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HomeMy WebLinkAbout03-1058PETITION FOR PROBATE and GRANT OF LETTERS Estate of CARMEN J. HEMPT No. also known as To: Register of Wills for the Deceased. County of Cumberland in the Social Security No. 177-26-727~) Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/at~ 18 years of a~e or older an the execut°rs named in the last will of the above decedent, dated Ianuary 28, 2002 , t~ and codicil(s) dated h (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with er last family or principal residence at 519 Reno St., New Cumberland Borough, Cumberland County, Pennsylvania (list street, number and muncipality) Decendent, then 71 years of age, died November 27, 2003 ,Xl~). ., at Harrisburg Hospital, Harrisburg, Dauphin County, Penn.qylv~nq~ Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: ~ Decendent at death owned property with estimated values as follows: (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~enn~ylvania $ situated as follows: ~lgKeno Street, New Cumberland Borough, Cumberland County, PA 5,000.00 115,000.00 WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testamentary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. ~'~ Robert P. H~l~pt, III ~' ~ 165 Hill-N-Dale Road ~'= York Haven, PA 17370 ltMsy f 410 Hidden Valley Road New Cumberland, PA 17070 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ ss 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 oJLl~e~itioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well~d~l~ ia~wcnister/fhe//~c~estate according to law. Sworn to or affirmed and subscribed r ~-~'~/- da of ROBERT P HEMI~T, III before me this _ _ y ~ ................ , 19__ ~ _~ / LY, NN¥..q 7.0LLO.qY Register [. "'~f~-~- / ~- /oc:"~- / ~ ~ - -- No. Estate Of CARMEN J. HEM?T , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW 19~, 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 January 28, 2002 described therein be admitted to probate and filed of record as the last will of Carmen J. ttempt and Letters Testamentary are hereby granted to Robert P. Hempt, III and Lynne Szollosy FEES Probate, Letters, Etc .......... $ Short Certificates( ) .......... $ Renunciation ................ $ $ TOTAL __ $ Filed ................................... · Stone ~39785 ATTORNEY (Sup. Ct. I.D. No.) 414 Bridge St., New Cumberland, PA 17070 ADDRESS (717) 774-7435 PHONE his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 98110 ;5 No. Local Registrar ~, /..UU 0 Date ~,u R,,v. Z,,? COMMONWEALTH OF PENNSYLVANIA · OEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH Ca_.__nrme O. Hempt .Female t · Harri ' ' ~ sburg ~arr~sburg Hospital ""~'~"~ ..... White I ~CE~'S USU~ ~U~N' ' It' I~O. ~:~'~) I y~ ~ I E~~ C~ . ~c~) 519 ~eno Street .E,,~ New Cumberland,PA 17070 ~'~ ~,,~) Cumberland ,t ,~.~.~ ,,,.~ ~., New Cumberland ,,Robert F. Hall, Sr. ,~,,Evelyn I~:T 'S N~E ~y~Pr~ IIN~OflMANT'S ua,u~$' Ao~ mugan(~, c.~. ~. z,p c=~ ~obert~P. Hempt, [11 ~.165 Hill-N-Dsle Road, York Heven,PA 17370 ~=~=~Z~ c,_.= .._.,,_.,.,.= I~%~g¢3~''°" I:~:~,,,~.-.-.~.-..c,...~ ~'~ ~''~"' ~ ~lDecember 3, 2003 I Rollin~ Green Mem' Par~ Camn Hill ::::-~ ...... II IZ,b. 12,c. ¢ ' q2,~ ~ ~*~, PA 17011 ~X~ ~ ~ /A/~r ~2b. FO 012342-L ~one&MurrayFH408 3rd St New Cumberla~0~ Yea [] No ~ [] No [] Scacide [] Couldnolbedeterm~,ed IPLACEOC~NJURY-a~heme,~a,m. sl,eeLfacl~,o~icll manner an stated ....... , . , ( ) [] INJURY AT WORK? ep\wills\HEMPTcarmen\l-02 LAST WILL AND TESTAMENT OF CARMEN J. HEMPT I, CARMEN J. HEMPT, of the Borough of New Cumberland, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I direct that my Co-Executors hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease from the residue of my estate. ITEM II: I devise and bequeath all the rest, residue and remainder of my estate of every nature and wherever situate as fol- lows: A. One-third thereof to my son, ROBERT P. HEMPT, III. Should my son, ROBERT P. HEMPT, III, predecease me, I devise and bequeath his share to his wife, JANICE HEMPT, and in default thereof to his issue, per stirpes. B. One-third thereof to my daughter, LYNNE SZOLLOSY. Should my daughter, LYNNE SZOLLOSY, predecease me, I devise and bequeath her share to her husband, STEPHEN SZOLLOSY, and in default thereof to her issue, per stirpes. Page 1 of 5 C. One-third thereof to my daughter-in-law, LYNDA HEMPT, provided she survives me. Should my daughter-in-law, LYNDA HEMPT, fail to survive me, her share shall be added to the other shares created in this Item II in the same proportion as they now bear to each other. ITEM III: I appoint my Co-Executors and their successors guard- ian of any property which passes, either under this will or otherwise, to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or to another for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to time for the minor's support and education (including college education, both graduate and undergraduate) without regard to his or her parent's ability to provide for such support and education, or to make payment for these purposes, without further responsibility, to the minor or to any person taking care of the minor. ITEM IV: I appoint my children, ROBERT P. HEMPT, III, and LYNNE SZOLLOSY, Co-Executors of this my last will. ITEM V: No fiduciary acting hereunder shall be required to post bond or enter security for the faithful performance of his/her duties in any jurisdiction. Page 2 of 5 IN WITNESS WHEREOF, I, CARMEN J. HEMPT, have hereunto set my hand and seal this 2(~_ day of ~2~J~ ~ , 2002. CARHEN\~. HE'PT SIGNED, SEALED, PUBLISHED and DECLARED by CARMEN J. HEMPT, the Testatrix above named, as and for her Last Will and Testament, and in the presence of us, who at her request, in her presence and in the presence of each other, have subscribed our names as witnesses. Witness Address Address COMMONWEALTH OF PENNSYLVANIA: : SS: COUNTY OF CUMBERLAND : I, CARMEN J. HEMPT, the Testatrix whose name is signed to the at- tached or foregoing instrument, having been duly qualified according to law do hereby acknowledge that I signed and executed this instru- Page 3 of 5 ment as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. CARHE~} J. HET HEMPT, the Testatrix, this Sworn to or affirmed to and acknowledged before me by CARMEN J. ~-~ day of ~~ , 2002. Notary Publ~ NOTARIAL SEAL PATRICHIA L. YOTER, No~y Public New Cumberland Boro. Cumberland Co. My Commi~ion Expires Nov. 18, 2002 COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF CUMBERLAND : the witnesses whose names are signed to the attached er feregeing instrument, being duly qualified accerding to law, depese and say that we were present and saw Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and that she executed it as her free and veluntary act for the purpeses therein expressed; Page 4 of 5 that each of us in the hearing and sight of the Testatrix signed the will as witnesses; that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. Witness Sworn to or affirmed to and acknowledged before me by witnesses, this day of ~-'~_k~t,O'.4~..