HomeMy WebLinkAbout02-0071PETITION FOR PROBATE and GRANT OF LETTERS.
Estate of' ~ ,~c~o .<, [__. ,~ ~; ~-k~ No.
also known iff ~' ' - To:
Deceased.
Social Security No. I (c, 0 - ! ~ - ~. I_~'_(~5
21-01-71
Register of Wills for the
County of
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age
in the las[ will of the above decedent, dated (.~ c_..--I-_ c-~
and codicil(s) dated
in the
named
,19
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in (x. ¢, na ~ oc- [0~_?.,~. County, Pennsylvania, with
h ,~-- last familv or principal residence at ~ ~ ~~ V: ~ I~
....... ~- ~ ~ ,,,/ ...... / ~ I I ~'-
~ ~ ~ ' ;r. (list street, number and muncip~ty)
Decendent, then ~~5<years of age, died .~ ~ ~ ~ ~ ~ I I ,~ ,
Except as follows, {eceden~d~ n°~ marry, was not divorced and did not ha~e a child born or adopted
after execution of the ~ill ~[f~re~ for probate; was not the victim of a killing and was never adjudicated
incompetent: .....
Decendent at death own.ed:property with estimated values as follows:
(If domiciled in Pa.) . <". '.: All personal property $
(If not domicil(d in-Pa.):. Personal property in Pennsylvania $
(If not domiciled in Pa.) Per'sonal property in County $
Value of real estate in Pennsylvania. $
situated as follows: I~q/~
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters ~ ~_~'-%-~ ~ ,~ ~,, _4x--~_.-~,
(testamentary; administration c.'t~a.; administration d.b.n.c.t.a.)
theron.
OATH OF' PERSONAL REPRESENTATIVE
COMMONWEAl, TH OF PENNSYLVANIA
COUNTY OF (.d,u rc,,b,~-- ~o_r,,=~ . f
.... '> ~- Z '~ r, /,, · .....
The petmoger(~J, abovevnamed swear(s) or affirm(s) that the statements ~n the foregmng pem~on are
true and c~ffecv'(o~th6 be~.' oUtfie knowledge and belief of petitioner(s) and that as personal represen-
f&tive(s) of ih(.aS¥~e de~ed~nt'~e[itioner(s) will well' and truly administer the estate according to law.
Sworn to 'or. 'affirmed and-subscribed
before me this _ 22nd __~_1__ day of
.d , 1 x2OO2
No. 21501-71
Estate Of AGNES ~. m4ZTU , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW JANUARY 23 :~p200~., in consideration of fi',~e petitiou on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED.that the instrument(s) dated OCTOBER 30, 1998
described therein be admitted to probate and filed of record as the last will of
AGNES L SMITH ;
and Letters TESTAMENTARY
are hereby granted to JOAN L MOSS
FEES
Probate, Letters, Etc .......... $ 80.00
Short Certificates( ) ...' ....... $ 24.00
12.00
~gnPua~s.
nmauon ................ $
JCP $ 5. O0
TOTAL__ $ 121.00
Filed ...J..AN.....2.2.,...299.2. .... · .............
ATTORNEY (Sup. Ct. I.D. No.i
ADDRESS
PHONE
105.805 REV 9/86
O~i ~nal~ ceruficate~wdl
this ~.. . ~, .~
-" 5:' -. , ,...,
'":'~"'" "' "~':'~"' '":~' ;'l>-. :'" '" :"%'"':: ~ '~: ~;''''~!'' ~'''?:~:':
-:,./,,,.f' :,., ~. '~.,,? ;?.:...- ,,
'. .' .... ~ ",.::..:! :'. ,%......-:,<.
, ;..~ , .,..:,~,e.T~: /,~. :Date , .,··., . . -
· . ., : .., < . ~,;:' -2~-,~· -~,,,.,,'. , ,...- .,?. ..
%.,: ., ,-:/ : ~ , .~,,, ,,. , ,,~ ,~. ~: , ? ....
..~:.: ...... :..~,5,~.-~-:~>=5~,~:.:= ........ ,,?US. 5.:~5:&--.-':-:---;~~..-.-~.~ ,b ~ gzy. ~,.,< :5%.; , r, 5'~-~.' X;'-'," ",,,~'-~,:¥: ':' .~-':-; .. ,' '~ >&c.'. :.' , '
R~v:: ~/17~: .... ~ .~,~ %,.:....,;:'-,Z .,~: KL.~/.'-,,>:....- : COMMONWEALTH OF;PENNSYLVANIA ~ DEPARTMENT OFHEALTH ~*~ VITAL RECORDS ~':'"q' '
::, ..... ~:< , ,: '~ · .... '~.- ',~ · 'v' -',~ .~: ,~" CERTIFICATE~,OF DEATH ~ ~ ... ~. ~: -~:. ~,',
:~.:.- · ~ .-'..~ '.? ~.:~.. ~'.. . .~. 5.' :.. <./ ~'.. , ~.~ ..' · x,. '~:.: ..... :'.~.~' .'. ~. ·'. .. . ' ~,~ .~'~ ':.
~z:. ..~ ':~ CITY. 8OFIO. I~4POFOEATH x. '~A~ll. IT~NAME(llnot,ns~.l~*~.~veslteelanglnt~nl~e~ .~ ,~'<'- .~ -~/' ..~.D~CEDENTOFHI~..ANICO~IGIN? RACE-AmIn~l~lndial~81ick. Wl'dll.~.
