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Home My WebLink About01-1099 theron. PETITION FOR PROBATE and GRANT OF LETTERS &tate of ---1":1 () '" 8 0, r.d 1\1 b-,o V.: a No. ~ - () 1- J 0. '1 q also known as To: Register of Wills for the ~ Deceased. County of C. ~ ht b-tr \ CI VIet in the Social Security No. ) cr '7 - ()q -)?6 '17 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 0 (' S in the last will of the above decedent, dated ~ c-t 0( \ cr q 0 and codicil(s) dated named , 19~ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in C U W1 h COUfiY, Pennsylvania, ~ith h Q ~ last family or principal residence at 3 ~ So u -1), ~ t Cl JJ1et'/~4N.u#Jjjt 1.7&6.-"\ {.lpp..er a l)-e V\ {/'- (list street, number and muncipality) Decendent, then ~ 3 years of age, died N 0 V ~ ~ ~ ~ 0 , ,19 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: 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: $ 'J CJ (') cj $ $ $ 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.La.; administration d.b.n.c.t.a.) ,e Q) u c: Q) :9-;;- '" '-' Q) ... QGQ) c: -g.g cd~'= 3~ Q),- :;0 ~ c OIl r;) CV~l 'ddlf h/uv AtL. Z> .:T. ro 1.. 7" z... ~6C) '7 's4!4A'b e/~cJ..G' ,.A/EC.H,I./II)C:.5.stl~ ~ F'#. /7(}$f>' OATH OF-PERSONAL REPRESENTATIVE COMMONWEALTH OF PE~YL:tNIA ~ ss COUNTY OF (I/~?>>.k.~. ?7A - ) 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 ~n. truly administer the estate according to law. /7-di/--1/ t'.1 oQ. ;:s ~ ..... ~ ~ ~ ~o. 21-2001- 1099 Estate of MARGARET N. LAVIA , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW DECEMBER 3RD __ ,__ :~_ 200!in cl.msicieratiun c the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated OCTOBER 9TH, 1990 described therein be admitted to probate and filed of record as the last will of MARGAREr N. LAVIA and Letters TESTAMENTARY are hereby granted to OONALD J. FOLTZ AND GARY L. FOLTZ ',~ !-: ~:: r.e: i t i (H '. 'J n y c. lliWIS~ FEES Probate, Letters, Etc. ......... $ 40.00 Short Certificates( 2) . . . . . . . . .. $ 6 . 00 Renunciation ................ $ x-Pages (2) $ 6.00 JCP TOTAL _ $ 5.00 Filed DEOl1BER. 3ro,20Q.l... $ .~7 ~PP.. . A TIORNEY (Sup. Ct. LD. No.) ADDRESS PHONE po :=('1) 6-~' ~ i', U';"'.. d - :o~ ([)() I.:.t::)O f:Q,,'Q ~;D (1', ... -', ':~: ~ ~~:) e5 -< W o MAILED LETTERS AND ~ 'TO EXEClTI'OR GARY FOLTZ. :u )> J;::I \0 W .,;:.. -l10'i.RO'i RE\' 9/Ril This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local ~egistrar. The original certificate will be forwarded to the State Vital Records Office for permanent. filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. No, ~~~~~ ~ Fee for this certificate, $2.00 p 7902318 1"b7~..v. )h. d-oO I , Date 21-2001-1099 H 105; 4J R.. 2/87 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT Of HEALTH · VITAL RECORDS CERTIFICATE OF DEATH TYPE/PAINT IN PERMANENT BLACK INK NAME OF DECEDENT If "51 _. l"" SEX STAlE FILE ""MIlER SOCIAL SECURITY NUMBER ~ @ ~ o <:. ~ z Female 197 - 09 - November 22,2001 AGE Ila5llk1haaYI UNDER , YEAR .....- Oeye BIRTHPlACE (C,'y ond S.... 01 fCfelQlfl Counuy) :oty,D 83 VIS 5 COUNTY OF OEAJH RACE ' A_ Inclien. Bleck. While. elC. (~I .... Cumberland .... '0. White DECEDENT'S USUAL OCCUI'IVlOl'f l~t":_~.::o:.. "=' '::~::f Homemaker MAAlTAL STATUS. _ SURVIVING 5I'OtJSE N_MeII'ied. _, 1"_. gow_nemel IlivGced (SpeclIy) I.. Widowed IS. I7c.CX_,__"'_in-Upper tollen - ,.. FATHER'S NAME IF.... MoOdIe. LaSI) Cumberland Did - M". 1OWn8hip? ~ Reese E. Derick ... _OAMANT'S NAME (TypelPTiroll Mechanicsburg, Pennsylvania DATE PRONOUNCED DEAD (Month. Day. 'lIla,) Nof)l.. 2.. 5:00 A.M. M H. November 22, 2001 27. PART I; EnIeIltte di....... iniufies Of' compk:a.ionawhit;h caused thf death 00 not eol... ,he mode 01 dying. such IS cardlac 01 f.5plfaloty 3ffesl. shodc Of heatt 'au. L.- onty one caUN on each...... ~~t ~OO~~ OUElOCORI'Sl' SEOOENCEOf): a ''''''''''..n.... '__n :-.....- I l PART .: 0Ibet .igntftc........- COnIIIIluIing 10"""'. buI .... rMUlIing in.. ~-u;- in""'" I , YuO =~ROFDE;/ "",,codenl 0 SuocKlo 0 TIME OF INJURY DESCRIBE HOW INJURY OCCURRED. l : DUE 10(011 I'S I' CONSEOUENCE Of)' WERE I'UlOPSY FINOINGS _LABLE PRIOR 10 COUP1.ETION OF CAUSE OF DEAlH? DI\TE OF INJURY (loIonll Day. '1\0.., INJURY AT WORK? Pending lnvMligalton o o o PlACE OF INJURY, AI home. '.rm, .._. tectOl'l, olfic:. M. buoklIng, etc. l~'vl He. ..... 0 NoD Homocide 'MEDICAL EXAMINEA/CORONER On the baai. of ..amin.Uon andlCM' invesUg.tton, in my opinion, de.th occurred a. lheUme. date, and plac:e. and due 10 the cau..(a) and "..nne,.. stlted.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . 3.e REGI~ L;l, Il~ I ~;1..1 Ii No~ NoD Could not be deletflllned 2... 2Ob. CERTaFIER IChack My onet .canlFYlNG PHVSICIAN (Ph,..s.c1dO cena'ytOQ cause ~ dealh when .loom... pfl~SlC.an nas prooounceo deal'" 3f\() complele<lllem 23) To the beat o' "'. know""'. death accUlNd due 10 the cau..