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Home My WebLink About02-1093Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS _state of Blanche V Goodhart No also known as Deceased Social Security No.204012998 R Michael Goodhart and Edward S Goodhart Petitioner(s), who is/are 18 years of age or older, apply(ies) for (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut ors named in the Last Will of the Decedent, dated 11 /21 /1988 and codicil(s) dated Lester S Goodhart died A ril 8 2001 State relevant circumstances, e.g., renunciation, death of executor, etc Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendente life, durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: Decedent at death owned property with estimated values as follows: 200,000.00 (if domiciled in PA) All personal property ......................................... $ (if not domiciled in PA) Personal property in Pennsylvania .................... $ (If not domiciled in PA) Personal property in County .............................. $ 100, 000.00 Value of real estate in Pennsylvania ........................................................................................ $ .............................. $ 300,000.00 Total ................................................................................... . Real Estate situated as follows: 1004 Tower Road, Southampton Township, Franklin County Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Signature Typed or printed name and residence __ ,., ,, R Michael Goodhart 301 Hillcrest Dr New Cu Goodhart 110 E Kin . Shiooensb mberland, PA ura PA RW-7 (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at Shippensburq Health Care Center 121 Walnut Bottom Road Shippensburq Township, Shippensburq PA (list street, number and municipality) Decedent, then 90 years of age, died November 3 , 2002 , at Shippensburq Health Care Center (Location) Oath of Personal Representative ommonwealth of Pennsylvania OUnty Of Cumberland The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estat~ccord~ng t~law.~ ~~ Sworn to and affirmed and subscribed ' R Michael Goodhart b ore me this ~-.--day of C6yni3E"~ N~~~ 2002 - Edward S Goodhart / - ~~ DECREE OF REGISTER Cumberland County, Pennsylvania Estate of Blanche V Goodhart Deceased No. ~~- ~~ - l~ q.~ also known as Social Security No: 204012998 Date of Death: 11/3/2002 AND NOW, December ~ 2002 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~ Testamentary ^ of Administration c t a d.b.n.c.t.; endente cite; durante absentia; durante minoritate) ( ..~., p are hereby granted to R Michael Goodhart and Edward S Goodhart in the above estate and that the instrument(s), if any, dated November 21 1988 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters ................................. ... ~~eg~star or wn .mom i ti2 ~ DD $ ,, i ~,~ Short Certificate(s) .............. . - Renunciation ....................... ... $ Affidavit ( ) .................... ... $ $ ltS% ~ ........... Extra Pages ( ). .. Codicil ................................ . $ - JCP Fee .................:............ ... $ 10.00 ~-~--~~' Attorney: Forest NMyers Inventory & Tax Forms ........ ..... $ I.D. No: 18064 Other .................................. .... $ Address: 137 Park Place West ~~p, 00 Shippensburq PA 17257 TOTAL .................... .........$ -~'~~ Telephone: 717 532.9046 DATE FILED: RW-7A l1is is to certify that the information here given is correctly copied from an original certificate 'off depth dul~~' filed ~with~ me as Local Registrar. The original certificate will he forwarded to the Stare Vital Records Office for perrran~nr tiling.. WARNING: It is illegal to duplicate this copy by photostat or photograph. '. FeL~ for this certificate, $Z.00 __ ~ 8711246 ~t, uT COMMONWEALTH Of PENNSYLVANIA • DEPARTMENT Of HEALTH • VITAL RECORDS CERTIFICATE OF DEATH - -~{-~~- ? r, • f SE% 90CIAL SECURITY NUMBER -~ DATE OF DEATN ,Mn ;~•.. +•.~ NAME a DECEDENT Ii i.L. Mieaa. Lul ' Female 9.204 - 01 - 2998 .. •11-03-02 >t ,. Blanche V. Goodhart . AOE ILae eNmoayl UNDER I YEN, UNDER 1 DAY DAfE OF N SMT/HUCF ICM ane MNWM IMOnM. Day.'~MII $laNaFapnl'dmnYl MaAA G PLACE a OEQN ICFecN a'IY a'N'- yN iMNUelp.f rn' pne' mtl•I _r__.. _ _._.---- --_ -. -. _ NpBpIUL: - -- OTHER: 7( ) aya MpNM , ~ ~ DOA ^ Ndna LJ RawMne ~. IsoacMl IroMIMN ^ EPoOUpMMM ^ 6-26-12 Ct)aEbersbuxg, PA va. ~ N, 90 NEiPANIC g1161N7 RACE - AmN•can IMan. B4cY. Wnaa aN e r~ COIINTV OF DERN CRY. BORO. Ty/P OF DEATN pACN.RY NAME (N nM ~newl~on. pN• tea ane rvn Ne ® YM ^ N yaN. NPNCeY CNNn, ISP•oMl Shippensburg Twp. w Shippensburg Health Care Center ~ "1p'n•p'"/0RN'"•"e ,N. Flhite Cumberland « ~ DECEDENT'S USUAL OCCUPATION HIND Of SU91NESSANDUSTRY yN90ECEDENT EVER Ha DECEDEM'S EDUCAI,DN N~µAUSirWUVSllleo.r~ie. Insi.. r ~,~ „~•I ARMED FORCES7 U S . . OelNOa Dlo,aelSwoM IG~..weoa.awaaraNr~mor PP 9 [}~ Shi ensbur r, eal a a a 'a s' ~ o n N a.aNNE .: w 1 , 1Pidowed u a 12 j°'2j 4 1 i Niase a d Nurse C , , „R oDnEm Registere „ T IyI owns ip ,~,.,N etMa PA ~ ,h.L'T TM.eNeaeNN NweN Shippensburg DEL~DENT•S MAN.1110 AD011ESS ENr.N. cawroAn.sM•. za coe.l ~~EµNT's ,TN . 121 Walnut Bottom Road aE91oENts °i'N"N , MN• Shippensburg, PA 17257 a,«Me.l Cumberland 'w'""4T ,yN.^aENn~r .a ~AY•~• ,n. ,w , MOTNER'S NAMEIfnI. MgIN. MaIWnlMnrnel FATNER'S NAMEIRNI. MiOOIN. LaNq Mary Elizabeth Betz Edward Simon Shatzer ~~ +E• '"Fa"'A"T'g"'"'"~R+'p"p"'" NIFOIMAANT•SMAp,N/0 ,9NNaI. sw.npcoe.l . Shippensburg, PA 17257 110 Eaat King St. Edward S. Goodhart , IDN PLACE qN-NrwaCaNReq. reaNe,y LDCArIDN cnyrto•n,s,re.zaeoe. . ME,NOOaFasvosyaN NMNn ^ RNnr.M waA E,r^ . DM "~') ® C «pn« PI.N. nI el.r Oe,.NUI^ ONrrl9vrpL- - ^ „~ 11 _7_02 2/e Spring Hill Cemeter 2t,, Shippensburg, PA 17257 14 sNINauREaP ILL NBEE OR PERSON ACTIND AS SUDN L~• ~'~,(~r F.H. ITK.