,. , , II. '-/,. ~,
D~CEO~NT'8 USUAL OCCUlt/ION ~, >
""' ~"~"',erator"' :' "":.,..:..,.. ~ ,,,' ....... ~ >:::.';. ~/)';':.':',-~ '"~rT:'~'m;.'.,.,. ,., '~ ~'- -~"~- '~"'"" ~", _ , '."~'" ,::.iii'~ ..,-W~dov'.':
~C~'*M~U, aAOO~SSe*,,tC,~Z~Co~,-.D~¢eo~,rs,' ' ':' '" ~ ~ ' '"~ '<> ..... ~" =' ..... ~' U~6e~ Allen ':-'
~ecban±c'~bu~§~ ~1.7055 .'~ ,,.'::~s~ ~.~ , .*'. ':.:.> :.~..." '"..~c>,:/5 ~.. '"~,~, "~?.. :,% .~:,~ .... ..... .~ '
~,::. -. .., .' .' :;. ~oan'.,,.~,,.Mo$$ ,? '.? >,. :: ' ,.." ,.5:', ,- ...,.- ~ ~: .62~2 North ~/ghlands:C±rcl'e~ PA
~-m°°°~c'~,L~:"~:' :..,: ~ ,>:% . ~ ~·<:-~ : "' Im~E~m~om~o, '.: % ,,, ~ I~c~ms~o~m,-,~,,~c~.c,,,~m~ ¥ Itoc~no,-c~.~,.~c~ . ,,
~i~ ca/'U ~a~I~.~'~m'l I ~l~~s :"~ ~' * "1~ ',?,r. '~' ..... ' ' '1 "' ~ ..... ~' "
.... . .... . ..... , ,, ,. ........ . .......... ,..,,
o~.~ ........ E] '~'/"'J~n ' " :>'"' ' ' ~ .... "' '
' "' ' ..... I*~::' uar¥, 1,5,--' 2002· ..~:-..,~, Shoop $ Cemetery ~.~,ii~'~arrtsburg, PA 17109
Name of Decedent:
Date of Death:
Will No.
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Admin. No.
To the Register:
of the Orpyns' Court Rules was
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a)
served on or mailed to the following beneficiaries of the above-captioned estate on
Name Address.
Notice has now been given to all persons entitled theg~tp under Rule_5.6(~,! except ~ r~ ~--~
Date: ,/a? ea?O 0 ~/, /
Signature
Name ,. ~ r~ c;, e,, L....~3. o~-'~
· .tO. !ii ~ Telephone (71~) ea~'. L/~,,~--- <~ t.~,~..
.... '.~ f3 ,. ,,~-. , ~Capacity: ersonal Representative
...... ~ o~ ~ .... ,.,~'t: ........... ' ..... ' ...... ,
........... ~.,~ ....... ~ ...... ~,_~ ............................................... Counsel for ~ersonal represen[ative
21-02-71
LAST WILL AND. TESTAMENT
OF
AGNES L. SMITH
I, AGNES L. SMITH, presently residing in Mechanicsburg, Cumberland County,
Pennsylvania, being of sound and disposing mind and memory, do make publish and declare this
to be my Last Will and testament, hereby revoking all Wills and Codicils previously made by
me.
ITEM I: I direct that all inheritance and estate taxes becoming due by reason of my
death, whether such taxes maybe payable by my estate or by any recipient of any property, shall
be paid by my Executor'out of the property passing under this Will, which is not specifically
devised or bequeathed, as an expense and cost of administration of my estate. My Executor shall
have no duty or obligation to obtain reimbursement for any such tax paid by my Executor even
though Such tax was paid on proceeds of insurance or other property not passing under this Will.
If the assets not specifically devised or bequeathed are not adequate for the payment of all such
taxes, then the recipients of the property specifically devised and bequeathed shall each pay a pro
rata portion of any such tax based upon the valuation of the property received by each such
recipient as finally determined for Federal Estate Tax purposes, or if no such determination is
made, then for applicable State Inheritance Tax purposes.
ITEM II: I hereby exercise all powers of appointment which I may have at the time of
my death in favor of my Executor, and all property subject to all such powers of appointment
shall be included in my estate.
ITEM III: I hereby give, devise and bequeath my entire estate, whether real, personal or
mixed, of whatsoever nature or kind and wherever located, unto the following individuals:
a) I give, devise and bequeath forty-two (42%) percent of my estate unto my niece, Joan
L. Moss.
Page 1 of 4
b) I give, devise and bequeath forty-two (42%) percent of my estate unto my brother-in-
law, Frank A. Smith.
c) I give, devise and bequeath eight (8%) percent of my estate unto my niece, Patricia
Morris.
d) I give, devise and bequeath eight (8%) percent of my estate unto Clair Tritt.
In the event that any of the foregoing beneficiaries predeceases me, then the share which
that deceased beneficiary would have received hereunder shall lapse, and the proceeds of that
share shall be distributed among my remaining beneficiaries in the same relative proportion they
would otherwise have received under this Will.
ITEM IV: In addition to such other powers as my Executor may be granted by law, or
under previous portions of this Will, he shall have tl~e following powers:
a) To retain investments I may have at my death so long as my Executor may deem it
advisable to my estate to d° so.
b) To vary investments, when deemed desirable by my Executor, then to invest in such
bonds, stocks, notes, real estate mortgages, or other securities, or in such other
property, t~al or personal, as he shall deem wise, without being restricted to so-called
"legal investments."
c) In order to effect a division of the principal of my estate or for any other purpose,
including any final distribution, my Executor is authorized to make said divisions or
distributions of the personalty ~nd realty partly or wholly in kind. If such division or
distribution is made in kind, said assets are required to be divided or distributed at
their respective values on the date or dates of their division or distribution.
d) To sell either at public or private sale and upon such terms and conditions as the
Executor may deem advantageous to the estate, any or all real or personal estate or
interest therein owned by the estate severally or in conjunction with other persons or
Page 2 of 4
acquired after my death by my Executor, and to consummate said sale or sales by
sufficient deeds or other instruments to the purchaser or purchasers, conveying a fee
simple title, free and clear of all trusts and without obligation or liability of the
purchaser or purchasers to see to the application of the purchase money or to make
inquiry into the validity of said sale or sales; also, to make, execute, acknowledge and
deliver any and all deeds, assignments, options or other writings which may be
necessary or desirable in carrying out any of the powers conferred upon my Executor
in this paragraph or elsewhere in my Will.
e) To mortgage real estate, and to make leases of real estate.
f) To borrow money from any party, to pay indebtedness of mine or of my estate,
expenses of administration or inheritance, legacy, estate and other taxes.
g) To pay all costs, taxes, expenses and charges in connection with the administration of
my estate. My Executor shall pay the expenses of my last illness and all funeral
expenses.
h) To vote any shares of stock which form a part of the estate, and to otherwise exercise
all the powers incident to the ownership of such stock.
i) In the discretion of my Executor, to unite with other owners of similar property in
carrying out any plans for the reorganization of any corporation or company whose
securities form a part of the estate.
