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HomeMy WebLinkAbout08-21-12r ~ ~ /` ~ ~~ .--~' ;.;~ ~ P `~~ ~t~ ~~ DECEDENT'S ESTATE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION U G~ _~ _~ - ~;_ - _ ~~~ ! r ~:-~c r cv ~~ ~r:., PURSUANT TO Pa. O.C. Rule 6.9 This form may be used in all cases involving the Audit of the Account of a Decedent's Estate. If space is insufficient, riders may be attached. Attach the spouse's election, if any; the papers required under items 8-19 inclusive; and any instrument pertinent to the adjudication. INCL UDE ATTACHMENTS AT THE BACK OF THIS FORM. Name of Counsel: STEVEN J. SCHIFFMAN, ESQ. Supreme Court I.D. No.: 25488 Name of Law Firm: SERRATELLI, SCHIFFMAN & BROWN, PC Address: 2080 LINGLESTOWN ROAD, SUITE 201, HARRISBURG, PA 17110 ESTATE OF -.- a- ~. Y.- --, -1 ~; `-":r -~ ~~ W ~` HELEN T COOVER ,DECEASED No. 21-11-1292 PETITION FOR ADJUDICATION / STATEMENT OF PROPOSED DISTRIBUTION Telephone: (717) 540-9170 Fax: (717 540-5481 Form OC-01 rev. 10.13.06 Page 1 of 10 h~ Estate of HELEN T COOVER ,Deceased 1. Name(s) and address(es) of Petitioner(s): Name: VANCE C. COOVER Address: PO BOX 84$ POCONO PINES, PA 18350 Identify any executors or administrators who have not joined in the Petition for Adjudication and Statement of Proposed Distribution and state reason: N/A Is this the first accounting by this fiduciary? ..................... Yes ~ No If not, identify prior accountings, the accounting periods covered, and the date of adjudication of the prior accounting. 2. Decedent died on OCTOBER 17, 2011 Letters Testamentary or ~ Letters of Administration were granted to Petitioner(s) on DECEMBER 5.2011 Date of Will (if applicable): TITNF. 1 ~ ~nn1 Date(s) of Codicil(s) (if applicable): N/A Date of probate (if different from date Letters granted): N/A Was a bond required? ~YYes /® No If yes, state amount: Are proofs of advertising of the grant of Letters attached? ......... Yes ~ No Dates of advertising of the grant of Letters: THE SENTINEL-Feb. 3. 10. 17.2012 & THE CUMBERLAND LAW JOURNAL-Feb. 10, 17, 24, 2012 Form OC-01 rev. 10.13.06 Page 2 of 10 Estate of HELEN T COOVER Deceased 3 . Was decedent survived by a spouse? ............................. Yes No If yes, name of the surviving spouse: 4. Has the surviving spouse filed to take an elective share? ............. Yes No (See Section 2201 et sue. of the Probate, Estates and Fiduciaries Code) If yes, date of election: 5. In the case of an intestacy, state the names of the decedent's surviving children or surviving issue of deceased children (if none, so state): 6. Did decedent marry after execution of Will or Codicil(s)? ........... Yes No Were any children born to decedent after execution of Will or Codicil(s)? ........................................... Yes No If yes, give names and dates of birth: Name: Date of Birth: 7. If required by the Medical Assistance Estate Recovery Act, 62 P.S. § 1412, was a request for a statement of claim sent to the Department of Public Welfare? .............................. ~ Yes ~ No Form OC-01 rev. 10.13.06 Page 3 of 10 Estate of HELEN T COOVER Deceased 8. Written notice of the Audit as required by Pa. O.C. Rules 6.3, 6.7 and 6.8 has been or will be given to all parties in interest listed in item 9 below, all unpaid creditors and all claimants listed in item 10 below. In addition, notice of any questions requiring Adjudication as discussed in item 14 below has been or will be given to all persons affected thereby. A. If Notice has been given, attach a copy of the Notice as well as a list of the names and addresses of the parties receiving such Notice. B. If Notice is yet to be given, a copy of the Notice as well as