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HomeMy WebLinkAbout10-26-12~~~~~~~~ ,.~ ~ ~ -~-, DECEDENT'S ESTATE ~-Ti ~z~ ~ ~ ~~ `~ ~ ~-, ; ~ tf~ _ . s. „' f_~1 COURT OF COMMON PLEAS OF nc-~' ~ -~= ~ CUMBERLAND COUNTY PENNSYLVANIA ~ '_ ~~ F=` rn , -~ `,~ O ORPHANS' COURT DIVISION D ~ _'"'~ ESTATE OF Ruth E. Sheibley ,DECEASED No. 21-11-0220 PETITION FOR ADJUDICATION / STATEMENT OF PROPOSED DISTRIBUTION 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: Keith O. Brenneman Supreme Court I.D. No.: 47077 Name of Law Firm: Snelbaker & Brenneman, P.C. Address: 44 West Main Street, Mechanicsburg, PA 17055 Telephone: 717-697-8528 Fax: 717-697-7681 Form OC-0! rev. l0.13.06 Page 1 of 10 Estate of Ruth E. Sheibley Deceased 1. Name(s) and address(es) of Petitioner(s): Name: Kathleen Hoffman Address: 929 Bonny Lane Mechanicsburg, PA 17055 Identify any executors or administrators who have not joined in the Petition for Adjudication and Statement of Proposed Distribution and state reason: None 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 10, 2011 ® Letters Testamentary or Q Letters of Administration were granted to Petitioner(s) on February 18.2011 Date of Will (ifapplicabde): September 3, 2004 Date(s) of Codicil(s) (if applicable): N/A Date of probate (if different from date Letters granted): same ac ahnve Was a bond required? DYes ®No If yes, state amount: Are proofs of advertising of the grant of Letters attached? ......... m Yes ~ No Dates of advertising of the grant of Letters: Cumberland Law Journal, March 4, 1 I, 18, 2011 & The Sentinel, March 3, 10, 17, 2011 Form OC-01 rev. 10.13.06 Page 2 of 10 Estate of Ruth E. Sheibley ,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 (f none, so state): N/A 6. Did decedent marry after execution of Will or Codicil(s)? ........... ~ Yes m 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-0I rev. 10.13.06 Page 3 of 10 Estate of Ruth E. Sheibley 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 l4 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): and Address of Each Debra Ann Wheeler Daughter 29% of residue 1261 High Street Boiling Springs, PA 17007 Alicia K. Deardorff Granddaughter 29% of residue 8170 Evelyn Street (Issue of Daniel R. Hummelstown, PA 17036 Hoffman, Deceased) Form OC-Ot rev. 10.13.06 Page 4 of ] 0 Estate of Ruth E. Sheibley Deceased Name and Address o/'Each Parry in /nterest ~ Relationship and Comments, i(ony ~ Interest Kathleen Hoffman Daughter-In-Law 13% of residue 929 Bonny Lane Mechanicsburg, PA 17055 Milton K. Sheibley Son 29% of residue 1300 York Haven Road Lot 49 York Haven, PA 17370 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. None 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 Form OC-01 rev. /0.13.06 Page 5 of l 0 Estate of Ruth E. Sheibley Deceased 0. 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 Clatm Claim Wrl! Claim Admitted? Be Paid /n Full? None Yes ~ Yes ~No ®No Yes ~ Yes ~No ~ No Yes ~ Yes ~No 0 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? ................................ DYes ~No Was family exemption allowed? ................................ Yes ~No Family exemption claimant's name and relationship: Name.• Relationship: Form oc-o1 rev. 10.13.06 Page 6 of 10 Estate of Ruth E. Sheibley 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 4/26/ 11 390.00 3/15/2012 71.44 .78 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: N/A 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. N/A Form OC-01 rev. /0.13.06 Page 7 of 10 Estate of Ruth E. Sheibley 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. 