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Home My WebLink About03-0748Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Martha Ann Mooney No.~I- 05--114'8 also known as , Deceased Social Security No. 166-48-8861 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut or r~ Decedent, dated 1/25/1992 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 bom or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendente lite. durante absentia; durante minodtate) 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 Cumber]and County, Pennsylvania, with his/her last family or principal residence at 661 Mud Level Road? Southampton Township? Shippensburg~ PA 17257 (list street, number and municipality) Decedent, then 48 years of age, died August 23 ,2003 , at Chambersburg Hospital (Location) Decedent at death owned property with estimated values as follows: (if domiciled in PA) All personal property ......................................... $ (if not domiciled in PA) Personal property in Pennsylvania .................... $ (If not domiciled in PA) Personal property in County .............................. $ Value of real estate in Pennsylvania ........................................................................................ $ Total ..................................................................................................................... $ 0.00 Real Estate situated as follows: \* Wherefore, Petitioner(s~r.p, AQActfully request(s) the thefppro.~te form ? the unsigned: probate of the Last Will and Codicil(s)presented with this Petition and the grant of letters in JJ //" (1 ,~ g~ature Typed or pdnted name and residence A. Lindsav Rowlan& 72 Derbyshire Drive, Carlisle: PA 17013 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and/affirm~-) that the ~in the foregoing Petition are true and correct to the best of the knowledge and belief of Pe~itioner/(~ and that, las pers~dal representative(s) of the Decedent, Petiti°ner(s) will well and truly administer the estate ac?trd, i~ I. aw' Sworn to and affirmed and subscribed A. i~S'A~R;WL~AN.D~- -- be~,e me this I 0 ~ ___ day of " k~ ~ DECREE OF REGISTER Estate of Martha Ann Moone¥ also known as Deceased No..~1- O.g- "}q~ Social Security No: 166-48-8861 Date of Death: 8/23/2003 AND NOW, ,~~0q lc2,,,. ,~ , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters [~ Testamentary {~ of Administration (c.t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minoritate) are hereby granted to \*A. Lindsay. Rowland in the above estate and that the instrument(s), if any, dated described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters .................................... Short Certificate(s) ............... $ Renunciation .......................... $ Affidavit ( ) ....................... $ Extra Pages( ta ) .............. $ Codicil ................................. $ JCP Fee ................................. $ Inventory & Tax Forms ............. $ Other ...................................... $ $ 18.0o ~o. oo /0. oo TOTAL ............................. $ ~ RW-7A ,e,~.terofW~l~ O O U Attorney Attorney: HAM[LTON C. DAVIS I.D. No: 10264 Address: P.O. BOX 40 SHIPPENSBURG PA 17257 Telephone: 532-5713 DATE FILED: 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 94.49924 No. Local Registrar Date H105.143 Rev. 2/87 TYPE/PRINT PERMANENT BLACK INK COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH '- Martha Ann Mooney '- Female 3. 166-- 48 -- 8861 4. 08/23/2003 ~. Franklin^OE<L'~B'~)J uNOe"'~I UNDER 1 D~ I DATE OF BIRTH '~ IGN~ ~ ~H{C~k~-- ......... s. 48 v~' ~ ; ~.02/11/1955 ~ g' I". ~ k. Chambersburg ~. Chambersburq Hospital ~'~'"=' ,0. ~ite ~T'S~~,~.~.~.Z~ ~'s Pennsylvania ,~c.~ ~ ~ Southampton 661 Mud Level Road ~mm~ ,L Shippensburg~ PA 17257 ,~) 'm-~ C~berland ~ ,~,.~ ~LSteward M. Mooney ~,~. Marion B. Gilbert .~. ~..~' ~nd~ay Rowland 1~72 DerbTsh~ro Dr~vo~ Carl~slo~ P~ ~7013 ~ ~ ~j ~, ....... j ~ranK~n co. ~. jj~, uo/zo/zuu~ J~ Salem Cemetery Ja~, Greene Twp ~ PA 17201 J~ ~ ~ ~ I I , J~ ~. ~s~ ~ fC~ ~ ~) , ~N~RE ~~ TITm ~ ~,~' TIT .... (.~.~ ...... ~,. ..................................................... ~ .,. C I ~;~//~ 'MEDICAL EXAMINER/CORONER .o,,~,,,,,:, ."":':,,",'~'~t ."'/."t'.%".":!/.~ ?,.:::,!?:,.,.o?:,.,~ .?. o.,?.?~,..: ::..,.,: .~:,.u~:: ..,. ,.,:~ ,.,.,,..~,. ?:: ."."¢. ?.".: 7...~..."?..