a list of the names and addresses of the parties receiving such Notice shall be submitted at the Audit together with a statement executed by a Petitioner or counsel certifying that such notice has been given. C. If any person entitled to Notice is not sui juris (e.g., minors or incapacitated persons), Notice of the Audit has been or will be given to the appropriate representative on such party's behalf as required by Pa. O.C. Rule 5.2. D. If any charitable interest is involved, Notice of the Audit has been or will also be given to the Attorney General as required under Pa. O.C. Rule 5.5. In addition, the Attorney General's clearance certificate (or proof of service of Notice and a copy of such Notice) must be submitted herewith or at the Audit. 9. List all parties (charitable and non-charitable) of whom Petitioner(s) has/have notice or knowledge, having or claiming any interest in the estate as beneficiaries under the Will or Codicil(s) or as intestate heirs if there is a complete or partial intestacy: A. State each party's relationship to the decedent and the nature of each party's interest(s): Name and Address ofEach Party in Interest ~ Relationship and Comments, if any ~ Interest VANCE C. COOVER PO BOX 845 POCONO PINES, PA 18350 Son-Residuary None-Insolvent Beneficiary Estate ABIGAIL HUME (COOVER) 408 CLASSON AVENUE BROOKLYN, NY 1123 8 Granddaughter- None-Insolvent Specific Bequest Estate Form OC-01 rev. 10.13.06 Page 4 of 10 Estate of HELEN T COOVER Deceased Name and Address of Each Party in Interest ~ Relationship and Comments, if any ~ Interest LOIS KELLER Friend-Specific None-Insolvent 820 LISBURN ROAD Bequest Estate APT. 704 CAMP HILL, PA 17011 NOTE: THE TRUST NAMED Helen T. Coover Trust None-Never Funded IN THE WILL AS 50% RESIDUARY BENEFICARY WAS NEVER FUNDED B. Identify each party who is not sui juris (e.g., minors or incapacitated persons). For each such party, give date of birth, the name of each Guardian and how each Guardian was appointed. If no Guardian has been appointed, identify the next of kin of such party, giving the name, address and relationship of each. C. State why a Petition for Guardian/Trustee Ad Litem has or has not been filed for this Audit (see Pa. O. C. Rule 12.4). D. If distribution is to be made to the personal representative of a deceased party, state date of death, date and place of grant of Letters and type of Letters granted. Form OC-O1 rev. 10.13.06 Page 5 of 10 Estate of HELEN T COOVER Deceased 10. Other than the claim for the family exemption, list the names of all known claimants and the amount of their claims and state whether each claim is admitted. Name and Address of Each Claimant Amount of Claim Claim Will Claim Admitted? Be Paid In Full? SEE ATTACHED Yes Yes No ~ No Yes ~ Yes No No Yes Yes No No Yes Yes No No If the estate is insolvent, attach a schedule setting forth the order of preference under 20 Pa.C.S. § 3392 and the proposed payments. 11. Was family exemption claimed? ................................ Yes No Was family exemption allowed? ................................ Yes No Family exemption claimant's name and relationship: Name: Relationship: Form OC-01 rev. 10.13.06 Page 6 of 10 #10 Name & Address of Claimant Amount of Claim Claim Will Claim Admitted Be Paid in Full Vance C. Coover, Jr. $500.00 Yes Yes PO Box 845 Pocono Pines, PA 18350 Lacy Hayes, Esq. 2550.00 Yes Yes 2216 Walnut Street Harrisburg, PA 17103 Steven Schiffman, Esq. 2500.00 Yes Yes SERRATELLI, SCHIFFMAN & BROWN 2080 Linglestown Rd., Suite 201 Harrisburg, PA 17110 Pennsylvania Department of $75,078.70 Yes No Public Welfare Recovery Section PO Box 8486 Harrisburg, PA 17105-8486 ATTN: Nicole L. Lipscomb TPL Program