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Home My WebLink About01-0436 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate afNICHOLAS R. OVER, Deceased. Social Security No. 190-68-3011 No. ~/-DJ- 43lo To: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner is 18 years of age or older, applies for letters administration on the estate of the above decedent. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his last family or principal residence at 176 East South Street, Carlisle (Borough of Carlisle), 17013. Decedent, then 20 years of age, died April 8, 2001, at Carlisle Hospital, 246 Parker Street (Carlisle Borough), Cumberland County, Pennsylvania. 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: N/ A $ 700.00 $ $ $ Petitioner, George L. Over, after a proper search, has ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: Cristal R. Over George L. Over, III Mother Father 176 East South St., Carlisle, P A 17013 176 East South St., Carlisle, P A 17013 THEREFORE, petitioner respectfully requests the grant of appropriate form to the undersigned. W administration In the OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ) : SSe COUNTY OF CUMBERLAND ) The petitioner above-named swears or affirms that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner and that as ersonal representative ofthe above decedent, petitioner will well and truly administer the estate acco . to law. Sworn to or affirmed and subscribed before me this 2nd day of .../1 . MAY I (7, 2001._ ~ { ,';f;.IA.I-<-,v /.JtZ/ MI4LU M ," 1-' Rlgister ~7 /(/;; -- c-;~~~? - ~/ No. 21-2001-436 Estate of NICHOLAS R. OVER, Deceased DECREE OF GRANT OF LETTERS AND NOW, May 3rd, 2001, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that Letters Administration are hereby granted to George L. Over, III. TOTAL $ 18 .00 $ 6 . 00 $ 5 .00 $ 5 . 00 $ 34 .00 I . aJ fJJ/lJ Register of Wil1:M~J /)?if Stephen L. Bloom, Esquire (/ Sup. Ct. I.D. No. 49811 2100 Longs Gap Road Carlisle, PAl 70 13 (717) 249-7717 Will Book # Page FEES Probate, Letters, Etc. Short Certificates( 2 ) Renunciation ,JCP Filed MAY 3rd,2001 CALL ATIOFNEY STEPHEN L. BLro1 C\LAS\EST A TES\over-pet 1 . c. hi' f ffi,ltion here given 15 correctly copied ti'orn an original certificate of death du~y: flied with This lS to celtll)' t at nt tn or < ,/' I R d Off f p'rmanent hllllg Local Registrar. The original certificate will be forwarded to the State v ita ecor 5 iCe or e . WARNING: It is illegal to duplicate this copy by photostat or photograph. me as P 7248123 ~~~ /......~'~~\" OF pi););.-- /\I\\'~"\..'(>--~4' '." ~I'\ ~~/ .."~'\. ~~~tl&a... . \~'\ N ~ '}!j'" \ -p' , I~::e!.. ~ \~~ ~ SI ';--#i: ;i:~ .... '" '.,.6.. ~ L" . ._.' ""C ," - ,.,"tq , <:l ..>,...--- ' (~~ \~', ../,~l -- ,().>., .. ' ~ " "~~j'il'-'/~ ~~ /' -%,~!' EN, ~.;jl!~ ~ ~ ~.~tu-~~ Local Registrar he for this cenitlcate, $2.00 APR 1 0 2001 Date No, 21-2001-436 H1OS,1<< Re., 1191 COMMONWEALTH OF PENNSYLVANIA. DEPARtMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH (Coroner~ "ElPRINT IN ~MANENT ACK INK UNDER I DAY Hours Minutes OVER DATE OF BIRTH (Month, Day, Year) STATE FILE NUMBER SOCIAL SECURITY NUMBER 190-6e-30ll DATE OF DEATH (Monlh, Oay, Year) 4. April 8, 2001 R BIRTHPLACE (City and Stale or Foreign Counlry) g';':;ity) 0 RACE. American Indian. atactc;, White, ete (Specily) White SURVIVING SPOUSE (It wrte, give maiden roame) twp i Carlisle citylboro I 24. 25. 21. PART I: Enter the diseaMS, injuries or complicatk>ns which caused the death. 00 not enle' the mode of dytng, lOch as cardiaC or respira Li:sl onty one caUM on each nne. 23b. 23c. WAS CASE REFERRED TO MEDICAL EXAMINERlCORONER? Ye'~ NoD arrest, shoct or heart failure. 28. , Appt'oximate : interval between : onset And death I PART II: Other significant conditions contributing to death. but not r..u~ing in the underlying cause gl\'8n In PART I. Investi ation DUE TO (OR AS A CONSEQUENCE OF): b. DUE TO (OR AS A CONSEQUENCE OF): DUE TO (OR AS A CONSEQUENCE OF): d. WERE AUTOPSY FINDINGS AVAILABLE PRIOR TO COMPLElION OF CAUSE OF DE.lJH? HomtcMje TIME OF INJURY INJURY AT WORK? MANNER OF DEATH Natural o o o Ve. Y.. 0 No~ Accident Pending Investlg8tion Coukl not be det.rmined 300. 2... 21b. CERTIFIER (ChecJ< only one) 'CERTIFYING PHYSICIAN (Ptlysiclan certifying cause of death when another physician he. pronounced death and completed lIem 23) TOIhe_ottnyknoMedge.d..lhoccurr9dduelolheC.UM(.).ndm.n...'.....ed........,........................... .,......... Suicide 29. o Coroner 'MEDICAL EXAMINER/CORONER On lhe bnI1 ollumlnallon Ind/or Inv.ltlgltlon.ln my opinion, dlath occurred II th.lIm., d.t., .nd plec.. .nd du.I" the c.ua.,.) and m.nner.. .....eeI.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " . . . . . . . . . . . . . . 31.. REGISTRAR'S SIGN.lJURE AN ~.~~~~ I~\ I~\ 101 D.lJE SIGNED (Month. Oey, Year) o 31c. 31d. April 9, 2001 NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DE!'J'H (11em 27) Type or Prinl Michael L. Norris, Coroner ~ 6375 Basehore Road, Suite #1 ~n Mechanicsburg, Pa. 17050 DATE FilED (Month, OeYf\r) 3.. l-\~" \0 I &Gt>\ 'PRONOUNCING AND CERTIFYING PHYSICIAN (PtlyslCien both prooouflClflQ deeth end certifying to C8U98 01 deeth) Tolhe_ 01 my knoMedge. de.lh occurr9d.llhe II..... d.,...nd ptec.. .nddu.lolhe c.u..(.).ndmenner...I.led......... .,.............,.. I -Yro~.L~~'~~'X. 1'rifr~~~'~'~'~'7'~to '796-5~~'!<"';;:" ".rl'-:t"'f~4/30iol 4: 50 PM 002/002 21-2001-436 RENUNCIATION In Re Estate of NICHOLAS R. OVER, deceased. To the Register of Wills of Cumberland County, Pennsylvania. The undersigned, Crista! R. Morrison Over, natural mother of the above decedent, hereby renounces the right to administer the estate and respectfully asks that I...etrers A.dministration be issued to George L. Over, m, natural father of the above decedent. WITNESS my hand this day of ~ 2001. ~({~O~ en Over 176 East South Street Carlisle~ P A 17013 COMMONWEALTH OF PENN S YLV ANIA ) : SSe COUNTY OF CUMBERLAND ) On this, the I day of ~ 2001, before me, the undersigned officer, personally appeared CristaI R. Over. known m (or satisfactorily proven) to be the person whose name is subscribed to the within instrwnent, aclmowledged that she executed the same for the purposes therein contained. my hand and official seal. ",; C:\LAS\BSrArns~ I .-......--\ OTARIAL SEAL . N HART Notary Pub\IC DAWN M. SHOO. "Qunty car\iS\8l.cumbe!\an~~v. 28, 2002,' My CommissIon Expires _.--oq'W"'" 'DiJ'lIl!r.t~~ .-.....1 ...-...-....... Ii.-~ ~1-~~~1,_,.'1~'''''''''' '"!>r\.~.;;"'.1rAIJ ~:~'''''.!;;''~i.J.,.ji..''':~._~~~.:., f STEPHEN L. BLOOM ATTORNEY ANDCQ~SELLOR AT LAW 2100 T,oi\;GS GAP ROAD CARLISLE, PENNSYLVANIA 17013 717-249-7717 ,- 1:: .-- CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: NICHOLAS R. OVER Date of Death: April 8, 2001 File No. 21-01-0436 To the Register: I certify that Notice of Beneficial Interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above estate on May 29,2001: Name Address Cristal R. Over George L. Over 176 East South Street, Carlisle, P A 17013 176 East South Street, Carlisle, P A 17013 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: N/A Date: May 30, 2001 ~J-~ Stephen L. Bloom, Esquire 2100 Longs Gap Road Carlisle, P A 17013 (717) 249-7717 Capacity: Counsel for Personal Representative C :\LAS \Estates\ 1 023 8-1 cert. not ~ /t-~~?-t0.2/ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG I PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT 1 ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN STEPHEN L BLOOM ESQ 2100 LONGS GAP RD CARLISLE fA 17013 11-05-2001 OVER 04-08-2001 21 01-0436 CUMBERLAND 101 *' REY-15~7 EX AFP 02-00l NICHOLAS R Amount Remitted (1) (2) (3) (4) u; ) (6) (7) (9) (10) (1S) (16) (17) (18) CHANGED .00 11733.77 .00 .00 31122.33 666.03 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subiect to Tax 171777.20 2.754.89 Ul) (2) (3) (4) .00 X .00 X .00 X .00 X MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE1 PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-V =is4,-ix--AFP--fi'2-:oo1--No;--ici--oF-'rtiHEiiiTAircE-TAX-A-PPRA-isiiiENT~--Ar.l-owAircE-oi----------- - -- - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF OVER NICHOLAS R FILE NO. 21 01-0436 ACN 101 DATE 11-05-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED NOTE: To insure proper credit to your accountl submit the upper portion of this form with your tax payment. 51522.13 :i'O.53:i' 09 151009.96- 666.03 151675.99- 00 = 045 = 12 = 15 = .00 .00 .00 .00 .00 If an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will reflect figures that include the total o~ Abh returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets NOTE: (9)= PAVMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED I SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $11 NO PAVMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)I YOU MAV BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) STEPHEN L. BLOOM ATTORNEY j\.ND-~UNSELLOR AT LAW 2100 LO:-.JGS GAP ROAD CARLISLE, PENNSYLVANIA 17013 717-249-7717 ,{ /'- e..... REGISTER OF WILLS OF CUMBERLAND COUNTY STATUS REPORT UNDER RULE 6.12 (For Resident Decedents Dying After July 1, 1992) Name of Decedent: NICHOLAS R. OVER O(""i :0 ,. .,,,. d =ctl CD ';:j :;, - (') Date of Death: April 8, 2001 0"" Q (I) c:::J (l c-:::l ~'I".l File No. : 21-01-0436 .,...' , - w Social Security No.: 190-68-3011 :t:? \0 ".""J' Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report t~ ft'>llowi~ 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: N/ A. 