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Home My WebLink About01-0737 PETITION FOR PROBATE and GRANT OF LETTERS Estate of 7b,furJIy &. 7?DC.Iitf No. 21-01-737 also known as To: Social Security N~O'l-t!)/- eflo 75 Deceased. Register of Wills for the County of C.ufVII)G~l.J4110 in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut in the last will of the above decedent, dated /!)C-rt> ~ e R 9, /q P;q and codicil(s) dated Ihd-Y ,1~;:Z~o / named ~ ,~eg (state relevant circnmstances, e.g. renunciation, death of executor, etc.) (list street, number and muncipality) D cendent, then 8~ at :/ #J4.N .4 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: ~o<:)o,~ $ __ _ _j~ (!)Q .. ~11# ~ - $ --=- $ /0('.000. .~ , Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: WHEREFORE, petitioner(s) respectfully request(s) the probate of the tiastwill and codicil(s) presented herewith and the grant of letterfestamentary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. ~ o u C o :E~ "'- 0"- c.::~ -g.g ccS.: 3~ 0'- :;0 cu c t:lI) i;;j OATH OF' PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA } S8 COUNTY OF CUMBERLAND The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to ~r. affirm~ and subscribed f~c7Y~ ~ ;;m~t~7t'1 ~j1$d~YOf' _~ ~ ;yv - -.: :'N"~"'~ ~ /~ -~.y9-f' ~o. 21-01-737 Estate of DOROTHY E ROUSH , Deceased DECREE OF PROBATE A~D GRA~T OF LETTERS AND NowAUGUST 9 ~ 200 ~ 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 OCTOBER 9, 1989 and codicil 5-25-2001 described therein be admitted to probate and filed of record as the last will of DOROTHY E ROUSH TESTAMENTARY EARL E and BARBARA L HOFFMAN and Letters are hereby granted to ~n~~/.u~IA~~.~;7r' R ster of WI FEES P~o_b;~le~etters, Etc. ......... $ 23~. gg Short c-ertificates( ).......... $~ ~ODICIL. 10:50 RenuncIatIOn ................ $ JCP $ 5.00 TOTAL _ $ 268.50 Filed ". AUGu~r. .].1 .2,00.1 . . . . . . . . . . . . . . . A TIORNEY (Sup. Ct. LO. No.) ADDRESS PHONE MAIL TO EXECUTOR --' 1 (\<; q(\<; ~"C\' (' IQf, 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. ~ ::3R~1L-- Fee for this certificate, $2.00 p 7431926 JUL 1 3 2001 Date VffT COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH SEX a. NAME OF DECEDENT If",. MIdclIe. Lie) "__rnmthv_R. lhush AGE IL- sWN.Y1 UNDER . YEAR ...... De,. 8tR'f~ \Cly ana S/aIe CII fer.. ColJnIIYl 83 Vrw. Sunbw:y Pa ~o "- - - COUNtY OF OERH White __Da OECEOl!NT'S USUAL OCCUMION ~":':~"::':::2.=r IoW'\tTAl SWUS -........ SURYIVlNG SPOUSE ~/Mrrled. ~ In......g,ve__1 ow-.d~ 1.. Widowed 200 St Jam I 5 Church Ibad Hrlnpipn JWp. .lMIl ... NA IilFONIIAHT'S NAME (TypeIPMl Farl Hoffman ~OF IlI$POSlTION 0aMliDft0 ::' L c-.lDn 0 ...................0 It _2'" _lie CICIlIlClMled by _wllo~~. PART ., Ol'- ~""""""-.riIIuIInQ1O dMlII.lIIll lllII........in.. ~_ giwn inFll\RT I. -.uT' CAUM (Final _or condiion .........~- lion J~ArI l~r) L. DUE 10 lOR AS A. CONSEOUEtiCE OF): c""'" (. of r' ~......... .... .....10........ _. ~UIClIIILYlND *- co.- III "'P"Y ..~- -*'0" deeel)LM'T I :. cI. DUE 1O(OA AS A CONSEQUENCE 0f'I: DUE 10 lOA AS A CONSEOUENCE OF): IUS ANAU1OP$Y WEllE AUlOPSY FINDINGS MANNER OF DEATH DATE OF IHJUAY EIFOAUED' .wIUI..A8lE PAIOA 10 IMooI\. o.y. ..,) COW'lE1'lON OF CAUSE ~ 0 OIF DEArH' ........ HomiCide AccicIM 0 "-ling ~lon 0 .. 0 No. __0 NoD Suicide 0 Could IllIIIle cIeI__ 0 TiMe OIF INJURY INJURV AT WORK? DESCRIBE HOW IHJURVOCCUflRIEO. ... 0 NoD REGISTRAR'S SlGNA.TURE AND NUMBER M.p. lL :nIL 21. EM.....lo-k only..... "CERTII'Y1NG I'H'ISlaAN (PhySlClM ~ cao-. r:J _'" .."." M>CIMr lIhYSoCoan has pfonounced deall\ ana completed Ilem 23) 1O__...'...............__..."'...cauMls)__,............................................................. . "1'RONOl1NC1'tG ANO CERTIFYING PHYSICIAN lJ'hysDan boIh pronourcong oea... _ o:erufyoN;J to c:ause 01 <1HIh' To'" _ 01_, ..........."'