HomeMy WebLinkAbout02-0193BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DTVTSZON
DEPT. 280601
HARRISBURG, PA 171ZB-O6DZ
COHNONNEALTH OF PENNSYLVANIA
DEPARTNENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSEHENT, ALLOWANCE OR DZSALLONANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
MILENNA R HERSHEY ESO
1099 N AREBA AVE
HERSHEY PA 17053-q80Z
DATE 02-10-2003
ESTATE OF PEARSON
DATE OF DEATH 02-03-2002
FILE NUHBER 21 0Z-0193
COUNTY CUHBERLAND
ACN 101
Amoun*~ Remi~:~:ed
REV-1647 EX AFP C01-05)
ALICE D
HAKE CHECK PAYABLE AND REH]:T PAYNENT TO:
REGISTER OF HILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~-~
REV-1547 EX AFP (01-03) NOTICE OF TNHERZTANCE TAX APPRAZSEHENT, ALLONANCE OR
DTSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF PEARSON ALICE D FTLE NO. 21 02-0193 ACN 101 DATE 02-10-2003
TAX RETURN NAS: (X) ACCEPTED AS FTLED ( ) CHANGED
RESERVATTON CONCERNTNG FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a~a (Schedule A) (1)
2. S~ocks and Bonds (Schadula B) (2)
$. Closely Held S~ock/Par~nership Zn~ares~ (Schedule C) (:3)
q. Not,gages/No,es Racaivabla (Schadule D) (q)
5. Cash/Bank Deposi~s/Nisc. Parsonal Proper~y (Schedula E) (5)
6. Jointly Owned Propar~y (Schedule F) (6)
7. Transfers (Schedule G) (7)
B. To~al AssaYs
APPROVED DEDUCTIONS AND EXENPTZONS:
9. Funeral Expensas/Ade. Cos~s/Hisc. Expenses (Schedule H) (9)
10. Dab~s/Nor~gaga Liabilities/Liens (Schedule I) (10)
11. To*al Deductions
12. Na~ Value of Tax Ra~urn
65~000.00
.00
.O0
.00
1~108.88
.00
.00
(8)
15,706.00
78,452.93
(11)
(12)
1:3.
NOTE:
ASSESSNENT OF TAX:
15. Amoun~ of Line lq at Spousal rate
16. Amoun~ of Line lq ~axable a~ Lineal/Class A ra~a
17. Aeoun~ of Line lq a* Sibling ra*e
18. Aeoun* of Line 14 ~axabla a* Colla*eral/Class B ra~e
19. Principal Tax Due
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT
DATE NUHBER INTEREST/PEN PAID (-)
Chari~abla/Govarnean~al Bequests; Non-elected 911:3 Trusts (Schadule J)
Ne~ Value of Es~a~e Subjac~ *o Tax
:Zf an assessment was issued previously, lines 14, 15 and/or
reflect figures that include the total of ALL returns assessed to date.
NOTE: To insure proper
cradi~ ~o your accoun*,
subei~ ~ha upper portion
of ~his form wi~h your
~ax payment.
IF PA/D AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL ZNTEREST.
66,108.88
9~.1S8.93
28,050.05-
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.°°I
.00
.00
.00
( IF TOTAL DUE ZS LESS THAN $1, NO PAYHENT IS REQUIRED.
ZF TOTAL DUE ZS REFLECTED AS A 'CREDIT' (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.)
ANOUNT PAID
(16) .00 x O0 = .00
(16), .00 x 045= .00
(17) . O0 x 12 = . O0
(18) . O0 x 15 = . O0
(19)-- . O0
(15) . O0
(14) 28,050.05-
16, 17, 18 and 19 t~ill
RESERVATION:
PURPOSE OF
NOTICE:
PAYNENT:
REFUND (CR):
OBJECTIONS:
ADNIN-
ZSTRATZVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
Estates of decedents dying on or before December IZ, 1981 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Comeoneealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral} rate on any such futura interest.
To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act Z:5 of ZOO0. (72 P.S.
Section 91~0).
Detach the top portion of this Notice and submit with your payment to the Rag[star of Hills printed on the reverse side.
--Make check or money order payable to: REGISTER OF NXLLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, may ba requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS1:5). Applications ars available at the Office
of the Register of Nills, any of the Z:5 Revenue District Offices, or by calling the special Iq-hour
answering service for forms ordering: 1-DO0-:56Z-ZOSO~ services for taxpayers with special hearing and / or
speaking needs: 1-B00-~47-:5020 (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. Z810Zl, Harrisburg, PA 17128-10Z1, 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 writing to= PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Ravlew Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
Zf any tax due is paid within three (:5) calendar months after the decadent's death, a five percent (51) discount of
the tax paid is allowed.
The 1SI tax amnesty non-participation penalty is computed on the tatar of the tax and interest assessed, and not
paid bs~ore January 18, 1996, the first day after the end of tho tax amnesty period. This non-participation
penalty is appeaZable [n the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged bag[nning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six (61) percent per annum calculated at a daily rate of .000164. AIl taxes which became del[nquent on and after
January 1, 1981 will bear interest at a rate which wilI vary from calendar year to calendar year with that rate
announced by the PA Depar~ent of Revenue. The applicable interest rates for 1981 through Z00:5 are:
Interest Daily Interest Daily Interest
Daily
Year Rate Factor Yea__r Rate Factor Yea__r Rate Factor
1981 ZOZ .000548 1987 97. .000147 1999 7;: .000192
198:5 161 .000~.:58 1988-1991 112 .000:~01 ZOO0 8Z .OOOZZ9
198~, 11Z .000:501 1992 97. .000247 Z001 91 .000147
1985 131 .000:556 1993=1994 7Z .00019Z ZOOZ 67. .000164
1986 107. .000Z7~, 1995-1998 91 .0002~,7 Z003 57. .000137
--Interest is calculated as follows:
ZNTEREST= BALANCE OF TAX UNPATD X NUHBER OF DAYS DELZNQUENT X DAZLY ZNTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond tho date of the assessment. If payment is made after the interest computation date sho~n on the
Notice, additional interest must be calculated.
PETITION FOR GRANT OF LETTERS
Estate of ALICE D. PEARSON
also known as
Gaye D. Larson
petitioner(s), who is/are 18 years of age or older, apply)ies) for:
, Deceased Social Security No,172-01-9567
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut rix
~-I Decedent, dated 10/11/95 and codicil(s) dated
named in the Last Will of the
State relevant circumstances, e.g., renunciation, death of executor, etc
Except as follows, Decedent did not marry, was not divorced and did not have a child born or a~ after execution of the documenta offered
for probate; was not the victim of a killing and was never adjudiceted incapacitated:
B. Grant of Letters of Administration
(c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante mlnoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Name Relationship Residence
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal
residence at 808 Coolidge Street, New Cumberland Borough, Pa
(list street, number and municipality)
Decedent, then 83 years of age, died February 3 ,2002 , at Thornwald Nursing Home, Carlisle, Pa
Decedent at death owned property with estimated values as follows:
(if domiciled in PA All personal property ......................................... $ 100.00
(if not domiciled in PA Personal property in Pennsylvania .................... $
(if not domiciled in PA Personal property in County .............................. $
Value of real estate in Pennsylvania ........................................................................................ $
Total ..................................................................................................................... $
Real Estate situated as follows: 808 Coolidge Street, New Cumberland~ Cumberland County, PA
Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in
the appropriate form to the undersigned:
75,000.00
75,100.00
Signature Typed or printed name and residence
Gaye D. Larson
11 Pine Street
Middletown~ PA 17057
Oath of Personal Representative
Commonwealth of Pennsylvania
County of CUMBERLAND
The Petitioner(s) above-named swear(s) and 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(s) of the
Decedent, Petitioner(s) will well and truly administer t~t~te acco~w.
Swom to and affirmed and subscribed
before me this. 2 1 s t day of
~ FEBRUARY 2002
MA~Y C L~IS -
DECREE OF REGISTER
Estate of ALICE D. PEARSON
also known as
Deceased
Social Security No: 172-01-9567 Date of Death:.2/3/02
AND NOW, FEBRUARY 22. 2002 , 2002 , in consideration of the Petition on the
reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ~ Testamentary I-I of Administration
((c.t.a., d.b.n.c.t.; pendente lite; durante al:~entia; durante minoriale)
are hereby granted to Gaye D. Larson
in the above estate and that the instrument(s), if any, dateclZ)ctober 11, 1995
described in the Petition be admitted to probate and filed of record as the Last Will of Decedent.
FEES
Letters .................................... $ 200.00
Short Certificates(s) ............... $ C~. ~O
Renunciation .......................... $
Extra Pages (2 ) ............... $ 6.00
I.T.R ....................................... $
JCP Fee ................................. $ 5.00
Inventory ................................ $
Other ...................................... $
TOTAL ...........................
mailed to attorney
on 2-22-02
MARY ~- LE~
Signature
Attorney: Milenna r. Hershey, Esquire
I.D. No: 58857
Address: 1099 W. Areba Avenue
Hershey
PA 17033
Telephone: 717-533-3798
DATEFILED: FEBRUARY 21, 2002
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.
Fee for this certificate, $2.00 ~,~
~,~'/. .~.
P 8 0 2 9 3 8 6 ~~~~ fE8 0 ~ 2002
No. ~ Date
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS
CERTIFICATE OF DEATH
Cumberland
tsman ,,s. Draf.~ng
442 Walnut Bottom Road
Carlisle. PA 17013
· Female ,- 172 --01 --9567 4. 2-3-02
; ,. 2-15-18 ,. Harrisb~g, P ~ ~,~U ~ ~ .~ -.:.i3
C~IZsle Bo~o , Thor~ld N~s~ng Home ,T .... ~'~' '
,~. ,~. ~'~ 12 ~"~" ,4. WZd0w~d
,~.~ Cumberland ~' ,,,.~ ~~. c~.e~sle Bo~o
,0. White
D~ 'R:) {O~1A~ A CO~4~EOUE NCE 0~): II - '~
It,al e,~a~d even~ DUE ~O (OR ~S A COf4SEOUE NCE OF): ~
Wll£iam R. Donmoqer ,,. Martha Miller
IN~Oi~AANlr'S NAM~ (Tyl~wp~{n~) INFO~RMANT'$ ~ ~ ~ ~ C '
~. R. T~ry Hamb~ I ....... ~ , ~.~,z~
[~. ~u~ coo~r~ge S~eet, New C~b~land, PA 17070
~ c,~ ~.-~.a %,.. ~-~-o~ i-~ c~o. ~o~ o~I ' ·
~ [m. 4100 Jonestown ~~r~g~ ~ P~7109
/~ ~ ~C~ REFER~DTO ME E MINE~R?
~,,. / ~ .. I.. ~<~. ~- ~o ~ J.. .~ .~
12~*. i~,.
· MEDICAL ~XAMINER~CORONER
"' ~::::':'"""*:"
ep\wills\pearson.ad\10-95
LAST WILL AND TESTAMENT
OF
ALICE D. PEARSON
no
B.
HAMBURG.
ITEM II:
my last will.
I, ALICE D. PEARSON, of the Borough of New Cumberland, Cumberland
County, Pennsylvania, declare this to be my last will and revoke any
will previously made by me.
ITEM I: I devise and bequeath all of my estate of every nature
and wherever situate as follows:
Twenty-five (25%) per cent to my niece, GAYE D. LARSON.
Seventy-five (75%) per cent to my nephew, R. TERRY
I appoint my niece, GAYE D. LARSON, Executrix of this
Should my niece, GAYE D. LARSON, fail to qualify or
cease to act as Executrix, I appoint my nephew, R. TERRY HAMBURG,
Executor of this my last will.
ITEM III: No fiduciary acting hereunder shall be required to post
bond or enter security for the faithful performance of his/her duties
in any jurisdiction.
