HomeMy WebLinkAbout04-0744Register of Wills Cumberlandcounty, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of Donna J. Parks
also known as Donna Jane Parks
, Deceased
Ray Richard Strayer,
{COMPLETE "A" OR "B~ BELOW:}
Social Security No.
164-30-2891
A. Probate and Grant of Letters and aver that Petitioner(sD is/are the execut or named in the Last Will of the
Decedent, dated July 7~ 2004 and codicil(s) dated
Except as follows, Decedent did nor marry, wes not divorced, and did not have a child horn or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incompetent:
B. Grant of Letters of Administration
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse
any) and heirs:
Name Ralstionship ~._., ~ Ras~denc.e :~
{COMPLETE IN ALL CASES:) Attach additional = heats if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal
residence at 1280-A Boiling Springs Road, Boiling Springs, Allen Township, Cumberland County, Pennsylvania 17007
Decedent, then 66 years of age, died August 3 ,20 0~_, at 1280-A Boiling Springs Read, Boiling Springs.
Decedent at death owned property with estimated values as follows: en Township, Cumberland County, PA
(If domiciled in PA) All personal property .............................. $ 100,000.00
(if not domiciled in PA) Personal property in Pennsylvania ...................... $
(If not domiciled in PA) Personal property in County ..........................
Value of real estate in Pennsylvania ............................................... $ 150,000.00
Total
.......................................................... s 250 000.00
Peel Estate situated as follows: 1280-A Boiling Spr nqs Road~ Boilinq Sprinqs, Allen Township, Cumbe~an ounty,
Wherefore, Petitioner(si respectfully request(s) the probate of the last Witl ar~ Codicil(si presented with this Petition and the grant of letters in the
appropriate form to the undersigned:
~/~.*~ Signature Typedorprinted,ameand residence
~'/?C~ /~ ~J.~./~._/ Ray Richard Strayer
889 King Street, Lewisberry, PA 17339
RW-7
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and
~orrect to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent,
Petitioner(s) will well and truly administer the estate according to law.
Sworn to and affirmed and subscribed
before me this ... { /'~- ' day of
2004
/q
Strayer
DECREE OF REGI
Estate of Donna J. Parks
also known as Donna Jane Parks
Deceased
.o.D.I- oq-qq
Social Security No: 164-30-2891
Date of Death: August 3, 2004
AND NOW, , 20. , in consideration of the Petition
on the reverse side hereon, ~atisfactory proof having been presented before me,
iT IS DECREED that Letters [~ Testamentary [] of Administration
are hereby granted to Ray Richard Strayer
in the above estate and that the instrument(s), if any, dated July 7, 2004
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters ...........................
Short Certificate(s) ..........
Renunciation ..................
Affidavit ( ) .................
Extra Pages ( ) ............
Codicil ..........................
JCP Fee ........................
Inventory & Tax Forms...
Other ............................
R~-7a
Attorney: Crai,q A. Hatch~ Esquire
I.D. No: 76361
Address: Gates, Halbruner & Hatch, P.C.
1013 Mumma Road, Suite 100, Lemoyne, PA 17043
Telephone: (717) 731-9600
DATE FILED: ~ ,,x-
Cumberland
1280 A Boiling Springs Road
Boiling Springs, Pennsylvania 17007
COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
~onna Jane Parks 2 Female ~ 164 -- 30 2891
HerndonR Strayer
Bernice E Gettys
889 King Street Lewisbem/ Pa 17339
Conolite Crematory ~,. Scha~ffers~owr[ Pa 17088
- // '"'"': .... ~' dy
Will of Donna J. Parks
Part 1. Personal Information
I, Donna J. Parks, a resident of the State of Pennsylvania, Cumberland County, declare
that this is my will. My Social Security number is 164-30-2891.
Part 2. Revocation of Previous Wills
I revoke all wills and codicils that I have previously made.
Part 3. Children ~
I have the following children now living: Arthur James Parks and Margaret Marie Lee.
Part 4. Grandchildren
I have the following grandchildren now living: Brian Dominick Yufer, my grea~-grandson
and Brian Todd Yufer.
Part 5. Dispogition of Property
All beneficiaries must survive me for 45 days to receive property under this will. As used
in this will, the phrase "survive me" means to be alive or in existence as an organization on
the 45th day after my death.
All personal and'real property that I leave in this will shall pass subject to any
encumbrances or liens placed on the property as security for the repayment ora loan or
debt.
IfI leave property to be shared by two or more beneficiaries, it shall be shared equally by
them unless this Will provides otherwise.
IfI leave property to be shared by two or more beneficiaries, and any of them does not
survive me, I leave his or her share to the others equally unless this will provides
otherwise for that share.
"Specific bequest" refers to a gift of specifically identified property that I leave in this will.
"Residuary estate" means all property I own at my death that is subject to this will that
does not pass under a specific bequest, including all failed or lapsed bequests.
I leave my birthstone ring; wedding rings; Mother's ring; big screen television; my Bible;
my shawl; and, for reasons best known to her, the amount of one thousand dollars
($1,000) to Margaret Marie Lee. If Margaret Marie Lee does not survive me, I leave this
property to Brian Dominick Yufer, my great-grandson.
: )
Will of Donna J. Parks
I leave the angel pictures and pictures of Christ I painted; my bedroom suite, which is
already in his possession; my IBM compatible computer; one (1) of my state quarter
collection books; and, for reasons best known to him, the amount of one thousand dollars
($1,000) to Brian Todd Yufer. If Brian Todd Yufer does not survive me, I leave this
property to Brian Dominick Yufer, my great-grandson.
I leave my adjustable (hospital type) bed to Keith Strayer. IfKeith Strayer does not
survive me, I leave this property to Ray Richard Strayer, Rosella Jean House, Nancy May
McCoy and Winnifred Ida Kovecevic in equal shares.
I leave pictures of my brother and sisters; the bedroom furniture from my second
bedroom, which is already in his possession; my roll-top desk; one (1) of my state quarter
collection books; and the balance remaining (after satisfying any and all debts owed by
me) from the sale of my homes and automobile to be placed in a trust fund I have
established at F& M Trust to Brian Dominick Yufer, my great-grandson, the joy of my
life.
I leave the amount of forty thousand dollars ($40,000) to Ray Richard Strayer, Rosella
Jean House, Nancy May McCoy and Winnifred Ida Kovecevic in equal shares.
I leave my krugerrand; and, the amount of thirty thousand dollars ($30,000) to Arthur
James Parks. If Arthur James Parks does not survive me, I leave this property to Brian
Dominick Yufer, my great-grandson.
I leave my blue-point Persian cat, Tiffany to Peggy Ann Harter. If Peggy Ann Harter does
not survive me, I leave this property to Sandra Lee Massie.
I leave my two (2) remaining cats, Pita and Printz; and, the amount of one thousand
dollars ($1,000) for the loving care they gave me during my illness to John Backenstoes
and Loft Backenstoes in equal shares.
I leave the amount of five thousand dollars ($5,000) to the Helen O. Krause Animal
Foundation, Inc.
I leave the amount of five thousand dollars ($5,000) to the ministry of Dale Danner and
the ministry of Kay Danner in equal shares.
I leave the amount of one thousand dollars ($1,000) for the loving care she gave me
during my illness to Sandra Lee Massie. If Sandra Lee Massie does not survive me, I leave
this property to Peggy Ann Harter.
Page2of$ Initial,:~/~_~_ --~t~\ Date:
Will of Donna J. Parks
I leave the amount of one thousand dollars ($1,000) for the loving care she gave me
during my illness to Sue Miller. If Sue Miller does not survive me, I leave this property to
Owen Strickler, Ashlee Peters, Eric Peters, Amanda Stine and Jacob Stine in equal shares.
I leave my residuary estate to Brian Dominick Yufer, my great-grandchild.
Part 6. Executor
I name Ray Richard Strayer to serve as my executor. If Ray Richard Strayer is unwilling
or unable to serve as eXecutor, I name Rosella Jean House to serve instead.
No executor shall be required to post bond.
Part 7. Executor's Powers
I direct my executor to take all actions legally permissible to have the probate of my will
done as simply and as free of court supervision as possible under the laws of the state
having jurisdiction over this will, including, filing a petition in the appropriate court for the
independent administration of my estate.
I grant to my' executor the following powers, to be exercised as he or she deems to be in
the best interests of my estate:
1) To retain property without liability for loss or depreciation.
2) To dispose of property by public or private sale, or exchange, or otherwise, and
receive and administer the proceeds as a part of my estate.
3) To vote stock, to exercise any Option or privilege to convert bonds, notes, stocks or
other securities belonging to my estate into other bonds, notes, stocks or other
securities, and to exercise all other rights and priv!leges of a person owning similar
property.
4) To lease any real property in my estate.
5) To abandon, adjust, arbitrate, compromise, sue on or defend and otherwise deal with
and settle claims in favor of or against my estate.
6) To continue or participate in~ any business which is a part of my estate, and to
incorporate, dissolve or otherwise change the form of organization of the business.
The powers, authority and discretion I grant to my executor are intended to be in addition
to the powers, authority and discretion vested in him or her by operation of law by virtue
. i..~) ~ ' rC?
Page3of5 Initials:~/.~_ /~~Date: ¢~.~&~
Will of Donna J. Parks
of his or her office, and may be exercised as'often as is deemed necessary or advisable,
without application to or approval by any court.
Part 8. Payment of Debts
Except for li~ns and encumbrances placed on property as security for the repayment of a
loan or debt, I want all debts and expenses owed by my estate to be paid using the
following assets in the order listed: any and all bank accounts remaining at the time of my
death.
Part 9. Payment of Taxes
I want all estate and inheritance taxes assessed against property in my estate or against my
beneficiaries to be paid in the manner provided for by the laws of Pennsylvania.
Part 10. No Contest Provision.
If any beneficiary under this will contests this will or any of its provisions, any share or
interest in my estate given to the contesting beneficiary under this will is revoked and shall
be disposed of as if that contesting beneficiary had not survived me.
Part 11. Severability
If any provision of this will is held invalid, that shall not affect other provisions that can be
given effect without the invalid provision.
Signature
I, Donna J. Parks, the testator, sign my name to this instrument, this ~ -~-~ day
declare that I sign and execute t~s instrument as my last will, that I sign it ~llin~y, ~d
that I execute it as my free and volunta~ act. I declare that I am of the age of majority or
othe~ise legally empowered to make a will, and under no constraint or undue influence.
Signature: ~ '~/~?~, :-~- :--~ '~'~ "-~-~
Witnesses
We, the witnesses, sign our names to this instrument, and declare that the testator
~llingly signed and executed t~s instrument as the testator's last will.
In the presence of the testator, and in the presence of each other, we sign this will as
witnesses to the testator's signing.
Will of Donna J. Parks
To the best of our knowledge, the testator is of the age of majority or otherwise legally
empowered to make a will, is mentally competent and under no constraint or undue
influence.
We declare under penalty of perjury that the foregoing is true and correct, this dayof _] ~[ q, 2~.,: q ,at
Residing at: l 2~ 5 ~.~ .... ~2~. (~5 . ~.~ ~,
Witness ~-" .. _ ~. ~ .... 0 ~
..... 0 ~ ,~ - -- d-~--~'
/ 70 :: 7
Page 5 of 5 Initials:
Affidavit
ACKNOWLEDGMENT
Commonwealth of Pennsylvania
Countyof: ~':c~v~,[.~c'r I£~ ,,cl,
I, x ~)/. )~ )/? .~ f'J ',;:/~J, the testator whose name is signed to the
attached or foregoing instrument, ha~ng been duly qualified according to law, do hereby
ac~owledge that I signed and executed the instrument as my Last Will; and that I signed
it willingly ~d ~ my ~ee and volunt~, act~he pu~oses therein expressed.
C
Testator',. ~-
~ T. ~, ~' ~blic
AFFIDAVIT
Commonwealth of Pennsylvania
witnesses whose names are signed to the attached or foregoing tnstrument, having been
duly qualified according to law, do depose and say that we were present and saw the
testator sign and execute the instrument as his/her Last Will; that the testator signed
willingly and executed it as his/her free and voluntary act for the purposes therein
expressed; that each subscribing witness in the hearing and sight of the testator signed the
will as a witness; and that to the best of our knowledge the testator was at that time 18 or
more years of age, of sound mind and under no constraint or undue influence.
Sworn to or affirmed and subscribed to before me by
and
this '-~>, dayof .'~c,\q , ?~6~t
Witness: :~c.~.~;~_' ~'~"1 (..a.~ :_
1~ . i//~ ~,? ',
~witnesses,
~Carol~ T ~, Notary Public
M~'~a~', Pefm-qyiv~a AssoCmtion of N ora rie~
Affidavit -- Page 1 of 1
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Donna J. Parks
Date of Death:
August 3, 2004
File No.: 21-04-0744
To the Register:
I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on October /'~, 2004.
Name Address
Margaret M. Lee
Arthur J. Parks
Brian T. Yufer
Brian D. Yufer, c/o Brian T. Yufer
Ray R. Strayer
Keith Strayer
Rosella Jean House
Nancy May McCoy
Winnifred I. Kovecevie
John & Lori Backenstoes
Peggy Ann Hatter
Sandra Lee Massie
Sue Miller
Helen O. Krause Animal Foundation, Inc.
Dale & Kay Danner
115 North Street, Harrisburg, PA 17101
1067 Shadowridge Drive, g40, Vista, CA 92081
126 Cedar Village Drive, York, PA 17402
126 Cedar Village Drive, York, PA 17402
889 King Street, Lewisberry, PA 17339
436 Clover Road, Etters, PA 17319
815 West Keller Street, Mechanicsburg, PA 17055
Big Springs Terrace, Lot 155, Newville, PA 17241
40 Burwick Drive, Mechanicsburg, PA 17055
1284 Boiling Springs Road, Boiling Springs, PA 17007
1288 Brandt Road, Mechanicsburg, PA 17055
1283 Boiling Springs Road Bc~ifi~ Springs, PA 17~7
1130 Boiling Springs Road, B ~o~t.~j~ Spri~s, PA I~7i307
P. O. Box 311, Mechanicsburgi?A 1705~0311
1 Briarwood Court, Mechanicsburg, PA 12~055
?
Notice has now been given to all persons entitled thereto under Rule 5.6(a).
Co r rsonal ~epres e
GATES, HALBRUNER & HATCH, P.C.
1013 Mumma Road, Suite 100
Lemoyne, PA 17043
(717) 731-9600
Dated: October /~, 2004
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF JNDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
REV-1162 EX(11 96)
NO. CD 004564
STRAYER RAY RICHARD
889 KING STREET
LEWISBERRY, PA 17339
....... f01d
ESTATE INFORMATION: SSN: 164-30-2891
FILE NUMBER: 21 04- 0744
DECEDENT NAME: PARKS DONNA J
DATE OF PAYMENT: 11/01/2004
POSTMARK DATE: 11/01/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 08/03/2004
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $24,000.00
REMARKS:
TOTAL AMOUNT PAID:
$24,000.00
SEAL
CHECK# 118
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF
THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE FORM 6.12 YEARLY
UNTIL COMPLETION.
