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Home My WebLink About01-1063 1/ REV-1500 EX + (6-00) OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA REV-1500 I 7- (). ~ -t, DEPARTMENT OF REVENUE DEPT. 280601 INHERITANCE TAX RETURN FILE NUMBER HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 2001 1063 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I Fry, M. Doris 180-28-3020 DECE- DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE DENT 10/30/01 04/06/1918 WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 3. Remainder Return CHECK ~ 1. Original Return r Supplemental Return 8 (date of death prior to 12-13-82) APPRO- 4. Limited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required (date of death after 12-12-82) PRIATE 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 0 a. Total Number of Safe Deposit Boxes (Attach copy of Will) (Attach a copy of Trust) BLOCKS 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death between 0 11. Election to tax under Sec. 9113(A) 12-31-91 and 1-1-95) (Attach Sch 0) .:tH($':$~ijMQ<<t'ii.~iMi$fjtMiit.Q.Qlij~..:j:t#.Qij~mgH.fli4.ti.R.IN.ijQiM.AnQJ.\I..lijQ.:Mi~iiwtgijrr.Q~:. NAME COMPLETE MAILING ADDRESS COR- John S. Davidson 320 West Chocolate Avenue RE- FIRM NAME (If Applicable) P.O. BOx 437 SPON DENT Yost & Davidson Hershey, PA 17033-0437 TELEPHONE NUMBER (717) 533-5101 None OFFICIAL USE ONLY 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) None-~ :0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) N~~ 2 (1) 4. Mortgages & Notes Receivable (Schedule D) (4) NMe (: O. 5. Cash, Bank Deposits & Miscellaneous Personal c...... ;:I::> Property (Schedule E) (5) 41,084.34 z 6. Jointly Owned Property (Schedule F) hJ r-...J 0 Separate Billing Requested (6) None v RECA- - PITULA- 7. Inter-Vivos Transfers & Miscellaneous ,'J, TlON Non-Probate Property (Schedule G or l) (7) None 00 8. Total Gross Assets (total Lines 1-7) (8) 41,084.34 9. Funeral Expenses & Administrative Costs (Schedule H)(9) 7,184.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 744.44 11. Total DeductIons (total Lines 9 & 10) (11) 7,928.44 12. Net Value of Estate (Line 8 minus Line 11) (12) 33,155.90 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax (13) None has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 33,155.90 SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (aX1.2) X .0 (15) - TAX 16. Amount of Line 14 taxable at lineal rate 33,155.90 X .0 45 (16) 1,492.02 - COMPU- 17. Amoun1 of Line 14 taxable at sibling rate 0.00 X .12 (17) 0.00 TATION 18. Amount of Line 14 taxable at collateral rate 0.00 X .15 (18) 0.00 19. Tax Due (19) 1,492.02 20. 0 IQHe.P.Kij~)f'yQijAijJgijmumJf$:i:Re.mijp:j:)fAij~R._Ift:1 ............ .. ............................................... ...............,.............................................;... ................................................. .. ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...... ... ............ ......... . . . . . .. ... .. .............. (:ii}.'ag.$)R&.T:Q:ANl}.~AQ;qV.J;$:JlQN$.Q~:R~J;~'ANPRJ;P.HeGl:tMATH.ii:ti{},H o PA15001 NTF 29755 Copyright 2000 Greatland/Nelco LP - Forms Software Oniy PA REV-1500 EX (6-00) Decedent's Com lete Address: STREET ADDRESS OUtlCXJk Pointe Page 2 1100 Graudon Wa CITY Mechanicsb Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount STATE PA ZIP 17055 (1) 1,492.02 74.60 Total Credits (A + B + C) (2) 74.60 3. interest/Penalty if applicable D. Interest E. Penalty 5. Total Interest/Penalty (D + E) If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Une 5 + 5A. This is the BALANCE DUE. ... .............................................::::::;)::8jt~~;i;;;a~::'\~;::;;:~~TEFi.O'~~~:tt=!.:~;7~:I .... (3) 0.00 4. (4) (5) (5A) (5B) 1,417.42 0.00 1,417.42 , . . . . . . . . . . . . . . . . . . . . . ,................................. ... .....PLEASE.ANSWER. THE.r=OLI.owiNG.QliEStlONS..BYPLACiNG.AN.j;Xjj..iN.THE.APPAOPRIATfsLOCKS.... 