IN WITNESS WHEREOF,
hand and seal this {~
I, ALICE D. PEARSON, have hereunto set my
day of O~'~O~_~ , 1995.
ALICE D. PEARSON
Page 1 of 3
SIGNED, SEALED, PUBLISHED and DECLARED by ALICE D. PEARSON, the
Testatrix above named, as and for her Last Will and Testament, and 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.
Address '
Witness
Address
COMMONWEALTH OF PENNSYLVANIA:
:SS:
COUNTY OF CUMBERLAND :
I, ALICE D. PEARSON, the Testatrix whose name is signed to the
attached or foregoing instrument, having been duly qualified according
to law do hereby acknowledge that I signed and executed this instru-
ment as my last will; that I signed it willingly and that I signed it
as my free and voluntary act for the purposes therein contained.
ALICE D. PEARSON
Sworn to or affirmed to and acknowledged before me by ALICE D.
PEARSON, the Testatrix, this
iNOTARIAL S -F_.AL
' ~ land,, ~ Cumberland Co,
My Commission BpJr~ ~ri113, 1999~
day of C~c%TDd~-~ , 1995.
Page 2 of 3
COMMONWEALTH OF PENNSYLVANIA :
:SS:
COUNTY OF CUMBERLAND
We, ('~:~"t ~
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, depose and say that
we were present and saw Testatrix sign and execute the instrument as
her last will; that Testatrix 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; that to the best of our knowledge, the Testatrix
was at that time eighteen or more years of age, of sound mind and
under no constraint or undue influence.
~__3~ne ~s
Witness
Sworn to or affirmed to and acknowledged before me by
witnesses, this (I day of
, 1995.
Notary Public
Page 3 of 3
STONE, LAFAVER & STONE
ATTORNEYS AT LAW
4~4 ~IDGE s~REET
~E%V c~BERLAND. PA 17070
JO.
CF~T'rFTCJt. TTON OF NOTICE UND~ RULE
Name of Decedent:
Date of Death:
Will No. 193-2002
Alice D. Pearson
Februar~ 3 ~ 2002
Ac~nin. No.
To the Register:
I certify that notice of estate a~ministration requiro~by Rule 5.6(a)
of the Or, hans' Court Rules was served on or mailed to the following
beneficiaries of the above-captioned estate on Februar~ 25, 2002 :
N~me
Ga~e D. LA~SOn
R. Terr~ ~_lw~urg
111 Pine street, l~.cb:~.etown~ PA 17057
808 Cooli~e Street, New O,~rland, PA
17070
Notice has now been given to all persons entitled thereto under Rule 5.6(a)
except n/a
Signature
Name: Milenna R. Hershey, Esquire
Address: 1099 W. Areba Avenue
Hershey, PA 17033
Telephone (717) 533-3798
Capacity:
Personal Representative
x Counsel for pez~t~al ~ ~
representatLve ~ ...... 0
October 28, 2002
Milenna R. Hershey, Esq.
1099 W.Areba Ave.
Hershey, Pa. 17033
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPARTMENT 280601
HARRISBURG, PA 17128-0601
Telephone
(717) 787-3930
FAX (717) 772-0412
Dear Ms Hershey:
Re:
Estate of Alice D. Pearson
File Number 2102-0193
This is in response to your request for an extension of time to file the Inheritance Tax Return for
the above estate.
In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for
filing the return is extended for an additional period of six months. This extension will avoid the
imposition of a penalty for failure to make a timely return. However, it does not prevent interest from
accruing on any tax remaining unpaid after the delinquent date.
The return must be filed with the Register of Wills on or before May 03,2003. Because Section
2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s)
will be granted that would exceed the maximum time permitted.
~~.__,S ' n ce r, el~/.,~..~ --
Jeffrey Hollenbush, Supervisor
Document Processing Unit
Inheritance Tax Division
REV-1500 EX + (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
NUMBER
2 1 -0 2 0
1 9 3
Z
X
I-
Z
LU
t"t DATE OF DEATH (MM-DD-Year)
0 02/03/2002
[] 1. Original Retum
UJ
I--
~ E ~' I [] 4. Limited Estate
"'o~1
'I-
I
~ 6. Decedent Died Testate (Attach copy of wi,)
o,..,,,I
L~J 9. Litigation Proceeds Received
Supplemental Retum
O4a. Future Interest Compromise (date of deah ater 12-12-82)
Decedent Maintained a Living Trust (^trach copy of Trust)
[~ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
Z
U.I
Z
O
t~
UJ
n,
O
THIS SECTION MUST BE COMPLETED. ALL CoRRESpoNDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME I COMPLETE MAILING ADDRESS
Milenna R. Hershey, Esquire I 1099 W. Areba Avenue
FIRM NAME (If Applicable)
TELEPHONE NUMBER
717-533-3798 Hershey PA 17033
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
[] Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
Total Gross Assets (total Lines 1-7)
Funeral Expenses & Administrative Costs (Schedule H) (9)
Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
Total Deductions (total Lines 9 & 10)
Net Value of Estate (Line 8 minus Line 11)
9.
11.
12.
13.
Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
65,000.00
1,108.88
il - O~ICIA~USE ONLY
(8)
(11)
15~706.00
78~452.93
66,108.88
94~ 158.93
(12)
(13)
-28,050.05
(14)
-28~050.05
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
r'-i 3. Remainder Return (dm ofdeath prior to 12-13-82)
r-'] 5. Federal Estate Tax Return Required
O 8. Total Number of Safe Deposit Boxes
[] 11. Election to tax under Sec. 9113(A) (Atach Sch O)
1 5. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.
x ~ (15)
x ~ (16)
x .12 (17)
x .15 (18)
(19)
.:
> · BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
0.00
0.00
0.00
0.00
0.00
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL SOCIAL SECURITY NUMBER
PEARSON ALICE D. 1 7 2 - 0 1 - 9 5 6 7
DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
02/15/1918 REGISTER OF WILLS
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Decedent's Complete Address:
STREET ADDRESS
808 Coolid~te Street
C,TY New Cumberland I STATE PA I ZIP 17070
Tax Payments and Credits:
1. Tax Due (Page l Line19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Pdor Payments
C. Discount
Interest/Penalty if applicable
D. Interest
E. Penalty
(1)
Total Credits ( A + B + C ) (2)
Total Interest/Penalty ( D + E )
(3)
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page I Line 20 to request a refund (4)
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. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
0.00
0.00
0.00
0.00
0.00
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ........................................................................... [] []
b. retain the right to designate who shall use the property transferred or its income; ........................................[] []
c. retain a reversionary interest; or ...................................................................................................... [] []
d. receive the premise 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 secudty 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.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE~ O .~ N J...~c~.~.~ RESP~qSIB(~..~ FOR Y c:z::=_~ FILING ~ RETURN
ADDP. F. SS~ 'l'11(~ine ~reetv Middletown
DATE
PA 17057
ADDRESS 1099 W. Areba Avenue
Hershey
DATE
Pa 17033
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. {}9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. {}9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedenrs lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1 )].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-15~2EX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
PEARSON ALICE D. 21 02 0193
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 pdce 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 which is jointly-owned with right of
survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
808 Coolidge Street, New Cumberland, PA by Deed recorded 1/18/54 in Deed Book M,
Vol 15, page 302 in names of Harry W. & Alice D. Pearson. Harry W. Pearson died
1/8/61 vesting title in surviving spouse. See attached agreement and settlement sheet
VALUE AT DATE
OF DEATH
65,000.00
TOTAL (Also enter on line 1, Recapitulation) $ 65,000.00
(If more space is needed, insert additional sheets of the same size)
R~-1508 EX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
PEARSON ALICE D. 21 02 0193
Include We proceeds of litigation and the date the proceeds were received by the estate. All pmpeAy jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. M&T Bank checking account #2678093325, see attached letter 1,108.88
TOTAL (Also enter on line 5, Recapitulation) $
1~108.88
(If more space is needed, insert additional sheets of the same size)
EV-1511 EX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
PEARSON ALICE D.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21 02
0193
ITEM
NUMBER DESCRIPTION AMOUNT
FUNERAL EXPENSES:
8
9
10
11
12
13
14
15
16
17
18
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Gaye D. Larson
Social Secudty Number(s) / EIN Number of Personal Representative(s)
Street Address 111 Pine Street
184-38-1787
City Middletown State PA
Year(s) Commission Paid: 2003
AttomeyFees Milenna R. Hershey, Esquire
Family Exemption: (If decedent~s address is not lhe same as claimant's, attach explanation)
Claimant
Zip 17057
Street Address
City State Zip
Relationship of Claimant to Decedent
Probate Fees Register of Wills, Cumberland County, PA
Accountanfs Fees
Tax Return Preparers Fees H&R Block
Patriot News, Estate notice
Cumberland Law Journal, estate notice
M&T Bank, estate checks
Register of Wills, filing fee for inventory and I.T.R.
Milenna R. Hershey, Esq., reimburse costs
PP&L, electric bills
UGI, gas bills
PAWC, water bills
Bom of New Cumberland, sewer and trash bills
Metropolitan Life, homeowners insurance
Robin Gasperetti, 2002 county real estate tax (balance)
Robin Gasperetti, 2002 school real estate tax (balance)
3,800.00
3,800.00
220.00
108.00
200.08
75.00
8.81
20.00
36.02
322.34
285.38
108.30
178.11
213.75
313.80
439.48
TOTAL (Also enter on line 9, Recapitulation) $ 15,706.00
(If more space is needed, insert additional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
PEARSO'N ALICE D. 21 02
Paqe 1
Schedule H - Funeral Expenses & Administrative Costs - BT.
0193
ITEM
NUMBER DESCRIPTION AMOUNT
19
2O
21
22
23
24
Jack Gaughen, ERA Real Estate, commission
Real estate notary, postage and transaction fees
Transfer taxes on real estate sale
David Schmidt, yard work
Register of Wills, filing account
Boro of New Cumberland, final sewer and trash
4,550.00
125.50
650.00
75.00
119.00
57.43
SUBTOTAL SCHEDULE H-B7 5,576.93
REV-1512 EX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
PEARSON ALI(~E
Include unreimbursed medical expenses.
FILE NUMBER
D. 21 02 0193
ITEM
NUMBER DESCRIPTION AMOUNT
1. Department of Public Welfare, priority claim 23,365.14
Department of Public Welfare, balance of medical assistance claim
Thornwald Nursing Home, balance due on care
Commerce Bank, mortgage line of credit, balance due on date of death
Pa. Dept of Revenue, state income tax
CACV, Inc., credit card
Howard R. Cohen, M.D., medical bill
11,387.23
4,496.04
18,982.80
105.00
19,916.08
200.64
TOTAL (Also enter on line 10, Recapitulation) $ 78,452.93
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (9-n~'~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCETAXRETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
PEARSC N
NUMBER
I.
1.
2
ALICE D,
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outfight spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
Gaye D. Larson
111 Pine Street
Middletown, PA 17057
R. Terry Hamburg
111 Pine Street
Middletown, PA 17057
FILE NUMBER
;~1 02
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
niece
nephew
0193
AMOUNT ORSHARE
OF ESTATE
25% of residue
75% of residue
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 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 $
(If more space is needed, insert additional sheets of the same size)
October 28, 2002
Milenna R. Hershey, Esq.
1099 W.Areba Ave.
Hershey, Pa. 17033
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPARTMENT 280601
HARRISBURG, PA 17128-0601
Telephone
(717) 787-3930
FAX (717) 772-0412
Dear Ms Hershey:
Re:
Estate of Alice D. Pearson
File Number 2102-0193
This is in response to your request for an extension of time to file the Inheritance Tax Return for
the above estate.
In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for
filing the return is extended for an additional period of six months. This extension will avoid the
imposition of a penalty for failure to make a timely return. However, it does not prevent interest from
accruing on any tax remaining unpaid after the delinquent date.