Investigator Messiah Village $47,779.58 Yes No 100 Mount Allen Drive Mechanicsburg, PA 17055 ATTN: Vonnie Hinds Estate of HELEN T COOVER Deceased 12. The amount of Pennsylvania Transfer Inheritance Tax and additional Pennsylvania Estate Tax paid, the date(s) of payment(s), and the interest(s) upon which paid, are as follows: Date Payment Interest NONE-INSOLVENT 13. On the date of death, was the decedent a fiduciary (personal representative, trustee, guardian, agent under power of attorney) or surety on the bond of a fiduciary? ................... ~ Yes ®/ No If yes, provide the name of the estate, indicate whether an account has been filed and confirmed absolutely and all awards performed, or, in the alternative, how the decedent's estate will be discharged for the decedent's fiduciary administration of the estate. 14. A. Describe in detail any questions requiring adjudication and state the position of the Petitioner(s) as to each question: B. Has notice of the question requiring adjudication been given to the parties identified in Paragraph 9 above? .................. Yes ~ No 15. If Petitioner(s) has/have knowledge that a share has been assigned, renounced, disclaimed or attached, provide a copy of the assignment, renunciation, disclaimer or attachment, together with any relevant supporting documentation. Form OC-01 rev. 10.13.06 Page 7 of 10 Estate of HELEN T COOVER Deceased 16. Had the decedent been adjudicated an incapacitated person? .......... Yes No If yes, attach a copy of the Order if available; otherwise state the Court, term, number, date, and name of Hearing Judge. 17. A. List or attach a separate list of additional receipts and disbursements since the closing date of the Account. NONE B. Has notice of the additional receipts and disbursements been given to the parties identified in Paragraph 9 above? ............. ~ Yes No 18. If a reserve is requested, state amount and purpose. Amount: Purpose: If a reserve is requested for counsel fees, has notice of the amount of fees to be paid from the reserve been given to the parties in interest? ........................................ Yes No If so, attach a copy of the notice. 19. Is the Court being asked to direct the filing of a Schedule of Distribution? .......................... Yes ~ No As to real estate only? ........................................ Yes No Form OC-01 rev. 10.13.06 Page 8 of 10 Estate of I-IELEN T COOVER Deceased V~herefore, your Petitioners} asks} that distribution be awarded to the parties entitled and suggests} that the distributive shares of income and principal (residuary shares being stated in proportions, not amounts) are as follows: A. Income: Proposed Distribietee(s) N/A B. Principal: Proposed Distributee(s) ALL TO CREDITORS Amount/Proportion INSOLVENT Amount/Proportion 100% Submitted By: (All petitioners must sign. Add additional lines if'necessary): Name of Pe 'oner: `IAN C. COOVER, JR. Name of Petitioner: I ornr oc-o~ rev. 10.13.06 Page 9 of 10 Estate of HELEN T COOVER ,Deceased Verification of Petitioner {Verification must be by at least one petitioner.) The undersigned hereby verifies * [that hei~he is trt~e~ of the above-named name of corporation andj that the facts set forth in the foregoing Petition for Adjudication /Statement of Proposed Distribution which are within the personal knowledge of the Petitioner are true, and as to facts based on the information of others, the Petitioner, after diligent inquiry, believes them to be true; and that any false statements herein are made subject to the penalties of 18 Pa. C.S. § 4904 {relating to unsrvorn falsification to authorities), e ,~ ~;,: ~~ r f, ~~ . ~~G/_/f % l Ct~ Zr Si~iature oi~P~titioner * Corporate