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ....................................... ~ I 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 eg 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 0 eg 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 eg 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 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 representative is based on information of which preparer has any knowledqe. SIGNAT RE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADD SS See Schedule attached ~SIGNATu~a:~RER OTHER THAN REPRESENTATIVE RESS o West Chocolate Avenue, Hershey, PA 17033 DATE / (/,['!dz- [72 P.S. Ii 9116 (a) (1. l)(i)]. For dates of death on or after January 1, 1995, the tax rate is imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. Ii 9116 (a) (1.1) (ii)]. The statute does nnt AXAmpt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure 01 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 Ju ly 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age Dr 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. li9116(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. Ii 9116(1.2) [72 P.S. Ii 9116(a)(1)]. The tax rate imposed on the net value of transfers to or forthe use of the decedent's siblings is 12% [72 P.S. li9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. o PA15002 NTF 29756 Copyright 2000 Greatland/Nelco lP - Forms Software Only Estate of: M. LOris Fry 21-2001-1063 'The following person (s) are signing the retUTIl as representative (s) of the estate: June M. Corrado 107 centerfield Drive Harrisburg, PA 17112 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 M. Doris Fry 21-2001-1063 Include proceeds of litigation & date proceeds were received by the estate. All prop. Jointly-owned with right of survivorship must be disclosed on Sch. F. ITEM NO. DESCRIPTION VALUE AT DATE OF DEATH 1 PNC Bank certificate of deposit #21001004280 20, 005.42 2 PNC Bank certificate of deposit #31800216474 6,062.09 3 PNC Bank checking account #5000621045 14,541. 83 4 Ladies diamond solitaire ring per appraisal attached 250.00 5 Ladies diamond band per appraisal attached 75.00 6 ladies diamond ring per appraisal attached 150.00 7 CPA81 NTF 10908 Copyright Forms Software Only, 1997 Nelco, Inc. TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 41,084.34 ~. o PNCBAN< November 29,2001 Ms June Corrado 107 Centerfield Dr Harrisburg, P A 17112 RE: Estate ofM Doris Fry (Deceased) SSN: 180-28-3020 DaD: 10-29-2001 Dear Ms Corrado: In response to your request for Date of Death balances for the customer noted above, our records show the following: CERTIFICATE OF DEPOSIT #21001004280 Established 10-25-1993 M DORIS FRY DaD Balance: $20,000.00 + $5.42 accrued interest #31800216474 Established 08-14-2001 M DORIS FRY DaD Balance: $6,049.94 + $12.15 accrued interest CHECKING ACCOUNT #5000621045 Established 11-07-1996 M DORIS FRY DaD Balance: $14,541.07 + $0.76 accrued interest Page 1 of2 A member of The PNC Financial Services Group One PNC Plaza 249 Fifth Avenue Pittsburgh Pennsylvania 15222 2707 . . 0. PNCBAN< Please note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not process any financial transactions or provide statements. If you need assistance with any of these items, please call1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch office. Sincerely, ~..c7 Ak~ Erica L. Schlegel 1-800-762-1775 P7-PFSC-04-F 500 First Avenue Pittsburgh, PA 15219 Page 2 of2 A member of The PNC Financial Services Group One PNC Plaza 249 Fifth Avenue Pittsburgh Pennsylvania 15222 2707 ii, G. M. JEWELRY ENT. Expert Jewelry Repairs . Jewelry Appraisals 4707 Jonestown Road HARRISBURG, PA 17109 (717) 545-0915 www.HarrisburgEast.com/GM.htm No Cash Refunds CUSTOMER'S ORDER NO. PHONE ~.~m.._ RECEIVED BY TOTAL L {/1118{ To Reorder: 800-225-6380 or nebs.com CJhankC}O:l REV-1511EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF M. [bris Fry SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-2001-1063 Debts of decedent must be reported on Schedule I. ITEM NO. DESCRIPTION A. FUNERAL EXPENSES: AMOUNT 1 Hcover FUneral Home 6,047.00 2 June Corrado - reimburse funeral hmcheon expenses 500.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN No. of Personal Representative(s) Street Address 0.00 City State Zip Year(s) Commission Paid: 2. Attorney Fees Name: John S. Davidson 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 500.00 0.00 4. Probate Fees 112.