(.) and manner .. I'.'H. . . . . ;no . PRONOUNCING AND CERllFYING PHYSICIAN IPhy5oCoan bo/I1 ;l<QnO<UlCong oedlt1 ",ld c""'yong 10 cause 01 <lednll To the bHt o' my knowJedga. death OC:Cl.IItM at the lime, ..e, and place, and due 10 the cauM(I) and manne'.. a.aled.. LAW OFFICES 5NEL8AKER Be ELICKER 21-2001-1099 LAST WILL AND TESTAMENT I, MARGARET N. LaVIA, of the Township of Upper Allen, County of Cumber- land and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils by me at any time heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my Executors or Executor, as the case may be, hereinafter named, as soon as conveniently may be done after my decease. SECOND. I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated, unto my two (2) sons, namely, DONALD J. FOLTZ and GARY L. FOLTZ, absolutely and in fee simple. Should either of my said sons predecease me and leave issue to survive me, I order and direct that the share to which such deceased son would have been entitled had he survived me should be distributed unto his issue per stirpes, said issue taking their deceased ancestor's share by rep- resentation and not per capita. THIRD. I nominate, constitute and appoint DAUPHIN DEPOSIT TRUST COMPANY to be the Guardian of any property which passes, either under this Will or otherwise, to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so. Such Guardian shall have the power to use principal as well as income from time to time for the minor's education, support and welfare, or to make payment for these purposes, without further responsibility to the minor or to any person taking care of the minor. LASTLY. I nominate, constitute and appoint my son, DONALD J. FOLTZ and my son, GARY L. FOLTZ as Co-Executors of this, my Last Will and Testament. Should either of my said sons fail to qualify or predecease me, the other , ... son shall serve as the sole Executor of this my Last Will and Testament. No person serving as Executor shall be required to post any bond to secure the faithful performance of his duties in the Commonwealth of Pennsylvania or in any other jurisdiction. IN WITNESS WHEREOF, I, MARGARET N. LaVIA, have hereunto set my hand and seal to this, my Last Will and Testament which consists of two (2) typewritten pages to each of which I have affixed my signature this <1 day of (j) A.D., One Thousand Nine Hundred Ninety (1990). Lf)JtMF-YJ .;t~t4sEAL) The preceding instrument, consisting of this and one (1) other typewritten page, each identified by the signature of the Testatrix, was on the date thereof signed, sealed, published and declared by MARGARET N. LaVIA, the Testatrix therein named, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence, and in the presence of each other, have subscribed our names as witnesses hereto. f~ (A.4",j- ']H. 7~ , LAW OFFICES SNEL8AKER Be ELICKER LAW OFFICES SNELBAKER Be ELICKER COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND We, MARGARET N. LaVIA, E. ROBERT ELICKER, II and JANET M. FORRY, 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, 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 hearin of the Testatrix, signed the Will as witness and that to the best of his or her knowledge, the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Witness (J-~e>;:' ? ~ Subscribed, sworn to and acknowledged before me by MARGARET N. LaVIA, the Testatrix, and subscribed and sworn to before me and JANET M. FORRY, witnesses, this S7~ day of 9J by E. ROBERT ELICKER, II (fJa!J:AAJ ' 1990. .~. Notary Public flOTARIlll SEAL !t~~!~l^ J;. TH'-lNSON. fllOTARY l'.,:(.,J"..CS3lhG BDxO CUM8ER~L1C m ~l ExpiRES DEC. 31, Hl~ ----.~-~_..~..-, ~/ CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: 11 RR (;./fR /::- r AI L4 V/A- Date of Death: 1V6 V. :J.:;" f).,oo; Will No. ~/-OI-lDqq Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on Name Address hDN L b J. r '" /?()6~ GftRY J.... ~~)...rz. J bL-:1 S, MIJ.eKEr S 7. ...f ii/I< &" /'1 iJ. AS "/()()/ AI , P,4. 1'76 II , Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: 3 .- 1/ - () ~ Signature Name CV~il.74 -So? /l12.t'1Jj) c!./~ e1.1! Address -~qUln~) ;;'3-;8 i/t:C//A6-. LJ4 o ,- IT * /1'0 sS- Telephone (1/1) 7t,~ -- ~Ytl6 Ot?: i d l L (Jb'W ZOo Capacity: Y Personal Representative _Counsel for personal representative INRE: ESTATE OF MARGARET N. LA VIA IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO: 2001-01099 TO: Clerk of the Orphans' Court Enter my appearance as attorney for the estate of Margaret N. La Via. August 7, 2002 ~un" ~7 f'~- :-....,: "...