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file afinal account with the Court? Yes_ No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: N/A. c. Did the personal representative state an account informally to the parties in interest? Yes No~ d. Copies of receipts, releases, joinders and approvals offormal or informal accounts may be filed with the Clerk of the Orphans ' Court and may be attached to this report. Date: December 13, 2001 ~~3~ Stephen L. Bloom, Esquire 2100 Longs Gap Road Carlisle, P A 17013 (717) 249-7717 Counsel for Personal Representative Signature: Name: Address: C:\LAS\Estates\I0238-statrpt.1 c Register of Wills of CUMBERLAND County, Pennsylvania INVENTORY Estate of Nicholas R. Over No. 21- 01- 0436 Date of Death 04/08/2001 also known as , Deceased Social Security No. 190-68-3011 George L. Over III, Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I !We verify that the statements made in this Inventory are true and correct. l!We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative Name of Attorney: Stephen L. Bloom, Esquire Signature: 1.0. No.: 49811 Signature: Address: 2100 Longs Gap Road Address: 176 East South St. Carlisle, PA 17013 Carlisle, PA 17013 Telephone: 717/249-7717 Telephone: 717/243 -4903 q/a?/u) Dated: Description Value (See continuation page(s) attached) (Attach additional sheets if necessary) Total: 4,856.10 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems,lnc. Form tlRW-7 (1992) , Estate of: Date of Death: County: INVENTORY Nicholas R. Over 04/08/2001 Cumberland CASH: E-Trade Account #4790-5492 237.77 Keystone Health Plan Central, Ambulance Reimbursement 364.00 Members 1st, Regular Savings Acct. 1/168634 - 00 2,520.56 3,122.33 STOCKS/LISTED: 17.2038 shares Ahold Stock 984.17 35 shares Worldcom Inc. GA NEW 649.60 1,633.77 BONDS: $200 Series EE Bond 100.00 100.00 TOTAL RECEIPTS OF PRINCIPAL........ ....... 4,856.10 -1- REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT REV-1500EX + (6-00) CAPB HpRL EplO CRAC KOTK ES o E C E o E N T COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 2806Q1 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Over Nicholas R. DATE OF DEATH (MM-OD- YEAR) c:. FILE NUMBER / t - ,;l :;?- ~ OFFICIAL USE ONLY 21-01-0436 NUMBER CQUNTYCODE yeAR SOCIAL SECURITY NUMBER 190-68-3011 THIS RETURN MUST BE FILED IN OUPlICATEWf,TH THE REGISTER OF WILLS SOCIAL S CURl Y NUMBER o o 3. date of death . Remainder Return prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch 0) DATE OF BIRTH (MM-DD-YEAA) 04/08 2001 05 21/1980 IF APPLlCABL.E SU VIV1NG SPOUSE'S NAME LAST, FIRST, AND MIDDL INlTlAL X 1. Original Return 4. limited Estate 6. Decedent Died Testate (Attach copy of Will) o 9. LItigatIon Proceeds Received 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach copy of Trust) 010. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) P NAME COMPLETE MAILING ADDRESS C 0 0 Ste hen L. Bloom, Es uire R N FIRM NAME (if Applicable) 2100 Longs Gap Road R 0 E E Ste hen L. Bloom, Es uire Carlisle1 PA 17013 S N T TELEPHONE NUMBER C o M p T U A T X A T I o N 49- 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule 8) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule 0) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule n (10) 11. Total Oeduclions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Une 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Sub'eet to Tax (Line 12 minus Line 13) (1) (2) (3) None 1,733.77 None None 3,122.33 666.03 None 17,777.20 2,754.89 x X X X o 0 o 45 .12 .15 OFFICIAL USE ONLY (8) 5,522.13 (11) 20.532.09 (12) (15,009.96) (13) 666.03 (14) (15,675.99) (15) (16) (17) (18) (19) 0.00 0.00 0.00 0.00 0.00 R E C A P I T U L A T , o N (4) (5) (6) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(aX1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount 01 Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. 0.00 0.00 0.00 0.00 Copyright (c) '2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 176 East South Street CITY I STATE I ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 Total Credits ( A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 TotallnterestIPenalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to requesla refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (sa) Make Check Payable to: REGISTER OF WILLS, AGENT J((j~!jt 0.00 0.00 0.00 0.00 i~~ii~Ai~ii~~~~i~~i~il~~~i:~~~~iR~iim,m:: Yes No ~~ jm:::iiiiiiiii~i~i~~~~ii~~~!~ii~A~ii~~~~~!1~~m~~~~~l~i~~iii~~i!~~~iii~~i'~~ 1. Did decedent make a transfer and: a. retain the use or income of the property transferred; b. retain the right to designate who shall use the property transferred or its income; . c. retain a reversionary interest; or. . d. receive the promise for life of either payments, benefits or care? 