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Home My WebLink About01-0690 PETITION FOR PROBATE and GRANT OF LETTERS Estate of Charles S Walters also known as N/A. Deceased Social Security No.: 178-16-6850 No. 21-01- <oClO To: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your pctitioners who arc 18 years of age or older and the Executrices named in the last will of the above decedent, dated April 10, 1996, and codiciI(s) dated None. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his last family or principal residence at 228 Garland Drive, Carlisle, Pennsylvania 17013 (Borough of Carlisle). Decedent, then 85 years of age, died June 20, 2001, at Carlisle Regional Medical Center. Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: No exceptions. Decedent at death owned property with estimated values as follows: (If domiciled in P A) All personal property (If not domiciled in P A) Pcrsonal property in Pcnnsylvania (If not domicilcd in P A) Personal property in County Value of real cstate in Pennsylvania situatcd as follows: None. $ ] 5.000.00 $ $ $ WHEREFORE, petitioners respectfully request thc probate of the last will and codicil(s) presented herewith and the grant of Ictters Testamentary thereon. ~~A lfJ!~i{&fiAA RosalitJ. McKeehan Six Hoerncr Circle Boiling Springs, P A 17007 (717) 258-3942 C1Q~~ ~\N%vb Dolores J. . 105 Mill Street Mount Holly Springs, PAl 7065 (717) 486,-7600 OATH OF PERSONAL REPRESENTATIVE COMMONWEAL TH OF PENNSYL VANIA ) ) SS COUNTY OF CUl\1BERLAND ) The petitioners above-named swcar or affinn that the statements in the foregoing petition are true and correct to the best of the knowledge and bclief of petitioners and that as personal representative of the above decedent petitioners will well and truly administer the estate according to law. Sworn to or afl1.nne~ subscribed before me ~ (1.lIlc~~ this ~ -3 ~ _ day of Rosalie J. MeK1han -r ,2001 r::\~ - ; _ 7nh&" /1 ~'-'~ ph . ea. ~ OUl-1k () .nw~. l\ ltJL e;;;;;;ct Dolores . White \ Ih-' alfS- /~ NO. 2 1- 01- 690 Estate of Charles S. Walters, Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW July 24th, 2001, 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 April 10, 1996, described therein be admitted to probate and filed of record as the last will of Charles S. Walters; and Letters Testamentary are hereby granted to Rosalie 1. McKeehan and Dolores 1. White. '->?xz~~,lt.e~ 'f"g, ~.~.~.~ M ry C. LewIs, RegIster of Wills FEES Probate, Letters, Etc. . . . . . $ 50.00 Short Certificates (3). .... $ 9 . 00 ~.~4~~.~~S. A$ 12.00 JCP $ 5.00 TOTAL $ 76.00 Filed: July JULY 24th , 2001 Robert R. Black, Esquire 36 South Hanover Street Carlisle, P A 17013 (717) 243-3727 (06267) MAILED LETTERS TO ATTORNEY JULY 25, 2001 1 AC;..QAC; U,t:'V ('\/Q(:, This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar, The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph, No. 2lu- ~~~~~ Fee for this certificate, $2.00 p 7402516 JUN 2 1 2001 Date ) H105. :43R.... 2187 COMMONWEALTH OF PENNSVLVANIA · DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH ..T Ie. sex STAll Fl\.E NUMlIER SOCIAL seCURITY NUMBER DATE OF Of.AlH ,Monfl. oat. '_1 NT II( NAME Of' DECEDENT (f~... _.l_l 85 Charles S. UNDER 1 YEAR UNDER 1 DN Mor-. Days _!: Minut.. Y.... 178 - 16 20, 2001 ,. AGE (La. ~y) ~IO ~.;( \ . I. COUNTY OF DEAl'H Ctm1berland RACE. _... _. JM.ck. WhiI.. oIC. (~ White 1711. 0IcI - heinl Cl~rland -.oIlip? 1?...fX) ~~'=OI MOTHEA'S NAME (Fir.. _. /oof..,.., Suo~amel 1.. ~lara: 'Barley IHFORMANT'S MAlUHO AODRESS cs--. CilyITown. SlMe. t ~i 228 Garland Drive, Car 1S e, PA 17013 PlACE OF OlSPOSITlON. _ 01 C-...." C,-..ooy LOCRtON. c~. SI.... rIP CocIe "'~.Zion Cemetery 21c. _ITAL STATUS. /oIaniad _MlITiacl._. Mar~ 14. 17c.O _.__'" SlJAVMHG SPOUSE /11_.__"""'1 DECEDENT'S USUAL OCCUMIOM (~":;:~%'"'::~:'r . ItL Malntanence It~ Rubber Mfg DlECEDENT'S MAILING AOOAESS jSlrtel. CilyIbwn. SlMo. Z.,CocleI DECEDENT'S 228 Garland Drive =r~~HCE Carlisle, PA ~~ 17.. SI... ..... '" FRltEA'S NAME (F.... /oofoCl<le. lal) 11. _OAMAHT'S NAME (TySleIPmll Carli~le CiIyIlIoro . John Calvin Walters Gayle Walters NAME AND ADORESS OF FAClUTY 219 N. Hanover St., Carlisle, PA 17013 DATE SIGHED (IIcI1Il. Day. -eo / 'UJ) D I 23lt. Ue. W'S CASE REFERRED TO:O EXAMINERICOROHER? NoE 2L 'AwIl_I. , inlarYII_II :--- I l PAIIT It: 0Iher~""""""'~"'_1tI. but ""'......ing i1111le ~ _gi.- ill FWrr I. \ :. d. WERE AUlOPSY FINDINGS ~PAIOIllO OF CAUSE ~_J ~_/~ ~,~t~ ,4> r .#- w". ~ TIME OF INJURY INJURY AT WORK? DESCRIBE I<<7N INJURY OCCURRED. OF DERH? ......... - ~ - Pending -igatloft J1~~ _ 0 tto]il Ywe 0 No 0 -- _. CEJmFIEJI (0-0 only one! 'ceRTlFYINC l'ttYSlClAM (Pt\_c~ t.auM ~ _ _ ~""""" gl1VSICoan "'". pron<lUncecI "".Wl .no comtllOllld lIem 231 T...._o'''''IltIowledge.....tlIOCC__.....c...M(.,_........'...'.'acl.......... ................................. S<licide o Could "'" be cIot.....~ o o o I'VICE OF INJURY. ~ !lome. .."". .,.... lacIOfy. ollie. 101. IluiIcIIIIg. etc. ISpecM :JOI. _ 0 NoD ft. 'MEDICAL EXAMINER'CORONER On... ...11. 01 .._I...llon .ndfor in"eallg.llott. In my opinion. d..lh occurred.1 \he tim.. d.'., and pl.e., and due 10 'he c.ulel.).IId "'anner.. .taled.. . . . .. . . . . .. .... . . . . . .. .. . . .. . . .. .. . .. .. . .. .. . . .. . .. . . .. . . . . . . . . . . . . . . . . . . .. . .. . . . . . . .. .. . . . .. . . . 31.. REGISTRAR'S SIGNATURE AND N ~l' ld.t\ DI ~1 lIC~~~ (pM",/, tI'" ry I _ L ATE SlGNEOf~. oe; _I o 3'/'~ 31d. ~ ..J. -0/ NAME AND ADORESS OF PER~ON ~ COMPt.ETED CAUSE OF DEATH i'\ (hem 27) Type Of Print.l c5. 6,;~...Mt '\/'~ " "'-' f'.Jl) 1/,., ,oK"..., i(( '" TT,.,..., // o 32. ~~ ~.//~ /'" 1;1 /-1. DATE FILED (Month. O.y. ~Il '~INO AND CER7IFYINO PHYSICIAN (""YsC....1XlItl ;lIonounconq ae.'" and Cf!f1'lyonq 10 cauw 01 "".,~\ To the beoet of my know\edgtt. death occurred ., ... 0Ine. CIa'.. .nd place. and due 10 lhe caUH(I) and mann., .. s..led.. , 34. ~-..J.P-~/ ( QWe.. d \ a.OC It 21-01-690 LAST WILL AND TESTAMENT OF CHARLES S. W ALTERS I, CHARLES S. WALTERS, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this to be my Last Will, hereby revoking all prior wills and codicils. FUNERAL EXPENSES FIRST: I direct the payment of my funeral expenses, including my gravemarker, as soon as may be convenient after my death. PAYMENT OF DEATH TAXES SECOND: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of administration of my estate. . DISTRIBUTION OF RESIDUE THIRD: I give and devise the rest of my estate as follows: 1. One-third of my estate to my daughter, Rosaiie l IvlcI(eehan, or her issue per stirpes; 2. One-third of my estate to my daughter, Dolores 1. White, or her issue per stirpes; and 3. One-third of my estate to the children of my deceased son, John L~ q1/ initials Walters, namely Kathy L. Hair, Kim L. Wolf, John C. Walters and Steven M. Walters, or their issue per stirpes. PROTECTION OF BENEFICIARIES (Spendthrift Provision) FOURTH: No interest in income or principal shall be assignable by a beneficiary or available to anyone having a claim against a beneficiary before actual payment to the beneficiary . MINORS AND INCAPACITATED BENEFICIARIES FIFTH: If any income or principal shall be payable to any person who shall be a minor or who shall be incapacitated for any reason, my executor as trustee shall hold such income and principal during minority or incapacity and shall be entitled to apply such income and