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Home My WebLink About02-22-07 . -I 15056051058 REV-1500 EX (06-05) PA Department of Revenue '* Bureau of Individual Taxes PO BOX 280601 Hanisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year .... ..........._, ,n...,_, File Number 21 06 .1099 Date of Birth 202-20-3400 12/20/1923 Decedent's Last Name Suffix Decedent's First Name MI Moose Mrs Bemida G (If Applicable) Enter SUrviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI N/A Spouse's Social THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Retum c:;::; 2. Supplemental Return C..,"") 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required c...) C) 4a. Future Interest Compromise (date of death after 12-12-82) c:::::; 7. Decedent Maintained a Living Trust (Att'3ch Copy of Trust) C::':; 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 D~ytirne Telep~()~Eil'oJurnbEir 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received o 8. Total !'.lumber of Safe Deposit Boxes C::':1 4. Limited Estate ~ Jacqueline M. Verney Firm Name City or Post Office Carlisle State ZIP Code (717) 243-9190 ~ . .......... .... .......0 c::;) REGisTEROf~sUSEO~ c-l~ rr1 -tIo ~ -,':;~~ ~ .j c) i::.J :r> Q:" :x ~:''1 \.0 ~~:J ::::.. ):> N DATE FILED N r. c r ~ (~'i 1..-- (-)C -n ...,. , Co- n t'" .... ~ L:./) ~ First line of address 44 S. Hanover Street Second line of address 17013 Correspondent's e-mail address: jmverney@aoJ.corr. Under penalties of peljury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG REO ;;;::7..l;~RE~URN.____.___ _______.__~_____~_~__ DAT~_;1.1 ~ 7._ ADO SS :J. 0 gll-f-~ 0..N': .... _~,_L.\.,\~ ~f~i tVG, SJP"" n(jl. S- ~~~~?~ARE,tO:r~PRESENTATIVE _ .______~___ ~ J../<-I S. #-A^'()tllL~ $', (!,A-LLt.~Lf., IA- "0'3 PLEASE USE ORIGINAL FORM ONLY DATE "\ .;;J. --I ~ 7 Side 1 L 15056051058 15056051058 ---1 REV-1500 EX Decedent's Name: RECAPITULATION Bemida 202-20-3400 Decedent's Social Security Number G Moose 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) C:) Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) <=:J Separate Bi!ling Requested.. . . . . ., 7. 8. Total G!oss~sets (total Lines1-I).......-'...... ._.d.'....:................ ~. 9. Funeral-Expenses &:AdministrativeCosts (Schedule H);;n.... .. .. . ..... .... .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10. 11. !otal~uctlons (totaluLine~9&10)':d"~"" .,:,. :.:.....................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. ~~ Y.~!~ ~~~!~~.toT1I)c (Li~~..~f .~i.nus.Line 13) .... . . . . . . . . . . . . . . . . . . . . 1~. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPUCABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable at lineal rate X.O.o.- 17. AinOunt of Une '14 'taxable at sibling rate X .12 18. Amount of Line 14 taxable atcollatEfranate X':15d'- 0.00 15. 0.00 16. 0.00 17. 0.00 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0.00 ~,~72.5~ 0.00 0.00 0.00 0.00 0.00 l'""~':''''''~ '"m,'",,," 15056052059 Side 2 L 15056052059 -l 15056052059 Side 2 L 15056052059 -l . REV-15eO EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Bemida G Moose STREET ADDRESS 20 Brenely Lane fl".~I"I!!I~r..... 1099 DECEDENrs SOCIAL SECURITY NUMBER 202-20-3400 CITY Mt. Holly Springs STATE PA I ZIP 17065 Tax Payments and Credits: 1. Tax Due (Page 2 line 19) 2. CreditslPayments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 0.00 Total Credits ( A + 8 + C ) (2) 0.00 3. InterestlPenalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) 4. If Line 2 is greater tha~ Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refu~. (3) 0.00 (4) 0.00 (5) 0.00 (5A) 0.00 (58) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 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;.......................................................................................... 0 [iJ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [iJ c. retain a reversionary interest; or.......................................................................................................................... 0 [i] d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 lil 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death with(\ut receiving adequate consideration? .............................................................................................................. 