HomeMy WebLinkAbout04-0417PETITION FOR PROBATE and GRANT OF LETTERS
Estate of' /¢/~/2~z~D ~',/~.,/¢~''~,''¢~5 - No.
also known as To:
Deceased.
Social Security No. 2~/' ~ '~ D~
Register of Wills for the
County of ff.t/.~?.ZZ, a-~.d~
Commonwealth of Pennsylvania
in the
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the ex.ecut,~_~' named
in the last will of the above decedent, dated ..~,
and codicil(s) dated ::~7/~,/,,~-a~f
"'- C
(state relevant circumstances, e.8. renunciation, death of executor, etc.)
Decendent was domiciled at death in ~r_-,~a,9~7~t-~"~-~ County, Pennsylvania, with
h/-9 last family or principal r~esidence at ~
(list street, number and muncipality)
Decendents then ~'~. years of,age, died
at ~ ~¢d/~4~7~ /¢~%/o t/~',~z.~/~ ~,,/~4~/
Except as foliows,~ec~dent did not marry, was not divorced and did not have a child born or adopted
after execution of tine will offered for probate; was not the victim of a killing and was never adjudicated
incompetent: /,)/A~'
Decendent 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 Penn~sylvA~nia
situated as follows~,~,
$
WHEREFORE, petitioner(s) respectfully request(s) the p~obate 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.)
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~ ss
COUNTY OF deAz~~
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 ~nd truly administer the estate according to law.
Sworn to or affirmed and subscribed V~~~--'
before me_this /~.,d[ day of ~ _) 'f f-'/ ~ ' ~'
'- Register' L' ~ ~
Estate Of
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW
g.
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated
described therein he.admitted to proba.t~ and filed of record as the last will of
7",
and Letters - ] ~l.~tt~r~n~, ,
are hereby granted to ' L~'~, Or
consideration of thc petition on
FEES
obate, Letters, Etc.. $ ~c3~. 07)
~o~~ates(~ .......... $~
...............
TOTAL ~ $.
Filed . ~. ~. ~.~.~
Register of Wills ~
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
or SS'4
(Rev. December 2001)
Department of the Treasury
.Intexna[ Revenue Service
Application for Employer Identification Number
(For use by employers, corporations, 'partnerships, trusts, estates, churches, IN
government agencies, Indian tribal entities, ce~ain individuals, and others.)~ OMB No. ~545-0~3
~ See separate instructions for each line. ~ Keep a copy for your records.
I Legal name of entity (or individual) for whom ~he EIN is being requested
2 Trade name of business (if different from name on line 1) 3 Executor trustee "care off' name
Sa Street adffress (if different) (Do'not enter a P.O. box.)
4a Mailing address (room, apt., suite no. and street, or P.O. bo>
4b City, state, and ZIP code 5b Cit~, state, and ZIP code
6 County and state where principal business is located
7a Name of principal officer, general partner, grantor, owner, or trustor 7b SSN, ITIN, or EIN
8a Type of entity (check only one box)
[] Sole proprietor (SSN) ' ::
[] Partnership
[] Corporation {enter form number to be filed) i~
[] Personal service corp.
[] Church or church-controlled organization
[] Other nonprofit organization (specify) >
[] Other (specif~) ·
8b If a corporation, name the state or foreign country State
(if applicable) where incorporated
r
[~"~state (SSN of decedent) ~'O? iO:~i ~'~
[] Plan administrator (SSN) ' ' '
[] Trust (SSN of grantor)
[] National Guard [] .State/local government
[] Farmers' cooperative [] Federal government/military
[] REMIC [] Indian tribal governments/enterprises
Group Exemption Number (GEN) ~-
Foreign countr~
Reason for applying (check only one box)
[] Started new business (specify type) ·,
E~' Banking purpose (specify purpose) · _¢~:7~'Z:~
[] Changed type of organization (speci~ new type)
[] Purchased going business
[] Created a trust (specify tTpe) ·
[] Created a pension plan (specify type) >
[] Hired employees (Check the box and see line 12.)
[] Compliance with, iRS withholding regulations
[] Other (specify) I~
10 Date business started or acquired (month, day, year) 11 Closing month of accounting year
12 First date wages or annuities were paid or will be paid (month, day, year). Note: If applicant is a withholding agent, enter date income wil/
first be paid to nonresident alien. (month, day, year) ............. ·
13 Highest number of employees expected in the next 12 months. Note: If the applicant does not Agricultural I Household I Other
expect to have any employees during the period, enter "-0-. ' . ......... ·
I
Check one box that best describes the principal activity of your business, [] Health care & social assistance [] Wholesale-agent/broker
[] Cons[ruction [] Rental & leasing [] Transportation & warehousing [] Accommodation & food service [] Wholesale-other [] Retail
[] Real estate [] Manufacturing [] Finance & insurance [] Other (specify)
14
15 Indicate principal line of merchandise sold; specific construction work done; products produced; or services provided.
16a Has the applicant ever applied for an employer identification number for this or any other business? ..... [] Yes [~o
Note: If "Yes," please complete lines 16b and 16c,
16b If you checked "Yes" on line 16a, give applicant's legal name and trade name shown on prior application if different from line 1 or 2 above.
Legal name · Trade name ~-
16c Approximate date when, and city and state where, the application was filed. Enter previous employer identification number if known.
Appr°ximate date when filed (mo.. day, year)I City and state where filed IPrevi°us EINi
I Complete this section only if ~u want to authorize the named individual to receive the entity's EIN and answer questions about the completion of this form.
Third Designee's name Designee's telephone number (include area code)
Party )
Designee Address and ZIP code
Under penalties of perjury, I declare that I have examined this application, and to the best of my knowledge and belief, it ia true, correct, and complete.
Name and title (t~l~e or print~leady) ·....//~_/~~. ~,~ ~.~w~. ~--~-~,;~-~.~.'~,~"~_..
~ignature· ~'J-~ ~"~,/~ Date
Privac:~;'A~-- '~'~" ~'n~aperwork Reduction Act Notice, see separate instructions. Cat. No. 16055N
For
Designee's fax number (include area code)
)
Applicant's telephone number (include area code)
Applicant's fax nu-rnber (include area code)
Form SS-4 (Rev. 12-2001)
Register of Wills of Cumberland County, Pennsylvania
OATH OF NON-SUBSCRIBING WITNESS
Estate of ~~
also known as
Number
2/-0 ~,-- L//7
, Deceased
(each) a subscribe~t..o, (each) being duly qualified acc;ording to law,~epose(s) and
say(s) that (I am/.~e are).,familiar with the signature of
of (one of the subscribing witnesses to) th~~od?l~ testat~
presented herewith and that ~ -15elieve-~e signature on th w~dl/c~ in
the handwriting of ~/.~ .'7'-f:~ ~
to the best
of ,~_.P~. knowledge and belief.
Sworn to or affirmed and subscribed
before me this ,.~,¢~.~ day of
,2o
For th~ Register
Sworn to or affirmed and subscribed
before me this ~.~,~/ day of
For ~ster
,20~ y
~__~.._,'£ '~ (Signat~e). /
-~ ~ (/~Si~nature)
~ [v ~ (Signat.~re)./
(/~(~, ._ s.S_ignature)
his 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.
