HomeMy WebLinkAbout03-0242PETITION FOR PROBATE & GRANT OF LETTERS
Estate of
also known as
CHLOE E. FORNEY
deceased.
Social Security No. 194-28-7567
No.
To: Register of Wills for the
County of Cumberland
Commonwealth of Pennsylvania
The Petition of the undersigned respectfully represents that:
Your Petitioners, who are 18 years of age or older and the Executors named in the Last Will of the
above decedent dated June 10, 1994 , and codicils dated none . The Executor
named none died Renunciations for none attached hereto.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal
residence at 30 Greason Road, Plainfield, West Pennsboro Township
Decedent, then 68 years of age, died
February 5 ,2003, at her residence
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:
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property
(If not domiciled in PA) Personal property in PA
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania, situated as follows:
$16,000.00
$
WHEREFORE, Petitioners respectfully requests the probate of the Last Will and Codicil(s) presented
herewith and the grant of letters testamentary thereon.
Signature(s) and Residence(s) of Petitioner(s):
Patricia A. Forne¥ n/k/a Patricia A. Stake
P.O. Box 66
Newvillel PA 17241
717-776-6405
Benson B. Stake
P.O. Box 66
Newville, PA 17241
717-776-6405
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
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 representative of
the above decedent, petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed
before me this ! ?" day of
March ,2003.
- Register
Benson B. Stake
No. 21-03- 242
Estate of CHLOE E. FORNEY
, deceased.
DECREE OF PROBATE & GRANT OF LETTERS
AND NOW, March 20th ,2003, 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
June 10, 1994 described therein be admitted to probate and filed of record as the
Last Will of Chloe E. Forney ; and Letters Testamentary are hereby granted to
Patricia A. Forney n/k/a Patricia A. Stake and Benson B. Stake
' ' FEES- '
Probate, Letters, Etc ........ $. 50.00
Shod Certificates(-2- ) .... $ 6.00
Renunciation(s) ........... $.
JCP .................... $. 10.00
Other Will Pages (-2-) .... $.6.00
TOTAL: .... $ 72.00
Filed. MAR. C.I-I .20,. 2003 ............
......... R~gi~r of Wills -
IRWIN McKNIGHT & HUGHES
Roger B. Irwin, Esquire (06282)
ATTORNEY (Sup. Ct. I.D. No.)
60 West Pomfret St., Carlisle, PA 17013
ADDRESS
717-249-2353
PHONE
CALLED ATTORNEY- MARCH 20, 2003
21-03-242
21-03-242
LAST WILL AND TESTAMENT
I, CHLOE E. FORNEY, of West Pennsboro Township, Cumberland County,
Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly
revoking all Wills and Codicils heretofore made by me.
1. I direct my executors to pay all of my debts, funeral and administrative expenses as
soon as may be done conveniently after my decease.
2. I authorize and empower my executors to sell any realty owned by me at my death and
not specifically devised herein, at either public or private sale, and to give good and sufficiem
deeds therefor, in fee simple, as I could do if living.
3. I give, devise and bequeath all of my estate of every nature and wherever situate to
Scott A. Fomey, and if he is not living at the time of my death, to Patricia A. Fomey and Benson
B. Stake, share and share alike.
4. I nominate and appoint Patricia A. Fomey and Benson B. Stake to be the executors of
this my Last Will and Testament; they are to serve as such without bond.
5. I hereby suggest that my personal representative retain the services of Irwin, Irwin &
McKnight, as attorneys in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ,o' day of June,
1994.
- CHLOE E. FORNEY~.~
(SEAL)
Signed, sealed, published and declared by CHLOE E. FORNEY, the testatrix above
named, as and for her Last Will and Testament, in the presence of us, who at her request, in her
presence and in the presence of each other have subscribed our names as witnesses hereto.
A CKNO WLEDGMENT AND AFFIDAVIT
WE, CHLOE E. FORNEY, BETZI A. MORRISON and CHERYL L. CLELAND,
the testatrix and witnesses respectively, whose names are signed to the foregoing instrument,
being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and
executed the instrument as her Last Will and that she had signed willingly, and that she executed it
as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in
the presence and hearing of the testatrix, signed the Will as a witness and that to the best of their
knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under
no constraint or undue influence.
