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Home My WebLink About01-0756 PETITION FOR PROBATE and GRANT OF LETTERS also known as ........................................... ........................ ................ No.....7. A ~~H.7.??~. To: Estate of ..................... E T.BE.L...M ..... M.I Z.E L.L............... ............ ..... ... ............................................................................................... ..................................., Deceased. Register of Wills for the C t f /Cumber 1 and th oun y 0 In e Commonwealth of Pennsylvania ... ............ ..... ....... ............... ................. ..... ............... .......................... .............. ..... ... ... ... .... Social Security No. ..!..?4..:::...l~..:-:'.~f.?f.... The petition of the undersigned respectfully represents that: Your petitioner(s) is/are 18 years of age or older and the execut.9.~......named in the last will of the above decedent, dated ~.~~.~...~.~.!............................... 19~.?... and codicil (s) dated .......~.~.z:1.~......................... ... ..... ... ....... ................ ........... ............. ................... ................................. ....... ... .............. .......... ....................................... ....................................... ... ........... ... ......... ... ........ ..... .......... ..... ......................... ... ....... ....... .... ........ .... ......... .......... ........ ................ ................ ........... .... .... .... .... ... ..... ........ ........ ..... .......... ........ ........................... ....... ....... ...... ......... .......... .... .... .................................. .... ............... ........... ..... (state relevant circumstAnces. e.g. renunciation. death of executor. etc.) Decedent was domiciled at death in 9umber lanCCounty, Pennsylvania, with m.r... last family or principal resi dence at ..2. ...shad.y;.. .Lane.. .D.[:j..v.e.,...Me.c han.ic.sb.ur g..,.... S.i I.v. e.I:.. .sp.r:i.ng............... . .r..QW.1J !?h J.P.!....9. ~.~!:?~~J ~.l} 9... ~.~ ~.~ ~.y..~.. J?ff. !}.~~.y.1 ~.?!!. ~f?.............................................................................. (list street. number and municipality) Decedent, then 9J~... years of age, died ......................................l1.~g.\H?t....1.1.....?Q.Ql.................. I~........., t Outlook pointe, Mechanicsburg, Pennsylvania a ....... ......................................................................................................................................... ... ............................... 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 adj udicated incompetent: .... ...no.t.. appl.icable... ............... .... ......... ...... ....... ..... ...................................... ......... Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $..:L.O'.I,.O'Q.O'.~.Q9.................... (If not domiciled in Pa.) Personal property in Pennsylvania $............................................ (If not domiciled in Pa.) Personal property in County $............................................ Val ue of real estate in Pennsylvania /J $.1. !?!\/'~"'''''' ....... ........... si tua ted as follows: ... c ~ 19. ~L. 9.9.9....9. 0..... -!!....(.... $.A .~. &..l '!. ~.f;...... J~: (,?:.......................................................... ...... ...... ........ ........... .... ....... ....... .. .......... ........... /::r.€~!1. 'f.1 i. C2. .6.WY" J.. .. P../f...../.l. ~. ~ S. .. ................ .. .. .......... .. .. ....... WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil{s) presented herewith and the grant of letters .....!: ~ ~.!:~~~.~ ~.~;t:.:y'.. ......... ..........:. :..~:................... ........... thereon. I testamentary; administration c.t.a.; aumi"ni"stration !!;b.n.c.t.a.) . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . "~~ u s: -;-"."' -.. -- "Rfcha~d"" .....ufi1"ch...... ............................ ~~ t ":l s: ..1G~.]... A ;i.~.pGr;.t-. .,&o&d........... ....... ........... .......... s:.2 c~ Bellefonte, PA 16823 ~.. ~p.. ..... EO c s: tlt ii.i OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA I SS 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 representative (8) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this ..J.Q.~.~.......... day of ~~.................................................... ................... .~................ ............... ............. ................................. ~ ; c . .. .. - . . . . . .. .. . . .. .. . . .. .. .. .. . .. . .. .. .. . . .. .. . . .. .. . . . ... .. . . . . .. . .. . .. .. ... .. .. .. .. .. . .. . . .. .. .. . .. . . .... . . . . . . .. . . . . .. .. . . . . . . . . . . . . . .. .. . . .. . . . . ;: No. ..21::,.o.L~7.56... Estate of .. ..... .~~~J:J1..l1..MIZ.ELL................... ................ ..., Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW, ..............~~~~.~}'...~.?.......... Jf~..~~.9}.., 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 . .... .... .... .... ...:!.~~~. ..?~...... .~. ??~. ................... .......... ........ ............ .... ........................................................... ......., described therein be admitted to probate and filed of record as the last will of ............................................ ETEHL M MIZELL . ............... .... ......... ........ ............... .......... ............................... ................................ ..-. ................... ........ .................. ........ , and Letters ........................ ..I~~I~~~!;~~........... ... ...... ...... ............... ......... ....... ......... ... .... .... ........ ... ..... ..... .... ......... are hereby granted to ... ........... ........... .~.l.C.~..JJ1.R.I(;.JJ......... ..... .... ..... ........... ................ ........ ..... .................... ..... ~.~/-':-d.~~. ( / /egwtef of Wills ......y.uuuT FEES Jt;ltfl It. 15tf !t'v- Probate, Letters, Etc. .. $.....fJJ.~.9.9... JCP FEE . . $.......19.:.9.9... 3.00 . . $.................... . $..........~.:.9.9... ATTORNEY (Sup. Ct. I.D. No.) I(JI Tit'IOVt~{tP1t ~/vJ Surl-e '4 ~(( ............. ............ ................}.................~..... .......J.......... ADDRESS 5kfe. Cof':Jtj /114 I tEe3 .~!.~..:..;,?,} .2..-:'.. [f. ~ .lJ.f......... ........ ........... ............. PHONE Short Certificates ( ) x-pages Renunciation TOTAL. . . $.....~1.~.~.9.9... Fil ed .............. ..AU~JJ.S.T... tQ~...~ R RJ........................_. 