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HomeMy WebLinkAbout02-0268Estate of ~?r.t~t~¢.~ ~. /J~.~¢e- also known as PETITION FOR PROBATE and GRANT OF LETTERS mo. / To.' Register of Wills for the Deceased. County of C~.rnl~r~a-~J in the Social Security No. igff., l,a- ~-~ cl Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/~ 18 years of age or older an the executr;3 named in the last will of the above decedent, dated /¢tt~ ~ t~t 12~ ,19 7a/ and codicil(s) dated ~br~,,~ ~ 8~ ~o~ ~ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in ~ ~.rnlo~t'~a~l County, Penns~(lvania, with last family or principal residence at 1~1 ~", (list street, number and muncipality) Decendent, then '7'7 years of age, d, ied ~tt r'c. ln .g' , j~_ .Zoo~., Except as follows, decedent did not marry, was not divorced and did not have a ch~d born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County ValUe of real estate in Pennsylvania situated as follows: ' ~7 WHEREFORE, petitioner(s) respectfully, request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters 4e~{'am~n (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 3 COUNTY OF Ct~_m ~_.~ f s8 The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct ~o the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this 8¢h day of k MARCH 2~02 Estate of ~A~c~,s B KOSER , Deceased DECREE OF PROBATE AND GRANT OF LETTERS /LND NOW MARCH 15, 2002 x~ , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated WILL 08-13-1979, CODICIL 02-28-2002 described therein be admitted to probate and filed of record as the last will of FRANCES B KOSER and Letters TESTAMETNARY are hereby granted to FRANCINE A BOWEN FEES Probate, Letters, Etc .......... $ 115 ~ h0 Short Certificates(4 ) .......... $ 12.00 Renunciation ................ $ 5.00 codicil 10.50 jcp $ 5.00 extra pages 6.00 TOTAL__ $. 148.50 Filed .tvJz~R.Cyl. ~,. 2Q 0.2 ................... mailed to attorney on 3-]5-02 ? ATTORNEY (Sup. Ct. I.D. No.) PHONE 1 RENUNCIATION deceased. To the Register of ..... Coumy, Pennsylvania. The undersigned ~o~{-LL~ 0~. ~<'O $&-l~x ,7'~'. of the above decedent, hereby renounce(s) the right to administer the es[ate az:d respectfully ask(s) that Letters WITNESS {Addre~sl (Signature) (Address) ($~gnature) (Address) REGISTER OF WILLS OF e ~.r~6e-/ez~,v~ COUNTY OATH OF SUBSCRIBING WITNESS · co~c~ -.~ ' (each) a witness to the will presented herewitN~h) being duly qualified according to law, depose(s) ~ ~ present and saw request of testa~ in h__ ~ ]~~ ~ ~ence of each other) (in~l~resence of the °ther subscrib7 ~ ~ ~ ~ ~ (Address) Register ~ (Name) (Address) REGISTER OF WILLS OF c__~_ ~ ~..,~b COUNTY OATH OF NON-SU_BSCRIBING WITNESS _..2 I- oa..a'.. (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that ..... _ ' *~'- will presented herewith and codicil that ~ o.~ $~ believes the signature on the will is in the handwriting of to the best of [o i$ ~ ~ knowledge and belief. Sworn to or affirmed and subscribed before me this 8 da-' of REGISTER OF WILLS OF ~u~aeat-,~3 COUNTY OATH OF SUBSCRIBING WITNESS codicil ast~ liar: i n~o,-bor,,t'ed-ff~e...e;n (each~ a subscribing witness to the ~ presented herewith, ~¢ac~) being duly qualified according to law, depose(s) and say(s) that she t~a$ present and saw the testat ~'~- , sign the same and that ~/n~ signed as a witness at the request of testatolx in h~-,~ presence and $:n t~e prc;cnccc. Seaz~ ct~zr) (~he Sworn fo or a~firmeig and subscribed before me this ~c9. day of (Name) (Address) (Name) IL..... NOTARIAL SEAL AURA A. TARASEW~, Notary Public Susquehanna Twp., Dauphin County My Commission Expires Aug. 30, 2004 (Address) REGISTER OF WILLS OF COUNTY OF NON-SUBSCRIBING WITNESS (each) a subscriber hereto, (each) being duly qualified to law, depose(s) and say(s) that ~ familiar with the signature of , testat o~ng witnesses to) the pr~ed herewith and (one will codicil that ' ~[~eves the signature on the will is in th iting of to the b~f~ knowledge and beli~~~.~% Sworn to or ~ubscribed before me this ~~day of ((NPtn~ddress~) R eg ts~er~ (Name) (Address) REGISTER OF WILLS OF Ct~fie£t.~-~0 COUNTY OATH OF SUBSCRIBING WITNESS codicil (liar ~ a subscribing witness to the-"':',, presented herewith, ~-~°~' being duly qualified according to law, depose(s) and say(s) that ~t ~ present and saw the testat r;~ , sign the same and that ~h~ signed as a witness at the request of testat r; ~ in h.~ presence and tln~ ..... th .......... ~-~,,~ ~,c ~.~ ~t~cr) (~ ~h~ .... presence ~e__ ~e Sworn to or affirmed and subscribed before me this /& ,% ~70~-cd.... day of (Address) (Name) (Address) REGISTER OF WILLS OF COUNTY OATH~WITNESS , (each) a su~ereto, (each) being duly quali. ... ... fie_d according'~'~ depose(s) and say(s) that t ~,,~~ili~r wit~ the signalur~ OfcodiciI '~ , estat_ _.__ of (one of the sub~itnesses to) the will presente~rewit..~ codicil '~ h and I~,~~-~.~ ~ belie~ the will is in the hand~ t° the best °f__..~ k~nd belief' ~ '~~.~~ and subscribed befo-~ '~ me this ~ 19day o~f (Name) ~ (Name) (Address) LAST WILL AND TESTAMENT OF FRANCES B. KOSER I, FRANCES B. KOSER, of the Borough of Mechanicsburg, County of Cumberland and State of Pennsylvania, being of sound and dis- posing mind, memory and understanding, do make, publish and de- clare this my Last Will and Testament. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. I give, devise and bequeath all the rest, residue and remainder of my estate, of whatsoever nature and wheresoever the same may be situated, to my husband, Donald J. Koser, absolutely and uncon- ditionally. In the event that my husband, Donald J. Koser, should predecease me, or should he die at about the same time as I do, such as in an accident common to both of us, then in such event, I direct the settlement and distribution of my estate to be made in the following manner, to wit: g. I give and bequeath the sum of One Thousand ($1,000.00) Dollars to my daughter, Francine A. Bowen. B. I give and bequeath the sum of One Thousand ($1,000.00) Dollars to my son, Donald J. Koser, Jr. C. I direct that the inheritance tax on the above bequests be paid out of my residuary estate. D. I give, devise and bequeath all the rest, residue and remainder of my estate, of whatsoever nature and wheresoever the same may be situated, to my three children, to wit, Francine -1- A. Bowen, Donald J. Koser, Jr. and Stephen A. Koser, share and share alike, per stirpes. LASTLY, I nominate, constitute and appoint my husband, Donald J. Koser, Executor of this my Last Will and Testament, and in the event that my said husband should predecease me, or should he be unable or unwilling to serve in such capacity for any reason, then in such event, I nominate, constitute and appoint my daughter, Francine A. Bowen, and my son, Donald J. Koser, Jr., Co-Executors of this my Last Will and Testament in his place and stead. IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of August, A. D. 1979. Frances B. Koser ( SE AL) Signed, sealed, published and declared by the above named Frances B. Koser, as and for her Last Will and Testament, in the presence of us who have subscribed our names hereto as witnesses at the request of said testatrix, in her presence and in the presence of each other. -2- LAST WILL AND TESTAMENT OF FRANCES B. KOSER J. Robert Stauffer Attorney-at-Law Market Square Bldg. Mechan±csburg, Penna. Henry Hall, Inc., Indiana, Pa. FORM 93 - O. C. DIVISION IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: ESTATE OF FRANCES B KOSER (Deceased) CLAIM