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Home My WebLink About01-0808 PETITION FOR PROBATE and GRANT OF LETTERS aJ.- OJ - 9'09 Estate of Miriam K. Willis also known as No. To: Register of Wills for the I Deceased. County of ("nmnprl ;::Inn in the Social Security No. 203 -10 - 7 7 8 7 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitione$), who is/an: 18 years of age or older an the executor in the last will of the above decedent, dated "A 11 g11 R t- q and codicil(s) dated named , 19....9l- (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumber land County, Pennsylvania, with h pr last family or principal residence at 1700 Ma rket Stxeet.. (Borough of Camp Hill). Camp Hill. Pennsylvania 17011 (list street, number and muncipality) Decendent, then 98 years of age, died at Camp Hill, Pennsylvania 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: 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: Auqust 13 2001 , $ 75.000.00 $ $ $ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary. theron. (testamentary; administration c.La.; administration d.b.n.c.t.a.) '" 0- u c u ~~ "'~ u~ ~u C -00 c'= CU';: _u ~o.. u'- :; 0 '" c 00 r;j Cf~,~~ U{PL, ~ Robert Dickman Willis 7.,01 S011t"h st.onpp "AVrry~r Sfi.~emanstown, A 1 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA I ~ ~ r- :::;:::; COUNTY OF CUMBERLAND J The petitioner(s) above-named swear(~) 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 17-''1-3 affirmed and h ly adI?inister the estate accp.rding to law. V /'~ OQ' :::s l:l - s::: ~ ~ No. 21-01-808 Estate of MIRIAM K. WILLIS , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW Auoust 30th, 2001 , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated Angn1'lt: q, 1993 described therein be admitted to probate and filed of record as the last will of Miriam K. Wi11is and Letters of testamentary are hereby granted to Robert Dickman Wi11is . !bzlx/Jfm2/~ Mary C. Lewls FEES Probate, Letters, Etc. ......... Short Certificates( 1)5 . . . . . . . . . Renunciation ................ x-Pages (4) JCP $ 115.00 $ 45.00 $ 12.00 $ 5.00 TOTAL _ $ Filed A\lg\l~.~. )9.t:l:J..,.?9.9~.. ~.~?~ :'.~~ /Andrew c. Shee1y #62469 ATTORNEY (Sup. eLl.D. No.) 95 127 South Market street, P.O. Box Mechanicsburg, PA 17055 ADDRESS 717-697-7050 PHONE CALL ATTORNEY ANDREW SHEELY U'()<;.~(\C; Q;l':,V (\l.<::r:, 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. t.?<'Vk/ ft{ ~-7~- Local Registrar . Fee for this certificate, $2.00 p 7620534 hUG 2 0 20m Date 21-01-808 :43_ 2187 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH AGE (laoI-Y1 UNDER' YEAR - Doyo SEX female STAll FIlE NUMBER SOCIAL SECURITY NUMBER DATE OF DEATH IMcrM. 0..". ....., NAME OF DECEDENT Ifw.. _.lMl' .. Miriam K. Willis ..203 -10 -7787 '.Au .13 2001 v... UNDER. DIll -1- 8IIlT-..ce (COy.... Stall Ol' FCfIlOf' CounuYJ 98 hiremanstown, P 7. FACIJTY NAME (M noIlMMUIlon. Q1ve"HI and numDerl ="'10 alUN1Y OF OERH Cumberland Co. llECEDENT'SUSUAl.~ I..~~"::':::.l=r ..~tal nygienist . dental DECEDENT'S IoWUNG ADllIlESS(Slr",~. _. z..c-. DECEDENT'S ACTUAL IlESIDENCE (500_ on__ .7e._ _SWUS._ ---. DMocMts-.J ..never married .7..0.....__.. ..... ,,.. Cumberland Co. Old - ..in. -' 1700 Market Street ... Camp Hill, PA 17011 Fo1lI'HEIl.SNAIolEIF...._.latl) Clayton F. Willis . . INFOIlMAHT'S NAME (T-"""l Robert D. Willis ". .... -::.:::.. Camp Hill MQTHEWS NAME {fir." MIdcIe. M8lden Surname) ... Ida Snuman INFOllMANT'SIoWUNO_SS\Slr...~_.Zip~ 204 S. Stonver Ave. ,Shiremanstown,PA 17011 PlACE OFOISPOIllTlON. -.. ..~..." er-.a.y I.OCRION. ~ _. Zip eo. .. au...... ~. ~::;tu..n, m 17008 . . WIISCASE REFERRED TO MEW" ~NE .... '1 F: 'D. _.: 0IlI0r1igllillcanl_~1O_."'" ..._.....-.......-..I'II\RTI. ...0 ~lO~ASA~~~~ f) F d. ~1O~ AS A CONSEOUENCE Of), ~ 10 (OR AS ACONSEOUENCE Of), WEllE AU10PSV FINDINGS UANNEROFDEA7H -...u: PAIOfllO pl. COMI'\.ETlON OF CAUSE 0 OF DEATH' -.. - -.. 0 Ponding- 0 ...}( ....0 ...0 - 0 Could not bI dltWmlMd 0 DA1'l; OF INJURY 1-. Doy._1 TIWE OF INJURY INJURY tt1lMlfl1(' DESCRIBE HOW IOUUIlY OCCUAIlED. .... 0 ...0 ... -- QRTIPIEIl.o- ~ onol -ClRTlFYaIQ PHYSICIAN (Physcancer1lfylng cause ~ dnIh when MQher physIC"'" hapr(lf'1OllnCed death ana competed.ern 231 ..............""tcnow...........OCC.............cauMC.I..-.....,.,.................. ....................... .... ..... ............... ... ... PlACE OF lNJUAV. AI home. 1wm.1ItnI.'adOIy. ofIce _ OlC.,Sp<<olv\ _. .SSK1~D~ ~I/ ~t//I -PIIONOUNCING AND CERTIP'Y..o PHYSICIAN cPhyslaan tloItl ptonounc.ng aeillh oInd(;~ 10 cauM 01 0Nlh' To the.... 01.., k~. ..11\ occ""" at.......... date. ..... ,.... aM due to.... UUM(.. and manner.. ....... 'IIEDICAL EXAIIINIIlICOIlONER On the...... or .....",..Ion and/or Invel....Iieft.ln my opinion, d..... occurreclatlhe time. date. and place. and due to Ih. cauH(a) and manner...ated................................................................................................. . :11.. '. -- . . LAST WILL AND TESTAMENT OF MIRIAM K. WILLIS I, MIRIAM K. WILLIS, having my legal residence at 824 Lisburn Road, Camp Hill, Pennsylvania, do hereby declare this to be my Last Will and Testament, revoking all other wills and Codicils heretofore made by me. ITEM ONE: I direct that all my just debts and the expenses of my last illness and funeral be paid from my estate as soon as practicable after my death. ITEM TWO: I may leave a Memorandum listing some of the items of my tangible personal property which I wish certain persons to have and request (but do not require) that my wishes as set forth in the Memorandum be observed by my Executor. ITEM THREE: I give the sum of Five Hundred and No/IOO ($500.00) Dollars to the following individuals, provided they survive my death by thirty (30) calendar days: A. My sister-in-law, RUTH WILLIS; and B. My friend, RUTH RADABAUGH. ITEM FOUR: I give all of the residue of my estate, of whatsoever nature and wheresoever situate, in equal shares to the following individuals who survive my death by thirty (30) calendar days: A. My niece, MARY ELIZABETH YOVICSIN; B. My niece, LENA M. WILLIS; C. My niece, BETTY WILLIS; and D. My nephew, ROBERT DICKMAN WILLIS. /JM!.7/: ?/t/r:J " ., ITEM FIVE: I appoint my nephew, ROBERT DICKMAN WILLIS, my Executor. In case of his inability or unwillingness to act or to continue to act as my Executor, I appoint my nephew's wife, JANET WILLIS, my Executrix. In case of her inability or unwillingness to act or to continue to act as my Executrix, I appoint my niece, LENA B. WILLIS, my Executrix. I give to my said Executor, in addition to the authority conferred by law, the power to sell any or all of my personal and real property at public or private sale, at such time and for such price and upon such terms and conditions as it may see fit, or in its discretion to retain the same for distribution in kind, and the power, but not the duty, to invest any cash without being limited to "legal" investments. No bond shall be required of any fiduciary hereunder in any jurisdiction. No fiduciary hereunder shall have any liability for any mistake or error of jUdgment made in good faith. ITEM SIX: I direct that all estate, inheritance and other taxes in nature thereof, together with any interest and penalties thereon, becoming payable because of my death with respect to the property constituting my gross estate for death tax purposes, whether or not such property passes under this my Last Will and Testament, shall be paid from the principal of my residuary estate, and no person receiving or having a beneficial interest in any such property, whether under this my Last will and Testament or otherwise, shall at any time be required to contribute to or refund any part thereof; PROVIDED, however, that this direction shall not apply to the taxes on any property included in my estate solely because of a power of appointment thereover which