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Home My WebLink About06-08-06 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 MANUFACTURERS AND TRADERS 213 MARKET ST HARRISBURG, PA 17101 __h____ fold ESTATE INFORMATION: SSN: 172-01-8979 FILE NUMBER: 2105-0887 DECEDENT NAME: SCHILLING J NEDRA DATE OF PAYMENT: 06/08/2006 POSTMARK DATE: 06/08/2006 COUNTY: CUMBERLAND DATE OF DEATH: 09/08/2005 NO. CD 006814 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,413.66 I I I I I I I I TOTAL AMOUNT PAID: $1,413.66 REMARKS: M&T INVESTMENT GRP CHECK# 083613237 SEAL INITIALS: CMM RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS OFFICIAL USE ONLY REV -1500 EX + (6-00) c P o 0 R N R 0 E E S N T C o M P T U A T X A T I o N REV-1500 INHERITANCE-- TAX RETURN RESIDENT DECEDENT FILE NUMBER o E C E o E N T COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Schi11in J. Nedra DATE OF DEATH (MM-DD-YEAR) 21-05-0887 DATE OF BIRTH (MM-DD-YEAR) COUNTY CODE YEAR SOCIAL SECURITY NUMBER 172-01-8979 THIS RETURN MUST BE FILED IN DUPUCATEWlTH THE NUMBER REGISTER OF WILLS SOCIAL SECURITY NUM6ER 1. Original Return 4. Limited Estate 6. Decedent Died Testate o 3 date of death . Remainder Return prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 2. 4a. 7. Supplemental Return Future Interest Compromise (date of death after 12-12-82) Decedent Maintained a Living Trust (Attach copy of Trust) Spousal Poverty Credit (date of death between 12-31-91 and 1- 1-95) (Attach copy of Will) D 9. Litigation Proceeds Received D 10. D 11. Election to tax under Sec. 91 13(A) (Attach Sch 0) NAME Jose h A. Macri, Vice-President & T.O. FIRM NAME (If Applicable) Manufacturers and Traders Trust Com an TELEPHONE NUMBER COMPLETE MAILING ADDRESS 213 Market Street Harrisburg, PA 17101 ~; c.:.:,'" R E C A P I T U L A T I o N 2 - 1 4 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 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 (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (8) 1,119,167.23 (11) 108.051.48 (12) 1,011,115.75 (13) 924.498.36 (14) 86,617.39 :::--J (1) (2) (3) 171,000.00 None None OFFICIAI.,.-USE ON~Y 'i,~_) -----: c--, ':_-) 1 . !:-~_-. ; -';.; , r ~ 1 _---' I.__J : ~~?\ -~ c."') (4) (5) None 34,252.79 -, -\ -=---{ (/) (J - j I (6) None o 913,914.44 103,654.74 4,396.74 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate. or transfers under Sec. 9116(aX1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. HH_~~!~8"j.f!jrl~~I\*-""~I.~"~~"'.I~\~.J.1Q"~l.i~.::': :~i~~"~.1iIt;I.m1l 0.00 0.00 0.00 86,617.39 (15) (16) (17) (18) (19) .0 0 .0 45 .12 .15 0.00 0.00 0.00 12.992.61 12,992.61 x X X X Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 53 Circle 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) 12,992.61 0.00 11,000.00 578.95 Total Credits ( A + B + C) (2) 11,578.95 3. Interest/Penalty if applicable D. Interest E. Penalty Totallnterest/Penalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WillS, AGENT mmmmmmlllllllllllllllill!ilillilllilillillilllllllllllIlllii!llilillll!i!llllllillilllliillilill!I!!I!llllil111!11!!ll!!!!lil!!I!!!!I!!I!II!lil!!!!!I!i!!!lii!iiii1IIIili!II!!!ill!llill!llliillllilllllllllllllmmmmmmmmmmmmmmmmmmlilllllllllillllilillll!il!liiliiiIWiIWIIIIIii!!I!!iillllllii!liillillililli!millli!llllliiiiii PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; . . . . . . . . . . . . . . . ~ ~ b. retain the right to designate who shall use the property transferred or its income; . . i.. c. retain a reversionary interest; or. . . . . . . . . . . . . . . . . . . . . . . . . . d. receive the promise for life of either payments, benefits or care? . . . . . . . . . 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . " 0 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FilE IT AS PART OF THE RETURN. 0.00 0.00 1,413.66 0.00 1,413.66 []] [!] [!] Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of pre~rer other than the p"ersontl representative is based on all information of which preparer has any knowledge. S'GNATUREOFPERSONRESPONSIBL~:~~~i~N~~(;ll Manufacturers and Traders Trust Company '!j h~'} ~.n:.;:;r~ent 213 Market Street ----------------------------------------------------- Trust Officer Harrisbur, PA 17101 Elizabeth G. Atticks , J. ~ 824 Lisburn Road ~immmmml~mmml!lmmml11!~m~mlmmmlm!mmli;I;11;~;~;I;;~1~;f:i:ili;i~~l~i;ii~;~i~!ill~li;l;ii;i;l;ii;li;i;i!;i;il;ii;!;~~!;ii;~~~I;ii;m;l;i!;!i;!;mlilmilrum~ml~rnlrnl1ilililmm:iilimiii For dates of death on or after July 1, 1994 and before January 1, 1995. the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 9116 (a) (1.1) (i)]. DATE ,,1., /ot" DATE The tax rate imposed on the net value of trans [72 P.S. 91 16(aX 1)]. 7fJ;Oj/C1ftA ~ ( () ()vy; -- /l/ffPJD The tax rate imposed on the net value of trans bUngs is 12% [72 P.S. 9116(aX1.3)]. A sibling is defined, under Section 9102, as an individual who has at leas.