petitioners must complete bracketed information. Certification of Counsel The undersigned counsel hereby certifies that the foregoing Petition for Adjudication/ Statement of Proposed Distribution is a true and accurate reproduction of the form Petition authorized by the Supreme Caurt, and that no changes to the form have been made beyond the responses herein. /~ Signature of C~i~isel for Petitioner Form OC-01 rev. 10.13.06 Page 10 of 10 PROPOSED SCHEDULE OF DISTRIBUTION Amount Available for Distribution: Class 1 Creditors - Costs of Administration 1. Sovereign Bank (Balance Request) 2. Cumberland Law Journal (Estate Ad) 3. The Sentinel (Estate Ad) 4. Register of Wills (Inheritance Tax Filing Fee) 5. Register of Wills (Probate Fee) 6. Register of Wills (Estimated Audit Filing Fee) 7. Vance Coover (Executor Fee) 8. Lacy Hayes (Attorney Fees) 9. Steven Schiffman (Attorney Fees) Class 2 Creditors - Famil~emption NONE $ 46,411.28 20.00 (Cost Advanced) 75.00 (Cost Advanced) 83.34 (Cost Advanced) 15.00 (Cost Advanced) 153.50 (Cost Advanced) 150.00 500.00 2550.00 2500.00 6046.84 Class 3 Creditors -The costs of decedent's funeral and burial• and the costs of medicines furnished to him within six months of his death, of medical and nursing services performed for him within that time, of hospital services including maintenance provided him within that time, and of services performed for him b~any of his employees within that time. 1. Messiah Village: 9,306.18 2. Pa Department of Public Welfare: 20,981.33 Class 4 Creditors -Cost of a gravemarker NONE Class 5 Creditors -Rents for the occupancy of the decedent's residence for six months immediatelyprior to his death. NONE Class 5.1 Creditors -Claims by the Commonwealth and its political subdivisions of the Commonwealth. 1. Pa Department of Public Welfare: 10,076.93 (Total - $54,097.37) Class 6 Creditors -All other claims. Available for Remaining Creditors -0- No. 8 -Notice Attachment The attached notice is being mailed as an attachment to the Petition and is being mailed to the following parties: Vance C. Coover PO Box 845 Pocono Pines, PA 18360 Abigail Hume 408 Classon Avenue Brooklyn, NY 11238 Lois Keller 820 Lisburn Road Apt. 704 Camp Hill, PA 17011 Lacy Hayes, Esq. 2216 Walnut Street Harrisburg, PA 17103 Pennsylvania Department of Public Welfare Recovery Section PO Box 8486 Harrisburg, PA 17105-8486 ATTN: Nicole L. Lipscomb TPL Program Investigator Messiah Village 100 Mount Allen Drive Mechanicsburg, PA 17055 ATTN: Vonnie Hinds ~~~ SERRATELLI SCHIFFMAN & BROWN p.~. TO: Interested Parties of the Estate of Helen T. Coover LORI K. SERRATELLI FROM: Steven ). Schiffman, Esq. STEVEN J. SCHIFFMAN ~> MICHAEL F. BROWN RE: Petition for Audit, Court A counting and Schedule of Proposed Distribution JOHN D. SHERIDAN' F.R. MARTSOLF DATE: August 21, 2012 CARA A. BOYANOWSKI This is to advise you that Vance C. Coover, Jr., Executor of the Estate Of Helen T. PAIGE MACDONALD-MATTHES MERRITT C. REITZEL COOVer, has filed the Petition for Audit, Final Account and Proposed Schedule Of JENI S. MADDEN Distribution with the Clerk for Audit. Copies of these documents are enclosed for your GARTH A. STEPHENSON review. of counsel (MD & DC bars only) The account will be presented for audit and confirmation at the Office of the SPERO T. LAPPAS of counsel Register of Wills, Cumberland County Courthouse, Carlisle, Pennsylvania on October 9, NEIL E. HENDERSHOT of counsel 2012 at 9:00 a.m. Any objections to the Account and Proposed Schedule of Distribution ADMITTED IN PA & NJ shall be filed no later than 9:00 a.m. on October 9, 2012. 