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HomeMy WebLinkAbout01-0832 PETITION FOR PROBATE and GRANT OF LETTERS Estate of \;.~"",,e... S. '&X No. .:JJ - 01 - 2r3:l also known as To: Register of Wills for the . Deceased. County of in the Social Security No. ~-Ji' - I?/-S;- Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the ewcu~ in the last will of the above decedent, dated ~..~~ and codicil(s) dated ~ named ,1~ Decendent was domiciled at death in he r last family or principal residence at (state relevant circumstances, e.g. renunciation, death of executor, etc.) (]. u.. Ir...:- ( ..., r ,IlPO I years f age;.- died at <S' ~ __4 · Except as ollows, decedent did not marry, was not div reed and did not have a child born or adopted after execution of e 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: $~ooo $ $ $ WHEREFORE, petitioner(s) respectfully request~probate of the last will and codicil(s) presented herewith and the grant of letters ~-s-b. ~ (testamentary; dmInlstratIon c.t.a.; admInistratIon d.b.n.c.t.a.) theron. ~ '" ~ '" u l::: '" -o~ .- '" "'~ '" ... 0::'" l::: -00 c::"O cu".:: ~'" ~Ilo "''- 50 ~ l::: 00 Vi OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 1- ss COUNTY OF CUBERLAND J The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed \.\ ~ t:: ........ ~:f. ~ before me this 6th day of { =1I ~ -, ) , ~. E~ OOX2001 ~ '/Y'ylIUJ. :rf._..T:_ ~ \6. ~ Rq~~ ~ /7 - ~ - )3 No. 21-01-832 Estate of JEANNE S BEX , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW SEPTEMBER 7 m2001, 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 NOV. 27.1 goB described therein be admitted to probate and filed of record as the last will of JEANNE S. BEX TESTAMENTARY JOHN E. BEX and Letters are hereby granted to ~ C,. i,,~ Db. ,()l$.Ct~ Register of Will! FEES Probate, Letters, Etc. ......... Short Certificates( 8) . . . . . . . . . . Renunciation ................ x-pages JCP $ 340.00 $ 24.00 $ $ 3.00 S.OO TOTAL _ $ 17?OO .. . . . ?~~ t. 7.,.2Q03.. . . . .. . . . . . . . . . . SCOTT M. DINNER, ESQ. ATTORNEY (Sup. Ct. J.D. No.) 3117 Chestnut St. CAMP HTT.T'r p~, 17011 ADDRESS Filed 717-761-5800 PHONE fY\~~~~ Cf-?-o\ LT. f'I".~f'I<; ':',T;.\' (I/~)/, This is to certify that the information here given is correctly copied from an original certificate of death du~y 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. Fee for this certificate, $2.00 p 7556007 No. 1.44W<~ (.d(.J~ Local Registrar Y1:C.#AA2~ ~ 7; JcfCJl_ Date HI05,144 Ae...., 1191 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH (Coroner) TYPErPRINT IN PERMANENT BLACK INK I ~ :J if) < "ii 12 111A.1 I IJJ SEX ..Female .. PLACE OF DEATH (ChedI 0011' one see InsltuctlonS on other SIde) HOSPITAl: Inpalienl 0 ~::It~) 0 R Bex UNDER 1 DAY Hours Minutes DATE OF BIRTH (MOllth,Day,'l8ar) BIRTHPLACE {Cily and State Of Ftxeign COllnky) Chicago, Illinois CITY, BOA Ie. DECEDENT'S USUAL QCCUPATK)N (Gi...e kind ot work dOne duf~ mosl 01 WOfkIH~~~mseak~~) 11a. 11 , DECEDENT'S MAILING ADDRESS (St/eel, CltyfTown. Stale, ZipCodel Own Home DECEDENT'S ACTUAL RESIDENCE (Seelnslfuctl()(l;; olherSlde) 17b. Counl 8 Mayfield Road Mechanicsburg, Pennsylvania 1705 STATE FilE NUMBER SOCIAL SECURITY NUMBER 359 14 DATE OF DEATH (MOll\t1, Day, Year) September 3, 2001 White SURVIVING SPOUSE (U wile, 9l"e maiden name) John E. Sex wp. twp Harro Scharbau John E. Sex Cumberland 17d.o ~'=~~":'Of MOTHER'SNAMEI"""_.MoideoSu"'amel Rowena Webster 10. 'NFORMANT'S!!AlLII'GApo~Ep~''''.~,,1]owo SI....ZipC"""J P 17055 . II Maynelo Koao MeCnanlCSDurg, a. city/bolO Conolite Crematory lOCATION. CClyfTown, Stale, Zip Code Schaefferstown, Pa. 17088 21<:. PLACE OF DISPOSITION. Name of Cemetery, Cremalory or OIh&r P1ace ld. LICENSE NUMBER FD-014318-L 22b. , death occurred IU the time, date IU1d place staled ,1Ie1 NAME AND ADDRESS Of FACILITY Myers Funeral Home, Inc. 37 East Main Street Mechanlcsburg, Pa 17055 LICENSE NUMBER DATE SIGNED (ManU" Da~, Year) 'c. 2311. 2Jc. WAS CASE REFERRED 10 MEDICAL EXAJJ!INEAICOAONER? ....JQ f'.O. NoD DATE PRONOUNCED DEAD (Month, Day, Year) September 3, 2001 .,.. TIME OF DEATH prx. '4. 