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Home My WebLink About01-0985 Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Matthew L. Winters also known as No. ~/-OJ- 9?6 , Deceased Social Security No. 379 - 22 - 5883 Elizabeth W. Winters Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) og A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut r ix the Decedent, dated 02/02/2000 and codicil(s) dated None named in the last Will of State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: o B. Grant of Letters of Administration (c.I.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationship Residence I (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumber land County, Pennsylvania with his/her last family or principal residence at 321 Elgin Circle, Upper Allen Township, Mechanicsburg, PA 17055 (list street, number, and municipality) Decedent,then~yearsofage,died 09/17/2001 at Holy Spirit Hospital, Camp Hill, PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PAl All personal property (If not domiciled in PAl Personal property in Pennsylvania (If not domiciled in PAl Personal property in County Value of real estate in Pennsylvania 250,000.00 $ $ $ $ situated as follows: Wherefore, Petitioner(s) respectfully request{s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the a ro riate form to the undersi ned: Si nature ~~ ~ Elizabeth 321 El in T ed or rinted name and residence W. Winters Circle, Mechanicsbur , PA 17055 Prepared by the PennsylvanIa Bar Associallon ~nrwriaht (e) 1996 form software only CPSystems, Inc. ,~J // i, / Form RW-1 (1991) Oath of Personal Representative Commonwealth of Pennsylvania County of Cumber land The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed co?'" ---' zL--=- "~c.....:.:::>2 Le. cc. Lc_.J ~~ ) E1iza&eth W. Winters before me this--1..&...imr of October 2001 F~~'<-,:;.:.;t~L/ Lewis / (I No. 21-2001-0985 Estate of Matthew L. Winters Deceased Social Security No: 379-22-5883 Date of Death: 09/17/2001 AND NOW, October 30th 2 0 0 1 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [!] Testamentary 0 Of Administration (c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to Elizabeth W. Winters in the above estate and that the instrument(s) dated 02/02/2000 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters. . . . . . . $ 270.00 6.00 Short Certificate(s). .2 $ Renunciation. $ Affidavits ( $ Extra Pages ( 13) . $ Codicil. $ JCP Fee. $ Inventory. $ Other $ TOTAL. . . . . . . .. $ 320.00 MAILED LETTERS TO ATTORNEY P..mared bv the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems. Inc. Form RW-1 (1991) f i)~;.,n" This is to cerrif\! that the information here given is correctly copied from an original c~rtific~te of death du!y tiled wilh me as Local Registrar' The original certificate will be forwarded to the State Vital Records OffIce tor permanent hlll1g. WARNING: It is illegal to duplicate this copy by photostat or photograph. No, , ",,;i['~~~~~ "",~\./ ' ~<F:--:" l~.~ ~.~\~ .~.""'-' - .~- i'~~: .:~ \?~ ~~{- ~" \.~% a '-'\" ' .}~~~, . /~ ~ \~ * .". ...... ..,~ ".' *,' .~ ~\" ,," /~\,l ~ ,%" .' ./~ " "'---~-!fMENt \\\~~l ,....,,'/'''';;';'HI/J11J11!! ,,-; t..t:-^!(Af./ Local ~-f.-'" ,7,':'-_'''- ..,"""~,';,'. ,~, ._ __'"-' ,- G<I-('..'!'~t.,..o(/;___'" ~ Registrar /T v Fe, for this certificate, 'ii2,OO P 7742001 SEP 2 0 200t Dale 21-2001-0985 .143Rev.2f87 COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH ., AGE (LaSl Birthdav) UNDER 1 VEAR _ 00.. sex ., / '{ J. Dol NAME OF oeCEDENT (Fits!. Middle. las, UNDER 1 DAY Holn MinuS.. DATE OF BIRTH ,.MOOlh. Day. '~t 9-23-26 BIRTHPLACe !C,ty i1f'.d S.... 01 FCf"tgn Counlly) 74 v... Clare, MI =~10 5, COUNTY OF OERH ., CITY,IlOAO, TWP OF DEATH .., Cumberlard DECeDENT'S USUAL OCCUPRION (~~.;;:"~"::"':::::.t~ Lutheran Mhinstry ...1. Minister 11L DECEOENT'S MAIlING ~ss (SIr.... c....-" _, l!p~l 321 Elgin Circle Mechanicsburg, PA 17055 ,a. FRtER'S NAME (First. Middle. Last) White SUAVlVlNG sPOUSE III wH. grve ITIalUen namel 'lb, CUmberland [);d - Iiw... -' 11..0 :...""::.:'.:.::.. MOTHER'S NAME (Fll'sI. MIdde. MiiIden Surname) .Elizabeth Wie and Allen ...... oeceDENT'S ACTUAl. ReSIDENCE cSee W\SInJCbOna on oIher SIde) 11.. 51... Pennsylvania - ... INFORMANT'S NAIoIE (T ypelPriflll Matthew L. Winters ... INfORMANT'S MAlUNG ADDRESS (SIr.... CilyIIawn, SIoIo, Zip Codel Bertha A. Ruthven ...., IotETHOO OF DISPOSITION _0 c,.....~ __51.,.0 0Ih0I (Spoc:Iy Elizabeth Winters 9-20-01 21c. East .,., Harrisburg Cemetery LICeNse NUMBeR 22', 012755-L 1M bNe 01 my know'-dge, dead\ occuned "11M time, dale and plaCe stated. aat1dJiDe) 11 ~CV( 2311, ':Ie, WOS CASe ReFeRReD TO MeDICAL eXAlAINeRICORONeR. ""JQro ...0 I : d. WERE AU1OP$Y FINO/NGS -'lAae PRKllllO COMPlETION OF CAUSE OF OERH' UANNE.R Of DEATH DArE OF INJURY ("""'lh,Day,_1 flue OF INJURY ... I AppIoximal. I intenfaI beCvttMn : onMt and da&h I I , YMO ...0 - - -... ~ o o - Pending InvrrnUgalion o o o ~E OF INJURY. At home, ta",,~.... tactOly. omc. u. buUng. MC.ISpeotv) -, Coutd noli be determined ... 210. CElfTIFISIIChedl: ani\, one) "CERTIFYING PHYSICIAN (Ph)'SICtan cerWylnq cause d dealh >Ml8l1 anoIhet phYSICoatl haS pr~ dealh ana completed lIem 23) To....bnto....y know.... o.ethoccumtddulttolbl CauM(S)and manner...tII,". .................. _............ ... "PRONOuNCING AND CERTIFYING PHYSICIAN tPh'fSlOCln boIh ilfonouncll'lQ oeath and Cef\ll'f'09lO caus.e 01 death\ To ChI ... 01 mr IcnowMdglt, a..tIt ocew"" at....... ~... ..nd plac.. .-nd due to tM C.UM~.) and mann.' .. alaled 'MEDlCAL EXAM'NERlCOROHER On the baaia of examin.Uon and/or investigation. in my opinion, de.th occurred at the lime. date, and pl.ce. and due to the cause(s) and manner.. .t.ted.. .. . . ... . .. . . ... .. . _ ....... ... . . _... .... ". ... ............ _ '. .. . . . . . . ........ ..... . . ... . . . .... ... 318. REGISTRA~NATUAEA~~~'''~ I U'4tAr.//"C 7~~ ~l~ll I .., DATE FilED (MOf1Ih. Day. Yea,) 34, 21-2001-0985 LAST WILL AND TESTAMENT OF MATI'HEW L. WINTERS I, MATfHEW L. WINTERS, of Upper Allen Township, Cumberland County, Pennsylvania, being of sound and disposing mind, do hereby make, publish, and declare this to be my Last Will and Testament, hereby revoking and making null and void all prior Wills and Codicils made by me at any time heretofore. ITEM I. All federal, state, and other death taxes payable because of my death, with respect to the property forming my gross estate for tax purposes, whether or not passing under this Will, including any interest or penalty imposed thereon, shall be considered an expense of the administration of my estate, and shall be paid from my residuary estate without apportionment or right of reimbursement. All such taxes on present or future interests shall be paid at such time as my Executor or my Trustee, hereinafter named, may think proper, regardless of whether such taxes are then due. ITEM II. I acknowledge that, as of this time, the home in which I reside with my wife, ELIZABETH W. WINTERS (my "Wife"), is titled to us as tenants by the entirety, so that it, and all personal property therein not otherwise solely owned by me, shall not pass under this Will, but shall pass by operation of law in the event that I predecease her. ITEM III. I give and bequeath certain items of tangible personal property that are solely owned by me at the time of my death and that are identified in any separate writing directing distribution thereof after my death which is dated and is signed by me at the end thereof, to those persons designated in such separate writing who survive me. If any item of tangible personal property is identified in more than one separate writing, I direct that, unless stated to the contrary, the separate writing bearing the last date shall govern the disposition of such item. ITEM IV. I bequeath my household