principal to the health, maintenance, support and education of such person during minority or incapacity without the appointment of any guardian or committee or any authority of court. My executor as trustee shall be entitled to make direct application hereunder or to make application by payment of income and principal to the parent or other person in charge of such minor or incapacitated person, or to his or her guardian or to a custodian under the Uniform Transfers to Minors Act. Any remaining income and principal to which such person shall be entitled shall be distributed to such person upon the termination of minority or incapacity. My executor as trustee shall have the same powers as my executor and shall serve without bond. POWERS OF EXECUTOWRIX SIXTH: T confer upon my executor the right to sell or othenvise convert any real or personal property at public or private sale, at such time or times, in such manner, and for such price or prices, and upon such terms and conditions as my executor shall determine, and to execute and deliver good and sufficient conveyances, assignments and transfers thereof, without liability of any purchaser for the application of any consideration; to borrow money and to secure its payment by mortgage of real or personal property, pledge of investments or otherwise, without liability on the part of the lenders ~y q1/ initials .' .' .' to see to the application thereof; to retain any investments at discretion; to invest and reinvest at discretion, without restriction to so-called "legal investments;" to make distribution in cash or in kind; and to do all other acts and things necessary or appropriate in the management, administration and distribution of my estate. APPOINTMENT OF GUARDIAN OF ESTATES OF MINORS SEVENTH: I appoint my executor as guardian of the estates of minors with power to hold all property payable by law to a guardian appointed by my will and to use it for the minor's health, maintenance, support and education, either directly or by payment to any person selected by my executor to disburse it whose receipt shall be a complete acquittance. Guardian may, in discharge of all the guardian's duties, pay any minor's share deemed impractical of administration to the parent or other person in charge of the minor or to his or her guardian or to a custodian for the minor under the Uniform Transfers to Minors Act. My executor as guardian shall have the same powers as my executor, and shall serve without bond. APPOINTMENT OF EXECUTORlRIX EIGHTH: I appoint Rosalie 1. McKeehan and Dolores 1. White, or the survivor, as Co-Executors of my will. I direct that my Co-Executors shall not be required to furnish security in any jurisdiction. INTERCHANGEABILITY OF LANGUAGE NINTH: Words used in the singular may be read to include the plural or the plural may be read as the singular. Similarly, the masculine form may be read to include the feminine and neuter; the feminine may be read to include the masculine and neuter; and the neuter may be read to include the masculine and feminine. HEADINGS TENTH: The headings used on the various paragraphs of this will are included for convenience only and shall have no legal significance. ~. v1 I/J I have signed this will this I D day of 11 fJ r\ ( L , 1996. .. . . J5~)} c.W6~ Charles S. Walters, Testator ~~ Robert R. Black J1~~ It Uff1., Witness ACKNOWLEDGMENT and AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND ) We, Charles S. Walters, the Testator in, and Robert R. Black andLt I\JDlQ A / KG\4M , the witnesses to the last will, the attached or foregoing instrument, who have signed the instrument, having been duly qualified according to law do depose and say: ( a) that I, the Testator do hereby acknowledge that I signed and executed the instrument as my last will, that I signed it willingly and as my free and voluntary act for the purposes therein expressed; and (b) that we, the witnesses, were present and saw the Testator sign and execute the instrument as his last will, that he signed it willingly and executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the will as a witness and that to the best of our knowledge the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. -' ~qjf~~.t7-- Testator, Charles S. Walters ~~ Witness, Robert R. Black Jl/q/o., Ii, UfTt Witness ~ ~ .K9un~ Notary Public I Notarial Seal Susan K. Guyer, Notary Public Carlisle Bora, Cumberland County My Commission Expires Sept. 4, 1999 Meml:lerl PlilllnSylvrania AQlbgiitllJ11 C)f otariel E ..-..-- CERTIFICATION OF NOTICE UNDER RULE 5.6 (e) Name of Decedent: Charles S. Walters Date of Death: June 24, 2001 Will No.: 21-01-0690 Admin. No. To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on : Name Rosalie 1. McKeehan Dolores 1. White Kathy L. Hair Steven M. Walters Kim L. Wolf John C. Walters, Jr. Address Six Hoerner Circle, Boiling Springs, P A 17007 105 Mill Street, Mount Holly Springs, P A17065 Eight East Countryside Drive, Boiling Springs, P A 17007 1312 Massachusetts Avenue, N.W. #506, Washington, DC 20005 314 Bonnybrook Road, Carlisle, P A 17013 706 North Pitt Street, Carlisle, P A 17013 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None. Date: ~ I{~/O I ~0(9vJe. Signature Robert R. Black, Esq. 36 South Hanover Street Carlisle, Pennsylvania 17013 Telephone (717) 243-3727 Capacity:_ Personal Representative --X- Counsel for Personal Representative " INRE: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYL VANIA ESTATE OF CHARLES S. WALTERS Deceased : ORPHANS' COURT DIVISION : NO. 21 - 01- 0690 Date of Death: Letters Testamentary Granted: Letters Advertised: Sentinel - Cumberland Law Journal - Account Stated as Final FIRST AND FINAL ACCOUNT OF ROSALIE J. McKEEHAN and DOLORES J. WHITE EXECUTRICES OF mE ESTATE OF CHARLES S. WALTERS LATE OF THE BOROUGH OF CARLISLE, CUMBERLAND COUNTY , PENNSYLVANIA June 20, 2001 July 24, 2001 August 16, 23, & 30, 2001 August 24, 31 & September 7,2001 SUMMARY & INDEX PRINCIPAL PAGE 2 3 19,1963.65 - 9.755.40 Receipts Less Disbursements Principal Balance Remaining 9,438.25 INCOME Receipts Less Disbursements Distributions to Beneficiaries 3 3 38.29 0.00 38.29 COMBINED BALANCE REMAINING $ 9..476.54 RECEWTSOFPmNCWAL 2001 8/6 Allfirst checking account #0010427872 1,072.21 9/11 Proceeds of sale 1997 Plymouth, VIN 2P4GP44RXVRZ07238 16,500.00 2002 2/9 Prudential Financial, distribution 739.44 3/6 Commonwealth of Pennsylvania, tax refund 90.00 5/1 Carlisle Regional Medical Center, refund 792.00 TOTALRECEWTSOFPmNCWAL DISBURSEMENTS OF PmNCWAL 2001 8/17 Hoffinan-Roth Funeral Home, balance funeral invoice 10/12 Carlisle Memorial Service, headstone lettering 11/14 Register of Wills, Agent for Commonwealth of Pennsylvania, Pennsylvania inheritance tax 11/14 Rosalie McKeehan, refund of inheritance tax payment 11/14 Landis & Black, attorney fees and costs advanced to date 12/6 Register of Wills, additional probate fee 2002 2/4 Carlisle Regional Medical Center, invoice Reserved: Landis & Black, balance, attorney's fees (estimated) 2 19,193.65 86.77 95.00 5,348.20 24.06 1,644.37 65.00 792.00 1,200.00 Landis & Black, costs to file account and releases 500.00 TOTAL DISBURSEMENTS OF PRINCIPAL 9,755.40 RECEIPTS OF INCOME 2001 5/1 Orrstown Bank, interest 0.38 10/5 Orrstown Bank, interest 7.90 11/5 Orrstown Bank, interest 6.76 12/5 Orrstown Bank, interest 5.80 2002 1/6 Orrstown Bank, interest 4.53 2/6 Orrstown Bank, interest 