__.......... lIet., ..... place. ..... due to... c.UM(sl_ m......r .. "steel.. . . . . . . . . . . . . . . . . . . . . . . . . "MEDICAL n....INEAlCOROMER On the bssIe of ......In.tlon .n4Irw In"._tlgatlon.ln m, opinion. d.atll occuned.t Ihe lime. datl..nd pl.c...nd clu. to Ihe csuM(_1 sncI __ ..ata...... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . .. . . . . .. . . .. .. . . . . . . . . . . . . . . . . . . . .. . . .. . . . . . .. . . . . . . . . . . I.. ' PA/JI'fj I().,I ~I / J I 34. 1. 7ft 1,/ 69-t:S-Will and Testament H",nry Hall. Inc., IndillnR, PII. J, DOROTHY E. ROUSH of 200 ST. JOHNS CHURCH ROAD. CAMP HILL County of CUMBERLAND and State of PENNSYLVANIA being of sound mind, memory and understanding, do make and lJublish this my lw;t TVill and Testament, he'reby revoking and making void all forme?' Wills by me at any time heret%l'e made. 1. I direct that all my debts and funeral expenses be paid as.soon as practicable after my death, by my Executors hereinafter named. 2. All the rest, residue and remainder of my estate, real, personal and mixed, and wheresoever the same may be situate, I give, devise and bequeath as follows: a, One-half <i) thereof untp DONALD V. ROHLAND, JR. of 4733 Spellman Street, Houston, Texas, and if he fails to survive me, unto his daughter, AMANDA ROHLAND, and in the event of her minority at the time of my Death, I appoint her mother, GAIL ROHLAND, to be Guardian of AMANDA ROHLAND'S ESTATE. b, One-fourth (t)c thereof unto OAKWOOD BAPiIST CHURCH, of 4315 CHES1lNUrri STREErr', CAMP HILL, PENNSYLVANIA. c. One-fourth (t) thereof- unto BARBARA L. HOFFMAN-and EARL E, HOFFMAN, of 4501 HAMPDEN AVENUE, CAMP HILL, PENNSYLVANIA. 3.1 hereby nominate, constitute and appoint BARBARA L. HOFFMAN AND EARL E. HOFFMAN, of 4501 HAMPDEN AVENUE, CAMP HILL, PENNSYLVANIA, as Executors of this My Last Will And Testament and further direct that neither one shall be required to post --a.ny:. bond -to- secure the rei t.hf'1l1 pA:rfo:rmance of "eir duties in in the Commonwealth of Pennsylvania or in any other jurisdiction. . ....- --- A 0 i;ft!~ f? ~~__~__ ~ ~ ...... ~ '(':' ~ r ~ ~ ~ I~ :;:l ~ I c t~?: <:'10 ~ (':) <::: <~ rJj (':) ".tl :;:l.. ~ \""'t ~ ~~ II\) ~: e ~ ....: .... :;:l.. t'-i 10 ~ ';::l) "'"-f 0 ,t; ~.. ~ .-- .. 10 1--' ~ ~ (f1 ::0 1--' (") ~ ~ I t"'(j 8 0 ~ ~ I t,:1.j 8 ~ ~ ~ 0 ::1 ~ z ~ ~ 0.. .... (I) 0 ~ K tu tzj ~ t-' Z . ~ <: (fJ ... . ::0 _ro ~ >> ~ Z n 0 rJj ~ ~ H tu 0 l""t ~ 0 ~ ~ en ~ 0 .... ?>' ~ I~ s ~ (") n ~ (':) ::r: ro (':) '"i ~ ::1 I /'1 ~ ::0 I / i :;:l.. 0 l""t .' .I >> t:1 o,(,;n{1o 1{~VtJ 10 pUV X l ~'1V18tJ1 PJVS 10 ~~u~s~.td ~1{7 U~ 07a.(,~1{7 8a88~u7~m, 8V 7sanb'a.t ~. ?"'1j ~Ir~f)/ )11) S;HUVU ,tn? pfJq~,"~sqns 01un fJ,121j ~a.lJ1{ 01l(t~ tS).fO ;JoufJsa.td ~1J7 UJ '7U~ut>>1StJ.L pUV llJ-M 1S111v"--:-7f)J .to! pun S11 v5- n (]7/ . ,J %< (.? .A (J( '_l pfJ UV a'lf8'!lQnd 'palVfJS 'pfJ1tlj~s I . _"5 . '- f:66 L '& /..:ew SeJ!dx~ UO!$9!wtItDJ'- 'ed "Og PUgflGq.wn, 'olOe fl!" .., , d Ale.oN '1~~~ 'V NVJr ~ MS 1V1~V1ON · GU1U !q. q~l e pu~p;:).tpunl{ <JuJu puvsno'lO auo p.to'] .tno jo J,VfJfi fJ1{7 u~ H3:tIO,L00 !o nvp qq. 6 a'l{} 'zvtJs Jiut paxifjv pU"lJ aUtvu nut pfJqJ.t~sqns 07UtlfJ.tfJ'l{ fJa/D'l{ 'paUtvu J;'LOlllJ lD1S,).L 'JIO HsnOH .a XHLOHoa '[ '.!/03H3HA1 ~~'fS3NX[Al "V.i 1u(Jut1J1saX pUV llJ,M 7.m2 nut SJ1{7 10 SJ.OPW(JX3 fJq OJ NVVW~ OR .3: 'lHVS PUli .NVW&d OH · '1 YHVtIHYS: 7U~oddv puv fJ7nn7SUOJ 'J~l)u(, fiqa,tfJ1{ op 1 CODICIL TO THE WILL OF DOROTHY E. ROUSH I Dorothy E. Roush, of 2200 St. Johns Church Road, Camp Hill, PA do make and publish this as a Codicil to my Will dated October 9, 1989. My Will is amended by: 1. Deleting paragraph 2. a. and substituting in its place the following: a. One-quarter (1/4) thereof unto my nephew, Donald V. Rohland, Jr. 2. Adding a new paragraph 2.d. as follows: d. One-quarter (1/4) therof unto my grand neIce, Amanda Rohland of Quakertown, P A. In all other respects my Will dated October 9, 1989 shall remain in full force and effect. In witness whereof, I Dorothy E. Rouch,_have hereunto set my hand and seal this dZ~TJ- day of May, 2001. )~~!5'< 8~ Dorothy E. Ro h Signed, sealed, published and declared by the above named Dorothy E. Rouch as a Codicil to her Last Will and Testament, as aforesaid, in the presence of us, who have hereunto subscribed our names as witnesses in her presence and in the presence of each other. ~ (14 7~ --#~ w . JA. Signed and sworn to before me a notary public this fl5' day of May. 2001. ,/ Notarial Seal Stepha!lie Gardner, Notary Publi Ham~b~rg. Dauphin County C My CommIssIon Expires Apr. 28, 2003 Member, Pennsylvania Association otiNltaries ~ ~ ~ CERTIFCATION OF NOTICE UNDER RULE 5.6(A) Name ofDecedent: P().f!tJ rllY ELI E# j:(htl g II Date ofDeath: "'~ r /.=3) t<Ot? I Will No.: ~()IJ / - 00 73 7 Admin No.: To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6~of~ Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on II 9 2..LkJ I : r , Name Address Date: #oe> / ~/{;;k-;; - ~~~ Signature ~ EJ.h;:;:-,If 141'/ - fJ;;Rt;4bi j. Jt,rFMPiI r Name - r:) l"'l N "& .LJ!5c>1 I-!t1MPJ)ftl 4uEIYOE. {?~I ;JiLl Id /70/{ Address C!IV1.3:L-J/t00 Telephone Capacity: Rl Personal Representative - z-t' Feu -roll (/21 i) D Counsel for personal representative ....- ~ 6 () Q) a: ...- N ;::::.. ~ ~~;,'J ,:ifj ~;: .", (l) ,,'. .0 t:s= 0= UU ...- p / .. ' Register of Wills of CUMBERLAND County, Pennsylvania INVENTORY Estate of Dorothy E. ROUSH No. 2001-00737 also known as Date of Death 07/31/2001 , Deceased Social Security No. 204 - 01- 2075 Earl E. HOFFMAN, Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: Ralph H. Wright, Jr. p.~naIR.pr.~ ~ Signature' 8 ar 1 E. OFFMAN I.D. No.: 56113 Signature: Address: P. O. Box 109 Address: 4501 Hampden Avenue Lemoyne, PA 17043-0109 Camp Hill, PA 17011 Telephone: 717/761-4540 Telephone: 717/737-4606 ~~ .:lOt);}- Dated: Description Value (See continuation page(s) attached) (Attach additional sheets if necessary) Total: 173,667.25 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form'RW-7 (1992) ~ .. Estate of: Date of Death: County: INVENTORY Dorothy E. ROUSH 07/31/2001 Cumberland CASH: Cash on Hand 2,309.82 Cash on Hand 152.59 Mellon Bank Savings Account 1,691.56 Mellon Bank Certificate of Deposit 45,900.00 Refund received from Homeowner's Insurance 73.02 Reimbursement to Estate for Taxes paid. See attached Settlement Sheet 965.31 PERSONAL PROPERTY: Household Goods 7,574.95 REAL ESTATE/PA: Residence located at 200 St. Johns Road, Camp Hill, PA 17011. As per attached Settlement Sheet 115,000.00 -1- 51,092.30 7,574.95 115,000.00 ,,- TOTAL RECEIPTS OF PRINCIPAL............... 173,667.25 -2- 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 RALPH H WRIGHT JR ESQUIRE 301 MARKET STREET LEMOYNE, PA 17043 -------- fold ESTATE INFORMATION: SSN: 204-01-2075 FILE NUMBER: 2101-0737 DECEDENT NAME: ROUSH DOROTHY E DA TE OF PAYMENT: 09/27/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/13/2001 NO. CD 001661 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $17,924.15 I I I I I I I I TOTAL AMOUNT PAID: $17,924.15 REMARKS: RALPH H WRIGHT JR ESQUIRE CHECK#144 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS 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 WRIGHT RALPH H JR ESQUIRE 301 MARKET STREET PO BOX 109 LEMOYNE, PA 17043-0109 _n_____ fold ESTATE INFORMATION: SSN: 204-01-2075 FILE NUMBER: 2101-0737 DECEDENT NAME: ROUSH DOROTHY E DA TE OF PAYMENT: 12/11/2002 POSTMARK DATE: 12/10/2002 COUNTY: CUMBERLAND DATE