To the Clerk of Orphans court Division: No. 2102-268 of 01 Index and make proper entry in your official records of the claim of ADVANTAGE RECEIVABLE SOLUTIONS for BLAIR CREDIT SERVICES CORPORATION (Claimant), account # 694546242, in the amount of $445.65 against the estate of the above named decedent. This claim is filed under Section 732 (b) (2) of the Fiduciaries Act of i949 as amended. The said decedent, who resided at 101 E ELMWOOD AVE, MECHANICSBURG, PA 17055, died on January 1, 01. Written notice of this claim was given to (Personal representative, if any, or counsel). April 18 ,2002 ADVANTAGE RECEIVABLE SOLUTIONS 1941 SOUTH 42ND STREET SUITE 380-25 PO BOX 6618 OMAHA, NE 68106-0618 800-999-3778 (Claimant's Address) IN RE: ESTATE OF FRANCES B KOSER (Deceased) No. 2102-268 of 01 ADVANTAGE RECEIVABLE SOLUTIONS for BLAIR CREDIT SERVICES CORPORATION (Claimant) Fee $ Filed Attorney Form 93 ARS-ARRC 25 RECOVERY MAINTENANCE RECDSP 10:41:27 4/18/2002 CLIENT: BLAIR CREDIT SERVICES/CATALOG ACCOUNT: 70587612 STATUS: ACTIVE STATUS PACKET: ADDRESS INFOR/~TiONI CONTACT TYPE: PRMCON OD AVE RG PREFIX: FIRST NAME: FRANCES MIDDLE NAME: B LAST NAME: KOSER EXTENDED: SUFFIX: MAIL CODE: More... cONTA l RESP: PRMRSP AREA CODE: PREFIX: NUMBER: EXTENSION: ANSWER CODE: SSN: 185129569 CALL CODE: CLI REF#: 694546242 REASON: 00-ACTIVE ADDRESS TXPE: PRMHOM STREET: 101 E ELMWO CITY: ~ STATE: PA ZIP CODE: ~ COUNTRY: US ~U~RENT ~ALA/~C~: 445.65000 ADJUSTED ~ALARC~: 0 00000 LISTIN~ BALANCE: 445.65000 ' PROMISED PAYMENTS: 0.00000 PRINCIPAL PAYMENTS: 0 00000 LOCAL LISTING BALANC 0.00000 ' ACTIVITY: More... REVIEW REVIEW ACCOUNT 4577 04/18/2002 10:41:19 RTNREC RETURN TO RECOVERY 2451 04/17/2002 12:32:41 CLLPB CALL PROBATE 2451 04/17/2002 12:32:38 FOLLOW UP ACTIVITY: ME: More... FOLLOW UP DATE: ACCOUNT A~'TRI~UT~SI F2=CONTINUE SEARCH F3=EXIT F4=PROMPT F6=ADD CONTACT F8=NEXT CONTACT F9=HISTORY F24=MORE KEYS FOLLOW UP TI F7=PREVIOUS CONTACT 1941 South 42nd Street, Suite 380 RO. Box 6618 Omaha, Nebraska 68106-0618 CERTIFICATION OF NOTICE UNDER RU!,F, 5.6(a) Name of Decedent: Date of Death: Will No. Frances B. Koser March 5, 2002 Admin. No. No. 21-02-0268 TO THE REGISTER: I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on April 26, 2002: Name Address Ms. Amanda Koser Mr. Chris Bowen Mr. Donald J. Koser, Jr. Ms. Donna Wise Ms. Louise Koser Ms. Francine A. Bowen Mr. Steve Koser 1616 Canterbury Trail - Apt 7-E, Mount Pleasant, MI 48858 15 Farmingdale Lane, Newark, DE 19711 412 18th Street, Sunset Beach, NC 28468 515 DeWitt Avenue, Harrisburg, PA 17109 2700 N. Highway AIA - Apt 4-101, India Atlantic, FL 32903 4281 Nantucket Drive, Mechanicsburg, PA 17050 c/o Donald J. Koser, Jr., 412 18th St, Sunset Beach, NC 28468 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: April 26, 2002 6 Clouser Road Mechanicsburg, PA 17055 Telephone: (717) 766-0209 Counsel for Personal Representative IN RE: ESTATE OF FRANCES B. KOSER STATE OF PENNSYLVANIA IN THE REGISTER OF WILLS COURT: CUMBERLAND COUNTY ESTATE NO. 21-02-268 STATEMENT OF CLAIM 1. MBNA America hereby presents for filing against the above estate this statement of claim in the amount of $ 8,805.50. 2. The basis for the claim is MBNA account number 4264299069470426 which was opened on 05-22-96. 3. The tax identification number of the claimant is 510331454. The name and address of the claimant is MBNA America, 1000 Samo~t Drive, Wilmington, DE 19884. ' 5. This claim IS NOT contingent. 6. This claim IS NOT secured. 7. The last payment made on the account was $127.00 on 03-06-02. :-~ Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true, to the best of my knowledge and belief. Executed this ~>~ / day of ~'"~ ,2002 ATRINA M. WOOTTEN Claimant State Of Delaware, County of New Castle IN WITNESS WHEP~F, I have set my hand and notarial seal this ~/ dayoftx-,,~~ ,2002 Nota~ Public X165-1 FRANCES B*KOSER POST REFERENCE PAYMENTS AND CREDITS 0306 06561139987 PURCHASES AND ADJUSTMENTS 0312 000884524085001 CUSTOMER INFORMATION SYSTEM 06/21/02 * 4264299069470426 * 14:39:44 CURBAL: 9167.72 CYCLE: 11 N 0000000000000000 CR LIN: 17300.00 STATUS: 5 CHANGED: 03/19/02 MARCH STATEMENT ***************************** TRAN DESCRIPTION. BC .... AMOUNT .... PAYMENT - THANK YOU 127.00CR 0312 CR PROT FEE @ .8500 PER 1 C 75.18 PREV BAL - PAY + $8823.19 $127.00 PF10=PAGE FORWARD PFll=TRANSACTION SUMlW_ARY 4-© 3 MBNAIS MARCH SALE + $75.18 CASH + F/C $0.00 $109.31 PF09=APRIL STMT PF18=FEBRUARY STMT STATEMENT ***************************** ='~ BAL PAl=BEGIN 188G~~68 1 PA2=SYSTEM MENU ACOT 192.168.14.20 WDA41R63 2/31 X165-1 FRANCES B*KOSER CR POST REFERENCE PAYMENTS AND CREDITS 0523 143AJ056697 CUSTOMER INFORMATION SYSTEM 06/21/02 * 4264299069470426 * 14:39:51 CURBAL: 9167.72 CYCLE: 11 N 0000000000000000 LIN: 17300.00 STATUS: 5 CHANGED: 03/19/02 JUNE STATEMENT ***************************** TRAN '-DESCRIPTION BC ---~ 0523 CREDIT PROTECTION AJ JUNE STATEMENT PREV BAL - PAY + $9111.62 $75.18 SALE + $0.00 CASH + F/C $0.00 $131.28 PF10=?AGE FORWARD PFll=TRANSACTION SUMMARY 4-© 3 MBNAIS PF06=MAY STMT PF09=APRIL STMT = ~ BAL $9,~72 192.168.14.20 WDA41R63 2/31 IN RE: ESTATE OF FRANCES B. KOSER STATE OF PENNSYLVANIA IN THE REGISTER OF WILLS COURT: CUMBERLAND COUNTY ESTATE NO. 21-02-268 STATEMENT OF CLAIM 1. MBNA America hereby presents for filing against the above estate this statement of claim in the amount of $ 9,913.00. 2. The basis for the claim is MBNA account number 4264298381596298 which was opened on 02-01-80. 3. The tax identification number of the claimant is 510331454. The name and address of the claimant is MBNA America, 1000 Samoset Drive, Wilmington, DE 19884. :.; ~- This claim IS NOT contingent. This claim IS NOT secured. The last payment made on the account was $154.00 on 03-06-02. Under penalties of perjury, I declare that I have read the foregoing, and the facts ali~ged true, to the best of my knowledge and belief. KAT~A M. WOOTTE~ ' ' ~NA America Claim~t State O~ De]a~e, Cou~t~ of New Castle ~ WI~SS ~~F, I have set my h~d and not,iai seal ~is day My Commission Expires:~ ~~~~ ~~ Notary Public X165-1 CUSTOMER INFORMATION SYSTEM 06/21/02 * 4264298381596298 * 14:37:06 FRANCES B*KOSER CURBAL: 10372.65 CYCLE: 12 N CR LIN: 15000.00 STATUS: 5 CHANGED: 03/19/02 MARCH STATEMENT ***************************** POST REFERENCE TRAN DESCRIPTION. BC ---AMOUNT--- PAYMENTS AND CREDITS __ 0306 06561105632 PAYMENT - THANK YOU 154.00CR MARCH STATEMENT PREV BAL - PAY + SALE + CASH + F/C = NEW BAL $9924.77 $154.00 $0.00 $0.00 $142.23 $9913.00 PF10=PAGE FORWARD PFll=TRANSACTION SUMMARY 4-© 1 MBNAIS PF09=APRIL STMT PF18=FEBRUARY STMT PAl=BEGIN AGAIN 1 PA2=SYSTEM MENU IFDI, 192.168.16.20 WDA4307C 2/31 LAW FroM BALOGH BECKER, LTD. JAMES A. BALOGH - MN GARY W. BECKER - DC, FL, IL, MN, WI MICHAEL C. CONN - MN CHELSEA A. JAGUSCH - MN, WI ANGELA M. HORN - MN MICHAEL D. JOHNSON - MN 4150 OLSON MEMORIAL HIGHWAY, SUITE 200 MINNEAPOLIS, MINNESOTA 55422-4804 TELEPHONE 763-852-8440 FAX 763-852-8499 TOLL-FREE 888-762-9997 07/24/02 OF COUNSEL: LITOW LAW OFFICES, P.C. 0OWA) LUSTIG, GLASER & WILSON, P.C. (MASSACHUSETTS) CUMBERLAND COUNTY COURTHOUSE 1 COURTHOUSE SQUARE, #102 CARLISLE, PA 17013 Re: In the Estate of FRANCES B KOSER ~ Probate Case No. 21-02-268 Social Security No: 186344754 : Last known residence: 101 E ELMWOOD AVE MECHANICSBUR~I~PA 17055 Our Client: SEARS, ROEBUCK AND CO. Account Number: 5484064651905 Amount of Debt: 3586.70 Dear Sir or Madam: Enclosed please find a Creditor's claim to be filed in the record with the