and personal effects, jewelry, automobiles, and other tangible personalty of like nature, not otherwise disposed of above, to my Wife, ELIZABETH W. WINTERS, if she survives me by thirty (30) days. If she does not so survive me, I make said bequest in equal shares to my children who survive the death of myself and my wife by thirty (30) days, namely, DEBORAH A. WINTERS, and MATIHEW L. WINTERS, IV. ITEM V. If my Wife, ELIZABETH W. WINTERS, survives me (and I direct that, for the purpose of this Item, she shall be deemed to have survived me, unless it appears unmistakably that she predeceased me), and if the federal estate tax due because of my death will be reduced by making this gift for her benefit, I give, devise, and bequeath to her, outright and absolutely, the least amount (based upon values as finally determined 2 for federal estate tax purposes) as shall be needed for the federal estate tax unlimited marital deduction to reduce the federal estate tax to the lowest possible figure after full use of all other deductions and credits allowable in calculating the federal estate tax, except that such amount shall be calculated without regard to the augmenting of my taxable estate by reason of generation-skipping transfers, and without regard for any credit for state death taxes that would not otherwise be payable. A. If the marital deduction, or any similar benefit, is allowable with respect to any property, including property held by entireties, which my Wife has received prior to my death, or at my death will receive otherwise than pursuant to this ITEM V., the value of such property shall be taken into consideration in calculating the size of the gift under this ITEM V. B. No property ineligible for the marital deduction, or any similar benefit, shall be distributed to this bequest pursuant to this ITEM V. C. Either cash or investments or both may be allocated to this bequest under this ITEM V. 3 D. Any property allocated under this ITEM V. in kind shall be valued at the value at which it is finally included in my gross estate for federal estate tax purposes, provided that the aggregate market value thereof on the date of allocation (plus the value as finally determined for federal estate tax purposes of all other property qualifying for the marital deduction) is at least equal to the dollar value of the marital deduction as finally determined for federal estate tax purposes. E. If any provision of my will shall result in depriving my estate of the marital deduction for federal estate tax purposes, such provision is hereby revoked and my Will shall be read as if any portion thereof inconsistent with allowance of the marital deduction for federal estate tax purposes is null and void. ITEM VI. If my Wife, ELIZABETH W. WINTERS, survives me (and I direct that, for the purpose of this Item, she shall be deemed to have survived me, unless it appears unmistakably that she predeceased me), I give, devise, and bequeath all of the residue of my estate, not otherwise disposed of above, whether real, personal, or mixed, and wherever situate, including any property over which I shall have any power of appointment other than any such power given to me in any will or inter vivos trust of my Wife, to my 4 Trustee, hereinafter named, IN TRUST NEVERTHELESS, for the following uses and purposes: A. My Trustee shall pay the net income therefrom to my Wife, ELIZABETH W. WINTERS, for and during her lifetime. However, if the income otherwise payable to my Wife shall at any time exceed the amount which my Trustee deems to be in her best interests (considering her other income and means of support known to my Trustee, including any income from her other solely-owned assets, her needs, the desirability of augmenting her separate estate, and any other circumstances and factors deemed pertinent), my Trustee may accumulate the same and add it to principal, as my Trustee deems advisable, in my Trustee's sole and absolute discretion. B. My Trustee shall pay as much of the principal of this Trust as my Trustee, in its sole and absolute discretion, may from time to time think advisable for the support or medical care of my Wife, with such payments being made to her or else applied directly for her benefit by my Trustee, after taking into account her other readily available assets and sources of income and support, including the availability of funds from the Trust established in Item V. 5 C. My Trustee may apply the funds in this Trust directly for the benefit of my Wife should she, by reason of age, illness, or any other cause in the opinion of my Trustee, be incapable of receiving or disbursing funds. ITEM VII. Upon the death of my Wife after the Trust under ITEM VI. has been established, or upon my death if my Wife has not survived me, the then-remaining principal and any undistributed income in the Trust, or the residue of my Estate, as appropriate, shall be distributed as follows: A. All the rest, residue and remainder shall be paid outright in equal shares to my children, DEBORAH A. WINTERS and MA'ITHEW L. WINTERS, IV, who are living at such time; provided, however, that if such a named child should not be so then-living, but leaves issue who are then-living, then such child's issue shall receive, per stirpes, the share that such child would have received had he or she so survived me, subject, however, to the further trust provisions set forth in ITEM VIII. hereof if applicable to a particular beneficiary, who is a grandchild or great-grandchild of mine, due to his or her age. If such a named child should not be so living and should not leave any such then-living issue, then that child's share shall 6 be distributed in equal shares to my other child who is then-living and to the issue of my other child if he or she is then-deceased, per stirpes. ITEM VIII. Any property passing hereunder to a beneficiary who is a grandchild or great -grandchild of mine who at the time of my death is under the age of twenty-one (21) (the "Beneficiary"), shall be held IN TRUST, NEVERTHELESS, by my Trustee, hereinafter named, for the benefit of such Beneficiary, upon the terms and for the purposes and uses, as follows: A. My Trustee shall hold and invest the principal of the Trust corpus, collect the income therefrom, and expend and apply so much of the net income (any income not so expended or applied to be accumulated and added to principal), and so much of the principal and accumulated income, as my Trustee shall deem necessary or advisable, in the sole and absolute discretion of my Trustee, for the support, maintenance, medical care, and education (including college education, both graduate and undergraduate) of the Beneficiary, after taking into consideration other readily available assets and sources of income. During illness or emergency, my Trustee may either pay a distribution to the Beneficiary, or may make a distribution for the benefit of the Beneficiary. 