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HomeMy WebLinkAbout01-0709 CUMBERLAND PETITION FOR GRANT OF LETTERS Estate of MARTHA G. HIVNER No. 1- 010 also known as , Deceased Social Security No. 207077477 Petitioner(s), who is/are 18 years of age or older, apply)ies) for: (COMPLETE "A" OR "B" BELOW:) Gl A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut OR Decedent, dated 3/1/01 and codicil(s) dated N/A named in the Last Will of the State relevant circumstances, e.g., renunciation, death of executor, etc Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: o B. Grant of Letters of Administration (c.t.a., d.b.n.C.t.a.: pendente lite, durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationship Residence I (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with his/her last family or principal residence at 4905 EAST TRINDlE ROAD, MECHANICSBURG, HAMPDEN TWP, CUMBERLAND COUNTY, PA 17055 (list street, number and municipality) Decedent, then 89 years of age, died JULY 27, 2001 , _ , at HOLY SPIRIT HOSPITAL (Location) Decedent at death owned property with estimated values as follows: (if domiciled in PA All personal property......................................... $ 392,043.26 (if not domiciled in PA Personal property in Pennsylvania .................... $ (if not domiciled in PA Personal property in County .............................. $ Value of real estate in Pennsylvania ........................................................................................ $ T atal ..................................................................................................................... $ 392,043.26 Real Estate situated as follows: N/A Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Typed or printed name and residence DONALD J. HAlKE 90 BUTTONWOOD ROAD NEWPORT PA 17074 RW-1 1[.0- 24-1-0 Oath of Personal Representative Commonwealth of Pennsylvania County of CUMBERLAND The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer t~2JCCO~d~ Sworn to and affirmed and subscribed J 31~T before me this ' day of ~. L ~~~...o., 'fY{ . ~1~U! '-- ri) DECREE OF REGISTER Estate of MARTHA G. HIVNER also known as Deceased No. (~J -OJ -070Cf Social Security No: 207077477 Date of Death: 7/27/01 AND NOW, J.1Jt'1 ~~ A u..G,. 2. LOa' , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~ Testamentary 0 of Administration are hereby granted to DONALD. J. HALKE ((c.t.a.. d.b.n.c.t.; pendente lite; durante absentia; durante minoriate) in the above estate and that the instrument(s), if any, dated 3 - 1- 200 \ described in the Petition be admitted to probate and filed of record as the Last Will of Decedent. FEES Letters................................... . Short Certificates( s) ............... Renunciation .......................... Extra Pages ( Q.. ) ............... I. T. R..................... ......... ......... JCP Fee ................................. Inventory ................................ Other ...................................... $ $ $ $ $ $ $ $ ~~~ t I' S;gnatu.. 15.00 6.00 Attorney: LINUS E. FENICLE 1.0. No: 20944 Address: 2331 MARKET STREET CAMP HILL PA 17011 04D CO TOTAL .............................$ · Telephone: 717-763-1383 DATE FILED: 05.805 REV 9/86 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. ~. D~ ~/?Z~ Local Registrar ' Fee for this certificate, $2.00 p .7619228 J" 3 1 2001 UL . 3R....2187 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH NAME Of' DECEDENT (fItS'. ModclIe.l_' ,. Malttha. G. H-ivnvr. STATE FILE NUMlER SEX SOCIAl. SECURITY NUMBER 2. Female 3. 207 - 07 -7477 :JuTJd7:~'~l1Q1u_ UNDER 1 YEAR Monlhe Days UNDER' OM .... ! ~ 8lATHPlACi (Coly and SI8Ie 01 fCl8lQll COUIlly) Pl.-cE Of' DEATH (CI>eck 0l'Iy 0I'e - ... fIlSItUChOoS 011_ _I HOSPITAL; OTHER: I..... 0 !lOA 0 =" 0 ~o 'L F Jr.a.nk. GIle.e.n.at.OO.lt INFOAIoIANTS NAME (T ypeIPrinll Vonald Halke 0irI ...... .... ill a --'1 17,..0 :..~.:.::at MOTHER'SNAME,F.s1.Modde.~Sut_) Malty Moyvr. ,.. 1NF9OB~~~~~~NeWPm, PA 17074 ~~;:ti~~~ 0 LOCA1'ION.~s-.~COde o 2tlt. Augu..6t 1, 2001 21c. Pe.nn.6ylva.n,{a. CJr.e.ma.toJr.y 2,.fIa.Jr.Jr.-iAbuJr.g, PA llCENSENtJU8EA NAMEANDADOAESSOf'Iir.CIUTV ..(,.mmvr.man- uvr. unvr. 2211. FV 013376-L onutOWfl Road. HcVr.1t..wbUlta. PA lMlIelIl at my 1InOwteCIga. clHlII occw.ad a1lhellmt. clata and plaCa _ad. lICENSE NUMBER SIGHED . . and TilIII Day. -.n MAAtTAI. STATUS. Mrlmad ~MMied.~ Olwor-' (SpecIyI 1.. Widowed _ _ __ ,.. 17c.ro ................. HamPden '711. Cwnb vr. land ~ 171 09 ome:--~-- 17109 2L or heertlailur. , ApprollirIwl. :=-= 23b. . *S CASE AEFEMED TO MEDICAL EXAMlHEAICOAONEA .....XJ FV NoD !WIT.: OlIler~~-"""lO"'.llul ....--. in.........._.... in FWn' I. -.vECMIR(FiNI _or~ -----c:='-*'lI" -..- =SequanIIaIr ..--- ...:ii...." IaedInO lO iIrlIlladIMe =_ E.-wmEIILYtNQ __CAUIll(o.-or ..-v -...iI-.acr_ - ,--='..anu..~)u.aT ~ E DUE 10 (OR AS ACONSEOUENCE Of): ........ AccidenI ~ o o ORE Of'INJURY (MonII. 08y. 'lUll TIME Of' INJURY INJURY AT WORK? DESCAl8E HOW INJURY 0CCUAflED. WERE AUlDPSY FINDINGS -.uaE PflIOA 10 Of' CAUSE MANNER OF DEATH Pending tnweMigMIcft ..... 0 NoD DERH? ~ ..... 0 No tKJ *" SuiCide Could ...be....-....cI __ B. caJn'....Icn- or-.y one) 'caJn'1I'YlNG PHYSICIAN (PIlJllC*' cerlIIyIng '*- dI dftIll _ ~ pl\ySCoan has pronouncad dealh aoa cornplaltlCl nem 231 To..........rroyllnowledge........___.......CAUM(.).....__........................................................... . _51 ~ .PRDNOlINONG AND CERTIFYING I'HYSICIAN ~ boIh pronouncono oeaI\ and cerlllylno 10 cause 01 deallll "=-II To.......olrroyknowleclge. _..occurNd....._.dat.. _pi..... __to_c.......)..............,.._ed.......................... ~ .= "MEDICAL EXAIIlNERICOftONEA On the ...... Of eaamtne'lon and/or I""..,.....loft, In my opinion, de.'h occurred", tile dme. da'.. and pllC.. and duo '0 the cauM(a)and __ 31.~.."a~........... '~":':;""""""'"'' .......,........... 'u' ........................... ....... l..........'. ~ ~~ ~,1 c>l n I SIGNRU IF...". t. o J1'" ./JI ", ILICENSE NUM8EIl 1/ 'ORE SIGNEO......... (' "llIarl o 31c. 0 ~ G ~ c.. '} ~ '1 L 3'... 7 I) 7/.u NAME AND AOOAESS Of' PERSON WHO COMPLETED CAUSE Of' DEATH (Ilem 2n Type CIt Print I A ~ 4 "I /(J L..l ^'Jt....41Aoot ,'(;, o 32. j ~.,,~ I ~ f' ^ 1111 '). I:E~:4;;~II~OO / . ctr\WII.,LS\HJvnel;M.will Febru~rY 23, 200,1 , LAST WILL AND TEST AMENT OF MARTHA G. HIVNER I, MARTHA G. HIVNER, of Mechanics burg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this my Last Will and Testament, hereby revoking any and all prior Wills and Codicils thereto by me at anytime heretofore made. 1. PAYMENT OF BURIAL EXPENSES AND DEBTS. I authorize my executor to pay all the expenses of (1) a funeral or memorial service; (2) the interment of my remains, including the costs of a gravesite, if necessary; and (3) the installation and inscription of a suitable marker at, and perpetual care of, the gravesite. I further direct my executor to pay all of my debts that my executor in his or her sole discretion may allow as claims against my estate. 2. DISPOSITION OF RESIDUARY ESTATE. 2.1 I devise and bequeath all the rest and remainder of my estate, real, personal or mixed as follows A. One third (1/3) to my cousin, JAMES O. HIVNER. If JAMES O. HIVNER fails to survive me, his share shall be given to his wife PHYLLIS HIVNER. If PHYLLIS HIVNER fails to survive me, his share shall be given to the surviving children of James O. and Phyllis Hivner, equally; B. One third (1/3) to my niece, ELIZABETH T. COOK. If ELIZABETH T. COOK fails to survive me, her share shall be given to her surviving children, equally; C. One third (1/3) to DONALD J. HALKE. If DONALD J. HALKE fails to survive me, his share shall be given to his wife, MELANIE A. HALKE. If MELANIE A. HALKE fails to survive me, his share shall be given to the surviving children of Donald 1. and Melanie A. Halke, equally. -'I . ',/.( /) )')-'} .,:-,,>~-~_,.1Ck'~.--- L; ~ /--//t'r"'J"',-"~/fiJ MARTHA G. HIVNER ctr\ WniS\HivnerM. will Febru~ry 23, 20Ql ' . . 3. POWERS OF ADMINISTRATION. 3.1. Grant of Powers. My executor, in the administration of my estate, (my "fiduciaries") shall have the powers and authorities set forth in this Article 3. These powers and authorities may be exercised by my executor and trustee in their sole and absolute discretion, without the permission or order of any court. These powers shall be supplementary to those conferred by law, including, but not limited to, those set forth in Title 20, Chapter 33, of the Pennsylvania Consolidated Statutes. 3.2. Retention of Assets. My fiduciaries shall have the power to retain any or all property of my estate, however received and acquired, for so long as they deem appropriate. This power may be exercised even though the property may not be of the type authorized by law for investment, and even though the retention may leave a disproportionately large amount of the value of my estate invested in one type of property . 3.3. Transfer of Assets. My fiduciaries shall have the power to sell, transfer, and convey any property, of whatever nature, including real property, and wherever situated, that I may own at the time of my death, or that may come into my estate or after my death. The sale, transfer, or conveyance may be by public or private sale, at such time, on such terms and conditions, including selling price and credit, in such manner, and for any reason that my fiduciaries deem appropriate, including, but not limited to, the purpose of obtaining net proceeds to be distributed to my residuary beneficiaries. 