HomeMy WebLinkAbout02-07-07
--
..
"", _~ 1It
.-J
15056051047
REV-1500 EX (06-05)
PA Department of Revenue '*
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601
Harrisbur ,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION' BELOW
Social Security Number Date of Death Date of Birth
Suffix
[ffiJJ
MI
m
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's last Name
Suffix
~
MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
~ 1. Original Retum
<::)
2. Supplemental Return
<::)
<::)
4. Limited Estate
c:::::>
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
-
c:::::> 4a. Future Interest Compromise (date of
death after 12-12-82)
<::) 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
<::) 10. Spousal Poverty Credit (date of death c:::::> 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Da irne Telephone Number
6. Decedent Died Testate
(Attach Oopy of Will)
9. Litigation Proceeds Received
D
8. Total Number of Safe Deposit Boxes
C)
Correspondent's &-mail address: b eamtrC s (j) eIJ j X. net
Under penalties of perjury, f 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. Dedaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNAT}lJjE.aF/ER~ RESPONSIBLE FOR fjJJNG RETURN OAZ
)( ~ / e.~ I ~/17
ADDRESS A-t..8EA.rlf L. t). ,
1()If /II/AlsrdN ,,/)~.. AJECN.4-AlJc,s8 UAG~ J7A 17f)!5S"
.
SIGNATU F P PAR:g.OTHE AN,BEPRESENTATIVE
ADDRESS ().1I1t~t.E. . S 1El.l>S E6f;..
, Cll;/(SEH /(1).. htE(!JlAAI/tJSMllIiG" XJA /7IS5"
. PLEASE USE ORIGINAL FORM ONLY
Side 1
L
1505b051047
15056051047
....J
.-J
REV-1500 EX
Decedent's Name:
RECAPITULATION
15056052048
1. Real estate (Schedule A). .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3.
4. Mortgages & "Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5.
6. Jointly Owned Property (Schedule F) <::) Separate Billing Requested . . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) <::) Separate Billing Requested.. . . . . .. 7.
8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8.
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). . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . .. 11.
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .OL
16. Amount of Line 14 taxable
at lineal rate X .01lS.
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..... . . . . . . . . . . . . . 19.
#
,.
., ,
. r
Decedent's Social Security Number
15.
16.
17.
18.
20. FILL IN THE OVAL IF YOU ARE REQUESTINGAREFUNDOFAN OVERPAYMENT
L
15056052048
Side 2
c::::>
15056052048
-.J
~V-1500 19( Page 3
File Number :1-1- t;b - ~ 2 ()
Decedent's Complete Address:
DECEDENTS NAME
{(oy Eo
CoOl<
'S7b1l/ bR./fG
STREET ADDRESS
CITY
hi eel/AN/e s ~ l{ /(G
STATE
/',4
ZIP
/7 () ~~
Tax Payments and Credits:
1. Tax Due (Page 2 line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
D
o
()
()
Total Credits ( A + 8 + C ) (2)
o
3.
Interest/Penalty if applicable
D. Interest
E. Penalty
o
o
4.
Total Interest/Penalty ( D + E )
If line 2 is greater than line 1 + line 3. enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund.
(3)
(4)
(5)
(SA)
(58)
o
D
5.
If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE.
o
A. Enter the interest on the tax due.
o
8. Enter the total of line S + SA. This is the BALANCE DUE.
o
Make Check Payable to: REGISTER OF WILLS, AGENT
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;.......................................................................................... D ~
b. retain the right to designate who shall use the property transferred or its income; ............................................ D 181
c. retain a reversionary interest; or.......................................................................................................................... D ~
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? ........................................................................................................................ ~ 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.
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 three (3) percent [72 P.S. ~9116 (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 zero (0) percent
[72 P.S. ~9116 (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 zero (0) percent [72 P.S. ~9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)].
The tax rate imposed on the net value of transfers to orforthe use of the decedent's siblings is twelve (12) percent [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 bfood or adoption.
.. REV.l5OB EX '0(1-97)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RE IDENT DECEDENT
ESTATE OF C. 00 KI (lay €.
FILE NUMBER
J... J- I)' - '120
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
('JJC 5ltN/( II-aer: 41= SD1 00:'1. 7DBY- (Sw.b I1Dm. 1<oy It. CocK
II'SS,;c.,'a'1e.S" lJirers/6'eel Rnt!rpr/~tts) (S. PfY)pr,.,!.,f."rst..i.p)
.r n t ere. $ file ~ r. ti" d. I). If'. ~'" .-t. fun IV I) - I
2.
3.
iJN't ~lIIYr A-tJe,:' # 5/J() 3S3 S~7'1 {suL I1IJRJ. ~Jt E. CDDk
A-'1e.AGr" :t'nsUr6,HCe", d,h'f t Invesfme.nt Su-R'/ceG} (S"/.
fJ"lpr;e~r.sh;p - Held It" r,d'McJa,.y P"ult1S OIl".t',S'~ ~i2)
Zl1ft,,.t,sf aev, -I'D eI./P,d.,,, Z~ /JI",3
4.
5.
f7A'e ~I}Alt' ,4-(J(!.7: :;If: 5ZJ() 1/-2.9 ()'f'dJ .(~" nDIII. /2Dy e. ~_(Jk
,/~/~ /<Py E- &oK A-s$D(!..;a~) (u/~ '''''I'r/ehrslu'p)
Infert.$f Il~ k t:l.l'hd. 611 ZfuH h, S
h.