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7 Register of Wills - filing fee for inheritance tax return 25.00 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 7,184.00 7 CPA11 NTF 10911 Copyright Forms Software Only, 1997 Nelco, Inc. REV-:1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF M. Doris Fry Include unreimbursed medical expenses. ITEM NO. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-2001-1063 DESCRIPTION AMOUNT 1 Elizabeth Cgden - special care provider 43.70 2 Kathleen Kush - special care provider 131.25 3 Special Care, Inc. - personal care 45.00 4 Holy Spirit Hospital 12.72 5 Outlook Pointe at Creekview - nursing home care 493.09 6 Brockie Pharma.tech - prescriptions 18.68 7 CPA12 NTF 10912 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 744.44 Copyright Forms Software Only, 1997 Nelca, Inc. REV~1513 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES M. Ibris Fry No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 June M. Corrado 107 Centerfield Drive Harrisburg, PA 17112 2 Mark T. Leach 804 Leeds Court Harrisburg, PA 17112 3 Denise R. Hamilla 1651 Melrose Avenue Hummelstown, PA 17036 4 Lisa A. Barnes 1743 Murrrna Road Harrisburg, PA 17112 5 Karen M. Zirrrnerman 691 South 82nd Street Harrisburg, PA 17111 FILE NUMBER RELATIONSHIP TO DECEDENT Do Not List Trustee(s) daughter grandson granddaughter granddaughter granddaughter 21-2001-1063 AMOUNT OR SHARE OF ESTATE 6,631.18 6,631.18 6,631.18 6,631.18 6,631.18 ENTER DOLLAR AMTS. FOR DISTRIBS. SHOWN ABOVE ON LINES 15 THROUGH 17 AS APPROPRIATE ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE None B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS None 7 CPA13 NTF 10913 TOTAL OF PART II -- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00 Copyright Forms Software Only, 1997 Nelco, Inc. (If more space is needed, insert additional sheets of the same size) v '-" LAST WILL AND TESTAMENT OF M. DORIS FRY I, M. DORIS FRY, of the Borough of Hummelstown, County of Dauphin and Commonwealth of Pennsylvania, declare the following to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. ARTICLE I I direct that all my just debts and funeral expenses, including the cost of my gravemarker, shall be paid from the assets of my residuary estate, as soon as practicable after my decease, as a part of the expense of the administration of my estate. ARTICLE II I give and bequeath certain items of my personal effects, household goods, furnishings and jewelry as are identified in a certain unsigned memorandum I have prepared prior to making this, my Last Will and Testament, to the individuals identified therein, in accordance with the directions set forth in such memorandum, a copy of which shall be filed with this my Last Will and Testament. In the event such an unsigned memorandum is not found with this my Last Will and Testament, then I direct that disposition of all of my personal belongings, household effects and furnishings be At ~d oJ);l/f7 v '-' accomplished in accordance with Article IV of this my Last Will and Testament. ARTICLE III I direct that any and all of my personal effects, household goods, furnishings and jewelry not disposed of in accordance with Article II above, be divided between my daughter-in-law, June M. Corrado, now or formerly of Hershey, Pennsylvania; my grandson, Mark T. Leach, now or formerly of Harrisburg, Pennsylvania; my granddaughter, Denise R. Hamilla, now or formerly of Hummelstown, Pennsylvania; my granddaughter, Lisa A. Barner, now or formerly of Harrisburg, Pennsylvania; and my granddaughter, Karen M. Zimmerman, now or formerly of Harrisburg, Pennsylvania, if they or any of them are then living, as nearly in equal shares, as they shall agree. Any such items of tangible personal property not so distributed shall be sold at public or private sale and the proceeds added to my residuary estate for distribution in accordance with the provisions of Article II of this my Last Will and Testament. ARTICLE IV All of the rest, residue and remainder of my estate, real, personal or mixed and wherever situate, including lapsed legacies and any property over which I may have power of