- p 2002 March 15 2001 Dec6 2002 Aug 7 7 21-01-1099 FAMIL Y SETTLEMENT AGREEMENT THE FIRST AND FINAL ACCOUNT OF GARY L FOLTZ AND DONALD J. FOLTZ, EXECUTORS UNDER THE LAST WILL AND TESTAMENT OF MARGARET N. LaVIA, LATE OF THE TOWNSHIP OF UPPER ALLEN, COUNTY OF CUMBERLAND, AND STATE OF PENNSYLVANIA, DECEASED, AND RELEASE OF THE DISTRIBUTEES UNDER THE WILL OF SAID DECEDENT HERETO ATTACHED. Date of Death: November 22, 2001 Dates Letters Advertised: Cumberland Law Journal- August 2nd, 9th & 16t\ 2002 The Sentinel- July 25th, August 1st & 8th, 2002 PERSONALTY PRINCIPAL ACCOUNT DEBITS Accountants charge themselves with the Personal Property set forth in the Inventory filed in the Office of Register of Wills in and for Cumberland County in the amount of: $ 8323.84 Accountants also charged themselves with the following: United Water Pennsylvania - Refund 14.49 Advancements by Gary L. Foltz and Donald J. Foltz, Executors of said Estate and sole legatees, devises and distributees under the Will of said decedent, to pay all debts, Funeral expenses, a Administration Expenses and taxes of said decedent. Gary L. Foltz - Joint Money Market Account 4243.60 Gary L. Foltz - Cash Advance Donald J. Foltz - Cash Advance 700.00 700.00 Carried Forward $ 13981.93 1 Brought Forward 2003 Feb Gary L. Foltz - Cash Advance Donald J. Foltz - Cash Advance TOTAL PERSONALTY PRINCIPAL ACCOUNT DEBITS PERSONALTY PRINCIPAL ACCOUNT CREDIT $ 13981.93 63.36 63.36 $ 14108.65 Accountant ask credit for the following: 2001 Dec PP & L - Electric ( 10/31 - 11/26/01) $ 47.48 Dec Myers Funeral Home - Funeral Expense 7220.00 Dec Verizon - Final Phone Billing 58.24 2002 Jan 17 Gary Foltz - Reimbursement for Probate Costs 57.00 17 MCI - Final Billing 4.06 May 9 Gingrich Memorials - Inscription 95.00 Aug 7 William L. Sunday - Reimbursement for Costs $ 168.83 Partial Fee 400.00 568.83 Aug 7 CharlYn Y. Guerriero - Notary Fees 8.00 7 Register of Wills - Filing Fees 25.00 7 Register of Wills, Agent - Pa Inheritance Tax 2906.06 2003 Feb William L. Sunday - Balance Attorney's Fee 400.00 Feb Register of Wills - Partial Filing Fee ( Family Settlement Agreement) 15.84 TOTAL PERSONALTY PRINCIPAL ACCOUNT CREDITS 2 $ 11405.57 PERSONALTY INCOME ACCOUNT RECEIPTS Accountants charge themselves with the following: 2001 Dec6 6 PNC Bank, N.A. - Interest (Checking Account # 50-0353-3286) PNC Bank, N.A. - Interest (Joint Money market Account) TOTAL PERSONALTY INCOME ACCOUNT RECEIPTS PERSONALTY INCOME ACCOUNT EXPENDITURES Accountants claim credit for the following: 2003 Feb Register of Wills - Balance Due to file Family Settlement Agreement TOTAL PERSONALTY INCOME ACCOUNT EXPENDITURES 3 $ .25 -:.2l $ 1.16 $ ---.UQ $ 1.16 ADVANCEMENTS To: Donald J. Foltz - 43 ~ shs Met Life Gary L. Foltz - 43 ~ shs Met Life To: Donald J. Foltz and Gary L. Foltz as tenants in common in equal shares: Furniture Costume Jewelry Clothing TOTAL ADVANCEMENTS RECAPITULATION Personalty: Principal Account Debits Credits Balance Income Account Receipts Expenditures $ 1.16 $ 1.16 Balance 0.00 Total Distributable Estate Less: Advancements Balance in hands of Accountants for Distribution 4 $ $ $ $ 1184.07 1184.07 300.00 25.00 10.00 $ 2703.14 14108.65 11405.51 $ 2703.14 $ $ 2703.14 2703.14 $ 0.00 RELEASE WHEREAS, Margaret N. LaVia, a widow, died November 22, 2001 leaving a Last Will and Testament dated October 9, 1990wherein and whereby she gave, devised and bequeathed the residue of her Estate after the paYment of her debts and funeral expenses unto her sons, Donald J. Foltz and Gary L. Foltz providing they survived the Testatrix; and WHEREAS, the residue of the Estate of Margaret N. LaVia, deceased, is distributable to her two sons, both or whom survived her, in equal shares. NOW KNOW ALL PERSONS BY THESE PRESENTS, that we, Donald J. Foltz and Gary L. Foltz, sole residuary legatees, devisees and distributees of the Estate of said decedent, and the only persons entitled to share in the distribution of said Estate, do hereby declare and say that we, and each of us, have examined the foregoing Account find the same to be true and correct and in strict accordance with the terms and provisions of said Will, and do hereby acknowledge that we, and each of us, this day have had and received of and from Donald J. Foltz and Gary L. Foltz, Executors of the Estate of Margaret N. LaVia, the Securities and Chattels set opposite our, and each of our names in the above stated Account as Advancements in full satisfaction, paYment and discharge of all such sum or sums of money, legacies and bequests, share or shares, purparts and dividends which were due, owing payable and belonging to us, and each of us, and by any means whatsoever, for or on account of our, and each of our, full share, part or dividend of the Estate of the said decedent and all interest accrued thereon. NOW THEREFORE, we, and each of us, the said residuary legatees, devisees and distributees of the Estate of Margaret N. LaVia, deceased, do by these presents remise, release, quit-claim and forever discharge the said Donald J. Foltz and Gary L. Foltz their heirs, executors and administrators, of and from all actions, suits, paYments, accounts, reckonings, claims and demands whatsoever, for