1: /NFI A'1)'fE: A-,;,7J{~ /ret, ~.s-~ .3S3 ~..'S Cltrr/e.d ""
/k iJ"I'JKs i?/ fJNC {s uJ, Mil!. ~}' IF: &'tJk As~D~~tt'S'.... #Jt.hp,,-
Mi,iIt ESf!hJHJ A1utJ1tJ1f) I1Ia5 411 ~S(fhJN a~ItAt //1 /IIA,&It
j7tehl/tlllJ5 fla/I #A /nSk/'llHCt. /tJ//C/eJ p)l~ ;;/~I'~s;fu ~
Jtltlt ~ SUlt;i Pllt bY #4h;AIII/n ;hSttr~ ~AyJAJJr'_
7knfprt ~/s PtNlUI/ b~1A4&e. ;,5 .11,1 bel? /,'s!etI A~I'eM
(is All ,~ ef ~/.'" tsfll-le.
(see Vahlllh ~11 ~fal-eh1~nf ~ eltllrt alia e.kt:l )
7. llJir:llll/J - {JlrNEY ~/()e /J1l1-aIIll!IC
3. 1/ ..h'f)1J 11I/1/1. :r~s ar, ~- a AI AI I'S S IIJA f6.y,.e4f
'I, Nit IS PA III/tie :z:;, s " r. fo. &AlA1lssifJl1 Pa.y /#I e ~ r-
If), /laoh'oA Nid! $,SIt/'.. e,. (};,#f 11I1's s/"" fl4j'AtMt-
f(, ,N~ h '0/1 IV/tie ~ It I'~ ~. f;IKM,'Sg/Oh ~'rAled
(,ll ~A f,AkllhhJ SA~ef )
VALUE AT DATE
'OF DEATH
-.
'7,S35'.8/
, (!)CJ
" .
-- 0-
(..,..~ 1ttJ11I.t.)
.. (!)"
JI
:2., 'l.3(),,~.3
f;. 19
'i72.0:l.
I
7,:/3 ,. oS-
I'
~ /,~. 72-
~
9~, IS'
~ .:l ~ i', 3()
TOTAL (Also enter on line 5, Recapitulation) $ 3 (, J ~ i~. r1
(If more space is needed, insert additional sheets of the same size)
-".
. SCIIE j). E: J ~'a'
--J~t,;.-tE'e}l~.T-~$7jj. ~mM,g.g'~)~...E?~€~ ~/-::5-.:~2~L_.
m.12.ik'~~~ ~It I?m~._a"'!'!/~~,,6.."'..o_o_..m_ .. ..__._0___4--~_'fS"
. . . . . . . . . . _p _~ #~*~~k~ &~tJ~"'~~$;"".._m ________m__u__!:J.f!)1.>.3~
. . . · · · · ~~ ~1-1'Ltf~~-"'~hcf-~1~ MQ!!t:t! L(!b~ovfs.f_.___._mm_o ~/r.J!L
~~:[ ..;~or~;t: ~-::-=~:=~~;(~::: !:e~~S4--:1~-::
20 l __n - ....... --- ... . .u..._ ........ --mmm_m_-'P.bfL...___'1J~_m_n......___n___ .. -.--
;~..{/l _~ &~mCht!~_~'n:_~bmlJ./-}n ._mmm.;;u!;Ol"_
;~ ~ _~? -~-dJ~ ~k~~~:~4-~zr#~;.:-:~.:__~~~::
35 · ;!; ... m_m.~~______oo...!/.;Il-~.a.m~_aon~__n~_n_mm~.m
1 ~ ~ : :l;D10~j'Ju_b,'k,0~m~e.. tJwAu.:m.',y,__mo_ ..- mOm.WWn. .--- .Omm_ ... -t 7:].~
1 ; ~ : .~~__d.~_r;.nch'ti1.j/LYlILAsW'l+.kk.1ns~.__L~/I-~~_wmm~L.,f Z_
50 . ~ ...2!ko(!,.qw:l!IL.~_ aAtAlL'.f.~~'Lmm ______m_ ..... ____.__~'--~C
~ ~ :~. ~3.__ --~(!:!L---~~~~/L---~~fJ---~~-.-~L~~.------_L~-~I:L-:_;J;.-.---_______..~X~_Z~__
~ ~ : ~ ~ IfM -r:.~-lir-Nlf. n1!! kn~ "-~ ~~p.':~.._I.?:'_If-_~_~ m },!L
25 · ~ ~_,_~_ot!lyjd __~/C!?2.~'t,.L..~..s.~,.'. ._.~~m/!::_I.____.__.~~~._.
: ~ {Z. ~._{-eH_g~~..f!,,;If("!.;C-.If.J.~I#~fW'Yjd_~ 2t~;Lm_._.m~~m'f.l_
1 0 0 ~ m ~Z _#!t..6uf;L.I?~/f.m ~~Er/ty_kk~.I.<<_~'. . __!~~!L-+,.___~Z!'m
; ~ ~ 0.2&. .M!f_m~_.IlynL__h~Ufl7j.?'~__ ~_~~'1onj2...tt:7, ____ o~.fL_
~ . ~' ~
~ ~ ~/___,gz__ :M!L__~_____~I:~I/...... .._*1l{~'-'tf--_?~ .._~{I:(J:.__... . ..a6_.!t.=.f._.m__n.__f~_s:~____
e)..-~:o-.-Et;~;~~:;-f:~~;~?~~;,;;;-o-~;;~.