appointment, I give, devise and bequeath to my daughter-in-law, June M. Corrado, now or formerly of Hershey, Pennsylvania; my grandson, Mark T. Leach, now or formerly of Harrisburg, Pennsylvania; my ~1l1J. .zh 111J ...../ '-' granddaughter, Denise R. Hamilla, now or formerly of Hummelstown, Pennsylvania; my granddaughter, Lisa A. Barner, now or formerly of Harrisburg, Pennsylvania; and my granddaughter, Karen M. Zimmerman, now or formerly of Harrisburg, Pennsylvania, in equal shares, as per stirpes. ARTICLE V I direct my Executor, hereinafter named, to payout of the principal of my estate, as part of the administration of my estate, all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed. ARTICLE VI My Personal Representatives shall have the following powers, in addition to those vested in them by law and by other provisions of my Will, applicable to all property, including property held for minors, whether principal or income, exercisable without court approval, and effective until actual distribution of all property. A. To retain any or all of the assets of my estate, real or personal, without regard to any principle of diversification, risk or productivity. B. To invest in all forms of property, common trust funds and mortgage investment funds, without restriction to investments authorized for Pennsylvania fiduciaries, as 3 . . v .~ they deem proper, without regard to any principle of diversification, risk or productivity. C. To sell, at public or private sale, to exchange or to lease for any period of time, any real or personal property, and to give options for sales, exchanges or leases, for such prices and upon such terms and conditions as they deem proper. D. To borrow money from any person or institution, and to mortgage or pledge any or all real or personal property, as they, in their sole discretion, shall choose, without regard for the dispositive provisions of this instrument. E. To compromise claims or controversy. F. To allocate receipts and expenses to principal or income, or partly to each, as they, from time to time, think proper, in their sole discretion. G. To distribute in cash or kind, or partly each. ARTICLE VII I hereby name and appoint JUNE M. CORRADO as Executrix of this my Last Will and Testament. Should JUNE M. CORRADO predecease me or be unwilling or unable to serve in such capacity, then I name and appoint MARK T. LEACH, as Executor of this my Last Will and Testament. 4 ~.:V?/f:? . . v -...../ ARTICLE VIII I hereby direct that my Personal Representatives shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~day of~~./~tr~ ' 1997. This Document, in its entirety, consists of Seven (7) Pages, this being Page Five (5). M. Zl?s~~~ SIGNED, SEALED, PUBLISHED, and DECLARED by the above named Testatrix, M. DORIS FRY, as her Last Will and Testament, and in the presence of us, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. ~a LJI}.J DEBRA D. N S~ ~ of Mechanicsburq, Pennsylvania 17055 of Hummelstown, Pennsylvania 17036 5 . .. "'" .-' COMMONWEALTH OF PENNSYLVANIA ) ) SS: ) . COUNTY OF DAUPHIN I, M. DORIS FRY, Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. & b-kM.I 3A M. DO IS FRY 7 Sworn or affirmed to and acknowledged before me by M. DORIS FRY the Testatrix, this IMay of ge b . 1997. ... NO~~ ~ My Commission Expires: r,IG;.;ri;;1 S.>,.! M:'ry r. 1~;'-.H' tv.r;,rv Pllb!;c ~.!"rn"'t'i' :"',h ~",,'lll~;'lr:). f) .Il;"\'lift County Iviy GOI',',.LSh)i\ ~/,pirl':; f\Ug. 23. 2Goo MIlfr.oor. P6l11l~)lvallla l\ssQUa1IOO 01 Notaries 6 . . v .. . COMMONWEALTH OF PENNSYLVANIA ) ) SS: ) COUNTY OF DAUPHIN We, JEFFREY M. MOTTERN and DEBRA D. NESS, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testatrix sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. ~4n) DEBRA D. E S MOTTERN and 1~~. Sworn or affirmed to and subscribed to before me by JEFFREY M. DEBRA D. NESS, the witnesses, this I ?1{ day of , 1997. NO~ (' 4 My Commission Expires: 7 [ r J'~~,lri;11 :'{>11 M'lrv r: I'J;' U, "I"t:H" rlJo1ic '.jJ;!