HomeMy WebLinkAbout12-01-08
15056041125
~ REV-1500 EX (Oli-05)
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO Box 280601 INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 7 1 0 1 4
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 7 4 4 6 6 6 4 6 1 0 2 9 2 0 0 7 0 5 2 4 1 9 5 4
Decedent's Last Name Suffix Decedent's First Name MI
S T O K E DAN I E L B
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
N A
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
O 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
^X 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
S C O T T W M O R R I S O N E S Q 7 1 7 5 8 2 2 3 0 0
~a
Firm Name (If Applicable)
First line of address
6 W E S T M A I N S T R E E T
Second line of address
P O B O X 2 3 2
City or Post Office State
N E W B L O`O M F I E L D P A
ZIP Code
REGISTER O Y ~,L,S USE ON
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DATE`FILED G.:
1 7 0 6 8
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Correspondent's a-mail address:
Under pennies of perjury, I declare that I have examin this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true,~or~ect and complete. declaration of prepay er than the personal representative is based on all information of which preparer has any knowledge.
</t1i
4977 ~]I~GONERS GAP
SIGNATU ER OFI.IG/2 -~
ATIVE
LANDISBURG PA`17040
6 WE'~'i' MAIN S
15056041125
PO BOX 232 NEW BLOOMFIELD PA 17068
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056041125
15056042126
REV-1500 EX
Decedent's Social Security Number
DANIEL B. STOKE
Decedent's Name:
1 7 4
4
6
6
6
4
6
RECAPITULATION
1. Real estate (Schedule A) ........................................ 1. 6 5 0 0 0• 0 0
2. Stocks and Bonds (Schedule B) .................................. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages & Notes Receivable (Schedule D) ........................ 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 1 6 0 1 5 • 4 4
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers & Miscellaneous N n-Probate Property
(Schedule G) ~ S
t
Billi
R
t
d
epara
e
ng
eques
e
....... 7.
8. Total Gross Assets (total Lines 1-7) ........................... 8. 8 1 0 1 5• 4 4
9. Funeral Ex enses & Administrative Costs Schedule H g, 4 0 2 1 • 5 6
10. Debts of Decedent, Mort a e Liabilities, & Liens Schedule I
9 9 ( ) ............ 10. 2 0 9 9 2 1 3
11. Total Deductions (total Lines 9& 10) ........................... 11. 2 5 0 1 3 6 9
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) .............. .... 12.
.... 13.
.... 14. 5 6
5 6 0
0 0
0 1 •
1 • 7
7 5
5
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X.o _ 0 0 0 15. 0. 0 0
16. Amount of Line 14 taxable
at lineal rate X .0 _ 0 0 0 16 0. 0 0
17. Amount of Line 14 taxable
5 6 0 0 1
at sibling rate X .12 7 5
17. 6 7 2 0. 2 1
18. Amount of Line 14 taxable
at collateral rate X .15 0 0 0 18 0. 0 0
19. Tax Due ....................................... ... .. ....19. 6 7 2 0. 2 1
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^
Side 2
15056042126 15056042126 J
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
DANIEL B. STOKE
File Number
21 07 1014
STREET ADDRESS
19 HARMONY HALL ROAD
CITY STATE ZIP
CARLISLE PA 17013
Tax Payments and Credits:
~. Tax Due (Page 2 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. InteresUPenalty if applicable
D. Interest
E. Penalty
(1) 6,720.21
Total Credits (A + B + C) (2)
O.OC
Total InteresUPenalty (D + E) (3) O.OC
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4) O.OC
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 6,720.21
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 +SA. This is the BALANCE DUE. (5B) 6,720.21
Make Check Payable fo: 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 : ...................................................................... ^ ^X
b. retain the right td designate who shall use the property transferred or its income; ............................... ^ Q
c. retain a reversionary interest; or ................................................................................................ ^ X^
d. receive the promise for life of either payments, benefits or care? ....................................................... ^ Q
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ^ Q
3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ......... ^ Q
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. ^ ^X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
r•
For dates of death on or after July 1,1994 and before January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. §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 zero (0) percent
[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 zero (0) percent (72 P.S, §9116(x)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. §9116(1.2) [72 P.S. §9116(x)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(x)(1.3)]. Asibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1502 EX + (6-98)
SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DANIEL B. STOKE 21 07 1014
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real roe which is 'ointl -owned wkh ri ht of survivorshi must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. ALL THAT CERTAIN TRACT OF LAND SITUATE IN MIDDLESEX TOWNSHIP, 65,000.0(
CUMBERLAND COUNTY, PENNSYLVANIA, BEING MORE PARTICULARLY
DESCRIBED IN DEED RECORDED IN CUMBERLAND COUNTY DEED BOOK H,
VOLUME 35, PAGE 940, KNOWN AS 19 HARMONY HALL DRIVE, CARLISLE. SOLD
TO CHARLES AND DONNA BARYON ON NOVEMBER 7, 2008.
