;T CARLISLE PA 17013 The informatic"1 W:l:C," re" n:q(je~ted ''':. tb.~ GRAC:, B1JiEY DECEASED (Social Security Nurrher 175-44-2867) is JS follows. Account Number(s) 500061019 Class of Acco'ill! CHECKING Date Opened 03 (W':: Principal '3a:iU1t~ 7550.32 Accrued Interest .3 7 Balance at Date of ['eath 7550.69 Account Ov,nership ITO Name of J-::int Owner, if any ELLEN SPAULDIt~6- Date Ownership Wl!.S Estahlished 030499 Additiona:.u'for!ll.';\tion Requested PLEASE COMPLETE W-9 Sincerely, ~~ot:r -----------.------.----- SL1'\itJt: E'.t.l?:ieeB flap. F,a. Box 1711. HAFlFl,AURG. PENN5Yl\S\N1A 171G::H711 ,bli .~e'.' '.E.6S.W..'t.'>OlNT (I-B66-929-7Ei46) . \vww.waypo;ntbank.c:om REV-1511EX+(1-97) '*' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bailey, Grace o. FILE NUMBER 21-01-00430 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Bauer Funeral Home - Kittanning, PA 4,732.76 2. Funeral Luncheon - Presbyterian Women 250.00 3. Flowers/Memorial Booklets 258.64 B ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Numbe~s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid; 2. Attorney Fees Jacqueline M. Verney, Esq. 44 S. Hanover St Carlisle,PA 5,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Cumberland County Register of Wills 500.00 5. AccountanfsFees Estimate 300.00 6. Tax Return Preparer's Fees Estimate 300.00 7. Advertise Letters A. Cumberland Law Journal 75.00 2 Liberty Ave. Carlisle, PA 17013 B. Sentinel 71.15 P.O. Box 130 8. Caflisle, PA 17013 telephone, mileage, copies, offic 200.00 Executor s expenses: Postage, supplie 9. Estate checking acct fee: checks Fulton Bank 16.25 TOTAL (Also enter on line 9, Recapitulation) $ 11,703.80 (If more space is needed, insert additional sheets of the same size) ~ . Bauer Family Funeral Homes Exceptional service... with a personal touch Mrs. Ellen Spaulding 247 S. York Road Dillsburg, P A Bauer Funeral Home, Inc. Kittanning, P A John W. Bauer, Supervisor SERVICES FOR: Grace O. Bailey Clark Chapel of the Bauer Funeral Home, Inc. EJderton, P A Jennifer A Bauer, Supervisor Bauer-Bly Funeral Home, Inc. Dayton, PA Frank O. Bly, Supervisor Basic Services of Funeral Directors Other Preparation of Body TOTAL PROFESSIONAL SERVICES: TOTAL FACILITIES & EQUIPMENT: Funeral Hearse TOTAL AUTOMOTIVE & TRANSPORTATION: Hancock Medium Weight Steel Clark 12 GA Standard Steel Vault Dress and Undergarments Register Book - Completed Memorial Folders Cemetery Equipment TOTAL MERCHANDISE SELECTED: Cemetery Charge Certified Copies Newspaper Notices Organist Clergyman Transportation To Messiah Village Fees from Hoffman-Roth Funeral Home TOTAL CASH ACCOMMODATIONS ITEMS: Acknowledgement Folders ADDITIONAL ITEMS: TOTAL: LESS CASH RECEIPTS: TOTAL AMOUNT DUE: TERMS: Net 30 Days 1 % monthly finance fee assessed on unpaid balance Maili A P. . Box 9 515 N. cKean Street Kittanning, PA 16201 INVOICE DATE: April 20, 2001 ACCOUNT: 01119 724-545-9464 Fax: 724-545-2224 E-mail: bauerfh@alltd.net MEMBER BY INVlTAnON OglSM NAnoNAL SELECTED MORTICIANS April 20, 2001 1,650.00 275.00 1,925.00 .00 175.00 175.00 2,025.00 1,050.00 125.00 30.00 25.00 20.00 3,275.00 715.00 80.00 36.00 35.00 75.00 419.76 475.00 