COMMONWEALTH OF PENNSYLVANIA
CHLOE E. FORNEY ~,,,_f
RYL L. CLELAND
COUNTY OF CUMBERLAND
SS:
Subscribed, sworn to and acknowledged before me by CHLOE E. FORNEY, the
testatrix herein and subscribed and sworn to before me by BETZI A. MORRISON and
CHERYL L. CLELAND, witnesses this / ~,' day of June, 1994.
]~ ~tary Public
CHLOE E. FO~
IRWIN, IRWIN & MCKNIGHT
WEST POMFRET PROFESSIONAL BUILDING
60 WEST POMFRET STREET
CARLISLE, PENNSYLVANIA 17013-3222
( 777 ) 249~2353
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
Date of Death:
Estate No.:
CHLOEE. FORNEY
FEBRUARY 5,2003
21-03-0242
To the Register:
I certify that notice of the beneficial interest required by Rule 5.6(a) of the Orphan's
Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate
on April 3, 2003 .
Sallie
Address
Scott A. Forney
c/o Patricia A. Stake; P.O. Box 66, Newville, PA 17241
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: 04/03/03
Name Roger B. Irwin, Esquire
Address 60 West Pomfret Street
Carlisle~ PA 17013
Telephone (717) 249-2353
none.
Capacity:
X
Personal Representative
Counsel for Personal Representative
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
CHLOE E. FORNEY
Date of Death:
FEBRUARY 5, 2003
No. 21-03-242
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete: X Yes No
2. If the answer is No, state when the personal representative reasonably believes that the
administration will be complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
~ Yes X No
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties
in interest? X Yes No
Date:
05/04/04
Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of Orphan's Court and may be
attached to this report.
Signature ~/~ ~~
IRWIN & McKNIGHT
. Roger B. Irwin, Esquire
Name (please type or print)
60 West Pomfret Street
Address
Carlisle, PA 17013
City, State, Zip
(717) 249-2353
Telephone Number
Capacity:
X
Personal Representative
Counsel for Personal Representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 002528
IRWIN ROGER B ESQ
60 W POMFRET ST
CARLISLE, PA 17013
........ fold
ESTATE INFORMATION: SSN: 1 94-28-7567
FILE NUMBER: 2103-0242
DECEDENT NAME: FORNEY CHLOE E
DATE OF PAYMENT: 05/05/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 02/05/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $5,099.38
TOTAL AMOUNT PAID:
$5,099.38
REMARKS: ROGER B IRWIN ESQUIRE
SEAL
CHECK# 019783
INITIALS: JA
RECEIVED BY:
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
REV- 1500 EX + (6-00)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. Z80601
HARRISBURG, PA 17128-0601
'VI- tz.ct-
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME(LAST, FIRST, AND MIDDLE INITIAL)
~Forne¥ Chloe E.
DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR)
02/05/2003 I 11/25/1934
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
1. Original Return ~ :~74~.. Supplemental Return
4. Limited Estate · Future lnterest Compromise (date of death after 12-12-82)
6. Decedent Died Testate Decedent Maintained a Living Trust
(Attach copy of Will) (Attach copy of Trust)
~ 9. Litigation Proceeds Received I'~ 10. Spousal Poverty Credit
/date cf death between 12-31-91 and 1-1-95)
NAME
Roger B. Irwin Esq.
FIRM NAME (If Applicable)
IRWIN McKNIGHT & HUGHES
TELEPHONE NUMBER
717/249- 2353
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or (3)
Sole -Proprietorship
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
-'-] Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13.
14.
OFFICIAL USE ONLY
FILE NUMBER
21-03-0242
COUNTYCODE YEAR NUMBER
SOCIAL SECURITY NUMBER
194-28-7567
THIS RETURN MUST BE FI LED IN DUPLICATE WITH THE
REGISTER OF W!~I_$
SOCIAL SECURITY NUMBER
(date of death
3. Remainder Return prior to 1;'- 13-8Z)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
r-~ 11. Election to tax under Sec. 9113(A)
(Attach Sch O)
COMPLETE MAILING ADDRESS
60 West Pomfret Street
West Pomfret Professional Bldg.