0 [iJ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 [iJ 4. Did decedent own an Individual Retirement Accoun~ annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 [iJ 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 an 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 an 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 exempt 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 decedenfs 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 or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116(a)(1.3)]. A siblinQ is defined, under Section 9102. as an individual who has at least one parent in common with the decedent, whether by blood or adoption. . . -, e:\.;JpS~ \wilb\n\OOM .wil 1ECl!ltJlill Club Qft!ltCltttttd .... OF ('") Co -=--:D a .'_1-0 ~ __:~o n __J l> r- .0 '"-_ Ii1 o~~.;~ N '-'(:.20 ~ ': BERNIDA G. MOOSE, of 204-A Lincoln Street, Carlisle..:~eUMberliind :::'"J -- ""'J --; . . County, Pennsylvania, being of sound and disposing mind, memory and v?fderstan~g, BERNIDA G. MOOSE '" <::::1 "::I c;".. -. : .-'~~ :.:. ....-1 \.-.~ :. :'-) '. :, ;.:.:~; - .', _ J ~: (:; ~.. ~ f~~ ~(~ .- ;" ~ do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all former Wills, Codicils, or writings in the nature thereof, by me at any time heretofore made. FIRST: I hereby order and direct my Executrix or Executor, hereinafter named, to pay all my just debts, funeral expenses, testamentary expenses and all Inheritance, Estate, Transfer and Succession Taxes, as soon as may be conveniently done after my death, out of my residuary estate. SECOND: I direct that my jewelry and antique dishes be divided equally among my three daughters, PEGGY RICKRODE, F. JEAN PLANK and MARY RICHWINE. THIRD: All the rest, reside and remainder of my estate.I'give to my five children, PEGGY RICKRODE, MARY RICHWINE, F. JEAN PLANK, TERRY L. MOOSE and TOM E. MOOSE, in equal shares, per stirpes. t:\~S I \willll\mOO:<L'. wil LASTLY: I nominate, constitute and appoint my daughter, F. JEAN PLANK, to be the Executrix of this my Last Will and Testament. In the event that the said F. JEAN PLANK, shall be unable to serve as Executrix for any reason, I appoint my sons, TERRY L. MOOSE and TOM E. MOOSE, jointly, to serve as Co-Executors. No Executor or Executrix shall be required to file bond in this or any other jurisdiction. J 18\ IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of d-l:Vu_A O_^(J- , 1997_ ~,fj'm~ Bernida G. Moose SIGNED, SEALED, PUBLISHED and DECLARED in the presence of: I -...... i; ., (' '.,\ . \ :+-Lr~ )----.... i If. ( . /' J J .r-r). /' -l,oL-\; \ , "..l-(..{/~J' ,. j./\_, ': ,,:v -./. i i \ ~p1JJfe~k ..j I . <) ') c:\~ 1 \wiIls\moole.wi1 COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUMBERLAND I, BERNIDA G. MOOSE, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed fO and acknowleSlged before me, by BERNIDA G. MOOSE, the Testatrix, this l i:A day of (de.b\..(.LCL-\..{ r'" , 1997. ~/~In~ Bernida G. Moose, Testatrix NOTARIALSEA1.. MERLENE MARHEVKA. Notary Plbl:c Carft!e. Curr.berland Ccu:tt, p~ My Commission Expires 6,.S,'OO 3 c:\';pl \wi1Js\moose.wil COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUMBERLAND We. / and ~.h U); a~,Ch' the witnesses who ched or foregoing instrument, being duly qualified acc ding to law, do depose an say that we were present and saw Testatrix sign and execute the instrument as his Last Will; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. k. { Sworn or affirmed to and subscribed to before me by { ..! ,.. ", · I and ~'UJil [V\C' C~d M C Q this 1J t--f\ day of -:~. -'~ ( '~. ~), (J~'~;""~ , Witness I iLC...~ . ( ( I , /_. GL'V----'- LA., .~/~~~ I ., Witness "'-Y)Q!~. LJ,\ '- 0., '- J ,. ~.kl Q-!J I Cl);tcCeJ\_ ' \ Notary PClbHc . NOTARIAL SEfi.l MERLEj,jE M.4RHEV'M NClilrj ;:\b[: Caif.sla, Cur..ter1and Cou:r.y. F c.. My Commission Expir9s M;l~li 4 ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Moose, Bemida G. FILE NUMBER 21-06-1099 Indude the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1 Cumberland Valley Memorial Gardens - prepaid burial VALUE AT DATE OF DEATH 2 United America Health Ins. refund 3,852.50 138.55 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3,991.05 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3,991.05 ~_"_l.",,-'{"'4~':>.