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LAW OFFICES
SNELBAKER &
BRENNEMAN, P.C.
RECEIPT AND RELEASE
WHEREAS, Helen M. Fusselman, late of Upper Allen Township,
County of Cumberland and Commonwealth of Pennsylvania, died on
May 11, 2006, having first made her Last Will and Testament in
writing probated before the Register of Wills of said Cumberland
County on May 22, 2006, and Letters Testamentary were issued on
the same date to Joyce E. Capp, the Executrix named in the Last
Will and Testament of said Decedent; and
WHEREAS, said Executrix has entered upon and completed her
administration of said Decedent's Estate as set forth in her
First and Final Account attached hereto, and intends to
distribute the net balance of the assets of said Estate to the
person named in the Statement of Proposed Distribution also
attached hereto, both of said documents being incorporated herein
by reference thereto; and
NOW KNOW ALL MEN BY THESE PRESENTS, that I, Joyce E. Capp,
being the principal legatee and distributee named in the Will of
said Decedent and the person entitled to share in the residuary
distribution of the Estate of said Decedent, do hereby declare
and say that I have examined the attached Account and Statement
of Proposed Distribution, and find the same to be true and
correct, and in strict accordance with the terms
ce-qd pro~:sions
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LAW OFFICES
SNELBAKER &
BRENNEMAN, P.C.
of said Will, and I do hereby acknowledge that I this day have,
had and received of and from Joyce E. Capp, Executrix of the
Estate of Helen M. Fusselman, the cash, personalty and/or real
estate set opposite my name in the above Statement of Proposed
Distribution, in full satisfaction, payment and discharge of all
such sum or sums of money, legacies and bequests, share or
shares, purports and dividends which were due, owing and payable
and belonging to me, by any means whatsoever, for or on account
of my full share, part or dividend of the Estate of Helen M.
Fusselman, Deceased.
NOW, THEREFORE, I, the said Joyce E. Capp, do by these
presents, remise, release, quit-claim and forever discharge the
said Joyce E. Capp, her heirs, executors and administrators, of
and from my said shares or dividends of the Estate aforesaid, and
of and from all actions, suits, payments, accounts, reckonings,
claims and demands whatsoever, for or by reason thereof, or of
any act, matter, cause or thing whatsoever, from the beginning of
the world to the day and date of these presents.
AND, desiring to avoid the delay and expense of the
settlement of said Estate by filing the foregoing Account of said
administration in the Office of the Register of Wills of said
Cumberland County and by having the balance in the hands of the
Executrix, as shown by said Account, distributed by the Court of
Common Pleas of Cumberland County - Orphans' Court Division, I do
hereby agree that the foregoing Account and Statement concerning
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the matter of settlement may be recorded with the same effect
upon me as if the same had been reported upon by said Court, in a
decree of distribution made on such proposed Statement of
Distribution by the said Court of Common Pleas - Orphans' Court
Division.
AND in consideration of the aforesaid settlement being made
without the aid of such Court of Common Pleas - Orphans' Court
Division, that I the said Joyce E. Capp, do hereby agree that if
any debts or demands other than those included in the above
referenced First and Final Account, as hereinbefore set forth,
shall be hereafter recovered against the Estate of said Decedent
and be legally payable out of the same, that I will return to the
said Executrix such amounts thereof as may be necessary to pay
such debts or demands.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this /J,+'-ctay of 7~ 2007.
WITNESSED BY:
~~~~
yce E.' Ca
(SEAL)
LAW OFFICES
SNELBAKER &
BRENNEMAN, P.C.
3
LAW OFFICES
SNELBAKER 8:
BRENNEMAN, P.C.
COMMONWEALTH OF PENNSYLVANIA)
SS.
COUNTY
OF
CUMBERLAND)
On this the I~+h day of a~\A::s.t
2007, before me, a
Notary Public in and for said State and County, the undersigned
officer, personally appeared Joyce E. Capp, known to me (or
satisfactorily proven) to be the person whose name is subscribed
to the within instrument and acknowledged that she executed the
same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official
seal.
