Loading...
HomeMy WebLinkAbout09-07-127h5;7r~ ~~ DECEDENT'S ESTATE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF FLORENCE M. FASICK ,DECEASED 21-12-0271 No c~ ~T=~ ~, . /'"1, g-..S 4 ~~ _ ~, T.i ~ t ~'.~ ' 1 ~ t ~ ~. ~ ~ PETITION FOR ADJUDICATION / r--1 .. _ '`'' ~ `= ^ STATEMENT OF PROPOSED DISTRIBUTION ~,; ~. _ ~' ~ _ =_= ` ~~ PURSUANT TO Pa. O.C. Rule 6.9 , ~~ =~~ ~ `~ ~-~ cxx~ 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: James D. Bogar, Esquire Supreme Court I.D. No.: 19475 Name of Law Firm: James D. Bogar Law Offices Address: One West Main Street, Shiremanstown, PA 17011 Telephone: (717) 737-8761 Fax: (717) 737 2086 - FoYm oc-o~ re~~. ro.~3.06 Page 1 of 10 Estate of FLORENCE M. FASICK 1. Name(s) and address(es) of Petitioner(s): Name: James D. Bogar Addy-ess: One West Main Street Shiremanstown, PA 17011 Deceased 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 February 27, 2012 Q Letters Testamentary or Q Letters of Administration were granted to Petitioner(s) on March 2. 2012 Date of Will (f applicable): August 5, 2011 Date(s) of Codicil(s) (f applicable): N/A Date of probate (if different from date Letters granted): Was a bond required? DYes ~ 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: Cumberland Law Journal and Central Penn Business Journal 3/9/12; 3/16/12 & 3/23/12 Form OG01 rev. 10.13.06 Page 2 Of 10 Estate of FLORENCE M. FASICK Deceased 3. Was decedent survived by a spouse? ............................. Q Yes ~ No If yes, name of the surviving spouse: 4. Has the surviving spouse filed to take an elective share? ............. Yes o (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 (f 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? .............................. /0 Yes 0 No Form OC-O1 rev. 10.13.06 Page 3 Of 10 Estate of FLORENCE M. FASICK 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: Fo,~m oc-ol rev. ~0.~3.06 Page 4 of 10 A. State each party's relationship to the decedent and the nature of each party's interest(s): Estate of FLORENCE M. FASICK ,Deceased 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. N/A 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). N/A 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. N/A Fo,_m oc-ol Ye,~.10.13.06 Page 5 of 10 Estate of FLORENCE M. FASICK ,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 Admitted? Will Claim Be Paid In Full? None Yes Q Yes ~No ~ No Yes Q Yes ~No ~ No ^Yes ^Yes ONo Q No DYes Q Yes ONo Q 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? ................................ DYes ©/ No Was family exemption allowed? ................................ ^Yes ^No Family exemption claimant's name and relationship: Name: Relationship: Fof-m oc-ol rer. l 0.13.06 Page 6 of 10 Estate of FLORENCE M. FASICK 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 May 23, 2012 50,803.44 0.00 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 0 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-O1 re~~. 10.13.06 Page 7 Of 10 Estate of FLORENCE M. FASICK Deceased 16. Had the decedent been adjudicated an incapacitated person? .......... 0 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. B. Has notice of the additional receipts and disbursements been __ . given to the parties identified in Paragraph 9 above? ............. Dyes _ No 18. If a reserve is requested, state amount and purpose. 4,500.00 Amount: Purpose: Costs to conclude administration of Estate, including preparation and filing of final 2012 personal income tax returns, federal and state fiduciary income tax returns, filing of First and Final Account and Statement of Proposed Distribution 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? ........................................ DYes ^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 0/ No Y As to real estate only? ........................................ Q es No Form OC-O1 rev. 10.13.06 Page 8 Of 10 Estate of FLORENCE M. FASICK ,Deceased Wherefore, your Petitioner(s) ask(s) that distribution be awarded to the parties entitled and suggest(s) that the distributive shares of income and principal (residuary shares being stated in proportions, not amounts) are as follows: A. Income: Proposed Distributee(s) Amount/Proportion Please see attached list. B. Principal: Proposed Disd•ibutee(s) Amount/Proportion Please see attached list. Submitted By: (All petitioners must sign. Add additional lines f necessary): .-~ ~~. <; `Name f Petitioner: a s D. Bogar, Executor Name of Petitioner: Form OC-01 rev. 10.13.06 Page 9 Of 1 Estate of FLORENCE M. FASICK Verification of Petitioner (Verification must be by at least one petitioner.) The undersigned hereby verifies * [that he~she of the above-named name of torpor-anon and] 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 unsworn falsification to authorities). 1S title Deceased ,- Sign ture of Petitio er * 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 Court, and that no changes to the form have been made beyond the responses herein. ' `~ 1 1 1 ~t~j g Signature of Counse~fo Petitioner e Form oc-ol rein. 10.13.06 Page 10 of 10 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: March 9, March 16, and March 23, 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. ie Coyne, Edi Fasick, Florence M., deed. Late of Lower Allen Township. Executor: James D. Bogar, One West Main Street, Shiremans- town, PA 17011. Attorney: None. SWOR~TO AND SUBSCRIBED before me this 23 of March, 2012 Notary NOTARIAL SEAL DEBORAH A COLLINS Notary Public CARLISLE BOROUGH, CUMBERLAND COUNTY My Commission Expires Apr 28, 2014 W,. ,.. _..,_.,....~,,.~.~~,a..~~,....~... THE CENTRAL PENN BUSINESS JOURNAL Proof of Publication Under the Pennsylvania Newspaper Advertising Act 45 Pa.C.S. § 101, et seq. Commonwealth of Pennsylvania } ss} County of Dauphin } Jerome Zany, being duly sworn according to law, deposes and says: That he is the Accountant of and duly authorized agent for JOURNAL PUBLICATIONS INC., a corporation organized and existing under the laws of the Commonwealth of Pennsylvania, with its principal office and place of business at 1500 Paxton Street, in the city of Harrisburg, County of Dauphin, State of Pennsylvania; that the THE CENTRAL PENN BUSINESS JOURNAL, a newspaper of general circulation distributed and circulated in Dauphin, Cumberland, Lancaster, Lebanon and York counties , is published by the said JOURNAL PUBLICATIONS INC. at 1500 Paxton Street, in the City, County and State aforesaid; and that THE CENTRAL PF,NN BUSINESS JOURNAL was established September 9th, 1984 and has been continually published ever since; That the printed notice or publication which is securely attached hereto is exactly as printed and published in the weekly editions/issues of the CENTRAL PENN BUSINESS JOURNAL which appeared on the 9th, 16th and 23rd day(s) of March 2012. That neither he nor said Corporation is interested in the subject matter of said printed notice or advertising, and that all of the allegations of this statement as to the time, place and character of publication are true; and This is a statement published by JOURNAL PUBLICATIONS INC. PUBLICATION '~'7N-(~ `I COPY ! Jerome ry EXECUTRIX'S NOTICE ESTATE OF FLORENCE M. FASICK Sworn to and subscribed before me thi day of 201? A.D. Letters Testamentary on the Estate of Florence M. Fasick, late of Lower Allen Township, Cumberland County, Pennsylvania, have been granted to the undersigned. All persons knowing NOTARY PU IC themselves to be indebted to said Estate are requested to make immediate payment, COMANONV1IEAi~T'H ®F PENNSYLVANIA and those having claims will present them, without delay, for settlement to: NOTARIAL SEAL DONNA SCHANKWEILER, Notary Public James D. Bogar, Executor ~ Cety ®f Harrisburg, Daupfiin Cowry One West Main Street ~ ~Y Commission Expires October 03, 2012 Shiremanstown, PA 17011 Publisher's Receipt for Advertising Cost JOURNAL PUBLICATIONS INC., publisher of the CENTRAL PENN BUSINESS JOURNAL, newspaper of general circulation, distributed and circulated in Dauphin, Cumberland, Lancaster, Lebanon and York counties, hereby acknowledges receipt of the aforesaid notice and publication costs and certifies that the same have been duly paid. THE CENTRAL PENN BUSINESS JOURNAL Re: ESTATE OF FLORENCE M. FASICK By Law Offices of James D. Bogar One West Main Street Shiremanstown, PA 17011 Attention: James D. Boar, Esquire Petition for Adjudication (Continued) 9. A. Name and Address Relationship Interest Virginia Bone Friend Specific 126 Clearview Drive Bequest - Camp Hill, PA 17011 $5,000.00 Marianna Davis Sister-in-law Specific 2300 Dulaney Valley Road Bequest - Apt. 0004 $10,000.00 Timonium, MD 21093 Marcia M. Montgomery Friend Specific 6 Redwood Court Bequest - Camp Hill, PA 17011 $10,000.00 Bethesda Mission Charity 50 of Rest, 611 Reilly Street Residue and Harrisburg, PA 17102 Remainder Elizabethtown College Charity 10% of Rest, One Alpha Drive Residue and Elizabethtown, PA 17022 Remainder Nursing Foundation of Charity 350 of Rest, Pennsylvania Residue and 2578 Interstate Drive Remainder Suite 101 Harrisburg, PA 17110 Peter Montgomery Friend 500 of Rest, 660 Bamberger Road Residue and Etters, PA 17339 Remainder Proposed Distributions (Includes Principal and Income Virginia Bone $ 5,000.00 specific bequest Marianna Davis $10,000.00 specific bequest Marcia M. Montgomery $10,000.00 specific bequest Bethesda Mission $33,671.32 Elizabethtown College $67,342.65 Nursing Foundation of Pennsylvania $235,699.25 Peter Montgomery $285,909.78 ~~-~~~ ~y In the Court of Common Pleas of Cumberland County, Pennsylvania Orphans' Court Division File No. 21-12-0271 Estate of Florence M. Fasick, Deceased Late of Lower Allen Township FIRST AND FINAL ACCOUNT AND STATEMENT OF PROPOSED DISTRIBUTION James D. Bogar, Executor Date of Death: Date of Executor's Appointment: Date of First Complete Advertisement: Accounting for the period: 02/27/2012 03/02/2012 Cumberland Law Journal 3/9/12; 3/18/12; 3/23/12 Central Penn Business Journal 3/9/12; 3/18/12; 3/23/12 02/27/2012 to 09/07/2012 Purpose of Account: James D. Bogar, Executor, offers this Account to acquaint interested parties with the transactions that have occurred during the Administration. It is important that the Account be carefully examined. Requests for additional information or questions or objections can be discussed with: James D. Bogar Bogar & Hipp Law Offices One West Main Street Shiremanstown, PA 17011 (717) 737-8761 .- ~~ ~~, ' _ .~-, ~--~-, J Su reme Court I.D. No. 19475 p _~ ~ -r: ~' , ~``~ : ~ =~ -! ~..... , ~ f ~" " .~ ~ „~ "-~ ~; _~.~ --,- ,:_~. .~A.l . l -- ~~r.. ~~ O ~~ SUMMARY OF ACCOUNT Estate of Florence M. Fasick, Deceased For the perinrl of Fphr~~arv ~ , 2012 through September 7, 2012 Current PAGES Value Proposed Distributions to Beneficiaries 7 PRINCIPAL Receipts: This Account Net Gain (or Loss) on Sales or Other Dispositions 1 2 758,277.38 Less Disbursements: Debts of Decedent Funeral Expenses Administration Expenses Federal, State & Local Taxes Commissions Fees Family Exemption Balance Before Distributions Transfer to (from) Principal Distributions to Beneficiaries Principal Balance on Hand For Information: Investments Made Changes in Holdings INC ME Receipts This Account Net Gain (or Loss) on Sales or Other Dispositions Less Disbursements Balance Before Distributions Transfer to (from) Income Distributions to Beneficiaries Income Balance on Hand For Information: Investments Made Changes in Holdings COMBINED BALANCE ON HAND 0.00 3 293.20 3 16,263.70 4 50,803.44 0.00 4 44,500.00 0.00 5 Fiduciary Acquisition Value 647,623.00 755,778.44 2,498.94 111,860.34 646,417.04 0.00 275.00 646,142.04 6 1,480.96 0.00 1,480.96 0.00 1,480.96 0.00 0.00 1,480.96 647,623.00 SCHEDULE A RECEIPTS OF PRINCIPAL Assets Listed in Inventory Fiduciary (Valued as of Date of Death) Acquisition Value Cash Cash 100.00 Metro Bank -Certificate of Deposit No. 7700174718. 91,081.36 Principal balance at date of death $90,986.63; accrued interest $94.73 PNC Bank -Certificate of Deposit No. 31600214329. 109,792.74 Principal balance as of date of death $109,587.34; accrued interest $205.40 PNC Bank -Checking Account No. 5140159833. 35,789.02 Principal balance at date of death $35,789.02 PNC Bank -Savings Account No. 5112502294. 28,112.80 Principal balance at date of death $28,112.80 PNC Investments -Account No. 005-637645. 434,592.16 Sovereign Bank -Certificate of Deposit No. 39,214.26 2335548638. Principal balance at date of death $39,131.33; accrued interest $82.93 Mutual of America -Annuity payment 136.52 Office of Personnel Management -pension payment 955.58 Social Security 1,036.00 Erie Insurance -Premium Refund 7.00 U.S. Treasury - 2011 Personal Income Tax Refund 614.00 Asbury Communities, Inc. -refund of overpayment 4,650.00 Total Cash Personal Property 746,081.44 ~: Personal Property -Property transferred in kind to 275.00 Peter Montgomery -per appraisal Personal Property -sold at auction 9,422.00 Total Personal Property 9,697.00 Total Receipts 755,778.44 Total Receipts of Principal 755,77s.44 -1- SCHEDULE B GAINS AND LOSSES ON SALES OR OTHER DISPOSITIONS -PRINCIPAL in 02/28/2012 Metro Bank -Certificate of Deposit No. 7700174718. Principal balance at date of death $90,986.63; accrued interest $94.73 Net Proceeds 91,109.01 Fiduciary Acquisition Value -91,081.36 27.65 02/28/2012 PNC Bank -Certificate of Deposit No. 31600214329. Principal balance as of date of death $109,587.34; accrued interest $205.40 Net Proceeds 109,895.44 Fiduciary Acquisition Value -109,792.74 102.70 02/28/2012 PNC Investments -Account No. 005-637645. Net Proceeds 436,939.98 Fiduciary Acquisition Value -434,592.16 2,347.82 02/28/2012 Sovereign Bank -Certificate of Deposit No. 2335548638. Principal balance at date of death $39,131.33; accrued interest $82.93 Net Proceeds 39,235.03 Fiduciary Acquisition Value -39,214.26 20.77 TOTAL GAINS AND LOSSES/PRINCIPAL LESS LOSS NET GAIN OR LOSS Loss 2,498.94 2,498.94 -2- SCHEDULE C DISBURSEMENTS OF PRINCIPAL Funeral Ex ep nses 03/21/2012 Neill Funeral Home -balance of funeral bill Total Funeral Expenses Administration Ex enses 03/02/2012 Cumberland Law Journal -Executor's Notice 03/02/2012 Register of Wills -probate fee 03/02/2012 Sovereign Bank -fee for date of death valuation 03/07/2012 Rowe's Auction Service -auctioneer's commission and trash removal fee 03/20/2012 Bethany Village -final bill 03/20/2012 Omnicare 03/27/2012 H8~R Block -tax preparation fee 04/03/2012 Journal Publications -Executor's Notice 04/11/2012 Mutual of America -reclamation of final annuity payment 05/10/2012 PA Department of Revenue - 2011 Personal Income Tax Due 05/23/2012 Register of Wills -additional probate fee 05/23/2012 Register of Wills -filing fee for PA Inheritance Tax Return and Inventory 07/12/2012 United States Treasury -Office of Personnel Management -Reclamation of final annuity payment 08!16/2012 Virtuox Inc. Lab -medical bill 'ISO BE PAID RESERVES: -Costs to conclude administration of Estate, including preparation and filing of final 2012 Personal Income Tax Returns, Federal and State Fiduciary Income Tax Returns, and First and Final Account and Statement of Proposed Distribution Total Miscellaneous Administrative Expenses 293.20 75.00 593.50 20.00 3,362.70 5,778.50 81.58 162.00 150.00 136.52 362.70 50.00 30.00 955.58 5.62 4,500.00 293.20 16,263.70 -3- 05/15/2012 'Ii0 BE PAID SCHEDULE C DISBURSEMENTS OF PRINCIPAL Continued Federal, State, and Local Taxes Register of Wills, Agent -Payment of PA Inheritance 50,803.44 Taxes at 5% discount Total Taxes Fees James D. Bogar, Esquire -Attorney fees for 44,500.00 representation of Estate per agreement Total Fees TOTAL DISBURSEMENTS OF PRINCIPAL -4- 50,803.44 44, 500.00 111,860.34 SCHEDULE D DISTRIBUTIONS OF PRINCIPAL 02/28/2012 Peter Montgomery -Personal property retained -per 275.00 appraisal 275.00 TOTAL DISTRIBUTIONS TO BENEFICIARIES 275.00 -5- SCHEDULE G RECEIPTS OF INCOME Metro Bank 07/31 /2012 Metro Bank 08/15/2012 Metro Bank -interest earned in Estate savings account through July 31, 2012 Metro Bank -interest earned in Estate checking account through August 15, 2012 TOTAL BANK INTEREST TOTAL RECEIPTS OF INCOME 1,465.61 1,465.61 15.35 15.35 1,480.96 1,480.96 -s- PROPOSED DISTRIBUTIONS TO BENEFICIARIES TO: Marcia Montgomery -Proposed Distribution (specific bequest) Marianna Davis -Proposed Distribution (specific bequest) Peter Montgomery -Proposed Distribution Virginia Bone -Proposed Distribution (specific bequest) TO: Bethesda Mission Bethesda Mission -Proposed Distribution TO: Elizabethtown College Elizabethtown College -Proposed Distribution TO: Nursing Foundation of Pennsylvania Nursing Foundation of Pennsylvania -Proposed Distribution Current Value Fiduciary 09/07/2012 Acquisition or as noted Value 10,000.00 10,000.00 285,909.78 5,000.00 310,909.78 33,671.32 33,671.32 67,342.65 67,342.65 235,699.25 235,699.25 Total 647,623.00 -7- In the Court of Common Pleas of Cumberland County, Pennsylvania Orphans' Court Division File No. 21-12-0271 Estate of Florence M. Fasick. Deceased Verification James D. Bogar, Executor under the Last Will and Testament of Florence M. Fasick, Deceased, hereby declares under oath that he/she has fully and faithfully discharged the duties of his/her office; that the foregoing 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 his/her knowledge, there are no claims now outstanding against the Estate; that all taxes presently due from the Estate have been paid; and that the grant of Letters Testamentary and the first complete advertisement thereof occurred more than four months before the foregoing Account. This statement is made subject to penalties of 18 Pa. C.S.A. Section 4904 relating to unsworn falsification to authorities. ~~ ii / ~~~ Dated : .t t `Z I ?-mot ~ ~ /'~~~,~(~: Jams D. Bogar, Exe,~u or '~