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HomeMy WebLinkAbout02-0587PETITION FOR PROBA E s Estare of Violet Rockey also known as Violet ,S. Rocket/ Socia! Security No. 160-1 - and GRANT OF LETTERS No. 21-02-587 To: Register of Wills for the County of Cumberland ~ the Commonwealth of Pennsylvania The petition of the undersigned respectfully represrnts that: Your petitioner(s), who~/are 18 years of age or older an the executors named in the last will of the above decedent, dated August 4, 1986 __ ,19 and codicil(s) dated (none ) (state tdevant cir~ntmstat~s, e.~. ceauadauoa death of otecutoc, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with her last family or prindpal residence at 22McBride Ave. , Carlisle,PA 17013 (Sx street, number wad muttdp~tiq) Decrndent, ~~ 88 yes of age, died „Aril 24, 2002 - ~_~ _ _ .__l ~l .. T]T l.dL 11.716 i~ .t.viacsi ~-a.r...~.a....- --___- Except as follows, decedent did not marry, was not divorced and did not have a cht7d born or adopoed after atecution of the w[11 offered for probazC was not the victim of a 1dIling and was never adjndiated incompetrnt: Decendrnt at death owned property with estimated valuer as follows: (If domiciled in Pa.) ~ ~SO~ pCO~yP~ylvazua (If not domiciled in Pa.) Personal property ' (If not domiciled in Pa.) Personal property in County value of real state in Pennsylvania sicuazed as foQows: WHEREFORE, petitioner(s) respectfully request(s) the probaze of the last will and codidl(s) presented herewith and the grant of lettczt testamentary ([tSStZttlCIItaty: "~"'+n*~3ot1 C.L1: i +n'ur~r~on d.b.II.C.L1.) theron. a -, i, ._: Y '' 7 - ~= u ~- >> z s Deceased. S 20,000.00 S S S OATH OF PERSONAL REPRESE~iTATIVE COMMOYWE~LTCH OU~~F P~ NSYLV~NIA ~ ,3 COL: VTY OF The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the bat of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well d truly adgmi ~ the state according to taw. Sworn to or affirmed and subscribed "'' ~" 6th day of .v a I. ke °p before me this '_ (~~~~ n Charles R. Rocke 159 East North Street Carlisle PA 17013 j1~jp. 21-02-587 Estate of vIOLET R, ROCI~'Y ~ Deceased DECREE..OF PROBATE ADD GRAI'~1T OF UTTERS AND NOw JUNE 25 2002 ~_~ ~ ~ronsida~atson of the petition on the reverse side hereof, satisfactory proof having been presented before me, TT IS DECREED that the iasunmeIIt(s} ~~ August 4, 1986 described therein be admitted co probate and filed of record as the last wi11 of Violet R. Rockey a/k/a Violet S. Rockey and Letters Testamentary ~ ; are hereby granted to ViYiar~ I , Rockey and Charles R Rockey ~a~~ Probate, Letters, Etc.......... s 50.00 -_ Short CertiFcates( ) .......... ~ 6.00 won ................ S JCP ~S 5.00 TOTAL S 76.00 Fled ..JUNE .6:_2002 ................... -- ,. ~ - r of ~/ f~~~ Bradley L. Griffie, Esq. 34349 ATTORNEY (Sap. Q t.D. Na) 200 North Hanover Street, Carlisle, PA ADDRESS 17013 (717) 243-5551 PHONE PETITION FOR PROBATE and GRANT OF LETTERS Estate of VIOLET S ROCKEY also known as Deceased. Social Security No. 160-16-3897 The petition of the undersigned respectfully represents that: in the Your petitioner(s), who is/are 18 years of age or older an thhe execu in the last will of the above decedent, dated AUGUST 4, 1986 named and codicil(s) dated , 19 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in CUMBERLAND County, Pennsylvania, with h last family or principal residence at 22 McBride Ave Carlisle PA (list street, number and muncipality) Decendent, then 88 years of age, died April 24 ~ X2002 at Carlisle Re Tonal Medical Center Carlisle PA ' Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ 20, 000.00 (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: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. Vivian I Rockey a.k.a. v".. ~1iVian Trans Rn..Lo., v~ ~" C ~ O K '« c0 C. a~ .,., O C CO Vl COMMONWEALTH OF PENNSYLVANIA 1 COUNTY OF CUMBERLAND ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well d truly administer t estate according to law. Sworn to or affirmed and subscribed ~'~ ~ t~ ~~ •. `, before me this 13th day of JUNE „ ~ 2002 ~ ~ a No. 21-02-587 To: OATH OF PERSONAL REPRESENTATIVE Register of Wills for the County of Commonwealth of Pennsylvania >; ~~~~~~~ aster ;l NO. 21-02-587 Estate Of violet S Rocket/ ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW JUNE 25 ~~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 August 4, 1986 described therein be admitted to probate and filed of record as the last will of Violet S Rockey ; and Letters Testamentar are hereby granted to Charles R Rockey and Vivian I Rockey aka Vivian Irene Rockey / -, / / / R aster of Wills ~~`~~ r FEES Probate, Letters, Etc. ......... ~ Short Certificates( ) .......... ~ Renunciation ................ ~ TOTAL $ ATTORNEY (Sup. Ct. LD. No.) .ADDRESS Filed ................................... PHONE This is to certify that die information here given is correctly copied From an original certiticare of deadl duly filed with me as Local Registrar. The original certificate will be foitivarded to the State Vital Kecords Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee For this certiticare, $2.00 nl~~ H Fps:- t ~• ~ .X~ a r ~`~~ ~ ~,1~ ~ Local Registrar ' ~\O .ice}. a\ q9 M _ ~,~~a~,''~ A? ~ 2 521102 _- _ ENT ,,,,,r„Irr" No. [)ate G' Htos.;uReY.?JBT COMMONWEALTH Of PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH MT NT +~ :i NAME OF DECEDENT (F/N. Mim». Lavl SEx SOCIAL SECVRITY NUMBER _ GATE OF DEATH,MOnm. D•y.''a•rl +• Violet Ruth Rocke :. Female ]. 