~-parent In eOffirnal1 with the decedent, whether by blood or adoption. Copyright (c) 2000 .form software only The Lackner Group, Inc. of transfers to or for the use of the surviving spouse is 0% Ise from tax, and the statutory requirements for disclosure of assets iciary. For dates of death on or after January 1, 199:- [72 P.S. 9116 (a) (1.1) (in]. The statute does I and filing a tax return are still applicable even For dates of death on or after July 1, 2000: The tax rate imposed on the net value of tram parent. an adoptive parent, or a stepparent of ,ears of age or younger at death to or for the use of a natural 'leal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2) Form REV-1500 EX (Rev. 6-00) REV-1S02 EX + (1-97) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER J. Nedra Schilling SS# 172-01-8979 09/08/2005 21-05-0887 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller. neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE A T DATE DESCRIPTION NUMBER OF DEATH 1 53 Circle Drive, Camp Hill, PA - Sale Price 171,000.00 More fully described in the Cumberland County Recorder of Deeds, Deed Book B19 Pag~s 597-599 TOTAL (Also enter on line 1, Recapitulation) S 171,000.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems. Inc. Form REV-1502 EX (Rev. 1-97) REV -1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT EST ATE OF FILE NUMBER J. Medra Schilling SS# 172-01-8979 09/08/2005 21-05-0887 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ITEM NUMBER 1 DESCRIPTION Erie Insurance Group - Refund of unearned Premium #Q080101395H VALUE AT DATE OF DEATH 2.00 2 Internal Revenue Service - Refund on Form 1040 1,800.00 3 Erie Insurance Group - Refund of unearned Premium on Homeowner's Policy #Q52 2900386 H 207.00 4 Erie Insurance Group - Refund of unearned Premium on Personal Catastrophe Policy #Q28 2350129H 72.00 5 Received from Patrick J. Reardon - Pro-Rata share of School Real Estate Tax (1/27/06 to 6/30/06) on Sale of 53 Circle Drive, Camp Hill, PA 693.00 6 Received from Patrick J. Reardon - Pro-Rata share of Sewer Expense (1/27/06 to 3/30/06) on Sale of 53 Circle Drive, Camp Hill, PA 91. 35 7 Received from AF&L Insurance Policy #2500 - Refund 1,929.49 8 Received from AF&L Insurance Policy #19208 - Refund 10,186.57 9 Received from AF&L Insurance Policy 112840 - Refund 360.58 10 Sovereign Bank Account #2334025919 - Date of Death Balance 186.14 Accrued Interest 0.21 11 Sovereign Bank Account #2331044732 - Date of Death Balance 14,652.36 Accrued Interest 0.04 12 Sovereign Bank Account /12331044848 - Date of Death Balance 121.26 13 Sovereign Bank Account #2331044856 - Date of Death Balance 1,435.31 14 Verizon - Refund on Cancellation 141.48 15 Personal Property - Sale Price 2,374.00 TOTAL (Also enter on line 5, Recapitulation) S 34,252. 79 (It more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) REV-1510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF J. Nedra Schilling SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY SS/} 172-01-8979 09/08/2005 FILE NUMBER 21-05-0887 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. DESCRIPTION OF PROPERTY %OF ITEM RELA'ltg~M{t~ t~b~~~5~~l~~J~~~~.1T~E6F ~~~~\FER. DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE NUMBER ATTACH ACOPYOFTHE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) 1 ING Account #C012275-0Y - 439,800.24 439,800.24 Annuity 2 Midland National Policy 440,318.00 440,318.00 /}8500060449 - Annuity J.W. Cole IRA Account #Jwl-006149 3 Prime Fund Capital Reserve 390.19 390.19 Fund - Date of Death Balance 4 2,937.861 shares Sentinel High 23,972.94 23,972.94 Yield Bond Fund Class A - Date of Death Balance J.W. Cole IRA Account #Jwl-006157 5 Prime Fund Capital Reserve 151.43 151.43 Fund - Date of Death Balance 6 1,137.456 shares Sentinel High 9,281. 64 9,281.64 Yield Bond Fund Class A - Date of Death Balance TOTAL (Also enter on line 7, Recapitulation) S 913,914.44 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1510 EX (Rev. 1-97) REV-1511 EX + (1-97) COMMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF J. Nedra Schilling Debts of decedent must be reported on Schedule I. ITEM NUMBER A. B. SSf! 172 - 01- 8979 09/08/2005 FILE NUMBER 21-05-0887 DESCRIPTION AMOUNT 1 FUNERAL EXPENSES: Romberger Memorials - Inscription 192.50 2 W. Orville Kimmel Funeral Home, Inc. - Funeral Expense 3,104.29 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions See Attached Schedule H-Bl Name of Personal Representative(s) Social Security Number{s) I EIN Number of Personal Representative(s) 16 - 0538020 Street Address 213 Market Street City Harrisburg State PA Zip 17101 71,400.00 Year(s) Commission Paid: 2. 3. Attorney's Fees Harry Bricker, Jr. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 17,350.00 City Relationship of Claimant to Decedent State Zip 4. Probate Fees Register of Wills 845.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs Cumberland County Register of Wills - Five Short Certificates 20.00 2 East Pennsboro Township - Sewer (October thru March 2006) 53 Circle Drive, Camp Hill, PA 241.50 3 Ensminger - Advertising Expenses on Sale of 53 Circle Drive, Camp Hill, PA 1,196.49 4 Ensminger Auctions - Commission on Sale of 53 Circle Drive, Camp Hill, PA and Personal Effects 6,840.00 Total of Continuation Schedule(s) 2,464..96 TOTAL (Also enter on line 9, Recapitulation) $ 103,654. 