2080 LINGLESTOWN RD. STE 201 HARRISBURG, PA 17110-g670 tel 717.54o.g17o fax 717.540.5481 WWW. SSBC-LAW. COM Thank you for your attention. IN RE: ESTATE OF : IN THE COURT OF COMMON PLEAS HELEN T. COOVER, :CUMBERLAND COUNTY, PENNSYLVANIA Deceased :ORPHANS' COURT DIVISION No. 21-1 1-1292 RULE 6.3 CERTIFICATION I, Steven J. Schiffman, Esquire, do hereby certify that the requirements of Rule 6.3 regarding notice have been met in the above ,:captioned matter. Dated: ~ ~ (~' w ~Z C~ ~~ r ~~ 1tY ' P ``~ S EVEN J. F~'~ FMAN, ESQ. PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland Tackie Cox, Sales Director, of The Sentinel, of the County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a newspaper of general circulation in the Borough of Carlisle, County and State aforesaid, was established December 13th, 1881, since which date THE SENTINEL has been regularly issued in said County, and that the printed notice or publication attached hereto is exactly the same as was printed and published in the regular editions and issues of THE SENTINEL on the following day(s): February 3,10 & 17, 2012 COPY OF NOTICE OF PUBLICATION NOTICE ESTATE OF HELEN T. COOVER, late of Cumberland County, Pennsylvania (died October 17, 20.11). Vance C. Coover, Jr., P.O. Box 845, Pocono Affiant further deposes that he/she is not Pines, PA 18350, Executor. Steven J. Schiffman, Esquire, SERRATELLI, SCHIF"FMAN & BROWN, P.C., 2080 Linglestown Road, Suite 201, interested in the subject matter of the Harrisburg, PA 17110, Attorney. aforesaid notice or advertisement, and that all allegations in the foregoing statement as to time, place and character of publication are true. Sworn to and subscribed before me this 2DIL ~DW~~ Notary Public My commission expires: .¢r~..~._ _ ... ,.~ ~ ~. _ BAM~I ATv~ !-~"C~~:~d~~ i`~ Ieot~~~ y Put;'ic CAFiLiS! ~ FsOROUGi-r, Ci;i~~,^BFRL~',N~ CNTY ^n~.~ g. I~~V COr"ilfi"'iiS'$I`'i(1 CXi~li . v,, ... '~ ~ ~- 1y PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, viz: February 10, February 17, and February 24, 2012 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. ~~ ~-. t,~ Lisa arie Coyne, E for Coover, Helen T., deed. Late of Cumberland County. Executor: Vance C. Coover, Jr., P.O. Box 845, Pocono Pines, PA 18350. Attorneys: Steven J. Schiffman, Esquire, Serratelli, Schiffman & Brown, P.C., 2080 Linglestown Road, Suite 201, Harrisburg, PA 17110. SWORN TO AND SUBSCRIBED before me this 24 of February, 2012 Notary NOTARIAL SEAL pEBORAH A COLLINS Notary Public CARLISLE BOROUGH, CUMBERLANp COUNTY My Commission Expires Apr 28, 2014 NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE INHERITANCE TAx DIVISION OF DEDUCTIONS AND ASSESSMENT OF TAX PO BOX 280601 HARRISBURG PA 17128-0601 STEVEN J SCHIFFMAN STE 201 2080 LINGLESTOWN RD HARRISBURG PA 17110-9670 (1) .00 (2) .00 c3) .00 (4) .00 (5) 46,410.00 (6) .00 (7) .00 CUT ALONG THIS-LINE----_ --~ R_ETA_IN LOWER POR_TION_ FOR YOUR RECORDS ~--- _ _________ REV-1547 EX AFP t12-11) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF: CLOVER HELEN TFILE N0.:2I li-I292 ACN: 1('il DATE: (~~-lA-~nl~ TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED 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 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) pennsylvan~a 1. ~ ~ - DEPARTMENT OF REVENUE REV-1547 EX AFP (12-11) NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment. (8) 46,410.00 (q) 5,962.00 (10)_ 121,488.00 11 . Total Deductions ( 11 ) 127 , 450.0 0 12. Net Value of Tax Return (12) 81 , 040 . 00- 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .0 0 14. Net Value of Estate Subject to Tax (14) 81 , 040 . 00- NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) .0 0 X 00 = .0 0 16. Amount of Line 14 taxable at Lineal/Class A rate C16) .0 0 x 04 5 = .0 0 17. Amount of Line 14 at Sibling rate tl7i .0 0 X 12 = .0 U 18. Amount of Line 14 taxable at Collateral/Class B ra te C18) .0 0 X 15 = .0 0 19. Principal Tax Due (19)= .0 0 TAX CREDITS: PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID DATE 07-16-2012 ESTATE OF COOVER HELEN T DATE OF DEATH 10-17-2011 FILE NUMBER 21 11-1292 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 09-14-2012 (See reverse side unde~~ Objections ) Amount Remitted- MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SgUARE CARLISLE PA 17013 TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ~ IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YDU MAY BE DUE FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. LAST WILL AND TESTAMENT OF HELEN T. CQOVER -~ ~ ~.. ~ C~~~ t ~ ~' ~~: _ .. _. ~. c~ _ .~. ._ , ,'/ ~ J , Wk.~ ---~ ~""' ~, _ -~_, ~,1 ~ _" ~ -~-i .. ~; ~, r--°. --~-, I, HELEN T. COOVER, now a resident of Cumberland County, Pennsylvania, declare this to be my Last Will and Testament. I revoke all my Wills and Codicils that I may have made previously. Article I My Executor shall pay my just debts, and all expenses related to my last illness, my funeral, and the adnunistration of my estate, from the principal of my residuary estate as soon as may be done after my death. A ,d-;..io TT My Executor shall pay all inheritance, estate and succession taxes (including interest and penalties, if any, but not including any generation skipping tax) payable by reason of my death, out of the principal of my residuary estate, without reimbursement from any person. Article III I give my friend Lois Keller, of Lewisberry, PA, Five Thousand Dollars ($5,000.00). I give my granddaughter, Abigail Coover, Twenty Five Thousand Dollars ($25,000.00). I give, devise, and bequeath the rest of my estate as follows: 1. One-half of my property, I give to my son, Vance C. Coover, Jr., l~r stirpes. ,. ~- HTC Page 1 of 2 Pages 2. The balance of the rest, remainder and residue, to a trust known as The HELEN T. COOVER 2001 TRUST, which I created today. Article IV I nominate, constitute, and appoint my son, Vance C. Coover, Jr., Executor of my Last Will and Testament. In the event of his renunciation, death, resignation, or inability to act for any reason whatsoever as my Executor, I nominate, constitute, and appoint my granddaughter, Abigail Coover, to act as ~.y Executor. I hereby relieve my Executor, whether original, substitute, or successor, from the necessity of posting security or bond in connection with his/her duties as such in any jurisdiction in which he/she may be called upon to act so far as I am able by law to do so. My Executor shall receive reasonable compensation for services rendered to my estate. IN WITNESS V~JHEREOF, I have hereunder set my hand and seal to this my Last Will and Testament consisting of two typewritten pages; the first of which bears my initials in the margin for the purpose of better identification this ~~'~ day of _ ~ ~ ~ ~~ , 2001. .~-, -: i ~------` f`= .~ -~~t~~~~.•, ~ ~._ r.~ ~ ,;.~ ,,_. ~ -(SEAL) HELEN T. COOVER Page 2 of 2 Pages -. - _ ACKNOWLEDGEMENT Commonwealth of Pennsylvania ss: County of Dauphin I, HELEN T. COOVER, the testator, whose name is signed to the attached or foregoing i~~s~trument, having been duly qualified, according to law, do hereby acknowledge that I signed and executed the instrument as my Last 'Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn to and acknowledged before me by HELEN T. COOVER, the testator, this t ~~ day of ~,~.x'~ ~ , 2001. ,~ ,.