or by reason thereof, or of any other act, matter, cause or thing whatsoever, form the beginning of the world to the day and the date of these said presents. AND, desiring to avoid the delaYing and expense of the settlement of the said Estate by filing the foregoing Account of said administration in the Office of the Clerk of the Orphans' Court of the Court of Common Pleas of Cumberland County, Pennsylvania, and by having the balance in the hands of the Executors, as shown by said Account, distributed by the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania, we, and each of us, do hereby agree that the foregoing statement concerning the manner of settlement may be recorded with the same effect upon us, and each of us, as if the same had been reported by the said Orphans' Court Division of the said Court of Common Pleas. AND, in consideration of the aforesaid settlement being made without the aid of said Orphans' Court Division, of said Court that we, and each of us, do hereby agree that if any debts or demands other than those included within The First and Final Account of the said Donald J. Foltz and Gary L. Foltz, Executors of the Estate of Margaret N. LaVia, deceased, as hereinbefore set forth, shall be hereafter recovered against the Estate of said decedent and be legally payable out of the same, that we, and each of us, shall return to said Executors such ratable amounts thereof as may be necessary to pay such legally enforceable debts or demands. 5 IN WITNESS WHEREOF, we have hereunto set our hands and seals this j~ dayof rFlB/2v4~; I , 2003. ~" ,(~~ Witness D2~i q ~~~ (SEAL) (SEAL) Witness STATE OF PENNSYLVANIA : ss. COUNTY OF CUMBERLAND Before me, the subscriber, a Notary Public in and for said State and County, personally appeared, Donald J. Foltz and Gary L. Foltz, and in due form of law acknowledged the foregoing Release to be his act and deed and desired that the same might be recorded as such. WITNESS my hand and notarial seal this 6(51'- day of 3 Uti e. ,2003. Notary PUb]' J P ~ (SEAL) Notalial Seal Gail P. Minnich, Notary Public Mechanicsburg Bom, Cumber1and County My Commission Expires Dec. 9, 2006 Member, Pennsylvania Association Of Notaries 6 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND l J 55: Gary L. Foltz and Donald J. Foltz being duly sworn ____ according to law, deposes and says that they are the __ _______Ex_~~utors__________ of the Estate of Ma~ar~t N. LaVia late of --- UpperuA11en------- _UH____ , Cumberland County, Pa., deceased and that the within is an inventory made by them ., the said Executors of the entire estate of said decedent, consisting of all the personal prop~rty and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. 1-1. . Gary L. Foltz ~ ?! ~ Sworn and subscribed before me, *Donald J. Foltz g..~ g, ~{,__ r-/ Executor _ .=j:q""~ ( ~?OO? 122 South Market Street *507 Broad Circle Shiremanstown, PA 17011-6639 *Mechanicsburg, PA 17055 N t rial Seal Ch Y. emera, Notary Public Mecha icsburg Boro, Cumberland County My Commission Expires May 18, 2006 Member, Pennsylvania Association Of Notaries Addr.ss Date of Death _____h__ 22 November Month 2001 Day Y.ar INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. +J " ClJL() >- CIJ ClJL() t- W III ~O >- ~ I- 10 +Jl' '" w -c( Q) CIlr-l '" ~ Q.. t- t'(j 0 0 Vl Q) ell ~re 0 0 w w -.-f C 0" t'(j r-I I ~ > 10 I J- Q.. Q.. ~ c r-I Z t- ...J LL t'(j c: 10 L. ... -c( 0 ....:I ClJ 0 9 LL ...J Q.. :t: w -c( w r-I CIl 0 . r-I >- -c( :J r-I > Z ~ Z < .... N Z 0 c . c:..o c +J ~ :3 ....:I -.-f fI.l Vl Z 0 t'(j 0 0 ~ ~ u ra :8-.-f Z W -c( .,. . ~ Q.. t'(j "tJ -.-f ~ D c r-I 3..c: 10 t'(j '+- ""i: r-I 0 0 -.-f '" ClJ :81 Q) 3: (Y):8 ...0 ~ ell E -0 .... ..! 0 I 10 :3 0 ...J U ii: co 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 WILLIAM L SUNDAY ESQUIRE 39 WEST MAIN STREET MECHANICSBURG, PA 17055-6230 _u_n__ fold ESTATE INFORMATION: SSN: 197-09-8587 FILE NUMBER: 2101-1099 DECEDENT NAME: LA VIA MARGARET N DATE OF PAYMENT: 08/12/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 11/22/2001 NO. CD 001509 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $2,906.06 I I I I I I I I TOTAL AMOUNT PAID: $2,906.06 REMARKS: GARY L FOLTZ & DONALD J FOLTZ C/O WILLIAM L SUNDAY ESQUIRE CHECK#10 SEAL INITIALS: CW RECEIVED BY: REGISTER OF WILLS MARY C. LEWIS REGISTER OF WILLS 1,?