7 ITEM IX. I direct that my Executor and Trustee shall be entitled to out -of- pocket expenses, and also to reasonable compensation, considering their efforts and involvement in the administration of my estate or a trust, as applicable. With regard to fees charged by a corporate or institutional fiduciary, I provide that it may charge fees for its services rendered as a trustee or an executor pursuant to its standard fee schedule for such services as in effect from time to time when such services are rendered. ITEM X. The interest of beneficiaries hereunder shall not be subject to anticipation or to voluntary or involuntary alienation. ITEM XI. I hereby appoint my wife, ELIZABETH W. WINTERS, as Executrix (the "Executor"), of this my Last Will and Testament. In the event of her refusal or inability to so serve, I then nominate and appoint my daughter, DEBORAH WINTERS, to serve in the capacity of successor Executor. In the event of her refusal or inability to so serve, I then nominate and appoint my son, MATIHEW L. WINTERS, IV, to serve in the capacity as successor Executor with all power and authority as vested in my Executor. ITEM XII. I hereby appoint PNC BANK, Camp Hill, Pennsylvania, to serve as the Trustee (the "Trustee"), of any trust created under this Will. 9 ITEM XIII. I direct that my Executor and Trustee shall not be required to give bond or post any other security for the faithful performance of their duties in any jurisdiction. ITEM XIV. Any person, other than my Wife, who shall have died at the same time as me, or in a common disaster with me, or under such circumstances that it is difficult or impossible to determine who died first, shall be deemed to have predeceased me. ITEM xv. My Executor and Trustee shall have the following powers in addition to those invested in them by law and by other provisions of my Will applicable to all property, whether principal or income, exercisable without Court approval, and effective until distribution of all property: A. To retain any investments I may have at my death so long as my Executor or Trustee may deem it advisable to my Estate or Trust so to do. B. To vary investments, when deemed desirable by my Executor or Trustee, and to invest in such bonds, common trust funds controlled by my Executor or Trustee, stocks, notes, real estate mortgages, or 10 I. In the discretion of my Executor or Trustee, to unite with other owners of similar property in carrying out any plans for the reorganization of any corporation or company whose securities form a part of my Estate or Trust. J. To compromise claims and to abandon any property which, in my Executor's opinion, is of little or no value. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of thirteen (13) typewritten pages, this 2nd day of February, 2000. ~ ~d2;>t- MATTHEW L. WINTERS We, the undersigned, hereby certify that the foregoing Will was signed, sealed, published and declared by the above-named Testator, MATTHEW L. WINTERS, as and for his Last Will and Testament, in the presence of us, who at his request and in his presence and in the presence of each other, have hereunto set our hands and seals the day and year above written, and we certify that at the time of the execution thereof, the said Testator was of sound and disposing mind and memory. /l, ~"~ 1-;." .1, Y /1 ... .." / "Mct.JCl ~."" . ct. /X.......kt<\.. ~ \j residing at /. / ;. ..C. /)...1 lAWvp NUl?, i ::J residing at \.. f'1LLCtd;_h.t~"'LU)1 il~ J .~ 13 COMMONWEALTH OF PENNSYLVANIA SSe COUNTY OF DAUPHIN We, the Testator, MATIHEW L. WINTERS, and ~JnoJc' ~.\. r0j 2. rllCL -\../ , and . t-.l u ( ! ';~L. '- , the witnesses, respectively, whose names are signed't'o the foregoin instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witness and that to the best of his/her knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~~~ MATIHEW L. WINTERS /id.~ ~ LI.\ ~_~ Witness \.- \"'-J Subscribed, sworn to and acknowledged before me by the Testator, MATIHEW L. WIN~RS, and subscribed and sworn to before me by RCtYl leI, 1.1, --rOT Zf,{I. . andV{:,J i _'j _\ kki': Cl " , , witnesses, this 2nd day of February, 2000. . -.;;;r< l , ! ..,l, :.:, \' , N otary Publ~~d . ._v',_ <....~,.A..._O;:...., L__~.' / (SEAL) 31345.1 I KIM~~~LJJgT~[~~~E~ary ~~IIC I I Harrisburg, Dauphin County 1 My Commission Expires Aug.19, 2003 ~- ._-. ~~""~',~ -"~.,..-,...'",",,,"""',~-"': 14 f. -- IN RE: ESTATE OF MA TTHEW L. WINTERS, Deceased : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYL VANIA : ORPHANS' COURT DIVISION : No. 2001-00985 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Will No. Matthew L. Winters, deceased September 17, 2001 Admin. No. 2001-00985 To the Register: I certify that notice of 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 October 31, 2001: Elizabeth Winters Matthew L. Winters, IV Deborah A. Winters 321 Elgin Circle, Mechanicsburg, P A 17055 1201 Foxfire Drive, Greensboro, NC 27410 438 Kindig Road, Waynesboro, VA 22980 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except N/A. Telephone ~~.~ Ronald M. Katzman, qUire Goldberg, Katzman & Shipman, P.C. P.O. Box 1268 Harrisburg, PA 17108-1268 (717) 234-4161 Date }O/3i 101 I Signature Name Address Capacity: _ Personal Representative -L Counsel for personal representative ..- ". . 1 e OFFICIAL USE ONLY REV-15oo EX +(6-00) / 7 - /6 '- FILE NUMBER iL{ .,: C P o 0 R N R D E E S N T C o M T P A U X I T I o N REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT D E C E D E N T COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. Z80601 HARRISBURG, PA 171Z8-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Winters Matthew L. DATE OF DEATH (MM-DD-YEAR) 21-01-985 DATE OF BIRTH (MM-DD-YEAR) COUNTY CODE YEAR SOCIAL SECURITY NUMBER 379-22-5883 THIS RETURN MUST BE RlED IN DUPUCATEWlTH THE NUMBER Winters, Elizabeth X 1. Original Return 4. Limited Estate 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 3. Remainder Return ~fJ~ fa ~~ir-sz) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes Supplemental Return Future Interest Compromise (date of death after 1Z-lZ-SZ) Decedent Maintained a Living Trust (Attach copy of Trust) Spousal Poverty Credit (date of cleath between lZ-31-91 and 1-1-95) 010. o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) NAME Ronald M. Katzman, Es uire FIRM NAME (If Applicable) Goldber , Katzman & Shi man, P.C. TELEPHONE NUMBER COMPLETE MAILING ADDRESS 320 Market Street P.O. Box 1268 Harrisburg, PA 17108-1268 (1) (2) (3) R E C A P I T U L A T I o N 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (t ) 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) 14. Net Value Sub'eel to Tax (Line 12 minus Line 13) (8) 296,047.33 (11) 19.541.11 (12) 276,506.22 (13) (14) 276,506.22 None 246,563.05 None OFFICIAL USE ONLY ,j~ ,.;1-d5-QCl c 0.. w~"""~'-" ~~ (4) (5) None 21,485.33 (6) None 27,998.95 14,455.67 5,085.44 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 276,506.22 X .0 0 (15) 0.00 X .0 45 (16) 0.00 X .12 (17) 0.00 X .15 (18) 0.00 (19) 0.00 ".opyrlght (c) ZOOO form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) 4 DeCedent's Complete Address: STREET ADDRESS 321 E1 in Circle CITY Mechanicsbur STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 0.00 Total Credits ( A + B + C) (2) 0.00 3. InterestlPenalty if applicable D. Interest E. Penalty TotallnterestlPenalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0.00 0.00 0.00 0.00 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; . . . . . . . . . . . . . . . ~ ~x~ b. retain the right to designate who shall use the property transferred or its income; . c. retain a reversionary interest; or. . . . . . . . . . . . . . . . . . . . . . . . . . d. receive the promise for life of either payments, benefits or care? . . . . . . . . . 2. If death occurred after December 12. 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. Did decedent own an Individual Retirement Account. annuity. or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [!] D IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. D D [XJ [XJ Under penalties of perJury. I declare that I have examined this return. Including accompanying schedules and statements, and to the best of my knowledge and belief. It Is true. correct and complete. Declaration of preparer other than the personal repr-.,tatlve Is based on alllnforrnatlon of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN El izbeth Winters re/_~ tJ h.