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? . 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. o o o []J []J []J Under penalties of perjury, I declare that I have examined thIs return, Including accompanying schedules and statements, and to the best of my knowledge and belief, It is true, atlen of pre parer other than the personal representative Is based on all Information of which preparer has any knowledge. George L. Over III 176 East South St. ---Carllsi,,-,--pP:- - ii6i3-- - --- ---- --- - -- - --- --- ---- Stephen L. Bloom, Esquire __ ?~99_J:,~!l.g~ _~_":l'_~_"":<i_ ____ ____ ___ _ __ _ ___ ___ ___ __ Carlisle PA 17013 DATE Q/27/0/ DATE For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 9116 (a) (1.1) (ill- 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)J. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0"/" [72 P.S. 9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2) [72 P.S. 9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(aX1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (c) 2.000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) REV-1503 EX t (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER Nicholas R. Over 5511 190-68-3011 04/08/2001 21-01-0436 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION UNIT VALUE VALUE AT DATE NUMBER OF DEATH 1 17.2038 shares Ahold Stock 984. 17 2 35 shares Worldcom Inc. GA NEW 18.56 649.60 3 $200 Series EE Bond 100.00 TOTAL (Also enter on line 2, Recapitulation) 1,733.77 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1503 EX (Rev.1-97) REV-150a EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCET~ RETURN RESIDENT DECEDENT ESTATE OF Nicholas R. Over SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY SS# 190-68-3011 04/08/2001 FILE NUMBER 21-01-0436 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 E-Trade Account #4790-5492 237.77 2 Keystone Health Plan Central, Ambulance Reimbursement 364.00 3 Members 1st, Regular Savings Acct. #168634-00 2,520.56 TOTAL (Also enter on line 5. Recapitulation) S 3,122.33 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems. Inc. Form REV-1508 EX (Rev. 1 -97) REV-1509 EX t (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Nicholas R. Over SCHEDULE F JOINTLY-OWNED PROPERTY SSff 190-68-3011 04/08/2001 FILE NUMBER 21-01-0436 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. A. SURVIVING JOINT TENANT'S) NAME George L. Over III ADDRESS 176 East South St. Carlisle, PA 17013 RELATIONSHIP TO DECEDENT Father B. c. JOINTLY-OWNED PROPERTY, LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial Institution and bank DATE OF DEATH DECO'S VALUE OF account number or similar Identifying number. NUMBER TENANT JOINT Attach deed for jointly- held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES 1 A 6.058 shares Johnson 404.10 50.00% 202.05 Controls 2 A 10/29/99 22.589 shares Texas 927.96 50.00% 463.98 Utili ties Company TOTAL (Also enter on line 6, Recapitulation) $ 666.03 T (If more space is needed insert additional sheets of the same size) Copyright (cl 1996 form software only CPSystems. Inc. Form REV-1509 EX (Rev. 1-97) REV-1511 EX +(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Nicholas R. Over Debts of decedent must be reported on Schedule I. ITEM NUMBER A. B. 7. 1 SS11 190-68-3011 FILE NUMBER 21-01-0436 04/08/2001 DESCRIPTION AMOUNT 1 FUNERAL EXPENSES, Ewing Brothers Funeral Home 7,460.00 2 Gordon's Memorials, Monument 5,000.00 3 Westminster Cemetery, Grave opening 815.00 4 Westminster Cemetery, Burial Rights 1,120.00 1. ADMINISTRATIVE COSTS, Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. 3. Attorney's Fees Stephen L. Bloom, Esquire 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 3,180.09 4. Register of Wills Probate Fees 34.00 5. Accountant's Fees 6. Tax Return Preparer's Fees Other Administrative Costs Register of Wills, Short Certificates 9.00 2 The Cumberland Law Journal - Publication of Legal Notice 75.00 3 The Sentinel - Publication of Legal Notice 84.11 TOTAL (Also enter on line 9, Recapitulation) $ 17,777.20 (If more space is needed, insert additional sheets of the same size) Copyright (el 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) REV-1S12 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCET/!tIX RETURN RESIDENT DECEDENT ESTATE OF Nicholas R. Over SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS SS# 190-68-3011 04/08/2001 FILE NUMBER 21-01-0436 Include unreimbursed medical expenses. ITEM NUMBER 1 2001 Personal Tax DESCRIPTION AMOUNT 10.00 2 Allyn G. Perkins, D.M.D., Final dental bill 320.00 3 Members 1st, Loan Acct. #168634-00 885.19 4 Members 1st, Visa Credit Card Acct. #4121449992686340 422.90 5 Providian Visa, Acct. #4031-1517-0055-9897 1,116.80 TOTAL (Also enter on