~.:'.: 7. L~ST WILL AND TESTAMENT I, MARTHA ANN MOONEY of Southampton Township, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament and revoke any will or codicil previously made by me. ITEM I: I direct that all my just debts and funeral expenses, including my gravemarker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as a part of the administration of my estate. ITEM II: I devise and bequeath all of my estate of every nature and wherever situate to my mother, MARION GILBERT MOONEY providing she shall survive me by thirty days. ITEM III: Should my mother, MARION GILBERT MOONEY, predecease me or die on or before the thirtieth (30th) day following my death, I devise and bequeath all of the residue of my estate of every nature and wherever situate in equal shares to such of my cousins, A. LINDSAY ROWLAND, SUSAN E. ROWLAND, BARBARA R. FETZER and GEORGE A. ROWLAND, as are living on the thirty-first (31st) day following my death. ITEM IV: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as part of the expenses of the administration of my estate. ITEM V: I appoint my cousin, A. LINDSAY ROWLAND, Executor of this my Last Will. Should he fail to qualify or cease to act as Executor, I appoint my attorney, HAMILTON C. DAVIS, Executor of this my Last Will. ITEM VI: I direct that my Executor or guardian or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ITEM VII: Should any beneficiary under this Will, including income or principal, including my spouse at any time prior to distribution thereof become in my Executor's opinion, disabled, then and in such event (hereinafter referred to as "the Disability") all other authority and discretion for any and all payments for the benefit of such disabled beneficiary (hereinafter referred to as "the Beneficiary) shall cease and be suspended and all questions concerning and payments for the Beneficiary during his or her Disability shall and will be held by my Executor as Special Trustee pursuant to the following: A. During the existence of the beneficiary's disability, no payments shall be made from this Trust of either income or principal until Special Trustee shall have taken into consideration all of the beneficiary's available other assets 2 and sources of income, including entitlement to benefits as services from any local, state or federal government or agency (or from any private agency). B. During the existence of the beneficiary's disability, all payments from this Trust which go to the benefit of the beneficiary are to be direct payments to the person or entity supplying goods or services to the beneficiary at the request of the Special Trustee. C. During the existence of the beneficiary's disability, no portion of this trust, either income or principal, shall be subject to anticipation, pledge, assignment or obligation of the Beneficiary nor be subject to any reimbursement, execution, attachment, levy or sequestration or any other claims of or interference from the creditors of the Beneficiary or the estate of Beneficiary or of anyone who may be obligated for the support of Beneficiary, including any government or governmental agency or private agency which has provided benefits or services to the Beneficiary. D. During the existence of beneficiary's disability (or for so long as there exists any claim against Beneficiary for reimbursement by any creditor), no portion of this Trust shall be or be able to be used to provide basic food, clothing and shelter for the Beneficiary (nor be able to be converted for 3 such items) but rather to provide the beneficiary with extra and supplemental care, maintenance, comfort, happiness and education in addition to and over and above his or her basic support. To this end, the Special Trustee may provide such resources and experiences as will contribute to and make the beneficiary's life as pleasant, comfortable and happy as is feasible. Nothing herein shall preclude the Special Trustee from purchasing those services and items which promote the beneficiary's happiness, welfare and development, including, but not limited to, vacation and recreation trips away from places of residence, expenses for traveling companions if requested or necessary, entertainment expenses, supplemental medical and dental expenses, social services expenses, transportation costs, private room, telephone and television services, a mechanical bed, an