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Date of Death:
Will No.:
Donna J. Parks
August 3, 2004
21-04-0744
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following w~
respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete: No
2. If the answer is No, state when the personal representative reasonably believes that the
administration will be complete: December 2005
3. If the answer to No.1 is yes, state the following:
A. Did the personal representative file a final account with the court? N/A
B. The separate Orphans' Court No. (if any) for the personal representative's
account is: NI A
C. Did the personal representative state an account informally to the parties in
interest? NI A
D. Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of Orphans' Court and may be attached to
this report.
Date: April 28, 2005
Capacity: Counsel for Personal Representative
JJf
REV-1500EX(&
nllPD
OFFlClAl USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DE PT 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21
COlMY CODE
04
0744
-----
YEAR
I'lMlER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
!z Parks Donna
~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
~ 8/3/2003 7/4/1938
W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
C
J
SOCIAL SECURITY NUMBER
164-30-2891
THIS RETUFIII MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~ [j] 1. Original Retum
\.:~CI)D
~ g:~ 4. Limited Estate
:J: 00 IJtl
o a:.... ~ 6. Decedent Died Testate (Attach copy of Will)
lLlIl
~ D 9. Litigation Proceeds Received
D 2. Supplemental Return D 3. Remainder Retum (date of death priorto 12-13-82)
D 4a. Future Interest Compromise (dale of death after 12-12-82) D 5. Federal Estate Tax Retum Required
D 7. Decedent Maintained a Living Trust (Attach copy of Trust) L 8. Total Number of Safe Deposit Boxes
D 10. Spousal Poverty Credit (dale of death between 12-31-91 and '.1-95) D 11. Election to tax under Sec. 9113(A) (Attach SchO)
...
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THIS SECTION MUST BE COMPLETED.ALLCOFlFlESPONDENCE ANDCONFIDamAi. TAX INP()flMATIoN StiOtJLDsE OIll1ic'lcDToe
NAME COMPLETE MAILING ADDRESS
Craig A. Hatch, Esquire 1013 Mumma Road, Suite 100
FIRM NAME (If Applicable)
Gates, Halbruner & Hatch, P.C. Lemoyne, PA 17043
TELEPHONE NUMBER
717-731-9600
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6. J~ Owned Property (Schedule F)
L.J Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
(6)
$197,992.00
$5,856.16
$0.00
$0.00
$235,713.49
$0.00
OFFICIAL USE ONLY
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)
$29,206.66
8. Total Gross Assets (total Lines 1-7)
$468,768.31
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedul.') (10)
(8)
$49,806.23
$29,443.19
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
(13)
$79,249.42
$389,518.89
$0.00
11. Total Deductions (total Lines 9 & 10)
(11)
12. Net Value 01 ESlate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(12)
14. Net Value Subject to To. (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
$389,518.89
15. Amount of Line 14 taxable at the spousal tax $0.00 ..0 ~(15)
Z rate, or transfers under Sec. 9116 (a)(1.2)
0
i= 16. Amount of Line 14 taxable at lineal rate $341,018.89 X.O 45 (16)
<(
...
::> $40,000.00
I>. 17. Amount of Line 14 taxable at sibling rate x.12 (17)
:!!
0 $8,500.00
(,) 18. Amount of Line 14 taxable at collateral rate x.15 (18)
><
<( 19. To. Due (19)
I-
20. ~
$0.00
$15,345.85
$4,800.00
$1,275.00
$21,420.85
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUE8nONS ON REVERSE SIDE AND RECHECK MATH < <
3W4645 1.000
v-
Decedent's Complete Address:
STREET ADDRESS
1280-A Boiling Springs Road
Cumberland
CITY I STATE I ZIP
Boiling Springs PA 17007-
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
$0.00
$24,000.00
$1,200.00
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
$0.00
$0.00
Total Interest/Penalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
(4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
A. Enter the interest on the tax due.
(SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
Ma~e Chec;k Pa able to:R~OFWH.LS,AGENT
(58)
;'~fali'm~l!~liiit~~^i;',fII0J,~,'F~~ . :~'"
$21,420.85
$25,200.00
$0.00
$3,779.15
$0.00
$0.00
$0.00
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and; Yes
a. retain the use or income of the property transferred;. . . . . . . . . . . . . . . D
b. retain the right to designate who shall use the property transferred or its income; . D
c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . D
d. receive the promise for life of either payments. benefits or care? . . . . . . . . . D
2. If death occurred after December 12,1982. did decedent transfer property within one year of death
without 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 ANSWEFl 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 retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete.
Declafalion of preparer other than the personal representative is based on all Information of which preparer has any knowledge.
SIGNA RE OF PEAS RESPONSIBLE FOR FILING RETURN
No
D9
D9
D9
D!l
D!l
Q!l
DATE
-:.o~
REPRESENTATIVE
Lewisberry, PA 17339
DATE
/f /;L 8'" (,:;lO.sS-
Lemoyne, PA 17043
f'';';'K'a:.'.iHg&i;;/4?'@8ti*"BT0~TI&.2f~~_w__~~4W'~411!"
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. 89916 (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 exemot a transfer to a surviving spouse from tax. and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1. 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. 8 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. S 9116(1.2) [72 P .S. S 9116(a)(1 )].
The tax rate imposed on the net value of transfers to or for the use oftha decedent's siblings is 12% (72 P.S. 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
Donna J. Parks
21 04 0744
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)olntIY-<lwned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION
NUMBER
1. Real Estate
VALUE AT DATE
OF DEATH
li197,992.00
Two single-family dwellings,
both being Tax Parcel No.
22-28-2401-010; located at
1280 Boiling Springs Road,
Boiling Springs, Monroe
Township, Cumberland County,
Pennsylvania; transferred to
Donna J. Parks by the
Administrator of Veterans
Affairs, an Officer of the
United States of America, by
its deed dated May 24, 1983,
and recorded on June 10, 2083,
in the Cumberland County
Recorder of Deeds Office at
Deed Book F, Volume 30, Page
749. Value is net sales price.
See attached copy of
Settlement Statement.
3W4695 1.000
TOTAL (Also enter on line 1, Recapitulation)
(If more space is needed. insert additionai sheets of the same size)
$
$197,992.00
REV-1503 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
Donna J. Parks
21 04 0744
All property Jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.68 Shares
of IBM common stock $5,856.16
noD High $86.80 per share; noD
Low $85.44 per share; noD
Average $86.12 oer share
3W46961.000
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
$5,856.16
REV.1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Donna J. Parks
FILE NUMBER
21 04 0744
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property lolntlv-owned with the right 01 survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1
1989 Mercedes Benz
VIN WOBBA2606KA873160
$5,000.00
value is proceeds from sale
2
AmeriChoice Federal Credit
Union
Savings Account No. 8412
$1,907.81
3
AmeriChoice Federal Credit
Union
Checking Account No. 8412
$3,075.59
4
AmeriChoice Federal Credit
Union
Checking Account No. 8412
$4.07
5
Comcast Cable
refund
$5.52
6
F&M Trust
Checking Acct. No. 34-34273
$211,571.76
Interest accrued to 8/3/2003
$4.62
7
F&M Trust
Savings Acct. No. 70-33699
$13,471.10
Interest accrued to 8/3/2003
$5.09
8
Liberty Mutual
insurance premium refunds on
Policy Nos. A02-563456-804,
FN2-281-665162-804 and
H32-281-665161-804
$575.15
9
Toews Corporation
refund of investment security
benefit
$92.78
3W46AD 1.000
$235,713.49
TOTAL (Also enter on line 5 Recaoitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (6-98)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Donna J. Parks
FILE NUMBER
04 21 0744
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 1tf:llDE TIE tw.E OF TIE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT A~ DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBEF TIE DAlE OF lRANSFeI. ATTIOiACOf"( OF TI-E DEED FOR REAl ESTAlE. VALUE OF ASSET INTEREST IIF APPUCABLE) VALUE
1. Security Benefit Variflex LS
Variable Annuity $29,206.66 100.000 $0.00 $29,206.66
Account No. 5500010244
Owner: Donna J. Parks
Annuitant: Donna J. Parks
Beneficiary: Brian T. Yufer
TOTAL (Also enter on line 7, Recapitulation) $ $29,206.66
(If more space is needed, insert additional sheets of the same size)
3W46AF 1.000
REV-1511 EX+(12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Donna J. Parks
FILE NUMBER
21 04 0744
ITEM
NUMBER
A.
B.
3W46AG 1.000
Debts of decedent must be reported on Schedule I.
DESCRIPTION
1.
FUNERAL EXPENSES:
Fine Art Photo
pictures for funeral service
Total from continuation pages
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s} Ray R. Strayer
Social Security Number(s) / EIN Number of Personal Representative(s}
Street Address 889 King Street
City Lewisberry
Year(s) Commission Paid: 2004
State PA
Zip 17339
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
7.
1
Cumberland Law Journal
publication of estate notice
2
Eagle Roll Off, LLC
dumpster for trash removal
Total from continuation pages
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$
AMOUNT
$42.19
$3,465.44
$20,000.00
$20,000.00
$313.00
$75.00
$1,032.06
$4,878.54
$49,806.23
Estate of: Donna J. Parks
Xtem
No.
2
3
Description
Gingrich Memorials
gravesite marker
MYers Funeral Home, Xnc.
funeral goods & services
Schedule H part 1 (Pagb 2)
Amount
$600.00
$2,865.44
Total (Carry forward to main schedule)
$3,465.44
Schedule H part 2 (Pag~ J)
Estate of: Donna J. Parks
Xtem
No.
Description
Amount
3
J&D Automotive
car inspection
$14.46
4
Lawn Maintenance
$20.00
5
Liberty Mutual Group
insurance premium on house,
rental property and vehicle
$674.87
6
Mary A. Murray, Tax Collector
real estate taxes
$1,615.27
7
Maxwell Enterprises
fee for preparation of
decedent's 2004 incame tax
returns
$145.00
8
Met-Ed
electric utility service
$454.91
9 Miscellaneous administrative
expenses
(postage, paper supplies,
etc. )
$40.35
10
Miscellaneous expenses related
to home maintenance
$100.47
11
Monroe Township Municipal
Authority
sewer bill for Donna J. Parks
and tenant
$426.00
12
Patriot-News Co.
fee for advertisement of auto
for sale
$29.20
13
Patriot-News Co.
publication of estate notice
$211.81
14
Patriot-News Co.
ad for sale of personal items
$16.00
15
Rick Mayberry
clean and prepare vehicle for
sale
$174.90
Total (Carry forward to main schedule)
$3,923.24
Schedule H part 2 (Pag~ .)
Estate of: Donna J. Parks
Xtem
No.
20
Description
Amount
16
Robert Stoner, Appraiser
real estate appraisal
$300.00
17
Supplies and labor for repairs
to light fixtures, doors and
outside faucet.
$154.29
18
Supplies and labor for
replacement of door and repair
water damage to ceiling.
$472 .70
19
The Sentinel
ad for sale of personal items
$18.00
u.S. Post Office
postage
$10.31
Total (Carry forward to main schedule)
$955.30
REV-1512 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RElURN
RESIDENT DECEDENT
ESTATE OF
Donna J. Parks
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
04 21 0744
Include un reimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
Carlisle Regional Medical
Center
medical bill
$876.00
2
Casey Williams, DMD
dental bill
$244.00
3
CE Service Center
television repair bill
contracted for prior to date
of death
$120.84
4
Internal Revenue Service
decedent's 2004 income tax
liability
$22,654.00
5
Met-Ed
electric utility service
$66.71
6
Monroe Township Municipal
Authority
sewer bill for Donna J. Parks
and tenant
$383.62
7
PA Department of Revenue
decedent's 2004 income tax
liability
$5,089.00
8
Sprint
phone service
$9.02
3W46AH 1.000
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
$29,443.19
REV-1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RElURN
RESIDENT DECEDENT
ESTATE OF
Donna J. Parks
NUMBER
I
1
2
3
4
FILE NUMBER
21 04 0744
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
John Backenstoes
1284 Boiling Springs
Boiling Springs, PA
Road
17007
None
$500.00
Lori Backenstoes
1284 Boiling Springs
Boiling Springs, PA
Road
17007
None
$500.00
Dale Danner
1 Briarwood Court
Mechanicsburg, PA 17055
None
$2,500.00
Kay Danner
1 Briarwood Court
Mechanicsburg, PA 17055
None
$2,500.00
Total from continuation pages
$383,518.89
ENTER DOLLAR AMOUNTS FOR DISTRIBUllONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV.1500 COVER SHEET
II NON.TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
3W46A11.000
B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON.TAXABLE DISTRIBUTIONS ON LINE 13 OF REV.1500 COVER SHEET
(If more space is needed, insert additional sheets of the same size)
$0.00
$
Schedule J part 1 (Pag6 ~)
Estate of: Donna J. Parks
Item
No. Description
Relation
Amount
5
Peggy A. Harter
1288 Brandt Road
Mechanicsburg, PA 17055
None
$0.00
6
Rosella J. House
815 West Keller Street
Mechanicsburg, PA 17055
$10,000.00
Sister
7
winnifred I. Kovecevic
40 Burwick Drive
Mechanicsburg, PA 17050
$10,000.00
Sister
8
Margaret M. Lee
115 North Street
Harrisburg, PA 17101
Personal property plus $1,000
cash
$1,500.00
Daughter
9
Sandra L. Massie
1283 Boiling Springs
Boiling Springs, PA
None
$1,000.00
Road
17007
10
Nancy M. McCoy
Big Springs Terrace,
Newville, PA 17241
$10,000.00
Lot 155
Sister
11
Sue Miller
1130 Boiling Springs Road
Mechanicsburg, PA 17055
None
$1,000.00
12
Arthur J. Parks
1067 Shadowridge Drive, #40
Vista, CA 92081
Son
$30,000.00
13
Keith Strayer
436 Clover Road
Etters, PA 17319
$500.00
Nephew
Total (Carry forward to main schedule)
$64,000.00
Estate of: Donna J. Parks
Item
No.
14
15
16
Description
Richard R. Strayer
889 King Street
Lewisberry, PA 17339
Brian D. Yufer
c/o Brian T. Yufer
126 Cedar Village Drive
York, PA 17402
Brian T. Yufer
126 Cedar Village Drive
York, PA 17402
Personal property and
$1,000.00 cash
Beneficiary of Annuity (Sch.
G)
Schedule J part 1 (Page j)
Relation
Amount
Brother
$10,000.00
Great Grandchild
$279,099.73
Grandson
$30,419.16
Total (Carry forward to main schedule)
$319,518.89
:;;\ :~; ~n ,:" 'i'~l!\ nw JTtt: lnjOnd~hl'lii1 JKTC g!'\lcn is '~OrrCC;iY :.'I.:'Pl'.:(! !rOrii ::.m ongin:tl
")'~~i.tl RC~l :i;'~u. ; iu: "l'!~pnal certificat( II be fonvardcd to tlit.: S:aLc: \iital Recor
:.:-:~rti~ICW:' oj (jc~liii (Ju~.y l-lk~d
) fri Ct: for Dcrmancnl Ci!inlY.
, ~ c'
W Hll rne ~l~'~
WARNING: It is illegal to duplicate th~s copy by photostat or phoIograp!1.