-c:2Y- // ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT 1 ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX I \. WILLIAM L SUNDAY 39 W MAIN ST MECHANICSBURG DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 09-30-2002 LAVIA 11-22-2001 21 01-1099 CUMBERLAND 101 *' REY-1547 EX iFP (01-021 MARGARET N PA 17055 Allount Re..itted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE1 PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ R"Ev:is4j-ix-iFP--Coi-:ozi--NOYici--OF-'=ftiHERYTANCi-YAX-AppRjrisEMENT-,--iLL"owANce-oii----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF LAVIA MARGARET N FILE NO. 21 01-1099 ACN 101 DATE 09-30-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) .00 2,368.14 .00 .00 5,955.70 2,121.80 62,766.98 (8) 81523.63 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of abb returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due .00 X 00 = .00 641579.21 X 045 = 21906.06 .00 X 12 = .00 .00 X 15 = .00 (19)= 21906.06 109.78 lll) (12) (13) (14) NOTE: To insure proper credit to your account1 subllit the upper portion of this forll with your tax paYllent. 731212.62 8.633 41 641579.21 .00 641579.21 TAX CREDITS: . ... ,...... R.."..... . (+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 08-12-2002 CDOO1509 .00 21906.06 TOTAL TAX CREDIT 21906.06 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED 1 SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $11 NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)1 YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) , 9'/ STATUS REPORT UNDER RULE 6.12 Name of Decedent: Margaret N. LaVia Date of Deathl November 22, 2001 Wi 11 . No . 21-01-1099 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate. 1. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believe~ that the administration will be complete: 3. If the answer ~o No.1 is Yes, state the following: 8. Did the personal representative file a final account with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: N/A 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 Cerk of tl].e Orphans I Court andf may be at.t.a.ched tOttthi.!~ reoort . Copy of Famlly Se~tlement Agreement ileQ June 26,~U03 1S a acn~ nereto Date, June 30. 2003 ~ ~ -L~ . Signature. ,'-. ~::: William L. Sunday Name (Please type or print) 39 West Main Street Mechanicsburg, . PA 1 7055-6230 Address ['"1", I _...J =:J --:' (717 ) 766-9622 Tel. No. \".,.1 C) a: p Capacity: Personal Representative X Counsel for personal representative (MAH :.rmf / AM3) 2002 March 15 2001 Dec6 2002 Aug 7 7 21-01-1099 F AMIL Y SETTLEMENT AGREEMENT THE FIRST AND FINAL ACCOUNT OF GARY L FOLTZ AND DONALD J. FOLTZ, EXECUTORS UNDER THE LAST WILL AND TESTAMENT OF MARGARET N. LaVIA, LATE OF THE TOWNSHIP OF UPPER ALLEN, COUNTY OF CUMBERLAND, AND STATE OF PENNSYL VANIA, DECEASED, AND RELEASE OF THE DISTRIBUTEES UNDER THE WILL OF SAID DECEDENT HERETO ATTACHED. Date of Death: November 22, 2001 Dates Letters Advertised: Cumberland Law Journal- August 2nd, 9th & 16th, 2002 The Sentinel- July 25th, August 1 st & 8th, 2002 PERSONALTY PRINCIPAL ACCOUNT DEBITS Accountants charge themselves with the Personal Property set forth in the Inventory filed in the Office of Register of Wills in and for Cumberland County in the amount of: $ 8323.84 Accountants also charged themselves with the following: United Water Pennsylvania - Refund 14.49 Advancements by Gary L. Foltz and Donald J. Foltz, Executors of said Estate and sole legatees, devises and distributees under the Will of said decedent, to pay all debts, Funeral expenses, a Administration Expenses and taxes of said decedent. Gary L. Foltz - Joint Money Market Account 4243.60 Gary L. Foltz - Cash Advance Donald J. Foltz - Cash Advance 700.00 700.00 Carried Forward $ 13981.93 1 Brought Forward 2003 Feb Gary L. Foltz - Cash Advance Donald J. Foltz - Cash Advance TOTAL PERSONALTY PRINCIPAL ACCOUNT DEBITS PERSONALTY PRINCIPAL ACCOUNT CREDIT Accountant ask credit for the following: 2001 Dec Dec Dec PP & L - Electric (10/31 - 11/26/01) Myers Funeral Home - Funeral Expense Verizon - Final Phone Billing $ 13981.93 63.36 63.36 $ 14108.65 $ 47.48 7220.00 58.24 2002 Jan 17 Gary Foltz - Reimbursement for Probate Costs 57.00 17 MCI - Final Billing 4.06 May 9 Gingrich Memorials - Inscription 95.00 Aug 7 William L. Sunday - Reimbursement for Costs $ 168.83 Partial Fee 400.00 568.83 Aug 7 Charlyn Y. Guerriero - Notary Fees 8.00 7 Register of Wills - Filing Fees 25.00 7 Register of Wills, Agent - Pa Inheritance Tax 2906.06 2003 Feb William L. Sunday- Balance Attorney's Fee 400.00 Feb Register of Wills - Partial Filing Fee (Family Settlement Agreement) 15.84 TOTAL PERSONALTY PRINCIPAL ACCOUNT CREDITS 2 $ 11405.57 PERSONALTY INCOME ACCOUNT RECEIPTS Accountants charge themselves with the following: 2001 Dec 6 6 PNC Bank, N.A. - Interest (Checking Account # 50-0353-3286) PNC Bank, N.A. - Interest ( Joint Money market Account) TOTAL PERSONALTY INCOME ACCOUNT RECEIPTS PERSONALTY INCOME ACCOUNT EXPENDITURES Accountants claim credit for the following: 2003 Feb Register of Wills - Balance Due to file Family Settlement Agreement TOTAL PERSONALTY INCOME ACCOUNT EXPENDITURES 3 $ .25 ---:2l $ 1.16 $ --1:lQ $ 1.16 ADVANCEMENTS To: Donald J. Foltz - 43 VI shs Met Life Gary L. Foltz - 43 12 shs Met Life To: Donald J. Foltz and Gary L. Foltz as tenants in common in equal shares: Furniture Costume Jewelry