1,835.76 14.00 14.00 7,224.76 ,/ 2",4'12,0!, --- .,....... (~ 4,732.76-- \~ , \ S / .. IY??I e~ -:Jt q~ alphographiGS@ Printshops Of The Future Capital City Plaza, 3401 Hartzdale Drive, Camp Hili, PA 17011 (717) 731-8444 / FAX (717) 731-8449 ~NVO~C[E 57763 NUMBER Spaulding, Ellen 717-766-1658 DATE 4/17/01 s o L o T o CUSTOMER P.O. NO. QUANTITY DESCRIPTION AMOUNT 100 100 100 Duplic front cover, 8.5 x 11 80# Via Cover Periwinkle, copied on 1 side Blank, Back covers, 8.5 x 11 80# Via Cover Periwinkle Duplic inside pages, 8.5 x 11 24# Classic Linen Antique Gray, 4 originals, copied on 1 side 14.00 9.00 44.00 Stapled Collated with covers on IR ~d- 0-l0 1.\,,1/0\ /. oct - ..u# n:f 0 l y-" Taken by: cmt Account Type: Charge Notification: Call Wanted: Wed 4/18 9:00 AM Booklets Deposit 1: 71.02 (cr card) AmI. Due: 0.00 SUB TAX SHIPPING L TOTAL "I understand that the charge for this job is due and payable upon completion and interest shall accrue on all past due accounts at the rate of 1 tl2 percent per month. In the event payment is not made and the account transferred to a collection agency or an attorney, I will pay the cost of collection, including attorney's fees and costs incurred." JOB PROOFED, APPROVED, AND OK TO PRINT DATE JOB RECEIVED AND ACCEPTED DATE ,~... ..~~. - - - - - Page 3 of 6 SPAULDING 1300 0826 4657 3, 2001 - t>"Y'~~~ls~~.'~~jli~iiJi~ii1S';i;L~;)i:- - Trans Post Description 04/13 PAYMENT THANK YOU Total Payments and Adjustments AT8.T Amount 358.71CR $358.71CR 1:.li~~~~i!~~1IE~~~!!!~~~im~~~~!I~~mi~~~!!!11 Purchases........................................................................................................~...........................................$465.31 Cash Advances and Checks .........................................................................~...............................................$O.OO Finance Charges ..................,..........,........................................................................................:......................$0.00 Total MasterCard Activity ............................................................................~...........................................$465.31 cJJl Purchases Trans Post Description 04/07 04/07 HOME DEPOT #4120 MECHANICS BURG PA 04/12 04/12 HOME DEPOT 120 MECHANICSBURG PA 04/17 04/17 ALPHAGRAPHICS PRINTSHO CAMP HILL PA 04/19 04/19 JOHNSTON THE FLORIS 7245481506 PA 04/21 04/21 COMFORT INN KITTANNING PA Total MasterCard Purchases lEI Cash Advances and Checks *This represents a portion of your total credit line. 1h1lpv/U;>t ~ l' /,qr /ktIN r ~.~ ( f7i~ --~fD v -f~/ / /c/ Cash Advance Umit....."..................$3.100.00* Total Cash Advances and Checks Finance Charge Information $465.31 $0.00 Nominal APR Days in x Billing Period Balance x Subject to Finance Charge PeriodIc Transaction ANNUAL FINANCE + Fee/FINANCE PE~GE ~ CHARGe RATE Periodic Rate PURCHASES Standard Purch 13.600% .03726%(0) x CASH ADVANCES 19.990% .05477%(0) )( 29 x 29 x $0.00 $0.00 $0.00 + $0,00 + $0.00 $0.00 13.600% 19.990% Total FINANCE CHARGE = $0.00 -- ...... .... ...~,."'".--......~...".-". ........ .... ................ "........-............-".. I"A{~s.