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Home My WebLink About02-0083PETITION FOR PROBATE and GRANT OF LETTERS Estate of DELILAH SOURS GARROTT also known as DELILAH S. DOLAN GARROTT, also known as DELILAH S. DOLAN Deceased. Social Security No. 202-20-7294 To: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner is 18 years of age or older and the Executrix named in the last will of the above decedent, dated October 15, 1998, and codicil(s) dated [none]. Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 442 Walnut Bottom Road, Borough of Carlisle. Decedent, then 92 years of age, died November 19, 2001, at 442 Walnut Bottom Road, Carlisle, Pennsylvania. Except as follows, decedent did not marry, was not divorced and did not have a child bom or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: $ $ $ $ 4,300.00 WHEREFORE, petitioner respectfully requests the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary thereon. Barbara'McCarty R.D. 3, Box 393 Manheim, PA 17545 (717) 665-3508 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ) : SS. COUNTY OF CUMBERLAND ) The petitioner above-named swears or affirms that the statements in the foregoing petition are tree and correct to the best of the knowledge and belief of petitioner and that as personal representative of the above decedent, petitioner will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this 23rd day of January t 2002 Barbara McCarty No. 21-2002-0083 Estate of DELILAH SOURS GARROTT a/k/a DELILAH S. DOLAN GARROTT, a/k/a DELILAH S. DOLAN, Deceased DECREE OF PROBATE AND GRANT OF LETTERS ANDNOW, January '24th,2002 , in consideration of the petition on the reverse side hereof, 'satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated October 15, 1998, described therein be admitted to probate and filed of record as the last will of Delilah Sours Garrott and Letters Testamen'ta~ are hereby granted to Barbara McCarty. Will Book # Page FEES Probate, Letters, Etc. $ 25.00 Short Certificates(2) $ 6.00 Renunciation $ x-pages (3) $ 9.00 JCP TOTAL ~. 5.00 45.00 ' - R~gisterof~Vills Mary C. Lewi~ Ivo V. Otto III, Esquire (27763) ATTORNEY (Sup. Ct. I.D. No.) MARTSON DEARDORFF WILLIAMS & OTTO 10 East High Street Carlisle, PA 17013 (717) 243-3341 Filed January 24th,2002 Call Attorney when letters are finished F:~FILES\DATAFILEXESTATES\6338-1¢tters.tes 105.805 REV 9/86 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 7714570 No. Local Registrar NOV 2, 0 2001 Date 21-2002-0083 COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH Delilah S. Dolan Garrott s~x -- I~m~cu",~u..E. T~~ . --F ~ t' , ~.' ~,, [ u~,,v~. I u~.,~ I 0~. ~-' . ...... ~" ~. 202 -- 20 --7294 ~, 11/1q/gan~ 92 v~ ~ : J , ~ 3/1 ..... J .... ~ ~ ..... ,o,~.. ~ ..... ~ ........ -- ,~rlisle, PA 17013 ~, J. Frank Sours Barbara B. McCarty ~ = ,".."'" ,,.,~,~ ,,~..,. ,~,,,. ~ ~arlls±e ~~ Fr~s - H~nd ~ ~j ~x 393, ~ ~, PA 17545 1/24/2001 ~te~ NSE~~ ~~ ~~rilsle, FA 17013 21-2002-0083 F:~FILES~DATAFILE\WILLS~6338.WIL/clm LAST WILL AND TESTAMENT 2i-2002-0083 I, DELILAH SOURS GARROTT, of the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils by me made. 1. I direct that all my just debts, funeral expenses, testamentary expenses and all inheritance taxes (whether such taxes may be payable by my estate or by any recipient of any property) shall be paid from my residuary estate as soon as practicable after my decease and as part of the administration of my estate. My Executor shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. 2. I give to my niece, BARBARA MeCARTY, the following: My picture of Lake George, the china closet in the kitchen and my marble-top table (the larger of the three). 3. I give to JOANNE ALLEN my solitaire diamond. 4. I give to GEORGIA ANN FARBER my diamond ring with two sapphires. 5. I give to NANCY HERRING my charm bracelet. 6. I give to CYNTHIA OLANDER my gold chain with Pisces. I direct that my bracelets (with the exception of my charm bracelet referred to in Item 5 herein) shall be divided between SABRINA FARBER and ER/CA FARBER. Page 1 of 4 Pages D.S.G. I give to LINDA BERKOSKI my cultured pearls and watch. 8. I give my antique jewelry to be divided among BARBARA McCARTY, NANCY HERRING and GEORGIA ANN FARBER. I give my earrings to be divided among GEORGIA ANN FARBER's children. I give, devise and bequeath all the rest, residue and remainder of my estate, both real and personal property, in equal shares, unto my nieces, BARBARA McCARTY, JOANNE ALLEN, GEORGIA ANN FARBER and NANCY HERRING, absolutely. 10. I nominate, constitute and appoint my said niece, BARBARA MeCARTY, as Executrix of my estate. In the event she is unwilling or unable to so act, then I appoint BARTON F. FARBER and GEORGIA ANN FARBER, or the survivor of them, as Executors of my estate. I further direct that my Executrix or Executors shall retain the firm ofMARTSON DEARDORFF WILLIAMS & OTTO in the settlement of my estate. 