HomeMy WebLinkAbout10-26-07
-I
15056041147
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX.280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
.
County Code
INHERITANCE TAX RETURN 21
RESIDENT DECEDENT
'fear
File Number
07
0190
Date of Birth
196141292
02172007
03171924
Decedent's Last Name
COOK
Suffix
Decedent's First Name
MARY
MI
E
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Suffix
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
[!] 1. Original Return 0 2. Supplemental Return 0 3. Remainder Return (date 01 death
prior to 12-13-82)
0 4. Limited Estate 0 4a. Future Interest Compromise 0 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
[K\ 6. Decedent Died Testate 0 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
0 9. Litigation Proceeds Received 0 10 Spousal Poveny Credit (date of death 0 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 . Daytime Telephone Number
KAREN H. COOK ESQUIRE 6103727700
Firm Name (If Applicable)
MASANO BRADLEY, LLP
REGISTER OF Wltl:;S USE O.N4Y
First line of address
1100 BERKSHIRE BOULEVARD
Second line of address
SUITE 201
.DATE FILED
City or Post Office
WYOMISSING
State
PA
ZIP Code
19610
t.""..,l
k COO k@masa n 0 b ra dIe y .c 0 m
Timothy G. Cook
2313 SW 44th Street, Cape Coral, FL 33914
SI(PATURE ~F ~REP~RER OTJlER THAN REPRESENTATIVE
~ ~ Karen H Cook Esquire
ADDRESS
I b) IJ, r;~
1100 Berkshire Boulevard, Wyomissing, PA 19610
Side 1
L
15056041147
15056041147
-I
--.J
15[]5b[]42148
REV-1500 EX
Decedent's Name MARY E. COOK
Decedent's Social Security Number
196141292
RECAPITULATION
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) D Separate Billing Requested............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) D 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 ejection 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, of
transfers under Sec. 9116
(a)(1.2) X ~
16. Amount of Line 14 taxable
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
o . 0 0
15.
273,074.65
16.
o . 0 0
17.
0.00
18.
19. Tax Due....... ..................... ..................... ..........,.......... .... ..................... ...................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L
15[]5b[]42148
195,000.00
30,230.04
32,312.26
41,041.41
298,583.71
23,680.81
1,828.25
25,509.06
273,074.65
273,074.65
o . 0 0
12,288.36
0.00
o . 0 0
12,288.36
D
15[]5b[]42148
--.J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 2107-0190
DECEDENT'S NAME
MARY E. COOK
STREET ADDRESS
108 East Maplewood Avenue
CITY 1 STATE IZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
11,000.00
578.95
Total Credits (A + B + C)
(2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
12,288.36
11,578.95
Total Interest/Penalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
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.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5) 709.41
(5A)
(5B) 709.41
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
a. retain the use or income of the property transferred;.................................................................................. 0
~: ~::::~ ~h;e~;~~i~on~~s:~~;~s~~~. .~.~.~.I~. ~~~. ~~~. :.~.~~.~.~~. .tr~~~.f~~r~~. ~.~ .i~.~. ~~~~~~;:::::::::::::::::::::::::::::::::::: B
d. receive the promise for life of either payments, benefits or care?.............................................................. 0
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?..... ........................... ....................... ................... ................ .................. ......... [.!J 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.
No
[.!J
[.!J
[.!J
[.!J
[.!J
[.!J
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. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero
(0) percent [72 P.S. 99116 (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. 99116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent,
except as noted in 72 P.S. 99116 1.2) [72 P.S. 99116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 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 blood or adoption.
Rev-1502 EX+ (6-98)
'*
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COOK, MARY E.
FILE NUMBER
2107 -0190
ESTATE OF
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 jOlntly-owned with right of survivorship must be disclosed on schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1
Real estate located at 108 East Maplewood Avenue, Borough of Mechanicsburg,-
County of Cumberland, Commonwealth of Pennsylvania, being more fully
described in Deed Book Volume 15-1, Page 495, Cumberland County Records - copy
of settlement sheet attached hereto
195.000.00
TOTAL (Also enter on Line 1, Recapitulation)
195.000.00
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule A (Rev. 6-98)
Rev-1503 EX+ (6-98)
.