line 10, Recapitulation) $ 2,754.89 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) REV-1513 EX +(9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Nicholas R. Over NUMBER I. SSff 190-68-3011 04/0812001 FILE NUMBER 21-01-0436 AMOUNT OR SHARE OF ESTATE 50% of Estate Residue 50% of Estate Residue ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON- TAXABLE DISTRIBUTIONS, A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE RELATIONSHIP TO DECEDENT Do Not List Tr.steels) NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] 1 Crista1 R. Over 176 East South Street Carlisle, PA 17013 Mother TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, Inc. 2 George L. Over III 176 East South Street Carlisle, PA 17013 Father B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 0.00 Form REV-1513 EX (Rev. 9-00) 7 13--0\; 12:08PM;Glent I:lsyrOl1 ;7'7960'918 # 2-' 2- GIANT Giant Food Stores, llC ... 00 AN AHolD USA ClMf>I\N'r' July 12, 2001 Delivered via facsimile to number 717-486-7727 Office of Attorney Stephen L. Bloom AUn: Ms. Lori A. Sullivan 2100 Longs Gap Road Carlisle, PA 17013 Dear Ms. Sullivan: RE: Nicholas Over The Ahold Associate Stock Purchase Plan allows for the purchase of American Depositary Shares ("ADSs") of Koninklijke Ahold nv through voluntary payroll deduction. The value of Nicholas Over's Ahold Associate Stock Purchase Plan account at April 8, 2001 was $984.17. The number of shares was 17.2038. The Cusip number is 500467303. Please contact our office if you need anything additional. Sincerely, ~~~ Kelly Hoffman Manager, Compensation and Benefits P.O. Box 249. 1149 HARRISBURG PIKE' CARLISLE, PENNSYLVANIA 17013-0249' 717.245.7474' 717.249.5871 FAX GIANT FooD STOKES, LLC OperalOrJ' of GIAI'IT FOOD SToRHS. MARTIN'S FOOD M....RKHTS FROM 7179601918 TO Lori A, Sullivan 7/13/01 12:07 PM Page 2 Metnbersl.' PEDERAL CREDIT UNION INSURANCE DEPARTMENT 5000 LOUISE DRIVE P. O. BOX 40 MECHANICSBURG, PA 17055 I -800-283-2328 or (717) 697-1161 REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Opened Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 168634 -00 06/19/1997 $2,519.07 $1.49 $2,520.56 None CHECKING ACCOUNT: Account Number/Suffix Date Account Opened Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 168634 -11 0611911997 $.00 $.00 $,00 None LOAN ACCOUNT: Account Number/Suffix Date of Loan Disbursement Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Co-Borrower 168634 -01 11114/2000 $884.60** $.59 $885.19 Signaturc/Co-Borrowcr/Contractual Pledge of Shares **Crcdit Life coverage purchased on loan. VISA CREDIT CARD ACCOUNT: Account Number Date Account Opened Balance at Date of Death Name of Joint Cardholder Collateral 4121449992686340 1111911999 $422.90 None Signature/Contractual Pledge of Shares MIl,,: '"~Dm..'" ~~krs ~. Insurance Products Supervisor May 30, 20{) I Estate of: NICHOLAS R. 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",I"'I1I"-;;;,.Tk';.r;:;:'-".;;;:-"",, N(ln~,' I~_ );::.'r<~iIll ___~____,_ (WH('t:I'S~:(lNL\' (~ 'tn."",,' SPAl't:n:IlIH(''\'rLlIN t'anlll'\"<ln.<t,-~~~_ :--:;:';lftlll1 S...."..~d ny, ,.\I'un "Nil MH'(IRIII\n:l'IN(;. 11";liM..n~r.Il<II<\.I'~""mpl<l..,l) '-NI,,,;:;iNi "~Ill~ ,'II' "1;1-1' l'llll<MlNl "A~I""'~H'lllIlI M<Il'11 I Il M"YII'H' .I~I' IJI'Il"lIll ,'I 'I III"'K "~I' I "I ~1"1" 1'1'1,.,11 P !iI!~l^t I'r~MII ~I"'''''I\'' I' "NIl III \'.n ""11 ~ \-".<11'''11,1 _ ~~~U1 WI"'~ P",'--M"'-'-,;.",.-",,:,,- M"""..t,al..n . (;,"w,< M"",""""""" . Retail Installment Contract and Securiw Agreement o Cumberland Valley Memorial Gardens 0 Riverview Memorial Gardens 0 Tn-County Memorial Gardens ~estminster Cemetery . 1921 Ritner Highway 3776 Peters Mountain Rd. 740 Wyndamere Road 1159 Newville Road _.____ Carlisle, PA 17013 Halifax. PA 17032 Lewisberry, PA 17339 Carlisle, PA 17013 Contract # 717-243-3541 717-B96-3272 717-93B-3435 717-249-2029 ,I', ,.' ( ~, _ ("" .~, ' < J TInS AGREEMENT, made by and between Seller and '"I 7 vK ~ " '-. ~ "--,,,,') : \-...... \.) \\ t \.~ (Please Print) (hereina&r called the "Purchaser") WITNESSETII TIfAT Purchaser agrees tn buy and Seller agrees to sell to Purchaser, or his designated beneficiary in accordance with the tenns hereof, the following items to be provided or used at the above checked location (hereinafter called "Cemetery"). In consideration for Seller binding itself to provide the items wiili- out regard to the actual cost and price of said items prevailing at the time of performance hereunder, Purchaser agrees that this Agreement shall be irrevocable. 