~ij);, ':i"hl) ":>Ii,', 1"""1', hill r;ounly ~,.Il'f ',_:1..11: .: ,():! I I; ;':.,',r", :',ii~l 2.'3, 2000 ~7uii:rw~~;j~;~ A::;-~~iaikul ul Nolarl8$ . '. ~ PETITION FOR PROBATE and GRANT OF LETTERS Estate of M. Dor; s Fry also known as No. 21-01-1063 To: Register of Wills for the Deceased. County of Cumber' and in the Commonwealth of Pennsylvania Social Security No. 180-28-3020 The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut r; X in the last will of the above decedent, dated Fe h r I J n r y 1 R, , q q 7 and codicil(s) dated n I a named ,~~- (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumber' and County, Pennsylvania, with h er last family or principal residence at Out' ook Po; nte. Mechani cshurg Borough (list street, number and muncipality) Decendent, then 83 at Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: no except; ons 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: years of age, died October 30. 2001 ,1\1 $ 50,000.00 $ $ $ -0- WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. ,..... i ~ ff ~~ ~. -Pftl,,/(, t:tZ!t~/f "'..... "'... l:(~ ].g tU"';:: 3&: "'.... 30 OJ I': tlO i:ii June M. Corrado 107 Centerfield Drive Hnrr;c;hlJrg, PA 1711/ (717) 652-3019 OATH OF PERSONAL REPRESENTATIVE COMMONW.EALTH OF PENNSYLVANIA } 58 COUNTY OP" uWaJRLAND \ .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. 'ItC/YJI ( 'ftLt'~ une M. Corrado ~ oq' ::s C:l .... So:: ~ ~ No. 21-01-1063 Estate of M. DORIS FRY , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW November 20 , :::>nnl *~ , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, lT IS DECREED that the instrument(s) dated February 18, 1997 described therein be admitted to probate and filed of record as the last will of M. Doris Fry and Letters Testamf'ntary are hereby granted to ,1IJnf> M forrrlrln FEES Probate, Letters, Etc. ......... Short Certificates( ).......... x-pag~s. RenuncIatIon ................ JCP 80.00 9.00 18.00 Filed $ $ $ $ 5.00 TOTAL _ $ 112.00 . .~~~~~~~. .1.~! . ~.qq ~. . . . . . . . . . . . . ~'r~. :/~~~~.b/.4t'J ~~~r egister of Wills John S. Davidson (1713q) ATTORNEY (Sup. Ct. 1.0. No.) 3?O Wf>"t fhornlrlt~ AvenllE', POBox 437 ADDRESS Hershey, PA 17033 (717) 533-5101 ~~p~ H 105.805 REV 9/86 This is to certity that the infotmation here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 No. Ac (llj~ ~ R'g;"''' p 7822468 !/-/--~ol Date 2]-01-1063 H1OS. '.(3 Aev. 2187 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH TyPEIP....T .. _EMf BUCK_ NAME OF DECEDENT tFwSl. Mickle. La5lJ SEX SWE FILE ~A SOCiAl SECURH't NUMBER DATE OF DEATH iMcrwh. 0..... "oUr, 1. M. DORIS FRY AGE (La. Birthday) UNOER 1 YEAR __ 0.,. .. female J.180 - 28 '.October 30, 2001 o w .. ::> ': ::; .. =".,10 .. COUNTY OF DEATH 83 v... UHOEA 1 DAY HOW01- BlRTHPL.ACf: (CIfy and se.. 01 FOl'UIQfl CounllVJ . ...Cumberland DECEDENT'S USUAL OCCUPATION (~r:=:w:r:a~~~:i . ".. Housewife "..Home makin DECEDENT'S WAllING ADDRESS (Srr1iMlt. CltylTown. Stale. lip Code) RACE. AmiNICVIlndian. Black. While. eI(;. (_I . ... 1.. white SURVIVING SPOuSE (II ...... (I.... maooeo namel 1100 Graudon Way Mechanicsburg, PA 17055 MARtTAl STATuS. Mat,ied Nail'" Manilld. Widowed. Divorced (Specify) ...widowed t7c.o )W,dIlcecMnIlivedin ..... Mechanicsburg CilyIbQrQ. Removal'fOm s.... 0 .... TIME OF OEATH DATE PROHOUNCEO DEAO IMonIh. Day. Yea" 23ft. 2)(:. WfroS CASE REFERRED TO MEDICAL EXA""INERlCORONER7 ...0 ,.,l'll. ./ \t ... Co: rt 6"" .. 2.. Clc...+ob ("'r' 30 () l 21, PART I: ene..-the disea541S, inluries OIcomplK;allons which caUS8d lhe (jealh Do not aneW I"" mode OrdW'If19, 5uch ilScard6ac Of ,esptralury aHlIst, shuck Ofhvart fallurlil LISl only on. CilIUM on INlCllIine OUElO(OA~ ;I~ raduv ... IApprolun...le :intervaJ~n 10f\MlI anddHCh I 1 PAAT II: OlIhar siglllficanc ~ conuGubng 10 dliath. but not ,asulng in lha undaftrlng c:aUM QiYM 11'\ PNlT I if) I: DUE 10 lOR AS ACONSEOUENCE Of) DuE TOtORASACONSEQUENCE OF). \-. :lOb. .... JOe. PLACE OF INJURY. AI home. larm, IIrHI. factory, office building, "c_ ISpec"...1 za.. 211b. at. JOe. CERTIFIEA lCheck 0f'II., onel .CERTlFYING PHYSICIAN IPhySlCoan Cetldytng cauS6 01 death whert df'IOlher phYSIC,an has pronounc8(j dealh ana Comptele<t lIem 231 TD the .....olmy know6adga, deelhoccunad du. to the cauM(sl and manner... ....Itd. . WERE AUlOPSY FINo.NGS MANNER OF DEATH A\AIUl.A81.E PRIOR ro COMPlETION OF CAUSE g..-- 0 OF DEATH? ...."'