~~ Local Registrar
P '10040484
No. ~ ~ Date
H105 143 Rev 2/87
TYPE/PRINT
PERMANENT
BLACK iNK
NAME OF DECEDENT (First, MiddM, Last)
AGE (Last ~itlhday)
78
Yrs.
COUNTY OF DEATH
Cumberland
~CE~m"S usus. OCCUP^nON
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
Harold T. Koser ~x Male JT~-slOS_,w,t~,_. 5089 DATEO. J~DEATH( .... ~,y, Vear)
East Pennsboro /~/0 / ct '-~?' ~" p /~/O. Sf' /C { ,.,, ,~ c~. (sp~.y> White
C~CEDENT'S
Mechanicsburg, Pennsylvania 17055 RES~m~CE
KIND O~ BUSINESS I INDUSTRY C~CEI~NTS EDUCATION MARITAL STATUS - Merited,SURVIVING SPOUSE
18.FATHE~ ~ME ifil, U~, Lift) Alfred E. Koser ~THE~S ~ME (~. u~.. ~ ~el May Vogelsong
INFOR I )
zo.. Jeffrey E. Koser ~. ~~i~¢~ PA 17111
Apr 23. 2004 z,,. ~echanicsburg Cemete~ ,,. Mechanicsburg. Pa. 17055
I
WAS AN AUTOPSy J WERE AUTOPSy FINDING~ J ~IANNER OF DEATH
,..Fo.,~o? ^V..~L...,O. TO
SIGNAT D LE TiFIER
WILL
I, HAROLD T. KOSER, of the Township of Saville, County of
Perry and State of Pennsylvania, being of sound and disposing
mind, memory and understanding, do make, publish and declare this
my Last Will and Testament.
I direct the payment of all my just debts and funeral expenses
as soon after my decease as the same can conveniently be done.
I give, devise and bequeath all the rest, residue and remainder
of my estate, of whatsoever nature and wheresoever situate, to my
wife, Betty J. Koser, her heirs and assigns, absolutel~i[~'~d
c ondit iona lly.
3.
In the event that my wife, Betty J. Koser, should predecease
me, or should she die at about the same time as I do, such as in
an accident common to both of us, then in such event, I give, devise
and bequeath my entire estate, real, personal and mixed, and where-
soever the same may be situate, to my two children, to wit, Jeffrey
E. Koser and Kathy E. Getty, share and share alike.
LASTLY~ I nominate, constitute and appoint my wife, Betty J.
Koser, Executrix of this my Last Will and Testament, and in the
event that my said wife should predecease me, or should she be
unable to serve in such capacity for any reason, then in such event,
I nominate, constitute and appoint my son, Jeffrey E. Koser, Exector
of this my Last Will and Testament in her place and stead.
IN WITNESS WHEREOF, I have hereunto set my hand
-1-
and seal this
A. D. 1974.
Harold T. Koser
(SEAL)
Signed, sealed, published and declared by the above named
Harold T. Koser, as and for his Last Will and Testament in the
presence of us Who have subscribed our names hereto as witnesses,
at the request of said testator,in his presence and in the presence
of each other.
-2-
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent: Harold T. Koser
Date of Death: April 18, 2004
Will No. 2004-00417
Admin. No. 21-04-0417
To the Register:
I certify that notice of beneficial interest 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 May 21,
2004:
Name
Kathy Eileen Getty
Address
40 Beechwood Dr.
Dillsburg, PA 17019
Calvary Lutheran Church
Jeffrey Alan Getty
Phillip Andrew Getty
Melanie Suzanne Koser
Corinne Elizabeth Koser
Michael Wevodau
Alan Wevodau
Brandon Cole Getty
Brittany Nicole Getty
208 Woods Dr.
PO Box 374
Mechanicsburg,
PA 17055
31 Chestnut Hill Rd.
Dillsburg, PA 17019
224 Fencepost Ave.
Palmyra, PA 17078
301 S. 29th St.
Penbrook, PA 17103
241 N. 67tn St.
Harrisburg, PA 17111
3116 43rd St.
Lubbock, TX 79413
130-8 London Ct.
Fayetteville, NC 28311
31 Chestnut Hill Rd.
Dillsburg, PA 17019
31 Chestnut Hill Rd.
Dillsburg, PA 17019
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) except None.
Date: // ~Z~
l f~. Ko§hr
N. 67th St.
Harrisburg, PA 17111
(717) 564-2736
Personal representative
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NOI&¥DI~Iflfld dO dOO~ld
PROOF OF PUBLICATION OF NOTICE
IN CUMBERLAND LAW JOURNAL
(Under Act No. 587, approved May 16, 1929), P. L. 1784
STATE OF PENNSYLVANIA :
COUNTY OF CUMBERLAND :
SS.
Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and
State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law
Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid,
was established January 2, 1952, and designated by the local courts as the official legal
periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly
issued weekly in the said County, and that the printed notice or publication attached hereto is
exactly the same as was printed in the regular editions and issues of the said Cumberland Law
Journal on the following dates,
viz.:
JUNE 4, 11, 18,2004
Affiant further deposes that he is authorized to verify this statement by the Cumberland
Law Journal, a legal periodical of general circulation, and that he is not interested in the subject
matter of the aforesaid notice or advertisement, and that all allegations in the foregoing
statements as to time, place and character of publication are tree.
Koser, Harold T., dec'd.
Late of the Township of Upper
Allen.
Executor: Jeffrey E. Koser, 241
N. 67th Street, Harrisburg, PA
17111.
Attorney: None.
, J / ' yne,,~ditor
S~FOJR]~ TO AND SUBSCRIBED before me this
18 .dayof JUNE 2004
DATE:
TO:
FROM:
RE:
MEMORANDUM
Sunday, July 11, 2004
Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013
Jeffrey E. Koser
241 N. 67th St.
Harrisburg, PA 17111
Estate of Harold T. Koser
Will No. 2004-00417
Enclosed please find Certification of Notice under Rule 5.6(a)
and Proofs of Publication relative to the above referenced
estate.
REV.T~EX{6-001
REV-1500
'* COMMONWEALTH OF
PENNSYLVANIA
. DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0001
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T1iIS RETURN MUST BE FILED IN DUPLICATE WITH T1iE
REGISTER OF WILLS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21 04
COONTYCODE YEAR
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DECEDENT'S NAME (lAST, FIRST, AND MIDDLE INITIAL)
Koser, Harold T.
SOCIAL SECURIIY NUMBER
204-03-5089
0417
NUt.flER
{!] 1. Original Return
D 4. Limited Estate
[!] 6. Decedent Died Testate (AlIach copy of Wi I)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (data of death after 12.12-82)
o 7. Decedent Maintained a Living Trust IAttach copy of Trust)
D 10. Spousal Poverty Credit (date of death Delween 12.31.91 and 1.1.95)
D 3. Remainder Return ldata of death prior to 12.13-82)
o 5. Federal Estate Tax Return Required
2... 8. Total Number of Safe Deposit Boxes
D 11. Eleclionto tax under Sec. 9113(A) (AlI3ch Sch 0)
THIS SECTION MUlIT BE COMPLETED. ALL CORIlEIl'OlIDENCE ANDC_TIAL TAllIHFORIIATIDH SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
.Jeffrey E. Koser ... ~___ ~_' 241 N. 67th 51.
