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01-1093
Register of Wills of CUMBERLAND County, Pennsylvania PETITION FOR GRANT OF LETTERS ~1-Ol..l093 Estate of MARION J. CHERCHUCK also known as No. , Deceased Social Security No. 204-18-4199 PAUL CHERCHUCK Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) [K] A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut or the Decedent, dated 01/05/1982 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: D 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: I Name Relationshio Residence I (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in CUMBERLAND County, Pennsylvania with his/her last family or principal residence at 251 EAST POMFRET STREET, CARLISLE BOROUGH, CARLISLE, PA 17013 (list street, number, and municipality) Decedent, then ~years of age, died 09/17/2001 at 251 EAST POMFRET STREET, CARLISLE, PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (jf not domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania 158,649.00 $ $ $ $ 104,300.00 situated as follows: 251 EAST POMFRET STREET, CARLISLE, PA + AN ADDITIONAL LOT 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 a riate form to the undersi ned: Si nature .... ,. PAULVCHERCHUCK 356 EAST BALTIMORE STREET, CARLISLE, PA 17013 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 according to law. fad ~ ~ Sworn to or affirmed and subscribed before me this 28thciayof PAU~C. H~~CHUCK Li>~ ff , 2001 No. 21-2001-1093 Estate of MARION J. CHERCHUCK Deceased Social Security No: 204 -18 -4199 Date of Death: 09/17/2001 AND NOW, Novanber 30th 2001 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters []] Testamentary D Of Administration (c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to l()\,t.l5~ PAULV CHERCHUCK in the above estate and that the instrument(s) dated 01/05/1982 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. ~c.~~~)~~ Registef of Wills Mary C. Lewis FEES Letters. . . . . . . $ 270.00 Short Certificate(s). 12. $ 36.00 Renunciation. $ Affidavits ( $ Extra Pages ( 4 ) . $ 12.00 Codicil. $ JCP Fee. $ 5.00 Inventory. $ Other $ TOTAL. $ 32~. 00 Attorney: LISA M. GREASON, ESQUIRE 1.0. No: 78269 GREASON LAW OFFICE 155 SOUTH HANOVER STREET Address: CARLISLE, PA 17013 Telephone: 717/241- 3030 //w~.b~ ~f~T rn~~ Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991) . . . ft marion here iven is correctly copied from an original certificate of death duly filed with r.. h(~ llsRto .cernfyTthhat t~e. malocrertificate will gbe forwarded to the State Vital Records Office for permanent filing. Loca eglsrrar. e ongm WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 p 7578747 No. 21-2001-1093 me as 21"_ ~. ~bl.-~~ Local Registrar Sf? 1 9 20n1 Date Hl05.144 Rey, 1/91 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH (Coroner) E1PRINT IN "'ANENT \CKINK SEX 2. Female J STATE FILE NUMBER SOCIAL SECURITY NUMBER 3, 204-18-4199 2001 UNDER 1 YEAR Days UNDER 1 DIl'( Houri Minutes PLACE OF DEATH (Check only one see instruct,,,,,s "" 0'''''' sode) HOSPITAL: Inpalien' 0 I.. reel and number} ~::ily)D CI lie, DECEDENT'S USUAL OCCUPATION (GIV' kOfld 01 work done during mOSl ofW""'9'ile:dOnq(~serefired) own Home . 11. nome maKer lib. OECEDENT'S MAILING ADDRESS (SIre.. CftylTown, Sta'e, lip Code) DECEOENT'S 251 East Pomfret street ~~~~c:iNcE Carlis1e.Pennae17013 ~~r~~ Ie. OOHER'S NAME (F~Sl, Middle, Lest) II. Charles Homa INFORMANT'S NAME (T ype/Pnnl) Michael Cherchuck 17b, Coun Cumberland DATE PRONOUNCED DEAD (MonIl1, OOy, 'r8ar) a.. 9: 10 A'M. 25. September' 17, 2001 27. MIlT f: EllIer'ne __. injuries or compliC.'ion. which couMd ,ne dee'h. Do not enl., ,ne mode 01 dyi"\l. such ee cordie. or reopiretory .rr.... IIhoc:k or hee" f.iIUr.. Lie, only ana _ on u.c:h line. b. e DUE TO (OR AS A CONSEOuENCE OF): d. WERE AUTOPSY FINDINGS _,LA8LE PRIOR TO COMPLETION Ol' CAUSE OF DEATH? MANNER OF DEATH DATE OF INJURY (Monll1. Day, lIla'l P!t o o Homicide D N.'ur.' No~ Ac:c:iden' Pending Inv81tigaltOn _0 NoD Suicide a. Could not be ctetermmed He. 21b. canlFIEII !Check only one) 'CEIlTlFYINO PHYSICIAN (Physic"'" C8rrilyu1g cause 01 deelh when another pIlysician nas pronounced death and cornplOled nem 23) Totne_ofmy k-.._occ\l.-_tothec.\In(.).ncIm.nne....t8lH. . ..,.............,..............., 'PIlONOUNClNO AND CEIlTlFYINO PHYSICIAN (PhysiCien boCh pronouncing deell1 and certifying 10 cause 0/ death) Tb!he _ of my k-., c1e81h occuned .tthe II..... del., .nd pIac., end due to the ..un(.).1Id manne,.. e18tH.. . . . . . . . . . . . . . . . , . 'MEDlCAL EXAMINER/CORONER On \he _Ie of ..emlnatlon encllor Inyeetlgatfon. In my opinion. dellth oc:c:urred .llhe lime, d.,.. .nd place, .nd due to the cllUe.,e) end ............ atated.. . . . . . . . . . . . . . . . . . . . . . . . . .. . .. . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31.. REGISTRAR'S SIGNATURE AND ~,I,~I,OI RACE - American Indian. Black. White, eolc (Speedy) White MARITAL STATUS. M.rried SURVIVING SPOUSE Never Married, Widowed. (It WIle, glve maiOen name) wfc!owpec"y) Did dec:8Clen' IIwJ in . town.hip? 11e.O Vel. decedent1ived in 'wo Carlisle city/boro LICENSE NUM8ER 23b. 23<:. WAS CASE REFERRED TO MED,9L EXAMINER/CORONER? -11;1 tlo 0 21. 'A!lP<ollimat. : interval between : onaet and dle'h i PART II: O1ne, .ignific:ant condhion. contributing '0 dleth. bu1 not relunlng in the undertyi"\l .euoe given in PART I CBDG TIME OF INJURY INJURY AT WORK? Coroner D 31b. LICENSE NUMBER o 31c. 3td. Se t. 18, 2001 NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH (ltern27)TypeOfP'in~tichael L. Norris, Coroner ~ 6375 Basehore Road, Suite #1 Y\~. Mechanicsburg, Pa. 17050 DATE FILED (Month. OOy, Year) 3.. 21-2001-1093 LAST WILL AND TESTAMENT OF MARION J. CHERCHUCK I, MARION J. CHERCHUCK, a domiciliary of Cumberland County, Commonwealth of Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this instrument to be my LAST WILL AND TESTAMENT. I hereby revoke any and all wills and codicils by me heretofore made. I IDENTIFICATIONS AND DEFINITIONS I am married to PAUL CHERCHUCK, hereinafter referred to as "my Spouse." We have six (6) children, JANET HELEN CHERCHUCK, PAUL LOUIS CHERCHUCK, THOMAS MARK CHERCHUCK, MICHAEL ANTHONY CHERCHUCK, IRENE BRIDGETT CHERCHUCK, and MARY ELLEN CHERCHUCK hereinafter referred to as "my Children." The following definitions obtain in any use of the terms in this Will: 1. "Descendants" means the immediate and remote lawful, lineal descendants of the person referred to, and it means those descendants in being at the time they must be ascertained in order to give effect to the reference to them, whether they are born before or after my death or of any other person. The persons who take under this Will as Descendants shall take by right of representation, in accordance wi th the rule of per stirpes distribution and not in accordance wi th the rule of per capi ta distribution. Persons legally adopted when under the age of fourteen years shall not be differentiated from blood descendants for any purpose. 2. "Survi ve me" is to be construed to mean that the person referred to must survive me by thirty days. If the person referred to dies within thirty days of my death, the reference to him shall be construed as if he had failed to survive me. 3. As used in this Will, the words "Executor," "he," "him," "his," and the like shall be taken as generic and applicable to a natural person of ei ther sex or a corporate person or other legal entity. Page 1 of 4 Pages __"l" _ _ II PAYMENT OF DEBTS AND TAXES I direct my Executor to pay the following as soon after my death as may be practicable: 1. All of my just debts and the expenses of my last illness, funeral and of the administration of my estate; but my Executor need not accelerate and pay those unmatured obligations which, in his opinion, it might be proper and more advantageous to retain or renew and pay as they become due and payable. 2. All inheritance, transfer, estate and similar taxes (including interest and penalties) assessed or payable by reason of my death, on any property or interest in my estate for the purpose of computing taxes. My Executor shall not require any beneficiary under this will to reimburse my estate for taxes paid on property passing under the terms of this Will. III RESIDUARY ESTATE A. I def ine "my Res iduary Esta te" as all of my property after the payment of debts and taxes under Article II, including real and personal property, whenever acquired by me, property as to which effective disposition is not otherwise made in this Will, and property as to which I have an option to purchase or a reversionary interest. B. I give my Residuary Estate to my Spouse if he survives me. C. If my Spouse does not survive me I direct my Executor to divide my Residuary Estate into ;qual shares and to distribute those shares as follows: 1. one share to each of my Children who survive me. 2. if any of my Children fail to survive me then his or her share shall be distributed amo~g his or her descendants who survive me- 3. if any of my Children fail to'survive me and leave no descendants who survive me, then his or her share shall be divided equally among such of my Children who survive me, or their descendants who survi ve me, as set forth in subparagraphs 1 and 2 above. Page 2 of 4 Pages bond of a Guardian appointed under this article. V APPOINTMENT AND POWERS OF EXECUTOR I nominate and appoint my Spouse, PAUL CHERCHUCK, as Executor of this my LAST WILL AND TESTAMENT. If PAUL CHERCHUCK is unable or unwilling to serve in this capacity, I appoint my son PAUL LOUIS CHERCHUCK to serve instead. I request that my Executor be permitted to serve without bond or surety thereon. I authorize my Executor to do any and all things which in his opinion are necessary to complete the administration and settlement of my estate, including full right, power and authority, without the order of any court and upon such terms and under such condi tions as my Executor shall deem best for the proper settlement of my estate; to bargain, sell at public or private sale, convey, transfer, deed, mortgage, lease, exchange, pledge, manage and deal wi th any and all property belong ing to my esta te; to compromise, settle, adjust, release and discharge any and all obligations or claims in favor of or against my estate; and to borrow money for the payment of inheritance and estate taxes or for any other purpose. Without in any way limi ting the scope of the powers enumerated herein of my Executor, I hereby specifically give to him full power to retain any and all securities or property owned by me at the time of my decease whenever, in his absolute and uncontrolled discretion, such a course shall seem to him to be best, without liability for depreciation or loss, and free from investment restrictions incident to executorship, whether imposed by common law or statute. In the execution of his duties and powers as Executor he shall have the power to comply wi th all legal requirements as to the execution and delivery of deeds and all other writings, documents or formali ties wi thout the order of any court; and he shall furnish a statement of receipts and disbursements at least annually to each person then enti tIed to recei ve income or property from my estate. Page 3 of 4 Pages Acknowledgment COMMONWEALTH OF PENNSYLVANIA)ss: COUNTY OF CUMBERLAND ) I, MARION J. CHERCHUCK, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby ack~owledge that ! sign~d and executed the 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. Sworn or affirmed to and acknowledged before me, by MARION J. CHERCHUCK, the Testator, thiS6-t:-&.day of o."'~~_LY' 1982. - r:7 l7T~ ~ ~-'<!!~ MARION J. HERCHUCK Testator Affidavit ;t~a ~ -Notary Public Gloria A. Gabner, Notary Public North Middleton Twp., Cumberland County My Commission Expires Feb. 5. 1983 , Member, Pennsylvania Association of Not~mS!~ (SEAL) COMMONWEALTH OF PENNSYLVANIA)ss: COUNTY OF CUMBERLAND ) and w'%<~~-r ~~;~nw ,thl;Zi~~~~i: .1!~rla;;fmes are signeo to the tta-: ed or foregoing instrument, being duly qUalified acCOrding to law, dO depose and say that we were present and saw Testator Sign and execute the instrument as her Last Will; that MARION J. CHERCHUCK, Signed 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 Testator Signed the Will as Witnesses; and that to the best Of our knOWledge the Testator was at that time 18 or more years Of age, Of sound mind and under no constraint or undue influence. sworn or affirmed to ~~d SUbscribed to before .~ b~ ~k~t A~Qf.. ,'/l')' rl'f , frllCltae / f'(fcllad , and JdsBrJ..:r. ~t~-t:" , Wi tnesses, tiS ~ day Of :f/fA.Jw:uul , 8. ~t.~J2~ ~~L,'d ~k u; , < , ~ ~ ~. U Notary PUbliC (SEAL) GlOria A. Gabner, Notary Pubiic North Middleton Twp., cumberland county MY CommiSSion EXPires Feb. 5/ 1983 Member. pennSYlvania Association Of Not~~ IN WITNESS WHEREOF, I have at Carlisle Barracks, Pennsylvania, this~ day of ~"~.IJ~7 ' 1982, set my hand (/ and seal to this my LAST WILL AND TESTAMENT consisting of four (4) typewritten pages. (SEAL) ;//l~ C). ~~ MARION J.'CHERCHUCK Testator Signed, sealed, published and declared by the Testator, MARION J. CHERCHUCK, as and for her LAST WILL AND TESTAMENT, in the presence of us, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. NAME ADDRESS ~'() ill ArY .!13~A,(3 .A~~ ~J' A.. f/(J (j)fi6 Car h'sl~ Ba(,>ic..dt~ fJA Aj- q s~;(r{ ~~/Z;:r~ ,~b(" ~ . Page 4 of 4 Pages . CERTIFICATION OF NOTICE UNDER RULE 5.6(!l Name of Decedent: MARION J. CHERCHUCK Date of death: SEPTEMBER 17, 2001 File No. 2001-01093 PA File. No. 21-01-1093 S.S. #: 204-18-4199 TO THE REGISTER: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above captioned estate. Janet Cherchuck Michael Cherchuck P.O. Box 566 434 Mill Race Road Gordonsville, VA 22942 Carlisle, PA 17013 Paul Cherchuck 356 E. Baltimore Street Carlisle, PA 17013 Irene Cherchuck 825 B Chestnut Ridge Road Chestnut Ridge, NY 10977 Thomas Cherchuck 8528 Rosedale Drive Oak Ridge N.C. 27310 Mary Ellen Wunder 256 Mt. Salem Road Wantage, NJ 07461-3602 Notice has now been given to all persons entitled thereto under Rule 5.6(a). o N C) EX: -.I. ;'j /;2- I~-rl Date a: c..J - o '~l Respectfully Submitted GREASON LAW OFFICE /J J t/ N - p ::~B 'f: ~ .:),)= UU COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT CHERCHUCK PAUL LOUIS 356 EAST BALTIMORE STREET CARLISLE, PA 17013 -------- fold ESTATE INFORMATION: SSN: 204-18-4199 FILE NUMBER: 21 - 200 1 - 1 093 DECEDENT NAME: CHERCHUCK MARION J DA TE OF PAYMENT: 12/17/2001 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 09/17/2001 NO. CD 000648 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $10,000.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 117 SEAL INITIALS: PB RECEIVED BY: REGISTER OF WILLS $10,000.00 MARY C. LEWIS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX( 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT GREASON LISA M ESQUIRE 28 SOUTH PITT STREET CARLISLE, PA 17013 _n___n fold ESTATE INFORMATION: SSN: 204-18-4199 FILE NUMBER: 2101-1093 DECEDENT NAME: CHERCHUCK MARION J DA TE OF PAYMENT: 11/13/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 09/17/2001 NO. CD 001834 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $996.85 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: LISA M GREEN ESQUIRE CHECK#126 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $996.85 MARY C. LEWIS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT GREASON LISA M 28 SOUTH PITT STREET CARLISLE, PA 17013 nn____ fold ESTATE INFORMATION: SSN: 204-18-4199 FILE NUMBER: 2101-1093 DECEDENT NAME: CHERCHUCK MARION J DA TE OF PAYMENT: 01/10/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 09/17/2001 NO. CD 002032 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $33.68 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: LISA M GREASON ESQUIRE CHECK# 831 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $33.68 DONNA M. OTTO DEPUTY REGISTER OF WILLS ~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG1 PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT * REY-IU7 EX AFP (01-05) Reco; F~(;q~'-, <> DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-23-2004 CHERCHUCK 09-17-2001 21 01-1093 CUMBERLAND 101 MARION J -04 MAR 12 P 1 :45 LISA M GREASON ESQ GREASON LAW OFFICE 50 E HIGH ST CARLISLE Allount Rellitted c; J2;: P A Gtt'iit5" . MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper cr&dit. to ~account, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE '~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ RE-Y-= ! i;O-j-EX--AFP-f 01-:03-r------...--i NifERi'fANCi-- TAX--STA-fEMi-NT-ifF'-Aifco[iiff--.-..---------------- -- - -- ESTATE OF CHERCHUCK MARION J FILE NO.21 01-1093 ACN 101 DATE 02-23-2004 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX.DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE I A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-19-2004 P R I NC I PAL TAX DUE: ........................................................................................................................................................................................................................... 11,327.35 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-17-2001 CDOO0648 526.32 10,000.00 11-13-2002 CDOO1834 19.57- 996.85 01-10-2003 CD002032 .00 33.68 02-03-2004 REFUND .00 209.93- TOTAL TAX CREDIT 11,327.35 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 lIE IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. J I?~~- 7 '" BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT *' REY-1U7 EX AFP COl-05) :;<~! DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-18-2003 CHERCHUCK 09-17-2001 21 01-1093 CUMBERLAND 101 MARION J LISA M GREASON ESQ GREASON LAW OFFICE 50 E HIGH ST CARLISLE Allount Rellitted , . PA 1'7013 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV:i60j-Ex-AFP--(Or:03i-------...--iNiiERi~fANCE-Tix-sTATEME-NT-OF-iccouiff--.-ii--------------------- ESTATE OF CHERCHUCK MARION J FILE NO.21 01-1093 ACN 101 DATE 02-18-2003 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-06-2003 P R I N C I PAL TAX DUE: ........................................................................................................................................................................................................................... 11,523.17 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-17-2001 CDOO0648 526.32 10,000.00 11-13-2002 CDOO1834 .00 996.85 01-10-2003 CD002032 24.36- 33.68 TOTAL TAX CREDIT 11,532.49 BALANCE OF TAX DUE 9.32CR INTEREST AND PEN. .00 . IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 9.32CR SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A ..CREDIT" (CRl, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l /1- 020-::' 7 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-06-2003 CHERCHUCK 09-17-2001 21 01-1093 CUMBERLAND 101 LISA M GREASON ESQ GREASON LAW OFFICE 50 E HIGH ST CARLISLE PA:~7013-1410 REV-1547 EX AFP (01-03) MARION J Amount Remitted ) CHANGED (1) (2) (3) (4) (5) (6) (7) 106,384.00 134,193.07 .00 .00 1,559.89 30,822.84 .00 (8) :S~~lD't MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ R EV =iStri-e:x--iFP--(Oi-:03')--HoT-icE--oF-i-NHErfiTAifcE-''AX-:;PPRA-isEM-ENT-:--iLLOWAifcE-O-ri----------------- DISALLOWANCE OF DEDUCTIONS AND ASS-ESSMENT OF TAX ESTATE OF CHERCHUCK MARION J FILE NO. 21 01-1093 ACN 101 DATE 01-06-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly OWned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 15. 14. (9) ClO) 16,889.38 .00 (11) (12) (13) Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) Net Value of Estate Subject to Tax NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 272,959.80 (14) 16.889.38 256,070.42 .00 256,070.42 NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 171 18 and 19 will reflect figures that include the total of Alh returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate IS. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: (15) .00 X 00 .00 (6) 256,070.42 X 045 = 11,523.17 Cl7) .00 X 12 = .00 US) .00 X 15 = .00 (19)= 11,523.17 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 12-17-2001 CDOO0648 526.32 10,000.00 11-13-2002 CD001834 .00 996.85 BALANCE OF UNPAID INTEREST/PENALTY AS OF 11-14-2002 TOTAL TAX CREDIT 11,523.17 BALANCE OF TAX DUE .00 INTEREST AND PEN. 24.36 TOTAL DUE 24.36 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. { IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE , c?-~-- 7 ~ BUREAU OF INDIVIDUAL INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 TAXES COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER t~iUNTY ACN 01-06-2003 CHERCHUCK 09-17-2001 21 01-1093 CUMBERLAND 101 LISA M GREASON ESQ GREASON LAW OFFICE 50 E HIGH ST CARLISLE PA 17013~1410 *' REV-1547 EX AFP C01-03) MARION J Amount Remitted ) CHANGED (1) (2) (3) (4) (5) (6) 0) 106,384.00 134,193.07 .00 .00 1,559.89 30,822.84 .00 (8) MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ R'E-y=is4-i-e:x--iFP-CO'r:03J--NO'T-ice:--OF-j-tiHER-iTAN-CE-'T-A'X-APPR"A-isEifENT-,--iLLOWAN-CE-O'R----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF CHERCHUCK MARION J FILE NO. 21 01-1093 ACN 101 DATE 01-06-2003 T AX RETURN WAS: (X) ACCEPTED AS F I LED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. CloselY Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. 10. ll. 12. 13. 14. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) Debts/Mortgage Liabilities/Liens (Schedule I) Total Deductions Net Value of Tax Return (9) UO) 16,889.38 .00 ell) el2) el3) (4) Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) Net Value of Estate Subject to Tax NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 272,959.80 1~.R8g ~8 256,070.42 .00 256,070.42 If an assessment was issued previously, lines 1~, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ~ returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS. NOTE: US) {un (17) (18) .00 X 00 .00 256,070.42 X 045 = 11,523.17 .00 X 12 = .00 .00 X 15 = .00 (19) = 11,523.17 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 12-17-2001 CDOO0648 526.32 10,000.00 11-13-2002 CDOO1834 .00 996.85 BALANCE OF UNPAID INTEREST/PENALTY AS OF 11-14-2002 TOTAL TAX CREDIT 11,523.17 BALANCE OF TAX DUE .00 INTEREST AND PEN. 24.36 TOTAL DUE 24.36 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN t1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) 'v COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPARTMENT 280601 HARRISBURG, PA 17128-0601 April 25, 2002 '02 I'lJ\Y -3 1 :1 9 Telephone (717) 787-3930 FAX (717) 772-0412 Greason Law Office C. _, 50 East High St. ell Carlisle, Pa.17013 Re: Estate of Marion J. Cherchuck File Number 2101-1093 Dear Ms Greason: This is in response to your request for an extension of time to file the Inheritance Tax Return for the above estate. In accordance with Section 2136 (d) of the Inheritance and Estate Tax Act of 1995, the time for filing the return is extended for an additional period of six months. This extension will avoid the imposition of a penalty for failure to make a timely return. However, it does not prevent interest from accruing on any tax remaining unpaid after the delinquent date. The return must be filed with the Register of Wills on or before December 17,2002. Because Section 2136 (d) of the 1995 Act allows for only one extra period of six (6) months, no additional extension(s) will be granted that would exceed the maximum time permitted. ..,''':'J" :~. ,/' /;' ',i : Sincerely /7 if: / /.' !' r'i".Jm1L'! '. / " ,/.1 / //i:>: /:;l 1/ ., ..~J' . ."... .'" ' {f-h ....' I""/,? ,.' / I .. " I'". '.""":-("' ~~~"-~.: {'//// - ./" / ".' .. v.... . '~'tN' ~_ii' l/' . Jeffrey D. Hollenbush,Supervisor Document Processing Unit Inheritance Tax Division C/1v &/\ STATUS REPORT UNDER RULE 6.12 Name of Decedent: Mo...r\DV\ :\. CXle.-V-C,.hUL~ Date of Death: 91 \ Ill-DD I Will No.: 2\- 0 \ - J09 3 Admin. No.: 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 0 No c;a 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: I "L/ ~ 'I D '3 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes 0 No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this repa . ,D Date: q / l-iJb~ d'/j / --I~fl M. GrDA.50n, iot, . Name ) -PO. 7301 38'S &r/1jjp If) 110/3 Address 7/7- 2il-jD3u Telephone No. Capacity: 0 Personal Representative NCounsel for personal representative Cumberland County - Register of Wills Hanover and High Streets Carlisle, PA 17013 Phone: (717) 240-6345 Date: 8/03/2004 PAULLOUISCHERCHUCK RE: Estate of CHERCHUCK MARION J File Number: 2001-1093 Dear sirIMadam: 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 AMMENDMENTS 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: 09/17/2004 Your prompt attention to this matter will be appreciated. Thank you. Sincerely, cc: File Personal Representative (s) Counsel Judge ~EV .'50~fX'16{{1>1 "'. *' REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT /0 Lo OFFICIAL USE ONLY ] C ~-S- I I FILE NUMBER 21 01 01093 COUNTY CODE YEAR NUMBER 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 Trust) o 1 D. Spousal Poverty Credit (date of death between 12-3H1~nd1-1-95) ,THI~.ll~CTION. MU,ST ElE COMP.~ETE!1.ALL COR,llESPOND~Ncefllo.c:ONFll>~~L Tj\J(JNFORM.,\TION Sfl09~D.ElEpIR~C!EPl.Q:, NAME COMPLETE MAILING ADDRESS LISA M. GREASON, ESQUIRE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT,280601 HARRISBURG.PA 17128-D601 ~ z w c w u w c DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) CHERCHUCK, MARION J DATE OF DEATH (MM.DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 09/1 7/200 I 10/3 0/1926 (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) w ~ :.::$(1) UZ~ w u z 0 u ~ ~ o 4. Limited Estate o o Original Return 6 Decedent Died Testate (Attach copy of Will) 9 Litigation Proceeds Received FIRM NAME (If applicable) GREASON LAW OFFICE TELEPHONE NUMBER 7171241,3030 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 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) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) SOCIAL SECURITY NUMBER 204-18,4199 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3 Remainder Retum (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11.Election to tax under Sec. 9113(A) (Attach Sch 0) 50 EAST HIGH STREET CARLISLE, PA 17013 (1) 106,384.00 OFFICIAL USE ONLY (2) 134,] 93.07 (3) None (4) None (5) 1,559.89 ~ (6) 30,822.84 (7) None (8) . 272,959.80 (9) 16,889.38 (10) (11) 16,889.38 256,070.42 (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) 256,070.42 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, x ,00 (15) or transfers under Sec. 9116(a)(1.2) z 256,070.42 .045 (16) 0 16. Amount of Line 14 taxable at lineal rate x ~ ~ ~ ~ 17.Amount of Line 14 taxable at sibling rate x .12 (17) ~ 0 u x 18. Amount of Line 14 taxable at collateral rate < x .15 (18) ~ 19. Tax Due (19) 1] ,523.17 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ] 1,523.17 .. ->>BESURE~TOANSWER Aii. CiIJESTIONS ON-REVERSE SIDE ANo'REcHEcK MATH '<<' .. -............. ......-....... ................_.. ....n......... .._..................... . Copyright 2000 form software only The Lackner Group, Inc. Form REV.1500 EX (Rev. 6.00) . DE)cedent's Complete Address: STREET ADDRESS 251 EAST POMFRET STREET CITY CARLISLE STATE PA 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 10,000.00 526.32 Total Credits (A + B + C) 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 TotallnterestlPenalty (0 + E) 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 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 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (1) 11,523.17 (2) 10,526.32 (3) 0.00 (4) (5) 996.85 (5A) (5B) 996.85 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?.. D ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without 0 101 receiving adequate consideration?. ~ o 181 o 181 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?. IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS 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 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 preparerhas any knowledge SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS PAlL llt::/'Z::zntluu;~ SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN . It , 356 BALTIMORE STREET CARLISLE, PA 17013 ADDRESS ADDRESS 50 EAST HIGH STREET CARLISLE, P A 17013 DATE / 1/;2i~ Z--- JI I; ,)/{tZ It ~~E 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 survivin9 spouse is 3% [72 P.S. 99116 (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. 59116 (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 stiff 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. 59116 (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. 59116 1.2) [72 PS 99116 (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. 59116 (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. '. SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CHERCHUCK, MARION J FILE NUMBER 21 - 01 - 01093 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 wimng 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 251 EAST POMFRET STREET, CARLISLE, PA 17013 NO. 03-2 I -0318-058 PARCEL VALUE AT DATE OF DEATH 73,050.00 255 EAST POMFRET STREET, CARLISLE, PA 17013 PARCEL NO. 03-21-03 1 8-067A 33,334.00 TOTAL (Also enter on Line 1, Recapitulation) 106,384.00 *' SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CHERCHUCK, MARION J FILE NUMBER 21 - 01 - 01093 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 18,880.38 LEGG MASON ACCOUNT # 360-02426 F ANESTOCK ACCOUNT # A25-0026869-B 15 20,384.85 2 COMMUNITY BANK INC 26 19,318.00 3 VARIOUS U.S. SAVINGS BONDS, SEE ATTACHED SHEET FOR DETAILS 75,609.84 TOTAL (Also enter on line 2, Recapitulation) 134,193.07 . Value As Of 106/2002 : ~jjJ!t1!~ 1 al:)c 1 Ul "'t Savinc ~=-J:l!ii~= CALCU. Bond Info Series Denomination Serial Number I EE Bonds -:1 $I 500 .:1 R esu Its # Bonds 132 Total Price $41,375.00 Total Interest $34,234.84 Total Value $75,609.84 Issue Interest Serial Number Issue Date Series Denom Price Interest Value Rate D2394411EE 05/1983 EE $500 $250.00 $544.80 $794.80 3.71% D2394410EE 05/1983 EE 500 250.00 544.80 794.80 3.71% . D2394409EE 05/1983 EE 500 250.00 544.80 794.80 3.71% - C61488915EE 12/1983 EE 100 50.00 102.20 152.20 4.07% C58045576EE 11/1983 EE 100 50.00 102.20 152.20 4.07% C58045637EE 11/1983 EE 100 50.00 102.20 152.20 4.07% - C58045697EE 12/1983 EE 100 50.00 102.20 152.20 4.07% - C57383173EE 10/1983 EE 100 50.00 105.40 155.40 4.56% - C45574321EE 09/1983 EE 100 50.00 105.40 155.40 4.56% C45574374EE 09/1983 EE 100 50.00 105.40 155.40 4.56% C57383115EE 10/1983 EE 100 50.00 105.40 155.40 4.56% C57383061EE 10/1983 EE 100 50.00 105.40 155.40 4.56% - Ll22975843EE 11/1983 ' EE 50 25.00 51.l0 76.10 4.07% - Ll22966649EE 09/1983 EE 50 25.00 52.70 77.70 4.56% C68323880EE 06/1984 EE 100 50.00 95.32 145.32 4.04% C68323653EE 04/1984 EE 100 50.00 99.08 149.08 4.19% C68076014EE 04/1984 EE 100 50.00 99.08 149.08 4.19% - C45574011EE 06/1983 EE 100 50.00 108.96 158.96 3.71% -- C45573559EE 06/1983 EE 100 50.00 108.96 158.96 3.71% C68323823EE 06/1984 EE 100 50.00 95.32 145.32 4.04% - 3.71% Ll22636546EE 05/1983 EE 50 25.00 54.48 ~ D2394405EE 04/1983 EE 500 250.00 570.80 820.80 '4.26% ~L R13025527EE 04/1983 EE 200 100.00 228.32 328.32 4.26% C34382100EE 04/1983 EE 100 50.00 114.16 164.JSi 4.26% C34382152EE 04/1983 EE 100 50.00 114.16 164.16 4.26% - C45573395EE 04/1983 EE 100 50.00 114.16 164.16 4.26% C45573452EE 05/1983 EE 100 50.00 108.96 !.i8...2.6 /3.71 % ",; C45573499EE 05/1983 EE 100 50.00 108.96 158.96 '3.71% '30) B (CC) CliC-I'CtlllC.!L 21-61 -16q3 , \ (I ,_-, ~._ ...., , /'... i __ 1'-...1",,07 Issue Date YTD 1m $198. Next Final Accrual Maturit: OS/2002 OS/20 I: OS/2002 OS/201: OS/2002 OS/20I: 06/2002 12/201: OS/2002 11/201: OS/2002 11/201: 06/2002 12/20 I: 04/2002 10/20 I: 03/2002 09/201: 03/2002 09/20 I: 04/2002 10/20 I: 04/2002 10/20 I: OS/2002 11/201: 03/2002 09/20 I: 06/2002 06/20 I' 04/2002 04/201' 04/2002 04/20 I' 06/2002 06/20 I: 06/2002 06/201: 06/2002 06/20 I' OS/2002 OS/20 I: 04/2002 04/201: 04/2002 04/20 I: 04/2002 04/20 I: 04/2002 04/201: 04/2002 04/201: OS/2002 OS/201: OS/2002 OS/20 I: C6432070EE 12/1980 EE 100 50.00 164.88 214.88~ 4.00% 06/2002 12/20 H - C6432022EE 12/1980 EE 100 50.00 164.88 ll4.8~/4.00% 06/2002 12/20H C6431978EE ] 1/1980 EE 100 50.00 164.88 214.88' '4.00% OS/2002 11/20 H C31575969EE 10/1981 EE 100 50.00 147.72 197.72 4.00% 04/2002 10/20 I C19089644EE 10/1981 EE 100 50.00 147.72 197.72 4.00% 04/2002 10/201 C19089595EE 10/1981 EE 100 50.00 147.72 197.72. 4.00% 04/2002 10/201 C31576080EE 11/1981 EE 100 50.00 147.72 197.724.00% OS/2002 11/201 C31576020EE 11/1981 EE 100 50.00 147.72 197.12,.4.00% OS/2002 11/201 - C19089539EE 09/1981 EE 100 50.00 147.72 197.72 4.00% 03/2002 09/201' C19089487EE 09/1981 EE 100 50.00 147.72 197.72 4.00% 03/2002 09/201' C58045762EE 05/1984 EE 100 50.00 95.32 145.32 4.04% OS/2002 OS/201' C68323756EE 05/1984 EE 100 50.00 95.32 145.32 ". 4.04% OS/2002 OS/201' ~ Ll23006622EE 05/1984 EE 50 25.00 47.66 72.66. 4.04% OS/2002 OS/201' _'"",..~";,,,,,,,,.,. C31576665EE 05/1982 EE 100 50.00 143.84 193.84'4.00% OS/2002 OS/201: .........- C31576717EE 05/1982 EE 100 50.00 143.84 193.84.4.00% OS/2002 OS/201; - C31576763EE 05/1982 EE 100 50.00 143.84 193.844.00% OS/2002 OS/201: L88676183EE 05/1982 EE --e:~-;C'l._B!::: 50 25.00 71.92 96.92 ..4.00% OS/2002 OS/201; ~, ..~ C31576866EE 06/1982 EE 100 50.00 143.84 !J}.ll.i.' 4.00% 06/2002 06/201; C31576556EE 04/1982 EE 100 50.00 143.84 193.84 4.00% 04/2002 04/201; ------ C31576616EE 04/1982 EE 100 50.00 143.84 193.84 4.00% 04/2002 04/201; ,-~.,---,-- C34381373EE 09/1982 EE 100 50.00 140.04 190.04 4.00% 03/2002 09/201: C34381471EE 10/1982 EE 100 50.00 140.04 190.04 4.00% 04/2002 10/201: C34381513EE 10/1982 EE 100 50.00 140.04 190.04 4.00% 04/2002 10/201; --- C34381564EE 10/1982 EE 100 50.00 140.04 1 '2!l..CW.. 4.00% 04/2002 10/201: ..,. , 06/2002 06/201: C31576820EE 06/1982 EE 100 50.00 143.84 193 84". 4.00% C34381417EE 09/1982 EE 100 50.00 140.04 190.04 4.00% 03/2002 09/201: C31576191EE 12/1981 EE 100 50.00 147.72 197.72 '4.00% 06/2002 12/201 -......,..,.....:~"." C31576]28EE 12/198] EE 100 50.00 147.72 t27.J2~ 4.00% 06/2002 12/201 L59079861EE 09/1981 EE 50 25.00 73.86 98.86 4.00% 03/2002 09/201 L45261083EE 05/198 ] EE 50 25.00 75.84 100.84.,/4.00% OS/2002 OS/201 - ~.... Ll0267783EE 09/1980 EE 50 25.00 92.20 11 7.20 4.00% 03/2002 09/20H L9497101EE 05/1980 EE 50 25.00 94.56 119.56>4.00% OS/2002 OS/20H ~~_-:.~~ "" L59240765EE 11/1981 EE 50 25.00 73.86 J8:8Q 4.00% OS/2002 11/201 LlI0038361EE 09/1982 EE 50 25.00 70.02 95.02 4.00% 03/2002 09/201: Ll16926006EE 11/1982 EE 50 25.00 63.92 88.92.. 6.00% OS/2002 11/201; C34381756EE 12/1982 EE 100 50.00 127.84 177.84. '6.00% 06/2002 12/201: ...~-- C34381707EE 12/1982 EE 100 50.00 127.84 177.84./6.00% 06/2002 12/201; . OS/2002 11/201: C34381610EE 11/1982 EE 100 50.00 127.84 177.84>/' 6.00% .'-1 Suh fl:, Cb) C het~dl dLtL L/-C)I - 1095 c' . I, ." /' .,. ./'1-(;; ) ~-o"" ~ ......... , C34381663EE 11/1982 EE 100 50.00 127.84 177.84 .6.00% OS/2002 111201: -- D36118256EE 10/1992 EE 500 250.00 ]75.80 425.80 6.00% 04/2002 10/202: - D36118257EE 10/1992 EE 500 250.00 175.80 425.80 6.00% 04/2002 10/202: . C383869303EE 10/1992 EE 100 50.00 35.16 85.16 6.00% 04/2002 10/202: C383869302EE 10/1992 EE 100 50.00 35.]6 85.16 6.00% 04/2002 10/202: -- M53410195EE 10/1992 EE ],000 500.00 351.60 851.60 6.00% 04/2002 10/202: . M53410196EE 10/1992 EE 1,000 500.00 351.60 851.60 6.00% 04/2002 10/202: ~ K108118533E 06/1975 E 75 56.25 291.51 347.76 4.00% 06/2002 06/200: KI08118568E 05/1975 E 75 56.25 290.67 .;146.92 4.00% OS/2002 OS/200: Q5202987145E 06/1975 E 25 ]8.75 97.17 115.92 4.00% 06/2002 06/200: Q6004531953E Ill] 975 E 25 18.75 96.01 114.76 4.00% OS/2002 IlI200: -....,.."".-.., Q6072634099E 04/1976 E 25 18.75 94.01 ] 12.76 4.00% 04/2002 04/200( ~~ T_ Q6021846623E 12/1975 E 25 18.75 96.26 ] ]5.01 4.00% 06/2002 ]2/200: --- Q6376885763E 10/1979 E 25 18.75 61.08 7~83 4.00% 04/2002 ] 0/200' Q6367134807E 09/] 979 E 25 18.75 61.08 79.83 4.00% 03/2002 09/200' Q6343425935E 05/] 979 E 25 18.75 62.49 81.24 4.00% OS/2002 OS/200' ""'-..----"" Q6274398457E 04/1979 E 25 18.75 61.71 80.46 4.00% 04/2002 04/200' ~ ~ Q6]25694387E ] 111976 E 25 ]8.75 94.]7 ] ]2.92 4.00% OS/2002 ] 11200( -"" - Q6103301370E 09/]976 E 25 ]8.75 93.08 ] ] 1.83 4.00% 03/2002 09/200( Q6079900859E 06/1976 E 25 18.75 95.34 1l4.09 4.00% 06/2002 06/200( ",,,,,,,'-'.;.0;',",",,,;,.,,,- Q60727020] 7E 06/1976 E 25 ]8.75 95.34 114.09 4.00% 06/2002 06/200( " Q6194449873E 09/1977 E 25 18.75 89.25 108.00 6.00% 03/2002 09/200' Q6]59050477E 04/1977 E 25 18.75 91.19 109.94 6.00% 04/2002 04/200' M534]0]9IEE 1011992 EE 1,000 500.00 351.60 851.60 6.00% 04/2002 10/202: ~-- M5341O]92EE 1011992 EE 1,000 500.00 351.60 851.60 6.00% 04/2002 ] 0/202: ~" M5341 0] 93EE 10/1992 EE ],000 500.00 351.60 ~1.6.Q. 6.00% 04/2002 ] 0/202: M53410194EE 1011992 EE ],000 500.00 351.60 851.60 6.00% 04/2002 10/202: ....., __,c,..", M53410]89EE ] 0/1992 EE 1,000 500.00 351.60 851.60 6.00% 04/2002 10/202: -'"..,,~- M53410190EE 10/1992 EE 1,000 500.00 351.60 851.60 6.00% 04/2002 10/202: -.. M52782315EE 09/1992 EE 1,000 500.00 351.60 851.60 6.00% 03/2002 09/202: M52782312EE 09/1992 EE 1,000 500.00 351.60 851.60 6.00% 03/2002 09/202: M527823 I I EE 09/1992 EE 1,000 500.00 351.60 851.60 6.00% 03/2002 09/202: M527823] OEE 09/1992 EE 1,000 500.00 351.60 851.60 6.00% 03/2002 09/202: M52782314EE 0911992 EE 1,000 500.00 351.60 851.60 6.00% 03/2002 09/202: M52782313EE 09/] 992 EE 1,000 500.00 351.60 851.60 6.00% 03/2002 09/202: M53410188EE 10/1992 EE ],000 500.00 351.60 851.60 6.00% 04/2002 ] 0/202: M534 10 187EE 10/1992 EE 1,000 500.00 351.60 851.60 6.00% 04/2002 10/202: - V3264504EE 10/1992 EE 5,000 2,500.00 ],758.004,258.00 6.00% 04/2002 ] 0/202: ~ .... ,,~ !?:) (c"'r C \ilucrlLtVL 21'01-,.]0'13 ~.- < " (f' \ r' ;., ~ .- .. , r,', I~. 'J V3264503EE ] 011 992 EE 5,000 2,500.00 1,758.00 4,258.00 6.00% 04/2002 10/202: - V4419190EE 05/1993 EE 5,000 2,500.00 1,308.00 t808.00 .3.75% OS/2002 OS/202: V4419189EE 0511 993 EE 5,000 2,500.00 1,308.00 ~,80!LQ.Q., 3.75% OS/2002 OS/202: M59308636EE 0611 993 EE 1,000 500.00 261.60 761.60 '3.75% 06/2002 06/202: - M59308637EE 06/1993 EE 1,000 500.00 261.60 761.60 3.75% 06/2002 06/202: - M58441575EE 05/1993 EE 1,000 500.00 261.60 761.60 3.75% OS/2002 OS/202: M5844] 574EE 05/1993 EE 1.000 500.00 261.60 761.6Q. '3.75% OS/2002 OS/202: M5844]573EE 05/1993 EE 1,000 500.00 261.60 761.60. 3.75% OS/2002 OS/202: M58441572EE 05/1993 EE 1,000 500.00 261.60 761.60 3.75% OS/2002 OS/202: - M58441577EE 05/1993 EE 1,000 500.00 261.60 761.60 3.75% OS/2002 OS/202: - M5844] 576EE 0511 993 EE 1,000 500.00 261.60 761.60 -3.75% OS/2002 OS/202: M58441569EE 0511 993 EE 1,000 500.00 261.60 761.60 3.75% OS/2002 OS/202: -- M58441568EE 05/1993 EE ],000 500.00 261.60 761.60 3.75% OS/2002 OS/202: --. M57377825EE 02/] 993 EE 1,000 500.00 351.60 851.60 6.00% 08/2002 02/202: M57377824EE 0211 993 EE 1,000 500.00 351.60 851.60 6.00% 08/2002 02/202: M58441571EE 05/1993 EE 1,000 500.00 261.60 761.60 3.75% OS/2002 OS/202: -".~"",,-- M58441570EE 0511 993 EE 1,000 500.00 261.60 761.60 3.75% OS/2002 OS/202: """'---;;-~ M57377821EE 0211 993 EE 1,000 500.00 351.60 851.60 6.00% 08/2002 02/202: M57377820EE 0211 993 EE 1,000 500.00 351.60 851.60 6.00% 08/2002 02/202: M57377819EE 02/1993 EE 1,000 500.00 351.60 851.60 6.00% 08/2002 02/202: M57377818EE 02/1993 EE 1,000 500.00 351.60 851.60 6.00% 08/2002 02/202: M57377823EE 02/1993 EE 1,000 500.00 351.60 851.60 6.00% 08/2002 02/202: M57377822EE 0211 993 EE 1,000 500.00 351.60 851.60 6.00% 08/2002 02/202: V3168752EE 0911 992 EE 5,000 2,500.00 1,758.00 4,258.00 6.00% 03/2002 09/202: V4884752EE 04/]994 EE 5,000 2,500.00 1,140.001,.640.00 4.27% 04/2002 04/202' - V4884753EE 0411 994 EE 5,000 2,500.00 1,140.00 1..~~0.00_ 4.27% 04/2002 04/202' M52782317EE 0911 992 EE 1,000 500.00 351.60 851.60 6.00% 03/2002 09/202: M52782316EE 09/1992 EE 1,000 500.00 351.60 851.60 6.00% 03/2002 09/202: "Y~e~lO_1 Viewing Bonds 1-132 Le end Note Description NT Not Issued NE Not Eligible for Payment P5 Includes 3-month interest penalty ME Matured (Exchangeable for HH) MN Matured (Not Exchangeable for HH) 1jum /cjJ C\'Kx (\\cv.: iL L I . C I. 0 I c"i 3 '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CHERCHUCK, MARION J ! FILE NUMBER 21 - 01 - 01093 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 NUMBER 1 DESCRIPTION VALUE AT DATE OF DEATH 2 MEMBERS FIRST FEDERAL CREDIT UNION SAVINGS ACCOUNT, # 186426 59.89 3 HOUSEHOLD GOODS, MISCELLANEOUS ITEMS 1,500.00 TOTAL (Also enter on Line 5, Recapitulation) 1,559.89 . '*' SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CHERCHUCK, MARION J . FILE NUMBER I 21-01-0]093 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 MICHAEL A. CHERCHUCK 251 EAST POMFRET STREET CARLISLE, PA 17013 SON JOINTLY OWNED PROPERTY: ITEM LETTER NUMBER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY Include name of financial institution and bank account number or similar identifying number. Attach deed for jointly-held real estate. , , Yo OF DATE OF DEATH ! DATE OF DEATH ~ D~CD'S VALUE OF VALUE OF ASSET INTEREST! DECEDENT'S INTEREST A JOINT CHECKING ACCOUNT AT COMMERCE BANK, ACCT # 05130036160 3,275.41 ' 100% 3,275.4 ] A JOINT SAVINGS ACCOUNT AT COMMERCE BANK, ACCT # 0616087394 I 27,547.43 100% 27,547.43 TOTAL (Also enter on line 6, Recapitulation) 30,822,84 - . SCHEDU.E H RJNERAL. EXPENSES & AIlIIIINSTRATlVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CHERCHUCK, MARION J , FILE NUMBER 21 - 01 - 01093 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT FUNERAL EXPENSES: FUNERAL EXPENSES FROM EWING BROTHERS FUNERAL HOME 6,000.00 2 RECEPTION AT ALLENBERRY 844.00 3 ST. PETER AND PAUL'S CHURCH, ST. CLAIR, PA 1,075.00 4 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City Year(s) Commission paid Attorney's Fees GREASON LAW OFFICE - LISA M. GREASON, State Zip 2. 5,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip 4. Probate Fees CUMBERLAND CO. REGISTER OF WILLS 323.00 5. Accountant's Fees 6 Tax Return Preparer's Fees 7. I Other Administrative Costs ADVERTISING FEES (THE SENTINEL AND THE CUMBERLAND COUNTY LEGAL JOURNAL 165.59 2 HOUSEHOLD EXPENSES 1,960.79 Total of Continuation Schedule(s) 1,521.00 TOTAL (Also enter on line 9, Recapitulation) 16,889.38 *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CHERCHUCK, MARlON J 3 SALE OF PROPERTY FEES - Schedule H Funeral Expenses & Administrative Costs continued FILE NUMBER I 21 - 01 - 01093 1,521.00 Page 2 of Schedule H RE't-1513 EX+ (9.0.0) '* SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CHERCHUCK, MARION J i FILE NUMBER 21 - 01 - 01093 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do. Not l.ist Truslee(s) AMOUNT OR SHARE OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) Janet Cherchuck, P.O. Box 566, Gordonsville, V A 22942 , Daughter one-sixth 2 Paul Cherchuck, 356 E. Baltimore Street, Carlisle, PA 17013 Son :one-sixth 3 Thomas Cherchuck, 8528 Rosedale Drive, Oak Ridge, NC 27310 Son 'One-sixth 4 Michael Cherchuck, 434 Mill Race Road, Carlisle, PA 17013 I Son one-sixth 5 Irene Cherchuck, 825 B Chestnut Ridge Road, Chestnut Ridge, NY 10977 i Daughter one-sixth 6 Mary Ellen Wunder, 256 Mt. Salem Road, Wantage, NJ 07461-3602 Daughter one-sixth Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, 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 - REV.1500U+16.{)01 w ~ lI:::~cn U~~ W U % 0 U ~ m . *' //' / ,/- / REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT 1&1 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 Trust) D 10, Spousal Poverty Credit (date of death between 12-31-.91 and 1-1~95) !THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME ",-, ,---"" '----, "" -----" ".,' --------" '-- ,------" ,,------ "" ,,----- "'" TCOMPLETE-MAILINCiADO-R-ES-S '_____m__' ---- LISA M. GREASON, ESQUIRE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT, 280601 HARRISBURG. PA 17128-0601 ~ z w o w U w o DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) CHERCHUCK, MARION J DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 09117/2001 I 10/3011926 (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) D 1 Original Return D D D 4. Limited Estate 6 Decedent Died Testate (Attach copy o/Will) 9. Litigation Proceeds Received FIRM NAME (If applicable) GREASON LAW OFFICE TELEPHONE NUMBER 717/241-3030 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) z o ~ :\ ~ ~ ~ < U W ~ 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) NUMBER 21 01 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 01093 NUMBER 204-18-4199 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3, Remainder Return (date of death prior to 12-13-82) D 5 Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 11.Election to tax under Sec. 9113(A) (Attach Sch 0) POST OFFICE BOX 385 CARLISLE, PA 17013 (1) None (2) None (3) None (4) None (5) 4,000.00 (6) None (7) None (8) 4,000.00 (9) 8,351.66 (10) (11) 8,351.66 (12) -4,351.66 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) -4,351.66 SEE INSTRUCTIONS ON REVERSE SlOE FOR APPLICABLE RATES -195.82 20. ~ CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT -195.82 >> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH << Copyright 2000 form software only The Lackner Group, Inc. 15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) z -4,351.66 .045 (16) 0 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) Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 251 E. PomlTet Street CITY Carlisle ! STATE PA IZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) -195.82 3. Interest/Penalty jf applicable D. Interest E. Penalty Total Credits (A + 8 + C) (2) 0.00 Total InteresUPenally (0 + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 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. (5) A. Enter the interest on the tax due. (5A) 8. Enter the total of Line 5 + 5A. This is the 8ALANCE DUE. (58) 0.00 195.82 0.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No 8. retain the use or income of the property transferred; ...................... ~ I 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?. 0 f:8J 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.. 0 f:8J 4. Did decedent own an Individual Retirement Account, annuity, or other non.probate property which contains a beneficiary designation? .................... ........................... ............,...................................... ... ....... ..... 0 ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Make Check Payable 10: REGISTER OF WILLS, AGENT Under penalties of pe~ury, 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. Oeclaration of preparer other than the personal representallve IS based on all In formation of which preparer has any knowledge SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN AODRESS P'UI~~t' tku4~ SiGNATt;~ OF RSON RESPONSIBLE FOR FILING RETURN DATE 356 East Baltimore Street Carlisle, PA 17013 /J111h3 DATE ADDRESS ADDRESS DATE 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. 99116 (a) (1.1) (in. 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. 99116 (a) (1.1) (iin. 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 ar for the use of a natural parent, an adaptive parent, or a stepparent of the child is 0% [72 P.S. 99116 (a) (1.2n. 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. 99116 1.2) [72 P.S. ~9116 (a) (1)] The tax rate impased on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116 (a) (1.3)J. 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 PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CHERCHUCK, MARION] FILE NUMBER 21 - 01 - 01093 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 NUMBER DESCRIPTION VALUE AT DATE OF DEATH 4,000.00 1993 OLDSMOBILE Model: Ciera sedan VIN: IG3AG55N2P6351646 TOTAL (Also enter on Line 5, Recapitulation) 4,000.00 - . *' SCHEDUL.EH FUNERAL EXPENSES & AD\IIINIS1RA11VE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CHERCHUCK, MARION J I FILE NUMBER 21 - 01 - 01093 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION AMOUNT B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Paul J. Cherchuck Social Security Number(s) I EIN Number of Personal Representative(s): 208-38-5295 Street Address Carlisle 356 East Baltimore Street 2. City Year(s) Commission paid 2003 Attorney's Fees Greason Law Office - Lisa M. Greason, Esquire PA Zip 17013 State 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees KerI)' Spangler, CPA 7. I Other Administrative Costs Property Tax for vacant lot at 225 East Pomfret Street, Carlisle, P A 17013 Parcel No. 03-21-0318-067 A TOTAL (Also enter on line 9, Recapitulation) 5,500.00 1,500.00 365.00 986.66 8,351.66 Cumberland County- Register of Wills Hanover and High Streets Carlisle, PA 17013 Phone: (717) 240-6345 Date: 8/03/2004 PAUL LOUIS CHERCHUCK RE: Estate of CHERCHUCK MARION J File Number: 2001-1093 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 AMMENDMENTS 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: 09/17/2004 Your prompt attention to this matter will be appreciated. Thank you. Sincerely, CC: File Personal Representative (s) Counsel Judge STATUS REPORT UNYDER RULE 6.12 Name of Decedent: Date of Death: Will No.. Admin. No.: Pursuant to Rule 6.12 of the Supreme Comet Orphans' Cou~ 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: 2. If the answer is No, state when the personal represTntative r, easonably believes that the administration will be complete: } 2. ]~1 !Oc/ o If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No ~'] 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 ['--] Date: ~5~G¥,9/Oc] Copies of receipts, releases, j oinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attache~ _ · L/ Name Address -n ~ '~ - Z ~ / -3o3o Telephone No. Capacity: ['-1 Personal RepresepXative ,~[~Counsel for personal representative FAMILY SETTLEMENT AND FINAL RELEASE ESTATE OF MARION J. CHERCHUCK 02~/-~/-/~@$ KNOW ALL PERSONS BY THESE PRESENTS, that Marion J. Cherchuck, late of Carlisle, Cumberland County, Pennsylvania, deceased, died testate on September 17, 2001, having first made her Last Will and Testament, which was duly executed on January 5, 1982 and probated in the Office of the Register of Wills of Cumberland County, on November 30, 2001. WHEREAS, the said Marion J. Cherchuck, by the aforesaid Last Will and Testament, named Paul Louis Cherchuck as Executor of said Last Will and Testament; WHEREAS, Letters Testamentary on the Estate of the said decedent were duly issued by the Register of Wills of Cumberland County, Pennsylvania, to the said Executor, hereinafter called personal representative; WHEREAS, the personal representative has gathered the assets of the Estate of the said decedent and the assets consist of personal and real property with the gross total value of $272,959.80 as set forth in the Pennsylvania Inheritance Tax Assessment Summary and Supplement approved by said personal representative and the Pennsylvania Department of Revenue, and which is attached hereto and made a part hereof, and marked Exhibit "A" and Exhibit "B"; WHEREAS, the debts and deductions, including the payment of inheritance tax in the said Estate, which have now been paid, leave a balance for distribution of $238,619.01, as set forth Exhibit "C" and Exhibit "D"; WHEREAS, the balance for distribution as shown in the ~id stat~nent .ma~ked Exhibit "C" and Exhibit "D" have been distributed or will be distributed in ¢~sh or::in~kind as herein indicated in accordance with the terms of the Last Will~ and Tes. tameni of the said Decedent; ._~:~ NOW, THEREFORE, Janet Cherchuck, Paul Louis Chercl~t~k Themas Cherchuck, Michael Cherchuck, Irene Cherchuck and Mary Ellen Wunder being all of the heirs under the Last Will and Testament of the said decedent, and being those persons entitled to inherit under said Last Will and Testament, do hereby each of us acknowledge that we have this day had and received from the aforesaid personal representative, in full satisfaction and payment of all sums of money, legacies, bequests, and devises as are given, devised and bequeathed to each of us respectively by the said Last Will and Testament, the amounts due us under said Last Will and Testament, which amounts we have received this day or prior to this day; and, each of us do hereby stipulate that in order to avoid the expense and time involved in the filing of a formal account and schedule of distribution, we each agree that no account is necessary and we do hereby agree that we do consent to distribution being made without the filing of an account and schedule of distribution, the same to be with the same force and effect as if they had been filed and confirmed by the Orphan's Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania. THEREFORE, we and each of us, do hereby remise, release, quitclaim and forever discharge the said personal representative, Paul Louis Cherchuck, his heirs, executors, administrators and assigned, of and from the said estate and from all actions, suits, payments, accounts, reckonings, claims, and demands whatsoever for or by reason thereof, or for any other use, matter, cause or thing whatsoever, touching upon the Estate of the said decedent, and each of us do further hereby covenant and agree that should any liability come due to the estate of the said decedent after the signing of this Agreement, we and each of us do hereby covenant and agree with each other and the aforesaid personal representative, that we will contribute pro-rata our share of the Estate to satisfy any and all claims, demands, suits or causes of action which may be successfully prosecuted against the said Estate or the aforesaid personal representative after the signing, sealing and delivery of this Family Settlement Agreement and Final Release. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. ZSOEO l, HARRISBURG, PA COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP <, LISA M GREASON ESQ GREASON LAW OFFICE 50 E HIGH ST CARLISLE DATE O~ :J-2003 ESTATE OF CH CHUCK DATE OF DEATH 09 ? 2001 FILE NUMBER COUNTY ACN 2] 2L-1093 CU:'I][LRLAND 10~ MARION J l Amou~ f Remitted PA 17013-1410 MAKE CHECK PAYABi ~ AND REMIT PAYMENT T©: REGISTER OF iS CUMBERLAND C ~]URT HOUSE CARLISLE, FA 7013 CUT ALONG THIS LINE ~- RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-IS47 EX AFP (01-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF CHERCHUCK MARION J FILE NO. 2i 0i-i095 ACN ID1 DATE 01-06-2005 TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule AD 2 Stocks and Bonds (Schedule B) $ Closely Held Stock/Partnership Interest (Schedule C) Mortgages/Notes Receivable (Schedule D) 5 Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6 Jointly Owned Property (Schedule P) 7 Transfers (Schedule G) 8 Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) iO. Debts/Mortgage Liabiiities/Liens (Schedule I) Il. Total Deductions 12. Net Value of Tax Return ( ) CHAN.' (2) 15q ~ 93.07 ($) .00 (4) .00 (5) 1, bb~. 89 (6) 30,822.84 c?) .00 (8) 16; F..- ~ 38 (9) (~o) . OD NOTE: To insure ~roper credit to your ~ccount, submit the uppe~ portion of this form w~!F~ your tax payment. 272,959.30 16.889.3~ 256,070.42 15. 14. NOTE: reflect figures that include the total of ALL returns ass~>~sed to date. ASSESSMENT OF TAX: Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) C15) . O0 Net Value of Estate Subject to Tax (14) 256,070.q2 If an assessment was issued pre¥ious!~/, lines 1~,, 15 and/?- !6~ 17, 18 and 19 12-17-2001 11-1~-2002 DATE 19. Princi TAX CREDITS PAYMENT .~n O0 nO 256,070,,',.? x 045= 11,525.~? , O0 x 12 = . . OD x 15 = . O0 (~): 11,523. 17 RECEIPT NUMBER CD000648 CD001854 DISCOUNT (+) INTEREST/PEN PAID (-) 526.52 .00 ] AMOUNT PAir" / lO,:)[]~.O0 ) ? 6 . 85 BALANCE OF UNPAID INTEREST/PENALTY AS OF ii-i4-2002 TOTAL TAX CREDIT I i1,52S.17'~ * IF PAID AFTER DATE INDICATED, SEE REV( )UE IS LESS THAN $1. NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST iUE IS REFLECTED AS n "CREDIT" (CR), YOU MAY BF. DUE 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) >al Tax Due DEPT. 'ZSOGG1 HARRISBUR~ PA 171~B-0601 COHMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX LISA M GREASON ESQ GREASON LAW OFFICE 50 E HIGH ST CARLISLE PA 17015 DATE 01 ..i-200~ ESTATE OF CH~ ?CHUCK DATE OF DEATH 09-~/-2001 FILE NUMBER 21 ~1-1095 COUNTY CUMBERLAND ACN ] 3 · AMD'.,: Remitted MARION J MAKE CHECK PAYA~:] AND REMIT PAYMENT REGISTER OF :4~LLS CUMBERLAND CO COURT HOUSE CARLISLE, PA i7013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT ~F 'TAX ESTATE OF CHERCHUCK MARION J FILE NO. 21 01-109S AC? i01 DATE 01-19- ;00fi TAX RETURN WAS: I X ) ACCEPTED AS FILED ( ) CHAN(;Fi~ RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRATSED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN 1. Real Estate (Schedule A) 2, Stocks and Bonds (Schedule B) (2) 5. Closely Held Stock/Partnership Interest (Schedule C) (3) ~. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) ($) &. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Hisc. Expenses (Schedule H) 10. Debts/Hortgage Liabilities/Liens (Schedule I) (10) 11. Total Deductions 12. Net Value of Tax Return NO. 01 .00 O0 O0 O0 q!;O0 O0 O0 O0 8:551.66 (8) .00 NOTE: To insure proper credit ~o your ~ccount, submit the upp~, portio~ of this form wJ~h your tax payment. 15. NOTE: ASSESSMENT OF TAX: lB. Amount of Line 16 at Spousal rate 16. Amount of Line Iff taxable at Lineal/Class A rate 17. Amount of Line lfi at SibIing rate 18. Amount of Line l~ taxable at Collaterai/Class B rate 19. Princi TAX CREDITS PAYMENT DATE 12-17-2001 11-13-2002 01-10-2005 q,O00,O0 (11) (12) ~,351 66- Charitable/Governmental Bequests; Non-elected 9115 Trusts iSchedule .: (15) Net Value of Estate Subject to Tax ~ an assessment ~as issued previously~ [~nes 1~, 15 an~? 16, 17, reflect ~igures that include the total of ALL returns assmssed to Oate. DISCOUNT {+) INTEREST/PEN PAID (-) 0O 251,718.76 ~al Tax Due RECEIP3 NUMBER and 19 will IlS) .00 x O0 = .00 (16) 251,718.76 x Oq5= 11,~27,35 (17) ·O0 x 12 = .00 (i8) ,00 x 15 = .O0 119)= 11,327.35 CDOOO6fi8 CDOO185q CDOOZO32 526.$2 19.57- .00 AMOUNT PAiD iOiO00.O0 996~85 53.68 IF PAID AFTER DATE INDICATED, SEE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX C~EDIT [ 11,557.28 ~N--~S~ ~ 'P~N. .00 TOTAL DUE I 209. s, scR REVE UE IS LESS THAN $~, NO PAYMENT IS REQUIRED. ~UE TS REFLECTED AS A "CREDIT" {CR):. YOU HAY BE DUE A ~FFIIND_ gFF ~FVFRgF gTDF GF 'tHIS FORH FOR INSTRUCTIONS. ) ASSETS: 1 2 3 4 5 6 7 8 9 10 11 12 251 E. Pomfret St, Carlisle (home) 255 E Pomfret St, Carlisle (Lot) Legg Mason Accout #360-02426 Fanestock Account # A25-0026869-B15 Community Bank Stock Various U.S. Savings Bonds Members 1st Federal Credit Union Household Goods, misc. items Jt Checking Acct at Commerce Bank Jt Savings Acct at Commerce Bank 1993 Oldsmobile Ciera Refund from Inheritance Tax TOTAL ASSETS EXPENSES 1 2 3 4 5 6 8 9 10 11 12 13 Ewing Brothers Funeral Home Allenberry- Reception St. Peter & Paul's Church, St. Clair Executor's fee Attorney's Fee Cumberland Co. Register of Wills/Probate Other Administrative Costs Accountant's fee Property Tax for lot Household expenses Sale of Property Expenses Inheritance Taxes Market Loss TOTAL DEBTS: $ 73,050.00 $ 33,334.OO $ 18,880.38 $ 2O,384.85 $ 19,318.00 $ 75,609.84 $ 59.89 $ 1,5OO.OO $ 3,275.41 $ 27,547.43 $ 4,OOO.OO $ 209.93 $ 277,169.73 $ 6,000.00 $ 844.OO $ 1,075.00 $ 5,5OO.OO $ 6,500.00 $ 323.00 $ 165.59 $ 365.00 $ 986.66 $ 1,960.79 $ 1,521.00 $ 11,523.17 $ 1,786.51 $ 38,550.72 NET ASSETS FOR DISTRIBUTION: $ 238,619.01 div. By 6 $ 39,769.83 Janet Cherchuck Cash: In Kind: a. b. C. TOTAL: 39,769.83 Paul L. Cherchuck Cash: In Kind: a. Community Bank 443 shares @ $27.30 b. TOTAL: $ $ 27,O79.8O 12,690.03 Thomas Cherchuck Cash: In Kind: a. Real Estate Lot on Pomfret St b. Car TOTAL: $ $ 6,435.83 33,334.OO Michael Cherchuck Cash: $ In Kind: a. 251 E. Pomfret St $ b. Community Bank $ 300 sh. @ @27.30 c. 1993 Oldsmobile $ TOTAL: 3,579.83 24,000.00 8,190.00 4,000.00 Irene Cherchuck Cash: In Kind: a. mutual fund b. C. TOTAL: $ 13,343.83 $ 26,426.OO Mary Ellen Wunder Cash: In Kind: a. b. C. TOTAL: $ 39,769.83 TOTAL DISTRIBUTION: $ 238,618.98 39,769.83 39,769.83 39,769.83 39,769.83 39,769.83 39,769.83 238,618.98 IN WITNESS WHEREOF, we have hereunto set our hands and seals the day and year noted below. Date PAUL LOUIS CHERCHUCK STATE/COMMONWEALTH OF COUNTY OF SS. ON THIS, the ~' day of .~-'~/Zz.cm,,~,,~I- , 2003, before me the undersigned officer, personally appears PAUL LOUIS CH.~RCHUCK, known to me (or satisfactorily proven) to be the person whose name ~s subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. WITNESS my hand and seal the day and year aforesaid. Notariaj Seal Lisa M. Greason, Notan/Public Cadisfe Bom, Cumr~er~and County MY Commission Expires Sept. 9, 2006 IN WITNESS WHEREOF, we have hereunto set our hands and seals the day and year noted below. Date Witness THOMAS CHERCHUCK STATE/COMMONWEALTH OF COUNTY OF SS. ON THIS, the day of ,-~rO.,,. , 20 before me the undersigned officer, personally appears THOMAS CHERCHUCK, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. WITNESS my hand and seal the day and year aforesaid. N/ry Public - IN WITNESS WHEREOF, we have hereunto set our hands and seals the day and year noted below. Date hR'i~ness r '~ ~'~RENE CHERCHUCK STATE/COMMONWEALTH OF /f/f'/'~? /~,~,~ COUNTY OF ,I~OC~ Iq,,d SS. CAROL ROSENBER(~ No~ary Public, Stste of ~ew York No. 01RO5053992 Qua!if.:'~ ~ Rockland Count~__ Com~issica E:~piz-e~ Jan. 2, 2~ ON THIS, the 1i day of ~ , 200~, before me the undersigned officer, personally appears IRENE CHERCHUCK, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. WITNESS my hand and seal the day and year aforesaid. otary Public'- IN WITNESS WHEREOF, we have hereunto set our hands and seals the day and year noted below. Date JANET CHERCHUCK ~/COMMONWEALTH OF ~C~ CO~"~ O" ~~~1; SS. ON THIS, the ~ day of ~ , 200~, before me the undersigned officer, personally appears JAr~I~T CHERCHUCK, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. WITNESS my hand and~.]~ieNol~day a~d ye, ar aforesaid. IN WITNESS WHEREOF, we have hereunto set our hands and seals the day and year noted below. Date Witness MICHAEL C~--I'E RC H I]C-K"' "'- ~'- STATE/COMMONWEALTH OF COUNTY OF SS. ON THIS, the /~n/ day of /'~¢'5~J'/ , 2003~ before me the undersigned officer, personally appears MICHAEL CHERCHUCK, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. WITNESS my hand and seal the day and year aforesaid. COMMONWEALTH OF PENNSYLVANIA James H. IVIcKee, Nolary Public I M~ll~m¢, Peft~vanle ASSOCialJ~l Of Notaries I~-~ry Pub~'c ' IN WITNESS WHEREOF, we have hereunto set our hands and seals the day and year noted below. Date Witness MARY ELLEN WUNDER STATE/COMMONWEALTH OF ~'~x~~:. COUNTY OF ~ SS. ON THIS, the ~0 day of R~-g,~42~y L:~'LLEN , 200~, before me the undersigned officer, personally appears MA WUNDER, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same for the purposes therein contained. WITNESS my hand and seal the day and year aforesaid. ..."" . Register of Wills of Cumberland County Name of Decedent: STATUS REPORT UNDER RULE 6.12 {'(\Qrtov\ j. C\\(({('cX\ucl Date of Death: q / Il /01 Estate No.: 'Z \ - () 1- 6/ DCI 3 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 l5a No 0 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? YesD NoJ8J 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 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be Date: ~attached to llUsreport". /~I { I AS~ L\1 <.'-':,Yed.'x!I1} f~ Name ) 7() ~O}L 3g':S) larliS/P flJ rlQ/3 Address J/l- 211 I -3030 Telephone No. 0" ,-, 'I I .;:J ~CJ .;~] _0; 0(, Capacity: 0 Personal Representative ~ Counsel for personal representative I G . 00 Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 8/30/2005 GREASON LISA M ESQUIRE POBOX 385 CARLISLE" PA 17013 RE: Estate of CHERCHUCK MARION J File Number: 2001-01093 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 9/17/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~~~ GLENDA FARNER STP~SBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge eQ