~)~~r!I~;~~~I!1~/ ,; ,',~>;- , , AT&T Universal Calling Card Calls """"""""'."".""""......"........"...............".........".."",,......,,..""......"..... $0.00 RECEIPT FOR PAYMENT ------------------- ------------------- Cumberland County - Register Of Wills Hanover and Hiqh Street Carlisle, PA 17013 BAILEY GRACE 0 File Number 2001-00430 Remarks JACQUELINE M VERNEY, ESQ AC Receipt Date Recetpt Time Rece~pt No. 5/01/2001 09:46:51 1025488 ------------------------ Distribution Of Receipt -----------------~------ Transaction Description Payment Amount Payee Name PETITION LTRS ADM EXTRA PAGES RENUNCIATION EXECU SHORT CERTIFICATE JCP FEE 375.00 3.00 10.00 60.00 5.00 Check# 1160 Total Received..... .... ~ Vfl~P"t V (t 190 rY;;~ f; ~ q CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN BUREAU OF RECEIPTS & CNTR M.D ftrm D ID WJ2tJe:; .j - Pr-- 01 RETAIN THIS PORTION FOR YOUR RECORDS REM1TIANCE ADDRESS I BILL TO THE SENTINEL - LEGAL JACQUELINE M. VERNEY P.o. BOX 130, CARLISLE, PA 17013 AD NUMBER I CLASS SALESPERSON BILLING DATE LINES 200181 10 PUBLIC NOTICES 15 05/30/01 20 AD DESCRIPTION START DATE STOP DATE EXECUTOR NOTICE LETTERS TESTAMENTA 05/16/01 05/30/01 PUBLICATION INSERTIONS RATE NET AMOUNT GROSS AMOUNT 3 THE SENTINEL - LEGAL 3 LGL 64.80 TOTAL AD CHARGE 64.80 3 2001 PROOF OF PUBLICATION OlPRF 6.35 DAYS RUN <.;//1,. :23 -/.50 PURCHASE DRGER I PAY THIS AMOUNT 71.15 85.38* Grace O. Bailey * AFTER 06/29101 MESSAGE: Thank you for advertising with The Sentinel. Deadlines for in-column legal advertisements: Monday is Friday at 11 a.m.; Tuesday is Friday at 4 p.m.; Wednesday is Monday at 12 Noon; Thursday is Tuesday at 12 Noon; Friday is Wednesday at 12 Noon; Sunday is Thursday at 12 Noon. If you have any questions regarding your Legal bill please call Dauris Henry at 243-2611, ext. 202 or Sherry Clifford ext 201. Fax your legals to 243-3754, attention Sherry Clifford You can also EMAIL yourlegalto:classad@epix.net. Please include a cover letter and the ad as an attachment. PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland. 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 May 16.23 & 30, 2001 UECllT!lR NCl"IICE . Letters T"tem.~f'Y'On Ih..E".to of GR.OI, 0 BAILE'(. 1.,. Of OIlP.; AUen TQWntt'lip; ,CUmbe,- la:nd90untr._p'A,d.... . C88Qd,t;i6vebie9n -grant. ed'o tIleunllerOlfllled, All p8r.(m8~nowing Ih"'-~l>ejnde_ to said ~at.t,e"*fll-,rtt.k8 paym.nllm~, and those havl~Q! cl~brllrwlll pres.nt them for.'UI.- mantlo: Jon N, Spaulcjlng. E>eaulor c/o Jacqueline ....' V.mey, Eequ1re 44S,ii_St Co,","'. PA ,7013 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. May 31, 2001 Sworn to and subscribed before me this day of May , 2001. U(;d; L~~ o ary Public 31st My commission expires: Notarial Seal Wendy L Metzger, Notary Public Carlisle Bora, Cumberland County My Commission Expires June 2, 2001 Member, Pennsylvania ASSOciation of Notaries CUMBERLAND LAW JOURNAL 2 LIBERTY AVENUE CARLISLE, P A 17013 JUNE 1,2001 Cumberland Law Journal is published every Friday by the Cumband County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication oflegal notices. TO: Jacqueline Verney, ESQUIRE RE: Grace