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HomeMy WebLinkAbout07-05-12 (3)'-', REV-1500 EX (02-,,, (1=1, PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 1 7 1 2 8-06 0, 1505611185 OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN 2 ], 1, 1, ], 0 9 6 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY 1,65-18-3901 1~042(J11, Decedent's Last Name Suffix FOX (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number Date of Birth MMDDYYYY 06201,9],9 Decedent's First Name M I VERONICA g Spouse's First Name M I THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (Date of Death ^ 4 Limited Estate ^ 4 F Prior to 12-13-82) ^ . a. uture Interest Compromise (date of 5. Federal Estate Tax Return Required 6 Decedent Died Testate ^ death after 12-12-82) 7 D d M ~ . (Attach Copy of Will) . ece ent aintained a Living Trust (Attach Copy of Trust.) 8. Total Number of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (Date of Death ^ 1 1. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number BRIDGET f1 • WHITLEY, ESQ • 71,7-233-18'IDO ~•' C rv '~~ REGISTER Or~j I~~ USE ONICY _ , _ `;~?~~-~ fT7 -•-- ~ ~-.- "" . ( ~ t ;~ ~ ~ t ~ j First Line of Address ~ `, ~ ~ r ~ r?' ~' _; . ~ ._~:J r :7 SKARLATOSZONARICH LLC . c7:~~ ,; -', Second Line of Address ~ -~ ~ -- ~ N : - '-~ T _: L7 S • 2ND ST • , 6TH FL ~-? ~ City or Post Office State ZIP Code DATE FILED HARRISBURG PA 171,01 Correspondent'se-mail address: BMWa~SKARLATOSZONARICH - COM Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which pr eparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN AT ~• •~ 7 3 ~~ ADD S JO N R • ZONARICH, 1,7 S • 2ND ST • , 6T HARRISBURG, PA ],77,01 SIGNAT RE OF PREPARE? OTH€R~THAN REPRESENTATIVE DATE BRIDGET ~1 • WHITLEY, ],7 S • 2ND ST • , 6TH FL, HARRISBURG, PA ],7101, PLEASE USE ORIGINAL FORM ONLY Side 1 1505611185 OM46473.000 15(J5611185 J 1505611285 REV-1500 EX (FI) Decedent's Social Security Number 7,65-18-3901 Decedent's Name: FOX V R O N T (" A g RECAPITULATION 1. Real Estate (Schedule A) 1 ~ • ~ 0 2. Stocks and Bonds (Schedule B) . 2 ~ • ~ ~ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . 3 ~ • ~ ~ 4. Mortgages and Notes Receivable (Schedule D) 4 0 • 0 O 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5. 9 5 , 91, L • ~ ~ 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested 6 ~ • ~ ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. ~ , ~ ~ 8. Total Gross Assets (total Lines 1 through 7) 8 9 5 , 911 • ~ ~ 9. Funeral Expenses and Administrative Costs (Schedule H). g. 2 ~ , 7 3 3 • ~ ~ 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10. 7, 3 , 4 2 7 • ~ 0 1 1. Total Deductions (total Lines 9 and 10) , _ 1 1 3 4 ,16 0 • ~ ~ 12. Net Value of Estate (Line 8 minus Line 11) 1Z. 67, , 751- ~~ 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) , _ 1 g 1, 1, , 7 5 2 • ~ ~ 14. Net Value Subject to Tax (Line 12 minus Line 13) _ 14 4 9 , 9 9 9 • ~ ~ TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers un~er Sec. 9116 15. ~•~0 16. Amount of Line 14 t xable 0 4 ~ at lineal rate X . o . o i] 16. ~ • ~ ~ 17. Amount of Line 14 taxable at sibling rate X .12 ~. ~ ~ 17. x• 0 0 18. Amount of Line 14 taxable at collateral rate X .15 5 0, 0 0 •0 0 18. 7, 5 0 0. 0 0 19. TAX DUE 19. 7, 5~~ • ~~ 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505611285 1505611285 DM4648 3.000 REV-1500 EX (FI) Page 3 Decedent's Complete Address: File Number a~. i. i. i.ngt_ DECEDENTS NAME FOX VERONICA B STREET ADDRESS CUMBERLAND CITY MECHANICSBURG STATE PA ZIP 1,7055- Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 7 ~ 500 , 00 2. Credits/Payments A. Prior Payments 7, ], 2 5. 0 0 B. Discount 3 5 6. 0 0 Total Credits (A + B) (z) 7 , 4 81, • 0 0 3. Interest (3) 0 . 