~ -~ `a ~~ Notary Public My Commission Expires: Notarial Seal Lynda R. Cvufter, Natary Pubfic My Com~~n' Dauphin County Expires Dec. 13, 2004 SEAL AFFIDAVIT Commonwealth of Pennsylvania ss: County of ~~~Q ~(~ We, $~ ~ G ~ - L~f~ ~ and Lacy Hayes, Jr., the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the testator sign and execute the instrument as his Last Will, that the testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testator signed the will as a witness; and that to the best of our knowledge the testator was at that time 18 or mare years of age, of sound mind and under no constraint or undue influence. Sworn to and subscribed to More me by ~~ ~ and Lacy Hayes, Jr., witnesses, this day of , ,~ ~~~ , 2001. My Commission Expires: SEAL Notarial S~ai = _ _ ~, _ _, _ -___ _ . A:~wl..o w~i a 1-os-a2.~ Loma R. Goofier. Notary iPu~lic ~ _ " _- -- __ --_ =_ _ =- Harrisburg, Dauptifn County -. -- _ My Commission Expires Dec. 13, 2t}t}4 ~ _ --- ~ - _ -` ~- 1 ;~-~ ' . ~% lvotai'y Public COURT OF COMIYION PLEAS OF CUMBERLAND, PA ORPHANS' COURT DIVISION File No. 21-11-1292 FIRST INTERMEDIATE ACCOUNTIN G OF VANCE C. COOVER, JR., Executor For Estate of HELEN T. COOVER Signatures: Date of Death: October 17, 2011 Date of Incapacity, if any None Date of Appointment: December O5, 2011 Date of First Complete Advertisement February 17, 2012 Accounting for the Period: October 17, 2011 to July 24, 2012 Purpose of Account: The above fiduciary offers this account to acquaint interested parties with the transactions that have occurred during his/her administration. It is important that the account be carefully examined. Requests far additional information, or questions, or objections, can be discussed with: SERRATELLI, SCHIFFMAN & BROWN, PC 2080 LINGLESTOWN ROAD, SUITE 201 HARRISBURG, PA 17110 STEVEN J SCHIFFMAN, ESQ. (717)540-9170 Supreme Co~rt,~.D. No. 254$ } t` SW ~ +T ~~ l r~ (... '... ~. i.....^. ~~ ~~yy ~_ r,,, ~i ~ ... . `n ~ .~ ~) Estate of HELEN T. COOVER Summary of Account Principal Receipts Net Gain on Sales or Other Dispositions Less Disbursements: Balance Before Distributions Less Distributions to Beneficiaries Total Principal Balance On Hand For Information: Investments Made Unpaid Expenses Unrealized Gains and Losses Income Receipts Net Gain on Sales or Other Dispositions Less Disbursements: Balance Before Distributions Less Distributions to Beneficiaries Total Income Balance on Hand For Information: Investments Made Unpaid Expenses Unrealized Gains and Losses Verification Combined Balance on Hand Page 2 $ 46,410.09 3 0.00 $ 46,410.09 4 0.00 5 6 $ 46,410.09 0.00 $ 0.00 $ 46,410.09 7 8 10 11 12 13 14 15 16 17 18 $ 1.19 0.00 $ 1.19 0.00 $ 0.00 $ 1.19 $ 46,411.28 $ 1.19 0.00 Estate of HELEN T. COOVER Receipts of Principal Inventory Value Cash and Cash Equivalents 10/17/2011 SOVEREIGN BANK CHECK ACCOUNT #0771024487 $ 46,022.07 Total Cash and Cash Equivalents Total Inventory Receipts Subsequent to Inventory 01/18/2012 CAPITAL BLUE CROSS (REFUND) Total Receipts Subsequent to Inventory Total Receipts of Principal Page 1 $ 388.02 $ 46,022.07 $ 46,022.07 $ 388.02 $ 46,410.09 (2) Estate of HELEN T. COOVER Gains and Losses on Sales or Other Dispositions of Principal Net Gain Net Loss No Gain or Loss $ 0.00 Page 1 (3) Estate of HELEN T. COOVER Disbursements of Principal Date Paid Total Disbursements of Principal Page 1 Amount Paid (4) $ 0.00 Estate of HELEN T. COOVER Distributions of Principal to Beneficiaries Distribution Value Total Distributions of Principal $ 0.00 Page 1 (5) Estate of HELEN T. COOVER Principal Balance On Hand Inventory Value Page 1 Cash and Cash Equivalents CAPITAL BLUE CROSS (REFUND) SOVEREIGN BANK CHECK ACCOUNT #0771024487 Total Cash and Cash Equivalents Total Balance on Hand 388.02 46,022.07 $ 46,410.09 $ 46,410.09 (6) Estate of HELEN T. COOVER Information Schedules -Principal Inventory Value