160 - 16 - 3897 a. April 24, 2002 ACE (Las Bnndayl UNDER t YEAR UNDER t D/O' DATE Of BIRTH BdTTHPUCE (Gay and M nm D M F S ' PLACE OF DEATH tCne cw aruy ory- uea mmYClms on ana v0s1 88 MgRM t Daya HOUM M rNRSa i g . ay. erl Apri1 llea aagn CtaaaYl HOSPITAL: OTHER: Yn. 1914 Carlisle PA ~ twK ~c ERlOutpet»M G ow ^ „~ ^ R.,,da,,,~ ^ iS~wcMl ^ 3 T COUNTY OF DEAM CfTY, BORO. TWP OF DEATH fACIL(rV NAME 31 opt msPMan, qne siren an0 numtaai WAS DECEDEM OF HISPANIC ORIGIN7 RACE - AmaK:nl nitian, B1aca, Wme. Nc. NO ® YM ^ 3 ysr, apacKy CWan, ISPa~~') ' „ Cumberland ~. Carlisle ,,. Carlisle Regional Medical Center ""~^•"~^^Rk•^•«° +• ,E. White DECEDEM'S USUAL OCCUPRgN KING OF BUSINESSIINDUSTRY WAS DECEDENT EVER IN DECEDENT'S EDUCATION MARITAL STATUS-Mart»d SVRVWING SPOUSE (Give Mnddwakmm mrnq oast U.S. ARMEDfORCEST ede e0m NMrMart»O,Wmaaad, tE wsa qve m,aenrw~el of waRin, al; m not wa rMweal YY ^ NO ® ENrmnlrylSacanary Cd»,a Dnacad ISPeeM I>lIA 8 U.Ra5+1 Own Home - Homemaker Wid ,:. ,]. „~ „E. ,.. ow „• DECEDENT'S MAILING ADDRESS (SnM.CRy/mwn, 5lb.Ia Codel DECEDENT'S ,T. s„t pA ,T ^ N O 22 McBride Ave. . . ~~ e. ., an01n1 EYad» IwP. e~~NCE Carlisle PA 17013 ~ aN'"`ro"' ~ ,. ipT No.ac.aMwva °'"""°~°' ,,,. Cumberland ,,..® wRnnacmWLmibn Carlisle ~„ FATHER'S NAME IFav. Mi0da. Lash MOTHER'S NAME (F+Y. MA^le. MaMM SAMma) „- Charles Stover „ Mabel Mentzer INFOHMANi'S NAME (TypelPrinh Vivian Rockey INF T'S MA NG SS IStrsaI, CRy a, Zip 1 Mc~r1e Ave., (~.ar~1sle PA 17013 TEa N METI,OD OF pSPOSITg DATE Of DISPOSITION PLACE OF DISPOSTION • Harm n Cam,ary, Crannay LOCRgN • CRyrtmM, Slne, Ip Goa r~( t BlKlulJ `r.m.,an^ R.ma.n`rns,na^ (M~ 1 ~a oa,n»n^ Odw FR»cRr+ ^ Apr3 1 26, 2002 Westminster Mem. Gardens Carlisle PA 17013 711 Tm. Ttc. T,d. sKiNQU OF FUNERAL SERV E Llc E oR RsoN ACTING SUCH LICENSE NUMBER NAME ANDAOORESSOF FACILRY ~ man- ~ era ome ' TTL Tze. 013144E ,x.219 N. Hanover St. Carlisle PA 17013 • Rama 2]ac aKy wmn Cat b UM Oaat n my Lnow»dga. aaln atarsd al Im lam, eta aM gate stated. LICENSE NUMBER DATE SIGNED yy.el.n» MK avaRaON n,mw W aaM a ' aRMy caw. d ann. (S~gnenne srm iilb) P,,ab,. M. wr1 - T]L /I 'odr !/!/ T]u. R - a 3 3 sy- T]e. ~ o0 Kam Ta•23 man W rompNlal try TIME OF OEATN A DQE PRONOUNCED DEAD (MOnm, Dey, lpah WAS CASE REFERRED 10 MEDICAL E%AMINERICOROHER7 / • Paaa, wro vraarac« a..tn. r ,UA (~ I--~ Na ^ No Yf-' Z a~Cl ~ f r ~ M . Ta. M. 23. " l 27. MRT I: EMer tm aasaaaa, inlunas a canpic liom wnkn uusaC Im aatn. Do ml aMM Im rtaa al Cyirq, sucn as prOiaC or raspiralory arrsal, anxk pr MN iodate. 1 Approtirmla PART 3: ONa SgnilkaM CorglYpv cplpiWm, ro aaM.0u1 Ln aKY ar wws On aam Foe. Many tNlwNrt n01 rasull n Ole aq urrderryNlq taa~e,IY«tn PART I. jansn and dam RIYEDIATE CAUSE (Fiml 1 mra•aeavAlron 2e.,.~1 t' -I rwtaatpndesml-~ a. '"Cal ...0 DUE TOIOR OUENCE OFy. _ L' SapwM»Ey En ea+a,ian a. Barry, M•a^9mRmraa;au DUE TO (OR AS ACONSEOUENCE OF): EMa,naDERLYNID ~ ^' - CA118E ID»aeba++Fay c. L - mna~avaraa OVE TOIOR ASACONSEOUENCE OFI: "--- raswrtp n aanl LAST I /,y~ a ' 1 (-1- . VNSANAUTOPSY WERE AUTOPSY FlNpNGS MANNER OF DEATH GATE OFINJURY TIME OF INJURY INJURY AT WORKT DESCRIBE /IOW INJURY OCCURRED. PERFORMED? AMUUBLE PRIOR Ta (Mmm. Dey, Year) COMPLETKIN Of CAUSE NataN ~ M tid F ^ Om a O DEATH7 VM ^ NO ^ AeeideM ^ Pendin, Imistigsti•n ^ M ]O e ]00. . ]Oe YN ^ Vaa ^ NO Srricia ^ Carm M a atarmaed ^ PUCE Of INIURV . At lama. larm, nren. today. Ollke LOCATION (Sbea. CAy/iowr, Smral EuROlnq. ate. ISlieenvl TEL TED. TE. ]Oa. )W, tG:AT,FIERICnxlt Oray mel SIGNATURE AND OFC R 'CERTIFYING PHYSK;IAN IPnysaa,n cMRy j Cause d deem +ntm anaher pnYSS W1 nos aanwnced aam era canpned nen 231 T f M O k Nd a ~w my new O, ast o ge, eM axunW dw b me eauselfl arM manmr as slnM ..................................................... / ~ ],0, v/ ~~ 1 LICENSE NUMBER DATE SGNED (MOrM, Day, Yeal •-RONOUNCING AND CERTIFYING /MYSICIAN (Pn Ta tm Deft OI m armWla Yscan Dom yonwnnnq Oeam arM cMdyah IN ease d aatnl r T•. aam aeurred a, m•tnn., ate,,m Lea.,naaw,•M. e.ua lanemmner.utnea .......................... ^ /..3 ]te. 1 1 ),a ~ ' - NAME AND ADDRESS OF PERSON WNO COMPLETED CAUSE DEATH Ilan 2717 ( YP+a Pnnt • -MEDICAL E7fAMINERlCORONER ( ~ '~ 3 0 7 On tM Doh of esaminnlon and/or Inyeatlgatbn, In my opinion, death x<urced al Ine time, dale, and place, and due to the ewse(s) and ^ Manner as atatW ' .