I possess but have not exercised or on any qualified terminable interest or to any generation-skipping transfer taxes. ITEM SEVEN: I realize that Executors and Trustees are given discretion by law to make various elections which affect -2- ~~~~ .. the income and estate taxes payable by estates, trusts and beneficiaries, as well as the relative shares of beneficiaries, such as taking administration expenses as deductions for either estate or income tax purposes, selecting options for the payment of employee death benefits, electing to take qualified terminable interest as part of the marital deduction, selecting alternate valuation dates, postponing the payment of taxes, filing joint income tax or gift tax returns and redeeming corporate stock. The decisions made by my fiduciaries in any of these matters shall be binding upon, and not subject to question by, any affected persons; PROVIDED, however, that if a corporate fiduciary is serving, its decision shall also be binding upon any individual cO-fiduciary. I rely upon my fiduciaries to take into consideration the total income and estate taxes payable by reason of their decisions including those payable by my survivors, and they are authorized in their discretion, but not required, to make adjustments between income and principal as a result thereof. IN WITNESS WHEREOF, I have at Hershey, Pennsylvania, this t:~ \ day of August, 1993, set my hand and seal to this my Last will and Testament consisting of five (5) pages. ~~t'~p~-&,;.-' (SEAL) I AM . WILLIS SIGNED, SEALED, PUBLISHED and DECLARED by MIRIAM K. WILLIS, the above named Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her request and in her -3- '. - ." . presence, and in the presence of each other, have hereunto subscribed our names as witnesses. Residence s~ f"\\~ ~-.3~ I (-6~7}~t~ Resid4nce III (jJ. f!M~1 I fJII-/7a53 -4- '" . ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA . . :SS COUNTY OF DAUPHIN : We, MIRIAM K. WILLIS, ~ L~ and E. Si iUtOLE , Testatrix and witnesses, respectively, whose names are sig ed to the attached and foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her last will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the will as witnesses and that to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ;;?t//:'-h~~' TESTATRIX Subscribed and sworn to and acknowledged before me by MIRIAM K. WILLIS, the Testatrix, and subscribed and e me by L- witnesses, on this I NOTARIAL SEAL CONNIE L. REESE, Notary Public Derry Twp., Dauphin County My Commission Exoires Feb. 20,1995 -5- .. C; CERTIFICATION OF NOTICE UNDER RULE 5.6(a) NAME OF DECEDENT: MIRIAM K. WILLIS Date of Death: August 13, 2001 will No. 0808 Estate No.: 21-01-0808 To the Register: I hereby certify that Notice of Beneficial Interest required by Rule 5.6(a) of the Orphans Court Rules was served or mailed to the following beneficiaries of the above-captioned Estate on September 11, 2001. Joanne Choyka Great-Niece 14 Bridge Lane Collegeville, PA 19426 Susan Kegerise Great-Niece 11 Chancelet Court Rockville, MD 20852 Kathy willis 7211 Audubon Drive Harrisburg, PA 17111 7211 Audubon Drive Harrisburg, PA 17111 David willis Robert Dickman willis Nephew 204 S. Stoner Avenue Shiremanstown, PA 17011 Mary Elizabeth Yovicsin Niece 31 Edith Road Framingham, MA 01701 Betty Willis Niece P.O. Box 567 Steelton, PA 17113 Lizabeth Roberts Great-Niece 1591 Woodhaven Drive Hummelstown, PA 17036 Lena M. Willis Niece 326 Caracus Avenue Hershey, PA 17033 Ruth Radabaugh Friend 5500 Wertzville Road Enola, PA 17025 , Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: NONE Date: November 27, 2001 Andrew C. Sheely, PA ID NO 62469 P.O. Box 95 127 S. Market Street Mechanicsburg, PA 17055 717-697-7050 Counsel for Personal Representative, John A. Bistline, Jr., Executor Estate of Myra M. Bistline COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2B0601 HARRISBURG, PA 17128-0601 REV-1162 EX( 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SHEELY ANDREW C ESQ PO BOX 95 MECHANICSBURG, PA 17055 n_h_n fold ESTATE INFORMATION: SSN: 203-10-7787 FILE NUMBER: 21-2001- 0808 DECEDENT NAME: WILLIS MIRIAM K DA TE OF PAYMENT: 11/13/2001 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 08/13/2001 NO. CD 000516 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $12,000.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: ANDREW SHEELEY CHECK# 2 SEAL INITIALS: AC RECEIVED BY: $12,000.00 MARY C. LEWIS REGISTER OF WILLS REGIS1~R OF WILLS /?-~'<:..3 ""' COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHEPcITANCE TaX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ANDREW C SHEELY 127 S MARKET ST PO BOX 95 MECHANICSBURG '02 jUri 1 (] DATE ESTATE OF DATE OF DEATH FILE NUMBER '\':3 :IJ 7 COUNTY ACN \.. PA 170.5: '* REV-1547 EX iFP COI-02' 06-04-2002 WILLIS 08-13-2001 21 01-0808 CUMBERLAND 101 MIRIAM K 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 ~ REV:is'4,-i3f-AFP-(fff':02Y-NOYici--OF-YtiHiifiTANCE-TAi-jfPPRA-isiiiiNi':--Ai.:DiwAifcE-Cri----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WILLIS MIRIAM K FILE NO. 21 01-0808 ACN 101 DATE 06-04-2002 TAX RETURN WAS: ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL AND SUPPLEMENTAL 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) 4. Mortgages/Notes Receivable (Schedule D) (4) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due C DITS: APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) UO) NOTE: DATE 11-13-2001 04-26-2002 + INTEREST/PEN PAID (-) 631. 58 .00 AMOUNT PAID 12,000.00 942.06 NUMBER CD000516 CD001116 INTEREST IS CHARGED THROUGH 06-19-2002 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM RETURN NO. 01 . 00 NOTE : To insure proper 42 ,360.72 credit to your account, . 0 0 subllit the upper portion .00 of this forll with your 68,944.43 tax paYllent. .00 .00 (8) 111,305.15 11,381.22 664.06 Ul) (2) (3) (4) 12.045 28 99,259.87 .00 99,259.87 .00 .00 .00 99,259.87 X 00 = X 045 = X 12 = X 15 = .00 .00 .00 14,888.98 14,888.98 (9)= TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 13,573.64 1,315.34 7.98 1,323.32 · 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.) REV-1470 EX (6-88) "* . INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENT'S NAME FILE NUMBER Miriam K. Willis 2101-0808 REVIEWED BY ACN CHARLES WRIGHT 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES Zero out the original return and accepted supplement return. ROW Page 1 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2B0601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. e D 001 1 1 6 DUPLICA TE SHEEL Y ANDREW C ESQ PO BOX 95 MECHANICSBURG, PA 17055 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- fold ---~------ -------- 101 I $942.06 ESTATE INFORMATION: SSN: 203-10-7787 I i FILE NUMBER: 2101-0808 I DECEDENT NAME: WILLIS MIRIAM K I DA TE OF PAYMENT: 04/26/2002 I POSTMARK DATE: 00/00/0000 I COUNTY: CUMBERLAND I DATE OF DEATH: 08/13/2001 I I TOTAL AMOUNT PAID: $942.06 REMARKS: ROBERT K WILLIS C/O ANDREW C SHEELY ESQUIRE CHECK# 11 INITIALS: VZ SEAL RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS I REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ANDREW C SHEELY ESQUIRE POBOX 95 S MARKET STREET MECHANICSBURG, PA 17055 n____n fold ESTATE INFORMATION: SSN: 203-10-7787 FILE NUMBER: 2101-0808 DECEDENT NAME: WILLIS MIRIAM K DA TE OF PAYMENT: 05/13/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 08/13/2001 ACN ASSESSMENT CONTROL NUMBER 101 TOTAL AMOUNT PAID: REMARKS: ROBERT D WILLIS C/O ANDREW C SHEELY, ESQUIRE CHECK#15 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS REV-1162 EXI11-96) NO. CD 001169 MARY C. LEWIS REGISTER OF WILLS AMOUNT $1,315.36 $1,315.36 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 ~HARRISBURG' PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT '* REY-I607 EX AFP (01-021 ANDREW C SH~ Y ,jU~ 1 0 '\ 8 127 S MARKET ST PO BOX 95 i.. MECHANICSB~~i PA 17055 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 06-03-2002 WILLIS 08-13-2001 21 01-0808 CUMBERLAND 101 MIRIAM K Allount RelliUed 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 =i6(fj-E3fAFP--(oy:02y------...