FIRM NAME IIfAppli~',' Harrisburg, PA 17111
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- - - ~ ~ATEOFBIRTH (MM-D[)'YEAR~
12106/1925
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(IF AFPLlCABLE) SURVIVING SPOUSE'S NAME (lAST, FIRST. AND MIDDLE INITIAL)
DATE OF DEATH (MM-O[)' YEAR)
04/18/2004
SOCIAL SECURIIY NUMBER
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TELEPHONE NUMBER
(717) 843-4311
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282,467.94
17,154.98
265,312.96
10.000.00
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0.00
11,489.09
0.00
0.00
11,489.09
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(1)
(2)
(3)
(4)
(5)
143,900.00
0.00
0.00
6,790.00
109,431.05
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Joinlly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus line 11)
13. Charitable and Governmental Bequests/See 9113 TruSts for which an election to tax has not been
made (Schedule J)
(6)
14,460.94
2,694.50
(11)
(12)
(13)
(6)
22,346.89
(7)
0.00
(9)
(10)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(14)
SEE INSTRUCTIONS 011 REVERSE SIDE FOR APPUCABLE RATES
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15. Amount of Line 14 taxable althe spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
0.00_ x 0 0
(15)
x.O 4,!i
255,312.~
0.00
0.00
(16)
(17)
(18)
(19)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
x .12
x.i5
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTlOHS ON REVERSE SIDE AND RECHECK MATH < <
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REV',1502 EX' (6'9,*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTjl.TE OF K ,- FILE NUMBER
oSe'-r) H t1 r 0 I d I i ;11 - 0 L/ . 0 4 /7
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 property wh\ch Is )olntly..owned with r\ght of survivorship must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
rrEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
/oc~ t<2cR a+-
Res ide lie' <2-.
3 LJ '"R 19 U r\ dR c' d 1 <2.Kd .
(YIec..h4n;c 5 burr I PA
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furc.AaS<?d
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COCA n f(,( 'Kecord-er
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TOTjl.L (Also enter on line 1. Recapitulation) $
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THIS INDENT~,LAfiD COLiNTY-PA
'00 RUG 3 APlIO Yl
in the year of our Lord
July
two
MADE THE 31st day of
thousand (2000) between
HAUBERT HOMES, INC., a
Pennsylvania Corporation, Grantor,
AND
Harold T. Koser
, Grantee(s)
WITNESSETH, that the said Grantor(s) for and in consideration of
the sum of $130,000.00
Dollars lawful money of the United States of America, unto it well
and truly paid by the said Grantee(s) at and before the sealing
and delivery of these presents, the receipt whereof is hereby
acknowledged, have granted, bargained, sold, aliened, enfeoffed,
released and confirmed, and by these presents do grant, bargain,
sell, alien, enfeoff, release and confirm unto the said
Grantee(s), their Heirs and Assigns,
ALL THAT CERTAIN lot or tract of land situate in the Township of
Upper Allen, County of Cumberland, Commonwealth of Pennsylvania,
known and numbered as Lot No. 15 on a plan for Bowman's Hill,
Phase I, dated March 29, 1993 and recorded in the Office of The
Recorder of Deeds, in and for Cumberland County in Subdivision
Plan Book 65, Page 139, as amended in Plan Book 66, Page 145,
more fully bounded and described as follows, to wit:
BEGINNING at a point on the northern right of way line of Round
Ridge Road, a 50 foot right of way at the southwestern corner of
Lot No. 14 on the aforementioned plan; thence along said northern
right of way line of Round Ridge Road South 43 degrees 32 minutes
45 seconds West a distance of 45 feet to a point at the
southeastern corner of Lot No. 16 on the aforementioned plan;
thence along said Lot No. 16 and through a partition wall North
46 degrees 27 minutes 15 seconds West a distance of 135.00 feet to
a point at lands now or formerly of M. R. K. Associates; thence
along said lands now or formerly of M. R. K. Associates North 43
degrees 32 minutes 45 seconds East a distance of 45 feet to a
point at the northwestern corner of Lot No. 14 on the
aforementioned plan; thence along said Lot No. 14 South 46
degrees 27 minutes 15 seconds East a distnace of 135 feet to the
point and place of BEGINNING.
CONTAINING 6,075 square feet.
D'" - r'o(",!",>
lUu~ ,,/h (-"f;: ct' 3
. " ,....,>..1 '1':1. 'l)
UNDER AND SUBJECT, Nevertheless, to the same condition,
restrictions, exceptions and reservations as exist by virtue of
prior recorded instruments, deeds and conveyances, and to the
right of ingress and egress extending for ten (10) feet from the
rear property line and extending across the side property line.
BEING THE SAME PREMISES WHICH Bowman's Hill Associates, a
Pennsylvania General Partnership, by their deed dated February 6,
1998 and recorded February 26, 1998 in the Office of the Recorder
of Deeds Office in and for Cumberland County, Pennsylvania in
Record Book 172, Page 630, granted and conveyed unto Haubert
Homes, Inc., a Pennsylvania Corporation.
TOGETHER with all and singular buildings and improvements, ways,
waters, water-courses, rights, liberties, privileges,
hereditaments and appurtenances whatsoever thereunto belonging or
in anywise appertaining, and the reversions and remainders,
rents, issues and profits thereof; and all the estate, right,
title, interest, property, claim and demand whatsoever of
Grantor(s), in law, equity, or otherwise howsoever, of, in and to
the same and every part thereof,
TO HAVE AND TO HOLD the said lot or piece of ground above
described hereditaments and premises hereby granted, or mentioned
and intended so to be, with the appurtenances unto the said
Grantee(s), their Heirs and Assigns, to and for the only proper
use and behoof of the said Grantee(s), their Heirs and Assigns
forever.
AND the said grantor hereby covenants and agrees that it will
warrant Specially the property hereby conveyed.
IN WITNESS HEREOF, said Haubert Homes, Inc. has caused this
Indenture to be signed in its corporate name by its President and
has caused to be affixed hereunto the common and corporate seal
of the said corporation, attested by its Secretary. the day and
year first above written.
HAUBERT HOMES, INC.
t:'"'- <?k cu.~~~l,
ON E. HAUBERT, SR., President
BY:
ATTEST: \). (), I~
0' " "06 '''I' ('-' 4
uU0r,,t;,... Ii\.t OJ..
STATE OF PENNSYLVANIA:
COUNTY OF e~b ,\0<->1) ~
On this, the.3\ day of",J '^-\"k- ,2000, before me, the
undersigned officer, personal~y appeared Don E. Haubert, Sr. who
acknowledged himself to be the President of Haubert Homes, Inc.,
a corporation, and that he as such President being authorized to
do so, executed the foregoing instrument for the purposes therein
contained by signing the name of the corporation by himself as
President.