-~/h v `i .................................................................................................. )1a. )T. Y ~90 REGISTRAR'S SIGNATURE AND NUMBE DATE fILED(MOnm. Oay. Merl ~• ~_- ~ I ...t..a_ ).. A r ~~ a-s do oa. ~~~t 3~i11 ~tn~ C~P~tttmPrtt OF VIOLET S. ROCKEY I, VIOLET S. ROCKEY, of 319 N. College Street, Carlisle, Cumberland County, Pennsylvania, being of sound 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 direct my Executor to pay the expenses of my last illness and funeral expenses from the property passing under this Will as an expense and cost of administration of my estate. SECOND: I direct my Executor to pay all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, from the property passing under this Will as an expense and cost of administration of my estate. THIRD: I give, devise, and bequeath the rest, residue, and remainder of my estate not disposed of in the preceding portions of this Will to the following persons in proportion to the following shares: (a) An amount equal to one-half (1/2) to my daughter, Vivian Irene Rockey, now of 143 A Pennsylvania Avenue, Carlisle, PA; (b) An amount equal to one-half (1/2) to my son Charles R. Rockey, now of 319 N. College Street, Carlisle, Pennsylvania; (c) In the event Vivian Irene Rockey or Charles R. Rockey predeceases me, I direct my Executor to divide their share of my estate to the remaining per named in Paragraphs (a) and (b) of this Item. (d) In the event Vivian Irene Rockey and Charles R. Rockey both GRIFFIE 8e TlJRO ATTORNEYS -AT-LAW 200 NORTH HANOVER STREET 76 NORTH MARKET STREET CARLISLE, PENNSYLVANIA 17013 MECHANICSBURG, PENNSYLVANIA 17055 predecease me, I direct my Executor to distribute my entire Estate to my niece, Louise Nicholson, now of Carlisle, Pennsylvania, or to her heirs. FOURTH: In addition to powers given them by law, by Executor and their successors and any guardian acting hereunder shall have the following discretionary powers applicable to all real and personal property held by them, effective without court order and until actual distribution. (a) To retain all property received by them including the stock of any corporate fiduciary acting hereunder, provided such property remains productive; (b) To invest in all forms of property without restriction to invest- ments authorized to fiduciaries, so long as such investments are productive; (c) 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; (d) To compromise controversies; (e) To exchange or sell real estate for cash, property or credit, publicly or privately, or to lease, even for a term exceeding five (5) years, without liability on the purchasers or lessees to see the application of the consideration, and to give options for these purposes without obligation to repudiate them in favor of a higher offer; (f) To apply income or principal to which any beneficiary is entitled directly for his or her maintenance and support should they deem such beneficiary incapable or receiving the same by reason of age, illness or any infirmity or incapacity, or to pay the same to such person as they select to disburse it, whose receipt shall be a complete acquittance therefore, without the intervention of any guardian; GRIFFIE 8e TURO ATTORNEYS•AT-LAW 200 NORTH HANOVER STREET 76 NORTH MARKET STREET CARLISLE, PENNSYLVANIA 17013 MECHANICSBURG, PENNSYLVANIA 17055 (g) To borrow money, including the right to borrow from any corporate fiduciary acting hereunder, and mortgage or pledge as security; (h) To hold investments in the name of the nominee; (i) To distribute in cash or kind or partly in each as valuations fixed by them; (j) To assume continuance of the status of any beneficiary with refer- ence to marriage, divorce, illness, incapacity or other change in the absence of information deemed reliable without liability for disbursements made on such assumption; and (k) To undertake any and all acts deemed necessary and proper by them for the proper and advantageous management of the settlement of my estate. FIFTH= I appoint Vivian Irene Rockey and Charles R. Rockey, jointly as Executors of this Will (herein referred to as "Executor"). In the event either of the name Executors is deceased, unable or unwilling to so serve, I appoint the other to act as the Executor. If none of the persons named in this paragraph are able to serve, I appoint Louise Nicholson, now of Carlisle, Pennsylvania, to serve as Executor. No fiduciary acting hereunder shall be required to post bond or enter security in any jurisdiction. SIXTH: Any person who shall have died at the same time as I shall have, or in a common disaster with me, or under such circumstances that the order of our deaths cannot be established by proof, or within (30) days of my death, shall be deemed to have predeceased me. SEVENTH: I hereby declare it to berry express desire that the Executor employ the law firm of Griffie & Toro, of Carlisle, Pennsylvania, for legal advice and assistance in the probate and administration of this my Last Will and Testament, they having considerable knowledge of my financial affairs, GRIFFIE 8c TllRO ATTORNEYS -AT-LAW 2'00 NORTH HANOVER STREET 16 NORTH MARKET STREET CARLISLE, PENNSYLVANIA 17~Oi3 MECHANICSBURG, PENNSYLVANIA 17055 views, and wishes respecting matters which may arise in connection with the administration of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, consisting of this and the preceding three (3) pages, at the end of each page of which I have also set my initials for greater security and better identification this ~"/ day of ~, 1986. -.? r'te' Violet S. Rockey GRIFFIE 8c TURO ATTORNEYS -AT-LAW 200 NORTH HANOVER STREET 16 NORTH MARKET STREET CARLISLE, PENNSYLVANIA 17013 MECHANICSBURG, PENNSYLVANIA 17055 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) SS COUNTY OF CUMBERLAND ) We, ~ w~~~.~ ~ ~ ;_.