ITEM V: Anything in this Will to the contrary nOtwithstanding, any beneficiary under
this Will may, at any time and from time to time, release, renounce, or disclaim, in whole or in
part, or otherwise limit any power or interest granted to such beneficiary under this Will, by
written instrument,' duly signed, acknowledged before a Notary Public and filed with my
Executor. Such instrument need not take effect immediately and may be contingent upon the
occurrence or nonoccurrence of any event.
Page 3 of 4
In addition, my Executor serving hereunder at any time may in like manner release,
renounce or disclaim, in whole or in part, or otherwise limit any power granted to such fiduciary
hereunder.
ITEM VI: I hereby nominate, constitute and appoint my nice, JOAN L. MOSS, to be the
Executrix of this my Last Will and Testament. In the event of her death, resignation, refusal or
inability to serve, I nominate, constitute and appoint my brother-in-law, FRANK A. SMITH, to
be the Executor of this my Last Will and Testament. My Executor is specifically relieved from
the duty or obligation of the filing of any bond or bonds in this or any other jurisdiction. My
Executor shall receive reasonable compensation for services rendered to my estate.
JTEM VII: Where appropriate throughout this my Last Will and Testament, all
references herein to the singular or the masculine shall include the plural or the feminine,
respectively.
IN WITNESS WHEREOF, I' have hereunto set my hand and seal to this my Last Will and
Testament, consisting of this page and the preceding three (3) pages, this ~qD ~ day of
,1998..
AGNES ~. SMITH, TESTATRIX
We the undersigned, hereby certify that the foregoing Will was Signed, sealed,
published and declared by the above-named Testatrix, as and for her Last Will and Testament, in
the presence of us, who, at her request and in her presence and in the presence of each other,
have hereunto set our hands and seals the day and year above written, and we certify that at the
time of the execution thereof, the said Testatrix was of sound and disposing mind and memory.
~,po~,,q"c_ "~/~,,d/-~ (SEAL) Residing at
~)'~_/L4 _d'~m (SEAL) Residing at
Page4of4 ~ ( '
COMMONWEALTH OF PENNSYLVANIA :
SS:
COUNTY OF CUMBERLAND
'~'~ "')~/TI n~ ~V'7 ,the Testatrix and/the witnesses, respectively, whose
names~are s~ed to tile-attached or foregoing instrument, being first duly sworn, do hereby
declare to the undersigned authority that the Testatrix signed and executed the instrument as her
Last Will, and that she had signed willingly and that she executed it as her free and voluntary act
for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of
the Testatrix, signed the Will as witnesses and that to the best of their .knowledge the Testatrix
was at that time eighteen years of age or older, of sound mind and under no constraint or undue
influence.
Subscribed, sworn to and acknowledged b~fore me by AGNES L. SMITH,
Testat.ri~, and subscribed and sworn to before me oy
~)~"~ ~ "-)")q'~ ~ ,witnesses, ~ ~--~
1998 t- -..7/
N a6~Public
My Commission Expires:
Notarial Seal
Karen M. Turner, Notary Public
Upper Allen Twp., CumberJa~d County
My Commission Expires May 29, 2000
Member, Pennsylvania Association of Notaries
and
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 00104O
MOSS JOAN L
6242 N HIGHLANDS CIRCLE
HARRISBURG, PA 17111
........ fold
ESTATE INFORMATION: SSN: 160-16-7150
FILE NUMBER: 2102-0071
DECEDENT NAME: SMITH AGNES L
DATE OF PAYMENT: 04/05/2002
POSTMARK DATE: 04/04/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 01 / 11/2002
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $4,500.00
TOTAL AMOUNT PAID:
$4,500.00
REMARKS: JOAN LMOSS
CHECK//108
SEAL
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
COMMONWEALTH O~= PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
CD
REV-1162 EX(11-96)
OO17O5
JAMES D HUGHES ESQUIRE
WEST POIVIFRET PROFESSIONAL BLDG
60 WEST POMFRET STREET
CARLISLE, PA 17013
........ fold
ESTATE INFORMATION: SSN: 160-16-7150
FILE NUMBER: 2102-0071
DECEDENT NAME: SMITH AGNES L
DATE OF PAYMENT: 10/09/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 01/11/2002
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $2,328.90
TOTAL AMOUNT PAID:
$2,328.90
REMARKS: JOAN LMOSS
C/O JAMES D HUGHES ESQUIRE
SEAL
CHECK# 11 6
INITIALS: SK
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
!nvento[y of the real and personal estate of
AGNES L. SMITH
deceased
1. 19 Shares Met-Life Inc. - Common Stock traded NYSE ........... ? .
2. Waypoint Bank- Certificate #18800004965 .... ..............
3. Waypoint Bank - Checking #1800033019 ....... ~ ........... ·
4. Capital Blue'.]Cross - Premium Refund ' '
5. Capital Blue Cross -JSecurity 65'Benefits
6. Conseco Direct'Life I~s. C°. - Refund ........ ~ ....... ....
7. Keystone InsuranceCompany - Hospital Indemnity ·
8. LoYal American Life Insurance Company - Premium Refund ..... .
9. Messiah Village - Storage Expense Refund. ' ' ~'"~ ''[ '~:'/''~':~ ~ "" '.' "
10. Miscellaneous Personal Property ......................
11. Verizon - Credit BalanCe Refund .......................
12. Washington National InsUrance - Premium Refund. ·
TOTAL ...................
