HomeMy WebLinkAbout04-0122Social Security No. 0 9 5-1 4 - 3 0'9 2Deceased'
The petition of the undersigned respectfully represents that:
Your petitioner(s), ,,','ho is/are 18 years of age or older an the execut
in the last will of the above decedent, dated
and codicil(s) dated
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of Maria A. Massa No. ~ /- O ~/- / 0~/
also known as To:
Register of Wills for the
County of Cumberland
Commonwealth of Pennsylvania
in the
ors
named
May 3 ,19 90
(state relevant circnmstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Cumberlan~d . Co_upty, pennsylvania, with
h er last family or principal residence at 1320 ~3eorgetown uxrc±e,
Carlisle, PA 17013
(list streett number and muncipality)
Decendent, then 81 >,ears of age, died January 8 ,:t¢g 2004
at Carlisle Regional Medical Center, Carlisle, PA '
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was noi the victim of a killing and was never adjudicated
incompetent:
Decendent 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
situated as follows:
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters
theron. (testamentary: administration c.t.a.; administration d.b.n.c.t.a.)
OATH OF PERSONAL REPRESENTATIVE
COMMONVfEALTH OF PENNSYLVANIA 3
COUNTY OF j,- ss
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will w,d'l'~hd truly administer the estate according to law.
Sworn to or aff~med and subscribed
before me this ~,0t7-/// day' of J/.
No. ~/'~6/- /~'g~'"
Estate of /7~)/~ /f /9]/%~/1 , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated
described therein be admitted to probate and filed of record as the last will of
and Letters
are hereby granted to ~~ ~ ~
~o,9~/~, in consideration of the petition on
FEES
Probate. Letters, Etc .......... $~~
Short Certiticates() ..........
Renunciation ................ $
TOTAL
Filed ~...~... ~.~ ..............
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ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
RENUNCIATION
In Re Estate of ~ ~ c
to,.
To the Register of Wills of 0 t_~
deceased.
County, Pennsylvania.
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
WITNESS
hand this
(Signature)
(Address)
(Signature)
(Address)
GEORGE M, GERMANN
ATTORNEY AND COUNSELOR
AT LAW
COLONIAL PARK. SUITE C
4040 COMMERCIAL WAY
SPRING HILL FLORIDA 34606
(904} 683-7942
DURABLE FAMILY POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS, That I, JOSEPH A. MASSA,
do hereby constitute and appoint my son, ROBERT J. MASSA, my
true and lawful attorney for me and in my name, place and stead
to bargain, sell, convey, execute contracts, bills of
sale, certificates of title, and agreements for deeds,
notes, mortgages, partial releases, and satisfactions of
mortgages on any and all real or personal property or
interest therein that is owned by me, and also to accept
drafts and bills of exchange and to sign and endorse
checks, drafts, withdrawal slips and all other items
pertaining to my financial business at any bank, savings
and loan association, credit union or other financial
institution at which I may have an account, specifically
including access to my Safety Deposit Box, and to sell,
transfer and assign any stocks, bonds, mutual funds or
brokerage accounts owned by me either individually or
jointly with another person and execute the necessary
stock powers or certificates pertaining thereto, and to
sign waivers, consents, authorizations and releases
pertaining to my health care and treatment,
hereby giving and granting unto my son, ROBERT J. MASSA, full
authority to do and perform all and every act and thing
whatsoever requisite and necessary to be done in and about the
premises as fully, to all intents and purposes, as I might or
could do personally, hereby ratifying and confirming all that
he shall lawfully do or cause to be done by virtue hereof.
It is my in'tent in executing this instrument that the
power conferred on my said attorney shall be exercisable
commencing with the date hereof notwithstanding any later
disability or incapacity that I may suffer, so that this
power of attorney shall not be affected by disability of
the principal except as provided by Florida Statute.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
the ~D day of 0c~k~ , 1988.
Si~ned and De/l~ivered
ELI ~ABETH COOK
STATE OF FLORIDA
COUNTY OF HERNANDO
BE IT KNOWN, That on the %~ day of 0~~ , 1988,
before me, a notary public in and for the State of Florida,
duly commissioned and sworn, personally came and appeared
JOSEPH A. MASSA, personally known, and known to be the person
described in and who executed the within Power of Attorney, and
he acknowledged the within Power of Attorney to be his act and
deed.
My commission expires:
IN TESTIMONY WHEREOF, I have hereunto subscribed my name
and affixed my seal of office the day and year last above
written.
Notar~ 7~ublic
ELIZABETH COOK FAGAI~
Hmary Public, State of Florida
t~y ~o~missi,;n Expires July 16,
*:onded Thru Troy Fain - Insurance Inc.
LAST WILL AND TESTAMENT
OF
MARIA A. MASSA
I, MARIA A. MASSA, residing in the County of Hernando,
State of Florida, being of sound mind and disposing intent, do
make, publish and declare this instrument to be my Last Will and
Testament, hereby revoking all former wills and codicils made by
me.
FIRST: I direct that my Personal Representative pay all
of my just debts, including the expenses of my last illness and
burial, as soon after my demise as practicable.
SECOND: I give, devise and bequeath to my beloved
husband, JOSEPH A. MASSA, if he survives me, all the rest and
residue of my estate, after expenses and taxes have been paid,
to include all of my property, both real and personal,
wheresoever situate, specifically providing for the unlimited,
to spouse, tax free estate marital deduction under the Economic
Recovery Tax Act of 1981.
THIRD: I hereby reserve unto myself the right to make a
list disposing of items of personal property. If I make such a
list, from time to time, it will be in my own handwriting,
signed, dated either contemporaneously with this Will or
subsequent hereto, will describe the items to be devised and the
individual devisees thereof with sufficient detail, and will be
MARIA A. MASSA
found with my copy of this Will. I will not devise by this list
any money, evidence of indebtedness, securities, or property
used in a trade or business.
FOURTH: Should my husband, JOSEPH A. MASSA, fail to
survive me or should we both die as a result of a common
disaster or so closely together from the standpoint of time that
it is difficult to determine which one predeceased the other,
then in either of these events, I give, devise and bequeath all
of the rest, residue and remainder of my property which I may
own at the time of my death or to which I or my estate may then
or thereafter be in any way entitled, both real and personal,
whatsoever and wheresoever situate, in equal shares, among my
following named children, per stirpes:
A. ROBERT J. MASSA, of Ellicott City, Maryland; and,
B. JANET A. HAMPTON, of Collinsville, Connecticut.
FIFTH: I hereby constitute and appoint my husband,
JOSEPH A. MASSA, and my son, ROBERT J. MASSA, Co-Personal
Representatives of this my Last Will and Testament. Should
either of them predecease me, or be unable or unwilling to serve
for any reason, then I appoint JANET A. HAMPTON, to serve with
the other of them as Alternate Co-Personal Representatives of
this my Last Will and Testament. I hereby waive requirement of
bond and authorize and empower my Personal Representative
appointed herein to sell at public or private sale any or all
property which I may own or be entitled to at the time of my
death, and to execute good and sufficient assignments,
conveyances and deeds.