1 : 00 A.. 27. PART I: Enler the diM...., Injuflea or compllcallOOI which caUMd lhe death. Do not enter tile mode of dying, such as cardiac Of respiratory arrest, shock or heart taikn. List onty one cause on each line I Approxlmata : irllerval betWeen :onHt and death i PART II: Other Mgniflcanl condItiOnl contributing to death, tMA not ruulling in the underlying CIIU$8 given in PART I Presumed Natural Causes DUE 10 lOR AS A CONSEQUENCE OF)' b. DUE TO (OR AS A CONSEQUENCE OF)' OUE lO(OA AS A CONSEQUENCE Of). d WERE AUlOPSV FINDINGS AltPJl.ABlE PRIOR TO COMPLETION OF CAUSE OF DEATH? MANNER OF DEATH DATE OF INJURV (MOflth.Day. Yttar) )(l o o o INJURV AT WORK? Nah.llal Homicide o o ... M. (J ~~d~~~~~::;l~tt home, farm, Ilr..l, ladory, onlce .... No [J Accidlilnl Pending In"esligation Ve. 0 No~ Yes 0 2... 21b. CERTIFiER (Check ont~ one) .CERTIFVtNQ PHYSICIAN (PtlySICIiIII c&rtllying cause of rjealn ",,"an anOlher pllysician has plUflounced Otldlt. <lnd cornf.>lt:llKt 1l00n 2:J) To tM bell 01 mY' knowtedge, death oc:cuned dua kI the cauHC') and manner al alated. Could not be (Jalermlned Suicida '0. >- z w :;: :;l o ~ o w :> < z .PRONOUNCING AND CERTIFYING PHYSiCIAN (Phy!.lCian both pronouncing death ana ceflifyillgto cause wI \J&altlj To lIM beat of my knowladge, death occurred a' thIi Ume, cqla, end place. end due to the ceu..(a) Ind menner " .taled .UEOK;AL EXAMINERlCOROHER On the bae'- of ..amin.tlon .00/. InvnUg.tton, in my opinion. d..th OCCURed.' the t1mt1, d.'., .nd place..nd due to the uuae(.) and m.nner.....led...,.,...,.,.,....,.."'....,....,..."""'.....""'.."..'.'..'.."......"'......".'..."... . 311. AEGIST "'. Coroner DATE NED (Monlll Day Yeafj 0310. 31d. Sept. 4, 2001 NAME AND ADDRESS Of PERSON WHO COMPlETED CAUSE Of DEATH (lIem27)Typeo<Prinf Michael L. Norris, Coroner M 6375 Basehore Road. Suite #1 p(u. Mechanicsburg, Pa. 17050 DATE FIlED(Montl1, Day. Year) 34. Se. Tembe./f!. ~ ..:< I)" I ,~ ., ; .40 , . JOINT 1JIast lIill attb Wtstattttttt BE IT REMEMBERED, That We, JOHN E. BEX and JEANNE S. BEX, hus- band and wife, of 8 Mayfield Road (Mechanicsburg 17055), Upper Allen Township, County of Cumberland and Commonwealth of Pennsylvania, both being of sound minds and disposing memories, and desiring to make this disposition of our earth ly affairs so that no contention may arise concerning the same when we, or either of us be dead, and also to provide for the distribution of each of our separate est ates in the event of our simultaneous deaths in a common disaster, so each mutua - ly in consideration of the other's making his or her Will, and of the provisions made herein in each other's behalf, make this our JOINT LAST WILL AND TEST AMENT, thereby voiding all prior Wills heretobefore made by either of us, and agree that the same cannot be changed or varied by either without the consent in writing of the other. AND FIRST, We direct that our respective funerals be conducted in manners corresponding with our respective estates and situations in life, and that all of our respective and just debts and funeral expenses shall be fully paid and satisfie as soon as conveniently may be after our respective deaths. AND to such estate as it has pleased God to entrust to us separately and joint it is the will and desire of each of us, and our mutual desire, that on the death of either of us our entire estate, real, personal and mixed whatsoever and whereso'" ever it may be situate, together with the rest, residue and remainder thereof, and the estate of the one so dying, shall pass to the survivor for life, with power to consume or pass on to our heirs hereinafter namoo., without giving Bond or the intervening of a Trustee. AND in the event of our simultaneuus deaths in a common disaster, the pro- ceeds from the sale of our real estate, if necessary, at private or public sale, together with all of the sum total of all monies, including the liquidation of any stocks, bonds, negotiable securities, insurance policies, and any other personalt as well as the rest, residue and remainder thereof, we bequeath and devise unto END OF PAGE ONE (l) OF TWO (2) PAGES .. ... . . ... .. our two (2) Beloved Sons, by dividing it into two (2) equal shares, share and share alike, namely: B~IAN WILLIAM LOUIS BEX, as of this date residing in Bloomington, Indiana; and JOHN DAVID BEX, as of this date residing at home with us. AND WE hereby nominate, constitute and appoint each other in the event of one pre-deceasing the other, as Executor or Executrix, but in the event of a common disaster, then our Son BRIAN WILLIAM LOUIS BEX shall be the Executor with commission. We trust that he shall consult Attorney Peter Kre hel, Sunbury, Pennsylvania 17801, for any assistance in the administration of our estates, and we further direct that our Executor shall not be required to post bond in this er any other jurisdiction. IN WITNESS WHEREOF, we , JOHN E. BEX and JEANNE S. BEX, the Testator and Testatrix, have hereunto set our hands and seals to this our Joint Will this :J.. 7 day of November, 1968. ~ t' -1/ Alw~ ..