SS:
WITNESS WHEREOF, I hereunto set my hand and official seal.
\..
a
~p.
Rhona N. NoiarfaI Seal Pui>llc
Ilal)""&'I~Countv
My~ Nov.24,2003
~ ~
CERTIFICATE OF RESIDENCE
I do hereby certify that the precise residence and complete post
office address ~f the wit~in named grantee is
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6iJiJ, 226,;[E 61.5
OMB NO. 2502-0265 "fl
A. B. TYPE OF LOAN:
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 10FHA 2-DFmHA 3.I!ICONV. UNINS. 4-DVA 5. DCONV. INS.
6. FILE NUMBER: 17. LOAN NUMBER:
SETTLEMENT STATEMENT MORAN-MPF-2004 0003702509
8. MORTGAGE INS CASE NUMBER:
C. NOTE: This form is furnished to. give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked "[POC)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
1.0 3I\J8 {MORAN-MPF-2004.PFD/MORAN-MPF-2004f6}
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME' AND ADDRESS OF LENDER:
Michael T. Moran and Estate of Harold T. Koser National City Mortgage Company
Suzan N. Moran 3232 Newmark Drive
34 Round Ridge Road Miamisburg, OH 45342
Mechanicsburg, PA 17055
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: I. SETTLEMENT DATE:
34 Round Ridge Road Mid-Penn Abstract Co.
Mechanicsburg, PA 17055 November 19, 2004
Cumberland County, Pennsylvania PLACE OF SETTLEMENT
125 Locust Street
Harrisburg. Pennsylvania 17101
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
101. Contract Sales Price 143,900.00 401. Contract Sales Price 143,900.00
102. Personal Prooertv 402. Personal Property
103. Settlement Charces to Borrower (Line 1400) , 6,905.06 403. i
104. 404. ,-
105. 405. ,-
Ad'ustments For Items Paid Bv Seller in advance Adjustments For Items Paid Bv Seller in advance
106. School Taxes 11/20/04 to 07101/05 , 1,062.05 406. School Taxes 11/20/04 to 07101/05 1 062.05
107. Countv Taxes 11/20/04 to 01/01105 39.91 407. Countv Taxes 11/20/04 to 01/01/05 39.91
108. CitvTaxes to 408. Citv Taxes to
109. Homeowners Association Fees 11/20/04 to 01/01/05 5.16 409. Homeowners Association Fees 11/20/04 to 01/01/05 5.16
110. 410.
111. i 411.
112. I 412.
120. GROSS AMOUNT DUE FROM BORROWER 151,912.18 420. GROSS AMOUNT DUE TO SELLER 145,007.12
I
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. De osit or earnest monev I 500.00 501. Excess Deposit (See Instructions)
202. Princioal Amount of New Loan{s) I 115,100.00 502. Settlement Charoes to Seller (Line 1400\ 8,543.00
203. Existina loan(s taken subiect to 503. Exlstinn loanfsHaken subiectto
204. 504. Payoff of first Mortgage
205. 505. Pavoff of second Mortaaae
206. Proceeds from 2nd Mta. 21,243.46 506. Deoosit retained bv seller 500.00
207. 507.
208. 508.
209. i 509.
Adjustments For Items Unpaid Bv Seifer Adjustments For Items UnDaid Bv Seifer
210. School Taxes to i 510. School Taxes to
211. CountvTaxes to I 511. CountvTaxes to
212. CiiVTaxes to , 512. Citv Taxes to
213. 513.
214. Quarterv Sewer 10/1 - 12/31 10/01104 to 11/20/04 54.35 514. QuartervSewer 10/1-12/3110/01104 to 11/20/04 54.35
215. 515.
216. 516.
217. 517.
218. 518.
219. i 519.
220. TOTAL PAID BY/FOR BORROWER i 136,897.81 520. TOTAL REDUCTION AMOUNT DUE SELLER I 9,097.35
,
300. CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TOIFROM SELLER:
301. Gross Amount Due From Borrower (Line 120) i 151,912.18 601. Gross Amount Due To Seller (Line 420) i 145,007.12
302. Less Amount Paid By/For Borrower (Line 220) i( 136,897.81) 602. Less Reductions Due Seller (Line 520) ( 9,097.35
303. CASH ( X FROM)( TO) BORROWER 15,014.37 603. CASH ( X TO) ( FROM) SELLER 135,909.77
......
The undersigned he::b;lY:'Cknowtedge recejpt of a completed copy of pages 1 &2 of this slatement & any/attachments referred to herein.
/"" j
," .,-..-"..,-
Borrower-'" -'_ .
Micha
Page 2
L. SETTLEMENT CHARGES
700. TOTALI'OMMlsslON Based on Price $ Ii/) % PAID FROM PAID FROM
Division of Commission f/ine 7001 as Follows: BORROWER'S SELLER'S
701.$ to FUNDS AT FUNDS AT
702.$ to SETTLEMENT SETTLEMENT
703. Commission Paid at Settlement
704. to
BOO. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Orinination Fee 1.0000 % to American Home Bank 1,151.00
802. Loan Discount % to
803. Administration Fee to National City Mortgage Company 410.00
804. Tax SelVice Fee to Lereta 77.00
805. Express Mail Fee to Federal Express 15.00
B06. Flood Certification to FDsl 7.50
807. Mortgage Broker Fee pd by NCMC to American Home Bank POC $2,014.25L
808. Application Fee to American Home Bank 345.00
809. Appraisal Fee to Mark Hilbert 275.00
810. Courier Fee to American Home Bank 21.00
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From 11/19/04 to 12/01/04 @ $ 16.560000/day ( 12 days 5.2500%) 198.72
902. Mor:tnane Insurance Premium for months to
903. Hazard Insurance Premium for 1.0 \/pars to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard Insurance 3.000 months $ 29.83 Der month 89.49
1002. Mo;:tnane Insurance months $ ner month
1003. School Taxes 6.000 months $ 144.86 ner month 869.16
1004, CoulltV Taxes 11.000 months $ 91.56 ner month 1,007.16
1005. City Taxes months @ $ per month
1006. months rfi> $ ner month
1007. months ----r,:;; $ ner month
1008. Annr'" ate Adiustment months tm $ ner month -726.22
1100. TITLE CHARGES
1101. Settlement or Closinn Fee to
1102. Abstract or Title Search to
1103. Title Certificate to Adler & Adler
1104. Title Insurance Binder to
1105. Deed prenaration to Adler & Adler 100.00
1106. Notan, Fees to JodVGoldrinn 18.00 4.00
1107. Attorney's Fees to
7lncludes above item numbers:
1108. Title Insurance to Mid-Penn Abstract Co. 1 078.75
lincludes above item numbers Endorsements 100, 300 & 8.1 )
1109. Lender's Coverage $ 136,685.00
1110. Owner's Coverage $ 143,900.00
1111. End. 100, 300, 8.1 & 710 to Mid-Penn Abstract Co. 200.00
1112. Closing Protection Letter to Fidelity National Title Insurance Co. 35.00
1113. Incoming Wire Fee to Mid~Penn Abstract Co. $11.000x2 22.00
1114.
1115.
1116.