~; < t c ~ and ~~ ~-'~~. ~• ~f~ ~~ the witnesses whose names are attached to law, do depose and say that we were present and saw testatrix sign and execute the instrument as her Last Will; that she signed willingly and that she 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 years of age, of sound mind and under no undue influence. P ~~,s ~ .~ t ~L~ ~ '{ 7 ~~''f~y r ) Sworn or affirmed and acknowledged before me by .~ ' ;',, ~ i - ~ ~-, -~ x ;~~ ~ ~. ~_ w__f. _~ A ~T, and " _, I %; t ~ ` 7`~"1 _1, ~ ~~~,_ this ~ ~ ~ day of 1986 . t p i l.~ ~ 1 / ,k ` LLI~ LIPt!vr r!rr,! EY, Notary Pu61iC } Carlisle, C:~mbe-'~nd Co., Pa. My' Commiricn E~:rires ~;"larch 27, 1989 GRIFFIE & TURD ATTORNEYS-AT-LAW 200 NORTH HANOVER STREET 16 NORTH MARKET STREET CARLISLE, PENNSYLVANIA 77013 MECHANICSBURG. PENNSYLVANIA 17055 ACKNOWLEDGEI"IENT COMMONWEALTH OF PENNSYLVANIA ) SS COUNTY OF CUMBERLAND j I, VIOLET S. ROCKEY testatrix whose name is signed to the attached or foregoing instr>.unent, 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. /%~ Sworn or affirmed and acknowledged before me by Violet S. Rockey the ,~_ y -~u X31" testatrix this ~ da of dt 1386 . _. ~.KE"LLIE L1~!~.p+~rCEY, hlotary Pubiid C3rli!e, Curof~er!>^d Co., Pa. N'w Commission ~;;,oires PJ~arch 27, 19[34 GRIFFIE & TURD ATTORNEYS -AT-LAW 200 NORTH HANOVER STREET 76 NORTH MARKET STREET CARLISLE, PENNSYLVANIA 77073 MECHANICSBURG, PENNSYLVANIA 17055 CERTIFICATE OF NOTICE UNDER RULE 5.6(a) ~,p Name of Decedent: Violet R. Rockey Date of Death: Apri124, 2002 Will No. 2002-0587 TO THE REGISTER: Admin. No. 21-02-0587 I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was mailed to the following beneficiaries of the above-captioned estate on September 27, 2002. NAME Vivian I. Rockey Charles R. Rockey ADDRESS 22 McBride Avenue Carlisle, PA 17013 159 East North Street Carlisle, PA 17013 Notice has now been given to all personal entitled thereto under Rule 5.6(a) except: NONE DATE: ~;o ~ ~ ;; ~ _~- R~radl riffie quire Counsel for Personal Representatives GRIFFIE & ASSOCIATES 200 North Hanover Street Carlisle, PA 17013 (717) 243-5551 (800) 347-5552 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: GRIFFIE BRADLEY L 200 N HANOVER STREET CARLISLE, PA 17013 fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: ssN: ~6o-is-sss~ FILE NUMBER: 2102-0587 DECEDENT NAME: ROCKEY VIOLET S DATE OF PAYMENT: 01 /24/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 04/ 24/ 2002 ACN ASSESSMENT CONTROL NUMBER REV-1162 EX(11-96) N0. CD 002083 AMOUNT 101 ~ 5444.88 TOTAL AMOUNT PAID: REMARKS: VIVIAN ROCKEY C/O BRADLEY L GRIFFIE ESQUIRE CHECK#111 INITIALS: VZ SEAL RECEIVED BY: 5444.88 DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS ,~'; , "l; O' *. f COMMONWEALTH OF . .' PENNSYLVANIA ~ ...... f-.:.~ DEPARTMENT OF REVENUE _' C~l' DEPT 280601 HARRISBURG. PA 17128-0601 "'"" - ;--- w ~ "'-'" u"'" w..u :1;00 u"'" ..Ill .. '" I- Z W C W U W C DECEDEflT S NAME (LAST. FIRST. AND MIDDLE INITIALI ROCKEY, VIOLET S. OA-:-E OF DEA.TH jMM-DD-YEAR) (] '7/- REV-1500 II C--- 04-24-02 FILE NUMBER INHERITANCE TAX RETURN RESIDENT DECEDENT -2L--1L-l -::OUNTY C::[)E VE.~'" .J:L -5- -1L -L NUMSE.~ i SOCIAL SECURITY NL;lJBER 160-16 3 8 9 7 DATE OF BIRTH IMM-DD-lEARI 04-08-14 THIS RETUR~ MUST BE FILED I~ DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURIT'i NUMBER I.IF APPlICABLEI SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL) 'Xi 1, Ongmal Return ~ l' 4, limited Estate ~ 6. Decedent Died Testate IAttllch copy ot Willi L-' r-, g, llilgation Proceeds Rece\\leo ~ o 2, Supplemental Return o 4a. Future Interest Compromise Idate oi aeath af!er 12. 2-821 o 7, Decedent Maintained a Living Trust ;AttaCl1 copyofTrustl o 10. Spousal Poverty Credit (dateordeatn ~tween 12-31.91 and ,.1.95\ o 3. Remainder R.eiu1T\ i,a~\e c\ de~\h pnor 10 '2.',).(\2', C 5 Federal Es:ale Tax Return Required 8. Tolal Number of Safe Deposit Boxes o 11 Election IC:ax under Sec, 9113(A) ,Attacr. 5ch OJ f- Z W o z o .. '" w " " o u SECT!Q8 M ~ NAME COMPLETE MAILING ADDRESS Bradle L. Griffie FIRM NAME (If Applicab~ GRIFFIE & ASSOCIATES TELEPHONE NUMBER (717) 243-5551 Es uiI:€. 1. Real Estate (Schedule A) 2 Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole~Proprielorship 4 Mortgages & Notes Receivable (Schedule D) 5 Cash, SanK Deposits & Miscellaneous Personal Property Z (Schedule E) 0 6. Jointly Owned Property (Schedule F) < o Separale Billing Requested ...J :::l 7 Inter-Vivos Transfers & Miscellaneous Non~Probate Property I- (Schedule G or l) ii: < 8. Total Gross Assets (total Unes i~7) U Funeral Expenses & Administrative Costs (Schedule H) W 9. 0:: Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 10. 11. Total Deductions (tolal Lines 9 & 10) 12 Net Value of Estate (Une 8 minus Line 11) 200 NORTH HANOVER STREET CARLISLE PA 17013 11} OFFICIAL USE ONLY n no 12) 0 nn (3) 0.00 (4) 0.00 15) 20,642.68 (6) 0.00 (7) 0 00 (B) 70,042 oR (9) 9 ,447 .25 ~~ 1,309.26 1111 10,756.51 (12) 9,886.17 (13) 0.00 (14) 9,886.17 13 Charitable and Govemmental Bequests/See 91.13 Trusts for which an election t.o tax has net been made ;Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE IHSTRUCTIOHS DH REVERSE SIDE FOR APPLICABLE RATES z o < l-' :::l Cl. == o u X ~ 15, Amounl of line 14 taxable at the spousal lax ~ate, or transfers under Sec. 9116 (a)(1.2) 16. Amount 01 Line 14 taxable at lineal rate H ,;molJ:-:)Il\ne 14 laxable at sibling rale 18 ~mollm of lirle 14 taxable at cQllateral rale :9 TaxOue 9,8B6.17 x.O_ (151 xO~ (16) x .12 (17) x .15 (1B) {191 444.88 444.88 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT -~:, ~.. -REQU:~i!lf<:<,:": c:;: -, 20 __ . '.