-.1. ~~ ~ (SEAL) (SEAL) Signed, Sealed, Published and Declared by the above named JOHN E. BEX and JEANNE S. BEX, husband and wife, as and for their Joint Last Will and Testa ment in the presence of us, who have hereunto subscribed our names at their request as Witnesses thereto, in the presence of the said Testator and Testa- trix and of each other. residing at ~ \'\~y~ 'l( \. Q\~\~ \\~ ,,- \,~~ r:,. ,~ . ~...._.. .- '. ,,~ , . residing at \.~-t.' rJt..~. ~\ ~ Ci)J (3, I' ~ \{'.~:L E~OF PAGE TWO (2) OF TWO (2) PAGES' . REGISTER OF WILLS OF CL.-L~{~ COUNTY OATH OF SUBSCRIBING WITNESS ., codicil (each) a subscribing witness to the will presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that present and saw the testat , sign the same and that signed as a witness at the request of testat_ in h presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this day of 19_ Register (Name) (Address) (Name) (Address) REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF NON-SUBSCRIBING WITNESS Q(~~ r S- ({;y b-, ~~~r1 ~. ~<< (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that WE ARE familiar with the signature of JEANNE S. BEX cXmDC will that test at RIX of (one of the subscribing witnesses to) the THEY presented herewith and ~k believes the signature on the will is in the handwriting of to the best of THEIR JEANNE S. BEX knowledge and belief. Sworn to or affirmed and subscribed before me this 6th day of SEPT'. X})9 2001 Register COMMONWEALTH OF PENNSYLVANIA" COUNTY OF CUMBERLAND } ~: John E. Bex being duly appointed according to law, deposes and says that he I ~ F.Xf"cnt-or of the Estate of Jeanne S. Bex late of Upper Allen 'f'own~h i P , Cumberland County, Pa., deceased and that the within is an inventory made by .John F. Rf"X , the said Executor of the entire estate of said decedent, consisting of all the personal prop.trty and real estate, except real .stat. outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. ~~ {)6+- de:, Jr ~~ ~~~ , lQ. ~oo I Swll\"h and subscribed before me, 8 Mayfield Road Date' of Death Mechancisburq, PA 17055 Aclclr... September Month 2001 Y..r INSTRUCTIONS , . An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of '949. nc ,- -,.. = (t" ~?2 rr ' ;''', \'1.-' 9 CJ C":l W >- -ti G .... W ... >- a:: .... III W ~ >< G 0::: G. Q) U G 0 In G 0 w !:Xl C '" - a:: w III . I- :I: G. LL G. C Z .... -I III .. -I -< 0 U) G. 0 u.. = W 0 -< w >. -< > Z a:: Q) ... Z 0 c c: c c: ::I In Z 0 0 a:: ltl 0 0 Z w -< Q) .. G. ~ ~ c ... - I: 0 G ..Q ~ ..M G E ... -! 0 ... ::I 0 -' U u: - V N d U"I ~nventory of the real and personal estate of Jeanne S. Bex deceased 1. 10.500 Shares Fulton Financial Common stock 228,48( 00 2. PNC Bank Svgs Acct. #5000753451 12.741 1 1 3. PNC Bank CD #21001025489 27,953 38 4. PNC Bank CD #21001029510 10,699 31 5. PNC Bank CD #21001029581 '4,316 87 6. PNC Bank CD #3140041086 26,391 71 7. PNC Bank CD #31700189823 28,051 47 8. PNC BAnk CD #31300191068 28,051 47 9. PNC Bank CD #31000189989 10,798\ 49 10. PNC Bank CD #31100213565 12,768] 18 11. 12- $1000 Series EE U.S. Savings Bonds 14,980 80 12. Mellon Bank Chekking Acct. #885-001-8923 132,,93 77 Total 548,161 56 r;L STATUS REPORT UNDER RULE 6.12 Name of Decedent: Jeanne S. Bex Date of Death: September 3, 2001 Will No. Admin No. 21-01-0832 Pursuant to Rule 6.12 ofthe 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 X No 2. If the answer is No, state when the personal representative reasonably believe that the administration will be complete. 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes X No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes X No Lr'I S:?' d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this repo~:=,,__.~ _, _, ~x~ ~~ SIgnature - John E. Bex Name (Please type or print) 8 Mayfield Road Mechanicsburg, P A 17055 Address 717-766-0697 Tel. No. Date~ N 0.... .- M U c:::J <.':.:,. ) :,) Cl Q.\CC cr: is 'iJ . .0 :J:. s:: J3= """ ..,i/I (.)0 Capacity: X Personal Representative _ Counsel for personal Representative t U.S. Postal Service CERTIFIED MAJL RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) CJ ...a ITI ru ITI ...a .-'l IT" I J Postage $ Certified Fee Postmark Return Receipt Fee Here (Endorsement Required) Restricted Delivery Fee (Endorsement Required) Total Postage & Fees $ CJ .-'l CJ CJ CJ I"- ...a .