1117. Transaction Fee to D'Angelo Realty Group 250.00
1118. Federal Express Charges to Adler & Adler 15.50
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees: Deed $ 38.50; Mortgage $ 68.50; Releases $ 107.00
1202. CliVICDuiiiVTax/Stamns: Deed . Mortnane 1,439.00
1203. State Tax/Stamns: Revenue StamDs ; Mortnane 1,439.00
1204. Cumberland Cou~ Recorder of Deeds
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. SUIVev to
1302. Pest Insnection to
1303. Inheritance Tax Escrow to Adler & Adler 7,000.00
1304.
1305.
1400. TOTAL SETTLEMENT CHARGES IEnter on Lines 103, Section J and 502, Section K\ 6,905.06 8,543.00
By signing page 1 of thiS statement, the slgnatones acknowledge receipt of a completed copy of page 2 of this Iwo page statement.
Certified to be a true copy.
Mid-Penn A ct Co.
SetUement Agent
( MORAN-MPF-2004/ MORAN-MPF-2004/6 )
REV-:507 EX' (6-98) *'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
K OS€r
.
,
/-la.r-ol d
-,
FILE NUMBER
.:J-J - 04- 04/7
All property jolnUy-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
I.
Note r-ece/ vdlhle -
Oreify,-:j:)h; //.'t> Cfn4 E1'h//Y
,Vof e Ieee)' Va b I ~
OretJ / J :roh V1 and KalAl
#3,500.DD
;).
3 z q f). O()
,
TOTAL (Also enter on line 4, Recapitulation) $
(If more space is needed, insert additIonal sheets of the same size)
(;. 7Cf f},OO
This letter is to serve as verification of a personal loan made between Harold T. Koser and
Phillip & Emily Getty in the amount of $3,500 in January 2003. This loan is to be paid in full
to Harold Koser over several installments. In the event this loan has not been satisfied, any
due amount will be paid back to the Estate of Harold T. Koser for proper disbursement.
Signed
Date
L{/; / tJ3
/ I
f/t8
~h~
Amount
Date Paid
Check #
PROMISSORY NOTE
This document serves as verification of a personnel loan made between Harold T. Koser and
John and Kathy Getty in the amount of $8000.00 on 07 April 2003.
This loan is to be repaid in full to Harold T. Koser in $100.00 installments commencing on or
about 01 July 2003.
.~tbe event th I'S loan ~as not been fully satisfied Prio. r to tb e demise of Harold T. Koser., tben the
amoun due and payable to hiS estate. . u~/-' , . ~?:1. ,1/
'~"'~CJ (l......u;<-<.l...~ --:4- rJ41f'Y")~ '<7n /.;f . ~_ ' ru:Ov.r
I ~-<M~7~ ~U~4~~~A>ate: yc. ~~..-:tt4~~lO.
C Y 1 . ()$d"500, ao)
G., &<.. -03 W1r
lfv 7~ 03
.tf-7 -0, ~
AMOUNT PAID
DATE
CHECK NR#
.fb ~ 000. ()()
, it/OIOO
it/I), Of)
.5"'01 c{I
SO,OD
60.60
$'tJ. b I)
;/; f!J (j
,!j 'tlJ; 0
"~O, () 0
jT() , () ()
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m;J~:f'Jd:?t,<. {/
REV:'50B EX+ (6-9B) .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
I< oser ) Ha, D) 01 T
FILE NUMBER
;;2 J- 0,-/ - 0'1/7
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
VALUE AT DATE
OF DEATH
/.
~.
3.
'I
5.
~.
DESCRIPTION
jqqg 6uie-k LeS:ihf'~
\fIN it: /G L.f HP 5~ K I W IiS309Js
t!Cfsh
/he 1?7 ber" <;; / sr Fe L/ ;4<c-01.-I '7 f :#57S9
;::::;e" rn fJn f ;LId}, '0174/ /3q /) k-.
A-~COU.J1rs .#- 7 tv 7 oCjs a.nJ:HCfol o~
P ('ern VY) T IV,l'! /C 1/4/ t5UI1 ~
ell:> ::# 7/50gQ3
J/ou5c--hold C!:rOOqS C{r1d
-Pu rfl ; ~ h tj ? 7 J 5,.'
j 5. 000, ov
./
/3'/,00
.?-3....5'1g.i/
51) l?O;;l.)?5
;; (p J I q S. W
J-.) 7SD. tJO
TOTAL (Also enter on line 5. Recapilujation) $ J Oq, 'f3lfl!)S
(If mOre space is needed, Insert additional sheets of the same SIZe)
st
t;end inquires to:
5000 Louise Drive
PO Box. 40
Mechanicsburg, PA 17055
www.members1st.org
Member's
Statement
of Account
:AcCount Number F<om To Page
5739 04-01-04 06-30-04 1 of 1
AEMBERS 1st
FEDERAL CREDIT UNION
Main Switchboard: (717) 697-1161 or (800) 283-2328
Ca/l-24: (717) 697-4372 or (800) 283-4372
TOO; (717) 697-5312 or (800} 283-2328 ext. 5312
TeleBranch: (717) 795-6049 or (800) 237-7288
CHANGE IS GOOD! WE'VE LOWERED
THE MINIMUM SAVINGS ACCOUNT
BALANCE FROM $25 TO $5 FOR
ANYONE UNDER THE AGE OF 22.
SEE THE ENCLOSED INSERT FOR
MORE INFORMATION.
=
....
1".111",1."11."11,,,11,1,.1.1.,1,,,11,,1,1,1,,1,..11,.11,1
31670
==
-
HAROLD T KOSER
clO JEFFREY E KOSER
241 NORTH 67TH STREET
HARRISBURG PA 17111
=
TRANS EFF.
DATE PATE
... TRANSACTION DESCRIPTION
.
AMOUNT
BALANCE
043004
050304
050304
050304
0517q~
05170~
SUFFIX:OO SAVINGS
DIVIDEND
SHARE WITHDRAWAL
TFR FROM SHARES
SHARE WITHDRAWAL
SHARE DIVIDEND
SHARE WITHDRAWAL
5739-05
9.10
-259.00
12732.03
-23523.09
.62
-25.62
11065.96
11075.06
10816.06
23548.09
25.00
25.62
.00
ANNUAL
ANNUAL
TRUTH IN SAVINGS
PERCENTAGE YIELD
PERCENTAGE YIELD EARNED
Y-T-D DIVIDENDS:
INFORMATION
II 1.00%
1.01%
37.27
--- ------------------------------------------------------------------------------
SUFFIX:05 INVESTMENT SVGS/MMA 12720.35
043004 DIVIDEND 10.98 12731.33
050304 SHARE DIVIDEND .70 12732.03
050304 TFR TO SHARES 5739-00 -12732.03 .00
Y-T-D DIVIDENDS:
TRUTH IN SAVINGS INFORMATION
ANNUAL PERCENTAGE YIELD I. 0%
ANNUAL PERCENTAGE YIELD EARNED I 1.05%
------------------------------------------------------------------
44.91
FOR 2004
*
IRA YTD * OTHER YTD
DIVIDENDS DIVIDENDS
.00 82.18
* TOTAL YTD * TOTAL YTD * TOTA
DIVIDENDS WITHHCLDING FORF
82.18 .00
YTD *
ITURES
.00
,
. --.-- ~~~ ...=/lOR<:1= ~IOE FOR IMPORTANT INFORMATION.