SEE ATTACHED SETTLEMENT STATEMENT.
TOTAL (Also enter on line 1, Recapitulation) ~ $ 65,000.0(
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
IN REST DAENTEDECEDENT N PERSONAL PROPERTY
ESTATE OF FILE NUMBER
DANIEL B. STOKE 21 07 1014
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. TAX PRO-RATION ON SALE OF 19 HARMONY HALL DRIVE, CARLISLE. SEE 418.5E
ATTACHED SETTLEMENT STATEMENT.
2. MEMBERS 1ST FEDERAL CREDIT UNION 17.1E
ACCOUNT # 101103-00
3. MEMBERS 1ST FEDERAL CREDIT UNION 343.8E
ACCOUNT # 101103-11
4. SALE OF 2003 TOYOTA TRUCK 14,500.OC
5. IEMBARQ REFUND ~ 19.7;
6. HARTFORD INSURANCE REFUND
7. STATE FARM FIRE REFUND
8. IU.S. TREASURY STIMULUS CHECK
66.04
47.1 ~
600.OC
9. IU.S. TREASURY -TAX REFUND ~ 2 87
TOTAL (Also enter on line 5, Recapitulation) I $ 16 01
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+(10-06)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE H
FUNERAL EXPENSES 8~
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
DANIEL B. STOKE 21 07 1014
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Street Address
City State Zip
Year(s) Commission Paid:
2. AttomeyFees SCOTT W. MORRISON, ESQ. 3,500.OC
3. Family Exemption: (If decedents address is not the same as claimants, attach explanation)
Claimant
SVeet Address
City State Zip
Relationship of Claimant to Decedent
4• Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS 264.OC
5. I Accountants Fees
6. Tax Retum Preparers Fees
7. CUMBERLAND LAW JOURNAL -ESTATE ADVERTISING 75.OC
8. THE SENTINEL -ESTATE ADVERTISING 182.5E
TOTAL (Also enter on line 9, Recapitulation) I S 4 021 5E
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-03)
' ~ SCHEDULE 1
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT ~
ESTATE OF FILE NUMBER
DANIEL B. STOKE 21 07 1014
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. SETTLEMENT COSTS ON SALE OF 19 HARMONY HALL DRIVE, CARLISLE. 5,375.4E
SEE ATTACHED SETTLEMENT STATEMENT.