21-01-756 REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS codicil (each) a subscribing . ess to the will presented herewith, (each) being~q~alified according to /~ law, depose(s) and say(s) t present and saw // signed as a witness at the . the presence of each other) (in the presence of the the testat , sign the same and t request of testat_ in h other subscribing witness(es)). Sworn to or affirmed an me this ubscribed before day of 19_ (Address) Register (Name) (Address) REGISTER OF WILLS OF COUNTY OATH OF NON-SUBSCRIBING WITNESS UO h "1 fA. 4 73<< K~1V- (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that he is familiar with the signature of ETHEL M MIZELL xXXJdictkx test at rix of (one of the subscribing witnesses to) the will presented herewith and ~lCxx that he believes the signature on the will is in the handwriting of ETHEL M MIZELL his (Address) (Name) (Address) 21-01-756 REGISTER OF WILLS OF 0JJmkr/flM COUNTY OATH OF SUBSCRIBING WITNESS elc;rks F. Sh,'~d.s- ~ eeElieil (each) a subscribing witness to the will presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that Iv tvtr/5 present and saw F#R/ /J(. !l//'ZI?!/ the testat"'; X , sign the same and that ~ signed as a witness at the request of testat.DA..- in h~ rr presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before ~ .f{~-;g;::? me this 14th day of ~ C/ouser R.r.' (Name) lI/ecHqH,'o:tw~ ~ 7rfUGUST ~ 2001 I ~5J ~r?l<~"'~'/Ili ~ (Address) Register (Name) (Address) REGISTER OF WILLS OF COUNTY OATH OF NON-SUBSCRIBING WITNESS (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that familiar with the signature of codicil testat_ of (one of the subscribing witnesses to) the will presented herewith and codicil that believes the signature on the will is in the handwriting of to the best of knowledge and belief. Sworn to or affirmed and subscribed before me this day of 19_ (Name) (Address) Register (Name) (Address) 10'i.80'i REV 9/8(, This is to certify that the information here given 1S correctly copied from an original certificate of death dul~ filed with me as Local ~egistrar. The original certificate will be forwarded to the State Vital Records Office for permanent tilmg. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 p 7555610 No. 21-01-756 (~~~~ ~~D~~n Local R glstrar l{-c1~ ~ dc:YJ / Date HIllS ;4JAev 2/87 COMMONWEALTH OF PENNSVlVANIA · OEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH i\' PfJPRINT IN PEAIoIANEHT Bl.ACK INK NAME OF DECEDENT ct... _. LHI SEX a. Female AGE (La.. 8ot1r>oayt UNDER' YEAR -.. o.ra UNDER , DAV -- 1-" BIRTHPlACE (Cdy atl<I 5IaIe Of FCl.ogn CounuYl Spring MiII~, 96 YIS I. COUNTY OF DEATH ... Cumberland DECEDENT'S USUAl OCC\JPlVlON (~=:~:.. ':::::.J.:T . I1L Assistant Personnel ft.. OEaOENT'S MAIlING ~etor", c.v"-'. ~. Z1pCodel 2 Shady Lane --..co.ono Mechanicsburg, Pennsylvania 1705 --I us DECEDENT EveR IN US AAIoIED FORCES? .....0 No!] Pennsvlvania STAll F'lI_R SOCiAl SECURITY NUMBER 3. 176 - 16- DATE OF OEATH ,_. Oa~._l August 4, 2001 ="v,O RACE....__._.WIlll.. "'" (Specoly, White IolAflITAl swus._ -...... --.... ~(Spdyt 14. Widowed 17e.[j ....___.. Silver Spring SURVIVING SPOuSE (...... gr;e__, 1'/10. Did -- .,. in. Cumberland -.oIlip? ,7..0 ~-==':::ol MOTHER'S NAME IF... _. -.Sur_, ~ 'e. FRllER'S NAME (Fir... MCIdIe. Lasll ,... 1NF00000000'S NAME (T ~onlI Franklin S. Musser Richard D. Ulrich II. Margaret Runkle 1Nf0000000T'S IoIAlUHO ADOAESStSlr... CiIyIbon. SIIIIt. ZipCodel . 1023 Air rt Road Bellefonte, Pa. 16823 PlACE OF DlSPOSITlON. II.- 01 c-.r" Ctemolaly lOCArlON . CilyITown, sw.. Zip Code 0< 0IIl0t ~ ~ fil ~ o ... o '" ~ z ate. FD-014318-L I : ~tW9t'v~ f/1A~~ r-==tJ,) 1.r" ~ASAC~QUENCE 00:. 40 "....) t"1t?.:rJ'S DUE 10 lOR ~ A CONSEOUE;NCE 00: tfi;tlt/r'cr~ ..J7J-h (OR AS'" CONSEQUENCE 00: WERE AU10PSY FINDINGS ~PAIOR1O COM'\.ETION OF CAUSE OF DEATH7 _R Of' DEATH / Mol.... G( _ 0 _ide 0 DATE OF INJURY (Mono.. 0.-" _I _. 0 P.-.g 1n~lion 0 Could "'" be de'.,moned 0 _0 NoD ale. a-.. :no CEllTIFlER IChecil oRy one) -CERTIFYING PHYSICIAN {Ph)'SOrancerlifylng ~ r:J dealh wOen JJ\OIn8f ph';SlC.atl has pl'ooounced dealh dOO complete<! Item 231 T...._..""--...,.._OCC__Io....cauHl...nclmo.....'...la,................... . .PRONOUHC&NG ANO CERTIf'YING ItttYStCIAH IPtlyslI(:tan t>oth ."onO\J(lC.og oedlh .md L..lllYlIl9IO cause of ~alt\\ To Ihe.... ofm, kAowledg_, death occ..,," ..Ihe...... dille.llnd place. and due to 1M cauMta) and mann.,.. a.aled.. '1lIE0lCAl. EXAMINER/CORONER On the basi. ore.amina'lon andIOf 'Ry.aUg.'ton. in my opinion. death ocCur'ed .. theUme. da,., i1nd pl~c.. and due to .he c.u..(a).net manner a. ...,...,. . . . . . . . . . . . . , . . . . . . . _ _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3'. ~.iliil .... Heckman Cemetery _ AND AIlDAESS OF FACIUTY 221:. M ers Funeral Home LICENSE NUM8ER Spring Mills, Pennsylvania 21.. ;la" / :II. . """""'...... ..... between :--- I I ff: No~ PART .: 0IIl0t oigniIIconI_-.buling 10 _.... bul .... --.g in _ ~ coo.. givM in PlUl'TI (l.AYnJn,*'L-f A-t-4ul<f ) ~tt=t;,)~ / TIME OF INJURY INJURY IIilVoIORK7 DESCRIBE HOW INJURY OCCURRED. _ 0 NoD 34. J .. LAST WILL AND TESTAMENT OF ETHEL M. MIZELL 21-01-756 I, ETHEL M. MIZELL, of the Township of Silver Spring, County of Cumberland, and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament, hereby revoking and making void all former Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon as conveniently may be after my decease. 2. give and bequeath the sum of One Thousand ($1,000.00) Dollars to each of my hereinafter-named grandnieces and grandnephews: Patricia Postle, Peggy Appleholm, Kent Ulrich, Tom Ulrich, Karen Baker, Linda Glantz, Denise Dissinger, Lori Beistline, Sharon Behrendt, Drew Musser, Janie Wiedman, Candy Snyder, Chuck Musser, Susan Paris, Diane Reumont, ~~: ..... ~ ill._....:wn. Should any of the above-named grandnieces or grandnephews have predeceased me and have been survived by children, then their children shall take their share per stiroes. Should any of the above-named grandnieces or grandnephews have predeceased me without surviving children, then their share shall lapse and become part of the raddue here!r.. AQ~ ~""' ~~ ~))O ~e ~~ ~.JI ~ ~ ~ -e.. .l--~~ I-<~ ~.s-frvI ~ ~ ~ A<f -~'~:!; J <;-~ jlIr -yv U' ~~ All the rest, residue and remainder of my Estate, rea, personal and mixed, whatsoever and wheresoever situate, shall be converted into cash and distributed as follows: ML-~~ (Xt 2~V"7~ A. T9r:l (1 Q~5) per l (fL. _.!f r -' eo, ..I\oIvlIY t, "'I ..J~w, '!y~ VVl Kenneth Ulrich. ~ .. J.A U) tJ}{L,~ {/~ /f:.w'r ~ B. Tt::1l (10~0) per cent thereof to my nephew, Richard Ulrich. t7/U~ {Yq)t,V#~ c. Ten (1 o~q t:)cr cent thereof to Darrell Eichorn, widower of my niece, Lucille E:;~~ (k)p::;:;/' ~ D. TeA (1 O~(,) 1ger com thereof to my nephew, Ned C. Musser. ~~ (jt,)~~yp< E. ;r en (1 O<}h) per cent thereof to my nephew, Ray F. Musser. ~-~ (Y/f)~~ F. ::reR (10~{,) per OCRt thereof to my nephew, Dean Musser. na-~ (/)1) ~~ G Tell (1 Oio) JJ'" c.el. t thereof to my greatnephew, Kris Kauffman. n@-~ ry~) ~~ H. l'en (10~b}.Iger eent thereof to my greatnephew, Andrew Glantz. ~~ (f1I) t,.