...~..._ n__'''_ ____ .....n..________...__ __~..__--..-.-.... .. ". ._______,,___._____._..n.__________
__~~L .' .o.Ef:tf!k ...E/!-15 t! J.T~.~._ ..(~~~ .1r~)'l-"'d!!!!'JnlJlftt~ItuiI.. . ___.____ __t'/S: Po.... .
n__ ._____.___~t!.. ~!:.?€_~E_n3El~fJt.~ __C8P(,f~!'.Z!.._/}tyS!.ft::JL~Ifif'~_._!t!I!!lf...__~~'!."~~
_ __ 3$"._1' .~Ui" {#= l>ESK Jl..It(A"r&f' eMfl:!7l ~ hP~JII_ l>EJ!l[:T._. _ _ ~t:', ~~_
_ __~~'__ ..5A~_~_ ~~ (l'f'!EX F/~/III(;_ fJ~d/N.E'T 7ii AI/(, 1l~J{IIII1E(~E?I. ~e>o...90
~~_l .3 ~A(fl!~eT{~__e:~~ ~ r ?'r~4' . 6.!!
'.. --', 3(i,~ 2~. "
ROY E. COOK ASSOCIATES
OFFICE FURNITURE INVENTORY
Item Quantity Price per Location
Unit
- DESKS:
Metal Desk - Walnut top, Black 1 $60 67 (Dad's
base 5' x 2 1J2', 28/1 high old desk)
. 2 drawers on left (14/1 x 6/1
and 14/1 x 12/1)
. 1 d rawer at seat
. Attached credenza, black,
on right, 40/1 x 20/1, 25"
high with 3 drawers (1
drawer 14" x 3/1 and 2
drawers 14/1 x 6")
Metal Desk - Walnut top, Black 1 $60 67 (Mom's
base 5' x 2 1J2', 28" high old desk)
. 2 drawers on right (14" x
6" and 14/1 x 12'')
. 1 drawer at seat
. Attached credenza, black,
on left, 40" x 20", 25"
high with 3 drawers (1
drawer 14" x 3" and 2
drawers 14" x 6'')
Metal Desk - Gray, 6' x 3', 29" 1 $50 Private
high office
. 3 drawers on left (11/1 x
6'')
. 2 drawers on right (14" x
12" and 14" x 6'')
. 1 drawer at seat
1
Item Quantity Price per Location
Unit
Small, Metal "Duty" Desks, 40" 4 $20 Moved to
x 20", 29" high, 2 drawers on basement
right (13" x 12" and 13" x 6/')
Metal Desk - Gray (very old), 1 $25 67-
5/ x 3D", 28" high Computer
. 3 drawers on left (14" x Room
6")
. 1 big drawer on right,
divided by 1 shelf (top 13
112", bottom 9/')
TABLES:
Metal Conference Table, 1 $35 67
Walnut top, brown legs, 6/ x 3/, Conference
30" high Room
Office Table, Walnut top, 8/ x 1 $15 Private
2/, 29" high office
67 ~u
Conference qjJu JMt
Room t ~
r-;;,y,J 16.
II E',.1'/
5-Drawer Metal filing cabinet -
Brown (very old), 58" H x 14
112" W x 26 3,4" D, each drawer
is 10 3/4" H x 13 1/2" W
1
$20
67-
Computer
room
(back
closet
2
Item Quantity Price per Location
Unit
FILING CABINETS:
6-0rawer Metal filing cabinet - 4 $35 each or 3-67;
Yellow 52" H x 21" W x 28" D all 4 for $120 i-basement
, ,
each drawer is 20" W x 7" H x
28" 0; drawers are divided
inside, with each side
measuring 9 1/4" W; drawers
are equipped with metal sizers
4-Drawer Metal filing cabinet - 2 $30 each or Private office
Black, 52" H x is'' W x 26 1/2" 2 for $50
D, each drawer is 11 1/2" H x
13 1/2" W
2-Drawer Metal filing cabinets 2 $15 each or 63 - F
- Beige, 28 3/4" H x 18" W x 2 for $25
25" 0, each drawer is 11 1/2" H
x 16 1/2" W
2-Drawer Metal filing cabinet - 1 $15 63 - F
Black, 28 1/2" H x is'' W x 26
1/2" 0, each drawer is 11 1/2" x
13 1/2" W
4-Drawer Metal filing cabinet - 1 $10 63 - B
Army Olive (very old), 52 1/4" H
x is'' W x 26" D, each drawer
is 13 1/2" W xli" H
3
Item Quantity Price per Location
Unit
CHAIRS:
Leather swivel chair (black) 1 $50 67-Morn's
with arms - good condition. desk chair
37" H seat 18" x 19" and back
,
17" x 16"
Small swivel chair with arms 1 $25 Computer
(brown leather back, rust room
fabric seat). 14" x 15" seat
and back 7" x 12"
Leather swivel chair (old). 19" 1 $10 Private
x 17" seat and back 18" x 18" office
Small chairs with Green 2 $10 each or 2 63 - B
leather seats/back and metal for $15
legs. 17" x 16" seat and back
12" x 15".
CHAIRS:
Leather straight-back 15 $10 each or 67 and in
chairs (peach) with brown 2 for $15. basement
metal legs. 35" H; 16" x AlliS for
15" seat and back 16". $100.
4
4 .
Item Quantity Price per Location
Unit
MISCELLANEOUS:
Copier Cabinet: Metal, dark 1 $25 67
gray with 2 doors. 26 1/2" W X
24" H x 24" D. Doors are 13"
W x 21" H. Cabinet has a
shelf 8" H to top, 12" H to
bottom
Printer Stand! Cabinet: 1 $25 67
Metal, 2 doors. 23" H x 20" W
x 35" D
Printer Stand on wheels: 1 $15 63 - B
Metal, blue door 3D" H x 29
3/4" W x 20" D. 2 doors (13" H
x 13" W) with open shelf 4 1/2"
H.
