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Home My WebLink About01-1095 PETITION FOR PROBATE and GRANT OF LETTERS Estate of. Bertha Froiland Williams also known as Bertha F. Williams No. To: 21-01-1095 Register of Wills for the 1 Deceased. County of Cumberland in the Social Security No. 186-01-7079 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut nr~ in the last will of the above decedent, dated Fp.hn Jr:try 1? and codicil(s) dated May 29, 2001 named , ~--2OOl (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cunberland h er last family or principal residence at Decendent, then 92 years of age, died November 22 ,,H} J001 at Haneland Center. 1901 N. 5th Strpp.t, Hr:trr;~h1Jrg, FA Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: 33 Center Drive, Lower Allen $ 50,000.00 $ $ $ 111,000.00 Township WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentm:y (testamentary; administration c.La.; administration d.b.n.c.t.a.) theron. V) '-' CI) u s:: CI) ~ --- .~~ CI) .... ~:g ~o C.w C'CSo= 3~ C1)<+-< ;:; 0 ~ s:: OIl Ci3 ~ ~"-\J Lynn Ru en all - 801 Old Rossville Rd. Lewisberrv, FA 17339 ~~~~ -- . . Box 765 Dal.1Phin, PA 1701 R OATH OF. PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ss COUNTY OF CUMBERLAND J Sworn to or affirmed and subscribed before me this 30th day of NOV~ ~ 2001 '7~v./ . W~h~/lr ~~ / Reg ter 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. ~~~~~~~~~~~ { ,-,~ <:'\..C'-. ~,-,-~eC'\~~" \ ~-tk~z-< Do uG L-ft-S ~!'iSA LL- VJ ~. ::s E:l ..... :.:: ~ ~ 17-~-Y- 7 ~o. 21-01-1095 Estate of BERTHA FROILAND WILLIAMS , Deceased DECREE OF PROBATE A~D GRA~T OF LETTERS AND NOW NOVEMBER 30 ~ 2001 in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated February 12, 2001: Codicil dated May 29, 2001 described therein be admitted to probate and filed of record as the last will of Bertha Froiland Williams, a/k/ a Bertha F. Williams and Letters Testamentary are hereby granted to Lynn Rubendall and Douqlas Bonsall >7~1{Jri:o~m//lL/ ~"7 ster of Ills - . FEES $ 235.00 $ 21.00 $ 18,00 $ 10.50 :>.uO TOTAL _ $ 229 50 Filed .NOV... .30,. ZQO l. . . . . . . . . . . . . . . . . . . Bridqet M. Whitley (#33580) AITORNEY (Sup. Ct. I.D. No.) Probate, Letters, Etc. ......... Short Certificates(7 ) . . . . . . . . . . Re88-.R:1Gtion ................ CODICIL JCP P.O. Box 11963, Harrisburg, PA 17108-1963 ADDRESS (717) 255-8027 PHONE ~~~~ on ,. """'..... -~ 3~ cr~ ro I, .: -.., 5,~ :~,~,'~ . ()." i d - :D~ ('1)0 <00 --...... <.no ;~T t~ L~... ~ UJ o ~ :;::::. \0 (,j U1 .;':~:_:;I..") ::'::::::(1,:': (J.j () ...... \ H10".80'i ~~~;()is to certify that the information here given is correctly copied from an original certificate of death dul~ filed with \me as Local Registrar. The original certificate will be forwarded' to the State Vital Records Office for permanent filmg. \ \ WARNING: It is illegal to duplicate this copy by photostat or photograph" Fee for this certificate, $2.00 p 7884753 No. 21-01-1095 ~Lo~e;:f~IrL- NOV 2 4 2001 Date .143 Rtw. 2187 COMMONWEALTH OF PENNSYLVANJA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH NAME OF DECEDeNT (F... Middle. L->> 1. Bertha F . AGE (1.asI ~ UNDER 1 VEAA Monb o.y. sex a.female Williams SWE FIlE NUMlJER SOCIAL seCURITY NUMBER 186- 01 DATE OF DEATH iMonlh. Day, ._) }I0V. 22, 2001 - 7079 UNDER 1 ow Hourw ! .... 3. 8lflTHP\.ACE (CiIy aAd PI.ACIi OF DEATH CChecI< oroIy one - _ ontIruclJOnS on 0Ihet .. Iii or Foreogll C'1tt HOSPITAL; OTHEll: P ummer, nn. InpeIient 0 EFI/OulpMienI D DOA D :::::e tJ ~)D Did ~ IiYe in a -...;p? 17dID ~-===of Hll.rrlRbu'rg MOTHER'S NAME (Fnl.loAiddIe. Maiden Surnamel 1 . da Erickson IN~'S~mSS~~~.~~1 17018 PLACE OF DISPOSITION . Nama of~ CtemalOly LOCR'ION. Cily/1llwn. SIaIa. Zip Coda or OIlIer PIKe Harrisburg Homeland Center Ie. ... KIND OF BUSINES8nNDUSTRY .. Dauphin DECEDENT'S USUALOCCUMION (Give Idnd of WClfl< Ollne UIllQ moll ftrg;e~~r---I Medical . 11 11b. DECEDENT'S MAILING ADDAESS (SIr.... Cily~, Stale. ZopCodaI :3:3 Center Dr. Camp HIll, Pa. 17011 1L !'RHER'S NAME (F...1. Middle. LaslI lL John FroIland INFORMANTS~(T~ .d;nougl.as A. liOnsa1l METltOO OF DISfIOSl1l2ti. . ~ c-ion 0 AeoMvIIIIroll'I StaleD DonaIion 0 OIlIer . 1L DECEDENT'S EDUCAI'ION ~DECEDENT eVER IN U.S. ARMeD FOACES? ...0 NoXJ ~ 1:1. Care DECEDENT'S ACTUAL RESIDENCE (See~ on 0Ihet IIdeI 12. 17a. SIaIe Pa. 1 lb. E DUE 10 (OR AS A CONSEQUENCE OF): WERE AU10PSY FINDINGS MUlA8lE PAIOR 10 COMPLET1ON OF CAUSE OF DEATH? DATE OF INJURY (1ioIonIh, Day, 'Illarl MANNER OF DEATH ~ D o College (1.401'5+1 UAflITAL STRlJS . w.rted N.- Uan*I. WIdowed. wI~er' 14. 17c.0 .... cIIcecIInlllvecllro RACE . Amenc:an Indian. IlIack. WIllIe. .. (Spayl 1.. Whl te SUlMVING SPOUSE eN...... gMllNlld8n nama) ~-€C Cumbo Co. Inc: Nol!9 PAIlT R: 0IIIar IigniIIcanl aNIdIIiana CllllItibuIInQ III dMIh. bul not.-ulllng in the undarIP'll- ~ in PART I. hIT II/. AhP~ /4 O-f t'w~/-h' {!'t'lJ""t:IY11 (. L.:;~ /I" .II I '~ I~ I TIME OF INJURY INJURY R WORl<1 DESCRIBE HOW INJURY OCCURRED. ....... -- Pending ~igaIIon D o D PLACE OF INJURY. AI home, farm. str_.lactllly. oIIIce buiIcIng, etc. (5peclIy1 :lOa. 3N. LOCRlON (SIr.. CilyIlOwn. SlaIe) - ...0 NoD Suidde Could not ba delenninad 21. 2IlI. CERTIFIER (Check only oneI "CEJn'1FVING PHYSICIAN (PhylEllln cartIyIng cauM 01_ -. anolhef physic.... has pronounced dea'" and complele<l Hem 23) To"'_oI",y~.da""__"''''caueeCsl_ma........_... ........... ............. ........ .... .............. "PRONOIINClNQ AND CERTIFYING PHYSICIAN (PhySicIan bolh pronounc"'ll dealh and c:e<1lIyIno to cause 01 dealh) To ..._of....,~. __ a'''' _. da... _ pIKe,.nd d...lo lhec:aUM(sl_ ...._r.....'........................... .. OIlEDlCAL EXAIIIHERICORONER On the buIs of uMllNtlon lIIldIor Innlllgallon. In my opinion. detdh occurred II Ihe lime, dlle, II1d place, and due 10 lhe ceuM(llend _ner.. alated.. . . . . . .. . . . . . ... . . . . . . .. . . . . . . .. . .. . . . . . . . . . . . . . . ... . . . . . . . . . . . .. . . . . . . . . .. . . .. .. .. . . . . .. . . . . . .. . 31.. REGISTRAR'S SIGNATURE AND NUMBER ~ ~ ~ 12r/1~/1 t1 ... D NoD M. *. :lOt. SlGNATUAE~LEOFCEAnF~ 7 o 3111. //~ I- ~ I/a~ tf(;(/lL) ~ ~:NSEO~O ~t:.u; SV L I:Ai;~J~\U) ;).cK;/ NAME AND ADORESS OF PERSON WHO COMPlETED CAUSE OF DEATH (hem21)TypaOlPrinll//b~y-1 J ~ql;fe#1 . /)01 emo D ItvJ.H,/<,,,,J~ )r7vrh""~ I~#.", e 32. fllfJ;", / 6 L' ~ y L.If :~EALED;~:;01 90 ::~ ~~ t1 1." ~~li'",; c. (1 C d ~ , 'c$ j; .,:::'I '" ~ :g ~~ (~ 0 Zir p. r"" C"> ~ c':.- 9_ ':~fl ~' ;;,~ ~<i:" -::;::. (/)9... ,. 21-01-1095 LAST WILL AND TESTAMENT OF BERTHA FROTT.AND WTT,T,TAMS I, BERTHA FROILAND WILLIAMS, residing at 33 Center Drive, Camp Hill, Pennsylvania, which I declare to be my domicile, do hereby make, publish and declare this to be my Last Will and Testament, and declare further that the terms of this my Last Will and Testament express my uncoerced and deeply felt wishes. FIRST: I hereby revoke all Wills, Codicils thereto or other testamentary instruments by me at any time heretofore made, regardless of where the same were so made or may now be situated, with the same efficacy as though the said Wills, Codicils thereto, or other testamentary instruments had never been made. SECOND: I hereby direct that all my legally enforceable debts and the legitimate and proper expenses incurred in the administration of my estate be paid as soon after my death as may be practicable. THTRD: I have prepared a list of personal property items designated "Bequests to Friends and Loved Ones." If this list should exist at the time of my death and if the items so listed remain in my possession at that time, I direct my Executors to distribute the items noted thereon to those individuals shown on the list who survive me. Any such item that cannot be , ",,/ ((-J:-1- i1M,J~,~/ I i. . , , ' ,,' / tel /~,{ [.L-tC/Y14/ - 1 - distributed shall be added to my Residuary Estate and disposed of as set forth below. FOURTH: All the rest, residue and remainder of the property, both real and personal and wherever situated, which I may own, or to which I may be entitled at the time of my death, is hereinafter called my "Residuary Estate," and shall be sold as soon as practicable. I direct my Executors to payout of my Residuary Estate, which is disposed of in paragraph "FIFTH" of this Will, but prior to any of the dispositions thereunder, all estate or inheritance taxes, or succession duties assessed by the United States, or by any state thereof, that shall be predicated upon my death as the taxable event, provided however, that no tax shall be paid out of or apportioned to any share passing to a charitable beneficiary, including the Messiah Lutheran Church. FIFTH: I give, devise, and bequeath my Residuary Estate as follows: a. I leave the sum of Five Thousand Dollars ($5,000) to my church, Messiah Lutheran Church, Commonwealth and Forster Streets, Harrisburg, Pennsylvania. b. I leave the remainder of my Residuary Estate, in equal shares, to my brother, J. Arthur Froiland of I.:?