74 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems,lnc. Form REV-1511 EX (Rev. 1-97) Estate of: J. Nedra Schilling Soc Sec #: 172-01-8979 Date of Death: 09/08/2005 Continuation of Schedule H-B1 (Personal Representative's Commissions) Item II Description Amount 1 Manufacturers and Traders Trust Company - Co-Executor's Fee 213 Market Street Harrisburg, PA 17101 35,700.00 2 Elizabeth G. Atticks - Co-Executor's Fee 824 Lisburn Road Camp Hill, PA 17011 35,700.00 71,400.00 Estate of: J. Nedra Schilling Sac Sec #: 172-01-8979 Date of Death: 09/08/2005 Continuation of Schedule H-B4 (Probate Fees) Item 11 Description Amount 1 Cumberland County Register of Wills - Probate Fee 845.00 845.00 Estate of: J. Nedra Schilling Soc Sec #: 172-01-8979 Date of Death: 09/08/2005 Continuation of Schedule H-B7 (Other Administrative Costs) Item If Description Amount 5 Hitz Heating - Fuel Oil Expense - 53 Circle Drive, Camp Hill, PA 970.05 6 Hitz Heating - HVAC Repair - 53 Circle Drive, Camp Hill, PA 66.99 7 Marsh Advantage America - Liability Insurance 53 Circle Drive, Camp Hill, PA 95.00 8 Marsh Advantage America - Property (Fire) Insurance 53 Circle Drive, Camp Hill, PA 282.00 9 Marsh Advantage America - Property Insurance $67 and Liability Insurance $22 - 53 Circle Drive, Camp Hill, PA 89.00 10 Pennsylvania American Water Company - Utility Expense 97.60 11 PPL Electric Utilities - Utility Expense 45.27 12 Robert R. Jones, Appraisers - Appraisal Fee - 53 Circle Drive, Camp Hill, PA 300.00 13 The Sentinel - Cost of Advertising and Proof of Publication 412.73 14 County Taxes (01/01/06 to 01/27/06) on Sale of 53 Circle Drive, Camp Hill, PA 31.32 15 Cumberland Law Journal - Cost of Advertising and Proof of Publication 75.00 2,464.96 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF J. Nedra Schilling REV-1512 EX + (1-97) SCHEDULE I DEBTS OF DECEDENT~ MORTGAGE LIABILITIES, AND LIENS SS1f 172 - 01- 8979 FILE NUMBER 21-05-0887 09/08/2005 Include unreimbursed medical expenses. ITEM NUMBER 1 10 11 12 13 DESCRIPTION ADT Security Services - Final Bill AMOUNT 13.06 2 Alan Ceperich CPA - 2005 Personal Income Tax Preparation Fee 195.00 3 Charles HeIlig - Grass Cuttings and Leaf Rakings 230.00 4 Comcast Cable - Cable Expense 144.01 5 Country Meadows - Nursing Home Expense 578.81 6 East Pennsboro Ambulance Service, Inc. - Medical Expense 59.16 7 East Pennsboro Township Treasurer - Certificate of 2005/2006 County/Township and School Taxes 5.00 8 Holy Spirit Hospital - Medical Expense 6.89 9 Market Square Presbyterian Church - Pledge - 101 1,260.00 Market Square Presbyterian Church - Pledge - Doorway to our Future 1,250.00 MCI Residential Service - Utility Expense 282.96 PPL Electric Utilities - Utility Expense 300.77 WSTB - Final Earned Income Tax 71. 08 TOTAL (Also enter on line 10, Recapitulation) $ 4,396. 74 (If more space is needed, insert additional sheets of the same size) Copyriqht (e) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF J. Nedra Schilling SS#172-01-8979 SCHEDULE J BENEFICIARIES 09/08/2005 FILE NUMBER 21-05-0887 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(aX1.2)) 1 Elizabeth G. Atticks 824 Lisburn Road Camp Hill, PA 17011 Friend Life Annuity 86,617.39 ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS J. Nedra Schilling Foundation 3/5ths share of Residue 606,669.45 Total of Continuation Schedule(s) 317,828.91 TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) r.nnvrioht lc)lOoo form software only The Lackner Group, Inc. 924,498.36 Form REV-1513 EX (Rev. 9-00) Estate of: J. Nedra Schilling Sac Sec #: 172-01-8979 Date of Death: 09/08/2005 Continuation of Schedule J, Part II-B (Charitable and Governmental Bequests) Item # Description Amount or Share of Estate 2 Manufacturers and Traders Trust Company, Trustee for the Charitable Remainder Annuity Trust f/b/o Elizabeth G. Atticks. Upon the Death of Elizabeth G. Atticks, the Residual Remainder shall be distributed to the J. Nedra Schilling Foundation 2/5ths share of Residue 317,828.91 317,828.91 REV- 1514 EX + (9-00) SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN Check Box 4 0 Rev-1500 Cover Sheet ESTATE OF FILE NUMBER J. Nedra Schillin~ SS# 172-01-8979 09/08/2005 21-05-0887 This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of dElath prior to 5- 1 -89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5- 1 -89. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Copy #1 D Will D Intervi1fos Deed of Trust D Other DATE OF BIRTH Term of Years Term of Years Term of Years 1. Value of fund from which life estate is payable 2. Actuarial factor per appropriate table Interest table rate - D 3 1/2% 0 6% 0 10% 3. Value of life estate (Line 1 multiplied by Line 2) $ 0.00 0.00000 D Variable Rate 0.0 % $ 0.00 DATE OF BIRTH Elizabeth G. Atticks 07 18 14 91 Term of Years T arm of Years 1. Value of fund from which annuity is payable 404,446.30 2. Check appropriate block below and enter corresponding (number) Frequency of payout - D Weekly (52) 0 Bi-weekly (26) 0 Monthly (12) D Quarterly (4) D Semi-annually (ERRD Annually (1) 0 Other ( ) 3. Amount of payout per period 4. Aggregate annual payment, Line 2 multiplied by Line 3 5. Annuity Factor (see instructions) Interest table rate - 0 3 1/2% lKJ 6% 0 10% 0 Variable Rate 0 . 