Carlisle, PA 17013
45,580.~'~93.,
None
9,669,45
126.35
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(a)(1.2) 0.00 X .0 0
16. Amount of Line 14 taxable at lineal rate 0.00 X .0 45
17. Amount of Line 14 taxable at sibling rate 0.00 X .12
18. Amount of Line 14 taxable at collateral rate 35,785.13 X .15
19. Tax Due
(8) 45,580.93
(11) 9,795.80
(12) 35,785.13
(13)
(14) 35,785.13
(16) 0.00
(16) o.oo
(17) 0.00
(18) 5,367.77
(19) 5,367.77
Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV- 1500 EX (Rev. 6-0o)
Decedent's Complete Address:
STREET ADDRESS
30 Greason Road
CITY
Plainfield
STATE
PA
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Biscount
(1)
268.39
Total Credits ( A + B + C ) (2)
I z1~7081
5,367.77
3. Interest/Penalty if applicable D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT,
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE, (SB)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
:. retain the use or incorne of the property transferred; .........................
· retain the right to designate who shall use the property transferred or its income; ...........
c. retain a reversionary interest; or ....................................
d. receive the promise for life of either payments, benefits or care? ...................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ................................ [~] ~']
3. Did decedent own an "in trust for" or payable upon death bank account or security at his
or her death? .............................................. [---] ~-~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property
which contains a beneficiary designation? ................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
268.39
0.00
0.00
5,099.38
0.00
5,099.38
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,
correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATUREOF PERSON RESPONSIBLE FOR FILING RETURN Patricia A. Stake DATE
- - >×-- - iy2-Ai ...........................
SIGNATURE OF PREPARER OTHER THAN REPRES~NTATIVE IRWIN Mc~IG~ & ~GHES DATE
~ ~ 60 Wes~ ~om[~e~ S~ee~ ~/
..................................................... y,
~0; da~es ;f deat~ ;r'~e; ~' ~, ~994 an~ g;f0're' oanua~ ~; ~ 9'95~ the tax rMe iAp0Sed on the net va~ue'0f transfem 'to ;; ~0; t~e'us, of the
surviving spouse ~-~2 P.S. 9116 (a) (1.1) (i)].
For dates of death on or after Janua~ 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statuto~ require~nts for disclosure of assets
and filing a tax return are ~ill applicable even if the surviving spouse is the only beneficial.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twen~-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2)
[72 P.S. 9116(a)(1)].
The ~x rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(a)(1.3)]. A sibling is defined, under
Section 9102~ as an individual who has at least one parent in com~n with the decedent, whether by blood or adoption.
Copyright (c) ZO~ form sof~are only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
ADDITIONAL Personal Representatives
Estate of Chloe E. Forney SS# 194-28-7567 02/05/2003
Under penalties of perjury, the undersigned declare that they
have examined this return, including accompanying schedules and
statements, and to the best of their knowledge and belief, it is
true, correct and complete.
Signature
Name
Address Line 1
Address Line 2
City, State, Zip
Date
Benson B. Stake
P.O. Box 66
Newville, PA 17241
REV- 1508 EX + (1-97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Chloe g. Forney SS~/ 194-28-7567 02/05/2003 21-03-0242
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1
2
3
4
5
DESCRIPTION
PNC Bank NA -
Waypoint Bank,
Waypoint Bank,
checking account
savings account #10189597
checking account #90590878
1986 Chevrolet Cavalier Sedan
Van Kampen Prime Rate, fixed income fund
TOTAL (Also enter on line 5, Recapitulation)
VALUE AT DATE
Of DEATH
3,997.75
5,184.05
10,451.78
1,000.00
24,947.35
$ 45,580.93
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV- 1508 EX (Rev. 1-97)
REV- 1511 EX + (I -97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Chloe E. Forney SS~/ 194-28-7567
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
02/05/2003
FILENUMBER
21-03-0242
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
1
2
3
DESCRIPTION
FUNERAL EXPENSES:
Eby Granite Works
Egger Funeral Home
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address
City State
Zip
Year(s) Commission Paid:
Attorney's Fees IRWIN Mc[42~IG[-~ & [-FJGHES
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
Probate Fees Register of Wills
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
Cumberland Law Journal - estate notice publication
Register of Wills filing fees
The Sentinel Legal
TOTAL (Also enter on line 9, Recapitulation) $
AMOUNT
1,039.00
6,163.18
2,200.00
72.00
75.00
25.00
95.27
9,669.45
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97)
REV-1512 EX + (1-97)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Chloe E. Forney SS~; 194-28-7567 02/05/2003 21-03-0242
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1
2
3
4
5
6
Patricia A. Rosendale CPA - income tax preparation
PP&L
Shipley Energy
Spring Road Family Practice
Sprint Telephone
The Wisconsin Cheese Factory
40.00
31.29
6.30
9.13
20.88
18.75
TOTAL (Also enter on line 10, Recapitulation) $ 126.35
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPS¥stems, Inc. Form REV-1512 EX (Rev. 1-97)
REV- 1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Chloe E. Forney SS~/ 194-28-7567
SCHEDULE J
BENEFICIARIES
02/05/2003
FILENUMBER
21-03-0242
NUMBER
II.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
transfers u~er Sec. 9116(a)(1 .Z)]
Scott A. Forney
75 Creekview Road
Newville, PA 17241
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Nephew
AMOUNT OR SHARE
OF ESTATE
remainder
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0 o 00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) Z000 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00)
LAST WILL AND TESTAMENT
I, CHLOE E. FOR.NEY, of West Pennsboro Township, Cumberland County,
Pennsylvania, declare this instrument to be my Last Will and Testament, hereby exp. ressly
revoking all Wills and Codicils heretofore made by me.
_ !. I direct_.my., executors to pay all_of my debts, funeral and administratiYe expenses as
soon as may be done conveniently after my decease.
2. I authorize and empower my executors to sell any realty owned by me at my death and
not specifically devised herein, at either public or private sale, and to give good and sufficient
deeds therefor, in fee simple, as I could do if living.
3. I give, devise and bequeath all of my estate of every nature and wherever situate to
Scott A. Forney, and if he is not living at the time of my death, to Patricia A. Forney and Benson
B. Stake, share and share alike.
4. I nominate and appoint Patricia A. Fomey and Benson B. Stake to be the executors of
this my Last Will and Testament; they are to serve as such without bond.
5. I hereby suggest that my personal representative retain the services of Irwin, Irwin &
McKnight, as attorneys in the settlement of my estate.
IN WITNESS WHEREOF, ! have hereunto set my hand and seal this ,o' day of June,
1994.
CHLOE E. FORNE¥~_J
Signed, sealed, pUblished and declared by CItLOE E. FORNEY, the testatrix above
named, as and for her Last Will and Testament, in the presence of us, who at her request, in her
presence and in the presence of each other have subscribed our names as witnesses hereto.
2
A CKNOWLEDGMENTAND AFFIDA I/TT
WE, CHLOE E. FORNEY, BETZI A. MORRISON and CHERYL L. CLELAND,
the testatrix and witnesses respectively, whose names are signed to the foregoing instrument,
being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and
executed the instrument as her Last Will and that she had signed willingly, and that she executed it
as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in
the presence and hearing of the testatrix, signed the Will as a witness and that to the best of their
knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under
no Constraint'or u~due influence.
CHLOE E. FORNEY .(,...f
CI~RYL L. CLELAND
COMMONWEALTH OF PENNSYLVANIA :
: SS:
COUNTY OF CUMBERLAND :
Subscribed, sworn to and acknowledged before me by CHLOE E. FORNEY, the
testatrix herein and subscribed and sworn to before me by BETZI A. MORRISON and
CHERYL L. CLELAND, witnesses this ~ .:' day of June, 1994.
f/ N~}tary Public
:ORPORATION
CHLOE E FORNEY
30 GREASON ROAD BOX 102
PLAINFIELD PA 17081
YOUR REPRESENTATIVE:
MA'I"I'H E~V SIMMONS
RR~: NRS
FOR QUESTIONS OR UP-TO-DATE ACCOUNT INFORMAT'ION:
717 564 6408
Statement Date: 02/01/03 to 02/28/03
TOTAL PORTFOLIO
SNAPSHOT $24,947.35
.~cu~iti~s ' $24,947.35 $25,109.13
TOTAL PORTFOLIO VALUE
$24,947.35 $25,109.13
Net Additions and Withdrawals ($85.44) . ($135.93)
Net Income and Expenses $85.44 $135.93
27,000.