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: SOO.OO rarpose: Filing fees, accountant fees and other miscellaneous costs associated with the administration of the Decedent's estate. 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 ONo As to real estate only? ........................................ Yes ~ No Form OC-0/ rev. /0.13.06 Page 8 of 10 Estate of Ruth E. Sheibley 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 See Accounting B. Principal: Proposed Distributee(sJ Amount/Proportion See Accounting Submitted By: (All petitioners must sign. Add additional lines if necessary): .. ee.~,~ Nam f Petitioner: Kathl offman Name of Petitioner: Form oc-oi rev. 10. /3.06 Page 9 of 10 Estate of Ruth E. Sheibley Verification of Petitioner (Verification must be by at least one petitioner.) Deceased The undersigned hereby verifies * [that heishe she is t;rre Executrix of the above-named name ofcorporat;on Estate of Ruth E. Sheibley 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). Signature of Petitioner * 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. Signature of Counsel for Petitioner Form OC-01 rev. 10.!3.06 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, vlz: March 4 March 11 and March 18 2011 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. Marie Coyne, Sheibley, Rnth E., deed. Late of the Borough of Carlisle. Executrix: Kathleen Hoffman, 929 Bonny Lane, Mechanicsburg, PA 17055. Attorneys: Keith O. Brenneman, Esquire, 3nelbaker & Brenneman, P.C., 44 W. Main Street, P.O. Box 318, Mechanicsburg, PA 17055. SWORN TO AND SUBSCRIBED before me this 18 of March, 2011 Notary NOTARIAL S DEBORAH A COLLINS Notary Public CARLISLE BOROUGH, CUMBERLAND COUNTY My Commission Expires Apr 28, 2014 PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland Tac3rie C'ew4 ~a1 Seies Manager of The Sentinel, of the County and State aforesaid, ~g sum, dep~es and says that THE SENTINEL, a newspaper of general circnlatiQn m the of Cazlisle, County and State aforesaid, was.established December 13,1882, ~ which date THE SENTINEL has been regularly issued in said County, and if~at fb~ pfd notice or publication attached hereto is exactly the same as was printed-and pe~d iin the regulaz editions and issues of THE SIIV TINEL an the following day(s): Mazch 3, March 2tt amd March 17 2011 COPY OF NOTICE OF PUBLICATION Affiant further deposes that he/she is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statement as tp.~me, place and character of publication Sworn tq and subscribed before me this 7 7 CI U ,~ _ ~ _ , ~ h /1 _ I ~ .. , Notary Public My commission expires: NOTARIAL SEAL BAMBI ANN HECKENDORN Notary Public CARLISLE BOROUGH, CUMBERLAND CNTY Nly Commission Expires Jan 27. 2014 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF PROGRAM INTEGRITY DIVISION OF THIRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8486 March 17, 2011 KEITH O BRENNEMAN ESQUIRE 44 WEST MAIN STREET MECHANICSBURG PA 17055 Re: Ruth Sheibley SSN: ###-##-7081 Dear Sir: Pursuant to your letter dated February 22, 2011, the Department of Public Welfare (DPW), Estate Recovery Program, has reviewed the information you provided regarding the above-referenced individual. It has been determined that this individual did not receive any type of assistance during the questioned period. Therefore, according to the information you provided, the Department's Estate Recovery Program will not seek any recovery from this estate. If your client applied for Medical Assistance and had an application and/or hearing pending at the time of death, please advise us and provide any additional information