-)~~ --~~~h~~~~-~b~~-i~~iA--ii655--------------------- SIGNATU~~REROTHERTHANREPRESENTATIVE Goldberg, Katzman & Shipman, P.C. ~. - - ~~~r ~~~~~1: ~ .s-~r~~-i 7i~-8? i2-~~~- -~~~~- - - - - - - - - -- DATE ~ -..:.l.. 0- c:.; 2. DATE 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) on 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) Oil]. The statute does not exempt a transfer to a surviving spouse from tax. and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%. except as noted in 72 P.S. 9116( 1.2) [72 P.S. 9116(aX 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(aX 1.3)]. A sibling is defined. under Section 9102. as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) , REV-1503 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS Matthew L. Winters SStl 379-22-5883 09/17/2001 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 10 11 12 DESCRIPTION UNIT VALUE 51.90466 shs AT&T Corp. held by Legg Mason in Acct. No. 17.4125 309-29962 - valued per acct rpt dtd 11/21/01 (att. to death tax return only) 2 16 shs AT&T Wireless Services Inc. held by Legg Mason 13.105 in Acct No. 309-29962 - valued per acct rpt dtd 11/21/01 (att. to death tax return only) 3 50 shs American Electric Power Inc. held by Legg Mason 47.25 in Acct. No. 309-29962 - valued per acct rpt dtd 11/21/01 (att. to death tax return only) 4 4.26186 shs Avaya Inc. held by Legg Mason in Acct. No. 11.44 309-29962 - valued per acct rpt dtd 11/21/01 (att. to death tax return only) 5 1 shs Berkshire Hathaway Inc. held by Legg Mason in 64100 Acct. No. 309-29962 - valued per acct rpt dtd 11/21/01 (att. to death tax return only) 6 167.54823 shs Bristol Myers Squibb Co held by Legg 58.675 Mason in Acct. No. 309-29962 - valued per acct rpt dtd 11/21/00 (att. to death tax return only) 7 240 shs Coca Cola Co. held by Legg Mason in Acct. No. 49.455 309-29962 - valued per acct rpt dtd 11/21/01 (att. to death tax return only) 8 Dividend for Coca Cola Co. held by Legg Mason - valued per acct rpt dtd 11/21/01 9 55.28905 shs Eastman Kodak Co. held by Legg Mason in Acct. No. 309-29962 - valued per acct rpt dtd 11/21/01 (att. to death tax return only) Dividend for Eastman Kodak Co. held by Legg Mason - valued per acct rpt dtd 11/21/01 148.5 shs Exxon Mobil Corp held by Legg Mason in Acct. No. 309-29962 - valued per acct rpt dtd 11/21/01 (att. to death tax return only) 240 shs General Electric Co. held by Legg Mason in Acct No. 309-29962 - valued per acct rpt dtd 11/21/01 (att. to death tax return only) Total of Continuation Schedu1e(s) 41.195 40.61 35.85 (If more space is needed, insert additional sheets of the same size) Copyright (e) 1996 form software only CPSystems, Inc. TOTAL (Also enter on line 2, Recapitulation) FILE NUMBER 21-01-985 VALUE AT DATE OF DEATH 903.79 209.68 2,362.50 48.76 64,100.00 9,830.89 11,869.20 43.20 2,277.63 24.33 6,030.59 8,604.00 140,258.48 246,563.05 Form REV-1503 EX (Rev. 1-97) Estate of: Matthew L. Winters Soc Sec #: 379-22-5883 Date of Death: 09/17/2001 Item # Continuation of Schedule B (Stocks and Bonds) Description Unit Value Value at Date of Death 13 163.40635 shs JP Morgan Chase & Co. held by Legg Mason in Acct. No. 309-29962 - valued per acct rpt dtd 11/21/01 (att. to death tax return only) 34.91 14 317.056 shs Legg Mason Invs Tr Inc. held in Acct. No. 309-29962 - valued per acct rpt dtd 11/21/01 (att. to death tax return only) 16.7 15 30502.56 shs Legg Mason Cash Resv Tr held in Acct. No. 309-29962 - valued per acct rpt dtd 11/21/01 (att. to death tax return only) 1 16 305.033 shs Legg Mason Value Tr held in Acct. No. 309- 29962 - valued per acct rpt dtd 11/21/01 (att. to death tax return only) 46.97 17 51.40112 shs Lucent Technologies held by Legg Mason in Acct. No. 309-29962 - valued per acct rpt dtd 11/21/01 (att. to death tax return only) 5.75 18 252.84264 shs Merck & Co. held by Legg Mason in Acct. No. 309-29962 - valued per acct rpt dtd 11/21/01 (att. to death tax return only) 67.125 19 Dividend for Merck & Co. held by Legg Mason - valued per acct rpt dtd 11/21/01 20 100 shs Newell Rubbermaid Inc. held by Legg Mason in Acct. No. 309-29962 - valued per acct rpt dtd 11/21/01 (att. to death tax return only) 22.4 21 90 shs Norfolk Southern Corp. held by Legg Mason in Acct. No. 309-29962 - valued per acct rpt dtd 11/21/01 (att. to death tax return only) 17.74 22 80 shs Public Service Enterprise Group held by Legg Mason in Acct. No. 309-29962 - valued per acct rpt dtd 11/21/01 (att. to death tax return only) 44.825 23 Dividend for Public Service Enterprise Group held by Legg Mason - valued per acct rpt dtd 11/21/01 24 170 shs Scudder Strategic Mun Income held by Legg Mason in Acct. No. 309-29962 - valued per acct rpt dtd 12.26 5,704.52 5,294.84 30,502.56 14,327.40 295.56 16,972.06 88.49 2,240.00 1,596.60 3,586.00 43.20 2,084.20 Estate of: Matthew L. Winters See Sec #: 379-22-5883 Date of Death: 09/17/2001 Item /1 Continuation of Schedule B (Stocks and Bonds) Description Unit Value Value at Date of Death 11/21/01 (att. to death tax return only) 25 Dividend Scudder Strategic Hun Income held by Legg Mason - valued per acct rpt dtd 11/21/01 (att. to death tax return only) 26 124 shs Xce1 Energy held by Legg Mason in Acct. No. 309-29962 - valued per acct rpt dtd 11/21/01 (att. to death tax return only) 27.955 27 16 shs Zimmer Holdings Inc. held by Legg Mason in Acct. No. 309-29962 - valued per acct rpt dtd 11/21/01 (att. to death tax return only) 25.41 28 50,000 Cambria County Bond, due 8/15/16 @ 5.5% held by Legg Mason in Acct. No. 309-29962 - valued per acct rpt dtd 11/21/01 (att. to death tax return only) 1. 0679 29 Interest on 50,000 Cambria County Bond held by Legg Mason - valued per acct rpt dtd 11/21/01 10.63 3,466.42 406.56 53,395.00 244.44 140,258.48 , REV-1508 EX +(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Matthew L. Winters SS# 379-22-5883 09/17/2001 21-01-985 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 United Healthcare Insurance Co. - reimbursement for medical bills VALUE AT DATE OF DEATH 2,940.00 2 1996 Chrysler Cirrus Sedan - valued per Kelley Blue Book 5,095.00 3 1992 Mercedes-Benz 300E - valued per Kelley Blue Book 8,450.00 4 Chase Manhattan Bank - settlement of lawsuit 0.33 5 Bequest received from Estate of Frederick C. Wingrove 5,000.00 TOTAL (Also enter on line 5, Recapitulation) $ 21,485.33 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) REV-1510 EX + (1-97) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Matthew L. Winters SSII 379-22-5883 09/17/2001 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM NUMBER 1 DESCRIPTION OF PROPERTY INCLUDE THIfNAME OF TRE TRA"flSFEREE THEIR RELATIONSHIP TO DECEDENT AND THE DATE O~ TRANSFER. ATTACH A COpy OF THE DEED FOR REAL EST ATE. 883 shs Ft. Insurance Growth Tr 111 held by A.G. Edwards in IRA No. 290-385261 - valued per 1tr dtd 1/14/02 - payable to Elizabeth Winters, spouse (att. to death tax return only) (8.5051) EXCLUSION OF APPLICABLE) "10 OF DECD'S INTEREST 100.00% DATE OF DEATH VALUE OF ASSET 7,510.00 2 834 shs Ft. Regal Bk & Thrift Growth Tr 111 held by A.G. Edwards in IRA No. 290-385261 - valued per 1tr dtd 1/14/02 - payable to Elizabeth Winters, spouse (att. to death tax return only) (7.8821) 6,573.67 100.00% 3 Money Market held by A.G. Edwards in IRA No. 290-385261 - valued per ltr dtd 1/14/02 - payable to Elizabeth Winters, spouse (att. to death tax return only) 9,867.83 100.00% 4 ELCA Board of Pension - pension benefit payable to Estate - valued per check received 4,047.45 100.00% TOTAL (Also enter on line 7. Recapitulation) S (If more space is needed, insert additional sheets of the same size) Copyright (e) 1996 form software only CPSystems, Inc. FILE NUMBER 21-01-985 TAXABLE VALUE 7,510.00 6,573.67 9,867.83 4,047.45 27,998.95 Form REV-1510 EX (Rev. 1-97) REV-1511 EX +(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Matthew L. Winters Debts of decedent must be reported on Schedule I. ITEM NUMBER A. B. SSII 379-22-5883 FILE NUMBER 21-01-985 09/17/2001 DESCRIPTION AMOUNT 1 FUNERAL EXPENSES: Myers-Harner Funeral Home - funeral services 2,060.00 2 Trinity Lutheran Church - co1umnberium 680.00 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. 