The return must be filed with the Register of Wills on or before May 03,2003. Because Section
2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s)
will be granted that would exceed the maximum time permitted.
Sincerely,
-:- //._.~ Jeffrey Hol enbush, Supervisor
Document Processing Unit
Inheritance Tax Division
LAST WILL AND TESTAMENT
OF
ALICE D. PEARSON
I, ALICE D. PEARSON, of the Borough of New Cumberland, Cumberland
County, Pennsylvania, declare this to be my last will and revoke any
will previously made by me.
ITEM I: I devise and bequeath all of my estate of every nature
and wherever situate as follows:
Twenty-five (25%) per'cent to my niece, GAYE D. LARSON.
Seventy-five (75%) per cent to my nephew, R. TERRY
ao
B.
HAMBURG.
ITEM II:
my last will.
I appoint my niece, GAYE D. LARSON, Executrix of this
Should my niece, GAYE D. LARSON, fail to qualify or
cease to act as Executrix, I appoint my nephew, R. TERRY HAMBURG,
Executor of this my last will.
ITEM III: No fiduciary acting hereunder shall be required to post
bond or enter security for the faithful performance of his/her duties
in any jurisdiction.
IN WITNESS WHEREOF,
hand and seal this {~
I, ALICE D. PEARSON, have hereunto set my
day of O~'~O~_~ ; 1995.
ALICE D. PEARSON
Page 1 of 3
SIGNED, SEALED, PUBLISHED and DECLARED by ALICE D. PEARSON, the
Testatrix above named, as and for her Last Will and Testament, and 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.
Witness
Address
Addre s s
COMMONWEALTH OF PENNSYLVANIA:
:SS:
COUNTY OF CUMBERLAND :
I, ALICE D. PEARSON, the Testatrix whose name is signed to the
attached or foregoing instrument, having been duly qualified according
to law do hereby acknowledge that I signed and executed this instru-
ment as my last will; that I signed it willingly and that I signed it
as my free and voluntary act for the purposes therein contained.
ALICE D. PEARSON
Sworn to or affirmed to and acknowledged before me by ALICE D.
PEARSON, the Testatrix, this ~ ('
NOTARIAL SEAL
CONSTANCE L. KARLI, Notary Public
New Cumberland, PA Cumberland Co.
My Commission Expires April 13, 1999
day of fDc~-~ , 1995.
Notary Pu~li~c
Page 2 of 3
July 24, 2002
RE: Estate Search
The Estate of: ALICE D PEARSON
Date of Death (D.O.D.) 2/3/2002
To Whom It May Concern:
Identified below is the account information requested.
1. M&T Bank accounts in which the decedent's name appears:
Account Account Number Account Title Opening Branch D.O.D. Accrued Interest
Type Balances
(Includes Accr.
Int.)
CHK 2678093325 ALICE D PEARSON 4320 $1108.88 $.00
OPENED 4/96
2. Loans, Mortgages, or other obligations titled in the decedent's name
Account Number Amount Owed
Account Description
NO Safe Deposit Box titled in the Decedent's name existed at our office.
I f you have any questions about the information provided, please contact our Records Department at (716) 635-4010 or 1-800-724-
2440 outside of the Buffalo, NY calling area. Thank you.
Sincerely,
M&T BANK CORPORATION
Authorized Signature
Manufacturers and Traders Trust Company · 1100 Wehrle Drive, RO. Box 767, Buffalo, NY 14240-0767
U. S. DEPARTMENT OF HOUSING and URBAN DEVELOPMENT OMB No. 2502-0265
SETTLEMENT STATEMENT Titlepro for WindowsTM
RIVERSIDE LAND TRANSFERS, L.L.C.
307 Market Street
Lemoyne, PA 17043-0109
(717)441-1555
B. TYPE OF LOAN
[] 1. FHA [] 2. FMHA [] 3. CONV.UNINS.
[] 4. VA [] 5. CONV. INS.
6. FILE NUMBER: 17. LOAN NUMBER:
I
130678
MORT. INS. CASE NO.:
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts )aid to and by the settlement agent are shown.
Items marked "(p.o.c.)" were paid outside the closing; they are shown here for information purposes and are not included in the totals.
D. NAME AND ADDRESS OF BORROWER:
Vincent R. Vergara, Chinatsu H. Vergara
G. PROPERTY LOCATION:
',808 Coolidge Street
Lot 6, Block E, Highland Park Extension
New Cumberland Borough
Cumberland County, PA 17070
E. NAME AND ADDRESS OF SELLER:
Alice O. Pearson, Gaye D. Larson
H. SETTLEMENT AGENT: Riverside Land Tran
F. NAME AND ADDRESS OF LENDER
Countrywide Home Loans, Inc.
Mechanicsburg
]fers
I. SETTLEMENT DATE:
Nov 27 2002
tWednesday
09:00 AM
PLACE OF SETTLEMENT:
J. SUMMARY OF BORROWER'S TRANSACTION
100. Gross Amount Due From Borrower
101. Contract sales price
102. Personal Property
103. Settlement Charges (line 1400)
104.
105.
Adjustments for items paid in advance by seller(s)
106. City/Town tax
107. County/City tax 11/27/2002 to 12/31/2002
108. Assessments
109. School Tax 11/27/2002 to 6/30~-2003
110.
1111. Refuse 11/27/2002 to 12/31/2002
h12.
120. Gross Amount Due from Borrower
200. Amounts Paid By Or In Behalf Of Borrower
201. Deposit or earnest money
2'02. Principal Amount of new loan(s)
K. SUMMARY OF SELLER'S TRANSACTION
406.
29.12 407.
408.
509.64 409.
410.
13.30 411.
412.
69,073.38 420.
500.
2,000.00 501.
52,000.00 502.
400. Gross Amount Due to Seller
65,000.00 401. Contract sales pdce 65,000.00
402. Personal Property
3,521.32 403.
404.
405.
Adjustments for items paid in advance by seller(s)
CityFrown tax
County/Citytax 11/27/2002 to 12/31/2002 29.12
Assessments
School Tax 11/27/2002 to 6/30/2003 509.64
Refuse 11/27/2002 to 12/31/2002 13.3C
Gross Amount Due to Seller 65,552.0~
Reductions In Amount Due To Seller
Excess deposit (see instructions)
Settlement charges to seller (line 1400)
Existing loan(s) taken subject to
Payoff of First Mortgage Loan
Commerce Bank
6,674.97
203. Existingloan(s)taken subjectto 503.
204. 504.
2O5. 505.
206. 506.
207. 507.
208. 508.
209. 509.
Adjustments foritems unpaid by seller
i210. City/Town tax 510.
18,831.0~
Payoff of Second Mortgage Loan
Adjustments for items unpaid by seller
City/Town tax
County/City tax 511.
County/City
tax
Assessments 512. Assessments
1213. School Tax 513. School Tax
;214, Sewer 10/1/2002 to 11/27/2002 13.67 514. Sewer 10/1/2002 to 11/27/2002 13.67
1215. 515.
L. SETTLEMENT CHARGES
700. Total Sales Commission based on Price: $
65,000.00 7.00 %
Division of Commission at: $ 4,550.00 Total
701. 4,550.00 ERA-NRT, Inc.
702.
703. Commission paid at Settlement
704,
Paid From
Borrower's
Funds At
Settlement
Paid From
Seller's~
Funds At
Settlement
4,550.00
800. Items Payable in Connection With Loan
801. Loan Origination Fee
802. Loan Discount
Countrywide Home Loans, Inc.
803. Appraisal Fee to George R. Ulsh
804. Credit Report to Landsafe
805. Inspection Feeto
806. Mortgage Insurance to
807. Assumption Fee to
808. Tax Service Fee to
Countrywide Tax Service
809. Flood Check Fee to Landsafe Flood
810. Document Preparation Fee to
Countrywide Home Loans
811.
425.00
35.00
90.00
25.00
350.00
900. Items Required By Lender To Be Paid In Advance
901. Interest from 11/27/2002 to 11/30/2002 @ 9.26 /Day
902. Mortgage Ins. Premium 0 Months to
903. Hazard Ins. Premium 0 Years to
904. 0 Years to
905. 0 Years to
37.04
1000. Reserves Deposited With Lender For
1001. Hazard Insurance 3 Months @ $ 26.08 /Month
1002. Mortgage Insurance 0 Months @ $ /Month
1003. City/Town Taxes 0 Months @ $ /Month
1004. County Taxes 11 Months @ $ 25.46 /Month
1005. Assessments 0 Months @ $ /Month
1006. School Taxes 7 Months @ $ 70.47 /Month
1007. 0 Months @ $ /Month
1008. Agg. Adj. 0 Months @ $ /Month
78.24
280.06
493.29
(310.56)
1100. Title Charges
1101. Settlement or closing fee
1102. Abstract or title search
1103. Title Examination
1104. Title Insurance Binder
1105. Document preparation
1106. Notary fees Cash 10.00 10.00
1107. Attorney's fees
(includes above items No.:) iiiiiiiiiiiiiii ~::::::::: ,,,,,,~ ....
1108. Title Insurance Riverside Land Transfers 798.75
(includes above items No.:) 1101-1104,1108 basic 100/300/8.1
1109. Lender's coverage $ 52,000.00
1110. Owner's coverage $ 65,000.00
1111. Wire Fee to Riverside Land Transfers 20.00
1112. Closing Service Letter to Riverside Land Transfers 35.00
1113. Express Mail to Riverside Land Transfers 22.50 15.50
1200. Government Recording and Transfer Charges
1201. Recording Fees: Deed $ 49.50 Mortgage $ 72.50 Release $ 122.00
1202. City/County tax/stamps: Deed $ 650.00 Mortgage $ 650.00
1203. State tax/stamps: Deed $ 650.00 Mortgage $ 650.00
1204. Recorder of Deeds
1205. Sewer July/August/September to New Cumberland Borough 21.83
1300. Additional Settlement Charges
1301. Refuse Oct/Nov/Dec to New Cumberland Borough 35.60
1302. Pest Inspection/Home Inspection to Biechler & Tillery 260.00
1303. Transaction Fee to ERA-NRT, Inc. 100.00 100.0C
1304. 2002 County Taxes to Robin Gasperetti, Tax Collector 342.92
1305. 2002 School Taxes to Robin Gasperetti, Tax Collector 949.12
1400. Total Settlement Charges (enter on lines 103 & 502, Sections J & K) 3,521.32 6,674.97
This iorm recommended and approved for, but not restricted to use by, the members of the Pennsylvania Association of REALTORS® (PAR).
S,.F~LER'S BJ. JSIN,ESS RELATIONSHIP WITH PA LICENSED BROKER
BROKER IS THE AGENT FOR SELLER. Designated Agent(s) for Seller, if applicable:
OR
Broker is NOT the Agent for Seller and is ~an: ~ AGENT FOR BUYER ~ TRANSACTION LICENSEE
B.~YE~'S .BUSINESS RELATION~S~ItlP WITH PA LICENSED BROKER
BROKER (Cofi)~.any) ~/¢~¢r~ &/~']-~'~. ~/~ ~ · PHONE
ADDRESS ~ff~ ~~ ~ ~& ~ i~/// FAX ~O/
BROKER IS THE AGENT FOR B~YER. Designated Agent(s) for Buyer, if applicable:
OR
Broker is NOT the Agent for Buyer and is ~an: ~ AGENT FOR SELLER ~ SUBAGENT FOR SELLER ~ T~NSACTION LICENSEE
When the same Broker is Agent for Seller and Agent for Buyer, Broker is a Dual Agent. All of Broker's licensees are also Dual Agents UNLESS
there are separate Designated Agents for Buyer and Seller. If the same Liceusee is designated for Seller and Buyer, the Licensee is a Dual Agent.
1. ~bi~ q rccmcnt/dated ~-")~Z~')-~ ~ ~~ ,isbetween 1
SELLER(S): ~~ ~ ~' ~~ ~
BUYER(S): ~ / '
, called "Buyer."
PROPERTY (1-98) Seller hereby agrees to sell and convey to Buyer, who hereby agrees to purchase:
ALL THAT CERTA.tN lot or pigce of ground~with building~ rind improvements, thereo~ erectS, if any,~own as:
county o[ C ?~d~ in the Commonwealth of Pennsylvania, Zip Code /~~
ldentification4e.g., T~ ID ~' Parcel ~; Lot, Blo~ Deed BooklORe, Recording Date)
(A) Purchase Price
U.S. Dollars
~8 which will be paid to Seller by Buyer as follows: 11t
l~ 1. Cash or check at signing this Agreement: $ ~ ~/'~ iS
~u 2. Cash or check within days of the execution of this Agreement: $ r --,~,'-- zo
2~ 3. $ -O--- ~t
~2 4. Cash, cashier's or certified check at time of settlement: $ ~'~,~ ff"t,"'W ~2
z3 TOTAL $ ~a/~r.;'~ '~ 2a
~4 (B) Deposits paid on account of purchase price to be held by Broker for Seller, unless otherwise stated here: 24
~5
2§ (C) Seller's written approval tompb~fo~e: ,~F_,7~ ~6
~? (D) Settlement to be on ~d)Z2~'"- or before if Buyer and Seller agree. 27
~8 (E) Conveyance from Seller will be by fee simple deed of special warranty unless otherwise stated here: 28
30 (F) Payment of transfer taxes will be divided equally between Buyer and Seller unless otherwise stated here:
' 3(]
31
33
.34
31
(G)
At time of settlement, the following will be adjusted pro-rata on a daily basis between Buyer and Seller, reimbursing where applicable: taxes 32
(see Information Regarding Tax Proration); rents; interest on mortgage assumptions; condominium fees and homeowner association fees, if ,33
any; water Hud/or sewer fees, if any, together with any other lienable municipal service. The charges are to be pro-rated for the period(s) :14
covered: Seller will pay up to and including the date of settletnent; Buyer will pay for.all days following settlement, unless otherwise stated as
here:
36
37
¢~ 4. FIXTURES & PERSONAL PROPERTY (1-00) ,311
~ (A) INCLUDED in this sale and purchase price are all existing items permanently installed in the Property, free of liens, iacluding plmnbing; 3~
ltl heating; lighting fixtures (including chandeliers and ceiling fans); water treatment systems; pool and spa equipment; garage door openers 40
it and transmitters; television antennas; shrubbery, plantings and unpotted trees; any remaining heating and cooking fuels stored on the 4~
~Z Property at thc time of settlement; wall to wall carpeting; window covering hardware, shades and blinds; built-in air conditioners; built-in 4Z
-',3 appliances; Hud the range/oven unless otherwise stated. Also included:
!~ 43
15 44
(B) LEASED items (not owned by Seller):
(C) EXCLUDED fixtures and ite~ns:
58§
59O
591
592
593
595
596
597
598
599
6OO
6tH
8O2
603
604
605
606
6O7
(A)
Tile following are part of this Agreemeut if checked:
[] Sale & Settlement of Other Property
Contingency Addendum (PAR Form SSP)
[] Sale & Settlement of Other Property Contingency
with Right to Continue Marketing Addendum
(PAR Form SSP-CM)
(B) []
[] Settlement of Other Property Contingency Addendum (PAR Form SOP)
[] Tenant-Occupied Property Addendum (PAR Form TOP) '
Buyer and Seller acknowledge receiving a copy of this Agreement at the time of signing.
NOTICE TO PARTIES: WHEN SIGNED, THIS AGREEMENT IS A BINDING CONTRACT. Return by facsimile transmission (FAX) of this
Agreement, and all addenda, bearing the signatures of all parties, constitutes acceptance of this Agreement. Parties to this transaction are advised
to consult an attorney before signing if they desire legal advice.
6O8
609 ,~ Buyer has received the Consumer Notice as adopted by the State Real Estate Commission at 49 Pa. Code §35.336.
610 ,~ Buyer has received a statement of Buyer's estimated closing costs before signing this Agreement,
611 ,J~ Buyer has read and understands the notices and explanatory information set forth in this Agreement.
§12 [] Buyer has received a Seller's Property Disclosure Statement before signing this Agreement, if required by law (see Information Regarding
613 the Real Estate Seller Disclosure Law).
614 ~ Buyer has received the Deposit Money Notice (for cooperative sales when Broker for Seller is holding deposit money) before signing this
615 Agreement.
616
617 BUYER'S MAILIN/~,'DDRESS:
BUYER'S CO
WITNESS
623
624 WITNESS
§27
628
62;'9
630
631
632
833
634
635
636
637
630
§39
640
641
642
643
644
645
646
6n7
648
649
650
651
652
853
§5§
WITNESS
BUYER,-~/'~/'~' U.~' DATE
ss#
BUYER : ./L~-'- DATE
BUYER DATE
SS#
Seller hereby approves the above contract this (date)
and in consideration of the services rendered in procuring the Buyer, Seller agrees to pay the named Broker for Seller a fee of
of/from the herein specified sale price, In the event Buyer defaults hereunder, any monies paid on account will be divided
Seller, ., Broker for Seller, but in no event will the sum paid to the Broker for Seller exceed the above specified Broker's fee.
[] Seller has received the Consumer Notice as adopted by the State Real Estate Commission at 49 Pa. Code §35.336.
[] Seller has received a statement of Seller's estimated closing costs before signing this Agreement..
[] Seller has read and understands the notices and explanatory information set forth in this Agreement.
SELLER'S MAILING ADDRESS:
SELLER'S CO N~~~F~-~
WITNESS/
WITNESS
SS#
SELLER ! DATE
SS#
WITNESS
SELLER. DATE
SS#
Broker's/Licensees' Certifications (check all that are applicable):
Regarding Lead-Based Paint Hazards Disclosure: Required if Property was built before 1978: The undersigned Licensees involved in
this transaction, on behalf of themselves and their brokers, certify that their statements are true to the best of their knowledge and belief.
Acknowledgement: The Licensees involved in this transaction have informed Seller of Seller's obligations under The Residential Lead-Based
Paint Hazard Reduction Act, 42 U.S.C. ~4852(d/. and are. awnr~
588
589
59O
591
592
593
594
595
596
597
598
599
6OO
601
602
6(13
6O4
605
6O6
607
608
609
610
611
612
~ 613
614
615
616
617
618
619
62O
621
622
623
624
625
626
627
628
629
630
631
632
633
634
635
636
· 637
638
639
640
641
642
643
644
645
646
647
648
649
65O
651
652
653
654
655
(B)
(C)
~D)
!E) Seller Assist
NOTAPHACABLE
[] APPLICABLE. Seller will pay:
[] $
WAIVED. This sale is NOT contiugeut on mortgage financing. `51
ELECTEI) 62
This sale is contmgeut upon Buyer obtaining mortgage financing as follows:
1. Ainount of mortgage loan $ .2..>~-, gSY~'~ '~ ·
2. Mmimuul Term -,,.~:5> .., years / ~., ~/
3. Type of motlgage ~.~V~?~L.~ ~?~2~2~V~ 6,5
4. Interest rate ~'~', ~ %; however, Buyer agrees to accept the interest rate as may be committed by the mortgage lender, not to
exceed a maximun~ interest rate of ff-~' ~ %. 68
5. Discount points, loan origination, loan placement and other fees charged by_)he lender as a percentage of the mortgage loan (excluding
any mortgage insurance pre~niums or VA funding fee) not to exceed ~% (0% if not specified) of the mortgage loan.
The interest rate aud fees provisions required by Buyer are satisfied if a mort.~age lender nrakes available to Buyer the right to guarantee an
interest rate at or below the Maximum Interest Rate specified herein with the percentage fees at or below the amount specified herein. Buyer 12
gives Seller the right, at Seller's sole option and as permitted by the mortgage lender and applicable laws, to contribute finin~cially, without 13
promise of reimbursement, to the Buyer and/or the mortgage lender to make the above terms available to Buyer. 74
Within /~ DAYS (10 days if not specified) of the execution of this Agreement, Buyer will make a completed, written mortgage application
for the mortgage terms specified above to .~/r. esponsible mortgage lender. The Broker fei' Buyer, if any, otherwise the Broker for Seller, is
authorized to communicate with tile ntgrt~age l~nder for tile purposes of assisting in the ~nortgage loan process.
1. Mortgage commitment date /~/~:5'~7. A~'~, ~¢~/-)~"". If a written comnfitment is not received by Seller by the above date Buyer
/.
aud Seller agree to extend the mortgage commmnent date until Seller terminates this Agreement in writing by notice to Buyer.
2. Upou receipt of a mortgage coimnitnlent, Buyer will promptly deliver a copy of the comnfitment to Seller.
3. Seller has the option to terminate this Agreement in writing, after tile mortgage commitment date if tile mortgage comnfim~ent:
a. Is uot valid until tile date of settlement, OR
b. Is couditioned upon tile sale and settlement of any other property, OR
c. Contaius arty other condition not specified in this Agreement that is not satisfied and/or removed in writing by the mortgage lender
withiu 7 DAYS afier tile mortgage cmnmitment date in paragraph 6 (C) (1).
4. If this Agreenmut is tm-minuted as specified in paragraphs 6 (C) (1) or (3), or the mortgage loan is lot obtained for settlement, all deposit monies
paid ou account of purchasc price will be returned to Buyer. Buyer will be responsible for inly premiums for mechanics' lien insurance and/or ~ 1
title search, or fee lbr cancellation of same, if any; AND/OR any premiums for flood insurance, nfine subsidence insurance and/or fire insur-
auce with extended coverage, or cancellation fee, if any; AND/OR auy appraisal fees and charges paid in advance to the mortgage lender.
It' the mortgage lender requires repairs to tile Property, Buyer will, upon receipt, deliver a copy of the mortgage lender's requirements to Seller.
Seller will, within 5 DAYS of receipt of the mortgage lender's requirements, notify Buyer whether Seller will make the required repairs
at Seller's expcuse.
1. If Seller chooses to make the required repairs, Buyer will accept the Property and agree to the RELEASE set forth in paragraph 25 of this q3
Agreenleut.
2. If Seller chooses not to make the required repairs, or if Seller fails to respond within the time given, Buyer will, within 5 DAYS,
notify Seller ill writing of Buyer's choice to terminate this Agreement OR make the required repairs at Buyer's expense and with Seller's go
permission, which will not be uu,'easonably withheld. If Seller denies Buyer permission to make tile required repairs, Buyer may, within .q'l
5 DAYS of Seller's denial, terminate this Agreement, in which case all deposit monies paid on account of purchase price will be
returned promptly to Buyer and this Agreement will be VOID.
1{lfl
1111
1~J2
· 1(I,1
, maxinmnl, toward Buyer's costs as pemfitted by the mortgage lender.
FHA/VA, IF APPLICABLE
IF) It is expressly agreed that notwithstanding arty other provisions of this COho'act, Buyer will not be obligated to complete the purchase of tile
Property described herein or to incur any penalty by forfeiture of earnest money deposits or otherwise unless Buyer has been given, itl accor-
dance with HUD/FHA or VA requirements, a written statement by the Federal Housing Commissionm; Veterans Administration, or a Direct
Endorsement Lender setting ibrth the appraised value of the Property of not less than $ (the dollar amount to be
inserted is the sales price as stated in this Agreement). Buyer will have the privilege and option of proceeding with consummation of the con-
tract without regard to the amount of the appraised valuation. The appraised valuation is amved at to determine the maximu,n mortgage the
Depamnent of Housing and Urban Development will insure. HUD does not warrant the value nor the condition of the Property. Buyer should
satisfy himselffherself that the price and condition of the Property are acceptable.