--iNifERi'~fANcE--TA3f-sTAYEME-NT-'ifF-Ac-cou'NY--...--------------------- ESTATE OF WILLIS MIRIAM K FILE NO. 21 01-0808 ACN 101 DATE 06-03-2002 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUMHARY OF THE PRINCIPAL TAX DUE~ APPLICATION OF ALL PAYHENTS~ THE CURRENT BALANCE~ AND, IF APPLICABLE~ A PRO~ECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-04-2002 P R I NC I PAL TAX DU E : ........................................................................................................................................................................................................................... 14~888.98 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-13-2001 CDOO0516 631.58 12~000.00 04-26-2002 CDOO1116 .00 942.06 05-13-2002 CDOO1169 .00 1~315.36 TOTAL TAX CREDIT 14~889.00 BALANCE OF TAX DUE .02CR INTEREST AND PEN. .00 If IF PAID AFTER THIS DATE~ SEE REVERSE TOTAL DUE .02CR SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $l~ NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT"' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) ANDREW C. SHEELY ATIORNEY AT LAW Telephone: (717) 697-7050 127 South Market Street P,O, Box 95 Mechanicsburg, Pennsylvania 17055 Fax: (717) 697-'1'065 April 25,2002 Register of wills Cumberland County Courthouse Carlisle, PA 17013 RE: The Estate of Miriam K. Willis No. 21-01-0808 Date of Death: August 13, 2001 Dear Register of Wills Lewis: I represent the Estate of Miriam K. Willis. Enclosed for filing please find an original and one copy of the Pennsylvania Inheritance Tax Return for the above-referenced Estate. In addition, I am enclosing two (2) checks. One check is in the amount of $15.00 and constitutes the fee for filing the return. The second check is in the amount of $942.06 and is made payable to the Register of Wills, Agent, same constituting the remaining Pennsylvania inheritance taxes due in the above-captioned estate. A prepayment in the amount of $12,000.00 was previously made. Please provide me with the appropriate receipts in this matter. Your time and consideration in this matter is greatly appreciated. ve/f t;uIH~ A~ SHEELY ACS/awm Enclosure c: Robert Dickman Willis, Executor Hand Delivered ~~S~I ~ . .......~t:V,'.(j00 EX (6.llJ"s ..... Z W C W (.) W o COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) REV-1500 OFFICIAL USE ONLY /?- Vt3 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ---2-L-lLL _QJi~L_ COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 203 - 10 Willis, Miriam K. 7787 DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) August 13, 2001 May 24,1903 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER W I- :.::~(/) uO:::':: wl1.U ::rOO uO::..J l1.1Il l1. <( I- Z W o z o l1. (/) W 0:: 0:: o U Q9 1. Original Return D 4. Limited Estate rn 6. Decedent Died Testate (Attach copy at Will) D 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy ofTrust) o 10. Spousal Poverty Credit (date at death belween 12-31-91 and 1-1-95) o 3. Remainder Return (date of death prior 1012-13-821 o 5. Federal Estate Tax Return Required 1- 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) NAME Andrew C. Sheely, Esquire 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. ~ortgages & 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) 10_ Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) z o ~ ..J :;:) !::: D.. <C (.) W 0:: z o ~ ..... :;:) D.. ::2 o (.) X ~ FIRM NAME (If Applicable) TELEPHONE NUMBER (717) 697-7050 14. Net Value Subject to Tax (Line 12 minus Line 13) COMPLETE MAILING ADDRESS ~ndrew C. Sheely, Esquire P.o. Box 95 127 South Market Street Mechanicsburg, PA 17055 OF-FICIAl USE ONLY (1) (2) (3) (4) (5) 33,591.64 ..."~#". ". ;', ' ~. 8 68,944.43 (6) (7) ...-~ (8) 102,536.07 (9)11 , 3 8 1 . 2 2 (10) 664.06 (11) (12) (13) 12,045.28 90,490.79 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) 90,490.79 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20.0 90,490.79 x.O_ (15) x.O_ (16) x .12 (17) x .15 (18) 13,573.62 (19) 13,573.62 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT . ,..' ::.i'~. ee $,l,IRIi: TOAN$W~R;AJ..L)~LiE$TIQ' ',- r REV-1503 EX -,,\1-97) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT MIRIAM K. WILLIS All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER FILE NUMBER 21-01-0808 ESTATE OF DESCRIPTION VALUE AT DATE OF DEATH 1. Miriam K. Willis died on Monday, August 13, 2001, at the ManorCare Health Services Facility in Camp Hill, pennsylvania. Stock values are listed as the mean betw en the high and low on August 13, 2001. Values based upon NYS and other sources as indicated. Stock High Low Mean D.O.D 1- A T & T Corporation (110 shares) 20.17 19.70 19.94 2,193.40 Cusip 001957109 2. A T & T Wireless Corporation (35 shares) 17.16 16.55 16.86 590.10 Cusip 00209A106 3 . Tri-Continental (566.606 shares)20.93 20.75 20.84 11,808.07 Cusip 895436 10 3 4 . Verizon Communications (164 shares) 53.69 53.25 53.47 8,769.08 Cusip 077853 10 9 5. Qwest Communications International[ Inc. (205 shares) 24.74 24.30 24.52 5,026.60 Cusip 749121109 6 . Income Fund of America (316.376 shares)16.45 16.45 16.45 5,204.39 Cusip TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) $33,591.64 'l FAHNE8TOCK ESTABLISHED 1881 Fahnestock & Co. Inc. 1015 Mumma Road Wormleysburg, PA 17043 (717) 763-8200 (800) 722-2294 (717) 763-1765 FAX Members of All Principal Exchanges WILLIAM H. ROBERTS Senior Vice President - Investmen(s Branch Manager January 31, 2002 Andrew C. Sheely. Esq. 127 South Market Street P.O. Box 95 Mechanicsburg, P A 17055 RE: Estate of Miriam K. Willis SS# 203-10-7787 Date of Death: August 13,2001 Dear Mr. Sheely, ~ ~ Please find listed below the Date of Death Valuations as of August 13, 2001 for the Estate of MiIiam K. Willis: SHARES SECURITY CLOSING PRICE HIGH LOW 110 A T & T Corp. $19.91 $20.17 $19.70 35 AT & T Wireless $16.93 $17.16 $16.55 566.606 Tri -Continental $20.81 $20.93 $20.75 164 Verizon Communications $53.64 $53.69 $53.25 205 Qwest Communications $24.66 $24.74 $24.30 316.376 Income Fund of America $16.45 $16.45 $16.45 If you need any further information, please don't hesitate to call me. Thank you. Very truly, ~ ~://~~ William H. Roberts Senior Vice President WHRllo r REV-t508~' (1-97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT MIRIAM K. WILLIS FILE NUMBER 21-01-0808 ESTATE OF Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of sUNivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 1. POSTMARK CREDIT UNION SAVINGS ACCOUNT NUMBER 20272 DATE ACCOUNT OPENED 9/9/38 PRINCIPAL BALANCE AT DATE OF DEATH $27,284.65 ACCRUED INTEREST 0 DATE OF DEATH VALUE $27,284.65 2. WAYPOINT BANK ACCOUNT NUMBER 1000003206 DATE CERTIFICATE PURCHASED 11/17/97 PRINCIPAL BALANCE AT DATE OF DEATH $ 5,000.00 ACCRUED INTEREST 5.82 DATE OF DEATH VALUE $ 5,005.82 ~ 3. WAYPOINT BANK ACCOUNT NUMBER 1054300398 DATE CERTIFICATE PURCHASED 01/31/97 PRINCIPAL BALANCE AT DATE OF DEATH $ 1,800.00 ACCRUED INTEREST 1.98 DATE OF DEATH VALUE $ 1,801.98 4. WAYPOINT BANK SAVINGS ACCOUNT NUMBER 400047223 DATE ACCOUNT OPENED 12/03/71 PRINCIPAL BALANCE AT DATE OF DEATH $ 7,357.42 ACCRUED INTEREST 4.79 DATE OF DEATH VALUE $ 7,362.21 5. WAYPOINT BANK ACCOUNT NUMBER 458195373 DATE CERTIFICATE PURCHASED 06/25/91 PRINCIPAL BALANCE AT DATE OF DEATH $ 2,440.12 ACCRUED INTEREST 13.63 DATE OF DEATH VALUE $ 2,453.75 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) , REV-15D8 E-""(1-97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MIRIAM K. WILLIS FILE NUMBER 21-01-0808 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. 6. 7. 8. 9. 