3. Attorney's Fees Goldberg, Katzman & Shipman, P.C. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Elizabeth Winters Street Address 321 Elgin Circle City Mechanicsburg State ~ Zip 17055 Relationship of Claimant to Decedent Spouse 7,500.00 3,500.00 4. Register of Wills 320.00 Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs Goldberg, Katzman & Shipman, P.C. - reservation for closing costs of estate administration 100.00 2 Register of Wills - additional short certificates 9.00 3 Commonwealth of PA - vehicle title transfer fees 81.00 4 Patriot News - estate notice advertisement fee 107.67 5 Cumberland Law Journal - estate notice advertisement fee 75.00 6 Register of Wills - filing fee for Inventory & Return 23.00 TOTAL (Also enter on line 9, Recapitulation) $ 14,455.67 (If more space is needed, insert additional sheets of the same size) Copyright (e) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) REV-1512 EX + (1-97) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Matthew L. Winters FILE NUMBER 21-01-985 SS11 379-22-5883 09/17/2001 Include unreimbursed medical .xpen.... ITEM NUMBER 1 10 11 12 13 14 15 16 17 18 19 20 21 DESCRIPTION Southern Delaware Imaging Associates - unriembursed medical bill AMOUNT 36.69 2 Delaware Anesthesia Associates - unreimbursed medical bill 17.19 3 Beeke Physician Network - unreimbursed medical bill 125.46 4 Cape Surgical Associates - unreimbursed medical bill 94.60 5 Delaware Cardiovascular - unreimbursed medical bill 14.76 6 Dr. Pa1ekar - unreimbursed medical bill 70.58 7 Dr. Parasher - unreimbursed medical bill 41.24 8 Dr. Kantor - unreimbursed medical bill 34.55 9 Kunkel Surgical - unreimbursed medical bill 32.00 Holy Spirit Hospital - unreimbursed medical bill 204.43 PA Neuro Associates - unreimbursed medical bill 4.75 Susquehanna Internal Medicine - unreimbursed medical bill 78.00 Pulmonary & Critical Care Medicine Associates, P.C. - unreimbursed medical bill 114.60 West Shore Anesthesia - unreimbursed medical bill 22.85 Mid Penn Urology - unreimbursed medical bill 9.98 Quantum Imaging & Therapeutic Associates, Inc. - unreimbursed medical bill 37.75 ENT Facial Plastic - unreimbursed medical bill 5.96 Sussex Pulmonary - unreimbursed medical bill 25.72 Peninsula Cardiology - unreimbursed medical bill 0.87 Sussex Emergency Associates - unreimbursed medical bill 13.46 Lifeline Air Ambulance - unreimbursed medical bill 4,100.00 TOTAL (Also enter on line 10, Recapitulation) S 5 ,085.44 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software onlyCPSysterns,lnc. Form REV-1512 EX (Rev. 1-97) REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Matthew L. Winters SCHEDULE J BENEFICIARIES SSII 379-22-5883 09/17/2001 FILE NUMBER 21-01-985 RELATIONSHIP IO II AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS [Include outright spotaal distributions, and transfers under Sec. 9116(aXl.2)] 1 Elizabeth Winters 321 Elgin Circle Mechanicsburg, PA 17055 Spouse Residue ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON- TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET S (If more space is needed, insert additional sheets of the same size) 0.00 Index to Exhibits Pennsylvania Inheritance Tax Return Estate of Matthew L. Winten, deceased Exhibit A: Copy of Letters Testamentary and Last Will and Testament Exhibit B: Copy of Legg Mason Account Report dated 11/21/01 regarding date of death balance Exhibit C: Copy of A.G. Edwards letter dated 1/14/02 75250.1 EXHIBIT A WHEREAS, on the 30th dated February 2nd 2000 was admitted to probate as the last will of WINTERS MATTHEW L (LA~~, ~~K~~, M~UUL~) Register of Wills of CUMBERLAND County, Pennsylvania Certificate of Grant of Letters No. 2001-00985 PA No. 21-01-0985 ESTATE OF WINTERS MATTHEW L (LA~~, t"l.K~~, lVJlUUL~) Late of UPPER ALLEN TOWNSHIP CUlYjH~KLAJ.\JLJ CUU.N~ 1: , Deceased Social Security No. 379-22-5883 day of October 2001 an instrument late of UPPER ALLEN TOWNSHIP CUMBERLAND County, who died on the 17th day of September 2001 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, MARY C. LEWIS , Register of Wills In and for the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to WINTERS ELIZABETH W who has duly qualified as Executor (rix) and has agreed to administer the estate according to law, all of which fully appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my Office the 30th day of October 2001. **NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE) 21-2001-0985 LAST WILL AND TESTAMENT OF MA'ITHEW 1. WINTERS I, MAITHEW L. WINTERS, of Upper Allen Township, Cumberland County, Pennsylvania, being of sound and disposing mind, do hereby make, publish, and declare this to be my Last Will and Testament, hereby revoking and making null and void all prior Wills and Codicils made by me at any time heretofore. ITEM 1. All federal, state, and other death taxes payable because of my death, with respect to the property fanning my gross estate for tax purposes, whether or not passing under this Will, including any interest or penalty imposed thereon, shall be considered an expense of the administration of my estate, and shall be paid from my residuary estate without apportionment or right of reimbursement. All such taxes on present or future interests shall be paid at such time as my Executor or my Trustee, hereinafter named, may think proper, regardless of whether such taxes are then due. ITEM II. I acknowledge that, as of this time, the home in which I reside with my wife, ELIZABETH W. WINTERS (my "Wife"), is titled to us as tenants by the entirety, so that it, and all personal property therein not otherwise solely owned by me, shall not pass under this Will, but shall pass by operation of law in the event that I predecease her. ITEM III. I give and bequeath certain items of tangible personal property that are solely owned by me at the time of my death and that are identified in any separate writing directing distribution thereof after my death which is dated and is signed by me at the end thereof, to those persons designated in such separate writing who survive me. If any item of tangible personal property is identified in more than one separate writing, I direct that, unless stated to the contrary, the separate writing bearing the last date shall govern the disposition of such item. ITEM N. I bequeath my household and personal effects, jewelry, automobiles, and other tangible personalty of like nature, not otherwise disposed of above, to my Wife, ELIZABETH W. WINTERS, if she survives me by thirty (30) days. If she does not so survive me, I make said bequest in equal shares to my children who survive the death of myself and my wife by thirty (30) days, namely, DEBORAH A. WINTERS, and MATIHEW 1. WINTERS, IV. ITEM V. If my Wife, EUZABETH W. WINTERS, survives me (and I direct that, for the purpose of this Item, she shall be deemed to have survived me, unless it appears unmistakably that she predeceased me), and if the federal estate tax due because of my death will be reduced by making this gift for her benefit, I give, devise, and bequeath to her, outright and absolutely, the least amount (based upon values as finally determined 2 for federal estate tax purposes) as shall be needed for the federal estate tax unlimited marital deduction to reduce the federal estate tax to the lowest possible figure after full use of all other deductions and credits allowable in calculating the federal estate tax, except that such amount shall be calculated without regard to the augmenting of my taxable estate by reason of generation-skipping transfers, and without regard for any credit for state death taxes that would not otherwise be payable. A. If the marital deduction, or any similar benefit, is allowable with respect