O. Bailey, ESTATE Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. -------------------------------------------------------------------- -------------------------------------------------------------------- Advertisement inserted on following dates: MAY 18,25, JUNE 1,2001 Advertising Cost Second Proof Request $ 75.00 $ 0.00 $ 0.00 $ 75.00 ------------- Proof of Publication Payment received Total Amount Due $ 0.00 --------- -------- Payment received MAY 16.2001 by Beckv H. MorgenthallExecutive Director PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 STATEOFPENNSYLVANIA : ss. COUNTY OF CUMBERLAND : Roger M. Morgenthal, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the 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: MAY 18,25, JUNE I, 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. ~~tor BaUey. Grace 0., dec'd. Late of Upper Allen Township. Executor: Jon N. Spauldtng, c/o Jacqueline M. Verney, Esquire. 44 South Hanover Street. Carlisle, PA 17013. Attorney: Jacqueline M. Verney, Esqu1re. 44 South Hanover Street. Carlisle. PA 17013. SWORN TO AND SUBSCRIBED before me this I day of JUNE. 2001 . NOTARIAL.8IW. LOIS E. SNVDEcu::.-= NIIIc CIr\IeIe 8010. . archCounlY5 My CommiSSion ExpireS M :h 5. 2!lO5 ~__"":"_" ."".,. ._c..- **************** SALE ****************** Mall Boxes Etc. Making Business Easler. Wor'ldwlde. **************************~************* Shlft:0248 Drw:Ol 10:203 Clerk:Bonnle 6/6/01 12:54:21 Center #3763 275 CUMBERLAND PARKWAY MECHANICSBURG, PA 17055 Phone 717-795-'8818 Qty Description Unit Ext nO ,.. _.____. _0 ,..-, __"__.______ ______._, _____ __ _____ 1 Office Supplies D.28T 0.28 Sub Total: Tax: Total Sale: 0.28 0.02 0.30 Cash: Change: 3 Visit our Web Site at: WWW.MBE.COM Dffi .eMax #039 97 Gateway Drive M*cf>anicsburs. Pa 17055 (717)' 69h,100 O!1D!:R BY PHONE 1-800-7Bll-6060 SALE ,0039 00003. 93470 664560 05125/01 if: 55 AM 030402656275 File Tote-Blue 9.99 9.9? PA TAX 6.000% TOTAL 47~6~60001066a34 VrSA CARDHOLDER: JON SPAULDING 0.60 (i0:~ 0.59 I AGREE TO PAY ABOVE TOTAL AMOUNT . " :.... .' c..... .,". .'.....:...: .:. ...... .:.'.'.:.' ',,';':"',.i . ACCORDING TO CARD ISSUER AGREEMENT. ,-...-........,.........,......,.----.-........;...-----...,--.'--............ . . ..... '. , , , , , ,. **************** SALE ****************** Ma I I Boxes He. Making Business Easler. Worldwide. **************************************** Shlft:0256 Drw:Ol 10:550 Clerk:PARVIN 6/15/01 12:41:59 Center #3763 275 CUMBERLAND PARKWAY MECHANICSBURG. PA 17055 Phone 717-795-8818 Qty Description Unit Ext 2 Office Supplies 0.31T 0,62 Sub Tota I: Tax: Total Sale: 0.62 0.04 0.66 - 1.00 0.34 Cash: Chang.: Visit our W.b Sit. at: WWW.MBE.COM OHi.eMax 1039 97 Gateway Ori~e . .Me.hani~sbur9' pa 17055 (717) 6?1-3100 OROER ~Y PHONE 1-800~?88-8080 003900002 61719 04118/01 SALE 689188. 02:07PM 09520535870~ Pastel Ivery 8 0~3100057~82 to.5 x8 "3 Subj 2 ITEMS 7.28.PA SU~TOTAL TAX 6.000% TOTAL ~7~686000106683~ VISA CARDHOLDER: JON SPAULDING . .,.... '.. ...0. . .. '. ", ....,' '.--".0' I AGREE TO PAY A80VE TOTAL AMOUNT ACCORDING TO CARD ISSUER AGREEMENT. --.~._-~._~-----_.