2. PP&L ELECTRIC 126.5
3. AERO ENERGY -FUEL OIL 219 9C
4. HOLY SPIRIT HOSPITAL 25.0C
5. STEVE BARRETT APPRAISAL SERVICE 325.OC
6. M&T BANK -PAYOFF TRUCK 13,991.81
7. (YORK DISPOSAL ~ 46.8E
8. ISOLLENBERGER'S MESSENGER SERVICE ~ 12.OC
9. (MIDDLESEX TOWNSHIP MUNICIPAL AUTHORITY ~ 198.0E
10. MEMBERS FIRST -CIVIL SERV. FUNDS 371.44
11. REAL ESTATE TAXES 300.OC
TOTAL (Also enter on line 10, Recapitulation) 13 20 992 1
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (g-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
DANIEL B. STOKE ~~ n~ ~n~~
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustees) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. KERRY L. STOKE Sibling
12 HEAVENS WAY 1/4
LOYSVILLE PA 17047
2. APRIL N. BOWER Sibling
4977 WAGGONERS GAP ROAD 1/4
LANDISBURG PA 17040
3. PHYLLIS ROBYNN STOKE Sibling
2235 SHERMANS VALLEY ROAD 1/4
ELLIOTTSBURG PA 17024
4. MICHAEL E. STOKE Sibling
64 HIGGINS ROAD 1/4
DUNCANNON PA 17020
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
L
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET S
to niuie space is neeaea, insert aaalnonal sheets of the same size)
LAST taI L,L AND TESTAMENT
OF
DANIEL B. STOKE
I, DANIEL B. STOKE, of 19 Harmony Hall Drive, Carlisle, Cumberland
County, Pennsylvania, being of sound and disposing mind, memory and understanding,
do make, publish and declare this to be my Last Will and Testament, hereby revoking and
making void all previous Wills and Codicils heretofore made by me.
FIRST
I order and direct my Executor hereinafter named to pay all of my just debts, ~~'
funeral expenses and expenses involved or connected with the administration of my estate
as soon after my death as is reasonably possible. I direct my Executor to pay all
inheritance, estate, succession and legacy taxes, to which my estate or the transfer of any
property hereunder may be subject, and to charge such taxes as part of the expenses of the
administration of my estate, being deducted and paid from the residue of my estate and
not to be deducted in any manner from any specific bequests made herein. However, my
Executor need not accelerate and pay those unmatured obligations which, in his, her or its
opinion, it might be proper and more advantageous to retain or renew and pay as they
become due and payable. If I do not own a burial plot or a grave marker at the time of my
death, I authorize my Executor/Executrix, in his, her or its sole discretion, to purchase a
GRIFFIE & ASSOCIATES
Attorneys At Law
200 N. Hanover Street Page 1 of 7 100 Lincoln Way East, Suite D
Carlisle, PA 17013 Chambersburg, PA 17201
v
burial plot and to erect a suitable grave marker at my grave, and ~o eapead wms >Frad~ my
estate for this purpose.
SECOND
I give, devise and bequeath my entire estate together with all insurance proceeds
thereon of whatsoever nature and wheresoever situate in equal shares to my siblings,
KERRY LEE STOKE, of Loysville, Pennsylvania, MICHAEL ELWOOD STOKE, of
Duncannon, Pennsylvania, APRIL N. BOWER, of Landisburg, Pennsylvania, and
PHYLLIS ROBYNN, of Elliottsburg, Pennsylvania, provided they survive me by sixty
(60) days, per capita. I direct my Executor/Executrix to divide among such beneficiaries
all personal property of a sentimental or family nature (excluding cash, stocks, bonds and
the like), including but not limited to jewelry, household goods, antiques, furniture and
memorabilia, in accordance with a separate memorandum which I may place with my
Will or deposit with my attorney. In the absence of such disposition by memorandum, I
direct that the said tangible personal property be divided between my residual
beneficiaries with due regard for their personal preferences in as nearly equal shares as
practical, with the value of such dispositions being credited to the share of each respective
recipient. If the said beneficiaries do not agree to the division of the personal property
provided for hereunder, the decision of my Executor/Executrix, including the decision to
sell the property at public or private sale and distribute the proceeds therefrom as
provided hereinafter, shall be final and conclusive on all parties.