I-<e'~' ;Ul thL~ cc[tifjcate~ $2.00
'f~~~$k~
. Local Registrar 0 d"'
ij- A /!
1.. 1;...) '-' ... ".-' \,) () W=i-
fl'1A0d.
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No.
HI05,143Rev.2187
COMMONWEALTH OF PENNSYIYANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
TYPElPRlNT
,.
PER....NENT
bLACK INK
NAME OF DECEDENT IFnl, Mir;lIIa.1..QI)
SEX
,. Female
Donna Jane Parks
AGE (lasl 8Il1hdeyl
UNDER 1 YEAR
...... ....
UNDER 1 0JII1{
I-IooQ I MInut..
! '
8IRTHPl...ACE(Cilyand
SUIlelll'foruigllCOUnlry)
Cartisle, PA.
~':.,YI[J
66 Yrs.
..
COUNTY OF OEATH
RACE -AmIIlll;an In.;N.n. B/iIc;l<, Whll.. tilt
(SlfOCil~)
...
Cumberland
Allen
While
...
DECEDENT'S USUAl OCCUP#\TIOH
~':o,"':":M~:a~\J:':'.i::r
Administrative Specialist "..
DECEDENT'S MAILING ADDRESS {SIfeel. c.ty/ilwn. 9Ial6, lip COde)
1280-A Boiling Springs Road
BOiling Springs, Pennsylvania 17007
KIND OF 6USlNESSIlNDUSTAY
VMS DECEDENT EVER IN
U,S. ARMED FORCES?
...0 NoliJ
IBM
MARITAL STIJ"US .Mewed
NeverMlrn.d.W~d,
DllIllrC8dlSpflCitYI
Divorced
SUAVIVINB SPOUSE
(II woltl.'J'V'",,,,,OIj(j{.nllI'*'l
12.
DECEDENT'S
ACTUAl
RESIDENCe
(SeelflBkuclionl
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Pennsylvania
17..51al.
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--
.....
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FATHEn'SNAME lfirGt. MKJdIlI. lllSl)
Herndon R. Strayer
Ray Strayer
17 ...u....~=()1 Allen
MOTtEA'S NAIIE (Fonl, t.llddle, ~SornatnllJ
... Bernice E. Gettys
INFORMANT'S MAILING AOOAESS lSU_, c.tyffown. SIaIe. Zip CodIIJ
,... 889 King Street Lewisberry, Pa. 17339
PLACE OF DI8POEIfTlON . Nan. III Cemet-v. CJ.mlllllf'l' LOCATION . C~~/Town, SllIl", Zop Code
w__
Conolite Crematory
~..
Cumberland
17b.eow.
..
INFORMANT'S NANf (lVP6iPrintl
<
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/ )_,/
Cl"_~Refnoy"IfomSlMeD
~-~I'\
Schacffcrstown, Pa 17088
21(:.
21d.
NAME AND ADDAESS OF FACILITY
:rile. Myers Funeral Home, Inc. 37 East Main Street Mechanicsburg, Pa 17055
UCEN. "'NUy)'R f7 .. C. OATE SIGNED t
- j;. IMont",Oi.l~"). y---rJ Y
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\'AS CASE REFERRED TO MEDICAl EXAMINER/CORONER?
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OFOEJO'H?
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DATE OF INJURV
lJ.,4l1nlh.O.v.VurJ
T1MeOFINJURV
INJURY AT WORK?
DESCRIBE HOW INJURY OCCURRED
~
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building, etc. (SpeciIv)
....
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STATE OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SHORT CERTIFICATE
I,
GLENDA FARNER STRASBAUGH
Register for the Probate of wills and Granting
Letters of Administration in and for
CUMBERLAND County, do hereby certify that on
the 12th day of August, Two Thousand and Four,
Letters TESTAMENTARY
in common form were granted by the Register of
said County, on the
, late of MONROE TOWNSHIP
estate of PARKS DONNA J
(Last. First, Middle)
a/k/a
PARKS DONNA JANE
in said county, deceased, to STRA YER RA Y RICHARD
(Last, First, Middle)
and that same has not since been revoked.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the
seal of said office at CARLISLE, PENNSYLVANIA, this 12th day of August
Two Thousand and Four.
File No. 2004-00744
PA File No. 21-04-0744
Da te of Dea th 8/03/2004
S. S. # 164-30-2891
~o;\:"-\
NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL
Will of Donna J. Parks
Part 1. Personal Information
I, Donna 1. Parks, a resident of the State of Pennsylvania, Cumberland County, declare
that this is my will. My Social Security number is 164-30-2891.
Part 2. Revocation of Previous Wills
I revoke all wills and codicils that I have previously made.
Part 3. Children
I have the foIlowing children now living: Arthur James Parks and Margaret Marie Lee.
Part 4. Grandchildren . :0 C . "T,
::::: n\ 0 'T, -:~'
I have the foIlowing grandchildren now living: Brian Dominick Yufej} ihy greit-grlll1d~~~
. (r. ~ .
and Brian Todd Yufer. ffi
Part 5. Disposition of Property
. , :D
All beneficiaries must survive me for 45 days to receive property und.er this wilt As \!Se,d
;,! .. ., ...'
in this wiIl" the phrase "survive me" means to be alive or in existenct?asan or~nization'bn
the 45th day after my death.
N
All personal and real property that I leave in this will shaIl pass subject to any
encumbrances or liens placed on the property as security for the repayment of a loan or
debt. .
IfI leave property to be shared by two or more beneficiaries, it shall be shared equaIly by
them unless this will provides otherwise.
IfI leave property to be shared by two or more beneficiaries, and any of them does not
survive me, I leave his or her share to the others equally unless this will provides
otherwise for that share.
"Specific bequest" refers to a gift of specificaIly identified property that I leave in this will.
"Residuary estate" means all property I own at my death that is subject to this wiIl that
does not pass under a specific bequest, including all failed or lapsed bequests.
I leave my birthstone ring; wedding rings; Mother's ring; big screen television; my Bible;
my shawl; and, for reasons best known to her, the amount of one thousand doIlars
($1,000) to Margaret Marie Lee. If Margaret Marie Lee does not survive me, I leave this
property to Brian Dominick Yufer, my great-grandson.
Page 1 of 5 Initials: /i:P I ti.1 ~ Date: 0./oL/
Will of Donna J. Parks
I leave the angel pictures and pictures of Christ I painted; my bedroom suite, which is
already in his possession; my ffiM compatible computer; one (1) of my state quarter
collection books; and, for reasons best knoWn to him, the amount of one thousand dollars
($1,000) to Brian Todd Yufer. If Brian Todd Yufer does not survive me, I leave this
property to ~rian Dominick Yufer, my great-grandson.
I leave my adjustable (hospital type) bed to Keith Strayer. If Keith Strayer does not
survive me, I leave this property to Ray Richard Strayer, Rosella Jean House, Nancy May
McCoy and Winnifred Ida Kovecevic in equal shares.
I leave pictures of my brother and sisters; the bedroom furniture from my $econd
bedroom, which is already in his possession; my roll-top desk; one (1) of my state quarter
coIlection books; and the balance remaining (after satisfying any and all debts owed by
me) from the sale of my homes and automobile to be placed in a trust fund I have
established at F& M Trust to Brian Dominick Yufer, my great-grandson, the joy of my
life.
I leave the amount offorty thousand dollars ($40,000) to Ray Richard Strayer, Rosella
Jean House, ~ancy May McCoy and Witlnifred Ida Kovecevic in equal shares.
I leave my krugerrand;and, the amount of thirty tho'usand dollars ($30,000) to Arthur
James Parks. If Arthur James Parks does not survive me, I leave this property to Brian
Dominick Yufer, my great-grandson.
I leave my blue-point Persian cat, Tiffany to Peggy Ann Harter. If Peggy Ann Harter does
not survive me, I leave this property to Sandra Lee Massie.
I leave my two (2) remaining cats, Pita and Printz; and, the amount of one thousand
dollars ($1,000) for the loving care they gave me during my illness to John Backenstoes
and Lori Backenstoes in equal shares.
I leave the amount of five thousand dollars ($5,000) to the Helen O. Krause Animal
Foundation, Inc.
I leave the amount offjve thousand dollars ($5,000) to the ministry of Dale Danner and
the ministry of Kay Danner in equal shares.
I leave the amount of one thousand dollars ($1,000) for the loving care she gave me
during my illness to Sandra Lee Massie. If Sandra Lee Massie does not survive me, I leave
this property to Peggy Ann Harter.
Page 2 of 5 Initials:lDf ~~~) Date:7f~/) <I
Will of Donna J. Parks
I leave the amount of one thousand dollars ($1,000) for the loving care she gave me
during my illness to Sue Miller. If Sue Miller does not survive me, I leave this property to
Owen Strickler, Ashlee Peters, Eric Peters, Amanda Stine and Jacob Stine in equal shares.
I leave my residuary estate to Brian Dominick Yufer, my great-grandchild.
Part 6. Executor
I name Ray Ric~ard Strayer to serve as my executor. If Ray Richard Strayeds unwilling
or unable to serve as executor, I name Rosella Jean House to serve instead.
No executor shall be required to post bond.
Part 7. Executor's Powers
I direct my executor to take all actions legally permissible to have the pr?bate of my will
done as simply and as free of court supervision as possible under the .Iaws of the state
having jurisdiction over this will, including, filing a petition in the appropriate court for the
independent administration of my estate.
I grant to my' executor the following powers, to be exercised as he or she deems to be in
the best interests of my estate:,
1) T9 retain property without liability for loss or depreciation.
2) To dispose of property by public or private sale, or exchange, or otherwise, and
receive and administer the proceeds as a part of my estate.
3) To vote stock, to exercise any option or privilege to convert bonds, notes, stocks or
other securities belonging to my estate into Qther bonds, notes,. stocks or other
securities, and to exercise all other rights and privileges of a person owning similar
property.
4) To lease any real property in my estate.
5) To abandon, adjust, arbitrate, compromise, sue on or defend and otherwise deal with
and settle claims' in favor of or against my estate.
6) To continue or participate in' any business which is a part of my estate, and to
incorporate, dissolve or otherwise change the form of organization of the business.
The powers, authority and discretion I grant to my executor are intended to be in addition
to the powers, authority and discretion vested in him or her by operationoflaw by virtue
. Page 3 of 5 Initials: lip ~ cdb- Date: 7/7,;0'1 .
Will of Donna J. Parks
of his or her office, and may be exercised as'often as is deemed necessary or advisable,
without application to or approval by-any court.
Part 8. Payment of Debts
Except for liens and encumbrances placed on property as security for the repayment of a
loan or debt, I want all debts and expenses owed by my estate to be paid using the
following assets in the order listed: any and all bank accounts remaining at the time of my
death.
Part 9. Payment of Taxes
I want all estate and inheritance taxes assessed against property in my estate or against my
beneficiaries to be paid in the manner provided for by the laws of Pennsylvania.
Part 10. No Contest Provision_
If any beneficiary under this will contests this will or any of its provisions, any share or
interest in my estate given to the contesting beneficiary under this will is revoked and shall
be disposed of as if that contesting beneficiary had not survived me.
Part 11. Severability
If any provision of this will is held invalid, that shall not affect other provisions that can be
given effect without the invalid provision.
Signature
I, Donna J. Parks, the testator, sign my name to this instrument, this 7 .t!:J. day
of '.::>u. \ \j ,;;l(XJ ~ , at (Y\1 re s ,A eneE'. . I
declare that I sign and execute this instrument as my last will, that I' sign. it willingly, and
that I execute it as my free and voluntary act. I declare that I am of the age of majority or
otherwise legally empowered to make a will, and under no constraint or undue influence.
Signature:
.) - Qi;1J(/
'ifi rL...-;1:'~k:....' --1.- l/ {U>.I~/
I /
{/
Witnesses
We, the witnesses, sign our names to this instrument, and declare that the testator
willingly signed and executed this instrument as the testator's last will.
In the presence of the testator, and in the presence of each other, we sign this will as
witnesses to the testator's signing.
. .~ ./) III I 11
Page4of5 Initials:!}j' ~~
Date: 717 Arc!
I
Will of Donna J. Parks
To the best of our knowledge, the testator is of the age of majority or otherwise legally
empowered to make a will, is mentally competent and under no constraint or undue
influence.
We declare under pemiIty of petjury that the foregoing is true and correct, this
. ','tf,._ day of ~ 2t}cl{ ~.at . ,
J2Jzl-A "2u>ici,,)., _ \.] ~\ d()IL}~'i., ~/<,~,J;-J P,.. -
. I .
'~V-1lI<'- Cd 0 I~C
Residing at: l2(:>; fL.....\.L"'" _ n. "'0 ~') ~4'\.L..v-td f I{ nOt; I
J li ~\ I K \
Witness't0~ (2, ~j\P?~'4AL7^ .
Re,;ding at 1-1 E:4 r;o;.t (j~<jL' r;;<J G:d7J ,iJ?r" ~
Witness '# 1:
/7(0'7
Page 5 of 5
lit]
Initials:~ ~
, I
~Date: 0/,/
Affidavit
ACKNOWLEDGMENT
Commonwealth of Pennsylvania
County of: eLl.. vr-. b eo (- \ C, ..., d
I, j () ^-) (. ) /! .f f/;jl2!./< S. the testator whose name is signed to the
attached or foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will; and that I signed
it willingly and as m..y free and volunt~ a.ctJ,eri!.. he pUr:Joses th rein expressed.
Q.. ,0 . .7!/'-! L/
Testator: /;L:' (:-'7Z/7'<---"'<--- ./ ct./V-/
t' ,/ /7
(-;l'/C-LI.';~i:" .. f ( a 7'"1 SC.7
Officer:
NowiliSeal
CaroIiae T. Ramoey. Notary Public
s~ Twp" o.uphin County
My COIIlIIIiIoion Eltpires Jan [6. 2007
Member,l'l!nn9ytvIInia AsSOCIBtlOrl 01 Notanes
AFFIDA VIT
Commonwealth of Pennsylvania
County of: C~(.lI"""'" be,- k j~
We, ~-;- ~ 1\\ J ~ 14- M l1-.5 <;.. ,,: and L (.,,~, fl'-r)c .~ k..-(c ";-l-~ the
witnesses whose names are signed to the attached or foregoing instrument, having been
duly qualified according to law, do depose and say that we were present and saw the
testator sign and execute the instrument as his/her Last Will; that the testator signed
willingly and executed it as his/her free and voluntary act for the purposes therein
expressed; that each subscribing witness in the hearing and sight of the testator signed the
will as a witness; and that to the best of our knowledge the testator was at that time 18 or
more years of age, of sound mind and under no constraint or undue influence.
Sworn to or affirmed and subscribed to before me by
and
""-0-'-',-
, dU .
. witnesses,
this 'f ~....
Witness:
Witness:
Officer:
Nowial Seal
CaroIiIoe T. Ramoey, Notary Public
S""'Iuc:hanna Twp.. Dauphin County
My Commia.ion Eltpires Jan. 16, 2007
Member, Pennsylvania ASsociation of Notaries
Affidavit - Page 1 of 1
I, Donna J. Parks of 1280-A Boiling Springs Road, Boiling Springs, Cumberland County,
Pennsylvania, 17007, being of sound mind, do hereby make this document a representation of
my wishes as to the personal care I receive during my remaining days.