~ I. ~n (10~(') ~er eent thereof to my greatnephew, John Baker. Should any of my above-named residuary beneficiaries have predeceased me and have been survived by children, their share shall go to their surviving children Wll. stirpes. Should they have predeceased me and not have been survived by children, then their share shall be , f,. ~\ r-r1. ~ I ):;L. <.1 . , .j ~ ~ proportionately divided among my residuary beneficiaries who do survive me. 4. I nominate, constitute and appoint my nephew, Richard Ulrich, to be the Executor of this, my Last Will and Testament. In the event that he should predecease me, or for any other reason be unable to act, or to continue to act, as such Executor, I appoint John 10. Baker, to be the Executor in his place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. 5. I authorize and empower my personal representative, in his sole and absolute discretion, to purchase or otherwise acquire and retain any investments of which I die seized, or any real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of, or grant options in regard to any or all property of any kind forming a part of my Estate for such terms and such prices as he may deem advisable; to borrow money for any purposes connected with the protection and preservation of my Estate; to mortgage or pledge any real or personal property forming a part of my Estate; or to join in or secure the partition of same; to compromise any claims or demands of my Estate against others or of others against my Estate; to make distribution in kind and to cause any share to be composed of cash, property in undivided fractional shares in property different in kind from any other share; and to execute and de!!ver such instruments as may be necessary to carry out any of these powers. IN WITNESS WHEREOF, I have hereunto set my hand and seal thisc:?GJday olr ~ $ hV~ (~)~ i1! lew{/tJA>)jku~ ~ ~ L.L_ Iz?L -' ~ (/ < -r~ ~ ---~~_-"2:TI~...!!L__(SEAL) Ethel M. Mizell :..~-~ Signed, sealed, published and declared by the above-named ETHEL M. MIZELL, as and for her Last Will and Testament, in the presence of us, who at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. ~--L-J1) ~~--------~-----~/ ------ E ,. -.. CERTIFICATION OF NOTICE UNDER RULE S.6(a) Name of Decedent: Ethel M. Mizell Date of Death: 08/04/2001 21-0f';,676S -, ~ Estate Number: 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 beneficianes of the above-captioned estate on September 7,2001. Name Address 400 N. Market St., Mechanicsburg, PA 17055 R.D. #2, Box 271, Sunbury, P A 17801-9537 617 E. Pine St., Palmyra, P A 17078 226 S. Reading Rd., Ephrata, P A 17522 5405 Taneytown Pike, TaneytowI},.MD 21787-1925 98 Margaret Dr., Mechanicsburg, PA 1705?:'t1734 1023 AIrport Rd., Bellefonte, P A 16823 . P.O. Box 15, Boalsburg, PA 16827 7317 Fox Rd., Raleigh, NC 27604 400 N. Market St., Mechanicsburg, P A 17055 217 W. Curtin St., Bellefonte, P A 16823 1310 First Avenue, Centre Point, IA 52213 2056 Middlebridge Rd., Silver Spring, MD 20906 2 Bridgefield Court, Luthersville, MD 2109..3 540 Lancaster Gate, 3217 Lancaster Ring Rd., Fredericksburg, VA 22408 619 W. Elm St., Palmyra, PA 17078 320 W. Main St., Rear, Palmyra, P A 17078 1217 Coventry Ave., Ventura, CA 93003 904 S. Franklin St., Palmyra, P A 17078 16 Heritage Rd., Akron, P A 17501 218 E. Walnut St., Ephrata, PA 17522 1 Garden Spot Dr., Stevens, P A 17578 1102 S. 27th St., Fort Dodge, P A 50501 6108 Chowen Ave., S., EdIna, MN 55410 6324 70th Ave., N. Brooklyn Park, Minneapolis, MN 55429 Andrew Glantz Kris Kauffman Dean Musser Ray F. Musser Ned C. Musser Darrell Eichorn Richard D. Ulrich John U. Baker Susan Paris Linda Glantz Karen Baker T om Ulrich Diane Reumont J 0 Lynn Karantzalis Brad Baker Sharon Behrendt Lori Beistline Chuck Musser Denise Dissinger Janie Weidman Candy Snyder Drew Musser Kent Ulrich Peggy Appleholm Patricia Postle ... -2- Notice has now been given to all persons entitled thereto under Rule S.6(a) except: N/ A Date: September 7, 2001 . Ba er, EsquIre Lee artin, Green & Reiter, Inc. Innovation Blvd., Suite 311 State College, P A 16803 Telephone: (814) 237-6291 Counsel to personal representative(s) ) COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS COURT DIVISION IN RE: ESTATE OF ETHEL M. MIZELL) late of Silver Spring Township, ) Cumberland County, ) Pennsylvania ) Estate No. 2101-0756 FAMILY SETTLEMENT AGREEMENT ~'- This Agreement executed this 25th day of August, 2002, by and betweeg' RICHARD D. ULRICH, of 1023 Airport Road, Bellefonte, Pennsylvania 16823, Executor and Beneficiary of the Estate of Ethel M. Mizell, AND RAY F. MUSSER, of 226 S. Reading Rd., Ephrata, Pennsylvania 17522, Beneficiary of the Estate of Ethel M. Mizell, AND DEAN MUSSER, of 617 E. Pine Street, PahnYfa, Pennsylvania 17078, Beneficiary of the Estate of Ethel M. Mizell, AND NED C. MUSSER, of 5405 Taneytown Pike, Taneytown, Maryland 21787-1925, Beneficiary of the Estate of Ethel M. Mizell, AND DARRELL EICHORN, of 98 Margaret Drive, Mechanicsburg, Pennsylvania 17055- 1734, Beneficiary of the Estate of Ethel M. Mizell, AND KRIS KAUFFMAN, of RD #2, Box 271, Sunbury, Pennsylvania 17801-9537, Beneficiary of the Estate of Ethel M. Mizell, AND JOHN U. BAKER, of P.O. Box #15, Boalsburg, Pennsylvania 16827, Beneficiary of the Estate of Ethel M. Mizell, AND ANDREW GLANTZ, of 400 North Market Street, Mechanicsburg, Pennsylvania, Beneficiary of the Estate of Ethel M. Mizell. Background 1. Ethel M. Mizell died August 4, 2001, a resident of Silver Spring Township, Cumberland County, Pennsylvania, leaving a Last Will and Testament dated June 26, 1998. A true and correct copy of said Will is attached hereto and made a part hereof and marked Exhibit "A" . 2. Under said Will, the Decedent appointed Richard D. Ulrich as Executor of her Estate. 3. Said Will was probated by the Register of Wills of Cumberland County, Pennsylvania, and Letters Testamentary were granted thereon to Richard D. Ulrich on August 4, 2001. 4. The Executor has proceeded with the administration of the Estate by taking charge of the assets of the Decedent; paying the legal debts of the Decedent; filing a Pennsylvania Inheritance Tax Return; and, paying the calculated tax due. 5. The Decedent's Will provided for distribution of $1000 to each of eighteen named individuals and provided that the residue of her Estate be divided equally among the parties hereto. 6. Attached hereto and made a part hereof and marked Exhibit "B" is a summary of the administration of the Estate by the Executor. 7. The parties hereto being all of the beneficiaries of the Decedent, by the execution of this Agreement, have agreed that the Executor may proceed to make distribution of the residue of the Estate of the Decedent without the necessity of filing a First and Final Account with the Orphans Court of Cumberland County in order to expedite the distribution of the remaining assets of the Estate to the said beneficiaries. NOW, THEREFORE, the parties hereto intending to be legally bound hereby, mutually agree as follows: 1. The parties hereto, and each of them, agree and acknowledge that they are satisfied that the Estate of the Decedent has been administered according to law and that distribution of the residue of the Estate of the Decedent shall be made by the Executor directly to the beneficiaries without the necessity of filing First and Final Account and Schedule of Distribution with the Orphans Court of Cumberland County. 