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COOK, MARY E.
lFILE NUMBER
2107-0190
ESTATE OF
All property Jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 3 shares of Agere Systems, Inc. 20.09 60.27
2 26.8969 shares of Alcatel-Lucent 13.286 357.35
3 324.206821 shares of AT&T Inc. 37.365 12.113.99
4 261.948 shares of Delaware Balanced Fund A Class - 19.00 4.977.01
account #2-5021709796
5 11 shares of Idearc Inc 35.24 387.64
6 241.060817 shares of Verizon 38.3475 9.244.08
7 105.4595 shares of VodaFone Grp PLC ADS 29.2975 3.089.70
TOTAL (Also enter on Line 2, Recapitulation) 30.230.04
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule B (Rev. 6-98)
Rev-15G8 EX+ (6-98)
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYl VP-NIP-
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
COOK, MARY E.
FILE NUMBER
2107 -0190
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jolntly-owned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 Members 1st Federal Credit Union - regular savings account #197900-00
VALUE AT DATE
OF DEATH
105.13
2 Members 1st Federal Credit Union - accrued interest on regular savings account
#197900-00
0.05
3 Members 1st Federal Credit Union - certificate of deposit #19900-42
3,726.24
4 Members 1st Federal Credit Union - accrued interest on certificate of deposit
#19900-42
5.86
5 Members 1st Federal Credit Union - certificate of deposit #197900-46
2.062.28
6 Members 1st Federal Credit Union - accrued interest on certificate of deposit
#197900-46
4.55
7 PNC Bank - checking account #5140013009
3,004.26
8 Prudential Financial - Alliance account #4351000392352
17.070.86
9 1999 Chevrolet Lumina - VIN 2G1WL52M2X9273240
3.000.00
10 Com cast - refund on cancellation of service
3.24
11 Erie Insurance Group - refund of premium on cancellation of homeowners
insurance
60.00
12 Erie Insurance Group - refund of premium on cancellation of auto insurance
202.00
13 Highmark - refund of premium on cancellation of health insurance
330.26
14 Personal property
1.474.35
Total of Continuation Schedule
See attached page
TOTAL (Also enter on Line 5, Recapitulation)
32.312.26
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
Rev-1508 EX+ (6-98)
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
COOK, MARY E.
FILE NUMBER
2107-0190
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
15
Susan P. Wagner- reimbursement of real estate taxes and sewer and trash at real
estate settlement
925.18
16
United States Treasu'Y - refund on 2006 - Form 1040 personal income tax
338.00
TOTAL (Also enter on Line 5, Recapitulation)
32.312.26
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
Rev-1510 EX+ (6-98)
.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
COOK, MARY E.
FILE NUMBER
2107-0190
This schedule must be completed and filed ~ the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE.
1 Commerce Bank - IRA account #07093 - 5.226.21 5.226.21
beneficiaries, children - Ralph W. Cook, III
Timothy G. Cook, and Sandra E. Sopko
2 Commerce Bank - accrued interest on IRA 165.23 165.23
account #07093 - beneficiaries, children - Ralph
W. Cook, III, Timothy G. Cook, and Sandra E.
Sopko
3 M & T Bank -IRA account #035004201756127- 4.918.92 4.918.92
beneficiaries - children, Timothy G. Cook, Ralph
W. Cook, III, and Sandra E. Sopko
4 M & T Bank - accrued interest on IRA account 18.17 18.17
#035004201756127 - beneficiaries - children,
Timothy G. Cook, Ralph W. Cook, III, and Sandra
E.Sopko
5 M & T Bank -IRA account #035004201756135- 4.853.02 4.853.02
beneficiaries - children, Timothy G. Cook, Ralph
W. Cook, III, and Sandra E. Sopko
6 M & T Bank - accrued interest on IRA account 13.05 13.05
#035004201756135 - beneficiaries - children,
Timothy G. Cook, Ralph W. Cook, III, and Sandra
E.Sopko
7 PNC Bank - IRA account #75800023930 - 13.643.71 13.643.71
beneficiaries - children, Timothy G. Cook, Ralph
W. Cook, III, and Sandra E. Sopko
Total of Continuation Schedule ee attached page
TOTAL (Also enter on Line 7, Recapitulation) 41.041.41
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule G (Rev. 6-98)
Rev-1510 EX+ (6-98)
.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
COOK, MARY E.