IN WITNESS WHEREOF, I have hereunto subscribed my name and
affixed my seal and declared this to be my Last Will and
Testament in the presence of the witnesses who have subscribed
their names hereto at my request, and in my presence, this ~
day of ~ , 1990.
MARIA A. MASSA
The foregoing instrument consisting of three (3) pages of
typewritten material including this page, was on the ~ day
of ~ , 1990, exhibited to us by the above-named
MARIA A. MASSA, Testatrix, declared by her to be her Last Will
and Testament, signed by her in our presence, and we signed in
her presence and in the presence of each other at her request as
~~~~of 5151 Commercial Way
C~OR~E M. GERMA~pring Hill, Florida
~ ~~ of 5151 Commercial Way
SHARON A. FLANNERY ~ Spring Hill, Florida
STATE OF FLORIDA :
COUNTY OF HERNANDO :
We, MARIA A. MASSA, GEORGE M. GERMANN and SHARON A. FLANNERY,
the Testatrix and the witnesses, respectively, whose names are
signed to the attached or foregoing instrument, being first duly
sworn, do hereby declare to the undersigned officer that the
Testatrix signed the instrument as her Last Will and that she
signed voluntarily and that each of the witnesses in the presence
of the Testatrix, at her request, and in the presence of each
other, signed the Will as witnesses and that to the best of the
knowledge of each witness the Testatrix was at that time eighteen
(18) or more years of age, of sound mind and under no constraint
or undue influence.
,~A4RI~)A. MASSA~-~ / I
~---G~R~E M. GERMANN 7'
A. FLANNERY ¢
Subscribed and acknowledged before me by MARIA A. MASSA, the
Testatrix, and subscribed and sworn to before me by GEORGE M.
GERMANN and SHARON A. FLANNERY, the witnesses, on the ~ day of
, 1990.
Notary Public
State of Florida at Large
My Commission Expires:
· ?~{~;~ CONSTANCE A BROOKS
~"~='.= ~ !,~,,2 co~ssl~' EXPIRES
This instrument prepared by: ~.,~:? June21,1993
GEORGE M. GERMANN, P.A.
ATTORNEY AND COUNSELOR AT LAW
5151 COMMERCIAL WAY
SPRING HILL, FLORIDA 34606
(904) 596-0526
CERTIFICATION OF NOTICE UNDER RULE 5.6~a~
Name of Decedent:
Date of Death:
Estate No.:
To the Register:
MARIA A. MASSA
Janua~ 8,2004
21-04-00122
I certify that notice of the beneficial interest estate administration required by Rule
5.6(a) of the Orphan's Court Rules was served on or mailed to the follOwing beneficiaries
of the above-captioned estate on March 3, 2004.
Name
Joseph A. Massa
Address
1320 Georgetown Circle, Carlisle, PA 17013
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None
Date: March 3, 2004
' ' SAIDIS, SHUFF, FLOWER & LINDS/~
Name
Address
James D. Flower, Jr.
26 West High Street
Carlisle, PA 17013
Telephone (717) 243-6222
__ Personal Representative
x Counsel for Personal Representative
\\;;,
~
~E'i.1500DI6.l),1'i
REV-1500
'* COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21 04
COUNTY CODE YEAR
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DECEDENT'S NAME ILAST, FIRST, AND MIDDLE INITIAL)
MASSA, MARIA A.
SOCIAL SECURITY NUMBER
095-14-3092
0122
NUMBER
~ 1. Original Return
o 4. limited Estate
o 6. Decedent Died Testate (Mach copy of Will)
o g- litigation Proceeds Recei'led
o 2. Supplemental Return
D 4a. Future Interest Compromise (dale of death a~er 12-12-82;
o 7, Decedent Maintained a Living Trust !Allarh cow 01 Tru,l)
o 10. Spousal Poverty Credit (date of death belween 12.31-91 and 1.1-SS)
o 3_RemainderReturn{daleofdealhpriorlo12-13-B2)
o 5. Federal Estate Tax Return Required
B. Total Number of Safe Deposi! Boxes
o 11. Election to tax under Sec. 9~~3(A) \Machsco0)
THIS $ECTIONMU$T BE COMPLETEO. ALL CORRESPONDENCEAl'iDCONFIDi:NTI.l\L TAX INFORMATION SHOULD BE DIRECTED TO:
....,
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-TO
DATE OF DEATH (MM.DD-YEAR)
01/0812004
DATE OF BIRTH IMM.DD.YEAR)
\ D5/2411922
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216,187.75
38,336.79
177 ,850.97
177,850.97
0.00
- -- -....- -.-
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
MASSA, JOSEPH A.
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NAME
THOMAS E. FLOWER
FiRM NAME (IJAWli~bje)
SAlOIS, SHUFF, FLOWER & LINDSAY
TELEPHONE NUMBER--
(717) 737-3405
COMPLETE MAILING ADDRESS
SAlOIS, SHUFF, FLOWER & LINDSAY
2109 MARKET STREET
CAMP HILL, PA 17011
1. Real Estate (Schedule A)
2. StOCKS and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
65,060.53
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3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
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S. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
B. Total Gross Assets (total lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Deceden!. Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (tola/lines 9 & 10)
12. Net Value of Estate (Une 8 minus Line 11)
(9)
(10)
(8)
10,153.84
28,182.95
(11)
(12)
(13)
(6)
92,000.00
(7)
59,127.22
13. Charitable and Govemmental BequestslSec 9113 Tr\lsts for which an election 10 tax Ilas not been
made (ScheduleJ)
14 Net Value Subject to Tax (Line 12 minus Line 13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at tile spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
177,850.97 x.OOO (15)
x .0 (16)
x .12 (17)
x 15 (18)
(19)
'16. Amount of Line 14 laxable at lineal rate
17. Ammmt ollil1€ 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
STREET ADDRESS
1 ~20 G"orgeto",n~ircl",
CITY'C" i' I
arise,
STATEpA
ZIP 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B, Prior Payments
C. Discount
(1)
000
0.00
0.00
0.00
3. InteresVPenalty if appHcable
D. Interest
E. Penally
Total Credits (A + B + C I (2)
0.00
0.00
0.00
TotallnteresVPenalty ( 0 + E ) (3)
4. If Lille 2 is greater than Une 1 + Line 3, enter the difference. This 15 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.