THIRD
I grant my Executor/Executrix the following powers in addition to and not in
limitation of such powers as my Executor/Executrix shall hold by law:
GRIFFIE & ASSOCIATES
Attorneys At Law
200 N. Hanover Street I DO Lincoln Way East, Suite D
Carlisle, PA 17013 Page 2 of 7 Chambersburg, PA 17201
..~,:.:,~......:,.~,,..~~.-:~~ ..:,.~Y:.
(a) To retain all property received including the stock of any corporate fiduciary
acting hereunder, provided such property remains productive.
(b) To join in any corporation, partnership, recapitalization, merger,
reorganization or voting trust plan; to delegate authority with respect thereto;
to deposit investments under agreements and pay assessments; and generally
to exercise all rights of investors, including but not limited to, the voting of
shares.
(c) To manage, operate, repair, improve, mortgage or lease on any terms any real
estate held or owned by my estate.
(d) To operate any business that I may own at my death.
(e) To invest any funds of my estate in any stocks, bonds, notes or other securities
200 N. Hanover Street
Carlisle, PA 17013
Page 3 of 7
100 Lincoln lvi'ay East, Suite D
Chambersburg, PA 17201
~sx-a ,-
or property, real or personal, without regard to the principle of diversification
or any other statute or general rule of law in his, her or its absolute discretion,
it being my intention to give my Executor/Executrix the broadest investment
powers possible, providing such investments do not unnecessarily prevent the
prompt settlement of my estate.
(f) To sell or otherwise dispose of any property, real or personal, tangible or
intangible, at any time forming a part of my estate in any manner and on such
terms and conditions as my Executor/Executrix shall see fit in his, her or its
absolute discretion.
(g) To borrow money for the payment of taxes or for any other proper purposes in
the administration of my estate, and to mortgage or pledge estate assets as
security.
GRIFFIE & ASSOCIATES
Attorneys At Law
(h) To compromise claims without court approval including, but not limited to,
any controversies with the Utited States of America or the Commonwealth of
Pennsylvania concerning estate and inheritance taxes on any interests that may
pass under this my Last Will and Testament.
(i) To distribute in cash or in kind upon any division or distribution of my estate.
(j) To undertake any and all acts deemed necessary and proper by my
Executor/Executrix for the proper, advantageous and prompt management of
the settlement of my estate.
(k) In general, to exercise all powers in the management of my estate which any
individual could exercise, in the management of similar property owned in his
own right, upon such terms and conditions as to him, her or it may seem best
and to execute and deliver all instruments and to do all acts which he, she or it
deems necessary or proper to carry out the purposes of this, my Last Will and ~~
Testament.
FOURTH
No interest of any beneficiary of my estate, either in income or in principal, shall
be subject to anticipation or pledge, assignment, sale or transfer in any manner, nor shall
any beneficiary have the power in any manner to charge or encumber his interest either in
income or principal, nar shall the interest of any beneficiary be liable or subject in any
manner while in the possession of my Executor/Executrix for the liability of such
beneficiary.
200 N. Hanover Street
Carlisle, PA 17013
GRIFFIE & ASSOCIATES
Attorneys At Law
Page4of7
100 Lincoln Way East, Suite D
Chambersburg, PA 17201
FIFTH
I nominate, constitute and appoint my sister, APRIL N. BOWER, as Executrix of
this my Last Will and Testament. In the event my sister is deceased, unable or unwilling
to serve or shall cease to serve for any reason whatsoever, then I nominate, constitute and
appoint my brother, KERRY LEE STOKE, as Executor of this my Last Will and
Testament. I direct that my Executor/Executrix shall not be required to give or post bond
for the faithful performance of his, her or its duties in this or any other jurisdiction.