574 94
30,028 36
8,146 32
334 10
890 30
144 8~
800 O0
28 34
170 00
500 00
4 13
36 75
41,658 11
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND ·
Joan L. Moss
'being' duly· swortt accordlng'to la~,, deposes ~nd Jays tl~af she ~ is: the :EXec~fz~ix ':' ' '
* of the Estate of Agnes L. Smith
late o,f * U~p_e~ Alien Township ~ , Cumberland County, Pa., deceased and ~ha~ fha
within is' an in~enf~'ry*m~d~ by Joan L. Moss ~* , ~he sald~ Executrix
of the entire estate of said decedent, cons;stUn9 of ell +he personal property and real estate, except real estate outside
~he Commonwealth of P~nhsylvanJa, end that the figures oppos;fe~each item of fh~ Inventory represent ~f's fe~r value
es of the dele of decedenf's death.
Sworn and subscribed before me,
thi~h ¢9~y of,~to~r, 2;02.
My, Commission ~plms A~ 14,
... ~r, Penn~Ja~ot~m~es
Date of Death ~ L1
Joan L. Moss,' ExecUtrix
6242 North Highlands Circle
Harrisburg, PA 17111
Address
, O1 ..... "~ " 2002 '-
See Article Iy, Fiduciaries Act of 1949.
Day Month Year
INSTRUCTIONS
I. An inventory imust be ~iled ~iihln three months after appoMfmenf of personal representative.
2. A supplement inventory must be filed within thlrty days of d~scovery of additional assets.
3. Additional sheets may. be aHached es..to personalty or realty
4.
0
>.
'X~ REV- 1500 EX + (6-00)
D
E
C
E
D
E
N
T
CAPB
HpRL
EplO
c~AC
~TK
"-ES
T
I
0
N
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV- 1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL/
Smith A~nes L.
DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR)
01/11/2002 J 05/04/1912
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
OFFICIAL USE ONLY
/7'-
FILE NUMBER
21-02-071
COUNTYCODE YEAR NUMBER
SOCIAL SECURITY NUMBER
160-16- 7150
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
1. Original Return U 2. Supplemental Return
4. Limited Estate ~ 48. Future lnterest Compromise (date of death after 12-12-82)
6. Decedent Died Testate 7. Decedent Maintained a Living Trust
(Attach copy of Will) (Attach copy of Trust)
[--~9. Litigation Proceeds Received I I Spousal Poverty Credit
10.
(date of death between 12-31-91 and 1-1-95)
(date of death
3. Remainder Return prior to 12-13-82)
,~. Federal Estate Tax Return Required
0 6. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach Sch O)
NAME
James D. Hu~hes., ~squire
'FIRM NAME (If Applicable)
IRWIN McKNIGHT & HUGHES
TELEPHONE NUMBER
717./249-2353 ·
COMPLETE MAILING ADDRESS
60 West Pomfret Street
West Pomfret Professional Bldg.
Carlisle, PA 17013
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or (3)
Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
~ 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)
13.
14.
None
574.94
None-)
41,083.~7
17,863
4,635.15
7,781.30
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13)
(8)
(11)
(12)
(13).
(14)
OFFICIAL USE ONLY
59,521.39
12,416.45
47,104.94
47,104.94
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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
0.00 X .0 0 '(15) 0.00
0.00 X .0 45 (16) 0.00
0.00 X .12 (17) 0.00
47,104.94 X .15 (18) 7,065.74
(19) 7,065.74
copyrigl~t (c) 2000 form software only T he Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
Messiah Village
100 Mt. Allen Drive
CITY
Mechanicsbur~
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
4,500.00
236.84
Interest/Penalty if applicable D. Interest
E. Penalty
STATE I ZIP
PA 17055
(1) 7,065.74
Total Credits ( A + B + C ) (2)
4,736.84
0.00
0.00
2,328.90
0.00
2,328.90
Total Interes[/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. . (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB)
Make Check Payable tO: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
~. retain the use or income of the property transferred;
· retain the right to designate who shall use the property transferred or its income; ...........
c. retain a reversionary interest; or ....................................
d. receive the promise for life of either payments, benefits or care? ........
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .................................
3. Did decedent own an "in trust for" or payable upon death bank account or security at his
or her death? ..............................................
4. 'Did de~:edent own an Individual Retirement Account, annuity, or other non-probate property
which contains a beneficiary designation? ................................ [----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.
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.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ~Toan L. Moss DATE
~,~,,~.../ ~. ~//)Z~'~-'" 6242 N Hi hlands Circle
.......... ; .... ~! .......... /c~L/o,4.
Harrisburg, PA 171:1-1- ........................
SIGN~ THAN "£PR£SENTATIVE. 60IRWINwestMCKNIGHT &porn fret StreetHUGHES
---~l-f; i~-;- ~k---i¥-di§ ...........................
Fot~lates of de~h0n 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 ' '
For d'ate~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. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets
and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (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. 9116(1.2)
[72 P.S. 9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(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.
Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
REV- 1503 EX + (.1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE B
STOCKS 8, BONDS
Asnes L. Smith SS# 160-16-7150 01/11/2002
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
FILE NUMBER
21-02-071
ITEM VALUE AT DATE
NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 19 shares Met-Life Inc., common stock traded NYSE 30.26 574.94
TOTAL (Also enter on line 2, Recapitulation) 574.94
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. ,'
Form REV-1503 EX (Rev. 1-97)
REV- 1508 EX + (1-97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
A~nes L. Smith SS# 160-16-7150 01/11/2002 21-02-071
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1
2
3
4
5
6
7
8
9
10
11
Waypoint Bank - certificate #18800004965
Waypoint Bank - checking #1800033019
CapiCal Blue Cross - premium refund
Capital Blue Cross - Security 65 benefits
Conseco Direct Life Ins. Co.
Keystone Insurance Company
Loyal American Life Ins. Co.