Small Folding Table on 1 $10 Private office
wheels: Metal. 36" W x 26"
H x 16" D. Folds 9" on both
sides.
Computer Desk: Metal. 48" 1 $25 Private office
W x 26 1/2" H x 23" D. Fiber
board shelf on bottom/back
10" D for length of desk.
Index card! cabinet: Metal. 1 $20 67-
5 1/2" x 4"-3 drawers; 8 1/2" X Computer
6" - 2 drawers room
5
. ..
\.
./ , .
Q PNCBAN<
OeiV 1
~4
i~( f
?-l {
August 7 ~ 2006
C\
~
:Mr. Jeff Wineka
2 E Main St.
MechaniC:sOurlJ P A 17055
sap
RE: Estate arRay Earle Cook (Dec.eased) I Roy E Cook Associatel
SSN: 190-26-6427
DOD: 05..09-2006
Dear Mr. Wineka:
In response to your requat for Date ofOeath balmoes for the customer noted abeve, our
recorda show the following:
Certtficata a1 Deposit
Account #31900214958 Established 09-21-200S
ROY EARLE COOK
ALBERTA L COOK
ODD balance; $61.389.27 + S19.30 accrued mterc,t
AGoount ~3180029044S Estab]ilhedOS~03-200o
R.OY EARLE COOK
ALBERTA L COOK
DOD bllaDce: $l00~OOO.OO + 593.76 accruoci'iD1erost
CMddlag Accoaat
Account#S0700S784S
EmbliSlhed 01~1-l979
ROY E COOK.
ALBERTAL COOK
DOD balance: $27,284.93'" $!.90 accrued iftte.reat
Acco\mt 1;5070027084 Ettablished 01-01 -1979
ROY B COOK ASSOCIAmS
DIVERSIFmD BNTBRP.R.ISES
ooD balance: $77535.81 + $0.00 aec;rued intete$t
Paae I of 3
'7'f76G14071i
12:23: 13 p,~.:._
08-07 -2006
2/6
Account #5OO3S35679 Established 12-11-2001
ROY E COOK. AGENCY
INSURANCE NOTARY &. INVEST SVC
DOD balance: $61564.42" SO,GO ac:cmed irltere.st
Account #5003535695 &tablisbed 10-31-200 1
ROY E COOK ASSOCIATES
NATIONWIDB Ese ACe!
DOD balance: $6,683.77 + $0.00 accrued interes1
Sayblli Account
Account #S003698574 Established 10-31-2001
ROY EARLE COOK
ALBERTA L COOK
DOD balance= 129.525.36 + S63.02accrued intereit
Account illS004290466 Estabtished 07-15-2003
ROY E COOK DIBIA
ROY E COOK. ASSOCIATES
DOD ba~ $2.930.03 + $1.99 accrued interest
IRA Aceount
Account #75600021603 Established It-1S-2001
R.OY EARLE COOK
DOD balan"; $129,002.91 + 5436.84 accrued interest
Account #7S600042666 Established 04-05-2002
ltOY EARLE COOK
DOD balance: $2.491.36 + Sl.47 acc:rucd i:tJta'est
Account #759000231'2 Established 04-19-2002
ROY BARLE COOK
DOD balance: $2,S~5.80 + 57.64 .a.ccnaed interest
Ac:c011l1t #75600027608 Established 10..08-2004
ROY'EAlU..E COOK
DOD balance: $991.12'" $0.14 accrued iatcnJst
For ben<<fic:1ary i_formation please caD 1-888-PNC-IRA5.
PI.8C 2 of 3
. 7" 7691 4tQ!S
1 2: 24: 28 p, ~'__ .o.:;:.07.:;,.~~~
3/6
. ........
The decedent mainta11\ed RCA # 4003041869003955 and., 4003048110322604. For
further information" please c;a1l1.SS8.762-226S. Select option 11 then option 3 and then 0
(zero). Atler pressing zetO, pleue remam on the tine to speak to a Loan Service
RCprC>>mtative. We do .Dot have acc:eu to Loan lntorbUldoD, you mult colltac:t the
Loan Area at the above nmbt! for further asslsel"'ce).
Please note that thi, office only provi dci date of death ballUlCles for dcposi1 accoUl1ts
(1RA3, CDs, Checking and Savin,p ae;ounts). W. do not process 8.-y ftDanclaJ
trauutions or provtde .tatements. If you ncocl aiSisf3nce with any of these items,
please call1-88&-PNC-BANK (1-888-762~2265) or atop by your local PNC Bank branch
office.
Sincerely,
~'c-, -;7_~
Erica L Schl~ael
1-8oo-762.-177S
P7-PFSC-04-F
500 PinllAwc,
P.ittsburih PA 1521'
Membor FDre
Pale 3 of)
TOT~ P. ta3
. REV-ISIO EX' + (1-97)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF C ()()K,I ~D Y
E.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
.2/- ~(, - ~Z()
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.
DESCRIPTION OF PROPERTY %OF
ITEM INClUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO OECEDENT AND THE DATE OF TRANSFER. DATE OF DEATH DE CD'S EXCLUSION TAXABLE VALUE
ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET IIF APPLICABlE \
NUMBER INTEREST
1. flJC RJANJt. 1a()/tIs tit ~ /I,w;~,! ,rtnls in aA
II<A A-etpuAt .,t;,rntA,r/ ~/I ~I /t/J/Ch /O()fr; -0-
p.jere t:I~S'1I1atitl ~4b/~ 10 ,4/kr14
1.. ~IJ~, "" 5t1l"l'lp/r ~/~41,'
!J IF 75' tJt)t) :l/~ tJ~ '12~ ~.:l.fjl SCtlHt as
d. .D.d.
f!JJ ,1e.er. Znt. 'A :rf~ ~. ~ LJ3("II/ va/I{es.