10 11 DESCRIPTION ALLFIRST BANK CHECKING ACCOUNT NUMBER DATE ACCOUNT OPENED PRINCIPAL BALANCE AT DATE OF DEATH ACCRUED INTEREST DATE OF DEATH VALUE FEDERATED FUND FOR US GOVERNMENT SERVICES ACCOUNT DATE OPENED: NUMBER OF SHARES PER SHARE VALUE AT DATE OF DEATH DATE OF DEATH VALUE PERSONAL CONTENTS OF DECEDENT VERIZON REFUND MANOR CARE REFUND 2001 FEDERAL INCOME TAX REFUND VALUE AT DATE OF DEATH 0090646002 12/28/71 $11,173.13 1.07 $11,174.20 # 8608701 06/10/86 1,232.735 $7.87 $9,701.62 1,200.00 126.28 2,820.92 13.00 TOTAL (Also enter on line 5, Recapitulation) $ 68,944.43 (If more space is needed, insert additional sheets of the same size) , _POSTMARK ~CREDIT UNION for first class flllllllCid} ,)t'1 "iet's September 5, 2001 Andrew C. Sheely Attorney At Law 127 South Market Street P.O. Box 95 Mechanicsburg, P A 17055 Re: Estate of Miriam K Willis SS# 203-10-7787 Account # 20272 Dear Mr. Sheely, The account of Miriam K. Willis at POSTMARK Credit Union was owned since September 9, 1938. There were no other owners on this account. Interest(dividends) is paid on the last day of the month for accounts and sub accounts. The following is an account status on August 13,2001. ~ Opened Balance 8/13/2001 Interest Rate Savings 9/9/1938 $27,284.65 2.75% There are no beneficiaries on this account. This should provide the information for you to handle the estate. If you have any questions please call. Sincerely, ~~. /2~ Bonnie Sommer Member Services Representative 2630 Unglestown Rood. Harrisburg. PA . 17110-3666 717.671.5119 '\ 09/05/2001 ANDREW SHEELY 127 S MARKET ST MECHANICSBURG P A 17055 "'WaYRqi!,~ lOOK FOR US. WE'll GET YOU THERE. The information which you requested on the accOlmt(s) of MIRIAM WILLIS ESTATE (Social Security Number 203-10-7787) is/are as follows: Account Number Class of Account Date Opened Principal Balance Accrued Interest 10000Q3206 CERTlFICA TE 11/17/97 5000.00 5.82 Balance at Date of 5005.82 Death Account Ownership SOLE Name of Joint Owner, if any Date Ownership Was Esta[,lished .- Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established I.dditional aformation .equested 1054300398 400047223 458195373 CERTIFICATE SA VINGS CERTIFICATE 01/31/97 12/03/71 06/25/91 1800.00 7357.42 2440.12 1.98 4.79 13.63 1801.98 7362.21 2453.75 SOLE SOLE SOLE PLEASE COMPLETE W-9 s/itrelY> J 2irJ111 KA~O~~ ~ SENIOR SERVICES R.EP. p NSYLVANIA 17105-1711 P.O. 80x 171 I. HARRISBURG. EN 46) . www.waypointbank.com Toll FrEE 1_866-WAYPOINT (1_866-929-76 ~...; '.>.i. U4:,;'UO,.... nLLI-11<~1 \...1::' ;jU.:~.l;;J4c::J::.~ p. .~~ , 11=. ..1111 allfirst ~A~;;:"" I -- AIlIiJ'SI Fimcncial Ct:'ltel"'I..\ ~() Box 90( l'vlillolllO, DE \ 9966 Sep;ernber 13, lOO : Andrew C. Sheely At1Qrney At Law 121 South Market Street PO Box 95 Mecbanicsburg, P A 1705t; Re: Estate c f;'vJirimn t<_ Wiliil Social Security: 20J..JO-77S:: Dale of Death: AUJ~3,jst 13. 2001: Dear Sir or Madam: \ . Per your inquiry dated August. 30, :.00 1 plea~e be ~dvjsd that. at. . le time (.[ death, the above-named dta;edent had on dtlPosit with this bank the folio" ing: L Type of Ace owl! J(elari~m,\,ljp Cheding W/lnterest Accollnt Number 0090646t: 02 Ownership (Names oj) diriam J<: WilIis,OWf/e/' Rober' D .Wil1i~', FOA Openir.g D~te J 2/28/7 ] Balance 0/1 Dale afDeOlI, n 1,1;'3./J Accrued Interest \' J.Gl Towl Jilj;';i} f""""" ....--...--.- 2. Type ojAccounI &je Ei'puif Box A,:count iI/umber j OO()459 j JOiJ J 6537 OJ.~nershjp (Names ejj MiriaM K. Willis, Uwner j.'(}ben D. Willis, P:JA Oplming Date 11/13/;8 ~ Federated Investors, Ine. Pittsburgh, ['elllhylvaniJ l~(kkbl1d, l\'LissachllSc'[lS Nc'\V Yelrk, No'\\' York Dublin, [rdlnc! \ y\ V\ \'. t'C:dCL1(c'dil1\"CS(l)rs. Cl...)lll .Federated September 6,2001 WORLD-CLASS INVESTMENT MANAGER @ Andrew C. Sheely 127 South Market Street PO Box 95 Mechanicsburg P A 17055-0095 Reference: 00177504 Federated Fund For US. Govt Secs - A Account Number: 8608701 Miriam K Willis I \ Dear Mr. Sheely: Thank you for contacting Federated. ~ On August 13,2001, the value of the referenced account, registered as shown and established on June 10, 1986, was $9,701.62, based on 1,232.735 shares at the net asset value of $7.87 per share on that date. Enclosed are two forms that will make it easy for the legal representative(s) to redeem shares. We recommend that he/she use the Redemption by Mail Form because it outlines all the information Federated needs to process the transaction. The legal representative(s) needs to complete the form that meets his/her needs and return it with the Order of Appointment naming the legal representative(s) of the Ms. Willis' estate. The court or clerk of court must certify the document within 60 days of the transaction request. The certification, usually an ink stamp or raised seal, must be original. If the legal representative( s) prefers to write a letter to provide redemption instructions, please ensure the letter includes all necessary information. A signature guarantee is required; see the form for details. The estate tax identification number must be certified on an IRS Form W -9 if the redemption proceeds are made payable to the estate. When Redeeming Shares Federated processes redemptions at the net asset value determined at the close of business on the date the request is received, in good order. Important Tax Information In January, tax forms are issued for each account that was open during the previous calendar year. To ensure delivery, the legal representative should notify Federated of any address changes. t 01;, " 1 ~~ ----- ,r) "i 11, ).., 'soma' 'f~operty ot M I fZ lAt'\ \~, /}J I LL I S 6' S Tf)f~ \ ,pra1s~ by Chuck E. Bricker AU094-L .' Date q ;24-<D \ ITEM VALUE ..' " ITEM VA LUE , ,'551. C oSTUj1f 5{I)JLc/tLY tf()/)fJ q<sT. COLLA'?-s I D,00 5" c 0? f rfll (Jt tJ PIATf 5 -:~D,Db ,:L 5 J L D vT"t It 5 2-D,l!'0 rv\05fC t) CJi, '}6,oo ., pt5T C..hLd S ]0 , b \) .... ., Ass-r. '(0 j 05 I Lib, U D " " \ D Iky-t S Jf\c>b~S }o 00 3 ~y,:) (tlitJli )S Be " -3 'tJC <; Cb?PEll LJ s \(Zf 90,DO \ LJ1J tt 'S ~ n0 ") Jb I\~ G (:,. KMA lJ'l Cti0( OLA1--f SCI 5D , 0 /) '\ ; I CQ.A.Lf8J-\L~\.J V'/)$t 15/ bC j) y A Lf <, {::A))1 v'!tS t , ,:lD />i> ~"'; .,,'i " 1.:';:': ,." :, -:~!t,I " '., ".,".> , " 'L S \-'\ A Ll-\t: vJ O--l> 1 p., D~t S ,0 Di~ ~ "I;' i, 0. D 1> ", G-o ~L. Rl\c...~ " : ,,'t-. I h ,\ [ell.s Dbi .' l-g , peS I 5Tt\lL \ J 5 <; jLvf(<-- 8bl b~ \ 'SEt J<lq -) ~; '\ IL-:~ 'j t-Il S SILVf\L o.Ob\ C u f P--~'/ Dol, Bf(..~ LSD,liD Cr{ff.-~Y Bvf f fT ':li6 I Ou c-;}( tiLt- '-I Jl UT cd O-l/J/1J f'(' 3,J)D DO 0 " !. ' ' i -:;Yf~ ' tJ'),O~dV ~"-f~~r/Jl-I/1p/;c;q15 A (~ --~ i-- --- all ~. ''BAt' ~O) -/0 ~1'/ ~ ", -.\.>'" ",.. A v0C1 ,-\-L C{~ J_c/_c6 \ " , , \ '~ l i U " , 1 , T. \ '. . ! -' ~.., ~ \ .' ,. \ 'C. \ , T T - .. -, ..,', 1 0.', ..v \ 'C~. .', ...." \ ...', ~ APPRA\SAL \, - -----------=----~-------------~------ --- . 8(1"'192413 CHE"O"~uMaeR. 20 3-1G -71a1 Pay To The Order of HIRIA" Kidlll S CIO ROaERT 0 WILLIS ZO-'t SO STONER AVE 5ttlRfMANSTOWN PA 17011-6157 FI.~U N1.IIU;, l<t,A. SQ\JTH "QRTLAltD, Nt 02/'0 l/.fJ~ DATE PAY*****it12b.28 Acct. No. 3200-1d41 Cash Within 180 Days ~ vel'lZlUl 52-153 112 ~7< (: 77C>7iP--- .'~~,-_......",.,... _.._--~' Authorized Signature III aDO . q 2 ~ . j III I: 0 . . 20 . 5 j q I: 00 a 0 0 j b 0 q b III . REV-1511EY~' (1-97) ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS MIRIAM K. WILLIS FILE NUMBER 21-01-0808 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT DESCRIPTION FUNERAL EXPENSES: 1. 2. FUNERAL PREPAID HEADSTONE INSCRIPTION s. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) ROBERT D. W~LLIS, ~X~CUTOR Social Security Numbe~s) I EIN Number of Personal Representative(s) 204 SOUTH STONER AVENUE Street Address City State PA Zip 17011 SHIREMANSTOWN, Year(s) Commission Paid: 2. 3. Attorney Fees Family Exemption: (Irhewi~~ adar!lss iM 1ii~J'ame Ni;~~MJj,~alta~ ~la~&b~E EME NT Claimant Street Address City Relationship of Claimant to Decedent State Zip 4. Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS PROBATE FEES AccountanfsFees LEGAL ADVERTISING: THE PATRIOT-NEWS CUMBERLAND COUNTY LAW JOURNAL BOREMAN & BABB, CPA Tax Return Preparer's Fees 5. 6. 7. FAHNESTOCK & CO., BROKERAGE FEES, CHARGES AND FEES ASSOCIATED WITH SALE OF SECURITIES TO PAY STATE AND FEDERAL TAXES, DEBTS OF DECDENT AND DISTRIBUTE ESTATE ASSETS FILING FEES FOR INHERITANCE TAX RETURNS MISC. POSTAGE AND MAILINGS Reserves to conclude administration of Estate, , . . . I '~'''' and copy charges of necessary FiduciarYTB.J;;At.q~lns t I' 9 R 't I t' ) orAL lAI so en er on Ine , ecapl u a Ion (If more space is needed, insert additional sheets of the same size) AMOUNT $ 0.00 $ 250.00 $ 4,750.00 $ 4,750.00 $ 177.00 21. 00 85.95 75.00 200.00 $ 526.79 $ 15.00 30.48 $ 500.00 $ SII 381.22 -~/.. \\\\\\\\\\\\\ \\\\~~ ., '" ~ o ~ '" :; $:, ~.~ ...'" 2!~ -o$:, "'-0 ~~ o~ ",CO %,'~ .~J) ~~ '5%. 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'il ~ -S ~ 0: 0 Q. :0 2' %. '" co ., ~ '" ~ ~\'i. ..:.. w~ ~.. Q.'" - '5~ c- O$:, ., w 0 '0 uJ~ ~ ~ ~~ co t> ~~ ~ i ~~ .r. u: ~ w ~ o -:t; -;i ~ UJ z ::> ... o I- <f> Z 4- ~ ~ .... o ~ w .... III ~ a: I- 'i. w ~ Q. ~ 'W ~ E- . ..J . \13 'l;4 - ... .9l --. '-' 'i2 :e u ~~ ':; <f> ;~ '0 :0 ~ ',....... ~ " \il ~ ....". tJ') ..... .. ~ ".~ ~ ~ . '" w c w'i>~ ., u ~ 4. 'tJ,'_ -s_ _u t': a:. 11\5 0'" Q.. E '-' ~~ ,::~:a. o!t z...<' \p% :;)<l>::> <li\- -'l~cP .&.- 1-\ ~uC!- o:~ \-c-w ~C!- 0:::'-'::. '0 \ \ \ \\ ~ \ \ \ \ \ Ui III o ~'" 'f,'2 ~~ '" ~~ i ~ ~ ~r" ~ ~~ ~ (0 z~ '" .~ '?,g ~ ~ ~1; ~ <f> i c 0; ~ ~ CP ,S \<, '" ;. ~ ~ ~ ~ ~ ~ ! ~ z. Q 4 ~ C!- '-' t u ~ 1 - ,4' I" .....".. July 18, 1989 Ms. Miriam K. Willis 106 November Drive Camp Hill, PA 17011 Re: Pennsylvania Funeral Trust Individual Trust Instrument Pre-Need Trust Agreement Dear Ms. Willis: ~ '<" Commonwealth National Bank has received and accepted the Individual Trust Instrument under the Pre-Need Trust Agreement for Miriam K. Willis, Account 10312. This Irrevocable Trust funded with $1,720.00, is a participant in the Master Pre-Need Trust of Musselman Funeral Home Inc.. Enclosed please find a copy of the executed Individual Trust Instrument for your records. If you have any questions, please consult with your funeral director. _ Very truly yours, }1'1 /~ ~)0--:-1Cr-.-- M. Kenneth Baylor Pennsylvania Funeral Trust Administrator Enclosure cc: Mr. Donald Musselman Musselman Funeral Home Inc. 324 Hummel Avenue Lemoyne, PA 17043 Managed by PENNSYLVANIA FUNERAL DIRECTORS ASSOCIATION 1f\A. Q....".."'" Q.......o""'.. u...._-:...~u_..... DA l~lA; 'T'....l...._L...__ anA/en..... r-"F-O ...,.....".......,i:: "'........,. RECEIPT FOR PAYMENT * CORRECTED * ------------------- ------------------- Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Receipt Date Receipt Time Receipt No. 8/30/2001 09:30:56 1026727 WILLIS MIRIAM K File Number 2001-00808 Remarks WILLIS ROBERT D SK ________________________ Distribution Of Receipt ------------------------ Transaction Description Payment Amount Payee Name PETITION FOR PROBA SHORT CERTIFICATE EXTRA PAGES JCP FEE 115.00 45.00 12.00 5.00 CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN BUREAU OF RECEIPTS & CNTR M.D Check# 4134 Total Received......... $177.00 $177.00 3L\egi~ter of Will~ anti <1:1erk of toe @rpoan~' <1:ourt (aunt!' of I!umbetlallb COURTHOUSE, CARLISLE, PA n013 MARY C. LEWiS Register of Wills & Clerk of the Orphans' Court JERRY R. DUFFIE, ESQ. Solicitor TO: ANDREW C SHEELY ESQ POBOX 95 MECHANICSBURG P A 17055 Estate of: MARIAM K WILLIS Date: JANUARY 4, 2002 2 SHORT CER TIFICA TES-------------------------------$6. 00 PLEASE REMIT FEE TO THE ATTENTION OF DONNA. . THANK YOU. RECEIPT FOR PAYMENT ------------------- ------------------- Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Receipt Date 11/29/2001 Receipt Time 15:57:26 Receipt No. 1027595 WILLIS MIRIAM K File Number 2001-00808 Remarks SHEELY ANDREW SK ------------------------ Distribution Of Receipt ------------------------ Transaction Description Payment Amount Payee Name SHORT CERTIFICATE 15.00 CUMBERLAND COUNTY GENERAL FUN Check# 2918 Total Received......... $15.00 $15.00 RECEIPT FOR PAYMENT ------------------- ------------------- Cumberland County - Register Of Wills Hanover and High StreeE Carlisle, PA 17013 Receipt Date Receipt Time Receipt No. 3/08/2002 13:17:26 1028597 WILLIS MIRIAM K File Number 2001-00808 Remarks ANDREW SHEELY, ESQ AC ________________________ Distribution Of Receipt ------------------------ Transaction Description Payment Amount Payee Name SHORT CERTIFICATE 3.00 CUMBERLAND COUNTY GENERAL FUN Check# 3030 Total Received......... $3.00 $3.00 CLAssiFIED ADVERTISING INVOICE ions regarding this invoice call (717) 255-8138 INVOICE NO- \rC5260Z11M CLASS START DATE IIs46 1110/02/01 ANDREW C. SHEELY ATTORNEY AT LAW 121 SOUTH HARKET STREET NECHANICSBURG ?A 17055 ACCOUNT NO, 16977050 AND ACCOUNT NAME IAI\lOR EW C. S HEEL Y IESTATE OF WILLIS DESCRIPTION OR TAG LINE ~e ~t-NeltJ5 BILUNGDATE 110/11101 I To Place your ad Call Classified (717) 255-8121 Tearsheet Request call (717) 255-8417 STOP DATE 1110/16/01 I GJ 1 /fJ I~ TIMES SIZE AD AMOUNT 11$ 1.30IN 81.45 BOX CHARGE AFFIDAVIT CHARGE 1.50 3.(}{) aOUl PRI NT ATTENTION GETTt:;R DEBIT MEMO CREDIT MEMO DISCOUNTS ADVANCE PAYMENT ~.I$ 85.95 \ \ TERMS I DUE UPON R feEl? T THE PATRIOT NEWS THE SUNDAY PATRIOT NEWS Proof of Publication Under Act No. 587, Approved May 16,1929 Commonwealth of Pennsylvania, County of Dauphin} ss Michael Morrow being duly sworn according to law, deposes and says: That he is the Asst. Controller of The Patriot News Co., a corporation organized and existing under the laws of the Commonwealth of Pennsylvania, with its principal office and place of business at 812 to 818 Market Street, in the City of Harrisburg, County of Dauphin, State of Pennsylvania, owner and publisher of The Patriot-News and The Sunday Patriot-News newspapers of general circulation, printed and published at 812 to 818 Market Street, in the City, County and State aforesaid; that The Patriot-News and The Sunday Patriot-News were established March 4th, 1854, and September 18th, 1949, respectively, and all have been continuously published ever since; That the printed notice or publication which is securely attached hereto is exactly as printed and published in their regular daily and/or Sunday/ Metro editions which appeared on the 2nd, 9th and 16th day(s) of October 2001. That neither he nor said Company is interested in the subject matter of said printed notice or advertising, and that all of the allegations of this statement as to the time, place and character of publication are true; and That he has personal knowledge of the facts aforesaid and is duly a.uthorized and empowered to verify this statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed and adopted severally by the stockholders and board of directors of the said Company and subsequently duly recorded in the office for the Recording of Deeds in and for said County'of auphi.in Miscellaneous Book "M", Volume 14, Page 317. \\ y commission expires June 6, 2002 PUSLlCATION ~ COpy EXECUTOR'S NOTICE Letten Testamentary on the Estate of Miriam K. Willis. late ofthe Boroullh of Comp Hili, Cum~erland County, PennsYlvania, have been lIronted to the underslllned. All per- - knowlnll tllemselvea to be Indebted to sold Estale will moke payment ImmediatelY and those hovlnll claims will preaent them for &ettlement 10: Robert Pickman Willis, Executor C/O Andrew C. Sheely, Esquire 127 South Market street P.O. BoxU Mecllanlcsburll, P A 17055 -IDZl.'",Hoso . ANDREW C. SHEELY ATTORNEY-AT-LAW 127 SOUTH MARKET STREET MECHANICSBURG, PA. 17055 Statement of Advertising Costs To THE PATRIOT-NEWS CO., Dr. For publishing the notice or publication attached hereto on the above stated dates $ Probating same Notary Fee(s) $ Total $ 84.50 1.50 85.95 Publisher's Receipt for Advertising Cost The Patriot News Co., publisher of The Patriot-News and The Sunday Patriot-News, newspapers of general circulation, hereby acknowledge receipt of the aforesaid notice and publication costs and certifies that the same have been duly paid. By.................................................................... ~.