-'l Sent Te::;. ~, E: ---------v-~------ffi---,v~n~~c-------~1_---------------------------- ~ Street, Apt. No.; or ~~i;r:~__~__J.\.~_QJ_~_R3~_____________ I"- -Ciiy:siaie:ziP+4-- --- - PS Forlll C)8on r\~c1Y 2000 Sf"8 RpIJerse for InstructlOIlS . Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. . Print your name and address on the reverse so that we can return the card to you. . Attach this card to the back of the mail piece, or on the front if space permits. 1. Article Addressed to: ~~ \'(\ ~ 2:'46'1>' 3111~ s*. ~ P-A /10/1 3. Service Type IiiJ"""Certified rtlail D Registered D Insufecl Mail D Express Mail D Retum Receipt for Merchandise DC.a.D. 4. Restricted Delivery? (Extra Fee) Dyes 2. Article Number '1 DO()l ~ 1 0 (T'ransfer from service labeQ PS Form 3811, March 2001 OOJO Qllc3 -23~o Domestic Return Receipt 102595-<l1-M-1424 " " - JRD/June 30, \,992/17858 JAN 0 3 v., Estate No.: 21-01-832 ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA In Re: Estate of Jeanne S Bex Late of Upper Allen Township NO. NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT ORPHANS' COURT RULE Personal Representative: John E. Bex Counsel for Personal Representative: Scott M Dinner Esq Date of Grant of Original Letters: September 7, 2001 Date of Delinquency Notice: December 17, 2001 The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court Orphans' Court Rules, was given by the Register of Wills on December 7, 2001, and that the ten (10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e) the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: January 2, 2002 Distribution: Personal Representative Counsel for Personal Representative Estate File A hearing is scheduled for 4t~/>~~;u at ;:30 In Courtroom No.3. If the Certification of Notice is filed prior to the hearing date, the hearing will automatically be cancelled. Georg4JU1r) oJ< ~ ) -dJ-3 -OcJ- - '-.1' CERTIFCATION OF NOTICE UNDER RULE 5.6(A) Name of Decedent: Jeanne S. Bex Date of Death: September 3, 2001 Will No.: 2001-00832 Admin No.: To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5 .6( a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 9 / 7 / 0 1 Name John E. Bex Address 8 Mayfield Road Mechanicsburg, PA 17055 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except n/ a Date: ~2/02 ~ Si~e SCOTI%.1JI'JI!~'R.& 'F.'QJlT~ Name 3117 Cftestnut Street Camp JiilJ; PJl17011 Address U1 If) (717) 761-5800 Telephone EC :.u: ~:: - ,",j, u Q) CC M N z c:::c: --, , , Capacity: 0 Personal Representative 'j Et Counsel for personal representative (l) .,..cl :':s:: \:1) :::: 00 ~ \, 1'7~/~q COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG. PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-18-2002 BEX 09-03-2001 21 01-0832 CUMBERLAND 101 REece R(T 02 FEB 25 SCOTT M DINNER ES~ 3117 CHESTNUT ST CAMP HILL le'.6,ril7011 ClImb\;:i ~\11 :5 7 Allount Rellitted '* REY-1547 EX AFP lIZ-IOl JEANNE S 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=is4-j-E3f-AFP-fi'2=oOY-NOTicE--OF-YNHEifiTANCE-YAX-APPRAisEifENT~--AiXoWANCE-oi----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BEX JEANNE S FILE NO. 21 01-0832 ACN 101 DATE 02-18-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel 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 ( ) CHANGED ll) (2) (3) (4) (5) (6) (7) .00 228.480.00 .00 .00 319.685.56 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Hortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Govern.ental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax I~ an assessment was issued previoUSly, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount 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 TAX CR TS: PAYME DATE NOTE: RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID (-) . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. (9) 1l0) 4,864.66 .00 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax pay_nt. 548,165.56 (11) (12) (13) (14) 4.864 66 543,300.90 .00 543,300.90 543,300.90 X .00 X .00 X .00 X AMOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 00 = 045 = 12 = 15 = .00 .00 .00 .00 .00 (19)= .00 .00 .00 .00 ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) REV-1500 EX . (6-00) . COMMONWEALTH OF , PENNSYLVANIA .~ . DEPARTMENT OF REVENUE DEPT 280601 HARRISBURG, PA 17128-0601 W I- :.: ~Ul 011:::.: w~g J: II::...J OtlQ c( REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W o w u w o DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Sex, Jeanne S. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) [g] 1. Original Return D 4. Limited Estate [g] 6. Decedent Died Testate (AttachcopyoIWII) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (dale 01 death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach copy ofTrust) D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) OFFICIAl. USE ONLY I?- ~ /3 FILE NUMBER 21 -01 o 8 3 2 COuiijy'CoiiE -YEAR- - - 't:iUMBER- - SOCIAL SECURITY NUMBER 3 5 9 - 1 4 - 1 715 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WillS -. .-.---, ~ II I. ~"r::o LJ 3. Remainder KelUII' \00'. u, u__...... D 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Soh OJ ~:~fi'it$~~$lStttQ.i\fMU$tJ:ilrm>Mj:iEetKA::::::::e~$.P:miltltiJ;Wl!fANQ:eONm:IlNnAt"it:::.:~~. ":'~MllIQi'ir$H(wttt:;S~m~lStB:::tor)t~ NAME COMPLETE MAILING ADDRESS Scott M. Dinner, Es FIRM NAME (~Appicabl9) 09/03/2001 03/31/1920 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Sex, John E. I- Z W o z o 11. Ul w II:: II:: o o Carn Hill 3117 Chestnut Street PA 17011 543,300.90 x 00 5 ._(1) X 0_(16) X12 (17) X .15 (18) (19) TELEPHONE NUMBER 717 761-5800 z o i= :s ::::> l- e: c:x: u 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) (3) (4) (5) (6) (7) (9) (10) 14. Net Value Subjectto Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o i= ~ ::::> a. :E o U X ~ 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount ofUne 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 OFFICIAL USE ONLY 228,~0 3~ C'"~ g:;) c5 - :TJ~ t"...., (0 ?;}, g:; ~!; ..,;... e C"":l W ..... ;,'~ 319,6a5_56 r' '" .fa.ao V N o U1 ,. """C ~;::J. (8) 548,165.56 4,864.66 (11) (12) (13) 4,864.66 543,300.90 (14) 543,300.90 20. Deceaent!s Complete Address: STREET ADDRESS 8 Mayfield Road . - CITY Mechanicsburg I STATE PA I ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. InteresVPenalty if applicable D. Interest E. Penalty 4. TotallnteresVPenalty (D + E) 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 (3) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (4) (5) (5A) (5B) to: REGISTER OF WILLS, AGENT A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check 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 [g] b. retain the right to designate who shall use the property transferred or its income.;...................................... 0 [g] c. retain a reversionary interest; .or............................... ................................................................... 0 [g] d. receive the promise for life of either payments, benefits or care?........... ...... ........................................ 0 [g] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?......................................................................................... 0 [Z] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death:?............... 0 [Z] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?.................................................................................................. 0 [g] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penakies of pe~ury, I declare that I have examined this return, incuding accompanying schedues and statements, and to the best of my knowledge and belef, it is true, correct and compete Declaration of preparer other than the personal representative is based on all information of which preparer has any knowedge ADDRESS PA 17011 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)). For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (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. F or dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P .S. ~9116(a)(1.2)). The tax rate imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ~!'.""'''. '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE B STOCKS & BONDS ESTATE OF Sex Jeanne S. All property jointly-owned with right of survivorship must be disclosed on Schedule F. FILE NUMBER 21 01 0832 ITEM NUMBER 1. DESCRIPTION 10,500 Shares Fulton Financial Common Stock @$21.76 VALUE AT DATE OF DEATH 228,480.00 TOT AL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 228,480.00 "',.,..".':. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Bex. Jeanne S. FILE NUMBER 21 01 0832 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. DESCRIPTION VALUE AT DATE OF DEATH 12,741.11 PNC Bank: Savings Account #5000753451 2 Certificate of Deposit #21001025489 27,953.38 3 Certificate of Deposit #21001029510 10,699.31 4. Certficate of Deposit #21 001 029581 14,316.87 5. Certificate of Deposit #3140041086 26,391.71 6. Certificate of Deposit #31700189823 28,051.47 7. Certificate of Deposit #31300191068 28,051.47 8. Certificate of Deposit #31000189989 10,798.49 9. Certificate of Deposit #311 00213565 12,768.18 10. 