that may affect a recovery by our Department. If you have any questions, please feel free to contact me. Sincerely, Y ~ Vince A. Porter Recovery Section Manager (717)772-6604 SNELBAKER ~ BRENNEMAN, P.C. A PROFESSIONAL CORPORATION ATTORNEYS AT LAW 4d WEST MAIN STREET MECHANICSBUR.G. PENNSYLVANIA 17055 KEITH O. BRENNEMAN RICHARD C. SNELBAKER- OF COUNSEL 7V-697-8528 P. O. BOX 318 FACSIMILE (717) 697-7681 Debra Ann Wheeler 1261 High Street Boiling Springs, PA 17007 Alicia K. Deardorff 8170 Evelyn Street Hummelstown, PA 17036 Re: Estate of Ruth E. Sheibley October 26, 2012 Milton K. Sheibley 1300 York Haven Road Lot 49 York Haven, PA 17370 Dear Ms. Wheeler, Ms. Deardorff and Mr. Sheibley: I am enclosing with this letter a copy of the Petition For Adjudication and a First and Final Account with respect to the Estate of Ruth E. Shiebley. On Page 6 of the First and Final Account is a schedule of proposed distribution to beneficiaries. Please note that the First and Final Account and schedule of proposed distribution are scheduled for confirmation before the Court of Common Pleas of Cumberland County to take place in Courtroom No. 1 of the Cumberland County Courthouse in Carlisle on November 27, 2012 at 9:30 A.M. The last day to file objections, if any you should have, to the First and Final Account or schedule of proposed distribution is November 27, 2012 at 9:30 A.M. Objections should be filed in the Office of the Register of Wills of Cumberland County and a copy served upon the undersigned as counsel for the Executrix of the Estate. Yours truly, Keith O. Brenneman KOB/sm Enclosure CC: Kathleen Hoffman, Executrix (w/enclosure) IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PA. ORPHANS' COURT DIVISION FILE NO: 21-11-0220 FIRST AND FINAL ACCOUNT OF Kathleen Hoffman, Executrix For ESTATE OF RUTH E. SHEIBLEY LAW OFFlCES SNELBAKER EC BRENNEMAN, P.C. Social Security #: Tax ID #: Date of Death: Date of Incapacity, if any: Date of Executrix Appointment: Date of First Complete Advertisement: Accounting for the period: 209-12-7081 38-6958253 February 10, 2011 None February 18, 2011 March 3, 2011 February 10, 2011 to September 12, 2012 Purpose of Account: Kathleen Hoffman, Executrix, offers this Account to acquaint interested parties with the transactions that have occurred during her Administration. It is important that the Account be carefully examined. Requests for additional information, questions or objections can be discussed with: Keith O. Brenneman Snelbaker & Brenneman, P.C. 44 West Main Street Mechanicsburg, PA 17055 Phone #: 717-697-8528 Supreme Court I.D. No: 47077 ~., ' ~ 2 C~~7 f-r ~ i' ~. .~ T_C1::- ~ ~ _ _,.t~ - -~ r j • • ~~ N "s'l Page 1 LAW OFFICES SNELBAKER 8C BRENNEMAN, P.C. SUMMARY OF ACCOUNT PRINCIPAL Receipts Net Gain on Sales or Disposition Less Disbursements: Debts of Decedent Funeral Expenses Administration Expenses Family Exemption Federal, State & Local Taxes Fees and Commissions Balance before Distributions Distributions to Beneficiaries Principal Balance on Hand For Information: Investments Made Changes in Holdings INCOME Receipts Less Disbursements Balance before Distributions Distributions to Beneficiaries Income Balance on Hand COMBINED BALANCE ON HAND Listing of unpaid creditors: Persons interest in the Distribution of Estate Proposed Statement of Distribution Affidavit/Verification PAGE Page 2 3 $15,186.59 3 0.00 $ 15,186.59 3 $ 1,000.41 3 0.00 3 1,137.90 4 0.00 4 462.22 4 4,250.00 6,850.53 $ 8,336.06 4 0.00 $ 8,336.06 4 $0.00 4 $0.00 4 $ 17.78 4 $0.00 $ 17.78 4 ~n nn $ 8,353.84 5 5 6 7 PRINCIPAL RECEIPTS Assets Listed on Inventory