Warning: Section 1010 of Title 18, U.S.C., Department of Housing and Urban Development and Federal Housing Administration
Transactions, provides, "Whoever for the purpose of... influenciug in any way the action of such Department, lnakes, passes, utters or pub-
lishes any statement, knowing tile same to be false.., shall be titled tinder this title or imprisoned not more dian two years, or both."
~G) U.S. Departnmnt of Housing and Urban Development (HUD) NOTICE TO PURCHASERS: Buyer's Acknowledgemeut
[] Buyer has received the HUD Notice "For Your Protection: Get a Home Inspection' (see Notices and hfformation oil Property Condition
Inspections). Buyer understands the importance of getting an independent honre inspection and has thought about this before signing this
Agreement.
Buyer's luitials Date
/ H) Certilicatim~ We the undersigued, Seller(s) and Buyer(s) party to this transaction each ccrtify that the terms of this contract for purchase are
true to the best of our knowledge and belief, and that any other agreement entered into by auy of these parties in conuection with this transac-
tion is attached to this Agreement.
INSPECTIONS (1-02)
IA) Seller agrees to permit mspectious by authorized appraisers, reputable certifiers, insurer's representatives, surveyors, municipal oflScials and/or
Buyc~ as may be required by the mortgage lender, if any, or insuring ageucies. Seller further agrees to permit any other inspections required by
or provided for in tile terms of this Agreement. Buyer has the right to attend all inspections.
(B) Buyer reserves thc right to make a pre-settlement walk-through iuspection of the Property. Buyer's righl to make this inspection is not waived
by any other provision of this Agreement.
l,i~; , Optinn 1. Within the time given for completing inspections: '1t8
1,19 1. Accept the Property with the inlbrmation stated in the report(s) and agree to the RELEASE set forth in paragraph 25 of this Agreement, OR
t50 2. Terminate this Agreement in writing by notice to Seller, in which case all deposit monies paid on account of purchase price will be returned 150
l!~t promptly to Buyer and this Agreement will be VOID, OR 151
!st 3. Enter into a mutually acceptable written agreement with Seller providing for any repairs or improvements to the Property and/or any credit 152
la3 to Buyer at settlement, as may be acceptable to the mortgage lender, if any. 153
154 Should efforts to reach a mutually acceptable agreement fail, Buyer nmst choose to accept the Property or terminate this Agreement within 154
~is the tinle given for completing inspections and according to the provisions in paragraph 8(C) (Option 1) I and 2.
<,~J [] Option 2. Within the time given for completing inspections: 1.s0
!5~ 1. Accept the Property with the information stated in the report(s) and agree to the RELEASE set forth in paragraph 25 of this Agreement,
~5~ UNLESS the total cost to correct tile conditions contained in the report(s) is more than $ ~,50
~ 2. If tbe total cost to correct the conditions contained in tile report(s) EXCEEDS the amount specified in paragraph 8(C) (Option 2) 11
l~,0 Buyer ~vill deliver the report(s) to Seller within the time given for inspection. 1~0
~ I a. Seller will, within 7 DAYS of receiving the report(s), inform Buyer in writing of Seller's choice to:
~ (1) Make repairs before settlement so that the remaining cost to repair conditions contained in the report(s) is less than or equal to
~3 the amount specified in paragraph 8 (C) (Option 2) 1. 1§3
~,,1 (2) Credit Buyer at settlement for the difference between the estimated cost of repairing the conditions contained in the report(s) 164
~% and die amount specified in paragraph 8 (C) (Option 2) 1. This option must be acceptable to the mortgage lender, if any.
10~ (3) Not make repairs and not credit Buyer at settlement for any costs to repair conditions contained in the report(s).
~t~Z b. If Seller chooses to make repairs or credit Buyer at settlement as specified in paragraph 8 (C) (Option 2) 2, Buyer will accept the 167
n~l Property and agree to the RELEASE set forth in paragraph 25 of this Agreement.
1~ c. If Seller chooses not to make repairs and not to credit Buyer at settlement, or if Seller fails to choose any option within the time
~ ~o given, Buyer will, within 5 DAYS: 17o
~ i 1 (1) Accept the Property with the information stated in the report(s) aud agree to the RELEASE set forth in paragraph 25 of this !
~ ?z Agree]nent, OR 172
~ za (2) Terminate this Agreement in writing by notice to Seller, in which case all deposit monies paid on account of purchase price will 173
~;'4 be returned promptly to Buyer and this Agreement will be VOID.
~;s 9. WOOD INFESTATION INSPECTION CONTINGENCY (1-02) 179
17~ [] WAIVED. Buyer understm~ds that Buyer has the option to request that the Property be inspected for wood infestation by a certified Pest Control !7§
~; z .~/, Operator. BUYER WAIVES THIS OPTION and agrees to the RELEASE set Ibrth in paragraph 25 of this Agreetnent. 1 ?7
~'~ (~A) ELECTED ~
178
: ;u Within /~.~ DAYS (15 days if uot specified) of the execution of this Agreement, Buyer, at Buyer's expense, will obtain a written "Wood-
,,,u Destroying Insect Infestation Inspection Report" from a certified Pest Control Operator and will deliver it and all supporting documents and
*:31 drawings provided by the Pest Coutrol Operator to Seller. The report is to be made satisfactory to and in compliance with applicable laws, mort- 1
~t2 gage lenders, and/or Federal Insuring and Guaranteeing Agency requirements, if any. The inspection will include all readily visible and 182
:~3 accessible areas of all structures on tile Property except the following structures, which will not be inspected: 183
a;~5 (B) If the inspection reveals evidence of active infestation(s), Seller agrees, at Seller's expense and before settle]nent, to treat for active infesta- 185
lt:~ tion(s), in accordance with applicable laws.
:81 (C) If the inspection reveals damage from active infestation(s) or previous infestation(s), Buyer, at Buyer's expense, has the option to obtain a writ- 1~7
~a~ ten report by a professional contractor, home inspection service, or structural engineer that is limited to structural damage to the Property caused 1
I~ by wood-desu-oying organisms and a proposal to repair file damage. Buyer will deliver the structural damage report and corrective proposal to 1tt9
~0 Seller withiu 7 DAYS of delivering the original inspection report. 190
191 (D) Within 5 DAYS of receiving the structural damage report and corrective proposal, Seller will advise Buyer whether Seller will repair, at
1~2 Seller's expense and before settlement, any structural damage from active or previous infestation(s).
1~3 (E) If Seller chooses to repair structural damage revealed by the report, Buyer agrees to accept the Property as repaired mid agrees to the RELEASE
~!:,4 set forth in paragraph 25 of this Agreement.
~!~s (F) If Seller chooses not to repair structural damage revealed by the report or fails to respond within the time given, Buyer, within 5 DAYS, 195
~!~5 will notify Seller in writing of Buyer's choice to:
~ ~; 1. Accept the Property with the defects revealed by the inspection, without abatement of price, and agree to the RELEASE set forth in para- t§7
198 graph 25 of this Agreement, OR 108
~9 2. M~e the repairs before settlement, if required by the mortgage lender, if any, at Buyer's expense and with Seller's permission, which will 199
;U0 not be unreasonably withheld, ill which case Buyer accepts the Property and agrees to the RELEASE set forth in paragraph 25 of this
~tn Agree,nent. If Seller denies Buyer perm/ssion to make the repairs, Buyer may, within 5 DAYS of Seller's denial, terminate this 201
~2 Agreement in writing, in which case all deposit monies paid on account of purchase price will be returned promptly to Buyer and this 202
:!u3 Agreement will be VOID, OR 203
'~'~ 3. Temfinate this Agree,nent, in which case all deposit monies paid on account of purchase price will be returned promptly to Buyer and 204
I.}5 this Agreement will be VOID.
;:0~ 10. RESIDENTIAL LEAD-BASED PAINT HAZARD REDUCTION ACT NOTICE REQUIRED FOR PROPERTIES
;:0z BUILT BEFORE 1978 (1-02) 207
~o8 [] NOT APPLICABLE ~'08
;'lis ~ APPLICABLE 209
~;0 (A) Seller represents that Seller has no knowledge concerning the presence of lead-based paint and/or lead-based paint hazards in or about the
~1 Property, unless checked below. 21t
~'t2 [] Seller has knowledge of the presence of lead-based paint and/or lead-based paint hazards iu or about tile Property. (Provide the basis for 212
:~ ~ determining that lead-based paint and/or hazards exist, the location(s), the condition of the painted surfaces, and other available infonna- 213
,: ~ ]ion concerning Seller's knowledge of the presence of lead-based paint and/or lead-based paint hazards.) 214
215
(B)
Records/Reports: Seller has no reports or records pertaining to lead-based paint and/or lead-based paint hazards in or about the Property,
unless checked below.
11.
(B)
......................... t~ ..... ,o,. ,.L,o~oo*m,~,t ,l~u/t~ ill~lt~:~tlUll O1 IIIt~ rl'op~2rly lur leuo-oaseO pulnt allClffor ;:'2.c~
Icad-based paint hazards, Buyer may deliver to Seller a writteu list of the specific hazardous conditions cited in the report and those Z~(i
corrections requested by Buyer, along with a copy of the risk assessment and/or inspection report. ~3z
3. Seller may, within 7 DAYS of receiving the list and report(s), submit a written corrective proposal to Buyer. The corrective proposal ~a~
will include, but not be limited to, the name of the remediation company and a projected completion date for corrective measures. Seller 23~
will provide certification from a risk assessor or inspector that corrective measures have been satisfactorily completed ou or before the 210
projected completion date. 241
4. Upon receiving the corrective proposal, Buyer, within 5 DAYS, will: 242
a. Accept the corrective proposal and the Property in writing, and agree to the RELEASE set forth in paragraph 25 of this Agreement, OR 24:1
Terminate this Agreement in writing, in which case all deposit monies paid on account of purchase price will be returned promptly ' 244
to Buyer and this Agreement will be VOID.
Should Seller fail to submit a written corrective proposal within the time set forth in paragraph 10(D)3 of this Agreement, Buyer,
within 5 DAYS, will:
a. Accept the Property in writing, and agree to the RELEASE set forth in paragraph 25 of'this Agreement, OR
b. Terminate this Agreement in writing, in which case all deposit monies paid on account of purchase price will be returned promptly
to Buyer and this Agreement will be VOID.
Buyer's failure to exercise any of Buyer's options within the time limits specified in this paragraph will constitute a WAIVER of
this contingency and Buyer accepts the Property and agrees to the RELEASE set forth in paragraph 25 of this Agreement.
(E) Certification: By signing this Agreement, Buyer and Seller certify the accuracy of their respective statements, to the best of their knowledge.
STATUS OF RADON (1-02)
(A) Seller represents that Seller has no knowledge concerning the presence or absence of radon unless checked below.
[] 1. Seller has knowledge that the Property was tested on the dates, by the methods (e.g., chat'coal canister, alpha track, etc.), and with
the results of all tests indicated below:
DATE TYPE OF TEST RESULTS (picocuries/liter or working levels)
COPIES OF ALL AVAILABLE TEST REPORTS will be delivered to Buyer with this Agreement. SELLER DOES NOT WAR-
RANT EITHER THE METHODS OR RESULTS OF THE TESTS.
Seller has knowledge that the Property underwent radon reduction measures on the date(s) and by the method(s) indicated below:
DATE RADON REDUCTION METHOD
RADON INSPECTION CONTINGENCY
WAIVED. Buyer understands that Buyer has the option to request that the Property be inspected for radon by a c~rtified inspector (see Environ-
mental Notices: Radon). BUYER WAIVES THIS OPTION and agrees to the RELEASE set forth in paragraph 25 of this Agreement.
ELECTED. Buyer, at Buyer's expense, has the option to obtain, from a certified inspector, a radon test of the Property, and will deliver a copy
of the test report to Seller withiu __ DAYS (15 days if not specified) of the execution of this Agreetnent. (See Environmental Notices:
Radon)
1. If the test report reveals the presence of radon below 0.02 working levels (4 picocuries/liter), Buyer accepts the Property and agrees to the
RELEASE set forth in paragraph 25 of this Agreement.
2. if the test report reveals the presence of radon at or exceeding 0.02 working levels (4 picocuries/liter), Buyer will, within 7 DAYS
of receipt of the test results:
Option 1
a. Accept the Property in writing and agree to the RELEASE set forth in paragraph 25 of this Agreement, OR
b. Termiuate this Agreement in writing, in which case all deposit monies paid on account of purchase price will be returned promptly to Buyer
and this Agreement will be VO1D, OR
c. Submit a written, corrective proposal to Seller. The corrective proposal will include, but not be linfited to, the name of the certified miti-
gation company; provisions for payment, including retests; and a projected completion date for corrective measures.
(1) Within 5 DAYS of receiving the corrective proposal, Seller will:
(a) Agree to the terms of the con'ective proposal in writing, in which case Buyer accepts the Property and agrees to the
RELEASE set forth in paragraph 25 of this Agreement, OR
(b) Not agree to the terms of the corrective proposal.
(2) Should Seller not agree to the terms of the corrective proposal or if Seller fails to respond within the time given, Buyer will, within
5 DAYS, elect to:
(a) Accept the Property iu writing aud agree to the RELEASE set forth in paragraph 25 of this Agreement, OR
(b) Terminate this Agreement in writing, in which case all deposit monies paid on account of purchase price will be returned
promptly to Buyer and this Agreement will be VOID.
Option 2
a.
b.
Accept the Property in writiug and agree to the RELEASE set forth in paragraph 25 of this Agreement, OR
Submit a written, corrective proposal to Seller. The corrective proposal will include, but not be limited to, the name of the certified miti-
gation company; provisions for payment, including retests; mad a projected completion date for corrective measures. Seller will pay a max-
imum of $ toward the total cost of remediation and retests, which will be completed by settlement.
( 1 ) If the total cost of remediation and retests EXCEEDS the amount specified in paragraph 11 (B) (Option 2) b, Seller will, within
5 DAYS of receipt of the cost of remediation, notify Buyer in writing of Seller's choice to:
(a) Pay for the total cost of remediation and retests, in which case Buyer accepts the Property and agrees to the RELEASE set forth
in paragraph 25 of this Agreement, OR
(b) Coutribute toward the total cost of remediation and retests only the amount specified in paragraph 11(B) (Option 2) b.
(2) if Seller chooses not to pay for the total cost of remediation and retests, or if Seller fails to choose either option within the time
given, Buyer will, within 5 DAYS, uotify Seller in writing of Buyer's choice to:
(a) Pay the difference between Seller's contribution to remediation and retests aud the actual cost thereof, in which case
Buyer accepts the Property and agrees to the RELEASE set forth in paragraph 25 of this Agreemeut, OR
(b) Terminate this Agreement, in which case all deposit monies oaid on account of ourchase nrice will he ret~m~ed nrcmmtlv
2~15
2,16
247
248
249
250
251
2.52
253
254
255
256
257
:>50
259
7.61
262
263
264
265
266
269
270
271
272
273
274
275
276
277
278
279
2811
281
282
2,~3
284
285
286
2811
289
29(I
291
292
293
294
295
~97
2!t9
3ti0
381
302
311:I
3~15
374
325
326
327
328
329
33O
331
332
333
334
335
335
33?
338
339
34O
341
342
343
344
345
346
347
348
349
35O
351
13.
inspectaon company. Seller also agrees to restore the Property, at Seller's expense, prior to settlement. '324
3. If the report reveals that the water service does not meet the minimum standards of any applicable governmental authority and/or falls to 325
satisfy the requirements for quality and/or quantity set by the mortgage lender, if any, then Seller will, within 7 DAYS of receipt Pf 326
the report, notify Buyer in writing of Seller's choice to: 327
a. Upgrade the water service to the minimum acceptable levels, before settlement, in which case Buyer accepts the Property and agrees 328
to the RELEASE set forth in paragraph 25 of this Agreement, OR 329
b. Not upgrade the water service. 338
4. If Seller chooses not to upgrade the service to minimum acceptable levels, or fails to respond within the time given, Buyer will, within 331
5 DAYS, either: 332
a. Accept the Property and the water service and, if required by the mortgage lender, if any, and/or any govermnental authority, upgrade 333
the water service before settlement or within the time required by the mortgage lender, if any, and/or any governmental authority, at :134
Buyer's expense and with Seller's permission, which will not be unreasonably withheld, and agree to the RELEASE set forth in para- a35
graph 25 of this Agreement. If Seller denies Buyer permission to upgrade the water service, Buyer may, within ~ DAYS of 336
Seller's denial, terminate this Agreement in writing, in which case ail deposit monies paid on account of purchase price will be 33?
returned promptly to Buyer and this Agreement will be VOID, OR 338
b. Terminate this Agreement in writing, in which case all deposit monies paid on account of purchase price will be returned pr0mpdy 339
to Buyer and this Agreement will be VOID. 340
STATUS OF SEWER (1,-02) 341
(A) Seller represents that the Property is served by: 342
Public Sewer
343
Individual On-lot Sewage Disposal System (See Sewage Notice 1) 344
[] Individual On-lot Sewage Disposal System in Proximity to Well (See Sewage Notice 1; see Sewage Notice 4, if applicable)
[] Community Sewage Disposal System
[] Ten-acre Permit Exemption (See Sewage Notice 2)
[] Holding Tank (See Sewage Notice 3)
[] None (See Sewage Notice 1)
[] None Available/Permit Limitations in Effect (See Sewage Notice 5)
345
346
347
,348
349
350
351
14.
(B)
INDIVIDUAL ON-LOT SEWAGE DISPOSAL INSPECTION CONTINGENCY
WAIVED. Buyer acknowledges that Buyer has the option to request ah individual on-lot sewage disposal inspection of the Property. BUYER
WAIVES THIS OPTION and agrees to the RELEASE set forth in paragraph 25 of this Agreement.
[] ELECTED
1. Buyer has the option, within DAYS (15 days if not specified) of the execution of this Agreement and at Buyer's expense, to
deliver to Seller a written inspection report by a qualified, professional inspector of the individual on-lot sewage disposal system.
2. Seller, at Seller's expense, agrees, if and as required by the inspection company, to locate, provide access to and empty the individual on-
lot sewage disposal system. Seller also agrees to restore the Property, at Seller's expense, prior to settlement.
3. If the report reveals defects that do not require expansion or replacement of the existing sewage disposal system, Seller will, within
7 DAYS of receipt of the report, notify Buyer in writing of Seller's choice to:
a. Correct the defects before settlement, including retests, at Seller's expense, in which case Buyer accepts the Property and agrees to
the RELEASE set forth in paragraph 25 of this Agreement, OR
b. Not correct the defects.
4. If Seller chooses not to correct the defects, or if Seller fails to respond within the time given, Buyer will, within ~ DAYS, either:
a. Accept the Property and the system and, if required by the mortgage lender, if any, and/or any governmental authority, correct the
defects before settlement or within the time required by the mortgage lender, if any, and/or any governmental authority, at Buyer's
sole expense and with Seller's permission, which will not be unreasonably withheld, and agree to the RELEASE set forth in para-
graph 25 of this Agreement. If' Seller denies Buyer permission to correct the defects, Buyer may, within ~ DAYS of Seller's
denial, terminate this Agreement in writing, in which case ail deposit monies paid on account of purchase price will be returned
promptly to Buyer and this Agreement will be VOID, OR
b. Terminate this Agreement in writipg, in which case all deposit monies paid on account of purchase price will be returned
promptly to Buyer and this Agreement will be VOID.
5. If the report reveals the need to expand or replace the existing individual on-lot sewage disposal system, Seller may, within 25 DAYS
of receipt of the report, submit a corrective proposal to Buyer. The corrective proposal will include, but not be limited to, the name of the
remediation company; provisions for payment, including retests; and a projected completion date for corrective measures.. Within
5 DAYS of receiving Seller's corrective proposal, or ff no corrective proposal is received within the time given, Buyer will:
a. Agree to the terms of the corrective proposal, if any, in writing, in which case Buyer accepts the Property and agrees to the RELEASE
set forth in paragraph 25 of this Agreement, OR
b. Accept the Property and the system and, if required by the mortgage lender, if any, and/or any governmental authority, correct the
defects before settlement or within the time required by the mortgage lender, if any, and/or any goverranental authority, at Buyer's
sole expense and with Seller's permission, which will not be unreasonably withheld, and agree to the RELEASE set forth in para-
graph 25 of this Agreement. If Seller denies Buyer permission to correct the defects, Buyer may, within 5 DAYS of Seller's
denial, terminate this Agreement in writing, in which case all deposit monies paid on account of purchase price will be returned
promptly to Buyer and this Agreement will be VOID, OR
c. Terminate this Agreement in writing, in which case all deposit monies paid on account of purchase price will be returned promptly
to Buyer and this Agreement will be VOID.
NOTICES, ASSESSMENTS & CERTIFICATES OF OCCUPANCY (1-02)
(A) Seller represents, as of Seller's execution of this Agreement, that no public improvement, condominium or homeowner association assessments
have been made against the Property which remain unpaid, and that no notice by any government or public authority has been served upon
Seller or anyone on Seller's behalf, including notices relating to violations of zoning, housing, building, safety or tim ordinances which remain
uncorrected, and that Seller knows of no condition that would constitute violation of any such ordinances which remains uncorrected, ualess
otherwise specified here: /~t~,A/'~--~'
;~:,: 1. A certification frown thc appropriate mmlicipal department or departlnents disclosing notice of any uncorrected violations of zoning, hous-
113 lng, building, safety or fire ordinances, AND/OR 413
~l,l ~ 2. A certificate permittiug occupancy of the Property. In the event repairs/itnprovements are required for the issuance of tile certificate, Seller
4~.:) will, within 5 DAYS of' Seller's receipt of the requirements, notify Buyer of tile requirements and whether Seller will make the 41,s
t lii required repairs/improvements at Seller's expense.
~l t If Seller chooses to make the required repairs/improvements, Buyer agrees to accept the Property as repaired and agrees to the RELEASE set ,117
~la foixh m paragraph 25 of this Agreement. If Seller chooses pot to tnake the required repairs/ilnprovements, Buyer will, within 5 DAYS, 41
,~ 19 notify Seller in writing of Buyer's choice to terminate this Agree~nent OR make the repairs/improvements at Buyer's expense and with Seller's 41
~;;u permission, which will not be um'easonably withheld. If Seller denies Buyer permission to make the required repairs or if Seller fails to respond 42u
~.;1 within the time given, Buyer may, within 5 DAYS, terminate this Agreement iu writing, in which case all deposit monies paid on account
t~;~ of purchase price will be returned proinptly to Buyer and this Agreement will be VOID. 42~
1,~3 15. TITLE, SURVEYS & COSTS ('1-02)
~;~:4 iA) The Property is to be conveyed free and clear of all liens, encumbrances, and easements, EXCEPTING HOWEVER the following: existing
~2s deed restrictions, historic preservation restrictions or ordinances, building restrictions, ordinances, easements of roads, easetnents visible upon
i;t~ the ground, easements of record, privileges or rights of public service companies, if any; otherwise the title to the above described real estate ,~
~? will be good and marketable and such as will be insured by a reputable Title Insurance Company at tile regular rates. ,1~7
.~;a (.B) Buyer will pay for the following: (1) Title search, title insurance and/or mechanics lien insurance, or fee for cancellation of same, if any;
~.>'~J (2) Flood insurance, fire insurance with extended coverage, mine subsidence insurance, or fee for cancellation of same, if any; (3) Appraisal ' 4211
13il fees and charges paid iii advauce to mortgage lender, if any; (4) Buyer's customary settlement costs and accruals. ,130
~31 lC) Any survey or surveys which may be required by the Title Insurauce Company or the abstracting attorney for the preparation of an adequate 431
*.:~7_ legal description of the Property (or the colwection thereof) will be secured and paid for by Seller. Any survey or surveys desired by Buyer or 432
i.~3 required by tile mortgage leuder will be secured and paid for by Buyer. 43,]
i34 ID) Iii tile event Seller is unable to give a good and marketable title and such as will be insured by a reputable Title Company at the regular rates, as 434
:~'~ specified in paragraph 15IA), Buyer will have the option of: (1) taking such title as Seller can give with no change to the purchase price; or (2) being ,135
13Ii repaid all monies paid by Buyer to Seller on account of purchase price and being reimbursed by Seller for any costs incurred by Buyer for any inspec- 43t3
I'l? tions or certifications obtained according to tile terms of the Agreement, aud for those items specified in paragraph 15(B) items (1), (2), (3) and in ,Iai
1:18 paragraph 15(C), iii which case there will be no further liability or obligation on either of the parties hereto and this Agreement will become VOID.