to any property, including property held by entireties, which my Wife has received prior to my death, or at my death will receive otherwise than pursuant to this ITEM V., the value of such property shall be taken into consideration in calculating the size of the gift under this ITEM V. B. No property ineligible for the marital deduction, or any similar benefit, shall be distributed to this bequest pursuant to this ITEM V. c. Either cash or investments or both may be allocated to this bequest under this ITEM V. 3 D. Any property allocated under this ITEM V. in kind shall be valued at the value at which it is finally included in my gross estate for federal estate tax purposes, provided that the aggregate market value thereof on the date of allocation (plus the value as finally detennined for federal estate tax purposes of all other property qualifying for the marital deduction) is at least equal to the dollar value of the marital deduction as finally detennined for federal estate tax purposes. E. If any provision of my will shall result in depriving my estate of the marital deduction for federal estate tax purposes, such provision is hereby revoked and my Will shall be read as if any portion thereof inconsistent with allowance of the marital deduction for federal estate tax purposes is null and void. ITEM VI. If my Wife, ELIZABETH W. WINTERS, survives me (and I direct that, for the purpose of this Item, she shall be deemed to have survived me, unless it appears unmistakably that she predeceased me), I give, devise, and bequeath all of the resid ue of my estate, not otherwise disposed of above, whether real, personal, or mixed, and wherever situate, including any property over which I shall have any power of appointment other than any such power given to me in any will or inter vivos trust of my Wife, to my 4 Trustee, hereinafter named, IN TRUST NEVERTHELESS, for the following uses and purposes: A. My Trustee shall pay the net income therefrom to my Wife, ELIZABETH W. WINTERS, for and during her lifetime. However, if the income otherwise payable to my Wife shall at anytime exceed the amount which my Trustee deems to be in her best interests (considering her other income and means of support known to my Trustee, including any income from her other solely-owned assets, her needs, the desirability of augmenting her separate estate, and any other circumstances and factors deemed pertinent), my Trustee may accumulate the same and add it to principal, as my Trustee deems advisable, in my Trustee's sole and absolute discretion. B. My Trustee shall pay as much of the principal of this Trust as my Trustee, in its sole and absolute discretion, may from time to time think advisable for the support or medical care of my Wife, with such payments being made to her or else applied directly for her benefit by my Trustee, after taking into account her other readily available assets and sources of income and support, including the availability of ftmds from the Trust established in Item V. 5 c. My Trustee may apply the funds in this Trust directly for the benefit of my Wife should she, by reason of age, illness, or any other cause in the opinion of my Trustee, be incapable of receiving or disbursing funds. ITEM VII. Upon the death of my WIfe after the Trust tmder ITEM VI. has been established, or upon my death if my Wife has not survived me, the then-remaining principal and any tmdistributed income in the Trust, or the residue of my Estate, as appropriate~ shall be distributed as follows: A. All the rest, residue and remainder shall be paid outright in equal shares to my children, DEBORAH A. WINTERS and MA'ITHEW L. WINTERS, IV, who are living at such time; provided, however, that if such a named child should not be so then-living, but leaves issue who are then-living, then such child's issue shall receive, per stirpes, the share that such child would have received had he or she so survived me, subject, however, to the further trust provisions set forth in ITEM VITI. hereof if applicable to a particular beneficiary, who is a grandchild or great-grandchild of mine, due to his or her age. If such a named child should not be so living and should not leave any such then-living issue, then that child's share shall 6 be distributed in equal shares to my other child who is then-living and to the issue of my other child if he or she is then-deceased, per stirpes. ITEM VIII. Any property passing hereunder to a beneficiary who is a grandchild or great-grandchild of mine who at the time of my death is under the age of twenty-one (21) (the "Beneficiary'), shall be held IN TRUST, NEVERTIffiLESS, by my Trustee, hereinafter named, for the benefit of such Beneficiary, upon the terms and for the purposes and uses, as follows: A. My Trustee shall hold and invest the principal of the Trust corpus, collect the income therefrom, and expend and apply so much of the net income (any income not so expended or applied to be accumulated and added to principal), and so much of the principal and accumulated income, as my Trustee shall deem necessary or advisable, in the sole and absolute discretion of my Trustee, for the support, maintenance, medical care, and education (including college education, both graduate and undergraduate) of the Beneficiary, after taking into consideration other readily available assets and sources of income. During illness or emergency, my Trustee may either pay a distribution to the Beneficiary, or may make a distribution for the benefit of the Beneficiary. 7 B. When the Beneficiary attains the age of twenty-one (21), the Trust pertaining to the Beneficiary shall terminate, and my Trustee shall distribute the then-remaining principal and any accumulated or undistributed income to the Beneficiary, outright. C. If the Beneficiary should die during the existence of this Trust and leave issue surviving, it shall be divided and then continued for the benefit of such then-living issue of the Beneficiary, per stirpes, with such beneficiaries being substituted for the Beneficiary for all purposes. D. If the Beneficiary should die before attaining the age of twenty-one (21) without leaving issue surviving as aforesaid, then that Trust shall terminate, and its assets shall be divided into as many equal shares as are created under Item VIll. hereof for the benefit of those living children of mine, or the issue, per stirpes. of any deceased child of mine, at the time of the death of such Beneficiary, and then distributed to such beneficiaries; Provided, however, that if a Trust established hereunder for any such beneficiaries exists at the time of such distribution, then such distribution shall be made to that Trust for such beneficiary. 