0 % 6. Adjustment Factor (see instructions) 7. Value of annuity - If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6)+ Line 3 4 6,066.70 24,266.80 3.5042 1.0186 86,617.39 0.00 NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13, 15, 16, 17 and 18. (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1514 EX (Rev. 9-00) Sovereign Bank ESTATE OF SOCIAL SECURITY #: DATE OF DEATH: J Nedra Schilling 172-01-8979 September 8, 2005 Account #: 2331044732 Type: In the name of: J Nedra Schilling Date of Death Balance: Int.(YTD) from 1/1/2005 to Accrued interest to date of death: Other Info: Checking Open date: 6/13/1997 $14,652.36 9/6/2005 $0.04 $4.3 8 Account #: 2331044848 Type: In the name of: J Nedra Schilling Date of Death Balance: Int.(YTD) from 1/1/2005 to Accrued interest to date of death: Other Info: Checking Open date: 7/15/1997 $121.26 8/25/2005 $0.00 $0.21 Account #: 2331044856 Type: In the name of: J Nedra Schilling Date of Death Balance: Int.(YTD) from 1/1/2005 to Accrued interest to date of death: Other Info: Checking Open date: 7/15/1997 $1,435.31 8/26/2005 $0.02 $0.33 Account #: 2334025919 Type: In the name of: J Nedra Schilling Date of Death Balance: Int.(YTD) from 1/1/2005 to Acc;rued interest to date of death: Other Info: Savings Open date: 5/12/1999 $186.14 8/31/2005 $0.21 $0.70 Page 1 of 1 ~ ~ . ~ If . i .' LAST WILL AN'O ~:~~trAMENT OF..:: ;. . I J. NEDRA SCHiLt.ING . ::! .'1'~ ,~)i.:~; I, J. NEDRA SCH:l~~W,~!(an.:~4~~r~i~~:~yidual, of the Borough of Camp Hill, County of Cumberland, and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament, hereby revoking and making void any and all Wills or testamentary writings by me at any time heretofore made. FIRST: I direct that all my debts, funeral expenses and inheritance taxes be paid by my personal representatives, hereinafter named, as soon after my death as may be practicable. SECOND: In the event my friend, Elizabeth G. Atticks, who presently resides at 1124 Columbus Avenue, Lemoyne, Pennsylvania, is"nving on the 31st day following my death, I give, devise and bequeath my home, situate at 53 Circle Drive, Camp Hill, Pennsylvania 17011, or any other home wl1i~h :may be my principal place of abode together with all policies of insuranc.e.on sai.d.r.~~!t~, to my friend, Elizabeth G. Atticks for and during the term of her natural life so)png. a's she pays all costs of maintenance thereof, including taxes, assessmer;ts.,~nsur~l"\c~ :~nd ordinary repairs, said property to :. :1 be insured in a reasonable amount insl,Iring the .iri:~rest of the remaindermen as wall as . ;:': . "Ji . . i~~:.~: ':: .: .'~l.:: '. herself. Upon the death of Eliz~~~m1~'. Atti~lWj!I.~~~ct my Executor, hereinafter named, ;' \~!. '~f~. ..,,!;I~;~j;;::;' I~')t f) to transfer said realty to the J. Nedra Schilling Fpundation. THIRD: I give and bequeath my personal effects, my clothing, jewelry, silver and China, to Elizabeth G. Atticks if she is living on the 31 st day following my death. FOURTH: I give, devise and bequeath all the rest, residue and remainder of my Estate, be it real, personal and mi>.<~d,.of .whatever nature and wheresoever the same may be situate, as follows: A. If Elizabeth G. Atticks does not survive me, all thereof outright to the J. Nedra Schilling Foundation. B. If Elizabeth G. Atticl(s survives me, three-fifths (3/5) thereof outright to the J. Nedra Schilling Foundation and tW<;l-fifths (2/5) thereof to Dauphin Deposit Bank h. ~ i .Hl :f ~ ~ ~ ',II,;;;': ;"'! ,'. j: ~ I .! ~ :"I! ; .,':; ;. 'll ~:.'~ " ., and Trust Company, as Trust~eJ .to be her~;'ik1rLlst and administered and distributed in .'. ";. . 'l~~. \ :,}.;" "J accordance. with the followi~~i p'~~~sio~~i~.~t.l$ :1.~\rnY intention to establish a charitable \' d.l. I~!." ,:: ' ,'} h' '!; I remainder annuity trust within th~ 1't1:elmit~g;olSection 6 of Rev. Proc. 90-32 and Section 664(d)(1) of the Internal Revenue Code (hereinafter referred to as "the Code"). 1. Pavmentbf Annuitv Amount. In each taxable year of the Trust, the Trustee shall pay to Elizabeth G. Atticks (hereinafter referred to as the "Recipient"), during the Recipient's life, an' annuity amount equal to six percent (6%) of the net fair market value of the a~sets passing in trust as finally determined for federal tax purposes; provided, however, that the payout percentage (as adjusted to reflect the timing and frequency of the annuity payments) shall not exceed the percentage that would result in a 5 percent probability that the Trust corpus will be exhausted before the death of the Recipient determined as of the date of my death (or the alternate valuation date, if applicable). The annuity 'amounfshaJr b:e paid in equal quarterly amounts, at the end of each quarter, from income and,' to 1hlf'.extent that income is not sufficient, from principal. Any income of the Trust for a t~xable year in excess of the annuity amount shall be added to principal. If the net fair market value of the Trust assets is incorrectly : determined, then within a rftr.~?n!ii?le P.E!~?~ .tjl11er the value is finally determined for . . . "7. - ..;" federal tax purposes, the ~ru.