~:;"-,.~,~" No. Cumberland Valley Memorial Gardens 1921 Ritner Highway · Carlisle, PA 17013 717-243-3541 INTERMENT/ENTOMBMENT AUTHORIZATION AND INDEMNIFICATION - DATA ON DECEASED - Burial No. CONTRACf NO. ~\3. 3 Property Deed No. Today's Date: \\ - 1'1-0h D.O.B. 0.0.0. TIME OF DEATH MARITAL STATUS VETERAN: WAR RECORD PLACE OF DEATH: - DATA ON NEXT OF KIN OR REPRESENTATIVE - a..~ s... - DATA ON PROPERTY OWNER - IN AME: ~ ~ ' J. r II ...~ RELATIONSHIP: . ~AM~. ~-rl="~~~ ~~~ OirL L:,,___. ADDRESS: - INTERMENTIENTOMBMENTIINURNMENT DATA- ANt BY:G~\w \ $' scr NAME: I PHONE: ~. ., ?()(~ EST. ARRIVAL AT CEMETERY ( r~ 3.6 \\.\'0 . - MAUSOLEUM - TEMP: _ PERM: ~ INCISING/SCROLL DEATH DATE NEEDED: RELIGIOUS AFFIUATION/OTHER: CRYPTINICHE NOj zz. 2..& ,"ttJb J... - BURIAL - bf..LlLIDVAL GARDEN NAME! LOT NO. GRAVE(S) SINGLEIREO TYPE OF ~TER BURIAL CONTAINER: OUTER BURIAL CONTAINER CO.: SECTION NO. ..."'" ,J~ - - TRIPLE _. 'I .. ro...... t't~n"'I""'C nil AVJ:~lnF OTHER OT~R SP~~IALL.~TRVCTIONS/S~E~IA~ E~~~ - RSf-1509 EX. (6-98. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Moose. Bemida G; FILE NUMBER 21-06-1099 If an asset was made joint within one year of the decedent's date of death, It mUlt be reported on Schedule G. SURVIVING .IOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO ::JECEDENT A. F. Jean Plank 20 Brenely Lane Mt. Holly Springs, PA 17065 daughter 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 ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTL Y-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 12/23/96 Sovereign Bank checking acct # 2891037901 2,131.50 1,065.75 50 " TOTAL (Also enter on line 6, Recapitulation) $ 1,065.75 . (If more space is needed, insert additional sheets of the same size) """'._._......-. __~~'ul"-~_._. .'-""..:. _~..1"-,.,,,c ~:._.~ _~...~~'.-, Sovereign Bank Berinda G Moose 202-20-3400 November 16, 2006 ESTATE OF SOCIAL SECURITY #: DATE OF DEATH: Account #: 2891037901 Type: Checking In the name of: Bemida G Moose or F Jean Plank Date of Death Balance: $2,131.50 Int.(YTD) from 1/1/2006 to 11/7/2006 Accrued interest to date of death: $0.02 Other Info: Open date: 12/23/1996 $0.75 Account #: 6817173175 Type: In the name of: Bemida G Moose Balance Due at Death: Int.(YTD) from to Accrued interest to date of death: Other Info: closed 12/11/06 Installment Loan Open date: 8/22/2002 $1,589.03 Page 1 of 1 ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Moose, Bemida G. FILE NUMBER 21-06-1099 Debts of decedent must be reported on Schedule I. . ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Cumberland Valley Memorial Gardens 1921 Ritner Highway Carlisle, PA 17013 Ewing Brothers Funeral Home, Inc 630 S. Hanover Street Carlisle, PA 17013 3,852.50 4,343.50 -2 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) - . - StreefAilareSS- City _ State Zip Year(s) Commission Paid: 2. Attomey Fees 1,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State . Zip Relationship of Claimant to Decedent 4. Probate Fees 125.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Advertise letters: Sentinel-$144.29; Cumberland Law Joumal-$75.00 219.29 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 9,540.29 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 9,540.29 Ewing Brothers Funeral Home, Inc. 630 South Hanover Street Carlisle, PA 17013- (717)243-2421 November 21,2006 F. Jean Plank 20 Brenely Lane Mount Holly Springs, P A 17065 The Funeral Service for Bernida G. Moose We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feci free to contact liS if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. I. PROFESSIONAL SERVICES S.:rviccs of Funeral Director/Staff. . . . . . . . . . . . . . . . . FUNERAL HOME SERVICE CHARGES . . . . . . . . . . THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED . . . . . . . . . . . . . Cash Advances Clergy/Mass Offering, . . . . . . Ccrtitic:d Copies of the Death Certificate. Sentinel Obit. . . . . . . . . TOTAL CASH ADVANCES AND SPECIAL CHARGES. Totlll Total Cost . S UB- TOTAL INITIAL PAYMENT / DISCOUNT / CREDITS TOTAL AMOUNT DUE The unpalJ balance o\'\:r ~5 Jays IS subjected to a 1.00 % service charge per month - 12.0000 % per annum. nO \J f" ',,^ ~ 0--: l~ l\7' A~~~L t ~YI {ih Member of National Funeral Directors Association $4025.00 $4025.00 $4025.00 $100.00 $36.00 $182.50 $318.50 $4343.50 $4343.50 0.00 $4343.50 y sY3. YO -0 - Cl~. F'f-U. C'/-"" Q 12.. \ t I a' RETAIN THIS PORTION FOR YOUR RECORDS 17013 BILLING DATE 01/17/07 START DATE 12/28/06 NET AMOUNT 137.94 137.94 L1N S 38 * 2 TOP DATE 01/11/07 GROSS AMO o JACQUELINE M. VERNEY PUBLIC NOTICES LETTBRS TESTAMENT INSERTIONS RATE 3 LGL 3 PROOF OF PUBLICATION 01PRF 6.35 DA YS RUN PURCHASE ORDER 'd PAY THIS AMOUNT Est. Bern1 a Moose 144.29 173.15* · AFTER 02/16/07 MESSAGE: Thank you for advertising with The Sentinel. Deadlines for in-column legal advertisements: Monday is Friday at 11 a.m.; Tuesday is Friday at 4 p.m.; Wednesday is Monday at 12 Noon; Thursday is Tuesday at 12 Noon; Friday is Wednesday at 12 Noon; Sunday is Thursday at 12 Noon. If you have any questions regarding your Legal bill please call Tammy Shoemaker 717-240-7176 Fax your legals to 717-243-3754 attention Tammy Shoemaker You can also EMAIL yourlegaltoClassifiedads:classified@cumberlink.com Please send a cover letter including your name and address as an attachment PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland Tammy Shoemaker, Classified Advertising Manager, of The Sentinel, of the County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a newspaper of general circulation in the Borough of Carlisle, County and State aforesaid, was established December 13th, 1881, since which date THE SENTINEL has been regularly issued in said County, and that the printed notice or publication attached hereto is exactly the same as was printed and published in the regular editions and issues of THE SENTINEL on the following day(s) December 28,2006 and January 04,11, 2007 COPY OF NOTICE OF PUBLICATION Affiant further deposes that he/ she is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statement as to time, place and character of publication are true{/] < , _ i < L ',- L" YV\ ntlt.' _,.J 0L L'e::f\'\(\JCQ) , EX~C~RIX~ Letters Testamentary on the Estate of BERNIDA G. MOOSE, late of the !:Sorough of Mount Holly Springs. Cumberland County. Pennsylvania, deceased. have been granted to the undersigned. All persons knowing themselves to be.lndebted to said I Estate wiU make payment Immediat~ly. and those having claims wiD present them fo~'.~w,ement. 'F. Jean Plank, Executrix cJoJacquellne M. Vemey. Esquire 44 South Hanover Street Carlisle. PA 17013 Jacqueline M. Vemey, Attorney 44 SoUth Hanover Street Car\lsle, PA 17013 - Sworn to and subscribed before me this 17th day of January, 2007. j. ' t~ 'R'lJ)~ Notary Publ My commission expires: q /1/08 COMMONWEALTH OF PENNSYLVANIA NotaJ1al Seal . Christina L Wdfe, Notary Public Cartisle Bora. CUmberland County My CommIssiOn Expires Sept 1, 2008 Member, Pennsylvania AMoclati(:'O Of Notaries CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 January 19,2007 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Jacqueline M. Verney, Esquire Bernida G. Moose, ESTATE RE: Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on following dates: January 5, 12, & 19, 2007 Advertising Cost 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 75.00 Total Amount Due $ 0.00' ---- ------ Becky H. Morgenthal, Executive Director PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 COMMONWEAL TH OF PENNSYL VANIA SSe COUNTY OF CUMBERLAND Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, VIZ: January 5, 12, & 19, 2007 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. Moose, Bernida G., dec'd. Late of the Borough of Mt. Holly Springs. Executrix: F. Jean Plank c/o Jacqueline M. Verney, Esquire, 44 South Hanover Street, Car- lisle, PA 17013. Attorney: Jacqueline M. Verney, Esquire, 44 South Hanover Street, Carlisle, PA 17013. NOTARIAL SEAL LOIS E. SNYDER, Notary Public Carlisle 8oro, Cumberland County My Commission Expires March 5. 2009 . ~ REVt'1512 EX+ (12'{)3) *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE UABILITIES, & UENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Moose, Bemida G. FILE NUMBER 21-06-1099 Report debts Incurred by the decedent prior to death which remained unpaid a. of the date of death, Including unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Sovereign Bank Installment Loan # 6817173175 1,589.03 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1,589.03