A. Enter the interest on the tax due.
(5)
(SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
........ ........ [KJ 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,
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred;..
b. retain the right to designate who shall use the property transferred or its income;..
c. retain a reversionary interest; or...
d. receive the promise for life of either payments, benefits or care? ..
2. ~f deat'n occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration?.
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?..
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?
Yes
%0
.................0
........0
.....0
.................0
%0
No
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[KJ
[KJ
Urtder pena~ies of pe~ury, I declare thai I have examined this return, including accompanying schedules 3ml statements. arrd \0 the best 01 my knowledge and belief, it is true, correct
and complete.
Oeda of preparer other than the persona) representative is based on all information of which preparer has any knowledge.
OF:p~~~ RE:UR:
ADDRESS 1
ROBERT J. MASSA, 1209 GEORGETOWN CIRCLE, CARLISLE, PA 17013
SJ~~R OFPREPARER OTHER~. REFNJMIVE. u.. .., - -- --
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A ES f
SAlOIS, SHUFF, FLOWER & LINDSAY, 2109 MARKET STREET, CAMP Hill, PA 17011
--- -- --- - -- - - --
DATE
1-/0 - O.s-
DATE
I-l{~(:"
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) (11) (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. S9116 (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 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. 99116(a)(1.2)).
The lax 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. 99116(1.2) [72 P.S, s9116(a)(1)).
The tax rate imposed on the net value of transfers to or for the use of the decedent's sibl"ings is 12% 172 P.S. S9116(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.1503 EX+ 16'9B*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Maria A. Massa
FILE NUMBER
21-04-0122
All property jointly-owned with rignt of sl.Irvivorsnip must be disclosed on Schedule F.
ITEM
NUMBER
,.
DESCRIPTION
1,000 shares A TEL Capital Equipment Fund @ 6.58
VALUE AT DATE
OF DEATH
2.
Van Kampen Gov't. Securities Fund Class A (ACGVX) principal bal. 58,428.59 plus 51.94 acc. int.
6,580.00
58,480.53
TOTAL (Also enter on line 2, Recapitulation) $
(11 more space is needed, insert additional sheets of the same size)
65,060.53
REV-1509 EX+ 16-98*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
Maria A. Massa
FILE NUMBER
21-04-0122
If an asset was made joint within one year of the decedent's date of deatn, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A Joseph A. Massa
1320 Georgetown Circle
Carlisle, PA 17013
surviving spouse
B
C
JOINTLY-OWNED PROPERTY:
LETTER DP,1E DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE iNCLUDE NAME OF F;NANCIAl INsmUTIONAND ElANKACCOUNT NUMBER OR SIMILAR DATE OF DEATH DEeD'S VALUE OF
NUMBER TENANT JOiNT 'DENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE VALUE OF ASSET INTEREST DECEDENTS INTERES1
,. A. dwelling, 1320 Georgetown Circle, Carlisle, Cumberland Co., PA 184,000.00 1/2 92,000.00
TOTAL (Also enter on line 6, Recapitulation) $ 92,000.00
(If more space is needed. insert additional sheets of the same size)
REV-1510 EX+ (6-98)
.
COMMONWEALTH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
Maria A. Massa
FILE NUMBER
21-04-0122
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of tile REV-1500 COVER SHEET 'IS yes
DESCRIPTION OF PROPERTY
ITEM INCLUOE THE NAME OF THE TRANSFEREL THEIR RELAJIONSHlr i"O GECEOENI I; NO DATE OF DEATH % OF DEeD'S EXCLUSION TAXABLE
NUMBER THE DATE OFi"RANSFER ATTACHACOPYOF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST IIFAPrLlCABLE) VALUE
1. Allianz Life Insurance Co., annuity #7235317 7,043.96 100
7,043.96
2. Allianz Life Insurance Co., IRA #7235294 52,083.26 52,083.26
100
TOTAL (Also enter on line 7 Recapitulation) $ 59,12722
(If more space is needed, insert additional sheets of the same size)
REV.1511 EX. 112'991.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Maria A. Massa
FILE NUMBER
21-04-0122
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Hoffman.Roth Funeral Home. Cremation Service Charges
cremation casket
3.
urn
2,975.00
1,430.00
225.00
2000
138.00
205.00
543.84
2.
4.
certified death certificates
5.
flowers
6.
7.
coroner cremation fee (25), organist (150), sexton (30)
Oickinson College. funeral reception dining service
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative{s)
Social Security Number{s)/EIN Number of Personal Represenlalive(s)
Street Address
City
Slate
Zip
Year(s) Commission Paid:
2.
Attorney Fees
846.00
3.
Family Exemption; (If decedent's address is not the same as claimant's, attach explanation)
3,500.00
Claimant Joseph A. Massa
Street Address 1320 Georgetown Circle
City Carlisle
Relationship of Claimant to Decedent surviving spouse
State PAZip 17013
4.
Probate Fees
271.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
10,153.84
REV-1512 EX+ (12-Q3)
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Maria A. Massa
FILE NUMBER
21-04-0122
Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbuTsed medical expenses.
ITEM
NUMBER
DESCRIPTION
ERA Mortgage loan (1/2 of $56,365.89 balance on loan secured by entireties real estate)
VALUE AT DATE
OF DEATH
28,182.95
TOTAL (Also enter on line 10, Recapitulation) $
28,18295
(If more space is needed, insert additional sheets of the same size)
REV-1515EX'I~OIlI *'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE 1AX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Maria A. Massa
FILE NUMBER
21-04-0122
RELATIONSHIP TO OECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSONIS) RECEIVING PROPERTY 00 Not List Trustee(s) OF ESTATE
I TAXABLE DJSTRIBUnONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
ENTER DOLlAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
11 NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
~
1 Joseph A, Massa, 1320 Georgetown eir., ea~isle, PA 17013 100.00
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-15DO COVER SHEET $ 100.00
%
%
(If more space is needed, insert additional sheets a/the same size)
LAST WILL AND TESTAMENT
OF
MARIA A. MASSA
I, MARIA A. MASSA, residing in the County of Hernando,
State of Florida, being of sound mind and disposing intent, do
make, publish and declare this instrument to be my Last Will and
Testament, hereby revoking all former wills and codicils made by
me.
FIRST:
I direct that my Personal Representative pay all
of my just debts, including the expenses of my last illness and
burial, as soon after my demise as practicable.
SECOND:
I give, devise and bequeath to my beloved
husband, JOSEPH A. MASSA, if he survives me, all the rest and
residue of my estate, after expenses and taxes have been paid,
to include all of my property, both real and personal,
wheresoever situate, specifically providing for the unlimited,
to spouse, tax free estate marital deduction under the Economic
Recovery Tax Act of 1981.