~3~I 16. ZONING CLASSIFICATION (1-02) 43g
l.Vl Failure of this Agreement to contain the zoning classification (except in cases where the property { and each parcel thereof, if subdividable } is zoned
i~ 1 solely or primarily to permit single-family dwellings) will render this Agreetnent voidable at the option of the Buyer, and, if voided, any deposits
~.l~ tendered by the Buyer will be returned to the Buyer without any requirement for court action.
~13 Zoning Classificatilm:
[] ELECTED. Within 15 DAYS of the execution of this Agreement, Buyer will verify that the ex:,sting use of the Property as
is permitted. In the eveut the use is not permitted, Buyer will, within the time
given for verification, notify Seller in writing that the existing use of the Property is not permitted and this Agreement will be VOID, in which
case all deposit monies paid oll account of purchase price will be returned promptly to Buyer. Buyer's failure to respond within the time
given will constitute a WAIVER of this contingency and all other terms of this Agreement remain in full force and effect.
17. COALNOTICE
NOT APPLICABLF.
APPLICABLE
'I'1 lis DOCUMF~NT MAY NOF SELL., CON VEY, TRANSFEI,t, INCLUDE Oil INSURE THE TFrLE TO THE COAL AND RIGHTS OF SUPPORT UNDERNEATIt THE SURFACE LAND
DESCRIBED OP, REI:ERRED 'IO HEREIN, AND THE OWNER OR OWNEI>-.S OF SUCtt COAL MAY HAVE THE COMPLETE LEGAL RIGHT TO REMOVE ALL SUCH COAL AND
IN THAT CONNECTION, DAMAGE MAY RESULT TO TIlE SURFACE OF 'FILE LAND AND ANY HOUSE, BUILDING OR OTHER STRUCTURE ON OR IN SUCH LAND. (This
notice is set forth m the manner provided iii Section 1 of the Act of July 17, 1957, P.L. 984.) "Buyer acknowledges that he may not be obtaining the
right of protection against subsidence resulting fi'om coal mining operations, and that the property described herein may be protected from damage
due to mine subsidence by a private contract with the owners of the economic interests in the coal. This acknowledgement is made for the propose
of complying with the provisious of Section 14 of the Bituminous Mine Subsidence and the Land Conservation Act of April 27, 1966." Buyer agrees
to sign the deed fi'oni Seller which deed will contain the albresaid provision.
18. POSSESSION (1-02)
iA) Possession is to be delivered by deed, keys and:
1. Physical possession to vacant Property free of debris, with all structures broom-clean, at day and time of settlement, AND/OR
2. Assignment of existing lease(s), together with any security deposits and interest, at time of settlement, if Property is leased at the
execution of this Agreeinent or unless otherwise specified herein. Buyer will acknowledge existing lease(s) by initialing said lease(s) at
time of execution of this Agreement.
]Bi Seller will not enter into any new leases, writteu extensiou of existing leases, if any, or additional leases for the Property without the written
consent of Buyer.
19. RECORDING (3-8§) This Agreelnent will not be recorded in the Office for the Recording of Deeds or in any other office or place of public record
and if Buyer causes or permits this Agreement to be recorded, Seller may elect to treat such act as a breach of this Agreement.
20. ASSIGNMENT (3-85) This Agreement will be binding upon the parties, their respective heirs, personal representatives, guardians and successors,
and to the extent assignable, on tile assigns of the parties hereto, it being expressly understood, however, that Buyer will not transfer or assign this
AgreentenI without the written consent of Seller.
21. DEPOSIT & RECOVERY FUND (1-02)
IA) Deposits paid by Buyer within 30 DAYS of settlement will be by cash, cashier's or certified check. Deposits, regardless of the form of
payment and the person designated as payee, will be paid in U.S. Dollars to Broker or party identified in paragraph 3(B), who will retain them
itl an escrow account until consummation or termination of this Agreement in conformity with all applicable laws and Fegulations. Any uncashed
check tendered as deposit monies may be held pending the acceptauce of this off'er.
tB) Upon termination of this Agreement, the Broker holding the deposit mouths will release the deposit monies in accordance with the terms of a
fully executed writteu agreement between Buyer and Seller.
(C) In the event of a dispute over entitlement to deposit monies, a broker holding tile deposit monies is required by the Rules and Regulations of
the SIate Real Estate Connnission (49 Pa. Code §35.327) to retain tile monies itl escrow until the dispute is resolved. Iii the event of litigation
for the return of deposit monies, a broker will distribute tile monie~ n~ ttlreclort hv n ri,mi ow, lo,. ,,f ..... .~ ~ ~h ..... h~,, ^ ............ e d ...... :~
5O0
5U3
51.14
5O5
5O5
5U7
5O8
5O0
510
(A) With/n 15 DAYS of the execution of this Agreement, Seller will submit a request to the association for a Certificate of Resale and the doc- 5110
uments necessary to enable Seller to comply with the Act. The Act provides that the association is requked to provide these documents within 501
10 days of Seller's request. 50':~ '
(B) Seller will promptly deliver to Buyer all documents received from the association. Under the Act, Seller is not liable to Buyer for the failure or S113
delay of the association to provide the Certificate in a timely manner, nor is Seller liable to Buyer for any erroneous information provided by 504
the association and included in the Certificate. 505
(C) Buyer may declare this Agree~nent VOID at any time before Buyer's receipt of the association documents and for 5 days thereafter, OR until 51111
settlement, whichever occurs first. Buyer's notice declaring this Agreement void must be in writing; thereafter all deposit monies will be 5117
returned to Buyer. 5011
(D) in the event the association has the right to buy the Property (right of first refusal), and the association exercises that right, Seller will reimburse
Buyer for all monies paid by Buyer on account of purchase price and for any costs incun'ed by Buyer for: (1) Title search, title insurance and/or 5~11
mechanics lien insurance, or fee for cancellation of same, if any; (2) Flood insurance and/or fire insurance with extended coverage, mine sub-
sidence insurance, or fee for cancellation of same, if any; (3) Appraisal fees and charges paid in advance to mortgage lender, if any. §12
23. MAINTENANCE & RISK OF LOSS (1-02) 513
(A) Seller will ~naintain the Property, grounds, fixtures, and any personal property specifically scheduled herein in its present condition, normal 514
wear and tear excepted. 515
(B) In the event any system or appliance included in the sale of the Property fails and Seller does not repair or replace the item, Seller will promptly
notify Buyer in writing of Seller's choice to: 517
1. Repair or replace the failed system or appliance before settlement or credit Buyer at settlement for the fair market value of the failed sys- 51
tern or appliance (this option must be acceptable to the mortgage lender, if any). In each case, Buyer accepts the Property and agrees to Mit
the RELEASE set forth in paragraph 25 of this Agreement, OR
2. Not repair or replace the failed system or apphance, and not credit Buyer at settlement for the fair market value of the failed system or 5Zt
appliance. If Seller does not repair, replace or offer a credit for the failed system or appliance, or if Seller fails to notify Buyer of Seller's
choice, Buyer will notify Seller in writing within 5 DAYS or before settlement, whichever is sooner, that Buyer will: 523
a. Accept the Property and agree to the RELEASE set forth in paragraph 25 of this Agreement, OR 524
b. Terminate this Agreement, in which case all deposit monies paid on account of purchase price will be returned promptly to Buyer
and this Agreelnent will be VOID. 526
(C) Seller will bear risk of loss from fire or other casualties until time of settlement. In the event of damage by fire or other casualties to any prop-
erty included in this sale that is not repaired or replaced prior to settlement, Buyer will have the option of rescinding this Agreement and 5~Jt
promptly receiving all monies paid on account of purchase price or of accepting the Property in its then condition together with the proceeds
of any insurance recovery obtainable by Seller. Buyer is hereby notified that Buyer may insure Buyer's equitable interest in this Property as of 5all
the time of execution of this Agreement.
24. ~VAIVER OF CONTINGENCIES 0-02) 532
If this Agreement is contingent on Buyer's right to inspect and/or repair the Property, Buyer's failure to exercise any of Buyer's options within 533
the time limits set forth in this Agreement will constitute a WAIVER of that contingency and Buyer accepts the Property and agrees to the
RELEASE set forth in paragraph 25 of this Agreement.
25. RELEASE (1-02) 53~
Buyer hereby releases, quit claims and forever discharges SELLER, ALL BROKERS, their LICENSEES, EMPLOYEES, and any OFFI- 537
CER or PARTNER of any one of them and any other PERSON, FIRM, or CORPORATION who may be liable by or through them, from
any and all claims, losses or demands, including, but not limited to, personal injuries and property damage and all of the consequences there-
of, whether now known or not, which may arise from the presence of termites or other wood-boring insects, radon, lead-based paint haz- 5411
ards, environmental hazards, any defects in the individual on-lot sewage disposal system or deficiencies in the on-site water service system, .541
or any defects or conditions on the Property. Should Seller be in default under the terms of this Agreement, this release does not deprive
Buyer of any right to pursue any remedies that may be available under law or equity. This release will survive settlement. 543
26. REPRESENTATIONS (1-02) 544
(A) Buyer understands that any representations, claims, advertising, promotional activities, brochures or plans of any kind made by Seller, Brokers, 545
their licensees, employees, officers, or parmers are not a part of this Agreement unless expressly incorporated or stated in this Agreement. It is
further understood that this Agreement contains the whole agreement between Seller and Buyer and there are no other terms, obligations, 547
covenants, represeutations, statements or conditions, oral or otherwise of any kind whatsoever concerning this sale. Furthermore, this 548
Agreement will not be altered, amended, changed, or modified ~xcept in writing executed by the parties.
~,B) It is understood that Buyer has inspected the Property before signing this Agreement (including fixtures and any personal property
specifically scheduled herein), or has waived the right to do so, and bas agreed to purchase the Property in its present condition unless
otherwise stated in this Agreement. Buyer acknowledges that Brokers, their licensees, employees, officers or partners have not made
an independent examination or determination of the structural soundness of the Property, the age or condition of the components, envi- 553
roumental conditions, the permitted uses, or of couditions existing in the locale where the Property is situated; nor have they made a
mechanical inspection of any of the systems contained therein, sss
lC) Any repairs required by this Agreement will be co~npleted in a workmanlike manner.