11. I direct that my Executrix or Executors shall not be required to file a bond to secure the faithful performance of their duties in any jurisdiction. 12. I authorize and empower my personal r. epresen, tative(s), in their sole and absolute discretion, to purchase or otherwise acquire and retain any investments of which I die seized or any real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant options in regard to any or all property of any kind forming a part of my estate for such terms and such prices as they may deem advisable; to borrow money for any purposes connected with the protection and preservation of my estate; to mortgage or pledge any real or personal property forming a part of my estate or to join in or secure the partition of same; to compromise any claims or demands of my estate against others or of others against my estate; to make distribution in kind Page 2 of 4 Pages D.S.G. and to cause any share to be composed of cash, property or undivided fractional shares in property different in kind from any other share; to employ agents, attorneys and proxies and to delegate to them such power as my personal representative considers desirable and to pay reasonable compensation for such services as may be rendered by such agents, attorneys and proxies; and to execute and deliver such instruments as may be necessary to carry out any of these powers. In addition, I direct that my personal representative shall have the power to conduct an inventory of any safe deposit box necessary to the administration of my estate. IN WITNESS WHEREOF I have hereunto set my hand and seal this /~""/'~['day of ~ , 199~. 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, have hereunto subscribed our names as witnesses thereto, in the presence of the said Testatrix and of each other. Page 3 of 4 Pages COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) SS. I, Delilah Sours Garrott, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my flee and voluntary act for the purposes therein expressed. Swom or affirmed to and acknowledged before me by Delilah Sours Garrott, the Testatrix, this ]~'4/a day of ~~ , 199~. COMMONWEALTH OF PENNSYLVANIA Notary Public COUNTY OF CUMBERLAND i Notarial Seal Corrine L. Myers, Notary Public · Carlisle Bore, Cumberland County ~4y Commission Expires May 27, 1999 the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Delilah Sours Garrott, the Testatrix, sign and execute the instrument as her Last Will; that the Testatrix signed willingly and that the Testatrix executed it as her free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the Testatrix, signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more yea~ of age, of sound mind and under no constraint or undue influence. Address /O ~../-¢1~ ..~/. /o4 /7a/3 Swom or affirmed to and subscribed before me this 16- day of ~:~,~.-ff~,~, 199 Notary Public Notarial Seal Corrine L. Myers, Notary Public Carlisle Bore, Cumberland County Page 4 of 4 Pages My Commission Expires May 27, 1999 F: \FILES\DATAF1LE\ESTATES\6338-notice.cer CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: DELILAH SOURS GARROTT Date of Death: November 19, 2001 File No. 2002-0083 To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on or about February 22, 2002. Barbara McCarty, R.D. 3, Box 393, Manheim, PA 17545 Joanne Allen, 10654 East Borne Avenue #302, Los Angeles, CA 90024 Nancy Herring, 31 Edward Lane, South Hampton, Long Island, NY 11965 Georgia Ann Farber, 1070 Park Avenue #9M, New York City, New York 10128 Erica Farber, 921 Kentor Way, Los Angeles, CA 90049 Sabrina Farber, 105 West 73rd Apartment 8B, New York City, New York 10023 Cynthia Olander, c/o Nancy Herring, 31 Edward Lane, South Hampton, Long Island, NY 11965 Linda Berkoski, c/o Nancy Herring, 31 Edward Lane, South Hampton, Long Island, NY 11965 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: N/A Date: February 22, 2002 Signature Name Ivo V. Otto III, Esquire MARTSON DEARDORFF WILLIAMS & OTTO Ten East High Street Carlisle, PA 17013 (717) 243-3341 Attorneys for Personal Representative REV - 1500 EX + COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY 3o // FILE NUMBER 21 02 00083 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 202-20-7294 THIS RETURN MUST BE FILED IN DUPECATE WiTH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) GARROTT, DELILAH S. DATE OF DEATH (MM-DD-YEAR) [ DATE OF BIRTH (MM-DD-YEAR) 11/19/2001 103/01/1909 IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) [] 0 [] 0 12-31-91 and 1-1-95} ~IAME . Ivo V. Otto, III, Esquire 1. Original Return [~] 2. Supplemental Return 0 3. Remainder Return (date oTcl~h~ri0r to '12-1342) 4. Limited Estate I-I 4a. Future Interest Compromise (date of death after 12-12-82) [-I 5. Federal Estate Tax Return Required 6. Decedent Died Testate (Attach copy I'~ 7. Decedent Maintained a Living Trust (Attach 0 8. Total Number of Safe Deposit Boxes of Will) copy of Trust) 9. Litigation Proceeds Received El 10. Spousal Poverty