~ :;/T,,'.:'> BIi'~ Decedent's Complete Address: STREET ADDRESS 22 McBride Avenue CITY Tax Payments and Credits: 1. Tax Due (Page Hine 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) o 00 o 00 0.00 (2) Total Credits IA+ 8 + C) 3. InteresUPenally if applicable D. Interest E. Penally n nn n nn (3) 0 00 (4) 0 no (5) 444.88 (SA) 0 00 (58) /..dlu RR Total InteresUPenally ( D + E) 4. It 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 444.88 n nn 5. If Line 1 + Line 3 IS greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. 8. Enter the totai of Line 5 + SA. This is the BALANCE DUE. 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 a. retain the ,use or income of the property transferred;....... .................... "' ...................".................. 0 b. retain the right to designate who shall use the property transferred or Its income;.... .................................. 0 c. retain a reversionary interest; or... .. ..... . ....... ........,................... 0' d. receive the promise for iife of either payments, benefits or care? . 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ..... ............. ................ 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 0 4. Did decedent own an Individual Retirement Account, annuily, or other non-probate property which contains a beneficiary designation? ................................................................................................. 0 iiJ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. No [] [J [J [] [] IX1 '--' Under DenaJljes of perjury, I declare :hat I have examined this retum, including accompanying schedules and statements, and to 1M best of my knowledge and lief, it is true, COlTect and complete Declaration of preparer other than me personal representative is based on all information of which pre parer has any knowledge SDN.RESPD R F ING RETURN ADDRESS /-J'f"{}:J PA 17013 CHARLES R. ROCKEY 159 E. Nbrth Street DATE Carlisle, PA 17013 BRADLEY L. GRIFFIE, ES UIRE Hanover Street, Carlisle, PA 17013 J~:t~~~~/;i;~1~~:f1:~t~~~J;f:2D;~~2{;~?~?:':'~~~;:~~:!Y{q:t;;,:--,.!~.:':-!~.~~~AJ~~~:f~~~}?:>{~~n]jhV~it~:I:t!~~~Rt ~ ..~"'~~,J~:'?f) 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. 99116 (al (1.11 till. 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 Ow, [72 PS. 99116 lal 11.1) (iill. The statute does not exemol 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 aHer 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 stepparenl of the child IS 0% [72 P.S. 99116(a)(1.2)). The tax rate imposed an 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. ~g116(1.2) [72 P.S. 19116(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. 99116(a)(1.3)1. A sibling is defined. under Section 9102, as an mdividual who has at least one parent in common with the decedent, whether by blood or adoption. ""''''''''''..". COMMONWEALTr! OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF VIOLET S. ROCKEY FILE NUMBER 21-02-0587 Include the proceeds of lrngation and ttle date the proceeds were received by the estate. All property jointty-owned 'Nittlthe right of survivorship must be disdosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH Certificate of Deposit M&T Bank Account #: 31003911166592 (see attached statement) $19,757.05 2. 2001 Federal Income Tax Refund 828.00 3. Health Insurance Premium Refund 57.63 TOTAL IAlso enter on line 5, Recapitulation) I $ ')f'I (.../. ') r... Q ~M&rBank MallulaCiUler~, and Tt"i:lcJ8IS TriJSI Company, 1100 Wehrle Drive, P.O. Box 767, Buffalo, I\JY lA24CJ-07C7 January 7" 2003 RE: Estate Search The Estate of: Date of Death (D.O.D.) VIOLET R ROCKEY 412412002 To \\Thom It May Concern: Identified below is the account infonuation requested. 1. ,M&T Bank acc~unts in which the decedent's name appears: Account Type Account Number Account Title Opening Branch D.O.D. Balances (Includes ACCL Int.) $19,757.05 Accrued Interest CD 31003911166592 VIOLET R ROCKEY VIVIAN ROCKEY POA 4345 $25.99 2. Loans, Mortgages, or other obligations titled in the decedent's name Account Number Amount Owed Account Description NO Safe Deposit Box titled io the Decedent's name existed at our office. 6'540100r1"800"724- If you have any questions about the information provided, please contact our Records Department at (716) 0 - 2440 outside of the Buffalo, NY calling area. Thank you. Siocerely, M&T BANK COlU'ORATION BY: 0~ Authorized Signature ~/2..4, o a DATE: 1-7 - 0 '3 eo''''''''''.;'. COMMONWEALTH OF PENNSYLI)ANIA INHERITANCE TAX RETURN RESlDE~1 DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF VIOLET S. ROCKEY FILE NUMBER 21-02-0587 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hoffman Roth Funeral Home $7 ,565.50 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions - Name of Pe""nal Represen1ative (5) Sodal Security Numbe~sl / EIN Number of Pe""nal Representative(s) Street Address City State Zip Yea~s) Commission Paid: 2. Attorney Fees GRIFFIE & ASSOCIATES 1,500.00 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Ciaimant Street Address City Stale Zip Relationship of Claimant to Decedent 4. Probate Fees 106.00 5. Accountants Fees 6. Tax Retum Preparer's Fees 7. Cumberland Law,'Journal (Legal Advertising) 75.00 8. The Sentinel (Lega 1 Advertising) 100.75 9. Reserve for closing 100.00 TOTAL (Also enter on line 9, Recapitulation) $ 9 447.25 (If more space is needed, insert additional sheets of the same size) "',.