Exchanges and Stock Distributions Personal Property (The decedent lived in a nursing home at the time of death and her personal property did not warrant the cost of an appraisal and the property was donated to charity) 10/17/2011 Received $ 0.00 Page 1 (7) Estate of HELEN T. COOVER Unpaid Principal Expenses REGISTER OF WILLS (INHERITANCE TAX FILING FEE) Total REGISTER OF WILLS (INHERITANCE TAX FILING FEE) CUMBERLAND COUNTY REGISTER OF WILLS (ESTIMATED ACCOUNTING FEE) Total CUMBERLAND COUNTY REGISTER OF WILLS (ESTIMATED ACCOUNTING FEE) CUMBERLAND LAW JOURNAL (Estate Advertisement) Total CUMBERLAND LAW JOURNAL (Estate Advertisement) DEPARTMENT OF PUBLIC WELFARE (MEDICAL ASSISTANCE RESTITUTION) Total DEPARTMENT OF PUBLIC WELFARE (MEDICAL ASSISTANCE RESTITUTION) LACY HAVES, JR. ESQ. (Previous Estate Attorney) $ 15.00 $ 15.00 $ 100.00 $ 100.00 $ 75.00 $ 75.00 $ 75,078.70 $ 75,078.70 $ 2,550.00 Page 1 (8) Unpaid Principal Expenses (Continued) LACY HAVES, JR. ESQ. (Previous Estate Attorney) Total LACY HAVES, JR. ESQ. $ 2,550.00 (Previous Estate Attorney) MESSIAH VILLAGE $ 46,408.55 Total MESSIAH VILLAGE $ 46,408.55 REGISTER OF WILLS (PROBATE FEE) $ 153.50 Total REGISTER OF WILLS $ 153.50 (PROBATE FEE) SERRATELLI, SCHIFFMAN & BROWN, PC $ 2,500.00 Total SERRATELLI, $ 2,500.00 SCHIFFMAN & BROWN, PC THE SENTINEL (Estate Publication) $ 83.34 Total THE SENTINEL $ 83.34 (Estate Publication) VANCE C. COOVER, JR. $ 500.00 Total VANCE C. COOVER, JR. $ 500.00 Total $ 127,464.09 Total Unpaid Expenses $ 127,464.09 Page 2 (9) Estate of HELEN T. COOVER Principal Unrealized Gains and Losses Market Value Inventory Value Gain or (Loss) Total Page 1 $ 0.00 $ 0.00 $ 0.00 (10) Estate of HELEN T. COOVER Receipts of Income Income Collected SOVEREIGN BANK CHECK ACCOUNT #0771024487 06/26/2012 Interest from date of death $ 1.19 until 6/26/2012 Total Income Collected Total Income Received Page 1 $ 1.19 $ 1.19 $ 1.19 (11) Estate of HELEN T. COOVER Gains and Losses on Sales or Other Dispositions of Income Net Gain Net Loss Page 1 No Gain or Loss 0.00 (12) Estate of HELEN T. COOVER Disbursements of Income Date Paid Amount Paid Total Disbursements of Income Page 1 0.00 (13) Estate of HELEN T. COOVER Distributions of Income to Beneficiaries Distribution Value Total Distributions of Income $ 0.00 Page 1 (14) Estate of HELEN T. COOVER Income Balance On Hand Inventory Value Page 1 Cash and Cash Equivalents SOVEREIGN BANK CHECK ACCOUNT #0771024487 Total Cash and Cash Equivalents Total Balance on Hand 1.19 $ 1.19 $ 1.19 (15} Estate of HELEN T. COOVER Information Schedules -Income Inventory Value Exchanges and Stock Distributions Page 1 (16) Estate of HELEN T. COOVER Income Unrealized Gains and Losses Total Page 1 Market Value 0.00 Inventory Value $ 0.00 Gain or (Loss) $ 0.00 (17) Estate of HELEN T. COOVER VERIFICATION VANCE C. COOVER, JR., Executor of HELEN T. COOVER, hereby declares under oath that said executor has fully and faithfully discharged the duties of their office; that the foregoing First and Intermediate Account is true and correct and fully discloses all significant transactions occurring during the accounting period; that all known claims against the Estate have been paid in full; that to their knowledge there are no claims now outstanding against the Estate; and that all taxes presently due from the Estate have been paid; and that the grant of Letters Testamentary and the first complete advertisement thereof occured more than four months before the filing of the foregoing First and Intermediate Account. This statement is made subject to the penalties of 18 Pa. C.S.A. Section 4904 rel to unsworn falsification to authorities. ~ ~~~ V CE C. COOVER, JR. Dated: ~ j er ~ ~~"