12-$1000 Series EE U.S. Savings Bonds (See Attached) 14,980.80 11. Mellon Bank Checking Account #885-001-8923 132,932.77 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 319,685.56 RE',~1~11EX+(1-97).. ~_ . .~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE T I\X RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Sex. Jeanne S_ FILE NUMBER 21 01 0832 Debts of decedent must be reported on Schedule I. ITEM I NUMBER DESCRIPTION AMOUNT A, FUNERAL EXPENSES: 1- Myers Funeral Home 1,2 B, ADMINISTRATIVE COSTS: I 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) I EIN Number of Personal Representalive(s) Street Address City State Zip Year(s) CommiSSion Paid 2. Attorney Fees Scott M. Dinner, Esq. I 5 3, Family Exemption (If decedent's address is not the same as claimant's, attach explanation) Claimant I Street Address I City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills I 4 5. Accountant's Fees 6_ T ax Return Preparer's Fees Charles F. Sullivan CPA 2,5 PA Inheritance Tax Return I 7. Legal Advertising: The Patriot-News Co. Cumberland Law Journal 1 --.~-- TOTAL (Also enter on line 9, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) 45_00 00.00 75.00 00.00 44.66 4,864.66 0. PNCBAN< Decedent Reporting Firstside Center 500 First Avenue, 4th Floor Pittsburgh, PA 15219-3128 November 2,2001 Charles F Sullivan 1513 Cedar Cliff Dr Camp Hill P A 17011 RE: Estate of Jeanne S Rex, Deceased SSN: 359-14-1715 DOD: 09/03/2001 Dear: Mr. Sullivan: /SCP Please find the date of death balances you have requested listed below. CERTIFICATES OF DEPOSIT #21001025489 JEANNE S REX DOD Ba1ance:$27,867.51 + $85.87 accrued interest #21001029510 JEANNE S BEX DOD Balance: $10,672.15 + $27.16 accrued interest #21001029581 JEANNE S BEX DOD Balance: $14,283.60 + $33.27 accrued interest #31400041086 JEANNE S BEX DOD Balance: $26,270.83 + $120.88 accrued interest Page 1 of2 A member of The PNC Financial Services Group One PNC Plaza 249 Fifth Avenue Pittsburgh Pennsyivania 15222 2707 Established 07/09/1993 Established 01/13/1992 Established 01/11/1989 Established 06/04/1996 o PNCBAN< #31700189823 Established OS/22/1995 JEANNE S BEX DOD Balance: $28,021.83 + 29.64 accrued interest #31300191068 Established OS/22/1995 JEANNE S BEX DOD Balance: $28.021.83 + $29.64 accrued interest #31000189989 Established 01/03/1994 JEANNE S BEX DOD Balance: $10,762.41 + $36.08 accrued interest #31100213565 Established 09/27/1996 JEANNE S BEX DOD Balance: $12,683.54 + $84.64 accrued interest CHECKING ACCOUNT #5140004479 Established 01/01/1978 JOHN E BEX JEANNE S BEX DOD Balance: $10,627.52 + $9.01 accrued interest SAVINGS ACCOUNT #5000753451 Established 03/10/1997 JEANNE S BEX DOD Balance: $12,728.09 + $13.02 accrued interest Our office only provides date of death balances for IRA's, CD's, Checking and Savings accounts. We do NO Financial Transactions or Statement Orders. For Further information please call1-800-4-BANKER or your local PNC Branch and ask to speak with a Financial Services Representative. SilJ;<(ere1y, " Jf \; \( ^ t ,'" 'J\~' "\ \ \1 \ ' 'J \1 \ ~< -, '-, . \.\" .'--~- .....'\.f\! - " - " ,_ "'I ; .', anarr Domre11 ....::;;;I-'-C..... ,,~-'v,\~, \J 1-800-762-1775 Page 2 of2 A member of The PNC Financial Services Group One PNC Plaza 249 Fifth Avenue Pittsburgh Pennsylvania 15222 2707 . ., Sav.ings Bond Calculator Value As Of ~OOl ! - Bond Info Series ~~ondS Denomination lit $~OO II Results # Bonds 12 Total Price $6,000.00 1_ Serial Number L Page 1 of 1 Total Value $14,980.80 Issue Date L________l I Total Interest $8,980.80 YTD In $292 Issue Interest Serial Number Issue Date Series Denom Price Interest Value Rate M19736643 10/1986 EE $1,000 $500.00 $748.40 $1,248.40 4.00% M19736642 10/1986 EE 1,000 500.00 748.40 1,248.40 4.00% M19736641 10/1986 EE 1,000 500.00 748.40 1,248.40 4.00% M19736640 10/1986 EE 1,000 500.00 748.40 1,248.40 4.00% M19736639 10/1986 EE 1,000 500.00 748.40 1,248.40 4.00% M19736638 10/1986 EE 1,000 500.00 748.40 1,248.40 4.00% M19736637 10/1986 EE 1,000 500.00 748.40 1,248.40 4.00% M19736636 10/1986 EE 1,000 500.00 748.40 1,248.40 4.00% M19736635 10/1986 EE 1,000 500.00 748.40 1,248.40 4.00% M19736634 10/1986 EE 1,000 500.00 748.40 1,248.40 4.00% M19736633 10/1986 EE 1,000 500.00 748.40 1,248.40 4.00% m19736632 10/1986 EE 1,000 500.00 748.40 1,248.40 