As I am aware that I have incurable cancer, my wishes are as follows:
(A) I wish to be allowed to remain in my home through this illness;
(B) I wish that my friends: Sandi Massie, John Backenstoes, Lori Backenstoes, and
Sue Miller be granted access to my home to assist me in any way I deem
necessary. I understand that hospice and/or nurses will be called in when this
disease renders me to a point that my friends can no longer tend to me alone;
(C) I DO NOT wish 'to have any member(s) of my immediate family involved in the
care I will receive at home;
(D) I DO NOT wish to have any member(s) of my immediate family move into my
home during this illness.
\1/i7~? ,
i\.. ,r,)", )'::J.'- t /
/}4,/f ,; --./' C"--,, / d..--/
, Donna J. Park; /'
Wiln~~
Witness: . 1
Witness:
State of Pennsylvania
County of Cumberland
On :::Ju.~C 30,dCOI-lbefore me, fl"I-c,),',H,,' T rZt';".'J("'V
/
d '/:. l 0/. ~ J II
appeare "I /~,t:,'! " if. L ICy' ,persona y
known to me (or proved to me on th basis of satisfactory evidence) to be the person whose
name is subscribed to the within instrument and acknowledged to me that she executed the
same in her authorized capacity. and that by her signature on the instrument the person, or the
entity upon behalf of which the person acted, executed the instrument
WITNESS my hand and official seal.
)
{?--c-
T /Z'}'1h:
Affiant
Type of ID
Notarial Seal
Caroline T, Ramsey, Nowy Public
Su",!""hann8 Twp., Dauphin COOlnty
My Commission Eltp\l'1'S Jan. 16, 2007
Member, PeMSylvllnla AssoclaUonofNotaries
Signature:
Known
Produced ID
(Seal)
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VA Form 26-10'. JUL 1982
Section 1820, Title 38 U.S.C..
PENNSYL VANIA
THIS INDENTURE made the 24th day of May , 19 83 ,
between the Administrator of Veterans Affairs, an Officer of the United States of America, whose address is
Veterans Administration, Washington, D. C. 20420 hereinafter called the Grantor and DONNA PARKS
hereinafter called the Grantee:
:-;'1:,',,1,:-;'
5';::.",!"!~;::G~ , _, ',r
{I~. ...tIth 1."1 ,U
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c; ::1:'0
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,S~:itEY Thiusaqa, ~ 00/100
:($60, OOO~'@)D.o~ars
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WITNESSETH that the said Grantor for and in consideration of the sum of
J
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tXJM.v\ 0 l'-j WE Ai iii
1)CFARTh\E1","r' ()I'; ";:i_~
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IV
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the receipt whereof is hereby acknowledged, hereby grants, bargains, sells, aliens, enfeotfs, releases, and con-
firms unto the said Grantee and Grantee's heirs or successors and assigns,
ALL THAT CERTAIN piece or parcel of land situate in Monroe Township, Cumberland County,
Pennsylvania, being bounded and described according to a survey made by Michael C. D'Angelo,
Registered Surveyor, dated May 5, 1978, as follows, to wit:
BEGINNING at a point on the Northern line of Blacksmith Alley (10 feet wide) at the corner
of lands now or formerly of Richwine; said point being measured 102.50 feet to the center
line of Main Street (Pa. Rt. 174); thence extending from said point of beginning and along
lands of Richwine, North 19 degrees 56 minutes 00 seconds West, the distance of 243.60 feet
to an iron pin at the corner of lands of Warner; thence along lands of Warner, North 68
degrees 38 minutes 00 seconds East the distance of 160.10 feet to a point at the corner of
lands now or formerly of Lyter; thence along said lands South 24 degrees 14 minutes 26
seconds East, the distance of 164.66 feet to a point un the Northern line of Blacksmith
Alley; thence along said line of Blacksmith Alley, South 44 degrees 15 minutes 00 seconds
West, the distance of 191.53 feet to a point, the place of BEGINNING.
BEING the same premises which Robert n. Failor, Sheriff of Cumberland County, by deed dated
November 15, 1979 and recorded November 19, 1979 in the Office for the Recording of Deeds
of Cumberland County, Pa. in Deed Book T, Volume 28 page 381, granted and conveyed unto
Max Cleland, as Administrator of Veterans Affairs in fee.
THE said Max Cleland, Administrator of Veterans Affairs, an Officer of the United States of
America, having resigned said office, was succeeded by Harry N. \~alters, by appointment of
the President of the United States.
BY Quit Claim Deed dated September 4, 1981, and recorded October 19, 1981 in the Office for
Recording of Deeds, for Cumberland County, in Deed Book No. Y Volume 29, page 131, Arthur J.
Parks conveyed ~nd assigned all his interest in said property under the Installment Contract
For Sale of Real Estate to his wife, Donna Parks.
,,')) /jJ." F: "
OW'Hlhip of //.(~~'.. J..<::~_
Cumbo Co., PI.I.
/,-J, / :de
L-v/,?' ,7 ,_ . ,., ,
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;t3htidl blit. Cumb ""=-P ?
. \".,,00., a. I
I S Real E:d.". Tranaf., T4r.
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-om to, 'e:;,. 'tit';l. iCtiJ
A""iIo
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TOGETHER with all and singular the improvements, ways, streets, aJleys, passages, waters, watercourses,
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, claims, and demand whatsoever of the said Grantor, in law, equity, or otherwise howsoever, of,
in, and to the same and every part thereof.
To HAVE AND To HOLD the said lot or piece of ground above described with the hereditaments and appurte-
nances, unto the said Grantee and Grantee's heirs or successors and assigns, forever.
Grantor covenants to warrant and defend all that hereinabove described against all persons lawfully claiming
or to claim the same or any part thereof by, through, or under Grantor.
IN WITNESS WHEREOF, Grantor on the day and year first above written has caused this instrument to
be signed and sealed on Grantor's behalf by the undersigned, being thereunto duly appointed, qualified and acting
pursuant to title 38, United States Code, sections 212 and 1820, and title 38, Code of Federal Regulations,
sections 36.4342 and 36.4520, pursuant thereto, as amended, and who is authorized to execute this instrument.
/
The A~' tor of vrerans Affairs
1 J ,- '.^,
II ',' -
.' , ,. " (f" J ,I I 7 I . . . ..
*By -- 'J_~':...<:~~~J~,::::__~~ftl1:.v.c.~t1..___ [SEAL ]
RONALD W. VELTMAN
SEALED AND DELIVERED IN THE PRESENCE OF-
. . Ii i ,\. 1;7. t I t-/ !I' ''1\/,.,. ,(: / ii)
. ,1-""-- -----~--~-~----~-
,
{:
Title: __________.________.____.__J..Qilll_QY.l!!:.~!Y._Q.{Ps..~!
.
.-------------------------------------------------~--------------------
Veterans Administration Regional Office or
STATE OF PENNSYLVANIA, }
88:
County of PHILADELPHIA
Regional Office & Insurance Center ___ phi l;l _.._J> A.
(City)
(215) 951-5501
Teleph one----------------------------------------------------
(Area code and number)
(Pursuant to a delegation of authority contained in
VA Regulations, 38 C.F.R., 36.4342 and 36.4520.)
On this date, before me, the undersigned, personally appeared ____ Ronald W. Veltman _,an
employee of the Veterans Administration, an agency of the United States Government, signer and sealer of the
foregoing instrument and acknowledged that he/she executed the same in the capacity therein stated for the
purposes therein contained, and as the deed of the Administrator of Veterans Affairs.
~?\!..!:"'l'
~.
~;~~ .'
IN WITNESS WHEREOF, I hereunto set my hand and official seal this the 24 tlL day,ofS'. ~'y. ,"" . '. Jl~ 83'.
:.. -'. :) ,.-.:~: .'..f' '.;
~ ~'."
, . J---------~- ~:2____?_______~_:~_~~-'" 'c~,,;;
1--~---~ c> '. ,~
,,/ ..~
My commission expires:
G' /i'
~J~~_Y-L6 L~__
. i !,. (}
~.
Notary Public in and fo." ths
Count1l and State afo..ssaid.
I hereby certify that the precise residt!nce of the, within-named Grantee is'",
: ., """, ,', , " j .,., !- ' 'I {' 11, .' . 1, ,I 7. ,', ;"
I';'" ~\,_ /'l.i . .......:,.. --v--'--:O::~:'''(_:jr.'"L'v-', /;,.-:_/ \.---c..."C~ i ,.L:J....._'L".N-..r:)..c _._J l\-;-""'-,->'C--=-,_~, r,;--.,.. .. f '-~'_'
Bo-*--J3, Allen--(.MOnr.beTwp.. )__BoilingSpl'i-ngs';--i'A'- ! r I' -
---------~-?k::,~-~ -<],-------,----------T----_---:--F-T~)~0-~'~------. -----I---~-=---~-:---------::------~'.,'--,
/# '.~~,_--....u,-l....-1'"7'-..n:-.+~l:-,._'"., _, I(V,---Ltt~, . 1--1~).".-.-,.~-(.., " 'l.tj'~"~" :_..~' (-~...c~~_.,c...'_/
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64/1B/2665 14:43
7177375355
MILLER LIPSITT LLC
PAGE 62
A. Settlement statement
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04/18/2665 14:43
7177375355
MILLER LIPSITT LLC
PAGE 63
WAllNlNO: It Ie. Cli"", to know;lI/lly "."" ,.1.. Olnl....nl. 10 0,. tl.ilccl81R10$
on lhll ., .ny Dill., .Iml'or ro'm. l'olIRlllco upon coo'ie,"", oon Inclt1dc: . fioc
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nt or by ma. III lb. tmntlldion, 1 rl1rU,c:rccrufy tl1II.tI bftve. l!Il,.~d It ofthc HU.D-J Sel~ermnr Sh.tcmc:nt.
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February ~4, ZOOS
IJnre
--- -
--- -
- ----
.E. ~ oS ':"5-
-- - ~ -
IBM Corporation
Investor Services J
gram (ISP)
IBM Stockholrlor Services
P.O. Box 43C
Providence, HI 02940-3073
Telephone:
1-888-IBM-6700
1-781-575-2727
(outside U.S., Canada, and Puerto Rico)
g926 2004(09',7 134060
1..,111,..111",11..,1",11.1...11"1...11,1..1,, I,ll" ,,11..1
DONNA J PARKS
1280 BOiliNG SPRINGS RD # A
BOiliNG SPRINGS PA
17007.9679
By Facsimile: 1-201-222-4488
E-Mail: ibm@equiserve.com
Internet http://www.ibm.com/investor
Issue# Account# Stock Symbol
9926 14636-44340 IBM
SAVE THIS STATEMENT FOR TAX PURPOSES
Investor Services Proaram liSP) Dividend Information
Record Date: AUD 10, 20041Pavable Date: SeD 10, 2004 I Dividend Option: All Cash
RECORD DATE SHARES FOR REINVESTMENT Amount Withheld From Gross Net Amount
Certificate Shares I Isp'shares I Total Shares Rate($) Gross Amount($) Tax($) I Feo($) Reinvested($)
I I 0.000 0.18 I
Please note: $12.24 was paid to you by check or deposit for the dividend on 68.000 shares which did not reinvest.
"Investor Services I'roaram (ISP) Account Activltv
Data Description Feos and/or Net Dollar Amount($} P rice per Transac1ion Shares Total Shares Hold
Commissions($} sharo($)
01/02/2004 Balance Forward 1,928.352 1,928.352
03/10/2004 Common Dividend Purchase 3.00 397.70 93.214 4.267 1,932.619
06/10/2004 Corrunoll DiviJellu PUld,a:;e 3.00 448.55 90.535 4.\:lt>4 1.93/ .573
07/15/2004 Shares Sold 208.80 162.973.60 84.220 .1,937.573 0.000
07/19/2004 Book-entry Credit 68.000 68.000
Year-To-Date Investment Summary
Gross Dividends Reinvested(S} I Tax Withheld($) Fees and/or Commissions Net Owk!ends Reinvest&d($) OptiDnal \nvestments($) I T ola) JnvElstments($)
Paid by You($)
852.25 I 6.00 846.25 I 846.25
Total Holdings and Market Value
Security
COMMON STOCK
ISp. Shares
68.000
(As of the close of business on 09/15/2004)
Total Shares Price per sharo($) Marl<e\ Vaiue($)
68.000 86.370 5.873.16
--- -
--- -
-----
----
-----
------
--- - -
---.-
IBM Corporation
Investor Services Program
Transac
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L t i;(/
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Neb site at
INTERNET ACCESS IS HERE!
We are pleased to announce that you can access your ac
htlp :ilwww.ibm.comiinvestor
You will need the issue number and account number locat,
and your password of 30267793 to gain access to your ac,
Iber (if applicable)
Partial Withd,
~ates
~
L
Issue a certitica1
number of share
Issue#: 9926 Account#: 14636-44340
DONNA J PARKS
128
Soli this nllmber
Janee or sale and/or
Full Withdraw
n. Names must be signed exactly
ant. (Pal1ner/OfficerfTrustoe
icerlTrustss.)
Optional Investment
Make check payable ro: i"'----l
Inveslment Plan Services
Amount enclosed in U.S.Dollars: __
Your Optlona' '.nvestmem can be a minimum of $50.00 per
Investment and a maximum of $250.000.00 per year
D ISS\.Ieat
and sell
[J 5ell all sha,os
09926 14636 44340 87
Address change or share transfer 0
Mark box and complete tha approprrat...
partion on \he reverse side I
/
\./
PA REV-1500
SCHEDULE E
CASH, BANK DEPOSITS &
MISCELLANEOUS PERSONAL
PROPERTY
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_~~"...._..~.~~"..,,~"':9~T!:!,~,~,,2,~.l?9t.~I.~~!:!.!'!f.!LE 9f.,,~Y.THORIZEO SIGNER
~ AmeriChoice
~ 1 FEDERAL CREDIT UNION
Building Relationships For Life
October 15, 2004
Craig A. Hatch, Esquire
Gates, Halbruner & Hatch, P.C.
1013 Mumma Rd. Suite 100
Lemoyne, P A 17043
RE: Estate of Donna J. Parks
Account #8412
SS #164-30-2891
The account is as follows:
Account Type
Date Opened
DOD Balance
Dividend Paid to DOD Ownership
Share-Savings-O 1
Checking-13
Checking-14
4/06/1981
4/06/1981
9/10/1997
Sole owner
Sole owner
Sole owner
$
$
$
$
$
$
1907.81
3075.59
4.07
11.01
o
o
The deceased does not have a safe deposit box with the credit union.
The account was closed August 13, 2004 for $4,987.47 by Raymond Strayer.
Please call me at (717)697-3474 if you need further assistance.
Sincerely, "
,jl~iMl~ d r0i0Jlili lru
Tracey L. :Milliken
Member Service Representative
Main Office: 217S Bumble Bee Hollow Road. Mechanicsburg, PA 17055 . Phone: (717) 697-3474
@ '-NCU;q
~D~I~~I~,: ~.''';'.'....,~_
Website: www.amf'richoicf'.org
. Fax: (717) 697-3713
~
tf4
....IlC...
ro__~T~ TT..._..__
@omcast
DATE
DUE
TOTAL
AMOUNT DUE
None
ACCOUNT
NUMBER
09547387314-01-0
See Note
Visit us on the web at www.comcast.com
DONNA PARKS
For service at:
1280 BOILING SPGS RD APT A
BOILING SPRINGS PA 17007-9679
Summary of Charges
Billed from 08/08/04 to 08/19/04
Previous Balance
Payments (includes payments received by 08/11/04)
Monthly Services
Taxes. Surcharges, & Fees
42.41
0.00
47.81 cr
0.12 cr
Total Due
You have a credit balance of $5.52!
$5.52 cr
Make No Payment!
Detail of Charges on back
News from Com cast
If your bill reflects a credit balance of $1.00 or over, a refund will be sent to you
automatically. If the credit is under $1.00. please return the notice to us or call the
Customer Service Telephone number in the upper right corner of your bill.
@<?om~~~l~!~
4008 N DUPONT HWY
NEW CASTLE DE 19720-6328
Please detach and enclose this coupon with your payment.
Do not send cash. Make checks payable to:
COMCASTCABLE~@ON
Total Amount Due
AMOUNT
ENCLOSED
$
Dete Due
ADDRESS SERVICE REQUESTED
See Note
None
000-08-04-8-0
Account Number 09547387314-01-0
Credit Balance, Do Not Pay.
AY 01 042085 113128185 A**5DGT
DONNA PARKS
1280 BOILING SPGS RO APT A
BOILING SPRINGS PA 17007-9679
1",111.1""11,1.1"1"1,,,11.11,,,1111,.1,1,,,1,11
COMCAST CABLE
POBOX 3005
SOUTHEASTERN PA
19398-3005
1...111",111".11..,111,11,111,11,,1,.,11,1.,1,,1,11'11111,,I
09547 387314 01 0
1
000552
least
--
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S STATEMENT
7 ITEMS DE~CRIBED^BOVE
IrTL Y. NO RH'EIPT DESIRED.
56353855
23.97
1020
09/17/04
5.52*****"
'./1
GNATURE
m.fmtrustonline.com
TRUST
April 19, 2005
Law Offices of
Gates, Halbruner & Hatch, P.C.
1013 Mumma Road, Suite 100
Lemoyne, PA 17043
RE: Donna J. Parks
Ms. Sepkovic:
In reference to the above customer, our records show the enclosed information to be
accurate as of August 3, 2004. We are waiving our researching fee for this information,
as the delay was an oversight on our part.
We apologize that your request was not handled promptly. If I may be of any further
assistance, please contact me.
Sincerely,
1l1~ {} Oa>>i)
Karen E. Davis
Deposit Operations Manager
717-264-6116
888-264-6116
P.O. Box 6010
Chambersburg, PA
17201-6010
FINANr.IAI ~nIIJTlnN~_ I'RnM pI'nPI I' vnll ICNnw
ACCOUNT INFORMATION
RE: Donna J. Parks
DATE OF DEATH Auqust 3, 2004
x
CHECKING
SAFE DEPOSIT
SAVINGS ____CERTIFICATE OF DEPOSIT
SHARES OF STOCK
DATE OPENED 01/30/04
ACCOUNT NUMBER 34-34273
ACCOUNT BALANCE AT DATE OF DEATH
ACCRUED INTEREST
TOTAL ACCOUNT BALANCE
INTEREST PAID YTD __$ 13.87
NAME(S) ON ACCOUNT Donna J. Parks
REGISTRATION OF ACCOUNT Individual
DATE CLOSED
08/13/2004
$ 211,571.76
$ 4.62
$ 211. 576.38
ACCOUNT INFORMATION
CHECKING
SAFE DEPOSIT
X SAVINGS ___CERTIFICATE OF DEPOSIT
SHARES OF STOCK
DATE OPENED 02/04/00
ACCOUNT NUMBER 70-33699
ACCOUNT BALANCE AT DATE OF DEATH
ACCRUED INTEREST
TOTAL ACCOUNT BALANCE
DATE CLOSED
08/13/04
$ 13,471.10
$ 5.09
$ 13,476.19
INTEREST PAID YTD
____$ 21. 25
NAME(S) ON ACCOUNT Donna J. Parks
REGISTRATION OF ACCOUNT Individual
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i'l
TOEWS
CORPORATION
1500 Market Street
12th Floor, East Tower
Philadelphia, PA 19102
215.665.5634
877.TOEWSCO (877.863.9726)
Fa>< 215.665.5755
Thursday, September 16, 2004
Donna J. Parks
1280 A Boiling Springs Road
Boiling Springs, P A 17007-9679
Account Registration:
Account Type:
Investment Company:
Account #:
Risk Management Portfolio:
Refund Amount:
Donna J. Parks
Non-Qualified
Security Benefit
5500010244
Growth
$92.78
This letter is to indicate that as of 8/13/2004 the above referenced account at Security
Benefit has been liquidated and our management services thus terminated,
Please find a check in the amount referenced above. This check represents a return of the
pro-rata fee. Please call your representative with any questions.
Investment Firm:
Representative:
H. Beck Inc.
Keeler, Danner, & Otto
5249 Simpson Ferry Road
Mechanicsburg, P A 17050
717-790-9059
Enc!.
PA REV-1500
SCHEDULE G
INTER-VIVOS TRANSFERS and
MISCELLANEOUS NON-PROBATE
PROPERTY
eeler &
anner
Registered Investment Advisor Agents
John R. Keeler, CFP
Registered Representative
FINANCIAL SERVICES LLP
Dale E. Danner, RFP
Registered Principal
5249 Simpson Ferry Road, Mechanicsburg, PA 17050
James A. Otto
Registered Principal
Operations Manager
(717) 790-9059 (800) 373.5452 Fax (717) 790-9268
October 14,2004
Gates, Halbruner & Hatch, PC
Attn: Traci Sepkovic
1013 Mumma Road Ste 100
Lemoyne, PA 17043
RE: Donna J. Parks
SSN: 164-30-2891
To Whom It May Concern:
The following information is in regards to Donna J. Parks and any accounts she held through us.
Product Owned:
Account Number:
Owner and Annuitant:
Account Established:
Beneficiary(ies) :
Date of Death balance:
Security Benefit Variflex LS Variable Annuity
5500010244
Donna J. Parks
March 04, 1996
Brian T. Yufer 100%
$29,206.66
Should you require any additional information or have questions on the above, please contact me.
. QoctfilllYd'\Vl~
--\(t\A~~, 'r-
Patricia A. Juliana,
Office Mgr.
j
Securities and Investment Advisory Services offered through H. Reck, Inc. Memher NASD, SIPe
Certain individuals are registered representatives of H. Beck, Inc., which is unaffiliated with Keeler & Danner Financial Services, LLP
PA REV-1500
SCHEDULE H
FUNERAL EXPENSES and
ADMINISTRATIVE COSTS
MY"fS Funeral Home, Tne.
Boyd L. Myers Jr., Supervisor
37 East Main Street
Mechanicsburg, Pennsylvania 17055
(717) 766-3421
Fax (717)795-7291
A standard of excellence in Central Pennsylvania since 1910
VVednesday,August25,2004
Mr. Ray Strayer
889 King Street
Lewisberry, Pa. 17339
Dear Mr. Strayer,
Thank you for selecting our funeral home to provide services for your family during your bereavement.
I hope that you found our services to be of the highest standards and that they met your needs and those
of your family and friends. The following is a summary of the service charges as previously explained and
provided in written form on the serl/ices for:
Donna Jane Parks
SUMMARY OF EXPENSES
TOTAL OF SERVICE RENDERED
LES8. Credits granted
LESS: Total Payments
PLUS Items ordered later
CURRENT BALANCE
Credits Granted: $167.52 Preneed Adjustment $1,070.0 Package Price Discount
$3,180.00
1,237.52
1,942.48
922.96
$922.96
PLUS: Items ordered 'liter
Memorilll Service
Book
Clem'
FIO\vers
Obit
550.00
65.00
ilJO.OO
65.00
142.96
Interest at the rate of 1.5 % per month ( 18 % per annum) will be added to balance after 30 days.
y questions or concerns that remain unanswered, please call me.
/J J1)tfj a7
C~
ORDER FORM
FIL~ COpy
ingricl
Since 1921
Foundation BY~
o Carved Lettered
o Drawing Required
o Drafter
o Sandblast By
Manufacturer
No. 2-20081
Supplier
Ack. #
Date Rec'd
Found. Ordered
Position Verified
SOLD TO: Th tst~L (if 'Do""",,!)..
c(~ Me \(0.,\ \C. St<'t.'1t('/
)l6'~ '<:::I'Y\, Sot rt,-,-T
L~wl;)loeYI"If P A '/1"39
Phone (H) qj?- ~Y,1 (W) 'Y~-'lsoa (..r,dD
oukl Ro~'t:. H""""G w~~ ih:!.t\l;\\t.cA
5243 Simpson Ferry Road, Mechanicsburg, PA 17050
(717) 766-5622. Fax (717) 766-8007
www.gingrichmemorials.com
~&
LlCeuXl'lr
Cemetery
Location
Date of Order f - '?, I - 0 ;-
Mf.PhIl.VI;(,S~
Sr.c. n e oW G
,
q+/ ()
tk STRAYte I~f-
Center Over
Graves Lot #
"ritl I t'l~
Approx. Date of Completion
Lettering
"le'" ~""\"'<;, Mt-t'IO\'-Y ~ l
DOt-l N l\ J~NE \'I\R~, ; .
JULY 4,
Iq38
AU&lJ.ST ....,)
?-'\)oy
4- Spelling and dates have been approved.
Type of Memorial fk-\- M.e....k Material ~\\lcnv.. \3II.H' Gnbj ~ (,,1l~Je
Size ~ X i::-{L x.D..:.!:L Finish ~tl'>p - b.-rJelf" SB Ffl..e.\
Size X X Finish
Misc.
Design
Location
o Vase
o Corner Posts
WHITE-Office
YELLOW-Production
Price $
Foundation $
$
$
TOTAL de# $
DEPOSIT 13? $
Balance Due
Upon Completion $
5':10.-
:?O.
Agreement: A 50% deposit is required to commencement of work.
Agree to pay stated balance upon erection regardless of labor troubles or shipments or any other good reasons. This order or contact
cannot be cancelled by customer unless agreed by both parties. The article herein mentioned shall remain the property of James R.
Gingrich Memorials until paid in full and they reserve the right to remove the same is not paid as stated.
I agree to carefully proofread all names and dates for accuracy and accept full responsibility for any errors or omissions. THERE
WILL BE AN ADDITIONAL CHARGE FOR ANY LETTERING ADDED TO THIS MEMORIAL AFTER ERECTED ON THE
CEMETERY.
I further agree to pay the balance stated for the work performed under this contract within thirty (30) days of receipt of the final invoice
and further agree that interest shall accrue at the rate of one and one-half percent (1~%) per month on the unpaid balance owed to
James R. Gingrich Memoriels not paid within thirty (30) days of the invoice date. In eddition thereto, I agree If It becomes necessary
for James R. Gingrich to Institute legal proceeding to collect any funds due from me for my account being past duethlrly (30) days,
to pay all court costs and attorneys fees Incurred by James A. Gingrich Memorials to collect the same.
bOO. -
bot), -
Dealer
~C~
f25
RECEIPT FOR PAYMENT
-------------------
-------------------
Cumberland County - Register Of Wills
Hanover and Hiqh Street
Carlisle, PA 17013 .
Receipt Date:
Receipt Time:
Receipt No. :
8/12/2004
09:22:09
1037496
PARKS DONNA J
2004-00744
RAY STRAYER
JA
------------------------ Receipt Distribution ------------------______
Fee/Tax Description Payment Amount Payee Name
Estate File. No. :
Paid By Remarks:
PETITION FOR PROBA
EXTRA PAGES
SHORT CERTIFICATE
T"n T"'lT""1T""'1
UL.t'" rn.c,
270.00
15.00
18.00
10.00
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
Check# 1016
Total Received.. .......
$313.00
$313.00
cj;.(I~ l J ~
fJ~
..1<.0 ,p..
1'1 ~: &.. I iT '11 J: -{sf9nJ 5870 'Wertzviffe 1(1.
~~~urnv -'3 ~~~1~5
anti !JIu.togfass 732-3588
\-
Liberty Mutual Group
PO Box 3008
Williamsport PA 17701
~.
PREMIUM NOTICE
08/06/04
Vish our webshe at: www.LlbertyMutual.com
For Salas/Service Assistance Contact:
5021 LOUISE DR HECIIANICSBURG
795-8703
DONNA J PARKS
1280A BOILING SPRINGS RD
BOILING SPRINGS PA 17007-9679
-
Policy Number FN2-288-665162-803 68 Type of Policy FIRE
APR or Billing Expense Fee Interest Computed On Minimum Due in Full Due Date
$4 PER INSTL 24.50 24.50 08/26/04
PLEASE SEE REVERSE SIDE FOR IMPORTANT INFORMATION
YOUR PREMIUM PAYMENTS ARE ~/dL--
NO LONGER BEING PAID VIA
THE INSURANCE DEDUCTION
PLAN. RECENT DEDUCTIONS
MAY NOT YET BE REFLECTED
IN THIS STATEMENT. YOUR
COVERAGE WILL REMAIN IN
EFFECT PROVIDED YOU PAY
THE MINIMUM DUE. IF YOU
HAVE A QUESTION PLEASE
CALL: 1-800-526-1547.
Please detach and return the bollom portion with your payment, in the envelope provided.
Liberty Mutual Group
PO Box 3008
Williamsport PA 17701
~
PREMIUM NOTICE .
08/06/04
Vlsh our webshe at: www.LlbertyMutual.com
For SalesJService Assistance Contact:
5021 LOUISE DR HECHANICSBURG
795-87113
DONNA J PARKS
1280A BOILING SPRINGS RD
BOILING SPRINGS PA 17007-9679
Policy Number FN2-288-665162-803 68 Type of Policy FIRE
APR or Billing Expense Fee Interest Computed On Minimum Due In Full Due Date
$4 PER INSTL 24.50 24.50 08/26/04
PLEASE SEE REVERSE SIDE FOR IMPORTANT INFORMATION
YOUR PREMIUM PAYMENTS ARE ~/dL--
NO LONGER BEING PAID VIA
THE INSURANCE DEDUCTION
PLAN. RECENT DEDUCTIONS
MAY NOT YET BE REFLECTED
IN THIS STATEMENT. YOUR
COVERAGE WILL REMAIN IN
EFFECT PROVIDED YOU PAY
THE MINIMUM DUE. IF YOU
HAVE A QUESTION PLEASE
CALL: 1-800-526-1547.
Please detach and return the bollom portion with your payment, in the envelope provided.
Liberty Mutual Group
PO Box 3008
Williamsport PA 17701
~
PREMIUM NOTICE
08/06/04
Visn our websne at: www.LibertyMutual.com
For SalesJService Assistance Contact
~021 LOUISE D~ HECH^NICSBU~G
79~-8703
ESTATE OF DONNA J PARKS
C/O RAY STRAYER EXECUTOR
889 KING ST
LEWISBERRY PA 17339-9575
Policy Number H32-288-665161-803 88 Type of Policy HOMEOWNERS
APR or Billing Expense Fee Interest Computed On Minimum Due In Full Due Date
$4 PER INSTL 88.66 88.66 08/26/04
PLEASE SEE REVERSE SIDE FOR IMPORTANT INFORMATION
YOUR PREMIUM PAYMENTS ARE
NO LONGER BEING PAID VIA
THE INSURANCE DEDUCTION ~ (02-
PLAN. RECENT DEDUCTIONS
MAY NOT YET BE REFLECTED
IN THIS STATEMENT. YOUR
COVERAGE WILL REMAIN IN
EFFECT PROVIDED YOU PAY
THE MINIMUM DUE. IF YOU
HAVE A QUESTION PLEASE
CALL: 1-800-526-1547.
Please detach and return the bottom portion with your payment, in the envelope provided.
Liberty Mutual Group
. PO Box 3008
Williamsport PA 17701
tJt
PREMIUM NOTICE
08/06/04
Vlstt our wabsne at: www.LlbertyMutual.com
For SaleslService Assistance Contact:
5021 LOUISE DR HECHANICSBURG
795-8703
ESTATE OF DONNA J PARKS
C/O RAY STRAYER EXECUTOR
889 KING ST
LEWISBERRY PA 17339-9575
Policy Number A02-288-563456-803 58 Type of Policy AUTOMOBILE
APR or Billing Expense Fee Interest Computed On Minimum Due In Full Due Date
$4 PER INSTL 103.16 103.16 08/26/04
PLEASE SEE REVERSE SIDE FOR IMPORTANT INFORMATION
YOUR PREMIUM PAYMENTS ARE
NO LONGER BEING PAID VIA
THE INSURANCE DEDUCTION ~
PLAN. RECENT DEDUCTIONS ( 02----
MAY NOT YET BE REFLECTED
IN THIS STATEMENT. YOUR
COVERAGE WILL REMAIN IN
EFFECT PROVIDED YOU PAY
THE MINIMUM DUE. IF YOU
HAVE A QUESTION PLEASE
CALL: 1-800-526-1547.
Please detach and return the bo"om portion with your payment, in the envelope provided.
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PROOF OF PUBLICATION OF NOTICE
IN CUMBERLAND LAW JOURNAL
(Under Act No. 587, approved May 16,1929), p, L.1784
STATE OF PENNSYLVANIA :
ss.
COUNTY OF CUMBERLAND :
Lisa Marie Coyne, Esquire, Editor ofthe Cumberland Law Journal, of the County and
State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law
Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid,
was established January 2, 1952, and designated by the local courts as the official legal
periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly
issued weekly in the said County, and that the printed notice or publication attached hereto is
exaciiy the same as was printed in the regular editions and issues of the said Cumberland Law
Journal on the following dates,
VIZ:
SEPTEMBER 24, OCTOBER 1, 8,2004
Affiant further deposes that he is authorized to verify this statement by the Cumberland
Law Journal, a legal periodical of general circulation, and that he is not interested in the subject
matter ofthe aforesaid notice or advertisement, and that all allegations in the foregoing
statements as to time, place and character of publication are true.
\. ('V
)K~ C/(,
Parks, Donna J., dec'd.
Late of Allen Bora,
Executor: Ray R. Strayer. 889
King Street. Lewisberry. PA
17339.
Attomeys: Craig A. Hatch, Es-
quire. Gates. Halbruner & Hatch,
P.C., 1013 Mumma Road, Suite
100. Lemoyne, PA 17043.
)1.',
/ Li a Marie Coyne, Ed' or
..-/
SWORN TO AND SUBSCRIBED before me this
8 day of OCTOBER 2004
NOT AR I\L SEAL
LOIS E. SNYDER, Notary Public
Ca:lisle Bora, Cumberland County
My Commission Expires March 5, 2005
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J & D AUTOMOTIVE ~_RVICES
RT 11 & 15
ENOLA, PA 17025
717-909-1400 717-909-4098
717-909-1500 FAX
Invoice
Date Invoice #
8/30/2004 7050
Bill To
License #
Donna J. Parks
l2S0A Boiling Splmgs Road
Boiling Springs, P A 17007
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vvdbea26d6ka873160
Due on receipt
95079
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Terms
MILES
Item
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Rate
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Inspection Stic_.. 1 Sticker # IM4 9316427 2.00 2.00T
sticker 1 Emission Sticker # IM4 5765705 0.00 O.OOT
MCI FEE 1 MeI transmission fee 4.15 4.15T
LOF Lube oil & filter 7.49 7.49T
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Sales Tax (6.0%) $0.82
Total $14.46
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LIBERTY MUTUAL GROUP
5021 LOUISE DR
MECHANICSBURG PA 17055
*049941*
~,.
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PREMIUM NOTICE
October 15, 2004
*19001 006986720041015*
ESTATE OF DONNA J PARKS
C/O RAY STRAYER EXECUTOR
889 KING ST
LEWISBERRY PA 17339-9575
For Customer Service Call: (717) 795-8703
Hearing Impaired Customers Call: (800) 243-9801
To Report a Claim Call: (800) 225-2467
Or Contact Us At: www.libertymutua1.com
This bill reflects paymcnts rcceived as of 10/15(2004.
PLEASE SEE REVERSE SIDE FOR POLICY DETAILS AND IMPORTANT INFORMATION
Please pay the current due. Any additional amount paid will reduce the remaining policy balance.
****Liberty Mutual offers an easy and convenient way to pay your bil1****
You can have your payments electronically deducted from your checking account, saving you the time of writing and
mailing a monthly check and reducing your monthly installment fees. Just check the box below and complete and return the
infonnation on the back of this fonn.
Change the batteries in your smoke alarms once a year; replace alanns every ten years.
~~~
~
! Please detach and return the bottom portion with your payment, in the envelope provided. !
LIBERTY MUTUAL GROUP
5021 LOUISE DR
MEC.HANICSBURG PA 17055
'048754*
~
PREMIUM NOTICE
*19001 005242320041015-
DONNA J PARKS
C/O RAY STRAYER EXECUTOR
889 KING ST
LEWISBERRY PA 17339-9575
October 15, 2004
~ .ti /F~~"=' S.~ire 0.'''(717) 795-8703
Healing Impaired Customers Call: (800) 243-9801
To Report a Claim Call: (800) 225-2467
Or Contact Us At: www.1ibertymutua1.com
This bill reflects payments received as of 10/15/2004.
PLEASE SEE REVERSE SIDE FOR POLICY DETAILS AND IMPORT ANT INFORMATION
Please pay the current due. Any additional amount paid will reduce the remaining policy balance.
****Liberty Mntual offers an easy and convenient way to pay your bill****
You can have your payments electronically deducted from your checking account, saving you the time of writing and
mailing a monthly check and reducing your monthly installment tees. Just check the box below and complete and return the
information on the back of this form.
Change the batteries in your smoke alanns once a year; replace alarms every ten years.
1 Please detach and return the bottom portion with your payment, in the envelope provided. 1
LIBERTY MUTUAL GROUP
5021 LOUISE DR
MECIIANICSIlURG PA 17055
*036215*
~.
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PREMIUM NOTICE
October 05, 2004
*19001 003093120041005*
DONNA J PARKS
889 KING ST
LEWISBERRY PA 17339-9575
For Customer Service Call: (717) 795-8703
Heming Impaired Customers Call: (800) 243-980 I
To RepOlt a Claim Call: (800) 225-2467
Or Contact Us At: W\vw.libcltymull",l.com
This bill reflects payments received as of 10/05/2004.
PLEASE SEE REVERSE SIDE FOR POLICY DETAILS AND IMPORTANT INFORMATION
Please pay the ClllTent due. Any aclditional amount paid will reduce the remuining policy bulunce.
****Liberty Mutual offers all easy and cOllvenient way to pay your bilI****
You cun have your payments electronically deducted from your checking account, saving you "the time of writing and
mailing a montl\1y check and reducing your monthly installment fees. Just check the box below und complete and rcturn the
infonnation on the back of this fOlm.
1 Please detach und retull\ the bottom portion with your payment, in the envdope provided. 1
Make Check I'ayahle To: LIBERTY MUTUAL GROUP
DONNA J PARKS
Please send all payments in the envdope provided.
Payments are 110 longer accepted in locul Libclty Mutual ol1ices.
.
Check here for change of address and
entcr infonnution on rcverse side.
..
CurrenIDue:/ .~ Pay either t Policy Balone.: Sales Oflice:
$ 65.28 atIlOWl! $ 616.85 0357
I
Policy Number: Due Date:
A02-281-563456-80 4 10/25/2004
AMOUNT ENCLOSED
Check here to have future paymcnts automaticlllly deducted from your chccking llccount. $
Libclty Mutual will initiate the transuction on the 5th day of each month for withdrawal
[rom your blink two business days lute)". You mllY sclcct a ditlerent day on the buck of
this fonn. Scc reverse side for rcquircd signature and additional infollllutioll.
.
286176922815634568020041005000005000000000065280061685
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MAXWELL ENTERPRISES
1332 BRANDT AVENUE -- NEW CUMBERLAND, PA 17070
VOICE: 774-7150 FAX: 774-2366
WEB: WWW.ACCOUNTANT-CITY.COM/MENTERPRISES * E-MAIL: ACCTWITHED@COMCAST.NET
DONNA J PARKS
1280A BOILING SPRINGS ROAD
BOILING SPRINGS PA 17007-9679
INVOICE DATE: 04/11/2004
SS NUMBER: 164-30-2891
TELEPHONE: 717-258-5377
INVOICE NO. :
1 FORM 1040
1 SCHEDULE B, SCHEDULE 1, INTEREST AND DIVIDEND INCOME
1 SCHEDULE E, SUPPLEMENTAL INCOME AND LOSS
3 FORM 1099R, PENSION, ANNUITY, PROFIT SHARING DISTRIBUTIONS
1 FORM 4562, DEPRECIATION AND AMORTIZATION
11 DEPRECIATION WORKSHEETS
1 SOCIAL SECURITY, RAILROAD TIER 1 RETIREMENT WORKSHEET
1 PA STATE RESIDENT RETURN
INVOICE
437.00
292.00
Remarks:
Copyright form software only, 2003 Universal Tax Systems, Inc, AU rights reserved.
145.00 . /
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Met-Ed
A ri"SiEoflf/Y Coo~
I Account Number: 1000207179951
September 21,2004
Page 1 of 4
M72
Bill for: ESTAT.E OF DONNA J PARKS
ALLEN ~ .J.!
1280A BOILING SPRINGS RD ~ Iff
/;lOlLING SPRINGS PA 17007
Billing Period: Aug 18 to Sep 20,2004 for 34 days
Next Reading Date: On or about Oct 18, 2004
Bill Based On: Actual Meter Reading
Your previous bill was
Total payments/adjustments
Balance at billing on September 21, 2004
Current Basic Charges
Met-Ed - Consumption
ue
Residential Time Of Day
To avoid a 1.50% Late Payment Charge being added to your bill, please pay by the due date.
CUGtomer Service 1-800-545-7741
Automated Outage Reporting 1-888-544-4877
Collections 1-800-962-4848
, ,-0';'jjJt~~,,'~'\+''Y''_'t"';;' ;~;>;~t1i;';i';\,"('1!.'/Ir.,.,."'l""1!'l!"_~~~'!'~."''''_ .''''' ",,,",,',<0;)0'7''''''''
h",_ ..lIal Time Of Day
Meter Number
Present KWH Reading (Actual)
Previous KWH Reading (Actual)
Kilowall Hours Used
G83271330
2,799
2,258
541
Meter Number
Present OnPeak Reading (Actual)
Previous OnPeak Reading (Actual)
OnPeak KWH Used (48.6%)
Off Peak KWH Used (51.4%)
G83271330
71,365
71,102
263
278
Page 1 of 4
M72
I
Met-Ed
A ""'tEnergy CC:npmY"
October 20,2004
I Account Number: 1000207179951
Bill for: ESTATE OF DONNA J PARKS
ALLEN
1280A BOILING SPRINGS RD
BOILING SPRINGS PA 17007
I
I
Billing Period: Sep 21 to Oct 19, 2004 for 29 days
Next Reading Dale: On or about Nov 16, 2004
Bill Based On: Actual Meter Reading
To avoid a 1.50% Late Payment Charge being added to your bill, please pay by the due dale.
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Novemnber18,2004
I Account Number: 10 00 20 7179 9 51
Bill for: ESTATE OF DONNA J PARKS
ALLEN
1280A BOILING SPRINGS RD
BOILING SPRINGS PA 17007
Page 1 of4
M72
Billing Period: Oct 20 10 Nov 17, 2004 for 29 days
Next Reading Date: On or about Dee 16, 2004
Bill Based On: Actual Meter Reading
To avoid a 1.50% Late Payment Charge being added to your bill, please pay by the due dab:!.
~. 111'-5
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~~
December 17, 2004
I Account Number: 1000207179951
Bill for: ESTATE OF DONNA J PARKS
ALLEN
1280A BOILING SPRINGS RD
BOILING SPRINGS PA 17007
Page 1 of 4
M72
Billing Period: Nov 18to Dee 16, 2004 for 29 days
Next Reading Date: On or about Jan 17, 2005
Bill Based On: Actual Meter Reading
Residential Time Of Day
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Residential Time Of Day
Meter Number G83271330 Meter Number G83271330
Present KWH Reading (Actual) 4,674 Present OnPeak Reading (Actual) 71,990
Previous KWH Reading (Actual) 3,678 Previous OnPeak Reading (Actual) 71,654
Kilowatt Hours Used 996 OnPeak KWH Used (33.7%) 336
OtlPeak KWH Used (66.3%) 660
Page 1 of 4
M72
Met-EeJ-.
January 19, 2005
I Account Number: 1000207179951
.,c_'c ~
A FITS...... .....~J ompany
Bill for: ESTATE OF DONNA J PARKS
ALLEN
1280A BOILING SPRINGS RD
BOILING SPRINGS PA 17007
Billing Period: Dec 17 to Jan 18, 2005 for 33 days
Next Reading Date: On or about Feb 15, 2005
Bill Based On: Actual Meter Reading
Prorated Bill
Residential Time Of Day
cM4F(J'
Payments:
01/05/05
-87.84
Total Payments
-87.84
Residential Time Of Day
Meter Number
Present KWH Reading (Actual)
- ....... - .. .. ..
G83271330
5.737
Meter Number
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G83271330
72.350
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CfR) TYIt /'tASTERcARD
SEQIIl83
TICI<ET I _19516
W1It COOE 221876
TOTAL $32.26
III I II US I KUI. V Alllt IIARDIIAllt
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HU)IANICSrnnu; PA I (lI!'!1
711 IIili 16:11
W/Il4/04 00:08 lOOl!i90f)
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139396 8.44S 8.44
PIi Elimy un:;r I
Ull056 1 21.99 21.99
PIN. llRS COHl.1 lUl:K51I
CUSTOMER COPY
SulJlolal
Sales lax
lotal Due
30.43
1.83
32.26
Bill ik C,lr d :12. 26
CallI ^c"" ....xxxx09442861
Authorization 221876
dx.A (01
UlAN!( YOIJ Hill SIHnNll AI IIIlIEIIS
HOtf)AY- r ILllAY tl:OOAH 10 6:00PM
SA TlJlDA Y 8: (lOAH 10 !): OOPM
SUNDAY 10:00A" 10 3:00PM
Registered No. ..,...'1'l9".....,611S -7 -, "".; 1.-,.'"
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Reg. Fee $ $7.50 Spec,al $ $0, ..~
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Date Stamp
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LEWISBERRY MPO
LEWISBERRY. Pennsylvania
173399998
4144060339-0097
09/17/2004 (717)938-6690 02:42:00 PM
Sales Receipt
Sale Unit
Qty Pri ce
Final
Price
Product
Description
VISTA CA 92081
First-Class
Rtn Recpt (Green Card)
Registered
Insured Value:
Article Value:
Label Serial #:
$1.06
$1.75
$7.50
$0.00
$0.00
RB612978696US
--------
--------
Issue PVI:
$10.31
Total:
Paid by:
Cash
$10.31
$10.31
~~
-- All sales final on stamps and postage.
Refunds for guaranteed services only,
Thank you for your business.
Customer Copy
Bi 11#:
Clerk:
1000300017059
04
Tt-IE liOMC PLF'Ol H-' 11 I
4200 DU<PV ':J ti/\I,r:LUUI\,. i'A : 11 []
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DfficeMax #322
3823 UNION DEPOSIT ROAD
HARRISBURG,PA. 17109
(717) 558-1550
Enter/Win www.officemax.com/store/survey
072782062057
Lb1 Disp 1-1/8x2-5/8 8lue
072782054809
Garage Sale Lbl Pre-Print
0072782054809
Garage Sale Lbl Pre-Print
$5.B9
$1.79
$1.79
SubTotal
Tax 6.000%
MAL
$9.57
$0.57
$10.14
$20.14
$10.00
Cash
Change
32443516
0322 00003 46205 2 09/08/0~
00273749 07:00:13 PM
ORDER BY PHONE 1-877-0FFICEMAX
111111111111111111111111111111111111111111111111111111111111111\
032200346200001090804000
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OfficelVlax
OfficeMax #746
600 CARLISLE PLAZA MALL
CARLISLE,PA. 17013
(717) 243-2764
Enter/Win www.officemax.com/store/survey
072782054809
Garage Sale Lbl Pre-Print
072782054809
Gdl dytl 3d ltl UJ 1 Prtl-Pr illl
083392099098
15x19 Garage Sale
083392099098
15x19 Garage Sale
$1.79
$1.79
$3.69
$3.69
SubTotal
Tax 6.000%
TOTAL
$10.96
$0.66
$11.62
$20.00
$8.38
Cash
Change
42441516
0746 00002 90130 3 09/15/04
00014990 10:09:46 AM
ORDER BY PHONE 1-B77-0FFICEMAX
1111111111111111111111111111111111111111111111111\1111\1\11\1111
074600290130001091504002
I,
LEWISBERRY MPO
LEWISBERRY. Pennsylvania
173399998
4144060339-0097
09/17/2004 (717}938-6690 02:42:00 PM
Sales Receipt
Sale Unit
Oty Price
Product
Description
Final
Price
$1.06
$1.75
$7.50
$0.00
$0.00
RB612978696US
VISTA CA 92081
First-Class
Rtn Recpt (Green Card)
Registered
Insured Value:
Article Value:
Label Serial II:
--------
--------
Issue PVI:
$10.31
Total:
Paid by:
Cash
$10.31
$10.31
B1111l:
Clerk:
1000300017059
04
-- All sales final on stamps and postage.
Refunds for guaranteed services only.
Thank you for your business.
Customer Copy
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4200 DERRY ST HARRISBURG. flA 17111
(717) 558.8105
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Order Confirmation
Ad Order
0001179006
Customer
Strayer
Customer Account
65198
Pavor Customer
Strayer
Sales
Iford
Pavor Account
65198
Order Taker
Iford
Customer Address
889 King Street
Lewisberry PA 17339 USA
Pavor Address
889 King Street
Lewisberry PA 17339 USA
Pavor Phone
717-938-6647
Order Source
Phone
Customer Phone
717-938-6647
Ordered Bv
Ray
Special PricinQ
None
oJ#
} I ~
PO Number
Customer Fax
Customer EMail
Tear Sheets
o
Proofs
o
Affidavits
o
Blind Box
Promo Tvpe
<NONE>
Invoice Text
(5N1f
M(v
Ad Order Notes
Materials
Net Amount
$29,20
Tax Amount
$0,00
Total Amount
$29.20
Pavment Method
it Card - MasterCard::
Pavment Amount
$29,20
Amount Due
$0,00
Ad Number Ad Tvpe
0001179006-0' CPPL
Ad Size
:1,OX10Li
Color
New Ad Color
Production Method Production Notes
Ad Booker
External Ad Number
Ad Attributes
Ad Released
No
Pick UP
9/3/20049:18:37AM
1
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THE PATRIOT NEWS
THE SUNDAY PATRIOT NEWS
Proof of Publication
Under Act No. 587, Approved May 16, 1929
Commonwealth of Pennsylvania, County of Dauphin} ss
Michael Morrow, being duly sworn according to law, deposes and says:
That he is the Controller of The Patriot News Co., a corporation organized and existing under the laws of
the Commonwealth of Pennsylvania, with its principal office and place of business at 812 to 818 Market Street, in
the City of Harrisburg, County of Dauphin, State of Pennsylvania, owner and publisher of The Patriot-News and The
Sunday Patriot-News newspapers of general circulation, printed and published at 812 to 818 Market Street, in the
City, County and State aforesaid; that The Patriot-News and The Sunday Patriot-News were established March 4th,
1854, and September 18th, 1949, respectively, and all have been continuously published ever since;
That the printed notice or publication which is securely attached hereto is exactly as printed and published
in their regular daily and/or Sunday/ Metro editions which appeared on the 24th day(s) of September and the 1st and
8th day(s) of October 2004. That neither he nor said Company is interested in the subject matter of said printed
notice or adveltising, and t1Iat all of the allegations of this statement as to the time, place and character of publication
are true; and
That he has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this
statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant to a resolution unanimously passed
and adopted severally by the stockholders and board of directors of the said Company and subsequently duly
recorded in the office for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book "M",
Volume 14, Page 317.
COpy
~<----
PUBLICATION
LETTERSTESTAMENTARY forth. Es.
tate at Donna J. Parks, deceased, late of Al-
Ien Boro, Cumberland County, Pennsvlva-
nla, were granted to Ray R. Strayer on Au-
gust 13, 2004. AII.,erlOns Indebted to the Es-
tate are requested to make Immediate pay.
ment and thOle having claIms aDOlnst the
Estate are requested to present them for
settlement without delay to:
Ray R. strayer, I!xecutar
889 King street
Lewlsberry, PA 17339
orto
Craig A. Hatch, ESQUire
GATES, HALBRUNER & HATCH, P.C.
1013 Mumma Road, Suite 100
Lemayn., PA 17043
GATES, HALBRUNER & HATCH, P.C.
ATTN: TRACl L. SEPKOVIC
1013 MUMMA ROAD, SUITEIOO
LEMOYNE, PA. 17043
Statement of Advertising Costs
To THE PATRIOT-NEWS CO.
For publishing the notice or publication attached
hereto on the above stated dates
211.81
Publisher's Receipt for Advertising Cost
The Patriot News Co., publisher of The Patriot-News and The Sunday Patriot-News, newspapers of general
circulation, hereby acknowledge receipt of the aforesaid notice and publication costs and certifies tlIat the same have
been duly paid.
By....................................................................
I
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Now you know
Ad Order
0001192045
~
kkline
Order Taker
kkline
Order Source
Phone
PO Number
Ordered Bv
Ray
Customer Fax
Customer EMail
Customer
Strayer
Customer Account
65198
Customer Address
889 King Street
Lewisberry PA 17339 USA
Customer Phone
717-938-6647
Order Confirmation
Pavor Customer
Strayer
Payor Account
65198
Pavor Address
889 King Street
Lewisberry PA 17339 USA
Pavor Phone
717-938-6647
Special PricinQ
None
Tear Sheets
o
f!:QQf!
o
Invoice Text
Ad Order Notes
Materials
Pavment Method
it Card - MasterCard::
Affidavits
o
Net Amount
$16.00
Payment Amount
$16.00
Blind Box
Tax Amount
$0.00
Amount Due
$0.00
Promo Tvpe
Class Level 2
Total Amount
$16.00
Ad Number Ad Type
0001192045-0' CPPL
Ad Size
: 1.0 X 5 Li
Production Method Production Notes
Ad Booker
External Ad Number
Ad Attributes
Color
<NONE>
Ad Released
No
Pick Up
10/13/2004 9:02:38AM
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'=CEIVED BL
- 24705
APPRAISAL INVOICE
Date: September 16, 2004
Prepared for:
Ray Strayer
899 Kinq Street
Lewisberry, PA 17339
S408051
Property Appraised:
Estate of Donna Parks
1280 Boilinq Sprinqs Road
Churchtwon. IJA 17055
Work Performed:
Single Family Appraisal Report
(717) 432-3693
T,)tal Amount Due:
Please make checks payable to:
Stoner Appraisals Ltd
129 Old York Road
Dillsburg, PA 17019
File No.:
S408051
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$300.00
$300.00
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THE HOME DEPOT 41.20
~ 6000 CARLISLE PIKE, MECH. PA 17055
"TORE MANAGER MARK ULRICH <717>795-9602 '
4120 00010 82064 10/30/04
11 CS200F 08:37 AM
SALE
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SALES TAX
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AUTH CODE 030436/8101733
P.O.H/JOB NAME: OJ PARK
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AUTH CODE 013890/5565027
P.O.#/JOB NAME: DJPARKS
YOUR OPINION COUNTSl COMPLETE A SURVEY
AT WWW.HOMEDEPOTOPINION.COM AND ENTER
TO WIN A $5,000 HOME DEPOT GIFT CAROl
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SAMS CLUB
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5~t~: 10/19/04
TIME: 10:17
TRAcE: .. 3453
MC~~~~~~~~~~~~*~2867
'APP CODE: 229835
GIFi~TRA~E: 998100SQl
ASI ,~ODE.
GATEWA'Y :
PUMP:
PRODUCT:
PRICE/GAL:
MET/GAL:
QUAt~TIT'( :
FUEL TOTi'
NEi TOTA'-
10
UNLEADE
$1.949
$1.899
14.570
$27.86
$27.86
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....... LDWE"S
CARLISLE. PA
(117)258 -7700
-SALE-
SALES I: S1710881 707570 11-07 -04
173407 REPRIR KIT MODEL 12.96
SUBTOTAL: 12.96
TAX 38550 : 0.78
INVOICE 04752 TOTAL: 13.74
BRLANCE DUE: 13.74
MIC : 13.74
H/C XXXXXXXXXXXX2867 321826
AMOUNT: 13.74
------------------------------------
1710 TERMINAL: 04 11/07/04 09:16:53
IIII~IIIIIIIIIIIIIII~~II~~IIIII~IIIII
THANK YOU RAY STRAYER
FOR SHOPPING LOWE'S
RECEIPT REQUIRED FOR CASH REFUND.
CHECK PURCHASE REFUNDS REQUIRE
15 DAY WAIT PERIOD FOR CASH BACK.
STORE HGR: JASON CRRRIER
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CARLISLE. PA
(717)258 -7700
-SALE-
SALES I: S1710TS1 707599 12-09-04
5996 8' STAIN 268 PIN 9.84
3 @ 3.28
SUBTOTAL: 9.84
TAX 38550; 0.59
INVOICE 10006 TOTAL: 10.43
BALANCE DUE: 10.43
CASH: 20.43
CHANGE: 10.00
1710 TERMINAL: 10 12/09/04 12:13:01
!IIIIII~II~IIII~IIII
THANK VOU FOR SHOPPING LOWE'S
RECEIPT REQUIRED FOR CASH REFUND.
CHECK PURCHASE REFUNDS REQUIRE
15 DAV WAIT PERIOD FOR CASH BACK.
STORE MGR: JASON CARRIER
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AUTrl CODE 0093~9/5020705
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THE SENTINEL
Printed on 09f28f2004 at 08:09 by 28
Ad# 273662
First taken by ?n
Last changed by
09f27/2004 13:00
09/28/2004 08:09
(717) 938-b647 Acct# 64192
RAY STRAYER
889 KING ST.
Given by RAY STRAYER
Start 09/30/2004 Stop 10f02/2004
Transient Bill Expir:
Class 443 CHURCHTOWN
Index: ESTATE/GARAGE SALE, FRI., OCT. I, S
Cols 1 Lines 8 Inches.0.81 Words 26 Box? N
LEWISBERRY. PA 17339
Subscr? N
Pb# Code Rate
1 YS
Base-Charge Addl-Charge Total-Cost
18.00 0.00 18.00
Ins
3
Start Stop
09f30f2004 10f02/2004
SMTWTFS
0000111
TOTAL AD COST
redit-Card-#
Exp-Date
Auth-Code
Payments:
Date
09/28/2004
***********2867 04f30/2005 227826U CVV
NET DUE
ESTATE/GARAGE SALE,
Fri., Oct. 1, Sat., Oct.. 2
& Sun., Oct. 3, 8am.
4pm, 1280A Boiling
Springs Rd. Household,
yard & garden equip.
ment, huuoewai65 &:
cleaning equipment.
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I
PA REV-1500
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES
and LIENS
PATIENT ACCOUNT STATEMENT
'{'
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d'''') CARusLE
Jf REGIONAL P.O. Box 4100
., ME Die ALe EN T E R Cartisle, PA 17013-4100
ADDRESS SERVICE REQUESTED
IF PAVING BV CREDIT CARD, FILL OUT BELOW AND SEE REVERSE SIDE
CHECK CARD USING FOR PAYMENT
.. ~ASTEACAAD . ~SCOVER Zl ~SA
ACCOUNT NO. STATEMENT DATE BALANCE DUE
9271726
09/27/2004
--
10/11/2004
MAKE CHECKS PAYABLE TO:
PARKS, DONNA J
889 KING ST
:;: lEW1SBERRV PA 17339
<>
CARLISLE REGIONAL MEDICAL CENTER
246 PARKER ST.
P.O. BOX 4100
CARLISLE PA 17013-4100
1...111,. .111"...,11,.11.11.,,1.1.,11, III ,.111I11,11",1..1,1
1...111...1..11.. .11.1.1..1.1...1.1.1...1.1.1.1..1.1.1.. .1..11
007852 858HMA 000082L
- 0 Please check if above address is incorrect and indicate change on reverse side.
TO INSURE PROPER CREDIT, DETACH AND RETURN THIS PORTION IN THE ENCLOSED ENVELOPE.
PAID
Carlisle Regional Medical err
. ,
,,~--
I
1- DONNA PARKS ESTATE
,
A.
124
60-430 16
313
1070916
11M "/~J/"r
cf)~.~d'''''''f ~ ~ /Ik/-u...!{e~. I $ g;~ S!'
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_.fmtruslon~ne.com
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.01ll70Q .(;11"
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DATE DESCR. ION REFERENCE CHARGES CREDITS
07/15/04 Consultation Donna 0.00
07/19/04 Reline Camp. Mand. Dent Donna 244.00
07/28/04 Statement Sent Account-
.. '1 p/er
I p
(:}~~(/L
<
CURRENT 30 DAYS 60 DAYS 90 DAYS NEW OUTSTANDING PLEASE PAY
BALANCE INSUllAIlCE
244.00 0.00 0.00 0.00 244.00 0.00 244.00
asey J. Williams, D.M.D., 210 Forge Road
PO Box 87, Boiling Springs, PA 17007
,YMENT IS DUE IN FULL UPON RECEIPT!
lANK YOU!
Next Appt. Day Date Time Reason
.~---- ~-- --- m.
.~ -- ----.
PLEASE GIVE 24 HOURS NOTICE IF YOU ARE UNABLE TO
KEEP THE ABOVE APPOINTMENT(S) .
INVOICE
CE SERVICE CENTER, Ir-.C
500 E NORTH ST, SUITE 1
CARLISLE, PA 17013
27-Jul-04
DONNA
PARKS
1280A BOILING SPRINGS RD
BOILING SPRINGS
PA
17007
INVOICE: 16140
BRAND: PROSCAN
MODEL: N
SERlAL: N
MDSC: TV
INVDATE: 7/8/04
BILL DATE:
7/27/04
BALANCE DUE:
$120.84
SERVICE PERFORMED
GMAS FUSE, 214756 CAPACITOR, 208002
CAPACITOR, 2.2UF@100V CAPACITOR--DIAGNOSE
AND REPAIR POWER SUPPLY REGULATOR-ADJUST
PICTURE
COMPLETED:
7/13/04
WtA :tf / () {---
PARTS/MDSC $19.00
LABOR $40.00
SERVICE CALL $55.00
PICKUP/DEL $0.00
SALES TAX $6.84
TOTAL CHARGES $120.84
DEPOSITS/ CREDIT $0.00
BALANCE DUE $120.84
This Invoice Is Due Upon Receipt
Interest of 1 1/2% per month will begin to accrue 30 days after bill date. Any discrepancies or
errors must be reported immediately, by contacting us at 717-241-9300.
Thank you for your prompt payment.
4'--'JYr-4'
~ "\-\ I
ctA1M CHE K
':JVV-('. i'JUllIl JU'='';:';'l, -JUIL";"; .L
Carlisle. P!~ t 7013
71].2419300
NAME
ADDRESS _
I\Jo Illerchandi:;e rlelivere(j '.vilhout this check. Not responsible lor qoods left over 30 days nor lor 1053 bv lire or theti
Form 1MO- V
Payment Voucher
OMS No. 1545-0074
164-30-2891
~ Do not staple or attach this voucher to your payment or return.
2 If a JOInt return, SSN shown second on your return 3 Amount you are
paying by check
or mone order
2004
Department of the Treasury
Internal Revenue SelVtce (99)
1 Your social security number (SSN)
4 Your first name, initial. and last name
22,654.
Donna J Parks
If a joint return, spouse's first name, initial, and last name
Home address (number and street)
Apt no.
1280-A Boilinq Springs Road
City, town or post office
State ZIP code
Boilinq Sprinqs
PA 17007
BAA
FDIA8601 10/19/04
--------------------------------------------------------------------.
, Detach Here and Mail With Your Payment and Return ,
COpy
, 1"'.'" ''''f','.'- i 'I l""~
Mail Form 1040-V (federal tax payment voucher) to the address listed below.
Internal Revenue Service Center
P.O. Box 80101
Cincinnati, OH 45280-0001
COpy
Make check payable to: Pennsylvania Department of Revenue
Mail to:
Pennsylvania Department of Revenue
Payment Enclosed
1 Revenue Place
Harrisburg PA, 17129-0001
Note: Write your SSN (and spouse's ssn if filing joint),
daytime phone number and tax year on your check.
CUT ALONG DOTTED LINE
PAIZ3401 01/04105
r -,
164-3[]-2B91
PA
[]4[][]918199
PAYMENT AMOUNT
PARKS
DONNA
J
$
5[]89.[][]
121m-A BOILING
BOILING SPRIN
PA
17[][]7
SPRINGS ROAD
DEPARTMENT USE
I
ONLY
I
Make check or money order
payable to the Pennsylvania
Department of Revenue
L
I
Met-Ed
August 18, 2004
~McOO:2Oii11iii~
Page 1 of 4
M72
~
A Firs/Energy Cnnl''''''Y
Bill for: ESTATE OF DONNA J PARKS
ALLEN
1280A BOILING SPRINGS RD
BOILING SPRINGS PA 17007
Billing Period: Jul 17 to Aug 17, 2004 for 32 days
Next Reading Date: On or about Sap 17, 2004
Bill Based On: Actual Meter Reading
Your previous bill was
T olal payments/adjustments
Balance at billing on August 18, 2004
Current Basic Charges
Met-Ed - Consumption
Met-Ed - Payment Plan Balance
Late Payment Charges
Total Current Charges
o ue P
To avoid a 1.50% Late Payment Charge being added to your bill, please pay by the due date.
~
Customer Service 1-800-545-7741
Automated Outage Reporting 1-888-544-4877
Collections 1-800-962-4848
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US
<D a
Register of Wills
cumberland
County, Pennsylvania
INVENTORY
Estate of Donna J. Parks
No. 21-04-0744
also known as
Date of Death 08/03/2004
, Deceased
Social Security No. 164-30-2891
Ray Richard Strayer,
Personal Representativels) of the above Estate, deceased, verity that the items appearing in the following inventory include ail
of the personal assets wherever situate and aU of the real estate in the Commonwealth of Pennsylvania of said Oecedent, that
the valuation pieced opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and
that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum
at the end of this inventory. I/We verify that the statements made in this Inventory are true and correct. l!We understand that
false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn felsification to
authorities.
Name of
Attorney:
Craig A. Hatch, Esquire
76361
;;Rep~te~_
I.D. No.:
Address:
Gates, Halbruner & Hatch, P.C.
Deted (;l! /) :; /J.. tJtl S
1013 Mumma Rd., Suite 10~glIL.QY!J.~.PA 17043
Telephone, (717) 731-9600
,)
Description
Value,
Real estate located at 1280 Boiling Springs Road
$197,992.06"
68 shares of IBM common stock
5,856.16
1989 Mercedes Benz
5,000.00
Arnerichoice Federal Credit Union; Savings Acct. #8412
1,907.81
Arnerichoice Federal Credit Union; Checking Acct. #8412
3,075.59
Arnerichoice Federal Credit Union; Checking Acct. #8412
4.07
Corncast Cable - refund
5.52
F&M Trust; Checking Acct. #343-34273
211,576.38
F&M Trust; Savings Acct. #70-33699
13,476.19
Liberty Mutual - insurance premium refunds
575.15
Toews Corporation - refund
92.78
TOlal: $439,561.65
(Attach Additional Sheets if neces$ary)
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may. at the election of the personal representative, include
the value of each item, but such figures should not be extended into the total of the Inventory.
RW-8
.)'-
PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF
THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE FORM 6.12 YEARLY
UNTIL COMPLETION.
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Date of Death:
Donna J. Parks
Will No.:
August 3, 2004
21-04-0744
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: No
2. If the answer is No, state when the personal representative reasonably believes that the
administration will be complete: January 2006
3. If the answer to No. I is yes, state the following:
A.
Did the personal representative file a final account with the court? N/ A
B.
The separate Orphans' Court No. (if any) for the personal representative's
account is: N/A
C.
Did the personal representative state an account informally to the parties in
interest? Nt A
D.
Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of Orphans' Court and may be attached to
this report.
Date: ~~st 4, 2005
t..-)
I [,'
C'
Cra' A. Hatch, Esquire
P I.D. # 76361
GATES, HALBRUNER & HATCH, P.c.
1013 Mumma Road, Suite 100
Lemoyne, P A 17043
(717) 731-9600
t.':
,
c_
c,,;
,~-
Capacity: Counsel for Personal Representative
~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
BUREAU OF INDIVIDUAL TAXE1h,'v;~rr ,c:r'(J\I'mISEHENT, ALLOllANCE DR DISALLDllANCE
INHERITANCE TAX DIVISI"" r"" r) '.", i_"_o;; DEDUCTIONS AND ASSESSHENT OF TAX
PO BOX 280601 - ~
HARRISBURG PA 17128-0601 ' ., I '.:
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
07-25-2005
PARKS
08-03-2004
21 04-0744
CUMBERLAND
101
APPEAL DATE: 09-23-2005
(See reverse side under Objections)
Allount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS +-
REV:is4;-Ei-AFP-ioi:osi-NOTicE-OF-iNHERiTANCE-TAi-APPRAisEMENT:-ALLOWANCE-OR---------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
DONNA J FILE NO. 21 04-0744 ACN 101
"![ ';"
c:;')
1; 2: 27
.~ "~' ..... '- :.- '-~-
CRAIG A HATC!! 'tSQ-
GATES ETAL
1013 MUMMA
LEMOYNE
RD STE 100
PA 17043
ESTATE OF PARKS
*'
REV-1547 EX AFP (06-05)
DONNA
J
DATE 07-25-2005
I~ an asses~ent was issued previously, lines 14, 15 and,or 16, 17, 18 and
re~lect ~igures that include the total ~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Aaount of Line 14 .t Spousal r.te (IS)
16. ~ount of Line 14 taxable .t Lln881/Class A rat. (16)
17. A~unt of Line 14 at Sibling rat. (17)
18. Amount of Line 14 taxable at Coll.ter81/Class B rete (18)
19. Principal Tax Due
TAX RETURN liAS: I X I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..l Est.t. (Schedule A)
2. Stocks .nd Bonds ISchaduI. B)
3. Closely Held Stock/Partnership Interest (Schedule Cl
4. Mortgages/Notes Receivable (Schedule DJ
5. CashIBenk DepositslHisc. Personal Property (Schedule EJ
6. Jointly Owned Prop.rty ISchoduI. FI
7. Tnmsf.,.s (Schedule GJ
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expens.s/A~. Costs/Misc. Expenses (Schedule HJ
ID. Debts/Hortu-g. Li~iliti.s/Li~s IScheduI. I)
11. Total o.ductions
12. Net Value of Tax Return
13. Ch8ritable/GoV8~ntal Bequests; Non-elected 9113 Trusts
14. Net Value of Estate Subject to Tax
NOTE:
I I CHANGED
III
(2)
131
(4)
151
(6)
(7)
197,992.00
5.856.16
.00
.00
235.713.49
.00
29,206.66
181
191
110)
49,806.23
NOTE: To insure proper
credl t to your account,
submit the upper portion
of this for. with your
tax paYll8l1t.
468,768.31
7Q.?4Q 4?
389,518.89
.00
389,518.89
19 will
.00
15,345.85
4,800.00
1,275.00
21,420.85
TAY C DrT$O.
,T, AHOUNT PAID
DATE NUI1BER INTEREST/PEN PAID 1-)
11-01-2004 CD004564 1,071 . 04 24,000.00
TOTAL TAX CREDIT 25,071. 04
BALANCE OF TAX DUE 3,650.19CR
INTEREST AND PEN. .00
TOTAL DUE 3,650.19CR
~
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDI~' ICR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
29.443.19
111)
1121
113)
1141
ISchaduI. J)
.00
341,018.89
40,000.00
8,500.00
x 00 =
X 045 =
X 12 =
X 15 =
119)=
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRIS8URG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
REV-1607 EX AFP (03-05)
CRAIG A HATCH ESQ
GATES ETAL
1013 MUMMA RD STE 100
LEMOYNE PA 17043
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
08-29-2005
PARKS
08-03-2004
21 04-0744
CUMBERLAND
101
DONNA
J
Amount Remitted
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
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REV-1607 EX AFP (03-05)
~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ...
ESTATE OF PARKS DONNA J FILE NO.21 04-0744 ACN 101 DATE 08-29-2005
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-18-2005
PRINCIPAL TAX DUE: 21,420.85
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
11-01-2004 "'. CD004564 L071.04 24,000.00
08-12-2005 REFUND .00 3,650.19-
TOTAL TAX CREDIT 21,420.85
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
.. IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
RK.
LAW OFFICES OF
GATES, HALBRUNER &-HATCH, P.C.
1013 MUMMA ROAD. SUITE 100. LEMOYNE. PENNSYLVANIA 17043
(717) 731-9600 . FAX: (717) 731-9627
December 19, 2005
BRANCH OFFICE:
3 WEST MONUMENT SQUARE. SUITE 304
LEWISTOWN. PA 17044
(717) 248-6909
WEB SITE:
www.GatesLawFirm.com
CORRESPONDENCE ADDRESS:
Lemoyne Office
STACEY L. NACE
ParalegaVOffice Manager
TRACI L. SEPKOVIC
Paralegal
VALERIE LONG
Paralegal
LOWELL R. GATES, LL. M.
LL. M. in Taxation
Also Admitted to Massachusetts Bar
MARK E. HALBRUNER
Also Admitted to New Jersey Bar
CRAIG A. HATCH, CELA
Cert~ied as an Elder Law Attorney by
the National Elder Law Foundation
ALBERT N. PETERLlN
Also Admitted to Maryland Bar
CLIFTON R. GUISE
Also Admitted to practice before the
U.S. Patent & Trademark Office
BYRON L. McMASTERS, LL.M.
LL. M. in Taxation
Cumberland County Courthouse
Office of the Register of Wills
One Courthouse Square
Carlisle, P A 17013
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RE:
Estate of Donna J. Parks
Estate No. 21-04-0744
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Dear Register of Wills:
Enclosed for filing is the final Status Report for the Estate of Donna J. Parks. Please time-
stamp the photocopy and return it to our office in the enclosed envelope.
Thank you for your assistance in this matter.
Sincerely,
':'/((((~a /~(U{/(C.
Traci L. Sepkovic
Paralegal
Enclosures
cc: Ray R. Strayer, Executor
PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF
THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE FORM 6.12 YEARLY
UNTIL COMPLETION.
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Date of Death:
Donna J. Parks
Will No.:
August 3, 2004
21-04-0744
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
2. If the answer is No, state when the personal representative reasonably believes that the
administration will be complete: NtA
3. If the answer to No.1 is yes, state the following:
A. Did the personal representative file a final account with the court? No
B. The separate Orphans' Court No. (if any) for the personal representative's
account is: Nt A
C. Did the personal representative state an account informally to the parties in
interest? Yes
D. Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of Orphans' Court and may be attached to
this report.
Date: December 19, 2005
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Crai A. Hatch, Esquire
P I.D. # 76361
GATES, HALBRUNER & HATCH, P.C.
1013 Mumma Road, Suite 100
Lemoyne, PAl 7043
(717) 731-9600
Capacity: Counsel for Personal Representative
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