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HomeMy WebLinkAbout04-0925 PETITION FOR PROBATE and GRANT OF LETTERS also known as _ ~wo~sff' To: Register of Wills for the ~ Deceased. County of _6--~,-.~g~zz/l,Op in the Social Security No. ~5/. Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that Your petitioner(s), who is/are lg years of age or older an the oxecut· _ in the last will of the above decedent, dated -~ 19 and codicil(s) dated -' -- (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in _ ( ~.o??.~..L4,q~,Lr~ County, Pennsylvania, with he--r' last family or p,I;incipal residence at _ (list street, number and muncipality) Decfi?uent, t~.en _~ years of age, died at_ <~grw/' /~./~ .2~ Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ / (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ sitnated as follows: WHEREFORE, petitioner(s) respectfully request(s) the probate of the la}t will,-and codicil(s) presented herewith and the grant of letters .' theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF (-tgnql3tqKt.~cl,:t> f ss The petitioner(s) above-named swear(s) or 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 as personal represen- tative(s) of the above decedent petitioner(s) wi!! well and truly administer the estate according to law. Sworn to or affirmed and subscribed ~ ~4~ ~.0©o.~-~ before me this I ~ d~,, ~ [ ~ ' f ier [ ~ Estateef CtOl~ [' [~(~i(c) ,Deceased ~N~ G~&~ z LETTERS are k:ereSy granted to ~[~k~ ~. FEES Probate, Letters, Etc .......... $ 7-5 D0 Short Certificates(T) .......... $ (0' OO ATT©RNEY (Sup. C:. !.D. NO.) TOTAL $. 4 ~, 0 O Filed ................................... PHONE LAST WILL AND TESTAMENT OF FLORA HICKS I, FLORA HICKS, of the County of Cumberland and Commonwealth of Pennsylvania, being of sound and disposing mind and memory, and not acting under undue influence of any person whomsoever, do make, publish, and declare this instrument to be my Last Will and Testament, in manner and form following. ITEM I: I hereby expressly revoke all Wills, Codicils and testamentary writings of whatsoever kind and nature heretofore made by me. ITEM II: I hereby direct my Executrix to pay all my just debts, expenses of administration and funeral expenses out of my estate as soon as is practicable after my decease. ITEM III: I give, devise and bequeath all of my estate of whatever nature and wherever situate at the time of my death unto my cousin, LOIS J. BYERS, of Cumberland County, Pennsylvania. ITEM IV: All death taxes (not income taxes) that may be assessed in consequence of my death, of whatever nature and by whatever Jurisdiction imposed, shall be considered a part of the expense of the administration of my estate, and my Executrix shall have the absolute power in her discretion to pay the same at once whether or not the law under which they are imposed permits the postponement of payment of all or part of them to a later date. ITEM V: I direct and empower my Executrix to sell any and all real estate of which I die seized, at such time and upon such terms as he may deem best, and to deliver good and sufficient deeds therefor to the purchaser or purchasers thereof. ITEM VI: I nominate, constitute and appoint LOIS J. BYERS, of Camp Hill, Cumberland County, Pennsylvania, Executrix of this my Last Will and Testament. IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of February, 1994, at the end hereof composed in all of hree pages, including the self-proving attestation clause and signatures of witnesses. FLORA HICKS ' , ~/ ,. . , . t?'~ COMMONWEALTH OF PENNSYLVANIA: : SS: COUNTY OF DAUPHIN: We, FLORA HICKS, the Testatrix and DONN L. SNYDER and DIANE E. GRISSINGER the witnesses, whose names are signed to the attached foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed, sealed, published, acknowledged, and declared the instrument as her Last Will and Testament; and that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; and that each of the witnesses in the joint presence of each other and in the presence and hearing of the Testatrix, signed the instrument as witness to her Last Will and Testament; and that to the best of their knowledge the Testatrix was at the time eighteen years of age or older, was of sound and disposing mind, memory and understanding, and was under no constraint or undue influence. FL~RA ~CKS, TESTATOR DON~ L. SNYDER ~~TNES~ DIANE E. GRISSINGER./ WITNESS Subscribed, sworn to and acknowledged before me, the undersigned officer, by Flora Hicks, the Testatrix, and subscribed and sworn to before me . by~ Donn L. Snyder and Diane E. Grissinqer , wltness~s, in the presence of each other, this 17th day of February , 1994~. ~ ~ary Public ~ Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717)240-6345 Date: 01/10/2005 KELLER ALFRED J 69 GREENSPRING DRIVE MECHANICSBURG, PA 17050 RE: Estate of HICKS FLORA E File Number: 2004-00925 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 01/24/2005 Your prompt attention to this matter will be appreciated. Thank You. cc: File Counsel Judge GLENDA FARNER STRASBAUGH Clerk of the Orphans' Court JRD/June 30, 1992/17858 Estate No.: 21-04-0925 ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYL VANIA In Re: Estate of Flora E. Hicks Late of Silver Spring Township NO. 21-2004-0925 NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT ORPHANS' COURT RULE Personal Representative: Alfred J. Keller Counsel for Personal Representative: Date of Grant of Original Letters: 10-14-2004 Date of Delinquency Notice: 01-24-2005 The undersigned, Glenda Farner-Strasbaugh, Clerk of the Orphans' Court, in accordance with Rule 5.6, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court Orphans' Court Rules, was given by the Clerk of the Orphans' Court on January 24, 2005, and that the ten (10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e) the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 02-09-2005 ~~~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File IJ~ // ,;u,,, s; 9; 3~ )I.. IH. A hearing is scheduled for at in Courtroom No.3. If the Certification of Notice is filed prior to the hearing date, the hearing will automatically be cancelled. Name of Decedent: F I-bIZ..I q!Ofor J-I-O'f - D?2-~ CERTIFICATION OF NOTICE UNDER RULE 5.6(a) ;-{;UO E. Date of Death: Will No. Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the O)"phans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on Aft:; V I ~ : } 11 t.frz-tj) J- . Kc:(~ Address ~(E-~---X"(0/IU;:=VA. M<<./!P-: ~'- (1@; / . Name /j Notice has now been given to all persons entitled thereto under Rule 5.6(a) except C~J,~ Signature Date: Ii; b I 7; O~ Name AtrfL.(J) -J. J4LLC(L Address Cq C;t1.r:---UV5l'1Z,,I'olC;Y(L jZllXrfr1I../'c:5.fW~ -t/; f160:> / TelephOne(71 [/111../j-2-j Capacity: ~ersonal Representative _Counsel for personal representative i'- \\ ,. REV-I500 ~ + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) I- Z W C W o W C Hicks Flora E DATE OF DEATH (MM-OD-Year) DATE OF BIRTH (MM-DD-Year) 9/3/2004 6/4/1901 (IF APPUCABlE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) w ~ :ll::-lI.I ua::ll:: wG.u :l:li!9 UtlD < 1RI1. Original Retum o 4. Limited Estate 1RI 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Retum o 4a. Future Interest Compromise (date of death alter 12-12-32) o 7. Decedent Maintained a Living Trust (AIlach copy 01 Trusl) o 10. Spousal Poverty Credit (date of death be~ 12.31-91 and 1-1.95) OFFICIAL USE ONLY FILE NUMBER 2 1 -04 0 9 2 5 "'COONiYCCXlE -vEM- - - NiiiER- - SOCIAL SECURITY NUMBER 2 02- 2 0 - 1 804 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Retum (date oIdealh priot 10 12-13-82) o 5. Federal Estate Tax Retum Required _ 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) ..... Z W Q Z o a.. lI.I W ~ o u THIS SEcnON MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS David H. Stone Es uire 414 Bridge Street FIRM NAME (If Appllcable) Stone LaFaver & Shekletski TELEPHONE NUMBER 717 774-7435 New Cumberland PA 17070- z o i= :5 ::J l- ii: <C o W 01:: 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. JoinUy Owned Property (Schedule F) o Separate BiHing Requested 7. Inter-VIVOS Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) (1) (2) (3) (4) (5) (6) (7) (9) (10) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o S ::J a.. :E o o ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 0.00 X _(15) 0.00 X _(16) 0.00 X .12 (17) 0.00 X .15 (18) (19) 20. D CHECr. HERE I.: (QU Al-\f f<I:QJ[STI~~G /l., REFU~.: : ~'I ;VtRP,~Yr\H,r OFFICIAL USE ONLY ~ c::> = c.n -:;~ S O/!:__ o SO ;-:~~.~~ -,-' -c: :;:J 3,679.0S.' c/) ;;" --' tS ~~ (- ::0 :' 1-1 (8) 4,161.53 0.00 (11) (12) (13) (14) > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIGEAND RECHECK MATH < < N N -0 -,,:,,"" (.oJ .. :xJ r-n c> o =0 C:J rTl CJ C) --1'1 --1-1 c'S rn o -n +"" 3,679.08 4,161.53 -482.45 -482.45 0.00 0.00 0.00 0.00 0.00 pt. o 'C I t Add ecetfents ample e ress: STREET ADDRESS rfi 46 E ord Rd. CITY I STATE I ZIP Camp Hill PA 17011- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 0.00 3. InterestlPenalty if applicable D. Interest E. Penalty Total Credits (A + 8 + C) (2) 0.00 TotallnterestlPenalty (0 + E) (3) 4. If Line 2 is greater than Une 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) 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; ........................................................................... 0 r&l b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 r&l c. retain a reversionary interest; or ...................................................................................................... 0 r&l d. receive the promise for life of either payments, benefits or care? ..... ........................................................ 0 r&l 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?......................................................................................... ...... 0 r&l 3. Did decedent own an "in trustfor" or payable upon death bank account or security at his or her death? ................. 0 r&l 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 0 r&l 0.00 0.00 0.00 0.00 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. SIG RESENTATIVE PA 17050 DATE ,Of PA 17070 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. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse Is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not examDt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedenfs siblings is 12% [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX + (6-98) . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hicks. Flora. E FILE NUMBER 21 04 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. 0925 ITEM NUMBER 1 DESCRIPTION Citizens Bank-Burial Reserve Acct. No. 6146908304 VALUE AT DATE OF DEATH 3296.13 2 Citizens Bank-Checking Acct. #6100675157 382.95 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3 679.08 REV-1~11 EX + (12-99) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hicks. Flora. E SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21 04 0925 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: Neumyer Funeral Home-funeral expenses 285.40 Neumyer Funeral Home-funeral expenses 3296.13 Lakeside Lutheran Church-funeral expense 50.00 Giant Foods-food for funeral dinner 150.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of Personal Represenlative(s) Street Address City State Zip Year(s) Commission Paid: 2. AlIDmey Fees David H. Stone, Esquire 250.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Prepare!'s Fees 7. Register of Wills-filing Inh. Tax Return and Inventory 30.00 8. Reserve for closing expenses 100.00 TOTAL (Also enter on line 9, Recapitulatiofl) $ 4161.53 (If more space is needed, insert additional sheets of the same size) REV-""""W COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hir.k!=: FII lra E NUMBER I. SCHEDULE J BENEFICIARIES NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS pnclude oubight spousal distributions, and transfers under Sec. 9116 (a) (1.2)) 1. Alfred J. Keller 69 Greenspring Dr. Mechanicsburg, PA 17050 FILE NUMBER ?1 n4 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Collateral nA?~ AMOUNT OR SHARE OF ESTATE 0.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART IT - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) "":'^f;'\"f':- .. <-'~'<""';,,:',:;\i'\ ,/ "",_i- ',' ,,'-' '~-','-'<', US059 BR301., -, -' : ' -, ;',,--, '~'- FL ORA E'H ic''':$,' ~: cl~~\~'f~~i':lkl,fpi" 1 70 is (( -',,"-::',;-,-, . 'iv' '~ Account Statement o OF 2 Beginning August 05, 2004 through September 03, 2004 Contents Checking CDs Page Page 1 2 Eheddg9 5""" A:l'Y U AM 5 Act n Olf . ...rMi&':$ ',' (hedcs* ",.. u tI bttok In chect.UfI/IfIICf Cltedl , A/IImlt Datil S38 373. SO 08/31 CIIedl' A"'i(lt. D. Deposits & AclcHtions Date A_lit DescrtptloR 0810S 159.89 Deposit 09/02 159.89 Deposit Daily Balance Dat. 08IOS Balallat 596.56 D.. 08/31 Bllana 223.06 Dat. 09/02 Balance 382.95 I '-or . r ' ,~' 11., _' _" i I ; FLORA E HICKS Citizens Bastc Checking 610061-515-7 ",","I hI-.ce 436.67 e TDtIl C.edcs 373. 50 o o Tutll De,lIIIts a AdIItIanl 319. 78 Carr8llt Balance 382. 95 Balance (a(cu(atfon Pnwiolls Balance Withdrawals Depd$its & Additions Intentst Paid Currlnt 8tlaMe.. ;;i", th;~' i:~_h -~_:;,,;} f"'ll.iat ii')IJ.::;;qg L€:lHh-:r ''''''i,-1'-.' :.~'-,"" impt),t,-,nt \1,fOlI1l;.;tion Account Statement e OF 2 Beginning August 05, 2004 through September 03, 2004 FLORA E HICKS BURIAL RESERVE 5 year CD 6146-908304 . PI'ftlDIS Balance 3,282.53 o e Tatll 1iallllCttaas 13.60 CDmtRt laIanee 3,296.13 -- ,'!"'"-. ~. :~ :{~ d ~ ::ori' ';1) ~ .. ~,:~J _ ~; . ~~ t~L , ^, LAST WILL AND TESTAMENT OF FLORA HICKS :::::l :-, --; i...-.r -0 ." ~.. .b-:. ,..' ::: _. I, FLORA HICKS, of the County of Cumberland and Commonwealth of Pennsylvania, being of sound and disposing mind and memory, and not acting under undue influence of any person whomsoever, do make, publish, and declare this instrument to be my Last Will and Testament, in manner and form following. ITEM I: I hereby expressly revoke all Wills, Codicils and testamentary writings of whatsoever kind and nature heretofore made by me. ITEM II: I hereby direct my Executrix to pay all my just debts, expenses of administration and funeral expenses out of my estate as soon as is practicable after my decease. ITEM III: I give, devise and bequeath all of my estate of whatever nature and wherever situate at the time of my death unto my cousin, LOIS J. BYERS, of Cumberland County, Pennsylvania. ITEM IV: All death taxes (not income taxes) that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be considered a part of the expense of the administration of my estate, and my Executrix shall have the absolute power in her discretion to pay the same at once whether or not the law under which they are imposed permits the postponement of payment of all or part of them to a later date. ITEM V: I direct and empower my Executrix to sell any and all real estate of which I die seized, at such time and upon such terms as he may deem best, and to deliver good and sufficient deeds therefor to the purchaser or purchasers thereof. ITEM VI: I nominate, constitute and appoint LOIS J. BYERS, of Camp Hill, Cumberland County, Pennsylvania, Executrix of this my Last Will and Testament. IN WITNESS WHEREOF, I have hereunto set my hand and seal this f1L day of February, 1994, at the end hereof composed in all of tliree pages, including the self-proving attestation clause and signatures of witnesses. ~~ {;;~ FLORA HICKS WI A(~ rt It" Mi~fJ./ JJ~k~ -' -t2A COMMONWEALTH OF PENNSYLVANIA: COUNTy OF : SS: DAUPHIN: We, FLORA HICKS, the Testatrix and DONN L. SNYDER and DIANE E. GRISSINGER the witnesses, whose names are signed to the attached foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed, ~ealed, published, acknowledged, and deolared the instrument as her Last Will and Testament; and that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; and that each of the witnesses in the joint pres"ence of each other and in the presence and hearing of the Testatrix, signed the instrument as witness to her Last Will and Testament; and that to the best of their knowledge the Testatrix was at the time eighteen years of age or ol~er, was of sound and disposing mind, memory and understanding, and was under no constraint or undue influence. ~1' r /) I _ ~~~~~ CKS, TE TATaR DO L. SNY ER /t2i/J/J1dJ t. ivuA/J I y tL/ '"i5IANE E. GRISSINGER WITNESS SUbscribed, sworn to and acknowledged before me, the undersigned officer, by Flora Hicks, the Testatrix, and subscribed and sworn to before me by: Donn L. SnYder and Diane E. Grissinqer , witnes s, in the pr nee of each other, this 17th day of , 19 Naron.tta F~ ~_ ~al'T1sburg. PA · .-;: =c r.ly Commise;10l'l Exp1res!Vov, 21, lt91 f - ...----.J REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY Estate of Flora E Hicks , Deceased No. 21 04 0925 Date of Death 9/3/2004 Social Security No. 202...20-1804 also known as Alfred J. Keller Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory inqlude all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation 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 the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. l!We verify that the statements made in this inventory are true and correct. l!We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: David H. Stone, Esquire 1.0. No.: 39785 Address: 414 BridQe Street New Cumberland Telephone: (717) 774-7435 69 GreensprinQ Dr. Mech. PA 17050 Dated 1f'l-oT' PA 17070- Description Citizens Bank-Burial Reserve Acct. No. 6146908304 Value 3296.13 Citizens Bank-Checking Acct. #6100675157 382.95 ...:2' M <( 1-0.:- 0: =) LLC) 00 Ll._ C)ff:; u.J () [C ..- LL C) o LLJ c', cr~ C-;, <-~) U.I CC 0- N N :=0>- C) -"" -- t-r:> = c:::> C'--l X (f) ~~8: (..) (1- L.j cC-:.- 05 (..) Total (Attach Additional Sheets if necessary) 3,679.08 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal r~presentative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 ~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: Flora E. Hicks Date of Death: September 3, 2004 Will No. 21-04-0925 To the Register: 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. Yes ~ State whether administration of the estate lS complete: No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: (a) Did the personal representative file a final account with the Court? Yes No X (b) The separate Orphans' Court No. (if any) for the personal representative's account is: N/A (c) Did the personal representative state an account informally to the parties in interest? Yes~ No Date: (d) Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be '~t'~~he1 to this report. " .' ~~.I ~'? !t' C-c.. '..:.\::.:> Davi'ct\H. s.t~lsq~ 414 Brlage Street New Cumberland, PA 17070 717-774-7435 Capacity: Personal Representative X Counsel for Personal Representative " '. I \ I ! - _ ~ :! i i j . ( 01-30-2006 HICKS 09-03-2004 21 04-0925 CUMBERLAND 101 APPEAL DATE: 03-31-2006 ( See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 9~!_~~P~~_!~!~_~!~~______~___~~!~!~_~P~~~_~P~!!P~_~P~_YPY~_~~9P~~~__~____________________ REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX flORA E FILE NO. 21 04-0925 ACN 101 BUREAU OF INDIVIDUAL -TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DAVID H STONE STONE ETAL 414 BRIDGE ST NEW CUMBERLAND DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN ESQ PA 17070 ESTATE OF HICKS REV-1547 EX AFP (06-05) flORA E TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED DATE 01-30-2006 I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ abh returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: ..~~~...,. (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 3.679.08 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 4,161.53 .00 (11) (12) (13) (14) NOTE: .00 .00 .00 .00 X 00 = X 045 = X 12 = X 15 = · IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 3,679.08 4.161 1i3 482.45- .00 482.45- (19)= .00 .00 .00 .00 .00 ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. ~ IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) _ _r • i F.ECISTE ti c:F ti^iLLS GF ~voc /- aiti~ COU_~TY, PF ~i?tiSYT V~,NI?. . 1Vallle GI Decede.?t:~~~ (~--s,~~r~i~ Date o: Deat;i: C~~Pi" .Z, ~~~~ File i`iu::bez.. ~~ 9/ B o /~'v~_;` P .. r • D.. r'r ~` C. 1 /. 77 T .-~-.~.-± the f~,11 is it •~ a; 1't';7^~r_'.`IQ_7 !tf tl;e "a ~i ?~Illstl'3t101? Oi a tai Jti :liu lv a u. v.t.. l~~iae v.as, a . Y'va _ •~ l ?~ t;~iti~ T.~C7~ ~` t~~ r. r~ f-l:~ the above-ca;~tioned estate: 1. State whether administration of the estate is corzplete :.................... ~ ~'es ~ No 2. If the anstivei is No, state when the personal representative it reasonably believes that the adirainistrationwrll be complete: i i 3. If the ai~s~ver to I~'o. l is YES, state the followinj: 't a. Did the personal representative ~ !e a fnal~acceunt with the Court? ....... Yes ~No I b. The separate Orphans' Court No. (if any) for the personal representative's account is: '~ ~~ c. Did the personal representative slat;, an account . informally to the parties in ii?terest? .:.................:.......... X'es ONo d. Copies of receipts, releases, joinders and approvals of formal or informal actor nos maybe filed with the Cleric of tl~e OrFhans' Court and maybe arached to this repotl:. _ DC Onrc ~.S /Td (J ~ Si~norrrt of ?er:on F1iir:g t Form ' _ '~fL~ CD Capacity: QPersoral Representative ~4ouusel G, ~ tE ~ ~ /'/r ~° _ ~Q tti'ar.:e oJPtrsar Filicgt a Fonu - o ~:, a' oc3'~ _ ~~ o r.. r~~z;,;ro.,z ~