18,000.
9,000.
B June 20O2 ~ December 2002
BSeptember2002 B ThisPedod
Portfolio Value
(in dollars)
A portfolio value less than $100.00 may not be displayed
Account carried with National Financial Se~Mces LLC, Member NYSE, SIPC
Account Number: E66-000825
Account Name: FORNEY CH
Statement Date: 02/01/2003 to 02/28/2003
FINANCIAL CORPORATION
ALERT: T~bl~ income
is de.'mined based on
in~torm~fion av~l,s, bJe m
~S at ~e time ~
h sub~ m c~ Fia~
in~mfion on ~fioa of
a~ on
in ~ of~ sub~t
SUMMARY
:::::::::::::::::::::::::: ::i:: :: ii!i i::: ::!~ ::::::::::::::::::::::::::::::::::: : ::: ::: ::::::::::::::::::::::::::::::::: :: ::::::::::::::::::::::::::::::::::::::::::::::::
Securities
Mutual Funds
Fixed Income $24,947.35 $25,100.13
Total Securities $24,g47.35 $25,109.13
TOTAL PORTFOLIO VALUE $24,947.35 $25,109.13
BEGINNING BALANCE $0.00
Mdifions and Withdrawals
Checking Activity ($85.44) ($135.93)
NET ADDITIONS AND WI'IHDRAWALS ($85.44) ($135.93)
Income and FF~peases
Taxable Income
Taxable Dividends $85.44 $! 70.93
NET TAXABLE INCOME $85.44 $170.93
Account Fecs $0.00 ($35.00)
NET INCOME AND EXPENSES $85.44 $135.93
ENDING BALANCE $0.00
DETAIL
Invest Financial Corporation is not affiliated with the depository institution and/or its subsidaries. Securities and insurance products am offered through Invest Financial Corporation (Invest),
Member NASD. SIPC. and affiliated insurance agencies and are not insured by the FDIC or NCUA. are not a deposit or other obligation of, or guaranteed by. any bank or credit union, are
subiect to risks including the possible loss of principal amount invested.
See last page
Account carried with National Financial Services LLC, Member NYSE, SIPC
for important information about your brokerage account and this statement.
APR-Ol-~003 17:~8 PNCBANK 412 ?~8 3458 P.0~×0~
PNCBAN<
April 1, 2003
Roger B. Irwin
West Pomfret Professional Building
60 West Porafret Street
Carlisle, PA 17013-3222
Estate of Chloe E. Forney, deceased
SSN: 194-28-7567
DOD: 2/5/2003
In response to your request for Date of Death balances for the customer noted above,, our
records show the following:
Checking Aecount
Account #5140409054
MISS CHLOE E FOR31EY
DOD balance: $3,977.50 + $.25 accrued interest
lat~r~st Paid 1/1/2003 - 2/5/2003 - $.75
Established 04/06/1984
Please note that this office only provides date of death balances for deposit ae, co.vns
(IRAs, CDs, Checking and Savings accounts). We do not process any l~mancial
transactions or provide statement~. If you need assistance with any of these items,
please call 1-885-PNC-BANK (1-8S8-762-2265) or stop by your local PNC Bnnlc branch
office.
Sincerely,
Raehelle Well~
1-800-762-1775
P7-PFSC-04-F
500 first Ave.
Pittsburgh PA 15219
M~mb~r FDIC
TOTAL P.02
LOOK FOR US. WE'LL GET YOU THERE.
03/10/2003
IRWIN MCKNIGHT & HUGHES
60 W POMFRET ST
CARLISLE PA 17013
The information which you requested on the account(s) of CHLOE FORNEY
(Social Security Number 194-28-7567) is/are as follows:
Account Number 10189597 90590878
Class of Account SAVINGS CHECKING
Date Opened 12/18/92 06/19/89
Principal Balance 5183.77 10451.71
Accrued Interest .28 .07
Balance at Date of 5184.05 10451.78
Death
Account Ownership SOLE
Name of Joint
Owner, if any
Date Ownership
Was Established
Account Number
Class of Account
Date Opened
Principal Balance
Accrued Interest
Balance at Date of
Death
Account Ownership
Name of Joint
Owner, if any
Date Ownership
Was Established
SOLE
N AR 1 1 200
IRWIN,/ cKNI6HI & HUGHES
Additional
Information
Requested
Sincerely, ~
SENIOR SERVICES REP.