•., .~libuYT~, PA 17257 012984-L ~- S Compl•,•Nema27Nt oMY •NI•n NyNq UaOwlamyN MIM INN. eNN Nno pl•oa wtlM. LICENSE NII DQE 9NSNSD T D•Y. ~1 ~~ e,,,•,<,A„ y „N, N,,.N.eI. M INr of eaMA - - - ~~ - 290 aNNh ne..aea.n. ~ 2L2e nNM1M~NWNIMW A,E OF pE DIDE PRONOUNCED pEAplMOnln. Day Y••,1 VMSCA9E REFERREDIO ME E%AMINEfVCORONERi N ` ^ ~ , aNr ha ` P•Ren.Iw plonaAlw.o«N. 1 " ~ I \ M \ l PARE N: OUw sgnMtW CaWlbrcpnNAANVrodaN.Dp • H• Z7. MRT I: ETNA. N4 eMNW. NjWIM a comPA<aINNn v.'NCy pure IM eaam. Oo no, aNw IM naea o1 MNIE, auto as cardAe or epiralery arraN. NnM a Man hNwa. ;AppN~r ~ ~~ N ~ p <«M ~,M ~ p~ 1 LY eMyo•r eAr an aad, Nna. , aNM1 antl era ~ NMlDIAT! CAIpE ff+MI ~ j0 ' /~ a . ~„ ~ / i _ ___ - _.. agar a ceneeon ~ y1,yyGKt . raaWNgnornl-~ a. . DuE roroR As A cON9E0UENCE aFY u ~~ -- I saNNNNMNMmneNbr+ e. Many,IMO,grinn•aaNr D,1E,OIOR A9ACONSEOUENCE OFI: ~ , eAr EnMrIIIE1ERYI110 ' -. eA,YEID..NraNwY •~ -.. NtlA aaNIME MNN d~A C~ ~~ aaulNq+•tlNaNILA1T A~IW/~/~~./('t~. e. VNl4 AN AUTOPSY ,MERE AUIOPSY'flNDN1[iS MANNER OF DEATN DATE OFINJURY TIME OFINJURV NUVRY AT VyDRKT DESCPoBE NOW INNJRY OCCVRRED. Y •aN PERFORMEOI AVANJIBLE PRIOR lO IMmm. DNy. ETION OF CAUSE ^ ~ NNVa LI NNmk1eN WN ^ No ^ AtttieaM ^ Pu,eNq NvNNlw,bn ^ A, YM ^ ND ^ BukMa ^ Coule nN, N eaw,nNw ^ PUCE OF NLURY. N Nwna, lann, afoul, NC,enA LOCATION ISN•a. CMROwn. SaAq ^ N e qa OuYtlMq Ne. ,Sp•oMl ~. M4 . ]~ 2Eb. >h. CERTIFIER CERTNRER ICNatl ady aW /.'[ Y •C[1RIPYMOPNYfICiAMIPhYNCrrioaWnV Cw~rd WNn wnsn andM PnYKanlu. VOnoart•o WaM WCampaNO nem 291 ^ ' Te M waa.•y.ne.Mew. a.Ie e«.n.a ate. r Nr e.N.ate.ne n,.n1NN a•.rw ..................................................... gyn. ~I oaE wNEOIM~ { ~ ~ l 4~V - , / •PRDNOUwwgANDeeRTVrxaPNYSICIANIPeY•c~NeeNwPnwzNao..m.ne~wMy+wrc«n.aawm, OJ / e ^ .......................... P L ET~Ep7 C/A~u9E OF DEATN Ts N,a MM a my knp,NlaeEa, e..,A e•ewnw M NV WnN, eNa, ane plaea, aM ew r Nr eaeaaal ane manner H Nala W IIO COM NA AND OF PERSON ~ , / ~ /-lL ~ /~ V/~-r7 s . / (nem 271 Typ. or PrNN yo / ? Y .. ~I / •YEDICAL E7AMINER/CORONER ';„d ~~ ~~~ ~ /~/'+~ On Nr ENNr el naminAllon and/oY Imea,IgAlbn, In my opNlon, MNt11 eeeuneN N Nr Ilme, NN1N. aIW p1ANN, ane eVN to,M owaa(a) AM ^ Y' /'-F ............... ............... .... r ...... ~ MI .................... a,atw ~ . ............. . •nMnM M ]Ia. REGISTRAR'S SIGNATURE AND NUMBER / / ~/' DATE FIL IMwNn. ONy. ~ 3 9.. 7 / f.Y~ ~/ v. V ~J_~-/off LAST WILL AND TESTAMENT DF BLANCHE U . GOCIDHART I, Blanche U. Gaodhart, of 1000'1 Tower Road, Shippensburg< Franklin County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make. publish and declare this as and for my last Wiil and Testament, hereby revoking ^11 other Wills and Codicils thereto, heretofore made by me. FIRST I direct the payment of my debts ^nd the e~;penses of my last illness and funeral from my estate as soon ^fter my death as conveniently may be done. In the event I am not the owner of a cemetery lot ^t the time of my death, I direct my Executor ^r Co-Executors to purchase such lot with a contract for perpetual care and to improve the lot and have erected thereon a suitable monument and marker, using therefor funds from my estate in such amounts as he or they in his or their sole discretion shall deem advisable. SECOND I give, devise ^nd bequeath all my property, whether real or personal, tangible or intangible, together with all insurance policies thereon, unto my husband, LESTER 5. GOOL3HART, provided he shall survive me by thirty C30J days. In the event my husband fails to survive me by thirty C30] days, I then give, devise and bequeath all my estate whether real or personal property, tangible or intangible, together with all insurance PAGE C]NE v aolicies thereon in the fallowing manner: CaJ ^ne-third of my estate to of my son, EDWARD S. GDDDHART, CbJ Dne-third of my estate to my son, R. MICHAEL GDDDHART, per stirpes, ^nd CcJ Dne-third of my estate to be distributed equally between my grandchildren, namely, ERIK M. GDDDHART and TRACZ A. LILLE`r'. in the event my son; EDWARD S. GDDDHART, shall predecease me, his one-third share shall be divided equally bet~w~een ERIK P'i. GDDDHART and TRACI A. LILLEY. THIRD i give, devise and bequeath all the rest, residue and remainder of my estate unto my husband, LESTER S. GODII-{ART, provided he shall survive me by thirty C30J days. Zn the event mu husband fails to survive me by thirty C30J days, I then give, devise and bequeath all the rest, residue and remainder of my estate, in the following manner: CaJ Dne-third ^f my estate to my son, EDWARD 5. GDDDHARI; CbJ Dne-third of my estate to my son, R. MICHAEL GDDDHART, per stirpes, and CcJ Dne--third of mu estate to be distributed equally between my grandchildren, namely, ERIK M. GDDDHART and TF.ACI A. LILLEY. In the event my son; EDWARD S. GDDDHART, shall predecease me, his one--third share shall be divided equally between ERIK f'?. GODDi-{ART and TRACI A. LILLEY. FOURTH I give, devise and bequenth any share ar shares of my estate which passes to a minor to be held, I~•~~ TRUST, by said minors parent or guardian until they reach they age of twenty- one C21J years ^f age. PAGE TWO ~ V , i~~~~,cp~-~'~ FIFTH I hereby direct that ^11 inheritance, estate or transfer ta;~es imposed upon my estate, whether passing under this, my Last will ^nd Testament or otherwise, be paid out of my estate. SIXTH Any and all sum or sums, whether in cash or in kind and whether from principal or income, payable to the benefic:~aries, or any of them, shall be made upon the sole receipt of the respective individual to whom the payment is made and free from anticipation, alienation, assignment, attachment or pledge and free from control by the creditors of such beneficiary. All shares of principal and income herein given shall be free from anticipation, assignment, pledge or obligation of any beneficiary and shall not be subject to any execution or attachment. 