(D) Broker(s) may perform services to assist unrepresented parties in complying with the terms of this Agreement. 557
(E) The headings, captions, and line numbers in this Agreement are meant only to make it easier to find the paragraphs. .558
27. DEFAULT (1-02) ssg
(A) Seller has the option of retaining all sums paid by Buyer, including the deposit monies, should Buyer:
1. Fail to make any additional payments as specified in paragraph 3; OR 561
2. Furnish false or incomplete information to Seller, Broker(s), or the mortgage lender, if any, concerning Buyer's legal or financial status,
or/'ail to cooperate in the processing of the mortgage loan application, which acts would result in the failure to obtain the approval of a
mortgage loan commitment; OR 554
3. Violate or fail to fulfill and perform any other terms or conditions of this Agreement. 5115
(B) Unless otherwise checked in paragraph 27 (C), Seller may elect to retain those sums paid by Buyer, including deposit monies, in one of the
following manners:
1. On account of purchase price; OR 568
2. As monies to be applied to Seller's damages; OR
INVENTORY
Estate of ALICE D. PEARSON
also known as
, Deceased
No. c~,l- r~-,.~l. -I~3
Date of Death 2/3/2002
Social Security No. 172-01-9567
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We
verify that the statements made in this inventory are true and correct. I/VVe understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Personal Representative:
Name of
Attorney: Milenna R. Hershey, Esquire Gaye D. Larson
58857
I.D. No.:
Address: 1099 W. Areba Avenue
Hershey PA 17033
Dated December 3, 2002
Telephone: 717-533-3798
Description Value
Real estate at 808 Coolidge Street, New Cumberland, PA
M & T Bank checking ~account
Total
(Attach Additional Sheets if necessary) 66,108.88
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsy vania may at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
RW-4
65,000.00
1,108.88
ESTATE OF ALICE D. PEARSON, :
LATE OF NEW CUMBERLAND, :
CUMBERLAND COUNTY, PENNSYLVANIA :
DECEASED :
IN THE COURT OF C0~ON P?.m~S
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DMSION
NO. 193 OF 2002
FIRST AND FINAL ACCOUNT
AND STATEMENT OF PROPOSED DISTRIBUTIONS OF
GAYE D. LARSON, Executrix
Stated for Period From February 3, 2002 through January 31, 2003
Date of Death
Date of Executrix Appointment
Date of Advertisement
Cumberland Law Journal
The Patriot News
February 3, 2002
February 22, 2002
March 8, 2002
March 15, 2002
March 22, 2002
February 26, 2002
March 5, 2002
March 12, 2002
Purpose of Account: Gaye D. Larson, Executrix, offers this account to
acquaint interested parties with the transactions that have occurred
during his administration.
It is important that the account be carefully examined. Requests for
additional information or questions or objections can be discussed
with:
Milenna R. Hershey, Esquire
1099 W. Areba Avenue'
Hershey, PA 17033
717-533-3798
SUmmARY OF ACCOUNT
PRINCIPAL
Page
Receipts 3
Net Gain (or Loss) on Sales
or Other Disposition 3
Less Disbursements and reserved
Amounts 4, 5
Distributions to Beneficiaries
Principal Balance Remaining
Subtotals
$66,231.03
-24,967.67
-38,879.86
0
Totals
$2,383.50
INCC~E
Receipts
Less Disbursements
Distributions to Beneficiaries
Income Balance Remaining
0
0
0
$ 0.00
Combined Balance Remaining
$2,383.50
RECEIPTS OF PRINCIPAL
Assets Listed In Inventory
(Value as of Date of Death)
Fiduciary
Acquisition
Value
Cash
M&T Bank checking account
$ 1,108.88
Real Property
808 Coolidge Street
New Cumberland, PA
$65,000.00
Adjustments to Inventory
4/12/02
M&T Bank, setoff and reduction
in proceeds for unprocessed checks
written and not considered in
inventory value-adjusted to reflect
actual proceeds received
$ -246.44
Receipts Subsec~uent to Inventor~
5/31/02
5/31/02
12/27/02
1/13/03
Blue Cross refund
Comcast cable refund
Met Life, homeowner refund
UGI, refund
Total Subsequent Receipts
$ 224.90
19.82
83.75
40.12
$ 368.59
11/27/02
GAINS AND LOSSES ON S~?.mS OR OT~.R DISPOSITIONf
Real Estate
Fiduciary Acq. Value
Net Proceeds
$65,000.00
40,032.33
Gain
Loss
-24,967.67
TOTAL PRINCIPAL RECEIPTS
$41,263.36
DISBURSEMENTS OF PRINCIPAL
Taxes Due
(A Statutory Priority Claim)
4/17/02 Commonwealth of PA, 2001 taxes
$ 105.00
Administration Ex~ensem
(A Statutory Priority Claim)
4/17/02
5/16/02
5/16/02
5/16/02
5/16/02
5/23/02
5/30/02
6/14/02
6/14/02
6/14/02
6/14/02
6/14/02
7/7/02
7/20/02
11/12/02
H&R Block, tax preparer
M&T Bank, estate checks
PP&L, electric
PAWC, water bill
Commerce Bank, mortgage
New Cumberland Boro, sewer
and trash
Met Life, homeowner insurance
UGI, gas bill
Verizon, telephone
PP&L, electric bill
PAWC, water bill
Commerce Bank, mortgage
UGI, gas bill
New Cumberland Boro,
Trash and sewer
M&T Bank, service charge
108.00
8.81
51.96
22.02
193.81
57.43
71.25
64.80
30.25
51.94
23.07
189.94
63.20
13.60
8.00
$ 958.08
1/28/03
1/28/03
1/28/03
Milenna R. Hershey, Esquire
Reimbursement for costs:
Register of Wills, Probate
Patriot News, Estate ad
Cumberland L.J., estate ad
Register of Wills, fee
Milenna R. Hershey, Esquire
Final Account fee, postage, tolls,
Copies
Gaye D. Larson, Executrix
Sewer and Trash;, gas, electric and
water bills; insurance, interest and
cleaning
220.00
200.08
75.00
20.00
$ 515.08
$ 141.59
$ 1,698.93
Fees and Commissions
(A Statutory Priority Claim)
1/28/03
1/28/03
Milenna R. Hershey, Esquire,
Partial fee
Gaye D. Larson, Executrix
Commission
Reserve to Pay
Milenna R. Hershey, Esquire, balance
$ 2,500.00
$ 3,800.00
$ 1,300.00
$ 7,600.00
(A Statutory Priority Claim)
1/28/03
1/28/03
Thornwald Nursing Home
Dept Public Welfare
$ 4,496.04
23,365.14
$27,861.18
Total Disbursements of Principal
And Reserved Amounts
$38,879.86
ESTATE OF ALICE D. PEARSON,
DECEASED
: IN THE COURT OF CCH~ON P?~S
: CU~BERLAND COUNTY, PENNSYLVANIA
: ORPHANS' COURT DIVISION
: NO. 193 OF 2002
STATEMENT OF PROPOSED DIST~TmUTIONR
PRINCIPAL
Cash Remaining
$2,383.50
TOTAL PRINCIPAL FOR DISTRIBUTION
$2,383.50
General Creditor/Claima~nt
Amount Proposed
Of Claim Payment By
Accepted Es tate
Omnium Financial Receivable
Services (MBNA)
Howard R. Cohen, MD
(Medical from Dec 2000)
Dept Public Welfare
$19,916.08
$1,506.80
$ 200.64 $ 15.18
$11,387.23 $ 861.52
Totals
$31,503.95
$2,383.50
Percentage of Payment Upon
Accepted Claims
7.5657%
VERIFICATION
I, Gaye D. Larson, Executrix of the Estate of Alice D. Pearson,
deceased, have read the foregoing First and Final Account for the
above Estate for the stated period from February 3, 2002 through
January 31, 2003, and hereby affirm that it is true and correct to the
best of my personal knowledge, information and belief.
I verify that all the statements made in the foregoing are true
and correct, and that false statements may subject me to the penalties
of 18 Pa.C.S. §4904 relating to unsworn falsification to authorities.
Dated:
7
IN RE:
ESTATE OF ALICE D. PEARSON,
DECEASED
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, PA
: ORPHANS' COURT DIVISION
: NO. 193 OF 2002
CERTIFICATE AS TO SERVICE OF NOTICF.
I hereby certify that on January 30, 2003, the attached "Notice" with attachments
was mailed by depositing a copy of the same in the United States Mail, Harrisburg,
Pennsylvania, with first-class postage, prepaid, to the persons set forth on the attached
Distribution List.
Milenna R. Hershey, Esquire
Counsel for the Executrix
1099 W. Areba Avenue
Hershey, PA 17033
717-533-3798
MILENNA R. HERSHEY, ESQUIRE
Attorney - at -Law
1099 W. Areba Avenue
Hershey, PA 17033
717-533-3798
Fax 717-533-1908
NOTICE AND CERTIFICATE OF SERVIC~
TO:
FROM:
RE:
Claimants, Creditors and Beneficiaries of the Estate of Alice D. Pearson, Deceased
(Per Attached Distribution List)
Milenna R. Hershey, Esq., Counsel for the Executrix
Filing of the Executrix' First and Final Account for Court Confirmation
As you are aware, I serve as Counsel for the Executrix of the Estate of Alice D. Pearson, who died
February 3, 2002, a resident of Cumberland County, Pennsylvania. Gaye D. Larson was appointed by the
Register of Wills of Cumberland County, Pennsylvania to serve as the Executrix of the Estate.
In connection with the administration of the Estate and its final distribution and termination, I now
enclose for your review a copy of the following documents, with all attachments, which will be filed on
January 31, 2003 with the Clerk of the Orphans' Court Division, Court of Common Pleas of Cumberland
County, Pennsylvania:
First and Final Account of the Estate by the Execulxix with Statement
of Proposed Distribution
2. Proposed Adjudication and Order of Court
The Account will be called for audit, confu'mation and distribution on March 4, 2003 at 9:00 a.m.
(prevailing time) in Courtroom 3, Cumberland County Courthouse, I Courthouse Square, Carlisle, Pa.
If you have any objections to the Account, you must present such matters to the Court no later
than 9:00 a.m. (prevailing time) on March 4, 2003. In the absence of written objections timely filed
pursuant to applicable state and local rules of court, it is expected that on the date of Audit, the Court will
confirm the Account as filed.
After a final Adjudication and Order is received from the Court, the Executrix would be expected
to make distribution accordingly without further proceedings.
Enclosures: As referenced above
Cc: Gaye D. Larson, Executrix
Milenna R. Hershey, Esquire
1099 W. Areba Avenue
Hershey, PA 17033
Chadwick O. Bogar, Esquire
Attorney for Thomwald Nursing Home
Latsha, Davis & Yohe, P.C.
P.O. Box 825
Harrisburg, PA 1710g-0925
Oeneral Creditors
Omnium Financial Receivable Services
Dept. 25
P.O. Box 6618
Omaha, NE 68106-0618
Dept of Public Welfare
Bureau of Financial Operations
Estate Recovery Program
P.O. Box 8486
Harrisburg, PA 17105-g486
Beneficiaries
R. Terry Hamburg
111 Pine Street
Middletown, PA 17057
Gaye D. Larson
111 Pine Street
Middletown, PA
17057
Dept. of Public Welfare
Bureau of Financial Operations
P.O. Box 8486
Harrisburg, PA 17105-1Mg6
Howard R. Cohen MD
4713 East Trindle Road
Mechanicsburg, PA 17050
Oaye D. Larson
111 Pine Street
Middletown, PA 17057
STATUS REPORT UNDER RULE 6.12 o K
Name of Decedent : ^"~'~ n oGepSON
Date of Death : ~~~~~002
Will No . 19~-~002 Admin . No .
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:
a . Did the personal representative file a final
account with the Court ? Yes ~_ 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 ? Yes No _
d . Copies of receipts , releases , joinders and
approvals of formal or informal accounts may be filed with the
Clerk of the Orphans' Court and may be attached to this report .
Date : 4!23!2003
/' ~=
Signature
n
Name (Please type or print )
1099 W. Areba Ave
Hershey PA 17033
Address
( 717) 533- 3798
Tel . No .
Capacity : Personal Representative
~_ Counsel for personal
representative