-r- f C)i / I':J.J' ,/:_) e!7/{~itt,. ~ -7 /, ,,- -l j /~~/ {(d:4;'~-!-.J - 2 - Plummer, Minnesota and my sister-in-law, Reba Schmidt of Phoenix, Arizona. c. If my brother, J. Arthur Froiland, shall fail to survive me for at least thirty (30) days, his share shall be paid to my church, Messiah Lutheran Church of Harrisburg, Pennsylvania. d. If my sister-in-law, Reba Schmidt, shall fail to survive me for at least thirty (30) days, her share shall be divided equally between her two daughters, Janet Smith (Mrs. Steve Smith) of Phoenix, Arizona and Virginia DeSantis of Phoenix, Arizona. SIXTH: A. I nominate and appoint my friends, DORIS MOWREY of Lemoyne, Pennsylvania, LYNN RUBENDALL of Lewisberry, Pennsylvania, and JEAN WHERLEY of Camp Hill, Pennsylvania, as Executors of this, my Last Will and Testament. If one or more of them shall fail to survive me, shall decline to act, or having qualified shall, for any reason thereafter, cease to act, then I appoint the one or two remaining to serve in her or their place and stead. [Space left intentionally blank.] t1 g::tf" / / :. ' ""') "/ /? . / / .' , ,j/ 'iZ '~/' ~/LAut, //1/ ,4,it:~..y/ - 3 - B. I direct that no bond or other security shall be required of my Executor(s) for the faithful performance of her or their duties. IN WITNESS WHEREOF, I sign, seal, publish and declqre this d. /7 ~- instrument as my Last Will and Testament on this J~;L day of February 2001. ~ -r71' .l j, /;'J (' ,',' ~"""/7,;1 . ? ~ "a/ <:__~j~> /1r;tV ': / JLtI-tA:ct:J ZLI/'L_L,' .(<:L?Yt . , BERTHA FROILAND WILLIAMS SIGNED, SEALED, PUBLISHED and DECLARED by Bertha Froiland Williams as and for her last will and testament, on the day and year last above written, in the presence of us, who, at this request, in her presence, and in the presence of each other, all being present at the same time, have hereunto subscribed 0 names as witnesses: ~v~ (JIM 1);. .~u/ - 4 - SELF-PROVING AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ~ur....b~ ~ SS. COUNTY OF ~^tH IIIN WE, BERTHA FROILAND WILLIAMS and Stefanie A. Morrison Patricia D. Olyarnik , and LindaM. Gutshall , the testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will and testament and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as witness and to the best of his or her knowledge the testatrix was at that time eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence. Witness ~~r- ")- ~L- ~SS. ~MIJt.~~ Witness Subscribed, sworn to, and acknowledged before me Froiland Williams, the testatrix, and subscribed before me by Stefanie A. Morrison Patricia D. Olyarnik , and Linda M. Gutshall witnesses, this 12th day of February 2001. by Bertha and sworn to , the ~ - 5 - NOTARIAL SEAL CYNTHIA J. RULE, Notary Public Camp Hi" Boro., Cumberland County M Commission _Expir~s Jan. 24, 2004 r;~ .-:--- CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Bertha Froiland Williams Date of Death: November 22, 2001 Admin. No.: 21-01-1095 To the Register: I certify that notice of estate administration required by Rule 5.6 of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above- captioned estate on December 6. 2001 : J. Arthur Froiland, P.O. Box 205, Plummer, MN 56748 Mrs. Reba Schmidt, 2544 N. Foote Drive, Phoenix, AZ 85008 Messiah Lutheran Church, 901 N. 6th Street, Harrisburg, PA 17102 Notice has now been given to all persons entitled thereto under Rule 5.6(a). Date: December 6, 2001 4u71('.~ BridgZ Whitley, Esq. Keefer Wood Allen & Rahal, LLP P.O. Box 11963 Harrisburg, PA 17108-1963 Capacity: Counsel for Personal Representatives Vd tv r;>:J!... It:lqU.'fl*'' ~J'----'_._~_.i",",,' v )~J11a!~ BZ: U\t L - 310 10. nSllr~;,. . _., ,u:ns!oaij Ju ~Jy',,-i( ,-osnIO.........u ..;..../, t"'" WOC] s ~ IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's will. If the decedent died without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND PENNSYL V ANIA In re Estate of Bertha Froiland Williams, deceased, TO: J. Arthur Froiland P.O. Box 205 Plummer, MN 56748 Please take notice of the death of decedent and the grant of letters to the personal representatives named below. The Decedent, Bertha Froiland Williams, died on the 22nd day of November, 2001, in Harrisburg, Dauphin County, Pennsylvania. The Decedent died testate (with a Will). The personal representatives of the Decedent are Lynn Rubendall, 801 Old Rossville Road, Lewisberry, PA 17339, (717) 938-9950; and Douglas Bonsall, P.O. Box 765, Dauphin, PA 17018, (717) 921-1957. The Will has been filed with the Office of the Register of Wills of Cumberland County, 1 Courthouse Square, Carlisle, P A 17013-3387. Phone number (717) 240-6345. A copy of the Will may be obtained by contacting the Register of Wills and paying the charges for duplication. ;L~ JJf. dfI.;:t Bridget M. Whitley, ESq.~ Keefer Wood Allen & Rahal, LLP P.O. Box 11963, Harrisburg, PA 17108 Telephone (717) 244-8027 Date: December 6, 2001 Capacity: Counsel to Personal Representatives IMPORTANT NOTICE NOTICE OF EST ATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's will. If the decedent died without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND PENNSYLVANIA In re Estate of Bertha Froiland Williams, deceased, TO: Mrs. Reba Schmidt 2544 N. Foote Drive Phoenix, AZ 85008 Please take notice of the death of decedent and the grant of letters to the personal representatives named below. The Decedent, Bertha Froiland Williams, died on the 22nd day of November, 2001, in Harrisburg, Dauphin County, Pennsylvania. The Decedent died testate (with a Will). The personal representatives of the Decedent are LYnn Rubendall, 801 Old Rossville Road, Lewisberry, PA 17339, (717) 938-9950; and Douglas Bonsall, P.O. Box 765, Dauphin, PA 17018, (717) 921-1957. The Will has been filed with the Office of the Register of Wills of Cumberland County, 1 Courthouse Square, Carlisle, P A 17013-3387. Phone number (717) 240-6345. A copy of the Will may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: December 6, 2001 A'~d- '>1(. ~ Bridget M. Whitley, Esq. Keefer Wood Allen & Rahal, LLP P.O. Box 11963, Harrisburg, PA 17108 Telephone (717) 244-8027 Capacity: Counsel to Personal Representatives IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's will. If the decedent died without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND PENNSYL VANIA In re Estate of Bertha Froiland Williams, deceased, TO: Messiah Lutheran Church 901 N. 6th Street Harrisburg, PAl 71 02 Please take notice of the death of decedent and the grant of letters to the personal representati ves named below. The Decedent, Bertha Froiland Williams, died on the 22nd day of November, 2001, in Harrisburg, Dauphin County, Pennsylvania. The Decedent died testate (with a Will). The personal representatives of the Decedent are LYnn Rubendall, 801 Old Rossville Road, Lewisberry, PA 17339, (717) 938-9950; and Douglas Bonsall, P.O. Box 765, Dauphin, PA 17018, (717) 921-1957. The Will has been filed with the Office of the Register of Wills of Cumberland County, I Courthouse Square, Carlisle, P A 17013-3387. Phone number (717) 240-6345. A copy of the Will may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: December 6,2001 ~~ YJt.~ Bridget . Whitley, Esq. Keefer Wood Allen & Rahal, LLP P.O. Box 11963, Harrisburg, PA 17108 Telephone (717) 244-8027 Capacity: Counsel to Personal Representatives ... SOLE CODICIL OF BERTHA FROILAND WILLIAMS 21-01-1095 I, Bertha Froiland Williams, of 33 Center Drive, Camp Hill, Cumberland County, Pennsylvania, do hereby declare this to be the Sole Codicil to my Last Will and Testament, dated February 12, 2001: 1. I hereby delete Paragraph SIXTH of my aforesaid Last Will and Testament, dated February 12,2001, in its entirety. 