~Q1~g~
Notary Public
~ TH OF PENNSYLVANIA
No4ariaI SeeI
Sandra K. ShaN8fS, ~CounlY
~Boro.
My eo....1ilIsIon ExpIres Nov. 22. 2C111
Member. Pennsylvania Association Of Notelfes
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LAW OFFICES
SNELBAKER &
BRENNEMAN, P.C.
ESTATE NO. 21-06-0439
FIRST AND FINAL ACCOUNT AND STATEMENT OF PROPOSED
DISTRIBUTION OF AND BY JOYCE E. CAPP, EXECUTRIX
OF THE ESTATE AND UNDER THE LAST WILL AND TESTAMENT
OF HELEN M. FUSSELMAN, DECEASED, LATE OF UPPER ALLEN
TOWNSHIP, CUMBERLAND COUNTY, PENNSYLVANIA
oyce E. Capp, Executrix as aforesaid and Accountant herein,
avers as follows:
DATE OF DECEDENT'S DEATH:
DATE LETTERS TESTAMENTARY ISSUED:
May 11, 2006
May 22, 2006
DATES EXECUTOR NOTICE ADVERTISED:
Cumberland Law Journal
Patriot-News
June 2,9, 16,2006
May 31, June 7, 14,2006
FIRST AND FINAL ACCOUNT
PERSONAL TV - PRINCIPAL ACCOUNT
DEBITS
he Accountant charges herself with the receipt of the following items of
Decedent's Personalty valued as of the date of Decedent's death:
1. Bank of Hanover, Certificate of Deposit, #145019
2. Bank of Hanover, Certificate of Deposit, #143095
3. Bank of Hanover, Certificate of Deposit, #143093
4. Bank of Hanover, Certificate of Deposit, #143092
5. Bank of Hanover, Certificate of Deposit #136609
6. Verizon, refund on phone service
7. Principal Financial Group, annuity #0182280 payment April and May 2006
8. Commonwealth of Pennsylvania, refund on Inheritance Tax
TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, DEBITS:
PERSONAL TV - PRINCIPAL ACCOUNT
CREDITS
he Accountant claims credit for the payment of the following items from
Decedent's Personalty Account:
1. Messiah Village, resident care
2. Alert Pharmacy Services, Inc., medical expense
3. Cocklin Funeral Home, Inc., funeral services
4. Associated Cardiologists, medical expense
5. Mobile X-Ray Imaging, Inc., medical expense
6. Capital Area Health Associates, medical expense
7. Holy Spirit Hospital, medical expense
8. Register of Wills, filing fee for Inheritance Tax Return
9. Register of Wills, Agent, Inheritance Tax
10. Snelbaker & Brenneman, P.C., attorney services
11. Snelbaker & Brenneman, P.C., costs advanced
Page 1
$ 5,003.86
3,016.73
10,001.67
3,518.47
2,000.97
7.59
342.19
39.47
$ 23,930.95
$ 9,136.72
79.28
8,152.08
1.76
26.00
112.01
25.00
15.00
2,094.75
1,250.00
334.69
LAW OFFICES
SNELBAKER 8:
BRENNEMAN. P.C.
