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Home My WebLink About04-0498 Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of ROSE R. RUGGIERI No..~l ~so know~ as State File No. , Deceased Social Secudty No. 195-07-2111 Rosemary R. Baer, Pe~'~>ner(,), who LsZm'e 18 years or age or older, ~'~pb'(ies) Icc (COMPLETE 'A' OR 'B' BELOW:) A. Probate and Grant of Letters Testamentary and aver thai PetJl~oner(s) tm/'are Ifle exeout named in ~ last W'~II of Ihs Decedent, dated and cod'~l(s) dated Except as follows, Decedent did not marry, was not divorced, and did not ha~ a child bom or adopted aJter execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: [~ B. Grant of Letlers of Administration - Petitioner(s) after a proper search has/have ascertaJned that Decedent left no Will and was survived by the following spouse Cd any) and heirs: i Name Rela~nship Residence 1 Rosemary R. Baer Daughter 1704 ~¢~hryn Street c ,umberla , PA -;1V070 --< (COMPLETE IN ALL CASES:) A~mh ad¢~onaJ ~ts ~f ~a~y. Beceden! was domicited at death in Ctzqtberlafld ~J~ Coun~y. Pennsylvania, with hire/her la~! ~rpdncipaJ residence at Messiah Village, Upper Allen Township, Cumberland County, Pennsylvania. Dec~dentthen 93 ¥.~r~o~.~..~ed Feb. 9 2004 , ~ Messiah Village, Upper Allen Township, Decedent at death owned property w~th estimated v-lue~ as foflow~: CLlmberlaJ4t~) County, Pennsylvania. (If domk=]ed in pA) A[ persocud pmpedy $ 9¢000.00 (If no! dom~led in PA) Personal property in Pennsylvania $' (If not domicJ'led in PA) Persoc'~nl properly In Cc~nty $ VaJue of real estate in Pennsylvania · i~uamd a., fo~ows: N/A W~erefore. Petitioner(s) respectfully request(s) the probate o1' the last W~II and Co(fic~'i(s) presented wil~ this Petition and the grant of letters in the appropriate form to the undersigned: ~nnted name and residence ] Rosemary R. Baer, Admin. ~ . " ~/~¢~-~_. 1704 Kathryn Street ~ New Cumberland, PA 17070 Probate Date: Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s)~.er"~'~-~-"Cs) that the sta. t~mertts. J,n the foregoing Petition are true and correct to the best of the knowledge/a-~d belief gf Petitione~nd that,~s personal representative(s) of the Decedent, PetitJone r(s) will well a~ly~' ,~,er~~r~: I. aw. Sworn Io or affirmed and subscribed (--------~'"~ before me Mis ~t~ day of Ro-sema~y R. Baer 20 04 For the Reglste.~. NO. c~l- O~r- L~q~' Estate ol ROSE R. RgGGIERI Deceased Social Seouril¥ No: Date o! Death: February 9, 2004 AND NOW, ~( \Ck~ ~--jk.~, .20 04 , In consideralion of lhe Petition on lhe reverse side hereon, 8atisfactor~ prool having been presented before me, IT IS DECREED that Letters J~ TestamentaryJ~[ C~ AdministraUon are hereby 9ranted to ROSEMARY R. B~R in the above estate and that the lnstrumenl(s) dated N/A described in the Petition be admitted to probate and filed of record as the last Will o! Decedent. Short Certificate(s) ....$ Renunciation ............$. Attorney: Michael H. Small, Esquire PRAECIPE $ ED. No: 19212 REV1500 $. Address: 201 South Railroad Street, P.O. Box 113 Codidl ...................... $. Palmyra, PA 17078-0113 JCPFee ................... $. IO.(~ Talephon,: (717) 838-1385 Inventory .................. $ Other ....................... $ TOTAL .............$ FormlRW-1 Pa,ge 2 of 2 Reps. red by the Pen~yba~ia Ba/A~:)d~on 1991 This is ~tq 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 ~ Local Registrar .,~ P 9 9 6 2 9 8 0 No. ~ Date Rev VaS? ~. COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS >-: CERTIFICATE OF DEATH .~er~. I" female 3. 195--07 --211114'2-9-04 ~. : : ct.25,19 0 Harrisburg ,~,~.,~ ~m,..~ ~ Cumberland pper Allen gJe*S',~& ~,~c.*~ C I~..~.~ ..... '~hite ,~ome maker ----- ~ ,? u o.~ o,~,, I?idowed 100 Mt. Allen Dr. ACTUAL ,7,.S~,. Pa o~ ,~.~.~ Ilnnor Mechaniosburg, Pa. ~'""~ ,,. gamut] ~zzn ,, ~n==~h~ ~ Cirillo m. Rosemary R, Baer ,~. 1704 Kathryn St. New Cumberland, Pa ~ ~ o,,~, I~*,~ ~ ~,~,,~,,.~ ,~%~:~s~..____ .... ,~ .... ~. ~,-.,~ ~..,o.. ~. ,,.. ~ ~ ' ,,..~"D ~""'~ c .... ,D, ...... s,,,.~ ~l""-I~' ~2, 2004 1",.I~6~Y Cross Cemetery I,,,.]Harrisburg' Pa. ~ SUCH I L~e.SE .U.eE. .~E ~o,~.~ ~ ~,~. 011248 ~ ~usselman p ~ & C S ~ c 32 I ~ ~ ~1 ~am.l~124.~ ~ ~ co~et~ ~ /~ ~ M. ~J DATE PRONOUNCED O~D (M~lh, Day, Y~0 ~S CASE REFERRED ~ YeI~MEDICAL E~INE~ORO~ER?I~ ~, ~ m ~ll [ DUE ~ (~ AS A C~SE~ENCE ~: 1 ~ ~ No~ Yes ~ ~ ~ ~ ~ ~u~letmined ~ P~CE~l~URY-Al~me,;arm. slreel, fa~o~,o~e ~N~.C~.~Ie} · I? ...... To~ .... yk ..... ,..d ............. h ............. p ................... (.) .......................................... ~ 3,.. ~g Ox3 %~% ~ ,,d. ~/q - CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Rose R. Ruggieri Date of Death: February 9, 2004 Will No. Admin. No. 2004-00498 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on Ju~e9,2004: Name Address Rosemary R. Baer 1704 Kathryn Street New Cumberland, PA 17070 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: none. Date: June 9, 2004 Signature Name: Michael H. Small, Esquire Address: 201/203 S. Railroad St. Palmyra, PA 17078 Tele.: (717) 838-1385 Capacity: Personal Representative X Counsel for Personal Representative Register of Wills of Cu erland County, Pennsylvania INVENTORY Estate of ROSE R. RDGGZERZ No. 21-04-0498 also known as Date of Death 02/09/2004 Deceased Social Security No. 195-07-211Z Rosemary R. Baer, Admin. 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 of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. IfWe verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 15 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative: Name of Attorney: Michael H. Small, Esquire Rosemary R. Bae_r, Admin. 1704 Kathryn Street I.D. No.: 19212 _New Cum~r] and, PA ] 7070 Address: 201 S. Railroad St., P.O. Box 113 Oate~ /~////~ Palmyra~ PA 17078-0113 Telephone: (717) 838-1385 Description Value See attached Schedule E - Cash, Bank Deposits, & Misc. Personal Property - Inheritance Tax Return $ 19~031.30 Total: $19,031.30 (Attach Additional Sheets if necessary) NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may. at the election of the personal representative, include the value o! each item. but such figures should not be extended into the total of the Inventory. RW-R ' REV-15~8 EX + (6-98) SCHEDULE E CouuONW~,T. oF PENNSVLVAN,^CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RES,DE.T DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER RUGGIERI. ROSE R. 51 04 0498 Include the proceeds of litigation and the date the proceeds were received by the estate. All propen'y jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M & T Bank Checking Account//73092150 9,852.29 - See Verification attached 2. IDS Life Insurance Company - Nursing Home Insurance 3,480.00 - Benefit check 3. IDS Life Insurance Company - Nursing Home Insurance 1,320.00 - Benefit check 4. United States Treasury - Social Security Benefit check for month of January 2004 1,608.00 5. Sun Life Financial - Annuity payment 908.32 6. Sun Life Financial - Annuity payment 640.38 7. ROBC Limited Partnership tYa The Bridges at Bent Creek 459.85 - Move out refund 8. JP Morgan - pension check 156.39 9. Highmark - Benefit check 508.72 10. Highmark Blue Shield - Benefit check 17.80 11. Healthnow NY Inc. - Medicare payment 71.20 12. Lord & Taylor - Credit card refund 8.35 TOTAL (Also enter on line 5, Recapitulation) $ 19,031.30 (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRIS6URG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004818 SMALL MICHAEL H ESQ P O BOX 113 201/203 SOUTH RAILROAD STREET PALMYRA, PA 17078 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold .................. 101 $6,728.18 ESTATE INFORMATION: SSN.' 195-07-21 1 1 FILE NUMBER: 2104-0498 DECEDENT NAME: RUGGIERI ROSE R DATE OF PAYMENT: 01/10/2005 POSTMARK DATE: 01 / 10/2005 COUNTY: CUMBERLAND DATE OF DEATH: 02/09/2004 TOTAL AMOUNT PAID: $6,728.18 REMARKS: CHECK# 12611 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REV-1500 EX + (6-00) COMMONWEALTH OF REV-1500 OFFICIAL USE ONLY PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN ,,[E.U.BER DEPT. 280601 "ARR.SBURG, PA17128-0601 RESIDENT DECEDENT 2 1-0 4 0 4 9 8 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Z RUGGIERI, ROSER. I 9 5 - 0 7 - 2 I 1 l t't DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE LU REGISTER OF WILLS t~ 02/09/2004 ! 0/25/1910 iii (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER N/A i-uu [~-11. Original Return [] 2, Supplemental Return J'~ 3. Remainder Retum (d~e of be~ prior to 12-13-82) r-I 4. UmitedEstata I--1 4a. Futurelnterest¢ompromise d o, e ,,2., . I--1 5. ,ederal Estate Tax Return Requi ,,,0~u ~ .z. ,,. ~ [] 6. Decedent Died Testate (At~h ~:,y of Wi,)r-1 7. Decedent Maintained a Living Trust (Attach copy of Trust) 1 8. Total Number of Safe Deposit Boxes < [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (d~ of de~ between ~2-3,-e~ ~nd ~-~-eS) [] 11. Election to tax under Sec. 9113(A)(Att~h S~h O) ~- B ~NFI~ TAX IN~OR~_~.TION $~l.D BE DIRECTED TO: ,,,z NAME COMPLETE MAILING ADDRESS ............................. z Michael H. Small, Esquire 201 South Railroad Street o o. FIRM NAME (If Applicable) ,,"' FARRELL & SMALL P.O. Box 113 O TELEPHONE NUMBER o 717/838-1385 Palmyra PA 17078-0113 1. Real Estate (Schedule A) (1) OFFicIAL USE oIqLy 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) 19,031.30 (Schedule E) O_ 6. Jointly Owned Property (Schedule F) (6) 19,947.21 I-- [~] Separate Billing Requested t.~., 7-< .... ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 133,281.35;~. ~ (Schedule G or L) ' <~ 8. Total Gross Assets (total Lines 1-7) (8) -~> ~ ~:'[~,-~.86 LU 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 14,276.8 l 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 8,468.04 11. Total Deductions (total Lines 9 & 10) (11) 22,744.85 12. Net Value of Estate (Line 8 minus Line 11) (12) 149,515.01 13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 149,515.01 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax ~ rate, ortransfers under Sec. 9116 (a)(1.2) 0.00 X __ (15) 0.00 ~ 16. Amount of Line14 taxable at lineal rate 149,515.01 X .045 (16) 6,728.18 D. 17. Amount of Line14 taxable at sibling rate 0.00 X .12 (17) 0.00 ~O 18. Amount of Line 14 taxable at collateral rate 0.00 X .15 (18) 0.00 19. Tax Due 6,728.18 (19) 20. E~] ' ' ' ' ' el ' ' ' (il a , ' lab e ,a eL~ '' , ' ~ a ~ ~HECK MATH< < Decedent's Complete Address: STREET ADDRESS Messiah Village 100 Mt. Allen Dr. CITY Mechanicsburg I STATE PA I zip 17055 Tax Payments and Credits: 1. Tax Due(Page 1 Line 19) (1) 6,728.18 2, Credits/Payments A, Spousal Poverty Credit B, Prior Payments C. Discount Total Credits ( A + B + C ) (2) 0.00 3. Interest/Penalty if applicable D, Interest E, Penalty Total Interest/Penalty ( D + E ) (3) 0.00 4, If Line 2 is greater than Line 1 + Line 3, enter the difference, This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 6,728.18 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB) 6,728.18 Make Check Payab/e to: REGISTER OF WILLB, AGENT 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 dght to designate who shall use the property transferred or its income; ........................................[] [] c. retain a reversionary interest; or ...................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ............................................................. [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate cons derat on? ............................................................................................... [] [] 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 benefic ary des gnat on? ....................................................................................................... [] . [] IF THE AN,~r~ TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. _Und.er. perl~es of perjuJy, I declare that I have_.ej~a~mined t~s.retur, q, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete, Defi;}t~ration of prepar~,~"other than the .pe, j:seff3a re~ive is b~ed on alt information of which preparer has any knowledge, //~IGNATI~O?~ PERSON RE.,915~)NSIB!-J~FOR FILI.~'RETURN /?, ~ , DATE i j . ADDRESS \ Rosema~ R. Baer, Admin. / / ,~ 1704 Kathryn Stre~et, Ne.a/ Cumberl ,andr~ ,7 PA 17070 SIGNATURE ~F-~PREPARER OTHEI~?IA~I.R.&=P~ESENTATJ)~ ~.//," ["-' DATE Mzchael H. Small, Effquire, Attorney for the Estate 201 South Railroad Street, P.O. Box 113, Palmyra PA 17078 : 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 decedent's 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-1508 EX + (6-96) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER RUGGIERI. ROSE R. 21 04 0498 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M & T Bank Checking Account #73092150 9,852.29 - See Verification attached 2. IDS Life Insurance Company - Nursing Home Insurance 3,480.00 - Benefit check 3. IDS Life Insurance Company - Nursing Home Insurance 1,320.00 - Benefit check 4. United States Treasury - Social Security Benefit check for month of January 2004 1,608.00 5. Sun Life Financial - Annuity payment 908.32 6. Sun Life Financial - Annuity payment 640.38 7. ROBC Limited Parmership Va The Bridges at Bent Creek 459.85 - Move out refund 8. JP Morgan - pension check 156.39 9. Highmark - Benefit check 508.72 10. Highmark Blue Shield - Benefit check 17.80 11. Healtlmow NY Inc. - Medicare payment 71.20 12. Lord & Taylor - Credit card refund 8.35 TOTAL (Also enter on line 5, Recapitulation) $ 19,031.30 (If more space is needed, insert additional sheets of the same size) 499 Mitchell Road. Millsboro, DE 19966 Mail Code DE-MBoI2 Phone (888) 5024349 Fax (302) 934-2955 July 16. 2004 Farrell & Small Attorneys At Law 201/203 South Railroad Street P. O. Box 113 Palmyra, Pennsylvania 17078-0113 Re: Estate ol(: Rose R. Ru££ieri Social Securi~: 195-07-2111 Date o£Death: February 09, 2004 Dear Sir or Madam: Per your inquiry dated July 07, 2004, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 73092150 Ownership (Names oJ) Rose R Ruggieri Rosemary R Baer, POA Opening Date 12/28/71 (Closed 6/24/04) Balance on Date of Death $9,851.50 Accrued Interest $ O. 79 Total $9,852.29 Please be advised, there was no safe deposit box found for the above decedent. For further account information, regarding ownership, closures and/or reimbursement of funds, please call the Highland Park Office it 717-737-3322. Sincerely, Nancy Clagett Records Management 'REV-1509 EX + (6-98) SCHEDULE F couMo.w ,m oF PENNSYLVAN,^ JOINTLY'OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER RUGGIERI. ROSE R. 21 04 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Rosemary R. Baer 1704 Kathryn Street Daughter New Cumberland, PA 17070 C JOINTLY-OWNED PROPERTY: LEI I ER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF ',,lUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTERE,c 1. A. 02/24/99 ! ginsco/Private Ledger - Investment Account #7863-5057 39,085.38 50. 19,542.6! consisting of 3,663.110 shares of PIMCO Total Remm (class C) ~ $10.67 per share - See Verification attached 2. A 02/24/99 Linsco/Private Ledger - Investment Account #7863-5057 809.04 50. 404.5~ - Cash Balance in Account as of date of death - See Verification attached TOTAL (Also enter on line 6, Recapitulation) $ 19,947.2 ] (If more space is needed, insert additional sheets of the same size) OCT-1Z-Z004 10:08AM FROM-SUSQEHANNA ' 'N¢IAL T1T?375002 T-?Z4 P.001/00? F-??0 4999 Louise Drive, Ste. t01 Mechanicsburg, PA 17055 FAX To: //~/~ ,~,~ From: D uane E, Herman Phone: ~ ~ /~2 ~ phone: ~7) 737-2100 -- CC: ~ of pa~ including oover she~__ '~* ._ ~ U~ent ~ For Review ~ Pleas~ Comment ~ Pl.~e Reply ~ Please Recycl~ *Ruggieri Estate = 4 Paqes + Cover .' ~omment~ 0CT-12-2004 IO:09AM FROM-SUSQEHANNA FINANCIAL ?1TT375002 T-T24 P.OO6/OOT F-TTO N "~ ~ L~ 0CT-12-2004 IO:O~]AM FRO~$U$~HANNA FINANCIAL 7177375002 T-T24 P.O0?/O0? F-??O ~.o SUS GUUEHANNA October 7, 2004 Michael H. Small, Esq. Farrell & Small PO Box 113 Palmyra, PA 17078-0113 Re: Rose R. Ruggieri LPL Account 7863-5057 Dear Mike: Pursuant to your request, the tbllowing information is provided relating to the value of PIMCO Total Retum (class C) shares as of February 9, 2004: Net Asset Value PIMCO Total Return (Ciasa C) $10.67 per share Cash balance in account as of February 9, 2004:$809.04 This is a joint account with Rose,nary Baer and the joint account was created on February 24, 1999. It: you require any additional intbrmation, please contact me. Yours very truly, g~ Zj)~ / 4999 Louise Drive, Suite 101, Mechanicsburg, PA 17055 Tel: 717-737-2100 / Fax: 717-737-5002/Toll Free: 800-349-8090 .~'Ctlt'[lt~;, {~'[~'t't'() ']'h~'Olt!l/.~ ~dCllrl~t'd,, ,~Ct'eicc ,Vcl.'or~', [tlc. · .llember.%;qSI)/SIP~' REV-1510 EX + (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER RUGGIERI, ROSE R. 21 04 0498 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reveme side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF~ICA~E) VALUE 1. Sun Life Financial - Annuity 55,488.11 100. 55,488.11 Contract Number 0200956489-01 - See Verification attached 2. Sun Life Financial - Annuity 77,793.24 100. 77,793.24 Contract Number 0200941295-01 ~- See Verification attached TOTAL (Also enter on line 7 Recapitulation) $ 133,281.35 (If more space is needed, insert additional sheets of the same size) Sun ':~.'~ Life Financial October 8, 2004 Michael H. Small, Esq. P.O. Box 113 Palmyra, PA 17078 RE: Rose R. Ruggieri Dear Mr. Small, Per our telephone conversation, please find the following information you requested: Policy # 0200956489 the value as of February 9, 2004 was $55,488.11 Policy # 0200941295 the values as of February 9, 2004 was $77,793.24 If you have any questions or if there is any other information needed, please give me a call at 877-281-3028, ext. 6864. Sincerely, M}~ Piccinin Asst. Operation Coordinator REV-1511 EX + (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER RUGGIERI. ROSE R. 21 04 0498 Debts of decedent must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Musselman Funeral Home & Cremation Services, Inc. - Funeral Bill (See copy attached) 9,653.81 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Secudty Number(s)lEIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attomey Fees Farrell & Small 4,360.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees (Initial probate costs - $65.00; Add't. probate costs - $23.00) 88.00 5. Accountant's Fees Duane E. Herman, CPA 175.00 6. Tax Retum Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 14,276.81 (If more space is needed, insert additional sheets of the same size) :-~~~ .................... To Funeral Expenses of ROSE R. RUGGIERI May 11, 2004 ~'"~% ~/ Rosemary Baer F 1',,%111~ 1704 Kathryn St. ~. ~1~'~New Cum]~rl~d, PA ~7070F2004e~ruary12 ' i"J.Llll$SINI'~]'I PRO~. St~V'r~, FAOT~TTTDS & ~U'I"OS $3,495.00 ]Ft;]n~]'a] ~I0rne S~ainless Steel Casket 3,150.00 "Cameo Rose" Burial Vault 1,950.00 $8,595.00 ~ C~em~;on ~erviees, ~nc. Cash Advance Items: ~lowers $240.00 £stablishe~ ~8~5 (bpies of death cert±~icates 40.00 Brian C. Musselman, ED. Patriot-News obituary 418.81 Supervisor St. Theres ' s Church 1 00 · O0 Organist 75.00 William G. Pegan. F.D. Cantor 50.00 P.O. Box 137 Altar servers 15.00 324 Hummel Avenue Tent & grave servicing 120.00 $1,058.81 Lem0yne, PA 17043-0137 (717) 763-7440 Fax: 717-730-9798 TOTAL $9,653.81 www.musselmanfuneral.c0m FOR APPOINTMENT PHONE 717-763-7440 REV-1512 EX + (6-98) SCHEDULE I COUUONW~'TH OF PE.NS¥'V^N,A DEBTS OF DECEDENT, INHERITANCE TAX RETURN RESIDENT DECEDENT MORTGAGE LIABILITIES~ & LIENS ESTATE OF FILE NUMBER RUGGIERI. ROSE R. 21 04 0498 Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Andrews & Patel Associates, P.C. - Balance due on Medical bill 100.00 2. The Bon Ton - Balance due on credit card account 230.74 3. PharMerica - Balance due on Medical bill re: Account #5702-01-16149 134.34 4. PharMerica - Balance due on Medical bill re: Account #571 I-01-01895 473.16 5. Quantum Imaging & Therapeutic - Balance due on Medical bill 5.83 6. Verizon - Balance due on account 19.69 7. Messiah Village - Balance due on Nursing Home Bill 7,504.28 TOTAL (Also enter on line 10, Recapitulation) $ 8,468.0,1 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER RUGGIE :{I. ROSE R. ;~1 04 0498 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Tru-_tee(s) OF ESTATE 1. TAXABLE DISTRIBUTIONS [include outright spousal distdbutions, and transfers under Sec. 9116 (a) (1.2)] 1. Rosemary R. Baer Lineal 1704 Kathryn Street Entire Residuary Estate New Cumberland, PA 17070 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. 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) STATUS REPORT UNDER RULE 6.12 Name of Decedent: Rose R. Ruggieri Date of Death: February 9, 2004 Will No. Admin. No. 2004-00498 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules,. ! 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 x No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: N/A 3. If the answer to No. 1 is Yes, state the followingt a. Did the personal representative file'a final account with the Court? Yes No X . b. The separate Orphans' Court No. (if any) for the personal representative's account is: N/A c. Did the personal representative state an account informally to the parties in interest? Yes x No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached ~o ~bis r~r~. - Signature ~. w ~'~'~-~r .... ..... ~ ~ Michael H. Small, Es~ire ~><h~ ~ ~' Name (Please type or print) 201 South Railroad St., P.O. ~xl13 ~.-~- , OC~ Palmyra, PA 17078-0113 L~j ~:~ --~ ~J'~ ( 717 ) 838--1385 ~ Tel. No. Capacity: __Perspnal Reprgsenta~ive x Counsel for personal ........ representative (~H:rmt/~3) BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX Z80601 HARRISBURG PA 171Z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX '* REV-1547 EX AFP (03-05) MICHAEL H SMALL FARRELL & SMALL PO BOX 113 PALMYRA ESQ DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-28-2005 RUGGIERI 02-09-2004 21 04-0498 CUMBERLAND 101 ROSE R Allount Rellitted PA 17078 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ I!V--M4"Yf.~.m~1m1.'lMn'1!C.W.IMftArf,lM!'t.m.lMlTftJlWf~.~tW'(MM.~fr.............. ... DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF RUGGIERI ROSE R FILE NO. 21 04-0498 ACN 101 DATE 03-28-2005 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets U) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 19.031.30 19.947.21 133,281.35 (8) NOTE: To insure proper credit to your eccount, subllit the upper portion of this forll with your tax paYllent. 172,259.86 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) UO) 14,276.81 8.468.04 Ul) (2) (3) (4) 22.744 85 149,515.01 .00 149,515.01 I~ an assessment was issued previoUSly, lines 14, IS and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. AlIOUnt of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CR D S: NOTE: .00 149,515.01 .00 .00 X 00 = X 0~)5 = X l~(.., X 15 ~..