SIXTH
I hereby declare it to be my expressed desire that my Executor/Executrix employ
the law firm of Griffie & Associates, of Carlisle, Pennsylvania, for legal advice and
assistance regarding this my last Will and Testament, they having considerable
knowledge of my affairs, views and wishes respecting any matters that may arise at the
probate of this instrument, the administration of my estate, and the execution of the
powers herein mentioned.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last
Will and Testament, consisting of seven (7) typewritten pages, the first four (4) of which
bear my signature on the side margin, for purpose of identification, this f 1, '`~
day of _ ~~~ -,~,~ , 2007.
WITNESS:
200 N. Hanover Street
Carlisle, PA 17013
Page 5 of 7
I00 Lincoln Way East, Suite D
C1:an:bersburg, PA 17201
r ~!~~
DANIEL B. STOKE
GRIFFIE & ASSOCIATES
Attorneys At Law
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA:
. SS.
COUNTY OF CUMBERLAND
I, DANIEL B. STOKE, the Testator whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will and Testament;
that I signed it willingly, and that I signed it as my free and voluntary act for the purposes
therein expressed.
~~'~ ~ - ~fj'~~~
DANIEL B. STOKE
Sworn or affirmed and acknowledged before me by the Testator this ~~ -
day of (~t"~~b,r"~ , 2007.
e . su:
No~u ~
~ ~. ~n
Notary rubNe
c,~cwtE ~o~ouaN, c
MI-{v~nMMlo~ ExpHa Apr 17, 1011
200 N. Hanover Street
Carlisle, PA 17013
GRIFFIE & ASSOCIATES
Attorneys At Law
Page 6 of 7 100 Lincoln Way East, Suite D
C'hambersburg, PA 17201
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA:
. SS.
COUNTY OF CUMBERLAND
' VVE, ) _ and ~, ~_,
the witnesses whose names are attached to the foregoing document, being duly qualified
according to law, do depose and say that we were present and saw the Testator sign and
execute the instrument as his Last Will and Testament; that he signed willingly and that
he executed it as his free and voluntary act for the purposes therein expressed; that each
subscribing witness in the hearing and sight of the Testator signed the Last Will and
Testament as witnesses and that to the best of our knowledge the Testator was at the time
18 or more years of age, of sound mind and under no constraint or undue influence.
Sworn or affirmed and su
i
and ~ l ~ ~ ~ l~ this ~~' day of ~- ~.,~ , 2007.
Notary Public
NO?ARIAI MAl
ROMN J. MiKTT
Nokxy h~ONC
OOOOYON. gM~MO
~~o11w~MMion ~tpM~f App 17, 2011
200 N. Hanover Street
Carlisle, PA 17013
GRIFFIE & ASSOCIATES
Attorneys At Law
100 Lincoln Way East, Suite D
Page 7 of 7 ('hambersburg, PA 17201
COMMONWEALTH OF PENNSYLVANW
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DIVISION OF THIRD PARTY LU161LITY
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG, PA 17105-8486
November 27, 2007
SCOTT W MORRISON
SCOTT W MORRISON
6 WEST MAIN STREET
PO BOX 232
NEW BLOOMFIELD PA 17068
Re: DANIEL B STOKE
SSN: 174-46-6646
Dear Attorney Morrison:
Pursuant to your letter dated October 29, 2007, the Department of Public
Welfare (DPW), Estate Recovery Program, has reviewed the information you
provided regarding the above-referenced individual.
It has been determined that DPW will only pursue t:he recovery of PROBATE
ESTATE claims when the individual was fifty-five years of age or older at the
time that assistance was received.
Therefore, according to the information you provided, the Department's
Estate Recovery Program will not seek any recovery from this estate.
If you have any questions, please feel free to contact me.
Sincerely,
.~ ,y
Carole A. Procope
Recovery Section Manager
(717)772-6604
~lr'1~/2008 13:56 7172433518 JVERNEY PAGE 01
rtUD , ~ UpfIFORM SF.7T~.EM1iEIVT STATEMENT UMtt Approval No. 25QZ-0~6~
A C "i. DrPARTMCNT OF Hb S[N(~ ANU uttnnrv ve~cw~ ~.'..~ b. File Nombcr: 7. loan Nltmboc~.