2. I hereby replace the provision noted in paragraph 1 above with the following prOVIsIon: SIXTH: A. I nominate and appoint my friends, LYNN RUBENDALL of Lewisberry, Pennsylvania and DOUGLAS BONSALL of Dauphin, Pennsylvania, as Executors of this, my Last Will and Testament. If one of them shall fail to survive me, shall decline to act, or having qualified shall, for any reason thereafter, cease to act, then I appoint the one remaining to serve alone. B. I direct that no bond or other security shall be required of my Executor(s) for the faithful performance of their or his or her duties. 3. In all other respects, I hereby ratify, confirm and republish the provisions of my aforesaid Last Will and Testament, dated February 12,2001, together with this Sole Codicil, as and for my Last Will and Testament. IN WITNESS WHEREOF, I have set my hand and seal on this my Sole Codicil to my Last Will and Testament, dated February 12, 2001, this ~ '7 day of May 2001. 11 ?h J J-...' , -? " ' .I '; ;.' ~/~,{1L4/ (' ;w~~.l. J[/L-?[l_JC~J BERTHA FROILAND WILLIAMS SIGNED, SEALED, PUBLISHED, and DECLARED by BERTHA FROILAND WILLIAMS as and for the Sole Codicil to her Last Will and Testament, dated February 12, 2001, on the day and year last above written, in the presence of us, who, at her request, in her presence, and in the presence of each other, all being present at the same time, have hereunto subscribed our names as witnesses: ff-~' &;~r f4Jd r1 ~-L' cY~ jjJ~o/ ..,. . " SELF-PROVING AFFIDAVIT COMMONWEAL TH OF PENNSYL VANIA SS, COUNTY OF CUMBERLAND I, Bertha Froiland Williams, the Testatrix and CC('1 10, s.vl'J)6J~ Eli 1:ct ~ t:h ::!. ~ Idskl~ , and L I #oI~ A ~ Gc./rs h~ // , the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Sole Codicil to her Last Will and Testament dated February 12, 2001, and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Sole Codicil as witness and to the best of his or her knowledge the Testatrix was at that time eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence, a '-39'. )'7 /~j)( /7dA/ 0 I>Ad4-<~ It/ 11tL~~. . Bertha Froiland Williams, Testatrix ~~. &;rd-QV- 1 ness ~.i4 /~ Witne ~~Ju.~p Witness Subscribed, sworn to, and acknowledged before me by Bertha Froiland Williams, the Testatrix, and subscribed and sworn to before me by Q~ G b Si.V ~ ~ [ 'I LcJ~ J Go ls:.f E~ , and ~/ Vv\ G..-:t ~ ! witnesses, this (~q+1-. day of May 2001. /~- o ARtAL SEAL CYNTHIA J. RULE, Notary Public Camp Hilt Boro., Cumberland County mmis$ion EXpll8S Jan. 24, 2004 IN THE MATTER OF THE ESTATE OF BERTHA F. WILLIAMS, DECEASED IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-01-1095 FAMILY SETTLEMENT AGREEMENT THIS AGREEMENT, made this 12th day of November, 2002. WITNESSETH: THE CIRCUMSTANCES leading up to the execution of this Agreement are as follows: 1. Bertha F. Williams (the "Decedent") died testate on November 22, 2001, and Lynn Rubendall and Douglas Bonsall duly qualified as Co-Executors (the "Executors") of her probate Estate (the "Estate"). 2. Item FIFTH of the Decedent's Last Will and Testament, dated February 12, 2001 (the "WillI!) provides a payment of Five Thousand Dollars ($5,000) from the residue of the Estate to Messiah Lutheran Church. 3. Shortly after the Decedent's death, the Executors distributed the sum of Five Thousand Dollars ($5,000) to Messiah Lutheran Church, in satisfaction of its rights under Item FIFTH of the Will. 4. Item FIFTH of the Will further provides for the equal division and distribution of the remainder of the residue of the Estate to the Decedent's brother, J. Arthur Froiland, and sister-in-law, Reba Schmidt (the "Beneficiaries"). 5. During the administration of the Estate, J. Arthur Froiland died, and Richard Froiland duly qualified as personal representative of his estate. 6. The Beneficiaries desire the Executors to settle the Estate informally in order to avoid the expense and delay involved with the formal adjudication of a First and Final Account by the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania (the "Court"). 7. The Beneficiaries desire to forever settle and compromise any and all claims and rights which they may possess, now or hereafter, in the Estate and to confirm their acceptance of the Informal Account (the "Account"), attached hereto as Exhibit "A" and incorporated herein by this reference. 8. The Beneficiaries wish to release the Executors and to indemnify them against any and all claims that may be asserted against the Estate or the Executors after the date hereof. 9. The Executors are willing to settle the Estate informally in consideration of the indemnifications hereinafter provided by the Beneficiaries. NOW THEREFORE, in consideration of the foregoing and intending to be legally bound, jointly and severally, the Beneficiaries, for themselves, their heirs, personal representatives, successors and assigns: 1. Represent and warrant that they have read and understand this Agreement and confirm that the facts set forth above are true and correct, to the best of their knowledge, information and belief. 2. Declare that they have sufficient information to make an informed waiver of their right to a formal accounting with the Court, and do hereby waive the filing and auditing of the same. 3. Acknowledge that the distributive share or amount as set forth in the informal account shall be in full satisfaction of their respective entitlements under the Will. 4. Release, remise, quitclaim and forever discharge the Executors, their heirs, personal representatives, successors and assigns, from and against all claims that they had, now have or may in the future have in connection with the Estate. 5. Agree to refund, on demand, all or any part of any aforesaid distribution, which has been determined by the Executors, or by the Court, or by any court of competent jurisdiction, to have been improperly made. 6. Agree to indemnify and hold harmless the Executors, their heirs, personal representatives, successors and assigns, from and against any and all claims, loss, liability or damage (whether or not related to the negligence of the Executors) that may hereafter be asserted against the Estate or against the Executors. 7. Agree to execute such other or additional documents as may be necessary to effectuate the agreements set forth herein. 8. Acknowledge that this Agreement shall be governed by and construed in accordance with the laws of the Commonwealth of Pennsylvania. 9. Consent to the Court exercising personal jurisdiction over them in any suit or action arising out of the enforcement of this Agreement. IN WITNESS WHEREOF, the Beneficiaries have placed their hands and seals on the attached Consents to Estate Settlement Agreement. CONSENT TO ESTATE SETTLEMENT AGREEMENT AND RECEIPT FOR DISTRIBUTION I, Reba Schmdit, hereby consent to and join in the Estate Settlement Agreement relating to the Estate of Bertha F. Williams, deceased, a copy of which Estate Settlement Agreement, including exhibits, has been provided to me. / ) - ~h; Jc~~~ Reba Schmdit STATE OF ARIZONA COUNTY OF U.~tWPA SS. 6ffiCIAL SEAL MARCO A. ZAZUETA ~ \.. ':".. NOTARY PUBLIC-ARIZONA ~ .' ~ MARICOPA COUNTY · My Comm. Expires Nov. 30, 2003 On this, the \ Z-~ of ~, 2002, before me, the undersigned officer, personally appeared Reba Schmidt, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same in the capacities and for the purposes therein contained. IN WITNESS WHEREOF, I hereunder set my hand an CONSENT TO ESTATE SETTLEMENT AGREEMENT AND RECEIPT FOR DISTRIBUTION I, Richard Froiland, in my capacity as personal representative of the Estate of J. Arthur Froiland, hereby consent to and join in the Estate Settle- ment Agreement relating to the Estate of Bertha F. Williams, deceased, a copy of which Estate Settlement Agreement, including exhibits, has been provided to me. k:-~~ Richard Froiland Personal Representative Estate of J. Arthur Froiland STATE OF MINNESOTA SS. COUNTY OF On this, the 14th day of November , 2002, before me, the undersigned officerJ personally appeared Richard Froiland: known to me (or satisfactorily proven) to be the Personal Representative of the Estate of J. Arthur Froiland and the person whose name is subscribed to the within instrument, and acknowledged that he executed the same in the capacity and for the purposes therein contained. IN WITNESS WHEREOF, I hereunder set my hand and official seal. .J{Q/1J4li of. d!7 Notary Pub ic .. If?Ao;~\ KAREN l. LOi>M3TfN ~e NOTARY PUBue-MiNNESOTA ~... MY COMM. EXP. JAN. 31, 2005 SUMMARY OF ACCOUNT Estate of Bertha F Williams For Period 11/22/2001 Through 10/30/2002 Principal Receipts Net Gain (or Loss) on Sales or Other Dispositions