~----------- , , ~Jldft,,~,~ ~~--- \; ------------------~--~-------- ********~***~*** SALE ****************** Mai I Boxes Etc. Making Business Easier. Worldwide. **************************************** Shift:0222 Drw:Ol 10:143 Clerk:PARVIN 5/5/01 12:20:00 Center #3763 275 CUMBERLAND PARKWAY MECHAN 1 CSBURG , PA 17055 Phone 717-795-B818 Qty Oeser I pt i on Un I t Ext ______ - __ ______.__ - ___._____"__________ ___0_- 100 Copies 0.05T 5.00 Sub Total: Tax: Total Saie: 5.00 0.30 5.30 <iii Cash: Change: Visit our Web Site at: WWW.MBE.COM 6~!> 7.28 0.44 $7.72 7.72 **************** SALE ****************** Ma i I Boxes Etc. Making Business Easler. Worldwide. ******************************~********* Shlft:02D4 Drw:Ol 10:577 Clerk:PARVIN 4/17/01 00:08:44 Center #3763 275 CUMBERLAND PARKWAY MECHANICSBURG, PA 17055 Phone 717-795-8818 Qty Oeser I pt I on Unit Ext 1 Fax 1 Copies 3.00 0.10T 3.00 0.10 3.10 0.01 3.11 @> SubTo~l: Tax: Total Sal e: Cash: Change: Visit our Web Site at: WWW.MBE.COM Mechanicsburg Main Post Offica MECHANICSBURG, Pennsylvania 170553459 05/0512001 (/m 697 -4641 12: 43: 40 PM Sales Receipt Final Product Sale Unit Description OW Price Price $6.80 1 $6.80 $6.80 Nondenom Statue/Lib PSA Bk $6.80 1 $6.80 :16.6C Nondenom - Statue/Lib PSA Bk 1st Class Env 1 $0.50 30.5C 10 x 13 - Total: @ $14.10 Pald by: Cash $15.10 Change Due: -$1.00 NetPost Maillng Online lets you send your mailln9s right from your computer! It's quick, easy and online at WWW.usps.com. Blll#: 1000500257414 Clerk: 08 ----- Thank you for your business ----- ~delphia , I 05/03/01 PAGE 2 2006444 ELLEN SPAULDING 200644405 DATE TIME RATE NUMBER * MINUTES AMOUNT TELEPHONE NUMBER: (717) 766-1658 04/08/01 08: 14 PM N ATHENS GA 706 543-4722 3.80 0.31 04/09/01 02:49 PM D LIVERPDOL NY 315 652-6715 16.70 1. 34 04/11/01 04:33 PM D SAYRE PA 570888-7711 2.00 0.18 ?;:I!fffr 04/15/01 02:25 AM N LIVERPOOL NY 315 652-6715 0.50 0.04_ = 04/15/01 06:30 AM N ATHENS GA 706 543-4722 6.40 0.52.. 12W04/15/01 06:43 AM N FREEPORT PA 724 295-4960 1.40 0.13..- ~"e 04/15/01 07:27 AM N ATHENS GA 706 543-4722 3.10 0.25 .. '2t!!11r 04/15/01 07:30 AM N LIVERPOOL NY 315 652-6715 2.90 0.24_ 04/15/01 11: 27 AM N REND NV 775 322-1597 0.40 0.04 1?YWtrJ. 04/15/01 11: 53 AM N KITTANNING PA 724 545-9464 1. 10 0.10" 04/15/01 01:18 PM N LAKE LAND FL 863 687-3261 0.90 0.08 04/15/01 01 :20 PM N RoCKISLAND IL 309 794-0429 1.40 0.12 04/15/01 01 :22 PM N PITTSBURGH PA 412 241-7994 1.30 0.12 04/15/01 01 :24 PM N ATHENS GA 706 543-4722 2.20 0.18 04/15/01 01 :28 PM N LIVERPOOL NY 315 652-6715 7.30 0.59 04/15/01 01: 37 PM N HERMINIE PA 724 446-9747 5.30 0.48 04/15/01 01 :54 PM N REND NV 775 322-1597 0.70 0.06 ?W~04/15/01 02:24 PM N FREEPORT PA 724 295-4960 0.80 O.OS" 04/15/01 04:27 PM N KITTANNING PA 724 548-1643 1.30 0.12 04/15/01 04:31 PM N KITTANNING PA 724 548-4069 0.80 0.08 04/15/01 04:55 PM N BLAIRSVL PA 724 459-8618 1.30 0.12 04/16/01 10: 15 AM 0 LIVERPOOL NY 315 652-6715 17.20 1. 38 04/16/01 10:52 AM 0 ATHENS GA 706 643-4722 18.90 1. 52 v'tr"t'104/16/01 11 :31 AM 0 CARLI SLE PA 717 243-9190 2.20 0.20 - 04/16/01 01 :02 PM 0 CARLISLE PA 717 243-9190 5.90 0.54 .. /..!lUVif'Cl4/ 16/01 01 :36 PM 0 FREEPORT PA 724 295-4960 1.10 0.10_ /'ie7II- 04/23/01 10: 19 AM 0 LIVERPOOL NY 315 652-6715 4.50 Q.36 .. 