C.) #' 75"(, tfJlJ/) 22" '" ~
:2, lf'l, .J"
]).) ,f~r. ~"t. "h Zft:Mt e. ca /. '17
E:) #- 751 t)()I) J3/ 7/l - 2, 5'" S, fo
F:) A-Ut'. -r" t" IJ h I frM E: ' 7, 'If
'.j 1/' 7~(, ~7' 01 "1
1Pf)() ,,, I. I Z.
11.) Aw-. h!: WI ZI-u" c. 'P.lif
( see. ~Alu.hlJn ~fafem~t aMJ:I Cllllrt
a tfadtuI Ii sc.kk'. E.)
TOTAL (Also enter on line 7. Recapitulation) $ I Js;, '1'17,,2 S'
(If more space is needed, insert additional sheets of the same size)
REV-'1511 EX+ (12-99) _
*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF C J L::"
()O~ ~ oy ~.
FILE NUMBER
:l./-~J -~;Zp
ITEM
NUMBER
A.
Debts of decedent must be reported on Schedule I.
DESCRIPTION
1.
FUNERAL EXPENSES:
m YEIt.s FU 1J1F1lA-l N()///F I9r /HEMAAJICS8J,utr;
( S~ S fJt:Alent a{fllc!tuI)
Ft-ttt\l.l&a1 L"'f1GheD.t1 Lt Mo.Soni G L"d1t. l-/Q,"~ t;Dd Os,J.r.c.:nut fr'M
G ; .,nt S I4p-Urtt4-....~~f-
"'P~ PIQtu , C4pS, Cc(.f.~e,,;/;... tr.OH1 ~.5 ~
~.
3.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s) A-LJJEJerl L. C!APK
Social Security Number(s)/EIN Number of Personal Representative(s) /1/- 2' -f) 3 S,
Street Address /fJf IfI/NS7'lJN P,f/;'E
City /JIEeHlfNICC$<<Jt6. State~Zip /1~~$-
Year(s) Commission Paid:
2.
Attorney Fees (!./(lI-lI.lES E. SNI/R..{)S 1f[/ ES~.
3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant A-L~E"lt.rl1 t.. ~I<
Street Address /()~ UlIIf.s7?;N lJlt/YG
City lH~l.N"'''ICSBUNG State~Zip 17/)SS-
Relationship of Claimant to Decedent tv / OI)If)
Probate Fees Mil ori~~ncJ ;'~w.e 4- ShD,.t c~rfirf.t:.Q;"h!.s
4.
5.
Accountant's Fees }
Ro0ER:r Plrll-I< 1'1f/l./C t=/NMCIAt. SlElfvIC,=,-s
,
Tax Return Preparer's Fees
6.
7.
,tdd.; f,~DnAI fJrohtlle fee.
F;/,irf fee ~,. J;/'e.r/fftI1Ge ~ /?elurn
nf,;" 1)1 I!-wul1f tv;HI p/,pAAnS' &U,.t
(Jh()f,t!/)fJ''eS~ ~t,/'/;t~ M6 ;/,n,s , ertd,' fors , etZ, e shIM.
(5tt &Jl1hitllah~n tPfige)
'.
f.
It).
AMOUNT
~8; 70S..7()
t
2 2~,'/'I
~
, ~ 3~/)~
~" S~ZZZ
,J
~ 7Sf), ()(;)
1
3, rot), ()f)
" 811..00
~S-f)tJ.. ~o
,.
CJ (), ~D
" S'.OfJ
" J 3 t:).. ()O
~':l..Sb
TOTAL (Also enter on line 9, Recapitulation) $ ;l ~ 198 /. 09
(If more space is needed, insert additional sheets of the same size)
. .