\'''".,,''''. COMMONW~l1H OF ~ENNSytW..NIA INHE~lfANCE TAX ~fTUIlN RESIDENT DECEOENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS Please Print or Type I FILE NUMBER 21-02-0587 ESTATE OF VIOLET S. ROCKEY ITEM NUMBER DESCRIPTION AMOUNT 1. Carlisle Regional Medical Center (medical services) $812.00 2. Pinker & Associates (medical services) 35.25 3. Spring Road Family Practice (medical services) : 40,83 4. Belvedere Medical Corporation (medical services) 361.21 5. Blue Mountain Anesthesiology Assoc. (medical services) 36 .05 6. Shermans Dale Family Practice (medical services) 23.92 TOTAL (Also enter on line 10, Recapitulation) ! '1 I IS 1,309.26 ! (If more space is needed, insert cdditioncl sheers of same size.) . . REV,'513EX~ 11.g7) '* SCHEDULE J BENEFICIARIES ESTATE OF NUMBER L COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN R!:SIDENT DECEDENT VIOLET S. ROCKEY NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributioos) 1. Vivian I. Rockey 22 McBride Avenue Carlisle, PA 17013 FILE NUMBER 21-02-0587 RELATIONSHIP TO DECEDENT Do Not Ust Trustee(s) Daughter Son AMOUNT OR SHARE OF ESTATE 507. 507. , ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 2. Charles R. Rockey 159 East North Street Carlisle, FA 17013 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PARTll. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ . _ ~ "'" _.. _, _I.. _ _L_ _, ...._ ___~ _:__\ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 BRADLEY L GRIFFIE ESQ GRIFFIE & ASSOCIATES 200 N HANOVER ST CARLISLE PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS 1 _____________________ ------------------------------ -------------------------- ---------------------------------- REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF ROCKEY VIOLET R FILE N0. 21 02-0587 ACN 101 DATE 03-17-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule Al 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule Cl 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) .00 (2) .00 (3) .00 (4) .00 (5) 20,642.68 (6) .00 (7) .00 (8) REV-1547 EX RFP (O1-OS~ NOTE: To insure proper credit to your account, submit the upper portion of this fore with your tax payment. 20,642.68 APPROVED DEDUCTIONS AND EXEMPTIONS: 9,447.25 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9l 26 3 09 1 10. Debts/Mortgage Liabilities/Liens (Schedule Il ._ . , (10) 57 756 10 11. Total Deductions (il) . . 9,886.17 12. Net Value of Tax Return (12) .00 13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedule J) (13) 9,886.17 14. Net Value of Estate Subject to Tax (14) NOTE: If an assessment was issued previously, lines f ALL 14, 15 andior 16, 17, 18 returns assessed to date. and 19 will reflect figures that include the total o COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE 03-17-2003 ESTATE OF ROCKEY VIOLET R DATE OF DEATH 04-24-2002 FILE NUMBER 21 02-0587 COUNTY CUMBERLAND ACN 101 Anount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ASSESSMENT OF TAX: 15. Anount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Anount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due DATE -24-i 0 /PEN PAID (-) (15) .00 X (16) 9,886.17 X (17) . 00 X (18) . 00 X AMOUNT PAID 4. 00 _ .00 045= 444.88 12 = .00 15 = .00 (19)= 444.88 TOTAL TAX CREDIT 444.88 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ^ IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. pFREFUND.DSEEIREVERSECSIDEAOFATHISEFORM FOR)INSTRUCTIONS,DUE FAMILY SETTLEMENT AGREEMENT aa0 "~ - 5 ~ IN THE ESTATE OF VIOLET S. ROCKEY DECEASED ;{,o AGREEMENT executed this ~ day of J i ~ , 2003, by and between CHARLES R. ROCKEY and VIVIAN I. ROCKEY a/k/a VIVIAN IRENE ROCKEY, Co-Executors of the Estate of VIOLETS. ROCKEY a/k/a VIOLET R. ROCKEY, deceased, and CHARLES R. ROCKEY and VIVIAN I. ROCKEY, heir and beneficiaries of the Estate of VIOLETS. ROCKEY a//r/a VIOLET R. ROCKEY. WHEREAS, VIOLET S. ROCKEY, late of Carlisle Borough, Cumberland County, Pennsylvania, died on April 24, 2002, having left a Last Will and Testament dated August 4, 1986; WHEREAS, on June 25, 2002, the Register of Wills in and for the County of Cumberland, Commonwealth of Pennsylvania, did constitute and appoint CHARLES R. ROCKEY and VIVIAN I. ROCKEY a/k/a VIVIAN IRENE ROCKEY, as Co-Executors of the Estate of VIOLET S. ROCKEY, in Estate Number 21-02-0587, and WHEREAS, the Co-Executrix has proceeded with the administration of said Estate consisting of assets in the amount of $19,814.68, plus interest and medical reimbursements of $1,570.68, disbursements in the amount of $9,935.17, and no prior distributions, leaving a principal balance on hand of $11,450.19, as set forth in the First and Final Account, a true and correct copy is attached hereto and made part hereof as Exhibit "A", and WHEREAS, the only party in interest in said