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HomeMy WebLinkAbout04-0129PETITION FOR PROBATE and GRANT OF LETTERS Estate of .,~Z/.5,~ ~_~ /rv4~m~ ~ also known as ~ Deceased. Social Security No. oqdd ~ ~/- ~.~ The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age.or older, an the execut in the last will of the above decedent, dated ~-,~_~,,~ ~ter- ,_~ and codicil(s) dated To: Register of Wills for the ~ County of d-~z~/ff~/,~m,_~ in the Commonwealth of Pennsylvania named (state relevant circumstances, e.g. renunciation, death of executor, etc.) Oecendent was domiciled at death in ~z~A/e (/~_~,~-~ County, Pennsylvania, with h ~ ~ . last family or principal residence a~,~-"~> - -/ (list street, number and rnunc~p~litY)- De, cendent, then ,40":~ _ years of age, died ~-~-~ Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted .after execution o f ~f/w:/g~ffered for probate; was not the victim of a killing and was never adjudicated ~ncompetent: 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 z~ex/-~r~Tt~?/ theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF 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 well a~ t~r:y a~ iniste~/h~.estate according to law' Sworn to or affirmed and subscribed ,~ ~~/ff ~¥~ /~z~~ b~ore me this /~ ~ day of [ ' ~ ' ~ / No. 9' Estate Of ~l~i~ .~ ~V~v'~ ~ , 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 _(~-I- ,:2.: c~-E'O / described therein be admitted to probate and filed of record as the last will of and Letters --'~-r-~ are hereby granted to ~lffogcc ,q, in consideration of the petitionon FEES ,~.0,~,~ ~etters, Etc .......... .~ ~ ~"f. r')c~.OO Si~/~t' ~ertificat es( )...' ....... $ ~iation ................ TOTAL Filed ~. ~d,~...~(~..,,f_~...4.~.. :..~zS)~.. ~. ..... / ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITN~ codicil (each) a subscribing witness to the will presented herewith,~h) being duly qualified according to law, depose(s) and say(s) that ,/'/' present and saw the testat. ., sign the same and that signed as a witness at the request of testat, in h presen~nd (in the presence of each other) (in the presence of the other subscribing witness(es)). / Sworn to or affirmed and su~ribed before me this ,~ day of (Name) (Address) Register (Name) (Address) REGISTER OF WILLS OF COUNTY O ,XU OV sOS-S l SCmmS w xs ss (each) a subscri)?er hereto, (each) being duly quat~ied according to law, depose(s) and say(s) that '[A]~_.~ [-q~-~ familiar with the signature of ~ [--~[ ~ ~ ~~~ testa~t~I ~ of ( ~ ' ) the resented herewith and that ~ believ~ the signature ~ on th will ' in the handwriting of to the best of _~ M~_ _ knowledge and belief. Sworn to or affirmed and ~ub:cribed before ........... me this /~/ day of ~'V .... (Name) (Address) 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 ~ /7 'L-~al'R'egis~rar - ! // P 10021204 No. ~ Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH Elsie Trueman Female ~ 200 -- 01- 3534 ~ January24,2004 i [ Jul3,19151 PRtib4Jfgh, PAI~a ~a ~a I~= ~ ~a / I~ I~, I~ ~ ~ T~. ~ ~1~ Dr. M~n~bu~,.PA 17055 ~ WhRe I~ ' It Itt Cumberland 258 Collier Dr. Mechanicsburg, PA 17055 ~,*~,~ ~.,t,..,~ t~ Louis Montogomery ~-m~-~ ,~ ~,~.~ Gall Shamitko ~ a,,, PA ~ ,h4~ ,....n.,m...d~ Monroe Twp. ,~.,._..~ Cumberland ~ ,,~3 Jan 29, 2004 FD-012142-L Jane Brown _. 258 Collier urive Mecnanicsourg, wA 17055 --'---------- Jefferson Memorial Park , PA 15236 ~r~. '~°R ~e~~ Home, Inc. 1503 Bm~tvflte Road Pitlsb~Jrgh, PA 15210 MARLIN R. McCALEB LAST WILL AND TESTAMENT I, ELSIE J. TRUEMAN, of the Township of Monroe, County of Cumberland and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils by me at any time heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my Executrix, hereinafter named, as soon as conveniently may be done after my decease. SECOND. I hereby make the following specific bequests: A. I give and bequeath the sum of Four Thousand and No/100 ($4,000.00) Dollars unto my grandson, JOHN J. MILLS, absolutely, if he survives me. B. I give and bequeath the sum of Four Thousand and No/100 ($4,000.00) Dollars unto my granddaughter, JULIANNE MARION GILL, absolutely, if she survives me. C. I give and bequeath the sum of Four Thousand and No/100 ($4,000.00) Dollars unto my grandson, PAUL ERIC SHAMITKO, absolutely, if he survives me. D. I give and bequeath the sum of One Thousand and No/100 MARLIN R. McCALEB ($1,000.00) Dollars unto my great-grandson, JOHN J. MILLS, JR., absolutely, if he survives me. E. I give and bequeath the sum of One Thousand and No/100 ($1,000.00) Dollars unto my great-granddaughter, KAYLA ANN MILLS, absolutely, if she survives me. F. I give and bequeath the sum of One Thousand and No/100 ($1,000.00) Dollars unto my great-grandson, AUSTIN GILL, absolutely, if he survives me. G. I give and bequeath the sum of One Thousand and No/100 ($1,000.00) Dollars unto my great-granddaughter, JUEL SHAMITKO, absolutely, if she survives me. H. I give and bequeath the sum of Two Thousand and No/100 ($2,000.00) Dollars unto my niece, ALICE LENTZ, absolutely, if she survives me. I. I give and bequeath the sum of Two Thousand and No/100 ($2,000.00) Dollars unto my grandnephew, LARRY LENTZ, absolutely, if he survives me. J. If any of the beneficiaries named above has not attained the age of twenty-one (21) years at the time of distribution of said bequests, then I order and direct that the bequest provided herein for such beneficiary shall LAW OFFICES MARLIN R. McCALEB be paid over and distributed unto his or her natural parents as custodians for the beneficiary under the Pennsylvania Uniform Transfers to Minors Act. THIRD. I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever situate, in equal shares unto my children, JOHN J. TRUEMAN and GAlL D. SHAMITKO, share and share alike, absolutely and in fee simple. Provided, however, that if my son, JOHN J. TRUEMAN, shall not survive me, then I order and direct that the share provided herein for him shall instead be paid over and distributed unto GAlL D. SHAMITKO, absolutely and in fee simple. Provided further, however, that if my daughter, GAlL D. SHAMITKO, shall not survive me, then I order and direct that the share provided herein for her shall be paid over and distributed unto her then-living issue, per stirpes, said issue to take the ancestor's share by representation and not per capita. LASTLY. I nominate, constitute and appoint my daughter, GAlL D. SHAMITKO, Executrix of this, my Last Will and Testament, to serve without bond in this or any other jurisdiction. IN WITNESS WHEREOF, I, ELSIE J. TRUEMAN, have hereunto set my hand and seal to this, my Last Will and Testament which consists of four (4) -3- MARLIN R. McCALEB typewritten pages to each of which I have affixed my signature this,~? -~,'~/~lay of ,::) (':J~?i~-'~-- , A.D., Two Thousand One (2001). The preceding instrument, consisting of this and three (3) other typewritten pages, each identified by the signature of the Testatrix, was on the date thereof signed, sealed, published and declared by ELSIE J. TRUEMAN, the Testatrix therein named, as and for her Last Will and Testament, 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 hereto. -A- ELSIE J. TRUEMAN LAW OFFIGES FP.2kNKEBERGER BUILDING 219 EAST MAIN STREET MEGHA---N'IGSBURG, PENNSYLVA_.N'IA 17055 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: ~/(_.~/~v ~, /p,/P ./t~ Admin. No. 