THIRD:
I hereby reserve unto myself the right to make a
list disposing of items of personal property.
If I make such a
list, from time to time, it will be in my own handwriting,
signed,
dated either contemporaneously with this Will or
subsequent hereto, will describe the items to be devised and the
individual devisees thereof with sufficient detail, and will be
~Q(~
MARIA A. MASSA
found with my copy of this will.
I will not devise by this list
any money, evidence of indebtedness, securities, or property
used in a trade or business.
FOURTH:
Should my husband, JOSEPH A. MASSA, fail to
survive me or should we both die as a result of a common
disaster or so closely together from the standpoint of time that
it is difficult to determine which one predeceased the other,
then in either of these events, I give, devise and bequeath all
of the rest, residue and remainder of my property which I may
own at the time of my death or to which I or my estate may then
or thereafter be in any way entitled, both real and personal,
whatsoever and wheresoever situate, in equal shares, among my
following named children, per stirpes:
A. ROBERT J. MASSA, of Ellicott City, Maryland; and,
B. JANET A. HAMPTON, of Collinsville, Connecticut.
FIFTH:
I hereby constitute and appoint my husband,
JOSEPH A. MASSA, and my son, ROBERT J. MASSA, Co-Personal
Representatives of this my Last Will and Testament.
Should
either of them predecease me, or be unable or unwilling to serve
for any reason, then I appoint JANET A. HAMPTON, to serve with
the other of them as Alternate Co-Personal Representatives of
this my Last Will and Testament.
I hereby waive requirement of
bond and authorize and empower my Personal Representative
appointed herein to sell at public or private sale any or all
property which I may own or be entitled to at the time of my
~ )S.u~,_
MARIA A. MASSA
death,
and
to
execute
good
and
sufficient
assignments,
conveyances and deeds.
IN WITNESS WHEREOF, I have hereunto subscribed my name and
affixed my seal and declared this to be my Last Will and
Testament in the presence of the witnesses who have subscribed
their names hereto at my request, and in my presence, this 3~
day of
rIi 'A- 'f
, 1990.
~()(~
MARIA A. MASSA
The foregoing instrument consisting of three (3) pages of
typewritten material including this page, was on the
3"",
day
of
~'ft~
, 1990, exhibited to us by the above-named
MARIA A. MASSA, Testatrix, declared by her to be her Last Will
and Testament, signed by her in our presence, and we signed in
her presence and in the presence of each other at her request as
of 5151 Commercial Way
Spring Hill, Florida
of 5151 Commercial Way
Spring Hill, Florida
STATE OF FLORIDA
COUNTY OF HERNANDO
We, MARIA A. MASSA, GEORGE M. GERMANN and SHARON A. FLANNERY,
the Testatrix and the witnesses, respectively, whose names
signed to the attached or foregoing instrument, being first
sworn, do hereby declare to the undersigned officer that
are
duly
the
Testatrix signed
signed voluntarily
the instrument as her Last Will and that she
and that each of the witnesses in the presence
of the Testatrix,
other, signed the
knowledge of each
at her request, and in the presence of each
Will as witnesses and that to the best of the
witness the Testatrix was at that time eighteen
(18) or more years of age, of sound mind and under no constraint
or undue influence.
Subscribed and acknowledged before me by MARIA A. MASSA, the
Testatrix, and subscribed and sworn to before me by GEORGE M.
GERMANN and SHARON A. FLANNERY, the witnesses, on the ~~ day of
M~ll ,1990.
My Commission Expires:
~....~~;~V.'~f;?,-,_ cOtJSTANCE A. BROOKS
This instrument prepared by: (i;l;"~ "J~,;~"~sr"199~ES
"'<f,'~f';',->-'" 6"ilul-.l" ldf'i'J ~GlI>..RY P!JSUC WlDEJlWRITE9$
",,"
GEORGE M. GERMANN, P.A.
ATTORNEY AND COUNSELOR AT LAW
5151 COMMERCIAL WAY
SPRING HILL, FLORIDA 34606
(904) 596-0526
L~n"I/.zk~G, /~.
Notary Public
State of Florida at Large
- .-- -'.-- --_._._..-------~------,._._._---_.__._._----_._-
\ A Settlement Statement!
I U_S. Departmeli\ of HO\.J:;'1119 and Utban Developmenl I
'- _ ._..3MBN~502.~g~5 RE~yD-1_@g,~_.__1
~~lYPE OQOAN_______"_________.____I
It, U.FHA 2. rJFmH.A 1 neonv, Unins.. i
_.LDY.A. ._U)Con,~___ ______ _ I
, 5_ FILE NUMBER 1 i_ LOAN NUMBER 1
I_LEWIS03,~__ ___lill3916L___ __'
I B MORTGAGE INS\JRAHCE CASE NUMBER i
T!'iI.-fOrii11irui<iiil\..<i~\....~<>\i~..ni~ioraclU~Ti&fi1iiYii'n1coii;,:'AriiOUrilSP.mnoiiiiifbyllia..iffJemen~iiIare~llOWi1:-----' -;~-~---~;--"I