~, , 2002. Notary Pu~/~ic NOTARIAL SEAL PATRICHI^ L. YOTER, Notary Public New Cumberland Boro. Cumberland Co. My Commission Expires Nov. 18, 2002 Page 5 of 5 LAST WTT,L AND TESTAMENT OF CARMEN J. ~ STONE, LAFAYER & SHEKLETSKI A PROFESSIONAL CORPORATION ATTORNEYS AT LAW 414 BRIDGE STREET NEW GUMBERLA/~TD, PA 17070 STONE, LAFAVER & SHEKLETSKI A PROFESSIONAL CORPORATION ATT~T LAW 414 BRIDGE STREET NEW GUMBERLAIq/), PA 17070 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Carmen J. Hempt Date of Death' November 27, 2003 Wil. A No. 21-03-10~%8 To the Register: I certify that no%ice 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 es2ate on January 9, 2005. Robert P. Hempt, III 165 Hill-N-Dale Road York Haven, PA 17370 Lynne Szollosy 410 Hidden Valley Road New Cumberland, PA 17010 Lynda Hempt 532 Reno Street New Cumberland, PA 17070 Notice has now been given ~o all persons entitled thereto under Rule 5.6(a) . r ate: f- .... David N. Stone, Esquire 415 Bridge Street New Cumberland, PA 17070 717-714-7435 Capacitt;: X Personal Repzesentative Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 2806O1 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 004261 SZOLLOSY LYNNE 410 HIDDEN VALLEY ROAD NEW CUMBERLAND, PA 17070 fold ESTATE INFORMATION: SSN: 177-24-7270 FILE NUMBER: 2103- 1058 DECEDENT NAME: HEMPT CARMEN J DATE OF PAYMENT: 08/1 2/2004 POSTMARK DATE: 08/1 2/2004 COUNTY: CUMBERLAND DATE OF DEATH: 1 1/27/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $6,688.00 REMARKS: SZOLLOSY LYNNE C/O DAVID H STONE CHECK//122 SEAL TOTAL AMOUNT PAID: 96,688.00 INITIALS: SK RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS REV-1500 EX (6-00) GOMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 21 COUNTY CODE -- 03 1058 YEAR NUMBER LU Z Z O X I- DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) ~.MPT CARMEN DATE OF DEATH (MM-DO-YEAR) DATE OF BIRTH (MM-DD-YEAR) 11/27/2003 12/17/1931 (IF APPLICABLE)SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~-~1. Original Return J-~4. Limited Estate [--~6. Decedent Died Testate (Attach copy of Will) r--~ 9. Litigation Proceeds Received J SOCIAL SECURITY NUMBER 177-24-7270 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER [~ 2. Supplemental Return J J 3. Remainder Return (date of death prior to 12-13-82) r~ 4a. Future Interest Compromise (date of death after 12-12-82) ~'~ 5. Federal Estate Tax Return Required {~7. Decedent Maintained a Living Trust (Attach copy of Trust) 8. Total Number of Safe Deposit Boxes ['~ 10. Spousal Poverty Credit (date of death between 12-3%91 and 1-1-95) [~ 1 1. Election to tax under Sec. 9113(A) (Attach Sch O) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME David H. Stone, Esquire FIRM NAME (If Applicable) Stone LaFaver & Shekletski TELEPHONE NUMBER 717-774-7435 COMPLETE MAILING ADDRESS 414 Bridge Street New Cumberland, PA 17070 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) [~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 1 0. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 1 1. Total Deductions (total Lines 9 & 10) 1 2. Net Value of Estate (Line 8 minus Line 11) 1 3. Charitable and Governmental Bequests/Sec 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) 119,000 4,5291' 2,20~;' 47,23~i: (8) OFFICIAL USE ONLY 172,972 17,632 6,727 (11) 24,359 148,613 0 148,613 (12) (13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 1 7. Amount of Line 14 taxable at sibling rate 1 8. Amount of Line 14 taxable at collateral rate 0 x.O 0 (15) 148,613 x.0 45 (16) 0 x .12 (17) 0 x .15 (18) (19) 19. Tax Due 0 6,688 0 0 6,688 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 3W4645 1.000 ~'~J~ Decedent's Complete Address: $ i ~E¥ ADDRESS 519 Reno Street Cumberland County New Cumberland STATE ZIP PA 17070- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty (1) Total Credits (A + B + C) (2) Total Interest/Penalty (D + E) (3) 6,688 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 6,688 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (5B) 6,688 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ....................... ~ ~-~ b. retain the right to designate who shall use the property transferred or its income; ......... [~ ~-~ c. retain a reversionary interest; or ................................ [~ [~ d. receive the promise for life of either payments, benefits or care? ................. ~-] ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................ ~ ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? r~ r~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................ ~ [] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 ks true, correct and complete. Declaration of preparer other than the personal representative ks based on all information of which preparer has any knowledge. SIGNATURE"OF PERSON RESPONSIBLE FOR FILING RETURN 410 Hiaden Valle~ R~ ADDRE~b-- ~ ~ ~- -".-~- DATE PA 17070 New Cumberland, DATE 414 Bridge Street New Cumberland, PA 17070 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. § 9916 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfem to or for the use of the surviving spouse is 0% [72 P.S. § 9116 (a) (1.1) (ii)] The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. § 9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. § 9116(1.2) [72 P.S. § 9116(a)(1 )]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% (72 P.S. § 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 3W4646 1.000 REV-1502 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER CA/~VmN ,7. EEM~? 