'1 Hemont
national Ban~
~ TlUst Company
MEMBER FDIC
May 11, 2004
Jeffrey E Koser
241 N 67th ST
Harrisburg PA
17111
Dear Jeff:
Please find the enclosed cashier's check *105523, in the amount
of $51,802:85. These funds are the proceeds from closed
accounts #767093 & 9010629, as you had requested these accounts
to be closed. The check reads Estate of Harold Koser as Harold
was the sole owner on both accounts.
Also, just wanted you to know that I will need the Certificate of
Deposit when you decide to cash it.
I was very sorry to hear about Harold's death, he was a very
nice gentleman to visit with when he called to do business. If
you should have any questions pertaining to your Father's
accounts, please don't hesitate to call me at (402)753-2271.
Sincerely
.:.~!:?d)
Personal Banker
Enclosures
Main Bank. 152 East 61\0 Street. Flemont. NE 63025 . Phone: 402.721.1050 Of 800-3 J 7-BANK . Fax: 402-72H\32) . W\rVWJremontnationa1.com
'1 Hemont
national Bank
{... TlUst Company
fl/~ cq6C, /of'
MEMBER FDIC
June 1, 2004
Jeffrey E Koser
Estate of Harold T Koser
241 N. 67th ST
Harrisburg PA 17111
Dear Jeff:
please find the enclosed cashier's check #105581, in the amount
of $26,195.49. These funds are the proceeds from Certificate
of Deposit #7150893, as you had requested this Certificate to be
c1 osed.
If you should have any questions pertaining to this transaction,
please don't hesitate to call me at (402)721-1050.
Sincerely
v' . /) ~
/:, ~ ..tra1.~
Kat~;'~ord d
Personal Banker
Enclosures
Main Bank. 152 East 6'" Str..t . Fremont, NE 68025 . Phone: 402-721-1050 or BOO-317-BANK . Fax: 402-721-0321 . www.tremonmatklnaLcom
REV:1509 EX+ 16-98*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLy-oWNED PROPERTY
05€r". 1-J-4rold I.
If an aaset ;,.. made joint within one year of the decedent's date of death, it must be reported on Schedule G.
FILE ~UJIIBER
OJ/ - 04 - 0'//7
ESTATE OF
A. .Teffretj E. Kose,--
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
.;;L4/ V. b 7+11
-J-/Arr j 5. b cA r"'J
Sf.
flll 1711/
SOr]
B.
C.
JOINTLY.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
I",M FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTlY-HELD REAL eSTATE. VALUE OF ASseT INTEREST DECEDENT'S INTEREST
1. A. 1)"/ fl Pel1lJ>1j I VI/n i,., ~fak
6crn K- check;n7 aCL'ttlnt
# I oC; 0'1 ~ 2-- 2- IS J I %7.3~ Sf) if ~ 5q '3
d. A-. I J"jv /1,Jr15Cj /vtlni PI 51&{ f .e:..
/3CfrJ J< ,5.?i v'in:!, S CKCOUn
:# die '-/-0;;' 4-s 3 ~1.50j.,.tfu 5D /</j7<:;
J
TlDTAL (Also enter on line 6. Recapitulation) $ ""2- 2, 3'1 Iie1
,18
3. :20
(If more space is needed, insert additional sheets of the same size)
REV~1511 EX+ (12'99t*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
os er- I ft4rold I
.
RLE NUMBER
?-I - t!J Lj - Olf/7
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
B.
,.
FUNERAL EXPENSES:
/h'1~rS -hmer.11 HorYI~
flint;( r ,. G.h - t1J... ern or; ,4. I
Ujl - t::narIlV'r1}
'd':t:;;{ nt f2 v od s 'l
:s~ in'S CAI b
/JId/tfs It,'d
3j[$'. !:.51
) bfS'T DV
'15 CV
LJ g5 . J 7
10 .~h
/00. 00
1.
ADMINISTRATIVE COSTS: ( )
personal Representative's Commissions d %
Name of Pel1lOnal Replesentalive(.) ) k'ff' re '1 2
Social Security Number(s)/E1N Number of Personal Representative(s)
Slreet Addle" ;;J 'I J /J b 7 + fo S. + ,
City Ha ('( ; ('bvv'(f
Year(s) Commission Paid: ;;J () 0 S"
Attorney Fees )Jon <12-,
#// d-92? 72-
J
J<o.ser
/g2-::S<</- 7/73
,State f.A Zip /7 I' J
2.
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
A.J 0 11 (Z
Sb"eetAddress
City
State
.Zip
Relationship of Claimant 10 Decedent
4.
Probate Fees
3OS? $"'0
5.
Accountant'. Fees AJ iJ 11 ./2_
Tax Return Preparer's Fees AJ {.? (1 it-
Alver! /5/nt 1~1f~,s. -
-5'(! rJ 7' 'r7t7 /
C Prh IJ{lr/t:?ncf Ldt/J J:)i.Arna I
55 I. 5:9
7:::: Ou
6.
7.
J'-f. 'f(PO,~B
TOTAL (Also enter on line 9, Recapitulation) $
(If more space IS needed, insert additional sheets of the same size)
REV'.1512 EX. 112-03) .
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIO!:NT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE UABIUTlES, & UENS
ESTATE Of V 11 Id FILE NUMBER
T) OSe'V- I rrp/rfJ /, "2/- 04 - 04/7
,
Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, Including unrelmbursed medical expenses.
VALUE AT DATE
OF DEATH
II, Cl,v
~1? .<]'5;
57.5-0
ITEM
NUMBER
DESCRIPTION
1.
fJ n /liZcI Wafer
I(ed C{){J~.er
U1.L
R i fI t,. 5. /-lev' ,( vt.Jd ,- L
~5.15
J..,
6,
'/.
5, E.,t.xon
&. fJf'L
"7 t:-ol//ns t:!61n sf/'t(crj'on
(/.. Wctlnt41 t5/Filar'Vl L:?ndsctl'~/n?
1- /l-f/')C( lIet:dfA ct7r'e-
/0, C2h~ rn / Al-</r7
u .,4/tr
) 2 fJ//J/J?U:: Ie /I (l?i I fh
3J,~
53.lg
;;? / gS': 7 ()
'12..l/v
/O.;L'()
37,10
73.5" h
/00 .0()
TOTAL (Also enter on line 10, Recapitulation) S
(If more space is needed, insert additional sheets of the same size)
~ bQr-,'5o
REV'~513EX'(9'OOI ..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
NUMBER
I
/0
r< 05.,fly I
/J-aro/d I.
FILE NUMBER
2/ - oy. OLfl7
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
q--rtlndsoV)
t3 ra.../5<JV)
cy IInJdtJ. '" t/1 H ~
tVdY/d tlt<IAfJA f~.
1ran4soYl
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o Cl ('tho J.so n
ar~l.-r - , .
