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'lE'I_ISOOUI6--001
'* COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 28060 I
HARRISBURG, PA 17128.0601
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
5'/eJu.;C;Cc:;!'.. W,4UFI'.. S'
DATE OF DEATH (MM-DD-YEAR)
Of,,-II-O;;!..
DATE OF BIRTH (MM-DD-YEARI
65- 30-ltp
(IF APPLICABLE) SURVIVING SPOUSES NAME (LAST. FIRST, AND MIDDLE INITIAL)
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o 4. Limited Estate
~ 6. Decedent Died Testate (Anachcopyo~Willl
o 9. Litigation Proceeds Received
o 2. Supplemental Return
D 4a, Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Anach copy ofTrustl
o 10. Spousal Poverty Credit (date of death between 12.31-91 and 1-1-95)
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NAME
OFFICIAL USE ONLY
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COMPLETE MAILING ADDRESS
FIRM NAME (11~plica~eJ
TELEPHONE NUMBER
FILE NUMBER
<:>2,--.Q~ __ 7~~
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
/7'1 - 0 S
3,S5/
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (date ofdeatl1 priol" to 12-13-82)
o 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
-~-'1' ~.-. li' ~"n' .._~-.-, ,,-- -' - - '. - ...,."
11- - ;,!I'lJiJp'::l., :4J~ 1:':<I+)']:i "j:::J;~Jf.h ,;' ','1- .,'/ <; >J,' .1-\ " . :" . .,;- '..l' ~
'" .,,~>l( ::.c~"; _""~.~,.'''''_~'f~'''~_~.... . _ . -..~_, " _ _ ,,~, ~
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
l/i 1\). APPLe t1-vE
'-.") h I f' f f. rJ'<; 10 /..1...(2 d ' Ik
7/7 S.3:2-..3&'-I'"'
17~S7
(1) Lf/,3;;'rp 5:}' OFFICIAL USE ONLY
(2) IV 0 tV e
(3) /Vof'le
(4) ,votJe
(5) g, ~ IS S9
(6) f'/o f0C-
(7) 1'-''' r' e..
(8)
So
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8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities. & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
1_ Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(9)
(p,G,O'{-.<::JO
/,SO().DO
(10)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(11)
(12)
(13)
II ,!-OLf 00
,
If f , 7 3~, 1 f
NONe
15. 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
20.0
Jf- f, 7:) R. / (
,0_(15)
, .0 '15 (16)
x 12 (17)
x 15 (18)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
(14)
if/, 731? If
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(19)
1,J>"1-? .21
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Decedent's Complete Address:
STREET ADDRESS G p-e-e,! f( I {J'3(; V I LLA9-X
:<10 6(5 Sff.!/NCj 120/11)
CITY ;V e. w v ILL E I STATE f'A- I ZIP / 7), 4- }
Tax Payments and Credits:
1. Tax Due (Page 1 line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
I J> 7--r, :i. /
Total Credits (A + B + C ) (2)
~J o,J e.
(3) /V o,-ve...
(4) NUt-..Ie-
(5) un ,y ;;;./
(5A) fVorle.
(5B) /, n~ 11
3. InteresUPenatty if applicable
D. Interest
E. penatty
TotallnteresUPenalty ( D + E )
4. If line 2 is greater than line 1 + Line 3, enler the difference. This is Ihe OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE.
A Enter the interest on the lax due.
B. Enter the lolal of line 5 + 5A This is the BALANCE DUE,
Make Check Payable to: REGISTER OF WILLS, AGENT
titi~', ..' .\, " .,'~ . ,.' . ~"' h'". - ,<.t~ cgt"-' , , , ,t."~_
PlEAS~ ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
No
lXJ
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o
IZI
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1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred; .......................................... 0
b. retain the right to designate who shall use the property transferred or ils income;. .......................................... 0
c. retain a reversionary interest; or............ ............................. ........................................... 0
d. receive the promise for life of either payments, benefits or care?.. ................... .....................".. .................. 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ................................... ......................................................... 0
3. Did decedent own an "in trust for" or payable upon dealh bank account or security at his or her death? ..'u...m'" 0
4. Did decedent own an Individual Retirement Account, annuity, or other non.probate property which
contains a beneftciary designation? ............................... ....................m......... .......... 0 ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
Under penaWes of perjury, I declare that I have examined ll1is return. including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete.
Declaration of pre parer other than lhepersonal represenlative is based on all informabon of which preparerhas any knowledge
DATE
L,-tyft./'v c An~6-&f.
ShfrPENSb &f/2') I fA.
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ADDRESS
/7:;"5' 7
//7 rV, Iff'rLE nVt
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
;:5 fe (, 2,003
ADDRESS
DATE
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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 PS. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, Ihe laK rate imposed on the net value of Iransfers to or for the use of the survivmg spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)].
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum 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 impose9 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. 99116(a)(I.2)].
The laK rate imposed on Ihe net value of transfers 10 or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(I)].
The tax rate imposed on the net I/a\ue of transfers to or for the use of the decedent's siblings is 12% 172 P.S. g9116(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.
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
UhU rcl<. 0.
s-rDufIet.
FILE NUMBER ~
.:zOOd-- 007/u
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defmed as the price at which property would be exchanged
between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with
right of
sUfYivorshiD must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
119 N. f'ErJrJ STR.eCT
s,^" PPCNS(,L/I<-:l I ff1
171.57
5J.
Lj I 13:2 r".
V:J. iJ"\.{bLI: H"uJe
S/"If'fc,^,'i:/oClI1..'j (jL>R."u'1h, CW"Y/btf2UttJO Cour"y, rl>
vYlRf' NC>
33.3]- 18<01-(')2.3
Ac((cS .050
(oNTPOL /"0u.
0.':1 3 - 0 0 " " :)..5-
A5SE~-SED VI]L0c
'-fL( I '-f I ()
uJAL.Tf.f2. ;). :3louFfe-i?-
AND
Ec:ny L.