P.O. Box 171 I. HARRISBURG. PENNSYLVANIA 17105-1711
T~II I=r~; I-~;~I~I~-WAYPOINT [I-laE;E;-9;~9-7E;4E;I · IN YORK ARE;A 717/1=11C;-4C;00 · w~vw_waunointbank.com
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
Patricia A. Stake & Benson B. Stake
being duly law . according fo law, deposes and says thatt hey are the
Co-Executors of the Estate of Chloe E. Forney
late of Wes~___P_e_~n~bpr~_ To~¢n_s_bip , Cumberland County, Pa., deceased and fha+ +he
wifhin is an inventory made by them ___ , the said Co-Executors
of the entire estate of said decedent, consisting of all the personal property and real estate, except real estate oufslde
the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value
as of the date of decedent's death.
and subscribed before me,
// 2ooa
Iacqueline L. Dra,~augh, Notary Public [
Carlisle Boro, Cumberland County
My Commission Expires Aug. 14,
Member, Pennsylvania Asso~a~on of
Sworn
Bens~n B. Stake
Patricia A. Executor - xa~b0~m~xxx Stake
P.O. Box 66
Newville, PA 17241
Address
Date of Death 5th February 2003
2.
3.
4.
Day Month Year
INSTRUCTIONS
An inventory must be filed wlfh~n three months after appointment of personal reprge~afivec~
A supplement inventory must be f, led w,fh,n fh,rfy days of d,scovery of additional
Additional sheets may be attached as to personalty or realty
See Article IV, Fiduciaries Act of 1949.
Inventory of the real and personal estate of
CHLOE E. FO1L. NEY
deceased
Van Kampen Prime Rate, fixed income fund
Waypoint Bank, checking account
Waypiont Bank, savings account
PNC Bank NA, checking account
1986 Chevrolet Cavalier Sedan
24,947
10,451
5,184
3,997
1,000
35
,78
,05
,75
~00
BUREAU OF TNDTVZDUAL TAXES
/NHERTTANCE TAX DIVISION
DEPT. Z80601
HARRTSBURG, PA 171IS-D601
CONNONWEALTH OF PENNSYLVANIA
DEPARTNENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSENENT, ALLOHANCE OR DISALLOHANCE
OF DEDUCTIONS AND ASSESSNENT OF TAX
'03 JUN-5 All .50
ROGER B IRWIN
IRWIN ETAL
60 W POMFRET ST__ ~~i:S'l?~ ~ :
DATE
ESTATE OF
DATE OF DEATH
FZLE NUN~ER
COUNTY
ACN
06-05-200:5
FORNEY
02-05-2005
21 0:5-0242
CUHBERLAND
101
Amount
REV-i~i7 EX RFP (01-OS)
CHLOE E
HAKE CHECK PAYABLE AND RENZT PAYNENT TO:
REGISTER OF WILLS
CUNI~ERLAND CO COURT HOUSE
CARLISLE, PA 1701:5
CUT ALONG THIS LINE ~'* RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTTCE OF INHERITANCE TAX APPRAISENENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX
ESTATE OF FORNEY CHLOE E FTLE NO. 21 0:5-0242 ACN 101 DATE 06-0:5-200:5
TAX RETURN HAS: (X) ACCEPTED AS F/LED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN EASED ON: ORIGINAL RETURN
1. Reel Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Hold Stock/PartnershAp Interest (Schedule C) ($)
q. Mortgages/Notes ReceAvabla (Schedule D) (q)
$. Cash/Bank Daposits/HAsc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Tote1 Assets
APPROVED DEDUCTIONS AND EXENPTZONS:
9. Funeral Expenses/Adm. Costs/NAsc. Expanses (Schedule H) (9)
10. Debts/Hortgago Liabi1Aties/LAens (Schedule I) (10)
11. Tote1 Deductions
12. Net Value of Tax Return
451580.9:5
.00
.00 NOTE: To Ansure proper
.00 crodlt to your account,
.00 submit tho upper port/on
.00 of thAs form wAth your
tax payment.
