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Home My WebLink About12-11-12y r t x ~ w ~ ~~~ RECEIPT AND RELEASE WHEREAS, Samuel H. Black, late of Mechanicsburg Borough, County of Cumberland and Commonwealth of Pennsylvania, died on November 11, 2011, having first made his Last Will and Testament in writing probated before the Register of Wills of said Cumberland County on November 15, 2011, and Letters Testamentary were issued on the same date to Constance E. Roland, the Executrix named in the Last Will and Testament of said Decedent; and WHEREAS, said Executrix has entered upon and completed her administration of said Decedent's Estate as set forth in her First and Final Account attached hereto, and intends to distribute the net balance of the assets of said Estate to the persons named in the Statement of Proposed Distribution also attached hereto, both of said documents being incorporated herein by reference thereto; and NOW, THEREFORE, KNOW ALL MEN BY THESE PRESENTS,- that we LAW OFFICES SNELBAKER SC BRENNEMAN, P.C. Susan C. Eagen, Margaret A. Woll, Constance E. Roland, Jessica A. ~B1_ack, Constance E. Roland and Kierna S. Black Trustees for Aaron {J. Black and Jordan D. Black, being the principal legatees and distributees named in the Will of said Decedent and the persons ~..~ entitled to share in the residuary distributiq of th~Es~~ of Q said Decedent, do hereby declare and say that ~ ~ndac~ ~ us, '%~ :~" .~' ~~ Wes. ~ ~ ~ i ~ `~ ~ S ~ • have examined the attached Account and Statement of Proposed Distribution, and find the same to be true and correct, and in strict accordance with the terms and provisions of said Will, and we do hereby acknowledge that we, and each of us, this day have, had and received of and from Constance E. Roland, Executrix of the Estate of Samuel H. Black, the cash and/or personalty set opposite our names in the above mentioned Statement of Proposed Distribution, in full satisfaction, payment and discharge of all such sum or sums of money, legacies and bequests, share or shares, purparts and dividends which were due, owing and payable and belonging to us, and each of us, by any means whatsoever, for or on account of our full share, part or dividend of the Estate of Samuel H. Black, Deceased. NOW, THEREFORE, we, and each of us, the said Susan C. Eagen, .Margaret A. Woll, Constance E. Roland, Jessica A. Black, Constance E. Roland and Kierna S. Black Trustees for Aaron J. Black and Jordan D. Black do by these presents, remise, release, quit-claim and forever discharge the said Constance E. Roland, her heirs, executors and administrators, of and from our said shares or dividends of the Estate aforesaid, and of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by reason thereof, or of any act, matter, cause or thing whatsoever, from the beginning of the world to the day and date of these presents. AND, desiring to avoid the delay and expense of the LAW OFFICES SNELBAKER SC 2 BRENNEMAN, P.C. S ~' • ~ ~ y settlement of said Estate by filing the foregoing Account of said administration in"the Office of the Register of Wills of said Cumberland County and by having the balance in the hands of the Executrix, as shown by said Account, distributed by the Court of Common Pleas of Cumberland County - Orphans' Court Division, we, and each of us, do hereby agree that the foregoing Account and Statement of Proposed Distribution concerning the matter of settlement may be recorded with the same effect upon us, and each of us, as if the same had been reported upon by said Court, in a decree of distribution made on such proposed Statement of Distribution by the said Court of Common Pleas - Orphans' Court Division. AND in consideration of the aforesaid settlement being made without the aid of such Court of Common Pleas - Orphans' Court Division, that we, and each of us, the said Susan C. Eagen, Margaret A. Woll, Constance E. Roland, Jessica A. Black, Constance E. Roland and Kierna S. Black Trustees for Aaron J. Black and Jordan D. Black do hereby agree that if any debts or demands other than those included in the above referenced First and Final Account, as hereinbefore set forth, shall be hereafter recovered against the Estate of said Decedent and be legally payable out of the same, that we, and each of us, will return to LAW OFFICES SNELBAKER 8C BRENNEMAN, P.C. 3 . ~ he said Executrix such amounts thereof as may be necessary to ay such debts or demands. IN WITNESS WHEREOF, we have hereunto set our hands,~g"~~~a~T;s, ..l q_,~.., ` . Q- `, ~~, h i s ~ 4~ d a y o f Nc~V~+~b QX 2 012. ,~~ STATE ~,~ OF ~-° ~ TENNESSEE ~, ITNESSED BY : ~'~;~ NOTAPY ~, PUBLfC Susan C. Eage Margaret A. Woll Constance E. Roland Jessica A. Black (SEAL ) (SEAL ) (SEAL ) (SEAL ) Constance E. Roland, Trustee for Aaron J. Black and Jordan D. Black (SEAL ) Kierna S. Black Trustee for. Aaron J. Black and Jordan D. Black LAW OFFICES SNELBAKER 8C 4 BRENNEMAN, P.C. ' • , '!~Ithe said Executrix such amounts thereof as may be necessary to pay such debts or demands. (SEAL ) Susan C. Eagen ~` ' ~~ ( SEAL ) ~! ~ Ma garet A. Woll ~. ~ ~~~: x ~.. ( SEAL ) onstance E. Roland `' WITNESSED BY ~' IN WITNESS WHEREOF, we have hereunto set our hands and seals ,,~ ~~'! this o~ 1 ~~ day of ~~J~~~~~" 2012 . -~; ~~~_, Jessica A. Black ~k.G~ir..~c- ~onstance for Aaron Jordan D. K'erna S. for Aaron Jordan D. (SEAL ) ~~"~----.. ( SEAL ) E. Roland, Trustee J. Black and Black (SEAL ) Black Trustee J. Black and Black LAW OFFICES SNELBAKER SC 4 BRENNEMAN, P.G. TT ~~ the said Executrix such amounts thereof as may be necessary to pay such debts or demands. IN WITNESS WHEREOF, we have hereunto set our hands and seals this day of 2012. WITNESSED BY: Susan C. Eagen Margaret A. Wol (SEAL ) (SEAL ) (SEAL ) Constance E. Roland (SEAL ) Jessica A. lack (SEAL ) Constance E. Roland, Trustee for Aaron J. Black and Jordan D. Black Kierna S. Black Trustee for Aaron J. Black and Jordan D. Black (SEAL ) LAW OFFICES SNELBAKER & 4 BRENNEMAN, P.C. . , COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND) On this the ~ ~ s f- day of n ~~(~~}QJ~--~ 2012, before me, a Notary Public in and for said State and County, the undersigned officer, personally appeared Margaret A. Woll, Constance E. Roland (Individually and as Trustee for Aaron J. Black and Jordan D. Black) and Kierna S. Black, Trustee for Aaron J. Black and Jordan D. Black, known to me (or satisfactorily proven) to be the persons whose names are subscribed to the within instrument and acknowledged that they executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ~~ TW ViANIA Notary Public 5ra K. ~Iww~w':, N~`Y ~ubNc g b- (~thfwrlMld Cvwity ri~v. ~-, Bois LAW OFFICES SNELBAKER 8C 6 BRENNEMAN, P.C. CALIFORNIA ALL-PURPOSE CERTIFICATE OF ACI~:NOWLEDGMENT State of California County of '~ ~~r`w[~r~c_~`[ld On ~ ~ ~ ~ ~ 1 Z-@ [ 2 before me, c~ (Here ins rt name and title of . , ,, personally appeared _~~~,~ ca ~ ~ ~r~~ ~_~'_ 1~ who proved to me on the basis of satisfactory evidence to be the person~s,~whose named subscribed to the within instrument and acknowledged to me that h+e ~e t~ executed the same in ie 'r authorized capacity(ros.}, and that by ~iTsf~thair signature(~..on the instrument the personrts~., or the entity upon behalf of which the person(}. acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. ..---- WITNES y hand and offici ~~ Signature of ary Public SAM PEREZ N ~= COMM. # 1947796 Nr~tary Public-Caiifornia <,, s.<w e~RNAR~erao N My s;mmissia'~ Es;pires Aug. 12, 2015 (Notary Seal) ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT (Title or escription of attached document) (Title or description of attached document continued) Number of Pages Document Date (Additional information) CAPACITY CLAIMED BY THE SIGNER ^ Individual (s) ^ Corporate Officer (Title) ^ Partner(s) ^ Attorney-in-Fact ^ Trustee(s) ^ Other INSTRUCTIONS FOR COMPLETING THIS FORM Any acknowledgment completed in California must contain verbiage exactly as appears above in the notary section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In such instances, any alternative acknowledgment verbiage as may be printed on such a document so long as the verbiage does not require the notary to do something that is illegal for a notary in California (i. e. certifying the authorised capacity of the signer). Please check the document carefully for proper notarial wording and attach this form if required. • State and County information must be the State and County where the document signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your title (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. • Indicate the correct singular or plural forms by crossing off incorrect forms (i.e. lie/she/tI}ey- is /ice) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. Impression must not cover text or lines. If seal impression smudges, re-seal if a sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of the county clerk. • Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. • Indicate title or type of attached document, number of pages and date. • Indicate the capacity claimed by the signer. 1f the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document 2008 Version CAPA v12.10.07 800-873-9865 www.NotaryClasses.com ~ ~ ESTATE N0.21-11-1224 FIRST AND FINAL ACCOUNT AND STATEMENT OF PROPOSED DISTRIBUTION OF AND BY CONSTANCE E. ROLAND, EXECUTRIX OF THE ESTATE AND UNDER THE LAST WILL AND TESTAMENT OF SAMUEL H. BLACK, DECEASED, LATE OF MECHANICSBURG BOROUGH, CUMBERLAND COUNTY, PENNSYLVANIA Constance E. Roland, Executrix as aforesaid and Accountant herein, avers as follows: DATE OF DECEDENT'S DEATH: November 11, 2011 DATE LETTERS TESTAMENTARY ISSUED: November 15, 2011 DATES EXECUTRIX NOTICE ADVERTISED: Cumberland Law Journal November 25, December 2, 9, 2011 The Sentinel November 18, 25, December 2, 2011 FIRST AND FINAL ACCOUNT PERSONALTY -PRINCIPAL ACCOUNT DEBITS The Accountant charges herself with the receipt of the following items of Decedent's Personalty valued as of the date of Decedent's death: 1. General Electric, .1747 shares of common stock valued at $16.35 per share $ 2.86 2. 2010 Dodge Grand Caravan, sale value 15,200.00 3. Boats and Trailers, 1986 Smoker Craft Bass Boat $50.00, 1972 C-Spirit John 250.00 Boat $25.00, 2002 Carry on trailer $150.00 and 1987 EAZ trailer $25.00 4. Cumberland Valley Motors, wages due the decedent 33.86 5. Erie Insurance, premium refund due the decedent on auto insurance 348.00 6. Internal Revenue Service, refund due the decedent on 2011 Final Individual 74.00 Taxes 7. Lincoln Financial Group, annuity #924426780 63,634.13 8. Member's 1st Federal Credit Union, savings account #199599-05 363.70 9. Member's 1st Federal Credit Union, checking account #199599-11 3,017.21 10. Member's 1st Federal Credit Union, savings account #199599-00 5.00 11. Proceeds from sale of chair lift 500.00 12. PPL, refund overpayment for electric service for cottage 195.25 13. PSERS, pension payment 366.24 14. HARP, refund overpayment on credit card 40.87 15. Commonwealth of Pennsylvania, Inheritance Tax Refund 155.31 TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, DEBITS: $ 84,186.43 PERSONALTY -PRINCIPAL ACCOUNT CREDITS LAW OFFICES SNELBAKER SC BRENNEMAN, P.C. The Accountant claims credit for the payment of the following items from Decedent's Personalty Account: 1. Member's 1st Federal Credit Union, check printing fee $ 6.87 2. Constance E. Roland, reimburse for airline ticket purchased for Susan Eagen 426.90 3. Margaret Woll, reimburse for funeral luncheon and sewer bill 366.04 Page 1 . f 4. PPL, final charge for electric service for cottage 5. Ritters Hardware, payoff revolving credit account 6. PSERS, reimburse pension overpayment 7. Penn Dot, duplicate title for trailer 8. United Water, final charge for water service at cottage 9. AARP, payoff credit card 10. Hollinger Funeral Home, funeral services 11. Hospital telephone and TV services 12. Penn Dot, transfer title fee for trailers 13. PA Fish and Boat Commission, transfer fee for boats 14. Joseph P. Cardinale, medical services 15. Register of Wills, Agent, estimated Inheritance Tax payment 16. Heritage Medical Group, medical services 17. Register of Wills, filing fee for Inheritance Tax return 18. Register of Wills, additional probate fee 19. General Electric Company, loss on sale of stock 20. Lincoln Financial Group, loss on annuity 21. Member's 1st Federal Credit Union, payoff auto loan 22. Member's 1st Federal Credit Union, auto loan payment 23. Member's 1st Federal Credit Union, check written prior to death to Margaret Woll, plus NSF fee Items to be paid upon execution of Receipt and Release: 24. Margaret A. Woll, payment of Family Exemption 25. Snelbaker & Brenneman, P.C, attorney services 26. Snelbaker & Brenneman, P.C, costs advanced as follows: a. Register of Wills, probate fee b. Cumberland Law Journal, advertise Executrix Notice c. The Sentinel, advertise Executrix Notice d. Register of Wills, short certificates 27. Register of Wills, filing fee for Receipt & Release and Inventory TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, CREDITS: PERSONALTY -INCOME ACCOUNT DEBITS The Accountant charges herself with the receipt of the following income from the investment of Personalty Principal: 1. Member's 1st Federal Credit Union, interest 2. Member's 1st Federal Credit Union, estate accounts, interest TOTAL, PERSONALTY, INCOME ACCOUNT, DEBITS: PERSONALTY -INCOME ACCOUNT CREDITS LAW OFFICES SNELBAKER SC BRENNEMAN, P.G. The Accountant claims credit for the payment of the following items from the Personalty Principal Account: 1. PA Department of Revenue, 2011 income tax TOTAL, PERSONALTY, INCOME ACCOUNT, CREDITS: 198.50 75.00 221.40 12.00 33.49 34.95 144.12 22.50 53.48 40.87 4,139.44 40.00 67.50 56.50 10.00 2,800.00 29.78 15.00 75.00 0.27 920.67 8,759.85 240.00 512.00 3,500.00 2,913.75 506.90 20.00 $ 25,735.88 $ 0.18 146.30 $ 146.48 $ 10.00 $ 10.00 Page 2 r ~ , REAL ESTATE -PRINCIPAL ACCOUNT DEBITS The Accountant charges herself with the receipt of Decedent's Real Estate as follows: $ NONE TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, DEBITS: $ NONE REAL ESTATE -PRINCIPAL ACCOUNT CREDITS The Accountant claims credit for the payment of the following items from Real Estate Principal Account: $ NONE TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, CREDITS: $ NONE REAL ESTATE -INCOME ACCOUNT DEBITS The Accountant charges herself with the receipt of the income from the investment of Real Estate Principal Account: $ NONE TOTAL, REAL ESTATE, INCOME ACCOUNT, DEBITS: $ NONE REAL ESTATE -INCOME ACCOUNT CREDITS The Accountant claims credit for the payment of the following items from the Real Estate Income Account: $ NONE TOTAL, REAL ESTATE, INCOME ACCOUNT, CREDITS: $ NONE LAW OFFICES SNELBAKER 8C BRENNEMAN, P.C. Page 3 ~, ~ RECAPITULATION LAW OFFICES SNELBAKER SC BRENNEMAN, P.C. PERSONALTY: PRINCIPAL ACCOUNT: Debits Credits Balance INCOME ACCOUNT: Debits Credits Balance TOTAL PERSONALTY REAL ESTATE: PRINCIPAL ACCOUNT: Debits Credits Balance INCOME ACCOUNT: Debits Credits Balance TOTAL REAL ESTATE: TOTAL FOR DISTRIBUTION: $ 84,186.43 $ 25,735.88 $ 58,450.55 $ 146.48 $ 10.00 $ 136.48 $ 58, 587.03 $ NONE $ NONE $ NONE $ NONE $ 58, 587.03 Page 4 LAW OFFICES SNELBAKER 8C BRENNEMAN, P.C. STATEMENT OF PROPOSED DISTRIBUTION Constance E. Roland, Executrix and Accountant herein, proposes to distribute the balance of the Estate of Samuel H. Black, Deceased, to wit: $ 58,587.03 in accordance with the Last Will and Testament of said Decedent as follows: 1. Susan C. Eagen 20% of residue per Item Al of Will Cash 2. Margaret A. Woll 20% of residue per Item A2 of Will Boats and Trailers, In-Kind Cash 3. Constance E. Roland 20% of residue as per Item A3 of Will Cash 4. Jessica A. Black 20% of residue as per Item A4 of Will Cash 5. Constance E. Roland and Kierna S. Black Trustees for Aaron J. Black 10% of residue as per Item A5 of Will Cash 6. Constance E. Roland and Kierna S. Black Trustees for Jordan D. Black 10% of residue as per Item A6 of Will Cash TOTAL FOR DISTRIBUTION: • ,, ; 11,717.41 11,717.41 11, 717.40 250.00 11,467.40 11,717.41 11,717.41 11,717.41 11,717.41 5,858.70 5,858.70 5,858.70 5,858.70 58, 587.03 Page 5 » 1 I COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND Constance E. Roland, being duly sworn according to law deposes and says: that she is the Executrix of the Estate and under the Last Will and Testament of Samuel H. Black, Deceased, and the Accountant herein; that there are no unpaid creditors or claimants of said Estate; that there are no persons interested in the distribution of said Estate other than as stated in the foregoing Statement of Proposed Distribution; and that the facts set forth in the foregoing First and Final Account and Statement of Proposed Distribution are true and correct to the best of her knowledge, information and belief. ,/,~ ., Constance E. Roland Executrix and Accountant Sworn to and subscribed before me this 12th day of November 2 12 Notary Pubic ooMMONw~un~ of ~n~snv~w~ NoteHa! s.~ Saricira K. Stiower~, Notary PubNc Med~ankslxwp Boro, Grlrriberl~~d County My Can~NamMon ~ Nov. 22 2015 M6~ER, Al AN Af NOT LAW OFFICES SNELBAKER SC BRENNEMAN, P.C. Page 6