HomeMy WebLinkAbout03-1009Register of Wills of
Estate of
also known as
Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Elaine~k. Montchal No. ~/--~)3' //(~
Raymond A. Montchal
Petitioner(s), who is/are 18 years of age or older, apply(les) for:
, Deceased
Social Security No. 189- 09- 9206
(COMPLETE 'A' or 'B' BELOW:)
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut or
the Decedent, dated 04/24/2000 and codicil(s) dated None
named in the last Will of
State relevant circumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated incompetent:
B. Grant of Letters of Administration
(c.t.a.; d.b.n.c.t.a; pendente lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and
heirs:
Name Relationship Residence
Ra.ymond A. Montchal
Elaine C. Baumbach
ISon
Daughter
(COMPLI:iE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland
P.O. Box 153, Hershey, PA
200 Spanslers Mill Rd., New Cumberld
County, Pennsylvania with his/her last family
or principal residence at 824 Lisburn Road, Lower Allen Township, Camp Hill,
(list street, number, and municipality)
Decedent, then 87 years of age, died 11/08/2003 at Camp Hill, PA
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property
(If not domiciled in PA) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
Value of real estate in Penn~y!vania
PA 17011
(Location)
275,000.00
125,000.00
situated as follows: 1505 Letchworth Road, Lower Allen Twp.
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of
letters in the appropriate form to the undersigned:
~/~,~ Signature
IRaymond A. Montchal
P.O. Box 153, Hershey,
Typed or printed name and residence
PA 17033
Prepared by the Pennsylvania Bar Association
Copyright (c) 1996 form software only CPSystems, Inc.
Form RW-1 (1991)
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
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 representative(s) of
the Decedent, Petitioner(s)will well and truly administer the estate acAdi~g~tO la~w~ ~
Sworn to or affirmed and subscribed
before me this ~)'7'/~day of ~A. Montchal
/'~.. , fa_ c .F~r the Register /
Estate of Elaine ~. Montchal
Deceased
Social Security No: 189- 09- 9206 Date of Death: 11/08/2003
AND NOW, , in consideration
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ~ Testamentary [] Of Administration
(c.t.a.; d.b.n.c.t,a,; pendente lite; durante absentia; durante minoritate)
are hereby granted to
Raymond A. Montchal
in the above estate and that the instrument(s) dated 04/24/2000
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters ........... $
Short Certificate(s) ..... $
Renunciation ........ $
Attorney: Michael L. Ban~s
Affidavits ( ) ....
Extra Pages ( ) .... $
Codicil ........... $
I.D. No: 41263
Bangs Law Office
Address: 302 Sou_th !8th Street
Camp Hill, PA 17011
JCP Fee .......... $ //~, ~;)~-P
Telephone: 717/730-7310
Inventory .......... $
Other ........... $
TOTAL ......... $ C~'/'-//~/
Prepared by the Pennsylvania Bar Association ~:opyrlght (c) 1996 form software only CPSystems, Inc.
Form RW-1 (1991}
105.805 REx,' 9/86
This is rD 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 fiiing.
WAFINING: It is illegal to duplicate this ¢op¥ blt photostat or photograph.
Fee for this certificate, $2.00
No.
Local Registrar
Date
~43 Roy. 2/a? COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
NAME OF DECEDENT (First. Middle, Last) STATE FILE NUMBER
] SEX [ SOCIAL SECURITY NUMBER [ DATE OF DEATH (Month Day Year)
~. ElaZne C. Montehal 12 Fema£e 13 189 - 09 - 9206 ], Novcmbe.~ 8', ~003
AGE (Lasl Birthday) ~ ,ER, YEAR I UNDER 1~ DAY I DATE OF BIRTHI BIRTHPLACE (City and IPLACE OF DEATH Iclheck o~1 ........ ins mc' '
Mor~ Days Hours I Minutes(Month, Day, Year)State or Foreign Country) HOSP TAL- IO~S Orl oth~. side)
,. I I:r.n,= ..... []
COUNIY OF DEATH CIBOROO
' ' ' FACILITY NAME ( f not insUlulion, give street and number) IWAS DECEDENT OF HISPANIC ORIGIN? [ RACE - American indian, Black,
· h. Cumber,?land I. Ea~ Pcnnsboro I UoV,, e~;~.;-t' IJ~.,~:4._O I"°[~]Yesr-]lfyes. speci~yCuban.
I~' lsd. ~ ~--~ ...~Je~[.~/[. rtb'~JJU.f..-f...C[~ lMexlcan, Pue~Rican, elc. I
DECEDENT'S USUAL ~ :CUPATION [ KIND OF BUSINESS I INDUSTRY IWAS DECEDENT EVER I~ I ......... ! ~' ·
.... t .... =,., I I" 'S' EDFO ES'"I '' I
11e. ~OU~.~X' o I / Yesl I Nol^l I ' ~n~ I ~ I Divorc~l(Speci~)
~ 111b' h2 ~ i13 (e-12112I 0q~s+) t ,...,
DEDEDENT'S IVlAILING ADi ESS (Slreet, City/Town, State, Zip Code) J DECEDENT'$ l?a. Stale
~4 /.~§t~ Road IACTU~ D~ ~. [] Yes. de*oden,i,,din/.OWe~
~ Camp H~ll, PA 17011 (Soeinst,~s ~ve~,
FATHER'S NAME (First. Mia.,i~.
~ MOTHER'S NAME (First. Middle. MaidEn Surname)
~OaU~NVS ~E (T~m~,t) Arthwt Wu~rtzel I~,. Philom.~ne Sehoner bet
· INFOR S ILING ^ RESS ( ee 'fy . S re. ' Code
,o,. Elarne Baumbach J2Ob ~ ~ang~rs ~,.t~ ~"/~[P2 ~e~ ~umberland, PA
~.12t"' L.J m~erlSpeci-' ~-,I ;". '' . .... f ceemax~on 3Dore;fy o~1
· 3 .~-x ~'-~ ,'P ~,~. LJl=,,NOVem~e4 lZ, ZOO3 Iz~=Penn~u~vania C~e-,.',.' .... I ..... -
] i~?~N~[. URN OF.EyNEI~AL s~{~101Gl~ LIcE NSEc- OR~P,~ON AOING AS SU CH LICENSE NUMBER ' ~..'__- ~:~. _ _ J 21 dl .FI ~/~q'2[ ~ ~ {'~l-
'items 24-26 must be cmp~l~ by ~ ' [ TIM~ ......... 23b. 123c
~mon ~o pro~unces dea~ ~ ~ u~ U~[H -- -- -- I DATE PRONOUNCED D~D (Month, Day Year) WAS ~SE REFERRED TO A M
~ : u r~ Novemo~ 8, 2003 '
27. PART l: Enter me dlllilll. InJurlee or comp#catlonl which ClUlld the de&ih, Do not enter Ihe mode of dylne, euch i! ce~dll~ or resplralory ureel, shock e~ heart failure,
~' any. leading to immediate
~ause. Enter UNDERLYING
CAUSE (Disease or injury
Ye'~l JL Nol--I
26.
: Approximate PART I1: Other signirk:ant co~ditinns contributing to death, but
, intel/al be?wee not resu#~ ~ ~e undedy~g cause given in PART I.
", onset add deal~
~DUE TO (~ AS A~N SEQUENCE ~): ~
~_~ AUTOPSY ~ WERE AUT~SY FINDINGS I ~NNER OF D~TH I DA ......
.... ORMED? AW,~LE P.,OR TO I ~ I(~ ~.'~i~Y I T,~E OF .NJU.Y I IN3U.V AT WORK? DESCRIBE HOW INJURY OCCURRED
I I Accident D Pending, ..... 'galion
OF DEATH? Yes
.omi ...o .oO ku, ,o, o Could not be determined ~130.' ,3Ob. M 3Oc. 3Od.
,~ ~ ~ ~ ~ PLACE OF INJURy - At home farm. s
On ~e basil of examination Indlor Investlgatl~, In my opinion, dea~ occurred at ~e time, date and place and due to the causes s} and (l~m 27) Type ~ Pdnt
DATE FILED (M~, Day, Year)
city/bore.
I, ELAINE W. MONTCI-IAL, of Lower Allen Township, Cumberland County,
Pennsylvania, declare this to be my last will and revoke any will previously made by me.
ITEM I. I direct that all my just debts and funeral expenses, including my gravemarker
and all expenses of my last illness, and any and all taxes and assessments imposed by any
governmental body as a result of my death, whether on property passing under this will or
otherwise, shall be paid from my residuary estate as soon as practicable after my decease as a
part of the expense of the administration of my estate.
ITEM II. I hereby make the following specific bequests:
A. The sum of Five Thousand ($5,000.00) Dollars to my grandson,
BRIAN BAUMBACH;
B. The sum of Five Thousand ($5,000.00) Dollars to my grandson,
CHRISTOPHER BAUMBACH;
C. The sum of Five Thousand ($5,000.00) Dollars to my grandson,
JOSHUA MONTCHAL;
D. The sum of One Thousand Five Hundred ($1,500.00) Dollars to my
step-granddaughter, STACEY HOOPER;
E. The sum of One Thousand Five Hundred ($1,500.00) Dollars to my
step-grandson, RUSTY MONTCHAL;
F. The sum of Two Thousand Five Hundred ($2,500.00) Dollars to my
niece, CHERYL HENRY, of Sunbury, Pennsylvania;
The sum of One Thousand ($1,000.00) Dollars to my friend, ERIKA
ELLIS;
H.
The sum of One Thousand ($1,000.00) Dollars to my friend,
ELEANOR SCOTT; and
I. The sum of Two Thousand ($2,000.00) Dollars to Grace Lutheran
Church.
ITEM III. I give, devise, and bequeath all the rest, residue, and remainder of my
possessions and estate of every nature and wherever situate to those of my issue, per stirpes, as
survive my death by thirty (30) days.
ITEM IV. All of the interests of the beneficiaries hereunder shall not be subject to
anticipation or to voluntary or involuntary alienation nor shall they be subject to any execution or
attachment.
ITEM V.
ITEM VI.
I appoint my son, RAYMOND A. MONTCHAL, executor of this my last will.
In addition to the other powers and authorities granted to my personal
representatives by Pennsylvania law and by the other terms and provisions of this will, I hereby
give to my personal representatives the following powers and authorities effective without court
approval and until actual distribution of all property: to compromise any claim or controversy;
to make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as
my personal representatives may determine and at valuations finally to be fixed by them; to
2
invest in all forms of property, including any stock or other securities in any corporate fiduciary
or its successor without restriction to investments authorized for Pennsylvania fiduciaries, as my
personal representatives deem proper, without regard to any principle of risk or diversification;
to retain any or all assets of my estate, real or personal, without regard to any principle of risk or
diversification; to sell at public or private sale, to exchange, or to lease for any period of time,
any real or personal property and to give options for sales, exchanges, or leases, for such prices
and upon such terms or conditions as my personal representatives deem proper; and to allocate
receipts and expenses to principal or income or partly to each as my personal representatives
deem proper in their sole discretion.
ITEM VII. I direct that my personal representatives and fiduciaries shall not be required
to give bond for the faithful performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand this ~ ~f~ day of
ELAINE W. MONTCHAL
The preceding instrument, consisting of this and THREE other typewritten pages, each
identified by the signature of the testatrix was on the date thereof signed, published, and declared
by ELAINE W. MONTCHAL, the testatrix therein named, as and for her last will, in the
presence of us, who at her request, in her presence, and in the presence of each other, have
subscribed our names as witnesses hereto.
4
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
)
( SS:
)
The undersigned, being the testatrix whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, does hereby acknowledge that I signed and
executed the foregoing instrument as my last will, that I signed it willingly; and that I signed it as my free
and voluntary act for the purposes therein expressed.
ELA'I~E W. MONTCHAL
Sworn or affirmel to and acknowledged
befo~ ,me b) ;tatrix~amed above
this~dayt ~ ~lq~Jt ,~000.
T~., C~
My ~m~ ~ ~ ~0,
OO~ONWEALTH OF ~E~SYLVANIA
)
( SS:
)
Sworn or affirmed to and
~a~:knowled~d befo~'e me this
y of~.j~' 2 0~~0
COUNTY OF CUMBERLAND
WE, fi'],c&t~./~ ~w (o~ and '~2X-~C-;t.~ ~. ~T'F , the witnesses whose
names are signed to the attached or foregoing instrument, being duly qualified according to law, do
depose and say that we were present and saw the testatrix sign and execute the instrument as her last will;
that she signed it willingly and that she executed it as her free and voluntary act for the purposes therein
expressed; that each of us in the hearing and sight of the testatrix signed the will as witnesses; and that to
the best of our knowledge, the testatrix was at that time 18 or more years of age, of sound mind, and
under no constraint or undue influence.
MxCX-Li~:L L. BANGS
ATTORNEY AT LAW
1302SOUTIt 18TH STRI~ET
GAIvlP HILL, PENNSYLVANIA 17011
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: ELAINE W. MONTCHAL
Date of Death:
November 8, 2003
Will No.: 21-03-1009 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 December
15, 2003:
NAME ADDRESS
Raymond A. Montchal
Elaine C. Baumbach
Brian Baumbach
Christopher Montchal
Joshua Montchal
Russel Montchal
Stacey Stamey
Erika Ellis
Cheryl Henry
Eleanore Scott
Grace Lutheran Church
Post Office Box 153, Hershey, PA 17033
200 Spanglers Mill Road, New Cumberland, PA
1505 Letchworth Road, Camp Hill, PA 17011
731 Moores Mountain Road, Lewisberry, PA
Post Office Box 153, Hershey, PA 17033
1591 Stoney Mountain Way, Dauphin, PA 17018
268 Quary Road, Hummelstown, PA 17036
24 Village Court, Mechanicsburg, PA 17055
836 Ft. Augusta Avenue, Sunbury, PA 17801
37 Highland Drive, Camp Hill, PA 17011
1610 Carlisle Road, Camp Hill, PA 17011
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: none.
Date:
~0~C~toAut~Ll~A~qetG,~i~l~l, PA 17011
(717) 730-7310
Capacity: Counsel for Personal Representative
Glenda Farner Strasbaugh
Register of Wills &
Clerk of the Orphans' Court
Marjorie A. Wevodau
First Deputy
Kirk S. Sohonage, Esquire
Solicitor
OFFICES OF
One Courthouse Square
Carlisle, Pa. 17013
(717) 240-6345
FAX (717) 240-7797
g gi trr of i llill anb (gle a[ ®rpl)an ' Court
tgountl~ of Cumberlanb
March 19, 2004
Michael L. Bangs, Esquire
Bangs Law Office
429 South 18th Street
Camp Hill, PA 17011
IN RE: Estate of Elaine W. Montchal
21-03-01009
Dear Mr. Bangs:
Your letter of March 19, 2004 was received today regarding the filing of the
Notice to the Beneficiaries on the above referenced estate. Your certification was indeed
received on December 16, 2003; however it was not docketed properly which triggered
the issuance of the delinquent notice.