above-referenced Estate. Please remm a file stamped copy of the claim in the enclosed self-addressed, stamped envelope. Thank you for your assistance. If you have any questions or concerns, please call our finn toll flee at 1-888-762-9997. Cordially, /s/Chelsea Jagusch Balogh Becker, Ltd. Attorneys for Claimant Enclosures If applicable, a check for the filing fee cc: Attomey for Estate Personal Representative This communication is l~om a debt collector. PCRTCOV 2101 7/22/2002 778523 COMMONWEALTH OF PENNSYLVANZA NO TICE OF CLAIPI COURT OF COMMON PLEAS OF CUMBERLAND .COUNTY ORPHANS' COURT DZVZSZON l:n Re: The Estate of: FRANCES B KOSER Deceased Court File No: 21-02-268 TO: THE CLERK OF THE ORPHANS' COURT DZVZSZOl~otice of claim by creditor, Pursuant to Section 3532(b)(2) of the Probate, Estates, and Fiduciaries Code, 20 PA.C.S.A. §3532(b)(2). l) 3) Claimant's name: SEARS, ROEBUCK AND CO. CIO BALOGH BECKER LTD, 4150 OLSON MEMORIAL Claimant's address: HVVY # 200 MINNEAPOLIS, MN 55422 8887629997 Creditor listed below is the owner and holder of a claim in the amount of $ 3586.70 4) The facts upon which this claim is based is an account for credit evidenced by the attached Affidavit of Account Stated. s) 6) 7) Decedent's address: 101 E ELMWOOD AVE MECHANICSBURG PA 17055 Date of Death: 03/05/02 That the claim arose prior to the death of the decedent on or about 8) That the claim is secured by On behalf of the claimant, ! do solemnly declare and affir/m0under the penalties of perjury that they Information and representations mac~' he, rein are true and correct to the best of my knowledge, information and belief./ t Dated.'~/~J/0 2/// ~ ~laima,~'~g-~sch/Angela M. Horn Attorney Written notice of claim was given to Personal Represen~tive and/or his/her counsel as stated below: FRANCINE A BOWEN Name 4281 NANTUCKET DR Address MECHANICSBURG PA 17050 City/State/Zip _See attached Affidavit of Nailing Date notice mailed IN RE ESTATE OF: FRANCES KOSER AFFIDAVIT OF ACCOUNT The undersigned, being first duly swom deposes and states the follows: 1. Your Affiant is authorized by the Claimant as its Attomey-In-Fact to make this Affidavit. Your Affiant has reviewed the account records of the Claimant with respect to the decedent. Your Affiant is familiar with these records and accounts and reviews them as a regular part of her duties. The Decedent purchased merchandise in the amount of $3,586.70 evidenced by account number 5484064651905. The unpaid balance does not include any post-death late payment charges, accrued interest, collection costs or attorney's fees. Further your affiant sayeth not BAL~CKER, LTD. ~)Yn; ~fits a~ Mic.hael C,/--Conn _ / Chelsea A. Jagusc~ ~ Angela M. Horn Michael D. Johnson 4150 Olson Memorial Highway., Suite 200 Minneapolis, MN 55422-4804 763-852-8449 Subscribed and sworn befi 'e me This ~) day of.~ffL ~L4 ,2002. //Not ubli~ - -- AFFIDAVIT OF MAILING I, Lucille Roberts , declare under penalty of perjury that on ~>~ '0 ~ , I placed the envelope for collection and mailing on the date and place shown below following our ordinary business practices. On the same day that correspondence is placed for mailing, it was deposited in the ordinary course of business with the United States Postal Service in a sealed envelope with postage fully prepaid. Personal Representative: FRANCINE A BOWEN 4281 NANTUCKET DR MECHANICSBURG, PA 17050 Attorney for Estate: CHARLES E SHIELDS III 6 CLOUSER RD~ ~D M~.AN CSBURG, PA 1 5 BALOGH BECKER, LTD ATTORNEYS AT LAW 4150 OLSON MEMORIAL HIGHWAY, SUITE 200 MINNEAPOLIS, MINNESOTA 55422 ADDRESS SERVICE REQUESTED IN THE COURT OF COMMON PLEAS, CUMBERLAND COUNTY PENNSYLVANIA ORPHANS' COURT DIVISION ESTATE OF FRANCES B KOSER ) ) Register's # 2102268 Deceased ) CLAIM To the Clerk of the Orphans' Court Division: Index and make proper entry in your official records of the claim of CI~BANK(SOUTHDAKOT~ NA in the amount of $3~682.00 against the estate of the above-named decedent. This claim is filed under Section 3532 (b) (2) PEF Code, 20 Pa. C.S. ss. 3532 (b) (2) . The said decedent, whose last known residence was at ELN~VOOD AVE MECHANICSBURG PA 170554244 lOl E Written notice of this claim was given to Executor, 4281 NANTUCKET DR MECHANICSBURG, PA 170500000 FRANCINE A BOWEN on October29. 2002. ~ l~imant ) KRISTEN WELLS, Manager of Citicorp Credit Services, Inc.,USA under limited power of attomey for CITIBANK SOUTH DAKOTA) NA 930 NW 110 Street, Kansas City, MO 64153 (Claimant's Address) 10/28/2002-210 Acct. 95398410000845636 Y6fir AT~ Universal Card Statement March 1 - March 29, 2002 Pa][e 1 of 2 FRANCES B KOSER Account 6398 4100 0084 15636 Calling Card + PIN No Annual Fee/Platinum Card How to Reach Us Account Online: www.universalcard.com Account OnCall: 1 800 636-8330 (For Automated Service Only) Customer Service: 1 800 423-4343 or write Cardmember Services, PO Box 44167 Jacksonville, FL 32231-4167 Minimum Payment Due ................................... ~154.00 Due Date*, ................................... april 23, 2002 *Payment must be received by 1:00 pm local time on the payment due date, Amount Past Due ............................................ ~6.00 Credit Line .............................................................. $7,060.00 Available Credit ........................................................ $0.00 Cash Advance Limit .............................................. $4,000.00 Available Cash Advance Limit ..................................... $0 .00 Previous Balance $3,682.00 Payments and Adjustments 0.00 MasterCard® Activity 108.20 Total AT&T Services 0.00 New Balance Note: Detailed activity starts on pa~e 2. The Annual Percentage Rate on your account may increase due to one of the followin~ reasons stated in your Card A~reement with us: if you fail to make a payment to us or any other creditor when due, you exceed your credit line or you make a payment to us that is not honored by your bank. $3,790.20 Payment Record Amount Paid: Date Paid: Check Number: Please follow payment instructions in the "Important Instructions for Making Payments" section of the original statement. ^coount Number I Payment Dua I ,ew Ba,ance i ,inimum Pevmentl $ Enter ^mount EncloseO 5398 4100 0084 5636 04/23/02 $3,790.20 $ 154.00 Make changes to address and phone number below: Apr./Suite IAddress City Home phone ( ) 0 XX 539861 20 O0 C FRANCES B KOSER 101 E ELNWOOD AVE NECHANTCSBURG PA 17055-6266 State Zip Business phone ( ) Make check payable to: A T& T Universal Card PO BOX 8220 SOUTH HACKENSACK NJ 07606-8220 53981 00008156360000 51000003790202 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF iNDIViDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 001949 SHIELDS CHARLES H III ESQUIRE 6 CLOUSER ROAD MECHANICSBURG, PA 17055 ........ fold ESTATE INFORMATION: SSN: 185-12-9569 FILE NUMBER: 21 02-0268 DECEDENT NAME: KOSER FRANCES B DATE OF PAYMENT: 12/16/2002 POSTMARK DATE: 12/14/2002 COUNTY: CUM BERLAN D DATE OF DEATH: 03/05/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $901.64 TOTAL AMOUNT PAID: $901.64 REMARKS: FRANCINEA BOWEN C/O CHARLES E SHIELDS III ESQ SEAL CHECK//1034 INITIALS: CW RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS REV-1500 EX (64)0) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 q~ HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN O0 RESIDENT DECEDENT DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) K o ~-~, F~',¢,vcE. s ...-~. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 03- OS- 2~Cz /o -ZB- (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) OFFICIAL USE ONLY /7- C., THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER - - SOCIAL SECURITY NUMBER tg.5' - t Z [~1. Original Return ~'--~ 4. Limited Estate ~1 6. Decedent Died Testate (Attacl~ copy of Will) r-'~ 9. Litigation Proceeds Received [~2. Supplemental Return E~4a. Future Interest Compromise (date of death after 12-12-82) r--] 7. Decedent Maintained a Living Trust (Attach copy of Trust) [~] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) [~]3. Remainder Return (date cf death pdor to 12-13-82) --]5. Federal Estate Tax Return Required ! 8. Total Number of Safe Deposit Boxes ---]11. Election to tax under Sec. 9113(A) (A,ac, Sch O) NAME C ~I ~L ~. /.. E~ ,~". ~H/ E~S ~ FIRM NAME (if Applicable) TELEPHONE NUMBER '7/'7 -- 7~ -- ~2 DC~ COMPLETE MAILING ADDRESS / Tz~ J-,.T 14. 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) --]Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) (13) (14) (8) ~/, 7~/. Vq ~ ~, ~t~.o~ OFFICIAL USE ONLY ~ / ? , 5'57, o/ 419, 5~'7.oI 15. 16. 17. 18. 19. 20. SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) Amount of Line 14 taxable at lineal rate Amount of Line 14 taxable at sibling rate Amount of Line 14 taxable at collateral rate x .0 ¢ (15) 1¢~ 5~'-/./¢/ x .o ,-,,s" (16) ,,d x .12 o71 ~ /.oe~ x .15 08) (19) Tax Due ?P.~, qb" . Is" FILE NUMBER COUNTY CODE YEAR NUMBER Decedent's Complete Address: STREET ADDRESS / ~ / ~-'v,j~.$ "]" ~,~,f ~ ~ o ~) .ajZ$"~/V'g~'~" ' ' CITY '/~ ~--v4/'d/v'/'C'~' ~ Ac ~"""""""";' I STATE ,~2~,~ ZIP / 743 ~""..~'- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Pdor Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C Total Interest/Penalty ( D + E If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (2) ~ ~'~/.~'¢ A. Enter the interest on the tax due. (3) ~ 0 (4) 0 (5) (EA) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT IF THE ANSWER PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; .......................................................................................... [] [] b. retain the dght to designate who shall use the property transferred or its income; ............................................ [] [] c. retain a reversionary interest; or .......................................................................................................................... [] [] d. receive the promise for life of either payments, benefits or cam? ...................................................................... [] [] If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. [] [] Did decedent own an "in trust for" or payable upon death bank account or secudty at his or her death? .............. [] [] Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [] TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. DeclaretJon of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF. jpERSON RESPONS~.)E F/~R FILING RETURN DATE ADDRESS ~,~'/VC/'/V~" SIGNATUREDF PREPARER OTHER THAU REPRESENTATIVE ADDRESS CH,q,t~./_,~ ~ ~bt'/~:~._~Z~..~ .b~ , ~$~. DATE For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. {}9116 (a)(1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneticiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 RS. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF ~'D $ &~'/~, ~' ,q/YC ~'J' ._,.,.,.~. FILE NUMBER ~/- ,o.7 - ~7~ All real propeAy owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the pdce at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH Tax Parcel # MADE THE ,,77~ day of and two (2002). THIS INDENTURE ...... in the year of our Lord two thousand BETWEEN FRANCINE A. BOWEN, Executrix of the Estate of FRANCES B. KOSER, Deceased, late of the Borough of Mechanicsburg, Cumberland County, Pennsylvania, Grantor AND LISA M. CLARKE, of the Borough of Mechanicsburg, Cumberland County, Pennsylvania, Grantee. WHEREAS, the said Frances B. Koser was vested in her lifetime with title to the premises hereinafter described in the Borough of Mechanicsburg, Cumberland County, Commonwealth of Pennsylvania; and WHEREAS, the said Frances B. Koser died, testate, on the 5th day of March, 2002, and Letters Testamentary were duly issued to Francine A. Bowen, as Executrix, and docketed to No. 21-02- 0268; and WHEREAS, the lands herein-mentioned were not specifically devised. NOW, THEREFORE, THIS INDENTURE WlTNESSETH, that the said Francine A. Bowen, Executrix, as aforesaid, for and in consideration of the sum of ONE HUNDRED FOURTEEN THOUSAND NINE HUNDRED and No/100 ($114,900.00) DOLLARS and other good and valuable considerations, to her in hand paid by the said Lisa M. Clarke, at and before the ensealing and delivery hereof, the receipt whereof is hereby acknowledged, has granted, bargained, sold, aliened, released, and confirmed, and by these presents, by virtue of the power and authority in her vested by the Fiduciaries Act of the Commonwealth of Pennsylvania, does grant, bargain, sell, alien, release, and confirm unto the said Lisa M. Clarke, her heirs and assigns, ALL THAT CERTAIN plot of ground situate in the Second Ward of the Borough of Mechanicsburg, County of Cumberland and State of Pennsylvania, bounded and described as follows, to wit: BEGINNING at an iron pin on the curb line on the north side of East Elmwood Avenue at the intersection of the curb line of the east side of South Arch Street; thence along the curb line of said South Arch Street North thirteen (13) degrees nine (9) minutes west eighty-two and two-tenths (92.2) feet to an iron pin at the comer of property now or formerly of Victor L. C. Hasskarl; thence along the line of said property now or formerly of Victor L. C. Hasskarl north eighty (80) degrees east one hundred nineteen and two-tenths (119.2) degrees feet to an iron pin; thence along the land of same south ten (10) degrees east eighty-two and one-tenth (82.1) feet to an iron pin on the curb line of the north side of East Elmwood Avenue aforesaid; thence along the curb line of said East Elmwood Avenue South eighty (80) degrees west one hundred fourteen and nine-tenths (114.9) feet to an iron pin on the curb line of the east side of South Arch Street, the place of BEGINNING. BEING THE SAME PREMISES which Mildred L. Seifert, single woman, by deed dated May 29, 1970 and recorded June 1, 1970 in the Recorder's Office in and for Cumberland County, Pennsylvania, in Deed Book "Q," Volume 23, Page 614, granted and conveyed unto Donald J. Koser and Frances B. Koser, his wife. The said Donald J. Koser departed this earthly life on January 8, 1980 whereupon full and absolute title became vested in the said Frances B. Koser, his wife, by virtue of the laws of Pennsylvania incident to tenancies by the entireties. SUBJECT TO: Easements and restrictions of Prior Record and holding rights and usages to easements of Prior Record. TO HAVE AND TO HOLD the said messuage or tenement and tract of land, hereditaments and premises hereby granted and released, or mentioned and intended so to be, with the appurtenances unto the said Grantee, her heirs and assigns, to and for the only proper use and behoof of the said Grantee, her heirs and assigns, forever. AND THE SAID GRANTOR, Executrix as aforesaid, her heirs, executors and administrators, does covenant, promise and agree to and with the said Grantee, her heirs and assigns, by these presents, that the Grantor has not done, committed any act, matter or thing whatsoever whereby the premises hereby granted, or any part thereof, is, are, shall or may be impeached, charged