~~:~f:": s~j,~t:l P;ff,:ff- the Recipient (in the case of an undervaluation) or receive from tl:le. Recip,ier.Jt,l(i(l the case of an overvaluation) an amount equal to the difference between the annuity amount(s) properly payable and the annuity amount(s) actually paid. 2. Deferral Provision. The obligation to pay the annuity amount shall commence with the date of my de~thJ.bl,:lt payment of the annuity amount may be deferred from such date until the end of the taxable year of the Trust in which occurs the complete funding of the Trust. Within a reasonable time after the end of the taxable year in which the complete funding of the Trust occurs, the Trustee must pay to the Recipient (in the case of an underpayment). or receive from the Recipient (in the case of an overpayment) the difference between:. (1) ~ny annuity amounts actually paid, plus interest, compounded annually,computed;f.9r:~ny period at the rate of interest that the federal income tax regulations und~.r sectio.~ i6&4 of the Code prescribe for the Trust for :.-;', ~~'~"~'..:l!~1 ~ ;, ~. : . {" ,., 1 .... '" ~ l~:!:,ll' 'l!f\.!~~f, ":; ",;,li ~.~ ~1~ ;~.,:' ".:,,1.,11,,., 011,:,: '~, ~;.. ;.1 " J ',~ such computation for such period; and (2) the annuity amounts pay'able, plus interest, compounded annually. computed for any period at the rate of interest that the federal income tax regulations under section, 664: prescribe for the Trust for ~uch computation for such period. 3. Proration of the Annuity Amount. In determining the annuity amount, the Trustee shall prorate the same on a daily basis for a short taxable year and for the taxable year ending with the Recipient's death. 4. Distribution to Charity. Upon the death of the Recipient, the Trustee shall distribute all of the then principal and income of the Trust (other than any I ~.~ i amount due the Recipient or the Recipient's ~state under provisions above) to the J. : ; ;',,'\, Nedra Schilling Foundation ("Foundation")'; I~ the Foundation is not an organization ,. ", ;.; I.. iin.il~ described in sections 170(c) and 2055(a) of'theCode at the time when any principal or ;. income of the Trust is to be distributed td it, then the Trustee shall distribute such principal or income to such one or more orga'nizatlons described in sections 170(c} and .). ~ _. I ~ : ; '.~.' ~ir" l 2055(a} as the Trustee shall seiect in its s'oie d~scretion. i : :_' Ill;,,; : ~. :"1", ~ ('~~i 5. Additi'on:~i corltab'Jtidn~. No additional contributions shall be made to the Trust after the initial contribution.. The initial contribution, however, shall be deemed to consist of all property:passing to the Trust by reason of my death. 6. Prohibited Transactions. The Trustee shall mak.e distributions at such time and in such manner as not to subject the Trust to tax under section 4942 of the Code. Except for the payment of the annuity amount to the Recipient, the Trustee shall not engage in any act of self-dealing, as defined in section 4941 (d) of the Code, and shall not make any taxable expenditures, as defined in section 4945(d) of the Code. The Trustee shall not make any investments that jeopardize the charitab,le purpose of the Trust, within the meaning of section 4944.of th~ Code and the regulations thereunder, or retain any excess business holdings, withi~ 1he:meaning of section 4943(c) of the Code. : .' . ~l 7. Taxable Year.' Thei taxable year of the Trust shall be the calendar year. 1 !..; :~ I_ ':4 , i . ;,'j . ~' ! .;~ ~ . 8. Powers of Tmstee." !,~ addition to the powers, authorities and discretion granted to it by common Jaw, st~tu~ or under any rule of court, I hereby :' . .' - ~. expressly authorize and emp~..;yer;the'Trust~~,tP;lexercise the powers set forth below. All , I ,_ . ,'). 'j ;;:!, 3f~'i , '. "f. i'.: ~:!:;: ~ -,.i<h";\'. :":1'" 3 "t ~ ~ ~ ~ powers granted to the Trustee, whether by law or by this Will, are subject to such limitations as are set forth elsewhere in this Will and are subject to the provisions of section 664 of the Code and the regulations and Treasury determinations thereunder, and all such powers .shall be exercised only in a manner consistent with the qualification of this Trust as a charitable remainde~ annuity trust under section 664(d){1) of the Code. (a) To invest and reinvest in real or leasehold property. , ., tangible or intangible personal property., con;~on trust funds, mutual funds, common , .' ".'.1. ... stocks, preferred stocks, bond~I' a,~d debeQ~~res, all as the Trustee may consider '-..:1 , . '!;i.. advisable or proper, without applica~ion to,'odh~~approval of, any court and without being : 0' II,:.' restricted as to the character of any investment of Trust funds. . I:": '..: :";. q" ,. ;;' (b) To sl~II, I~~~.~}~r.rove, partition, mortgage, or exchange ;'. :.1 ,. any and all property at any ~}~.~;;~o,~~ing_ ~f~:1\,?f the trust, in such manner, for such purposes and upon such te~~s~H:~~e T~U.~:~~'.fu~y deem advisable. , (c) To vote in pers~n oTby proxy with respect to any shares of stock or other securities held by it, for any purpose, and to tal(e any action which the Trustee may deem necessary Dr proper in connection therewith, participate in any voting trust, merger or reorganization and to hold investments in the name of a nominee. (d) Toqorrow, p~ ~dvance money for purposes connected with the protection, preservation or improvement of any trust, and create one or more mortgages on, or pledges of, any part or all of the property included in such trust, wherever the Trustee shall deem the same in its judgment advisable. (e) To pay, compromise, compound, extend, modify, renew, adjust, submit to arbitration, sell Qr release. a.n~';claims or demands of the trust against , i i . ..; ,: others or of others against such t~ust as ;t.h~; Tr.