FILE NUMBER
2107-0190
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S TAXABLE
EXCLUSION
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER. ATTACH A COpy OF THE DEED FOR REAL ESTATE
8 PNC Bank - accrued interest on IRA account 38.52 38.52
#75800023930 - beneficiaries - children, Timothy
G. Cook, Ralph W. Cook, III, and Sandra E. Sopko
9 Sovereign Bank - IRA account #0358002913 - 12.147.53 12,147.53
beneficiaries, children - Ralph W. Cook, III,
Timothy G. Cook, and Sandra E. Sopko
10 Sovereign Bank - accrued interest on IRA 17.05 17.05
account #0358002913 - beneficiaries, children -
Ralph W. Cook, III, Timothy G. Cook, and Sandra
E.Sopko
TOTAL (Also enter on Line 7, Recapitulation) 41.041.41
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule G (Rev. 6-98)
REV-1151 EX+ (12-99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
COOK, MARY E.
FILE NUMBER
2107-0190
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 321.49
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees MASANO BRADLEY, LLP 5,975.00
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 324.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 17,060.32
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 23,680.81
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev-1502 EX+ (6-98)
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
COOK, MARY E.
FILE NUMBER
2107-0190
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Auer Memorial Home & Cremation Services, Inc. - funeral services
196.49
2
James R. Gingrich Memorials - inscription
125.00
Subtotal
321.49
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule H-A (Rev. 6-98)
Rev-1502 EX+ (6-98)
*'
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
IFILE NUMBER
2107-0190
COOK, MARY E.
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
1-800-Got-Junk?
488.00
2
Cumberland Law Journal - estate advertising
75.00
3
Haar's Auction Service - personal property sales commission
589.74
4
Lester W. Erb, Inc. - fuel oil delivery
300.08
5
Masano Bradley, LLP - reimbursement for costs advanced
165.38
6
Miscellaneous administratitve expenses
300.00
7
Molly Garman - reimbursement for picture
245.22
8
National Penn Bank - printed check charges
21.43
9
PPL Electric Utilities - utility service
73.50
10
PPL Electric Utilities - utility service
32.18
11
The Patriot News - estate advertising
319.07
12
Tri-County Abstract Service - real estate settlement costs
14.433.99
13
United Water Pennsylvania - utility service
7.37
14
Verizon - utility service
9.36
Subtotal
17.060.32
Form PA-1500 Schedule H-87 (Rev. 6-98)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Rev.1512 EX+ (6-98)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
COOK, MARY E.
FILE NUMBER
2107-0190
Include unreimbursed medIcal expenses.
ITEM
NUMBER DESCRIPTION
VALUE AT DATE
OF DEATH
1 Associated Cardiologists - medical services
115.87
2 Barry L. Heckard, Sr., Tax Collector - per capita tax
9.80
3 Corncast - utility service
66.58
4 PNC Bank - checks clearing checking account #5140013009 after date of death
1.288.31
5 PPL Electric Utilities - utility service
96.69
6 Quantum Imaging & Therapeutic Associates - medical services
40.50
7 United Water Pennsylvania - utility service
38.94
8 Verizon - utility service
171.56
TOTAL (Also enter on Line 10, Recapitulation)
1,828.25
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
REV.1513 EX+ (9-00)
.
SCHEDULE ..
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
COOK, MARY E.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116(a)(1.2)]
RELATIONSHIP TO
DECEDENT
00 Not List Trustee(s)
FILE NUMBER
2107-0190
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
I.
Ralph W. Cook III
6 Buck Run
Mohnton, PA 19540
Son
One-Third (1/3)
of residuary
estate
Timothy G. Cook
2313 SW 44th Street
Cape Coral, FL 33914
Son
One-Third (1/3)
of residuary
estate
Sandra E. Sopko
5404 Tecamec Road NE
Rio Rancho, NM 87144
Daughter
One-Third (1/3)
of residuary
estate
Total
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 6-98)
REGISTER OF WILLS
CUMBERLAND County, Pennsylvania
CERTIFICATE OF GRANT OF LETTERS
No. 2007-00190
Es ta te Of: MARY E COOK
PA No. 21-07-0190
(First, Middle, Last!