2. The parties hereto, and each of them, agree and acknowledge that all expenses itemized on Exhibit "B" not heretofore paid shall be paid the Executor as a part of the expense of the administration of the Estate. 3. The parties hereto, and each of them, agree and acknowledge to the balance remaining for distribution as shown on Exhibit "B" shall be distributed by the Executor as stated therein. 4. The parties hereto, and each of them, agree and acknowledge that the personal property and household goods of the Decedent valued at $7,000 per an appraisal by the Executor has been distributed among family members in a manner satisfactory to all parties. Said amount, although shown on the inheritance tax return, has been omitted from the list of Estate assets set forth on Exhibit "B". 5. The parties hereto, and each of them, agree and acknowledge that the amounts to be distributed as recited may be increased as of the date of distribution because the funds are presently maintained in interest-bearing investments or reduced in order to satisfy any outstanding expenses that may arise. 6. The parties hereto, and each of them, agree and acknowledge that by the execution of this Agreement, they do hereby acquit, exonerate and discharge the Executor and agents thereof of the Estate of Ethel M. Mizell, and each other individually, of and from all actions, suits, claims or demands, and further releases and discharges the Executor from the performance of any further duties with respect to the administration of the Estate of Ethel M. Mizell, except for the distribution of the residue of the Estate in accordance with the terms of this Agreement. IN WITNESS WHEREOF, the parties hereto, intending to be legally bound hereby, have hereunto set their hands and seals the day and year first above written. ------ Wl'tNESS~ . EfJ..) ll1C~ D. uLll1C}{, individually and as E",ecutor of the Estate of Ethel }O\. }o\w:\l tr (SBAL) <'[;~ e ~ DBAN ~\JSSBll (SEAL) (SBAL) " (SBAL) SBAL) (SBAL) (SBAL) Vl t\NDllE\1V GVJ"ffZ COMMONWEALTH OF PENNSYLVANIA ) ) SS: COUNTY OF CENTRE ) ON THE, the :J.~ day ofh~ . 2002, before me, a Notary Public, the undersigned officer, perso ally eared Richard D. Ulrich, Dean Musser, Ned C. Musser, Ray F. Musser, Darrell Eichorn, Kris Kauffman, John U. Baker, and Andrew W. Glantz known to me (or satisfactorily proven) to be the persons whose names are subscribed to the within instrument, and acknowledged that they executed the same for the purpose therein contained. IN WITNESS WHEREOF, I have hereunto set my hand and official seal. My Commission Expires: J ~ NO~ Notarial Seal Mary Ann Bjalme. Notary Public Bellefonte Boro. Centre COUDty M Commiuion ire5 Mar. 2.5. 2005 MIn"tbIf, PtnnIyIYInll A8sOCIItIOn of NotarI8t - LAST WILL AND TESTAMENT OF ETHEL M MIZELL I, ETHEL M. MIZELL, of the Township of Silver Spring, County of Cumberland, and State of Pennsylvania. being of sound and disposing mind, memory and understanding, do make. publish and declare this to be my Last Will and Testament, hereby revoking and making void all former Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as sopn as conveniently may be atter my decease. 2. I give and bequeath the sum of One Thousand ($1,000.00) Dollars to each of my hereinafter-named grandnieces and grandnephews: Patricia Postle, Peggy Appleholm, Kent' Ulrich. Tom Ulrich, Karen Baker, Linda Glantz, Denise Dissinger, Lori Beistline, Sharon Behrendt, Drew Musser, Janie Wiedman, Candy Snyder, Chuck Musser, Susan Paris, Diane Reumont, ~~. 'IV ....,11. ...~..". Should any of the above-named grandnieces or grandnephews have predeceased me and have been survived by children, then their children shall take their share wu:~. Should any of the above-named grandnieces or grandnephews have predeceased me without surviving children, then their share shall lapse and become part of the :'~c!d:.:c herein. A P "ID ~....... ~ ~ ~a '\,"'-\ ~"iI- ~ -er<.r JI ~'VVY'<Y'l , ~~ ~-e...l.-~~ I.{At~~~-~~ ~ ~ ~b.- ,~ ,'l~~ .'::' ) ~:-ji 1Je~1 \ l)., ~ ~-"'" :P" ' ' ~~ -:, ~ VV' All the rest, residue and remainder of my Estate, rea, personal and mixed, whatsoever and wheresoever situate, shall be converted into cash and distributed as follows: t#U-~ (Yet )f:.~ ~ A Ten (19%) per ~ llr~~r ~ U.. .~l",un 'I, "'I "...;;Kbw, 'i:,..VY\.. vVl Kenneth Ulrich. _ -.d U_) (J}(L.~ {~ IJ:.....,...,~ B. 1't111 (I 0%) per c~nt thereof to my nephew, Richard Ulrich. t7lU ~ (y,,) t, "" ...-re C TeA (1 g%,) pcr earlt thereof to Darrell Eichorn. widower of my ,~-:a..~-.c:-~~' ~ niece, Lucille Eichorn. --?-'('/hJ . tJ'1l2,~~ 1~ t/vr1~ D. Tefl ~~ f'""er eent thereof to my nephew. Ned C. Musser. t>Ja~ r}4)ee~""'< E. .:ren (10%) per cent thereof to my nephew, Ray F. Musser. ~-~ (Y'?)'i:--n~ F. :reA (10%) per seAt thereof to my nephew, Dean Musser. hU"~ (}11) ~~ G T l!1I (16%) fJt::, C&..t thereof to my greatnephew, Kris Kauffman. .na-~ (y,,) t;.~~ H. 1"ell {16%).~er eent thereof to my greatnephew. Andrew Glantz. t>1U ~ (y.,; f.., ~Ie( I. +en (1 0%.) {;.~-e\.."nt thereof to my greatnephew. John Baker. EXHIBIT II All Should any of my above-named residuary beneficiaries have predeceased me and have been survived by children, their share shall go to their surviving children ~~. Should they have predeceased me and not have been survive.d by children, then their share shall be \ t;.~\ ~,'~l~(l ;;,:l · ill ~; .. ,,~ ~~, ~~"~ :;:,j ~.1 :i~ ~~1 utOf1 ~' ~;~~ proportionately divided among my residuary beneficiaries who do survive me. 4. I nominate, constitute and appoint my nephew, Richard Ulrich, to be the Executor of this, my Last Will and Testament. In the event that he should predecease me, or for any other reason be unable to act,' or to continue to act, as such Executor, I llppoint John \D. Baker, to be the Executor in his place and stead. I further direct that they shall not be requir~d to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. . ; 5. j ~~ I ~ ;~ ~~1 \:,',.........'..~..,..:."j ';r; "{:. :.;~ J I authorize and empower my personal representative, in his sole and absolute discretion, to purchase or otherwise acquire and retain any investments of which I die seized, or any real or personal property of any nature; to sell, lease, pledge. mortgage, transfer. exchange. dispose of, or grant options in regard to any or all property of any kind forming a part of my Estate for such terms and such prices as he may deem advisable; to borrow money for any purposes connected with the protection and preservation of my Estate; to mortgage or pledge any real or personal property forming a part of my Estate; or to join in or secure the partition of same; to compromise any claims or demands of my Estate against others or of others against my Estate; to make distribution in kind and to cause any share to be composed of cash. property in undivided fractiol'\~1 shares in pr";.''