- refund
hospital'indemnity
- premium refund
Messiah Village - storage expense refund
Miscellaneous personal property
Verizon - credit balance refund
Washington National Insurance - premium refund
30,028.36
8,146.32
334.10
890.30
144.87
800.00
28.34
170.00
5OO.O0
4.13
36.75
TOTAL (Also enter on line 5, Recapitulation) $ 41,083.17
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97)
REV-1509 EX + (1-97)
' SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Agnes L. Smith SS~/ 160-16-7150 01/11/2002
FILE NUMBER
21-02-071
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 ADDRESS RELATIONSHIP TO DECEDENT
A.Joan L. Moss Niece
6242 N. Highlands Circle
Harrisburg, PA 17111
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
include name of financial institution and bank DATE OF DEATH DECD'S VALUE OF
ITEM :OR JOINT MADE account number or similar identifying number.
NUMBER TENANT JOINT Attachdeed for jointly-held realestate. VALUE OF ASSET INTEREST DECEDENT'S INTERE~
1 A 03/28/78 ~llfirst Financial Center 11,419.24 50.00% 5,709.62
NA - relationship checking
w/interest ~0079602339
2 A 04/26/00 Waypoint Bank - savings 24,307.32 50.00% 12,153.66
tJ1860010371
TOTAL (Also enter on line 6, Recapitulation) $ 17,863.28
(If more space is needed insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1509 EX (Rev. 1-97)
REV-1510 EX+ (1-97) SCHEDULE G
INTER-VIVOS TRANSFERS &
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERT~
RESIDENT DECEDENT
ESTATE OF
Agnes L. Smith SS# 160-16-7150 01/11/2002
FILE NUMBER
21-02-071
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
DESCRIPTION OF PROPERTY % OF
ITEM INCLUDE THE NAME OF THE TRANSFEREE THEIR DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE'
RELAT ONSH PTO DECEDENT AND THE DATE OF TRANSFER.
NUMBER ATTACH A COPYOF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST 0F APPLICABLE)
1 Dottie Williams, friend - 45.00 100.00% 45.00 0.00
gift of personal property
2 Frank Smith, brother-in-law 167.00 100.00~ 167.00 0.00
gift of personal property
3 Jennifer Faiola, friend - '10.00 100.00% 10.00 0.00
gift of personal property
4 Joan Moss, niece - gift of 270.00 100.00% 270.00 0.00
personal property
5 Joel High, friend - gift of 10.00 100.00% 10.0£ 0.00
personal property
6 Patsy Morris, friend - gift 50.00 100.00% 50.0C 0.00
of personal property
7 Patty Roland, friend - 20.00 100.00% 20.00 0.00
gifts of personal property
8 Stephanie McClune, friend - 20.00 100.00% 20.00 0.00
gift of personal property
TOTAL(Alsoenteronline7, Recapitulation) $ 0.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1510 EX (Rev. 1-97)
REV-1511 EX + (1-97)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
A~nes L. Smith SS~/ 160-16-7150 01/11/2002 21-02-071
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
1
2
3
4
FUNERAL EXPENSES:
Zimmerman Auer Funeral Home
Zimmerman Auer Funeral Home -
inscription
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) Joan L. Moss
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address 6242 N. Highlands Circle
City Harrisbur~ State PA
Zip l7111
Year(s) Commission Paid:
2002
Attorney's Fees IRWIN McKNIGHT & HUGHES
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
Probate Fees Register of Wills
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
Cumberland Law Journal
Register of Wills
The Sentinel
Vital Records
estate notice
- filing fees
publication
Legal estate notice publication
death certificates
172.00
105.00
1,900.00
2,100.00
121.00
50.00
75.00
25.00
71.15
16.00
TOTAL (Also enter on line 9, Recapitulation) i$ 4,635.15
(if more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1
REV-1512 EX + (1-97)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Agnes L. Smith SS~/ 160-16- 7150 01/11/2002
FILE NUMBER
21-02-071
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 Co. check written prior to d/o/d
3
4
5
Conseco Direct Life Ins.
cleared bank after d/o/d
Messiah Village
after d/o/d
Messiah Village final bill
Pharmerica
Shepherdstown
check written prior to d/o/d, cleared bank
Family, medical bill
TOTAL (Also enter on line 10, Recapitulation)
AMOUNT
144.87
4,972.15
1,800.00
835.18
29.10
7,781.30
(if more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc, Form REV-1512 EX (Rev. 1-97)
REV-1513 EX + (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
A~nes L. Smith SS# 160-16-7150 01/11/2002 21-02-071
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
4
I1.
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
transfers under Sec. 9116(a)(1.2)]
Patricia Morris
44 South 28th Street
Harrisburg, PA 17103
Joan L. Moss
6242 N. Highlands Circle
Harrisburg, PA 17111
Frank A. Smith
2 Red Bud Drive
Mechanicsburg, PA
Clair Tritt
17055
244 Alexander Spring Road
Carlisle, PA 17013
Niece
Niece
Brother-in-Law
Friend
8% of
remainder
42% of
remainder
42% of
remainder
8% of
.remainder
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
0.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) Z000 form software only The Lackner Group, Inc. Form REV- 1513 EX (Rev. 9-00)
LAST WILL AND TESTAMENT
OF
At;NES L. sMrru,
I, AGNES L. sMITH, presently residing in Mechanicsburg, Cumberland County,
Pennsylvania, being of sound and disposing mind and memory, do make publish and declare this
to be my Last Will and testame.nt, hereby revoking ali Wills and Codicils previously made by
.... ITEM!: i direct that all inheritance and estate taxes becoming due by reason of my
death, whether such taxes may be payable by my estate or by any recipient of any property, shall
be paid by my Executor out ofthe property passing under this Will, which is not specifically
devised or bequeathed, as an expense and cost of administration of my estate. My Executor shall
have no duty or obligation to.obtain reimbursement for any such tax paid by my Executor even
though such tax was paid on proceeds of insurance or other property not passing under this Will.
If the assets not specifically devised or bequeathed are not adequate for the payment of all such
taxes, then the recipients of the property specifically devised and bequeathed shall each pay a pro
rata portion of any such tax based upon the valuation of the property received by each such
recipient as finally determined for Federal Estate Tax purposes, or if no such determination is
made, then for applicable State Inheritance Tax purposes.
ITEM Il: I hereby exercise all powers of appointment which I may have at the time of
my death in favor of my Executor, and all proPerty subject to all such powers of appointment
shall be included in my estate.