-~..~,..---~.-~.) !} r. CUMBERLAND LAW JOURNAL 2 LIBERTY AVENUE CARLISLE, P A 17013 OCTOBER 19,2001 Cumberland Law Journal is published every Friday by the Cumband County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Andrew C. Sheely, ESQUIRE RE: Mirianl K. Willis, ESTATE \ \ Legal advertisements must be received by Friday Noon. All legal advertising musf be paid in advance. Make all checks payable to: Cumberland Law Journal. ----------------------------------------------------~---------------- ------------------------------------------------------------------~-- Advertisement inserted on following dates: OCTOBER 5, 12, 19,2001 Advertising Cost Second Proof Request $ 75.00 $ 0.00 $ 0.00 $ 60.00 ------------- Proof ofPub1ication Payment received Total Amount Due $ 15.00 --------- --------- Payment received OCTOBER 1,2001 by Becky H. Morgenthal/Executive Director . (' PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 STATE OF PENNSYLVANIA : ss. COUNTY OF CUMBERLAND : Roger M. Morgenthal, Esquire, Editor of the Cumberland Law Journal, ofthe COlmty and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, VIZ: OCTOBER 5, 12, 19,2001 ~ Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. Willis, MirillD1 K., dec'd. Late of the Borough of Camp Hill. Executor: Robert Dickman Willis. c/o Andrew C. Sheely. Esquire. 127 South Market Street. P.O. Box 95. Mechanicsburg. PA 17055. (717) 697-7050. Attorney; Andrew C. Sheely. Es- quire. 127 South Market Street. P.O. Box 95. Mechanicsburg. PA 17055. (717) 697-7050. (;[qp~-- Rog r M. Morgenthal, EdItor SWORN TO AND SUBSCRIBED before me this 19 day of OCTOBER, 2001 dA~J~. ~a&v ...liQ1ID:Y~ ., ,.M "NmARlf~ SEAL lOtS E. SNYDEf{, Noiuty Pti~l\~ CarlisW 80m, C\j~II\}~l\t;ncl Q.lU1~~'Ii\l: My ~n E.lq}ilil~ \\11.i1li-ch 5. LVW ( , i\: ) ~ .. 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COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER MIRIAM K. WILLIS 21-01-0808 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. 1. Neighborcare Pharmacy $ 80.32 2. Reimbursement to PSERS 583.74 TOTAL (Also enter on line 10, Recapitulation) $ 664.06 (If more space is needed, insert additional sheets of the same size) j . ~ . COMMONWEALTH OF PENNSYLVANIA PUBLIC SCHOOL EMPLOYEES' RETIREMENT SYSTEM Mailing Address PO Box 125 Harrisburg PA 17108-0125 Toll-Free - 1-888-773-7748 (1-888-PSERS4U) Local- 717-787-8540 Web Address: www.psers.state.pa.us Building Location 5 North 5th Street Harrisburg P A January 28,2002 ANDREW C SHEELY ATTORNEY AT LAW 127 S MARKET ST PO BOX 95 MECHANICSBURG PA 17055 RE: Miriam K. Willis S.S.# 203-10-7787 Dear Mr. Sheely: Thank you for the Short Certificate. Since Eugene K. Willis is also deceased, the prorated payment and premium assistance payment is now payable to the estate of Miriam K. Willis. In~ our previous correspondence, we failed to request the return of the August 31,2001 payment. We should have included the following paragraph: The August 31, 2001 payment of $1 ,298.53 has already been electronically transferred to Dauphin Deposit Bank, account #90646002. Since we already received the Short Certificate, please reimburse PSERS for the overpayment of $583.74 ($1,298.53 net payments minus $55.00 premium assistance minus $659.79 prorated payment). Make your check or money order payable to PSERS and send to the mailing address shown. We are sorry for this oversight. When we receive the reimbursement" we can close this account. Please include the decedent's name and social security number with all correspondence. If you have any questions, please contact the Member Service Center by calling toll-free 1-888- 773-7748 (local calls 787-8540). If you prefer, you may reach PSERS by FAX at 717-772-3764. For your convenience, the Member Service Center is staffed each business day from 7:30 a.m. to 5:00 p.m. Deceased Processing Center jms Enclosure(s) .. .. . 1~~;'Oi'_;;;;;'~"'"'''''''' -'" .;.......".....;. _ ..;:;-.....Oi...... ...-,;--,,;~..;....... . PNClBANK PNC Bank, N.A. 040 @ Central PA ~;'..............-;~.;.....nn;...... _ .............'.-....:-.. __ .i.......;;-;-........ 0;....;...... .... _ ,;....;;c.o;....... _ .";;;..;;.,.;~.~,,...'"'''''''''-..~I #~ 'l 60-1273/313 DATE iN ~ u. 1'2- "2 ~ t:::. ( r NE\G:r~BCRCf\~ f~~~MJ),-y I $8C)~ 51b~ '( ~ 371 DO \\{ ~ DOLLARS [fl~,~::i::,::~:~,. 'ST?y~ ~;:;71 Ex FOR f1tR D S ~I : 0 :l . :1 . 2 ? :1 8 I: 5 0 0 :l It 2 0 0 2 ? III .,100000080:1 V' . . -- - - - . .,.'..............'. ..............,......... NP II ... ., . REV.1513 EX' (1.97) *' SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MIRIAM K. WILLIS FILE NUMBER 21-01-0808 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. RUTH RADABAUGH FRIEND $500.00 5500 Wertzville Road per will Enola, P A 17025 MARY ELIZABETH YOVICSIN NIECE 25 % of 31 Edith Road Rest, residue Framingham, MA 01701 & remainder of estate BETTY WILLIS NIECE 25 % of P.O. Box 567 Rest, residue Steelton, P A 17113 & remainder of estate ROBERT DICKMAN WILLIS NEPHEW 25 % of ~ 204 S. Stoner A venue Rest, residue Shiremanstown, P A 17011 & remainder of estate 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 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART D - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) .. I I . REV.1513 EX + 11.97) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER 21-01-0808 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY 1. TAXABLE DISTRIBUTIONS (include outright spousal distributions) DAVID & KATHY WILLIS 1. 7211 Audubon Drive Harrisburg, P A 17111 REAT-NEPHEW GREAT NIECE Personal contents of memorandum LIZABETH ROBERTS 1591 Woodhaven Drive Hummelstown, P A 17036 IECE 25% of Rest, residue & remainder of estate LENA M. WILLIS 326 Caracus A venue Hershey, PA 17033 REAT-NIECE Personal contents per memorandum SUSAN KEGERISE 11 Chancelet Court Rockville, MD 20852 GREAT-NIECE Personal contents per memorandum JOANNE CHOYKA 14 Bridge Lane Collegeville, P A 19426 GREA T-NIECE Personal contents per memorandum 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 1. B. CHARlT ABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) , ,I . LAST WILL AND TESTAMENT OF MIRIAM K. WILLIS I, MIRIAM K. WILLIS, having my legal residence at 824 Lisburn Road, Camp Hill, Pennsylvania, do hereby declare this to be my Last Will and Testament, revoking all other wills and Codicils heretofore made by me. ITEM ONE: I direct that all my just debts and the expenses of my last illness and funeral be paid from my estate as soon as practicable after my death. ITEM TWO: I may leave a Memorandum listing some of the items of my tangible personal property whiqh I wish certain persons to have and request (but do not require) that my wishes as set forth in the Memorandum be observed by my Executor. ITEM THREE: I give the sum of Five Hundred and No/IOO ($500.00) Dollars to the following individuals, provided they survive my death by thirty (30) calendar days: A. My sister-in-law, RUTH WILLIS; and B. My friend, RUTH RADABAUGH. ITEM FOUR: I give all of the residue of my estate, ot whatsoever nature and wheresoever situate, in equal shares to the following individuals who survive my death by thirty (30) calendar days: A. My niece, MARY ELIZABETH YOVICSIN; B. My niece, LENA M. WILLIS; C. My niece, BETTY WILLIS; and D. My nephew, ROBERT DICKMAN WILLIS. ~~~ .. 