C Note I.tems m. "". ed "(p..o.c.)" were paid O'.Jt5Ide the closing; !he~ .re Sh. own_ nere lor inform~tJon PUrl'. oses and .r.. not J1d""". '. ,,'II,.. \o\'.\~_ , TI\\eEApreSS Se.\llerr,ent
sYs.'.em
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, G,'j-",\\\~CF50P,?,,0WER GREGORY L. LEWIS - - --- ----
f-- ---.6QORESS'.. __ _____._._______ ___._ _______m_____ ------ ---. ---' --------
, E, NA..'.1E OF SELLER: JOSEPH MASSA
I ~ __ ADDRE~_ _ _ __ _ _.__ _____ _ --~ ------~ - - --- --~ -- ~
F NAME OF LENDER M&T MORTGAGE CORPORATION '
l __}'LlDRESS______ 2270ERJ!igOU~IJ.ANCASTER,P~17601_.__ _- ____ -- --- -- - -- - :
G, ?ROPE.qTY ADDRESS: 1320 GEORGETOWN CIRCL.E, Carlisle, PA 17Q13 I
_____ __.~OT56--'J:HASE4,_WALNUTCOURTlCarlisleBorouQ!L___.______ _______ ____~._ ._
, :-1. SETllEMENl AGP~1: l&M REAL ESTATE SERVICES, LLC, Telephone: 717-249-2353 Fax: 717.249.6354 \
13'--;l.,C~.Qf_SE-;-IlEMf.lli:___ _...J'lestp!)mfret Professio!!~U?!9g".60 West Eomfret Strll Carlisl~,EA 170'11.__ __ _____ __ _ '
.1. SETTlEMENI DAlE o.3/2S12004 - 1
'.~-"-:-j, SUM!.fAjlY~ E10RRO\l{ER'S TRANS~TIQH: . +___ J{, SUMMAEY iJFsE[LER'S tRAlI~ACTION: --=.=1
I-:~ G~~;~,~~e~~~:~EFROM~ROWER__+=--=184,GOQ~ 1~~ 9C~~~"~':~~: DUE TO SELLE"--=-=-t= ~ 184,GGOO~
-~.2.~:::~';~.;h:f~lcb;;;ow"I"neI4QQL L B'246.~~i p"'O.C"Pm.,en, -.. .----:-=.=-=-~--l::'-----~ ---j-'
~,;L.__._ _._____._~__.. _'__"_. 4D4,.._ .__,-_._.._____"_" -----..--
110~ -=-. ... -=_ A~\~~;;;.1?r.ileJ~.' "d';-""O' :"d"C.~' _=- =C05-=-_ Adj<<,lmect; to"""" I@k,,"el :c adY,"~ =-=- ~
__lC~SC[)ooWr _ __9312~104\Q{}6/3!lli1_~_ ._ __ _~~~!U-4QL School Tax__~/29/04l-J06f301Q!. J___ _ 536.90 I
L:~: ---=_=----=---=----=-~:..:-E ~-=---+;: --=--__=~__=_=_=_=_~-__=__=_+- __=__=_____=___--J
I:i;- - --- --___--t------ i :~; - --- ---- - =t=------j
LJ20.G~Q!3'iAMQlJNTDUE F. Ro...~~ORR9.;NE.U== 19~3,22f.420,.GROSS.AMOU!IT-0lJ" TO. ~ELLE.. c=- 1_ -. . .='~53Q9Q.j
!..lQO."MOUIm;Pb.lDBY..QRQNBEHALFOFBORROW<B~- _ _ 500,f!E'DUCTIONS~AMQUJ"T~"TQ~L"R __~_ _ _ ___I
1201. 9~SaDreamesl rT]O.D.iJ,---------F' ___ .MQO'O~O; 501~cesspeDosit(sg~!r!!..ctiGn~_ ___ _+-____._ ___I
.' L.QLJ'r'''2Pa\2..m0'mOlceY;jgac''- _ _. _ _' ._. _...ill~OO .- 502~1!eme.ntchar~tosell~Uii.. Ilni;flL.OQL--- __.' _~.__1~g2.3'L
;_ 2Ql ~xls\mqIClanis\laKton_s\.lbJec\\9_ _ __.__ ___ ~3~~I~sltak~Q~bJffiL ____~--_ ----~
:_?04 .__.________.. _____.__ ________ ?~~~~~~~t;~bTeLCi!n-.--_-- __ 1..____..l~1365.89:
~~~.-.= .=... ~. k. . .~~.. -. ..=-.}.. j
PO=-=~_Mjustmentsforite!llS u~aid ~S-elIer=----=--==\ ?i!9 ~_ Ml!illme~!s for!i~m.swwaid~r=-.==-=i
'_ 21J.o. CQ;ntili!",~__Q1101J04lO(l3/2~1()4. L~_~9.32U11J_Q~ ta~___91101!04t003f29/04__T_ ____ ~9,32_1
~\t .- -1- --rm - .c-:-u -I - ~
1~:-- - - ~:- =-E m - - - =1=-- - ~
I' 220,TmALPAIO.BYIFOR.BORRO~ER = .1-- 1~29.32~20' TOTAL REDUCTIO.N AM.OUNlQ~E SE.L.LE~..= 69,m~
300, CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER .
: -~l: Glgss amou~~;;~ f,am bGrraW81 ~1lQL.__ ~= 1WS3.22 601, Gross amo\.lnt d\.le!~ sell~ne-420) ~_=-~~--~184g~.~
L.J(lLJ..essam. O@"-""..'-"'.i[Orb.CII'W~C'. 22Q1-t~--153.42~.4"02 ,"'cedCObOc.i'",O"--."id08"""-.U.'IIce520L- _1_. -. ____..6~5.97.5~1
UOgASH FROr.t~OR1WWEIL_ _ _~_ _lMs3~iliOHASH TO SELLER _ _ ____ __ ~ _ _ 1ll,9393~
LAWOFFICES
IRWIN & McKNIGHT
WEST POMFRET PROFESSIONAL BUILDING
60 WEST POMFRET STREET
CARLISLE, PENNSYLVANIA 17013-3222
(717) 249-2353
us. DEPARTMENT OF HOUSING Mm URBAN DEVELOPMENT File ~Jumber: LEWISGJ..Q4 PAGE 2
SETTLEM~Nl~D~ T~~ENT_ __PE~HUD-1 {3iB?L______~~leExQress_~!tlement S~m Printeq 03/~9/2004 aill:,1g--1Mfl
~ L,-S~TTLEfv1EN:T-CH~RG;L____,_____________ _,____ _~______._! PAID FROM II PAID FROM
~70QJ9TAL $ALES/BRO~R'S COMMISS10t-J. based on~!.1~4MQ.OO =jQ,540.0L____ __ __ __J BORROWER'S SELLER'S
L__pr,!:.!~loic01lmission~00)8s'ollows: ___________________~ FUNDS AT j' FUNOSAT
'\-~6;, _~ -=-__=-_,.19=~OO _ {~~_:A.NIITJ,NC.-~=__=__=_~~=_=~ ~~_=- -=---=--=-=-~j~ETIlEMENT j_~:_LEM~T_1
i 703. C()rHnIS~aio al Seltlemenl_ -, " ,,'," ' I- -11- ' , 1Q,540.1}Qj
~lg~.,;~~~s~~~lr~:~~ON-NEd~~;~:~ L~;N----=--=: , ~-=-- =-:_----- ,-,-, =__~OO,OL_ =-3Q~OQi
r------- ------- ~ ------ ---- - ---- --~--- -- --1
'.~~, -t;;-=~~It)n ~-0:625 ~~M&T MORTGAGECORPORATIOij=.=~=_==~==~ Lk- _~_~!LQQ :--=-=--=J
1_ 603 -,:~Q~isal rr:L-_____ _19-M&TMQRTGAGE COF;PO~"\~ ___J.~QJ1~PQ B~~; lRI____~5.00 t---- ____ ~
~~~:_ ~~ec~~~~~~_== _ (0- M&T~QfHGAGE CqRPo'RATION=-~~-=-==-=-=-=~_~R\ -= 38S.QQJ_-=--=--==-=!
