HomeMy WebLinkAbout05-09-08
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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 Year
File Number
INHERITANCE TAX RETURN 2 1 0 8
RESIDENT DECEDENT
-0109
Date of Birth
125221910
01012008
03181917
Decedent's Last Name
Suffix
Decedent's First Name
LENA
MI
E
DEROSA
(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
181 1. Original Return 0 2. Supplemental Return
o
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
0 4. Limited Estate 0 4a. Future Interest Compromise
(date of death after 12-12-82)
181 6. Decedent Died Testate 0 7. Decedent Maintained a Living Trust
(Attach Copy of Will) (Attach Copy of Trust)
0 9. Litigation Proceeds Received 0 10 Spousal Poverty Credit (date of death
. between 12-31-91 and 1-1-95)
o
o
8. Total Number of Safe Deposit Boxes
o
11. Election to tax under Sec. 9113(A)
(Attach Sch. 0)
First line of address
CORRESPONDENT - THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
BRADLEY L GRIFFIE 7172435551 ~
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REGISTER OF ~ ~E O~
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DATE FILED
200
NORTH
HANOVER
STREET
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Firm Name (If Applicable)
GRIFFIE & ASSOCIATES
Second line of address
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City or Post Office
CARLISLE
State
PA
ZIP Code
17013
C d t' 'I dd b g r iff i e @ g r iff i e 1 a w . com
orrespon en s e-mal a ress:
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIG TURE OF PERSON RE ONS BLE FOR FILING RETURN DATE
C Anthony C. DeRosa
411 Glenn Avenue, Boiling Springs, PA 17007
S PREP ER OTHER THAN REPRESENTATIVE
DATE
Bradley L Griffie
Han~treet, Carlisle, PA 17013
L
Side 1
15056041147
15056041147
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15056042148
REV-1500 EX
Decedent's Name'
DEROSA, LENA E
105,000.00
RECAPITULATION
1. Real Estate (Schedule A)..........................
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)................
6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested.............
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 0 Separate Billing Requested.............
8. Total Gross Assets (total Lines 1-7).................................................
Decedent's Social Security Number
125221910
1.
5.
1,739.74
6.
2,785.24
7.
8.
109,524.98
21,249.45
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/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J)................................................. 13.
14. Net Value Subject to Tax (Line 12 minus Line 13)................................................. 14.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, of
transfers under Sec. 9116
(a)(1.2) X .00
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
84,429.39
19. Tax Due.....................
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L
15056042148
15.
16.
17.
18.
19.
992.23
22,241.68
87,283.30
87,283.30
3,799.32
3,799.32
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15056042148
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RcV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT' NAME
DeRosa, Lena E
STREET ADDRESS
1208 Pheasant Drive South
File Number 21 - 08 - -0109
-~----_._.~---_..__.._--
_.,~--~._~._---,------------_.-
CITY
Carlisle
--~---!STATE-;~---!ZIP~-;O-~-
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1) 3,799.32
4,300.00
189.97
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C)
(2) 4,489.97
Total Interest/Penalty (0 + 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.
(3)
(4)
0.00
--._----~-,-_._-_.__._-----
690.65
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(5)
(SA)
(5B)
0.00
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:
a. retain the use or income of the property transferred;.................... ............................................................. r:J
b. retain the right to designate who shall use the property transferred or its income;...................... [J
r-l.
c. retain a reversionary interest; or..... ................... ........... ......................................... ............ ..................,...... u
d. receive the promise for life of either payments, benefits or care?.......................................................... D
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?..................... .................................................."......... .....................,........ [J
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.. 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................... .......... ...... ........................... ..........,.................... D [J(]
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Yes
No
1-:-1.
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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 exemot a transfer to a surviving spouse from tax, and the statutory requirements
for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a
natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 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.
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SCHEDULE A
REAL ESTATE
l__~__________ _____~_
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF DeRosa, Lena E
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 wilflng 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 survivorship must be disclosed on
schedule F.
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ITEM
NUMBER
VALUE AT DATE OF
DEATH
---------------
105,000.00
DESCRIPTION
1208 Pheasant Drive South
Carlisle, Cumberland County, PA
(HUD-1 Settlement Sheet attached)
TOTAL (Also enter on Line 1, Recapitulation)
105,000.00
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF DeRosa, Lena E
FILE NUMBER
21 - 08 --0109
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
DESCRIPTION
VALUE AT DATE OF
DEATH
221.40
Highmark Insurance premium refund
2 Comcast Refund
28.45
3 Highmark Insurance reimbursement for medical costs
4.12
4 Personal property, household furnishings
(appraisal attached)
895.00
5 Tax proration credited at settlement
230.66
6 Tax proration credited at settlement
291.44
7 Homeowner's Insurance refund from State Farm
68.67
TOTAL (Also enter on Line 5, Recapitulation)
1,739.74
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F I
JOINTL Y -OWNE~_~~~~ERT~u_~_
ESTATE OF
DeRosa, Lena E
I FILE NUMBER- _~__~__m
, 21 - 08 - -0109
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME
Anthony C, DeRosa
ADDRESS
411 Glenn Avenue
Boiling Springs, PA 17007
RELATIONSHIP TO DECEDENT
Son
A
Janet A. DeRosa
411 Glenn Avenue
Boiling Springs, PA 17007
Daughter-in-Law
B
JOINTLY OWNED PROPERTY:
LETTER DATE ~~SCRIPIIOi1\ ~F PROJlERTY DATE OF DEATH %OF I DATE OF DEATH
ITEM Include name 0 Inanclallns I u Ion an DanK account number
NUMBER FOR JOINT MADE or similar identifying number. Attach deed for jointly-held real VALUE OF ASSET l~lE~~~Ti VALUE OF
TENANT JOINT estate. DECEDENT'S INTEREST
+--
A Sovereign Bank 799,24 100% 799.24
Checking Account No, 41098463
(Statement attached)
2 A Sovereign Bank 376.26 50% 188.13
Savings Account No. 1694003888
(Statement attached)
3 B Sovereign Bank 2,245.14 50% 1,122.57
Checking Account No. 2891031474
4 A Sovereign Bank 1,350.60 50% 675.30
Certificate of Deposit No. 2891031474
TOTAL (Also enter on line 6, Recapitulation)
2,785.24
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SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21 - 08 --0109
ESTATE OF DeRosa, Lena E
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES:
A. Ewing Brothers Funeral Home, Inc.
u---r--------------
I AMOUNT
DESCRIPTION
7,311.73
2 Expense for trip to New York for burial
494.31
3 Memorial Solutions (Headstone)
481 .00
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City
Year(s) Commission paid
Attorney's Fees Griffie & Associates
State
Zip
2.
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
3,000.00
Street Address
City
Relationship of Claimant to Decedent
Probate Fees
State
Zip
4.
448.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1
The Sentinel (Estate ad)
150.64
TOTAL (Also enter on line 9, Recapitulation)
21,249.45
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Schedule H
Funeral Expenses &
Adminis1ra1ive Cos1s continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF DeRosa, Lena E
2 I
i Cumberland Law Journal (Estate ad)
I
3 Nassau County Board of Election
(Costs searching for missing heir)
4 State Farm
(Homeowner's insurance)
5 Linden Hall Antiques
(Personal property appraisal)
6 PPL Electric Utilities
(final bill)
7 Realtor's Commission
, (Real estate settlement costs)
8 Notary Fees
(Real estate settlement costs)
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9 I Transfer Tax
. (Real estate settlement costs)
10 2008 CountylTownship real estate taxes
to Robin Sollenberger
11 North Middleton Authority
(Final water and sewer bill)
12 I Marshall Electric
. (Electric repairs to real estate)
13 Beam's Carpet Service
I (Repairs to real estate)
I
14 I Reserves
I
1
~NUMBER
21-08--0109
-----r~-- 75.00~~-
5.00
81.75
125.00
55.64
6,300.00
10.00
1,050.00
302.60
138.61
654.57
65.60
500.00
Page 2 of Schedule H
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SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF DeRosa, Lena E
I FILE NUMBER
121 - 08 --0109
I .__~______~_~_.._
Include unreimbursed medical expenses.
-- ----~~---
ITEM DESCRIPTION AMOUNT
NUMBER
-
1 West Shore EMS - Carlisle 288.52
Ambulance Service
2 Comcast Cable 33.91
3 North Middleton Authority 79.90
(water and sewer)
4 Wal-Mart Credit Card 304.18
5 Forest Park Health Center 50.00
(transportation)
6 PPL Electric Utilities 128.24
7 Spring Road Family Practice 54.84
(medical services)
8 Cumberland Pathology Associates 18.62
(medical services)
9 Embarq 34.02
(final telephone bill)
f----------_.__.
TOTAL (Also enter on Line 10, Recapitulation) 992.23
REV-1513 IiX+ (9-00) .~
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COMMONWEALTH OF PENNSYLVANIA ~
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
I.
NAME AND ADDRESS OF PERSON(S)
RECEIVING PROPERTY
I
!TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116 (a) (1.2)]
RELATIONSHIP TO
DECEDENT
Do Not List Trustee(s)
I
I FILE NUMBER ...
--.Ju_.-.3.~__~=. -0 1 ~9 ~___________
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
ESTATE OF
DeRosa, Lena E
'--~-I
NUMBER
'-"'~----'----'-r---
I
George T. Scare
106 Clinton Avenue
Mastic, NY 11950
Son
One third
2 Victor Scaro
9120 Cutler Ridge Drive
Miami, FL 33157-8889
Son
One third
3 Anthony Carl DeRosa
411 Glenn Avenue
Boiling Springs, PA 17007
Son
lone third
Enter dollar amounts for distributions shown above on lines 1 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" - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
0.00
11Iagt lIUl aub m~gtamtttt
OF
LENA E. DeROSA
I, LENA E. DeROSA, of 1208 Pheasant Drive South, Carlisle, Cumberland
County, Pennsylvania, being of sound and disposing mind, memory and understanding, do
make, publish and declare this to be my Last Will and Testament, hereby revoking and
making void all previous Wills and Codicils heretofore made by me.
FIRST
I order and direct my Executor hereinafter named to pay all of my just debts,
funeral expenses and expenses involved or connected with the administration of my estate,
including all taxes that may be assessed in consequence of my death, as soon after my
death as is reasonably possible from the proceeds and assets of my estate prior to any
other distributions. However, my Executor need not accelerate and pay those unmatured
obligations which, in his, her or its opinion, it might be proper and more advantageous to
retain or renew and pay as they become due and payable. If I do not own a burial plot or
a grave marker at the time of my death, I authorize my ExecutorfExecutrix, in his, her or
its sole discretion, to purchase a burial plot and to erect a suitable grave marker at my
grave, and to expend sums from my estate for this purpose.
G:RIFFIE Be ASSOCIATES
ATTORNEYS.AT.LAW
200 NORTH HANOVER STREETPage 1 of8
CARLISLE, PENNSYLVANIA 17013 CHAMBERSBURG PENNSYLVANIA
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SECOND
I give, devise and bequeath my entire estate of whatsoever nature and wheresoever
situate, together with all insurance proceeds thereon, in equal shares to my children,
ANTHONY CARL DeROSA, VICTOR SCARO and GEORGE SCARO, who
survive me by sixty (60) days, per stirpes. I direct my Executor/Executrix to divide
among such beneficiaries all personal property of a sentimental or family nature (excluding
cash, stocks, bonds and the like), including but not limited to jewelry, household goods,
antiques, furniture and memorabilia, in accordance with a separate memorandum which I
may place with my Will or deposit with my attorney. In the absence of such disposition by
memorandum, I direct that the said tangible personal property be divided between my
residual beneficiaries with due regard for their personal preferences in as nearly equal
shares as practical, with the value of such dispositions being credited to the share of each
respective recipient. If the said beneficiaries do not agree to the division of the personal
property provided for hereunder, the decision of my Executor/Executrix, including the
decision to sell the property at public or private sale and distribute the proceeds therefrom
as provided hereinafter, shall be final and conclusive on all parties.
THIRD
I have specifically chosen to provide no distribution of my estate to my son,
RAYMOND SCARO, not out of want of affection, but because I feel the I have provided
200 N. Hanover Street
Carlisle, PA 17013
GRIFFIE & ASSOCIATES
Attorneys At Law
Page 2 of8
38 N. Main Street
Chambersburg, PA 17201
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for Raymond Scaro during my lifetime as I wished and do not want to have any
distribution whatsoever from my estate to him.
FOURTH
I grant my ExecutorlExecutrix the following powers in addition to and not in
limitation of such powers as my ExecutorlExecutrix shall hold by law:
(a) To retain all property received including the stock of any corporate fiduciary
acting hereunder, provided such property remains productive.
(b) To join in any corporation, partnership, recapitalization, merger, reorganization
or voting trust plan; to delegate authority with respect thereto; to deposit
investments under agreements and pay assessments; and generally to exercise
all rights of investors, including but not limited to, the voting of shares.
(c) To manage, operate, repair, improve, mortgage or lease on any terms any real
estate held or owned by my estate.
(d) To operate any business that I may own at my death.
(e) To invest any funds of my estate in any stocks, bonds, notes or other securities
or property, real or personal, without regard to the principle of diversification
or any other statute or general rule of law in his, her or its absolute discretion,
it being my intention to give my ExecutorlExecutrix the broadest investment
powers possible, providing such investments do not unnecessarily prevent the
prompt settlement of my estate.
200 N. Hanover Street
Carlisle, PA 17013
GRIFFIE & ASSOCIATES
Attorneys At Law
Page 3 of8
38 N. Main Street
Chambersburg, PA 17201
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(f) To sell or otherwise dispose of any property, real or personal, tangible or
intangible, at any time forming a part of my estate in any manner and on such
terms and conditions as my Executor/Executrix shall see fit in his, her or its
absolute discretion.
(g) To borrow money for the payment of taxes or for any other proper purposes in
the administration of my estate, and to mortgage or pledge estate assets as
security.
(h) To compromise claims without court approval including, but not limited to,
any controversies with the United States of America or the Commonwealth of
Pennsylvania concerning estate and inheritance taxes on any interests that may
pass under this my Last Will and Testament.
(i) To distribute in cash or in kind upon any division or distribution of my estate.
G) To undertake any and all acts deemed necessary and proper by my
Executor/Executrix for the proper, advantageous and prompt management of
the settlement of my estate.
(k) In general, to exercise all powers in the management of my estate which any
individual could exercise in the management of similar property owned in his
own right, upon such terms and conditions as to him, her or it may seem best
and to execute and deliver all instruments and to do all acts which he, she or it
deems necessary or proper to carry out the purposes of this, my Last Will and
Testament.
200 N. Hanover Street
Carlisle, PA 17013
GRIFFIE & ASSOCIATES
Attorneys At Law
Page 4 of8
38 N. Main Street
Chambersburg, PA 17201
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FIFTH
No interest of any beneficiary of my estate, either in income or in principal, shall be
subject to anticipation or pledge, assignment, sale or transfer in any manner, nor shall any
beneficiary have the power in any manner to charge or encumber his interest either in
income or principal, nor shall the interest of any beneficiary be liable or subject in any
manner while in the possession of my Executor/Executrix for the liability of such
beneficiary.
SIXTH
I nominate, constitute and appoint my son, ANTHONY CARL DeROSA, as
Executor of this my Last Will and Testament. In the event my spouse is deceased, unable
or unwilling to serve or shall cease to serve for any reason whatsoever, then I nominate,
constitute and appoint my son, VICTOR SCARO, as Executor of this my Last Will and
Testament. I direct that my Executor shall not be required to give or post bond for the
faithful performance of his, her or its duties in this or any other jurisdiction.
SEVENTH
I hereby declare it to be my expressed desire that my Executor/Executrix employ
the law firm of Griffie & Associates, of Carlisle, Pennsylvania, for legal advice and
assistance regarding this my last Will and Testament, they having considerable knowledge
of my affairs, views and wishes respecting any matters that may arise at the probate of this
instrument, the administration of my estate, and the execution of the powers herein
mentioned.
200 N. Hanover Street
Carlisle, PA 17013
GRIFFIE & ASSOCIATES
Attorneys At Law
Page 5 of8
38 N. Main Street
Chambersburg, PA 17201
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IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last
Will and Testament, consisting of eight (8) typewritten pages, the first five (5) of which
bear my signature on the side margin, for purpose of identification, this
day of ;2;.1 LfHk , 2001.
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LENA E. DeROSA
200 N. Hanover Street
Carlisle, PA 17013
GRIFFIE & ASSOCIATES
Attorneys At Law
Page 6 of8
38 N. Main Street
Chambersburg, PA 17201
,
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA:
: SS.
COUNTY OF CUMBERLAND
I, LENA E. DeROSA, the Testatrix whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby acknowledge
that I signed and executed the instrument as my Last Will and Testament; that I signed it
willingly, and that I signed it as my free and voluntary act for the purposes therein
expressed.
~ L1Q~
LENA E. DeROSA
Sworn or affirmed and acknowledged before me by LENA E. DeROSA the
Testatrix this !:;t!r dayof" 11jhJ1fjL .2001.
a4~
Notarial Seal
Robin J. Goshorn. Notary Public
Carlisle Bora, Cumberland CountY
My Commission Expires Apr. 17. 2003
200 N. Hanover Street
Carlisle, PA 17013
GRIFFIE & ASSOCIATES
Attorneys At Law
Page 7 of8
38 N. Main Street
Chambersburg, PA 17201
AFFIDAVIT
COMMONWEALTH OF PENNSYL VANIA:
: SS.
COUNTY OF CUMBERLAND
WE, I!tt t/S t( ,j Lch fJ1a f1
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and rJr-o-d 1<-, L- C, I ~(_
the witnesses whose names are attached to the foregoing document, being duly qualified
according to law, do depose and say that we were present and saw the Testatrix sign and
execute the instrument as her Last Will and Testament; that she signed willingly and that
she executed it as her free and voluntary act for the purposes therein expressed; that each
subscribing witness in the hearing and sight of the Testatrix signed the Last Will and
Testament as witnesses and that to the best of our knowledge the Testatrix was at the time
18 or more years of age, of sound mind and under no constraint or undue influence.
Sworn or affirmed and subscrib
~/~. 19 fb
and J~L" y;;
this / :;ffi- day of V').f t7In-lu.r- ,2001.
'/~A'~~
Notary Pub I'"
Notarial Seal
~n J. Goshom, Notary Public
Carlisle Bora. Cumberland County
My Commission Expires Apr. 17, 2003
200 N. Hanover Street
Carlisle, PA 17013
GRIFFIE & ASSOCIATES
Attorneys At Law
Page 8 of8
38 N. Main Street
Chambersburg, PA 17201
,
.
Attachment to
Schedules "A" "E" and "H"
,
A.Set'ij~rn~A'iJ!~~~tYiilliy~tl' u.s. Department of Housing ,and Urban Development
R ""!a ~,;;'r::~~n':\'~';'" :'L ,11" 1ill.',:",,'l ";,!;1;;:,:!:,: .- ., .
'. f . .... . . -
.. DFaA 2. , DE~:!Ii:~-!;[]qonv. 01l~k":i'1 6. File NUl11ber .., ,7. Lo~Number \ 8. Mortgage Insurance Case Number
4 D"~ < . n;.; . <,i~':,"" . ..~.,'" 8100-737
C. Note: 'This form Is furnished' to 'gIve you 8 statement of actual' settlement 'costs. Amounts paid to end by the settlement agenl 81l!1 shown, I TitleExpress Settlement System
Items marked .~(p.o~c.)" were pal~ outside the closing; they are shown here for information purposes and ~re not included, in the lotals.
WA~N~NG: It IS B crime to knoWll"!9ly '!lake false statements to.~':;II~nl~~,S~les on this or any other simlla,rforrn. Penalties upon p
D. NAME OF BORROWER: Louise A. Metz and Susan Marie Metz
'inTi"""". ? JaneUme:darlislePA 17013
E. NAMEOFSELLER:" The Estate. of Lena E. Derosa
. AnnllPSS' '. 4'1'nletm";\v~nue Boilin!! Snr;""< PA 17007
F. NAME OF LENDER:
G. PltbPEItTY ADDRESS' 1208 'PheaSant Drive South, Carlisle, P A 17013
"' .... '" ..
H. SETILEMENT AGENT'" 'Sa1zIIi.a.rmHughes, P.C., Telephone: 717.249-6333 Fax: 717-249-7334
95'A I~.xander Sorin!! Road. Carlisle P A 17013"'
1 .... 03/28/2008
.. ., J.'RUMMAR'l"'OFBORROWER'STRANSACTlnN: K. RUMMARY OF SELLER'STRANSACT1ON:
,no 400 'co
.M , nn,'" ......... 1'05 000.00 ~rl1 ..' . .. 105 000.00
.no ..... .... AM
'2 078.50 Ari. .-",,;'
104" .... ,., .,.., - ~nA
.nR" . .....,. '. ......., AM
." .,~ hi> ...II~, ' , ''''''"'0
1nR .... . ....,.., A=
.07 03/28/08 'n:L2,t31/08 230.66 An7 03/28/08 to 12/31/08 230.66
'nR 03/'28/08'- 06/30 108 291.44 Ano 03/28/08 In 06/30/08 291. 44
.na. . ~na
11n .. , Hn
.." . ..,
.,? .... .. .. A<?
1 107 600..60 A?n ,.,,,n,,." TO SELLFR 105 522.10
?nn .In RY OR ON RFHAI F OF ROR 'OINFR finn. R--' ._~._.." I" T
7n1 3 000.00 on<
on? on? B 455,BB
OM ono
704 on'
?M ... <n<
on< ons
?n7 . fin7
0;;' orio
7no ,. <no
r it~m. ."nn~;rl hv '~I ' "nn~irl nv .~II
71n ..n
0<1 0<1
717 <17 -
71' 0<0
71~ , !. O<A ~ .,.. ,
715.. <,.
?<A ..... . <1A ;
717.'... " .n <17
?<. )T :>"): .. 0.0
: .",;:!ii;. ). . ,. .. ..... <10 ,
??n".Tt:lT" R 3 000.00 fi?n TnT'" ,cc" co B 455.B8
"'Inn. r.A!,;H AT T "Rn.. n" Tn "nRR( IWER 5nn r...".... AT T TO OR F"n.. "'" I F
.n. 107 600.60 An1 - 105 522.10
'07 ',. 3 000.00 OM 'n. . <olio, to;n. <om 8 455.B8
" F"n.. "n"RI"\'^IF" M"'I r.A"H Tn!';""1 FR 97
104 600.60 066.22
-, " ,
sUBsTiTuTE FORM 1099seiL'ER'sTATEMENT: The Information contained herein Is Important tax Information and Is being furhished 10 the Internal Revenue S~tvice. If you ere required to file a return,
a negligence penalty or other sanction will be Imposed on you If this Item is required to be reported and the IRS delermlneslhat It has not been reported. The Contract Sales Price described on
line 401 above constitutes the Gross Proceeds of this transaction.
You sie requlred"by law'to provide't.he'~~Wement agent (Fect Tax ID No: ) wlth your correct taxpayer Identification number. If you do not provide your correct taxpayer Identification
number, you may be subject to dvll orClimlnal penalties Imposed by law, Under penalllas of perjury, I certlfy that the number shown on thIS statement Is my correct taxpayer Identification number.
TIN:_._-",<,'iJ,',' ";.."/~~"~~':SELLER(S) SIGNATURE{S):
SELLER(S) NEW MAILING ADDRESS:
SELLER(S) PHONE NUMBERS; (H)
(W)
U~. DEPARTMENT OFHOUSING AND URBAN DEVELOPMENT
File Number: S 100-737
· PAGE 2
~
Ii' :!""U)i;HA! '. . , ~H.'O' .
L n:n,,:.,' ...;:. ;i.,;!!;~thj~" PAID FROM PAID FROJIII
I n'I.....S105 000.00 @ 6.000-6 300.00 BORROWER'S SELLER'S
~. . . FUNDS AT FUNDS AT
7.01 'IF,i., '", ""3'![175.00 10 WOlfe.ii, 'Shearer SETTLEMENT SETTLEMENT
7n? ",u; '.::. '3' 12'5..00 10 Coldwell Banker Homesale GrouD
7nO 6 300.00
704 In Coldwell Banker 195.00
RM {)H
Rn. .... % '.'
Rn7 %
803.6';' I~- .... . ... ...
aD .'
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RM ........,. .' .. i.'.
Rm " ..... .............. ,. . ." ,
908 '".;"...: ....... ",".,',,,,, .1 . '. .
.na...;~.l\..:.",' ,.i"i'!. 'i',,1 -' . .'
'810 ......... .' ~."'" ............, y' ..!.,N": .,:., ~"i"'"''
'A11 "..iii."...... .. ". ...:..:=".,., ',;.. .,;'.
.,'
on1,iif"'...... c........... -.l1iIS . Idav
aM "'. ". .... . ...,.........Iri
on, ..". ,"'.12110'
904. ~.
905....... . ......;..,....
....- ...1..".' ... Imn
1nM -" "".",,"C.: ....... . 'mo. Ill>S Imn
1nn' .. mo..1llU. Imn
. mn. iIlls -.lmo
10n~ ....; .' :mo~ Imo
1Ma""'" ,'''',. .... '", ..,",.,." 0.00 0.00
" .. .,....'"
11n1 .. .,.
Hn? ,.,', ,", ..,
I1no . ..'
i104
,'n~ .'" ., .
"OR '. .. 10 Cash 10.00
1107 In Griffie & Associates (POC)
,'" '. \
110R ....... ..,,,,- ..'
.L."i,c. ".' ,. \
11no .. ._;:;... ... ,"".
1110 -
i11'.
111? . ... to Salzmann Ruahes P.C. 795.00
1113." ... ....
, 1?M
1?0. 36:'50 " , Relea'e S 36.50
1?0? ,..., . n-" ~!11150. 00 . Mno-tna"", 1 050.00
1203. . n"""rl''''1'OSO . 00 'M"rle .. 1 050.00
1204 .. ... ',,:'
1?n~ .' ", ." '., "',I"l.:;'
1300.ADDITIONAL SETTLE'
1301 " .. ..llLRo:b~iii'SolleribeJ:ger Tax Collector 302.60
..n? . to NOrth Midd1e.ton Authority I 138.71
..no to Marsha.ll Electric 654.57
1400 T{)TAI " ,1M ~. 'nO<'M C. 'M~' 2 078.50 i 8 455.88
I
HUO CERTIFICATION OF BUYE;R AND SELLER
Th.ESd~~ (" .oO~ ~,
WARNING: IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS 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 AND SECTION 1010.
DA
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Attachment to Schedule "E"
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To: Bradley L. Griffie, Attorney
200 North Hanover Street
Carlisle, PA 17013
From: William G. Rowe, Appriaser
211 N. Old Stone House Road
Carlisle, PA 17015
Re: Personal Property Appraisal
Estate of Lena E. DeRosa
1208 Pheasant Dr. So.
Carlisle, PA 17015
Date: February 12, 2008
LINDEN HALL ANTIQUES
211 N. OLD STONE HOUSE ROAD
CARLISLE, PA 17015
717-249-1978
LIVING ROOM
Sofa - older model
Recliner
Christmas decorations
Wall hangings
Knick knacks
Portable bed
Stands (2)
Lamps
TV. - older model
Closet items
Dressers (2)
DINING AREA I KITCHEN
Desk
Table I chairs
CDs
Knick knacks
Wall hangings
Microwave I stand
Small appliances
Kitchenwares
Dishes
BEDROOM
Bedroom set
Wall hangings
Upholstered chair
Housewares
Closet items
BEDROOM - STORAGE
Vacuum sweeper
Single bed
Housewares
DeRosa Appraisal
$30.00
$15.00
$10.00
$10.00
$20.00
$20.00
$20.00
$10.00
$20.00
$10.00
$45.00
$50.00
$125.00
$20.00
$10.00
$15.00
$20.00
$10.00
$15.00
$15.00
$185.00
$10.00
$15.00
$10.00
$10.00
$20.00
$15.00
$10.00
1
02/12/2008
.
. to,
.
BEDROOM
Stands (2)
Sweeper
Lamps
Sewing machine
Wall hangings
PATIO
Grill - not working
Plastic table I chairs
STORAGE UNIT
Lawn mower - electric
Step ladder
Long-handled tools
Hand tools
Miscellaneous garage items
Appliances - appraised with real estate --
DeRosa Appraisal
Washer, dryer, refrigerator, stove
Total
2
$30.00
$15.00
$5.00
$10.00
$10.00
$0.00
$10.00
$15.00
$5.00
$20.00
$5.00
$5.00
$895.00
~_.~
William G. Rowe
r~
0211212008
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Attachment to Schedule "F"
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,
Sovereign Bank
ESTATE OF
SOCIAL SECURITY #:
DATE OF DEATH:
Lena E DeRosa
125-22-1910
January 1, 2008
Account #: 0041098463 Type Checking
In the name of: Lena E DeRosa or Janet A DeRosa
Date of Death Balance: $799.24
Int.(YTD) from 1/1/2008 to 1/1/2008
Accrued interest to date of death: $0.00
Other Info: Closed 3/17/08
Account #: 1694003888 Type: Savings
In the name of: Lena E DeRosa or Anthony DeRosa
Date of Death Balance:
Int.(YTD) from 1/1/2008
Accrued interest to date of death:
Other Info: Closed 3/17/08
to
$376.26
1/1/2008
$0.00
Account#: 2891031474 Type: Checking
In the name of: Lena E DeRosa or Anthony C DeRosa
Date of Death Balance: $2,245.14
Int.(YTD) from 1/1/2008 to 1/1/2008
Accrued interest to date of death: $0.04
Other Info: Closed 3/17/08
. Account #: 2895279954 Type: CD
In the name of: Lena E DeRosa or Anthony C DeRosa
Date of Death Balance: $1,350.60
Int.(YTD) from 1/1/2008 to 1/1/2008
Accrued interest to date of death: $0.15
Other Info: Closed 3/17/08
Page 1 of 1
Open date: 11/23/2007
$0.00
Open date: 10/18/1999
$2.68
Open date: 8/4/1989
$1.20
Open date: 12/19/2000
$53.47