The URL can be used to link to this page

Home My WebLink About01-0590 Estate of Ida L. Kocur REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA PETITION FOR GRANT OF LETTERS oJ./- 01- 590 No. -- also known as , Deceased Social Security No. 174204213 Petitioner(s), who is/are 18 years of age or older, apply)ies) for: (COMPLETE "A" OR "B" BELOW:) o A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut Decedent, dated and codicil(s) dated named in the Last Will of the State relevant circumstances, e.g., renunciation, death of executor, etc Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: GJ B. Grant of Letters of Administration (c.I.a., d.b.n.c.l.a.: pendente lite, durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: Relationship co" ~""--:.; 'S.\" <;.~ "S.\ <i..~ b ?tL....-..- ~~~~ (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at 422 Third St., West Fairview, PA 17025 (list street, number and municipality) Decedent, then 77 years of age, died May 31 , 2001 ,at Holy Spirit Hospital (Location) Decedent at death owned property with estimated values as follows: (if domiciled in PA All personal property ......................................... $ (if not domiciled in PA Personal property in Pennsylvania .................... $ (if not domiciled in PA Personal property in County .............................. $ Value of real estate in Pennsylvania ........................................................................................ $ Total.......... ..... ...... .... .............. ....... .... ................ ....... ....... ....... ...... ....... .... ...... ....... $ Real Estate situated as follows: 422 Third St., West Fairview, PA 17025 65,000.00 60,000.00 125,000.00 Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Typed or printed name and residence Ma belle Shank 401 5th Street West Fairview, PA 17025 RW-1 /6 _ ,;13 r?'- II , I~ to certifY tlut the information here given is correctly copied from an original certifIcate of death dul~ filed with :,; I Registrar. The origin,d certificate will be fOlwarded ro the State Vital Records Office for permanent fillt1g. me as WARNING: It is illegal to duplicate this copy by photostat or photograph. No. ~ffiW;;;~ ff,il'(~\l\\ OF pi'i:----~ l\~~\ ~~~~ ~~~ ~~I _ T, _ \?.. ~ ~I .~ .. "~~ ~BI ,a#~; .I.i:~ ... \ _ ~ '"6 . I ~ \ *\~ ._'-,<~--" -~/ *l ,,4. '. /...~\' \. ~;,o,.''-'_/~ ii ~ ""4b". ~\,><".'r" "'-_,'1q/)I__o/ ~ """,., """,'"EN1 \\ """ '''J//no/IIIJJI ~~~ Fee f,)r this certificate, $2.00 P 7429347 JUN 0 2 200\ Date .143A.....2187 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH 77 L. Kocur UNDER 1 VEAl! M_ Days sex female STAlE FILE NUUBER SOCIAL SECURnv NUMBER 3.174 _20 _4213 DAlE OF OEATH IMcnr.. Day. ....., '0 m~ "31, JOo I NAME Of DECEDENT if 11$1_ MIddle. Las) .. Ida AGE (l.. Bif1tIdav) V... BIRTHPlACE IC.,_ cJIilb"':"'~:ounUY' PlACE Of' DEATH fC~ onty QI'le -- ... IflslrudiClll9 on oret ..., HOSPITAl, I_~ OClAD g:iIy'O COUNTY Of' DEArH Cumberland RACE - Ame~ 1ndNIn. Slack. While. * I_I Wt.l te DECEDENT'S USUAL llCCIJM10H ";-=:.:~'~,:'=::~:f homemaKer 11.. 11". DECEDENT'S """LING ADORESS (50<... CilytTown. _. Zop C<<M1 A/2 Third St. WE!st-Falrv18w, Pa. KINO OF BUSINESSllHDUSTRV' IoWllTAL STAruS._ -..."....-. wi~~ SUAv1VIHG SPOUse tW WIle. 9M'l'nMi8n name.l 17025 DECEDENT'S ACTUAL RESIDENCE (SeeIOSlruCIIOnI on_~ 170. SIal. Pa . ... (l;d 17..0.....__.. - M"'. Cumberland -' 17XJ :...-=-.::::.. West Fairview MOTHER'S NAME {F.st. MIC:de. Ma.den SurnwneL Mclbel L. <<ohr ... ~B'l.""'T5trflNG~~~t",c=N~~~iew , Pa. 17025 ..... ... MI'HEA'SNAME(Fitll. MIddte. lasl) Edward R. '111. -- II. lNFOlIMAHT'S NAME (T _p,",,' Marybelle Shank folETHOO OF IllSPOSlTION _ 0 c,....."'" a ..............aw.O au... (SpoaIy Jauss PlACE OF DISPOSITION. _ ..~. Cr......... ow.-~ite Crematory 2le. Co. LICE'"Bl~~ L .... .. 0' my know&edge, death occu..,~ i1llhe lime, dale and ptace II_led eandTitle) I : .. WERE AUlOPSV FINDINGS A\AJLABLE PRtOR 10 COMPLETION OF CAUse OF OE.crH' ~C\A.d",.,. _br....."o<<.$ DUE TO lOA AS ~ C~OVENCE Cfl' ~~I"'cJ 'b-. c.. DUE lOICA AS A CONSfOUENCE OF): L. ....... ^'" c... ~ DUE 10 (OA AS A CONSEOUENCE OF), , I Cv/, "5 vl"t!!.. 23b. . WOSCASE REFERRED TO ~ EXAI,UNEAiCOIlOHEA1 "';'L:J FD HoD 21, t AppIoaU'nal. IWetWI bMwMn : GnMt and dN1h , I , PART H: 0IIl0t ~-conlributinglO_.... ftOI. resuling in the undertwinQ ca.-. given in AVn' I. I .,.;}c.., wig - MANNER OF DEATH ......... ~ o o DATE OF tNJUAY (Mon.... Day, Year) TIME OF INJURY INJURY AT WORK? DESCRf8E HOW' INJURY OCCURRED. Hom.icMMi o o o PLACE OF INJURY. AI home, farm. SI'.... factory, orlce M. buitding. .ce. jSpecdY) 3... '1M 0 NoD Accident Pendtng 1n~.liQillhon ....0 ~ Y.. 0 NoD Suicide Could not be delemuned b.tll ~ II ( I LOCATION lSU... c.ty/Tcwn. SIoI., 2Ia. 20. CERTFIUIICtleck aniy onel '"CERTIFYING PHYSICIAN (PhYSICICUl cerWytog cause 01 dealh wh8ll aooIher phYSIC""" ha$.pronounced de~lh ana completed IIem nl To Ihe Met 01 "'y knowlltdge,.ath OCCUITN due 10 .... cau.e{.).nd manner .. statlld......... ....... ... - -o!!!;l - '=' .PRONOUNCIHG AND CERTIFYING PHYStClAH (PhySIClClI1 bod'1 iJ1OOOuflC'rlQ Uelllh and Cet1r1Y"'\91O cause 01 (team) ! To.... be.1 ot my knowledge, de.th OCC..,,.,H .1.......... chle, .and place. and d.... to the nUNC.) and m.nn., a. slaled.. . . . . . . . . .. ............. ;=I -MEDICAL EXAU.NEAlCORONEA On lb. basi. 0' examination and/Of' inv.sllgalion. in my opinion. d..th occwred .It the Urn.. dat.. and place, i1nd due to the cau.e(s) and ....nn.r ...111ed.. . . . . . . . . . . . . . . . . . . . . . . . . . . .. ................ . . . . . .. . .. .. . ..... . ... '" .. ..... 3101. 1:13 REG'STRAR'S SIGNATUR~ .?'C ~ ~ ~ o 34. 21-01-590 RENUNCIATION In Re Estate of IDA L KOCUR deceased. To the Register of Wills of CUMBERLAND County, Pennsylvania. The undersigned sisters and brother of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters of ADMINISTRATION be issued to MARYBELLE SHANK WITNESS hand this day of ,19_. ~~,~ (~~ 6~~ s. ~~ t)~. a;a8 ~CL-I ro-. /7d .:2.5- (Address) . ~ure /S-J~ I ,-u - -pJAH7'- i!/7 71~ IPL I 7/~lJ- (Address) _fj~. /YJ K~ y :;; _~~nat~ J{) I ap1 ~ CO--'~ po-- I 115 { d (Address) 21-01-590 RENUNCIATION In Re Estate of IDA L KOCUR deceased. To the Register of Wills of CUMBERLAND County, Pennsylvania. The undersigned Brother of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters be issued to MARYBELLE SHANK WITNESS hand this day of ,19_. '!9 /u~ , ~ (Sill ure) i 31 P/7-{ 7;;.v BlVD 5;1JV/~~J;;;w;o .-;; 7y~~tl (AcI&ress) (Signature) (Address) (Signature) (Address) REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA t: --- CERTIFICATION OF NOTICE UNDER RULE 5.6(a) ORIGINAL Name of Decedent: Ida L. Kocur Date of Death: 05/31/2001 Estate No. 2001-00590 SSN: 174-20-4213 File No. 2001-00590 Date Letters Granted: 06/25/2001 Will or Administration No. To the Register: I certify that Notice of Estate Administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on Address 401 5th Street West Fairview 1532 Thompson Street Harrisburg 45 Spring Road Carlisle 131 Patton Blvd. San Antonio 602 S. Enola Drive West Fairview PA 17025 Name Marybelle Shank June Keefer PA 17104 Sophie Kosinski PA 17013 William Jauss TX 78207 James Jauss PA 1702~ Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: 07/03/2001 ~~ ~/ /\.0 A ~.. f---- cSigna~re JAN't~ROWN Name (Please type or print) Capacity: __ Personal Representative .. _ X.___ Counsel for Personal Representative Address 845 Sir Thomas Court - Suite 9 Harrisburg PA 17109 Telephone No. 717-541-5550 ~msopu3 llBf/HVf llrnlS!SSY I~j:Jap'l ~-~ PUl!llOH..'Y ~:>!SS~f ,j)ll TJrfJ{f . ~~\)~ 'Apl~:>U!S '~:>YJO AlU P~lUO:> Ol ~~lJ P~J ~s~~Id 'suoHs~nb Alrn ~A~q nOA J1 '~:>YJO AlU OllU~wA~d JO ld!~:>~l ~ pu~s ~S~~Id '~l~lS~ ~AOq~ ~qllOJ S~X~l ~:>lrnl!l~qu! JO lU~wA~d~ld lOJ OO'OO~'O 1 $ JO luno~ ~ql U! 'lU~j:Jy 'SmMJO l~lS!j:J~lI ~ql Ol ~Jq~A~d ~p~lU 'llll~qlUnN }[:>~qJ pug: ~s~~Id P~sopu3 :Ul~:>UOJ A~W n lUOqJ\'\ 01, 06S0-IO-IZ 'oN Vd 06S00- 100, 'oN au.tl .IDJO)I ''] uPI JO aJuJs:t[ : all nOL 1 Yd '~Is!ImJ ~l~nbs ~snoqllnoJ ~uO ~snoqllnoJ AlunoJ PU~Jl~qlUnJ smM JO l~lS!j:J~lI TOOl '(l lsnj:Jny V1Sl'InlO:>.:IO 1:>IH1SIO ONV Vd NI 031l11'10V, NOtlVONnO.:l MVl H3013 lVNOI1VN 3Hl AS A3NHOilV MVl H3013 03I.:111H3:>.. t~~6- ~ 179 (L ~ L) 311~IS:)V.:l 0999- ~ 179 (L ~L) 3NOHd3131 .. \fl38 'N3zvH '.:l 31131~VV'J .NMO~8 'l NVr lau'Pld@::>osseQlf :1!ew3 60~n Vd '8~n8sl~~vH 6 31lns 1~no8 s~oHl ~IS 917B dYE) HSIl8N3 3010 M'Vll'v' S~013SNnO~ ON'v' SA3N~Oll'v' SHLVIJOSSV 1fl NM.OlIH''1 NV! ~ ... I 1:1," 1"'1 I'" I:.'" '" , C~: ~".,,1 'I:"" ijl~;: @ ,>f.~1 fIJ() ~ t; '" ,~"' "" o 'I ..."W 0 '7, e \ WII.,,,,,,, EE ~ '~~' Iii Cl ':s. ~~. W.~"'II ~ Q"lINIl .:a ~ . [1':, . 'j.,( . "'''1 l"- ::r ::r ru ::r ru o CO ru N 1~) ~,." U[ (l) CIl ;::l o ,..t::1 1:: ;::l o (l) U ~ € &M CIl ;::l CI) 0 ::::: 0 (l) r-- ~U~- 4-,"'0..2<: o ~ 1:: 0.. "':'"' ;::l (jJ Q) 0 (l)~ ti..oUrii 'en S (l);"::: 2 ;::l l=l ~ i-<-<UOU rJ) ~ ..... u 0 rJ) fi: O'l rJ) "- ::::> 0 < <( 0 ,.- ~(.') U t-- o<S !< n5 ~ O'l cf '" ::J l.U Z ~ ~ 0 >-- <5 I 5 ~ o:W f- (f) a: o l.U a: ::::> S g cJj In ~ en 0 1.0 a: a: ~ <( ~ CO I ~ Z ~ .. ~ t]/I ~ ;11; I '. ,..1.. {' fr'! / ~ i : J I " , I , \ , . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BROWN JAN L 845 SIR THOMAS COURT HARRISBURG, PA 17109 _n_____ fold ESTATE INFORMATION: SSN: 174-20-4213 FILE NUMBER: 21-2001- 0590 DECEDENT NAME: KOCUR IDA L DA TE OF PAYMENT: 08/24/2001 POSTMARK DATE: 08/23/2001 COUNTY: CUMBERLAND DATE OF DEATH: 05/31/2001 NO. CD 000194 ACN ASSESSM ENT CONTROL NUMBER AMOUNT 101 I $10,500.00 I I I I I I I I TOTAL AMOUNT PAID: $10,500.00 REMARKS: MARYBELLE SHANK C/O JAN L BROWN & ASSOCIATES CHECK# 112 SEAL INITIALS: PB RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS ~V-1500EX+~-00) '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 .... Z W C W o W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) KOCUR IDA L. DATE OF DEATH (MM-DD-Year) c REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY / ,,- ~ 3 ?- J / --~-~ FILE NUMBER 2 1 -0 1 0 5 9 0 ""CO'UNTY"'CoiiE ----y-EA~ - - NuMBER- - SOCIAL SECURITY NUMBER DATE OF BIRTH (MM-DD-Year) 1 7 4 - 2 0 - 4 2 1 3 THIS RETURN MUST BE FilED IN DUPLICATE WITH THE REGISTER OF WILLS 05/31/2001 01/18/1924 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) w ~ lo:: -Ill () O::lo:: wl1.() J:OO () O::..J l1.lD l1. <( [Xl 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received SOCIAL SECURITY NUMBER o 2. Supplemental Retum o 4a. Future Interest Compromise (date 01 death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy ofTrust) o 10. Spousal Poverty Credit (date 01 death between 12-31-91 and 1-1-95) o 3. Remainder Return (date 01 death prior to 12-13-82) o 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) t- Z W C Z o l1. III W 0:: 0:: o () z o i= ~ ::J .... 