ESr or {!/)OK, R I)Y E. ,Rt:.tF /Y~ . ,;2/-/)'-Q2/)
J
_______ .________-.-~Et). _(I. ~ ~;;_____________..__________..______._____._______~_____
___~___ '~--./l-dy~b'siA.f__LlL.-{!ullflKrh,n' ~__.:J;l!_.ll!./ _ .~7..5:df)
_ a : /k/J"uf/S'I", ;" e..,..~:r" S&1nh~/ _ ___. . __-.--507.91
-------.1-4A'In~-/Jr;~--::.J.~"---.k. ~~~--~!:ttLCA,.~~.~l~;..---..m..-------.-----....---
: ~ k ' ,
___h__._'___ : Ic/~ ,~__~ .s/A4~S... .. ..__._______._________________~________ S-~~~t._____
/'1. ; .,Y..I"un;eX - ;IN.rtY'~!Jdh Ru (J~II"'flAl ~r ~hf{1/oy".J'~ n!..' w,'/rdufj l'
1 tLf t5u~~'ne~$. 3'1z.00
___ lS: 1 H TS T of 7i~~" k ~,~ b,.. ~;nd,"" It;; e~~ 3o'1.3~
I&.,! "JIII!. ~ ~ ~-I"V~(;t. CkJYt! $:DO
; ~
IZ ! ~ &-J Atu!;t L,h ~ ~II,T 1z,r ~"s,.~~s . z~~ J "2 5. p,
/8: ! exe-'~ ~ ,*,lu{iDIIJ, &pIe foher C4rfrl:~ fe: (..q~ ~
~ I~ 7~2c;_
1'1. ! &,.1 h;',fMU4J ~;a2& -: ~n1J IJlJDtt<<p~ 4,4 ~S:oo
________. ~ 1 dr{ -r; 7e~/lt:i k 6,'11& "",r It/,A~o/l~4-.---.-..-. ,)f,$Z).~_
---.-.-.-.-~ Le~-- ~_~__~~_C!~tL__._.._.__________..__.____._.______~~ ~_
! "",' 5r
___....2~~yD.i~NL--1!Mtp~ bU:Jc/vN.~~-"-_ H/;~~j!sld __._..___~, '17 ____"
01~ ! AT f~ 7e19~, ~ 6/1/& .,(H-. pj/AeI,"l 0/ e.,~ ~ :f~. 7,l
d'f., j j/'~i~ ~"'I'ub- ~ CDsls -/Dr NI;,eI,Af l<.p~,.~ ~'./7
as:; ,44"C- 4JAeU:, L'4e ,,/, C1et/ir fZ,~ 6Jl~''N.s~ /A~$t "'31. 75
\ ~
~ .1 PIU"L 1=Ja~~1 Serv,'us. A-,~J'Ju~', '''ot/:eep~ tU..DI ""(I.~
~7. j ATir; rd~kNI ~ 6,'11.J ~ atlA~~~ '.rk~ 5/~. ~s
P; i Y&;Z- tkp~ ~ &Wrc -6r Ah'"q',o/ ~ esh& :'/.~.J
c7l: I /.lA'/!. ~ ~ ~M fir Ch-a/,r .,br J;~s:AL~.r~ //'k;es! I~~. ,~
3D-I -';'I'-~ _Slw<<~;y ~5h,u~? ~lu ~ L;~Scl. /3. s:z
~/. I A-T$7:. /e~kN~ -4 b,/!J ~ w//J~1~4'esJ'L~ 2/7, ?S-
3t. i ~;y'e &.R 4M:J ~~ ~r Cha','t /"r ~R~//V~~~ //I~~$I ~.3~ 77
33. j #//~/l ~M~ /JJ4';'/h &s-B ~r ~1'~ eSbe~ _..../~f7
, ,
~I S'~ /!r'N4I- N/ ~ ~ ~r ~$I ~ 12 Atiz- a/.I'JC?
"d?S4__.ltii!'.hQ"4J_~_ cert; ftca.ns. ~~. 00
a_d____1'.:__~A/~l!c~~etl___I!:~",,_~~s..i.uL_~-"t. :/l;~11 A-ndwH.J.4____ 1>85"1,09
_..~...__. .__+__~~~~~~f---~__-~~~~~~~~~~~...A/,'!!!.~-~-~~ ..! r.I.u, ~~__________.____~
~'/
Myers Funeral Home, Inc.
Boyd L. Myers Jr., Supervisor
37 East Main Street
Mechanicsburg, Pennsylvania] 7055
/5"'--- ...
(7) 7) 766-3421
Fax (7) 7) 795-7291
A standard of excellence in Central Pennsylvania since 1910
Thursday, June 1, 2006
Mrs. Alberta L. Cook
109 Winston Drive
Mechanicsburg, Pa. 17055
Dear Mrs. Cook,
Thank you for selecting our funeral home to provide services for your family during your bereavement. I
hope that you found our services to be of the highest standards and that they met your needs and those
of your family and friends.
The following is a summary of the service charges as previously explained and provided in written form
and herein indicated as PAID-IN-FULL.
Rov E. Cook
SUMMARY OF EXPENSES
TOTAL OF SERVICE RENDERED
LESS: Credits granted
LESS: Total Payments
CURRENT BALANCE
$9,630.70
925.00
8,705.70
$0.00
Credits Granted: $925.00 Package Price Discount
If there are any questions or concerns that remain unanswered, please call me.
/~/~~
~-
'.
,r
ALBERTA L COOK
DESRA COOK KEENAN
109 WINSTON DRIVE
MECHANICS BURG, PA 17055
1500
l' -J/ J 7'rY7Yl/ - 60-1273/313
Da~ ~_ I~~ ~I
~~I~~~I;~.e(S -;JU11-f/LtU.CVdVJU.,..lYJC. 1$ 6'10~/1{)
~'~~c~~:;d&)-tIJ~d ~~~'%t.",,, ~ 2:.S
J>NC Rank, NA 040-
Cenlrall'^
FO?A; Ca:;/:~lYl1er~/~~ifrd
I: 0 3 . 3 . 2 7 3 a I: 500 ~ g 5 7 7 a Sill . 500:
Myers Funeral Home, Inc.
Bovd L. Mvers Jr.. Supervisor
37 East Main Street
MechanicsburQ. Pennsvlvania 17055
'.
(717) 766-3421
105
Fax (717) 795-7291
STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED
Char&es are only for those items that you selected or that are required. Ifwe are required by law or by a cemetery or crematory to use any items, we will
explam in writing below. If you selected a funeral that may requIre embalming, such as a funeral with viewing, you may have to pay for embalming. You
do not have to pay for embalming you did not approve if you selected arrangements such as direct cremation or immediate burial. Ifwe charge you for an
embalming, we will explain why below.