.. """""... Ac_ 0 Pending lrwuIigalion 0 ...0 ,., 0 - 0 CoukJ nof beo detefmlf'led 0 DATE OF INJURV lMonlh Day. Year} TIMe OF INJURY INJUAY AT WORK? DESCRIBE HOW' INJUAY OCCURRED ... 0 ,.,0 12L..<t.:l.JZI,-\1 DATE StGNEO l~. Da~. '!'earl /tl Ji Cf .... ~ o w ~ o ~ o w :> .. z "PROHOUHCINQ AND CERTIFYING PHYSICIAN lPhySlC~ boIh pronouoclO9 oeath .md certllyllll,J lO..:ause 01 aealN To tM betit 01 my knowledge. de..th CK:curred .llt\tI Ume, dat., and pt...e, and due 10 1M ...u"Ca) and manner.. ataled.. .MEDICAL EXAMINER/CORONER On Ih. be.i. 0' ..aminellon and/or inveslig.hon, in my opinion, death occurred althe lime, dale, and place, Ind due to Ihe c.useCs.lnd menner..at4lted..... .........................,.... :I,.. REGISTRAR'SSIGN.rURE'NONUM~_a~~___u___ [J JJ. DATE FtLEO(MOIllh Da'f_l'ealj l4 11- '-0 \ 21-01-1063 LAST WILL AND TESTAMENT OF M. DORIS FRY I, M. DORIS FRY, of the Borough of Hummelstown, County of Dauphin and Commonwealth of Pennsylvania, declare the following to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. ARTICLE I I direct that all my just debts and funeral expenses, including the cost of my gravemarker, shall be paid from the assets of my residuary estate, as soon as practicable after my decease, as a part of the expense of the administration of my estate. ARTICLE II I give and bequeath certain items of my personal effects, household goods, furnishings and jewelry as are identified in a certain unsigned memorandum I have prepared prior to making this, my Last Will and Testament, to the individuals identified therein, in accordance with the directions set forth in such memorandum, a copy of which shall be filed with this my Last Will and Testament. In the event such an unsigned memorandum is not found with this my Last Will and Testament, then I direct that disposition of all of my personal belongings, household effects and furnishings be JJ; lY () ~I/ fir! accomplished in accordance with Article IV of this my Last Will and Testament. ARTICLE III I direct that any and all of my personal effects, household goods, furnishings and jewelry not disposed of in accordance with Article II above, be divided between my daughter-in-law, June M. Corrado, now or formerly of Hershey, Pennsylvania; my grandson, Mark T. Leach, now or formerly of Harrisburg, Pennsylvania; my granddaughter, Denise R. Hamilla, now or formerly of Hummelstown, Pennsylvania; my granddaughter, Lisa A. Barner, now or formerly of Harrisburg, Pennsylvania; and my granddaughter, Karen M. Zimmerman, now or formerly of Harrisburg, Pennsylvania, if they or any of them are then living, as nearly in equal shares, as they shall agree. Any such items of tangible personal property not so distributed shall be sold at public or private sale and the proceeds added to my residuary estate for distribution in accordance with the provisions of Article II of this my Last Will and Testament. ARTICLE IV All of the rest, residue and remainder of my estate, real, personal or mixed and wherever situate, including lapsed legacies and any property over which I may have power of appointment, I give, devise and bequeath to my daughter-in-law, June M. Corrado, now or formerly of Hershey, Pennsylvania; my grandson, Mark T. Leach, now or formerly of Harrisburg, Pennsylvania; my ~&eJ- ~ tlf; granddaughter, Denise R. Hamilla, now or formerly of Hummelstown, Pennsylvania; my granddaughter, Lisa A. Barner, now or formerly of Harrisburg, Pennsylvania; and my granddaughter, Karen M. Zimmerman, now or formerly of Harrisburg, Pennsylvania, in equal shares, as per stirpes. ARTICLE V I direct my Executor, hereinafter named, to payout of the principal of my estate, as part of the administration of my estate, all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed. ARTICLE VI My Personal Representatives shall have the following powers, in addition to those vested in them by law and by other provisions of my Will, applicable to all property, including property held fqr minors, whether principal or income, exercisable without court approval, and effective until actual distribution of all property. A. To retain any or all of the assets of my estate, real or personal, without regard to