or encumbered in title, or otherwise howsoever. IN WITNESS WHEREOF, the said Executrix of the Estate of Frances B. Koser, deceased, Grantor herein, has hereunto set her hand and seal the day and year first above written. WITNESS: FRANCINE A. BOWEN, Executrix Estate of FRANCES B. KOSER, Deceased COMMONWEALTH OF PENNSYLVANIA : :SS. COUNTY OF CUMBERLAND : On this, the o77/~ day of ~. , A.D. 2002, before me, a Notary Public, in and for said County and State,'the undersigned officer, personally appeared FRANCINE A. BOWEN, known to me (or satisfactorily proven) to be the person described in the foregoing instrument, and acknowledge that she executed the same in the capacity therein stated and for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. Notary Public My Commission expires: (SEAL) CERTIFICATE OF RESIDENCE I do hereby certify that the precise and exact post office address of the within Grantee is: Attorney for Grantee A. S~efflement Statement u.s. Department of Housing and Urban Development ~ 'Il' OMB No. 2502-0265 B. Type of Loan 1' [] FHA 2' ~-) FmHA 3' E] C°nv' Unins'lFile NumberCl arke IL°an Number704765687 Mortgage Insurance Case Number 4. [] VA 5. [] Cony. Ins. C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "p.o.c." were paid outside of closing; they are shown hare for informational purposes and are not included in the totals. ~!:::.N~:~N~i:.~P~i::~:.i::ie~B~ ~ ~i ~ ::::::::::::::::::::::::::::::::::::: E. NAME AND ADDRESS OF SELLER: Estate of Frances B. Koser (Seller TIN - ) 101 East Elmwood Avenue, Mechanicsburg, PA 17055 G. PROPEFITY 101 East Elmwood Avenue LOCATION: Hechan~csburg, PA 17055 I. SI:I ILEMENT DATE: September 27. 2002 J. SUMMARY OF BORROWER'S TRANSACTION ~ ~::~! G ROSS ~ A MOU N~:::. D 0 E:. FROM::. B~J~O~R?:i~ 102. Personal property i~i:~i~i~i i~i~ 104. 402. Personal property ~i:: ii::ili i::?:?::.ii: :.::::ii 404. ADJUSTMENTS FOR ITEMS PAID BY SELLER IN ADVANCE: lO7. Cou.ty taxe, 9/27/02to 12/31/02 91.20 i:. ii~i ~i~i::::i::i~i::?:~i::?.:::::. ~:i::.:i i ~!~2 ~. ii,::~.~. ~.~.:: ~ 109, 111, 120,797.04 120. GRO~ AMOUNT DUE FROM BORROWER: 407. County taxes 9/27/02 to 12/31/02 91.20 409. 411. 420. GROSS AMOUNT DUE TO SF~ ~ FR: 115,858.13 201. Deposit or earnest money 1,000.00 501. Excess deposit (see Instructions) 203. Existing loan(s) taken subject to 205. 207. 209. 509. ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: ADJUSTMENTS FOR ITEMS UNPAID BY SELLER: 210. City/town taxes to 510. city/town taxes to i03. Existing loan(s) taken subject to 505. Payoff of second mortgage loan 507. 212. Assessments to 214. 216. 218. : ~: :: ::i:: :::.:: :. i::iiiii::::?:?:::ii::i::::::ii: ii:: i i:i:. iii i::i?: :ii::: i :::::::::::::::::::::::: i:!:: i ?.iiiii::iiii? 2~0. TOTAL PAiD BY/FOR BORROWER: 117,203.00 ~i:? O:AS:~ :.A Ti i~ii i;i EE~E~ ~0~O: i~l~O~E~ii :::: ?::i i: i ii i::ii:i:i ii ?:i?ii ?:?iii::?:i::i:. 301. Gross amount due from borrower (line 120) I 120.797.04 303. CASH ()~]FROM) ( 0 TO) BORROWER: I 3,594.04 I 512. Assessments to 514. 516. 518. 520. TOTAL REDUCTIONS 48. 575.08 IN AMOUNT DUE SELLER: 601. Gross amount due to seller Iline 420) ! 115,858.13 O03. CASH (~'T~TO) (DFROM) SELLER: [ 67.283.05 HUD-1 (3-86)- RESPA, HB 4305,2 PAGE I HUD-1 IRev. 3/861 OMB No. 2502-0265 700. TOTAL SALES/BROKER'S COMMISSION BASED ON PRICE $ 114.900.00 ~ ~ - 6.744.00 702. ~ to PAID FROM BORROWER'S FUNDS AT SETTLEMENT PAID FROM SELLER'S FUNDS AT SETTLEMENT 704. 800. ITEMS PAYABLE IN CONNECTION WITH LOAN: 802. Loan discount 804. Credit report to: PRMI 35.00 806. Mort.qa,qe insurance application fee to 8o8. FHA UFMIP 16.84.7.! .. 81o. Flood Certification to PRMI 13.50 900.' ITEMS REQUIRED BY LENDER" TO BE' PAID IN' ....... ADVANCE:' 902. Mort~a~e insurance premium for mos. 1000. RESE:HVES DEPOSITED WITH LENDER: 1002. Mort a · insurance months @ $ per month 1004. Count roert' taxe 6 months o $ 28.45 per month 1006. Flood insurance months @ $ per month 1008. months @ $ per month 1100. TITLE 1101. Settlement or closinl~ fee to 1103. Title examination to 1105. Document preparation to 1107. Attorney's fees to (includes above items Numbers: 1100. Lender's covers · 113 998.00 ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: 1111. Endorsements 100 300 900 ($ 113 1113. 1200. REC( ,so4. MERS Ass~qnment Fee- PRMI J ~ ~ I 13~. ADDITIONAL ~m~LEMENT CHARGES: 1802. Pest inspection to Terminex International 1304. Home Warranty-Home BuTers Resale Warrant~ ~os. 2002 County/Bore Tax 1400. TOTAL SETTLEMENT CHARGES 35.00 369.00 383.19 4.938.91 10.266.51 I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or :,y/~in this traneactlon.,~rther certify that I have received a copy of the HUD-1 Settlement Statement. Date: 9/27/02 Agent: ,J~H¢,~ [~ ~ ~- o~.: 9/27/02 Borrow~z ' ~ Lfsa*M. ~arke~ ~ Estate of Frances B. Koser Seller or Borrower: Date: Agent: Date: Thewith HUD-lthis statement.Settlement Statement which I have prepared Is a true and accurate account of this transactlon~(~ause the funds to be disbursed In accordance ............... Date: ~ ~- Settlement Age?: ~ Date: 9/27/02 / Fens~Pr'~acher and Associates WARNING: It is a crimo to knowingly make false statements to the United States on this or any opler 81mllar f~rm, Ponat os upon conviction can Include a fine and Imprison- mont. For details soo: Title 18 U.S. Code Section 1001 and Section 1010. REV-1508EX+{1-97)~~ COMMONWEALTH OF PENNSYLVAN$^ INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER ,~/-o.~ !nciude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disc~nsed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. ,,~ . :T.n~'. ~,r_~r. ~ d.o. et. o,, -T-t-em I. ,o7 1.19 Ve~,'cle ~3.~ l~l Aw81 WIJb ~lqlg~ TOTAL (Also enter on tine 5, ~apitulation) $ /0/~. ~7 (If more space is ne~, inse~ additional s~ts of the same size) Pers'onal ~roperty of APPRAISAL Appraised by Chuck E. Bricker AU094-L Date ~ ~?~_~~_ ITEM VALUE ITEM VALUE r'-/~/As z/~ ~c ~,~ ~ [ PNCBAN<. June 18, 2002 Charles E. Shields, III 6 Clouser Road Mechanicsburg, PA 17055 RE: Estate of Frances B, Koser, deceased SSN: 185-12-9569 DOD: 3/5/2002 Dear Mr. Shields: In response to your request for Date of Death balances for the customer noted above, our records show the following: Checking Account Account #5070081099 FRANCES B KOSE'R DOD balance: $1,537.61 4- $0.07 accrued interest Established 03/l 2/t 980 Savings Account Account #5030058417 FRANCES B KOSER DOD balance: $3,490. [3 + $1.14 accrued interest Established 03/01/1980 Please note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not process any financial transactions or provide statements. If you need assistance with any of ~ese items, please call 1-885-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branct~ office. Sincerely, Rachelle Wells 1-800-762-1775 PT-PFSC-04-F 500 flint Ave. Pittsburgh PA 15219 M eml~ex FDIC Kelley Blue Book Used Car Values 10/10/02 9:22 AM Blue Book New Car Pricing Build a Car Incentives My Car's Value Used Car Retail Free Price Quote Buy a Used Car Sell Your Car Motorcycles Financing Insura ncc Lemon Check Warranties Accessories Car Reviews Car Previews Decision Guides Advice About kbb Home The Trusted Resource Repairs. [BreakdoWnI Maintenance J Savings Blue Book Private Party Report Pennsylvania · October 10. 