For Services of
Charge to Alberta L. Cook
Roy E. Cook
Name
A. CHARGE FOR SERVICES SELECTED:
1. PROFESSIONAL SERVICES
Services of Funeral Director and Staff
Embalming
Casketing, dressing, cosmetology
Other Preparation of body
Hairdresser / Barber
Autopsy Remains
SUB-TOTAL PROFESSIONAL SERVICES
2. USE OF FACILITIES AND SERVICES
For visitation / wake service $
For funeral ceremony $
For memorial service $
Equipment & services for graveside servi~ $
$
SUB-TOTAL FACILITIES AND EQUIPMENT
3. AUTOMOTIVE EQUIPMENT
Vehicle to transfer remains to Funeral Hom~
Hearse (Casket Coach)
Flower Car / Floral Distribution
Family Car
Lead Car / Clergy Car
Utility Car
Out of town transportation
$
$
$
$
$
$
$
$
SUB-TOTAL AUTOMOTIVE EQUIPMENT
TOTAL SERVICES, FACILITIES, AUTOMOBILE
B. CHARGES FOR MERCHANDISE SELECTED
Casket Hanover $
Other Receptacle $
Outer Burial Container $
Acknowledgment Cards $
Register Book $
Memorial Folders $
Prayer Cards $
Temporary Grave Markers $
Burial Clothing $
Other Clothing $
Cremation urn $
$
$
Date Of Death
109 Winston Drive
Address
$
$
$
$
$
$
$
1795.00
995.00
295.00
May 9, 2006 Date of Contract
Mechanicsburg, Pa.
LIly ~late
C. SPECIAL CHARGES
Forwarding Remains to other Funeral Hom~ $
Receiving Remains form other Funeral Hom~ $
Immediate Burial $
Direct Cremation $
$
SUB-TOTAL OF SPECIAL CHARGES
D. CASH ADVANCED
Opening Grave/Crypt
Newspaper Patriot
Newspaper
Clergy / Mass Offering
Certified Copies of Death Certificate 20
Family Flowers
Cemetery Equiptment
Saturday Extra Cemetery
SUB-TOTAL OF CASH ADVANCED
We charge you for our services in obtaining the following:
NONE
May 10, 2006
17055
Zip
C$
$
$
$
$
$
$
$
$
$
$
995.00
220.50
175.20"
120.00
230.00
125.00
D$
1,865.70
Al$
3,085.00
SUMMARY OF CHARGES
TOTAL ABOVE ITEMS (A,B.C.D) $ 9,630.70
Sales Tax (if App) (tiJ % $ 0.00
TOTAL OF ALL SECTIONS $
LESS: Payment Made $
LESS: Credits Pending $
LESS: Credits granted Package Price Discount $
BALANCE DUE Jun 9, 2006 $
9,630.70
925.00
8,705.70
A late charge of 1.5% per month on the outstanding balance (annual rate of 18%)
will be added to the balance.
REASON FOR REQUIRED SERVICES OR MERCHANDISE
Family Viewing
Cemetery requires outer burial container
DISCLAIMER OF WARRANTIES
Our funeral home makes no representations or warranties regarding caskets
or outer burial containers. The only warranties, expressed or implied, granted
in connection with goods sold with the funeral service are the express written
warranties, if any, extended by the manufacturer thereof. No other warranties
including the implied warranties of merchantability or fitness for particular
TOTAL MERCHANDISE SELECTED B $ 3,445.00 purpose are extended by the seller.
I agree that I have examined the items of goods and services selected above and found them to be correct and according to the arrangements I have
requested. I acknowledge receipt of a copy of this Statement of Funeral Goods and Services Selected. I represent that I have sufficient funds available for
payment of the cash price for the goods and services selected. I also agree to make payment of $ 8705.70 within 30 days. I agree to be jointly and severally
liable with anyone else who signs below. A LATE CHARGE of 1.5% per month (18% per annum) Will be applied to the unpaid balance beginning 30 days after
the date of this contract. I will also pay the Funeral Director all reasonable costs paid by the Funeral Director to collect amounts I owe under tflis agreement.
Those costs may include attorney fees and court costs. Any items requested after the date of this agreement will be considered part of this agreement and will
be reflected on the final bill.
(Seal)
Purchaser
(Seal)
Purchaser
395.00
A2 $
395.00
350.00
295.00
lncl
195.00
A3 $
A$
840.00
4,320.00
3350.00
95.00
REV.1512 EX .11.97)
,
.
~
~
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF /) .. LL..
<.:.BO~ (ICf!))' E:
FILE NUMBER
-2/- 0' -1{2.0
Include un reimbursed medical expenses.
ITEM
NUMBER
1.
J.
3.
DESCRIPTION
--c-
fNC ~A-AJK - 'Bu~;~~$S L;'YI-e af Cr-e.a:., - :Interest- /:)cpenSl~
/lJ,.NfUl OMJ/ ~ /J-t6/t. ti tdi. ,I t:I~Nj c/~l'eel" J.fe"wll rd.r
1JIII/Bts ttltlJ t!A1f/) - ~liS/I1~$S Sr,4&1feS- a;r/1nA aNd' ~
b,eIole r/.Ji D/ eI~4/i - a/~;&/ 4/fe;w4~
/l177~S It',,teLJtlIl/-A!E- .J'I.(I',<J//~s- ur/~n ad ~ ~
~ ,f a'~411 - c/e4I"e-~ 1Z1f&.~~,,;1J/s
fJA1e/< 1='111I,f1/le,1.IJ.{. :58(!J'1e,g- h"''! f/~r'// ~ tf/;(lV"fer~ 74jc
jJH!,{Jllru,'Mt -Ul/,'#eII ~ R!Ar ~Je d& ~f eI~"II-tU~4H.II'
albll/ll't:ls.