5EUENTH GODDHART; Executor of this, my Last bill and Testament. In the event of the death, resignation, renunciation or inability to act for any reason whatsoever ^f my said husband. I nominate, constitute and appoint my sons, EDWARD 5. GOQD}{ART and R. Pi1CHAEL GDDDHAP.T, or the survivor, Co-Executors of this, my Last Will and Testament. I hereby relieve my Executor or Co-Executors from the necessity of posting security in connectiori~.uith his or their duties as such in any .jurisdiction in which he or they may be called upon to act, insofar as I am able by law to do so. PAGE THREE IN WITNESS WHEREOF, I have hereunto set mu ha?~d and secl to this my Last Will and Testament, consisting of Four ~`I] typewritten pages, the First three C3] of which bear m~} signature in the margin Far the purpose of identification this _ _~~b~-_._ day of November , 1988 . Blanche U. Goadhart, Testatrix 5IGNED, SEALED, PUBLISHED AND DECLARED by the above named Testatrix, BLANCHE U. GOODHART, as and For her Last Will and Testament, in the presence of us; wh^ at her request and in her sight and presence and in the sight and presence of each other have hereunto subscribed our names as witnesses. __ PAGE FOUR CDf1MDNWEALTH OF PENNSYLVANIA - - SS COUNTY DF FRANKLIN - I, BLANCHE U. GDDDHART, the Testatrix, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby ac~;nowledge that I signed and e;<ecuted the instrument as my Last Will and Testament; that i signed it willingly; and that I signed it ^s my free and voluntary act for the purposes therein expressed. Blanche U. Goodhart, Testatrix Sworn or affirmed to ^nd acknowledged before me by Blnnche U. Goodhart, Testatrix, the ~~'~ _ day of November , iS88. Notary Public NOTARIAL SEAL CAROL G. REBUCK. NOT;RY PUCiUC SHlPPENS6l,iRG. "?'„''<'.!'d .. ;'.~~!T'~ MY COMMlSS!ON EXPIRES tv1AY 15, 1969 PAGE FIVE COMMONWEALTH OF PENNSYLVANIA • 5S COUNTY OF FRANKLIN We , ---~~_F.''~ ~;_,~.-~-e-~,`?-------- and --~c~~ ,_~-s~..._ t-~-`= i~~cssd ti ~ _ ulitnesses, whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw BLAPICHE U. GOODHART, Testatrix, execute the instrument as her Last Will and Testament., that she signed it willinglL~ and that she executed it as her Free ^nd voluntary act for the purposes therein expressed; that each of us in the nearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the Testatrix was at the time eighteen or mare years of age and under no constraint or undue influence. -~ -- Sworn to and subscribed before and __~~i~S.t~~=S~'~~'=~____s__, I.uitnesses, this :~\°L~_ day of November, 1988. Pdatary Public NOTARIAL SEAL CAf?OL G. REBUCK, NOTARY PUBLIC SHIFF~NSBUR ;. FRANKLIN COUNTY MY COMPAISSION EXPIRES MAY F~, 1989 PAGE SIX. 6 CERTIFICATION OF NOTICE UNDER RULE 5 6(a) Name of Decedent: Blanche V Goodhart Date of Death: November 2, 2002 Estate No.: 21-02-1093 To the Register: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on December 09, 2002. Name Address Edward S Goodhart 1 10 E King Street Shippensburg PA 17257 R Michael Goodhart 301 Hillcrest Drive New Cumberland PA 17070 Erik M Goodhart 42971 Golf View Drive South Riding VA 21052 Traci A Lilly 25 Cedar Drive York Haven PA 17370 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None. Date: ~. ~Z oZ. Forest N Myers, Esquire Attorney I.D. #18064 137 Park Place West Shippensburg PA 17257 Phone 717..532.9046 Fax 717.532.8879 e-mail fnmyers~earthlink.net Capacity: _X Counsel for Personal Representative LAw OFFICE ~ O R E S T N e Y E R S 137 Park Place West, Shippensburg, Pennsylvania 17257 717/5 32-9046 Fax 717/532-8879 July 30, 2003 fnmyers@earthlink.net Register of Wills One Court House Square Carlisle PA 17013 Re: Blanche V Goodhart, Deceased Inheritance Tax Return No: 21-02-01093 Dear Sir or Madam: Enclosed for filing is the original Pennsylvania Inheritance Tax Return (REV - 1500) in the above estate, with attachments. Our check for the filing fee is enclosed as well as the calculated tax. Please return the copy and file copy, time stamped, in the enclosed envelope. Sincerely, Forest N Myers t~ Gook for us on t(c we6 at forestmvers.lawoffice.com COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RrCEIVEV FROM: MYERS FOREST N ESQ 137 PARK PLACE WEST SHIPPENSBURG, PA 17257 fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: ssN: 204-0~-2998 FILE NUMBER: 2102-1093 DECEDENT NAME: GOODHART BLANCHE V DATE OF PAYMENT: 07/31 /2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 1 1 /03/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 ~ $2,892.56 TOTAL AMOUNT PAID: REMARKS: JANET L GARRETT-C/O FOREST N MYERS -CAN NOT READ POSTMARK CHECK#140 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS DONNA M. OTTO $2,892.56 DEPUTY REGISTER OF WILLS REV-1162 EX(11-96) NO. CD 002857 i/oio ~ ~a~~~ Received of Janet L. Garrett C/O Forest N. M ers Es uire Address 137 Park Place West Shippensbur¢ PA 17257 Page No. No. Estate 21-2002-1093 Estate of Blanche V. Goodhart Social Security No 204-01-2998 Died 11-03-2002 Paid 07-31-2003 Postmark Date Can not read Postmark ACN 101 _~ ~~ ;-- , Tax 2 892.56 Check # 140 Int. SK ~__ w ~ ~ vt~~ ~C.~.~ C~.titi t,,,l~'1ti.,~`~v,,.~.e~ L~-,yti~ • ~~' ~`~Cx-~-`~ ~~-~ C L' ~~~~ ~~~ tit-= L ~ ,~ ~ ~ ~( Wit.