1. DFSCRIPI'ION OF BURIAL RIGHTS. The Burial Rights coveted by the Agreement are shown by the map of such gardenlbuilding on file in the office of the CEMErERY. and are more particularly described below. The purchase price of Burial Rights does not include IntermenUEntnmbment/Inumment Fees (opening and closing ~). Burial Rights in ~ Grave Space(s) 'Mausoleum: 0 Chapel 0 Garden 0 Tandem 0 Side-by-Side 0 Single _ Lawn Crypt: 0 Double Depth 0 Side-by-Side 0 Developed 0 PreconsIruction o Single 0 Developed 0 Preconstruction Niche: 0 Chapel 0 Garden 0 Single 0 Companion 0 Developed 0 Preconstruction *Maximum casket dimensions are: length 85", width 29". height 26" 1st Choice 2nd Choice 1st Choice 2nd Choice / Garden Section Lot Space(s) ',""",u.,J 01'.: 0\.""" (::r /.;l;;<. i, ~ '~, ~,S (.,.. . j Building Section No.(s) Level 3. ITEMIZATION OF CHARGES (A)BuriaIRightS(asdescriDedinPara.iabove) ~$ U \.1;;'0 ~ou (B) Perpetual Care $ (C) Less Certificate Discount $ ______, . (D) Second Right of Interment $ (E)Vault(s) _$ (F) Urnes) _$ (G) Mausoleum Leltering/Crypt Plate $ (H) MemoriallMonument $ (I) Granile Base(s) _ $ (l) Installation Charge _ $ (K)Caskets _$ (L) IntermentlEntombmentlInumment Fees __ $ (M)Permanent Records & Processing Fee $ (N) Other $ (0) Sales Tax $ 4. TOTAL CASH PRICE (A THRU 0) $ r. 2. MERCHANDISE o Check here if merchandise is being purchased for use at another cemetery. Cemetery's Name: A. VAULT(S) #1. Description #2. Description B. URN(S): #1. Description #2. Description c::.\ - 0 - .-0 - -0. () C. MEMORIAL INFORMATION: Memorial Design: Vase: Y I N Bronze Size _X _ Granite Size_ X_ Location (Section, etc.) C) x x > p,\ P P 1\ '. j/'\ ITEMIZATION OF THE AMOUNT FINANCED (I) Total Cash Price $ '.) .......,- "_'0 ., (2) A. Cash Down Payment" V (I;{T- ...J! l..,- $ loIlCoo B. Trade In: $ Old Agreement No. - 0 C Total Down Paymenl (2A + 2B) $ , d. I'., l'x...:) (3) Unpaid Balance of Cash Price (1 - 2C) $ .:> /GO.. 00 (4) Finance Charge $ ('..... - .- (5) Total Unpaid Balance (3 + 4) $ -~ ~). - _,\.-,U.OQ C Q"ifl() u- - o. ~I <: 1 ,- ~'-" I ..J .... V'-.. D. MONUMENT INFORMATION: l)'pe: Color: Size: x Die: Base: x x x E. CASKET(S): 1. Model: l)'pe: l)'pe: Model # 2. Model: Model # S. PAYMENT. The Purchaser shall pay SELLER for such rights in accordance with the following disclosure statement: ANNUA~ PERCENTAGE RATE FINANCE CHARGE AMOUNT FINANCEO TOTAL OF PAYMENTS TOTAL SALE PRICE The cost of your credit The dollar amount the credit will The amount of credit provided The amount you will have paid The lolal cost o~urchase as a yeariy rate. cost you. 10 you on your own beha~. aft~ou have made all payments on credit, inclu I~ down - O- j "3 Ld). 00 as !I!1Uled. payment of $J I ~ -.: ():) % $ - () - $ $ -' , JI..() . 00 $ '1,-:,:, . DO , YOUR PAYMENT SCHEDULE WILL BE: Number of Payments Amount of Payments First Payment Due Date Thereafter, Payments Are Due /..;/ $ ,;) J- 0 00 /"1 A 'I 0/,3 .)t.>o ( ~onthlY on the o:::>? (.? i) -~ $ _..._-_.._-----"_..~._--- SECURITY: You are giving a security interest in the goods or property being purchased or in part of lhe funds paid under this Agreement held in a Merchandise Trust Fund. PREPAYMENT: If you payoff early, you will not have to pay a penalty and you may be entitled to a refund of part of the Finance Charge. NOnCE: See the remainder of this Agreement (including General Provisions on the reverse side hereof) for additional information about nonpayment, default, securily interests, ~y required payment in full before the scheduled date, and prepayment refunds and penalties. If you do not meet your contract obligations, you may lose the funds paId under thIS Agreement held in the MerchandISe Trust Fund. THIS AGREEMENT ARISES OUT OF A CONSUMER CREDIT SALE AND IS SUBJECT TO THE ADDITIONAL GENERAL PROVISIONS CONTAINED ON THE REVERSE SIDE OF THIS AGREEMENT, WHICH ARE A PART OF THIS AGREEMENT. Seller reserves Ihe right to refuse to accept this Agreement within teJ (10) days of the date hereof by notifying the Purchaser in writing of this refusal. . . ... .. .. . . . - . ' STEPHEN L. BLOOM ATTORNEY AND COUNSELLOR AT LAW 2100 Longs Gap Road Carlisle, Pennsylvania 17013,Tel 717-249-7717 Federal EIN 25-1851818 Invoice submitted to: Over, Nicholas R. Estate clo George L. Over, Administrator 176 E. South Street Carlisle PA 17013 September 26, 2001 In Reference To: Estate Administration Invoice #713 Professional Services Hrs/Rate Amount 4/26/01 PL Research special requirements for Petition for Letters of 1.00 95.00 Administration; Telephone conference with Paula Murphy at Giant 95.00/hr Foods re required information; Correspondence with Giant Foods 4/27/01 PL Telephone conference with Register of Wills re Renunciation of Mrs. 1.67 158.33 Over; Telephone conference with Mr. Over; Telephone conference with 95.00/hr Solicitor to Register of Wills (Mr. Wright); Prepare Renunciation and Petition for Letters of Administration; Prepare Estate Information Sheet for Register of Wills 4/30/01 PL