a. Cumberland Law Journal, advertising Executrix Notice
b. Patriot-News, advertising Executrix Notice
c. Register of Wills, probate fees
d. Register of Wills, short certificates
12. Reserve for filing fees, accounting fees and costs associated
with the administration of Decedent's estate
TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, CREDITS:
PERSONALTY - INCOME ACCOUNT
DEBITS
he Accountant charges herself with the receipt of the following
income from the investment of Personalty Principal:
1. Bank of Hanover, Certificates of Deposit, interest
2. Orrstown Bank, estate checking account, interest
TOTAL, PERSONALTY, INCOME ACCOUNT, DEBITS:
PERSONALTY - INCOME ACCOUNT
CREDITS
he Accountant claims credit for the payment of the following items
from the Personalty Principal Account:
TOTAL, PERSONALTY, INCOME ACCOUNT, CREDITS:
REAL ESTATE - PRINCIPAL ACCOUNT
DEBITS
he Accountant charges herself with the receipt of Decedent's
Real Estate as follows:
TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, DEBITS:
REAL ESTATE - PRINCIPAL ACCOUNT
CREDITS
he Accountant claims credit for the payment of the following
items from Real Estate Principal Account:
TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, CREDITS:
REAL ESTATE -INCOME ACCOUNT
DEBITS
he Accountant charges herself with the receipt of the
income from the investment of Real Estate Principal Account:
TOTAL, REAL ESTATE, INCOME ACCOUNT, DEBITS:
REAL ESTATE -INCOME ACCOUNT
CREDITS
he Accountant claims credit for the payment of the following items
from the Real Estate Income Account:
TOTAL, REAL ESTATE, INCOME ACCOUNT, CREDITS:
Page 2
75.00
129.69
106.00
24.00
1,000.00
$ 22,227.29
$ 151.88
10.48
$ 162.36
$ NONE
$ NONE
$ NONE
$ NONE
$ NONE
$ NONE
$ NONE
$ NONE
$ NONE
$ NONE
RECAPITULATION
ERSONALTY:
PRINCIPAL ACCOUNT:
Debits
Credits
Balance
INCOME ACCOUNT:
Debits
Credits
Balance
TOTAL PERSONALTY
EAL ESTATE:
PRINCIPAL ACCOUNT:
Debits
Credits
Balance
INCOME ACCOUNT:
Debits
Credits
Balance
TOTAL REAL ESTATE:
OTAL FOR DISTRIBUTION:
LAW OFFICES
SNELBAKER &
BRENNEMAN, P.C.
Page 3
$ 23,930.95
$ 22,227.29
$ 162.36
$ NONE
$ NONE
$ NONE
$ NONE
$ NONE
$
1,703.66
$
162.36
$ NONE
$ NONE
$ 1,866.02
$ NONE
$ 1,866.02
LAW OFFICES
SNELBAKER &
BRENNEMAN, P.C.
STATEMENT OF PROPOSED DISTRIBUTION
Joyce E. Capp, Executrix and Accountant herein, proposes to
istribute the balance of the Estate of Helen M. Fusselman, Deceased, to wit:
1,866.02 in accordance with the Last Will and Testament of said Decedent
s follows:
Joyce E. Capp
100% of residue as per Item 3 of Will
OTAL FOR DISTRIBUTION:
Page 4
$ 1,866.02
$ 1,866.02
LAW OFFICES
SNELBAKER &
BRENNEMAN. P.C.
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY
OF CUMBERLAND
Joyce E. Capp, being duly sworn according to law deposes and says:
that she is the Executrix of the Estate and under the Last Will and Testament of
Helen M. Fusselman, Deceased, and the Accountant herein; that there are no
unpaid creditors or claimants of said Estate; that there are no persons
interested in the distribution of said Estate other than as stated in the foregoing
Statement of Proposed Distribution; and that the facts set forth in the foreqoing
First and Final Account and Statement of Proposed Distribution are true and
correct to the best of her knowledge, information and belief.
V?~ fl. ~
. Joyce E. Ca
Executrix and Accountant
Sworn to and subscribed before me
this 1-3#-- day of Cl~~t- 2007
~OndAO..~
Notary Public
COMMONW TH OF PENNSYLVANIA
NolarlaI Seal
Sandra K SOONers. /IIotaIy PubIc
Mechanlcsburg Boro, Cumberland County
My Ccmllli98lon Expires Nov. 22. 2007
Member, Pennsylvania Association OfNotaI1es
Page 5