Credit (date of death between El 11. Election to tax under Sec. 9113(A) (Attach Sch O) COMPLETE MAILING ADDRESS. :IRM NAME (If applicable) Martson Deardorff Williams & Otto YELEPHONE NUMBER 717/243-3341 ~ 10 East High Street Carlisle, PA 17013 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) I-I 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) None 21 :10 None None 4,538.79 None None 8,938.36 11,374.73 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (8) (11) (12) (13) (14) OFFICIAL IJSE ONLY 4,755.89 20,313.09 insolvent SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, x or transfers under Sec. 9116(a)(1.2) o_z 16. Amount of Line 14 taxable at lineal rate x ~ 17. Amount of Line 14 taxable at sibling rate x :2 O ~ 18. Amount of Line 14 taxable at collateral rate x 19. Tax Due .00 (15) .045 (16) .12 (17) .15 (18) (19) 20. C] ............. Copyri9ht 2000 form so,are only The Lackner Group, Inc. Form REV4500 EX {Rev. 640) Decedent's Complete Address: ISTREET ADDRESS 442 Walnut Bottom Road CITY Carlisle STATE PA i ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments ^. Spousal Poverty Credit B. P~ior Payments C. Discount (1) Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ' 0.0 0 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 a. retain the use or income of the property transferred; ............................................................................. r-I [] b. 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 considerat on? ........... [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ...... [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property Which contains a beneficiary designat on? ................... [] [] 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 ADDRESS SIGNATUREDFPERSDN RESPONSIBLErFOR~=IEI~ ----ADDRESs R.D. 3, Box 393 Manheim, PA 17545 DATE ADDRESS DATE 10 East High Street Carlisle, P.~ 17013 2(/~/~2~x. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §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. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF GARROTT, DELILAH S. FILE NUMBER 21 - 02 - 00083 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 10 shares Sprint, account #233652 DESCRIPTION TOTAL (Also enter on line 2, Recapitulation) UNIT VALUE 21.71 VALUE AT DATE OF DEATH 217.10 217.10 ESTATE OF COMMONWEALTH OF PENNSYLVANIA INHERITANCETAXRETURN RESIDENT DECEDENT GARROTT, DELILAH S. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21 - 02 - 00083 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER 1 2 3 4 DESCRIPTION M&T Bank, Checking #533750 M&T Bank, refund for returned safe deposit box key Blue Cross/Blue Shield, refund of premium Proceeds of sale of personal property TOTAL (Also enter on Line 5, Recapitulation) VALUE AT DATE OF DEATH 3,885.34 15.00 158.45 480.00 4,538.79 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCt'E[:XJLE H FUI~.=RAL~ & ~TNECOSTS ESTATE OF GARROTT, DELILAH S. FILE NUMBER 21 - 02 - 00083 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION NUMBER A. 1 2 3 FUNERAL EXPENSES: Ewing Brothers Funeral Home, Carlisle, PA Carlisle Memorial Service, Carlisle, PA, inscription Quality Inn, Carlisle, PA, Funeral reception ADMINISTRATIVE COSTS: Personal Representative's Commissions Barbara McCarty Social Security Number(s) / EIN Number of Personal Representative(s): Street Address R.D. 3, Box 393 City Manheim State PA Zip 17545 Year(s) Commission paid Attorney's Fees Martson Deardorff Williams & Otto Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees Register of Wills of Cumber]and County Zip Accountant's Fees Tax Return Preparer's Fees H & R Block Other Administrative Costs Witman Auctioneers Inc., appraisal of personal property The Sentinel, advertising Letters Testamentary Cumberland Law Journal, advertising Letters Testamentary Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) AMOUNT 5,998.52 105.00 418.69 334.00 1,500.00 45.00 125.00 212.00 106.79 75.00 18.36 8,938.36 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GARROTT, DELILAH S. FILE NUMBER 21 - 02 - 00083 Certified mail, PA Dept. of Public Welfare (2) Register of Wills, filing fee, inheritance tax return 8.36 10.00 Page 2 of Sch~dule H COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS GARROTT, DELILAH S. FILE NUMBER 21 ~ 02 - 00083 Include unreimbursed medical expenses. ITEM NUMBER 1 2 4 DESCRIPTION Sprint (outstanding check written prior to date of death) United Church of Christ Homes, account payable Brian H. Robertson, DDS PA Dept. of Public Welfare TOTAL (Also enter on Line 10, Recapitulation) AMOUNT 22.28 2,915.30 15.00 8,422.15 11,374.73 ACCOUNT NO~ ACCOUNT TYPE S$3750 It,IT DIRECT CHECKING O0 00fiS19H NM 017 STATEMENT PERTOO PAGE NOV. 03-DEC. 05· 2001 1 OF DELILAH S GARROTT C/O BARBARA MCCARTY RR $ BOX $93 MANHEIM PA 175q5-8929 3,863O INTEREST PAID YEAR TO DATE 2~ .qO HIGH STREET-CARLTSLE BEG/NNZNG BALANCE 3 · 88S. 34 ACCOUNT SUMMARY I DEPOSTTS:, , ........ , OTHER: , .... OTHER ADDZTIOfa~ I CHECKS PAID l: : SuBTRAcTIoNS No. I ANO4J(qT I NO' I .M O4JNT INO' I AMOUNT 01 0.00 I 11 22.20 I 0 I 0.00 CURRENT :'J:t :ENDING INTEREST:POI BALANCE I 0.00 ~ 3·863.06 ACCOUNT ACTIVITY POST/eft; ......... ........ :': DEPOSZTS~ ~EREST :CHECKS: i iOTHERii :i DAILY DATE TRANSACTION DESCRIPTION ! ............ & !O~HERi A-n-niT/~ i i :SUBTRACTi~i i ..... BA£~E i 11- 03- 01 BEGINNING BALANCE .~S..~ 11-20-01:CHECK NUMBER 0120 22.28 ~3,863.'~6 ENDING BALANCE $3·863.06 I 120 11-20-01 22.28 ~EFFECTZVE JANUARY 1, 2002· RETAIL LEGAL PROCESSING FEES WILL BE $100. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG. PA 17105-8486 July 30, 2002 MARTSON DEARDORFF WILLIAMS & OTTO IVO V OTTO III ESQUIRE TEN EAST HIGH STREET CARLISLE PA 17013 Re: DELILAH GARRETT DOLAN CIS #: 510155414 SSN: 202-20-7294 Date of Death: 11/19/2001 Dear Attorney Otto: Please be advised that the Department of Public Welfare maintains a claim in the amount of $8,422.15 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's itemized statement of claim. A portion of this medical expense, namely $8,422.15, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $.00, is to be entered as a priority Class 6 claim against the estate. Please acknowledge receipt of this letter and advise whether the Commonwealth's claim is admitted and when payment may be expected. If the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the deed, the latest tax assessment, and a current appraisal, if available. Sincerely, Edna L. Guido Claims Investigation Agent 717-772-6614 717-705-8150 FAX Enclosure COIvlMONVVEAI.TH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS TPL SECTION - CASUALTY UNIT PO BOX 8486 HARRISBURG PA 17105-8486 July 30, 2002 STATEMENT OF CLAIM SUMMARY Estate of GARRETT DOLAN, DELILAH 510 155 414 INPATIENT .00 .00 .00 OUTPATIENT .00 .00 .00 LONG TERM CARE 7,223.39 .00 7,223.39 DRUG 1,198.76 .00 1,198.76 ~ ~ ':'~'~" ! ........... ' · ~ ': :~ ~· 8,422.15 .00 8,422.15 July 30, 2002 STATEMENT OF C~IM GARRE~ DO~N, DELI~H 510 155 414 PHARMERICA INC #22000 111 RUTHAR DRIVE NEWARK DE 19711 09101101 - 09101/01 03/25/02 205770140901 0000000000¢0 130.00 111.96 DIAGNOSIS 1: PRESC PRESCRIPTION DRUGS DIAGNOSIS 2: PROCEDURE: 09/17101 - 09/17101 03/25/02 205770121701 DIAGNOSIS 1: PRESC PRESCRIPTION DRUGS DIAGNOSIS 2: PROCEDURE: 000000000000 130.00 107.98 09/19/01 - 09/19/01 03/25102 205770131501 DIAGNOSIS 1: PRESC PRESCRIPTION DRUGS DIAGNOSIS 2: PROCEDURE: 000000000000 83.40 67.18 09/19/01 - 09/19/01 03/25/02 205770141001 DIAGNOSIS 1: PRESC PRESCRIPTION DRUGS DIAGNOSIS 2: PROCEDURE: 000000000000 24.95 7.97 09/19/01 - 0911 9/01 03/25/02 205770112201 DIAGNOSIS 1: PRESC PRESCRIPTION DRUGS DIAGNOSIS 2: PROCEDURE: 000000000000 5.20 4.80 09/22/01 - 09/22/01 03/29/02 205770121801 DIAGNOSIS 1: PRESC PRESCRIPTION DRUGS DIAGNOSIS 2: PROCEDURE: 000000000000 44.55 30.10 09127101 09/27101 03/25/02 205770076101 DIAGNOSIS 1: PRESC PRESCRIPTION DRUGS DIAGNOSIS 2: PROCEDURE · 000000000000 138.55 119.32 10/04/01 - 10104/01 03/25/02 205770085601 DIAGNOSIS 1: PRESC PRESCRIPTION DRUGS DIAGNOSIS 2: PROCEDURE: 000000000000 130.00 111.98 duly 30, 2002 STATEMENT OF CLAIM G ARRE'I'T DOLAN, DELILAH 510 155 4t4 PHARMERICA INC #22000 111 RUTHAR DRIVE NEWARK DE 19711 10117101 - 10/17101 03/26/02.-' DIAGNOSIS 1: DIAGNOSIS 2: PROCEDURE: 205770035801 000000000000 24.95 7.97 PRESC PRESCRIPTION DRUGS 10117101 - 10/17101 03/25/02 205770141101 DIAGNOSIS 1: PRESC PRESCRIPTION DRUGS DIAGNOSIS 2: PROCEDURE: 000000000000 83.40 67.18 10117101 - 10/17101 03/25/02 205770131601 DIAGNOSIS 1: PRESC PRESCRIPTION DRUGS DIAGNOSIS 2: PROCEDURE: 000000000000 5.20 4.80 10/19/01 - 10/19/01 03/25/02 205770095801 DIAGNOSIS 1: PRESC PRESCRIPTION DRUGS DIAGNOSIS 2: PROCEDURE: 000000000000 130.00 107.98 10123/01 - 10123/01 03/25/02 205770105301 DIAGNOSIS I: PRESC PRESCRIPTION DRUGS DIAGNOSIS 2: PROCEDURE: 000000000000 44.55 30.10 10126/01 - 10/26/01 03125/02 205770151101 DIAGNOSIS 1: PRESC PRESCRIPTION DRUGS DIAGNOSIS 2: PROCEDURE: 000000000000 138.55 119.32 11103/01 - 11103/01 03/25/02 205770112301 DIAGNOSIS 1: PRESC PRESCRIPTION DRUGS DIAGNOSIS 2: PROCEDURE: 000000000000 130.00 111.98 11114101 - 11114/01 03125/02 205770015801 DIAGNOSIS 1: PRESC PRESCRIPTION DRUGS DIAGNOSIS 2: PROCEDURE: 000000000000 24.95 7.97 July 30, 2002 STATEMENT OF CLAIM G ARRETT DOLAN, DELILAH 510 155 414 PHARMERICA INC #22000 111 RUTHAR DRIVE NEWARK DE 19711 11114/01 - 11114/01 03/25/02 205770151201 000000000000 5.35 4.99 DIAGNOSIS 1: PRESC PRESCRIPTION DRUGS DIAGNOSIS 2: PROCEDURE: 11114/01 - 11/14/01 03/25/02 205770131701 DIAGNOSIS 1: PRESC PRESCRIPTION DRUGS DIAGNOSIS 2: PROCEDURE: 000000000000 83.40 67.18 11117101 - 11117101 03/25/02 205770035901 DIAGNOSIS 1: PRESC PRESCRIPTION DRUGS DIAGNOSIS 2: PROCEDURE: 000000000000 130.00 107.98 PHARMERICAINC #22000 19 1718840 1,487.00 1,198.76 July 30, 2002 STATEMENT OF CLAIM G ARRETT DOLAN, DELILAH 510 155 414 THORNWALD HOME 442 WALNUT BOTTOM RD CARLISLE