0: <C o w a::: z o i= <C .... ::J 0.. :E o o ~ .... 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) (6) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) NAME Jan L. Brown FIRM NAME (If Applicable) Jan L. Brown & Associates TELEPHONE NUMBER 717 541-5550 COMPLETE MAILING ADDRESS 845 Sir Thomas Court Suite 12 Harrisbur PA 17109 (1) (2) (3) (4) (5) , . 4~QO.00 ~ 1 OFFlg,lA[;lIISE ONLY ....- ,~' l. ~ : ij r,.., c:' f'-.J Ul 88,331.04 ""';~')", N i i _.~ (8) 137,331.04 25,626.93 3,848.09 (11) (12) (13) 29,475.02 107,856.02 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 107,856.02 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due X _(15) X _(16) 107,856.02 X .12 (17) 12,942.72 X .15 (18) (19) 12,942.72 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT o d' I C I t Add ece ents omple e ress: , STREET ADDRESS S 422 Third treet CITY I STATE I ZIP West Fairview PA 17025 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 12,942.72 10.500.00 552.63 Total Credits (A + 8 + C) (2) 11,052.63 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check to: REGISTER OF AGENT 1,890.09 1,890.09 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 !Xl b. retain the right to designate who shall use the property transferred or its income; ........................................ D !Xl c. retain a reversionary interest; or ...................................................................................................... D !Xl d. receive the promise for life of either payments, benefits or care? ............................................................. D !Xl 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?................. ................... ............................... ................ .... ....... D !Xl 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. D !Xl 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... D !Xl IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. .lAA- . PA 17025 DATE PA 17109 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. 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 0% [72 P.S. 99116 (a) (1,1) (ii)l. 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 e':en 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 0% [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 4.5%, 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 orfor the use of the decedent's siblings is 12% [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-1502EX+:~97) _~_ ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER KOCUR IDA L 21 01 0590 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorshiD must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 49,000.00 422 N. Third Street West Fairview, PA 17025 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 49000.00 ,~'~"'l'" *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF KOCUR IDA L FILE NUMBER 21 01 0590 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 Allfirst Bank checking account # 52828565 VALUE AT DATE OF DEATH 8,223.50 2. Commonwealth State Retirement System pension check 615.50 3. PSECU account # 0174204213 74,859.97 4. Dept. of Treasury, Social Security 393.00 5. 1991 Buick LeSabre 2,500.00 6. Milton S. Hershey Medical Center overpayment 19.70 7. HGS Administrators, health insurance benefits 185.42 8. Household goods and furnishings 1,000.00 9. Comcast cable overpayment 20.95 10. Dept. of Treasury, 2001 Income Tax refund 513.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 88331.04 .. REV-1511EX + (1-97) '* SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF KOCUR IDA L FILE NUMBER 21 01 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. 1. B. 2. 3. 4. 1. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. DESCRIPTION FUNERAL EXPENSES: Musselman Funeral Home ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Marybelle Shank Social Security Number(s) I EIN Number of Personal Representative(s) Street Address 401 5th Street City West Fairview State PA Zip 17025 Year(s) Commission Paid: 2002 Attomey Fees Jan L. Brown & Associates Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip Probate Fees Cumberland County Register of Wills Accountanfs Fees Tax Retum Preparer's Fees H&R Block Allfirst Bank, check order fees Duty's Lock & Key Cumberland Law Journal, legal advertising UGI gas The Sentinel, legal advertising East Pennsboro Township, sewer and trash Pa. American Water PPL electric Ted Wagner, Stacey Powley landscape maintenance Marybelle Shank, house garage and basement locks PennDOT, auto title fee Real estate closing costs TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0590 AMOUNT 1,005.00 5,887.00 8,240.00 316.00 113.00 12.99 77.00 75.00 423.95 103.55 184.28 69.96 122.91 450.00 8.47 22.50 8,515.32 25626.93 ~'m"."~. '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF KOCUR IDA L. Include unreimbursed medical expenses. ITEM NUMBER FILE NUMBER 21 01 0590 DESCRIPTION AMOlJNT 1. 38.24 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Verizon Comcast cable Pa. American water UGI gas PPL electric 31.42 14.76 133.65 31.15 Travelers Property Casualty, homeowners 213.00 Pulmonary & Critical Care Assoc. 