2002 1988 Chevrolet Celebrity Wagon 4D Engine: V5 2.8 Liter Trans: Automatic Drive: Front Wheel Drive Mileage: 5,000 Equipment Air Conditioning Power Steering AM/FM Stereo Buy a New Car Buy a Used Car List Your Car For Sale Online Free Lemon Check Financing Quote Znsurance Quote Warranty Quote Print "For Sale" Siqn Payment Calculator Consumer Rated Condition: Good "Good" condition means that the vehicle is free of any major defects. The paint, body and interior have only minor (if any) blemishes, and there are no major mechanical problems. Tn states where rust is a problem, this should be very minimal, and a deduction should be made to correct it. The tires match and have substantial tread wear left. A clean title history is assumed. A "good" vehicle will need some reconditioning to be sold at retail; however major reconditioning should be deducted from the value. Most recent model cars owned by consumers fall into this category. Private Party Value $1,100 Private Party value represents what you might expect to pay for a used car when purchasing from a private party. It may also represent the value you might expect to receive when selling your own used car to another private party. Get a Used Car Trade-In Value v[ ..... II.L IIII1_1. _ Get Znvoice & MSRP on New Cars Copyright © 2002 by Kelley Blue Book Co., All Rights Reserved. Sep-Oct 2002 Edition. The information in this report was printed from the Kelley Blue Book Web site (www.kbb.com) and is http://www.kbb.com/kb/ki.dll/kw.kc.ur?kbb; 154320;PA041 &;p&723;Chevrolet; 1988%20Celebrity& 15 ;CH;O3 Page ! of 2 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATEOF bT'o s~-/~, )=/G~MC~:.~ ~ FILENUMBER o~,I-DP, - Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. 1. FUNERAL EXPENSES: /~ bL FE ZZI Fru/VE,~Z Hb/~'~' DI:r lr/E E/.t~ /V/ C$ ~ e4/~C_B ~ ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) / FIN Number of Personal Representative(s) Street Address /-// ~ ~ / ,~/~Z/l/ 7"~ /,b z -~ b - ?.z / ¢ Year(s) Commission Paid: o,~Zg~ P- Attorney Fees C/e-//~/~ZE,.,C ~. S/-///~-7_.Z)..~' ~ / ~..~. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant /Y'~/~"~'- ~"//~'/,~/_ ~- Zip Street Address City Relationship of Claimant to Decedent Probate Fees Accountant's Fees State __ Zip Tax Return Preparer's Fees H ~/~ Z~'/-~e/(' (e.~'~.) ,4 a'd,'3 'o,, ,, / ,s /,o,,t ,.~hE'e~.~/ TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insefl additional sheets of the same size) .9, A/O al E 'Q3 lb. oo ~e 76. aa m. X~r~,/ ~,~/~c~ 3l 33. $~. $~. F.p, 20~. oo Vt .p 9..T. oo ~1, .5 ~B. oo ct. o o GEORGE M. I-IOUCK (1912-1991) CHARLES E. SHIELDS, III A TTORNEY-A T-LA W 6 CLOUSER ROAD Corner of Trindle and C lou~er Roads MECHANICSBURG, PA 17055 TELEPHONE (717) FAX (717) 766-0209 795-7473 October 2,. 2002 Malpezzi Funeral Home 8 Market Plaza Way Mechanicsburg, PA 17055 Re: Koser Estate Dear Mr.Malpezzi, Enclosed is a check in the amount of $3669.00 drawn on the Frances B. Koser Estate in payment of your invoice dated April 17, 2002. Thank you for your assistance with this. CES:dab Very truly yours, Charles E. Shields, III ESTATE FRANCES KOSER FRANCINE A. BOWEN, EXECUTRIX 4281 NANTUCKET DRIVE MECHANICSBURG, PA 07050-7650 Pay to the Order of . i .PNCBAN( PNC Bank, N.A. 040 Central PA For 1015 April 17, 2002 Francine Bowen 4281 Nantucket Dr. Mechanicsburg, PA 17050 Malpezzi Funeral Home 8 Market Plaza Way Mechanicsburg, PA 17055 (717)697-4696 The Funeral Service for Frances Koser We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. 1. PROFESSIONAL SERVICES Services of Funeral Director/Staff ................... $3260.00 FUNERAL HOME SERVICE CHARGES ............ $3260.00 SELECTED MERCHANDISE: Steel Protective Casket $1750.00 Register, Memorial Cards, Ackn. $45.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED ............... $5055.00 AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES. CASH ADVANCES Clergy/Mass Offering. ...................... Organist. Certified Copies of the Death Certificate ................. Flowers ........................... TOTAL CASH ADVANCES AND SPECIAL CHARGES ........ CONTRACT PRICE ................... HISTORY 04/09/2002 Americo ....................... TOTAL AMOUNT DUE .................. $100.00 $75.00 $32.00 $132.50 $339.50 $5394.50 $-1725.23 $3669.27 PROPOSAL ANI ACCEPTANCE PROPOSAL SUBMt~ ~eu TO STREET ;,q~;~4¢ ~ :~. [~ '-~' ........ :-. CITY, STATE AND ZIP CODE A~CHITECT IDATE OF PLANS PHONE ~'7% ~,;~ , ;.; .~ £':' JOB NAME JDATE !? JOB LOCATION JOB PHONE We hereby submit specifications and estimates for: ~': ~ ~;~' ' ' ; ""L , ~' ~ -~ . . ~ .~. ~..~z....*.=..=~.. r~,~ ............. .--~-~.:,~ ........................................................................................................... ................ ~-~-'~ -.~ ........... *=...:~ ............ ,,.~,~= .................. ~.~.t ~ .................. [,~,.~..2., ................. 2~}~¢,_x ............................................................................................................................................................................ ................................................................................................................... ~L.':,,:~ ............ ~;;-.;..~..~,;;:,.L~,:~.::'...~ ............... :" ...~ ....... : ........... ........................................................................................................................................................................... : .......... ........ ............................................................................................................................................................................................. ............... ., ................... ........... Payf~ent to be made as foll6w~: We Propose hereby to furnish material .and labor--complete in accordance with above specifications, for th~_.~m of: t'~:~ ~ .....· ...... , ' dollars ($ All material is gm, iunleed to be as specified. All work to be completed in a workman- Authorized i'. 'i! ,! i Signature " :'2 ~ ........ z...--..- :~ '~. ",: Note: This proposal may be withdrawn by us if not accepted within like manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders, and will become an extra charge over and above the estimale. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance. Our workers are fully covered by Workmen's Com- pensation Insurance. days.. Acceptance of Proposal -The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance ;;~' !? "' .' ";? Signature ESTATE FRANCES KOSER FRANCINE A. BOWEN, EXECUTRIX 4281 NANTUCKET DRIVE MECHANICSBURG, PA 07050-7650 Date 1013 041 Pa), to the O PNCBAN<' PNC B~ N.~ C~al PA ~:D3~E?3~. SOD3~OO~,' ~0~,3 000 012 i0-:L1'39 , i0-00 ':' 10 '. O© i 50 ~' iSg -'. DONALD J. KOSER, JR. DARLENE M. KOSER 412 lgTH STREET SUNSET BFZtCH, NC 28468 Date C/.. [. 