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Home My WebLink About02-0757PETITION FOR PROBATE and GRANT OF LETIT~ERS Estate of Dorothy C. Moyer No. ~~~~~- /~~ also known as To: Deceased. Social Security No. 17 9-12 -~ 8 7 6 $ 5,000.00 The petition of the undersigned respectfully represents that: Your petitioner(s), who isiare 18 years of age or older an the executrices named in the last will of the above decedent, dated March 30 ~ , 19,2$__ and codicil(s) dated (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland _ County, Pennsylvania, with h_ er last family or principal residence at 102 Forge Road South Middleton Twp. , Cumberland Count, Boiling ~Dri gs, PA X7007 (list street, number and muncipality) Decendent, then 87 years of age, died July 12, ~ 2002 at Carlisle Regional Medical Centel, Cumberland CoLnt-,.~, ('arl;SlP pa i ~m~ Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (lf domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters Testamentary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. v V C ~. vv a~ ~~ °= ~a ~w ~~ Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania Carolyn A. Bear 102 Hilltop Road Boilin rin s 0 n _ mil ~ 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 represen- tative(s) of the above decedent petitioner(s) will well a d truly administer the estate according to law. Sworn to or affir ed and subscribed ~ v, be e me this ~lst day of ~~ Au st 2002 nna M. to,lst Deputy Re ter! n Y - ~ ~ ~-~3 ~a Gerogie A. Mummert 102 Forge Road B~ilin~ Springs PA 1 00 No. Estate of Dorothy C. Moyer ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW August 21st, ~~ 2002, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated March 30th, 1978 described therein be admitted to probate and filed of record as the last will of DOrOtt~y~Mo~rPr ' and Letters Testamental are hereby granted to Georgie A. Mutrmert and Carolyn A. Bear P !. ~~~ Register of Wills na M.Otto, 1st D~put: FEES Probate, Letters, Etc......... . Short Certificates(5) ......... . Renunciation . ~ 1~........... . x-Pages (1) JCP TOTAL .^ 21-2002-757 ~ 25.00 ~ 15.00 ~ 5.00 ~ 3.00 ~- ~ 53.00 Filed ?~~9u~t . ~~~St ~ 205.2 .............. . 65200 ATTORNEY (Sup. Ct. LD. No.) Philip H. Spare ADDRESS 44 West Main Street,Mechanicsbura, PA 17055 PHONE (717) 696-857_8 PUT LE1'T"I`ERS IN ATTORNEY PHILIP H. SPARE FILE ON 8/21/2002 .80, REV' 9l8(, ~"zis is to certify that the information here given is correctly copied from an original certificate o(~ death duly filed wit me as local Registrar. The ~~riginal certificate will be forwarded to the Stare Vital Records Office for permanent tiling. WARNING: It is illegal to duplicate this copy by phol:ostat ar photograph. Fee for this certificate, $2.00 ~ 8482029 No. Local Registrar ~l~L ~ 4 2002 ~~~te H,os :.a Re„ met COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH INt eTATE FiIE NUMBER NAME OF DECEDENTIEnv M~ade.Lal SEX SOCIAL SECURItt NUMBER DATE OF DElsTH,Mwsn. Dav. bar? ) ,. Dorothy C. Moyer ,. Female ,- 179 - 12 - 3876 .. July 12, 2002 BIRTH 88RNPUCE ;GNaA F AGE hav 9.tlway) UNDERIYEAR UNDERIDAY GATE O PLACE OF DEATH ICneca oNl'nne --:ee ~nvrucl.p'r9 to ulhe~sdsY ___ D a Momma . Olp Iforws . Mvrutea AMr L1 Y. itS{I iuuaECegn Counny},T p HOSPIUL[[:~~ Nt HER: a~ ^-~ ^ L es Mechanicsburg 87 Yry ~ DOA InpM+m p~ ERK7u,perrom . O RavNncl ^ i5pecihl ^ Hom 1915 6. 7. S M. . COl1Ntt OF BERM CRY, BORO. TNP OF DEATH FACRRY NAME fll,ra,ny~, pqn. q,v! s1rM ono numoerl YMS OECEOEM OF HISPANIC ORIGIN? RACE ~ Amwran NWn. BMCk, Whka. Nc. No ® Yea ^ d y... apscly QrWn, 15pecaY) rland Carlisle Carlile Regional Medical Center M.arJn PwnoRiun a,t. White b C 1 . . e um DECEDENT'S USVAL OCCUPATKkI KIND OF BUSINESSANDUSTRY WAS DECEDENT EVER IN DECEDENT'S EDUCRION MARITAL STATUS-Martwd SURVIVING SPOUSE U.S. MMEDFORCES? ode [wn ed NwM Marr'ild, Wtlowvtl. fK Ma. glue m~wnrW"I lCuva vuid Mvrora dar"dur•rg nOf dararaing E"; aD nd uaa ralald) Ma^ No® ENm1meMSecwWary CdNga Diwrcad (SpecM Widow Laundromat 1D'n 8 (,•«'.' ,~. ,a. • ,,. Owner ,,.. ,:. ,~, oFCEOENt'S MAn.ING ADDRESS rs1rMl,Day/TVem, SMls. ZOCoa) ~FI ~~..s DECEDENT'S PA ,7e X1) `M e.cwHX aww in S. Middleton ?.wE+. ~p 102 Forge Road Did ~ ~N E 17i 5"" Ne.Nra Boiling Springs PA 17007 G '~„, ~'~'" Cumberland T No. dlcadlrAlMd ^ ,w wilnnaduallmMOl t•rleero. ,Tn.Gwl ,Td. FRNER'S NAME )Four Mope. Las) MOTHER'S NAME Ifual. MaloN. MaX1en SW name) ,~- Edward Ep le ,.. Alca Nauss INFORMANT'S NAME (Typdprv% INFORMANT'S MAd,d/¢ 53151resl.CMrUwn. $lele,j' C,odal rings PA 17007 S Borin R ad 102 H llt p g o , op i Carolyn Bear zoe DATE OF DISPOSITION PUCE OF DISPOSRgN-Hama dClmNwy, Cremnory LOCATION-CeylWwn.Sma. Zq Cpol METl,000F DISPOSITIO N ,(( ~y Bur,N L:J Cramllian^ RanVaY hom Slall^ (MMM. DaY. Yerl wpnF Nato • ^ om.rlsp.eeyL ^ July 15, 2002 Westminster Cemetery Carlisle PA 17013 ~, :,.. x,0. 