~;,j UII))=' < .00 ,",728.18 2:::~ .0-0-,") :<':'~,0f1 :6,728;'1& < '.,~ + AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 0,) (.r, INTEREST IS CHARGED THROUGH 04-12-2005 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 6,728.18 132.50 6,860.68 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)~~ BUREAU OF INDIVIDUAL TAXES' INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT '* REV-1607 EX AFP (03-05) ,.' ~ '-., >...: DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 04-04-2005 RUGGIERI 02-09-2004 21 04-0498 CUMBERLAND 101 ROSE R MICHAEL H SMALL ESQ FARRELL & SMALL PO BOX 113 PALMYRA PA 17078 Allount Re.i tted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ .......................................~........................................................................ REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT KKK ESTATE OF RUGGIERI ROSE R FILE NO.21 04-0498 ACN 101 DATE 04-04-2005 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 03-28-2005 PRINCIPAL TAX DUE: 6,728.18 PAYMENTS (TAX CREDITS): BAL PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-10-2005 CD004818 .00 6,728.18 ANCE OF UNPAID INTEREST/PENALTY AS OF 01-11-2005 TOTAL TAX CREDIT 6,728.18 BALANCE OF TAX DUE .00 INTEREST AND PEN. 47.70 IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 47.70 II! 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CD om::::J a. mrDCCCI ... a. .,.., .. :r ., ....m ....m .. .. :J., .....::1 III 10 ..... III a tT .... .... ::l ::l .. a.... " o .. ., COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 005496 SMALL MICHAEL H ESQ POBOX 113 201/203 SOUTH RAILROAD STREET PALMYRA, PA 17078 ACN ASSESSMENT CONTROL NUMBER AMOUNT nnu__ fold 101 $47.70 ESTATE INFORMATION: SSN: 195-07-2111 FILE NUMBER: 2104-0498 RUGGIERI ROSE R 06/28/2005 06/27/2005 CUMBERLAND 02/09/2004 DECEDENT NAME: DATE OF PAYMENT: POSTMARK DATE: COUNTY: DATE OF DEATH: TOTAL AMOUNT PAID: $47.70 REMARKS: CHECK#12806 SEAL INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU Of INDIVIllUAB~ED OFFICE OF IIlIERITAIlCE TAll DIYISIIlIl OE~lt'~i:O r,<- '1'1,1 ' (' PO lOX 211'81 I l \j:.);;...~ i ',-,t~ ~,\t ~ . '" _1_ PA 17128-0611"" COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT Z005 JUL 22 PH 2: 10 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN CLERK OF ORD;.JI,,\!'~ (V'IIRT 1 I It""':) \ u \....11.)...) l I MICHAEL ~SViAC.t ili;SCC:; P/\ FARRELL & SMALL PO BOX 113 PALMYRA PA 17078 *' AEY-1607 EX AFP C03-05) 07-18-2005 RUGGIERI 02-09-2004 21 04-0498 CUMBERLAND 101 ~t R_IU_ ROSE R MAKE CHICK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 NOTE: To In_a _ cradlt to your _t. __It tha _r portion of this fora with your tax ~t. CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS ... REV-1607 EX AFP (03-05) ... INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF RU66IERI ROSE R FILE NO.21 04-0498 ACN 101 DATI 07-18-2005 THIS STATEHENT IS I"IICIVmED TO ADVISE OF THE CUItUNT STATUS Of THE STATED AeN IN THE NAIlED ESTATE. SIIllIIN JELOlf IS A SUIIlARY Of THE I'ItIMCIPAL TAlC DUE. APPLICATIlIN OF ALL PAYHENTS. THE CURRENT BALANCE. AIlD. IF APPLICABLE. A PRO.IECTED INTEREST nllURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 03-28-2005 PRINCIPAL TAX DUE: 6.728.18 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-10-2005 CD004818 .00 6.728.18 06-27-2005 CD005496 47.70- 47.70 TOTAL TAX CREDIT 6.728.18 BALANCE OF TAX DUE .00 INTEREST AND PIN. .00 TOTAL DUE , .00 . IF PAm AFTER THIS DAtE. SEE REVERSE SIOE FOR CALCULATUII OF AIlDITIllNAL INTEREST. I IF TOTAL DUE IS LESS THAN U. NO PAYHENT IS REIlUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" leRl. YOU MY BE DUE A REFUND. SEE REVERSE SIDE Of THIS FORlt FOR ItISTRllCTIlINS. l S1Z