0 ~ Pay to the ' BankefAmerica. MILLER'S · Floor Sending · 2633 Reel Street · Harrisburg, PA 17110 (717) 236-0312 INVOICE INVOICE NO. DESCRIPTION AMOUNT ./'2 Please Pay From This Invoice TAX TOTAL - '~'~ (717) 766-~5§2 -II{STALLEO SALE- SALE'; ~: SO~O~[~X 9008§ 06-24-02 09465 STI03 i§6.12 12' CARPET STRATOS E 00 ~ 5.64 62479 663 59.00 OUTDOOR CAAPET ADHES 2 ~ 29.50 [Pt] 10614 253!6 14.97 8L.CONTACT CEMENT 8E [PL] INVOICE 81981 SUBTOTAL: 260.0B -INSTALLED SOS SALE- SALES #: S0405TS2 96080 06-24-02 8896O 329.25 N LABOR CH8 TO INSTALL DETAIL CREDIT 25.00- [DD] ORIB. PO#: 64585 INVOICE 81982 SUBTOTAL: 304.25 -INSTALLED SOS SALE- SALE~ ~: S0405T$2 96068 06-24-02 183097 DETAIL FEE CARPET [DO] ORIG. PO#: 64586 25.00 N INUO!CE 81983 SUBTOTAL: 25.00 iNVOICE 81981 SUBTOTAL: 260.09 INVOICE ~19§2 SUBTOTAL: 304.25 INUOICE B1983 SUBTOTAL: 25.00 SUBTOTAL : 589.34 TAX 38550 : 15.60 BALANCE DUE: LCC ' LCC XXXXXXXXXXXX72B? 1205 AMOUNT: 004.94 604.94 604.94 /"- 001505 .................................... PAINTS & WALLCOVERINGS 10406 TUCKER STREET · BELTSVILLE, MD 20705-2297 1-800-723-8766 IliMrr lo; P.O. BOX 651 BELTSVILLE, MD 20704-065 '"' .... .... ~:' CUSTOMER COPY Receipt of these goods constitutes acceptance of the terms and conditions of sale as set forth on the reverse side. ' ~ CONTRACT Imp~evin8 Home Improvement' INSTALLED SALES APPLIA/NCES CONTRACT / STORE NO, STREET ADDRESS . STREET DDRESS / . , 1 ~ MA, MD -- State License Numbe~ All Other States ~ Lowe's EmPloyee NUmber. ~ / * · AL. CT. FL, MA, MD. NV ff45450 unlimiled. TN ~16066, Ohly. This is a contract between Lowe's (as defined in the Terms and COnditions) ("Lowe's"), and the above-named Customer for the installation of goods at the Customer's residential premises (the "Premises,') at the following installation address: . New Installation []Yes []No Name of Appliance(',..- ~ .Y);.sJl c,J~,.%~fm-- Name of Appliance Name of Appliance Lowe's to arrange the installation of the following appliance(s): Replacement Installation .~.Yes [] No Setting appliance anO cutting Qut io fit (if necessary) [] Yes [] No [lectrical Hookup []Yes ~,~o Plumbing Hookup (it nocossary) [~s [] No Venting (if necessary) [] Yes [] No~'--------~'''''' Repla,ei~ment installation will consist of the following items: Setting in and reconnecting to present electrical, plumbing, and vent pipe (if applicable). This does not include changing or extending present electrical or plumbing lines. Any changes or additions not listed on this contract will be at an additional charge for material and labor. Additional Specifications: The Environmental Protection Agency (EPA) has requested that Uat'ls Lowe's notify installation customers that a lead based paint hazard may exist in dwellings built *Tax prior to 1978. See pamphlet EPA 747-K-99-001 for details. Labor * Wh~,l~er..isl~able; check local tax restrictions. (SOS Labor #88964) NOTICE TO CUSTOMER All items listed in this contract and specification sheet(s) are to be installed under conditions agreed upon at time of purchase and at the price appearing on this contract form. This assumes sound existing substructures, superstructure and points of attachments. Extra labor or material incident to installation necessitated by defective substructures, superstructure, points of attachment, or the moving of fixtures or appliances to be billed at extra cost to customer. DO NOT SIGN THIS CONTRACT UNTIL COMPLETE AND YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS CONTRACT. BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDER- STAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH._O..N._THE REVERSE SlDE'O-~ THIS CONTRACT. YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF- ~~I61~'A-T~/E' .,/'" .__ WITNESS OUR HAND(S) AND SEAL(S) BELOW THIS DAY OF (~, // ~ ,/] /'/-'y/', ____. ~ WITNESS ~ /(~~ (Seal) / ,~,v~n'e r ~ (Seal) Ii' v (Seal) Manager Spouse Customer acknowledges receipt of a true copy of this contract which was completely filled in Prior to Customer's execution hereof. If credit is extended to you, you the buyer may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. See the attached notice of cancellation form for an explanation of this right. 90863 (Rev. 1/02) © 2002 by Lowe's.® Lowe's and the gable design are registered trademarks of LF Corporation. I IN~TALLED SALES SPECIALIST i-~"~RE O. II STREET Home Improvement Warehouse INSTALLED SALES CARPET CONTRACT _rC"_ ,,,., .,, I .2'¢ o CDS,O.ER, .. 01~ ~ STATE ZIP CITY STAT?,~ ZIP '""'- I ! ~IA, ~D ~ State License Number; All ~her 81utes -- Lowe's E~pbyee Number. ' AL, CT, FL, MA. MD. NV ~45450 unlimited, TN ~16066, only. This is a contract between Lowe's (as defined in the Terms and Conditions) ("Lowe's"). and the above-named Customer for the installation of goods at the Customer's residential premises (the "Premises") at the following installation address: STREET ADDRESS _ / ~ · ', A CITY STAT,~ ZIP j /?o-. , x ~/ '~; ....... :' ' '- Lowe's to install Carpet as specified on sheet and drawing ---- as shown. Lowe's will furnish transition molding and clean . Carpet#: ~ ¢;r~'Jv~'V~Ouantity:-~' ~0 ~ Type Installation Tack StriP:up carpet:~ Glue down: ~ Take old Yes ~ No No Haul away old carpeVpad. Yes ~/ Carpet Steps: Yes~ No ~/ : Cu~ing down exterior doors: Yes ~ No~ ~ of doors: Cutting down interior doors: Yes ~ No~ Haul away ol0 0oor. Yos ~ ~o ~o , of Appliances: ~ Moving Refrigerator: Yes ~ No (with ice maked Yes ~ No Moving Furniture: Yes ~ Take up toilet: (& reinstal,) Yesm NO ' *Any work or material not specified is not included in this contract. Any changes or additions will be al an additional charge for the material and * Show size of room(s) where carpet is to be installed. labor. Additional Specifications: The Environmental Protection A~ency (EPA) has requested that Mar'Is kow~'s notff~ installation customers that a load basod paint hazard ma~ exist in dwellings built ~lax prior to 1078. See pamphlot ~ 747-K-~-001 [or details. Cabot *Tax * Where applic~bl~ labor check local t~x r~slrictions. NOTICE TO CUSTOMER All items listed in this contract and specification sheet(s) are to be installed under conditions agreed upon at time of purchase and at the price appearing on this contract form. This assumes sound existing substructures, superstructure and points of attachments. Extra labor or material incident to installation necessitated by defective substructures, superstructure, points of attachment, or the moviRg of fixtures or appliances to be billed at extra cost to customer. DO NOT SIGN THIS CONTRACT UNTIL COMPLETE AND YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS CONTRACT. BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDER- STAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS CONTRACT. YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. WITNESS OUR HAND(S) AND SEAL(S) BELOW THIS __ DAY OF lager ~ (Seal) Owner / Spouse (Seal) (Seal) Customer acknowledges receipt of a true copy of this contract which was completely filled in prior to Customer's execution hereof. If credit is extended to you, you the buyer may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. See the attached notice of cancellation form for an explanation of this right. 90807 (Rev. 7/01) CUSTOMER COPY (717}766-8562 -INSTALLED SALE- SALES fi: S0405TS2 96088 06-27-02 171537 0.00 6LB 7/16" REBOND CAR 135 ~ 0.00 [PL] 46023 74989 3.96 RESIDENTIAL PACK OF [PL] 16641 92569 5.99 1.5"X12'GOLD BINDER [PL] 171539 0.00 7LB 3/8" REBOND CARP 50 @ 0.00 [PL3 INVOICE 82421 SUBTOTAL: 9.95 -INSTALLED SOS SALE- SALES fi: S0405TS2 96088 06-27-02 89107 06558-065-1200-AB 149.76 Select Cho{ce 156 @ 0.96 [PL] 89107 06558-065-1200-AB 161.28 Select Choice 168 ~ 0.96 [PL] 89107 06558-065-1200-flB 161.28 Select Choice 168 @ 0.96 [PL] 89107 OB558-O65-1200-AB 172.80 Select Choice 180 @ 0.96 [PL] 89107 06558-065-1200-flb 138.24 Select Choice 144 @ 0.96 [PL] 89196 06803-5795-15-AB 273.60 Sweet Success Brambl 360 9 0.76 [PL] ORIG. POf: 64705 INVOICE 82422 SUBTOTAL: 1,056.96 -INSTALLED SOS SALE- SALES fi: S0405T$2 96088 06-27-02 8896O 88960 543.96 N LABOR CHO TO INSTALL DETAIL CREDIT 25.00- [DD] 88.44 N LABOR CH6 TO INSTALL [DD] 88960 299.32 N LABOR CH0 TO INSTALL ORI6, PO#: 64~06 INV0ICE 82423 SUBTOTAL: 906.72 INVOICE 82421 SUBTOTAL: 9.95 INOOICE 82422 SUBTOTAL: 1,056.96 INUOICE 82423 SUBTOTAL: 906.72 SUBTOTAL : 1,973.63 TAX 38550 : 64.02 nnl nHFP llllF' ?.ll'~7 6~ RE~.$512 E~ * (147) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER AMOUNT Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. ~ q&bq ~fqo ~fq7 TOTAL (Also enter on line 10, Recapitulation) ,5'7 ~oc, s 6 3, S"2~- o,7 (If more space is needeci, insert additional sheets of the same size) REV-1513 EX + {I-97} ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATEOF ~O,.SE~, ~'~'/'J~S ~' FILENUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS (include outdght spousal distributions) II. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) L&ST WILL AND TESTAMENT OF FRANCES B. KOSER I, FRANCES B. KOSER, of the Borough of Mechanicsburg, County of C~nberland and State of Pennsylvania, being of sound and dis- posing mind~ memory and understanding, do make, publish and de- clare this my Last Will and Testament. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. i give, devise and bequeath all the rest, residue and remainder of my estate, of whatsoever nature and wheresoever the same may be situated, to my husband, Donald J. Koser, absolutely and uncon- ditionally. In the event that my husband, Donald J. Koser, should predecease me~ or should he die at about the same time as I do, such as in an accident common to both of us, then in such event, I direct the settlement and distribution of my estate to be made in the following manner~ to wit: Ao I give and bequeath the sum of One Thousand ($1,000.00) Dollars to my daughter, Francine A. Bowen. B. I give and bequeath the sum of One Thousand ($1,000.00) Dollars to my son, Donald J. Koser, Jr. C. I direct that the inheritance tax on the above bequests be paid out of my residuary estate. D. I give, devise and bequeath all the rest, residue and remainder of my estate, of whatsoever nature and wheresoever the same may be situated, to my three children, to wit, Francine -1- A. Bowen, Donald g. Koser, Jr. and Stephen A. Koser, share and share alike, per stirpeso LASTLY, I nominate, constitute and appoint my husband, Donald J. Koser, Executor of this my Last Will and Testament, and in the event that my said husband should predecease me, or should he be unable or unwilling to serve in such capacity for any reason, then in such event, I nominate, constitute and appoint my daughter, Francine A. Bowen, and my son, Donald J. Koser, Jr., Co-Executors of this my Last Will and Testament in his place and stead. IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of August, A. D. 1979. Frances B. Koser ( SE AL ) Signed, sealed, published and declared by the above named Frances B. Koser, as and for her Last Will and Testament, in the presence of us who have subscribed our names hereto as witnesses, at the request of said testatrix, in her presence and in the presence of each other. -2- GEORGE M. HOUCK (1912-1991) CHARLES E. SHIELDS, A TTORNEY-A T-LA W III 6 CLOUSER ROAD Corner of Trindle and Clouser Roads MECHANICSBURG, PA 17055 TELEPHONE (717) 766-0209 FAX (717) 795-7473 December 13, 2002 Attn: Cheryl Register of Wills Cumberland County Court House 1 Court Square Carlisle, Pennsylvania 17013 Estate of Frances B. Koser 21-02-268 Dear Cheryl: Enclosed are the Inheritance Tax Returns (REV -1500) and the following checks drawn on the account of the Estate of Frances B. Koser: Check # 1032 - $15 - Filing Fee Check # 1033 - $~- Additional Probate Fee Check # 1034 - $901.64 - Inheritance Tax Thank you for your kind attention to this matter. Very truly yours, Charles E. Shields, III CES:dab Charles E. Shields. [Il 6 Clouser Road Mechanicsburg, PA 17055 A~tn: Cheryl Register of Wills Cumberland County Court House 1 Court Square Carlisle, Pennsylvania 17013 -BUREAU OF ZNDZVZDUAL TAXES TNHERZTANCE TAX DTVZSION DEPT. 180601 HARRISBURG, PA 17118-0601 CONNON#EALTH OF PENNSYLVANZA DEPARTHENT OF REVENUE NOTZCE OF ZNHERZTANCE TAX APPRAZSENENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTZONS AND ASSESSHENT OF TAX CHARLES E SHIELDS 11! 6 CLOUSER RD HECHANICSBURG PA 17055 REV-1611? EX AFP (01-n5) DATE 02-10-Z005 ESTATE OF KOSER FRANCES DATE OF DEATH 05-05-2002 FZLE NUNBER 21 02-0268 COUNTY CUHBERLAND ACN 101 Amount Ram/fred I HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGZSTER OF NZLLS CUHBERLAND CO COURT HOUSE CARLZSLE, PA 17015 CUT ALONG THZS LZNE ~ RETAZN LONER PORTZON FOR YOUR RECORDS ~ REV-1547 EX AFP [01-03) NOTZCE OF ZNHERZTANCE TAX APPRAZSENENT, ALLONANCE OR DZSALLONANCE OF DEDUCTZONS AND ASSESSHENT OF TAX ESTATE OF KOSER FRANCES ~ FZLE NO. 21 02-0268 ACN 101 DATE 02-10-2005 TAX RETURN gAS: ( ) ACCEPTED AS FZLED (X) CHANGED SEE ATTACHED NOTZCE RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORTGTNAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks end Bonds (Schedule B) 3. Closely HaZd Stock/Partnership Znterast (Schedule C) (3) ~. Hortgages/Notas Receivable (Schedule D) (~) 5. Cash/Bank Deposits/Nisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Tote! Assets APPROVED DEDUCTZONS AND EXEHPTZONS: 9. Funeral Expanses/Adm. Costs/Hisc. Expenses (Schedule H) (9) 10. Dabts/Hortgaga Liabilities/Liens (Schedule T) (10) 11. Total Deductions 12. Nat Value of Tax Return 114z900.00 .00 .0O .00 10;004.47 .00 .00 (8) 41,761.44 NOTE: To insure proper credit to your account, submit the upper portion of this for. with your tax payment. 13. lq. NOTE: 124,904.47 IF PA/D AFTER DATE ZNDZCATED, SEE REVERSE FOR CALCULATZON OF ADD/T/ONAL INTEREST. TAX CRED]:TS: PAYHI~NT DATE 12-14-2002 NUNBER CD001949 OZSCOUNT TNTEREST/PEN PATD (-) 1.32- reflect figures that include the total of ALL returns assessed to date. . O0 x O0 = . O0 19,369.01 x 045= 871.60 187.00 x 12 = 22.45 1.00 x 15 = .15 (19)= 894.20 AHOUNT PAZD 901.64 ASSESSHENT OF TAX: 15. Amount of Line 1~ et Spousal rate (15) 16. Amount of Line 1~ taxable at Lineal/Class A rate (16). 17. Amount of Line lq at Sibling rate (17) 18. Amount of Line 1~ taxable et Collateral/Class B rate (18) 19. Principal Tax Due TOTAL TAX CREDZT BALANCE OF TAX DUE ZNTEREST AND PEN. TOTAL DUE 900.32 6.12CR .00 6.1ZCR ZF TOTAL DUE TS LESS THAN $1, NO PAYHENT TS RE~UZRED. TF TOTAL DUE TS REFLECTED AS A "CREDTT' (CR), YOU NAY BE DUE REFUND. SEE REVERSE STDE OF THIS FORH FOR TNSTRUCTTONS.) Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (1:5) .00 Net Value of Estate Sub.iect to Tax (1~) 19,557.01 ~ an assess;ant ~as issuecl previously, lines 14, 15 and/or 16, 17, 18 and 19 ~ill 63,586.02 (11) (22) 19,557.01 REV-lt~0 EX (6-88)  INHERITANCE TAX COMMONWEALTH OF PENNSYLVANIA EXPLANATION DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURGI PA 17128-0601 DECEDENT'S NAME~,'f~e,,"-m ~-m ~, ~,~,,,,~., FILE NUMBER nvo~-n,r-n~l~.,,-o B 2102-0268 REVIEWED BY ACN Kath~n Harbilas 101 ITE~ SCHEDULE NO. EXPLANATION OF CHANGES The value of the estate has been adjusted as the result of the correction of an error in arithmetic. ROW Page 1 STATUS REPORT UNDER RULE 6.12 Name of Decedent: /Z~/f~//~_~5- Date of Death: ~/~-- Will No. Admin. No. ~/-~c~_ ~2~ Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yeses.__ No__ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. ! is Yes, state the following: a. Did the personal r~p~esentative file a final account with the Court? Yes__ No~ . b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes~ No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this r~p~ort. Date: ~' ~'~3 ~/~'~ ~~ ~--~ Signature ~/ Charles E. Shields, III Name (Please type or print) 6 Clouser Road, Mechanicsburg, PA 17055 Address ~717 ) 766-0209 Tel. No. Capacity: Personal Representative (MAH:rmf/AM3) __Counsel for personal representative