PA 17013 09/01/01 - 09130/01 DIAGNOSIS 1: DIAGNOSIS 2: PROCEDURE: 03104/02 205688848501 000000000000 2,909.76 2,909.76 10101101 - 10131101 DIAGNOSIS 1 DIAGNOSIS 2 PROCEDURE 03/04/02 205688848601 000000000000 3,018.65 3,018.65 11101101 11118/01 DIAGNOSIS I: DIAGNOSIS 2: PROCEDURE: 03/04/02 205688848701 000000000000 1,294.98 1,294.98 THORNWALD HOME 36 0767142 I 7,223.39 I 7,223.39 F: ~ILES~)A TAFILE\WILLS~6338. WIL/ckn LAST WILL AND TESTAMENT I, DELILAH SOURS GARROTr, of the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils by me made. 1. I direct that all my just debts, fimeral expenses, testamentary expenses and all inheritance taxes (whether such taxes may be payable by my estate or by any recipient of any property) shall be paid from my residuary estate as soon as practicable after my decease and as part of the administration of my estate. My Executor shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. 2. I give to my niece, BARBARA McCARTY, the following: My picture of Lake George, the china closet in the kitchen and my marble-top table (the larger of the three). 3. I give to JOANNE ALLEN my solitaire diamond. 4. I give to GEORGIA ANN FARBER my diamond ring with two sapphires. 5. I give to NANCY HERRING my charm bracelet. 6. I give to CYNTHIA OLANDER my gold chain with Pisces. I direct that my bracelets (with the exception of my charm bracelet referred to in Item 5 herein) shall be divided between SABRINA FARBER and ERICA FARBER. Page 1 of 4 Pages D.S.G. and FARBER's children. o I give to LINDA BERKOSKI my cultured pearls and watch. 8. I give my antique jewelry to be divided among BARBARA McCARTY, NANCY HERRING GEORGIA ANN FARBER. I give my earrings to be divided among GEORGIA ANN I give, devise and bequeath all the rest, residue and remainder of my estate, both real and personal property, in equal shares, unto my nieces, BARBARA McCARTY, JOANNE ALLEN, GEORGIA ANN FARBER and NANCY HERRING, absolutely. 10. I nominate, constitute and appoint my said niece, BARBARA McCARTY, as Executrix of my estate. In the event she is unwilling or unable to so act, then I appoint BARTON F. FARBER and GEORGIA ANN FARBER, or the survivor of them, as Executors of my estate. I further direct that my Executrix or Executors shall retain the firm ofMARTSON DEARDORFF WILLIAMS & OTTO in the settlement of my estate. I direct that my Executrix or Executors shall not be required to file a bond to secure the faithfifl performance of their duties in any jurisdiction. I authorize and empower my personal representative(s), in their sole and absolute discretion, to purchase or otherwise acquire and retain any investments of which I die seized or any real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or graat options in regard to any or all property of any kind forming a part of my estate for such terms and such prices as they may deem advisable; to borrow money for any purposes connected with the protection and preservation of my estate; to mortgage or pledge any real or personal property forming a part of my estate or to join in or secure the partition of same; to compromise any claims or demands of my estate against others or of others against my estate; to make distribution in kind Page 2 of 4 Pages D.S.G. and to cause any share to be composed of cash, property or undivided fractional shares in property different in kind fi.om any other share; to employ agents, attorneys and proxies and to delegate to them such power as my personal representative considers desirable and to pay reasonable compensation for such services as may be rendered by such agents, attorneys and proxies; and to execute and deliver such instruments as may be necessary to carry out any of these powers. In addition, I direct that my personal representative shall have the power to conduct an inventory of any safe deposit box necessary to the administration of my estate. IN WITNESS WHEREOF I have hereunto set my hand and seal this /,5'- 4~'C day of ~ , 199~. 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, have hereunto subscribed our names as witnesses thereto, in the presence of the said Testatrix and of each other. Page 3 of 4 Pages COMMO~ALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) SS. I, Delilah Sours Garrott, Testatrix, whose name is signed to the attached or foregoing instnunent, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. this Swom or affirmed to and acknowledged before me by Delilah Sours Garrott, the Testatrix, day of' (-O~ ,199~. COMMONWEALTH OF PENNSYLVANIA Notary Public COUNTY OF CUMBERLAND Notarial Seal Corrine L. Myers, Notary Public Carlisle Boro, Cumberland County ~y Commission Expires May 27, 1999 the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Delilah Sours Garrott, the Testatrix, sign and execute the instrument as her Last Will; that the Testatrix signed willingly and that the Testatrix executed it as her free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the Testatrix, signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more yea~ of age, of sound mind and under no constraint or undue influence. ~~.