1058 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1. Property located at 519 Reno St., New Cumberland, Cumberland County, PA sold to Nicolas E. Dunphy and Heather M. Dunphy, his wife, on June 4, 2004 TOTAL (Also enter on line 1, Recapitulation) $ 119,000 119,000 3W4695 1.000 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER CARMEN J. HEMPT 1058 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 6 ? 9 10 1996 Chevy Lumina Van Comcast-refund Internal Revenue Service Refund on decedent's 2003 federal income tax Mutual of Omaha-refund on insurance PA Dept. of Revenue-refund on decedent's PA40 return for 2003 Personal property sold Personal property sold at auction Pinnacle Health Emerg. Dept. refund Verizon-refund Washington National Insurance-refund TOTAL (Also enter on line 5, Recapitulation) $ 2,915 15 806 35 49 5O 460 28 26 145 4,529 3W46AD 1.000 (If more space is needed, insert additional sheets of the same size) REV-1509 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER ~N J. HEIV~T 1058 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. JOINTLY-OWNED PROPERTY: u:~ ~u< DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOW~ MADE INCLUOE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'S VALUE OF NIJMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR NUMBER TENANT JOINT JO~N~_Y+ELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. i 10/4/1996 Waypoint Bank-Checking Acct. #700027842 joint w/Lynne Szollosy 1,357 50.000 679 2 10/4/1996 Waypoint Bank-Savings Acct. #760009029 joint w/Lynne Szollosy, Princ. $3,049.07, Int. $.31 3,049 50.000 1,525 TOTAL (Also enter on line 6, Recapitulation) $ 2,204 3W46AE 1.000 (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER ~N J. HEM~T 1058 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM ~NCLL~E ~ NNVIE OF Ti'E 'PRANSFEREE. THEIR REI_~TIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER TI-~ DATE O¢ 'IT~N,~SEER. ATt'ACH A COPY OF THE DEED FO R REAL ESTATE. VALUE OF ASSET INTEREST (IF/~'PL)CABLE) VALUE 1. Allianz Life Insurance Company-Annuity Policy #661934 Robert P. Hempt, III and Lynne Szollosy beneficiaries 22,842 100.000 0 22,842 2 Zurich Life-Annuity Policy #FK4058074 24,397 100.000 0 24,397 TOTAL (Also enter on line 7, Recapitulation) $ 47,239 (If more space is needed, insert additional sheets of the same size) 3W46AF 1.000 REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER CARMEN J. HEMPT 1058 Debts of decedent must be reported on Schedule I. ITEM NUMBER 5. 6. 7. DESCRIPTION AMOUNT FUNERAL. EXPENSES: Robert Hempt-Reimb. on funeral services with Stone & Murray Funeral Home ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State __ Zip Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State __ Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Borough of New Cumberland-trash and sewer service at property Total from continuation pages TOTAL (Also enter on line 9, Recapitulation) $ 5,929 8,648 275 41 2,739 17,637 3W46AG1.000 (Ifmorespaceisneeded, inse~additionalsheetsofthesamesize) Schedule H part 2 (Page 2) Estate of: CARMEN J. HEMPT Item No. Description Amount 7 10 11 12 Checks written by decedent but not cleared by bank until after death Comcast-cable service at property Cumberland Law Journal-adv. grant of letters PAWC-water service at property PPL Corp.-electric service at property Reserve for closing expenses Robin Gasperetti-Tax collector taxes due on property Settlement costs on sale of property ($1,194.00) less reimb, on taxes and trash ($306.67) The Patriot News Co.-advertising grant of letters UGI-gas service at property Verizon-telephone service at property 28 30 75 70 111 200 404 887 134 709 91 Total ~Carrv forward to main schedule% 2.739 REV-1512 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER CARMEN J. HEMPT 1058 Include unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Robert Hall-Reimb. of money loaned while decedent was living West Shore EMS-ambulance service 6,100 627 TOTAL (Also enter on line 10, Recapitulation) $ 6, '/2 ? 3W46AH 1.0o0 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER CARMEN J. HEMPT 1058 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Robert P. Hempt, III 165 Hill-N-Dale Road York Haven, PA 17370 33.333333% Residue: 49,538 Lynda Hempt 532 Reno Street New Cumberland, PA 33.333333% Residue: 17070 49,538 Son Daughter-in-law 49,538 49,538 49,538 Total from continuation pages ENTERD~LLARAM~UNT~F~RD~TR~BUT~N~H~WNAB~VE~NL~NES15THR~UGH18~ASAPPR~PRIA~E~NRE~15~c~VERSHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART ii - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0 3W46AI 1.000 (If more space is needed, insert additional sheets of the same size) Estate of: CARMEN J. HEMPT Item No. Description Schedule J part i (Page 2) Relation Amount 3 Lynne Szollosy 410 Hidden Valley Road New Cumberland, PA 17070 33.333333% Residue: 49,538 Daughter 49,538 Total tCarrv forward to main schedule% 49.538 LAST WILL AND TESTAMENT OF CARMEN J. HEMPT I, CARMEN J. HEHP?, ef ~he Borough cf New Cumberland, Cumber!ant County, Pennsylvania, declare this to be my last will and revoke any will previeusiy made by me. iTEH I: I direct that my Co-Executors hereinafter named shall pay all my just debts and funeral expenses as seen as conveniently may be done after my decease from the residue ef my estate. ITEH II: I devise and bequeath all the rest, residue and remainder ef my estate ef every nature and wherever situate as fel- lows: A. One-third thereof to my sen, ROBERT P. HEHPT, III. Should my son, ROBERT P. HEHPT, III, predecease me, I devise and bequeath his share to his wife, JANICE HEHPT, and in default thereof to his issue, per stirpes. B. One-third thereof to my daughter, LYNNE SZOLLOSY. Should my daughter, LYNNE SZOLLOSY, predecease me, I devise and bequeath her share to her husband, STEPHEN SZOLLOSY, and in default thereof to her issue, per stirpes. Page 1 of 5 C. One-third thereef to my daughter-in-law, LYNDA NEMPT, previded she survives me. Should my daughter-in-law, LYNDA HBHPT, fail to survive me, her share shall be added to the other shares created in this Item II in the same proportion as they new bear te each other. ITRH Iii: i appeinT my Ce-Execu%ers and their successers guard- ian ef any property which sasses, either under %his ,sill er o%herwise, te a minor and with respect te which I am authorized to appeint e guardian and have net otherwise specifically dene se, erevided that ~his appointment ©f a guardian shall net supersede the right ef any fiduciary in its discretion ~e distribute a share where possible To the minor or to another fer the minor's benefit. Such guardian shall have the power to use principal as well as inceme frem time to time for the minor's support and education (including college educatien, beth graduate and undergraduate) without regard te his er her parent's ability te provide fer such suppert and education, er t© make paymen~ for these purpeses, witheut further responsibility, te the miner or to any persen taking care of the miner. ITEH IV: I appeint my children, ROBERT P. HEHPT, III, and LYNN~ SZOLLOSY, Co-Executors o~ this my last will. ITEH V: No fiduciary acting hereunder shal~ be required to pest bend or enter security for the faithful perfermance ef his/her duties in any jurisdiction. Page 2 of 5 and seal this IN WITNESS WHEREOF, I, CARHEN J. HEHPT, have hereunto set my hand ~_~ day of '" ' _.3,..x:-,__,k,j~? .~ ~.( , 2 0 0 2 . SIGNED, SEALED, PUBLISHED and DECLARED by CARHEN J. HEHPT, the Testatrix above named, as and for her Las~ Will and Testament, and in the presence of us, who at her request, in her presence and in the presence of each ether, have subscribed our names as witnesses. Witness Address Address %' " COMMONWEALTH OF PENNSYLVANIA: : SS: COUNTY OF CUMBERLAND : I, CARHEN J. HEHPT, the Testatrix whose name is signed to the at- tached or foregoing instrument, having been duly qualified according ~o law de hereby acknowledge that I signed and executed this instru- Page 3 of 5 ment as my last will; that I signed it willingly and that I signed as my free and voluntary act fer the purposes therein centained. CARMEN-" J. H~HPT Sworn to or affirmed %e and acknewledged before me by CARMEN J. HEMPT, the Testatrix, ~his ~. day of .l,:--~.-,_t...l u~_~ , 2002. Netary Pub 1 i,~ NOTARIAL SEAL P^TRI,?IA 1. ¥O'I'ER, Nolmy Pub!lc Ne,,',, Cu,nberla~d Boro. Cumberland My Commission Expires t,lov. 18, 2002 COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF CUMBERLAND : ~ the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; Page 4 of 5 that each ef us in the hearing and sight ef the Testatrix signed ~he will as witnesses; that te the best of our knowledge, the Testatrix was at that time eighteen er more years of age, of sound mind and under no constraint er undue influence. ' , Ke'ss Witness Sworn to or affirmed to and acknowledged before me by witnesses, this day of 'h~%e~'~.l..~ , 2002. !. Notary P u b~Cl c NOTARIAL S-EAL PATRICHIA L. YOTER, Notary Public New Cumberland Boro. Cumberland Co. My Commi~o.q Expires Nov. 18, 2002 Page 5 of 5 re\ded\hall.exe\l-97 DEED THIS INDENTURE made the ~(J~ay of ~¢~ , in the year 1997, between CARMEN J. HEMPT and ROBERT F. HALL, II, individually and as Co-Executors of the Last Will and Testament of EVELYN M. HALL, late of the Borough of New Cumberland, County of Cumberland, and Commonwealth of Pennsylvania, of the first part, hereinafter called the Grantors, - AND- CARMEN J. HEMPT, of the second part, hereinafter called the Grantee; WHEREAS, the said EVELYN M. HALL became in her lifetime seised, as of fee, of and in to a certain tract of land, together with the improvements thereon erected, situate in the Borough of New Cumberland, County of Cumberland, and Commonwealth of Pennsylvania, and more particularly described hereinafter; and being so thereof seised, died on March 13, 1996, having first made her Last Will and Testament in writing dated May 16, 1967, duly probated and registered in the Office of the Register of Wills of Cumberland County on April 15, 1996, wherein and whereby she appointed as Co-Executors, the said CARMEN J. HEMPT and ROBERT F. HALL, II, to whom letters testamentary were duly issued by said Register of Wills on April 15, 1996, and wherein and whereby said premises hereinafter described were not specifically devised, all as in and by said Will and the records of said Register of Wills more fully appears; NOW THIS INDENTURE WITRESSETH, that the said Grantors, for and in consideration of the sum of ONE AND NO/100 ($1.00) Dollars, which has -1- been paid to her by the said Grantee at or before the sealing and delivery hereof, receipt whereof is hereby acknowledged, has granted, bargained, sold, aliened, released and confirmed, and by these presents does grant, bargain, sell, alien, release and confirm unto the said Grantee, ALL THOSE CERTAIN lots of land situate in the First Ward of the Borough of New Cumberland, County of Cumberland, and Commonwealth of Pennsylvania, more particularly bounded and described as follows, to wit: BEGINNING at the intersection formed by the southeastern corner of Reno Avenue and Chestnut Street as shown on the Plan of D. R. Kebaugh as recorded in the Cumberland County Recorder's Office in Plan Book No. 1, Page 6; thence in a southwesterly direction sixty (60) feet six (6) inches to a point; thence in an easterly direction on a line parallel with Chestnut Street one hundred forty (140) feet, more or less, to a ten (10) foot alley; thence in a northerly direction, along said ten (10) foot alley sixty (60) feet six (6) inches to the southerly line of Chestnut Street; and thence in a westerly direction along the southerly line of Chestnut Street one hundred forty and eight-tenths (140.8) feet to the place of BEGINNING. Being all of Lots Nos. 45 and 46 and the northerly portion of Lot No. 44 as shown on the aforesaid plan. BEING the same premises which Leona E. Martorana and Santi Martorana, husband and wife, by their deed dated May 23, 1941, and recorded in Cumberland County Deed Book I, Vol. 12, Page 584, granted and conveyed unto Robert F. Hall and Evelyn M. Hall, husband and wife. The said Robert F. Hall died December 26, 1989, thus vesting title in Evelyn M. Hall, the decedent. TO~ETHER with all and singular the buildings, improvements, ways, streets, alleys, passages, waters, water-courses, rights, liberties, privileges, hereditaments and appurtenances whatsoever, thereunto belonging or in any wise appertaining and the reversions and remainders, rents, issues and profits thereof, and all the estate, right, title, interest, property, claim and demand whatsoever of her, -2- the said EVELYN M. HALL, at and immediately before the time of her decease, in law, equity, or otherwise howsoever, of, in, to or out of the same. TO HAVE AND TO HOLD the said lot or piece of ground above described, with the buildings and improvements thereon erected, hereditaments and premises hereby granted or mentioned, and intended so to be, with the appurtenances unto the said Grantee, to and for the only proper use and behoof of the said Grantee, forever. And the said Grantors, for themselves and their respective heirs, executors and administrators, does covenant, promise and agree to and with the said Grantee, her heirs and assigns, that they, the said Grantors, have not heretofore done or committed any act, matter or thing whatsoever whereby the premises hereby granted, or any part thereof, is, are, shall or may be impeached, charged, or encumbered in title, charge, estate or otherwise howsoever. IN WITNESS WHEREOF, the said Grantors have hereunto set their hands and seals the day and year first above written. CARMEN J. HEd~PT, individually and as Co-Executor of the Last Will and Testament of EVELYN M. HALL (SEAL) ROBERT F. HALL, II, Individually and as Co-Executor of the Last Will and Testament of EVELYN M. HALL -3- COMMONWEALTH OF PENNSYLVANIA: COUNTY OF L~'-~;~.~'~..c,~_.-,~.~--- : SS: On this, the /~3 ~ day of ~.~-~'~ ~ , 1997, before me a Notary Public, the undersigned officer, personally appeared CARMEN J. HEMPT, individually and as Co-Executor of the Last Will and Testament of EVELYN M. HALL, 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. IN WITNESS WHEREOF, I have hereto set my hand and notarial seal. ! Kayo R. Luc:k.~: .', Not-:..~y Pu~ic ~ j Nm'~Cumbedand 5:i-,~, C'.xm'.:e,r:s.~ CountyJ ~ k'~l/Commi~!cn F£~.oir~s ",?,etch 27, 1997 J -,~~ l¢cmo~l, r ¢,nns¥~va.-;;a,~c~a~on 0, Notaries COMMONWEALTH OF PENNSYLVANIA: COUNTY OF f ¢,~¢'~ ,f !¢(i''~" : On this, the ~/~'day of ~'~rY~Li",. , 1997, before me a Notary Public, the undersigned officer, personally appeared ROBERT F. HALL, II, individually and as Co-Executor of the Last Will and Testament of EVELYN M. HALL, 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. IN WITNESS WHEREOF, I have ! THE J I I ~- -,-~ hereto set my hand and -4- ~ ~ I ,Joan L. Flummet Notary Pub c ! I CarlJsie Boro, Cumberland County I Member, Pennsylvania Association of ~o~rics I hereby certify that the precise address of the Grantee for, COMMONWEALTH OF PENNSYLVANIA: : SS: COUNTY OF CUMBERLAND : RECORDED on this i"~i day of i~]~'~ C,:{.% , A.D. 1997, in the Recorder's Office of the said county, in Deed Book j~L.t , Page~-~ . Given under my hand and the seal of the said office, the date above written. Recorder. -5- re\ded\HEMPTeseDUNPHY DEED Parcel: 25-24-0811-088 THIS INDENTURE made the day of , in the year 2004, between ROBERT P. HEMPT, iii, and LYNNE SZOLLOSY, Co-Executors of the Last Will and Testament of CARMEN J. HEMPT, late of the Borough of New Cumberland, County of Cumberland and Commonwealth of Pennsylvania, of the first part, hereinafter called the Grantor, -- AND - NICOLAS E. DUNPHY and HEATHER M. DUNPHY, husband and wife, of the second part, hereinafter called the Grantees; WHEREAS, the said CARMEN J. HEMPT became in her lifetime seised, as of fee, of and in to a certain tract of land, together with the improvements thereon erected, situate in the Borough of New Cumber- land, County of Cumberland, and Commonwealth of Pennsylvania, and more particularly described hereinafter; and being so thereof seised, died on November 27, 2003, having first made her Last Will and Testament in writing dated January 28, 2002, duly probated and registered in the Office of the Register of Wills of Cumberland County on December 23, 2003, wherein and whereby she appointed as Co-Executors, the said ROBERT P. HEMPT, III, and LYNNE SZOLLOSY, to whom Letters Testamentary were duly issued by said Register of Wills on December 23, 2003, wherein and whereby said premises hereinafter described were not specifically devised, all as in and by said Will and the records of said Register ef Wills more fully appears; NOW THIS INDENTURE WITNESSETH, that the said Grantor, for and in consideration of the sum of One Hundred Nineteen Thousand and NO/100 ($119,000.00) Dollars, which has been paid to her by the said Grantees at or before the sealing and delivery hereof, receipt whereof is hereby acknowledged, has granted, bargained, sold, aliened, released and confirmed, and by these presents does grant, bargain, sell, alien, release and confirm unto the said Grantees, ALL THOSE CERTAIN lots of land situate in the First Ward of the Borough of New Cumberland, County of Cumberland, and Commonwealth of Pennsylvania, more particularly bounded and described as follows, to wit: BEGINNING at the intersection formed by the southeastern corner of Reno Avenue and Chestnut Street as shown on the Plan of D. R. Kebaugh as recorded in the Cumberland County Recorder's Office in Plan Book No. 1, Page 6; thence in a southwesterly direction sixty (60) feet six (06) inches to a point; thence in an easterly direction on a line parallel with Chestnut Street one hundred forty (140) feet, more or less, to a ten (10) foot alley; thence in a northerly direction, along said ten (10) foot alley sixty (60) feet six (06) inches to the southerly line of Chestnut Street; and thence in a westerly direction along the southerly line of Chestnut Street one hundred forty and eight-tenths (140.8) feet to the place of BEGINNING. Being all of Lots Nos. 45 and 46 and the northerly portion of Lot No. 44 as shown on the aforesaid Plan. BEING the same premises which Carmen J. Hempt and Robert F. Hall, II, individually and as Co-Executors of the Estate of Evelyn M. Hall, by deed dated March 21, 1997, and recorded March 17, 1997, in the Office of the Recorder of Deeds in and for Cumberland County, Pennsylvania, in Record Book 154, Page 561, granted and conveyed unto Carmen J. Hempt, decedent herein. 2 TOGETHER with all and singular the buildings, improvements, ways, streets, alleys, passages, waters, water-courses, rights, liberties, privileges, hereditaments and appurtenances whatsoever, thereunto belonging or in any wise appertaining and the reversions and remainders, rents, issues and profits thereof, and all the estate, right, title, interest, property, claim and demand whatsoever of her, the said CARMEN J. HEMPT, at and immediately before the time of her decease, in law, equity, or otherwise howsoever, of, in, to or out of the same. TO HAVE AND TO HOLD the said lot or piece of ground above de- scribed, with the buildings and improvements thereon erected, hereditaments and premises hereby granted or mentioned, and intended so to be, with the appurtenances unto the said Grantees, to and for the only proper use and behoof of the said Grantees, forever. And the said Grantor, for herself and her respective heirs, executors and administrators, does covenant, promise and agree to and with the said Grantees, their heirs and assigns, that she, the said Grantor, has not heretofore done or committed any act, matter or thing whatsoever whereby the premises hereby granted, or any part thereof, is, are, shall or may be impeached, charged, or encumbered in title, charge, estate or otherwise howsoever. -3- IN WITNESS WHEREOF, the said Grantor has hereunto set her hand and seal the day and year first above written. Witness of the Last Will and Testament of CARMEN J. HEMPT ~ (SEAL) ~ SZOLL~Y, C~-~ecutor of the Last Will and~Pestament of CARMEN J. HEHPT COMMONWEALTH OF PENNSYLVANIA: : COUNTY OF CUMBERLAND : SS: On this, the day of , 2004, before me a Notary Public, the undersigned officer, personally appeared ROBERT P. HEMPT, III, and LYNNE SZOLLOSY, Co-Executors of the Last Will and Testament of CARMEN J. HEMPT, known to me or satisfactorily proven to be the persons whose names are subscribed to the within instrument, and acknowledged that they executed the same for the purposes therein contained. IN WITNESS WHEREOF, I have hereto set my hand and notarial seal. Notary Public -4- I hereby certify that the precise address of the Grantee is Attorney for -5- K'elley Blue Book - Private Party Pricing Report - Chew-olet, Lumina Minivan Page 1 of 2 Kelley Blue Book BLUE BOO[ PRI'tATE PARTY REPORT Pennsylvania * July 15, 2004 1996 Chevrolet Lumina Minivan Passenger Search Listings for This Car · ~- List Your Car For Sale Online  Buy a New Car Free Lemon Check ~ Auto Loans from 3.85% APR Insurance Quote Print "For Sale" S~n Payment Calculator Engine: V6 3.4 Liter Trans: Automatic Drive: Front Wheel Drive Mileage: 48,000 Equipment 7 Passenger Air Conditioning Power Steering AM/FM Stereo ABS (4-Wheel) Consumer Rated Condition: Good "Good" condition means that the vehicle is free of any major defects. The paint, body and interior have only minor (if any) blemishes, and there are no major mechanical problems. In states where rust is a problem, this should be very minimal, and a deduction should be made to correct it. The tires match and have substantial tread wear left. A clean title history is assumed. A "good" vehicle will need some reconditioning to be sold at retail; however major reconditioning should be deducted from the value. Most recent model cars owned by consumers fall into this category. Private Party Value Search Local Listings for This Car $2,915 Private Party value represents what you might expect to pay for a used car when purchasing from a private party. It may also represent the value you might expect to receive when selling your own used car to another private party. Get a Used Car Trade-In Value Get Invoice & MSRP on New Cars Get a Person to Person Auto Loan http://www kbb.com/kb/ki.dll/kw.kc ur?kbb.PA;805516;PA041 & 17070;van+p&723 ;Chev... 7/15/2004 K. elley Blue Book - Private Party Pricing Report - Chevrolet, Lumina Minivan Page 2 of 2 Copyright © 2004 by Kelley Blue Book Co., All Rights Reserved. Jul-Aug 2004 Edition. The specific information required to determine the value for this particular vehicle was supplied by the person generating this report. Vehicle valuations are opinions and may vary from vehicle to vehicle. Actual valuations will vary based upon market conditions, specifications, vehicle condition or other particular circumstances pertinent to this particular vehicle or the transaction or the parties to the transaction. This report is intended for the individual use of the person generating this report only and shall not be sold or transmitted to another party. Kelley Blue Book assumes no responsibility for errors or omissions.(v.04071) http://www.kbb.corn/kb/ki.dll/kw.kc.ur?kbb. PA;805516;PA041 & 17070;van+p&723 ;Chev... 7/15/2004 LOOK FOR US. VVE'LL GET YOU THERE. 1 / 15/2004 STONE LAFAVER 8,: SHEKLETSKI 414 BRIDGE ST PO BOX E NEW CUMBERLAND PA 17070 The information which you requested on the account(s) of CAREN J HEMPT (Social Security Number 177-24-7270) is/are as follows: Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established 700027842 760009029 CHECKING SAVINGS 100496 100496 1357.15 3049.07 .00 .31 1357.15 3049.38 JTO JTO LYNN L LYNNE L SZOLLOSY SZOLLOSY 100496 100496 Additional Information Requested /Sinc~rel,v: ~ i/t SENIOR SERVICES REP. P.O. Box 171 I. HARRISBURG. PENNSYLVANIA 17105-1711 Toll FrEE 1-866-WAYPOINT (I-866-9E9-7646) · IN YORK AREA 717/815-4500 · vvww. wagpointbank, com Allianz Life Insurance Company of North America PO Box 59060 Minneapolis, MN 55459-0060 800/950-1962 Allianz December 1, 2003 ROBERT P HEMPT 111 & LYNNE L SZOLLOSY C/O ARTHUR RHOADS 321 2ND ST NEW CUMBERLAND PA 17070 Re: CARMEN J HEMPT, deceased . ~., Annuity Policy Number: 6619434 Dear Mr. Hempt 1II & Ms. Szollosy: This letter is in reference to your request for a date of death value on the above policy. Please.~ ~.be advised that the cash value and annuitization value as of November 27, 2003 w a~.53~nd $26,521.95, respectively. Thank you. SinOerely, T Claim Examiner January 14, 2004 ZURICH Robert P Hempt III Lynne Szollosy 410 Hidden Valley Road New Cumberland PA 17070 Re: Policy Number: FK4058074 / Claim Settlement Annuitant Carmen J Hempt Dear Mr. Robert Hempt III & MS. LYNNE SZOLLOSY: I hope you found that our assistance with your claim helped ease a difficult time. Although I have completed the claim processing for Carmen J Hempt, I am still available if you need any additional help. The enclosed check for $24,397.39 represents your portion of the single sum payment from this policy. Please contact me if you need any further information. Sincerely, Susan Filler Zurich Life Claim Representative 1/888-397-8485, option #2 Enclosure cc: Arthur Rhoads 321 2nd Street New Cumberland pA 17070 ZL-ADDR 1600 McConnor Parkway, Schaumburg, Illinois 60196-6801 300M (10/03) OMB NO. 2502-0265 'ir A. B. TYPE OF LOAN: U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.E~FHA 2.[~FmHA 3. ~]CONV. UNINS. 4.E]VA 5. E]CONV. INS. 6. FILE NUMBER: I 7. LOAN NUMBER: SETTLEMENT STATEMENT DUNPHY,N 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "[POC]" were paid outside the closing; they are shown here for informational purposes and are not included in the total& 1 0 3'98 (DUNPHY.N PFD/DUNPHY,N/5) D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: NICHOLAS E. DUNPHY and ESTATE OF CARMEN J. HEMPT HEATHER M. DUNPHY 519 RENO STREET NEW CUMBERLAND, PA 17070 G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 25-1857112 I. SETTLEMENT DATE: 519 RENO STREET Midstate Abstract Company NEW CUMBERLAND, PA 17070 June 4, 2004 CUMBERLAND County, Pennsylvania PLACE OF SETTLEMENT 2331 Market Street Camp Hill, PA 17011 J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract Sales Price I 119,000.00 401. Contract Sales Price 119,000.00 102. Personal Propedy [ 402. Personal Property 103. Settlement Charges to Borrower (Line 1400) I 2,543.25 403. I 104. I 404. 105. ¢ 405. j Adjustments For Items Paid By Seller in advance Adjustments For Items Paid By Seller in advance 106. City/Town Taxes to I 406. City/Town Taxes to 107. County Taxes 06/04/04 to 01/01/05 i 237.80 407. County Taxes 06/04/04 to 01/01/05 I 237.80 108. School Taxes 06/04/04 to 07/01/04 [ 57.42 408. School Taxes 06/04/04 to 07/01/04 i 57.42 109. Trash Proration 06/04/04 to 07/01/04 ! 11.45 409. Trash Proration 06/04/04 to 07/01/04 I 11.45 120. GROSS AMOUNT DUE FROM BORROWER ,J 121,849.92 420. GROSS AMOUNT DUE TO SELLER I 119,306.67 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 201. Deposit or earnest money I 501. Excess Deposit (See InstructionsI 202. Principal Amount of New Loan(s) I 502. Settlement Charges to SeUer (Line 1400) 1,194.00 203. Existing loan(s) taken subject to I 503. Existing loan(s) taken subject to 204. J 504. Payoff of first Mortgage 205. I 505. Payoff of second Mortgage 206. [ 506. 207. I 507. 208. ) 508. '209. I 509. Adjustments For Items Unpaid By Seller Adjustments For Items Unpaid By Seller 210. City/Town Taxes to 510. City/Town Taxes to 211. Count,/Taxes to 511. Count}, Taxes to 212. School Taxes to 512. School Taxes to 213. Sewer Proration 04/01/04 to 06/04/04 I 15.35 513. Sewer Proration 04/01/04 to 06/04/04 I 15.35 216. [ 516. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER [ 15.35 520. TOTAL REDUCTION AMOUNT DUE SELLER 1,209.35 300. CASH AT SETTLEMENT FROM/TO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER: 301. Gross Amount Due From Borrower ILine 1201 121,849.92 601. Gross Amount Due To Seller (Line 420) I 119,306.67 302. Less Amount Paid By/For Borrower (Line 220) ( 15.35 602. Less Reductions Due Seller (Line 520) ( 1,209.35; 303. CASH( X FROM)( TO)BORROWER 121,834.57 603. CASH( X TO)( FROM)SELLER 118,097.32 The q/ndersigned hereby acknowledge receipt of a completed copy of pages 1&2 of this statement & any attachments referred to herein. H EATHfi-'R MT-D-UNPHY ,/' (~ Page 2 L. SETTLEMENT CHARGES 700. TOTAL COMMISSION Based on Price $ ~ °~o PAID FROM PAID FF~OM Division of Commission (line 700) as Follows: BORROWER'S SELLER'S 701. $ to FUNDS AT FUNDS AT 702. $ to SETTLEMENT SETTLEMENT 703. Commission Paid at Settlement 704. to 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Origination Fee % to 802. Loan Discount % to 1803. Appraisal Fee to 804. Credit Report to 805. Lender's Inspection Fee to 806. Mortgage Ins. App. Fee to 807. Assumption Fee to 808. 809, 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to @ $ /day ( days %) 902. MIP Totlns. for LifeOfLoan for months to 903. Hazard insurance Premium for 1.0 },ears to 904. 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance months ~ $ per month 1002. Mortgage Insurance months ~ $ per month 1003. Cit},/Town Taxes months ~ $ per month 1004. Count}, Taxes months ~ $ per month 1005. School Taxes months (~) $ per month 1006. months ~ $ per month 1007. months @ $ per month 1008. months ~ $ per month 1100. TITLE CHARGES 1101. Settlement or Closing Fee to 1102. Abstract or Title Search to 1103. Title Examination to 1104. Title Insurance Binder to 1105. Document Preparation to 1106. Closing Service Letter to i1107. Attorney's Fees to Reager & Adler, PC 360.00 (includes above item numbers: ) 1108. Title Insurance to MIDSTATE ABSTRACT 953.75 (includes above item numbers1102, 1103 & 1104 ) 1109. Lender's Coverage $ 1110. Owner's Coverage $ 119,000.00 1111. Endorsements 100, 300, 8.1 1112. Notary Fee Cash 1113. Notary Fee Cash 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording Fees: Deed $ 39.50; Mortgage $ ; Releases $ 39.50 1202. Cit¥/Coun~ Tax/Stamps:Deed 1,190.00; Mortcjage 1,190.00 1203. State Tax/Stamps: Revenue Stamps 1,190.00; Mortgage 1,190.0C 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Surve}' to 1302. Pest Inspection to 1303. Tax Information to Cash 4.00 1304. 1305. J 2,543.2~ 1,194.00 1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section ,," ,,'1 By sigmng peg Certified to be a true copy. Settlement Agent ( DUNPHY,N / DUNPHY,N / 5 ) Inventory of the real and personal estate of Carmen J. Hempt deceased Estate of CARMEN J. HEMPT Estate Inventory Valued as of Date of Death Tangible Personal PropeCy 1996 Chevy Lumina Van Personal property sold at auction Total Tangible Personal Prope~y Miscellaneous Comcast-refund Internal Revenue Service Refund on decedent's 2003 federal income tax Mutual of Omaha-refund on insurance PA Dept. of Revenue-refund on decedent's PA40 return for 2003 Personal property sold Pinnacle Health Eme~g. Dept. refund Verizon-refund Washington National Insurance-refund Total Miscellaneous Real Property Property located at 519 Reno St., New Cumberland, Cumberland County, PA sold to Nicolas E. Dunphy and Heather M. Dunphy, his wife, on June 4, 2004 Total Real Property Total Inventory 2,915.00 459.72 14.71 806.00 35.30 49.00 50.00 28.40 25.56 145.41 119,000.00 3,37~.72 1,15t.38 119,00¢.00 123,524.10 ss: belng duly according to law, deposes and says tHa't' he late of ................ Cumberland County, Pa., deceased and that the wi+bin is an inventory made by +he said the entire estate of ~aid decedent, consisflng of all the personal property ~nd real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of fha Inventory represent ff's fair value of +he date of ,~ec~denf's death. and subscribed before me, 19 bynne Szollosl~ .... +oF- 410 Hidden Valley Rd. New Cumberland, PA 17070 Addrg~ Date of Death 27 11 2003 D~y Month Year INSTRUCTIONS !. .An ;nvenfor'/ must be Filed within three months after appointment of personal represenfafive. 2. A :uppiemenf inventory must be filed wifh;n thirty days of discovery of ~dd;fional assets. }. Aa~monai :h~-*~ ma,/ be a,*acnea as to personalty or realty ¢. See Article .V Diduciaries Actor 1949. BUREAU OF ZNDZVTDUAL TAXES INHERITANCE TAX DTVTSTON DEPT. 180601 HARRTSBURG, PA 17118-0601 COHMONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DAVID H STO~E ESQ STONE ETAL ,~ qlq BRIDGE ST NEN cUI~BERL .~O DATE lO-Oq-ZOOq ESTATE OF HEMPT DATE OF DEATH 11-27-2005 FILE NUMBER 21 0:5-1058 COUNTY CUMBERLAND ACM 101 I Amoun~ Remi~ad CARMEN J MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF MILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 1701:5 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HEMPT CARMEN J FILE NO. 21 0:5-1058 ACN 101 DATE lO-Oq-ZOOq TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~e (Schedule A) (1) 2. S~ocks and Bonds (Schedule B) (2) 3. Closely Held S~ock/Par~narship Zn~eres~ (Schedule C) (3) q. Mortgages~No,es Receivable {Schedule D) 5. Cash/Bank Deposits~Misc. Personal Propar~y (Sch®dula E] ($) 6. Jointly Owned Proper~y {Schedule F) (6) 7. Transfers (Schedule 8. To,al Asse~s APPROVED DEDUCTZONS AND EXEMPTZONS: 9. Funeral Expenses/Adm. Costs~Misc. Expanses [Schedule H] (9) 10. Dab~s/Mor~gage LiabA11~ias/Lians (Schedule Z) (10) 11. Total Deduc~/ons 12. Ne~ Value of Tax Re~urn 119~000.00 O0 O0 O0 q/529. O0 2~20q O0 47~Z$9. O0 17,6:52.00 6,727.00 (11) 13. 14. NOTE: ASSESSMENT OF TAX: 1E. Amoun~ of Line lq a~ Spousal ra*e 16. Amoun~ of L/ne 14 ~axable a~ LLneel/Cless A ra~a 17. Aeoun~ of L/ne 14 a~ S/bl/ng re~e 18. Aeoun~ of Line 14 ~axable a~ Collateral/Class B ra~a 19. Princ/pal Tax Due TAX CREDITS: PAYMENT RECEZPT 015COUNT (+J DATE NUMBER ZNTEREST/PEN PAZD (-) 08-1Z-ZOOq CDOOqZ61 .00 Char/~abla/governean~al Baques~cs; Non-elected 9113 Trusts (Schedule J) (15) Na'~: Value of Es~ca~a Sub.~ec~ ~o Tax (14) Zf an assesseent t~as issued previously, 11nes 14, 15 and/or 16, 17, reflect flgures that include the tote! of ALL returns assessed to date. NOTE: To /nsura proper cradi~ ~o your account, sube/~ ~he upper por~ion of ~h/s form wi~h your ~ax payean~. 172,972.00 ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 2~.~59.00 lq8,615.00 .00 lq8,615.00 18 and 19 will (1.;) .00 X O0 = .00 (16) lq8,615.00 X Oq5 = 6,688.00 (17) .00 x 12 = . O0 (18), .00 x 15 = .00 (19)= 6,688. O0 AMOUNT PAID 6,688.00 TOTAL TAX CREDIT BALANCE OF TAX DUEI ZNTEREST AND PEN. TOTAL DUE 6,688.00 .00 .00 .00 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REgUZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR TNSTRUCTZONS.) RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying an or before December 12, 1982 -- if any future interest in the estate is transfarrsd in possession or enjoyment to Class B (collateral) baneficiarias of the decedent after the expiration af any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at fha lawful Class B (collateral) rate on any such futura interest. To fulfill the requirements af Section ZlqO of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (71 P.S. Section 91q0). Detach the top portion of this Notice and submit aith your payment to the Register of Rills printed on the reverse side. --Make check or money order payable to: REGISTER OF NZLLS, AGENT A refund of a tax credit, ahich ams not requested on the Tax Raturn, may be requested by completing an "Application for Refund of Pennsylvania Inharitance and Estate Tax" (REV-151S). Applications ara available at the Office of the Register of Rills, any of the 15 Revenue District Offices, or by calling the special 24-hour answering service for fores ordering: 1-800-56Z-ZOS0; services for taxpayers with special hearing and / or speaking needs: 1-800-447-5010 (TT only). Any party in interest not satisfied aith the appraisement, alloaance, or disalloaanca of deductions, or assessment of tax (including discount or interest) as shown on this Notica must object within sixty (60) days of receipt of this Notice by: --arittan protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1011, OR --election to have the matter deterainad at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered an this assessment should ba addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 260601, Harrisburg, PA 17118-0601 Phone (717) 787-6505. Saa page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is allowed. The 151 tax aanasty non-participation penalty is computed on the total of the tax and interest assessed, end not paid before January 18, 1996, the first day after the and of tha tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same tiaa period as you mould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day free fha date of death, to the date of payaant. Taxes ehich became delinquent before January 1, 1981 bear interest at the rate of six (61) percent per annum calculated at a daily rate of .000164. All taxes which became dalinquant an and after January 1, 1961 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through Z004 are: Zntarest Daily Interest Daily Interest Daily Yaar Rata Factor Year Rata Factor Year Rate Factor ~ lOX .000548 ~"~)"~%-1991 llZ .OOOSOl ~ 9X .0002~7 1985 162 .000458 1992 9Z .000247 ZOOZ 6Z .000164 1984 112 .000501 1993-1994 72 .000192 2005 52 .000137 1985 132 .000356 1995-1998 92 .000247 2004 41 .000110 1986 lOX .000274 1999 7Z .OOO19Z 1987 lOZ .000274 2000 7Z .OO019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payaant is made after the interest computation data sheen on the Notice, additional interest must bm calculated.