4' .. ITEM FIVE: I appoint my nephew, ROBERT DICKMAN WILLIS, my Executor. In case of his inability or unwillingness to act or to continue to act as my Executor, I appoint my nephew's wife, JANET WILLIS, my Executrix. In case of her inability or unwillingness to act or to continue to act as my Executrix, I appoint my niece, LENA B. WILLIS, my Executrix. I give to my said Executor, in addition to the authority conferred by law, the power to sell any or all of my personal and real property at public or private sale, at such time and for such price and upon such terms and conditions as it may see fit, or in its discretion to retain the same for distribution in kind, and the power, but not the duty, to invest any cash without being limited to "legal" investments. No bond shall be required of any fiduciary hereunder in any jurisdiction. No fiduciary hereunder shall have any liability for any mistake oi error of judgment made in good faith. ITEM SIX: I direct that all estate, inheritance and ~ other taxes in nature thereof, together with any interest and penalties thereon, becoming payable because of my death with respect to the property constituting my gross estate for death tax purposes, whether or not such property passes under this my Last Will and Testament, shall be paid from the principal of my residuary estate, and no person receiving or having a beneficial interest in any such property, whether under this my Last Will and Testament or otherwise, shall at any time be required to contribute to or refund any part thereof; PROVIDED, however, that this direction shall not apply to the taxes on any property included in my estate solely because of a power of appointment thereover which I possess but have not exercised or on any qualified terminable interest or to any generation-skipping transfer taxes. ITEM SEVEN: I realize that Executors and Trustees are given discretion by law to make various elections which affect -2- r FJ;~ ~& ). ~ I .. the income and estate taxes payable by estates, trusts and beneficiaries, as well as the relative shares of beneficiaries, such as taking administration expenses as deductions for either estate or income tax purposes, selecting options for the payment of employee death benefits, electing to take qualified terminable interest as part of the marital deduction, selecting alternate valuation dates, postponing the payment of taxes, filing joint income tax or gift tax returns and redeeming corporate stock. The decisions made by my fiduciaries in any of these matters shall be binding upon, and not subject to question by, any affected persons; PROVIDED, however, that if a corporate fiduciary is serving, its decision shall also be binding upon any individual cO-fiduciary. I rely upon my fiduciaries to take into consideration the total income and estate taxes payable by reason of their decisions including those payable by my survivors, and they are authorized in their discretion, but not required, to make adjustments between income and principal as a result thereof. IN WITNESS WHEREOF, I have at Hershey, Pennsylvania, this ~~ . \ day of August, 1993, set my hand and seal to thlS my Last Will and Testament consisting of five (5) pages. ~~~/ IR\AM . WILLIS (SEAL) SIGNED, SEALED, PUBLISHED and DECLARED by MIRIAM K. WILLIS, the above named Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her request and in her -3- ., . , . presence, and in the presence ot each other, have hereunto subscribed our names as witnesses. Residence s~ f"\\\~ G:.-..)~ I (-b~YP.V'I)""'(~ Resid~nce IZI W. fl/u;~~, !+tIC (flII-/7053 ~ ~ -4- 't_ . l . ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA :SS COUNTY OF DAUPHIN . . We, MIRIAM K. WILLIS, E. STAADU=: ~L_~ and , Testatrix and witnesses, respectively, whose names are sig ed to the attached and foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her last will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the will as witnesses and that to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ,( ;:;;- Jt! t- .-' .. / (t~~~'4'V2 ' '~~z' TESTATRIX Subscribed and sworn K. WILLIS, the Testatrix, by (~L_~ witnesses, on thlS to and acknowledged before me by MIRIAM and subscribed and sworn to befo e me . STaA--OLE a Public , NOTARIAL SEAL ~ CONNIE L. REESE, Notary Public Derry Twp., Dauphin County My Commission EXDire~~!:~~.?~: 1995 -5- '" f .. ,. ~ MEMORANDUM TO THE LAST WILL AND TESTAMENT OF MIRIAM K. WILLIS It is my desire that the items listed below be distributed in-kind to the individuals whose name or names appear opposite the items listed: 4 ' "',.'... '~. -.- \_.. . , e,;h " :--~" e/~t--U;fi-- ~'4J.~~~.t--t- ',CIU'1-i,,~,/~/-;;?/_~p,r!c'A-/~~t?:cL/,<-&'.:~{,!';2tX2 !~t&1- "JH4' Dnd/.uF t;/~~'~t. ~~~o.'~ g~ /.'/..',/~'<4f,..f;!C~,.."J 0et''- /Lc-..t--/''-~,,) ~~,!,,--/f f)!b-4?'7ZL:> "':'? /" ".' ' L'r ,( 6t '.t",' h - ," (, l", .' .~;:._-- " ..' 1'--,---- , {/;.,:__._.,-~---'--~: ,,/r,~ t.e: ~ JC, .' :.;1' :,7 '/i;"l'l,,//.:z/:l ({V).-1.-- i-{ e-/f ~t..? ~tL-- It- '-ft:.c..):.t" -J-. .fpJ?:;!c, c.f.... -I'll.- jc.'- __ v (/ ~. /) //1/.1/1 " '. Ie '- ;., '_"1./ c-U"" .,' .'''' -t'; . -" "- " '. .' " .j ~, f)~~/i"~,:"~f7!l~vv in.. a cf~U,.L~ d..t,{,.u{x u't: t4.cflf ",j. ~; "tU-L(lJh1l~~" . ~';~.' ~~L':I-.'~. .~l -t(e..~..o, ~.1cT~/f;1.'-" f-,0i'ze.J,"c.../.z. '7}.Z.~1h/' t'<:., (--;-., j1 '// / . , " . '~u:z./, ~'/P~ t- ;:P}j:~~cr!2~~ l~'i...' '-.'-l~'at-::!, ,'. / I 'f*fT~,r, h;jJ7'lFtE~/ . J ~ -'/ {/..h j , (;>a'Yl2.t.-lrk;..t-e~Z:j//U"l a~...,,~,<<.l- .. ' i / .. ~ flut /2 ffff . ,. DA E , /, "'j' "'/'l' , .'" / 'J" -- ,', / ',-;;'/ -~j / / , MiRli~ \<..<. ~I\;L s --' / (I i /,J ~ \, ~E'-150, EX (6-00) - COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 .:',.3, :,F3t'\:i""~'" OFFICIAL USE ONLY ~ ___.____lJ_= V _~~________ FILE NUMBER INHERITANCE TAX RETURN RESIDENT DECEDENT .... Z W C W (.) W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Willis, Miriam K. DATE OF DEATH (MM-DD-YEAR) 08-13-01 DATE OF BIRTH (MM-DD-YEAR) 05-24-03 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) w I- lO::$(/) utt:lO: wo.u ;rOO utt:..J 0. III 0. <( D 1. Original Return D 4. Limited Estate D 6. Decedent Died Testate (Atlach copy of Will) D 9. Litigation Proceeds Received [!J 2. Supplemental Return D 4a. Future Interest Compromise (date of death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach copy ofTrust) D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) D 3. Remainder Return (date of death prior to 12-13-82) D 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) ~JQi COMPLETE MAILING ADDRESS Andrew C. Sheely, Esquire P.o. Box 95 127 S. Market Street Mechanicsburg,:cp~ I~055 OFFICIAL USE ONLY I- Z W o z o 0. (/) w tt: tt: o U NAME Andrew C. Sheely, Esquire FIRM NAME (If Applicable) TELEPHONE NUMBER 717-697-7050 z o ~ ..J ;:) !:: c.. <t (.) w 0:: 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship ~ 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D 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) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) (1) (2) 42, 360 . 7 2 (3) (4) (5) 68,944.43 (6) (7) (9) 11, 3 8 1 . 