2,d. x1a . UNERA SE9wCEl 9E PE ND ASSUCN LICENSE NUMBER NAMEANOAOORESSOFFACKITY HD (~(]~ROt era ome ' sEDNR ~ . m. C/_. ,,, 014351-L x,t. 219 N. Hanover St. Carlisle PA 17013 a lama 2xat onry when d'Pn9 b dla Ole1 a my knowMdge, Nam occurred at the Imra, data orb pan flared. LICENSE NUMBER DATF $KiNED 1bar1 Pawah. Day pmyuew a M availatYa al tuna of Nun a • oaraM arra a ann. wa and Tak) ~.,~1 ~l.I.L t V^' xx.. (, p I, xxe. J d l 7 l ` ~ , xx. ~.1 ~ I ~. c~ O(11~, - 4wrn 2a4e muR bl compered oY TIME OF DEA7H OATS PRONOUNCED DEAD IMonm. Day, Marl WAS ASE REFER RED TO MEDICAL E7UMINER/CORONER7 ^ Ne~ s - paraM aNO PrornPnt•• N.m. J ,,L1 J, ~ o U ~- x z t ~ r A. M xs 1a . , . . x.. xt. MRt I: Emw ml Oiyafaa. uIPPNf w cOmplioanor" wncn Mused rM Natn Do not lmw IM mode al dying, such a: card'Mt or reapirelory arrest SMCa w MM raawe. r Appmaunall In11nM pNwNn PART II: Olhx figndkaM GoM1YwM pwXfiOMPp b Nnn, oM npl rMpnulg M lira urldar,/i^0 rMrW pvan n PMT (. L01 wtlY OM 4ufe M lads lit". ~ 1 onM and Nam F l ATE CAUSE IYMEO l ~ 1 .u I d...,awtww4n ~~ r 5 ~ t~, ~~ 52a¢n~ C2ttr~t ~zovasc« rasJtrq a+o•aaq-- .. ~ DUE,O A$ACONSEOUENCE OF}//~~ ``~~ /%/1 G!// /N Jr-GL~T't'N'~1 ' s+dalnnalr a^condilonf E try, "ed'urgbmnldWS o. .DUE TOIOR ASAC SEQUENCE OEI: I cant. Emw UNOERLYNVO ~ CAUSE IDnslslw+ytlrY • a+a.w,ad lvann ~ e. 011E 70108 AS ACONSEOVENCE GF): l reaarp n OMmI LAST 0. V1sS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH GATE OFIWURY TIME OFINJURY kUURVQWORK7 DESCRIBE MOW INJURY OCCURRED. PERFOfiMED? AWUE/LE PRK7R TO (MOnm. Day. Marl COMPLETION aF CAVSE ry ^ OF OFAH? ~%~ NHW11 LJ ~ ^ ~~ AcedsM ^ Pargmglmyfligalldn ^ a. Ob. a,- ]Oe. Jdd N,f ^ No yy ^ No ^ Suicide ^ Could nd M derlnnmed ^ PIACE OF INJURY - AI home. term, slrlel, IK,ery, omen LOCRION ISaed. CM~Emm. SWa) DuaNKi, Mt. tSpKnv1 xr. xse. r. xo.. xor. CERTIFIE,110nrca ar,iy once SIGNATURE DTITLE OF CERTIFIER •CERTlfY1NG PNYSR;IANlPnyy[an cMlAyv+g cause d Deem »nen andner pnvLC~an nos ww~arrceo Naln ant eomdarad non 171 Ta dra 41ai a1 mY aner"dgl,N•M OnunW du~bd"eauulfl and manner al flat W ..................................................... `,~ j1 x,a. D IM,net Day. Marl DATE SMaNE LICENS NUMBER E 'IRONOVNGMG AND CERTIFYING PHYSICIAN IPnyscMn hXl'.~.Ywrwnc~ng Deem arW [Milymq to cause of deaml ^ l d N d ~, ~1 / ~ ~'` ( / /I=/,~ U3 y d ~'S E f ` /~ [~iTJ/ Ji<, xld. ........ ..... .......... ... manner as a l Tp IM Deal el my knovdadxw, death occurred at tl" rlrnl, NTa, and plaza, aM duo la,M caufela) an ETEO CAUSE OF DEAtH NAME AND ADDRESS OF PERSON WMO COMP` - 'l {1tem 271 Typew Prinl j~v,~ ~ Jr/l 'MEDICAL E)IAMINER/CORONFR d ~ T N. P~ /+~ r.,. vrt ~`- ^ On the heaia of efamina,fon and/w invesligalion, in my opinion, death occurred a, the Ilene. dau, and plate, and tlu! to M! uufe(a) an ................................... . . . . r as ftated nn i'~r S ~ /7i'fi5' /< ^'H' /~ /~ .. . ...................................................... . . ma e x,.. y p i v ~r xx. /~ REGrSTRAR'S SIGNATURE AN R DA7E FILED IMpnm. Day. estate ~• ~~~ LAST WILL AND TESTAMENT 2I-?I}!)2.-7~7 I, DOROTHY C. MOVER, of the Township of South Middleton, County of Cumberland and Commonwealth of Pennsylvania, being of sound and dis- pos_i.ng mind, memory and understanding, do make, publish and declare this as and far my Last Will and Testament, hereby revoking and making void all former wills and codicils by me at any time heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my Executor or Executors, as the case may be, here- inaf'ter named, as soon as conveniently may be done after my decease. SECOND. :I give, devise and bequeath all the rest, residue and ~i remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated, unto my husband, SAMUEL L. MOVER, absolutely and in fee simple, if he survives me by as many as sixty (6 U) days. THIRD. If my husband, SAMUEL L. MOVER, should not survive me by as many as sixty (60) days, then and in that event, I give, devise and. I bequeath all th.e rest, residue and remainder of my Estate, real, j personal and mixed, whatsoever and wheresoever. situated, in equal share unto my three (3) children, namely, GEORGIE A. NIl1MMERT, CAROLYN A. 13F,AR and 1-'REDERICK L. MOVER, share and share alike, absolutely and in fee simple. If any of my said children should predecease me and .leave lawful issue to survive me, I order and direct that the share of any deceased child under the foregoing paragraph of this Item Third shall_ be distributed unto said issue per stirpes by representation and not per capita, subject, however, to the protective trust provisions of Item Fourth hereinbelow. FOURZ'II. I order and direct that the distributive share of each beneficiary hereunder who has not attained tlxe age of twenty-one (21) LAW OFFICES years at the time for distribution thereof shall be de7._ivered and SNELBAKER. 1CCALEB & FLICKER .~, paid over unto CCNB, N.A., of New Cumberland, Pennsylvania, as my testamentary trustee, IN TRUST, NEVERTHELESS, to hold, manage, invest and reinvest the same, and any accumulation of income therefrom, far the use and benefit of said beneficiary until such beneficiary attains the age of twenty-one (21) years, in the meantime said Trustee shall have discretionary power and authority to expend and apply for the benefit of the beneficiary from time to time such amounts of income and principal as my said Trustee shall deem necessary and proper for the comfortable support, maintenance and education of said beneficiary; and at such time as the beneficiary attains the age of twenty-one (21) years, said trust shall be terminated and 1.he then remaining balance thex:~eof, if an.y, shall be distributed unto said beneficiary free of said trust, absolutely. LASTLY. I nominate, constitute and appoint my husband, SAMUEL L. MOYF;K, to be the Executor of this, my Last Will and Testament, but if for any reason he should fail to qualify as such Executor or cease so to serve, then and in that event, I nominate, constitute and appoint my three (3) children, namely, GEORGIE A. MUMMF.RT, CAROLYN A. BEAR and FREDERICK L, MOYER, (or the survivor, of them if any should fail to qualify or cease sa to serve} to be the Executors of this, my Last 49111 and Testament, each and all to serve without bond. IN WITNESS WHEREOF, I, DOROTHY C. MOYEF~, have hereunto set my LAW OFFIC 65 SNELBAKER. :CALEB & FLICKER hand and seal to this, my Last Will and Testament which consists of (2) typewritten pages to each of which I have affixed my signature thin Cy `-"~~ day of ~;1~~::l,-<_.~~'~- A. D. , One Thousand Nine I[undyed Seventy- eight (1978) . ' ~-7 ~, i - ~ J~~-~ .t'~u C.- ~, f, ~ ~f,::,~..- (SEAL) The preceding instrument, consistinh of this and one (1) other typewritten page, each identified by the signature of the Testatrix, was on the date thereof signed, sealed, published and declared by DOROTIiY C. MOYER, the Testatrix therein named, as and far her Last Will and Testament, in the presence of us, who, a1`er request, in her presence, and in. the presence of each other, v sub cribed our names i, r as witnesses hereto. ' 21-2002-757 REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF SUBSCRIBING WITNESS Richard (' 4nPlha-ter ~'R~#~ ~;~~ a subscribing witness to the will presented herewith,~~ being duly qualified according to law, depose(s) and say(s) that he was present and saw Tlnrnth~ f Mn~pr --- + the testatrix ,sign the same and that he signed as a witness at the request of testatrix in et> r _ presence and (in the esen e o /c~her) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this 2 6th day of august xxor 2002 Donna M. Otto 1st Deputy Register REGISTER OF WII:~,.S OF (.BATH OF NON~`aSUI Ri ar Sn~,J,amker 44 West Main Street, Mechanicsburg, PA 17055 (Address) (Name) (Address) (each) a subscriber hereto, (each) being duly q familiar with testat of (one of the that to the best of _. COUNTY G WITNESS according to law, depose(s) and say(s) that ture of _ , codicil witnesses to) le will presented herewith and codicil believes the signatu~g on the will is in the handwriting of and belief. Sworn to or affirmed .and subscribed before me this . day of 19 Register (A (Name) (Address) REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS codicil (each) a subscribing witness to the will presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that present and saw the testat ,sign the same and that signed as a witness at the request of testat in h_~ presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this day of 19 Register (Name) (Address) (Name) (Address) REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF NON-SUBSCRIBING WITNESS Carolyn A. Bear -- , ~ a subscriber hereto,~~xbeing duly qualified according to law, depose(s) and say(s) that she is familiar with the signature of Dorothy C. Moyer ~~ testatrix of x~fxxi~x~~~x~j the will presented herewith and she ~~ that believes the signature on the will is in the handwriting of Dorothy C. Moyer to the best of her ltnowledee and belief. Sworn to or affirmed and subscribed before me this day of _ Au.g~st x~t 2002 Register ~'1/ Cam-, %'~ G~~ Carolyn A. Beyl~ame) 102 Hilltop Road Boiling Sprin~~~dress) pA 17007 (Name) (Address) RENUNCIATION 21-2002-757 In Re Estate of Dorothy C Moyer deceased. To the Register of Wills of The undersigned Cumberland County, Pennsylvania. son and heir-at-law of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters Testamentary be issued to Georgie A Mummert and Carolyn A. Bear W 1TNESS cucrt~.n 1~. rivyci (Address) (Signature) (Address) (Signature) hand this ,day of , (Address) CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Dorothy C. Moyer, Deceased Date of Death: No. 2002-00757 To the Register: PA No. 2102-0757 I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on or about September 4, 2002: Name Georgie A. Mummert Carolyn A. Bear Frederick L. Moyer Address 107 High Street, Apartment 6 Boiling Springs, PA 17007 102 Hilltop Road Boiling Springs, PA 17007 937 Castle Pond Drive York, PA 17402 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: NONE. Date: September 4, 2002 July 12, 2002 -, Philip H. Spare, Esquire 44 West Main Street Mechanicsburg, PA 17055-0318 (717) 697-8528 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17125-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SNELBAKER BRENNEMAN & SPARE PC C/O PHILIP SPARE 44 WEST MAIN STREET MECHANICSBURG, PA 17055 fold ESTATE INFORMATION: ssN: i ~s-i 2-3s~6 FILE NUMBER: 2102-0757 DECEDENT NAME: MOYER DOROTHY C DATE OF PAYMENT: 04/02/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/12/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 ~ $269.76 TOTAL AMOUNT PAID: REMARKS: SNELBAKER BRENNEMAN & SPARE PC CHECK#1732 SEAL INITIALS: SK RECEIVED BY: DONNA M. OTTO 5269.76 DEPUTY REGISTER OF WILLS REV-1162 EX111-96) NO. CD 002379 REGISTER OF WILLS . r. .. w,,v t5uu tx ?00) / 1 ~( ~{ ,~ / 1 t J lJ / OFFICIPL USE ONLY Gr r COMMONWEALTH OF PENNSYLVANIA RE'V-1500 DEPARTMENT OF REVENUE DEPT. 280601 INHERITANCE TAX RETURN FILE NUMBER HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 - 2002 0757 ~ - « - - ~o M . OOE YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER -- Z Moyer, Dorothy C 179-12-3876 WQ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) TWS RETURN M UST 8E FIIED IN DUPLICATE WITH THE v 07/12/2002 4/14/15 REGISTER OF WILLS 0 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER FW- Qy tYj aU U am Q H ®1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date or death prior to t2-t3-92) ~ 4. Limtted Estate ~ 4a. Future Interest Compromise (date of death after t2-t2-82) ~ 5. Federal Estate Tax Return Required ®6. Decedent Died Testate (Attach copy of Vvill) ~ 7. Decedent Maintained a Living Trust (Attach copy of Trust) ~ 8. Total Number of Safe Deposit Boxes 0 9 Litigation Proceeds Received ~ 1 O. SpoUSal POVerty Gfedlt (date of death between 1231-91 and 1-1-95) ~ 1 1. Election to tax under Sec. 9113(A) (Attach scn of ; IS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDEfVTIAL TAX1Nf0iR,MATION SH013LD BE DIRECTED 70: z ____-- i~AME COMPLETE MAILING ADDRESS o Philip H. Spare 44 West ~ Main Street ~ FIRMNAME(IfApplicable) Mechanicsburg, PA 17055 ~ Snelbaker, Brenneman & Spare, P.C. TELEPHONE NUMBER 717-6 97-8 528 1 Real Estate (Schedule A) (1) 0 • 00 OFFIGPL USE ONLY 2 Stocks and Bonds (Schedule B) (2) 0.00 3 Closely Held Corporation, Partnership or Sole-Proprietorship (3) 0.00 4. Mortgages & Notes ReceNable (Schedule D) (4) 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) h l S d E 7 771.43 r ( c e u e ) z 6 Jointly Owned Property (Schedule F) (6) 1 , 335.97 O ~ Separate Billing Requested q 1 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 0.00 H (Schedule G or L) Q 8. Total Gross Assets (total Lines 1-7) (t3) 9 , 107.40 U ~ 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 1,335.99 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (schedule p (10) 1 , 776.73 1 1 Total Deductions (total Lines 9 & 10) (11) 3 , 112.72 12 Net Value of Estate (Line 8 minus Line 11) (12) 5 , 994.68 13. Charitable and Governmental Bequests(Sec 9113 Trusts for which an election to tax has not been 0 00 made (Schedule J) (13) . 14. Net Value Subject to Tax (Line 12 minus Line 13) (1q) 5, 994.68 Z O F- Q F- 7 a 0 U X a f- SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 1 S Amount of Line 14 taxable at the spousal tax 0 00 • rate, or transfers under Sea 9116 (a)(1 2) x .On (15) 16 Amount of Line 14 taxable at lineal rate 5 , 994.68 x .045-- (16) 0 ' 00 17 Amount of L1ne 14 taxable at sibling rate x 12 (17) 18 Amount of Line 14 taxable at collateral rate 0 • 00 x .15 (18) 19 Tax Due (19) ~ • e ra • • Z 0 _- > > BE'SURE TO ANSWER ALL'QUfSTtONS ON REVf`RSf SIQE AND 0.00 269.76 0.00 0.00 269.76 ECK MATH c < V 2W4645 1.000 )ecec~ent's Complete Address: STREFTADDRESS 102 Forge Road S . Middleton Twp . , Cumberland County CITY STATE ZIP Boiling Springs PA 17007 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 269.76 2. CreditslPayments A. Spousal Poverty Credit 0.00 B. Prior Payments 0.00 C. Discount 0.00 Total Credits (A + g + C) (2) 0.00 3. InterestlPenalty if applicable D. Interest 0 .00 E. Penalty 0.00 Total InterestlPenalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. est a refund 20 t 1 Li P (~) o requ ne age Check box on This is the TAX DUE enter the difference 2 th Li t 3 i + (5) 269.76 5. . . ne , er an Line s grea If Line 1 d th t (5A) 0.00 ue. e ax A. Enter the interest on B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 269.76 Make Check Payable to.' REG~STEROFWILLS,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; . 0 c. retain a reversionary interest; or 0 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? 0 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 QUES710NS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined [his return, including accompanying schedules and statements, antl to the best of my knowledge and belief, it is true, correct and complete. no~iarnr;~., ~s ~re~wror inner than [he personal representative is based on all information of which preparer has any knowledge. See attached sheet Y r Of ADDRESS 44 st ain Street P. O. Bax 318 Mechanicsburg, PA 17055 ___ 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. § 9916 {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. 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 f ,except as noted in 72 P.S. F 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. 2 W 4646 1.000 •Estate of: Dorothy C Moyer 179-12-3876 Co-Executrice Carolyn A Bear GeOrgie A. Mummert 102 Hilltop Road 107 High Street soiling Springs, PA 17007 Apartment 6 Boiling Springs, PA 17007 REV-1508 EX + i~-9~) COMMONWEALTH OF PENNSYLVAPIIA INHERITANCE TAX RETURN RESIDENT DECEDEPJT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Moyer, Dorothy C 21-2002-0757 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship m ust pe disclosed on Schedule F. 2Wa6AD 2.000 (If more space is needed, insert additional sheets of the same size°) REV-1509 EX+(1-97) ` ~ SCHEDULE F ~MMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Moyer, Dorothy C 21-2002-0757 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A.Mummert, Georgie A 107 High Street Daughter Apartment 6 Boiling Springs, PA 17007 B Bear, Carolyn A 102 Hilltop Road Daughter Boiling Springs, PA 17007 ~ Moyer, Frederick L 937 Castle Pond Drive Son York, PA 17402 JOINTLY-OWNED PROPERTY: ITEM NUMBER ~ErrER FoR~owT T~7uvT DATE MADE JOINT DESCRIPTION OF PROPERTY Include name of financial institution and bank account number or similar identif in number. Attach deed for ointl -held real estate. DATE OF DEATH VALUE OFASSET %OF pECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST i, Ijq. Incept . M&T Bank, checking account '214.94 50.00 107.47 #1292021 2 nsc 10/21/1999 Tyco, total 900 shares of 2,457.00 50.00 1,228.50 common stock, valued at $2.73 per share. Shares are registered as follows: Dorothy C. Moyer and Frederick L. Moyer, Jt. Ten. 300 shares Dorothy C. Moyer and Georgie A. Mutr~rlert, Jt. Ten 300 shares Dorothy C. Moyer and Carolyn A. Bear, Jt. Ten. 300 shares TOTAL (Also enter on line 6, Recapitulation) ~ $ 1 , 335.97 2wasAE 2.000 (If more space is needed, insert additional sheets of same size) . REV-~ei~~+(~-s~~ ' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Moyer, Dorothy C Debts of decedent must be re o ITEM NUMBER A. FUNERAL EXPENSES: 1. B. 1 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-2002-0757 le 1. DESCRIPTION AMOUNT ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) i EIN Number of Personal Representative(s) Street Address 2 3 City State Zip _ Year(s) Commission Paid: AttorneyFeesN~e~ Snelbaker, Brenneman & Spare, P.C. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 4. 5. 6. 7. 8 9 10 Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Register of Wills, Cumberland County, filing fee for Inheritance Tax Return Cumberland Law Journal, advertising Executrices notices Patriot-News, advertising Executrices notices Reserve for filing fees, accounting fees and other miscellaneous costs associated with the administration of the Decedent's Estate. 0.00 750.00 o.oo 53.00 0.00 0.00 15.00 75.00 142.99 300.00 TOTAL (Also enter on line 9, Recapitulation) $ 1 , 335.99 zwasnc 2.000 (If more space is needed, insert additional sheets of same size) ~ REV-151'G IX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Moyer, Dorothy C 21-2002-0757 2wasnr+ z o00 (If more space is needed, insert additional sheets of the same size) REV-i5:3 EX+ (9-OOj SCHEDULE) COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mover. Dorothv C 21-2002-0757 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE i. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Mummert, Georgie A Daughter 1,998.23 107 High Street Apartment 6 Boiling Springs, PA 17007 2 Bear, Carolyn A Daughter 1,998.23 102 Hilltop Road Boiling Springs, PA 17007 3 Moyer, Frederick L Son 1,998.22 937 Castle Pond Drive York, PA 17402 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, O N REV-1500 COVER SHEET 11, NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 2W46AI 1.000 (If more space is needed, insert additional sheets of the same size) l~'c~~-~~ COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 E% RGP (01 -03J `a DATE 05-12-2003 R ; , ~~ j _ _ ~E' ~- ESTATE OF MOVER DOROTHY C DATE OF DEATH 07-12-2002 FILE NUMBER 21 02-0757 ~O3 AIRY 16 ~~~ .~6 COUNTY CUMBERLAND PHILIP H SPARE ACN 101 SNELBAKER ETAL Amount Remitted 44 W MAIN ST L v€F - . MECHANICSBURG PA 1 Y~`-; ~~$irJ~. MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT H OUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ -------------------------------------------------------------------------------------------- REY-1547 EX AFP (01-03 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE -------------------- OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MOVER DOROTHY C FILE N0. 21 02-0757 ACN 101 DATE 05-12-2003 TAX RETURN WAS: C X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) C4) .00 of this form with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) 7,7 71.4 3 tax payment. 6. Jointly Owned Property (Schedule F) (6) 1 , 335.97 7. Transfers (Schedule G) C7) .00 8. Total Assets C8) 9, 107.40 APPROVED DEDUCTIONS AND EXEMPTIONS: 1,335.99 9. Funeral Expenses/Adm. CostslMisc. Expenses (Schedule H) C9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) C10) 1,776.73 11 . Total Deductions (11) 3 • 1 7 9 - 72 12. Net Value of Tax Return C12) 5,994.68 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C13) .00 14. Net Value of Estate Subject to Tax (14) 5,994.68 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate C15) • 00 X 00 = . 00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 5, 944.68 X 045 = 269.76 17. Amount of Line 14 at Sibling rate (17) • 00 X 12 = . 00 18. Amount of Line 14 taxable at CollaterallClass B rate (18) •00 X 15 - .00 19. Principal Tax Due c19)= 269.76 TAY CRFTITTS. PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 04-02-2003 CD002379 .00 269.76 TOTAL TAX CREDIT 269.7b BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE C IF TOTAL DUE IS LESS THAN 81, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) 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 foi life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Tai at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side --Make check or money order payable to: REGISTER OF HILLS, AGENT REFUND CCR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" CREY-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 CTT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg. PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" CREY-1501) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three C3) calendar months after the decedent's death, a five percent (5Y.) discount of the tax paid is allowed. PENALTY: The 15Y. 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 time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one C1) day from the date of death, to the date of payment. Taxes which became delinquent before January I, 1982 bear interest at the rate of six C6%> percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 20% .000548 1987 9% .000247 1999 7% .000192 1983 16% .000438 1988-1991 11% .000301 2000 8% .000219 1984 11% .000301 1992 9% .000247 2001 9% .000247 1985 13% .000356 1993-1994 7% .000192 2002 6Y. .000164 1986 10% .000274 1995-1998 9% .000247 2003 5% .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. ESTATE NO. 21-02-0757 FIRST AND FINAL ACCOUNT AND STATEMENT OF PROPOSED DISTRIBUTION OF AND BY GEORGIE A. MUMMERY AND CAROLYN A. BEAR, EXECUTRICES OF THE ESTATE AND UNDER THE LAST WILL AND TESTAMENT OF DOROTHY C. MOYER, DECEASED, LATE OF SOUTH MIDDLETON TOWNSHIP, BOILING SPRINGS, CUMBERLAND COUNTY, PENNSYLVANIA Gerogie A. Mummert and Carolyn A. Bear, Executrices as aforesaid and Accountants herein, avers as follows: DATE OF DECEDENT'S DEATH: DATE LETTERS TESTAMENTARY ISSUED: DATES EXECUTOR'S NOTICE ADVERTISED: Cumberland Law Journal Patriot-News Co. July 12, 2002 August 29, 2002 September 13, 20, 27, 2002 September 17, 24, October 1 , 2002 FIRST AND FINAL ACCOUNT PERSONALTY -PRINCIPAL ACCOUNT DEBITS The Accountants charge themselves with the receipt of the Decedent's personalty, goods and chattels as set forth in their inventory heretofore filed in the amount of: 1 . Georgie A. Mummert, funds from joint checking account held at M&T Bank, #1292021 2. Three Springs Family Practice, refund on medical expenses paid TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, DEBITS: PERSONALTY -PRINCIPAL ACCOUNT CREDITS LAW OFFICES SNELBAKER. BRENNEMAN & SPARE The Accountants claim credit for the payment of the following items from Decedent's Personalty Account: 1 . Three Springs Family Practice, medical services 2. Central Penn Medical Group, medical services 3. Register of Wills, Agent, Inheritance Tax 4. Register of Wills, filing fee for Inheritance Tax Return 5. Register of Wills, additional probate fee 6. South Middleton Twp. Mun. Authority, water/sewer payment 7. Judy Campbell, taxes 8. Roger Fickett The following items are to be paid subsequent to the confirmation of this Accounting: 9. Snelbaker, Brenneman & Spare, P.C., attorney services 10 Snelbaker, Brenneman & Spare, P.C., costs advanced on behalf of the Estate: a. Register of Wills, probate fee b. Cumberland Law Journal, advertising Executrices notice c. Patriot-News, advertising Executrices notice TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, CREDITS: S 7,771 ,43 2 i 4.94 64.10 5 8,050.47 S 95.64 28.02 269.76 1 5.00 15.00 99.0 1,444.07 1 10.00 7 ~ 0.00 270.99 53.00 75.00 142.99 Page 1 LAW OFFICES SNELBAKER. BRENNEMAN & SPARE PERSONALTY -INCOME ACCOUNT DE61TS The Accountants charge themselves with the receipt of the following Income from the investment of Personalty Principal: 1 . Tyco, dividends from Jointly held stock 2. F&M Trust, checking account # 33-08294, interest TOTAL, PERSONALTY, INCOME ACCOUNT, DEBITS: PERSONALTY -INCOME ACCOUNT CREDITS he Accountants claim credit for the payment of the following items from the Personalty Principal Account: TOTAL, PERSONALTY, INCOME ACCOUNT, CREDITS: REAL ESTATE -PRINCIPAL ACCOUNT DEBITS The Accountants charge themselves with the receipt of Decedent's Real Estate as set forth in their Inventory heretofore filed in the amount of: TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, DEBITS: REAL ESTATE -PRINCIPAL ACCOUNT CREDITS The Accountant claims credit for the payment of the following items from Real Estate Principal Account: TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, CREDITS: REAL ESTATE -INCOME ACCOUNT DEBITS The Accountants charge themselves with the receipt of the income from the investment of Real Estate Principal Account: TOTAL, REAL ESTATE, INCOME ACCOUNT, DEBITS: REAL ESTATE -INCOME ACCOUNT CREDITS The Accountants claim credit for the payment of the following items From the Real Estate Income Account: TOTAL, REAL ESTATE, INCOME ACCOUNT, CREDITS: Page 2 $ 45.00 8.32 $ 53.32 s ninNF S NUNk $ NONE $ NONE $ NONE _ $ NONE+ $ NONE $ NONE $ NONE $ NONE RECAPITULATION LAW OFFICES SNELBAKER. BRENNEMAN & SPARE PERSONALTY• PRINCIPAL ACCOUNT: Debits Credits Balance INCOME ACCOUNT: Debits Credits Balance TOTAL PERSONALTY REAL ESTATE: PRINCIPAL ACCOUNT; Debits Credits Balance INCOME ACCOUNT: Debits Credits Balance TOTAL REAL ESTATE: TOTAL FOR DISTRIBUTION: 5 8,050.47 S 3,097.48 S 4,952.99 S 53.32 S NONE $ 53.32 S 5,006.31 S NONE 5 NONE S NONE S NONE $ NONE S NONE $ 5,006.31 Page 3 OMMONWEALTH OF PENNSYLVANIA) SS. OUNTY OF CUMBERLAND) Gerogie A. Mummert and Carolyn A. Bear, being duly sworn according to law desposes and says: that they are the Executrices of the Estate and under the Last Will and Testament of Dorothy C. Moyer, Deceased; that they are the Accountants herein; that the foregoing is a true and complete accounting of their administration of said Estate; that the attached list or schedule (*] contains the names, addresses and amounts due unpaid creditors who have given proper notice of their claims; that the attached list or schedule [**] contains the names and addresses of all persons interested in the distribution of said Estate; and that the facts set forth herein are true and correct to the best of their knowledge, information and belief. Georgie ummert, E/x~ecutric ~ lit-, %~~~~, Carolyn A. ar, Executrice Sworn to and subscribed before me this ~ fti day of ~" 2003. ~.. ,; LAW OFFICES SNELBAKER. BRENNEMAN & SPARE Page 4 * UNPAID CREDITORS: * ~ PERSONS INTERESTED IN DISTRIBUTION OF ESTATE; LAW OFFICES SNELBAKER. BRENNEMAN $C SPARE Georgie A. Mummert 107 High Street Apartment 6 Boiling Springs, PA 17007 2. Carolyn A. Bear 102 Hilltop Road Boiling Springs, PA 17007 Frederick L. Moyer 937 Castle Pond Drive York, PA 17402 NONE Page 5 STATEMENT OF PROPOSED DISTRIBUTION LAW OFFICES SNELBAKER. BRENNEMAN & SPARE Georgie A. Mummert and Carolyn A. Bear, Executrices and Accountants herein, proposes to distribute the balance of the Estate of Dorothy C. Moyer, Deceased, to wit: 55,006.31 in accordance with the Last Will and Testament of said Decedent as follows; 1 . Georgie A. Mummert 1 /3 of residue as per Item Third of Will 2. Carolyn A. Bear 1 /3 of residue as per Item Third of Will Frederick L. Moyer 1 !3 of residue as per Item Third of Will TOTAL DISTRIBUTION: 5 1,668.77 5 1 ,668.77 5 1 ,668.77 5 5,006.31 Page 6 COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND: Georgie A. Mummert and Carolyn A, Bear, being duly sworn according to law, deposes and says that the facts set forth in the foregoing Statement of Proposed Distribution are true and correct to the best of their knowledge, information and belief. Georgie .Mummert, xecutrice Carolyn A. ear, Executrice Sworn to and subscribed before me this t l'`~day of ~~Zt/Ve 2003. _.__ , _ .:_- _ . ~ _. ~~ ~ ~.~s ac Idai :; ~1tlali LAW OFFICES SNELBAKER. BRENNEMAN & SPARE Page 7 Inventory of the real and personal estate of DOROTHY C. MOYER, Deceased Page 1 t ~~ v COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND 1 ss: Georqie A. Mummert & Carolyn A. Bear being duly sworn according to law, deposes and says that they are the Executrices of the Estate of Dorothy C. Moyer late of ~o1~t~1-Ma-G1S31e_tS]I1__Town~ht ~ ,Cumberland County, Pa., deceased and that the within is an inventory made by Georgie A. Mummert &a~_ _ ,the said Fx ~t-ri of the entire estate of said decedent, consisting of a the personal property and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death . Sworn and subscribed before me, 1~~,2-0-43 /'~ Executor -Administrator Georgie A. MummeY C ro yn A. Bear Geor ie A. Mumm~~°:: ck, 107 High St., Apt. 6, Boiling Springs, PA Carolyn A. Bear 102 Hilltop Rd, Boiling Date of Death 12th July 2002 rings, F Day Month Year INSTRUCTIONS An inventory must be filed within three months after appointment of personal representative. A supplement inventory must be filed within thirty days of discovery of additional assets. Additional sheets may be attached as to personalty or realty $ee Article IY, Fiduciaries Act of 1949. U w v ~ O I o Z O ~ F-- W W - OLL - W ~ ~ -~ Z ~ W W Q W J ~ Z Q - C ~ ~ o ~" U. +~ ~ ~ o ~ '~~ ~ ~ ~ -o m ~n N ~ ~o + T U n . o Q ~ -o ~ o j .Q d ~ ~ i ~ _ U m q ~ O n. ~ c o C?a Q x K a -r-+ -r-I ~ ~ ~ m o W 0 ii m STATUS REPORT UNDER RULE 6.12 Name of Decedent: DoROTxY C . MOYER Date of Death: July 12, 2002 Will No.: Admin. No.: 2t-n~_ms~ Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes ~ No n 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yeses No II Confirmed by Court August 26, 2003. b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes ^ No c. Copies of receipts, releases, joinders and approval of formal or informal accounts maybe filed with the Clerk of the. Orphans' Court and maybe attached to this re ort. Date: 6 /21 /04 Signatur .Philip H. Spare. Esquire Name Snelbaker, Brenneman & Spare, P.C. 44 W. Main Street Mechanicsburg, PA 17055 Address (717) 697-8528 Telephone No. Capacity: ~ Personal Representative Counsel for personal representative