329.55 Dept. of Treasury - return item + return fee 399.50 Quantum Image & Therapy Assoc. 151.43 East Pennsboro School District, real estate tax 697.63 West Shore Pathology Gadani Associates 130.52 1,677.24 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3 848.09 "'''''~.. '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF I<nr.IIR IDA I SCHEDULE J BENEFICIARIES NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Marybelle Shank 401 5th Street, West Fairview, PA 17025 2. June Keefer 1532 Thompson Street, Harrisburg, PA 17104 3. Sophie Kosinski 45 Spring Road, Carlisle, PA 17013 4. William Jauss 131 Patton Boulevard, San Antonio, TX 78207 5. James Jauss 602 South Enola Drive, West Fairview, PA 17025 FILE NUMBER 21 01 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Sister Sister Sister Brother Brother Ofi90 AMOUNT OR SHARE OF ESTATE 1/5 1/5 1/5 1/5 1/5 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) A. U.S. DEPARTMENT OF HOUSING and URBAN DEVELOPMENT OMB No. 2602-0265 SETTLEMENT STATEMENT TITlEPRQ . SI::CURI::D LAND laS8Jprinl TFtANSFERS; INC. B. TYPE OF LOAN 5006 East Trlndle Road 1.Q<iFHA 2. I I FMHA 3 I I CONY. UN INS. Suite 203 4. [ IVA 5. I J CONY. INS. Mechanlcsburg, PA 17055 6. FILE NUMBER: I 7. LOAN NUMBER: 503182 35738 Phone: (717) 591-8500 FAX: (717) 591-1)506 8. MORT. INS. CASE NO.: 441-6728597 C. NOTE: This form is furnished 10 give you a slatement of aclual settlement costs. Amounts paid to and by the settlement agent are shown. lIems marked '(p .o.c.)' were paid oulside the closing; Ihey are shown here for informational purposes and are not included in the totals. D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F NAME AND ADDRESS OF LENDER: Andrew W. Bell Estate of Ida L. Kocur Aurora Financial Group, Inc. 9 Eaves Dr., Ste. 190 Marleton, NJ 08053 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: I. SETTLEMENT DATE: 422 North Third Street Secured Land Transfers, Inc. 11/28/01 West Fairview BOROUGH PLACE OF SETTLEMENT: CUMBERLAND County 717 Market Street, Lemoyne, PA 17043 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400.GROSS AMOUNT DUE TO SELLER 101. Contract sales price 49000.00 401.Contract sales price 49000.00 102. Personal property 402.Personal property 103. Selllement charges to borrower (line 1400) 3462.58 403. 104. 404. 105. 405. Adjustments for ilems paid by seller in advance Adjustments for items paid by seller in advance 106. CllyfTown lax 10 406.CllyfTown lax 10 107. County tax 11/28/011012/31/01 16.58 407.County tax 11/28/011012131/01 16.58 108. Assessments to 408. Assessments 10 tOR School 11/28/ 01to 06/30/02 41/.37 1/09. School 11/28/ 01to 06/30/02 417.37 110. Sw/Rf: ~87. 75/q tend 12/31 31.73 410. Sw/Rf: ~87. 75/q tend 12131 31.73 III 411. 112. 412. 120 GROSS AMOUNT DUE FROM BORROWER 52928.26 420.GROSS AMOUNT DUE TO SELLER 49465.68 200. AMOUNTS pAID BY OR IN BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. Deposit or earnest money 650.00 50l.Excess deposit (see instructions) 202. Principal amount of new loan(s) 48615.00 502.Selllement charges to seller (line 1400) 6429.00 203. Existing loan(s) taken subjeclto 503.Existlng loan(s) laken subjecl to 204. 504.Payoff of First Morlgage Loan NONE 205 505Payoff of Second Mortgage Loan 206 (S) - (B) Prepalds 1330.00 506. (S) - (B) Prepalds 1330.00 207. (S) - (B) Cl.OSlng Costs 1222.00 507. (S) (B) Cl.OSlng Costs 1222.00 20B. 50a. 209. 509. Adjustments for items unpaid by seller Adjustments lor items unpaid by seller 210. CltyfTown lax 10 510.CityfTown tax to 211. County lax 10 511.Counly lax to 212. Assessments 10 5 '2. Assessments 10 213 School 10 5'3. School 10 214. 514. 215. 515. 216. 51G. 2!7. 517. 218. 518. 219 519. 220. TOTAL PAID BY/FOR BORROWER 51817.00 520. TOT AL REDUCTION AMOUNT DUE SELLER 8981.00 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER 301. Gross amount due from borrower (line 120) 52928.26 GOI.Gross amount due to seller (line 420) 49465.68 302. Less amount paid by/for borrower (line 220) 51817.00 G02.Less reduclion amounl due seller (line 520) 8981.00 303 cAsH (IXJ FROM) ([ J TO) BORROWER 1111 . 26 G03.CASH (!XI TO) ([ J FROM) SELLER 40484.68 Buyer or Borrower's Signature Seller's Signa lure HUD-l Rov. 5/86 L. SETTLEMENT CHARGES 503182 ~ 700. TOTAL SALES/BROKER'S COMMISSION ba..d on prlca $ 49000.00 7.0 I BORROWER'S SELLER'S FUNDS AT FUNDS AT Division of Commission (line 700) as follows: Total: $3,430.00 SETTLEMENT SETTLEMENT 701. $ 3"430.00 to Century 21 @ The Helm 70Z. $ to 703. Commission paid al Settlement 3430.00 704. Trans Fee Century 21 @ The Helm I 125.00 125.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Origination Fee % 802. Loan Discount % 803. Appraisal Fee to Patrick McCarthy 350.00 804 Credit Report to Credit Lenders Svc Aqenc'y 50.00 805. Lenders Inspection Fee Patrick McCarthy 75.00 806. Mortgage Insurance Application Fee 10 807. Assumplion Fee 808. Commi t Fee Aurora Financial Group 250.00 809 Flood Cert Transamerica Flood Cert 16.00 810 YldSpdPrem byAFG-HMS($729.23POC) 811 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest from 11/28/01 to11/3 0/01 @$ 10.66/day 31.98 902. Mortgage Insurance Premium for mo. to Aurora Financial Group 718.46 903. Hazard Insurance Premium for yrs. 10 904. yrs. 10 905. . 000. RESERVES DEPOSITED WITH LENDER FOR 001. Hazard Insurance 2 mo. @$ 20.83 /mo. 41. 