,tJ,dL - e/edhc "r ()'<<;:'~s- tlJlYlfu ;uu/ ~ b~ c:t'd
~f tr/u& - ck4~/ ~~
/Vest S"'~ ~/,{ItJACIl .Jb.JI'C~ s
SU~IItt!J,~JI"~ 0/1 - W,./I/M au'.JIJIII ~ ~.lhl/.~.tIr
fJNC /!JA-NK SIN(jt.G NAME /..ING of Cl!.EI>JT '-~II-# A-e.c-r
4() 03 Otf8/ IID3 ;l~~ 01/ (ba.lttrIGC DI\ a.()IJ.)
AMOUNT
'I ~ 3. 1/
..
" "S~ "I
nw
~
.2t t:J.t:JD
~
c:l SlJ. 3'1
~ 1,37- 7t.f
, 'lOC1.. Sl;
.
/ 1~ I ~ 3. II
fa
IfI.} S7/.3/
~
3 2, I t)a(). /') tJ
...
;:J./~ OS~.'2
,
3J 7' 'f; liD
~
s:
h..
71
7.
f_
ell,fSE 1JJA-NIIArrA-/Y' tlJAN/( A~~ 7: If" S'l9() .9/C9 ()otJfI
~.]9'
9.
ellIfS~ ~A-NK USA-
,fc,e.,; :# '13" 1'3tJ S/2/ "23 g
If) I C/TI-~MK $iJ/AT/I tJlIKoTA,. N,/J.. Aeer: # S'lfl '192tJ
lIdoS q~S7
II.
,
])11fIEJf/~ cw8 /NrGil'MIlTiDAJAi- ~~, 3Dt!'JOe:>2// ~9.3"
TOTAL (Also enter on line 10, Recapitulation) $ q ~ I Lf ~O. IS
(If more space is needed, insert additional sheets of the same size)
RE'l-1513 EX+ (9-00)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
COOk~ teor t:;
FILE NUMBER
.:1./-", - '(2-D
NUMBER
I
RELATIONSHIP TO DECEDENT
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s)
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
At, 8t:,zrA- ,--out SE" ~()K W 1 Do fA)
If) 9 WINStON p/!lvE
1Y/E"(!Jf,lH,as~ flAG,! /lA- 17()SS
1.
AMOUNT OR SHARE
OF ESTATE
100%
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 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)
.."
~
LAST WILL AND TESTAMENT OF ROY EARLE COOK
I, ROY EARLE COOK, a married man, currently of 109 Winston Drive,
Mechanicsburg (Lower Allen Township), Cumberland County, Pennsylvania, being of sound
and disposing mind, memory and understanding, do make, publish and declare this my Last Will
and Testament, hereby revoking and making void any and all prior Wills by me at any time
heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my
decease as the same can conveniently be done.
2.
All the rest, residue and remainder of my estate, real, personal and mixed,
whatsoever and wheresoever situate, I give, devise and bequeath to my wife, ALBERT A LOUISE
COOK, to his own use and benefit absolutely.
3.
In the event my wife, ALBERTA LOUISE COOK should predecease me or die at
about the same time I do, such as in an accident or disaster common to both of us, I hereby direct
that all the rest, residue and remainder of my said estate be divided and distributed to my daughters,
LAURIE COOK BENNER and DESRA COOK KEENAN, in equal shares, Der stirDes.
4.
I nominate, constitute and appoint my wife, ALBERTA LOUISE COOK, to be
the Executrix of this my Last Will and Testament. In the event that she should predecease me
or is unable or unwilling to act as Executrix, I nominate, constitute and appoint my daughters,
DESRA COOK KEENAN and LAURIE COOK BENNER to serve as Co-Executors. I further
direct that they shall not be required to file bond or other security in the Office of the Register of
Wills for the purpose of administering my Estate.
day of
IN WITNESS WHEREOF, I have hereunto set my hand and seal this /vli
mtLU'./v , A.D. 2005.
"\ /1
,'1/ ./ (Vi /'// /
{A~dtd/ C~. dlta! &-U/-ZZ[
~W~
~ c;.~~
ROY E RLE COOK
(SEAL)
.. .
Signed, sealed, published and declared by the above-named ROY EARLE COOK as and
for his Last Will and Testament, in the presence of us, who at his ryquest and in his presence, and
in the presence of each other, have hereunto subscribed our names as witnesses.
tlZtt&4.J (~lJZt,t!laJ !JJ~
.~~~
GEORGE M. HOUCK
(1912-1991)
Register of Wills
Cumberland County Court House
1 Court Square
Carlisle, PA 17013
4
Dear Register of Wills:
,
<;HARLES E. SIUELDS, m
ATTORNEY-AT-LAW
6 CLOUSER ROAD
Corner of Trindle and Clouser Roads
MECHANICSBURG, PA 17055
February 6, 2007
Re: Estate of Roy E. Cook
No. 21.06-0420
TELEPHONE (717) 766-0209
FAX (717) 795-7473
Please find enclosed 2 copies of the Inheritance Tax Return along with Check No. 592, in
the amount of $90.00 for the additional probate fee due and Check No. 593, in the amount of
$15.00, for the filing fee for the above-captioned Estate. I have also enclosed an additional copy
to be date-stamped for our records.
Thank you for your kind attention to this matter.
CES/mjj
Enclosures
Very truly yours,
~p~~
Charles E. Shields, III
Attorney-At-Law
o
~,{; ?i1
'1~f}
: ~~ ~~L;
: ';..1) :;.~
~: 8 C'f~
---'55
-:-0 -4
..;:;-..
f',.)
c.:?
c:::>
-...I
--r'1
rr1
co
I
-.J
-0
3:
l);>
o
\0
~. .'