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HomeMy WebLinkAbout12-06-11INVENTORY REGISTER. OF WILLS OF ()1 COY I~h ~ COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA 1 COUNTY OF J SS File Number~l ~ O~0 ' - 16 Personal Representative(s) of the Estate of l_ ,,,~, ~r deceased, depose(s) and say(s) that the items appearing in the following inventory include alt of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the vahaation placed 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 invent. ~ •..:, I verify that the statements made in this Inven- ' Q _- ~~' tory are true and correct. I understand that false state- ~'' ~ _ '~ r- ments herein are made subject to the penalties of -~~ r~~ .3 ': 18 Pa.C.S. § 4904 relating to unsworn falsification to ~`=' ~ ~ t -' authorities. ~ cn ~~ ~ ~ - `. f..~ { i ~. . , ~ t~ ~ ., ~r, ", ~=._ -, Attorney -- (Name) ~ ,~ , .^ (Address) (Supreme Cot~l.~. No.) R° ~ `. ' '~' -..~ ~ (Telephone) DATE OF DEATH `~ ~T RESIDENCE I DECEDENT'S SOC. SEC. NO. ee ~ t in ~~ ~ . FI URES MUST B TOTALED n 3~ t55. 6~ ~. '1C~~~a rov~r~ Pre~~ ~-2ri~v~ dm~5 3 t ~~-~v~n ~ ~vVn Yo re ~ s ~ c~ ~ ns c~.r~- h ce ~ 7 ~~ ~(~~ (owl ~V:Q lA-c (c- c~ir d eA l~P-~ ~~ S /~1-~4~~ G~'i 1 l ~. 5G h CG ~ l~-i 6 Y1 5 ~ ~ ~S ce~t~~Q, ne o ~.s ~ (~ ~ n A°` ~ o e. 10 U ~ 6 6 I B ~~ ~r1~ ~lb~ivu~ ~ S~oeS ~vs211~. ~~h~,~W G ~~l ~5 ~ ~- I I l t 5 S i ~ h Q. s !1\- 5 ~1 Q.VI I e. ~ ic) Q S 4Cirl~-2~ 4r ,~~5 f Ne- , (Attach additional sheets as needed) TOTAL: , ~ 0.00 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. (See 20 Pa. C.S. 3301 ~ t~~~ Form RW-09 rev. 10.13.06 ACNB BANK ~ 16 LINCOLN SQUARE PO BOX 3129 GET~YSBURG. PA 17325 oMfNee~aP of AcccluuT - Pels;,o~tAL PuaPOSE ^ ~nnDUAL ^ ^ .lo~rr - wmt ~ law ~« a. auras ti ^ .lo~lT - No ~ lastarrrrsiraaasaord ^ rRUSr - SEPARATE AG~IT: ^ REVOCABLE TRUST ONION AS DEFWED W THIS AG'~@!T 1 Name and Addraw of Barrsfayariss: i ii ; !; 3 DATE oPBtEfl 9/281201/ BY_~OflTlefh Iwrrlr-L Df~OBiT s 57.7T3.97 ^ CASH ® CHECK [Q Xfer - ACNB acd earns ownaralrip HOME TELEPHONE # _(7171451-S~IOS ~ SU51t1E5S PHONE i ORIVHfS tiCENSE ! SSA 45938 EMPLOYER MOTHER'S MAKIBd NAME Name and address of aomaarra who wi always luronr yor loeation OYYBIERSFiIP OF ACCdUNT - S PtJ ^ 901.E PROPRIETORSHIP ^ CORPORATION: ^ FORI PROFfT ^ NOT FOR PROFIT ^ PARiNERSH~ ® ESt~e BllSMtEbS: ,AipZAT N: AUTFIORIZATKIN DATED: 92812011 BACKUP 1MfiiiFlOLp^rHi CEftT1FiCAT10NS TN: 45$5Q5938 ® TA7~AY0t I.D. NU~Eh -The Taxpayer idert Number dawn above 1TW- is my r:orract taxpayer iden number. ® BACKUP NRiHFiOtDNG - i am rat aubjsct m backup whhitoltlirrg aiUrsr because I have tat been notified that 1 sm subject to backup witlrhoidirlg ps a raatlt of a failwe to repot aN interest a dividends, or the Nlrirrlal Revenue Service has notified me that 1 am ra bnger K to budcup vritflltoldilrg. klterrld Rsvanrre - i ~ an exempt recipient under the RspuWtions. Accotilrr awttellsl a Aooftese CLAIR W LEHMAN ESTATE 9 KINGS ARMS i MECHANICSBURG PA 17241 ^ NEW ^ IXISTING TYPE ~ ®CHECKWG ^ SAVINGS ^ MONEY MARKET ^ CERTIFICATE OF DEPOSIT ^ NOW ^ This is Your Ictlar~l oral: ESta~e Cher~cklg ® Perrrtanertt ^ Tertrporary socatelt apreetnerlt. Number