Other Receipts Less Disbursements: Accrued Liabilities Administration Expenses (prin) Fees and Commissions (prin) Funeral Expenses (prin) Inheritance Tax Other Expenses (prin) Balance before Distributions Distributions to Beneficiaries principal Balance on Hand For Information: Changes in Investment Holdings Income Receipts Less Disbursements Balance before Distributions Distributions to Beneficiaries Income Balance on Hand Combined Balance on Hand EmorT A Page 1 2 3-4 4 4-5 5 5 5 $ 3,560.09 541.90 18,318.97 7,507.00 13,855.49 17.97 6-7 8-10 11 12 Fiduciary Acquisition Value $142,560.98 13.30 0.00 $142,574.28 43,801.42 $ 98,772.86 98,772.86 $ 0.00 $ 14.16 0.00 $ 14.16 14.16 $ 0.00 $ 0.00 RECEIPTS OF PRINCIPAL Estate of Bertha F Williams As of 10/30/2002 Assets Listed in Inventory (Valued as of date of death) Cash on Hand Cash on hand Checking Accounts Mellon Bank Checking Account Savings Accounts MONY Savings Account $14.51 Accrued Interest Mellon Bank Savings Account $0.74 Accrued Interest Common Stocks K mart 378 Units MONY Group, Inc. 7 Units Household Goods & Furnishings Household goods and furnishings Misc. Personal Property Automobile Button Collection Miscellaneous Property Contract for sale of real estate Refunds AT & T (telephone equip.) Donegal Mutual Insurance TOTAL INVENTORY $ 3,234.21 5,683.16 $ 2,547.72 217.67 $ 820.00 12,894.00 $ 7.01 55.00 'Page 1 Fiduciary Acquisition Value $ 58.42 2,764.29 8,917.37 2,765.39 11,525.74 13,714.00 102,753.76 62.01 $142,560.98 G~INS AND LOSSES ON SALES OR OTHER DISPOSITIONS Estate of Bertha F Williams For Period 11/22/2001 Through 10/30/2002 01/14/2002 Sale of MONY Group, Inc. 7 Units Net Proceeds Fiduciary Acquisition Value $ 230.97 217.67 Net Gain $ Net Gain $ .Page 2 Gain Loss 13.30 13.30 DISBURSEMENTS OF PRINCIPAL Estate of Bertha F Williams For Period 11/22/2001 Through 10/30/2002 Accrued Liabilities AT & T 12/28/2001 AT & T Check number 101 Charles Furrier 07/22/2002 Charles Furrier Check number 117 Community Life Team Ambulance 05/03/2002 Community Life Team Ambulance Check number 115 Heritage Cardiology Associates 05/13/2002 Heritage Cardiology Associates Check number 116 Holy Spirit Hospital 12/28/2001 Holy Spirit Hospital Check number 102 Homeland Center 12/14/2001 Homeland Center Check number 92 Homeland Center (2) 01/25/2002 Homeland Center Check number 106 Keefer Wood Allen & Rahal 01/25/2002 Keefer Wood Allen & Rahal, LLP Pre-mortem legal services Check number 108 Oakwood Center Radiation Oncology 01/07/2002 Oakwood Center Radiation Oncology Check number 104 -Page 3 $ 25.01 130.00 68.82 2.05 644.98 1,183.44 24.15 500.00 574.71 DISBURSEMENTS OF PRINCIPAL Estate of Bertha F Williams For Period 11/22/2001 Through 10/30/2002 PP & L Electric Utilities 12/14/2001 PP & L Electric Utilities Check number 100 Penna American Water Company 12/14/2001 Penna. American Water Company Check number 99 Rhoads Pharmacy 12/14/2001 Rhoads Pharmacy Check number 95 Susquehanna Surgeons, Ltd. 02/21/2002 Susquehanna Surgeons, Ltd. Check number 114 Verizon 12/14/2001 Verizon (Check was for $22.49, but $13.41 was refunded by the company on 1/14/02) Check number 96 Administration Expenses (prin) 12/06/2001 PennDOT - fee for duplicate title Check number 91 12/14/2001 Special Services Unlimited: fee to clean house and remove trash Check number 98 01/05/2002 Lynn Rubendall - reimbursement for out-of-pocket expenses Check number 103 01/25/2002 Postmaster - LemoYne (postage) Check number 105 Fees and Commissions (prin) 08/14/2002 Keefer Wood Allen & Rahal, LLP Attorney fees and disbursements Check number 118 $ 22.50 406.00 99.80 13.60 $ 5,701.66 'Page 4 $ 26.50 24.88 240.79 105.69 9.07 541.90 DISBURSEMENTS OF PRINCIPAL Estate of Bertha F Williams For Period 11/22/2001 Through 10/30/2002 08/14/2002 Lynn Rubendall - Executor fee Check number 120 08/14/2002 Douglas Bonsall - Executor fee Check number 121 10/17/2002 Keefer Wood Allen & Rahal, LLP Attorney fees and disbursements Check number 124 Funeral Expenses (prin) 12/14/2001 Musselman Funeral Home Check number 93 12/14/2001 Rolling Green Cemetery (check amount was $1,600, but $125 was refunded on 12/31/01) Check number 97 Inheritance Tax 02/14/2002 Register of Wills, Agent Penna. Inheritance Tax pre-payment Check number 110 08/15/2002 Register of Wills, Agent for payment of Pennsylvania Inheritance Tax Check number 119 Other Expenses (prin) 02/14/2002 AT & T Check number 109 TOTAL DISBURSEMENTS OF PRINCIPAL $ 5,000.00 5,000.00 2,617.31 $ 6,032.00 1,475.00 $ 12,500.00 1,355.49 .Page 5 $ 18,318.97 7,507.00 13,855.49 17.97 $ 43,801.42 -DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES Estate of Bertha F Williams For Period 11/22/2001 Through 10/30/2002 To: J. Arthur Froiland Partial Distribution of Residue 02/14/2002 Estate checking account Check number 111 02/25/2002 K mart 189 Units Balance before distribution $2,547.72 08/14/2002 Estate checking account Check number 122 To: J. Arthur Froiland Final distribution of residue 10/30/2002 The beneficiary received a 50% interest in the estate's residue, representing a portion of the following assets: Cash Less: Undistributed income Total for J. Arthur Froiland To: Reba Schmidt Partial Distribution of Residue 02/14/2002 Estate checking account Check number 113 02/25/2002 K mart 189 Units 08/14/2002 Estate checking account Check number 123 To: Reba Schmidt Final distribution of residue $ 40,000.00 1,273.86 5,000.00 619.65 -7.08 40,000.00 1,273.86 5,000.00 .Page 6 $ 46,886.43 -DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES Estate of Bertha F Williams For Period 11/22/2001 Through 10/30/2002 10/30/2002 The beneficiary received a 50% interest in the estate's residue, representing a portion of the following assets: Cash $ Less: Undistributed income Total for Reba Schmidt To: Messiah Lutheran Church Partial Distribution of Residue 02/14/2002 Estate checking account Check number 112 TOTAL DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES 619.65 -7.08 .Page 7 $ 46,886.43 5,000.00 $ 98,772.86 INFORMATION SCHEDULES Estate of Bertha F Williams For Period 11/22/2001 Through 10/30/2002 Changes in Investment Holdings MONY Group, Inc. 01/14/2002 Sale of MONY Group, Inc. 7 Units Automobile 01/14/2002 Sale of automobile Button Collection 08/14/2002 Sale of Button Collection Household goods and furnishings 12/28/2001 Collection of asset: sale of household goods and furnishings 02/04/2002 Collection of asset: sale of household goods and furnishings AT & T (telephone equip.) $ 02/04/2002 Collection of Asset: refund from AT & T Contract for sale of real estate 12/07/2001 Collection of asset: proceeds from sale of real estate Donegal Mutual Insurance $ 03/13/2002 Collection of asset: refund from Donegal Mutual Insurance $ 217.67 -217.67 $ 820.00 -820.00 $ 12,894.00 -12,894.00 $ 11,525.74 -3,939.87 -7,585.87 7.01 -7.01 $ 102,753.76 -102,753.76 55.00 -55.00 . .Page 8 $ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 INFORMATION SCHEDULES Estate of Bertha F Williams For Period 11/22/2001 Through 10/30/2002 AT & T 12/28/2001 AT & T Charles Furrier 07/22/2002 Charles Furrier Community Life Team Ambulance 05/03/2002 Community Life Team Ambulance Heritage Cardiology Associates 05/13/2002 Heritage Cardiology Associates Holy Spirit Hospital 12/28/2001 Holy Spirit Hospital Homeland Center 12/14/2001 Homeland Center Homeland Center (2) 01/25/2002 Homeland Center Keefer Wood Allen & Rahal 01/25/2002 Keefer Wood Allen & Rahal, LLP Pre-mortem legal services $ 25.01 -25.01 $ 130.00 -130.00 $ 68.82 -68.82 $ 2.05 -2.05 $ 644.98 -644.98 $ 1,183.44 -1,183.44 $ 24.15 -24.15 $ 500.00 -500.00 .page 9 $ 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 . . ) ... INFORMATION SCHEDULES Estate of Bertha F Williams For Period 11/22/2001 Through 10/30/2002 Oakwood Center Radiation Oncology 01/07/2002 Oakwood Center Radiation Oncology PP & L Electric Utilities 12/14/2001 PP & L Electric Utilities Penna American Water Company 12/14/2001 Penna. American Water Company Rhoads Pharmacy 12/14/2001 Rhoads Pharmacy Susquehanna Surgeons, Ltd. 02/21/2002 Susquehanna Surgeons, Ltd. Verizon 12/14/2001 Verizon (Check was for $22.49, but $13.41 was refunded by the company on 1/14/02) $ 574.71 -574.71 $ 26.50 -26.50 $ 24.88 -24.88 $ 240.79 -240.79 $ 105.69 -105.69 $ 9.07 -9.07 . t>age 10 $ 0.00 0.00 0.00 0.00 0.00 0.00 ~ Dividends MONY Group, Inc. .. RECEIPTS OF INCOME Estate of Bertha F Williams For Period 11/22/2001 Through 10/30/2002 12/31/2001 Annual dividend Total Dividends Interest MONY Savings Account 01/14/2002 Collection of asset and accrued income: MONY Savings Account 12/04/2001 Interest Mellon Bank Savings Account Total Interest TOTAL RECEIPTS OF INCOME $ 3.15 10.50 0.51 · 4 \ t>age 11 $ 3.15 11.01 $ 14.16 .. .. . DISTRIBUTIONS OF INCOME TO BENEFICIARIES Estate of Bertha F Williams For Period 11/22/2001 Through 10/30/2002 . . l t>age 12 To: J. Arthur Froiland Final distribution of residue 10/30/2002 Distribution of income pursuant to final distribution of estate's residue $ 7.08 To: Reba Schmidt Final distribution of residue 10/30/2002 Distribution of income pursuant to final distribution of estate's residue 7.08 TOTAL DISTRIBUTIONS OF INCOME TO BENEFICIARIES $ 14.16 Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Bertha F. Williams No. 2001-1095 also known as Date of Death 11/22/2001 , Deceased Social Security No. 186-01-7079 We, Lynn Rubendall and DouQlas Bonsall Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. I.D. No.: 33580 ~i~i~~~:~~~~S} Dated: ~n,rJl1; ;l.17J.J- ' Attorney: BridQet M. Whitley Address: P.O. Box 11963 HarrisburQ, PA 17108-1963 Telephone: 717-255-8027 Description Value (Other side) ~ ,. "0' 1., n i ......