-~~--~~ ~,~i~Y-c_z~-~ ~`i i ~ R tl ~~~ ~~ -~- } COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: MYERS FOREST N ESQ 137 PARK PLACE WEST SHIPPENSBURG, PA 17257 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ACN ASSESSMENT CONTROL NUMBER fold ESTATE INFORMATION: SSty: 204-01-299s FILE NUMBER: 2102-1093 DECEDENT NAME: GOODHART BLANCHE V DATE OF PAYMENT: 07/31 /2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 1 1 /03/2002 AMOUNT 101 ~ 512,892.56 TOTAL AMOUNT PAID: REMARKS: THIS RECEIPT SHOWS CORRECTED INH TAX PAYMENT PD ON 07-31-03 SEAL CHECK# 140 INITIALS: SK RECEIVED BY: DONNA M. OTTO 512,892.56 DEPUTY REGISTER OF WILLS REGISTER OF WILLS REV-1162 EX(11-96) NO. CD 003026 lv~l~ IQ~GP-[ A ~ REV_1!<l<lE~+(I.oII1 '. . *' /7-/05- It.! REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT C;~ ,',; " i\L ',jS\,:, CN~S COMMONWEALTH OF ?ENNSY\...VANIA DEPARTMENT OF REVENUE DEPT.2B0601 HARf3.!.SBURG,PA 17128-0601 NUMBER 21 02 01093 _--.L COIJNTY COD~ YEAR NUMI3~ -I ----SOCIAL SECURITY NUMBER '--- --- , 204-01-2998 t-- THIS RETU'RN MUST BE FILED iNO'UPLICATE WITH THE .,.. ffi o "' u "' o ! DEcEDE~n~'S NAM'E (LAs:r:-RRST,'AND NIIDDlE INIT~ 'I Goodhart, Blanche V , ~;;O:~:T; (MM.6oYEAR} -' I ~A;;2:/;:;~ (MM.oDYEAR} lilF)i..PPLICABLE) SUR\/I\/lNG' SPOUSE'-S NAME (LAST, FIRST AND MIDDLE INITIAL) ISOCIALSEC~;~I;u:;:' OF WILLS _ I U 2. Supplemental Return - 0-3 RemalnderReturn(dateofdealhpriorto12-13-si) 0 4a. Future Interest Compromise (date of death after 0 5 Federal Estate Tax Return Required 12-12-B2) I ~ 6. Decedent Died Testate {Attach copy 0 7. Decedent Maintained a Living Trust (Attach 0 8. Total Number of Safe Deposit Boxes of Will) copy of Trust) o 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death between 0 11.Election to tax under Sec. 9113(A) (Attach Sch O) ~!ns$~QTiOii "IUSm coMPiiteo:-m eo~~~':O eoNiiiiiEl'lTIAii'l'I\lIifiii!o~IONiHcfuLti e~l!eme-Q Te;- AME !COMPlETE MAILING ADDRESS Forest N Myers ~IRM NAME(if;PPllcabj;)- - - - I Law()f~ces afForest N Myers -- -- _I "I ELEPHONE NUMBER 717/532-9046 _.___ ___. ,..,..__.nn ..,.,___m .___.' ,_' ._ . ...---,' ....--.-. .--.---- ,-_. .,-'.. .-'. .- 1. Real Estate (Schedule A) ~ ~ ::.::::!(I) u<<~ l!,~g %<<~ u.m ~ r~ D 4. Limited Estate 1, Original Return .~ ~~ 02 u:l' 137 Park Place West Shippensburg, P A 17257 (1) 118,972.35 2. Stocks and Bonds (Schedule B) (2) (3) (4) (5) (6) (7) None None r .,.>' 3. Closely Held Corporation, Partnership or Sole-Proprietorship None . ..\ None o '^' z o ~ S ~ ~ " ;j "' << 4. Mortgages & Notes Receivable (Schedule 0) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G Dr L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 16,820.03 184,349.08 i= w None (8) Cj C' 303,321.43 (9) 10. Debts of Decedent, Mortgage Liabilities, & liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) (11) 16,820.03 286,501.40 12. Net Value of Estate (Line 8 minus Line 11) (12) 13, Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (13) I \- (14) 286,501.40 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) 2 286,501.40 .045 (16) 0 16.Amount of Line 14 taxable at lineal rate x ~ ~ ~ ~ . 17.Amount of Line 14 taxable at sibling rate x .12 (17) ~ 0 u E 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 12,892.56 12,892.56 20, D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. >>IlE$URETO ANSWERAtLQ~ES1101l$'OW'REVeR$ESlliE"NO:R!(QIlE~MATH<<~- ~~--~ Form REV-1500 EX (Rev. 6-00) Copyright 2000 form software only The Lackner Group. Inc. Decedent's Complete Address: STREET ADDRESS Shippensburg Health Care Center Walnut Bottom Road CITY Shippensburg --lSTATE-PA- - -[ZIP 1;-25~- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 12,892.56 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty B. Enter the total of Line 5 + 5A. This is theBALANCE DUE (3) 0.00 (4) -.-...-- (5) 12,892.56 (5A) -- - (5B) 12,892.56 - - - TotallnterestlPenalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is thEOVERPA YMENT Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE A. Enter the interest on the tax due. Make Check Payable to: REGISTER OF WILLS, AGENT 1. Did decedent make a transfer and: a. retain the use Dr income of the property transferred;.. b. retain the right to designate who shall use the property transferred or its income;.. c. retain a reversionary interest: or.. ...........n... d. receive the promise for life of either payments, benefits or care?.. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?. 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes No ~ i o .......0 o ~ ~ ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury. I declare that I have examined this return. inciuding accompanying schedules and statements, and to the best of my knowledge and beiief, it is true, correct and complete. Declaration preparer other than the personal represe_ntativ:e IS based~11 information of which p!eparerhas any know.ledge_ ____ ___ __ _ _ _ SIGNATURE OF PERSON RESPONSIB FOR FILING RETURN ADDRESS - - -- -- -- --- - DATE ---- Edward S Goodhart -~.. SIGNATURE OF PERSON R PONSIBLE FOR ILlNG R ~Cha<lGOO art ~/", SIG~E F PREPARER O~HAN-REPRESENTAiWE- F~ ADDRESS - 110 East King Street S_hippensburg,PAl!7257 '7 - t<'b -03 --O;..TE - - -- 301 Hillcrest Drive Ne",-CumberlandJ'.A 17070 ~DRESS r-t'PrL);J -- DATE - -- 137 Park Place West Shippensburg, PA 17257 ., '18-0' 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. !i9116 (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. ~9116 (a) (1.1) (iiH. The statutedoes not exemota 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 .5. ~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. 59116 1.2) [72 P.S. !i9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 120!o {72 P .S. 59116 (a} (1.3)). A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. *' SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ---" ~ L__ __ ___ ..___ __ _ -, FILE NUMBER -- I 21-02-01093 ESTATE OF Goodhart, Blanche V 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 compelied to buy or seli, both having reasonable knowledge of the reievant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. ITEM NUMBER I DESCRIPTiON VALUE AT DATE OF DEATH --.. -- -- ..--- - 118,972.35 Residence located at 10004 Tower Road, Southampton Township, Franklin County, net of sale per attached settlement statement TOTAL (Also enter on Line 1, Recapitulation) II 8,972.35 . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT -..-- -- --- ----- IFILENUMBER - - I 21-02-01093 ---- - ..- ---- -- ..-- ESTATE OF Goodhart, Blanche V Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorshIp must be disclosed on schedule F. ITEM NUMBER 1 DESCRIPTION VALUE AT DATE OF DEATH -----...---- 17,388.18 Orrstown Bank, checking account #531561 2 Orrstown Bank, investment account # 0259 166,476.09 3 Blue Cross/Blue Shield, refund 484.81 4 TOTAL (Also enter on Line 5, Recapitulation) 184,349.08 *' I L SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS I I ~-----~~ FILE NUMBER I 21-02-01093 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Goodhart, Blanche V Debts of decedent must be reported on Schedule I. ITEM NUMBER A-I FUNERAL EXPENSES:--- - 1 ! Fogelsanger-Bricker Funeral Home DESCRIPTION AMOUNT B. 1 ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions -I I I I I I \ I 7,000.00 Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City State Year(s) Commission paid Attorney's Fees Law Office Forest Myers Zip 2. 1,500.00 3. Family ExemptJon: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent Probate Fees Register ofWi11s, Cumberland County State Zip 4. 319.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs \ Carlos Leffler, fuel oil 675.55 2 CFJMA. sewer service 212.48 _.1 Total of Continuation Schedulels) 7, 113.00 TOTAL (Also enter on line 9, Recapitulation) 16,820.03 *' Schedule H Funeral Expenses & Administrative Costs continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Goodhart, Blanche V 3 ! - Sprint Telephone, telephone 4 Penelec, electric service 5 C.V. Wenger, repairs to water line at home 6 Borough of Shippensburg, water 7 Debbie Heckman, tax collector, 2003 County & Township taxes 8 Chambersburg Advanced Life Support, ambulance 9 Chambersburg Hospital, medical services 10 Phannacare, medicine 11 Shippensburg Health Care Center, final bill I FiLE NUMBER- - I 21-02-01093 1- - - I I I I I I I \ \ I Page 2 of Schedule H 162.50 129.35 1,117.00 115.95 223.13 203.00 11.00 41.97 5,049.10 REV-151J EX+ (9-00) . *' SCHEDULE J BENEFICIARIES . . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT -- --- -- ---- -- ESTATE OF Goodhart, Blanche V - -- - -- -- ---- ----- ----- I FILE NUMBER 21 - 02 - 01093 -- --- -- --, NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT JlQ..No_lUst Inm-te$) AMOUNT OR SHARE OF ESTATE I. 'I TAXABLE DISTRIBUTIONS (include outright spousal distributions) Edward S Goodhart 1110 East King Street Shippensburg PA 17257 I I son lone third of estate I I R Michael Goodhart 301 Hillcrest Drive I New Cum berland P A 3 I Erik M Goodhart 42971 Golf View Drive I South Riding VA 20152 I son lone third of estate 2 17070 I grandson lone sixth of estate 4 'I Traci Lilley 25 Cedar Drive I York Haven PA 17370 1 granddaughter lone sixth of estate I I Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover She~t II. I NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT I BEING MADE \ B. CHARITABLE AND GOVERNMENTAL DISTRiBUTIONS i ~ TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTiONS ON LINE 13 OF REV-1500 COVER SHEE i. LAST WILL AND TESTAMENT OF BLANCHE U. GOODHART I , Blanche U. Goodhart, of 1000~ Tower Rood, Shippensburg, franklin Count~, Penns~lvania, being of sound and disposing mind, memor~ and understanding, do hereb~ make, publish and declare this as and FDr m~ last Will and Testament, hereb~ revDking all Dther Wills and CDdicils theretD, heretDFore mode b~ me. FIRST I direct the pa~ment DF m~ debts Dnd the expenses DF my lost illness and Funeral FrDm m~ estate os SDDn DFter my death os cDnveniently may be dDne. In the event I am nDt the DWner of o cemeter~ IDt at the time of m~ death, I direct my ExecutDr Dr Co-Executors to purchase such lot with 0 contract For perpetual care Dnd to improve the lot Dnd hove erected thereon 0 suitable mDnument and marker, using thereFDr Funds FrDm m~ estate in such amDunts os he Dr they in his Dr their sDle discretiDn sholl deem advisDble. SECOND I give, devise and bequeDth 011 m~ property, whether reDl Dr personal, tangible Dr intangible, together with 011 insurance policies thereon, untD m~ husband, LESTER S. GOODHART, provided he shDll survive me by thirty [30) days. In the event m~ husband fDils to survive me b~ thirt~ [30) days, I then give, devise and bequeath 011 m~ estate whether rsal Dr persDnal prDpert~, tangible or intangible, together with 011 insurance PAGE ONE ~tJ~ policies thereon in the Following monner: [oj One-third of my estate to of my son, EDWARD S. GOODHART; [bJ One-third of my estate to my son, R. MICHAEL GOODHART, per stirpes, and [cJ One-third of my estate to be distributed equally between my grandchildren, namely, ERIK M. GOODHART and TRACI A. LILLEY. In the event my son, EDWARD S. GOODHART, shall predecease me, his one-third shore shall be divided equally between ERIK M. GOODHART and TRACI A. LILLEY. THIRD I give, devise and bequeath 011 the rest, residue and remainder of my estate unto my husband, LESTER S. GOODHART, provided he shall survive me by thirty (30J days. In the event my husband fails to survive me by thirty (30) days, I then give, devise and bequeath all the rest, residue and remainder of my estote, in the following manner: [a) one-thlrd of my estate to my son, EDWARD S. GOODHART; [b) One-third of my estate to my son, R. MICHAEL GOODHART, per stirpes, ond [cJ One-third of my estote to be distributed equally between my grandchildren, namelbJ, ER I K M. GOODHART and TRAC I A. LI LLEY . In the event my son, EDWARD S. GOODHART, shall predecease me, his one-third share shall be divided equally between ERIK M. GOODHART ond TRACI A. LILLEY. FOURTH I give, devise and bequeath any share Dr shares of my estate which passes to a mi nor to be held, I N TRUST, by said minors parent Dr guardian until they reach they age of twenty- one [21) years of age. PAGE TWO ~ t/.)kJI~ FIFTH I hereby direct that all inheritance, estate or transFer taxes imposed upon my estate, whether passing under this, my Last Will and Testament or otherwise, be paid out of my estate. SIXTH Any and all sum or sums, whether in cash or in kind and whether From prIncipal or income, payable to the beneFiciaries, or any aF them, shall be made upon the sole receipt of the respective individual to whom the payment is made and Free From anticipation, alienation, assignment, attachment or pledge and Free From control by the creditors of such beneFiciary. All shares of principal and income herein given shall be Free From anticipation, assignment, beneFiciary and shall not attachment. pledge or be subject obligation of any to any execution or SEVENTH I nominate, constitute and appoint my husband, LESTER S. GOODHART, Executor of this, my Last Will and Testament. In the event of the death, resignatIon, renunciation or inability to act For any constitute and reason whatsoever of my said husband, I nominate, appoint my sons, EDWARD S. GOODHART and R. MICHAEL GOODHART, or the survivor, Co-Executors of this, my Last Will and Testament. I hereby relieve my Executor or Co-Executors from the necessity of posting securIty in connection with his or their duties as such in any jurisdiction in which he or they may be called upon to act, insoFar as I am able by law to do so. PAGE THREE ~ ~..~.. .L_ IN WITNESS WHEREOF, I hove hereunto set m~ hand and seal to this m~ Lost Will and Testament, consisting of four [~) tidpewritten pages, the first three (3) of which bear my signature in the margin for the purpose of identification this __~~__ day of November, 1988. __~_J.L_Ai".>La.d~____ Blanche U. Goodhort, Testatrix SIGNED, SEALED, PUBLISHED AND DECLARED bid the above named Testatrix, BLANCHE U. GOODHART, os and for her Lost Will and Testament, in the presence of us, who at her request and in her sight and presence and in the sight and presence of each other hove hereunto subscribed our names os witnesses. -~-~-~---------- ~tM..-_v LJ ~ ------------------------- PAGE FOUR COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF FRANKLIN I, BLANCHE V. GOODHART, the Testatrix, whose nome is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and valuntary act far the purposes therein expressed. -~--~'---'~--- ,~ ----- Blanche V. Gaodhart, Testatrix Sworn or affirmed to and acknowledged before me by Blanche U. Goodhart, Testatrix, the ~~~_ doy af November, 1988. _____~~22 . ~"u.k'-~_____ Notary PublIC NOTARIAL SEAL CAROl G. REBUCK, NOTARY PUBLIC SHIPPENS[)l)RG. F:l,qr\~ !'~ ~~j~l"!T'I MY COMMISS!ON EXPIRES MAY25, 1989 PAGE FlUE . .' COMMONWEALTH OF PENNSYLUANIA SS COUNTY OF FRANKLIN We, __fQ:L"'.""L~",:~",\~6________ and __~9,.,~~-t>..-_\",;L..i~q,~'IJ:L, witnesses, whase names are signed to the foregoing instrument, being dul~ qualified according to law, do depose and sa~ that we were present and saw BLANCHE U. GOODHART, Testatrix, execute the instrument as her Last Will and Testament, that she signed it willingl~ and that she executed it as her free and voluntar~ act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the Testatrix was at the time eighteen or more years of age and under no constraint Dr undue influence. . \ '" ~~ -------------~----------------- .e,c:z;~ u "'-----. ____f~~__________________________ Sworn to and subscribed before me b~ ~Qi~~~.~_~~~_________ and ____~~~~~~~~~~_____, witnesses, this ~~~~_ da~ of November, 1988. ____~J~.'_~~_________ f\J()tary Public NOTARIAL SEAL CABO~.(;j. REBUCK, NOTARY PUBLIC SHIPPE~JSEHJRG. FFlANKlIN COUNTY MY COMMISSION EXPIRES MAY.I5, 1989 PAGE SIX A. Settlement Statement U.S. Department of Housing and Urban Development * lr OMS No. 2;02-0265 (Page t) B. Type ofLoao i~0 FHA 2. D FmHA- 4. Q '!.~ 5. LI Conv. Ins. 3. ILl Cony. Vnins. !6.FileNumber .-- {}3M30-0054 I"Loan.Numbt'f f" Mortgage Insurance Case Number - -..-- C. Note: T~I. form 10 turRi.bed to &I"" you a ,tale""",1 or..lUIl '.ttle"'.nl....l.. Am.uulo paid to ond by Ih. ..ttle..oot agent .re.ho"..II.... ",.rked "(p.o...j" wue paid oulllde the clMing; thO)' ore.bo... h"", inrocm.olionol purpNtJund or< notlndud.dinl~."''''''. IE. Name, Address, and Taxpayer identification # of Seller Blanche V Goodhart Estate llO East King Street , Shppensburg PA 17257 I D. Name and Address of Borrower Melvin L Bigler 9822 Molly Pitcher Highway Shippensburg PA 17257 F. Name and Address of Lender Orrstown Bank 77 East King Street Shippensburg P A 17257 G. Property Location J. Summary ofBorro:'Yer's Transactions 100. Gross Amount Due From Borrower IH. Settlement Agent Name, Address and Taxpayer Identification Number Forest N Myers 137 Park Place West ; Shippensburg P A 17257 Place of Settlement 77 East King Street, Shippensburg PA K. Summary of Seller's Transaction 400. Gross Amount Due-To Seller -jI.settlernentDate 5.27.2003 10004 Tower Road Shippensburg, Southampton Township, Frank]in County 10]. Contract safes price 102. Personal Property I~ Settlement ch~esto borrower (line 140?l___ 104. 105. Adjustments for items paid by seller in advance 106. City/town taxes - OS/27/03 to 12l311()3 107.----COunty~.~='__ .__.~ __ 108. Assessments to 109. Sch~o] T~-- OS/27/03 to 06/30/03 110. Garbage Fe~__ - --- _.~ 111. 112. Contract sales price ~~rsonal Property --- 120,000.00 - r- -'135.98 85.36 - -- 120. Gross Amount Due From Borrower 123,280.84 420. Gross Amount Due To Seller 120,221.34 200. Amounts P81d By Or ID Behalf Of Borrower 500. Reductions m Amount Due To Seller - [ 1,000.00 E~cess deposit (see instructions) - I 201. Deposits or earnest money 501. ],000.00 Principal am-ount of n~w loan(s~ -- 115,000.00 502. Settlement charges to seller (line 1400) 1,249.99 202. 203: Existing ioan(s) taken subject to 503. Existing loan(s) taken subject to - 204. 2nd Mortgage t~ Edward S & R Michael Goodhart 30,000.00 504. Payoff of first mortgage loan - 20s.-- - 505. Payoff of ~ec~nd mortgage 10fl!! - 206:--- - -- - --- - 506. iOi.--- -- 5o.? 2nd Mortgage to Edward S -& R Michael Goodhart - -- -- 30,OO~:OO 208. --~-~- 508. 209.------- ---- ._1- 509. I _n._ Adjustments for items unpaid by seller Adjustments for_items unpaid by seller ---" 210. Cityftown ~es \0 ~- 510. City/town ~es to - - 211. County taxes to 511. County taxes to 212. Assessments -- 5l2. Assessments to to 213. School-Tax 513. School Tax --... to to .-- ------- -- 2]4. +- 514. 215. ---- 515. -- - ~- - -_..,--- ---- 516. 2~ - - ~~? - - ~- --- -- - - -- 518. 219. - - 519. - .--- --~- -- -- --- - 220. Total Paid By/For Borrower 146,000.00 520. Total Reduction Amount Due Seller 32,249.99 , 300. Cash At Settlement FromfTo Borrower 600. Cash At Settlement ToIFrom Seller 3~Gross Amount due from borrow~; (line 120) I 123,280.84 601. Gross Amount due to seller (line 420) - I 120,221.34 302. Less _amo~~ paid by/for borrower Qine 22~) ( 146,000.00 602. Less redu~tions in ~mt. ~~e seller (line 520) ( 32,249.99) 30.3. Cash [J From [K] To Borrower I $ 22,719.16 603. Cash lliJ T. o From Seller $87,971.35 I have carefully rllvrewed the HUD-l Settlement Statement and to the best of my krtowledge and belief,]t is a true and accurate statement of all receipt. and disbursements made on my aC""Dnt or by rne in this IransactiOll. I further certify thm I have received]l""mpleted ""pyofpagesland2oflhisHUD-ISettlementStaternent. Borrower Melvin L Bigler Seller R Michae] Goodhart SETTLEMENT AGENT CERTIFlCATlQN TheHlJO--I SetllemOOIStlll,,",0lI_1whicll [havepre;l"!od i.at"",,,,,da,,,,,,ratc.ooountoflhiilfl/l"":lion_lhave ""u..dth.fuad'lObed;.b"~lo""cordancoWlthlh"'''I.,,,."1 Seller Edward S Goodhart Seller's Taxpayer Identification Number Solicitation and Certification Youl!<'[I!q"iredbylawloprovidelh.SotllemeelAllOfll""ned.bovewilhYO"!'wn;eetI~.y<<rideol;fi";OTI ~~~~.~jq~;~r, ~':' l'~'1,:l~~ t.~~r.~~~~ 'i'~~, y~J.':';'~~~t~.';/~~fil':':&;'i'h':~~:J ""''''n01\\h".~"rnytorTet\\,xp'y.r"leJitlrl<:allonnumb.r Borrower Settlement Agent Date r.~~.I~~0':'~~n'd~.'l1.~e.;;:l'f~~tJ~~~J.~~oe"1~~t~J'~I~r~~il~~o:;::'d S""I;onWIO. HUD-13191 Seller's Signature D,,,, RESPA, He 4305,2 L. Settlement Charges 700. Tob;i"s~leslB~Oker's CommisSiO;J;;sed ~-. -~,----- @__",;,;-;.;__n_ - Di\'ision ofCommiss.ion (line 700) as follows:' _.-- 701. $----.- to 702$-- ~---- -.-to 70~ Commissi~~paid at Settlement 7~-'.-'--'-' -~ 800. Items Payable in Connedion With Loan 801. Loan Origination Fee % Soz.-LoanDlscount ---- --- % 8~. ~ppraiSalFee--- to OrrstownBank 804. ~ort ---to 80s:- Lend~r's In~pection Fee ~- 806.-Mortgage I~;u~plication Fee to ~-ApplicrrtiOn Fee to: Orrstown Bank 808. Flood CertffiCat~e to:Orrstown Bank 809. UNdrewriting Fee to: Orrstown B~-- 810-.-~'-- --. - 8~---- 900. Items Required By Lender To Be Paid In Advance 90-j-:-Interest from .. to @$ ~2. -Mortgage Ij;surancePremium for 903, Hazard Insurance Premium for 904.- ~._-- ---..-..-.-- 1000. Reserves Deposited With Lender iOOI, Hazard Insurance -- -I 002. Mortg~geI;surance 1003. Citypropertytaxes-- 1004.- County property taxes j 60s:- Annual asse;-ments----- -\006. scho~fTaxes 1007. ~_. 1008. Ag regate Reserve Ad'ustment 1100. Title Charges 1W~~r-;;~- 1102. Abstract or title search 1103. Title ex~ination l104:-Title-insurance binder fl0S. Document preparation . 1106. Notary'Sf~--"- 1107. Atlomey'sfees- -~des above items numbers: Dos.-Title illsurana- --.- -------vnclud~ite~ers: 1I09. Lender'~ coverage !]}O. o~~rage 111l. 1112.--~ .---- .-- -- 1i1I..-~- -_.~ 1200. Government Recording and T}'ansfer Charges 1201. Recording fees: De~~ 41.50; MortgageS 53.50; Releases $ ~- Cjty/CDuntY~s:-oee~ 1,200.00 ; Mortgage $ 1203. Statetax/stamps:Deed$ l,200.00---------;MO~ 1204. Recorder-of Deeds, record 2nd Mortgage - 120-S~.'-_.'-'---~ 1300. Additional Settlement Charges----- ~~~~: -n~~:;~~s~~ction to:--==-~ ---=----==----===:=:------=-- --r=-_ - I - ---== ~-- ---~- - - 1304. Borough of Shipp ens burg, final water bill -------- -- 43.99 1305, 1400. --Paid From----r.~P-aid From - Borrowers SeUers Funds at Funds at Settlement Settlement I I i ----- ---r- ---- --l-=- -- -=r:: - =:b0- fso:QOt-= _ _ ~ - - -== =l---=--==t=-~ . u .u - t .~~H~__= -----1 -- -T- Id,y _ -=_~~ ---=+---=-_--=--= months to ~=+___-- .. -==------~~-- - _~. -=r~ -. ~_ months@$ months @ S months-@$ months @ $ - months@$ months @ $ months @ .$ per month per month per month -per!llonth per month per month permollth ~ LaWOffi~Fo,,,tN~ --=~~- 85~1~~ : "'::_-c -= -, . - 1))- 270,-~0~0_~0_ .. 6.00 to PennAttomeys- --=-=----= ----- -- -- ---1---- .. -- --. i____l15~ _=_==____________=_ - :r-=-----=~ ___- -==-----=--:.-==~-T- .1=-== ~_.._-_.- _. ____ .....~i,.2.~~~~~=--- .. ... J,200.oo - ----- - 43.50. --- _--==-=_ ~_-- =:t::_= Total Settlement Char es (enter on lines 103, Section J and 502, Section K) 3,059,50 Initial Escrow Account Statement Required by Section 10 (c) (1) of the Real Estate Settlement Procedures Act (RESPA) If checked Othe terms of your loan require you to have all escrow account to assure that lile certain obligations relating lD the mortgaged property, such as taxes. insurance premiums and other charges are paid, The amount specified below will be collected, a.long with your mortgage principal and interest payments, during the first 12 months after your account is opened to pay these anticipated expenses; EscJ'ow Account 1,249.99 Payee Your escrow account payment will be $ Purpose p" Beginning Date: Anticipated Due Date Estimated Amount --~_..- ~--- HUD-13/91 RESPA, HB 4305.2 ~ ORRSTOWN BANK TO: Law Office Forest N Myers 137 Park Place West Shippensburg, PA 17257 FROM: ORRSTOWN BANK P.O. BOX 250 SHIPPENSBURG PA 17257-0250 RE: ESTATE OF Blanche V Goodhart DECEASED DATE OF DEATH: November 2,2002 IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD, ON THE ABOVE DATE, THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK: (1) CHECKING ACCOUNTS ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED 531561 Lester S Goodhart 4/3/86 Blanche V Goodhart DATE OF DEATH PRINCIPLE & ACCRUED INTEREST 17,381.52 6.66 (2) SAVINGS ACCOUNT DATE OF DEATH ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPLE & ACCRUED INTEREST (3) CERTIFICATES OF DEPOSIT DATE OF DEATH ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPLE & ACCRUED INTEREST Date: 12/13/02 By: Timothea Customer Service Operator D n onv ,)i:;() C'LJIDDI::l\ICOIIOr-. 0/1. "'I'"7'"lt::-r Tel 1"7-i"7\ 1:'0:>1"\ co......" O...~ .. .... RRSTOWN , ','. . ' BANK December 12, 2002 Forest N. Myers, Esquire 137 Park Place West Shippensburg, P A.172S7 RE: BLANCHE V. GOODHART Dear Mr. Myers: According to our records, the above referenced decedent has the following account within the trust department: BLANCHE V. GOODHART INVESTMENTACCT # 0259 OPENED 6/3/94 BALANCE AS OF DOD 11/2102: $ 166,214.06 ACCRUED INCOME TO DOD $262.Q3 (Includes October interest not posted unti111/4102) Should you have any further questions, please contact us. PO Box 250. Shippensburg, PA 17257 . (717) 532-6114. (717) 532-4143 Fax. www.orrstown.com BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX FOREST N MYERS F N MYERS LAW OFFICES 137 PARK PL WEST SHIPPENSBURG PA 17257`• REY-1547 EX ~FV (01-037 DATE 09-09-2003 ESTATE OF GOODHART BLANCHE V DATE OF DEATH 11-03-2002 FILE NUMBER 21 02-1093 ' '`CF~UNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF GOODHART BLANCHE V FILE N0. 21 02-1093 ACN 101 DATE 09-09-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 118,972.35 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this form with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 184,349.08 tax payment. 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule Gl (7) .00 321 43 303 8. Total Assets (g) . , APPROVED DEDUCTIONS AND EXEMPTIONS: 16,820.03 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00 11. Total Deductions (11) 16.820.03 286,501.40 12. Net Value of Tax Return (12) 00 13 Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) . . 14. Net Value of Estate Subject to Tax (14) 286,501.40 NOTE: If an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 00 00 .00 15 (15) Amount of Line 14 at Spousal rate . X = . 16 Amount of Line 14 taxable at Lineal/Class A rate (16) 286,501.40 X 045. 12,892.56 . 17 Amount of Line 14 at Sibling rate (17) .00 X 12 .00 . 18 Amount of Line 14 taxable at Collateral/Class B rate (18) •00 X 1 5 .00 . (19)= 12,892.56 19. Principal Tax Due IAA GKCL11~- + AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-31-2003 CD002857 .00 2,892.56 INTEREST IS CHARGED THRUUGM UY-L4-ZUU3 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM TOTAL TAX CREDIT 2,892.56 BALANCE OF TAX DUE 10,000.00 INTEREST AND PEN. 71.24 TOTAL DUE 10,071.24 * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN 51, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) Hanover and High Street Carlisle, PA 17013 Phone: (717) 240-6345 Date: 9/24/2004 MYERS FOREST N ESQ 137 PARK PLACE WEST SHIPPENSBURG, PA 17257 RE: Estate of GOODF~ART BLANCHE V File Number: 2002-01093 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6 12) in the above captioned estate. ' As per the AMENDMENTS TO SUPREME COURT ORPHAi~S, COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent,s death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 11/03/2004 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge ~TATUS REPORT UNDER RULE 6.17 Name of Decedent: Date ofDeath: _ Will No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State,whether administration of the estate is complete: 2. If the answer is No, state when the personal representative reasonably believes that the adrninistrafion will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes _ No [] b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal r?presentative state in interest? Yes )~ No /~] an account informally to the parties c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Cleric of tli~lrohana* Court. and may be attached to this report. .~2.~ ,~ .?~: Date: ~ Signature ~ r------ Address C~C~ D ~)~,,.~ ~',~ Ct/~]~ 2X'vlephone No. ' C~vacity: ~ Personal Representative Counsel for personal representative