Late Of:
MECHANICSBURG BOROUGH
CUMBERLAND COUNTY
Deceased
Social Security No: 196-14-1292
WHEREASr on the 1st day of March 2007 an instrument dated
April 26th 1999 was admitted to probate as the last will of
MARY E COOK
(First, Middle, Last!
la te of MECHANICSBURG BOROUGH, CUMBERLAND County,
who died on the 17th day of February 2007 and
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA FARNER STRASBAUGH Register of Wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
TIMOTHY G COOK
who has duly qualified as EXECUTOR(RIX)
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 1st day of March 2007.
, yjlJ-nk~~!u~~~
l.iliA ('y_~
-4/. tl Deputy
* *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
1flaat ~llJill alt~ ~~~gtmtt~1tt
OF
MARY E. COOK
I, MARY E. COOK, of the Borough of Mechanics burg, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make,
publish and declare this my Last Will and Testament, hereby revoking and making void any
and all Wills by me at any time heretofore made..
1.
I direct the payinent of all my just debts and funeral expenses as soon after my decease
as the same can conveniently be done.
2.
I direct that there shall be paid out of my residuary estate all estate, inheritance and like
taxes together with any interest or penalty thereon imposed by the Government of the United
States, or any state or territory thereof, or by any foreign government or political subdivision
thereof, in respect to all property required to be included in my gross estate for estate,
inheritance or like tax purposes by any of such governments, whether the property passes under
this wil.1 or otherwise.
3.
I give, devise and bequeath my entire estate, real, personal and mixed, in equal. shares, to
my three children, RALPH W. COOK III, TIMOTHY G. COOK and SANDRA E.
SOPKO, absolutely and in fee simple.
4.
In the event my son, RALPH W. COOK III, should predecease me, his share shall not
- 1 -
lapse, but go to his son, RALPH W. COOK IV.
5.
In the event my son, TIMOTHY G. COOK, should predecease me, his share shall not
lapse, but shall pass to his heirs in eqmil shares per stirpes.
6.
In the event my daughter, SANDRA E. SOPKO, should predecease me, her share shall
lapse and fall into the residue of my estate.
7.
I nominate, constitute and appoint my three children, RALPH W. COOK Ill,
TIMOTHY G. COOK and SANDRA E. SOPKO, to be the Executors of this my Last Will
and Testament and if for any reason one or more would be unwilling or unable to act as such,
then the remaining children shall serve as Executors. I further direct no bond or other secutiry
shall be required of my personal representatives to guarantee the faithful performance of their
duties..
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~01A day of
April, 1999.
.7n~ Ct (LlJ
ry . 00
(SEAL)
Signed, sealed, published and declared by the above named MARY E. COOK as and
for his Last Will and Testament, in the presence of us who have subscribed our names hereto as
witnesses, at her request, in her presence and in the presence of each other.
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M NO. 2502-0265 '-r
A. B. TYPE OF LOAN:
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.DFHA 2.DFmHA 3.DcONV. UNINS. 4.DVA 5. DCONV. INS.
6. FILE NUMBER: 17. LOAN NUMBER:
SETTLEMENT STATEMENT WAGN67-07
8. MORTGAGE INS CASE NUMBER:
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Am~unts paid to and by the settlement ~gent are. shown.
Items marked "[POC)" were paid outside the closing; they are shown here for informatIOnal purposes and are not Included In the totals.
1.0 3198 (WAGN67-07.PFDIWAGN67-0715)
D. NAME AND ADDRESS OF BUYER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:
SUSAN P. WAGNER ESTATE OF MARY E. COOK CASH
405 GETTYSBURG PIKE 108 EAST MAPLEWOOD AVENUE
MECHANICSBURG, PA 17055 MECHANICSBURG, PA 17055
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 25-1619811 I. SETTLEMENT DATE:
108 EAST MAPLEWOOD AVENUE TRI-COUNTY ABSTRACT SERVICE
MECHANICSBURG, PA 17055 April 16, 2007
CUMBERLAND County, Pennsylvania PLACE OF SETTLEMENT
3414 CHESTNUT STREET
CAMP HILL, PA 17011
J. SUMMARY OF BUYER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BUYER: 400. GROSS AMOUNT DUE TO SELLER:
101. Contract Sales Price I 195,000.00 401. Contract Sales Price 195,000.00
102. Personal Property 402. Personal Property
103. Settlement CharQes to Buyer (Line 1400f 3,236.88 403.
104. 404. I
105. 405. I
Adjustments For Items Paid By Seller in advance Adiustments For Items Paid Bv Seller in advance
106. CitylTown Taxes 04/16/07 to 01/01/08 I 464.74 406. CitylTown Taxes 04/16/07 to 01/01/08 I 464.74
107. County Taxes to I 407. County Taxes to I
108. SCHOOL TAX 04/16/07 to 07/01/07 371.23 408. SCHOOL TAX 04/16/07 to 07/01/07 371.23
109. SEWERITRASH APRIL-JUNE 04/16/07 to 07/01/07 89.21 409. SEWER/TRASH APRIL-JUNE 04/16/07 to 07/01/07 I 89.21
110. 410. i
111. 411.
112. I 412. I
120. GROSS AMOUNT DUE FROM BUYER I 199,162.06 420. GROSS AMOUNT DUE TO SELLER 195,925.18 .
200. AMOUNTS PAID BY OR IN BEHALF OF BUYER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Deposit or earnest money 3,000.00 501. Excess Deposit (See Instructions) T
202. Principal Amount of New Loan(s) 502. Settlement Chames to Seller (Line 1400) 14,433.99
203. Existino loan(s) taken subiect to 503. Existino -Ioan(s) taken subject to
204. 504. Payoff of first Mortgage I
205. 505. Payoff of second Mortaage I
206. 506.
207. 507. (Deposit disb. as proceeds) I
208. 508.
209. I 509. ,
Adjustments For Items Unpaid By Seller Adjustments For Items Unpaid By Seller
210. CitylTown Taxes to 510. Citv/Town Taxes to
211. County Taxes to 511. County Taxes to
212. SCHOOL TAX to 512. SCHOOL TAX to I
213. I 513.
214. 514.
215. I 515. !
I
216. I 516. I
217. 517.
218. 518. I
219. 519. I
220. TOTAL PAID BY/FOR BUYER 3,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER I 14,433.99
300. CASH AT SETTLEMENT FROMITO BUYER: 600. CASH AT SETTLEMENT TO/FROM SELLER:
301. Gross Amount Due From Buyer (Line 120) I 199,162.06 601. Gross Amount Due To Seller (Line 420) I 195,925.18
302. Less Amount Paid By/For Buyer (Line 220) ( 3,000.00) 602. Less Reductions Due Seller (Line 520) ( 14,433.99
,
303. CASH ( X FROM) ( TO) BUYER 196,162.06 603. CASH ( X TO) ( FROM) SELLER 181,491.19
"
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The undersigned hereby acknowledge receipt of a completed copy of pages 1 &2 of this statement & any attachments referred to herein.
I HAVE CAREFULLY REVIEWED THE HUD-1 SETTLEMENT STATEMENT AND TO THE BEST OF MY KNOWLEDGE AND BELIEF, IT IS A TRUE AND
ACCURATE STATEMENT OF ALL RECEIPTS AND DISBURSEMENTS MADE ON MY ACCOUNT OR BY ~ TRANSACTION. I RTHER CERTIFY
THAT I HAVE RECEIVED A Y OF THE HUD-1 ~ETTLEMENT STATEMENT. \ \
Buyer ';A-(l a'1/( . < ; ~ S
SUSAN P. WAGNER ESTATE OF MAR E. OOK
TO THE BEST OF MY Km. LEDGE, THE .HUD-1 SET.TLEMEN.r ST. AT. EME;NT WHICH I HAVE PREPARED IS A TRU AND ACCURATE ACCOUNT OF THE
FUNDS WHICH WER / 9jVi=D AND Ij~F BEE,. "y~.' ~. U.lSED_B~ THE UNDERSIGNED AS PART OF THE SETTLEMENT OF THIS
TRANSACTION. ..~c..o...-"/ V /'.. ~'----'""
,SETTLEMENT OFFICER
I Settlement Agent '
WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMEtl-rS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON
CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE: TITLE 18 U.S. CODE SECTION 1001 & SECTION 1010.