electric wheelchair, personal care services, and the like. E. During the existence of the beneficiary's disability, should the existence of this Trust disqualify the beneficiary from eligibility for substantial governmental or private aid or benefits or services or should any interest of the Beneficiary hereunder (whether income or principal) while undistributed and in the possession of the Special Trustee be subject to attachment, execution, sequestration or reimbursement by any creditor, assignee, subrogee or provider of aid, benefits or 4 services to or for the Beneficiary, then this Trust may, in the discretion of the Special Trustee be terminated and the then remaining principal and any accumulated and undistributed income be distributed to those persons (other than the Beneficiary) who would be entitled to the Beneficiary's share of my estate pursuant to the provisions of ITEM III of this Will had the Beneficiary predeceased me. This is because it is my intention in executing this Trust to provide for the comfort and happiness of the Beneficiary without interfering with, reducing or disqualifying him or her from the aid, benefits or services he or she would otherwise be entitled to and to ultimate distributive shares for all of beneficiaries. F. maximize the my ultimate Upon the cessation of the disability of the beneficiary (if such cessation shall be considered reasonable degree of medical certainty), terminate and all principal and any permanent with a this Trust shall accumulated and undistributed income shall be distributed to the Beneficiary. G. Upon the death of the Beneficiary this Trust shall terminate and the assets shall be distributed to those persons (other than the Beneficiary's estate) who would be entitled to the Beneficiary's share of my estate pursuant to the provisions of ITEM III of this Will had the Beneficiary predeceased me. IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will and Testament, written on seven paper, dated this ~- day of ~~y (7) sheets of , 199~ MARTHA ANN MOONEY (SEAL) The preceding instrument, consisting of this and six (6) other typewritten pages, each identified by the signature of the Testatrix, was on the day and date thereof signed, published and declared by the Testatrix therein named, as and for her Last Will, 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~ereto. residing at J~ ~e/£~(~.~ 6 COMMONWEALTH OF PENNSYLVANIA : · SS. COUNTY OF CUMBERLAND : I, MARTHAANN MOONEY, 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 the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. MARTHA ANN MOONE~ (SEAL) Sworn to or af$ir~d a~d ac.~now!edged before me by .~d~_~_. ~4~/~, the Tes~atrix~ this ,:,~'~-day of / ~ : : SS. We, ~/ ....~m r/~/~ and , , the witness whose names are signed to the att~che~ or foregoing instrument, being duly ~alified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her ~st Will; that the Testatrix signed willingly and executed it as her free and voluntary act for the pu~oses therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Will as a witness; and that to the best of our ~owledge the Testatrix was at that time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. ~~ ~~ Sworn to or affirmed and subscribed to be~gre ~ b~ /--//~VI~i'/'I~ ~ ~/~j¢5~ and ~/~ ~,, ~~ ~ w~t~esses, this ~dav ~f ~~ , 199~. ~-J 7 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Martha Ann Mooney Date of Death: August 23, 2003 Will No.: 21-03-0748 To the Register: I certify that notice of (beneficial interest) estate administration 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 November 26, 2003 · Name A. Lindsay Rowland, Susan E. Rowland, George A. Rowland, Barbara R. Fetzer, Address 72 Derbyshire Drive, Carlisle, PA 17013 1223 W. Poplar, York, PA 17404 1436 Kirkwood Road, Harrisburg, PA 17110 2631 Puritan Court, Oak Hill, VA 20171 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None Date: 11/26/03 ~'~ t~ ~~~" Nalne~ Address: Telephone: Capacity: __ Signature Hamilton C. Davis, Esq. P.O. Box 40 Shippensburg, PA 17257 717-532-5713 personal representative X counsel for personal representative LAW OFFICES OF ZULLINGER- DAVIS PROFESSIONAL CORPORATION JOEL R. ZULLINGER 14 North Main Street Suite 200 Chambersburg, PA 17201 717-264-6029 Fax: 717-264-1884 zulngrlaw~supernet.com Dale F. Shughart, Jr. of counsel HAMII,TON