6. TYPE ~ LOAN B_5
t, F1tA 2• FmFIA ~ clnauranceCnseNumllcr
3, Conv. Unins. a, VA 5. Conv. lns. R. Mort g
o.c.
C, NOT)r: This form is furnished to Rive you a statorttrnt of actual settlement costs. Amoants paid to and by the sotdcmottt ascot arc sh0«n, f(cros P~
were paid outside ilte et0.ain~: thoy aro sho+*~ here for idfpmgti~nal purpuSCS trod arc not included in the totals,
NOTG; TIN = Tax a rs tdcntif'lction Number
p. NAME AND AC'DR[•;55 OP DORROWER: E. NAMLi, ADDRESS ANU'TIN OF SF.LLF:R: F. NAME AND ADDRESS L7F LtiNI)T;R;
A ril iV. Sower, Ivxe.Gutrix o£ None
Char",esw.sartor•. 1?
~:tra 1,• Barton Daniel. S• Stoke
32G0 Twilighti brine 19 Harmony Hall Drive
Crestv,ieu, Pi 32539 Ca~tisle, PA 17p13
Ci. PROPERTY LOCATION: H. SF.TTI.F.MEN'1' AGE~1T NAME. ADDRESS Ai`tD T1N
19 Harmony Hatl Drive Jdqueline M.Vr?rney, Eequire
Car1=51e, PA ?.'7013 +!4 South HP vEr Street Carl'sle•~ PA 1701
'" PLACE nF SEI-tLGMF:NT 1. SL•TT1.FiMtfN'f DATE;
94 South Flanovpr Street 11!07/2008
to
SELC.ER'S STATrMr-.NT
The info;matic+n contained i^ Blocks F., G, Fl, and 1 and nn line 4Q t {or, if line 401 1,5 3fiiCiiSlGCd, line 4q3 and 404,1 is impartaut tas infarnlalion and is being fumishcJ to the
Internal Rc~rnue Service (sce Seller Ccrtitrcatiott)_ If you arc rt:quircd to fire a naurn. a ncgtigence prnalty or other sanction .~~iU he imposed nn you if this item is required
to be reported and tlrc IRS dttctmincs that it hac oat been repprtcd. You arc required to proride flee 5ettlcment A.gcnt wi111 your correct 18xpa}cr idenlifn."[liPn number. If rou
do not ptOvidc the SClllelrlCnt Agent with yotu curroct IaXpzyM identi(iwliott number, you may he subject to civil or crirnlnnt pcnnitich iropoaed by In~•. Ua~der pennltiaa ~~f
perjury, f certify that the number sho~m rm this statement is t»y etxrect taspayet identification nvrnher.
(Scllcr's5ignnhtrc) Rpril N. Fso~rer, Exetutrix of (Scllcr'sSigatiriirt:l Daniel B, Stoke
,i1 EASY SOFT, loc. 2001 Pscviqus tdillOfl3 are obsolete PkGL• I Fenn FIUU-1 (3/R6) ref Nonifhmk a345.2
L. s~~-r>VcM~rn' c~u>zc~s
ved the . Scttlettbent Statement i~nd tO the beat of my
the in [coon. 1 further certify that 1 rec~prl~~
of tho
PAID FROM t -r -u..'.......
BORROWERS I SELLER'S
mpg A7 FUNDS AT
it is a true and aecurste statement of all
v ewer C eSW.BartonDonnaL.Barton
Selter A i~. ~%. $o e
gct~ Daniel B. Stoke ~ trawcr Chxigtoprier J. Harton eftlresettkmcntaf
The HL'D-t Scttleourrt Statement which 1 have K s (n~c and accurate aceOUm oi'thc funds diRburscd tn' AD be dicbutscd try the undersigned as Pant
th' tranaBCtion.