4.00% Ijjjjiii I Viewing Bonds 1-12 let end Note Description NI Not Issued NE Not Eligible for Payment P5 Includes 3-month interest penalty ME Matured (Exchangeable for HH) MN Matured (Not Exchangeable for HH) http://www . publicdebt. treas.gov /serv letlSBCPrice Next Final Accrual Maturit 10/2001 10/201lv 10/2001 10/201 0> 10/2001 10/201L. 10/2001 10/201 U, 10/2001 1O/201l.. 10/2001 10/201 (p 10/2001 10/201 (p 10/2001 10/201 (p 10/2001 10/201 (p 10/2001 10/201& 10/2001 10/2010 10/2001 10/2010 9/24/2001 . .f' '. ~ Mellon Bank Monday, October 01, 2001 Account Number Account Title 885-001-8923 Jeanne S Sex Date Opened: 02/03/1995 Account Type: DO Principal Sal Int from Last Account Sal YTD Int to as of DOD Posting to 000 as of DOD DOD $132,831.94 $100.83 $132,932.77 $2,424.11 Page 2 of 2 r ~''''"."., '* COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES 1, NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) I I John E. Sex 8 Mayfield Road Mechanicsburg, PA 17055 FILE NUMBER 21 01 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) 0832_ . AMOUNT OR SHARE OF ESTATE ESTATE OF Sex Jeanne S. NUMBER I. Spouse 1100% 1. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: I A, SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE i I I I I I II. B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1, TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEE $ (If more space is needed, insert additional sheets of the same size) WHEREAS I on the 7th dated November 27th 1968 was admitted to probate as the last will of BEX JEANNE S (LAb'1' I 1<'l1<.b'1' I J.VlllJlJLJ:;) ( . !. -' Register of Wills of CUMBERLAND County I Pennsylvania Certificate of Grant of Letters No. 2001-00832 PA No. 21-01-0832 ESTATE OF BEX JEANNE S (LAb'1' I l"lKbT I lVlllJlJLJ:;) Late of UPPER ALLEN TOWNSHIP CUIV1.l:5J:;1<.LAl\IlJ CUUNT X I Deceased Social Security No. 359-14-1715 day of September 2001 an instrument late of UPPER ALLEN TOWNSHIP CUMBERLAND CountYI who died on the 3rd day of September 2001 and, WHEREAS I a true copy of the will as probated is annexed hereto. THEREFORE I II MARY C. LEWIS , Register of wills in and for the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to BEX JOHN E who has duly qualified as Executor (rix) and has agreed to administer the estate according to lawl all of which fully appears of record in my Office at CUMBERLAND COUNTY COURT HOUSEl CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my Office the 7th day of September 2001. ~a'" Q. 4.~^ a.......p4~1~ \ eglsrJer 0 l S * *NOTE* * .ALL NAMES ABOVE APPEAR (LAST I FIRST I MIDDLE) ---.-----.'....---..-- .. ,....-~.......1. (. JOINT 1E&st JIIill &w QItst&tlttut BE IT REMEMBERED, That We, JOHN E. BEX and JEANNE S. BEX, hus- band and wife, of 8 Mayfield Road (Mechanicsburg 17055), Upper Allen Township, County of Cumberland and Commonwealth of Pennsylvania, both being of sound minds and disposing memories, and desiring to make this disposition of our earth ly affairs so that no contention may arise concerning the same when we, or either of us be dead, and also to provide for the distribution of each of our separate est ates in the event of our simultaneous deaths in a common disaster, so each mutua - ly in consideration of the other 's making his or her Will, and of the provisions made herein in each other's behalf, make this our JOINT LAST WILL AND TEST AMENT, thereby voiding all prior Wills heretobefore made by either of us, and agree that the san,e cannot be changed or varied by either without the consent in writing of the other. AND FIRST, We direct that our respective funerals be conducted in manners corresponding with our respective estates and situations in life, and that all of our respective and just debts and funeral expenses shall be fully paid and satisfie as soon as conveniently may be after our respective deaths. AND to such estate as it has pleased God to entrust to us separately and joint it is the will and desire of each of us, and our mutual desire, that on the death of either of us our entire estate, real, personal and mixed whatsoever and whereso" ever it may be situate, together with the rest, residue and remainder thereof, and the estate of the one so dying, shall pass to the survivor for life, with power to consume or pass on to our heirs hereinafter named, without giving Bond or the intervening of a Trustee. AND in the event of our simultaneous deaths in a common disaster, the pro- ceeds from the sale of our real estate, if necessary, at private or public sale, together with all of the sum total of all monies, including the liquidation of any stocks, bonds, negotiable securities, insurance policies, and any other personalt as well as the rest, residue and remainder thereof, we bequeath and devise unto END OF PAGE ONE (1) OF TWO (2) PAGES .A .. .' ...