!rty rliffarent in kind from any other share; and to ~x~cute and del!"'e~ such instruments as may be necessary to carry out any of these powers. IN WITNESS WHEREOF,\ have hereunto set my hand and seal thi"",,6,/{day Of~ ~ $ hU~ (Yt)~ eJt (e.w{;/Jh,)jluJ~ ~ ~~ ~ ..~ cr < ~ ___~'J::.?::b_2:r1~~Jl___(S EAL) Ethel M. Mizell ;.~--- ;J I Signed, sealed. puhlished and declareci by the above-named ETHEL M. MIZELL. a~ and for her Last Will and Testament. in the presence of us, who at her request and in her presence, and in the presence of each other. have hereunto subscribed our names as witnesses. ~--L- - ~~--------~------'/ ------ EXHIBIT "B" SUMMARY OF THE ASSETS AND DEBTS & DEDUCTIONS OF THE ESTATE OF ETHEL M. MIZELL ASSETS 1. 2. 3. 4. 5. 6. 7. Checking Account PNC Bank Sale of PP&L Stock Sale of Morgan Stanley Stock Sale of AllState Stock Sale of Sears Stock Cash Paid to Estate from Real Estate Income Since Date of Death $7,691.66 $3,482.89 $41,598.74 $22,568.04 $26,222.20 $123,685.01 $9,209.13 TOTAL ASSETS $234,457.67 DEBTS & DEDUCTIONS 1. Myers Funeral Home 2. Funeral Flowers 3. Administration Expenses 4. Final Bills/ Dumpster/ Landfill 5. Estate Tax 6. Partial Distribution to Named Beneficiaries $6,515.00 $132.50 $547.60 $1,263.20 $33,425.99 $20,000.00 TOTAL DEBTS & DEDUCTIONS $61,884.29 RECAPITULATION ASSETS DEBTS AND DEDUCTIONS $234,457.67 $61,884.29 Subtotal Less Unpaid Administration Fees $172,573.38 $2..573.38 BALANCE FOR DISTRIBUTION 5170.000 DISTRIBUTION 1. 2. 3. 4. 5. 6. 7. 8. Richard D. Ulrich 1/8 Ray F. Musser 1/8 Dean Musser 1/8 Ned C. Musser 1/8 Darrell Eichorn 1/8 Kris Kauffman 1/8 John U. Baker 1/8 Andrew Glantz 1/8 $21,250.00 $21,250.00 $21,250.00 $21,250.00 $21,250.00 $21,250.00 $21,250.00 $21,250.00 TOTAL DISTRIBUTION 5170..000.00 The final distribution may vary slightly due to the maintenance of certain assets in interest-bearing investments. Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Mizell, Ethel M. No. 21 - 01 - 0756 also known as Date of Death 8/4/2001 . Deceased Social Security No. 176-16-2979 Richard D. Ulrich The PersonafFrepresentative(S)of the above Estate~eceased~ verify that the items appearing in the following Inventory include all of the p~rsonal assets wherever situate and all of the real estate located 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 the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. l!We verify that the statements made in this Inventory are true and correct. l!We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. Personal Representative Signature: ~1f~ A.7/~_ lcar . ~- Signature: Attorney: John U. Baker 1.0. No.: 84529 Signature: Address: 101 Innovation Blvd., Suite 311 State College, PA 16803 Address: 1023 Airport Road Bellefonte, P A 16823 Telephone: (814) 237-6291 Telephone: (814) 355-4253 -------- Dated: ~(dJql62 Personal PrODertv Sears Common Stock 23,135.00 Allstate Common Stock 18,626.00 Morgan Stanley Common Stock 59,108.40 PPL Common Stock 4,540.00 PNC Bank Acct. No. 10-1331-8522 74.31 PNC Bank Acct. No. 50-7011-5121 7,044.94 Reimbursement for pre-paid annual real estate taxes on sale of real estate 572.41 Household goods 7,000.00 Total Personal Property $120,101.06 (Attach additional sheets if necessary) Total Personal Property and Real Estate $245,101.06 , .. Register of Wills of Cumberland County, Pennsylvania INVENTORY continued Estate of Mizell, Ethel M. , Deceased No. 21 - 01 - 0756 Date of Death 8/4/2001 Social Security No. 176-16-2979 also known as Real Estate Real estate situate at 2 Shady Lane, Mechanicsburg, Pennsylvania, sold to David S. & Hermine Horton on November 30,2001 (copy of settlement statement attached) 125,000.00 Total Real Estate $125,000.00 2 /b-~-9 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE \,- BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG. PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISAllOWANCE H>>fr:REDUCTIONS AND~SESSMENT OF TAX 'OZ DATE ESTATE OF .Ol\TE OF DEATH FILE NUMBER COUNTY ACN 06-10-2002 MIZELL 08-04-2001 21 01-0756 CUMBERLAND 101 17 JOHN U BAKER LEE ETAL 101 INNOVATION BLVD STATE COLLEGE PA 16803 * REY-1547 EX AFP [01-02) ETHEL M 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=is4j-ix--AFP--col-:02i--NoTici--oF-'rtiHEifiTANci-"fA'rA-PPRAIsiMENT-;-AL1-Q'wANci-oi----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MIZELL ETHEL M FILE NO. 21 01-0756 ACN 101 DATE 06-10-2002 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. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) 125.000.00 105.409.40 .00 .00 14.691.66 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule 11 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estat. Subject to Tax (91 (10) 10,682.10 1.263.20 (1lJ (12) (13) (14) NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 245,101.06 11 .945 30 233,155.76 .00 233,155.76 NOTE: If an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will reflect figures that include the total of ~ returns assessed to date. ASSESSMENT OF TAX: 15. Allount of line 14 at Spousal rate 16. Allount of line 14 taxable at lineal/Class A rate 17. Amount of line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class Brat. 19. Principal Tax Due TAX CREDITS: (15) .00 X 00 = .00 (16) .00 X 045 = .00 (17) .00 X 12 = .00 (18) 233,,155.76 X 15 = 34,973.36 (19)= 34,,973.36 ..","en I In:l;~.lf" I {+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10-26-2001 CDOO0449 1,547.37 29,400.00 04-30-2002 CDOO1129 .00 4,,025.99 TOTAL TAX CREDIT 34,973.36 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . 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.) 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 NO. CD 001129 DUPLICATE BAKER JOHN U 101 INNOVATION BLVD SUITE 311 STATE COLLEGE, PA 16803 -------- fold ESTATE INFORMATION: SSN: 176-16-2979 FILE NUMBER: 2101-0756 DECEDENT NAME: MIZELL ETHEL M DA TE OF PAYMENT: 04/30/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 08/04/2001 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $4,025.99 I I I I I I I I TOTAL AMOUNT PAID: $4,025.99 REMARKS: RICHARD D ULRICH CIO JOHN U BAKER CHECK# 4552 SEAL INITIALS: DO 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 BAKER JOHN U 101 INNOVATION BLVD SUITE 311 STATE COLLEGE, PA 16803 -------- fold ESTATE INFORMATION: SSN: 176-16-2979 FILE NUMBER: 21-2001- 0756 DECEDENT NAME: MIZELL ETHEL M DATE OF PAYMENT: 10/26/2001 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 08/04/2001 NO. CD 000449 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $29,400.00 I I I I I I I I TOTAL AMOUNT PAID: $29,400.00 REMARKS: RICHARD 0 ULRICH C/O JOHN BAKER ESQUIRE CHECK# 491 5 SEAL INITIALS: PB RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS J .. STATUS REPORT UNDER RULE 6.12 Name of Decedent: '-'lc.e I Ik. r\1('Z ~ II Date of Death: g/~ Will No.: R61I- ()O.,S(, Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State ~ether administration of the estate is complete: Yes ~ No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. lfthe answer to No.1 is Yes, state the following: a. Did the personal r~entative file a final account with the Court? Yes _ No M b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal repyeSentative state an account informally to the"farties in interest? Yes N No 0 F~lIt"b Sttllttftt'vrf" H;1reeVlttnf:- c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the. Orphans' Court and may be attached to this report. Date: *,3 JIJh,z U, Bakt!tr Name ...0 ~-:- ~I r"",tN/f,;"" jJ/wI. 5~ ~J/ Address ~/~ C-II~(j /It ~ f'1J3 (gIU el.Jl- ~~I/ I Telephone No. o _J ::::J ---") . "'Ii I" "': -*"~... Capacity: Q ~rsonal Representative ~ounsel for personal representative ''''l P REV ~ 11DI IX + ('-00) . I -----r.