any principle of diversification, risk or productivity. B. To invest in all forms of property, common trust funds and mortgage investment funds, without restriction to investments authorized for Pennsylvania fiduciaries, as 3 ~;Qlttl . . . . they deem proper, without regard to any principle of diversification, risk or productivity. C. To sell, at public or private sale, to exchange or to lease for any period of time, any real or personal property, and to give options for sales, exchanges or leases, for such prices and upon such terms and conditions as they deem proper. D. To borrow money from any person or institution, and to mortgage or pledge any or all real or personal property, as they, in their sole discretion, shall choose, without regard for the disposi ti ve provisions of this instrument. E. To compromise claims or controversy. F. To allocate receipts and expenses to principal or income, or partly to each, as they, from time to time, think proper, in their sole discretion. G. To distribute in cash or kind, or partly each. ARTICLE VII I hereby name and appoint JUNE M. CORRADO as Executrix of this my Last Will and Testament. Should JUNE M. CORRADO predecease me or be unwilling or unable to serve in such capacity, then I name and appoint MARK T. LEACH, as Executor of this my Last Will and Testament. 4 ~'4tf/~ , . ARTICLE VIII I hereby direct that my Personal Representatives shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ----L1 day of ;Z..M--.; 1'1'1 1997. This Document, in its entirety, consists of Seven (7) Pages, this being Page Five (5). M. Zl?s~~ay SIGNED, SEALED, PUBLISHED, and DECLARED by the above named Testatrix, M. DORIS FRY, as her Last Will and Testament, and in the presence of us, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. ~aO~ DEBRA D. N S~ ~ of Mechanicsburg, Pennsylvania 17055 of Hummelstown, Pennsylvania 17036 5 COMMONWEALTH OF PENNSYLVANIA ) ) SS: ) COUNTY OF DAUPHIN I, M. DORIS FRY, Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. M. ~s-4:~/~ Sworn or affirmed to and acknowledged before me by M. DORIS FRY the Testatrix, this I nay of ge 1. . 1997. ~r: No'~ar~ Publ ~ My Commission Expires: I k:::,;r;;,;1 ~;<.::J ~fi:~n/ E. ;'~;:':"'<:"'. r'v:.,!;,rv ~UbJ_fC l H,un" , , ;~""~ ;", Oii,,1 tk"';:!)",~r,~, rln Gounty (;,y,~",:,,,,:, t:J,d,::.:.:.~,g 23,2000 iV';;i7.~r:'(;;:;:;:;~;Vfu~i~ A;:~u4Iauon 01 Notarial; 6 '. COMMONWEALTH OF PENNSYLVANIA ) ) SS: ) COUNTY OF DAUPHIN We, JEFFREY M. MOTTERN and DEBRA D. NESS, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testatrix sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. ~~) DEBRA D. E S MOTTERN and 1~t. Sworn or affirmed to and subscribed to before me by JEFFREY M. DEBRA D. NESS, the witnesses, this (J(~day of , 1997. ~~~ Notary Publ' My Commission Expires: 7 [-.. ~k1fv F. H;;n ;;r:l" '<:L>..f'~'ii \';r ,'. .' 23, 2000 ~r_;.....iW""j." ui........ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: DAVIDSON JOHN S 320 WEST CHOCOLATE AVE HERSHEY, PA 17033 ______n fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: SSN: 180-28-3020 FILE NUMBER: 21 - 200 1 - 1063 DECEDENT NAME: FRY M DORIS DATE OF PAYMENT: 01/22/2002 POSTMARK DATE: 01/18/2002 COUNTY: CUMBERLAND DATE OF DEATH: 10/30/2001 ACN ASSESSMENT CONTROL NUMBER 101 TOTAL AMOUNT PAID: REMARKS: JUNE M CORRADO C/O JOHN S DAVIDSON ESQUIRE CHECK# ? SEAL INITIALS: CW RECEIVED BY: REV-1162 EX(11-96) NO. CD 000776 MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS AMOUNT $1 ,41 7.42 $1 ,41 7.42 1P IN RE: ESTATE OF M. DORIS FRY, DECEASED IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 2001-01063 00 ,... "':"'~ CERTIFICATE OF NOTICE UNDER RULE 5.