3.4. Investment. My fiduciaries shall have the power to invest and reinvest any property in my estate in preferred and common stocks, bonds, notes, common trust funds (including any managed by any corporate fiduciary), interests in investments, trusts, mutual funds, leases, mortgages on property wherever located, and, generally, in any property and in proportions of property as my fiduciaries deem advisable, even though the investments are not of the character or proportions authorized by applicable law for the investment of the funds. 3.5. Power to Borrow. My fiduciaries shall have the power to borrow money for any purpose, for any periods of time, and on any terms and conditions as they deem advisable (including the power to borrow from any corporate fiduciary), and to pledge, mortgage, or otherwise encumber any property in my estate to secure repayment of any loan, as well as the power to renew existing loans either as maker or endorser. 3.6. Power to Hold Property in Nominee Form. My fiduciaries shall have the power to hold any property in the name of a nominee or in bearer form. 2 ./;l1-af:L... .;. //~ MARTHA G. HIVNER ctr\ WILtS\HivnelM.will February 23, 20Ql . 3.7. Distribution in Cash or in Kind. My fiduciaries shall have the power to make distributions in cash or in kind, or partly in cash, in divided or undivided interests, as amended, or other applicable law, and to determine which assets shall be sold and which shall be distributed in kind, without notice to or consent by any beneficiary. 3.8. Distribution to Minors and Persons Under Disability. My fiduciaries shall have the power to make distributions or payments to or for the benefit of any beneficiary who is a minor, an incompetent, or who in the fiduciaries' judgment is incapacitated. The distributions or payments shall be made in anyone or more of the following ways: (1) directly to the beneficiary; (2) directly to the creditor in payment of the debts or expenses of the beneficiary; (3) to the guardian of the person or estate of the beneficiary; (4) to any custodial parent of a minor beneficiary; (5) to a custodian for the beneficiary under any law related to gifts to minors, including to my fiduciaries in that capacity; or (6) to any other person who shall have the care and custody of the person of the beneficiary. There shall be no duty to see to the application of funds so paid, provided due care was exercised in the selection of the person to whom the funds were paid, and the receipt of the person shall be full acquittance of the fiduciaries. 3.9. Continuation or Liquidation of Business. My fiduciaries shall have the power to continue or to permit the continuation of any business, incorporated or unincorporated, in which I may have any interest at the time of my death for any period of time, or to liquidate the business on any terms as they deem appropriate. This power includes, but is not limited to (1) the power to invest additional sums in any business, even to the extent that my estate may be invested largely or entirely in the business, without liability for any loss resulting from lack of diversification; (2) the power to act as or to select other persons to act as directors, officers, or employees of any business, to be compensated without regard to being a fiduciary under this Will; and (3) the power to make any other arrangements in regard to any business as my fiduciaries shall deem proper. 3.10. Employment of Agents. My fiduciaries shall have the power to employ and pay the compensation of any and all attorneys, agents, custodians, attorneys-in-fact, experts, investment counsel, accountants, bookkeepers, or other agents or providers of services as my fiduciaries deem advisable in the administration of my estate. 3.11. Commissions. My fiduciaries shall have the power to take reasonable commissions on account at any time during the administration of my estate without the approval of any beneficiary or of the court, but subject to allowance or disallowance on the settlement of the final accounts of my fiduciaries. 3 /Jt.,vd:J;..; b /7,;'ry 9/i_ MARTHA G. HIVNER ctr\ WILLS\Hivne.rM.will February 23, 20Ql' 3.12. Third Party Reliance. No person or corporation dealing with my executor shall be required to see to the application of any property paid or delivered to my executor, or to inquire into either the authority of my executor to enter into any transaction or the expediency or propriety of any transaction entered into by my executor. 3.13 Charitable Donations. In the event that any of my tangible personal property is donated to a charitable organization( s) then my fiduciary is instructed to use the value of said donation( s) as an inheritance tax deduction for any inheritance tax return which may be required to be filed as a consequence of my death. 4. PAYMENT OF DEATH TAXES. 4.1. Payment of Estate Taxes. I direct that all federal and Pennsylvania estate taxes payable as a result of taxes assessed on property passing under this Will shall be paid from my residuary estate as a part of the expenses of the administration of the estate. 4.2. Inheritance Tax. I direct that the Pennsylvania inheritance taxes payable as a result of my death, limited to taxes assessed on property passing under this Will, shall be paid out of my residuary estate and shall not be deducted or collected from any beneficiary under this Will or other transferee. 5. EXECUTOR. 5.1. Appointment. I name, constitute, and appoint DONALD J. HALKE, as executor of my estate. If DONALD J. HALKE shall not survive me, shall not serve as executor for any reason, or shall cease to serve as executor for any reason after appointment, his wife, MELANIE A. HALKE, shall act as executor in his place. 5.2. Bond Not Required. None of the individuals named in Section 5.1 shall be required to furnish a bond for the faithful performance of his duties as executor. 6. PRESUMPTION IN CASE OF SIMULTANEOUS DEATH. For the purposes of this Will, in determining whether a person has survived me or another person, a person shall not be deemed to have survived me or another person if he or she dies within sixty (60) days of my death or of the death of the other person. 7. LIABILITY OF EXECUTOR. My executor shall not at any time be liable for mistake of law or of fact, or both law and fact, or errors of judgment, nor for any loss coming to any /;7;n/-../- ,6, J,:~~ 4 MARTHAG.HIVNER . ctr\ WIL'LS\Hivne.rM. will February 23, 20~I' beneficiary under this Will, or to any other persons, except through actual fraud or willful misconduct on the part of the executor or trustee. My executor may, from time to time, consult with counsel with respect to the meaning, construction, and operation of this Will, particularly with respect to the appointments, allocations, and disbursements, and may act on the advice of counsel in all matters without incurring liability on account of his or her actions. 8. INTERPRETATION. 8.1 Successors of Fiduciaries. All pronouns referring to an executor and the term "executor" shall be construed to mean any person acting as my executor, co-executor, personal representative, or administrator, as the case may be. 8.2 Number and Gender. If required by the context of this Will, singular language shall be construed as plural, plural language shall be construed as singular, and the gender of personal pronouns shall be construed as either masculine, feminine, or neuter. 8.3 Headings. All headings used in this Will to describe the contents of each article, paragraph, or other division are provided for convenience only and shall not be construed to be a part of this Will. 8.4 Governing Law. This Will shall be construed in conformity with the law of the Commonwealth of Pennsy lvania. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of five (5) typewritten pages, the first four (4) of which bear my signature in the margin for the purpose of identification, this ~ day of H /I~t I( , 2001. /J'i .'} "j5t. -4. ~. )-/ --t/--:..