I 1N1V,ddLll.lf/'t( ,,-
da t-IfJ h 1- .( Y'
501'1
AMOUNT OR SHARE
OF ESTATE
2,OOIJ.OlJ
;;1, 000..J()
6,fJOO.OIJ
~J 0<90. 00
"2--; 0 f) o. v J
100.00
-;:;00. 0 v
";-0 ~ < 0 c)
1/2-
I/z
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 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
f.
2.
3.
if.
$:
~.
1.
g'.
9.
NAME AND ADDRESS OF PERSDN(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS {include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)1
>>ffr-e 'J ~ 'I
rh,' / J,'f' (;e.1f ')
Lor,'l1l1<l J<(}S~r
fY) (l.}an, e )( osflr
t11 ,'e-ha<? / ltJev udal/(
-II 14 " l.(J e v (1 d a.. '-'L
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'f:>r)tfeir7<f C,e7fy
J{4Th'1 C;-etl y
::rpfFr~'f /-('f}S-fr
Church
TOTAL OF PART /1- ENTER TOTAL NON. TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-l500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
~/Vcl(,cr
Lu1h.llr-Cf"''''
/0.1 I)C}O. 0;;
1.9.1 0 00.00
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11~96l
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
KOSER JEFFREY E
241 N 67TH STREET
HARRISBURG, PA 17111
_n____~ laid
ESTATE INFORMATION: SSN: 204-03-5089
FILE NUMBER: 2104-0417
DECEDENT NAME: KOSER HAROLD T
DATE OF PAYMENT: 01/18/2005
POSTMARK DATE: 01118/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 04/18/2004
NO. CD 004856
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $11,489.09
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK#1603
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$11,489.09
GLENDA FARNER STRASBAUGH
REGISTER OF WilLS
INVENTORY AND APPRAISEMENT
Estate of Harold T. Koser
File No. 21-04-0417
Cumberland County, Pennsylvania
Real Property
1. 34 Round Ridge Road, Mechanicsburg, Lower Allen
Township, Cumberland County - Conveyed to decedent
by deed dated July 31, 2000, recorded in Cumberland Co.
Deed Book 226, p. 613
(Refrigerator, microwave, washer, dryer, dehumidifier,
window coverings included at no additional cost when
property was sold on November 19, 2004)
Automobile
2. 1998 Buick LeSabre VIN # 1G4HP52K1WH530915
Notes Receivable
3. Note receivable - Phillip and Emily Getty
4. Note receivable - John and Kathy Getty
Cash
5. Cash on hand
6. Members 151 FCU savings account # 5739
7. Fremont National Bank passbook accounts # 767093 and
# 9010629
8. Fremont National Bank CD # 7150893
Note - Checking and savings accounts at Pennsylvania
State Bank were jointly held and not subject to probate
Personal Property
Guns
9. Winchester Model 1400, 16 gauge
10. Marlin Model 39-A. .22 caliber
11. Harrington & Richardson, 12 gauge
12. Stevens Model 38-B, 410 gauge
13. Treadmill
14. Dell computer
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$143,900.00
5,000.00
3,500.00
3,290.00
134.00
23,548.71
51,802.85
26,195.49
200.00
200.00
60.00
75.00
25.00
250.00
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15. Computer desk and chair
16. 5-piece bedroom suite with adjustable double bed
17. 4-piece bedroom suite with double spring & mattress
18. 9-piece dining room suite
19. Dinette set
20. Sofa
21. Recliner
22. Glider chair
23. Rocking chair
24. Set - coffee and end tables with lamps
25. Entertainment unit
26. 27" RCA television wNCR
27. Bookcase stereo
28. Bookcases
29. Deacons bench
30. Desk and chair
31. Decorative plates
32. Assorted pots, pans, dishes, utensils, glassware, towels,
bedding, knick-knacks, household goods and supplies
50.00
600.00
300.00
300.00
25.00
100.00
20.00
20.00
20.00
50.00
50.00
75.00
30.00
50.00
25.00
25.00
50.00
150.00
Total estate value
$260,121.05
Prepared and submitted by:
o ;j;f),;f'
Date
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 4/07/2005
ADKINS HANNAH
351 STUMPSTOWN RD
MECHANICSBURG, PA 17055
RE: Estate of SALAMON REBECCA
File Number: 2003-00417
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of -the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
5/09/2005
Your prompt attention to this matter will be appreciated.
Thank You.
I~ncer~ ik=J~lu.~
A_,,~_ _ ~~
. ,.~...t
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Counsel
Judge
cI
IN RE:
ESTATE OF HAROLD T. KOSER,
DECEASED
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
No. 21-04-0417
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AGREEMENT TO SETTLE ESTATE ,
t...)
THIS AGREEMENT is made this 2nd day of A~(,l5-r- , 2005,1~d iS2:.~
based on the following averments by Jeffrey E. Koser, ~s Executor: ''''
1. Harold T. Koser died testate April 18, 2004.
2. A will dated April 22, 1974, and a codicil dated January 21,2002, were filed with
the Court on April 28, 2004, by Jeffrey E. Koser, who was named in the will as
Executor.
3. An oath was administered by which Jeffrey E. Koser swore to faithfully perform
all duties associated with his role as Executor.
4. Jeffrey E. Koser marshaled the estate assets, sold the real estate and paid all
bills relating to the estate.
5. After determining that the assets were more than sufficient to pay the specific
bequests provided for in the codicil, Jeffrey E. Koser issued checks from the
estate checking account to all the designated beneficiaries on May 22, 2004. All
of the funds so distributed have cleared the account.
6. Other than the specific bequests provided under the terms of the codicil, the will
provides that the entire probate estate is shared equally between Jeffrey E.
Koser and Kathy E. Getty.
7. Jeffrey E. Koser prepared an accounting and a proposed schedule of distribution,
a copy of which is attached hereto, and submitted it to William D. Schrack, III,
Esquire, at his request, for review with his client, Kathy E. Getty.
8. Kathy E. Getty, by and through her attorney, has indicated her acceptance
thereof and requested distribution.
9. Jeffrey E. Koser, Executor, is willing to make final distribution without reserve and
without the formality of an accounting to the Court based upon the execution of
this agreement.
"0
","'J
NOW, therefore, in consideration of the foregoing, Jeffrey E. Koser and Kathy E.
Getty each agrees as follows:
1. I wish to forever settle any and all claims and rights I may have under the terms
of the will.
2. I represent that I have read and understand this agreement and hereby
knowingly and voluntarily waive a formal accounting with the Court.
VP
3. I accept the accounting attached hereto as complete and accurate and
acknowledge that the distribution set forth therein shall be in complete
satisfaction of my entitlement under the Will.
4. I release and forever discharge the Executor and indemnify him against any and
all claims against the Estate after this date.
5. I agree to refund, on demand, any portion of the final distribution that the
Executor or the Court determines to have been made improperly.
6. I acknowledge that this agreement is effective upon my receipt of the sum listed
under my name as "FINAL DISTRIBUTION" in the attached accounting.
IN WITNESS WHEREOF, the parties hereto set their hands and seals.