\"uQ.ck""s-,o,o fgo ft"I2T\
0T'LjFF~fl, Wire. (bEci?f1SED /;;"-'-1-7'1)
fi/2." '"'
E L "1 cRt- f11 '1 (i.1 r: LtC( /Y1i rJj
:J, r\lov /9(P4
I 'q
,I I
IV. f",y-JvV :STflE:ti.
:SOLO To
flfYlyL
L 0 vJ
/2.- Ii'- 0.2
Fv R..
LN{ 700,
00
10 to T- i' f2-'~ c.<::C'.Ij S
'-f,(3d.-G,5d.-
eno'lce Pf~"ft:-"r7 S2,TLI:J->1I='~1 , '",
ESCKOf.,..J~G,t~3/0~~."'-"t) f"oA rfl.
IN Me j2.;"'t" c \'. TfI)i.
TOTAL(Alsoenteronllne1,Recapltulation) $ Lj / I J :zit:. S:L
(If more space Is needed, 'nsert additional sheets of the same size)
''''''~'''.(''9'''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
I.JJ fI LiC!.R S,
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
STo u..,-,;r-e..r:-
FILE NUMBER
::?eJO,;{- 007/0
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
1.
3
VALUE AT DATE
OF DEATH
DESCRIPTION
FO'}t:: L-:5If^' '}G:12- - Bf!.lc1<L=K. FLl rJi.P-f1L- H ",,,,c:
PR.t'.Pllicc> FL-(r'~nAl 15 flJl'l/2dl 20"';:,t.
bi q 0'+ "0
C(l':.c.K'{ 1\Jd- 0''1 CC 0 cf N T
!P71.57
;;'oC):i-. FC:DtMl.1.iVe""1E'. TAX (2.E~ur!D
I ;J. '-10. 00
I\\.""e',
Cht'C.I<I~d ACC"l!"" f\)elrY( bC'1L f.,1'-1-(,,'f"l
cOklVc'RrE>> /0 EsTrt-it= /lCCoLj-<.'i rJ()rr,bil'-
113 3':::") 'f "17 ON
IS rH-I;} oJ.
OFZR-SIO"'-'''' BlltlK
77 E I<i"'j STIZe.e::I
$,,; Ff'('ASS bC\l2...d ,P(l 17"2.57
f R.o '1 bA Te. "F- T)cATll ip.. 1/ - o:J-
UiJTIL G!'eCi'-i"'g..ACCOL;.Vi Ipq<+ ("Lf"i
Co.0vEt2-TEO -'/0 EST/1-,,<,, I'ICeou.D,
J"'30046(',
(00 c:hrd:-S
/::,- ;1L{J CO.:!. ,
u....\fZ..iTT-c.'"'" Q.A1A
0!'1
LN e.. rce..
NO rl0r'''-'-( 0~\~.s w',rl,LRflv-.l'"
f\.C (,0."'1 (,qc+ "'it
i~fI.." "1.
TOTAL(Alsoenteronline5,Recapitulation) $ is g \ b, S?
(If more space is needed, insert additional sheets of the same size)
REV.1511EX~(1.97)
'*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TM RETURN
RESIDENT DECEDENT
ESTATE OF
LJ f[ L-.T e R
..;
STouFrc:./'-
FILE NUMBER
':<OClQ -007/0
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES: r:O'JC:L-S'f1N~';I'--- GRlckE/i. t'u.f'lil!f!1.- tf,,,,,e
t {, 90<1- DO
II J W. kiN:} is-u,eCT ,
Sh, rfff"sbu.QJ' Pti. /72.57
f'p-erA',i::, FUNtOf'flL It PJ!-fi;-l'J-'; ,."e,# I,)
JS ("111 fLcf, ;;1.00:2,
oR-P-S,ov',J GA"'" chcckl>J~ /lCC"u.,o r
NUMbc(Z. Io'i'-lb'-/I
C~,2C.f:..$ ii,.:l. Ar?l1>l...(N T 1p,'i04- 0..,2
B. ADMINISTRATIVE COSTS: DAre PR,n 15 MA(1.C" loe;L
t Personal Representatwe's Commissions
Name of Personal Representative (s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City Slate Zip
Year(s) Commission Paid:
2. Attorney Fees
3- Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation)
Claimant
Street Address
City Slate Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ h. 904- . GO
-
(If more space is needed, insert additional sheets of the same size)
REV.1512EX.(1-9Ij
~.
~
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
L<J A l..-Tc.p- oS
,:5 To L),J f eJ<.
FilE NUMBER
.;zOO.:J..-Cli':>710
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
~. ~
i~DD.OO
cosr Df~-
CPeD" I~ A",'1 L 1..'''.0 It:)
NeW Ful'-rl"fce For<- /1'1 ;v.
Ci2c1J11 'fowl! i<D
fJE.r/,v srr<eCT.
/50 0 . "5'
CMt..ck L-VRIITE~ 1'0 ~
1(("1 GfJ-iI/U'- fLW'1hl"!al\/4l HeATliJa
'-100 ;v. E';ircL ST"-'Cei
Sh, Pff:N'5bltlL;} ,fl\- {7'J..S7
deer: Nt>. 101.,
Dk1C 1- :1.:' ~o3
fI"1DtjlpT ""/500, D,'?.
f'1'1(l. GRt,V[fZ I/IISTN-u=1O FU(l.NItCr:. 1'\5 PIt",-, Or
(~'} r2 e e.. "1 C '"' f0 "'JOT/.'l Te t> 13E T".h~E Y'J
r1M'1 L L0v-', T3u\cl2..
loJA L-7 ((1. C :s '0 ufFe[2. I t X c: CuT<> (1.
.SEL(.f(1..
EXC CLnll/iS (!.[IIL1T7 I !,Jet '-r<3!2.- Pr')"''''T
ftAu= PE4L ESlPrrc I $ cu.r. fL YT?CN I
Pew.s""" NT T"
t; AI'Vi.'1 L.
SeLl. cq-
LoW ON
1\''\ y0, ('f.i.J rJ
-STf'1.Eci
I 8 tEe '>:1
TOTAL (Also enter on line 10, Recapitulation) $ I .5 0 D. 0 D
(If more space is needed, insert additional sheets of the same size)
""""'EX.".97'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
l f't+SL' I)
ESTATE OF
i~L'fILJeP- S. -Sro ILf'FeF-
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
L TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. 'Ylf/f2.iLYfJ L, 5TOU,C(Cf(
'I :;"J>l~,,'r bt:iv6
S/'itf'E",,,l,ul1,:} f" /ns7
.2 WAL'reJ1. c. STcv..ffCiZ- III /J. ANLtO 1'\1'"
.s h IF f'[JVSbli/?'d Fit {J 157
3 !(Id.lt-f,O L. STou.ffcR 7 w~r<lc.k AVe
shipPENSJ,UIZ:J fA /n.57
if E1H.vIfI2.D c:. SToL{F,"Q2.. I\~ Yi. N. fe,"," Sn::ecT
.5hi PfEr'sb<{(l.j ('If 17257
5 1L.l1rhp.~fJ L. ;JIltS 11/:;.7 flscof Gil'-cLE
FF:EDt::lZick!Sht.{iZ) VIt .:<;< 'f "7
FILE NUMBER
,200.').- 007/0
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
\.) Au:yh,c; rL-
7)571. 9i?
SON
7 , ';;7 ( . 'I g
:s ON
7 57/ 9-P
,
SON
7, 37 (. 'i <?
D Ff v.. ;)),IC f2-
7, 57/ 9 J'
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17. AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ REfUXrJce ffTp.::L
(If more space is needed, Insert additional sheets of the same size)
REV.1513 EX + 11.97)
.
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERlT ANCE TAX RETURN
RESIDENT DE EDENT
Lv A LTC R.. S,
<STou.ffc-,:
C flc~~)
FILE NUMBER
::/<10;1..-00710
AMOUNT OR SHARE
OF ESTATE
ESTATE OF
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
RELATIONSHIP TO DECEDENT
Do Not Ust Trustee(s)
1 .D A v,:rt A '76 C:oTTl1-o.12- Gou.f':T
. <-RyS ,(jL . Ct"-~r>1nN ~ q
l'1U~!f";CSh4"-; p", /7050-
G, ""1 '" 0 '" /'ILJ. g.hn: iL
$ 0""
560
J. SUSAN M. .:To,J e~
9/01 }J"W C..4STlE DR;vE
IvIEchll" ,'u V;LLE VI1- '<31/'"
,
CR./t;Ob Oftlli0rel\.
-..
S 60. {"l~
3 fiR"C E. S,rES
tf {5 w. ki "''} -STR eel
:shiffENSbLl.f2.;j. (It (71.."q
C.f2fHl'C S0 r->
.-
5DO.~
'f RokfRT L. STou.ffeR- C/o /YiR-:> :Tosefh RosE.
Lf'i8 L,NnLf'/ 0.011'1 WcSt
c..hfir>1i,E l<.:fhtJP.J fir /71.0 I
GRft"DS0r-'
<rr-
StI'D, 1:>""..'>
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART IT . ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 39, g 59.9 C:>
(If more space is needed, Insert additional sheets of the same size)
VITAL STATISTICS
CERTIFICATION OF BIRTH
DATE OF 6-3-16 FilE
BIRTI1 NO. 11 7 526-16
(MO_. OAY. VEllA. HOUR)
CITY, BOROUGH, DATE
OR TOWNSHIP LURGAN FILED 7-11-16
OFBIATH 11.10, nAY, YEAR)
COUNTY OF DATE
BIRTH FRANKLIN ISSUED 11-30-78
{MO, DAV. YEAR)
SUBJECT
WALTER SKELLY STOUFFER
SEX
MALE
This is. truecertiliClllhon olnem. &m:l birttl raet50n file In Vii'.! SttltistiCS, PennsylY...i.Oep....un.ntotHefl,lItl
~ NrwLt:v
CHARlE$HAROESTER
STATfIlEGlSTRAR
.,t--iC3"'~e
The information appearing on the certified copy of birth is exactly transcribed from information contained on the original birth
certificate as filed with the Office of Vital Statistics.
If you wish to correct the certified copy issued, please complete the lower portion of this form in the presence of a notarizing official
and forward to the Division of Vital Statistics, PO Boy; 1528, New Castle, Pa. 16103
PL~SE SUBMIT DOCUMENTARY EVIDENCE TO SUPPORT THE CHANGES REQUESTED, SUCH AS COPIES OF MARRIAGE RECORD,
BAPTISMAL RECORD, NATURALIZATION RECORD, ETC,
~. ,---- ---- -
CORRECTIONS DESIRED
DATA ORIGINAL RECORD NOW READS (print full names, dates, other)
NAME OF SUBJECT -
--
DATE OF BIRTH
- --" -
SEX -
OTHER ERROR -
OTHER EAAOR
FATHER'S SIGNATURE
SWORN AND SUBSCRIBED BEFORE ME
(NOTARY PUBLIC) THIS DAY OF 19
MOTHER'S SIGNATURE
SUBJECT'S SIGNATURE
-"-
PRESENT ADDRESS
STREET
C1Tl SHTt lIpeoor
V 298315
,\.,.....\...,....., tl ...,,,,R,<
....c.....r.........'...
~..' r..,". ,,,, L ~ ~ r.
LAST WILL AND TESTAMENT
I, WALTER S. STOUFFER, of 119 North Penn Street, Shippensburg,
Cumberland County, Pennsylvania, being of sound mind, memory and disposition,
do hereby make, publish and declare this my Last Will and Testament, hereby
revoking and making void all wills by me at any time heretofore made.
FIRST. I order and direct the payment of all my just debts and funeral
expenses as soon as may be convenient after my decease~
SECOND. I give, devise and bequeath all my estate, real, personal and mixed,
whatsoever and wheresoever situate, to my children, in five equal shares,
on a per capita distribution basis.
THIRD. I nominate, constitute and appoint WALTER C. STOUFFER, of 119 North
Penn Street. Shippensburg, Cumberland County, Pennsylvan1a, to be the Executor
of this my Last Will and Testament; if he be unable to fulfill the duties of
Executor, I then nominate, constitute and appoint MARILYN L. STOUFFER, of
122 North Earl Street, Shippensburg, Cumberland County, Pennsylvania, to be
the Executor of this my Last Will and Testament.
FOURTH. I direct that my personal representatives shall not be required to
give bond for the faithful performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I, WALTER S. STOUFFER,
have hereunto set my hand
"6--;r}; day of February,
and seal to this my Last Will and Testament, this
1977.
Signed, sealed~ published and
declared by WALTER S. STOUFFER,
the Testator, as and for his
Last Will and Testament, in the
presence of us who have at his
reques t signed our names as
witnesses hereto in the
presence of the said Testator
and each o~her.
2,/lha / _~ ?/Lt-li~ )
1/
(SEAL)
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CODICIL TO LAST WILL AND TESTAMENT
I wish to amend my will and give $500.00 to each of my four
grandchildren whose names are as follows:
Susan Marie Stouffer Jones
Robert Lee Stouffer
Crystal Darlene Sites
Aric Eugene Sites
lhfi7J -. i.4zt:;/frv
Walter S. Stouffer
119 N. Penn Street
Shippensburg, PA 17257
October 18, 1993
Witness:
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~churrll EWER H. FLEMING, JR, ODd rWlY \/, FLEMItlG, hlo vU., of 12 South ~;
WLBhington Str..~, Sh1ppen.burc, CUmb.rl~4 County, P.nnaylvanJa, ;1
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end WALTER S, STOUFFER and BET'l"t L. STOUfFER, his vire, N tenant. by the ent1retl...' l'
of thlf Borough or Sbl1'Jpenaburs. Cwn"berla.nd County. Pennaylvan1., I~
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MADE this
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.lxtr-four (1964),
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propert:r formerly ot C. A. GoOdhart r..tate. nO'(, or on the
W'e.t by llorth Penn Stre.t. Havins a trontage on Hor enn Street ot
tventy-one (21) r..t. thr.. (3) 1noh... and & 4.pth ot "Vtnty-thre.
(n) r..t,
BEING a portion or that real e.tate ~hi.h Charle. O..ar K11lh~.. and Iren.
V. .l-tl11h"".., hit vir., 'by thdr. Peed dated April 19, 1952, and reoorded in the
otfic. or the .R~oord.r or 0..41 ot CUmb.rland coUnty 1~ De.4 Book "A-. Vol. l~.
pl.'.' 14. convey.d to El..mer H. rl.mJ.n8. Jr.&Q4 rofa.ty W. JPl.za.1n" b1. vir.. Greto"
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Co""",., CUflllERLAND
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do~ 01
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November
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th. ~nd.,.,ig",d offic..., p....OMU~ on.on4 Elm.., K. ~lelll1Dg, Jr. and Mary II. Flelll1ng, bh .
vir.
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it 11 P S~.r~ t Sb . nlburg, Penna.
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A U.S. DEPARTMENT OF HOUSING ..nd URBAN DEVELOPMENT
SETTLEMENT STATEMENT TITLEPRO
LIBERTY LAND l..._rp,'nl
:
TRANSFER, INC. 8. TYPE OF LOAN
4660 Trindle Road, Suite 101 1 { J F=HA 2. [JFMHA , 3. ( leONV UNINS.
Camp Hill, PA 17011 4, [ ]VA 5. [XCONV _ INS
6 FIL.E NUMBER; I 7. lO~N NUMBeR'
Phone (717) 975-9915 Fax (717) 763-7460 201..t;,6 63<1<186752
e. MORT. INS, CASE NO. i
C. NOTE; Thle; form is fun,lahed to give you 8 slatemenl or aClul!Il '.111.ment costs. Arnounfe paid 10 and by the settlement ag"nlerA shown. Items marked
'(p.o.c.)* WlQre paid outsidlll the closing; they are Ghown her. for 'InforTTlatlonl!.l pwrpOHIS ...nd ar~ net Jncrudqd In the tota~.
D. NAME AND ADDRESS OF BORAOWER; E. NAME AND AODRESS OF SELLER; ESTATE F, NAME AND ADDRESS OF LENDER:
AMy L. LOW WALTER s. STOUFFER ABN AMRO MORTG-!>-GE GROUI?,
I INC.
,
I
G. PAOF>ERN LOCATION: H. SETTLEMENT AGENT' ~ I. SETTLEMENT DATE:
~<19 N. PENN STREET CHOICE PROPERTY SETTLEMENTS INC i <12/<18/02
SHIPPENSBtJRG BOROUGH, PLACE OF SETTl...EMENT;
CUM!3ERLAND COtJNTy, PA. REALTY EXECUTIVES CHAMBERS BURG , PA. I
,J. SUMMAR'" 0" BORAOWEf'l"S TJIIl4HSACTlo",: K. SUMMARY OF SELLEft"S TRANSAcnON:
HlO. GROSS AMOUNT DUE '"RONl BOA'f\OweA "00.0111:0$$ ...IotlOUNT DUe: TO $ELL'EFI
101. Contnu:t salQlI- "'-rice 44900.00 401.Contrac::t salin nco i 44900.00
102. PgrsonaMop;:::;:' -10::l!.Psraonilll pronertv :
103, Settlement c::hart"les to borrower (l'ne 1400) 2307.85 "0.11. :
'0". .0". i
l~S. <tOl!;. i
Ahtment8 for items paid b seller In advanoe Ad;u~tment$ for Items DaJd bv aell.r In ..,dyanc::e
loe. C--;;;(Tgwn tax .. 'lIotl.CI-{fown llilX '0 j
101,COUnNtalIf <1;;!7J.8 702'0 <1:;i73 <1 102 7.02 "07.C"U~~ <12/J.8-/02...12J31 02 7.02
loBi. A....."..ntli to 40..A...l&s""ents .. I
'09. 127<18'02..0E;'30/03 235.<10 -1OS. <12/18/02.. 06/30/03 I 235.:1.0
" '0 4'0. to I
". 411. ,
\t. .".. :
:!o. GROSS AMOl/NT DUI! ~"Oll.t BORROWER 47449.97 .0(20. GROSS AMOUNT DUI!"TO Sl!U.ER i 45Jl42.<12
;)(l, AMOUNTS PArD 8Y Oft IN BEHALf" OF' 80,.AOWER 500. AEDUCTlON$ IH AMOUNT DUE TO S~...
)1. De calf Dr ..rneet mon.v J.OOO.OO 5cl'l.Excesa denosit 151111 Ins<<ructiona) ,
):1'. Prine';;:.. ArT'Iount ~ new la..r;t;\ 40400.00 lSDa.S.tIIemenl char.:.... ~o ..".r rllne 1400' 38<15.60
n E.xilltln'" ~teJcCil" aUblect to dO:l.El(lalln loanfS'-taJcan sublect to i
". &01l.Payoff ot Fif1lt Mortgage LOlln I
ESC.FOR INHERITANCE TAX 3000.00
" l5ol.Payof't' at Second Mortgage Loan
< .....
r. 1507,
,. SO". ,
, ....
AdiUsttncmts for items un...aid bv IIbllar AdlUSDTlClnts for Items unaald bv IlClJllBr
). Cir>..:froWn lb: ,. lun.~:rrown t~ to
, Coun!y(.a.z ,. 1!111.CoUl'l ... ..
, A,,:.e..menl. .. ft2.AsiMasmltnl' ..
, to $,13. .. ,
, 1514, I
fiTS. I
:5111.
. 517.
:5H!o.
:JHI.
TOTAL PAlO BYJ'FOJl BORROWER 4<1400.00 :5%0. TOTAL REDUCTION AMOUNT Due eeLLI!" i 68<15.60
. CASH....T &ElTLeJ,ilENT F,.OM OR TO UOA:R.QWIa'I ClEKl.CASH AT SeTTLlI!"'l9'IT TO OR ,,"ROM .sIit-LER
Gross amount duo fram borrcwe;' 'IIn. 120) 47449.97 eel.Grass amount due 10 $Qller tllne .lI201 I 45<142.<12
Los:!; amount nald b~/Tor borrow.,rtiine 220) 41400.00 IW:l.Le:r;;S reduction .&mounl due seUer (line 520) , 68<15.60
CASHaXFROM) a ] TO) lloRAOWER' 6049.97 603. CAS'" (( XTO) ([ ) ",OM) SI!LLER I 383:26.52
,
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c:,"-;;;r P"'rr"'.....r.s SlUn.r..u.
<
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~,-<-4{'c ,.P1k!-f
Selltlr'5 Slgnaturl!l
HUD-1 I=I.Q". 't!.J66
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-; t..-UH1";K.">lur"L
1m tJUJ
u.s, DEPARTMENT OF HOUSING AND URBAN O~IJE:lOPMENT
SETTLEMENT STATEMENT
L S NT HA O1.4G
TOT4L SAL.ES/BAOKER'S COMMrssrON a--d on
Di\.'lsion 01 CommissIon <'Jne 700 86 folloWs:
$ 1347.00 10
s 1.347.00 to
Com.rnl&sion p~id at Settlement
~s 44900.00 6.0
Total; 2 694.00
HALE );tEAL ESTATE
J;tEALTY EXECUTIVES
P.ll"a:
70
1=.
1 .
600. ITEMS PAYABLE' IN CONNecT1ON wtTH LOA'"
eO 1. Loan OrJ ihation I=Re %
e02. loart Ol&counl '"
80.1. praisar Fee to
804. CJedi1 Report 1:0
BOt!. Looder'6 Inspection Fbe
~05 PROCESSING FEE
807. LENDER ADMINISTRATIVE FEE
80.. DEFSRR.BD P
."".APPLICATIO
81D. FLOOD CERT
ALLIED HOME MORTGAGE
27S.00!
ALLIED HOME MORTGAGE
AnN AMRO MTG. GROUP
959.50 AnN AMRa TO AHMC
350 POC ALLIED HOME MTG.
ALLIED HOME MORTGAGE
75.00
375.00
6.00
811.
goo_ Il1!MS "'!OUmED JlYLENOEJI TO _ PAID IN ADVANCE
Y01,lntef"esttrorn J.2 ~B 02 to12 31. 02 U:!i
902. Mort Q, e Insurance Premium tar ITJO. 10
, 903_ Hazard Insuranc$ Premium for' 1. rs. to
904. ,to
gos.
1000. RESERVES OEJl'O$lTQ) WITH L....DER FOR
\OC>1. Hoaard Insur~ 3 mo.. 5
\002. Mon a eo Il"'1Wrance mo, . $
'003. CT lTcWh t.ax. mo, 0' $
004. Count tax 1.:2 mo, 0 S
00&. AsS8tlSmlilnt6 mo. 0 $
006. SCHOOL 7 mo.aS
007. trio. 0 S
008. AGG . ADJ a mo. G $
lOO. TITUI! CHARGSS
1 Q . Settl.m.nt or c~sing taelo
102. .Abstract or title. soardl 10
103. nu_ .xaminaUon to
10<4, TiU. inauranc:e binder to
10.5. Document ,.. aratlon to
06. Not . 'oos 10
rn. Attom . 18U to
(ncludes abova Jlems No.:)
Ol!. TItl_ Insurlllnee (0
include. abav.liwna. No.:)
:>9. I.etrd.r'1I coy.r. _ S
10. Own.r'. CQVefa e $
11. END.
,.. INS. CLOS .
1:3_ EXP a MAIL
>0. GO~ RECORDING AND TRANSFER CHAAGES
;..Reoctding1aes: DeedS 38.50 Mo .uS 62.50
'2. City/county taxJ8tmnp5~ Deed $ -449 ~ 00 Mortgage S
.~. statol.:uclstam s: DeedS 449. OOMon a s1;
7 _ lS/da
100.10
312
poe STATE
FARM
26.00
Imo.
/mo.
Imo.
rmo.
Imo.
Imo.
Img.
/mo.
7B.00
16.J.0
J.93.20
36.13
252.91
-266.61
OEL
CASH
ZULLINGER
ES
10.00
15.00
14 ~ 00
CHOICE
PROPERTY
SETT.
300 6.1
40 400
44 900
CHOICE PROPERTY SETT.
STEWART TITLE GUARANTY C
CHOrCE PJ;tOPBRTY SETT.
Miae-. $
J.01.00
449.00
449.00
..
5.
O. ADQITlONAL SETTLE~ c:HARa~
1. Pest ins eolian to
z 10
INTERSTATE PEST
593.60
,.
J. TOT.AL~CH"FlGES ~lIiIn!.e,"onl\nu,; lC3I:ll"ld&Q~ScetioI"llJlJand K) 2307. as 3815.60
I"...rlios"~ Ih.1 ...IIiro~ '" ."'um.e-d by Sct'I_m,4.golnl l....lh.. .;oCC:'""""Y 0' ...I..""'................Iosto.d by ....,..~,,~ "'....-.. om ,,,. /-lUD-1 S"'IIom..., 61..\........."".
So:>l~"I Agent hl!l"Ilby .."'phl....1y
,~..ln. ltgi'll I" doposlle"", _u_ <>oll<>o1_ r~ DI...u..-....... ;" _ if>C*"",1 bju.r....g .e..,.,..."IIrt. ""''''''611, ",_ed 1n.U1u1lon .nd to <;.<sdll .....,. .I.-......"ll.. ......n.....
'0 __ 0..... _"~I..lI.ddklo..al
f'o....II.....''''';t.._....~lc.'t>b.\I..~licwl.
HUe ceFlTIF1CAnoN OF eUY"EFlS AND SEU-EAS I
,~"'.... c:.sr..tulty ,ov)..Wed 11'1.. HUD., SGltlllllnenl Staloment at"ld lo th" b,,=t or my knoWI.dg~ and beller. It)... tfl..:l and ~c"".la .I:III...,onc or;;lll r",ce!pl, l!lnd dI3bllr$..ments
a on lilY a.eCOUl'lt bV me ;<1 this transactlon_ I furthor cll;lrtlfy lholl hOlVO rClc&J",,,d P .,opy", th. HUO.1 S..t.tl...rnent St",t8rTleFll
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'y.
nrEl...row...r'..Sig.n.,,,..
',Acfd,..,,,,,,, F'to......:
fl" If./,dCt( d;z:;:..-<'ff-'" .NI e,c
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w.",..j,. ft.1"""",,1
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.S. Co'" S_I.on 100'\ ..nd S....llcn 1010. I HUD..lll..",-, :'5/116
ESCROW AGREEMENT
RE: CASE # 20146
SELLER: WALTER S. STOUFFER ESTATE
BUYER: AMY S. LOW
PROPERTY: 119 N. PENN STREET, SHIPPENSBURG BOROUGH
On this, the 18th day of December, 2002, the undersigned hereby
appoint (s) Choice Property Settlements, Inc. ("Escrow Agent") as
Escrow Agent and direct Escrow Agent to withhold from the net
proceeds due to Seller at the settlement the sum of $3000.00
Escrow Agent will release fund upon the following conditions:
Receipt of Acceptance by Commonwealth of Pennsylvania of
Inheritance Tax Return in the Estate of Walter S. Stouffer.
It is agreed and understood that the Seller has 180 days
from the date hereof to satisfy such conditions. It is agreed
and understood that if the Seller has not produced in hand to
Escrow Agent such satisfaction of conditions, Escrow Agent is
authorized to payout such amounts as are necessary to satisfy
such conditions without further liability, in Escrow Agents sole
discretion.
Escrow Agent shall hold the monies in escrow, separate and
apart from its own funds, and shall invest the same in a
federally insured Bank. It is hereby agreed and understood that
Professional Abstract Inc. will pay no interest on funds escrowed.
The Escrow Age~t shall not be liable for any mistake of fact
or error of judgment or any acts of omission of any kind unless
caused by its willful misconduct or gross negligence. The
parties hereto each release the Escrow Agent from any act done or
omitted to be done by the Escrow Agent in good faith in a
performance of its obligations and duties hereunder.
The undersigned hereby jointly and severally indemnify the
Escrow Agent and hold it harmless against any loss, liability or
expenses incurred without negligence or bad faith, on the part of
the Escrow Agent, arising out of or in connection with the
acceptance of, or the performance of its duties under this
agreement, as well as the costs and expenses of defending against
any claim or liability arising under this Agreement.
In the event of litigation arising out of this transaction
with Escrow Agent is named as party defendant and as a result
thereof suffers loss or damage includi~g but not limited to cost
and/or attorney's fees, said.loss or damage to Escrow Agent shall
be payable out of the escrow funds. Further, in the event of
such controversy, Escrow Agent shall be and is empowered hereby
to pay the escrow funds into court for final determination and
distribution pursuant to final court order entered for such purpose.
We, the undersigned, do hereby certify that we are aware that
the Federal Deposit Insurance Corporation ("FDIC") coverages
apply only to a maximum of $100,000.00 for each individual
depositor. Further, we understand that Escrow Agent assumes no
responsibility for, nor will we hold same liable for, any loss
occurring which arises from the fact that the amount of the above
account may cause the aggregate amount of any individual
depositor's accounts to exceed $100,000.00 and that the excess
amount is not insured by the Federal Deposit Insurance Corporation.
Intending to be legally bound the undersigned set their hands
and seals.
i~ja.ffi;.,-- C ~._<Lj}p/'( e-/e<:'.
CHOICE PROPERTY SETTLEMENTS, INC.
D~W.
Label Your fi~t name and Init,al last name OMBNo. 1545-0085
I
(See page 21.) L {elf? Lief .s' ,S' T (I u Fret?-- Your aocIalsecurtty number
A I) 'f: 0:'- J.:J S I
.
E 11 a joint retum. spouse's first name and initial last name Spouse's social security number
Use the L
IRS label. H Home address (number and street), 11 you have a PO box, see page 22 I Apt. no
Otherwise. E J/ 7 ('J (ff'f'LE /fVE .. Important! ...
please print R
or type E City. town or post oHice. state, and liP code. If you have a foreign address, see page 22. VOU mllst enter your
ShIFFErJ,S6tp<'l If! /7257 SSN(s) above.
Form
1040A
Presldenllal
Election Campaign It.
(See page 22.) ,
Filing
status
Check only
one box
Exemptions
If more than six
dependents,
see page 24.
Income
Attach
Form(s) W-2
here, Also
attach
Form(s)
1099-R if tax
was withheld,
If you did not
get a W-2. see
page 27
Enclose, but do
not attach, any
payment.
Adjusted
gross
income
Department of the Treasury-lntemal Revenue Service
U.S. Individual Income Tax Return
(s) 2002
IRS Use Only-Oo not write or staple In this space.
Note. Checking "Ves" will not ch~e your tax orreduce YOfJr'refund. ;C)~ "}, S~use
Do you, or your spouse if filin9 a joint return, want $3 to 90 to thi.1und?, ~ oYesg)No oVes DNa
1 eg Single 4 0 Head of househoid (with qu , (See page 23,)
20 Married filing jointly (even ff only one had income) . ,lfthe quallfyi . a I. your dePendent.
3 0 Married filing separately. Enter spouse's SSN above and . enter this '
full name here. .. 5 0 .\Quali
. ear,
7
6a l3! Yourself. If your parent (or someone ,else).:
dependent On his or her. tax .
b' 0 Spouse
c,D!lpendents:
(:ii:
,11r.First name
d Totai number of
'7 ;? .
Sa Taxable interest, Attach Schedule 1
b Tax-exempt interest. Do not inciude
9 Ordina dividends. Attaoh Sohedule
3).
10 Ca ital ain distributions
11a IRA
distributions, 11 a
12a Pensions and
annuities. 12a
11b
11b
12b
12b
13
14a
13
14a
14b
~ 15 J J. I I ()
15
16
17
18
19
20
20
21
Subtract line 20 from line 15. This is your adjusted gross income.
I I (/
~ 21
i J..,
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 57.
Cat. No. 11327A
Form 1040A (2002)
Tax,
credits,
and
payments;
Standard I'
Deduction l
for-
. People who
checked any
box on line
23a or 23b or
who can be
claimed as a
dependent,
see page 34.
. All others:
Single,
$4,700
Head of
household,
$6,900
Married filing
jointly or
Qualifying
widow{er),
$7,850
Married
filing
separately,
$3,925
If you have
a qualifying
child. attach
Schedule
EIC,
Refund
Direct
deposit?
See page 52
and fill in
45b, 45c,
and 45d.
Amount
you owe
Third party
designee
Sign
here
Joint return?
See page 22.
Keep a copy
for your
records.
Paid
preparer's
use only
,f>
l .'~i
"'\;.. '\,,'
S o?50
(O:J-" 0
'3000
00
00
00
3
00
Do you want to allow another person to discuss this return with the IRS (see page 54)?
Designee's Phone Personal identification ~
name .. no. .. ( number (PIN) ..~
Under penalties of perjury, I declare that 1 have examined this return and accompanying schedules and statements, and to the best of my
k.nowledge and belief, they are true, correct, and accurately list all amounts and sources of income I received during the tax year. Declaration
of preparer (other than the taxpayer) is based on all information of which the preparer has any k.nowledge.
Your signature W~C ~~6bt(~ Date YSi;lrQQSU~Bti~ri
~ ~ WcJb, s ~~6>-C 1_1.2-03 bi:cE/lSc'O
r Spouse's signature. If a Jomt return, both must sign. Date Spouse's occupation
Daytime phone number
( 7ilIS31-3b'fd'
Preparer's ~
signature r
Firm's name (or ~
yours if self-employed),
address, and ZIP code
Date
I
Form 1040A (2002)
SOLD BY
NAME
ADDRESS
CITY
TIM GRUVER'S PLUMBING
P.O. Box 194 .
SHIPPENSBURG, PENNSYLVANIA 17257
Phone 532-2727
DATE
- 2... 2.. -c)
PHONE
Walter S. Stouffer Estate
REV 1500 Explanation
25 February 2003
Reference Walter S. Stouffer estate account (checking) number 103004017 statement
date 10 February 2003.
The following is an additional explanation to this REV 1500 working from the above
statement that reflects the final value and proposed distribution of the Walter S. Stouffer
estate based on receipt of acceptance from the Commonwealth of Pennsylvania.
1. Estate account balance as of 10 February 2003
2. Asset: Choice Property Settlements escrow balance
3. Asset: Walter S. Stouffer federal income tax refund based on
22 January 2003 filing. Income tax refund not received
as of this filing.
4. Liability: The above referenced checking account statement dated
10 February 2003 does not reflect Check 106 (23 Jan 03)
to TimGruver's plumbing. Shortly after sale of 119 North
Penn Street (18 Dee 02) furnace needed replaced and estate
agreed to pay $1500.00 toward purchase of new furnace.
5. State estate tax: 4.5% X $41.738.11 (net value of estate)
6. Net value of estate for distribution
7. Distribution of $500.00 to each of 4 grandchildren
8. Equal distribution of $37,859.90 between 5 children
$37,589.90 divided by 5 equals $7,571.98 each
9. Ending Balance
it-! ~ c.- AJ:o.-UL6 ({ I/G
Walter C. Stouffer
Executor
Estate of Walter S. Stouffer
$38,998.11
+ $ 3,000.00
+ $ 1.240.00
$43,238.11
- $ 1,500.00
$41,738.11
$ 1,878.21
$39,859.90
$39,859.90
$ 2,000.00
$37,859.90
$37,859.90
$
0.00
O~~N
BANK
Date 2/10/03
PRIMARY ACCOUNT
ENCLOSURES
1",111",1.,1,1,1,1,1..,1",11"11",.11",11",111,,,1,1,,11
WALTER S STOUFFER
ESTATE OF WALTER S STOUFFER
117 NORTH APPLE AVENUE
SHIPPENSBURG PA 17257-1311
C H E C KIN G A C C 0 U N T S
OPPORTUNITY CHECKING W/SAPE
ACCOUNT NUMBER
PREVIOUS BALANCE
DEPOSITS/CREDITS
CHECKS/DEBITS
SERVICE FEE
INTEREST PAID
CURRENT BALANCE
103004017
38,987.27
.00
.00
.00
10.84
38,998.11
CHECK SAFEKEEPING
Statement Dates 1/13/03 thru
DAYS IN THE STATEMENT PERIOD
AVERAGE LEDGER
AVERAGE COLLECTED
Interest Earned
Annual Percentage Yield Earned
2003 Interest paid
Page 1
103004017
2/10/03
29
38,987.27
38,987.27
10.84
0.35%
20.27
ACTIVITY IN DATE ORDER
DATE DESCRIPTION
2/10 Interest Deposit
TRACE NO
AMOUNT
10.84
BALANCE
38,998.11
(j) OUTSTANDING CHECKS
To Reconcile Your Checking Accounl
1. UsI and Tatsl all outsiQndi1g checks includinglhose still outstanding from
previous statemenls.
NUMBER
AMOUNT
2. Enter the MBsJance Tt'lts statamenlM found in the last block or the summary
line on the fron! of Ihis statement.
3 List deposits and other credits nol shown on this statement.
4 Total items lisled in steps 2 and 3.
5 Enter and Subtractlhe loIal mlhe outstanding checks as deterTnined in
Slep 1 abO\le from total in Step 4.
6 This Figure shouk:! be your checkbook balance. If it da8S not agree, nWMwI
the above steps, note the following instructions and If necessary review
your checkbook entries.
TOTAL
RECONCILEMENT
(2)
~
@
@
@
IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR ELECTRONIC TRANSFERS
Telephone: 717-S32~114 . Address: P.O. Box 60, Orrmwn, PA 17244
If you thinkyourstatementor receipt iswrong or 11 you need more Infonnationabout a transfero nthe a1atement or receipt, please con1act us 8S soon as possible using
the above telephone number orad dress, we must hearfrom you nolaterthan60daysafterwe sent you the FIRST statement on which the errororproblem appeared.
(1) Tellusyournarne andaecount number(/rany).
(2) Describe the errororthetransferyou are unsure about 8nd explain 8S clearly as you can why you believe there issnerror orwhyyou need more infonnation.
(3) Telluslhe dollar emount o!the suepeded error.
'fyouteH us orally, we may require that you send usyour complaintorquestion In wrlingwllhin 1 0 buslne88dsys.
We will determine whether an error occurred wilhin 10 busine8S days (20 bU8iness days if the transfer involved a new account) after we hear from you and will
correct any error promptly. It we need more time. however, we may take up to 45 days (90 days if the transfer involved 8 new account, a point-of.aale transaction, or a
foreign-Initiated transfer) to Investigate your complaint or question. Ifwe decide to dO this, we Will credd your account wllhln 10 business days (20 buslnessdays/rthe
transferinvoJved a new account) for the amountyouthlnkls In error, so thatyouwll havethe use Of the money during the Ume It takes us to CQmp~te our Investigation. If
we askyouto put yourcomptaint or question in writingandwe do not receive it within 1 0 business days. we may not crectityouraccount. Youraccountiaoons;dered a new
account forthe first30daysafterthe first de posit ismade, unless each of you a lready has an established 8ccountwith usbeforethis8ccount isopened.
We will tell you the results within three businessdaysaftercompletlng Qurinvestigation.lfwe deckl'ethatthere was noerrar, we will send YOUB wrltten explanation.
You mayaskforcopiesoflhe documentsthatwe used in our investigation.
LINE OF CREDIT ACCOUNT INFORMATION
Important Infonnation About Your Account Charges:
We computethe FINANCE CHARGE on youraccount by app/ying the periomcrate to the "average daily balance" of your account (including current transactions).
To get the "average daity balance," we take the beginning balance of your accouri each day, add any new loans, and subtract any payments, credits, unpaid finance
charges, and unpaid insurance premiums, Thisgivesusthe dally balance. Then. we add up all the daily balances forthe billing cycle and divide thetotal by the number
of days in the billing cycle. Thisgives usthe "average da ily balance."
If a "finance charge adjustment" is shown on this statement, we computed this portion of the FINANCE CHARGE by multiplying the principal amount to which the
adjustment applies by the periodic rate which applied In the billing cyde forwhich the adjustment was made and by the number of days for which the adjustment was
made.
BillingRighlsSummary
In Case of Errors or Questions About Your Statement
If you think your statement is wrong or if you need more information about a transaction on your statement, write us on a separate sheet at the address shown on your
statement as soon as possible. We must hear from you no later than 60 days after we sent you the first statement on which the error or problem appeared. You can
telephone us, but doing so will not preserve your rights.
Inyourletter,give us the fOllowing information:
(1) Yourname and account number.
(2) The dollar amount of the suspected error.
(3) Describetheerrorandexplain, if you can, why you believe Ihere is an error. If you need more information, describe the item you are unsure about.
You do not have to pay a ny amount in question while we are investigating, but you are still obligated to pay the amo unts on your statement that are not in question.
V\thile we Investigate your question, we cannot report you as detinquent ortake any action to collect the amount in question.
This isa summary of your rights: a full statement of your rights and the bank's responSibilities under the Federal Fa ir Credit BillingAct will both be sent: to you upon
request and in response to a blUing error notice.
Name of Decedent:
STATUS REPORT UNDER RULE 6.12
Date of Death: ! I Z/q .~ ¢ ~ O O A
WillNo.: 20~.- o ~'7l O Admiu. No.: 20o~- ooVl O
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the adminis~ation of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. If the answer tO No. 1 is Yes, state the following:
Did the personal representative file a final account with the Court?
Yes/X' No []
The separate Orphans' Court No. (if any) for the personal representative's
account is: a o o 2. - o ow ~ o
c. Did the personal representative state an account informally to the parties
in interest? Yes [~ No ['-1
Date:
Co
l~? m,,,.h, o¢
Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the. Orpham' Court
and may be attached to this report.
Signature
b. IR r-c . C
Name
Address
Telephone No. o
Capacity: ~,,Personal Representative (2,
[__J Counsel for personal representativo~