- ~ i lIl::$Ul ID :rllE~ I Gf~ ! ~ ~ : D l / b -c:2Co IFILE NUMBER 21 01 , COUNTY CODE YEAR SOCIAL SECURITY NUMBER 176-16-2979 . REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT , 9 0756 NUMBER 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship z o 1= 4: oJ ::;) ... ii: 4: U UJ a:: 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) COM~~=.i;~T06:~~~;0~ANIA I DEPT. 280601 I HARRISBURG. PA 17128-0601 J ---~[DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAL) I Mizell, Ethel M. JomrnEATFf(MM-DD-YEAR) i DATE OFlJlRTAlMM=DD-YEAR) .08/04/2001 I 09/07/1904 ! (jF);Ppj)CABLE)SUR,iiVTNGSPOUSE'S NAME(LAST. FIRST AND MIDDLE INmAG------------ ... z UJ a UJ U UJ a .._-_._~-~._-~~_..~----~...--~..~ 1. Original Return D 4. Limited Estate D 6. Decedent Died Testate (Attach copy D of Will) 9. Litigation Proceeds Received D 2. Supplemental Return I THIS RETURN MUST BE FILED IN DUPLICATE WITH THE i REGISTER OF WILLS -- ------+--SOCIAL SECURITY NUMBER 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95 D 3. RemiiTri(lerRelurn (date of death priOrTOU::n:lJ2T- o 5. Federal Estate Tax Return Required o 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) .... UlZ UJUJ a:: a a:z 00 Ua.. ~John u. Baker rlRMNAME (If applicable)-~~ ! Lee, Martin, Green & Reiter, Inc. 101 Innovation Blvd., Suite 311 ,State College, PA 16803 irELEPHONENUMBE-R~---.-._-~- --~i · i ",,,,~1.4,--,-2.J7=~9J -c=..,==,==---===--==--,---==,-,-,--~-- 1. Real Estate (Schedule A) (1) 10, Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) (2) (3) (4) 125,000.00:: ------~~_. ,..... 105,409.40: r"_' None None \.. ) (5) 14,691.66 (6) None (7) None (8) 245,101.06 (9) 10,682.10 ---~~~----- (10) 1,263.20 (11 ) 11,945.30 (12) 233,155.76 (13) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 233,155.76 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES x .00 (15) x .045 (16) I 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) z o 1= 4: ... ::;) a.. :IE o U >< 4: ... 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 x .12 (17) 19. Tax Due 233,155.76 x .15 (18) 34,973.36 (19) 34,973.36 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. >> BE SURE 10 ANSWE:R ALL QUESnONS ON REVERSE SIDE AND RECHECK MATH<< Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 2 Shady Lane CITY -M~ch~~i~sbu~~ -~~-~------------------~~--TST A TE P A --- --zip 17055-~--------- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 34,973.36 ytT,40~mr -----134'/.31 Total Credits (A + B + C) (2) 30,947.37 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnterestlPenalty (0 + E) 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (3) (4) (5) (SA) (58) 0.00 4,025.99 4,025.99 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;............................................................................. 0 1m b. retain the right to designate who shall use the property transferred or its income;................................ 0 1m c. retain a reversionary interest; or............................................................................................................ 0 1m d. receive the promise for life of either payments, benefits or care?......................................................... 0 1m 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?......... ...................................................................................................... 0 1m 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?...... 0 1m 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?............................................................................................................... 0 1m IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ----~~ Uriderpenalties ,,(perjury, I declare that I have examined this return. including accompanying schedules and statements. and to the bestof my knowledge and belief. it is true. correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge -~-~-------,----_._.._----~---._-------------- SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS :"'" ADORE~S- 101 It' nnova lon State College I DATE '1 !~C{/~ z _._-~J:r - ~dllL 31f--- A ---- """'0"( . ~ E ESENTATIVE 1023 Airport Road BelIefonfe, P A 16823 Blvd. I Ste. PA 16803 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 99116 (a) (1.1) (i)]. For dales of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)). The statute does not exempt a transfer to a surviving spouse from tax. and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116 (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. 99116 1.2) [72 P.S. 99116 (a) (1)). The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116 (a) (1.3)). A sibling is defined, under Section 9102. as an individual who has at least one parent in common with the decedent, whether by blood or adoption. - LAST WILL AND TESTAMENT OF ETHEL M. MIZELL I, ETHEL M. MIZELL, of the Township of Silver Spring, County of Cumberland, and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do make. publish and declare this to be my Last Will and Testament. hereby revoking and making void all former Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as sOfn as conveniently may be aner my decease. 2. give and bequeath the sum of One Thousand ($1,000.00) Dollars to each of my hereinafter-named grandnieces and gFaf'ldnephews: Patricia Postle, Peggy Appleholm, Kent Ulrich, Tom Ulrich, Karen Baker, Linda Glantz, Denise Dissinger, Lori Beistline, Sharon Behrendt, Drew Musser, Janie Wiedman, Candy Snyder, Chuck Musser, Susan Paris, Diane Reumont, ~~: nw ~-:'I ....:w... Should any of the above-named grandnieces or grandnephews have predeceased me and have been survived by children, then their children shall take their share W mimu.. Should any of the above-named grandnieces or grandnephews have predeceased me without surviving children, then their share shall lapse and become part of the ~:l:::duc herein. A ~ 'D ~o('.... ~ ~ '"';:5-0 .h.......... r.;"iI- \,c. ~ , 2:..,'\;VVoo(Y"> ..-;:"',.;:::::- ~ .-e... }- ~ I-<A'~ '&S;,Jirvl ~ ~ jt- p.b-- _~. ~~ !:--+-;:a l"l~ ~, -;:.-. All the rest, residue and remainder of my Estate, re]: pelsonal and mixed, whatsoever and wheresoever situate, shall be converted into cash and distributed as follows: ~-~ (l't )eV"".