per copy of attached: $13,460.94 (Valued as of Date of Death) LAW OFFICES SNELBAKER EC BRENNEMAN, P.C. ADJUSTMENTS TO INVENTORY 0.00 SUBSEQUENT RECEIPTS 8/27/2011 Camp Hill Physicians, refund overpayment $ 36.50 12/20/2011 Pennsylvania Department of Revenue, refund on Inheritance Tax 82.90 1/28/2012 Commonwealth of Pennsylvania, unclaimed property consisting of 1,602.53 MetLife, Inc stock and dividends 9/12/2012 Pennsylvania Department of Revenue, refund on Inheritance Tax 3.72 TOTAL PRINCIPAL RECEIPTS $15,186.59 PRINCIPAL GAINS OR LOSSES ON SALES OR OTHER DISPOSITIONS NONE $0.00 $0.00 TOTAL GAINS AND LOSSES $0.00 $0.00 LESS LOSS $0.00 NET GAIN/LOSS TRANSFERRED TO SUMMARY $0.00 DISBURSEMENTS OF PRINCIPAL DEBTS OF DECEDENT 2/8/2011 Church of God Home, check written prior to $ 80.85 death for nursing home care from Member's 1st checking account 7/21/2011 Church of God Home, nursing home care 280.76 7/22/2011 Continuing Care RX, medical services 125.31 7/22/2011 West Shore EMS, ambulance service 401.84 7/25/2011 Cumberland Goodwill EMS, ambulance service 75.15 7/28!2011 Camp Hill Physicians, medical services 36.50 $ 1,000.41 FUNERAL EXPENSES $0.00 $0.00 ADMINISTRATION EXPENSES 4/19/2011 Greenawalt & Company, P.C., preparation of $ 175.00 2011 Individual Income Taxes 3/19/2012 Register of Wills, filing fee for Supplemental 15.00 Inheritance Tax Return The following items are to be paid upon confirmation of the Accounting `"" Snelbaker & Brenneman, P.C., costs advanced: 447.90 a. Register of Wills, probate fees 123.50 b. Cumberland Law Journal, advertise 75.00 Executrix Notice c. The Sentinel, advertise Executrix Notice 219.40 d. Register of Wills, filing fee for Inventory 30.00 and Inheritance Tax Return ""~ Reserve for filing fees, accountant fees and other 500.00 miscellaneous costs associated with the administration of the Decedent's estate $ 1,137.90 Page 3 DISBURSEMENTS OF PRINCIPAL -CONTINUED FAMILY EXEMPTION NONE $0.00 $0.00 FEDERAL STATE & LOCAL TAXES 4/26/2011 Register of Wills, Agent, PA Inheritance Tax $ 390.00 3!15/2012 Register of Wills, Agent, PA Inheritance Tax 72.22 $ 462.22 FEES AND COMMISSIONS The following items are to be paid upon confirmation of the Accounting *** Kathleen Hoffman, Executrix Commission $ 750.00 *** Snelbaker & Brenneman, P.C., attorney services 3,500.00 $ 4,250.00 TOTAL DISBURSEMENTS OF PRINCIPAL $ 6,850.53 DISTRIBUTIONS OF PRINCIPAL TO BENEFICIARIES NONE $0.00 $0.00 PRINCIPAL BALANCE ON HAND I Cash Cemetery Plots **** Less expenses to be paid subsequent to confirmation of First and Final Account as as listed on page3 & 4 of accounting TOTAL PRINCIPAL BALANCE ON HAND FIDUCIARY VALUE AT ACQUISITION 9/12/2012 VALUE $ 12,551.74 $ 12,460.94 1,000.00 1,000.00 -5,197.90 $ 8,353.84 $ 13,460.94 INFORMATION SCHEDULES PRINCIPAL INVESTMENTS MADE LAW OFFlCES SNELBAKER EC BRENNEMAN, P.C. NONE $0.00 $0.00 CHANGES IN PRINCIPAL HOLDINGS NONE $0.00 $0.00 RECEIPTS OF INCOME 2/18/2011 Member's 1st Federal Credit Union, closing interest $ 0.59 9/12/2012 Member's 1st Federal Credit Union, estate checking, interest 17.19 TOTAL RECEIPTS OF INCOME $ 17.78 DISBURSEMENTS OF INCOME NONE $0.00 $0.00 DISBURSEMENTS OF INCOME TO BENEFICIARIES NONE $0.00 $0.00 Page 4 " UNPAID CREDITORS: NONE "` PERSONS INTERESTED IN DISTRIBUTION OF ESTATE: 1. Debra Ann Wheeler 1261 High Street Boiling Springs, PA 17007 2. Alicia K. Deardorff 8170 Evelyn Street Hummelstown, PA 17036 3. Kathleen Hoffman 929 Bonny Lane Mechanicsburg, PA 17055 4. Milton K. Sheibley 1300 York Haven Road Lot 49 York Haven, PA 17370 LAW OFFICES SNELBAKER 8C BRENNEMAN, P.C. Page 5 PROPOSED DISTRIBUTION