11/07/2006
eme t Jacqueline iK. Vein , Esquire Date
V6 It is a crime to knowingly make ftllae atiltcmenLS to the United Status on this or arty Other similar forth. Penattics upon conviction can inchrde 6 fine and
lmprisanmcnt. For details sec: 'Citle 18 U.S. Cade Secti~ 1001 mA Section 11110. farm f1UD-I (3J86) re 1-[m~dt~ook 430 .2
4? £,+,SY SOFT, Inc. 200 t PrcviO+ts aditiot~ are Obsolete PaQc Z
/ T IS DB~RD
MADE THE ! ~~~ day of in the year
of our Lord one thousand nine hu dred ninety-one (1991).
BETWEEN H. PAUL MELTON and LUCILLE B. MELTON, husband and wife,
Grantors,
and DANIEL B. STOKE, Grantee,
WITNESSETH, that in consideration of NINETEEN THOUSAND and NO/100----
-----------------------($19,000 00)--------------------------Dollars,
in hand paid, the receipt whereof is hereby acknowledged, the said
Grantors do hereby grant and convey to the said Grantee, their heirs
and assigns,
ALL that certain tract of land situate in Middlesex Township,
Cumberland County, Pennsylvania, bounded and described in accordance
with Subdivision Plan for Carl H. Anderson prepared by Larry V.
Neidlinger, Registered Professional Land Surveyor, dated July 17,
1986, and recorded in the hereinafter named Recorder's Office in Plan
Book 52, Page 49, as follows:
BEGINNING at a point in the centerline of the Township Road known as
Harmony Hall Road, which road was formerly L.R. 21067, at the South-
west corner of land now or formerly of Leonard J. Redding and wife
described in the hereinafter named Recorder's Office in Deed Book "Q",
Volume 22, Page 223, which adjoining land is sometimes known as land
of U-Haul; thence from said point at the Place of Beginning along the
southern line of said land now or formerly of Leonard J. Redding and
wife, North 62 degrees 05 minutes East a distance of 336.40 feet to an
existing iron pin at the dividing line between Lots Nos. 2 and 2-A;
thence along said dividing line between said Lots Nos 2 and 2-A, South
27 degrees 55 minutes East a distance of 49.93 feet to an iron pin set
in line of land now or formerly of Etha M. Zeigler; thence along line
of said land now or formerly of Etha M. Zeigler, South 62 degrees 06
minutes 30 seconds West a distance of 341.11 feet to a railroad spike
in the centerline of said Township Road known as Harmony Hall Road,
which road was formerly L.R. 21067; thence along the centerline of
said Harmony Hall Road, North 22 degrees 31 minutes West a distance of
50 feet to a railroad spike at the Place of BEGINNING.
-1-
~neo,c N35 SAGE 940
~;'~~''
THE above described tract of land is all of Lot No. 2 as shown on said
Subdivision Plan for Carl H. Anderson, dated July 17, 1986, recorded
as aforesaid, and contains as acre of 0.388 acres, more or less.
THE westernmost 25 feet of the above-described tract of land consti-
tutes a portion of the dedicated right-of-way of said Harmony Hall
Road, formerly L.R. 21067, as shown on said Subdivision Plan for Carl
H. Anderson, dated July 17, 1986, recorded as aforesaid.
BEING the same premises which Carl H. Anderson and Isabella M.
Anderson, husband and wife, by their deed dated July 27, 1989, and
recorded August 8, 1989, in the Office of the Cumberland County
Recorder of Deeds in Deed Book 34, Volume C, Page 326, granters aid ,,
conveyed unto H. Paul Melton and Lucille B. Melton, Grantors er`ei.n~;
cn ~ ~ o
'~ c; c,
rn ma-,~-~
_~ ~ ~~ t'S
^~ % •7
~ • _'1
~ t 'Tl
School Gist. Cumb. Co., Pa. ~ ~, < <:,
1~ Reaf Es3:ate Transfer Te Do ~ ~ ~~ '`
'z a ~-.