L. SETTLEMENT CHARGES
700. TOTAL COMMISSION Based on Price $ 195,000.00 (Q) 6.0000 % 11,700.00 PAID FROM PAID FROM
Division of Commission (line 700) as Follows: BUYER'S SELLER'S
701. $ 5,875.00 to CENTURY 21 A BETTER WAY FUNDS AT FUNDS AT
702. $ 5,825.00 to HOMEMASTERS REALTY GROUP SETTLEMENT SETTLEMENT
703. Commission Paid at Settlement 11,700.00
704. TRANSACTION FEE to
BOO. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Oriqination Fee % to
802. Loan Discount % to
803. Appraisal Fee to
804. Credit Report to
805. Lender's Inspection Fee to
806. Mortqaqe Ins. App. Fee to
807. Assumption Fee to
808.
809.
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From to @ $ /day ( days %)
902. MIP Totlns. for LifeOfLoan for months to
903. Hazard Insurance Premium for 1.0 years to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER .
1001. Hazard Insurance months @ $ per month
1002. Mortqaqe Insurance months @ $ per month
1003. CitvlTown Taxes months (cj) $ per month
1004. County Taxes months @ $ per month
1005. SCHOOL TAX months @ $ per month
1006. months (Q) $ per month
1007. months @ $ per month
1008. AGGREGATE ESCROW ADJUSTMEI months (cj) $ per month
1100. TITLE CHARGES
1101. Settlement or Closing Fee to
1102. CLOSING PROTECTION LETTER to FIRST AMERICAN TITLE INSURANCE COMPANY
1103. Title Examination to
1104. Title Insurance Binder to
1105. Document Preparation to
1106. Notarv Fees to CASH 8.00 4.00
1107. Attorney's Fees to
(inc/udes above item numbers: )
1108. Title Insurance to TRI-COUNTY ABSTRACT SERVICE AGENT 1 200.38
(inc/udes above item numbers: )
1109. Lender's Coverage $
1110. Owner's Coverage $ 195,000.00 1,200.38 106230054
1111. ENDORSEMENTS
1112.
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees: Deed $ 38.50; Mortgage $ Releases $ 38.50
1202. City/County Tax/Stamps: Deed 1,950.00' Mortqage 1,950.00
1203. State Tax/Stamos: Revenue Stamps 1,950.00; Mortaaqe 1,950.00
1204.
1205. OVERNIGHT/COURIER FEES
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Survey to
1302. Pest Inspection to HOME PARAMOUNT 40.00
1303. TAX CERTIFICATION FEE to TRI-COUNTY ABSTRACT SERVICE RE-IMBURSEMENT 5.00
1304. SEWER/TRASH JAN-MARCH to MECHANICSBURG BOROUGH 28.80
1305. See addit'l disb. exhibit to 746.19
1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K) 3,236.88 14,433.99
By signing page 1 of this statement, the signatories acknowledge receipt of a completed copy of page 2 of this two page s(~tement. / "\
Page 2
Certified to be a true copy.
fJiLu / L '71~ /
. i . '. tGtv tt /J1 1/ - ...I-':.L.~
ZETTLEMENT OFFICER ~ J' ' i
Settlement Agent i
(WAGN67-07/ WAGN67-07/5)
ADDITIONAL DISBURSEMENTS EXHIBIT I
Buyer: SUSAN P. WAGNER
Seller: ESTATE OF MARY E. COOK
Lender: CASH
Settlement Agent: TRI-COUNTY ABSTRACT SERVICE
(717)761-8870
Place of Settlement: 3414 CHESTNUT STREET
CAMP HILL, PA 17011
Settlement Date: April 16, 2007
Property Location: 108 EAST MAPLEWOOD AVENUE
MECHANICSBURG, PA 17055
CUMBERLAND County, Pennsylvania
PAYEE/DESCRIPTION
NOTE/REF NO
BUYER
SELLER
BARRY L. HECKARD, TAX COL.
2007 COUNTY/TOWNSHIP TAXES
MECHANICSBURG BOROUGH
SEWER/TRASH APRIL-JUNE
639.37
106.82
Total Additional Disbursements shown on Line 1305
$
0.00
$
746.19
(WAGN67 -07 .PFD/W AGN67 -07/4)