0 0 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) 0 , 0 0 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1, 9 • 0 0 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred ^ ^X b. retain the right to designate who shall use the property transferred or its income ^ c. retain a reversionary interest ^ d. receive the promise for life of either payments, benefits or care? ^ 2. If death occurred after Dec. 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? ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 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 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in [72 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. OM4671 2.000 REV-1508 EX+ (7t-10) Pennsylvania DEPARTMENTOF REVENUE INHERITANCE TAX RETURN RESIDEM DECEDENT SCHEDULE E CASH, BANK DEPOSITS, 8r MISC. PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Veronica B. Fox 21 11 1096 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M&T Bank Savings Account No. 15004219963558 83,302 Interest accrued to 10/4/2011 0 2 M&T Bank Checking Account No. 3440014862 4,960 3 U. S. Treasury - Tax Refunds 6,371 4 Department of Revenue - Tax Refund 108 5 Cash 151 6 U. S. Treasury - Tax Refunds 911 7 Pennsylvania Dept of Revenue 108 Tax refund _ - TOTAL (Also enter on line 5 Recapitulation) $ ~ 95 , 911 owasAD 2.000 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+(io-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AN D INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Veronica B. Fox 21 11 1096 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ Auer Cremation - Amount due after prepayment 283 2 Nicholas and Alexi Basehore 225 B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: State ZIP 2. 3. Attorney Fees: Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant 18,680 Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 270 5. Accountant Fees: 6. Tax Return Preparer Fees: 870 7. 1 Cumberland Law Journal - Estate Notice 75 2 The Sentinel - Legal Advertising 200 3 SkarlatosZonarich LLC - Costs 125 Total from continuation schedules 5 TOTAL (Also enter on Line 9 Recapitulation) I $ 20 733 swasnc z o0o If more space Is needed, use addltlonal sheets of paper of the same size. Estate of: Veronica B. Fox Schedule H Part 7 (Page 2) 4 MST Bank Bank Service fee 21 11 1096 5 Total (Carry forward to main schedule) 5 REV-1512 EX ~r (12-08) Pennsylvania SCHEDULE I C~EPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES S~ LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Veronica B. Fox 21 11 1096 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Alert Pharmacy 63 2 F'aul D. Dalbey, DPM 65 3 SkarlatosZonarich LLC - Costs 155 4 Pinnacle Health Emergency 451 5 Philhaven 56 6 Messiah Village 12,637 _ TOTAL (Also enter on Line 10 Recapitulation) ~$ 13 427 awasAH z o0o If more space is needed, insert additional sheets of the same size. REV-1513 E:K+ (01-10) pennsylvania C~PARTMENT OF REVENUE IiNHERITANCE TAX RETURN F2ESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER: veronica ts. rox 211 11096 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBEF: NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Randy and Pamela Miller 429 Gibson Avenue Bethany Beach, DE 19930 General Bequests: 20,000 Niece 20,000 2 Theresa A. Sekula 66 Wabank Road Millersville, PA 17551 General Bequests: 10,000 Niece 10,000 3 Thomas Norkevich 429 W. South Street Mahony City, PA 17948 General Bequests: 10,000 Nephew 10,000 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 8 OF REV-1500 COVER SHEET, AS APP ROPRIATE. I I NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1 See Attached 1 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 11 , 752 n more space Is neeaea, use aaamonal sheets of paper of the same size. 9W46AI 2.000 Estate of: Veronica B. Fox 21 11 1096 Schedule J Part 1 (Page 2) Item No. Description Relation Amount 4 Joan Domshock 205 Pond St., Apt. 1207 Bristol, PA 19007 General Bequests: 10,000 Niece 10,000 Estate of: Veronica B. Fox Schedule J Part 2B (Page 1} Item No. Description 1 Grace United Methodist Church 216 State Street Harrisburg, PA 17101 One Half of Residue: 5,876 2 Parish of St. Patrick's Cathedral 212 State Street Harrisburg, PA 17101 21 11 1096 Amount 5,876 One Half of Residue: 5,876 5,876 O p~ LAST WILL AND TESTAMENT OF VERONICA B. FOX I, VERONICA B. FOX, of Dauphin County, Pennsylvania, being af~sound and disposing mind and memory, do make, publish and declare this to be my Last Wi11 and revoke any Wilts and codicils previously made by rne. ARTICLE ONE Specific Bequests of Tangible Personal Property I give and bequeath all of my tangible personal properTy, including, but not limited ta, all my automobiles, fi-rniture, furnishings, books, pictures, jewelry. cl}ina, liners, silver, clothing, household effects and personal effects, and other tangible persona] property of like nature (not including cash, securities and other property used for the production of income}, together with any existing insurance thereon as I may have provided in a memorandum kept with the original of this WiII, or to the extent not so provided or not effectively disposed of in any such memorandum or if the law of my state does not permit tl~e use of a memorandum. Any property not distributed according to such memorandum s1~all be sold and the net proceeds small become part of my residuary estate. ARTICLE TWO Specific Bequests of Cash I give and bequeath: (A) the sum of Twenty Thousand ($20,000.00) Dollars to RANDY S. MILLER and PAMELA M. MILLER or the survivor of them; or, if both of them do not survive me. this gift shall ]apse and become part of my residuary estate; and {B) the sum of Thirty Thousand ($30,OOOAO) Dollars to be divided equally an~ongst the following individuals: THERESA A. SEKULA, JOAN DEMSHOCK and THOMAS NOR]{EVICH or the survivor of them; or, if there is no survivor, this gift shall lapse and become part of my residuary estate_ ARTICLE THREE Residuary Estate I give, devise and bequeath all the rest, residue and remainder of my property of every hind and description (including lapsed legacies and devises} wherever situate and whether acquired before ar after the execution of this Will as follows: (A) Fifty (50%} Percent thereof to the PARISH OF ST. PATRICI{'S CATHEDRAL, located at 21? State Street, Harrisburg, Pennsylvania, if in existence at the time of my death in memory of Dale Allison Fax and Veronica Berchunas Fox with thanks to God; or, if it is not in existence at the time of my death, to the GRACE UNITED METHODIST CHURCH, located at ?16 State Street, Harrisburg, Pennsylvania; and ~lU+ti1,171~~@7,i»,41~lc:it ua' L,IST l~'II.1, ce T~'~STtih~ENT OF I~ERONIC_ti 13. FQ~` ATTORNEYS AT LAW Page I o~ 7 (B) Fifty (50%} Percent thereof to the GRACE UNITED METHODIST CHURCH, located at ZI6 State Street, Harrisburg, Pennsylvania, if in existence at the time of my death in memory of Dale Allison Fox atld Veronica Berchunas Fox with thanks to God; or, if it is not in existence at the time of my death, to the PARISH OF ST. PATRICK'S CATHEDRAL, located at 2l2 State Street, Harrisburg, Pennsylvania. ARTICLE FOUR Payment of Taxes I direct that all estate, inheritance and other death taxes (other than generation-skipping transfer taxes), and all interest and penalties thereon imposed by reason of my death with respect to properly subject to such taxes by reason of my death, whether such property passes through my probate estate or outside of my probate estate, and payable to any federal, state or foreign taxing authority, whether payable by my estate or by any recipient of such property, sliali be paid by the recipient of such property- ARTICLE FIVE Protective Provisions The principal of my estate and the income therefrom, so long as the same are held by my Executor-, shall not be subject to anticipation, assignment, pledge, sale or transfer in any manner, nor shall any beneficiary have power in any manner to charge or encumber his/her interest in my estate, nor shall the said interest of any beneftciary be Liable or subject in any manner while in the possession of my Executor for any liability of said beneficiary, whether such liability arises from said beneficiary's debts, contracts, torts, or• other engagements of any type. ARTICLE SIX owers of Executor In addition to and without limiting the powers conferred by case law, by statute, and by other provisions hereof, my Executor shall have the following rights and powers exercisable without the need for court approval: (A) Accept and Retain Investments- To accept and retain any form of real or personal property received by transfer, devise, bequest or otherwise without being required to diversify and without being limited to the types of investments in which fiduciaries are authorized by law to invest. This authority shall specifically include the authority to accept and retain any stock of a corporate fiduciary hereunder, or in any corporation which controls or is controlled by it, or any other corporation in which it holds any ownership interest, together with any stock dividends received thereon, or any stocl: acquired in the exercise of subscription rights, or received by reason of any consolidation, merger or reorganization, without liability for such retention. (B) Invest. To invest and reinvest in any farm of real or personal property without limitation by any law applicable to investments by f duciaries. (C) Voting Rights- To vote a security in person or by proxy, to participate in or consent to any merger, reorganization, dissolution, liquidation, voting trust plan, or other action SIi11ilA'I1~~~r"1~1.\AIUf~-l ur L.~1ST GI~IL.L ~ TEST.~I~IENT OF IBRONICA B. FOX ATTORNEYS AT LAW IJ[Tgp ~ ~f 7 affecting any securities held hereunder, and; to exercise conversion, subscription, and other- rights of whatever nature. {D) Title To Property To register or Fold securities and/or other property in the name of a nominee or nominees, including that of a clearing corporation, a depository, in book entry form, or to retain securities ar~d/or other property unregistered or in a form permitting transfer by delivery.. (E) Sale. Lease and Other Dealings with Property. To sell, from time to time, at public or private sale, exchange, lease, encumber, option or otherwise dispose of all or any portion of assets held hereunder; to make, execute and deliver deeds, mortgages, leases, assignments and other documents necessary to carry out any of the powers granted hereunder, which shall specifically include ttre authority to grant leases which extend beyond the period authorized by law, and; to partition, subdivide, improve and impose any restrictions on real estate held hereunder and enter- into agreements concerning the partition, subdivision, improvement; zoning or management of any such real estate. (F) Borrow. To borrow money from any person or institution and pledge property as security for repayment of funds. (G) Distributions in Kind. To make distributions in cash or in kind, or partly in each, and; to allot different kinds of property to different shares without regard to differences in the income tax basis of such property. Any such designation. division, allocation, apportionment or valuation of property shall be binding and conclusive on all parties. (H) Power to Distribute Outright. In any instance where property would be immediately distributable to a beneficiary of a trust, distribution may be made directly to such beneficiary without funding such trust. The receipt of any such distribution by any such beneficiary shall be a full acquittance of the fiduciary making such distribution as to any amounts so distributed. (I) Settle Claims. To institute, prosecute and defend any and all legal proceedings; and compromise, release, adjust and/or settle any debt or claim. _ (1) Employment of Agents. To employ agents including attorneys, accountants, and others to perform administrative duties_ (K) Disclaimer. To disclaim any interest m property which would devolve to me or to my estate by whatever means, including but not limited to the following means: as a benefciary under a will, as an appointee under the exercise of a power of appointrnent, as a person entitled to take by intestacy, as a donee/beneficiary of an inter vivos transfer, as a beneficiary under any insurance policy, as a beneficiary under an individual retirement accotrnt or annuity, and as a beneficiary under any qualified or non-qualified retirement plan. ARTICLE SEVEN riduciaries (A} Appointment of Executor. I appoint JOHN R. ZONARICI-I, ESQUIRE or• the Managing Partner of Slcarlatas & Zonarich, LLP as Executor of this Will (rny said Executor and any successor )=•xecutor or co-Executars shall be referred to herein as my "Executors" ar "Executor"). {B) Miscellaneous. Any successor Executor shall succeed to the capacity of its predecessor without re-conveyance or transfer of property and have all of the rights, powers, SIL~lIiIAT(~~.k7.(7\'Ai~ll(5I r~r' LAST WILL c~ TESTAMENT OF YERONIC~113. FOX ATTORNEYS AT LAW Pnge 3 of 7 authorities and discretion confen-ed upon the original E.xecutor_ No successor Executor shall be obligated to examine the accounts, records, or acts of a previous Executor nor shall any such successor Executor in any way or manner be responsible for any act or omission to act on the part of any such previous Executor. No Executor serving hereunder at any time shall be required to file any bond or enter security in any Court or jurisdiction in which such fiduciary may be called upon to act. ARTICLE EIGHT In#ernretation (A) Cluld, Children. Grandchild Grandchildren and Issue. Whenever the terms "child," "children," "grandchild," "grandchildren" and "issue" are used herein, such terms shall be interpreted to include adopted persons as well as natural persons, provided in each instance that the adoptee is under the age of eighteen (I 8} years at the time of adoption. Suc11 terms are also intended to include persons in gestation at any pertinent time under this WiII, provided such persons survive birth by thirty (30) days. (B) Survival Clauses. If any beneficiary hereunder should die within thirty (;0) days after my death or within thirty (i0) days after any other person the survival of whom determines such beneficiary's rights hereunder, then such beneficiary shall be deemed to Dave predeceased me or such other person, as the case may be, far all purposes hereunder_ (C} Governing Law.. Tlus Will shall be construed and governed in all respects by and in accordance with the laws of the Commonwealth of Pennsylvania.. (D) Gender and Number_ Where appropriate except where the context otherwise requires, whenever used herein, the singular includes and plural, the plural the singular and words of-any gender shall be applicable to all genders. (E) Headinr~s/Captions. The headings/captions of Articles, Sections and Paragraphs used herein are for convenience of reference only and shall have no significance in the construction or interpretation of this Will_ IN WITNESS WHEREOF, I have hereunto set my hand and sea] and caused this my Last Wi]i and Testament, consisting of 5~-- ~--~ ~) typewritten pages, including this attestation clause and ~e following Acknowledgment and Aff davit, to be executed, declared and published this oz/=day of , 200$, at Harrisburg, Pennsylvania. (JOlre~zce~ ~, ~a-yG VERONICA B. FOX 51uti~1.r171Xi~~t7.iil~litlf~3 i~r L.,IST N~ILI. & TEST,~MENT OF T~ERONICA B. FOB' ATTORNEYS AT LAW D~4C ~ O~ On this ~~7 day of ~~ , ?008, VERONICA E. FOX declared to us, tl~e undersigned, that the foregoing strument was her Last Will, and sloe requested us to act as witnesses to t}re same a~~d to her signature thereon. She thereupon signed said Wiil in our presence, we being present at the same time. We now, at her request, in her presence, and in the presence of each of us, hereby subscribe our names as winsesses thereto. By so doing, each of us declares that he/she be}ieves this Testatrix to he of~sound mind and memory. Wifiesses: fitness Wifies '~ Address: (~ // Au JiSo ~c (11 ~ilitlfl'It~~sr7~)1AI~lf,'I-l »>~ LAST FYILI. cf T£STAA~ENT OF VERONICA I3. FO,I' ATTORNEYS AT LAW Page S oj~7 ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN SS: I, VERONICA B. FOX, the Testatrix, whose Warne 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; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein expressed. VERONICA B. FOX Swom r affirmed to and acknow}edged before me by VERONICA B. FOX, the Testatrix this v~/S~day of X008. ,.~ , -- l~G%(/LL .'L (SEAL.) N tary Public My Conunission Expires: COMMONWEALTH OF PENNSYLVANIA Notarial Seal Sherry L Devlin, Notary Public Qty Of Harrisburg, Dauphin County My Corruntsston E~ires Dec. 18, 2D11 Member, Pennsylvania As~oclalton of Natartes S~v1R11171~~C7.1?~,'r121C13 >>>~ L.~ST WILL c~ TESTAMENT OF I~ERONICf113. FOCI' ATTORNEYS AT LAW n~ae ~ O~ AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF DAUPHIN ) We, ~ l= A ~ ~. -~G ~ a ~ f C {~ and SS. GtZcz_ Y? ~ ~ , ~ ~a.~.L cci the witnesses, whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw VERONICA B. FOX, sign and execute the instrument as the Testatrix's free a2~d voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Wi11 as witnesses; and that to the best of our' knowledge, tl~e Testatrix was at the time twenty-one (Z l) or more years of age, of sound mind and under no constraint or undue influence. ~~ fitness Witne Sworn or a rmed to and acknowledged before me by ~ e ~ '~ ~• ~ "~~ `~~ ~ C ~~ and -~~~ ~tz.e~ • ~ ~cCCr `cep ,the witnesses, thisa/stday of ~ , ~ppg. _ GG~ (SEAL.} Notary P is My Commission Expires: COMMONWEALTH OF PENNSYLVANIA Notarial seal Sherry L Damon, No~ry Public City OF Harrisburg, Dauphin Counly My Corrurussion Expires Dec_ 18, 2011 Member, Pennsyl~~ani~ Association of Notaries ~1~:11~r~'ll ~~~%t>l•11iN'71 u~' LtiST 13tILL ~ TE-ST~IAIENT OF I~ERONICA 13. FO.~l ATTORNEYS AT LAW Pnge 7 of 7 01VI&TBank 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Skarlatos Zonarich LLC 17 South Second Street 6'~ Floor Harrisburg, PA 17101 Re: Estate of Veronica Fox Social Security: 165-18-3901 Date of Death: October 4.2011 Phone 888-502-4349 F ax (302)934-2955 November 2, 2011 Dear Sir or Madam: Per your inquiry on October 24 2011, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Accounx Savings Account Account Number 15004219963558 Ownership (Names o~ Veronica B Fox John R Zonarich (POA) Opening Dare 08/31/09 Balance on Date of Death $83,302.46 Accrued Interest ,$ .23 Total ----- - ------ ----- ---- _ _ --- --- ---- - -- - --- $83,302.69 2. Type ofAccount Checking Account Account Number 3440014862 Ownership (Names o~ Veronica B Fox John R Zonarich (POA) Opening Date 06/15/76 Balance on Date of Death $4, 959.96 Accrued Interest $ .00 Total ,$4,959.96---------------- ---------- -.. - ----- -- ~ ~ U ~ ~ O~ .d `o o °D A. N d ~ O~ U ~~ ,o O o p O ~ ~ ~~~~ U R, L1. C w w z a W~ a F W a a~ w U F A ~I O H A w ~ -~ ~ N ~ :~ .O O ~ ~ b •~ a~i b ~ c A :: ~ w ~ d ~ a z A A v4 w O ~ ~ o ~ ,~, ~ 0p N M y ~ O ~ ~ ~ ~ O ~ ~ r ~ a~i z '~ ~ ~ ~i ~ o Fi ~ }~+ ~ 'w" a ~ d ~~~~ ~ c3 A w o~ r ~ m A d ~ , 1-1 b ~ aq~ a~°q- a °~' ~~' c ~ ~ °~ '~ A aa. o ate.: .~ A 0 m ,~ a z +~ q a -o v v d O ---U: ~i F ~ ~ ~ o ~ U U ~ O d H 0 a, 0 w b ~2 0. U Ci ~ x • ~ "~ ~ ~ v ,b b a~ d ~ +' o ~ `+'~ 'b w b p ~ ~ ~° w O W ~ ~ y O ~ ~ U O ~ d ~ d Q i, d ,'~i d p ~ cUC C/~ ~Szz