TO BENEFICIARIES Kathleen Hoffman, Executrix and Accountant herein, proposes to distribute the balance of the Estate of Ruth E. Sheibley, Deceased, to wit: $8,353.84 in accordance with the Last Will and Testament of said Decedent as follows: 1. Debra Ann Wheeler $ 2,422.61 29% of residue as per Item 2C of Will $ 2,422.61 2. Alicia K. Deardorff $ 2,422.61 29% of residue per Item 2A of Will $ 2,422.61 3. Kathleen Hoffman $ 1,086.01 13% of residue per Item 26 of Will $ 1,086.01 4. Milton K. Sheibley $ 2,422.61 29% of residue as per Item 2D of Will $ 1,422.61 Woodlawn Memorial Gardens, two cemetery $ 1,000.00 plots In-Kind TOTAL DISTRIBUTION: $ 8,353.84 LAW OFFICES SNELBAKER 8C BRENNEMAN, P.C. Page 6 AFFIDAVIT /VERIFICATION KATHLEEN HOFFMAN, Executrix under the Last Will and Testament of RUTH E. SHEIBLEY, Deceased hereby declares under oath that she has fully and faithfully discharged the duties of her office; that the foregoing First and Final 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; to her knowledge, there are no claims 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 filing of the foregoing First and Final Account. This statement is made subject to penalties of 18 pa. C.S.A. Section 4904 relating to unsworn falsification to authorities. Q Kathleen Ho ,Executrix Dated: atj J r}- Subscribed and sworn to by KATHLEEN HOFFMAN before me this a ~~~ day of ~ PM 201 Notary Public COMMONWEALTH OF PENNSYLVANIA Nobrial Seal Susan L. Matrazi, Notary PubYc Medwnlrsburg eo% Cumberland County t"lY CAmmissfon ExpMes Nov. 24, 2015 MEMBER, PENNSYLVANU ASSOCUTION OF NOTARIES LAW OFFICES SNELBAKER 8C BRENNEMAN, P.C. Page 7 INVENTORY REGISTER OF WILLS OF CUMBERLAND COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland SS Kathleen Hoffman, Executrix COUNTY, PENNSc~LVANI~= ~~ s ~ c-- '~ ~ !~7 ~, ; '_"~ File Number 21-11-0220 -~ a rn N ~- Personal Representative(s) of the Estate of Ruth E. Sheibley ,';O-n _,~ _ _ ~r deceased, depose(s) and say(s) that the items appearing in the following inventory include all of the persott~l assets wl~ver sif~i~ and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite eaedr~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 of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I verify that the statements made in this Inven- ~~~~~~ tory are true and correct. I understand that false state- ments herein are made subject to the penalties of Kathleen Hoffma xecutrix 18 Pa.C.S. § 4904 relating to unsworn falsification to - 9?9 Rnnn 7 ane authorities. Mechanicsburg., PA 17055 Attorney -- (Name) Keith O. Brenneman (Supreme Court I.D. No.) 47077 (RddressJ Snelbaker & Brenneman, P.C., 44 West Main Street, Mechanicsburg, PA 17055 (Telephone) 717-697-8528 urn ~ C yr V t:A I M February 10, 2011 LAST RESIDENCE DECEDENT'S SOC. SEC. NO. 801 North Hanover Road, Carlisle Borough, Carlisle, PA 17013 209-12-708] FIGURES MUST BE TOTALED Woodlawn Memorial Gardens, Inc., two cemetery plots 2. Members 1st Federal Credit Union, savings account #224207-00 3. Members ] st Federal Credit Union, savnlgs account #224207-01 4. Members 1st Federal Credit Union, checking account #224207-1 I 5. Members 1st Federal Credit Union, money management account #224207-OS 6. Bankers Life and Casualty Company, refund unused health insurance premium due the decedent (Attach additional sheets as needed) 1,000. UU 6,179.32 4,603.91 l ,562.42 0.51 1 l 4.78 TnTei.• 13,460.94 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each item, but such figures should not be extended into the total of the Inventory. (See 10 Pa. C.S. ,¢ 3301(b)) Form RW-09 rev. 10.13.06