-~ r*' _
Dats g'~~-9! ,amt ~ -~-~ .~` °
t-~ r• ~.
Cumb. Co. Dist Col. A9t./73
iCNI11S~1!l of
numb. Ca., Pa ~_ ~, _ ~,, ; ; -~
y96 Reai Estate transfer Tax _~ , _, ~~,,: , -,.; _ ,;~ . _ , `
Date - (~'9~ --7Amt. ~- _--_ -:: f _ c __ .
Cumb. Co. Dist. Col• A9t• ~, ... ,._.. ~ ,. .
/~
AND the said Grantors hereby covenant and agree that they will
warrant specially the property hereby conveyed.
-2-
~OOK ~35 PAGE 941
.,
n
and seals the day and year first above written.
!I Signed, Sealed, and Delivered
in the Presence of
~I
Ij, -.n...~.
~~ ~~ ~/fit-.
: H . 2r,UL MELTON
: `~~ ' -
L CILLE B. MELTON
COMMONWEALTH OF PENNSYLVANIA:
SS:
COUNTY OF CUMBERLAND :
3'Y
On this, the ~ day of ~_ ~ • ~n ~ , ].~91, bef:~re mfg
the undersigned officer, a Notary Public, personally appeared H. Paul
Melton and Lucille B. Melton, husband and wife, known to me (or
satisfactorily proven) to be the persons whose. names are subscribed to
the within instrument, and acknowledged that they executed the ;ame
for the purposes therein contained.
IN WITNESS WHEREOF, said Grantors have hereunto set ~~heir
IN WITNESS WHEREOF, I have hereunto set my hand an.ci offici~Yl se~~l
the day and year first above written.
• O• ,; ~• + •. -O = Dar:~e~~e :v. rW Notary Public
`~: 4 .•~~S-•r : O = Mechanicsbury Bo~ro,~Cumber(and Courrty
:- ~ ~~, ' r s v~ . My Commission F.~ires July 3,1995
. .-
?+ : j°"~~ ~v.~- :~,'~ ... Member, PennsylvaniaAssodatlOn Of NOterieB
-3-
Notary Public ~~
BpOK ~ ~rJ PAGE 9~
.~.,
I do her~e~by~ certify t.kiai: the precise reside a and complete post
office add~~c~.c.~ f a w~~~=,-Y~ na~Gr tee i
DATED : ~ ~+ ~ 9/
COMMONWEALTH OF PENNSYLVAr?T: r,:
. SS:
COUNTY OF CUMBERLAND
L~~~~~
Att e or ~
i~~ 4
RECORDED on this ~ ~ _,__ day of ~~ A. D.
1991, in the Recorder's C~:I:f .ceQ of the said County, in Deed Book
I~ , Volume ~ , I'~~c~e !~
Given under my hand and t.~ie seal of the said office, the date above
written.
.~~, ~.
~` v ~
~Y\ w'
•• ~ `t
' ~ .- 'i.. ~ y /~r. {
•..
,~,~
~~...QI'
a~r ~ 4
Recorder.
j PAGE g~
4~
•~ •
REGULAR SAVINGS ACCOUNT:
Account Number/ Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
CHECKING ACCOUNT:
Account Number/Suffix
Date Account Established
rincipal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
St
MEMBERS 1St
FEDERAL CREDIT UNION
101103-00
03/28/1988
$15.56
$1.63
$17.19
None
101103-11
11 /02/1998
$343.86
$.00
$343.86
None
M ERS 1ST FEDERA CRE I UNION
~~ ~ ~~~
~~-
anielle A. Kline
insurance Services Specialist
November 29, 2007
Estate of: DANIEL STOKE
Date of Death: October 29, 2007
Social Security Number: 174-46-6646
50(10 Louise Drive P.O.13ox 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 ~www.memberslst.org