~ MARTHA G. HIVNER ~~ Signed, sealed, published and declared by the above-named Testatrix, MARTHA G. HIVNER, as and for her Last Will and Testament, in the sight and presence of us, who, at her request, in her sight and presen d in the si ~prese e of each other, have hereunto subscribed our names as witnesses. r-- Address 2- ~J/ $Q~/ J r tf/f/J j/t t., # ~j31 hfAlzJ ~ fly 1IdL fA /70// Address 5 ctr\ WlbLS\HivntvM. will February 23, 2091' COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF ) I, MARTHA G. HIVNER, THE TESTATRIX, WHOSE NAME IS SIGNED TO THE FOREGOING INSTRUMENT, HAVING BEEN DULY QUALIFIED ACCORDING TO LAW, DO HEREBY ACKNOWLEDGE THAT I SIGNED AND EXECUTED THE INSTRUMENT AS MY LAST WILL AND TESTAMENT; THAT I SIGNED IT WILLINGLY; AND THAT I SIGNED IT AS MY FREE AND VOLUNTARY ACT FOR THE PURPOSES THEREIN EXPRESSED. SWORN OR AFFIRMED TO. AND ACKNO~EDGEp BEFORE ME BY MARTHA G. HIVNER, THE TESTATRIX THIS J~ DAY OF it/cUte l~ ,2001. Notarial Seal Monica D. Zercher, Notary Public Camp Hili Bore, Cumberland County My CommIssion Expires Jan. 14,2002 Member, Pennsylvania ASSOCiation of Notarie. )1;~j~vId~ .J:] _ /+_A/1~ MARTHA G. HIVNER /tb~ NOTARY PUBLIC ) : SS. COUNTY OF ) WE, lv/tJlIJ b- rc-UZ:C to AND ar\S+'Nt M. S+Chl<.r THE WITNESSES WHOSE NAMES ARE SIGNED TO THE FOREGOING INSTRUMENT, BEING DULY QUALIFIED ACCORDING TO LAW, DEPOSE AND SAY THAT WE WERE PRESENT AND SA W THE AFORESAID TESTATRIX SIGN AND EXECUTE THE INSTRUMENT AS HER LAST WILL AND TESTAMENT; THAT SHE SIGNED WILLINGLY AND THAT SHE EXECUTED IT AS HER FREE AND VOLUNTARY ACT FOR THE PURPOSES THEREIN EXPRESSED; THAT EACH OF US IN THE HEARING AND SIGHT OF THE TESTATRIX SIGNED THE WILL AS WITNESSES; AND THAT TO THE BEST OF OUR KNOWLEDGE THE TESTATRIX WAS AT THE TIME EIGHTEEN (18) OR MORE YEARS OF AGE, OF SOUND MIND AND UNDER NO CONSTRAINT OR UNDUE INFLUENCE. I ~f DAY OF COMMONWEALTH OF PENNSYLVANIA 1l SWORN OR AFFIRMED TO AND SUBSZO BEFORE ME, THIS /" tlvLL t-- ,2001. ~ ~~ WITNESS ~ J I '1 /'-' b 75L. NOTA~t PUBLIC Notarial Seal Monl~ D. Zercher, Notary Public Camp HII! Bore, Cumberland County My Commission Expires Jan. 14, 2002 Member, Pennsylvanici^ Association of Notamei t ./ CERTIFICATION OF NOTICE UNDER RULE 5.6 (a) Name of Decedent: Martha G. Hivner Date of Death: July 27,2001 Will No. 21-2001-0709 of2001 Admin. No. 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-captioned estate on September 6, 2001: Name Address Elizabeth Cook 71 Dividing Ridge Road Halifax, P A 17032 J ames Hi vner 6720 Hillhaven Drive PIano, TX 75024 Donald J. Halke 90 Buttonwood Road NewPort, PA 17074 Notice has now been given to all persons entitled thereto under Rule 5.6 (a) except N/A Date: September 6, 2001 ~~~ Linus E. F enic1e, Esquire Reager & Adler, PC 2331 Market Street Camp Hill, PA 17011 (717) 763-1383 Counsel for Personal Representative IN RE: : IN THE COURT OF COMMON PLEAS : OF CUMBERLAND COUNTY : ORPHAN'S COURT DIVISION THE ESTATE OF MARTHA G. HIVNER : ESTATE NO. 21-01-0709 NOTICE THE FIRST AND FINAL ACCOUNT FOR THE ESTATE OF MARTHA G. HIVNER FILED WITH THE CUMBERLAND COUNTY ORPHAN'S COURT ON . THE ACCOUNT WILL BE PRESENTED TO THE ORPHAN'S COURT FOR AUDIT ON MARCH 5, 2002 IN THE CLERK OF THE ORPHAN'S COURT, CUMBERLAND COUNTY COURTHOUSE, 1 COURTHOUSE SQUARE, CARLISLE, PA 17013 AT 9:00 A.M. ANY OBJECTIONS TO THIS ACCOUNTING MUST BE MADE BY MARCH 5, 2002 AT 9:00 A.M. AND SHALL BE FILED WITH THE CLERK OF THE ORPHAN'S COURT, CUMBERLAND COUNTY COURTHOUSE, 1 COURTHOUSE SQUARE, CARLISLE, PENNSYLVANIA 17013. Court of Common Pleas of Cumberland County of Pennsylvania Orphan's Court of Division Estate of Martha G. Hivner, Deceased Late of the Township of Hampden First and Final Account of Donald J. Halke, Executor and Proposed Schedule of Distribution Will No.: 21-01-0709 Date of Death: July 27, 2001 Letters Granted: August 2, 2001 First Complete Advertisement of Grant of Letters:), August 31, 2001 A-v.- ~1A- ~ (- Z Y I 't-06{ , ~E:Y y(- J 7 ) frUgV)~ ~ It;"+- zz 1 U"O I ( Yt-t.:h ~ I ) loo I Accounting Period: Date of Death - Present } Gross Estate $402,907.58 Purpose of Account: The Executor offers this Account to acquaint interested parties with the transactions that have occurred during his Administration of the Estate. It is important that the Account be carefully examined. Requests for additional information or questions or objections can be discussed with inus E. F enic1e, Esquire Sup Ct. I.D. Number: 20944 Reager & Adler, P.C. 2331 Market Street Camp Hill, PA 17011 (717) 763-1383 First and Final Account Estate of Martha G. Hivner Cumberland County Probate Number 21-01-0709 Recapitulation Estate Assets Less: Administrative Expenses Less: Debts of Decedent 402,907.58 -68.100.06 334,807.52 57.64 334,749.88 Amount Available for Distribution $334,749.88 First and Final Account Estate of Martha G. Hivner Cumberland County Probate Number 21-01-0709 Estate Assets PSECU Savings Account PSECU Checking Account PSECU Certificate of Deposit PSECU Certificate of Deposit PSECU Certificate of Deposit PSECU Certificate of Deposit PSECU Certificate of Deposit PSECU Certificate of Deposit PSECU Accrued Interest Waypoint Bank Certificate of Deposit First National Bank of Newport Certificate of Deposit First National Bank of Newport Accrued Interest Return of Security Deposit from Nursing Home Return of Medical Insurance Premium Refund from Pharmacy Metropolitan Life Insurance Proceeds Amount 1,141.13 1,420.96 35,449.91 81,552.45 10,801.65 20,005.95 41,248.24 96,070.65 5,485.46 10,039.07 98,865.73 7.83 193.55 162.00 34.00 429.00 $ 402,907.58 First and Final Account Estate of Martha G. Hivner Cumberland County Probate Number 21-01-0709 Administrative Expenses Funeral Expenses Amount 8/21/01 Zimmerman Auer Funeral Home 2,294.86 Costs of Administration 7/31/01 Cumberland County Register of Wills 7/31/01 Cumberland Law Journal 8/22/01 The Sentinel 9/19/01 Register of Wills - Inheritance Tax Filing Fee 9/20/01 Bank Service Charge 10/20/01 Bank Service Charge 11/20/01 Bank Service Charge 12/20/01 Bank Service Charge 1/20/02 Bank Service Charge 2/20/02 Bank Service Charge 1/02 First and Final Account Filing Pee 340.00 75.00 67.91 25.00 4.00 4.00 4.00 4.00 4.00 4.00 113.00 Federal and State Taxes 9/19/01 Pennsylvania Department of Revenue - Inheritance Tax 54,271.67 Fees and Commissions Reager & Adler, P.C. - Legal Fees Donald J. Halke, Executor's Commission 3,000.00 7,891.62 Total Administrative Expenses Total 2,294.86 644.91 54,271.67 10,891.62 $68,103.06 8/21/01 8/21/01 First and Final Account Estate of Martha G. Hivner Cumberland County Probate Number 21-01-0709 Debts of Decedent Country Meadows AT&T Amount 54.00 3.64 Total 57.64 Schedule of Proposed Distribution In accordance with Paragraph Two - Disposition of Residuary Estate - of the Last Will and Testament of Martha G. Hivner, the estate of the decedent shall be distributed as follows: 1. One third (1/3) to James O. Hivner, cousin of the decedent 2. One third (1/3) to Elizabeth T. Cook, niece of the decedent 3. One third (1/3) to Donald J. Halke, friend of the decedent In accordance with the terms of the Last Will and Testament and in accordance with the First and Final Account herein each of the residual beneficiaries shall receive that portion of the estate as set forth opposite their names: 1. James O. Hivner - $111,583.30 2. Elizabeth T. Cook - $111,583.29 3. Donald J. Halke - $111,583.29 $334,749.88 total available for distribution /3 beneficiaries = $111, 583.29 per beneficiary ----------- EXHIBIT A .----- Register of Wills of CUMBERLAND County, Pennsylvania Certificate of Grant of Letters ~~. ~ ~~. . . . .. ~.. -'. . ",- \.. . ;,,, -.. ~.(' " ~ ."~' ') .J ~ .,...... q .. : ,-:-'" ~ . . . ~.. ... ~ :-- ': '-- ....' - : ... .. ,~ ~.: .. -:- .!'~: . .!.!!"~,-,,,'l _.~ ~C-\\: .~l .~.. .' , ""..., ----.-.." . No. 2001-00709 PA No. 21-01-0709 ESTATE OF HIVNER MARTHA G (LA~l, tlK~l, M1UUL~) ~ ;: ~ .... - Late of HAMPDEN TOWNSHIP CUM~~KLANU CUUN1Y, Deceased WHEREAS, on the 2nd dated March 1st 2001 was admitted to probate as the last will of HIVNER MARTHA G (LA~l, tlK~l, M1UUL~) Social Security No. 207-07-7477 day of August 2001 an instrument late of HAMPDEN TOWNSHIP CUMBERLAND County, who died on the 27th day of July 2001 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, MARY C. LEWIS , Register of Wills in and for the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to BALKE DONALD J who has duly qualified as Executor (rix) and has agreed to administer the estate according to law, all of which fully appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my Office the 2nd day of August 2001. * * NOTE * * ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE) LAST WILL AND TESTAMENT OF MARTHA G. HIVNER I, MARTHA G. HIVNER, of Mechanicsburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this my Last Will and Testament, hereby revoking any and all prior Wills and Codicils thereto by me at anytime heretofore made. 1. PA YMENT OF BURIAL EXPENSES AND DEBTS. I authorize my executor to pay all the expenses of (1) a funeral or memorial service; (2) the interment of my remains, including the costs of a gravesite, if necessary; and (3) the installation and inscription of a suitable marker at, and perpetual care of, the gravesite. I further direct my executor to pay all of my debts that my executor in his or her sole discretion may allow as claims against my estate. 2. DISPOSITION OF RESIDUARY ESTATE. 2.1 I devise and bequeath all the rest and remainder of my estate, real, personal or mixed as follows A. One third (113) to my cousin, JAMES O. HIVNER. If JAMES O. HIVNER fails to survive me, his share shall be given to his wife PHYLLIS IDVNER. If PHYLLIS HIVNER fails to survive me, his share shall be given to the surviving children of James O. and Phyllis Hivner, equally; B. One third (113) to my niece, ELIZABETH T. COOK. If ELIZABETH T. COOK fails to survive me, her share shall be given to her surviving children, equally~ C. One third (1/3) to DONALD J. HALKE. If DONALD J. HALKE fails to survive me, his share shall be given to his wife, MELANIE A. HALKE. If MELANIE A. HALKE fails to survive me, his share shall be given to the surviving children of Donald J. and Melanie A. Halke, equally. -\'",; ~(' ,). ) / ".... ..' " ,J.! /. " ,( , , '/~/>d~/~-..lr'. /"i-, MARTHA G. HIVNER 3. POWERS OF ADMINISTRATION. 