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HomeMy WebLinkAbout04-0013 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate Of~o. y r 11\ L,!VI 0 7)-re.. also known as A)(v.."" J'nf')7)fP P,M"!j L~e lYldv'L Deceased Socwl Secunty No J 5S'-C; - ,::1,b - '-J (" I. c;- No To c:;./-ov- 1...3 Register of WIlls for the County of Ci.Ambt<^faYld.. m the Commonwealth of Pennsylvama The petltlOn of the undersIgned respectfully represents that , Your petltloner(Olj, who Is/..... 18 years of age or older, applle!". for letters of admmlstratlOn on the estate of (d b n . pendente lite, durante absentia, durante mmontate) the above decedent " . 0 . Decendent was domicIled at death m C /Ambe rlCl.-Vl " . iounty, Pennsylvama, wIth hiS last famIly or pnnclpal resIdence at qSo Ore)", oV'd A-lIf " 3;;1., UJ/,uf .rAI/e.Y) 1DWYlShV (hst street, number}'1d mUnIcipality) D~.c5:.ndent, then 57 years of age, died "Pe.CQ-fY\be-v 01/1, ~003 ,1'9": at !1QP DieIMUD. Av--t, it '3 d, /""H r 411 CIA 1l..>r> j C It.-I\\f l'<!i II ) P r. 110 II Decendent at death owned property with estImated values as folllows (If domIcIled In Pa ) All personal property (If not domIciled In Pa ) Personal property m Pennsylvama (If not dolmcIled In Pa ) Personal property m County Value of real estate In Pennsylvama situated as follows No,.,c. $ ,;;1,0, DOO ES-t $ $ $ Petltloner_ after a proper search haS..- ascertamed that decedent left no Will and was survIved by the follOWIng spouse (If any) and hem Name Residence L., f'l\OO.(' La II ~ r:; '" THEREFORE, peuuoner(s) respectfully request(s) the grant of letters of admInistratIOn In the appropnate form to the undt;rSlgned ~ v: ,,' . ~ u u c u -g3 U" "'u c ..,0 c" ~" 3~ U~ ~ 0 <ii c '" .;; , . ~~ -< r/U; dJ;t9(YcJI;! IfflR-; . p (;)88 Tim/pf-,/, V/FuJ DrI,f'{J M ecl,~\Y\{c" hUV'j iPA I'7Dr;:?) /?- /~?-3 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF } ss The petltlOner(s) above,named swear(s) or affirm(s) that the statements In the for~goIng petition are true and correct to the best of the knowledge.and,behef of petltloner(s) and that as personal - vJ '-'........ representatlve(s)'of-ttie,above decedent petltlOner(s) wIll well and truly adn;lmstertjie~a~~1rdIng to law. . ~A --K.. affirmed' 'ang, subscnbed lr ~1>>di4. c(titrrv- ~~G.{. :;/,::: day of "-"",,::: '~'!:;f.t ~(M/A~A~Y1 ~ . [ RegISter [ ~ ~ ~ " .... ::l :;; d OIl Vi " No.....~/-O ~- /..E Estate of ---..BAR R ( J J L _ ~,RS , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW JAn! "" 1'<.1 t l.n ~1-. In conSIderation of the petItIOn on the reverse SIde hereof, satlsfacto y proof havIng been presented before me, IT IS DECREED that fYlE:.RF()\TI-I L fVj(TPE ISlare entitled to Letters of AdmInIStratIOn, and In accord wIth such fIndIng, Letters of AdmInIstratIon rtE.R.EDIT14 rr'cY,1( E are hereby granted to In the estate of 'l?-A1<.:l'1 I ~O<F . ,v ~ ~,-x::, t-\-::;?,..",= $ $ /rJ,= TOTAL _ $ A D A.<J~ ~~~~~//:/;. P;r;NJ~A uf .u -= .~~gJsterofWI~~~ "~rJ.~'~) ";"~~)" - FEES Letters of Admlmstratlon Short CertIficates( ) ~latlOn F~~ \ ' ... A TfORNEY (Sup Ct [D No) 6G [[\1 S- NWr \70, ADDRESS ,1}1 \_ ~~ lJ;U~I-~PHONE This IS to cernfy that the mformatlOn here given IS correctly copIed ftom an ongInal cernficate of death duly filed WIth me as Local RegIstrar The ongInal certIficate will be forwarded to the State Vital Records Office for permanent filmg WARNING: It IS Illegal to duplicate this copy by photostat or photograph. No ~/l(~ Local RegIstrar Fee for this certIficate, $2 00 p 9812995 JAN 0 2 2004 Date 144 Rev 1191 COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH (Coroner) L Moore Male llWE"FlLENUMBER SOCIAl. SECURITY NUMBER 185-36-4615 ).. O.IJ"EOF DERH(MonIh Day 'IMI) 4 ~D~~~~ber~29 2003 'E< em BlRTHPLACEl(:cy....:! SWIOlFOI-'ot>CounIrjI UNDER 1 YEAR ........ ..,. UNOER101<< Hours M"'UI" ,. ER/OuIpm....O g:,:",o Cumberland Lower Allen 950 Orchard Avenue 17. Stale PE'..nnsv 1 van~a "- +1 (1.4015+) 17eX) v...___'" MAArTALSWUS Mun.d -......- --- " llURVlVlOOsPOUSE J (11_ gove,..-,Nlmel " DECEDENT A UPATION ~~.J:1oO::'::~~ 11 Barber t1b. Barner S DECEOEHT SMAlUNQAOQf\ESS($lrBlll CoIyfTown Stale ZlpCode) 950 Orchani Ave. Lot 32 Camp H~ll, PA 17011 " FAlHEA S NAUE iFnl Middle laII) vm~~~:'1N ",0 "'J6l DECEDENT 8 EOl..ICA1ION " .. "" ,. -, -.. CUmberland lownatllp? 17dD ~o.:r=gI MOTHEA S NAt.lE(F~SI. Ulddle MadenSurnMlOl) L<ir.1er Allen ... I)'W~""P ~ -- '" To.....t.tlQlmy~ daalhoe<:&llTedal.....Urne dateand-'lUled {Sognalw..ndTIII8) Ilorothy"'Hanna~,~\..;r . I' " INFORMANTjMAlLlNGAOORfSSp_ ~ SIlllf Z-'p,Ca;1e)..., "" '10 .:',>~, \..i 187U Beacon ~t. Apt, 4, Brook~ne, MIl 02445 PLACEOf'DtSPOSlTIOH KameolCemel...,Cr~ LOOATIOH f1bwn Stal..ZIpCodl orOtIlef~ Vemcl.l A. Moore M~th Moore RelTlO'o'allfllftlSlMeD PER~ACTING AS SUCH 1-5-04 LICENSE NUMBER 012755-L 2,past Harnsburg cran, NAME AND ADDRESS OF FAClUTY Wers-Hamer Fll, LICENSE NUUBER ;f,.~, ....... 21d. Harrisbur ;~ PA , /. - 1903 Mkt St, ,00",.,PA 170H'" DAfESlGNED (MQnIho.v'Marl '" "" WAS CASE REFERRED 10 UE~ EXAMINERICOAONER7 u. JPF VH j.Xl FD ..>4l-) l"~iNo~ l' ;,: !=..~ PART II ~~~~-=~~ lonM1..-d~1'I I .. ... TlMEOF DE,tJH Aprx. DA1EPROHOUNCEDOEAD(MonIh Oey Vaet) 2. 9: 00 A. 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CouI<lnolbood.I.,mll>lod Coroner o PRONOUHClNO AND CERTtl'YINQ PHYSICIAN (Phyadan bQltl plQI'lI.U'oClI\Q dealh and l*liylng 10 CIIU&II '" ...Ih] TO u.._lolmyk.-lHge, dull'I occutrecl.l_ U.... ute andplKtl ancl.w.toUM cauM(.landmanllM...teleod DAfE6KlNED(UanIl,Oey"-) 'U o 310 31d December 31, 2003 N.fJ.lE AND ADDRESS OF PERSON WHOCOMPLETED CAUSE OF DEATH (Uem21)TypeOl'Prinl Michael L. Norris, Coroner 6375 Basehore Road, Suite #1 Mechanicsburg, Pa. 17050~'>r;1 L MEDICAL EXAMIHERICOAONER Onlhe~ol.~lonandlOl'ln"..llgMlon.lnmyoplnlon.d..lhoccurnd.llIMllme.d.I.,and~..ncId~IOI""t.u"(.I.nd mMln.,...lated ". REGISTRARS .1.<,/ ""',/1 " J}. t~ .If .' It ....., ~ " r! - I I I I I I I ~wl ~3:1 a:-' wol "WI ~I=I ~gl @i~1 irl91 ~~I ~ zf: Ow ~~I 1-0 1-" "z a: a: w::> "I- .,W t,;~ W" .,1- :5~ 0. 0;;:;;...-0;;;.:.. __~-;;lll;;i,,~ . . . ~~~li! i ~ a ~: -a.... ilq:r/I ~~~~lli (81 ~ &~.........I f f~ill (gl!So" ailoii"tt "g.8::::1!tS C1J.,< i 1.1 i l~ fi1~: J i )' p:I I .~ i ! 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JRD/June 30, 1992/17858 MAY U 6 2004 ~ In Re: Estate of BARRY L MOORE Late of LOWER ALLEN TOWNSHIP ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA Estate No.: 21-04-13 NO. 21-2004-13 NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT ORPHANS' COURT RULE Personal Representative: MEREDITH L MOORE Counsel for Personal Representative: Date of Grant of Original Letters: 01-06-2004 Date of Delinquency Notice: 04-16-2004 The undersigned, Glenda Farner-Strasbaugh, Clerk of the Orphans' Court, in accordance with Rule 5.6, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its certification required by Rule 5,6(e), Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court Orphans' Court Rules, was given by the Clerk of the Orphans' Court on APRIL 16,2004, and that the ten (10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6( e) the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Glenda Farner Strasbaugh Clerk of the Orphans' Court Date: 05-06-2004 Distribution: Personal Representative Counsel for Personal Representative Estate File ~ :L ;L.10'l 9; J () Jl,ftI, A hearing is scheduled f6r I I at I in Courtroom No.3. filed prior to the hearing date, the hearing will automatically b If the Certification of Notice is c I . CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: ~ I!.... '1h trf!/'tJ2; Date of Death: ~ "()..9, a....oo 3 Will No. Admin. No. ,) 00'+- 000/3 To the Register: I certify that notice of (lteReAeiel iRwl'e8t) estate lldministration required by Rule 5.6(a} of the Qrphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on ~IY\4./I. CAt, d <6 1 aooi : ~ Address ~ ~'lh~ allJ-. tUfA;ct~ k, CtLnlf M) PA- 1701/ Notice has now been given to all persons entitled thereto under Rule 5.6(a) except "'0 elfC6fYj1 oJJs Date: 0pnlL q I ao O~ Signature Name ih flU ~ ;(. fn (}17\{. N c:":' Address ! 8,70 (dJe.a. UTY\.. Mru..e..t-) O~pt, 'f 13~. N,4 O;).Lj-(f5 ,/ LL. o >- = ::c Telephone(~8r ?-0V -rOOD <<:::t P ,.- J :::: - "\,.-: '...., --..: Capacity: ~ Personal Representative _Counsel for personal representative o 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 MOORE MEREDITH L 1288 TIMBERVIEW DRIVE MECHANICSBURG, PA 17050 _h_Uh fold ESTATE INFORMATION: SSN: 185-36-4615 FILE NUMBER: 2104-0013 DECEDENT NAME: MOORE BARRY L DATE OF PAYMENT: 09/17/2004 POSTMARK DATE: 09/14/2004 COUNTY: CUMBERLAND DATE OF DEATH: 12/29/2003 NO. CD 004396 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $5,386.42 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: MOORE CHECK# 1035 SEAL INITIALS: CCP RECEIVED BY: REGISTER OF WILLS $5,386.42 GLENDA FARNER STRASBAUGH REGISTER OF WILLS 22 Chiswick Road #12 Brighton, MA 02135 832-264-9000 (M) 617-432-7836 (W) September 14, 2004 Mary C. Lewis Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 Re: Estate Tax Return for Barry L. Moore Ms. Lewis, Enclosed, please find two copies of the Estate Tax Return for the Barry L. Moore Estate as well as payment in the form of check #1035 in the amount <!p$S,386.42. Ify.9o;:: have any questions or concerns, please to not hesitate to call. My cor$et info~ation;is;- listed above. ,., (/) rr. -0 Thank you for your cooperation. --" --J :r::;. \0 Sincerely, ,,, VI (~ .., ..-4"" ~>r~ Meredith L. Moore, Ph.D Administrator, Barry L. Moore Estate 22 Chiswick Road #12 Brighton, MA 02135 832-264-9000 (M) 617 -432-7836 (W) September 14, 2004 Chris Puogar Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 Re: Estate Tax Return for Barry L. Moore Ms, Puogar, Enclosed, please find check #1036 in the amount of $15.00 for the filing fee of the estate tax return for the estate of Barry L. Moore, If you have any questions or concerns, please to not hesitate to call. My contact information is listed above. Thank you for your cooperation. Sincerely, (V~~~ Meredith L. Moore, Ph.D Administrator, Barry L. Moore Estate REV.lSOO EX (6~0) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 W I- x::$l/) ylI:X: WILY :1:00 yll:-' ILID IL c( INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W C W (.) W C DECEDENT'S NAME (lAST, FIRST, AND MIDDLE INITIAL) MOORE, BARRY L. OFFICIAL USE ONLY FILE NUMBER 21 ~L -D.Oill L __ COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 185 - 36 4615 DATE OF DEATH (MM-DD.YEAR) 12/29/2003 DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (daleoldealh prior 10 12,13-82) D 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Anech Sch 0) 12-13-46 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) None ~ 1. Original Retum D 4. Limited Estate o 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Return D 4a. Future Interest Compromise (daleoldeathaner 12,12-82) o 7. Decedent Maintained a Living Trust (Attach copy olTmst) o 10. Spousal Poverty Credit (data oldeath belweeo 12,31,91 and 1,1,95) I- Z W C Z o IL l/) W a:: a:: o y NAME , Danlel J. Clement, Esquire FIRM NAME !!! ~ic8b1e) Law Ottices of TELEPHONE NUMBER 570-524-2277 COMPLETE MAILING ADDRESS 25 S. 4th street p.O. Box 93 Lewisburg, PA 17837 (1) (2) (3) (4) (5) z o 5 =>> l- ii: ct: (.) w 0:: 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) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or l) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which An election to tax has not been made (Schedule J) 90,837.79 (6) (7) 52,244.71 (9) 18,815.25 4,569.04 (10) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ~ =>> Q. ::!E o (.) g 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x.O_ (15) x .0 45 (16) x .12 (17) x .15 (t8) (19) 16. Amount of Line 14 taxable at lineal rate 119,698.21 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT d ~:::::.. OFFICIAL USE ONLY _:0 ""''J ; ...