~.$tee shall deem advisable and to make " .' !' '\ any payments in connection ther~Vfittl. .. .-'1 'l'!,), I .. ~ 1 ,; (f) ~Q ..~?<e<rvt~",':ar.knowledge and deliver any and all instruments in writing which the rruste~. may; qeem advisable to carry out any of the . .!.!i. powers described herein, incl49in~ t~eiPow~F.,~Q ,t~qicate any division or distribution of any ..' .. .... ~~ ". ",'.:1 trust by deeds or other writin,~~"lil~ i?~~uni.~~f~~~~.~t<<;1ed among the public records of any jurisdiction where any such property may be Ipcated. No party to any such instrument in writing signed by the Trustee shall be boun~ to see the application by the Trustee of . 4 j ~ ~ any money or other property paid and delivered to it pursuant to the terms of such instrument. 9. Provisions Reaardina Trustee. (a) Any. Trustee, max/resign at any time. Such resignation . ..:~ :~: shall be effective upon thirty (39) p.ays writt~tJ:;np,tice delivered or mailed to the then current adult beneficiary of the Trus:t.. :. 11" :,.; ~ .:!_ ~ l-:~'.. lll; . '. (b) The Iruste~ .Ofi~t;hil?tTrust shall serve as such at all times .' . ;~: , without bond. The Trustee shall notbe reql:J!r:9fQolf.iIe an inventory or annual report with " . :~ any court. I ; J . : ~ "' i\k:'li: h:;:, ". \..~ ;): .\~ld (c) ,ij';r.~~~:!:~~usf~~(f~~ii?P?e entitled to compensation as calculated under its schedule of fees publiphed :ff:om time to time. If the portion of the annual fee payable to the Trustee is less t,han :~he minimum annual commission then charged by the Trustee for administering similar trusts, the Trustee shall be entitled to receive from the principal of the Trust a fee equai to the difference between said minimum annual commission and the annual f~e payable to the Trustee from the Trust. (d) Trustee compensation, taxes, and other reasonable Trust expenses shall be charged against tho principal of the Trlist, and no part thereof shall be apportioned against the amounts payable under paragraph B.1 of Item Fifth of this Will. 10. Governina Law. The operation of the Trust shall be governed by the laws of Pennsylvania. The Tru~tee,how~~er, is prohibited from exercising any power or discretion granted unde,r.,: .s,~id ,':~~~' ::~~,at would be inconsistent with the qualification of the Trust under se~Jjpn 664(d):\:1')~f the Code and the corresponding , . regulations. ~ ....,. t. I... :,: I';'. 11. limited Power of Amen9ment. The Trustee shall have the . ,';' '!'~; . ,'1 power, acting alone to amend t~E( .T.~u~t in a.p~.~~~;?er required for the sole purpose of ensuring that the Trust qualifi~~: ~~;I'~i9on~i.nJ.:i~ .W:,::qualify as a charitable remainder 'I. I. ..11~'~':' ~:1" I :,~. 4 !:~:~ . ;11:: annuity trust within the meaning of section 664(d..}'P) of the Code. 12. Investment of Trust Ass~ts. Nothing herein shall be construed to restrict the Trustee from investing the Tru~t assets in a manner that could result in the annual realization of a reasonable amount of income or gain from the sale or disposition of Trust assets. 5 ~ ~ FIFTH: I hereby nominate, constitu'te, and appoint Dauphin Deposit Bank and ',' .' , ':',;! Trust Company and Elizabeth G., f\,tticks .to:~.e'r;ve as co-Executors of this, my Last Will '!. '-' ;',' :;i~" :iP~' and Testament providing ho~ev~.r,:.shO~I~\~~p~r. fail to qualify or cease to act as co- . ": ,":1 Executor of this, my Last WiII:and Testarpel1t;.J.her~by nominate, constitute, and appoint . . . " :. ,." ii- the other as sole executor. I furt~eq:Jirect, th~t,the personal representatives shall serve ,I' ;.... L: "," ':f :!~\ without bond. Said persona~~{~~f.'nent~t~y~~ J~~~~n have the power to discharge all the debts,liens and encumbran~~?:,r.,~~,r.l~~:m~,~T~i~$~~}~:well as any taxes thereon, to pay for the cost of the final disposition of.myremain~;~f~d final illness, if any, to receive any and all commissions and other compe.nsation for services rendered by me during my lifetime ! . .,.; and to perform any and all fiduciary duti,es authorized by statute. Further, I direct my personal representatives to preserve my Estate and any instructions pertaining to the distribution of the same from any attachment 'or anticipation while in the hands of my personal representative, it being my express intent that all legacies shall be free from any attachment or anticipation while in the hands of the accountant for my Estate. SIXTH: In order to clarify the position of Dauphin Deposit Bank and Trust Company and Elizabeth G. Atticks as co-Executors I herestate that over the years I have had a very high opinion of Dauphip D~Po.si.t;~anl< and Trust Company and its Trust Department and its professionali~,m in admiP~~!~fing Estates. Similarly, I have an equally : :.' ~ I !'~:' .~; rt . high opinion of Elizabeth G,. Att,ic~$; S~~.i,.t~,:,~kgood Christian woman who is highly ~ ; "' . .~.~;~.~.!: ;'.' . . I:., intelligent and who possesses,the h!ghe~t;~,~re~ of integrity. These are my reasons for naming both as co-Executors. ~~p,itiol!1~.~ly,)1 .;i.s my request and I hereby direct that .. 1-., ..