3.1. Grant of Powers. My executor, in the administration of my estate, (my "fiduciaries") shall have the powers and authorities set forth in this Article 3. These powers and authorities may be exercised by my executor and trustee in their sole and absolute discretion, without the permission or order of any court. These powers shall be supplementary to those conferred by law, including, but not limited to, those set forth in Title 20, Chapter 33, of the Pennsylvania Consolidated Statutes. 3.2. Retention of Assets. My fiduciaries shall have the power to retain any or all property of my estate, however received and acquired, for so long as they deem appropriate. This power may be exercised even though the property may not be of the type authorized by law for investment, and even though the retention may leave a disproportionately large amount of the value of my estate invested in one type of property. 3.3. Transfer of Assets. My fiduciaries shall have the power to sell, transfer, and convey any property, of whatever nature, including real property, and wherever situated, that I may own at the time of my death, or that may come into my estate or after my death. The sale, transfer, or conveyance may be by public or private sale, at such time, on such terms and conditions, including selling price and credit, in such manner, and for any reason that my fiduciaries deem appropriate, including, but not limited to, the purpose of obtaining net proceeds to be distributed to my residuary beneficiaries. 3.4. Investment. My fiduciaries shall have the power to invest and reinvest any property in my estate in preferred and common stocks, bonds, notes, common trust funds (including any managed by any corporate fiduciary), interests in investments, trusts, mutual funds, leases, mortgages on property wherever located, and, generally, in any property and in proportions of property as my fiduciaries deem advisable, even though the investments are not of the character or proportions authorized by applicable law for the investment of the funds. 3.5. Power to Borrow. My fiduciaries shall have the power to borrow money for any purpose, for any periods of time, and on any terms and conditions as they deem advisable (including the power to borrow from any corporate fiduciary), and to pledge, mortgage, or otherwise encumber any property in my estate to secure repayment of any loan, as well as the power to renew existing loans either as maker or endorser. 3.6. Power to Hold Property in Nominee Form. My fiduciaries shall have the power to hold any property in the name of a nominee or in bearer form. )/1~.J /-/~ 2 MARTHA G. HIVNER 3.7. Distribution in Cash or in Kind. My fiduciaries shall have the power to make distributions in cash or in kind, or partly in cash, in divided or undivided interests, as amended, or other applicable law, and to determine which assets shall be sold and which shall be distributed in kind, without notice to or consent by any beneficiary. 3.8. Distribution to Minors and Persons Under Disabili(y. My fiduciaries shall have the power to make distributions or payments to or for the benefit of any beneficiary who is a minor, an incompetent, or who in the fiduciaries' judgment is incapacitated. The distributions or payments shall be made in anyone or more of the following ways: (1) directly to the beneficiary; (2) directly to the creditor in payment of the debts or expenses of the beneficiary; (3) to the guardian of the person or estate of the beneficiary; (4) to any custodial parent of a minor beneficiary; (5) to a custodian for the beneficiary under any law related to gifts to minors, including to my fiduciaries in that capacity; or (6) to any other person who shall have the care and custody of the person of the beneficiary. There shall be no duty to see to the application of funds so paid, provided due care was exercised in the selection of the person to whom the funds were paid, and the receipt of the person shall be full acquittance of the fiduciaries. 3.9. Continuation or Liquidation of Business. My fiduciaries shall have the power to continue or to permit the continuation or- any business, incorporated or unincorporated, in which I may have any interest at the time of my death for any period of time, or to liquidate the business on any terms as they deem appropriate. This power includes, but is not limited to (1) the power to invest additional sums in any business, even to the extent that my estate may be invested largely or entirely in the business, without liability for any loss resulting from lack of diversification; (2) the power to act as or to select other persons to act as directors, officers, or employees of any business, to be compensated without regard to being a fiduciary under this Will; and (3) the power to make any other arrangements in regard to any business as my fiduciaries shall deem proper. 3.10. Employment of Agents. My fiduciaries shall have the power to employ and pay the compensation of any and all attorneys, agents, custodians, attorneys-in-fact, experts, investment counsel, accountants, bookkeepers, or other agents or providers of services as my fiduciaries deem advisable in the administration of my estate. 3.11. Commissions. My fiduciaries shall have the power to take reasonable commissions on account at any time during the administration of my estate without the approval of any beneficiary or of the court, but subject to allowance or disallowance on the settlement of the final accounts of my fiduciaries. /?t...~ .;~ /(r /..../. ~~.;_ 3 MARTHA G. HIVNER 3.12. Third Party Reliance. No person or corporation dealing with my executor shall be required to see to the application of any property paid or delivered to my executor, or to inquire into either the authority of my executor to enter into any transaction or the expediency or propriety of any transaction entered into by my executor. 3.13 Charitable Donations. In the event that any of my tangible personal property is donated to a charitable organization(s) then my fiduciary is instructed to use the value of said donationes) as an inheritance tax deduction for any inheritance tax return which may be required to be filed as a consequence of my death. 4. PAYMENT OF DEATH TAXES. 4.1. Payment of Estate Taxes. I direct that all federal and Pennsylvania estate taxes payable as a result of taxes assessed on property passing under this Will shall be paid from my residuary estate as a part of the expenses of the administration of the estate. 4.2. Inheritance Tax. I direct that the Pennsylvania inheritance taxes payable as a result of my death, limited to taxes assessed on property passing under this Will, shall be paid out of my residuary estate and shall not be deducted or collected from any beneficiary under this Will or other transferee. s. EXECUTOR. 5.1. Appointment. I name, constitute, and appoint DONALD J. HALKE, as executor of my estate. If DONALD J. HALKE shall not survive me, shall not serve as executor for any reason, or shall cease to serve as executor for any reason after appointment, his wife, MELANIE A. BALKE, shall act as executor in his place. 5.2. Bond Not Required. None of the individuals named in Section 5.1 shall be required to furnish a bond for the faithful performance of his duties as executor. 6. PRESUMPTION IN CASE OF SIMULTANEOUS DEATH. For the purposes of this Will, in determining whether a person has survived me or another person, a person shall not be deemed to have survived me or another person if he or she dies within sixty (60) days of my death or of the death of the other person. 7. LIABILITY OF EXECUTOR. My executor shall not at any time be liable for mistake of law or of fact, or both law and fact, or errors of judgment, nor for any loss coming to any /h,'CL.n- /, J~~ 4 MARTHA G. HIVNER beneficiary under this Will, or to any other persons, except through actual fraud or willful misconduct on the part of the executor or trustee. My executor may, from time to time, consult with counsel with respect to the meaning, construction, and operation of this Will, particularly with respect to the appointments, allocations, and disbursements, and may act on the advice of counsel in all matters without incurring liability on account of his or her actions. 8. INTERPRET A TION. 8.1 Successors of Fiduciaries. All pronouns referring to an executor and the term "executor" shall be construed to mean any person acting as my executor, co-executor, personal representative, or administrator, as the case may be. 8.2 Number and Gender. Ifrequired by the context of this Will, singular language shall be construed as plural, plural language shall be construed as singular, and the gender of personal pronouns shall be construed as either masculine, feminine, or neuter. 8.3 Headings. All headings used in this Will to describe the contents of each article, paragraph, or other division are provided for convenience only and shall not be construed to be a part of this Will. 8.4 Governing Law. This Will shall te construed in conformity with the law of the Commonwealth of Pennsylvania. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of five (5) typewritten pages, the first four (4) of which bear my signature in the margin for the purpose of identification, this ~ day of }//f.l!11I ,2001. /ti .J., 1~. L A. ) -/ ;/I-:J~_ MARTHA G. HIVNER ~~$w (A / Signed, sealed, published and declared by the above-named Testatrix, MARTHA G. HIVNER, as and for her Last Will and Testament, in the sight and presence of us, who, at her request, in her sight and presen {d in the si ~prese e of each other, have hereunto subscribed our names as witnesses. ~ Address 2 37; I//Q~/ J r t{/I/l pI. ~ # ';3:31 ~.JzJ~ tLr /2tJlJ IA L70/1 Address 5 COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF ) I, MARTHA G. HIVNER, THE TEST A TRlX, WHOSE NAME IS SIGNED TO THE FOREGOING INSTRUMENT, HAVING BEEN DULY QUALIFIED ACCORDING TO LAW, DO HEREBY ACKNOWLEDGE THAT I SIGNED AND EXECUTED THE INSTRUMENT AS MY LAST WILL AND TESTAMENT; THAT I SIGNED IT WILLINGLY; AND THAT I SIGNED IT AS MY FREE AND VOLUNTARY ACT FOR THE PURPOSES THEREIN EXPRESSED. SWORN OR AFFIRMED TO. AND ACKNOW,lJ-EDGEP BEFORE ME BY MARTHA G. HIVNER, THE TESTATRIX THIS I ~ DAY OF ' t /tfA<- C--- , 2001. Notarial Seal Monica D. Zercher, Notary Public Camp Hili Bom, Cumberland County My Commission Expires Jan. 14,2002 Member, Pennsylvama ASSOCiation ot Notarll' )J/~l,.....--:I::! ,b. .J:J. /+_kn~ MARTHA G. HIVNER Ilb~ NOTARY PUBLIC ) : SS. COUNTY OF ) WE, Iv/fl/(I 't. rc,UZ-Cto AND (1r',S+'NC M. S+Chle..r THE WITNESSES WHOSE NAMES ARE SIGNED TO THE FOREGOING INSTRUMENT, BEING DULY QUALIFIED ACCORDING TO LAW, DEPOSE AND SAY THAT WE WERE PRESENT AND SA W THE AFORESAID TESTATRIX SIGN AND EXECUTE THE INSTRUMENT AS HER LAST WILL AND TESTAMENT; THAT SHE SIGNED WILLINGLY AND THAT SHE EXECUTED IT AS HER FREE AND VOLUNT AR Y ACT FOR THE PURPOSES THEREIN EXPRESSED; THAT EACH OF US IN THE HEARING AND SIGHT OF THE TESTA TRlX SIGNED THE WILL AS WITNESSES; AND THAT TO THE BEST OF OUR KNOWLEDGE THE TESTA TRlX WAS AT THE TIME EIGHTEEN (18) OR MORE YEARS OF AGE, OF SOUND MIND AND UNDER NO CONSTRAINT OR UNDUE INFLUENCE. jSf DAYOF COMMONWEALTH OF PENNSYLVANIA i~l SWORN OR AFFIRMED TO AND SUBSCRlB /~' ~l.. (, ~ ,2001. I Notanal Seal Monica D. Zercher, Notary Public Camp HiI.' Boro, Cumberland County My Commission Expires Jan. 14,2002 Member, Pennsylvania' ASSOCIation 01 N6ltHl~:; CUMBERLAND LAW JOURNAL 2 LIBERTY AVENUE CARLISLE, PA 17013 AUGUST 31, 2001 Cumberland Law Journal is published every Friday by the Cumband County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Linus E. Fenic1e, ESQUIRE RE: Martha G. Hivner, ESTATE Legal advertisements nlust be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. --------------------------------------------------------------------- --------------------------------------------------------------------- Advertisement inserted on following dates: AUGUST 17,24, 31,2001 Advertising Cost $ 75.00 $ 0.00 $ 0.00 $ 75.00 ------------- Proof of Publication Second Proof Request Payment received Total Amount Due $ 0.00 Payment received AUGUST 13.2001 by Beckv H. Morgenthal/Executive Director ~ EXHIBIT B . . PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland. Sherry Clifford, Classified Ad Manager of THE SENTINEL, of the County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a newspaper of general circulation in the Borough of Carlisle, County and State aforesaid, was established December 13th, 1881, since which date THE SENTINEL has been regularly issued in said County, and that the printed notice or publication attached hereto is exactly the same as was printed and published in the regular editions and issues of THE SENTINEL on the following dates, viz Copy of Notice of Publication ESTATE NOTICE letters Testamentary for the Estate of MARTHA G. HIVNER wbodied July 27, 2001, late of the Township Qf H~en were granted to Donald J. Halke. EX$cutor, on August 2,2001,A11 tho.se having a claim or those Indebted to the estate should make their position known by contac::ting: Linus E. Fenicle, Esquire Reager & Adler, P.C. 2331 Market Street Camp Hill, PA 17011 (717) 763-1383 August 8, 15 and 22, 2001 Affiant further deposes that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statement as to time, place and character of publication are true. ~7/~~ August 22, 2001 Sworn to and subscribed before me this day of August , 2001. ~O~ Notary Public 22nd My commission expires: NOTARIAL SEAL SHIRLEY O. DURNIN, Notary Public Carlisle Bora., Cumberland County Commission Ex 'res Au .9.2003 . . PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 STATEOFPENNSYLVANIA : SSe COUNTY OF CUMBERLAND : Roger M. Morgenthal, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, VIZ: AUGUST 17,24,31,2001 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. BiVDer, Martha G., dec'd. Late of the Township of Hamp- den. Executor: Donald J. Halke. Attorney: Linus E. Fenic1e. Es- quire. Reager & Adler. P.C.. 2331 Market Street. Camp Hill. PA 17011. (717) 763-1383. SWORN TO AND SUBSCRIBED before me this 31 day of AUGUST. 2001 . . CUMBERLAND LAW JOURNAL 2 LIBERTY AVENUE CARLISLE, PA 17013 AUGUST 31, 2001 Cumberland Law Journal is published every Friday by the Cumband County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Linus E. Fenicle, ESQlJIRE RE: Martha G. Rivner, ESTATE Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. -------------------------------------------- ------------------------------------------------- Advertisement inserted on following dates: AUGUST 17,24,31,2001 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 PaYment received $ 75.00 Total Amount Due $ 0.00 -------- ------ PaYment received AUGUST 13. 2001 by Becky H. Morgenthal/Executive Director BXHIBIT C . . BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG. PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT .. IEY-lU7 EX AFP 112-DI) LINUS E FENICLE REAGER & ADLER 2331 MARKET ST CAMP HILL DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-19-2001 HIVNER 07-27-2001 21 01-0709 CUMBERLAND 101 MARTHA G Allount Rellitted PA 17011 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this form with your tax paYllent. CUT ALONG THIS LINE .- RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV =i6"ifj-e:X--AFP--fi"2-:oo-r------...-iNirERi'i"-ANc'E--TAX-STA-fEM'E-NT-cfF-AC-couiff--...---------------- - - --- ESTATE OF HIVNER MARTHA G FILE NO.21 01-0709 ACN 101 DATE 11-19-2001 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-05-2001 P R I NC I PAL TAX DU E : ....................................................................................... 57,128.07 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-25-2001 CDOO0313 2,856.40 54,271.67 TOTAL TAX CREDIT 57,128.07 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 PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-05-2001 HIVNER 07-27-2001 21 01-0709 CUMBERLAND 101 LINUS E FENICLE REAGER & ADLER 2331 MARKET ST CAMP HILL PA 17011 .* REY-1547 EX AFP HZ-DD) MARTHA G Allount Rellitted CHANGED (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 394.580.86 .00 .00 (8) MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ii"f,,=is4-j-i:x--AFP-fi'2-:oo1--No,.-icE"-oF-.rNHEifiTAN-ci-TAX-A-PPRA-isEi"-ENT:--ALi-oWAN-CE-O~q----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HIVNER MARTHA G FILE NO. 21 01-0709 ACN 101 DATE 11-05-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 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/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 Bequestsi Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax 13,669.39 57.64 (11) (12) (13) (14) (9) (10) NOTE: To insure proper credit to your account, subllit the upper portion of this form with your tax paYllent. 394,580.86 13 7'J7 03 380,853.83 .00 380,853.83 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: .00 X 00 = .00 .00 X 045 = .00 .00 X 12 = .00 380,853.83 X 15 = 57,128.07 (19)= 57,128.07 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) PAYMENT MUST BE MADE BY 04-27-2002*. TOTAL TAX CREDIT .00 BALANCE OF TAX DUE 57.1128.07 INTEREST AND PEN. .00 TOTAL DUE 57.1128.07 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1.1 NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) COMMONWEALTH OF PENNSYLVANIA OEPARTMENT 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 LINUS E FENICLE 2331 MARKET STREET CAMP HILL, PA 17011 _n_____ fold ESTATE INFORMATION: SSN: 207-07-7477 FILE NUMBER: 21 - 2001 - 0709 DECEDENT NAME: HIVNER MARTHA G DA TE OF PAYMENT: 09/25/2001 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/27/2001 NO. CD 000313 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $54,271.67 I I I I I I I I TOTAL AMOUNT PAID: $54,271.67 REMARKS: DONALD HALKE C/O LINUS E FENICLE CHECK# NO # SEAL INITIALS: DO RECEIVED BY: TAXPAYER MARY C. LEWIS REGISTER OF WILLS ) ...... ct, INVENTORY Estate of HIVNER, MARTHA G. No.21 C\ ~ 0709 also known as Date of Death 07/27/2001 , Deceased Social Security No. 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 the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the penalties of 18 Pa, C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative: I.D. No.: LINUS E. FENICLE /J61LIL/ <to I -'0 7 'f Name of Attorney: Address: 2331 MARKET STREET CAMP HILL PA 17011 Telephone: 717-730-7366 Description Value Stocks & Bonds Closely-Held Corporation, Partnership or Sole-Proprietorship Mortgages & Notes Receivable Cash, Bank Deposits, & Misc. Personal Property PSECU - SAVINGS 1,141.13 PSECU - CHECKING 1,420.96 Total (Attach Additional Sheets if necessary) 394,580.86 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. RW-4 .~ -.. Continuation of Inventory HIVNER, MARTHA G. 21 20 0709 Pa~e 1 Description of Inventory Description PSECU - CERTIFICATE OF DEPOSIT Value 35,449.91 PSECU - CERTIFICATE OF DEPOSIT 81,552.45 PSECU - CERTIFICATE OF DEPOSIT 10,801.65 PSECU - CERTIFICATE OF DEPOSIT 20,005.95 PSECU - CERTIFICATE OF DEPOSIT 41,248.24 PSECU - CERTIFICATE OF DEPOSIT 96,070.65 WAYPOINT BANK - CERTIFICATE OF DEPOSIT 10,039.00 FIRST NATIONAL BANK OF NEWPORT - CERTIFICATES OF DEPOSIT 96,154.92 RETURN OF SECURITY DEPOSIT FROM NURSING HOME 500.00 RETURN OF MEDICAL INSURANCE PREMIUM 162.00 REFUND FROM PHARMACY 34.00 Real Estate .!' Subtotal $ Grand Total $ 392,018.77;. 394,580.86 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 LINUS E FENICLE 2331 MARKET STREET CAMP HILL, PA 17011 -------- fold ESTATE INFORMATION: SSN: 207-07-7477 FILE NUMBER: 21-2001- 0709 DECEDENT NAME: HIVNER MARTHA G DA TE OF PAYMENT: 09/25/2001 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/27/2001 NO. CD 000313 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $54,271.67 I I I I I I I I TOTAL AMOUNT PAID: $54,271.67 REMARKS: DONALD HALKE C/O LINUS E FENICLE CHECK# NO # SEAL INITIALS: DO RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS '- /6-:J,~/~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REV-IU7 EX AFP UZ-DOl LINUS E FENICLE REAGER & ADLER 2331 MARKET ST CAMP HILL RecoraerirAr, 0":,':: of Registe~- ~ 0 VYIns ::~: TE OF DATE OF DEATH .01 ole -7 All "3SFILE NUMBER " COUNTY ACN 12-03-2001 HIVNER 07-27-2001 21 01-0709 CUMBERLAND 101 MARTHA G Clerk-i)! s Court Qanberiand Co. PA PA 17011 I Allount Rellitted 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 payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REY=ii,o-,-ix-AFP--ri"2:olir------...-iNHERITANcf-fAif-sTATEMi-NY-OF-Accou'Nf--.i.--------------------- ESTATE OF HIVNER MARTHA G FILE NO.21 01-0709 ACN 101 DATE 12-03-2001 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 10-29-2001 P R I NCI PAL TAX DUE: ........................................................................................................................................................................................................................... 57,128.07 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-25-2001 CDOO0313 2,856.40 54,271.67 TOTAL TAX CREDIT 57,128.07 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.. (CRJ, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) 16'~7'-.!! BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG I PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT * REV-IU7 EX AFP H2-00l lINUS E FENIClE REAGER & ADLER 2331 MARKET ST CAMP HIll 1)1 tilV 26 All:48 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-19-2001 HIVNER 07-27-2001 21 01-0709 CUMBERLAND 101 MARTHA G AecoraedOm~i of Register Of 'IVins Allount Rellitted I"l_..L..()rt' ,'::; ,',':.. {'r urt ""'VI" '=" ",.. ,-,. 'v '-.AJ . PACMtierfand Co., PA 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 form with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REv:i6(fj-Ex-AFP-(12.:0(ir------...--iNiiiRi'~fANcE-fAx-sT'AfEHE-Nf-cfF-ACCouiif--.-..--------------------- ESTATE OF HIVNER MARTHA G FILE NO.21 01-0709 ACN 101 DATE 11-19-2001 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF lAST ASSESSMENT OR RECORD ADJUSTMENT: 11-05-2001 PR I NCI PAL TAX DU E : ........................................................................................................................................................................................................................... 57,128.07 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-25-2001 CDOO0313 2,856.40 54,271.67 TOTAL TAX CREDIT 57,128.07 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 $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) \/h-02-Y'?-$ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG I PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX LINUS E FENICLE REAGER & ADLER 2331 MARKET ST CAMP HILL DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-05-2001 HIVNER 07-27-2001 21 01-0709 CUMBERLAND 101 '* REV-1547 EX AFP U2-UDJ MARTHA G Allount Rellitted PA 17.1J11 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 ~ R"E-y=is4-j-ix--AFP-fi"2"=ocir-NCifici--OF-i-NHiifiTANCE-TA)rAPPRAisiMENT~--Ai:LOWAirCE-oi----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HIVNER MARTHA G FILE NO. 21 01-0709 ACN 101 DATE 11-05-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED 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. Hortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2J (3) (4) (SJ (6) (7) .00 .00 .00 .00 394.580.86 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule HJ 10. Debts/Hortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitab1e/Governllenta1 Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 13,669.39 57.64 (11) (12) (13) (14) NOTE: To insure proper credit to your account, subllit the upper portion of this form with your tax payment. 394,580.86 13 7'?7 03 380,853.83 .00 380,853.83 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ~ returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount 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 (1S) .00 X 00 = .00 (16) .00 X 045 = .00 (17) .00 X 12 = .00 (18) 380,853.83 X 15 = 57,128.07 (19J= 57,128.07 TAX CREDITS: PAYHENT RECEIPT DISCOUNT (+) AHOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) PAYMENT MUST BE MADE BY 04-27-2002~. TOTAL TAX CREDIT .00 BALANCE OF TAX DUE 57,128.07 INTEREST AND PEN. .00 TOTAL DUE 57,128.07 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIYW. (CRJ, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION. ()/' 'oK . , ) STATUS REPORT UNDER RULE 6.12 or,:: ::: (';~ ::s~ 0" " Name of Decedent: Martha G. Hivner (T; r';~ C-. c: :z. ::0 ~ " ~;\ 8 Date of Death: July 27.2001 (",::, --" w :g N W N 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: Will No.: 21-01-0709 Admin. No.: ~" J.> ;-:,,:;. 1. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is yes, state the following: A. Did the personal representative file a final account with the court? Yes X No B. The separate Orphans' Court No. (if any) for the personal representative's account is: The number is the same as the Will Number C. Did the personal representative state an account informally to the parties in interest? Yes X No D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: ~#2/tl3 Li us. E. Fenicle, Esquire Reager & Adler, P.C. 2331 Market Street Camp Hill, P A 17011 (717) 763-1383 Counsel for Personal Representative . Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 ~ Date: 6/10/2003 HALKE DONALD J 90 BUTTONWOOD ROAD NEWPORT, PA 17074 RE: Estate of HIVNER MARTHA G File Number: 2001-00709 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 7/27/2003 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, DONNA M. OTTO DEPUTY REGISTER OF WILLS cc: IFile Counsel Judge REV-15C'!lID<+(6-00) . _ '*' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128.0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICiAl USE ONLY c 7-3 FILE NUMBER 0 I 21"2 ll- 0709 "'COUNTYCODE ---VEAR- - - 'NUim:R-- I- Z W C W () W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) HIVNER MARTHA G. DATE OF DEATH (MM-OD-Year) DATE OF BIRTH (MM-DD-Year) SOCIAL SECURITY NUMBER THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER W I- x:$U) u"''' w~u :I:n:9 u"-,,, "- < 07/27/2001 12/14/1912 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) [Xl 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 ofdealh after 12.12.82) o 7, Decedent Maintained a Living Trust (Attach copy ofTrust) o 10. Spousal Poverty Credit (dateofdealh between 12-31-91 and 1-1-95) o 3. Remainder Return (date ofdeath prior to 12-13-82} o 5. Federal Estate Tax Return Required Q... 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113{A) (Attach Sch 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX..INFORMATION,SHOULOSEOIRECTEO TO: NAME COMPLETE MAILING ADDRESS LINUS E, FENICLE 2331 MARKET STREET FIRM NAME (If Applicable) REAGER & ADLER P.C. TELEPHONE NUMBER 717-730-7366 CAMP HILL PA 17011 I- Z W C Z C "- '" w '" '" C u z o ~ ::;) l- ii: < () W D:: z o !::i: I- ::;) II.. :!; o () ~ 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of De<:edent, Mortgage Liabilities, & Liens (Schedule I) (10) 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) OFFICIAL USE ONLY (1) (2) (3) (4) (5) 394,580.86 (6) (7) (8) 394,580.86 13,669.39 57,64 X .0_(15) X .0_(16) X .12 (17) 380,853,83 X .15 (18) 57,128.07 (19) 57,128.07 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate (11) (12) (13) 13,727.03 380,853.83 17. Amount of line 14 taxable at sibling rate (14) 380,853,83 18. Amount of line 14 taxable at collateral rate 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 19. Tax Due Decedent's Coml'llete Address: STREET ADDRESS 4905 EAST TRINDLE ROAD CITY I STATE I ZIP MECHANICSBURG PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A Spousal Poverty Credit B. Prior Payments C. Discount (1) 57,128.07 2.856.40 Total Credits (A + B + C) (2) 2,856.40 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) A Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 54,271.67 54,271.67 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................................................... D 00 b. retain the nght to designate who shall use the property transferred or its income; ........................................ 0 IZI c. retain a reversionary interest; or ...................................................................................................... D lRl d. receive the promise for life of either payments, benefifs or care? ............................................................. 0 IZI 2. If death occurred affer December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.......................................................................... .................... 0 IZI 3. Did decedent own an "in trust fo( or payable upon death bank account or security at his or her death? ................. 0 IZI 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .............. ............................... .................................... ................... D [K] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. DATE <1 ,," <>, PA 17074 DATE J 'f/n ADDRESS LINUS E. FENICLE 2331 MARKET STREET, CAMP HILL PA 17011 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)]. 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)l. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even jf the surviving spouse is the only beneficiary. For dates of death on or affer 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 Iransfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(I.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. 'EV""'EV"'"".. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF HIVNER. MARTHA G FILE NUMBER 21 20 0709 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. DESCRIPTION VALUE AT DATE OF DEATH 1,141.13 PSECU - SAVINGS PSECU - CHECKING 1,420.96 PSECU - CERTIFICATE OF DEPOSIT 35,449.91 PSECU - CERTIFICATE OF DEPOSIT 81,552.45 PSECU - CERTIFICATE OF DEPOSIT 10,801.65 PSECU - CERTIFICATE OF DEPOSIT 20,005.95 PSECU - CERTIFICATE OF DEPOSIT 41,248.24 PSECU - CERTIFICATE OF DEPOSIT 96,070.65 WAYPOINT BANK - CERTIFICATE OF DEPOSIT 10,039.00 FIRST NATIONAL BANK OF NEWPORT - CERTIFICATES OF DEPOSIT 96,154.92 RETURN OF SECURITY DEPOSIT FROM NURSING HOME 500.00 RETURN OF MEDICAL INSURANCE PREMIUM 162.00 REFUND FROM PHARMACY 34.00 TOTAL (Also enter on line 5. Recapitulation) $ (If more space is needed, Insert additional sheets of fhe same size) 394 580.86 '''''''',.,,''''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF HIVNER MARTHA G FilE NUMBER 21 20 0709 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A FUNERAL EXPENSES: 1. ZIMMERMAN AUER FUNERAL HOME 2,294,86 B, ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (5) DONALD HALKE 7,891,62 Social Security Numbe~s) I EIN Number of Personal Representative(s) Street Address 90 BUTTONWOOD ROAD City NEWPORT State PA Zip 17074 Year(s) Commission Paid: 2001 2 Attorney Fees REAGER & ADLER, P,C, 3,000,00 3, Family Exemption: (If decedenfs address is not the same as c1aimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4, Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS 340,00 5, Accountanfs Fees 6, Tax Return Preparer's Fees 7, CUMBERLAND LAW JOURNAL 75,00 8, THE SENTINEL 67,91 TOTAL (Also enter on line 9, Recapitulation) $ 13669,39 (If more space is needed, insert additional sheets of the same size) REV'''''''.'''''''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF HIVNER MARTHA G. FILE NUMBER 21 20 0709 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. COUNTRY MEADOWS 54.00 2. AT&T 3.64 TOTAL (Also enter on line 10, Recapitulation) $ (If more space IS needed, Insert additional sheets of the same size) 57.64 REV_1513-EX+l1_S71.' . , __.___ __u__ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER 1-lI\l~I"'" ",r., 21 ?n n7nQ RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. ELIZABETH T. COOK NIECE ONE THIRD 71 DIVIDING RIDGE ROAD HALIFAX, PA 17032 2, JAMES O. HIVNER COUSIN ONE THIRD 6720 HILLHAVEN DRIVE PLANO, TEXAS 75024 3. DONALD HALKE FRIEND ONE THIRD 90 BUTTONWOOD ROAD NEWPORT, PA 17074 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRtATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (It more space is needed, Insert additional sheets of the same size) Register of Wills of CUMBERLAND County, Pennsylvania Certificate of Grant of Letters ,,, . (>o...-.....~~II~" h.... "" ....-'....., ........ - ": '- ... :..... 1-" '~_"."~""" .~ ".-'..:, . . ......'.: No. 2001-00709 PA No. 21-01-0709 ESTATE OF HIVNER MARTHA G (LAb 1 , tLKbl, MLUUL~i 'V ~ . - ~ .. ~', ..' ..... ~ .~.'...""""': .; .... ...,' .. ""},,,,' .. ..... .~\' " .. 'V" '\....\ ..... '. ,;:.., ~....., Late of HAMPDEN TOWNSHIP CUM~hKLANU CUUN1Y, Deceased Social WHEREAS, on the 2nd dated March 1st 2001 was admitted to probate as the last will of HIVNER MARTHA G (LAbl', tLKbl, l'UUUL~) day Security No. 207-07-7477 of August 2001 an instrument late of HAMPDEN TOWNSHIP CUMBERLAND County, who died on the 27th day of July 2001 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, MARY C. LEWIS , Register of Wills in and for the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to HALKE DONALD J who has duly qualified as Executor (rix) and has agreed to administer the estate according to law, all of which fully appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my Office the 2nd day of August 2001. * *NOTE* * ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE) . .' LAST WILL AND TEST AMENT OF MARTHA G. HIVNER I, MARTHA G. HIVNER, of Mechanics burg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this my Last Will and Testament, hereby revoking any and all prior Wills and Codicils thereto by me at anytime heretofore made. I. PAYMENT OF BURIAL EXPENSES AND DEBTS. I authorize my executor to pay all the expenses of (1) a funeral or memorial service; (2) the interment of my remains, including the costs of a gravesite, if necessary; and (3) the installation and inscription of a suitable marker at, and perpetual care of, the gravesite. I further direct my executor to pay all of my debts that my executor in his or her sole discretion may allow as claims against my estate. 2. DISPOSITION OF RESIDUARY ESTATE. 2.1 I devise and bequeath all the rest and remainder of my estate, real, personal or mixed as follows A. One third ('!o) to my cousin, JAMES O. HIVNER. If JAMES O. HIVNER fails to survive me, his share shall be given to his wife PHYLLIS HlVNER. If PHYLLIS HIVNER fails to survive me, his share shall be given to the surviving children of James O. and Phyllis Hivner, equally; B. One third ('!o) to my niece, ELIZABETH T. COOK. If ELIZABETH T. COOK fails to survive me, her share shall be given to her surviving children, equally; C. One third ('!o) to DONALD J. HALKE. If DONALD J. HALKE fails to survive me, his share shall be given to his wife, MELANIE A. HALKE. If MELANIE A. HALKE fails to survive me, his share shall be given to the surviving children of Donald J. and Melanie A. Halke, equally. ^)""i ._,," ,#-//. j.; /, I.. . .h'...... ~. y-/,'...,..;.-..il.F;..... MARTHA G. HIVNER 3. POWERS OF ADMINISTR'ATION. 3.1. Grant of Powers. My executor, in the administration of my estate, (my "fiduciaries") shall have the powers and authorities set forth in this Article 3. These powers and authorities may be exercised by my executor and trustee in their sole and absolute discretion, without the permission or order of any court. These powers shall be supplementary to those conferred by law, including, but not limited to, those set forth in Title 20, Chapter 33, of the Pennsylvania Consolidated Statutes. 3.2. Retention of Assets. My fiduciaries shall have the power to retain any or all property of my estate, however received and acquired, for so long as they deem appropriate. This power may be exercised even though the property may not be of the type authorized by law for investment, and even though the retention may leave a disproportionately large amount of the value of my estate invested in one type of property . 3.3. Transfer of Assets. My fiduciaries shall have the power to sell, transfer, and convey any property, of whatever nature, including real property, and wherever situated, that I may own at the time of my death, or that may come into my estate or after my death. The sale, transfer, or conveyance may be by public or private sale, at such time, on such terms and conditions, including selling price and credit, in such manner, and for any reason that my fiduciaries deem appropriate, including, but not limited to, the purpose of obtaining net proceeds to be distributed to my residuary beneficiaries. 3.4. Investment. My fiduciaries shall have the power to invest and reinvest any property in my estate in preferred and common stocks, bonds, notes, common trust funds (including any managed by any corporate fiduciary), interests in investments, trusts, mutual funds, leases, mortgages on property wherever located, and, generally, in any property and in proportions of property as my fiduciaries deem advisable, even though the investments are not of the character or proportions authorized by applicable law for the investment of the funds. 3.5. Power to Borrow. My fiduciaries shall have the power to borrow money for any purpose, for any periods of time, and on any terms and conditions as they deem advisable (including the power to borrow from any corporate fiduciary), and to pledge, mortgage, or otherwise encumber any property in my estate to secure repayment of any loan, as well as the power to renew existing loans either as maker or endorser. 3.6. Power to Hold Property in Nominee Form. My fiduciaries shall have the power to hold any property in the name of a nominee or in bearer form. J77..,ol-l- j1 /-/~ 2 MARTHA G. HlVNER 3.7. Distribution in Cash or in Kind. My fiduciaries shall have the power to make distributions in cash or in kind, or partly in cash, in divided or undivided interests, as amended, or other applicable law, and to determine which assets shall be sold and which shall be distributed in kind, without notice to or consent by any beneficiary. 3.8. Distribution to Minors and Persons Under Disabilitv. My fiduciaries shall have the power to make distributions or payments to or for the benefit of any beneficiary who is a minor, an incompetent, or who in the fiduciaries' judgment is incapacitated. The distributions or payments shall be made in anyone or more of the following ways: (I) directly to the beneficiary; (2) directly to the creditor in payment of the debts or expenses of the beneficiary; (3) to the guardian of the person or estate of the beneficiary; (4) to any custodial parent ofa minor beneficiary; (5) to a custodian for the beneficiary under any law related to gifts to minors, including to my fiduciaries in that capacity; or (6) to any other person who shall have the care and custody of the person of the beneficiary. There shall be no duty to see to the application of funds so paid, provided due care was exercised in the selection of the person to whom the funds were paid, and the receipt of the person shall be full acquittance of the fiduciaries. 3.9. Continuation or Liquidation of Business. My fiduciaries shall have the power to continue or to permit the continuation of any business, incorporated or unincorporated, in which I may have any interest at the time of my death for any period of time, or to liquidate the business on any terms as they deem appropriate. This power includes, but is not limited to (1) the power to invest additional sums in any business, even to the extent that my estate may be invested largely or entirely in the business, without liability for any loss resulting from lack of diversification; (2) the power to act as or to select other persons to act as directors, officers, or employees of any business, to be compensated without regard to being a fiduciary under this Will; and (3) the power to make any other arrangements in regard to any business as my fiduciaries shall deem proper. 3.10. Employment of Aj:ents. My fiduciaries shall have the power to employ and pay the compensation of any and all attorneys, agents, custodians, attorneys-in-fact, experts, investment counsel, accountants, bookkeepers, or other agents or providers of services as my fiduciaries deem advisable in the administration of my estate. 3.11. Commissions. My fiduciaries shall have the power to take reasonable commissions on account at any time during the administration of my estate without the approval of any beneficiary or of the court, but subject to allowance or disallowance on the settlement of the final accounts of my fiduciaries. .I?t. ,v-d:/;...;. ?''/'''' . " v... 3 MARTHA G. HIVNER 3.12. Third Party Reliance. No person or corporation dealing with my executor shall be required to see to the application of any property paid or delivered to my executor, or to inquire into either the authority of my executor to enter into any transaction or the expediency or propriety of any transaction entered into by my executor. 3.13 Charitable Donations. In the event that any of my tangible personal property is donated to a charitable organization(s) then my fiduciary is instructed to use the value of said donationes) as an inheritance tax deduction for any inheritance tax return which may be required to be filed as a consequence of my death. 4. PAYMENT OF DEATH TAXES. 4.]. Payment of Estate Taxes. ] direct that all federal and Pennsylvania estate taxes payable as a result of taxes assessed on property passing under this Will shall be paid from my residuary estate as a part of the expenses of the administration of the estate. 4.2. Inheritance Tax. I direct that the Pennsylvania inheritance taxes payable as a result of my death, limited to taxes assessed on property passing under this Will, shall be paid out of my residuary estate and shall not be deducted or collected from any beneficiary under this Will or other transferee. 5. EXECUTOR 5.1. Appointment. I name, constitute, and appoint DONALD J. HALKE, as executor of my estate. If DONALD J. HALKE shall not survive me, shall not serve as executor for any reason, or shall cease to serve as executor for any reason after appointment, his wife, MELANIE A. HALKE, shall act as executor in his place. 5.2. Bond Not Required. None of the individuals named in Section 5.1 shall be required to furnish a bond for the faithful performance of his duties as executor. 6. PRESUMPTION IN CASE OF SIMULTANEOUS DEATH. For the purposes of this Will, in determining whether a person has survived me or another person, a person shall not be deemed to have survived me or another person ifhe or she dies within sixty (60) days of my death or ofthe death of the other person. 7. LIABILITY OF EXECUTOR. My executor shall not at any time be liable for mistake of law or of fact, or both law and fact, or errors of judgment, nor for any loss coming to any };'''~ /. h;~ 4 MARTHA G. HIVNER beneficiary under this Will, or to any other persons, except through actual fraud or willful misconduct on the part of the executor or trustee. My executor may, from time to time, consult with counsel with respect to the meaning, construction, and operation of this Will, particularly with respect to the appointments, allocations, and disbursements, and may act on the advice of counsel in all matters without incurring liability on account of his or her actions. 8. INTERPRETATION. 8.1 Successors of Fiduciaries. All pronouns referring to an executor and the term "executor" shall be construed to mean any person acting as my executor, co-executor, personal representative, or administrator, as the case may be. 8.2 Number and Gender. Ifrequired by the context of this Will, singular language shall be construed as plural, plural language shall be construed as singular, and the gender of personal pronouns shall be construed as either masculine, feminine, or neuter. 8.3 Headings. All headings used in this Will to describe the contents of each article, paragraph, or other division are provided for convenience only and shall not be construed to be a part ofthis Will. 8.4 Governing Law. This Will shall be construed in conformity with the law of the Commonwealth of Pennsylvania. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of five (5) typewritten pages, the first four (4) of which bear my signature in the margin for the purpose of identification, this ~ day of 1111411 ,2001. )i:~.J'i..... /J. N.I.c~_ MARTHA G. HIVNER Signed, sealed, published and declared by the above-named Testatrix, MARTHA G. HIVNER, as and for her Last Will and Testament, in the sight and presence of us, who, at her request, in her sight and presen d in the si ~prese e of each other, have hereunto subscribed our names as witnesses. - Address 2 3J/ /y~Q?'/ J r tf/(/? ;f/;f, ~ b a~~ Address ~331 mfJzJ~ ~ 1/dI, fA /7011 5 '-;1 i COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF ) I, MARTHA G. HIVNER, THE TESTATRIX, WHOSE NAME IS SIGNED TO THE FOREGOING INSTRUMENT, HAVING BEEN DULY QUALIFIED ACCORDING TO LAW, DO HEREBY ACKNOWLEDGE THAT I SIGNED AND EXECUTED THE INSTRUMENT AS MY LAST WILL AND TESTAMENT; THAT I SIGNED IT WlLLINGL Y; AND THAT I SIGNED IT AS MY FREE AND VOLUNTARY ACT FOR THE PURPOSES THEREIN EXPRESSED. SWORN OR AFFIRMED TO. AND ACKNOWlyEDGEp BEFORE ME BY MARTHA G. HIVNER, THE TESTATRIX THIS J --r DAY OF ' t !ciAo (..... , 2001. Notarial Seal Monica D. Zetcher, Notary Public Camp Hili Born, Cumberland County My Commission Expires Jan. 14, 2002 Member, Pennsylvanra AssocIation of Notarl.. Ili~ ,>:I;/, ~~J:J _ /-1-A .:,~ MARTHA G. HIVNER ;{J~ ~ NOT~Y PUBLIC COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF ) WE, j,JtJI(J b. ;?;,{/Z'C U3 AND o'rls+,tJt 1'1. S+ohlu- THE WITNESSES WHOSE NAMES ARE SIGNED TO THE FOREGOING INSTRUMENT, BEING DULY QUALIFIED ACCORDING TO LAW, DEPOSE AND SAY THAT WE WERE PRESENT AND SAW THE AFORESAID TESTATRIX SIGN AND EXECUTE THE INSTRUMENT AS HER LAST WILL AND TESTAMENT; THAT SHE SIGNED WlLLINGL Y AND THAT SHE EXECUTED IT AS HER FREE AND VOLUNTARY ACT FOR THE PURPOSES THEREIN EXPRESSED; THAT EACH OF US IN THE HEARING AND SIGHT OF THE TESTATRIX SIGNED THE WILL AS WITNESSES; AND THAT TO THE BEST OF OUR KNOWLEDGE THE TESTATRIX WAS AT THE TIME EIGHTEEN (I 8) OR MORE YEARS OF AGE, OF SOUND MIND AND UNDER NO CONSTRAINT OR UNDUE INFLUENCE. / sf DAY OF fl SWORN OR AFFIRMED TO AND SUBSCRI /1..-1..[ ~ ,2001. .' Notarlal Seal Monica 0, Zercher, Notary Public Camp Hill Bartl, Cumberland County My Commission Expires Jan, 14, 2002 Member, Pennsylvanra" ASSOCiation ot N6ttl"ij~ aSS ~1'#'~ WITNESS / l 1 -") :7 /1... I" 'i/- NOTARY PUBLIC