ITEM II.I: I hereby give, devise and bequeath my entire estate, whether real, personal or
mixed, of whatsoever nature or kind an, d wherever located, unto the following individuals:
a) I give, devise and bequeath forty-two (42%) percent of my estate unto my niece, Joan
L. Moss.
Page 1 of 4
, devis a bequeath forty-two (42%) percent of my estate unto my brother-in-
~lr law,'Frank A. Smith. ~,
c) I give, devise and bequeath eight (8%) percent of my estate unto my niece, Patricia
Morris.
d) I give, devise and bequeath eight (8%) percent of my estate unto Clair Tritt.
In the event that any or'he foregoing beneficiaries predeceases me, then the share which
that d~ beneficiary would have received hereunder shall lapse, and the proceeds of that
share shall bo distributed among my remaining beneficiaries in the same relative proportion they
would otherwise have received under this Will.
~: In addition to such other powers as my Executor may be granted by law, or
under previous portions 0fthis Will, he shall have the follOwing powers:
a) To retain investments I may have at my death so long as my Executor may deem it
b)
advisable to my estate to do so.
To vary investments, when deemed desirable by my Executor, then to invest in such
bonds, stocks, notes, real estate mortgages, or other securities, or in such other
property, real or personal, as he shall deem wise, without being restricted to so-called
c)
"legal investments." ........................................
In order to effect a division of the principal of my estate or for any other purpose,
including any final dis_tribution, my Executor is authoriZed to make said divisions or
distributions of the personalty and realty partly or wholly in kind. If such division or
distribution is made in kind, said assets are required to be divided or distributed at
d)
their respective values on the date or dates of their division or distribution.
To sell either at public or private sale and upon such terms and conditions as the
Executor may deem advantageous to the estate, any or all real or personal estate or
Page 2 of 4
interest therein owned by the estate severally or in conjunction with other persons or
uired after my death bymy Executor, and to consummate said sale or sales by
~ sufficient deeds or other instruments to the purchaser or purchasers, conveying a fee
simple title, free and:clear of all trusts and without obligation or liability of the
purchaser or purchasers to see to the application of the purchase money or to make
inquiry into the validity of said sale or sales; also~ to make, execute, acknowledge and
deliver any and all d~eds, assignments, options or other writings which may be
............. :... ....... ......,,..necessary or desirable in carrying out any of the powers conferred upon my Executor
in this paragraph or elsewhere in my Will.
e) To mortgage real estate, and to make leases of real estate.
f) To bon'ow money from any party, to pay indebtedness of mine or of my estate,
expenses of administration or inheritance, legacy, estate and other taxes.
g) To pay all costs, taxes, expenses and charges in connection with the administration of
my estate. My Executor shall pay the expenses of my last illness and all funeral
expenses.
h) To vote any shares of stock which form a part of the estate, and to otherwise exercise
all the powers incident to the ownership of such stock.
i) In the discretion of my Executor, to unite with other owners of similar property in
carrying out any plans for the reorganization of any corporation or company whose
securities form a part of the estate.
ITEM ¥: Anything in this Will to the contrary notwithstanding, any beneficiary under
this Will may, at any time and from time to time, release, renounce, or disclaim, in whole or in
part, or otherwise limit any power or interest granted to such beneficiary under this Will, by
written instrument, duly Signed, acknowledged before a Notary Public and filed with my
Executor. Such instrument need not take effect immediately and may be contingent upon the
occurrence or nonoccurrence of any event.
Page 3 of 4
~in addition, my Executor serving hereunder at any time may in like manner release,
renounce or disclaim, in whole or in part, or otherwise limit any power granted to such ~iduciary
hereunder.'
ITEM ~: I hereby nominate, constitute and appoint my nice, $OAN L. MOSS, to be the
Executrix of this my Last Will and Testament. In the event of her death, resignation, refusal or
inability to serve, I nominate, co~gtitute and appoint my brother-in-law, FRANK A. SMITH, to
_____b..9_~$. x~.tor of this my Last Will and Testament. My Executor is specifically relieved from
the duty or obligation ofthe filing of any bond or bonds in this or any other jurisdiction. My
Executor shall receive reasonable compensation for services rendered to my estate.
ITEM VII: Where appropriate throughout this my Last Will and Testament, all
references herein to the singular or the masculine shall include the plural or the feminine,
respectively.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and
Testament, consisting of this page and the preceding three (3) pages, this ~,.~O ~ day of
,1998.
AGNE~ESTA'~IX
,Pago 4 of 4
We the undersigned, hereby certify that the foregoing Will was signed, sealed,
published and declared by the above-named Testatrix, as and for her Last Will and Testament, in
the presence of us, who, at her request and in her presence and in the presence of each other,
have hereunto set our hands and seals the day and year above written, and we certify that at the
time of the execution thereof, the said Testatrix was of sound and disposing mind and memory.
~,ff'c ,~%.~ff/.-~ (SEAL) Residing at ~2-.' 27.
,Jr'
COMMONWEALTH OF PEI~8'YLVANIA '
ed to the attaclaecl or foregoing lnStrUln~m,
declare to the undersigned authority that the Testatrix signed and executed the instrument as her
Last'Will,' and that she had signed willingly and that she executed it as hefTr~e-fl~d voluntary act
for the purpo~s therein expressed, and that each of the witnesses, in the presence and hearing of
the Testatrix, signed the Will as witnesses and that to the best of their knowledge the Testatrix
was at that time eighteen years of age or older, of sound mind and under no constraint or undue
influence.
AONE~ L. SMITH
wi6ie;
Subscribed, sworn to and aeknowledgecl I~fore me by AG .NE~ ~S L. SMITH,
TestatO, and subscribed and sworn to before me by ~ .z.Z ~ ~'~_~a~--
1998. "- J
lqbtL~Public
My Commission Expires:
Notarial Seal
Kamn M. Turner, Notary Pu'ol~c
Upper Allen Twp., Cumberland County
My Commission Expires May 29, 2000
Member, Pennsylvania Association of Notaries
and
LOOK FOR US. WE'LL GET YOU THERE.