Please accept my sincerely apology for this error and any inconvenience it may
have caused.
Respectfully,
Glenda Famer Strasbaugh
Register of Wills and Clerk of the Orphans'
Court
GFS :maw
FROM :P~/HG$ LgW OFFICE FAX NO. :717730737d Mar. 19 ~ I~:~PM P~
429 8OUTI-I 18TM STR. F. JCI'
CAMP HII.I., PA 17011
[~.-mil: mlkelm n_ .m~. v ~'_~zot t .net
PIION P.: '/17-730-7310
FAX: 717~730-7374
MICHAEL L. RANGS, Attorney-at-Law
W~NDY S, CIIF_~BRO, Paral~l~al
March 19,2004
WILLIAM E. MILLgR,
Of Coua~!
VIA FACSIMILE 240-7797
Gienda Farncr Slrasbaugh, Register of Wills
Cumberland Cotmly Courthouse
One Courthouse Square
Carlisle, PA 17013
RE~: Estate o. f Elaine ~ Montchal
File 2003-01009
Dear Ms. Strasbaugh:
Today, March 19, 2004, I received your notice dated March 1 I, 2004 wherein you indicate that thc
Notice to the Beneficiaries has not been filed with your office. You also note that the filing will be
delinquent on March 18, 2004, yesterday.
Please check your records. Enclosed is a copy of thc notice that was filed with your office on
December ! 2, 2003. Please correct your records accordingly.
· Very truly yours,
M~chae Bangs
w~c
Enclosure
302 SOUTH 18TM STREI/T
CAMP HILL, PA 17011
E-re=ti: ban~l=w~paonli~9... _eq~m~
OFFICE
PHONE: 717-730-7310
FAX: 717-730-7374
MICHAEL L. BANGS, Attorney-at. Law
WILLIAM E, MILLER, JR.
WENDY S. CHESBRO, Paralegal
December 12, 2003
Of Counsel
Donna M, Otto, Deputy Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
RE: ,Estate of Elaine ~ Montchal
File No. 21-03.1009
Dear Ms. Otto:
Enclosed please find a Certification of Notice Under Rule 5.6(a) which I filc as a part of the
above-referenced estate.
Thank you very much.
Very truly yours,
wsc
Enclosure
cc: Mr. Raymond A. Montchal
Michacl L. Bangs
Ed Wd£a:aI lzBOa SI ',dew t,/.£~.~i/..Ii: 'ON ×U._d Ei3I_d_dO ~O-I S,_qNl:lS: WO~
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Dec~xient:
Date of Death:
Will No.:
To the Register:
ELAINE W. MONTCHAL
November 8, 2003
21-03-1009
Admin. No:
I certify that notice of beneficial interest (estate administration) required by Rule 5.6(a) of thc Orphans'
Court Rules was s~rved on or mailed to thc following beneficiaries of the above-captioned estate on Dec, ember
15, 2003:
NAME
Raymond A. Montehnl
Elaine C. Bn~nbnch
Brian Baumbach
Christopher Montchal
Joshua Montchal
Russel Montchal
Stacey Stamey
Erika Ellis
Cheryl Hem'y
Eleanore Scott
Grace Lutheran Church
ADDRESS
Post Office Box 153, Hershey, PA 17033
200 Spanglers Mill Road, New Cumberland, PA
1505 Letchworth Road, Camp Hill, PA ~7011
73 ! Moores Mountain Road, Lcwisberry, PA
Post Office Box 153, Hershey, PA 17033
1591 Stoney Mountain Way, Dauphin, PA 17018
268 Quary Road, Hummelstown, PA 17036
24 Village Court, Mechanicsburg, PA 17055
836 Ft. Augusta Avenue, Sunbury, PA I7g01
37 Highland Drive, Camp Hill, PA 17011
1610 Carlisle Road, Camp Hill, PA 17011
Notice has now been given to nil persons entitled thereto under Rule 5.6(a) except: none.
'lvflCHAEL L. BANGS, Esquire
302 South 18~ Street, Camp Hill, PA 17011
(717) 730-7310
Capacity: Counsel for Personal Representative
t~d 14~,~:~I t~{/k?. 6I -a~ ~L£L~F=LL~L: 'ON :qO_~ K)I._-I_.40 t'l:F1 !Zl, l:~: ~
FROM :~qh~S LRW OFFICE FAX NO. :7177307374 Mar. 19 2004 12:23PM Pi
429 SOUTH 18TH STREET
CAMP HILL, PA 17011
Emaih raikebangs@veri~,on.net
BAN(iS I.A OFFICe:
PHONE: 717-730-7310
FACSIMILE: 717-730-7374
MICHAEL L. BANGS, Esquire
WILLIAM E. MILLER, JR.
WENDY S. CHESBRO, Parnlegal
Of Counsel
DATE: ~ NUMBER OF SHEETS:
TO FAX N0.:
REFERENCE/SPECIAL INSTRUCTl~S:
This facsimile communication contains CONFIDENTIAL INFORMATION, which may also bc
LEGALLY PRIVILEGED and which is intended only for the use of the recipient(s) named above. If you are
not the intended recipient or the employee or agent responsible for delivering it to the .intended recipient, you are
hereby notified that any dissemination or copying of this facsimile is strictly prohibited. If you have received
this communication in error, please notify ns by telephone (717-730-7310) and return the original facsimile to us
at the above address by mail without retaining any copies. Thank you.
IF YOU EXPERIENCE ANY PROBLEM RECEIVING THIS TRANSMISSION, PLEASE CONTACT
THE MACHINE OPERATOR LISTED BELOW. THANK YOU.
ORIGINAL CORRESPONDENCE WILL BE FORWARDED BY MAIL
ORIGINAL CORRESPONDENC~ FORWARDED BY MAIL.
MACHINE OPERATOR
429 SOUTH 18xu STREET
CAMP HILL, PA 17011
E-mail: mikebangs~.verizon.net
BAN(iS OFFICE
MICHAEL L. BANGS, Attorney-at-Law
PHONE: 717-730-7310
FAX: 717-730-7374
WILLIAM E. MILLER, JR
WENDY S. CHESBRO, Paralegal
June 8, 2004
Of Counsel
Glenda F. Strasbaugh, Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
RE: Estate of Elaine Montchal
File No. 21-03-1009
Dear Ms. Strasbaugh:
Enclosed for filing as a part of the above-referenced estate please find the following:
1. The original and one copy of a Pennsylvania Inheritance Tax Return;
2. The original Inventory;
3. A check in the amount of $19,334.34 paying the amount of tax due; and
4. A check in the amount of $25.00 to pay the filing fee.
Please return a paid receipt to me in the enclosed, stamped, pre-addressed envelope. If you have
any questions or require anything further, please contact me directly.
Very truly yours,
L. B~gs
wsc
Enclosures
cc: Mr. Raymond A. Montchal
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF IND~VIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 004032
BANGS MICHAEL L
302 S. 18TH STREET
CAMP HILL, PA 17011
........ fold
ESTATE INFORMATION: SSN: 189-09-9206
FILE NUMBER: 2103- 1009
DECEDENT NAME: MONTCHAL ELAINE W
;)ATE OF PAYMENT: 06/10/2004
POSTMARK DATE: 06/09/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 1 1/08/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 t~19,334.34
TOTAL AMOUNT PAID'
$19,334.34
REMARKS:
SEAL
CHECK# 1020
INITIALS' JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
429 SOUTH 18TM STREET
CAMP HILL, PA 17011
E-mail: mikebangs~,verizon.net
BANffS OFFIC
PHONE: 717-730-7310
FAX: 717-730-7374
MICHAEL L. BANGS, Attorney-at-Law
WENDY S. CHESBRO, Paralegal
June 8, 2004
WILLIAM E. MILLER, JR.
Of Counsel
Glenda F. Strasbaugh, Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
RE: Estate of Elaine Montchal
File No. 21-03-1009
Dear Ms. Strasbaugh:
Enclosed for filing as a part of the above-referenced estate please find the following:
1. The original and one copy of a Pennsylvania Inheritance Tax Return;
2. The original Inventory;
3. A check in the amount of $19,334.34 paying the amount of tax due; and
4. A check in the amount of $25.00 to pay the filing fee.
Please return a paid receipt to me in the enclosed, stamped, pre-addressed envelope. If you have
any questions or require anything further, please contact me directly.
Very truly yours,
wsc
Enclosures
cc: Mr. Raymond A. Montchal
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 004032
BANGS MICHAEL L
302 S. 18TH STREET
CAMP HILL, PA 17011
........ fold
ESTATE INFORMATION: SSN: 189-09-9206
FILE NUMBER: 2103- 1009
DECEDENT NAME: MONTCHAL ELAINE W
DATE OF PAYMENT: 06/10/2004
POSTMARK DATE: 06/09/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 1 1/08/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $19,334.34
REMARKS:
TOTAL AMOUNT PAID:
9,334.34
SEAL
CHECK# 1 O2O
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
Register of Wills of
CUMBERLAND
INVENTORY
County, Pennsylvania
Estate of Elaine C. Montchal
a~so known as
, Deceased
No. 21-03-1009
Date of Death 11/08/2003
Social Security No. 189- 09- 9206
Raymond A. Montchal,
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned
no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this
Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein
are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Personal Representative
Name of k n~~n
Attorney: Michael L. Ban~s Signature: __ ,,,
I.D. No.: 41263 Signature: (/~ay~o tchal
Address: 429 South 18th Street Address: ~t Office Box 153
Camp Hill, PA 17011 Hershey, PA 17033
Telephone: 717/730- 7310
Dated:Teleph°ne: 717 ~q~
Description
(See continuation page(s) attached)
Value
(Attach additional sheets if necessary) Total: 325,429.79
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
Prepared by the Pennsylvania Bar Association
Copyricj ht (c) 1996 form software only CPSystems, Inc. Form #RW-7 (199~')
Estate of:
Date of Death:
County:
INVENTORY
Elaine C. Montchal
11/08/2003
Cumberland
CASH:
PNC Bank - Account
#514022-2898
PNC Bank - Account
#50-0088-0995
PNC Bank - Account
#50-0102-3928
(19.12)shares Smith Barney Citigroup
- Money Market Funds
The Woods - Refund for 11/9 to
11/30/03 Prorated
UGI Utilities, Inc. Refund
STOCKS/LISTED:
401.71 shares Prudential Financial
Jennison Fund
2,129.38 shares Prudential Financial
Dryden High Yield Fund
1,116.93 shares Prudential Financial
Dryden Total Return Bond
90.00 shares Smith Barney Citigroup
Loral Space and
Communications
210.04
55,198.65
8,992.79
(19.12)
4,654.33
38.75
5,792.67
12,052.27
14,196.22
33.30
69,075.44
-1-
1,000.00 shares Smith Barney Citigroup
Readers Digest Assn. Inc.
900.00 shares Smith Barney Citigroup
- Rite Aid Corp.
1,000.00 shares Smith Barney Citigroup
Spiegel C. A
1,000.00 shares Smith Barney Citigroup
Sun Microsystems Inc.
300.00 shares Smith Barney Citigroup
Tupperware Corp.
400.00 shares Smith Barney Citigroup
Worldcom Inc.
800.00 shares Smith Barney Citigroup
Xerox Corp.
14,465.00
5,589.00
100.00
4,152.00
4,473.00
12.40
8,352.00
REAL ESTATE/PA:
1505 Letchworth Road, Lower
Allen Twp.
126,500.00
129,854.35
126,500.00
TOTAL RECEIPTS OF PRINCIPAL ...............
325,429.79
-3-
200.00 shares Smith Barney Citigroup
Adelphia Business
Solutions
6.00 shares Smith Barney Citigroup
Agere Systems Inc. C1.A
158.00 shares Smith Barney Citigroup
Agere Systems Inc. C1.B
300.00 shares Smith Barney Citigroup
- Bristol Myers Squibb Co.
200.00 shares Smith Barney Citigroup
Campbell Soup Co.
23.00 shares Smith Barney Citigroup
WTS Chiquita Brands Int'l
800.00 shares Smith Barney Citigroup
Cholestech Corp.
200.00 shares Smith Barney Citlgroup
- Conagra Foods Inc.
3.38 shares Smith Barney Citigroup
- Dryden High Yield Fund
500.00 shares Smith Barney Citigroup
P.H. Glatfelter Co.
49.00 shares Smith Barney Citigroup
Graham Field Health
Products
600.00 shares Smith Barney Citigroup
Lucent Technologies, Inc.
165.00 shares Smith Barney Citigroup
- PPL Corp.
5,100.00 shares Smith Barney Citigroup
Pope Evans & Robbins Inc.
1,300.00 shares Smith Barney Citigroup
Proxymed Inc.
2.80
22.83
579.07
7,572.00
5,237.00
108.10
6,100.00
4,775.00
19.16
6,412.50
0.05
1,985.70
6,638.78
21,183.50
-2-
REV-1500 EX + (6-00)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
NHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Montchal Elaine C.
DATE OF DEATH (MM-OD-YEAR) I DATE OF BIRTH (MM-OD-YEAR)
11/08/2003 02/12/1916
( F APPL CABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
cAPB
HpRL
~pIO
~AC
~TK
rivES
C
O
R
R
E
S
C
O
M
T
I
0
1. Original Return ~ 247! Supplemental Return
4. Limited Estate . Future Interest Compromise (date of death after 12-12-82)
6. Decedent Died Testate Decedent Maintained a Living Trust
(Attach copy of Will) (Attach copy of Trust)
U 9. Litigation Proceeds Received [ J 10. Spousal Poverty Credit
(date of death between 12-31-91 and 1 - 1-95)
NAME
Michael L. Bangs
FIRM NAME (If Applicable)
OFFICIAL USE ONLY
FILE NUMBER
21-03-1009
COUNTYCODE YEAR NUMBER
SOCIAL SECURITY NUMBER
189-09-9206
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(date of death
3. Remainder Return prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
I~ 1 1. Election to tax under Sec. 9113(A)
(Attach Sch O)
COMPLETE MAILING ADDRESS
429 South 18th Street
Camp Hill, PA 17011
TELEPHONE NUMBER
717/730-7310
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or (3)
Sole -Proprietorship
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
r---] Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
Total Gross Assets (total Lines 1-7)
Funeral Expenses & Administrative Costs (Schedule H)
126,5(~0 ~00
(9)
Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
Total Deductions (total Lines 9 & 10)
Net Value of Estate (Line 8 minus Line 11 )
9.
10.
11.
12.
13.
129,854135
None
None
OFFICIAL USE ONLY
14.