C. DAVIS 20 East Burd Street, Suite 6 P.O. Box 40 Shippensburg, PA 17257 717-532-5713 Fax: 717-530-5222 davislaw~supernet.com May 19, 2004 Register of Wills Cumberland County One Courthouse Square Carlisle, PA 17013 Estate of Martha Ann Mooney Est. No. 21 03 0748 Dear Sir or Madam: Enclosed herewith please find an inheritance tax return, filed in duplicate, and payment in the amount of Three Thousand Six Hundred Seventy-Eight and 36/100 ($3,678.36), as paymem for the above estate. A check for filing fee in the amount of $15.00 is also enclosed If there are any questions or concerns, please contact me at the Shippensburg office. Thank yOU. Sincerely, Hamilton C. Davis for Zullinger - Davis Professional Corporation HCD/njk Enclosure COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 003976 DAVIS HAMILTON C P O BOX 04O SHIPPENSBURG, PA 17257-0040 ........ fold ESTATE INFORMATION: SSN: 166-48-8861 FILE NUMBER: 2103-0748 DECEDENT NAME: MOONEY MARTHA ANN DATE OF PAYMENT: 05/25/2004 POSTMARK DATE: 05/24/2004 COUNTY: CUMBERLAND DATE OF DEATH: 08/23/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $3,678.36 REMARKS: TOTAL AMOUNT PAID' $3,678.36 SEAL CHECK# 103 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER COUNIY CODE 03 0748 YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INmAL) SOCIAL SECURITY NUMBER ~ Mooney, Martha Ann 166-48-8861 ut DATE OF DEATH (MM-DD-YEAR) t DATE OF BIRTH (MM~DD-YEAR) CI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE o 08/23/2003 02/1 l/1955 "' REGISTER OF Wll I .~ (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Z [] 1. Original Return [] [] 4. Limited Estate [] [] 6. Decedent Died Testate (Attach copy [] of Will) [] 9. Litigation Proceeds Received [] 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach copy of Trust) 10. Spousal Povedy Credit (date of death between 12-31-91 and 1-1-95) [] 3. Remainder Return (date of death prior to 12-13-82) [] 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes [] 11.Election to tax under Sec. 9113(A) (Attach Sch O) THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHO~._ JLD BE DIRECTED TO: ~AME Hamilton C. Davis :IRM NAME (if applicable) Zullinger - Davis, PC 'ELEPHONE NUMBER 7 ] 7/532-5713 COMPLETE MAILING ADDRESS 20 East Burd Street, Suite 6 P.O. Box 40 Shippensburg, PA 17257 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) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) None None None None 26,261.18 None None 1,738.75 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental 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) (8) 26,261.18 1,738.75 24,522.43 24,522~43 (11) (12) (13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) x .00 (15) 16. Amount of Une 14 taxable at lineal rate x .045 (16) 17. Amount of Line 14 taxable at sibling rate x .12 18. Amount of Line 14taxableat collateral rate 24,522.43 x .15 19. Tax Due (17) (18) 3,678.36 (19) 3,678.36 >> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE ~4DE AND RECH_I::¢K MATH << Copyright 2000 form soltware only The Lackner Group, Inc. Form REV-I$00 EX (Rev. 64)0) Decedent's Complete Address: ISTREET ADDRESS 661 Mud Level Road crt* Shippensburg [STATE PA IZn' 17257 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 3,678.36 Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line I + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page I 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. (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 3,678.36 3,678.36 · ANSWE~R TO ANY OF T.H~ QUESTIONS IS YES, lara~:m of pre~lare~otrler than the pers/bnal representative is based on ,11 information of which preparer has any knowledge. s,~.~.F o~ ~.f.¢~?o. ,E~.O.S,~ ~o, ~'d.".".U~.~.. ^o~.~ss .s../~a~m~.