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 : Name (rz~,.ij ~, d~a.,.,~d.~,~, ,~-- . . Address VFh , ~- Ph' //:, ,.TL __.; ' " / ~ ' . Notice ha~ now been given to all persons entitled thereto under Rule 5.6(a) except. Signature Name 4'~// Address .~ ~--~c_ Telephone (7/,?) Capacity: /Personal Representative Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF NDIVIDUAL TAXES DEPT 28060~ HARRISBURG PA i 7128 0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV 1162 EXIll 96) NO. CD 0O4529 SHAMITKO GAlL D 258 COLLIER DRIVE MECHANICSBURG, PA 17050 ESTATE INFORMATION: SSN: 200-01-3534 FILE NUMBER: 2104 0129 DECEDENT NAME: TRUEMAN ELSIE J DATE OF PAYMENT: 10/22/2004 POSTMARK DATE: 1 0/22/2004 COUNTY: CUMBERLAND DATE OF DEATH: 01/24/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $5,624.67 TOTAL AMOUNT PAID: $5,624.67 REMARKS: G D SHAMITKO SEAL CHECK#1007 INITIALS: VZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA HARRISBURG PA 17!28-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FIRST, AND MIDDLE INITIAL UJ T LU FILE NUMBER SOCIAL SECURITY NUMBER DATE OF DEATH lMM DD YEAR) DATE OF BIRTH IMivl DD YEAR:, THIS RETURN MUST BE FILED IN DUPLICATE WITH THE F APPL CABLE} SURV V NG SPOUSES NAE/LAST FIRST AND 'vIIDDLE INITIAL~ SOCIAL SECURITY NUMBER 3 Remainder Return ~ 4 Limited Estate [] 5 Federal Estate Tax Return Required ~6 Decedent Died Testate ~:h:h :c~, ot alii; [] 7 Decedent Maintained a Living Trust :At:ar, cop! f T"tiS[ 8 Total Number of Safe Deposit Boxes ~]9 [] 11 Election to tax under Sec 9!13(A) ,At:ac, Scq Cu Litigation Proceeds Received THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: UJ X FIRM NAME :lfAap ca31el TELEPHONE NUMBER COMPLETE MAILING ADDRESS 1. Real Estate (Schedule A) I1} 2 Stocks and Bonds (Schedule B/ (2) 3 Closely Held Corporation Partnership or Sole-Proprietorship (3) 4 Modgages & Notes Receivable (Schedule D} (4) 5 Cash, Bank Deposits & M)scellaneous Personal ProperLy (5) ~///~, 2~'(:,~' (Schedule E) ¢ Owned Property (Schedule F) rD) g Requested 7 Inter-Vivos Transfers & Miscellaneeus Non Probate ProperLy r7/ !Schedule G or L) 8 Total Gross Assets (total Lines 1-7) 9 Funeral Expenses & Administrative Costs (Schedule H) 19) /.~ ~'~ / 10 Debts of Decedent Modgage Liabilities, & Liens (Schedule I} (10) / ~ ~ ~ 11 Total Deductions (total Lines 9 & 10/ 12 Net Value of Estate (Line 8 minus Line 11) 13 Charitable and Governmental Bequests/Sec 9113 Trusts for which an erection to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Lie 13i 15 20 Amount of Line 14 taxable at kneel rate Amount of Line 14 taxable at sibling rate Amount of Line 14 taxable at collateral rate SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Amount of Line 14 taxable at the spousal tax rate or transfers under Sec 9116 (a)(1.2 Tax Due > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Decedent's Complete Address: Tax Payments and Credits: 1 Tax Due (Page 1 Line 19) 2 Credits/Payments A Spousal Poverty Credit B Prior Payments C Discount 3. Interest/Pena]tyif applicable ~-- D Interest E. Penalty 4 If Line 2 Ls greater than Line 1 + Line 3, enter the difference This is the OVERPAYhIENT. Check box on Page 1 Line 20 to request a refund 5 If Line 1 + Line 3 ts greater than Line 2, enter the difference This is the TAX DUE. Total Credits ( A + B + C ) (2) Total Interest~Penalty ( D + E ) (3) (4) A Enter the interest on the tax due. (SB) B Enter the tote of Line 5 + 5A This is the BALANCE DUE, Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes No 1 Did decedent make a transfer and: a retain the use or ~ncome 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 L~ [] without rece v ng adequate cons deration? 3 Did decedent own an "in trust for" or payable upon death bank account or security at his or her dea h? 4 Did decedent own an Individual Retirement Account, annuity, or other non-probate property which F~ r~ contains a beneficiary designation? IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS For dates of death on or after July f, 1994 and before January 1, 1995. the tax rate imposed on the net value of transfers to or for the use of the surviwng spouse Ls 3% [72 PS §9116 (a)(1.1) 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 PS §9116 (a) (11) (ii)l The statute does n~ot exemp~ a transfer to a surviving spouse from tax and the statutory requirements for disclosure of assets and filing a tax return are the suP,'iving spouse is the only beneficiary, Fo dates o dee h on or afte Ju y 1,2000: The tax rate imposed on the net va ue of trans ers f om a deceased ch d 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% I72 PS. §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) I72 P,S. §9116(a)(f)] The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 PS. §9116(a)(1.3)] A sibling is defined, under Secton 9102 as individual who has at least one parent in common with the decedent, whether by blood or adoption, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESfDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONALPROPERTY ESTATE OF FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate All prope~y jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. * ~ P/fC TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) Yotal Banking Statement ?NC ~t,~ 1~ PNCBAN< ELSIE J TRUEHAN COLLIER DR NECHAHICSBURO FA 17055-gq0q or call 1 888-PNC SANK MovingT Please contact tls at t-888-PNC-IgANK ilelatJonship Overview PO Box 609 Pittsburgh PA 15230-9738 TOOterrninal: I 800 53t-t648 Bai~k Oepos~ Accounts '- ' 2?,,077.37 turboTax(R) for the Web(sMi. It's as easy as 1-2-3. 15':~ on Turbdi'ax{R) for the Web~s,~i) sci lice Visit ~savw.pncbank.~:om/offers/TTW [m .fret details aml access to helpful Pr~.,.;,,=, Plan Interest Checking AccoLmt Summary tlalam~ce Summary 1,719 25 4,887 rransaction Summary interest Ssmu~a~y ~L2OZ 28 L7351~5 72 Please see the Aclivib/Detail section for Premium Plm] Account Statement ForUm period 01/1~2004to 02/10/2004 ELSIE J TRUEN~N 258 COLLIER DR MECHANICSBURG PA 17055-9404 Primer? a¢cotmt mzmber: ?0 9009 0226 Page. 1 of 2 Accotmt Link ¢. hy Web on pncbank.c~om call 1-888 PNC-BANK Moving? Please contact us at 1 888 PNC BANK TurboTaxl;i Ior the Weblsal. It's as easy as 1-2-3. 15% mi fm boTax(R) iZ. d~e Wc}~SM: scrdce Visit wx~.lmcba.k.com/oll'ers/T]¥?'[t~l uffc~' details ;md acces~ to ~ ~ t~he'l/U' d]ForlnalioH. Premium Plan Performance Moaey Market Accomtt Seminary Balance S#mmar~ 21,13621 6 91 rio 21.H3 12 136 t5 ()(I Interest Summary I~cli~it¥ Detail Elsie J Trueman Please see the Activity Detail section for additional information. As of 02/10. a total of $14.93 in interest was earned this year. Deposits and Other There was t Deposit or Other Addition )1 ]4 21,Bfi.21 ¢2'1o 21,1-13 I,,,IJJ,,,Jli,.,J,J,,J,J,hJ,,,i,dll,,.l.l,i,J,h,h.l,II ELSIE J TRUEMAN Z58 COLLIER DR MECHANICSBURG PA 17055-g40~ JANUARY ACCOUNT NUMBER 530109100 MATURING ACCOUNT INFORMATION MATURITY DATE 2/14/2004 MATURITY VALUE $I0,000.00 IF AUTOMATICALLY RENEHEO TER~ q8 MONTHS MAT~JRITY DATE 2/l.L/20O8 YOUR DOLLAR BANK INCOME CERTIFICATE HILL MATURE ON IHE DATE SHDHN ABOVE. FOR YOUR CONVENIENCE, ME MILL AUTOMATICALLY RENEN YOUR CERTIFICATE FOR THE SAME TERM AT THE ANNUAL PERCENTAGE YIELD IN EFFECT OH THE MATURITY DATE - IF ME DON'T HEAR FROM YOU MITHIN SEVEN CALENDAR DAYS AFTER THE MATURITY DATE. BECAUSE THE ANNUAL PERCENTAGE YIELD AND INTEREST RATE HAVE NOT YET BEEN DETERMINED, YOU CAN CALL 1-&OO-242-BANK OR YOUR DRANCN OFFICE ON THE ~TURITY DATE FOR THE CURRENT ANNUAL PERCENTAGE YIELD AND INTEREST RATE. YOUR NEXT ~RTURITY DATE, IF YOU CHOOSE TO AUTOMATICALLY RENEH YOUR CER- TIFICATE, IS SHONN ABOVE. PLEASE READ THE ENCLOSED PAMPHLET, ENTITLED "IMPORTANT INFORMATION ABOUT YOUR CERTIFICATE," THAT DETAILS TNE TERMS AND CONDITIONS OF YOUR ACCOUNT. GET THE BEST RATE AVAILABLE! BEFORE YOUR CERTIFICATE MATURES, USE OUR SPECIAL REMEMAL SERVICE. -CALL ]-80O-Z~-BANK MONDAY - FRIDAY 9 A.M, TO 5 -TELL US YOU NISH TO RENEN. -YOU MILL RECEIVE THE ANNUAL PERCENTAGE YIELD ON THE DAY YOU CALL OR ON YOUR MATURITY DATE, MMIC, NEVER IS HIGHER! -YOU NIH EITHER MAY. NANT TO CHANGE THE TERM OF YOUR CERTIFICATE OR ADD MONEY? IT'S EASY. JUST MAKE YOUR CHOICE DELON, SIGN AND MAIL THIS NOTICE BACK TO US IN THE ~NCLOSED ENVELOPE, AT DOLLAR BANK, ME ARE HORKING HARDER TO BE YOUR BANK. TRY US FOR ALL YOUR OTHER FINANCIAL NEEDS, TOO, -i~ANT 'iD PAY DILLS ~Y PHUNE~ 1R¥ OUR TELEPHONE BANKING SERVICE. -NEED A CHECKING ACCOUNT THAT HAS NO MINIMUM BALANCE RE#UIREMENTS AND NO MONTHLY SERVICE CHARGES? NE HAVE IT. -PUT YOUR NOME TO MURK FOR YOU, OUR HOME E~UI/Y LOANS ARE THE PERFECT BORROMING OPTION. CALL 1-&OO-2~2-BANK TO OPEN AN ACCOUNT OR TO APPLY FOR A CONSUMER LOAN BY PHONE. THANK YOU FOR INVESTING NITH DOLLAR BANK. TO CHANGE THE TERN OF YOUR CERTIFICATE COMPLETE THIS SECTION, SIGN AND MAIL CHANGE MY RENEWAL TERM TO (6 MONTHS TO lO YEARS AT ANY 6 MONTH INTERVAL) ADDITIONAL DEPOSIT OF ~ IS ENCLOSED. (DO HOT SEND CASH.) SIGNATURE(S) DATE SUBSTANTIAL PENALTY FOR EARLY HITHDRANAL OF ALL OR ANY PORTION OF THEDALANCE HELD IN A CERTIFICATE OR TIME DEPOSIT. PO Box 32760 Louisville, KY 40232 Classic Account Statement January 1 * January 31, 2004 Page 1 of ELSIE J TRUEMAN 258 COLLIER DR MECNANICSBURG PA 17055-9404 INVESTOR INFORMATION Investm, Update Worried about reac6inq your financial qoals so you can live comfortabiy ~unng retirement'? Contact your Financ~a Consultant today for an annual review of your portfolio. CONTACT INFORMATION Your Financial Consultant (J2D1) MARCIE MCCARDELL 717-691-4036 Customer Service Desk 1-800-762.6111 Access your account online al www.pncinvestments,com ACCOUNT VALUE Cash Equivalents Assets held at PNC investments Assets not held at PNC Investments Account Number 84192163 Office Servicing Your Account PNC INVESTMENTS 2 EAST MAIN ST MECHANICSBURG, PA 17055 $0.00 $0.00 $66,164 30 Total Account Value as of January 31, 2004 $66,164.30 Total Account Value as of December 31, 2003 $65,937.04 ASSET MIX Your account is carried with J.J.B, llillmrd, W.I. Lyons, lnc Annuities100.0% ELSIE J TRUEMAN 84192163 -- if an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. ADDRESS SURVIVING 301NT TENANT(S) NAME REI~&TIONSHIP [0 DECEDENT JOINTLY-OWNED pROPERTY: ITEM 1. deed for jointly-heal rea[ estate DESCRIPTION OF PROPERTY BATE OF DEATH VALUE OF ASSET TOTAL (A~so enter on I ne 6. Recapitulation (If more space is needed, insert additional sheets of the same stze) GREA?KR pITTSBI]RG~ POLICE FCU 133~ C~'~RTIERS A%q~YJE We wish you all a prosperous HAPPY NEW yEAR! ! .~ ELSIE TRU~IAN OR GAiL ~UF~AN 258 COLLIER DR MECHA/qICSBURG PA 17055 7/01/03 12/'31/03 3485 i 7/O1 I BE$I~{Ti~ BA~L/~qCE-SVGS 38 . 72 4 , 500 . 62 7/01 1 DIVIDEND 34.04 4,534.66 1/01 1 DIVIDE~FO PAYABLE DI~;IDEND EARNED OF 34.04 FOR PERIOD 7/01 TO 12/31 POSTED i/0l ON AVG DAILY BA/~ 4,500.62 AN?~JAL pERCENTAGE yIELD EA/~NED 1.51% ....... y]~a~D TO DA~~E INTEREST 0.00 yF~29 ~ DATE DIVIDE~D 94.21 READSHAW FUNE1CAL HO/vIE, INC. 1503 g!t.;xnsx, illc Re,ad Pittsbnrgh, PA !5210 3971 412 882 3,q50 Fax 412-882 369[ Harry A Readst~a~ III. Supervisor Kevin R. Dietetic Smtday, Febnlary S. 2004 Mca (}ail Shamitko 258 Collier Drive Mechanicsburg, PA 17055 Dear Gall I'hank you ~or se!ecting our lkmeral horn: ;o p~ovide SCl xices ~c,r your lzamii~ dui mg )pin time of bm eavmne~l I hope that you ~bund our service, so fa~, to be of the highest standards that ~xc always try to achiex e. The following ~s a summaq: of thc sca*ice charges ~s p:e.,iously explained anti p~ovided m written fi)tm on the sec'rices for: ELSIE TRUEMAN 1, Professional Services Se~x'ices O£Funeral Director And Stuff 5 128090 Embalming $ q60,00 Casketing, dressing, cosmetology $ 15000 SUB-TOT.AL PROFESSIONAL SERVICES For visilafion / wake service S 260.~'} Fn~ funeral ceremony S 30000 SUB-TOTAL FACILITIES AND EQUIP/~,IEN'I x.,ehiole to lranstler remains to Funeral 110me $ 150 00 Usc Of Hea.rse $ Faro; I-, Car Lead Car ' Clergy Car $ 75.00 Our Of Town 'I ransporatmn $ 36630 SUB-TOTAL AUTOMOTIVE EQUIPMENT TOTAL OF PROFESSIONAL SERVICES, FACILITIES AND AUTOMOTIVE EQUIPMEN F Merchandise Casket: T[O~ Outer Burial Container Windsor (Tierd Top) SStXl. Ot) Ac~owledgement C~rds $ 20.00 Register Book S Crucifix,Cross S 25.00 Prayer Cards $ 50.00 Name Plate S 20.043 Crucifix/Cross Exterior $ 25.0t3 $2,020,00 $560.00 $941.30 $3,521.30 IOTAL MERCHANDISE SELECTED CASH ADVANCES Newspaper Church or Clergy Ce~lified Copies o?Death Certifiv. atu Hairdresser Vaul*~ Ser'.qce Charge SUB-TOlr &t, Ok CASH ADVANCED 15 S200 153,00 75 00 30 00 4000 $1,925.00 TOTAl. FUNERAL CONTRACT BALANCE DLJE $5,774.30 $5,77:1.30 RECEIPT JEFFERSON MEMORIAL PARK, INC. 401 Curry Hollow Road, Piffsburgh, PA 15236 (412) 655-4500 A~r~ Dollars Memorial Parlg In1. ~ PAYMENTS Ol/3~ 01/~& 800.00 ¢1~ TOTAL POR ~LL~HG CYCLE FRON 01/t?/200~ THRQUGH 02/14/2004 $813,08 $800.00 CR ~ ~ALAN6~ T~ANSCER$, 6HECAS.O,OOOOQQ% Bi,~ 0.00% ANNUAL PI~ RGE NTAC, IE PLEASE SEE REVERSE ~JDE FOR tMPORTAN'r INFOR~TION t62 CB3 1~,~ 110;2 0000 O0 WEST MIFFLIN SPRINGHILL SUITES t000 REGIS AVE PITTSBURGH, PA 15236 412-653-9800 Page: 1 Date: 1/30/04 Arrival: 1]27104 Departure: Guest Name: SHAMITKO, MR HARRY Mbr ID: Room: 212 Address: XXX Level: Folio Id: 26481 - 4Y2 XXX, NE 11111 Plan; MARH US Dat~ Description Reference Charges Credits Balance 1127104 Regular Room Charge Room 212 $49,00 $0.00 $49.00 ~ 127104 State Tax Room 212 $3.43 $0.00 $52.43 1127104 Occupancy Tax Room 212 .$3.43 $0.00 $55,86 1128~04 Re~alar Room Charge Room 212 $49.00 $0,00 $104.86 1t28/04 State Tax Room 212 $3.43 $0.00 $108.29 1 t2810,4 Occupancy Tax Room 212 $3 43 $0.00 $111.72 t129~04 Regular Room Charge Room 2!2 $49,00 $0.00 $160.72 1/29/04 State Tax Room 212 $3.43 $0.00 $164.15 1/29~04 Occupancy Tax Room 212 $3.43 $0 00 $167.58 1130/04 Visa XXXXXXXXXXXX6607 ALM $0.00 -S167,58 $0.00 X Tota~ Folio Page 1 $0.00 Ca~f~kk~ aci~ mipl of goods and/or services in the a~our~ of the total RECEIPT FOR PAYHENT ~.~e~lan~,~o~,~ey R~qlo~e~ ~ W:i£s Hanover ano H~Gh Stree~ Carlisle, PA 17013 Recezeu Dame Rece~}Y Time RecempE NO. !!:~5:54 i035541 ELSIE g ~=le Nuugoe r 2004-00129 Remarks GAIL D SHA~MiTKO AC Distribution Of Receipt Transaction Description Payment Amount PFIiTi©N FOR PeORA EXT~P~ PAGES SHORT CERTIPICAT~ JCP P~E 235~00 9.00 15.00 !0,00 Payee Name CE>~BERLAt{D CObqNTY GF~'{ERAL FUN CLMBERIJeND COiJ~IFFY GENERAL FUN CiMBERLAND COhH~TY GENEP~L FUN 8IREAU OF RECEiP'iS ~ CNTR H.D ~n=.~ 4112 $269.00 Total ~ecelve,d ......... $269 00 COMVC/~¥EALTH OF PENNSYLVAr A ESTATE OF SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES,& LIENS FiLE NUMBER Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION ,aMOUNT TOTAL {Also enter on line 10. Recapitulation) (If more space Is needed, insert additional sheets of lhe same size) COMMONWEALTH OF PENNSYL¥5',N[A STATE EMPLOYEES~ RETII~.MENT SYST~M February 13, 2004 Estate of Elsie Trueman CIO Gail Shamitko 258 Collier Drive Mechanicsburg PA 17055 Invoice//i 2336 RE: Elsie Tr'ueman SS#: 200-01-35,34 Deaf Ms. Shamitko: We have recently been informed of the death of Elsie '1 rueman, a retired member of this System. We wish to extend our condolences to you at this time. Since Ms Trueman died 1/24t04 and the January check was not returned to our office, this account has been overpaid in the amount of $25.49 for the period from 1t25/04 - 1/30/04 it will therefore be necessary for our office to be reimbursed for $25.49 to liquidate this overpayment The reimbursement should be made payabto to The State Em;)loyes' Retirement System, and mailed with Be enclosed copy of this letter to the address shown above. We also need a certified copy or an original death cerlificate fo? our file. Upon receipt of the reimbursement, this ac¢ounl will be closed There are no further benefits to be paid from this System Si~ouid you have any euestions concerr ng this matter, please do not h ..... e to contacl me at the above address or by telephone at (717) 783-9065 o( 1-800-633-5461. Thank you for your cooperation. Sincerely, Linda Dolan, Adm;nistrative Assistant Ha, rrisbur9 Regionat Counseling Center ESTATE OF ELSIE J TRUEMAN ,~ GAlL O SHAMITKO EX~.C. ~00~. ~ 258 COLLIER John M. Sullivan, M D & Associates LLC 1001 South Market Street Suite ~ Mechanicsburg PA IF055 Statement Tax ID: 25-t876194 Phone #: (717)697-5050 Elsie ,J Trueman 258 Cot]icl Drive Mechaniceburg, PA 1/'055 Dale: 02,¢25~2004 Patien(: Elsie ,J Truemar~ Account #: 3790 Page: 1 I Please i0~¢85;04 199Z~3 LEVEL3ES¥ PATIENT iJMS 02/24/0~ 102 24~,4 PEBTF does not cover Medica~e Ded~J~:tahlF, 952 Cu~ent: $~.~8 Past Due: $000 I DAVID A WIEGAND MD 1000 NORTH FRONT STREET gt'2TE 400 ~ONJ4LEYSBURG, PA 2 V043 Tel: 7t 7/761-5556 TRUEMAN, ELSZE J 258 COLLIER DR MECHA~I CSBURG , PA 17055 'PLEASE REMIT TIlE BALANCE DUE. STATEMENT Patient Tax I.D. TH~K YOU ! TRUEhbBaN, ELSIE J 251 738000 STAT~MEN~ DATE 02/24/04 ACCOUNq NUi~iBER 2~o~43 i / MO ¢NDI=ATE AMOUiCT PAID Place DATE Codes: iH=in Patient 02/02/04 02/0X/04 02/02/04 02/02/04 02/17/04 02/17/04 OH=Out Patuent nR=Em_rgency Room DESCRIPTION 470 ~H Balance forward last ~:tatement _99254 iN£TIAb HOSPITAL CONSULT MCC,k' MEDICARE CHECK MCDS MEDICARE DISALLOWAa¥CE MCDD MEDICARE DEiSUCT ~.~OT MET PT$2~ PEBTF PAYM~WT I NDD 2NS DEDUCTIBLE NOT MET ESTATE OF ELSIE J IRIJENIAN 1003 GAlL D SHAMITKO EXEC. PNCBA Ref. P~hy: DEMIOiELE~ I~T(7~EL A ~D CURR~T ~IOUNT ~ P~gT DUE ~0UArT PDEASE~ ~AY $ O. O0 J $ 49.52 THIs 0,00 210. O0 69. 78 73.26 49. b2 -17. 44 49.52 YOUR ACCOUNT IS NOW PAST DUE. PLEASE REMIT THE BAI_e~YCE DUE OR CALL THE OFFICE TO MAKE OTHER ~%RP~UYGEMENTS . ......... , FOR ~00~2 P.zt. 2/xi~'.t~tt'_~ REV-1513 EX+ (9 00) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DO NOt List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ENTER DOLLAR AMOUNTS FOR DiST~'~T~I(~R~/~:O~J ,~;'~E O~N/CLi~'E~SS~i'~ ~ HROUGH 18, AS APPROPRIATE, ON REV_1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET (If more space is needed, insert additional sheets of the same size) ELSIE J. TRUEFIAN LAST WILL AND TES'rAMENT !, ELSIE J. TRUEMAN, of the Township of Monroe, Count'/of Cumberland and Commonwealth of Pennsylvania, being of sound and disposing mind memory and underslanding, do hereby make, publish and declare this as and for my [ asr Wilt and Testament, hereby revoking and making, void all former wills and codlc~to' '"~' by me at ally time heref[ofore made. _FI~R_S~, I order and direct that alt my just debts and funeral expenses De paid by my Exeoutrix, hereinafter named, as soon as convenientiy may be done after my decease. SECOND. t hereby make the following specific bequesls: A. I give and bequeath the sum of Four Thousand and No/100 ($4,000.00) Dollars unto my grandson, JOHN J. MILLS, absolutely, if he survives me. lB. I give and bequeath the sum of Four Thousand and No/10© ($4,000,00) Dollars unto my granddaughter, JULtANNE MARION Gill absolutely, if she survives me. C, I give and bequeatb the sum of Four Thousand and No/100 {$4,000.00) Dollars unto my grandson, PAUL ERIC SHANtlTKO, absolutely, if he survives me. D I give and bequeath [l~e sum of One Thousand and No/100 ($'f,000.00) Dollars unto my r~re**-,-,~'-,4'',-,'-' r~L,,, j. ~ .... absolutely, if he survives me. E. I give and bequeath the sum of Ona Thousand and No/100 ($1,000.00) Dollars unto my great-§rar~ddaughter, KAYLA ANN MILLS, absolutely, if she survives me. F. I give and begueath the sum of One Thousand and No/100 ($1,000.00) Dollars unto my great-grandson, AUSTIN GILL, abso!utely, ¢ he survives me. G I give and bequeath the sum of One Thousand and No/100 ($1,000.00) Dollars unto my great-granddaughter, JUEL SHAMI1 KO, absolutely, if she survives me. H i give and bequeath the slim of Two Thousand and No/100 %2 000.00) Dollars unto my niece. AtJCE LENTZ absolutely, if she survives rl~e. I. I give and bequeath the sum of Twc Thousand and NollO0 ($2,000.00) Dollars unto my grandnephew, LARRY LENTZ, absolutely, if he .,~,, Vl~ es trio. J, If any of the beneficiaries named above has not attained the age of twenty-one (21) years at the time of distribution of said bequests, then I order and direct that the bequest p¢~ r'lr~rt h~,r~in f',-,r ~,,~-~, ~- ...... be paid over and distributed unto his or her natural parents as custodians for the beneficiary under the Pennsylvania Uniform Transfers to Minors Act, THIRD. I give, devise and bequeath all the r(~.st, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever situate, in equa~ shares unto my children, JOHN J. TRUEMAN and GAlL D. SHAMITKO, share and share alike, absolute!y ,~nd ir, fee simple Pro,4ded, however, that if i-ny son, JOHlxi J_ TRUEMAN, shall not survive me, then I order and direct that the share provided herein for him shall instead be paid over and distributed unto GAtL D. SHAMITKO, absolutely and in fee simple. Provided further, how~ver, that if my daughter, GAlL D. SHAM1TKO, shall not survive me, then 1 order and direct that the share provided herein for her shall be paid over and distributed unto her thenqiving issue, per stirpes, said issue to take the ancestor's share by representation and not per capita _EAST_LY. I nominate, constitute and appoint my daughter, GAlL D St tAMITKO, Executrix of this, my Last Will ~nd Test,ament, to s3rvG '~¥;~ ,uui oond in this or a;~y other jurisdictio~ IN WITNESS WHEREOF, I, ELSIE ~1 TRUEMAN, have hereunto set my hand and seal to this, my Last Will and Testament which consists of four typewritten pages to each of which I have affixed my signature this ' day of A.D., Two Thot~sand One (2001). The preceding instrument, consisting of this aod three (3) other typewritter~ pages, each identified by the signature of the Testatrix, was on the date thereof signed, sealed, published and declared by ELSIE J_ 'I-RUEMAN, the Testatrix therein named, as and for her Last Will and Testament, 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 hereto REV-1511 EX+ (12-99) COMMONWEALTN OF PENNSYLVANIA INHERITANGE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule t. ITEM NUMBER DESCRIPTION FUNERAL EXPENSES: ADMINISTRATIVE COSTS: Personal Representatives Commissions Name of Personal Representative(s) Social Security Number(s),'EiN Number of Personal Representative(s~ Street Address City Year(s) Commission Paid: State Zip Attorney Fees Family Exemption: (If decedents address is not the same as claimant's attach explanation) Relationship of Claimant ,o Decedent State L~-~ Zip /,~'~¢~ Probate Fees Accountants Fees Tax Return Preparer's Fees AMOUNT TOTAL (Aisc enter on line 9. Recapitulation) S ~' ¢~',~/ ~ more space ~s needed insert additional sheets ol the same size) COHHONNEALTH OF PENNSYLVANIA BEPARTNENT OF REVENUE D~AU OF ZNDZVZDUA, T~A~,_~ OFFCE rur NOmE CE INHERITANCE TAX PO BOX 2806fll HARR~SBURO, PA 17~-060~ ~E~C'TC[~} r', t~¢'~ APPRAISE~E~I~ ALLOWANCE OR DISALLOWANCE ""[ t '~ OF DEDUCTIONS A~D ASSESSMENT OF DATE ESTATE OF DATE OF DEATH FILE NUNBER COUNTY ACN REV-lB47 EX AFP (E9-~4) 12-27-2006 TRUEHAN ELSIE J 01-26-2006 11 06-0129 CUHBERLAND 101 Aeount RemLtted J HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGISTER OF NILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~'- RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP [01-03) NOTZCE OF ZNHERZTANCE TAX APPRAZSENENT, ALLONANCE OR DZSALLONANCE OF DEDUCTZONS AND ASSESSNENT OF TAX ESTATE OF TRUEHAN ELSIE J FZLE NO. 11 06-0129 ACN 101 DATE 12-27-2006 TAX RETURN NAS: ( } ACCEPTED AS FZLED ( X} CHANGED SEE ATTACHED NOTICE RESERVATZON CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Reel Estate (Schedule A} (1) 2. Stocks and Bonds (Schedule B) (2) $. Closely Held Stock/Partnership Interest (Schedule C) ($) q. Nortgeges/Notes Rece/veble (Schedule D) S. Cash/Bank Depos/ts/H/sc. Personal Property (Schedule E) (S) 6. Jo/ntly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Tote1 Assets APPROVED DEDUCTIONS AND EXENPTZONS: 9. Funeral Expenses/Ada. Costs/N/sc. Expenses (Schedule H) (9) 10. Debts/Nortgege L/eb/lit/es/L/ens (Schedule T) (10) 11. Total Deduct/ons 12. Net Value of Tax Return 125~271.92 Z~267.$$ .00 .00 NOTE: To insure proper .00 cred/t to your account, .00 subm/t the upper portion .00 of th/s form with your tax payment. (8) 127,559.25 11,751 125.69 (11) 11.876 (12) 115,662.60 15. 1~. NOTE: Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) . O0 Net Value of Estate SubSect to Tax (1~) 115,661.60 I~ an assessment ~as issued p~evtously, lines l&, 15 and/o~ 16, 17, 18 and 19 ~ill ~e~lect ~lgu~es that include the total o~ ALL ~etu~ns assessed to date. ASSESSNENT OF TAX: 15. Amount of L/ne 14 et Spouse1 rate 16. Amoun~ of L/ne 1~ taxable et Lineal/Class A rate 17. Amount of L/ne 1~ at S/bl/ng rate 18. Amount of L/ne 1~ taxable at Collateral/Class B rate 19. Princ/pel Tax Due TAX CREDITS: PAYHENT RECEZPI' DISCOUNT DATE NUNBER INTEREST/PEN PAID (-) (is) .00 x O0 = .00 (161 111,662.60 x 065= 5,026.80 (17) .00 X 12 = . O0 (18) 6,000.00 x 15 = 600.00 (19)= 5,626.80 ANOUNT PAID I .00 5,626.67 TOTAL TAX CREDIT 5,626.67 BALANCE OF TAX DUEJ .15 INTEREST AND PEN. .00 TOTAL DUE .15 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS RE~UZRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDZT' (CR), YOU NAY BE DUE . A REFUND. SEE REVERSE SIDE OF THZS FORH FOR ZNSTRUCTZONS.) ;~,~V~_ 10-22-2006 CD006529 ZF PA/D AFTER DATE ZNDZCATED, SEE REVERSE FOR CALCULATZON OF ADDZTZONAL INTEREST. REV-1470 EX (6-88)  INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG~ PA 17128-0601 DECEDENT'S NAME FILE NUMBER Elsie J, Trueman 2104-0129 REVIEWED BY ACN Destiny $,R,Brown 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES The value of the estate has been adjusted as the result of the correction of an error in arithmetic. Row Page 1 Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 12/16/2005 SHAMITKO GAIL D 258 COLLIER DRIVE MECHANICSBURG, PA 17050 RE: Estate of TRUEMAN ELSIE J File Number: 2004-00129 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, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of wills a Status Report of completed or uncompleted administration. This filing is due by: 1/24/2006 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, k 1"".-0 " /) . ~,.tl-'# // ","",~A'lk t7.Wa%?L/ .J:~~t&'4.haq#:-, # '-- ......" ' .~- -- " .---. ~' GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge \(1, ~fCVt : """""'""..' "", ...../\~-x...).. I~f ~ '(..\ I,;", -..., ~~ ~J ~ "::[.) _~_.'1..._,.~.~ ~,-'1:'''':rr,T~llil_ ~L:r.-1...,____:i....__-.ii____..:::l ,0__-.--.~- K""'\'C:z:;.Jlt:;iI\.I:;;Jl' <\J'!i. 'ij'i{ JU!.JL:si tUiJl \V1\JLlUl.illlJi\CJr Jl.i:1lUU v\UlUJi.!l.lLJ ST ATDS REPORT Ul\luER R1JLE 6.12 Name of Decedent: E/s/cT --r;;ffynr7Yj Date of Death: \ 1:n u a 1 ,-,;J~ /;10'71:;/' Estate No.:,-;:/.1P-5/'- C't? /,29 . . Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration ofthe above-captioned estate: 1. State whether administration of the estate is complete: Yes 0 No !&l 2. If the answer is No, state when the persunal reJ?lesentativc r~ascnably believe~ that the administration win be complete: I?t /aft r HJ/tf! d?a{',,,A, 31. ~d ~- 3. If the answer to No.1 is Yes, state the fcllowing: a. Did the personal representative file a fmal account wiLt 'the Court? Yes 0 No 0 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 0 No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. .~. ""l ~:" ,4);1 ~ Lfi;:n~/~ Signature Gel/'j j\ (:;;/;r;>>//r)4 Name Date: /k-,(()ftJt._ e_~ 0.?-Y (1(l//;>~r J~t;J/.P Address/lecJ;U//ibbttrf J /4 /7C03---- (7/7) ~ 9)7- x-.32'-P , ".i T'elep11011e "I'-To. Capacity: lZl Pei:"sG7'lal P....epresentati.ve o C.Qi_lIlsel for persoTlal represer.!.tati"ile ~.~ Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 1/16/2007 SHAMITKO GAIL D 258 COLLIER DRIVE MECHANICSBURG, PA 17050 RE: Estate of TRUEMAN ELSIE J File Number: 2004-00129 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 1/24/2007 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, I t", I./JIJ.I; /'l /.JI..b!ut~ VrI'vJ'!lAi ~b)t'- Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel Pa. O.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF Ik( (17 jtfA-I,r;/ COUNTY, PBNN~VL VANIA. Date of Death: da V/IILlf-j' ~ ~ c l / (Ill f" ft1",z /? d</; .?{tftJ;5/ File Number:,'? #::/-.?~t7/~y Name of Decedent: f/..5 /p , Pursuant to Pa. O.c. Rule 6.12, I report the following with respect to completion of the administration of the above-captioned estate: ""'" ;::--:;) c~...:) CJ, ;.:. 1. State whether administration of the estate is complete: . . . . . . . . . . . . . . . . . . . . ~es ~:~ D No -., ['.) ,- ... 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: ~~ , I f') 3. lfthe answer to NO.1 is YES, state the following: a. Did the personal representative file a final account with the Court? . . . . . .. DYes ~No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? ............................... ~y es D No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date t/~/ ?~;Y yJ iU! 1) vt~(~ff- Signature of Person Filing this Form Capacity: ~Personal Representative D Counsel &-ct// IJ. ~~m//~ Name oj Person Filing this Form . A ~7 (?erg: ~ r fJ f'd/e- Address - /llet/za~;~5i:l7 tf/cf //dJ'j- (11/) ~Y/-YJbr Telephone Form RW-/O rev. 10.13.06 Cr .~~'<,.?~ :-;\"'J;:0t':'::W~0;.;~Y'i~~>i:S:"~':~>' -i ~,-",; ',' ;". ',:C . ~;.; 0A(!i\.-~:'k;:>;v,\" ::::;;:,J'",;..;j,,,,Jii,<>" vk. ,,,, '" ~ I l~ ~ ~ "'. (}<,. ~ .' ~, "",' ..., (-) tU -- ~ ~ ;;J':1 . t~~ "~~ t~, :., '::N"' ~':?2:1! ~ l:'\'~ -1 '" ~ "~ ITlr,J \~, -- "~ -.-- g ...., ....-~;:+. J> -0 '{; ~) :3 ~ -j ,,," :u ''0 J> a:l Z '< U) 3 J> 0 (J) -1 ::l <3 z !:; 0 IT1 :s: (j) 0 (') :u tu -U lJ' ::,. :~ ..-;: ~ ~ 5' ~~ m ~ ~~- CJ (') 0 m g; ::~'1J Q 1 ~ a. CJS~ . :u 'r; ~:':j 21 ." c: ~ o. 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" ~ -l-~ \ 1--- T I \ l I I \ i --' , . -' t--.-.-- ---_.. -...-.-'-.....- .- 1 I I .--j - I --- .1-- I --- -- I =4 ..4___ I I \ I ,. I --1 I I \ I t:: ~ --I i ~ {~,\:,';' 0 ~ ~ )1.):--;::;:, Om. C'. ~~ i~:x) ?; ,<~ , ~" \ I 0 c; ,..,,) ~' .;-t-~~ I 'J.'.:; - ~-" ~ 0 '''' '-. m t:.' ~" _, -g ~, ~. \--\--- !!!. .---- --.- .S \_-..- L___ y:" .' t.~, I . I ~~- ~'}-- ~ \ ~~, i I ~--'~ ~-' \:'(' - -1 ~ .r~ . ~\\ ~ ~ ,~ ,-' ~ g ~ ~,1 ~ a '" ., (j 5 . r~\ ' . ~!\ ~ ~ ~_. ~ ~ (--. "," ,. ~~), :n ~ (' \~ ~::T . \: 9 ~ n Q1 ~- ~ I I -- -- -- I - ......- --~-l- ; --- --- ---~'. \.':'\.~:E,"U Q """ '" ' :::j ~ a. ~, ~ '\\"'. ;!; s: . -'" ^\ '-' rn ~'G ~~::!l ~-\. _t ~ -..\ .;, ~~~\=rl~ ~~~ g "(.... 51 .....----- ~ -- .--- -- -----------.- --- - ----- (f) n <n ." < o' II> n =r '" -~ II> " ',' l:€l)-. · ~~~ I~~ Id \ ..;:. ~ t ~"\> ~ ~ ~~J~ I \ ~~~_: n c:, ~rg 90 ~ (f) -- ~ .=j C--__ -- \ , -----~-- I i ~ ,- __a~ REV-1500 (~; F~t.~~tit t.~~~~ {>i~:l~f COMMONWEALTh OF P9lNS'tlVNLA ~ ~OFRfVEHlJE INHERITANCE TAX RETURN OEP L 16lJii>> ~~""""""":i_ ,RESIDENT DECEDENT I- ~"J'L !WE JASU:1RST,ANHKJIl.1'f! HAt. ,__._ Z 1-11, E~ sl'e J, ~ OAif OfOC-'TH{W-OO-~ ! D.\1EOf'elRrrl jfIW.{JIJ."'f)R) ri Ol- ~"'I/- .>l/7p :/ I d 7' -zJ3 - /7~~_m W ~IF APP!t(;MLEf>'i<M>~SflOU5FS ~~ f,V..<:iJ(. F.ffiTml ~::n.f t~ffWJ C aI ::t:~e 0<<,11: ~~8 --%J l,,)a.. Go 4; :z Q ~ -J ~ I- ~ <4; <.> w a: C-1/ ~ 1. Olig.itlal Reu.m n .. Limiled f'lb!!le i....-.j o 2. ~relllal Retlirn n Q. fJU,,~~i(;I'n~~1!_'!I!Ii1f!l\H';;' .L............. .- r:-x!3. !Y~ Oi<ld l~ ~ ",,,.,"'"11. L!J . . .. o ii. UtiJatlOll Proceeds Ke<;e.'1IOO fiLE NUiIfBER ~.L- ?J_L 11/ C;' /d P vAJ1.TiClJiA. \'Pi< ",,;\iflfJ'l 5OC:..1IIl Sl:URr\' ~~ d("7,{l - 07/ -~'JP/ lMS lIIE'l1RIlIB51' liE HIS WlliUII'UCAlE WIJH TIt: REGISTER OF WILLS ~~" Sl8:~.IIf"" ".,a,&:'R e-,., u_"""-','_..... .. . . . t_J --" ~~KiJ;; 4v::w.~ i_e-:$: ~.4iW~ u:-~ .. lJooi':Ger.t ~.!M.w a UVllflj 1!W~_~_,; n 10. Spci;sa' P<;werty Credit (_d:lft!t;~1.<>-:!!-'-'., W -!<<:'; U 5~;,~!~~~~~ 5.~,&w:.I:a 01 ~ [~Bw.... U tL 3ealo!'llc laX lroer See.9113'.AJ ;/!ll;>'Ji $.:I> OJ t- z: .... a z 0. G. U) .Ii> at fI:: 8 ,_f.. - . J I a~EE~AOORESS L!5L~Le(4: ?h'f .. ~7 t!.t1/her IJrJ~.;re __ __ I .... PII- / :7tl'-.:;,0 ........-....-----~--_1ltlet hllJ'ues6,,~' ~ ,,"< '~':.~'~"c:.::' ~ . ~N\..~ /'/7 .. ~77'-7t:30-JY 1 Real Estate t&nedule AI 2. Srod<;~ and ~-.ls (~Bj a. Clc'al'\\j H?.ld c.:.jliM~. !'ilM\'.;-;;h;p \Y ~opr'",iurst.ip 4. ~!I..'IIo!es R~ ISclledule OJ 5. Cash, flu, CA!pu!llis'&M'~~'~ fSd"nsd\ll& l;) ~ ~lo>mIy OwretlPiopet!,y {SclJeOuIe F} o $eparale Billing Requested 1r:-1et.\fj'lO$ TlllIY.Ifel~; e. Mffi(;ella~m*, N<::r..Pll;l!:ate Pttl'.,li:fly (SchedlAe G ur L) 3. Total Qross Asset5 {1OOiIl.11eS '\-7) '9. fUflel3! ~&~ Ccsll;i~<i(jH) :C.Deb:S of DocOOerl!. Mortgage Uatilt-es. & lier.s (~ I) n. TllIaf ~!!aIal i)ll&$ s $1~j (1) /'lid JJ.I? {2} I~ f1 p...... (3) ;~ ne ....,,"" (4) /~ r1 e. i~\.! /~ -";-7/ /!:Z ,", k2;rrl...LL "~-"'-'-_ ,; .~g l6}_...._~ ~_d:...L_~.._ {1} ...#.. F)>" --"-u ~4;-' -' ,~..;!i: !~ /d.,.. ,,' ~''''',;/ ,/ (9) /~ /..::> ,;/ -.,....?7"-~-------_.-- (10) / ~...:;i--.t::!Z. ._.___M.___ J /J'~" Ill! jP' ...,/ .;.:.-- ;>"/', :---- .. " ,,"/ "'''' .r V ~__~_ _J ..--- _' _,_ ,c:; tt2rr //:..2.1 q;J /' .-' j2. ~ 'lab! 1lffst;J!e~S !!!!!'I'.;:$iJne H) t. 13. Charl!atJle and ~ernaI ~.9IB TMb forwtlidl aneJedioo to ~I( ~ notllem mD {SdIe'ltie J) I -tot Net VlItue Subject w Tax {!Joo 12 ~IS V,le IS} 5fE INS11lliCiJOWS ON REVERSE SWE fOR APPi.lCABlE RATES z o !( I--' =:J Q.. :i o u X ~ ~5. Amcu/lt {}" U~ 14 tax.abI8 at lI1e ~ lax !ale, or ir.Iflsfers ur.4ar Sec_ 91i€ (aX 12) 16. Amcm rJ I..il& 14 taxable at Iinooi r.Jfe '1 i\e;'''''''1!':''l..if1o>>4~iR~f. 18. Amcunt of Line 14 tax.abIe at ooIlelieroi .~ ',9. Tax OU", /;-:::"7)1-- "///, i,.:7-P f1/ ~0 ---- "-' .., .1".6- .,.". j/ #"Z'P ~ J ,- .___._.__..____.__. "!'<t'.7 ;t.~ _. tlS} itS) -. l:-_~) __ ct. U " 15 J --. -0 it.Y' /../....::. tf.~ /' ~-',(-i> ....~ ,r .--- .c'? -- .~/ ~.. ./ ~ ;;r' (l,lSl 'Y<-?: L5~?/ - f$- /'_ {~;,'t ., "" $ ;,8, .~ k.'Pv - - ;Y ;-'S1~";;-:~'.2-:/ ~ > ~ CHE':;" "EKE ,= '::::. 4R1:' RE-~.JES""\v A REFUt,;) .:);o"lN O';,!E~PA.,'r~E.'-IT. 20.[1 ~.t'"!:'~U;"",'0,>;",. SCHEDULE I DEBTS OF DECEDENTi MORTGAGE lIABILITIES, & LIENS CGf,fMCHWEAl ffi Of' f'FiIIit:;1rl liWA ltM.w,AJU 'Ai( RfTUffil RESmaiT DECfJENl ESTATE OF 4 / --~ ~~::--d;-;- /-':.-~ ~5i E! I I n//",/7:ld.:?;/ Include unreimbursed medical ex~. !rEM NUMBER. FILE NUMBER "', ,i~/ "'}/7/ ' // .,x.I -.{,'. -Lz~/~ .7 ~t;~:s;!.:,qrf!irUg AMOUj,;T 1. .-- -- 1.1. ST4'- / e. R-::'m/~,,/vee.5 /1,t1/'re yn-f)y'l I -,-- I Ii ,,/; !1 II!. rS,:.{, /~~ D i K,., t '.' -.I <41 ",,,j ;'(>6 If , / fi? I~ I 1""'-"' n /1'. -. /' -c ,a.> 'v. I I I I ! i ! ~ i ;. I I ,JLCc.~.-L;_Jr;::J' , . ~/ --lj.. ~ ~<-.;) ,-~7; ?"'F- <--- 4::L.7 &1 i.'A"C"4) ,,< 4.9 J.>-.z - ~ <...-'" I { I I ------~--__-JI -~<; TOT ALl,Also enter on lire 10 Recapitulation) , $ /97~ I itf .mor~ s~;('; a~. ~;r.sCrt addrrtC1-;;;; s"eet;;:i'tt'-li: 5d~ 5:~j .~,~ "e'-~c<.fji rU(,td;/h7 J-..?:7M< ~--/4~. COMMONWFJ\UH OF PENNSYLVANIA SlATE EMPLOYEES' RETIREMENT S\,'STi.M HMlttSBURG RI1GIONA l COtJNSf?UNG {>>''rrR J(\ NOlITM nmw STR~T.ItOOM 1ft HARRlSBlJRQ. I'A 111m 11118J-'fli65 I -800-6 3,l- 54'; I FAX: It1-1l!3~m W__<;er.l.~.p:u~ February 13,2'004 l,-,vc.>>ce #12336 Estate of Bsie Trueman C.;o Gail Shami.ko 258 Colitw fJflve Medlanicsburg PA 17055 Vt:a. MS, Shamrtko~ RE SS#:: EiDe Truenlail 200-01-3524 We have fecenUy been infonned of the death of Elsie Trueman, a ,.ed member of this System. We wish to extend our condolences. to you at this lime. Since Ms, Trueman died 1/24104 and the January check was O,)t returned to our office, this account has been overpaid in too amount of $25.49 for the period fror-n l12St'U4,- 1/3Oru4 Ii wtll therefore be necessary for our office to be reimbursed for $25.49 to ftquidate this O'ierpa:Yfnent The re~mem sooufd be ma<..le payable to The State Em~es' Retirement: S'fstem, and maik:K1 with .I\e. en.dosed oopy of this letter to the address shown~_ We also need a certffiOO copy or an origml death OOftiflcate for our fje, Upon receipt of the reimbursement, this. account wiR be dosed ~e are no further benefds to be paid from this. System. Should you have any questions concerning this maUer. please 00 not hc:;.i!~~ to oontact me at the above address or by telephone at (717) 783,.9005 O,f 1-800-633-5401, Thank. YOiJ for your cooveratiofL Enclosure Sincerely, "f', /] f...'1 d'lu\ ,"--"'J'\.!JY , r 3_ t , "0 ,- ":' .' . .i }J y,; f.t ~.l: 4""~ Linda Dclan, M'n;~ As..~istant Hamsburg Region~ C~ Center ~-~~~~~;",b,,- ~~114'''_!&.~~;u.~~ailI!t1I1iR _ - -- , -',' -'!iIift~~-'--'iCT-:~_ ESTATE OF ELSIE" TRUEMAN - ,- GAIL D SHAMmco EXEC. 1 002 ~ 2!i8 COUIER 00 -'t~_-/' f I MEClWtlCSBURG. PA 17OS5-!I4Oi Datl7h~ t~~.&'"~ SJ-I2T~;:~ I Pay to t~~1 ~"*--"'" , _ / .L-- f,._. :'.. O~1-~.2.F1-~~ ~L -"..; 01 "4~ r f.L/ ,,- ~~~...-" ..... ": nil>, IJ.'~ '1;:c.' 17. (/71::'''';' L-4i /J"L....~L:?l./.~ I l1V,pa'/: .. $ ~; _~-:$/ :& / ~:=~_ __~ "I ..... E ri:i(/ ..~ Ji ~>f.~t ~ < -<::::::.....- ti ~~.: 'c~k;Jd. :1:[ze -~--~::Doll"", 6l "'-"-',- ~>J.i{; ...... :'iA lI4II I'.iurit" . <;'_al FA , Pmn - /" /""! p,h".,. ," _,./ .p', ././7. ,{iti /1 -.-'0,.<.,", l John M. Suaivan, M.D. 8. As:sociate-s lie 1001 South Market Street Sui6 S ~PA1lQ55 Statemenl Tax fO: 25-1\1"15194 Phone 11- : (n 1'1397 -fN<"..J1 Dafe: 92l25.'2C;()4 Page 1 Bsie J Tn.ll9fnan 258 Cother Drive Mechanicsbwg, PA 17lY..>5 p~' Sse J Trueman Account :t : 3700 -.----.......-- - <----_._----- I f'le3$e ri5^f ~ ~L$5CAa t_.."~_~,_._"._ ,_____,_._. .___.~_ ;-_~~;____o_"."~ ~ tIate ~ ~f Provider/Diagnosis:' !..t::lcdion IAmoi.Im ;......----~!".... 'I<>~~..-=~F.-.- -...... _..m. .--...'----- ," I -----<- --4---- ~~'"~~!'....~u t .ry_'oo I~H~ f992l3 'lE\"EL 3 EST PATIENT . pWS 142tH) Iro &;~~#~ U2l24.'U& I !)2-24-04 PEBTf doos not.1X1Wlr Meck-are Oedu<.:iabk i ,Oi;UiW04 ) MCOO !~A3Il'JDOOootIDle 61!09i'04 i M'COS tedlcate ~~'lCe I i ; 1 1lntKiranee ; l &;Il!I1I;e I ~.- ----; j I i i . r l I 50.48" I .952 , P;,l.~. ' Balance ! 5t)A~ J ____..______ Corrilot : $50.48 Past Due _ $000 I .. -.---L- Tt,~amcunl - , ${lOO! 5:'.(;48; - - u --.------r-------- __.1..... ..-----...:-------.--1 i R&asepaythJs 3ffl6'.i'l( - $5(i-~1:S1 ~-_._----->,,- --------.--- g I ___._---1..- WE ACCEPT MASTERCARD AND VISA RRST SIlt PlEASE CAI.1. AT ONCE IF YOU HAVE ANY 8ilLlNG QUES nONS ~__.,-:f'a.1!)~l..t:.*4i.rl:::'~.Jd.~?ti:.~J;:'r~~ __~C~:~::<;i:";;-~~oI\'.~~~ 7;.-. ;.;..,r : ."f-"----.'.-ti 1 004 ii I OII-ll.tJl:li ~ " j '~...........""..:~~~--~-" . ESTATE OF ELSIE J TRUEMAN GAll. 0 SHAMlTKO EXEC. M~OO ~G, PII 17Q5!l.94O'f '.._.'~~ ~ DaW'..&fd.:...-~,..5:"'{"'C 7" f1 r;:::i:~~tZ.-k-.l~ i ~~;Z't.~ .,' ..,; ilIt} ''1-: ft~ fV~'- $, " 7~~> fi2''4~MFdi:d:Ji__~~~!=~:~~:_'::=3 ~::-:-=::~ :,i::lm fJ-. Q'PNCBAN< i'r~;llooir.~NA CodtaI f' ^ l'I;"Mif, Phm / . ' ,..v I"~ ,<, ,// k .<,-? 'r;:- ,Cl"~~" . .;.~." ~4-<<a;$.-~'.-G:~~~"~'~~7~ f_ F Nl../#':.t:'#"I ~'f_. ""..~< ~ l' ..... ':!'I ""!\,",~C'J"!'I_:%" o.u{; ~ . - -- ~ ':::;.~-.. ~ l l !' ~ , DAVID A WIEGAND 14D 1000 NORTH FRONT STREET STATEMEN1' Ci"l'..r("'"'....-.- .......... _.__~~....;y,. "uu WoP,MLEYSBURG, PA ~ 7043 Patient; TRUEM.lJ,N, ELSIE J' Tax I. D, 251738()(}l) Tel: 7~7/761-5556 STATfi;MEl'J'1' DATE PAOE 02/24/04 ~ TRUEMAN, ELSIE J 258 COLLIER DR MECRANICSBURG, PA 1. 7055 ACCOUNI NUlvlBER 2C1634J ., 1 / MO IlIDI CATE ,-.~. AJofCJ.J-:::T FAID $ )'/v______ "PLEASE REMIT TIlE BALANCE DUE. THANK YOU J Place Codes: IH-:=In Pat.if:nt .rDATE II ICD9 CD'; p~~:~ --, r~ If nr q II 'r Balance forward last statement 102/02/04' .' MeeK Mh"DIC,'ARB L'HEC"K 102/02/04' ! MCDS MEDICARE DISALLOWA1VCE '.102/02/04 I lM<..liD MEDICARE DEDUt.'Y' NOT ME'T ~;()2/1.7104 t PTFP PEBTF PAYMENT < ! 02/.17/04 II I INDD INS DbuUC'TIBLE N{u MET 'j ) ! II II! DRSCRIPTION ER=Emergency Room OH=Out Patient r II llMOUlIT ~ II ~ ,: n H Ii i r I I' I I: I: I; ~~ ~ Ii I :1 it It: Ii h 'I MICHAEL A MD I; ~[ PLEASE FAY !I THI::; fl_MOUNT:! $ "" _ ._. .................'1-.. ~ '!J: P'rn..... ~~~~~< ~~~;~~~'Q9'~~'ii:iiP..l;"______.~>M..Q.4.J#.~~:-:iil.~l!l _ ~_IRgrTI__.. ESTIlTE OF ElSIE J TRUEMAN GAIL 0 SItAII1'1l(O EXEC~ ~ COl.UER Df1 MECHANlCS8UAG. PA 1~ 1003 D J.",J. ~/ .'? ,'~J~;'" ./ . a~'l ,,' ,Y, ,~~.<:'/ J /' ~'l1Ji"'3't3 ll41 Pa.t.o'h ("1~. . L' '1 Y I. e ,I" "J" l '_ . j,'''''' L' $ ." " Q:::t. Orderof. "'l/'4;' .iT . U/J~L":'1h' , f;/ if '" I I -;Y;9' ~)'1, /u~ /' /~~N< ~ --~-:C/~~'--~~- Ik>llars (;\ =. , PNC~ KA. t<<> Prionty , ./~~!.-^ . Plant l/J, /J #. p .~. F<f1F#~/"'dltf/IJ5,~<<.J' -I L.ki.lJ! 'ypi<:'~~r; L.,;-~f.Ji:."SI!' ':O:l & j it 2? 38': 500t. L 52258". 1,00:1 "'!S~<>'.i.~~.... (}~':~'J!\.'ijlEWNM. It ' ~ I CURRENT ~Nr , $ 0.00 C~_'n.'" Ref. Pby: DEMICIISLEr DUE AlofOf.1NT I( /; 49.52 If YOUR ACCOUNT IS NOW PAST DUE. PLBASE REMIT THE BALANCE DUE OR CALL THE OFI?ICE TO MAKE OTHER 1lRRANGEMENTS. r!!.~~ ~'''C::; i?fJR ~UUK PAx M1:fN1' ! t# '---..::.:;:..;-. il :1 ! ~ j d 0.00 iJ 210.00 it -69.78 n -~73.26 II 49.!J2 fl H -17.44 l! II 49.52 ti p ~ ; H }f II II II II It H '~ Ii !. 1. Ii H ~ } ~i ,( r~ II It tj --J J! Ii 49.5..; tl !l REV-1513 EX+ <9,* ;:-.c::~TH OF PeiNSYLVAJW!. INHERfrANCE.TAX RETlJRN R€S.'DEmDEC~ le...DUU I BENEFICIA-~ 1 RLE fWItBER "7/' _ /.? L./- -- ?l.t::' /' _;7 .c: .<;;....>>_. -.....,1' /" ~ ~/ _._~~-~- AEl...lH!ONSHlPl0 DECEDOfT l AMOUNT 00 SHARE WW'E f,."<<) ~ss oc ~'Si RECEl'/lNG ~EffiY ._'." _ Ori Hd ~:!,~s) __~___. Of ESTATE TAXA&.E OO'TR1SUTlONS Ijn;:.~ ~t ~ dSlooutt~ 3I1rll;;ID&tef;; uooer Sec. 9116 i.a~ P2Jl . .' !<< , _?I..' 0t .- -' I' r- "#'-v:~ -I ' .. I -, . '--Ox. ,u;zs;c;,rt I -y.., /-6' , '- Ji:Jll~l .J, - /ll;l~s . ." I ' . I / ~ -'". II -;-;: ';-f;" II~ ~I - (l ,3.''''. t ,{... !'/Id/'.':.Idelvcrry... -flrf/;b.7''W....... '; -(",,,...r-('-r.:ft'-<</.t:(f..;7tl~ /.,.r-I'O. ...~ ~ .A', .""'.<'l[ t't J. uu t.:i _~. .". /l '...- ! - c" f,' i' "---"........ -:> I . ._ : Herhn. p',d /J-;~,3tJ 'f,iT-eaI'-iP'r..iK14u(/11'- ' IJ .'.' , .J I kCf..Y la.. /hitf /11t lis) . l I ;..' ~ :1. !3Jlh I< H J1C. /I141.;;-n ~-jl) /,3 j, ~r//1l i[.U1 IlTr.;.n~/;'JU:ih4 kr l:Jl'..i ihfi7 !.'"f1 . "~l' -, ,I"~ r.r, ../f'J '# ~ d__-Jd "p-,:-! !ft/.;;-[--,'jf ~./I j j1PIJe (-Ieel';': (}/I ..y?lh'lblvre4 '-'''1~mLr'5'-~', !:E ! . ' '.' I. . i-jf ,,/ #'-t""2f .{ I. .91.r<<-I- c;'/c. ,;5JaM.' J':J:L; j/J......--;.r /~" //;;-">'1" 1.''-.')-2 t,' ;;tv.'1tJ..I.s';~7 . ,,'.;' "".'. ~. ;!!t. <<-! -" . ~/ '-' ,_~'~E - J)fT ..0( ; , -..A . ,1,6../1:"- ....... I _ . .....l..., .1-4-- f., t "I. A.I1 ~1 17 ,-r (' ,mt1ha-:l.fCli " /' IJ~ej 1C_~ri6lrnl//i(.. J /lJec/1.a.trlc_:So....l,T./"/'f/.7I'/<.:fyre........ f,c-;'"",. J~'f ! . r. l.d/,.",'p / ..r'? 1 A--:'7"~ ~ .. t I ~. - L#A t-rc "'~ ~. 1-7" LL y,ei'.... ~ - '--'~.... /" iJriitr./J"l /i/~1.r ftl't?!' t~t:. I '. v . .~ f. I' J...Uy r:v J..e J1 C-z p/ ffShu ':/ h.. PA /~ '-::td. 5-"/ Itf-rp. !:,;;lnl? f-iJe,kJ Iii ~"<, ~' . ~~; __ ~_ . _' / ~-'t-. I / / A<1l:t.hc:: /d Ud/rl <J 1('de'WZYl tJ/;,<>;:/f:' "it) ;;4~3 i Jon. IA ren..v"dt'r.ff'~: . . I/.&~:/ II 4~/lf;1 ~S:--{?c#;er' /)",<c:. J fJ(uyhic>J"- I;: ,-t:-l'1,.tf"d'tf .<"f-e~Vt-rc I .' . .' /dee.Az.~H / cs.6 U 'F ;JA'- /~:L -; r f i ENTER oou.J\R MUJIltTS R;1{ DtS1P.f9UTlONS SI1OWf'~ M!!:NE Of'J LiMES 151ffROUGH 1~. A,S .."~t.:n:. ':)Ill !'lfV-~500 covrn stifn I I. NON-rAXA8l..E~S: A, Sf"'<.JU&\l DlSTRlBU110WS iJIIDER SEC110N 9113 FOR ....'H~:::;H AN ELEcnON TO TAX is 001 B8NG AAADE I I t I , I l ~ ~ r .~'" ESTATE OF -/ ' .,!::,/";;/ f::: --;-- ---=;--' 'J. f?lcJ1J;'{:{ i} ~R JJ 1 t I I 1 I 1 I B CHAflTABtE AND 60"~.AL i)jSTRl8Uno~ t j -.- .~-~~~_.~-._-- \ 10TAL OF PART n - alTER TOTAl. NON-- TAXABlE DlSfRtBUTiONS 00 UNE 13 OF RE'J-1500 COVE~_~~~T 1 $ ._____.____._~_ ~ __.. .._ ~~ ~!"!-~ ~ ~~~~_~_~t~ ~t~~.!f.~'!O ,~~ RECEIPT FOR PAYMENT ------------------- ------------------- Cumberland County -. Reaister ot Wills Hanover and Hiqh Street Carlisle, PA 17013 Receipt Date: Receipt Time: Receipt No.: 10/22/2004 12:36:33 1038211 TRl.JEf-@J.'\J ELS I E J Estate File No. : Paid By Remarks: 2004-00129 G SF.A.MI TKO VZ - - - - - - -- - - - - - - - - - - - - - - - - Receipt Distribution - - - - - - - - - - - - - - - - - - -- - -_ Fee/Tax Description INti TAX RETURN Payment Amount Payee Name 15.00 CUMBERLAl',m com"IT'Y GBNERAL FJN Cash Total Received......... $15.00 $15.00 CO:tilUONWEAl.-:t-" Cl/f ?ENh5Y,,-VA,.,n~~ DEPARftkEhr 01- ME'vEi'.JJE 5JR,::AL Of ,N:)_:\!;-~...AL r AXES .;)€PT ;?f(HjD1 rlJ\F;RlSBURG. FA ; l' 21Hl&'J J ReV-1162 EX{] 196) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND EST ATE TAX OFFICIAL RECEIPT SHAMITKO GAIL 0 258 COLLIER DRIVE MECHANICSBURG, PA 17050 ------- f(;,j(O NO. CD 004529 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $5,624.67 I I ESTATE iNFORMA T!ON: SSN: 200-01-3534 i i FILE NUMBER: ~ 2104-0129 TRUEMAN ELSIE J 10/22/2004 10/22/2004 CUMBERLAND 01/24/2004 I I DECEDENT NAME: I DATE OF PAYMENT: I POSTMARK DATE: I ! I COUNTY: , DATE OF DEATH: ! I ! 1 I ;. I i 1 1 , I ~ l I I REMARKS: G 0 SHAMITKO CHECK# 1007 SEAL TOTAL AMOUNT PAID: INITIALS: VZ RECEIVED BY: TAXPAYER $5,624.67 GLENDA FARNER STRASBAUGH REGISTER OF WilLS ,-~..i~~~_4.~irr._::"::'~~._._____~ j~~~~~~m~~_-'____/"i'.;I-!?!.~...._-r~,,-.._",,_,~;;;;.~ ESTATE OF ELSIE J TRUEMAN d' ~ . 1 007 ~ GAIL D SHAMITKO EXEC. I. ;;f-/ I ::C=~G, PI. 11055-9404 Hat '~tf(;f./~.~~6'?/ lllJ-1273;~~ ! P t tt ,., , . "" ./~'" ~ ;fff~~~~Wt'.~;,/_../ I ~~d;Y"-'- " I.. v~04.../.~~4~J7~_6d#;n"1Iars !\l "'~-~. . S 'O~ 1'-"'-' .-.. ." I , - r I 'dL DAI"'-. PriurilJ' ~ ~~NA. I.!4iJ Plan t .,~ ,,- 1 .'.. i 1~~1€~~"1~< <5B::~~::J'~~~~4;;/ I _~ .___~~~_.r~W<f~~~#if_~~NI_,__~_~_-__:~~_q~~...a,:_~~~~ ~...~.., 'G:.~'W4Ifill!t'2i6f{''f&Ui':wnrM Mr. Jobn.1- Trueman 4205 W &, 135 S Angola, IN 46703 Estate of Elsie J. Trueman Gail D. Sbamitko, Executrix 258 Collier Drive ~.~PA 17055 STATEMENT OF RECEIPT/ACKNOWLEDGEMENT 1, JOHN 1. TRUEMAN, acknowledge receipt of the total sum of Thirteen Thousand Four Hundred Forty Five and 10/100 ($13,445.10) Dollars (distribution as outlined below) as the fuJfillmeftt of tile bequest of my mother, Elsie J. Trueman. Distribution date 3fl5t04 1IlSi05 UI&1J5 2I04IU5 Distribut.iooAmount Method of distribution S3,OO(tOO advance Cashier-'s~ #1169546 $1.000.00 advance Wire Transfer $ 20.00 fee foiwire transfer $7,425.10 Check #]0]8 I further acknowJedge that this is the fun and only amount I am to receive ftom the estate of Elsie J. Trueman. /~~ Ma~~pJ~ Mr. John J. Mills 3613 Huddebeny Highway Bertl~ PA 15530 Estate of Elsie J. Trueman Gail D. Sbamitlro. Executrix 258 Collier Drive Mecbanicsburg, PA 17055 STATEMENT OF RECElPT/Ao...'NOWLEDGEMENT 1" JOHN J. MIU.S" acknowledge receipt afthe swn of Four Thousand and No/tOO ($4,000.00) Dollars as the fulfillment of tile bequest afmy grandmother. Elsie J. Trueman. I furthec acbowIedgetbat this is the full and only amount I ~ to Ieceive from the estate of Elsie J. TJ1Jt'DI3D . . ,'''., ..:~"" r",." ."",,~ J.....;.':e.' ,,/';:'~~;/""L::::::::--- JolltiJ(Miits (gnmdson) ,,' / -- -.;ie;- u..s Date MIs. JuliaJme Marion Gill 136 Spring Run Apple Creek, OH 44606 Estate of Elsie J. Trueman Gail D. Shamitko. Executrix 258 Collier Dri,,'"e MedwUcsburg, PA 17055 STATEMENT OF RECEIPTJACKNOWLEOOEMENT I, JULIANNE .MARION ~ acknowledge receipt of the swn of Four Thousand and No/tOO ($4Jm.OO) DoIJaI's as the fulfillment oCtile bequest of my grandmother. Elsie J. Trueman. I ftlithes acknowledge that this is the full and only amount I am to receive from the estate of Elsie J. Trueman. J~~~~i -U 1..1-los- Date Mr. Paul Eric Shamitko 258 Collier Drive Mecbanicsburg, PA 11055 Estate of Elsie J. Trueman Gail D. Sbamidro, Executrix 258 Collier Dml: Mecbanicsburg,. P A 17055 STATEMENT OF RECEIPT/ACKNOWLEDGEMENT ~ PAUL ERIC SHAMITKO, acknowledge receipt of the sum of Four Thousand and Noll 00 ($4~oo(lOO) DoIlaIs as the fulfillment oftbe bequest of my grandmother, Elsie J. Trueman. I further ad.oowledge that this is the fun and only amount I am to receive from the estate of Elsie J. Trueman. ; , ~ .-' ---- .,' ...~....j. ~ ~/ t<'-~F" . ....::... Paul Eri\; Shamitko (gtandson) /' -~c7.>'- Date Me. yaw '-:>namIIKO. ~usrowan u. 1..M..ft. for Juel Sbamitko 258 Collier Drive Mecbanicsburg, PA 17055 Estate of Elsie J. Trueman Gail D. Sbamitko~ Executrix 258 Collier Drive ~urg. PA 17055 STATEMENT OF RECEIPTl ACKNOWLEDGEMENT I, PAUL SHAMITKO. ackoowledge.in the capacity of custodian under UT.MA. for my daughter Juel Shamitko, a minor. the transfer and receipt of check # 1016 in the amount of One Thousand and NaltOO ($1,000.00) Dollars as the fulfillment of the bequest of her great- grandmother" (my graudmother) Elsie J. Trueman. I further ackno",iedge that this is the full and only amount she is to receive fium the estate. of Elsie J. Trueman. //J~ '"'. ...., ,.:r'~,- ~-.., ". /d.u~' ., C--'i .- . Paul SbamitJro. Clmodian U.T.MA for JueI Sbami1ko .../ -'?c,7.-c?S- Date Mr. John I. Mills, Custodian U.T.M.A for John J. Mills. Jr. 3613 Huckleberry Highway Berli~ PA 15530 Estate of Elsie 1. Trueman Gail D. Shamitko. Executrix 258 Collier Drive Mecbanicsburg, PA 17055 STATEMENT OF RECEIPT/ACKNOWLEDGEMENT I~ JOHNJ. MJll.S, ~koowledge> in the capacity of custodian undeI" UT.MA for my son. John J. Mills. It.., a miMI, the transfer and receipt of check # 1014 in the amount of One Thousand and Noll 00 ($1,000.00) DonaIS as the fulfillment of the bequest ofms great-grandmodlec, (my grandmodler) ,Elsie J. Trueman. I further aeknowledgetbat this is 1be full and only amount be is to receive from the estate of Elsie J. Trueman. '/"-'~/;;~~::~ L..>".,,7/~'~~ ~--l._..~ Jobnc;JA;fitfS,. Custodian U.T.M.A. Ii" - for John J. Mills, Jr. .2. '.., ____..-c- - /,.,.... - 0 .j Date Me. John J. MiLis, Custodian U.T.M.A. for Kayla Ann Mills 3613 Huckleberry Highway Berlin, PA 15530 Estate of Elsie J. Trueman Gail D. Sbamitko,. Executrix 25& Collier Drive Mecbanicsburg. PA 17055 STATEMENT OF RECEIPT/ACKNOWLEDGEMENT I. JOHN J, MILLS, acknowledge" in the capacity of custodian under U.T.M.A for my daughter Ka)'Ja Ann Mills, It minor, the trnnsfec and cea:ipt of check. # 1015 in the amount of One ThousaDdandNoiIOO ($I.OOOJJO) Dollars as the fulfillment of the bequest of her great- grandmother, (my grandmother) Elsie 1. Trueman. I further acknowledge that this is the full and only aDMIt she is to receive from the estate of Elsie J. Trueman. f -~ fl ....-,/- ~ /....-' - d,5 Date JQttttJtMill<' C 'an U.T.M.A. (or Ka1fa Ann Mills Mrs. Julianne GilL Custodian U.T.MA for Austin Gill 136 Spring Run Apple Creek. OH 44606 Estate of Elsie J. TmeUl~ Gail D. S~i1ko, E.~ix 258 Collier Drive Mechanicsburg,. PA 17055 STATEMENT OF RECEIPT/ACKNOWLEDGEMENT I, JULIANNE GILL,. acknowledge, in the capacity of custodian under UT.MA for my son Austin Gill. a minor, the uansferand receipt 6f check # 1013 in the amount of One Thousand and No/tOO ($J,OOO.OO) DollaIS as.the fuJfiHmentofthe bequest ofms great-grandmother, (my grandmother) Elsie J. Trueman. I further acknowledge that this is the full and onlyamoWlt he is to receive fium the estate ofEl~ J. Trueman. l~ 6< (tfOS- Date Mr. Lan:y Lentz 5207 Browns Way PiUsbm:gh., PA 15224 Estate of Elsie J. Trueman Gail 0_ Sbamitlro~ Executrix 2SS Collier Drive Mccl1anicsburg. PA 110:55 STATEMENT OF RECEIPT/ACKNOWI.EOOEMENT 1, LARRY I.ENTZ, acbJowIedge receipt oCtile sum ofTwoTbousand and No/Ioo ($2,000.00) DoIItus as the fulfillment of the bequest of my great aun~ Elsie J. Trueman. I tUrtbtr acbJowIedge that this is the full and only amount I ant to receive from the estate of Elsie J. T~ ,. . y~ ~~ ",~'. ..2/1 2-00.5 Dati Mrs. Alice Lentz 52ft] Browns Way Pittsburgh, PA 15224 Estate of Elsie J. Trueman Gail D. Shamitko. Executrix 258 ColiierDri'V"e Mecbanicsburg. PA 11055 STATEMENT OF RECEIPT/ACKNOWLEDGEMENT I, ALICE LENTZ" acknowledge receipt of the sum of Two Thousand and No/lOO ($2,000.00) Dollars as the fulfillment of the bequest of my aunt. Elsie 1. Trueman. I further ac1.nowledge that this is the full and only amount I am to receive from the estate of Elsie J. Trueman Yd,.' ,~ (i q,t'U!L/~~ . Alice Lentz (~) t:r ::J;,,./.2-/) 'Loo .S- Date