_~ ]QQ,}-lgrl~.6J2p. ,I~tlc;~e~_.--. .1~g~ORTGAGE COR~ORATI.ON _. _ ___~. P:~~JjIJQ,QgJ~~r-,--___ _ L__ _ ___ .J
L_.B.07----.?mcesslng F~ __ _ _' l'L_M&T MORTGAGE CORPORATI~ _._ __ ____ __ _~~___---.195.0g...f ____ _ j
,~QUax Se~vlc~ f~______ _~__M&IM9!IT9AG~ C9RPORATfO~______ ___ _ ____ _._-----1R,,__ _ __~2:M :____ _ _ _ ~
: :':~ Fieod C"",C3l<Gc~==~M&T MORTGAGE CPIJ!'ORATION =-==--=-==--=_=Rf== _1200 t=-=-== 1
'I ~~, ITEMS REQUIRED BY LENDER TO B~fAlD I-N ADVANCE---=-=-=_-==-=_==-~= i - _.1--- ----\
,-1QL i[@[e~lf~Q!ll_Q~?~904 to 04l01J~~L_@L __~,lli~Js!aL -_ ______~ Day!-___J,,~I ___= 51J..'4= ~-_==~~ i
9Gf:.._MgrtQaQe Insuran.@frQl!iUrn ~_ _~tL_ _ _~__ ~_~_ _ _ __--I_ ___~_! __ ~ _ , _,'
i, :~:~z~;o]r.sur,mc~prelTllli!ft for___.________:~ .---~-- - ---- -- -- ---___-t---~-~ r--- =--=-~
, 905-~___=_====-=----=_=_::::_-==-=-=_-__=___=___ ___=_.=-- - r:______ -- L . --- - I
! 1000JlESEIf{~SDE~!m~QWITI:Ij,ENDERFOR_______ __ _ -- ---- -----,
L,1001,J:tiizardin~(i;nce____ ___.J1,mo..M--____~8.6?1mQ_~~______~_~ CRl--=---=-4~_!!!.!~__ - ~--l
~ :::~:'=:'=-==_-_==_ ::t-=---=---=-~:: -=---=-__=_-=-=-=-___-=t--=-__=_~-r-==_=_~l
~~~~_CoLJntillQ@rt1 Taxes_____~ _ ,_LITlQill___ __~9.26 Imo ____ _______hBl_ __ 158.52_t___. _ --J
~005,SChGOITax-_-" _ 10rno@$ 1?!ll.Lf!\iL____.__,___,___-.h~---1JrrJO __ ...j
'..JQQLAJl9[.~!~l\Fi~sAdiustment JQ_M&T MORTGAG~ COR,PQRATjQJL____ __ __~_~ _1-Bl._ .394,391' _ '_ _-- 0.00 I
ti~~' ;~~~~~~~~~;O-l~-~_==_=~===~==~~_=____=__=__=_~~_=~_-~-~_=_~-_~-r~_=- __= =~-~ =~-=j
n~u:'~:u~;:~!€:;===~=----_-___ - _-=_-=_-i=-.::: t-=-=J
~lG5, Dccurnent Preoaratior:!...., _.______.__________.____________+,___._~--- _ ---l
~ ~:;~:=ef:.,_=__=____ ~SAIDIS~IJ.FFFLO\'l~R & UNDSA"-=--=--_-_=-=--_==__t ~-_____ 10~t===1J~j
l-_Jl1lciudesabo,.e!~~NQ:______'____________~______.l,___~__'t_ _ :, i
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__---1!0Q.U.(j~eb\.wel:em5t!9.:. -~------ __,_.~___,~~_.l_ =1 \ 1
[.JjQ1_Jend~QliCL __ ______147.200.00 --=- _. _ . . _~-~ -~_____:----- ---!~- -'---',
L_ UJO-,- Owner's Polg ~__~.---J~OO.Q!L~j)7a.75 -=-=---=-~-=--=----=--=-=- -=- -__-_ _ _J _ _ ____ J
.J.l1LJnd 1m ~Q~OLgnQ.D~ndto STGCll~~EAL ~TAIL______ __ __ _ __ __ _ I _ _____ 250,QQ.I__ ___. I
\ 1i12_ErjQ900,820 -: ! ----j
L~l11J CI@n~cL;--=_==---=-~-(~STG-CII&MREAL ESTATE ---_____ ---:--------:--__-- --1--- -35"'oo_r--- -- - --l
I J100 ~O~RNMENTJECORDJNG AND TRANSFER CH~~ES ==-== ===-==-=:==-=-----== "- -.:::=== ==1
'..J2Q1~Qfaln..9l'~ Deegj~!qQ.~ ~0jgg~~Ji.L~c.Bgleastl ~~__~._ _ __ ___ -+______117.00 I .. I
1,-1202, Cih!Ca\!I1i ~r~rr:Q~ _ __----.QeedH.,840.00 ___..MortoaoeL-_______ ______,__U4Q,OO t------=-_=_~ -=-_:-_----1
\.JlQl.~ta(e_kxlslafl}f@____~.J2eed 1l,840.~ _,Mgr1oaoe $_________ ____ __ _ 1_______-1____ 1J40,QO I
~~~~~O:~~T~~NT~~RG~~_. _ -==_-:::- --=_~=-__~;~~_ _=--=~-~~-=~
i 13G2,PeSUDi~!iQ[!________________________ '.'_ I. I ---I
~J303 AHS HOME WARRANI'L_ to AMERICAN HOME ~J~___~______ ___--=-_=-_-~-- -~ -1--~ -262:47J
C l~' SEW~R_~~!t6~~ -=-==-~AB~~~R.Q!&tL~.- ---__~~___=_~~~~__=_-_}--.- _j-=---=--_1~i4~
f--.l306..20Q~Orr~\{f. lLXES __..J9 DARLENE M.OYER.JAX COLLECTOR _,___________ _L-__~~.161_... ___---_-1
j i30L.YvJ@ I~____._ __ __-.J?J~tIi REAL E~ATE SERYICE~ LL~__ ___ _____l_ __ _~:~ :-__--- -:
1-1JQ1l ",,=hi.D'~ -- - -- -j~~ REAL ESTAT~~RVICESJ,L~__ - - - - --- -~- __-,050f-__ ~-:-~1
~ 1.!Q9.JQIA!.gT!b~M~li!:!8RGf& _ lenterQ.nlines 103 Sec\ioo j and 50Lj&cllon K) . _ ___ __ _L __ J!,~~nl_ __13J1Q~1!]
HUOCERT1FICATlONOFIlUYERA!-IOSEI-I.ER
:""~"': i';::~~,::",:(z~~~~:~:~:,:;:,~:~~~,.;,~:,:~:~:,g~::.:,,,., ""."., .~.'"",." """"m.',,' '00"","'" """"",m'." m." ,. m,oo,,'" m"
"o[,~"^l~-L~ -----
t ",hk~ j 1I~~:' p'&par&~ 1$ a true ano a~curale account of !/lis Iran.actio
, ";Z";~?"''''''.m."'
om
WARNIN.G.: 1T IS ,l.Cf'liME TO KNCWlNGL Y MAKE FALSE STA,TfMEtHS TO WE
UNITED STATES ON THIS OR ANY SIMILAR FOR'" PENALTIES UPON CilllVICT\ClN
c..... INCLlIDE A FIf<E: A/olO lMPR1<;;OIolMENT. FOR OETAJL.S SEE TITLE 18;
US_CODE SECTlON 1001 AND SECTION W'O
VAN KAMPEN
INVESTMENTS
(; cnctat IOns of Experience'"
1-00182152; D4/G2,iOI.-13n2.0B
Investment Report
January 1. 2.004 - March 31, 2.004
Page 1 of 2
MARIA MASSA
AlC 475-019032-051
THE HEATHER
1320 GEORGETOWN CIR
CARLISLE PA 17013-3578
003D~~
I",III",IJI"""IJ"II",II"I,I,/",II"I",I,III"",11,1
Total Portfolio Value 'a~ alMareb 31,2004'
$0.00
OuarterlyActivity
VemAQ-Oate Activit\!
Beginning Value
I nvestme nts/Contributions
Withd rawa I s/ Re d em ptio n s
Investment Earnings
Change in Market Value
Total Portfolio Value
$58,428.59
$0. 00
$0.00
$201.26
($58,629 85)
$0.00
$58,428,59
$0.00
$0 00
$201.26
($58,629 851
$0.00
-
-
Financial
Advisor
BOWMAN, WILLIAM
475-051
MORGAN STANLEY DEAN WITTER
301 S TRYON S1 S1E 1600
CHARLOTTE NC 28202
@
6
Access
Your Account
On the Web
(Booi 84n424
vankampen.com
Expecting a tax refimd? Talk to your
financial advisor about additional
investment opporrunities v.'ith
Van Kampen -- and don't forget to ask
how you can have your refund deposited
into your account.
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in our 2003 Tax Guide. Simply go to
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Fund Name/Svmbol Ol'eningVallle + Investments! Withdrawalsj + Investment + Change . Closing Value
Fund/Account NlImiler 115 of 1/1)1/2004 Contributions Redemptions Ellrnings in Value /lsof3j31j2004 ~
c
Non-Retirement '"
Government Securities Fund Class A (ACGVX)
29/670510065 S58,428.59 $0,00 $0.00 $20126 1$58.629851 $0.00
Total All Accounts $58,428.59 $0.00 $0.00 5201.26 1558,629.85) 50.00
1-001821521
04/02/04-13.02.08
VAN KAMPEN
INVESTMENTS
Investment Report
GeneratlOlls of [x/Jericncc'"
January 1,2004 - March 31,2004
Page 2 of 2
Government Securities Fund Class A (ACGVX)
Fund/Account Number
Account Owner
29/670510065
Maria. Massa
A/e 475-019032-051
Year-to-Date Dividends
Year-to-Date Capital Gains
Dividends are
Capital Gains are
$201. 26
$0,00
Reinvested
Reinvested
Trade
Oa1e
Transaction
DeSCfilltion
Dollar
Amount
7
Share
Price
=
Shares This
Transaction
Total
Shares
Beginning Value as of 1/01/2004
01/30/2004 Income Reinvest
02/17/2004 TransferTo 6910039974
Ending Value as of 3/31/2004
$58,428,59
$201,26
$0,00
$0.00
$10,36
$1039
$0,00
$10,43
19,371
(5,659 1961
5,639,825
5,659 196
0,000
0,000
Thank you faT choosing Van Kampen lnvesunents. Your satisfaction is important to us. If you notice
any inaccuracies on your statement, please contact us within 60 days of receiving this statement.
Maria Massa
Ale 475.019032.051
The Heather
132Q Georgetown err
Carlisle PA 17013-3578
To make investments by mail. please complete, detach and mail this srub with your
cheCK. ~or address changes. visit vankampen.com or complete the reverse side of
this form and return itto Van Kampen
Fund Name/Symbol
Fund/Account Number
GO\lernment Securities Fund Class A (ACGVX)
29/670510065
Investment
Amount
VAN KAMPEN INVESTMENTS
P.O,BOX219319
KANSAS CITY, MO 64121-9319
$
$
$
s
Total Amount
$
1,11",1"1,,,11,,\,\,,,111,1,,,,11,,,,111,1,,1
Please rumemberto include the account number on your check and specifyrhe
amount being invested above
1209 Georgetown Circle
Carlisle, P A 17013
January 15,2004
ATEL
600 California St.
6th Floor
San Francisco, CA 94108
Dear ATEL
This is a letter of instruction following the death of my mother, Maria A, Massa, on
January 8, 2004 The MA Massa Revocable Living Trust under Soc Sec # 095-14-3092
owns 1000 units of A TEL Capital Equipment Fund. I am the successor trustee, and my
t:1ther, Joseph A. Massa (Soc Sec 075-16-9043) is the beneficiary
1 have enclosed a copy of the death certificate, the relevant pages from the Trust
agreement documenting my status as Trustee and my father's as beneficiary.
Please send future monthly distributions, payable to Joseph A. Massa to the M.A Massa
Revocable Living Trust, Robert J Massa, Trustee, 1209 Georgetown Circle, Carlisle, P A
17013
If you have any questions, or if you need further information, please contact me by emai!
attllil>Sit!fMicki.I],sQI1,.,,,gtJ, by work phone at 717-245-1287, or by cell phone at 7] 7-805-
4139 Thank you.
Sincerely,
Robel1 J Massa
Teresa D Kayn, 04:06 PM 4/15/02 -0400, Re: Amount Due on my account
Y~hoQ\ MY.Y~\1QoJ Milll
"Y"A.Hoot. FINANCE ~e~~s~~ 51gt]lJQ~
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ADVERTISEMENT
, In ''''^^ ~
1209 Georgetown Circle
Carlisle, PA 170 J 3
January 15, 2004
AlIianz Life Insurance Cu.
PO Box 59060
Minneapolis, lVIN 55459-0060
Dear Allianz
This letter references Policy numbers 7235294 and 7235317, (Maria A Massa IRA and
Maria Massa Living Trust, respectively)
This is to notifv you ofMrs Massa's death on January 8, 2004. A copy of the death
certificate IS enclosed.