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF n,^-,?h\~ : SS:
On this, the ~nA day of A~\\...J- ,2005, before me, a Notary
Public in and for the Commonwealth of P sylvania, the undersigned officer, personally
appeared JEFFREY E. KOSER, known to me to be the person whose name is subscribed to
the foregoing instrument, and acknowledged that he executed the same for the purpose therein
contained.
IN WITNESS WHEREOF, I have hereto set my hand and Notarial seal.
NOIW' .....
~LQlIf".
NoIaIY NllIC
(2fOf 1.,.-111'.... ~ COUNl'I
_c:..o,..J1II;l1\_~ 28. 2Oll9
Ny~u- ;I~
NOTARY PUBLI
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
On this, the Ilblfaay of ,2005, before me, a Notary
Public in and for the Commonwealth 0 Iva i the undersigned officer, personally
appeared KATHY E. GETTY, known to me to be th rson whose name is subscribed to the
foregoing instrument, and acknowledged that he executed the same for the purpose therein
contained.
IN WITNESS WHEREOF, I have hereto set my hand
SS:
.-l8I SelII
Janel S. GoM. NolaIY Ptdc
l)ill9b<lgllolO, YOII<CounIY
My~ ExplreS Oct. 25, 2008
~.~~Of~
FIRST AND FINAL ACCOUNTING
AND PROPOSED DISTRIBUTION
Estate of Harold T. Koser
File No. 21-04-0417
Cumberland County, Pennsylvania
NON-CASH ASSETS (distributed in kind)
Guns and household aoods
Winchester Model 1400, 16 gauge
Marlin Model 39-A .22 caliber
Harrington & Richardson, 12 gauge
Stevens Model 38-B, 410 gauge
Treadmill
Dell computer
Computer desk and chair
5-piece bedroom suite - adjustable double bed
4-piece bedroom suite - double spring &
mattress
9-piece dining room suite
Dinette set
Sofa
Recliner
Glider chair
Rocking chair
Set - coffee and end tables with lamps
Entertainment unit
27" RCA television wNCR
Bookcase stereo
Bookcases
Deacons bench
Desk and chair
Decorative plates
Assorted pots, pans, dishes, utensils,
glassware, towels, bedding, knick-
knacks, household goods and supplies
1998 Buick LeSabre
Note repayment- Phillip and Emily Getty
Note repayment - John and Kathy Getty
Total in kind distribution - Kathy
Total in kind distribution - Jeff
TOTAL IN KIND DISTRIBUTIONS
Kathv
$ 25.00
250.00
20.00
25.00
320.00
3,500.00
3.290.00
$ 7,110.00
Jeff TOTAL
$ 200.00
200.00
60.00
75.00
50.00
600.00
300.00
300.00
25.00
100.00
20.00
20.00
50.00
50.00
75.00
30.00
50.00
25.00
50.00
150.00
2,430.00
5,000.00
2,750.00
5,000.00
3,500.00
3.290.00
$ 7,430.00
$ 14,540.00
CASH ASSETS
04/18/05 Cash on Hand
05/06/04 Members 1st FCU savings account # 5739
05/06/04 Patriot News Refund
05/15/04 Fremont National Bank passbook accounts # 767093
and # 9010629
05/17/04 Veterans Burial Allowance
05/17/04 Liberty Mutual Car Insurance refund
OS/26/04 Members 1st FCU savings account # 5739
06/07/04 Fremont National Bank CD # 7150893
06/15/04 Cable refund
08/25/04 Deposit on sale of house
10/04/04 Homeowner Insurance refund
11/23/04 Sale of house
02/05/05 Refund of Escrow reserve from sale of house
02/24/05 Waste Management refund
05/17/05 Apria Healthcare refund
05/17/05 IRS refund
06/13/05 Harvard Health letter refund
TOTAL
$ 134.00
23,523.09
40.05
51,802.85
TOTAL ESTATE ASSETS (Non-cash and cash)
100.00
365.00
25.62
26,195.49
30.92
500.00
270.00
135,909.77
7,000.00
20.69
10.20
2,236.00
4.00
$ 248,167.68
$ 262,707.68
DEBTS OF THE DECEDENT
05/08/04 United Water PA $ 11.08
05/09/04 Red Cooper 28.95
05/09/04 UGI 57.50
05/09/04 Ritter's Hardware 55.15
05/09/04 Exxon Mobil 39.68
05/09/04 PPL 53.18
05/09/04 Collins Construction 2,185.70
06/19/04 Pinnacle Health 100.00
TOTAL $ 2,531.24
ESTATE EXPENDITURES
04/20/04 Giant Foods $ 485.27
04/23/04 Calvary Ladies Aid 100.00
04/23/04 Sam's Club (mints) 10.86
04/26/04 George's Cleaners 9.36
04/27/04 Mail Boxes, Etc. (copies) 9.39
04/28/04 Register of Wills 273.50
05/05/04 Forwarding postage due 5.63
05/11/04 Stamps 7.40
05/14/04 Myers Funeral Home 318.54
05/18/04 Checks 16.40
05/19/04 Gingrich Memorials 840.00
OS/22/04 Walnut Bottom Landscaping 84.80
OS/22/04 Apria Healthcare 10.20
OS/22/04 Sentinel 81.59
OS/22/04 Law Joumal 75.00
OS/28/04 United Water PA 11.08
OS/28/04 PPL 42.47
OS/28/04 UGI 57.50
OS/29/04 Chemlawn 37.10
06/01/04 AT&T 73.56
06/13/04 Gingrich Memorials 95.00
06/15/04 Walnut Bottom Landscaping 84.80
06/15/04 Landscaping plants 12.00
06/15/04 Country Market Nursery (mulch) 15.87
06/17/04 AT&T 29.95
06/27/04 UGI 57.50
06/27/04 Eugene Burd (driveway sealing) 105.00
06/27/04 PPL 58.96
07/02/04 Goodville Mutual (Homeowners Ins) 388.00
07/02/04 Waste Management 35.39
07/02/04 United Water PA 6.76
07/05/04 Lowe's (painting supplies) 30.46
07/06/04 Sherwin Williams (paint) 192.35
07/06/04 Country Market Nursery (mulch) 10.58
Date:
r--
C'?
C"
;f)
Register of Wills of Cumberland County
STATUS REPORT UNDER RULE 6.12
.J-IaroJd I. Koser
<iJ4 - / g -;200 4
- 0'-/ - 04/7
Name of Decedent:
Date of Death:
Estate No.: r It ;:;;. /
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration ofthe above-captioned estate:
1. Sta~e;;rther administration of the estate is complete:
Yes/" No 0
2. If the answer is No, state when the personal representative reasonably believes that
the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes 0 No 0
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the pers~~epresentative state an account informally to the parties in
interest? Ye~ No 0
c. Copies of receipts, releases, joinders and approval of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report.
8-/0- ;)otJS
/~~,
~' .
JeFfrey E
Name
d-L/ I IV. fa 7-fh 3fj
Address
lfarob!Ju1, PA
. Telephone No. (7 (7 ) '5 '-7L/ -
~ersonal Representative
nCounsel for personal representative
Ko se r
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