4.39 3/5 Orrstown Bank, interest 3.83 4/7 Orrstown Bank, interest 4.70 TOTAL RECEIPTS OF INCOME 38.29 DISBURSEMENTS OF INCOME 2001-2002 NONE TOTAL DISBURSEMENTS OF INCOME 0.00 3 INRE: : IN THE COURT OF COMMON PLEAS OF : CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF CHARLES S. WALTERS Deceased : ORPHANS' COURT DIVISION : NO. 21 - 01- 0690 SCHEDULE OF PROPOSED DISTRIBUTION Combined Balance for Distribution Remaining as per First and Final Account TO: Rosalie J. McKeehan (1/3) Dolores 1. White (1/3) Kathy L. Hair (1/12) Steven M. Walters (1/12) Kim L. Wolf(1/12) John C. Walters, Jr. (1/12) TOTAL BALANCE FOR DISTRIBUTION 9,476.54 3,158.85 3,158.85 789.71 789.71 789.71 789.71 $ 9.476.54 ROSALIE 1. McKEEHAN and DOLORES 1. WHITE, Executrices under the Last Will and Testament of CHARLES S. WALTERS, deceased, hereby declares under penalties of petjury that they have fully and faithfully discharged the duties of their office; that the foregoing First and Final Account is true and correct and fully discloses all significant transactions occurring during the accounting period; that all known claims against the estate have been paid in full; that the first complete advertisement of the grant of letters was more than four months from the date the account was filed; that, to their knowledge, there are no claims now outstanding against the Estate; and that all taxes presently due from the estate have been paid. They understand that false statements herein are made subject to the penalties of 18 Pa. C.S.A. 4904 relating to unsworn falsification to authorities. '#~";"'J YJt~~ 51j:?>lo").mL.rJ~Jt1--5/13/Q';l Rosali . McKeehan, Executrix Dolores . White, Executr6c / 4 LAST WILL AND TESTAMENT OF CHARLES S. W ALTERS I, CHARLES S. WALTERS, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this to be my Last Will, hereby revoking all prior wills and codicils. FUNERAL EXPENSES FIRST: I direct the payment of my funeral expenses, including my gravemarker, as soon as may be convenient after my death. PA YMENT OF DEATH TAXES SECOND: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residumy estate as a pati of the expense of administration of my estate. . DISTRIBUTION OF RESIDUE THIRD: I give and devise the rest of my estate as follows: 1. One-third of my estate to my daughter, Rosalie J. IvIcI(eehan, or her issue per stirpes; 2. One-third of my estate to my daughter, Dolores J. White, or her issue per stirpes; and 3. One-third of my estate to the children of my deceased son, John .~~ crY initials .. /1 -EtH-I~"~ Pc Walters, namely Kathy L. Hair, Kim L. Wolf, John C. Walters and Steven M. Walters, or their issue per stirpes. PROTECTION OF BENEFICIARIES (Spendthrift Provision) FOURTH: No interest in income or principal shall be assignable by a beneficiary or available to anyone having a claim against a beneficialY before actual payment to the beneficiary . MINORS AND INCAPACITATED BENEFICIARIES FIFTH: If any income or principal shall be payable to any person who shall be a minor or who shall be incapacitated for any reason, my executor as trustee shall hold such income and principal during minority or incapacity and shall be entitled to apply such income and principal to the health, maintenance, suppol1 and education of such person during minority or incapacity without the appointment of any guardian or committee or any authority of cow1. My executor as trustee shall be entitled to make direct application hereunder or to make application by payment of income and principal to the parent or other person in charge of such minor or incapacitated person, or to his or her guardian or to a custodian under the Uniform Transfers to Minors Act. Any remaining income and principal to which such person shall be entitled shall be distributed to such person upon the telmination of minority or incapacity. My executor as uustee shall have the same powers as my executor and shall serve without bond. POWERS OF EXECUTORlRIX SIXTH: I confer upon my executor the right to sell or othel'\vise convert any real or personal property at public or private sale, at such time or times, in such manner, and for such price or prices, and upon such telms and conditions as my executor shall detelmine, and to execute and deliver good and sufficient conveyances, assigmnents and u'ansfers thereof, without liability of any purchaser for the application of any consideration; to bon"ow money and to secure its payment by mortgage of real or personal propeliy, pledge of investments or othelwise, without liability on the palt of the lenders .t J ujt/ initials \, . , €if.f ,/5, 1 A - Z to see to the application thereof; to retain any investments at discretion; to invest and reinvest at discretion, without restriction to so-called "legal investments;" to make distribution in cash or in kind; and to do all other acts and things necessaty or appropriate in the management, administration and distribution of my estate. APPOINTMENT OF GUARDIAN OF ESTATES OF MINORS SEVENTH: I appoint my executor as guardian of the estates of minors with power to hold all property payable by law to a guardian appointed by my will and to use it for the minor's health, maintenance, support and education, either directly or by payment to any person selected by my executor to disburse it whose receipt shall be a complete acquittance. Guardian may, in discharge of all the guardian's duties, pay any minor's share deemed impractical of administration to the parent or other person in chat.ge of the minor or to his or her guardian or to a custodian for the minor under the UnifolID Transfers to Minors Act. My executor as guardian shall have the same powers as my executor, and shall serve without bond. APPOINTMENT OF EXECUTORlRIX EIGHTH: I appoint Rosalie J. McKeehan and Dolores J. White, or the survivor, as Co-Executors of my will. I direct that my Co-Executors shall not be required to furnish security in any jurisdiction. INTERCHANGEABILITY OF LANGUAGE NINTH: Words used in the singular may be read to include the plural or the plural may be read as the singular. Similarly, the masculine form may be read to include the feminine and neuter; the feminine may be read to include the masculine and neuter; and the neuter may be read to include the masculine and feminine. HEADINGS TENTH: The headings used on the various paragraphs of this will are included for convenience only and shall have no legal significance. I have signed this will this I ~ay of f1 (J I< ( L , 1996. "" ., e: )( i4'1 r) l '\ ~ ~ 3 ~~j}cyJ/~ Charles S. Walters, Testator (UeJ- ~ Robert R. Black rt~/C0 /J, U"1, Witness ACKNOWLEDGMENT and AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) SS. We, Charles S. Walters, the Testator in, and Robeli R. Black and 'Lt NO,4 A ,~~~)4(Y\ , the witnesses to the last will, the attached or foregoing instrument, who have signed the instrument, having been duly qualified according to law do depose and say: (a) that I, the Testator do hereby acknowledge that I signed and executed the instrument as my last will, that I signed it willingly and as my free and voluntaty act for the purposes therein expressed; and (b) that we, the witnesses, were present and saw the Testator sign and execute the insnument as his last will, that he signed it willingly and executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the will as a witness and that to the best of '" n Ei If, 13 ,f J} 'f ";:,':t.;~~ our knowledge the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. -'~L7f/~ Testator, Charles S. Walters ~~ Witness, Robert R. Black {:ddo., 4, }UfT} Witness " ~l 7100 .~ ~LYGAJ Notary Public [Notarial Seal Susan K. Guyer, Notary Public Carlisle Boro, Cumberland County My Commission Expires Sept. 4, 1999 Memtlerl Plilnnslfllf'ilniQ I\Q;QQilItIUI1 of Ngtariol '" .., e~fll rs 11 J4 - t5' ~ /6-c:J-Y~// B~EAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION ) DEPT. Z80601 M HARRISBURG I PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-21-2002 WALTERS 06-20-2001 21 01-0690 CUMBERLAND 101 AecorClec, Regi,~;tG; :~(: of ROBERT R BLACK ESQ LANDIS & BLACK 36 S HANOVER ST CARLISLE .02 P 3 :45 JAN 18 C:erh PA 1 tlulabeCL= 'un li"~:fI !~.. *' REY-1547 EX AFP lIZ-DO) CHARLES S Amount Rellitted (1) (2) (3) (4) (S) (6) (7) .00 40,359.00 .00 .00 16,500.00 .00 64,996.00 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-,,=is'4j-EX--AFP--li'2-:oiir-NCfficE--OF-'rtiliEififANCi-.Y-A)rA-PPRA-isEifENT~--AL1-owANci-oR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WALTERS CHARLES S FILE NO. 21 01-0690 ACN 101 DATE 01-21-2002 TAX RETURN WAS: ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/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 J) 14. Net Value of Estate Subject to Tax (9) 1l0) 4,214.00 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. (8) 121,855.00 792.00 lll) (12) (13) (14) Ii 006 00 116,849.00 .00 116,849.00 NOTE: If an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: IS. Allount of Line 14 at Spousal rate 16. Allount of Line 14 taxable at Lineal/Class A rate 17. Allount of Line 14 at Sibling rate 18. Allount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: (15) .00 X 00 = .00 (16) 116,849.00 X 045 = 5,258.20 (17) .00 X 12 = .00 (18) .00 X 15 = .00 (19)= 5,258.20 PAYMfNT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-16-2001 CDOO0536 .00 5,348.20 TOTAL TAX CREDIT 5,348.20 BALANCE OF TAX DUE 90.00CR INTEREST AND PEN. .00 TOTAL DUE 90.00eR . 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 ..CREDlr. (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) REV-1470 ;4 (6-88) . INHERITANCE TAX . COMMONWEALTH OF PENNSYLVANIA EXPLANATION DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENrS NAME FILE NUMBER Charles S. Walters 2101-0690 REVIEWED BY ACN John Kuchinski 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES G Total on Schedule G was not correctly carried forward to recapitulation page. ROW Page 1 \, /6-c:J-</S:- // BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT * REY-IU1 EX AFP UI-02) RfJC, ,)1 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-04-2002 WALTERS 06-20-2001 21 01-0690 CUMBERLAND 101 CHARLES S ROBERT R BLACK ESQ LANDIS & BLACK 36 S HANOVER ST CARLISLE .02 ~PR -1 PI2 :47 Allount Rellitted CISi;, PA 17o.~nb(.., MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-\i:i6oj-ix--AFP--Coi-:ozl-------...--iNHERITANcE'-yiX--STAfEMftiy-CfF-iccouiif--...--------------------- ESTATE OF WALTERS CHARLES S FILE NO.21 01-0690 ACN 101 DATE 03-04-2002 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-21-2002 P R I N C I PAL TAX DUE: hu.....uh......U..u.uu........u..uuu."......."...........Uu.....u"..uuu.m".u..u.uumu...mu"......u......u".u...u.u...."........um__u".u_...m....u..."......... 5,258.20 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-16-2001 CDOO0536 .00 5,348.20 02-19-2002 REFUND .00 90.00- TOTAL TAX CREDIT 5,258.20 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) '- 16 - c::2 -<'/6-:' / / COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE *' BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG I PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISE"ENTL ALLONANCE OR DISALLONANCE OF DEDUCTION~, AND ASSESS"ENT OF TAX ON JOINTLY HELD OR TRUST ASSETS Recoraed of Register olvViIls REV-1S41 EX AFP U2-00> GAYLE R 228 GARLAND CARLISLE .01 ole -7 All :34 WALTERS DR., - '-., ,.-. &~~h~~) Co~:Op~ DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY SSN/DC ACN 12-10-2001 WALTERS 06-20-2001 21 01-0690 CUMBERLAND 178-16-6850 01148257 CHARLES S Allount Rellitted 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~i-ix--AFP--(i;r:ooi------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 12-10-2001 ESTATE OF WALTERS CHARLES S DATE OF DEATH 06-20-2001 COUNTY CUMBERLAND FILE NO. 21 01-0690 TAX RETURN WAS: S.S/D.C. NO. 178-16-6850 (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 01148257 FINANCIAL INSTITUTION: ALLFIRST BANK ACCOUNT NO. 0010427597 TVPE OF ACCOUNT: () SAVINGS (Xl CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 07-02-1993 Account Balance Percent Taxable X Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate X Tax Due 320.79 0.500 160.40 .00 160.40 .15 24.06 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10-22-2001 CDOO0425 .00 24.06 TOTAL TAX CREDIT 24.06 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 · IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. . ( IF TOTAL DUE IS LESS THAN $1, NO PAY"ENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRl, YOU "AY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. l .. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. Z8060l HARRISBURG~ PA l71Z8-060l *' INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 01-0690 ACN 01148257 DATE 10-16-2001 REV.1545 EX UP tD9.00) GAYLE R WALTERS 228 GARLAND DR CARLISLE PA 17013 TYPE OF ACCOUNT EST. OF CHARLES S WALTERS D SAVINGS S. S. NO. 178-16-6850 [X] CHECKING DATE OF DEATH 06-20-2001 D TRUST COUNTY CUMBERLAND D tERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ALLFIRST BANK has provided the Depart.ent with the infor.ation listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent~ you were a joint owner/beneficiary of this account. If you feel this infor.ation is incorrect~ please obtain written correction fro. the financial institution~ attach a copy to this fo~ and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions .ay be answered by calling (717) 787-8:!27. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0010427597 Date 07-02-1993 Established x 320.79 50.000 160.40 .15 24.06 TAXPAYER RESPONSE To insure proper credit to your account~ two (Z) copies of this notice .ust accompany your pay.ent to the Register of Wills. Make check payable to: "Register of Wills~ Agent". Account Balance Percent Taxable AIIount Subject to Tax Rat. Potential Tax Due x NOTE: If tax payments are made within three (3) .onths of the decedent.s date of death~ you may deduct a 51. discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [] The above information and tax due is correct. 1. You .ay choose to re.it pay.ent to the Register of Wills with two copies of this notice to obtain a discount or avoid interest~ or you .ay check box "An and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent"s representative. [] The above information is incorrect and/or debts and deductions were paid by you. You .ust complete PART ~ and/or PART ~ below. If you indicate a different tax rate, please state your relationship to decedent: PART [!] TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ perjury, I declare that the facts I and belief. have reported above are true, correct HOME (7/7) ~ V.s.3 ~ WORK ( ) TELEPH UMBE and DATE 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 MCKEEHAN ROSALIE J SIX HOERNER CIRCLE BOILING SPRINGS, PA 17007 n______ fold ESTATE INFORMATION: SSN: 178-16-6850 FILE NUMBER: 21-2001- 0690 DECEDENT NAME: WAL TERS CHARLES S DATE OF PAYMENT: 10/23/2001 POSTMARK DATE: 10/22/2001 COUNTY: CUMBERLAND DATE OF DEATH: 06/20/2001 NO. CD 000425 ACN ASSESSMENT CONTROL NUMBER AMOUNT 01148257 I $24.06 I I I I I I I I TOTAL AMOUNT PAID: $24.06 REMARKS: ROSALIE B MCKEEHAN CHECK# 974 SEAL INITIALS: AC RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BLACK ROBERT R 36 S HANOVER STREET CARLISLE, PA 17013 -------- fold ESTATE INFORMATION: SSN: 178-16-6850 FILE NUMBER: 21-2001- 0690 DECEDENT NAME: WALTERS CHARLES S DATE OF PAYMENT: 11/16/2001 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 06/20/2001 NO. CD 000536 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $5,348.20 I I I I I I I I TOTAL AMOUNT PAID: $5,348.20 REMARKS: DELORES J WHITE" CHECK#103 SEAL INITIALS: DO RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS . I"' I vOh ~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: Charles S. Walters Date of Death: June 20, 2001 Will No. 21-01-690 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 181 No 0 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 fmal account with the Court? Yes 181 No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes 0 No 0 d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. ...- ~ N 0: ""1 _(2cJtf)~~ Robert R. Black, Esq. 36 South Hanover Street Carlisle, Pennsylvania 17013 (717) 243-3727 Date: May t"V- _ 2003 N N ?d: ;;c .~ Capacity: _ Personal Representative X Counsel for Personal Representative "". 103",' ',0/' ~.~~ (:~ (/' 3;~) ~a: a: r"'\ P J) .' ..u ..:: s= ~) == ':) c.1 . Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 5/07/2003 MCKEEHAN ROSALIE J SIX HOERNER CIRCLE BOILING SPRINGS, PA 17007 RE: Estate of WALTERS CHARLES S File Number: 2001-00690 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 6/20/2003 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, DONNA M. OTTO DEPUTY REGISTER OF WILLS cc: )File Counsel Judge REV-1500f:XIG-,~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 I i.c - d~:-5- II REV-1500 - l._.~_ ..::.-- OFFICIAL USE ONLY w ,.., x~tf) ,,"'''' w"o ",00 0"'.... ..<Xl .. " FILE NUMBER 21-01 INHERITANCE TAX RETURN RESIDENT DECEDENT COUNTY CODE o 6 9 0 ----- YEAR NUMBER I- Z W Q W (,) W Q DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Walters, Charles S. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 06-20-2001 07-03-:1915 SOCIAL SECURITY NUMBER 178 - 16 - 6850 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Walters, Gayle R. [KJ 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date ofoeath after 12.12-82) o 7. Decedent Maintained a Living Trust (Attach copy of Trust) o 10. Spousal Poverty Credit (date of death Mtweell 12.-31-9' anu 1-1-9S) 03. Remainder Return (date of death prior to 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 Sch 0) ,.., Z W C Z o .. U> w '" '" o o NAME COMPLETE MAILING ADDRESS 36 South Hanover Street Carlisle, PA 17013 Robert R. Black, Esq. FIRM NAMEl!fApplicable) Landis & Black TELEPHONEfi!~~!;J 43 - 3 7 2 7 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) 0.00 (2) 40,359.00 (3) 0.00 (4) 0.00 (5) 16,500.00 (6) 0.00 (7) 66,996.00 OFFICIAL USE ONLY r'l (", ~ ~~~ == (I.' -<~ o-:>r g'l iY 3. Closely Held Corporation, Partnership or Sole-Proprietorship d - ::o~ ('I) ~ d''; :2 ~ z o ~ :J l- ii: <( (,) W 0:: 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 (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (8) 123,885.00 ~ '" ;p o N 9", ',] t }, , (9) (10) 4,214.00 792.00 g. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (11) 5,006.00 (12) 118,849.00 (13) 0.00 (141 118,849.00 x.o~ (151 0.00 x.O~ (16) 5,348.20 x .12 (17) 0.00 x .15 (18) 0.00 (19) 5.348.20 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o !;( I-' :J ll.. ::E o (,) g 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under See, 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: ~ STREET ADDRESS 228 Garland Drive " CITY Carlisle I STATE PA I ZIP 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) 24.00 (by Gayle Walters, spouse) Total Credits (A + B + C ) (2) 24.00 3. InteresUPenalty If applicable D. Interest E, Penalty TotallnteresUPenalty ( 0 + 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 request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE, (5) 5,348.20 0.00 0.00 5,324.20 A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A, This is the BALANCE DUE, (5A) (5B) 5,324.20 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred; ''''''''''''''''''''''''''''''''''''''''''''''''''''''' ...."........, 0 b, retain the right to designate who shall use the property transterred or Its income; """"""'''''''''''''''''''''''''''''''' 0 c. retain a reversionary interest; or. .................... ...................................................................................."..m.....'" 0 d. receive the promise for life of either payments, benefits or care? ...... ............m.. ...................................... ...... 0 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ................... ..................................................................... 0 3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? ..,....,..,,, 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................... ................................... ................ ................... No Q9 o lliI o o [Xl ...0 0 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, r declare that r have examinea' this return, including accompanying schedules and statements, and to the best of my knowledge and beJief, 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. , Dolores J. i te 105 Mill St., Boiling Springs, PA DATf/ N{ 0 I ADDRESS Esq. Street, Carlisle, PA 17013 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, ~9116 (a) (1.1) (i)l. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.s. ~9116 (a) (1.1) (Ii)]. The statute does not ex-emat a transfer to a sUlviving 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 beneficianes is 4,5%, except as noted in 72 P,S, ~9116(1.2) [72 p.s, ~9116(a)(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, ~9116(a)(1.3)], A sibling is deflne<l, under Section 9102, as an Individual who has at leas! one parent In common with the decadent, whether by blood or adoption, ~ SCHEDULE B STOCKS AND BONDS Walters, Charles S. File Number 21-01-0690 Estate of (AU property jointly-owned with Right of Survivorship must be disclosed on Schedule F.) Item Number Descriptiou VaIue at Date of Death I. Capital World Growth and Income, 564.566 shares @ $25.79 per share. See attached letter. 2. Putnam Growth and Income, 414.762 shares@$19.19pershare. See attached letter. 3. Putnam Voyager, 589.019 shares @ $20.00 per share. See attached letter. 4. Federal Home Loan Bond, 6,000 shares @ $101.00 per share. See attached letter. $14,560.00 $7,959.00 $11,780.00 $6,060.00 TOTAL (also enter on line 2, Recapitulation) $40,359.00 SCHEDULE E CASH, BANK DEPOSITS & MISC. PERSONAL PROPERTY Walters, Charles S. File Number 21-01-0690 Estate of Include the proceeds of litigation and the date the proceeds were received by the estate. AIl property jointlY-ilwned with Right of Survivorship must be disclosed on Schedule F. Item Number Description Value at Date of Death 1. Proceeds of sale of 1997 Plymouth, VIN 2P4GP44RXVR207238 2. Harleysville Life Insurance Co. Death claim group policy G0025 19, $5,000. 3. First UNUM Life Ins. Co. Death claim group policy 00459195-0001, $2,500. $16,500.00 $0.00 $0.00 TOTAL (also enter on line 5, Recapitulation) $16,500.00 SCHEDULE F JOINTLY-OWNED PROPERTY Estate of File Number Walters, Charles S. 21-01-0690 H an asset was made joint within one year of the decedent's date of death, it must he reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A. Gayle R. Walters ADDRESS 228 Garland Drive, Carlisle, P A 17013 RELATIONSHIP TO DECEDENT Wife B. Gayle R. Walters 228 Garland Drive, Carlisle, P A 17103 Wife C. Jointlv-{)wned nrooertv: LETTER DESCRIPTION OF PROPERTY DATE OF 0/. of DATE OF ITEM FOR DATE Include name of financial institution and DEATH VALUE DECD'S DEATH VALUE NUMBER JOINT MADE bank account number or similar OF ASSET INT. OF DECEDENT'S TENANT JOINT identifying number. Attach deed for INTEREST jointly-held real e.tate. 1. A. 7/93 Allfirst checking account $321.00 0 $0.00 0010427597. See attached letter. 2. B. 7/93 Allfirst checking account $826.00 0 $0.00 0010427872. See attached letter. TOTAL (Also enter on line 6, Recapitulation) $0.00 SCHEDULE G INTER-VIVOS TRANSFERS & MISe. NON-PROBATE PROPERTY Estate of File Number Walters, Charles S. 21-01-0690 Thia lIChedule must be completed and filed if the answortoany ofquestions 1 through 4 on the reveIlle aide ofthc REV-ISOO COVER SHEET ill yes DESCRIPTION OF PROPERTY %OF ITEM Include name oUhe transferee, their rebtlonlhlp to deeedent, dllte or DATE OF DEAm DEeD'S EXCLUSION NUMBER transfer. Att.ch. copyofu.e Deed ror reJll eablte. V ALOE OF ASSET INTEREST (it applkable TAXABLE VALUE 1. Prudential Insurance Co. of America. Annuity contract no. E0191689. See attached correspondence. Beneficiaries: Rosalie McKeehan - daughter $32,498.00 100% $32,498.00 Dolores White - daughter $32498.00 100% $32498.00 TOTAL(Also enter on line 7, Recapitulation) $64,996.00 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Estate of File Number Walters, Charles S. 21-01-0690 Debts of decedent must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. Funeral Expenses: 1. Hoffinan-Roth Funeral Home. Balance $86.77. Carlisle Memorial Service, lettering $95.00 $182.00 2. 3. B. Administrative Costs: 1. Personal Representative Commissions $0.00 2. Attorney Fees $3,000.00 Landis & Black, estimated. 3. Family Exemption Claimant: NONE 4. Probate Fees $232.00 Landis & Black, advanced to date. 5. Accountant's Fees 0$0.00 6. Tax Return Preparer's Fees, estimated. $300.00 7. Reserve for Closing and Releases $500.00 TOTAL (Also enter on line 9, Recapitulation) $4,214.00 SCHEDULE I DEBTS OF DECEDENT MORTGAGE LIABILITIES AND LIENS Estate of File Number Walters, Charles S. 21-01-0690 Include unreimbursed medical expenses. Item Number Description Amount I. Carlisle Regional Medical Center. In-patient care. $792.00 TOTAL (Also enter on line 10, Recapitulation) $792.00 SCHEDULE J BENEFICIARIES E_eof File Number Walters, Charles J. 21-01-0690 Relationship to Decedent Amount or Share Number Name and Address of Person(s) Receiving Property Do Not Ust Trustee(s) of Estate I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. Rosalie J. McKeehan, Six Hoerner Circle, Boiling Daughter One-third Springs, PA 17007. SSN: 206-32-2588 2. Dolores J. White, 105 Mill Street, Mount Holly Springs, Daughter One-third PA 17065. SSN: 207-34-6259 3. Kathy L. Hair, Eight East Countryside Drive, Boiling Granddaughter One-twelfth Springs, PA 17007. SSN: 201-36-3442 4. Steven M. Walters, 1312 Massachusetts Avenue N.W. Grandson One-twelfth #506, Washington, D.C. 20005. SSN: 161-54-1344 5. Kim L. Wolf, 314 Bonnybrook Road, Carlisle, PA Granddaughter One-twelfth 17013. SSN: 202-54-9644 6. John C. Walters, Jr., 706 North Pitt Street, Carlisle, Grandson One-twelfth PA 17103. SSN: 202-54-7908 ENTER DoLlAR AMouNTS FOR DISTRIBUTIONS SHOWN ABoVE ON LINES 15 THROUGH 17. As APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS A. Spousal distributions under Section 9113 fOf which an election to tax Is not being made. 1. B. Charitable and Governmental Distributions 1. TOTAL OF PART 11- Enter Total Non-Taxable Distributions on Line 13 of REV 1500 Cover Sheet o.on ,. LAST WILL AND TESTAMENT OF CHARLES S. W ALTERS I, CHARLES S. WALTERS, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this to be my Last Will, hereby revoking all prior wills and codicils. FUNERAL EXPENSES FIRST: I direct the payment of my funeral expenses, including my gravemarker, as soon as may be convenient after my death. PAYMENT OF DEATH TAXES SECOND: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a patt of the expense of administration of my estate. DISTRIBUTION OF RESIDUE THIRD: I give and devise the rest of my estate as follows: 1. One-third of my estate to my daughter, Rosaiie J. McKeehan, or her issue per stirpes; 2. One-third of my estate to my daughter, Dolores 1. White, or her issue per stirpes; and 3. One-third of my estate to the children of my deceased son, John ~.JqY initials . Walters, namely Kathy L. Hair, Kim L. Wolf, John C. Walters and Steven M. Walters, or their issue per stirpes. PROTECTION OF BENEFICIARIES (Spendthrift Provision) FOURTH: No interest in income or principal shall be assignable by a beneficiary or available to anyone having a claim against a beneficimy before actual payment to the beneficiary . MINORS AND INCAPACITATED BENEFICIARIES FIFTH: If any income or principal shall be payable to any person who shall be a minor or who shall be incapacitated for any reason, my executor as trustee shall hold such income and principal during minority or incapacity and shall be entitled to apply such income and principal to the health, maintenance, support and education of such person during minority or incapacity without the appointment of any guardiml or committee or any authority of comt. My executor as trustee shall be entitled to make direct application hereunder or to make application by payment of income and principal to the parent or other person in charge of such minor or incapacitated person, or to his or her guardian or to a custodian under the Uniform Transfers to Minors Act. Any remaining income and principal to which such person shall be entitled shall be distributed to such person upon the telmination of minority or incapacity. My executor as tlUstee shall have the SaJ.lle powers as my executor and shall serve without bond. POWERS OF EXECUTORlRIX SIXTH: T confer upon my executor the right to sell or otherwise convert any real or personal property at public or private sale, at such time or times, in such manner, and for such price or prices, and upon such telms and conditions as my executor shall determine, and to execute and deliver good and sufficient conveyances, assigrunents and transfers thereof, without liability of any purchaser for the application of any consideration; to bOll'OW money and to secure its payment by mortgage of real or personal property, pledge of investments or othelwise, without liability on the part of the lenders .ti $/ initials to see to the application thereof; to retain any investments at discretion; to invest and reinvest at discretion, without restriction to so-called "legal investments;" to make distribution in cash or in kind; and to do all other acts and things necessary or appropriate in the management, administration and distribution of my estate. APPOINTMENT OF GUARDIAN OF ESTATES OF MINORS SEVENTH: I appoint my executor as guardian of the estates of minors with power to hold all property payable by law to a guardian appointed by my will and to use it for the minor's health, maintenance, support and education, either directly or by payment to any person selected by my executor to disburse it whose receipt shall be a complete acquittance. Guardian may, in discharge of all the guardian's duties, pay any minor's share deemed impractical of administration to the parent or other person in charge of the minor or to his or her guardian or to a custodian for the minor under the Uniform Transfers to Minors Act. My executor as guardian shall have the same powers as my executor, and shall serve without bond. APPOINTMENT OF EXECUTORfRIX EIGHTH: I appoint Rosalie J. McKeehan and Dolores J. White, or the survivor, as Co-Executors of my will. 1 direct that my Co-Executors shall not be required to furnish security in any jurisdiction. INTERCHANGEABILITY OF LANGUAGE NINTH: Words used in the singular may be read to include the plural or the plural may be read as the singular. Similarly, the masculine form may be read to include the feminine and neuter; the feminine may be read to include the masculine and neuter; and the neuter may be read to include the masculine and feminine. HEADINGS TENTH: The headings used on the various paragraphs of this will are included for convenience only and shall have no legal significance. I have signed this will this I ~ay of /JiJl<( L ,1996. j{.~'y; 016~ Charles S. Walters, Testator MeJ- f0L~ Robert R. Black Ji' /7/) (/l7Clo.-- 1l:f0t1n1, Witness ACKNOWLEDGMENT and AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) SS. COUNTY OF CUMBERLAND ) We, Charles S. Walters, the Testator in, and Robelt R. Black and L ~JOA A, 'Rq>..(I,^, , the witnesses to the last will, the attached or foregoing instrument, who have signed the instrument, having been duly qualified according to law do depose and say: (a) that I, the Testator do hereby acknowledge that I signed and executed the instrument as my last will, that I signed it willingly and as my free and voluntaIY act for the purposes therein expressed; and (b) that we, the witnesses, were present and saw the Testator sign and execute the instrument as his last will, that he signed it willingly and executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the will as a witness and that to the best of our knowledge the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. ,t~4f(~ Testator, Charles S. Walters ~~ Witness, Robert R. Black {Y/~dCN Ii. ~rH~ Witness ~(~G0 K~LVA.f\.....) Notary Public . , () u G Notarial Seal Susan K. Guyer, Notary Public Carlisle Bora, Cumberland County My Commission Expires Sept. 4, 1999 MemBerl P~nnsYlvijnlP, l\ilil9QltltlQM "1 NIHarioa 21 West High Street Carlisle, PA 17013 (717) 258-4688 www.edwardjones.com Art Amundsen Investment Representative Edward Jones October 4, 2001 Landis & Black 36 South Hanover SI. Alln: Robert R. Black Carlisle, PA 17013 Dear Dear Mr.Black: Name of Deceased: Account Registration: Account Number: Date of Death: Date of Valuation: CHARLES S WALTERS CHARLES S WALTERS 37702497-1-6 JUNE 20, 2001 JUNE 20, 2001 Quantity Description Value Per Item Total Value 564.566 CAP WORLD GI $ 25.79 $14560.16 414.762 PUTNAM G/I $19.19 $ 7959.28 589.019 PUTNAM VOY $ 20.00 $ 11780.38 6000 FED HOME BD $101 $ 6060.00 The values listed are as of JUNE 20,2001, the day that CHARLES S. WALTERS passed away. The values were obtained from an outside historical pricing service and while we believe that they are reliable, we do not guarantee their accuracy. Please let us know if you need any other information or assistance. AflT AMUNDSEN EdwardJones October 03, 2001 Historical Quote Symbol Descriplion!T ype Date Value CWGIX CAPITAL WORLD GROWTH & INCOME COM Adjusted Closing Price 06/20/2001 $25.7900 PGRWX PUTNAM FD FOR GROWTH&INCOME SH BEN IN Adjusted Closing Price 06/20/2001 $19.1900 PVOYX PUTNAM VOYAGER FD INC CL A Adjusted Closing Price 06/20/2001 $20.0000 -;if/; ,AJ J> C (t;'D . Horne- /-oliN) "'/:M/~Ol la/.Po Page 1 This information is for tax and estate purposes only and while believed accurate, is not guaranteed. There is no warranty that any trades were or would have been executed at these prices on the dates given. o 00 OJ 1..0 (X) 1..0 <.n w SIGNA.TUR~ OF P~RSON "'OMINI~TER1NO OATH 1ST LIEN DATE: lSTlIENHQlDER ...J <( UJ (J) STREET CITY FINANCIAL l~'S:T'rrlITj()N NUMBER 2ND LIEN OA TE: + IF NO LIEN. CHECK o ThO u""""''9""d ...""'V "'..... """II'''''''''' '0' c..t1~"'.,. of T"'. to "'" ...h;cl. "..,,,ib.. ob0v8, .u~;ed \0 fI>o .nc.mbr"",... ond _, I.~ do......' JorI~ ""... 2ND LIENHOLDER STREET SI(;NATURE OF APPLICANT OR AUTf<OAlZED SIONER e,TV STATE ZIP (TYPE OR PRINT) Cenificate of Title musl be submitted within 20 days, unless the purchaser is a registered dealer holding the vehicle for resale. WAR NI NG ,~"':~5DJ~~~~E o~~:~bV~l~~ ~ft:~~~TW~1E~guMf~iTE~uTL'i~N '1!~'i,G~Nlt'o~~~gB2~Em:H THE TA!\NSFER OF OWNERSHIP, FAILURE A.'ASSlt;NMENT::-,OF.::.T.ITLE~ ~:f:=d~t~_7'~r;=le=~J:Sa~~~= LMT FlAST M.l. '~.I.;"" .', ... SeGUonD(ln~rt<)nloflf1!shml'lmus!""c:ompO>l&d. 1~,~!ff:~~J,~,,!~,~~~~~f.~y/ourl<110WIed<J..lha\ th',OOOJnelllrreadir1l;j' i& c,.....'::.". ',:::..":":,:"'.r.EIlTHS ;1'. ~:~'.....;.c..i:~~~'~ 'X miles a.nd rg('aC1!l {/IlJa:dualml18age or Ihe vehicle, unlessOflElo(UH!lfalklwlngboxeslschacked- O Reflects 1M 8movnl 1:>1 mileage O. Is NOT Ihe actual m11ear.: mexcesaolllsmlIchanlealllmlls 'WARNlNO, C\llomelefdWep~"cy ~~ lIWll furthe, cer1lly lhellhe vehicle 15 !rllll 01 Any BnGuml:lI8IJCellnd thai OWnlltshlp I~ he,eby trell5fll<rfldIOlhBpEl'son(s) or tha M<ile' jlsled, ,,' ", SUBSCAIBED AND SWORN TO BEFORE ME; MO. D" tONATURE OF PERSON ADMlNI TEl'lING OATH ..J "" UJ (/) B. . . . IlWecertlfy.lothllbeSlotmyfourknowledqelhalln&odomllla<tIl8dingls ::;;:::' ::':: <,-'" ~~",~,,: -:- ,': ,:; '::::re-NfHS: ,=- ~::2:,:~'i2;~ X mIIa,ancl '9~e:tts lht! 8.CIUllll1lllfl8gflOllhllv<il,hi<:la, unlesa0tl8 of the tolklwlogbo~&lIls checked: C,'" O Retl<oCls \tH!1l11l()Unt 01 ",UeRlle 0: I,. NOT the ""lual ml~a!'/E' ,", \Inllxcess 01 ,15 mac/wlk;allimJ!s,' WARNING: Qdomiller discrepancy', lfWe further certify lhal 1M I'8hlc!e Is lJ" ()f any encumbrance and lhallha ownElnjhlp Is IuVsby ttllllSMrred 10' 1M pelsonls) or the d9tlJef IIslod. ' ,,' '" ',' SUBSCRIBED AND SWORN TO BEFORE ME: MO. D" YEAR SIGNAWRE OF PERSON ADMINtSTERtNG OATH ..J l5 U) P\JRCHAS!;.RORFUlL BUSINESS NAME CO-PURCHASER STREET ADORESS STA1,E PUHCHAsE PriicE"'"----- ORCIN '" P RCHASERSIGNATURE CO-PURCHA ERSIOw"Tl.JR S\GNATUR OF E EFI I NATURE OF CO.$ llER SELLER ANOOR 2~N~E~~&r~~~1 HERE If purchaser listed In Block A 19 NOT a regIstered dealer Section 0 on the Iront of thIs form must be completed " LAST FIRST Pt;i'lCHAS1H'ItlRFUu.. ,,~StNESS ~ME CO.PUACHASER :' STREET ADOIlE-SS COY STATE P\JflCfJ.0\5EPAtCE OflIJIN '" PURCHASERSIGNAWRE PURCHASER ANO/OR CO.PUFlCHA$ER MUST n4 TNAM ~ CO.PU ASEAS TUBE S 14", Af'OFSEl SELLER MUST HANDPRINT NAME HERE Re.ASSIGNMENT OF TITLE BY REGISTERED DEALER. gt6~~a,~i~~s !i9..I a registered dealar Secllon 0 on the front of this form must ,IIJ!B ~~rr., ",,,I.M:.,,!,I ~t~~QU' knowllKlge Ihat Ih,! odoll1elJ&r reading Is :::',::',:"::;:,,'.:::,',"'..'::::TENTI-lS ,! ~.L,~:,:~;~'''2 X mllBsaM rellll<e\S lhtI ac(Ual~~~"ot1h8,V,~~~." yn\J&ssone.oflhltfollowiogOOKeaJsch.ecJ<ed: ': ,'.,': ...: , O. Retlec1s1halIl1lQUfllotmiJaaga D.. IsNOTlh!'lllotulllmil'1lag:e'" Irt eltCfJ9$ of lis mechanleallimilS . WARNING: OdonlfHEIl' dJllCl"(lpel1c)' IIW$ fwIhEIl' certil)i Ihallhe vehicle 15 tree 01 eny 9flcumbrance and Iller In..own9tshlp Is hel9by transl9ITBdto Ihepe.soo(s)o.lhedea!..rlisled. SUBSCRfBED AND SWORN to BEFORE ME: MO DAY YEAR 51 NA REOFPER N WNI$T RING LAST FIRST PUACHASER OR FULL OOSINES8NA~E CO.PURCHASE;R stREET ADDRESS CITV SMTE PURCHASEPRtCE oqOIN '" PURCH'" EASIGNA R RCHASER SIGNATU E 1N/&CIl1IJfy,IOll1ebestotmyloUlknowllldlllllhatlh&odom6larnwdlngJs. :',:-:-:-::::: '::~ .-:, 'TENTHS " G'='~(,:::,,:,::'~~ X milo:lslIndr8l!6et8lMaClual mlle~g..o'the~9hlcle: UnI08SQf1em!l1l!lfoJJowinllbo'esi$Chil~kBd O RI!ll~ Ih" amounl 01 mUeage 0, III NOT ttwactual mJll>l>llli In e.cElss ollIS me<::hanlcal ~mf(s WARNING: Cldornlllerdlscrl>J>ancy lIWelurthllrcerulylhsllhilvllhi<:!ei"freeolllllV&ncumbranCEll;lJ'\dthlllll1eOWMfship (sht!teby tranlJ'e.redtolfIEI person{s) or lhe dealer Ilsl$d SUBSCRJBED AND SWOI'tN TO BEFORE ME: MO YEAR DAY S!GNATlJR OF PER ON M N\ ERING A H ..J ;; "" ~ UJ ~(/) LAST FIRST MJ. ::,,,, """ "','" PURCHASEI'! OR fVU:,' BUSINESS NAME .., CQ.P\JRCHASSR STREET ADDRESS "IT STATl:: PtJRCHASEPfIICE OROIN ,. PVRCHASERSI NATlJflE PURCHASER AND/OR CQ.PURCI1ASER MUST HA. PAJNT H R CO-PUACHMERSIQNATUllE SIGNATURE01" llE gH~C~ Ij~R~IF APPLICATION F9!l D~Al~!l T!Tl~AI~II)COMPl~T~~~CTI9ND.TITlIN!:>F~I;S$ Sf:LLER MUST HANOPRlNT NAME HERE M,1. ), ~ ~ ~ ~ rg en ~ G) 1; ~ m ~ ~ (;; ~ rn i: CO en -< ~ '" o ii 'IJ N ;g to i;; '" o i!; -< ~ :;! rn ] m ~ i;l ~ ), '" ~ :n " rg ~ ~ ~ d ), ~ ~ ii1 'IJ 52 :;! en .. .. M.' OC\, 01 01 04:051" ALLFIRST CIS 3029342955 1".2 IJ allfirst Alltirst Firwncial Center N.A. PO Box 900 MiIlbom. DE 19966 October 1,2001 Landis & Black Attorneys At Law 36 South Hanover Street Carlisle, P A 17013 Re: Estate or Charles S. Walters Social Securitv: 178-16-6850 Date or Death: June 20. 2001 Dear Sir or Madam: Per your inquiry dated September 18, 200 1 please be advised that at the time of death, the above-named decedent had on deposit wilh this bank the following: 1. Type of Accouru Golden Age Checking Account Number 0010427597 Ownership (Names of) Charles S. Walters, Owner Gayle R Walters, Owner Carolyn L Leba, POA Rosalie J. McKeehan, POA 07/02/93 Opening Date Balance on Dale of Dealh Total $320.79 $ 0.00 u's3'jiT79..-...-.um Accrued Interest 2, Type of Account Golden Age Checking Account Number 0010427872 Ownership (Names of) Charles S. Waliers, Owner Gayle R Walters, POA Opening Dale 05/17/93 Balance on Dale of Death $825.85 Total $ 000 $lfiTliS""" Accrued Interest ~c~ 01 01 04:05p ALLFIRST CIS 3029342955 p.3 This letter doe!l not inciude any accOllnt~ in which the deceased may have hetn listed as Powe,. of Allonwy, Custodian of Uniform Tn:msfers. Represf!nlaftve Payee, fJI' Trflstee limier (1 Writton Agreement. FOI' further (/ccounl information. cIOn/res and/or r~imbu,.sement of funtiE reftr to below branch CARLISLE OFFICE 2 WEST HIGH STREET CARLISLE. rA 17ft1l 717.240-6703 ~ Assistant I Cis Services, (302) 934-2909 UUUUVV":::O I I I I I I I I ~'&udential The Prudential Insurance Company 01 America Prudential Annuity Services P.O. 80)\ 14205 New Brunswick, N.J. 08906.4205 Check Statement ROSALIE MCKEEHAN 6 HOERNER CIRCLE BOILING SPRINGS PA 1]00] Date: JULY 03 2001 Owner: Ros a 1 i e McKeehan Annuitant: Charles S Wa Iter s Contract Number: E0191689 Type of Contract: Discovery Classic Market Type: Non Qua I if i ed 1 of Thank you for your patience while we completed your request for death benefits from the contract listed above. The table below provides a breakdown of how we determined the net check amount. Taxable amounts are reported to you and the Internal Revenue Service. The federal taxable amount of your payment is $ 2646.94. The state taxable amount is $ 2646.94. We have presented this information based on our knowledfle of tax law. You may wish to consult your tax adviser if you have any tax questions. Because each SItuation is unique, neither Prudential nor its representatives can provide tax advice. Financial Breakdown Information GROSS FUNO WITHDRAWL AMT FEDERAL TAX WITHHOLDING DELAYED CLAIM INTEREST NET AMOUNT OF CHECK 32759.65 264.69 2.65 32497.61 <VPAS d065982) <$ Prudential PLEASE DETACH CHECK - KEEP STATEMENT FOR RECORDS VOID WITHOUT BLUE BACKGROUND AND GENUINE CHAIN LINK WATERMARK ,'1II111!"'0 ,I' I':" ',', : ' : ' : ' ; , ! : ' : ' : ;:' : ' : : ~ ' : ' : ' , " ' , Chase Manhattan Bank Delaw~' 1201 Markel Street" , " Wilmington, DE 19801 The Prudentlalll'lsurance C~~p~n}to' Arn~r,lca " Prudential Annul1y Services P.O. Box 14205 New Brunswick, N.J. 08906-4205 ,';;;,":',:;:! p.V' ~>'!*THI RTY~TWO THOUSAND FOUR HUNDRED N I '~,*)~,t,'I!>,!>,!*****)~**~q:***'~******~'*~'AND 61/100 6~d':r.Of' I ROSAL I E MCKEEHAN********~,******f,*******,~ 6 HOERNER CIRCLE************************ BOILING SPRINGS PA 1]00] C. U,wMJll" , , T~gAs4B~R :tt,j+Y~ d1A~ ~'." " i??t,}:>,,???l Irp' ;""S."\T~SV co TROLLER ,,,,,.,,,,,,'I',":'~",":"~:,,,,,,,,," ,,,~,l:!"'tur!\Y);!'l.!\''911J(I!;I.\!{,Itl<i,jQ:e!l!jl~J.I!t,_8!!l!kJ'',,,,,,~,,,, "";"''''':'':', lI'ObBOOOS:lBI,II' I:O:lUOO2b71: b:lO~1,727~2 SO"lIl' 000000282 ~. Prudential The Prlldentiallnsurance Company of America PrUdential Annuity Services P.O. Box 14205 New Brunswick, N.J. 08906-4205 I" " Check Statement Date: JULY 03 2001 DELORAS 105 MILL MT HOLLY WHITE STREET SPRINGS PA 1]065 Owner: Annuitant: Contract Number: Deloras White Charles S Walters EOl91689 Type of Contract: Discovery Classic Market Type: Non Qualified Page 1 of Thank you for your patience while we completed your request for death benefits from the contract listed above. The table below provides a breakdown of how we determined the net check amount. Taxable amounts are reported to you and the Internal Revenue Service. The federal taxable amount of your payment is $ 2646.94. The state taxable amount is $ 2646.94. We have presented this information based on our knowledse of tax law. You may wish to consult your tax adviser if you have any tax questions. Because each situation is unique, neither Prudential nor its representatives can provide tax advice. Financial Breakdown Information GROSS FUND WITHDRAWL AMT FEDERAL TAX WITHHOLDING DELAYED CLAIM INTEREST NET AMOUNT OF CHECK 32759.66 264.69 2.65 32497.62 (VPAS d065982) ~. Prudential ";':t:::i:::,:::::::::- !';,!'<~TH'I RTY~TWO THOUSAND FOUR HUNDRED N I >~,~**;..*;~,~!'<,!,<*,,~.~'f'iJ.M!t<f'*'~M'**M<>~**"'AND 62/ I 00 PLEASE DETACH CHECK. KEEP STATEMENT FOR RECORDS -'I.'III.'jrUI:I'II.~~'.'I=-:",l";'~:,I~lll~I'.""I'~~::I"'I.'~I=-":"'I~..h'I~.W'.':(:II'j"1:I;_ 'il'lllm"'''OGi''''''8 G "',:'.'>:::- ,.', "", ..', "-", ",-': ", ,':-", -:.' 1111.1;,,11.'11,1' .." .,,, ",," The Prudential Insurance Company oIAmerlca>>''', :<>:- ." '. . '.' . . ..... ',II','li,I,I,IIIII"'~'11I "':""'" ",' Prudential Annuity Service~> ':', .'. ..... ....... . """PII''''''''', P.O. Box 14205 . Chase Manhattan Bank Defaw' I " New Brunswick, N.J. ()890S'.42()5 1201 Market Slreet ' Wilmington, DE 19801 ",w'.'';,',','" ',':':::',:i'::'::,:,',::,::, p;.y:'", To the I O'de, of, DE LORAS WH I TE*)H"~***)b~***'~*******'~*M'f'*f' 105 MILL STREET************************* MT HOLLY SPRINGS PA 1]065 ~."lW";';""'!!Il'~'~'t'.".,"" ';'J'''J'::;'C ',"i.'!U"j"JU'~~".' "....','~u'~"'~',.: .: "'.""""" '" 11.01;,80005:18511.1:0:11.1.0021;,71: 1;,:10 j,l.,727 I. 2 50'111.