For the IRA account (7235294), please issue a lump sum payment to the surviving
spouse, Joseph A Massa (ssn 075-16-9043) at the above address Include any survivor
benefits, as well
For the Trust account, (7235317) I have been designated as the Trustee upon my
mother's death. I faxed a copy of the relevant pages of the Trust agreement, but enclose
one herein for your convenience. The surviving spouse, Joseph A Massa, has been
designated as the beneficiary of the net income from the Trust. Please change the address
of the Maria Massa Living Trust to the address above, and change the trustee to Robert J
Massa (son)
Please provide me with any instructions I may need to regarding options to subsequently
terminate the Annuity in 7235317 due to my mother's death and to receive a lump sum
payment for the benefit of my father. Based on this information, I will make a decision
regarding these optjons.
Also, please contact me by phone at 717-245-1287 (work) or 717-805-4139 (cell) if you
need any other documentation. Thank you.
Sincerely,
Robert 1. :V1assa
Allianz Life Insurance Company of North America
PO Box 59060
Minneapolis, MN 55459-0060
800/950-1962
Allianz @)
January 13.2004
Maria A. Massa Living Trust dtd 05/03/1990
C/o Robert Massa
\209 CJeorgetovm Circle
Carlisle. P A ] 70] 3
Re: Maria A. Massa. deceased
Policy Number 72353] 7
C OJ-- ;PCU--l~
_ '-/ r IJ_
~
Dear Trustee:
W'e are sorry' to hear o[your recent loss.
Listed below are the options available to
pte accept our sincere sympathies.
e trust as the named beneficiary:
1) Select an Annuit)' OPti<>n~ent. Annultlzc the contract receiving the higher
Annuitizatlon Value 0<<$52,083.2 . Please refer to the contract regarding settlement options
and mlOlIl1Um payout p~ ".
2) Select the Guaranteed Bcnefit Account. Receive the lump sum Cash Value of $47,668.50
in 3n interest bearing account. See the enclosed question and ans\'\'cr sheet regarding this
program.
In accordance with IRS regulations, the policy must either be annuitized within one year
horn the date of death or cashed out within live years from the date of death. Based on
state regulations, the policy proceeds must be claimed within two to five years from the
date of death or the proceeds may be paid to the appropriate state.
The enclosed Annult\' Claim Form needs to be completed by the trustee and returned to our home
office along with one certified death cel1lficate (must have raised state seal), and if available, a
dated obituary. \Ve \vill also require the entire COP v of the Trust A!!reement indl\din~ any
Amendments. Refer to the Special Instructions Section for specific requirements necessary to
process your claim.
Please give this matter your Pronzpt Attention and submit your claim form as soon as possible.
Thank you. and again please accept our condolences.
Sincerely,
trr,~~
Stephanie Paut
Claims Examiner
Alllanz Life Insurance Company of North America
PO Box 59060
Mmneapolls, MN 55459-0060
800/950-1962
Allianz @
January 13. 2004
Joseph A. Messa
C/o Robert Massa
1209 Georgetown Circle
Carlisle. PAl 70 13
Re: Maria A. Massa, deceased
Policy Number 7235294
Dear Mr. Massa:
\\/c are sorry to hear of your recent loss. Please accept our sincere sympathies.
Listed below are the options available to you as the named beneficiary:
I) Select the Spousal Option. You could continue the original contract in your name and cam
interest at a competitive rate.
2) Select an Annuity Option Settlement. Annuitize the contract receiving the higher
Annuitization Value of $8,596.15. Please refer to the contract regarding settlement options
and minimum payout periods. ,
3) Select the Guaranteed Benefit Account. Receive the lump sum death benefit' f $7,04:3.96
in an interest bearing account. See the enclosed question and answer sheet regal'
program.
Based on state regulations, the policy proceeds must be claimed within two to five years from the
date of death or the proceeds ma) be paid to the appropriate state.
Please complete and return the enclosed Annuitv Claim Form to our home office along with one
certified death certificate (must have raised state seal), and if available, a dated obituary. Refer
to the Special Instructions Section for any specific requirements necessary to process your
claim.
Please give this matter your Pronlpt Attention and submit your claim form as soon as possible.
Thank you, and again please accept our condolences.
Sincerely,
~~~
Stephanie Paul
Claims Examiner
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY. PENNSYLVANIA
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Maria A. Massa
Date of Death: January 8,2004
Will No.: 2004-0122
Admin. No.: 21-04-0122
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion ofthe 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.
Dare: Lf~ 7 ~o 5 ~w;c~-
LD. No. 83993
SAIDIS, SHUFF, FLOWER & LINDSAY
2109 Market Street
Camp Hill, PA 17011
(717) 737-3405
;.'......'"
Capacity: _ Personal Representative
~ Counsel for Personal Representative
cPf
BUREAU OF INDIV:tOUALTAkES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
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)
DATE
ESTATE OF
DA TE OF DEATH
FILE NUMBER
COUNTY
ACN
04-04-2005
MASSA
01-08-2004
21 04-0122
CUMBERLAND
101
Allount Re..i Hed
MARIA
A
THOMASr~'F(OWER
SAIDIS ETAL
2109 MARKET ST
CAMP HILL
PA 17011
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 ~
"t~-.t!r4,.Y!.m.m!'1m,.wtm.W.!MftAY'I'4M."t.m.lmlYftNlWf~.'rCtW4M!'1!'.r.Jt'.............. ...
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MASSA MARIA A FILE NO. 21 04-0122 ACN 101 DATE 04-04-2005
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)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
65.060.53
.00
.00
.00
92.000.00
59.127.22
(8)
NOTE: To insure proper
credit to your account.
submit the upper portion
of this forn with your
tax paYllent.
216.187.75
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral ExPenses/Ad... Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Lians (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/GovernllBntal Bequestsj Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
10.153.84
28.182.95
(11)
(12)
(13)
(14)
38.336 79
177.850.97
.00
177.850.97
I~ an asseSSMent was issued previoUSly, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ~ returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. AIIount of Line 14 taxable at Lineal/Class A rat. (16)
17. Anount of Line 14 at Sibling rat. (17)
18. Amount of Line 14 taxable at Collat.ral/Class B rate (18)
19. Principal Tax Due
X CR :
NOTE:
(19)=
.00
.00
.00
.00
.00
177 .850.97 X
.00 X
.00 X
.00 X
00 =
045 =
12 =
15 =
DATE
NUMBER
+
INTEREST/PEN PAID (-)
AMOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.00
. 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.) ~
Q...: