The URL can be used to link to this page

Home My WebLink About02-0784PETITION FOR PROBATE and GRANT OF LETTERS Estate of JAMES BELL No. a-~ ^ a L ~ ~ ~~ also known as To: Register of Wills for JAMES L BELL Cumberland County, Deceased. Pennsylvania Social Security No. 195-16-4306 The Petition of the undersigned respectfully represents that: Your Petitioner, who is 18 years of age or older and the Executrix named in the Last Will and Testament of the above decedent, dated December 15, 1998. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his principal residence at Church of God Home, 801 North Hanover Street, Room 410, North Middleton Township, Carlisle, Cumberland County, Pennsylvania. Decedent, then 76 years of age, died August 5, 2002, at Carlisle Regional Medical Center, Carlisle, Borough of Carlisle, Cumberland County, Pennsylvania. 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: N/A. Decedent at death owned property with estimated values as follows: (If domiciled in Pa.} All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: $ `_ $ 1,000.00 _ WHEREFORE, Petitionerrespectfullyrequests the probate ofthe Last Will and Testamentpresented herewith and the grant of letters TESTAMENTARY thereon. Helen A. Bell Church of God Home, Room 410 801 North Hanover Street, Carlisle, Pennsylvania 17013 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ) SS COUNTY OF CUMBERLAND The Petitioner above-named swears or affirms that the statements in the foregoing petition are true and correct to the best of the lciowledge and belief of Petitioner and that as personal representative of the above decedent I'et,itioner will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this 30th day of AUGUST , 20,j02 ,,., / ~y ~~ ~ , ~~ Helen A. Bell Register _ ~ ~ 1-ss=~ ~ NO. 21-02-784 Estate of James Bell, a/k/a James I. Bell, Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW AUGUST 30, , 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 December 15, 1998 described therein be admitted to probate and filed of record as the last will of JAMES BELL, A/K/A JAMES I. BELL; and Letters Testamentary are hereby granted to Helen A. Bell. y / / ~ ~ 6 r-~ ri ,~C'jL}'~Q.~~! 1 ~ / ~~1' 1 .~. i~ ~~t.~t ~'Y~ r~yLiC.e-.C.(r 1 j~ Register of wills FEES Probate, Letters, Etc............ $ 18.00 Short Certificate(s) .....7....... $ 21.00 ~.•E~~RA••PGS••5 $ 15.00 TOTAL $ 59.00 Filed....AUGUST 30, 2002 ............................................ F.\User Folder\Firtn Docs\Estates\2833- I .pec letters. wpd ~~~ ~~ Michael J. Hanft, Es~ire Attorney I.D. No. 57976 19 Brookwood Avenue, Suite 106 Carlisle, PA 17103-9142 (717} 249-5373 LETTERS PUT IN ATTORNEYS FILE IN PRO. OFFICE, 8/30/02 ~,, (, ~ (•.I~i ~ ~:~ ~ ,~, - la'~rn7anon Mere given ~s correct[v copied From aa~ orl~i!~a tc?rd( ;_.it, ~,. =~ ,. (•ru ti.,1r° t ied wit} n.e as (.I I, a ~~°i..n-:. 1 l'+.1~.:' n( ,.~ir ~(+ ce~rti Hlca to will be. forwarded to die State lira! ~:r~<ire i ~. t ~tti i..r i. 1 ~r,-ri. „-,~_,r t,s, ~~~ r. 1~UARPIlIVG. It is illegal to duplicate this copy by photostat or photograla~+. Frr to :tus ..sr:i'-,~.Itt. SLUG ~ X007506 H IDS, ; tl Rw. 2'8T 91NT 1ENT INK L?.n~ COMMONW EALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VfTAI RECORDS CERTIFICATE OF DEATH NAME OF DECEDENT IFn9. Made, Last y ~ F ~ +~ SEK SCGIAL SECVRITY NUMBER DATE OF DEATH,MCrnn. Der. Nary 1 ,. James Bell :Male ~. 195 - 16 - 4306 •• Aug. 5, 2002 AGE (US B+maa~ UNDER I YEAR UNDER 1 DAY DATE OG BIRTH BIFLTHPI,ACE IGry and PLACE OF DEATH ICne cw nnrv yy- ree,nauupora on peer coat Morelia r Dayf ybun r MYWIM !MOnm. Day. 'berl Stalaa FCregn CdxurVl HOSPITAL OTHER: 76 YM1 une 30,192 Harrisburg,PA Irpariantfl ENOuIWri.nt G DOA C „ar'"•'9 ^ Ry,m„p• C ,~~,, ^ s. e. T, k • COUNTY OF DEiQH CrtY, BORO.TWPOF DEATH FACIL(Tl'NAME pl nol mv~turwn, <Ave sneer an0 namomr NMS D ECEDEM OF HISPANIC ORIGINY MCE-Amencanlwian, Bha. NTX•. e,c, CL ~~ No l Yw ^ M xlry Cuban aA a (SpeuYl ( - Cumberland Carlisle Carlisle Re ional Medical Center y , pa p ; ""°"•"""°""a"•"` White ~ ~ g 1e DECEDEM'S USUAL OCCUPQION KIND Oi BUSINESS/INDU57RY NNS DECEDENT EVER rN OECEDEM'S EDUCATION MARRAL STATVS~Marrrd SURVIVttaG SPOUSE IGwa woe d wpw dprat dAmg now U. S. ARMED F011CEST n am c Naar MMwd, Widowaq la Me. 9na maban rwlnal pl woran, wa: m rw>• w rrnnedl Y ftJ ^ Elamanruy/Sacondary CaMga oieaud {SpecN) • „a, Draftsman ,,,, Electronics ea No ,_. ,,, jPrzj l2 ° ~""' ,., „• DECEDEM'S MAILIND ADDRESS (Snow, Cay/town. Slab, Zp C"nal DECEDENT'S pA Nor h Mt ddl tQn ,Te a.cad.raw.db ® w Church of God Home ,,,p. . . ACTUAL tT.,Star. Dw RESIDENCE dscadaro 801 North Hanover St ~ w^~^` . „ , Rp, pKadsr, Ilya, ^ ,e. .coin arnw Fnu• of cAYlnelo_ 17D. Coup ,Te. FATHER'S NAMEIF S, Edda. Last MOTMEP'S NAME (F S.Mbcla. Hagen Surname) ,,, Agustus Bell ,,. Ethel Albri ht INFORMAM'S NAME (fy,wPrVN) I NFORMANT'S MANNO ADDRESS lSnaaL CaY/iw.n. SIeM, Zp C"oel „a•Helen A. Bell x,,.801 North Hanover St. Carlisle Pa 17013 ME'T/IW OF gSPOSI7gN DATE OF q5 I ION PLACE OF gSF'OSITION • NaIM d CarMary. Cnmwory LOCATION ~ Cityyfi, Sewa, to Com 91au, [jC CrMUtbn^ Removal lrorn $tata^ (MOnm. DaY. rl O/Qtlar Place IndiantOWn Gap . [,°"r"°n~ °~rs0`M~ ^ TTe. A 9, 2002 :,e. Na io x,d. ' SKiNAT FVHE SONACTIHOASSIICH L NSENUMBER NAME AHDADORESSOF ILITY Hoffman-Roth Elaneral Home • „a. ~ :n, ne. 219 N. Hanover St. Carlisle Pa 170 3 ems 27e<onlywMn pnilyin, .. OIIY•ICiN w not ayaa.el. •t ImN M mam m ' N n wd btM OSal of mT knowNdye, math al malima. aateaM~p~Myn~s•~le~a` ~j~ /~~ LICENSE NUMBER DATE SIGNED ISpnanne and T~nel F t' 1 e/V Ma+m. Dar.'~bl 'i ~tSl~~ ~ -,<" ,L w ' - usa~~$t~t ycau•s aw oM - ~. . LA J ~ ~0. :k. n~ K d oY 2A "N°I M W ~w EOF D QN CASE REFERRED70 MEDICALEXAMINEPICORONER9 TE PRON'Ur1CED D m. Dey. Year) ( ~ .+I o pr OrIOI areas iln t ~; ; ~ 1~3 M ~' ~~ ~ /S Y..^ ~ M ~ ( IT. PART 1: EMw (M diaaaMS. injrKia• ar cornpFCanmle wnkn caused rM matn. Do rpl anlM IM mode of dying, earn as prdiae ar n•piratpry ana•1, •MCk of Mart lailura. r Agpreannala PART 11: qMr aigniACaM eorldl:oru parlbiOWip,p mam, do Lisl enlypM 4rNa MlafA liM. ~MaMIDMwMA nplra•uan,mlM UlldallYV5 Carlae WanePMRT I. l raaM and mam RIY[gATE CAUSE (FVw I ) J, I ~ / r dr.eaarwroabn V`LV DfJ, M.i./LI , 1}~rC 'J!-. i rasuarq n oaaml--+ DUE TOIOIL AS CplLSEOUE,yCE CFI' SapwnKaey Nw mndeeipru e. ' E ayry, l•adilq n n•nad4la raw. Erow UIDERlT1110 DUE 70 (OR AS A C.ONSEOUENCE OF'I: 1 I CAUBE (Diaraaa aKrKy c. • M /•nMad aweros DUE 70 (di AS aGONSEWENCE 9F): 1 - rauaungn oeaarl LA37 a. NRS AN AIfIOPSY WERE AUTOPSY FINpNGS MANt1ER OF DEATH DATE OFIWVRY TIME OF IN.IURV IWURY AT WORKT DESCPoBE NOW INJURY OCCURPED. PERFORMED) AMUUBLE PRIOR TO (MOnm. OaY Veer) C.OMPlET10N OF DAVSE ^ Ns rw ~ Ib icid OF DFAM u m • N•• ^ ~~ AecimM ^ Pandn, Invnngarbn ^ Yea ^ No YM ^ Hp ~ Suleim ^ CwW rolMdetermMed ^ SM. s0A M. PLACE Of IWUPY.AI norm,larm, srNt. latbry. oeba LOCATION (SeeM. Cal'/bwr, Stww critdbq, etc. ISOedYI lea. Zee. ». ]Oa. 70F. CERTIFIERICMdaryy nrrN SIGNATLM AND TIT OFr~RTIFIE 'CEMIFY[a0 MIYSICIAN (Pnyycwr cenayng Wuae d mam when endow lJnvacyn nas COnpuncea mam arq campNed Kem 131 ~ (( `' Tema laal W mT anarl•C9a, mam aeewrred ew ro ma ew•e(f) and manner as alelea ..................................................... / ]t0. • IICENS[ M R ORE SK3NED( nn Day, ~) '-RONOIMCMID AHD C[RTIFYINO-HYSIC,AN IPnyscan narh pdqurCU5 mam arWCendyvgbcausBdmaml Ta tM Deal a m,. AnowNd,n, mam eeeumd al tna came, eau, arw PI«a, an0 auaa tLra eauaep) and mannw a• .Clad .......................... ^ •~ ''~~^ T+e. ~ l) Y ~ Tti 7 J L ' NAME AND ADDRESS OF PER [WHO COMPLEfEDCAUSE/p^F DE H paa Prml . 1 / ftlwn 27T T ~f 'MEDICAL FJIAMINER,CORONER y{~ '~ .~ ', h~ y Se, f / `+ On LM Wait of a•aminatlon anNd lnvea,igatlon, in my ppmien, dewA occurred at the Ilme, date, and phce. and dueto Me uux(al and ~I'~~It TVi / ,~ f ~ YJ p ) p r mMr1N as staled........... LJ ],a. .......................................................................... ........ ..... Jf. J• ~ REGISTRAR'S SMaNATURE AND N A F ~ ~ '~ ~ GATE FILED (Mdlm. DaY. taarl ' ~ ,~, . e.,.. . - - t aooa, ~,. . v v LAST WILL AND TESTAMENT OF 21-02-0784 JAMES I. BELL SAIDIS, SHUFF & MASLAND ATTORNEYS•AT•LAW 2109 Market Street Camp Hill, PA I, JAMES I. BELL, of Camp Hill, Cumberland ~~ounty, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST I direct the payment of my just debts and expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. If there is no cemetery lot available for my interment owned by me at the time of my death, I authorize my personal representative to purchase such cemetery lot with a contract for perpetual care, using funds from my estate ire such amount as my personal representative shall consider necessary and desirable, and I authorize my personal representative to cause title to or ownership of such lot so purchased to be vested ir.~such person as my personal representative shall designate. Further, I authorize my personal representative to expend funds from my estate, in such amount as my personal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. 1 SECOND I give, devise and bequeath all the rest, residue and remainder of my estate to my beloved wife, HELEN A. BELL, absolutely and in fee simple if she survives me by thirty (30) days. THIRD In the event that my wife, HELEN A. BELL, fails to survive me by thirty (30) days, then I give, devise and bequeath all the rest, residue and remainder of my estate equally to my son, DENNIS J. BELL, and my daughter, TERI L. HETTLER, if they survive me. However, if either one of them does not survive me, then ~~ give, devise and bequeath all the rest, residue and remainder of my estate to my surviving son or daughter. FOURTH I direct that any and all inheritance, estate, and transfer taxes imposed upon my estate passing under this Will or otherwise shall be paid out of the principal of my residuary estate. FIFTH SAIDIS, SHUFF & MASLAND A71'ORNEYS•AT•I.AW 2109 Market Street Camp Hill, PA In addition to the powers conferred by law, I authorize any guardian, executor or executrix acting under this instrument, in any such fiduciary's absolute discretion: A. To retain any investments I own at my death and to invest in all forms of real and personal property, without being confined to investments authorized by a statutory list, without 2 being required to diversify and regardless of any principle of law limiting delegation of investment responsibility by any such fiduciary; B. To compromise claims and to abandon any property which, in any such fiduciary's opinion, is of little or no value; C. 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 or leases; D. To join in any merger, reorganization, voting-trust plan or other concerted action of security holders, and to delegate discretionary duties with respect thereto; E. To borrow from anyone, even if the lender is a fiduciary hereunder, and to pledge property as security for repay- ment of the funds borrowed; F. To make loans to, and to buy property from, my SAIDIS, SHUFF & MASLAND ATTORNEYS•AT•IAW 2109 Market Street Camp Hill, PA spouse's executor or administrator; G. To employ and to rely upon advice given by investment counsel, to delegate discretionary authority to make changes in investments to investment counsel, and to pay investment counsel reasonable compensation in addition to any fees otherwise payable to any such fiduciary; H. To employ a custodian, to hold property unregistered or in the name of a nominee (including the nominee of: any institution employed as custodian), and to pay reasonable compensation to the custodian in addition to any fees otherwise payable to any such fiduciary; I. To hold two or more accounts hereunder as a combined 3 fund (allocating ratably to such accounts all receipts from, and expenses of, the combined fund) for convenience in investment and administration; provided that any combination of accounts for this purpose shall not alter their status as separate accounts; J. To distribute in cash or in kind; K. To renew or extend the time for payment of any obligation, secured or unsecured, payable to or by any such fiduciary for as long a period or periods of time and on such terms as such fiduciary may determine and to adjust, settle and ark>itrate claims or demands in favor or against them; and L. To exercise all elections which any such fiduciary .may have with respect to income, gift, estate, inheritance and Mother taxes, including without limitation, execution of joint income tax returns, election to deduct expenses in computing one tax or another, election to split gifts and election to pay or to defer payment of any tax in all events without any such fiduciary being bound to require contribution from any other person. SIXTH I do hereby nominate, constitute and appoint my wife, HELEN A. SAIDIS, SHUFF & MA5LAND ATTORNEYS•AT•I.AW 2109 Market Street Camp Hill, PA BELL, to act as Executrix, of this my Last Will and Testament. However, if she is unwilling or unable to act as Executrix, I direct the duties of Executrix, to be performed by my daughter, ITERI L. HETTLER. SEVENTH I direct that no personal representative, guardian, trustee or 4 other fiduciary appointed under this instrument shall be required to give bond for the faithful performance of any such fiduciary's duties in any jurisdiction. IN WITNESS WHEREOF, I, JAMES I. BELL, have hereunto set my h-a-n°d and seal to this my Last Will and Testament, this j'~~~day of .GYM -~ ~_ ~..~'~`"- JAMES I. BELL Signed, sealed, published and declared by the above-named Testator, JAMES I. BELL, as and for his Last Will and Testament in the presence of us, who have hereunto subscribed our names ~at his request as witnesses thereto, in the presence of said Testator and ADDRESS ~~[ ~ ~C ~- U~~, ,,~ ~ ,~ z.; ~ ~~- ADDRESS C~~'_~.~`7,,7 .C" ~.__. ~._ . SAIDIS, SHUFF & MASLAND ATTORNEYS•AT•LAW 2104 Market Street Camp Hill, PA COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND WE, the undersigned, the Testator, and the witnesses, 5 Hof each other. irespectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as This Last Will and Testament and that he signed willingly (or willingly directed another to sign for him), and that he executed it as his free will and voluntary act for the purposes therein expressed, and that each of the witnesses, in the preser.~ce and hearing of the Testator signed the will as witnesses and ghat to the best of their knowledge the Testator was at that time eighteen years of age or older, of sound mind, and under no constraint or (undue influence. JAMES I. BELL „ W~.`tness ~ s Witness SAIDIS, SHUFF & MASLAND ATTOItNEYS•AT•LAW 2109 Market Street Camp Hill, PA Subscribed, sworn to and acknowledged before me by the Testator and subscribed and sworn to before me by both witnesses, this /~~'~, day of ,eL ~,yt~jQ~' 1998 . No 6 Shelby L. YingMoJ, Npt~ry Ku Camp Hill Boro. Cumbe~rand C~ My Commission F_xpires April 8, l \ V F:AUser FolderlFirm Docs\Estates\2833-Icen.wpd CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: JAMES BELL, A/K!A JAMES I. BELL Date of Death: August 5, 2002 Will No. 21-02-0784 To the Register: 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 December 11, 2002: Name Address Helen A. Bell c/o Church of God Home, 801 N. Hanover Street, Carlisle, Pennsylvania 17013 Teri L. Poe 613 East 13th Street, Mountain Home, Arizona 72653 Dennis J. Bell 306 Shady Lane #120, El Cajon, California 92021 Notice has not been given to all persons entitled thereto under Rule 5.6(a) except: NIA HANFT & KNIGHT, P. C. Date: December 13, 2002 ~i~CT /A IJ-,~a. Michael J. Hanft, Esc}i'tire Attorney LD. No. 57976 19 Brookwood Avenue, Suite 106 Carlisle, Pennsylvania 17013-9142 Telephone (717) 249-5373 Capacity: Counsel forpersonal representative .~..,- ~-~ \ R~V-l_EX.(lI-GO) ~ l"-{",\ " \ . ,---- ,/ 11- ?5'5-1 *' OFFICIAL USE ONLY REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF ~UE DEPT. 280801 HARRIS8URG, PA 17128-0601 FILE NUMBER 21 COUNTY COOE 02 YEAR 00784 NUMBER w ~ ):~Vl U~'" w~g ::E:~..J U~m ~ <( ~ Z W o w U w o DECEDENrs NAME (LAST, FIRST, AND MIDDLE INITIAl) Bell, James I. SOCIAL SECURITY NUMBER 195-16-4306 DATE OF DEATH (MM-DO-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPUCATE WITH THE 08/05/2002 06/30/1926 REGISTER OF WILLS SOCIAL SECURITY NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FiRST AND MIDDLE INITIAL) Bell, Helen A. 181 1. Original Return o 4. Limited Estate 181 6. 09. !z w o z o ~ o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy of TtlJSt) o 10. Spousal Poverty Credit (date of death between 1-91 and 1.1.95 i'HISS~CTIQNMl.iSTBECOMP!-ETED:'I\I.UCCRRESeQNDEN.CE:t.il()'l:jCNIQENrlAciff ... !NFORMA 'ON1sHCU'tO'IlE OIRECTED. 'C:Li M,~jj! ME COMPLETE MAILING ADDRESS Michael J. Hanft, Esquire IRM NAME (If applicable) Hanft & Knight, P.C. o o 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required Decedent Died Testate (Attach copy of Will) . Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes o 11.Election to tax under Sec. 9113(A) (Attach SchO) 19 Brookwood Avenue, Suite 106 Carlisle, PA 17013 ELEPHONE NUMBER 717/249-5373 1. Real Estate (SeIledule A) (1) OFFICIAL USE ONLY None None None None 166,341.02 None None (8) 8,676.94 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) z o 1 " " ~ 1i w ~ 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . (5) (6) (7) 166,341.02 (g) (10) 11. Total Deductions (total Lines 9 & 10) (11) 8,676.94 157,664.08 12. Net Value of Estate (Line 8 minus Line 11) (12) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (13) (14) 157,664.08 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, 157,664.08 x .00 (15) or transfers under Sec. 9116(a)(1.2) z .045 (16) ~ 16.Amount of Line 14 taxable at lineal rate x ~ 17.Amount of Line 14 taxable at sibling rate x .12 (17) '" 0 U ~ 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 0.00 0.00 20. 0 y\m_i~~IIIlIIIlIIIl~~eill!JRErrQ~W~"1il;'-"'!U~I.l!:!~i9tliR"mm;~q~~~~~ CHECK HERE!F YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS Church of God Home 801 North Hanover Street CITY Carlisle ISTATE PA I ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + 8 + C) 3. Interest/Penalty if applk;able D. Interest E. Penaity TotallnteresUPenalty (D + E) 4. If Line 2 is greater than Line 1 + Une 3, enter the difference. This Is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (1) 0.00 (2) 0.00 (3) 0.00 (4) (5) 0.00 (5A) (58) 0.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;.................................................................................. b. retain the right to designate who shall use the property transferred or its income;.................................... c. retain a reversionary interest; or.,..."...................,.".................................................................................... d. receive the promise for life of either payments, benefits or care?............................................................. 2. 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?......... 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... Yes No ~ I o 181 o 181 o ..181 ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Church of God Home 801 North Hanover Street Carlisle, PA 17013 Under penalties of perjury. I declare lhat I have examined this return, induding accompanyir.g schedules and statements. and to the best of my knowledge and belief. it is true, COfTElCt and complete, Declaliltion of preparer other than the personal representative is based on all information of vmlch preparer has any knONleclge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS Helen A. Bell .r;.,,, ~ SIGNATURE OF RSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE 9-(0 -03 DATE ADDRESS DATE 19 Brookwood Avenue, Suite 106 Carlisle, PA 17013 q- (0-43 For dates of death on or after July 1 t 1994 and before January 1 t 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)l. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. S9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent. an adoptive parent. or a stepparent of the child is 0% [72 P.S. S9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries is 4.5%, except as noted in 72 P.S. S9116 1.2) [72 P.S. ~9116 (a) (1 )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. S9116 (a) (1.3)1. 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. *' SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANt4 INHatlTANCe TAX RETtJRN REsceHi DECEDENT ESTATE OF Bell, James 1. I FILE NUMBER 21 - 02 - 00784 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 DESCRIPTION VALUE AT DATE OF NUMBER DEATH I Citizens Bank Che",king Account No. 6100653110 26,718.02 2 1990 Oldsmobile VIN 1G3WSS4TlLD28551O 500.00 3 The Income Fund of America Mutual Fund Account No. 59561433 73,287.00 4 Delaware Tax-Free PA Mutual Fund Account No. 00715077558412 16,023.00 5 B.M.A. Fixed Annuity Contract No. 40089023 17,037.00 6 Mass Mutual Life Immediate Annuity Contract No. T-29,443 16,233.00 7 American Investors Life Fixed Annuity Contract No. 325028 16,543.00 . TOTAL (Also enter on Line 5, Recapitulation) 166,341.02 *' SCHEDULEH FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMON~lMOFPENN$'r'LVANlA INHERITANCe TAX RETURN RESIDeNT DeCEDENT ESTATE OF Bell, James I. I FILE NUMBER 21 - 02 - 00784 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: I Hoffman -Roth Funeral Home, Inc. 7,402.60 "- B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City State - Zip Year(s) Commission paid 2. Artomey's Fees to Hanft & Knight, P.C. 1,000.00 3. 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 4. Probate Fees to Cumberland County Register of Wills 59.00 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. Other Administrative Costs I The Sentinel Advertising Fee 135.92 2 Fee for Certified Letter to Department of Public Welfare 4.42 Total of Continuation Schedule(s) 75.00 TOTAL (Also enter on line 9, Recapitulation) 8,676.94 *' SchedUe H Fln!I'aI Expens e. & Ad1lirMcdiveCosts~ COMMONWEALTH OF PENNSYL.VANIA INHeRITANCE TAX RETURN RESIOENT DECEOENT ESTATE OF Bell, James 1. I FILE NUMBER 21 - 02 - 00784 3 Cumberland Law Journal Advertising Fee 75.00 " ~ Page 2 of Schedule H REV.1513 EX+ (1.00) . SCHEDULE J BENEFICIARIES COMMONlNEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bell, James 1. I FILE NUMBER 21 - 02 - 00784 RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY "_ ~e.~EDENT OF ESTATE I. TAXABLE DISTRIBUTIONS (include outnght spousal distributions) 1 Helen 1. Bell wife 100% residue of estate Church of God Home 80 I North Hanover Street Carlisle, Pennsylvania 17013 "- Enter dollar amounts for distributions shown above on lines 15 through 18, as ap~roprlate. on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE - ~ B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET .,..~ -- ".'~ Q' SAIDIS, SHUFF & MASLAND ATI'DRNF.W_AT_UW 2109 Market Street C.mp Hili. PA . '.' ~ . ''l; .~;. ',;:',."<,: LAST WILL AND TESTAMENT ~02-784 ~ @t@JP OF JAMES I. BELL Ix JAMES 1. BELL, of Camp Hill, Cumberland County, " Pennsylvania, being of sound and disposing mind, memory and understanding,.do hereby make, publish and declare this as and for my Last will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST I direct the payment of my just debts and expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. If there is no cemetery lot available for my interment owned by me at the time of my death, I authorize my personal representative to purchase such cemetery lot with a - " contract for perpetual care, using funds from my estate in such amount as my personal representative shall consider necessary and .- desirable, ~".'4 and I authorize my personal representative'to cause title to or ownership of such lot so purchased to be vested in such person as my personal representative shall designate. Further, I authorize my personal representative to expend shall ~. ..'... funds from my and inscription of a suitable marker for my 1 ~---:--;-~-- --. SAIDlS. SHUFF & MASLAND. ATJ'DItNEYSeAT.lAW 2109 Market 'Street C1mp HIIJ,PA . . '.' ~ . SECOND I give, devise and bequeath all the rest, residue and remainder of my estate to my beloved wife, HELEN A. BELL, absolutely and in fee simple if she survives me by thirty (30) days. <" THIRD In the event that my wife, HELEN A. BELL, fails to survive me by thirty (30) days, then I give, devise and bequeath all the rest, residue and remainder of my estate equally to my son, DENNIS J. BELL, and my daughter, TERI L. HETTLER, if they survive me. However, if either one of them does not survive me, then I give, devise and bequeath all the rest, residue and remainder of my estate to my surviving son or daughter. FOURTH I direct that any and all inheritance, estate, and transfer .... .... taxes imposed upon my estate passing under this Will or otherwise shall be paid out of the principal of my residuary estate. .- ~"'-"1 FIFTH In addition to the powers conferred by law, I authorize any guardian, executor or executrix acting under this instrument, in any such fiduciary's absolute discretion: . -'~' '~. "{;~':<~'~":'>-::<':f--':'. A. To retain ~a,ny investments ,I, own ~ '. , . ~~~: J ., '~i:>: :~. ,'-",. ,;. '" > J~:;'.-~;:;:; "".' invest in all forms of real and personal property,. confined to investments authorized by a statutory list, 2 ."--~-----' --.' -'..- "" SAlOIS, iHUFF & MASLAND A11'ORNEVSooAT-rAW 2109 Market Street Comp Hill, P ^ .,' being required to diversify and regardless of any principle of law limiting delegation of investment responsibility by any such fiduciary; B, To compromise claims and to abandon any property which, in any such fiduciary's opinion, is of little or no value; , C, 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 or leases; D. To join in any merger, reorganization, voting-trust plan or other concerted action of security holders, and to delegate discretionary duties with respect thereto; E, To borrow from anyone, even if the lender is 'a fiduciary hereunder, and to pledge property as security for repay- ment of the funds borrowed; F, To make loans to, and to buy property from, my spouse's executor or administrator; G. To employ and to rely upon advice given by investment ~ - , counsel, to delegate discretionary authority to make changes in investments to investment counsel, and to pay investment counsel ._:;..;..... reasonable compensation in addition to any fees otherwise payable to any such fiduciary; H. To employ a custodian, to hold property unregistered or in the name of a nominee (including the nominee of any institution employed as custodian), '.' all.d, to pay reason;;l.b~e_ ~ compensation to the custodian in add:~~id~:>'to any feesg{~~fll payable to any such fiduciary ;;'&.~;;;'Ji~~~ ~~--....:-,,: ~'.~:: ~~ I. To hold t~lO or more accounts hereunder as a conib:ined" ~. ~ "<- ~:....,?- ...~:.: .,:,. 3 ". ~ .,., SAlOIS, SHUFF & MASLAND ATTORNEYS-At-lAW 2109 Market Street C1mp Hili. PA , " '" , fund (allocating ratably to such accounts all receipts from, and expenses of, the combined fund) for convenience in investment and administration; provided that any combination of accounts for this purpose shall not alter their status,as separate accounts; J. To distribute in cash or in kind; K. To renew or extend the time for payment of any" "", , obligation, secured or unsecured, payable to or by any such fiduciary for as long a period or periods of time and on such terms as such fiduciary may determine and to adjust, settle and arbitrate claims or demands in favor or against them; and L. To exercise all elections which any such fiduciary may have with respect to income, gift, estate, inheritance arid other taxes, including without limitation, execution of joint income tax returns, election to deduct expenses in computing one tax or another, election to split gifts and election to payor to defer payment of any tax in all events without any such fiduciary being bound to require contribution from any other person. ~ ~ .. SIXTH ,- ..."...... I 'do hereby nominate, constitute and appoint my wife, 'HELEN A. BELL, to act as Executrix, of this my Last will and Testament. However, if she is unwilling or unable to act as Executrix, I direct the duties of Executrix, to be performed by my daughter, TERI L, HETTLER. ~" J SEVENTH I direct that no personal representative, guardian, trustee or 4 SAIDIS, >HUFF & MAS LAND ATTORNEYS-AT-lAW 2109 Market Street: Camp Hill. PA . . '. . other fiduciary appointed under this instrument shall be required to give bond for the faithful performance of any such fiduciary's duties in any jurisdiction. IN WITNESS WHEREOF, I, JAMES I. BELL, have hereunto set my J .:;:/J.-, this ~ day of hand and seal to this my Last will and Testament, --U~'<n~ 1'\ ,1998. ~.-JY.~. JAMES I. BELL Signed, sealed, published and declared by the above-named Testator, JAMES I. BELL, as and for his Last Will and Testament in the presence of us, who have hereunto subscribed our names at his request as witnesses thereto, in the presence of said Testator and of each other. ADDRESS (' f+/i\P {\- \ (. \...- r A . .. ADDRESS rY }/J!L '''{If) \!:.--6j::J,' /' a.... , COMMONWEALTH OF PENNSYLVANIA SS. COUNTY CUMBERLAND OF WE, the undersigned, the Testator, and .the witnesses, 5 --._-~-- - ---"-'--"-'~' --.---- .~ '. SAlOIS, SHUFF & MAS LAND ATrORNEYS-AT-UW 2 t 09 Market Street Camp Hili. PA respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament and that he signed willingly (or willingly directed another to sign for him), and that he executed it as Qis free will and voluntary act for the purposes therein " expressed, and that each of the witnesses, in the presence and hearing of the ~estator signed the will as witnesses and that to the best of their knowledge the Testator was at that time eighteen years of age or older, of sound mind, and under no constraint or undue influence. ~~.~' JAMES I. BELL ,~ /jb~1 (l, /:3d~~ Witness ~ .- ;,.....'!' Subscribed, sworn to and acknowledged before me by the Testator and subscribed and sworn to before me /.5'11. day of I!J'J~A by both witnesses, this , 1998. Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/08/2004 HANFT MICHAEL J 19 BROOKWOOD AVENUE SUITE 106 CARLISLE, PA 17013 RE: Estate of BELL JAMES File Number: 2002-00784 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the abo~e captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 8/05/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, GLENDA FARNER STRASBAUGH REGISTER OF WILLS CC: File Personal Representative(s) Judge Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/08/2004 BELL HELEN A CHURCH OF GOD HOME 801 NORTH HANOVER ST, ROOM 410 CARLISLE, PA 17013 RE: Estate of BELL JAMES File Number: 2002-00784 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 8/05/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, GLEN-DA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge Name of Decedent: Date of Death: Admin. No. ORPHANS' COURT DIVISION OF THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA STATUS REPORT UNDER RULE 6.12 JAMES BELL, a/k/a JAMES I. BELL August 5, 2002 21 02-0784 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: State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: is: Yes ao Did the personal representative file a final account with the Court? Yes No X The separate Orphans' Court No. (if any) for the personal representative's account c. Did the personal representative state an account informally to the parties in interest? X No d. Copies of receipts, releases, j oinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: July 19, 2004 Respectfully submitted, HANFT & KNIGHT, P.C. Attorney ID No. 57976 19 Brookwood Avenue, Suite 106 Carlisle, Pennsylvania 17013-9142 (717) 249-5373 Counsel for personal representatives F:\User Foldc~Firm Docs~Estatcs~2833-1status.rpLwpd SAIDIS SHUFF, FLOWER & LINDSAY 26 W. High Street Carlisle, PA IN THE OFFICE OF THE REGISTER OF WILLS FOR CUMBERLAND COUNTY, PENNSYLVANIA INRE: ESTATE OF JAMES I. BELL : NO. DECEASED. PETITION TO REVOKE LETTERS AND NOW COMES, HELEN A. BELL, Petitioner, and states in support of her Petition the following: WHEREAS, Letters Testamentary were granted to the Petitioner on ,~ ~,_- ~ 0 / ~)2.--- inthe Estate of James I. Bell; and WHEREAS, Petitioner has renounced her rigb,tr.to continue as Executrix and ~i;! ' WHEREAS, the Will of the said James I. Bell, Decee~'-bd, nominates and appoints my daughter, TERI LYNNE POE, as successor. ~ NOW, THEREFORE, Petitioner prays the Register~f Wills ~:&voke the Letters Testamentary granted to her in the said Estate and appoint the said TERI LYNNE POE, Executrix, and grant Letters Testamentary to her. WITNESS: Helen A. Bell, Petitioner SAIDIS SHUFF, FLOWER & LINDSAY 26 W. High Street Carlisle, PA COMMONWEALTH OF PENNSYLVANIA COUNTY OFCUMBERLAND On this, the ~.~'"~ SS. undersigned officer, personally appeared THOMAS E. FLOWER, I.D # 83993, known to me (or satisfactorily proven) to be a member of the bar of the highest Court of said state and a subscribing witness to the within instrument, and certified that he was personally present when HELEN A. BELL, Petitioner, whose name is subscribed to the within instrument, executed the same, and that said person has acknowledged that he/she executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. NOTARIAL SEAL RENEE L. MURRAY, No~rv ~li~. Carlisle Boro Cumbertand C~i~'~, My Comm &Sion EX~re~ Des ~ day of October, 2004, before me, the ESTATE OF JAMES I. BELL, DECEASED BEFORE THE REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA NO. 21-2002-0784 ORDER OF THE REGISTER OF WILLS AND NOW, this 28th day of October, 2004, upon consideration of the Petition to Revoke Letters filed by Thomas E. Flowers, Esquire indicating the Petitioner has renounced her fight to continue as Executrix for the above-named decedent it is hereby ordered that the Letters Testamentary which were granted to Helen A. Bell on August 30, 2002 are hereby revoked. Whereas the Petitioner respectfully requests that Letters be issued to Teri L. Hettler, now know as Teri Lynne Poe, the successor nominated in the WilI of James I. Bell, it is also ordered that upon return to the Register of Wills the original Certificate of Grant of Letters and all unused Short Certificates which had been issued with respect to the Estate of the above-named Decedent, Letters of Administration d.b.n.c.t.a, shall be issued to Teri Lynne Poe. da Farner Strasbau~h, Register f~ills Register of Wills of CountY, Pennsylvania RENUNCIATION / also known as , Deceased The undersigned, HELEN A. BELL (surviving spouse) (executrix) of (Relationship) (Capacity) the above Decedent, hereby renounce(s) the right to adr~nistar the estate and respectfully request(s) that Letters be issued to TERI LYNNE POE WITNESS by her (as successor or alternate executrix) hand this, '~ ¢ ~ day of October , 2004 . (Signature) Church of God Home, Hanover Street, Carlisle, PA (Address) (Signature) (Address} (Signature) (Address) Swom to or affi/~~ before me this ~ ~ day o* October , 2004 /~ /~,~ ~/// / ,J NOTARIAL SEAL ~O~W PubI~ - ~ ..... I ~a~o, Cum~dand ~u~, PA I My Co--sion E~ims: I MY~mm~Jon E~ires D~. 13, 2~m q~llfl~ to a~nl~ ~th~ S~w date of N~ Renuncia~ons ex~uted ou~e the Office of Regi~er of Wills a~aflon of Not~'s co--om) in so~ counties are required to ~ nom~ed. BEFORE THE REGISTER OF WILLS COUNTY OF CLrMBERLAND, PENNSYLVANIA ESTATE OF JAMES BELL, Deceased Late of North Middleton Township : No: 2002-00784 PRAECIPE FOR ENTRY OF APPEARANCE TO THE PROTHONOTARY: Please enter my appearance on behalf of Ted Lynn Poe, Executrix of the Estate of James Bell, deceased. Papers may be served at the address set forth below. Date: 2004 SAIDIS, SHUFF, FLOWER & LINDSAY Thomas E. Flower, Esquire Supreme Ct. ID # 83993 2109 Market Street Camp Hill, PA 17013 (717) 737-3405 Register of Wills of CU BE ^ND County, Pennsylvania PETITION FOR GRANT OF LETrERS Estate ot James Bell , Oeceased No. 2002-00784 Social Security No. 195-16-4306 Petitioner(s), who is/are 18 years of age or older, appl,/(ies) for: (COMPLETE 'A' or 'B' BELOW:) ] A. Probate and Grant o[ Letters Testamenta~ and aver that Petitioner(s} is/ara the ex*mm, ~x named in the last Will of the Decedent, dated and codiciKs) dated .. Petitioner's mother, Helen A. Bell,~"~'dent's surviving spouse, who was appointed Executrix of this Estate, now resides in a nursing home and is unable to ~ontinue to serve as Execumx. t'etmoner ]s named as her successor in the decedent's Will and now asks that 'Letters Testamentary be granted to her. State relevant circumstances, e.g., renunciation, death of executor, otc. Except as foliows, Oecedent did not merry, was not divorced, and did not have a chiid born or adopted after execution of the documents offered for probate; was not the victim of a kitlthg and was never adjudicated incompetent: ] B. Grant of Letters of Administration . . ~. (c.t.a.; d.b.n.c.t.a; pendente lito; durante ~bsenfia; ~i3;l{Tanta Petitioner(s) after a proper search has/have ascertained that Oecedent left no Will and was survived by the following spo ~-e~:; (if any) I Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in No1%11 Midd]eton Township, Cumberland County, PennsyNania with his/her last family or principal residence at ...8.01 North Hanover Street, Carlisle, Notch Middleton Township, Cumberland County, Pennsylvania (list street, number, and municipality) Decedent, then 76 years of age, died August 5, 2002 at Carlisle Regional Medical Center, Carlisle, Cumberland County, PA (Location) Decedent at death owned property with es§mated values as follows: (If domiciled in PA) All personal propen'7 (If nOt domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal proped;y in County Value of real estate in Pennsylvania situated as follows: $ Wherefore, Petitioner(s) respectfully request(s) the probate of [he last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersi~nad: I ./iF~ Signature Teri Lynne Poe Typed or printed name and residence 613 East 13th Street Mountain Home~ AR 72653 Oath of Personal Representative Commonwealth ot' Pennsylvania ComW of The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best ot 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 according to law. Teri Lynne Poe Sworn to or affirmed and subscribed before me thi~.~%ay of 613 East 13th Street 72653 No, / Social Security No: 195-16-4306 Oats of Death: August 5, 2002 ANO NOW, this r~q'~y'~ day of 2004 of ~ Per,ion on the revere side he~on, safl~acto~ p~of havi~ been presented befo~ DeceaSed IT iS DECREED that Letters [] Testamentary [] Of Administration (c,t.a.; d.b.n.¢.La.; pendente IRe; daranta abse~ durante mlr~orRata) are hereby granted to Teri LTnne Poe in the above estate and that the instrument(s) dated described in the Petition be admilted to probate and filed of record as the last Will of Decedent. FEES Letters ........... $ Short Certiticate(s) ..... $ Renunciation ........ AffMavits ( ) .... Extra Pages ( ) .... Codicil ........... JCP Fee .......... Inventory .......... Other ........... 5.oo Attorney: Thomas E. Flower, Esquire I.D. No: 83993 Address: 2109 M~rket Street Camp Hill~ PA 17011 Telephone: (717) 737-3405 TOTAL ......... Form RW-1 (lggl)