<'! l-tI ';:J ..,j '.II (8) 143,082.50 (11) (12) (t3) 23.384.29 119~98.21 (14) 119,698.21 5,386.42 5,386.42 'l"; ,t,;\::;, 1lI., PA Central MAIN - 959 East Park Drive Harrisburg, PA 17111 BRANCH - 25 West Main Street Shiremanstown, PA 17011 BRANCH - 5137 Jonestown Road Harrisburg, PA 17112 FEDERAL CREDIT UNION www.pacentralfcu.com 800-356-3875 FAX 717-564-1503 August 2, 2005 Glenda Farner Strasbaugh Clerk of Orphans Couq Cumberland County One Courthouse Square Carlisle, Pa. 17013 Re: Estate of Barry Moore, Deceased Ashley R. Moore, a minor Restriction of account Dear Ms. Strasbaugh: P A Central FCU has opened an account and it has been marked with the required restriction in accordance with paragraph 15 of the Statement of Proposed Distribution in the Estate of Barry L. Moore, Deceased, No. 2004-00013, approved June 21, 2005. Sincerely, ~~.w~ Sharon M. Lehman Loan Officer P A Central FCU 564-4661 ext 205 /"-..;> c,~::. r-::-) c.rJ ""U '-1 r-'t"1 ; C'-) "-U~ '----' , i~~~) ("1 - -JJ C) ""- rn ~~.. c: G) .~. .'.... I .t..- '. J ~ \.-0 N 'V REV. 1508 EX. (1.971 '*' . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF BARRY L. MOORE FILE NUMBER 21-04-00013 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 168.37 2. 3. 4. 5. 6. 7. 8. Waypoint Bank Checking Account 0100674324 PO Box 1711 Harrisburg, PA 17105 Waypoint Bank Savings Account 8978017096 PO Box 1711 Harrisburg, PA 17105 393.73 CCFNB Checking Account 3000076216 Orangeville, PA 1,228.15 CCFNB Certificate of Deposit 5000096713 Orangeville, PA 73,460.00 Guns 1,450.00 1988 Victorian Mobile Home (value based upon sale at VIN IV7514CK0212 fair market value in arms length transaction) 1996 Ford Truck (value based upon sale at fair VIN 1FTCR10A9TT48214 market value in arm~ length transaction) 12,000.00 2,000.00 Insurance Refund 137.54 TOTAL (Also enter on line 5, Recapitulation) $ 90, 83 7 . 79 (If more space is needed, insert additional sheets of the same size) "~..".,," '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF BARRY L. MOORE FILE NUMBER 21-04-00013 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER 1. DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANsrEREE. THEIR RELATIONSHIP TO DECEDENT AHD THE OATE or TRANsrER ATTACH A COPY or THE DEED rQR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECO'S INTEREST EXCLUSION Ir APl'lICABlE \ TAXABLE VALUE Meredith L. Moore - daughter. Inter-vivos nla Cash gift made by decedent within one year of death. o o 25,553.31 2. Ashley R. Moore - daughter. Inter-vivos cash gift made by decedent within one year of death. nla o o 25,553.31 3. Phoenix Investment Partners PHX-Seneca Strategic Theme - Fund A 00005477894-8 Statestreet Bank & Trust Co., Custodian for IRA Rollover of Barry L Moore 101 Munson Street PO Box 88 Greenfield, MA 01302-0088 Meredith L. Moore and Ashley R. Moore were designated sole beneficiaries in equal shares. 1,138.09 100 1,138.09 TOTAL (Also enter on line 7, Recapitulation) $ 52, 244 . 71 (If more space is needed, insert additional sheets of the same size) !lfV.IS1lex, (hll '*' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT BARRY L. MOORE FILE NUMBER 21-04-00013 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION FUNERAL EXPENSES: 1. Myers-Harner Funeral Home B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representalive(s) Meredith L. Moore Social Security Number(s) I EIN Number of Personal Representative(s) 1 7 0 - 5 4 - 5 5 4 4 Street Address 22 Chiswick Road, Apt. 12 City Brighton State MA Zip02135-7178 2. 3. 4. 5. 6. 7. 8. 9. 10. 11 . 12. 13. 14. (s) Commission Paid: 2004 AllomeyFees Daniel J. Clement Family Exemption: (If decedenfs address is not the same as c1aimanfs, attach explanation) n / a Claimant Street Address City Relationship of Claimant to Decedent State Zip Probate Fees Accountanfs Fees Daniel J. Clement Tax Retum Preparer's Fees Advertising Letters of Administration Shuler Realty - lot rent Eshenaurs - propane and repairs PP&L - electric PA American Water - water Safe Auto - insurance payments Trinity Lutheran Church - Columbarium Providian - VISA bill Mary Ann Klementik - trailer maintenance & funeral *continued* TOTAL (Also enteron line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) AMOUNT 4,323.00 4,500.00 2,500.00 90.00 250.00 174.19 1,100.00 1,643.17 153.96 98.49 384.00 680.00 314.86 759.20 SCHEDULE H - Continued FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF BARRY L. MOORE FILE NUMBER 21-04-00013 16. 17. 18. 19. 20. 21 . 22. 23. 24. Larry's Auto Salon - clean and detail truck Kramer Brothers Glass - repair screens and windows Verizon - phone bill Bonnie K. Miller, Treasurer - real estate tax Commonwealth of PA - trailer title PA Dept of Revenue - income tax Postmaster - stamps Allied Roofing - net cost after insurance proceeds for trailer roof repairs Mary Ann Klementik - Reimbursement for miscellaneous administrative expenses 25. Bob ott - painting TOTAL $ 185.45 620.00 166.31 68.12 22.50 40.00 37.00 85.00 150.00 470.00 $18,815.25 REV,I512 EX -(1-81) ESTATE OF '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT BARRY L. MOORE FILE NUMBER 21-04-00013 Include unrelmbursed medical expenses. ITEM NUMBER 1. DESCRIPTION AMOUNT Commonwealth of Pennsylvania, Department of Revenue Inheritance Tax paid on Certificate of Deposit, CCFNB No. 5000085243 4,569.04 TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ 4,569.04 , . , REV.15t3 EX. 11,97) '*' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES BARRY L. MOORE ESTATE OF NUMBER NAME AND ADDRESS OF PERSON{S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) t Meredith L. Moore 22 Chisw~ck Road, Apt. 12 Brighton, MA 02135-7178 2. Ashley R. Moore 2112 Wentworth Drive Camp Hill, PA 17011 FILE NUMBER 21-04-00013 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) daughter daughter AMOUNT OR SHARE OF ESTATE 50% 50% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, 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. none B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. hone 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) f' 1 t 'i 1 $ ~ , t.! ." Ii . f ,. (lj 3,3- "'", <D <D e~ ~'" g"1'n e~ e: ::l. rJ"~ "'""'" ~~ @l. 'el ~e; ~ ~ i - cr a. g'I en CD !I. n 51! ~ ;;; I~ ~ w '" ~-_.- ~ I;j zl ill' @ 55 h. ::::;' t::r- ::::: 1 z~ ~~;r ~~j!; [):J += [):J CJ CJ += ~ 1::-1 1I1 CJ 1::-1 1I1 J zen 0 ~~ ; <D ;;} -'?, {-..... .,". 1":", :- T .~. ,......, (': \._i .:~ F \ :;- ..;~ ("~ 7' """1 " ,I' ." :r a ::l <D " , '" a 3 ~ ",.. '7 I ?-. f ~,,< ('t' ~'~,-.l ~;, M \ '7' e-..... .,... ,-'t" ~ e. Cil III \' ,.., 'H ...., ~ -\ 1 'b_ . \ ~ ~ <;';> <' "^ ~ ~...,. (' N ;; i : ' " , \ f,f lit -:"" { .A":" . 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W ..~ ~ [~ .., i ~< c2i' ; .l!, :i'! fi ~,J a f. ~' ~o : g~ .. ao.. o ~~ iji ~'~ . &'C i ~~ l fi? ~ o Zir ~e. ~~ ~- =0 ~ 1~ .c' '\ o ~~ [w f!:l ~ \l ia' )1... ~~ ;p !~ a- <D CCI . ,if o ~~ f r.~ &'" I '1U ~ [Qi il~ o il:ilir w~e. ..~ tp ~cn~ .. ..:. if"' w"" I ~o "';l' lie. ~ o ~ ~ i'1 ; O....! 15dI _ !I!. ~n~g> "a ~ ~' I 0 en 11O~.~::> III " Z !'{...~c.. <CI 0 c=- a'o~ en l ....t. 1"~ I! [: ~~~Jil: ~ f ,-. ~' 0 if. ~Ii<! ii, ". i!!". ~j{"z II>> ...... I 1!!l ~ ~l:al' ill- ~U:;!"< :c- O .. ~'lI'5I'" -D' ;:'ifElif III If "' ~a n 8.W,'! il: . = "" ;;- ..!if il a m ElifW 5!: ~ ~ ~ii I n ~ tr::l. Si" '2: Ii i~ 1'5 ~,CC1 ~ i ~ !! i-:: ~' oD-. of lu~1 ~ ~, ~ l~ g ::;' 51 r:- 5" I- e.i ~ i ~ ~ .~. I ~ ' ..J I 194 ~ ~J O,2n ~' ,JaCD '" ",i ., .. - a. .g II ~ 01;>0 a &' ~[ ~ /" e:!: :!l < n '5' ~D ,.. if o ;:<;r C'e. <D~ 'I ~f~ I d~e; i~J Iil'[ [ ;< ot. l- s if ll' t .. of "if~a ;:, lii~e; I ll'.O~f li~bJ' !lifa -'Ill'::> i r I r ~ i c.... t , i f I ... 8 ClO CIl ciS' = S' CJ ij Cl __ ::::I, ::, III ~ CI ~ III " ::!'l ;I ~ ..c i- ~i i I III m ~~ CCI m = ~ I i Ci1 : ~ ~ i' Ii' ~ a ,. ~ ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DANIEL J CLEMENT ESQ 'CJ~ D J CLEMENT LAW OFFICE PO BOX 93 LEWISBURG DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 12-06-2004 MOORE 12-29-2003 21 04-0013 CUMBERLAND 101 -3 ;~ ..~~ : ,-.~~, 1 . REY-1547 EX AFP 109-04) BARRY L Allount Rellitted , PA \7~37 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=is4-j-EX--AFP--CoY:oiY-NOTYCE-OF-YNHEififAifcE-TAX-A-PPRXisEifiNi':--ALDiwAifcE-OR'----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MOORE BARRY L FILE NO. 21 04-0013 ACN 101 DATE 12-06-2004 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED 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: IS. Allount of Line 14 at Spousal rate (IS) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19, Principal Tax Due TAX CREDITS: .00 X 00 = .00 119,698.21 X 045 = 5,386.42 .00 X 12 = .00 .00 X 15 = .00 (19)= 5,386.42 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 (1) (2) (3) (4) (5) (6) (7) ,00 ,00 .00 .00 90.837.79 .00 52.244.71 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9, Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10, Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 18,815.25 4.569.04 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 143,082,50 (11) (12) (13) (14) 23.384 29 119,698.21 ,00 119,698.21 , ~"'_n. IU::L.C.LI" I l+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-14-2004 CD004396 .00 5,386,42 TOTAL TAX CREDIT 5,386,42 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. <: tI' IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DU~'\ A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERYATION: Estates of decedents dying on or before December lZ, 198Z -- 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 eny estete 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: PAVMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIYE CORRECTIONS: DISCOUNT: PENAL TV: INTEREST: To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act Z3 of ZOOO. (7Z P.S. Section 9140). 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 HILLS. AGENT 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 end Estate Tax" (REY-1313). Applications are available online at www.revenue.state.pa.us. any Register of Wills or Revenue District Office, or from the Department's Z4-hour answering service for forms orders: 1-8oo-36Z-Zo5o; services for taxpayers with special hearing and/or speaking needs: 1-8oo-447-30Zo (TT only). Any party in interest not satisfied with the appraisment, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within 60 days of the date of receipt of this notice by filing one of the following: A) Protest to the PA Department of Revenue, Board of Appeals. Vou may object by filing a protest online at www.boardofappeals.state.pa.us on or before the expiration of the sixty-day appeal period. In order for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals website. Vou may also send a written protest to PA Department of Revenue, 80ard of Appeals P.O. Box Z810Z1, Harrisburg, PA 171Z8-10Z1. Petitions may not be faxed. B) Election to have the matter determined at the audit of the account of the personal representative. C) Appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, P.O. Box Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See pege 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REY-1501) for an explanation of administratively correctable errors. 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, 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 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, 198Z 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 1, 198Z 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 198Z through Z004 are: Interest Daily Interest Daily Interest Rate Factor Vear Rate Factor Vear Rate ~:orom n!il-1991 --rrr- ~ Zii01 -w-- 16% .000438 199Z 9% .000Z47 ZOOZ 6% 11% .000301 1993-1994 7% .00019Z Z003 5% 13% .000356 1995-1998 9% .000Z47 Z004 4% 10% .000Z74 1999 n .00019Z 10% .000Z74 ZOOO n .00Dl9Z Vear 1m 1983 1984 1985 1986 1987 Daily Factor .~ .000164 ,000137 .00ollO --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER 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. IN RE: ESTATE OF BARRY L, MOORE, Late of Lower Allen Township, Cumberland County, Pennsylvania IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PA ORPHANS' COURT DIVISION NO. 21-04-0013 FIRST AND FINAL ACCOUNT MEREDITH L. MOORE, ADMINISTRATRIX FOR THE ESTATE OF BARRY L. MOORE, DECEASED Date of Death: Date of Administratrix's Appointment: First Complete Advertisement of Grant of Letters: Accounting Stated for the period: December 29, 2003 January 6, 2004 September 3, 2004 December 29, 2003 to Purpose of Account: Meredith L. Moore, Administratrix, offers this account to acquaint interested parties with the transactions that have occurred during her administration. The account also includes a Statement of Proposed Distribution of the estate. It is important that Requests for additional can be discussed with: the account be carefully examined, information or questions or objections Daniel J. Clement, Esquire 25 S. Fourth Street P.O. Box 93 Lewisburg, PA 17837 (570) 524-2277 -1- SUMMARY OF ACCOUNT PRINCIPAL BALANCE ON HAND Fiduciary Current Acquistion Page Value Value 3 $90,837,79 $90,837.79 3 $ 4,569.04 4 17,141.67 4 7,000.00 4 $28,710,71 4 $62,127.08 4 200.00 4 $61,927.08 4 $ 200,00 PRINCIPAL Receipts TOTAL PRINCIPAL RECEIPTS Less Disbursements: Debts of Decedent Administration Expenses Fees and Commissions TOTAL PRINCIPAL DISBURSEMENTS Balance before Distributions Reserve for future estate settlement expenses Distributions to Beneficiaries INCOME: Receipts TOTAL INCOME DISBURSEMENTS 4 $ 1,950.54 4 $ 1,950.54 3 $90,837.79 4 $63,877.62 4 $ -0- 4 $ 200.00 Balance Before Distributions Distributions to Beneficiaries Income Balance On Hand Combined Balance on Hand -2- RECEIPTS OF PRINCIPAL Fiduciary Acquisition Value Assets Listed in Inventory Filed with Court and simultaneously with this Account, valued as indicated therein (copy attached and incorporated herein as Exhibit 1) $90,837.79 TOTAL INVENTORY $90,837.79 DISBURSEMENTS OF PRINCIPAL Debts of Decedent Commonwealth of Pennsylvania, Dept, of Revenue, Inheritance Tax due in the amount of $4,569.04 on Certificate of Deposit, CCFNB No. 5000085243, paid September 14, 2004 Total Debts of Decedent Administration Expenses Myers-Harner Funeral Home Cumberland County Law Journal - advertise Letters Patriot News - advertising Letters Shuler Realty - lot rent Eshenaurs - propane and repairs PP&L - electric PA American Water - water Safe Auto - insurance payments Trinity Lutheran Church - columbarium Providian - VISA bill Mary Ann Klementik - mobile home maint. and funeral Larry's Auto Salon - clean and detail truck Kramer Brothers Glass - repair screens & windows Verizon - phone bill Bonnie K. Miller, Treasurer, real estate tax Commonwealth of PA - moblie home title PA Dept, of Revenue - income tax Postmaster - stamps Allied Roofing - net cost after insurance proceeds for mobile home roof repairs -3- $ 4,569,04 $ 4,569.04 $ 4,323.00 75.00 99.19 1,100.00 1,643.17 153.96 98.49 384.00 680.00 314.86 759.20 185.45 620.00 166.31 68.12 22.50 40.00 37.00 85,00 Mary Ann Klementik - reimbursement for miscellaneous administrative expenses Bob Ott - painting, mobile home PA Inheritance Taxes Register of Wills, Probate Fees Register of Wills, Filing fee for Account Total Administrative Expenses Fees and Commissions Meredith L. Moore, Administratrix Commission Daniel J. Clement, Esquire - Attorney's fee Total Fees and Commissions TOTAL DISBURSEMENTS OF PRINCIPAL RECEIPTS OF INCOME CCFNB - Interest on Certificate of Deposit Sovereign Bank - Interest through 3/13/05 Waypont Bank - Interest for 2004 Total Receipts of Income TOTAL INCOME AVAILABLE FOR DISTRIBUTION 150.00 470.00 5,386.42 150.00 130.00 $17,141.67 $ 4,500,00 2,500,00 $ 7,000.00 $28,710.71 $ 296.86 349.75 1,303.93 $ 1,950,54 $ 1,950.54 DISTRIBUTIONS OF PRINCIPAL AND INCOME TO BENEFICIARIES TOTAL PRINCIPAL AND INCOME AVAILABLE FOR DISTRIBUTION TO BENEFICIARIES A, B. Meredith L. Moore Ashley R. Moore PRINCIPAL BALANCE ON HAND Fees and costs to finalize estate settlement TOTAL PRINCIPAL RESERVE PRINCIPAL BALANCE ON HAND -4- $63,877,62 $31,938.81 $31,938,81 $ 200.00 200.00 $ 200.00 COMMONWEALTH OF PENNSYLVANIA UNION 58: COUNTY OF MEREDITH L, MOORE, Administratrix of the Estate of Barry L. Moore, Deceased, hereby declares under oath that she has fully and faithfully discharged the duties of her office; that the foregoing First and Final Account and the facts set forth in the Statement of Proposed Distribution are true and correct and fully discloses all significant transactions occurring during the accounting period; that all known claims against the Estate have been paid in full; that, to her knowledge, there are no claims now outstanding against the Estate; and that all taxes presently due from the Estate have been paid. lllli ((j)jj (c(' cI/i~ MEREDITH L, MOORE, Administratrix Sworn to and subscribed before me this 6th day of April , 2005, ~VJC~ ,f; ~ NOTARIAL. SEAI~ SUSAN G. STULL, NOTArw PUBLIC LEWISBURG BOROUCH COUNTY OF UNION MYCOMMISSIO;i ,XiiHlS W,V ;:4, 2007 ~._..,...--,.,.,~,~.,.- E8T\MOORE,ACC -5- IN RE: ESTATE OF BARRY L, MOORE, Late of Lower Allen Township, Cumberland County, Pennsylvania IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PA ORPHANS' COURT DIVISION NO. CERTIFICATION OF NOTICE Daniel J. Clement, Attorney for Meredith L. Moore, Administratrix of the Estate of Barry L. Moore, Deceased, verifies that written Notice by United States First Class Mail was given of the filing of the Account and Statement of Proposed Distribution to every unpaid claimant who has given written notice of his/her claim to the Administratrix and to every other person known to the Administratrix to have or claim an interest in the Estate as creditors, beneficiary, heir the written Notice is attached. or next of kin. A copy I understand that false statements herein are subject to the penalties of 18 Pa. C.S.A. ~4904 relating to unsworn falsification to authorities. , Clement, Esquire Attor y for Meredith L. Moore, Administratrix of the Estate of Barry L, Moore, Deceased Date: Lj.-'l-oS- -6- IN RE: ESTATE OF BARRY L, MoollE, Late of Lower Allen Township, Cumberland County, Pennsylvania IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PA ORPHANS' COURT DIVISION NO. 21-04-0013 NOTICE TO THE BENEFICIARIES OF THE ESTATE OF BARRY L. MOORE, DECEASED Meredith L. Moore, 22 Chiswick Road, Apt. 12, Brighton, MA 02135 Ashley R. Moore, 2112 Wentworth Drive, Camp Hill, PA 17011 Melody J. Moore, Guardian of the Estate of Ashley R, Moore, 2112 Wentworth Drive, Camp Hill, PA 17011 You are hereby notified that Meredith L, Moore, Administratrix of the Estate of Barry L. Moore, Deceased, has filed her First and Final Account and Statement of Proposed Distribution and verified inventories of all property of the estate of the deceased in the Office of the Clerk of the Orphans' Court Division of the Court of Common Pleas of the 9th Judicial District, Cumberland County, Pennsylvania, One Courthouse Square, Carlisle, Pennsylvania 17013- 3387. Copies of these documents are attached. If you object to any part of the Account or Statement of Proposed Distribution you must file objections by 8:30 a.m. on June 21, 2005. If no objections are filed on or before 8:30 a,m. on June 21, 2005, the Court may confirm the Account on June 21, 2005. You are warned that if no objections are filed, the Account will be confirmed and distribution will be made in accordance with the Schedule of Distribution. If you have any questions concerning -1- this Notice, you should Administratrix's attorney. . Date: April 8, 2005 contact the your attorney or Da el . Clement, Esquire Att n I.D, No, 10222 25 S. th Street PO Box 93 Lewisburg, PA 17837 (570) 524-2277 Attorney for Administratrix -2- REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY Estate of Barry L. Moore, Deceased No, 21-04-0013 Date of Death: December 29, 2003 Social Security No. 185-36-4615 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 of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I verify that the statements made in this Inventory are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities. Attorney: Daniel J. Clement, Esquire 25 S, 4th Street P,O. Box 93 Lewisburg, PA 17837 570-524-2277 I,D, No.: 10222 ( OILttd,i/{:R- J~tdcTl-L. Meredith L, Moore Administratrix of the Estate of Barry L. Moore, Deceased Date: 4/6/05 Description Value Waypoint Bank - Checking Account No. 0100674324 $ Waypoint Bank - Savings Account No. 8978017096 CCFNB - Checking Account No. 3000076216 CCFNB - Certificate of Deposit No, 5000096713 Guns 1988 Victorian Mobile Home (value based upon sale at fair market value in arms length transaction) VIN IV7514CK0212 1996 Ford Truck (value based upon sale at fair market value in arms length transaction) VIN 1FTCR10A9TT48214 Insurance Refund 168.37 393.73 1,228,15 73,460.00 1,450,00 12,000.00 2,000.00 13 7.54 Total $90,837.79 EXHIBIT A IN RE: ESTATE OF BARRY L. MOORE, Late of Lower Allen Township, Cumberland County, Pennsylvania IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PA ORPHANS' COURT DIVISION NO. STATEMENT OF PROPOSED DISTRIBUTION OF THE ESTATE OF BARRY L, MOORE, DECEASED FILED BY MEREDITH L. MOORE, Administratrix AND REQUEST FOR ORPHANS' COURT APPROVAL Meredith L. Moore, Administratrix, represents to the Court in regard to the distribution of the Estate of Barry L. Moore, Deceased, the following material facts and information, to wit: 1. Barry L, Moore died December 29, 2003. 2. The decedent died intestate and his daughter, Meredith L. Moore, was appointed Administratrix on January 6, 2004. 3. The granting of Letters of Administration was published in the Cumberland Law Journal on September 3, 10 and 17, 2004 and The Patriot News on August 17, 24 and 31, 2004. Proof of Publication is attached hereto and made a part hereof. 4. The decedent had no spouse at the time of his death, 5. The decedent died leaving to survive him as sole heirs and next of kin his two daughters, Meredith L. Moore and Ashley R. Moore. Ashley R. Moore, born May 2, 1991, is a minor, 6. Melody J. Moore of 2112 Wentworth Drive, Camp Hill, PA 17011, mother of Ashley R. Moore, was appointed sole guardian of the Estate of Ashley R. Moore on April 23, 2004 by Order of the -1- Cumberland County Court of Common Pleas, Orphans' Court No, 21-04- 356 [It is observed that the appointment of Melody J. Moore as the sole guardian fails to fully comply with the 20 Pa.C.S.A. ~5112(3), since Melody J. Moore is the mother of Ashley R. Moore who is eligible for appointment as guardian of the estate of her minor child only where a co-guardian is appointed] . 7. The Administratrix has completed her responsibility of administering the Estate and is ready to distribute the estate assets consisting of cash in the amount of $63,877,62, (after reserving $200 for future estate settlement expenses). The Administratrix proposed to distribute the estate assets in equal shares to the intestate heirs, namely Meredith L. Moore and Ashley R, Moore in the manner provided hereinbelow. 8. There are no unpaid credi tors from whom the Administratrix has received written or actual notice of a claim. 9. No charitable bequests are involved. 10. The decedent held no fiduciary capacity. 11. The Pennsylvania inheritance taxes have been paid in full. The Notice of Inheritance Tax Appraisement, Allowance or Disallowance of Deductions and Assessments of the Tax received from the Pennsylvania Department of Revenue is attached hereto. 12, The Estate is not subject to Federal Estate Tax. -2- 13. A reserve in the amount of $200 has been established for fees and costs to finalize the estate settlement and payment of the final expenses for preparing and filing the final fiduciary tax return. 14. This is the First and Final Account of the estate, 15. The Administratrix proposes to distribute the assets as indicated hereinabove, as follows: The amount of $31,938.81 directly to herself in cash and the share of her sister, Ashley R. Moore, to be deposited in a Certificate of Deposit with Pennsylvania Central Federal Credit Union in the name of Melody J. Moore, Guardian of the Estate of Ashley R. Moore, subject to the restriction to be noted on the records of said depository that no withdrawals may be made from such account until the minor Ashley R, Moore obtains the age of majority on May 2, 2009, except as authorized by prior Order of the Court, [Evidence of the marking of such account to indicate the restriction shall be promptly filed of record] . 16, It is requested in addition to authorizing distribution of the Estate assets as indicated hereinabove that Melody J. Moore, Guardian of the Estate and person of Ashley R. Moore, as above indicated, be authorized by the Court to execute and deliver to said Administratrix a Receipt and Release or other similar instrument conditioned on the deposit of the minor's share of the estate proceeds as indicated hereinabove, -3- IN WITNESS WHEREOF, Meredith L, Moore, Administratrix of the Estate of Barry L. Moore, Deceased, hereby requests your Honorable Court to approve the First and Final Account as stated and to decree confirmation and distribution of the Account in accordance therewith. GrrlAuL'ctt~ ce(\;t Lou~.9---- Meredith L, Moore, Administratrix of the Estate of Barry L, Moore, Deceased -4- . THE PATRIOT NEWS THE SUNDAY PATRIOT NEWS Proof of Publication Under Act No. 587, Approved May 16, 1929 Commonwealth of Pennsylvania, County of Dauphin} ss Joseph A. Dennison, being duly swom according to law, deposes and says: That he is the Assistant Controller of The Patriot News Co., a corporation organized and existing under the laws of the Commonwealth of Pennsylvania, with its principal office and place of business at 812 to 818 Market Street, in the City of Harrisburg, County of Dauphin, State of Pennsylvania, owner and publisher of The Patriot- News and The Sunday Patriot-News newspapers of general circulation, printed and published at 812 to 818 Market Street, in the City, County and State aforesaid; that The Patriot,News and The Sunday Patriot-News were established March 4th, 1854, and September 18th, 1949, respectively, and aU have been continuously published ever since; That the printed notice or publication which is securely attached hereto is exactly as printed and published in their regular daily and/or Sunday! Metro editions which appeared on the 17th, 24th and 31st day(s) of August 2004. That neither he nor said Company is interested in the subject matter of said printed notice or advertising, and that all of the allegations of this statement as to the time, place and character of publication arc true; and That he has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed and adopted severally by the stockholders and board of directors of the said Company and subsequently duly recorded in the office for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book "M", Volume 14, Page 317. COpy OTARYPUBLIC 'ssion expires June 6, 2006 PUBLICATION InI,tratlcm tor the ..tate 0' ! late 'of Lower Allen Town- I County, Pennsylvania, IthL.fMOn".Tlm. bel" VI.. DrlMeChanlc:abUrv. f'A 17050. An'tOM haYl lust claims agalntt the ... tate shoUld- t them, duly authenticat- ed. to the Admlnl,tratorwlthDutdelGV, MEREDITH MORRE 1288 TIMER VIEW DRIVE MECHANICSBURG, PA. 17050 Statement of Advertising Costs To THE PATRIOT-NEWS CO. For publishing the notice or publication attached hereto on the above stated dates 99.19 Publisher's Receipt for Advertising Cost The Patriot News Co., publisher of The Patriot-News and The Sunday Patriot-News, newspapers of general circulation, hereby acknowledge receipt of the aforesaid notice and publication costs and certifies that the same have been duly paid. By.................................................................... PROOF OF PUBLICA'IION OF NOTICE IN ClJIVIBERI.AND I.A W JOURNAL (Under Act 1'0.537, "pproved May 16,1929), P. L.1784 STATE OF PEN]\'SYLVANIA : ss. COUNTY OF CUMBERLAND : Lisa Marie Coyne, Esquire. Editor orthe ('umberland Law Journal, of the County and State aforesaid, bClI1g duly sworn, according to law. deposes and says that the Cumberland Law JoulIlal, a legal "cl'lllclical published in t!,e !Jor'll'J ,,''Carlisle in the County and State aforesaid, was established J"nuary 2,1952. "nd designated by the local courts as the official legal periodical for the publication of "II legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Jout"nal on the j()llowing dates, v\z: SEPTEMBER 3,10,17,2004 Affiant further deposes tll"t he is 'lUthorized III verify this statement by the Cumberland Law Journal, a legal periodical of general circulat;,.n. and that he is not interested in the subject matter of the allll'c",id notice or advertisement, and that all allegations in the foregoing statements as to time, place and character orpublic"tion are true. Moore, Barry L.. dee'd. Late of the Township of Lower Allen. Administratrix: Meredith L. Moore, 1288 TImber View Dlive, Mechan- icsburg. PA 17050. Attomey: Daniel J. Clement. Es- quire. 25 South Fourth Street, Lewlsburg. PA 17837. SW 1''10 AND SUBSCRIBED before me this ---11_dayof SEPTEMBER 2004 N SEAL LOIS E. SNYDER. Notary Public Carlisle Bora, Cumberland County My Commission Expires March 5, 2005 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU QF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG~ PA 17128-0601 NDTICE DF INHERITANCE TAX APPRAISENENT, ALLDWANCE DR DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX DANIEL J CLEMENT ESQ D J CLEMENT LAW OFFICE PO BOX 93 LEWISBURG PA 17837 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 12-06-2004 MOORE 12-29-2003 21 04-0013 CUMBERLAND 101 Amount Re..itt.d .. IEV-l!;nniFPID,.a41 BARRY L MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-,;:is4-j-EX--AFP--riiFciin:jiiYicE--OF-iNiiEififAiicrTAX-j("pjiRj("isEi"-iNT~--ALroMAiicE-iiR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MOORE BARRY L FILE NO. 21 04-0013 ACN 101 DATE 12-06-2004 TAX RETURN WAS: (X I ACCEPTED AS FILED I CHANGED I~ an assessment was issued previously, lines 14, 15 and,or 16, 17, 18 and 19 will reflect ~igures thet include the tote1 of abb returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rat. (15) 16. Allount of Line 14 taxable at Lineal/Class A rat. (16) 17. hount of Line 14 af Sibling rat. (17) 18. Amount of Line 14 taxable at Collateral/Class Brat. (18) 19. Prlnclpal Tax Due RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..l Est.t. (Schedul. A) 2. Stocks and Bonds (Schedul. B) 3. Closely Held stock/Partnership Interest (Schedule CJ 4. "artgas-s/Nates Receivable (Schedule DJ 5. Cash/Bank Deposits/"lsc. Personal Property (Schedule E) 6. ~olntly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets III 121 (31 (41 (51 (61 (7) .00 .00 .00 .00 90.837,79 .00 52,244.71 (81 APPROVED DEDUCTIONS AND EXEMPT~ONS: 9. Funeral Expenses/Ad.. Costs/"isc. Expenses (Schedule H) 10. Dobts/Hortgage Liebilities/Liens (Schedule II 11. Total Deductions 12. Net Value of Tex Return 13. Charltable/GoYer~entel Bequests; Non-elected 9113 Trusts (Schedule ~) 14. Net Value of Estata Subject to Tex (91 1101 18,815.25 4.569.04 (111 1121 1131 1141 NOTE: .00 119,698.21 .00 .00 X 00 = X 045 = X 12 = X 15 = 1191= DATE 09-14-2004 INTEREST/PEN PAID (-I ,00 AHOUNT PAID 5,386.42 NUHBER CD004396 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST, NOTE: To insure proper credit to your account, sub.it the upper portlon , of this for.. with your tax payltent. 143,082.50 23.384 79 119,698.21 .00 119,698.21 .00 5,386.42 .00 .00 5,386.42 5,386.42 .00 .00 .00 IF TOTAL DUE IS LESS THAN 01, NO PAYftENT IS REQUIRED. IF TDTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU NAY BE DUE A REFUND, SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.I REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY Estate of Barry L, Moore, Deceased No. 21-04-0013 Date of Death: December 29, 2003 Social Security No, 185-36-4615 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 of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I verify that the statements made in this Inventory are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification to authorities. Attorney: Daniel J. Clement, Esquire 25 S, 4th Street P.O, Box 93 Lewisburg, PA 17837 570,524-2277 I.D. No.: 10222 , ilU<<.tlac..:-R j/!t~c~ Meredith L. Moore Administratrix of the Estate of Barry L. Moore, Deceased Date: 4/6/05 Description Value Waypoint Bank - Checking Account No. 0100674324 $ Waypoint Bank - Savings Account No. 8978017096 CCFNB - Checking Account No. 3000076216 CCFNB - Certificate of Deposit No. 5000096713 Guns 1988 Victorian Mobile Home (value based upon sale at (~ fair market value in arms length transaction) VIN IV7514CK0212 1996 Ford Truck (value based upon sale at fair .market value in arms length transaction) VIN IFTCRI0A9TT48214 ~nsurance Refund 168,37 393.73 1,228.15 73,460.00 1,450,00 12,000.00 2,000.00 13 7.54 Total $90,837.79 '~"'BbV certify thai written nolice of lIle filing 01 ,iI;S Ar..<:ount, and of the date. time and place .~er; the same will be preeeoted 10 \he Court " confirmation and of \he \BIt day to lIIe written ,Bctlons to satd Aooounl, hM been given to .." ulpaid claim8fll and to avety other pelson ";" .,0 to \he accounliBflllo have or cleim an " ",; ;1" :\;a es\ate '*' Cl'OOltor. benali!:iIlry, "~~( nf io:in. 0 P>H 'i ~OOO ~ ..... rT 0 o~oc:: o t:H/l "I <Q 'i (D , 'tl3:3: ":IH0-3H ~ ..... 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'tl ~, _00''1;. ..'tl~8 - 0 -.0 -.oc ::r.:;,~ 0. - .f.~g> no.:! ..::r"':;- ::r!.:~ e,o..! ~--. , *) '"-, Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 11/15/2005 MOORE MEREDITH L 1288 TIMBERVIEW DRIVE MECHANICSBURG, PA 17050 RE: Estate of MOORE BARRY L File Number: 2004-00013 Dear Sir/Madam: It has corne to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 12/29/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~~ ,_/ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge ll. Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 BARRY L. MOORE Name of Decedent: December 29, 2003 Date of Death: Estate No.: 21-04-0013 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: I. State whether administration of the estate is complete: Yes QU No 0 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 0 b. The separate OfP.hans' Court No. (if any) for the personal representative's account is: 'N7 A c. Did the personal representative state an account informally to the parties in interest? Yes 0 No IE c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached ~o this report. Date: 12-8-05 ~ \ (. Daniel J. Clement Name -. (7) 25 South 4th Street Lewisburq. PA 17837 Address 570 524-2277 Telephone No. c,.') I Capacity: 0 Personal Representative [l Counsel for personal representative (-,,' ~t LAW OFFICES OF DANIEL J. CLEMENT 25 SOUTH FOURTH STREET P.O. BOX 93 LEWISBURG, PENNSYLVANIA 17837 (570) 524-2277 FAX: (570) 523-6247 December 8, 2005 Ms. Glenda Farner Strasbaugh Cumberland County - Register of Wills One Courthouse Square Carlisle, PA 17013 In re: Estate of MOORE BARRY L. File Number: 2004-00013 Dear Ms. Strasbaugh: On behalf of the personal representation in the above estate, we are submitting herewith the Rule 6.12 Status Report as required by the Orphan Court Rules. Should you have any questions, do not hesitate to call. Very truly yours, D DJC/cwl Enclosure --;- VJ I; (, ::'1 I, r~ , ' :lr-- ,',',1.. ' " ,~'.( . :""J .