66 1002. Morlgage Insurance 2 mo. @$ 19.88 /mo. 39.76 1003. City!T own lax mo. @$ /mo. t004. County tax 7 mo. @$ 15.29 /mo. 107.03 1006. Assessments mo. @$ /mo. 005. School Tax 3 mo. @$ 59.32 /mo. 177.96 1007. mo. @$ /mo. 008. Aqqreqate mo. @$ /mo. -43.75 1100. TITLE CHARGES 101. Selllement or closing leelo 1102. Abstracl or title search to 103. Title examination to 104. Title insurance binder to 1106. Document preparation to Jan L. Brown & Assoc. 110.00 105. Notary fees to Cash 8.00 107. Allorney's fees to Jan L. Brown & Assoc. 525.00 (includes above ilems No.:) }i@%Nf_W*,,-mqW .fr~ilil~~$ii~~~~J.f~mjjlti.@~mw 108. Title Insurance to Secured Land Transfers - (includes above ilems No. ) Ends:100/300/900-RI 109. Lender's coverage $ 48,615 110. Owner's coverage $ 49,000 1111. ICPL Fee Secured Land Transfers 35.00 112. I 1113. I 200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording fees: Deed $ 25.50 Mortgage $ 39.50 Misc. $ 65.00 202. City/county tax/stamps: Deed $ 490.00 Mortgage $ 490.00 203. State lax/stamps: Deed $ 490. OOMortgage $ 490.00 1204. 1205. Electrical Michael Powley 680.00 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survey to 1302. Pesllnspeclion to Biechler & Tillery 35.00 1303. Rdn/Hmlnsp Biechler & Tillerv 345.00 1304. Pest Treat Penn Pest, Inc. 556.50 1305. Rf/BeamRep Robert S. Valentine, Inc. 437.50 1400. TOTAL SETTLEMENT CHARGES (enler on lines 103 and 502, Sections J and K) 3462.58 6429.00 Parlies agree lhal no liabilily is assumed by Setllemenl Agenllor IIle acclJracy 01 inlormalion lurnished by others as stlown on the HUD-l Settlement Slatement. Settlement Agent hereby I:lxpressly reserves Ihe right 10 deposit any amounts collecled lor disbursemenl in an inleresl bearing account in 8 Federallv insured inslilution and 10 credil any inleresl so earned 10 its own accounl as addilional compensalionlor its services in !tlis lransaclioli HUD CERTIFICATlOIj OF BUYERS AND SELLERS I have carerully reviewed the HUD.l SetUement Slatement and to the basi of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account by me in this Iransaction. Ilurthe ertily thall have received a copy of the HUD-l Setllemenl Statement /J'-ll7tt4lflt J!lj; (-:f'4:_~J: ., (.ljL~'JL' Seller's Signalure Seller's New Address & Phone . ud accurate accouul otlhi, ,ran"cliori/~ ~'e Ihe ''Iud, to be di,bursed in accordance wilh lI,is "atemeu" SaUtaman' Agan' Dala WARNING:. II is a crime 10 knowill~ly make lalse slalemen s 0 Ilia Uniled Slales on IIlis or aoy similar lorm. Penallles upon conviclion can include a line and imprisonmenl. For delails see TIlle 18: U,S. Code Sechon 1001 and Sachan 10\0 HUO-I Rev. 5/86 J .- , c REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY Estate of KOCUR, IDA L. No. 2001 00590 IDA L KOCUR , Deceased Date of Death 05/31/2001 Social Security No. 174204213 also known as Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. l!We verify that the statements made in this inventory are true and correct. l!We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative: Name of Attorney: Jan L. Brown Marvbelle Shank I.D. No.: Address: 845 Sir Thomas Court, Suite 12 HarrisburQ Telephone: (717) 541-5550 Dated 2/22/02 PA 17109 Description Allfirst Bank checking account # 52828565 Commonwealth State Retirement System pension check PSECU account # 0174204213 Dept. of Treasury, Social Security 1991 Buick LeSabre Milton S. Hershey Medical Center overpayment Total (Attach Additional Sheets if necessary) 137,331.04 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 4 ~'" " Continuation of Inventory KOCUR, IDA L. 21 01 0590 PaQe 1 Description of Inventory Description HGS Administrators, health insurance benefits Value 185.42 Household goods and furnishings 1,000.00 Comcast cable overpayment 20.95 Dept. of Treasury, 2001 Income Tax refund 513.00 422 N. Third Street West Fairview, PA 17025 49,000.00 Subtotal $ 50,719.37 137,331.04 Grand Total $ JAN L. BROWN & ASSOCIATES ATTORNEYS AND COUNSELORS AT LAW OLOE ENGLISH GAP 845 SIR THOMAS COURT SUITE 12 HARRISBURG, PA 17109 EMAIL jlbassoc@ptd.net JAN L. BROWN' MARIELLE F HAZEN" STEVEN C. SKOFF TELEPHONE (717) 541-5550 FACSIMILE (717) 541-9223 . ADMITTED IN PA AND DISTRICT OF COLUMBIA "CERTIFIED ELDER LAW ATTORNEY BY THE NATIONAL ELDER LAW FOUNDATION February 22, 2002 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 ~.-- ;..,J.... .... ,- ... ::.;; q' ~ .- d N " rn crJ Re: Estate of Ida L. Kocur File No. 2001-00590 PA File No. 21-01-0590 N ',J. .U ...", :'.,) Gentlemen or Ladies: Enclosed please find the following: 1. The Inventory for the above-captioned estate. 2. An original and one copy of REV-l 500, Inheritance Tax Return. 3. A check payable to the Register of Wills in the amount of$25 to cover the filing fees. 4. A check payable to the Register of Wills, Agent in the amount of$1,890.09 to cover the Inheritance Tax shown to be due. 5. An extra copy of the Inventory and Page 1 ofthe Inheritance Tax Return. Please time stamp these copies, and return them in the envelope provided. If you have any questions, feel free to contact this office. Sincerely, ~1~~d; Brenda F. Kephart Legal Assistant bfk Enclosures -j C; 0'0 0 ~ ~ZCt>:l ~t>:l::s:.G) t-t tJjH HOt>:l(l) (l)0~t-3 ~ t-tCt-tt>:l = t>:l~~~ i =' t-3Z '"d::r:t::IO t"" ~o ~ CO ~ . (1)0:<: \Il I-'t>:lCH =' tI1 > == ~ \Il~"'1 -.J Zt-t ~ ;dCS= ~"""'. O(l)t-3t-t ". ,/'..-# d :0 1-'100-<:(1) .~~I~ ~ ~ ~.~ (ij wC ~.."" -' N c:. ~O "....... ~O Zt"l ~ ' ' t>:lC ~ '\Il ~ r, ~ w t-3 ~~n~ > \,,) ::r: ~ g:E(/) '-.;'1 0 C S; ~ ~ ~,' (I) '- t>:l ... ~ ..r:,'.~ -1 .. ... = :--..> e \C """ --' ~ (/) ,.. ,. ,. .". i; r= m o ...., ;n o :s: ~ 'U o g m Ut-Uf,()p ~..". " , "'14 -~. J'~,!,\. .\\~~) '\"t i,I\\I'!li ,',1I!11,\1 ", \'1, i\~\ Wi ~~\I ".\\I,!\ Iii .II ~ '\ II II COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1712B-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BROWN JAN L 845 SIR THOMAS COURT HARRISBURG, PA 17109 ___nn_ fold ESTATE INFORMATION: SSN: 174-20-4213 FILE NUMBER: 2101-0590 DECEDENT NAME: KOCUR IDA L DA TE OF PAYMENT: 02/25/2002 POSTMARK DATE: 02/22/2002 COUNTY: CUMBERLAND DATE OF DEATH: 05/31/2001 NO. CD 000886 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,890.09 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: MARYBELLE SHANK C/O JAN L BROWN ESQUIRE CHECK#136 SEAL INITIALS: CW RECEIVED BY: REGISTER OF WILLS $1,890.09 MARY C. LEWIS REGISTER OF WILLS ~OuJ- SqO FAMILY SETTLEMENT AGREEMENT AND FINAL RELEASE IN ESTATE OF IDA L. KOCUR, DECEASED KNOW ALL MEN BY THESE PRESENTS, that WHEREAS, IDA L. KOCUR, who resided at 422 Third Street, West Fairview, Cumberland County, Pennsylvania, died intestate on May 31, 2001; WHEREAS, the said IDA L. KOCUR was survived by five (5) siblings; WHEREAS, JAMES R. JAUSS, WILLIAM L. JAUSS, JUNE E. KEEFER and SOPHIE M. KASINSKI, four (4) siblings of the said IDA L. KOCUR, have renounced their right to serve as administrators in favor ofMARYBELLE SHANK, the fifth (5th) sibling of the said IDA L. KOCUR. Said Renunciations were filed with the Register of Wills of Cumberland County, Pennsylvania; WHEREAS, MARYBELLE SHANK agreed to serve as Administratrix of the Estate of IDA L. KOCUR, deceased; WHEREAS, on June 25,2001, Letters of Administration were granted to MARYBELLE SHANK. Said estate was duly indexed and recorded in Cumberland County Courthouse, Register of Wills, File No. 2001-00590; WHEREAS MARYBELLE SHANK is hereinafter called Personal Representative; WHEREAS, the intestate heirs of the Estate oflDA L. KOCUR, deceased, are: 1. Marybelle Shank, sister, Administratrix 2. June E. Keefer, sister (died January 29,2002) 3. Sophie M. Kosinski, sister 4. William L. Jauss, brother 5. James R. Jauss, brother - 1 - WHEREAS, each of the above-identified parties in interest is entitled to a one-fifth (l/5) distributive share of the residuary estate; WHEREAS, the said Personal Representative has gathered the assets of the estate of the said decedent, and the assets consist of both real property and personal property to a total value of $137,331.04 as set forth in Exhibit A, which is a statement of account of the said Personal Representative, and which is attached hereto, made a part hereof and marked Exhibit A; WHEREAS, it is the desire of the parties to this Agreement that final distribution of this estate be accomplished without a formal accounting to the Orphans' Court Division of the Court of Common Pleas of Cumberland County, it being the desire of the parties to avoid the expense, delay and publicity of a formal accounting; WHEREAS, the balance for distribution as shown in the said statement marked Exhibit A has been reduced to cash and distribution is made as indicated therein. NOW, THEREFORE, KNOW YE, that each of the parties does hereby acknowledge receipt of the amount set opposite their name in the table and schedule of distribution in said statement attached hereto and marked Exhibit A; Each of the parties to this Agreement do hereby remise, release, quit claim and forever discharge the said Personal Representative, MARYBELLE SHANK, her heirs, executors, and administrators and assigns, JAN L. BROWN & ASSOCIATES, ATTORNEYS AT LAW, JAN L. BROWN, ESQUIRE, MARIELLE F. HAZEN, ESQUIRE, AND STEVEN C. SKOFF, ESQUIRE of and from the said estate and from all actions, suits, payments, accounts, reckoning, claims and demands whatsoever for or by reason thereof, or for any other use, matter, cause or thing whatsoever touching upon the estate of the said decedent, and each of us do further -2- hereby covenant and agree that should any liability come due to the estate of the said decedent after the signing of this Agreement, and each of us do hereby covenant and agree with each other and the aforesaid Personal Representative that we will contribute pro rata our share of the estate to satisfy any and all claims, demands, suits or causes of action which may be successfully prosecuted against the said estate or the aforesaid Personal Representative after the signing, sealing and delivery of this Family Settlement Agreement and Final Release. Each party to this Agreement acknowledges that this Agreement shall be indexed and recorded in the estate proceedings and that the terms hereof shall be binding upon their respective heirs, successors, administrators and assigns. IN WITNESS WHEREOF, we have hereunto set our hands and seals this ,;; ~ day of ~~ ,2002. ':!k/2dtt. 