~. ~ .. d - :u$' (1)0 (0 a ..... ,..""t ::~;~ f~ Name of Decedent: M. Doris Fry z o <:: N \0 Will No. Admin. No. a o h:- 00 Date of Death: October 30,2001 To the Register: I hereby certify that notice of the beneficial interest 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 November 26,2001: June M. Corrado, 107 Centerfield Drive, Harrisburg, P A 17112 Mark T. Leach, 804 Leeds Court, Harrisburg, P A 17112 Denise R. Hamilla, 1651 Melrose Drive, Hummelstown, PA 17036 Lisa A. Barner, 1743 Mumma Road, Harrisburg, P A 17112 Karen M. Zimmerman, 691 South 82nd Street, Hummelstown, P A 17111 Notice has been given to all persons entitled thereto under Rule 5.6(a) except: no exceptions. Date: !JfiUfW1Q.r", 1..3; ~aClI t:xd.,;. ~~ ~ S. DaVIdson, Esquire 320 West Chocolate Avenue P.O. Box 437 Hershey, PA 17033 (717) 533-5101 Capacity: Personal Representative X Counsel for Personal Representative Nov200IRJDisk#1/Fty Ccrtificlte of Notice 11.26-01 ~~o/ YOST & DAVIDSON 320 WEST CHOCOLATE AVENUE P. O. BOX 437 HERSHEY, PENNSYLVANIA 17033-0437 JON A. YOST JOHN S. DAVIDSON TELEPHONE 717-533-5101 FAX 717-534-1293 January 17, 2002 Office of Register of Wills CUMBERLAND COUNTY COURTHOUSE One Courthouse Square Carlisle, P A 17013 RE: Estate ofM. Doris Fry File No. 21-2001-1063 Dear Ms. Lewis: I enclose the original and two copies of the inheritance tax return for the referenced estate together with a check in the amount of$I,417.42 in payment of inheritance tax and a check in the amount of$15.00 in payment of the filing fee. Please return a time-stamped copy of the inheritance tax return together with your receipts to me in the self-addressed, stamped envelope which is provided. Thank you. Very truly yours, YOST & DAVIDSON J(t:.:~ JSD/rIh Enclosures an .,... ........ == (t~ f';:'~ ~ ~ ~? L :;:::::. z N N ;l ;.:,' IJ ':..f1 co :I:; tTl :;.::l c;n ~ ld.-. :< ~ ~ ~ ~ ~ Z:'tl(") "'" ZOx "I' ~~~ ~ ~~!; ~ ~~'-I <: Z m_ ;; ~ 0 mCll ~ ~ ~ v.> ~ v.> -.l f ~ ~ DO J;;a; g.r ~':..." d '" :JJi' (D CJ :,"1- ::~ ",Ii ~ ~ -0 W N ~ ," fu ("")0("")0 Q):::lC-t, ""'S(l)3:-t, ---I CD ...... -'. ("") I"T'1 (") III 0 ;;0 (l) --'s:::, (l)""'S>0 .. c+:z:-t, ::TO "'00 ;;0 >S:::("")(l) III 0 1.0 (l) C-'. ....... :z: III '-lVl-ic+ 0.0 -< (l) ....... s::: ""'S WQ)("") ""'S 00 (l)C-t, ;;0 -i:::E: ::t: -' . 0--' C --' VI III I"T'1 ,,::" ,., .':,;: )S', ;~:,.'! o ...... ~ ." -. i 0 - S>> NO-'...... It en !.NOON co 00'0 * en J:o....... ~ '" It 3: ~ OUNlt!o ~N~' r~lil S>> -. ~ ;;O~l~. - ~ ; ~III !.Nee Vol 'v /7-02..2-'? BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX RfJC\.. DATE ESTATE OF DATE OF DEATH P 2 :1 SFILE NUMBER COUNTY ACN .02 MAR 1 8 JOHN S DAVIDSON YOST & DAVIDSON PO BOX 437 HERSHEY GEil Gllfnb-,;. PA 17033-1183 03-11-2002 FRY 10-30-2001 21 01-1063 CUMBERLAND 101 Allount Relli tted '* REV-1541 EX AF' 101-021 M D 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--foY=02Y-NCfficE--OF-YNHEififAifcE-"-Ai-APPRAisEitENT~--ALrowAifcE-oR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF FRY M D FILE NO. 21 01-1063 ACN 101 DATE 03-11-2002 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: IS. Allount of Line 14 at Spousal rate (IS) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due C ITS: TAX RETURN WAS: (X) ACCEPTED AS FILED 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) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets NOTE: + INTEREST/PEN PAID (-) 74.60 DATE 01-18-2002 NUMBER CDooo776 · IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ) CHANGED (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 41, 084.34 .00 .00 (8) (19)= NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 41,084.34 7.928 44 33,155.90 .00 33,155.90 .00 1,492.02 .00 .00 1,492.02 1,492.02 .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.) (9) (10) 7,184.00 744.44 (11) (12) (13) (14) .00 33,155.90 .00 .00 X 00 = X 045 = X 12 = X 15 = AMOUNT PAID 1,417.42 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ~v/ PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: M. Doris Fry Date of Death October 30.2001 Will No.: 2001-01063 Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the above-mentioned 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 1S: C. Did the personal representative state an account informally to the parties in interest? Yes X No D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: Yh ~ I 7~ ::l G d "2... ~ >> fW\.tlu- Sfg9ature ['-- ;'~I John S. Davidson. Esquire Name (Please type or print) ;~" 1..,,'._.. o ("l ~ ;:? 320 West Chocolate Ave.. P.O. Box 437. Hershey. PA 17033 Address ('.J p _c .,I~ :: ..."'1.,.... --' \-....;. (717) 533-5101 Telephone No. (MAH:rmtJ AM3) Capacity: Personal Representative RW. -27 X Counsel for Personal Representative