Clothing TOTAL ADVANCEMENTS RECAPITULATION Personalty: Principal Account Debits Credits Balance Income Account Receipts Expenditures Balance Total Distributable Estate Less: Advancements $ 1.16 $ 1.16 0.00 Balance in hands of Accountants for Distribution 4 $ $ $ $ $ 1184.07 1184.07 300.00 25.00 10.00 2703.14 14108.65 11405.51 $ 2703.14 $ $ 2703.14 2703.14 $ 0.00 RELEASE WHEREAS, Margaret N. LaVia, a widow, died November 22, 2001 leaving a Last Will and Testament dated October 9, 1990wherein and whereby she gave, devised and bequeathed the residue of her Estate after the payment of her debts and funeral expenses unto her sons, Donald J. Foltz and Gary L. Foltz providing they survived the Testatrix; and WHEREAS, the residue of the Estate of Margaret N. La Via, deceased, is distributable to her two sons, both or whom survived her, in equal shares. NOW KNOW ALL PERSONS BY THESE PRESENTS, that we, Donald J. Foltz and Gary L. Foltz, sole residuary legatees, devisees and distributees of the Estate of said decedent, and the only persons entitled to share in the distribution of said Estate, do hereby declare and say that we, and each of us, have examined the foregoing Account find the same to be true and correct and in strict accordance with the terms and provisions of said Will, and do hereby acknowledge that we, and each of us, this day have had and received of and from Donald J. Foltz and Gary L. Foltz, Executors of the Estate of Margaret N. LaVia, the Securities and Chattels set opposite our, and each of our names in the above stated Account as Advancements in full satisfaction, payment and discharge of all such sum or sums of money, legacies and bequests, share or shares, purparts and dividends which were due, owing payable and belonging to us, and each of us, and by any means whatsoever, for or on account of our, and each of our, full share, part or dividend of the Estate of the said decedent and all interest accrued thereon. NOW THEREFORE, we, and each of us, the said residuary legatees, devisees and distributees of the Estate of Margaret N. La Via, deceased, do by these presents remise, release, quit-claim and forever discharge the said Donald J. Foltz and Gary L. Foltz their heirs, executors and administrators, of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by reason thereof, or of any other act, matter, cause or thing whatsoever, form the beginning of the world to the day and the date of these said presents. AND, desiring to avoid the delaYing and expense of the settlement of the said Estate by filing the foregoing Account of said administration in the Office of the Clerk of the Orphans' Court of the Court of Common Pleas of Cumberland County, Pennsylvania, and by having the balance in the hands of the Executors, as shown by said Account, distributed by the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania, we, and each of us, do hereby agree that the foregoing statement concerning the manner of settlement may be recorded with the same effect upon us, and each of us, as if the same had been reported by the said Orphans' Court Division of the said Court of Common Pleas. AND, in consideration of the aforesaid settlement being made without the aid of said Orphans' Court Division, of said Court that we, and each of us, do hereby agree that if any debts or demands other than those included within The First and Final Account of the said Donald J. Foltz and Gary L. Foltz, Executors of the Estate of Margaret N. LaVia, deceased, as hereinbefore set forth, shall be hereafter recovered against the Estate of said decedent and be legally payable out of the same, that we, and each of us, shall return to said Executors such ratable amounts thereof as may be necessary to pay such legally enforceable debts or demand.s. 5 IN WITNESS WHEREOF, we have hereunto set our hands and seals this Jf day of 1'EP,#i?! ~4{ ~~ Witness , 2003. Witness 3d~1- f~ (SEAL) -:!i~tz;l~ (SEAL) ST ATE OF PENNSYLVANIA : ss. COUNTY OF CUMBERLAND Before me, the subscriber, a Notary Public in and for said State and County, personally appeared, Donald J. Foltz and Gary L. Foltz, and in due form of law acknowledged the foregoing Release to be his act and deed and desired that the same might be recorded as such. -r- WITNESS my hand and notarial seal this :2 6 day of J0\ (\ €- Notary pUbR~ P fiW ,2003. (SEAL) Notarial Seal Gail P. Minnich, Notary Public Mechanicsb~rg. Boro, Cumberiand County My CommISSIon Expires Dec. 9, 2006 Member, Pennsylvania Association Of Notaries 6 RE'I".1500El:(6-00 W I- :::.::~(/) U"'''' Wo.U ",00 U"'~ 0.'" 