Telephone conference with Register of Wills re Renunciation 075 71.25 procedural matters; Telephone conference with Solicitor for Register of 95.00/hr Wills (Mr. Wright); Finalize Renuciation and Petition for Grant of Letters; Telephone conference with Mr. Over; Correspondence with same 5/2/01 SLB Conference with client for Probate at Register of Wills; Administrative 1.25 218.75 matters 175.00/hr PL Administrative Matters; Conference with client and Mr. Bloom 200 190.00 95.00/hr 5/4/01 PL Administrative Matters; Obtain Short Certificates from Register of Wills; 1.50 142.50 Telephone conference with Ms. Murphy re Short Certificate; 95.00/hr Correspondence with same; Telephone conference with District Attorney's Office re police investigation public access policies PRi\CTICAI. C()l:]'.;SI"L + CI-IRISTli\N PERSPEcTlvr.: Over, Nicholas R. Estate 5/7/01 PL Telephone conference with client re file status, iife insurance and information re public access to police investigation matters 5/8/01 PL Telephone conference with Trustmark Insurance Company re claim for death benefits 5/9/01 PL Administrative Matters 5/10/01 PL Telephone conference with Mr. Prince at Trustmark Insurance re status of claim 5/15/01 PL Telephone conference with client 5/17/01 PL Draft Form SS-4 and correspondence to IRS re same; Office conference with Mr. George Over re administration of estate; Administrative matters SLB Conference with client (Mr. George Over) 5/21/01 PL Administrative Matters; Organizing file information 5/22/01 PL Correspondence; Administrative and accounting matters 5/29/01 SLB Administrative Matters 5/23/01 PL Review additional records received from Mr. Over (funeral bill, burial plot, medical records); Administrative matters; Correspondence 5/24/01 PL Preparation of Legal Notices for Publishing; Telephone conference with Masland Associates re medical records and Statement of Physician; Telephone conference with Mr. Prince at Trustmark re medical records; Correspondence to Members 1 st re date of death information; Prepare required Beneficiary Notice and Certification; Correspondence with client 5/29/01 PL Administrative Matters; Correspondence 5/30/01 PL File Certification of Notice with Register of Wills Office 6/1/01 PL Review correspondence and account information received from Members 1st; Telephone conference with Mr. Norris (County Coroner) re determination of cause of death; Telephone conference with Mr. PR!\(.'I'[(,.'\I, (:()l'NSI':I. + (:IIRIS'j'[i\\J P/':RS/)!':(.TIVE Page 2 Hrs/Rate Amount 0.33 31.67 95.00/hr 0.08 7.92 95.00/hr 0.33 31.67 95.00/hr 0.17 15.83 95.00/hr 0.08 7.92 95.00/hr 2.25 213.75 95.00/hr 0.67 116.67 175.00/hr 1.00 95.00 95.00/hr 4.42 419.58 95.00/hr 0.15 25.81 175.00/hr 1.50 142.50 95.00/hr 3.58 340.42 95.00/hr 0.25 23.75 95.00/hr 0.08 7.92 95.00/hr 1.75 166.25 95.00/hr Over, Nicholas R. Estate 6/2/01 PL Prince at Trustmark Insurance re medical records; Correspondence with Trustmark providing copies of same Accounting Matters; Review checkbook disbursement records for unidentified liabilities/deposits; Research valuation for Series EE Bond 6/6/01 PL Review Members 1 st bank statement, credit card statements and Keystone Insurance information 6/12/01 PL Administrative and Accounting Matters; Review outstanding debt information; Confirmation of assets and date of death valuations; Preparation of Inheritance Tax Return and Schedules; Determine status of Keystone check payable to decedent; Telephone conference with Executor 6/18/01 SLB Review Proof of Publication (The Sentinel) 6/15/01 PL Telephone conference with client (Mr. Over) re status of death certificates and Members 1st Visa account; Telephone conference with County Tax Office re taxes due; Telephone conference with Dr. Perkins' office re balance due; Review asset statements from TXU, Johnson Controls and E-Trade; Telephone conference with E-Trade Securities 6/19/01 PL Telephone conference with Administrator re estate account and payment of dental bill and personal taxes; Telephone conference with Members 1st re Visa account; Correspondence with Administrator; Correspondence with Social Security Administration; Adminstrative matters re legal notices, Register of Wills and accounting 6/18/01 PL Telephone conference with Members 1st; Telephone conference with Providian 6120101 PL Administrative Matters; Obtain additional Short Certificates at Register of Wills; Deposit Keystone Insurance check 6121101 PL Confirm status of Series EE Bond and documentation of same; Telephone conference with TXU and Johnson Controls re transfer of assets to joint tenant; Draft Affidavit of Domicile for transfer of assets and prepare Estate Account Application and Account Transfer Form for E- Trade Securities; Administrative matters; Preparation of Inheritance Tax Return and Schedules 6122101 PL Telephone conference with E-Trade re estate account application; Telephone conference with Administrator re additional information required for application; Revise application; Research re inheritance tax rules for deceased minor; Calculations for applicable inheritance tax base; Preparation of Inheritance Tax Return and Schedules; Correspondence PR/\(:TI(:i\r.