8 ITEM IX. I direct that my Executor and Trustee shall be entitled to out -of- pocket expenses, and also to reasonable compensation, considering their efforts and involvement in the administration of my estate or a trust, as applicable. With regard to fees charged by a corporate or institutional fiduciary, I provide that it may charge fees for its services rendered as a trustee or an executor pursuant to its standard fee schedule for such services as in effect from time to time when such services are rendered. ITEM X. The interest of beneficiaries hereunder shall not be subject to anticipation or to voluntary or involuntary alienation. ITEM XI. I hereby appoint my wife, EUZABETH W. WINTERS, as Executrix (the "Executor"), of this my Last Will and Testament. In the event of her refusal or inability to so serve, I then nominate and appoint my daughter, DEBORAH WINTERS, to serve in the capacity of successor Executor. In the event of her refusal or inability to so serve, I then nominate and appoint my son, MATI'HEW L. WINTERS, IV, to serve in the capacity as successor Executor with all power and authority as vested in my Executor. ITEM XII. I hereby appoint PNC BANK, Camp Hill, Pennsylvania, to serve as the Trustee (the "Trustee"), of any trust created under this Will. 9 ITEM XIII. I direct that my Executor and Trustee shall not be required to give bond or post any other security for the faithful performance of their duties in any juris diction. ITEM XIV. Any person, other than my WIfe, who shall have died at the same time as me, or in a common disaster with me, or under such circumstances that it is difficult or impossible to determine who died first, shall be deemed to have predeceased me. ITEM XV. My Executor and Trustee shall have the following powers in addition to those invested in them by law and by other provisions of my Will applicable to all property, whether principal or income, exercisable without Court approval, and effective until distribution of all property: A. To retain any investments I may have at my death so long as my Executor or Trustee may deem it advisable to my Estate or Trust so to do. B. To vary investments, when deemed desirable by my Executor or Trustee, and to invest in such bonds, common trust funds controlled by my Executor or Trustee, stocks, notes, real estate mortgages, or 10 other securities or in such other property, real or personal, as my Executor or Trustee deem wise, without being restricted to so-called legal investments. C. In order to effect a division of the principal of my Estate or Trust or for any other purpose, including any final distribution, my Executor or Trustee is authorized to make said divisions or distributions of the personalty and realty partly or wholly in kind. If such division or distribution is made in kind, said assets are required to be divided or distributed at their respective values on the date or dates of their division or distribution. D. To sell either at public or private sale and upon such terms and conditions as my Executor or Trustee may deem advantageous to my Estate or Trust, any or all real or personal estate or interests therein owned by my Estate or Trust severally or in conjunction with other persons or acquired after my death by my Executor or Trustee, and to consununate said sale or sales by sufficient deeds or other instruments to the purchaser or purchasers, conveying a fee simple title, free and clear of all trust and without obligation or liability of the purchaser or purchasers to see to the application of the purchase money or to make inquiry into the validity of said sale or sales; also, to make, execute, acknowledge, and deliver any and all deeds, 11 assignments, options, or other writings which may be necessary or desirable, in canying out any of the powers conferred upon my Executor or Trustee in this paragraph or elsewhere in my Will. E. To mortgage real estate, and to make leas es of real estate for any period of time as is deemed reasonable by them. F. To borrow money from any party to pay indebtedness of mine, or of my Estate or Trust, expenses of administration, or inheritance, legacy, estate or other taxes. G. To pay all costs, taxes, expenses, and charges in connection with the administration of my Estate or Trust. My Executor shall pay expenses of my last illness and funeral expenses. H. To vote any shares of stock which form a part of my Estate or Trust, and to otherwise exercise all the powers incident to the ownership of such stock. 12 1. In the discretion of my Executor or Trustee, to unite with other owners of similar property in carrying out any plans for the reorganization of any corporation or company whose securities form a part of my Estate or Trust. J. To compromise claims and to abandon any property which, in my Executors opinion, is of little or no value. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of thirteen (13) typewritten pages, this 2nd day of February, 2000. . #;;X ~~ MA'ITHEW L. WINTERS We, the undersigned, hereby certify that the foregoing Will was signed, sealed, published and declared by the above-named Testator, MATrHEW L. WINTERS, as and for his Last Will and Testament, in the presence of us, who at his request and in his presence and in the presence of each other, have hereunto set our hands and seals the day and year above written, and we certify that at the time of the execution thereof, the said Testator was of sound and disposing mind and memory. It /lII!, ~ /~J/:;t/U\ ~. "'\..; . \.) residing at 1 C, ..wop ,JJuW. P 1\ f~1 ..::"..J residing at "-11,LlcLl1p.l.0'UTh "1=? . 13 COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF DAUPffiN We, the Testator, MA'ITHEW L. WINTERS, and Kc..rncJd }-.\. ~2.IYlCLZ) ,and .:bh T HLLr-'4..q' , the witnesses, respectively, whose names are signect=to the foregoin instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, 'signed the Will as witness and that to the best of his/her knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~~~ MATl'HEW L. WINTERS ,~alLA~~" , Witness ~1r.~ {'i~UM(f Itness Subscribed, sworn to and acknowledged before me by the Testator, MATI'HEW L. WINTERS, and subscribed and sworn to before me by RL;y-,(L\ d H _ -+<~"'O-:'\ and y~u-~ -=r ,,-lu-n-CL-,-y , witnesses, this 2nd day of February, 2000. 1\ J -, ~ l " (-.'----ir-v\ . " -j -, .Lr--rl _U~0::--'--1 I~ < - I I ~,J ( Notary public ' '~j (SEAL) 31345.1 I - - NOTARIAL SEAL --, KIMBERLY D, MilLER. Notary Public I Harrisburg. Dauphin County t~y ~ommlssion expires Aug. 19. 2003 . 14 EXHIBIT B Estate Valuation Estate of Matthew L. Winters Personal Assets Personal and Confidential A Service of Legg Mason Wood Walker, Inc. Financial Advisor - Sheila Spainhour Shaffer - Washington, DC Prepared: November 21,2001 Legg Mason Wood Walker, Inc. - 100 Light Street- P.O. Box 1476. Baltimore, Maryland 21203-1476. (410) 539-0000 We believe the i,iforlllationlO be accurate but Legg Mason Wood Walker, fnc. cannot be held responsible for any losses caused by inadvertent errors and/or omissions. If there are any questions regarding this report please contact Legg Mason Wood Walker, fllc. or your Legg Mason Financial Advisor. Estate Valuation Personal Assets Date of Death: 09/17/2001 Valuation Date: 09/17/2001 processing Date: 11/21/2001 Estate of: Matthew L. Winters Account: 309-29962 Report Type: Date of Death Number of Securities: 23 File ID: Winters, Matthew L. Personal Shares or Par Security Description High/ASk Low/Bid Mean and/or Div and Int Adjustments Accruals Security Value 1) 51.90466 AT&T CORP (001957109; T) COM NYSE 09/17/2001 18.32500 16.50000 H/L 17.412500 903.79 2 ) 16 AT&T WIRELESS SVCS INC (AWE) COM NYSE 09/17 /2001 13.69000 12.52000 H/L 13 .105000 209.68 3 ) 50 AMERICAN ELEC PWR INC (025537101; AEP) COM NYSE 09117/2001 48.50000 46.00000 H/L 47.250000 2,362.50 4) 4.26186 AVAYA INC (AV) COM NYSE 09117/2001 11.83000 11.05000 H/L 11.440000 48.76 5) 1 BERKSHIRE HATHAWAY INC DEL (084670108) NYSE 09/17/2001 65700.00000 62500.00000 H/L 64100.000000 64,100.00 6 ) 167.54823 BRISTOL MYERS SQUIBB CO (110122108; BMY) COM NYSE 09/17/2001 60.00000 57.35000 H/L 58.675000 9,830.89 7 ) 240 COCA COLA CO (191216100; KO) COM NYSE 09/17 /2001 50.20000 48.71000 H/L 49.455000 11,869.20 Div: 0.18 Ex: 09/12/2001 Rec: 09/15/2001 Pay: 10/01/2001 43.20 8) 55.28905 RASTMAN KODAK CO (277461109; EK) COM NYSE 09/17120Gl 42.00000 40.39000 H/L 41.195000 2,277.63 Div: 0.44 Ex: 08/30/2001 Rec: 09/04/2001 Pay: 10/01/2001 24.33 9) 148.5 EXXON MOBIL CORP (30231GI02; XOM) COM NYSE 09/17/20G1 41.45000 39.77000 H/L 40.610000 6,030.59 10) 240 GENERAL ELEC CO (369604103; GE) COM NYSE 09/17/20G1 37.20000 34.50000 H/L 35.850000 8,604.00 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300. (Revision 6.3.3) Date of Death: 09/17/2001 Valuation Date: 09/17/2001 : Processing Date: 11/21/2001 Shares or Par Security Description High/Ask Low/Bid 34.00000 H/L 16.70000 Bid 1.00000 Bid 46.97000 Bid 5.50000 H/L 16) 252.84264 MERCK & CO INC (589331107; MRK) COM NYSE 09/17 /2001 68.10000 Div: 0.35 Ex: 08/30/2001 Rec: 09/04/2001 Pay: 10/01/2001 66.15000 H/L 17 ) 100 NEWELL RUBBERMAID INC (651229106; NWL) COM NYSE 09/17/2001 23.00000 Estate of: Matthew L. Winters Account: 309-29962 Report Type: Date of Death Number of Securities: 23 File ID: Winters, Matthew L. Personal Mean and/or Div and Int Security Adjustments Accruals Value 34.910000 5,704.52 11) 163.40635 J P MORGAN CHASE & CO (46625HI00) NYSE 09/17/2001 35.82000 21.80000 H/L 16.83000 H/L 20) Div: 0.54 Ex: 09/05/2001 Rec: 09/07/2001 Pay: 09/28/2001 44.15000 H/L 170 SCUDDER STRATEGIC MUN INCOME (488427105; KSMI COM SH BEN INT NYSE 09/17/2001 12.32000 Div: 0.0625 Ex: 09/13/2001 Rec: 09/17/2001 Pay: 09/28/2001 12.20000 H/L Page 2 16.700000 5,294.84 12) 317.056 LEGG MASON INVS TR INC (52465QI01; LMALX) AMERN LEADG TR NASDAQ 09/17/2001 1. 000000 30,502.56 13) 30502.56 LEGG MASON CASH RESV TR (524658101) SH BEN INT NASDAQ 09/17/2001 46.970000 14,327.40 14) 305.033 LEGG MASON VALUE TR INC (524659109; LMVTX) CL A PRIM SH NASDAQ 09/17/2001 5.750000 295.56 15) 51.40112 LUCENT TECHNOLOGIES INC (549463107; LU) COM NYSE 09/17/2001 6.00000 67.125000 16,972.06 18) 90 NORFOLK SOUTHERN CORP (655844108; NSC) COM NYSE 09/17/2001 18.65000 88.49 22.400000 2,240.00 19) 80 PUBLIC SVC ENTERPRISE GROUP (744573106; PEG) COM NYSE 09/17/2001 45.50000 17.740000 1,596.60 44.825000 3,586.00 43.20 12.260000 2,084.20 10.63 This report was produced with EstateVal, a product of Estate valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300. (Revision 6.3.3) Date of Death: 09/17/2001 . ~ Valuation Date: 09/17/2001 . Processing Date: 11/21/2001 Shares or Par Security Description Low/Bid High/Ask 21) 124 XCEL ENERGY INC (XEL) COM NYSE 09/17/2001 28.41000 27.50000 H/L 22) 16 ZIMMER HLDGS INC (ZMH) COM NYSE 09/17/2001 24.78000 H/L 26.04000 23) 50000 CAMBRIA CNTY PA G.O. BDS (132033GA3) FT Intr. DTD: 01/15/1998 Mat: 08/15/2016 5.5% 09/17/2001 106.91500 106.66500 A/B Int: 08/15/2001 to 09/17/2001 Total Value: Total Accrual: Total: $246,563.05 Page 3 Estate of: Matthew L. Winters Account: 309-29962 Report Type: Date of Death Number of Securities: 23 File ID: Winters, Matthew L. Personal Mean and/or Div and Int Adjustments Accruals security value 27.955000 3,466.42 25.410000 406.56 106.790000 53,395.00 244.44 $246,108.76 $454.29 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300. (Revision 6.3.3) EXHIBIT C . . . · ~GEdw~~~!trsI11;N!"fo 6700 Main Street 1 Beresford Court Williamsville. I,iew York 14221 January 14, 2002 Goldberg, Katzman & Shipman, P.C. Attn: Cheryl L. Baker, CLA 320 Market Street Strawberry Square PO Box 1268 Harrisburg, P A 17108 Re: Matthew Winters, Sf. Dear CheryL (716) 626-1300 Fa.", (716) 626-4300 1-800-452-5244 Here are the DOD valuations for both of the accounts as of 9/17/01. Matthew Winters IRA Ft msurance Growth Tr # 1 Ft Regl Bk & Thrift Growth #1 Cash/Money Market 883 units @8.50511unit 834 units @7.88211unit $9867.83 Matthew & Elisabeth Winters joint Account BP P. L. C. Chevrontexaco Corp Dominion Res mc New Exxon Mobil Corp Ft DJIA Dart 10 Port 10/00 Ft Leading Brands Growth #9 Kimberly Clark Corp Pa lMIT # 222 Van Kampen Amem Cap Bnet 5 Cash/Money Market 2116 shs @49.16/share 162 shs @ 90.22/share 99 shs @ 60.24/share 2000 shs @ 40. 15/share 970.2227 units @ 8.9029/unit 2043.2729 units @ 8.8514/unit 1364 shs @ 63.18/share 1 unit @ 1020.05/unit 2545.677 units @ 9.7082/unit $1784.86 If you have any questions please do not hesitate to contact me. Sincerely, Brenda Lochhead Financial Associate to David J Wahler Vice President Invesmtents OF CO{';.'.EI. F. LEE SIIII'\J'.'" JOSHI A D. L(.CK ARTfURL GOLDHFRC (1 'is 12(00) H\RRY B. (;OL!>HER(i (1"61.1998) RO"iALIJ \1. KHZ\IA', PAIL J. Esp",. "FIL HE'-.iJER'i'", J. J\\ Ci)Oi'I,R T//O\L'.S E. BRE';'-ER JOH'- A. ST\Ti ER APRIL L. S I R\'-li.KI P.l' (;{'Y I! BRO'lK, JEFFERSO'\ .1 SHIP\i\,\ JERK:.1 R:,so \IICH.\FL J. CRi)!:!.,ZI THO\{AS J. WE hER Sn:\'I-:~; E (jKiBB AR"'OI.J> B. "(,,,.\'\ ROYCE L. \l(iERis E\A'\ .1. KI.I'\I'. III JOH'\ I); LCRI':-,ZC: JOIl'-. R "I'\(:,K, DAVID \1 S:F.u:F1. ;j.....J.......Ji::J.O" S--' 0;;'. 320 MARhET STREET · STRAWBERRY SQ{'\RE P.O Box 1268 . HARRISBI'RG, PE'\'\SYLL\'\IA 17108.1268 717.234.4161 · 717.234.6808 (FAX) GOLDBERG, KATZMAN &> SHIPMAN, P.C. ATTORNEYS AT LAW February 22, 2002 Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, P A 17013 Re: Estate of Matthew Winters, deceased File No. 2001-00985 Dear Sir or Madam: Enclosed please find the following documents for filing for the above- referenced Estate: 1. An original and two (2) copies of the Pennsylvania Inheritance Tax Return. 2. An original and two (2) copies of the Inventory. Please time-stamp the extra copy of each and return them to me in the enclosed self-addressed, stamped envelope. I have enclosed a check in the amount of Twenty-three Dollars ($23.00) for the filing fees. If you have any questions, please do not hesitate to contact me at the above telephone number. Very truly yours, ( \ , .. '''I ~. /. cf,. i.t 'X>" I.'i ' /. '\. (j ''''7- ) \.....,.-\._. ,/1 \,,,__~ I -.... ..~,),"....... chbryi L. Baker, CLA Certified Legal Assistant Enclosures 71583.2 CARLISLE OFFICE: 717.24.1.0597. YOHK OFFICE: 717.84.'.7912 ~, !~-:.. ~ ( l: ,,' :;:" CT' ,.-) J.~ ~ ':\ ,., rF' ; c> "~f ;~ ~~:,~\~l ~~ "j\\. - -- C\1 ~ CIJ CIJ C\1 - o ..., ~ -- LL l,..""~ /~-........,~ // f.'.v' <'! '~.~: " I .~""/"~, , ,; ," .,)/,," ~ .,~_N. N <J .' .J> ~ ~ .~ )1) ou fIJ :3 o 'E g -: Uou - .o~~ -: c::3...... = fIJ :3 0" 0 =:::: 0 t:n t"-- '=::>Uou...... - ;;> <I) ....... :~-gO:3;;:.. : 0 ~ _ == ~ 1i 'E ~~ = ti..o :3 fIJ == OJ::.. S O:os -:Q)':3U~ "':~U"""U \ /?-/b-/~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX OIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX '02 12 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 04-08-2002 WINTERS 09-17-2001 21 01-0985 CUMBERLAND 101 .r: J .; .J RONALD M KATZMAN GOLDBERG ETAL PO BOX 1268 HBG ESQ REV-1547 rx AFP (01-02) MATTHEW L \_-" - P A f7t.1iI!l8" 0 158 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ R "EV= iS47-EiCAFP--coT:oiY-NDTfcE--oF-YNHER-fTAircE-TAX-APPR'A-fSEM-E'NT-,--AL.i-OWAN-CE-O-ri----------- -- - - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WINTERS MATTHEW L FILE NO. 21 01-0985 ACN 101 DATE 04-08-2002 T AX RETURN WAS: (X) ACCEPTED AS F I LED ) CHANGED If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of !hh returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 246,563.05 .00 .00 21,485.33 .00 27,998.95 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (9) ClO) 14,455.67 5,085.44 14. Net Value of Estate SUbject to Tax NOTE: 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS' Cl5) 276,506.22 X 00 Cl6) .00 X 045 = Cl7) .00 X 12 Cl8) .00 X 15 Cl9)= NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 296,047.33 Cl1) Cl2) Cl3) (14) 19 .1)4] . 1 ] 276,506.22 .00 276,506.22 .00 .00 .00 .00 .00 . PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED. SEE REVERSE --- ~., ~'" ATTn... nl: 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 --- "_U~De~ eTnl: nl: THIS FORM FOR INSTRUCTIONS.) i: L.J/ V STATUS REPORT UNDER RULE 6.12 Name of Decedent: MATTHEW L. WINTERS Date of Death: September 17, 2001 Will No. Admin. 2001-00985 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 X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes No X d. Copies of receipts, releases, joinders and approvals of formal or information accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. ~~ Signature Date: (' !S.D[,?U r"~.") Ronald M. Katzman, Esquire Goldberg, Katzman & Shipman, P.C. 320 Market Street. P.O. Box 1268 Harrisburg, PA 17108-1268 (717) 234-4161 -::' J___'; Capacity: Personal Representative X Counsel for personal representative