04/24/01 09:54 AM D ELIZABTHVL PA 717 362-3346 3.00 0.27 YElZNIf'J 04/30/0 1 11 :07 AM 0 CARLISLE PA 717 243-9190 0.70 0.07 .. z: ::::z 04/30/01 06:52 PM N 8RIDGEPoRT CT 203 334-5054 1.40 0.12 --------- ---------~--- TOTAL FOR (717) 766-1658 CALLS: 30 116.50 9.74 ======-== ====..======= TOTAL FOR SERVICE CALLS: 30 116.50 9.74 ~ Adelphia , I 06/03/01 2006444 ELLEN SPAULDING PAGE 2 200644405 DATE TIME RATE NUMBER * MINUTES AMOUNT TELEPHONE NUMBER: (717 ) 766-1658 v'~1 05/03/01 10:37 AM 0 CARLISLE PA 717 243-9190 4.90 0.45"- 05/07/01 08,16 PM N LOCKWOOD NY 607 598-7107 10.20 0.82 '1,4# I OS/23/01 09:31 AM 0 OIR ASST 724 555-1212 1.00 0.95 .. OS/23/01 09,31 AM 0 BUTLER PA 724 283-6668 0.80 0.08... y'~ OS/25/01 10:21 AM 0 CARLISLE PA 717 243-9190 3.80 Q.35-'- OS/27/01 09: 17 AM N CARLISLE PA 717 258-1353 0.60 0.061 --------- ------------- TOTAL FOR (717 ) 766-1658 CALLS: 6 21.30 2.71 ==::11"':"'=== ",============" TOTAL FOR SERVICE CALLS: 6 21.30 2.71 1057 0328 21179 Y I I I I I ----_...--_.__.,-_.,-,--_..__.,._~--------_._-_._- -_.._._---_.~_.. --- - ---------.- "._-~---_..._.._-------------- EST OF GRACE 0 BAILEY JON SPAULDING EXEC 247 S YORK RD DILLSBURG PA 17019 Fulton Bank People dedicated to your slIccess.;" STATEMENT OF ACCOUNTS 3621-64077 X STATEMENT PERIOD FROM THROUGH 5-09-01 6-10-01 0 PAGE 1 OF 1 8 ENCLOSURES o ESTATE REGULAR CHECKING PREVIOUS DEPOSITS/ CHECKS/ STATEMENT BALANCE CREDITS 1 DEBITS 9 15,698.67 2,146.48 8,053.79 ACCOUNT: 3621-64077 SERVICE FEES .00 ENDING BALANCE 9,791.36 DATE ACTIVITY DESCRIPTION REFERENCE 05-09 BEGINNING BALANCE 05-11 CHECK 101 05-14 CHECK 92 05-14 CHECK 93 05-14 CHECK 95 -15 K BOOK F DEPOSITS/ CHECKS/ CREDITS DEBITS 05-24 DEPOSIT 05-29 CHECK 05-30 CHECK 06-05 CHECK 06-10 ENDING BALANCE 9 740 02421307280 103 01007004690 102 00907303710 104 01108407090 2, 146 . 48 ,/ BALANCE 15,698.67 15,440.03 01306304040 01006706750 01210303890 01210303880 00779 .54.....1 2,100.00'/ 55.10 ,/ 10,066.77 10,050.52 9,800.52 11,947.00 11,946.46 9,846.46 9,791.36 9,791.36 CHECK NO 92 93 94 95 TOTAL NUMBER OF CHECKS CHECK * INDICATES SKIP AMOUNT 4,732.76 453.00 250.00 187.50 8 SUMMARY IN CHECK NUMBERS CHECK NO 101* 102 103 104 TOTAL AMOUNT OF CHECKS AMOUNT 258.64 2,100.00 .54 55.10 8,037.54 SERVICE FEE BALANCE INFORMATION FROM 5-09-01 THROUGH 6-10-01 AVERAGE LEDGER BALANCE 11,090.82 AVERAGE COLLECTED BALANCE MINIMUM LEDGER BALANCE 9,791.36 MINIMUM COLLECTED BALANCE 11,025.78 9,791.36 BANKING IS EASIER THAN EVER. THAT IS BECAUSE YOU CAN NOW USE ANY DROVERS BANK ATM WITHOUT INCURRING FEES. THERE ARE OVER 35 LOCATIONS THROUGHOUT YORK COUNTY FOR YOUR CONVENIENCE! i , , , D rlmcr HQUIRIES TO: i CUMBERLAND PARKWAY 360 CUMBERLAND PARKWAY MECHANICSBURGL.f~U055 _____ Memher FD.LC www.fultonbank.com REV.1512 EX. (1-97) . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21-01-00430 ESTATE OF Bailey, Grace o. Include unreimbursed medical expenses. ITEM NUMBER 1. Messiah Village 100 Mt. Allen Drive Mechanicsburg, PA 17055 DESCRIPTION final bill 14 days in April, 2001 AMOUNT 2,100.00 2. Verizon telephone bill .54 3. Pharmerica medication 55.1Q 4. CP02 wheel chair rental 14.44 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 2,170.08 MESSIAH VILLAGE STATEMENT Resident: GRACE 0 BAILEY Resident Number Date 000010011 04/30/2001 Page Amount Due 1 2,100.00 100 Mt. Allen Drive P.O. Box 2015 Mechanicsburg, PA 170552015 (717) 697-4666 Discharge Date 04/15/2001 B I ELLEN SPAULDING L 247 S. YORK ROAD L DILLSBURG, PA 17019 T o Date Description Charges Credits Total 4,650.00 2,100,00 6,750.00 -4,650,00 2,100,00 04/01/2001 Beginning Balance ROOM & BOARD - SEMI-PVT 14 DAYS AT 150,00 PER DAY PAYMENT RECEIVED - THANK YOUI 04/12/2001 ~v~ 01~i Current Past Due 31-60 Days 61-90 Days 91-120 Days Over 120 RACE 0 BAILE 2,100.00 0.00 0.00 0.00 1%FIN Statement End Date: ~,. Ver;701J Page 2 of 10 717 796-2296-420 6ay April 30,2001 This information is required by the Public Utility Commission, "Basic" service includes the line charge, local calling and TOUCH lONE service (if applicable). "Non-Basic" service includes optional services, other than TOUCH TONE, such as Maintenance agreement for inside wire and Guardian and does not incllJde toll services. Past DUe CUrrent Tota l:s Ba lances Charges BASIC $.00 $.54 $.54 TOlL $.00 $.00* $..00 NON-BASIC $.00 $.00* $.00 --R9. @~l The following pages provide additional billing details. -- /2*( * (Includes Yerizon and other service provider(s) charges.) TOTALS $.00 $.54 PHARMERlCA ~~ For Comments and lor Concerns: 111 RUTHAR DRIVE NEWARK, DE 19711- For Payment: PO Box 6176 Carol Stream, Il 60197-6176 IF YOU HAVE ANY QUESTIONS CO~ICERNING THIS STATEMENT OR WISH TO PAY WITH YOUR VISA, MASTERCARD, AMERICAN EXPRESS, OR DISCOVER PLEASE CAll A BilLING REPRESENTATIVE AT 800-352-9161 CUSTOMER NAME BAilEY GRACE FROM HRU DATE! DATE RX NO, 033101 PHYSICIAN NAME ZIMMERMAN lAWRENCE B STATEMENT DATE 04/30101 ACCT. NO. 5711-01-00783 DOLLAR QTY. CODE AMOUNT 335.11 ,/ . .",. .,.. .,.. .". 1u,4lAAl ~ : $578.24 te6f6talCl!fO 7i? ~C-E. i 412 ~brAn""'T:'nT""A ...IIIL PLEASE RETURN BOTTOM PORTION WITH PAYMENT - Retain lop portion lor your records PAT I E N T CPO 2 B ILL I N G CENTER S TAT E MEN T 151 NORTH 5TH ST. MIFFLINBURG, PA 17844 (866)227-9229 PATIENT NAME: GRACE 0 BAILEY STATEMENT DATE: 5/3112001 ACCOUNT NO. : 0094-0024422-000003-MC I D ATE I INVOICE I DES C RIP T ION I QTY I C H A R G E S PAY MEN T S B A LAN C E I I I # I BILLED C REO ITS I I 5/31/1999 I 999 117 WHEELCHAIR STANDARO I 10.42 .00 10.42 I I 5/31/1999 I 999 183 LEGRESTS/ELEVATING PAIR FOR C I 4.02 .00 4.02 I I I I I I I I I I I I 1 I I I I I I I I I I I I I I I I _I I I I- I I I I I I I I 1 I I I I 1 I I I I I I I I I I 1 I I I I I 1 I I I I I I I I I I I I I $14.44 $.00 . $14.44 I I TOT A L DUE---> '% * Payments received after 5/31/2001 are not reflected on this statement. ~~ -""\ Balance reflects the charges assigned to the patient, as of the statement date. *** BALANCE IS SUBJECT TO CHANGE ** REV_1513EX+(2.871 ... COMMONWEALTH OF P~NNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Bailey, Grace O. FILE NUMBER 21-lJl-00430 ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR NUMBER SHARE OF ESTATE A. Taxable Bequests: 1. Bruce A. Bailey son 1/3 240 Hunnicutt Drive Athens, GA 30606 2. Elizabeth Ann Hay daughter 