.00
(8)
9,669.45
126 .:55
15.
NOTE:
45,580.9:5
(11) 9.79~.80
(12) :55,785.1:5
Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) . O0
Nat Value of Estate Subject to Tax (1~) :55,785.1:5
~f an assessment ,as Sssued previousZy, 1Shes 14, 15 and/or 16, 17, 18 and 19 ~A~Z
refZect fSgures that Anclude the total of ALL returns assessed to date.
ASSESSNENT OF TAX:
15. Amount of LAne 1~ at Spousal rata
16. Amount of Line 1~ taxable at LAneal/Class A rata
17. Amount of LAne 1~ at Sibling rate
18. Amoun~ of LAne 1~ taxable at Collateral/Class B ra~o
19. PrincipaZ Tax Due
TAX CREDITS:
PAYNENT RECEIPT DISCOUNT (+)
DATE NUNBER INTEREST/PEN PAID (-)
05-05-200:5 CD002528
Z68.$9
(1~i) .00 x O0 = .00
(16) .00 x 045= .00
(17) .00 x 12 = .00
('~8) :55,785.1:5 x 15 = 5,:567.77
(19)= 5,:567.77
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
ANOUNT PAID
5,099. :58
TOTAL TAX CREDIT I
· ALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
5,:567.77
.00
.gO
.00
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT ZS REQUIRED.
IF TOTAL DUE 1S REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
RESERVATION:
Estates of decedents dying on or before December 12, 198Z -- if any future interest in the estate [s transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Cammonaealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE:
PAYNENT:
REFUND (CR):
OBJECTIONS:
ADNIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To fulfill the requirements of Section Il40 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S.
Section 9140).
Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF HILLSj AGENT
A refund of a tax credit, ahich was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance end Estate Tax" (REV-1515). Applications ara available at the Office
of the Rag[star cf Hills, any of the Z3 Revenue District Offices, or by calling the special [4-hour
answering service for farms ordering: 1-800-36Z-2050; services for taxpayers aith special hearing and / or
speaking needs: 1-DOO-447-50ZO (TT only).
Any party in interest not satisfied aith the appraisement, a11awance, or disalloaance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object aithin sixty (60) days of receipt of
this Notice by:
--arittan protest to the PA Department of Revenue, Board of Appeals, Dept. ZDZOZ1, Harrisburg, PA 171ID-lO[I, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in ariting to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Revise Unit, Dept. ZB060i, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decadent" (REV-1SO1) for an explanation of administratively correctable errors.
If any tax due is paid aithin three ($) calendar months after the decedent's death, a five percent (SI) discount of
the tax paid is allowed.
The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January lB, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you mould appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning aJth first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the datm of payment. Taxes ehich bmcame delinquent before January l, 198Z bear interest at the rata af
six (DZ) percent per annum calculated at a daily rate of .000164. All taxes which became delinquant on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year aith that rate
announced by the PA Department of Revenue. The applicable interest rates far 19aZ through ZOO5 are:
Interest Daily Interest Daily Intsrast Daily
Year Rate Factor Yea_._r Rate Factor Yeast Rate Factor
1982 20Z .000548 1987 9Z .000247 1999 7Z .O0019Z
1983 16Z .000438 1988-1991 1IX .000301 ZOO0 8Z .000Z19
1984 Ill .000301 1992 9Z .000247 2001 9Z .000247
1985 15Z .000556 1993-1994 7Z .O0019Z ZOOZ 6Z .000164
1986 XOZ .000274 1995-1998 9Z .O00Z47 2003 5Z .0001~7
--Interest is calculated as folloas:
INTEREST = BALANCE OF TAX UNPAID X NUtlBER OF DAYS DELIN&IUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date shown on the
Notice, additional interest must be calculated.
IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY
PENNSYLVANIA
ORPHANS' COURT DIVISION
ESTATE OF
CHLOE E FORNEY
)
) Register's #
Deceased)
21-03-242
CLAIM
To the Clerk of the Orphans' Court Division :
Index and make proper entry in your official records of the
claim of CITIBANK (SOUTH DAKOTA) NA in the amount of
1~536.32 against the estate of the above-named decedent. This
claim is filed under Section 3532 (b) (2) PEF Code, 20 Pa. C.S.
ss. 3532 (b) (2)
The said decedent, whose last known residence was at
201 DOUBLING GAP RD NEWVILLE, PA 17241
Written notice of this claim was given to ROGER IRWIN
60 W POMFRET CARLISLE~ PA 17013
on July 30, 2003
(Claimant)
SHAWN HARMER of Citicorp Credit
Services, Inc. USA under limited power
of attorney for CITIBANK (SOUTH DAKOTA)
NA
7930 NW 110?H ST
KANSAS CITY, MO 64153
(Claimant' s Address)
Account #(s) 4059052011023986
A~count Statement
Statement Date
Account number
New balance
Past due amount
Minimum payment due
Payment due date
Credit limit
Available credit
Days in billing period
Transactions
Trans Post
02/26 02/26
02/26 02/26
Duplicate Statement
Page 1 of 2
02/26/03
4059 0520 1102 3986
$1,596.75
$31.00
$63.00
03/23/03
Account Su~nary
Previous balance
Payments and credits
Purchases and advances
FINANCE CHARGE
Debit adjustments
New balance
$1,536.~
$0.00
$0.00
$21.48
$38.95
$1,596.75'
.qs
$9, 300 For customer service or to report a lost or stolen sard
30 Send payments to: P.O. BOX 8034
SOUTH HACKENSACK, NJ 07606-8073~4~--
Reference Number Description Amount
LATE FEE 35.00
CREDIT PROTECTION FEE 3.95
*FINANCE CHARGE* PURCHASES $21.48 CASH ADVANCE $0.00 21.48
An amount followed by a minus (-) is a credit or credit balance.
YOUR ACCOUNT IS ONE MONTH PAST DUE. PLEASE PAY
THE MINIMUM AMOUNT DUE SHOWN ABOVE. IF YOU HAVE
ALREADY SENT US THIS PAYMENT, THANK YOU.
Please detach bottom portion and return with your payment in the enclosed envelope.
Make changes to address and phone number below:
Address
City State Zip
Home phone Business
e-mail
Account number 4059 0520 1102 3986
New balance $1,596.75
Minimum payment due $63.00
Payraent due date 03/23/03
Amount enclosed: $
Make check or money order payable to: MELLON/CBSD
To ensure proper credit, please return this portion with your
payment at least 5 business days prior to the due date.
Please write your account number on the check.
CHLOE E FORNEY
30 GREASON RD
BOX 102
PLAINFIELD PA 17081-0102
P.O. BOX 8034
SOUTH HACKENSACK,NJ 07606-8034
FinJnce ~arge Information
' Average
Daily
Balance
Purchases 1,546.67
Cash 0.00
CARDMEMBER NEWS
Duplicate Statement
Daily Annual
Periodic Nominal Percentage Transaction
Rate APR Rate (APR) Fees
.04630% 16.90% 16.90% 0.00
.04630% 16.90% 0.00
LET YOUR CREDIT CARD PAY ROUTINE BILLS AUTOMATICALLY. USE YOUR
CARD TO AUTOMATICALLY PAY RECURRING BILLS FOR MEMBERSHIPS,
DONATIONS, INSURANCE, PROPERTY RENTAL, HEALTH CLUBS,
NEWSPAPERS OR MAGAZINE SUBSCRIPTIONS OR HOME SECURITY. JUST
CALL YOUR SERVICE PROVIDERS AND ASK ABOUT PAYING YOUR BILLS
AUTOMATICALLY. ONE PAYMENT. LESS PAPERWORK. MORE TIME FOR YOU.
ADDITIONAL CARDS AT NO ADDITIONAL COST. GIVE A FAMILY OR
HOUSEHOLD MEMBER THE CONVENIENCE AND SECURITY OF A CARD IN
THEIR OWN NAME. CALL TODAY 1-800-552-4636.
Finance
Charge
21.48
0.00