} Total: $142,560.98 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. Form RW-7 (Dauphin County) - Rev. 9/92 1?-c:J.y - 7 ~ 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 BRIDGET M WHITLEY ESQ KEEFER ETAL PO BOX 11963 HBG PA 17108 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 09-30-2002 WILLIAMS 11-22-2001 21 01-1095 CUMBERLAND 101 * REY-1547 EX AFP <01-02) BERTHA F Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-Y=is4j-ix--AFP--foi-':oil--NOTicE--ciF-iNHEifiTANCi-,."Ax-7rppi7risiHENT-,--AL'rciwANCi-oi----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WILLIAMS BERTHA F FILE NO. 21 01-1095 ACN 101 DATE 09-30-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED 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~ ~ returns assessed to date. ASSESSMENT OF TAX: IS. Allount of Line 14 at Spousal rate (IS) 16. AlIOunt 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 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 (1) (2) (3) (4) (S) (6) (7) .00 2.765.39 .00 .00 139.795.59 .00 .00 (8) 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 Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (<<}) (10) 26,463.71 3.590.77 (11) (12) (13) (14) NOTE: .00 X 00 = .00 X 045= 53,753.25 X 12 = 53,753.25 X 15 = NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 142,560.98 30.054 48 112,506.50 5,000.00 107,506.50 (1<<})= .00 .00 6,450.39 8,062.99 14,513.38 TAX CREDITS: .-ftln~nl ".......... . I (+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 02-14-2002 CDOO0864 657.89 12,500.00 08-15-2002 CDOO1533 .00 1,355.49 TOTAL TAX CREDIT 14,513.38 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BONSALL DOUGLAS PO BOX 765 DAUPHIN, PA 17018 -------- fold ESTATE INFORMATION: SSN: 186-01-7079 FILE NUMBER: 2101-1095 DECEDENT NAME: WILLIAMS BERTHA FROILAND DA TE OF PAYMENT: 02/15/2002 POSTMARK DATE: 02/14/2002 COUNTY: CUMBERLAND DATE OF DEATH: 11/22/2001 NO. CD 000864 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $12,500.00 I I I I I I I I TOTAL AMOUNT PAID: $12,500.00 REMARKS: DOUGLAS A BONSALL CHECK# 110 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT WHITLEY BRIDGET M KEEFER,WOOD,ALLEN & RAHAL P.O.BOX11963 HARRISBURG, PA 17108-1963 -------- fold ESTATE INFORMATION: SSN: 186-01-7079 FILE NUMBER: 2101-1095 DECEDENT NAME: WILLIAMS BERTHA FROILAND DATE OF PAYMENT: 08/16/2002 POSTMARK DATE: 08/15/2002 COUNTY: CUMBERLAND DATE OF DEATH: 11/22/2001 NO. CD 001533 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,355.49 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: DOUGLAS BONSALL C/O BRIDGET M WHITLEY ESQUIRE CHECK# 11 9 SEAL INITIALS: CW RECEIVED BY: REGISTER OF WILLS $1,355.49 MARY C. LEWIS REGISTER OF WILLS , - ';:,:~:~G-._-'--'!~:: ffE~- .:~~~~ E (' ''<:~, ,~J;:l U,[VOSrl-;tif I: I AijG I ~)' II .. \ _I;~" ::,. ~~ I ::1: ..t;~l' ~ ....... h ..J " ~ _"" ,I << ",'~ J~' ,~tl,~f\j _\ ,]",4"_-.--,,., Ilt ~""If'!"' . (:J~ lJ: ..is 1 S '1 ELR~T ~LA. {UlAII, Keefer Wood & Allen Rahal, LLP 210 Walnut Street P.o. Box 11963 Harrisburg, PA 17108-1963 ,\TTOIl:\EYS a t L.\ \r TO: Mary C. Lewis Register of Wills for Cumberland County 1 Courthouse Square Carlisle, P A 17013 ~. ~ " ~ ~ c:.; i".:. -- ..r --' C" ~~:::~ ....' -- -..--. ""IIIIK' ~--,- HEATH L. ALLEN N. DAVID RAHAL CHARLES W. RUBENDALL II ROBERT L. WELDON EUGENE E. PEPINSKY, ..JR. ..JOHN H. ENOS m GARY E. FRENCH DONNA S. WELDON BRADFORD DORRANCE ..JEFFREY S. STOKES ROBERT R. CHURCH STEPHEN L. GROSE R. SCOTT SHEARER WAYNE M. PECHT ELYSE E. ROGERS CRAIG A. LONGYEAR DONALD M. LEWIS:III BRIDGET M. WHITLEY ..JOHN A. FEICHTEL ANN McGEE CARBON ELIZABETH ..J. GOLDSTEIN BARBARA A. GALL STEPHANIE KLEINFELTER KEEFER WOOD ALLEN & RAHAL, LLP 210 WALNUT STREET P. O. BOX 11963 HARRISBURG. PA 17108-1963 ESTABLISHED IN 1878 OF COUNSEL: SAMUEL C. HARRY PHONE 17171 255-8000 WEST SHORE OFFICE: 415 F ALLOWFIELD ROAD CAMP HILL. PA 17011 (717) 612-5800 EIN No. 23-0716135 www.keeferwood.com WRITER'S CONTACT INFORMATION: August 15, 2002 (717)255-8027 E-mail Address: bwhitley@keeferwood.com Mary C. Lewis Register of Wills for Cumberland County 1 Courthouse Square Carlisle, P A 17013 Re: Dear Mrs. Lewis: p t...., Estate of Bertha F. Williams No. 2001-1095 ,~, . - _.'~ Enclosed for filing, please find the following: 1. Two copies of the Pennsylvania Inheritance Tax Return for the Estate of Bertha F. Williams. 2. One copy of the Inventory, which is one page in length. The tax due with the Pennsylvania Inheritance Tax return is $1,355.49, and I enclose a check in this amount in payment of the tax due. I also enclose a check in the amount of $25 for the filing fee the inventory and tax return. Please confirm your receipt and filing of the Pennsylvania Inheritance Tax Return and Inventory by date stamping the enclosed copies of the first page of each. I enclose a self-addressed, stamped envelope for your use. Thank you for your assistance in this matter. Enclosures cc: Douglas A. Bonsall Very truly yours, KEEFER WOOD ALLEN & RAHAL, LLP By: fU~1'rt, ~ Bridget M. Whitley ~t/i' Name of Decedent: STATUS REPORT UNDER RULE 6.12 Bertha F. williams Date of Death: November 22. 2001 will No. 21-01-1095 Admin. No. Pursuant to Rule 6.12 of the Supreme Court orphans' Court Rules, I report the following with respect to completion of the administra- tion 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 person- al representative's account is: c. Did the personal representative state an account infor- mally 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: 11/27/2002 A:d~.~ >>l.~ (s~e Bridget M. Whitley Name (please type or print) Keefer, wood, Allen & Rahal LLP 210 walnut St., P.O. Box 11963 Harrisburg. PA 17108-1963 Address ',-'.; 717-255-8027 Tel. NO. capacity: x Personal Representative counsel for personal representative M:';\~-1JOO EX + (6-00) OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA REV-1500 I 7 - .24 7 - DEPARTMENT OF REVENUE DEPT. 280601 INHERITANCE TAX RETURN FILE NUMBER HARRISBURG. PA 17128-0601 RESIDENT DECEDENT 21 2001 1095 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER IWilliams, Bertha F. 186-01-7079 DECE- I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE DENT . DATE OF DEATH (MM-DD-YEAR) 11/22/01 1/25/1909 WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 3. Remainder Return CHECK ~ ,. Original Return ~' Supplemental Return B (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) PR lATE 6. Decedent Died Testate 7. Decedent Maintaineda Living Trust 1 8. Total Number of Safe Deposit Boxes (AttachcopyotWill) (Attach acopyofTrust) BLOCKS 9. Litigation Proceeds Received 10. Spousal Poverty Credit(dateof dtJath between D 11. Election to tax under Sec. 9113(A) 12-31-91 an,: 1,,1..95) (Attach Sch 0) nnSSECllONM\JSTSe9Ql\1!M,Tel;kA44qQllllESJ>Q'lPl$!\lYl'ilkCONFIOENTIAljlAXJi'IOOl'\MAfiQNSfldOLlll'lElllflECTllOfO; NAME COMPLETE MAILING ADDRESS COR- Bridget M. Whi tley , Esq. P.O. Box 11963 RE- FIRM NAME (If Applicable) Harrisburg, PA 17108-1963 SPON DENT Keefer Wood Allen & Rahal, LLP TELEPHONE NUMBER 717-255-8027 None I OFFICIAL USE ONLY 1 Rea! Estate (Schedule A) (1) 2 Stocks and Bonds (Schedule B) (2) 2,765.39 0"'- - 3. Closely Held Corporatlo~, Partner-ship r)r Sole-Proprietorship (3) None 4 Mortgages & Notes Receivable (Schedule D) (4) None 5 Cash. Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 139,795.59_ _. 6. Jointly Owned Property (Schedule F) D Separate Billing Requested (6) None RECA- I I PITULA- 7. Inter-Vivos Transfers & Miscellaneous -"'" I TION Non-Probate Property (Schedule G or L) (7) None I I ~ 8. Total Gross Assets (total Lines 1-7) (8) 142,560.98 9. Funeral Expenses & Administrative Costs (Schedule H)(9) 26,463.71 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 3,590.77 11. Total Deductions (total Lines 9 & 10) (11) 30,054.48 12. Net Value of Estate (Line 8 minus Line 11) (12) 112,506.50 13. Charitable and Governmental Be uests/Sec 9113 Trusts for which an election to tax 1 . . TAX COMPU- TATION 6- I 1'4 q has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) ( 3) 5,000.00 107,506.50 (14t SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES 15. Arnountol Line 14 taxable at the spousal tax 16 17. 18. 19. I 120 rate, ortransters under Sec. 9116(a)(1.2) X .0 (-15) Arnountof Line 14 taxable at lineal rate 0.00 X,O ~ (16)--- AmountofLme14taxableatsiblingrate 5:r, 753.25_ 1\.12 (17)------ AmountotLme14taxableatcollateralrate 53,753.25 x.15 (18) Tax Due (19) D I CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMEIf!J 0.00 ---6 ~450:39- 8,062.99 __ 14,513.3~ >> BE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND RECHECK MATH<< o PA15001 NTF 29755 Copyright 2000 Greatland/Nelco LP- Forms Software Only . '., Estate of: Bertha F. Williams SUJVIlVJARY OF ALLOCATIONS TO BENEFICIARIES Taxable at sibling rate J. Arthur Froiland 53,753.25 Taxable at collateral rate Reba Schmidt 53,753.25 21-2001-1095 fl/~',~f."/-11l00 EX (6-00) u"cecienl's Complete Address' Page 2 ,- - --,- STREET ADDRESS 33 Center Drive CITY I STATE I ZIP CamP Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C, Discount (1) 14,513.38 12,500.00 657.89 Total Credits (A + B + C) (2) 13,157.89 3. Interest/Penalty if applicable D. Interest E Penalty Total Interest/Penalty (0 + E) 4. If Line 2 is greater than Line 1 + Line 3. enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + sA. This is the BALANCE DUE. Make Check (3) 0.00 (4) (5) 1,355.49 (5A) 0.00 (5B) 1 ,355.49 BY 1. Did decedent make a transfer and: a. retain the use or income of the property transferred: 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? Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? Did decedent own an Individual Retirement Account annuity, or other non-probate property which contains a beneficiary designation? 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 bellef, it is true, correct and complete. DeclaratIon of preparer other than the personal representative is based on information of which preparer has any knowledqe. SI ATU PE N RESPONSIBLE FOR FILING RETURN 3, 4, Yes No ~ I B ~ o IBl ADDRESS 210 Walnut . V" ~\~ ,\\ \ (}.~ I '(!((..t;:i4/ I( \ "\ \'\ , 'f' I",., \ ", '~"'_:<' t}~AV \. I( DATE ,r/,ff/OZ- " '.'J. \ "C spouse [72 P,S.!3 9116(a)(1.1)(i)J. For dates of death on or after January 1,1995, the tax rate is imposed on the net value of transfers to ortor the use of the surviving spouse is 0% [72 P.S.!j 9115 (a) (1.1)(ii)J. The statute rlopc;no! I'xprnnta transfertoasurvivingspousetromtax. and the statutory requirements for disclosure of assets and filingataxreturn arestillapphcable even if thesurvivingspouseistheonlybeneficiary. For dates of death on or after July 1,2000: The tax rate imposed onthe net value of transfers from a deceased childtwenty-one years of age oryoungerat death to orfortheuse of a natural parent, an adoptive parent. orastepparentofthe child is 0%, [72 P.S.!39118(a)(1.2)], The tax rate imposed on the net value of transfers to orfor the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72.P.S.!3 9115(t.2) [72 P.S.!3 9118(a)(1)J. The tax rate imposed on the net value of transfers to or for the use of the decedEmt's siblings is 12% [72 P.S.!3 9115(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 29755 Copyright 2000 GreatlandfNelco LP- Forms Software Only Estate of: Bertha F. Williams 21-2001-1095 The following person(s) are signing the return as representative(s) of the estate: Lynn Rubendall 801 Old Rossville Road Lewisberry, PA 17339 Douglas Bonsall P.O. Box 765 Dauphin, PA 17018 REV-15?3 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bertha F. Williams SCHEDULE B STOCKS & BONDS FILE NUMBER 21-2001-1095 All property Jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NO. DESCRIPTION VALUE AT DATE OF DEATH K mart - 378 shares @ 6.74 CUSIP No. 482584109 2,547.72 2 MaNY Group, Inc. - 7 shares @ 31.095 CUSIP No. 615337102 217 . 67 7 CPA31 NTF 10905 Copyright Forms Software Only, 1997 Nelco, Inc. TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 2,765.39 t' ,', RoVe,508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bertha F. Williams SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21-2001-1095 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 Refund received from AT & T 7.01 2 Mellon Bank Checking Account 2,764.29 3 Cash 58.42 4 MCNY Savings Account Date of death value: $3,219.70 Accrued interest: $14.51 3,234.21 5 Mellon Bank Savings Account Date of death value: $5,682.42 Accrued interest $0.74 5, 683. 1 6 6 Proceeds from sale of real estate; the agreement of sale was executed prior to decedent's death and closing occurred shortly after the decedent's death. Copy of settlement sheet attached. 102,753.76 7 Refund received from Donegal Mutual Insurance Company 55.00 8 1988 Oldsmobile Cutlass Sierra Value at price received on sale 820.00 9 Button Collection Valued at amount received at auction sale 12,894.00 10 Household goods and furnishings Valued at amcunt received at auction sale 11,525.74 7 CPA81 NTF 10908 Copyrlgh1 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) 139,795.59 R~V-1511EX + l'-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bertha F. Williams SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-2001-1095 Debts of decedent must be reported on Schedule I ITEM NO. DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Musselman Funeral Home 6,032.00 2 Rolling Green Cemetery 1 ,425.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 10,000.00 Name of Personal Representative(s) See attached Social Security Number(s)/EIN No. of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees Name: Keefer Wood Allen & Rahal, LLP 7,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 0.00 Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 289.50 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7 PennDOr - fee for duplicate title 22.50 8 Legal advertising fees 175.31 9 Attorneys' accrued and anticipated disbursements in connection 500.00 with estate administration 10 Special Services Unlimited (cleaning decedent's home) 406.00 11 Lynn Rubendall (out-Df-pocket expenses of Co-Executor) 99.80 12 Postmaster - Lemoyne 13.60 TOTAL (Also enter on line 9, Recapitulation) $ 26,463.71 7 CPAII NTF 10911 <If more space is needed, insert additional sheets of the same size) Copyright Forms Software Only, 1997 Nelco, Inc. Estate of: Bertha F. Williams Item No. SCHEDULE H, PART B -- Personal Representative's Commissions Description Name: Social security number: Street address: City, State and Zip: Year commissions paid: 2 Name: Social security number: Street address: City, State and Zip: Year commissions paid: Lynn Rubendall 801 Old Rossville Road Lewisberry, PA 17339 2002 Douglas Bonsall P.O. Box 765 Dauphin, PA 17018 2002 TOTAL. (Carry forward to main schedule) . . . . . . Page 2 21-2001-1095 Amount 5,000.00 5,000.00 10,000.00 Rfov-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bertha F. Williams Include unreimbursed medical expenses. ITEM NO. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-2001-1095 DESCRIPTION AMOUNT Oakwood Center Radiation Oncology 574.71 2 Pennsylvania American Water Company 24.88 3 PP & L Electric utilities 26.50 4 AT & T 25.01 5 Holy Spirit Hospital 644.98 6 Homeland Center 1 ,207.59 7 Rhoads Pharmacy 240.79 8 Verizon 9.07 9 Keefer Wood Allen & Rahal Fees for pre-mortem legal services including estate planning and sale of real estate 500.00 10 Dr. Albert Zanetti 30.68 11 Susquehanna Surgeons, Ltd. 105.69 12 Community Life Team Ambulance 68.82 13 Heritage Cardiology Associates 2.05 14 Charles Furrier 130.00 7 CPA12 NTF 10912 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3, 590. 