'f ;f~ WItness MAR'f ELLE SHANK, individually and as Admirustratrix of the Estate of Ida 1. Kocur, deceased Witness , personal representative of the ESTATE OF JUNE E. KEEFER Witness SOPHIE M. KOSINSKI Witness WILLIAM 1. JAUSS Witness JAMES R. JAUSS - 3 - COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF DAUPHIN On this the 'J. ~ day of Feb(lUlry , 2002 before me, a Notary Public, the undersigned officer, personally appeared MARYBELLE SHANK, 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. IOTAR/AI. SEAL -~ IIOUAND, NOTARYPUIUC CITY M HARRISBURG. DAUPHIN COUNTY MY COMMISSI N EXPIRES MARCH 4 2 hereby covenant and agree that should any liability come due to the estate of the said decedent after the signing of this Agreement, and each of us do hereby covenant and agree with each other and the aforesaid Personal Representative that we will contribute pro rata our share of the estate to satisfy any and all claims, demands, suits or causes of action which may be successfully prosecuted against the said estate or the aforesaid Personal Representative after the signing, sealing and delivery of this Family Settlement Agreement and Final Release. Each party to this Agreement acknowledges that this Agreement shall be indexed and recorded in the estate proceedings and that the terms hereof shall be binding upon their respective heirs, successors, administrators and assigns. IN WITNESS WHEREOF, we have hereunto set our hands and seals this ~ day of Jft: I ,2002. Witness MAR YBELLE SHANK, indiVidually and as Administratrix of the Estate of Ida 1. Kocur, deceased ~ Witness Witness SOPHIE M. KOSINSKI Witness WILLIAM L. JAUSS Witness JAMES R. JAUSS - 3 - COMMONWEALTH OF PENNSYLVANIA COUNTY OF ('tf\vr-~,;l(i\~ SS: On this the ~Jt1 day of ,1fY\' I the undersigned officer, personally appeared ~y ~OI. , 2002 before me, a Notary Public, 1'\ $V~/" , personal representative for the ESTATE OF JUNE E. KEEFER, known to me or satisfactorily proven to be the person whose name is subscribed to the within instrument, and acknowledged that he/she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ~I Notary Public ._"".,"~~,_,,.,,_,...,.... .'~" ,._~.,.., _'_.' "'"'_.~C'_~'_",""'~_" ....,... -.,.~ '~< hcta.:<ial Seal J W .i.l.I. i.a .I.n D., Vviennan, N..O..la...ry Public New Cumberlim<1 Cumberland County MY.~:0~:,mi!'sir:i' ~..e~~.:..~~, 2~~4 h.:C'c~_, , J')t ~':~.J:?:ries hereby covenant and agree that should any liability come due to the estate of the said decedent after the signing of this Agreement, and each of us do hereby covenant and agree with each other and the aforesaid Personal Representative that we will contribute pro rata our share of the estate to satisfy any and all claims, demands, suits or causes of action which may be successfully prosecuted against the said estate or the aforesaid Personal Representative after the signing, sealing and delivery of this Family Settlement Agreement and Final Release. Each party to this Agreement acknowledges that this Agreement shall be indexed and recorded in the estate proceedings and that the terms hereof shall be binding upon their respective heirs, successors, administrators and assigns. IN WITNESS WHEREOF, we have hereunto set our hands and seals this day of ,2002. Witness MAR YBELLE SHANK, individually and as Administratrix of the Estate of Ida L. Kocur, deceased Witness , personal representative of the ESTATE OF JUNE E. KEEFER !([LUi Witness /' ,-Ii' /i It(jt-i/\ ~ '7-r1 {{~ SOP E M. KOSINSKI Witness WILLIAM L. JAUSS Witness JAMES R. JAUSS - 3 - COMMONWEALTH OF PENNSYLVANIA COUNTY OF C C\ V\ t t/e~/10t ~\{ ( SS: On this the 1 c; fY1 day of R ~)yH Ci ICf--' 2002 before me, a Notary Pnblic, the undersigned officer, personally appeared SOPHIE M. KOSINSKI, 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. {I eLk ( Notarial Seal Karisa J. Lehman, Notary Public Carlisle Boro, Cumberland County My Commission Expires Aug. 25, 2003 hereby covenant and agree that should any liability come due to the estate of the said decedent after the signing of this Agreement, and each of us do hereby covenant and agree with each other and the aforesaid Personal Representative that we will contribute pro rata our share of the estate to satisfy any and all claims, demands, suits or causes of action which may be successfully prosecuted against the said estate or the aforesaid Personal Representative after the signing, sealing and delivery of this Family Settlement Agreement and Final Release. Each party to this Agreement acknowledges that this Agreement shall be indexed and recorded in the estate proceedings and that the terms hereof shall be binding upon their respective heirs, successors, administrators and assigns. IN WITNESS WHEREOF, we have hereunto set our hands and seals this day of ,2002. Witness MARYBELLE SHANK, individually and as Administratrix of the Estate ofIda L. Kocur, deceased Witness , personal representative of the ESTATE OF JUNE E. KEEFER Witness SOPHIE M. KOSINSKI Witness lu) Witness JAMES R. JAUSS - 3 - STATE OF TEXAS SS: COUNTY OF BEXAR On this the ~~- day of 1- ~ ' 2002 before me, a Notary Public, the undersigned officer, personally appeared WILLIAM L. JAUSS, 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. ~JVW~~ r -otary Public - ~ hereby covenant and agree that should any liability come due to the estate of the said decedent after the signing of this Agreement, and each of us do hereby covenant and agree with each other and the aforesaid Personal Representative that we will contribute pro rata our share of the estate to satisfy any and all claims, demands, suits or causes of action which may be successfully prosecuted against the said estate or the aforesaid Personal Representative after the signing, sealing and delivery of this Family Settlement Agreement and Final Release. Each party to this Agreement acknowledges that this Agreement shall be indexed and recorded in the estate proceedings and that the terms hereof shall be binding upon their respective heirs, successors, administrators and assigns. IN WITNESS WHEREOF, we have hereunto set our hands and seals this day of ,2002. Witness MARYBELLE SHANK, individually and as Administratrix of the Estate of Ida 1. Kocur, deceased Witness , personal representative of the ESTATE OF JUNE E. KEEFER Witness SOPHIE M. KOSINSKI Witness WILLIAM 1. JAUSS ~l:~ Witness ~4'~? /?4~ ES R. JAUSS ~ - 3 - COMMONWEALTH OF PENNSYLVANIA COUNTY OF {!U/llB~~ SS: On this the ~ 6 day of ~J2..W~ ,2002 before me, a Notary Public, the undersigned officer, personally appeared JAMES R. JAUSS, 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. NOTARIAL SEAL I JAMES E. GREEN, Notary Public . Camp Hill, Cumberland County I My Commission Expires June 6, 2005 .. ACCOUNTING OF THE ESTATE OF IDA L. KOCUR Assets Real estate $49,000.00 Cash, Bank Deposits and Miscellaneous Personal Property $88,331.04 TOTAL $137,331.04 Expenses Funeral Expenses & Administrative Costs $25,626.93 Debts $3,848.09 Inheritance Tax $12,390.09 TOTAL $41.865.11 TOT AL AMOUNT TO BE DISTRIBUTED $95.465.93 ASSET DISTRIBUTION TO BENEFICIARIES* Name Amount Marybelle Shank June E. Keefer Sophie M. Kosinski William L. Jauss James R. Jauss $19,093.18 $19,093.18 $19,093.19 $19,093.19 $19,093.19 $95.465.93 * Based on interest accrued, actual distribution will be increased by $509.12 ($101.82 or $101.83 per beneficiary). "Exhibit A" '" /b-c::233- // BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRIS8URG. PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER 'C7 ..).J COUNTY ACN '02 i\P1~ 1 2 ,~ ' i' I JAN J L 845 HBG L BROWN BROWN & ASSOCIATESC_ SIR THOMAS CT STl ('" , PA 1716~f~ID"158 04-08-2002 KOCUR 05-31-2001 21 01-0590 CUMBERLAND 101 REV-1547 EX AFP <01-02) IDA L Amount Remitted (1) (2) (3) (4) (5) (6) (7) (9) ClO) CHANGED 49,000.00 .00 .00 .00 88,331. 04 .00 .00 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax 25,626.93 3.848.09 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF KOCUR IDA L FILE NO. 21 01-0590 ACN 101 DATE 04-08-2002 TAX RETURN WAS: (X) ACCEPTED AS F I LED NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. (8) 137,331.04 RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets Cl1) Cl2) Cl3) Cl4) ?9.471i.D? 107,856.02 .00 107,856.02 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS' Cl5) .00 X 00 .00 Cl6) .00 X 045 = .00 Cl7) 107,856.02 X 12 12,942.72 Cl8) .00 X 15 .00 Cl9) = 12,942.72 . PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 08-23-2001 CDOOO194 552.63 10,500.00 02-22-2002 CDOO0886 .00 1,890.09 TOTAL TAX CREDIT 12,942.72 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION, Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE, To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 9140). PAYMENT, Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Make check or money order payable to, REGISTER OF MILLS J AGENT REFUND (CR), A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS, Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, 8ureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. DI SCOUNT : If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (5%) discount of the tax paid is allowed. PENALTY: The 15% tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6%) percent per annUM calculated at a daily rate of .000164. All taxes which became delinquent on and after January I, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2002 are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 1982 20% .000548 1992 9% .000247 1983 16% .000438 1993-1994 7% .000192 1984 11% .000301 1995-1998 9% .000247 1985 13% .000356 1999 7% .000192 1986 10% .000274 2000 8% .000219 1987 9% .000247 2001 9% .000247 1988-1991 11% .000301 2002 6% .000164 -- Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. c / STATUS REPORT UNDER RULE 6.12 BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND ,PENNSYLVANIA Name of Decedent: IDA L KOCUR Date of Death: 05/31/2001 File No. 2001-00590 .-~-~.--,._.,._--~-- --- _.__._------~--- Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to the completion of the administration of the above-captioned estate: 1 . State whether administration of the estate is complete: YES _lL_ NO__ 2. If the answer is "No", state when the personal representative reasonably believes that the administration will be complete: 3 If the answer to No.1 is "Yes", state the following: a. Did the personal representative file a final account with the Court? YES ___ NO~- b. The separate Orphan's Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? YES ~ NO __ Filed Family Settlement Agreement and Final Release d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: _1:l-Jro~Q:L-_----- 'il1fl~ II--- dY~-LZ~",:, Ig atu i'-" ...- Marybelle Shank Name (Please type or print) 401 5th Street Address ',J' " West Fairview _JA 1702L__ "''-oj P -' " "': r '" .-? .....-.. 717-732-2381 Tel. No. Capacity: ~ Personal Representative Counsel for personal representative