(8) 432,803.76
(11) 11.,651.83
(12) 421,151.93
(13) 2,000.00
(14) 419,151.93
(15) O. O0
69,478.95
None
106,970.46
9,446.83
2,205.00
Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(aX1.2) x .0 0
16. Amount of Line 14 taxable at lineal rate 414,651.93 X .0 45
17. Amount of Line 14 taxable at sibling rate X .12
18. Amount of Line 14 taxable at collateral rate 4,500.00 X .15
19. Tax Due
(16) 18,659.34
(17) O. O0
(18) 675.00
(19) 19,334.34
Copyright (c) 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. S-O0)
Decedent's Complete Address:
STREET ADDRESS
824 Lisburn Road
Cl~ STATE ZiP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
0.00
(1)
Total Credits ( A + B + C ) (2)
19,334.34
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to re(iuest a refund (4)
5. if Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: ~Yes No
a. retain the use or income of the property transferred; ......................... ~ ~.~
b. retain the right to designate who shall use the property transferred or its income; ...........
c. retain a reversionary interest; or ....................................
d. receive the promise for life of either payments, benefits or care? ...................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ................................ [--'] []
3. Did decedent own an "in trust for" or payable upon death bank account or security at his
or her death? .............................................. [~ r~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property
which 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.
0.00
0.00
0.00
19,334.34
0.00
19,334.34
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,
correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
DATE
SIGNATURE OF P~RSON RESPONSIBLE FOR FILING RETUR" Raymond A. Montchal
/
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. 9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets
and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116(1.2)
[72 P.S. 9116(a)(1
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(a)(1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Copyright (c) ?000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00)
ESTATE OF
FILE NUMBER
Elaine C. Montchal SS# 189-09-9206 11/__08/2003 21-03-1009
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price
at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable
knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM ~ --
NUMBER DESCRIPTION
1 1505 Letchworth Road, Lower Allen Twp.
(See attached real estate appraisal)
TOTAL (Also enter on line 1, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc.
VALUE AT DATE
OF DEATH
126,500.00
$ 126,500.00
Form REV-150Z EX (Rev. 1-97)
APPRAISAL OF REAL PROPERTY
LOCATED AT:
1505 Letchworlh Road
Lower Alien Township, Cumberland County
Camp Hill, PA 17011
FOR:
Michael L. Bangs, Esquire
302 South 18th Street, Camp Hill, PA 17011
for the
Estate of Elaine C. Montchal
AS OF:
November 8, 2003 ** Retrospective Market Value
BY:
Clement A. Leo
PA Certified Residential Appraiser
L.G. CONNOR REAL ESTATE APPRAISERS LTD
2159 Market Street,
Camp Hill, PA 17011
L.G. Connor Real Estate Appraisers
~om] ~A2 --~'TOTAL lor Windows,' appraisal software by a la mode, ~nc. -- 1-800*ALAMOD£
REV- 1507 EX, (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Elaine C. Montchal SS#
189-09-9206
SCHEDULE A
REAL ESTATE
11/08/2003
FILENUMBER
21-03-1009
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price
at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable
knowledge of the relevant facts. Real property which is jointly-owned with ri~lht of survivorship must be disclosed on Schedule F.
DESCRIPTION
ITEM
NUMBER
1505 Letchworth Road, Lower Allen Twp.
(See attached real estate appraisal)
VALUE AT DATE
OF DEATH
126,500.00
TOTAL (Also enter on line 1, Recapitulation) $ 126,500.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1502 EX (Rev. 1-97)
APPRAISAL OF REAL PROPERTY
LOCATED AT:
1505 Letchworth Road
Lower Allen Township, Cumberland County
Camp Hill, PA 17011
FOR:
Michael L. Bangs, Esquire
302 South 18th Street, Camp Hill, PA 17011
for the
Estate of Elaine C. Montchal
AS OF:
November 8, 2003 ** Retrospective Market Value
BY:
Clement A. Leo
PA Certified Residential Appraiser
L.G. CONNOR REAL ESTATE APPRAISERS LTD
2159 Market Street,
Camp Hill, PA 17011
L.G. Connor Real Estate Appraisers
Fom~ GA2 --.-"TOTAL Iur Windows,~ ~upraisa] software by a la mode, inc, -- 1 *800*ALAMODE
December 19, 2003
File No, 03-782
L. G. Connor Real Estate Appraisers, Ltd.
2159 Market Street
Camp Hill, PA 17011
Bangs Law Office
ATTN: Michael L. Bangs, Attorney-at-Law
302 South 18th Street
Camp Hill, PA 17011
RE: 1505 Letchworth Road, Camp Hill, PA 17011
Dear Mr. Bangs:
Pursuant to your request, I have prepared a Complete Appraisal,
Summary Report for the property captioned in the "Summary of Salient
Features" which follows.
The accompanying report is based on a site inspection of
improvements, investigation of the subject neighborhood area of influence,
and review of sales, cost and income data for similar properties.
This appraisal has been made with particular attention paid to the
applicable value influencing economic conditions and has been processed
in accordance with nationally recognized appraisal guidelines.
The value conclusions stated herein are as of the date as stated in
the body of the appraisal and contingent upon the certifications and limiting
conditions attached.
Please do not hesitate to contact me or any of my staff if we can be
of additional service to you.
Respectfully,
Pennsylvania State Certified Residential Appraiser
Form DCVR -- "TOTAL for Windows" appraisal software by a la mode. inc. -- 1-800-ALAMODE
SUMMARY OF SALIENT FEATURES
Subject Address
Legal Descnption
City
County
State
Zip Code
Census Tract
Map Reference
1505 Letchworth Road
Deed Book 00170, Page 00321
Camp Hill
Cumberland
PA
17011
3240-0109.00
Sale Pdce
Date of SaJe
$ NA
NA
Borrower / Client
Lender
NA
Michael L. Bangs, Esquire
Size (Square Feet)
Pdce per Square Foot
Location
Age
Condition
TotaJ Rooms
Bedrooms
Ba~s
1,419
Average
55 years
Average
6
3
1
Appraiser
Date of Appraised Value
Clement A. Leo, Certified Residential Appraiser
November 8, 2003 '* Retrospective Mad(et Value
Rna Estimate of Value $ 126,500
Form SSD -- "TOTAL for Windows" appraisal software by a la mode, inc. -- 1-800-ALAMODE
LQ. Connor Real Estate Appraisers
UNIFORM RESIDENTIAL APPRAISAL REPORT E,eNo. o3-782
Address 1505 Letchwonth Road City Camp Hill State PA Zip Code 17011
Deed e 00321 Oounty Cumberland
Assessors Parcel No. 13-23-0547-303 Tax Year 03-04 R.E. Taxes $1,649.74 Special Assessments $ 0.00
Borrower NA 6urrent Owner Estate of Elaine C. Montchal "
Leasehold .....
NA
Highland Park Map Reference Census Tract 3240-010900
Sale P~ce $ NA Date of Sale NA Descnption and $ amount of loan ch~oes/concessi0ns lo be pad by seller NA
Client Michael L Bangs, Esquire Address 302 South 18th Street, Camp Hill, PA 17011
~raJser Clement A Leo. Cert. Residential Appraisr Address 2159 Market Street~ Camp Hill, PA 17011
L0cat~on -: Urban F ~ Suburban ~'-! Rural , Predominant I pR..SingJefamilyh°using.¢~ t Presentlanduse Fo°
occupancy I ~,c ~ur ,
Builtup 'i 0var75% ' 25-75% ! : Under25% . $(000) (yrs 10nefam~ly . 90 j .' Notlikely
Growl:hrate ' iRapid i:~Stabte ', jSIow L_:J0wner L 90 Low New J2-4family 4 _J ~_ nprocess
?ropertyvalues ; Increasing ' Stabe ' ; Dec nng ['-! Tenant [-'~5~---Hi.qh--7--~¢Muti.famiy _3~To: '
"h r-~ ~-:- -- . .
Demand, supply S ortega ; ..; Inbalance : 0versuppy [i:~ Vacant (0-5% [ ]Pred°minantL: , JCommercia]'~
' n ~' : /i iVac.t~erS~li ~O0-1tO 50-60 / I
_Ma~kebn~'ome , , U der 3 mos ~"i 3-6 mos ; , Over 6 mos.
#oft: Race and the racial c~mp~Ben ~t the nlll#llarhood are na al~al~l fact~.
Neighborhood boundaries and characteristics: The neighborhood boundaries are indicated on the enclosed neighborhood.map in the addenda of
Immediate hborhood is residential in nature.
Likely
Factors that affect the marketability of the properties in the neighborhood (proximity to employment and amenibes, employment stability, appeal to market, etc.):
Schools. shopping, employment, recreation and houses of worship are all within a 15-30 minute driving time of the subject property. ___
r maintenance programs were observed. Employment stability is good due to the State Capital in Harrisburg, the Army __
in New Cumberland, and the Naval Supply Depot in Mechanicsburg. Steady price increases and MLS statistics show a
demand for ~he area
MaAet cond~bons ]n the subject neighborhood (including support for the above conclusions related to the fiend of properly values, demand/supply, and marketing time
-- such as d~ta on competitive proposes for sale in the neighborhood, description of the prevalence of sales and financing concessions, otc.):
, tax records and MLS statistics show prices to be stable. The MLS shows that the typical marketinq time for the area is 3-6 months.
funds are readily available with conventional loans being 5.75% to 6.25% interest, fixed 30 year, 95% mortgage with up to three
;oints. Sellers are not required to offer sales or financing concessions~ but seller assistance is occurring.
Design
Extsting/Proposed
Age firs )
Project Information for PUDs(If applicable) - - Is the developer/builder in control of the Home Owners' Assoc ation (HOA)? ,!-i.! Yes [~' i No
Approximate lo~ number of units in the subject proiect Approximate total number of units for sale in Be subject project
Descnbe common elements and recreatJonal facilities:
D~mens~ons 55' x 120' per enclosed deed Topography Level
Site a~ea _6=6__0_0 square feet or 0.15 acre per tax office Corner Lot i J Yes [:. ] No Size Average for area
Specdic zoning classification and descn¢on _R-1 Single Family Established Residential Shape Rectangular
Zoning cornphance ~ ~ Legal r.. j LegaJ duncan/erin, ng (Grandfathered use) r~. ] IllegaJ ~_i i No zoning Drainage . Appear~s Adequate
"' Present use i J Other use (explain) View Average Street
Utilities P,ub!Jc Other I Off-site Improvements Type Public Pdvate Landscaping Tyj~i_cal f_oEJhe~ a.(ea
Elecb~cdy ~ ' Street Macadam ["~ [ ! Driveway Sudace Concrete
Gas : * t Curb/gutter Concrete [*~ [ i Apparent easements Standard Utility
Water ~ : Sidewalk Yes I : i' i FEMA Special F~ood Hazard Area i .: Yes ~ NO
SanitaJy sewer : Street lights Yes ": ' '
: L_%,, ~ ~ FEMA Zone C Map Date 9/30/77
Storm sewer · Alley None r [ ] FEMA Map No. 4210160
Comments (apparent adverse easements, encroachments, special assessments, slide areas, illegal or legal nonconforming zoning use, etc.): Standard
easements for electric, telephone, etc. There are no known or apparent adverse easements, encroachments or conditions that would ~act on the value of the
GENERAL DESCRIPTION EXTERIOR DESCRIP'rlON FOUNDATION BASEMENT INSULATION
Nc of Units One Foundation Concrete Block Slab No AreaSq Ft. 576 Roof
No ol Stories 2 Ex'tenor Walls Brick/Alum Craw~ Space No % Rnished 0% t Ceiling -- ' ' i
Type (Dot/Att) Detached Root Surface Basement Full Ceiling Joists _lWalls _-' - ' ,'
Gutters & Dwnspts, Aluminum Sump Pump No Wal~s doric Bloc~k ~ROOr ' '
Window Type Double Hun, Dampness None noted Floor Concrete ~None
__ Storm/Screens Yes Settlement Due To Age Outside Er~ No ~Unknown -- ' *.
No Infestation None noted
576
I 603
8t6
~inished area above qrade contains 6 1 1
iNTER!OR Materials/Condition ~JTCHEN EQUIP. A'ITIC AMENI'~ES CAR STORAGE:
Floors WOOd Type FHA I.xO None ~.1 Fireplace(s) # 1 ~'~ None
Walls Drywall/Avg Fuel Gas Range/Oven E~,' stairs [ ~
· , .: Pabo ___ ! .~ Garage #of cars
Tdm/Rnish Wood/Avg Condition Disposal i~i~i Drop Stair i J Deck ~ Attached
Bat~ Floor Vinyl/Ay9 COOLING Dishwasher ~ Scut'de [~ ! Porch Enclosed i~' i Detached
Bat~ Wainscot Ceramic/Avg.___ Central Yes Fan/Hood r,'!~l Roor L ~ Fence ~ _ ! . Built-In 1
Doors Wood/Avg Other No Microwave '~'~1 Heated i ~ Pool ' '
Carport
i 'i I car
Addibonai leatures (special energy efficient items, etc.): :Average for area. Four ceiling fans. Enclosed rear porch.
Condition ct the improvements, depreciabon (physical, functional, and external), repairs needed, quality of construc~on, remodeling/additions, etc.: The home is
le condition. There were no apparent functional inadequacies. The construction quality is typical for the an,a The estimated
is below the actual age due to maintenance~ condition, and comparison to competing neighborhoods. Physical depreciation is
~e. Unless otherwise mentioned, there were no significant (See Addendum)
Adverse environmental conditions (such as, but not limited to, hazm'dous wastes, toxic substances, otc.) present in the improvements, on the site, or in ~
immediate vicinity of the subject property: The property is of an age where lead based paint may be present. The market does not penalize the
but the ctient should be advised of it's possible existence. It is assumed that it is not present. If the client has a
~r~dd~e Mac Form 70 6/'93 PAGE 1 OF 2 Fannie Mae Form 1004 6/93
Form UA2 -- "TOTAL for Windows" appraisal so'.ware by a la mode, inc. -- ~-600-ALAMODE
UNIFORM RESIDENTIAL APPRAISAL REPORT
VaJuation S
File No. 03-782
ESTIMATED SITE VALUE
ESTIMATED REPRODUCTION coST-NEW-OF IMPROVEMENTS:
Dwelling· 1,419 Sq. Ft. @$_ = $
576 Sq. Ft. @$ =
Ga'age/Om'port 240 Sq. Ft. @$ __ =
TuteJ Esbmated Cost New = $
Less Physical Funcuonal ExtemaJ
Depreciation
Depreciated Value ct Improvements ..........
:'As-is" Value ct Site Improvements
&NOICATEO VALUE BY COST APPROACH
iTEM I SUBJECT
1505 Letchworth Road
Address Cam PA
S~es Puce NA
Data and/or Tenant &
Verification Source ~ection
VALUE ADJUSTMENTS DESCRIPTION
SaJes or Financing
Concessions
=$
=$
Comments on Cost Approach (such as, source of cost esbmate, site value,
square foot calculation an~ 1or HUD, VA and FmHA, Uqe e~mated remaining
economic life of bhe property): The
result in an excellent estimate of value if the buil¢
Loca~on
.reasonably new, and the improvements reflect the hi~
best use of the land. However~ when items of physical
depreciation must be estimated, an area of judQement is
involved which is subject to error. The Cost Approach was not
utilized due to the a9~:.
COMPARABLE NO. 1 COMPARABLE NO. 2 COMPARABLE NO 3
1492 Letchworth Road 2016 Dickinson Avenue 1503 Chatham Road
PA PA PA
0.06 miles 0.79 miles 0.12 miles
MLS, Agent and
Courthouse Records
DESCRIPTION
Conventional
None
10/11/02 1DOM
0.15 acre 0.15 acre
View Street Street
, of ConstmctJon
Condibon
Above Grade
Room Count 6 '. 3 ' 1 3 :
Basement & Finished Full Bsmt Full Bsmt
Rooms Below Grade Unfinished Unfinished
FHA/CA FHA/CA
1
Ft. 0
+1,000
' Eff]c4ent Items
Porch. Pabo, Deck,
Enclosed Porch None
,lace
None None
91.24 90.49
MLS, Agent and MLS; Agent; Ext. Inspection
Courthouse Records Courthouse Records
DESCRIPTION
Conventional
None
DESCRIPTION
Conventional
None
2/28/03 4100M 6-30-03 5DOM
0.20 acre
.Street
B~s
7 : 3 : 1
Full Bsmt
Rec Room
Hot Water/None
Enclosed Porch
)lace
None
OM3 acre
u Street
Bock & Alum/Av
Full Bsmt.
Unfinished
FHA / None
Scm. Porch
)lace x2
None
Bat~s
1
Ft. -2.100
+5OO
Adjusted Sales Price i: :; :X}:'.';~ ~;::i ~::
Comments on Sales Comparison (including the subject property's comp~bilit'/to U~e neighborhood, etc.): After a thorough search of all available data
~arables chosen were considered the best available. Adjustments were made to reflect ~ub_~tantial differences between the co~
and the subject. The adjustments that were made reflect the typical actions of buyers and seller in the marketplace. Sale #1 had
remodeled kitchen and bath. All coi~parables were considered equally.
EM SUBJECT COMPARABLE NO. 1 COMPARA~E NO. 2 COMPARABLE NO 3
and Data NA None None None
prior sales NA NA NA NA
~f~_~p~r.~s.al NA Courthouse Records Courthouse Records Courthouse Records
Date. Pnce and
Source, for
AnaJysis of any current agreement of sale, option, or listing of subject property and analysis of any pdor sales of subject and comparables within one year of ~e date of appraisal:
Poor sales of the comparable properties occurred more than one year ago. The subject is currently not under contract nor listed in the o
act has not transferred within the past three years.
IN DrCATED VALUE BY SALES COMPARISON APPROACH
INDICATED VALUE BY INCOflE APPROACH (if Applicable)Estimated Market Rent $ '~ /Mo X Gros; Rani MulUplier 0 =$$ 126
This appra~saJ is made ~' ] as is ~ sublect to ~e repots, alterations, mspections or conditions Ilsted'l~elow '~
subject
to
complebon
per
plans
&
specificai~ons
Conditions of Appraisal No warranty of this appraisal is given or implied. No liability is assumed for the structural and/or mechanical elements of
iect.
Final Reconciliation: Due to the lack of rental data, the Income Approach was considered inappropriate and not utilized. Greatest weight was __
ivan to the Sales Comparison Approach as it reflects the typical actions of buyers and sellers in the open market.
** Retrospective market value as of the date of death
The purpose of this appraisal is to esbmate the market value of the real properly tha~ i$ ~ subject of ~s report, based on Ihe above condibons and the ce~fical~on, con~ngent
~d Iimibng conditions, and market value detiniSon ~at are stated in 53e attached Freddie Mac Fon-n 439/FNMA form 1004B (Revised June 1993 .).
I (WE) ES'~MATE THE MARj~'T VALUE, AS DERN ED, OF THE REAL P~OPERTY THAT IS THE SU 8JECT OF THIS REPORT, AS OF Nove tuber 8, 2003 ~'
(WHICH IS TH E OA~'.E~OF/~N SPECTION AND ~IE~EC~ DATE OF THIS REPORT) TO BE $ 126 500 --
APPRAISER' ' ~ .......
. ' /~}l /~' .... ~/~/_~ -.. SUPERVISORY APPRAISER (ONLY IF REQUIRED):
Signature
Name Clement A Leo~ Certified Residential Appraiser Name
_Da!~ Repod Signed December 19, 2003 Date Report Sic]ned
State Cert]Iication # RL~O01765-L Sta~te PA State CerUfic~on #
Or State License #- ~t.~te 9r State l~icense #
:reddie Mac Form 70 6/93 PAGE 2 OF 2
Form UA2 -- "TOTAL for Windows" appraisal software by a la mode, inc. -- 1-800-ALAMODE
Inspect Property
State
Fannie Mae Form 1004 6-93
UNIFORM RESIDENTIAL APPRAISAL REPORT
MARKET DATA ANALYSIS
ITEM
1505 Letchworth Road
PA
1608 Letchworth Road
PA
miles
Da~a and/or
Tenant &
MLS; Agent; Ext. Inspection
S~es or fnancing
D_ate of SaJA/'~J_me
None
9'20'O~)-7-D°M i . 'tlj200
Above Grade
Room Count
Basement & finished
Full Bsmt
Full Bsmt.
ished
or to, or less
Porch, PaSo, Deck,
Adjusted SaJes Price
Date, Price and Data
Source for prior sa~es
Comments:
Enclosed Porch
None
NA
NA
None
Market Data Ana/ysis 6-93
Form UA2.(AC) -- "TOTAL for Windows. apprasal software by a la mode inc.
, -- 1-800-ALAMODE
LCieBOrTower/Client NA
Property Address- i ~05 Letchworth Road
~L_Oamp Hill
nder NA
Supplemental Addendum File No. 03-782
County Cumbedan(~ State PA Zip Code 17011
· URAR: Condition of the Improvements Co, nt'd:
items observed that require immediate repair. No functional or economic obsolescence was observed.
· URAR: Adverse Enyironmental Conditiorl$ Cont'd;
concern, then a qualified expert in this area should be contacted. There are no known or apparent adverse
environmental conditions that would negatively impact on the sale of the property.
· UR. AR: Special Limitinf:l Conditions
This appraisal is not a home inspection and the appraiser is not acting as a home inspector when preparing the
report. The borrower has the right to have the home inspected by a professional home inspector. When
performing the inspection of this property, the appraiser visually observed areas that were readily accessible. The
appraiser is not required to disturb or move anything that obstructs access or visibility. The inspection is not
technically exhaustive. The inspection does not offer warranties or guarantees of any kind.
The appraiser is not a home or environmental inspector. The appraiser provides an opinion of value. The
appraisal does not guarantee that the property is free of defects or environmental problems. The appraiser
performs an inspection of visible and accessible areas only. Mold may be present in areas the appraiser cannot
see. A professional home inspection or environmental inspection is recommended.
If the property is sold, this appraisal is subject to satisfactory inspection reports including, but not limited to: wood
infestation, water test(s), radon, building inspections, etc.
· URAR: Supplemental Certifications
I certify that,
This COMPLETE APPRAISAL- SUMMARY APPRAISAL REPORT was prepared by Clement A. Leo for the
exclusive use of Michael L. Bangs, Attorney-at-Law, of Bangs Law Office for use in estate settlement purposes.
Estimated market value is the most probable price in terms of cash or in terms of financial arrangements equivalent
to cash. Michael L. Bangs is considered to be my client. The information and opinions contained in this appraisal
set forth the appraiser's best judgment in light of the information available at the time of the preparation of this
report. Any use of this appraisal by any other person or entity, or any reliance or decisions based on this appraisal
are at the sole responsibility and at the sole risk of the third party. I accept no responsibility for damages suffered
by any third party, as a result of reliance on or decisions made or actions taken based on this report.
In my opinion, the reasonable exposure time linked to the value opinion is up to 180 days.
I further certify that, to the best of my knowledge and belief:
- The statements of fact contained in this report are true and correct.
- The reported analyses, opinions, and conclusions are limited only by the reported assumptions and limiting
conditions, and are my personal, impartial, and unbiased professional analyses, opinions, and conclusions.
- I have no present or prospective interest in the property that is the subject of this report or to the parties
involved with this assignment.
- My engagement in this assignment was not contingent upon developing or reporting predetermined results.
- My compensation for completing this assignment is not contingent upon the development or reporting of a
predetermined value or direction in value that favors the cause of the client, the amount of the value opinion, the
attainment of a stipulated result, or the occurrence of a subsequent event directly related to the intended use of
this appraisal.
- My analyses, opinions, and conclusions were developed, and this report has been prepared, in conformity
with the Uniform Standard of Professional Appraisal Practice.
- I have made a personal inspection of the property that is the subject of this report.
- N(;~;)ne provided signific~pt professional assistance to the person signing this report.
Certified Residential Appraiser
Form TADD -- "TOTAL for Windows" a,opraJsal software by a la mode, inc. -- 1-800-ALAMODE
DEFINITION OF MARKET VALUE: The most probable price which a property should bdng in a competitive and open mallet under all conditions
requisite to a fair sale, the buyer and seller, each acting proden~y, knowledgeably and assuming the price is not afected by u~dne stimdus Implicit in this
delinition is the consumma~on of a sale as of a specified date and the passing of t~e from seller to buyer unde; conditions whereby: (1) buyer and ~ler are
typically motivated; (2) both pa~es are well ioformed or well advised, and each a~ng in what he considem his own best interest; (3) a reasonable time is ~llowed
for exposure in tim open market; (4) payment is made in terms of cash in U.S. dollars or irt terms of financial arrangements compara~e thereto; and (5) the ~ce
represents the normal consideration for the property sold unaffected by special or creative financing or sales concessions* granted by anyone associated w~
the sale,
* Adjustments to the comparables must be made for special or cre~ve financing or sales concessions. No adjustments are necessary
for those costs which we normally paid by sellers as a result of ffad~on or law in a market area; these costs are readily identifiable
srnce the seller pays these costs in vidua~ly all sales ffansactions. Special or crea~ve financing adjustments can be made to the
comparable property by compa;isone to financing terms offered by a ~ird party institudonal lender that is not already involved in the
properly or ffansacbon. Any edjus~ent should not be calculated on a mechanical dollar for dollar cost of the financing or concession
but the dollar amount of any adiustmeot should ap~'oximate the manV. nt's reaction to the financing or concessions based on the
appraser's judgement.
STATEMENT OF LIMITING CONDITIONS AND APPRAISER'S CERTIFICATION
CONTINGENT AND LIMITING CONDITIONS: The appraiser's certifica~on that aRnears in the appraisal report is subject to the folJowlng
condi~ons:
I The appra'ser will not be responsible for matters of a legal name that atfect either the property being appraised or the title to it The appraiser assumes that
bhe title is good and marketable and, therefore, will not render aaT opinions about the He. The properly is appraised on the basis of it being under responsible
ownership.
2. The appraiser has provided a sketch in the apprmsal report to show ~mate dimensions of the improvements and the sketch is included only to assist
the reader of the report in visualizing the prope~ and understanding the appraiser's determination of its size.
3. The apprmser has examined the available flood maps that are provided by the Federal Emergency Management Agency (or other data sources) and has noted
rn the appraisal report whether the subject site is located in an identified Special Rood Hazard Area. Because the al:pr~ser is not a surveyor, he or she makes
no gua.~antees, express or implied, regarding this determJnabon.
4. The appraiser will not give tesUmony or appear in court because he or she made an aPprmsal of the property in question, unless specific arrangements to do
so have been made beforehand.
5 The appraiser has estimated the value of the land in the cost approach at its highest and best use and the improvements at their conthbuto~y value. These
separate valuations of the land and improvements must not be used in conjunction w~ any other appraisal and are invalid if they are so used.
6. The appraiser has noted in the appraisal report any adverse conditions (such as, needed repairs, depreci~un, the presence of hazardous wastes, toxic
substances, etc.) observed du~ng the inspection of the subject property or that he or she became aware of dubng the normal research involved in performing
the appraisal. Unless otherwise stated in the appraisal report, the Aopralsm' has no knowledge of any hidden or unappm'ent condrdons of the properP/ or
adverse environmental condi~ons (including the presence of hazardous wastes, toxic substances, etc.) that would make the property more or less valuable, and
has assumed that there are no such conditions and makes no ~uarantees or wananties, express or implied, regarding the condition of the properly. The
appraiser will not be responsible for any such conditions that do exist or for any engineering or tasting that mi~,ht be required to discover whether such
condibons exist. Because the appraiser is not an expert in the field of environmental hazards, the appraisal report must not be considered as an
environmental assessment of the property.
7. 'i'he appraiser ob~ned the intorma~on, estimates, and opinions that were expressed in the appraisal report from sources that he or she considers to be
reliable and believes them to be ~e and correct. The appraiser does not assume responsibility for rte accuracy of such items that were furnished by o~'ler
par~es,
8. The appraiser will not disclose b'e contents of the appraisal report except as provided for in the Uniform Standards of Professional Appraisal Prac~ce.
9, The appraiser has based his or her appraisal report and valuafion conclusion for an abpraisal that is subject to satisfactory completion, repairs, or
alterabons on the assumption that complelJon of the improvements will be performed in a workmanlike manner.
10. The appraiser must provide his or her P~or whtten consent before h'm lender/client specified in the appraisal report can disthbute the appraisal report
(including conclusions about the property value, the appraiser's identity and professional designations, and references to any professional appraisal
organiza~ons or the firm w~ which the appraiser is associate~ to anyone other than the borrower; the mortgagee or its successors and assigns; the mor~age
insurer; consultants; professional agpraisal organiza~ons; any state or federally approved financial insUtution; or any depadment, agency, or instrumentality
of the United States or art/ state or the Dtst~ct of Columbia; excelX that ttm lander/client may distribute the property descdpfion sect]on of the report only to data
collect]on or report]ng sen'ice(s) withou~ having to ob~n the a~ser's ~or written consent. The ap~alser's written consent and approval must also
be obtained before bhe appraisal can be conveyed by anyone to the public through aclvert]sing, public raisons, news, sales, or other media.
Freddie MacForm4396-93
Page 1 of 2
Fannie Mae Form I004B 6-93
L.G. Connor Real Estat~/kopratsem
I:nrm AF:.R -- "TnTAI fnr Windnwc. nnnr~ie;~l *nfi'w~r~ hv ~l hi ronda in~' -- I-R~In. AI AMnn~:
APPRAISER'S CERTIFICATION: The Appraiser certifies and agrees that:
1. I have researched the subject market area and have saected a minimum of three recent s~es of propeCdes most similar and proximate to the subject property
for consideration in the sales comParison analysis and have made a dollar adjustment when appro~ate to reflect the market reaction to those items of significant
vanafion. If a significant item in a comparable property is supedor to, or more favorable than, the subject property, I have made a negative adjustment to reduce
the adiusted sales price of the comparable and, if a significant item in a comparable property is in~edor to, or less favorable than the subject property, I have made
a positive adiustment to increase the adjusted sales price of the comparable.
2. I dave taken into consideration the factors that have an impact on value in my development of the es~mate of market value in the appraisal report I have not
~owingly withheld any significant information from the a,opralsal report and I believe, to the best of my knowledge, that all statements and informadon in the
appraisal report are true and correcL
3. I stated in the appraisal report only my own personal, unbiased, and professional analysis, opinions, and conclusions, which are subject only to the contingent
and limibng conditions specified in this 1grin.
4 I have no present or prospective interest in the property that is the subject to this report, and I have no present or prospective personal interest or bias with
respect to the paracipants in the t~ansaction. I did not base, either paraally or completely, my analysis and/or the estimate of mad(et vaJue in the apprasal report
on the race, color, religion, sex, handicap, familial status, or nadonal origin of either the prospecUve owners or occupants of the subject property or of the present
owners or occupants gl the properties in the vicinit7 of the subject property.
5 I have no present or contem~ated future interest in the subject property, and neither my current or future employment nor my compensaUon for performing this
appra~saJ is contingent on the appraised value of the property.
6 I was not required to report a predetermined value or direction in value that favors ~ cause ot the client of any ralated party, the amount ol the value estimate,
the attainment of a specific result, or the occurrence of a subsequent event in order to receive my compensadon and/or employment for pedorming the appraisal. I
did not base the appraisal report on a requested minimum valuadon, a specific valuadon, or the need to approve a specific mortgage loan.
7 I pedormed this appraisal in conformity with the Uniform Standards of Professional AppralsaJ Prac~Jce that were adopted and promulgated by the Appraisal
Standards Board cd The Appraisal Foundadon and that were in place as cd the efle~ve doe cd this aapralsal, wi~ the exception cd the departure pro~sion ot those
Standards, which does not aPCy. I acknowledge that an esUmate of a reasonable Ume for exposure in the open market is a con~tion in the ddinition of market value
and the estimate I developed is consistent with the markeUng time noted in the neighboCnood secUon of t~s report, unless I have otherwise stated in the
reconciliation section.
8 I have personally inspected the intedor and exterior areas cd the subject property and the extedor of all proper'des listed as comparables in the apprasai report.
turner cer'dty that I have noted any apparent or known adverse condilJons in the subject improvements, on the subject site, or on any site within the immediate
vicini~ of the subject property of which I am aware and have made adjustments for these adverse condiUons in my analysis of the property value to the extent that
had market evidence to support them. [ have also commented about the effect oi' the adverse conditions on the marketability of the subject property.
9 I personally prepared ali conclusions and opinions about the real estate that were set forth in the appraisal report ff i relied on significant professional
assistance from any individual or thdividuals in the performance of the apprasal or the preparation of the appraisal report I have named such individual(s) and
disclosed the specific tasks performed by them in the reconciliadon section of this appraisal report. I cerUfy that any individual so named is qualified to pedorm
the task. I have not authorized anyone to make a change to any item in the report; therefore, ff an unauthorized change is made to the appraisal report I will take
no responsibility for it.
10. Please see additional Special Limiting Conditions and Supplemental Certifications, which are listed in the Addendum of this report
and are considered to be part of this Statement of Limiting Conditions and Appraiser's Certification.
SUPERVISORY APPRAISER'S CERTIFICATION: if a supervisor/ apprmser signed the appraisal report he or she ceCdfies and agrees that:
I directly super~se the appraiser who prepared the appraisal report, have reviewed the al3xalsaJ report, agree with the statements and conclusions of the appraiser,
~eree to be bound by the appraiser's certiticadons numbered 4 throu§h ? above, and am ta~r~ full responsibility for the, a~rai~ and the a~pral~ rep~.
ADDRESS OF PROPERTY APPRAISED:
Si§nature: _ v
Name: Clement A. Leo, Certified Residentiel Appraiser
Date Signed: December 19.2003
State Certification #: RL-001765-L
or State License #:
State: PA
Expiration Date of Certificadon or License: June 30, 2005
1505 Letchworth Road, Camp Hill, PA 17011
SUPERVISORY APPRAISER (only if required):
Signature:
Name:
Date Signed:
State Ce~ficadon #:
or State Ucense #:
State:
Ex~iradon Date of CeCdfication or License:
Did [~-i_} Did Not Inspect Prope~
Freddie Mac Fom3 439 6-93
Page 2 of 2
Form ACR -- "TOTAL for Windows" appraJsa/software by a la mode, inc. -- f-800-ALAMODE
Fannie Mae Form 10048 6-93
Location Map
BOrTOWer/Client NA
Property Address 1505 Letchworth Road
City Camp Hill
Lender NA
County Cumberland State PA Zip Code 17011
eerier
Fo,"m MAP.LOC -- "TOTAL for Windows" appraisal software by a la mode, inc. -- 1-800-ALAMODE
REV- 1~03 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE B
STOCKS & BONDS
Elaine C. Montchal SS# 189-09-9206 11/08/2003
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
FILE NUMBER
21-03-1009
ITEM
NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE
OF DEATH
1 401.711 shares Prudential Financial - Jennison Fund 14.42 5,792.67
2 2,129.377 shares Prudential Financial - Dryden High 5.66 12,052.27
Yield Fund
3 1,116.933 shares Prudential Financial - Dryden Total 12.71 14,196.22
Return Bond
4 90 shares Smith Barney Citigroup - Loral Space and .37 33.30
Communications
5 200 shares Smith Barney Citigroup - Adelphia Business .014 2.80
Solutions
6 6 shares Smith Barney Citigroup - Agere Systems Inc. 3.805 22.83
C1.A
7 158 shares Smith Barney Citigroup - Agere Systems Inc. 3.665 579.07
C1.B
8 300 shares Smith Barney Citigroup - Bristol Myers 25.24 7,572 00
Squibb Co. '
9 200 shares Smith Barney Citigroup Campbell Soup Co. 26.185 5,237.00
10 23 shares Smith Barney Citigroup - WTS Chiquita Brands 4 70
Int'l ' 108.10
11 800 shares Smith Barney Citigroup - Cholestech Corp. 7.625 6,100.00
12 200 shares Smith Barney Citigroup Conagra Foods Inc. 23.875 4,775.00
13 3.379 shares Smith Barney Citigroup Dryden High Yield 5.67 19.16
Fund
14 500 shares Smith Barney Citigroup - P.H. Glatfelter Co. 12.825 6,412.50
15 49 shares Smith Barney Citigroup - Graham Field Health .001 0 05
Products ·
16 600 shares Smith Barney Citigroup Lucent 3.3095 1,985.70
Technologies, Inc.
17 165 shares Smith Barney Citigroup PPL Corp. 40.235 6,638.78
Total of Continuation Schedule(s) 58,326.90
TOTAL (Also enter on line 2, Recapitulation) 129,854.35
d, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc.
Form REV-1503 EX (Rev. 1-97)
Estate of:
Soc Sec #: 189-09-9206
Date of Death: 11/08/2003
Elaine C. Montchal
Item Description
Continuation of Schedule B
(Stocks and Bonds)
Unit
Value
Value at Date
of Death
18
19
2O
21
22
23
24
25
26
5,100 shares Smith Barney Citigroup
Robbins Inc.
Pope Evans &
1,300 shares Smith Barney Citigroup Proxymed Inc.
1,000 shares Smith Barney Citigroup - Readers Digest
Assn. Inc.
900 shares Smith Barney Citigroup Rite Aid Corp.
1,000 shares Smith Barney Citigroup Spiegel C. A
1,000 shares Smith Barney Citigroup - Sun Microsystems
Inc.
300 shares Smith Barney Citigroup Tupperware Corp.
400 shares Smith Barney Citigroup - Worldcom Inc.
800 shares Smith Barney Citigroup - Xerox Corp.
16.295
14.465
6.21
.10
4.152
14.91
.031
10.44
0.00
21,183.50
14,465.00
5,589.00
100.00
4,152.00
4,473.00
12.40
8,352.00
58,326.90
SMITH BAKNEY_
c~t~group'7'
Elaine W. Montchal
Account 724-81076-12-550
Approximate Account Value on November 7,
2003
Security
Money Market Funds
Loral Space and Communications
Adelphia Business Solutions
Agere Systems Inc. Cl. A
Agere Systems Inc. Cl. B
Bristol Myers Squibb Co.
Campbell Soup Co.
WTS Chiquita Brands Int'l
Cholestech Corp.
Conagra Foods Inc.
Dryden High Yield Fund
P.H. Glatfelter Co.
Graham Field Health Prods.
Lucent Technologies Inc.
PPL Corp.
Pope Evans & Robbins Inc.
Proxymed Inc.
Readers Digest Assn. Inc.
Rite Aid Corp.
Spiegel Cl. A
Sun Microsystems Inc.
Tupperware Corp.
Worldcom Inc.
Xerox Corp.
· Keyport Life Annuity
Quan~ Avg. Price Totalvalue
-19.12 $1.00 ~$19.12
90 $0.37 $33.30
200 $0.014 $2.80
6 $3.805 $22.83
158 $3.665 $579.07
300 $25.24 $7,572.00
200 $26.185 $5,237.00
23 $4.70 $108.10
800 $7.625 $6,100.00
200 $23.875 $4,775.00
3.379 $5.67 $19.16
500 $12.825 $6,412.50
49 $0.001 $0.05
600 $3.3095 $1,985.70
165 $40.235 $6,638.78
5,100 $0.00 $0.51
1,300 $16.295 $21,183.50
1,000 $14.465 $14,465.00
900 $6.21 $5,589.00
1,000 $0.10 $100.00
1,000 $4.152 $4,152.00
300 $14.91 $4,473.00
400 $0.031 $12.40
800 $10.44 $8,352.00
n/a n/a $111,177.17
$208,971.74
Total Account Value
***The information herein has been obtained from sources we believe to be reliable, but do not
guarantee its accuracy or completeness.
CitigroupGlobalMarketslnc. llNorth3rdStreet, 2ndFloor Harrisburg, PA 17101 Te17177801700 Fax7172332090 Toll-free8002371700
Prudential Financial
Prudential Investments
Prudential Mutual Fund Services LLC
P O Box 8098
Philadelphia, PA 19101
(800) 225-1852
www.prudential.com
Bangs Law Office
Michael L Bangs
302 South 18th Street
Camp Hill PA 17011
Shareholder: Elaine C Montchal
Account Number: 03800733359
December 24, 2003
Dear Mr. Bangs:
I am writing to you in reference to a recent correspondence regarding the
Prudential mutual fund account listed above.
I would like to confirm this account was established on August 22, 1997. It is an
individual retail account, and is registered as follows:
Elaine C Montchal
200 Spanglers Mill Rd
New Cumberland PA 17070-2335
Please note that November 8, 2003 was a non-business day. The value of the
account on the close of business on November 7, 2003 was as follows:
Fund
Jennison Value
Dryden High Yield
Dryden Total Return Bond
Share Balance Shar_____~ePriceTotaIValue
401.711 $14.42 $5,792.67
2,129.377 $5,66 $12,052.27
1,116.933 $12.71 $14,196.22
The value on the close of business on November 10, 2003 was as follows:
Fund
Jennison Value
Dryden High Yield
Dryden Total Return Bond
Share Balance Share Price TotaIValue
401.711 $14.34 $5,760.54
2,129.377 $5.66 $12,052.27
1,116.933 $12.70 $14,185.05
The account balance is determined by multiplying the total number of shares in
the account by the Net Asset Value (price per share of the fund).
Please keep in mind that the Net Asset Value of the fund fluctuates on a daily
basis and therefOre the account value will also fluctuate daily.
The dividends that were earned on this account from January I 2003 through
November 8, 2003 were as follows: '
Fund
Jennison Value
Dryden High Yield
Dryden Total Return Bond
Amoun[
$0.00
$684.98
$403.51
I trust that this information has been helpful.
In the event that you have questions or need further assistance, please do not
hesitate to contact our Prudential Mutual Fund Service Center at 1-800-225.1852,
Monday through Friday, 8:00am to 8:00pm, eastern time. For account information
that is available 24 hours a day, 7 days a week, you may access your account
online at _www.prudential.com.
Sin_cerely,/ ,,~ ' , ·
ennifer Migliaro L/
Customer Service Associate
ESTATE OF
FILE NUMBER
Elaine C. Montchal SS# 189-09-9206 11/08/2003 21-03-1009
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on Schedule F.
ITEM
NUMBEF
1
2
3
4
5
6
7
VALUE AT DATE
DESCRIPTION
OF DEATH
Dryden Total Return Bond - (1/1/03 to 11/8/03)
PNC Bank Account #514022-2898
PNC Bank - Account #50-0088-0995
PNC Bank - Account #50-0102-3928
19 shares Smith Barney Citigroup Money Market Funds
The Woods Refund for 11/9 to 11/30/03 Prorated
Uti Utilities, Inc. Refund
TOTAL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc.
403.51
210.04
55,198.65
8,992.79
(19.12)
4,654.33
38.75
$ 69,478.95
Form REV-1508 EX (Rev. 1-97)
' J~N~ 22~004 18:48
PNCBANK
768 3dSE: P.O1
PNCBAN
~Ianuary 23, 2004.
Miohael L, Bangs
302 South 18'~ Strut
Camp Hill, PA 17011
Estate of Elaine C. Montchal, deceased
SSN: 189-09-9206
DOD: 11/8/2003
Dear Mr. Bangs:
In response to your request for Date of Death balances for the cUstOmer noted above, our
recor& s~ow ~.e following:
Checking Accounis
Account #5140222898
ELAINE C MONTCHAL
DOD balance: $210.04 + $.14 acorued interest
Interest Paid 1/I/2003 - 11/8/2003 - $3.60
Savings Accounts
Established 02/01 / 1983
Account #5000880995
c omcaxr
DOD balance: $55,198.65 + $23,08 accrued interest
Interest Paid 1/1/2003 - 11/8/2003 - $357.13
Account #5001023928
ELAINE C MONTCHAL
DOD balance: $8,99239 + $1.91 accrued interest
Interest Paid 1/1/2003 - 1 I/8/2003. $55.10
Established 11 / i 0/1998
Established 08/09/1996
Page 1 of 2
~IN-2~-~004 18:49 PNCSANK
P. 02
Please note that this office only providea date of de~h b~lanee~ for deposit aooounts
(IRAs, CDs, Checking a~d Savin~ zex:ounts). We do mint procems ~ny financial
~.ansac~ons or provide statements, If you need assistance With any of these items
please call 1-SSS.PHC.BANK (I-888-762-2265) or stop by your local PNC Bm~k br~nch
office..
Sineerdy,
Rachdle Wdls.
1-800-76:2-1775'
P7-PFSC-O4.F
500 first
Pimburgh PA 15219
Page 2 of 2
Member FDIC
TOTAL P.02
REV-1510 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Elaine C. Montchal SS~/
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
189-09-9206
11/08/2003
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
FILE NUMBER
21-03-1009
, insert additional sheets of the same raze)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1510 EX (Rev. 1-97)
DESCRIPTION OF PROPERTY % OF
ITEM INCLUDETHE NAME OF THE TRANSFEREE, THEiR DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER.
NUMBER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST 0F APPLICABLE
1 Keyport KeyBonus Fixed 104,952.64 104,952.64
Annuity - Contract
KA00782400- 01
2 Prudential Annuity - 2,017.82 2,017.82
Contract f/A2021340
TOTAL (Also enter on line 7, Recapitulation) $ 106,970.46
Prudential Financial
The Prudential Insurance Company of America
Annuity Services
PO Box13379
Philadelphia, PA 19101
(888) 778-2888
BANGS LAW OFFICE
ATTN MICHAEL L BANGS
429 SOUTH 18TM STREET
CAMP HILL PA 17011
Contract Number: A2021340
Payee: Elaine Montchal
May 5, 2004
Dear Mr. Bangs:
You recently wrote concerning the above referenced contract.
The value as of November 8, 2003 was $2,017.82.
If you have any questions, please call the Prudential Annuity Service Center at (888) 778-2888. The
Service Center is open Monday through Friday between 8:00 a.m. and 8:00 p.m. Eastern time. If you
are using a telecommunications device for the hearing impaired, you may call (800) 654-7637,
Monday through Friday between 8:00 a.m. and 8:00 p.m. Eastern time.
Sincerely,
Post Issue Approver ~
A Prudential business
Corporate Office: 751 Broad Street, Newark NJ 07102-3777
Life Financial
May 7, 2004
Bangs Law Office
Attn: Michael L. Bangs
429 South 18th Street
Camp Hill, PA 17011
Keyport KeyBonus Fixed Annuity
Contract Number KA00782400 - 01
Elaine C. Baumbach, Raymond A. Montchal,
and Elaine W. Montchal (Deceased) Co-Owners
Elaine W. Montchal (Deceased) Annuitant
Dear Mr. Montchal and Ms. Baumbach,
Thank you for your recent request for the value on November 8, 2003 for the annuity contract
referenced above. We welcome the opportunity to assist you.
Our records indicate that the surrender value of this contract on November 8, 2003 was
$104,952.64.
We hope t,~s information has been helpful. If you
Cus~/~/rvice Department at (800) 367.3653. have anY questions, please contact our
~mer
Correspondence Representative
CFMdodval
Sun Life Financial PO Box 9133 Wellesley Hills, MA 02481
Sun Life ASsurance Company of Canada (U.S.) and Independence Life and Annuity Company are members of the Sun Life Fihfini:ial group of companies.
COMiMNO~?W_EALTH OF PENNSYLVANIA I FUNERAL EXPENSES & I
N ~ ~ sR I ~)/~1~(~ %TM c~gEETNUTR N ADMINISTRATIVE COSTS
Elaine C. Montchal SS# 189-09- 9206 11/08/2003 FILE NUMBER
~ 21-03-1009
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
FUNERAL EXPENSES:
1 Cremation Society of PA
2 trace Lutheran Church - Funeral Luncheon
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
Attorney's Fees Michael L. Bangs
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent ~
Probate Fees Register of Wills
Accountant's Fees
Tax Return Preparer's Fees
Other Administrative Costs
Bonnie K. Miller, Treasurer 2004
Tax
2
3
4
5
6
County/Township Real Estate
Cumberland Law Journal Estate Advertising
L C. Connor Real Estate Appraisers Real Estate Appraisal
PA Water Company - PA Water Company
The Sentinel - Estate Advertising
The Woods at Cedar Run - Beauty Shop charge
Total of Continuation Schedule(s)
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc.
TOTAL (Also enter on line 9, Recapitulation)
AMOUNT
1,339.00
107.56
6,000.00
342.00
550.00
528.26
75.00
300.00
55.94
122.63
12.00
14.44
9,446.83
Form REV-1511 EX (Rev. 1-97)
Estate of:
Soc Sec #: 189-09-9206
Date of Death: 11/08/2003
Elaine C. Montchal
Item Description
Continuation of Schedule H-B7
(Other Administrative Costs)
Amount
Verizon - Verizon
14.44
14.44
REV-1512 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Elaine C. Montchal SS~/
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
11/08/2003
189-09-9206
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
Internal Revenue Service 2003 Final Lifetime Taxes Due
PA Department of Revenue - 2003 Final Lifetime Taxes Due
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1
FILE NUMBER
21-03-1009
AMOUNT
1,826.00
379.00
2,205.00
Copyright (c) 1996 form software only CPSystems, Inc.
Form REV-1512 EX (Rev. 1-97)
REV- 1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Elaine C. Montchal SS# 189-09-9206 11/08/2003
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
4
I1.
SCHEDULE J
BENEFICIARIES
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
transfers under Sec. 9116(a)(1.Z)]
Brian Baumbach
1505 Letchworth Road
Camp Hill, PA 17011
Christopher Baumbach
731 Moores Mountain Road
Lewisberry, PA 17339
Elaine C. Baumbach
200 Spanglers Mill Road
New Cumberland, PA 17070
Erika Ellis
24 Village Court
Mechanicsburg, PA
17055
Cheryl Henry
836 Ft. Augusta Avenue
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Grandson
grandson
Daughter
Friend
Niece
FILE NUMBER
21-03-1009
AMOUNT OR SHARE
OF ESTATE
5,000.00
5,000.00
One-half of
remaindr
1,000.00
2,500.00
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 2,000.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) ;)000 form software only The Lackner Group, Inc. Form REV-1513 EX (Rev. 9-00)
2,000.00
B. CHARITABLEAND GOVERNMENTALDISTRIBUTIONS
Grace Lutheran Church
1610 Carlisle Road
Camp Hill, PA 17011
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEh_I
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
Estate of: Elaine C. Montchal
Soc Sec #: 189-09-9206
Date of Death: 11/08/2003
Continuation of Schedule J, Part I
(Taxable Bequests)
Item
Name and Address of Beneficiary
Relationship
Amount or
Share of Estate
6
7
8
9
10
Sunbury, PA 17801
Stacey Hooper
268 Quary Road
Hummelstown, PA 17036
Joshua Montchal
Post Office Box 153
Hershey, PA 17033
Raymond A. Montchal
Post Office Box 153
Hershey, PA 17033
Russell Montchal
1591 Stoney Mountain Way
Dauphin, PA 17018
Eleanor Scott
37 Highland Drive
Camp Hill, PA 17011
step-granddaugh
1,500.00
Grandson
5,000.00
S on
One-half of
remaindr
Grandson
1,500.00
Friend
1,000.00
( Lka'na (antvhM
I, ELAINE W. MOlh'TCItAL, of Lower Allen Township, Cumberland County,
Penn~lvania, declare this to be my last will and revoke any will previously made by me.
ITEM I. I direct that all my just debts and funeral expenses, including my gravemarker
and all expenses of my last illness, and any and all taxes and assessments imposed by any
governmental body as a result of my death, whether on property passing under this will or
otherwise, shall be paid from my regiduary estate as soon as pmcticable after my decease as a
part of the expense of the administration of my estate.
ITEM II. I hereby make the following specific bequests:
A. The sum of Five Thousand ($5,000.00) Dollars to my grandson,
BRIAN BAUMBACH;
B. The sum of Five Thousand ($5,000.00) Dollars to my grandson,
CHRISTOPHER BAUMBACH;
C. The sum of Five Thousand ($5,000.00) Dollars to my grandson,
JOSHUA MONTCHAL;
D. The sum of One Thousand Five Hundred ($1,500.00) Dollars to my
step-granddaughter, STACEY HOOPER;
E. The sum of One Thousand Five Hundred ($1,500.00) Dollars to my
step-grandson, RUSTY MONTCHAL;
F. The sum of Two Thousand Five Hundred ($2,500.00) Dollars to my
niece, CHERYL HENRY, of Sunbury, Pennsylvania;
The sum of One Thousand ($1,000.00) Dollars to my friend, ERIKA
ELLIS;
H.
The stun of One Thousand ($1,000.00) Dollars to my friend,
ELEANOR SCOTT; and
I. The sum of Two Thousand ($2,000.00) Dollars to Crraee Lutheran
Church.
ITEM IH. I give, devise, and bequeath all the rest, residue, and remainder of my
possessions and estate of every nature and wherever situate to those of my issue, per stirpes, as
survive my death by thirty (30) days.
ITEM IV. All of the interests of the beneficiaries hereunder shall not be subject to
anticipation or to voluntary or involuntary alienation nor shall they be subject to any execution or
attachment.
ITEM V. I appoint my son, RAYMOND A. MONTCHAL, executor of this my last will.
ITEM VI. In addition to the other powers and authorities granted to my personal
representatives by Penn.qylvania law and by the other terms and provisions of this will, I hereby
give to my personal representatives the following powers and authorities effective without court
approval and until actual distribution of all property: to compromise any claim or controversy;
to make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as
my personal representatives may determine and at valuations finally to be fixed by them; to
invest in all forms of property, including any stock or other securities in any corporate fiduciary
or its successor without restriction to investments authorized for Pennsylvania fiduciaries, as my
personal representatives deem proper, without regard to any principle of risk or diversification;
to retain any or all assets of my estate, real or personal, without regard to any principle of risk or
diversification; to sell at public or private sale, to exchange, or to lease for any period of time,
any real or personal property and to give options for sales, exchanges, or leases, for such prices
and upon such terms or conditions as my personal representatives deem proper; and to allocate
receipts and expenses to principal or income or partly to each as my personal representatives
deem proper in their sole discretion.
ITEM VII. I direct that my personal representatives and fiduciaries shall not be required
to give bond for the faithful performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand this ~ day of
,2000.
ELAINE W. MONTCHAL
3
The preceding instrument, consisting of this and THREE other typewritten pages, each
identified by the signature of the testatrix was on the date thereof signed, published, and declared
by ELAINE W. MONTCHAL, the testatrix therein named, as and for her last will, in the
presence of us, who at her request, in her presence, and in the presence of each other, have
subscribed our names as witnesses hereto.
4
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
)
( SS:
)
Thc undersigned, being the testatrix whose name is signed to the attached or foregoing
insmunent, having been duly qualified according to law, does hereby acknowledge that I signed and
executed the foregoing instrument as my last will, that I signed it willingly; and that I. signed it as my free
and voluntary act for the purposes therein expressed.
ELA'I~qE W. MONTCHAL
Sworn or affirmed to and acknowledged
befo~:~']ne by ,~s~ri~, oamed above
No-ta~ Ptibli, #Ot~l~tll[~
COMMONWEALTH OF PENNSYLVANIA
)
( SS:
)
Sworn or affirmed to and
this
5
under no constraint or undue influence.
COUNTY OF CUMBERLAND
names are signed to the attached or foregoing instrument, being duly qualified according to law, do
depose and say that we were present and saw the testatrix sign and execute the instrument as her last will;
that she signed it willingly and that she executed it as her free and voluntary act for the purposes therein
expressed; that eaoh of us in the hearing and sight of the testatrix signed the will as wimesses; and that to
the best of our knowledge, the testatrix was at that time 18 or more years of age, of sound mind, and
429 South 18th Street
Camp Hill, PA 17011
AMOUNT
~'~"~ $2 90
0000
LEMOYNE,HH
17043
JUN 09.'04
00053281-03
17013
First Class Mail
I!elN sselo
Glenda F. Strasbaugh, Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
IN RE:
ESTATE OF
ELAINE W. MONTCHAL
Deceased
) IN THE COURT OF COMMON PLEAS OF
) CUMBERLAND COUNTY,
) PENNSYLVANIA
)
) ORPHANS' COURT DIVISION
)
) NO. 21-03-1009
RECEIPT AND RELEASE
I, JOSHUA MONTCHAL, the undersigned, being a beneficiary under the Estate of
Elaine W. Montchal, deceased, do herebyi
1. State and acknowledge that I ar~ an adult individual;
2. Waive the filing of an Account or Schedule of Distribution by the person,al.
representative of the Estate;
3. Acknowledge that I have received the sum of $5,000.00, pursuant to Item .t!' (C) of
decedent's Will to which I am entitled as a beneficiary of the Estate of Elaine W. Montchal;
4. To the extent of said distribution, release Raymond A. Montchal, Executor, of the
Estate of Elaine W. Montchal, and his heirs and personal representatives, from all liabilities,
whether due to his negligence or otherwise, which he may have by reason of his administration
of the Estate;
5. Agree to refund to the Estate and to the said Raymond A. Montchal, Executor, any
portion of the distribution to which I am not properly entitled, and, to the extent of said
distribution, to indemnify him and the Estate for claims made against him and to reimburse him
and the Estate all expenses and costs incurred in connection with any such claim; and
6. Declare that this instrument shall be legally binding upon me, my personal
representatives, and assigns.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
~.~ U I~'~. ., 2004.
day of
JOSHU
(
~ ~ }6~c~_.~ (SEAL)
MONTCHAL
COMMONWE/~I~TH OF PENNSYLVANIA )
L ( SS:
COUNTY OF k._ [3,_Y3~L.(~{._ )
On this, the Il day o .f.~(.i(~ MONTCHAL~~, 4 b fie .e[5tth~ /1(!..~16,
undersigned officer, personally appeared JOSHUA , t~ari~or ~a~is a~c~orily
proven) to be the person whose name is subscribed to the within instrument and acknowledged
that (s)he executed same for the purposes therein contained.
IN WITNESS WHEREOF, I.~havf ~aereu~to s~ ~k~v~hand and official seal.
Notary_ Publ~ v.
IN RE:
ESTATE OF
ELAINE W. MONTCHAL
Deceased
) IN THE COURT OF COMMON PLEAS OF
) CUMBERLAND COUNTY,
) PENNSYLVANIA
)
) ORPHANS' COURT DIVISION
)
) NO. 21-03-1009
RECEIPT AND RELEASE
GRACE LUTHERAN CHURCH, the undersigned, being a beneficiaryunder the Estate
of Elaine W. Montchal, deceased, does hereby:
1. Waive the filing of an Account or Schedule of Distribution by the personal ~
representative of the Estate;
2. Acknowledge the receipt of the sum of $2,000.00, pursuant to Item II (I) of decedent's
Will to which it is entitled as a beneficiary of the Estate of Elaine W. Montchal;
3. To the extent of said distribution, release Raymond A. Montchal, Executor, of the
Estate of Elaine W. Montchal, and his heirs and personal representatives, from all liabilities,
whether due to his negligence or otherwise, which he may have by reason of his administration
of the Estate;
4. Agree to refund to the Estate and to the said Raymond A. Montchal, Executor, any
portion of the distribution to which it is not properly entitled, and, to the extent of said
distribution, to indemnify him and the Estate for claims made against him and to reimburse him
and the Estate all expenses and costs incurred in connection with any such claim; and
5. Declare that this instrument shall be legally binding upon it, its successors and assigns.
to be executed this /tS> day of
IN WITNESS WHEREOF, Grace Lutheran Church has caused this Receipt and Release
x ~d~'Ad~-'" ,2004.
GRACE LUTHERAN CHURCH
By:
Name: Rev. B. Penrose Hoov~l:
Title: Senior Pastor
COMMONWEALTH OF PENNSYLVANIA )
(SS:
COUNTY OF CUMBERLAND )
On this, the /Q day of Vgd~ ,2004, before me, the
undersigned officer, personally appeared ~/~.5::~",~e,,5~-.~.~,~.- , known to
me (or satisfactorily proven) to be the person whose name is subscribed t'~ the within instrument
and acknowledged that (s)he executed same for the purposes therein contained on behalf of
Grace Lutheran Church.
IN WITNESS WHEREOF, I have h$,r. qunto set my hand and of_fi,cial seal.
]/ i ............... ~ARIAL SEAL I
I ,JAMES E.,GREEN, Notary Public I
Camp Hi,I Cumberland County I
My Commission Expires June 6, 20051
IN RE:
ESTATE OF
ELAINE W. MONTCHAL
Deceased
) IN THE COURT OF COMMON PLEAS OF
) CUMBERLAND COUNTY,
) PENNSYLVANIA
)
) ORPHANS' COURT DIVISION
)
) NO. 21-03-1009
RECEIPT AND RELEASE
I, BRIAN BAUMBACH, the undersigned, being a beneficiary under the Estate of Elaine
W. Montchal, deceased, do hereby:
1. State and acknowledge that I am an adult individual;
2. Waive the filing of an Account or Schedule of Distribution by the personal
representative of the Estate;
3. Acknowledge that I have received the sum of $5,000.00, pursuant to Item II (A) of
decedent's Will to which I am entitled as a beneficiary of the Estate of Elaine W. Montchal;
4. To the extent of said distribution, release Raymond A. Montchal, Executor, of the
Estate of Elaine W. Montchal, and his heirs and personal representatives, from all liabilities,
whether due to his negligence or otherwise, which he may have by reason of his administration
of the Estate;
5. Agree to refund to the Estate and to the said Raymond A. Montchal, Executor, any
portion of the distribution to which I am not properly entitled, and, to the extent of said
distribution, to indemnify him and the Estate for claims made against him and to reimburse him
and the Estate all expenses and costs incurred in connection with any such claim; and
6. Declare that this instrument shall be legally binding upon me, my personal
representatives, and assigns.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
.~ o~... ,2004.
day of
.,,~'~.~~EAL)
~RIAN BAUM~ACH
COMMONWEALTH OF PENNSYLVANIA )
(SS:
COUNTY OF CUMBERLA,Np '~ )
On this, the day of <.._~ ,2004, before me, the
undersigned officer, p~rsonally appeared BRIAN BAUMBACH, known to me (or satisfactorily
proven) to be the person whose name is subscribed to the within instrument and acknowledged
that (s)he executed same for the purposes therein contained.
IN WITNESS WHEREOF, I hav. e t]ereunlio set my hand and official seal.
l~qo~'ary Publi~//
IN RE: )
)
)
ESTATE OF )
ELAINE W. MONTCHAL )
Deceased )
)
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY,
PENNSYLVANIA
ORPHANS' COURT DIVISION
NO. 21-03-1009
RECEIPT AND RELEASE
I, ELEANOR SCOTT, the undersigned, being a beneficiary underthe Estate_~of Elaine
W. Montchal, deceased, do hereby:
1.
2.
State and acknowledge that I am an adult individual;
representative of the Estate;
3. Acknowledge that I have received the stun of $1,000.00, pursuant to Item II (H) of
decedent's Will to which I am entitled as a beneficiary of the Estate of Elaine W. Montchal;
4. To the extent of said distribution, release Raymond A. Montchal, Executor, of the
Estate of Elaine W. Montchal, and his heirs and personal representatives, from all liabilities,
whether due to his negligence or otherwise, which he may have by reason of his administration
of the Estate;
5. Agree to refund to the Estate and to the said Raymond A. Montchal, Executor, any
portion of the distribution to which I am not properly entitled, and, to the extent of said
distribution, to indemnify him and the Estate for claims made against him and to reimburse him
and the Estate all expenses and costs incurred in connection with any such claim; and
6. Declare that this instrument shall be legally binding upon me, my personal
representatives, and assigns.
Waive the filing of an Account or Schedule of Distribution by the personal
I
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
2004.
ELEANOR SCOTT
~~'--(SEAL)
. . day of
COMMONWEALTH OF PENNSYLVANIA )
(SS:
COUNTY OF CUMBE IR~ANDi ~X~.An,~ )
On this, the [T day of ( ~ljlt~ , 2004, before me, the
undersigned officer, perso'nally appeare"d"ELEANOR SCOTT, known to me (or satisfactorily
proven) to be the person whose name is subscribed to the within instrument and acknowledged
that (s)he executed same for the purposes the
IN WITNESS WHEREOF~v~
NIJt~tI~
· ein contained.
i~ se~m¢~nd an¢ official seal.
?ubli~ ....
IN RE:
ESTATE OF
ELAINE W. MONTCHAL
Deceased
) IN THE COURT OF COMMON PLEAS OF
) CUMBERLAND COUNTY,
) PENNSYLVANIA
)
) ORPHANS' COURT DIVISION
)
) NO. 21-03-1009
RECEIPT AND RELEASE
I, RAYMOND A. MONTCHAL, the undersigned, being a beneficiary under the Estate
of Elaine W. Montchal, deceased, do hereby:
1. State and acknowledge that I am an adult individual;
r-
2. Waive the filing of an Account or Schedule of Distribution by the personal
representative of the Estate;
3. Acknowledge that I have received the sum of $126,500.00, as a partial distribution to
which I am entitled as a beneficiary of the Estate of Elaine W. Montchal;
4. To the extent of said distribution, release Raymond A. Montchal, Executor, of the
Estate of Elaine W. Montchal, and his heirs and personal representatives, from all liabilities,
whether due to his negligence or otherwise, which he may have by reason of his administration
of the Estate;
5. Agree to refund to the Estate and to the said Raymond A. Montchal, Executor, any
portion of the distribution to which I am not properly entitled, and, to the extent of said
distribution, to indemnify him and the Estate for claims made against him and to reimburse him
and the Estate all expenses and costs incurred in connection with any such claim; and
6. Declare that this instrument shall be legally binding upon me, my personal
representatives, and assigns.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
~ ,2004.
D A. MONTCHAL
(SEAL)
__day of
COMMONWE/BLTH OF PENIS, SYLVANIA )
i' ' (SS:
COUNTY OF .. L,( [~/~~" \ )
On this, the "~/-r ~m* day of..v-, . .~, (..! ~/J/U~ ,2004, before me, the
undersigned officer, personally appeared ~.AYMOND A. MONTCHAL, known to me (or
satisfactorily proven) to be the person whose name is subscribed to the within instrument and
acknowledged that (s)he executed same for the purposes therein contained.
IN WITNESS WHEREOF, I haveJhereu~to s_.et ~1¥ hand and official seal.
/ "'
IN 1~:
ESTATE OF
ELAINE W. MONTCHAL
Deceased
) IN THE COURT OF COMMON PLEAS OF
) CUMBERLAND COUNTY,
) PENNSYLVANIA
)
) ORPHANS' COURT DIVISION
)
) NO. 21-03-1009
RECEIPT AND RELEASE
I, RUSSELL MONTCHAL, the undersigned, being a beneficiary under the Estate of
Elaine W. Montchal, deceased, do hereby:
1.
2.
State and acknowledge that I am an adult individual; ....
Waive the filing of an Account or Schedule of Distribution by the personal
representative of the Estate; ~
3. Acknowledge that I have received the sum of $1,500.00, pursuant to Ite_m~. II (E) of
decedent's Will to which I am entitled as a beneficiary of the Estate of Elaine W. M0ntchal;
4. To the extent of said distribution, release Raymond A. Montchal, Executor, of the
Estate of Elaine W. Montchal, and his heirs and personal representatives, from all liabilities,
whether due to his negligence or otherwise, which he may have by reason of his administration
of the Estate;
5. Agree to refund to the Estate and to the said Raymond A. Montchal, Executor, any
portion of the distribution to which I am not properly entitled, and, to the extent of said
distribution, to indemnify him and the Estate for claims made against him and to reimburse him
and the Estate all expenses and costs incurred in connection with any such claim; and
6. Declare that this instrument shall be legally binding upon me, my personal
representatives, and assigns.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
~ ,2004.
day of
COMMONWEALTH OF PENNSYLVANIA )
( SS:
COUNTY OF C ct~f3~l.h, db )
On this, the [ }~4x day of -~td~, ,2004, before me, the
undersigned officer, personally appeared RUSSELL MONTCHAL, known to me (or
satisfactorily proven) to be the person whose name is subscribed to the within instrument and
acknowledged that (s)he executed same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
Notary Publ~ ' ~
Notarial Seal
Harold E. Robinson, Notary Public
~leehanicsburg Boro, Cumberland County[
My Commission Expires July 19, 2005 [
Member, Pennsylvania Association of Notaries
IN RE: ) IN THE COURT OF COMMON PLEAS OF
) CUMBERLAND COUNTY,
) PENNSYLVANIA
ESTATE OF )
ELAINE W. MONTCHAL ) ORPHANS' COURT DIVISION
Deceased )
) NO. 21-03-1009
RECEIPT AND RELEASE
I, CHERYL HENRY, the undersigned, being a beneficiary under the Est'~ of Elaine
W. Montchal, deceased, do hereby:~c:-
1. State and acknowledge that I am an adult individual;
2. Waive the filing of an Account or Schedule of Distribution by the personal
representative of the Estate;
3. Acknowledge that I have received the sum of $2,500.00, pursuant to Item II (F) of
decedent's Will to which I am entitled as a beneficiary of the Estate of Elaine W. Montchal;
4. To the extent of said distribution, release Raymond A. Montchal, Executor, of the
Estate of Elaine W. Montchal, and his heirs and personal representatives, from all liabilities,
whether due to his negligence or otherwise, which he may have by reason of his administration
of the Estate;
5. Agree to refund to the Estate and to the said Raymond A. Montchal, Executor, any
portion of the distribution to which I am not properly entitled, and, to the extent of said
distribution, to indemnify him and the Estate for claims made against him and to reimburse him
and the Estate all expenses and costs incurred in connection with any such claim; and
6. Declare that this instrument shall be legally binding upon me, my personal
representatives, and assigns.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
Oz~. ,2004.
// day of
(SEAL)
COMMONWEALTH OF PENNSYLVANIA )
( SS:
COUNTY OF //Joz-/?t~v~''be--,z/ct~''-~ )
On this, the It '---- day of --~,,. e_..
,2004, before me, the
undersigned officer, personally appeared CHERYL HENRY, known to me (or satisfactorily
proven) to be the person whose name is subscribed to the within instrument and acknowledged
that (s)he executed same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
Notatty Pubic d r /,._~/
IN RE: )
)
)
ESTATE OF )
ELAINE W. MONTCHAL )
Deceased )
)
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY,
PENNSYLVANIA
ORPHANS' COURT DIVISION
I, STACEY ItOOPER, the undersigned, being a beneficiary under the Estate of Elaine
W. Montchal, deceased, do hereby:
1. State and acknowledge that I am an adult individual;
2. Waive the filing of an Account or Schedule of Distribution by the perso~al
representative of the Estate; .~-i
3. Acknowledge that I have received the sum of $1,500.00, pursuant to It¥~ II (D) of
decedent's Will to which I am entitled as a beneficiary of the Estate of Elaine W. Montchal;
4. To the extent of said distribution, release Raymond A. Montchal, Executor, of the
Estate of Elaine W. Montchal, and his heirs and personal representatives, from all liabilities,
whether due to his negligence or otherwise, which he may have by reason of his administration
of the Estate;
5. Agree to refund to the Estate and to the said Raymond A. Montchal, Executor, any
portion of the distribution to which I am not properly entitled, and, to the extent of said
distribution, to indemnify him and the Estate for claims made against him and to reimburse him
and the Estate all expenses and costs incurred in connection with any such claim; and
6. Declare that this instrument shall be legally binding upon me, my personal
representatives, and assigns.
RECEIPT AND RELEASE
NO. 21-03-1009
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
~7~, -e ,2004.
(SEAL)
__ day of
COMMONWEALTH OF PENNSYLVANIA )
(SS:
COUNTY OF ~.),a ~a,--"-'~' )
On this, the a" '~ day of t~-t~ ,* ( ,2004, before me, the
undersigned officer, personally appeared STACEY HOOPER, known to me (or satisfactorily
proven) to be the person whose name is subscribed to the within instrument and acknowledged
that (s)he executed same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
Notary Public
NOTARIAL SEAL
DONNA D. SMITH, Notary Public
Derry Township, Dauphin County
My Commission Expires April 29, 200?
IN RE:
ESTATE OF
ELAINE W. MONTCHAL
Deceased
) IN THE COURT OF COMMON PLEAS OF
) CUMBERLAND COUNTY,
) PENNSYLVANIA
)
) ORPHANS' COURT DIVISION
)
) NO. 21-03-1009
RECEIPT AND RELEASE
I, CHRISTOPHER BAUMBACIt, the undersigned, being a beneficiary under the
Estate of Elaine W. Montchal, deceased, do hereby:
1. State and acknowledge that I am an adult individual;
2. Waive the filing of an Account or Schedule of Distribution by the personal,
representative of the Estate; e:]? ·
3. Acknowledge that I ~ the sum of $5,000.00, pursuant to Item II~(B) of
decedent's Will to which I am entitled as a beneficiary of the Estate of Elaine W. Montchal;
4. To the extent of said distribution, release Raymond A. Montchal, Executor, of the
Estate of Elaine W. Montchal, and his heirs and personal representatives, from all liabilities,
whether due to his negligence or otherwise, which he may have by reason of his administration
of the Estate;
5. Agree to refund to the Estate and to the said Raymond A. Montchal, Executor, any
portion of the distribution to which I am not properly entitled, and, to the extent of said
distribution, to indemnify him and the Estate for claims made against him and to reimburse him
and the Estate all expenses and costs incurred in connection with any such claim; and
6. Declare that this instrument shall be legally binding upon me, my personal
representatives, and assigns.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
,2004.
CHRISTOPHER BAUMBACH
(SEAL)
__ day of
COMMONWE~rkTH OF PF4NNSX~LVANIp~ )
'bt. (ss.
COUNTY OF (-.f 1~/(~~, , '
On this, the /~ dayof ~~ , 2004, before me, the
undersigned officer, pe'f~onally appeare~l:lR/ST(~PHER BAUMBACH, known to me (or
satisfactorily proven) to be the person whose name is,,~t~ subscribed to the within instrument and
acknowledged that (s)he executed same for the purposes therein contained.
IN WITNESS WHEREOF, I have,h~}reunto Iset n~ ~ and official seal.
N&Yy Public ~ .......
I WENDY & CHESORO, ~ ~
!,
IN RE: ) IN THE COURT OF COMMON PLEAS OF
) CUMBERLAND COUNTY,
) PENNSYLVANIA
ESTATE OF )
ELAINE W. MONTCHAL ) ORPHANS' COURT DIVISION
Deceased )
) NO. 21-03-1009
RECEIPT AND RELEASE
I, ERIKA ELLIS, the undersigned, being a beneficiary under the Estate of Elaine W.
Montchal, deceased, do hereby:
1. State and acknowledge that I am an adult individual;
2. Waive the filing of an Account or Schedule of Distribution by the persondl~
representative of the Estate;
3. Acknowledge that I have received the sum of $1,000.00, pursuant to Item I-I (G) of
decedent's Will to which I am entitled as a beneficiary of the Estate of Elaine W. Montchal;
4. To the extent of said distribution, release Raymond A. Montchal, Executor, of the
Estate of Elaine W. Montchal, and his heirs and personal representatives, from all liabilities,
whether due to his negligence or otherwise, which he may have by reason of his administration
of the Estate;
5. Agree to refund to the Estate and to the said Raymond A. Montchal, Executor, any
portion of the distribution to which I am not properly entitled, and, to the extent of said
distribution, to indemnify him and the Estate for claims made against him and to reimburse him
and the Estate all expenses and costs incurred in connection with any such claim; and
6. Declare that this instrument shall be legally binding upon me, my personal
representatives, and assigns.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this . .
.5 V ~ P,~. ., 2004.
lq day of
'~RIKA ELLIS
(SEAL)
COMMONWEALTH OF PENNSYLVANIA )
(SS:
COUNTY OF CUMBERLO~D ~ )
On this, the diiy of ' 2004, before me, the
undersigned officer, pe['sonally appeared"~RIKA ELLIS, ~o~ to me (or satishctorily proven)
to be the person whose nme is subscribed to the within instrument and ac~owledged that (s)he
executed sine for the pu~oses therein contained.
IN WITNESS WHEREOF, I have tl/ereunto set/~y/ha~ and 9fficial seal.
otar~ Public~ - -
I NOT~n.m~t. i
I wr=nm,$.~,l~/~ I
I
IN RE:
ESTATE OF
ELAINE W. MONTCHAL
Deceased
) IN THE COURT OF COMMON PLEAS OF
) CUMBERLAND COUNTY,
) PENNSYLVANIA
)
) ORPHANS' COURT DIVISION
)
) NO. 21-03-1009
RECEIPT AND RELEASE
I, ELAINE C. BAUMBACH, the undersigned, being a beneficiary under th~:'Estate of'
Elaine W. Montchal, deceased, do hereby: [:
1. State and acknowledge that I am an adult individual;
2. Waive the filing of an Account or Schedule of Distribution by the persona! '
representative of the Estate;
to'dl r¢c ~'~ue_
3. Acknowledge that I E~¥e r~c~c2-~-~d the sum of $126,500.00 in kind, as a partial
distribution to which I am entitled as a beneficiary of the Estate of Elaine W. Montchal;
4. To the extent of said distribution, release Raymond A. Montchal, Executor, of the
Estate of Elaine W. Montchal, and his heirs and personal representatives, from all liabilities,
whether due to his negligence or otherwise, which he may have by reason of his administration
of the Estate;
5. Agree to refund to the Estate and to the said Raymond A. Montchal, Executor, any
portion of the distribution to which I am not properly entitled, and, to the extent of said
distribution, to indemnify him and the Estate for claims made against him and to reimburse him
and the Estate all expenses and costs incurred in connection with any such claim; and
6. Declare that this instrument shall be legally binding upon me, my personal
representatives, and assigns.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
,2004.
ELAINE C. BAUMBACH
.(SEAL)
day of
COMMONWEALTH OF PENNSYLVANIA )
( ss:
COUNTY OF C4Lv.,_,EP. LAND )
On this, the /g4% day of ~ ,2004, before me, the
undersigned officer, per--~-~onally appeare~FELAINE C. BAUMBACH, known to me (or
satisfactorily proven) to be the person whose name is subscribed to the within instrument and
acknowledged that (s)he executed same for the purposes therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
{qotary Public
Notarial Seal
Patricia A. Gordon, Notary Public
Fairview Twp., York County
My Commission Expires July 31, 2005
Member, Pennsylvania Association of Nolarles
BUREAU OF INDIVIDUAL TAXES
TNHERTTANCE TAX DTVZSZON
DEPT. 280601
HARRTSBURG, PA 17128-0601
HICHAEL L BANGS
qZ9 S 18TH ST
CAHP HILL
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DZSALLO#ANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
Rccor~-<:~-~' ...... of
, ~ ri.L, ::: DATE
DATE OF DEATH
FILE NUH~ER
JUL 30 gll :30 COUNTY
ACN
I
08-OZ-ZOOq
HONTCHAL
11-08-Z005
21 05-1009
CUNBERLAND
101
Amoun~ Reei'l:ted
ELAINE W
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03} NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HONTCHAL ELAINE WFZLE NO. 21 03-1009 ACN 101 DATE 08-02-200~
TAX RETURN NAS: (X} ACCEPTED AS F/LED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es*a~e (Schedule A) (1)
2. S~ocks and Bonds (Schedule B) (2)
3. Closely Held S~ock/Par~nership Zn~ares~ (Schedule C) (3)
q. Mortgages/No,es Receivable (Schedule D) (q)
5. Cash/Bank Deposits/Misc. Personal Proper~y (Schedule E)
6. Jointly Owned Propar~y (Schedule F) (6)
7. Transfers (Schedule G) (7}
8. To'al Asse~s
APPROVED DEDUCTIONS AND EXEHPTZONS:
9. Funeral Expenses/Adm. Costs/Misc. Expanses (Schedule H) (9)
10. Deb~s/Nor~gage Liabilities/Liens (Schedule I) (10)
11. To,al Deductions
12. Net Value of Tax Ra~urn
126z500.00
129z85R.$5
.00
.O0
69~q78.95
.00
NOTE: To insure proper
credi~ to your account,
submi~ the upper portion
of ~his form with your
~ax payment.
9,qq6.85
2.205.00
(11) l! .6;1.83
(12) q21,151.95
13.
lq.
NOTE:
reflect f/gures that include the total of ALL returns assessed to date.
ASSESSHENT OF TAX:
15. Amount of Line lq a~ Spousal ra~:e (1-;) . O0 X O0 =
16. Amount: of Line lq ~caxable at Lineal/Class A ra~:e (16) qIq,65! .95 x Oq5 =
17. Aeoun~ of L/ne lq at Sibling ra~e (17) .00 X 12 =
18. Amoun~ of L/ne lq ~axable a~ Collateral/Class B ra~e (18) q,500.O0 X 15 =
19. Principal Tax Due (19)=
TAX CREDITS:
PAYMENT RECEIPT D/SCOUNT
DATE NUMBER INTEREST/PEN PAID (-
06-09-ZOOq CDOOqO~2 .00
AMOUNT PAID
19,$$q.3q
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
Chari~cable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (13)
Nc'l: Value of Ese:ate Sub.~ac~: ~:o Tax (lq) q19,151.95
If an assessment ~as issued previously, lines 14, 15 and/or 16, 17, 18 and 19 w111
Z,000.00
.00
18,659.$q
.00
675.00
19,$$q.$q
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
19,$3q.$q
.00
.00
.00
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS RE{)UIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
106z970.q6
(a) q$2,805.76
RESERVATION:
Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the la~ful Class B (collateral) rate on any such futura interest.
PURPOSE OF
HOT[CE:
To ~ulfi11 the requirements of Section ZlqO of the inheritance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S.
Section 91qO).
PAYHENT:
REFUND (CR):
OBJECTZONS:
ADH[N-
[STRAT[VE
CORRECTIONS:
Detach the tap portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF HILLS, AGENT
A refund of a tax credit, ehich ems not requested on the Tax Return, may ba requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1515). Applications ara available at the Office
of the Register of Hills, any of the 23 Revenue District Offices, or by calling the special Iq-hour
answering service for fores ordering: 1-800-362-2050; services for taxpayers with special hearing and / or
speaking needs: 1-800-q~7-SOZO (TT onZy).
Any party in interest not satisfied with the appraisement, allaaancs, or disallowance of deductions, or assessment
of tax (including discount or interest) as sho~n on this Notice must object aithin sixty (60) days of receipt of
this Notice by:
--written protest to t~e PA Department of Revenue, Board of Appeals, Dept. 2810Z1, Harrisburg, PA 171Ia-lOg1, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Reviae Unit, Dept. [BO601, Harrisburg, PA 171Z8-0601
Phone (717) 787-6505. See page S of the booklet "instructions for inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
DISCOUNT:
if any tax due is paid eithin three (5) calendar months after the decedent's death, a five percent (SI) discount of
the tax paid is alloaed.
PENALTY:
The 1SI tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same tiaa period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
iNTEREST:
interest is charged beginning aith first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of
six (6Z) percent per annum calculated at a daily rate of .000164. All taxes ahich became delinquent on and after
January 1, 1982 ~il1 bear interest at a rate which mill vary from calendar year to calendar year aith that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through gOOq are:
interest Daily interest Daily interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
198Z ZOZ .OOOSqB ~'8-1991 IIX .gOO301 ~ 9Z .OOOZq7
1985 16Z .000458 199Z 9Z .O00Zq7 2002 6Z .OOOX6~
198q 11Z .000501 1995-199q 7Z .00019Z 2005 5Z .000157
1985 152 .000556 1995-1998 9Z .0002~7 200~ ~Z .000110
1986 lOX .00027~ 1999 7Z .O0019Z
1987 ZOZ .O00Z7q ZOO0 7Z .00019Z
--Interest is calculated as fallows:
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DEL'rNQUENT X DAILY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent ~ill reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment is made after the interest computation date sha~n an the
Notice, additional interest must be calculated.
REGISTER OF WILLS OF CUMBERLAND COUNTY
REPORT OF STATUS OF ADMINISTRATION
(For Resident Decedents Dying after July 1, 1984)
ESTATE NO. 21 - 03 - 1009
Name of Decedent:
Social Security No.:
ELAINE W. MONTCHAL
189-09-9206
Date of Death:
November 8, 2003
Name of Personal Representative:
Raymond A. Montchal
Capacity Executor __X Administrator c.t.a.
(check one) Administrator Administrator d.b.n.
X No
Is the administration of the estate complete? Yes
If "Yes", how was the administration ended? (check one)
By court accounting
By account stated to parties in interest
Did the parties release the
personal representative? yes
Other (explain)
X
Total amount paid to date to creditors and for funeral and $3 1,2 0 4 o 7 6
administrative expenses
Total value of distributions to date to beneficiaries
$174,251.44
If administration is not complete, estimated value of assets $0.0
still in administration
NOTE: This status report is due no later than the due date for filing of the Pennsylvania
inheritance tax return or, if no inheritance tax return is required, nine (9) months after the
date of death; if the administration of the estate has not been concluded, a summary report
shall be filed annually thereafter until the administration is complete.
Date:
I certify under penalty of perjury that the foregoing information is correct to the best of my
knowledge, information and belief.
Attorney for Estate //~./
IN RE: IN THE COU-RT OF COMMON PLEAS OF
CUMBERLAND COUNTY.
PENN SYLVAN1A
ESTATE OF
EEAINE W. MONTCHAI. ORPHANS' COURT DIVISION
Deceased
NO. 21-03-1009
RECEIPT AND RELEASE
h ELAINE C. BAUMBACH, the undersigne& being a beneficiary under thc Estate of
Elaine W. Montcha!. deceased, do hcreby:
I. State and acknowledge that I am an adult individual;
2. Waive the filing of an Account or Schedule of Distribution by the personal
represcntative of the Estate:
3. Acknowledge that i have received all sums of money and personal property to which l
am entitled as a beneficiary of the Estatc of Elaine W. Montchal;
4. To the extent of said distribution, release RAYMOND A. MONTCHAL, Executor of
the Estate of Elaine W. Montchal, and his heirs and personal representatives, l¥om all liabilities.
whcther due to his negligence or otherwise, which he may have by reason of his administration
of the Estate:
~o ....E.,tat= an,~ [o thc said RAYMOND A. M ..... ,.~,tA~.. E~,ccmo,.
5. Agret' to rcPdnd ' ,t,~ ~ · , ,4 I ri ('IKIT/~[ · .......
any portion of thc distribution to which I am not properly entitled, and. to the extent of said
distribution, to indemnify him and the Estate tbr claims made against him and to reimburse him
and the Estate all expenses and costs incurred in connection with any such claim: and
6. Declare that this instrument shall be legally binding upon me, my personal
representatives, and assigns.
IN WITNESS WHEREOF, I havc hereunto set my hand and seal this
iS{- day of
ELAINE C. BAUMBACII
COMMONWEALTH OF PENNSYLVANIA )
( SS:
COUNTY OF CUMBERLAND I )
On this. the da',' of ,M, , 2004, belbre me, the
undersigned officer~r'sonally aCpeared ~LAINE C. BAUMBACH. known to me (or
satisPactorily proven) to be the person whose name is subscribed to the within instrument and
acknowledged that she executed same t~r the purposes therein contained.
1N WITNESS WHEREOF, 1 ha? h~cunto ~et my/h~d and official seal.
Notary Public ~'
~ ~DYS,~,~ ~ ~
IN
ESTATE OF
ELAINE W. MONTCHAL
Deceased
IN EHE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY.
PENNSYI.VANiA
ORPHANS' COURT DIVISION
NO. 21-03-1009
RECEIPT AND RELEASE
1. RAYMOND A. MONTCHAL, the undersigned, being a beneficiary under the Estate
of Elaine W. Montchal. deceased, do hereby:
I. State and acknowledge that I am an adult individual;
2. Waive thc filing of an Account or Schedule of Distribution by the personal
representative of the Estate;
3. Acknowledge that I have received all sums of money and personal property to which 1
am entitled as a beneficiary of the Estate of Elaine W. Montchal;
4. To thc extent of said distribution, release RAYMOND A. MONTCHAL. Executor of
the Estate of Elaine W. Montchal, and his heirs and personal representatives, from all liabilities,
whether duc to his negligence or otherwise, which he may have by reason of' his administration
of the Estate:
5. Agree to refund to the Estate and to the said RAYMOND A. MONTCHAL, Executor,
any portion of the distribution to which I am not properly entitled, and, to the extent of said
distribution, to indemnilS' him and the Estatc tbr claims made against him and to rcimburse him
and thc Estate all expenses and costs incurred in connection with an} such claim; and
6. Declare that this instrument shall be legally binding upon mc, my personal
representatives, and assigns.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ,/- ~-
.2004.
day of
RA~A. MONTCHAL
(SEAL)
COMMONWEALTH OF PENNSYI,VANIA )
( SS:
COUNTY OF CUMBERLAND )
On this, the ,~(~ da>' of * , ( I ,2004, belbrc mc. the
undersigned officer, personally appeared RAYMOND A. MONfCHAL, known to me (or
satisfactorily proven) to be thc person whose name is subscribed to the within instrument and
acknowledged that hc executed samc fi)r the purposes therein contained.
IN WITNESS WHEREOF, I have: hereunl?, set.iT~$', hand/ : and official seal.
.'qotarv Public'