~l~fwlaml Il f t' , 72 Derby. shire Drive I ~ /'T--" ( [1 ~ ~./~. Carlisle, PA 17013 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 usa 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 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 beneficiary des gnat on? ........................................................................................................................ [] [] IF THE YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. s return, including accompanying schedules and statements, and to the best of my know~edge and belief, it is true, correct and complete. DATE DATE ADDRESS SIGNATURE OF PREPARER OTHER THAN REPRESENTA~VE DATE 20 East Burd Street, Suite 6 P.O. Box 40 Shippensburg, PA 17257 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% 1172 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. ESTATE OF Mooney, Martha Ann SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21 - 03 - 0748 Include the proceeds of li~gation and the date theproceeds were received by the estate. All property jointly-owned with the right of survivorsh,p must be disclosed on schedule F. ITEM NUMBER DESCRIPTION M&T Checking Account No. 1321145 National Planning Money Manager Account National Planning Interest TOTAL (Also enter on Line 5, Recapitulation) VALUE AT DATE OF DEATH 1,795.77 24,449.00 16.41 26,261.18 COMMONINEALTH OF PE/~SYLVANIA IMdERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSi~ & AD&'~ISTRATNE COSIS ESTATE OF Mooncy, Martha Ann FILE NUMBER 21 - 03 - 0745 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT ,4. FUNERAL EXPENSES: ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Hamilton C. Davis, Esquire Family Exemption: (If decedent's address is not the same as claimant's, attach exHanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees Cumberland County Register of Wills __ Zip Accountant's Fees Tax Return Pmpamr's Fees Other Administrative Costs Legal Advertising - The News Clxronicle Legal Advertising - Cumberland County Legal Journal Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) 1,000.00 60.00 92.75 75.00 511.00 1,738.75 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mooney, Martha Ann SdledtleH FILE NUMBER 21 03 - 0748 Ovrstown Bank Check Order Reserve for Contingencies 11.00 500.00 Page 2 of Schedule H COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J J BENEFICIARIES ESTATE OF Mooney, Martha Ann J FILE NUMBER 21 - 03 - 0748 I RELATIONSHIP TO NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT AMOUNT OR SHARE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 A. Lmdsay Rowland Cousin 1/4 Residue 72 Derbyshire Drive Carlisle, PA 17013 2 Susan E. Rowland Cousin 1/4 Residue 1223 W. Poplar York, PA 174041 3 George A. Rowland Cousin 1/4 Residue 1436 Kirkwood Road Harrisburg, PA 17110 4 Barbara R. Fetzer Cousin 1/4 Residue 2631 Puritan Court Oak Hill, VA 20171 , 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET MarT Bank May 3, 2004 Law Offices of Zullinger - Davis Hamilton C. Davis 20 East Burd Street, Suite 6 P.O. Box 40 Shippensburg, PA 17257 499 Mitchell Street, Millsboro, DE 19966 Estate of Martha Ann Mooney Date of Death: August 23, 2003 Social Security Number: 166-48-8861 Dear Mr. Davis: In response to your request, please be advised that at the time of death, the above- named decedent had on deposit with this bank the following accounts. Account Type ........................... Checking Account Account Number. ...................... 1321145 Ownership (of names ) .............. Mart_ha A. Mooney Opening Date ........................... 07/15/96 (account closed 10/07/03) Balance on Date of Death. .........$1,795.77 Accrued Interest $ 0.00 Total ....................................... $1,795.77 - - Sincerely, Charlene Warrington, Records Management 1-888-502-4349 MARRAZZO AND ASSOCIATES FINANCIAL GROUP, p. C. [NSU.RA. NCE - ANNU ITi'I:.S - INV E.~TMi:.I~r$ -RETIRgM'E~,-T ~LA,NNI,'~G. GR OT.~ ItENKFTTS - tNCOM£ TAX PRKPARAT;ON Zullinger-Davis Professional Corporation Attn: Hamilton C. Davis Fax # 717-530-5222 May 6, 2004 Per your request, the value of Martha Mooney's investment account #4NR-050275, as of August 23, 2003, was $24,449. If you have any questions or need additional information, please do not hesitate to call. Sincerely, ~t SgCURITT~S AnD INVE.q?MENT AD¥ISORY ~R~ OF~R~D ¥~OUCg nA~ONAL PLA~G CORPo~oN A~ A ~Cl~ ~E~ ~ · MA~ ~ a~T~ ~'ANCIAL GRO~, ~. C. AND h~ ARg $gp~ AND ~~ S01 S. ARLll~GTON AVENUE HARR/SBURG, PA 1'7109 LOCAL (717) 652-6122 TOLL FREE (888) 718-0092 FAX (717) 652-69]9 LAST WILL AND TESTAMENT I, MARTHA ANN MOONEY of Southampton Township, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament and revoke any will or codicil previously made by me. ITEM I: I direct that all my just debts and funeral expenses, including my gravemarker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as a part of the administration of my estate. ITEM II: I devise.and bequeath all of my estate of every nature and wherever situate to my mother, MARION GILBERT MOONEY providing she shall survive me by thirtY days. ITEM III: Should my mother, MARION GILBERT MOONEY, predecease me or die on or before the thirtieth (30th) day following my death, I devise and bequeath all of the residue of my estate of every nature and wherever situate in equal shares to such of my cousins, A. LINDSAY ROWLAND, SUSAN E. ROWLAND, BARBARA R. FETZER and GEORGE A. ROWLAND, as are living on the thirty-first (31st) day following my death. ITEM IV: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as part of the expenses of the administration of my estate. ITEM V: I appoint my cousin, A. LINDSAY ROWLAND, Executor of this my Last Will. Should he fail to qualify or cease to act as Executor, I appoint my attorney, HAMILTON C. DAVIS, Executor of this my Last Will. ITEM VI: I direct that my Executor or guardian or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ITEM VII: Should any beneficiary under this Will, including income or principal, including my spouse at any time prior to distribution thereof become in my Executor,s opinion, disabled, then and in such event (hereinafter referred to as "the Disability,,) all other authority and discretion for any and all payments for the benefit of such disabled beneficiary (hereinafter referred to as "the Beneficiary) shall cease and be suspended and all questions concerning and payments for the Beneficiary during his or her Disability shall and will be held by my Executor as Special Trustee pursuant.to the following: A. During the existence of the beneficiary,s disability, no payments shall be made from this Trust of either income or principal until Special Trustee shall have taken into consideration all of the beneficiary,s available other assets 2 and sources of income, including entitlement to benefits as services from any local, state or federal government or agency (or from any private agency). B. During the existence of the beneficiary,s disability, all payments from this Trust which go to the benefit of the beneficiary are to be direct payments to the person or entity supplying goods or services to the beneficiary at the request of the Special Trustee. C. During the existence of the beneficiary,s disability, no portion of this trust, either income or principal, shall be subject to anticipation, pledge, assignment or obligation of the Beneficiary nor be subject to any reimbursement, execution, attachment, levy or sequestration or any other claims of or interference from the creditors of the Beneficiary or the estate of Beneficiary or of anyone who may be obligated for the support of Beneficiary, including any government or governmental agency or private agency which has provided benefits or services to the Beneficiary. D. During the existence of beneficiary,s disability (or for so long as there exists any claim against Beneficiary for reimbursement by any creditor), no portion of this Trust shall be or be able to be used to provide basic food, clothing and shelter for the Beneficiary (nor be able to be converted for 3 such items) but rather to provide the beneficiary with extra and supplemental care, maintenance, comfort, happiness and education in addition to and over and above his or her basic support. To this end, the Special Trustee may provide such resources and experiences as will contribute to and make the beneficiary.s life as pleasant, comfortable and happy as is feasible. Nothing herein shall preclude the Special Trustee from purchasing those services and items which promote the beneficiary,s happiness, welfare and development, including, but not limited to, vacation and recreation trips away from places of residence, expenses for traveling companions if requested or necessary, entertainment expenses, supplemental medical and dental expenses, social services expenses, transportation costs, private room, telephone and television services, a mechanical bed, an electric wheelchair, personal care services, and the like. E. During the existence of the beneficiary,s disability, should the existence of this Trust disqualify the beneficiary from eligibility for substantial governmental or private aid or benefits or services or should any interest of. the Beneficiary hereunder (whether income or principal) while undistributed and in the possession of the Special Trustee be subject to attachment, execution, sequestration or reimbursement by any creditor, assignee, subrogee or provider of aid, benefits or services to or for the Beneficiary, then this Trust may, in the discretion of the Special Trustee be terminated and the then remaining principal and any accumulated and undistributed income be distributed to those persons (other than the Beneficiary) who would be entitled to the Beneficiary,s share of my estate pursuant to the provisions of ITEM III of this Will had the Beneficiary predeceased me. This is because it is my intention in executing this Trust to provide for the comfort and happiness of the Beneficiary without interfering with, reducing or disqualifying him or her from the aid, benefits or services he or she would otherwise be entitled to and to maximize the ultimate distributive shares for all of my ultimate beneficiaries. F. Upon the cessation of the disability of the beneficiary (if such cessation shall be considered permanent with a reasonable degree of medical certainty), this Trust shall terminate and all principal and any accumulated and undistributed income shall be distributed to the Beneficiary. G. Upon the death of the Beneficiary this Trust shall terminate and the assets shall be distributed to those persons (other than the Beneficiary,s estate) who would be entitled to the Beneficiary,s share of my estate pursuant to the provisions of ITEM III of this Will had the Beneficiary predeceased me. IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will and Testament, written on seven (7) sheets of paper, dated this ~ ~ day of ~~W , 199~. / MARTHA ANN MOONEY (SEAL) The preceding instrument, consisting of this and six (6) other typewritten pages, each identified by the signature of the Testatrix, was on the day and date thereof signed, published and declared by the Testatrix therein named, as and for her Last Will, in the presence of us, who, at her request, in her presence, and in the presence of each other have subscribed our names as witnesse~ereto. .,: .,- ~ residing at/r~, .~ . residing at .~/-~ J9~. £ ~r~,/~ ~ ~ / · 6 COP[MONWEALTH OF PENNSYLVANIA : : SS. COUNTY OF CUMBERLAND : I, MARTHA ANN MOONEY, 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 the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. MARTHA ANN MOONEY Sworn to or affirmed amd ackn,.o, wledged before me bv 4,{;I('-ii."'~ /~:,I~ Testatrix, this .~-3'~-- day of ;/ /,," Notary ~Public /: // ' COMMONWEALTH OF PENNSYLVA/NIA : : ss. COUNTY OF CUMBERLAND : (SEAL) witness whose names are signed to t~e attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her Last Will; that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Will as a witness; and that to the best of our knowledge the Testatrix was at that time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. ~~//~ : Sworn to or affirmed and subscribed to FIRST CLASS ZiPCObi~ ~ 7 ~-" ~ .; MAIL HAMILTON C. DAVIS ATTORNEY AT LAW P.O. BOX 40 SHIPpENSBURG, pENNSYLVANIA 17257~O40 Register of wills cumberland county One courthouse Square Carlisle, PA ~70q3 FIRST CLASS MAIL BUREAU OF INDIVIDUAL TAXES TNHERTTANCE TAX DTVTSZON DEPT. 280601 HARRISBURG, PA 17128-0601 COHHONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-IG4? EX AFP (01-03) HANILTON C DAVIS ZULLINGER DAVIS PO ~OX ~0 SHIPPENSBURG PA 17257 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 07-19-Z00q NOONEY 08-25-2005 Z! 05-07q8 CUMBERLAND 101 Amoun'l: Remi ~:'l:ed NARTHA A HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF HOONEY HARTHA A FILE NO. 21 03-07q8 ACH 101 DATE 07-19-200R TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~e (Schedule A) (1) 2. S~ocks and Bonds (Schedula B) (2) 5. Closely Held S~ock/Par~nership In~ares~ (Schedule C) ($) q. Mor~gagas/No~as Receivable (Schedule D) (q) S. Cash/Bank Dapos/~s/Misc. Personal Proper~y (Schedule E) (5) 6. Jo/n~ly Owned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To,al Assa~s APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Dab,s/Mortgage L/ab/1/~/es/Lians (Schedule Z) (10) 11. To*al Deductions 12. Na~ Value of Tax Re~urn 15. 1~. Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) Ne~ Value of Es~a~a Subjec~ ~o Tax 262261.18 .00 .00 NOTE: To insure proper .00 credi~ ~o your account, .00 suba/~ ~ha upper por~/on .00 of ~h/s fore w/~h your ~ax payment. .00 (8) 1,758.75 .00 NOTE: 26,261.18 (11) ~ ,738.75 (12) 2~,522.