Estate is the above-named party, and WHEREAS, said party in interest desires that the Executrix shall not be required to file an Account with the Orphan's Court of Cumberland County, Pennsylvania, and that the net estate of the decedent shall be distributed without the necessity of filing a formal Account to avoid the expense, delay and publicity of a formal accounting, but should instead be distributed in accordance with the Executrice's Proposed Schedule of Distribution, a true and correct copy of which is attached hereto and made a part hereof as Exhibit "B". NOW THEREFORE, in consideration of the mutual promises, covenants and agreements recited herein, the above-named heirs and beneficiaries of the Estate of VIOLET S. ROCKEY does hereby mutually agree as follows: 1. The parties hereto, and each of them, agree and acknowledge that they have fully and carefully examined the First and Final Account of CHARLES R. ROCKEY and VIVIAN I. ROCKEY a/k/a VIVIAN IRENE ROCKEY, Co-Executors for the Estate of VIOLET S. ROCKEY, deceased, and Proposed Schedule of Distribution relating thereto, and find them to be true and correct, and acceptable to the parties hereto and each of them, and further that each of them has received a copy of this Family Settlement and Final Release and of said Account and Proposed Schedule of Distribution. 2. The parties hereto hereby agree that in order to avoid the expense, delay and publicity involved in the filing of a formal Account and Schedule of Distribution, no accounting to the Court is necessary and we do hereby agree that we do consent to distribution being made without the filing of an Account and Schedule of Distribution, the same to be with the same force and effect as if they had been filed and confirmed by the Orphan's Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania. 3. The parties hereby remise, release, quitclaim and forever discharge the Estate of VIOLET S. ROCKEY, and CHARLES R. ROCKEY and VIVIAN I. ROCKEY a/k./a VIVIAN IRENE ROCKEY, Co-Executors, their heirs, executors, administrators and assigns, from all manner of acts, suits, claims, accountings, debts and demands whatsoever which we or any of us or our legal representatives or assigns may at any time hereafter have against said Executrix, estate, or assets thereof, touching or concerning the Estate of the Decedent. 4. The parties hereto covenant and agree that they will contribute their share of the Estate to satisfy all claims, debts, demands, suits or cause of action which may be successfully brought against the Estate or the Executrix after the execution of this Family Settlement and Final Release. 5. The parties hereto hereby agree that they will at all times in the future and wherever necessary, appropriate or convenient, made, execute and deliver to said Executrix, and/or to the other party or persons, any and all instruments, documents, conveyances, deeds, releases or other instruments of any kind necessary or convenient to carry out the intention of this Family Settlement and Final Release. 6. This Family Settlement and Final Release constitutes the entire understanding among the parties hereto, and each of them acknowledges that no representations or statements of any kind, written or oral, have been made to them or any of them prior hereto by the Executrix or any other person or party upon her behalf. 7. This Family Settlement and Final Release shall inure to the benefit and shall bind the parties hereto, and each of them, their heirs, executors, administrators, successors and assigns. 8. This Family Settlement and Final Release shall be governed by the laws of the Commonwealth of Pennsylvania. IN WITNESS WHEREOF, the parties hereto have hereunto set their respective hands and seals the day and year first above written. Date: ~~~ ~~ Date: ~ ~~ Date: ~ -~ ~-~ Date: ~ - .3 -- ~Q~ ~ R. ROCKEY, R. ROCKEY, . "'~~ V1IV~IANI. ROCKEY, Co-Execut r V ~ ~r~~ VIVIANI. ROCKEY, individua y FIRST AND FINAL ACCOUNT OF CHARLES R. ROCKEY and VIVIAN L ROCKEY a/k/a VIVIAN IRENE ROCKEY CO-EXECUTORS OF THE ESTATE OF VIOLET S. ROCKEY Deceased Date of Death: Apri124, 2002 Date of Co-Executors' Appointment June 25, 2002 Accounting for the Period of Apri124, 2002 to July 1, 2002 Purpose of Account: CHARLES R. ROCKEY and VIVIAN I. ROCKEY a/k/a VIVIAN IRENE ROCKEY, Co-Executors of the Estate of VIOLET S. ROCKEY, offers this Account to acquaint interested parties with the transactions that have occurred during their administration of the Estate for the accounting period indicated above. The Account also indicates the proposed distribution of the Estate. It is important that the Account be carefully examined. Request for additional information or questions or objections can be discussed with: Bradley L. Griffie, Esquire GRIFFIE & ASSOCIATES 200 North Hanover Street Carlisle, PA 17013 (717) 243-5551 (800) 347-5552 SUMMARY OF ACCOUNT Principal -Total Assets $19,814.68 Less Disbursements of Principal (-) 9,935.17 Less Distributions (-) 0.00 Post death interest and Reimbursements 1,570.68 TOTAL remaining for Distribution $ 11,450.19 RECEIPTS OF PRINCIPAL CASH and BANK ACCOUNTS M&T Bank Certificate of Deposit # 31003911166592..........$ 19,757.05 SUBTOTAL available for distribution $ 19,757.05 PERSONAL PROPERTY None ..................................................................................$ 0.00 SUBTOTAL available for distribution $ 0.00 MISCELLANEOUS ASSETS Health Insurance Premium Refund .................................$ 57.63 SUBTOTAL available for distribution $ 57.63 TOTAL ASSETS ACCOUNTED FOR: $ 19,814.68 DISBURSEMENTS OF PRINCIPAL DEBTS OF DECEDENT Pinker &Associates ...................................................................$ 35.25 Shermans Dale Family Practice ................................................... 23.92 Spring Road Family Practice .........................................................40.83 SUBTOTAL: $ 100.00 FUNERAL EXPENSES Hoffman Roth Funeral Home .........................................$ 7,565.50 SUBTOTAL: ADMINISTRATION EXPENSES $ 7,565.50 Register of Wills -probate fees ................................................$ 116.00 Attorneys fees to GRIFFIE & ASSOCIATES (through 05/31/03) ............................................................. 1,510.00 Advertising The Sentinel .........................................................................115.79 Cumberland Law Journal .......................................................75.00 Bank fees ..........................................................................................8.00 SUBTOTAL: PENNSYLVANIA INHERITANCE TAX $ 1,824.79 Tax due (paid) ...........................................................................$ 444.88 Di scount/Penalty/Interest .................................................................0.00 Total net due $ 444.88 TOTAL $ 9,935.17 INTEREST, DIVIDENDS AND REIMBURSEMENTS Post-Death interest on Certificate of Deposit 04/2 5 /02 ..................................................................... $ 5 2.10 OS/ 16/02 ....................................................................... 86.79 06/ 16/02 ....................................................................... 89.68 07/ 16/02 ....................................................................... 86.79 08/ 16/02 ....................................................................... 89.68 09/ 16/02 .......................................................................89.68 10/ 16/02 ....................................................................... 86.79 11 / 16/02 .......................................................................89.68 SUBTOTAL: $ 671.19 Medical Reimbursements from Life & Health Ins. Co. of America (LHICA) 05 /21 /02 ..................................................................... $ 5 7.63 06/27/02 .......................................................................12.23 07/08/02 .........................................................................9.86 07/ 11 /02 .......................................................................50.20 07/25/02 ......................................................................... 8.34 07/31 /02 .........................................................................5.74 08/ 12/02 .......................................................................71.26 08/ 12/02 .......................................................................19.20 08/ 12/02 .........................................................................5.62 08/ 12/02 .......................................................................17.77 08/ 13/02 .........................................................................5.19 09/06/02 .......................................................................18.03 09/ 12/02 .........................................................................1.74 09/ 13/02 .....................................................................107.80 10/24/02 .....................................................................160.83 10/24/02 .......................................................................19.7 7 10/28/02 .........................................................................7.45 02/ 17/03 .....................................................................219.88 02/ 18/03 .......................................................................50.00 04/01 /03 .......................................................................3 6.05 04/01 /03 .......................................................................14.90 SUBTOTAL: $ 899.49 TOTAL $ 1,570.68 PROPOSED SCHEDULE OF DISTRIBUTION Remaining proceeds of $11,407.56 to be distributed equally to two (2) surviving heirs, Charles R. Rockey and Vivian I. Rockey. EXHIBIT "B" STATUS REPORT UNDER RULE 6.12 Name of Decedent: vivian I. RoCkey a/k/a Vivian Irene Rockey DateofDeath: April 24, 2002 Will No.: 2002-00587 Admin. No.: 21 -02-0587 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: 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: Did the personal representative file a final account with the Court? Yes _ No k--"] 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 I-X-] No [-"] Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the. Orphans' Court and may be attached to this report. Family Settlement Agreement: of ffuly 3, 2003, was filed on July 7, 2003. 200 N. Hanover St., Carlisle, PA Address 717-243-5551: Telephone No. Capacity: ["'] Personal Representative [] Counsel for personal representative