~ . .' Elizabeth G. Atticks receive t~r.,~j:ll))~ Ex~i!ljor'~ l,ee as is received by Dauphin Deposit <' i :.';:.~ ~~: . .; ):;~ t. ~ ~ ~~ ~l Bank and Trust Company. I :~f~~~;.,~~~at '~~~t~,y.~~nt be made to her from my Estate as a charge against my Estate. ' .,.;'. d' .- , , SEVENTH: I hereby ciirect th,at all tax,~~ attributable to the passing of any assets ; ':. by means of this Will or otherwise, or that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from the residuary of my estate as a part of the expens.e of. tl:l~ administration of my estate. 6 .;':'! ,/';i'~. 1 : .! ':1 :~~;~i ;~: IN WITNESS WHEREOF-,:.I, ~:'~~~,F.!A SCHILLING, have signed, sealed, published and declared this to be my! Last ~ill an;~:! estament, consisting of this and two . . .' I (2) additional pages in the marg:in f31' each Of'V1ol~,b~ I, have also set my hand for greater ~' '. ': I. .; ; ~~~ ~ . . t: security and better identificatio:?:'~7l~:~,~ ~~ffl~t~r~a.r- ,1998. . . j;.-"Jf.u4~ (SEAL) M:Nedra Schilling ~ ~ The preceding instrument, consisting of this and two (2) other typewritten page, each identified by the signatu,re of th~,;restatrix, was on the day and date hereof signed, sealed, published and declared by J. NEDRA SCHILLING, Testatrix herein named as and for her Last Will, in the presence of us, who at her request, in her presence and in the presence of each other have hereunto subscribed our names as witnesses hereto. We further certify that at the time of the execution hereof, the said J. NEDRA SCHILLING was of sound and di posin7mi d, memory and understanding. ~],. ~~ /~ ( of ,g84~ LflJ2t1i?J'Y OSl'ot N- HI1~Q.J.~et/a.d \ f(i- /"711'1> ": .1! ;! .~. ~, ~o.m~~.):,Of ,~~/~ ~~~bf4~1n;~~~'~~ ~- "1, C\.' ~~~ S2 "'- '- '- , < \ : ,I i ;:~t '~ff:: :~,i ,'f:~,.i,~: ::;1:1 COMMONWEALTH OF PENNSYLVANIA ), COUNTY OF DAUPHIN ss: " I, J. NEDRA SCHILLING, Testa.trix. whose name is signed to the attached or foregoing instrument, having been duly qualified acpording to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affir2ed to and ac~ before me by J. NEDRA SCHILLING, the Testatrix. this 6? day of' 1998. L!-?~~df&6cV/ . . Notar:y ublic :; My:pommission expires: , , (SEAL) l~~;\~L .~. '7 '. Nolarial Seal Mary Ann Anderson, Notary Public I &_....a_...._ 1"'\_.._....,_ "'_.._.... .,f 1 ~ ~ ~ ~ : . ','., ;' ~ 1 \. , ;\ I; ;:: ;,,~!;;: COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN we,~ fv(. Qi'\U'<"- J..(' , : " ;~.; d~), ,.,.. !.. ," 1,1 t .' . .. i' : j . ';lI~!!h,M: l' l~! p< :1:T: ;' .:: 'J:~. ~i! ~. ,i' j!~ SS: and I the witnesses whose .names are signed to the attached or foregoing instrume duly qualified according to law, do depose and say that we were present and saw J. NEDRA SCHILLING, Testatrix, sign and execute the instrument as her Last Will and Testament; that J. NEDRA SCHILLING signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as. .W~~1esses; and that to the best of our . . ;"."Y :'~ .~ knowledge, the Testatrix was at that time 18 or ',T!ore years of age, of sound mind, and under no constraint or undue influence. i :.\. ,.'{r, Sworn to and subscribed before me this :II AI day of Yf'", 1998. ~~AVd~~ Not ry ubllc My commission- expires: (SEAL) ~ I I , ',: . ,':. ,I . " d'; i " . 'i,' I ;~! t . :) ;,'. 'i: .~. . .., \~i,::' !, 1f9,.-f 0 )J1.~ ':; ~~ t 1'.:1.,1 ; I Nolarial Seal i (. . Mary Ann AndersOl1. Notary Public Harrisburg, Dauphin County My. C?!>!'",rrdssloi1 ExpIrasOaL 30, 199B I.I,.....,~.'" ~.....,'* ~'~\"'imi:ln.,r "W;;a~ " "'; .i' i ~ ~ :aA.RRY L. BIU:CSE1R" Jllt.. ATTORNE'f~ ' T'ME CMAE1ItON M....N.,ON ..07 NORTH FRONT .Tft~rr HAlUUSBtlRG, FENNS'YL'V.A.NXA. lTl01-1~96 (7171 :a33.~555 FIRST CODICIL TO LAST~LLANDiESTAMENT OF J. NEDRA SCHILLING I, J. NEDRA SCHILLING, an adult: indiyidual, of the Borough of Camp Hill! . , County of Cumberland and commo~~alth of p~nsYlvania, being of sound and disposing p~ mind, memory and understanding, do rake, ~Ub'ITh and declare this to be my First Codicil to my Last Will and Testament, which Last 'wilY~nd Testament is dated May 28, 1998. FIRST: I hereby revoke Ite~~ S~cond and Third of my Last Will and Testament. ,,' J.iH .~. i',' ;-~." SECOND: In all ~th~~:'respectsJ~~er.~ ratify, confirm and republish my :" .!~. ~i ' Last Will and Testament dated May 28, 19,98,' tog~th,~r with this First Codicil as and for my Last Will and Testament. IN WITNESS WHEREOF, I, J. NEDRA SCHILLING, have signed,' sealed, published and declared this to be my First Codicil 'to my 'LasfWill and Testament consisting of this I, " .t,~ and one additional page in the margin of each of whiCh I have also set my hand for greater security and better identification this '2...~ day of r::>. ~ _ ~ . ,2000. ,~~~ .~~ (SEAL) . I \ ~ ~.. : ,- I:. ", '~ ,.\ r" ,:AW '.~ \ . r i . .J "/,1 ; i~J. ~:;l ! J . t , 'Ill I,,,' :;; . .j ~dl '; h ~\ '[ll:~il , , I ~,:.l I J J,. ,"11~. i;.; !' .~_..._,... .....,.1..~~..;"l1'~fIttool..~..~..,........._.--:""""'..-.....;.;,..f._... ._~:.... . .,' '," .. , .0..