~3 (15) . O0 (lq) 2q,522.~$ Zf an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 ,111 reflect flgures that /nclude the total of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Aaoun~ of L/ne lq a~ Spousal ra~a 16. Aeoun~ of Line lq ~axable a~ Lineal/Class A ra~a 17. Amoun~ of L/ne lq a~ S/bl/ng 18. Aeoun~ of L/ne lq ~axabla a~ Collateral/Class B ra~a 19. Pr/nc/~al Tax Due TAX CREDITS PAYMENT RECEIPT DISCOUNT DATE NUMBER INTEREST/PEN PAID (- 05-2q-200q CD00~976 .00 ~ x oo,: m .oo ~0 x ~:: o .00 z~,s2 s~ ~ ~?~' '~ ~ x i TOTAL TAX CREDIT I 3,678.36 BALANCE OF TAX DUEl .00 INTEREST AND PEN. .~0 TOTAL DUE . q0 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. (15) (16) (17) (18} ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CA), YOU MAY BE DUE-~\ A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) RESERVATION: Estates of decedents dying on or before December 1Z, 198Z -- if any futura interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of tho decedent after the expiration of any estate for life or for years, tho Commonwealth hereby expressIy reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section ZltO of the Inheritance and Estate Tax Act, Act Z5 of ZOO0. (7Z P.S. Section 91~0). Detach the top portion of this Notice and submit with your payment to the Register of Mills printed on the reverse side. --Make check or money order payable to: REGISTER OF MILLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-13IS). Applications are available at the Office of the Register of Hills, any of the Z5 Revenue District Offices, or by calling the special Z~-hour answering service for farms ordering: 1-DO0-56Z-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-~7-30Z0 (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 sheen 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. ZDlOZ1, Harrisburg, PA 171ID-lOll, 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 Review Unit, Dept. Z80601, Harrisburg, PA 171ZD-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1SOI) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the decadent's death, a five percent (SI) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same tiaa period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquencyj or nine (9) months and one (1) day from the date of death, to the data of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6X) percent par annum calculated at a daily rate of .00016q. All taxes which became delinquent on and after January 1, 198Z will bear interest at a rate which will vary from calendar year to caIendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through ZO0~ are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ 20Z .0005~8 ~'8-1991 1XZ .000501 ~ 9Z .O00Z~7 1985 16Z .000~38 199Z 9Z .O00Z~7 ZOOZ 6Z .00016~ 19D~ 11Z .000501 1993-199~ 7Z .00019Z 2003 5Z .000157 1985 13Z .000356 1995-1998 9Z .O00Z~7 ZO0~ 4Z .000110 1986 IOZ .000274 1999 7Z .00019Z 1987 IOZ .O00Z7~ ZOO0 7Z .O0019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. STATUS REPORT UNDER RULE 6.12 Name of Decedent: Martha A. Mooney Date of Death: 08/23/2003 Estate No. 2003-00748 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 -X 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 X 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 X 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 ~ f. J-:--~ Hamilton C. Davis, Esquire P.O. Box 40 Shippensburg, PA 17257 (717) 532-5713 Date: '<?/J::: /OS- I I CT> ., - - , , c:-.. lrL._" c' \....:0 l.:- Capacity: _ Personal Representative XX Counsel for Personal Representative c-:~ ,-' " t<, I' 11-'\ , If? c.;:") {.-;::5 <-l 0_ c) r) Cumberland County - Register Of Wills One Courthouse Square Carlislel PA 17013 Phone: (71 7) 240 - 6345 Date: 7/27/2005 DAVIS HAMILTON CI ESQ. POBOX 040 SHIPPENSBURGI PA 17257-0040 RE: Estate of MOONEY MARTHA ANN File Number: 2003-00748 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES I NO. 103 SUPREME COURT RULES DOCKET NO. 11 for decedents dying on or after July 11 19921 the personal representative or his counsell within two (2) years of the decedent's deathl shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 8/23/2005 Your prompt attention to this matter will be appreciated. Thank You. SincerelYI ~~~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge ~