HomeMy WebLinkAbout04-0786 PETITION FOR PROBATE and GRANT OF LETTERS
Estateof~q~.~//~f~F?~~-/)~OlJ No. 5'~ ! --0~-07 f~)
also known as / To:
Social Security No. e;~O [- / ~ t~LID~ccsed'
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age ar Qlder an the execuO'~X
in the last wilt of the above cJe. qedent, dated ?k/d~/,t4 ~/'~'d ~ '
and codicil(s) dated
Register of wJ41s for the ~
County of ~ _,~W_)/~d_/~in the
Commonwealth of Pennsylvania
named
, 19 ti,/
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in ~-J/f4 taO~L~6J~3 .. ~-County, Perl~yJvania, ~vith
.... .
last family or pnnc~pal residence at ~ t~ /k], / 7
/9,3,/
(list street, number and muncipality)
Decen en/7~ years of age, died ~7-~.~7'-/0 ,~~,
at ~n..t,~t~
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 inapennsylvania
situated as follows: PliTCO;
$/,Y-o..
$
/oo-~ crv~
WHEREFORE, petitioner(s) respectfully~.ryg_gA~t,(s) t_he pr.o]?§t,e of the last will and codicil(s)
presented herewith and the grant of letters ~7.~ S'~ ~
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
OATH OF'PERSONAL REPRESENTATIYE ~ ' '
COMlVlONWEA~'It OF PENNSY.LYANIA ~ ss :'i~,. , ,:
COUNTY OF.(~J',,~-,E~ L.,d-,,J t~_ . j ,~ ~. -'o__.. :~:':::
The petitioner(s) above,n~ed swe~(s) or affirm(s) that the statements in the ~r~oing ~tition ar~
true and correct to the best of the knowledge and belief of petitioner(s) and that'as ~rson~represen-
tative(s) of the above decedent petitioner(s)will ~~uly~~ admini~efstate according~ ~ to law.
Sworn to or affirmed and subscribed ~ ~~~ ~ ~~ ~
before me this ~]q~ day 9f [ ~/- ~ ~
OATH OF NON-SUBSCRIBING WITNESS
Estate of//~~
Also known as
No.
,Deceased
(each) a subscriber hereto, (each) being duly qualified acc, ording to law, depose(s) and say(s) that
~',~ familiar with the signature of/~~x/,~/t>x/'~ ~&J~tte-iX. of
(one of the subscribing wimesses to) the codicil/w~l presented herewith and that _/~- beheve~
the signature on the codicil/will is in the handwriting of /~L~I/ fi~//~ ~ ~zx-IXtt~/
to the best of ~ y knowledge and belief.
/
Sworn to or affirmed and subscribed
Beforetime this /7ct) 2~d~ ~(f
, .
(Address)
Also lmown as
OATH OF SUBSCRIBING WITNESS
.,Deceased
(each) a subscribing witness to the will/codicil presented herewith, (each) being duly qualified
according to law, depose(s) and say(s) [~. uteric present and saw
[I')~,~ ~t10¢¢_ , C..0t~[4 ,thetestatf,~ , sign the same and
that [.~.. signed as a witness at the request of the testat e[K in her- presence
and ¢IM~~!~~t~,t~*) (in the presence of the other subscribing wimess(es).
· :, (Name)
.~ ,~z ~ (Address)
Sworn to or affirmed and subscribed
i_s_[6[[1~ day of
,20 ~-~
For the Register ~¢C(~I
(Address)
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.
· Pl:31.
'YPE/PRINT
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
STATE FILE NUMBER
1. Mary Cowan 2. Female a. ,. August 10, 2004
~h, o., March 1 1924 '""'" ~
East Pennsboro Holy Spirit Hospital
J .... ~ H~e m.. h,.~ 2 I
,,.. Homemaker
i DECi.:DENT,$ M.~dLiNG AD I)RE~ ~lj-~,lf. Cil¥ . $1ale. Zip CoDe) [DEC£~NT*B
230 N. 17th Stree
,, ~p Hill, PA 17011
,.. robert 3. ~r
~, N~cy ~wan
~' .... " ' ., 014404-L
-- ~"~'~"~' ,~ 7:31 P.u[.. August ~0, 2004
~>~ .. Cardiomvooathv
.~T,.,~ ~y~ (~y~ ~ ~. ~ ~ ~ ~ ~y~ ~ .~ O~ C~ ,~*~) ~ ~~~// Coroner
· m.u~o~Y~lm,~*~m~q~-~m) J,,d August 11, 2004
,~2aTv~o,,.., Michael L. Norris, Coroner
6375 Basehore Road, Suite
~,.~.~~.~'.f~.[m.,.f~O.~ ~ ~ Mechanicsburg, Pa. 17050
,,. Myrtle Fought
Jm 1119 Green St.? Harrisburg~ PA 17102
2,c BFH Crematory 2,, Grantville~ PA 17028
,A~*.O~D.~O~C,U~ · St 3125.Walnut
J,~.CentralPACreraat].on y.~rrzsmrg, ¢~'17109
'04 &UG17 P1:31
LAST WILL AND TESTAMENT
OF
Mary Har~er Cowan
~c~ I, Nary;.~ar~er Cowan, of the Borough of Cams Hill,
~'~nd'i~o~ty, Pennsylvania. make, wublish and declare
this to be my Last Will and Testament, hereby revoking and
making void any and all wills wreviously made by me.
I direct my Executrix. hereinafter named, to have my
body cremated and my ashes buried in the backyard of my home
at 230 North 17th Street, Cam~ Hill, next to the grave of my
dog Maggie. I further direct the wayment for these expenses
and any other debts I may have to be made as soon after my
death as may be convenient.
I devise and bequeath all the rest, residue and
remainder of my estate of every nature and wherever situate to
be divided equally among my four children, Eileen, Nancy,
Matthew, and Maura. If any of these ~redecease me, I direct
that his or her share go to a surviving child or, wer stirwes,
to surviving children.. If any of my children die without issue
and ~redecease me, I direct that his or her share be divided
among the remaining children.
I a~oint my daughter Nancy Cowan Executrix of this, my
Last Will and Testament.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this ~ ~' day of November, 1991.
Signed by the above-named Testatrix as and for her Last
Will and Testament in the ~resence of us who, at her request,
in her ~resence and in the wresence of each other, have
hereunto subscribed our names as witnesses.
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717)240-6345
Date: 12/06/2004
COWANNANCY
1119 GREEN STREET
HARRISBURG, PA 17102
RE: Estate of COWAN MARY HARPER
File Number: 2004-00786
Dear Sir/Madam:
It has come to my attention that you have not filed the
Certification of Notice Under Rule 5.7 (a) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES,
NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on
or after July 1, 1992, the personal representative or his
counsel, within ten (10) days after giving proper notice to the
beneficiaries and intestate heirs as required by subdivision
(a) of Rule 5.7, shall file with the Register of Wills or Clerk
of the Orphans' Court his/her Certification of Notice.
This filing will become delinquent on 12/03/2004
Your prompt attention to this matter will be appreciated.
Thank You.
CC:
File
Personal
Judge
Representative(s)
Sincerely,
Clerk of the Orphans' Court
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717)240-6345
Date: 12/06/2004
COWANNANCY
1119 GREEN STREET
HARRISBURG, PA 17102
RE: Estate of COWAN MARY HARPER
File Number: 2004-00786
Dear Sir/Madam:
It has come to my attention that you have not filed the
Certification of Notice Under Rule 5.7 (a) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES,
NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on
or after July 1, 1992, the personal representative or his
counsel, within ten (10) days after giving proper notice to the
beneficiaries and intestate heirs as required by subdivision
(a) of Rule 5.7, shall file with the Register of Wills or Clerk
of the Orphans' Court his/her Certification of Notice.
This filing will become delinquent on 12/03/2004
Your prompt attention to this matter will be appreciated.
Thank You.
cc:
File
Counsel
Judge
GLENDA FARNER STRASBAUGH
Clerk of the Orphans' Court
CERTIFCATION OF NOTICE UNDER RULE 5.6(A)
NameofDecedent: ~141Ct/ NAt€-P6L ~xJA)
I .
Date ofDeath: ;<k/62c) sr /D ,;)en) l-
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Will No.: c:2.b6 'i --(}o1 {f0
Admin No.: 6<.. / - (YF () 7 a{,
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule . a) of the Orphans' ourt Rules ~. < t.
\vas served 011 or mailed to the following beneficiaries of the above-captioned estate on " S:r-r.:'~.1 ~~
Name
Address
E1L~~;J Y0AJJt-M
)1xJJ;Z;4- (LJ!4;-J
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. /4-.... ~ ~u:,4,J . R~ uJ. ~J f'2,ptJ &- ~ c=. il~G:~ .17b5f
;.//JrJO-A../ (7~~)4rJ /11') Qt:.,!;;J ?-: 'i-1M/2IS'6J,e~V';4171<J2
Notice has (ow been given to all per~ons entitled thereto under Rule 5.6(a) except .
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REV.i';jr;1) EX :5.()i))
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
~-L- tJ:I
COUNTY CODE YEAR
flfl::2X~
NUMBER
o 2. Supplemental Return
o 4a. Future Interest Compromise (dale of death after 12.12-82)
o 7. Decedent Maintained a Living Trust (AltachcopyolTrusl)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95,
Real Estate (Schedule A) (1) 1f-5/ o-v
Stocks and Bonds (Schedule B) (2) Ie; 1. $ify:.
,
3 Closely Held Corporation, Partnership or Sole-Proprietorship (3) 0
4 Mortgages & Notes Receivable (Schedule D) (4) 0
"".-?
Cash, Bank Deposits & Miscellaneous Personal Property (5) &3 7 S
Z (Schedule E)
0 6. Jointly Owned Property (Schedule F) (6) .;1.. 3.00 I
< o Separate Billing Requested I
...I (7) 0
::> 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
!:: (Schedule G or L)
0.
<( 8. Total Gross Assets (total Lines 1-7)
U 9. Funeral Expenses & Administrative Costs (Schedule H) (9) /3 . / S'S-
w
a:: -'
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) I <; C; '1
11. Total Deductions (total Lines 9 & 10)
12 Net Value of Estate (Line 8 minus Line 11)
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C
W
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DEC~iiNA~~~:~DMI~;~-!/AR-rftc I S~I~\S~RITYN;Z 6llhcJ
DATE OF DEATH (MM~D-YEAR) /'~E OF BIRTH(MM:OD-YEARj..-.- --- rTH1S RETURN MUST ElE FILED IN'DUPLlCATE WrrH THE
o 8 - / 0 .-~ ~ r 03 -- 0 L - /2;;;L.:I . REGISTER OF WILLS
(IF ~:0~IVINGSPOUSE'SNAME(LASi RRST.AND MIDDLE-INITIAL)'- -- --- raCIAL SECURITY NUMB.ER--.- -..-.
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a.
<l:
~1 Original Return
o 4. Limited Estate
S 6. Decedent Died Testate (Attach copy of Vljll)
[J 9 Litigation Proceeds Received
o 3. Remainder Return (date of death prior to 12-1:\-82)
o 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
....
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME A /<J- /Ii (; p ?<..i!1 ~ '_ _ ~. . COMPL:~E/MA5'NG~ E ,J~72e Ej
FIRM NAME (If Apphc;ble) 1- _. 1111 S G- /)A _ / 7/6.J-
_ '_ _ _ }ff/V A!./Z/ cl 1..1/2 ~ / /t .
13 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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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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
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19 Tax Due
20.0
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE sloe AND RECHECK MATH < <
35:?r' ~_tz_>1...
x .0 (15)
_ _ XO-r.s':-(16)
x12 (17)
x .15 (18)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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Decedent's Complete Address:
STREET ADDRESS J( 3 D /-.1, _ j_Z
-~~ -- ------
CITY
?4rM p IJ I L~
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
ZIP / 7 0 /
/(;C17'/.00
o
----- - - -.--- 0
~~~ -=-- ()
(2)
/605/, UU
Total Credits (A + B + C )
3.
Interest/Penalty if applicable
o I nlerest
E Penalty
----u
o
4.
Total Interest/Penalty ( D + E )
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.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
[&
I
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred; .......................................................................................... 0
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0
c. retain a reversionary interest; or.................. ........... ......... ............. ......... ........... ............................ ....................... 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .................. ......... ............ ........,. ........... ......... ...... ............. .., ................... 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................... ............................... ........ .... ................ ...................... 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.
Under penalties of perjury. I declare that I have examined this return. including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
Sl9_N~TU~E PERSO.N....RESPO?. LE F.OR FILlN. G. RETURN
....7 f10.. t!~ (!;..{IVl..;~
ADDR{s/l .," j/ ./--.
i/I/5' ~~~~
SIGNATURE OF RE RER OTHER THAN REPRESENTATIVE
g~~,T]f
~TE / 5/ 2}6-6)
_L1'/<cJ,l:-- ~ 2- ()
DATE
ADDRESS
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 PS !}9116 (a) (1.1) (i)).
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (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.
LAST WILL AND TESTAMENT
OF
Mary Harper Cowan
I. Mary Harper Cowan. of the Borough of Cam, Hill.
Cumberland County. Pennsylvania. make. pUblish and declare
this to be my Last Will and Testament. hereby revoking and
\,:
making void any and all wills ,reviously made by me.
I direct my Executrix. hereinafter named. to have my
body cremated and my ashes buried in the backyard of my home
at 230 North 17th Street. Camp Hill. next to the grave of my
dog Maggie. I further direct the ,ayment for these expenses
and any other debts I may have to be made as soon after my
death as may be convenient.
I devise and bequeath all the rest. residue and
remainder of my estate of every nature and wherever situate to
be divided equally among my four children. Eileen, Nancy,
Matthew, and Maura. If any of these predecease me, I direct
that his or her share go to a surviving child or, per stirlles,
to surviving children.. If any of my children die without issue
and predecease me, I direct that his or her share be divided
among the remaining children.
I appoint my daughter Nancy Cowan Executrix of this, my
Last Will and Testament.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this ~V re.. day of November, 1991.
)VIQ)U6 ~/-€IV ~~
Signed by the above-named Testatrix 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.
~kct.~
All ~,X ~ '~ OJ\c-ot~ ( \
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
/1 It R "- H 0... yo ~ V" 0 W 0vv1 t( I - O'r - 66 '7810
All real property owned solely or as a tenant in co mon 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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
ALL that certain piece or parcel of land situate in the Borough of Camp Hill. County of Cumberland and
State of Pennsylvania, more particularly bounded and deScribed as follows, to wit:
J 47 10n
/
1,
BEGINNING at a point on the western line of Seventeenth Street three hundred sixty-eight (368) feet
measured northwardly along the western line of said Street from the northwest corner of Seventeenth
and High Streets; thence in a westerly direction along a line parallel with High Street and at right angles
with Seventeenth Street one hundred seventy-five (175) to a fifteen foot alley; thence in a northerly
direction along the eastern line of said fifteen foot alley fifty-eight (58) feet to a point; thence in an
easterly direction along a line parallel with High Street and at right angles with Seventeenth Street, one
hundred seventy-five (175) feet to Seventeenth Street; thence in a southerly direction along the western
line of Seventeenth Street fifty-eight (58) feet to the point or place of BEGINNING.
HAVING THEREON erected a two story frame dwelling house No. 230 North Seventeenth Street. Camp
Hill. Pennsylvania.
BEING the same premises which Robert J. Harper and Mary Harper (Cowan). his daughter, by Deed
dated August 30, 1961 and recorded in the Cumberland County Recorder's Office in Deed Book H20
Page 545, granted and conveyed unto Mary Harper Cowan. Grantor herein.
it /1 ~ Cj d()
ALTA Policy
Schedule C
. ('$,1#1' . --4)
- ,r,
A. B. TYPE-oF LOAN:
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.DFHA 2.OFmHA 3. ~CONV. UNINS. 4. OVA 5.OCONV. INS.
0. , 17. LOAN
SETTLEMENT STATEMENT 04679 00037709528
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 totals.
1.0 3/98 (04679104879124)
U. NAMI-' ANI A OF ~ E. NAME AND ADDRESS OF <::i=1 I i=R: F. NAME AND ADDRESS OF LENUER:
Richard R. Miller, Jr. and Estate of Mary Harper Cowan National City Mortgage Co.
Jan R. Miller 3232 Newmark Drive
Miamisburg, Ohio 45342
G. PROPERTY LOCATION: . H. SETTLEMENT AGENT: 25-1878915 I. SETTLEMENT DATE:
230 North Seventeenth Street Keystone Land Transfer, Ltd.
Camp Hill, PA 17011 December 13, 2004
Cumberland County, Pennsylvania PLACE OF SETTLEMENT
3421 Market Street
Camp Hill, PA 17011
J. UI- :.::; ,,~ K. Ut
100. GROSS DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
1U1. (.;ontract ::;ales I-'rlce 149,900.00 401. (.;ontract Sales Price 149,900.00
102. Personal Property 4U:.!. I-'ers.onal I-'roperty
1Uj. ::;eUlement (.;narges to Borrower (Line 1400) 694.09. 403.
104. 4U4.
1UO. 4U5.
AdjUstments ror trems Paid By Seller In advance Adjustments For Items Paid By Seller In advance
1UO. (.;ltyfTown Taxes to 4UO. (';Ity/l own Taxes to
107. County Taxes I ~ 1.:>/U<t to U IIU IIU;:) jU.08 407. (.;ounty Taxes to v IIV IIVv jO.08
1 Uti. ::;cnool I ax I.e.t ""v. to VffV 'v,", 923.10 408. School Tax to VffV IIV,", 923.10
1U~. ::;ewer ILf ,"'tv.. to v ItV Itv,", o.:.!u 409. Sewer 'Lf ,"'tV' ,0 6.20
110. 410.
111. 411.
112. 41:.!.
120. GROSS AMOUNT DUE FROM BORROWER 151,554.07 420. GROSS AMOUNT DUE TO SELLER 150,859.98
200. AMOUNTS PAID BY OR IN BEHALl-\JF BORROWER: 500. RED IN AMOURlDUE TO SELLER:
:.!01. Ueposlt or earnest money 1,UUU.00 501. Excess Deposit (See Instructions)
:.!u:.!. I-'rlnclpal Amount of New Loan(s) 119,900.00 502. Settlement Charges to Seller (Line 14UU) 10,719.50
:'!OJ. I:.Xlstlng 10an(S) taKen SUbject to 5Uj. I:.Xlstlng loan(s) taKen suOjecTlO
:.!U4. I-'roceeds from 2nd Mtg. ","""u"'..,Ju 504. paYOff of first Mortgage
:.!U5. 5U5. l-'ayoTT or secona Mortgage
:.!OO. 5UO.
1207. 507. (Deposit disb. as proceeds)
!LUtI. 508.
1209. 509.
AdjUstments For Items Unpaid By Seller AGjustments-Forltems -vnpaTdBy :seller
210. CityfTown Taxes to 510. CityfTown Taxes to
211. (.;ounty Taxes to 511. county Taxes to
L1L ::;cnool I ax to 512. School Tax to
213. 513.
214. 514.
L10. 515.
210. 510.
LlI. 517.
218. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER 143,282.50 520. TOTAL REDUCTION AMOUNT DUE SELLER 10,719.50
"UU. ~I:I : 600. \';A~M AI ::il: I :
301. Gross Amount Due From Borrower (Line 120) 101,004.UI OU1. l::iross Amount uue 10 ::>eller (Line 420) ,
jU:'!. Less Amount I-'ala t:lyll-or t:lorrower (Line ~r 14j,:.!tI:.!.5U) OU2. Less Keductions Due Seller (Line 520) 1 U,lll:l.0U)
303. CASH ( X FROM) ( TO) BORROWER 8,271.57 603. CASH ( X TO) ( FROM) SELLER 140,140.48
OMS NO 2502 0265 ,...0...
The undersigned hereby acknowledge receipt of a completed copy of pages 1 &2 of this statement & any attachments referred to herein.
Borrower
Seller ~~ :4-
te of Harper Cowan
cv. Y'2 _./ /li _ _ ::../,...., A aA--1
. c.o~.......
L. SETTLEMENT CHARGES
700. TOTAL COMMISSION Based on Price $ 149,900.00 @ 3.0000 % 4,497.00 PAID FROM PAID FROM
Ulvlslon or vommlSSlon (lme fUU) as rOIlOWS: BORROWER'S SELLER'S
IU1. '114,4::1I.UU 10 nowaro nanna uetweller FUNDS AT FUNDS AT
lV~.'II to SETTLEMENT SETTLEMENT
IU;'. vommlSSlon l""alO at ~eUlemem 4,4::1I.UU
l V4. I ransacuon r ee 10 Ke/Max KeallY ASSOC. inC. 'I~O.UU
BOO. A YABLE IN Tlv.... VYlI n LOAN
tlUl. Loan unglnatlon ree U.UUUU 'J'o to
llU;.!. Loan UISCOUnt % to
tlU;'. Appraisal ree 10
OU4. vreOll Kepoll to
llUO. Lenaers inspection ree 10
OUO. Mortgage ins. App. ree to
tlU f. ASSUmptiOn ree 10
OUO.
tlU::I.
tllU.
tl11.
O'I~. ApplicatiOn ree to t"'remler runOlng mc. POl,;
tll;'. I ax ~ervlce ree 10 Lereta I I.UU
014. AomlnlSlratlOn ree 10 NatiOnal vllY MOrtgage VO. 41U.UU
tll0. rlooa vert 10 rU~1 LOU
01 O. ~xpress Mall to rea t:x 10.UU
tll(. t"'rocesslng ree 10 I""remler runOlng me. 'IOU.UU
0'10. tlrOKerree.p Y l'lvlVlv to t"'remler runOlng
tll::1. ,
o~u.
900. ITEMS REQUIRED BY LENDER TO tit: PAID IN ADVANCE
901. Interest From 12/13/04 to 01/01/05 @ $ 18.070000/day ( 19 days %) **** 343.3,
::IV~. IVlortgage Insurance t"'remlumTor monms to
HUJ. Hazard Insurance' Premium tor 1.U years to
::IU4.
::IUO.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard Insurance 2.000 months :jj 48.58 per month 97.16
lUU;.!. Mortgage Insurance momns per monm
lUUJ. l,;itylTown Taxes months per month
1 UU4. l,;ounty I axes 10.000 months 4H.;.!0 per momn 492.50
1005. :lchool Tax 0.000 months 140.J9 per month 114;.!.J4
lUUo. momns per momn
1007. months per month
10011. Aggregate AdjUstment monthS per month -J4f.4H
1100. TITLE CHARGES
1101. Settlement or Closing Fee to
11102. Abstract or Title Search to
11 U;'. Title Examination to
1104. Htle Insurance tiinoer to
11 UO. uocumem t"'reparatlon to Keystone Land ransTer, Lta. 1 UU.OO
1100. Notary rees to Keystone Land I ranster, Ltd. 12.00 12.00
1107. Attorney's Fees to
(lnclUues BDove ([em numDers: )
11108. Title Insurance to Keystone Land Transfer, Ltc. 1,lUtl.fO
(mCluaes BDove Item numDers: )
llU::I. Lenaersvoverage 'II I""I-\LH-IUv IUvL IL
I I IV. vwnersvoverage 'II , ',""uu,
1 'I'll. ~naorsemems 1 UU,;'UU,tl. 1 to "eyslOne Lana I ransTer, Ltc. 10U.UU
111 L. vlOSlng t"'rotectlon Letter to KeYStOne Lana I ranSTer, Lta. .)O.UU
'I 'I 'I,). I ax KecelptS to "eyslOne Lana I ransTer, Lta. O.UU
I I 14. vvernlgm to "eYSlOne Lana I ranSTer, Lta. 14.00
1110. KetrleVe t: Mall uocumentS to "eyStone Lanu I ranSTer, Lt~. J5.00
111 0.
"Ill( .
1110.
1200. GuvERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees: Deed $ 38.50; Mortgage $ 64.50; Releases $ 103.00
uu~. vllY'voumy I aX/~tamps:ueea 1,4::1::1.UU; Mortgage 10L.Otl 140.4L
1203. State TaXl~tamps: Kevenue ~tamps 1 ,4HH.UO; Mortgage 1,4HH.UU
1 LU4.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Survey to
l;'UL. I-'est inspection to Homespec POl,;
lJUJ. Iransactlon Fee to Mowara Manna uetweller lLo.UU
1:i1l4. HAlmhllr!':Fl T",Y RFlC'.AlnT!': Tn (:n::arIA~ WI c::nn "'''''
REV-1503 EX+ (6-98) I':
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
1t1~
FILE NUMBER
H ~ C6 W ClN1 :J J - (j JJ - DO 7 :;'.b
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
VALUE AT DATE
OF DEATH
:).
DESCRIPTION
SBe. C.OWlWlI.A-Y1lca.J"iOl1S
~o W\ yY\ ClV\ S+od:
ShanL. ~ f1cu-ke-i pr1c-e - $ ~e;.I/5"
~ fA c; t p 14 783 8'7 G /(J'j
Be II S (f1A.,111
C6 Yl1 m ~h S+ock
$~ 7,015 / ~ hcVU
t!- U 5J p 14 0 7q B b 0 / o"J-
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5J77.0b
If I &<f. I 'f':;;
t."3)0'7'1,I(,,,
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TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
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/
, MRP Investment Prograin
~ ftom SCUDDER INVESTMENTS
NEW ACCOUNT CONFIRMAtiON
Confirmation Date 02/01/2005
Account Number 04295077673-0
AlPS U SP.PRSP.9X12 81- 32 212 100000oo QOOOOOO
ESTATE OF MARY HARPER COWAN
NANCY COWAN EXEC
1119 GREEN ST
HARRISBURG PA 17102-2920 <~,
Effective S~ptember 20. 2004.
registered mail to Scuaderlnv
The new address is:. Scudder In
6th AClor Kansas City. ~MO' 64105:
Scudder Distributors, Inc. is the princIpal underwriter and distributor of each fund.
the addr.ess 10r sending express . certified or
en Service Company has changea.
tsService Company 210 West 10th Street.
,
Daily Transaction Summary
FUNb NAME - (Symbol) DOLLAR SHARE NUMBER OF TOTAL SHARES ACCOUNT
TRANSACTION TYPE DATE AMOUNT PRICE SHARES OWNED VALUE
GNIIJA Fund-Clan AARP - (AGNMX)
Transfer From 716800755 02/0112005 $0.00 $0,00 4,169.145 4,169,145 $0.00
Shares Redeemed - ACH 02/0112005 $63,287.62 $15.18 4,169.145 0.000 $0.00
Account Information
GNMA Fund-Class AARP
TAX IDENTIFICATION NUMBER .
DIVIDEND AND CAPITAL GAIN INFORMATION
On File
Your dividends and capital gains will be wired to the following
bank:
PENNSYL VANIA STATE EMPLOYEE CR
Account Number 0450385877
ESTATE OF MARY H COWAN
NANCY COWANEXECUlRIX
N
N
~
:;;
1111111 11111 11111 1111111111 1111 II~
ARPS 18 SP.PRSP.9X12 B8 32 212 10000000 0000000
REV.1504 EX + (1.97~
I
SCHEDULE C
CLOSEL Y.HELD CORPORATION,
PARTNERSHIP or SOLE.PROPRIETORSHIP
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
rn~~ /
;l1l1,e-y /lA-ILl' EiC C ~4A.J
(
Schedule C-1 or C-2 (Including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship.
See instructions for the supporting information to be submitted for sole-proprietorships.
FILE NUMBER
402/- 0 Y-Cd 7)(-':,
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
/\/0/-1. L
TOTAL (Also enter on line 3, Recapitulation) $ 0
(If more space is needed, insert additional sheets of the same size)
Rf'1.l505EX + (1.971
.
SCHEDULE C-1
CLOSELY-HELD CORPORATE
STOCK INFORMATION REPORT
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
. - () Lf - Q 0 7 g~
1.
Address
City
2. Federal Employer 1.0. Number
3. Type of Business
State
Zip Code
State of Incorporation
Date of Incorporation
Total Number of Shareholders
Business Reporting Year
ProductfService
4.
STOCK
TYPE
Voting I Non-Voting
TOTAL NUMBER OF
SHARES OUTSTANDING
PAR VALUE
NUMBER OF SHARES
OWNED BY THE DECEDENT
VALUE OF THE
DECEDENT'S STOCK
Common
Preferred
$
$
Provide all rights and restrictions pertaining to each class of stock.
5. Was the decedent employed by the Corporation? 0 Yes o No
If yes, Position Annual Salary $ Time Devoted to Business
6. Was the Corporation indebted to the decedent? 0 Yes o No
If yes, provide amount of indebtedness $
7. Was there life insurance payable to the corporation upon the death of the decedent? 0 Yes 0 No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
8. Did the decedent sell or transfer stock of this company within one year prior to death or within two years if the date of death was prior to 12-31-82?
DYes 0 No If yes, 0 Transfer 0 Sale Number of Shares
Transferee or Purchaser
Attach a separate sheet for additional transfers andlor sales.
Consideration $
Date
9. Was there a written shareholder's agreement in effect at the time of the decedent's death?
If yes, provide a copy of the agreement.
DYes 0 No
10. Was the decedent's stock sold?
DYes
o No
If yes, provide a copy of the agreement of sale, etc.
11. Was the corporation dissolved or liquidated after the decedent's death? 0 Yes 0 No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
12. Did the corporation have an interest in other corporations or partnerships? 0 Yes 0 No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
A. Detailed calculations used in the valuation of the decedent's stock.
B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years.
C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been
secured, attach copies.
D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent.
E. List of officers, their salaries, bonuses and any other benefits received from the corporation.
F. Statement of dividends paid each year. List those declared and unpaid.
G. Any other information relating to the valuation of the decedent's stock.
, REV-1506 EX+ (9-00)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C-2
PARTNERSHIP
INFORMATION REPORT
ESTATE OF
(~
FILE NUMBER
.2/ -0
-CO 7 rk
1.
Date Business Commenced
Address
Business Reporting Year
State
Zip Code
City
2. Federal Employer I.D. Number
3. Type of Business
Product/Service
4. Decedent was a 0 General 0 Limited partner. If decedent was a limited partner, provide initial investment $
5.
A.
B.
C.
D.
6. Value of the decedent's interest $
7. Was the Partnership indebted to the decedent? ................................. 0 Yes 0 No
If yes, provide amount of indebtedness $
8. Was there life insurance payable to the partnership upon the death of the decedent? ..... 0 Yes 0 No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was
prior to 12-31-82?
DYes 0 No
If yes, 0 Transfer 0 Sale
Percentage transferred/sold
Consideration $
Transferee or Purchaser
Attach a separate sheet for additional transfers and/or sales.
10. Was there a written partnership agreement in effect at the time of the decedent's death? 0 Yes 0 No
If yes, provide a copy of the agreement.
Date
11. Was the decedent's partnership interest sold? ....................................... 0 Yes 0 No
If yes, provide a copy of the agreement of sale, etc.
12. Was the partnership dissolved or liquidated after the decedent's death? ................... 0 Yes 0 No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
13. Was the decedent related to any of the partners? .................................... 0 Yes 0 No
If yes, explain
14. Did the partnership have an interest in other corporations or partnerships? . . . . . . . . . . . . ., 0 Yes 0 No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
THE FOllOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE
A. Detailed calculations used in the valuation of the decedent's partnership interest.
B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years.
C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have
been secured, attach copies.
D. Any other information relating to the valuation of the decedent's partnership interest.
flEV-1507 EX+ (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
CL:;4A-i
FILE NUMBER
02/- C)
ITEM
NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
DESCRIPTION
1,
rJ () t-l L
- ()() 7 ?G
VALUE AT DATE
OF DEATH
TOTAL (Also enter on line 4, Recapitulation) $ (]
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
(!~(
AI:nclude the.p~oceeds of litiga,tion ,and the date the proceeds were received by the estate.
property JOintly-owned with right of survivorship must be disclosed on Schedule F.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ITEM
NUMBER
DESCRIPTION
I
13~~ Aucl-,'o?t-
9'3 10 Mo flvcuR..
~~'2-~ to- 170S6?,:;g
(! &YvlccuiL e~~ - !(ej~d
if 00 '6 N D~ f"G;V r '-uq h lVO-y
~ ~!)e /'!1dO
:!..
01tM ~ 9~ Htrmt ~ce~ tJu#
4, I<~ W/E )Ie-hI( ye. ~ /11 q I
:5. 5rAk ~ ~(fWJ ~ ~
V E- VL I L6..J (1" ".u<< o,.j)"" c. "'- ?:, I ,,/ b 61", 1> S
/7-' SWC-lc- })/ 1I/7J E tV [) S
(/ {5M 1t1.. 07V
!J/0bE;J~
3.
,;"
7
~.
13 t'I-L SiJJrn
,4P4/LfJ - ~,AJM;4. FUND
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, Insert additional sheets of the same size)
FILE NUMBER
od7n
VALUE AT DATE
OF DEATH
:}CJ~(),OO
~,7i
'75.56
r;:L. /5
:280. ex>
ILf~ .;;k-:;L
I P). oD
~;p'7 32-
/ L/~S: ?'I
037'1. 77
o ~ 7!f' .,00
REV-1509 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
'?tJ
FILE NUMBER
- 0 ~() 0 7 ~(e,
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
A ;t1;tuM J.
SURVIVING JOINT TENANT(S) NAME
B
C
JOINTLY-OWNED PROPERTY:
A
LETTER
ITEM FOR JOINT
NUMBER TENANT
ADDRESS
RELATIONSHIP TO DECEDENT
10/ /AJL ;4-:
1-1 () d NT' J.fp /-I.-f QP~~G---S
IJ A _ I 7 oC:, ~
DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JO TLY.HEL REAL ESTATE.
~v~
j . -~ ~-
'~1!9~ 5/ 0
"'-- - 4./C;,! 50 g
Jt- ~5(f i(/f~ (J7)?
~:! ~~ If" M^'*
~G-t.J~rC
,
%OF
DECD'S
INTEREST
DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
025/ tRJj
TOTAL (Also enter on line 6, Recapitulation) $ 023 CJZJ j
(If more space is needed, insert additional sheets of the same size)
THIS DEED
MADE THElf"ttday of
hundred ninety seven (1997).
PARCEL NO.: 40.30.2644.045
Inti..
in the year of one thousand nine
BETWEEN DAVID S. BOLLINGER and RENITA K. BOLLINGER,
husband and wife, hereinafter referred to as:
Grantors,
and MARY H. COWAN, and MAURA COWAN, hereinafter referred to as:
Grantees.
WITNESSETH, that in consideration of NINETY THREE THOUSAND
FIVE HUNDRED ($93,500.00) DOLLARS in hand paid, the receipt thereof is
hereby acknowledged, the said Grantors do hereby grant and convey to the said
Grantees, their heirs and assigns: as joint tenants with the right of survivorship
ALL THAT CERTAIN tract of land with improvements thereon erected situate in
the Township of South Middleton, County of Cumberland, and Commonwealth of
Pennsylvania, being more fully bounded, limited and described as follows, to
wit;
BEGINNING at a point in the center of the Pine Road, said point being the
northeastern corner of land now or formerly of William Lewis; thence by the
center line of said Road, North 65 3/4 degrees East 100 feet to a point; thence
by land now or formerly of Tom O. Bietsch, et ux of which the herein described
premises was a part, South 23 3/4 degrees East 286 feet, more or less, to line of
land now or formerly of James W. Craighead; thence by said lands, South 611/2
degrees West 100 feet to a point; thence by land now or formerly of William
Lewis, North 23 3/4 degrees West 293 feet, more or less, to the Place of
BEGINNING.
CONTAINING .66 acres, more or less, and being improved with a dwelling
house and other improvements, and being known as 101 Pine Road, Mount
HoUy Springs, Pennsylvania.
AND BEING the same premises which Florence R. Jay, widow, by her deed
dated April 29, 1992, and recorded in the Office of the Recorder of Deeds in
Cumberland County, Pennsylvania, in Deed Book "Q", Volume 35, Page 372,
granted and conveyed unto David S. Bollinger and Renita K. Bollinger, husband
and wife, Grantors herein.
AND the said Grantors do hereby covenant and agree that they will
warrant specially the property hereby conveyed.
IN WITNESS WHEREOF, said Grantors have hereunto set their hands and
seals the day and year first above written.
SIGNED, SEALED AND DELIVERED
IN THE PRESENCE OF
~
WI. TNES.. :1\'.... . / O-//~
('\ (. "V { ?,V
G' ~
): ~ )
J)./v'j'/ ':.-' ,,_'7 \t,
, /I, ,',
/' ~/lJ Ij;-~
DAVID S. BOLLINGER
WITNESS
'- '~~i ji/'lI fJ !(
RE ITA K. BOLLINGER /
/
COMMONWEALTH OF PENNSYLVANIA
.
.
: SS :
COUNTY OF CUMBERLAND
.
.
On this, the Lf!!day of A.D. 1997, before me appeared
DA VID S. BOLLINGER and TA K. BOLLINGER, husband and wife,
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 hereunto set my hand and official seal.
f..-.--/' .IIIOTARW. Bl
_It. MASSCt NOTARY PU8U(
~-. IIID: CUIEIUND C:O. M
.,. r I f~OIIIESDBftIER. ,. tWJ
I HEREBY CERTIFY, that the precise residence and complete post office
address of the within Grantees are: 101 PINE ROAD, MT. HOLLY SPRINGS, PA 17065
COMMONWEALTH OF PENNSYLVANIA
.
.
: SS
.
.
COUNTY OF CUMBERLAND
.
.
Recorded on this _ day of . A.D. 1997, in the Recorder's
Office of the said County in Deed Book -' Page _.
Given under my hand and the seal of the said Office, the date above
written.
Recorder
+
PSECU MORTGAGE STATEMENT
MAURA COWAN
101 Pine Road
Mount Holly Springs PA 17065
J
~;:;
JUDYA. CAMPBELL, TAX COLLECTOR
P.O. BOX 300, 6 HOPE DRIVE
BOILING SPRINGS, PA 17007
'~.:_';., '<';x,,;:,"':-'<:':"',.,i>
Control No: 040c005126
Assessed' ., Land,
Values" 28 '620
COUNTY OF CUMBER
SOIlTH.MIDDl.ETOK .
Rates.... .0
COUNTYR E . '. ....
Rates
COUNTY LIB
TAXPAYER COPY
2005 'Statement of Reel ESbde Taxes
Improvement Mineral
65 8900'
Bill No:
Bill Date:
Total
94. 510
1035
F TAXES ARE IN ESCROW, FORWARD TO MORTGAGE CO,
;1.Q()FE.E FORADplTIONAL RECEIPTS.
'AYABLE
TO:
TAX
~YER
r>"-'J-,;,:: " ..: .;':'~
COWAN, MARY H & MAURA
101 PINEROAD . .' .' .
MOUN"{ HOLLY SPRINGS PA 17065
J:f. Paid .~ Afte.r
J:f,..Paid '. or Before.
IF,NOT PAID BY 121141'20051HIS BILL W
cLAiM BUREAU FOR COLLECTlONAN'
YOUR'PROPERTYf'i' .
',',[;,," -
. .' . 12/1412005,
.. SEE REvERsE SIDE OF BIll FOR A BREAKDOWN of YOUR COUNTY TAX DO
FF1CE
~URS:
MON 10AM-7:30PM
TUES & WED 10AM-5:30PM
CLSD WKS OF 8/1-8n, 11/28-12/4
& HOLIDAYS PHONE (717)258-6517
REV.1510 EX + (1.9?!
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF A.J 1/
/~I4t<:- V Ii #/GP61L
I
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.
FILE NUMBER
r;2I-Q 7' -Q() 7 &
DESCRIPTION OF PROPERTY %OF
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE
ATTACH A CQPYOF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IF APPLICABLE)
NUMBER
1. /fly' ;KI t-
TOTAL (Also enter on line 7, Recapitulation) $ 0
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)g_~tt
~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ITEM
NUMBER
A
B
FILE NUMBER
02/-6Lf 00 b
DESCRIPTION
AMOUNT
FUNERAL EXPENSES
(~Ait7lA L f?4-. C!i&b1A--'/--r1 tJ~
CIIA-tlZ- j2~.AirAL
~OIJ 0
e L?P1-Ai I' ~ C-
~pljJ81?MS
-:rrJ v'1 TA-7T 4 Af -S
/101,710
/07. ~o
/~7. ;;L!
/e;- 9 5
c;:,? -3 J
~.Ii
7.50 C,.,/6'
:::Je<c;
ADMINISTRATIVE COSTS:
1.
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:
2.
Attorney Fees
3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State _Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
/1/ 6 8-'j . ;LS'
7.
YLL
A--7T;4ct-1 c:) - 14 / 5 c. ~y f'L",J S.t:-S'
TOTAL (Also enter on line 9, Recapitulation) $ /$
(If more space is needed, insert additional sheets of the same size)
~(l?)
-
;fA r$Cfl.ctlJ<JWU5 [:ff'uJSES
i. s+ eve. Nil-VI r" - 1~a.M> t<JJ.~
). Pv-wrt pe5+ - fx~"'"
3 V~
4 Sewif
5 {)-#io C MM~ /J1if"f / Jfr;r1tt ~ ~
b fi0C 1~ cW-
'1 h ~ W~
S. p~ W~
<1. (/oc./;J-r<-j ~c.JS' CU;M-"'6K-t.-~~iJ
D6f'c~ AtJ77 c~
10. { ,.t,J), pSfd-- \
I I, !<!.€y)Tbf'J{ f-J'" C b w\I,lI So" I M'.j
G '7 D. ()()
/St).5D
( I 7. 11
~ &.06
I .Q q, S-O
:2J~.3D
) bq.5~
50. 1~
g--9S-~tf7J
3~~
q 1,",0. dO
~
-
REV-1512 EX+ (12-03) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
FILE NUMBER
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
2.
3.
'1.
5.
itf..; 1 U)1i /lU5a f CMCL
c!wm~~ e~\{ Reo) t '7 fc;v/e Jt'v'f
130:-(011 ~ Dep~ S+ORe.
A 1'; 1 WI t<.e Ie ~5
c! IA./YYl ber Icvnd 6>ui1t ~G h (/0/ f ()..IY.-
3'f,Q(
I'3QO,Q3
33. II
11,IR
I&.~{)
1.
/ 1'l? - S-7
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
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!!!!!!!!!!!!!!
g~ j}VW-
We appreciate your
cardmembership.
MARY H COWAN
Account 4784 5580 0082 8849
Calling Card + PIN
Minimum Payment Due........................................... $34.91
Due Date~................................................. October 4, 2004
"'Payment must be received by 1;00 pm local time on the payment due date.
Amount Past Due.................................................... $19.41
Credit Line.......................................................... $10,500.00
Available Credit............................................................ $0.00
Cash Advance Limit............................................. $9,500.00
Available Cash Advance Limit.................................... $0.00
11:11.'.ft'!lmm.~!:1~~1Ii:li~~!~:~1~1!~I!:);!l!!!ii!:!I;!.l
Previous Balance
~iZ.mc~:~~ct~~j~stments
Total AT&T Services
New Balance
Note: Detailed activity starts on page 3.
3095
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$34.91
D~urn.o.nt Do",^rrl
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PGEN00010204
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Page 1 of 4
How To Reach Us
Visit: www.universalcard.com
Customer Service: 1 800423-4343 or write
Card member Services, PO Box 44167
Jacksonville, FL 32231-4167
The Annual Percentage Rate on your
account may increase due to one of the
following reasons stated in your Card
Agreement with us: jf you fail to make a
payment to us or any other creditor when
due, you exceed your credit line or you
make a payment to us that is not honored
by your bank.
IMPORTANT INFORMATION
ABOUT CREDIT REPORTING
WE MAY REPORT INFORMATION ABOUT
YOUR ACCOUNT TO CREDIT BUREAUS.
LATE PAYMENTS, MISSED PAYMENTS, OR
OTHER DEFAULTS ON YOUR ACCOUNT
MAY BE REFLECTED IN YOUR CREDIT
REPORT.
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Page 3 of 4
Trans Post Description
08/19 08/19 AD&D INS AUG
Total Payments and Adjustments
888-527-6808 TX
Amount
11.54CR
$11. 54CR
Purchases.. ............... .... .... ........... ............... .... ............................... .............. ............ ..... ............... .... ............ .... 0.00
Cas h Adva nces and Checks ............ ......... .... ................................................... ........... ....................... .....:... ... 0.00
Fi nance Charges ............ ... ........... ............ .............. ....... ............................................................................. ..... 0.50
Fees. ...... ......... ..... ..... ... .......... ........... ......................... ................ ............ ............ .......................... ............ ....... 15.00
Total VisaCard Activity....... ............... ............... ...... .......................... ............ ...................... ... .................... $15.50
4LJ1 Purchases
Total Visa Card Purchases.............................................. $0.00
\$\ I Cash Advances
Cash Advance Limit............................. $9,500.00' 'This represents a portion of your total credit line.
AnanceChargelnfonnation
Nominal Periodic
APR Rate
Days in
x Billing
Period
Periodic
~
CHARGE
Transacllon
+ Fee/~
CHARGE
Balance
x Subject 10
Finance Charge
PURCHASES
Standard Purch 12.490% .03422%(0) x 32
CASH ADVANCES
Standard Adv t9.990% .05477%(0) x 32
$21.33
+
$0.00
= ("')
x
=$.00
+
$0.00
$0.00
x
(*) One minimum FINANCE CHARGE of $0.50 was Imposed.
Total FINANCE CHARGE
I Fees
I Standard Purch
.Irans Post
09/14
Total Fees
D.escription
lATE FEE - AUG PAYMENT PAST our
MJMML
PERCENTAGE
RATE
12.490%
t9.990%
$0.50
Amount
.l5_.JtO
$15.00
AT&T Universal Calling Card Calls......................................................................................................... $0.00
IA;I\ Tc~n
2004-05 PERSONAL TAX NOTICE
CAMP HILL SCHOOL DISTRICT
MAKE CHECKS PAYABLE TO:
...-- ..-. .......1
** SCHOOL ** JULY 1 2004
JANET L MILLER
1939 WALNUT STREET
CAMP HILL PA 17011
PHONE 717-763-0177
I. WEDNESDAY 9:00AM TO 2:00PM
4:00PM TO 6:00PM
SEE NEWSLETTER FOR EXCEPTIONS TO
THESE HRS.
944
D1SCOUNr AND PENALTY HAVE BEEN COMPUTED FOR YOU A CONVENIENCE
PAY THIS AMOUNT
14.70
15.00
16.50
M
4.90
5.00
5.50
M
9.80
10.00
11.00
M
'YoP
M '- %P
ISCOUNT
ACE
ENALTY
M DURING THIS PERIOD
07/01-08/31
09/01-10/31
FTER 10/31
COWAN, MARY H.
230 N. 17TH ST.
CAMP HILL PA 17011
LAST DATE FOR EXONERATION
12/15/04
IF UNPAID BY 12/13/04 TAXES
WILL BE TURNED OVER TO
DELINQUENT COLLECTOR.
ACCT # 001-0000416
SS# 201-16-2164
JOB TITLE: HOMEMAKER
DAYS FROM DATE OF BILL
EXT 6365.
DEADLINE TO CORRECT OR APPEAL JOB TITLE IS 90
CALL 240-6365 OR 697-0371 EXT 6365 OR 532-7286
~ IF: YOU OESJRE:).A',RE~EIPn: ENCLOSE A STAMPED AOOR~SSEO ENVE[oPE WITH YOURlCQPIES
TAX YEAR
2004-05 PERSONAL TAX NOTICE
CAMP HILL SCHOOL DISTRICT
MAKE CHECKS PAYABLE TO:
DATE
** SCHOOL ** JULY 1 2004
ASSESSMENT
BILL NO. C2
JANET L MILLER
1939 WALNUT STREET
CAMP HILL PA 17011
PHONE 717-763-0177
I. WEDNESDAY 9:00AM TO 2:00PM
4:00PM TO 6:00PM
SEE NEWSLETTER FOR EXCEPTIONS TO
THESE HRS.
944
DISCOUNT AND PENALTY HAVE BEEN COMPUTED FOR YOUR CONVENIENCE
PAY THIS AMOUNT
14.70
15.00
16.50
M
9.80
10.00
11.00
M
'YoP
M 'YoP
ISCOUNT
ACE
ENALTY
M DURING THIS PERIOD
7/01-08/31
9/01-10/31
FTER 10/31
COWAN, MARY H.
230 N. 17TH ST.
CAMP HILL PA 17011
LAST DATE FOR EXONERATION
12/15/04
IF UNPAID BY 12/13/04 TAXES
WILL BE TURNED OVER TO
DELINQUENT COLLECTOR.
ACCT # 001-0000416
SS# 201-16-2164
JOB TITLE: HOMEMAKER
DAYS FROM DATE OF BILL
EXT 6365.
D~'.'r~~OB TITLE IS 90
CALL 240-6365 OR 697-0371 EXT 6365 OR 532-7286
I~ 11;."'"
-.-- ...-. ""...
2004-05 REAL ESTATE TAX NOTICE
CAMP HILL SCHOOL DISTRICT
MAKE CHECKS PAYABLE TO:
** SCHOOL **
JULY 1 2004
1
PA 10
I. WEDNESDAY 9:00AM TO 2:00PM
4:00PM TO 6:00PM
SEE NEWSLETTER FOR EXCEPTIONS TO
THESE HRS.
134,720
519
JANET L MILLER
1939 WALNUT STREET
CAMP HILL PA 17011
PHONE 717-763-0177
%P
M
%P
M
%P
M DURING THIS PERIOD
DISCOUNT AND PENALTY HAVE BEEN COMPUTED FOR YOUR CONVENIENCE
PAY THIS AMOUNT
1,684.65
1,719.03
1 890.93
ACCT: NO 01-21-0269-075
Ja et L. Miller, Tax Call ctor
ISCOUNT
ACE
ENALTY
230 N 17TH STREET
1,684.65
1,719.03
1 890.93
COWAN, MARY HARPER
230 NORTH 17TH STREET
CAMP HILL PA 17011
LAND
Residential Building
IF~'.:Ii~U.'~:"."~~mr
THIS BILL TO YOUR MORTGAGE COMPANY
IF UNPAID BY 12/13/04 TAXES WILL BE
TURNED OVER TO CUMBERLAND CO.
TAX CLAIM BUREAU.
$1.00 FEE FOR ADD'L RECEIPTS REQUESTED
003764109
10/06/04
33.11
o
DUE NOW
30.00
MARY H COWAN
230 N 17TH ST
CAMP HILL PA 17011-3910
1..111I11111111.11I11.1111 1111.1.1,1,111 11I,1111111 11111.1..11
REGULAR CREDIT PLAN (10)
U9/08/04 CORP
12.00
I All TI:AH
2004-05 REAL ESTATE TAX NOTICE
CAMP HILL SCHOOL DISTRICT
MAKE CHECKS PAYABLE TO:
JANET L MILLER
1939 WALNUT STREET
CAMP HILL PA 17011
PHONE 717-763-0177
SCHOOL R E
1 0 %pl 2 . 7 6 0 M
%P
1,684.65
1,719.03
1,890.93
ACCT NO 01-21-0269-075
COWAN, MARY HARPER
230 NORTH 17TH STREET
CAMP HILL PA 17011
I F.~'~"~lrf1i9""~'~'ft~~~";"."~
THIS BILL TO YOUR MORTGAGE COMPANY
........... ..-. "'""...
** SCHOOL ** JULY 1 2004
134,720
519
I. WEDNESDAY 9:00AM TO 2:00PM
4:00PM TO 6:00PM
SEE NEWSLETTER FOR EXCEPTIONS TO
THESE HRS.
%P
ICE
M %P
DISCOUNT AND PENALTY HAVE SEEN COMPUTED FOR YOUR CONVENIENCE
M DURING THIS PERIOD
PAY THIS AMOUNT
07/01-08/31
09/01-10/31
AFTER 10 31
DISCOUNT
FACE
PENALTY
1,684.65
1,719.03
1 890.93
230 N 17TH STREET
LAND
Residential Building
IF UNPAID BY 12/13/04 TAXES WILL BE
TURNED OVER TO CUMBERLAND CO.
TAX CLAIM BUREAU.
$1.00 FEE FOR ADD'L RECEIPTS REQUESTED
-
-
~ _ L- AT.T Wireless
EILEEN M SCANLAN
MARY COWAN
230 N 17TH ST
CAMP HILL PA 17011-3910
SUMMARY OF MONTHLY CHARGES FOR ACCOUNT 2202496606
Questions?
. attwireless.com
. 1-800-888-7600
. 611 from your Wireless phone
. TTY users -1 866 4-AWS-TTY
Date of Invoice: 10/13104
Your billing cycle began on 09/12 and ended on 10/11.
Current Monthly Charges
Monthly Service Charges
Home Airtime Charges
Home Long Distance Charges
Messaging, Content, Application & Wi-Fi
Roaming Charges
Other Charges and Credits
Taxes, Surcharges & Regulatory Fees
Total Current Monthly Charges
TOTAL AMOUNT DUE
Your Wireless Account is
Currently in Canceled status
.00
.00
.00
.00
.00
.00
.76CR
.76CR
You can now pay your invoice online @ www.attwireless.com/ocs
AT&T WIRELESS APPRECIATES YOUR BUSINESS
21.12
21.12
Note: =>
Weo"'~'
,.
r
. REV-1513 EX+ (9-00.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF , / /I
/111112-v JI/JlCfEfL ( ~J1,J
~AME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)J
NUMBER
I
FILE NUMBER
48011- c'f- CO 7J.6
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
1.
;\1 0 ,J f::--
II
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
;JO ~E-
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
tf uA1 t
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
o
(If more space is needed, insert additional sheets of the same size)
REV.1514EX . (1.97)
SCHEDULE K
LIFE EST A TE, ANNUITY
& TERM CERTAIN
Check Box 4 on Rev-1500 Cover Sheet
/) FilE NUMBER
12 YJ,u C ()J:4iJ ,-;2 / -- 0 ~ -(}(1 7 f"-f,
This sche Ie is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death
prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit.
Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5 -1-89.
Indicate the type of instrument which created the future interest below and attach a copy to the tax return.
D Will D Intervivos Deed of Trust D Other
lIF'E<ESTATEINTERESTCAl.CUtATION
NEAREST AGE AT
DATE OF DEATH
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DATE OF BIRTH
TERM OF YEARS LIFE ESTATE IS
PAYABLE
o Life or 0 Term of Years_
o Life or 0 Term of Years _
o Life or 0 Term of Years _
o Life or 0 Term of Years _
1. Value of fund from which life estate is payable
2. Actuarial factor per appropriate table
Interest table rate - 03 1/2% 06% 010% 0 Variable Rate
3. Value of life estate (Line 1 multiplied by Line 2)
ANNUI'tYIN'TEREST.C)\J..cUI...ATION
$
%
$
NAME(S) OF NEAREST AGE AT TERM OF YEARS
ANNUITANT(S) DATE OF BIRTH DATE OF DEATH ANNUITY IS PAYABLE
o Life or 0 Term of Years _
o Life or 0 Term of Years _
o Life or 0 Term of Years _
o Life or 0 Term of Years _
1. Value of fund from which annuity is payable $
2. Check appropriate block below and enter corresponding (number)
Frequency of payout - 0 Weekly (52) 0 Bi-weekly (26) 0 Monthly (12)
D Quarterly (4) D Semi-annually (2) D Annually (1) 0 Other ( )
3. Amount of payout per period $
4. Aggregate annual payment, Line 2 multiplied by Line 3
5. Annuity Factor (see instructions)
Interest table rate 031/2% 06% D 10% 0 Variable Rate %
6. Adjustment Factor (see instructions)
7. Value of annuity -If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period,
calculation is : Line 4 x Line 5 x Line 6 $
If using variable rate and period payout is at beginning of period, calculation is : r')
(line 4 x Line 5 x line 6) + line 3 $ ~ L
NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on
Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on
Lines 13,15,16 and 17.
(If more space is needed, insert additional sheets of the same size)
REV-1644 EX+ (3-64)
~i~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
II.
(L sl Name) (First Nome) (Middle Initial)
This schedule is appropriate only for estates of ~c#'Yfts dying on or before December 12, 1982.
This schedule is to be used for all remainder retur'~"~ election to prepay has been filed under the provisions
of Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust principal.
Remainder Prepayment:
A. Election to prepay filed with the Register of Wills on
(attach copy of election)
B. Name(s) of Life T enant(s) Date of Birth
or Annuitant(s)
INHERITANCE TAX
SCHEDULE ilL"
REMAINDER PREPAYMENT OR INVASION
OF TRUST PRINCIPAL
J
FILE NUMBER ,;2/-()"f/-cJcJ 7%
I. Estate of
(Dote)
Age on date
of election
Term of years income
or annuity is payable
C. Assets: Complete Schedule L- 1
1. Real Estate
2. Stocks and Bonds
3. Closely Held Stock/Partnership
4. Mortgages and Notes
5. Cash/Misc. Personal Property
6. Total from Schedule L-l
D. Credits: Complete Schedule L-2
1. Unpaid Liabilities
2. Unpaid Bequests
3. Value of Uninc\udable Assets
4. Total from Schedule L-2
$
$
$
$
$
$
$
$
$
III.
E. Total value of trust assets (Line C-6 minus Line D-4)
F. Remainder factor (see Table I or Table II in Instruction Booklet)
G. Taxable Remainder value (Line E x Line F)
(Also enter on Line 7, Recapitulation)
Invasion of Corpus:
A. Invasion of corpus
$
$
$
(Month, Day, Year)
B. Name(s) of Life Tenant(s)
or Annuitant(s)
Date of Birth
Age on date
corpus consumed
Term of years income
or annuity is payable
C. Corpus consumed
D. Remainder factor (see Table I or Table \I in Instruction Booklet)
E. Taxable value of corpus consumed (Line C x Line D)
(Also enter on Line 7, Recapitulation)
$
S
$
cJ
,.-
REV-l b4b EX + (3-84)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I. Estate of
~1AI2-i/ Ji4fLrVL
(fast Name)
I Description ~
A. Unpaid Liabilities Claimed against Original Estate, and payable from assets
reported on Schedule l- 1 (please list)
;Va tit-
INHERITANCE TAX
SCHEDULE L-2
REMAINDER PREPAYMENT ELECTION
-CREDITS-
arz-u/~(J
FILE NUMBER /;2/-0 ~ -{)67.fl;.;
(First Name)
(Middle Initial)
Amount
II. Item No.
Total unpaid liabilities $
(include on Section II, line 0-1 on Schedule l)
B. Unpaid Bequests payable from assets reported on Schedule l-l (please list)
Total unpaid bequests $
(include on Section II, Line 0-2 on Schedule l)
C. Value of assets reported on Schedule l-l (other than unpaid bequests listed under
"B" above) that are not included for tax purposes or that do not form a part
of the trust.
Computation as follows:
Total unincludable assets $
(include on Section II, line 0-3 on Schedule l)
III.
TOTAL (Also enter on Section II, line 0-4 on Schedule l)
(If more space is needed, attach additional 8J12 x 11 sheets.)
$
~
REV-1647 EX. (1-97)
SCHEDULE M
FUTURE INTEREST COMPROMISE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Check Box 4a on Rev.1500 Cover Sheet
FILE NUMBER
/2-{ L tfu.i0~ c2 /- 6 -u() 7 &b
This hedule is appropriate only for estates of decedents dying after December 12, 1982.
This schedule is to be used for all future interests where the rate of tax which will be applicable when e fu re interest vests in possession
and enjoyment cannot be established with certainty.
Indicate below the type of instrument which created the future interest and attach a copy to the tax return.
o Will 0 Trust 0 Other
I. Beneficiaries
NAME OF AGE TO
BENEFICIARY RELATIONSHIP DATE OF BIRTH NEAREST BIRTHDAY
1.
2.
3.
4.
5.
II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months
of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such
withdrawal right.
o Unlimited right of withdrawal o Limited right of withdrawal
III. Explanation of Compromise Offer:
IV. Summary of Compromise Offer:
1. Amount of Future Interest $
2. Value of Line 1 exempt from tax as amount passing to charities, etc.
(also include as part of total shown on Line 13 of Cover Sheet) $
3. Value of Line 1 passing to spouse at appropriate tax rate
Check One 06%, 03%, 00%
(also include as part of total shown on Line 15 of Cover Sheet) $
4. Value of Line 1 Taxable at 6% Rate
(also include as part of total shown on Line 16 of Cover Sheet) $
5. Value of Line 1 Taxable at 15% Rate
(also include as part of total shown on Line 17 of Cover Sheet) $ 0
6. Total value of Future Interest (sum of Lines 2 thru 5 must equal Line1) $
(If more space is needed, insert additional sheets of the same size)
I
.REV-1648~EX (1-921
'*'
SCHEDULE N
SPOUSAL POVERTY CREDIT
COMMONWEALTH OF PENNSYLANIA
INHERITANCE TAX DIVISION
ESTATE OF
1. Taxable Assets total from line 8 (cover sheet) .................................................................... 1.
2. Insurance Proceeds on Life of Decedent............................................................................ 2.
3. Retirement Benefits..................... ............. ............ ........................... ........... ..................... 3.
4. Joint Assets with Spouse ................................................................................................. 4.
5. PA Lottery Winnings ...................................................................................................... 5.
6d.
6a. Other Nontaxable Assets: List (Attach schedule if necessary).. 6a.
6b.
6c.
6. SUBTOTAL (Lines 6a, b, c, d) ......................................................................................... 6.
7. Total Gross Assets (Add lines 1 thru 6)............................................................................. 7.
8. Total Actual Liabilities .................................................................................................... 8.
9. Net Value of Estate (Subtract line 8 from line 7)................................................................ 9.
If fine 9 is greater than $200 000 - STOP The estate is not eligible to claim the credit If not continue to Part /I
PART II - CALCULATION OF JOINT EXEMPTION INCOME - (Attach copies of Federal Individual Income
Tax Returns for decedent and spouse. )
Income: 1. TAX YEAR: 19 2. TAX YEAR: 19 3. T AX YEAR: 19
a. Spouse. .... ....... ... ....... 1a. 2a. 30.
b. Decedent.................. . lb. 2b. 3b.
c. Joint .......................... 1c. 2c. 3c.
d. Tax Exempt Income..... 1d. 2d. 3d.
e. Other Income not
listed above ........... 1e. 2e. 3e.
f. Total.......................... If. 2f. 3f.
4. Average Joint Exemption Income Calculation
4a. Add Joint Exemption Income from above:
(H)
+ (2f)
+ (3f)
=
1+ 3)
4b. Average Joint Exemption Income ..................................................................................... =
If line 4(b) is greater than $40,000 - STOP. The estate is not eligible to claim the credit. If not, continue to Part III.
PART III _ CALCULATION OF SPOUSAL POVERTY CREDIT FOR RESIDENT AND NONRESIDENT
ESTATES
1. Insert amount of taxable transfers to spouse or $100,000, whichever is less.......................... 1.
2. Multiply by credit percentage (see instructions) .................................................................. 2.
3. This is the amount of the Resident Sp.ousal Poverty Credit. Include this figure
in the calculation of total credits on line 18 of the cover sheet. ............................................ 3.
4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the
decedent's gross estate...................................,'.... ................................... ....................... 4.
5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal .?\
Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet. 5. U
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
NO. CD 005695
COWAN NANCY
1119 GREEN STREET
HARRISBURG, PA 17102
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
______H told -~----._-- --------
101 I $16,091.00
ESTATE INFORMATION: SSN: 201-16-2164 I
FILE NUMBER: 2104-0786 I
DECEDENT NAME: COWAN MARY HARPER I
DA TE OF PAYMENT: 08/16/2005 I
POSTMARK DATE: 08/16/2005 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 08/10/2004 I
I
TOTAL AMOUNT PAID: $16,091.00
REMARKS:
CHECK#132
INITIALS: JA
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
02-13-2006
COWAN
08-10-2004
21 04-0786
CUMBERLAND
101
APPEAL DATE: 04-14-2006
( See reverse side under Objections)
Amount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
~Yr_~~9~~_r~!~_~!~~------~-__~~!~!~_~9~~~_~9~!!9~_E9~_Y9Y~_~~~9~~~__~____________________
REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
MARY H FILE NO. 21 04-0786 ACN 101
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
.. -- 'ApPRAISEI1ENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSI1ENT OF TAX
".~ I.'
;~ j
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
NANCY COWAN
1119 GREEN ST
HBG
PA 17102
ESTATE OF
COWAN
REV-1547 EX AFP (06-05)
MARY
H
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
DATE 02-13-2006
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. 110rtgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/l1isc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
149,900.00
193.484.00
.00
.00
6.375.00
23.001. 00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/l1isc. Expenses (Schedule H)
10. Debts/l1ortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
13,195.00
1.997.00
(1lJ
(12)
(13)
(14)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
372,760.00
11;.192 no
357,568.00
.00
357,568.00
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
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)
19. Principal Tax Due
TAX CREDITS:
.00 X 00 = .00
357,568.00 X 045 = 16,091.00
.00 X 12 = .00
.00 X 15 = .00
(19)= 16,091.00
. n. " .~~. (+J AI10UNT PAID
DATE NUI1BER INTEREST/PEN PAID (-)
08-16-2005 CD005695 .00 16,091. 00
BALANCE OF UNPAID INTEREST/PENALTY AS OF 08-17-2005 TOTAL TAX CREDIT 16,091.00
BALANCE OF TAX DUE .00
INTEREST AND PEN. 216 . 04
TOTAL DUE 216 . 04
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYI1ENT IS REQUIRED. @
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU I1AY BE DU
A REFUND. SEE REVERSE SIDE OF THIS FORI1 FOR INSTRUCTIONS.)
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 7/05/2006
COWAN NANCY
1119 GREEN STREET
HARRISBURG, PA 17102
RE: Estate of COWAN MARY HARPER
File Number: 2004-00786
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by:
8/10/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
/r .G&' ..Ll- L /J
llbwiz.~ l.~U' ,~~~-"
/1
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
~
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 7/05/2006
COWAN NANCY
2601 NORTH THIRD STREET
PO BOX 2649
HARRISBURG, PA 17105-2649
RE: Estate of COWAN MARY HARPER
File Number: 2004-00786
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES I NO. 103
SUPREME COURT RULES DOCKET NO. 11 for decedents dying on or after
July 11 19921 the personal representative or his counsell within two
(2) years of the decedent's deathl shall file with the Register of
wills a Status Report of completed or uncompleted administration.
This filing lS due by:
8/10/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report I please disregard
this notice.
SincerelYI
(.-#, ~
'/" r
Lm?,.4M...rJ)~ " ,.,,'
Glenda Farner Strasbatlgh
Clerk of the Orphans' Court
cc: File
Personal Representative(s)
~
In Re: Estate of
COW AN MARY HARPER
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 2004-00786
NOTICE OF FAILURE TO FILE STATUS REPORT
Personal Representative:
COW AN NANCY
Counsel for Personal Representative: COWAN NANCY
Date of Decedent's Death: 8/10/2004
The Orphans' Court record indicates that neither the above named personal representative
nor the above named counsel for the personal representative have filed with the Register of Wills
or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme
Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court
Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report.
If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of
such delinquency and the undersigned will requests that a Court conduct a hearing to determine
whether sanctions should be imposed upon the delinquent personal representative or counsel for
the delinquent personal representative.
Date:
8/29/2006
l" ~,.:~' (~-:. I A ft
.M~h~ 'v-ftl)UM/~J./ ;&i;d~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
o
o
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o
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'esentative
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UNITED STATES POSTAL SERVICE
H/\RRI;::;gLJFI;G
1::!' .~~~~:
'USPS
~ " Pee ;L. G-10 "
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· Sender: Please print your name, addressrlnd ZIP+4~this box · . ,,,,,,~.'"
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C-Zrn -ClI..,---- r<I In
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Glenda Farner Strasbaugh o8~ -0 (c~ (-~
Register of Wills and Clerk ~~'""hans~ourti~ S~
County of Cumberland .::p -i ;. :.-',; ,')
One Courthouse Square,..j;> C" '
Carlisle, PAL 70 13
r.'). ". ,.....11.,
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SENDER: COMPLETE THIS SECTION
. .
.
. Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
. Print your name and address on the reverse
so that we can return the card to you.
. Attach this card to the back of the mailpiece,
or on the front if space permits.
A. Signature /J
~ ./~ I / / '\..0 Agent
/' ,,(~.'"'-<:~ . -'~_____ !i:l.Addressee
B. Received by ( Print~d Name) I C. Date of Delivery
D. Is delivery address different from item 1? 0 Yes
If YES, enter delivery address below: 0 No
1. Article Addressed to:
COVJAN NANCY
]119 GREEN STREET
HARRISBURG PA 17102
3. Service Type
~ Certified Mail
--P Ae!jistGlrliUil
o Insured Mail
q Express Mail
EI Return Receipt for Merchandise
o C.O.D.
4. Restricted Delivery? (Extra Fee)
o Yes
Domestic Return Receipt
2. Article Number
(Transfer from service label)
PS Form 3811 , February 2004
7005 0390 0003 2639 0100
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
COWAN NANCY
1119 GREEN STREET
HARRISBURG, PA 17102
n_n___ fold
ESTATE INFORMATION: SSN: 201-16-2164
FILE NUMBER: 2104-0786
DECEDENT NAME: COWAN MARY HARPER
DA TE OF PAYMENT: 09/19/2006
POSTMARK DATE: 09/18/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 08/10/2004
NO. CD 007222
ACN
ASSESSM ENT
CONTROL
NUMBER
AMOUNT
101 I $216.04
I
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I
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I
TOTAL AMOUNT PAID:
REMARKS: COWAN NANCY
CHECK# 4722
SEAL
INITIALS: AJW
RECEIVED BY:
REGISTER OF WILLS
$216.04
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
------
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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
=: ;J:NHERITANCE TAX
SiATEMENT OF ACCOUNT
REV-1607 EX AFP (03-05)
NANCY COWAN
1119 GREEN ST
HBG
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
10-10-2006
COWAN
08-10-2004
21 04-0786
CUMBERLAND
101
MARY
H
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23
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Amount Remitted
PA 17102
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, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE
-+
RETAIN LOWER PORTION FOR YOUR RECORDS
+-
REV-1607 EX AFP (03-05)
---------------------------------------------------------------------------
~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ...
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.
ESTATE OF COWAN
MARY
H FILE NO.21 04-0786
ACN 1 01
DATE 10-10-2006
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-02-2006
PRINCIPAL TAX DUE: 16,091.00
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
08-16-2005 CD005695 .00 16,091. 00
09-18-2006 CDOO7222 216.04- 216.04
TOTAL TAX CREDIT 16,091. 00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
1lI 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" (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
~
. '
Register of Wills of Cumberland County
STATUS REPORT UNDER RULE 6.12
/1;4 tcr' ~/C {~ i/>i,J
Name of Decedent: ~1 A /2..1/
. /
DateofDeath: 1~o/Of
/
Estate No.: :J..t 0 4- () 7 ~.~
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 pg.:. 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?
Yes.~ No 0
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the person&representative state an account informally to the parties in
interest? Yes 2Sl 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 report.
Date:~~
:? Cl ;;
:. 07n7
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Capacity:
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Name /
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Address ;J/~uJ€0 ,031-
(7/ 7 \~5~-j~,~
Telephone No.
M"Personal Representative
. 0 Counsel for personal representative
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