-Y'" _____- A reo (1Q%) per '('J.I'C'~ ~=~ -. I., .:1...".. "3i '''' ..wp~w, ~ V"Y\. vVl Kenneth Ulrich. _'.d lJ_) tJXt.1tHfr"I ( ~ ) 'i:.v4 ~ B. -or.." (1 O"l~) per cent thereof to my nephew, Richard Ulrich. (7)U ~ {Ye;} t,l4't vre C. reFl (10%) per 6ent thereof to Darrell Eichorn, widower of my If;) -a.....- <-c.A..... ~ niece, Lucille Eichorn. ~ /_ ) . ~-~ (ft;) ~vr1...-r'- D. TeA (W%} r.,er eeRt thereof to my nephew, Ned C. Musser. ~~ (l'f)~...p~ E. .:ren (10%) per cent thereof to my nephew, Ray F. Musser. ~_~(j/q)~v# F. ..reA (10%) per --Gootthereof to my nephew, Dean Musser. na-~ ry.,) ~~ G. Ten (10')0) ..,." "ell! thereof to my greatnephew. Kris Kauffman. nce-~ (Ytf) ~~~ H. rei, (18%ll'er eent thereof to my greatnephew. Andrew Glantz. t>1a ~ (y.,j t- ~Ie( I. +en (10%t-pe!'~ thereof to my greatnephew. Jchn B3ker. Should any of my above-named residuary beneficiaries have predeceased me and have been survived by children, their share shall go to their surviving children w~. Should they have predeceased me and not have been survived by children, then their share shall be \ t.~\ ~.0"l1~<.1 >j :;'~I ~:Ij ,~;" l~ ~ .~j '~,.'~.1 '".' ., ';.1 i~i1 "J proportionately divided among my residuary beneficiaries who do survive me. 4. I nominate, constitute and appoint my nephew, Richard Ulrich, to be the Executor of this, my Last Will and Testament. In the event that he should predecease me, or for any other reason be unable to act, or to continue to act, as such Executor, I ;}ppoint John \D. Baker. to be the Executor in his place and stead. I further direct that they shall not be requir~d to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. ", ! J a ~ ~ ~~ :."i ,;J :1 .l '1 1 5. I authorize and empower my personal representative, in his sole and absolute discretion, to purchase or otherwise acquire and retain any investments of which I die seized, or any real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of, or grant options in regard to any or all property of any kind forming a part of my Estate for such terms and such prices as he may deem advisable; to borrow money for any purposes connected with the protection and preservation of my Estate; to mortgage or pledge any real or personal property forming a part of my Estate; or to join in or secure the partition of same; to compromise any claims or demands of my Estate against others or of others against my Estate; to make distribution in kind and to cause any share to be composed of cash. property in undivided fractio,,:;!1 shares i" pr"!''1'rty rliflare"I in kind from any other share; and to ~x~cl.!te and del!'!e~ such instruments as may be necessary to carry out any of these powers. IN WITNESS WHEREOF, I have hereunto set my hand and seal thisc:i(,.J(day Ofr ~,$ hU~ (l!i)~ e7f 1ew{/L1~)~~ ~ ~~ ~~ ~ ,cr, < ___~2:::?:b_'2:Il~~-A___(SEAL) Ethel M. Mizell '--z;==--=- I ~ ! I Signed. sealed. puhlished and declareo by the above-named ETHEL M. MIZF.LL. as and for her Last Will and Testament, in the presence of us, who at her request and in her presence, and in the presence of each other. have hereunto subscribed our names as witnesses. ~--L- - ~g . SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT , .'---___.__~__.-_____~_______~__..~_.________L__________~__ ESTATE OF i FILE NUMBER I i 21-01-0756 n ________ __________________________ ______~_______________ __________1______________ - ------- 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 wl1icli is jointly-owned with right of survivorship must lJe disclosed on schedule F. Mizell, Ethel M. ~_._--~ -~_._-----~------~-~-~._-----_._-~---------~--_._-~ ITEM NUMBER 1 DESCRIPTION VALUE AT DATE OF DEATH 125,(fob.00 Real estate situate at 2 Shady Lane, Mechanicsburg, Pennsylvania, sold to David S. & HermineI-lorton--- on November 30, 2001 (copy of settlement statement attached) -~----_.__._-_.._~~--,~--~----~-----_.._---_._---- ------~-~---~---_._---------- TOTAL (Also enter on Line 1, Recapitulation) 125,000.00 814-237-5861 L M G ~ R CSC) 5?3 P~2/~3 APR ~5 '~2 ~9:59 A.. Settlement Statement i. Type of Loan 1. 0 FHA 2.0 FmHA 3.0 Conv. Un,,,,, File Numbor Hor'ton '\. 0 VA 5, ~ CO''IV, In3, C. NOTE: T"12 rorm Is fUmlaneo to gIVe YO'" . ctAlSlmont or actual !lIlnl8menl costs. Amount.. paiO 10 ana by tho oaattlomanr &pel'll IIlre snown. Itom~ ma.r1<oCl ~p.o.c.- were Dllla Dul:ilcse 01 CIOSInQ: ,,,.V are sPlawn herB lor Iofonn"tiona' purp08.,8 and 01'0 not InclUoad In th. toealS. Q:':I\I~E."ND: .lmPRESS OF 'SCFlRO'WEf'I: Dn IdS. Had:o..;...1"Id .. Hei'di~.,,,. ~or;tOn:<":':;:,:": :;..: :'~~;'j:';':". .'. .' . P . D .. a_ au, liIa{,t. i ~,..>k. Jf~ lUSt. E. NAME AND ADDRESS OF SELLER: Enil'te of !'th..l "'. loIi %ell cia John V, Baker, !~q.. 101 InnovatIon Blvd. St~t.c CollaGe, PA 15S0$ .,0..... U.3. C)_par,,",,,, o. HO"."'a ..~" u."..~ O"".Ia..",.~, ~ OMII N". ~O~2eG LDIl" Number Mor'tg~g" In.uranc~ Coee Number 1II';'.lIII.~' ANI) 4ElDReSS OF LENDER! G. PROPERTY 2 Shlldy L.An. l.OCATlON: "'..chan I c .burg. PA 17055 H":;zlII.I.I'~liNTARFi'f1 SMlI!'3 & Jlle2oc'~UI.. P.C. " .~JjT:~~=F 10-13 IlIunwna Rl)ad, SU11:C 1\10. I.~O~. PA. 17Q4l I'. SeTn.eMENT DATE: AR NT'OUE 1IeI'6W.>>.r3 2 .,041. ~o. AC.JuSl1lllENT$ FOR ITEMS PAID BY SEl.l.EFI IN ADVANCE: ;','1ll!1;" ~ ,ft. _......w.;..... 10.. OJ. . no.;. ~c~l T~~ 11 aO/Ol-05/30/0Z ",. f:' 1~. G AMOUNT DUE FROM eOFlAoweF\: ;':':AMClUNTPAI ~ IN _HAU" e 125,572.41 ~ac.. ..,. Deltc." o,r ....".'1 ",,'iU'. t'Ttn.C''o~ ~41 ." ".." ,.....,.) 203. EJd.,tnlll tct..",t.) .ake" e..d:lIi_D! 'I. ta~ " ., ._c."... ""e.t aa- lO~" ~." '. lI07. _.~.. 220. TOTAl. PAID BV/FOA BOFlAOWEA: A; T o 507, CI.... IDO. AO.JU5T1\/lENT5 FOFI ITEMS UNPAID "".. AO,JUSTMENTS FOR ITEMS UNPAID BV SELLEF\: a. o. c:I. "Awn ,..... " ,'1'1." : a..." ...,... I. '-'0. 0."/'0_" t&a.. ,. . . '. "till. 2'.... :~,a. ' \olI I. ~10. '*~l<. It,.. . . '.>>l&. ..,:s:. su, ,t5. S"', &~T. :'I PI .. f at If_ t)a I!' 1 nll €JFFtOM) ( 0 TO) BOAAOWER; 303. CASH HUD-l (3-86) - RESPA, HB 4305.2 PAGE 1 814-23?-5861 L M G & R C5C) 5?3 P03/03 APR 05 '02 10:90 ro , n...":" "'Aft . ,'~'..-'.'-_... ....~.,. ~'I" 01_ :..811L L .. "I1IG':1:r;r.0::"'[.. OMS N.a. :II"a:;t-o~e~ :;: ~~~. >.' :.' ,: ";;;:>:".... '00, TOTAL SALES/SAOKER'S COMMISSION OAOCCl ON PRICE I III ...- P.P>IO FROM E10RFlOWER'g FUNDS AT SETT\...EME'NT PAlO FROM SELLER'S FUNDS AT SETTLEMENT OIVISION 01' OMMISSION (LillI!::: l AS FOI..LOWS: .: ~..;::-::.--:": ....: -.' :::.;-:~ ',. .:.;.:.. .'. .-: ..:~:7.~:~;~~:::'~': '. . " IN . NNI: TH L n '~'.A.~"',"'ii,.. .t~; .. eoc..:-tM,,:.:t....': .tfl..~ . "'..., " ... J~;UH1"lIOft, :'t~"'. aOA. U' .'0. .'11 JUo. '" ""'....._.;~ FIT IN AOV .. Men . . ...."rll". ."""'''' ler . '0 ."",Iu," - .., mGl'tt" "';:-::;;::<:};:,"-: .;.,.......... II: eo WIIH L cc.aun rNu\'t.... ~'$ mon''''. 8 . MD.I\t8. '* . mont". 8 S ............ . rno.."h. . . m."' . month. .. . .nt. ..... ~.,.., P'" ",0"'" ~.( ,m;o,..... ... ",0"'" ~'"'.. .. "'0"'''' .....'.'::.......... ,1ft....,...... 1 DO~ M.rUt" f~.: DIY: ..,..a""tV ..",.. "00" ea~n.. ..'I'ae:-QL..tr._. .40(11<.'.....".. ...:..........,.. I.. '0 " .'., . ,. ..... 1 "'''''' "'3. "D7. ",,,o'''.Y. ,... '0 " G~te9 , A3~QC;~tC:. P,~. . N...""'.......~ i,:O.>rnlol. ia.....:....... ,.". es~.. &.As'OCt~to=. P.C. , .t.......ttii...iti.1i'ilIMiI.' 0.__ L. 4. -. c r. . vc IN A N ER .,. ~. .tarn .: ... 250. l""~ ADD N MENT H s: .. , ':lIO::l. ..... .". .e, t:3tJ1l SJ1vq."ltslr1flC1 TllID. Sew.&1" ~9 11130 ,80.. ..b... lilt .oct Tax 11 '" f' T t" &n ,30.. Sarrow.ri 2,684.75 1 387.4 C..'LI."".,,' thala",.,,, ...... I. ,". .... en PflV "'no...<lO_ ."G ........ It i. ... true an" ~Celo.lra'8 at~'.mlllnt G' all r.cetp1:'S I ".... ...e....d . COG, 01 1n. HUD-1 Sent.",.". ,..,..,.".,."'. .... __E~ of Ethel M. MIzell Da..:11/30/01 ::~~~~. / 1SJ:7J 1 _ Rlcnard O. Ul~~c~ ~x~cutDr ..nd diwbuf.omen'. ",&dt ......--.(l....:;e:to).1/30 101 8.r,"._.r~ \-bsf' (9~ D:o,..,ll/ 30/0 1 o...t.: :~::. 7~~-;.~:::'':;::~"' 0...'....."' .h'oh I h.... ...OD....., I. a'.... .."01 .."........ .......nl .. .n.. "JU\...."lo~. In.... 0........ Q' -;- =UD.~'h. lu~d. h 41.0".....)......: ; ~:o;~~"~. 0"'.' :>.."........ ....""" ~~2.!..."'_ G.~8~ . As_oc1a~~ ..C. WARNING: ".It. e,.",. 10 ..."ow'",g'Y ",..,,_ '.1". ",.,.",_",. .. 'he Uf\110d 8Ia'.CI 0" 'hi. .r any otn.r elm"'" UlIfl'fl, Pe";ahl.. uoon 1;00"'...'0\101"1 OQn Inc.lwd. " ""Q an4 rmp,..on, "'.f\(. For d.t.lI. ...; TI,I. ..., U.-' Coal. :!I_Cno" "001 ;I"GI a.c;,t,," 1010, . SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT -_._._--_.~ FILE NUMBER 21-01-0756 ESTATE OF Mizell, Ethel M. All property jointly-owned with right of survivorship must be disclosed on Schedule F. --ITEM--T-...- n_.____n__~________~n~____-_ NUMBER \ DESCRIPTION --r~ Sears Common Stock I ---\- . ; UNIT VALUE 'I' VALUE AT DATE I OF DEATH 46.27r~23,n5-:-00 33.50 I 18,626.00 63.15 i 59,108.40 45.40 I 4,540.00 I I 2 Allstate Common Stock 3 Morgan Stanley Common Stock 4 PPL Common Stock _____~.___ L__~___----_._- TOTAL (Also enter on line 2, Recapitulation) I 105,409.40 I SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mizell, Ethel M. -----~.-!FfL.~ENUMBER ] 21-01-0756 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 PNC BankAcct: No. 10-1331-8522 DESCRIPTION 2 PNC Bank Acct. No. 50-7011-5121 3 Reimbursement for pre-paid annual real estate taxes on sale of real estate 4 Household goods TOTAL (Also enter on Line 5, Recapitulation) VALUE AT DATE OF DEATH - _._~-- - --1'f31 7,044.94 572.41 7,000.00 ~ 14,691.66 . SCHEDlJL.E H FUNERAL EXPENSES & ADIVIINIS1RA TIVE COSlS COMMONWEALTH OF PENNSYLVANIA INHERIT ANCE TAX RETURN RESIDENT DECEDENT L ESTATE OF M' II hiM Ize , Et e . I FILE NUMBER I 21-01-0756 __.______________~..._.______..____.__.__.____.__~_~-_~___u__ Debts of decedent must be reported on Schedule I. --rfEM------ -.---------- . ..-----.-.- . ---.-----. NUMBER. DESCRIPTION . A-:---- [FUNE-RAlEXPENSes:- ------- I Myers Funeral Home, funeral expenses I AMOUNT 2 Garden Boquet, funeral flowers B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 2. Picbaro D TT] d ('1:1 Social Security Number(s) I EIN Number of Personal Representative(s): ?nl-nl- ':lA7f; Street Address 1023 Airport Road City Bellefonte State PA Zip 16823 Year(s) Commission paid 2002 Attorney's Fees Lee, Martin, Green & Reiter, Inc. - John U. Baker 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address State Zip 4. City Relationship of Claimant to Decedent Probate Fees Register of Wills, letters testamentary Register of Wills, short certificates 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. I 2 3 Other Administrative Costs The Sentinel, estate advertising Cumberland Law Journal, estate advertising Seller's share of transfer tax on sale of real estate Total of Continuation Schedule(s) r------. ! 10,682.10 TOTAL (Also enter on line 9, Recapitulation) 6,515.00 132.50 1,000.00 1,000.00 273.00 18.00 112.60 75.00 1,250.00 306.00 *' Schedule H Funeral Expenses & Administrative Cos1s continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mizell, Ethel M. FILE NUMBER 21- 01-0756 4 i Notary fees on sale of real estate 3.00 6 Register of Wills, estimated court costs to conclude administration 7 Lee, Martin, Green & Reiter, Inc., copies, phone, fax, etc. during administration 3.00 250.00 50.00 5 D. Wiest, Tax Collector, tax certification on sale of real estate Page 2 of Schedule H .. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ! FILE NUMBE~--- 21 - 01 - 0756 ESTATE OF Mizell, Ethel M. Include unreimbursed medical expenses. ITEM NUMBER ----1- ..--A~ fvfodgelewski, private nursing care Tor decedellt----~-----. DESCRIPTION AMOUNT 50.00- 2 Brooks Pharmacy, final drug bill for decedent 83.82 3 Young Medical Equipment, medical expense 21.45 4 Pinnacle Hospital, medical expense 11.00 5 Associates Cardiologists, medical expense 2.05 6 Moffitt Heart, medical expense 16.62 7 Verrzion, final phone bill 3.82 8 United Water, final water bill 34.80 9 212.15 10 Silver Spring Authority, final sewer bill PPL, final electric bill 223.15 II York Waste Disposal, final garbage bill 29.34 12 Paul & Linda GIants, land fill disposal 575.00 TOTAL (Also enter on Line 10, Recapitulation) 1,263.20 . i I I I i FILENUMBER ~---- 21-01-0756 SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mizell, Ethel M. i -----~----~~--_._--_.~-------------_._._._-~_._-----~.------,~-- -.---------- I. RELATIONSHIP TO NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT ~__~____ ____~______+--~o Not LisIT....stet(lIL TAXABLE DISTRIBUTIONS (include outright spousal distributions) , Andrew Glantz greatnephew 400 N. Market St. Mechanicsburg, PA 17055 i AMOUNT OR SHARE OF ESTATE -----+---- --- -- ---- NUMBER il/8th of residue 2 Kris Kauffman R.D. #2, Box 271 Sumbury, PA 17801-9537 greatnephew i I II/8th of residue 3 John U. Baker P.O. Box 15 Boalsburg, PA 16827 greatnephew I I II/8th of residue 4 Ray F. Musser 226 S. Reading Rd. Ephrata, PA 17522 nephew II/8th of residue I i i i See Continuation Schedule(s) attached Enter dollar amounts for distributions shown above on lines 15 through 17, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET , ..~--_._----~ -~---- ----.....------.--.-..-- -------~ ,w- SCHEDULE J BENEFICIARIES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ______~SIDE~~~ECE~~_____L __------1 i FILE NUMBER i 21-01-0756 - i RELATIONSHIP TO . A~OUNT ~~ SHAR~ DECEDENT i , Do Not LlstTrustee(s) i OF ESTATE --+---~-------'-------r-------~~~-- ESTATE OF Mizell, Ethel M. i NUMBER 1 I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 5 Ned C. Musser 5405 Taney town Pike Taney town Pike nephew ,1/8th of residue 6 Dean Musser 617 E. Pine St. Palmyra, PA 17078 nephew I/8th of residue 7 Richard D. Ulrich 1023 Airport Rd. Bellefonte, PA 16823 nephew I i 1/8th of residue ! l 8 Darrell Eichorn 98 Margaret Dr. Mechanicsburg, P A 17055-1734 husband of deceased niece iI/8th of residue I i I _________L__________~________~_____ Page 2 of Schedule J