0. " REV-1500 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT 280601 HARRISBURG, PA 17128-0601 INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W C W o W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) LaVia Margaret N DATE OF DEATH (MM-OD-YEAR) November 22, 2001 OATE OF BIRTH (MM-DD-YEAR) December 16, 1917 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) N/A [Xl 1. Original Return o 4. limited Estate rn 6, Decedent Died Testate {Attacl1 oopyo!Will) o g, Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7, Decedent Maintained a Living Trust (Attach oopyofTrust) o 10. Spousal Poverty Credit (date ofdealh betweeo 12-31-91 aod 1-1-95) OfFICiAl / Y "'---'" i 1- ~ </- FILE NUMBER 2....L-~L COUNTY CODE YEAR 1..fr..--9..--9.._ NUMBER SOCIAL SECURITY NUMBER 197 - 09 - 8587 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (dale of deatl1 prior to 12-13,82) o 5. Federal Estate Tax Return Required o 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (AltachSchO) I- Z W " Z o 0. '" W '" '" o U NAME William L. Sunday FIRM NAME {If Applicable) COMPLETE MAILING AODRESS 39 West Main Street Mechanicsburg, PA 17055-6230 (1) . OFFICIAL USE ONLY --l I (2) 2368.14 (3) I (4) (5) 5955.70 (6) ::>121.80 (7) 62766.98 TELEPHONE NUMBER (717) 766-9622 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) z o 5 ~ I- it <l: o w c::: 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total lines 1-7) g, Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & liens (Schedule I) (9) (10) 8523.63 109.78 11. Total Deductions (total Lines g & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (ScheduleJ) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SlOE FOR APPLICABLE RATES z o < I-' ~ ll.. :!! o o g 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under See, 9116 (a)(1.2) x.O_ (15) x .042... (16) x .12 (17) x .15 (18) (19) 16. Amount of Line 14 taxable at lineal rate 64579.21 17. Amount of Line 14laxable at sibling rate 18, Amount of Line 14 taxable at collateral rate 19 Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT """t. C~:;;:;:imr:i~mU~;!Yl!ff." . ,""'''', (8) 73212.62 (11) (12) (13) 8633.41 64579.21 o (14) 64579.21 :1906_06 2906.06 Decedent's Complete Address: STREET ADDRESS 32 South int Drive CITY Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount 2906.06 Total Credits (A + 8 + C ) (2) o 3. InteresVPenaity if applicable D. Interest E. Penalty Totai interesUPenalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAVMENT. Check box on Page 1 Une 20 to request a refund (4) o 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 2906.06 A. Enter the interest on the tax due. 8. Enter the total of Line 5 + 5A. This is the 8ALANCE DUE. (5A) (58) o 2906.06 Make Check Payable to: REGISTER OF WILLS, AGENT ~1.:nlllliHllr' p IlillIlR1]ri'"''']lil1lF11 1 rillmrm~mllllmllln ~1~--1?lllI lJr ~"~~1If -lm1r:1111fI!7 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS *Except as an incident of Joint 1. Did decedent make a transfer and: ownership Ves a. retain the use or income of the property transferred;... . ............... ....... 0 b. retain the right to designate who shall use the property transferred or its income;.. ........ 0 c. retain a reversionary interest; or.. ......... 0 d. receive the promise for life of either payments, benefits or care?. ................ ....... D 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .. .. 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?... . 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . No [XI * [XI * [XI * [XI [XI IXl ..... GJ D IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and 10 the best of my knowledge and belief, it is true, correct and complete. Declaralion of pre parer other than the personal representative is based on all information 01 which preparerhas any knowledge SIGNA OF PERS N RES ONSIBL FOR FILING RETURN ** * * ** 2002 39 West Main Street, Mechanic~hllrq. PA 170~~-h?<O __:__1] _Ill ,lllli1W- j tilll ,"'.. _ 111_"". PJIIll.Ulmllllllllil!lEilllr!lllllll For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 99116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 PS. 99116(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. 99116(1.2) [72 P.S. 99116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. .,",~'~"'..""'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Margaret N. Lavia All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. FILE NUMBER 21-01-1099 DESCRIPTION VALUE AT DATE OF DEATH $ 2368.14 87 aha MetLife - Common - NYSE @ 27.22 TOTAL (Also enter on line 2, Recapitulation) $ 2368.14 (If more space is needed, insert additional sheets of the same size) .,",."om."." . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY Margaret N. LaVia FILE NUMBER 21-09-1099 lndude the proceeds of litigation and the date the proceeds were received by the estate. All property jointty-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. VALUE AT DATE OF DEATH DESCRIPTION Interest Checking Account #50-0353-3286 in PNC Bank, N.A. Principal Accrued Interest Cash on possession Comcast - Refund Donegal Mutual Insurance Co. - Auto Premium Refund 1994 Olds Cutlass - @ Sale price Furniture: Bed, Mattress and springs Couch Chair Kitchen table and chairs 2883.63 .04 39.32 3.20 149.00 2500.00 $100.00 100.00 50.00 50.00 300.00 Costume jewelry Clothing PP&L - Refund 25.00 10.00 45.51 TOTAL (Also enter on line 5. Recapitulation) $ 5955.70 (If more space is needed, insert additional sheets of the same size) REV.l!iOllEX. (1-91j '* SCHEDULE F . JOINTL Y.OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERJTANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Marqaret N. LaVia If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. FILE NUMBER 21-01-1099 SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A Gary L. Foltz 122 South Market Street Shiremanstown, PA 17011 Son B. c. JOINTLY-OWNED PROPERTY: lETTER DATE DESCRIPTiON OF PROPERTY . %OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank CkX:OUnt number or similar identifying number. Atta::h DATE OF DEATH DECO'S VAlUE OF NUMBER TENANT JOfNT deed for jointly-held real estate. VAlUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. Joint Money Market Account #50-3012-0866 in PNC Bank N.A. in joint names of Margaret N. LaVia and Gary L. Foltz, opened as a joint account on 2Af4/83 Principal 4243.46 50% 2121. 73 Accrued Interest .14 50% .07 TOTAL (Also enter on line 6, Recapitulation) $ 2121.80 .. (If more space IS needed, Insert additional sheets of the same size) '''''''''''.,'',9''. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Margaret N. LaVia FilE NUMBER 21-01-1099 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER 1. DESCRIPTION OF PROPERTY INCLUDE THE NAME OFTHETRI\NSFEREE,THEIR RELATIONSHIPTODECEDENTAN OTHEDATEOFTRANSFER ATTACHACOPVOFTHEDEEDFOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET Metropolitan Life Insurance Company issued Nonqualified Tax Deferred Annuity, Contract No. 073 337 511 B to Margaret LaVia, owner and annuitant,on February 4, 1999 with Donald Foltz and Gary Foltz as named beneficiaries. Accumulation Value on Date of Death $44603.52 2. Metropolitan Life Insurance Company issued Nonqualified Tax Deferred Annuity, Contract No. 007 056 843 MA to Margaret LaVia, owner and annuitant, on January 11 1985 with Donald Foltz and Gary Foltz as named beneficiaries Accumulation Value on Date of Death $18163.46 %OF DECO'S INTEREST EXCLUSION IFAPPLICAllI.~~' 100% o 100% o TOTAL (Also enter on line 7, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) TAXABLE VALUE $44603.52 $18163.46 QQ REV.~-511 EX+ (12-99) ~,~ ~~ '''~ ESTATE OF Margaret N. LaVia COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-01-1099 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Myers Funeral Horne - Funeral Expense $ 7220.00 James R. Gingrich Memorials - Inscription 95.00 B ADMINISTRATIVE COSTS: 1 Personal Representative's Commissions Name of Personal Representalive(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City _..__..'"________.._______.________ State ___ Zip Year(s) Commission Paid: 2 Attorney Fees 800.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City___ -- State __lip Relationship of Claimant to Decedent 4. Probate Fees 51.00 5. Accountant's Fees 6 Tax Return Preparer's Fees 7 Register of Wills - (2) Short Certificates 6.00 8. Cumberland Law Journal - Executors' Notice 75.00 9. The Sentinel - Executors' Notice 93.83 10. PP&L - Electric (11/26-12/26/01) 24.80 11. Register of wills - Filing PA Form 1500 and Inventory 25.00 12. Charlyn Y. Guerriero - Notary 8.00 Reserved for filing Account,Reed ReleaseE 125.00 TOTAL (Also enter on line 9, Recapitulation) $ 8523.63 Debts of decedent must be reported on Schedule I. (If more space is needed, insert additional sheets of the same size) - REV-1512EX.:1-,dJ \il-~ -~ H ~'>. , 0; _u.' .. " v ~(- .- ,-' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN Rf'SIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Marqaret N. LaVia FILE NUMBER 21-01-1099 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. PP&L Electric Utilities - Electric (10/31 - 11/26/02) $ 47.48 2. Verizon - Final phone bill 58.24 3. Me! - Final Bill 4.06 TOTAL (Also enter on line 10, Recapitulation) $ 109.78 (If more space IS needed, Insert additional sheets of the same slle) REV-J513 EX+ (9-00) . . '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Margaret N. LaVia FILE NUMBER 21-01-1099 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Donald J. Foltz Son One-half ( 507 Broad Circle Annuities Sch Mechanicsburg, PA 17055 31383.49 One-half ( distributable Est 2 Gary L. Foltz Son One-half ( 122 South Market Street Annuities Sch Shiremanstown, PA 17011-6639 31383.49 Joint P Sch F 2121.80 One-half ( distributable Est ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18. AS APPROPRIATE. ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ J,) G. ~) ate J,) G rop J,) ate (If more space is needed, insert additional sheets of the same size)