02/01/2002
JOAN MOSS'
6242 N HIGHLANDS CIRCLE
HARRISBURG PA 17111
The information which you requested on the account(s) of AGNES SMITH DECEASED
(Social Security Number 160-16-7150) is/are as follows:
AccoUnt Number 1800004965 1800033019 1860010371
Class of Account CERTIFICATE CHECKING SAVINGS
Date Opened 06/26/98 09/08/99
,PrincipalBalance 30000.00 ........ 8145.87:
Accrued Interest 28.36 .45
Balance at Date of 30028.36 . 8146.32
Death
Account Ownership SOLE SOLE
Name of Joint
Owner, if any
Date Ownership .
Was Established
O4/26/OO
.... , ..... 24294.14 ..................................................
13.18
24307.32
JTO
JOAN MOSS.
04/26/00
Account Number
Class of Account
Date Opened
Principal Balance
Accrued Interest
Balance at Date of
Death
Account Ownership
Name of Joint '
Owner, if any
Date Ownership
Was Established
Additional ·
Information
Requested ....
PLEASE COMPLETE W-9
}~v~erely'
SENIOR SERVICES REP.
RO. Box 171 I. HARRISBURG. PENNSYLVANIA 17105-1711
Toll Fr~ 1-86G-WAYPOINT (I-B66-gE~9-764G) · www.waupointbank.¢om
allfirst
Joan L. Moss, Executrix For
The Estate of Agnes L. Smith
6242 N Highlands Circle
Harrisburg, PA 17111
Atlfirst Financial Center N.A.
P.O. Box 900
M i 1 kS~hC~rn%' ~(~ )1 ~.~ 909 '
F ax (302) 934-2955
February 7, 2002
Re: Estate qf Agnes L Smith
- Social Securi~': 160-16- 71'50
Date of Death: danuar~ 11, 2002
Per your inquiry dated January 26, 2002, please be advised that at the time of death, the above-named decedent
· had on deposit with this bank the following:
Type. of Account
Account Number
Relationship Checking W/Interest.
0079602339
Ownership (Names oJ)
Opening Date
· Balance on Date of Death
AgneS L. Smith, Owner
,loan L. MOSS, Owner
03/28/78
$11,416.87
Accrued Interest $ 2. 37
Total $11,419.24
77ds letter docs not inirlude a~ty accounis in which the deceased may have been listed as Power oJ Attorney,
Custodian of Uniform Transfers, Representative Payee, or Trustee under a Written Agreement.
For further account information, closures and/or reimbursement of funds refer to below branch:
COLONIAL PARK OFFICE
4950 JONESTOWN ROAD
HARRISBURG, PA 17109-1703
717-255-2233
Assistant I
Cis Services, (302) 934-2909
FIRST AND FINAL ACCOUNT OF
JOAN L. MOSS, EXECUTRIX
OF THE ESTATE' OF AGNES L. SMITH, DECEASED
LATE OF UPPER ALLEN TOWNSHIP
CUMBERLAND COUNTY, PENNSYLVANIA
Estate File Number: 21-02-071
Employer Identification Number: 03-6074722
Date of Death:
January 11, 2002
Letters Granted:
January 23, 2002
Dates of Advertisement:
The Sentinel -
Cumberland Law Journal -
Feb. 15 & 22; March 1, 2002
Feb. 22; March 1 & 8, 2002
Account Stated To:
January 31, 2003
PRINCIPAL:
Receipts
Net Gain or (Loss) on Conversions
Debts of Decedent
Funeral Expenses
Costs of Administration
Distributions to Beneficiaries
Reserves
INCOME:
Receipts
PROPOSED DISTRIBUTION:
SUMMARY & INDEX
Pages
Amount
2 $59,525.63
2 ($18,182..18)
3 $2,330.26
3 $105.00
4 $7,115.90
4 None
4 $5,250.00
3 $4,035.45
4-5 $3~0, S 77. 74
Purpose of Account: Joan L. Moss, Executrix offers this account to acquaint interested parties
with the transactions that have occurred during her administration. This account also indicates
the proposed distribution of the estate. It is important the account be carefully examined.
Requests for additional information, questions or objections can be discussed with:
James D. Hughes, Esquire
IRWIN, McKNIGHT & HUGHES
60 West Pomfret Street
Carlisle, PA 17013
(717) 249-2353
RECEIPTS OF PRINCIPAL
Cash:
Waypoint Bank, certificate
Waypoint Bank, checking
Check #93 written 01/30/02 Pharmerica - $407.09
Check #94 written 01/30/02 Zimmerman-Auer - $172.00
Check #95 written 02/11/02 The Sentinel - $71.15
Capital Blue Cross, Security 65 premium refund
Keystone Insurance Company, insurance benefit
Capital Blue Cross, premium refund
Messiah Village, storage expense refund
Conseco Direct Life Ins. Co., refund
Washington National Insurance, premium refund
Loyal American Life Ins. Co., refund
Verizon, credit balance refund
Tangible Personal Property:
Miscellaneous personal property
Stocks:
19 shares Met-Life Inc., common
Jointly-Owned Property:
Allfirst Financial Center, relationship checking ($11,419.24)
Waypoint Bank, savings ($24,307.32)
TOTAL RECEIPTS OF PRINCIPAL
Value of Assets
Listed in Inventory
(d/o/d value)
$30,028.36
$8,150.56
$890.30
$800.00
$334.10
$170.00
$144.87
$36.75
$28.34
$4.13
$500.00
$574.94
$5,709.62
$12,153.66
$59,525.63
Fiduciary
Acquisition
Value
$30,844.61
$7,500.32
$890.30
SS00.00
$334.10
$170.00
$144.87
$36.75
$28.34
$4.13
$0.00
$590.03
$0.00
$0.00
$41,343.45
RECEIPTS SUBSEQUENT TO INVENTORY
(Value When Received)
02/08/02
02/12/02
03/01/02
03/13/02
04/01/02
05/01/02
05/25/02
06/01/02
07/01/02
08/01/02
09/01/02
10/01/02
11/01/02
12/01/02
01/08/03
Waypoint Bank, interest ................................................................................... $1.43
New York Life Insurance - benefit ........................................................... $1,598.90
Waypoint Bank, interest ................................................................................... $3.14
Metropolitan Life Insurance - benefit ....................................................... $1,406.77
Waypoint Bank, interest ................................................................................... $3.79
Waypoint Bank, interest .................................................................................... $2.53
Conseco Direct, accident policy benefit .................................................... $1,000.00
Waypoim Bank,
Waypoint Bank
Waypoint Bank
Waypoint Bank
Waypoint Bank
Waypoint Bank
Waypoint Bank
Waypoint Bank
interest ................................................................................... $2.77
interest ................................................................................... $2.74
interest ................................................................................... $3.15
interest ................................................................................... $3.13
interest ................................................................................... $3.32
interest ................................................................................... $1.83
interest ..................................................................................... $.89