(:()I'N~I.:r. + (:JII{]S'j'IA:"J PI':RS[ll,:(:'rIVl': Page 3 HrslRate Amount 0.83 79.17 95.001hr 0.25 23.75 95. OOlh r 2.67 253.33 95.001hr 0.08 175.00Ihr 14.58 2.75 9500lhr 261.25 3.00 95 OOlhr 285.00 0.33 31.67 95.001hr 0.33 3167 95.001hr 6.75 641.25 9500lhr 7.08 95.001hr 672.92 Over, Nicholas R. Estate Page 4 HrslRate Amount 6125101 PL Draft Letters of Instruction to TXU, Johnson Controls and E-Trade; 1.00 95.00 Administrative matters 95.001hr 6126101 PL Revise Letters of Instruction; Accounting and Inheritance Tax matters 2.67 253.33 95.001hr 6129101 PL Review Proof of Publication of Notice and receipt of payment from 2.25 213.75 Cumberland Law Journal; Meet with Administrator re execution of 9500lhr Letters of Instruction to E-Trade, TXU and Johnson Controls and discussion re status of administration; Telephone conference with Social Security Administration; Telephone conference with Ms. Murphy and Ms. Harry of Giant Foods re Ahold stock, additional employee benefits and life insurance policies 7113101 PL Telephone conference with Keystone Health Plan and RWC Corp. re 3.00 285.00 outstanding medical bill; Telephone conference with Tax Office re 95.001hr school tax bill; Telephone conference with Mrs. Over re status of insurance claim and RWC bill; Correspondence with Mr. Prince at Trustmark enclosing Statement of Physician and Insurance Beneficiary's Statement, Death Certificate and insurance policy; Telephone conference with Members 1st re credit life claim; Correspondence with Ms. Anders at Members 1 st enclosing Death Certificate for credit life insurance coverage on loan 7117101 PL Review TXU activity statement re date of death valuation; Research re 0.83 79.17 actual price per share on date of death 9500lhr 7124101 PL Review TXU, Johnson Controls and E-Trade stock information re 3.00 285.00 transfer of assets to Administrator; Telephone conference with 9500lhr Johnson Controls re date of death account valuation and market value; Research re stock history quotes; Administrative matters 816101 PL Review Bank Statement and draft correspondence to Administrator 0.17 15.83 95.001hr 817101 PL Additional research re date of death valuation for stocks; Administrative 2.67 253.33 matters 95.001hr 819101 PL Preparation of Inheritance Tax Return and Schedules; Preparation of 108 102.92 Inventory for filing with Register of Wills 95 OOlhr 8110101 PL Review correspondence received from Trustmark re claim for 0.42 39.58 insurance; Draft correspondence to Administrator re same 95 OOlhr 8114101 PL Research re stock valulation matters; Telephone conference with 4.25 403.75 E- Trade, TXU and Johnson Controls re additional accounUdate of 95.001hr death valuation information; Prepare Inventory; Prepare Inheritance Tax Return and Schedules 9/4/01 PL Review correspondence received from Trustmark re life insurance 0.17 15.83 proceeds 9500lhr P R i\ C T J C :\ L C () L N S E J.. 01< ell J{ 1ST J A N PER S p f.: c: T' I V F Over, Nicholas R. Estate 9/7/01 PL Telephone conference with Mrs. Over re tax refund and life insurance proceeds; Draft correspondence to Executor 9/10/01 PL Correspondence; Administrative matters Administrative Matters; Preparation of Inheritance Tax Return and Schedules; Preparation of Inventory Telephone conference with Mrs. Over re Inheritance Tax Return; Review file documentation re assets and expenses; Finalize Inheritance Tax Return, Schedules and Exhibits and prepare for filing; Finalize Inventory and prepare for filing 9/25/01 SLB Review and finalize Inheritance Tax Return, Schedules and Exhibits; Review and finalize Inventory 9/21/01 PL 9/24/01 PL Subtotai of charges Discount against fees actually incurred For professional services rendered Additional Charges: 5/2/01 Probate Fee - Cumberland County Register of Wills 5/24/01 Publishing Fee - Legal Notice - Cumberland Law Journal 6/18/01 Publishing Fee - Legal Notice - The Sentinel 6/19/01 Add'l Short Certificate (x3) Fee - Cumberland County Register of Wills Total costs Total amount of this bill Balance due PAYABLE UPON RECEIPT - THANK YOU F'R;\(:TI(:/\], (:()[::'\JSI':J. + CI1R1S']'I/\I\ PI.:RSPJ.:( 'j'IVI': Page 5 Hrs/Rate Amount 2.00 190.00 9500/hr 1.00 95.00 95 OOlhr 1.75 166.25 95 OO/h r 4.00 380.00 95.001hr 0.33 17500/hr 58.33 79.47 $7,749.15 ($4,569"~6) $3,180.09 34.00 75.00 84.11 9.00 $202.11 $3,382.20 $3,382.20