OF DEATH: 07/13/2001 NO. CD 001937 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $48.77 I I I I I I I I TOTAL AMOUNT PAID: $48.77 REMARKS: RALPH H WRIGHT JR ESQUIRE CHECK# 8207 SEAL INITIALS: CW RECEIVED BY: REGISTER OF WILLS DONNA M. OTTO DEPUTY REGISTER OF WILLS //)-~~C; - y \, 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-liD7 EX AFP (01-031 RALPH H WRIGHT JR JOHNSON ETAL PO BOX 109 LEMOYNE PA 17043 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-21-2003 ROUSH 07-13-2001 21 01-0737 CUMBERLAND 101 DOROTHY E 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 paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV: ii;b-j-ix-AFP-(ol-:o3)-------...-iNiiERi~.._ANcE--YA;f-sTjrfEME-tiY-OF-ACCouiff--.-..---------------- -- - -- ESTATE OF ROUSH DOROTHY E FILE NO.21 01-0737 ACN 101 DATE 01-21-2003 THIS STATE"ENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NA"ED ESTATE. SHOWN BELOW IS A SU""ARV OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAV"ENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-25-2002 P R I NC I PAL TAX DU E : ................................mnnm......................nm........................nmnm.....................n....mm................................................................................... 17,493.80 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-27-2002 CDOO1661 430.35- 17,924.15 12-10-2002 CDOO1937 48.77- 48.77 TOTAL TAX CREDIT 17,493.80 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 PAV"ENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRl, YOU "AV BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. l /6-o?~f- 7 V BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG. PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSES:)MENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 11-25-2002 ROUSH 07-13-2001 21 01-0737 CUMBERLAND 101 RALPH H WRIGHT JR JOHNSON ETAL PO BOX 109 LEMOYNE PA 11043 *' REV-1547 EX AFP C01-02) DOROTHY E 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-Y=is4-f-ix--AFP--("oi-:021--NoT'ici--oF-'rNHiifiTANcE-T'AX-APPRAisiMENT~--ALi-oWAirCE-oi----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF ROUSH DOROTHY E FILE NO. 21 01-0737 ACN 101 DATE 11-25-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED 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: IS. Allount of Line l~ at Spousal rate (IS) 16. Allount of Line l~ taxable at Lineal/Class A rate (16) 17. Allount of Line l~ at Sibling rate (17) 18. Allount of Line l~ taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: .00 X 00 = .00 .00 X 045 = .00 .00 X 12 = .00 116,625.36 X 15 = 17,493.80 (19)= 17,493.80 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) ~. 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 (1) (2) (3) (~) (S) (6) (7) 115.000.00 .00 .00 .00 58.667.25 .00 .00 (8) 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) l~. Net Value of Estate Subiect to Tax (9) (10) 14,220.50 3.946.27 (11) (12) (13) (1~) NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 173,667.25 18.166 77 155,500.48 38,875.12 116,625.36 ." .....~. .........-. . (+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-27-2002 CDOO1661 430.35- 17,924.15 BALANCE OF UNPAID INTEREST/PENALTY AS OF 09-28-2002 TOTAL TAX CREDIT 17,493.80 BALANCE OF TAX DUE .00 INTEREST AND PEN. 48.77 TOTAL DUE 48.77 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) STATUS REPORT UNDER RULE 6.12 /' (} a~ Name of Decedent: DOROTHY E. ROUSH Date of Death: JULY 15.2001 Will No.: 2101-0737 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rule, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the Estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's Account is: c. parties of interest? Did the personal representative state an account informally to the 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: Marctr27, 2003 .~~ /RALPH H. IGHT, JR. JOHNSON, DUFFIE, STEWART & WEIDNER 301 Market Street P.O. Box 109 LemoYlle, P A 17043 (717) 761-4540 Capacity: Personal Representative (x) Counsel for Personal Representative RfY ~ 1500 EX + (6-00) CAPB HpRL EplO CRAC KOTK ES C P o 0 R N R 0 E E S N T C o M P T U A T X A T I o N OFFICIAL USE ONLY REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT /t!- c;2~9- ~ FILE NUMBER o E C E o E N T COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG,PA 17128-0601 DECEDENT'S NAME (lAST, FIRST, AND MIDDLE INITIAL) ROUSH Doroth E. DATE OF DEATH (MM-DD-YEAR) COUNTY CODE YEAR SOCIAL SECURITY NUMBER 204-01-2075 THIS RETURN MUST BE ALEO IN DUPLICATE WITH THE DATE OF BIRTH (MM-DO-YEAR) 2001-00737 NUMBER REGISTER OF WILLS SOCIAL SECURITY NUMBER X 1. Original Return 4. limited Estate X 6. Decedent DIed Testate 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust 1 3 date of death . Remainder Return prior to 12-13-82) S. Federal Estate Tax Return RequIred 8. Total Number of Safe Deposit Boxes (Attach copy of WJU) (Attach copy of Trust) o 9. LitIgation Proceeds Received 0 10. Spousal Poverty CredIt 0 11. Election to tax under Sec. 9113(A) (date of death between 12-31-91 and 1-1-95) (Attach Sch 0) !i[~QMl!~~'(ml':..':':.J~$j!!!:I1l!! f{: ,~(>;~!!I&lll~~!: 'j"~"'~ii!Q;~Li!lQ!!~li!lijeil:!I~~(;ll'~!lI!!:!!l:':, COMPLETE MAILING ADDRESS Copyright (c) 2000 form software only The Lackner Group, Inc. ID:j;f!:!!I($,'~:Elfil{' NAME Ra1 h H. Wri ht, Jr. FIRM NAME (If Applicable) Johnson, Duffie, Stewart & Weidner TELEPHONE NUMBER P. O. Box 109 301 Market Street Lernoyne, PA 17043-0109 R E C A P I T U L A T I o N 61-454 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) S. Cash, Bank Deposits & Miscellaneous Personal Property (SChedule E) 6. Jointly Owned Property (SChedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (SChedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estato (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Sub'ect to Tax (Line 12 minus Line 13) (1) (2) (3) 115,000.,00 N61le None OFFICIAL USE ONLY (8) 173,667.25 (11) 18.166.77 (12) 155,500.48 (13) 38.875.12 (14) 116,625.36 (IS) (16) (17) (18) (19) 0.00 0.00 0.00 17.493.80 17,493.80 (4) (5) None 58,667.25 (6) None None 14,220.50 3,946.27 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(aX1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. 0.00 0.00 0.00 116,625.36 x X X X ,0 0 ,0 45 .12 ,15 Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 200 St. Johns Church Road CITY I STATE I ZIP Camn Hill FA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 17,493.80 Total Credits ( A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnteresVPenalty ( D + E) (3) 4. If Line 2 is greater than Une 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 line 20 to request a refund (4) S. If Line 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 11Hlml1111ml111111l11l1l11ml111l11mml111111l11lmmmill!1l!lil1J'!milmll!1l!lill!lil1mmmmmmm!WII!iililllillliiimmrllimiil!I!!JIJ]liil!lIIl1111JII1llIJmmil!IIII!!IIIll!IW1!!iIIWllIll!!IIII!!!1lillli!II! I!illll!I!!i!I!!ilii!!!!!!!!llil!WWli!!!!I!il!li!!i!i!IIIIII!I!!!!!lmllllll!Wmll!mmlimmmll!! . . PLEASE ANSWER tHE FOLLOWiNG QUEstiONS BY PLACING AN "X'; iN tHE i\PPR6PRIATEBl.OCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .' ....... ~ ~ix b. retain the right to designate who shall use the property transferred or its income; . c. retain a reversionary interest; or. . .' ............ d. receive the promise for life of either payments, benefits or care? 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . 3. Did decedent own an ~in trust for" or payable upon death bank account or security at his or her death? . . . . . . . . 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 0.00 0.00 17,493.80 430.35 17,924.15 !Ii!!!!!!! HiifH! o o o IT] IT] IT] Under penalties of perJury, I declare that I have examined this return, Including accompanying schedules and statements, and to the best of my knowledge and bettef, It is true, complete. Declaratfon of preparer other than the personal representatfve Is based on all Information of which pre parer has any knowledge. ATUR OF R SIBLE FO FILING RETURN ___~;9L~~;~:~!'_"tl!'___________________________ ?(J<( )IJ(j~ Cam Hill, PA 17011 Johnson, Duffie, Stewart & Weidner D~E - - -~~m~Ynt~ pi9_~ i 7(J43: (Jl09 - - - - - - - - - - - - u - - - - - - - -/ ~ .<,,( ZdoZ-_ ;:;;;;;fi~jl!ljJlll!I!I!!lfllllii!il!!JJ!I!iJ!11ri!!!!iliiilWJ!IIJl!!II!!!!!I!!!lilllli!!!!i!!!I!!I!lllll!ilil!IIIIIIIII!II!lllllliilliiW!Wlllilil)]jl!il!Wlil!llii!iim!lll!II!lllilllllli!lWJil111!lll jiij~l!iIIIWI]1lJIii!WiliJil]iil!!lliiiilliiiJil 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 tor the use of the surviving spouse is 3% [72 P.S. 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) (iin The statute does not exempt a transfer to a surviving spoLJse from tax, and the statutory requirements for disclosure of assets and 1iling 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 (21)(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(aXnt The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12"10 [72 P.S. 9116(a)( 1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Flev. 6-00) REV-1S02 EX +(1-97) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dorothy E. ROUSH SS# 204-01-2075 07/31/2001 2001-00737 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with riaht of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE DESCRIPTION NUMBER OF DEATH 1 Residence located at 200 St. Johns Road, Camp Hill, PA 17011. As 115,000.00 per attached Settlement Sheet TOTAL (Also enter on line 1, Recapitulation) $ 115,000.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1502 EX (Rev. 1-97) REV-1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Dorothy E. ROUSH SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY SSft 204-01-2075 07/31/2001 FILE NUMBER 2001-00737 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Cash on Hand 2,309.82 2 Cash on Hand 152.59 3 Mellon Bank Savings Account 1,691.56 4 Mellon Bank Certificate of Deposit 45,900.00 5 Refund received from Homeowner's Insurance 73.02 6 Reimbursement to Estate for Taxes paid. See attached Settlement Sheet 965.31 7 Household Goods 7,574.95 TOTAL (Also enter on line 5, Recapitulation) $ 58 I 667 . 25 (If more space is needed, insert additional sheets of the same size) Copyright (cl 1996 form software only CPSystems, Inc. Form REV-150S EX (Rev. 1-97) REV-1511 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCET~ RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Dorothy E. ROUSH Debts of decedent must be reported on Schedule I. ITEM NUMBER A. B. SSff 204-01-2075 FILE NUMBER 2001-00737 07/31/2001 DESCRIPTION AMOUNT 1 FUNERAL EXPENSES, Myers-Harner Funeral Home, Inc. 6,927.00 1. ADMINISTRATIVE COSTS, Personal Representative's Commissions Name of Personal Representative(s) Ear 1 E. HOFFMAN Social Security Number(s) I EIN Number of Personal Representative(s) Street Address 4501 Hampden Avenue city Camp Hill State PA Zip 17011 4,000.00 Year(s) Commission Paid: 2. 3. Attorney's Fees Johnson, Duffie, Stewart & Weidner Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 3,000.00 4. Register of Wills Probate Fees 268.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs Filing Fee to Cumberland County for Inheritance Tax Return and Inventory 25.00 TOTAL (Also enter on line 9, Recapitulation) $ 14,220.50 (If more space is needed, insert additional sheets of the same size) Copyright(c) 1996 form software only CPSystems, Inc. Form REV-1S11 EX (Rev. 1-97) REV-1512 EX +(1-97) COMMONWEALTH OF PEN NSYL VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Dorothy E. ROUSH SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS SSjf 204-01-2075 07/31/2001 FILE NUMBER 2001-00737 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1 Hampden Township 2 Hampden Township 3 Hampden Township 4 Hampden Township 5 PA Department of Revenue 6 Pennsylvania American Water Company 7 Pennsylvania American Water Company 8 Pennsylvania American Water Company 9 Pennsylvania American Water Company 10 Pennsylvania American Water Company 11 Pennsylvania American Water Company 12 Pennsylvania American Water Company 13 Pennsylvania American Water Company 14 Pennsylvania American Water Company 15 Pennsylvania American Water Company 16 Pennsylvania American Water Company 17 Pennsylvania American Water Company 18 Pennsylvania Power & Light 19 Pennsylvania Power & Light 20 Pennsylvania Power & Light 21 Pennsylvania Power & Light 22 Pennsylvania Power & Light 23 Pennsylvania Power & Light Total of Continuation Schedule(s) AMOUNT 70.00 70.00 70.00 70.00 99.00 22.72 32.84 8.73 9.96 9.96 9.99 10.47 10.50 12.62 10.51 10.51 11. 07 37.68 31.64 39.39 29.59 48.59 33.81 3,186.69 TOTAL (Also enter on line 10, Recapitulation) $ 3,946.27 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) Estate of: Dorothy E. ROUSH Soc Sec #: 204-01-2075 Date of Death: 07/31/2001 Continuation of Schedule I (Debts of Decedent, Mortgage Liabilities and Liens) Item # Description Amount 24 Pennsylvania Power & Light 31.32 25 Pennsylvania Power & Light 27.75 26 Pennsylvania Power & Light 29.94 27 Pennsylvania Power & Light 36.07 28 Pennsylvania Power & Light 33.20 29 Pennsylvania Power & Light 33.85 30 Settlement costs for sale of Real Estate 2,167.65 31 Traveler's Insurance 291. 00 32 UGI Gas Company 55.38 33 UGI Gas Company 144.53 34 UGI Gas Company 82.00 35 UGI Gas Company 82.00 36 UGI Gas Company 43.00 37 UGI Gas Company 43.00 38 UGI Gas Company 43.00 39 UGI Gas Company 43.00 ~ - - - - - - - - - - - - - 3,186.69 REV-1513 EX t{9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Dorothv E. ROUSH SSjf 204-01-2075 07/31/2001 FILE NUMBER 2001-00737 RELATIONSHip TO DECi;DENT AMOI,J!C' ~ OR SHARE Do Not List Trustee(s) OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS [Include outright spousal distrIbutions, and transfers under Sec. 9116(aX1.2)J 1 Barbara L. Hoffman 4501 Hampden Avenue Camp Hill, PA 17011 Friend 1/8 of Residual Estate 2 Earl E. Hoffman 4501 Hampden Avenue Camp Hill" PA 17011 Friend 1/8 of Residual Estate 3 Amanda Rohland 11 Fairfield Street Newville, PA 17241 Grand Niece l/4th of Residual Estate 4 Donald V. Rohland, Jr. 11 Fairfield Street Newville, PA 17241 Nephew l/4th of Res idual Estate ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS, A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS Oakwood Baptist Church, Camp Hill, Pennsylvania 38,875.12 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET S 38,875.12 (If more space is needed, insert additional sheets of the same size) Copyright {cl 2000 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00) Exhibit A Exhibit 8 LISTING OF DOCUMENTS Last Will and Testament of Dorothy E. Roush Codicil to Last Will and Testament of Dorothy E. Roush ".CS-WllI "nd TOIllllmp.nt HOInr, """, Inc., Indl,,"", PII, 31.: DOROTHY E. ROUSH ~ 200 ST. JOHNS CHURCH ROAD. CAMP HILL Cuunty of CUMBERLAND and State of PENNSYLVANIA beinu of Buund mind, memory ancl ttndC1'sta.ndino. do make aud lJtI,blish this my lm;l Will alld Testcunent, he1'ebY.1"fwoking and making void all fOl'nl.C1' Wills by me at any time heret%rt' 11mdr>, 1. I direct that all my debts and funeral expenses bs paid as. soon as practicable after my death, by my Executors hereinarter named. ~. All the restl residue and remainder or my estate, real, personal and mixed, and wheresoever the BRme may be situate, I'give, devise and bequeath as follows: a, One-half (tJ thereof untp DONALD V. ROHLAND, JR. of 4733 Spellman Street, HouEton, Texas, and if he rails to survive me, ~nto hie daughter, AMANDA ROHLAND, and in the event or her minority at the time of my Death, I appoint he~ mother, GAIL ROHLAND, to be Guardian of AMANDA ROHLAND'S ESTATE. b, One-f~-;:;;;-th-iF-tb-;r-;'~f~~t~. OAKWCioiJ-BAP-iisTCHURcIi;-- of. 4315 CHESTNUT STREET, CAMP HILL, PENNSYLVANIA. c. One-fourth (!J thereof unto BARBARA L. HOFFMAN and EARL E, HOFFMAN, of 4501 HAMPDEN AVENUE, CAMP HILL, PENNSYLVANIA. 3.1 bereby nominate, constitute &nd appoint BARBARA L. HOFJ<lI\AN AND EARL E. HO FJ<lI\AN , of 4501 HAMPDEN AVENUE, CAMP HILL, PENNSYLVANIA, as Executors of this My Last Will And Testament and further direct that neither one shall be required to pOEt -8J\.'Y,-'bond..~.-to..--s..e.c...u~<>. t:ng, f'Q1 +hf'111 pRT'f'OT'mRnrlA of' "Air dy.ti~~_i.1l___._~__. 1n the Commonwealth of Penn~ylvania or in any other ....J.uI!..i.sd of ~ + i nn. ...___. ,______ _ _______._ . <c-~J41{~~e1' i? M~ -4_. "I , I do Ii.,'eby make, cO""'titute and appoint BARBARA L. HO F'FMAN and EARL E. HO FFMAN to be Exec1!to.!:!!..-ol this mlllast Will a.nd Testament 1!"II'IT!\'ESS WHEREOF, I, DOROTHY E. ROUSH the Tn:fat aaOVe -named. luwe ker6u.nto slI.bscribed. my name uncI. a.jJi.xed. my seal. th.e 9 th dc.y of OCTOBER 1Ii71C hlln(I1'ed. and eighty nine. in. th.e Y6a.r of OlLT Lord onB thoHsanrf. 1 / t/ ,'J NOfARlAl sw. JfAN A. m~' Notary P ~HIlI Boro, ~mbllrklOd'.eO., Pa. , , ,....'"""",..,"" 1"",,,,. ",",y 3, 1993 ;--.,_ <L/ .(.' // 1 Stgned.. sealed, Pl~bltSh8 .' ed L."(-l reI ft{"-ye.<" . /Lr1v (/1 as (Lnd fOl' ---1LlL...,/l-- . last Will and Testament, in the p1'escncc of l.tlS, 1oho kava hSJ'e 1tnto subsctibed our'1tlllrnes at~/"i,u'i'.r),l Z r~quest as witnesses thereto in the presence of said testat..,j( Cl.n.d of each ot LCt.. . /1f,1-~~~~ j 'I ~ Cl .. ..... 0 ." ~ '" ~ ~ ~ ~ ~ 15 0 ~ ~ ~ ~ cd '" ~ ..... g H la' 0 z '" .. f:-t '" "" . Z ,.., i'iI '" :>< '"'Cl '" 0 '" E 'r, z ~ 0 ~ cd 0 E-< ....... g; cIJ ....... .~ A 0 ,.., ~ 0 ,.., '" H '" ..... ..... '" c 0.. cd ~ :>:: H ~ .. o..l 0 ./ l/ \ " .8 "'" .~ c ~ c '>: '" .~ ~ ,S ." I ~ ." l; ." ~ ~ ~ "'- 'll OJ ;; " ." I ~ ~ ~ 2 '" '" ~ 0. ~ " CODICIL TO THE WILL OF DOROTHY E. ROUSH I Dorothy E. Roush, of 2200 St. Johns Church Road, Camp Hill, PA do make and publish this as a Codicil to my Will dated October 9, 1989. My Will is amended by: 1. Deleting paragraph 2. a. and substituting in its place the following: a. One-quarter (1/4) thereof unto my nephew, Donald V. Rohland, Jr. ' 2. Adding a new paragraph 2.d. as follows: d. One-quarter (1/4) therof unto my grand neIce, Amanda Rohland of Quakertown, P A. In all other respects my Will dated October 9, 1989 shall remain in full force and effect. In witness whereof, I Dorothv E. Rouch._have hereunto set my hand and seal this -:1..,,7'>- day of May, 2001. I~~~. ff~ Dorothy E. Ro Signed, sealed, published and declared by the above named Dorothy E. Rouch as a Codicil to her Last Will and Testament, as aforesaid, in the presence of us, who have hereunto subscribed our names as witnesses in her presence and in the presence of each other. ~ ::;;0 .5~ -Yl~ w . J/.... Signed and sworn to before me a notary public this ::15' day of May, 2001. Notarial Seal Stephanie Gardner, Notary Public Harn~b~rg, Dauphin County My Commission Expires Apr. 28, 2003 ME:mber, Pennsylvania Association of Notaries ..' - -...--.-..-.--..-.---- ._------- .... ~..,.._~-..-.~----_._-_.-.-..'-_. .---