interest ................................................................................... $1.06
TOTAL RECEIPTS SUBSEQUENT TO INVENTORY .................................. $4,035.45
DISBURSEMENTS
Debts of Decedent:
02/12/02
02/12/02
02/13/02
02/23/02
04/01/02
05/25/02
11/04/02
Pharmerica ............................................................................................................. $428.09
Messiah Village .................................................................................................. $1,800.00
Electronic Health Information .................................................................................. $24.44
Electronic Health Information .................................................................. . .............. $24.44
Shephardstown Family Practice .............................................................................. $29.10
Shephardstown Family Practice .............................................................................. $10.00
Riverside Anesthesia ............................................................................................... $14.19
Subtotal: ..................................................................................................................................... $2,330.26
Funeral Expenses:
08/10/02 Zimmerman Auer Funeral Home ........................................................................... $105.00
Subtotal: ........................................................................................................................................ $105. O0
Costs of Administration:
02/12/02 Cumberland Law Journ'al, estate notice publication ................................................ $75.00
03/25/02 B&L Income & Accounting Services ...................................................................... $50.00
04/04/02 Register of Wills Agent, inheritance tax payment .............................................. $4,500.00
08/14/02 Joan Moss, reimburse probate fees ........................................................................ $137.00
10/09/02 Register of Wills Agent, inheritance tax due ...................................................... $2,328.90
10/09/02 Register of Wills, filing fee ..................................................................................... $25.00
Subtotah ..................................................................................................................................... $7,115.90
Distributions to Beneficiaries:
None
................................................................................................................... $00.00
Subtotal: .......................................................................................................................................... $00.00
Reserves:
Irwin, McKnight & Hughes, attorney fee ........................................................................... $2,100.00
Joan L. Moss, executrix fee ................................................................................................ $1,900.00
Register of Wills, filing fees .................................................................................................. $750.00
Patricia A. Rosendale CPA, tax return preparation ............................................................... $500.00
Subtotal: ..................................................................................................................................... $5,250. O0
TOTAL DISBURSEMENTS OF PRINCIPAL ................................................ $14,801.16
RECAPITULATION
TOTAL RECEIPTS ........................................................................................................ $45,378.90
TOTAL DISBURSEMENTS ...................................................................................... - $14,801.16
BALANCE FOR FINAL DISTRIBUTION ...................................................... $30,577.74
PROPOSED DISTRIBUTION TO BENEFICIARIES
Joan L. Moss
Frank A. Smith
Clair Tritt
Patricia Morris
42% of remainder
42% of remainder
8% of remainder
8% of remainder
$12,842.65
$12,842.65
$2,446.22
$2,446.22
ENDING BALANCE
COMMONWEALTH OF PENNSYLVANIA :
i SS
COUNTY OF CUMBERLAND :
JOAN L. MOSS, Executrix for the Estate of Agnes L. Smith, deceased, hereby declares
under oath [under penalty of perjury] that she has fully and faithfully discharged the duties of her
office; that the foregoing First and Final Account is 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.
JOAN L. MOSS, Executrix
Swom and subscribed
before me this 31st
of Janu. ary, 20~3~
Notary ~/ubX~ic
Notarial Seal
Jacqueline L. Drawbaugh, Notary Public
Carlisle Boro. Cumberland County
My Commission Expires Aug. 14, 2003
Member, Pennsylvania Association ot Notaries
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
AGNES L. SMITH
Date of Death:
January 11, 2002
No. 21-02- 0071
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:
1. State whether administration of the estate is complete: X Yes __ 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?
x Yes No
b. The separate Orphans' 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
Date:
d. Copies of receipts, releases, joinders and a_,p. provals of formal or informal
accounts may be filed with the C1/o~o)/Orphan's Court and may be
attached to this repo,~,-~-~
5/13/03
I I'RW/I~N, McKNIGHT & _HUGHES
[ J/afnes D. Hughes, Esquire
k,,~.Rqame (please type or print)
60 West Pomfret Street
Address
Carlisle, PA 17013
City, State, Zip
(717) 249-2353
Telephone Number
Capacity:
X
Personal Representative
Counsel for Personal Representative
~quare . use
~013
~oncern:
Re: Es
File
~d a
· Please ~,~_. ount ors
rte.-vmy t/us to the ~
'"' ~ " "" i'i .,/
Re,-',.i,.-ztr::5 ,'< Witls
'OZ ~PR-5 Pt:04
6242 N. Highlands Circle
Harrisburg, PA 17111
April 4, 2002
Register of.W. ills ....................
Carlisle County Courthouse
1 Courthouse Square
Carlisle'S' PA:'"'17013
Re:
EState of Agnes L. Smith
.S._S_,~160_-.!_6_.,_7__15._0_ ..............................
Date of Death: 1/11/2002
File No. 2002-00071
To Whom It May Concern:
Enclosed you will find a check in the amount of $4,500.00 made payable to
Register of Wills; Agent. Please apply this ~to the Inheritance Tax due on the.
above-referenced estate..
Should you have any questions, please telePhone me at 717-545-9433.
Thank yoU.
3'y0u ,
joan. L'. Moss, Executrix