~ ~ Address /t~ ~..,Z./~ ,..~-/, Sworn or affirmed to and subscribed before me this/,~-'Mday of t~~-~, 199 ~'. Notary Public [ Notarial Seal Corrine L. Myers, Notary Public ! Carlisle Boro Cumberland Count Page 4, of 4 Pages ,~,~¥ Corem ssion Expires May 27, 1 ~)Y99 BUREAU OF ZNDTVZDUAL TAXES /NHERTTANCE TAX DZVZSZON DEPT. 180601 HARRTSBURG, PA 17118-0601 ZVO V OTTO 11! ESQ HARTSON ETAL 10 E H~GH ST CARLISLE CONNONWEALTH OF PENNSYLVANZA DEPARTHENT OF REVENUE NOTZCE OF ZNHERZTANCE TAX APPRAZSEMENT, ALLOWANCE OR DZSALLOWANCE OF DEDUCTZONS AND ASSESSMENT OF TAX PA' 1'7015 DATE ESTATE OF DATE OF DEATH FZLE NUHBER COUNTY ACN 09-$0-2002 GARROTT 11-19-2001 21 02-0085 CUHBERLAND 101 Amount Remitted REV-IS,I? EX AFP DELILAH S HAKE CHECK PAYABLE AND RENZT PAYHENT TO: REGISTER OF WILLS CUH]~ERLAND CO COURT HOUSE CARL/SLE, PA 17015 CUT ALONG THZS LZNE ~ RETAZN LOWER PORTZON FOR YOUR RECORDS ~ REV-1547 EX AFP (01-0:~) NOTZCE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLOWANCE OR DZSALLOWANCE OF DEDUCTZONS AND ASSESSHENT OF TAX ESTATE OF GARROTT DELILAH S FZLE NO. 21 02-0083 ACN 101 DATE 09-$O-ZOOZ TAX RETURN NAS: (X) ACCEPTED AS FZLED ( ) CHANGED RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Roe1 Estate (Schedule A) {1} 2. Stocks and Bonds (Schedule B) 3. Closely Held S~ock/Par~narshAp Znterost (Schedule C) ($) ~. Mortgages/Notes Receivable (Schedule D) (fi) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6} 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTZONS AND EXEHPTZONS: 9. FuneraZ Expenses/Ado. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilitios/LAens (ScheduZo Z) (10) 11. Tote1 Deductions 12. Nat Value of Tax Return 0O 217 10 00 00 q~558 79 00 00 (8) 8,938.36 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 15. NOTE: ASSESSHENT OF TAX: 15. Amount of Line 1~ at Spousal rata 16. Amount of Line lq taxable at Lineal/Class A rate 17. Amount of Line lfi a~ Sibling rate 18. Amount of Line lq taxable at Collateral/Class B rate 19. Princi)al Tax Duo TAX CREDZTS PAYMENT RECE/PT DzsCOUNT DATE NUMBER ZNTEREST/PEN PAID (-) q,755.89 11f$7q.75 (11) 20.313.09 (12) 15,557.20- Charitable/governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) . O0 Nat Value of Estate Subjoc~: to Tax (lq) 15,557.20- Zf an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect flgures that include the total of ALL returns assessed to date. IF PA/D AFTER DATE ZNDICATED, SEE REVERSE FOR CALCULATION OF ADDZTZONAL ZNTEREST. (15) .00 X O0 = .00 (16) .00 X Oq5= .00 (17) . O0 x 12 = . O0 (18) .00 x 15 = .00 (19)= .00 AHOUNT PAZD TOTAL TAX CREDZT I .00 BALANCE OF TAX DUEI . O0 ZNTEREST AND PEN. I .00 TOTAL DUE I . O0 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS RE~UZRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDZT' (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SZDE OF THZS FORH FOR ZNSTRUCTZONS.) RESERVATION: Estates of decedents dying on or before December 1Z, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the laaful Class D (collaterat) rate on any such future interest. PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section Z140 of the Inheritance and Estate Tax Act, Act 25 of 2000. (Ti P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on tho reverse side. --Make check or money order payable to: REGISTER OF NILES, AGENT A refund of a tax credit, mhich was not requested on the Tax Return, may ba requested by completing an "Application for Refund of Pennsylvania Xnharitance and Estate Tax" [REV-ISIS). Applications are available at the Office of the Register of Mills, any of the ZS Revenue District Offices, or by calling the special Z~-hour answering service for forms ordering: 1-800-SDZ-Z050~ services for taxpayers with special hearing and / or speaking needs: 1-800-~7-50Z0 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax [including discount or interest) as shown on this Notice must object within sixty [60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in ariting to: PA Department of Revenue, 5ureeu of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 171Z8-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) 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 (5X) discount of the tax paid is allowed. The 15Z 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 (6Z) percent par annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOZ are: Year Interest Rate Daily Interest Factor Year Interest Rate Daily Interest Factor 198Z 20Z .O00S~8 199Z 9Z .000Z47 1985 1DX .000~$8 1993-1994 7Z .O0019Z 19D~ Ill .000301 1995-1998 9Z .000247 1985 Z3Z .000356 1999 7Z .OOOIeZ 1986 IOZ .000274 ZOO0 DZ .O00Z19 1987 9Z .O00Z~7 ZOO1 9X .000Z47 1988-1991 llZ .000301 ZOOZ 6Z .000164 --Interest is calculated as folloas: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELTNQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond tho date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest oust be calculated. F:\FILES\DATAFILEXESTATES\63381 -account. formal IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-02-0083 ESTATE OF DELILAH SOURS GARROTT, Deceased Late of Carlisle Borough Cumberland County, Pennsylvania FIRST AND FINAL ACCOUNT OF BARBARA MCCARTY, EXECUTRIX Date of Death: November 19, 2001 Date Letters Testamentary Issued: January 24, 2002 Date of First Complete Advertisement of Grant of Letters: February 15, 2002 Account Stated to October 4, 2002 SUMMARY PRINCIPAL: Receipts Net Gains/Losses on Conversions Disbursements $5,283.37 -104.30 5,179.07 -3,165.93 Principal Balance Remaining $2,013.14 INCOME: Receipts Disbursements Income Balance Remaining $3.75 0.00 $3.75 COMBINED BALANCE REMAINING $2,016.89 PRINCIPAL RECEIPTS 10 Shares Sprint M&T Bank, Checking #533750 M&T Bank, refund for safe deposit box key Blue Cross, premium refund Proceeds from sale of furniture Ewing Brothers Funeral Home, refund $ 217.10 3,885.34 15.00 158.45 480.00 527.48 TOTAL RECEIPTS OF PRINCIPAL: $ 5,283.37 NET GAINS(LOSSES) ON CONVERSIONS 10 Shares Sprint: Cost basis: 11/19/01 DOD Value $217.10 Redemption: 7/17/02 Proceeds $112.80 TOTAL LOSSES ON CONVERSIONS: PRINCIPAL DISBURSEMENTS 11/20/01 02/05/02 02/05/02 02/05/02 4/12/02 Sprint, outstanding check Witman Auctioneers Inc., appraisal of furniture Qualiy Inn, funeral reception Carlisle Memorial Service, inscription H&R Block, 2001 Income Tax Return Reserved for later disbursement: Barbara McCarty. Executrix Commission MARTSON DEARDORFF WILLIAMS & OTTO, disbursements: Probate fee $45.00 Sentinel 106.79 Cumberland Law Journal 75.00 Bond premium for last stock 3.81 Filing fee, Inheritance Tax Return 10.00 Certified mail fees 8.36 MARTSON, DEARDORFF, WILLIAMS & OTTO, attorney fees Reserved for additional filing fees TOTAL DISBURSEMENTS: INCOME RECEIPTS Sprint, 12/01 dividend Sprint, 3/12 dividend Sprint, 6/01 dividend TOTAL INCOME RECEIPTS: INCOME DISBURSEMENTS None TOTAL INCOME DISBURSEMENTS: $ -104.30 $ -104.30 $ 22.28 212.00 418.69 105.00 125.00 334.00 248.96 1,500.00 200.00 $ 3,165.93 $ 1.25 1.25 1.25 $ 3.75 $ 0.00 $ 0.00 CLAIMS OF UNPAID CREDITORS United Church of Christ Homes, Nursing home care within six (6) months of death not covered by Medicare Commonwealth of PA, Department of Public Welfare TOTAL CLAIMS OF UNPAID CREDITORS $ 2,915.30 8,422.15 $11,337.45 COMMONWEALTH OF PENNSYLVANIA ) 'SS. COUNTY OF CUMBERLAND ) Barbara McCarty, being duly swom according to law, deposes and says: That she is the Executrix of the Estate of Delilah Sours Garrott, deceased; 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; and that all taxes presently due from the estate have been paid. Barbara McCarty (Executor and Accountant) Swom to and subscribed before me this /&q& day of ~~c(, 2002. Public v , NOTARIAL SEAL CORRINE L. MYERS, Notary Pul~ic Carlisle Boro, CumberlandCounht My Commission £~pires Ma)/27, 2003 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 21-02-0083 SCHEDULE OF PROPOSED DISTRIBUTION BY BARBARA MCCARTY, EXECUTRIX Barbara McCarty, Executrix of the Last Will and Testament of Delilah Sours Garrott, deceased, proposes to distribute the balance in her hands, to wit: $2,016.89, in accordance with the said Last Will and Testament as heretofore filed in the Office of thc Register of Wills of Cumberland County, Pennsylvania, as follows: TO: United Church of Christ Homes, 25.7138% of Combined Balance Remaining Commonwealth of PA, Department of Public Welfare, 74.2861% of Combined Balance Remaining TOTAL DISTRIBUTION: $ 518.62 1,498.27 $2,016.89 STATEMENT OF THE REASONS FOR THE PROPOSED DISTRIBUTION The above distribution is proposed in accordance with the Last Will and Testament of Delilah Sours Garrott. Sworn to and subscribed before me this i~*k-day of ~, 2002. No~t-ary Public ~ Barbara McCarty'- t '""~7~ NOTARIAL SEAL C~O~..fl!NE~ L. MY_EP~, Notan/Public ~Jar. s~e ~oro. CumberlandCounl~ Commission E~pire,s May 27, 2003 F: \FI LES\DATAFILE\W1LLS\6338.WIL/cim LAST WILL AND TESTAMENT I, DELILAH SOURS GARROTT, o£ the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils by me made. 1. I direct that all my just debts, funeral expenses, testamentary expenses and all inheritance taxes (whether such taxes may be payable by my estate or by any recipient of any property) shall be paid £rom my residuary estate as soon as practicable alter my decease and as part of the administration of my estate. My Executor shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. 2. I give to my niece, BARBARA McCARTY, the following: My picture of Lake George, the china closet in the kitchen and my marble-top table (the larger of thc three). 3. I give to JOANNE ALLEN my solitaire diamond. 4. I give to GEORGIA ANN FARBER my diamond ring with two sapphires. 5. I give to NANCY HERRING my charm bracelet. 