77 Copyright Forms Software Drily, 1997 Nelco, Inc. REV-1513 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES Bertha F. Williams No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 J. Arthur Froiland P.O. Box 205 Plummer, MN 56748 2 Reba Schmidt 2544 N. Foote Drive Phoenix, AZ 85008 FILE NUMBER RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Brother Sister-in-law 21-2001-1095 AMOUNT OR SHARE OF ESTATE 53,753.25 53,753.25 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 1 Messiah Lutheran Church 901 N. 6th Street Harrisburg, PA 17102 7 CPA13 NTF 10913 TOTAL OF PART II -- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ Copyright Forms Software Only, 1997 Nelca, Inc. (If more space is needed, insert additional sheets of the same size) 5,000.00 5,000.00 t~~~ LAST WILT, AND TESTAMENT OF' RF'RTHA PROTLAND WTLLTAMS I, BERTHA FROIUli~ WILLIAMS, residing at 33 Center Drive, Camp Hill, Pennsylvania, which I declare to be my dooicile, do hereby make, publish and declare this to be my Lase IJill and Testament, and declare further that the terms of this my Last Will and Testament express my uncoerced and deeply felt wishes. FTRST: I hereby revoke all Wills, Codicils t~ereto or other testame~tary instruments by me at any time heretofore made, regardless of where the same were so made or may r.ow be situated, with the same efficacy as though the said Wills, Codicils thereto, or other testamentary instruments had never been made. SRC":OND; I hereby direct that all my legally e~forceable debts and the legitimate and proper expenses incurred in the administration of my estate be paid as soon after my death as may be practicable. THTRD: I have prepared a list of personal property items designated "Bequests to Friends and Loved Ones." If this list should exist at the time of my death and if the items so listed remain in my possession at that time, I direct my Executors to distribute the items noted thereon to those individuals shown on the list who survive me. Any such item that cannot be .. < '..11:, '---, .-r' /,. , '^ I ~.._ ~-::'_-/':)-::.:1./ - 1 - distributed shall be added to my Residuary Estate and disposed of as set forth below. FOURTH: All the rest, residue and remainder of the property, both real and personal and wherever situated, which I may own, or to which I may be entitled at the time of my death, is hereinafter called my "Residuary Estate," and shall be sold as soon as practicable. I direct my Executors to payout of my Residuary Estate, which is disposed of in paragraph "FIFTH" of this Will, but prior to any of the dispositions thereunder, all estate or inheritance taxes, or succession duties assessed by the United States, or by any state thereof, that shall be predicated upon my death as the taxable event, provided however, that no tax shall be paid out of or apportioned to any share passing to a charitable beneficiary, including the Messiah Lutheran Church. FT"'TH: I give, devise, and bequeath my Residuary Estate as follows: a. I leave the sum of Five Thousand Dollars ($5,000) to my church, Messiah Lutheran Church, Commonwealth and Forster Streets, Harrisburg, Pennsylvania. b. I leave the remainder of my Residuary Estate, in equal shares, to my brother, J. Arthur Froiland of ;'/ .--, ! ~ . ~ i ;/ I / -__I' .,..~" -~, ; i . , J ~ , (~,:__F'::__t/ - 2 - Plummer, Minnesota and my sister-in-law, Reba Schmidt of Phoenix, Arizona. c. If my brother, J. Arthur Froiland, shall fail to survive me for at least thirty (30) days, his share shall be paid to my church, Messiah Lutheran Church of Harrisburg, Pennsylvania. d. If my sister-in-law, Reba Schmidt, shall fail to survive me for at least thirty (30) days, her share shall be divided equally between her two daughters, Janet Smith (Mrs. Steve Smith) of Phoenix, Arizona and Virginia DeSantis of Phoenix, Arizona. SIXTH; A. I nominate and appoint my friends, DORIS MOWREY of Lemoyne, Pennsylvania, LYNN RUBENDALL of Lewisberry, Pennsylvania, and JEAN WHERLEY of Camp Hill, Pennsylvania, as Executors of this, my Last Will and Testament. If one or more of them shall fail to survive me, shall decline to act, or having qualified shall, for any reason thereafter, cease to act, then I appoint the one or two remaining to serve in her or their place and stead. [Space left intentionally blank.] '1 /"" , , ~ -.->/ "'/'" ' _ _ '/' /,-, ..2...,.. .- /' ,2-_-"'-.///A->l..-, ~[-(.~--:-;;-;...._-;", - 3 - B. I direct that no bond or other security shall be required of my Executor(s) for the faithful performance of her or their duties. IN WITNESS WHEREOF, I sign, seal, publish and declare this ,71 } 1 instrument as my Last Will and Testament on this (~. day of February 2001. BERTHA FRO . ' , {C . :.( '- ,-d S ~~v~ ~~.IJ;. ~W SIGNED, SEALED, PUBLISHED and ) DECLARED by Bertha Froiland ) Williams as and for her last will ) and testament, on the day and year) last above written, in the ) presence of us, who, at this ) request, in her presence, and in ) the presence of each other, all ) being present at the same time, ) have hereunto subscribed 0 names) as witnesses: ) ) ) ) ) ) ) ) ) ) - 4 - SELF-PROVING AFFIDAVIT COMMONWEALTH OF PENNSYLV~,IA (:.lH.... \:ll:/ G ..ol S S . COUNTY OF L .th u.u'l' WE, BERTl-'.A FROILAND WILLIAMS and Stefanie A. Morrison Patricia D. Olyarnik ,and LindaM. Gutshall , the testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will and testament and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as witness and to the best of his or her knowledge the testatrix was at that time eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence. 1 /. ~., :::r '_. h. ,/(d -H,h ~+-,:/y.. / - :-'-';/_/.~"" ~/' :..-_ 3.4L-r'--""-V BERTHA FROILAND ILL / r / '/! /"A " ... :./ /. ,/ / ..?7-"!--Y' S Testa'trix Witness ~~:'~\0-~c- ~ss 1Jr~;);. ~&# Witness Subscribed, sworn to, and acknowledged before me Froiland Williams, the testatrix, and subscribed before me by Stefanie A. Morrison Patricia D. Olyarnik ,and Linda M. Gutshall witnesses, this 12th day of February 2001. by Bertha and sworn to , the :"'to, .......... '.,\' Q ~ . , Notar' Publ' " \ l - 5 - NOTARIAL SEAL CYNTHIA J. RULE. Notary Pub~c Camp HiH Boro.. Cumberland County Commission Expires Jan. 24. 2004 ; ,~ ,. '0' (C(Q)flf SOLE CODICIL OF BERTHA FROILAND WILLIAMS I, Bertha Froiland Williams, of 33 Center Drive, Camp Hill, Cumberland County, Pennsylvania, do hereby declare this to be the Sole Codicil to my Last Will and Testament, dated February 12,2001: I. I hereby delete Paragraph SIXTH of my aforesaid Last Will and Testament, dated February 12,2001, in its entirety. 2. I hereby replace the provision noted in paragraph I above with the following provIsIOn: SIXTH: A. I nominate and appoint my friends, LYNN RUBENDALL of Lewisberry, Pennsylvania and DOUGLAS BONSALL of Dauphin, Pennsylvania, as Executors of this, my Last Will and Testament. If one of them shall fail to survive me, shall decline to act, or having qualified shall, for any reason thereafter, cease to act, then I appoint the one remaining to serve alone. B. I direct that no bond or other security shall be required of my Executor(s) for the faithful performance of their or his or her duties. 3. In all other respects, I hereby ratify, confirm and republish the provisions of my aforesaid Last Will and Testament, dated February 12,2001, together with this Sole Codicil, as and for my Last Will and Testament. y' IN WITNESS WHEREOF, I have set my hand and seal on this my Sole Codicil to my Last Will and Testament, dated February 12,2001, this ~ "I day of May 2001. ~Q~>;ZL/ d;~~ kJd~ BERTHA FROILAND WILLIAMS SIGNED, SEALED, PUBLISHED, and DECLARED by BERTHA FROILAND WILLIAMS as and for the Sole Codicil to her Last Will and Testament, dated February 12, 2001, on the day and year last above written, in the presence of us, who, at her request, in her presence, and in the presence of each other, all being present at the same time, have hereunto subscribed our names as witnesses: -ff-~' &:~Or r4Wrf! ~J4iL-' Co/M 111.~~ ',' SELF-PROVING AFFIDAVIT COMMONWEALTH OF PENNSYL VANIA SS. COUNTY OF CUMBERLAND I, Bertha Froiland Williams, the Testatrix and rrJ'{' e. D ~;I)dl i?I Elil:c.~th :1. ~lc.Is-b~ ,and L,,.;cI~ A,6</~h...// ,the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Sole Codicil to her Last Will and Testament dated February 12, 200 I, and that she had signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Sole Codicil as witness and to the best of his or her knowledge the Testatrix was at that time eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence. /7 + ,." /J> .7;:~t j /j'-./d<.vt J?iL!Cc.:z.,.,..,.d Bertha Froiland Williams, Testatrix ~~. S~Itd12v- I ness ~~.i~ /&~ Witne ~~)u.~p Witness Subscribed, sworn to, and acknowledged before me by Bertha Froiland Williams, the Testatrix, and subscribed and sworn to before me by C.CJ L, D .Sev ~u::l G.-.i [ I 'Lc.-1J.-d-+., J c....~ l.d ::\Lc..,-,,- , and L'-^-.L>- VI" C--..J ..0~ witnesses, this :) q ';:'-L day of May 200 I. ( .~ .~ " ,. ~ .f \ ,I {\ . , ',' I. \-'1-,d~k<.,-- -,/.c:- L~--'--Z. , . 'f NO ARIAL SEAL CYNTHIA J. RULE. Notary Public Camp Hill Bore. Cu."1berland County .M . commission EApIi" ~an 24.2004 COMMCNW!AtTH OF ~!NN5yt"ANIA Oe~.l.nMeNT OF ReV!~Ue INHERITANCE TAX DIVISION DE~T 1$060 I HARRlsaURG, ~A 17113-0601 Please Print or Type MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS' COUNTY CODE FILE NUMBER SOCIAL SECURITY OR DEATH CERTIFICATE NUMBER 186-01-7079 DATE OF DEATH November 22, 2001 (STATE) Rfll-49S,fX.'I_Q11 ~t:. ",.,"(\ SAFE DEPOSIT BOX INVENTORY DECEDENT'S NAME (LAST, FIRST, MIDDLEl ~illiams, Bertha F. ADDRESS OF DECEDENT (STREET) (CITY) 33 Center Drive Camp NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX (NAME) Hill Charles W. Rubendall II, Counsel for the Estate ISTREET ADDRESS) (CITY) 210 Walnut Street Harrisburg NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING a. (NAME) (RElATIONSHIP) Charles W. Rubendall II, Counsel for the Estate (STREET ADDRESS) {CITY} 210 Walnut Street Harrisbur~ b. (NAME) (RELATIONSHIP) (STREET ADDRESS) (CITY) c, (NAME) (RELATIONSHIP) (STREET ADDRESS) (CITY) NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED (NAME) Citizens Bank (STREET ADDRESS) PA (STATE) PA (STATE) PA (STATE) (STATE) (CITY) (STATE) Cam Hill PA DATE AND TIME OF LAST ENTRY 4/8/02, 12:45 .m. TITLE UNDER WHICH BOX IS REGISTERED Bertha F. Williams 1510 Cedar Cliff Drive I NAME OF PERSON MAKING LAST ENTRY Charles W. Rubendall II DATE OF CONTRACT TO RENT BOX NUMBER OF BOX 28 NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX a. {NAME} Bertha F. Williams (STREET ADDRESS) 33 Center Drive (CITY) b. (NAME) Douglas A. Bonsall (STREET ADDRESS) (STATE) P. O. Box 765 (ZIP CODE) {CITY} 17011 Dauphin Camp Hill PA NAME AND TITLE OF EMPLOYE TAKING THE INVENTORY Melissa Auman, Teller Mana er WAS A WILL IN THE BOX? :JYES X::NO If yes, a. Date of will: b. Name and address of personal reptesentutive, if named in the will (NAME) N/A (STREET ~DDRESS) (CITY) c. Nome and address of attorney, if any (NAME) N/A ISTREET ADDRESS) (CITY) (STATE) PA (STATE) ISTATE) (ZIP CODE) 17011 (ZIP CODE}. 17101 (ZIP CODE) 17101 (ZIP COOE~ (ZIP CODE) (ZIP CODEr 17011 (ZIP CODE) 17018 (ZIP CODE) {;:IP CODE) Page 01___ SAFE DEPOSIT BOX INVENTORY INSTRUCTIONS (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares end closs of stock. (3) Obligations of U. S. Government: Number of items, dote of issue, face value, names in which registered and type of ownership, i.e., jointly held, payable on death, etc. (4) Bonds: Designate by nome, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, nome of bank and branch, and balance. (6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other contents. i ITEM ITEM DESCRIPTION NO. I Nothing; box was empty i , I I ~ , I I ' ~ , ! ~ LJ , I # I CERTIFY UNDER PENALTY OF PERJURY T THE ABOVE RECORD IS PERSON RECEIVING COPY OF F MY KNOWLEDGE AND BELIEF. SAFE DEPOSIT BOX INVENTORY, SIGNATURE PRINT NAME ,PRINT NAME AND CHECK APPROPRIATE BOX BELOW- Charles IPRINT TITLE I W. Rubendall II Counsel far the Estate CHECK APPROPRIATE BOX o Executor{trix) 0 Administrator(trix) I 0 Estate Representative 0 Joint awner of safe deposit box Attach additional 8%/1 x 11/1 sheet {s} if necessary or use duplicates of this page of form. I NOTE: .: CITIZENS BANK Account Number Account Title 262-110-1803 Bertha F Williams 126-28 Bertha F Williams Thursday, December 13, 2001 Date Opened: 10/28/1985 Account Type: 00 Principal Sal Int from Last Account Sal YTD Int to as of DOD Posting to DOD as of 000 000 $2,764.29 $0.00 $2,764.29 $0.00 Date Opened: 04/28/1989 Account Type: SO Principal Sal Int from Last Account Sal YTD Int to as of 000 Posting to 000 as of DOD DOD 00110-037728 Account Type: SA Mrs. Bertha F Williams Or Russell G Williams (Deceased) Date Opened: 08/13/1971 Principal Sal Int from Last as of 000 Posting to DOD $5,682.42 $0.74 Account Sal as of 000 $5,683.16 YTD Int to 000 $11.70 Page 2 of 2 . . ~ II ~ 0 -i 0 m 0 0 :6 1> -i 2 ~ -i 1> -i ::c , :;0 1> OJ C) 0 m :;0 -i S;-nO 2 0 1>0..... m c.n 2 .....;;00 -n c.n C , ..... S; 1>-< -i OJ 0 0 m :;oOC :;0 0..... -0 :;0 :>< <F> , c.n m2 W -< 2 -0 WOO 2 0 , ""-i:E: "" 2 m I -l>o <..n 1> ~O-< -l>o ;;0 c.n <=> wmo C m cn:-C3: ~ "::i 0 '= ;; -oC ....., OJ CJ) ~. .. n 1>0:;0 m 00 :;0 ~g'~ ~ '" -ic.n <F> 2 0 m ~x_ ~ z~;' ~ ..... <J W -i 0 0 -i ~ -i -i 1> 0 1> I 1> ~~= <=> ::c -< "" -i , 0 ..... -< " ~ m-s; 1> , "" 2 0 ~ ~ 0 ;;. 3 ~ mm <D , n ~ W m ". 1> -n 2 Qo -i ~ n Q OJ -i -i ....., 0 ::c c:: 0 '"' 0- 0 m 0 0 ..... i ~ ~ < 0 0 0 ::c c.n ~ n 0 ~ mOJO C C m c :;oc 0 C) 0 c.n 1>0, ..... -i , :>< -i 000 2 1> C O::C -i c.n 0 OJ :;ocC) m 1> m:;oo :;0 OJ -i -n c.nm m 0 m 0 c.n- -i c.n 2 :;0 0 -i c.n 0 0 1> -< 0-< ---- 0 20 0 C -i C -i -l>o :;0 1> :;0 <F> 1> ---- 0 >< 0 :;0 -i OJ 0 "" m 1> 0 ..... 0 C2 <F> 0 0 c.n:>< :;0 -l>o "" 0 0 1>< <..n ;;0 c.n -i ..... <..n 2 I I 1> m CJ) -i ....., 1> m <D -l>o -n * 00 0 -i * 00 -l>o ...;) * ....., "" * 0 0 * 0 * 0 w 00 -l>o 0 ~ "" <..n -l>o "" c..v -l>o cr> CO <D ....., "" ~ ~~ ....., ~ rv ~ CO Q) . . OMS NO 2502 0265 .....:-.. ,r ^ B. TYPE 0 AN: U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1 [l9FHA 2.DFmHA 3.0CONV. UN INS. 'OVA 5.DCONV, INS 6. I SETTLEMENT STATEMENT MCLAUGHLIN 521635201 8. MORTGAGE INS CASE NUMBER: 441-673945-2-703 c. NOTE: Th;s form ;s furnished to give you 8 statement of aclual setllement costs. Amounts paid to and by the sell/amenl agent are shown. Ilems marked "(PQC]" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. '" 3196 (MCLAUGI!LINPFDIMClAUGHLINI32) D NAME A" 0 ADDRESS OF BOKKOWER: E. NAIVlt: AND ADDRESS OF SELLER: F. NAME AND AuDRESS OF LENDER: CATHY L. MCLAUGHLIN GMAC MORTGAGE CORPORA liON ESTATE OF BERTHA F. WiLLIAMS Lynn Rubendall and Douglas Bonsall, Co-Executors G PROPERTY lOCATION: H. SETTLEMENT AGENT: 23-2402316 I. SETTLEMENT DATE: 33 CENTER DRIVE PURITY ABSTRACT COMPANY CAMP Hill, PA 17011 December 5, 2001 CUMBERLAND Counly. Pennsylvania PLACE OF SETTLEMENT 3329 MarkelSlreel Camp Hill, PA 17011 100. liROSS AMuUNT DUE:: fROM BORRuYVi:R: 400. GROSS AMuUNT DUE TO SELLER: onrac '" nce on rac '" co, , 10;,'. I-'ersonall roperly 40Z. ersonall-'roperly , emen arges 0 orrower lne14UU) 104. 404. Adjustments "' ems " Y e erlna vance ~ustments 0' ,m, " Y e erma vance ouny wp axes 0 0 I ouny wp axes 0 , 28.25 'Y " 0 'Y " 0 , 000 " 0 6307ll 000 " 0 63070 < '" WOOl,. 0 , 4"''' 0 '.u' 0 12.T 0 /20 GROSS AMOUNT DUE FROM BORROWER 120,243.72 420 GROSS AMOUNT DUE TO SELLER 113,678.76 200. AMOUNTS PAID BY OR IN BEHALF OF B RROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: eposl mearnes money xce$S eposl ee ns ructons) r1ncl[l<l moun 0 ow O;:Jns 0 , emenl larges 0 e" 10' .~ ,-,_l XIS Ing oan s aensuJec 0 XIS Ing oan s aensuJec 0 , I ~U4. l-'ayoII of first Mortgage '05 ,yo o secon or gage <0, 15U7. (Oeposl Is.asprocees 1"9. ~usmens "' em, np81 Y e", ~usmens "' ,m, np8ldl:ly:Jeller ounly wp axes 0 51U. County/Twp axes 0 'Y " 0 'Y " to 000 " 0 I . School' ax 0 , m '10. 220 TOTAL PAID BYIFOR BORROWER 116,113.00 520 TOTAL REDUCTION AMOUNT DUE SELLER 10.925.00 1300. , ross moun uet-roml:lorrower '" 60~. Gross moun "' 0 'ec 10' I l,6787B 1302 '" moun " Y 01 orrower\Llne LLU) I ess Keduc Ions uue Seller 10' 10,925.00 303. CASH ( X FROM) ( TO) BORROWER i 4,130.72 603. CASH ( X TO)( FROM) SELLER 102.753.76 , The undersigned hereby acknowledge receipt of a completed copy of pages 1&2 of this st<llement & any allachmenls referred to herein. Bwow", (0:1}~ Q~ CAT Y . HL , Seller ESTATE OF BERTHA F. WilLIAMS BY JII4~<l '1J (/fcf'v>cCU "'-:P"~ Susan . Thomas, Agent ' ( (~~! NIlH~fl\f1::l~ I NIlH8(lVl::lVII) OO'S 6'L ~ iN3l"J3liBS ~V SONf1:1 S.!Hl13S l"JmUOIVd 1. ~Iled 96'\>99'9 00'L9 lueEiltlUaWillllas M03 anJI e aq 01 pa!J!\JaJ )UaWalel~ aOed OM) S14) 10 7 "eed)O ~<!oo palaidilloo e '" Id,"o,.. aOpalMou~oe ~auOI"Ue,. 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