1/3 14 Forrester Road Liverpool, NY 13090-2441 3. Ellen Jane Spaulding daughter 1/3 247 S. York Road Dillsburg, PA 17019 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY AMOUNT OR SHARE OF ESTATE B. Charitable and Governmental Bequests: 1. TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Re<epitulotion) S (If more space is needed, insert additional sheets of same size) LAST WILL AND TESTAMENT OF GRACE O. BAILEY I, Grace O. Bailey, of South Buffalo Township, Armstrong County, Pennsylvania, hereby make, publish and declare this to be my last will and Testament and I do hereby revoke any and all testamentary dispositions which I have heretofore made. FIRST: I hereby direct that all of my just debts, funeral expenses, and expenses of my administration be paid out of my estate as soon as may be practicable after my death. SECOND: I bequeath to my daughter, Ellen Jane Spaulding, my diamond ring. Further, I hereby give and bequeath the rest and residue of my entire estate to my children, Bruce A. Bailey, Elizabeth Ann Hay and Ellen Jane Spaulding, their heirs and assigns forever, per stirpes, so much of said property as they may each select, and any unselected items may be sold and the proceeds distributed as part of the rest of may estate. THIRD: I appoint Bruee A. Bailey and my son-in-law, George Hay as Co-Executors of this, my Last Will and Testament, and direct that they shall not be required to enter any bond or security in any jurisdiction in which they may act. I also grant them the power to sell any property not specifically devised. IN WI1NESS WHEREOF, I, Grace O. Bailey, have executed this, my Last Will and Testament,onthis,X-dayof rYIa~d ,19ft. - . 1ft 8M f/ (j. 11t'4&t - /' Grace O. Bailey, Te atrix SIGNED, SEALED, PUBLISHED and DECLARED by the above named Testatrix as and for her Last Will and Testament, in the presence of us, who have hereto subscribed our names at her ~ ......."'-. '."''''''' 0'''' T~. ._ -j, Witness, ~/ ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA COUNTYOF C.U1;;/;.eA)CU1J SS. I, Grace O. Bailey, Testatrix, whose name is signed to the foregoing Instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the foregoing Instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~c~o~Ley~e~~ ~ Sworn or affirmed to and acltnowledged before me, by TIee O. Bailey, the Testatrix, this c7(,'l>Ldayof rna~c.I- , 1191. A Ll/~}n. k~ Notary Public Notarial Seal Diane M. Smith, Notary Public Mechanicsbur~ Bora, Cumberland County My CommissIOn Expires June 22, 2000 Page 1 of2 AFFIDAVIT COMMONWEAL1H OF PENNSYLVANIA COUNfY OF (!{ Un iu, /04J We, -Ja-I S"?ALIL1D~d 55. maTTe/ R. Uh!fN5 .ilI, the witnesses, , whose names are signed to the foregoing Instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the foregoing Instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint Witn Sworn or affirmed to and subscribed to before me by:x,,, "pro u IJiN' '" m,rr,/ R. /Ji)!l)f.t..r<.ll( ,witnesses, this cX\'i..dayof fllr1^(f..... and /qq9 II I I ^Oia~ ~. ~ru7L Notary Public Notarial Seal . Diane M. Smith, Notary PublIc MeChanic8buro Boro, Cumberland CountJ MV commission El<pires June 22, 200 Page 2 of2