-'..... . I The preceding instrument, consisting of this and one other typewritten page each identified by the signature of the testatrix was on the day and date hereof signed, sealed, published and declared by J. NEDRA SCHILLING, the t~statrix herein named as and for her First Codicil to Last Will, in the presence of us, who at her request, in her presence and in the presence of each other have hereunto subscribed our names as witnesses hereto. We further certify that at the time of the execution hereof, the said J. NEDRA SCHILLING was of sound and disposing mind, memory and understanding. ~~'-c.~ I\., .. ~ ~ .~ ; l~ufA C ~ ~A~>~, .,~." COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN of.~!:rJ~.\~~ ~~- ~"> '~ ,-<' :".;;" ". .~~ ~ " --- . ~~." i~Yb1-- 11 ~l ~i c24L cUJ/ ". ",t. \ ! .... ..I~+rfA_-/1~// "';y;V f-l 17/0/ qf ::Ilb--~p 'n. ;;< f'tf..--4. ;'i,fl!lJ.~ If'4 /7/=", $_S: I, J. NEDRA SCHILLING, Testatrix whose name is signed to the attached or ~ ~ ~ foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my First Codicil to my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the , .... " I' 0.. Sworn or affirmed to and acknowledged before me by J. NEDRA SCHILLING, the /f\ ~ I day. of. . <.Y?.~/j:/; .//6 purposes therein expressed. Testatrix, this ~ -6- tlv . ~; :: r'"." 'i, l' 1 "',, . '..:... ~ ,2000 ',"," "! ",:. Not' Public MY ~ ", 'mission expires: 1_1/ 9 /~ 9..- , (Selal) ,"':.; 7 ' I. tt.,T'{4 1" "'t " ;' ~~~': ;..: :7:" , NOTARIAL SEAL AGNES G. NICHIGI, Notary Public Harrisburg, Dauphin County My Commission expires June 19, 2002 Member. PennsylvanIa Assoclallon of Notaries 2 ~ ~ r\'- ~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN :.~J I . ~ --, ). ;, :.i;' SS: '. :::?:l ,~. , , "and , the witnesses to the att~ 'r fp~ oing instrument, being duly qualified according t law, do depose and say t We, were present and saw CAROLYN D. EPPLEY, Testatrix, sign and execute the instruri1~cit as her First Codicil to Last Will and Testament; that CAROLYN D. E,PPLEY Sign~~jY,i1I~'\lfl_'9IY, and that she executed it as her free a~d voluntary act for .the .purpqS~~ t~~r~~Q.~~~sed; that each of us in the hearing and sight of the Testatrix slgn~d ~~,e WII! ~~~~Wlrtl:7Isses; and t~at to the best of our knowledge, the ~estatrix was. at ~a~.~if11e 1 ~,:~!M~f~ years of age, of sound mind, and under no constraint or undue Influence. .r; I : i .'. ~~~~\( 91/-7/'- (! fk~ 1\ Sworn to and subscrib~ be!.or~ /Tie this :J S' -a. day of LP~~~rA ,2000 . . Nota Public I My lmission expires: t 19'/~ ~ (SEAL) NOTARIAl.. SEAl AGNES G. NICflICI, Nolaly Public "" Harrisburg, Dauphin County . ... ; i "'1 Commission Expfres June 19, 2002 ~ ~Assoclation or Notanes . ' : t::,;j i'. : :; ,....~ ~ ~. , " , ; ,!.... ~ ,. ..t'!1~.t1"1! . . ~ r ,.: , I ...; ,) .: . ..~ l ; .!I . ~ \. .. '" .:~::\' '~:~~';-:, ;}:: . t :':. ,,,,I! 1 .,' ,," ';'.. ': ;:,~!i;!~i! Ii! J~r:\~{q~~ . -, ~ : 3 Register of Wills of CUMBERLAND County, Pennsylvania INVENTORY Estate of J. Nedra Schilling No. 2005 - 00887 also known as June N. Schilling Date of Death 09/08/2005 ,Deceased Social Security No. 172 - 01- 8979 , Manufacturers and Traders Trust Company and Elizabeth G. Atticks 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. Personal Representative Joseph A. Macri Vico President Trust OHicer Name of Attorney: Harry L. Bricker, Jr. Signature: Company 1.0. No.: 07049 Signature: Address: 407 North Front Street Address: Harrisburg, FA 17101-1296 Harrisburg, FA 17101 Telephone: 717/233 - 2555 Telephone: 717/255-2174 Dated: () ;C) 1 : ,'-'') ......., .::::::1 r:"C"J .--.... c_ C~~ -lJ ,-I f1-=1 , .' \_,~ '".' ? ~':":~::-:', ,m:. "._~:.J Description -0 In C} C) --n -"~ ('-) r-n ': :Value "1 I OJ ;-; ~:'\:;f c::> (See continuation page(s) attached) (Attach additional sheets if necessary) Total: 205,252.79 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. Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems.lnc. Form IIRW-7 (1992) Estate of: Date of Death: County: INVENTORY J. Nedra Schilling 09/08/2005 Cumberland CASH: Erie Insurance Group - Refund of unearned Premium Policy #Q080101395H Internal Revenue Service - Refund on Form 1040 Erie Insurance Group - Refund of Unearned Premium on Homeowner's Policy #Q52 2900386 H Erie Insurance Group - Refund of Unearned Premium on Personal Catastrophe Policy Q28 2350129H Received from Patrick J. Reardon - Pro-Rata share of School Real Estate Tax (1/27/06 to 6/30/06) on Sale of 53 Circle Drive, Camp Hill, PA Received from Patrick J. Reardon - Pro-Rata share of Sewer Expense (1/27/06 to 3/30/06) on Sale of 53 Circle Drive, Camp Hill, PA Received from AF&L Insurance Policy #2500 - Refund Received from AF&L Insurance Policy #19208 - Refund Received from AF&L Insurance Policy #2840 - Refund Sovereign Bank Account #2334025919 - Date of Death Balance Accrued Interest 1 2.00 1,800.00 207.00 72.00 693.00 91.35 1,929.49 10,186.57 360.58 186.14 0.21 Estate of: Date of Death: County: J. Nedra Schilling 09/08/2005 Cumberland Sovereign Bank Account #2331044732 - Date of Death Balance Accrued Interest 14,652.36 0.04 Sovereign Bank Account #2331044848 - Date of Death Balance 121.26 Sovereign Bank Account #2331044856 - Date of Death Balance 1,435.31 Verizon - Refund on Cancellation 141. 48 PERSONAL PROPERTY: Personal Property - Sale Price 2,374.00 REAL ESTATE/PA: 53 Circle Drive, Camp Hill, PA - Sale Price 171,000.00 TOTAL RECEIPTS OF PRINCIPAL... ...... ...... 2 31,878.79 2,374.00 171,000.00 205,252.79