--..---,-- our two (2) Beloved Sons, by dividing it into two (2) equal shares, share and share alike, namely: BRIAN WILLIAM LOUIS BEX, as of this date residing in Bloomington, Indiana; and JOHN DAVID BEX, as of this date residing at home with us, AND WE hereby nominate, constitute and appoint each other in the event of one pre-deceasing the other, as Executor or Executrix, but in the event of a common disaster, then our Son BRIAN WILLIAM LOUIS BEX shall be the Executor with commission. We trust that he shall consult Attorney Peter Kre hel, Sunbury, Pennsylvania 17801, for any assistance in the administration of our estates, and we further direct that our Executor shall not be required to post bond in this or any other jurisdiction. IN WITNESS WHEREOF, we , JOHN E. BEX and JEANNE S. BEX, the Testator and Testatrix, have hereunto set our hands and seals to this our Joint Will this n...- day of November, 1968. ~~ ,. ft14 lvv~---J. ~.)& (SEAL) (SEAL) Signed, Sealed, Published and Declared by the above named JOHN E. BEX and JEANNE S. BEX, husband and wife, as and for their Joint Last Will and Testa ment in the presence of us, who have hereunto subscribed our names at their request as Witnesses thereto, in the presence of the said Testator and Testa- trix and of each othe r. ::> r:) MAV\' \ ~ ~b",\ residing at 1') \ \ ( \\;.. .... '" \"\\'.;\.Jk0.'\.. ':'\"'~"~j, r~ 0 .' . ) I\..v-e. - ... I 'v m;dingat \I\~~j \A ~> J?Gt)J=&-.e 1:1a 0,--/ 'y~-< EJb OF PAGE TWO (2) OF TWO (2) PAGES' FIRST AND FINAL ACCOUNT OF JOHN E. BEX, EXECUTOR FOR THE ESTATE OF JEANNE S. BEX, DECEASED Date of Death: Date of Executor's Appointment: Accounting for the Period: September 3, 2001 September 7, 2001 September 7,2001 To December 26,2001 Purpose of Account: John E. Bex , Executor, offers this account to acquaint interested parties with the transactions that have occurred during his administration. The account also indicates the proposed distribution of the estate. It is important that the account be carefully examined. Requests for additional information or questions or objections can be discussed with John E. Bex, 8 Mayfield Road, Mechanicsburg PA 17055. ,......r. ....,1\".... ,... . ::::; ~t ~.7. d - o C'"J VJ .-A \J r0 r' ~ RECEIPTS OF PRINCIPAL Cash: PNC Bank Savings Account #5000753451 Certificate of Deposit #21001025489 Certificate of Deposit #21001029510 Certificate of Deposit #21001029581 Certificate of Deposit #3140041086 Certificate of Deposit #31700189823 Certificate of Deposit #31300191068 Certificate of Deposit #31000189989 Certificate of Deposit #31100213565 Mellon Bank Checking Account #885-001-8923 Stocks & Bonds 10,500 Shares Fulton Financial Comm Stk. 12 - $1000 Series EE U.S. Svgs. Bonds TOTAL INVENTORY Assets Listed In Inventory (Valued as of Date of Death) $12,741.11 27,953.38 10,699.31 14,316.87 26,391.71 28,051.4 7 28,051.47 10,798.49 12,768.18 132,932.77 $228,480.00 14,980.80 $548.165.56 Fiduciary Acquisition Value 304,704.76 243,460.80 $548.165.56 SUMMARY OF ACCOUNT Proposed Distribution to Beneficiaries Receipts Total Less Disbursements: Funeral Expenses Administrative Expenses Fees and Commissions Balance before Distributions Distributions to Beneficiaries PRINCIP AL BALANCE ON HAND Principal Current Value $1245.00 619.66 3,000.00 Fiduciary Acquisition Value $ 548,165.56 548,165.56 4,864.66 $543,300.90 543,300.90 0.00 , FUNERAL EXPENSES: Myers Funeral Home $1245.00 ADMINISTRATIVE EXPENSES: Register of Wills Legal Advertising TOTAL $475.00 144.66 $619.66 FEES AND COMMISSIONS: Scott M. Dinner, Esq. Charles F. Sullivan CPA TOTAL 500.00 2,500.00 $3,000.00 John E. Bex, Executor under the will of Jeanne S. Bex, deceased, hereby declares under oath (penalties of perjury) 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 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. (' _.~\ . ---.-.- ..---~-=... . ----- . ~ '- . .. /... ~..- ---===--,-. -~ ,~ Johri E. Bex Executor Subscribed and sworn to by John E. Bex before me this ;;) u *'day of k~~, 2001. ~"-~ "- Notary Public NolariaI Se&I Dawn M. BIai'. Nolary PubIc u.. MIn Twp.. ClInbedand Cot.nly My~1 &pRe Oeclembet 15.2005 MerrDIr. P8r'li___ AIIocI6rl 01 NoIIrfee