of signadrros required for widldrawal 2 FACSMAILE SI(~IATUREfS) ALLOWED? ^ YES ® NO [X SIONATUR~1S) - Tas lwdoeiDlMd aoeea tas tlta tarsts stated an awry WYe ~ tltb faro acid ~nlsad.d#S ~aoe~t of a aonrpNtad copy. The tradaaiplsd fiatasr aataeriaa tae Srwciri irdMrtion to wri(y a~sdit and aanploynrtttt hielay snd/a hew a awit npadrg apsllcy a aadk spat w the twdsrsi~rsd, w ildvidaals. The ~b~ gaelalotelstlfie~s~aeae~sl a1f a aipy and sgros to the ® Deposit Accautt ® Funds Aveilabiity ^ Tnrtlt in Savings ® Hectronic Fund Transhrs ®Privacy ® Substintte Checks (i): ~ J LINDA E LEHMAN I.D. # 197-4Q7312 D.o.e. 1Q/15J1949 12ic GARY L LEHMAN IrD. # 210-445213 D.o.6. 8/21/1953 1 131: , `_ J I.D. # D.O.B. (41: I.D. # D.O.B. ^ amrror~sd Sgrer (Mrdividud Acoourrts apyl Lx J LD.# D.O.B. 019a2 Brroars sys6wris, Ins.. sr. Cbud. MN Farm I~PSC1wZ-PA at9l10oa (pegs 1 of 21 ~~ ~~ AC;~~TB BANK statement Dom: 1»o7~ia. Acx~unt #: 2454602 "'*'"~""'*"AUTO*'3-DIGR 170 1806 0.5700 AB 0.358 9 7 42 p~ 1 Imllladllm~b4lbm~66d6~hdldnlhn6lullnd ~3 CLAIR W 4EHMAN ESTATE 91aNGS A~l-AS MECHANI~SBURG PA 17058.2349 FREE INTERNET BILL PAYMIENT. NOM. ALWAYS. Meet yolur new checkbook. Mrith Internet Bill Payment, you can pay bills alnd send Honey to just about anyone. It's wick and easy - if you can type a few numbers and click with a mouse, you can do it. stop by one of our offices or contact us toll-free 1.888.334.2262. ESTATE CHECKING Accourrt # 2454602 Accourrt Summary Beginning Balance Activity End'mg Balance Previous Statement Balarfce to/u/u 357,773.97 + Deposris and Other Credos 1- 97.32 -Checks Paid or Other Deus 3 71.79- -Service Charges .00- +interestPaid .00 ~~ Balance 557,799.50 Days in Statement Period 27 Account Detail Date Activity Descrtiption Deposits/Credlts Chec lcs/Debrtc Balance 10-12 BEGINNINGS BALANCE. HARLAND LARKE CHK ` r a 1, ~ `3C ' ~' ' ' 57,773.97 ¢ ORDERS ~ u•4D 57,762.57 CLAlR W L~hN1AAN ESTATE 10-14 CHECK#1 50.39 57,712.18 10-26 CHECK # 2 10,00 57, 702.18 11-01 CUSTOMER DEPOSIT 97.32 57, 799.50 11-07 ENDING BALANCE 57,799.50 Checks Paid - • i~dcabes srnn rn cr~errz ^.r+.. Check # Date Amount Check # Date Amouert 1 10-14 50.39 ~ 2 :10-26 10.00 Total Number bf Checks: 2 Total Amount of Checks: 560.39 END OF STATEMENT arnb.com • arnbbuslness.com • P.O Box 3129, Gettysburg, PA 7 7325 • Phone 7i 733431 bi -Toil Free 1.888334.ACNB (2262) i v A~;~~TB BANK Smterrrent Date. 10~23~11 Atxount ~: 122815 "''"""""""AUTO"S-DIGIT 170 1034 0.9920 AB 0.368 5162 ~ 1 ludlludl6m~~611~uu6lut6~6dlduA~u1du16u1 803 CLAIR W L.~FiMAN ' 9 FANGS AIMS t1~CHANtCSBURG PA 1702:349 i check out our low rates on haare equity lines and loans! usie the funds for any needs you nay have --- pay off high irrtarest bills, build your dress kitchen or pay for tuition. visit acnb.cas or stop by one of our offices today. Equal Fwusirrg Lender. Equal Opportunity Lender. Mesber FDIC. ESTEEM CHECKtN~ Account # 122x15 A~ccourrt 8umrr~srv Beginning Balance ActivKy End"mg Balance Previous Sf$fiement t3alanae 09/2],/11 524,986.33 + Deposes and Olher Cremes - .00 -Checks Paid or Other Delb~s 1 24,986.55- -Service Charges .00- +Interest Paid . 22 Erld~rg Balance s.00 Days in Statement Period 32 Account Detail Date Y ~~ Depoau~/Ctedits ChecicsJDebr'ts t3alance BEGINNING BALANCE 24,986.33 09-29 INTEREST PAYR~NT .22 24,986.55 09-29 CLOSING TR'ANSACTFON 24,986.55 .00 10-23 ENDING BALANCE . ~ hrbenest Surrrrnarv From 09/21N1 Through 10/ZS111 Days to Staberkrerrt Period 32 Interest Famed s.22 Annual Percentage Yield Famed .05% Interest Paid lltis Year s6.81 Interest 4lfdhhlrld Ttris Year s.o0 Overdraft Char~aes ! Refin~ds Sumrrrary Description This Cycle YTD Total rehrmedl item lees _00 .00 arnbcom • arnbbusiness.com • P.O. Box 3i 29, Gettysburg, PA i 7325 • Phone 7i 73343161 • Toll Free i.888334.ACNB (2262) D ACNB BANK °; ;~ i i 7 l StaTement Date: 09/30/11 Account #: 9080030619 """"""""AUTO"3-0~IT 170 9476 0.75010 AT 0.365 351 120 I~~dI1~~~I11.u.M~hll...ul~6dlululbtull~uldull.ul CLAIR W L~tiMAN 9 KINGS A1~1AS MECHANICSBURG PA 17050-2349 843 check out our loM rates on hose equity lines and loans! use the funds for any needs you say have --- pay off high interest bills, build your dress kitcfie~t or pay for tuition. visit acnb.cos or stop by one of our offices today. Equal Housing Lender. Equal Opportunity Lender. timber FDIC. Page 1 STATEMENT SAVINGS Account ~ 9ot;o434s19 Account Surnmarv &=gm~9 Balance Activity Ending Balance Previous Statement Balance 06/30/11 51,663.45 + Deposits and Other Cred'ds - .~ _ - Vlfrthdraalals or Other Deti~Cs I 1,663.85 - -Service Charges .00- +Interest Paid .40 Ending Balance 5.00 Days in Statement Period 92 Accourrt Detail Datie Y Description DeposNsJCredits YYrthdrawalsJDebits Balance BEGINNING BALANCE 1,663.45 07-29 INTEREST PIAYMENT .24 1,663.59 08-31 INTEREST PAYMENT .14 1,663.73 09-29 INTEREST P~IYMENT .12 1, 663.85 09-29 CLOSING TRANSACTION :1,663_85 .00 09-30 ENDING BALiANCE _ ~ Days in Sfialtement Period Interest Earned Annual Perfoerrtage Yield Eamed irrterest Pad This Year Interest W~hheld Tips Year 92 5.40 .10% 51.23 s.oo acnbcom = arnbbusiness.com • P.O.Box 3129, Gettysburg, PA i 7325 • Phone 717.334.3161 • Toil Free 1.888334.ACNB (2262) ~} ~ R 1~ ~~~ ~ r~~ ~~\..~~ ~1~NK statement Date: 09/30/11 Aocourrt# 1645773 "**""'""~"""'AUTO"3-DIGIT 170 3680 0.830 AT 0.365 151241 p~ 1 h~dlhulihn~hldh~~ohh~lhdulldulhxhh~lhnl 803 CLAIR W L' EHMAN 9 KINGS ARMS MECHANi!~SBURG PA 17050-2349 dr~ck out our lar rates on hove equity lines and loans! ulse the funds for arty needs you may have --- pay off high interest bi11s, build your dream-kitchen or pay for tuition. visit arnb.com or stop by one of our offices today. Equal Housing Lender. Equal opportunity t_~er. Member FDIC. CLASSIC MONEY MARKET ACCOUNT Account # 1645773 ACCOUiIt $tlrrNrlBfY Beginn"s~g Balance Activity Endhrg Balance Previous Statement Balance 08/31/11 540,066.98 + Deposhs and Other Crel~5 .00 - Checs Paid or Other D~6i4s 2 40,071.16- -Service Charges .00- +Interest Paid 4.18 Ending Balance 5.00 Days in statement Period 30 Account Detail Date - Descrip#ion DepositstCnedits ChecltslDebr~s Balance BEGINNING BALANCE 40,066.98 09-21 CHECK # 142 8,947.59 31,119.39 09-29 INTEREST l~AYMENT 4.18 31,123.57 09-29 CLOSING TRANSACTION 31,123.57 .00 09-30 ENDING BALANCE , p0 Ctrecl[s Paid _ - srao in ct~ect n^ne~er Check # Date Amount Check # Date Amount 142 09-21 8,947.59 Total Number bf Checks: 1 Total Amount of Checks: 58,947.59 acnb.com - acnbbusiness.com • P.O. Box 3129, Gettysburg, PA i 7325 • Phone 717.334.31 fit • Tol! Free 1.888334.ACNB (2252) Ip ~ Pennsylvania Act 171 , A - -: Calculation of Private Pay. Refunds for. fired Residents for- Pennsylvania Assisted Living & .Nursing ~aeilities for contracts entered into on or after February T, `20Q3 for residents who are. 60 -years of age or older) :info : ~on~~ ~e cpiet+Qd't~y bus~ess office siaff Resident name Clair VII et '~' s `~~-~ Communit)r name &,levet of cue: (choose from drop-dc~in list) (~rieer~ Ridge Vdfag~e ~Nwsin9 Birthdabe: - _ - 12/2~ft917 Age on ioove~in dabs: 93 . Move-in date . ~ _ .. . _ 1?J3/2018~ Date. of expiryion 9/20/2011 Number ~f days betw!aert day the advance payment, was posted and the __ dafie refund cheek.. will be mailed 52 .~..__m-- -.. Number of days in the month of expiration ~ _ ~:. .. iVumber of unused days that wee prepaid 10 Daily elder Sane services ci~arge (included in Room ~ Hoard rate) ~ 56.00 Unused skier cane on which interest is to be paid S 560.00 - ~. advance biNirig p~d_(~ staberrtent or account inquiry) " --- - - - _~12f1~~?11 " Month ending date for morrth of expiration 9/3012QZ 1 Dace refund c~eclc is bo be rrrailed Ir>tenest rate per year 3% Amount of r+~und (exuding interest) per' Anc~hary Charge Repat and; __ . _~ ~ -- _. _. , _ . , _ q AIR ~ ember amount as a P amount,. $ 3,152.69 . Interest motion for infierest on elder care services paid in advance $ 2.39 Tcfal amount to be refunded ~ 11i5 08 Refund 'f , : . . --- ~.. . Resident's Eslafie or Personal _ babe a~~;t~r_ . _. , ._m ~.~ .. - ~ Add - Add 916n~s ARns City State ~ - Mechanicsl~wrg PA 17050 .., ~~ A -'PRESBYTERIAN HOMES 11/111Z~~ 1 - ~ AT !' ©F: CLAIIt W I,IN No. X284 x'rr: ~ rax n QED ~o'ri~ t#' orscx~tnrr` airur~`r MPt,~Q 9/19!2012 REECC, H* (~tV REEi7t~ WITH IN1~iEST ( 171) 3155.08 0.00 3155.08 CNl"sCR F1lJOat1T 53.,155.08 T~TI~~~' $3,155.08 50.00 S3, 155.08 -~< F _ __ .~~MERIC~AI~T PROGRESSIVE urn a ee~ ca~-ritr of r~cw rose October 24, 2011 ~~® Linda Lehaan And Gary L Lehaan j ` C/0 Linda Lelhaan 9 Kings Arcs Iiechanicsburg, PA 17050-2349 `-- -if : - Po 1 i cy Nusbe= c X3107469 - _- Policyholder: Clair W Lehaan PO BOX 13Q Pensacola R 32591 B~-645-4116 ~ l- rvww.UniverralAmericardnsunmcePlanscom .'. To Whoa It Icy Concern: We are sorry to learn of the .passing of Iir..~Lehaan, and wish to extend our sincerest condolences to you and your faaily. Asper your request, we have cancelled the. above referenced policy effective Septsaber 21, 2011. The enclosed check for $97.32, reflects a refund of the unearned preaiua._ •-.:: Should you have say questi"c~as or further concerns, please feel free to contact our oiffice at 1-800-645-4116. Sincerely, HKA Policyholder Services cc: 2iichael J Clinton 710 Longs Gap Rd Carlisle, PA 17013-8527 P14 ~:~ s: ~ . ~° f a i '3 1 °~ y ` .x+ ~# , , ~ €~ ~ . ~ '~~ _ { C :`~~ _ - _. ~ . A .. - _ ... ._ _ ~~ _ 'a _ - - _. .:-:~ J ~ - ~ __ - ~ - _ - _ - - lam- . Y ._ `~Tyy R~ ~ iF ~. ' O ~ ~ ~ O _ . Q .- " F S ~ . ~~ ~ = ~ oe _ cp ~ ~ ,~ ~ a ~ ~ am ~ ~ = ~' C ? _- - __