2 2 (10) 664.06 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o < ~ ;:) c.. :E o (.) g 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 99,259.87 19. Tax Due 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 2-1- - 0-1- 0-.8.....Q Jl. _ _ COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 203 - 10 - 7787 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER j'\..i (8) 111,305.15 (11) (12) (13) 12,045.28 99,259.87 (14) 99,259.87 x.O_ (15) x.O_ (16) x .12 (17) x .15 (18) 14,888.98 (19) 14,888.98 . :.r.';. ~e ~U~ETQA"SWeR AL,L; QUE$Qti$.oNR~YE., Se~tQ~"~Nb.R1;g, . " MIRIAM K. WILLIS 21-01-0808 Miriam K. Willis died on Monday, August 13, 2001, at the ManorCare Health Services Facility in Camp Hill, Pennsylvania. stock values are listed as the mean between the high and low on August 13, 2001. Values based upon NYSE and other sources as indicated. Stock High Low Mean D.O.D 1- A T & T Corporation (110 shares) 20.17 19.70 19.94 2,193.40 Cusip 001957109 2 . A T & T Wireless Corporation (35 shares) 17.16 16.55 16.86 590.10 Cusip 00209A106 3. Tri-Continental (566.606 shares)20.93 20.75 20.84 11,808.07 Cusip 895436 10 3 4 . Verizon Communications (328 shares) 53.69 53.25 53.47 17,538.16 Cusip 077853 10 9 5 . Qwest Communications International, Inc. (205 shares) 24.74 24.30 24.52 5,026.60 Cusip 749121109 6 . Income Fund of America (316.376 shares)16.45 16.45 16.45 5,204.39 Cusip $42,360.72 FIRST AND FINAL ACCOUNTING AND STATEMENT OF DISTRIBUTION FOR THE ESTATE OF MIRIAM K. WILLIS LATE OF CAMP HILL BOROUGH, CUMBERLAND COUNTY ROBERT DICKMAN WILLIS, EXECUTOR ESTATE NO. 21-01-0808 ORPHAN'S COURT DIVISION CUMBERLAND COUNTY, PENNSYLVANIA Date of Death: August 13, 2001 Date of Executor Appointment: August 30, 2001 Accounting for the Period: August 30, 2001 to July 24, 2002 Legal Advertisement: Patriot News: October 2, 2001, October 9, 2001, October 16, 2001 Law Journal: October 5, 2001, October 12, 2001, October 19, 2001 Purpose of Account: Robert Dickman Willis, Executor, offers this first and final accounting to acquaint beneficiaries and interested parties with the transactions that have occurred during the administration of the Estate of Miriam K. willis. This accounting does not address payments made for expenses of the Estate of Miriam K. willis prior to August 30, 2001. This accounting also reflects advance distributions and indicates the proposed remaining distributions from the Estate of Miriam K. Willis to the beneficiaries. It is important that the account be carefully examined. Requests for additional information or questions or objections can be discussed with: Andrew C. Sheely, Esquire 127 S. Market St., P. O. Box 95 Mechanicsburg, PA 17055 (717) 697-7050 SUMMARY OF ACCOUNTING RECEIPTS OF PRINCIPAL & INCOME RECEIPTS OF PRINCIPAL RECEIPTS OF MISCELLANEOUS ITEMS RECEIPTS OF DIVIDEND INCOME $ 98,258.85 3,135.92 412.87 TOTAL OF ALL RECEIPTS $101,807.64 DISBURSEMENTS OF PRINCIPAL AND INCOME AS OF JULY 24,2002 TOTAL OF ALL DISBURSEMENTS $ 6,005.89 14,257.42 664.06 (Radabaugh) 500.00 $ 21,427.37 ADMINISTRATIVE EXPENSES AND PAYMENTS STATE INHERITANCE TAX PAYMENTS MISCELLANEOUS DEBTS OF DECEDENT ADVANCED DISTRIBUTIONS TO BENEFICIARIES ESTATE ACCOUNT BALANCE AS OF JULY 24, 2002 $ 80,380.27 LESS: AMOUNTS REMAINING TO BE PAID Robert D. Willis, Executor Commision Andrew C. Sheely, Esq. (Attorney fees) Reserve For Distribution $ 2,375.00 $ 2,375.00 $ 500.00 $ 5,250.00 CASH REMAINING FOR DISTRIBUTION TO BENEFICIARIES $ 75,130.27 2 RECEIPTS OF PRINCIPAL 1) Postmark Credit Union Savings Account Number 20272 Balance as of 11/01/01 as deposited $ 27,442.01 2 ) waypoint Bank Certificate of Deposit #1000003206 Balance as of 10/19/01 as deposited $ 4,965.57 3) Waypoint Bank Certificate of Deposit #458195373 Balance as of 10/19/01 as deposited $ 2,420.90 4 ) Waypoint Bank Certificate of Deposit #1054300398 Balance as of 10/19/01 as deposited $ 1,788.26 6) waypoint Bank Certificate of Deposit #400047223 Balance as of 10/19/01 as deposited Allfirst Bank Checking Account #0090646002 Balance as of 10/20/01 as deposited $ 7,423.96 5) $ 8,930.93 7 ) Federated Fund for US Govt Services Inc. Account #8608701 Balance as of 4/1/02 as deposited $ 9,943.83 8) Net Proceeds of Sale of Stocks Sold 2/5/02 as deposited $ 28,901.34 9) Net Proceeds of Sale of Stocks Sold 6/26/02 as deposited $ 6,442.05 TOTAL RECEIPTS OF PRINCIPAL $ 98,258.85 3 MISCELLANEOUS RECEIPTS TOTAL MISCELLANEOUS RECEIPTS $ 300.00 2.00 $ 2,820.92 $ 13.00 $ 3,135.92 1) Federal Tax Refund 2) Cash Refund 3) Manor Care Refund 4) Federal Income Tax Refund DIVIDEND INCOME 1 ) Tri-Continental Corp. 9/24/01 $ 39.66 2 ) AT&T Wireless 7/09/01 $ 6.54 3 ) AT&T 8/01/01 $ 4.13 4 ) AT&T 11/01/01 $ 4.13 5) Misc. Dividend Income 12/01/01 $ 129.33 6 ) Verizon 1/10/02 $ 126.28 7 ) Tri-Continental Corp. 1/22/02 $ 39.66 8 ) Verizon 4/10/02 $ 63.14 TOTAL DIVIDEND INCOME $ 412.87 4 DISBURSEMENT OF PRINCIPAL AND INCOME ADMINISTRATION EXPENSES 1) HEADSTONE INSCRIPTION 2) ADMINISTRATIVE/ATTORNEY FEES AND COMMISSIONS a. Partial Executor Commission $2,375.00 b. Partial Attorney Fee $2,375.00 3) PROBATE FEES, ADVERTISING AND MISC. CHARGES 4) ACCOUNTANT FEES $ 250.00 $ 4,750.00 $ 650.89 $ 355.00 $ 6,005.89 TOTAL ADMINISTRATION EXPENSES INHERITANCE, ESTATE AND INCOME TAXES 1) STATE INHERITANCE TAX PAYMENTS $ 14,257.42 TOTAL INHERITANCE, ESTATE & INCOME TAXES $ 14,257.42 MISCELLANEOUS DEBTS OF DECEDENT $ 664.06 ADVANCE CASH DISTRIBUTIONS 1) RUTH RADABAUGH (specific bequest) $ 500.00 TOTAL DISBURSEMENTS & DISTRIBUTIONS $ 21,427.37 ESTATE ACCOUNT BALANCE AS OF JULY 24, 2002 $ 80,380.27 LESS: AMOUNTS REMAINING TO BE PAID Robert D. Willis, Executor Commision $ 2,375.00 $ 2,375.00 $ 500.00 $ 5,250.00 Andrew C. Sheely, Esq. (Attorney fees) Amount to be held in reserve TOTAL AMOUNT TO BE PAID/HELD IN RESERVE CASH REMAINING FOR DISTRIBUTION TO BENEFICIARIES $ 75,130.27 5 PROPOSED DISTRIBUTION OF REMAINING PRINCIPAL AND INCOME NAME OF DESCRIPTION BENEFICIARY AMOUNT OF DISTRIBUTION MARY ELIZABETH YOVICSIN 25 % of Residual Estate 31 Edith Road Cash Distribution Framingham,MA 01701 $ 18,782.57 BETTY WILLIS 25 % of Residual Estate 117 November Drive Cash Distribution Camp Hill, P A 17011 ROBERT DICKMAN WILLIS 25 % of Residual Estate 204 South Stoner A venue Cash Distribution Shiremanstown, P A 17011 $ 18,782.57 $ 18,782.57 LENA M. WILLIS 25 % of Residual Estate 326 Caracus Avenue Cash Distribution Hershey, PA 17033 $ 18,782.56 DA VID & KATHY WILLIS 7211 Audubon Drive Harrisburg, PA 17111 Personal Contents per Memorandum LIZABETH ROBERTS 1591 Woodhaven Drive Hummelstown, P A 17036 Personal Contents per Memorandum SUSAN KEGERISE 11 Chancelet Court Rockville, MD 20852 Personal Contents per Memorandum JOANNE CHOYKA 14 Bridge Lane Collegeville, PA 19426 Personal Contents per Memorandum 6 Robert Dickman Willis, Executor, under the Last will and Testament of Miriam K. Willis, deceased, hereby declares under oath that he has fully and faithfully discharged the duties of his office; that the foregoing First and Final Account is true and correct and fully discloses all the significant transactions occurring during the accounting period; that all known claims against the estate have been paid in full; that, to his knowledge, there are no claims now outstanding against the estate; and that all taxes presently due from the estate have been paid. Date:July 24, 2002 ~ r?U ))I~~ W~- Robert Dickman willis Sworn and affirmed to and acknowledged before me, Ann W. Martin, this 24th day of July, 2002. rLJ:t:rrn~ 7 n n tI.I trl c::: ~ ::0 ~~ :5: t"i rn :5:trlOH 8 tJ:I trl 1-3 H:><:~::O H :5: NO trl 8 > ::otrl (J) ~ trl -...J::o:to' ~~~ 8 1-3 n Hn::08 H n trl8 o 0 trl trl tI.I C:::05:C:::O trl :I: (J)::E:8 .........~......... 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Il' -~ 9,) ::. 0 to C7Ql:3 . iQ,ili~ c: a. ;;if!f!lfj :=. t ilfl itlf<~ o -. 0. ;:)-- - iP] H ::J"~ 11!f) ,I Il :J "C ~ ~_CT 'f(Ii"U . 0 c: r IlflSa9. . -g :: ~ II fIll) =.Q ~t::l . UI' h! f I I ! ill .x:i -!il5"t 1 I - '5 i -c ill ~ g, IS . -... STATUS REPORT UNDER RULE 6.12 (2; 'o~ Date of Death: (' ,I fVl/ ,ia M k, WI 1/ /5 0'8' 1/3 J~?) I Name of Decedent: Will No.: 2-1 -2-00 I _ (}<gO r Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes ~ No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did ~j,personal representative file a final account with the Court? Yes p. No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes 0 No IX1 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. 1"'- r~ ;fncfrt vJ (J ~ Name Date: 1.b1/1JJ '..J\ ~ .) c: I ;J- 7 ->: /11 c:r-/4;- S'f- Address /L1 ~ ~ A V'1/ d- s-'7V) ,p-+ /7 v ~ ( [1- b1'7 - 7cJRJ Telephone No. Capacity: 0 Personal Representative W-Counsel for personal representative