6. I give to CYNTHIA OLANDER my gold chain with Pisces. I direct that my bracelets (with the exception of my charm bracelet referred to in Item 5 herein) shall be divided between SABR1NA FARBER and ERICA FARBER. Page 1 of 4 Pages D.S.G. I give to LINDA BERKOSKI my cultured pearls and watch. 8. I give my antique jewelry to be divided among BARBARA McCARTY, NANCY HERRING and GEORGIA ANN FARBER. FARBER's children. I give my eamngs to be divided among GEORGIA ANN I give, devise and bequeath all the rest, residue and remainder of my estate, both real and personal property, in equal shares, unto my nieces, BARBARA McCARTY, JOANNE ALLEN, GEORGIA ANN FARBER and NANCY HERRING, absolutely. 10. I nominate, constitute and appoint my said niece, BARBARA McCARTY, as Executrix of my estate. In the event she is unwilling or unable to so act, then I appoint BARTON F. FARBER and GEORGIA ANN FARBER, or the survivor of them, as Executors of my estate. I further direct that my Executrix or Executors shall retain the firm ofMARTSON DEARDORFF WILLIAMS & OTTO in the settlement of my estate. 11. I direct that my Executrix or Executors shall not be required to file a bond to secure the faithful performance of their duties in any jurisdiction. 12. I authorize and empower my personal representative(s), in their sole and absolute discretion, to purchase or otherwise acquire and retain any investments of which I die seized or any real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant options in regard to any or all property of any kind forming a part of my estate for such terms and such prices as they may deem advisable; to borrow money for any purposes connected with the protection and preservation of my estate; to mortgage or pledge any real or personal property forming a part of my estate or to join in or secure the partition of same; to compromise any claims or demands of my estate against others or of others against my estate; to make distribution in kind Page 2 of 4 Pages D.S.G. and to cause any share to be composed of cash, property or undivided ~ractional shares in property different in kind fi.om any other share; to employ agents, attorneys and proxies and to delegate to them such power as my personal representative considers desirable and to pay reasonable compensation for such services as may be rendered by such agents, attorneys and proxies; and to execute and deliver such instruments as may be necessary to carry out any of these powers. In addition, I direct that my personal representative shall have the power to conduct an inventory of any safe deposit box necessary to the administration of my estate. IN WITNESS WHEREOF I have hereunto set my hand and seal this /.5--4'~t'day of ~ , 199~. 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, have hereunto subscribed our names as wimesses thereto, in the presence of the said Testatrix and of each other. Page 3 of 4 Pages COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ) SS. I, Delilah Sours Garrott, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. this COMMONWEALTH OF PENNSYLVANIA ) · SS. COUNTY OF CUMBERLAND ) Sworn or affirmed to and acknowledged before me by Delilah Sours Garrott, the Testatrix, J~-&dayof (-~~ ,199~. Notary Public o Notarial Seal Corrine L. Myers, Notary Public : Carlisle Boro, Cumberland County ~.y Commission Expires May 27, 1999 the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Delilah Sours Garrott, the Testatrix, sign and execute the instrument as her Last Will; that the Testatrix signed willingly and that the Testatrix executed it as her free and voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the Testatrix, signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more year~ of age, of sound mind and under no constraint or undue influence. Address /O ~. ,Z¢~ ~'7t· ~t,--l,~/~' ,°,4 / 7a z a Sworn or affirmed to and subscribed before me this/~-4~day of (0~, 199 Notary Public i Notarial Seal Corrine L. Myers, Notary Public i Carlisle Boro, Cumberland Count Page 4 of 4 Pages .~,.ly Commission Expires May 27, 1~9Y99 .?g _-,. REGISTER OF WILLS OF CUMBERLAND COUNTY STATUS REPORT UNDER RULE 6.12 (For Resident Decedents Dying After July 1, 1992) Name of Decedent: DELILAH SOURS GARROTT Date of Death: November 19, 2001 File No.: 21-02-0083 Social Security No.: 202-20-7294 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: State whether administration of the estate is complete: Yes X 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: Did the personal representative file a final account with the Court? Yes X No bo The separate Orphans' Court No. (if any)for the personal representative's account is: Did the personal representative state an account informally to the parties in interest? Yes ~ No ~ Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: January-31,2003 Signature: Name: Address: Ivo V.'~o]II~'~qt~re - MARTSON DEARDORFF WILLIAMS & OTTO Ten East High Street Carlisle, PA 17013 (717) 243-3341 Counsel for personal representative F:\FILES~DATAF1LE\ESTATESWORMSXsrep